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1.
Chest ; 162(4):A2002, 2022.
Article in English | EMBASE | ID: covidwho-2060885

ABSTRACT

SESSION TITLE: Occupational and Environmental Lung Disease Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Hypersensitivity Pneumonitis (HP) one of the most common interstitial lung diseases (ILD) and is caused by an allergic reaction to an inciting agent in the airway of a susceptible individual1. The diagnosis is challenging as many of the classic symptoms, dyspnea and fatigue, are nonspecific. An accurate diagnosis involves careful history taking, physical exam, pulmonary function tests (PFTs), chest computed tomography (CT) imaging, and lung biopsy. CASE PRESENTATION: Patient is a 51 year old female with no PMH presents to clinic with worsening dyspnea and nonproductive cough. Symptoms began 6 months ago. She could not identify any triggers and was prescribed steroids and antibiotics with minimal relief. The patient has never smoked, denies drug use but had two pigeons. During the COVID pandemic she admitted to staying indoors more often and was not nearly as active outdoors as before. She denied fevers, chills, night sweats and weight loss. CXR showed no focal infiltrates, sharp costophrenic angels with no evidence of acute pathology. PFT's showed FVC pre 1.78, FVE1 pre 1.35, FVE1 % predicted pre 48%, FEV1/FVC pre 76%, TLC pre 3.23, VC pre 2.06 and a DLCO pre 10.98 with her LLN of 16.59. FVC post 1.91, FEV1 post 1.57, FVE1 % predicted post 58%, FEV1/FVC post 82% (Fig 1). She had positive pigeon serum antibodies. CT chest showed faint diffuse ground glass opacities bilaterally with mild mosaic attenuation reflecting HP (Figs 2, 3). The patient was diagnosed with HP, started on steroids and surrendered her pigeons with resolution of her symptoms. DISCUSSION: Diagnosis of HP is challenging as the classic symptoms of dyspnea and fatigue can be nonspecific. Physicians should be aware about increasing exposures to home antigens during the COVID pandemic in patients who have been indoors for prolonged periods of time. PFTs show a restrictive pattern and DLCO impairment. CT show the presence of centrilobular nodules, ground-glass opacities, mosaic attenuation/perfusion and air trapping and in longstanding disease there can be honeycombing and traction bronchiectasis2. Mainstay treatment is antigen avoidance and corticosteroids. Identification and complete avoidance of the antigen is the mainstay of treatment. Antigen avoidance is critically stressed as repeated exposures can result in HP progression and avoidance of the antigen is associated with improved lung function1. Corticosteroid initiation in progressive patients resulted in a reversal with an improvement of lung function3. Corticosteroids are often used in non-fibrotic HP however its efficacy remains unclear as long term prognosis has never been studied1. CONCLUSIONS: Physicians should recognize that prolonged time indoors, that have been exacerbated during the COVID19 pandemic, can increase the time patients are exposed to home antigens thus a prompt diagnosis and strict avoidance of the antigen is required to prevent irreversible damage. Reference #1: Maria Laura Alberti, "Hypersensitivity Pneumonitis: Diagnostic and Therapeutic Challenges". Frontiers in Medicine, Front. Med., 23 September 2021 ;https://doi.org/10.3389/fmed.2021.718299 Reference #2: Zompatori M, Calabrò E, Chetta A, Chiari G, Marangio E, Olivieri D. Chronic hypersensitivity pneumonitis or idiopathic pulmonary fibrosis? Diagnostic role of high resolution Computed Tomography (HRCT). Radiol Med. 2003 Sep;106(3):135-46. English, Italian. PMID: 14612834 Reference #3: De Sadeleer LJ, Hermans F, De Dycker E, Yserbyt J, Verschakelen JA, Verbeken EK, Verleden GM, Wuyts WA. Effects of Corticosteroid Treatment and Antigen Avoidance in a Large Hypersensitivity Pneumonitis Cohort: A Single-Centre Cohort Study. J Clin Med. 2018 Dec 21;8(1):14. doi: 10.3390/jcm8010014. PMID: 30577667;PMCID: PMC6352061. DISCLOSURES: No relevant relationships by Aryeh Bernstein No relevant relationships by Thai Donenfeld No relevant relationships by Lourdes Marie F aminiano

2.
Urology Practice ; 8(6):668-674, 2021.
Article in English | Web of Science | ID: covidwho-1713815

ABSTRACT

Introduction: The COVID-19 pandemic starkly affected all aspects of health care, forcing many to divert resources towards emergent patient needs while decreasing emphasis on routine cancer care. We compared prostate cancer care before and during the pandemic in a multi-institutional cohort. Methods: A prospective regional collaborative was queried to assess practice pattern variations relative to the initial COVID-19 lockdown (March 16 to May 15, 2020). The preceding 10 months were selected for comparison. The impact of the lockdown was evaluated on the basis of 1) weekly trends in biopsy and radical prostatectomy volumes, 2) comparisons between those undergoing prostate biopsy, and 3) clinicopathological characteristics within radical prostatectomy patients. Categorical variables were compared using Fisher's exact and Pearson's chi-square tests, and Wilcoxon rank sum test to evaluate continuous covariates. Results: Overall, there was a 55% and 39% decline in biopsy and prostatectomy volumes, respectively. During the pandemic, biopsy patients were younger with fewer COVID-19 severity risk factors (17.0% vs 9.7% no risk factors, p=0.023) and prostatectomy patients had higher grade group (GG;45.6% >GG 4 vs 28%, p=0.01). Large variation in the change in procedural volume was noted across practice sites. Conclusion: In a multi-institutional assessment of surgical and diagnostic delay for prostate cancer, we found a non-uniform decline in procedural volume across sites. Future analyses within this cohort are needed to further discern the effects of care delays related to COVID-19.

4.
Journal of Urology ; 206(SUPPL 3):e43, 2021.
Article in English | EMBASE | ID: covidwho-1483584

ABSTRACT

INTRODUCTION AND OBJECTIVE: Minority communities disproportionately shouldered poor COVID-19 outcomes, however the impact of the pandemic on prostate cancer (PCa) surgery is unknown. To that end, we sought to determine the racial impact on PCa care during the first wave of the pandemic. METHODS: Using a multi-institutional collaborative we evaluated practice patterns for Black and White patients with untreated non-metastatic PCa during the initial COVID-19 lockdown (March-May 2020) compared to prior (March-May 2019). Patient and practice characteristics were compared by race using Fisher's exact and Pearson's chi-square to compare categorical variables and Wilcoxon rank sum to evaluate continuous covariates. We determined the covariate-adjusted impact of year and race on surgery, using logistic regression models with a race year interaction term. RESULTS: Among the 647 men with non-metastatic PCa, 269 received care during the pandemic and 378 prior. Surgery was significantly less likely in Black men (1.3% v 25.9%;p<0.001), despite similar COVID-19 risk factors, biopsy Gleason grade group, and comparable surgery rates prior (17.7% vs. 19.1%;p=0.75). Black men had higher PSA (8.8 vs. 7.2 p=0.04) and were younger (38.2% vs. 24.4% <60 yr;p=0.09). Regression results demonstrated an 94% reduced odds of surgery (OR=0.06, 95% CI 0.007-0.43;p=0.006) for Black patients, with no change for White patients (OR=1.41, 95% CI 0.89-2.21;p=0.142), after adjusting for covariates. Changes in surgical volume varied by site (33% increase to complete shutdown), with sites that experienced the largest reduction in cancer surgery, caring for a greater proportion of Black patients (figure). CONCLUSIONS: In a large multi-institutional regional collaborative, odds of prostatectomy declined only among Black patients during the initial wave of the COVID-19 pandemic. While localized prostate cancer does not require immediate treatment, this study illuminates systemic inequities within healthcare. Public health efforts are needed to fully recognize the unintended consequence of diversion of cancer resources to the pandemic in order to develop balanced mitigation strategies as viral rates continue to fluctuate.

5.
American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407164
6.
Journal of Clinical Oncology ; 39(15 SUPPL), 2021.
Article in English | EMBASE | ID: covidwho-1339359

ABSTRACT

Background: Minority communities have been disproportionately affected by COVID-19, however the impact of the pandemic on prostate cancer (PCa) treatment is unknown. To that end, we sought to determine the racial impact on PCa surgery during the first wave of the COVID-19 pandemic. Methods: After receiving institutional review board approval, the Pennsylvania Urologic Regional Collaborative (PURC) database was queried to evaluate practice patterns for Black and White patients with untreated non-metastatic PCa during the initial lockdown of the COVID-19 pandemic (March-May 2020) compared to prior (March-May 2019). PURC is a prospective collaborative, which includes private practice and academic institutions within both urban and rural settings including regional safety-net hospitals. As data entry was likely impacted by the pandemic, we limited our search to only practices that had data entered through June 1, 2020 (5 practice sites). We compared patient and disease characteristics by race using Fisher's exact and Pearson's chi-square to compare categorical variables and Wilcoxon rank sum to evaluate continuous covariates. Patients were stratified by risk factors for severe COVID-19 infection as described by the CDC. We determined the covariate-adjusted impact of year and race on surgery, using logistic regression models with a race∗year interaction term. Results: 647 men with untreated nonmetastatic PCa were identified, 269 during the pandemic and 378 from the year prior. During the pandemic, Black men were significantly less likely to undergo prostatectomy compared to White patients (1.3% v 25.9%;p < 0.001), despite similar COVID-19 risk-factors, biopsy Gleason grade group, and comparable surgery rates prior (17.7% vs. 19.1%;p = 0.75). White men had lower pre-biopsy PSA (7.2 vs. 8.8 vs. p = 0.04) and were older (24.4% vs. 38.2% < 60yr;p = 0.09). The regression model demonstrated an 94% decline in odds of surgery(OR = 0.06 95%CI 0.007-0.43;p = 0.006) for Black patients and increase odds of surgery for White patients (OR = 1.41 95%CI 0.89-2.21;p = 0.142), after adjusting for covariates. Changes in surgical volume varied by site (33% increase to complete shutdown), with sites that experienced the largest reduction in cancer surgery, caring for a greater proportion of Black patients. Conclusions: In a large multi-institutional regional collaborative, odds of PCa surgery declined only among Black patients during the initial wave of the COVID-19 pandemic. While localized prostate cancer does not require immediate treatment, the lessons from this study illuminate systemic inequities within healthcare, likely applicable across oncology. Public health efforts are needed to fully recognize the unintended consequence of diversion of cancer resources to the pandemic in order to develop balanced mitigation strategies as viral rates continue to fluctuate.

7.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277694

ABSTRACT

Introduction: Severe acute respiratory syndrome from COVID 19 typically presents with cough, fever, myalgias and progresses to respiratory and multi-organ failure. However, neurological manifestations of COVID 19, namely Guillain-Barre syndrome are rare. We present a case of acute inflammatory demyelinating polyneuropathy (AIDP), a form of GBS in a patient with recent COVID infection. Case: 66 year old man with no significant medical history presented to the emergency department for progressive weakness of all extremities for 2 days. Patient was diagnosed with COVID 19 three weeks prior to onset of weakness. As per patient, he only had mild respiratory illness with cough, general weakness without respiratory symptoms. Two days prior to presentation, he felt weakness in his lower extremities, which then progressed to involve the upper extremities. On initial evaluation the patient's pupils were symmetric and 3mm, reactive to light, visual field were full to confrontation, cranial nerves intact, shoulder shrug symmetric with full strength. He had decreased motor tone with 2/5 strength in both upper and lower extremities and depressed or absent reflexes in all extremities. His labs were significant for positive COVID 19 PCR and antibodies. CT head was negative for acute stroke or intracranial pathology. The patient was admitted to MICU where he developed respiratory muscle weakness with diminished vital capacity of 12ml/kg and negative inspiratory force of 12mmHg and he was intubated. Cerebral spinal fluid showed elevated protein to 145mg/dL, WBC of 4/UL with 50% lymphocytes and glucose of 67. Other CSF studies were negative for oligoclonal bands, EBV, CMV, cryptococcus, syphilis, and sarcoidosis. Electromyography was consistent with moderate AIDP. He received 5 doses of IVIG with no significant improvement so he underwent tracheostomy and was initiated on plasmapheresis for AIDP. Discussion: GBS is an immune-mediated disease that typically affects the peripheral neurons and nerve roots after respiratory or gastrointestinal illness. Typical infections are Campylobacter jejuni, Zika virus, Influenza, and there are even reports of GBS after MERS and SARS COV-1. However, there has been increasing evidence of COVID 19 causing neurologic manifestations such as encephalitis, meningitis, stroke, and GBS [1]. Patients, such as the one presented in this report with GBS, usually have a long and protracted disease despite aggressive treatments with IVIG and plasmapheresis with reliance on mechanical ventilator. Understanding the full spectrum of diseases and systems affected by COVID 19 can help clinicians provide better care.

8.
Veterinary Business Journal ; 208:14-14, 2020.
Article in English | CAB Abstracts | ID: covidwho-1227370
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