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Objectives: Opioids play a significant role in the effective management of cancer-related pain. The COVID-19 lock down may have reduced access to opioids and caused a decline in the use of prescription of opioids among cancer survivors. This study compared opioid prescription rates among cancer survivors before and after the onset of COVID-19 pandemic using real-world electronic health records (EHR). Method(s): Cohort analyses of cancer patients using data from EHR database from the TriNetX, a global federated health research network across 76 healthcare organizations. We analyzed changes in prescription opioid use before (March 1, 2018, through March 1, 2019) and after onset of COVID-19 (April 01, 2020, through March 2021) among cancer survivors. The key outcome variable was any opioid prescription within 1 year of cancer diagnosis. One-to-one propensity score matching was used to balance the characteristics (age, sex, race, diagnoses including diabetes, hypertensive diseases, overweight, mood disorders, and visual disturbances) of the two cohorts. Data were analyzed using the TriNetX platform. Result(s): There were 1,502,143 cancer survivors before COVID-19 and 1,412,599 cancer survivors after the onset of COVID-19. The one-to-one propensity-score match yielded 1,382,561 cancer patients, mean age 64 at cancer diagnosis, and 73% were white. Percentage of opioid use among cancer patients declined from 35.6% before the COVID-19 to 35.1% after the onset of the pandemic (OR=0.976, 95% CI 0.971-0.981). Average number of opioid prescriptions within 1 year of cancer diagnosis declined from 5.7 before to 5.3 after the COVID-19 onset (p<0.001). Conclusion(s): Among cancer survivors, a small decline in prescription opioid use was observed after the onset of COVID-19 pandemic. Future studies are needed to distinguish the impact of revised guidelines, opioid prescription policy changes, and COVID-19 lock down on lower rates of prescription opioid use among cancer survivors.Copyright © 2023
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Objectives: The aim of this study was to assess Jordanian physicians' awareness about venous thromboembolism (VTE) risk among COVID-19 patients and its treatment protocol. Method(s): This was a cross-sectional-based survey that was conducted in Jordan in 2020. During the study period, a convenience sample of physicians working in various Jordanian hospitals were invited to participate in this study. Physicians' knowledge was evaluated and physicians gained one point for each correct answer. Then, a knowledge score out of 23 was calculated for each. Key Findings: In this study, 102 physicians were recruited. Results from this study showed that most of the physicians realize that all COVID-19 patients need VTE risk assessment (n = 69, 67.6%). Regarding VTE prophylaxis, the majority of physicians (n = 91, 89.2%) agreed that low molecular weight heparin (LMWH) is the best prophylactic option for mild-moderate COVID-19 patients with high VTE risk. Regarding severe/critically ill COVID-19 patients, 75.5% of physicians (n = 77) recognized that LMWH is the correct prophylactic option in this case, while 80.4% of them (n = 82) knew that mechanical prevention is the preferred prophylactic option for severe/critically ill COVID-19 patients with high bleeding risk. Moreover, 77.5% of physicians (n = 79) knew that LMWH is the treatment of choice for COVID-19 patients diagnosed with VTE. Finally, linear regression analysis showed that consultants had an overall higher knowledge score about VTE prevention and treatment in COVID-19 patients compared with residents (P = 0.009). Conclusion(s): All physicians knew about VTE risk factors for COVID-19 patients. However, consultants showed better awareness of VTE prophylaxis and treatment compared with residents. We recommend educational workshops be conducted to enhance physicians' knowledge and awareness about VTE thromboprophylaxis and management in COVID-19 patients.Copyright © 2022 The Author(s). Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved.
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Diabetes mellitus is prevalent worldwide and affects 1 in 10 adults. Despite the successful development of glucose-lowering drugs, such as glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 inhibitors recently, the proportion of patients achieving satisfactory glucose control has not risen as expected. The heterogeneity of diabetes determines that a one-size-fits-all strategy is not suitable for people with diabetes. Diabetes is undoubtedly more heterogeneous than the conventional subclassification, such as type 1, type 2, monogenic and gestational diabetes. The recent progress in genetics and epigenetics of diabetes has gradually unveiled the mechanisms underlying the heterogeneity of diabetes, and cluster analysis has shown promising results in the substratification of type 2 diabetes, which accounts for 95% of diabetic patients. More recently, the rapid development of sophisticated glucose monitoring and artificial intelligence technologies further enabled comprehensive consideration of the complex individual genetic and clinical information and might ultimately realize a precision diagnosis and treatment in diabetics.
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Introduction: One in five pregnant women in the UKis obese. Obesity is associated with increased risk of both maternal and foetal adverse outcomes. RCOG guidelines [1] recommend that all women with a booking BMI over 40 kg/m2 should be reviewed antenatally by a senior obstetric anaesthetist to guide risk assessment, medical optimisation and shared decision-making. The 2021 MBRRACE report [2] recommends that all women should be reweighed in the third trimester for accurate VTE risk scoring and prophylactic LMWH dosing. In our institution, reconfiguration of hospital areas as part of the COVID-19 response led to loss of designated clinic space for our obstetric anaesthetic clinic. As a result, our practice since has been to initially offer a telephone consultation followed by a face-to-face review if needed. Finding space for the latter has often been a significant logistical challenge. Our project sought to assess whether our practice continued to meet national standards in the wake of these changes. Method(s): Following audit approval, we retrospectively reviewed all women with a BMI >40 kg/m2 undergoing caesarean section (CS) over a six-month period (1/4/22 to 31/9/22). Result(s): 20 women met inclusion criteria (Category 1-3 CS - 12 women;Category 4 CS - 8 women). 100% of patients had booking height, weight and BMI recorded. 20% (4/20) of patients were reweighed in the 3rd trimester. Only 55% (11/20) of patients had been referred to and reviewed in the antenatal obstetric anaesthetic clinic (Figure). Of the 11 patients referred, 6 were referred later than 30 weeks. Of the 9 patients not referred, 8 had a BMI between 40 and 45 kg/m2. By contrast, 87% (6/7) of patients with BMI over 45 kg/m2 were referred and seen. Discussion(s): Our audit showed that we are not meeting national standards. Possible reasons identified were lack of awareness of the RCOG standards and referral criteria (especially for women with a BMI of 40 to 45 kg/m2) and logistical issues in undertaking face-to-face reviews without designated clinic space. Presentation of our results at the joint anaesthetic, obstetric and midwifery governance meeting has helped identify space in the antenatal clinic for face-to-face reviews, to start from March 2023 and to raise awareness of the national standards to ensure referral of all women with a BMI over 40 kg/m2. A reaudit is planned in 6 months. [Figure presented]Copyright © 2023 Elsevier Ltd
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Compared to other respiratory viruses, the proportion of hospitalizations due to SARS-CoV-2 among children is relatively low. While severe illness is not common among children and young individuals, a particular type of severe condition called multisystem inflammatory syndrome in children (MIS-C) has been reported. The aim of this prospective cohort study, which followed a group of individuals under the age of 19, was to examine the characteristics of patients who had contracted SARS-CoV-2, including their coexisting medical conditions, clinical symptoms, laboratory findings, and outcomes. The study also aimed to investigate the features of children who met the WHO case definition of MIS-C, as well as those who required intensive care. A total of 270 patients were included between March 2020 and December 2021. The eligible criteria were individuals between 0-18 with a confirmed SARS-CoV-2 infection at the Infectious Disease Hospital "Prof. Ivan Kirov"in Sofia, Bulgaria. Nearly 76% of the patients were <= 12 years old. In our study, at least one comorbidity was reported in 28.1% of the cases, with obesity being the most common one (8.9%). Less than 5% of children were transferred to an intensive care unit. We observed a statistically significant difference in the age groups, with children between 5 and 12 years old having a higher likelihood of requiring intensive care compared to other age groups. The median values of PaO2 and SatO2 were higher among patients admitted to the standard ward, while the values of granulocytes and C-reactive protein were higher among those transferred to the intensive care unit. Additionally, we identified 26 children who met the WHO case definition for MIS-C. Our study data supports the evidence of milder COVID-19 in children and young individuals as compared to adults. Older age groups were associated with higher incidence of both MIS-C and ICU admissions.Copyright © 2023 P. Velikov et al., published by Sciendo.
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Background: Nurses and other first responders are at high risk of exposure to the SARS-CoV2 virus, and many have developed severe COVID-19 infection. A better understanding of the factors that increase the risk of infection after exposure to the virus could help to address this. Although several risk factors such as obesity, diabetes, and hypertension have been associated with an increased risk of infection, many first responders develop severe COVID-19 without established risk factors. As inflammation and cytokine storm are the primary mechanisms in severe COVID-19, other factors that promote an inflammatory state could increase the risk of COVID-19 in exposed individuals. Alcohol misuse and shift work with subsequent misaligned circadian rhythms are known to promote a pro-inflammatory state and thus could increase susceptibility to COVID-19. To test this hypothesis, we conducted a prospective, cross-sectional observational survey-based study in nurses using the American Nursing Association network. Method(s): We used validated structured questionnaires to assess alcohol consumption (the Alcohol Use Disorders Identification Test) and circadian typology or chronotype (the Munich Chronotype Questionnaire Shift -MCTQ-Shift). Result(s): By latent class analysis (LCA), high-risk features of alcohol misuse were associated with a later chronotype, and binge drinking was greater in night shift workers. The night shift was associated with more than double the odds of COVID-19 infection of the standard shift (OR 2.67, 95% CI: 1.18 to 6.07). Binge drinkers had twice the odds of COVID-19 infection of those with low-risk features by LCA (OR: 2.08, 95% CI: 0.75 to 5.79). Conclusion(s): Working night shifts or binge drinking may be risk factors for COVID-19 infection among nurses. Understanding the mechanisms underlying these risk factors could help to mitigate the impact of COVID-19 on our at-risk healthcare workforce.Copyright © 2023 The Authors. Alcohol: Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.
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COVID-19 due to severe acute respiratory syndrome coronavirus 2, which has become a global pandemic, produces elevated liver enzymes, especially in severe cases. The mechanism suggests involvement of an administrated drug, cytokine storm, or hypoxia, etc., as opposed to virus-induced direct damage. If liver enzymes are elevated in COVID-19, we should evaluate for the presence of other liver diseases, and strictly follow-up liver enzyme values. In patients with COVID-19 complicated by chronic liver disease, we will use telemedicine/visits by phone, so as not to interrupt the treatment of the underlying disease, avoid unnecessary outpatient visits, and strive to halt the spread of the infection. Metabolism-associated fatty liver disease, which is often related to obesity, diabetes, and hypertension, may be a risk factor for COVID-19 severity. International academic societies have recommended guidance outlining the evidence to date regarding the management of patients with COVID-19 and liver disorders, and chronic liver disease under the COVID-19 pandemic.Copyright 2020 The Japan Society of Hepatology.
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The number of people with long-term consequences of COVID-19 is increasing worldwide. The long-term prognosis for patients remains poorly understood. Objective. To study cardiometabolic and psychocognitive features in comorbid elderly patients with atrial fibrillation (AF), de-pending on the presence of post-COVID syndrome (PCS). Material and methods. The observational analytical cohort study included 223 patients with AF and comorbidity (coronary artery disease, hypertension, obesity, type 2 diabetes mellitus) aged 60-74, who were divided into two groups: group 1 included 123 patients without COVID-19 and group 2 included 110 patients with a history of COVID-19 and the presence of PCS. The study evaluated laboratory and instrumental tests, and a general clinical study assessing psychocognitive disorders using the SPMSQ and HADS questionnaires was conducted. Results and discussion. In COVID-19 survivors, compared with patients of group 1, there were more pronounced atherogenic changes in total cholesterol (TC) (p=0.003), low-density lipoprotein cholesterol (p<0.001), and triglycerides (p=0.011). Lower dia-stolic blood pressure was found in COVID-19 survivors (p<0.001). In addition, patients in group 2 had higher median pulse pressure (p<0.001) and heart rate (p<0.001). In group 2 patients, a larger ascending aorta diameter was observed (p<0.001). The anx-iety-depressive syndrome was more common in COVID-19 survivors with comorbidities, and a statistically significant difference was found in clinical anxiety (24%, p=0.041) and subclinical depression (21%, p=0.015). When assessing cognitive function, mod-erate cognitive impairment was detected in 22% (p=0.005) of patients with PCS and severe cognitive impairment in 2% (p=0.007). Conclusion. In comorbid elderly patients with the post-COVID syndrome, a high prevalence of psychocognitive disorders and adverse cardiometabolic changes were observed, supporting the need for long-term monitoring of the general clinical condition and psychocognitive status of COVID-19 survivors.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
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Objectives: This analysis was conducted to develop a comprehensive list of ICD-10 CM codes for underlying conditions identified by the CDC as being associated with high-risk of developing severe COVID-19 and assessed the consistency of these codes when applied to large US based datasets. Method(s): The comprehensive list of ICD 10-CM codes for CDC-defined high-risk underlying conditions were mapped from CDC references and FDA Sentinel code lists. These codes were subsequently applied to Optum's de-identified Clinformatics Data Mart Database (claims) and the Optum de-identified Electronic Health Record (EHR) database across 3 years (2018, 2019 and 2020) among continuously enrolled subjects >= 12 years of age to determine the performance and consistency in identifying these high-risk underlying conditions annually over these years. Result(s): A total of 10,276 ICD-10 codes were mapped to 21 underlying conditions. Within the claims data, 62.7% of subjects >= 12 years had >= 1 CDC-defined high-risk condition (excluding age) with 26.6% of patients >= 65 years while in the EHR data 38% had >= 1 high-risk underlying condition (excluding age) with 14.4% >= 65 years. These results were similar and consistent in both datasets across all years. Patients aged 12-64 years in the claims data had a higher rate of >=1 high risk underlying condition relative to the EHR data, 49.3% and 34%, respectively. The top 5 conditions among the >= 65 were identical across both databases: hypertension, immunocompromised status, heart conditions, diabetes (type 1 or 2), and overweight/obesity. The top 5 conditions among the 12-64 age group were also similar among the databases and included: immunocompromised status, hypertension, overweight/obesity, smoking (current or former), and mental health conditions. Conclusion(s): These findings present a comprehensive list of codes that can be used by researchers, clinicians and policy makers to identify and characterize patients that may be at high-risk for severe COVID-19 outcomes.Copyright © 2023
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Obesity represents a higher risk of severe COVID-19 infection, which may lead to the requirement of a mechanical ventilation in intensive care units and premature death. The underlying mechanisms are multiple: alteration of the respiratory performance, presence of comorbidities such as diabetes, hypertension or obstructive sleep apnea, finally inadequate and excessive immunological responses, possibly aggravated by ectopic intrathoracic fat depots. Thus, COVID-19 may challenge the so-called <<obesity paradox>> commonly reported by intensivists in patients with acute respiratory distress syndrome. These findings require reinforced preventive and curative measures among obese patients to limit the risk of progression towards an unfavorable outcome in case of COVID-19.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.
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In the COVID-19 pandemic, millions of people have had to stay in isolation for months. Children did not go to school for a long time, they spent much more time at home and were sedentary. They also spent much more time on screen-related activities (personal computer (PC), mobile phone, music player, tablet, game console, and television (TV). These situations have had various effects on children and adolescents. Undoubtedly, long-term restrictions and lifestyle changes have had effects on individuals with childhood obesity, pubertal progression, and type 1 diabetes (T1D). In this review, articles investigating the effect of COVID-19 quarantine/pandemic on adolescence, childhood obesity and diabetes were compiled and the effect of the COVID pandemic on these frequently encountered situations in pediatric endocrine practice was tried to be revealed. © 2022, Pamukkale University. All rights reserved.
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Objectives: Reporting a case of a COVID-19 vaccinated patient admitted to our intensive care unit with severe acute respiratory failure due to SARSCoV2 - Omicron variant, rapidly deteriorating requiring intubation, prone ventilation, and ECMO support. Method(s): A 62 years old Caucasian male was admitted in ICU for rapidly deranging respiratory failure and fever which occurred over the previous 24h. The patient received two doses of SARS-CoV2 vaccine (Oxford, AstraZeneca), the last one over five months before onset of symptoms. The patient was admitted to the intensive care unit (ICU) with tachypnea, low peripheral saturation (80%), elevated serum creatinine (2.4 mg/dl), and mild obesity (BMI 34,6). Pressure support ventilation trial (2 hours) failed carryng out to orotracheal intubation and protective ventilation. Worsening of respiratory exchanges (5 th day from the admission) required a rescue prone ventilation cycle, in the meantime an indication was given to the placement of veno-venous ECMO. The cannulation site was femoro-femoral and the configuration used was Vivc25- Va21, according to the current ELSO nomenclature;ECMO flow was progressively increased until a peripheral saturation of 95% was obtained. Result(s): The patient passed out after 2 month of extracorporeal support with no sign of recovery of pulmonary and renal function. Conclusion(s): Unlike evidences showing a lower symptomatic engagement of the Omicron variant SARSCoV2 positive patients, we have witnessed a rapid and massive pulmonary involvement. The short time that passed from the onset of symptoms and the rapid decay of respiratory function required rapid escalation of the intensity of care up to extracorporeal support. The patient showed previous pathologies that can lead to suspicion of a loss of immune coverage given by the vaccine, in addition to the long time elapsed since the last dose. (Figure Presented).
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Introduction: Abdominal wall surgery has been one of the major victims of the COVID-19 pandemic, with a large number of patients who have seen their surgery delayed and many are still waiting to be operated on today. On the other hand, botulinum toxin is one of the main protagonists in optimizing abdominal wall surgery, especially important in complex hernia, but we must not forget that it can have adverse effects. Case report: We present the case of a 54-year-old man with a history of obesity, diabetes, hypertension, chronic renal failure and kidney transplant in 2000, who presented a midline incisional hernia as a result of an epigastric hernia operated on in 2006 and subsequently two onlay permanent synthetic mesh in 2010 and 2015. In February 2020 he presented an incisional hernia M2-4W3R3 with a volume of 35%, botox was infiltrated as optimization for surgery and while awaiting placement of a pneumoperitoneum catheter, the surgery was suspended due to the COVID-19 situation. He returns to our clinics in 2022 with a growth of the hernia and a volume of 95%. Weight loss, botulinum toxin and preoperative pneumoperitoneum were indicated. We performed a reconstruction of the abdominal wall with bilateral transversus abdominal release and preperitoneal 45x60cm polyvinylidene fluoride mesh and abdominoplasty. Discussion(s): Botulinum toxin can facilitate abdominal surgery, especially in complex hernias, but we must not forget that blocking the abdominal muscles can have adverse effects. The COVID-19 pandemic has been especially hard on surgical waiting lists, delaying surgeries and aggravating pathologies.
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SARS-CoV-2 infection during pregnancy has significant implications for both mothers and their offspring. Pregnant individuals are more likely to progress to severe or critical COVID-19 than nonpregnant reproductiveaged women. Similarly, COVID-19 is associated with a number of pregnancy complications including preterm birth, hypertensive disorders of pregnancy, and cesarean delivery. These adverse outcomes and the morbidity for pregnant people with COVID-19 are closely linked to the severity of COVID-19, and the variant of SARS-CoV-2. Recent data demonstrate that the worst maternal and fetal outcomes were present during the time period of the Delta variant of SARS-CoV-2. Specifically, there was an increase in stillbirth observed in association mostly with the Delta variant due to placental damage, and a greater risk of intensive care unit admission when compared to time periods when other non-Delta strains were predominant. Like other populations, pregnant individuals with other comorbidities such as obesity and chronic hypertension are at increased risk of more severe disease. Early in the pandemic, pregnant patients were much less likely than the general population to be vaccinated, due to a lack of data for vaccine efficacy and safety in pregnancy. As reassuring data have emerged, the vaccination rate of the pregnant population has increased, resulting in decreased disease severity and improved maternal outcomes. Vaccination also has beneficial implications for early neonatal health. The long-term implications of SARSCoV- 2 infection during pregnancy for both mothers and their children remain largely unknown and are a subject of ongoing investigation.
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Objective. To assess the impact of obesity and overweight on the course of COVID-19. Patients and methods. This prospective study included 218 patients with SARS-CoV-2 infection aged 18 to 94 years hospitalized between June 2020 and March 2021. We evaluated their clinical and laboratory parameters and their association with body weight. All patients were divided into 3 groups depending on their body mass index (BMI). Group 1 included 81 patients with grade 1-3 obesity (BMI >=30);group 2 comprised 71 overweight patients (BMI >=25 and <30);group 3 included 66 patients with normal body weight (BMI >=18.5 and <25). We analyzed clinical symptoms (including shortness of breath, fever, myalgia, headache, fatigue, changes in the oropharynx, cough, rhinorrhea, sore throat, anosmia, and diarrhea), prevalence of concomitant disorders and complications, findings of computed tomography and pulse oximetry, and findings of instrumental and laboratory examinations (complete blood count, urine test, electrocardiography, echo cardiography, biochemical assays, including C-reactive protein, procalcitonin, alanine aminotransferase, aspartate aminotransferase, lactate, lactate dehydrogenase, activated partial thromboplastin time, prothrombin index, D-dimer, ferritin). Data analysis was performed using the Statistica 6.0 software. Results. We found that overweight and obese patients were more likely to have the main COVID-19 symptoms and comorbidities than those with normal weight. Overweight and obese patients also required respiratory support more frequently than patients with normal weight. Obese and overweight patients had more severe systemic inflammation (CRP, procalcitonin), cytolysis (ALT, AST), and thrombosis (D-dimer). Conclusion. Our findings suggest that obesity and overweight are the factors associated with a more severe SARS-CoV-2 infection, which should be considered when planning their treatment and developing resource strategies.Copyright © 2022, Dynasty Publishing House. All rights reserved.
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BACKGROUND: According to the results of the ESSE-RF study, the frequency of obesity in the population reached 29.7%. Obesity is one of the main risk factors for the development of cardiovascular diseases. Features of the course of COVID-19 in patients with obesity is a very urgent problem. AIM: The aim of the study was a comparative investigation of clinical and laboratory-instrumental parameters in AH patients with or without obesity who had COVID-19 associated pneumonia, to identify the role of obesity as a potential predictor of post-COVID cardiovascular complications 3 months after discharge from the hospital. MATERIALS AND METHODS: Materials and methods. The study included 174 patients with COVID-19-associated pneumonia. Group 1 included 78 patients with AH without obesity, group 2 - 96 patients with AH and obesity. All patients were tested with a blood sample at the time of admission and 3 months after discharge from the hospital. We assessed parameters of general blood test, biochemistry, hemostasis, inflammation biomarkers - concentration of C-reactive protein (CRP), highly sensitive CRP (hs-CRP), homocysteine, IL-6, etc. All patients initially underwent computed tomography of the chest. In both groups, 24-hour blood pressure monitoring was performed using BPLaB device, according to the standard protocol;echocardiography using an expert class ultrasound diagnostic system Vivid S70. The study is registered with the Clinical Trials.gov database Identifier: NCT04501822. RESULT(S): Results. The biomarker that significantly distinguished the both groups of patients, as well as subgroups according to the degree of obesity was the concentration of maxCRP and hs-CRP, which was significantly higher in group 2. In addition, the registered maximum values of MPO, NT-proBNP, IL-1,6, TNA-alpha and NRL parameters in group 2 of patients with 2-3 degrees of obesity, may indicate the highest probability of developing delayed adverse cardiovascular complications in this group of patients. Mean systolic blood pressure, variability of systolic and diastolic blood pressure, and heart rate at night were significantly higher in AH patients with obesity. Numerous correlations of obesity with laboratory and instrumental parameters have been registered, which may indicate an increased likelihood of delayed unwanted cardiovascular complications in this particular group of patients. Multiple regression showed that obesity is an independent predictor of an increase in LDH, hs-CRP and right atrium. CONCLUSION(S): Dynamic control of the studied parameters in patients with AH and OB registered an increased concentration of CRP at the initial stage and 3 months after treatment, with a general trend towards a decrease in the increased initial structural parameters of ECHO CG. The logistic regression method showed that the presence of OB in patients with AH is an independent factor causing increased levels of immune inflammation (CRP), a marker of tissue destruction (LDH), and load on the right atrium.Copyright © Endocrinology Research Centre, 2022.
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INTRODUCTION: Obesity is a high cause of death in both non-communicable and communicable diseases such as COVID-19. The aim of this study is to increase the awareness of emergency department (ED) managers and employees about this problem by showing obesity rates according to triage level in patients admitted to the ED. MATERIAL AND METHODS: BMI levels and complaints of 1246 patients admitted to the ED according to the 3-level triage were re-evaluated with the 5-level ESI (Emergency Severity Index) triage for this study. RESULTS: The mean BMI of 1246 patients was found to be 27.25 ± 5.88 (overweight). 26% of the ED patients were found to be obese and 37.7% of them were overweight. While the mean BMI score of the 6-11 age group was found to be class 1 obesity, the other pediatric and adult age groups were found to be overweight. The highest mean BMI according to both the 3-stage triage system and the 5-stage ESI triage system was found in triage 1 patients (28.8011 ± 7.98;28.18 ± 6.78, respectively). Obese patients mostly applied to the ED with orthopedic problems and trauma (26.5%). Also, of the patients with class 3 severe obesity, 50% presented with trauma. CONCLUSIONS: The higher the BMI, the higher the triage severity level. BMI levels should be evaluated in the field of triage together with vital signs, especially in trauma patients, and obesity should be considered in ED and hospital management. Copyright © 2023 Via Medica.
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Objective: To investigate how medical congresses have evolved since the COVID-19 pandemic, and its impact on how healthcare professionals interact with and develop congress publications. Research design and methods: International and regional congresses (2019-2022) in two therapy areas (obesity and oncology) were included. Data on attendance, attendee demographics, registration fees, and virtual capabilities were obtained from publicly- available sources or contacting congresses directly. Data on accepted publications were from authors' experience. Result(s): Twenty-three congresses were included. Congresses moved from face-to-face to fully virtual in 2020 and 2021, with most becoming hybrid in 2022. Despite the option of virtual attendance, total attendee numbers did not significantly change compared with pre-pandemic levels, although slightly decreased in 2021. Registration fees decreased during 2020-2021 but returned to pre-pandemic levels (regardless of virtual/live attendance) by 2022. Virtual and hybrid congresses provided access to oral session recordings and digital posters via congress apps or websites for a limited time after the event. In general, a broader range of digital publications was supported in 2021/2022, often associated with shorter lead times. Conclusion(s): Since the COVID-19 pandemic, congresses have embraced hybrid formats, offering virtual attendance options and a range of digital possibilities. Overall attendance and demographics remain relatively unchanged. Delegate testimonials support in-person attendance, citing the value of networking opportunities. Broader digital options from virtual congresses may be confounded by general advancements in journal publication extenders. As publication professionals, it is important to consider how congress delegates interact with live and digital content, and adapt content and delivery to maximise impact and optimise dissemination to all audiences.
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Objectives: Obesity is a condition prone to pose difficulties to a successful extra-corporeal membrane oxygenation (ECMO) support. Not being a contraindication, it yields significant challenges to physicians and may interfere with patient;s outcome. The number of obese patients supported by ECMO has increased during COVID-19 pandemic due to severe illness in this population. We designed a retrospective study in order to identify prognostic factors for 180-day survival in critical COVID-19 obese patients in venovenous ECMO (VV-ECMO). Method(s): Single-center retrospective cohort of critical COVID-19 adult patients in VV-ECMO, obese and overweight (according to WHO classification), admitted in a tertiary hospital;s ICU from April 1st 2020 to May 31th2022. Univariate logistic regression analysis was performed to assess 180-day mortality differences. Result(s): The analysis included 41 patients. The median [interquartile range (IQR)] age was 55 (IQR 45-60) years and 70,7% were male. Median body mass index (BMI) was 36 (IQR 31-42,5) Kg/m2 ;39% of patients had a BMI >=40 kg/m2 . The sampling had 3 (IQR 1,5-4) days of invasive ventilation prior to ECMO and 63,4% were weaned from ECMO-VV support after a median of 19 (IQR 10-34) days. The median ICU length of stay was 31,9 (IQR 17,5-44,5) days. The invasive ventilation period was 30 (IQR 19-49,5) days. The 60, 90 and 180-day mortalities were 41,5%. On the univariate logistic regression analysis we found that higher BMI was associated with higher 180-day survival (odds ratio [OR] 1,157 (1,038-1,291), p 0,009). Younger age, female patients, less invasive ventilation time prior to ECMO and fewer complications at time of ECMO cannulation were associated with higher 180-day survival [respectively, OR 0,858 (0,774- 0,953), p 0,004;OR 0,074 (0,008-0,650), p 0,019;OR 0,612 (0,401-0,933), p 0.022;OR 0.13 (0,03-0,740), p 0,022)]. Conclusion(s): In this retrospective cohort of critical COVID-19 obese adult patients supported by VVECMO, a higher BMI, younger age and female patients were associated with higher 180-day survival. A shorter invasive ventilation time prior to ECMO and fewer complications at ECMO cannulation were also associated with increased survival.
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Purpose: Organic food consumption decreases the risk of becoming obese or overweight. This study intends to see the influence of customer perceived value, COVID-19 fear, food neophobia, effort and natural content on the intention to purchase organic food (IPOF) that leads to the actual purchase of organic food (APOF). Moreover, organic food availability is a moderator between IPOF and APOF. Design/methodology/approach: PLS-SEM is used for hypothesis testing. A purposive sampling technique was followed to gather data from organic food consumers in Lahore, Gujranwala and Islamabad and a total of 479 questionnaires were part of the analysis. Findings The outcomes show that customer perceived value, effort and natural content is positively related to IPOF. Despite this, COVID-19 fear and food neophobia are negatively associated with IPOF. IPOF and organic food availability are positively related to APOF. Finally, organic food availability significantly moderated between IPOF and APOF. Practical implications: This study outcome reveals that companies of organic food can recognize customer perceived value, COVID-19 fear, food neophobia, effort, natural content and organic food availability in their decision-making if they determine the actual purchase of organic food. This study offers a valuable policy to companies of organic food to enhance customer's behavior in purchasing organic food in Pakistan. Besides, practitioners and academicians can benefit from this study finding. Originality/value: This initial research integrates customer perceived value, COVID-19 fear, food neophobia, effort, natural content, IPOF and organic food availability to determine APOF in the COVID-19 pandemic. Moreover, consumption value theory is followed to develop the framework.