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1.
Annals of Emergency Medicine ; 78(4 Suppl):S147-S148, 2021.
Article in English | GIM | ID: covidwho-2035740

ABSTRACT

Study Objective: As a consequence of the opioid epidemic, overall Hepatitis C (HCV) infections have increased in the United States. HCV mortality now surpasses more than 60 other infections (eg, HIV, and TB). The CDC now recommends universal HCV screening, for all adults aged =18 years. Several reports highlight the success of large urban EDs to provide screening and linkage to care for HCV but the ability to utilize rural EDs has not been explored. Our objective was to highlight results of an electronic health record (EHR) driven "opt-out," universal HCV screening program in a small rural community ED that serves the economically disadvantaged, rural/mountainous area of SC, including parts of Appalachia.

2.
4.
Braz J Microbiol ; 53(2): 759-775, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1750908

ABSTRACT

In 2019, severe acute respiratory syndrome caused by CoV-2 virus became a pandemic worldwide, being the fast spread of the disease due to the movement of infected people from one country to another, from one continent to another, or within the same country. Associated comorbidities are important factors that predispose to any fungal coinfections. Because of the importance of fungal infections in COVID-19 patients, the aim of this work was to collect data of the more encountered mycoses related to patients undergoing this disease. Aspergillosis was the first COVID-19-related fungal infection reported, being A. fumigatus the most frequent species for CAPA. Other fungal infections related include mainly candidiasis and mucormycosis, being Rhizopus spp. the more prevalent species found. Influenza-associated pulmonary aspergillosis is well documented; thus, similar complications are expected in severe forms of COVID-19 pneumonia. Therefore, in patients with COVID-19, it is important to take special attention to the surveillance and suspicion of fungal coinfections that might worsen the patient's prognosis.


Subject(s)
COVID-19 , Coinfection , Mycoses , COVID-19/epidemiology , Coinfection/epidemiology , Humans , Mycoses/epidemiology , Pandemics , SARS-CoV-2
6.
Multiple Sclerosis Journal ; 27(2 SUPPL):758-759, 2021.
Article in English | EMBASE | ID: covidwho-1496076

ABSTRACT

Introduction: Information about how SARS-CoV-2 specific humoral and cellular response is modified by disease-modifying therapies (DMTs) is scarce. Objective: To investigate humoral and cellular responses to SARS-CoV-2 and factors for presenting them in a Barcelona cohort of pwMS. Methods: Retrospective cohort study of adult unvaccinated PwMS with confirmed COVID-19 with at least one SARS-CoV-2 antibody (Ab) determination included from February 2020 to May 2021 and followed until May 2021. Demographic, clinical and laboratory data were obtained. Humoral SARS-CoV-2 response was measured with commercial chemiluminescence immunoassays targeting specific Ab against spike (IgG-S) and nucleocapsid proteins (Ig-N), as per clinical practice. SARS-CoV-2 specific T-cell response was studied in 42 selected pwMS according to DMT by a whole blood Interferon-Gamma (IFN-y) Release Immunoassay. Humoral and cellular response was assesed using a logistic regression model corrected for age, sex, comorbidities, MS form, expanded disability status scale, DMT, COVID-19 severity and PCR result. Results: 145 pwMS were enrolled (mean age 46.8 years;64.1% female;18.6% progressive forms, 20.7% untreated, 22.8% on anti-CD20s therapies and 56.6% on other DMTs). Humoral and cellular tests were performed from 0.3 to 13.1 months after COVID-19. 121(83.5%) presented positive Ab (57.6% anti-CD20 therapy, 90.2% other DMTs, 93.3% untreated). Untreated patients presented higher Ig-N titres (34.3[128.8]) compared to those with anti-CD20s (0.08[0.13], p<0.01), and other DMTs (19.55[42.92], p<0.01). Humoral response persisted over 6 months in 12/12 untreated, 9/22 with anti-CD20s and 22/28 with other DMTs (p=0.068). 31/42(73.8%) presented cellular response (81.0% anti- CD20, 62.5% other DMTs, 80.0% untreated), with similar levels of IFN-y levels among DMTs. 5/12(41.7%) anti-CD20-treated PwMS with negative Ab presented cellular response. In the multivariate analysis, humoral response decreased in anti-CD20 therapy (OR 0.08[95% CI,0.01-0.55]) and was associated with male sex (OR 3.59[1.02-12.68]). Cellular response was associated with seropositivity (OR13.0[1.29-130.4]), but can be present even in the absence of Ab. Conclusions: Humoral response is altered by DMTs, specially in anti-CD20-treated PwMS. Cellular response is associated with seropositivity but can be present in anti-CD20-treated PwMS even in the absence of Ab. Both can be detected up to 13.1 months after COVID-19.

7.
Multiple Sclerosis Journal ; 27(2 SUPPL):769-770, 2021.
Article in English | EMBASE | ID: covidwho-1496075

ABSTRACT

Background: Information about humoral and cellular responses to SARS-CoV-2 vaccination in patients with Multiple Sclerosis (PwMS) and other autoimmune diseases (AID) is scarce. Objective: To determine humoral and cellular responses after SARS-CoV-2 vaccination in PwMS and anti-CD20-treated patients with other AID. Methods: Ongoing prospective study performed in two Catalan MS centres from February 2021. Unvaccinated adult pwMS and other anti-CD20-treated AID were recruited. Demographic, clinical and laboratory data were obtained. Whole blood samples were obtained before and 30-90 days after vaccination. The humoral response to SARS-CoV-2 was qualitatively and quantitatively measured before and after vaccination with commercial chemiluminescence immunoassays targeting SARS-CoV-2 antibodies against spike (TrimericS, IgG anti-S) and nucleocasid proteins (Elecsys, Ig anti-N). In 150 selected patients according to diseasemodifying therapy (DMT), the SARS-CoV-2 specific T-cell response was assessed after vaccination by a whole blood Interferon-Gamma Release immuno Assay (IGRA) that uses two Qiagen proprietary mixes of SARS-CoV-2 S protein (Ag.1 and Ag.2) selected to activate both CD4 and CD8 T cells. Results: 457 patients have been enrolled in the study (anti-CD20 therapy n=164, S1P DMTs n=37, natalizumab n=32, cladribine n=29, alemtuzumab n=31, other DMTs n=129, no DMT n=35). Participants characteristics are: mean age 48.1 years (SD 12.0), 69% female, 422 pwMS (29.4% progressive forms) and 35 with other AID, disease duration 13.9 years (IQR 14.1), median EDSS 3.0 (IQR 3.0). 450 have been fully vaccinated (94.2% mRNA vaccine). Pre-vaccination samples were collected 0.33 days (SD 0.5) before the first vaccine dose of which 12 (3.35%) had positive anti S/N immunoglobulin (Ig). As of June 30th, 42 post-vaccination samples have been obtained (1.3 months [SD 0.42] after the 2nd vaccination dose). Positive IgG rates were 44.8% (n=13/29) for CD20s, 100% (8/8) for other DMTs and 100% (4/4) for no DMT. No anti-N Ig were detected. Media titres of anti-S IgG were lower in anti-CD20-treated patients (7.8 [IQR 50.1]) compared to untreated patients (800 [0], p<0.01) or other DMTs (755 [228], p<0.01). Conclusions: Initial results of the study suggest blunted anti-S/N Ig response under anti-CD20 therapy. Knowledge of the cellular response in these patients will be crucial. Data from the cellular study and the completed humoral study will be presented at the meeting.

8.
American Journal of Respiratory and Critical Care Medicine ; 203(9):2, 2021.
Article in English | Web of Science | ID: covidwho-1407565
9.
American Journal of Respiratory and Critical Care Medicine ; 203(9):2, 2021.
Article in English | Web of Science | ID: covidwho-1407287
11.
Journal of General Internal Medicine ; 36(SUPPL 1):S402-S402, 2021.
Article in English | Web of Science | ID: covidwho-1349089
12.
Blood ; 136:37-40, 2020.
Article in English | EMBASE | ID: covidwho-1348289

ABSTRACT

Introduction:Recently there has been a renewal of therapeutic tools for the treatment of lymphoid neoplasms to increase the antitumor efficacy and reduce the toxicity generated by conventional chemotherapies, which adds to the intrinsic immunological dysfunction of the disease itself. To date, few data are published about infection risk of these new drugs, and the need for infectious prophylaxis is unknown. The aim of the study is to analyze the infectious complications in patients with LPD treated with monoclonal antibodies (obinutuzumab, ofatumumab, brentuximab, nivolumab and pembrolizumab), BTK inhibitors (ibrutinib, acalabrutinib) and PI3K inhibitors (idelalisib). Methods: Multicenter retrospective study in patients with LPD treated with targeted therapies (single agents or combination) in 18 Hematology centers in Spain, from the time of their commercial availability to March 2020. Patients in clinical trials were excluded as well as patients with active infections at the beginning of treatment. Results:During the study period, 380 patients were included.Baseline characteristics of the entire cohort are shown in Table 1.Median follow-up was 17.3 months (range 0-103), the longest follow-up corresponding to CLL patients (24 months, range 0-98) and the shortest to LBCL (5 months, range 0-25). Median exposure to target drugs was 8 months (range 0-72).Ibrutinib was administered to 219 patients(1 FL, 147 CLL, 27 MCL, 10 DLBCL, 1 TL and 32 WM, 1 HL),Brentuximab to 49(31 HL, 14 TL and 4 DLBCL) andIdelalisibto 35 patients (16 affected by chronic lymphocytic leukemia - CLL, 15 FL and 1 DLBCL, 1 WM, 1MCL, 1HL).Obinutuzumabcombinations were used in 10 (6 CLL, 3 FL, 1 MCL) and 5 HL patients (of which 4/5 underwent previous BMT) receivedNivolumab. A total number of 237 infectious events occurred in 148/380 patients (38.9%), 39% of which were grade 3 and 54/148 (36.4%) experienced 2 or more infective episodes: of those 54, 21 (38%) had underwent 3 or more lines of therapy and 28 (51%) had hypogammaglobulinemia. Hospitalization was required in 59.2% events. A bacterial cause of infection was reported in 40% of cases, and viral in 16%, including 11/237 (4,6%) SARS-CoV-2 infection. Invasive fungal infection (IFI) occurred in 3.3% (8/237). Noteworthy, no case of PJP was identified. Lung was the most frequent site of infection in 24% of cases (57/237) while the upper respiratory tract was involved in 17% of events (41/237). Urinary tract infections were diagnosed in 10% (24/237). Other sites involved were skin and soft tissue 7%, gastrointestinal tract 5,4%, bloodstream infections 3% and catheter related infections 2,5%. Considering drugs individually, 86 patients that receivedIbrutinib(39.2 %)experienced a total of 137 infectious episodes: 30% bacterial, 19% viral, 5% fungal and 45% clinical and image-based infections;the 17(34.6%of those who received Brentuximab, experienced a total of 16 infectious episodes: 56% bacterial, 37.5% viral infections and one catheter-related sepsis. Of those who receivedIdelalisib,18 (51.4%)experienced a total of 28 episodes: 42% bacterial, 14% viral and 7% fungal. Four patients treated withObinutuzumabcombinations (40%) experienced one infection during treatment (25% bacterial and 75% viral). Only one patient treated withNivolumabexperienced more than three infections, he was also under corticosteroid treatment. Focusing on IFI (Table 2): 7/8 infections were identified in CLL patients, 6 out 7 being on ibrutinib treatment and 1/7 on Idelalisib.Aspergilluswas the fungus most frequently isolated. The targeted drug was discontinued temporarily in 4 patients and indefinitely in 3. Twenty three (6%) patients died due to infection in our series. Conclusions: 1. We identified 38.7% infections in our LPD patients treated with targeted drugs, with a median drug-exposure time of 8 months (range 0-72), with a non-negligible incidence of bacterial infections. 2. The highest rates of infection were found in patients treated with with Idelalisib and Ibrutinib (51.4% and 39.2% respectively). 3. IFI (3.3%) occurr d with low frequency, mostly in CLL patients during ibrutinib treatment, leading to its temporal discontinuation in most of the cases. 4. No case of PJP was identified in our cohort. 5. An analysis to determine risk factors for infection and the optimal monitoring and prophylaxis for these patients is ongoing. [Formula presented] Disclosures: Hernandez-Rivas:Janssen:Membership on an entity's Board of Directors or advisory committees;Abbvie:Membership on an entity's Board of Directors or advisory committees;Roche:Membership on an entity's Board of Directors or advisory committees;AstraZeneca:Membership on an entity's Board of Directors or advisory committees;Gilead:Membership on an entity's Board of Directors or advisory committees;Celgene/BMS:Membership on an entity's Board of Directors or advisory committees;Rovi:Membership on an entity's Board of Directors or advisory committees.Lopez-Guillermo:novartis:Consultancy;celgene:Consultancy, Research Funding;roche:Consultancy, Research Funding;gilead:Consultancy, Research Funding.

13.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277770

ABSTRACT

Rationale: Pulmonary function abnormalities have been known to last for months or even years in recovered survivors from previous coronavirus pneumonias. However, the long-term pulmonary sequelae of coronavirus disease 2019 (COVID-19) is unknown, and comprehensive clinical follow-up data are lacking, particularly in low-medium income countries. Accordingly, the purpose of this study was to describe changes in persistent symptoms and pulmonary function abnormalities at approximately two and four months of follow-up. Methods: We conducted a prospective, observational study in patients recovering from COVID-19. Patients were evaluated in the pulmonary function laboratory at approximately two and fourth months following the onset of COVID-19 symptoms. During the follow-up visits, patients were asked to report all persistent symptoms at the time of testing from a list currently recognized as part of post COVID syndrome. They then underwent a standardized 6-Minute Walk Test (6MWT) and pulmonary function testing, which included spirometry and diffusion capacity for carbon monoxide (DLCO). Patients were excluded if they were unable to complete all pulmonary function tests in the two follow-up visits. Wilcoxon signed-rank test and McNemar's test were used where appropriate to compare anthropometric, pulmonary function, symptoms, and 6MWT variables between follow-up visits. Results: A total of 30 COVID-19 confirmed patients were included for the follow-up evaluation. The median time from the onset of COVID-19 symptoms to follow-up was 54 days (IQR: 47-70 days) for the first visit and 120 days (IQR: 111-135 days) for the second visit. Although symptoms persisted at the second follow-up visit, the majority of persistent symptoms improved compared to the first visit (Table 1). There was also a marked improvement in the median number of symptoms at the second compared to the first follow-up visit (2 vs. 4 symptoms, respectively, p=0.003). There was a significant improvement in forced vital capacity, forced expiratory volume in 1 second, DLCO, and the proportion of patients with a persistent restrictive pattern on spirometry (Table 1). Despite improvements in pulmonary function, there was no significant change in 6-minute walk distance, although there was a significant improvement in end exercise SpO2. Conclusions: A significant proportion of patients in this study showed improvements in persistent symptoms and pulmonary function at 120 days compared to 54 days following the onset of acute COVID-19 symptoms. Characterizing changes in pulmonary function, symptoms, and functional capacity over time will enable clinicians to understand the long-term implications and recovery trajectory of their COVID-19 patients.

14.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277764

ABSTRACT

Rationale: Dyspnea is one of the most common symptoms associated with coronavirus disease 2019 (COVID-19). Over 40% of COVID-19 survivors experience persistent dyspnea approximately 60 days following hospital discharge (Carfi et al., JAMA, 2020). Understanding differences in pulmonary function and functional capacity between those that do and do not experience persistent dyspnea may provide insight into the underlying mechanisms of this symptom in survivors of COVID-19. Accordingly, the purpose of this study was to compare spirometry, diffusing capacity of the lungs for carbon monoxide (DLCO), and 6-minute walk test (6MWT) outcomes in COVID-19 patients with and without persistent dyspnea. We hypothesized that COVID-19 patients with persistent dyspnea would have lower forced vital capacity (FVC), DLCO, and 6-minute walk distance (6MWD) compared to patients without persistent dyspnea. Methods: Non-critical patients (n=186) with varying degrees of COVID-19 severity reported all persistent symptoms using a standardized questionnaire and underwent pulmonary function testing and a 6MWT between 30 and 90 days following the onset of acute COVID-19 symptoms. Patients were divided into those with (n=70) and those without (n=116) persistent dyspnea. Independent t-tests and Fisher's Exact test were used where appropriate to compare anthropometric, pulmonary function, symptoms, and 6MWT variables. Results: There was no difference in the time of experimental testing relative to the onset of acute COVID-19 symptoms between those with vs. those without dyspnea (59±13 vs. 60±14 days, respectively). Groups had similar age, height, mass, body mass index, sex, and frequency of comorbidities. Patients with persistent dyspnea had significantly lower FVC (p=0.03), forced expiratory volume in 1 second (p=0.04), and DLCO (p=0.01) compared to non-dyspnea patients. 47% of patients with persistent dyspnea had a restrictive pattern on spirometry compared to 33% in the non-dyspnea group. Patients with persistent dyspnea also had lower 6MWD (% predicted, p=0.03) and nadir oxygen saturation (p<0.001), and higher Borg 0-10 ratings of dyspnea and fatigue (both p<0.001) during the 6MWT compared to patients without persistent dyspnea. Conclusions: We have shown that dyspnea is a common persistent symptom across varying degrees of initial COVID-19 severity. Patients with persistent dyspnea had a number of abnormalities compared to well-matched patients without persistent dyspnea, including greater restriction on spirometry, lower DLCO, reduced functional capacity, and increased desaturation and exertional symptoms during a 6MWT. This suggests that there is a true physiological mechanism that may explain persistent dyspnea after COVID-19.

15.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277648

ABSTRACT

Rationale: Clinical outcomes after coronavirus-2019 disease (COVID-19) have been well described, including persistent symptoms and abnormalities on pulmonary function tests and imaging. However, the presence and underlying mechanism of functional impairments after COVID-19 remain unclear. Methods: Patients with SARS-CoV-2 confirmed by real-time polymerase chain reaction were recruited from a hospital in Yucatan, Mexico. Patients who were able to complete surveys, pulmonary function tests, and 6-minute walk tests within 30-90 days after symptom onset were included. COVID-19 severity based on the location of treatment and need for supplemental oxygen was categorized as follows: mild (ambulatory, no hypoxemia), moderate (ambulatory, supplemental oxygen (O2) ≤ 5 l/min), or severe (hospitalised, O2 > 5 l/min without invasive mechanical ventilation). The association between COVID-19 severity and 6-minute walk distance (6MWD) was determined using multivariable linear regression, and underlying mechanisms for reduced 6MWD were then explored. Unadjusted and adjusted linear regression models were used to determine the association between potential predictor variables (Borg dyspnea, Borg fatigue, and end-exercise SpO2) and 6MWD. A final model with Borg dyspnea and end-exercise SpO2 as co-primary endpoints was performed to explore the independent relationship of these two predictors with 6MWD. All models were adjusted for age, sex, smoking, and body mass index (BMI). Results: There were 148 eligible patients with a mean age of 47±14 years and BMI of 32±7kg/m2, with 66% males and 19% current or past-smokers. There were 26% patients with mild, 10% with moderate, and 64% with severe COVID-19 illness. The mean follow-up time was 59 days. The mean 6MWD was 450±104m (83±19% predicted). Patients with severe COVID-19 had a lower 6MWD compared to patients with mild COVID-19 (- 52m [95%CI -88,-15], p=0.006). There was no difference in 6MWD between mild and moderate COVID-19. For every unit increase, Borg dyspnea (coefficient -21m [95%CI -31,-10]) and end-exercise SpO2 (coefficient 13m [95%CI 8,18]) were associated with 6MWD (both p<0.001);however, Borg fatigue was not. When Borg dyspnea and end-exercise SpO2 were included as co-primary predictors, both variables remained independently associated with reduced 6MWD with coefficients of -13m (95%CI -23,-2) and 10m (95%CI 5,16), respectively, after adjusting for covariates (Table 1). Conclusions: Patients with severe COVID-19 had significantly lower 6MWD compared to those with mild disease. Exertional dyspnea and hypoxemia were independent predictors of lower 6MWD, suggesting that dyspnea related to hypoxemia is not the sole driver of reduced functional capacity in COVID- 19 survivors.

17.
Revista Cubana De Reumatologia ; 22(4):9, 2020.
Article in Spanish | Web of Science | ID: covidwho-1094972

ABSTRACT

Introduction: the current world medical panorama is focused on the control of COVID-19. The disease occurs more frequently in patients with chronic diseases and can be associated with other viral diseases;in this situation, the risk of serious complications in patient's increases. Objective: to present the clinical manifestations present in a patient with gout in whom dengue and COVID-19 coexist. Clinical case: A 50-year-old male patient is presented with a diagnosis of gouty arthropathy of 5 years of evolution that begins with an atypical inflammatory picture for this disease, accompanied by other clinical manifestations such as marked decay, hemorrhagic skin lesions, hematuria and progressive dyspnea. Dengue and COVID_19 diagnosis is made through serological studies. Conclusion: it is important to know the joint pattern in the course of rheumatic diseases, this, together with the prevailing epidemiological characteristics, facilitates the diagnosis of association of different diseases as occurred in the case presented.

18.
J Intern Med ; 289(6): 906-920, 2021 06.
Article in English | MEDLINE | ID: covidwho-1066727

ABSTRACT

BACKGROUND: COVID-19 pandemic causes high global morbidity and mortality and better medical treatments to reduce mortality are needed. OBJECTIVE: To determine the added benefit of cyclosporine A (CsA), to low-dose steroid treatment, in patients with COVID-19. METHODS: Open-label, non randomized pilot study of patients with confirmed infection of SARS-CoV-2 hospitalized from April to May 2020 at a single centre in Puebla, Mexico. Patients were assigned to receive either steroids or CsA plus steroids. Pneumonia severity was assessed by clinical, laboratory, and lung tomography. The death rate was evaluated at 28 days. RESULTS: A total of 209 adult patients were studied, 105 received CsA plus steroids (age 55.3 ± 13.3; 69% men), and 104 steroids alone (age 54.06 ± 13.8; 61% men). All patients received clarithromycin, enoxaparin and methylprednisolone or prednisone up to 10 days. Patient's death was associated with hypertension (RR = 3.5) and diabetes (RR = 2.3). Mortality was 22 and 35% for CsA and control groups (P = 0.02), respectively, for all patients, and 24 and 48.5% for patients with moderate to severe disease (P = 0.001). Higher cumulative clinical improvement was seen for the CsA group (Nelson Aalen curve, P = 0.001, log-rank test) in moderate to severe patients. The Cox proportional hazard analysis showed the highest HR improvement value of 2.15 (1.39-3.34, 95%CI, P = 0.0005) for CsA treatment in moderate to severe patients, and HR = 1.95 (1.35-2.83, 95%CI, P = 0.0003) for all patients. CONCLUSION: CsA used as an adjuvant to steroid treatment for COVID-19 patients showed to improve outcomes and reduce mortality, mainly in those with moderate to severe disease. Further investigation through controlled clinical trials is warranted.


Subject(s)
COVID-19/drug therapy , Cyclosporine/therapeutic use , Glucocorticoids/therapeutic use , Methylprednisolone/therapeutic use , Prednisone/therapeutic use , COVID-19/mortality , COVID-19/pathology , Cyclosporine/adverse effects , Drug Therapy, Combination , Female , Glucocorticoids/administration & dosage , Humans , Lung/pathology , Male , Methylprednisolone/administration & dosage , Middle Aged , Pilot Projects , Prednisone/administration & dosage , Treatment Outcome
20.
J Assist Reprod Genet ; 37(7): 1567-1577, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-617321

ABSTRACT

PURPOSE: The state of limited resource settings that Coronavirus (COVID-19) pandemic has created globally should be taken seriously into account especially in healthcare sector. In oncofertility, patients should receive their fertility preservation treatments urgently even in limited resource settings before initiation of anticancer therapy. Therefore, it is very crucial to learn more about oncofertility practice in limited resource settings such as in developing countries that suffer often from shortage of healthcare services provided to young patients with cancer. METHODS: As an extrapolation during the global crisis of COVID-19 pandemic, we surveyed oncofertility centers from 14 developing countries (Egypt, Tunisia, Brazil, Peru, Panama, Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India). Survey questionnaire included questions on the availability and degree of utilization of fertility preservation options in case of childhood cancer, breast cancer, and blood cancer. RESULTS: All surveyed centers responded to all questions. Responses and their calculated oncofertility scores showed different domestic standards for oncofertility practice in case of childhood cancer, breast cancer, and blood cancer in the developing countries under limited resource settings. CONCLUSIONS: Medical practice in limited resource settings has become a critical topic especially after the global crisis of COVID-19 pandemic. Understanding the resources necessary to provide oncofertility treatments is important until the current COVID-19 pandemic resolves. Lessons learned will be valuable to future potential worldwide disruptions due to infectious diseases or other global crises.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/prevention & control , Delivery of Health Care/standards , Fertility Preservation/methods , Neoplasms/therapy , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/transmission , Coronavirus Infections/virology , Delivery of Health Care/economics , Developing Countries , Female , Fertility Preservation/economics , Fertility Preservation/statistics & numerical data , Humans , Neoplasms/virology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , SARS-CoV-2 , Surveys and Questionnaires
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