ABSTRACT
Introduction and Objectives: Limited healthcare access and resource inequities pose significant barriers to care, all of which have been amplified during the COVID-19 pandemic. DFUs represent an especially challenging medical problem to prevent and treat due to the resource intensive care required. We sought to evaluate the feasibility of multidisciplinary, mobile, DFU outreach clinics to improve access to care. Method(s): Our clinic model focused on creating mobile diabetic foot clinics staffed by volunteer clinical providers who specialize in Vascular Surgery, Diabetes, and Podiatry. We recruited volunteer healthcare providers from an academic medical center. We partnered with local community centers with established programs providing services to unhoused individuals. Result(s): Between June 2020 and August 2022, a total of 130 unhoused individuals were seen at four mobile clinics set up at different locations. Diabetic foot care was provided by volunteers from seven departments: Endocrinology/Diabetes, Vascular Surgery and Vascular Lab, Podiatry, Addiction Medicine, Smoking Cessation, and Financial. On average, 32 healthcare provider volunteers participated at each clinic. Services provided include: vitals, blood glucose, HgA1c, lipid panel testing, ankle-brachial index, podiatric exam, wound care, medical education, COVID vaccination/booster, insurance enrollment, and new socks and shoes. Of 130 unhoused patients, 29% had hypertension (38), 34% had abnormal ABI (44), and 14% had diabetes (18). Fifteen patients were further identified as high risk for developing DFU-associated amputation (12%) and were provided with ambulatory follow-ups. Conclusion(s): In our pilot experience, it is feasible to provide consistent comprehensive DFU care through mobile outreach clinics. By using the infrastructure of partner organizations and healthcare expertise of an academic center, our clinics could integrate into existing community services. [Formula presented]Copyright © 2022
ABSTRACT
Background: Patients with neuromuscular diseases (NMD) are classified as risk groups for a potentially severe course of a SARS-CoV-2 infection. An online registry (www.covid19-nme.com) was developed to gather information about the severity of COVID19, a potential progression of NMD through the SARS-CoV-2 infection and the possible influence of medication on the course of the infection. Methods: Since February 2021, patients of all ages (children, adolescents and adults) with NMD and an infection with SARS-CoV-2 have been included in this register. In addition to demographic data, pre-existing diseases and therapies, information about the NMD, the course of the SARS-CoV-2 infection as well as the clinical findings before and after the infection are recorded. Results: So far 94 patients (37% female, age: median 60 years (1-94 years)) from Germany and Austria have been recorded. The diagnoses represent the entire spectrum of NMD: different forms of polyneuropathies (PN) including CIDP and hereditary PN, ICUAW, myasthenic syndromes, motor neuron diseases (SMA and ALS) as well as various muscle diseases such as dystrophinopathies and myotonic syndromes. The collected mRS (measure for description of neurological impairment) depicts a significant worsening after the SARS-CoV2 infection (p = 0.02;Wilcoxon), whereby the patients with ICUAW were excluded from the analysis. The duration of symptoms showed a positive correlation with age (r = 0.343;p = 0.005) and weight (r = 0.291;p = 0.030), but not with the type of NMD. In total, 13 patients deceased due to the SARS-CoV2 infection. The probability of a fatal outcome of COVID19 correlates with increasing age (r = 0.313;p = 0.004) but not the type of NMD. The ventilation situation did not change in NMD patients due to the infection with SARS-CoV2. Summary: The first results of the evaluation of the covid-19.nme registry indicate that the clinical symptoms of NMD progress due to an infection with SARS-CoV2. The underlying cause for this remains unclear. Autoimmunological processes and a possible neurotropy can be considered as pathophysiological mechanisms.
ABSTRACT
The health effects of coronavirus disease 2019 (COVID-19) caused by the infection of SARS-CoV2 (severe acute respiratory syndrome coronavirus 2) are becoming increasingly clear as the pandemic spreads. In addition to the lungs, other organs are also affected, which can significantly influence morbidity and mortality. In particular, neurological symptoms involving the central nervous system can lead to acute or long-term consequences. The mechanisms of this neuropathogenesis of SARS-CoV2 infection and its relation to acute and chronic neurological symptoms are the subject of current studies investigating a potential direct and indirect viral infection of the nervous system. The following review summarizes the current status of neuropathological manifestations, molecular pathogenesis, possible infection pathways in the nervous system, and systemic effects. In addition, an overview of the Germany-wide CNS-COVID19 registry and collaborations is presented, which should contribute to a better understanding of the neurological symptoms of COVID-19.