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1.
Preprint in English | MEDLINE | ID: ppcovidwho-290700

ABSTRACT

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can result in a hyperinflammatory state, leading to acute respiratory distress syndrome (ARDS), myocardial injury, and thrombotic complications, among other sequelae. Statins, which are known to have anti-inflammatory and antithrombotic properties, have been studied in the setting of other viral infections and ARDS, but their benefit has not been assessed in COVID-19. Thus, we sought to determine whether antecedent statin use is associated with lower in-hospital mortality in patients hospitalized for COVID-19. This is a retrospective analysis of patients admitted with COVID-19 from February 1 st through May 12 th , 2020 with study period ending on June 11 th , 2020. Antecedent statin use was assessed using medication information available in the electronic medical record. We constructed a multivariable logistic regression model to predict the propensity of receiving statins, adjusting for baseline socio-demographic and clinical characteristics, and outpatient medications. The primary endpoint included in-hospital mortality within 30 days. A total of 2626 patients were admitted during the study period, of whom 951 (36.2%) were antecedent statin users. Among 1296 patients (648 statin users, 648 non-statin users) identified with 1:1 propensity-score matching, demographic, baseline, and outpatient medication information were well balanced. Statin use was significantly associated with lower odds of the primary endpoint in the propensity-matched cohort (OR 0.48, 95% CI 0.36 a" 0.64, p<0.001). We conclude that antecedent statin use in patients hospitalized with COVID-19 was associated with lower inpatient mortality. Randomized clinical trials evaluating the utility of statin therapy in patients with COVID-19 are needed.

2.
Journal of Clinical Oncology ; 39(15 SUPPL), 2021.
Article in English | EMBASE | ID: covidwho-1339234

ABSTRACT

Background: COVID-19 has had profound direct and indirect effects on population health to date and long-term effects are anticipated. Vulnerabilities to the most serious consequences of infection include older age, obesity, African American race and the presence of comorbid conditions. African American cancer survivors represent a particularly high-risk group, therefore understanding the impact of the virus and our strategies to prevent its spread on this patient population is important. Methods: The Detroit Research on Cancer Survivors (ROCS) cohort is a unique effort to understand the determinants of poor outcomes in African American cancer survivors. Eligible participants were diagnosed with breast, prostate, colorectal, or lung cancer on or after 1/1/2013, or with endometrial or any other cancer before age 50 on or after 01/01/2016 and were identified through the Metropolitan Detroit Cancer Surveillance System cancer registry. To date, we have enrolled 4173 survivors. Full participation includes completion of a baseline survey, and collection of biospecimens, medical records and tumor tissue, if available. Participants are also followed annually for outcomes and changes in history. A supplemental survey focused on the impact of COVID-19 was offered to enrolled participants beginning in the spring of 2020. The results presented here include data from 890 survivors who also completed the ROCS COVID survey. Results: Nearly all ( > 99%) survivors reported some change in their daily activities in an effort to reduce the risk of infection. At the time of survey, just over 1/3 of participants reported being tested for the virus and among those, 12% reported positive results. More than 40% of survivors reported some disruption in their access to medical care. A substantial ( > 40%) proportion of survivors reported feeling anxious, depressed and/or isolated during the COVID-19 pandemic. Approximately 40% of patients reported changes in health behaviors as a direct result of the pandemic that are known to negatively affect survivorship outcomes (physical inactivity, smoking, alcohol use). Notably, 30% of survivors reported declines in physical activity and these declines were significantly associated with increased anxiety (p = 0.008), depression (p = 0.005) and poorer healthrelated quality of life (p < 0.001). Conclusions: The influence of the COVID- 19 pandemic on African American cancer survivors has been substantial, affecting both their physical and mental health and access to needed medical care. Coupled with changes in health behaviors as a direct result of the pandemic, these factors will likely affect outcomes in this high-risk patient population making further study and interventions necessary to mitigate the long-term impact of the pandemic on cancer outcomes.

3.
Couple and Family Psychology: Research and Practice ; 2021.
Article in English | Scopus | ID: covidwho-1298824

ABSTRACT

The COVID-19 pandemic has affected profoundly all parties and health-care delivery. Most hospitalized patients find that separation from loved ones takes a toll on them and the safety measures instituted come at a huge cost to their physical and emotional well-being. Family members are distressed and traumatized because they are unable to support or advocate for their loved ones and feel disconnected from the health-care team. Health-care professionals (HCPs) experience psychological and moral distress because the absence of families negatively affects their ability to provide quality, compassionate, and timely care. As a result, there have been calls for revisions of policies and procedures to reprioritize patient- and family-centered care (PFCC). Building upon their experience as frontline HCPs, health-care team leaders, and patients and family members who are also frontline HCPs, the interprofessional team (psychologists, psychiatrists, hospitalists, nurses, and specialists) of co-authors reviewed the literature and developed collegial consensus on a roadmap for PFCC during the pandemic that includes guiding principles along with associated best practices and implementation strategies for their operationalization. The guiding principles focus on providing safe yet compassionate and ethical PFCC;balancing community health and the mitigation of viral transmission with appreciating family members as essential partners in care;fostering communication between patients and their families;and promoting interactions and decision-making among HCPs, patients, and families. We hope this roadmap facilitates the transformation of the health-care culture during the pandemic to one that is truly patient and family centered. (PsycInfo Database Record (c) 2021 APA, all rights reserved) © 2021 American Psychological Association

4.
Cancer Epidemiology Biomarkers and Prevention ; 30(4):803-804, 2021.
Article in English | EMBASE | ID: covidwho-1241070

ABSTRACT

Purpose: Financial hardship due to cancer is more common among African American than White survivors. The COVID-19 pandemic and its economic fallout have also disproportionately affected African Americans. The purpose of this study is to describe the financial and employment impacts of COVID-19 in a population of African American cancer survivors and to compare those impacts with those experienced after a cancer diagnosis. Methods: Results include survey data from 593 participants in the population-based Detroit Research on Cancer Survivors (ROCS) cohort who completed the ROCS enrollment survey and a supplemental questionnaire related to the impact of the COVID-19 pandemic on their financial wellbeing and employment. Most participants (96%) were not diagnosed with COVID-19 by the time they completed the supplement and reflect the societal impact of the pandemic rather than a personal COVID-19 diagnosis. Analyses compare reports of financial hardship (using assets, borrowing money, experiencing debt, decreases in income) and employment impacts (changes to work schedules, duties, hours, employment status) due to cancer and due to the COVID-19 pandemic. Results: A similar proportion of ROCS participants reported financial hardship (41% vs. 42%) and borrowing money (5% vs. 6%) related to the COVID pandemic and their cancer diagnosis, respectively. Fewer survivors reported borrowing money (9% vs. 17%;p<0.001) or experiencing a decrease in income due to COVID than cancer (20% vs. 28%;p = 0.001);however;more reported debt associated with COVID (30% vs. 17%;p<0.001). Changes to work schedules (44% vs. 36%) and hours worked (44% vs. 28%) related to the COVID pandemic and cancer were common, and not statistically different from one another. More survivors changed their work duties due to the COVID pandemic (20%) than cancer (12%;p = 0.048). Prevalence of changes to employment status were similar for cancer (6%) and COVID (11%). Conclusions: The COVID-19 pandemic was associated with similar levels of overall financial hardship, and higher prevalence of debt and some work changes, than individual cancer experiences. These additional burdens on a financially vulnerable population could exacerbate existing cancer-related inequities.

5.
Journal of the American Geriatrics Society ; 69(SUPPL 1):S112, 2021.
Article in English | EMBASE | ID: covidwho-1214851

ABSTRACT

Home visits are an important and positive part of geriatric education for medical students (MS), but the main lessons learned by MS are not known. As part of the new Aging/End of Life Care curricular theme at Harvard Medical School, first year medical and dental students participate in older adult home visits with geriatrics faculty to learn about the geriatric assessment. Our mixed methods analysis explores students' main lessons learned. We collected anonymous evaluation forms from 310 students following a one-time geriatric home visit over a 3 year period. Using a 5-point Likert scale, MS rated their comfort with various aspects of geriatric assessment and rated whether their interest in geriatrics increased after the home visit. MS described two lessons learned. Two coders analyzed 604 lessons learned and identified major themes which were then organized into the Geriatric 5Ms Framework (Multicomplexity, Mobility, Mind, Matters Most, Medications). Qualitative and quantitative data were analyzed using Excel, Dedoose and JMP statistical software. A majority of MS (72%) reported their interest in geriatrics somewhat or greatly increased after the home visit. Of the 604 lessons learned that were coded, 51% related to mobility. 56% of responses related to multicomplexity, of which the most common was understanding different living facilities (43%). After a geriatric home visit, MS interest in geriatrics increases as they learn about applying the Geriatric 5Ms Framework. The most common lessons learned related to mobility and multicomplexity, essential areas of focus in a geriatrics curriculum. Though more difficult to arrange in the COVID-19 era, educational home visits are an important opportunity to increase MS interest in geriatrics and build their skills to improve the care of older adults.

6.
Br J Dermatol ; 184(3): e56-e121, 2021 03.
Article in English | MEDLINE | ID: covidwho-1147471
8.
Journal of Pharmacy and Pharmacognosy Research ; 9(2):126-146, 2021.
Article in English | EMBASE | ID: covidwho-984802

ABSTRACT

Context: Currently, there is no effective antiviral therapy recommended for novel coronavirus pneumonia 2019 (COVID-19). Aims: To assess the safety of ozonized saline solution (O3SS) used as a complementary therapy in adult COVID-19 patients. Methods: Twenty-five adult patients hospitalized with mild to severe symptoms of COVID-19, who met the inclusion criteria and were treated from April 18 to April 26, 2020, at Virgen De La Paloma Hospital, Madrid, Spain were included in this study. Patients were assigned to receive standard care consisting ceftriaxone (250 mg – 2 g twice daily for 7 days) plus azithromycin (500 mg once daily for 5 days), of 200 - 400 mg hydroxychloroquine twice daily for 5-7 days plus tocilizumab 400 mg twice daily for 5 days, low molecular weight heparin and 40 to 60 mg metil-prednisone plus O3SS, 200 mL, 3-5 µg/mL per day for 10 days. No control group was included, the data was compared to clinical trials in this subject. Secondary endpoints assessed included the clinical status of participants, laboratory examinations, and duration of viral shedding. Results: Patients with COVID-19 with mild to severe symptoms who received intravenous O3SS as an adjunct treatment experienced no side effects. The main results of O3SS treatment were a tendency to improve clinical symptoms without side effects. None of the patients treated died. Conclusions: Early evidence of efficacy shown improvements in symptoms such as dyspnea, weakness, and reduction in body temperature were observed and corresponded to improvements in laboratory results including D-dimer, fibrinogen, lactate dehydrogenase, and C-reactive protein. These preliminary data will serve as the basis for a future study of the effectiveness of this therapy.

9.
BJOG ; 128(1): 97-100, 2021 01.
Article in English | MEDLINE | ID: covidwho-972231

ABSTRACT

OBJECTIVE: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is present in the vaginal secretions of both reproductive-aged and postmenopausal women during acute SARS-CoV-2 infection. DESIGN: Prospective study. SETTING: A single tertiary, university-affiliated medical centre in Israel. Time period, 1 June 2020 through to 31 July 2020. POPULATION: Women who were hospitalised in a single tertiary medical centre, who were diagnosed with acute SARS-CoV-2 infection by a nasopharyngeal RT-PCR test. METHODS: Women were diagnosed with acute SARS-CoV-2 infection by a nasopharyngeal RT-PCR test. Vaginal RT-PCR swabs were obtained from all study participants after a proper cleansing of the perineum. MAIN OUTCOME MEASURES: Detection of SARS-CoV-2 in vaginal RT-PCR swabs. RESULTS: Vaginal and nasopharyngeal swabs were obtained from 35 women, aged 21-93 years. Twenty-one women (60%) were in their reproductive years, of whom, five were in their third trimester of pregnancy. Most of the participants (57%) were healthy without any underlying medical conditions. Of the 35 patients sampled, 2 (5.7%) had a positive vaginal RT-PCR for SARS-CoV-2, one was premenopausal and the other was a postmenopausal woman. Both women had mild disease. CONCLUSION: Our findings contradict most previous reports, which did not detect the presence of viral colonisation in the vagina. Although passage through the birth canal exposes neonates to the vaginal polymicrobial flora, an acquisition of pathogens does not necessarily mandate neonatal infection or clinical disease. Nevertheless, when delivering the infant of a woman with acute SARS-CoV-2 infection, a clinician should consider the possibility of vaginal colonisation, even if it is uncommon. TWEETABLE ABSTRACT: When delivering the infant of a woman with acute SARS-CoV-2 infection, a clinician should consider the possibility of vaginal colonisation.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , SARS-CoV-2/isolation & purification , Vagina/virology , Adult , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Nucleic Acid Testing/methods , Female , Humans , Infant, Newborn , Israel/epidemiology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/prevention & control , Prospective Studies , Vaginal Smears/methods , Vaginal Smears/statistics & numerical data
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