Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 38
Filter
1.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P104-P105, 2022.
Article in English | EMBASE | ID: covidwho-2064498

ABSTRACT

Introduction: The COVID-19 pandemic has resulted in delayed provision of essential and nonessential medical care. The objective of this study was to identify trends and possible delays in the timing of pediatric cochlear implant (CI) preand postoperative care during COVID-19 compared with pre- COVID at a single center. Method(s): Patients under the age of 18 years old who underwent initial CI at a single tertiary care center between January 1, 2016, and February 29, 2020, were included in the pre- COVID-19 group, and patients implanted between March 1, 2020, and December 31, 2021, were included in the COVID- 19 group. Data from revision or sequential second-side CI surgeries were excluded. Time intervals between care milestones including confirmation of severe to profound hearing loss, CI surgery, and CI activation were compared for the pre- COVID-19 and COVID-19 groups, as were the number and type (virtual vs in person) of postoperative visits. Result(s): A total of 98 patients met inclusion criteria, of which 70 were implanted pre-COVID and 28 during COVID. At the time of first CI, patients in the COVID group were significantly older (mu=5.7 years, 95% CI, 4.0-7.5) compared with patients in the pre-COVID group (mu=3.7 years, 95% CI, 2.9-4.6;P=.02). The interval between severe to profound hearing loss confirmation and first CI surgery was significantly longer for the COVID group (mu=99.7 weeks, 95% CI, 48.8-150) compared with the pre-COVID group (mu=54.2 weeks, 95% CI, 39.6-68.8;P=.02). All patients underwent activation within 7 weeks after implantation, although the time between first CI surgery and activation was significantly shorter for the COVID group (mu=3.8 weeks, 95% CI, 3.6-4.0) compared with the pre-COVID group (mu=4.3 weeks, 95% CI, 4.1-4.5;P=.01). Conclusion(s): Pediatric patients undergoing cochlear implantation during the COVID-19 pandemic experienced significant delays in care. Future work will aim to reveal impact of delayed care on outcomes in this population.

2.
British Journal of Surgery ; 109:vi88, 2022.
Article in English | EMBASE | ID: covidwho-2042559

ABSTRACT

Aim: To determine if ketamine sedation is a safe and cost-effective way of treating paediatric patients presenting with nail bed injuries to the emergency department. Method:Aretrospective cohort study was carried out over a nine-month period in children between ages 18 months and 16 years old, presenting to the paediatric emergency department (PED) at Chelsea and Westminster Hospital, London, with nail bed injuries requiring repair by the plastic surgery team. The primary outcome measures are complications at the time of sedation and at outpatient follow up including surgical site infection at seven days. A secondary outcome measure of parental satisfaction was collected at four months. A cost analysis comparison against procedures completed under general anaesthetic was also undertaken. Results: During the 9-month period, 10 nail bed repairs were performed under ketamine sedation in the PED. There were no serious adverse events recorded. No cases required further procedures and there were no cases of surgical site infections at 7 days. Parents reported favourable outcomes, with an average overall satisfaction score of 9.4 (where 10 is complete satisfaction). At follow up, there was one recorded complication which was successfully treated, with all patients being discharged from follow up within 3 months. Conclusion: This small study has shown ketamine procedural sedation in the paediatric population to be a safe and cost-effective method for the treatment of nail bed injuries in children presenting to PED. We believe that this management strategy, brought to the fore during the COVID-19 pandemic, should be considered as standard across all PEDs.

3.
Annals of Surgical Oncology ; 29(SUPPL 2):S461, 2022.
Article in English | EMBASE | ID: covidwho-1928244

ABSTRACT

INTRODUCTION: It is believed that greater time from diagnosis to surgery increases the likelihood of sentinel lymph node positivity for patients with melanoma who present with clinical N0M0 disease. There is a paucity of data, however, on a safe window for surgery, which has become particularly relevant during the COVID-19 pandemic. We sought to determine how the risk of N+ disease changed with increasing time to surgery, and to evaluate what may be a safe window for surgery. METHODS: We performed an IRB approved retrospective review of patients diagnosed with clinical N0M0 malignant melanoma who underwent wide local excision and sentinel lymph node biopsy at two institutions from 1/2018-6/2021. Student's t-test, Wilcoxon-Mann-Whitney, bivariate and multivariable logistic regression analyses were performed where appropriate. RESULTS: There were 437 patients identified, 140 (32%) surgically treated within 30 days, 238 (55%) 31-60 days, and 59 (13%) 60+ days post-diagnosis, 128 (29%) with positive sentinel lymph node(s) (Table with demographics). Time to surgery was not a significant predictor of N+ disease for 0-30 vs 31-60 days (OR 0.72;95% CI 0.46-1.13) or 0-30 vs 60+ days (OR 0.65;95% CI 0.33-1.29). This remained true adjusting for T-stage, mitosis, ulceration, and institution (OR 0.75 95% CI 0.45-1.20, and OR 0.62;95% CI 0.29-1.30, respectively), and when only examining T3-T4 lesions (OR 0.91;95% CI 0.46-1.83 and OR 0.88;95% CI 0.32-2.45, respectively). T-stage expectedly was the greatest predictor of N+ disease (T1 vs T2 OR 3.08;95% CI 1.44-6.59, vs T3 OR 5.89;95% CI 2.64-13.10, vs T4 OR 10.63;95% CI 4.08-27.68). CONCLUSIONS: Increased time from melanoma diagnosis to wide local excision and sentinel lymph node biopsy did not appear to significantly influence final nodal positivity rate in patients who presented with clinical N0M0 disease. These findings warrant further evaluation to determine if it is safe to wait up to 60 days or longer prior to undergoing surgical treatment for malignant melanoma.

4.
J Vis Exp ; (183)2022 05 18.
Article in English | MEDLINE | ID: covidwho-1879504

ABSTRACT

Histopathologic analysis of human temporal bone sections is a fundamental technique for studying inner and middle ear pathology. Temporal bone sections are prepared by postmortem temporal bone harvest, fixation, decalcification, embedding, and staining. Due to the density of the temporal bone, decalcification is a time-consuming and resource-intensive process; complete tissue preparation may take 9-10 months on average. This slows otopathology research and hinders time-sensitive studies, such as those relevant to the COVID-19 pandemic. This paper describes a technique for the rapid preparation and decalcification of temporal bone sections to speed tissue processing. Temporal bones were harvested postmortem using standard techniques and fixed in 10% formalin. A precision microsaw with twin diamond blades was used to cut each section into three thick sections. Thick temporal bone sections were then decalcified in decalcifying solution for 7-10 days before being embedded in paraffin, sectioned into thin (10 µm) sections using a cryotome, and mounted on uncharged slides. Tissue samples were then deparaffinized and rehydrated for antibody staining (ACE2, TMPRSS2, Furin) and imaged. This technique reduced the time from harvest to tissue analysis from 9-10 months to 10-14 days. High-speed temporal bone sectioning may increase the speed of otopathology research and reduce the resources necessary for tissue preparation, while also facilitating time-sensitive studies such as those related to COVID-19.


Subject(s)
COVID-19 , Ear, Middle , Humans , Pandemics , Staining and Labeling , Temporal Bone/pathology
5.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-337494

ABSTRACT

Importance: Understanding the severity of post-vaccination COVID-19 breakthrough illness among people with HIV (PWH) can inform vaccine guidelines and risk-reduction recommendations. Objective: Estimate the rate and risk of severe breakthrough illness among vaccinated PWH and people without HIV (PWoH) who experience a breakthrough infection. Design, setting, and participants: The Corona-Infectious-Virus Epidemiology Team (CIVET-II) collaboration consists of four US longitudinal cohorts from integrated health systems and academic centers. Adults (≥18 years old), in-care, fully vaccinated by June 30, 2021 with HIV, and matched PWoH (on date fully vaccinated, age group, race/ethnicity, and sex) were the source population. Those who experienced a post-vaccination SARS-CoV-2 breakthrough infection were eligible. Severe COVID-19 breakthrough illness was defined as hospitalization due to COVID-19. Discrete time proportional hazards models estimated adjusted hazard ratios (aHR) and 95% confidence intervals ([,]) of severe breakthrough illness by HIV status adjusting for demographics, COVID-19 vaccine type, and clinical factors. The proportion of patients requiring mechanical ventilation or died was compared by HIV status. Exposure: HIV infection Outcome: Severe COVID-19 breakthrough illness, defined as hospitalization within 28 days after a breakthrough SARS-CoV-2 infection with a primary or secondary COVID-19 discharge diagnosis. Results: Among 1,241 PWH and 2,408 PWoH with breakthrough infections, the cumulative incidence of severe illness in the first 28 days was low and comparable between PWoH and PWH (7.3% vs. 6.7%, respectively, risk difference=-0.67% [-2.58%, 1.23%]). The risk of severe breakthrough illness was 59% higher in PWH with CD4 counts <350 cells/mm3 compared with PWoH (aHR=1.59 [0.99, 2.46]). In multivariable analyses among PWH, being female, older, having a cancer diagnosis, and lower CD4 count increased the risk of severe breakthrough illness, while previous COVID-19 reduced the risk. Among all patients, 10% were mechanically ventilated and 8% died, with no difference by HIV status. Conclusions and Relevance: The risk of severe COVID-19 breakthrough illness within 28 days of a breakthrough infection was low among vaccinated PWH and PWoH. However, PWH with moderate and severe immune suppression had a higher risk of severe breakthrough infection. Recommendations for additional vaccine doses and risk-reduction strategies for PWH with moderate immune suppression may be warranted.

6.
Science ; 375(6583):864-+, 2022.
Article in English | Web of Science | ID: covidwho-1769817

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant of concern evades antibody-mediated immunity that comes from vaccination or infection with earlier variants due to accumulation of numerous spike mutations. To understand the Omicron antigenic shift, we determined cryo-electron microscopy and x-ray crystal structures of the spike protein and the receptor-binding domain bound to the broadly neutralizing sarbecovirus monoclonal antibody (mAb) S309 (the parent mAb of sotrovimab) and to the human ACE2 receptor. We provide a blueprint for understanding the marked reduction of binding of other therapeutic mAbs that leads to dampened neutralizing activity. Remodeling of interactions between the Omicron receptor-binding domain and human ACE2 likely explains the enhanced affinity for the host receptor relative to the ancestral virus.

7.
Stroke ; 53(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1723997

ABSTRACT

Introduction: Coronavirus Disease 2019 (COVID-19) is associated with an increased risk of stroke and worse stroke outcomes. A clinical score that can identify high-risk patients could enable closer monitoring and targeted preventative strategies. Methods: We used data from the AHA's COVID-19 CVD Registry to create a clinical score to predict the risk of stroke among patients hospitalized with COVID-19. We included patients aged >18 years who were hospitalized with COVID-19 at 122 centers from March 2020-March 2021. To build our score, we used demographics, preexisting comorbidities, home medications, and vital sign and lab values at admission. The outcome was a cerebrovascular event, defined as any ischemic or hemorrhagic stroke, TIA, or cerebral vein thrombosis. We used two separate analytical approaches to build the score. First, we used Cox regression with cross validation techniques to identify factors associated with the outcome in both univariable (p<0.10) and multivariable analyses (p<0.05), then assigned points for each variable based on corresponding coefficients. Second, we used regularized Cox regression, XGBoost, and Random Forest machine learning techniques to create an estimator using all available covariates. We used Harrel's C-statistic to measure discriminatory performance. Results: Among 21,420 patients hospitalized with COVID-19 (mean age 61 years, 54% men), 312 (1.5%) had a cerebrovascular event. Using traditional Cox regression, we created and internally validated a risk stratification score (CANDLE) (Fig) with a C-statistic of 0.66 (95% CI, 0.60-0.72). The machine learning estimator had similar discriminatory performance, with a C-statistic of 0.69 (95% CI, 0.65-0.72). For ischemic stroke or TIA, CANDLE's C-statistic was 0.67 (95% 0.59-0.76). Conclusion: We developed an easy-to-use clinical score, with similar performance to a machine learning estimator, to help stratify stroke risk among patients hospitalized with COVID-19.

8.
JAMA Otolaryngol Head Neck Surg ; 148(4): 307-315, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1706644

ABSTRACT

IMPORTANCE: Emerging reports of sudden sensorineural hearing loss (SSNHL) after COVID-19 vaccination within the otolaryngological community and the public have raised concern about a possible association between COVID-19 vaccination and the development of SSNHL. OBJECTIVE: To examine the potential association between COVID-19 vaccination and SSNHL. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study and case series involved an up-to-date population-based analysis of 555 incident reports of probable SSNHL in the Centers for Disease Control and Prevention Vaccine Adverse Events Reporting System (VAERS) over the first 7 months of the US vaccination campaign (December 14, 2020, through July 16, 2021). In addition, data from a multi-institutional retrospective case series of 21 patients who developed SSNHL after COVID-19 vaccination were analyzed. The study included all adults experiencing SSNHL within 3 weeks of COVID-19 vaccination who submitted reports to VAERS and consecutive adult patients presenting to 2 tertiary care centers and 1 community practice in the US who were diagnosed with SSNHL within 3 weeks of COVID-19 vaccination. EXPOSURES: Receipt of a COVID-19 vaccine produced by any of the 3 vaccine manufacturers (Pfizer-BioNTech, Moderna, or Janssen/Johnson & Johnson) used in the US. MAIN OUTCOMES AND MEASURES: Incidence of reports of SSNHL after COVID-19 vaccination recorded in VAERS and clinical characteristics of adult patients presenting with SSNHL after COVID-19 vaccination. RESULTS: A total of 555 incident reports in VAERS (mean patient age, 54 years [range, 15-93 years]; 305 women [55.0%]; data on race and ethnicity not available in VAERS) met the definition of probable SSNHL (mean time to onset, 6 days [range, 0-21 days]) over the period investigated, representing an annualized incidence estimate of 0.6 to 28.0 cases of SSNHL per 100 000 people per year. The rate of incident reports of SSNHL was similar across all 3 vaccine manufacturers (0.16 cases per 100 000 doses for both Pfizer-BioNTech and Moderna vaccines, and 0.22 cases per 100 000 doses for Janssen/Johnson & Johnson vaccine). The case series included 21 patients (mean age, 61 years [range, 23-92 years]; 13 women [61.9%]) with SSNHL, with a mean time to onset of 6 days (range, 0-15 days). Patients were heterogeneous with respect to clinical and demographic characteristics. Preexisting autoimmune disease was present in 6 patients (28.6%). Of the 14 patients with posttreatment audiometric data, 8 (57.1%) experienced improvement after receiving treatment. One patient experienced SSNHL 14 days after receiving each dose of the Pfizer-BioNTech vaccine. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, findings from an updated analysis of VAERS data and a case series of patients who experienced SSNHL after COVID-19 vaccination did not suggest an association between COVID-19 vaccination and an increased incidence of hearing loss compared with the expected incidence in the general population.


Subject(s)
COVID-19 , Hearing Loss, Sensorineural , Hearing Loss, Sudden , Vaccines , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Cross-Sectional Studies , Female , Hearing Loss, Sensorineural/chemically induced , Hearing Loss, Sensorineural/epidemiology , Hearing Loss, Sudden/epidemiology , Hearing Loss, Sudden/etiology , Humans , Male , Middle Aged , Retrospective Studies , Vaccination/adverse effects
9.
Physiotherapy (United Kingdom) ; 114:e160-e161, 2022.
Article in English | EMBASE | ID: covidwho-1702517

ABSTRACT

Keywords: Health Coaching;Self-management;Patient Activation Purpose: Due to the Covid-19 pandemic primary care musculoskeletal (MSK) services within the National Health Service (NHS) were reduced following staff redeployment and restrictions to face-to-face services. Therefore, a local strategy to manage MSK waiting lists was required. The aims of this project were to involve patients in decision making early within their care pathway, understand their level of activation (knowledge, skills and confidence in self-management) and agree an action plan to support their self-management. Methods: This was a service improvement project within one NHS adult outpatient MSK service. Patients on the routine waiting lists for advanced practice or usual physiotherapy and osteopathy appointments were contacted to book a consultation and were asked if they consented to completing the Patient Activation Measure® (PAM®). Clinicians (10 physiotherapists and one podiatrist) who had undergone brief health coaching training telephoned the patients and used the T-GROW (Topic, Goal, Reality, Options and Way forward) model to frame the conversation and shared decision making to establish a management plan. Clinicians were aware of the patient's PAM® score prior to calling. They provided feedback on their experience of the calls and the usefulness of the PAM® score for informing their decisions. A patient partner (expert by experience) called a sample of patients who consented to follow up to capture their experience. Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically. Results: Data were collected for 568 patients. The average consultation duration was 21.5 min. The PAM® was completed for 278 patients (49%). PAM® scores for these patients were: 1 (low activation) n = 24 (9%);2 n = 67 (24%);3 n = 100 (36%);4 (high activation) n = 87 people (31%). Reasons for not completing the PAM® included time and language barriers. Following the calls 105 people (18.4%) were discharged to self-manage with exercises, self-care information or signposted to other services. Seventy-two percent of these patients had higher levels of activation (PAM® score 3 or 4). Other outcomes included 16 people being referred to secondary care and 14 people having medical imaging arranged. Patients who remained on the waiting list received reassurance and information about their condition. Clinician feedback highlighted the benefit of establishing expectations, providing reassurance, signposting to other services and facilitating self-management. In 79% of consultations clinicians felt that the PAM® score accurately reflected the patient's knowledge, skills and confidence. All 9 patients who gave feedback said the call helped them to clearly understand their management plan and most patients were highly satisfied with the call although some expected a face-to-face service. Conclusion(s): Calling patients early in the MSK care pathway using a health coaching framework with knowledge of their PAM® score helped to determine patient expectations, support self-management and signpost to wider community resources. Impact: This project helped to respond to service demands during the Covid-19 pandemic and offers an innovative approach to involving patients in their care pathway at an earlier stage which could be further evaluated through both qualitative and quantitative research. Funding acknowledgements: This work was not funded and was part of the services for Sussex Musculoskeletal Partnership.

11.
Critical Care Medicine ; 50(1 SUPPL):535, 2022.
Article in English | EMBASE | ID: covidwho-1691828

ABSTRACT

INTRODUCTION: In 2018, we implemented the Resident Acute Deterioration Simulation Series. High-fidelity simulation is now an integral part of our intern curriculum. This study was an effort to assess this curriculum. Our primary hypothesis was that repeat exposure to the same clinical scenario through simulation would increase critical action completion rate, decrease the time to critical action, and improve intern comfort in dealing with these acute clinical situations. METHODS: Interns completed four high-fidelity simulations over the course of the academic year. For each simulation, a critical action checklist was developed. During each session, interns were timed with the action completion rate and time to each critical action recorded. Interns were debriefed after the scenario. They completed the same scenario within a one month period, again with their action completion rate and time to critical actions recorded. They also completed pre and post session surveys measuring comfort managing acute patient deterioration. RESULTS: Due to the COVID-19 pandemic, we were able to complete and record data for 2 simulation scenarios in their entirety- status epilepticus and status asthmatics. For both scenarios, there was an improvement in action completion rate, with the status epilepticus scenario increasing by 40% (40% of critical actions completed in the first simulation and 80% on repeat) and the status asthmaticus scenario increasing by 60% (40% vs. 100% action completion). There was no statistically significant mean difference in time to action before and after repeat simulation exercise for either simulation scenario. A paired t-test was conducted and we found a statistically significant mean increase of 1.23 in the comfort levels of interns before and after repeat simulation exercise (95% CI [0.47 - 0.84], p < 0.001). CONCLUSIONS: Repeat exposure to simulation improved overall resident critical action completion, however there was no statistically significant improvement in the time to critical action completion. In reviewing this data we can reconcile this, as the more critical actions that are completed, the more time that will take. We were also able to support that repeat simulation exposure increase rate comfort in managing acute patient deterioration.

12.
Embase;
Preprint in English | EMBASE | ID: ppcovidwho-326896

ABSTRACT

Numerous safe and effective COVID-19 vaccines have been developed that utilize various delivery technologies and engineering strategies. The influence of the SARS-CoV2 spike (S) glycoprotein conformation on antibody responses induced by vaccination or infection in humans remains unknown. To address this question, we compared plasma antibodies elicited by six globally-distributed vaccines or infection and observed markedly higher binding titers for vaccines encoding a prefusion-stabilized S relative to other groups. Prefusion S binding titers positively correlated with plasma neutralizing activity, indicating that physical stabilization of the prefusion conformation enhances protection against SARS-CoV-2. We show that almost all plasma neutralizing activity is directed to prefusion S, in particular the S1 subunit, and that variant cross-neutralization is mediated solely by RBD-specific antibodies. Our data provide a quantitative framework for guiding future S engineering efforts to develop vaccines with higher resilience to the emergence of variants and longer durability than current technologies.

13.
Embase;
Preprint in English | EMBASE | ID: ppcovidwho-326771

ABSTRACT

The SARS-CoV-2 Delta variant is currently responsible for most infections worldwide, including among fully vaccinated individuals. Although these latter infections are associated with milder COVID-19 disease relative to unvaccinated subjects, the specificity and durability of antibody responses elicited by Delta breakthrough cases remain unknown. Here, we demonstrate that breakthrough infections induce serum binding and neutralizing antibody responses that are markedly more potent, durable and resilient to spike mutations observed in variants of concern than those observed in subjects who were infected only or received only two doses of COVID-19 vaccine. However, wee show that Delta breakthrough cases, subjects who were vaccinated after SARS-CoV-2 infection and individuals vaccinated three times (without infection) have serum neutralizing activity of comparable magnitude and breadth indicate that multiple types of exposure or increased number of exposures to SARS-CoV-2 antigen(s) enhance spike-specific antibody responses. Neutralization of the genetically divergent SARS-CoV, however, was moderate with all four cohorts examined, except after four exposures to the SARS-CoV-2 spike, underscoring the importance of developing vaccines eliciting broad sarbecovirus immunity for pandemic preparedness.

15.
Plant Biotechnol J ; 20(2): 360-373, 2022 02.
Article in English | MEDLINE | ID: covidwho-1621953

ABSTRACT

In the age of synthetic biology, plastid engineering requires a nimble platform to introduce novel synthetic circuits in plants. While effective for integrating relatively small constructs into the plastome, plastid engineering via homologous recombination of transgenes is over 30 years old. Here we show the design-build-test of a novel synthetic genome structure that does not disturb the native plastome: the 'mini-synplastome'. The mini-synplastome was inspired by dinoflagellate plastome organization, which is comprised of numerous minicircles residing in the plastid instead of a single organellar genome molecule. The first mini-synplastome in plants was developed in vitro to meet the following criteria: (i) episomal replication in plastids; (ii) facile cloning; (iii) predictable transgene expression in plastids; (iv) non-integration of vector sequences into the endogenous plastome; and (v) autonomous persistence in the plant over generations in the absence of exogenous selection pressure. Mini-synplastomes are anticipated to revolutionize chloroplast biotechnology, enable facile marker-free plastid engineering, and provide an unparalleled platform for one-step metabolic engineering in plants.


Subject(s)
Genetic Engineering , Plastids , Metabolic Engineering , Plants/genetics , Plastids/genetics , Synthetic Biology , Transgenes
16.
JMIR Med Educ ; 7(4): e25654, 2021 Dec 08.
Article in English | MEDLINE | ID: covidwho-1599308

ABSTRACT

BACKGROUND: Despite the ubiquity of social media, the utilization and audience reach of this communication method by otolaryngology-head and neck surgery (OHNS) residency programs has not been investigated. OBJECTIVE: The purpose of this study was to evaluate the content posted to a popular social media platform (Twitter) by OHNS residency programs. METHODS: In this cross-sectional study, we identified Twitter accounts for accredited academic OHNS residency programs. Tweets published over a 6-month period (March to August 2019) were extracted. Tweets were categorized and analyzed for source (original versus retweet) and target audience (medical versus layman). A random sample of 100 tweets was used to identify patterns of content, which were then used to categorize additional tweets. We quantified the total number of likes or retweets by health care professionals. RESULTS: Of the 121 accredited programs, 35 (28.9%) had Twitter accounts. Of the 2526 tweets in the 6-month period, 1695 (67.10%) were original-content tweets. The majority of tweets (1283/1695, 75.69%) were targeted toward health care workers, most of which did not directly contain medical information (954/1283, 74.36%). These tweets contained information about the department's trainees and education (349/954, 36.6%), participation at conferences (263/954, 27.6%), and research publications (112/954, 11.7%). Two-thirds of all tweets did not contain medical information. Medical professionals accounted for 1249/1362 (91.70%) of retweets and 5616/6372 (88.14%) of likes on original-content tweets. CONCLUSIONS: The majority of Twitter usage by OHNS residency programs is for intra and interprofessional communication, and only a minority of tweets contain information geared toward the public. Communication and information sharing with patients is not the focus of OHNS departments on Twitter.

17.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-296600

ABSTRACT

Importance: Recommendations for additional doses of COVID vaccine are restricted to people with HIV who have advanced disease or unsuppressed HIV viral load. Understanding SARS-CoV-2 infection risk post-vaccination among PWH is essential for informing vaccination guidelines. Objective: Estimate the risk of breakthrough infections among fully vaccinated people with (PWH) and without (PWoH) HIV in the US. Design setting and participants: The Corona-Infectious-Virus Epidemiology Team (CIVET)-II cohort collaboration consists of 4 longitudinal cohorts from integrated health systems and academic health centers. Each cohort identified individuals a18 years old, in-care, and fully vaccinated for COVID-19 through 30 June 2021. PWH were matched to PWoH on date fully vaccinated, age group, race/ethnicity, and sex at birth. Incidence rates per 1,000 person-years and cumulative incidence of breakthrough infections with 95% confidence intervals ([,]) were estimated by HIV status. Cox proportional hazards models estimated adjusted hazard ratios (aHR) of breakthrough infections by HIV status adjusting for demographic factors, prior COVID-19 illness, vaccine type (BNT162b2, [Pfizer], mRNA-1273 [Moderna], Jansen Ad26.COV2.S [J&J]), calendar time, and cohort. Risk factors for breakthroughs among PWH, were also investigated. Exposure: HIV infection. Outcome: COVID-19 breakthrough infections, defined as laboratory evidence of SARS-CoV-2 infection or COVID-19 diagnosis after an individual was fully vaccinated. Results: Among 109,599 individuals (31,840 PWH and 77,759 PWoH), the rate of breakthrough infections was higher in PWH versus PWoH: 44 [41, 48] vs. 31 [29, 33] per 1,000 person-years. Cumulative incidence at 210 days after date fully vaccinated was low, albeit higher in PWH versus PWoH overall (2.8% versus 2.1%, log-rank p<0.001, risk difference=0.7% [0.4%, 1.0%]) and within each vaccine type. Breakthrough infection risk was 41% higher in PWH versus PWoH (aHR=1.41 [1.28, 1.56]). Among PWH, younger age (18-24 versus 45-54), history of COVID-19 prior to fully vaccinated date, and J&J vaccination (versus Pfizer) were associated with increased risk of breakthroughs. There was no association of breakthrough with HIV viral load suppression or CD4 count among PWH. Conclusions and Relevance: COVID-19 vaccination is effective against infection with SARS-CoV-2 strains circulating through 30 Sept 2021. PWH have an increased risk of breakthrough infections compared to PWoH. Recommendations for additional vaccine doses should be expanded to all PWH.

18.
19.
J Thorac Oncol ; 16(11): 1821-1839, 2021 11.
Article in English | MEDLINE | ID: covidwho-1492352

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which enters host cells through the cell surface proteins ACE2 and TMPRSS2. METHODS: Using a variety of normal and malignant models and tissues from the aerodigestive and respiratory tracts, we investigated the expression and regulation of ACE2 and TMPRSS2. RESULTS: We find that ACE2 expression is restricted to a select population of epithelial cells. Notably, infection with SARS-CoV-2 in cancer cell lines, bronchial organoids, and patient nasal epithelium induces metabolic and transcriptional changes consistent with epithelial-to-mesenchymal transition (EMT), including up-regulation of ZEB1 and AXL, resulting in an increased EMT score. In addition, a transcriptional loss of genes associated with tight junction function occurs with SARS-CoV-2 infection. The SARS-CoV-2 receptor, ACE2, is repressed by EMT through the transforming growth factor-ß, ZEB1 overexpression, and onset of EGFR tyrosine kinase inhibitor resistance. This suggests a novel model of SARS-CoV-2 pathogenesis in which infected cells shift toward an increasingly mesenchymal state, associated with a loss of tight junction components with acute respiratory distress syndrome-protective effects. AXL inhibition and ZEB1 reduction, as with bemcentinib, offer a potential strategy to reverse this effect. CONCLUSIONS: These observations highlight the use of aerodigestive and, especially, lung cancer model systems in exploring the pathogenesis of SARS-CoV-2 and other respiratory viruses and offer important insights into the potential mechanisms underlying the morbidity and mortality of coronavirus disease 2019 in healthy patients and patients with cancer alike.


Subject(s)
COVID-19 , Lung Neoplasms , Bronchi , Humans , Lung , Peptidyl-Dipeptidase A , SARS-CoV-2
20.
Hiv Medicine ; 22:96-96, 2021.
Article in English | Web of Science | ID: covidwho-1377298
SELECTION OF CITATIONS
SEARCH DETAIL