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Introduction: Lung cancer is the leading cause of cancer-related death in the US with an estimated 236,740 new cases and 130,180 deaths expected in 2022. While early detection with low-dose computed tomography reduces lung cancer mortality by at least 20%, there has been a low uptake of lung cancer screening (LCS) use in the US. The COVID-19 pandemic caused significant disruption in cancer screening. Yet, little is known about how COVID-19 impacted already low use of LCS. This study aims to estimate LCS use before (2019) and during (2020 and 2021) the COVID-19 pandemic among LCS-eligible population in the US. Method(s): We used population-based, nationally representative, cross-section data from the 2019 (n=4,484), 2020 (n=1,239) and 2021 (n=1,673) Behavioral Risk Factor Surveillance System, Lung Cancer Screening module. The outcome was self-reported LCS use among eligible adults in the past 12 months. For 2019 and 2020, the eligibility was defined based on US Preventive Services Task Force (USPSTF) initial criteria-adults aged 55 to 80 years old, who were current and former smokers (had quit within the past 15 years) with at least 30 pack years of smoking history. For 2021, we used the USPSTF updated criteria- adults aged 50 to 80 years, current and former smokers (who had quit within the past 15 years) with at least 20 pack years of smoking history. We applied sampling weights to account for the complex survey design to generate population estimates and conducted weighted descriptive statistics and logistic regression models. Result(s): Overall, there were an estimated 1,559,137 LCS-eligible respondents from 16 US states in 2019 (AZ, ID, KY, ME, MN, MS, MT, NC, ND, PA, RI, SC, UT, VT, WV, WI), 200,301 LCS-eligible respondents from five states in 2020 (DE, ME, NJ, ND, SD), and 668,359 LCS-eligible respondents from four states in 2021 (ME, MI, NJ, RI). Among 2,427,797 LCS-eligible adults, 254,890;38,875;and 122,240 individuals reported receiving LCS in 2019, 2020 and 2021, respectively. Overall, 16.4% (95% CI 14.4-18.5), 19.4% (95% CI 15.3-24.3), and 18.3% (95% CI 15.6-21.3) received LCS during 2019, 2020, and 2021, respectively. In all years, the proportion of LCS use was higher among adults aged 65-74, insured, those with fair and poor health, lung disease and history of cancer (other than lung cancer). In 2020, a higher proportion of adults living in urban areas reported receiving LCS compared to those living in rural areas (20.36% vs. 12.7%, p=0.01). Compared to non-Hispanic White adults, the odds of receiving LCS was lower among Hispanic adults and higher among Non-Hispanic American Indian/Alaskan Native adults in 2020 and 2021, respectively. Conclusion(s): LCS uptake remains low in the US. An estimated 2,011,792 adults at high-risk for developing lung cancer did not receive LCS during 2019, 2020 and 2021. Efforts should be focused to increase LCS awareness and uptake across the US to reduce lung cancer burden.
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Objectives: Clinical Practice Research Datalink (CPRD) Aurum captures primary care electronic healthcare records for ~28% of the population in England. From August 2020-;March 2022, all SARS-CoV-2 polymerase chain reaction (PCR) tests performed were reported back to the patient's general practitioner (GP), making the CPRD a closed system uniquely positioned to answer COVID research questions. Method(s): We defined persons with COVID as those recorded in primary care with a positive PCR test from August 1, 2020-March 31, 2021. We required continuous registration with their GP practice for >=365 days prior to diagnosis to establish comorbid conditions, and eligibility for linkage to Hospital Episode Statistics (HES) Admitted Patient Care data. Hospitalizations for COVID were defined as persons admitted with a primary diagnosis of COVID (ICD-10-CM U07.1) within 12 weeks of the initial primary care diagnosis record. Result(s): Our cohort included 535,453 persons diagnosed in primary care with COVID, with 2% later hospitalized. The hospitalized group was 57% male, 42% current/former smokers, 35% obese46% with a Charlson Comorbidity Index >1 and 98% had never received any COVID vaccine. Hospitalizations increased with age;<0.1% of patients aged 1-17, 1% aged 18-49, 4% aged 50-64, 9% aged 65-74, 13% aged 74-84, and 11% of COVID cases aged >=85 were hospitalized. Persons living in socially disadvantaged areas were overrepresented in the hospitalized cohort (25% in the Index of Multiple Deprivation's most deprived quintile). Conclusion(s): Consistent with other studies, hospitalized COVID patients were disproportionately those with male sex, smoking history, high body mass index, comorbidity and unvaccinated status. Hospitalizations were more common with age, and for individuals living in socially and economically deprived communities. Understanding the demographic and clinical characteristics of this cohort can help contextualize future work describing healthcare resource utilization and costs, as well as the impact of vaccines, associated with COVID in England.Copyright © 2023
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Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a respiratory condition characterised by a progressive and irreversible decline in lung function. COPD prevalence increased by 44.2% between 1990 and 2015, resulting in 3.2 million deaths globally in 2015.(1) Inhalers are an essential treatment for people living with COPD. However, poor adherence to inhaled medicines is associated with worsening symptom severity, increased hospitalisation, comorbidity, and mortality.(2) Patient Reported Outcome Measures (PROMs) have been designed to examine the factors that contribute to poor medication adherence (MA). To date, none provide a holistic assessment that could be used to design tailored MA interventions. This study sought to address this by evaluating a novel PROM that holistically assesses four key factors of MA referred to as Social, Psychological, Usage, and Rationale, in short, SPUR. Aim(s): To explore the validity of the SPUR model as a holistic PROM of MA in patients living with COPD Methods: This cross-sectional study surveyed adults living with COPD from a large London NHS Trust between January and December 2021. Participants were eligible if they had >=1 inhaler prescribed for a minimum of 6 months prior to the study and were able to read and write in English. Participants who were too clinically unwell to independently complete the survey were excluded, which often included those with a Covid-19 diagnoses. Convenience sampling was used to recruit participants from in-patient wards and the acute admissions unit prior to administration of face-to-face surveys. Survey questions related to socio-clinical data, the SPUR tool, and a previously validated PROM known as the Inhaler Adherence Scale (IAS) that was included as a comparator. The Medication Possession Ratio (MPR), a measure of a patient's pill count in a given time period, was used as an objective comparator of MA. MPR, IAS, and SPUR scores were compared using Spearman's rank correlation coefficient (p). Symptom severity was examined using the COPD Assessment Test (CAT), with a Chi-square analysis (chi2) conducted to explore the relationship between the CAT and SPUR. Result(s): From 123 patients approached for this study, 100 participated providing a response rate of 81.3%. The modal age range was 70-79 years. Participants were predominantly white (90%), educated to GCSE level (51%), and identified as female (52%). Over two thirds (67%) were ex-smokers. SPUR was significantly (p<0.01) and positively correlated with IAS (p=0.65) and MPR (p=0.30), demonstrating that SPUR is a valid measure of MA. Chi-Square analysis identified a significant (p<0.01) relationship between CAT and SPUR scores (chi2=8.570);hence SPUR could reliably identify patients with poorer adherence, which was associated with worsening symptom severity. Conclusion(s): A study strength includes the implementation of an objective measure (MPR) and PROM (IAS) as part of validating SPUR. However, the results should be treated cautiously given the small sample size, which was limited due to Covid-19. This study provides early evidence of SPUR as a reliable holistic measure of MA with significant associations to COPD symptom severity, which could be applied in clinical practice to prospectively address patient outcomes linked to poor MA.
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Purpose of Study Surgical site infections (SSI) burden U.S. hospitals with around $1.5 billion annually. To reduce SSI, irrigating the incision with an antimicrobial solution before closure is recommended. Hence, we evaluate the impact of Irrisept, a form of diluted chlorohexidine 0.05%, on reducing the prevalence of SSI in a high-risk breast cosmetic surgery population. Methods Used We conducted a retrospective cohort study using data in the electronic medical record for breast implant exchange patients in one practice and analyzed infection rates between 42 patients from July 2018-June 2019 that did not receive Irrisept irrigation (control group) with 16 patients from July 2019-July2020 that received Irrisept irrigation (experimental group;significantly less due to Covid-19). We executed descriptive analyses, independent T test, ANOVA (for 3 types of incision location), and Chi-squared to assess comorbidities and intraoperative factors. Summary of Results Among the control group (n=42), 4 patients had a postoperative infection;in the experimental group (n=16), 0 had an infection (9.52% vs. 0%;p=0.04) suggesting the use of Irrisept significantly decreases SSI. The p values from the T test and ANOVA (p<0.05=significant) showed no significant differences in breast cancer (0.84), previous radiation (0.32), history of chemotherapy (0.57), obesity (0.40), renal failure (0.32), smoker/previous smoker (0.41), type of implant (0.32), incision location (0.68), acellular dermal matrix use (0.32), or drain use (0.58) between two groups. The only significant comorbidity was diabetes (p=0.04) with 9.52% (control) vs. 0% (experimental). However, greater percentage of experimental group were obese (25% vs.14.29%) and had a history of smoking (25% vs. 9.52%). Conclusions A concern regarding the implementation of Irrisept irrigation is associated costs. However, the results show the use of Irrisept decreases the infection rates, ultimately relieving the financial burden of postoperative infections. Therefore, we recommend irrigating the incisions of breast surgery patients with Irrisept as both a preventative and economic measure.
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Background: Despite favorable vaccine responses of people with HIV (PWH), susceptibility to SARS-CoV-2 (SCv2) infection and increased risk of COVID-19 in immunocompromised PWH continue to be of concern. Here, we searched the Swiss HIV Cohort Study (SHCS) with>9500 actively enrolled, optimally treated PWH to identify factors associated with SCv2 infection in the pre-and postvaccination area. Method(s): We utilized information on SCv2 events reported to the SHCS in 2020 -2021. To detect asymptomatic infection, we screened pre-pandemic (2019) and pandemic (2020-2021) bio-banked plasma for SCv2 antibodies (Ab). SCv2+ and matched SCv2- PWH were additionally screened for Abs to circulating human coronaviruses (HCoV). Data were compared to HIV negative (HIV-) controls. SCv2 data and >26 behavioral, immunologic and disease-parameters available in the SHCS data base were analyzed by logistic regression, conditional logistic regression, and Bayesian multivariate regression. Result(s): Considering information on the SCv2 status of 6270 SHCS participants, neither HIV-1 viral load nor CD4+ T cell levels were linked with increased SCv2 infection risk. COVID-19-linked hospitalization (87/982) and case fatality rates (8/982) were low, but slightly higher than in the general Swiss population when stratified by age. Compared to HIV-, PWH had lower SCv2 IgG responses (median effect size= -0.48, 95%-Credibility-Interval=[-0.7, -0.28]). Consistent with earlier findings, high HCoV Abs pre-pandemic (2019) were associated with a lower risk of a subsequent SCv2-infection and, in case or infection, with higher Ab responses. Examining behavioral factors unrelated to the HIV-status, people living in single-person households were less at risk of SCv2 infection (aOR= 0.77 [0.66,0.9]). We found a striking, highly significant protective effect of smoking on SCv2 infection risk (aOR= 0.46 [0.38,0.56], p=2.6*10-14) which was strongest in 2020 prior to vaccination and was even comparable to the effect of early vaccination in 2021. This impact of smoking was highly robust, occurred even in previous smokers and was highest for heavy smokers. Conclusion(s): Our unbiased cohort screen identified two controversially discussed factors, smoking and cross-protection by HCoV responses to be linked with reduced susceptibility to SCv2, validating their effect for the general population. Overall weaker SCv2 Ab responses in PWH are of concern and need to be monitored to ensure infection- and vaccine-mediated protection from severe disease.
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Previous studies comparing treatment outcomes and the recovery of smokers after COVID 19 infection have yielded contradictory results. The aim of this retrospective study was to compare recovery and the rate of posthospital complications of former long-term smokers (FS) with non-smoking (NS) controls observed in PostCovid out-clinic hospital. We compared 88 FS and 96 NS, who had suffered from moderate to severe Covid-19 pneumonia, and were observed during 1-year follow-up period. The inclusion criteria were positive PCR test for SARS-CoV-2 infection and hospitalization due to acute respiratory failure. We compared lung function tests, blood gas analyses, onset of new symptoms and incidence of thrombotic incidents. Mean age of participants was 64.8+/-11.4 years for NS and 63.8+/-8.8 years for FS. At the beginning of follow-up FS group had significantly lower pulmonary function tests vs NS, including FEV1 (89.9% vs 94.6%, p<0.01);FVC (87.5% vs 94.3%, p< 0.01);DLco (62.3% vs 72.7%, p< 0.01), with a tendency for slower recovery during subsequent examinations. There was no significant difference between two groups regarding blood gas levels, number of reported symptoms and incidence of pulmonary embolism (7 vs 7). According to the results we can conclude that former smokers initially had worse lung function scores and prolonged recovery course. However, there was no significant difference in the number of symptoms and the frequency of thrombotic complications.
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Introduction: Pneumothorax was described as complication in COVID-19 patients although clinical risk predictors for its presentation and the potential role in patient's outcome is still unclear. Aim of the study: To assess risk predictors, therapeutic strategies and outcome of ARDS hospitalized COVID-19 patients with pneumothorax. Method(s): We performed a retrospective case-control analysis of 184 patients admitted for severe respiratory failure to our COVID-19 semi-intensive care respiratory unit (SARS-CoV-2 infection confirmed by molecular testing) from october 2020 to march 2021 reporting clinical and radiological features, comorbidities, treatments and outcomes. Result(s): The 8% of sample experienced spontaneous PNX (of which 75% right PNX and 8% bilateral PNX). The mean age of whole sample was 76 years, 53% males, 43% were obese, 50.5% current or former smokers, 52.7% had hypertension, 80% had a history of cognitive impairment, 80% had received non-invasive ventilation before pneumothorax. The mean P/F of pneumothorax group at our unit admission was 168. The 100% of them underwent chest dreinage. Their mortality was 83.1% (p<0.001). Conclusion(s): PNX may be a complication of severe COVID-19 infection associated with a worse prognosis in terms of mortality, consistently with the possible mechanism of hyperinflammatory form associated with critical illness. In our experience high-flow oxygen therapy may be a safer alternative to avoid the potential fatal occurrence of pneumothorax in COVID-19.
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Background: COVID-19 infectivity has been linked to various background factors, but there is no data on preCOVID determinants of COVID-19 diagnosis by the clinician, RT-PCR, and diagnosis by both methods. In an adult representative sample with pre-COVID data, we aimed to identify determinants of subsequent COVID-19 diagnosis by the clinician and RT-PCR. Method(s): In the cohort of 42,621 adults, 5,705 were diagnosed with COVID-19 by a clinician based on ICD-10 codes and 3,936 using RT-PCR. Pre-COVID data were available for several demographic factors, socio-economic (SES) factors, and several indicators of respiratory symptoms. Result(s): In total, 6,560 (15.4%) were diagnosed with COVID-19 by either clinician or RT-PCR;47% had both clinician diagnosis and RT-PCR;40% had clinician diagnosis but not RT-PCR confirmation;and 13% had only RTPCR confirmation. Proportion of those diagnosed by a clinician increased by age, but those of age >= 60 years were less likely to be confirmed with RT-PCR than those younger. Clinician diagnosis of COVID-19 did not differ by smoking, BMI, childhood on a farm, education, SES, or respiratory symptoms, but those with >= 2 co-morbidities were more likely to be diagnosed than those with <2 co-morbidities. For RT-PCR, ex-smokers, those who grew up on a farm, those with less high school education, those with respiratory symptoms, asthma, COPD, and >=2 co-morbidities were less likely to be diagnosed with COVID-19. Conclusion(s): Pre-COVID factors may influence COVID diagnosis and these act differentially for clinician-based diagnosis and based on RT-PCR. Such information can be useful for planning future screening efforts for COVID or other similar outbreaks.
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Background: As patients with immune conditions were excluded from COVID-19 vaccine clinical trials, it is important to accumulate realworld data in this setting, particularly to identify those who would benefit from repeated doses. Method(s): Effectiveness and Safety of COVID-19 Vaccine in Patients with Inflammatory Bowel Disease (IBD) Treated with Immunomodulatory or Biological Drugs (ESCAPE) is a prospective, multicentre, observational study assessing effectiveness and safety of COVID-19 vaccines in patients with IBD (ClinicalTrials.gov ID: NCT04769258). Here we present data on the rate of breakthrough SARS-CoV-2 infections in the timeframe between 14 days after the second dose and the third dose of COVID-19 vaccine (or a maximum of 9 months from the second dose). The risk factors for SARS-CoV-2 infection, including lack of seroconversion (cut-off for IgG anti-SARS-CoV-2: OD 0.28) and IgG anti-SARS-CoV-2 levels after 8 weeks from the second dose, and treatment for IBD, were assessed. Result(s): Out of the 1076 patients with IBD enrolled in the ESCAPE study, data on breakthrough SARS-CoV-2 infection were available in 953 cases. Most of the patients received homologous, doubledose mRNA-based vaccines (BNT162b2 or mRNA-1273: 99.2%). Seroconversion was reported in 92.7% of cases (median OD 1.60 [IQR 0.8-3.6]), while SARS-CoV-2 infection was documented in 95 patients (10.0%), of whom 9 died. At multivariable regression analyses, age (OR 0.97, 95% CI 0.96-0.99;p<0.001) being former smoker (OR 2.23, 95% CI 1.26-3.88;p=0.005), and lack of seroconversion (OR 0.42, 95% CI 0.20-0.99;p=0.034) were independent predictors of SARS-CoV-2 infection. Conversely, none of the treatments for IBD was associated with breakthrough SARS-CoV-2 infection. Notably, all 9 patients who died had reported seroconversion after the second dose. Conclusion(s): IBD patients without seroconversion after COVID-19 vaccines are at increased risk for SARS-CoV-2 infection, while medications for IBD had no impac.
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Introduction: Natural history of COVID-19 is yet unknown. A standardized follow-up may allow evaluating different patterns of COVID-19 evolution. AIM: To describe imaging and clinical-functional pulmonary data at 3- (T3) and 12-months (T12) follow-up in COVID19 patients. Method(s): COVID-19 patients discharged from Pisa University Hospital, Italy, from March to September 2020 were evaluated. Expert radiologists qualitatively assessed the evolution of COVID-19 pneumonia CT signs (PS) (baseline acute disease vs. T3) by using an original coding system. A chest CT at T12 was performed only in patients who had persistent PS at T3. Both at T3 and T12, all the patients underwent spirometry, plethysmography, DLCO and pulmonary visit. Result(s): Among 307 discharged patients, 57% and 44.3% were followed up at T3 and T12, respectively, while 12.4% died within T3. Followed patient's characteristics were: 62.9% men;median age 60.3 yrs;11.3% smokers and 30.6% ex-smokers;mean BMI 29.1 kg/mq;43.8% had 1+ comorbidities;median hospitalization 15 days;17.4% stayed 3+ days in ICU. At T3, 52.1% of patients showed resolution of PS, 82.8% had normal spirometry and 76.7% normal DLCO. Among patients with persistent PS at T3 (47.9%), 59.4% showed stability or improvement and 39.1% resolution of PS at T12. 31.6% had persistent PS at T12. An increased proportion of patients with normal lung function was observed at T12, but 5.6% and 20.4% had a restrictive pattern and reduced DLCO, respectively. Conclusion(s): About a third of patients show persistence of PS and about a fifth has DLCO abnormalities at 12- months from the acute COVID-19. Further follow-up is planned for these patients.
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Introduction: We have previously described pneumothorax (PTX) and pneumomediastinum (PM) in COVID-19. Incidence is approx. 1%, and usually associated with a poor prognosis. Method(s): With Caldicott approval, all patients with Covid-19 with PTX and PM are flagged to the pleural service for ongoing analysis. Demographics and outcomes are collected. Result(s): 46 were identified (Total: 4506, 01/03/20-02/01/22): mean age 57.5 years (range 19-91). 37 (82%) male, 45 white Caucasian, 1 South East Asian, 20 ex-smokers, 8 never smokers, 1 current smoker & the rest unknown. Respiratory comorbidity was most commonly COPD (12), asthma (4), combined pulmonary fibrosis and emphysema (1), previous TB (1), & active lung cancer (1). Average estimated frailty score was 2 (range 1-6). Mean BMI was 28 (range 18.5-46.7), mean height 1.72m (range 1.55-1.84). Average number of days to air leaks is 13.29 patients had PTX [16 isolated PTX (including 6 bilateral)] & 22 had PM (4 isolated PNM). 18 patients had concurrent surgical emphysema. 10 patients were intubated at the time of air leak, 16 on CPAP or HFNC, 13 on oxygen, the rest on air. 32 were managed conservatively. Others had a variety of small, large bore and subcutaneous drains and 1 was transferred for ECMO. There were 10 deaths with 1 directly due to PTX in a 91 yr old, CFS of 6 and intercurrent stroke. 1 was associated with PM, CFS 2 & lung cancer, 1 85 yr old with CFS 4 & COPD, 1 82 yr old with CFS 3 on CPAP & the rest were on mechanical ventilation). Conclusion(s): Inpatient incidence of PTX and PM is still approximately 1%. Survival is better as overall Covid19 survival improves(direct mortality from air leak approx. 21 %) with mortality due to other factors rather than the air leak.
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Aim: To investigate the association between tobacco smoking habits and severity and mortality of COVID-19 disease among ICU hospitalized patients. Material: Baseline sociodemographic, co-morbidities and clinical characteristics of 222 adult (70 women) COVID-19 hospitalized patients, aged 69+/-8yrs, mean ICU length of stay 35+/-12 days, were retrospectively collected and analyzed from 01/08/2020-01/08/2021. Also, information about caregivers' tobacco smoking behaviors were obtained. Result(s): 57 patients were current smokers (35+/-4 pack/yrs) and 61 ex-smokers(28+/-9pack/yrs). E-cigarette users were 18 patients (2 ex-smokers), dual users 22 (all current smokers). 37 continued to smoke up to hospital admission. Arterial hypertension (47/35) diabetes (44/24), betamuI>30 (22/34), coronary disease (40/22) and COPD (41/28) noted as main comorbidities in current smokers and ex-smokers. CT findings of pulmonary emphysema were detected in 31% of current and ex-smokers. 51% (113) of total patients died, aged 71+/-4 yrs, and ICU length of stay 40+/-15 days. Current smokers and ex-smokers were hospitalized in ICU for a longer period 29+/-7 days (p=0.001). APACHE II (48+/-8) and SOFA score (11+/-3) were higher in current smokers and ex-smokers (p=0.003). 53% of ICU patients had a family member that smoked, and 35% of them were willing to undergo a Tobacco Prevention and Cessation Program. 90% of current smokers after ICU discharge quitted smoking. Conclusion(s): Tobacco smoking is a serious comorbidity in ICU patients hospitalized for covid 19 disease, with both current smokers and ex-smokers reveal more severe rates of mortality and morbidity.
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Background: Persistent symptoms and impairments occur after both severe and mild COVID-19 infection. Studies have focused on follow-up after hospitalisation, however studies in non-hospitalised people are warranted. Aim(s): To evaluate long-term impact on physical function and health-related quality of life (HRQoL) in non-hospitalised adults with post COVID-19 condition. Method(s): Preliminary results from assessment in non-hospitalised adults (n=51), with >= 3 months of persistent symptoms after infection, was performed at Karolinska University Hospital. Baseline assessment was in median 9 months after illness onset and follow-up 20 months after illness onset. Assessments consisted of dynamic spirometry, maximal inspiratory pressure (MIP), 6-minute walk test (6MWT), mMRC dyspnoea scale (0-4) and HRQoL (EQ5D VAS: 0-100). Result(s): Mean age was 42 years (SD:10,8) and 92 % were women. Prior to infection 82 % worked and at baseline 47 % were on full-time sick leave compared to 33 % at follow-up. Median BMI was 25 (IQR: 5,6), 16 % had asthma and 35 % were smokers or former smokers. Improvements between baseline and follow-up were seen in 6MWT (75 % vs 82 % of predicted distance, p<0.05), MIP (81 % vs 95 % of predicted, p<0.05) and mMRC (3 vs 2, p<0.05). HRQoL was impaired and unchanged (mean EQ VAS: 34 vs 39). Lung function, expressed as % of predicted, was normal and unchanged (FEV1: 85 % vs 88 %, FVC: 88 vs 89 %). Conclusion(s): The results indicate that although physical function improve to some degree, impairments in physical function and HRQoL remained 20 months after COVID-19 infection. Finding causes and rehabilitation to improve these impairments are urgently needed.
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Premise Pulmonary involvement by COVID-19 is almost constant;even in many pts cured from the acute phase (interstitial pneumonia) respiratory symptoms and signs persist (dyspnea, cough, desaturation, respiratory failure) and from pneumonia it passes to interstitial disease (ground-glass) and from there to pulmonary fibrosis (honeycomb lung). Objective of the study We asked whether the severity of the acute phase is matched by an equally severe long covid (LC). As indicators of severity, we used the minimum p/F at onset and the extent of disease at chest CT. Method(s): To consecutively evaluate all pts recovered from the acute phase of COVID-19 who presented to the pulmonology outpatient clinic with urgent referral from May 30, 2020, to January 31, 2022. Result(s): 314 outpts, mean age 62.3 years, 142 women, 172 men, with urgent request, for pulmonary examination and treated on an outpt basis presented a picture of LC with persistent lung lesions at 2 and 6 months respectively in 100% (66 at echo-thorax and 248 at chest CT) and 78.34% (246 pts) of the subjects. Of these compared with p/F: < 100: 27 pts 8.6% 101-200: 97 pts 30.8% 201-300: 103 pts 32.8% >300: 87 pts 27.7% (p/F 127 severe, 103 average, and 87 normal) Discussion From these data, it appears that severity of COVID-19 disease is not a predictor for the development of LC. Conclusion(s): Further study are needed to identify what elements may be used to identify predictor for LC. Possible among these may be: not having been treated with steroid in the cytokine phase, low vitamin D values, pre-existence of pulmonary fibrosis or interstitial disease, pre-existence of lung lesions in former smokers, obesity, diabetes, hypertension.
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Objectives: There has been a significant increase in pulmonary embolism (PE) cases during the coronavirus disease of 2019 (COVID-19) pandemic. In this study, we aimed to compare the effects of COVID-19 positivity on morbidity and mortality in patients treated with a diagnosis of high-risk PE. Method(s): In this single-center and observational study, patients who were referred to our center with the diagnosis of PE between January 1, 2019 and 2021 were retrospectively evaluated. Patients with moderate- and low-risk PE according to the European Society of Cardiology PE guidelines, those who did not undergo computed tomography pulmonary angiography (CTPA) or the ones who did not accept treatment were excluded from the study. The patients included in the study were divided into two groups, as those with and without COVID-19, and compared in terms of demographic data, comorbidities, symptoms, thromboembolism in vessels other than the pulmonary artery, laboratory parameters, treatments, and prognosis. Result(s): A total of 384 PE cases were identified during the study period. Among them, 322 cases that were in the intermediate or low-risk category, 21 cases who did not undergo CTPA, and one case who did not accept thrombolytic therapy were excluded from the study. A total of 40 cases were included in the study. The groups with and without COVID-19 consisted of 23 and 17 patients, respectively. In the group of patients with COVID-19, inflammatory markers were higher, Wells score was lower, and thromboembolism was seen in vessels other than the pulmonary artery. The two groups were similar in terms of other laboratory parameters, demographic data, comorbidities, symptoms, treatment, and prognosis. Conclusion(s): While the involvement of COVID-19 in PE etiology does not change mortality, it may cause more thrombosis development in both venous and arterial systems outside the pulmonary area by significantly increasing inflammation. However, the lower Wells scores in COVID-19 PE cases in our study indicate that new clinical assessment tools are needed to detect PE risk in COVID-19 patients.©Copyright 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.
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Introduction and objective: Chronic obstructive pulmonary disease (COPD) is a public health problem of the first order and underdiagnosis of this disease is a universal phenomenon. The objective of our study is to determine the prevalence of COPD and to analyze the clinical, radiological and functional characteristics of patients without a previous diagnosis of COPD and diagnosed with this disease in the post-COVID follow-up consultation, and to compare them with patients without COPD. Methods and materials: A study was carried out of the patients referred to the post-COVID consultation who were diagnosed with COPD in said consultation between the months of June 2020 and February 2021. The variables included were: sex, age, smoking habit, pack-year index (IPA), degree of dyspnea according to the mMRC scale, function and characteristics in chest CT. Result(s): Of the 371 patients evaluated in the post-COVID follow-up consultation, 23 of them, 11%, were diagnosed with COPD. 61% were men with a mean age of 60 +/- 11 years, 17% being active smokers, 56% ex-smokers with a mean IPA of 26 +/- 15. The rest of the variables are shown in Table 1. Significant differences were found between patients with and without COPD in terms of smoking (p<0.001) and lung function (p=0.002). No significant differences were found in the rest of the variables. 21% of COPD patients had emphysema on chest CT. Conclusion(s): The diagnosis of COPD was established in 11% of the patients evaluated in the post-COVID consultation.
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INTRODUCTION: The relationship between smoking and increased morbidity/mortality with COVID19 is well documented;however, there is little data on the relationship between former smokers (FS) and COVID19. Risk stratification of FS is dependent on years since smoking cessation (SC). We conducted a study to determine, if years since SC influenced COVID19 outcomes. METHOD(S): A retrospective cohort study at a single institution. Inclusion criteria: age >= 18 and admitted to the hospital from Jan 2020 to Nov 2021 for COVID19. Patients were divided into two categories;SC < 15 years, and SC > 15 years. The primary outcome was mortality, with secondary outcomes: requirement of nasal cannula (NC), NIV, and mechanical ventilation (MCV). Odds ratios (OR) were calculated for all outcomes. Post-hoc age-adjusted odds ratios (AOR) for age < 75, were calculated for all outcomes. Mortality data was collected on all patients, and OR were calculated between FS, smokers (CS), and non-smokers (NS). RESULT(S): The total number of patients was 608 with 256 being FS, 308 non-smokers, 30 CS, and 14 unknown smoking status. The mean age of FS was 70. There were 154 males (60%) 102 females (40%). Total FS < 75 was 152. Obesity rates were 64.1% and 67.6%, T2DM (Diabetes Mellitus) rates were 34.3% and 59.5% in SC < 15 and SC > 15, respectively. There was no difference in mortality between the two groups, OR (OR 0.81, CI 0.46-1.40, p=0.45) and AOR (AOR 0.79, 0.37-1.69, p=0.54). There was an increased risk of MCV for the SC < 15 group (OR 2.1, CI 1.02-4.57, p=0.04). AOR did not replicate this trend. There was no difference in patients requiring NC (AOR 1.38, CI 0.70-2.74, p=0.36) or MCV (AOR 1.65, CL 0.69- 3.91, p=0.25) between the two groups. SC < 15 had lower rates of NIV (AOR 0.36, CI 0.15-0.90, p=0.029). There was no difference in mortality between FS and CS (OR 1.69, CI 0.70-4.19, p=0.24). The FS group had higher rates of mortality than NS (OR 1.43, CI 1.00-2.05, p=0.048). CONCLUSION(S): Regardless of the timing of SC, FS have the same mortality and MCV rates with COVID19. High comorbidity burden was noted in both population groups, with the SC > 15 group having higher rates of T2DM. Further studies are needed to determine the full effect of SC on COVID19 outcomes, including effect of pack years.
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Background. During the COVID-19 pandemic, social interventions such as social distancing and mask wearing have been encouraged. Social risk factors for SARS-CoV-2 infection and subsequent hospitalization remain uncertain. Methods. Adult patients were eligible if admitted to Emory University Hospital or Emory University Hospital Midtown with acute respiratory infection (ARI) symptoms (<= 14 days) or an admitting ARI diagnosis from May 2021 - Feb 2022. After enrollment, an in-depth interview identified demographic and social factors (e.g., employment status, smoking history, alcohol use), household characteristics, and pandemic social behaviors. All patients were tested for SARS-CoV-2 using PCR. We evaluated whether these demographic and social factors were related to a positive SARS-CoV-2 test upon admission to hospital with ARI using a logistic regression model. Results. 1141 subjects were enrolled and had SARS-CoV-2 PCR results available (700 positive and 441 negative). The median age was greater in the SARS-CoV-2 negative cohort than in the positive cohort (60 and 53 years, respectively;P< .0001). Those who tested positive were more likely to have had at least some college education compared to those who tested negative (64.3% vs 52.3%, P< .0001;adjusted odds ratio [aOR]: 1.4 [95%CI: 1.1, 2.0]). Compared to those who tested negative, those who were SARS-CoV-2 positive were also more likely to be employed (48.9% vs 26.5%, P< .0001;aOR: 1.7 [95%CI: 1.1, 2.3]), have children 5-17 yo at home (27.6% vs 17.9%, P=.0002;aOR: 1.5 [95%CI: 1.1, 2.1]). Those with COVID-19 were less likely to receive home healthcare (6.2% vs 13.3%, P< .0001;aOR: 0.5 [95%CI: 0.4, 0.9]) and to be a current or previous smoker (7.6% vs 17.7%, P< .0001;aOR: 0.3 [95%CI: 0.2, 0.5]). Conclusion. Among adults admitted to the hospital for ARI, those who tested positive for SARS-CoV-2 were typically younger, more likely to care for school-aged children, more likely to work outside the home, but were less likely to receive home healthcare or smoke. Personal and public health strategies to mitigate COVID-19 should take into consideration modifiable social risk factors.
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Aims: To describe longitudinal associations between health-related quality of life (HR-QoL) scores and demographic, clinical, and health behavioral characteristics in a multisite U.S. cohort of adults in HIV care. Method(s): People with HIV (PWH) completed an electronic assessment of patient-reported outcomes (PROs) as part of routine clinical care between 2016 and 2021 including measures for HR-QoL (EQ-5D-3L), substance use (ASSIST, AUDIT/AUDIT-C), smoking, and HIV stigma, among others. We used generalized linear latent and mixed models with nonparametric random effects for the intercept term to accommodate repeated measures on individuals to examine longitudinal factors associated with HR-QoL overall and stratified by birth-sex. Result(s): PWH (n = 10,559, median age at first assessment = 49, 17.8% cis-gender women, 1.4% transgender women;68.3% non-White) completed 33,866 assessments. Lower HR-QoL scores were associated with increasing age (p <= 0.0001);identifying as female (cis or transgender) compared to cisgender male (p <= 0.0001, p = 0.005, respectively);living in the Southeast or Western US relative to Northeast (both p <= 0.0001);identifying as a sexual orientation other than gay (heterosexual p = 0.03, bisexual p = 0.009, other p <= 0.0001);higher internalized HIV stigma (p <= 0.0001);current or former smoking (both p <= 0.0001);past methamphetamine use (p = 0.015) and current cocaine/crack, methamphetamine, opioid and cannabis use (p <= 0.0001 for each except cannabis, which was p = 0.007). Higher HR-QoL scores were associated with race/ethnicities other than White (Black: p = 0.002, Hispanic: p = 0.002, other: p <= 0.0001);the COVID-19 pandemic period (March 2020-December 2021) (p <= 0.0001);and increased AUDIT/AUDIT-C score (p = 0.001). In sex stratified models men (n = 8666) had higher HR-QoL scores among non-white compared to white (Black p = 0.0006, Hispanic p = 0.007, Other p <= 0.0001);and during the COVID period (p <= 0.0001). Men had lower HR-QoL scores among heterosexual and bisexual men relative to gay (p = 0.004, p = 0.005), if they were a former smoker (p <= 0.0001), and among past or current methamphetamine users relative to nonusers (p = 0.002, p <= 0.0001). Women (n = 1893) had higher HR-QoL scores if in care longer (p = 0.005), and lower HR-QoL if in the South (p <= 0.0001), if previously used cocaine/crack (p <= 0.0001), or if currently uses marijuana (p = 0.001). Conclusion(s): Our findings describe HR-QoL and its associations among a large diverse cohort of PWH, identifying potentially modifiable factors to improve HR-QoL, such as substance use, smoking, and impact of HIV-related stigma.
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SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: To address rural healthcare disparities by providing access to home based pulmonary rehabilitation (HBPR) program for eligible veterans at the Salem Veterans Affairs Medical Center (VAMC) who reside in remote areas or those with barriers of long travel time and transportation hardship. METHODS: The Pulmonary Section at the Salem VAMC received a grant from the Office of Rural Health to establish HBPR program for eligible veterans. Its goal was to improve quality of life and potentially reduce COPD hospitalizations and exacerbations (AECOPD). Under the direction of pulmonologists, the program was run by an exercise physiologist (EP). Referrals were received from inpatient and outpatient providers. After an initial in-person evaluation, weekly telehealth meetings (telephone, video) occurred over 12 weeks. Veterans were provided with the equipment, and an individualized targeted exercise program along with education and counseling on tobacco cessation, nutrition, oxygen compliance, stress management, medication adherence. Follow up appointments were scheduled at 3, 6 and 12 months post completion. RESULTS: Between September 2020 and January 2022, 312 consults were received, 206 consults were scheduled and 175 veterans enrolled. To date, 100 have completed the program with 24 ongoing. 30% declined service, citing: comorbidities, physical debility, difficulty remembering scheduled appointments, lack of motivation, social reasons, worsening health status. Mean age was 71, male predominance (95%). Referral diagnoses included: COPD (86%), chronic hypoxic respiratory failure (55%), COVID-19 (11%), Interstital Lung Diseases (10%). Mean FEV1 was 57% predicted, mean MMRC Dyspnea Scale 2.5, mean BODE score 5. 20% of enrolled veterans were active smokers, 72% were former smokers. 6 minute walk test increased from 156 meters on enrollment to 216 meters on completion. 45 veterans required hospitalization for pulmonary issues during their participation in the program. EP identified on weekly appointments 20 AECOPD that were treated as outpatient, 1 spontaneous pneumothorax that led to hospitalization, and facilitated the refill of inhalers or adjustment of medical regimen. Patient satisfaction score, including perception of benefit post completion was 29.4/30. CONCLUSIONS: HBPR at the Salem VAMC provided access to eligible veterans, overcoming barriers of rurality, transportation hardship and lack of nearby conventional programs. It also offered off business hours PR to veterans who continue to work. It allowed decrease in community care referrals thus establishing useful and cost effective service. CLINICAL IMPLICATIONS: Pulmonary Rehabilitation has been shown to reduce morbidity, improve functional status and have mortality benefit. Healthcare discrepancies and disparities have been a major obstacle for enrollment. HBPR would address these issues and contribute to decreased health service utilization and costs. DISCLOSURES: No relevant relationships by Nathalie Abi Hatem No relevant relationships by Brittany Frost No relevant relationships by Mitchell Horowitz No relevant relationships by Deepa Lala