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1.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880942
2.
Journal of Cystic Fibrosis ; 20:S40-S40, 2021.
Article in English | Academic Search Complete | ID: covidwho-1454655
3.
Critical Care Medicine ; 49(1):113-113, 2021.
Article in English | Web of Science | ID: covidwho-1326624
4.
Heart ; 107(SUPPL 1):A91, 2021.
Article in English | EMBASE | ID: covidwho-1325144

ABSTRACT

Background Limitation of activity and restriction of movement have been widely, and effectively, enforced to reduce COVID- 19 transmission. Physical activity is however a critical measure in the prevention of cardiovascular disease. Pulmonary arterial hypertension (PAH) is a devastating, disease driven by small vessel vascular remodeling, leading to right heart failure. Exercise capacity relates to clinical outcomes and exercise training improves key indicators of cardiopulmonary function. Here, we describe the temporal effects of UK government restriction measures on daily activity, heart rate and quality-of-life (QoL) in patients with PAH. Methods From November 2019 to March 2020 patients were enrolled into the arrhythmia sub-study of The UK National Cohort Study of Idiopathic and Heritable PAH (REC:13/EE/ 0203) and implanted with insertable cardiac monitors. Daily heart rate, heart rate variability and activity were transmitted remotely. Standard questionnaires were administered remotely to assess QoL (EmPHasis-10), anxiety (GAD-7) and depression (PHQ-9). Results Median age of the 26 patients implanted with insertable cardiac monitors was 49 years, 23(88%) were female and 5(19%) had heritable PAH with mutations in BMPR2. At enrolment 10(38.5%) patients were low risk (<5% 1-year mortality), 10(38.5%) were intermediate risk (5-10%) and 6 (23%) were high risk (>10%). The mean duration from insertion to census date was 21.1weeks±5.7. No complications were reported. Completeness of remote monitoring data was 100%. Following lockdown, mean activity was reduced (3.16vrs 2.68hours, -0.48 hours, 95%CI -0.27-0.69, 16%, p<0.0001). During the period April 14th to 23rd QoL was reduced (26(18-38)vrs 32 (17-47), p<0.01) and anxiety (1(0- 9)vrs 10 (5-18), p<0.001) and depression scores increased (3 (1-16)vrs 11 (3-17), p<0.001) compared to pre-lockdown levels. The observed increase in depression scores persisted to the census date (3(1-16)vrs 11(8-17), p<0.01). No change in day or night heart rate, or heart rate variability, was observed and no patients developed COVID-19. Conclusion In this cohort of patients with idiopathic and heritable PAH, UK protective health measures were effective in preventing COVID-19 in patients thought to be vulnerable. However, these protective measures resulted in reduced daily activity and QoL and were associated increased anxiety and depression indicators. Patients may decondition through periods of reduced activity. This may have implications for riskassessment and endpoint adjudication in clinical studies, both of which use measures of exercise capacity.

5.
Journal of the American Geriatrics Society ; 69(SUPPL 1):S21, 2021.
Article in English | EMBASE | ID: covidwho-1214839

ABSTRACT

INTRODUCTION Post-acute withdrawal, also described as protracted, extended or persistent withdrawal, refers to a syndrome that includes anxiety, irritability, hostility, mood instability, fatigue, insomnia and increased physical complaints often related to gastrointestinal symptoms, pain and weakness. Unlike acute withdrawal, where treatment guidelines and practices are highly predictable and protocol driven;post-acute interventions are highly symptom driven and individualized. Attention to co-occurring medical and psychiatric disorders is vital as well. It is well-known that benzodiazepines pose greater risks to older adults including confusion, ataxia, syncope, risk of falls, fractures, delirium and excess hospitalizations. There is limited literature on managing post-acute withdrawal syndromes in older adults, with few available guidelines for medication management of emerging symptoms. The additional challenges of the COVID-19 pandemic have increased both the stress on older adults in need of care and of providers seeking to engage patients in therapeutic relationships. We focus on representative cases of older adults seeking treatment related to benzodiazepines withdrawal and describe flexible treatment approaches for their evolving and complex needs. METHODS Cases studies were identified from the patient population at Mount Sinai Beth Israel, an urban medical center serving a multicultural and socioeconomically diverse population that includes several NORC sites. Patients were identified from those who presented to the ambulatory care center that offers adult, geriatric and dual-diagnosis services. A personalized treatment planning approach was developed in each case and included the time period of the COVID-19 quarantine. RESULTS The results will be discussed. CONCLUSION Despite the proven negative outcomes of chronic use providers continue to prescribe benzodiazepines inappropriately to older adults. The need to care for patients treated with these agents is high. Postacute withdrawal syndrome is poorly understood and under recognized in older adults. Efforts such as de-prescribing, patient centered approaches to rational prescribing and use remote education programs should be increased. COVID-19 pandemic conditions lead to an increase in overall symptoms reported but did not prevent patients from engaging in successful treatment.

6.
Diagnostics ; 11(4):09, 2021.
Article in English | MEDLINE | ID: covidwho-1209859

ABSTRACT

Accurate phenotyping of patients with pulmonary hypertension (PH) is an integral part of informing disease classification, treatment, and prognosis. The impact of lung disease on PH outcomes and response to treatment remains a challenging area with limited progress. Imaging with computed tomography (CT) plays an important role in patients with suspected PH when assessing for parenchymal lung disease, however, current assessments are limited by their semi-qualitative nature. Quantitative chest-CT (QCT) allows numerical quantification of lung parenchymal disease beyond subjective visual assessment. This has facilitated advances in radiological assessment and clinical correlation of a range of lung diseases including emphysema, interstitial lung disease, and coronavirus disease 2019 (COVID-19). Artificial Intelligence approaches have the potential to facilitate rapid quantitative assessments. Benefits of cross-sectional imaging include ease and speed of scan acquisition, repeatability and the potential for novel insights beyond visual assessment alone. Potential clinical benefits include improved phenotyping and prediction of treatment response and survival. Artificial intelligence approaches also have the potential to aid more focused study of pulmonary arterial hypertension (PAH) therapies by identifying more homogeneous subgroups of patients with lung disease. This state-of-the-art review summarizes recent QCT developments and potential applications in patients with PH with a focus on lung disease.

7.
Critical Care Medicine ; 49(1 SUPPL 1):113, 2021.
Article in English | EMBASE | ID: covidwho-1193939

ABSTRACT

INTRODUCTION: Severely ill patients with COVID-19 pneumonia have been found to have an extensive cytokine mediated inflammatory response. This has been demonstrated by elevated pro-inflammatory markers, including interleukin 6 (IL-6). Tocilizumab is an IL-6 antagonist that has been hypothesized to benefit patients with COVID-19 by reducing cytokine release. We set out to evaluate outcomes of patients who received tocilizumab at our health system. We also assessed the impact that the timing of tocilizumab administration and the presence or absence of corticosteroids had on patient outcomes. METHODS: A retrospective analysis was conducted of patients diagnosed with COVID-19 who received tocilizumab between March 20, 2020 and June 10, 2020. Data collected included patient age, weight, gender, timing of tocilizumab administration, dose, concomitant therapies including corticosteroids, respiratory status at the time of tocilizumab administration, patient disposition, change in C-reactive protein, change in lactate dehydrogenase, change in liver function tests, need for renal replacement therapy, and the incidence of secondary infections. RESULTS: Two-hundred-twelve patients received tocilizumab during the specified period. Overall, as of June 17, 2020, 165 patients (77.8%) had been discharged from the hospital, 14 patients (6.6%) were still hospitalized, 3 of those patients required mechanical ventilation, and 33 patients (15.6%) had died. Among the subset of patients who received tocilizumab within 24 hours of admission and received corticosteroids (n=97), 82 patients (84.5%) had been discharged from the hospital, 5 patients (5.2%) were still hospitalized, one of whom required mechanical ventilation, and 10 patients (10.3%) had died. Of the 212 total patients who received tocilizumab, 12 patients (5.7%) required initiation of renal replacement therapy, 4 patients (1.9%) had new onset seizure activity, and 23 patients (10.8%) developed a secondary infection as evidenced by at least one positive culture following administration. CONCLUSIONS: The early use of tocilizumab in combination with corticosteroids may improve outcomes in patients with COVID-19 pneumonia. Further evaluation of this treatment strategy is needed to fully assess clinical benefit.

9.
Thorax ; 76(Suppl 1):A46-A47, 2021.
Article in English | ProQuest Central | ID: covidwho-1050407

ABSTRACT

S75 Figure 1Difference between the fibrotic and inflammatory groups in mean 129Xe ADC (a) and LmD (b) at baseline study visit[Figure omitted. See PDF]Conclusions129Xe DW-MRI could have a role in differentiating changes in the airway microstructure between fibrotic and inflammatory ILD. 129Xe RBC:TP has sensitivity to longitudinal change with a decline in gas exchange observed in the fibrotic group but not in the inflammatory group.

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