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Background: The COVID-19 pandemic has accelerated the adoption of telemedicine in post-surgical follow-up visits. Studies suggest that this practice is appropriate for bariatric surgery patients. One of its limitations, however, is providers' reduced ability to monitor post-op weight loss. This study aims to determine whether bariatric surgery patients' weight loss is accurately reported during virtual follow-up visits, relative to traditional office visits. Methods: We examined the medical records of 227 patients who underwent bariatric surgery in 2019 and 2020. The weights of these patients at their 6-month post-op visits were collected, and it was noted whether the weight was measured in the office or self-reported. The results were stored in a REDCap database. Analysis was performed with R using a Wilcoxon test. Results: Of a potential 227 patients, six-month weights were obtained for 146 patients (94 in-person and 52 self-reported). The in-person group averaged 10.28 (+/-3.59) BMI weight loss while the telemedicine group averaged 12.71 (+/-4.23) BMI weight loss (p < 0.01). The average weight loss at 6 months were 27.8 (+/-13.0) kg and 37.8 (+/-12.8) kg for in-person and telemedicine patients respectively (p < 0.01). Conclusions: We found a significant difference in weight loss between the in-person and telemedicine groups, suggesting that weight changes among the latter group may not be accurately reported. This calls into question the utility of weight loss data obtained from bariatric surgery patients during the pandemic, as the vast majority is self-reported. Limitations of this study include a small sample size, fluctuations in patient weight loss patterns due to the pandemic, and our inability to obtain confirmatory in-office weights from the telemedicine group. However, the significant deviation from the in-person group suggests inaccurate reporting, whether intentional or unintentional. Further studies are needed to establish the accuracy of self-reported weight changes in bariatric surgery patients.
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Background: Early in the pandemic, obesity was identified as a risk factor for severe manifestation of COVID-19 disease, with reports of increased risk for mechanical ventilation, intensive care unit (ICU) admission, and mortality. As COVID-19 care has evolved, we aim to evaluate outcomes in patients with obesity in subsequent waves. Methods: A total of 1615 patients admitted to an urban hospital system with confirmed Sars-CoV- 2 were included in the study -600 patients presented during the initial wave of COVID-19 from Mar. 15, 2020-May 5, 2020 and 1015 patients presented during the second wave from Nov. 1, 2020-Jan. 31, 2021. The primary outcome of mortality and secondary outcomes of ICU admission, need for mechanical ventilation, need for advanced respiratory support (high flow nasal therapy, BiPAP, or mechanical ventilation), ICU length of stay, and hospital length of stay were investigated. Multivariate logistic and linear regression was performed with adjustments for age, race, gender, wave, and obesity status. Results: Between wave 1 and 2, the racial composition of patients varied (p < .001), with a decrease in those identifying as Black (56.83% vs 46.31%) and increase in those identifying as White (8.17% vs 11.23%), Asian (1.33% vs 3.05%), and Other/Not Reported (3.00% vs 8.47%). However, age, gender, BMI composition and percentage of patients with obesity (49.83% vs 52.12%, p = 0.37) were similar between waves. Compared to wave 1, wave 2 patients, regardless of obesity status, had decreased odds of ICU admission (OR: 0.593, 95%CI [0.462, 0.760]), use of advanced respiratory support (OR: 0.694, 95%CI [0.550, 0.874]), and in-hospital length of stay in days (β = -1.515, 95% CI [-2.40, -0.63]). Conclusions: Compared to wave 1 of the COVID-19 pandemic, patients in wave 2 with and without obesity had decreased odds of ICU admission, need for advanced respiratory support, and hospital length of stay. As the COVID-19 pandemic has progressed, modest improvements have benefited patients, regardless of obesity status.
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Background: COVID-19 has been identified as a risk factor for coagulopathy leading to increased risk of venous thromboembolic events (VTE). However, the risk profile of VTE in patients with obesity -a patient population with higher risk for VTE at baseline -is poorly described. The aim of this study is to determine if obesity and BMI is associated with increased rates of VTE in patients hospitalized with COVID-19. Methods: Patients admitted with confirmed Sars-CoV- 2 infections from November 2020-January 2021 were examined. Patients were excluded if they were minors, currently pregnant, or if their COVID-diagnosis was an incidental finding in the setting of an unrelated admission -i. e. penetrating trauma. Imaging results were used to verify VTE related patient outcomes, pulmonary embolisms (PE) and deep vein thrombosis (DVT). COVID-19 specific anticoagulation regimes looking at standard, intensive, and therapeutic anticoagulation were examined. Results: Of 1505 patients included in the study, 754 (50%) had BMI < 30kg/m2 and 751 (50%) had BMI >30kg/m2. DVTs occurred in 40 (2.66%) patients, with no differences in incidence between those with and without obesity (2.40% vs 2.92%;p = 0.53). PEs occurred in 35 (2.33%) of patients, with no differences in incidence between those with and without obesity (2.40% vs. 2.25%;p = 0.85). No significant differences existed in the initial intensity (p = 0.50) of anticoagulation regimen or maximum intensity (p = 0.27) between those with and without obesity. In multivariate logistic regression adjusting for age, sex, race, prior history of venous thromboembolic events, use of antiplatelet medications, and intensive care unit admission, BMI was not associated with increased odds of experiencing a DVT (OR = 0.978;95% CI 0.934, 1.024;p = 0.348) or PE (OR = 1.005;95% CI 0.959, 1.052;p = 0.849). Conclusions: Patients with obesity hospitalized for COVID-19 were not at higher risk for thromboembolic events, such as DVTs and PEs, compared to patients without obesity.
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BACKGROUND AND OBJECTIVES: The role of schools in the spread of SARS-CoV-2 infections in the community is still controversial. The objective of our study was to describe the epidemiology of SARS-CoV-2 infections in different pediatric age groups during the first 2 months of the fall back-to-school period, in the context of increasing viral transmission in France. METHODS: Weekly epidemiological data provided by Santé Publique France and the Ministry of National Education were analyzed according to the age groups defined by the different school levels. Weeks (W) 34-42 were considered for analysis. RESULTS: The PCR positivity rate and incidence rate increased in all age groups during the study period, in an age-dependent manner. At W42, with adults being considered as reference, the risk ratio for a positive PCR test was 0.46 [95% CI: 0.44-0.49] and 0.69 [0.68-0.70] for children aged 0-5 years and 6-17 years, respectively. Similarly, the incidence rate ratio was 0.09 [0.08-0.09], 0.31 [0.30-0.32], 0.64 [0.63-0.66], and 1.07 [1.05-1.10] for children aged 0-5 years, 6-10 years, 11-14 years, and 15-17 years, respectively. Children and adolescents accounted for 1.9% of the newly hospitalized patients between W34 and W42, and for 1.3% of new intensive care admissions. No death was observed. Among infected children and adolescents, the percentage of asymptomatic individuals was 57% at W34 and 48% at W42. The number of schools closed remained low, less than 1% throughout the study period. The number of confirmed cases among school staff was consistent with the data measured in the general population. CONCLUSION: In the context of increasing viral transmission in the population, the spread among children and adolescents remained lower than that observed among adults, despite keeping schools open. However, the impact was age-dependent, with data in high schools close to those observed in adults.
Subject(s)
COVID-19/epidemiology , COVID-19/transmission , Health Policy , Schools/organization & administration , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Asymptomatic Infections/epidemiology , COVID-19/prevention & control , Child , Child, Preschool , Female , France/epidemiology , Hospitalization/trends , Humans , Incidence , Infant , Infant, Newborn , Male , Middle Aged , Young AdultABSTRACT
The educational and social benefits provided by school far outweigh the risks of a possible COVID-19 contamination of children in school environments or in daycare centers. Following summer break, the back-to-school period in France is taking place in the context of an increasing viral spread and requires strict adherence to health measures to limit the risk of outbreaks in communities. Based on a critical update of the role of children in the transmission of the infection, and of children's susceptibility to infection, the French Pediatric Society published practical guidelines for school re-entry and the management of COVID-19 infections in schools.