ABSTRACT
Objectives:Trends in the extent of cannabis use in the total population and increased cannabis use and number of days of cannabis use among those who used cannabis were characterized over an 11-month period during the novel coronavirus disease pandemic in Canada.Methods:Data were obtained from a national web-based, cross-sectional survey of adults who spoke English and resided in Canada, which was repeated at seven time points between May 8, 2020 and March 23, 2021 (n = 7021). Participants provided self reports of cannabis use, increased cannabis use, and number of days of cannabis use. For outcomes where a significant trend was observed, changes within demographic subgroups were further explored to identify differential patterns of change. Trends were assessed using Cochrane Armitage Test and Kruskal-Wallis Test.Results:Cannabis use rose from 11.5% at Wave 1 to 14.1% at Wave 7 (P = 0.017). A similar trend within demographic subgroups was not observed, suggesting an absence of differential patterns of change. No changes were found among those who used cannabis in regards to increased cannabis use since before the pandemic (55.7% at Wave 1 to 49.7% at Wave 7;P = 0.614) and the number of days of cannabis use (4.0 days at Wave 1 to 4.0 days at Wave 7;P = 0.878).Conclusions:Given that more people reported cannabis use, and about half of those who used cannabis increased cannabis use, evidence-based policies and interventions are needed to ensure minimal transition to near daily or daily cannabis use.
ABSTRACT
Introduction: COVID-19 disease progression can be accompanied by a 'cytokine storm' that leads to secondary sequelae such as thrombosis and acute respiratory distress syndrome. Several inflammatory cytokines have been associated with COVID-19 disease progression, but have far too much daily intra-individual variability to be useful in tracking the course of the disease. In contrast, we have shown that the inflammatory biomarker γ' fibrinogen (γ' Fbg) has a 6-fold lower coefficient of variability compared to other inflammatory markers such as hs-CRP. The aims of the study were to measure γ' Fbg in serial blood samples from COVID-19 patients at a tertiary care medical center in order to investigate its association with clinical measures of disease progression. Hypothesis: Our hypothesis was that γ' Fbg levels would be elevated in COVID-19 patients compared to historical controls, and that the degree of elevation would be associated with disease severity. Methods: COVID-19 patients at a tertiary care medical center were retrospectively enrolled between 3/16/2020 and 8/1/2020. γ' Fbg was measured using the GammaCoeur ELISA (Gamma Diagnostics, Patent Pending). Results: Our results showed that ten out of the eighteen patients with COVID-19 had the highest levels of γ' Fbg ever recorded. The previous highest γ' Fbg level of 80.3 mg/dL was found in a study of 10,601 participants in the ARIC study. γ' Fbg levels were significantly associated with the need for ECMO and mortality. Conclusions: We found that COVID-19 patients can develop extraordinarily high levels of γ' Fbg. This has several important clinical implications. γ' Fbg contains a high affinity binding site for thrombin that binds to anion-binding exosite II on thrombin and protects it from inactivation by heparin. High levels of γ' Fbg therefore provide a reservoir of heparin-resistant clot-bound thrombin when the γ' Fbg is clotted. These findings have potential clinical implications regarding prophylactic anticoagulation of COVID-19 patients and suggest that heparin prophylaxis may be less effective than using other anticoagulants, particularly direct thrombin inhibitors.
ABSTRACT
Objectives: (1) To quantitatively review attendance at virtual epilepsy clinics during covid-19 in comparison with face-to-face clinics in the same period last year. (2) To qualitatively evaluate parent/carer opinion regarding the service delivery change. Method: Retrospective study of virtual epilepsy clinic attendances were compared with face-to-face appointments. Electronic/paper records on attendance were reviewed for clinics completed March -August 2019 and 2020. A qualitative feedback survey with parent/carers was carried out by telephone in September 2020. Results: Telephone virtual clinics improved the DNA rate by 37%. In 2019, 51 of 70 scheduled face-to-face reviews attended. 15 did not attend, and there were 4 cancellations, giving a DNA rate of 27%. During 2020 lockdown, 53 of 64 scheduled telephone reviews were completed. Eleven patients were uncontactable giving a non-attendance rate of 17%. Telephone clinics proved popular with patients due to less disruption to work and schoolwork, and a less stressful experience. 100% of parents felt that telephone review clinics were a good alternative to attending face-to-face clinic and their needs were sufficiently met via telephone. 40% of patients had reservations about a telephone-based service, as they found a face-to-face review more reassuring, had variable audio signal quality and the distraction of other children at home. Conclusions: The classic model of consultant review at epilepsy clinic every 6-12 months is outdated in a modern society. Reforms to the review service of this relatively stable patient population are inevitable. Telephone clinics both improved attendance and had good feedback from the families. A blend of face-to-face and telephone reviews was the preferred option for families and would help provide an effective service, particularly in light of covid-19.