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BackgroundAnti-synthetase syndrome (ASS) is a rare auto-immune condition that combines autoantibodies and specifics clinical manifestations, including myositis, interstitial lung disease (ILD), polyarthritis, mechanic's hands, Raynaud's phenomenon, and unexplained fever. The hallmark of this syndrome is the presence of anti-aminoacyl-tRNA-synthetase (ARS) antibodies. Several anti-ARS antibodies have been described, anti-Jo1 being the most common, followed by anti-PL7, anti-PL12, anti-OJ, anti-EJ, anti-KS, anti-YRS, and anti-Zo. According to a recent epidemiological survey, the rising number of patients with autoimmune diseases, including idiopathic inflammatory myopathies (IIM) coincides with the COVID-19 pandemic.ObjectivesTo evaluate the clinical characteristics of ASS patients with different anti-ARS antibodies from a tertiary rheumatology center.MethodsWe conducted a retrospective, single-centered study on consecutive patients diagnosed with ASS from 1 January 2015 to 31 December 2022. Clinical and serologic data were obtained by medical records review from hospital database. Myositis-specific antibodies (MSA) and myositis-associated antibodies (MAA) were tested using commercial ELISA kits. We included all patients fulfilling Connor's criteria for ASS.ResultsSixty-one patients (44 females) with mean age 54.4 (13.8) years were included. The most frequently reported clinical manifestation was arthralgia (68.8%), followed by Raynaud's phenomenon (67.2%), ILD (65.6%), myositis (46%), mechanic's hands (44.3%), arthritis (39.3%), and fever (18.0%). The typical triad for ASS, including myositis, arthritis and ILD was present in 17 patients. Twenty-eight (45.9%) patients were PL7+, 21 (34.4%) were Jo1+, 3 (4.9%) were PL12+, and 2 (3.2%) were OJ+. Seven patients were positive for more than two anti-ARS antibodies. The most frequently found MAA was anti-Ro52 (n=23, 37.7%). Of the 61 patients included, 41 (67.2%) patients were diagnosed in the last 3 years (COVID-19 pandemic). The most frequently detected MSA in ASS patients diagnosed during COVID-19 pandemic was anti-PL7 (25/28), while anti-Jo1 was the most common MSA in ASS patients diagnosed before 2020 (p<0.05) (Fig 1).The anti-Jo1+ patients were younger, have significantly more frequent muscle involvement and significantly higher levels of CK than anti-PL7+ patients (p<0.05). The co-occurance of anti-Ro52 antibodies was more frequently observed in anti-Jo1+ patients (n=11, 52.4%) than in anti-PL7+ patients (n=6, 21.4%) (p<0.05). We did not find statistically significant differences between ASS groups regarding sex, disease duration, clinical manifestations including dermatologic lesions, Raynaud's phenomenon, arthralgia/arthritis, ILD, fever, and cancers (all p>0.05).ConclusionASS patients have heterogenous manifestations, and different types of anti-ARS antibodies are associated to distinct clinical and immunological features. The COVID-19 pandemic led to increase prevalence of ASS cases and to a remarkable shift in the anti-ARS antibodies profile, with increased frequency of anti-PL7 antibodies. Further studies are needed to investigate the link between SARS-CoV-2 infections and myositis.References[1]Witt LJ, et al. The Diagnosis and Treatment of Antisynthetase Syndrome. Clin Pulm Med. 2016 Sep;23(5):218-226.[2]Gracia-Ramos AE, et al. New Onset of Autoimmune Diseases Following COVID-19 Diagnosis. Cells. 2021 Dec 20;10(12):3592.[3]Connors GR, et al. Interstitial lung disease associated with the idiopathic inflammatory myopathies: what progress has been made in the past 35 years? Chest. 2010 Dec;138(6):1464-74.[4]García-Bravo Let al. Association of anti-SARS-COV-2 vaccine with increased incidence of myositis-related anti-RNA-synthetases auto-antibodies. J Transl Autoimmun. 2022 Jun 30;5:100160.Figure 1.ASS patients with positive anti-ARS antibodies per year (from 2015 to 2022). The green line shows the PL7+ patients;and the orange line shows the Jo1+ cases.[Figure omitted. See PDF]AcknowledgementsI have no acknowledgements to declare.Disclosure of Inter stsNone Declared.
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We evaluated the impact of COVID-19 restriction on the angioplasty service and outcome of critical limb ischaemia (CLI) patients undergoing lower limb angioplasty in a UK secondary care setting. Consecutive patients were analysed retrospectively. Pre-COVID-19 (08/2018-02/2020), 106 CLI-patients (91% Fontaine 4; 60% diabetes mellitus) and during COVID-19 (03/2020-07/2021) 94 patients were treated (86% Fontaine 4; 66% diabetes mellitus). While the average monthly number of patients treated did not change, the proportion of day cases significantly increased (53% to 80%) and hospitalised patients decreased. Patients treated in <=14/5 days after referral significantly increased to 64/63%. Kaplan-Meier survival analysis (30-day/1-year) showed that neither wound healing nor mortality were significantly changed during COVID-19. In day cases, 1-year but not 30-day major amputations significantly increased, and clinically driven target lesion revascularisation decreased during COVID-19. 1-year mortality was significantly worse in hospitalised as compared to day cases (14% vs 43%) at similar wound healing rates (83% vs 84%). The most frequent known-causes-of-death were infectious disease (64%) and cardiovascular (21%) was less frequent. Despite COVID-19 restriction a safe and effective angioplasty service was maintained while shortening waiting times. Very high mortality rates in hospitalised patients may indicate that CLI should be treated more aggressively and earlier.
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COVID-19 , Diabetes Mellitus , Critical Illness , Communicable DiseasesABSTRACT
Indian power system witnessed its largest very short-time demand ramping during light off event conducted to express solidarity with COVID-19 volunteers. 32 GW demand ramping was observed within 25 minutes and recorded as the highest ramping event across the globe. System operator has taken precautions and successfully handled the event with the help of hydro generation. However, system experienced severe frequency and voltage deviations due to unexpected consumer behaviour. A systematic study and an in-depth analysis of such a severe event would help system operators and planners to prepare for similar events. This paper presents a critical analysis of the activity and conducted a survey to understand consumer response during that event. It also proposes a modified Bottom-Up Approach to estimate Expected Demand Reduction (EDR) for such critical events. Proposed model is validated using data collected from the conducted survey. Proposed EDR estimation model offers better results than the Top Down and Bottom-up approach models used by system operator. © 2022 IEEE.
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This article is aimed at addressing concepts, approaches and challenges that are both very characteristic of the era we are living in and that would also greatly benefit from being more and better integrated into our learning systems (both in the formal and non-formal educational systems and lifelong learning). Those issues and themes have emerged from, or have been exacerbated by, socio-economic systems in place since the middle of the 20th century, promoting amongst other things, a consumption society based on a linear over-exploitation of natural resources, the globalization of exchanges, a rapid urbanization process and not-always-harmonious mixes of cultures and communities. The COVID-19 pandemic seems to have culminated in triggering reflections on what matters most and, conversely, on what makes our world so un-sustainable and non-resilient. From these, a new momentum has been generated on reviewing where our efforts on teaching and learning about ‘sustainability' got us to. Our focus here is on new approaches to education for sustainability at global, community and personal levels, as well as at levels that connect those. From linking the local to the global through ‘global citizenship,' to experiential learning generated through practical projects such as urban agriculture, to an emotional involvement into understanding sustainability issues through art forms, we re-visit sustainability through the eyes of the learners, questioning the boundaries of the ‘sustainability educational project' beyond the ones which, for (too) long, have paralleled those of neo-liberal reforms. Copyright © 2023 Simon, Vieira and Jecu.
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OBJECTIVES: Consent is a communication process between the patient and a health care provider, in which both parties have the opportunity to ask questions and exchange information relevant to the patient's diagnosis and treatment. The process of informed consent is designed to protect a patient's autonomy in their medical decision-making in the context of an asymmetric relationship with the health care system. A proper consent process assures a patient's individual autonomy, reduces the opportunity for abusive conduct or conflicts of interest, and raises trust levels among participants. This document was developed as an educational tool to facilitate these goals. METHODS: This practice parameter was produced according to the process described under the heading "The Process for Developing ACR Practice Parameters and Technical Standards" on the ACR website ( https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards ) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS. Committee members were charged with reviewing the prior version of the informed consent practice parameter published in 2017 and recommending additions, modifications, or deletions. The committee met through remote access and subsequently through an online exchange to facilitate the development of the revised document. Focus was given on identifying new considerations and challenges with informed consent given the evolution of the practice of radiation oncology in part driven by the COVID-19 pandemic and other external factors. RESULTS: A review of the practice parameter published in 2017 confirmed the ongoing relevance of recommendations made at that time. In addition, the evolution of the practice of radiation oncology since the publication of the prior document resulted in the need for new topics to be addressed. These topics include remote consent either through telehealth or telephone and with the patient or their health care proxy. CONCLUSIONS: Informed consent is an essential process in the care of radiation oncology patients. This practice parameter serves as an educational tool designed to assist practitioners in optimizing this process for the benefit of all involved parties.
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COVID-19 , Radiation Oncology , Humans , Pandemics , Clinical Decision-Making , Informed ConsentABSTRACT
Objectives: Trauma-focused CBT (TF-CBT) has been established as an effective treatment to reduce symptoms of psychological distress including PTSD, anxiety, and depression in parents of preterm infants. The current study compares results of a group-based intervention developed to reduce symptoms of posttraumatic stress with a prior study using an individual version of the treatment manual. Method(s): A total of 26 mothers of preterm infants (25-34 weeks' gestational age;>600 g) received 6 sessions of TF-CBT including psychoeducation, cognitive restructuring, progressive muscle relaxation, and the writing and sharing of their trauma narrative. Outcomes were compared with a group of 62 mothers who participated in a prior RCT with individual therapy based on the same model. Results were also compared for mothers receiving in-person treatment vs telehealth during the COVID-19 pandemic. Result(s): For the entire study period (baseline to follow-up), the individual intervention showed greater improvement in trauma symptoms assessed with Davidson Trauma Scale (d = 0.48;p =.016), although both conditions showed noticeable improvement. Similar patterns were found for maternal depression (Beck Depression Inventory-II [BDI-II]) and anxiety (Beck Anxiety Inventory [BAI]). In-person treatment was found to be superior to telehealth treatment administered during the COVID-19 pandemic, although the difference was not significant. Conclusion(s): Group-based TF-CBT is an effective treatment modality for parents of premature infants with symptoms of psychological distress. However, recruitment of parents was difficult, raising questions about feasibility. Future group-therapy approaches will require a more flexible, open-ended group format in which parents have the option of participating without making a commitment for the full 6-session protocol. Given the national shortage of neonatal intensive care unit (NICU)-based psychological services, group therapy is a potentially viable and cost-effective way to deliver care. PTSD, PAT, P Copyright © 2022
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INTRODUCTION: The COVID-19 pandemic has disrupted many aspects of clinical practice in oncology, particularly regarding early cancer diagnosis, sparking public health concerns that possible delays could increase the proportion of patients diagnosed at advanced stages. In 2009, a cancer fast-track program (CFP) was implemented at the Clinico-Malvarrosa Health Department in Valencia, Spain with the aim of shortening waiting times between suspected cancer symptoms, diagnosis and therapy initiation. OBJECTIVES: The study aimed to explore the effects of the COVID-19 pandemic on our cancer diagnosis fast-track program. METHODS: The program workflow (patients included and time periods) was analysed from the beginning of the state of alarm on March 16th, 2020 until March 15th, 2021. Data was compared with data from the same period of time from the year before (2019). RESULTS: During the pandemic year, 975 suspected cancer cases were submitted to the CFP. The number of submissions only decreased during times of highest COVID-19 incidence and stricter lockdown, and overall, referrals were slightly higher than in the previous 2 years. Cancer diagnosis was confirmed in 197 (24.1%) cases, among which 33% were urological, 23% breast, 16% gastrointestinal and 9% lung cancer. The median time from referral to specialist appointment was 13 days and diagnosis was reached at a median of 18 days. In confirmed cancer cases, treatment was started at around 30 days from time of diagnosis. In total, 61% of cancer disease was detected at early stage, 20% at locally advanced stage, and 19% at advanced stage, displaying time frames and case proportions similar to pre-pandemic years. CONCLUSIONS: Our program has been able to maintain normal flow and efficacy despite the challenges of the current pandemic, and has proven a reliable tool to help primary care physicians referring suspected cancer patients.
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COVID-19 , Lung Neoplasms , Humans , COVID-19/epidemiology , Pandemics , Communicable Disease Control , Referral and Consultation , Lung Neoplasms/diagnosisABSTRACT
BACKGROUND: With the COVID-19 pandemic, the stigmatisation of migrants as mere vectors of diseases has worsened. Our goal was to assess how migration rates could affect yellow fever dynamics in Latin American communities, one of those being in Necocli, Colombia, with 70 000 inhabitants and another 70 000 migrants annually waiting to access central America.
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INTRODUCTION: Magnetic resonance imaging (MRI) of the brain could be a key diagnostic and research tool for understanding the neuropsychiatric complications of COVID-19. For maximum impact, multi-modal MRI protocols will be needed to measure the effects of SARS-CoV-2 infection on the brain by diverse potentially pathogenic mechanisms, and with high reliability across multiple sites and scanner manufacturers. Here we describe the development of such a protocol, based upon the UK Biobank, and its validation with a travelling heads study. A multi-modal brain MRI protocol comprising sequences for T1-weighted MRI, T2-FLAIR, diffusion MRI (dMRI), resting-state functional MRI (fMRI), susceptibility-weighted imaging (swMRI), and arterial spin labelling (ASL), was defined in close approximation to prior UK Biobank (UKB) and C-MORE protocols for Siemens 3T systems. We iteratively defined a comparable set of sequences for General Electric (GE) 3T systems. To assess multi-site feasibility and between-site variability of this protocol, N = 8 healthy participants were each scanned at 4 UK sites: 3 using Siemens PRISMA scanners (Cambridge, Liverpool, Oxford) and 1 using a GE scanner (King's College London). Over 2,000 Imaging Derived Phenotypes (IDPs), measuring both data quality and regional image properties of interest, were automatically estimated by customised UKB image processing pipelines (S2 File). Components of variance and intra-class correlations (ICCs) were estimated for each IDP by linear mixed effects models and benchmarked by comparison to repeated measurements of the same IDPs from UKB participants. Intra-class correlations for many IDPs indicated good-to-excellent between-site reliability. Considering only data from the Siemens sites, between-site reliability generally matched the high levels of test-retest reliability of the same IDPs estimated in repeated, within-site, within-subject scans from UK Biobank. Inclusion of the GE site resulted in good-to-excellent reliability for many IDPs, although there were significant between-site differences in mean and scaling, and reduced ICCs, for some classes of IDP, especially T1 contrast and some dMRI-derived measures. We also identified high reliability of quantitative susceptibility mapping (QSM) IDPs derived from swMRI images, multi-network ICA-based IDPs from resting-state fMRI, and olfactory bulb structure IDPs from T1, T2-FLAIR and dMRI data. CONCLUSION: These results give confidence that large, multi-site MRI datasets can be collected reliably at different sites across the diverse range of MRI modalities and IDPs that could be mechanistically informative in COVID brain research. We discuss limitations of the study and strategies for further harmonisation of data collected from sites using scanners supplied by different manufacturers. These acquisition and analysis protocols are now in use for MRI assessments of post-COVID patients (N = 700) as part of the ongoing COVID-CNS study.
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COVID-19 , Inosine Diphosphate , Biological Specimen Banks , Brain/diagnostic imaging , COVID-19/diagnostic imaging , Humans , Magnetic Resonance Imaging , Phenotype , Reproducibility of Results , SARS-CoV-2 , United KingdomABSTRACT
The Asia-Pacific region has the largest number of cases of colorectal cancer (CRC) and one of the highest levels of mortality due to this condition in the world. Since the publishing of two consensus recommendations in 2008 and 2015, significant advancements have been made in our knowledge of epidemiology, pathology and the natural history of the adenoma-carcinoma progression. Based on the most updated epidemiological and clinical studies in this region, considering literature from international studies, and adopting the modified Delphi process, the Asia-Pacific Working Group on Colorectal Cancer Screening has updated and revised their recommendations on (1) screening methods and preferred strategies; (2) age for starting and terminating screening for CRC; (3) screening for individuals with a family history of CRC or advanced adenoma; (4) surveillance for those with adenomas; (5) screening and surveillance for sessile serrated lesions and (6) quality assurance of screening programmes. Thirteen countries/regions in the Asia-Pacific region were represented in this exercise. International advisors from North America and Europe were invited to participate.
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Adenoma , Colonic Polyps , Colorectal Neoplasms , Adenoma/diagnosis , Adenoma/epidemiology , Adenoma/surgery , Asia/epidemiology , Colonoscopy , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/pathology , Consensus , Early Detection of Cancer , HumansABSTRACT
Restrictive COVID-19 measures can have significant mental health impacts, particularly on young people. How such measures may influence day-to-day momentary affect, nonetheless, remains to be explored. Experience sampling data were collected from 165 young people (aged 15-24) as part of a larger epidemiological youth mental health study in Hong Kong. We examined the impact of one of the most stringent COVID-19 measures - dine-in restrictions - on momentary positive and negative affect and current contexts and activities of these young people. The effects of a milder form of COVID-19 measure - school suspension - were separately examined. Multilevel analysis revealed that those in the dine-in ban group, compared to dining-as-usual, showed significantly reduced momentary positive affect (ß = -0.17, SE = 0.06, p = 0.003). Its effect remained significant even when accounting for baseline depressive and anxiety symptoms and socioeconomic status (ß = -0.15, SE = 0.05, p = 0.008). The effect of dine-in ban on reduced momentary positive affect was found specifically when participants were in indoor locations (e.g., home, office), alone, and engaged in passive leisure activities. This pattern was not observed when participants were at school or at other outdoor locations, with friends, or engaged in active leisure activities. No significant effect of school suspension on momentary affect was observed. More severe COVID-19 measures, such as dine-in ban, can have significant impacts on the momentary positive affect of young people. Certain contexts and activities may offer protection against the consequences of COVID-19 measures. The current findings may help to inform future designs of mental health interventions and public health policies. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03183-y.
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COVID-19 , Skin Neoplasms , Humans , Mohs Surgery , Prevalence , Retrospective Studies , SARS-CoV-2 , Skin Neoplasms/surgeryABSTRACT
Background: The pandemic of COVID-19 has led to alterations in SOP across the transfusion process, including administration of blood in COVID-19 wards. COVID-19 patients who present with symptomatic anaemia and have multiple risk factors will need blood transfusions. ABO-incompatible blood transfusions leading to acute haemolytic transfusion reaction is a rare but potentially fatal complication. The National Haemovigilance Coordinating Centre of the National Blood Centre, Malaysia reported the national incidence of incorrect blood components transfused (IBCT) in relation to total blood products transfused in 2019 to be 75 per 10,000 units. Five IBCTs reported were related to administration errors. Aims: We reported two IBCTs involving two patients who required blood transfusions in a COVID-19 ward. Patient 1 was a 74 year old man who complained of chest pain, with a haemoglobin (Hb) of 5.7 g/ dl. Patient 2 was a 50 year old woman with a Hb of 6.4 g/dl. When the two units of blood arrived on the ward, one doctor completed the pre-administration checklist in the 'clean' zone, which Nurse 1 then counter-checked. Nurse 1 put the two blood bags into separate transparent plastic bags and labelled them with the wrong patient's identity sticker. She then handed both blood bags to Nurse 2 in the 'dirty' zone, without the patients' blood compatibility labels, blood request forms and bedside checklist forms. Positive patient identification was not done by Nurse 2 and the transfusions commenced. Patient 1 complained of chills around 10 min into the transfusion. The error was only realized 35 min into the transfusion when the symptoms persisted and the temperature taken was 38°C. Patient 2, who was given a unit of group O blood that belonged to Patient 1, did not report any adverse reactions. Our aim is to identify the root causes of these IBCTs and to execute the necessary changes in pre-transfusion SOP to minimize future recurrences. Methods: Samples from both patients were investigated for transfusion reactions. Rechecking of blood groups was done manually with the test tube method. Direct and indirect anti human globulin tests (DAT/IAT) and recheck of cross-matching were performed with the column agglutination technology (CAT) method at 37/AHG phase. Urine samples were tested using urine dipsticks. Isohaemagglutinin (anti-A/B titre) was performed using the CAT method at 37/AHG phase. Plasma Hb was measured with a photometer and a microcuvette. Results: Both patient 1's post-transfusion samples (immediate and post-24 h) were O-RhD positive. Blood group of the donor's bag was B-RhD positive. DAT for both samples was positive with IgG(3+) and C3D (1+). IAT for both samples was negative. Recheck of crossmatching with both samples was incompatible (4+). Urine tests were negative for haemoglobin. A low anti-B titre of 1:16 was detected. Plasma Hb was measured twice at a low level below the reference range. Patient 2's workup was unremarkable. Summary/Conclusions: Two IBCTs occurred in the COVID-19 ward, with one major ABO-mismatched IBCT due to human errors and deviation from standard SOP. Pre-transfusion SOP was still unclear in the COVID-19 ward setting prior to these incidences. All medical personnel in the COVID-19 ward underwent retraining on safe transfusion practices. One COVID-19 patient's blood compatibility label, blood request form, bedside checklist form and blood bag should be brought into 'dirty' zone to be checked by two medical personnel at one time.
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BACKGROUND: Young people are most vulnerable to suicidal behaviours but least likely to seek help. A more elaborate study of the intrinsic and extrinsic correlates of suicidal ideation and behaviours particularly amid ongoing population-level stressors and the identification of less stigmatising markers in representative youth populations is essential. METHODS: Participants (n = 2540, aged 15-25) were consecutively recruited from an ongoing large-scale household-based epidemiological youth mental health study in Hong Kong between September 2019 and 2021. Lifetime and 12-month prevalence of suicidal ideation, plan, and attempt were assessed, alongside suicide-related rumination, hopelessness and neuroticism, personal and population-level stressors, family functioning, cognitive ability, lifetime non-suicidal self-harm, 12-month major depressive disorder (MDD), and alcohol use. RESULTS: The 12-month prevalence of suicidal ideation, ideation-only (no plan or attempt), plan, and attempt was 20.0, 15.4, 4.6, and 1.3%, respectively. Importantly, multivariable logistic regression findings revealed that suicide-related rumination was the only factor associated with all four suicidal outcomes (all p < 0.01). Among those with suicidal ideation (two-stage approach), intrinsic factors, including suicide-related rumination, poorer cognitive ability, and 12-month MDE, were specifically associated with suicide plan, while extrinsic factors, including coronavirus disease 2019 (COVID-19) stressors, poorer family functioning, and personal life stressors, as well as non-suicidal self-harm, were specifically associated with suicide attempt. CONCLUSIONS: Suicide-related rumination, population-level COVID-19 stressors, and poorer family functioning may be important less-stigmatising markers for youth suicidal risks. The respective roles played by not only intrinsic but also extrinsic factors in suicide plan and attempt using a two-stage approach should be considered in future preventative intervention work.
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Autoimmune haemolytic anaemia (AIHA) is caused by autoantibodies that react with self-red blood cells (RBCs) and cause them to be destroyed with or without complement mediated mechanism. Its clinical presentation is heterogeneous, ranging from asymptomatic to severe forms with fatal outcomes, also it can be either idiopathic or secondary to a coexisting disorder. We report an elderly gentleman on haemodialysis, who presented with severe haemolytic anaemia after one month of first dose of ChAd Ox 1 nCoV-19 vaccine (viral vector vaccine) for SARS- CoV – 2, who also had asymptomatic COVID 19 infection around 6 months prior to vaccination. This is the first reported case of AIHA following COVISHIELD vaccine and till now there are no other reported cases from India. © 2022 Journal of Association of Physicians of India. All rights reserved.
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PURPOSE: To assess and correlate pulmonary involvement and outcome of SARS-CoV-2 pneumonia with the degree of coronary plaque burden based on the CAC-DRS classification (Coronary Artery Calcium Data and Reporting System). METHODS: This retrospective study included 142 patients with confirmed SARS-CoV-2 pneumonia (58 ± 16 years; 57 women) who underwent non-contrast CT between January 2020 and August 2021 and were followed up for 129 ± 72 days. One experienced blinded radiologist analyzed CT series for the presence and extent of calcified plaque burden according to the visual and quantitative HU-based CAC-DRS Score. Pulmonary involvement was automatically evaluated with a dedicated software prototype by another two experienced radiologists and expressed as Opacity Score. RESULTS: CAC-DRS Scores derived from visual and quantitative image evaluation correlated well with the Opacity Score (r=0.81, 95% CI 0.76-0.86, and r=0.83, 95% CI 0.77-0.89, respectively; p<0.0001) with higher correlation in severe than in mild stage SARS-CoV-2 pneumonia (p<0.0001). Combined, CAC-DRS and Opacity Scores revealed great potential to discriminate fatal outcomes from a mild course of disease (AUC 0.938, 95% CI 0.89-0.97), and the need for intensive care treatment (AUC 0.801, 95% CI 0.77-0.83). Visual and quantitative CAC-DRS Scores provided independent prognostic information on all-cause mortality (p=0.0016 and p<0.0001, respectively), both in univariate and multivariate analysis. CONCLUSIONS: Coronary plaque burden is strongly correlated to pulmonary involvement, adverse outcome, and death due to respiratory failure in patients with SARS-CoV-2 pneumonia, offering great potential to identify individuals at high risk.
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COVID-19 , Coronary Artery Disease , Plaque, Atherosclerotic , Vascular Calcification , Calcium , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Coronary Vessels/diagnostic imaging , Female , Humans , Lung , Male , Predictive Value of Tests , Prognosis , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2 , Vascular Calcification/diagnostic imagingABSTRACT
Background: Giant cell arteritis (GCA) is a sight-threatening disease requiring long-term immunosuppression, which carries inherent risk. Temporal artery biopsy (TAB) is the gold-standard investigation to confirm the diagnosis. Guidelines classically recommend a post-fixation sample length of 20 mm to achieve reliable histopathological results, but recent studies suggest sample lengths >6 mm are adequate. Benchmarking/Standard: Various papers report a minimum TAB length ranging from >6 mm to >20 mm to avoid false negative histology results. No reports examine the effect of COVID lockdowns on GCA presentations and TABs. Methods: All TABs in South Australia processed by the public state-wide pathology provider from September 2017 until June 2020. Histological diagnosis and sample lengths were extracted from reports. Clinical information and biochemistry for cases at the Royal Adelaide Hospital were derived from medical records. Results: A total of 362 temporal artery biopsies were conducted;156 conducted at Royal Adelaide Hospital, of which 41% were performed by Ophthalmology. Thirty-one percent of Ophthalmology TABs were <10 mm compared to 20% outside Ophthalmology (p = 0.018). TABs performed by Ophthalmology were twice as likely to be positive (34.4% vs 17.2%). Visual symptoms (p = 0.046), older age (p = 0.02), elevated ESR (p = 0.002) and elevated platelets (p = 0.003) were significant predictors of positive histology. Length was not significantly associated with positive histology after adjusting for above factors (p = 0.617). COVID-19 precautions and lockdown in April-May 2020 did not significantly alter the number of TABs. Recommendations: Given that most TABs were performed by Ophthalmology registrars, more direct supervision and techniques such as ultrasound marking may increase sample length. However, TAB lengths <20 mm are acceptable.
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INTRODUCTION: The epidemiology and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are different in children and adolescents compared with adults. Although coronavirus disease 2019 (COVID-19) appears to be less common in children, with milder disease overall, severe complications may occur, including paediatric inflammatory multisystem syndrome (PIMS-TS). Recognising the distinct needs of this population, the National COVID-19 Clinical Evidence Taskforce formed a Paediatric and Adolescent Care Panel to provide living guidelines for Australian clinicians to manage children and adolescents with COVID-19 and COVID-19 complications. Living guidelines mean that these evidence-based recommendations are updated in near real time to give reliable, contemporaneous advice to Australian clinicians providing paediatric care. MAIN RECOMMENDATIONS: To date, the Taskforce has made 20 specific recommendations for children and adolescents, including definitions of disease severity, recommendations for therapy, respiratory support, and venous thromboembolism prophylaxis for COVID-19 and for the management of PIMS-TS. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES: The Taskforce currently recommends corticosteroids as first line treatment for acute COVID-19 in children and adolescents who require oxygen. Tocilizumab could be considered, and remdesivir should not be administered routinely in this population. Non-invasive ventilation or high flow nasal cannulae should be considered in children and adolescents with hypoxaemia or respiratory distress unresponsive to low flow oxygen if appropriate infection control measures can be used. Children and adolescents with PIMS-TS should be managed by a multidisciplinary team. Intravenous immunoglobulin and corticosteroids, with concomitant aspirin and thromboprophylaxis, should be considered for the treatment of PIMS-TS. The latest updates and full recommendations are available at www.covid19evidence.net.au.
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COVID-19/complications , COVID-19/therapy , Adolescent , Age Factors , Australia , COVID-19/diagnosis , Child , Child, Preschool , Humans , Infant , Infant, NewbornABSTRACT
Background: For infection control reasons, dying patients in care facilities were isolated from their relatives due to visit restrictions, regardless of COVID-19 diagnosis. Aim: To explore bereaved relatives' experiences with visit restrictions of dying patients during the COVID-19 pandemic. Methods: Post-bereavement online survey plus additional semi-structured in-depth interviews to assess relatives' experiences with patients who died between 3.-11.2020 in different care settings, with/without COVID-19. Quantitative data were analysed descriptively including subgroup analysis and qualitative data by content analysis. The presented results focus on relatives' experiences with visit restrictions and are part of the PallPan project which develops a 'National Strategy for Palliative Care during a Pandemic'. PallPan is a project of the National Network University Medicine (NUM) to manage and overcome the pandemic. Results: 81 relatives responded to the online survey, 87.5% felt burdened by the pandemic-associated circumstances, 9.6% reported that even after the end of the official visitor ban, visits were not allowed in all facilities and the majority of relatives (65.4%) still felt burdened. Interviews with 32 relatives revealed the importance of visits respectively the burden relatives suffered when visits were prohibited. This caused difficulties in communication with the healthcare team about the patient's condition/treatment and reduced the possibility of (physical) closeness with the dying. Case-by-case decisions to allow companionship and farewell were valued by the bereaved. Conclusion: Visit restriction at the patient's end of life caused a great burden on relatives even months after the patient's death. Concepts to enable visits during the last days of life are needed including flexible pathways to ensure shared time and close companionship of patients and relatives.
ABSTRACT
Background: The COVID-19 pandemic has disrupted many aspects of clinical practice in oncology, particularly in making timely cancer diagnosis. Our public health system has been concerned about potential delays leading to a higher proportion of patients with advanced stages. Our cancer diagnosis fast-track program (CFP) in the Clinic-Malvarrosa Health department in Valencia (Spain) is connecting primary care (PC) with different specialists to speed cancer diagnosis and treatment upon well founded suspicion. A 10-year evaluation of our CFP has recently been published. The aim of this analysis was to investigate the impact of the COVID-19 pandemic on the CFP. Methods: We analysed the programme flow during the state of emergency starting on March 16, 2020 for one year. Results: During that year, 975 suspected cancer cases were submitted to the CFP. The submissions only decreased during the times of highest COVID-19 incidence and stricter lockdown (March, April and October 2020). However, referrals were slightly higher than in the two previous years (average 877). Of those 975 patients, 817 were seen by the corresponding specialist. A cancer diagnosis was confirmed in 197 (24.1%) with 33% urological, 23% breast, 16% gastrointestinal and 9% lung cancer. Median time from referral to the specialist visit was 13 (interquartile range, 8 to 22 days) days and a diagnosis was reached in a median of 18 days (interquartile range, 10 to 30 days). In cancer patients, treatment was started in around 30 days (interquartile range, 13.5 to 51 days) from the time of diagnosis. Sixty-one percent of cancers were found in an early stage, 20% in a locally advanced stage, and 19% in an advanced stage. These intervals and proportions were similar to the previous years. Conclusions: Our programme has proven to be a reliable tool to help PC physicians referring patients with cancer suspicion cancer, maintaining its normal flow and efficacy despite the current pandemic. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.