ABSTRACT
Background/Aims During 2020-2021 many usual hospital services were affected as focus turned towards managing COVID-19. Elective outpatient surgery ceased and rheumatology staff were redeployed to covid wards. This reduced the availability of temporal artery biopsy (TAB) and temporal artery ultrasound (TAUS) to aid in diagnosing giant cell arteritis (GCA). The rheumatology team making diagnoses of GCA or not-GCA were doing so often based entirely on clinical and laboratory findings. We aimed to determine referral patterns and investigations for suspected GCA during the covid pandemic, compare diagnoses at 6 months after initial assessment and retrospectively apply the Southend Pretest Probability Score (PTPS) and correlate with the diagnosis of GCA or not-GCA. Methods We reviewed all electronic referrals for suspected GCA from July 2020 - June 2021. Clinical details and investigations reviewed. PTPS applied giving a result of low, intermediate or high probability of GCA. Results 84 referrals for suspected GCA over 12 months. 20 diagnosed GCA/ large vessel vasculitis (LVV), 64 not-GCA. Peak referral months Nov 2020 and April 2021 with 13 and 16 referrals. Lowest in October 2020 with 1 referral. 57 female, 27 male. Mean age 70.1 years. 19% male referrals diagnosed GCA, 26% female diagnosed GCA. All LVV and PMR diagnoses were female. 27 TAUS, 6 TAB, 7 PET, 13 CT, 3 MRI performed. 30 patients had no additional investigations. Of 20 GCA;14 had supporting investigations, 6 were clinical diagnoses. All GCA diagnoses were consistent at 6 months. One not-GCA case was subsequently diagnosed with LVV on CTPET. All other not-GCA diagnoses were consistent at 6 months. The PTPS was retrospectively applied based on available clinical information in all except 2 cases, and compared to GCA/not-GCA diagnosis and investigations undertaken. Conclusion Referral numbers for suspected GCA were higher than previous years however the number of actual GCA diagnoses was similar. With limitations on diagnostic investigations due to covid, diagnoses of GCA with and without additional tests were accurate at 6 months, and correlated with a high probability score. The PTPS is a therefore valuable clinical tool in the assessment of GCA. (Table Presented).
ABSTRACT
Background. There are limited data regarding SARS-CoV-2 (SC2) environmental contamination in staff areas of healthcare settings. We performed environmental sampling of staff areas in wards where coronavirus disease 19 (COVID-19) patients received care and compared findings to surfaces within COVID-19 patient rooms. Methods. The study was conducted at the Hospital of the University of Pennsylvania (Philadelphia, PA) from 9/15/20-1/26/21. Sampling of 20cm2 surfaces in staff common areas (breakroom high-touch surfaces comprising tables and microwave/refrigerator handles;bathroom surfaces comprising toilet, sink, and doorknob;and floors), nurse workstations (computer mice and floors), and COVID-19 patient rooms (high-touch surfaces comprising bedrail, computer mice/ keyboards, and doorknobs;bathroom surfaces;and floors) was performed using flocked swabs one or more times per week. Specimens underwent RNA extraction and quantitative real-time polymerase chain reaction to detect the SC2 N1 region. Median comparisons were performed using Wilcoxon rank sum test. Trends in odds were evaluated using Score test. Results. Proportions of surface specimens with detectable SC2 RNA are summarized in Table 1. Median copy numbers were lower among staff toilets compared to COVID-19 patient toilets (135.6 vs. 503.8 copies/specimen, p=0.02), lower among staff breakroom compared to patient room high-touch surfaces (104.3 vs. 220.3 copies/ specimen, p=0.007), and similar between staff and patient room samples from sinks and floors. At nurse workstations, SC2 RNA was detected among 22/177 (12.4%) computer mouse and 147/178 (82.6%) floor samples. Odds of SC2 detection increased by study week among common area (p< 0.001) and nurse workstation samples (p< 0.001) (Figures 1 and 2). Conclusion. A low prevalence of detectable SC2 RNA was observed among staff area high-touch surfaces;however, the likelihood of detection increased over time. Environmental SC2 RNA detection may reflect primary contamination from infected healthcare workers or secondary contamination from contact with infected patients, though a direct relationship between surface SC2 RNA viral detection and transmission risk has not been established.
ABSTRACT
Rationale: Vitamin D may be protective during the Covid-19 pandemic1 but levels in the Irish population are typically low2. Daily supplementation of 20μg Vitamin D is recommended3. Our aim was to assess if vitamin D content in enteral feeding regimens of nursing home residents were adequate. Methods: Vitamin D intake were assessed by calculating the content of enteral feeding regimens and additional vitamin D supplements prescribed. It was not feasible to measure serum vitamin D levels. Results: Forty-two tube fed residents were reviewed. Average age 58 years (range 25-94 years), 52% male, average duration on enteral feeding 46 months (range 1-102 months). Less than half (43%) ate oral diet. Enteral feeding provided average 18.7μg daily (range 6.2-50μg), 3 residents received <10 μg/d and 14 receiving >20 μg/d. There was no significant difference in intakes between those on oral diet or nil per oral (18.6μg versus 18.9μg). Eleven residents (26%), were taking additional vitamin D supplements. Conclusion: The majority of nursing home residents on longterm tube feeding reviewed were receiving adequate intakes of vitamin D. Enteral feeding provides a reliable source of vitamin D in comparison to usual dietary intakes of nursing home residents. The vitamin D content of the enteral feeding regimen should be discussed with the dietitian before additional supplements are prescribed to avoid excessive intakes. Specific recommendations on vitamin D requirements for adults on tube feeding, particularly in residential settings are required. References: 1. McKenna MJ and Flynn MAT. (2020) Covid-19, Cocooning and Vitamin D Intake Requirements. Irish Medical Journal Vol 113;No. 5;P79 2. Cashman KD, Muldowney S, McNulty B et al. (2013) Vitamin D status of Irish adults: findings from the National Adult Nutrition Survey. British Journal of Nutrition 109, 1248–1256 3. Laird E and Kenny RA. (2020) Vitamin D deficiency in Ireland – implications for COVID-19. Results from the Irish Longitudinal Study on Ageing (TILDA) Disclosure of Interest: None declared