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1.
Vasc Endovascular Surg ; : 15385744221106272, 2022 Jun 01.
Article in English | MEDLINE | ID: covidwho-1868977

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, cardiovascular patients were found to be presenting to hospitals with myocardial infarctions and cerebrovascular accidents at progressed disease states. We noticed a parallel in acute limb ischemia (ALI) patients presenting during Massachusetts' COVID-19 State of Emergency declaration. We question whether patients developed a hesitancy to seek medical attention at hospitals due to fear of COVID-19. Our objective was to compare acuity of ALI, interventions, and limb survival in patients presenting before, during, and after a state of emergency. METHODS: Four timeframes were set to compare patients presenting peri-2020 COVID-19 State of Emergency and patients presenting during a pre-pandemic era at a tertiary, academic institution. A reference period from 2019, Pre-State of Emergency period, State of Emergency period, and Post-State of Emergency period were designated. Patient characteristics, interventions, and outcomes data were collected. Unpaired t-test, ANOVA, and Chi-square statistical analyses were used. RESULTS: A total of 95 patients presenting with ALI were identified. Compared to Reference group, state of emergency group had more patients presenting with Rutherford Class III, 12.9% vs 35%, and less patient presenting with Class I, 45.1% vs 0%, P = .02. State of emergency group had more delayed presentations with ≥6 hours after symptom onset, 45% vs 85%, P = .01. Above-knee amputations were performed in 20% of patients during state of emergency and 31.6% for Post-State of Emergency, vs 6.5% in the Reference group; P = .03. There was no difference in intensive care unit admission, length of stay, or mortality between patients from different groups. CONCLUSION: During a state of emergency, ALI patients were noted to present later from symptom onset, have greater disease severity, and more likely to undergo amputations. We suspect delay in presentation and limb lost to be attributed to reluctance to seek immediate medical attention.

2.
Hand (N Y) ; : 15589447221081871, 2022 Mar 23.
Article in English | MEDLINE | ID: covidwho-1759652

ABSTRACT

BACKGROUND: To evaluate the impact of coronavirus disease 2019 (COVID-19) on the clinical practice, health, and quality of life of Brazilian hand surgeons when only essential services and emergency procedures were being provided. METHOD: A questionnaire of 50 questions was sent to members of the Brazilian Society of Hand Surgery addressing work and life routines before the pandemic and during the initial quarantine period from April to August 2020. RESULTS: Two hundred ten hand surgeons answered the questionnaire; 55.2% lived in the southeast region and worked in the capital and metropolitan regions, in both the private and public systems. Thirty-eight percent of the sample had other sources of income besides medicine, and due to a drop of 50% or more in the volume of consultations and surgeries, one-third had to apply for financial loans or access personal savings, and 69% made financial cuts in their domestic and life routines. More than 40% gained weight and stopped doing physical activities, while 20% lost weight and started physical activities. Approximately 30% were diagnosed with COVID-19, 92% of whom had mild symptoms and quarantined at home, and 89% had psychological symptoms such as anxiety, fear, insecurity, and insomnia. CONCLUSIONS: Coronavirus disease 2019 had a significant impact on the lives of Brazilian hand surgeons by drastically reducing the number of consultations and surgical procedures, generating not only financial difficulties but also changes in the exercise routine, changes in body weight, associated psychological symptoms, and changes in the family/life routine.

4.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-330706

ABSTRACT

With the emergence of SARS-CoV-2 variants that may increase transmissibility and/or cause escape from immune responses 1-3 , there is an urgent need for the targeted surveillance of circulating lineages. It was found that the B.1.1.7 (also 501Y.V1) variant first detected in the UK 4,5 could be serendipitously detected by the ThermoFisher TaqPath COVID-19 PCR assay because a key deletion in these viruses, spike DELTA69-70, would cause a "spike gene target failure" (SGTF) result. However, a SGTF result is not definitive for B.1.1.7, and this assay cannot detect other variants of concern that lack spike DELTA69-70, such as B.1.351 (also 501Y.V2) detected in South Africa 6 and P.1 (also 501Y.V3) recently detected in Brazil 7 . We identified a deletion in the ORF1a gene (ORF1a DELTA3675-3677) in all three variants, which has not yet been widely detected in other SARS-CoV-2 lineages. Using ORF1a DELTA3675-3677 as the primary target and spike DELTA69-70 to differentiate, we designed and validated an open source PCR assay to detect SARS-CoV-2 variants of concern 8 . Our assay can be rapidly deployed in laboratories around the world to enhance surveillance for the local emergence spread of B.1.1.7, B.1.351, and P.1.

5.
Annals of Emergency Medicine ; 78(4):S33, 2021.
Article in English | EMBASE | ID: covidwho-1748279

ABSTRACT

Study Objectives: Emergency departments (EDs) serve as the front lines for diagnosing and treating patients with a variety of diseases encompassing the entire spectrum of severity. Patients with suspected respiratory tract infections, whether bacterial or viral, present to EDs with a range of unpredictable clinical courses, with a significant number at risk of progressing to critical illness caused by a dysregulated immune response that leads to organ dysfunction (sepsis) and death, as seen in severe COVID-19. In the setting of a pandemic or local outbreak caused by a novel pathogen or in situations where pathogen identification is limited, a pathogen-independent assessment of the host response could assist clinicians in the risk stratification of persons under investigation for infection by providing a patient-centered, objective assessment of the state of immune activity. The objective of this study was to assess the performance of IntelliSep test to stratify such a population for risk of sepsis and poor outcomes. Methods: The IntelliSep test is a novel in vitro diagnostic that quantifies the state of immune activation by measuring the biophysical properties of leukocytes from a routine blood draw sample in under 10 minutes. The test provides a single score, the IntelliSep Index (ISI), between 0.1-10.0 (inclusive), stratified into three discrete interpretation bands of risk for disease severity: Green (0.1–4.9), Yellow (5.0–6.2), and Red (6.3–10.0), developed in prior sepsis-focused studies (O’Neal Jr., PLOS ONE, 2021). In a prospective study at a large academic medical center in Baton Rouge, LAA early in the COVID-19 pandemic (April 07 – April 28, 2020) and prior to widespread availability of rapid SARS-CoV-2 diagnostics, adult patients presenting to the ED with respiratory symptoms who had a CBC drawn within 4.5 hours of initial vital signs were enrolled. An aliquot from the CBC draw was tested, and patients were followed by retrospective chart review for outcome information. Sepsis disease status was determined by objective evaluation of infection (per modified CDC objective definitions), and organ dysfunction (defined as an increase in Sequential Organ Failure Assessment (SOFA) score of 2 or more points), and in select cases, physician clinical review. C-reactive protein (CRP) values were collected when ordered per standard care. Results: The 282 patients (34% SARS-CoV-2+) in the final analysis (observed sepsis incidence rate of 30.9%) were stratified by the ISI as 182 (64.5%) Green, 54 (19.1%) Yellow, and 46 (16.3 %) Red. The test achieved an area under the receiver operating curve of 0.85 (0.8 – 0.9, 95% CI). When comparing subjects in Green and Red Bands, negative predictive value and positive predictive value were 90% (78% – 96%, 95% CI) and 80% (68% – 90%, 95% CI), respectively, and a diagnostic odds ratio of 35.3 (22 – 48, 95% CI) was observed. Additionally, in the subpopulation of subjects with CRP ordered (N = 168), when compared to CRP with cutoff ≥ 75, the ISI showed superior negative predictive value (97.9% vs. 95.4%) in predicting all-cause 7-day mortality and positive predictive value is predicting the need for hospital stay of ≥ 2 days (94.4% vs. 87.3%). Conclusion: The ISI, a quantitative measure of immune activation, may offer a pathogen-independent means for rapid diagnosis and risk stratification for sepsis amongst ED patients presenting with respiratory symptoms, with the potential to aid physicians in improving outcomes and efficiency of care.

6.
8.
Morbidity and Mortality Weekly Report ; 70(1):7-11, 2021.
Article in English | CAB Abstracts | ID: covidwho-1395386

ABSTRACT

This study discusses the quarantine period for COVID-19 affected athletes during June to October 2020. To minimizse the spread of COVID-19, athletic programs implemented plans to implement measures designed to minimise the impact of the coronavirus disease. These include restricting outdoor activities and keeping athletes isolated from the rest of the team. Regional athletic conferences created policies that vary depending on the type of sport and conference. Stricter quarantine policies were also implemented in some countries to reduce the burden of compliance. Although most athletes reported experiencing COVID-19 exposure at social gatherings and from roommates, most of them had less than 2 weeks between their quarantine start and their first positive COVID-19 test result. 458 out of 1,830 athletes tested positive for the RT-PCR test during the 14-day quarantine. The rate of positive test results among those who did not receive a positive result decreased from 27% to 5% after day 10. The recommendations from the CDC support the use of different options to reduce quarantine for college athletes. These include reducing the duration of quarantine and improving compliance with mitigation measures. Twenty-four universities and colleges participated in the study of 2,257 quarantined athletes. Out of the 2,830 athletes, the most common sports they played were football, track and field, and soccer. Most of them reported being exposed to various activities while in quarantine. Only three universities and colleges contributed data on athletes who tested positive for SARS-CoV-2 during quarantine. Out of the 620 athletes, 159 remained quarantined. 436 (73.4%) of the athletes with an available exposure date tested positive for tuberculosis, and quarantine began a mean of 1.1 days after their reported exposure. Out of the 620 athletes with positive tests, 405 achieved positive results. The rate of positive tests decreased over the quarantine period. The median interval between when a positive specimen was collected and when quarantine was initiated was 2 days. Among the individuals whose test results remained unfavorable after day 5, 26.9% had a positive result. Among the 29 athletes who tested positive for Influenza A during the quarantine period, 26 percent did not have been tested previously. Although data support the CDC's recommendation that people with confirmed or suspected cases of SARS-CoV-2 should stay in quarantine for 14 days, this advice is not intended to reduce transmission among the general population. Adherence to quarantine can improve a population's adherence to isolation and mitigation strategies.

9.
Critical Care Medicine ; 49(1):90-90, 2021.
Article in English | Web of Science | ID: covidwho-1326428
10.
Critical Care Medicine ; 49(1 SUPPL 1):90, 2021.
Article in English | EMBASE | ID: covidwho-1193896

ABSTRACT

INTRODUCTION: Limited information is available to guide antimicrobial stewardship interventions in COVID-19 infections. Two meta-analyses have been published to date showing a rate of bacterial co-infection between 7-8% in COVID-19, with only 1 case of methicillin-resistant Staphylococcus aureus (MRSA) among those publications. METHODS: In an effort to optimize use of anti-MRSA therapy, the COVID-19 Task Force at this large, hybrid community and academic medical center implemented routine MRSA nasal swabs for all COVID-19 patients, suspected or confirmed, requiring anti-MRSA therapy. This retrospective review was conducted to evaluate the use of MRSA nasal swabs in patients admitted between April 13, 2020 and July 26, 2020. Electronic health record-generated reports were created to identify patients with a diagnosis code of COVID-19 infection or COVID-19 rule out who also received an MRSA nasal swab. RESULTS: Out of 263 patients identified with MRSA nasal swabs, 113 patients were included in the final analysis. Almost 75% of patients required ICU admission and the overall mortality rate was 41.6%. A total of 12 swabs (10.6%) resulted as positive for MRSA. In response to swab results, 54 patients (47.8%) had anti-MRSA agents discontinued and another 37 patients (32.7%) were never started on anti-MRSA therapy (collectively referred to as ?discontinued? in this report). The median duration of anti-MRSA therapy overall was 12 hours (12 hours in the discontinued group versus 120 hours in the continued group). Sputum cultures were obtained in 29 patients, with pathogens identified in 13. Most pathogens were gram-negative, including Pseudomonas aeruginosa in 8 cases. Methicillin-resistant Staphylococcus aureus was isolated in sputum cultures of two patients;both had MRSA positive nasal swabs and were continued on anti- MRSA therapy. CONCLUSIONS: With implementation of MRSA nasal swabs in COVID-19 patients, anti-MRSA therapy was reduced in 80.5% of patients in the study cohort, with median duration 12 hours for anti-MRSA therapy. Of the 22 patients with therapy continued, 11 were for pneumonia and MRSA positive swab and 10 for treatment of an alternative indication. MRSA nasal swabs may serve as an effective antimicrobial stewardship tool in COVID-19 pneumonia.

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