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1.
Topics in Antiviral Medicine ; 30(1 SUPPL):10, 2022.
Article in English | EMBASE | ID: covidwho-1880370

ABSTRACT

Background: Botswana has a high prevalence of women living with HIV (WLHIV) and experienced a severe nationwide COVID-19 epidemic in 2021. We evaluated adverse birth outcomes among women routinely tested for COVID-19 by HIV status, during a period when few women had access to COVID-19 vaccination. Methods: The Tsepamo Study performs birth outcomes surveillance at government hospitals throughout Botswana. We analyzed data from 13 Tsepamo sites that performed routine COVID-19 screening at delivery with rapid antigen or PCR testing between Sept 1, 2020 and Sept 30, 2021 (start dates differed by site). This analysis includes singleton deliveries with known HIV status and a COVID-19 screening test between 14 days prior and 3 days after delivery. Outcomes included maternal death, preterm delivery (PTD), very preterm delivery (VPTD), small for gestational age (SGA), very small for gestational age (VSGA), stillbirth, and neonatal death. Differences in outcomes by COVID-19 and HIV status were assessed using log binomial regression adjusted for maternal age. Results: A total of 17,627 deliveries occurred at the included sites during COVID-19 screening, and 11,149 (63.3%) were screened for COVID-19;among 10,090 (99.7%) with a known HIV status, 530 (5.3%) COVID-19 tests were positive, including 141/2129 (6.6%) among WLHIV and 389/7961 (4.9%) among women without HIV (aRR 1.32, 95% CI 1.09, 1.60). Maternal deaths were reported in 19 (3.8%) women with COVID-19 and 11 (0.12%) women without COVID-19 (aRR 30.5, 95% CI 14.6, 63.7), and did not differ by HIV status. Adverse birth outcomes (any) were more common among infants born to women with COVID-19 (34.3% vs. 26.3%;aRR 1.32, 95% CI 1.16,1.49), including PTD (21.2% vs. 13.3%;aRR 1.60, 95% CI 1.34,1.90) and stillbirth (5.5% vs. 2.8%;aRR 1.89, 95% CI 1.30,2.75), and there was a trend for higher neonatal mortality (2.0% vs. 1.4%, aRR 1.5, 95% CI 0.79, 2.85). Most adverse birth outcomes were highest among infants exposed to both COVID-19 and HIV (Figure 1). Conclusion: Infants born to women with COVID-19 experienced more adverse birth outcomes than other infants, including a 2-fold risk for stillbirth. Those exposed to both COVID-19 and HIV had the highest risk for most adverse outcomes. Further research is warranted to understand the biological interaction between COVID-19, HIV infection, and adverse birth outcomes, and whether some associations were impacted by challenges in care delivery during the height of the COVID-19 epidemic in Botswana.

2.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779451

ABSTRACT

Background: The COVID-19 pandemic strained healthcare systems worldwide, delaying breast cancer screening and surgery. In 2019, approximately 80% of breast cancers in the U.S. were diagnosed on screening examinations, with 76.4% of eligible Medicare patients undergoing screening at least every two years. Since the start of the pandemic, many women have been reluctant to seek elective screening mammography, even with the lifting of "lock-down". We describe the effect of the COVID-19 pandemic on breast cancer presentation at an academic medical center in a city hit hard by the pandemic. Materials and Methods: The institutional IRB-approved Breast Cancer Registry Database was queried for patients enrolled during two time periods, those undergoing first surgical procedure before the start of the pandemic (4/1/2019-3/31/2020) to those the year after the pandemic started (4/1/2020-3/31/2021). Elective cancer surgery was paused for 3 weeks, ending 4/20/2020, and access to routine breast care was limited for 3 months. Variables included age, method of detection, palpability, histologic subtype and staging, neoadjuvant systemic therapy, cancer specific treatments, and radiation uptake. Results: 349 patients were in the 2019 cohort;246 in the 2020 cohort. No differences in baseline characteristics, including age at presentation, nodal status, or operation type. Fewer cancers were detected on routine mammography post-COVID vs. pre-COVID. Increase in detection of breast cancer through self-Sexams in 2020 was seen compared to 2019. Palpability on presentation also increased. More patients were treated with neo-adjuvant therapy chemotherapy, and 36 of 45 (80%) eligible early-stage breast cancer patients accepted neoadjuvant hormonal therapy during the period that elective cancer surgery was on hold. Patients received radiation therapy less frequently during the pandemic. The proportion of patients diagnosed with invasive ductal cancers was higher in the 2020 cohort and the proportion of patients diagnosed with ductal carcinoma in situ (DCIS) and for invasive lobular cancers (ILC) was lower. Conclusions: Patients at an academic New York City medical center presented with more palpable and invasive breast cancers during the COVID-19 pandemic compared to the preceding year, and fewer patients with DCIS and ILC, cancers typically detected following screening mammography. While stage migration with an increase in diagnosis of late stage cancers has been described, in our population the stage shift occurred in early stage breast cancer, with decreases in DCIS and increases in Stages I-II, with the higher stages III-IV essentially unchanged. This reflects the effect of delay in our previously highly-screened population, with an average screening delay of 3 + months, and many patients missing their yearly screening altogether. While many medical interactions during COVID-19 were via telemedicine, radiation therapy requires daily office visits, and fear of exposure contributed to the lower rate of radiation. Given the increase in invasiveness and stage of breast cancers diagnosed during the COVID-19 pandemic, this study emphasizes the importance of screening for diagnosis and treatment of breast cancer, even in the face of a concurrent health crisis.

3.
Embase;
Preprint in English | EMBASE | ID: ppcovidwho-326897

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in southern Africa has been characterised by three distinct waves. The first was associated with a mix of SARS-CoV-2 lineages, whilst the second and third waves were driven by the Beta and Delta variants respectively1–3. In November 2021, genomic surveillance teams in South Africa and Botswana detected a new SARS-CoV-2 variant associated with a rapid resurgence of infections in Gauteng Province, South Africa. Within three days of the first genome being uploaded, it was designated a variant of concern (Omicron) by the World Health Organization and, within three weeks, had been identified in 87 countries. The Omicron variant is exceptional for carrying over 30 mutations in the spike glycoprotein, predicted to influence antibody neutralization and spike function4. Here, we describe the genomic profile and early transmission dynamics of Omicron, highlighting the rapid spread in regions with high levels of population immunity.

4.
American Journal of Transplantation ; 21:855-855, 2021.
Article in English | Web of Science | ID: covidwho-1668596
6.
Female Pelvic Medicine and Reconstructive Surgery ; 27(10 SUPPL 1):S111-S112, 2021.
Article in English | EMBASE | ID: covidwho-1511118

ABSTRACT

Objective: While some surgical subspecialties have investigated the impact of the COVID-19 pandemic on the education of their residents and fellows, the field of urogynecology has mostly yet to explore this. We surveyed current FPMRS fellows to better describe some of the adversities they have faced during this time and how the pandemic has impacted their training. Methods: An original 24 item questionnaire to assess the impact of COVID-19 in FMPRS fellow- residents was created using Qualtrics™(Provo, Utah, USA). The survey collected information from different domains, including demographics, year of training, burnout effect, changes in the residency program, and its impact on the number of surgeries. The questionnaire was distributed to all residency Program Directors (PD) and/or Program Coordinators (PC). Then the link was forwarded to the residents. Results: Seventy-five fellows completed the survey. Only 22.3%of the fellows reported that they took direct care of a patient who was diagnosed with COVID 19. During the pandemic the fellows reported a drastic decrease of the number of cases per week, with most of the mdoing just on average 1 to 3 cases (79.3%) and just a minority doing more than 4 (20.7%). 65.4% of the fellows reported that they were suggested to be on research block or were pulled away from clinical duties at some point during the pandemic. None were asked to take vacations and 25.2% were asked to cover gyn cases and gyn emergencies. Most of the fellows reported that they felt that at some extent their training has been affected (75%). Despite the residents had no more working hours compared to prior to the pandemic, most of them (77.8%) reported feeling more burned out than prior to the pandemic. All the graduating fellows reported some concerns about their ability to find jobs with 66.6% of them reporting that there are not enough jobs available and the rest reporting concerns about the future of the economy in the country. Conclusions: The COVID-19 pandemic has influenced medical education, including the FPMRS fellowship training. Overall, the fellows reported doing fewer surgeries. Still, they considered that the decreased number of surgeries will not have an overall impact on their training. The pandemic's long-term effect on the fellow's training is unknown, and further studies will be necessary to assess this.

7.
American Journal of Transplantation ; 21(SUPPL 4):855, 2021.
Article in English | EMBASE | ID: covidwho-1494553

ABSTRACT

Purpose: We describe short-term outcomes as well as peri- and post-transplant complications in patients with prior coronavirus disease 2019 (COVID-19) who subsequently underwent kidney transplantation. Methods: This was a single-center, retrospective cohort study of all recipients of isolated living- or deceased-donor kidney transplants between 4/1/2020-10/1/2020. Patients with prior PCR confirmed COVID-19 were considered candidates for kidney transplantation if they were at least 4 weeks post-infection, had resolution of symptoms, and had one negative nasopharyngeal PCR swab specimen. Standard doses of induction and maintenance immunosuppression were administered at the time of transplant and included anti-thymocyte globulin, tacrolimus, mycophenolate, and tapering corticosteroids. Patients were followed from the date of transplantation until study conclusion (11/1/2020), to compare short-term patient and allograft outcomes between those with prior COVID-19 and COVID-19 naïve controls transplanted during the same time-period. Results: 81 patients received isolated kidney transplants during the review period, 13 (16.0%) of whom had recovered from prior COVID-19 infection. The median time between COVID-19 diagnosis and transplantation was 71 (IQR=56.5-135) days, and all 10 patients who were tested had evidence of significant antibody titers to the SARS-CoV-2 spike protein. The majority of patients had mild disease (69.2%), while 3 patients required hospital admission and supplemental oxygen, and 1 patient required mechanical ventilation. Baseline characteristics were similar between COVID-19 positive and negative patients, with the exception of more Hispanic/ Latino patients in the prior COVID-19 group (53.8% vs 17.6%;p<0.01). At study conclusion, after a median follow-up of 3.6 months, patient and allograft survival were similar between COVID-19 positive and negative patients (92.3%/92.3% vs 100.0%/98.5%), and mean baseline serum creatinine was 1.5 mg/dL in both groups. One patient with prior mild COVID-19 died due to a pulmonary embolism within 1-month of transplant;however, no differences were observed in the overall rate of thromboembolism (7.7% vs 4.4%;p=0.61). Index hospital length of stay and readmission rate within 30-days of transplant were also similar between groups, but patients with prior COVID-19 did have a higher incidence of delayed extubation posttransplant (15.4% vs 1.5%;p=0.02). No cases of COVID-19 re-infection or biopsy proven allograft rejection were observed among patients with prior COVID-19. Conclusions: In our preliminary experience, patients with prior COVID-19 infection appeared to have similar short-term outcomes when compared with COVID-19 naive patients. We did observe a potential signal for increased peri-operative respiratory complications in patients with prior COVID-19, which may warrant additional monitoring and further study in multi-center cohorts.

8.
American Journal of Transplantation ; 21(SUPPL 4):604-605, 2021.
Article in English | EMBASE | ID: covidwho-1494500

ABSTRACT

Purpose: Kidney transplant recipients are thought to be at high risk for mortality from COVID-19 due to the necessity for chronic immunosuppressive therapy to prevent graft rejection. However, the optimal immunosuppressant management strategy for patients with COVID-19 remains unknown. Methods: We conducted a single-center, retrospective review of all kidney or kidneypancreas transplant recipients with a functioning graft who were hospitalized with COVID-19 between 3/15/2020-5/15/2020. Patients were followed from the date of admission, up until 1 month following hospital discharge or study conclusion (6/15/2020). Multivariable logistic regression was used to identify potential patient or immunosuppression characteristics associated with the development of severe COVID-19 and in-hospital mortality. Results: 69 (3.2%) patients followed longitudinally at our center were hospitalized with COVID-19 during the review period, 38 of whom were admitted to the study institution. Patients were ethnically diverse, and the majority were receiving tacrolimus (84.2%), mycophenolate (89.5%), and corticosteroids (81.6%) at baseline. Following COVID-19 diagnosis, median tacrolimus trough levels decreased by-11% (-26%-+17%) during hospitalization and mycophenolate doses were reduced by at least 50% in 33 patients. Adjunctive therapy included hydroxychloroquine (68.4%), convalescent plasma (26.3%), anticoagulation (52.6%), and participation in clinical trials (10.5%). Twenty patients developed severe disease, and 11 (28.9%) died during hospitalization. Admission characteristics associated with increased risk for mortality included age (OR=2.0;1.0-4.0) and history of HIV (OR=22.6;1.1-483.7). No association was found between baseline tacrolimus trough levels, mycophenolate dosing, or the number of immunosuppressants prescribed and COVID-19 mortality. Similarly, the degree of immunosuppression reduction following hospital admission was not associated with survival or severe disease progression. No differences were observed in the prescription of adjunctive therapies, with the exception of a higher daily dose of prednisone equivalents in patients who died (37.0 vs 15.4;p=0.02). Among survivors, death-censored allograft survival was 96.2% at 1-month, and no cases of biopsy proven rejection were observed during the review period. Conclusions: The findings from our study confirm age as a significant risk factor for COVID-19 mortality in kidney transplant recipients, and suggest HIV status as an additional risk factor that may warrant further investigation. Pre-emptive immunosuppression reduction does not appear to be warranted, as baseline immunosuppression intensity and dose modulation following diagnosis of infection were not associated with hospital outcomes. However, no episodes of acute rejection were observed, so providers may wish to consider immunosuppression reduction on a case-by-case basis.

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