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1.
Indian Journal of Transplantation ; 16(2):234-236, 2022.
Article in English | EMBASE | ID: covidwho-1939189

ABSTRACT

Coronavirus disease-2019 (COVID-19) which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported from Wuhan, China, and later became a pandemic. While infection is very common, reinfection with SARS-CoV-2 is rare because immune responses from past infection reduce the risk of reinfection. In this report, we describe the case of a kidney transplant recipient who was reinfected with SARS-CoV-2 after successfully recovering from moderate COVID-19, 6 months ago. The first infection occurred in September 2020 while the reinfection occurred in April 2021. Our case highlights that kidney transplant recipients can be reinfected with COVID-19, and therefore, recovery from a primary infection should not be taken as license to shun COVID-related precautions. The disease severity, clinical course, and outcome of reinfection may be different from the first infection.

2.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925399

ABSTRACT

Objective: To compare telehealth (telemedicine (video) and telephone) utilization pre-COVID-19 (10/6/2019-2/29/2020) and during the COVID-19 pandemic (3/1/2020-5/1/2021) among the diverse patient populations served by child neurology clinics at Seattle Children's Hospital (SCH). Background: SCH serves a five-state geographic area comprising 27% of the United States' landmass, of which 25% is rural. Prior to the COVID-19 pandemic, the Neurology department utilized telemedicine visits infrequently (0.001% visits). COVID-19 demanded rapid implementation of telehealth with variable demographic use. Utilization of telephone versus telemedicine visits may indicate populations at risk of a care gap with increased telehealth use. Design/Methods: We tracked telemedicine, telephone, and in-person neurology visit utilization based on race/ethnicity, English proficiency, insurance type, interpreter utilization, broadband status, area deprivation index (ADI), and zip code of residence. While broadband status, ADI, and zip code data included only patients from the state of Washington, other measures included all patients seen. Results: Prior to the pandemic, telemedicine was used primarily for remote patient populations with a higher frequency of Hispanic and non-English proficient household patients. During the COVID-19 pandemic, we found a trend toward increased telephone visit utilization for patients of Hispanic ethnicity (14.7% vs 6.9% overall), patients from non-English proficient households (18.5% vs 10.1% overall), and those who reside in a cluster of four zip codes in Eastern Washington (11.9% of all phone visits). Areas with less broadband access or a higher ADI utilized telephone visits more compared to telemedicine visits. Conclusions: Given Seattle Children's Hospital's long-term goal of increased telemedicine use to improve access to care for underserved populations, further interventions are necessary to close the access to care gap for patients and families who reside in areas with lower broadband internet access, possess limited socioeconomic resources, Hispanic families, and those with limited English proficiency.

3.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925329

ABSTRACT

Objective: To investigate whether delays in intravenous thrombolysis (IVT) administration during the Coronavirus (COVID-19) pandemic for patients with suspected acute ischemic stroke are associated with worse neurologic outcomes. Background: The COVID-19 pandemic has had a deleterious impact on health care systems across the world. Delays in presentation and management of emergent medical conditions like myocardial infarction, and stroke have been reported with a recent multicenter cohort study demonstrating that the COVID-19 pandemic has led to delays in IVT administration. It is unknown if these delays contribute to meaningful differences in short-term outcomes. Design/Methods: This was a nested observational cohort study of adult acute ischemic stroke patients receiving IVT from 9 comprehensive stroke centers in 7 states across the United States. Patients admitted prior to the pandemic (1/1/2019-2/19/2020) were compared to those admitted during the early pandemic (3/1/2020-7/31/2020). The effect of delay in IVT administration on death and discharge destination was estimated using multivariable logistic regression model. Results: There were 676 patients who received IVT with a median age of 70 (IQR 58-81) years and median NIHSS of 8 (IQR 4-16). 313 patients (46.3%) were female. During the early COVID19 period, longer treatment delays were observed (median 46 versus 38 minutes, p=0.01) that were associated with higher in-hospital death or hospice discharge (OR per hour 1.08, 95% CI 1.01-1.17, p = 0.03). After multivariable adjustment, this effect was strengthened (aOR 1.15, 95% CI 1.07-1.24, p < 0.001). Each hour delay in IVT administration was also associated with 7% lower odds of being discharged home or to a rehabilitation facility (aOR 0.93, 95% CI 0.89-0.97, p < 0.001). Conclusions: Treatment delays observed during the COVID-19 pandemic led to worse shortterm outcomes with higher rates of mortality and hospice care along with lower rates of discharge to home or rehabilitation facility.

4.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880699
6.
Journal of Investigative Medicine ; 70(4):1151, 2022.
Article in English | EMBASE | ID: covidwho-1868762

ABSTRACT

Purpose of Study Research has shown that low levels of physical activity in U.S. adolescents contributes to childhood obesity. Some studies have shown benefits from Doctor's office and school-based interventions for underserved adolescents with less access to affordable healthcare. Few studies have examined the Emergency Department (ED) as a setting to reach this population. The purpose of this study is to determine the receptivity of underserved adolescents with receiving an ED intervention to increase their physical activity. Methods Used This pilot study consists of a cross-sectional survey. The study population included were underserved adolescents between the ages of 12 to 18 who qualified for public insurance and presented to the ED. Children with private insurance or those presenting with COVID-19 or COVID-19 symptoms were excluded. Data points collected included age, race/ethnicity, comfort levels for discussing physical activity in the ED on a 1:10 scale, likelihood to change their opinions about physical activity in ED on a 1-10 scale, preferred setting to receive an intervention on physical activity, and setting most likely to change their opinions about physical activity. Summary of Results Out of the 47 patients that were enrolled to date, 51% were male, the mean age was 15 years (SD 2 yrs.). Patients identified as Hispanic/Latino (34.0%), White/ Caucasian (29.8%), African American (27.7%), Biracial (6.4%), and Asian (2.1%). For comfort level discussing physical activity in the ED, the mean was 6.5 (SD 2.4), 53.2% picked high comfort (7-10), 36.2% picked medium comfort (4-6), and 10.6% picked low comfort (0-3). For likelihood to change their opinions about physical activity in the ED, the mean was 6.6 (SD 2.5), 57.4% picked high likelihood (7-10), 29.8% picked medium likelihood (4-6), and 12.8% picked low likelihood (0-3). Most preferred physical activity intervention settings were: School (56.8%), Doctor's office (31.8%), and ED (6.8%). Settings most likely to change an adolescent's physical activity opinions were: Doctor's office (44.2%), ED (30.2%), and School (20.9%). Comfort level and likelihood levels were similar across gender and race/ethnicity groups when tested with a Kruskal-Wallis test. Conclusions Underserved adolescents report being comfortable and likely to change their physical activity opinions if approached in the ED setting. This reported receptivity suggests the ED may be a good venue to institute an intervention. The most preferred intervention setting for underserved adolescents was school, and the venue most likely to impact change was the Doctor's office followed by the ED. (Table Presented).

7.
Heart Rhythm ; 19(5):S428, 2022.
Article in English | EMBASE | ID: covidwho-1867191

ABSTRACT

Background: Left atrial appendage closure (LAAC) devices are a practical replacement to long term oral anticoagulation in the appropriate patient. Incomplete occlusion and resulting device leak are important clinical endpoints which may prompt anticoagulation continuation. During the coronavirus pandemic, cardiac computed tomography (CCT) was used as an alternative to transesophageal echocardiogram (TEE) for pre-planning and post-operative confirmation. A residual leak of >5mm on TEE has been used as a cutoff for anticoagulation continuation, but CCT is less codified for device leak quantification and its significance. Objective: Compare CCT and TEE in regards to post-operative leak with respect to resulting outcomes after LAAC device implant. Methods: Between March 1st 2020 and October 31st 2021, 151 patients underwent LAAC device implantation at a single center. These patients had a pre-procedural CCT or TEE and a subsequent confirmatory CCT or TEE 45 days after implant. Baseline demographics, imaging, device characteristics, and resulting outcome measures were collected by chart review. Data was then retrospectively analyzed with a non-linear model to assess significance. Results: Of the 151 patients, the median age was 77 with an interquartile range (IQR) of 10 and 40% were female. The median CHADSVASc was 4 and HASBLED score was 4 with an IQR of 2 and 1, respectively. For the 45 day post-procedural imaging confirmation there was a total of 110 patients who underwent TEE, 30 underwent CCT, and 11 dropped out. A total of 34 patients (22%) had a device leak of any size. In CCT group there were 18 patients (60%) with a device leak <5mm and in the TEE group 16 patients (15%) had a device leak with 14 having a primary leak <5mm (P < 0.001). Major adverse events include: 1 death (all-cause), 14 major bleeding events, 1 MACE event (MI). There was zero instances of post-device stroke. None of these outcomes were statistically significant in regards to device leak or imaging modality. Conclusion: Based on this analysis, CCT had a significantly greater rate of detecting post-operative device leak when compared to TEE. There does not appear to be any significant difference in outcomes with regards to CCT and TEE in patients undergoing LAAC device implant. This suggests that CCT may be overly sensitive for subclinical device leak.

8.
Asian Journal of Pharmaceutical and Clinical Research ; 15(5):128-131, 2022.
Article in English | EMBASE | ID: covidwho-1863544

ABSTRACT

Objective: An acute respiratory infection of unknown origin was first detected in Wuhan, China, and reported to the WHO on December 31, 2019, and within a month, this outbreak was declared as a Public Health Emergency of International Concern. This study was carried out with an objective to assess the spectrum of clinical presentations and host-related factors in outcome of COVID-19 during the first wave. Methods: This study was a retrospective observational study on 427 laboratory conformed COVID-19 cases at tertiary care center in North India during 6 months of the first wave. The demographic data, clinical profiles, comorbid conditions, treatment given, duration of hospital stay, and outcome were collected on a predesigned pro forma by the investigator himself and entered a Microsoft Excel sheet and analyzed using SPSS version 17.0 software. Results: Mean age of the study participants was 48.70 years. Majority (34.89%) belonged to above 60 years. About 74% were male. Mean duration of symptoms before detection was 1.30 and mean duration of hospital stay was 11.98 days. Majority had fever (73.54%) followed by myalgia (49.88%). About 85.48% had more than 3 symptoms and 69.32 had symptoms for less than 3 days before getting detected. About 40.52% had comorbidities and only 14.05% had history of contact with COVID confirmed case. Only 8.2% were asymptomatic while 23.19% had severe symptoms. Majority 91.57% were admitted to hospital while only 8.43% were put under home isolation. About 74% were positive on rapid antigen test (RAT) while 29.51% needed RT PCR test to turn positive. About 28.1% had bilateral pneumonia on chest X-ray findings. About 6.3% of were pregnant ladies. The overall mortality rate of our hospital during that 6-month period was 4.69%. Out of all parameters, only age category was statistically significant associated with outcome on discharge while other variables such as comorbidity, symptom duration, and severity of disease during admission did not show any statistically significant association. Conclusion: This single-center study provided the spectrum of clinical presentations and host-related factors in outcome of COVID-19 during the first wave which may help in decrease the burden of disease, minimize social disruption, and reduce the economic impact associated with a pandemic. Early detection, admission, and treatment of individuals with comorbidities and elderly would increase the recovery from the disease, thereby reduce mortality.

9.
Asian Journal of Pharmaceutical and Clinical Research ; 15(5):10-14, 2022.
Article in English | EMBASE | ID: covidwho-1863543

ABSTRACT

Telemedicine is the utilization of electronic facts to correspond expertise for sustaining healthcare when physical distance part the users. Within the same time frame, patient-related data can be simultaneously get collected for large number of people using remote monitoring. However, there is always a disadvantage if any issue arises due to software and hardware. Thus, computer-based patient monitoring can be problematic at sometimes if we exclusively depend on computer system. There should always be a balance between computer dependency and human intelligence use. Each and every one's life difference can be made by maintaining the balance between the two. Here, in this review article, we discussed the historical perspectives, telemedicine system concepts, telemedicine centers infrastructure, role in diverse spheres, types of telemedicine technology, applications in public health, current initiatives, and finally the success and popularity of telemedicine during COVID-19 pandemic.

10.
Journal of the American College of Cardiology ; 79(9):2199-2199, 2022.
Article in English | Web of Science | ID: covidwho-1849102
12.
2nd International Conference on Innovative Practices in Technology and Management, ICIPTM 2022 ; : 424-428, 2022.
Article in English | Scopus | ID: covidwho-1846107

ABSTRACT

In the research of applying deep learning to CT intelligent recognition of new coronary pneumonia, many researchers have built deep neural network training models on understanding the content of medical image data and assisting in the diagnosis of new coronary pneumonia. The AMDRC-Net architecture is proposed, in which the residual structure solves the problem of network degradation through identity mapping. At the same time, for the new situation that the residual system hinders the exploration of new features, inspired by the latest research such as attention mechanism, the research length Attention Guidance Mechanism. First, focus on the security of the deep learning model discuss the adversarial attack method based on gradient ascent;to solve the problem of its singularity, the long and short attention mechanism is used to increase the effective adversarial disturbance while reducing the redundant disruption. Next, the proposed adversarial attack algorithm AAS transforms the adversarial attack problem into an adaptive constraint problem;that is, the micro-transformation idea is used in the iterative attack, and the relationship between the attention guidance mechanism the DNN adversarial attack is explored. In the last experiment, on the CT data set of new coronary pneumonia, AMDRC-Net is used for model training, and comparison experiments, visualization experiments, and adversarial attack experiments are designed. © 2022 IEEE.

13.
COVID-19 by Cases: A Pandemic Review ; : 231-246, 2021.
Article in English | Scopus | ID: covidwho-1837683
14.
Clinical Neurosurgery ; 67(SUPPL 1):54, 2020.
Article in English | EMBASE | ID: covidwho-1816184

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has substantially disrupted inpatient and outpatient neurosurgical care. METHODS: Patients who underwent a neurosurgical operation, inpatient consult, or outpatient appointment at Vanderbilt University Medical Center between March 23, 2019 and April 20, 2020 were identified. The March 23, 2020 Tennessee gubernatorial executive order was used to distinguish pre-and post-COVID cases. RESULTS: The total number of pre-and post-COVID cases was 4,152 and 195, respectively. Overall, a 45% reduction in median weekly operative case volume was demonstrated (82/week to 45/week;P=.001) after March 23. There was an observed downtrend in case volume in the weeks leading up to March 23. There was a 47% reduction for adult procedures (68/week to 36/week;P = .001) and 29% reduction for pediatrics (14/week to 10/week;P = .017). Among adult procedures, the most significant decreases were seen for spine surgeries (P = .008) and endovascular procedures (P = .036). Total weekly inpatient consults to adult neurosurgery decreased by 30% (97/week to 68/week;P <.001) with no significant change to pediatric consults. Adult and pediatric outpatient clinic visits decreased by 28% (552/week to 400/week;P = .021), with a 54% decrease for in-person encounters (551/week to 254/week;P = .001). Weekly Telehealth encounters increased from 0/week to 130/week. CONCLUSION: There was a significant reduction in pediatric and adult neurosurgical procedures, clinic visits, and adult inpatient consults during COVID-19. Telemedicine was increasingly used for assessment. Identifying neurosurgical procedures most impacted by COVID-19 delays may aid in the development of effective triage strategies for elective surgeries as they are reinstated.

15.
Morbidity and Mortality Weekly Report ; 71(7):255-263, 2022.
Article in English | GIM | ID: covidwho-1812722

ABSTRACT

What is already known about this topic? Protection against COVID-19 after 2 doses of mRNA vaccine wanes, but little is known about durability of protection after 3 doses. What is added by this report? Vaccine effectiveness (VE) against COVID-19-associated emergency department/urgent care (ED/UC) visits and hospitalizations was higher after the third dose than after the second dose but waned with time since vaccination. During the Omicron-predominant period, VE against COVID-19-associated ED/UC visits and hospitalizations was 87% and 91%, respectively, during the 2 months after a third dose and decreased to 66% and 78% by the fourth month after a third dose. Protection against hospitalizations exceeded that against ED/UC visits. What are the implications for public health practice? All eligible persons should remain up to date with recommended COVID-19 vaccinations to best protect against COVID-19-associated hospitalizations and ED/UC visits.

17.
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation ; 41(4):S223-S223, 2022.
Article in English | EuropePMC | ID: covidwho-1781818

ABSTRACT

Introduction We present a case of a 39 year old male with nonischemic cardiomyopathy who was successfully bridged to HeartMate3 Left Ventricular Assist Device (LVAD) despite multiple life threatening complications secondary to Covid-19. Case Report 39-year-old male with past medical history notable for tobacco abuse and recently diagnosed non-ischemic cardiomyopathy presented to our institution with NYHA Class IV symptoms and was found to be in cardiogenic shock. On admission Covid-19 PCR was negative. He initially responded to the initiation of inotropic support and aggressive diuresis with normalization of his end-organ function and improvement in his symptoms over three days. He suddenly experienced rapid hemodynamic decline necessitating escalation of inotropic and mechanical circulatory support with VA ECMO and Impella 5.5. On that day, his wife felt unwell and was found to be positive for Covid-19. The patient's Covid-19 PCR was repeated and also positive. He underwent treatment with Regeneron. His hospital course was further complicated by multiple sequelae of Covid-19 including pneumonia, acute renal failure necessitating hemodialysis (HD), and Guillain Barre Syndrome (GBS) presenting with bilateral ascending paralysis extending to his hip flexors, improved with intravenous immune globulin (IVIG) therapy. Over a period of two weeks, he demonstrated improvement and was weaned from VA ECMO to Impella 5.5. Unfortunately, he was unable to tolerate weaning the Impella 5.5. He was aggressively rehabilitated. After extensive multidisciplinary discussion, LVAD implantation was recommended to the patient. Following insertion of a HeartMate3 LVAD, the patient demonstrated renal recovery and ongoing improvement in physical ability. He was discharged to an acute rehabilitation facility and was subsequently discharged home. He will be monitored for listing for cardiac transplantation pending abstinence from tobacco use. Summary Covid-19 can present with multiple life threatening complications that can add novel challenges to the management of patients with stage D cardiomyopathy. Despite complications of acute renal failure and paralysis secondary to GBS from Covid-19, our patient was successfully supported with temporary mechanical circulatory support, aggressively rehabilitated, and transitioned to a durable HeartMate 3 LVAD.

18.
Wellcome Open Research ; 6(34), 2021.
Article in English | CAB Abstracts | ID: covidwho-1780279

ABSTRACT

Background: Household overcrowding is associated with increased risk of infectious diseases across contexts and countries. Limited data exist linking household overcrowding and risk of COVID-19. We used data collected from the Virus Watch cohort to examine the association between overcrowded households and SARS-CoV-2.

19.
British Journal of Surgery ; 109(SUPPL 1):i7, 2022.
Article in English | EMBASE | ID: covidwho-1769190

ABSTRACT

Aim: A retrospective case-control study comparing Surgical Site Infections (SSIs) following primary hip and knee arthroplasty before and during the SARS-CoV-2 pandemic across East Sussex NHS Trust (ESHT). The aim of this study was to evaluate whether the government advice relating to increased vigilance surrounding hand hygiene and use of personal protective equipment (PPE) reduced SSIs following elective arthroplasty. Method: Data was obtained from Public Health England website relating to SSIs following primary hip and knee arthroplasty between April 2019 and March 2020 (pre-pandemic) performed at ESHT and compared to April 2020 to March 2021 (pandemic). Results: A total of 454 patients underwent a total hip replacement (THR) during the pre-pandemic period with 12 patients developing an SSI (2.6%). Comparatively, during the pandemic period, 146 patients underwent a THR with 4 reporting an SSI (2.7%). A total of 449 patients underwent a total knee replacement (TKR) during the pre-pandemic period with 11 reporting an SSI (2.5%). In contrast, 9 of the 138 patients undergoing a TKR during the pandemic group developed an SSI (6.5%). Conclusions: As the data shows, there was no significant difference observed between SSIs following THR performed at ESHT prior to and during the pandemic. Surprisingly, there was a 2.6-fold increase in SSI following TKR during the pandemic period compared with prepandemic. Both of these findings seemingly reject the null hypothesis that increased vigilance to hand hygiene and use of PPE mandated by the government and echoed by healthcare trusts during this time would reduce transmission of infections.

20.
Annals of Emergency Medicine ; 78(4):S74, 2021.
Article in English | EMBASE | ID: covidwho-1748267

ABSTRACT

Study Objectives: Continuing education for EMS personnel is often limited to online lectures and self-study, as educational resources vary from department to department. Moreover, social distancing measures during the current COVID-19 pandemic further limit the ability for in-person training experiences. Simulation, unlike traditional forms of online learning, allows educators to create specific learning objectives and reinforce clinical concepts through a scenario and debrief, in an environment that does not compromise patient safety. Traditionally simulation is performed in-person, however given the need to socially distance, virtual simulation has been proposed in various forms as an educational tool. The aim of our study was to determine the impact of virtual simulation to teach EMS personnel respiratory failure management. We also explored their perceptions of this learning experience in comparison to other training modalities. This study presents a unique way to provide education to paramedics during the Coronavirus pandemic, without some of the logistical concerns that accompany traditional in-person simulation. Methods: In total 90 Kissimmee Fire Department (KFD) personnel underwent a virtual simulation on respiratory failure. The participants were divided in groups of 3 to 6 with a designated team leader. Each session was virtually conducted by a physician. The physician facilitator was remotely broadcasted to the EMS team, performing tasks on a mannequin in the physician’s broadcasted room as dictated by the EMS team and providing vital signs. Each session was approximately 25 minutes with 15 minutes of case progression and 10 minutes of debrief. 42 EMS personnel then participated in a 13 question survey to determine how the simulation affected their comfort level with respiratory failure in both COVID-19 patients and non-COVID-19 patients. They also recorded feedback on the virtual simulation and any issues they might have had during the sessions. Results: The 42 EMS personnel responding to the survey felt an increased comfort level in managing respiratory failure in a suspected or known COVID-19 patient after the virtual simulation. There was an increase in “extremely comfortable” responses from 24% to 43% before and after the simulation, and a decrease in “somewhat uncomfortable” responses from 10% to 0%. There was a slight increase in the comfortability of managing respiratory non-COVID-19 patients as well, with an increase in “extremely comfortable” responses from 40% to 48%, and a decrease of “somewhat uncomfortable” responses from 2% to 0%. Only 12% of the responders stated they underwent simulation training once a month or more. In general 86% of the responders felt the video platform was easy to use, and the most common technical difficulty involved audio issues. Conclusions: EMS personnel undergoing a virtual simulation and debrief in the management of respiratory failure in the setting of the COVID-19 pandemic felt more comfortable in their management of these patients after their sessions. The majority recommended continuing this type of training in the future in survey responses. Our cohort had extensive EMS experience, but did not frequently undergo simulation training, which highlights a potential area of improvement for EMS education. First responders continue to be essential in the safe and effective management of COVID-19 patients, and virtual simulation is a viable option to facilitate EMS training. [Formula presented]

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