ABSTRACT
Introduction Iron deficiency anaemia (IDA) can be a sign of serious underlying disease but often overlooked. Recently updated guidelines of the British Society of Gastroenterology (BSG) recommend male and postmenopausal female patients with IDA should be screened for coeliac disease and undergo dual endoscopy (or CT). Aims This project looked to assess current adherence to these guidelines at the Queen Elizabeth Hospital in Birmingham. Methods A retrospective audit was performed using health informatics for patients who attended AMU/CDU from April 2018 to March 2021. The number of patients with IDA in this time frame was identified. A further analysis of this group was made to determine the proportion of patients with IDA who had IgA TTG measured as well as those who had OGD and colonoscopy/CT colonoscopy requested. Results There were 67797 patients in this study period. 32422 (47.8%) were anaemic (Hb < 120g/dl for women, <130g/dl for men as per WHO guidelines) of which 6357 (19.6%;9.38% of total) had a microcytic anaemia (MCV <83 as per University Hospitals Birmingham laboratory reference range). Ferritin was tested in 3337 (52.5%) of this group, and of those, 1041 (31.2%) were found to have overt IDA (ferritin <30 mg/mL). Rate of investigation The patient cohort with confirmed IDA comprised 334 males (32.0%), 556 post-menopausal females (53.4%, defined as age ≥45) and 151 pre-menopausal females (14.5%). A further analysis was made to explore how male and postmenopausal female cases were investigated, and if the rate of investigation was affected by the COVID-19 pandemic from 1st March 2020 onwards in this subgroup. Results are shown in the table below. In general, only a minority of patients underwent further investigation with males more likely to undergo OGD than females. Surprisingly, apart from increased TTG check latterly, little difference was seen after onset of the COVID-19 pandemic. Conclusions This large-scale study found that only a small minority of patients with IDA underwent further investigation. Whilst the study period includes the pandemic era, our results don't suggest this made a significant impact on practice. Nevertheless, these findings indicate a strong need for increased awareness and quality improvement about optimising IDA investigation according to BSG guidelines.
ABSTRACT
Objective: To identify common neurological complications in COVID-19 patients. Background: The novel Sars-CoV-2 virus was declared a Pandemic by WHO on March 11, 2020. Majority of the data published at this time brings into light the profound respiratory distress and cardiovascular outcomes however much is left to be discovered as far as neurological outcomes are concerned as suggested by anecdotal evidence and limited data. Design/Methods: We conducted a retrospective observational study from January 1, 2020 to April 30, 2020 on data collected from a multicenter health system based in Kansas City Metro area in United States. Composite neurological outcomes from the data included seizures (new onset), delirium (requiring medications), hemorrhagic and ischemic strokes (new onset, diagnosed > 48-72 hours after hospitalization). Results: Of the 346 people who tested positive for COVID-19, 89 (25.7%) were admitted to the hospital with 27 (30%) of the admitted patients requiring ICU level of care at some point. Delirium was seen in 19 patients (21%) of the total admitted out of which 14 patients (51%) were in the ICU. We observed a total of 2 cases of stroke, one ischemic and one hemorrhagic (2.2% of admitted patients). Seizures were not observed in this cohort of patients. Conclusions: Contrary to anecdotal data, we did not observe significant number of patients experiencing seizures or strokes in this cohort of patients. COVID-19 patients admitted to the hospital were documented to have significant levels of delirium. It is unclear as to why delirium was highly prevalent, could this be due to underlying ARDS or attributable to the critical condition or can it be a primary neurological outcome of COVID-19 is yet to be established. It would however benefit clinicians to closely monitor for worsening mentation or neurologic examination in COVID-19 patients.
ABSTRACT
SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The novel Sars-CoV-2 virus causes a viral pneumonia (COVID-19) and corticosteroids have been shown to prolong viral shedding and may increase mortality in viral pneumonias(1). Patients with asthma typically require inhaled corticosteroids. It is unknown if asthmatics will therefore have worse outcomes as a result. METHODS: This is a retrospective cohort study of asthmatics compared to the general population diagnosed with COVID-19 pneumonia from a multicenter health system in Kansas City. The primary outcome is admission to a hospital. Secondary outcomes include mechanical ventilatory support and in-hospital all-cause mortality. RESULTS: In this cohort, asthmatics had an average BMI of 32.9 +- 3.2, as compared to 31.2+-0.8 in the general population. Mean age is 49.0 +- 6.0 vs 54+-1.79. As of 5/1/2020 there have been 345 patients positive for COVID 19. 24 have asthma. 7/24 with asthma (29.2%) vs 79/321 non-asthmatics (24.6%, OR 1.26, p=0.6) have required admission to a hospital. 2/24 (8.3%) asthmatics have required mechanical ventilation vs 17/321 (5.2%, OR 1.49, p=0.6) non-asthmatics. 0 asthmatics have died and 7/321 (2.8%, OR 0.8, p=0.9) non-asthmatics have died. CONCLUSIONS: In conclusion, based on this limited retrospective data, asthma does not appear to be a significant risk factor for hospital admission, mechanical ventilation, or death. CLINICAL IMPLICATIONS: Larger, prospective studies are needed to ensure asthmatics are not at increased risk of worse outcomes due to COVID-19. DISCLOSURES: No relevant relationships by Ibrahim Alakhras, source=Web Response No relevant relationships by Hashaam Arshad, source=Web Response No relevant relationships by Taylor Brinton, source=Web Response No relevant relationships by Ain Ejaz, source=Web Response no disclosure on file for Gregory Howell