Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 12 de 12
Filter
1.
Topics in Antiviral Medicine ; 31(2):357, 2023.
Article in English | EMBASE | ID: covidwho-2319990

ABSTRACT

Background: Antiretroviral therapy is highly effective in achieving HIV viral load suppression (VLS) but requires sustained engagement in care. The COVID-19 pandemic disrupted medical care, and its impact on engagement in HIV care and VLS remains unclear. Health information exchanges (HIEs) enable examination of patient care across multiple health systems. We sought to leverage HIE data to examine the effect of pandemic-related disruptions in HIV care on VLS and to explore racial/ethnic disparities in VLS. Method(s): We performed a retrospective observational study of people living with HIV (PLWH) using de-identified data from Healthix, an HIE encompassing >20 million patients and 8,000 healthcare facilities in the greater New York City (NYC) region, between 1/1/2018 and 7/14/2022. We identified PLWH based on HIV viral load (VL) tests and HIV diagnosis codes (ICD and SNOMED). We established two cohorts: PLWH engaged in care in 2020 with >=1 VL test in 2019, 2020, and 2021(Group A) and PLWH not engaged in care in 2020 with >=1 VL test in 2019 and 2021 but 0 VL tests in 2020 (Group B). HIV VLS outcomes were categorized as suppressed (< 200 copies/mL) or not suppressed ( >200 copies/mL) using the last VL in 2019, first VL in 2021, and last recorded VL. We compared proportions using X2-tests and fit a group-stratified logistic regression to examine the effect of race/ethnicity on VLS. Result(s): We identified 711,358 VL tests representing 81,122 patients at 249 facilities. Of these patients, 36,199 met our definition of PLWH. Of those, 12,448 met the inclusion criteria for Group A, and 3,377 met the inclusion criteria for Group B. In 2019, Group B had a lower VLS proportion than Group A (85.9% vs 88.1%, X2 = 12.3, p< 0.0001). In 2021, this gap increased;the proportion of VLS was 80.7% in Group B and 88.0% in Group A (X2 = 121.8, p< 0.00001). Most recently, VLS in Group B had increased to 85.6%, but the inter-group gap in VLS had grown from 2.2% to 4.4%. Within both groups, Black and Hispanic patients had lower odds of VLS than white patients. This disparity was greatest in Group B when they reengaged in care in 2021, with 72.0% of Black patients (OR 0.30, 95% CI 0.22-0.42), and 79.1% of Hispanic patients (OR 0.45, 95% CI 0.31-0.63), compared to 89.5% of white patients achieving VLS. Conclusion(s): VLS remained high among PLWH who stayed engaged in care in 2020, dropped among PLWH who disengaged in care, and was lower in minoritized groups even after controlling for engagement in care.

2.
Topics in Antiviral Medicine ; 31(2):403-404, 2023.
Article in English | EMBASE | ID: covidwho-2313527

ABSTRACT

Background: Vaccine uptake has been notably lower in minoritized populations in the United States. The impact of previous infection with SARSCoV- 2, disease severity, and persistent symptoms on the uptake of COVID-19 vaccines and boosters in predominantly Black and Latinx communities has not been examined. We aimed to describe correlates of vaccine uptake in a minoritized cohort hospitalized for COVID-19 during the first pandemic wave in New York City, and investigate whether those with more severe initial COVID-19 and persistent symptoms would be less likely to get vaccinated. Method(s): This retrospective cohort study included the electronic medical records of the first 894 consecutive adult patients who survived hospitalization for COVID-19 at a large quaternary care medical center in Northern Manhattan between 1 March and 8 April 2020. We ed data regarding demographics, comorbidities, oxygen requirements during hospitalization, persistence of symptoms at 3- and 6-months after admission, COVID-19 vaccinations through November 2022, and influenza vaccination during the 2018-2019 through 2021-2022 seasons. Unadjusted and adjusted logistic regression analyses were conducted to describe the predictors of COVID-19 vaccination, delayed vaccination (first dose after 6 May 2021), and receipt of a booster vaccine. Statistical analyses were performed using R V.4.2.1. Result(s): The cohort of 894 patients was predominantly Latinx (54%) and Non- Hispanic Black (15%). 41% received at least one influenza vaccine pre-COVID, and 67% had at least one comorbidity. 22% (199/894) remained COVID-19 unvaccinated. Of the individuals who received at least one dose of COVID-19 vaccine, 57% (397/695) received at least one booster. Exactly 31% (212/695) delayed vaccination. 25% (27/106) of unvaccinated individuals reported persistent generalized symptoms compared to 18% (78/436) of vaccinated individuals. Multiple logistic regression showed that Hispanic/Latinx ethnicity, age 35-64, and concurrent influenza vaccination were associated with increased COVID-19 vaccine uptake. No association was found between vaccine uptake and disease severity or persistence of symptoms. Conclusion(s): Achieving a deeper understanding of the factors driving vaccine hesitancy is critical to increasing and sustaining acceptance of COVID-19 vaccination especially in communities with historically low uptake of annual vaccines.

3.
Hepatology ; 76:S575-S576, 2022.
Article in English | Web of Science | ID: covidwho-2156981
4.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003114

ABSTRACT

Background: Cardiac injury associated with multi-system inflammatory syndrome in children (MIS-C) has been extensively reported but the impact of cardiac injury in children with SARSCoV-2 infection in the absence of MIS-C has not been well described. In this study we describe the cardiac involvement found in children with positive SARS-CoV-2 PCR tests and evaluate the association of cardiac injury with severe outcome in this population. Methods: A retrospective chart review of all patients ages 0-21 presenting to the emergency department or admitted at our institution during and just beyond the peak of the COVID-19 pandemic at our institution was performed. We excluded patients with MIS-C, cardiomyopathy, or complex congenital heart disease. Cardiac injury was defined as elevated high sensitivity troponin and/or N-terminal pro-brain type natriuretic peptide above 99th percentile. Severe illness was defined as need for advanced respiratory support (positive pressure or mechanical ventilation above baseline), inotropic or vasopressor support, and/or death from any cause during admission. Results: During the study period there were 103 patients with positive SARS-CoV-2 PCR, 17 of whom were excluded for MIS-C, 4 of whom were excluded for cardiomyopathy, 2 for complex congenital heart disease including one with repaired Taussig-Bing anomaly and one with double outlet right ventricle who underwent Fontan surgery. Of the 80/103 (78%) patients remaining in the analysis, 31/80 (39%) were female and the median age was 12.5 years (IWR 1.9-17.5). High-sensitivity troponin T and/or NT-proBNP were measured in 27/80 (34%) patients and abnormalities were present in 5/27 (19%), all of whom had underlying comorbidities such as lung disease, diabetes, or genetic syndromes. Severe outcome occurred in 14/27 (52%) patients and 5/5 (100%) of those with cardiac injury as compared to 9/22 (41%) patients without cardiac injury (p<0.05). Advanced respiratory support was more common in those with cardiac injury as compared to those without, occurring in 5/5 (100%) patients with cardiac injury and in 8/22 (36%) patients without cardiac injury (p<0.05). Electrocardiographic abnormalities were identified in 14/38 (37%) studies and no left ventricular dysfunction was identified on echocardiography. Conclusion: During the initial peak of the pandemic at our institution, cardiac injury was present in 19% of those for whom high-sensitivity troponin and/or NT-proBNP were measured. Presence of cardiac injury was associated with greater risk of severe outcomes including advanced respiratory support. Larger studies to determine the true incidence of cardiac injury in children with COVID-19 would be useful to guide recommendations for standard workup and management.

5.
Open Forum Infectious Diseases ; 8(SUPPL 1):S280, 2021.
Article in English | EMBASE | ID: covidwho-1746643

ABSTRACT

Background. Antibiotic use among patients with COVID-19 is common, exceeds the prevalence of probable bacterial co-infection, and promotes development of resistant organisms. Lack of diagnostic microbiological data may prolong empiric broad-spectrum therapy. Here we evaluate the use of the BioFire FilmArray pneumonia panel (PP), a novel rapid diagnostic test, and antibiotic decisions among intensive care unit (ICU) patients with COVID-19. Methods. We conducted a retrospective review of adult ICU patients admitted with COVID-19 between January 2020 and May 2021 at an academic medical center. ICU patients who underwent bronchoscopy/bronchoalveolar lavage (BAL) with PP (PP group) were matched by age (< 65 or ≥65), BMI (< 30 or ≥30), and BAL date (within 60 days) to ICU patients who did not undergo BAL (no-BAL group). PP patients were matched by age and BMI to ICU patients who underwent BAL without PP (no-PP group). Antibiotic use was compared between groups. Chi squared analysis, t-test, and ANOVA were used for comparisons as appropriate. Results. 65 patients were included;the majority were male (65%), < 65 years (86%), and had BMI ≥30 (54%) (Table 1). Only 17 no-PP matches were identified for PP patients due to infrequent BALs. Similar proportion of patients in PP and no-PP groups had organisms identified from BAL (54% vs. 47%, p=0.65). Among PP patients with a detected organism, all (n=13) had subsequent changes in antibiotic regimen ≤72 hours after BAL;10/13 (77%) had a change targeted to detected organism and 5/13 (39%) had antibiotic narrowing. Among PP patients with no detected organism, only 4/11 (36%) had antibiotic narrowing or maintenance off antibiotics. In all groups, average antibiotic use exceeded 70% of admission duration. Table 1. Patient characteristics and antibiotic management. Abbreviations: BAL - bronchoalveolar lavage Conclusion. Rapid, highly sensitive diagnostic tests have potential to guide clinical decisions and promote antibiotic stewardship among patients with severe viral pneumonia and suspected bacterial co-infection. In this descriptive analysis, antibiotic management did not differ significantly with use of PP. While most patients with detected organism on PP had targeted antibiotic changes, a negative PP did not appear to influence antibiotic narrowing. Larger studies and provider education are needed to evaluate potential of the PP for antibiotic stewardship.

6.
Ostaszewski, M.; Niarakis, A.; Mazein, A.; Kuperstein, I.; Phair, R.; Orta-Resendiz, A.; Singh, V.; Aghamiri, S. S.; Acencio, M. L.; Glaab, E.; Ruepp, A.; Fobo, G.; Montrone, C.; Brauner, B.; Frishman, G.; Gomez, L. C. M.; Somers, J.; Hoch, M.; Gupta, S. K.; Scheel, J.; Borlinghaus, H.; Czauderna, T.; Schreiber, F.; Montagud, A.; de Leon, M. P.; Funahashi, A.; Hiki, Y.; Hiroi, N.; Yamada, T. G.; Drager, A.; Renz, A.; Naveez, M.; Bocskei, Z.; Messina, F.; Bornigen, D.; Fergusson, L.; Conti, M.; Rameil, M.; Nakonecnij, V.; Vanhoefer, J.; Schmiester, L.; Wang, M. Y.; Ackerman, E. E.; Shoemaker, J. E.; Zucker, J.; Oxford, K.; Teuton, J.; Kocakaya, E.; Summak, G. Y.; Hanspers, K.; Kutmon, M.; Coort, S.; Eijssen, L.; Ehrhart, F.; Rex, D. A. B.; Slenter, D.; Martens, M.; Pham, N.; Haw, R.; Jassal, B.; Matthews, L.; Orlic-Milacic, M.; Senff-Ribeiro, A.; Rothfels, K.; Shamovsky, V.; Stephan, R.; Sevilla, C.; Varusai, T.; Ravel, J. M.; Fraser, R.; Ortseifen, V.; Marchesi, S.; Gawron, P.; Smula, E.; Heirendt, L.; Satagopam, V.; Wu, G. M.; Riutta, A.; Golebiewski, M.; Owen, S.; Goble, C.; Hu, X. M.; Overall, R. W.; Maier, D.; Bauch, A.; Gyori, B. M.; Bachman, J. A.; Vega, C.; Groues, V.; Vazquez, M.; Porras, P.; Licata, L.; Iannuccelli, M.; Sacco, F.; Nesterova, A.; Yuryev, A.; de Waard, A.; Turei, D.; Luna, A.; Babur, O.; Soliman, S.; Valdeolivas, A.; Esteban-Medina, M.; Pena-Chilet, M.; Rian, K.; Helikar, T.; Puniya, B. L.; Modos, D.; Treveil, A.; Olbei, M.; De Meulder, B.; Ballereau, S.; Dugourd, A.; Naldi, A.; Noel, V.; Calzone, L.; Sander, C.; Demir, E.; Korcsmaros, T.; Freeman, T. C.; Auge, F.; Beckmann, J. S.; Hasenauer, J.; Wolkenhauer, O.; Willighagen, E. L.; Pico, A. R.; Evelo, C. T.; Gillespie, M. E.; Stein, L. D.; Hermjakob, H.; D'Eustachio, P.; Saez-Rodriguez, J.; Dopazo, J.; Valencia, A.; Kitano, H.; Barillot, E.; Auffray, C.; Balling, R.; Schneider, R.; Community, Covid- Dis Map.
Molecular Systems Biology ; 17(12):2, 2021.
Article in English | Web of Science | ID: covidwho-1589729
7.
Diabetes Metab ; 47(6): 101267, 2021 11.
Article in English | MEDLINE | ID: covidwho-1330743

ABSTRACT

AIM: - Patients with diabetes have increased morbidity and mortality from COVID-19. Case reports describe patients with simultaneous COVID-19 and diabetic acidosis (DKA), however there is limited data on the prevalence, predictors and outcomes of DKA in these patients. METHODS: - Patients with COVID-19 were identified from the electronic medical record. DKA was defined by standardized criteria. Proportional hazard regression models were used to determine risk factors for, and mortality from DKA in COVID-19. RESULTS: - Of 2366 patients admitted for COVID-19, 157 (6.6%) patients developed DKA, 94% of whom had antecedent type 2 diabetes, 0.6% had antecedent type 1 diabetes, and 5.7% patients had no prior diagnosis of diabetes. Patients with DKA had increased hospital length of stay and in-patient mortality. Higher HbA1c predicted increased risk of incident DKA (HR 1.47 per 1% increase, 95% CI 1.40-1.54). Risk factors for mortality included older age (HR 1.07 per 5 years, 95% CI 1.06-1.08) and need for pressors (HR 2.33, 95% CI 1.82-2.98). Glucocorticoid use was protective in patients with and without DKA. CONCLUSION: - The combination of DKA and COVID-19 is associated with greater mortality, driven by older age and COVID-19 severity.


Subject(s)
COVID-19 , Diabetic Ketoacidosis , Aged , COVID-19/mortality , Diabetic Ketoacidosis/epidemiology , Humans
8.
Topics in Antiviral Medicine ; 29(1):210, 2021.
Article in English | EMBASE | ID: covidwho-1250705

ABSTRACT

Background: The long-term sequelae of coronavirus disease 2019 (COVID-19) have been increasingly recognized. Cardiac, pulmonary, and neuropsychiatric symptoms have been reported to persist up to two months after hospitalization. However, much remains to be learned about the durable long-term effects of COVID-19 for patients and the health care system. Here, we describe the persistence of COVID-19 sequelae up to six months after presentation. Methods: We examined the electronic medical records of the first 1190 patients diagnosed with SARS-CoV-2 infection by reverse transcriptase polymerase chain reaction assay and hospitalized at a quaternary-care center in New York City. All initial hospital presentations occurred between March 1 and April 8, 2020. We manually abstracted data for two follow-up periods representing three-and six-months post-hospitalization. Abstracted information included type and dates of encounters;use of tele-health;presence and persistence of symptoms;morbidity;and mortality. Descriptive statistics for categorical and continuous variables were tabulated and distributions were examined by visit;at presentation, three months and six months. Results: Patients had a median age of 60 and 61 years at three and six months, respectively. About 45% were female and 50% identified as Hispanic/Latinx. Of 1190 patients, 78% (N=928) survived their initial hospitalization. Among the 61% (n=570) of survivors who had follow-up encounters at three and six months, patients frequently reported cardiopulmonary symptoms (35.7% and 28%), dyspnea (22.1% and 15.9%), generalized symptoms (25.4 % and 26.4%) and neuropsychiatric symptoms (20.1% and 24.2%). Tele-health encounters represented 59% and 28.2% of encounters at three and six-months, respectively. Twenty-percent of patients had reduced mobility or reduced independence in the six months after hospitalization. Of survivors, 17% weredischarged to a nursing or rehabilitation facility and 10.3% remained there at three months post-hospitalization. Conclusion: The prevalence was high of at least one COVID-associated symptom six months after hospitalization. Cardiopulmonary symptoms were most common and persisted longer than previously reported. Providers, patients, and their families must be sensitized to and anticipate these potential sequelae. Further follow-up and studies of COVID-19 survivors are necessary to confirm these findings and investigate outcomes beyond six months. (Figure Presented).

9.
Topics in Antiviral Medicine ; 29(1):243, 2021.
Article in English | EMBASE | ID: covidwho-1250004

ABSTRACT

Background: Health care workers (HCWs) remain disproportionately affected by COVID-19. They experience higher transmission rates of SARS-CoV-2, and the extent, duration and pattern of antibody response remains under examined. The correlates of serological patterns are also unclear. We examined longitudinal SARS-CoV-2 sero-patterns and their correlates among a cohort of HCW. Methods: HCWs (N=465) were recruited at a large quaternary medical center in New York City and followed prospectively with bi-monthly assessments of the following;demographic characteristics, COVID-19 exposure in the work, home and community settings, and molecular and antibody COVID-19 laboratory tests including quantitative measurements of antibody titers. Baseline and longitudinal patterns in antibody response and titers over the first 4 months were used to characterize HCW who remained persistently seronegative, seropositive, those who acquired and lost seropositvity and those with variable seropositivity. Chi-square test for the association of seropattern correlates and loess regression was used to examine longitudinal trends. Results: Baseline seropositivity was 32.6% (N=148/465), 34.6% (N=153/441) at month 2 and 38.3% (N=125/326) by month 4. Exactly 63.9%, 27.3%, 1.5%, 1.5% and 5.7% of HCW tested overall were persistently seronegative, persistently seropositive, became positive after baseline, lost seropositivity and had variable positivity, respectively. Among seropositive HCW, mean antibody levels increased from 53.7 at baseline to 69.8 at month 2 and 82.9 at month 4 (figure 1). Factors significantly associated with being ever seropositive were, history of prior COVID-19 testing, household member testing COVID-19 positive, whether there were other essential employees in the home, and history or current symptoms. We also observed an association with contact of suspected or confirmed co-worker as significantly higher among HCW who were persistently positive (24.5%), incident seropositives (33.3%) and variable seropositivity (52.2%) than those who were persistently negative (19.9%) or lost seropositivity (16.7%). Conclusion: HCWs exposure risks continue to persist in the workplace and in the home. We observed few positive molecular tests, suggesting few transmission, but these exposure may potentially sustain seropositivity. These findings are preliminary and need to be further investigated.

11.
IEEE Transactions on Big Data ; 2021.
Article in English | Scopus | ID: covidwho-1054478

ABSTRACT

Counterfactual inference is a useful tool for comparing outcomes of interventions on complex systems. It requires us to represent the system in form of a structural causal model, complete with a causal diagram, probabilistic assumptions on exogenous variables, and functional assignments. Specifying such models can be extremely difficult in practice. The process requires substantial domain expertise, and does not scale easily to large systems, multiple systems, or novel system modifications. At the same time, many application domains, such as molecular biology, are rich in structured causal knowledge that is qualitative in nature. This manuscript proposes a general approach for querying a causal knowledge graph with a causal question and converting the qualitative result into a quantitative structural causal model that can learn from data to answer the question. We demonstrate the feasibility, accuracy and versatility of this approach using two case studies in systems biology. The first demonstrates the appropriateness of the underlying assumptions and the accuracy of the results. The second demonstrates the versatility of the approach by querying a knowledge base for the molecular determinants of a SARS-CoV-2-induced cytokine storm and performing counterfactual inference to predict the causal effect of medical countermeasures for severely ill COVID-19 patients. IEEE

12.
Journal of Bone and Mineral Research ; 35:47-48, 2020.
Article in English | Web of Science | ID: covidwho-1008519
SELECTION OF CITATIONS
SEARCH DETAIL