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1.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779465

ABSTRACT

Background: During the SARS-CoV-2 pandemic in 2020, the use of routine screening mammography (SM) and diagnostic mammography (DM) was limited for several months in order to reduce patient exposure and redeploy medical personnel. Previous studies suggest such delays result in more late-stage breast cancer diagnoses. We hypothesized that this impact would vary between institutions depending on regional variations in shutdown periods and the ability and willingness of patients to resume screening. Methods: Patients diagnosed with invasive breast cancers from 2016-2020 were identified using the Beth Israel Deaconess Medical Center (BIDMC) and the Duke University Medical Center (DUMC) cancer registries. Rates of mammography were ascertained from billing data. Baseline patient characteristics, demographics, and clinical information were gathered and cross-referenced with the electronic medical record. Late-stage was defined as Anatomic Stage III-IV disease (AJCC 8th edition). Chi-squared analysis was used to examine monthly distributions in stage at presentation for diagnosis in 2016-2019 compared to in 2020 at each institution. Results: There were 5907 patients diagnosed with invasive breast cancer between 2016-2019 (1597 at BIDMC and 4310 at DUMC) and 1075 in 2020 (333 and 742, respectively). Mammography was limited from 3/16/20-6/8/20 at BIDMC and from 3/16/20-4/20/20 Sa t DUMC. There were fewer SM at each institution during their respective shutdown periods in 2020 than in the same months in 2019: BIDMC 1713 versus 8566 (80% reduction) and at DUMC 1649 versus 5698 (71% reduction). Following the pandemic shutdown, SM volume increased in July-December 2020 compared to July-December 2019 (108% at BIDMC and 116% at DUMC). The proportion of patients diagnosed with late-stage disease at BIDMC was greater in 2020 than in 2016-2019, at 12.6% and 6.6%, respectively (p < 0.001);86% of late-stage diagnoses and 68% of all diagnoses in 2020 at BIDMC occurred from July-December following the initial shutdown period. The proportion of patients diagnosed with late-stage disease at DUMC in these two cohorts were 14.3% in 2020 and 16.2%% in 2016-2019 (p = 0.1);50% of late-stage diagnoses and 51% of all diagnoses in 2020 at DUMC occurred in the period following the initial shutdown from July-December. Conclusion: We identified variation between two large academic medical centers in the impact of the SARS-CoV-2 pandemic shutdown on the proportion of late-stage breast cancer diagnoses. These dissimilar outcomes may be the result of differences in referral patterns as well as regional differences in the approach to SM during the pandemic. In particular, a shorter closure time and substantial increase in SM volume following the initial shutdown period in the Southeast region may have prevented an increase in late-stage diagnoses. Further information and analysis may help suggest additional strategies to minimize adverse effects of reduced cancer screening in future public-health emergencies.

2.
WMJ ; 120(4):313-315, 2021.
Article in English | MEDLINE | ID: covidwho-1619158

ABSTRACT

INTRODUCTION: A wide range of complications from COVID-19 are being reported, including cardiac complications. CASE PRESENTATION: A 71-year-old woman with systemic lupus erythematosus complicated by focal segmental glomerular sclerosis status post kidney transplant presented with worsening left-sided chest pain after receiving treatment for COVID-19 pneumonia at an outside hospital. She was subsequently diagnosed with acute pericarditis, likely secondary to viral infection with COVID-19, and was successfully treated with aspirin and colchicine for 90 days without complications. DISCUSSION: NSAIDs and colchicine are mainstays in acute pericarditis treatment. Though treatment presented a potential challenge given this patient's prior kidney transplant, aspirin and colchicine proved to be effective in treating her case of COVID-19-associated pericarditis. CONCLUSION: This report has implications for future treatment of renal transplant patients with COVID-19-related pericarditis and emphasizes the need for research into the pathophysiology of pericarditis in the context of COVID-19, including risk factors and treatment.

3.
Obesity ; 29(SUPPL 2):189-190, 2021.
Article in English | EMBASE | ID: covidwho-1616053

ABSTRACT

Background: Individuals living in rural areas have higher obesity and obesity related co-morbidities than their urban counterparts. Understanding rural-urban differences associated with weight management may inform the development of effective weight management interventions for adults living in rural areas. Methods: The International Weight Control Registry (IWCR) is an online registry designed to assess factors contributing to successes and challenges with weight loss and weight loss maintenance across the world. We examined demographics, weight history and weight management strategies in a sample of urban and rural residents in the Midwestern U.S. (IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, WI). Participants were classified as rural or urban by the Rural-Urban Commuting Area Code. Analyses included Chi-square tests for proportions and independent t-test and Wilcoxon rank sum test for continuous variables. Results: The sample was 45% rural (n = 78 of a total N = 174) with a mean age of 50.3 years. Rural residents were more likely to be white, non-college graduates, and have lower family income compared with urban areas (p < 0.05). Rural and urban residents reported similar weight histories and strategies for weight management. Work-related physical activity was higher and weekday sitting time was lower in rural compared to urban residents (p < 0.01). These data could potentially be impacted by the relative number of residents working from home during COVID-19 (Urban: 59% vs. Rural: 37%, p < 0.05). Rural residents were more likely to report a lack of neighborhood walkability (p < 0.01) and healthy food availability (p < 0.05) compared with urban residents. Conclusions: These data suggest rural-urban differences in demographic characteristics, opportunity for leisure time physical activity, and the availability of heathy foods should be considered in the development of weight management interventions. The consistency of the observed findings will be evaluated at the regional, national and international levels as the size of the available sample in the IWCR increases.

4.
Journal of Clinical Oncology ; 39(15):3, 2021.
Article in English | Web of Science | ID: covidwho-1533309
5.
Research on Biomedical Engineering ; 2021.
Article in English | Scopus | ID: covidwho-1469800

ABSTRACT

Purpose: The rapid increase in the spread of the coronavirus disease of 2019 (COVID-19) has led to a need for reliable, effective, and readily available testing on a large scale. While diagnostic testing has been a support to public health, newer technology can be used to provide low-cost and convenient test options for patients. X-ray scanning can be performed to resolve this issue and produce quicker and more precise results. Currently, a radiologist is required to examine these X-ray images. However, deep convolutional neural networks can also be used to perform X-ray examinations and employed for the detection of COVID-19. We propose a Conditional Generative Adversarial Network (cGAN) with a fine-tuned deep transfer learning model to classify chest X-rays into six categories: COVID-Mild, COVID-Medium, COVID-Severe, Normal, Pneumonia, and Tuberculosis. Methods: A total of 1229 images were taken to form a dataset containing six classes corresponding to the six categories. A cGAN was used to increase the number of images. Generative Adversarial Networks (GAN) are used to train a model for generating new images. cGAN is an extension of GAN consisting of a generator and discriminator network that are trained simultaneously to optimize the model. The generated images were then trained using deep transfer learning models such as ResNet50, Xception, and DenseNet-169 to achieve the classification into six classes. Results: The proposed model helped achieve a training and validation accuracy of up to 98.20 % and 94.21 % respectively. The model was able to achieve a test accuracy of 93.67 %. The use of cGAN not only helped to increase the size of the training dataset but it also helped to reduce the problem of over-fitting. Conclusion: The proposed approach will help to diagnose COVID-19 quickly at an early stage. © 2021, Sociedade Brasileira de Engenharia Biomedica.

6.
Journal of Clinical Oncology ; 39(15 SUPPL), 2021.
Article in English | EMBASE | ID: covidwho-1339315

ABSTRACT

Background: During the SARS-CoV-2 pandemic, routine screening mammography (SM) was stopped and diagnostic mammography (DM) was limited for several months across the United States in order to reduce patient exposure and redeploy medical personnel. We hypothesized that this delay would result in patients presenting with later-stage disease following the initial shutdown. Methods: Patients diagnosed with invasive breast cancers from 2016-2020 were identified using the Beth Israel Deaconess Medical Center Cancer Registry. Baseline patient characteristics, demographics, and clinical information were gathered and cross-referenced with our electronic medical record. Late-stage disease was defined as initial anatomic stage III-IV disease in the AJCC 8th edition staging system. The control cohort consisted of patients diagnosed from 2016-2019;patients diagnosed in 2020 were the test cohort. Chi-squared analysis was used to compare monthly distributions in stage at diagnosis between the control and test cohorts. Multivariate analysis was performed using a logistic regression model. Results: There were 1597 patients diagnosed with invasive breast cancer between 2016-2019 and 333 in 2020. Median age at diagnosis was 60 years;99% were female, and 69.1% were white. Mammography was limited from 3/16/20-6/8/20, with 90% reduction in volume during this time. The number of screening studies performed in March, April, May, and June of 2020 were 987, 1, 4, and 721 compared to 2042, 2141, 2241, and 2142 in 2019. The volume of new diagnoses per month decreased substantially during the shutdown (see table). The proportion of patients diagnosed with late-stage disease was 6.6% in the control cohort compared to 12.6% in the 2020 test cohort (p < 0.001);92.9% of late-stage diagnoses in 2020 occurred from June to December following the shutdown period. On multivariate analysis, year of diagnosis (2020 vs 2016-2019;OR = 4.25 95% CI 0.035-0.095, p < 0.001), lower income (<200% of the federal poverty level;OR = 2.73 95% CI 0.016-0.099, p = 0.006) and increased Charlson Comorbidity Index (OR = 12.01 95% CI 0.037-0.052, p < 0.001) were associated with later stage at diagnosis. Conclusions: Patients were more likely to be diagnosed with late-stage breast cancer following the global shutdown due to the SARSCoV-2 pandemic. Patients with lower income and medical comorbidities were disproportionately affected. These data raise significant concerns regarding the impact of SARS-CoV-2 on cancer diagnoses and long-term outcomes, especially in vulnerable patient populations. (Table Presented).

7.
Journal of Clinical and Diagnostic Research ; 15(6):VI01-VI03, 2021.
Article in English | EMBASE | ID: covidwho-1278707

ABSTRACT

The Coronavirus Disease 2019 (COVID-19) pandemic began in December 2019 in Wuhan, China. Such sudden infectious outbreaks take a toll on the psychological health of our brave frontline health care physicians. Frontline health care physicians become vulnerable to psychological problems like depression, anxiety, stress, and insomnia. Long working hours, increased patient load, and risk of spread of contagion to family members are a few of the major contributing factors. Such factors, coupled with chronic stress and emotional exhaustion predispose doctors to experience burnout which has also been reported to increase the risk of mental morbidities. Early counselling, pandemic preparedness, self-care efforts, and stress management can help to cope in these adverse times. Various online portals have also been developed as an intervention strategy in mitigating the negative impact of this pandemic. The purpose of this viewpoint is to highlight the need to address such issues in physicians, find possible root causes, and suggest relevant measures to curb the incidence of these problems.

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