Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 7 de 7
Filter
1.
Investigative Ophthalmology and Visual Science ; 62(8), 2021.
Article in English | EMBASE | ID: covidwho-1378817

ABSTRACT

Purpose : Coronavirus disease (COVID-19) has escalated to a global pandemic with increasing reports of ophthalmic disease. We report ophthalmic observations of hospitalized COVID-19 patients and correlate retinal disease findings with clinical and laboratory data. Methods : Retrospective review of COVID-19 patients who underwent ophthalmic exam during hospitalization within Emory Healthcare between April-July 2020. Results : Thirty-seven patients were examined with 23 (62%) females and a mean age of 54 years. 35 patients were admitted to the ICU. Ophthalmic manifestations included conjunctival injection in 12 eyes (17%), chemosis in 8 (11%) and retinopathy in 20 eyes (27%) with bilateral retinopathy in 6 patients (16%). No difference in baseline comorbidities or COVID-19 complication development was observed between patients with and without retinopathy. However, patients with retinopathy required ICU care for 1 week longer than those without retinopathy (27.6 vs 19.9 days p=0.19). The mean sequential organ failure assessment score at ICU admission was 6.18. All patients with retinopathy required both mechanical ventilation and vasopressors, while in patients without retinopathy, 15 (65%) and 12 (52%) required mechanical ventilation and vasopressors respectively (p=0.015, p=0.002). 6 patients with retinopathy required extracorporal membrane oxygenation compared to 1 without retinopathy (p=0.0070). While the mean peak D-Dimer was elevated at 18477, in the entire cohort, the peak D-Dimer was higher in patients with retinopathy (28,971 vs 12,575, p=0.0298). The fibrinogen nadir during hospitalization was on average 338 for the entire cohort, and reduced in patients with retinopathy (262 vs 381, p=0.029). Peak D-dimer analyses with a threshold of 16,508 showed an odds ratio of 16.7 (95% CI 3.11-89.3) for retinopathy. Fibrinogen nadir with a threshold of 367 showed odds ratio of 0.06 (95% CI 0.01-0.53) with 0.75 concordance. Conclusions : Retinopathy was the most common ophthalmic manifestation in a critically ill COVID-19 population, exceeding 25% of patients. Elevated D-dimers and a lower fibrinogen nadir in patients with retinopathy suggest a pathogenic relationship between coagulation pathways and retinal microangiopathy.

2.
Jama-Journal of the American Medical Association ; 326(1):46-55, 2021.
Article in English | Web of Science | ID: covidwho-1330273

ABSTRACT

Importance Preventive interventions are needed to protect residents and staff of skilled nursing and assisted living facilities from COVID-19 during outbreaks in their facilities. Bamlanivimab, a neutralizing monoclonal antibody against SARS-CoV-2, may confer rapid protection from SARS-CoV-2 infection and COVID-19. Objective To determine the effect of bamlanivimab on the incidence of COVID-19 among residents and staff of skilled nursing and assisted living facilities. Design, Setting, and Participants Randomized, double-blind, single-dose, phase 3 trial that enrolled residents and staff of 74 skilled nursing and assisted living facilities in the United States with at least 1 confirmed SARS-CoV-2 index case. A total of 1175 participants enrolled in the study from August 2 to November 20, 2020. Database lock was triggered on January 13, 2021, when all participants reached study day 57. Interventions Participants were randomized to receive a single intravenous infusion of bamlanivimab, 4200 mg (n = 588), or placebo (n = 587). Main Outcomes and Measures The primary outcome was incidence of COVID-19, defined as the detection of SARS-CoV-2 by reverse transcriptase-polymerase chain reaction and mild or worse disease severity within 21 days of detection, within 8 weeks of randomization. Key secondary outcomes included incidence of moderate or worse COVID-19 severity and incidence of SARS-CoV-2 infection. Results The prevention population comprised a total of 966 participants (666 staff and 300 residents) who were negative at baseline for SARS-CoV-2 infection and serology (mean age, 53.0 [range, 18-104] years;722 [74.7%] women). Bamlanivimab significantly reduced the incidence of COVID-19 in the prevention population compared with placebo (8.5% vs 15.2%;odds ratio, 0.43 [95% CI, 0.28-0.68];P < .001;absolute risk difference, -6.6 [95% CI, -10.7 to -2.6] percentage points). Five deaths attributed to COVID-19 were reported by day 57;all occurred in the placebo group. Among 1175 participants who received study product (safety population), the rate of participants with adverse events was 20.1% in the bamlanivimab group and 18.9% in the placebo group. The most common adverse events were urinary tract infection (reported by 12 participants [2%] who received bamlanivimab and 14 [2.4%] who received placebo) and hypertension (reported by 7 participants [1.2%] who received bamlanivimab and 10 [1.7%] who received placebo). Conclusions and Relevance Among residents and staff in skilled nursing and assisted living facilities, treatment during August-November 2020 with bamlanivimab monotherapy reduced the incidence of COVID-19 infection. Further research is needed to assess preventive efficacy with current patterns of viral strains with combination monoclonal antibody therapy. This randomized clinical trial assesses the effect of a single intravenous infusion of bamlanivimab vs placebo on incidence of COVID-19 among residents and staff of skilled nursing and assisted living facilities. Question Among residents and staff of skilled nursing and assisted living facilities with high risk of SARS-CoV-2 exposure, what is the effect of bamlanivimab on the incidence of COVID-19? Findings This randomized phase 3 clinical trial included 966 participants who were residents and staff at US skilled nursing and assisted living facilities with at least 1 confirmed SARS-CoV-2 index case and who were negative at baseline for SARS-CoV-2 infection and serology, enrolled from August to November 2020. The incidence of COVID-19 infection among those treated with bamlanivimab vs placebo was 8.5% vs 15.2%, respectively, a difference that was statistically significant. Meaning Bamlanivimab monotherapy compared with placebo reduced the risk of COVID-19 in residents and staff of skilled nursing and assisted living facilities.

4.
Critical Care Medicine ; 49(1 SUPPL 1):59, 2021.
Article in English | EMBASE | ID: covidwho-1193835

ABSTRACT

INTRODUCTION: Several reports have associated COVID-19 and cancer patients with poor outcomes. We describe outcomes of COVID-19 cancer patients who required ICU level care. METHODS: A retrospective cohort of cancer patients with COVID-19 admitted to a comprehensive cancer center,between March and May 2020.All patients had positive RT-PCR for SARS-CoV-2.Demographics, clinical, and outcome data were recorded.All patients were admitted to a designated COVID unit.Patients who required >6L O2, HFNC or invasive mechanical ventilation were considered ICU level.Continuous data is presented as median. RESULTS: A total of 37 patients were included.The median age was 62 (54-72) years,65% of them were female, 41% African American, and the median BMI was 30.The majority (54%) had solid tumors;with 55% had metastatic disease. Hematological malignancy were 17 (46%);of them, 47% had active disease, 41% had relapsed malignancy, and 12% were in remission;stem cell transplants receipents 7, (71% were autologous). The most common comorbidities were hypertension (63%), Diabetes mellitus (37%), hyperlipidemia (31%), obstructive sleep apnea (23%), and chronic kidney disease (20%). Majority (81%) had a performance status score of 0-1. The most common symptoms were fever (74%), dyspnea (51%), and cough (48%). 48% patients were neutropenic, and 73% had undergone cancer treatment within 90 days of admission.Total of 54% of patients were mild-moderate,14% severe,and 32% critical.Interventions received:57% hydroxychloroquine,51% azithromycin,8% remdesivir,16% convalescent plasma,22% statins,38% vitamin C,30% zinc,43% tocilizumab,11% anakinra,43% aspirin,78% heparin, 40% steroids, and 16 awake patients did self-proning.From this cohort,15 patients required ICU level care;with 3 of them transitioning to palliative care.Of the remaining 12 were ICU patients;67% required HFNC, and 33% IMV with a median 10 ventilator days.Complication wise,83% of them developed shock and required 3 days on vasopressor therapy.All ventilated patients survived, one patient on HFNC developed a sudden fatal pulmonary embolism. Overall hospital and 28-day mortality was 8%. CONCLUSIONS: In our cohort, the mortality rate of critically ill cancer patients with COVID-19 was lower than reported. This early finding should be interpreted with caution.

5.
Dermatology Online Journal ; 27(2):15, 2021.
Article in English | MEDLINE | ID: covidwho-1168559
6.
Journal of the American Society of Nephrology ; 31:274, 2020.
Article in English | EMBASE | ID: covidwho-984578

ABSTRACT

Background: Haemodialysis patients represent a unique challenge in the COVID-19 pandemic, balancing infection risk while safely providing life-sustaining haemodialysis. Asymptomatic infection rates in haemodialysis patients are unknown. Aims: 1 - To define rates of asymptomatic swab positivity in a cohort of prevalent haemodialysis patients 2 - To define rates of antibody positivity in patients known to have been historically swab positive 3 - To define rates of antibody positivity in patients without prior symptoms or clinical suspicion of COVID-19 Methods: A programme of COVID-19 screening using a validated nasopharyngeal PCR analysis was carried out across a prevalent cohort of 1253 haemodialysis patients. Concurrently all patients were offered antibody testing for Anti-SARS-CoV-2 IgG/IgM (Roche) and a total of 848 tests were completed. Results: 1 - Routine screening over a 4 week period from 4/5/20 to 1/6/20 confirmed 7 cases of asymptomatic swab positivity (0.6%). 2 - In our cohort there were 197 confirmed swab positive cases of COVID, and of the 153 survivors 124 were antibody positive (81%). 10 patients were highly clinically suspicious of COVID and managed as such;of those 3 were antibody positive (30%). 3 - Of the remaining swab negative patients who had antibody testing (n=710) 82 were antibody positive (11.5%). Conclusions: In a large inner-city London haemodialysis where the population prevalence of COVID has been high, we demonstrate 1 - low asymptomatic rates of virus carriage at this later stage in the pandemic 2 - significant proportions of swab positive patients seroconverting to be antibody positive 2 - suggestion that 11.5% of patients had previous been asymptomatic carriers and had seroconverted to be antibody positive.

7.
Clinical Psychology Forum ; 2020(331):19-23, 2020.
Article in English | Scopus | ID: covidwho-918705

ABSTRACT

This paper discusses the use of the ‘Whirlpool of Grief’ which provides a visual method for conceptualising, discussing and understanding loss that may be beneficial as practitioners navigating the impact of the Covid-19 crisis. © 2020, British Psychological Society. All rights reserved.

SELECTION OF CITATIONS
SEARCH DETAIL