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1.
Critical Care Medicine ; 51(1 Supplement):211, 2023.
Article in English | EMBASE | ID: covidwho-2190546

ABSTRACT

INTRODUCTION: COVID-19 is often associated with hyper-inflammatory state reported as cytokine storm. Various markers have been proposed for early identification of developing cytokine storm and prognostication. Specifically, high ferritin levels have been shown to be an independent predictor of severity and in-hospital mortality. This study explores the trend of inflammatory markers on COVID-19 patients in hopes to provide clinical correlation with patient outcomes. METHOD(S): An IRB-approved retrospective study was done on 141 patients admitted for COVID-19 from March to April 2020. CRP, ferritin, and lactate dehydrogenase (LDH) levels were obtained on initial presentation and trended during hospitalization. Time to peak using Wilcox Signed Rank Test and area under the curve (AUC) was calculated. A subgroup analysis was done on patients who received high versus standard dose steroids to analyze effects on inflammatory markers. This is defined by at least 6 mg dexamethasone, 32mg methylprednisolone, or 40 mg prednisone daily for at least 3 days. Primary outcome of this study is to assess the trend of inflammatory markers throughout admission and clinically correlate with outcomes. RESULT(S): Time to peak for ferritin was slightly later[3.46 days+/-1.69(pCRP-Ferritin:0.046,pLDH-Ferritin:0.038)] compared to CRP(3.15 +/- 1.49) and LDH(3.04 +/- 1.75). AUC for CRP was significantly decreased(coef.-581CI[- 1029to-133]p0.013) for patients who received high dose steroids compared to those who received standard doses. There was no significant difference between AUC for LDH and ferritin. Peak CRP,LDH, and ferritin for survivors was 245(158-301), 604(448 -776), 1216(654-2478) respectively;and for non-survivors was 272(207-331) p0.049, 872(624-1220)p< 0.001, 2326(1016-3710)p0.012 respectively. CONCLUSION(S): Inflammatory markers have been a central topic of study in finding predictors of outcomes for COVID-19. This study showed that ferritin peak occurred slightly later than CRP and LDH. We can anticipate ferritin to have a slightly longer course to peak. AUC is suggestive of persistence of inflammation over time. We showed that CRP was significantly lower for patients who received high dose steroids compared with standard dose. Non-survivors had significantly increased peak levels of ferritin, LDH, and CRP.

2.
Chest ; 162(4):A911-A912, 2022.
Article in English | EMBASE | ID: covidwho-2060726

ABSTRACT

SESSION TITLE: Critical Care Management of COVID-19 SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: Superimposed bacterial co-infection is common among patients with Coronavirus disease-19 (COVID-19) pneumonia. Incidence of any superimposed infection ranges from 0% to 40%. Up to 50% of COVID-19 patients who died, had concomitant bacterial or fungal infection. Steroids are recommended for the treatment of acute hypoxemic respiratory failure (AHRF) due to COVID-19 and are thought to mitigate inflammatory organ injury. This retrospective study explores a subset of COVID-19 patients receiving Epoprostenol (iEPO) for AHRF and compared two different steroid treatment strategies and the impact on patient outcomes. METHODS: This is a retrospective study of 101 COVID-19 patients with AHRF receiving iEPO and systemic steroids. Patients in the high dose steroid group (n=59) received a minimum of dexamethasone 20mg daily or solumedrol 100mg daily while the standard dose steroid group (n=52) were those who received any lower dose. Patients that were DNR/I were excluded from the study. The primary outcome of the study was the rate of bacterial co-infection defined by positive cultures. Secondary outcome was mortality. RESULTS: Results showed that patients treated with high dose steroids were older (66.77±11.17 vs 60.33±14.49, p0.006) and received a longer treatment course (18 days (12-25) vs 12.5 days (10-17), p 0.004). Univariate and Multivariate analysis showed that higher dose steroids were not associated with increased risk of superimposed bacterial infection (OR 0.96, CI (0.34-2.66), p0.93). The duration of steroids, regardless of the dose, was associated with increased risk of superimposed bacterial infection (OR 1.06, CI (1.01-1.13), p0.033). When adjusted for comorbidities and inflammatory state, there was no significant difference in mortality between patients treated with high dose compared to standard dose steroids (OR 3.60, CI (0.65-19.93), p0.14). A longer duration of steroids was associated with a trend towards improved mortality (OR 0.93, CI (0.87-1.00), p0.072). CONCLUSIONS: Our study suggests that the duration of steroids, rather than dosage, had an effect on patient outcomes. There was no difference in bacterial co-infection rates between the two groups, but infection rates were increased among those who received a longer course of steroid treatment. There was a trend towards lower mortality with increased steroid duration, however, this did not reach statistical significance. Given this trend towards lower mortality, future prospective studies should investigate steroid duration to determine if a longer course of treatment leads to better outcomes in patients with COVID-19 pneumonia and refractory AHRF. CLINICAL IMPLICATIONS: Based on our study, patients should not receive a higher dose or longer duration of steroid treatment given the increased risk of bacterial infection with no definitive improvement in mortality. DISCLOSURES: No relevant relationships by Natasha Garg No relevant relationships by Abhinav Hoskote No relevant relationships by Raymonde Jean No relevant relationships by Arpanjeet Kaur No relevant relationships by Sara Luby No relevant relationships by Omar Mahmoud No relevant relationships by Maria Athena Riego No relevant relationships by Edith Robin No relevant relationships by James Salonia No relevant relationships by DISHANT SHAH No relevant relationships by Venus Sharma No relevant relationships by Elizabeth Zipf

3.
IJID Reg ; 5: 13-17, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2004138

ABSTRACT

Objective: To estimate the seroprevalence of anti-SARS-CoV-2 antibodies in the general population in Gabon, Central Africa. Methods: From May to July 2021, a cross-sectional study involving participants recruited in the general population in three districts in Gabon was conducted. Eligible participants who provided written informed consent were tested for anti-SARS-CoV-2 antibodies using a simple rapid diagnostic assay. Results: Overall, 1609 participants were recruited, 1361 (84.6%) from urban sites and 248 (15.4%) from a rural area. The estimated overall seroprevalence was 13.1% (95% CI 11.4-14.8%). The risk of seropositivity increased with age, and the prevalence in the different age groups ranged from 12.9% (8.0-19.4%) in those aged 15-24 years to 23.3% (14.2-34.6%) in those ≥ 65 years old. A higher prevalence was found in the rural population (17.3%; 12.8-22.6%) compared with urban regions (12.3%; 10.6-14.1%). Being a woman was also associated with higher risk of infection (p < 0.001). Conclusions: This seroprevalence survey revealed a moderate seroprevalence in Gabon, illustrating a relatively low rate of circulation of the virus in the country and correlating with low numbers of confirmed cases and deaths reported to date.

4.
N Engl J Med ; 387(2): 148-159, 2022 07 14.
Article in English | MEDLINE | ID: covidwho-1931553

ABSTRACT

BACKGROUND: Neonatal hypoxic-ischemic encephalopathy is an important cause of death as well as long-term disability in survivors. Erythropoietin has been hypothesized to have neuroprotective effects in infants with hypoxic-ischemic encephalopathy, but its effects on neurodevelopmental outcomes when given in conjunction with therapeutic hypothermia are unknown. METHODS: In a multicenter, double-blind, randomized, placebo-controlled trial, we assigned 501 infants born at 36 weeks or more of gestation with moderate or severe hypoxic-ischemic encephalopathy to receive erythropoietin or placebo, in conjunction with standard therapeutic hypothermia. Erythropoietin (1000 U per kilogram of body weight) or saline placebo was administered intravenously within 26 hours after birth, as well as at 2, 3, 4, and 7 days of age. The primary outcome was death or neurodevelopmental impairment at 22 to 36 months of age. Neurodevelopmental impairment was defined as cerebral palsy, a Gross Motor Function Classification System level of at least 1 (on a scale of 0 [normal] to 5 [most impaired]), or a cognitive score of less than 90 (which corresponds to 0.67 SD below the mean, with higher scores indicating better performance) on the Bayley Scales of Infant and Toddler Development, third edition. RESULTS: Of 500 infants in the modified intention-to-treat analysis, 257 received erythropoietin and 243 received placebo. The incidence of death or neurodevelopmental impairment was 52.5% in the erythropoietin group and 49.5% in the placebo group (relative risk, 1.03; 95% confidence interval [CI], 0.86 to 1.24; P = 0.74). The mean number of serious adverse events per child was higher in the erythropoietin group than in the placebo group (0.86 vs. 0.67; relative risk, 1.26; 95% CI, 1.01 to 1.57). CONCLUSIONS: The administration of erythropoietin to newborns undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy did not result in a lower risk of death or neurodevelopmental impairment than placebo and was associated with a higher rate of serious adverse events. (Funded by the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT02811263.).


Subject(s)
Erythropoietin , Hypothermia, Induced , Hypoxia-Ischemia, Brain , Neuroprotective Agents , Administration, Intravenous , Cerebral Palsy/etiology , Double-Blind Method , Erythropoietin/administration & dosage , Erythropoietin/adverse effects , Erythropoietin/therapeutic use , Humans , Hypothermia, Induced/methods , Hypoxia-Ischemia, Brain/complications , Hypoxia-Ischemia, Brain/drug therapy , Hypoxia-Ischemia, Brain/therapy , Infant , Infant, Newborn , Neuroprotective Agents/administration & dosage , Neuroprotective Agents/adverse effects , Neuroprotective Agents/therapeutic use
5.
International Marketing Review ; 2022.
Article in English | Scopus | ID: covidwho-1922510

ABSTRACT

Purpose: Disruptive external forces can bring businesses to a standstill and make their strategic plans obsolete overnight. COVID-19 exemplifies such a disruptive force, which has caused worldwide havoc and ongoing disruption in many sectors of the economy, while concurrently providing great opportunities for others. The goal in this study is to examine the experiences of firms that have been impacted by a prior disruptive force, offer five theoretical lenses for framing and examining such events, and provide a set of axioms based on the research findings. Design/methodology/approach: The authors used a qualitative approach involving five short international marketing case studies of firms based in South Korea and Taiwan. These nations and firms were selected on the bases of their overall judicious navigation of the conditions presented by the COVID-19 pandemic. The authors gathered information about these firms through primary sources of information (personal and remote interviews as well as other communications), which the authors augmented with information from secondary sources. Findings: The results indicate that external forces can bring both opportunities and threats to firms' international marketing strategies. The authors found that two strategies help firms cope with managerial issues associated with both the demand and the supply sides in successful firms in these nations: (1) leveraging opportunities presented by the pandemic through the successive introductions of new product and (2) the expansion of both the domestic and international markets. Research implications: The research provides five theoretical lenses to articulate the impact of disruptive external forces on international marketing strategies. Practical implications: The research offers thirteen demand and supply side axioms for marketing managers involved in international business (e.g. exporters, importers, MNCs) to cope with disruptive external forces, like COVID-19. Social implications: Disruptive external forces, such as the pandemic, have enormous impact on firms and consumers alike. This research aims to limit the negative impact of future disruptions by engaging in contingency planning and added resilience, through which firms may continue to function and, to a large extent, consumers are able to acquire the necessary goods and services to maintain their quality of life. Originality/value: The authors attribute the quicker response of these firms to their agility in managing the market impacts related to COVID-19 and to their prior conditioning in their respective geopolitical spheres. The authors summarize the findings in a set of nine supply side and a set of four demand side axioms. © 2022, Emerald Publishing Limited.

6.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880778
7.
Psychol Addict Behav ; 36(7): 786-797, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-1702298

ABSTRACT

OBJECTIVE: Prospective research is needed to better-understand changes in substance use from before to during the coronavirus disease (COVID-19) pandemic, among emerging adults (18-25 years), a high-risk group for substance use. METHOD: N = 1,096 (weighted sample N = 1,080; 54% female) participants enrolled in the Québec Longitudinal Study of Child Development, who completed prepandemic (2019; 21 years) and COVID-19 (mid-March to mid-June 2020) surveys. COVID-19-related and preexisting factors were examined as moderators of change in substance use. RESULTS: Full sample analyses revealed decreased binge drinking (p < .001, Bayes factor [BF] = 22, Cohen's f² = 0.02), but no changes in alcohol and cannabis use. Stratified analyses revealed emerging adults who reported < monthly use prepandemic increased their alcohol use (p < .001, BF > 150, f² = 0.05) and binge drinking (p < .001, BF = 27, f² = 0.01), but not their cannabis use. Conversely, emerging adults who reported >monthly use prepandemic decreased their binge drinking (p < .001, BF > 150, f² = .12) and cannabis use (p < .001, BF > 150, f² = .06), but did not change their alcohol use frequency. Several factors moderated change in substance use, including employment loss (p = .005, BF > 39, f² = .03) and loneliness (p = .018, BF > 150, f² = .10) during COVID-19. CONCLUSIONS: Changes in alcohol and cannabis use frequency among emerging adults in the first 3 months of COVID-19 largely differed according to prepandemic substance use, COVID-19-related factors, and preexisting factors. While some youth with preexisting vulnerabilities (e.g., more frequent substance use prepandemic) remained stable or decreased their substance use during COVID-19, emerging adults who experienced employment loss, loneliness, and financial concerns during COVID-19 increased their substance use, highlighting the need for increased supports for vulnerable populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Subject(s)
Binge Drinking , COVID-19 , Cannabis , Substance-Related Disorders , Adult , Adolescent , Child , Female , Humans , Male , Pandemics , Binge Drinking/epidemiology , Longitudinal Studies , Prospective Studies , Bayes Theorem , Birth Cohort , Alcohol Drinking/epidemiology , Substance-Related Disorders/epidemiology
8.
Am J Epidemiol ; 190(11): 2262-2274, 2021 11 02.
Article in English | MEDLINE | ID: covidwho-1517822

ABSTRACT

The prevalence of mental health problems represents a significant burden on school and community health resources as early as preschool. Reducing this burden requires a better understanding of the developmental mechanisms linking children's early vulnerabilities with mental health after the transition to formal schooling. The 3D-Transition Study (2017-2021) follows 939 participants from a pregnancy cohort in the province of Québec, Canada, as they transition to kindergarten and first grade to examine these mechanisms. Biannual assessments include completed questionnaires from 2 parents as well as teachers, parent-child observations, anthropometric measurements, and age-sensitive cognitive assessments. Saliva is also collected on 11 days over a 16-month period in a subsample of 384 participants to examine possible changes in child salivary cortisol levels across the school transition and their role in difficulties observed during the transition. A combination of planned missing-data designs is being implemented to reduce participant burden, where incomplete data are collected without introducing bias after the use of multiple imputation. The 3D-Transition Study will contribute to an evidence-based developmental framework of child mental health from pregnancy to school age. In turn, this framework can help inform prevention programs delivered in health-care settings during pregnancy and in child-care centers, preschools, and schools.


Subject(s)
Epidemiologic Research Design , Mental Health , Prenatal Exposure Delayed Effects , Schools , Stress, Psychological , Adverse Childhood Experiences , Child Development , Child, Preschool , Female , Humans , Hydrocortisone/metabolism , Infant , Life Change Events , Longitudinal Studies , Male , Pregnancy
9.
JACCP Journal of the American College of Clinical Pharmacy ; 2021.
Article in English | EMBASE | ID: covidwho-1312735

ABSTRACT

Introduction: Due to the current coronavirus disease 2019 (COVID-19) pandemic, telehealth has shifted from an underutilized service to a medical necessity almost overnight. While guidelines are available regarding implementation of telepharmacy services, there is limited practice-level evidence demonstrating successful adoption of telepharmacy for the delivery of clinical pharmacy services. Objectives: The purpose of this article is to provide a description of how telehealth has been utilized to deliver pharmacy services within a Community Health Center (CHC), to discuss the impact of telehealth services, and to provide a framework by which other entities may create successful telehealth programs within the ambulatory care setting. Methods: Overall CHC productivity, clinical pharmacist productivity, and patient demographics were compared between the 7 months preceding and the 7 months after implementation of telehealth services. Patient satisfaction with telehealth was measured via anonymous surveys administered via Feedtrail XM and provider satisfaction was measured via a survey created by the New Jersey Primary Care Association. Results: Telepharmacy has caused a shift in the demographics of patients receiving pharmacy services, increasing the proportion of patients with private insurance, who were 65 years or older, and who were non-English speakers. While overall productivity at the CHC remained stable, the number of clinical pharmacy encounters increased. Patients were satisfied with telepharmacy visits indicating that they were of the same or greater quality than in-person visits and expressed a preference to continue telepharmacy visits in the future. CONCLUSIONS: Our results suggest that telepharmacy is an effective way to deliver care particularly around chronic conditions. To be sustainable, telehealth requires ongoing support from local, State, and Federal agencies in terms of maintaining regulations around expanded scopes of practice and in terms of reimbursement.

10.
American Journal of Obstetrics and Gynecology ; 224(2, Supplement):S491, 2021.
Article in English | ScienceDirect | ID: covidwho-1055522
11.
Chest ; 158(4):A2460, 2020.
Article in English | EMBASE | ID: covidwho-871899

ABSTRACT

SESSION TITLE: Late-breaking Abstracts SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: On April 7, 2020, 597 people died from COVID-19 in NYC. That was the peak of a pandemic which has caused nearly twenty-thousand confirmed deaths in the city since March 11, 2020. Internal Medicine residents took care of these patients. Traditionally communication skills and nuances necessary for breaking bad news and complex goals of care discussions are refined over years of practice, not weeks. Poor coping skills with patient death in large numbers can lead to burnout and compassion-fatigue. This study aims to examine the impact that the COVID-19 pandemic has had on house-staff, their communication skills and perceived abilities to cope with patient death. METHODS: An IRB approved (#20-03637) anonymous REDCap survey was shared by email to all Mount Sinai Morningside and West Internal Medicine house-staff who had worked from March to June 2020. Respondents answered open and closed ended questions plus Bugen’s “Coping with Death Survey” (CDS) which uses Likert-scale questions to produce scores from 30 to 210. Scores below 105 indicate inadequate coping and scores above 157 suggest optimal coping. RESULTS: There was a total of forty-eight respondents (n=94 surveyed) of whom thirty-two answered every question. Their mean age was 29.5 (n=48, SD 2.53). 47.9% (n=23) had worked as doctors for three years, 47.9% (n=23) had worked as doctors outside of the U.S., and 56.3% (n=27) were interns. Before the pandemic, house-staff discussed goals of care, broke bad news, and encountered patient death “less than once a week” (44.2%, n=19), (58.1%, n=25), (93%, n=40) respectively. During the pandemic they discussed goals of care “every day” (48.8%, n=21). They broke bad news and encountered patient death “every other day” (46.5%, n=20) and (39.5%, n=17) respectively. Levels of comfort and fluency with these conversations improved from before (Mean 52.05, SD 24.01) and during (Mean=76.7, SD 14.89) the pandemic (t=6.7301, p=0.0001, n=40). 92.3% (n=36) of respondents feel more comfortable treating dying patients but 51.3% (n=20) of them remember a “particularly bad experience at work”. Three people (7.7%) have changed their career plans. Respondents’ (n=32) overall CDS score mean was 131.5 (SD 20.07). Those with less than two years’ experience working as doctors (n=16, Mean 124.44, SD 18.20) compared to those with more experience (n=16, Mean=138.56, SD 19.88) had a significantly lower mean CDS score (t= 2.0965, p= 0.0446). CONCLUSIONS: More than half of residents remember traumatic encounters during this period of high patient death. While their levels of comfort caring for and communicating with these patients improved during this time, their ability to cope with death remains suboptimal, particularly amongst the junior house-staff. CLINICAL IMPLICATIONS: Internal Medicine residency programs should implement breaking bad news workshops and educate house-staff on resilience in times of crisis. DISCLOSURES: No relevant relationships by Raymonde Jean, source=Web Response No relevant relationships by Katherine Mark, source=Web Response No relevant relationships by Georgina Osorio, source=Web Response No relevant relationships by Patrick Tobin-Schnittger, source=Web Response

12.
Chest ; 158(4):A688, 2020.
Article in English | EMBASE | ID: covidwho-871847

ABSTRACT

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Diabetes has been shown in recent studies to be highly prevalent in critically ill patients with severe coronavirus disease 2019 (COVID-19). However, data comparing clinical outcomes in diabetic and non-diabetic patients remained limited. We aim to compare characteristics and clinical outcomes of diabetic and non-diabetic critically ill patients with severe COVID-19. METHODS: Following institutional review board approval, we identified 115 patients who were admitted to the intensive care unit (ICU) for severe COVID-19. De-identified patient data was retrospectively collected and analyzed using Stata version 15.1 (StatCorp). Data reported here are those which are available through April 28 2020. RESULTS: We identified 115 patients who were admitted to the ICU for severe COVID-19. The population had a mean age of 63.44 years, 67% were male, the mean BMI was 33.30. The mean duration of symptoms prior to hospitalization was 6.35 days. Comorbidities were common, 68 patients had a Charlson comorbidities index equal to or above 3. The most common comorbidities included hypertension (65%), diabetes (41%) and hyperlipidemia (35%). The most common symptoms were dyspnea (81%), cough (75%) and fever (68%). When comparing the 47 diabetic and the 68 non-diabetic patients in our study, there was a similar number of patients requiring invasive (65% diabetic;51% non-diabetic) and non-invasive mechanical ventilation (36% diabetic;48% non-diabetic). There were no significant differences in their clinical management. Both populations had similar rates of shock requiring vasopressors (57% diabetic;48% non-diabetic) and renal failure requiring renal replacement therapy (27% diabetic;25% non-diabetic). There were no significant differences in the rate of acute kidney injury (61% diabetics;40% non-diabetics) and acute hepatic injury between both groups (27% diabetics;22% non-diabetics). Diabetic patients had significantly higher rates of troponin elevation (89% diabetics;70% non-diabetic). After propensity score matching, diabetics were more likely to experience in hospital mortality (OR 2.94 CI 1.32;6.52, p-value 0.008) and were less likely to be discharged from the hospital (OR 0.38 CI 0.17;0.83, p-value 0.02) when compared with non-diabetics. CONCLUSIONS: Diabetics experience higher rates of mortality and are less likely to be discharged when compared with non-diabetic patients. CLINICAL IMPLICATIONS: Further studies to evaluate management strategies in diabetic patients with severe COVID-19 may be useful given the increased risk for mortality in this population. DISCLOSURES: No relevant relationships by Yasmin Herrera, source=Web Response No relevant relationships by Kam Sing Ho, source=Web Response No relevant relationships by Raymonde Jean, source=Web Response No relevant relationships by Joseph Poon, source=Web Response

13.
Chest ; 158(4):A687, 2020.
Article in English | EMBASE | ID: covidwho-866552

ABSTRACT

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Severe acute respiratory syndrome coronavirus-2 (SAR-CoV-2) is a novel virus that causes coronavirus disease 2019 (COVID-19). Previous studies have detected high levels of pro-inflammatory cytokines in COVID-19 patients, including interleukin-6 (IL-6). Tocilizumab is a humanized monoclonal antibody against IL-6 receptors and has been identified as a potential therapeutic agent for COVID-19. We aim to describe the treatment response of critically ill COVID-19 patients who received tocilizumab. METHODS: Following institutional review board approval, we identified 67 critically ill patients with laboratory confirmed COVID-19 infection who received tocilizumab. Decisions regarding clinical management, including tocilizumab administration, were made solely at the discretion of the treating provider. De-identified patient data was retrospectively collected and analyzed using Stata version 15.1 (StatCorp). Data reported in this study are those which are available through April 25 2020. RESULTS: We identified 67 critically ill patients with COVID-19 who were given tocilizumab (mean age 57 years (53-61), 71% male). At the time of tocilizumab administration, 42 patients required invasive mechanical ventilation, 11 required non-invasive mechanical ventilation, 11 required high flow nasal cannula and 3 patients required non rebreather mask or nasal cannula oxygen support. Three days after tocilizumab administration, 53 patients had no change in oxygen support requirements, 13 patients had reduced oxygen support requirements, and 2 patients required higher levels of oxygen support. For patients who remained on mechanical ventilation, there was a decrease in mean FIO2 requirement by 8.98%. There was a significant decrease in mean IL-6 by 129, CRP by 63, WBC by 1.71. Seven days after tocilizumab administration, 39 patients had no change in oxygen support requirements, 27 patients had reduced oxygen support requirements and 1 patient required higher levels of oxygen support. For patients who required mechanical ventilation, there was a decrease in mean FIO2 requirement by 13.36%. There was a significant decrease in mean IL-6 by 130, CRP by 107, WBC level by 2.87. There was no significant change in daily max temperature at day 3 or 7. CONCLUSIONS: In this cohort of 67 patients treated with tocilizumab for severe COVID-19, improvement in oxygen support requirements was seen in 13 patients at day 3 and 27 patients at day 7. Improvement in FIO2 and several markers of inflammation including WBC, CRP and IL-6 were seen at day 3 and 7. Further studies such as randomized placebo controlled trials of tocilizumab will be required to better measure its efficacy and safety in patients with COVID-19. CLINICAL IMPLICATIONS: Tocilizumab use in critically ill patients may reduce oxygen support requirements and laboratory markers of inflammation. Further studies are required to establish efficacy and safety. DISCLOSURES: No relevant relationships by Yasmin Herrera, source=Web Response No relevant relationships by Kam Sing Ho, source=Web Response No relevant relationships by Raymonde Jean, source=Web Response No relevant relationships by Joseph Poon, source=Web Response

14.
Am J Obstet Gynecol ; 223(3): 372-378, 2020 09.
Article in English | MEDLINE | ID: covidwho-658728

ABSTRACT

The coronavirus disease 2019 pandemic has altered medical practice in unprecedented ways. Although much of the emphasis in obstetrics and gynecology to date has been on the as yet uncertain effects of coronavirus disease 2019 in pregnancy and on changes to surgical management, the pandemic has broad implications for ambulatory gynecologic care. In this article, we review important ambulatory gynecologic topics such as safety and mental health, reproductive life planning, sexually transmitted infections, and routine screening for breast and cervical cancer. For each topic, we review how care may be modified during the pandemic, provide recommendations when possible on how to ensure continued access to comprehensive healthcare at this time, and discuss ways that future practice may change. Social distancing requirements may place patients at higher risk for intimate partner violence and mental health concerns, threaten continued access to contraception and abortion services, affect prepregnancy planning, interrupt routine screening for breast and cervical cancer, increase risk of sexually transmitted infection acquisition and decrease access to treatment, and exacerbate already underlying racial and minority disparities in care and health outcomes. We advocate for increased use of telemedicine services with increased screening for intimate partner violence and depression using validated questionnaires. Appointments for long-acting contraceptive insertions can be prioritized. Easier access to patient-controlled injectable contraception and pharmacist-provided hormonal contraception can be facilitated. Reproductive healthcare access can be ensured through reducing needs for ultrasonography and laboratory testing for certain eligible patients desiring abortion and conducting phone follow-up for medication abortions. Priority for in-person appointments should be given to patients with sexually transmitted infection symptoms, particularly if at risk for complications, while also offering expedited partner therapy. Although routine mammography screening and cervical cancer screening may be safely delayed, we discuss society guideline recommendations for higher-risk populations. There may be an increasing role for patient-collected human papillomavirus self-samples using new cervical cancer screening guidelines that can be expanded considering the pandemic situation. Although the pandemic has strained our healthcare system, it also affords ambulatory clinicians with opportunities to expand care to vulnerable populations in ways that were previously underutilized to improve health equity.


Subject(s)
Ambulatory Care , Betacoronavirus , Coronavirus Infections/epidemiology , Gynecology , Pneumonia, Viral/epidemiology , COVID-19 , Contraception , Early Detection of Cancer , Female , Genital Neoplasms, Female/diagnosis , Humans , Mental Health , Pandemics , Pregnancy , SARS-CoV-2 , Sex Offenses , Sexual Health
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