ABSTRACT
Introduction: Due to the presence of ACE 2 receptors in the diaphragm, its involvement is likely among patients with Covid 19. This study aimed to describe the presence of diaphragm dysfunction among patients who have recovered from Covid 19. Method(s): The thickness fraction (TF) of the diaphragm was assessed via ultrasonography in supine or semirecumbent posture in the right hemidiaphragm in the zone of apposition. A TF of less than 20% was classified as diaphragm dysfunction. Result(s): A total of 50 (males 34) with a mean age of 49.36 years and recovered from acute Covid were enrolled in the study. Among these 50 participants, 11, 12, and 27 had recovered from mild, moderate, severe Covid, respectively. Overall, 37(74%) subjects were hospitalized, 13 (26%) cases were home quarantined;30 (60%) subjects required oxygen during the course of illness. The average weeks from the onset of symptoms to enrolment was 7.1 weeks. Among the study participants, 9 (18%) subjects (8 males and 1 female) had diaphragm dysfunction (thickness fraction less than 20%). Among subjects who were managed at the hospital (n=37), diaphragm dysfunction was observed in 8 (21.6%). Of patients who had diaphragm dysfunction, 3 out of 9 had mild disease, whereas 6 of 9 (66.6%) subjects had severe illness. sub7 out of 9 (77.7%) subjects were hospitalized and 6 required oxygen during the illness. Conclusion. A significant percentage of COVID-19 survivors had diaphragm dysfunction which may also attribute to the persistent shortness of breath. There is an urgent need for large-scale (nationwide) assessment of diaphragm function among the survivors.
ABSTRACT
Introduction: The persistence of symptoms beyond 4 weeks of SARS-CoV-2 infection is referred to as long COVID. There is lack of data about the clinical determinants and natural history of this condition. Aims & objectives: We aimed to determine the risk factors, symptomatology, spirometric abnormalities and evolution of long COVID over a 1-year period. Method(s): We enrolled adult patients at 1-4 months after diagnosis of COVID-19. The demographics, COVID-19 history, clinical symptoms and spirometric results were recorded. Follow-up assessments were done in-person or telephonically at 4-8 months and 8-12 months, respectively. Result(s): We enrolled 128 patients (69% male) with median (IQR) age of 49 (37-56) years. Among these, 99 (77%) needed hospitalization, and 47 (37%) received oxygen for COVID-19. At the 1st assessment at median (IQR) of 64.5 (39.5-90) days after COVID-19 onset, 86 (67%) patients had symptoms, most commonly dyspnea (34%), fatigue (19%) and cough (19%). Reduced FVC (<80% of predicted) was found in 61% subjects. On multivariate analysis, the predictors of symptomatic long COVID were female gender (OR, 4.1;95% CI: 1.5-11;p=0.006) and dyspnea during acute COVID-19 (OR, 3.6;95% CI:1.1-11.3;p=0.03). The predictors of reduced FVC were dyspnea (OR, 4.4;95% CI: 1.6-12;p=0.004) and oxygen therapy (OR, 5.6;95% CI: 1.5-21;p=0.01) during acute COVID-19. The proportion of symptomatic patients reduced between 1st and 2nd assessment (67% vs 37%, p<0.001) and then plateaued at 3rd assessment (42%). Conclusion(s): Persistent symptoms are common over a 1-year follow-up among survivors of COVID-19. Female gender and dyspnea during acute COVID-19 may predict development of long COVID.
ABSTRACT
BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic profoundly impacted delivery of health care. South Western Sydney Local Health District (SWSLHD) experienced some of the highest cases, admissions and deaths during the Delta and Omicron waves in New South Wales. This study aims to determine the impact of the pandemic on emergency surgery services for adults presenting with acute appendicitis. METHODS: A retrospective review of patient records was performed of adults presenting with acute appendicitis between 1st March 2021 and 31st March 2022, which was compared to a pre-COVID control period of the same dates in 2019-2020. Patients managed operatively or conservatively were included. RESULTS: 1556 patients were included in the operative arm; 723 and 833 respectively in the study and control groups, which were comparable at baseline. 1.66% were COVID positive. During the pandemic, patients were significantly more likely to be investigated with computered tomography (CT) scan (p ≤ 0.001), present with complicated appendicitis (p = 0.03), and require caecectomy (p = 0.005). They had higher American Society of Anaesthesiology (ASA) scores (p = 0.001) and significantly lower negative appendectomy rates (p = 0.001). Fifty-two patients were included in the conservative arm; 29 and 23 respectively in the pandemic and control groups. Patients were comparable at baseline. There were two COVID positive patients. During the pandemic, there was a significant reduction in complications (p = 0.033), readmissions (0.044) and interval appendicectomy (p = 0.0044). CONCLUSION: We identified higher rates of complicated appendicitis, caecectomies and greater reliance on CT imaging preoperatively during the pandemic in SWSLHD.