ABSTRACT
Aim: A comparative analysis of short term outcome of colorectal resections undertaken before and during COVID-19 pandemic. Method(s): A retrospective analysis of prospective database of colorectal cancer resections pre and post COVID-19 (2019 vs 2020) in a DGH. The cohort had 106 patients (60 in 2019;46 in 2020). Outcome parameters analysed were, Length of stay (LOS), stoma formation, resection margin, Clavien-dindo classification of complications, 30 day re-admission rate and 30 day mortality. Demographic data included age, gender and type of resection Results: A total of 60 resections were performed in 2019, 53% being female and median age 68 years In 2020 there were 46 resections, median age 70.5yrs and 43% female. In 2019 15/60 (25%) of resections were performed as an emergency and in 2020 10/46 (22%) (P = 0.65). Median LOS was 8 days in 2019 and 7 in 2020 (P = 0.25). 5/60 patients were readmitted within 30days in 2019 and 9/46 in 2020 (P = 0.045*). In both arms 30 day mortality was 0. In 2019 8 patients suffered Clavien-dindo complications rated at 2 or greater and 11 in 2020 (P = 0.08). Stomas were formed in 26/60 in 2019 and 28/46 in 2020 (P = 0.037*). Finally in 2019 7/60 resections had R1 resection and 4/46 in 2020 (P = 0.62). Conclusion(s): The analysis found no signifcant difference in short term outcome of the two periods including length of stay or days in ICU. Comparatively little statistical difference was found between the two years despite COVID-19. The only parameters notably different were the stoma rate rising from 43% to 61%, and 30 day readmission rate increasing from 8% to 20%. This data-set is too small to infer if problems related to stoma care were responsible. This analysis would suggest that there was not a significant difference in occupancy of ICU beds despite increasing stoma formation at a local level. Many of these patients will need reversal and the pandemic is likely to continue, therefore should stomas be formed as readily? Larger multicentre audit may validate such observations.
ABSTRACT
BACKGROUND AND AIM: Bronchiolitis is the most common lower respiratory illness in young children, mostly caused by Respiratory Syncitial Virus (RSV);PICU admission for respiratory support is required in some cases. The recent Covid-19 pandemic has altered dynamics of viral transmission in the community. We aim to describe if there has been a modification in the number and characteristics of patients admitted to Italian PICUs between the pre-pandemic and post-pandemic period. METHOD(S): Multicenter retrospective observational study based on the national electronic web-based national registry of the Italian Network of PICU Study Group (TIPNet). PICU admissions due to bronchiolitis were compared from 2017 to 2022, considering the seasonal peak periods (October, 1st to April, 30th). RESULT(S): 918 patients have been admitted due to bronchiolitis to Italian PICUs in the above mentioned years. Cumulative yearly admissions are reported in Figure 1. The winter season of 2020-2021 reported a significantly lower number of admissions. RSV was consistently the reported cause in most cases throughout the years except in season 2020-2021, when it was never reported. In the 2020-2021 season, enterovirus was reported in 23% of cases. Covid-19 as cause of bronchiolitis was reported in one case in 2020- 21 and 2 cases in 2021-22. CONCLUSION(S): Covid-19 pandemic, due to possibly multiple factors, has changed the panorama of PICU admissions due to bronchiolitis in Italy. Although research is still ongoing, it seems that Covid itself is not a cause of severe bronchiolitis requiring respiratory support. (Figure Presented).
ABSTRACT
Introduction: Concerns have emerged during Covid-19 pandemic about management of Disease Modifying Therapies (DMTs) in patients with Multiple Sclerosis (pwMS). In particular, Ocrelizumab (OCR)-treated pwMS faced possible delays of scheduled infusions due to disruption of MS Centers activities as well as safety worries during lockdown periods. Objective(s): To assess changes of OCR infusion schedule in Italian pwMS during the first wave of COVID-19 pandemic (observation period: February-June 2020) and to investigate predictive factors determining delaying of OCR infusions. Material(s) and Method(s): Data were extracted from the Italian MS Register database. pwMS with an OCR infusion scheduled during the observation period and at least two previous OCR infusions were selected. Demographics (age, gender), disease characteristics (MS phenotype, disease duration, Expanded Disability Status Scale score, number of previous OCR infusions) and location of MS Centers among three Italian macro-regions (North, Center, South) were tested as potential predictors for treatment delay using univariable and multivariable linear model analyses. Result(s): Five-hundred ninety-nine pwMS (343 F/256 M;411 Relapsing MS/188 Progressive MS) from 65 MS centers were included in the analysis. Mean interval between two OCR infusions was 28.1 weeks (SD 2.72) before the observation period compared to 30.8 weeks (SD 5.45) during the observation period, with a mean delay of 2.7 weeks (p <0.001). No clinico-demographic factors emerged as predictors of infusion postponement, except for location of MS centers in the North of Italy (4.7 weeks vs 1.5 in the Center and 1.6 in the South). Such a difference was confirmed in multivariate analysis (p < 0.001) adjusting for prelockdown mean OCR infusion schedule. Conclusion(s): This large registry-based study shows that OCR infusions were significantly delayed during the first wave of COVID-19 pandemic in Italy. The location of the MS Centers in Northern Italy was the only predictor of OCR infusion postponement. This geographical area corresponds to the region in Italy that was hit first and more strongly by Covid-19 pandemic. The observed delay in OCR infusions disruptions of MS centers activities due to a drastic reduction of healthcare workers availability (because of infection/quarantine and/or reallocation in Covid Units) and concerns about using an immunosuppressive DMT like OCR during a new virus pandemic with many uncertainties.
ABSTRACT
Introduction: Cognitive difficulties experienced in MS impact areas such as work, socialising, self-care and many activities of daily living. There is a high prevalence of cognitive difficulties in MS, but despite this there are few programmes targeting cognition that focus on the ability to function well in everyday life. The COB-MS programme, an occupation-focused cognitive intervention, was developed to address this. It focuses on both the functional difficulties and the wide-ranging symptoms that present in MS, including the ability to maintain employment, social activities, home management and self-care. Objective(s): Here we report on the results of feasibility and initial efficacy of the COB-MS as a cognitive intervention for people with MS. Method(s): Although initially designed for in-person delivery, the COB-MS was adapted for online delivery due to the COVID-19 pandemic. Data was collected from people with MS experiencing cognitive difficulties at baseline, post-intervention, 12-weeks, and 6-month follow-up. The primary outcome measure was the Goal Attainment Scaling at 12 weeks. Data was also collected in cognition, quality of life, and mood. Result(s): One hundred and twenty-five people with MS and cognitive difficulties were randomised to either usual care or COB-MS intervention. Ninety-four participants were retained at 6-month follow-up. Fidelity data was collected and analysed for occupational therapist conducting the intervention. A qualitative evaluation of the COB-MS from the perspective of participants also took place. All feasibility results will be presented- preliminary efficacy, participant experiences, intervention fidelity, and overall outcomes from the trial. Conclusion(s):The results provide recommendations for a future definitive trial of COB-MS, with respect to both feasibility and preliminary, clinical efficacy.