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1.
Expert Opin Pharmacother ; 23(8): 865-868, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1764381
2.
JTCVS Open ; 5: 17-25, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1454583

ABSTRACT

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has posed challenges to health care services across the world. There has been a significant restructuring of health care resources to protect services for patients with COVID-19-related illness and to maintain emergency and urgent medical and surgical activity. This study assessed access to emergency treatment, logistical challenges, and outcomes of patients with acute aortic syndrome during the early months of the COVID-19 pandemic in the United Kingdom. METHODS: This was a multicenter study, from March 1 to May 20, 2020 that included 19 cardiac centers, was a retrospective analysis of prospectively collected data obtained from individual centers' national cardiac surgical databases. Demographic details, choice of treatment, operative details, and outcomes were collected. COVID-19 screening, timing of surgery, and outcomes of COVID-19-positive and -negative patients were also analyzed. RESULTS: In total, 88 patients presented with acute aortic syndrome to participating centers from March 1 to May 20, 2020. There were 79 aortic dissections (89.8%), 7 intramural hematomas (7.9%), and 2 penetrating aortic ulcers (2.3%). Seventy-nine patients (89.8%) underwent surgery. In-hospital mortality was 25.3% (n = 20). Postoperative complications included 13.9% postoperative stroke (11.4% permanent and 2.3% temporary), 16.5% rate of hemofiltration, and 10.1% rate of tracheostomy. Nine patients were treated conservatively with a mortality of 60%. Seven patients were diagnosed with COVID-19, and there was no associated mortality. CONCLUSIONS: Despite extensive restructuring of health care resources, access to emergency and urgent treatment for patients with acute aortic syndrome was maintained in the early months of the COVID-19 pandemic in the United Kingdom. Clinical outcomes were similar to the prepandemic period.

4.
Expert Opin Pharmacother ; 22(18): 2455-2474, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1379407

ABSTRACT

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic is the largest public health challenge of the twenty-first century. While COVID-19 primarily affects the respiratory system, manifesting as interstitial pneumonitis and severe acute respiratory distress syndrome (ARDS), it also has implications for the cardiovascular system. Moreover, those admitted to hospital with severe COVID-19 are more likely to have cardiovascular comorbidities such as hypertension and diabetes mellitus. The underlying pathophysiology of why COVID-19 onset can further decline cardiac pathologies as well as trigger acute onset of new cardiac complications is not yet well understood. AREAS COVERED: In this review, the authors extensively review literature focused on the current understanding and approaches of managing patients who have underlying cardiovascular diseases and concomitant COVID-19 infection. Furthermore, the authors explore the possible cardiovascular implications of the suggested COVID-19 therapeutic agents that are used to treat this lethal disease. EXPERT OPINION: Current evidence is evolving around the many trialed pharmacotherapeutic considerations for the management of coronavirus disease 2019 (COVID-19) in patients with cardiovascular disease. While we await such data, clinicians should advocate for careful consideration of all concomitant medications for those presenting with COVID-19 on a patient-by-patient basis.


Subject(s)
COVID-19 , Cardiovascular Diseases , Cardiovascular System , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/epidemiology , Humans , Pandemics , SARS-CoV-2
5.
J Card Surg ; 36(9): 3306-3307, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1282007
6.
Cancer Control ; 28: 10732748211024214, 2021.
Article in English | MEDLINE | ID: covidwho-1269852

ABSTRACT

The unprecedented threat of COVID-19 has taken its toll on the field of cancer research, with trial accrual rates seeing a sharp decline since the beginning of the pandemic. Recent evidence has suggested that decreased participation appears to be more pronounced in women than men, which raises concerns about an exacerbation of gender bias in research. The following manuscript is a commentary article to the recent study by Fox et al, who aimed at investigating the concerns of patients with regard to participating to cancer research, as well as examining potential gender disparities within their sample population. We provide a brief critique of their work, especially focusing on important limitations concerning sample size and under-representation of ethnic minority groups, before discussing their findings in light of current literature on gender differences in anxiety and risk perception, how this might be interpreted in the context of the current pandemic, and its impact on participation in cancer research. We present multiple lines of evidence which support the idea that women might experience greater anxiety during the COVID-19 pandemic which could have a significant impact on cancer research participation and consequently the external validity of studies in the field. The first attempts to tackle these challenges have shown promise, but further research is required to perfect this process and target those groups who are at greatest need of intervention.


Subject(s)
COVID-19 , Neoplasms , Female , Humans , Male , Minority Groups , Pandemics , SARS-CoV-2 , Sexism
7.
J Card Surg ; 36(9): 3364-3367, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1269754
8.
J Card Surg ; 36(8): 2692-2696, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1226689

ABSTRACT

OBJECTIVE: The coronavirus disease (COVID-19) increases the respiratory complications and carries a higher mortality in the immediate postoperative period. The aim of this study was to analyze the outcomes of patients with type A acute aortic syndromes (AAS) diagnosed with COVID-19 in the perioperative period. METHODS: Retrospective analysis of prospectively collected data between March and August 2020 from 20 participating cardiac surgery centers in the United Kingdom. RESULTS: Among 122 patients who underwent emergency surgical repair for type A AAS at the participating centers, 3 patients (2.5%) tested positive for COVID-19 in the preoperative screeing, and 4 cases turned to be positive in the postoperative period having been operated on an unknown COVID-19 status. Another patient was diagnosed of COVID-19 disease based on radiological features. These eight patients had increased postoperative complications, including respiratory failure, longer ventilation times, and Intensive Therapy Unit (ITU) stay and increased mortality when compared with COVID-19 negative patients. CONCLUSION: COVID-19 disease in the perioperative period of type A AAS poses a challenge. Despite the increasing morbidity and mortality associated with the virus, the prognosis of the aortic disease is poorer and emergency surgery should not be contraindicated based on the COVID-19 diagnosis alone.


Subject(s)
COVID-19 Testing , COVID-19 , Humans , Postoperative Complications/epidemiology , Retrospective Studies , SARS-CoV-2 , Syndrome , United Kingdom/epidemiology
9.
Cancer Control ; 28: 1073274821997425, 2021.
Article in English | MEDLINE | ID: covidwho-1105647

ABSTRACT

This systematic review aims to gather primary data from cancer institutions that have implemented changes to cancer service provision amid the COVID-19 outbreak to inform future intervention and health care facility response strategies. A comprehensive literature search was done on Global Health Medline and EMBASE using pertinent key words and MeSH terms relating to COVID-19 and Cancer service provision. A total of 72 articles were selected for inclusion in this systematic review. Following the narrative synthesis that was conducted of the literature, 6 core themes that encompassed common cancer service intervention adopted by institutions were identified: (1) Testing and Tracking, (2) Outreach and Communication, (3) Protection, (4) Social Distancing (5) Treatment Management, (6) Service Restructuring. Since cancer patients are a high-risk population amid the COVID-19 pandemic, these areas of targeted intervention can be used to inform necessary actions in institutions facing similar risks, based on previous learning from numerous cancer centers globally.


Subject(s)
COVID-19/epidemiology , Cancer Care Facilities/organization & administration , Neoplasms/diagnosis , Neoplasms/therapy , Communication , Humans , Infection Control/organization & administration , Pandemics , Physical Distancing , SARS-CoV-2
10.
J Healthc Leadersh ; 13: 19-26, 2021.
Article in English | MEDLINE | ID: covidwho-1088819

ABSTRACT

Inequalities in health have existed for many decades and have led to unjust consequences in morbidity and mortality. These have become even more apparent during the COVID-19 pandemic with individuals from black and minority ethnic groups, poorer socioeconomic backgrounds, urban and rurally deprived locations, and vulnerable groups of society suffering the full force of its effects. This review is highlighting the current disparities that exist within different societies, that subsequently demonstrate COVID-19, does in fact, discriminate against disadvantaged individuals. Also explored in detail are the measures that can and should be taken to improve equality and provide equitable distribution of healthcare resources amongst underprivileged communities.

11.
J Card Surg ; 36(5): 1729-1733, 2021 May.
Article in English | MEDLINE | ID: covidwho-1075870

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has increased the burden on hospital staff world-wide. Through the redistribution of scarce resources to these high-priority cases, the cardiac sector has fallen behind. In efforts to reduce transmission, reduction in direct patient-physician contact has led to a backlog of cardiac cases. However, this accumulation of postponed or cancelled nonurgent cardiac care seems to be resolvable with the assistance of technology. From telemedicine to artificial intelligence (AI), technology has transformed healthcare systems nationwide. Telemedicine enables patient monitoring from a distance, while AI unveils a whole new realm of possibilities in clinical practice, examples include: traditional systems replacement with more efficient and accurate processing machines; automation of clerical process; and triage assistance through risk predictions. These possibilities are driven by deep and machine learning. The two subsets of AI are explored and limitations regarding "big data" are discussed. The aims of this review are to explore AI: the advancements in methodology; current integration in cardiac surgery or other clinical scenarios; and potential future roles, which are innately nearing as the COVID-19 era urges alternative approaches for care.


Subject(s)
COVID-19 , Cardiac Surgical Procedures , Artificial Intelligence , Humans , Pandemics , SARS-CoV-2
12.
Curr Opin Pulm Med ; 27(3): 163-168, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1072464

ABSTRACT

PURPOSE OF REVIEW: To summarize current literature evidence on the role of computed tomography (CT) scan in the diagnosis and assessment of coronavirus disease 2019 (COVID-19) pneumonia. RECENT FINDINGS: Recent guidelines on the use of CT scans in COVID-19 vary between countries. However, the consensus is that it should not be used as the first line; a notion supported by the WHO. Currently, several investigations are being used including reverse transcription PCR testing, chest radiographs, and ultrasound scans, and CT scans. They are ideally performed later during the disease process as the sensitivity and specificity are highest by that time. Typical COVID-19 features on CT scans vary but include vascular enlargement, ground-glass opacities, and ground glass opacification together with consolidation. SUMMARY: Since COVID-19 was declared as a global pandemic, there was a push towards identifying appropriate diagnostic tests that are both reliable and effective. There is a general agreement that CT scans have a high sensitivity but low specificity in diagnosing COVID-19. However, the quality of available studies is not optimal, so this must always be interpreted with the clinical context in mind. Clinicians must aim to weigh up the practicalities and drawbacks of CT scans when considering their use for a patient. The ease and speed of use of CT scans must be balanced with their high radiation doses, and infection control considerations.


Subject(s)
COVID-19/diagnosis , Lung/diagnostic imaging , Tomography, X-Ray Computed/methods , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Infection Control/methods , Radiologic Health/methods , SARS-CoV-2 , Sensitivity and Specificity
13.
J Med Ultrasound ; 28(4): 207-212, 2020.
Article in English | MEDLINE | ID: covidwho-1067854

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has now infected six million people and is responsible for nearly four hundred thousand deaths. We review the potential role of the lung ultrasound to evaluate its benefits and potential roles to compare it to the current gold standard of computed tomography. A literature search was carried out utilizing electronic search engines and databases with COVID-19. Keywords related to the lung ultrasound (LUS) were used to refine this search - only the relevant articles found are cited. This review showed that there exists a strong correlation between the CT and LUS scan in COVID-19. Prominent features include the vertical B-lines, thicker pleural lines, and subpleural consolidation. Potential roles include reducing transmission between health-care workers and monitoring the progress of the disease. However, the current research is scarce compared to well-established imaging modalities, and as such, there is a necessity for more research to confirm the findings of this review.

15.
Expert Opin Drug Discov ; 16(2): 115-117, 2021 02.
Article in English | MEDLINE | ID: covidwho-1066185

ABSTRACT

Introduction: The COVID-19 pandemic has catalyzed the production of potential antivirals and vaccines from research organizations across the globe. The initial step for all drug discovery models is the identification of suitable targets. One approach organizations may take to tackle this involves issuing raw data publicly for collaboration with other organizations in order to spark discussion, collectively experiment and stay up to date with advances in scientific knowledge. Areas covered: Numerous organizations have released genomic data, amongst other tools, for the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and this has led to the development of growing datasets of knowledge for continued collaboration amongst different scientific communities. A different technique employs a more closed, market-driven method in order to stay ahead financially in the race for developing a suitable antiviral or vaccine. The latter allows sustained motivation for company ambitions and progress has been made toward clinical trials for potential drugs. Expert opinion: A case can be made for both open and closed drug discovery models; however, due to the rapidly evolving nature of this deadly virus, organizations should collate their research and support one another to ensure satisfactory treatment can be approved in a timely manner.


Subject(s)
Antiviral Agents/pharmacology , COVID-19/drug therapy , Drug Discovery/organization & administration , SARS-CoV-2 , Viral Vaccines/pharmacology , COVID-19/epidemiology , COVID-19/prevention & control , Clinical Trials as Topic , Drug Discovery/economics , Drug Discovery/methods , Humans , International Cooperation , SARS-CoV-2/drug effects , SARS-CoV-2/genetics
16.
Acta Biomed ; 91(4): e2020135, 2020 11 05.
Article in English | MEDLINE | ID: covidwho-1059506

ABSTRACT

Background and aim The coronavirus-19 (COVID-19) pandemic has had a profound impact on many aspects of our lives, including medical education. The suspension of clinical placements and cancellation of objective structured clinical examinations (OSCE) is likely to have an influence on students' performance.   Methods Using a questionnaire, a retrospective observational study was conducted. Our primary focus was 3rd year medical students following their examinations in May 2020.    Results Out of 46 responses obtained, the results demonstrated over 2/3 felt they perform better in clinical OSCE compared to written examinations and the majority performed worse this year during the pandemic. On a Likert scale, a mean result of 3/5 was obtained for confidence upon returning to placement and to address this, most stated they would benefit from extra optional teaching. Additionally, a further average of 3.82 was derived to represent how greatly students believed the absence of third year clinical OSCE would negatively impact their performance in the OSCE for the following academic year.  Conclusion The results of our study highlight that the cancellation of clinical placements and OSCE due to coronavirus has negatively impacted on medical education and if we are to be faced with future pandemics, we must be better prepared to train future doctors.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control , Education, Medical/organization & administration , Educational Measurement , Students, Medical/psychology , COVID-19/prevention & control , COVID-19/transmission , Humans , Retrospective Studies , Self Efficacy
17.
Acta Biomed ; 91(4): ahead of print, 2020 07 13.
Article in English | MEDLINE | ID: covidwho-1058708

ABSTRACT

COVID-19 has impacted the primary management of cardiac conditions, decreasing the number of interventions of coronary diseases. Elective coronary treatments and imaging have been largely cancelled across the world to make way for increased resources for COVID-19 patients. The impact on these cardiac patients during these times may be drastic. The number of hospital patients presenting with coronary symptoms during the outbreak has also decreased internationally. In this review, we discuss how COVID-19 has affected primary cardiac intervention globally and our service, possible reasons why, and how morbidity rates can be reduced by introducing scoring systems and telemedicine.


Subject(s)
COVID-19/epidemiology , Cardiology/organization & administration , Telemedicine/organization & administration , COVID-19/prevention & control , COVID-19/transmission , Cardiac Imaging Techniques , Cardiac Surgical Procedures , Humans , Practice Patterns, Physicians'
18.
Acta Biomed ; 91(4): ahead of print, 2020 07 13.
Article in English | MEDLINE | ID: covidwho-1055387

ABSTRACT

Coronavirus Disease (COVID-19), first emerged in Wuhan, China, in December 2019 and has now become a worldwide health emergency. The symptoms of Coronavirus vary from anosmia, fever, and cough to severe complications such as acute respiratory distress syndrome, which often require intubation and subsequent ventilation. Procedures such as these are aerosol-generating, and this adds additional challenges due to the risks posed to staff. In this brief article, we discuss the need for ventilation, risks raised to healthcare staff in this context, and ways to potentially mitigate these risks. We also discuss emerging themes, including phenotypes of COVID-19 and the role of prone positioning.


Subject(s)
COVID-19/therapy , Infection Control , Respiration, Artificial , COVID-19/complications , Humans
19.
J Card Surg ; 36(3): 848-856, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1029257

ABSTRACT

BACKGROUND: A significant restructuring of the healthcare services has taken place since the declaration of the coronavirus disease 2019 (COVID-19) pandemic, with elective surgery put on hold to concentrate intensive care resources to treat COVID-19 as well as to protect patients who are waiting for relatively low risk surgery from exposure to potentially infected hospital environment. METHODS: Multicentre study, with 19 participating centers, to define the impact of the pandemic on the provision of aortovascular services and patients' outcomes after having adapted the thresholds for intervention to guarantee access to treatment for emergency and urgent conditions. Retrospective analysis of prospectively collected data, including all patients with aortovascular conditions admitted for surgical or conservative treatment from the 1st March to the 20th May 2020. RESULTS: A total of 189 patients were analyzed, and 182 underwent surgery. Diagnosis included: aneurysm (45%), acute aortic syndrome (44%), pseudoaneurysm (4%), aortic valve endocarditis (4%), and other (3%). Timing for surgery was: emergency (40%), urgent (34%), or elective (26%). In-hospital mortality was 12%. Thirteen patients were diagnosed with COVID-19 during the peri-operative period, and this subgroup was not associated with a higher mortality. CONCLUSIONS: There was a significant change in service provision for aortovascular patients in the UK. Although the emergency and urgent surgical activity were maintained, elective treatment was minimal during early months of the pandemic. The preoperative COVID-19 screening protocol, combined with self-isolation and shielding, contributed to the low incidence of COVID-19 in our series and a mortality similar to that of pre-pandemic outcomes.


Subject(s)
Aortic Diseases/surgery , COVID-19/epidemiology , Emergencies , Pandemics , SARS-CoV-2 , Vascular Surgical Procedures/methods , Adult , Aged , Aged, 80 and over , Aortic Diseases/epidemiology , Comorbidity , Emergency Service, Hospital , Female , Humans , Incidence , Male , Middle Aged , Retrospective Studies , United Kingdom/epidemiology
20.
Brain Behav ; 10(11): e01839, 2020 11.
Article in English | MEDLINE | ID: covidwho-1023271

ABSTRACT

OBJECTIVE: Olfactory and taste dysfunction (OTD) is a potential neurological manifestation of coronavirus-2019 (COVID-19). We aimed to investigate the diagnostic value of symptoms of anosmia and dysgeusia for COVID-19. METHODS: A comprehensive electronic search was conducted using PubMed, MEDLINE, Scopus, Cochrane database, and Google Scholar from 1 June 2020 to 12 June 2020. All studies reporting symptoms of anosmia and dysgeusia in COVID-19-positive patients were included. A total of 23 studies were included in the systematic review. RESULTS: Symptoms of anosmia and dysgeusia were frequently reported by COVID-19-positive patients. Symptoms were more common in females and in younger patients. There was no direct association between the severity of COVID-19 and the presence of symptoms. However, some evidence was found for a longer duration of these symptoms and increased severity of COVID-19 infection in young patients. CONCLUSION: OTD is commonly reported by COVID-19 patients. Due to limited literature on the association between OTD and COVID-19, it is currently not possible to conclude that these symptoms alone can be used to diagnose COVID-19. However, the presence of OTD can potentially be used as a screening tool for COVID-19 especially in young and female patients. Further research is required to establish the true diagnostic value of these symptoms and efficacy as screening tools for COVID-19 patients.


Subject(s)
COVID-19 Testing/metabolism , COVID-19/diagnosis , COVID-19/physiopathology , Dysgeusia/physiopathology , Olfaction Disorders/physiopathology , Female , Humans , Pandemics , SARS-CoV-2
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