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1.
Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617060

ABSTRACT

Background: Respiratory syncytial virus (RSV) is the main cause of acute bronchiolitis. The peak of the infection is historically described in the autumn/winter season. The 2020 COVID-19 pandemic seems to have modified the seasonality of some respiratory viruses. The first case of SARS-CoV-2 infection diagnosed in Portugal was in March 2020. School closure and the use of masks are some of the pointed reasons for a decreased number of RSV infections observed in the autumn/winter season post the beginning of the pandemic. Interestingly, there are now a few studies from around the globe showing the resurgence of RSV infections in the spring/summer season that followed. Aim: To characterize the population of RSV infected infants admitted to a tertiary hospital before and after the beginning of the COVID-19 pandemic. Methods: A retrospective, descriptive, study was performed. All the RSV infected infants who were admitted to a Portuguese tertiary hospital from January 2017 to August 2021 were evaluated. The diagnosis of RSV infection was made through polymerase chain reaction of nasal secretions. Data such as age, gender, reason for admission, comorbidities, viral coinfection, bacterial superinfection, oxygen therapy, admission at Intensive Care Unit, ventilatory support and length of hospital stay were analyzed. Results: The data of a total of 354 patients was analyzed. The median age was 4 months (min 9 days, max 4 years), 50% were male. Before the COVID-19 pandemics (between 2017 and 2019), the peak of RSV infections used to occur in the months of December and January (medium of 25 and 28 cases per month, respectively). However, in December 2020 and January 2021 there was no detection of RSV. Nonetheless, a peak of RSV infection was verified in July and August 2021 (18 and 15 cases per month, respectively). The number of patients admitted for non-respiratory motifs, but in whom RSV was detected during the course of hospital stay, increased in 2021 (39%), comparing to 2017 (0%), 2018 (3%), 2019 (8%) or 2020 (3%), p<0,05. The number of viral coinfections was higher in 2021 (50%) comparing to 2017 (29%), 2019 (19%) or 2020 (18%), p<0,05. The patients admitted in 2021 were older (12 months average) than patients admitted in 2017 (5 months average) or 2018 (6 months average), p<0,05. Conclusions: RSV seasonality was modified by the COVID-19 pandemic, with an increase of the hospital admissions being registered in the summer of 2021. Our tertiary hospital's numbers reproduce what is being described in other places of the world. Subsequent studies are needed to verify the behavior of RSV infections in the next seasons, to understand if RSV infections are becoming more or less severe and to analyze the impact of SARS-CoV-2 virus on the virulence of RSV.

2.
European Stroke Journal ; 6(1 SUPPL):515, 2021.
Article in English | EMBASE | ID: covidwho-1468029

ABSTRACT

Background and Aims: A new syndrome of vaccine-induced immune thrombotic thrombocytopenia (VITT) has emerged as a rare side-effect of vaccination against COVID-19. Cerebral venous sinus thrombosis (CVST) is its most common manifestation but has not previously been described in detail. Our objectives were to document the features of post-vaccination CVST with and without VITT and to assess whether VITT is associated with a worse outcome. Methods: We collected clinical characteristics, laboratory results and radiological features on admission of patients with CVST following vaccination against COVID-19. We compared the VITT and non-VITT groups for the proportion of patients who were dead or dependent at the end of admission. Results: 70 patients with CVST following vaccination against COVID-19 had VITT, and 25 did not. The median age of the VITT group (47 years) was lower than in the non-VITT group (57 years, p = 0.0045). Patients with VITT-associated CVST had more intracranial veins thrombosed (median 3) than non-VITT patients (median 2, p = 0.041) and more frequently had extracranial thrombosis (44%) than non-VITT patients (4%, p = 0.0003). Death or dependency (mRS 3-6) occurred more frequently in VITTassociated CVST (47%) than in non-VITT CVST (13%, p = 0.0020). This adverse outcome was less frequent in VITT patients who received nonheparin anticoagulation (36%) than in those who did not (75%, p = 0.0031) and in those who received intravenous immunoglobulin (40%) than in those who did not (73%, p = 0.022). Conclusions: CVST is more severe in the context of VITT. Non-heparin anticoagulants and immunoglobulin may improve outcome of VITTassociated CVST.

3.
European Stroke Journal ; 6(1 SUPPL):119, 2021.
Article in English | EMBASE | ID: covidwho-1468000

ABSTRACT

Background and Aims: To evaluate the impact of the first wave of the UK COVID-19 pandemic on patient-reported health outcomes after hospital admission for acute stroke. Methods: This retrospective study included adults with acute stroke admitted to the University College London Hospital Hyperacute Stroke Unit who were included in the Stroke Investigation Group in North and central London registry. We included two separate cohorts of consecutively enrolled patients at two-time points: 16th March -16th May 2018 and 16th March -16th May 2020. Patients in both cohorts completed the Patient-Reported Outcomes Measurement Information System-29 version 2.0 measure 30 days after stroke. Results:We included 205 patients who were alive at 30 days (106 before and 99 during the COVID-19 pandemic), of whom 98% provided outcomes. After adjustment for confounding factors, admission with acute stroke during the COVID-19 pandemic was independently associated with: increased anxiety (β=-28.0 95% Cl [-31.0, -25.0] p<0.001), fatigue (β=-9.3 95% Cl [-11.8, -6.9] p<0.001), sleep disturbance (β=-2.3 95% Cl [-4.2, -0.4] p=0.018), pain interference (β=-10.8 95% Cl [-13.3, -8.2] p<0.001);reduced physical function (β=5.2 95% Cl [2.6, 7.7] p<0.001) and participation in social roles and activities (b=6.9 95% Cl [4.9, 8.8] p<0.001). Conclusions: Compared with the pre-pandemic cohort, patients admitted during the first wave of the COVID-19 pandemic reported poorer health outcomes in all domains and independent of confounding factors. Stroke service planning for any future pandemic should include measures to mitigate the major adverse impact on health outcomes.

4.
Colorectal Disease ; 23(SUPPL 1):103, 2021.
Article in English | EMBASE | ID: covidwho-1458264

ABSTRACT

Introduction: Strategies for radiotherapy in rectal cancer have changed significantly in the past year, with the publication of the RAPIDO trial and the COVID-19 pandemic. As part of our COVID-19 response we audited and compared our radiotherapy treatments during the first COVID-19 peak with the equivalent period in 2019. Methods: All neoadjuvant rectal radiotherapy patients between 01/03/2019-30/ 06/2019 and 01/03/2020-30/ 06/2020 were identified. Patient demographics, tumour characteristics, radiotherapy treatment and outcome data were collected from electronic hospital records and radiotherapy planning software. Results: Eighteen patients underwent neoadjuvant (chemo-) radiotherapy in 2020 compared to 8 during 2019, >100% increase. 'Ugly' disease was present in 83% (15/18) in 2020 and 88% (7/8) in 2019. More patients received short course radiotherapy (SCRT) (56%, 10/18) and total neoadjuvant therapy (TNT) (72%, 13/18) in 2020 compared to 2019, 12% (1/8) and 50% (4/8) respectively. Surgery was performed in 56% (10/18) with 7 complete resections in 2020, 4 patients await exenteration, 3 declined surgery and 1 progressed. Local control rates were 78% (14/18). Whilst in 2019 surgery was performed in 75% (6/8) with 3 complete resections, 1 patient opted for watch and wait and 1 patient progressed. Local control rates were 75% (6/8). Radiological and pathological response will be presented. Conclusion: Radiotherapy practice has changed significantly in the last 12 months with increased volume of patients, more SCRT and more TNT. This pragmatic response to external pressures shows early indicators of equivalent outcomes. Longer follow up is needed to fully assess the benefit of TNT on reducing distant recurrence.

6.
10th Global Telehealth Conference 2020 ; 277:114-123, 2021.
Article in English | Scopus | ID: covidwho-1232529

ABSTRACT

The current COVID-19 pandemic has highlighted the limitations of relying solely on in-person contact for diagnosis, monitoring and treatment of mental health conditions. Mobile health approaches can be used to monitor mental health patients remotely, but they are not properly integrated with existing models of healthcare service delivery. We present findings from a case study of a mobile app enabled cloud-based software program rolled out in a phone based psychological service to enable real-time/temporal monitoring. The program offered patients an app to record measures of symptoms in everyday contexts and provided clinicians with access to an accompanying dashboard to use information from the app to tailor treatments and monitor progress and ultimately facilitate earlier and personalised care decisions. Feedback related to implementation and utility was gathered from clinicians through a focus group conducted two months post-roll-out. Findings identified that the system is valuable and feasible, however implementation issues were identified. These are discussed in order to inform future work in this area to support the delivery of timely and responsive mental health care in the community. © 2021 The authors and IOS Press.

7.
Academic Psychiatry ; 29:29, 2021.
Article in English | MEDLINE | ID: covidwho-1209101

ABSTRACT

OBJECTIVE: Alarming rates of anxiety and burnout in pre-clinical health profession trainees are now challenged by additional COVID-19 stressors. This study explored COVID-related stressors among first-year medical, physician assistant, nurse practitioner, and veterinary medical students. The authors examined associations between resilience, news monitoring, and COVID stress. METHODS: Students completed an online questionnaire that included the Brief Resilience Scale at their matriculation in August 2019. Survey results were linked to demographic information collected by all schools. A follow-up survey in May 2020 included original questions on COVID-19 stressors and news monitoring. Statistical analyses included descriptive statistics and multivariable linear regression models. RESULTS: Across schools, 74% (266/360) provided consent for the 2019 survey, and 76% (201/264) responded to COVID-19 questions in the follow-up 2020 survey. Students were "extremely" or "very" concerned about family members getting infected (n = 71, 76% School of Medicine (SOM);n = 31, 76% School of Nursing (SON);n = 50, 75% School of Veterinary Medicine (SVM)) and curriculum schedule changes (n = 72, 78%, SOM;n = 28, 68% SON;n = 52, 79% SVM). Greater frequency of COVID news monitoring was associated with greater COVID-related stress (p = 0.02). Higher resilience at matriculation was associated with lower COVID-related stress ten months later (p < 0.001). CONCLUSIONS: Amid COVID-19 uncertainty, health science schools should address the immense student stress regarding curriculum disruptions. The results of this study underscore the powerful role of resilience in protecting against stress not only during the known academic rigor of health professions training but also during unprecedented crises.

8.
J Neurol ; 268(9): 3105-3115, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1064490

ABSTRACT

BACKGROUND AND PURPOSE: There are very few studies of the characteristics and causes of ICH in COVID-19, yet such data are essential to guide clinicians in clinical management, including challenging anticoagulation decisions. We aimed to describe the characteristics of spontaneous symptomatic intracerebral haemorrhage (ICH) associated with COVID-19. METHODS: We systematically searched PubMed, Embase and the Cochrane Central Database for data from patients with SARS-CoV-2 detected prior to or within 7 days after symptomatic ICH. We did a pooled analysis of individual patient data, then combined data from this pooled analysis with aggregate-level data. RESULTS: We included data from 139 patients (98 with individual data and 41 with aggregate-level data). In our pooled individual data analysis, the median age (IQR) was 60 (53-67) years and 64% (95% CI 54-73.7%) were male; 79% (95% CI 70.0-86.9%) had critically severe COVID-19. The pooled prevalence of lobar ICH was 67% (95% CI 56.3-76.0%), and of multifocal ICH was 36% (95% CI 26.4-47.0%). 71% (95% CI 61.0-80.4%) of patients were treated with anticoagulation (58% (95% CI 48-67.8%) therapeutic). The median NIHSS was 28 (IQR 15-28); mortality was 54% (95% CI 43.7-64.2%). Our combined analysis of individual and aggregate data showed similar findings. The pooled incidence of ICH across 12 cohort studies of inpatients with COVID-19 (n = 63,390) was 0.38% (95% CI 0.22-0.58%). CONCLUSIONS: Our data suggest that ICH associated with COVID-19 has different characteristics compared to ICH not associated with COVID-19, including frequent lobar location and multifocality, a high rate of anticoagulation, and high mortality. These observations suggest different underlying mechanisms of ICH in COVID-19 with potential implications for clinical treatment and trials.


Subject(s)
COVID-19 , Cerebral Hemorrhage/complications , Cerebral Hemorrhage/epidemiology , Cohort Studies , Humans , Male , Middle Aged , SARS-CoV-2
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