Oxidative stress in diverse clinical conditions of SARS-CoV-2 Cuban hospitalized patients

Context: COVID-19 related to SARS-CoV-2 infection generates inflammation with increased reactive oxygen species production. Drug treatment and others factors could influence systemic oxidative stress during pathogenic insult. Aims: To determine the redox status in COVID-19 patients with different clinical conditions and explore the relationship between redox and hematological hemochemical variables. Methods: In this comparative longitudinal study, blood samples were drawn from 160 individuals divided into four groups: COVID-19 asymptomatic, COVID-19 symptomatic (low and moderate symptoms), COVID-19 convalescent, and presumable healthy subjects. Demographic, redox, hematological, and hemochemical indices were assessed. Statistical analyses compared the median values of each variable and explored individual, simultaneous indices, and multivariate alteration. Results: Relative to the healthy group, acute COVID-19, and convalescent groups had significant differences in global damage indices and antioxidant status (p<0.05). The convalescent group showed significantly higher damage (malondialdehyde, advanced oxidation protein products, nitric oxide) and lower antioxidant enzymatic activities and glutathione concentration compared to other groups (p<0.05). Global modification of redox indices showed that more than 80% of studied individuals in acute conditions had simultaneous detrimental differences compared to a healthy status. The discriminant analysis permitted obtaining two canonical functions (p< 0.05) that reflect 98% of redox variables with 95% of variances with successful case classifications. Conclusions: These results corroborate that oxidative stress occurred in different COVID-19 and post-acute conditions with different molecular alterations of redox indices. Redox diagnosis should be considered in early diagnosis and treatment of infection, which would be worthwhile to conduct a more comprehensive study and management of disease evolution. © 2023 Journal of Pharmacy & Pharmacognosy Research.

INDEX SCREENING COLONOSCOPY QUALITY METRICS FOR TRAINEES HAVE IMPROVED DURING THE COVID-19 PANDEMIC

Introduction: The coronavirus-2019 (COVID-19) pandemic has led to the suspension of elective outpatient procedures. Clinical educators have raised concerns that gastroenterology fellows have gotten reduced endoscopy exposure with possible decrease in quality metrics. We investigated whether quality parameters such as adenoma detection rate (ADR) and withdrawal times in index screening colonoscopies where fellows were involved have been affected now that elective procedures have resumed in greater numbers. Methods: This is a single-center observational study comparing patients who underwent index screening colonoscopies since our outpatient facilities reopened (7/1/2021 through 9/30/2021) with a pre-pandemic cohort (7/1/2018 through 9/30/2018). We collected demographic information and we tabulated the number of polyps detected, the number of tubular adenomas, and the withdrawal times. We used Chi-square testing to determine significance among our categorical variables and used t-tests to compare means for our numerical variables, particularly between procedures with and without fellow involvement, and between cohorts. All statistical analysis was done in R (R Core Team, 2020). Results: We identified 121 patients in the 2018 cohort without trainee involvement and 38 patients in the same cohort wherein fellows did the procedure. We also identified 186 patients in the 2021 cohort without fellow involvement and 58 patients in the same cohort wherein a trainee did the procedure (Table 1). The 2018 group had an overall ADR of 32.2% (25.0% for women, 39.3% for men) without fellows, and an overall ADR of 21.1% (5.6% for women, 35.0% for men) with trainees. The ADR for women was significantly lower for trainees (p=0.01), but otherwise ADR and withdrawal times were not significantly different. The 2021 cohort, however, showed improvement in all ADRs for fellows compared to 2018, and the ADR for women was equivalent to that of the attendings. Moreover, the withdrawal times were significantly longer for trainees in 2021 (18.9 vs. 15.3 minutes;p=0.01). When comparing fellows' metrics from 2018 and 2021, there was no statistically significant difference in overall ADR, ADR for men, or withdrawal times, though ADR for women had improved (p=0.02). Conclusion: When compared to a similar pre-pandemic cohort, the quality metrics for index colonoscopies have improved for our fellows, particularly with regard to female patients. We are undertaking further data collection to ensure that our findings are stable over a longer time period.(Table Presented) (Table Presented)

INDEX SCREENING COLONOSCOPY QUALITY METRICS HAVE NOT DIMINISHED DURING THE PANDEMIC

Introduction: The ongoing coronavirus-2019 (COVID-19) pandemic has seen a decrease in the overall number of screening colonoscopies performed with the suspension of elective outpatient procedures. We sought to evaluate whether screening colonoscopy quality parameters such as adenoma detection rate (ADR) and withdrawal times have been affected now that such elective procedures have resumed in greater numbers. Methods: This is a singlecenter observational study comparing patients who underwent index screening colonoscopies since our outpatient facilities reopened (7/1/2021 through 9/30/2021) with a pre-pandemic cohort (7/1/2018-9/30/2018). We collected demographic information including patient age, sex, comorbidities, among others, and we tabulated the number of polyps detected, the number of tubular adenomas, and the withdrawal times. We used Chi-square testing to determine significance among our categorical variables and used t-tests to compare means for our numerical variables. All statistical analysis was done in R (R Core Team, 2020). Results: We identified and included 159 patients in the 2018 cohort and another 244 patients in the 2021 cohort (Table 1). The pre-pandemic group included 78 women (49.1%) and had an overall ADR of 29.6% (20.5% for women, 38.3% for men). The 2021 group was larger and included 133 women (54.5%) and had an overall ADR of 32.0% (27.1% for women, 37.8% for men). We found no statistically significant differences in patient characteristics, number of polyps detected, or ADR between the two groups (Tables 1 and 2). There was no significant difference in the odds of detecting an adenoma based on day of the week, morning versus afternoon session, or involvement of a fellow. We found an increase in mean withdrawal time in the 2021 cohort (16.2 minutes vs. 13.6 minutes, p= 0.005) compared to pre-pandemic. Conclusion: The pandemic has not adversely affected the quality of screening colonoscopies performed at our institution, regardless of when the procedure was done or whether a trainee was involved. We are undertaking further data collection to ensure that our findings are stable over a longer time period. (Table Presented) (Table Presented)

SURVEILLANCE COLONOSCOPY METRICS HAVE IMPROVED FROM BEFORE THE PANDEMIC

Introduction: Since the start of the coronavirus-2019 (COVID-19) pandemic, there has been a decrease in the overall number of elective gastroenterology procedures. We sought to evaluate whether surveillance colonoscopy quality parameters such as polyp detection rate (PDR) and withdrawal times have been affected now that such elective procedures have resumed in greater numbers. Methods: This is a single-center observational study comparing patients who underwent surveillance colonoscopies since our outpatient facilities reopened (7/1/2021 through 9/30/2021) with a pre-pandemic cohort (7/1/2018-9/30/2018). We collected demographic information including patient age, sex, comorbidities, among others. We then tabulated the number of polyps detected, the number of tubular adenomas (TA), and the withdrawal times. We used Chi-square testing to determine significance among our categorical variables and used t-tests to compare means for our numerical variables. All statistical analysis was done in R (R Core Team, 2020). Results: Our pre-pandemic cohort included 195 patients (86 women;44.1%), of whom 81 (41.5%) had a TA on their surveillance colonoscopy. Our 2021 cohort consisted of 308 patients (140 women;45.5%), of whom 149 (48.4%) had a TA on surveillance (Tables 1 and 2). The mean PDR was significantly higher in the 2021 cohort (2.2 vs. 1.5 polyps per colonoscopy;p=0.001), and the mean withdrawal time was likewise longer compared to the pre-pandemic cohort (18.9 minutes vs. 15.8 minutes;p=0.002). While the rate of tubular adenoma detection was similar overall in both groups (41.5% vs. 48.4%;p=0.13), it was higher for male patients in the 2021 group compared to 2018 (55.4% vs. 43.1%;p=0.04). We found no difference in polyp or TA detection based on patient comorbidities, age, sex, race, day of the week, morning versus afternoon endoscopy session, or whether a fellow was involved in the procedure. Conclusion: Despite the 1.5-year hiatus in elective procedures, our quality metrics for surveillance colonoscopies have improved from before the pandemic, and this may be related to longer withdrawal times. We have been able to carry out more surveillance procedures compared to a similar pre-pandemic period irrespective of patient demographic factors, procedure timing, and trainee involvement. We are undertaking further data collection to ensure that our findings are stable over a longer time period. (Table Presented) (Table Presented)