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1.
Crit Care Clin ; 38(3):i, 2022.
Article in English | PubMed Central | ID: covidwho-2184659
2.
Annals of Translational Medicine ; 10(22) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2204830

ABSTRACT

Background: The electrothermal effect of hysteroscopic bipolar electrosurgical resection may cause damage to the endometrium, leading to intrauterine adhesion (IUA). Although some studies have demonstrated the efficacy and feasibility of auto-cross-linked hyaluronic (ACP) gel in preventing IUAs, controversy over its use continues. In this randomized controlled multi-center 2-arm parallel trial, we aimed to examine the efficacy and safety of ACP gel in preventing IUA after hysteroscopic electrosurgical resection and facilitate pregnancy in patients. Method(s): Patients from 4 centers in China were randomly assigned (1:1) to receive an intrauterine infusion of ACP gel or nothing after hysteroscopic electrosurgical resection. The randomization assignment was generated by computer and kept in a sealed envelope. A second-look hysteroscopy was performed within 3 months of the surgery. Result(s): From June 2018 to May 2021, 200 patients were recruited. Ultimately, 82 patients in both groups were included in the result analysis. The baseline characteristics were comparable. The outcomes were assessed by using per-protocol analysis. The incidence of IUA in the ACP gel group was lower than that in the control group [3.66% vs. 10.98%, risk ratio (RR) =0.333, 95% confidence interval (CI): 0.094-1.187, P=0.072], and the planned pregnancy rate was higher than that of the control group (60.98% vs. 40.54%, RR =1.504, 95% CI: 0.949-2.384, P=0.071), but the difference was not statistically significant. There was no significant difference in menstruation change. Menstrual volume remained unchanged in most cases (86.59% in ACP gel group vs. 89.02% in the control group, RR =0.877, 95% CI: 0.877-1.109, P=0.815). Menstrual volume decreased in 10 women in the ACP gel group and 8 in the control group (12.20% vs. 9.76%, RR =1.250, 95% CI: 0.520-3.007, P=0.617). No adverse effects were observed after the ACP administration. Conclusion(s): The present study showed that the use of ACP gel appeared to reduce both the tendency of IUA and American Fertility Society (AFS) scores and improve the subsequent pregnancy rate during hysteroscopic electrosurgical resection when treating polyps, fibroids, and uterine septum. ACP might be recommended to prevent IUA after such surgery. Further studies should be conducted with larger numbers of participants. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100047165. Copyright © Annals of Translational Medicine.

3.
MMWR - Morbidity & Mortality Weekly Report ; 71(5152):1625-1630, 2022.
Article in English | MEDLINE | ID: covidwho-2204208

ABSTRACT

Monovalent COVID-19 mRNA vaccines, designed against the ancestral strain of SARS-CoV-2, successfully reduced COVID-19-related morbidity and mortality in the United States and globally (1,2). However, vaccine effectiveness (VE) against COVID-19-associated hospitalization has declined over time, likely related to a combination of factors, including waning immunity and, with the emergence of the Omicron variant and its sublineages, immune evasion (3). To address these factors, on September 1, 2022, the Advisory Committee on Immunization Practices recommended a bivalent COVID-19 mRNA booster (bivalent booster) dose, developed against the spike protein from ancestral SARS-CoV-2 and Omicron BA.4/BA.5 sublineages, for persons who had completed at least a primary COVID-19 vaccination series (with or without monovalent booster doses) >=2 months earlier (4). Data on the effectiveness of a bivalent booster dose against COVID-19 hospitalization in the United States are lacking, including among older adults, who are at highest risk for severe COVID-19-associated illness. During September 8-November 30, 2022, the Investigating Respiratory Viruses in the Acutely Ill (IVY) Network assessed effectiveness of a bivalent booster dose received after >=2 doses of monovalent mRNA vaccine against COVID-19-associated hospitalization among immunocompetent adults aged >=65 years. When compared with unvaccinated persons, VE of a bivalent booster dose received >=7 days before illness onset (median = 29 days) against COVID-19-associated hospitalization was 84%. Compared with persons who received >=2 monovalent-only mRNA vaccine doses, relative VE of a bivalent booster dose was 73%. These early findings show that a bivalent booster dose provided strong protection against COVID-19-associated hospitalization in older adults and additional protection among persons with previous monovalent-only mRNA vaccination. All eligible persons, especially adults aged >=65 years, should receive a bivalent booster dose to maximize protection against COVID-19 hospitalization this winter season. Additional strategies to prevent respiratory illness, such as masking in indoor public spaces, should also be considered, especially in areas where COVID-19 community levels are high (4,5).

8.
American Journal of Respiratory and Critical Care Medicine ; 203(9):2, 2021.
Article in English | Web of Science | ID: covidwho-1407545
9.
American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407475
10.
American Journal of Respiratory and Critical Care Medicine ; 203(9):2, 2021.
Article in English | Web of Science | ID: covidwho-1407445
11.
American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407356
12.
American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407278
13.
American Journal of Respiratory and Critical Care Medicine ; 203(9):2, 2021.
Article in English | Web of Science | ID: covidwho-1407183
14.
American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407171
15.
American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407100
16.
American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407069
17.
American Journal of Respiratory and Critical Care Medicine ; 203(9):2, 2021.
Article in English | Web of Science | ID: covidwho-1407046
18.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277733

ABSTRACT

Background: As more reports emerge that many COVID-19 survivors suffer protracted and lingering symptoms, how to define and better characterize these patients with post-acute COVID-19 is a research challenge. To understand the overall symptom burden in patients with post-acute COVID-19, we explored whether identifiable symptom clusters exist in a cohort of patients with post-acute COVID-19 and then examined whether these clusters are associated with quality of life impairments. Methods: In a prospective observational study of COVID-19 patients at a Covid-19 Recovery (CORE) clinic between June and December 2020 (eligible patients had either a positive COVID-19 PCR or IgG antibody test), we administered a modified revised Edmonton Symptom Assessment survey which assessed whether patients had 13 symptoms over the week prior to presentation to the clinic on a scale of 0 (no symptoms) to 10 (most severe symptoms). We performed exploratory factor analysis to search for clustering of symptoms into factors and examined the relationship between these clusters and quality of life measures. Results: Across 127 adult patients treated at CORE (mean (standard deviation (SD) age 51.8 (14.0);73.2% were women. We found four symptom factors: emotional factor (including depression and anxiety), activity limiting factor (fatigue, sleepiness and shortness of breath), gastrointestinal symptom factor (nausea, appetite and taste changes) and pain factor (pain, neuropathy). The Cronbach's α for the individual factors ranged from 0.64-0.84. The emotional factor was associated with an increased odds of reporting worse emotional (Odds Ratio (95% Confidence Interval (95% CI) 1.9 (1.2-3.3) and worse cognitive health status (OR 4.9 (2.5-9.5);the activity limiting factor was associated with increase odds of worse physical health status (OR 4.5 (2.1-9.7);the gastrointestinal symptom factor was associated with increase odds of worse cognitive health status (OR 2.1 (1.1-4.2). Conclusions: We found four symptom factors in adult patients with post-acute COVID-19. There was strong internal correlation between the factors and the factors were associated with quality of life measures. Routine assessment of post-acute COVID-19 patient's emotional, gastrointestinal, pain and activity limiting symptoms is important as they may be associated with impaired health related quality of life.

19.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277654

ABSTRACT

Rationale: Recent reports suggest that many patients diagnosed with COVID-19 will experience protracted symptoms. As part of a COVID-19 Recovery Engagement program, we aimed to 1) elucidate the type and trajectory of protracted symptoms after COVID-19 diagnosis and 2) compare symptom prevalence and severity at 1, 3 and 6 months after COVID-19 diagnosis. Methods: This is a prospective observational study of adults diagnosed with COVID-19 at Montefiore Medical Center from March 2020 to December 2020. We identified patients with a positive SARS-CoV-2 result who were recently treated in outpatient, Emergency Department, or hospital settings within the medical center. Patients were contacted for consent via telephone at 1, 3, and 6 months after diagnosis and asked to complete 1) a modified revised Edmonton Symptom Assessment (mrESAS), which assessed 13 symptoms on a scale of 0-10 and 2) three additional questions that asked patients to compare their physical, emotional and cognitive health status to their pre-COVID health state. We used chart review to gather additional data for each of the patients, including demographics, past medical history, and course of COVID-19 illness.Results: We enrolled 141 patients (mean (standard deviation (SD) age 49.5(16.9)], with 29 in the 1-month cohort, 22 in 3-month cohort, and 90 in 6-month cohort;46/141 (32.6%) were hospitalized. In patients in the 1-month cohort, there was a high (≥ 25% of patients) prevalence of 7/13 symptoms: pain (31%), fatigue (31%), sleepiness (30.3%), nausea (30.3%), change in taste (31%), breathlessness (27.6%) and anxiety (37.9%). In general, prevalence of symptoms was lower in patients at 3- month and 6-months after discharge. We found a higher prevalence of nausea and change of taste symptoms in the 1-month group compared with the 3- and 6-month group (10% at 1-month reported nausea vs 1.8% in 3- and 6-month cohorts, p= 0.026;31% at 1-month reported change in taste vs. 10.7 in the 3- and 6-month groups, p=0.006 for change of taste). Furthermore, in the 6-month cohort, 24.4%, 25.6% and 30% reported being worse than pre-COVID in their physical, emotional and cognitive health status, respectively. Conclusion: Patients at 1-month post-COVID experience more nausea and taste change than patients called at later time points after diagnosis. Even at 6 months after COVID diagnosis, over one-fourth of all patients still consider themselves to have worse health status than before their illness. COVID-19 survivors have a significant risk of residual symptoms for months after diagnosis.

20.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277461

ABSTRACT

Rationale: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic led to elevated inhospital morbidity and mortality. We aim to understand the frequency, timing, and outcomes associated with organ failure as defined by Sequential Organ Failure Assessment (SOFA) score for adult inpatients before and during the SARS-CoV-2 pandemic. Methods: A retrospective cohort of 17,722 unique patients age ≥18 years and their 20,675 admissions to 3 hospitals within the Montefiore Health System from 1 February 2020 through 31 May 2020 was constructed from the electronic health record. The cohort was stratified into two groups based on admission date with the cutoff being on or after 17 March 2020, when the confirmed index case of SARS-CoV-2 was admitted. Sequential Organ Failure Assessment (SOFA) scores were computed every 2 hours for each patient starting at admission using an automated SOFA calculator to produce a SOFA score composed of cardiovascular, coagulation, liver, renal, and respiratory components. The neurologic component was not computed due to sparsity of Glasgow Coma Scale data captured electronically. Results: A total of 1,789,930 SOFA scores were computed for the 20,675 admissions. Testing for SARS-CoV-2 occurred more during the pandemic (87.6% vs. 1.7%), with 48.4% of pandemic admissions testing positive. There was a significant increase in ICU admissions, usage of invasive mechanical ventilation, ICU and hospital length of stay, and mortality during the pandemic as compared to before (Table 1). Renal failure was the most common organ failure on presentation for both periods, but the most common organ failure during hospitalization was respiratory, which increased 53% during the pandemic. The burden of organ failure was higher during the pandemic, with a significant increase in multiorgan failure as indicated by the number of patients with maximum SOFA scores ≥ 6 as compared to before the pandemic. Conclusions: Before and during the SARS-CoV-2 pandemic, respiratory and renal systems were the most common organ systems to fail. There was a marked increase in the burden of multiorgan failure during the pandemic leading to increased ICU admissions, invasive mechanical ventilation, hospital length of stay, and mortality.

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