ABSTRACT
Achalasia is a rare esophageal motility disorder that leads to dysphagia, regurgitation, and several other symptoms. While the etiology of achalasia is not completely understood, studies have suggested an immune reaction to viral infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as a potential cause. Here, we present a case report of a previously healthy 38-year-old male who presented to the emergency room with severe shortness of breath, recurrent vomiting, and dry cough, that had progressively worsened over five days. The patient was diagnosed with coronavirus disease 2019 (COVID-19), and a chest CT also revealed prominent features of achalasia with a markedly dilated esophagus and areas of narrowing at the distal esophagus. The initial management of the patient included IV fluids, antibiotics, anticholinergics, and corticosteroid inhalers which improved his symptoms. This case report highlights the importance of considering the acute-onset of achalasia in COVID-19 patients and the need for further research on the potential association between SARS-CoV-2 and achalasia.
ABSTRACT
Introduction: Coronavirus Disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has become a worldwide pandemic. It is primarily a pulmonary disease which can lead to respiratory distress syndrome;some go on to develop ventilator dependent chronic respiratory failure. In these patients, enteral feeding is critical and initially provided by nasogastric (NG) or orogastric (OG) tubes. However, feeding tubes are associated with local complications such as nasopharyngeal/oropharyngeal erosions and esophageal/gastric cardia ulceration. Percutaneous endoscopic gastrostomy (PEG) tube placement facilitates longer-term enteral access. Minimal data exists on the safety and efficacy of PEG tube placement in patients with SARS-CoV-2 infection. Methods: A retrospective chart review was performed to collect data for patients who underwent PEG tube placement between January 2020 to January 2021 at Houston Methodist Hospital. Inclusion criteria included patients who had endoscopic PEG tube placement during this time interval. Exclusion criteria included patients who underwent PEG placement via interventional radiology or surgically. Approval for study was obtained from the Institutional Review Board at Houston Methodist Hospital. Success was defined as PEG placement and use to provide enteral nutrition with no complications over a 4-week period after placement. Results: 36 patients with (mean age 63.6 years;38.8% females) and 104 patients without COVID-19 infection (mean age 64.9 years, 44.2% females) were included in the study. 25 patients were excluded who had missing data, had PEG-J tube placed, or had it placed by interventional radiology initially and exchanged endoscopically during the study period. Table 1 summarizes the main demographic and clinical characteristics of participants. COVID-19 patients were more likely to be obese, be on anticoagulants and have a tracheostomy in place. 11.1% of the patients with COVID-19 developed PEG-related complications compared to 16.3% patients without COVID-19 χ2 with Yate's correction (1, N=140) = 0.23, p=0.65. The success rates of PEG placement in patients with and without COVID -19 were similar at 97.2% and 90.3%, respectively,, χ2(1, N=140) =1.7, p=0.18. Conclusion: This is, to our knowledge, the first study to assess the safety and efficacy of PEG tube placement in patients with SARSCoV- 2 infection. The study demonstrates that despite high BMI and rate of anticoagulant therapy, PEG placement was universally successful, and complication rates no different from those of age- and gender-matched non-COVID-19 patients. PEG tube placement offers a safe and effective means of providing longer term access for enteral nutrition in COVID- 19 patients. (Table Presented)
ABSTRACT
Introduction The CytospongeTM test is a non-endoscopic method to collect cells from the oesophagus and test for biomarkers of early oesophageal cancer and its precancerous form, Barrett's oesophagus. The real-world implementation pilots of the Cytosponge has been accelerated in response to the COVID-19 pandemic. At the onset of the pandemic, when endoscopy services were paused, guidelines from the British Society of Gastroenterology were updated to recommend the use of alternatives including the Cytosponge. In December 2020, NICE published a Medtech Innovation Briefing for use of the Cytosponge test as a triage tool for endoscopy to identify people at risk of oesophageal cancer. Aims & methods Implementation pilots were launched within the NHS in England and Scotland, as well as the Innovate UK-funded research project, Project DELTA. The Cytosponge test was offered to two patient cohorts as an alternative to endoscopy: (1) patients already diagnosed with Barrett's Oesophagus, and so in need of routine surveillance;and (2) patients referred from primary care with reflux symptoms. Samples were received, processed and analysed at the ISO 15189:2012 accredited laboratory at Cyted. Pathology reports were issued with TFF3, p53 and atypia biomarker results and clinical recommendations. Any reports positive for p53/atypia biomarkers were double reported. Here, we evaluate the real-world laboratory metrics for the Cytosponge test in secondary care. Results Between August 2020 and November 2021, Cytosponge tests were delivered to 5373 patients at 48 hospitals across England and Scotland. For 4842 diagnostic reports issued by mid-November, 2807 patients had Barrett's Oesophagus and 2034 reflux symptoms. For Barrett's surveillance, 2629 (93.7%) of patient samples had sufficient cellular material for analysis, including sampling the gastric cardia. Of these 324 (12.3%) exhibited cellular atypia (including uncertain significance), dysplasia, or aberrant p53 expression. These patients were recommended to have an endoscopy. Patients without evidence of atypia/dysplasia/p53 were recommended surveillance by Cytosponge or endoscopy after the recommended interval by clinical guidelines. In the symptomatic reflux cohort, 1854 (91.2%) patient samples had sufficient cellular material for analysis, including sampling the gastric cardia. Of these 185 (10.0%) exhibited intestinal metaplasia corroborated by TFF3 expression and a further 44 (2.4%) exhibited atypia/ dysplasia/p53. These patients were recommended to have an endoscopy. Otherwise, patients were recommended management according to symptoms. Discussion A high-quality centralised laboratory service has enabled accelerated real-world implementation of the Cytosponge in the secondary care setting. This has enabled triage and care of patients who have not been able to access endoscopy during the COVID-19 pandemic.
ABSTRACT
OBJECTIVE: To investigate the impact of coronavirus disease 2019 (COVID-19) on psychosocial and behavioral responses of the non-health care workforce and to evaluate transmission prevention behavior implementation in the workplace. PARTICIPANTS AND METHODS: We deployed the baseline questionnaire of a prospective online survey from November 20, 2020, through February 8, 2021 to US-based employees. The survey included questions on psychosocial and behavioral responses in addition to transmission prevention behaviors (e.g., mask wearing). Select questions asked employees to report perceptions and behaviors before and during the COVID-19 pandemic. Data were analyzed descriptively and stratified by work from home (WFH) percentage. RESULTS: In total, 3607 employees from 8 companies completed the survey. Most participants (70.0%) averaged 90% or more of their time WFH during the pandemic. Employees reported increases in stress (54.0%), anxiety (57.4%), fatigue (51.6%), feeling unsafe (50.4%), lack of companionship (60.5%), and feeling isolated from others (69.3%) from before to during the pandemic. Productivity was perceived to decrease for 42.9% of employees and non-work-related screen time and alcohol consumption to increase for 50.7% and 25.1% of employees, respectively, from before to during the pandemic. Adverse changes were worse among those with lower WFH percentages. Most employees reported wearing a mask (98.2%), washing hands regularly (95.7%), and physically distancing (93.6%) in the workplace. CONCLUSION: These results suggest worsened psychosocial and behavioral outcomes from before to during the COVID-19 pandemic and higher transmission prevention behavior implementation among non-health care employees. These observations provide novel insight into how the COVID-19 pandemic has impacted non-health care employees.