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1.
JOURNAL OF GENERAL INTERNAL MEDICINE ; 37(SUPPL 2):199-199, 2022.
Article in English | Web of Science | ID: covidwho-1935278
3.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927721

ABSTRACT

Introduction: First synthesized in 1869, Hydroxyurea is known for its efficacy in treating myeloproliferative disorders, cervical cancer, and sickle cell disease. Usually well-tolerated, Hydroxyurea has numerous documented adverse effects, including bone marrow suppression, fevers, gastrointestinal upset, anorexia, and maculopapular rash. In addition, one rare side effect is interstitial pneumonitis, a potentially devastating complication if overlooked. We present one such case of Hydroxyurea-induced interstitial pneumonitis. Case Description: A 65-year-old man with a six-month diagnosis of Chronic Granulocytic Leukemia (CGL) on Hydroxyurea developed acute hypoxemic respiratory failure saturating 80% on room air with HR 102, RR 24, and increasing oxygen requirements (10 Lpm) after being admitted with complaints of worsening dyspnea, fatigue, and productive cough with yellow/green sputum. Physical examination was notable for cachexia, ill appearance, generalized weakness, hoarse voice, tachycardia, tachypnea, diffusely diminished breath sounds, and scattered rales on auscultation of lung fields. Initial imaging was notable for bilateral airspace disease and pulmonary opacities on chest radiography and bilateral pneumonia (concerning for COVID-19 pneumonia), mediastinal adenopathy, and splenomegaly on chest computed tomography. Initial laboratory results were notable for leukocytosis 62.5 th/uL, lactic acidosis 2.5 mmol/L, procalcitonin level 4.95 ng/mL, and negative COVID-19 PCR test. Prompt initiation of Vancomycin/Cefepime therapy ensued upon collection of blood cultures in light of possible sepsis. Flagyl, Valacyclovir, and Posaconazole were added to antimicrobial coverage, along with steroid therapy, due to minimal clinical improvement. Tachycardia with significant oxygen requirements alternating between BiPAP and heated high flow nasal cannula with FiO2 ranging from 70-85% persisted. Daily imaging also showed worsening airspace disease. Negative viral, bacterial, and fungal cultures led to subsequent discontinuation of Hydroxyurea therapy due to suspicion of medicationinduced pneumonitis. Three days after cessation of Hydroxyurea, the patient's oxygen requirements began to decrease and imaging revealed interval resolution of pneumonitic changes in the absence of antimicrobial therapy. The patient was later transitioned to Ruxolitinib for his underlying CGL prior to his discharge home without the need for home oxygen therapy. Discussion: Thought to be caused by hypersensitivity pneumonitis, pulmonary toxicity from Hydroxyurea can easily be misdiagnosed. Unfortunately, while much is known about the pancytopenic, gastrointestinal, and cutaneous side effects of Hydroxyurea, few cases in the literature highlight the potentially fatal interstitial pneumopathy caused by Hydroxyurea, first reported in 1999. Thus, this case serves as an additional contribution to the minutiae of literature detailing Hydroxyurea's adverse pulmonary side effect profile. (Figure Presented).

4.
Sleep ; 45(SUPPL 1):A113-A114, 2022.
Article in English | EMBASE | ID: covidwho-1927400

ABSTRACT

Introduction: Poor sleep, most commonly insufficient sleep duration or low sleep quality, has been linked with disruptions of mood. However, it is unclear how sleep healthmore broadly, other multiple dimensions of sleepis associated with mood. The purpose of this study was to investigate the associations between sleep health and mood in a sample of desk-working sedentary adults. Methods: This cross-sectional study used baseline data from inactive adults with desk-based jobs (N=125, 49.6% female, 43.9±10.6 years) who enrolled in an ongoing clinical trial. Sleep was assessed using validated questionnaires and 7 nights of actigraphy. Collectively, these measures were utilized to assess six different sleep dimensions: regularity, satisfaction, alertness, timing, efficiency, duration. Each dimension was categorized as good or poor. A sleep health score was calculated by summing the number of good dimensions (range: 0-6;higher is better). Mood was assessed using Profile of Mood States (POMS);its 7 subscales (tension, anger, fatigue, depression, esteem-affect, vigor, confusion) were summed (with a constant of 100) to create a Total Mood Disturbance (TMD) score. Multiple linear regression models examined associations between sleep health and mood adjusting for age, gender, and whether pre- or post-COVID-19. Results: The mean sleep health score was 4.7±1.1;the mean TMD score was 96.6±18.5. Better sleep health was associated with lesser TMD (β=-0.32, p<0.001) and better mood on each of the POMS subscales (β≥0.18, p<0.05), aside from esteem-related affect (p=0.31). Of the individual sleep dimensions, only satisfaction, alertness, and efficiency were associated with TMD (β≥0.18, p<0.05). Satisfaction was the only individual sleep dimension that was consistently associated with better mood on each subscale (β≥0.17). Alertness, efficiency, and duration were inconsistently associated with individual mood subscales. Regularity and timing were not associated with any mood subscales (p≥0.267 and p≥0.073, respectively). Conclusion: Better sleep health was associated with less TMD. Satisfaction was the sleep dimension that consistently associated with each subscale of mood. The cross-sectional, observational design limits casual inference between sleep health and mood disturbance due to a lack of temporality and the potential for residual confounding.

5.
Sleep ; 45(SUPPL 1):A22, 2022.
Article in English | EMBASE | ID: covidwho-1927381

ABSTRACT

Introduction: COVID-19 resulted in many office workers switching to remote work. Emerging studies report working from home has negatively affected sleep health (SH) and psychological well-being. Our aim was to evaluate the relationship between SH and healthand work-related quality of life and explore whether these associations differed pre- and post-COVID-19 emergence. Methods: Baseline data from 125 adults enrolled pre- (n=59) and post-COVID-19 emergence (n=66) in a clinical trial with desk jobs were included in this analysis (86.4% White;49.6% female;43.9±10.7 y). Health-related quality of life (HRQoL) was assessed using the SF-36 questionnaire, which addresses eight health concepts (physical, social, and role functioning;mental health;health perceptions;energy or fatigue;pain;general health) and yields 2 summary scales (mental component summary, physical component summary). Workplace productivity and worker health was measured using the Health and Work Questionnaire (HWQ). Six SH dimensions were assessed using questionnaires (satisfaction, alertness) and 7 nights of actigraphy (regularity, timing, efficiency, duration). Each dimension was categorized as good or poor;a composite score was created based on the sum of good SH dimensions. Multiple linear regression models were adjusted for gender and age and stratified by enrollment pre- or post-COVID-19 emergence. Data are presented as standardized coefficients (β) and p-values (p). Results: Compared to participants enrolled prior to COVID-19, those enrolled post-COVID-19 had worse SF-36 emotional, social, and general health and greater HWQ-assessed impatience (all p<0.05);however, SH did not differ between those enrolled pre- and post-COVID. Prior to COVID-19, greater SH was associated with higher SF-36 physical component scores (β=.389, p=.003);however, no association was observed post-COVID (β=.137, p=.271). In contrast, no association was observed pre-COVID between SH and SF-36 mental component scores (β=.181, p=.160), but greater SH was associated with greater mental component scores post- COVID (β =.308, p=.004). Furthermore, better SH was associated with lower stress post-COVID (β =-.423, p<.001). Conclusion: SH was associated with HRQoL and workplace and worker health, though these associations sometimes differed between pre- and post-COVID emergence. Research should explore whether promoting SH in employees impacts their personal and workplace-related quality of life.

6.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925553

ABSTRACT

Objective: COVID-19 pandemic public health interventions upended many aspects of daily life. However, the effects on outcomes in Parkinson's Disease (PD) patients remained unclear. This study was conducted to determine the impact those interventions had on the mood, movement, and quality of life (QOL) of PD patients. Background: Several studies have demonstrated an association between certain lifestyle behaviors, including exercise and social interaction, and positive PD outcomes. This study investigated specific PD patient outcome changes following both the disruption of many of those behaviors and the introduction of tele-medicine as the mainstay of outpatient visits. Design/Methods: Comprehensive clinical assessments were conducted for 150 PD patients both before and after the onset of COVID-19 public health interventions. Through a retrospective chart review, quantitative disease markers and qualitative lifestyle changes were recorded and analyzed to determine changes in disease outcomes and QOL measures between the two subsequent visits. These changes were also differentiated by visit type: in-person versus video versus telephone call. Results: The paired analysis showed an increase in Hoehn and Yahr scale in the post-COVID patient visit in comparison to the pre-COVID visit from 1.86 to 2.02 (n = 122, p = 0.006.) Several non-movement PD symptoms worsened in the subsequent visits, including activities of daily living status, exercise frequency, and sleep disturbance frequency. Overall movement symptoms did not worsen, including bradykinesia, rigidity, resting tremor, gait abnormality, and falls, and patients did not have greater Levodopa needs. Outcome changes differentiated by visit type is pending. Conclusions: The implementation of COVID-19 public health interventions was associated with worsening sleep habits and exercise frequency, as well as greater dependency in daily living among patients with PD. While QOL measures and non-movement PD symptoms worsened, no association was demonstrated between the pandemic interventions and worsening movement symptoms or greater levodopa needs.

7.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925436

ABSTRACT

Objective: In this case series, we present six cases of GBS in the setting of SARS-CoV-2 infection seen at our institution. Case 1/2: 88 and 80 year old females who both presented with ascending weakness and sensory deficits and had diminished reflexes on examination. Both tested positive for SARS-CoV-2 infection prior to symptom onset. CSF and electrodiagnostic work up were only performed for the second case, which demonstrated albuminocytologic dissociation and severe acute polyradiculitis, respectively. Case 3: 57 year old male who presented with left facial weakness and asymmetric hemibody weakness with diffusely reduced reflexes. He tested positive for COVID-19 infection after symptom onset. CSF studies demonstrated albuminocytologic dissociation. Case 4/5: 45 and 37 year old females who both presented with bilateral facial and lower extremity weakness and reduced reflexes. Following SARS-CoV-2 infection, CSF evaluation in both cases revealed albuminocytologic dissociation. Electrodiagnostic evaluation in the second case demonstrated acute demyelinating polyradiculopathy. Case 6: 60 year old female who presented with right eye ptosis and right lower extremity weakness/numbness following upper respiratory symptoms. Tested positive for SARS-CoV-2 infection. CSF evaluation demonstrated albuminocytologic dissociation. Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus implicated in the COVID-19 pandemic is associated with a range of respiratory symptoms as well as a wide range of neurological manifestations including Guillain-Barre syndrome (GBS). Design/Methods: NA Results: NA Conclusions: In all the presented cases, some degree of weakness was present. Four of the cases demonstrated cranial nerve involvement. In two of the six cases, MRI Brain imaging revealed subtle enhancement within the internal auditory canal. CSF studies were performed on five out of the six cases, which demonstrated albuminocytologic dissociation in all the cases. Electrodiagnostic evaluation was conducted on two cases and demonstrated severe polyradiculopathy in both cases.

8.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925235

ABSTRACT

Objective: To compare the risk of SARS-CoV-2 infection before and after mass vaccination among patients with multiple sclerosis (pwMS) taking different disease-modifying therapies (DMTs) compared to the general population (GP). Background: Real-world data in the GP show that SARS-CoV-2 vaccines are effective in preventing infections, but it is still unclear whether vaccination offers the same level of protection for pwMS taking immunomodulatory DMTs. Design/Methods: National Health Service (NHS) England and NHS Improvement (NHSE/I) hold prescribing data on all MS DMTs in England. Public Health England (PHE) collected data on all SARS-CoV-2 tests in England. Datasets of NHE/I and PHE were merged to estimate the monthly rates of SARS-CoV-2 infections in the entire population of pwMS taking DMTs in England. Publicly available data were used for the same analysis in the GP. The relative risk (RR) of infection in pwMS taking DMTs compared to the GP was calculated during two waves of the pandemic: before (November 2020-January 2021) and after (July-September 2021) mass vaccination. Results: All 42,402 pwMS taking DMTs in England were included. A total of 28,113 (66.3%) patients were tested for SARS-CoV-2 out of whom 4,104 (14.6%) tested positive. Pre-vaccination, the RR (95%CI) of infection was beta-interferon: 0.75(0.65-0.87), cladribine: 0.93(0.75-1.14), dimethyl fumarate: 1.15(1.05-1.25), fingolimod: 0.88(0.76-1.02), glatiramer acetate: 1.05(0.93-1.19), natalizumab: 1.08(0.96-1.21), ocrelizumab: 1.20(1.07-1.34), teriflunomide 0.79(0.63-0.99). Post-vaccination, it was beta-interferon: 0.73(0.63-0.85), cladribine: 1.21(1.02-1.45), dimethyl fumarate: 1.34(1.24-1.45), fingolimod: 1.63(1.47-1.82), glatiramer acetate: 0.85(0.74-0.98), natalizumab: 1.22(1.10-1.36), ocrelizumab: 2.18(2-2.36), teriflunomide: 1.04 (0.85-1.27). Conclusions: The risk of SARS-CoV-2 infection in patients taking ocrelizumab and fingolimod substantially increased compared to the general population following vaccination which agrees with the suppressed humoral immune response observed with these DMTs. The changes associated with other DMTs are less clear. Further analysis of data collected longitudinally over a longer period will reveal their impact on the effectiveness of SARS-CoV-2 vaccines.

9.
Global Advances in Health and Medicine ; 11:12-13, 2022.
Article in English | EMBASE | ID: covidwho-1916550

ABSTRACT

Methods: A retrospective study was performed on moderate to severe PASC adult patients participating in a virtual, 10-week Post-COVID Syndrome SMA program from April 1, 2021 to September 15, 2021. Outcomes included change at 3 months in: PROMIS Global Physical Health (GPH) and Mental Health (GMH) (≥50=Very Good), post-COVID functional status (PCFS;0=No limitations, 4=Severe limitations), medical symptom questionnaire (MSQ;0=No symptom burden, 100=Severe symptom burden) and nutrition and lifestyle adherence survey (NLAS;45=Ideal behaviors). Improvements of 5.00 or more TScore points in PROMIS GPH/GMH are considered clinically meaningful. Outcomes were summarized using frequency count (%) or mean [SD] with 95% confidence intervals (CI). Results: A total of 22 patients were eligible and mean age was 44.3 [11.3], 86% were female, and 86% were white. Patients attended 8 visits on average, and at baseline had fair PROMIS GPH (37.15 [8.18]) and PROMIS GMH (37.98 [6.48]), moderate MSQ scores (82.0 [28.2]), limitations in PCFS (2.7 [0.45]), and less than ideal NLAS behaviors (22.5 [6.9]). At 3 months, patients exhibited minimal improvement in PROMIS GPH (0.76 [5.52], -1.69 to 3.21);however, 23% improved 5.00 points or more, and 41% improved 2.50 or more. PROMIS GMH had similar results. Patients exhibited significant improvements in PCFS (-0.53 [0.64], -0.89 to -0.18), MSQ (-33.2 [23.3], -49.8 to -16.6) and NLAS (7.4 [12.4], 0.8 to 14.0). Background: Post-Acute Sequalae of COVID-19 (PASC) describes patients with persistent symptoms weeks after diagnosis. Interventions targeting systemic chronic inflammation (SCI), a potential contributor to PASC, may be beneficial. The objective was to determine if an SMA delivering nutrition and lifestyle-based interventions for PASC patients improves health related quality of life (HRQoL), functional status, and symptom burden. Conclusion: Interventions targeting SCI can improve functional status and symptom burden in patients with PASC. Further research is warranted to delineate factors associated with improvements in HRQoL.

10.
Journal of Clinical and Diagnostic Research ; 16(6):DD01-DD03, 2022.
Article in English | EMBASE | ID: covidwho-1897158

ABSTRACT

Ochrobactrum intermedium (O. intermedium) is a novel emerging gram negative bacillus infecting immunocompromised hosts. It is known for its multidrug resistance and to distinguish it from other species of Ochrobactrum genus by conventional methods, is often difficult. Here, authors report two unusual and interesting cases of bacterial infection due to O. intermedium in a 28-year-old female and 46-year-old male having Coronavirus Disease-2019 (COVID-19) infection. Rapid identification by Matrix Assisted Laser Desorption/Ionisation-Time Of Flight (MALDI-TOF) mass spectrometry and patient's treatment guided by antibiotic sensitivity yielded in favourable outcome. Present report describes clinical and microbiological characteristics of this rare pathogen and also highlights the need of automated methods for proper identification of such opportunistic pathogens and their unique antibiotic susceptibility profiles.

11.
Circulation ; 145:3, 2022.
Article in English | Web of Science | ID: covidwho-1896097
12.
Diabetes Research and Clinical Practice ; 186, 2022.
Article in English | EMBASE | ID: covidwho-1894938

ABSTRACT

Background: The COVID-19 pandemic resulted in national international implementation of changes to the daily life of individuals. These changes included lockdown and social distancing. During COVID-19 pandemic. During COVID-19,doctors and nurses and other allied healthcare professionals were redeployed to the front line to manage patients presenting with COVID-19 in acute setting. Healthcare providers from different institutions had to adapt to the way of supporting and managing patients with different chronic conditions including diabetes. The implementation of lockdown affected diabetes care (Bonora et al 2020). COVID-19 pandemic enabled healthcare professionals to apply innovation including telemedicine/telephone clinics to manage diabetes patients and other patients needing outpatient follow up. Aim: To assess the effect of lockdown on diabetes control among diabetes patients in East London-Single centre experience. Method: Retrospective cohort study identified patients who were reviewed in the diabetes clinic before and after the pandemic and the A1C levels before December 2019 and in 2021.The data was obtained from clinic letters and clinic notes Demographic data were obtained including type of diabetes mellitus, gender, age. Outcomes assessed were change in HbA1C (worsening or improvement), if the patients had diabetes review during the pandemic (telemedicine) and whether HbA1C blood tests were done. Results: In total the results of HbA1C of 101 patients were identified.46 were females, 55 were males. The patients were aged between 17-to 89 years, mean age 56 years. There was improvement in HbA1c in 26 patients (26%) (despite pandemic and lockdown), and there was deterioration of HbA1c in (74 patient) 74% of all patients. 34 (34%) Patients were type 1 diabetes 61 patients (60%) were type 2 diabetes. 6 patients (6%) were Late Onset Diabetes of Adults (LADA). Discussion: In UK the first lockdown measure prevented spread of prevent spread of COVID-19 was introduced in March 2020.This resulted in disruption of patient‘s care especially those with chronic condition including diabetes. The worsening of diabetes control in these patients is explained by lack of exercise, weight gain and poor diet (Pal et al 2020) and probably poor compliance (Ghosal et al 2020). The patients in this study reported anxiety and stress due uncertainty of COVID-19 pandemic and probably this contributed to worsening HbA1C. HbA1C in 74% of patients in this study deteriorated compared to 26% whose diabetes control improved. COVID-19 pandemic has helped healthcare professional to be more flexible and innovative in managing patients with diabetes and other chronic conditions (Monaghesh,E, Hajizadeh, A 2020).

13.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880698
14.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880592
15.
Fertility and Sterility ; 116(3 SUPPL):e300, 2021.
Article in English | EMBASE | ID: covidwho-1880189

ABSTRACT

OBJECTIVE: This study sought to determine how various stressors related to COVID-19 impacted the patient experience during fertility treatment. MATERIALS AND METHODS: An anonymous survey was distributed to patients at a private fertility clinic via the patient portal. Survey questions investigated patient demographics and feelings of anxiety regarding COVID-19 related stressors. Baseline levels of anxiety were measured by GAD-7, a 7-question generalized anxiety disorder scale. Patient confidence in their fertility treatment and potential changes to their treatment plan due to COVID-19 were assessed. Responses ranged from “not at all” to “all of the time”. Survey responses were analyzed at two different points, on Feb 5th with 290 participants and April 11th with 647 to determine average response and response frequencies. RESULTS: Of the initial 290 participants, 89% were women with an average age of 33.8. 58.9% reported pursuing fertility treatment for at least a year. The average GAD-7 Anxiety Severity Score for this cohort was 5.79, indicating an overall feeling of mild anxiety among respondents. 59% of respondents reported COVID-19 health concerns as one of their causes of stress, but only 29% reported considering or ultimately delaying treatment due to the pandemic. The data was again analyzed with 647 participants, of whom 80% were women with an average age of 34.5. 47.8% reported pursuing fertility treatment for at least a year. The average GAD-7 Anxiety Severity Score was 5.01 for this cohort, indicating a reduced overall feeling of mild anxiety. 52% of respondents reported COVID-19 health concerns as one of their causes of stress, but only 17% reported considering or deciding to delay treatment due to the pandemic. CONCLUSIONS: Individuals struggling to conceive often report feelings of depression and anxiety. Over the past year, the ongoing COVID-19 pandemic has been shown to cause increased stress, anxiety, and feelings of depression across almost all populations. For those already experiencing heightened levels of stress and anxiety prior to the pandemic, the effect of increased stress and worry may have detrimental effects on health outcomes. While the cause-and-effect relationship between stress and infertility is still unclear, it is important to consider how the COVID-19 pandemic leads to increased distress among infertility patients and how this may impact perceived treatment outcomes. In comparing results between data collection on Feb. 5th and April 11th, it appears that patients may be experiencing a reduction in stress regarding COVID-19. As the pandemic continues to evolve in terms of vaccine, treatment, and spread mitigation plans, patients continue to be resilient in adapting to COVID-19. Being aware of the increased levels of stress and anxiety experienced by patients during the ongoing COVID-19 crisis can help healthcare providers alleviate some of these worries. IMPACT STATEMENT: Various stressors, particularly during COVID-19 may impact a patient's experience in their fertility treatment, allowing healthcare providers an opportunity to help mitigate these during care.

16.
ACS Environmental Au ; 1(1):71-84, 2021.
Article in English | Scopus | ID: covidwho-1878488

ABSTRACT

Outbreaks from choir performances, such as the Skagit Valley Choir, showed that singing brings potential risk of COVID-19 infection. There is less known about the risks of airborne infection from other musical performances, such as playing wind instruments or performing theater. In addition, it is important to understand methods that can be used to reduce infection risk. In this study, we used a variety of methods, including flow visualization, aerosol and CO2measurements, and computational fluid dynamics (CFD) modeling to understand the different components that can lead to transmission risk from musical performance and risk mitigation. This study was possible because of a partnership across academic departments and institutions and collaboration with the National Federation of State High School Associations and the College Band Directors National Association. The interdisciplinary team enabled us to understand the various aspects of aerosol transmission risk from musical performance and to quickly implement strategies in music classrooms during the COVID-19 pandemic. We found that plumes from musical performance were highly directional, unsteady and varied considerably in time and space. Aerosol number concentration measured at the bell of the clarinet was comparable to that of singing. Face and bell masks attenuated plume velocities and lengths and decreased aerosol concentrations measured in front of the masks. CFD modeling showed differences between indoor and outdoor environments and that the lowest risk of airborne COVID-19 infection occurred at less than 30 min of exposure indoors and less than 60 min outdoors. © 2021 The Authors. Published by American Chemical Society.

17.
Rheumatology (United Kingdom) ; 61(SUPPL 1):i80, 2022.
Article in English | EMBASE | ID: covidwho-1868399

ABSTRACT

Background/Aims The COVID-19 pandemic has hugely impacted on the structure of rheumatology services across the country and remote consultations have become a familiarity. It is important to understand the effectiveness of new patient consultations conducted over the telephone, whether there is a role to continue using teleconsultations to triage referrals and whether there is a difference in outcomes based on the type of initial consultation [telephone or face-to-face (F2F)]. Methods All new referrals to our department that received an initial telephone consultation over a 2-month period (October-November 2020) were identified. The conversion rate to a F2F consultation and discharge rates were calculated. Referrals were also separated into two groups based on the referral details [early inflammatory arthritis (EIA) and nonearly inflammatory arthritis (non-EIA)]. Patients ultimately diagnosed with inflammatory arthritis (IA) were identified and separated into two groups according to their initial consultation;initial telephone consultation (October-November 2020) and initial F2F consultation (March-April 2021). The time from first encounter to disease-modifying antirheumatic drug (DMARD) initiation was calculated and compared between the two groups. Results October-November 2020: 154 new patient referrals had teleconsultation for their first appointment (44% were EIA referrals). 56% of the 154 patients were given a F2F appointment following the telephone consultation. The conversion rate was higher in the EIA group in comparison to the non-EIA group (69% vs 41%). 10 patients were diagnosed with IA (8 were EIA referrals) and the average time to initiation of DMARD was 55 days. 19% of the 154 patients were discharged following the initial telephone consultation, of which 72% were non-EIA referrals, with the most common diagnoses being mechanical/degenerative problems and fibromyalgia. These results were presented at a departmental meeting and it was agreed that all future new EIA referrals should have an initial F2F consultation to minimise the number of consultations and potential delays in treatment. March-April 2021: 319 patients had a F2F consultation for their first consultation. There were 39 patients with confirmed IA in this group (36 were EIA referrals). The average time to initiation of DMARD was 22 days, with 40% starting a DMARD on initial consultation. Conclusion There seems to be a role for teleconsultation for new patient referrals, as evidenced by a 19% discharge rate. However, high conversion rates to F2F appointment in the EIA group suggests that initial teleconsultations were not only ineffective but also led to slower DMARD initiation. One limitation of this project was that EIA patient sample sizes were small. As our specialty continues to utilise other modes of consultation beyond traditional F2F reviews, we must adapt and better identify which patients are most suitable for each particular mode of consultation.

18.
Journal of Clinical and Experimental Hepatology ; 12:S43-S44, 2022.
Article in English | EMBASE | ID: covidwho-1859850

ABSTRACT

Background: COVID-19 has become a major health emergency worldwide. The characteristics and outcome of COVID-19 in patients with CLD remain unclear. Aims: CLD represents a major disease burden globally. Given this high burden, how different underlying liver conditions influence the outcome in patients with COVID-19 needs to be meticulously evaluated. So, we conducted this study to see the outcome of the patient and to look for predictors of severity and mortality in patients with CLD with COVID-19 infection. Methods: This was a single-center, observational study conducted at a tertiary care center. We recruit 50 consecutive patients of COVID-19 with CLD. Matched comparison group patients with CLD without COVID-19 collected retrospectively from historical data with 1:2 ratio using stratified sampling. Results: Mean age of the study population was 51 ± 12 years with the majority were male. Most patients (21/50) were presented with predominantly respiratory symptoms of which fever was the most common symptom (85%). Jaundice (70%) was the most common GI symptom. Twenty patients had ACLF. All patients with ACLF were having severe COVID-19 infection and succumb to multi-organ failure. Mortality was double in a patient with CLD with COVID-19 infection than historical control. Diabetes was the only comorbidity which was associated with severe infection. Patients in the severely ill subgroup had higher mortality, high creatinine, and raised D-dimer but lower lymphocytes count. (P <0.05). Multivariate logistic regression for severity showed that only D-dimer reached significance. CURB-65 score on admission and Child Turcotte Pugh score on admission correlates with mortality (P <0.05). Serum D-dimer level and reduced lymphocyte counts were associated with mortality on multivariate analysis. Conclusion: The presence of CLD in covid-19 patients was associated with a poor outcome. Raised D-dimer on admission can predict severe infection. Child-Pugh and CRUB65 scores were highly associated with non-survival among these patients.

19.
Journal of Clinical and Experimental Hepatology ; 12:S40-S41, 2022.
Article in English | EMBASE | ID: covidwho-1859849

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) is a respiratory system trophic disease. Liver involvement is emerging from recent data. Studies describing liver function test (LFT) abnormalities are sparse from our population. Aims: We studied LFT abnormalities in different categories of COVID-19 and its significance in relation to primary outcomes of in-hospital mortality. Methods: It was a retrospective study from a single center of a metropolitan city. All consecutive patients with proven COVID19 by reverse transcriptase-polymerase chain reaction from 23rd March 2020 till 31stOctober 2020 were enrolled. Of 3280 case records profiled, 1474 cases were included in the study. Clinical characteristics, biochemical parameters and outcomes were recorded. Results: Deranged LFTs were present in 681/1474 (46%) patients. Hepatocellular type of injury was most common (93%). Patients with deranged LFTs had more probability of developing severe disease (P<0.001) and mortality (P<0.001). Higher mean age (P<0.001), male gender (P<0.001), diabetes mellitus (P<0.001), chronic kidney disease (P<0.02) cirrhosis (P<0.001), lower oxygen saturation (SpO2) levels at admission (P<0.001), higher serum creatinine (P value<0.001), D-dimer levels (P<0.001) and positive radiological findings on Chest X-ray (P<0.001) were associated with deranged LFTs. Acute liver injury was seen in 65 (4.33%) cases on admission and 57(3.5%) cases during hospital stay. On admission, raised serum bilirubin, aspartate and alanine transaminases, international normalized ratio and low serum albumin were found to be significant. However, on multivariate analysis for predicting mortality, age, serum creatinine, and PaO2/FiO2 ratio only were found to be significant (P<0.001). Conclusion: In COVID-19, LFT abnormalities are common and multifactorial. As severity of disease progresses, derangement in LFT’s increase. However, it is not associated with in- hospital mortality.

20.
Lung India ; 39(SUPPL 1):S65, 2022.
Article in English | EMBASE | ID: covidwho-1856985

ABSTRACT

Background: TB and COVID 19 have similar presentation. This study Aims to identify the problems and difficulties faced by TB patients during COVID 19 pandemic and Lockdown. Methods: A 35 Questionnaire based study where a total of 100 diagnosed TB cases in DOTS OPD were asked regarding the difficulties faced by TB patients for Diagnosis of TB and starting treatment, and also the ease of availability of consultation, anti TB drugs, Investigations and counselling during the period of pandemic and lockdown. Results: Out of 100 patients diagnosed with TB, 42% were COVID 19 suspects, 38% had symptoms for <1month which helped in early diagnosis of TB. 6% patients had symptoms for > 6 months. 27% patients faced problems getting diagnosed, of which 51.8% had travel difficulty, 29.6 % - financial, 18.5 % - lack of health care access, 19% of the patients had no access to high protein diet during lockdown. 31% of patients had side effects due to AKT, Vomiting 74%, 16% Itching, 9.6% Joint pains. 57% patients required admission. All patients were satisfied about counselling regarding disease and treatment course. Patients reported for follow up after 6.7 days on average. Conclusion: TB patients faced difficulties during COVID 19 pandemic.

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