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Background and Aim: The COVID-19 pandemic has modified liver disease-related care delivery with implementation of telemedicine, previously unavailable in safety net settings. We aimed to assess patient satisfaction with telemedicine for hepatology care (telehepatology) in vulnerable populations with fatty liver disease (FLD). Methods: From 06/01/2020-11/ 30/2021, 218 consecutive participants with non-alcoholic or alcohol-related FLD with or without advanced fibrosis/cirrhosis receiving care in hepatology clinics within the San Francisco safety net health care system were surveyed by phone or in person. Sociodemographic and clinical parameters were captured by self-report and through the electronic medical record. Satisfaction with telehepatology was measured using a Likert scale from 1-5 with 1 representing “very dissatisfied” and 5 representing “very satisfied”. Median time of survey assessment since onset of the pandemic (03/01/2020) was 60.3 (range 8.7-90.3) weeks. Alcohol use in the prior 12 months was categorized as none, moderate (#1 drink/day for women and #2 drinks/day for men), and heavy (>moderate). Severity of liver disease was assessed by liver biopsy (n=97), MR elastography (n=88), or presence of liver nodularity on abdominal imaging (n=33). Descriptive analyses were performed and multivariable models were used to assess factors associated with satisfaction with telehepatology, adjusting for age, sex, and time since pandemic onset. Results: Median participant age was 52 years, 62% were female;60% Hispanic, 20% Asian, 11% White, 3% Black, 6% other race/ethnicity;and 75% were non-English speakers. 37% used alcohol (23% had heavy alcohol use), 40% had diabetes, and 35% had advanced (stage 3-4) fibrosis/cirrhosis. 166 participants (76%) had received telemedicine care and 126 (58%) had telehepatology. Overall, 72% reported satisfaction (55% very satisfied) with telehepatology. A similar proportion of those with and without advanced fibrosis/cirrhosis were satisfied with telehepatology (70% vs 71%, p=1.0). Alcohol consumption (vs none) especially moderate use appeared to be associated with less satisfaction (Coef -1.1, p=0.004 for moderate use and Coef -0.5, p=0.2 for heavy use) but no other sociodemographic or clinical factors were associated with telehepatology satisfaction on multivariable analysis. Conclusions: In this diverse and vulnerable population, in which a significant proportion had advanced fibrosis/cirrhosis FLD, over 70% were satisfied with telehepatology. Importantly, alcohol use negatively impacted perceived satisfaction with telehepatology, suggesting that patients who use alcohol may benefit from adaptations to telemedicine care delivery. As vulnerable populations have known barriers to healthcare access, telehepatology represents an important modality for liver care, and has the potential for reducing health disparities.
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Introduction: Coronavirus disease 2019 (COVID-19) is known as the most recent pandemic condition declared by the World Health Organization (WHO). It is widely believed that this infection is less frequent and severe in children, but few mortality reports are available in this age group population. Case Presentation: We described nine pediatric patients with probable or confirmed COVID-19 who died due to disease complications. Their age ranged between seven months and 14 years. All had underlying diseases, and three of them had been hospitalized before the COVID-19 diagnosis due to their previous medical conditions. Cough and respiratory symptoms were the most common symptoms observed in these patients. Bilateral ground-glass opacities were common radiologic findings. Conclusions: Although COVID-19 is less common in the pediatric group, all ages are vulnerable to this infection, and mortality may occur, especially in patients with underlying diseases. We emphasize that children with underlying diseases and COVID-19 should be hospitalized and monitored tightly during treatment. © 2021, Author(s).
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Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively;p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions. © 2021 Tehran University of Medical Sciences.
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Background and objectives: COVID-19 outbreak is characterized as a pandemic. Owing to the effect of this disease on people's lives, news about the methods of preventing and treating this disease is released every day. There have been some clinical data suggesting that vitamins C and D can be useful in treating patients with COVID-19 disease. In this study, we aimed to examine vitamin C and D searching trends in 10 countries and worldwide about the COVID-19 news based on the data on Google Trends.
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Background: Stigma and poor linkage to care, amplified in the setting of the COVID-19 pandemic, are significant barriers for treating hepatitis C (HCV) in vulnerable patients, reducing our ability to implement a rapid test and treat (TnT) strategy with minimal monitoring within a simple patient cascade, as currently available HCV therapies would allow us to do This real-world analysis evaluates our ability to implement this approach in both general (GP) and vulnerable (VP) populations Methods: HCV-infected patients from 32 clinical cohorts in 8 countries treated with sofosbuvir/ velpatasvir without a history of decompensation or prior NS5A-inhibitor exposure were included in this analysis The VP included prisoners, homeless patients and patients with mental disorders Time to treatment (TT) between the most recent HCV RNA measurement and treatment initiation was estimated based on available data Results: A total of 2449 patients were included, 937 in GP (58% males), 1512 (72% males) in VP (59% with mental disorders, 31% homeless, 10% imprisoned) Mean age [standard deviation] was 55 [14] and 50 [14] years in GP and VP respectively Genotype 3 was observed in 35% and 33% respectively, compensated cirrhosis confirmed in 20% and 18% of GP versus VP. The median TT [MTT, interquartile range] was 55 days [23- 107] in GP and 60 days [27-132] in VP The longest MTT of 66 days [32-134] was observed in patients with mental disorders MTT was 63 days [29-149] in prisoners and 27 days [13-71] among the homeless Only 13% of GP and 8% of VP were treated the same day of diagnosis, and 70% of GP and 63% of VP were treated within 3 months In patients with mental disorders only 4% were treated the same day of diagnosis Cure rates were high and consistent with previously reported cure rates Conclusion: MTT varies across HCV patient groups, from over 6 months to 1 day This analysis shows that a quick treatment start is possible, both in general population and in vulnerable populations, supporting the feasibility of a TnT approach in all populations New strategies should be considered to engage patients with mental disorders in this model of care more effectively.
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Introduction: Since the end of December 2019, most countries have been affected by the coronavirus disease 2019 (COVID-19) epidemic. The prevalence of COVID-19 in children has been reported much lower than adults. Most patients have mild symptoms, whereas some cases are asymptomatic. Information on the pediatric clinical manifestations is limited;therefore, reporting specific cases can improve the diagnosis process. Case Presentation: In this article, we reported a 12-year-old boy with chickenpox and COVID-19 at the same time. The patient initially had symptoms of chickenpox and then developed pneumonia. The PCR-test for COVID-19 was positive. The IgM test was positive, and IgG was negative. Chickenpox infection was confirmed by the serological test (positive IgM). The radiographic results showed reverse halo sign and vascular enlargement. Conclusion(s): These imaging findings are uncommon signs of COVID-19 in pediatrics. The patient was treated with hydroxychloro-quine and azithromycin and discharged a few days later with good condition. Copyright © 2020, Author(s).
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After the outbreak of 2019 novel corona virus infection in China, we have the outbreak of disease in Iran and until March 05, 2020 have been reported a total number of confirmed cases more than 3500 and approximately 3.3% deaths. The corona virus disease 2019 (COVID-19) infection as a newly emerging disease in East Asia has caused a great challenge in managing the patients and controlling the disease especially in children. This algorithm is based on the standard diagnosis and treatment strategies for pediatric viral infections and available strategies to prevention of COVID-19 infection. It is hoped that with international co-operation, this global dilemma will end with the least burden of disease. Due to the lack of scientific evidences in children, this algorithm is essential for decision making.