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The authors propose that social prescribing is an empowering strategy to assist individuals to connect and thrive within their communities and supports improvements in their health and well-being. Whilst, social prescribing schemes have been developed within western healthcare systems for some decades and continue to gain popularity, there has been little evidence of its widespread use within the Middle East. This region has continued to be predominantly focused on pharmaceutical interventions for individuals experiencing addiction and substance misuse and whilst it is acknowledged that there are enclaves throughout the region, these are not common practice. A world shaped by a post-COVID-19 global economic crisis appears to have had detrimental effects on physical and mental health due to substance misuse and addictions. The use of social prescribing utilizes psychological and social factors rather than an overreliance on the bio-medical model which relies on biological interventions to treat addictions and substance use disorder. Firstly, the authors will advocate for a wider exploration of the use of social prescribing in order to create a holistic approach to combating the health and social care determinants of addictions and substance for the Middle Eastern region. The paper will demonstrate how the use of social prescribing could be used to reaffirm empowerment as a means of aiding people to become more independent of hospital institutions and current pharmaceutical interventions. Seminal work on empowerment and peer-support will be presented to create awareness on the challenges of establishing and promoting empowerment within entrenched bio-medical models of care. Secondly, the authors will remonstrate for a need to establish peer-support by empowering those with lived experiences of addictions and substance misuse issues to become members of the multi-disciplinary team to treat these conditions. Copyright © 2022 Richard Mottershead, et al.
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Introduction: Since the emergence of the novel coronavirus SARS-CoV-2 in December 2019 in Wuhan, cases of the associated disease COVID-19 are seen worldwide. To collect clinical data of the pandemic the international, multicenter Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) registry was established. Here, we present a first description of cancer patients with COVID-19 from LEOSS. Patients and Methods: We retrospectively analyzed a cohort of 283 patients (pts) with cancer and COVID-19 from a total of 1808 pts enrolled between March 6th, 2020, and June 26th, 2020. Baseline characteristics include socio-demographics, comorbidity according to Charlson Comor-bidity Index (CCI), ECOG and outcome of COVID-19. Clinical manifestation of COVID-19 was described in four phases: uncomplicated (asymptomatic/mild symptoms), complicated (need for oxygen supplementation), critical (need for life supporting therapy) and recovery (clinical improvement/discharge). Result(s): Median observational period was 11 (range 0-48) days, median inpatients stay 12.5 (range 0-72) days. Most patients were aged 66 years or older (75.5%), 112 (39.5%) pts were female. Median CCI was 4 (0-15), 46/119 (16.5%) pts had an ECOG >2. Solid tumors were seen in 61%, lymphoma and leukemia in 14.5% and 10.5% respectively. One hundred and seven pts (38%) had an active malignant disease and 76 (27%) had received anti-cancer treatment within the last 3 months. In 181 (64%) pts COVID-19 remained in the uncomplicated phase whereas 93 (33%) pts developed a complicated or critical phase. Sixty-three (22.5%) pts required intensive care, 35 out of 63 needed mechanical ventilation. A total of 79 (28%) pts died, 67 (23.5%) from COVID-19. Median survival was 33 days and worse compared to non-cancer pts (non-cancer pts: med. survival not reached, p-value < 0.001). Conclusion(s): As expected, cancer patients hospitalized for COVID-19 frequently have severe disease and an adverse outcome. To confrm these results, age-and comorbidity adjusted analysis are needed. An update of the analysis will be presented at the DGHO Annual Meeting.
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Introduction: On 27.01.2020 the first case of Covid-19 infection in Germany was described, on 11.3.2020 the worldwide spread of Covid-19 was declared a pandemic. The risk group includes people with comorbidities and weakened immune systems, which means that palliative patients belong to this risk group. Approximately 10% of this patient group is cared for by an SAPV in addition to their primary care. Especially at the beginning of the coronary crisis, the care of palliative patients by family doctors and nursing services was ofen massively complicated or reduced due to overwork, tightened isolation measures or an occurred Covid-19 infection. In addition, the current legal situation made access to nursing homes more difcult. SAPV had to ensure the protection not only of patients but also of its employees, since COVID-19 infections within the SAPV team would have led to considerable gaps in care. At the beginning of the pandemic, protective equipment was patchily available. The example of an SAPV is used to illustrate the restructuring and measures taken to maintain palliative care: Methods: Separation of persons: SAPV trips are carried out alone (doctor/nurse), no personal contact with the coordinators or among the team members, instead more telephone contact and video conferences Contact with hospices/nursing homes/patients mainly through video consultation Protective measures: initially all SAPV visits with surgical face masks, in case of suspected corona FFP-2 mask, in the course of the pandemic: all visits with FFP-2 mask. In case of suspected corona: at the beginning of the pandemic, disposable rain ponchos, later again available protective gowns/glasses Telephone corona screening by coordinator upon patient admission Directly before visiting the patient: renewed telephone corona screening by doctor/nurse on the basis of a given list of questions At each visit: reduce contact with relatives, keep distance rule as far as possible, reduce visiting time, shif detailed discussions to video consultation Providing a room within the SAPV ofces for video conferences 8.Equipping the SAPV cars with protective clothing, disinfectant Results: So far no Covid-19 infection among the team members, full maintenance of SAPV care. Conclusion(s): Even in times of crisis, rapid and sometimes innovative structural changes can maintain continuous outpatient care for palliative patients.
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Aim/Introduction: Knowledge about COVID-19's physiopathology is still scarce, mainly with respect to the recovery phase. Nonetheless, its association with an increased incidence of thromboembolic phenomena is well established. Ventilation/Perfusion single-photon emission computed tomography (VP-SPECT) plays a major role in the evaluation of pulmonary embolism (PE) and microvascular disease, given its high sensibility and low radiation burden. We aim, with this study, to review the contribution of VP-SPECT in these patients' follow-up, with a particular focus on those with long-COVID-19. Material(s) and Method(s): We performed a retrospective study with COVID-19 patients that underwent VP-SPECT in our Department, until march-2022. Functional impairment of global pulmonary perfusion (FIGPP) was quantified by assigning points for each segment with a mismatch defect (a total of 36 points in 18 segments). PE was defined by the presence of segmental or subsegmental pleural-based mismatch defect(s) assessed at least 2 points. All relevant demographic/clinical data were collected. Result(s): Sixty patients (mean age 54.8+/-12.8 years, 51.3% female) with a history of COVID-19 underwent VP-SPECT on average 285.6+/-127.2 days after infection. There was a high prevalence of severe infections (58%, N=29) and admitted patients (64.9%, N=37), with a mean length of stay in the hospital of 22.5+/-17.2 days. Six patients (10.2%) had acute PE associated. The main reason for VPSPECT was post-infection fatigue/dyspnoea (71.7%;N=43). Only 6.9% of patients underwent VP-SPECT during acute disease (N=4). Median FIGPP was 6% (0-47). Patients who were hospitalized (p=0.066) or who had severe disease (p=0.161) showed no statistically significant differences in FIGPP. Management change after VP-SPECT occurred in 11.9% (N=7). Patients who did not start anticoagulant therapy (N=46) showed a median FIGPP of 6% (0-18). Conclusion(s): Our findings suggest that, although clinically relevant, persistent post-COVID-19 fatigue/dyspnoea symptoms do not appear to be justified by a FIGPP associated with significant thromboembolism and are unrelated to disease severity and need for hospitalisation. However, VP-SPECT played an important role both in excluding serious sequelae of thromboembolism and in identifying patients at higher risk of developing pulmonary hypertension.
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Background: Healthcare workers are the White army compacted the COVID-19 epidemic, and reports worldwide have shown an increase in SARS-CoV-2 among healthcare workers due to their direct interactions with infected patients. This study aimed to examine the clinical manifestations and risk factors for SARS-CoV-2 infection among healthcare workers in Palestine and offer recommendations to ensure health workers' safety and adopt workplace safety policies. Method(s): This questionnaire-based cross-sectional observational study was conducted using an online questionnaire to collect information about SARS-CoV-2 transmission, signs, symptoms, and treatment reported by healthcare workers. Furthermore, we explored policies, protocols, and practices that make health workers vulnerable to SARS-CoV-2 infection. Result(s): A total of 389 healthcare workers were included, 216 (55.5%) were exposed to the SARS-CoV-2 virus, 173 (44.5%) were infected with the virus, and the prevalence of hospitalization was 16%. The most commonly reported symptoms are fatigue, weakness, and muscle pain. Female healthcare workers experienced a significantly extended duration of symptoms than male workers. Direct contact (working less than 1.5 m) with suspected or confirmed COVID-19 patients and lack of COVID-19 and PPE training were risk factors for COVID-19 infection among HCWs. Conclusion(s): The healthcare system must ensure a safe work environment and adopt policies and procedures to ensure HCW safety, proper training, and resource availability to cope with crises. Copyright © 2022 Abukhalil et al.
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The coronavirus outbreak has shifted the medical community's focus. A novel coronoviridae variant (COVID-19) was found in Wuhan, China, in December 2019. Initially, an infection causes a wide range of symptoms, including muscle aches, fever, dry cough, and shortness of breath. COVID-19 infection affects all gastrointestinal system organs because it aims to hit the ACE2 receptor (angiotensin-converting enzyme 2), which is located in intestinal epithelial cells in the human body and liver cells. Coronavirus-caused liver damage often causes decreased albumin and increased aminotransferase and bilirubin. Pathophysiological hypotheses include direct damage, immune-mediated injury, ischemia and hypoxia, thrombosis, and medication hepatotoxicity. The harm is most likely multifactorial, and infected patients with preexisting liver illnesses should be managed accordingly. A vaccine will be required to help reduce COVID-19 cases and provide immunity to the public. However, safety considerations, particularly for RNA-or DNA-based vaccines, must be addressed when assessing the types of vaccines accessible. The effects of severe COVID-19 infection on gastrointestinal symptoms and liver damage in patients with chronic gastrointestinal disease are discussed in this study. Copyright © 2022, Bahrain Medical Bulletin. All rights reserved.
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It is no doubt that the outbreak of the novel coronavirus caught the world including South Africa, off-guard. This statement refers in particular, to the fact that the outbreak of the pandemic firstly exposed the level of unpreparedness of government and its different departments, including the private sector to deal with unforeseen outbreaks like the coronavirus which leads to COVID-19. This is a typical example of systemic problems within the government and the private sector. Secondly and most importantly, this outbreak exposed the level of inequality between schools in rural areas and those in townships and affluent parts of the country which are mostly habited by black middle class and white people. The purpose of this paper is to investigate the systemic challenges and the emotional impact of this virus on the learners and their parents;the learners and their teachers, and to venture into the policymaking and implementation terrain of the Department of Basic education with a specific focus on how the DBE responded to the outbreak. Furthermore, this paper makes a case out of the emerging case by case approach of the government and the DBE in dealing with the threats which are posed by this pandemic to communities and schools. The researchers hold the view that this paper will expose the levels of inequality between schools in different parts of the country and advocate for a culture of foresight in the education management system;a culture that acknowledges that schools, like communities and business entities, are vulnerable and susceptible to external forces that may have long-lasting effects on their functionality. Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.
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Background: There has been a myriad of vascular manifestations associated with the coronavirus disease 2019 (COVID-19) pandemic, including reports of associated small- and medium-vessel vasculitis. However, there are limited reports of large vessel vasculitis, specifically aortitis, related to the COVID-19 infection. Case presentation: A 62-year-old female with history notable for peripheral artery disease, chronic obstructive pulmonary disease, hypertension, and hyperlipidemia presented for evaluation of abdominal pain. She was hospitalized two weeks prior with a COVID-19 infection causing respiratory failure. At presentation, she endorsed one week of progressive lower abdominal pain with anorexia. Vitals were notable for a blood pressure of 185/93 mmHg and heart rate of 94. Labs were notable for white blood cell count 8.1, CRP 85.4, and ESR of 96. A CT abdomen/pelvis with IV contrast demonstrated circumferential wall thickening of the infrarenal aorta with surrounding inflammatory stranding, suggestive of aortitis (Panel A). Additional evaluation included negative blood cultures, non-reactive RPR, normal IgG subclass 4, negative ANA screen, negative myeloperoxidase and proteinase-3 antibodies, and negative cryoglobulin. Given her recent COVID-19 infection, it was felt that her aortitis was COVID-19 related. For this, the patient was initiated on prednisone 60mg daily after her negative infectious work up with subsequent resolution of her abdominal pain. Repeat imaging and labs at 2 weeks demonstrated resolution of aortic findings (Panel B) and normalization of inflammatory markers. Her prednisone was tapered over a 6-week course without recurrence of symptoms. Conclusion(s): Aortitis should be recognized as a potential complication related to COVID-19 infections. While aortitis is associated with significant morbidity and mortality, early initiation of corticosteroids can lead to favorable outcomes.
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Introduction: TdP is a polymorphic VT that occurs with prolonged QT interval and can cause sudden cardiac death. Trends in incidence and outcomes of TdP during the COVID-19 pandemic are not well-established. We aim to report incidence of intrahospital TdP and VT, baseline characteristics of patients with TdP, and trends in post-TdP recovery and mortality before and during the COVID-19 pandemic. Method(s): Patients with diagnoses of VT and TdP from 2016-2020 at our institution were included. The diagnosis was confirmed after analysis of the patients' ECGs. Demographics, medical history, and hospital course data were collected. Chi-square/Fisher's exact, one-way ANOVA, and logistic regression analyses were conducted. Result(s): Seventy-four patients were included in the analysis. Average age was 60 +/- 17, and 57% were male. Fifty-two (70%) patients were in the ICU at time of TdP. Co-morbidities included hypertension (53%), atrial fibrillation/flutter (41%), diabetes mellitus (34%), CAD (26%), and CKD (22%). Average LVEF was 39 +/- 19%. Forty-two (57%) underwent emergent defibrillation, 19 (26%) required transvenous pacing, and 7 (10%) were administered isoproterenol for acute management of TdP. Median recovery time of QTc interval to <500ms was 3 days. Twenty-two (30%) received an ICD. Follow-up device check data was available for 15 patients;4 had at least 1 episode of NSVT. Fifteen (20%) patients died during their admissions. The proportion of patients with VT that had TdP increased in 2020 compared to prior years (p<0.001). However, the proportion of patients with TdP that died during admission was not significantly different across 2016-2020. Conclusion(s): The proportion of patients with TdP relative to those with VT increased significantly in 2020, concurrent with the first wave of the COVID-19 pandemic. The absolute number of hospitalized patients with TdP did not change from 2016-2020. Mortality rate in patients with TdP did not differ significantly from 2016-2020.
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INTRODUCTION: The appropriate use of empiric antibiotics for patients with severe COVID-19 presents a clinical challenge. Bacterial coinfection can be difficult to exclude, sometimes resulting in empiric antibiotic therapy. However, antibiotics alter the respiratory tract microbiome and these changes in the lung microbiome have been associated with prolonged ARDS in COVID-19. We hypothesized that early antibiotic use increase the risk of prolonged mechanical ventilation in patients hospitalized with COVID-19. METHOD(S): We used the National Covid Cohort Collaborative (N3C) to identify a retrospective cohort of patients admitted between March 2020 and May 2022 with a positive COVID-19 PCR or antigen test 15 days prior or within 48 hours of admission. We collected demographics, Charlson comorbidity index, month of hospitalization, antibiotics received, surgical procedures, details of mechanical ventilation, and diagnoses. We defined early empiric antibiotic use (EEAU) as administration of IV antibiotics for at least three calendar days before the sixth hospital day. Prolonged mechanical ventilation was defined as 14 consecutive days of mechanical ventilation. Our primary analysis used logistic regression after propensity score matching (PSM) with multiple imputation via chained equations for missing data. Sensitivity analyses included varying the required days of antibiotic exposure, using PSM with complete cases only, and using inverse probability of treatment weighting. RESULT(S): Our final cohort included 283,314 admissions. Prolonged mechanical ventilation and EEAU was observed in 1.4% and 13.9% of cases, respectively. In the unadjusted cohort, patients who received EEAU were more likely to be older, obese, and have more comorbidities. These patients were also more likely to have had mechanical ventilation, ECMO, major surgery, or a traumatic diagnosis during the first days of their hospitalization. After PSM, the standardized mean difference for all variables was less than 0.05. Early antibiotic use was associated with an increased risk of prolonged mechanical ventilation (OR 1.86, 95% CI 1.71 - 2.03). This finding was robust to all approaches in our sensitivity analysis. CONCLUSION(S): In our retrospective cohort, EEAU is independently associated with increased risk of prolonged mechanical ventilation.
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Background. Patients admitted to the hospital with SARS-CoV-2 infection are often treated with antibacterial agents in addition to antivirals, although bacterial coinfection in this population is uncommon. Overuse of unnecessary antibiotics can lead to suboptimal outcomes, including increased bacterial resistance, adverse events, and costs. Our Antimicrobial Stewardship (AS) Program routinely provides recommendations for appropriate therapy based on molecular/microbiologic tests, clinical findings, and procalcitonin (PCT). PCT can assist in differentiating bacterial from viral respiratory infections, and can be useful in the decision to discontinue antibiotic therapy if viral monomicrobial infection is suspected. The purpose of our quality improvement project was to review the appropriateness of antibiotics utilized for patients admitted with SARS-CoV-2 and to promote optimal patient care and AS at our institution. Methods. We performed a retrospective review of SARS-CoV-2 patients from our institution's COVID-19 registry for patients hospitalized from March 2020-April 2021. We compared patients with PCT < 0.25 ng/mL to those with PCT > 0.25 ng/mL and assessed differences in patient characteristics and disease presentation, including: age, gender, WBC, serum creatinine, culture results, disease severity, patient location, duration of antibiotics, length of stay, 30 day readmission and mortality. Characteristics were compared using descriptive statistics and appropriate inferential statistics. Results. Shown in Table 1. If prescribed antibiotics, median duration of antibiotic therapy was significantly reduced in the PCT < 0.25 group vs. the PCT > 0.25 group (2 days vs. 4.1 days). Median WBC, SOFA score, serum creatinine, and length of stay were significantly lower in the PCT < 0.25 group compared to the PCT > 0.25 group. Severity adjusted models showed significantly decreased duration and overall likelihood of antibiotic use for PCT < 0.25 vs. PCT > 0.25. 30 day readmission and 30 day mortality were significantly lower in the PCT < 0.25 group vs. the PCT > 0.25 group. Conclusion. Antibiotic utilization was reduced in patients admitted with SARS-CoV-2 infection and PCT < 0.25, and if prescribed antibiotics, duration was significantly shorter vs. those in the PCT > 0.25 group.
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Background. COVID-19 disease became a global health care crisis and was declared pandemic by WHO in March 2020. Little is known how the immunosuppressive medications impact the mortality rate in Solid Organ Transplant (SOT) recipients. There is also minimal data regarding the incidence of transplanted graft failure or rejection that could be attributed to the COVID-19 infection itself or its complications and management. Our study aims to investigate the management of COVID-19 infection, outcome of the infection, transplant failure and rejection rates in SOT recipients. Methods. We conducted a retrospective cohort study of all consecutive SOT recipients who were admitted to our transplant center from March 2020 to April 2021 with COVID-19 infection. Data was collected from the electronic medical records after receiving Institutional Review Board approval. Results. A total of 135 patients met the inclusion criteria. After the diagnosis of COVID -19 infection, 31% recipients had decrease in the dose of immunosuppressive medications (change group) and 69% had no changes in the dose (no change group). Out of the 73 Kidney Transplant recipients 33% were in the change group compared to 14% of liver, 25% of heart and 27% of lung transplant recipients. Of the total 42 recipients in the change group, 28.6% required Intensive Care Unit (ICU) level care significantly higher compared to 7.5% in the no change group (p-value < 0.005). Mechanical ventilation was required in 14.3% of the patients in the change group and 6.5% in the no change group (p-value < 0.5). Out of the total, 85.7% patients in the change group survived compared to 94.6% in the no change group (p-value < 0.1). Overall, the transplant rejection rate was higher in the change group compared to the no change group (p-value < 0.5). Conclusion. Our study showed a significantly higher ICU admission rate and mortality in SOT recipients who had their immune suppression reduced at the time of COVID-19 diagnosis. The same group also had a higher risk of rejection of transplanted graft. More studies with larger sample size needs to be done to further understand the management of immunosuppressive drugs in the SOT recipients with COIVD-19 infection.
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Objectives: The purpose of this paper is to present a theoretical model of the causal factors and consequences of burnout among pediatric nurses. Method(s): The significant results of selected four studies on pediatric nurse were integrated to build a comprehensive theoretical model on burnout among pediatric nurses. The four studies involved in this study have used the same convenient sample of 225 pediatric nurses from nine Jordanian hospitals. The selected sample of pediatric nurses answered self-reported questionnaires including the Copenhagen burnout inventory, the abbreviated form of the world health organization quality of life survey (WHOQOL-BREF),nurse-perceived patient adverse events, in addition to questions about demographic traits, intent to quit, and job satisfaction. Result(s): The suggested theoretical model is an integration of the results of empirical research related to pediatric nurses' burnout, quality of life, perceived adverse events, job satisfaction, social support, Compassion Satisfaction - Compassion Fatigue model, and the empowerment model. Conclusion(s): The proposed model might be suitable in directing future studies discovering scientific gaps about burnout, quality of life, job satisfaction, social support, and perceived adverse events among pediatric nurses during and after the COVID-19 pandemic. Also, this model will provide an inclusive theoretical framework for future studies examining nurses' burnout. Copyright © 2022
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Objectives: This pragmatic review provides a summary of the recently published economic cost of four preventable diseases in the UK (type 2 diabetes, obesity, myocardial infarction, and stroke). Method(s): A MEDLINE (OvidSP) search strategy was designed to identify UK studies reporting economic costs. The search was restricted to UK papers from 2016 onwards. 1,590 records were screened based on title/. 86 were reviewed for eligibility and 20 included. Result(s): 17 studies were extracted, including retrospective studies preceding 2016 with some overlap between diseases. Comparability was difficult due to the variety of methods and models being used, for example: One diabetes study estimated costs of >3Bn associated with poor glycaemic control, and another estimated costs of 5.6Bn/year for hospital care. Obesity studies estimated incremental per obese person costs compared with the general population and by magnitude of obesity but did not estimate an overall direct and societal cost. Myocardial infarction studies also estimated incremental per patient costs. One study estimated a potential saving of 68Bn to the health and social care system over 25 years if people at high risk of cardiovascular disease were detected and managed. Atrial fibrillation is estimated to cost the UK health system between 8 and 16Bn. A stroke study estimated the annual UK health and social care cost will be 17Bn in 2025, while a 2017 European study estimated the annual direct and societal cost to the UK at 7.5Bn. Conclusion(s): These representative preventable diseases impose strong collective pressure on the healthcare system and are costly. These examples also show that delayed action increases the economic burden. Longer-term care represents a significant burden on a constrained health and social care system which the Covid-19 pandemic has further highlighted as fragile. Action should be taken now against preventable disease to help protect the NHS from future shocks. Copyright © 2022
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Aims: For cancer patients with oligo metastatic disease (OMD), defined as five metastases or less, a more aggressive treatment approach has been suggested. In SOFT, an international multicenter phase II trial, patients with OMD and infra-diaphragmatic soft tissue metastases were treated with online MR-guided stereotactic ablative radiotherapy (SABR). To better identify early adverse events related to SABR, longitudinal collection of electronic patient-reported outcomes (ePROs) were included. As this is a short-course treatment in an elderly population our aim was to report the feasibility of continuous ePRO for the first 100 patients. Method(s): Patients were enrolled at four sites;Herlev Hospital, Rigshospitalet, Odense University Hospital in Denmark, and Henry Ford Hospital, Detroit. They were allocated to 3-8 radiotherapy fractions depending on target site and dose to organs at risk. Early toxicity was measured with eight symptomatic AEs from the PRO-CTCAE item library and quality of life with the EUROqol EQ-5D-5L at pre-specified time points (Fig. 1). A link to the ePRO system (REDCap) was sent out electronically. In case of no computer access, a paper version was provided. The invitation was re-send after 2 days. No back-up call was provided. Result(s): The first 100 patients having reached a 24-week follow-up evaluation were included in the analysis. Five patients had a second enrollment (105 enrollments) and 19 had more than one target. The median age was 70 years. The majority were men (67%) and had oligo metastatic recurrence (54%) (Table 1).The consent rate for ePRO completion was 87% (91 electronic/13 paper/1 declined). For an elderly population with metastatic cancer, the overall adherence level to PRO completion was high (88%) and the high level remained until week 24 (retention rate 91%) (Fig. 2). Only 44% of the paper questionnaires were completed week 24. This may partly be due to in-person visits being changed to telephone consults during COVID-19. Four patients (4%) reported technical difficulties. Conclusion(s): Collecting ePROs among elderly cancer patients with OMD having short-course radiotherapy is feasible. All but one patient completed PROs with the majority doing electronic reporting. Overall, adherence was high except for patients completing paper-based PROs.
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Introduction: Coronavirus disease 2019 (COVID-19) is accompanied by a hypercoagulable state with micro- and macrovascular thrombotic complications. In plasma samples from COVID-19 patients, von Willebrand factor (vWF) levels were shown to be highly elevated and, like the relative lack of its counterpart, ADATMS13 (a disintegrin-like and metalloprotease with thrombospondin repeats 13), predictive of adverse outcomes, especially mortality. However, vWF is usually not included in routine coagulation analyses, and histologic evidence of its involvement in thrombus formation in COVID-19 is lacking. Moreover, since vWF is also an acute phase protein it needs to be determined whether it is a bystander, i.e. a biomarker reflective of endothelial dysfunction, or a causal factor in the pathogenesis of COVID-19. Method(s): We compared lung, lymph node and heart autopsy samples from 28 patients with lethal COVID-19 (B.1 virus-lineage) to controls, and systematically assessed for vWF and platelets (CD42b) by immunohistochemistry. Controls comprised of 24 lungs, 23 lymph nodes, and 9 hearts, and did not differ significantly from the COVID-19 group respecting age, sex, BMI, blood group, or anticoagulant use. Result(s): Compact platelet-rich microthrombi were more frequent in patients, who died of COVID-19 (36% vs. 8%, p = 0.02;staining for CD42b). This difference was more pronounced when lungs were analyzed for vWF: in normal lungs, vWF is physiologically present in vascular endothelial cells (Figure 1A). A completely normal pattern of vWF was rare in both groups (controls vs. COVID-19: 25% vs. 7%;p = 0.081), but vWF-rich thrombi were exclusive to COVID-19 (39% vs. 0%, p <0.01), as were NETosis thrombi enriched for vWF (25% vs. 0%, p <0.01). 46% of COVID-19 patients had either vWF-rich thrombi, NETosis thrombi, or both (Figures 1B&C). Such trends were also seen in pulmonary draining lymph nodes (35% vs. 17%, p = 0.147), where the overall presence of vWF was very high (Figure 1C). Conclusion(s): We bring in situ evidence of vWF-rich thrombi that we context as likely attributable to COVID-19. In line with the growing evidence that increased plasma vWF correlates with adverse outcomes, this supports the hypothesis that high levels of vWF and a dysregulation of the vWF/ADAMTS13 ratio contribute to COVID-19 morbidity and mortality. Hence, vWF may be a therapeutic target in severe COVID-19, warranting further studies.
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Introduction/Background The magnitude of adverse outcomes caused by the disrupted surgical cancer care during the COVID-19 pandemic is unclear. The aim of CovidSurg-Gynaecological Cancer study was to evaluate the changes in care and short-term outcomes of surgical patients with gynecological cancers during the initial phase of the COVID-19 pandemic internationally. Methodology A multicenter, international prospective cohort study including consecutive patients with gynecological cancers who were initially planned for non-palliative surgery. Primary outcome The incidence of pandemic-related changes in care Secondary outcomes 30-day postoperative morbidity and mortality rates A composite outcome of unresectable disease or disease progression, emergency surgery and death Results We included 3973 patients (52 countries;7 world regions;27% from low-and-middle-income countries). Lower-than-reported rate (22/3778;0.6%) of perioperative SARS-CoV-2 infections was observed. This group had higher morbidity (63.6% vs 19.1%;p<0.0001) and mortality (18.2% vs 0.7%;p<0.0001) rates, compared to the uninfected cohort. In 20.7% (823/3973), standard of care was adjusted. Significant delay (>8 weeks) was observed in 11.2% (424/3784), particularly in those with ovarian cancer (213/1355;15.7%). This delay was associated with the use of neoadjuvant chemotherapy (p<0.0001), a composite of adverse outcomes including disease progression and death (95/424;22.4% versus 601/ 3360;17.9%, p=0.024), compared to those who had operations within 8 weeks of their MDT decisions. One in thirteen did not receive their planned operations (189/2430;7.9%), in whom 1 in 20 (5/189;2.7%) died and 1 in 5 (34/189;18%) experienced disease progression or death within 3 months of MDT decisions for surgery Conclusion One in five surgical patients with gynecological cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations. This global data on the magnitude of care changes and their consequences could be used to leverage resources for the ongoing mitigating strategies worldwide.
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Objectives: Transmission from asymptomatic patients is one of the biggest challenges in controlling the Coronavirus disease 2019 (COVID-19) outbreak because these cases are a potential source for disease spread. Based on this situation, the aim of our study is to determine the prevalence of COVID-19 in asymptomatic pediatric dental patients representing Sivas and surrounding provinces. Method(s): The population of the study consists of pediatric patients between the ages of 0-14 who applied to Sivas Oral and Dental Health Hospital General Operating Room for dental treatments between July 2020 and August 2021. Result(s): Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was detected in only 5 patients (approximately 1.80%) out of 278 asymptomatic pediatric patients. Conclusion(s): It is thought that the COVID-19 infection, which threatens the whole world, can progress asymptomatically in children, and therefore it may be a risk factor for the spread of the infection. To tackle the COVID-19 pandemic, it is recommended to maintain a high level of infection control measures in schools and day-care and to implement widespread testing on a global scale targeting the pediatric population. Copyright © 2022 by Prusa Medical Publishing.