ABSTRACT
Introduction: Breast Incidentalomas occur as an unexpected abnormality demonstrated on imaging performed for unrelated symptoms. Pre-COVID19 pandemic management involved urgent referrals for initial breast team evaluation. Clinical encounters occurred prior to the Multi-Disciplinary Team meeting (MDT). COVID-19 restrictions necessitated streamlining and optimising service provision with clinically appropriate encounters. Our aim was to re-audit (SU-CA-21-22-068) findings and management of breast incidentalomas during the pandemic. Methods: Pre-pandemic analysis of practice (November 2019 - January 2020) led us to the intervention of all referrals straight to MDT without an unnecessary prior clinical encounter, with secondary planned investigations and clinical assessment thereafter. Completion of audit loop and analysis included referral information, MDT outcome, imaging, and clinical correspondence with descriptive analysis. Results: Post-intervention 61 patients were referred to the MDT over an 18-month period (February 2020 - October 2021). 90% of patients were referred following CT scans. Median age 71 (range 32-93), 38% of patients had no additional breast imaging and 74% of patients did not require a tissue biopsy. 15% (n=9) were diagnosed with new breast cancer, 36% were new benign, with 34% already known lesions. 16% of patients required no further intervention. Conclusion: 15% of incidentalomas were diagnosed as malignancies, compared to local 3-4% from one stop clinics. Prompt referral to MDT accelerates triple assessment and tissue diagnosis. Streamlining of patient care optimised appropriate clinical encounters for vulnerable patients. Early senior radiological assessment at the MDT of incidentalomas during COVID-19 provided confirmation of benign features and therefore no further intervention and reassurance for 16% of patients.
ABSTRACT
INTRODUCTION: Immunomodulation has been suggested as a treatment for COVID-19 to manage the hyperinflammatory state caused by cytokine release. Tocilizumab (TCZ) is an interleukin-6 (IL-6) monoclonal antibody approved for T-cell therapy induced cytokine release syndrome (CRS) and may provide benefit in COVID-19 patients with CRS. This study was conducted to assess clinical outcomes in patients with severe COVID-19 treated with TCZ. METHODS: Retrospective, single center, cohort study of adults with severe COVID-19 admitted to the intensive care unit who received TCZ between March 2020 to April 2020. All doses of TCZ were 400 mg given intravenously. A control group of severe COVID-19 patients who did not receive TCZ was randomly selected for comparison based upon similar baseline demographics (APACHE IV, SOFA score, age, gender, mechanical ventilation, multi-system organ failure (MSOF), and prone therapy). COVID-19 treatments received, temperature, inflammatory markers, mortality, diagnosis of superimposed infection and length of stay (LOS) was also collected. RESULTS: 25 patients who received TCZ and 17 patients who did not receive TCZ were included in the study. Baseline demographics were not significantly different between the TCZ vs. control group (APACHE IV = 53 vs. 55;SOFA score = 6.7 vs. 7.2). All patients were mechanically ventilated and 88% of patients in each group were diagnosed with MSOF. Maximum temperature and inflammatory markers were not significantly different (median IL-6 = 157.8 pg/mL vs. 131.5 pg/mL). There was no significant difference between the number of patients who received hydroxychloroquine, azithromycin, steroids, remdesivir, or convalescent plasma. 16 patients (64%) in the TCZ group received one dose and 9 (36%) received two doses. The mortality rate was not significantly different (8/25, 32% vs. 5/17, 29%;p = 0.86). The incidence of superimposed infection following TCZ administration was significantly higher compared to the incidence of superimposed infection at any time during admission for the control group (18/25, 72% vs. 7/17, 41%;p = 0.045). Mean LOS was 27 days vs. 19 days. CONCLUSIONS: There was no significant difference in mortality in COVID-19 patients who received TCZ. Our study suggests that patients who receive TCZ are at a significantly higher risk of infection.
ABSTRACT
The 2019 coronavirus (SARS-CoV-2) has been declared a public health emergency of international concern by the World Health Organization. Due to the sudden appearance of this pandemic process associated with increasing morbidity and mortality worldwide, various treatments have been implemented. In this framework, high doses of vitamin C began to be used in critically ill patients. We analyze the clinical trials and/or research papers available in the literature. Although more evidence on its effectiveness is needed is important for the specialist to understand the clinical logic of this use to determine if it is correct as a concomitant treatment. Conclusions: It seems that using high doses of vitamin C parenterally is a safe, available and economical alternative especially for critically ill patients.