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1.
The British journal of surgery ; 109(Suppl 1), 2022.
Article in English | EuropePMC | ID: covidwho-1998552

ABSTRACT

Aim We assessed the short-term outcomes and characteristics of urological cancer patients operated on during the COVID-19 pandemic. This is the first time these outcomes are assessed in urological patients on a large scale. Method All bladder, kidney, and prostate cancer patients who underwent elective cancer surgery between March 2020 and July 2020 in the international COVIDSurg-Cancer collaborative database were included in the study. The primary outcome was 30-day mortality. Secondary outcomes were respiratory complications within 30-days and the factors associated with COVID-19 infection. Results A total of 1,902 patients were included in the study. A total of 21 (0.1%) mortalities and 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30-days of operation. Mortality was more likely in patients aged 80 or above, ASA grade 3 or 4, ECOG grade 1 or above, undergoing major surgery, and amongst patients who had concurrent COVID-19 infection (OR 31.9, 95%CI 12.4–81.42, p<0.001;univariable logistic regression). Respiratory complications were more likely in patients aged over 70, from an area with high community risk, with a revised cardiac risk index of 1 or higher or with a concurrent COVID-19 infection (OR 40.6, 95%CI 11.41–144.45, p<0.001;multivariate). A total of 42 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay;designated COVID-19 sites were not associated with increased COVID-19 infections. Conclusions Major urological cancer surgeries are safe to perform during the COVID-19 pandemic on well-selected patients with appropriate risk-stratification. Concurrent COVID-19 infection is associated with a higher risk of mortality and respiratory complications.

2.
Journal of Urology ; 207(SUPPL 5):e482, 2022.
Article in English | EMBASE | ID: covidwho-1886508

ABSTRACT

INTRODUCTION AND OBJECTIVE: COVID-19 has caused significant disruption to the management of urological cancer, this study aims to assess 30-day postoperative outcomes for patients undergoing urological cancer surgery during the COVID-19 pandemic. METHODS: COVIDSurg study is the largest international, multicentre study of COVID-19 in surgical patients performed to date. COVIDSurg-Cancer explored the safety of performing elective cancer surgery during the pandemic. All bladder, kidney, UTUC and prostate cancer patients who underwent elective cancer surgery between March 2020 and July 2020 were included. Univariable and multivariable regression was performed to assess association of patient factors with mortality, respiratory complications and operative complications. RESULTS: A total of 1,902 patients from 36 countries were included. 658 (34.6%) patients had bladder cancer, 590 (31.0%) kidney cancer or UTUC, and 654 (34.4%) prostate cancer. These patients underwent elective curative surgery for their cancers (prostatectomies, nephrectomies, cystectomies, nephroureterectomy, TURBTs). 62% of sites were not designated “hot” COVID-19 sites (i.e. did not actively admit patients with COVID-19).A total of 42/1902 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay. 21 (0.1%) mortalities were observed;of those, 8 (38.1%) were diagnosed with COVID-19. Mortalities were found to be more likely in patients with concurrent COVID-19 infection (OR 31.7, 95% CI 12.4- 81.42, p<0.001), aged over 80, ASA grade 3+ and ECOG grade 1+. 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30 days of surgery. Respiratory complications were more likely in patients aged with concurrent COVID-19 infection (OR 40.6, 95%CI 11.41-144.45, p<0.001), over 70, from an area with high community risk or with a revised cardiac risk index of 1+. There were 84 major complications (Clavien-Dindo score ≥3). Patients with a concurrent COVID-19 infection (OR 7.45, 95% CI 2.73-20.3, p<0.001) or aged 80 or above were more likely to experience major complications. CONCLUSIONS: Elective urological cancer surgeries are safe to perform during the COVID-19 pandemic. This study highlights important risk-factors associated with worse outcomes. Our data can inform health services to safely select patients for surgery during the pandemic. Patients with concurrent COVID-19 infection have a higher risk of mortality and respiratory complications and should not undergo surgery if possible.

3.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-333583

ABSTRACT

While SARS-CoV-2 infection has pleiotropic and systemic effects in some patients, many others experience milder symptoms. We sought a holistic understanding of the severe/mild distinction in COVID-19 pathology, and its origins. We performed a whole-blood preserving single-cell analysis protocol to integrate contributions from all major cell types including neutrophils, monocytes, platelets, lymphocytes and the contents of serum. Patients with mild COVID-19 disease display a coordinated pattern of interferon-stimulated gene (ISG) expression across every cell population and these cells are systemically absent in patients with severe disease. Severe COVID-19 patients also paradoxically produce very high anti-SARS-CoV-2 antibody titers and have lower viral load as compared to mild disease. Examination of the serum from severe patients demonstrates that they uniquely produce antibodies with multiple patterns of specificity against interferon-stimulated cells and that those antibodies functionally block the production of the mild disease-associated ISG-expressing cells. Overzealous and auto-directed antibody responses pit the immune system against itself in many COVID-19 patients and this defines targets for immunotherapies to allow immune systems to provide viral defense. ONE SENTENCE SUMMARY: In severe COVID-19 patients, the immune system fails to generate cells that define mild disease;antibodies in their serum actively prevents the successful production of those cells.

5.
British Journal of Surgery ; 109(SUPPL 1):i9, 2022.
Article in English | EMBASE | ID: covidwho-1769189

ABSTRACT

Aim: We assessed the short-term outcomes and characteristics of urological cancer patients operated on during the COVID-19 pandemic. This is the first time these outcomes are assessed in urological patients on a large scale. Method: All bladder, kidney, and prostate cancer patients who underwent elective cancer surgery between March 2020 and July 2020 in the international COVIDSurg-Cancer collaborative database were included in the study. The primary outcome was 30-day mortality. Secondary outcomes were respiratory complications within 30-days and the factors associated with COVID-19 infection. Results: A total of 1,902 patients were included in the study. A total of 21 (0.1%) mortalities and 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30-days of operation. Mortality was more likely in patients aged 80 or above, ASA grade 3 or 4, ECOG grade 1 or above, undergoing major surgery, and amongst patients who had concurrent COVID-19 infection (OR 31.9, 95%CI 12.4-81.42, p<0.001;univariable logistic regression). Respiratory complications were more likely in patients aged over 70, from an area with high community risk, with a revised cardiac risk index of 1 or higher or with a concurrent COVID-19 infection (OR 40.6, 95% CI 11.41-144.45, p<0.001;multivariate). A total of 42 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay;designated COVID-19 sites were not associated with increased COVID-19 infections. Conclusions: Major urological cancer surgeries are safe to perform during the COVID-19 pandemic on well-selected patients with appropriate risk-stratification. Concurrent COVID-19 infection is associated with a higher risk of mortality and respiratory complications.

6.
J Hosp Infect ; 123: 52-60, 2022 May.
Article in English | MEDLINE | ID: covidwho-1757533

ABSTRACT

BACKGROUND: Meticillin-resistant Staphylococcus aureus (MRSA) infections are rampant in hospitals and residential care homes for the elderly (RCHEs). AIM: To analyse the prevalence of MRSA colonization among residents and staff, and degree of environmental contamination and air dispersal of MRSA in RCHEs. METHODS: Epidemiological and genetic analysis by whole-genome sequencing (WGS) in 12 RCHEs in Hong Kong. FINDINGS: During the COVID-19 pandemic (from September to October 2021), 48.7% (380/781) of RCHE residents were found to harbour MRSA at any body site, and 8.5% (8/213) of staff were nasal MRSA carriers. Among 239 environmental samples, MRSA was found in 39.0% (16/41) of randomly selected resident rooms and 31.3% (62/198) of common areas. The common areas accessible by residents had significantly higher MRSA contamination rates than those that were not accessible by residents (37.2%, 46/121 vs. 22.1%, 17/177, P=0.028). Of 124 air samples, nine (7.3%) were MRSA-positive from four RCHEs. Air dispersal of MRSA was significantly associated with operating indoor fans in RCHEs (100%, 4/4 vs. 0%, 0/8, P=0.002). WGS of MRSA isolates collected from residents, staff and environmental and air samples showed that ST 1047 (CC1) lineage 1 constituted 43.1% (66/153) of all MRSA isolates. A distinctive predominant genetic lineage of MRSA in each RCHE was observed, suggestive of intra-RCHE transmission rather than clonal acquisition from the catchment hospital. CONCLUSION: MRSA control in RCHEs is no less important than in hospitals. Air dispersal of MRSA may be an important mechanism of dissemination in RCHEs with operating indoor fans.


Subject(s)
COVID-19 , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections , Aged , COVID-19/epidemiology , Carrier State/epidemiology , Humans , Methicillin , Methicillin-Resistant Staphylococcus aureus/genetics , Pandemics , Staphylococcal Infections/epidemiology
7.
International Joint Conference on Neural Networks (IJCNN) ; 2021.
Article in English | Web of Science | ID: covidwho-1612802

ABSTRACT

In this paper we apply an inverse optimal controller (IOC) based on a control Lyapunov function (CLF) to schedule theoretical therapies for the novel coronavirus disease (COVID-19). This controller can represent the viral dynamics of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the host. The virus dynamics consider the antiviral effects and immune responses as control inputs. The proposed controller is based on a Recurrent High Order Neural Network (RHONN) used as an identifier trained with Extended Kalman Filter (EKF). Simulations show that applying treatment 2 days post symptoms would not significantly alter the viral load. The proposed controller to stimulate the immune response displays a better effectiveness compared to the effectiveness displayed by the antiviral effects.

8.
Chest ; 160(4):975A-975A, 2021.
Article in English | Web of Science | ID: covidwho-1530918
10.
Chest ; 160(4):A417, 2021.
Article in English | EMBASE | ID: covidwho-1457696

ABSTRACT

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: With ongoing efforts to vaccinate the public against SARS-CoV2, there have been reports of breakthrough COVID-19 cases. We report a case of an immunocompromised patient who was infected despite being fully vaccinated. CASE PRESENTATION: 63-year-old female with COPD, rheumatoid arthritis on abatacept, prednisone, & methotrexate (MTX), and Sweet syndrome presented to the ED with acute non-exertional chest pain, palpitations, and dyspnea at rest. She denied fevers or chills but reported diarrhea and vomiting. She had no history of or exposure to COVID-19 and had completed her 2-dose mRNA SARS-CoV-2 vaccination 45 days prior. On presentation she was in respiratory distress, hypotensive, tachycardic, and tachypneic. She was saturating at 86% on room air, requiring supplemental O2. Physical exam was significant for scattered bilateral wheezes. CBC showed no leukocytosis. CRP was elevated. Lactic acid, ferritin and LDH were within normal limits. D-dimer was higher than the age-adjusted cutoff;CTA of the chest revealed no PE but showed bilateral ground glass opacities with consolidations. She tested positive for SARS-CoV-2. She was admitted for severe sepsis from COVID-19 pneumonitis and started on dexamethasone and remdesivir. SARS-CoV-2 IgG antibodies were positive. Given her immunocompromised status, bronchoscopy with BAL was performed and revealed copious thick secretions. Gram stain and bronchial brushings were negative for bacterial etiologies. Lavage culture was positive for aspergillus antigen and cytology revealed markedly enlarged reactive cells. Galactomannan serum antigen was positive. She was discharged on day 9 with a prolonged course of voriconazole. She had residual dyspnea on exertion but did not require supplemental O2. A nasal swab to test for variant strains was still pending. DISCUSSION: The COVID vaccine proved effective in preventing severe COVID-19 infections but trials excluded immunocompromised patients. This case of infection despite vaccination and detectable IgG titers reveals suboptimal protection. From data on pre-existing vaccines in immunocompromised patients, MTX is known to reduce immunogenicity. Our patient remained on immunosuppressants after vaccination, which may have contributed to her subsequent viral and fungal infections. Rheumatology guidelines suggest holding MTX for one to two weeks after vaccination to improve vaccine response. Employing this strategy will maximize immunogenicity against SARS-CoV-2 in immunocompromised patients. CONCLUSIONS: The American College of Rheumatology recommends vaccinating patients with rheumatological conditions against SARS-CoV-2. This case highlights individual patient factors to consider in the battle against COVID-19 in immunosuppressed patients. Non-viral infections must also be considered despite the ongoing pandemic. Determining protective antibody titers can guide booster vaccine recommendations. REFERENCE #1: Sonani B, Aslam F, Goyal A, Patel J, Bansal P. COVID-19 vaccination in immunocompromised patients. Clin Rheumatol. 2021;40(2):797-798. doi:10.1007/s10067-020-05547-w REFERENCE #2: Day AL, Winthrop KL, Curtis JR. The effect of disease-modifying antirheumatic drugs on vaccine immunogenicity in adults. Cleve Clin J Med. 2020;87(11):695-703. Published 2020 Nov 2. doi:10.3949/ccjm.87a.20056 REFERENCE #3: COVID-19 Vaccine Clinical Guidance Summaryfor Patients with Rheumatic and Musculoskeletal Diseases DISCLOSURES: No relevant relationships by Vernon Chan, source=Web Response No relevant relationships by Dana Daoud, source=Web Response No relevant relationships by Jeet Lund, source=Web Response

11.
Chest ; 160(4):A742, 2021.
Article in English | EMBASE | ID: covidwho-1457657

ABSTRACT

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: ECMO has long been used in the ICU as a salvage or bridge therapy for selected ICU patients. There had been a variety of cannulas available in the market. We report 2 cases with positive outcomes associated with the use of jugular dual lumen cannula. CASE PRESENTATION: An obese 42-year-old obese female, with PMH of hypothyroidism and ulcerative colitis, was admitted for acute hypoxic respiratory failure due to COVID-19. Patient underwent conventional treatment at the time (dexamethasone, remdesivir, convalescent plasma and antibiotics) for COVID-19 but was ultimately intubated on day 8 due to profound hypoxia requiring VV ECMO on day 10. She remained on full ECMO support until day 56. Her FiO2 was eventually weaned down to 21% but she continued to require a sweep of 3L secondary to profound muscular weakness and obesity. After transitioning to the jugular dual lumen cannula on day 75 for long-term ECMO, her sedation was weaned down, that allowed participation of physical therapy. She was decannulated on day 94 and was discharged to LTAC on day 100. A 48-year-old female was tested positive for COVID-19 after being exposed 12 days before. Due to worsening symptoms, she eventually sought care at the hospital. Despite the standard treatment, her respiratory status continued to worsen. She was intubated on Day 2 before receiving full support on VV ECMO on day 6. Despite effort to wean down to FiO2 of 21%, she still required a sweep of 1L. After being transitioned to a jugular dual lumen cannula on day 71, she was weaned off of sedation and able to participate in therapy. She was eventually decannulated on day 79, and discharged to a rehab facility on day 85 to continue her recovery. DISCUSSION: Transition from a dual cannula ECMO system to a single cannula ECMO system allowed increased mobility and participation of physical therapy while in the ICU for patients requiring extended time on ECMO. Study has suggested a reduction of up to 35% in muscle mass among ECMO patients by day 20 of their cannulation. In an economic study performing on transplant patients, a 73% reduction in post-transplant ICU cost was reported for those who underwent rehabilitation while being supported on ECMO. Both studies demonstrated the potential benefits with promoting early rehabilitation for ECMO patients. Regarding the technique involved, there was a recent report of a similar transition without any ECMO interruption, allowing the patient uninterrupted time on ECMO while benefiting from early rehab. CONCLUSIONS: We present two cases of severe COVID-19 patients with an extended period of time on VV ECMO became severely debilitated. They were transitioned to a jugular dual lumen cannula, allowing early participation in rehab, resulting in their eventual discharge. These cases demonstrated these cannulas were valuable tool to reduce patients' reliance on support, before being transitioned off of ECMO. REFERENCE #1: Hayes K, Holland AE, Pellegrino VA, Mathur S, Hodgson CL. Acute skeletal muscle wasting and relation to physical function in patients requiring extracorporeal membrane oxygenation (ECMO). J Crit Care. 2018;48:1-8. doi:10.1016/j.jcrc.2018.08.002 REFERENCE #2: Bain JC, Turner DA, Rehder KJ, et al. Economic Outcomes of Extracorporeal Membrane Oxygenation With and Without Ambulation as a Bridge to Lung Transplantation. Respir Care. 2016;61(1):1-7. doi:10.4187/respcare.03729 REFERENCE #3: Chan EG, Chan PG, Harano T, Sanchez PG. Transition of femoral-jugular to dual-stage left subclavian without discontinuation of extracorporeal membrane oxygenation. J Card Surg. 2020;35(10):2794-2797. doi:10.1111/jocs.14881 DISCLOSURES: No relevant relationships by Vernon Chan, source=Web Response No relevant relationships by Marina Dolina, source=Web Response

12.
Chest ; 160(4):A504-A505, 2021.
Article in English | EMBASE | ID: covidwho-1457656

ABSTRACT

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The controversy surrounding the association of ACE inhibitor (ACEi) use in the COVID-19 pandemic has been well documented. Since then, studies have been published refuting the findings. While there was a recent study in France on hypertensive patients on one of ACEi, angiotensin II receptor blocker (ARB) or calcium channel blocker (CCB), we performed a retrospective study reviewing the outcomes (i.e. admissions, readmission and mortality) associated with COVID-19 patients and their use of anti-hypertensive medications (anti-HTNs), specifically ACEi/ARB, thiazides, beta blocker (BB) and CCB, to look at the outcomes associated with their use, regardless of their roles in anti-hypertensive management. METHODS: We performed a retrospective study on patients with a positive COVID-19 RT-PCR test since January 2019. 606 adult patients were randomly selected. Data on demographics, co-morbidities, admission status, length of stay, types of anti-hypertensives and outcomes were collected and reviewed. RESULTS: Our study demonstrated the use of ACEi (24.1%) and thiazides (17.5%) had a reduced rate of admission when compared to patients on BB (32.3%) or CCB (32.4%). It should be noted thiazides were not as widely used (n = 63) in our population. Thus, it was not possible to comment on whether its use had a role in preventing hospitalization. Among the agents, ACEi is widely used for a multitude of diseases. As a result, it is often a first line agent employed by many, which was consistent with the data (n = 294) collected in this study. Interestingly, when assessing readmission rates, ACEi had the lowest percentage (8.1%;6/74) among the classes (BB 13.3%;8/60, CCB 18.4%;7/38, Thiazide 15.4%;2/13). Its judicious use and lower rates of admission and readmission were perhaps a compliment to the fine work by the physicians involved in their care.For mortality, there was a minimal percentage difference across the classes (ACEi 25.7%, BB 23.3%, CCB 23.7%, thiazides 23.1%). While there was a difference in number of patients across all four medications, the similar mortality suggested the co-morbidities, rather than the medications, may have a stronger influence on the outcomes in these patients. CONCLUSIONS: Our study demonstrated ACEi had a reduced rate of admission and the lowest rate of readmission compared to patients on BB or CCB. There was no difference in mortality across all four anti-hypertensive classes. We believe studies assessing co-morbidities while controlling for anti-hypertensive use could be beneficial in further our understanding in predicting outcomes of COVID-19 patients. CLINICAL IMPLICATIONS: ACEi use did not appear to have higher admission rates than other anti-hypertensives. Its use resulted in the lowest re-admission rates. The use of specific anti-hypertensive class had no bearing on mortality rates of COVID-19 patients. DISCLOSURES: No relevant relationships by Ali AKRAM, source=Web Response No relevant relationships by Vernon Chan, source=Web Response No relevant relationships by Dana Daoud, source=Web Response No relevant relationships by Olufunmilayo Folaranmi, source=Web Response No relevant relationships by Christopher Hemsley, source=Web Response No relevant relationships by Hafiza Wajeeha Javaid, source=Web Response No relevant relationships by Sarah Maurice, source=Web Response No relevant relationships by Junaid mir, source=Web Response No relevant relationships by Aisha Parihar, source=Web Response No relevant relationships by Britney Plotnick, source=Web Response No relevant relationships by Jayaram Thimmapuram, source=Web Response

13.
Chest ; 160(4):A700, 2021.
Article in English | EMBASE | ID: covidwho-1457655

ABSTRACT

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: The diagnosis of lung malignancy can often be incidental. We present a hemodynamically unstable patient with COVID-19 and pericardial effusion, subsequently diagnosed with metastatic adenocarcinoma of the lung. CASE PRESENTATION: A 54-year-old male with no significant medical history was diagnosed with COVID-19 two weeks prior to presentation. He had dyspnea on exertion since that time and presented to the hospital after having an abnormal CXR and leukocytosis on out-patient testing. His blood pressure was 95/68 with a heart rate of 129. EKG revealed atrial fibrillation and electrical alternans. He had mildly elevated BNP and troponin, with lactic acidosis. Bilateral opacities were noted on CXR. A large effusion concerning for tamponade was noted on bedside echo. He underwent immediate pericardiocentesis and had 2L serosanguinous fluid drained. After initial stabilization, he was found to have extensive bilateral lower extremity DVT and PE.Repeat TTE showed residual effusion with tamponade physiology observed. Despite the findings on imaging, a pericardial window was not pursued due to concerns of anesthesia induction in the setting of a new PE. He underwent placement of a pericardial drain instead. After the procedure, heparin drip was initiated with an IVC filter placed soon after. The patient eventually had a pericardial window placed. His arrhythmia was chemically converted back to sinus rhythm. On POD5, the drains were removed.Autoimmune workup of the fluid was within normal limits, but cytology resulted in a diagnosis of adenocarcinoma positive for TTF-1. Thus, he was diagnosed with stage IV adenocarcinoma of the lung. CT revealed multiple lytic lesions with diffuse lymphadenopathy. MRI showed no evidence of brain metastasis. He was transitioned to apixaban at discharge, with out-patient oncology follow-up. DISCUSSION: A small study of 31 patients showed pericardial effusion was an independent risk factor predicting severity of COVID-19 infection, with reports of the virus being detected in pericardial fluid.[1,2] While virus infection can cause pericardial effusion, other causes should not be ignored in the workup. With hemodynamic instability, immediate intervention is warranted despite the risk involved with pericardiocentesis. In patients with large volume of pericardial effusion extracted, 5% of them will suffer from paradoxical hemodynamic instability and pulmonary edema afterwards, a condition known as pericardial decompression syndrome.[3] The increased venous return after decompression will compress the LV, based on the principle of ventricular coupling, reducing the cardiac output. Treatment for this condition is supportive. CONCLUSIONS: While COVID-19 is known to cause pericardial effusion, other causes, such as malignancy, should not be forgotten and should always remain in our differential. The risk involved with immediate pericardiocentesis goes beyond cardiac injury. REFERENCE #1: Chen Q, Xu L, Dai Y, et al. Cardiovascular manifestations in severe and critical patients with COVID -19. Clin Cardiol. 2020;43(7):796-802. REFERENCE #2: Farina A, Uccello G, Spreafico M, Bassanelli G, Savonitto S. SARS-CoV-2 detection in the pericardial fluid of a patient with cardiac tamponade. Eur J Intern Med. 2020;76:100-101. REFERENCE #3: Prabhakar Y, Goyal A, Khalid N, et al. Pericardial decompression syndrome: A comprehensive review. World J Cardiol. 2019;11(12):282-291. DISCLOSURES: No relevant relationships by Rumon Chakravarty, source=Web Response No relevant relationships by Vernon Chan, source=Web Response

14.
J Hosp Infect ; 116: 78-86, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1404776

ABSTRACT

AIM: To describe the nosocomial transmission of Air, multidrug-resistant, Acinetobacter baumannii, nosocomial, COVID-19 Acinetobacter baumannii (MRAB) in an open-cubicle neurology ward with low ceiling height, where MRAB isolates collected from air, commonly shared items, non-reachable high-level surfaces and patients were analysed epidemiologically and genetically by whole-genome sequencing. This is the first study to understand the genetic relatedness of air, environmental and clinical isolates of MRAB in the outbreak setting. FINDINGS: Of 11 highly care-dependent patients with 363 MRAB colonization days during COVID-19 pandemic, 10 (90.9%) and nine (81.8%) had cutaneous and gastrointestinal colonization, respectively. Of 160 environmental and air samples, 31 (19.4%) were MRAB-positive. The proportion of MRAB-contaminated commonly shared items was significantly lower in cohort than in non-cohort patient care (0/10, 0% vs 12/18, 66.7%; P<0.001). Air dispersal of MRAB was consistently detected during but not before diaper change in the cohort cubicle by 25-min air sampling (4/4,100% vs 0/4, 0%; P=0.029). The settle plate method revealed MRAB in two samples during diaper change. The proportion of MRAB-contaminated exhaust air grills was significantly higher when the cohort cubicle was occupied by six MRAB patients than when fewer than six patients were cared for in the cubicle (5/9, 55.6% vs 0/18, 0%; P=0.002). The proportion of MRAB-contaminated non-reachable high-level surfaces was also significantly higher when there were three or more MRAB patients in the cohort cubicle (8/31, 25.8% vs 0/24, 0%; P=0.016). Whole-genome sequencing revealed clonality of air, environment, and patients' isolates, suggestive of air dispersal of MRAB. CONCLUSIONS: Our findings support the view that patient cohorting in enclosed cubicles with partitions and a closed door is preferred if single rooms are not available.


Subject(s)
Acinetobacter Infections , Acinetobacter baumannii , COVID-19 , Cross Infection , Acinetobacter Infections/drug therapy , Acinetobacter Infections/epidemiology , Acinetobacter baumannii/genetics , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Cross Infection/drug therapy , Cross Infection/epidemiology , Drug Resistance, Multiple, Bacterial , Humans , Microbial Sensitivity Tests , Pandemics , SARS-CoV-2
16.
Critical Care Medicine ; 49(1):76-76, 2021.
Article in English | Web of Science | ID: covidwho-1326666
17.
Critical Care Medicine ; 49(1):39-39, 2021.
Article in English | Web of Science | ID: covidwho-1326511
18.
Journal of Clinical Urology ; 14(1 SUPPL):11, 2021.
Article in English | EMBASE | ID: covidwho-1325305

ABSTRACT

Introduction: The risks of delaying cancer surgery and the best management for these patients during COVID-19 is unknown. This systematic review aims to compare outcomes of patients with localised prostate cancer (PCa) who experienced any delay of radical prostatectomy (RP) (including surgical waiting times and use of neoadjuvant hormone therapy [NHT]), compared to those who underwent immediate RP. Methods: MEDLINE and Cochrane CENTRAL were searched for studies pertaining to the review question. Outcomes included (Biochemical) Recurrence-free survival, cancer-specific survival, overall survival and positive surgical margin (PSM). Results: 4,120 studies were retrieved. 36 observational studies investigated the effects of delayed RP. A variety of PCa risks and delay periods contributed to considerable heterogeneity in the include studies. When stratifying by PCa risk groups, low risk PCa (Grade Group [GG] 1) can be delayed safely from at least 26 weeks to 2.6 years, without significant effects on all outcomes. Similarly, RP can be safely delayed for 6 to 9 months in intermediate risk patients (GG 2/3). In high-risk patients (GG 4/5), the delay of RP for 2 or more months tends to associate with worsen recurrences, hence NHT should be considered. Ten RCTs show 3-months of NHT is non-inferior for oncological outcomes and superior for PSM compared to immediate RP. The risk of biases of the included studies ranged from low to serious risk. Conclusion: RP is safe to be delayed in low-risk and intermediate-risk PCa patients. High-risk patients should be offered NHT;there is no sufficient evidence extending NHT over 3-months.

19.
Critical Care Medicine ; 49(1 SUPPL 1):76, 2021.
Article in English | EMBASE | ID: covidwho-1193868

ABSTRACT

INTRODUCTION: Convalescent plasma therapy (CPT) is a relatively new treatment option offered for COVID 19 pneumonia. Both the side effects and disease course after treatment with CPT have not been thoroughly investigated. CPT is primarily reserved for those participating in FDA approved clinical trials, however this case highlights an immunocompromised patient who benefited from CPT although was excluded from the clinical trial. METHODS: A 60-year-old female with a past medical history of rheumatoid arthritis (RA) was admitted for COVID 19 pneumonia on 6/18/2020. Her current management of her RA included Rituximab infusions which she received most recently one week prior to admission. On presentation she was noted to be febrile and in hypoxic respiratory failure requiring HFNC for oxygen support. She was treated with a 5-day course of dexamethasone and Remdesivir during her hospitalization. She initially had a great clinical response and was afebrile and weaned off of supplemental oxygen by the time of discharge. Patient was re-admitted three weeks later with fevers and SOB. COVID swab remained positive and coronavirus antibodies were negative. Patient was admitted to the ICU for high oxygen O2 requirements and required intubation. Bronchoscipt with alveolar lavage was performed which revealed no bacterial or fungal source of infection. Due to continued elevation of inflammatory markers, oxygen requirement and clinical symptoms, the patient was started on a second course of Remdesivir which was extended to 10 days. The patient was approved for CPT and received transfusion two weeks after admission with no adverse effects. Patient was discharged on room air 4 days after treatment and inflammatory markers markedly trended down. Her repeat COVID swab prior to discharge was negative. RESULTS: Research surrounding CPT in immunocompromised patients infected with COVID-19 is limited. With no vaccine available, CPT has been shown to be beneficial with clearance of viral load. Our case demonstrated the successful use of CPT in an immunocompromised individual. Further research needs to be done to evaluate the effectiveness of CPT in immunocompromised patients infected with COVID 19.

20.
Critical Care Medicine ; 49(1 SUPPL 1):39, 2021.
Article in English | EMBASE | ID: covidwho-1193798

ABSTRACT

INTRODUCTION: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can lead to a constellation of viral and immune symptoms called Coronavirus Disease 2019 (COVID-19). Emerging literature increasingly supports the premise that SARS-CoV-2 promotes a prothrombotic milieu. However, to date there have been few reports of an acute aortic occlusion (AAO), itself a rare phenomenon. We report a case of fatal AAO in a patient with COVID-19. METHODS: A 59-year-old Caucasian male with a past medical history of peripheral vascular disease presented to the Emergency Department (ED) for evaluation of shortness of breath, fevers, and dry cough. His symptoms started 5-7 days prior to the ED visit;received antibiotics in the outpatient setting without any effect. He was found to be febrile, tachypneic, and hypoxemic. He was placed on supplemental oxygen via a nonrebreather mask. Chest X-ray (CXR) showed multifocal opacifications. Intravenous antibiotics for possible pneumonia was initiated. Hydroxychloroquine was initiated to cover possible COVID-19 pneumonia. During the hospitalization, the patient became progressively hypoxemic for which he was placed on bilevel positive airway pressure (BiPAP). D-dimer, ferritin, lactate dehydrogenase, C-reactive protein were all elevated. SARS-CoV-2 Reverse Transcription Polymerase Chain Reaction (RT-PCR) was positive. On day 3, the patient was upgraded to the intensive care unit (ICU). Soon after he was intubated, he developed a mottled appearance of skin which extended from his bilateral feet up to the level of the subumbilical plane. Bedside ultrasound revealed an absence of flow from the mid-aorta to both common iliac arteries. The patient was evaluated emergently by vascular surgery. After a discussion with the family, it was decided to proceed with comfort-directed care and the patient expired later that day RESULTS: Viral infections have been identified as a source of prothrombotic states due to the direct injury of vascular tissue and inflammatory cascades. SARS-CoV-2 appears to follow a similar pattern with numerous institutions identifying elevated levels of thrombotic complications. We believe that healthcare providers should be aware of both venous and arterial thrombotic complications associated with COVID-19, including fatal outcomes.

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