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1.
Emerg Infect Dis ; 28(13):208-216, 2022.
Article in English | PubMed | ID: covidwho-2162884

ABSTRACT

The US Centers for Disease Control and Prevention (CDC) supports international partners in introducing vaccines, including those against SARS-CoV-2 virus. CDC contributes to the development of global technical tools, guidance, and policy for COVID-19 vaccination and has established its COVID-19 International Vaccine Implementation and Evaluation (CIVIE) program. CIVIE supports ministries of health and their partner organizations in developing or strengthening their national capacities for the planning, implementation, and evaluation of COVID-19 vaccination programs. CIVIE's 7 priority areas for country-specific technical assistance are vaccine policy development, program planning, vaccine confidence and demand, data management and use, workforce development, vaccine safety, and evaluation. We discuss CDC's work on global COVID-19 vaccine implementation, including priorities, challenges, opportunities, and applicable lessons learned from prior experiences with Ebola, influenza, and meningococcal serogroup A conjugate vaccine introductions.

2.
Applied Biosafety ; 27(4):231-236, 2022.
Article in English | Web of Science | ID: covidwho-2160875

ABSTRACT

Introduction: Healthcare organizations faced unique operational challenges during the COVID-19 pandemic. Assuring the safety of both patients and healthcare workers in hospitals has been the primary focus during the COVID-19 pandemic.Methods: The NIH Vaccine Program (VP) with the Vaccine Management System (VMS) was created based on the commitment of NIH leadership, program leadership, the development team, and the program team;defining Key Performance Indicators (KPIs) of the VP and the VMS;and the NIH Clinical Center's (NIH CC) interdisciplinary approach to deploying the VMS.Results: This article discusses the NIH business requirements of the VP and VMS, the target KPIs of the VP and the VMS, and the NIH CC interdisciplinary approach to deploying an organizational VMS for vaccinating the NIH workforce. The use of the DCRI Spiral-Agile Software Development Life Cycle enabled the development of a system with stakeholder involvement that could quickly adapt to changing requirements meeting the defined KPIs for the program and system. The assessment of the defined KPIs through a survey and comments from the survey support that the VP and VMS were successful.Conclusion: A comprehensive program to maintain a healthy workforce includes asymptomatic COVID testing, symptomatic COVID testing, contact tracing, vaccinations, and policy-driven education. The need to develop systems during the pandemic resulted in changes to build software quickly with the input of many more users and stakeholders then typical in a decreased amount of time.

3.
Thorax ; 77(Suppl 1):A125, 2022.
Article in English | ProQuest Central | ID: covidwho-2118242

ABSTRACT

Introduction & ObjectivesIn patients with pulmonary arterial hypertension (PAH), cardiopulmonary haemodynamics and exercise capacity relates to clinical outcomes, and exercise training improves cardiopulmonary function. Public health measures that limit physical activity have been widely enforced to reduce COVID-19 transmission. COVID-19 infection causes endothelial dysfunction, which is central to the pathophysiology of PAH. Here, we describe the temporal effects of UK government restriction measures on daily activity and quality of life (QoL) in patients with PAH and the effect of COVID-19 infection on cardiopulmonary haemodynamics and physical activity.MethodsPatients were enrolled in FIT-PH (NCT04078243) and implanted with remote monitoring devices that provided mean pulmonary artery pressure (mPAP), cardiac output (CO;CardioMEMS, Abbott), day/night heart rate (DHR/NHR), heart rate variability (HRV), and physical activity (PA;Medtronic LinQ). Data were transmitted and reviewed in accordance with established clinical protocols. Standard questionnaires were administered remotely to assess QoL (EmPHasis-10), anxiety (GAD-7), depression (PHQ-9) and collect dates of COVID-19 infection.ResultsFollowing a lockdown, mean activity was reduced compared to pre-lockdown levels (p<0.0001, n=26). QoL was reduced (p<0.01), whereas anxiety (p<0.001) and depression scores increased (p<0.001) compared to pre-lockdown levels. During lockdown measures, there was no change in mPAP, CO, DHR, NHR, or HRV. Of the cohort, 7 patients contracted COVID-19, leading to an decreased CO, increased mPAP and total pulmonary resistance. Consistent with observed changes in haemodynamics PA, HRV, DHR were reduced and NHR increased.ConclusionsIn this cohort of patients with PAH, protective health measures resulted in reduced daily activity and QoL and were associated with increased anxiety and depression indicators. COVID-19 infection resulted in acute changes to haemodynamics and physical activity.

4.
Engineering (Beijing) ; 15: 126-132, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2095307

ABSTRACT

By providing a means of separating the airborne emissions of patients from the air breathed by healthcare workers (HCWs), vented individual patient (VIP) hoods, a form of local exhaust ventilation (LEV), offer a new approach to reduce hospital-acquired infection (HAI). Results from recent studies have demonstrated that, for typical patient-emitted aerosols, VIP hoods provide protection at least equivalent to that of an N95 mask. Unlike a mask, hood performance can be easily monitored and HCWs can be alerted to failure by alarms. The appropriate use of these relatively simple devices could both reduce the reliance on personal protective equipment (PPE) for infection control and provide a low-cost and energy-efficient form of protection for hospitals and clinics. Although the development and deployment of VIP hoods has been accelerated by the coronavirus disease 2019 (COVID-19) pandemic, these devices are currently an immature technology. In this review, we describe the state of the art of VIP hoods and identify aspects in need of further development, both in terms of device design and the protocols associated with their use. The broader concept of individual patient hoods has the potential to be expanded beyond ventilation to the provision of clean conditions for individual patients and personalized control over other environmental factors such as temperature and humidity.

6.
Chest ; 162(4):A2552-A2553, 2022.
Article in English | EMBASE | ID: covidwho-2060959

ABSTRACT

SESSION TITLE: Pulmonary Issues in Transplantation Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Fibrotic interstitial lung disease (fILD) can be idiopathic or associated with several underlying conditions and in response to various types of injury. Post COVID-19 fILD is an increasingly recognized clinical entity with the potential for a large burden of morbidity and mortality.[1] We present a series of 6 patients with progressive pulmonary fibrosis as sequela of COVID-19 requiring lung transplantation. CASE PRESENTATION: Four of the 6 patients had known underlying chronic ILD prior to COVID-19 infection (2 with idiopathic pulmonary fibrosis [IPF] and 1 each with scleroderma and rheumatoid arthritis associated ILD). The other 2 patients had no prior history of lung disease and asymptomatic before infection. One of these had a strong family history of IPF. The presentations involved signs of progressive respiratory failure after the initial lung injury from COVID-19. 4 patients were hospitalized during their acute COVID-19 illness and had varying treatments including steroids, antibiotics, anti-virals, convalescent plasma, Tocilizumab, and non-invasive positive pressure ventilation. At the time of transplant evaluation, CT imaging showed prominent interstitial thickening, honeycombing consistent with fibrotic processes for all our patients;PFT revealed severe restrictive ventilatory defect with reduced diffusion capacity ranging 24%-53%;3 patients required venous-venous extracorporeal membrane oxygenation (ECMO) as a bridge to transplantation for 14 and 93 days. The remainder required 6-10 L of supplemental oxygenation at rest. Two patients underwent initial transplant evaluation while in respiratory failure.5 patients received bilateral lung transplantation and one single left lung transplantation.Duration of time between initial COVID-19 induced lung injury and transplantation ranged from 3-13 months, with a median 6-7 months.Lung explant pathology showed advanced usual interstitial pneumonia in all. Superimposed diffuse alveolar damage was noted in 3 cases. Post-transplant to discharge ranged 10-31 days and at 2 months follow-up, all patients were liberated of oxygen needs. All subjects remain alive at a median 11-12 months, with no evidence of allograft dysfunction. DISCUSSION: Since the emergence of SARS-COV2 in 2019, histopathological fibrotic anomalies have been found to be present in up to one-third of those who recover from ARDS due to COVID-19 [2] and their incidence increases as duration of ARDS increases [3]. Further work is required to understand the pathogenesis of the fibrotic process following acute COVID-19. CONCLUSIONS: We highlight this syndrome with our case series of 6 patients who showed progressive fibrotic disease after COVID-19. Patients with pre-exiting ILD appear to be particularly at risk but this entity may occur in those without pre-existing ILD. Lung transplantation offers a viable treatment option for selected patients with an otherwise poor prognosis. Reference #1: 1.Bharat, A., Querrey, M., Markov, N. S., Kim, S., Kurihara, C., Garza-Castillon, R., Manerikar, A., Shilatifard, A., Tomic, R., Politanska, Y., Abdala-Valencia, H., Yeldandi, A. V., Lomasney, J. W., Misharin, A. V., & Budinger, G. (2020). Lung transplantation for pulmonary fibrosis secondary to severe COVID-19. medRxiv : the preprint server for health sciences, 2020.10.26.20218636. https://doi.org/10.1101/2020.10.26.20218636 Reference #2: 2. Rai DK, Sharma P, Kumar R. Post covid 19 pulmonary fibrosis. Is it real threat?. Indian J Tuberc. 2021;68(3):330-333. doi:10.1016/j.ijtb.2020.11.003 Reference #3: 3. Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, Curtis HJ, Mehrkar A, Evans D, Inglesby P, Cockburn J, McDonald HI, MacKenna B, Tomlinson L, Douglas IJ, Rentsch CT, Mathur R, Wong AYS, Grieve R, Harrison D, Forbes H, Schultze A, Croker R, Parry J, Hester F, Harper S, Perera R, Evans SJW, Smeeth L, Goldacre B. Factors associated with C VID-19-related death using OpenSAFELY. Nature. 2020 Aug;584(7821):430-436. doi: 10.1038/s41586-020-2521-4. Epub 2020 Jul 8. PMID: 32640463;PMCID: PMC7611074. DISCLOSURES: no disclosure on file for Philip Camp;research relationship with United Therapeutics Please note: 2016- ongoing by Reda Girgis, value=Grant/Research research relationship with Pfizer Please note: 2014-2020 by Reda Girgis, value=Grant/Research Speaker/Speaker's Bureau relationship with Boehringher Ingelheim Please note: 2016-ongoing by Reda Girgis, value=Honoraria Speaker/Speaker's Bureau relationship with Genentech Please note: 2016-ongoing by Reda Girgis, value=Honoraria No relevant relationships by Ryan Hadley No relevant relationships by Sheila Krishnan No relevant relationships by Sheetal Maragiri No relevant relationships by Edward Murphy No relevant relationships by Jay Patel No relevant relationships by Keval Ray No relevant relationships by Gayathri Sathiyamoorthy No relevant relationships by Neel Shah No relevant relationships by Subhan Toor

7.
Chest ; 162(4):A830-A831, 2022.
Article in English | EMBASE | ID: covidwho-2060698

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: Acute respiratory distress syndrome (ARDS), due to Coronavirus disease 2019 (COVID-19) Is associated with a significant rate of mortality. The ideal sedative(s) of choice in mechanically ventilated COVID-19 patients is still unclear. Here we report the clinical outcomes of using propofol for more than 48 hours vs any other sedative in such patients. METHODS: This was a retrospective study of patients admitted to an intensive care unit (ICU) at Trumbull Regional Medical Centre and Sharon Regional Medical Centre between February 2020 and January 2022 with COVID-19 viral pneumonia. Our study consisted of 176 patients with moderate to severe ARDS as per Berlin’s criteria who were mechanically ventilated for atleast 48 hours. The primary outcome was mortality at 28 days from the date of intubation. Secondary outcomes included ventilator free days during the first 28 days after intubation (defined as being alive and free from mechanical ventilation), mortality at the end of hospitalization, length of stay, and readmission rate. RESULTS: Out of 176 patients, 100 patients received sedation with propofol for more than 48 hours (test group) and 76 patients received other sedative agents or received propofol for less than 48 hours (control group). We compared the outcomes of the two different groups using paired t-test. The average age of the study population (63 vs 67 p=0.061), gender((0.44 vs 0.49 females p=0.54), BMI (34.93 vs 34.08 p=0.54), and oxygen requirement on admission (0.73 vs 0.64 p= 0.227) were not statistically different between the test and control groups respectively. Prevalence of comorbidities including diabetes, hypertension, chronic kidney disease, active cancer, and COPD were not significantly different between the two groups. There was a significant difference in the primary outcome of mortality at day 28 from intubation between the test and control group (0.62 vs 0.84 p=0.001). A significant difference in the secondary outcome of mortality at the end of hospitalization between the test group and control group (0.67 vs 0.84 p =0.009) was also observed. There were no statistically significant differences in the rest of secondary outcomes. CONCLUSIONS: In this retrospective study, using propofol for more than 48 hours was associated with decreased mortality at day 28 (22%) as well as at end of hospitalization (17%) in mechanically ventilated COVID-19 patients. Propofol is known to have antiviral effects as well as immunosuppressive effects on biosynthesis of inflammatory cytokines by macrophages which is likely responsible for the mortality benefits that we encountered in this study. CLINICAL IMPLICATIONS: Even though we found mortality benefits with using propofol in our study population, further investigations using prospective studies with a larger study population are required and clinicians need to be cautious with the complications associated with long term use of propofol. DISCLOSURES: No relevant relationships by Arooj Ahmed no disclosure submitted for Manuel Bautista;No relevant relationships by Apeksha Gupta No relevant relationships by Anirudh Jaglan no disclosure on file for Saman Karki;no disclosure submitted for Ritha Kartan;No relevant relationships by Tamandeep Kaur No relevant relationships by Sanjay Mahat No relevant relationships by Krutarth Pandya No relevant relationships by Stuti Patel No relevant relationships by Janki Patel no disclosure on file for Kim Porter;No relevant relationships by Aayush Pradhan No relevant relationships by Arun Pyakuryal No relevant relationships by Pratik Saha No relevant relationships by Parth Shah

8.
Chest ; 162(4):A491, 2022.
Article in English | EMBASE | ID: covidwho-2060608

ABSTRACT

SESSION TITLE: COVID-19 Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: The SARS-CoV-2 pandemic quickly spread throughout the world after it was first identified in Wuhan, China in 2019. Severe cases of hypoxic respiratory failure have since filled hospitals over the past few years. We present a case of an immunosuppressed patient with persistent respiratory failure from SARS-CoV-2, with a failure to mount antibody response, treated with convalescent plasma. CASE PRESENTATION: We present a 54-year-old female with a past medical history significant for rheumatoid arthritis on immunosuppression with methotrexate, prednisone, sulfasalazine, and rituximab who presented with diarrhea, cough, and shortness of breath. She was unvaccinated and tested positive for COVID-19 pneumonia, which was treated with corticosteroids and Remdesevir. CT thorax revealed diffuse infiltrates (Figure-1). She had progressive hypoxia requiring ICU stay and her course was complicated by inferior wall STEMI, requiring Intra-aortic balloon pump and intubation given worsening hypoxia. She had progressive improvement and was discharged from the hospital on 4 L of supplemental oxygen after a 30-day hospital stay. She presented two days after discharge with cough, fevers and increasing oxygen requirements up to 100% high flow nasal cannula. She was septic and was treated with steroids and antibiotics. She was febrile despite broad spectrum antibiotics. CT thorax demonstrated diffuse infiltrates worsened from the previous and steroid dosing was increased (Figure-2). No obvious source of infection was found, and further evaluation revealed positive Covid-19 RT-PCR. Despite her initial infection occurring two months prior, COVID-19 anti-spike and anti-nucleocapsid antibodies were negative. She was treated with two doses of convalescent plasma and had improvement in her oxygenation, going from 80% high-flow nasal cannula to 6L of supplemental oxygen within two days of administration. DISCUSSION: It's unclear whether immunosuppressed patients with rheumatologic disease are at an increased risk of severe SARS-CoV-2 infection. However, the use of immunosuppressants places patients at risk of an improper immune response to infection. In immunocompetent patients, the typical time to negative SARS-CoV-2 RT-PCR is 3 weeks after positivity (1), and most patients develop antibodies within 2-3 weeks after viral exposure (2). Anti-CD20 monoclonal antibodies like rituximab, commonly used for rheumatologic diseases, can hinder humoral immunity, and impair vaccine response (3). Given our patient's immunosuppressive regimen, we suspect she failed to mount an immune response to COVID-19, resulting in 56 days of infection without an adequate antibody response, successfully treated with convalescent plasma. CONCLUSIONS: Patients with significant immunosuppression regimens may fail to produce antibody responses to SARS-CoV-2, resulting in prolonged infection. Reference #1: Rodríguez-Grande, C., Adán-Jiménez, J., Catalán, P., Alcalá, L., Estévez, A., Muñoz, P., Pérez-Lago, L., de Viedma, D. G., Adán-Jiménez, J., Alcalá, L., Aldámiz, T., Alonso, R., Álvarez, B., Álvarez-Uría, A., Arias, A., Arroyo, L. A., Berenguer, J., Bermúdez, E., Bouza, E., … de la Villa, S. (2021). Inference of active viral replication in cases with sustained positive reverse transcription-PCR results for SARS-CoV-2. Journal of Clinical Microbiology, 59(2). https://doi.org/10.1128/JCM.02277-20 Reference #2: Boechat, J. L., Chora, I., Morais, A., & Delgado, L. (2021). The immune response to SARS-CoV-2 and COVID-19 immunopathology – Current perspectives. In Pulmonology (Vol. 27, Issue 5). https://doi.org/10.1016/j.pulmoe.2021.03.008 Reference #3: Eisenberg, R. A., Jawad, A. F., Boyer, J., Maurer, K., McDonald, K., Prak, E. T. L., & Sullivan, K. E. (2013). Rituximab-treated patients have a poor response to influenza vaccination. Journal of Clinical Immunology, 33(2). https://doi.org/10.1007/s10875-012-9813-x DISCLOSURES No relevant relationships by Issa Makki No relevant relationships by John Parent No relevant relationships by Jay Patel No relevant relationships by Ruchira Sengupta

9.
Chest ; 162(4):A351-A352, 2022.
Article in English | EMBASE | ID: covidwho-2060571

ABSTRACT

SESSION TITLE: Post-COVID-19 Infection Complications SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Coccidioidomycosis caused by the fungi C. immitis and C. Posadasii is well known to be endemic to the Southwest United States. Less than 1% of these infections will manifest as extrapulmonary symptoms and multiple sites causing dissemination fungemia [1]. Risk factors for disseminated infection include exogenous immunosuppression, immunodeficiency, pregnancy, and ethnic backgrounds of African and Filipino descent [2]. CASE PRESENTATION: A 39-year-old previously immunocompetent Congolese male with recent onset of recurrent skin abscess, and positive testing for COVID-19 three week prior (not treated with steroids). He presents with shortness of breath, back pain, fevers after recently migrating from the Southwest region to the Midwest. Upon admission imaging with Computed Tomography (CT) revealed extensive pulmonary infiltrates (Fig 1), intra-abdominal abscesses, and magnetic resonance imaging revealing (MRI) osteomyelitis of the thoracic (Fig 2) and lumbar spine (Fig 3). His work of breathing continued to worsen, requiring prompt intubation, and he was initiated on a broad-spectrum antimicrobial regimen, including fluconazole, voriconazole, cefepime and vancomycin. Immunoglobulins, HIV and oxidative burst testing was unremarkable. Cultures from image-guided aspiration of the psoas abscess, incision, and drainages of skin abscess and bronchoalveolar lavage fluid were all positive for coccidioidomycosis, transitioned to amphotericin B. Course complicated with the development of multidrug-resistance pseudomonas aerogenes VAP treated with inhaled tobramycin and meropenem. He developed progressive acute respiratory distress syndrome with refractory hypoxemia. After 3 weeks of antimicrobial and anti-fungal treatment, a decision was made to transfer the patient to a lung transplant center, however, due to ongoing fungemia, he was deemed to be not a candidate for extracorporeal membrane exchange and lung transplantation. About a month into his hospitalization, the family decided to withdraw care. DISCUSSION: Reactivation of latent coccidiomycosis has been largely studied in the immunosuppressed population that includes HIV, hematological malignancies, and diabetes mellitus, however little is known about this fungal infection in the immunosuppressed state in the setting of COVID-19. Thus far only two case reports have been reported of co-infection if COVID-19 and pulmonary coccidioidomycosis [3]. The days of the COVID-19 pandemic might contribute to further delays in diagnosing this fungal infection due to similarities of pulmonary manifestation. CONCLUSIONS: This case demonstrates a COVID-19 infection leading to an immunosuppressed status resulting in disseminated infection from reactivation of latent coccidiomycosis. As a result, physicians must maintain a high level of suspicion for superimposed fungal infections in those with even relative immunosuppression from a recent COVID infection. Reference #1: Odio CD, Marciano BE, Galgiani JN, Holland SM. Risk Factors for Disseminated Coccidioidomycosis, United States. Emerg Infect Dis. 2017;23(2):308-311. doi:10.3201/eid2302.160505 Reference #2: Hector RF, Laniado-Laborin R. Coccidioidomycosis–a fungal disease of the Americas. PLoS Med. 2005;2(1):e2. doi:10.1371/journal.pmed.0020002 Reference #3: Shah AS, Heidari A, Civelli VF, et al. The Coincidence of 2 Epidemics, Coccidioidomycosis and SARS-CoV-2: A Case Report. Journal of Investigative Medicine High Impact Case Reports. January 2020. doi:10.1177/2324709620930540 DISCLOSURES: No relevant relationships by Stephen Doyle No relevant relationships by Connor McCalmon No relevant relationships by John Parent No relevant relationships by Jay Patel No relevant relationships by Angela Peraino No relevant relationships by Keval Ray

10.
Journal of Thoracic Oncology ; 17(9):S248-S249, 2022.
Article in English | EMBASE | ID: covidwho-2031517

ABSTRACT

Introduction: Delays in initiation of treatment for advanced cancers are associated with poorer outcomes. In advanced NSCLC, one factor impacting time of treatment initiation is next-generation sequencing (NGS) testing. In our hospital system, Northwestern Medicine, the standard for NGS testing at Northwestern Memorial, the 894-bed academic hospital, is in-house reflex testing on all histologies and stages for a 50-gene panel of mutations and fusions. At affiliate hospitals, there is no set protocol so testing is sent to private vendors. The purpose of this study was to compare time from biopsy to treatment between the academic center and two affiliate hospitals evaluating for impact of NGS testing, radiation therapy, repeat biopsies, and the COVID-19 pandemic. Methods: We queried the Northwestern Medicine Enterprise Data Warehouse for patients with a new diagnosis of lung cancer between January 1, 2019 and December 31, 2020 at Northwestern Memorial Hospital (NMH), Central DuPage Hospital (CDH), and Delnor Hospital. This yielded a total of 864 patients - 623 (72.1%) diagnosed in 2019 and 241 (27.9%) diagnosed in 2020. Inclusion criteria for analysis: new diagnosis of stage IV NSCLC with diagnostic evaluation conducted at one of the three aforementioned hospitals. Results: 191 patients with stage IV NSCLC met inclusion criteria, 68.6% (131/191) diagnosed in 2019 and 31.4% (60/191) diagnosed in 2020. 148/191 patients received systemic therapy, 102 diagnosed in 2019 (44 NMH / 58 CDH and Delnor), and 46 diagnosed in 2020 (27 NMH / 19 CDH + Delnor). 59/148 patients had radiation prior to systemic therapy (29 NMH, 30 CDH + Delnor), and 20/148 required repeat biopsy (10 NMH, 10 CDH + Delnor). Median time from first biopsy to treatment was 30 days at Northwestern and 37 days at CDH + Delnor overall;in 2019, these times were 35 days at Northwestern and 38 days at CDH + Delnor, and in 2020, these times were 26 days at Northwestern and 37 days at CDH + Delnor (Figure 1). [Formula presented] Conclusions: Time from biopsy to treatment decreased between 2019 and 2020 at Northwestern but not at CDH + Delnor, and was shorter overall at Northwestern compared with CDH + Delnor. Radiation therapy and need for repeat biopsy did not differ between the two sites, suggesting that reflex NGS may be associated with faster turnaround times. Fewer patients presented with lung cancer in 2020 than 2019, highlighting the impact of the COVID pandemic on cancer care. Keywords: NGS, Time to treatment

12.
Pericarditis: From Diagnosis to Treatment ; : 61-75, 2022.
Article in English | Scopus | ID: covidwho-2011928

ABSTRACT

Acute pericarditis is an inflammation of the pericardium accompanied by chest pain, pericardial effusion, and electrocardiographic (ECG) changes. It is mainly caused by viruses, followed by bacterial and other infections, tumors, underlying diseases, trauma, medications, and environmental factors. Several reports have emerged on pericarditis as a potential side effect associated primarily with mRNA vaccines, particularly in male adolescents after the second dose. However, the exact mechanism of COVID-19 vaccine-induced pericarditis remains elusive. The most common clinical presentation seen in patients is the elevation in troponin level, as well as C-reactive protein. To exclude other etiologies causing pericarditis, a meticulous diagnostic workup is performed. Thus, a detailed history and physical examination and the timing and type of the vaccine are important. Owning to the novel etiology of pericarditis caused by the COVID-19 vaccine, treatment is based on the patient's symptoms and diagnostic workup, including pain management and nonsteroidal anti-inflammatory agents with or without colchicine. However, dual therapy with intravenous immune globulins and/or corticosteroids may be beneficial in severe cases. This chapter will emphasize the emerging adverse events of vaccineinduced pericarditis, summarizing its epidemiology, pathogenesis, clinical presentation, diagnosis, management, and limitation. © 2022 Nova Science Publishers, Inc.

13.
Frontiers in Cardiovascular Medicine ; 9, 2022.
Article in English | EMBASE | ID: covidwho-2005852

ABSTRACT

Prolonged critical care stays commonly follow trauma, severe burn injury, sepsis, ARDS, and complications of major surgery. Although patients leave critical care following homeostatic recovery, significant additional diseases affect these patients during and beyond the convalescent phase. New cardiovascular and renal disease is commonly seen and roughly one third of all deaths in the year following discharge from critical care may come from this cluster of diseases. During prolonged critical care stays, the immunometabolic, inflammatory and neurohumoral response to severe illness in conjunction with resuscitative treatments primes the immune system and parenchymal tissues to develop a long-lived pro-inflammatory and immunosenescent state. This state is perpetuated by persistent Toll-like receptor signaling, free radical mediated isolevuglandin protein adduct formation and presentation by antigen presenting cells, abnormal circulating HDL and LDL isoforms, redox and metabolite mediated epigenetic reprogramming of the innate immune arm (trained immunity), and the development of immunosenescence through T-cell exhaustion/anergy through epigenetic modification of the T-cell genome. Under this state, tissue remodeling in the vascular, cardiac, and renal parenchymal beds occurs through the activation of pro-fibrotic cellular signaling pathways, causing vascular dysfunction and atherosclerosis, adverse cardiac remodeling and dysfunction, and proteinuria and accelerated chronic kidney disease.

14.
Dysphagia ; 2022 Jul 16.
Article in English | MEDLINE | ID: covidwho-1935771

ABSTRACT

To explore laryngeal function of tracheostomised patients with COVID-19 in the acute phase, to identify ways teams may facilitate and expedite tracheostomy weaning and rehabilitation of upper airway function. Consecutive tracheostomised patients underwent laryngeal examination during mechanical ventilation weaning. Primary outcomes included prevalence of upper aerodigestive oedema and airway protection during swallow, tracheostomy duration, ICU frailty scores, and oral intake type. Analyses included bivariate associations and exploratory multivariable regressions. 48 consecutive patients who underwent tracheostomy insertion as part of their respiratory wean following invasive ventilation in a single UK tertiary hospital were included. 21 (43.8%) had impaired airway protection on swallow (PAS ≥ 3) with 32 (66.7%) having marked airway oedema in at least one laryngeal area. Impaired airway protection was associated with longer total artificial airway duration (p = 0.008), longer tracheostomy tube duration (p = 0.007), multiple intubations (p = 0.006) and was associated with persistent ICU acquired weakness at ICU discharge (p = 0.03). Impaired airway protection was also an independent predictor for longer tracheostomy tube duration (p = 0.02, Beta 0.38, 95% CI 2.36 to 27.16). The majority of our study patients presented with complex laryngeal findings which were associated with impaired airway protection. We suggest a proactive standardized scoring and review protocol to manage this complex group of patients in order to maximize health outcomes and ICU resources. Early laryngeal assessment may facilitate weaning from invasive mechanical ventilation and liberation from tracheostomy, as well as practical and objective risk stratification for patients regarding decannulation and feeding.

15.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927835

ABSTRACT

Invasive aspergillosis is a rapidly progressive, fatal infection that usually occurs in immunocompromised patients. The spectrum of clinical presentation ranges from non-invasive, invasive, destructive and allergic aspergillosis. It is rare to see overwhelming aspergillosis in an immunocompetent host. Nevertheless, certain risk factors such as underlying fibrotic lung disease, suppurative infection, long-term corticosteroid use and uncontrolled diabetes mellitus (DM) have been described. We hereby present a case of invasive pulmonary aspergillosis in a patient with uncontrolled DM. A 60-year-old man with a history of heavy smoking (50- pack-year), poorly controlled DM presented to the hospital with a large area of erythema with eschar over his left posterior thigh. Clinical examination and CT abdomen pelvis confirmed necrotizing fasciitis involving his perineum and left thigh. Admission CT abdomen showed a small left lower lobe infiltrate (Day 1, Panel A). He underwent urgent debridement and intraoperative tissue cultures grew coagulase-negative staphylococcus, Proteus Vulgaris and anaerobic gram-positive rods. He received piperacillintazobactam, vancomycin, and clindamycin for 16 days which was subsequently narrowed to ceftriaxone and metronidazole. He had worsening leukocytosis but all his blood cultures have been negative. Tracheal aspirate gram stain on day 5 showed moderate yeast, and cultures grew Candida albicans and Aspergillus fumigatus. CT scan of his chest showed bilateral reticulonodular opacities with a new loculated right pleural effusion (Day 16, Panel B). Trans-esophageal echocardiogram did not show any right-sided heart valve vegetation. He received intravenous voriconazole for disseminated aspergillosis. Despite of new prophylactic antifungal strategies, more sensitive and rapid diagnostic tests, as well as various efficacious treatments, survival of invasive disseminated aspergillosis remains poor. High clinical suspicion with a proactive investigation approach is the key to minimizing mortality. Various risk factors such as hematopoietic-cell transplantation, neutropenia, solid-organ transplantation, chemotherapy, prolonged ICU stay, structural lung disease, impaired mucociliary clearance after a recent pulmonary infection (including SARS-CoV-2) have been well described. Our case highlights the importance of recognizing uncontrolled DM as a crucial risk factor for disseminated aspergillosis. (Figure Presented).

16.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925519

ABSTRACT

Objective: Assess patient satisfaction of telemedicine implementation during the COVID-19 pandemic Background: We aimed to learn neurology clinic patient opinions of a new telemedicine clinic during the COVID-19 pandemic in an urban academic center. Design/Methods: We conducted surveys on neurology clinic patients or caregivers with consent who had ≥ 1 telemedicine visit during the COVID-19 pandemic. The patient survey was adapted, with permission, on the Massachusetts General Hospital TeleHealth Virtual Visit Patient survey and responses were managed using REDCap database. Results: Forty-one patient surveys were completed, of which 52.6% of responders were Black, and 65.8% were women. Over 55% of patients were 18-45 years old. Fifty-eight percent of patients had education beyond a high-school diploma. Sixty-five percent of patients had their first telemedicine visit during the pandemic and most of them were at home (97%). Fifty-nine percent used smart phones, 25.6% had a cell phone without video capacity, and 92.1% used their own device. Wi-Fi was used by 67.6% and 27% used cellular network data. Twenty-five percent of patients experienced some technical issues and over 50% was specifically with joining a video visit. Despite the technical issues, more than 75% of patients reported that they still received the care they needed. Overall positive rating was 67.5%. Four patients strongly disliked telemedicine. Eighty-seven percent reported their virtual visit is as effective as a traditional office visit in communicating their needs. Compared to virtual visit, 49% of patients felt more confident that an office visit would address their health concern better. Fifty percent of patients reported that an office visit had better overall quality. Eighty-three percent would recommend a virtual visit to their family and friends. Conclusions: Our study demonstrated telemedicine has received high overall patient satisfaction in an urban-based neurology clinic. More surveys need to be completed to determine clinical significance.

17.
19th International Conference on Humanizing Work and Work Environment, HWWE 2021 ; 391:1105-1116, 2022.
Article in English | Scopus | ID: covidwho-1919571

ABSTRACT

COVID-19 Pandemic made working from home a necessity for IT professionals and computer users. Prolong working hours in confined or awkward posture leads to musculoskeletal injuries. The aim of the present study was to assess the prevalence of work-related Musculoskeletal disorders (MSDS) and ergonomic limitations of computer users from IT background working from home due to the COVID-19 Pandemic. Eighteen subjects from IT Industry between 25 and 35 years were randomly selected for this study. A Workstation checklist and a Modified Nordic Questionnaire was used to assess the present workplace at home and prevalence of discomfort or pain. The postural analysis was performed using the standardised protocol of Rapid upper limb assessment (RULA). The study indicated that IT professionals working from home had an increased likelihood of developing work-related musculoskeletal injury primarily in neck, Shoulder, wrist, elbow and lower back. About 49% of the subjects were respondent to discomfort or pain. 28% of the subject felt moderate low back pain and 44% experienced mild low back pain, 50% were having neck discomfort and 44% underwent both. RULA scores of IT professionals indicated the risk of development of musculoskeletal injury. IT was also revealed that 65% of the subjects were unaware of work ergonomics and 17% of subjects followed work ergonomics. It may be concluded that lower back discomfort and pain in upper extremities are the major health issues, occurred prevalently among the IT professional during working from home without an ergonomic workplace during COVID 19. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

18.
International Journal of Intelligent Systems and Applications in Engineering ; 10(2):159-165, 2022.
Article in English | Scopus | ID: covidwho-1898095

ABSTRACT

The 2019 pandemic in Wuhan, China caused a devastating global outbreak of the Coronavirus Disease (SARSCoV-2). Machine learning offers a number of prediction models for future events that are based on training and testing, including conventional machine learning and Deep Learning. This study shows that machine-learning models can anticipate the number of future SARS-CoV-2 patients that are currently seen as a possible risk to the human race. Supervised machine learning models like linear regression, vector support and regression tree are used for prediction. Data on the total cases and recovery cases are based on two types of predictions: new infections and recovery situations. The machine-learning regression model is used to generate the outcome. In this paper, we present prediction of future forecasting of Covid cases based on current situation by applying dataset of before and after pre-trial vaccine. © 2022, Ismail Saritas. All rights reserved.

19.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880963
20.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880784
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