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INTRODUCTION: Several state-based and single center studies have demonstrated evidence of higher COVID-19 exposure rates, infection rates, and worse morbidity and mortality outcomes among minorities. Furthermore, challenges with vaccine access, hesitancy, distrust of the medical system further influenced who was protected from COVID-19.This study combines databases to conduct a multisite study across diverse states during the pandemic. METHOD(S): We conducted an ancillary study using the VIRUS (Viral Infection and Respiratory illness Universal Study) registry data supplemented by electronic medical record data from Mayo Clinic enterprise to assess demographics and outcomes among hospitalized patients with severe COVID-19. We included hospitalized adult patients admitted in five participating sites between April 2020 and January 2022 including academic hospitals in MN, AZ, and FL and two community hospitals in MN and WI. Selfidentified race and ethnicity data was categorized as White, Black, Asian, and Other;Hispanic and non-Hispanic. Other baseline characteristics, disease severity, and vaccination status were included in the analyses. The primary outcome was hospital mortality, the secondary outcomes were length of stay and healthcare utilization. Multivariable regression models were developed to analyze the interactions of relevant variables to predict outcomes. RESULT(S): 6904 patients were included. 3398 (57.8%) were male and 86.9% White,3.6% Black,3.3% Asian,6.2% Other. The mean age of Whites was 64.9 years v.53.8, 58, 52.8 respectively (p< 0.0005). Whites had higher Charlson comorbidity scores-5.2 v.4.0,3.6,3.0 respectively (p< 0.005). Vaccination rates were low in cohort, but higher among Whites 11.2% v.5.4%,4.6%,5.0% respectively (p< 0.0005). Mortality outcomes between different racial groups did not differ (p=0.41). Non-Hispanics were older than Hispanics- mean age 64.5 years v.53 (p< 0.005) and had higher Charlson comorbidity scores-5.2 v.3.4 (p< 0.005) Vaccination rates among non-Hispanics were 10.7 v 3.4% (p< 0.005)). Mortality outcomes between ethnic groups did not differ(p=0.86). Mortality outcomes between vaccinated and unvaccinated patients did not differ (p=0.9). CONCLUSION(S): Despite differences in risk factors between demographic groups, outcomes did not differ significantly in this cohort.
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INTRODUCTION: During the COVID-19 pandemic, the burden on the healthcare system makes it critical to examine readmission patterns. In this study, we evaluated the readmission rates and risk factors associated with COVID-19 from the large SCCM Discovery VIRUS: COVID-19 Registry. METHOD(S): This was a retrospective, cohort study including hospitalized adult patients from 181 hospitals in 24 countries within the VIRUS: COVID-19 Registry. Demographic, clinical, and outcome data were extracted and divided into two groups: Patients with readmission with COVID-19 in 30 days from discharge and those who were not. A univariate analysis is done using chi-square and t-test as appropriate. Multivariable logistic regression was used to measure risk factor associations with 30-day readmission. RESULT(S): Among 20,283 patients, 1,195 (5.9%) were readmitted within 30 days from discharge. The median (IQR) age of readmitted patients was 66 (55-78) years and 45.2% were female, 60.2% were white, and 78.9% non-Hispanic. Higher odds of readmission were observed in patients aged >60 vs 18-40 years (OR 2.76;95% CI, 2.23-3.41), moderate COVID-19 disease (WHO Ordinal scale 4-5) vs Severe COVID-19 (WHO Ordinal scale 6-9) (OR 1.23;95% CI, 1.10-1.39), no ICU admission at index hospitalization (OR 1.70;95% CI, 1.32-1.80), and Hospital length of stay <=14 vs >14 days (OR 1.53;95% CI, 1.32-1.80) vs those not readmitted (p= < 0.001). Comorbidities including coronary artery disease (OR 2.14;95% CI 1.84-2.48), hypertension (OR 1.58;95% CI 1.40-1.78), congestive Heart Failure (OR 2.54;95% CI 2.16-2.98), chronic pulmonary disease (OR 2.26;95% CI 1.94-2.63), diabetes (OR 1.32;95% CI 1.17-1.49) or chronic kidney disease (CKD) (OR 2.41;95% CI 1.2.09-2.78) were associated with higher odds of readmission. In multivariate logistic regression adjusted for age group, hospital length of stay <=14 days and, highest WHO COVID-19 ordinal scale and index ICU admission coronary artery disease, congestive heart failure, chronic pulmonary disease, chronic kidney disease, hospital length of stay <=14 days and age >60 years remained independent risk factors for readmission within 30 days. CONCLUSION(S): Among hospitalized patients with COVID-19, those readmitted had a higher burden of comorbidities compared to those non-readmitted.
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Objective: Immunization by vaccination has a crucial role in controlling COVID-19 pandemic. Determination of the factors affecting the effectiveness of the vaccine can increase the success rates. We aimed to investigate the effectiveness of CoronaVac and factors affecting its effectiveness in healthcare workers.
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SESSION TITLE: COVID-19 Infections: Issues During and After Hospitalization SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: Pneumothorax and pneumomediastinum (PTX/PM) has been associated with patients hospitalized with COVID-19 infections. The aim of our study was to assess the risk factors, hospital length of stay, and mortality of PTX/PM among hospitalized patients with COVID-19 infection in a matched case-controlled study. METHODS: Adult patients with confirmed COVID-19 infections who were hospitalized at 5 Mayo Clinic hospitals (Minnesota, Arizona, Florida, Wisconsin) between March 2020 and January 2022 were retrospectively screened. PTX and or PM in at least two consecutive imaging studies were included. They were matched to control patients based on age, gender, hospital admission period, severity on admission day and the day preceding the incident. Summary statistics, Mann Whitney-U, and chi-square tests were performed RESULTS: A total of 197 patients were included in the descriptive analyses.The median age was 61 years and the majority were men (70.8%). Patients with underlying pulmonary comorbidities was 2.27 (OR 1.42-3.62, p value < 0.001) times more likely to develop PTX/PM. Ten percent of the total cases had these complications present upon hospital admission.Patients who developed PTX/PM had a longer hospital length of stay compared to controls, 20 versus 12 days, OR 4.53 (p=0.002). On the day prior to developing PTX/PM, 42 (31%) of patients had been on high-flow nasal cannula only and 14 on non-invasive ventilation (10.4%). The highest recorded positive end-expiratory pressure, plateau, and driving pressures were recorded in our case group on the day before the complication and all were significantly higher than matched controls. In-hospital mortality in patients whose COVID-19 course was complicated by PTX/PM was 44.2% vs. those without, 21.1%, adjusted OR 2.71 (p=0.001). Sixty two percent were treated conservatively without any intervention. CONCLUSIONS: We have demonstrated in the largest study to date, that patients who were hospitalized with COVID-19 infection and had a PTX/PM had a longer hospital length of stay, were associated with higher mechanical ventilatory pressures, and had a higher in-hospital mortality, when compared with matched controls. CLINICAL IMPLICATIONS: Complications of PTX/PM in patients with COVID-19 infections can occur spontaneously and in barotrauma. Pre-existing lung disease is a risk factor for the development of these complications. Patients with PTX/PM have a longer hospital length of stay and higher in-hospital mortality which is in contrast with existing published data. DISCLOSURES: No relevant relationships by Natalya Azadeh No relevant relationships by Meghan Brown No relevant relationships by Rodrigo Cartin-Ceba No relevant relationships by Anusha Devarajan No relevant relationships by Juan Pablo Domecq No relevant relationships by Sandeep Khosa No relevant relationships by Amos Lal No relevant relationships by Shahraz Qamar No relevant relationships by Kenneth Sakata No relevant relationships by Mayank Sharma No relevant relationships by Nikhil Sharma No relevant relationships by Jamil Taji No relevant relationships by Fahimeh Talaei No relevant relationships by Aysun Tekin No relevant relationships by Diana Valencia Morales No relevant relationships by Stephanie Welle
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The aim of this study is to investigate the effects of quarantine/social isolation on maternal depression, breastfeeding and sleep quality in mothers who have just given birth during the pandemic period that has affected the whole world. This cross-sectional study included women who gave birth during either in the first peak of the first wave (April, 2020) or the end of the first peak (July, 2020) of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic in a tertiary pandemic regional referral centre. A total of 210 patients were enrolled to the study. The research data were collected using specific questionnaires including the Pittsburgh Sleep Quality Index (PSQI), the Edinburgh Postpartum Depression Scale (EPDS) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). As a result, maternal postpartum depression and sleep quality scores did not differ significantly among postpartum women with different timelines according to the intensity of the SARS-CoV-2 pandemic (p=0.205 and p=0.352, respectively). The Breastfeeding Self-Efficacy Scale was significantly better (p=0.000) in the post-quarantine period than in the early stages of the pandemic when there were strict quarantine regulations. In conclusion, Sleep quality and postpartum depression remained unchanged with regard to the severity of the quarantine among women who gave birth during the SARS-CoV-2 pandemics. The breastfeeding self-efficacy of mothers was found as improved in the post-quarantine period.
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OBJECTIVE: There is little evidence related to the effects of the Omicron severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant on pregnancy outcomes, particularly in unvaccinated women. This study aimed to compare pregnancy outcomes of unvaccinated women infected with SARS-CoV-2 during the pre-Delta, Delta and Omicron waves. METHODS: This was a retrospective cohort study conducted at two tertiary care facilities: Sancaktepe Training and Research Hospital, Istanbul, Turkey, and St George's University Hospitals NHS Foundation Trust, London, UK. Included were women who tested positive for SARS-CoV-2 by real-time reverse-transcription polymerase chain reaction (RT-PCR) during pregnancy, between 1 April 2020 and 14 February 2022. The cohort was divided into three periods according to the date of their positive RT-PCR test: (i) pre-Delta (1 April 2020 to 8 June 2021 in Turkey, and 1 April 2020 to 31 July 2021 in the UK), (ii) Delta (9 June 2021 to 27 December 2021 in Turkey, and 1 August 2021 to 27 December 2021 in the UK) and (iii) Omicron (after 27 December 2021 in both Turkey and the UK). Baseline data collected included maternal age, parity, body mass index, gestational age at diagnosis and comorbidities. The primary outcome was the need for oxygen supplementation, classified as oxygen support via nasal cannula or breather mask, non-invasive mechanical ventilation with continuous positive airway pressure (CPAP) or high-flow oxygen, mechanical ventilation with intubation, or extracorporeal membrane oxygenation (ECMO). Inferences were made after balancing of confounders, using an evolutionary search algorithm. Selected confounders were maternal age, body mass index and gestational age at diagnosis of infection. RESULTS: During the study period, 1286 unvaccinated pregnant women with RT-PCR-proven SARS-CoV-2 infection were identified, comprising 870 cases during the pre-Delta period, 339 during the Delta wave and 77 during the Omicron wave. In the confounder-balanced cohort, infection during the Delta wave vs during the pre-Delta period was associated with increased need for nasal oxygen support (risk ratio (RR), 2.53 (95% CI, 1.75-3.65); P < 0.001), CPAP or high-flow oxygen (RR, 2.50 (95% CI, 1.37-4.56); P = 0.002), mechanical ventilation (RR, 4.20 (95% CI, 1.60-11.0); P = 0.003) and ECMO (RR, 11.0 (95% CI, 1.43-84.7); P = 0.021). The maternal mortality rate was 3.6-fold higher during the Delta wave compared to the pre-Delta period (5.3% vs 1.5%, P = 0.010). Infection during the Omicron wave was associated with a similar need for nasal oxygen support (RR, 0.62 (95% CI, 0.25-1.55); P = 0.251), CPAP or high-flow oxygen (RR, 1.07 (95% CI, 0.36-3.12); P = 0.906) and mechanical ventilation (RR, 0.44 (95% CI, 0.06-3.45); P = 0.438) with that in the pre-Delta period. The maternal mortality rate was similar during the Omicron wave and the pre-Delta period (1.3% vs 1.3%, P = 0.999). The need for nasal oxygen support during the Omicron wave was significantly lower compared to the Delta wave (RR, 0.26 (95% CI, 0.11-0.64); P = 0.003). Perinatal outcomes were available for a subset of the confounder-balanced cohort. Preterm birth before 34 weeks' gestation was significantly increased during the Delta wave compared with the pre-Delta period (15.4% vs 4.9%, P < 0.001). CONCLUSIONS: Among unvaccinated pregnant women, SARS-CoV-2 infection during the Delta wave, in comparison to the pre-Delta period, was associated with increased requirement for oxygen support (including ECMO) and higher maternal mortality. Disease severity and pregnancy complications were similar between the Omicron wave and pre-Delta period. SARS-CoV-2 infection of unvaccinated pregnant women carries considerable risks of morbidity and mortality regardless of variant, and vaccination remains key. Miscommunication of the risks of Omicron infection may impact adversely vaccination uptake among pregnant women, who are at increased risk of complications related to SARS-CoV-2. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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COVID-19 , Premature Birth , COVID-19/epidemiology , Female , Humans , Infant, Newborn , Male , Oxygen , Pregnancy , Pregnancy Outcome/epidemiology , Retrospective Studies , SARS-CoV-2ABSTRACT
Background: The first cases of COVID in the United States were reported in January 2020. The pandemic has resulted in significant precautionary measures, prolonged quarantine, and minimization of patient exposure to public areas, including in-person outpatient clinic visits and labs. Post liver transplant patients require close monitoring to ensure optimal graft function and immunosuppression modifications in order to prevent or early diagnose rejection. The aim of this study was to assess the effect of the COVID pandemic on the incidence of biopsy proven rejection. Methods: All liver biopsies of patients obtained by the Miami Transplant Institute were reviewed by the center's transplant pathologist. Histology was reported as mild, moderate- severe acute T cell mediated rejection, chronic rejection or no evidence of rejection (including indeterminate rejection) based on the Banff criteria. The year 2019 was compared to the year 2020 and 2021 in which COVID erupted in the US. Chi square test was used to compare between the groups for statistical significance. Results: Out of 1482, 1618 and 1679 adult and pediatric patients followed at our center in 2019, 2020 and 2021 (data available until May 2021) 188 (12.7%), 156(9.6%) and 79 (4.7%) had a liver biopsy in 2019, 2020, 2021 respectively (p<0.0001). Rejection was mild in 5.5/6.6%, moderatesevere in 1.6/1.1%, chronic 0.4/0.1% and no rejection in 92.6/92.2% in 2019 vs 2020 for the entire outpatient cohort. Of the biopsies performed in 2019, mild, mod-severe, chronic and no rejection was found in 43.1%, 12.2%, 3.2% and 41.5% compared with 68.6%, 10.1%, 1.3% and 19.2% in 2020 and 44.3%, 12.7%, 6.3% and 36.7% in 2021 (p<0.001) (table 1). Conclusion: Despite overall reduction in the frequency of liver biopsies performed on post LT patients during COVID, there was no overall increased percentage of rejection considering all outpatients followed. There was a substantial increase in histologically confirmed rejection during COVID of the patients who had a liver biopsy, without a surge in 2021 suggesting that clinicians were diagnosing rejections appropriately despite COVID restrictions.
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TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Despite exhaustive efforts by the global healthcare to treat COVID-19, the death toll continues to rise. Ivermectin, a known anti-parasitic agent, when re-purposed for treating COVID-19, has demonstrated positive results in several studies. We aim to evaluate the benefit and risk of Ivermectin therapy in COVID-19 patients. METHODS: We conducted a systematic search for full-text manuscripts published from February 1, 2020, to August 15, 2021, that focused on the efficacy and safety of Ivermectin use in COVID-19. Overall mortality and need for intensive care unit (ICU) admission were primary outcomes;secondary outcomes were adverse effects, need for mechanical ventilation, viral clearance, time to viral clearance, need for hospitalization, and length of hospital stay. Random-effects models were used for the quantitative and qualitative analyses. RESULTS: A total of 52 studies (n= 17561) were included in the qualitative analysis and out of these, 44 studies (n=14019) were included in the quantitative analysis. In the qualitative analysis of Ivermectin treatment, a mortality rate of 3.6%, ICU admission rate of 5.4%, mechanical ventilation rate of 3.9%, and adverse event rate of 6.6% were observed. In the overall mortality meta-analysis, odds of death were lower in the Ivermectin-arm compared to the non-Ivermectin arm (OR 0.54, p=0.009). However, in the subgroup analysis of 15 randomized controlled trials, we observed lower odds of mortality in the mild/moderate sub-group (OR 0.31, p=0.06) but without statistical significance. In the severe/critical sub-group, odds were only marginally lowered and were not statistically significant.(OR 0.86, p=0.56). The benefit with Ivermectin was not statistically significant in the meta-analysis of the need for ICU admission (OR 0.48, p=0.17), mechanical ventilation (OR=0.75, p=0.12) and duration of hospitalization (MD -1.80, p= 0.06). The meta-analysis of adverse effects was inconclusive (OR 0.87, p=0.30). Ivermectin, frequently used as adjunctive treatment, was linked with higher odds of achieving viral clearance (OR 3.52, p=0.0002), in a shorter duration (MD -4.12, p=0.02) as well as reduction in the need for hospitalization (OR 0.34, p=0.008). CONCLUSIONS: In the updated quantitative analysis, we found that mortality benefit with Ivermectin treatment is uncertain. Trends of decreased need for ICU admissions and mechanical ventilation, and duration of hospitalization were observed but were not significant. Mostly as an adjuvant treatment, Ivermectin may help accelerate viral clearance as well as reduce the need for hospitalization. Meta-analysis for adverse events suggested that there may be no difference in the adverse event rate with Ivermectin and other treatments, but this cannot be concluded with confidence. The qualitative analysis showed that Ivermectin led to better clinical outcomes in COVID-19 patients and a lower incidence of adverse events. CLINICAL IMPLICATIONS: Well-designed larger observational studies and clinical trials are needed to confirm Ivermectin's mortality benefit in COVID-19 and to further investigate its ideal dosage and timing in the disease course, drug interactions, and possible synergistic drug combinations to achieve maximum benefit. We also need to evaluate the impact of Ivermectin in patients infected with the newly emerging strains and its role in vaccinated patients. Finally, we recommend physicians to exercise caution while prescribing Ivermectin for COVID-19 while we await evidence-based guidelines. DISCLOSURES: No relevant relationships by Vikas Bansal, source=Web Response No relevant relationships by Abhishek Bhurwal, source=Web Response No relevant relationships by Shree Spandana Ghanta, source=Web Response No relevant relationships by Smruti Karale, source=Web Response No relevant relationships by Rahul Kashyap, source=Web Response No relevant relationships by Hira Khan, source=Web Response No relevant relationships by Janaki Makadia, source=Web Response No relevant relationsh ps by Ishita Mehra, source=Web Response No relevant relationships by HEMANT MUTNEJA, source=Web Response No relevant relationships by ROMIL SINGH, source=Web Response No relevant relationships by Muhammad Tayyeb, source=Web Response No relevant relationships by Aysun Tekin, source=Web Response
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Objective: Virtual learning experiences have become widely used during the ongoing COVID-19 global crisis. Given its cost-effectiveness, accessibility, and flexibility, remote training experiences are likely to assume a permanent and expanded role in medical education and quality improvement initiatives. However, little is known about how best to measure the effectiveness of remote training interventions. The Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) is an established critical care quality improvement program with evidence of improved care processes and patient outcomes in an international quality improvement trial. Our aim was to develop a structured implementation and longitudinal evaluation framework that measures the complex contributors to the impact of this remote training program, including incorporation into processes of care and sustainment over time. Methods: We convened an international topic review group that included individuals with diversity in clinical expertise, nationality, and experience in medical education, quality improvement, implementation science, and research methodology. We recruited individuals with experience designing and participating in various medical remote training programs, including teleconferences, tele-consults, online video/chat platforms, and virtual simulation classrooms. Through a series of facilitated discussions, we directed the group to develop a conceptual framework to guide the development of remote learning programs and accompanying evaluation tools to measure their impact. Results: The review group members included education experts and continuing medical education participants from China and the United States with practice backgrounds in Critical Care, Internal Medicine, Anesthesiology and Emergency Medicine. The group developed a conceptual framework based on the CIPP (context-input-process-product) quality evaluation model. The framework includes three phases: before, during, and after the remote training. The proposed quantitative and qualitative evaluation tools blend the Proctor taxonomy, an expansion of the popular RE-AIM framework used to categorize implementation outcomes, to include early (i.e. acceptability, appropriateness, feasibility), mid (i.e. adoptions, fidelity), and late (i.e. sustainability) stage outcomes to provide a more complete understanding of the implementation process and facilitate generalization of our findings. Elements of the Logic Model were also used to guide the program development process. Conclusions: We propose a dynamic, longitudinal implementation evaluation framework that has sufficient rigor and flexibility to meet the needs of the existing and emerging remote medical training programs in global practice settings. The outcomes from these mixed-methods analyses will provide a robust toolbox to guide the design, delivery, implementation, and sustainment of remote medical educational programs.