ABSTRACT
Vaccine hesitancy is one of the major global health impedances. Due to the unprecedented developing rate, the COVID-19 vaccine engendered a high level of hesitancy worldwide. The aim of this study is to assess hesitancy of COVID-19 vaccine among healthcare workers in Sudan. An online-based cross-sectional survey was conducted in Sudan between May and June 2021 using conventional sampling. An anonymous online questionnaire was distributed to healthcare workers (HCW) through different social media platforms and 930 healthcare workers agreed to participate. Data were cleaned in excel sheet and then statistically analyzed using R software version 4.0.2. Of total participants, 67.3% of them were females. Over three-fifths of the study participants agreed that COVID-19 vaccine is important and should be mandatory. A total of 570 (61.3%) agreed that COVID-19 vaccines are safe, whilst 584 (62.8%) had concerns regarding side effects of the vaccine and 533 (57.3%) believe insufficient trials were conducted. A total of 375 (40.3%) accept vaccination absolutely, while 292 (31.4%) accept with some hesitation and only 48 (5.2%) refuse absolutely. Insufficient information about side effects (42.6%) and the vaccine (39.9%) were the most common concerns regarding COVID-19 vaccination. Majority of Sudanese healthcare workers believed that COVID-19 vaccination should be mandatory. A high reliance on social media was observed among healthcare workers in Sudan for information on the COVID-19 pandemic.
ABSTRACT
Background: The CMS Hospital at Home (H@H) program during the COVID 19 pandemic was successfully applied as a suitable alternative to unnecessary admissions in lower risk patient populations. As the top 5% pts ($50,000/Year) account for 50% of the US healthcare expenditure over 15 years (5:50 Rule), we sought to investigate the long-term clinical and financial effectiveness and sustainability of new model of home hospital and critical care (H2C2) on the top 5% patients. Methods: 68 consecutive pts with top 5% annual cost profile (~4 admissions/pt with severe chronic dx [CHF, CAD, CODP, sepsis] +/-ventilator, PEG, dialysis, LifeVest) were enrolled in a multiple MSO program. On-site & On-line care started 3/2019 via patented processes and individualized protocols/devices (24/7 monitoring + ICU level Telemetry, 12-lead ECG). All Medicare Part A, B & D costs, admissions and LOS for pts were computed and normalized per phase (PRIOR, DURING, POST H2C2) to determine effectiveness and sustainability. Results: Of the 68 patients, 90% discharged to PCP, 6% admitted to hospice and 4% remained on the program for continuous care. There were no deaths at home. Compared to baseline, H2C2 had an over 70% sustained total cost reduction. Conclusion: This is 1st study to assess long-term clinical & financial impacts of H2C2 in top 5% of high-risk/cost pts. H2C2 was safe with a significantly sustained reduction of admissions and costs both during and 1.5 years post H2C2. Further studies are warranted for scalability. [Formula presented]
ABSTRACT
This is a case of an 81-year- old man who underwent a transanal minimally invasive surgery (TAMIS) to excise a large rectal polyp. He had a background of prostate cancer, insulin dependent type 2 diabetes, epilepsy and hypertension. He was COVID negative throughout. Initial diagnosis was made by colonoscopy which demonstrated a large polypoid lesion in the mid/upper rectum 7 cm from the anal verge. Biopsies confirmed this to be a tubulovillous adenoma displaying high and low grade dysplasia. MRI showed a 6 cm lesion at the 9 o'clock position staging T2 or less, N0, CRM clear. No distant metastasis was noted on completion CT. Due to the COVID-19 pandemic and concurrent treatment of his prostate cancer, the procedure took place 10 months after diagnosis. He underwent transanal minimally invasive surgery (TAMIS) for removal of the polyp without complication. Intraoperatively the polyp was found to be 10x8 cm, with the resected specimen size of 12x11 cm. Histology demonstrated a tubulovillous adenoma with areas of high grade displasia. No invasive neoplasm was evident and excision was complete with a minimum clearance of 1mm at 11 o'clock. The patient recovered well and went home day one post procedure with 28 days of VTE prophylaxis and five days of oral antibiotics. He was seen in clinic three weekslater with slight anal pain, which improved with the use of Anusol. He will under go a flexible sigmoidoscopy in 3 months time followed by another in 3 years time.
ABSTRACT
Background: Coronavirus 2019 (COVID-19), also known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), infection is a pandemic that causes acute respiratory injury, hospital admission and death. Older adults are at a higher risk of serious illness and death from this pandemic. Many COVID-19 patients have a pre-existing cardiovascular disease (CVD). We aim to develop a risk factor stratification tool, using Artificial Intelligence (AI) method, to predict mortality, ICU admission, and length of hospital stay, in patients with CVD during this pandemic. Methods: This is a retrospective cohort study. An IRB approval was obtained. Patients with confirmed (SARS-Cov-2) test, age more than 60 and older, who were admitted to the Sparrow hospital between March 2020 and October 2020 were included. CV risk factors including Hypertension (HTN), Chronic Ischemic Heart Disease (CHD), Heart Failure (HF), and Cardiac Arrhythmia (CA) were used. Results: Of the 426 patients with COVID-19(mean age:74.5 years), at least 1 CVD was identified in most patients. HTN being the most common (55%), followed by CHD (22%), HF (20%) and CA (3%). Multivariable logistic regression has been conducted to identify risk factors for adverse outcomes and competing risk survival analysis for mortality. Outcomes measures included hospital stay > 7 days, ICU admission, and death. Discussion: Our data suggests patients with HTN required longer hospital stay, had higher ICU admissions and death rate. Conclusion: CV risk factors are common in older adults. HTN is the commonest CVD in this population. Several CV risk factors may contribute to the severity of COVID19 and its impact on older adults. Our study suggests that CV risk factors including HTN, HF, CHD, and CA have major impact on COVID-19 infection in hospitalized geriatric populations - see graph 1. Patients with HTN, had longer hospital stay, ICU admission, and mortality. Based on this work, we suggest that a large data sample might be required to develop an AI software that can help predict outcomes and the need for certain resources for older patients.
ABSTRACT
INTRODUCTION: The acute respiratory distress syndrome (ARDS) resulting from coronavirus disease 2019 (COVID-19) is associated with a massive release of inflammatory cytokines and high mortality. Preliminary mortality rates of those who require mechanical ventilation ranges from 31-66%. Mesenchymal stromal cells (MSCs) have anti-inflammatory properties and are being studied as a potential treatment for steroid-resistant graft-vs-host disease, which is characterized by excessive immune activation and tissue damage. Furthermore, MSCs have shown activity in pre-clinical studies in treating acute lung injury. We aimed to determine the safety and feasibility of MSC in mechanically ventilated patients with COVID-19 moderate to severe ARDS. METHODS: Eleven patients were treated with remestemcel-L, an allogeneic cryopreserved MSC product, under individual patient emergency investigational new drug (eIND) applications. Patients were eligible if they had COVID-19 disease with moderate to severe ARDS and had been receiving mechanical ventilation for less than 72 hours prior to the first infusion. Patients with pre-existing lung disease requiring supplemental oxygen or severe liver or kidney injury were excluded. Each patient received two infusions of remestemcel-L at a dose of 2 million cells/kg/ infusion, 48-120 hours apart. RESULTS: Remestemcel-L infusions were well-tolerated in all eleven patients. After 28 days of follow-up, ten patients (91%) were extubated, nine (82%) remained liberated from mechanical ventilation and were discharged from the ICU and two (18%) died. The median time to extubation was ten days. Eight patients (73%) were discharged from the hospital. C reactive protein levels significantly declined within five days of MSC infusion. Five patients developed secondary infections and one patient experienced pulmonary embolism, which were thought to be attributable to their underlying disease. CONCLUSIONS: Remestemcel-L infusions to treat COVID-19 associated moderate to severe ARDS were safe and associated with substantial clinical and laboratory improvement. A randomized controlled trial based on these results is underway.