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Radiotherapy-induced secondary malignancy is a well-known occurrence. During the COVID-19 pandemic, many people have undergone serial computed tomography (CT) imaging, and concerns have been raised regarding radiation-induced malignancies due to frequent scanning. Accordingly, various low and ultra-low-dose CT (LDCT) thorax protocols have been developed to reduce the dose of radiation. Major governing bodies worldwide have established guidelines regarding the indications for CT scans and chest X-rays during the pandemic. We, therefore, aimed to provide facts about the effects of radiation (both diagnostic and therapeutic). Through this article, we intend to break the myths and 'mithya' (misbeliefs) regarding diagnostic radiation and its association with cancer in this COVID-19 era. For this review, we performed a search in Google using specific keywords pertaining to imaging during COVID-19 and radiation risk. We also included the names of various global governing bodies in the Google search. We included only full text articles and guidelines from authentic websites. From this review, we conclude that if we follow the recommendations of various global governing bodies and use CT scan only in cases of moderate to severe COVID-related symptoms, adhere to the principle of 'as low as reasonably achievable' for radiation protection, and use LDCT scan protocols, we can significantly reduce the mean effective radiation dose delivered and the estimated cancer risk.Copyright © 2023 Cancer Research, Statistics, and Treatment. All rights reserved.
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Introduction: Crohn's disease (CD) and ulcerative colitis (UC) can be difficult to manage and, due to a lack of meaningful quality measures, patient (pt) care may vary by provider. To understand where gaps in care may exist for these pts, this study assessed specific healthcare resource utilization (HRU) and medication metrics that may be potential quality of care (QOC) indicators. Method(s): Using a large commercial US claims database (2019-2020), pts with CD or UC were identified. Potential QOC indicators were selected based on clinical guidelines and recommendations from measures of quality organizations and included CD or UC prevalence;gastroenterologist (GE) and IBD-related non-GE outpatient visits;IBD-related emergency department visits or hospitalizations;excessive steroid use (prednisone equivalent >=10 mg/day for >=60 consecutive days or a single prescription of >=600 mg prednisone);excessive steroid users on corticosteroid (CS)-sparing therapy;excessive steroid users with central dual-energy X-ray absorptiometry (DEXA) or osteoporosis pharmacologic treatment;use of targeted immunomodulators (TIMs) and oral mesalamine (CD only);imaging assessments;and assessment of inflammatory biomarkers. National percentages of pts achieving each metric are reported. Result(s): In total, 41,555 CD and 52,507 UC pts were identified in 2019, resulting in a 0.3% and 0.4% prevalence, respectively (Table). Over a third of CD pts (39.8%) and almost half of UC pts (45.5%) did not visit a GE in 2019. Around 10% CD pts, and up to 6.4% of UC pts, had IBD-related ED visits or hospitalizations. 17.1% CD and 14.5% UC pts were excessive steroid users, yet < 9% CD and UC pts, received DEXA scans and/or bone treatments. A third of excessive steroid users with CD (34.5%), and over half (53.0%) of those with UC, did not receive CS-sparing therapy. The rate of TIM use was over two times higher in CD vs UC pts (CD: 44.3%;UC: 18.9%). Despite evidence that mesalamine is ineffective in CD, 18.7% of pts with CD were prescribed it. Inflammatory biomarker level testing rates were < 50% in both CD and UC. Similar outcomes were reported in 2020, with lower HRU, possibly due to COVID-19. Conclusion(s): This analysis of QOC indicators highlights various areas for improvement that may provide better treatment outcomes and reduce HRU for pts with CD and UC. Future research is needed to assess outcomes in pts that are not being routinely monitored. (Table Presented).
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Background: Fitness is a marker of physiological and mental health. The purpose of this pilot study was to assess the feasibility of processes to recruit women with polycystic ovary syndrome (PCOS) during the Covid pandemic and collect their health and fitness data. Additionally, the data was used to explore possible associations between anthropometrics, PCOS biomarkers, health-related quality-of-life (HRQoL), and depressive symptoms with that of fitness and self-reported physical activity levels among women with PCOS. Method(s): A convenience sample of women with PCOS (n = 15) were recruited via flyers and the snowball method. Participants completed surveys, anthropometrics, a dual energy x-ray absorptiometry scan, blood work, and a fitness assessment. Data were statistically analyzed using Spearman correlations. Result(s): Feasibility measures of recruitment and retention rates were 83% and 100%, respectively. Fidelity measurement for process averaged 97%. Participants (age 25.9 (+/- 6.2), mostly White (80%), single (60%), and employed full-time (67%)) were categorized as obese (body mass index (BMI) 32.2 kg/m2 +/- 8.3, percent bodyfat 41.1% +/- 8.1) with <=1 comorbidity. Most participants were not regularly physically active and had high free testosterone levels (7.6 pg/mL+/-4.3), elevated high-density lipoprotein (63.2 mg/dL+/-12.9), fair cardiovascular capacity, and below average muscular strength/endurance. The following statistically significant and strong associations were found: (1) VO2 max with percent bodyfat (-0.59;p = 0.02), sex hormone binding globulin (0.73;p = 0.00), HRQoL (0.72;p = 0.00), and depressive symptoms (-0.67;p = 0.00), (2) abdominal strength with BMI (-0.66;p = 0.01) and high density lipoprotein (HDL) (0.59;p = 0.02), (3) physical activity level with percent bodyfat (-0.72;p = 0.00), and (4) resistance training with low density lipoprotein (LDL) (-0.52;p = 0.05). Conclusion(s): Collecting health and fitness data from women with PCOS is a feasible research approach. Randomized controlled trials in which health and fitness data are collected from women with PCOS are needed to confirm possible associations between fitness and PCOS clinical features and is in the planning process. Copyright: Copyright © 2023 The Author(s).
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Purpose of Study: The COVID-19 pandemic has presented considerable challenges in the care of patients with chronic diseases, including osteoporosis. In this study, we determined whether initiation of pharmacologic treatment was delayed for patients who were newly diagnosed with osteoporosis during the pandemic. Methods Used: Patients >= 50 years who were newly diagnosed with osteoporosis using dual-energy x-ray absorptiometry (DXA) screening at a single academic institution were included. Patients with osteoporosis diagnosed between March 1, 2018 to January 31, 2020 (pre-pandemic cohort) were compared to patients diagnosed between March 1, 2020 to January 31, 2022 (pandemic cohort). Basic demographics including age, gender, race, and ethnicity were evaluated. Primary outcomes included the proportion of patients who were initiated on pharmacologic therapy at 3-months and 6-months of diagnosis, as well as the mean time from osteoporosis diagnosis to initiation of pharmacologic treatment. Ordering providers (primary care vs specialty care providers) and types of pharmacologic agents were also compared. Summary of Results: In total, 1,189 were newly diagnosed with osteoporosis on DXA during the study period, with 576 patients in the pre-pandemic cohort and 613 in the pandemic cohort. There was no significant difference between cohorts with regard to age (69.3 vs 68.8 years, p=0.33), gender (87.0 vs 86.1% female, p=0.67), or ethnicity (88.2 vs 86.0% Non-Hispanic, p=0.25). However, there was a higher proportion of Whites in the pre-pandemic cohort (74.1 vs 68.4%, p=.028). Overall, only 40.5% of patients (n=481) newly diagnosed with osteoporosis were started on pharmacologic therapy within 6 months of diagnosis. Proportions of patients treated at 3-months (31.8 vs 35.4%, p=0.19) and at 6-months (37.8 vs 42.9, p=0.08) were comparable between cohorts (47.2 vs 50.2% p=0.30). Mean time from osteoporosis diagnosis to initiation of pharmacologic treatment was similar (46 vs 45 days, p=0.72). Ordering providers did not differ between cohorts (65.1 vs 57.4% primary care providers, p=0.08). Bisphosphonates were the most often prescribed in pre-pandemic (90%) and pandemic cohorts (82.1%). Conclusion(s): This is the first study to compare the impact of the COVID-19 pandemic on the pharmacologic treatment of patients who were newly diagnosed with osteoporosis. In our retrospective comparative study, we found only 40.5% of patients with newly diagnosed osteoporosis were treated pharmacologically within 6 months of diagnosis, and the COVID-19 pandemic did not significantly affect treatment rates. Bisphosphonates were the most often prescribed medication group. Further studies are needed to better understand patient-, provider-, and system-specific factors contributing to the low treatment rates of patients newly diagnosed with osteoporosis.
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Purpose of Study: Several survey studies have expressed concerns regarding a general decline in osteoporosis screening as a result of the COVID-19 pandemic. We compared our institution's experience on osteoporosis screening using dual-energy x-ray absorptiometry (DXA) before and during the COVID-19 pandemic. Methods Used: Patients >=50 years who received DXA screening at our academic institution were included. Patients with DXA completed between March 1, 2018 to January 31, 2020 (pre-pandemic cohort) were compared to patients with DXA completed between March 1, 2020 to January 31, 2022 (pandemic cohort). Basic demographics including age, gender, race, and ethnicity were evaluated. DXA utilization was calculated as the number of DXA studies completed monthly. The ordering providers (primary care vs specialty care providers) and mean time from initial order to DXA completion were compared between cohorts. Chi square tests were performed for categorical data, while independent t-tests were performed for continuous data, with significance set at 0.05. Summary of Results: In total, 10,680 DXA studies were completed at our institution over the study period. From March 1, 2018 to January 31, 2020, 5,375 DXA studies were completed (pre-pandemic cohort). From March 1, 2020 to January 31, 2022, 5,305 DXA studies were completed (pandemic cohort). Mean monthly DXA utilization did not differ between cohorts (233.7+/-28.5 vs 230.7+/-59.9 studies, p=0.83). There were also no statistically significant differences when comparing total DXA procedures per quarter per year between cohorts. Patients were older in the pandemic cohort at the time of DXA completion (69.3+/-8.2 vs 68.6+/-8.3 years, p<0.001). The distributions for gender (89.6% vs 89.2% female, p=0.5), ethnicity (90.3% vs 89.3% Non-Hispanic, p=0.09), and race (74.4% vs 73.3% White, p=0.21) did not differ between cohorts. The mean time from initial order to DXA completion was shorter for the pre-pandemic cohort (79.1+/-104.4 vs 88.8+/-107.6 days, p<0.001). The ordering providers (67.2% vs 62.7% primary care providers, p<0.001) also differed. Conclusion(s): This is the first study to quantitatively compare the rates of osteoporosis screening before and during the COVID-19 pandemic. In our retrospective study, we found that DXA utilization to screen for osteoporosis was not affected by the COVID-19 pandemic. However, DXA completion was more delayed, and the ordering providers were more likely to be non-primary care providers.
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Studies on the effects of training confinement on athletes with physical impairments are limited. Hence, in this retrospective cohort study, we aimed to investigate the impact of prolonged cessation of organized team training due to the coronavirus disease 2019 pandemic on the body composition of elite female Japanese basketball athletes. Fourteen female wheelchair basketball athletes (aged ≥20 years) were enrolled. The primary outcomes were lean and adipose indices measured using whole-body dual-energy X-ray absorptiometry. The impact of prolonged organized team training cessation on body composition was investigated by comparing the body composition at baseline and post-training confinement. A reduced whole-body lean mass (p = 0.038) and percent lean mass (p = 0.022), as well as an increased percent body fat (p = 0.035), were observed after the confinement period. The regional analysis revealed reduced percent lean and increased percent fat masses in the trunk (p = 0.015 and p = 0.026, respectively) and upper limbs (p = 0.036 and p = 0.048, respectively). In conclusion, prolonged organized team training cessation reduced lean mass and increased body fat percentage, primarily in the trunk and upper limbs. Individualized training programs targeting these body regions should be implemented to improve body composition and physical conditions in athletes during and after prolonged cessation of organized team training.
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Background: Hepatic osteodystrophy includes osteoporosis in liver cirrhosis (LC). The presence of osteoporosis has long term impact in patients of LC in both pre-and post liver transplant setting. Zoledronic acid is a third generation bisphosphonate. Compared to oral bisphosphonates, it has added benefit of no risk of esophagitis and intravenous administration on annual basis. Limited data is available on use of zoledronic acid in patients of LC. We evaluated safety and efficacy of zoledronic acid as add on therapy to calcitriol in patients of LC with osteoporosis. Method(s): A prospective controlled randomized, open label clinical trial was conducted at tertiary care center in patients of liver cirrhosis from March 2020 till January 2022. Trial was registered with Clinical trial registry CTRI/2020/03/024247 dated 25.03.2020. Patients of LC were screened with DEXA scan. Diagnosis of osteoporosis was made with z-score <-2.0 and/or t-score <-2.5 at LS-spine and/or hip. At baseline bone mineral density (BMD) at spine and hip and FRAX (fracture risk assessment tool) score major osteoporotic (MO) and major hip (MH) were determined. Patients were divided into group I zoledronic acid (5 mg intravenous single dose) + SMT, Group II standard medical therapy (SMT) (oral calcitriol 0.25 mug BID and calcium 500 mg BID) for 12 months. Primary end points included DELTABMD at spine and hip, DELTAFRAX score MO and DELTAFRAX score MH at 12 months. Secondary end points included any pathological fracture, change in serum calcium, phosphorus, ALP, vitamin D levels and quality of life (QOL) assessment by IOF QoL QUALEFFO-41 at 12 months. Result(s): Out of 117 patients of LC, 58 had osteoporosis. Finally, 49 patients were randomized with 25 patients allocated to group I and 24 to group II. Due to COVID-19 pandemic enrolment was severely affected and 11 patients were lost to follow up. An intention to treat analysis was done. In primary end points, BMD increased from baseline to 12 months in Group I at LS spine (0.742+/-0.016 to 0.93+/-0.02, P<0.001) and right hip (0.744+/-0.019 to 0.923+/-0.039, P<0.02) as compared to group II at LS-spine (0.77+/-0.01 to 0.77+/-0.02, P=0.6) and right hip (0.808+/-0.022 to 0.81+/-0.21, P=0.09) gm/cm3 respectively. The FRAX score MO (3.16 to 1.91, P<0.001) and FRAX score MH (1.47 to 0.55, P<0.001) decreased from baseline to values at 12 months in group I as compared to group II FRAX score MO (2.97 to 2.82, P=0.07) and FRAX score MH (1.3 to 1.19, P=0.17) respectively. In secondary end points, no significant change was seen in presence of any pathological fracture or serum calcium, phosphorus, ALP and vitamin D levels. QUALEFFO score increased by +13.8 (28.7%) which was statistically significant (P<0.001) compared to baseline QUALEFFO score. No significant difference for adverse effects was noted between two groups. Conclusion(s): Zoledronic acid was safe and effective in improving BMD and FRAX score MO and MH, QUALEFFO score at 12 months in patients of LC with osteoporosis as compared to SMT. (Figure Presented).
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Background: It is important to identify and treat lowbone mineral density (BMD) to prevent fractures and secondary complications. Individuals with cystic fibrosis (CF) are at risk of low BMD because of medication-related side effects, low body mass index, delayed puberty, and the effects of abnormal CF transmembrane conductance regulator. According to 2018 registry data, only 4% of patients aged 8 and older had completed a dualenergy X-ray absorptiometry (DEXA) scan at the Yale Pediatric CF Center. Our aim was to improve assessment of bone health by using a multidisciplinary team (MDT) to identify those at risk. Method(s): The MDT worked to identify patients at our center who were aged 8 and older and should undergo BMD screening based on the following risk factors: less than 90% of ideal body weight (our nurse coordinator queried from PortCF, and our dietician screened as part of regular nutritional assessment), percentage predicted forced expiratory volume in 1 second less than 50% (our nurse coordinator queried from PortCF, and our respiratory therapist screened as part of regular assessment), history of glucocorticoid use of 5 mg/d or more for more than 90 days per year or repeated antibiotic courses (our pharmacists queried medication history), history of fracture (our physical therapist added fracture screening to the regular musculoskeletal screen), history of delayed puberty or aged 18 and older (identified during weekly clinic conference). COVID delayed introduction of our plan. All members of the MDT were able to help explain the process and importance of DEXA scanning. The clinic nurse coordinator and PT monitored for scan completion and communicated with the team when results were available so that follow-up education and counseling could be provided. Dates of completed scan and recommended follow-up were added to the weekly clinic log for tracking. Result(s): Thirty-nine of 57 patients in our pediatric clinic met criteria for BMD assessment. The percentage of eligible patients completing screening rose from 4% in 2018 to 19.2% in 2019 and 33.3% in 2020 using a multidisciplinary approach to patient identification and education. As of March 2022, 51% of eligible patients had completed an initial assessment. Five of the 20 completed (20%) had results indicating low BMD for age. Three received referrals for additional physical therapy because of overall low physical activity levels and moderate postural deviations. The remaining two were already involved in regular physical activity. Education on safe bone-loading activity and protective education was provided. The team continues to provide dietary counseling and referrals to endocrine clinic as appropriate. One of the five patients with initial low BMD has undergone a 2-year follow-up scan and demonstrated significant improvement in BMD. Conclusion(s): A multidisciplinary approach to BMD screening was helpful. The percentage of eligible patients completing screening rose from 4% in 2018 to 19.2% in 2019 and 33.3% in 2020. We encountered challenges in getting all appropriate patients to complete their scans, largely because of COVID. Twenty-five percent of those scanned had low BMD for age. Standardizing multidisciplinary education and counseling will be an important next step, as will following the repeat scans of those whose initial scans were abnormal. Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
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Background: Cystic fibrosis (CF) is associated with complications such as CF-related diabetes (CFRD) and bone disease. The Cystic Fibrosis Foundation advises routine screenings as the standard of care for early identification and treatment of these complications. Specifically, the foundation recommends annual completion of an oral glucose tolerance test (OGTT) and a dual-energy X-ray absorptiometry (DEXA) bone density scan at least every 5 years. In 2019, 55% of eligible patients completed an OGTT, and 68% completed a DEXA scan at UVA Health System (UVAHS). Transition of in-person clinic visits to telemedicine during 2020 and 2021 decreased completion of health screenings. The UVAHS team used quality improvement tools to design a process to maintain and increase OGTT and DEXA completion rates with the newhybrid nature of clinical care. The aim of this project is to define a replicable, reliable process for obtaining health screenings in the setting of hybrid patient care. Method(s): Quality improvement tools highilghted in the Model for Improvement methodology guided production of a simplified failure mode effects analysis (sFMEA) to identify areas for intervention. A process was developed to track patient eligibility and completion of screenings and adapted through iterative plan-do-study-act (PDSA) cycles. CF registered dietitians (RDs) documented completion of OGTTs and DEXAs in a secure Excel spreadsheet coded to flag patients due for each health screening. Two weeks before clinic, both RDs referenced the spreadsheet to determine patients due for health screenings. All identified patientswere contacted to inform them of the health screenings due. Patients and RDs then coproduced a plan for completion of the health screenings at an in-person visit, at a local lab, or in conjunction with a non-CF health care appointment. Regardless of the plan, patients were provided outpatient lab order requisitions. To ensure communication with other care team members, patients contacted about and scheduled for their screenings were denoted in the shared Health Insurance Portability and Accountability Act-compliant clinic tracking platform. Clinic nurses received outside lab results via fax and all in-house results through the electronic medical record system. Once lab results were reviewed and communicated to the patient, the health screening spreadsheet was updated. Result(s): In 2020 and 2021, 39% of eligible patients completed an OGTT, and 76% of eligible patients completed a DEXA scan. Of thosewho completed an OGTT in 2020 and 2021, 68% and 74%, respectively, indicated abnormal results consistent with impaired fasting glucose tolerance or CF-related diabetes. Most patients with up-to-date DEXA scans by the end of 2021 were positive for osteopenia or osteoporosis (53%). Conclusion(s): Through the creation of a standardized protocol using iterative PDSA cycles, patients continued to sustain routine health screenings despite reduced in-person clinic visits, allowing for identification and intervention for many patients regarding diabetes and bone health. Continuation of this protocol will enhance our ability to collect patient health screenings while providing the same high-quality care via telemedicine that we provide with in-person visits. Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
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Background: Comanagement of glycemia and adiposity is the cornerstone of cardiometabolic risk reduction in type 1 diabetes (T1D), but targets are often not met. The intestinal microbiota and microbiota-derived short-chain fatty acids (SCFAs) influence glycemia and adiposity but have not been sufficiently investigated in longstanding T1D. Objectives: We evaluated the hypothesis that an increased abundance of SCFA-producing gut microbes, fecal SCFAs, and intestinal microbial diversity were associated with improved glycemia but increased adiposity in young adults with longstanding T1D. Methods: Participants provided stool samples at ≤4 time points (NCT03651622: https://clinicaltrials.gov/ct2/show/NCT03651622). Sequencing of the 16S ribosomal RNA gene measured abundances of SCFA-producing intestinal microbes. GC-MS measured total and specific SCFAs (acetate, butyrate, propionate). DXA (body fat percentage and percentage lean mass) and anthropometrics (BMI) measured adiposity. Continuous glucose monitoring [percentage of time in range (70-180 mg/dL), above range (>180 mg/dL), and below range (54-69 mg/dL)] and glycated hemoglobin (i.e., HbA1c) assessed glycemia. Adjusted and Bonferroni-corrected generalized estimating equations modeled the associations of SCFA-producing gut microbes, fecal SCFAs, and intestinal microbial diversity with glycemia and adiposity. COVID-19 interrupted data collection, so models were repeated restricted to pre-COVID-19 visits. Results: Data were available for ≤45 participants at 101 visits (including 40 participants at 54 visits pre-COVID-19). Abundance of Eubacterium hallii was associated inversely with BMI (all data). Pre-COVID-19, increased fecal propionate was associated with increased percentage of time above range and reduced percentage of time in target and below range; and abundances of 3 SCFA-producing taxa (Ruminococcus gnavus, Eubacterium ventriosum, and Lachnospira) were associated inversely with body fat percentage, of which two microbes were positively associated with percentage lean mass. Abundance of Anaerostipes was associated with reduced percentage of time in range (all data) and with increased body fat percentage and reduced percentage lean mass (pre-COVID-19). Conclusions: Unexpectedly, fecal propionate was associated with detriment to glycemia, whereas most SCFA-producing intestinal microbes were associated with benefit to adiposity. Future studies should confirm these associations and determine their potential causal linkages in T1D.This study is registered at clinical.trials.gov (NCT03651622; https://clinicaltrials.gov/ct2/show/NCT03651622).
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Background: Denosumab (Dmab), a fully human monoclonal antibody that inhibits receptor activator of nuclear factor kappa-β ligand (RANKL), which selectively inhibits osteoclastogenesis can be used for a long period unlike the relatively short period with Teriparatide.1-2 However the effects of Dmab can quickly regress if the treatment is delayed.3 Objectives: The pandemic led to multiple prolonged lockdowns since March 2020 to Jan 2022 in India. This resulted in follow up Dmab treatment delays. The retrospective study was aimed to look for the effect of the delays. Methods: The bone mineral density (BMD) trends from the central dual-energy X-ray absorptiometry (DXA) at our centre were studied. The trends of patients under Dmab for one year and delay in follow up for 10-12 months for the forth dose were evaluated. 21 postmenopausal women who had been under treatment with Dmab 60 mg subcutaneous injection at 6 monthly interval for one year followed up with such delays. 6 were excluded because of history of sars-cov-2 infection and glucocorticoid use. In the study group of 15 (n=15), the mean BMD at L2, L3 & L4 (sp BMD) and Right and Left Hip (hip BMD) were studied from before treatment (a BMD), 6 months after 1st and at the time of 2nd injection (b BMD), 6 months of the 2nd and at the time of 3 rd injection of Dmab (c BMD), and that due to delay in follow up of 10-12 months (d BMD). The mean percentage trend change between a-b, b-c, and c-d BMDs was evaluated. The least signifcant change (LSC) 4 from a single centre DXA was used to validate the fndings. Results: The mean percentage change after the treatment for the 1st 6 months of Dmab (a-b BMD) was 4.08% and 3.60% and the second injection resulted in a further change (b-c BMD) of 5.98% and 4.52% in the sp BMD & hip BMD respectively. The delay in follow up of 10-12 months resulted in a change (c-d BMD) of-7.81% in the sp BMD and-2.96% in the hip BMD. The LSC from a single centre DXA is 2.6% and 3.6% for sp BMD and hip BMD respectively. A p>0.05 was considered statistically signifcant. Table 1 shows the BMD changes. Conclusion: These fndings suggest that regressive trend in BMD are seen when the treatment with Dmab is delayed even as early as 10 to 12 months. It was seen much faster in the spine compared to the hip. It is therefore advised that short term treatment with Dmab without follow up could lead to loss of all gains and may also worsen the osteoporosis.
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Introduction Inflammatory Bowel Disease (IBD) homes have been shown in academic settings to improve patient outcomes and decrease health care utilization, resulting in an overall improvement in healthcare quality. Scarce information is available demonstrating their utility in a community practice setting where economic drivers and available resources may differ significantly from academic institutions. The value of these integrated care model homes is often achieved by implementing basic health maintenance initiatives that are lacking with traditional care, which is largely focused on primary disease management. This study seeks to define the baseline compliance of required health maintenance screenings and vaccinations in patients enrolled in a community based IBD Home. Methods We conducted a retrospective analysis of IBD patients enrolling in the IBD Home program of a large community based practice from January 2021 to January 2022. The multidisciplinary team comprised of a gastroenterologist, physician's assistant, dietician, nurse and social worker. No specific education was provided regarding health maintenance requirements to collect baseline compliance. Data collection included patient compliance with bone density scans, dermatologic exams, annual pap smears and receipt of pneumonia, Hepatitis A, Hepatitis B, influenza, and COVID -19 vaccines. Results There were 51 IBD patients enrolled in the IBD Home program with 63% female. of the total cohort, 100% of patients lacked in one or more of the recommended health maintenance guidelines. Specifically, only 27% were current with bone density scans, 29% with routine dermatologic screening, and 16% with PAP smears (HPV vaccination status unknown). Regarding vaccinations, 78% had received influenza, 33% pneumonia, 27% hepatitis A, 43% hepatitis B and 60% for Covid 19 (two doses). Conclusions The analysis of these elements provided key insights into the factors contributing to the low levels of health maintenance compliance noted in these IBD patients. Many community-based gastroenterologists refer patients to their primary care physicians who are not aware of the specific IBD health maintenance guidelines. Further, many gastroenterologists educate patients about the guidelines but lack mechanisms to easily implement the recommendations and to closely monitor patient compliance. Enrolling patients into an integrated IBD medical home provides the resources needed to facilitate heath maintenance issues, although our study illustrates a need to intervene further to effectively impact compliance.
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Type 3 intestinal failure (IF) is known to negatively impact bone metabolism contributing to increased prevalence of osteoporosis and associated increases in morbidity and mortality. It has been challenging to appropriately monitor for these pathologies under the restrictions imposed by the ongoing COVID-19 pandemic. We performed a retrospective audit assessing compliance with current guidelines1. All type 3 IF patients receiving home parenteral nutrition (HPN) prescribed at a national centre prior to 1st May 2021 were included. Data was collected from hospital electronic recorded, de-identified and collated on an excel spreadsheet that was securely stored on a departmental computer. 270 patients fulfilled inclusion criteria (35.5% male, mean age 54.0 ± 17.5 years). The mean age at HPN initiation was 45.8 ± 18.5 years and the mean number of years on HPN was 8.2 ± 7.2 years. The maximum duration of HPN administration in this cohort was 37 years. DEXA scan results performed within the preceding 5 years were available for 23.0% of patients. Of these scans 96.8% of patients had evidence of reduced bone density (45.2% osteopenic, 51.6% osteoporotic). Comparing DEXA results at diagnosis and in the last 5 years, a majority (54.2%) of patients progressed or remained osteoporotic, with 8.3% showing improvement in bone density and 4.2% of patients having a return to normal bone density. 59.6% of patients had blood tests performed within the preceding 12 months. 54.4% of patients had undergone plasma vitamin D levels measurement. Vitamin D levels were found to be low (<50nmol/L) in 32.7%. 44.4% of patients were receiving vitamin D supplementation of which 86.7% were prescribed oral supplements and 13.3% intramuscular supplements. 31.3% of patients with osteoporosis were on bisphosphonate therapy. These results demonstrate high prevalence of metabolic bone disease amongst type 3 IF patients on HPN. This highlights a potentially modifiable risk of low-trauma fracture which has a very high morbidity and mortality index. Our findings regarding the prevalence and longitudinal changes in bone density are in agreement with the published ESPEN surveys2,3. The results also demonstrate poor compliance with current guidelines. We believe this reflects the challenges of obtaining non-emergent scans and blood test due to COVID-related restrictions as well as our patients’ very understandable fear of exposure should they attend hospital for a face-to-face review. It is also possible that some of these tests were performed locally, due to many patients living far away from our national referral centre, and thus not visible to the audit team. These findings have highlighted the need for greater education and prompted our group to increase our focus on metabolic bone disease during clinic interactions and to create a subsection of our database for tracking DEXA intervals for this patient cohort. References 1. Pironi L, Arends J, Bozzetti F, et al. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr 2016;35: 247-307. 2. Pironi L, Labate AM, Pertkiewicz M, et al. Prevalence of bone disease in patients on home parenteral nutrition. Clin Nutr 2002;4: 289-296 3. Pironi L, Tjellesen L, De Francesco A, et al. Bone mineral density in patients on home parenteral nutrition: a follow-up study. Clin Nutr. 2004 Dec;23(6):1288-302
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Objective: To assess if current practices in bone health monitoring and treatment at a specialist regional cystic fibrosis (CF) centre are in line with current European CF guidelines. Methods: An audit of bone health of all adolescents and adults atWolfson CF centre UK was conducted. Data was gathered between December 2020 and November 2021 from medical records which included timing of last DEXA scan and if it had been within last 5 years, DEXA scan T/Z scores, vitamin D status and bisphosphonate use. Results: 237 individuals were identified, 106 female with a median age of 30 (±15) years. DEXA scans had been conducted in the last 5 years for 70% of the clinic. Of thosewho had a DEXA scan (n = 199), 53% were conducted on time in line with guidelines and 27% were overdue by more than 3 years. Median Z scores were −0.7 (±1.9) at the spine, −0.4 (±1.63) at the neck of femur, −0.6 (±1.5), total femur, and −0.4 (±1.75) total body. CF-related low bone mineral diseasewas present in 0.4–11% of clinic depending on the site of the Z score. 80% of the clinic had had vitamin D levels checked within the last year, with 47% being classed as sufficient (≥75 nmol/L). However, only 3% were classed as deficient with levels below 25 nmol/L. Bisphosphonate treatmentwas indicated in 19% of individuals. However, this had happened in just half of this group. 46% used oral medication, 54% intravenous. Conclusion: The majority of individuals had DEXA scans on time and repeated within 5 years. However, roughly a quarter of individuals were overdue by ≥3 years. Vitamin D levels should be checked at least annually as a minimum and this occurred in the majority of the clinic. There was a very low proportion of vitamin D deficiency but improved monitoring is needed, especially in those with vitamin D insufficiency. Although these results suggest that more robust measures could be in place for bone health monitoring and treatment, the coronavirus pandemic would have had an effect.
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Background: Cardiorespiratory fitness (CRF) is a powerful predictor of all-cause mortality among individuals with coronary artery disease (CAD). A structured community-based phase III cardiac rehabilitation (CR) is very important in lifelong maintenance of phase II CRF and health gains. During the COVID-19 pandemic, CR programs had to adapt, mainly using new technologies and remote follow-up. The CRF impact in patients (Ps) who kept going their phase III program, during this troubled era is still unknown. Purpose: Assess the variation in CRF and prognostic parameters in Ps with CAD who maintain high adherence levels in their phase III CR before and during the COVID-19 pandemic. Methods: A cohort of Ps enrolled in a community-based phase 3 CR program, with active participation at the end of 2019, was included in this retrospective study. The inclusion criteria for this study were high levels of attendance (>80%) to the CR program before and during COVID-19 and high levels of physical activity with more than 150 mins of moderate to vigorous physical activity (MVPA). All Ps were evaluated with transthoracic echocardiography (TTE) and a cardiorespiratory exercise test (CPET) in a cycloergometer in 2019 and between october and november of 2021. All Ps had used accelerometers to measure their physical activity levels and dual-energy absorptiometry (DEXA) scan to evaluate their body composition. Between 2020 and 2021, Ps had online (in lockdown periods) and face to face exercise training sessions, 3xtimes per week, 60 mins each exercise session. A t-test paired two sample for means was used to compare CPET variables before the beginning of the first COVID lockdown (end of 2019) and after the removal of the majority of restrictions (end of 2021). Results: A total of 30 Ps with high levels of adherence were included (99.6% male, 65 ± 9 years old). In this cohort, the majority had history of an ACS before the referral to the CR program (73.3%) and 55.6 ± 10.4% of left ventricular ejection fraction. There was no significant difference in body mass index (27.9 ± 3.2 kg/m2 vs 28.1 ± 3.6 kg/m2, p=0.493 but there was a significant increase in the percentage of body fat mass (30.1 ± 5.7% vs 31.0 ± 6.6%, p= 0.042). There was a maintenance on MVPA levels (352 ± 137 minutes/week vs 313 ± 194 minutes/week, p = 0.106) during this period. When comparing the 2 CPET results, Ps achieved higher exercise loads in the 2021 test (175 ± 51W vs 185 ± 52W, p=0.005), higher VO2 peak (25.3 ± 6.9 ml/kg/min vs 21.5 ± 6.3 ml/kg/min, p =0.001) and higher percentage of predicted VO2max (78.8 ± 16.8% vs 95.27 ± 20.8%, p = 0.001). Conclusion: In spite of all the difficulties in maintaining a phase III CR program during the COVID-19 pandemic, we observed that in physically active CAD Ps, with the aid of new technologies and remote follow-up (during the lockdown periods) and face to face exercise sessions, it is still possible to have functional gains and improvements in CRF. (Figure Presented).
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We present the data and achievements of our pioneer Fracture Liaison Service (FLS) in Argentina, after 4 y of the Capture the Fracture program, within the Sanatorio Las Lomas private hospital. The aim is to evaluate our FLS consolidation after its implementation, taking in account the obstacles we faced and the experiences we obtained. Our secondary prevention program was launched during 2017, developed and attended by the Endocrinology and Metabolism Dept.'smedical staff. Immediately the Orthopedic Dept. joined us. We identified and gathered fractured patients in emergency, ambulatory and hospitalized rooms. During the first visit we included physical exam, personal and familiar medical history, BMD evaluation by DXA scan with TBS and FRAX algorithm and mineral metabolism laboratory testing. From 521 included patients, the fracture index was: 30.4% radius, 17.1% femoral, 16% vertebral, 11.6% tibial, 4% humerus and 11% other sites. Comparing April 2021 vs. April 2020, despite SARS-Cov-2 pandemic, we achieved an increase in patients recruitment (46.64%), doubling the number. We attribute this to our increased efforts by contacting fractured patients by telephone, offering medical assistance. The refracture index was 20%, with 25% of these patients suffering a third fracture. The centinel fracture and the most predictive of a second episode was the radius fracture. In the next chart we present the numbers achieved in our private hospital FLS.
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PURPOSE/HYPOTHESIS: Cardiovascular (CV) disease has conventionally been a pathology associated with older adults, but recent evidence has shown that younger individuals are developing CV issues. One of the factors contributing to this epidemic may be the increased time constraints placed on young adults. Specifically, the sedentary activity of full-time students may be causing detrimental effects to their health, including increasing the risk for CV disease. The COVID-19 pandemic has added quarantine restrictions that have further increased the risk for CV disease. The purpose of the present study is to determine the effects of COVID-19 restrictions on The University of Texas at El Paso's (UTEP) Doctor of Physical Therapy (DPT) students' health outcomes. The proposed study's objectives are: to determine differences in fitness capacity, body composition, physical activity levels, and fear of COVID during and after strict COVID-19 restrictions. We hypothesize that COVID-19 quarantine restrictions will produce detrimental effects of DPT students' health outcomes. NUMBER OF SUBJECTS: Using convenience sampling, 18 participants were recruited via online meetings and emails from UTEP's DPT class of 2023. Following the first round, 2 participants dropped out, leaving 16 subjects for data analysis. MATERIALS AND METHODS: This longitudinal study required 2 visits (during strict restrictions (Nov. 2020) and 3 months after restrictions were lifted (July 2021)). Primary outcome measures were cardiorespiratory fitness levels, measured via maximal oxygen consumption (VO2max), and body composition measured via Dual Energy X-ray Absorptiometry and BMI. Secondary outcome measures were the International Physical Activity Questionnaire to assess physical activity levels and a validated fear of COVID survey. A paired t-test for each variable was performed to determine differences in health outcomes. RESULTS: After a period of 7 months, participants' VO2max (41.66, SD = 8.43, P = 0.013), BMI (25.20, SD = 3.29, P = 0.016), and moderate physical activity minutes per week (935.94, SD = 733.36, P = 0.01) increased. No significant changes in participants' fear of COVID-19 was observed. CONCLUSIONS: Following the removal of quarantine restrictions, significant increases in aerobic capacity and moderate exercise time were likely observed due to increased workout facility availability, more in-person learning, and increased social interaction. While BMI increased, body fat % remained statistically unchanged, suggesting BMI gains stemmed from muscle mass increasing. Moreover, the unchanged fear of COVID-19 suggests it was not significantly affecting the participants' activity levels;rather, the easing of restrictions was likely a critical factor improving their health. CLINICAL RELEVANCE: The results of this study suggest that easing the COVID-19 restrictions can have a positive impact on DPT studentsv health and potentially mitigate CV risk factors;reflecting the importance of accessibility for students' health and how similar educational programs react to future health crises.
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Background: Integrative therapies such as TCM are often expected to establish their usefulness through evidence based methods that are acceptable to all stakeholders. Objective: To describe the challenges of recruiting and retaining participants in a clinical trial during COVID-19 Study Design: Commentary and observations during a prospective case series investigating the usefulness of a Chinese herbal medicine for osteoporosis. Challenges: Our clinical trial intended to recruit a small number of patients (n = 10). But the follow up was for one year and also required DEXA scans periodically to assess the improvement in bone density. The pandemic's impact was felt on the recruitment, data collection and compliance of study protocol. It also created challenges in retaining all patients in the trial, who were recruited already.When the pandemic hit us, we were in the middle of the trial. Several patients needed the herbal supplement refill, some required scans, and others required clinical screening and evaluation. With the closures, we had to move the data collection points. The diagnostic imaging center did not prioritize the scans for clinical research patients over other essential patients creating missing data. Patients in the trial, who had questions regarding the supplements or time points felt disconnected as well. Mailing of supplements were not easy because of the pandemic and the fear of virus on the mailed packets. Solutions: A dedicated research assistant, who maintained a personal relationship with the research patients kept the communication channel open and could explain the next steps and how the trial is being conducted in the new challenging situation. Patient cooperation was requested in distributing the supplements in the parking lots, DEXA scans were skipped for one time point. Study forms were emailed. Conclusion: Despite these challenges, only one patient dropped out of the study and could successfully recruited all patients.
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AIM: To, in children, investigate the associations between serum furin, obesity, overweight, body fat and circulating markers reflecting adipose tissue or systemic inflammation. METHODS: We analysed furin, leptin, adipocyte fatty acid-binding protein, triglycerides, interleukin (IL)-6, IL-8 and C-reactive protein in serum from 166 children in the Pediatric Osteoporosis Prevention (POP) study collected at mean age (SD) 9.9 (0.6) years. Children were classified as low-to-normal weight, overweight or obese. Total body fat mass (kg), trunk fat mass (kg) and total body lean mass (kg) were measured by dual-energy X-ray absorptiometry. Body fat percentage (%) was calculated. RESULTS: We found that circulating furin levels were higher in children with obesity and overweight compared with children with low-to-normal weight (p < 0.001 and p = 0.006, respectively). Also, there were positive correlations between circulating furin, total body fat mass, trunk fat mass, body fat percentage, triglycerides, adipokines and pro-inflammatory markers. CONCLUSION: This study indicates associations between furin, adiposity and a pro-inflammatory milieu in children. We suggest that future studies investigate the role of furin in fat tissue inflammation and associated increased risk of cardiometabolic diseases in children. Studies should also investigate whether higher furin levels could be a link between obesity and severe coronavirus disease 2019 in children.
Subject(s)
COVID-19 , Furin , Absorptiometry, Photon , Adiposity , Body Mass Index , Child , Humans , Obesity , Overweight , SARS-CoV-2ABSTRACT
We report the impact of the COVID-19 pandemic on bone densitometry practice in a Northern Italy Orthopedic Hospital, comparing the first 4 months of 2020 with the corresponding period of 2019. COVID-19 pandemic had a disruptive effect on the daily practice of bone densitometry (about - 50% of examinations). INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) pandemic radically changes hospital organization to guarantee patient and staff safety, with the unavoidable cessation of normal outpatient activities. We report the impact of the COVID-19 pandemic on dual energy x-ray absorptiometry (DXA) testing in a Northern Italy Orthopedic Hospital. METHODS: We analyzed the number of DXA examinations performed at our Institution before, during the lockdown, and immediately after outpatient practice reopening (January 24th to May 27th, 2020), comparing them with the corresponding period of 2019. RESULTS: The number of DXA examinations showed a tremendous reduction from n = 1247 performed from January to May 2019 to n = 623 of 2020 (- 49.9%). No exams were performed in April 2020 (- 100%). On May 2020, a faint resume was observed, with n = 43 DXA (- 84.4% compared to 2019). CONCLUSION: COVID-19 pandemic had a disruptive effect on the daily practice of bone densitometry with DXA. After reopening, we observed a persistence of DXA examination reduction, confirming the fact that returning to normality will probably be a slow process.