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Purpose: Atopic dermatitis (AD) is a chronic, relapsing and remitting inflammatory skin disease characterized by intense itch. The disease burden includes physical limitations, psychosocial discomfort, and a reduced quality of life (HRQoL). This study presents the results of a parent-reported survey on the psychosocial impact of AD on Italian pre-adolescent children (6-11 years old), with a specific focus on bullying, self-isolation, absenteeism, and presenteeism. Methods: An online questionnaire was sent to 3067 random recipients and 160 matched the inclusion criteria for age, self-reported AD diagnosis, localizations (according to ISAAC), and disease severity (POEM ≥8). 100 children, with comparable ages, not matching the inclusion criteria for AD, were recruited as a control group. Results: Children with AD and their caregivers had a significantly lower quality of sleep (QoS) compared to the control group. The presence of AD was directly responsible for many restless nights, both in children and caregivers (58.9 and 55.4 respectively). Children with AD and their parents also experienced significantly more daytime drowsiness (43.6 and 54.6 days, respectively). Children with AD were more frequently victims of bullying at school (20.0% vs 9.0%; p≤0.05) or in other social environments (16.9% vs 3.0%; p≤0.05). AD caused 17.7 days of absenteeism and 20.1 days of presenteeism per student over the previous 12 months, accounting for 37.8 days of study impairment overall. Severe/very severe AD had a significantly greater impact on presenteeism than moderate AD (25.1 vs 17.5 days; p≤0.05). Presenteeism, which was more pronounced among bullied students, was positively correlated with absenteeism only in the AD cohort. Conclusion: AD has a detrimental impact on the HRQoL of pediatric patients, causing stigmatization and social isolation. Functional distress was also reported by caregivers. Our study might inform the public and policymakers about the disease burden of AD at a young age.
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Background: The COVID-19 Pandemic hit INDIA in March 2020. This pandemic lead to confinement of students at home for more than a year. This influenced their dietary behaviours and physical activity along with increase in stress levels. The net result of pandemic was alterations in weight, increasing the risk of obesity and diseases associated with obesity especially in affluent class. AIMS and OBJECTIVES: This study aims to evaluate the effect of confinement on body weight in students of 17-18 yrs of Jaipur and to identify the contributory factors. Material and Methods: A school based, cross-sectional, observational study was carried out from January 2021 to june 2021involving 300 students in age group of 17-18 years studying in private school belonging to affluent class. Students were made to fill a proforma regarding their daily lifestyle and physical activities. Physical activity was evaluated with the International Physical Activity Questionnaire. Weight before the pandemic confinement was compared to the post confinement weight. Data was analysed using DATAtab Team (2023). DATAtab: Online Statistics Calculator. DATA tab e.U. Graz, Austria. URL https://datatab.net/ Results: More than 50% of students gained significant weight during the pandemic. Only one third of participants were moderately physically active. Factors contributing to weight gain included increased consumption of unhealthy food, altered sleep pattern, increased screen time and decreased physical activity. Conclusion: The study showed that confinement lead to significant weight gain in students of affluent class .The findings showed the short term effects of pandemic confinement. This study during Covid19 confinement will help the health authorities in understanding and implementing newer policies for healthy lifestyle when newer pandemics waves arrive. [ FROM AUTHOR] Copyright of Journal of Pharmaceutical Negative Results is the property of ResearchTrentz and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Background: Since the outbreak of COVID-19, vaccination has been considered as an important measure against it. Side effects have always been an inseparable component of vaccination, which in this study, Sinopharm vaccine, its side effects and the differences of their manifestation amongst men and women have been investigated. Objective(s): This study aimed to compare the side effects of the Sinopharm vaccine among men and women working in some medical centers in Tehran, Iran. Method(s): This cross-sectional descriptive-analytical study on 890 healthcare workers of 7 medical centers in Tehran within 2 months, from late June to late August 2021. The samples were selected by the complete enumeration method, and the required data were collected using a questionnaire. Only those who received the Sinopharm vaccine at least 10 days before the study were included. Result(s): Of 890 participants, 22.96% and 77.30% were women and men, respectively, and 65.8% of women and 78.1% of men were in the age range of 20-29 years. It was revealed that 74.75% of women and 26.16% of men had at least one side effect. The incidence of at least one side effect was significantly higher in women than in men (P<0.001). It was also found that 12 side effects were significantly higher in women than in men. Most men and women had side effects within the first 24 h after vaccination. There was no significant difference in taking therapeutic measures to reduce or minimize the post-vaccination complications between men and women;however, 9.4% of men and 27.2% of women reported a decline in their ability to perform daily activities as they were unable to do their everyday tasks the day after vaccination which was significantly different between the two groups (P<0.001). Conclusion(s): The results showed that the occurrence rate of side effects after receiving the Sinopharm vaccine was significantly higher in women than in men. Moreover, women were significantly less able to perform daily routines than men.Copyright © 2022, Author(s).
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Background/Purpose: The COVID-19 pandemic and associated mitigation procedures have significantly altered daily life in ways that may disproportionately affect patients with CNS tumors. This study aimed to explore differences in symptom burden and interference, mood disturbance, and health-related quality of life in the CNS tumor patient population during the COVID-19 pandemic, compared to a normative sample of pre-pandemic data. Method(s): Data from the Neuro-Oncology Branch (NOB) Natural History Study, including demographic and clinical data, as well as PROs including PROMIS Anxiety and Depression Short-Forms, EQ- 5D-3L, MDASI-Brain Tumor/Spine Tumor, and NeuroQOL-Cognition Function, were collected and compared across groups ('NOB normative sample' and 'COVID year' patients) using one-sample proportion tests. Result(s): 178 COVID year CNS tumor patients (55% male, 82% Caucasian, median age 45 years) were compared with 678 NOB normative sample patients with similar demographic and clinical characteristics. Symptom burden remained comparably high during the COVID year compared to the NOB normative sample with the most common moderate-severe symptoms being fatigue (31% vs. 35%), difficulty remembering (28% vs. 24%), drowsiness (22% vs. 25%), disturbed sleep (20% vs. 22%), and distress (20% for both). However, a significantly greater proportion of COVID year assessments endorsed moderate-severe depression on the PROMIS compared to the NOB normative sample (17% vs. 12%, p = 0.023, Cohen's h = 0.22) and moderate-severe depression/anxiety on the EQ-5D-3L was also more prevalent (53% vs. 43%, p = 0.009, Cohen's h = 0.28). There were no other significant differences in PROs between groups. Conclusions and Implications: These findings demonstrated that while objective symptom burden for CNS tumor patients was unchanged, there was an increase in depression reported during the COVID-19 pandemic. Future work should investigate potential pandemic-era interventions for screening, targeting, and improving both mood disturbance and other disease-specific symptoms to improve symptom burden and quality of life.
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Background: Introduction: Coronavirus disease (COVID-19) is a global problem. The COVID-19 pandemic has infected millions of people and the number of patients who have been exposed to postcovid implications are increased. Postcovid changes are more investigated in adults, although information is scarce in pediatric patients. Method(s): The aim of the study was to evaluate the radiological changes of respiratory system in peaditric patients after acute mild and severe covid infections. Research subjects: 259 pediatric patients (age: 10 months -18 years) recovered from Covid-19 and had a negative PCR test were examined. All patients underwent X-ray examinations. Patients were divided into 3 subgroups. Patients (46%) recovered from severe or moderate covid pneumonia and had non-respiratory symptoms upon arrival at the clinic: weakness, mild fatigue, drowsiness. Patients (28%) recovered from covid infection and had respiratory symptoms: cough, shortness of breath during exercise, respiratory failure;Patients (26%) with a fever upon entry to the hospital. The statitical analysis was done using SPSS 12.0 software. Result(s): Patients, whose had (69.9% ) the severe Covid pneumonia and postcovid respiratory symptoms (cough 78.4%), which was the cause of abnormal changes in the cardiovascular system were onserved in 48.6% of patients. Unlike other types of viral infections, the changes continue in the postcovid period. Severe course of the disease does not always mean detection of postcovid syndrome and vice versa. However, in case of mild disease the possibility development of various degrees of polyorgan damage was 26.9%. Conclusion(s): The radiological changes are manifested during 4th week from recovery and may last for a longer period of time, however the radiological changes do not always indicator a severity of the disease.
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Nowadays, technology is growing rapidly followed by modernization. Face detection technology is one technology that has been developed and applied in various sectors such as biometrics recognition systems, retrieval systems, database indexing in digital video, security systems with restricted area access control, video conferencing, and human interaction systems. Eye detection is a further development of face detection in which the image of a human face was detected to be processed by detecting the location of both eyes on the face. Nowadays, the eye detection system can be used as a means of developing more complex applications and can be applied directly in the aspect of technology that uses eye detection like, eye state detection system, drowsiness and fatigue detection system, safety driving support systems or driver assistance system. In this study we propose drowsiness detection system utilizing current novel classification model such as Deep Neural Network (DNN), combined with Haar Cascade. The DNN is utilized to detect face, while Haar Cascade is utilized for detecting the eyes and its state on the detected face. In this study, due to Covid19 pandemic, we focused on developing the classifiers for detecting the face with mask. Apart from that, our proposed classifiers are also capable of identifying non-masked faces. The experimental result showed that by utilizing DNN and Haar Cascade, our proposed system could reach accuracy, precision, recall, and f1 measure as much as 81%, 88%, 80%, and 84%, respectively. © 2022 IEEE.
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Background: Although vaccines have been launched, COVID-19 has not been effectively curbed, and the number of infections is increasing. Compared with western medicine, Traditional Chinese Medicine has made some achievements in the treatment of COVID-19, which should be paid attention to and play a greater role. As a classical Chinese medicine prescription for treating pestilence, Lianhuaqingwen (LHQW) has gone to many countries with the Chinese medical team to participate in the local fight against the epidemic, which has been widely recognized. Method(s): We searched MEDLINE, EMBASE, AMED, Chchrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science, Chinese National Knowledge Infrastructure (CNKI), VIP Information Database (VIP), Chinese Biomedical Literature Database (CBM), and Wanfang Database from inception up to November 24, 2021, which formed the basis for evidence used to formulate recommendations. Sixteen randomized controlled trials (RCTs) involving 1896 patients were enrolled. LHQW is a traditional Chinese medicine compound preparation, which contains 13 traditional Chinese medicine (TCM) components. Two dosage formulations of LHQW were included: granule and capsule. The most commonly used dosage formulation was granule (15/17, 88.24%), followed by capsule (2/17, 11.76%). Conclusion(s): This systematic review and Meta analysis suggested that, in the treatment of COVID-19, LHQW Capsule (Granule) could not only significantly improve the fever symptoms, shorten the fever time, but also reduce the cough and fatigue symptoms, improve the clinical efficiency, improve the lung CT, significantly reduce the number of patients with mild to severe diseases, and have certain anti-inflammatory effect. And there is no server adverse events which support the safety of LHQW Capsule (Granule) for the treatment of COVID-19. As a classic formula of TCM, LHQW Capsule (Granule) could be used as potential candidates for COVID-19 in this battle.Copyright © 2022
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Background: The SARS-CoV-2 invades the cells by attachment of virus spike proteins (S1, S2) to cell membrane and engages angiotensin-converting enzyme 2 (ACE2), which is highly expressed in the epithelium of cerebral vasculature. Here, we describe a patient with encephalitis following SARS-CoV-2 infection. Case presentation: A 77-year-old male patient presented with mild cough and coryza lasting for eight days without a prior history of underlying disease or neurologic disorder. Oxygen saturation (SatO2) was decreased and behavioral changes, confusion, and headaches were started within three days prior to admission. Bilateral ground glass opacifications and consolidations were noted on chest CT scan. Lymphopenia, highly elevated D-Dimer and ferritin were noted in laboratory results. Brain CT and MRI showed no changes regarding encephalitis. Cerebrospinal fluid was collected as the symptoms persisted. The results of SARS-CoV-2 RNA RT-PCR from CSF and nasopharyngeal samples were positive. The combination therapy with remdesivir, interferon beta-1alpha and methylprednisolone was started. Due to deterioration of the patient's status and SatO2, he was admitted to the ICU and intubated. Tocilizumab, dexamethasone, and mannitol were started. The patient was extubated on the 16th day of ICU admission. The patient's level of consciousness and SatO2 were improved. He was discharged from the hospital a week later. Conclusion(s): RT-PCR of CSF sample along with brain imaging can help with diagnosis when encephalitis due to SARS-CoV-2 is suspected. However, no changes regarding encephalitis may be seen on brain CT or MRI. Combination therapy with antivirals, interferon beta, corticosteroids, and tocilizumab can help patients recover in these conditions.Copyright © 2022 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran.
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Background: The coronavirus disease 2019 (COVID-19) has been sabotaging the world over the last two years and vaccine is one of the key solutions. However, the concerns over its side effects can cause vaccine refusal, subsequently affecting many countries' education system recovery plans. Objective(s): To actively evaluate adverse effects and their severity following COVID-19 immunization among schoolchildren aged 12 to 17 years, to support parents' decision-making. Material(s) and Method(s): The present study was an observational study whereby a Google-form survey on Pfizer COVID-19 vaccine adverse effects (CVAE) was responded between January and April 2022 by 537 participants. Descriptive statistics were used to analyze basic characteristics. Chi-square tests were performed for comparative analyses between junior (aged 12 to 15 years) versus senior (aged 16 to 17 years) high school students, and McNemar's test for the first dose versus second dose groups analysis with a significance level set at p-value less than 0.05. Result(s): At least one CVAE was reported in 93.85% of the included participants, albeit mostly mild. The most common symptom as a local event was tenderness at the puncture site (82.50%), whereas systemic events were predominated by myalgia (74.67%). The second dose was associated with increased frequency and severity of adverse effects compared to the first dose (p<0.001). The older age group had significantly more side effects compared to the younger group (p<0.05). Conclusion(s): The high incidence of CVAEs in schoolchildren was predominated by mild symptoms, with the second dose and older group associated with increased frequency of symptoms. The predominance of mild symptoms found in the present study may help reduce the concerns of parents over CVAEs, ultimately accelerating vaccine coverage in the children group, which is still a gap in vaccine administration.Copyright © 2023 JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND.
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Drowsiness is a common problem that many drivers encounter due to long working hours, lack of sleep, and tiredness. Tired drivers are as dangerous as drunk drivers because they have slower reaction times and suffer from reduced attention, awareness, and ability to control their vehicles. Drowsy driving causes many traffic accidents, especially fatal crashes. Therefore, the best way to prevent accidents involving drowsiness is to alert the drivers ahead of time. The accuracy of the drowsiness prediction reduces if the studies only focus on facial landmarks, ignoring other fatigue features such as tilting head, blinking, and yawning. To solve these problems, we propose an approach to detect driver drowsiness efficiently and accurately using IoT and deep neural networks improved from LSTM, VGG16, InceptionV3, and DenseNet. The use of transfer learning technique combined with multiple drowsiness signs is to improve the accuracy of the drowsiness detection in various driving conditions. The time-varying factor is also taken into consideration in the models developed from LSTM and DenseNet. When the driver's fatigue is detected, the IoT module emits a warning message along with a sound through a Jetson Nano monitoring system. The experimental results demonstrate that our approach using deep neural networks can achieve high accuracy of up to 98%. Notably, this approach has also been verified in cases with/without wearing a mask and glasses. This has a practical meaning in the Covid-19 pandemic situation when everyone needs to comply with the wearing of masks in public places.
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Purpose: To compare the frequency of occurrence of various symptoms of post-covid syndrome (PCS) in groups of patients with rheumatic diseases (RD) of the elderly to young. Material(s) and Method(s): The study involved 89 patients with RD who underwent COVID-19, verified by RT-PCR for SARS-CoV- 2 RNA, for the period from 05/15/2020 to 12/01/2021. Participants in the study, after talking with the research physician, completed questionnaires on past COVID-19 and post-COVID syndrome (PCS). The information was supplemented with data from discharge records after inpatient treatment for COVID-19. Result(s): The data obtained were differentiated depending on the age of the participants: <60 years (group 1), N = 69 and >=60 years (group 2), N = 20. Both groups were dominated by women (82.6% and 85%). The average age in group 1 was 41.9 +/- 11.6 years, in group 2 -68.5 +/- 5.1 years. 33 (47.8%) patients in group 1 and 10 (50%) in group 2 noted the development of PCS. In group 1, the following symptoms of PCS prevailed: memory impairment -in 17 (51.5%) patients, fatigue, weakness -in 14 (42.4%), problems with concentration -in 14 (42.4%), arthralgia -in 12 (36.4%) %, shortness of breath during physical exertion -in 11 (33.3%), drowsiness -in 10 (30.3%), irritability -in 9 (27.3%). In group 2, the most common memory impairment -in 8 (80%) patients, weakness, fatigue -in 7 (70%), arthralgia -in 7 (70%), problems with concentration -in 6 (60%), weight loss -in 5 (50%), irritability -in 5 (50%), sleep disturbance -in 5 (50%). The frequency of occurrence of different manifestations of PCS did not differ significantly between the groups. On average (median), each patient in group 1 noted 4 [2;8], group 2 -10 [8.25;12.5] symptoms of PCS at the same time, but the differences did not reach statistical significance. Conclusion(s): The frequency of occurrence of various clinical manifestations of PCS did not have statistically significant differences between the study groups. In a comparative assessment, the group of elderly patients noted a greater number of symptoms of PCS at the same time.
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A 36-year-old male, diabetic, with 10-day history of inpatient care due to SARS-CoV-2 pneumonia. Dyspnea, drowsiness, and a 24-hour asthenia evolution were the main symptoms the patient manifested. He had tachycardia, tachypnea, pallor, and a generalized jaundice. Laboratory studies revealed severe normochromic normocytic anemia with an intravascular hemolysis (Coombs test direct positive, LDH and indirect bilirubin increased, haptoglobin decreased), HBsAg: positive, IgM anti-HBc: negative and transaminases increased. The patient started treatment with tenofovir, apart from that boluses of methyl-prednisolone, human immunoglobulin and multiple microtransfusions were also given, having a good clinical evolution. Copyright © 2022, Sociedad Chilena de Infectologia. All rights reserved.
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Voici un siècle, alors que se répandait l'épidémie de grippe dite espagnole, René Cruchet, en France, et Constantin von Economo, en Autriche, attiraient l'attention des médecins militaires et civils sur l'apparition d'une autre pandémie, l'encéphalite léthargique. Après une phase de somnolence irrépressible plus ou moins prolongée, ceux qui survivaient développaient, progressivement, des séquelles permanentes de type syndrome parkinsonien ou paroxystiques à type de dystonies variées. Les patients étaient souvent des enfants et de jeunes adultes. De 1920 à 1946, la Société Médico-Psychologique consacre vingt séances à l'étude des séquelles neuropsychiatriques de ces encéphalites. À côté des mouvements anormaux, les psychiatres prennent en charge des délires hallucinatoires, des comportements violents et agressifs avec désinhibition sexuelle, des épilepsies myocloniques, etc. Il ressort des présentations cliniques résumées ici que cette pandémie permet aux psychiatres de rapporter à des lésions diencéphaliques et mésencéphaliques des détériorations psychiatriques comme jamais ils ne l'avaient fait auparavant. L'hypothèse étiologique actuelle conclut cette présentation. A century ago, when the so-called Spanish flu epidemic was spreading, René Cruchet in France and Constantin von Economo in Austria drew the attention of military and civilian physicians to the existence of another pandemic, encephalitis lethargica. After a more or less prolonged phase of irrepressible drowsiness, those who survived progressively developed permanent sequelae, i.e. parkinson' syndrome, or various types of paroxysmal dystonia. The patients were often children and young adults. From 1920 to 1946, the Société Médico-Psychologique devoted twenty sessions to the study of the neuropsychiatric sequelae of these encephalitides. In addition to abnormal movements, psychiatrists treated hallucinatory delusions, violent and aggressive behaviors with sexual disinhibition, myoclonic epilepsy, etc. The clinical presentations summarized here seem to demonstrate that this pandemic allowed psychiatrists to relate psychiatric deterioration to diencephalic and mesencephalic lesions in a way that they had never done before. The current etiological hypothesis concludes this presentation. [ FROM AUTHOR]
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The impact of COVID-19 has changed the way work is being done especially in the IT sector. The emergence of work from home as an option has resulted in the evolution of hybrid work culture going forward as the world is moving towards endemic. On these circumstances there has been drastic change in work pattern of employees which clearly impacted the efficiency levels and their wellbeing (both physical and mental). It has also become imperative for the employers to track the efficiency of employees during their working hours in order to ensure maximum productivity in hybrid working model. This paper proposes a system that can detect and track the employee efficiency though facial landmarks by assessing the parameters like drowsiness and stress using deep learning techniques and hybridization of classification algorithms. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Background: Comprehensive evaluation of new treatment regimens in RRMM patients both from physician's and patients' perspective is worthwhile. Aims: We aimed to evaluate clinical and patient-reported outcomes during IRd treatment as ≥ 2nd line in RRMM patients in a multicenter real-world evidence study. Methods: Adult patients with RRMM who have been assigned IRd as ≥2nd line treatment were enrolled in 18 centers of Russian Federation from April 2019 till May 2020. Treatment response was evaluated by IMWG 2011 criteria. For assessment of adverse events (AEs) NCI CTCAE v. 4.0 was used. Patients filled out RAND SF-36 and ESAS-R questionnaires at baseline, at 1 and 3 mos, and thereafter every 3 mos till 18 mos after IRd treatment onset. Statistical analysis of patient-reported outcomes was conducted using GEE with adjustment to age, gender and baseline quality of life (QoL). Duration of response (DOR), progression-free (PFS) and overall survival (OS) from the start of IRd treatment were evaluated using Kaplan-Meyer method. Results: In total, 40 patients with RRMM were enrolled into the study: median age - 64 years (range, 33-80), 35% males. Durie-Salmon stage at study entry: II/III - 40/60%, ECOG status 0/1 - 70%, 2/3 - 30%. Median time since initial MM diagnosis - 55 mos (range, 2.0-99.0). Median number of lines of prior therapy - 3 (range, 1-7). Comorbidities were revealed in 65% patients;median Charlson Comorbidity index - 2 (range, 0-5);95% patients had bone complications. The median duration of IRd treatment - 7.5 mos (IQR, 3.9-18.0). Two-thirds of the patients (28/39) responded to therapy. The overall response rate was 46.2% (95%CI: 30.6-61.8), median DOR - 16.3 mos (95%CI: 15.4-17.3). Among them 3 patients achieved complete response, 1 - stringent complete response, 2 - very good partial response, 12 - partial response. Ten patients had minor response. Clinical benefit rate - 71.8% (95%CI: 57.7-85.9). Six patients (15.4%) had stable disease and 4 (10.3%) progressed upon therapy. Median PFS was 10.6 mos (95%CI: 6.3-16.3). During the entire period of the study 5 deaths were registered: 3 were related to progression, 2 - because of COVID-19. Median OS was not reached. One-year OS rate was 85.2% (95%CI: 71.0-99.0). AEs were revealed in 55% patients: grades 1-2 AEs - 15 patients;grades 3-4 AEs - 7 patients;SAEs - 3 patients (neurological toxicity, gastric bleeding, hypotension and diarrhea). Baseline QoL was dramatically impaired by the majority of SF- 36 scales;42% patients experienced severe/critical QoL impairment. At baseline all the patients experienced symptoms;85% with moderate-to severe symptoms (≥4 scores on the scale from 0 to 10). The most prevalent and severe symptoms were tiredness (98%), drowsiness (90%), pain (82%) and shortness of breath (80%). During IRd treatment QoL was stable or improved. Physical and role physical functioning, general health, vitality and mental health significantly improved as compared to baseline (GEE, p<0.05). Twice increase of Integral QoL Index was observed - 0.27 at baseline vs 0.48 at 18 mos (p<0.05). Severity of pain, tiredness and nausea meaningfully decreased during IRd treatment as compared to baseline (GEE, p<0.05). Total ESAS-R score decreased by 10 points at 18 mos of therapy as compared to baseline - 31 vs 21 (GEE, p<0.05). Summary/Conclusion: In summary, results obtained in a real-world evidence study confirmed RCTs data that IRd regimen is an effective treatment in RRMM patients. This treatment is accompanied with definite improvement of QoL. Our results demonstrate benefits of IRd, both from physician's and patient's perspective.
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Background: It is assumed that patients with immuno-infammatory rheumatic diseases (IIRDs) in old age are susceptible to a more severe course of COVID-19 both due immunological disorders (autoimmune disease and its activity, immuno-suppressive therapy, immunosenescence leading to systemic subclinical chronic infammation with increased secretion of IL-6, IL-1, IL-18, TNF-α) and due to the presence of comorbid pathology. There are no Russian data on the course of COVID-19 in elderly patients with IIRDs. Objectives: To study the features of the course of COVID-19 in elderly patients with IIRDs. Methods: The study included 93 patients with IIRDs: 72 women, 21 men, average age 67.5±6.1 years. Of them, 62 patients suffered from rheumatoid arthritis, 9-systemic sclerosis, 5-ankylosing spondylitis, 4-Sjogren's disease, 4-systemic vasculitis, 3-psoriatic arthritis, 2-osteoarthritis, 1 systemic lupus erythematosus, 1-polymyositis, 1-rheumatic polymyal-gia, 1-gout. At the moment of COVID-19, 10 patients had high activity of IIRDs, 26-moderate, 40-low, 17-remission. 69 patients were treated with disease-modifying antirheumatic drugs-DMARDs (40-methotrexate, 12-lefunomide, 8-sulfasalazine, 7-hydroxychloroquine), 45-glucocorticoids (34-low doses, 11-medium or high doses). 36 patients received biologic or target DMARDs: 24-rituximab (the interval from the last administration to the development of COVID-19 symptoms averaged 7 months), 4-TNF-α inhibitors, 3-abatacept, 2-secukinumab, 1-tofacitinib, 1-baricitinib, 1 ustekinumab. Comorbidities included hypertension (n=74), coronary artery disease (n=27), obesity (n=17), diabetes mellitus (n=8), bronchial asthma (n=5), chronic obstructive pulmonary disease (n=4), chronic kidney disease (n=3). The patients were interviewed by a research doctor, additional information was obtained from medical documentation. Results: The most common symptoms of COVID-19 were fever-67.7%, weakness/drowsiness-53.7%, cough-48.4%, as well as anosmia and dyspnea-35.5% each, headache-20.4%, body aches-16.1%, congestion nose-8.6%, chest pain-7.5%, dysgeusia-5.4%, diarrhea/vomiting-3.2%. According to CT chest scan, 8 patients had 0% of lung damage, 31-25%, 32-50%, 12-75%, in other cases the study was not carried out (n=9) or data are not available (n=1). In 2 patients the course of COVID-19 was complicated by bacterial pneumonia, in 1-bacterial-fungal. An asymptomatic course was noted only in 2 patients (PCR+/IgM +, CT 0, close contact with a confrmed case of COVID-19). Recovery was noted in 90 patients, fatal outcome-in 3. Exacerbation of IIRDs after COVID-19 was noted in 48.4% of patients, which required intensifying antirheu-matic therapy. Conclusion: Preliminary data indicate that COVID-19 is characterized by moderate and severe course in elderly patients with IIRDs. Further studies are required to identify risk factors for severe course and complications in order to provide timely qualifed care.
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Background: Fatigue is common in patients undergoing radiotherapy (RT). Melatonin, an inexpensive natural supplement, may improve symptoms and attenuate the side effects of RT. The effect of melatonin for prevention of fatigue and other symptoms was evaluated in a double-blind placebo-controlled trial. Methods: Early-stage or ductal carcinoma in-situ breast cancer patients ≥ 18 years, female, Eastern Cooperative Oncology Group performance status (ECOG PS) < 3, hemoglobin ≥9 g/dL. RT with curative intent, randomized 1:1 to melatonin 20 mg or oral placebo, starting night before RT initiation until 2 weeks post-RT. Sample size of 142 evaluable patients in each arm for 80% power and interim analysis at mid recruitment using the unified family method rho = 0.3. Randomization stratified to RT duration (< 3 weeks, ≥3 weeks) and prior chemotherapy. Primary outcome : Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue subscale after completion of RT with additional scores measured at baseline, 2 and 8 weeks post-RT. Secondary outcomes : FACIT-F subscales, Edmonton Symptom Assessment System (ESAS) and Patient Reported Outcomes Measurement Information System (PROMIS) Fatigue-Short Form 8a. Secondary analyses reported using an F-test at a 5% significance level. Results: For this interim analysis, 85 patients screened;80 randomized;39 received melatonin and 38 placebo. 72 included in the analysis as 5 patients had no post baseline FACIT score. Characteristics of age, race, and ECOG PS similar in both arms. Treatment X time for FACIT-Fatigue not significant for melatonin compared to placebo (p .83). FACIT physical, emotional, and functional wellbeing scores not significantly different (p .35, .62, and .71) but showing a trend for social well-being (p .06). PROMIS scores not changed over time (p .34). ESAS individual symptoms of anxiety, well-being, drowsiness, poor appetite, nausea, pain, shortness of breath, sleep and tiredness not significant, except for depression (p.04). However, a decrease of 0.01 unit in depression score is not considered clinically significant. No grade 3 or 4 adverse events. No participants died during study, 2 died after study completion from breast cancer recurrence. 16 withdrew prior to study completion because of adverse events, unrelated hospitalizations, RT discontinuation, and COVID-19 precautions. Trial was stopped based on statistical analysis demonstrating no difference for primary outcome and imminent expiry of available drug. Discontinuation was approved by Data Safety Monitoring Committee. Conclusions: Melatonin did not prevent fatigue in patients with early stage breast cancer undergoing RT. Melatonin also demonstrated no benefit for other symptoms, except depression. Analysis showed little evidence of an effect, and the trial was terminated early.
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Background This project analysed the Integrated Palliative Outcome Scale (IPOS) in a 20-bedded in-patient unit during the COVID-19 Pandemic. The scores were taken at admission, at change in Phase of Illness and at point of discharge or death. These scores were used to monitor symptom progression and effectiveness of management during the COVID-19 pandemic. Methods The Electronic patient record (EPR) identified 110 hospice inpatients, from a total 141 admissions between 1st October 2020 - 31st March 2021) who had at least one IPOS recorded. Initial and subsequent IPOS scores were inputted and analysed in Microsoft Excel and baseline symptom prevalence and outcome measures reported (bar charts and radar plots). Results Over the 6-month period analysed 93% of patients admitted had a primary cancer diagnosis and 7% non-cancer related conditions. The worst rated physical symptoms on admission included;weakness (2.67), poor mobility (2.59) and poor appetite (2.27). Family worry was the top score of all the domains with an average initial admission score of 3.13, this is not unsurprising, and likely that the visiting restrictions in place will be contributing to this domain All physical symptoms were successfully reduced from start to end of admission except for impact of drowsiness. The greatest reductions in average scores of the physical domains were seen for constipation (28.6%), Nausea (23.9%) and Weakness (17.2%). However, average scores for anxiety, depression and sharing feelings rose by 2.3%, 10.5% and 5.7% during the admission. Conclusions This work confirms that an in-patient unit can collect and analyse patient outcomes data, even during a pandemic. The results demonstrate the positive impact that admission to a hospice can have on the symptoms of terminally ill patients, especially physical symptoms. For us it has highlighted areas of improvement especially psychological and spiritual care.
ABSTRACT
Background/aims: Short-term specialized palliative homecare that is initiated timely based on complex needs has been advocated for older people with frailty. But there is insufficient evidence on the feasibility of such an intervention. To assess the feasibility and preliminary effectiveness of a timely shortterm specialized palliative homecare intervention (i.e., Frailty+) for older people with frailty and family. Methods: Pilot randomised controlled trial and process evaluation. Eligible patients were 70 years or older, had a clinical frailty score 5-7, complex needs and about to be discharged home from hospital. They were randomly assigned (1:1) to Frailty+ or standard care. The Frailty+ group received specialized palliative care by a palliative homecare nurse over 8 weeks, who followed guides for home visits. The primary endpoint was change on a sum score based on five key symptoms, i.e., breathlessness, pain, anxiety, constipation, drowsiness, over 8 weeks. Feasibility, implementation, mechanisms and context were assessed post-intervention using mixed methods. We used thematic and descriptive statistical analyses. Results: 37 patients were randomly assigned to Frailty+ group (n=19, mean age 84y) or standard care (n=18, mean age 84y) and 26 family carers. The Frailty+ group received at least one home visit, as intended. Hospital care staff reported difficulties in patient identification. Patients and family reported positive views on the home visits, nurses that the guides were often not useful. Most important contextual factors were related to the COVID-19 crisis e.g., less continuity of care. Mean sum scores on primary outcome at baseline was 6.0 in Frailty+ and 5.6 in the control group, at 8-weeks was 4.5 in Frailty+ and 4.1 in the control group (adjusted ratio 1.0). Conclusions: Frailty+ was well received by patients and family and to a lesser extent healthcare providers. Based on these results, further refinement of Frailty+ and RCT design is needed to optimize the intervention and evaluation.
ABSTRACT
Objective: Poison centers frequently manage calls involving ethanol-containing hand sanitizers. During the 2020 COVID-19 pandemic, our Specialists in Poison Information sensed rising numbers of cases. The increased use was not surprising due to the desire to sanitize skin and reduce transmission of COVID-19. We sought to compare hand sanitizer trends pre-pandemic and during the pandemic including a sub-analysis for children 0-5 years. Methods: We queried the National Poison Data System for human exposures of all ages within our 4-state poison center from 1 January 2015 to 31 October 2021. Generic codes for all types of hand sanitizers were included plus 2 product codes for methanol-containing hand sanitizer. Data captured included age range, product type, reason, gender, route, clinical effect, medical outcome, month, management site, and therapies. The query was repeated for the same parameters in children 0-5 years old. Descriptive statistical analyses were utilized. Results: Our poison center managed 5,819 human hand sanitizer exposures during the study period;67% occurred in children 0-5 years old. From 2019 (n=723) to 2020 (n=1,272), hand sanitizer exposures increased by 76%, 38% [all ages, children 0-5 years];52% were male. Most [77%, 99%] of these exposures were unintentional and [89%, 96%] involved ingestion as the primary route and exposures in children 0-5 years represented 64% of the total number of ingestion cases. Exposures in 2020 occurred throughout the year with higher volumes in March and July through December. Most cases were managed on-site (non-hospital) [81%, 89%], with [18%, 11%] evaluated in or referred to a hospital. Most [87%, 89%] clinical outcomes were minor or no effect overall, with similar numbers in 2020 [82%, 87%]. The top clinical effect in children 0-5 years was vomiting. For all ages, the most common effects were vomiting, nausea, and drowsiness. There was one death involving an adult who intentionally consumed hand sanitizer as an alcohol substitute. The product was contaminated with methanol and he died from methanol intoxication. Non-ethanol or isopropanol hand sanitizers were involved in 10% of exposures during the study period and 19% of exposures in 2020. Conclusion: We confirmed our suspicion that hand sanitizer exposures rose significantly in 2020. Explanations include increased usage and availability in the home paired with more time spent at home overall due to coronavirus school restrictions, working from home, and quarantine. Fortunately, even during 2020, most medical outcomes resulted in none or minor effects. Additional sub-analyses are needed to characterize other aspects including non-ethanol hand sanitizer exposures.