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The TG6002.03 trial is a dose-escalation phase 1 clinical trial of TG6002 infusion via the hepatic artery in patients with liver-dominant colorectal cancer metastases. TG6002 is an engineered Copenhagen strain oncolytic Vaccinia virus, deleted of thymidine kinase and ribonucleotide reductase to enhance tumor selective viral replication and expressing FCU1, an enzyme converting the non-cytotoxic prodrug 5-fluorocytosine (5-FC) into the chemotherapeutic compound 5-fluorouracil (5-FU). In this trial, patients with advanced unresectable liver-dominant metastatic colorectal cancer who had failed previous oxaliplatin and irinotecan-based chemotherapy were treated with up to 2 cycles of TG6002 infusion 6 weeks apart via the hepatic artery on day 1 combined with oral 5-FC on days 5 to 14 (where day 1 = TG6002 infusion). TG6002 infusion was performed over 30 minutes via selective catheterization of the hepatic artery proper. 5-FC oral dosing was 50mg/kg x4 daily. Blood was sampled for TG6002 pharmacokinetics and 5-FC and 5-FU measurements. Sampling of liver metastases was performed at screening and on day 4 or day 8 for virus detection and 5-FC and 5-FU quantification. In total, 15 patients (median age 61 years, range 37-78) were treated in 1 UK centre and 2 centres in France and received a dose of TG6002 of 1 x 106 (n=3), 1 x 107 (n=3), 1 x 108 (n=3), or 1 x 109 pfu (n=6). Fourteen of the 15 patients received a single cycle of treatment, including one patient who did not received 5-FC, and one patient received two cycles. TG6002 was transiently detected in plasma following administration, suggesting a strong tissue selectivity for viral replication. In the highest dose cohort, a virus rebound was observed on day 8, concordant with replication time of the virus. In serum samples, 5-FU was present on day 8 in all patients with a high variability ranging from 0.8 to 1072 ng/mL and was measurable over several days after initiation of therapy. Seven of the 9 patients evaluable showed the biodistribution of the virus in liver lesions by PCR testing on day 4 or day 8. Translational blood samples showed evidence for T-cell activation and immune checkpoint receptor-ligand expression. At 1 x 109 pfu, there was evidence for T-cell proliferation and activation against tumour-associated antigens by ELISpot and for immunogenic cell death. In terms of safety, a total of 34 TG6002-related adverse events were reported, of which 32 were grade 1-2 and 2 were grade 3. The maximum tolerated dose was not reached, and a single dose-limiting toxicity was observed consisting of a myocardial infarction in a context of recent Covid-19 infection in a 78-year-old patient. These results indicate that TG6002 infused via the hepatic artery in combination with oral 5-FC was well tolerated, effectively localized and replicated in the tumor tissues, expressed its therapeutic payload and showed anti-tumoral immunological activity.
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Background: COVID-19 made many changes in life of persons and even after post COVID era these changes are integral to our life. Some of the changes were online classes, work from home, and online gaming. Computer work leads to static position of neck, shoulders, and upper limbs for extended hours. This leads to higher risk of developing visual, musculoskeletal and psychological problems. Aims and Objectives: The present study was carried out to determine prevalence of musculoskeletal health disorders, assess work distribution, and their probable interaction with musculoskeletal health problems in computer users of Ahmedabad city. Material(s) and Method(s): A cross-sectional study was carried out over a period of 1-year time among 800 participants to study the musculoskeletal problems among computer users. Result(s): Out of 800 participants, 76.75% of participants had any computer related musculoskeletal problem. If participants work more than 4 h in a single spell prevalence of musculoskeletal problems was 82.95%. Regular exercise has significant role in preventing computer-related musculoskeletal problems. Conclusion(s): Computer-related musculoskeletal problems have relation with number of hours spent in single spell, total daily working hours, and years of computer-related work.Copyright © 2023, Mr Bhawani Singh. All rights reserved.
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Introduction: Enhanced recovery after operation and surgical site infection (SSI) bundles have been implemented in hospital systems nationwide to mitigate complications after colorectal operation. These quality improvement bundles (QIB) aim to improve patient safety and should decrease healthcare costs. This study identifies the impact of QIB on SSI rate and hospital costs. Method(s): Vizient and SSI reporting data was queried from 2016- 2021, for all colorectal resections tracked by the National Healthcare Safety Network across the enterprise. The operations were linked to a financial database. Data was analyzed quarterly to identify a relationship between SSI rate, hospital cost, and implementation of SSI mitigation elements. Result(s): 4,163 patients were identified during the study period. SSIs peaked in quarter 2 of 2018 at 5.3%, after which SSI mitigation efforts were announced. A steady decrease is seen in SSI rates, until quarter 3 of 2020, when our hospital system experienced its first COVID wave. With adjustment for procedure type, hospital costs increased by 15.8% per case from 2018-Q3 forward on average with the sharpest elevation observed in quarter 3 of 2019, due to medication startup costs for our SSI bundle. Conclusion(s): We successfully reduced colon SSIs with implementation of an ERAS bundle but incurred 16% greater costs compared with pre implementation, especially during the early implementation period.
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Introduction: The importance of psychological safety, staff morale, culture and civility (PSMCC) has been highlighted by multiple recent maternity investigations as key to the provision of safe, high quality maternity care [1]. These factors are also crucial for staff retention and recruitment. Concomitantly, the NHS Staff Survey indicates an almost universal decline in staff motivation and engagement since COVID;a trend also noted in our institution [2]. Regular, authentic, individual and group positive feedback could improve PSMCC by creating a culture of kindness and appreciation, reinforcing positive behaviour and improving teamwork. At UHP, an established 'Learning for Excellence (LfE)' positive feedback system is in place, facilitating provision of volitional, authentic feedback to individuals and enabling organisational learning about what works. The aim of this project was to assess the impact of a shift to a more positive, appreciative narrative in maternity using intensive positive feedback from patients and staff. Method(s): A literature review to derive validated questions for incorporation into a questionnaire to assess baseline levels of PSMCC and perceptions of positive feedback receipt. QI methodology and stakeholder focus groups aided the development of the interventions. Once established, the impact of these positive interventions on PSCMM will be assessed. Result(s): There were 103 responses to the baseline questionnaire. 24% staff felt their actions at work were never positively acknowledged;45% felt undervalued. 63% felt they do not receive enough positive feedback, whilst 93% believed that receiving more positive feedback would improve staff morale, wellbeing, culture and care. Discussion(s): Based on these findings, interventions to provide regular, authentic, positive feedback across our maternity unit have been created. These include: 1)motivational board sharing positive feedback stories from patients and staff obtained via LfE, showcasing the kind, compassionate and high quality care delivered;2) Weekly email shots of LfE stories focussing on specific positive behaviours such as teamwork and patient centred care;3) A white board for staff and patients to share positive messages ad hoc;4)Promotion of the LfE initiative to patients thus increasing positive feedback to staff. The impact of these interventions will be assessed shortly and presented in full.Copyright © 2023 Elsevier Ltd
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Recently, chatbots have been used in various domains including health care and entertainment. Despite the impact of using chatbots on student engagement, there is little investment in how to develop and use chatbots in education. Such use of advanced technologies supports student learning, both individually and collaboratively. The effective use of chatbots in education depends on different factors, including the learning process, teaching methods, communications, etc. In this paper, the authors focus on the systematic utilization of chatbots in education. A proof of concept has been developed and tested using two MSc module, i.e., cloud computing and software engineering. The authors have used AWS Services to build the backend of Chatbot and integrate it with Facebook Messenger to allow students to learn via an additional venue, i.e., social media. The use of EDUBOT proved that chatbot can improve student learning and engagement especially at the time of COVID-19 where higher education is moving towards online teaching. Extending EDUBOT framework will help to support students ' admin and other queries. © 2023, IGI Global. All rights reserved.
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The degree of immunity provided by standard vaccine regimens, boosted regimens, and immune responses elicited by the combination of vaccination and natural infection remain unknown for the immunocompromised population. The relative magnitude, quality, and durability of serological responses, and the likelihood of neutralizing protection against future SARS-CoV-2 variants following these modes of exposure are unknown but are critical to the future trajectory of the COVID-19 pandemic. This study aims to directly compare the humoral and cellular immune responses among heart transplant recipients (HTxRs) who received COVID-19 vaccines before or after naturally acquired SARS-CoV-2 infection. HTxRs were enrolled prospectively in the study belonging to three groups: vaccine-only (1-/2-/3-/4- doses vaccinated individuals with no history of COVID-19 or breakthrough infection), hybrid immunity (1-/2-/3-/4- doses vaccination after recovery from natural SARS-CoV-2 infection) and breakthrough infection (2-/3-/4- doses vaccinated individuals with PCR confirmed breakthrough infections). Vaccination protocol includes homologous primary/boosted BNT162b2 vaccine. Serum samples, collected longitudinally immediately before and 3 weeks after each dose or SARS-CoV-2 infection, were tested for SARS-CoV-2 anti-RBD IgG antibodies and for neutralizing antibodies (using live virus micro-neutralization assays) against wild-type sublineage B.1.1.50, the B.1.617.2 (delta) variant and four omicron variants (BA.1, BA.2, BA.4 and BA.5). SARS-CoV-2-specific-T-cell response were evaluated in a subset of patients by IFN-γ release of stimulated peripheral blood mononuclear cells. 1) Neutralizing antibody titers against wild-type virus and the variants of concern after breakthrough infection, hybrid immunity, and vaccination alone;2) T-cell response after breakthrough infection, hybrid immunity, and vaccination alone;and 3) Quality of the neutralizing antibody response [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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Heart transplant (HT) recipients are at high risk for poor immunity after COVID-19 vaccination. A multidose vaccine strategy is thus recommended, but the clinical outcomes and immune correlates of clinical protection against SARS-CoV-2 are unknown. In a case-control study of HT recipients vaccinated with the BNT162b2 vaccine between March 2020 and May 2022, patients were prospectively assessed for vaccine-induced neutralizing antibodies (nAbs) against the wild-type virus and Delta and Omicron variants (using live virus micro-neutralization assays), and for T-cell response. Clinical outcomes included COVID-19 infection and kidney function. Comparative analyses with controls were conducted to identify correlates of infection. We characterized 67 (43.8%) COVID-19 infections. Repeat vaccination decreased the risk of contracting COVID-19 (HR 0.05, p=0.02;HR 0.02, p=0.01;HR 0.01, p=0.004;for 1-2-, 3- and 4- doses, respectively) and of severe-critical disease (HR 0.003, p<0.001). Vaccine prevention of infectivity was lower for the Omicron. Vaccine-induced nAbs against the Delta and Omicron variants were associated with a reduced risk for COVID-19 (HR 0.36, p=0.01;HR 0.21, p=0.01, respectively), whereas a vaccine-induced T-cell response was not (p=0.6). The optimal nAbs titer thresholds for the prediction of COVID-19 were 48 (wild-type), 24 (Delta), and 4 (Omicron). COVID-19 was associated with an increased risk of long-term renal dysfunction (OR 17.4, p<0.001), with the extent of deterioration correlating with the severity of acute COVID-19. A repeat vaccination strategy provides protection from severe infection with SARS-CoV-2 and to a lesser extent from mild infection. BNT162b2-vaccine-induced nAbs conferred clinical immunity. Our findings could assist in rationally focusing improvements for future vaccines and immunotherapeutic for SARS-CoV-2 and population-tailored vaccination strategy. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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In 2022, omicron (BA.1) and omicron subvariants (BA.2, BA.4, and BA.5), the most antigenically divergent variants to date, outcompeted previous variants in the context of substantial preexisting population immunity from vaccination, infection, or both. Omicron variants continue to cause substantial numbers of illnesses and deaths. Booster immunization with mRNA vaccines improves neutralizing antibody responses against variants and vaccine effectiveness in heart transplant recipients (HTxRx). Nonetheless, the vaccine effectiveness against omicron is lower than that against other variants. The bivalent vaccine contains two mRNA components of SARS-CoV-2 virus, one of the original strain of SARS-CoV-2 and the other one in common between the BA.4 and BA.5 lineages of the omicron variant. This study aims to evaluate the immunogenicity, safety and reactogenicity of omicron-containing bivalent Pfizer-BioNTech COVID-19 booster in HTxRx. HTxRx who had received a homologous 2-doses primary/1-2 booster doses BNT162b2 vaccination schedule or 2-/3-/4- doses vaccinated HTxRx with breakthrough infections are prospectively enrolled to receive the bivalent Pfizer-BioNTech COVID-19 booster. Safety assessments include solicited local and systemic adverse reactions within 7 days after bivalent booster administration. Serum samples, collected longitudinally immediately before and 3 weeks after the bivalent booster dose, are tested for SARS-CoV-2 anti-RBD IgG antibodies and for neutralizing antibodies (using live virus micro-neutralization assays) against wild-type (B.1.1.50), the delta variant (B.1.617.2) and four omicron variants (BA.1, BA.2, BA.4 and BA.5). SARS-CoV-2-specific-T-cell response are evaluated in a subset of patients by IFN-γ release of stimulated peripheral blood mononuclear cells. 1) Tolerability and reactogenicity;2) bivalent booster-induced anti-RBD IgG antibodies;3) bivalent booster-induced variant-specific neutralizing antibodies;3) SARS-CoV-2-specific-T-cell response, and 4) post-bivalent booster vaccine infection and hospitalization. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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Introduction: COVID19-associated cardio complications occur through different mechanisms including the inflammatory response causing severe issues such as ARDS, sepsis, and coagulopathy. Many points remain unclear regarding the impact of coagulation disorder in patients who are admitted with COVID19 infection. We present an analysis of the cardiovascular outcomes of coagulation disorders in COVID19-related hospitalizations. Method(s): The Nationwide Inpatient Sample database from 2020 was queried to identify COVID-19 patients. Subsequently, we classified COVID hospitalization based on the presence or absence of coagulation disorder. The primary outcome measure was in-hospital mortality. Secondary outcomes were in-hospital cardiovascular outcomes, ICU admissions, bleeding, Stroke, and resource utilization. Result(s): Out of 1,060,885 patients with a diagnosis of COVID, 43905 had coagulation disorder. On adjusted analysis, patients with COVID and coagulation disorder had significantly higher odds of MACCE (aOR 1.57, 95% CI 1.47-1.67, p<0.001), in-hospital mortality (aOR 1.56, 95% CI 1.46-1.67, p<0.001), cardiac arrest (aOR 1.38, 95% CI 1.28-1.57, P<0.001), acute MI (aOR 1.32, 95% CI 1.19-1.47, P<0.001), stroke (aOR 2.11, 95% CI 1.76-2.52, P<0.001), cardiogenic shock (aOR 2.19, 95% CI 1.78-2.70, P<0.001), MCS (aOR 3.98 CI 2.31-6.85 p<0.001), and bleeding (aOR 1.64 CI1.40-1.92 p<0.001) compared to patients without coagulation disorder. The length of stay (11.43 vs 7.27) and mean in-hospital cost was increased ($150,759.70 vs $75321.1) in patients with and without coagulation disorders. Conclusion(s): COVID patients with coagulation disorder have a significantly higher risk of MACCE, in-hospital mortality, cardiac arrest, AMI, stroke, shock, MCS, and bleeding. Large prospective trials are needed to further study these findings. [Formula presented]Copyright © 2023
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As the outbreak of COVID-19 increased in various countries. India is also majorly affected with the COVID-19 by that education system is affected, and it has transferred the traditional face-to-face teaching to online education platform. Considering student's perspective on both online and offline learning mode in India, we conducted a survey to collect the data. In that survey questionnaire, focus was on the factors and situation which can affect the education system. Using that data, we used Kruskal Wallis test to collect the evidence for which learning mode is better and Naive Bayes Algorithm, we were able to conclude the results. © 2022 IEEE.
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The negative impact of COVID on the respiratory system is well characterized in a general population. The increased complexity of COVID in lung transplant recipients (LTRs) and assessment of injury severity is less defined. We compared allograft injury as measured by donor derived cell-free DNA (dd-cfDNA) in LTRs with post-transplant COVID. We hypothesized more severe COVID infection would be associated with higher lung injury, as evidenced by higher dd-cfDNA. All LTRs positive for COVID with peri-infection dd-cfDNA (%, AlloSure, CareDx) from Memorial Hermann Hospital (MHH) and University of Texas Health Science Center San Antonio (UTHSC-SA) were evaluated. LTRs were stratified on hospitalized vs not hospitalized for COVID. Time between dd-cfDNA result and COVID infection was calculated and graphed. LTRs with concurrent immune events (acute cellular rejection or antibody mediated rejection) were excluded. Twenty-eight LTRs had post-COVID dd-cfDNA results available (MHH 18, UTHSC-SA 10). Peri-COVID infection dd-cfDNA trends are shown in Figure 1. Seventeen (61%) were hospitalized and 39% (n=11) were not. Median max dd-cfDNA in hospitalized LTRs was 1.10% (IQR 0.82, 2.40) drawn at median 50 days (IQR 35, 151) post-COVID. Median max dd-cfDNA in not hospitalized LTRs was 0.94% (IQR 0.45, 1.80) drawn at median 81 days (IQR 43, 235). As dd-cfDNA levels were not drawn at the same times post-COVID between hospitalized and not hospitalized patients, differences cannot be directly compared. However, there are clear elevations in median dd-cfDNA among COVID hospitalized LTRs indicating a higher degree of allograft injury in those patients. Both the dd-cfDNA elevation preceding date of COVID positivity and the following decay between hospitalized and not hospitalized LTRs could be important prognostically. Investigation into effect of COVID treatment on dd-cfDNA, time to return to dd-cfDNA baseline levels, and resolution of pulmonary function are warranted. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Introduction: It is known that patients with COVID-19 infection have a significant incidence of arrhythmias. According to a study from Wuhan, China in 2020, approximately 17% of hospitalized COVID-19 patients suffered from arrhythmia, including Atrial Fibrillation (AF). Here we present a study of the outcomes of AF in COVID admissions at the national cohort registry. Method(s): Utilizing the NIS of the year 2020, we identified patients with diagnosis of COVID-19 and subsequently classified COVID-admission into with and without AF. Multilogistic regression analysis (OR) was done to compare in hospital outcomes. Result(s): Of 1,060,976 patients with diagnosis of COVID, 57,011 (5.37%) had AF. On adjusted analysis, COVID-AF patients had significantly higher odds of heart failure (aOR 1.25, 95% CI 1.19-1.31, P=0.001). On the contrary, there was no statistically significant difference in the odds of MACCE (aOR 0.97, 95% CI 0.91-1.01, P=0.19), in hospital mortality (aOR 0.93, 95% CI 0.88-0.09, P=0.07), AMI (aOR 1.12, 95% CI 1.03-1.22, P=0.08), MCS (aOR 0.86, 95% CI 2.08 - 2.60, P= 0.789), cardiogenic shock (aOR 1.15, 95% CI 0.90-1.45, P=0.257), major bleeding (aOR 1.12, 95% CI 0.96-1.30, P=0.136), PCA (aOR 0.30, 95% CI 0.87-1.93, P=0.205), PCI (aOR 0.10, 95% CI 0.49-2.40, P= 0.82), stroke (aOR 1.02, 95% CI 0.84-1.23, P=0.871) between the two cohorts. The presence of AF in COVID-19 hospitalizations was associated with higher length of stay (9.25 +/-9.05 vs 7.35 +/- 8) and higher adjusted total charge(97,321 155,117+/- vs 77,372+/- 149,354) compared to COVID without AF association. Conclusion(s): COVID-19 patients with AF can have higher odds of heart failure compared to COVID-19 patients without AF. The odds of in hospital mortality, MACCE, MCS, AMI, major bleeding, PCI, PCA and stroke were similar. Large prospective trials are needed to validate these findings. [Formula presented]Copyright © 2023
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Introduction: Congestive heart failure (CHF) is the most common cardiac admission diagnosis worldwide with high risk of morbidity and mortality. The data on the clinical impact of CHF on COVID-19 hospitalizations is limited. Here we present a study of the cardiovascular outcomes of baseline CHF on COVID-19 admissions at a national level. Method(s): The National Inpatient Sample database from 2020 was queried to identify patients with a primary diagnosis of COVID-19 and stratified based on the presence of congestive heart failure. Multivariate regressions analysis was done to compare inpatient outcomes among COVID patients with and without CHF. The primary outcome measure was in-hospital mortality. Secondary outcomes were in hospital cardiovascular outcomes. The adjusted odds ratios (aOR) of in-hospital outcomes were calculated using chi-square statistics in software STATA v.17. Result(s): 1,060,885 weighted COVID-19 hospitalizations were identified, of which 115,685(10.9%) were associated with CHF. On adjusted analysis, patients with COVID-CHF had significantly higher odds of MACCE (aOR 1.23, 95% CI 1.182-1.28, P<0.001), MCS ( aOR 3.22, 95% CI 2.26-3.26, P<0.001), cardiogenic shock ( aOR 2.72, 95% CI 2.26-3.26, P<0.001), AMI (aOR 2.72, 95% C. On the contrary, patients with COVID and baseline CHF had a lower incidence of inpatient AKI (aOR 0.64, 95% CI 0.49-0.84, P<0.001). The odds of in-hospital mortality, major bleeding and cardiac arrest between the two cohorts were similar. Additionally, presence of CHF in COVID hospitalization was associated with higher length of stay (8.81+/- 8.91 vs 7.28 +/-7.9) and adjusted total charge ($96,640 +/- 177,439 vs $76,214 +/-145,830) compared to COVID without CHF Conclusion(s): COVID 19 patients with CHF have increased odds of MACCE, MCS, cardiogenic shock, AMI, PCA and PCI. Out of hospital outcomes need further studies. [Formula presented]Copyright © 2023
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Background: People presenting with early-stage LPCa have several treatment options. There is therapeutic equipoise with lack of randomised evidence for superiority of radiotherapy or surgery. PACE-A aimed to determine if there is improved quality of life (QoL) following SBRT compared to surgery. Method(s): PACE (NCT01584258) is a phase 3 open-label multiple-cohort RCT. In PACE-A, people with LPCa, T1-T2, Gleason<=3+4, PSA<=20ng/mL & suitable for surgery were randomised (1:1) to SBRT or surgery. SBRT dose was 36.25Gy/5 fractions in 1-2 weeks;surgery was laparoscopic or robotically assisted prostatectomy. Androgen deprivation was not permitted. Co-primary endpoints were patient reported outcomes (PROs) of Expanded Prostate Index Composite (EPIC-26) questionnaire number of absorbent pads per day & EPIC bowel subdomain score at 2 years. Target sample size was 234 participants (pts) to detect 9% difference in urinary incontinence (80% power, 5% 2-sided alpha) & 5-point difference in mean bowel subdomain score (90% power, 5% 2-sided alpha) with higher EPIC score (range 0-100) indicating better QoL. Secondary endpoints included clinician reported toxicity and additional PROs (1% significance level). Analysis is by treatment received. Result(s): From Aug 2012 to Feb 2022, 123 men from 10 UK centres were randomised. The IDMC advised stopping recruitment after a 2-year gap in during COVID. Pts had median age 66years (IQR: 61, 69), median PSA 8ng/ml (6, 11) with 52% tumours >=T2b and 79% Gleason 3+4;93% pts were of white race. 58/63 pts received SBRT as allocated (2 received surgery, 2 unknown, 1 withdrawn);48/60 received surgery as allocated (1 received SBRT, 3 received CRT, 2 unknown, 6 withdrawn). 8 laparoscopic and 42 robotic assisted operations were performed. Median follow-up is 50 months (IQR 41, 74). At 2 years, fewer SBRT pts reported use of urinary pads: 2/43 (4.5%) vs 15/32 (46.9%), p<0.001. SBRT pts had significantly worse bowel subdomain score (mean (SD) 88.4 (12.7) vs 97.3 (5.5), p<0.001). 7/45 (15.6%) SBRT and 0/31 (0%) surgery pts reported moderate/big problem with bowel symptoms (p=0.04). SBRT pts reported less EPIC sexual subdomain score (58.0 (31.9) vs 29.3 (20.5), p<0.001);there was no evidence of a difference in urinary subdomain score (85.5 (19.8) vs 80.5 (20.8), p=0.29). At 2 years, CTCAE genitourinary grade 2 or higher(G2+) toxicity was seen in 5/54 (9.3%) SBRT vs 4/42 (9.5%) surgery pts (p=0.97);there was no G2+ gastrointestinal (GI) events seen in either group. Conclusion(s): PACE-A contributes the first randomised data to the comparison of SBRT with surgery in LPCa providing PRO data relevant to informed decision making. Compared to surgery, pts receiving SBRT had better urinary continence & sexual bother score;clinician reported GI toxicity was low but SBRT pts reported more bowel bother at 2 years.
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Introduction: It is now evident that anticoagulation plays a key role in the management of COVID-19 infection, however the significance of previous long-term oral anticoagulation in patients who later presented with COVID-19 is still unknown. Here we present an analysis of the impact of long-term oral AC on COVID-19 hospitalizations at the national cohort registry. Method(s): The NIS database from 2020 was queried to identify COVID-19 patients on long term AC use. Multivariate regression was done to compare inpatient outcomes among COVID-19 patients with and without AC. Result(s): Of 1,060,925 patients with primary diagnosis of COVID, 102, 560 (9.6%) were on AC. On adjusted analysis, patients with COVID-19 and AC use had significantly lower odds of MACCE (aOR 0.63, 95% CI 0.6-0.66, p<0.001), in-hospital mortality (aOR 0.61, 95% CI 0.58-0.64, p<0.001), cardiac arrest (aOR 0.67, 95% CI 0.6-0.75, P<0.001), acute MI (aOR 0.72, 95% CI 0.63-0.83, P<0.001), stroke (aOR 0.79, 95% CI 0.66-0.95, P=0.002), cardiogenic shock (aOR 0.58, 95% CI 0.44-0.75, P<0.001), ICU admission, (aOR 0.53, 95% CI 0.49-.57, p<0.001) mechanical ventilation,(aOR 0.54, 95% CI 0.51-.58, p<0.001) tracheostomy, (aOR 0.4, 95% CI 0.32-.5, p<0.001) and septic shock, (aOR 0.53, 95% CI 0.48-.58, p<0.001) compared to patients without AC. Additionally, lower adjusted total charge ($70,987+/-109,234 vs 79,239+/-153,418, p<0.001) in patients taking AC was observed. However, the adjusted OR of major bleeding, MCS, PCI, new HD and length of stay were similar between the two groups. Conclusion(s): Patients with COVID-19 infection who are on long term AC use have lower risk of MACCE, in-hospital mortality, cardiac arrest, acute MI, stroke cardiogenic shock and ICU admissions with no significant increased risk of major bleeding. Large prospective trials are needed to validate these findings. [Formula presented]Copyright © 2023
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Introduction: The impact of prolonged covid illness has been devastating for many people worldwide. Aim(s): We analysed the characteristics of patients referred to our Long Covid clinic. Method(s): Preliminary data;retrospective analysis from electronic and paper case notes. Result(s): 317 patients were included;majority were female (68%) & white (83%). Median age was 49 years (range 16-86 yrs). Wide range of symptoms experienced, most commonly fatigue & dyspnoea. 74% of patients were not admitted to hospital with their original covid illness. Majority had only 1-2 long term medical comorbidities. 43% had a history of previous/current mental health illness. Lung function results showed mild asthma (13%), significant asthma (6%), ILD (3%) and were normal in 63%. 41% had potentially treatable causes for fatigue (e.g. low Vitamin D or hypothyroidism). 82% of patients were referred to rehabilitation and physiotherapy for fatigue and/or breathing pattern disorder. The mean Body Mass Index (BMI) was 30, with 30% of patients overweight, 38.5% obese and 9% morbidly obese. 28% had abnormal overnight oximetry - 16% were mild and 4% severe. Conclusion(s): Long covid has predominantly affected young, middle-aged white women. We have noted many patients with high BMI, previous mental illness, breathing pattern disorder, asthma and abnormal overnight oximetry. More than 80% needed rehabilitation, physiotherapy and psychological support. More data is being collected.
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Background Coronary artery anomalies are rare with an incidence of 0.3 to 1.3%. Here we are describing an extremely rare anomaly of the left anterior descending artery (LAD) Case A 55-year-old female with covid-related chronic hypoxemic respiratory failure, pulmonary embolism on apixaban and IgG deficiency on IVIG therapy presented with dyspnea and increased oxygen requirement. EKG had no ischemic changes. Troponins were negative. CTPE was negative. TTE showed normal EF with no valvular or wall motion abnormalities. Right ventricular systolic pressure wasn't calculated due to insufficient TR. Decision-making Left and right heart catheterization was negative for coronary artery disease, bridging or pulmonary hypertension but revealed a dual LAD system and an interesting right coronary anatomy as seen below. These findings were confirmed with a coronary CT angiogram (done in the past that we reviewed again). Stress test was negative for ischemia of the apical anterior wall. The patient reported undergoing coronary angiograms multiple times at other institutions before for recurrent chest pains but has not been diagnosed with anomalous coronary artery until current admission. Conclusion This is a rare anomaly that has been not described before (upon our literature review). It is important to recognize dual LAD system as Inability to visualize the additional vessel, especially when the long LAD originates from the right coronary sinus, can be misinterpreted for mid-LAD occlusion. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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To explore laryngeal function of tracheostomised patients with COVID-19 in the acute phase, to identify ways teams may facilitate and expedite tracheostomy weaning and rehabilitation of upper airway function. Consecutive tracheostomised patients underwent laryngeal examination during mechanical ventilation weaning. Primary outcomes included prevalence of upper aerodigestive oedema and airway protection during swallow, tracheostomy duration, ICU frailty scores, and oral intake type. Analyses included bivariate associations and exploratory multivariable regressions. 48 consecutive patients who underwent tracheostomy insertion as part of their respiratory wean following invasive ventilation in a single UK tertiary hospital were included. 21 (43.8%) had impaired airway protection on swallow (PAS ≥ 3) with 32 (66.7%) having marked airway oedema in at least one laryngeal area. Impaired airway protection was associated with longer total artificial airway duration (p = 0.008), longer tracheostomy tube duration (p = 0.007), multiple intubations (p = 0.006) and was associated with persistent ICU acquired weakness at ICU discharge (p = 0.03). Impaired airway protection was also an independent predictor for longer tracheostomy tube duration (p = 0.02, Beta 0.38, 95% CI 2.36 to 27.16). The majority of our study patients presented with complex laryngeal findings which were associated with impaired airway protection. We suggest a proactive standardized scoring and review protocol to manage this complex group of patients in order to maximize health outcomes and ICU resources. Early laryngeal assessment may facilitate weaning from invasive mechanical ventilation and liberation from tracheostomy, as well as practical and objective risk stratification for patients regarding decannulation and feeding.
ABSTRACT
Rationale: The alpha-gal syndrome (AGS) is caused by IgE to galactose-α-1,3-galactose (α-Gal) and is strongly linked to tick bites. To date there have been limited studies on the natural history of AGS and α-Gal sensitization. Here we monitored α-Gal IgE levels over time among sensitized individuals in an employee vaccine cohort unselected for allergic disease. Methods: University of Virginia employees were recruited for an IRB-approved COVID-19 vaccine study. Study subjects provided blood samples and answered a questionnaire capturing medical history including diet and allergy history. α-Gal IgE (cut-off 0.1 kU/L) and total IgE were assayed in banked serum by ImmunoCAP and slopes calculated by linear regression. Results: Of the 266 subjects in the study, 46 (17%) were sensitized to alpha-gal. 38 sensitized subjects had two or more samples separated by at least 100 days. Of these, 68% were female, median age was 55.6 and α-Gal IgE levels dropped over time in 25 (66%). Median rate of decay among subjects with decreasing titers was 53%/year (IQR 46-61). Of the 38 sensitized subjects, 12 (32%) reported interval tick bites over the course of the study. The correlation between α-Gal IgE slopes and total IgE slopes was moderately strong (Pearson's R = 0.60, P<0.001). Conclusions: α-Gal IgE levels decrease over time in many subjects, with a median decay rate of 53%/year. Although α-Gal specific IgE is often only a small fraction of total IgE, both track closely with each other over time, likely a reflection of changes in IgE relating to tick bites.
ABSTRACT
Background: COVID rapidly became a multisystemic infection with varied cardiovascular complications including Acute Coronary Syndrome. Current literature is limited on the impact of COVID on ACS patients. Methods: We queried the national inpatient sample (NIS) from 2020 to identify patients who were admitted for ACS and stratified them based on the presence or absence of COVID. The adjusted odds ratios (aOR) of in-hospital outcomes and resource utilization were calculated using chi-square statistics in the software STATA v.17. Results: Out of 883940 patients analyzed, who were admitted for ACS, 3900 patients had COVID. On adjusted analysis, patients with COVID had significantly elevated In-Hospital mortality (aOR, 2.91 CI 2.25-3.79), MACCE (aOR 2.53, CI 1.90-3.10), cardiac arrest (aOR 3.34, CI 1.1-10.1) with longer length of stay (6.34 ± 0.39 vs 4.48 ± 0.02). Interestingly, the outcome PCA (aOR, 0.39 CI 0.33-0.46) showed significant improvement. Interestingly, mean costs were elevated in patients without COVID at $105,550.8 vs $98597.7 in patients without COVID. In terms of trends, as exposure increased through the year with the highest levels in December, the mortality also increased (April 18.52% vs 25.64%). Interestingly, the cardiac arrest percentage decreased from April 2020 (7.4%) to Dec 2020 (1.98%) as well as MCS in April 202 (11.11%)vs December 2020 (3.47%) in patients exposed to COVID. Conclusions: In patients admitted for ACS, the presence of COVID significantly increases the risk of MACCE, in-hospital mortality, and cardiac arrest. Prospective trials are necessary for the identification of risk factors to improve clinical outcomes in these patients. Key words: COVID, Sars-2 coronavirus. Coronavirus. ACS. Acute Coronary Syndrome. [Formula presented]