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Severe COVID-19 infection can cause advanced respiratory failure requiring ECMO. In some cases, lung transplantation (LT) is a last viable treatment option. This study aims to evaluate outcomes among COVID patients bridged to LT with ECMO and identify risk factors for early mortality post-LT. Using the UNOS database, we identified 442 patients who underwent LT for COVID-19 respiratory failure between August 2020 and September 2022. Outcomes of patients requiring preoperative ECMO (n=253) were compared to those who did not require ECMO pre-LT (n=189). Survival analyses were conducted using the Kaplan-Meier survival function and Cox proportional hazards models. Risk factors for post-LT mortality were analyzed using a multivariate logistic regression model. Out of 442 patients, 253 required preoperative ECMO support for a median of 73 days (IQR 40, 119). The most common ECMO platform was veno-venous (p=0.0008). Patients requiring ECMO were younger, more frequently in an ICU, had higher LAS scores, more likely to require bilateral LT, had higher rates of tracheostomy and pre-LT dialysis, and were more likely to have ARDS etiologies of respiratory failure (all p<0.0001). At 1 and 6 months post-LT, there was no difference in survival between ECMO and non-ECMO patients (95.5% vs 97.5% at 1 month, 92.7% vs 93.4% at 6 months) (Fig 1a). However, ECMO patients had higher rates of prolonged ventilation, post-operative ECMO, new dialysis, and increased length of stay (all p<0.0001) post-LT. Risk factors for mortality included BMI (p=0.007), pan-resistant bacterial infection (p=0.01), preoperative VA ECMO (p=0.0008), prior cardiac surgery (p=0.05), and single LT procedure (p<0.0001) (Fig 1b). Our findings suggest that ECMO can safely be used as a bridge to LT in well-selected patients with COVID-19 respiratory failure despite prolonged support. Here we identify possible risk factors associated with early mortality that may require further evaluation. [ 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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Aim: Amid COVID pressures, standards of surgical practices need constant reviewing to maintain patient safety and streamline care pathways. Newly published BOAST (British Orthopaedic Association Standards for Trauma and Orthopaedics) guidelines for paediatric supracondylar fractures became a benchmark against which a restructured DGH trauma unit's performance can be appraised. Method: Theatre records were analysed between April-2020 and September-2020. Data were collected to reveal time to theatre, operative techniques, documentations of ulnar nerve protection, complications, follow-up plans, time to first post-op radiograph and to wire removal. Results: 90% of patients underwent operations within 24-48 hour. Although there was no incidence of iatrogenic nerve injury, documentation of ulnar nerve protection was not identified in 45% of crossed wire fixations. Wire size was not mentioned in 14%. 33% did not have first follow-up with radiograph within 4-10 days, and 43% of patients did not have the wires removed till 4 weeks post op. Conclusion: This re-audit highlights the need to improve in documentation for ulnar nerve protection and to identify the delays in follow-up appointments. Although BOAST no longer recommends a fixed timeframe for follow-up plan, first radiograph within 4-10 days and wire removal within 4 weeks are still reasonable locally.
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Background: Traditional health care delivery has been forced to transform to online or telehealth forums due to COVID-19. Patrons receiving psychological therapies had routines disrupted. In Western Australia, interstate and international borders have remained closed, and social and physical distancing restrictions have begun ease within the state. However, the uncertainty of the COVID-19 pandemic remains ever present. As routine in-person appointments recommenced, encouraging a sense of community and addressing physical health through a free exercise programme were hypothesised to be beneficial. Methods: A complimentary, bodyweight exercise programme was offered alongside psychological treatments in a community-based Psychological Services Centre. The Psychological Services Centre already provides group programmes to tackle common issues like sleep and stress for patrons to access. The inclusion of free classes targeting physical activity was hypothesised to be a wellattended component;however, recruitment appeared to be negatively affected by the global COVID-19 pandemic. Results: To overcome these challenges, the recruitment approach was modified. The psychological services centre structurally changed the forms patrons complete as a new client, adding a box indicating whether they would like to be contacted directly regarding relevant research opportunities. This initiative gathered over 70 patrons of which a total of three participants responded to the direct email. Conclusion: Flexibility in delivery (e.g. time variants, online vs in-person) and providing take-home materials (e.g. programme reminders) are essential for ensuring participant involvement. While requiring more creativity on behalf of the researchers, the additional modes of delivery will undoubtedly be advantageous for the participants.
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Background. Understanding the disease burden of SARS- CoV-2 in young children has been challenging as the majority are asymptomatic or experience mild symptoms and were rarely tested. SARS-CoV-2 is traditionally detected through respiratory secretions but has also been reported in feces where shedding may continue for weeks after respiratory samples show resolution. We examined the prevalence of SARS-CoV-2 in already collected fecal samples from young children through the pandemic as well as associated demographic factors. Methods. As part of an ongoing longitudinal microbiome study in Northern Virginia, serial stools samples were collected from infants before and throughout the Covid-19 pandemic. Reverse transcription quantitative-PCR detecting SARS-CoV-2 nucleocapsid gene in the N1 and N2 regions was performed. Penalized logistic regression models were developed to evaluate the association between fecal positivity and potential risk factors. Results. The overall prevalence of SARS-CoV-2 in infant feces was 1.69 % (13 samples) with a prevalence at delivery, 2, 6, 12 and 24 months of 0, 0, 2.56, 1.96, and 0.85 % respectively. Fecal positivity was first detected 31 days before the reported first case of Covid-19 in Northern Virginia;prevalence rates peaked in September at 4.5% (Figure 1). Only one infant who tested positive was symptomatic with COVID-19 21 days before his stool was collected. Of the 13 positive samples, 8 reported Hispanic ethnicity and 7 reported an essential worker (Table 1). Penalized logistic regression model showed association between Hispanic ethnicity and testing positive (OR 5.04 (95% CI 1.7 - 15.0)) that remained after controlling for the presences of an essential worker (OR 4.7 (95% CI 1.6 - 14.0)). Conclusion. Prevalence of SARS- CoV-2 in infant stool correlated with the prevalence of COVID-19 during the pandemic, with higher rates in those of Hispanic ethnicity corelating with regional trends. Fecal positivity in asymptomatic infants even before quarantine restrictions supports the early but silent transmission of SARS-CoV-2. This study likely underestimates true prevalence rates as stool samples were stored without viral preservative. There are many socioeconomic factors that predispose to disease while ethnicity may be a mediating or confounding factor.
ABSTRACT
Background: Understanding the disease burden of the severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) in young children has been challenging as the majority are asymptomatic or experience mild symptoms and were rarely tested especially near the start of the pandemic. Since children are a potential reservoir of SARS-CoV-2, this is vital epidemiological data to understand. SARS-CoV-2 is traditionally detected through respiratory secretions;however, detection of SARS-CoV-2 has also been reported in feces and shedding may continue for weeks after respiratory samples show resolution. This allows the unique opportunity to examine the prevalence of SARS-CoV-2 in stool samples of young infants collected during the pandemic who may otherwise not be tested for SARS- CoV-2. We examined the prevalence of SARS-CoV-2 in already collected fecal samples from young children through the pandemic as well as associated demographic and clinical factors. Methods: As part of an ongoing longitudinal microbiome study in Northern Virginia, serial stool samples were collected from infants before 2 days of life, 2 months, 6 months, 12 months and 24 months of age before and throughout the Covid-19 pandemic. Stool samples were stored at -80°C without viral preservative. Viral RNA was extracted and reverse transcription quantitative-PCR detecting SARS-CoV-2 nucleocapsid gene in the N1 and N2 regions was performed as per manufacturer guidelines (CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel assay). Positive and negative controls were included on each plate. At each time point, household infectious history particular to SARS-CoV-2 infection and social demographic factors were collected. The characteristics of the study cohort were described and univariate analyses were performed to investigate associations between test results and characteristics of the study cohort. Penalized logistic regression models were developed to evaluate the association between fecal positivity and ethnicity, essential worker status, and other potential risk factors. Results: 769 serial stool samples from 595 infants were included. The overall prevalence of SARS-CoV-2 in infant feces was 1.69 % (13 samples) with a prevalence at delivery, 2 months, 6 months, 12 months and 24 months of 0, 0, 2.56, 1.96, and 0.85 % respectively. There were no positive stool samples collected in 2019 prior to the start of the pandemic. Fecal positivity was first detected 2/3/2020, 31 days before the reported first case of Covid-19 in Northern Virginia;prevalence rates peaked in September at 4.5% (Figure 1). One infant who tested positive was symptomatic and diagnosed with COVID-19 21 days before his stool was collected;no other infant with a positive stool sample was symptomatic or had a personal or family history of a SARS-CoV-2 (Table 1). Of the 13 positive samples, 8 reported Hispanic or Latino ethnicity and 7 reported an essential worker (Table 1). Penalized logistic regression model showed an association between Hispanic ethnicity and testing positive (OR 5.04 (95% CI 1.7 - 15.0)) that persisted after controlling for a household member being an essential worker (OR 4.7 (95% CI 1.6 - 14.0)). Conclusion: Studying infant stool allows a unique glimpse into SARS-CoV-2 burden in an understudied population. Prevalence of SARS- CoV-2 in infant stool correlated with the prevalence of COVID-19 during the pandemic, with higher rates in those of Hispanic ethnicity correlating with regional trends. Fecal positivity in asymptomatic infants even before quarantine restrictions supports the early but silent transmission of SARS-CoV-2. This study likely underestimates fecal positivity and true prevalence rates as stool samples were stored without viral preservative. Although this study suggests an association between Hispanic ethnicity and fecal positivity, there are many socioeconomic factors that predispose to disease while ethnicity may be a mediating or confounding factor.
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More than 1 year after the outbreak of COVID-19, Canadian fruit and vegetable markets continue to adjust to the evolving landscape. In this article, we focus on three key measures of input and output market performance that serve as indicators of the stability of fruit and vegetable markets in Canada in the medium-term, and offer some insight for how these markets will continue to adjust in the longer run. Specifically, we use data to highlight the most recent trends in (1) the production and aggregate movement for major fruit and vegetable crops in the United States and Canada, (2) labor supply and immigration visa patterns, and (3) U.S.-Canada trade patterns for fruits and vegetables. We provide evidence that the fresh produce supply chain in Canada, and for markets in their largest trade partner in the United States, has remained relatively robust.
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OBJECTIVE: This study aimed to assess olfactory dysfunction in patients at six months after confirmed coronavirus disease 2019 infection. METHODS: Coronavirus disease 2019 positive patients were assessed six months following diagnosis. Patient data were recoded as part of the adapted International Severe Acute Respiratory and Emerging Infection Consortium Protocol. Olfactory dysfunction was assessed using the University of Pennsylvania Smell Identification Test. RESULTS: Fifty-six patients were included. At six months after coronavirus disease 2019 diagnosis, 64.3 per cent of patients (n = 36) were normosmic, 28.6 per cent (n = 16) had mild to moderate microsmia and 7 per cent (n = 4) had severe microsmia or anosmia. There was a statistically significant association between older age and olfactory dysfunction. Hospital or intensive care unit admission did not lead to worse olfactory outcomes compared to those managed in the out-patient setting. CONCLUSION: At six months after coronavirus disease 2019 diagnosis, approximately two-thirds of patients will be normosmic. This study is the first to describe six-month outcomes for post-coronavirus disease 2019 patients in terms of olfactory dysfunction.
Subject(s)
COVID-19/complications , Olfaction Disorders/etiology , Anosmia/diagnosis , Anosmia/etiology , Female , Hospitalization , Humans , Male , Middle Aged , Olfaction Disorders/diagnosis , Smell , Time FactorsABSTRACT
The COVID-19 pandemic exposed critical weaknesses in the US food supply chain. Faced with the near-complete loss of the food service distribution channel, stories of wasted food, failing suppliers, and food shortages were common. We argue that the pandemic revealed a fundamental lack of resilience in the food supply chain that, while causing short-term welfare losses, need not have happened, and resulted from a failure of vision rather than a market failure in the traditional sense. We present a model of supply chain flexibility, grounded in real options theory, that demonstrates how firms can increase shareholder value by maintaining flexibility across supply chains. We present an example from the US fresh produce industry (onions) to demonstrate our hypothesis.