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1.
Journal of Investigative Medicine ; 70(4):1167, 2022.
Article in English | EMBASE | ID: covidwho-1868773

ABSTRACT

Purpose of Study Streptococcus intermedius is a Gram-positive bacterium that is part of normal oropharyngeal flora but can cause serious infections such as brain and liver abscesses. An increase of brain abscess cases related to sinusitis were recognized during the coronavirus disease 2019(COVID-19) pandemic. We present three cases of brain abscess related to sinusitis in pediatric patients. S. intermedius was isolated in all cases. Methods Used A retrospective chart review was performed in patients with brain abscess whose cultures grew S. intermedius during the COVID-19 pandemic. Summary of Results Case 1: A 6-year-old male with 4-day history of headaches, diagnosed with viral infection by his pediatrician. He was also seen at an Urgent Care facility for fevers and managed supportively. He then developed a seizure- like episode which prompted an emergency room (ED) visit. Head computerized tomography (CT) revealed bifrontal epidural abscess and pansinusitis. He underwent bifrontal craniotomy with evacuation of epidural abscess and maxillary antrostomy. He was treated with a prolonged course of IV antibiotics with good response to treatment and resolution of seizures. Case 2: A 9-year-old female with left eye pain and swelling for six days associated with headaches and emesis. She was diagnosed with a hordeolum at an ED. Worsening of symptoms prompted a second ED visit where a CT revealed preseptal cellulitis and abscess. Further imaging showed left orbital abscess with epidural abscess. She underwent bicoronal craniotomy with evacuation of abscess and maxillary antrostomy. Treatment also included a prolonged course of IV antibiotics. She was discharged at neurologic baseline. Case 3: A 14-year-old male with fever, left eye and forehead swelling for two weeks. At the initial ED visit, he was diagnosed with a 'boil' and prescribed antibiotics and steroids. He had interval improvement of swelling but continued with daily fevers and developed vomiting prompting another ED visit. He was admitted to the pediatric intensive care unit (PICU) due to hypertension and vision changes. Upon arrival to the PICU, he required immediate cardiopulmonary resuscitation due to pulseless ventricular tachycardia. Further workup demonstrated extensive subdural empyema and partial venous sinus thrombosis. Left decompressive hemicraniectomy and maxillary antrostomy was done emergently. He received a prolonged course of IV antibiotics. He developed right sided weakness, required nutritional and ventilatory support despite appropriate treatment. Conclusions S. intermedius can cause life threatening intracranial infections which may have increased during the COVID- 19 pandemic for reasons unknown. The diagnosis is often delayed as patients present with nonspecific symptoms. Prompt neurosurgical intervention and administration of prolonged antibiotics improve outcomes.

2.
Journal of Museum Education ; 46(4):454-466, 2021.
Article in English | CAB Abstracts | ID: covidwho-1839840

ABSTRACT

The COVID-19 pandemic is a global, collective, traumatic experience. Trauma-aware museum educators can play a therapeutic role in helping visitors reengage with life as the world reopens. This article explores the dynamics of what a trauma-aware approach to engaging with art may be, specifically detailing methods that can create new cognitive, emotional, and sensory experiences that contradict the experiences of trauma by replacing them with sensations rooted in agency and connection. Through their experiences working at different museums, the authors outline the main principles of trauma-aware art museum education (T-AAME) as it relates to visitors: orientation (setting a supportive tone);being with one another (regulation, attunement, and responsive pacing);choice and voice;and connection. The article also discusses museum-based art therapy as it compares to art museum education to highlight the overlaps and distinctions between the two and to show that museum experiences can be therapeutic without being therapy.

3.
National Technical Information Service; 2020.
Non-conventional in English | National Technical Information Service | ID: grc-753590

ABSTRACT

Reported cases of mumps infection in the United States (U.S.) have dropped since the introduction of the single-component mumps vaccine in 1967. After introduction of the multi-component measles, mumps, rubella (MMR) vaccine, cases in the U.S. and worldwide fell to the point where the International Task Force for Disease Eradication identified mumps for eventual global eradication. By 1991, all military recruits received an MMR vaccine. By 2010, the Department of Defense (DoD) had adopted a policy of immunizing recruits with MMR vaccine only if their antibody titers to measles or rubella had dropped below threshold levels established by the commercial testing laboratories as indicative of immunity. As part of a 2010 Defense Health Board (DHB) review of MMR immunization practices by the Department of the Navy, the DHB recommended that the Navy continue the practice of MMR immunization based on serosurveillance, but that universal MMR vaccination be re-instituted in the event of an increased risk of a mumps outbreak.

4.
Journal of Investigative Medicine ; 70(2):589, 2022.
Article in English | EMBASE | ID: covidwho-1707355

ABSTRACT

Case Report Multi-system inflammatory syndrome in children (MIS-C) is a recently described clinical syndrome in children that continues to progress in its manifestations. The syndrome is associated with the novel coronavirus disease 2019 (COVID-19), and can affect any organ system in the body, leading to a wide variety of symptoms. This syndrome is often misdiagnosed in its initial presentation, and many families require multiple evaluations before finally being diagnosed and admitted for the appropriate treatment. Symptoms are caused by overwhelming inflammation and often involve the gastrointestinal, integumentary, cardiac, and hematologic systems. A high index of suspicion at the time of initial presentation should be maintained to obtain an accurate diagnosis of MIS-C. Patient Case We report the case of a previously healthy 11-year-old male who presents with acute cervical lymphadenitis that did not respond to appropriate outpatient antibiotic therapy. He has a history of testing positive for SARS-CoV-2 via PCR, associated with mild cough and rhinorrhea, about three weeks prior to the onset of current symptoms. Upon initial presentation physical exam and laboratory results were not consistent with MIS-C, however inflammatory markers were slightly elevated which was consistent with a diagnosis of cervical lymphadenitis. Over the course of the next several days, the patient developed gastrointestinal symptoms including abdominal pain, vomiting and diarrhea. He also developed non-purulent conjunctivitis, and a generalized erythematous rash, associated with significant leukocytosis, transaminitis, and elevated coagulation markers. His electrocardiogram (EKG), and echocardiogram (ECHO) remained within normal limits despite elevated pro-BNP levels, and he later developed significant hypotension, hypoxemia, and bilateral pleural effusions requiring a short course of diuretics. The patient remained febrile despite receiving a normal saline bolus, treatment with intravenous immune globulin (IVIG), and intravenous steroids. He had ongoing symptoms, and the erythematous rash reappeared. His steroid dose was increased, and the patient had a good response in both labs, and clinical status. Leukocytosis has continued, but there is significant improvement in all other inflammatory markers, and the patient is on course to be discharged home safely. Conclusion Many patients are unfortunately misdiagnosed after multiple evaluations before the final diagnosis of MIS-C is made. Multi-system inflammatory syndrome in children (MISC) may mimic other conditions such as gastroenteritis, acute appendicitis, Kawasaki Disease, sepsis, or even lymphadenitis. Clinicians should be alert to subtle signs of inflammation, such as lymphadenitis, that may progress to more classic symptoms of MIS-C such as persistent fever, abdominal pain, and a rash.

5.
Occup Med (Lond) ; 72(1): 35-42, 2022 01 13.
Article in English | MEDLINE | ID: covidwho-1501101

ABSTRACT

BACKGROUND: Health care workers (HCWs) have been recognized as being at higher risk for coronavirus disease 2019 (COVID-19) infection; however, relevant factors and magnitude have not been clearly elucidated. AIM: This study was aimed to describe COVID-19 infections among hospital employees at a large tertiary care hospital located in Ontario, Canada from March to July 2020, towards better understanding potential risk factors. METHODS: Data on all HCWs with either a positive COVID test or a high-risk exposure from March to July 2020 were analyzed. HCWs with positive COVID test results and high-risk exposures were described. Those who developed COVID-19 following high-risk exposure were compared to those who did not. Data were also analyzed to determine trends over time. RESULTS: Over the period of observation, 193 staff (2% of total working staff) had a positive COVID-19 test. Incidence of HCW infections closely followed community incidence. Overall, 31% of COVID-19 cases were deemed occupationally acquired. Of these, 41% were acquired from a patient, with the remainder (59%) from fellow staff. Over the same period, 204 staff were identified as having a high-risk exposure. The majority of exposures (55%) were patient-associated, with the remaining (45%) resulting from staff-to-staff contact. Overall, 13% went on to develop COVID-19. Of these cases, 58% were patient-associated and 42% were a result of staff-to-staff transmission. CONCLUSIONS: HCWs are at risk for work-related COVID-19. Given the number of infections attributed to staff-staff transmission, greater attention could be paid to implementing prevention measures in non-clinical areas.


Subject(s)
COVID-19 , Health Personnel , Humans , Ontario/epidemiology , Personnel, Hospital , Risk Factors , SARS-CoV-2
6.
Stroke ; 52(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1234427

ABSTRACT

Background: The Colorado Pediatric Stroke Program provides comprehensive, multidisciplinary care for pediatric stroke patients and their families. The team, which includes dedicated inpatient and outpatient nurse coordinators, instituted a plan to support the transition from the inpatient to outpatient setting. Purpose: A survey was used to determine family preparedness for clinic and ease of scheduling their appointment. The data were collected before and after enacting remote scheduling and telehealth visits due to the COVID-19 pandemic. Methods: Our team provided educational materials and an outpatient appointment time to families at time of discharge starting in 2019. In January 2020, the stroke clinic staff surveyed parents and guardians about their preparedness for clinic. Telehealth encounters were initiated due to COVID-19 in March 2020, with staff conducting RedCAP surveys by telephone. The survey measured several components of visit preparedness and satisfaction including: understanding of diagnosis, reason for referral prior to clinic visit, familiarity with the stroke team prior to clinic visit, and ease in appointment scheduling. We compared results before and after March 2020 via two-tailed chisquare analysis or two-tailed Fischer's test. Results: Prior to telehealth, families favorably reported responses with 92% (47/52) knowing the reason for referral, 86% (42/49) receiving educational material prior to clinic, and 84% (42/50) reporting familiarity with our team. All patients (50/50) reported that scheduling was easy. Only scheduling ease had a significant change during the pandemic, with 11% (2/11) of patients reporting difficulties with scheduling after starting telehealth (P=0.03). Conclusion: Childhood stroke is a disease with significant morbidity and mortality, requiring close follow-up care. Families report robust preparedness for clinic after the implementation of a comprehensive discharge plan. Although small numbers, remote scheduling and telehealth transition may present previously unseen barriers to scheduling during the pandemic. During abrupt changes in clinical operations additional scheduling resources may be needed to ensure continuity of care.

7.
Thorax ; 76(SUPPL 1):A59-A60, 2021.
Article in English | EMBASE | ID: covidwho-1194253

ABSTRACT

Introduction COVID-19 mortality rates are high, particularly in patients requiring invasive ventilatory support, developing a cytokine storm, or experiencing thromboembolic disease. Our goal was to determine if traffic-light driven, personalised care was associated with improved survival in acute hospital settings. Methods Outcomes were evaluated during two implementation phases of a real-time clinical decision support tool that had been developed as part of a Trust's COVID-19 response, using a reporting and bioinformatics team to support Clinical and Operational teams. Following optimisation, the tool defined patients' clinical status in terms of risk of preventable complications based on blood test results (Ddimer, C reactive protein and ferritin). Feedback to wardbased clinicians enabled rapid modification of care pathways, in the first phase following a daily review, and in the second phase, in real-time (dashboard updated every 10 minutes). Results 1039 COVID-19 positive patients were admitted by 21/05/2020. Focusing on the first 939 completed encounters to death or home discharge (median age 69ys;60% [563/939] male), 568/939 (60.4%) received thromboembolism risk flags, and 212/939 (22.5%) cytokine storm flags. The maximum thromboembolism flag discriminated completed encounter mortality between no flag (9.97% [37/371]);medium-risk (28.5% [68/239]);high-risk (51.2% [105/205]);and suspected thromboembolism (52.4% [65/124]), Kruskal Wallis p<0.0001. 173 of 535 consecutive COVID-19 positive patients whose hospital encounter completed before real-time introduction died (32.3% [95% confidence intervals 28.0, 36.0]), compared to 46 of 200 (23.0% [95% CI 17.1, 28.9]) admitted after implementation of real-time traffic light flags (p=0.013). The realtime cohort were older (median age 72ys compared to 67ys, p=0.037), and were more likely to flag at risk of thromboembolism on admission. However, adjusted for age/sex, the probability of death was 0.33 (95% confidence intervals 0.30, 0.37) before real-time implementation, and 0.22 (0.17, 0.27) after real-time implementation (p<0.001). In subgroup analyses, older patients, males, and patients with hypertension (p£0.01) and/or diabetes (p=0.05) derived the greatest benefit from admission under the real-time traffic light system. Conclusion Personalised early interventions were associated with a reduction in mortality. We suggest benefit predominantly resulted from early triggers to review/enhance anticoagulation management, without exposing lower-risk patients to potential risks of full anticoagulation therapy.

8.
Scandinavian Actuarial Journal ; 2021.
Article in English | Scopus | ID: covidwho-1096379

ABSTRACT

This paper describes a general approach for the stochastic modeling of assets returns and liability cash-flows of a typical pensions insurer. On the asset side, we model the investment returns on equities and various classes of fixed-income instruments including short- and long-maturity fixed-rate bonds as well as index-linked and corporate bonds. On the liability side, the risks are driven by future mortality developments as well as price and wage inflation. All the risk factors are modeled as a multivariate stochastic process that captures the dynamics and the dependencies across different risk factors. The model is easy to interpret and to calibrate to both historical data and to forecasts or expert views concerning the future. This feature is particularly useful in unprecedented circumstances like pandemics when historical data alone does not give a reasonable description of the future. The simple structure of the model allows for efficient computations. The construction of a million scenarios takes only a few minutes on a personal computer. The approach is illustrated with an asset-liability analysis of a defined benefit pension fund, pre- and post-COVID-19. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

9.
British Journal of Pharmacology ; 178(2):390-391, 2021.
Article in English | Web of Science | ID: covidwho-1085822
10.
J Intern Med ; 288(4): 469-476, 2020 10.
Article in English | MEDLINE | ID: covidwho-810836

ABSTRACT

INTRODUCTION: Higher comorbidity and older age have been reported as correlates of poor outcomes in COVID-19 patients worldwide; however, US data are scarce. We evaluated mortality predictors of COVID-19 in a large cohort of hospitalized patients in the United States. DESIGN: Retrospective, multicenter cohort of inpatients diagnosed with COVID-19 by RT-PCR from 1 March to 17 April 2020 was performed, and outcome data evaluated from 1 March to 17 April 2020. Measures included demographics, comorbidities, clinical presentation, laboratory values and imaging on admission. Primary outcome was mortality. Secondary outcomes included length of stay, time to death and development of acute kidney injury in the first 48-h. RESULTS: The 1305 patients were hospitalized during the evaluation period. Mean age was 61.0 ± 16.3, 53.8% were male and 66.1% African American. Mean BMI was 33.2 ± 8.8 kg m-2 . Median Charlson Comorbidity Index (CCI) was 2 (1-4), and 72.6% of patients had at least one comorbidity, with hypertension (56.2%) and diabetes mellitus (30.1%) being the most prevalent. ACE-I/ARB use and NSAIDs use were widely prevalent (43.3% and 35.7%, respectively). Mortality occurred in 200 (15.3%) of patients with median time of 10 (6-14) days. Age > 60 (aOR: 1.93, 95% CI: 1.26-2.94) and CCI > 3 (aOR: 2.71, 95% CI: 1.85-3.97) were independently associated with mortality by multivariate analyses. NSAIDs and ACE-I/ARB use had no significant effects on renal failure in the first 48 h. CONCLUSION: Advanced age and an increasing number of comorbidities are independent predictors of in-hospital mortality for COVID-19 patients. NSAIDs and ACE-I/ARB use prior to admission is not associated with renal failure or increased mortality.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/epidemiology , Diabetes Mellitus/epidemiology , Disease Management , Hypertension/epidemiology , Pneumonia, Viral/epidemiology , Age Factors , COVID-19 , Comorbidity , Coronavirus Infections/therapy , Diabetes Mellitus/therapy , Female , Follow-Up Studies , Hospital Mortality/trends , Humans , Hypertension/therapy , Inpatients , Male , Michigan/epidemiology , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Prevalence , Prognosis , RNA, Viral/analysis , Retrospective Studies , Risk Factors , SARS-CoV-2 , Survival Rate/trends
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