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1.
Mayo Clinic Proceedings ; 2022.
Article in English | ScienceDirect | ID: covidwho-2165688

ABSTRACT

Objective To develop and validate an updated lung injury prediction score (c-LIPS) tailored for predicting acute respiratory distress syndrome (ARDS) in coronavirus disease-2019. Patients and Methods This was a registry-based cohort study using the Viral Infection and Respiratory Illness Universal Study. Hospitalized adult patients between January 2020 and January 2022 were screened. Patients who qualified for ARDS within the first day of admission were excluded. Development cohort consisted of patients enrolled from participating Mayo Clinic sites. The validation analyses were carried out on remaining patients enrolled from more than 120 hospitals in 15 countries. The original LIPS was calculated and enhanced using reported COVID-19 specific laboratory risk factors, constituting c-LIPS. The main outcome was ARDS development and secondary outcomes included hospital mortality, invasive mechanical ventilation, progression in World Health Organization ordinal scale. Results The derivation cohort consisted of 3710 patients, of whom 28% developed ARDS. The c-LIPS discriminated COVID-19 patients who developed ARDS with an AUC of 0.79 compared to original LIPS (AUC 0.74, P<.001) with good calibration accuracy (Hosmer-Lemeshow P=.50). Despite different characteristics of the two cohorts, the c-LIPS's performance was comparable in the validation cohort of 5426 patients (16% ARDS), with an AUC of 0.74;and its discriminatory performance was significantly higher than the LIPS (AUC 0.68, P<.001). The c-LIPS's performance in predicting the requirement for invasive mechanical ventilation in derivation and validation cohorts had an AUC of 0.74 and 0.72, respectively. Conclusion In this large patient sample c-LIPS was successfully tailored to predict ARDS in COVID-19 patients.

2.
Cureus ; 14(8): e28394, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2056318

ABSTRACT

Clopidogrel is an antithrombotic agent widely used for the secondary prevention of cerebrovascular and cardiovascular complications. Clopidogrel can cause serious adverse events, including gastrointestinal bleeding. Pulmonary complications caused by clopidogrel are not widely described, and clopidogrel-induced interstitial lung disease (ILD) is rare. Here, we report a case of drug-induced ILD in a patient who presented with dyspnea, chest pain, and mild fever. The patient underwent percutaneous coronary intervention two months ago and was commenced on clopidogrel. He was diagnosed with clopidogrel-induced ILD based on clinical and imaging findings, history of drug exposure without any change, exclusion of other respiratory disorders, and clinical improvement after discontinuation of clopidogrel and steroid use.

3.
Hosp Pract (1995) ; 50(4): 326-330, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1997024

ABSTRACT

OBJECTIVES: The COVID-19 pandemic severely restricted in-person learning. As a result, many educational institutions switched to online platforms to continue teaching. COVID-19 webinars have been useful for rapidly disseminating information to frontline healthcare workers. While conducting COVID-19 webinars through online platforms is a popular method to train medical professionals, their effectiveness has never been investigated. Our aim was to ascertain the usefulness of COVID-19 webinars during the pandemic. METHODS: We conducted an online survey of about 400 frontline healthcare workers. 112 people responded to the survey (response rate = 28%). In it, we asked several questions to determine whether webinars had been a useful resource to help deal with COVID-19 patients. RESULTS: We found that a majority of healthcare worker respondents had favorable opinions of online education during the pandemic as around 78% of respondents either agreed or highly agreed that webinars are a useful source of knowledge. A significant proportion (34%) did not participate in webinars and gave time constraints as their main reason for not participating. CONCLUSION: Our results indicated that while online education is a great way to disseminate information quickly to a large amount of people, it also comes with its disadvantages. As we transition into a post-pandemic world, we need to make sure that online teaching is designed with the best interests of the healthcare workers in mind to ensure that we get the most out of it.


Subject(s)
COVID-19 , Pandemics , Health Personnel , Humans , SARS-CoV-2 , Surveys and Questionnaires
4.
Cureus ; 14(6), 2022.
Article in English | EuropePMC | ID: covidwho-1958082

ABSTRACT

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a class of autoimmune diseases that can cause kidney failure because of mononuclear cell infiltration and the destruction of small and medium-sized blood vessels. Coronavirus disease 2019 (COVID-19) may trigger or exacerbate autoimmune diseases. We present a case of ANCA-associated vasculitis in a patient with rheumatoid arthritis after a COVID-19 infection, who presented with intermittent hemoptysis and dyspnea and was diagnosed with COVID-19 pneumonia three weeks ago. Her clinical, radiological, and serological picture was concerned with pulmonary-renal syndrome. Her serum was positive for antinuclear antibody and ANCAs, and renal biopsy showed pauci-immune crescentic glomerulonephritis. She was diagnosed clinicopathologically with pauci-immune glomerulonephritis in the setting of rheumatoid arthritis (RA) after a COVID-19 infection. Her condition improved after she was treated with rituximab and pulse dose methylprednisolone.

5.
Front Endocrinol (Lausanne) ; 13: 780872, 2022.
Article in English | MEDLINE | ID: covidwho-1902945

ABSTRACT

Background: Obesity affects the course of critical illnesses. We aimed to estimate the association of obesity with the severity and mortality in coronavirus disease 2019 (COVID-19) patients. Data Sources: A systematic search was conducted from the inception of the COVID-19 pandemic through to 13 October 2021, on databases including Medline (PubMed), Embase, Science Web, and Cochrane Central Controlled Trials Registry. Preprint servers such as BioRxiv, MedRxiv, ChemRxiv, and SSRN were also scanned. Study Selection and Data Extraction: Full-length articles focusing on the association of obesity and outcome in COVID-19 patients were included. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used for study selection and data extraction. Our Population of interest were COVID-19 positive patients, obesity is our Intervention/Exposure point, Comparators are Non-obese vs obese patients The chief outcome of the study was the severity of the confirmed COVID-19 positive hospitalized patients in terms of admission to the intensive care unit (ICU) or the requirement of invasive mechanical ventilation/intubation with obesity. All-cause mortality in COVID-19 positive hospitalized patients with obesity was the secondary outcome of the study. Results: In total, 3,140,413 patients from 167 studies were included in the study. Obesity was associated with an increased risk of severe disease (RR=1.52, 95% CI 1.41-1.63, p<0.001, I2 = 97%). Similarly, high mortality was observed in obese patients (RR=1.09, 95% CI 1.02-1.16, p=0.006, I2 = 97%). In multivariate meta-regression on severity, the covariate of the female gender, pulmonary disease, diabetes, older age, cardiovascular diseases, and hypertension was found to be significant and explained R2 = 40% of the between-study heterogeneity for severity. The aforementioned covariates were found to be significant for mortality as well, and these covariates collectively explained R2 = 50% of the between-study variability for mortality. Conclusions: Our findings suggest that obesity is significantly associated with increased severity and higher mortality among COVID-19 patients. Therefore, the inclusion of obesity or its surrogate body mass index in prognostic scores and improvement of guidelines for patient care management is recommended.


Subject(s)
COVID-19 , COVID-19/complications , Female , Hospitalization , Humans , Obesity/complications , Obesity/epidemiology , Pandemics , Respiration, Artificial
6.
Cureus ; 14(5): e25065, 2022 May.
Article in English | MEDLINE | ID: covidwho-1884696

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has turned into a global healthcare challenge, causing significant morbidity and mortality.Healthcare workers (HCWs) who are on the frontline of the COVID-19 outbreak response face an increased risk of contracting the disease. Some common challenges encountered by HCWs include exposure to the pathogen, psychological distress, and long working hours. In addition, HCWs may be more prone to develop mental health issues such as anxiety, depression, suicidal thoughts, post-traumatic stress disorder (PTSD), sleep disorders, and drug addictions compared to the general population. These issues arise from increased job stress, fear of spreading the disease to loved ones, and potential discrimination or stigma associated with the disease. This study aims to review the current literature to explore the effects of COVID-19 on healthcare providers' physical and mental well-being and suggest interventional strategies to combat these issues. To that end, we performed a literature search on Google Scholar and PubMed databases using combinations of the following keywords and synonyms: "SARS-CoV-2", "Healthcare-worker", "COVID-19", "Well-being", "Wellness", "Depression", "Anxiety", and "PTSD."

7.
World J Crit Care Med ; 11(2): 102-111, 2022 Mar 09.
Article in English | MEDLINE | ID: covidwho-1791995

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) course may be affected by environmental factors. Ecological studies previously suggested a link between climatological factors and COVID-19 fatality rates. However, individual-level impact of these factors has not been thoroughly evaluated yet. AIM: To study the association of climatological factors related to patient location with unfavorable outcomes in patients. METHODS: In this observational analysis of the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: COVID-19 Registry cohort, the latitudes and altitudes of hospitals were examined as a covariate for mortality within 28 d of admission and the length of hospital stay. Adjusting for baseline parameters and admission date, multivariable regression modeling was utilized. Generalized estimating equations were used to fit the models. RESULTS: Twenty-two thousand one hundred eight patients from over 20 countries were evaluated. The median age was 62 (interquartile range: 49-74) years, and 54% of the included patients were males. The median age increased with increasing latitude as well as the frequency of comorbidities. Contrarily, the percentage of comorbidities was lower in elevated altitudes. Mortality within 28 d of hospital admission was found to be 25%. The median hospital-free days among all included patients was 20 d. Despite the significant linear relationship between mortality and hospital-free days (adjusted odds ratio (aOR) = 1.39 (1.04, 1.86), P = 0.025 for mortality within 28 d of admission; aOR = -1.47 (-2.60, -0.33), P = 0.011 for hospital-free days), suggesting that adverse patient outcomes were more common in locations further away from the Equator; the results were no longer significant when adjusted for baseline differences (aOR = 1.32 (1.00, 1.74), P = 0.051 for 28-day mortality; aOR = -1.07 (-2.13, -0.01), P = 0.050 for hospital-free days). When we looked at the altitude's effect, we discovered that it demonstrated a non-linear association with mortality within 28 d of hospital admission (aOR = 0.96 (0.62, 1.47), 1.04 (0.92, 1.19), 0.49 (0.22, 0.90), and 0.51 (0.27, 0.98), for the altitude points of 75 MASL, 125 MASL, 400 MASL, and 600 MASL, in comparison to the reference altitude of 148 m.a.s.l, respectively. P = 0.001). We detected an association between latitude and 28-day mortality as well as hospital-free days in this worldwide study. When the baseline features were taken into account, however, this did not stay significant. CONCLUSION: Our findings suggest that differences observed in previous epidemiological studies may be due to ecological fallacy rather than implying a causal relationship at the patient level.

8.
JMIR Res Protoc ; 11(3): e27921, 2022 Mar 15.
Article in English | MEDLINE | ID: covidwho-1745198

ABSTRACT

BACKGROUND: The rapid emergence of the COVID-19 pandemic globally collapsed health care organizations worldwide. Incomplete knowledge of best practices, progression of disease, and its impact could result in fallible care. Data on symptoms and advancement of the SARS-CoV-2 virus leading to critical care admission have not been captured or communicated well between international organizations experiencing the same impact from the virus. This led to the expedited need for establishing international communication and data collection on the critical care patients admitted with COVID-19. OBJECTIVE: Developing a global registry to collect patient data in the critical care setting was imperative with the goal of analyzing and ameliorating outcomes. METHODS: A prospective, observational global registry database was put together to record extensive deidentified clinical information for patients hospitalized with COVID-19. RESULTS: Project management was crucial for prompt implementation of the registry for synchronization, improving efficiency, increasing innovation, and fostering global collaboration for valuable data collection. The Society of Critical Care Medicine Discovery VIRUS (Viral Infection and Respiratory Illness Universal Study): COVID-19 Registry would compile data for crucial longitudinal outcomes for disease, treatment, and research. The agile project management approach expedited establishing the registry in 15 days and submission of institutional review board agreement for 250 participating sites. There has been enrollment of sites every month with a total of 306 sites from 28 countries and 64,114 patients enrolled (as of June 7, 2021). CONCLUSIONS: This protocol addresses project management lessons in a time of crises which can be a precept for rapid project management for a large-scale health care data registry. We aim to discuss the approach and methodology for establishing the registry, the challenges faced, and the factors contributing to successful outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT04323787; https://clinicaltrials.gov/ct2/show/NCT04323787.

9.
Cureus ; 14(2): e21998, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1716121

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic brought about an unprecedented time. Multiple systemic complications have been recognized with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as it can do much more than affect the respiratory system. One of the intriguing neurological complications is Guillain-Barre syndrome (GBS). We reviewed three cases in which patients presented with GBS following COVID-19 infection. All three cases had positive lumbar puncture results with albumino-cytological dissociation. Each patient was treated with plasmapheresis and improved clinically. Although an exact causal relationship between COVID-19 and GBS cannot be drawn from this case series alone, it signifies the importance of this complication. It warrants further studies to establish the causal relationship. One should have a high suspicion for acute inflammatory demyelinating polyneuropathy (AIDP) in patients presenting with acute onset of ascending weakness following COVID-19 infection.

10.
Clin Endocrinol (Oxf) ; 2022 Feb 18.
Article in English | MEDLINE | ID: covidwho-1708522

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is associated with high rates of morbidity and mortality. Primary hypothyroidism is a common comorbid condition, but little is known about its association with COVID-19 severity and outcomes. This study aims to identify the frequency of hypothyroidism in hospitalized patients with COVID-19 as well as describe the differences in outcomes between patients with and without pre-existing hypothyroidism using an observational, multinational registry. METHODS: In an observational cohort study we enrolled patients 18 years or older, with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection between March 2020 and February 2021. The primary outcomes were (1) the disease severity defined as per the World Health Organization Scale for Clinical Improvement, which is an ordinal outcome corresponding with the highest severity level recorded during a patient's index COVID-19 hospitalization, (2) in-hospital mortality and (3) hospital-free days. Secondary outcomes were the rate of intensive care unit (ICU) admission and ICU mortality. RESULTS: Among the 20,366 adult patients included in the study, pre-existing hypothyroidism was identified in 1616 (7.9%). The median age for the Hypothyroidism group was 70 (interquartile range: 59-80) years, and 65% were female and 67% were White. The most common comorbidities were hypertension (68%), diabetes (42%), dyslipidemia (37%) and obesity (28%). After adjusting for age, body mass index, sex, admission date in the quarter year since March 2020, race, smoking history and other comorbid conditions (coronary artery disease, hypertension, diabetes and dyslipidemia), pre-existing hypothyroidism was not associated with higher odds of severe disease using the World Health Organization disease severity index (odds ratio [OR]: 1.02; 95% confidence interval [CI]: 0.92, 1.13; p = .69), in-hospital mortality (OR: 1.03; 95% CI: 0.92, 1.15; p = .58) or differences in hospital-free days (estimated difference 0.01 days; 95% CI: -0.45, 0.47; p = .97). Pre-existing hypothyroidism was not associated with ICU admission or ICU mortality in unadjusted as well as in adjusted analysis. CONCLUSIONS: In an international registry, hypothyroidism was identified in around 1 of every 12 adult hospitalized patients with COVID-19. Pre-existing hypothyroidism in hospitalized patients with COVID-19 was not associated with higher disease severity or increased risk of mortality or ICU admissions. However, more research on the possible effects of COVID-19 on the thyroid gland and its function is needed in the future.

12.
Cureus ; 14(1): e21374, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1705086

ABSTRACT

Mass vaccination against coronavirus disease 19 (COVID-19) has effectively controlled the pandemic and has been remarkably effective and safe. Reports of a few adverse events have been reported after post-marketing surveillance. We present a rare case of multiple sclerosis (MS) relapse in a female who presented with fatigue, involuntary eye movements, and numbness; autoimmunity following the COVID-19 vaccine has also been described. She was diagnosed with MS six years back and was in remission. She received her COVID-19 vaccine 18 days ago. Her clinical and radiological features confirmed the MS relapse. Her serology for COVID-19 immunoglobulin G (IgG) and IgM was positive, and she was managed with intravenous methylprednisolone and symptomatic management. Our case provides a possible association of vaccine-associated MS relapse; however, more evidence is warranted from future studies.

13.
Cureus ; 13(12): e20628, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1675215

ABSTRACT

Acute transverse myelitis (ATM) following coronavirus disease 19 (COVID-19) is rarely reported in the literature. We report a case of ATM after COVID-19 infection in a female who presented with sudden onset bilateral lower limb weakness, paresthesia, and urinary retention. She developed fever, cough, dyspnea two weeks ago, and her COVID-19 test was positive one week later. After a complete physical examination and detailed investigations, including cerebrospinal fluid analysis, autoimmune screening, and infectious workup, a diagnosis of ATM due to COVID-19 was made. Magnetic resonance imaging of the whole spine confirmed the diagnosis of ATM. She was managed with intravenous methylprednisolone, physical therapy, and bladder training and her condition improved gradually.

14.
Critical Care Medicine ; 50:120-120, 2022.
Article in English | Academic Search Complete | ID: covidwho-1599538

ABSTRACT

The Structured Team-based Optimal Patient-centered care for COVID-19 VIRUS (STOP-VIRUS) Collaborative was created to identify and implement current best COVID-19 practices using standard quality improvement methodology in a learning community of participating U.S. sites. B Introduction: b Interim SCCM VIRUS Registry analysis demonstrated variation in patient outcomes independent of acuity or comorbidity, suggesting opportunities for critical care process improvement. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

15.
Critical Care Medicine ; 50:55-55, 2022.
Article in English | Academic Search Complete | ID: covidwho-1598631

ABSTRACT

B Introduction: b The severity of COVID-19 may be affected by environmental factors. While considering the altitude level, we found that it had a non-linear relationship with 28-day mortality (p=0.001, odds ratios for altitudes 75, 125, 400, and 600 m.a.s.l were: 0.96, 1.04, 0.49, and 0.51, respectively). [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

16.
Critical Care Medicine ; 50:58-58, 2022.
Article in English | Academic Search Complete | ID: covidwho-1598630

ABSTRACT

B Introduction: b Better delineation of COVID-19 presentations in different climatological conditions might assist with prompt diagnosis and isolation of patients. When adjusted for baseline differences, at lower latitudes (< 30°) patients presented less commonly with gastrointestinal symptoms (p< 0.001, odds ratios for latitudes 15°, 25°, and 30°: 0.32, 0.81, and 0.98, respectively). [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

17.
Critical Care Medicine ; 50:45-45, 2022.
Article in English | Academic Search Complete | ID: covidwho-1598175

ABSTRACT

The severity in hospitalized COVID-19 patients, such as the requirement of invasive mechanical ventilation and intensive care unit admission with obesity was the chief outcome. Our aim is to estimate the association of obesity with severity and all-cause mortality in coronavirus disease 2019 (COVID-19) patients. All-cause mortality in COVID-19 hospitalized patients with obesity was the secondary outcome. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

18.
Critical Care Medicine ; 50:79-79, 2022.
Article in English | Academic Search Complete | ID: covidwho-1598003

ABSTRACT

B Methods: b This was an observational cohort analysis of adult, hospitalized, patients enrolled in the SCCM Discovery VIRUS Registry. B Conclusions: b Our multivariate analysis from a large multinational registry showed that diarrhea was more common in obese patients than non-obese patients. B Introduction: b While obesity is associated with the severity of COVID-19 disease, it is unclear whether gut mechanisms in patients with obesity predispose to increased susceptibility to SARS-CoV-2. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

19.
Critical Care Medicine ; 50:49-49, 2022.
Article in English | Academic Search Complete | ID: covidwho-1598002

ABSTRACT

B Introduction: b Gastrointestinal symptoms are common is patients with COVID-19. There were significant differences in baseline demographics, and signs and symptoms and comorbidities at hospital admission between patients with and without gastrointestinal symptoms. Upon hospitalization, patients presenting with gastrointestinal symptoms (isolated or along with other non-gastrointestinal symptoms), may have a better prognosis than patients with non-gastrointestinal symptoms. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

20.
Critical Care Medicine ; 50:119-119, 2022.
Article in English | Academic Search Complete | ID: covidwho-1597165

ABSTRACT

B Conclusions: b Most respondents agree that webinars are an important medium for the dissemination of information on COVID-19 and that these webinars have informed their clinical practice. Around 75% of respondents either agreed or highly agreed that webinars are a useful source of knowledge despite only 68% of them reporting to have active participation in webinars relating to COVID-19 treatment/management. Overall, our survey showed a strong interest from front liners for COVID-19 webinars. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

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