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1.
European Heart Journal Cardiovascular Imaging ; 23(SUPPL 1):i143, 2022.
Article in English | EMBASE | ID: covidwho-1795324

ABSTRACT

Introduction: The impact of acute infection by SARS-COV2 on the cardiovascular system has been previously reported in the literature, with a higher propensity in patients with more serious pattern of disease and pro-inflammatory status. Nevertheless, the long-term burden and sequels of COVID-19 on the cardiovascular system is still unknown. Purpose: To evaluate the long-term impact of COVID-19 on left ventricular function in patients with severe clinical presentation requiring intensive care hospitalization. Methods: This was a single-center observational, prospective study which included patients requiring admission to the Intensive Care Unit (ICU) due to COVID-19 infection from January to November 2020. All discharged patients were contacted to perform a clinical, electrocardiographic and echocardiographic evaluation and those who accepted were included on the protocol. Baseline and clinical characteristics were collected from clinical reports. For the global longitudinal strain (GLS) analysis all patients with significant wall motion abnormalities and valvular cardiopathy were excluded. Statistical analysis was performed with Mann-Whitney and a safety cut-off was established with ROC curve analysis. Results: A total of 43 patients were included (mean age 64 ± 12, 67.4% males). During SARS-COV2 infection 49% presented with severe ARDS and 51% with moderate, 35% required invasive mechanical ventilation, 14% noninvasive mechanical ventilation and 52% with high nasal flow cannula. On the follow-up analysis, fatigue was the most reported in symptom (52% patients) and the majority did not present other signs or symptoms suggestive of heart failure, with the mean NT-proBNP of 49 ± 389 pg/dL. The standard ECG and echocardiogram did not show significant changes with a mean LVEF of 58 ± 7.8 and mean TAPSE of 21 ± 4. The strain analysis showed low value of GLS (mean GLS of -17.14 ± 2.36) for a reference cut-off of -18%, suggesting subclinical left ventricular dysfunction in this subset of patients with preserved ejection fraction. Maximum CPR values during ICU did not correlate either with the extent of disease evolvement in CT (p= NS) or ARDS severity (p= NS). Nevertheless, maximum CPR correlated significantly with GLS reduction (R = 0.44, p = 0.019). A CPR value higher than iger30mg/ dL had 100% specificity for GLS reduction and a cut-off of 14gm/dL reported a sensitivity of 65% and specificity pf 75% for reduction in GLS. Conclusion: In our study, we reported subclinical impairment in left ventricular function detected with global longitudinal strain after serious infection with SARS-COV2. The detected myocardial dysfunction was related with higher inflammatory as expressed by CPR values. Longterm monitoring of these patients should be undertaken in order to timely detect late complications.

2.
ESMO Open ; 7(2): 100448, 2022 Mar 07.
Article in English | MEDLINE | ID: covidwho-1763725

ABSTRACT

BACKGROUND: Androgen-deprivation therapy (ADT) has been associated with cognitive decline, but results are conflicting. This study describes changes in cognitive performance in patients with prostate cancer, according to ADT, during the first year after prostate cancer diagnosis. PATIENTS AND METHODS: Patients with prostate cancer treated at the Portuguese Institute of Oncology of Porto (n = 366) were evaluated with the Montreal Cognitive Assessment (MoCA), before treatment and after 1 year. All baseline evaluations were performed before the coronavirus disease 2019 (COVID-19) pandemic and 69.7% of the 1-year assessments were completed after the first lockdown. Cognitive decline was defined as the decrease in MoCA from baseline to the 1-year evaluation below 1.5 standard deviations of the distribution of changes in the whole cohort. Participants scoring below age- and education-specific normative reference values in the MoCA were considered to have cognitive impairment. Age- and education-adjusted odds ratios (aORs) were computed for the association between ADT and cognitive outcomes. RESULTS: Mean MoCA scores increased from baseline to the 1-year evaluation (22.3 versus 22.8, P < 0.001). Cognitive decline was more frequent in the ADT group, and even more after the onset of the COVID-19 pandemic (aOR 6.81 versus 1.93, P for interaction = 0.233). The 1-year cumulative incidence of cognitive impairment was 6.9% (9.1% before and 3.7% after the pandemic onset), which was higher among patients receiving ADT, but only after the pandemic (aOR 5.53 versus 0.49, P for interaction = 0.044). CONCLUSIONS: ADT was associated with worse cognitive performance of patients with prostate cancer, mostly among those evaluated after the first COVID-19 lockdown.

3.
2021 IEEE EMBS International Conference on Biomedical and Health Informatics, BHI 2021 ; 2021.
Article in English | Scopus | ID: covidwho-1730846

ABSTRACT

The worldwide pandemic caused by the new coronavirus (COVID-19) has encouraged the development of multiple computer-aided diagnosis systems to automate daily clinical tasks, such as abnormality detection and classification. Among these tasks, the segmentation of COVID lesions is of high interest to the scientific community, enabling further lesion characterization. Automating the segmentation process can be a useful strategy to provide a fast and accurate second opinion to the physicians, and thus increase the reliability of the diagnosis and disease stratification. The current work explores a CNN-based approach to segment multiple COVID lesions. It includes the implementation of a U-Net structure with a ResNet34 encoder able to deal with the highly imbalanced nature of the problem, as well as the great variability of the COVID lesions, namely in terms of size, shape, and quantity. This approach yields a Dice score of 64.1%, when evaluated on the publicly available COVID-19-20 Lung CT Lesion Segmentation GrandChallenge data set. © 2021 IEEE

5.
Revista Univap ; 27(55):10, 2021.
Article in Portuguese | Web of Science | ID: covidwho-1667837

ABSTRACT

The Covid-19 pandemic impacted Hospital Service Management, as well as the performance and role of leaders in the face of this new epidemic. The present study aimed to assess the prevalence of factors associated with the role of hospital managers' leadership before and during the Covid-19 pandemic. The databases SciELO (Scientific Electronic Library Online), Google Scholar, classic books on Hospital Management and the CAPES Portal were employed in a search for articles that evaluated Hospital Management and the performance of the leadership, before and during the current pandemic moment. The pandemic evidenced a global crisis, requiring a transformation in the structure and work process of health units, highlighting the need for good planning to face this epidemic. The research highlights the fundamental role of leadership in management for obtaining good results: the hospital administrator must be assertive in making decisions and have good internal and external communication. It is concluded that, beyond the routine actions, it is necessary to have specialized training, innovative vision and willingness to face potential challenges and abrupt adaptations, in the face of epidemic and pandemic episodes.

6.
European Heart Journal ; 42(SUPPL 1):1240, 2021.
Article in English | EMBASE | ID: covidwho-1554488

ABSTRACT

Aims: To evaluate the impact of the COVID-19 pandemic on patient admissions with acute coronary syndromes (ACS) and primary coronary angioplasty (PPCI) in countries participating in the Stent-Save a Life (SSL) global initiative. Methods and results: We conducted a multicenter, observational survey to collect data on patient admissions for ACS, STEMI and PPCI in the SSL participating countries throughout a period during the COVID-19 outbreak (March and April 2020) compared with the equivalent period in 2019. From the 32 member countries of the SSL global initiative, 17 accepted to participate in the survey (3 from Africa, 5 from Asia, 6 from Europe and 3 from Latin America (LATAM)). We observed a global reduction of 27,5% and 20,0% in admissions with ACS and STEMI respectively. The decrease in PPCI was 26,7% (Figure 1). This trend was observed in all countries except two. In these two countries, the pandemic peaked later than in the other countries. Conclusions: This survey shows that the COVID-19 outbreak was associated with a significant reduction of hospital admissions for ACS and STEMI as well as a reduction of PPCI, which can be explained by both patient and system related factors.

9.
Palliative Medicine ; 35(1 SUPPL):222, 2021.
Article in English | EMBASE | ID: covidwho-1477073

ABSTRACT

Background: Burns are a global public health problem, accounting for around 300,000 deaths annually. 25% of patients aged 45-65 with severe burns die. Given the changing environment of the COVID-19 pandemic, health services, including burn intensive care units (BurnICUs), were redesigned to be most effective. Aim: To explore organizational models and designs of end-of-life (EOL) care in BurnICUs during the COVID-19 pandemic. Methods: Qualitative study using in-depth interviews. All 5 BurnICUs reference centres across Portugal were invited;3 participated. 15 professionals (12 nurses;3 physicians) were interviewed after the first wave of the pandemic (July-October 2020), until reaching theoretical saturation. Analysis: inductive thematic analysis. Results: Five themes emerged and divided in sub-themes: (i) Risk of infection/sepsis and strict visiting procedures (flexibility, by-passing visiting restrictions;struggle with visiting restrictions;videoconferencing);(ii) Hampered consultation model (specialist consultation and interventions from other professionals were impeded);(iii) Difficulties in case management (physicians on call);(iv) Palliative care (PC) not included;and (v) BurnICUs were reorganized. Discussion: Organization design refers to the way in which the building blocks of organizations are (re)arranged to improve effectiveness and adaptive capacity. Findings show that decisions were made to adapt BurnICUs both to the challenges and impact of the COVID-19 pandemic and to the needs of critically burned patients. Tasks, rules, procedures and communication channels were reorganized. Conclusions: BurnICUs were redesigned as organizational needs changed during the COVID-19 pandemic. Despite strict visiting procedures, strategies were implemented to meet patients and families' needs at the EOL. As before the pandemic, palliative care was not involved in EOL care. Findings show the need to further explore PC involvement in EOL care in BurnICUs.

10.
Nephrology Dialysis Transplantation ; 36(SUPPL 1):i461-i462, 2021.
Article in English | EMBASE | ID: covidwho-1402472

ABSTRACT

BACKGROUND AND AIMS: Coronavirus disease 2019 (COVID-19) has affected the care of patients on chronic hemodialysis (HD). It has been reported that older adults and those with comorbidities, such as diabetes mellitus, hypertension, cardiovascular disease and chronic kidney disease are prone to develop severe disease and poorer outcomes. By virtue of their average old age, multiple comorbidities, immunosuppression and frequent contact with other patients in dialysis facilities, chronic HD patients are at particular risk for severe COVID-19 infection. The aim of this study was to compare clinical presentation, laboratory and radiologic data and outcomes between HD and non-HD COVID-19 patients and find possible risk factors for mortality on HD patients. METHOD: A single center retrospective cohort study including patients on HD hospitalized with a laboratory confirmed COVID-19 infection, from March 1st to December 31st of 2020 and matched them to non-dialysis patients (non-HD) (1:1). Data regarding patient baseline characteristics, symptoms, laboratory and radiologic results at presentation were collected, as well as their outcomes. Categorical variables are presented as frequencies and percentages, and continuous variables as means or medians for variables with skewed distributions. A paired Student's t-test was performed on parametric continuous values or Mann-Whitney for non-parametric continuous variables. Chi-squared test was performed for comparing categorical variables. Logistic regression was used to identify risk factors for mortality on HD patients. A p-value of less than 0,05 indicated statistical significance. RESULTS: A total of 34 patients HD patients were included, 70,6% male, mean age of 76,5 years, median time of dialysis of 3,0 years. Among them 85,3% were hypertensive, 47,1% diabetic, 47,1% had cardiovascular disease, 30,6% pulmonary chronic disease and 23,5% cancer. The most frequent symptoms were fever (67,6%), shortness of breath (61,8%) and cough (52,9%). At admission, 55,9% of patients needed oxygen supply, one required mechanic ventilation and was admitted to intensive care unit. Regarding laboratory data, the most common features were lymphopenia in 58,9% (median-795/uL), elevated LDH in 64,7% (median-255 U/L), raised C-reactive protein in 97,1% (median-6,3 mg/dlL, raised D-dimer in 95,8% (median 1,7 ng/mL), and all patients presented high ferritin (median 1658 ng/mL) and elevated Troponin T (median 130ng/mL). The majority presented with radiologic changes, particularly bilateral infiltrates in 29,4%. Concerning clinical outcomes, the median hospitalization time was 11 days and 13 patients (38,2%) developed bacterial superinfection. Mortality rate was 32,4%. When matched to 34 non-HD patients there was no statistical significant differences in sex, age and comorbidities. The HD group had a tendency to more ventilator support need (p=0,051), higher ferritin and troponin levels (p=<0,001 for both), whereas the non-HD group presented with greater levels of transaminases (p= 0,017). There was o significant difference in hospitalization time (median of 11 vs 7 days, p=0,222) neither in mortality (median of 32,4 vs 35,3%, p=0,798). When the logistic regression was performed, only bacterial superinfection was a predictor for mortality on hemodialysis patients (p=0,004). CONCLUSION: Our study compared outcomes for COVID-19 patients on chronic HD to non-dialysis patients and showed no difference in hospitalization time nor in death rate. In spite of these results, the mortality in patients on chronic HD is still not negligible, with up to 32% of in-hospital mortality. Bacterial superinfection is a predictive risk factor for mortality. Hence the importance of interventions to mitigate the burden of COVID-19 in these patients, by preventing its spread, particularly in hemodialysis centers.

11.
HemaSphere ; 5(SUPPL 2):379, 2021.
Article in English | EMBASE | ID: covidwho-1393457

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) pandemic has imposed several constrains in the medical practice, especially in hematologic patients (pts) where a higher mortality rate is expected. In our center strict measures were implemented earlier, with the use of personal protective equipment, hand wash at all times, internal separated circuits, frequent prophylactic tests, teleconsultation and rapid isolation of positive cases. However, data is still limited and risk factors for increased susceptibility remain unclear. Aims: Characterize our pts with COVID-19 regarding the type of hematologic disease, the respective treatment, infection severity and identification of any possible risk factors that may have impact in the outcome. Methods: Pts with a positive quantitative RT-PCR from nasopharyngeal swab between 18/03/2020 and 02/02/2021 were identified. Epidemiologic, laboratory, and clinical characteristics were retrospectively collected. Chi-square and Mann-Whitney-U tests were performed to identify statistical differences between groups and logistic binary regression to assess predictive risk factors. Severity of illness was defined by level of care [ambulatory, general inpatient wards and intensive care unit (ICU)], need for respiratory support, incidence of thrombotic events, acute kidney injury and/or death. Active hematologic treatment was defined as therapy within 6 months of COVID-19 diagnosis. Results: A total of 81 pts were identified, with a median age of 61 years (19-88), 52% were male, 63% had an ECOG PS 0 and 69% had at least one comorbidity (hypertension 36%, dyslipidemia 21%, cardiovascular disease 21%, diabetes mellitus 14% and pulmonary disease 11%). Regarding the hematologic disease, 83% had a neoplastic malignancy (non-Hodgkin lymphoma 30%, myeloproliferative neoplasms 16%, acute myeloid leukemia 11% and multiple myeloma 11%), 64% were in active treatment and 43% had active disease. Concerning the COVID-19 infection, 46% required hospital admission among which 65% needed respiratory support and 9% admitted to an ICU. Median overall survival (OS) was not reached (84% at 1 month) and the mortality rate was 17%, mainly in pts with active disease and neoplastic malignancy. Non-survival pts had a lower hemoglobin level (8,3g/dL vs 12g/dL;p-value 0,016), a higher CRP (218mg/L vs 22mg/L;p-value 0,041), acute renal failure (36% vs 6%;p-value 0,014), more need of respiratory support (71% vs 27%;p-value 0,004) and mechanical ventilation (21% vs 5%;p-value 0,022). There were no statistical differences regarding age, absolute lymphocyte count, platelet count and LDH. Regression analysis revealed hemoglobin level (p-value 0,026), CRP (p-value 0,05) and respiratory support (p-value 0,003) as predictive factors for death. In our pts there were no thrombotic events. Summary/Conclusion: Nearly half of the pts were admitted to the hospital and discharged. In our analysis low hemoglobin level, high CRP and respiratory support were associated with poorer survival, however, given our small sample, these findings need to be confirmed. Contrary to most of the published results, the number of confirmed COVID-19 positive cases was surprisingly low, with only 81 cases in 11 months, with a mortality rate similar to the general population and lower than expected. We believe that implementing early and rigorous protective measures as well as create self-awareness may be the key to improve mortality rate in this highly susceptible population.

12.
European Heart Journal Cardiovascular Imaging ; 22(SUPPL 3):iii14, 2021.
Article in English | EMBASE | ID: covidwho-1379453

ABSTRACT

Introduction: Pulmonary embolism (PE) is a recognized complication of SARS-COV2 infection due to hypercoagulability. Before the COVID era, the need for computed tomography pulmonary angiography (CTPA) to rule out PE was determined by clinical probability, based on Wells and Geneva scores, in association with D-dimer measurements. However, patients with SARS-COV2 infection have a pro-thrombotic and pro-inflammatory state which may compromise the usefulness of these algorithms to select patients for CTPA. Purpose: To evaluate the accuracy of the Wells and Geneva scores to predict PE in patients with SARS-COV2 infection. Methods: Retrospective study of consecutive outpatients with SARS-COV2 infection proved by positive PCR who underwent CTPA due to suspected PE. The Wells and Geneva scores were calculated and the area under the curve (AUC) of the receiver operating characteristic curve was measured. Results: We enrolled 235 patients (61% males, mean age 69.10 ± 16.69 years) and the incidence of pulmonary embolism was 15% (35 patients). In patients with PE, emboli were located mainly in segmental arteries (60%) and bilaterally (46%). Patients with PE were older (mean age 75.06 ± 2.23 vs. 68.06 ± 1.21 years, p = 0.022), and did not differ in sex or risk factors for thromboembolic diseases from the non- PE group. Patients with PE had higher D-dimer levels (median 15.41 mg/dl, IQR 1.17 - 20.00) compared to patients without PE (median 5.99 mg/dl, IQR 0.47 - 2.82, p < 0.001). There was no statically significant difference between the average Wells score in patients with PE and without PE (1.04 and 0.89 respectively, p = 0.733) and the AUC demonstrated that the Wells score had no discriminatory power (AUC = 0.52). Within patients with PE, 19 patients had a Wells score of zero. Regarding the Geneva score, there was also no difference between the average score in patients with and without PE (4.20 vs 3.93 respectively, p = 0.420). AUC for Geneva score was 0.54. Clinical probability combined with D-dimer measurement had a 100% sensitivity for both Wells and Geneva scores, but a specificity of 10% and 11%, respectively. Conclusion: PE diagnosis may be challenging in patients with SARS-COV2 infection since both conditions may have similar signs and symptoms and may be associated with increased D-dimers. According to our results, traditional clinical prediction scores have little discriminatory power in these patients and a higher D-dimer cut-off should be considered to better select patients for CTPA to minimize radiation exposure and contrast-related complications in COVID-19 patients.

14.
Revista Cubana de Enfermeria ; 37, 2021.
Article in Spanish | Scopus | ID: covidwho-1342741

ABSTRACT

Introduction: The COVID-19 pandemic has interfered with the quality of life and well-being of sex workers, as there has been a drop in income due to the absence of clients during social distancing policies. Objective: To analyze the perception that women in paid sexual service have on the quality of life during the COVID-19 pandemic. Methods: Descriptive and qualitative study, carried out with 30 women residing in the Alto Sertão de Bahía Productive Region (Brazil), in areas where prostitution sites are located, between August and September 2020. The in-depth interview was used as a technique of information gathering, whose speeches were subjected to Semantic Content Analysis. Results: Two categories were observed, which portrayed the perception of the quality of life of the participants during the pandemic, with references to the concept and attitudinal problems indicated by the World Health Organization. The positive aspects were related to the money that sex work can bring to them and the means to obtain a healthy life, however, as something far from being achieved at that time. In turn, the statements of some women showed that the negative dimension was surrounded by demotivation with the sexual service. Conclusion: There is a quality of life associated with money and well-being, obtained with sexual service, however, they are having difficulty thinking about this aspect during the pandemic due to the reduction in customer demand. © 2021, Editorial Ciencias Medicas. All rights reserved.

15.
European Journal of Neurology ; 28(SUPPL 1):617, 2021.
Article in English | EMBASE | ID: covidwho-1307768

ABSTRACT

Background and aims: Internuclear ophthalmoplegia (INO) can be caused by a multitude of mechanisms leading to lesion of the medial longitudinal fasciculus (MLF), including infection. Currently, neurological manifestations have been described in COVID-19 patients, either due to immune mediated response or direct viral invasion of the central nervous system. Methods: Report of a clinical case Results: A previously healthy 54-year-old male presented with complaints of sudden onset dizziness and diplopia, preceded by self-limited diarrhea the day before. At examination the patient was apyretic. Neurological examination was striking for a hypertrophic right eye and a bilateral INO, but was otherwise unremarkable. Brain computed tomography scan with contrast was normal, as well as standard blood tests. RT-PCR for SARS-Cov2 was negative, as tests for HIV, VDRL, hepatitis A, B and C viruses, CMV, Borrelia, botulism and IGRA test. Stool microbiologic study was negative. Brain MRI and CSF studies were normal. Autoimmunity panel tests, including acetylcholine receptor antibody, anti-MuSK, anti-GQ1b and onconeural antibodies, were within normal range. A 5-day course of high-dose intravenous methylprednisolone was started, with progressive symptoms improvement and resolution of diplopia. One week after discharge, a serologic COVID-19 test was requested, which was positive for IgG and IgM, with a negative RT-PCR test. Conclusion: In this case, despite the lack of imaging findings, namely in the brainstem, the dramatic clinical response to anti-inflammatory therapy seems to favor an immune mediated mechanism. After extensive negative workup, the serologic positive test suggests a potential relationship between a bilateral INO and SARS-Cov2 infection.

16.
Sustainability ; 12(18), 2020.
Article in English | CAB Abstracts | ID: covidwho-1229299

ABSTRACT

Countries are facing a pandemic crisis in the context of a new disease from the coronavirus family, referred to as COVID-19. This article aims to present the main facts related to the fight against the pandemic from the perspective of the Portuguese governance, aiming to contribute to the knowledge of crisis management by political leaders as well as the performance of public entities. The present research was conducted through a quantitative approach, using data publicly provided by the Portuguese Directorate General of Health. An explanatory and descriptive study is presented about the current panorama, and yet to be shared good practices of crisis management and the relevance of organizational values in crisis management and crisis coordination are also discussed. Based on the lessons from Portugal, the authors suggest the relevance of organizational values and stakeholders' coordination as key factors in crisis situations, such as the current one.

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