ABSTRACT
Introduction: Posterior mediastinal mass is most likely due to neurogenic tumor, meningocele or thoracic spine lesions. Caudate lobe of the liver herniation presenting as posterior mediastinal mass is a rare occurrence. Diaphragmatic herniation (DH) of the caudate lobe presents in various way including dyspnea, dyspepsia or incidental finding on imaging. We present a case of diaphragmatic hernia of the caudate lobe of the liver presenting as a posterior mediastinal mass found during evaluation of dyspnea. Case Description/Methods: A 75-year-old female presented to her physician with worsening shortness of breath from her baseline of 3 days duration. She had a history of sarcoidosis, COVID pneumonia over 1 year ago, COPD, diastolic heart failure, and hypertension. She was initially evaluated for COVID re-infection, which was negative and a CT of the chest with contrast to check for sarcoidosis flare revealed posterior mediastinal mass measuring 4.5 x 6.5 x 6.4 cm. Further work up with CT chest and abdomen with contrast revealed that the posterior mediastinal mass had similar attenuation as the liver and appears continuous with the caudate lobe of the liver. This was confirmed by NM scan of liver. Review of her records from an outside organization revealed similar finding on imaging a few years ago. Patient denied any history of trauma and laboratory work up revealed normal liver functions. After pulmonologist evaluation she was started on 2 L home oxygen following six-minute walk test, and also CPAP following a positive sleep study. Pulmonary function tests were performed and inhalers were continued. Given the chronicity of her symptoms and co-morbidities with stable caudate lobe herniation, conservative management was advised with surgery warranted if symptoms persist despite treatment (Figure 1). Discussion(s): DH is typically found on the left side with stomach or intestine while the right side is usually guarded by the liver. Isolated herniation of part of the liver into the thoracic cavity is rarely reported and is mostly acute from traumatic or spontaneous rupture requiring immediate repair. Our patient was initially evaluated for the posterior mediastinal mass for concerns of tumor, followed by the finding of what was thought to be acute herniation of the caudate lobe of liver into the thoracic cavity. Review of records showed this to be a stable lesion, we suspect that the patient had congenital diaphragmatic defect. Chronic and stable liver herniation into thoracic cavity can be managed conservatively if uncomplicated.
ABSTRACT
Community-acquired pneumonia is a potentially serious infection in children with high morbidity rate, risk of severe course and unfavorable outcomes. Specialists have noted the increased incidence of the destructive forms in the recent years. Aim. To present a clinical case of destructive pneumonia in a 1 year 2 month old child, hospitalized in the State Budgetary Healthcare Institution "Children's City Clinical Hospital of St. Vladimir Moscow Healthcare Department", and analyze it in terms of current understanding on the disease pathogenesis. Conclusion. During COVID-19 (COronaVIrus Disease 2019) pandemic, pulmonologists and pediatric surgeons encountered an unconventional course of destructive pneumonia. A large number of studies of pathophysiological processes in acute viral interstitial pneumonias have recently allowed to expand our understanding of the role of coagulation system. At the same time, new questions arose concerning the clinical course and development of the pathological infectious process.Copyright © Zaytseva O.V. et al., 2023.
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) may result in a severe acute respiratory syndrome that leads to a worldwide pandemic. Despite the increasing understanding of COVID-19 disease, the mortality rate of hospitalized COVID-19 patients remains high. Objective(s): To investigate the risk factors related to the mortality of admitted COVID-19 patients during the peak of the epidemic from August 2021 to October 2021 in Vietnam. Method(s): This is a prospective cohort study performed at the Hospital for Rehabilitation-Professional diseases. The baseline and demographic data, medical history, clinical examination, the laboratory results were recorded for patients admitted to the hospital with confirmed COVID-19. A radiologist and a pulmonologist will read the chest radiographs on admission and calculate the Brixia scores to classify the severity of lung abnormalities. Patients were followed up until beingrecovered or their death. Comparison of clinical and subclinical characteristics between recovery and death groups to find out risk factors related to the death of COVID-19 patients Results: Among 104 admitted COVID-19 patients, men accounted for 42.3%, average age of 61.7 +/- 13.7. The most common symptoms were fever 76.9%, breathlessness 74%, and fatigue 53.8%. The majority (84.6%) of the study population had at least one co-morbidity, including hypertension (53.8%), diabetes (25.9%), gastritis (19.2%), ischemic heart disease (15.4) %), stroke (9.6%) and osteoarthritis (9.6%). The rate of mild and moderate COVID-19 is 13.4%, severe 32.7%, and critical 40.4%. There are 88 inpatients (84.6%) who needed respiratory support. The median hospital stay was 13 days (IQR 10-17.75 days). The rate of intubated patients with mechanical ventilation was 31.7%. The overall mortality rate was 29.8%. Risk factors related to death included Brixia scores > 9, Urea > 7 mmol/L, Ferrtin > 578 ng/ml, Failure to get vaccinated, Age > 60 years, and Low Oxygen SpO2 < 87% (BUFFALO). Conclusion(s): The main result of the study is the independent risk factors related to the death of admitted COVID-19 patients including Brixia scores > 9, Urea > 7 mmol/L, Ferrtin > 578 ng/ml, Failure to get vaccinated, Age > 60 years, and Low Oxygen SpO2 < 87% ((BUFFALO) which suggests that these COVID-19 patients should be closely followed up.Copyright © 2023 Hanha et al.
ABSTRACT
Background: Pulmonary Arterial Hypertension (PAH) is a form of pulmonary hypertension, where the narrowing of arteries in the lungs restricts blood flow and so increases pressure in the vessels. Studies have demonstrated that initial combination therapies are optimal for PAH management. However, prescription of monotherapy treatment is still prevalent as a first line therapy. Purpose(s): The purpose of this research was to investigate prescribing trends of physicians for first line patients with PAH in the UK, Germany, Italy and Spain. We investigated the proportions of newly diagnosed patients and the prescription trends for monotherapy and combination therapy prior to and during the COVID-19 pandemic. Method(s): A multi-country, multi-centre online medical chart review study of patients with PAH was conducted between April - June of 2019, 2020 and 2021 respectively. Recruited from a large access panel, 178 treating cardiologists, pulmonologists & rheumatologists in the UK (n=16), Germany (n=55), Italy (n=55) and Spain (n=52) were screened for duration of practice in their speciality and caseload (>=5 PAH patients in the last 3 months), and provided data on 694 PAH patients (UK = 71, Germany = 206, Italy = 208, Spain = 209). Reported patient data pertained to medical chart information reflecting the prior year, i.e., Q2 2021 data reflected the 2020 period (advent of the COVID-19 pandemic). Result(s): In this dataset, there has been a consistent decrease in the proportion of newly diagnosed (i.e. diagnosed within 12 months of being reported) patients reported from 2019 to 2020 and 2021. In 2019, 49% of the reported patients were diagnosed within the last 12 months. However, the newly diagnosed patient population dropped to 37% in 2020 and continued to drop to 27% in 2021. Despite this, there has been an increase in reported first line patients within the newly diagnosed segment from 74% in 2019, to 75% in 2020, then at 87% in 2021. This increase can be seen to coincide with the ongoing COVID-19 pandemic. In 2019, 58% of reported newly diagnosed patients were recorded as receiving monotherapy. This did drop to 33% in 2020;however, in 2021 monotherapy uptake increased to 47%. Of note, the usage of the endothelin receptor antagonist (ERA) drug class increased from 67% in 2019 to 83% in 2020 but dropped to 69% in 2021. Conclusion(s): This data set suggests a decreasing trend in newly diagnosed patients and a gradual shift in treatment type to first line monotherapy prescription, which coincided with the height of the COVID-19 pandemic. More newly diagnosed patients (those diagnosed within 12 months of being reported) are receiving monotherapy treatment at the expense of combination therapy, and this has also coincided with the pandemic. Further investigation using comparator cohort is warranted to assess whether the challenges physicians faced during the pandemic has had a causal effect on the prescribing habits for PAH therapies.
ABSTRACT
Background: In March 2020, the state of alarm was declared in Spain due to the health crisis caused by SARS-COV-2. The rapid spread of the virus generated uncertainty and concern about the impact it could have on patients with severe asthma (SA) and boosted for the first time the use of teleconsultation for the management of these patients. For this reason, it was necessary to facilitate the transition to a hybrid model that combines face-to-face and digital consultations. Objective(s): Development of the first document designed for SA patients, aimed to support the preparation of the telematic follow-up consultations with their specialist. Method(s): Nine experts in SA from different specialties: 4 allergists, 3 pulmonologists and 2 asthma unit nurses contributed to the conceptualization and development of the document. In a first phase of conceptualization, the profile of patients to which the material is addressed was defined and the minimum content needed to be useful to both patients and healthcare professionals (HCPs) was established. A first draft was prepared and refined after evaluation by adult patients and parents of pediatric patients through cognitive interviews. Result(s): Onasm@ is the first document intended for SA patients to prepare the telematic follow-up consultation with their specialist. It consists of three blocks: A first one with general considerations to be applied on the telematic consultation, a second one to collect all the information that might be requested by the healthcare professional (HCP) during the off-site visit (asthma medications, dosage, adherence, asthma crisis events, emergency visits and oral corticosteroid use) and the third block with tips for achieving and maintaining asthma control. The asthma control test (ACTTM) for adults and the children's version (cACTTM) is also incorporated. Conclusion(s): The transition to a hybrid healthcare model due to the pandemic situation makes it essential to support SA patients to face the telematic follow-up consultation with their specialist. Onasm@ is the first document designed to help patients to appreciate the information needed to face this type of visit, with the aim to promote a fluid communication with their HCP and more efficient visits. This type of document could be applied to the management of other conditions and as such have broader impact on the future of healthcare, which is currently immersed in far-reaching change and transformation.
ABSTRACT
Introduction: During the COVID-19 pandemic, the number of patients who required admission to the intensive care unit (ICU) and prolonged intubation (ETI) or a tracheotomy (TT) due to severe ARDS has increased. Causes of persistent dyspnea after severe COVID-19 pneumonia include diffuse lung disease and pulmonary embolism. However, other causes of persistent dyspnea need to be ruled out in COVID-19 ICU-survivors, including iatrogenic tracheal stenosis (TS). Iatrogenic TS account for 50% of the 15-20 patients evaluated every year in the laryngotracheal multidisciplinary team (MDT) of our center. The management of these patients requires an individualized and multidisciplinary assessment, including Interventional Pulmonologists, Thoracic Surgeons and Otolaryngologists. The objective of this study was to describe the cases of iatrogenic TS after severe pneumonia due to COVID-19. Material(s) and Method(s): A descriptive study of the cases of iatrogenic TS in COVID-19 ICU-survivors evaluated at our center's MDT, from the end of the first wave to present. Result(s): A total of 10 patients were included, 70% were women, with a median age of 60 years [53.5-64.5]. The median ICU stay was 58.5 days [34-91]. All patients were intubated and 9 of them (90%) required TT, in 2 cases due to extubation failure. Symptoms at diagnosis included dyspnea in 3 (30%), stridor in 6 (60%) and 1 (10%) was asymptomatic. TS location was glottic in 2 (20%) and tracheal in 8 (80%). The main cause of TS was ring fracture secondary to TT (40%). Conclusion(s): Iatrogenic TS is a rare cause of dyspnea in COVID-19 ICU-survivors, but it must be considered in these patients given the high number of patients who required prolonged ETI or TT during the COVID-19 pandemic.
ABSTRACT
Introduction: During the COVID-19 pandemic, alternatives to face-to-face teaching were on the urge. What's more, in the context of the respiratory support of COVID patients, the training and capacitation of personnel capable of taking care of these patients was critical. Aims and objectives: Develop a Virtual Reality (VR) app for remote training of medical staff in the management of different acute respiratory diseases, including COVID-19. Method(s): Pulmonologists and software developers designed an app based on a virtual hospital using VR glasses. The teacher programs different clinical scenarios, where the student can converse with the patient and explore him, observing the respiratory mechanics and the skin coloration, auscultating different noises in various cardiac and pulmonary foci, edema in the lower extremities, etc. The student can request different tests (blood analysis, radiography, etc.) and prescribe treatment, including oxygen therapy and respiratory support. The clinical situation of the patient can change during the simulation. Result(s): Different acute respiratory diseases were successfully simulated, with a correct interaction between the student and the teacher. Conclusion(s): VR can be used as a tool for the remote training of medical staff, and provide high fidelity simulations for training in a wide variety of clinical situations.
ABSTRACT
Introduction: The occurrence of the late effects of covid-19(long-covid)is a hot issue. Detailed data on its forms within the population are still lacking. Aim(s): We want to describe the long-covid in the population of the Czech Republic(CR)in relation to the covid severity. Method(s): Prospective collection of data on consecutive patients(pts)sent by GPs to pulmonologists started since June,21. The interim analysis concerns pts enrolled by February,22. The analysis was based on data collected in Information System of Infectious Diseases of the CR, especially its long-covid module. The 44 outpatient centers cover all 14regions of the CR and represent 13% of all(343)outpatient clinics of pulmonologists, they are responsible for the care of long-covid pts in the CR. Result(s): 3.489pts have been included in the study so far. After the removal of 40%pts with significant comorbidities,1.895"healthy"post-covid individuals (50%men,69%non-smokers)remained. Only a minority of these pts with long-covid 874(46%)were hospitalized due to covid severity. Inpatients were older, more often males/obese, less likely smokers. Inpatients had more severe post-covid residual CTchanges, more frequent diffusion capacity impairment, more restrictive ventilation pattern, and more oxygen desaturation during walking. Contrary nonhospitalized pts had more cough, and obstructive ventilation pattern. Hospitalized and non-hospitalized pts did not differ in incidence of resting desaturation, dyspnea, fatigue, expectoration, and chest pain. Despite the fact that 64%of the CR population is fully vaccinated, only 25(1.3%)were vaccinated among long-covid cohort. Conclusion(s): Previously hospitalized have more severe long-covid, however, most pts had only a mild acute COVID.
ABSTRACT
Background and objective: Biologic therapies are known to reduce exacerbations and improve severe uncontrolled asthma management. The at-home administration of biologics has increased during the COVID-19 pandemic, but the characteristics of severe uncontrolled asthma patients who may benefit from at-home administration of biologic therapy have yet to be identified. Material(s) and Method(s): This project is based on the Delphi method, designed to reach an expert consensus through a multidisciplinary scientific committee addressing the following questions: clinical characteristics, treatment adherence, patient or caregiver administration ability, patient self-care, relationship with the healthcare professional, patient preference, and access to the hospital. Result(s): One hundred and thirty-one healthcare professionals (pulmonologists, allergists, nurses, and hospital pharmacists) completed two Delphi consensus questionnaires. Fourteen items were identified as priority characteristics, the first five being: 1. The patient follows the healthcare team's indications/recommendations to control their disease, 2. The patient is capable of detecting any deterioration in their disease and of identifying exacerbation triggers, 3. The patient receives biologic therapy and has stable disease with no vital risk, 4. The patient takes responsibility for their self-care, 5. The patient has occupational/educational obligations that prevent them from going to the hospital regularly. Conclusion(s): Disease stability and control plus the ability to identify exacerbation triggers are the most important characteristics when opting for at-home administration for a patient with severe uncontrolled asthma on biologic therapy. These recommendations could be applicable in clinical practice.Copyright © 2022
ABSTRACT
Introduction: The impact caused by the Coronavirus disease (COVID-19) has considerably altered the provision of outpatient rehabilitation services, especially pulmonary rehabilitation (PR). Objective(s): To describe the situation of PR services in Latin America 18 months after the beginning of the COVID-19 pandemic. Method(s): Cross-sectional study in which a survey was sent to professionals from PR centers in Latin America. An online questionnaire was applied from May to September 2021. The following data were included: demographic data of the programs, evaluation strategies, program structure, RP intervention in post-COVID-19 patients, and perception of therapeutic strategies for the care of post-COVID patients. COVID-19. The questionnaire was distributed in Spanish and Portuguese languages. This study was approved by the ethics committee. Result(s): Responses were received from 196 centers from 14 countries;Most of the surveys were answered by physiotherapists/kinesiologists in 65.7%. In the evaluation of exercise tolerance, the 6-minute walk test is the most used. Less than 50% of the institutions evaluate the quality of life, symptoms, and lung function. In the prescription of exercise intensity, there is reduced use of CPET and it is prescribed mainly with subjective scales of symptoms (Borg Scale) (78.1%), and response to exercise with vital signs (71.4%). The programs have, practically, for the most part, physical therapists (90.8%), as well as pulmonologists (60%), psychologists (35%), among other professionals. Conclusion(s): The application of these programs in Latin America is heterogeneous, both in the evaluations and the interventions carried out.
ABSTRACT
Introduction: Telemedicine has already been used for the patients with respiratory diseases especially at follow up of long term mechanically ventilated patients and tele-pulmonary rehabilitation. Aim(s): To assess the efficacy of telemedicine consultation system in the management of COVID-19 suspected patients at hospital admission. Method(s): To reduce the risk of SARS-CoV-2 contamination among health-care workers, the COVID-19 pandemic control committee of our centre established a tele-medicine consultation group including pulmonologists, radiologists, emergency medicine and infectious disease specialists. Suspected COVID-19 patients were examined in the pandemic outpatient clinic or emergency department at their first admission by a physician. The physician consulted to the tele-consultation group with a structured medical story and test results after the first examination. Result(s): 469 patients were evaluated through teleconsultation, of 58.2 % were pre-diagnosed with COVID-19. SARS-COV-2 PCR resulted positive in 76.3 % of 273 patients with COVID-19 pre-diagnosis. 288 patients were hospitalized, and 0.9 % of discharged patients were re-admitted to the hospital due to deterioration. Main diagnoses were as follows: COVID-19 (n:289, 62 %), Cardiogenic pulmonary edema (n:40, 8.6 %), non-COVID-19 pneumonia (n:44, 9.4 %), COPD exacerbation (n:8, 1.7 %). Consistency rates between pre- and main diagnosis were 87,2 % for COVID-19 and 63,5 % for non-COVID-19 diseases. Discussion(s): The teleconsultation could be considered an effective method for the management of COVID-19 during the admission to hospital with a reduced risk of transmission of SARS-CoV-2 among health-care workers.
ABSTRACT
Introduction: In the post-acute phase, COVID-19 survivors may have persistent symptoms, lung function abnormalities and sequela lesions on thorax CT. This new entity is defined as post-COVID Interstitial Lung Disease (ILD) or a residual disease. Aim(s): To investigate the characteristics and clinical significance of post-COVID-19 ILD. Method(s): Patients with persistent respiratory symptoms after recovery were evaluated by a team including two pulmonologists and a radiologist. Pulmonary function tests, 6-minute walking test, thorax HRCT were performed. Post-COVID ILD was defined as presence of all the followings: respiratory symptoms, hypoxemia, restrictive lung functions and interstitial changes on follow-up HRCT. Result(s): A total of 375 post-COVID-19 patients were evaluated on average 91 days after recovery and 262 of them were included. 17.9 % of the patients were non-hospitalized with mild COVID-19;10.8 % of the patients had received high flow nasal oxygen, of 17.5 % had required non-invasive mechanical ventilation, of 8.8 % had been intubated. The most prevalent symptoms were dyspnoea, exercise intolerance and fatigue. The mean mMRC score was 1.82, oxygen saturation was 94.1, 6-minute walking distance was 374 meters. Pulmonary functions (percentage of mean predicted value +/- SD) were as follows;FEV1:79+/-19, FVC: 73+/-19, FEV1/FVC: 87+/-9, DLCO: 64.5+/-21.8. On CT, GGOs, fibrotic bands, and a combination of them were detected. The mean CT score was 13.5. Discussion(s): The presence of symptoms and functional defects in addition to radiological parenchymal lesions requires the definition of this new entity is post-COVID-19 ILD which could be seen even in non-hospitalised patients with mild COVID-19.
ABSTRACT
Introduction: SARS-COV-2 pandemic challenged the medical education face-to-face meetings. ILD Virtual Clinics(ILD-VC) were thought as a non-traditional medical education model to address topics about a holistic managementof ILDs. Weekly videoconferencing interviews with local experts and Q&A from the public were developed. Objective(s): To describe a virtual medical education model with an innovative format through interviews with experts indifferent ILD topics as a best practice.Implementation: 20 episodes of ILD-VC were carried out with an audience of pulmonologists, rheumatologists andgeneral physicians from Argentina, Paraguay and Uruguay. Each 60 minutes duration episode with the presence ofthe coordinators and an expert in a specific topic for each episode recognized as an unmet need. The main objectivewas to discuss ILD management from different points of view and create a digital library with advices from thechosen experts. Some of the topics were: antigen searching for HP;determining progression in PF-ILDs;amongothers. The number of virtual assistants was 217 per episode (average) with a maximum of 382 and more de 4300connections in total. A third season in planned for 2022. Conclusion(s): This innovate format provided a better understanding of ILD holistic management. Disclosures: The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE). The authors did not receive payment related to the development of the abstract. Boehringer Ingelheim (BI) was given the opportunity to review the manuscript for medical and scientific accuracy as well as intellectual property considerations. The study was supported and funded by BI.
ABSTRACT
Since the introduction of the first home oxygen systems, evidence has been generated about their benefits;however, controversies persist in their prescription in respiratory and non-respiratory diseases (Albert, R.K. et al. N Engl J Med 2016;375: 1617-27). The access to home oxygen systems has always been limited in the Dominican Republic;the COVID-19 pandemic has increased the need to reduce hospital stays, avoid readmissions, treat patients at home due to the lack of beds, risk of infection, or fear of isolated admission;generating an unprecedented rise in prescriptions, and an oxygen crisis in some countries (Usher AD. Lancet 2021;397: 868869). In order to optimize the available resources, we thought about the possibility of rationalize the use of home oxygen systems. From April 2020 to December 2021, we followed up 327 patients diagnosed with COVID-19 under home oxygen treatment;every two weeks we perform a phone call to assess the need to continue the oxygen therapy according to the oxygen saturation, and clinical evolution. The data results shows that 80% needed oxygen therapy less than 30 days and 93.2% of the patients less than 90 days, which corresponds to provisional use, and allowed us to provided the oxygen therapy to all those patients with only 20 oxygen concentrators. Provisional prescriptions of home oxygen therapy is an area of controversy due to lack of evidence on their benefits;however, it has played an important role due to the changing needs during the COVID-19 pandemic. As long as the prescription is reviewed by a pulmonologist to optimize resources, it becomes a useful tool as we have been able to observe.
ABSTRACT
Background: Poor prognosis of lung cancer is linked to its late diagnosis, typically in the advanced stage 4 in 50-70% of incidental cases. Lung Cancer Screening Programs provide low-dose lung CT screening to current and former smokers who are at high risk for developing this disease. Greece is an EU country, returning strong from a long period of economic recession, ranked 2nd place in overall age-standardized tobacco smoking prevalence in the EU. In December 2020, at the Metropolitan Hospital of Athens, we started the 1st Screening Program in the country. We present our initial results and pitfalls met. Method(s): A weekly outpatient clinic offers consultation to possible candidates. LDCT (<=3.0mGy), Siemens VIA, Artificial Intelligence multi-computer-aided diagnosis (multi-CAD) system and LungRADS (v.1.1) are used for the validation of any abnormal findings with semi-auto measurement of volume and volume doubling time. Patients get connected when necessary with the smoking cessation and Pulmonology clinic. USPSTF guidelines are used, (plus updated version). Abnormal CT findings are discussed by an MDT board with radiologists, pulmonologists/interventional pulmonologists, oncologists and thoracic surgeons. A collaboration with Fairlife Lung Cancer Care the first non-profit organization in Greece is done, in order to offer the program to population with low income too. An advertisement campaign was organized to inform family doctors and the people about screening programs, together with an anti-tobacco campaign. Result(s): 106 people were screened, 74 males & 32 females (mean age 62yo), 27/106 had an abnormal finding (25%). 2 were diagnosed with a resectable lung cancer tumor (primary adenocarcinoma) of early-stage (1.8%). 2 with extended SCLC (lung lesion & mediastinal adenopathy). 1 with multiple nodules (pancreatic cancer not known until then). 3 patients with mediastinal and hilar lymphadenopathy (2 diagnosed with lymphoma, 1 with sarcoidosis). 19 patients were diagnosed with pulmonary nodules (RADS 2-3, 17%) - CT follow up algorithm. Conclusion(s): We are presenting our initial results, from the first lung cancer screening program in Greece. Greece represents a country many smokers, who also started smoking at a young age, with a both public and private health sector, returning from a long period of economic recession. COVID-19 pandemia has cause practical difficulties along the way. LDCT with AI software, with an MDT board and availability of modern diagnostic and therapeutic alternatives should be considered as essential. A collaboration spirit with other hospitals around the country is being built, in order to share current experience and expertise. Copyright © 2022
ABSTRACT
Purpose: Although, much has been written about COVID risk and immunization efficacy in transplant recipients, there is little data on the impact of COVID on transplant professionalism. Method(s): A survey about the impact of COVID on professional development was sent to transplant providers. There were 138 responses (10% response rate) with equal representation from transplant nephrologists, pulmonologists, surgeons, cardiologists and advanced practice providers. Responses were evenly divided between gender and across regions of the US. Result(s): 75% of respondents reported that COVID has had a negative impact on their own education with the primary reasons given being 'virtual fatigue' and not taking time off to attend virtual meetings leading to lack of engagement. 40% of respondents reported that staffing shortages made it difficult to attend virtual meetings. When asked about any positive impact of COVID on their education 43% said the ability to view sessions on their own time without travel requirements was positive. The impact of COVID on fellows' education was seen with reduced disease specific education due to focus on COVID and reduced fellow time on the wards (55% & 48% respectively).74% of respondents reported a negative impact on their professional relationships within their own center. The primary reasons were physical and emotional fatigue (43%) and staffing shortages (37%). The inability to socialize outside the work setting also had a significant impact. Fortunately, few had family or colleagues ill with COVID, but 3 reported death of co-workers or family members. Though most reported no positive impact on their work relationships (62%), "bunker mentality" and increased patience with colleagues were reported by 35%. 64% of respondents reported fatigue and lack of opportunity to see colleagues outside their own institution as a negative impact on those relationships. 76% described no positive impact on those relationships. 60% of respondents related a negative impact on their own research as there was no time to focus on research and/or most non-COVID research stopped, leading to lack of connection with research colleagues. 81% of respondents reported 'burnout' and 18% reported Post Traumatic Stress Syndrome (PTSD). When asked what the most significant impact of COVD on professionalism the overwhelming responses were emotional and physical fatigue and isolation from colleagues. The emotional stress of family and colleagues ill and sometimes dying from COVID takes a toll. Conclusion(s): In summary, in addition to the stress and physical toll the pandemic created for health care providers, transplant professionals reported a loss of ability to advance the field of transplantation due to the inability to attend professional meetings, participate in transplant-related research, and network with colleagues on topics other than COVID related care.
ABSTRACT
SESSION TITLE: Late Breaking Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: The science continues to develop in terms of the epidemiology of persistent, or long COVID, especially in the pediatric population. The impact of persistent COVID-19 on cardiorespiratory fitness in the form of physical activity and athletic performance among children/adolescents is not well described, especially among vulnerable populations. METHODS: A retrospective electronic health record review identified children/adolescents with previously diagnosed COVID (N=312, 52.9% male, mean age at diagnosis 6.6 [SD 5.9] years, 20.5% non-Hispanic White [NHW], 19.2% non-Hispanic Black [NHB], and 54.5% Hispanic, 85.26% hospitalized due to COVID-19 illness) from one pediatric healthcare system that serves predominantly Medicaid-dependent families. Patients or caregivers completed a follow-up telephone survey from March 2021- February 2022 to estimate the prevalence of persistent COVID symptoms, defined as the presence of symptoms lasting ≥ 30 days. Multiple logistic regression models explored the association between physical activity and the presence of long COVID. RESULTS: 71 (22.8%) patients reported long COVID and the most prevalent symptoms included tiredness (21 [6.7%]), shortness of breath (18 [5.8%]), cough (16 [5.1%]), headache (14 [4.5%]), difficulty with thinking/concentration (14 [4.5%]), disrupted sleep (14 [4.5%]), other symptoms (12 [3.8%]), anxiety (11 [3.5%]), body aches (11 [3.5%]), joint pain (10 [3.2%]) chest pain (9 [2.9%]), intermittent fever (6 [1.9%]), and loss taste/smell (5 [1.6%]). Almost a third (32%, N = 24) of patients who participated in any athletics or physical activity in or outside of school reported a negative impact on physical or athletic performance, and 66.7% reported it was directly related to COVID-19 illness. Specific complaints when returning to physical activity post-COVID illness included tiredness (7 [36.8%]) and shortness of breath (2 [10.5%]). The odds of a decline in physical activity performance was over twice that (OR 2.17, 95% CI 0.54-8.71, p = 0.28) among children with long COVID versus those reporting no long COVID after adjusting for demographics. There was no difference by age (mean 9.8 vs. 9.7 years, p = 0.93), sex (50% girls vs. 50% boys, p =0.71), or race/ethnicity (25% NHW vs. 25% NHB vs. 37.5% Hispanic, p = 0.25) in terms of decline in physical activity performance. Two children were recommended to delay re-entry into physical activity. CONCLUSIONS: A substantial proportion of ethnically diverse children from low resource backgrounds who had severe COVID illness are reporting long-term impacts on physical activity and cardiorespiratory fitness. Findings can inform pediatricians about this vulnerable population in post-COVID-19 recovery efforts. CLINICAL IMPLICATIONS: Pediatric pulmonologists and other sub-specialists should screen and monitor patients who have had previous severe COVID-19 illness for persistent cardiorespiratory impacts. DISCLOSURES: No relevant relationships by Kubra Melike Bozkanat No relevant relationships by Jackson Francis No relevant relationships by Weiheng He No relevant relationships by Alejandra Lozano No relevant relationships by Matthew Mathew No relevant relationships by Sarah Messiah No relevant relationships by Angela Rabl No relevant relationships by Sumbul shaikH No relevant relationships by Nimisha Srikanth No relevant relationships by Apurva Veeraswamy No relevant relationships by Sitara Weerakoon No relevant relationships by Luyu Xie
ABSTRACT
SESSION TITLE: Unique Uses of Pulmonary Function Tests SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Prevention of asthma exacerbations can be done through adequate self management at home. This study aimed to evaluate the feasibility and safety of a portable spirometer for unsupervised home spirometry measurements among patients with asthma. METHODS: A single center, prospective, single-arm, open study recruited 25 patients with moderate or severe asthma. After a 45 min video training session by a respiratory therapist, patients performed daily spirometry at home with the Spirobank Smart MIR mobile spirometry system that was bluetooth connected to the KevaTalk app. Each spirometry examination was recorded and evaluated according to the ATS/ERS acceptability and repeatability criteria. Patients had to perform at least three technically acceptable maneuvers with the KevaTalk app guiding them if they had a good or bad blow. The best value of the three maneuvers were used for subsequent analyses. Patients also entered their daily check ins and symptoms via the KevaTalk Asthma app, tracked their controller and rescue medication use, filled up ATAQ questionnaires as well as were reminded of their action plans. Data obtained from spirometry was reviewed by nurses and pulmonologist and the Keva365 remote monitoring platform prompted alerts based on patient checkins, use of medication and PEF values in the red or yellow zone. Any escalations based on nurse review were reported to the office. RESULTS: Mean age of the patients was 57 years. 1155 spirometry sessions were completed over the duration of 9 months of the study. Data for FEV1, FEV6, PEF FEV1/FVC, as well as the Best Predicted and LLN values was reviewed daily for patients. Flow volume loops during the sessions were reviewed to identify if the home spirometry was done correctly and retraining was provided if needed. The reported values were tracked over the duration the patient was enrolled in the Keva program. 60.9% of patients were found to have peak flows in their respective red zones at least once and 87% were found to have peak flows in their yellow zone at least once, during the course of the study. If 3 consecutive values were in the yellow or red zone along with worsening of symptoms, the physician's office was informed for further course of action. CONCLUSIONS: The COVID-19 pandemic led to paucity of in office spirometry and face-to-face visits for asthmatic patients. Increasing the availability of spirometry with handheld devices along with a remote monitoring platform is useful for improving asthma control and reducing the risk of asthma-related hospital admissions and deaths. CLINICAL IMPLICATIONS: Remote objective spirometry yields clinically meaningful information that helps with asthma patient management and prevent an exacerbation from becoming worse. DISCLOSURES: No relevant relationships by Karim Anis No relevant relationships by Varada Divgi No relevant relationships by Jyotsna Mehta No relevant relationships by Shail Mehta No relevant relationships by Denzil Reid