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The proceedings contain 109 papers. The topics discussed include: dose intensity of palbociclib and initial body weight dosage: implications on progression free survival in 220 patients with ER+/HER2-negative metastatic breast cancer;characteristics of Nirmatrelvir/Ritonavir (Paxlovid) recipients and clinical interventions by oncology pharmacists at a tertiary outpatient cancer center;safe handling of non-carcinogenic drugs in the Ghent University Hospital: development, implementation and communication of hospital-specific guidelines;case series: use of olaparib in uncommon locations in patients with impaired homologous recombination;real-world data evaluation of medicines used in special situations in oncohematology: a retrospective study from a comprehensive cancer institution;Dostarlimab in the treatment of recurrent endometrial cancer: real life experience;medication-related osteonecrosis of the jaws and CDK4/6 inhibitors in breast cancer;and efficacy and safety outcomes of generic imatinib in adults with chronic myeloid leukemia (CML) following the switch from branded imatinib.
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SARS-CoV-2 has infected more than 600 million people worldwide over the last 2.5 years. So far, there efficacy of many antiviral drugs against COVID-19 has been evaluated only in small studies conducted in different countries. Objective. To assess the efficacy of umifenovir in patients with COVID-19. Materials and methods. We performed systematic search of publications in the PubMed and Google Scholar databases. Sixteen studies with a total of 1,843 patients were included in the analysis. The following endpoints were evaluated: frequencies of negative PCR test on days 7 and 14;mortality in patients with mild, moderate, and severe disease;and frequency of fever resolution on day 7. Results. We found that patients receiving umifenovir demonstrated a significantly higher frequency of negative PCR test on day 7 than patients who received no causal therapy or other antiviral drugs (odds ratio (OR) 1.69, 95% confidence interval (CI): 1.09-2.62, p = 0.02, I2 = 13%). This difference was even more significant among patients with mild to moderate COVID-19 (OR: 2.03, 95% CI: 1.24-3.32, p = 0.005, I2 = 0%), as well as on day 14 (OR: 2.02, 95% CI: 1.35-3.94, p = 0.0007, I2 = 50%). We also observed a reduced risk of death in the studies that included only patients with mild and moderate disease (JR: 0.53, 95% CI: 0.33-0.83, p = 0.006, I2 = 0). Umifenovir therapy did not affect the frequency of fever resolution by day 7 (OR: 0.87, 95% CI: 0.49-1.56, p = 0.64, I2 = 0%). Conclusion. Umifenovir significantly accelerated virus elimination by days 7 and 14 among patients with mild to moderate COVID-19. Umifenovir also reduced the risk of death compared to other antiviral drugs.Copyright © 2022, Dynasty Publishing House. All rights reserved.
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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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Objective: The current study aimed to describe the clinical characteristics of mild SARS-CoV-2 infected pregnant women with abnormal liver function (ALF), explore the association between ALF with maternal and fetal outcomes. Method(s): This retrospective analysis included 87 pregnant patients with mild SARS-CoV-2 infection admitted and treated from December 1, 2022, to 31, 2022 in the department of Obestircs at Beijing Obstetrics and Gynecology Hospital. We evaluated patients for demographic and clinical features, laboratory parameters and pregnancy complications. Result(s): 27 Patients in this cohort had clinical presentations of ALF. Compared with the control group, the peripheral blood platelet (PLT), D-dimer quantitative determination (D-Dimer), lactate dehydrogenase (LDH), total protein (TP), albumin (ALB), indirect bilirubin (DBIL), gamma- glutamyltranspeptidase (GGT) and total bile acid (TBA) showed significantly differences (p<0.05). 12 cases (44.44%) complicated with pregnancy induced hypertension (PIH), 14 cases (51.85%) complicated with intrahepatic cholestasis of pregnancy (ICP), 2 cases (7.4%) complicated with acute fatty liver during pregnancy (AFLP) and 5 cases (14.81%) complicated with postpartum hemorrhage in patients with abnormal LFT were significantly higher than those in the control group (p<0.05). Compared with the control group, the incidence of premature delivery (22.22%) and fetal distress (37.04%) in the experiment group were significantly higher (p<0.05), and the incidence of neonatal asphyxia was not significantly different (p>0.05). Conclusion(s): Pregnant women are generally susceptible to mild SARS-CoV-2 and may induce ALF. ALF is associated with increased risk of mother and infant. The maternal and infant outcomes of those who terminated pregnancy in time are acceptable. Therefore, pregnant women with COVID-19 who received antiviral treatment should be closely monitored for evaluating liver function and relevant indicators. The long-term outcomes in the future are worth to further study.Copyright © 2023
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Objectives: Malnutrition is a prevalent condition affecting 30-50% of hospitalized patients. Malnutrition is linked to impairments in health outcomes and increased economic burden on healthcare systems. We assessed the prevalence and burden of malnutrition by examining demographic characteristics, Disease Related Group (DRG) payments and associated claims among Medicare inpatients (65+ years) with and without COVID-19. Method(s): Hospital inpatient COVID-19 claims from the Centers for Medicare & Medicaid Services (CMS) Inpatient Prospective Payment System (IPPS) between October 2020 - September 2021 were analyzed. The International Classification of Diseases, Tenth Revision, and Clinical Modification (ICD-10-CM) were used for malnutrition diagnoses. Demographic variables were compared based on the COVID-19 status;economic burden was analyzed by DRG payment of malnutrition cases with and without COVID-19. Result(s): Among 7,394,657 Medicare inpatient claims, only 12% had a documented malnutrition diagnosis. Of these patients, 1.2% had COVID-19. Regardless of COVID-19 status, malnourished patients averaged 75 years of age, and were predominantly female (54%) and White (78%) followed by Black (14%), and Hispanic (2%). Sepsis, kidney failure, and urinary tract infection (UTI) were the most common primary diagnoses in malnourished patients, regardless of COVID-19 status. Malnourished patients with COVID-19 had significantly higher DRG payments ($27,407 vs. $18,327) and increased cost of outlier payment ($3,208 vs. $2,049) compared to those without COVID-19, regardless of other diagnoses. Conclusion(s): Malnutrition diagnosis was confirmed in only 12% of the Medicare inpatients, thus suggesting that malnutrition continues to be underdiagnosed and undertreated - evidenced by high rates of hospitalizations/claims and payments in both COVID-19 and non-COVID-19 cases. It is imperative for hospitals to implement nutrition-focused protocols to identify, diagnose and address malnutrition among all Medicare inpatients regardless of COVID-19 status (and especially among patients with sepsis, kidney failure, and UTI). Nutrition-focused protocols can effectively improve patient health outcomes and reduce healthcare costs.Copyright © 2023
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Objective. To study the characteristics of cardiotocography (CTG) and pregnancy outcomes in patients who had a mild coronavirus infection in the third trimester. Patients and methods. The parameters and variations of CTG and pregnancy outcomes were analyzed in 32 low-risk pregnant women who experienced mild COVID-19 in the third trimester (the study group) and in 30 pregnant women (matched pairs) who had no coronavirus infection (the comparison group). Results. A total of 375 CTGs were analyzed: 221 in the study group and 154 in the comparison group. Normal CTG recordings were found in 87% of pregnant women in the study group, which was significantly less frequent than in those without COVID-19 (97%) (p = 0.02), and suspicious CTG in 10 and 1.3%, respectively, which was 3.38-fold more frequent than in the comparison group (p = 0.04). Pathological CTG recordings were observed only in two women in the study group. The features of CTG in women who had a mild form of COVID-19 in the third trimester were a significant decrease in the number of accelerations, short-term variation (STV) in the range of 3 to 5 ms, long-term variation (LTV) <50 ms, a tendency toward tachycardia and low heart rate variability (<5 ms), and prolonged decelerations. The frequency of fetal asphyxia and neonatal morbidity was higher in the study group. Conclusion. COVID-19 even in its mild form may have a negative effect on the fetus, increasing the frequency of fetal hypoxia and neonatal asphyxia.Copyright © 2023, Dynasty Publishing House. All rights reserved.
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Background: X-Linked Moesin-Associated Immune Deficiency (X-MAID) is a rare severe combined immunodeficiency (SCID) subtype that can present at any age due to its variability. Depending on severity, patients demonstrate failure to thrive, recurrent bacterial and viral infections, and increased susceptibility to varicella zoster. It has been characterized by marked lymphopenia with hypogammaglobulinemia and impaired T-cell migration and proliferation. Case Presentation: This is a report of a Cuban 7-year-old male with poor weight gain and facial dysmorphia. He had a history of recurrent bacterial gastrointestinal infections and pneumonia beginning at 4 months of age. He additionally had 4-6 upper respiratory tract and ear infections annually. While still living in Cuba, he was admitted for a profound EBV infection in the setting of significant leukopenia. A bone marrow biopsy confirmed no malignancy. After he moved to the United States, his laboratory work-up revealed marked leukopenia with low absolute neutrophil and lymphocyte count with low T and B cells, very low immunoglobulin levels IgG, IgA, and IgM, and poor vaccination responses to streptococcus pneumonia, varicella zoster, and SARS-CoV-2. Genetic testing revealed a missense pathogenic variant c.511C>T (p.Arg171Trp) in the moesin (MSN) gene associated with X-MAID. He was managed with Bactrim and acyclovir prophylaxis, and immunoglobulin replacement therapy, and considered for hematopoietic stem cell transplantation. Discussion(s): Diagnosis of X-MAID should be considered in patients with recurrent infections and profound lymphopenia. As with SCID, early diagnosis and intervention is of utmost importance to prevent morbidity and mortality. This case demonstrates the importance of genetic testing in identifying this disease as it may prompt an immunologist to consider HSCT if conservative management is suboptimal. In the current literature, HSCT appears promising, but the long-term outcomes have yet to be described.Copyright © 2023 Elsevier Inc.
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Aim To analyze the differences in clinical characteristics and outcomes of coronavirus disease 2019 (COVID-19) critically ill patients with or without vascular calcification. Methods COVID-19 critically ill patients admitted to the intensive care unit of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in February 2020 were analyzed retrospectively. According to the chest CT findings, the patients were divided into vascular calcification group and non-vascular calcification group. The vascular calcification group was further divided into aortic calcification group, coronary calcification group and simultaneous calcification group (both aorta and coronary artery calcification). The clinical characteristics and outcomes of patients were compared in different groups. Results Compared with the non-vascular calcification group, the patients in the vascular calcification group were older and had a higher proportion of hypertension and coronary heart disease, which showed higher levels of leukocyte count, neutro-phil count, C-reactive protein, globulin, lactate dehydrogenase, international normalized ratio, D-dimer, creatinine, crea-tine kinase-MB, high-sensitivity cardiac troponin, myohemoglobin and N-terminal pro-B-type natriuretic peptide, lower levels of lymphocyte count, platelet count, albumin, estimated glomerular filtration rate, and higher risk of death. Compared with aortic calcification group, the outcomes of coronary calcification group and simultaneous calcification group were worse. Conclusion Vascular calcification, especially coronary artery calcification, may be a risk factor for poor prognosis in COVID-19 critically ill patients. © 2022, Editorial Office of Chinese Journal of Arteriosclerosis. All rights reserved.
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Objectives: This study aimed to determine disease severity, clinical features, clinical outcome in hospitalized patients with the Omicron variant and evaluate the effectiveness of one-dose, two-dose, and three-dose inactivated vaccines in reducing viral loads, disease course, ICU admissions and severe diseases. Method(s): Retrospective cohort analysis was performed on 5,170 adult patients (>=18 years) identified as severe acute respiratory syndrome coronavirus 2 positive with Reverse Transcription Polymerase Chain Reaction admitted at Shanghai Medical Center for Gerontology between March 2022 and June 2022. COVID-19 vaccination effectiveness was assessed using logistic regression models evaluating the association between the risk of vaccination and clinical outcomes, adjusting for confounders. Result(s): Among 5,170 enrolled patients, the median age was 53 years, and 2,861 (55.3%) were male. 71.0% were mild COVID-19 cases, and cough (1,137 [22.0%]), fever (592 [11.5%]), sore throat (510 [9.9%]), and fatigue (334 [6.5%]) were the most common symptoms on the patient's first admission. Ct values increased generally over time and 27.1% patients experienced a high viral load (Ct value< 20) during their stay. 105(2.0%) of these patients were transferred to the intensive care unit after admission. 97.1% patients were cured or showed an improvement in symptoms and 0.9% died in hospital. The median length of hospital stay was 8.7+/-4.5 days. In multivariate logistic analysis, booster vaccination can significantly reduce ICU admissions and decrease the severity of COVID-19 outcome when compared with less doses of vaccine (OR=0.75, 95%CI, 0.62-0.91, P<=0.005;OR=0.99, 95%CI, 0.99-1.00, p<0.001). Conclusion(s): In summary, the most of patients who contracted SARSCoV-2 omicron variant had mild clinical features and patients with vaccination took less time to lower viral loads. As the COVID-19 pandemic progressed, an older and less vaccinated population was associated with higher risk for ICU admission and severe disease.Copyright © 2023
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Background: The overarching aim of the study was to (1) investigate how working with COVID-19 patients has impacted work environment, and (2) to identify how factors in the work environment impact adverse health outcomes among hospital personnel (HP), throughout the four waves of the pandemic. Material(s) and Method(s): In a web-based survey altogether 2472 HP participated from four large university hospitals in Norway, whereof N = 680 in April-June 2020 (T1), N = 1073 in December-January 2020/2021 (T2), N = 818 in April-May 2021 (T3), and N = 972 in December 2021-February 2022 (T4). At each time point participants reported on pandemic related work tasks, work environment and adverse health outcomes. Somatic symptoms, psychological distress, posttraumatic stress symptoms and burnout served as outcomes of multivariable linear regression models. The percentage of responders involved in ICU treatment of COVID-19 patients varied between 21% and 40% from T1-T4. Result(s): Reported stressors altered in strength during the 4 waves. Preliminary results indicate that exposure to patients with COVID-19 was associated with more frequent experience of work environmental factors. Compared to colleagues not working with patients with COVID-19 HP reported challenges related to professional competency and training, predictability in teams and work environment, manageable workload, adequate help and support for work stress management, user-friendliness of Personal Protection Equipment and infection protection safety. Furthermore, these environmental factors were associated with symptoms of psychological unhealth on at least one timepoint. Conclusion(s): The results may help guide organizational efforts to maintain professional competency and to reduce stress more efficiently among hospital personnel at different stages in response to long-term crises.
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Cultural competency is the ability to respectfully engage, understand, and communicate through conscientious interaction, enabling effective work and meaningful relationships in cross-cultural situations. Cultural competency recognizes the importance for organizations of participants' diverse social and cultural values, beliefs, and behaviors, and has gained attention because it can bridge health perspectives, understanding, and respect between health professionals and patients. There remains a need for cultural competency in healthcare as disparities persist across the U.S. in racial and ethnic minority groups who experience worse health outcomes and lower healthcare quality than the general public. Therefore, a cultural competency training curriculum was created using various resources to improve interactions between Pacific Islander patients and healthcare professionals. This training helps to reduce racial/ethnic disparities in healthcare by encouraging mutual understanding and improving patient satisfaction, adherence to medical instructions, and overall health outcomes by highlighting patient-centered care as a result of utilizing components of cultural competency. To improve patient experiences in Hawai'i, healthcare professionals need the tools to better interact with patients from different cultures, such as Pacific Islanders. This training provides healthcare professionals with culturally-based content for improving cultural competence techniques for interacting with Pacific Island patients. This training was pilot tested with key stakeholders from community organizations and Cancer Center faculty/staff. Local health clinics, providers, and practices will have the opportunity to participate in this training through a Zoombased electronic training format and be provided with three continuing medical education credits. The initial delivery of the training was intended for in-person sessions;however, a virtual format was adapted due to the COVID-19 pandemic and subsequent social distancing regulations. Healthcare providers are provided pre-training resources, a pre- and post-test, and a course evaluation to determine the validity of training objectives. To date, two Federally Qualified Health Centers have been provided the training, n=60, as well as one Cancer Health Equity Partnerships' Scientific Workshop, n=40. For attendees, the analysis of correct responses from the pretest to post-test showed a significant improvement on 6 of the 12 questions. Respondents also agreed that the training resources aligned with the course objectives. Improved patient interactions from this training can help support better patient outcomes, adherence to medical advice regarding cancer screenings, and many other aspects of improving health equity for Pacific Islanders.
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Objectives: Treatment of severe respiratory distress syndrome (ARDS) due to COVID-19 by veno-venous extracorporeal membrane oxygenation (VV-ECMO) had a mortality of up to 70% in Germany. Many patients with COVID-19 need VV-ECMO support longer than 28 days (long-term VV-ECMO). Evidence on mortality, complications during intensive care, functional status after discharge and mortality-predictors for patients supported with long-term VV-ECMO is lacking. Method(s): Retrospective study of 137 consecutive patients treated with VV-ECMO for ARDS due to COVID-19 at University Hospital Regensburg from March 2020 to March 2022. Result(s): 38% (n=52;87% male) of patients needed longterm VV-ECMO support. In these, SOFA score (median [IQR]) at ECMO initiation was 9 [8-11], age 58.2 [50.6- 62.5] years, PaO2/FiO2-ratio 67 [52-88] mmHg, pCO262 [52-74] mmHg, Murray-Score 3.3 [3.0-3.6] and PEEP 15 [13 - 16] cmH2O. Duration of long-term support was 45 [35-65] days. 26 (50%) patients were discharged from the ICU. Only one patient died after hospital discharge. At VVECMO initiation, baseline characteristics did not differ between deceased and survivors. Complications were frequent (acute kidney injury: 31/52, renal replacement therapy: 14/52, pulmonary embolism: 21/52, intracranial hemorrhage 8/52, major bleeding 34/52 and secondary sclerosing cholangitis: 5/52) and more frequent in the deceased. Karnofsky index (normal 100) after rehabilitation was 70 [57.5-82.5]. Twelve of the 18 patients discharged from rehabilitation had a satisfactory quality of life according to their own subjective assessment. Four patients required nursing support. Mortality-predictors within the first 30 days on VV-ECMO only observed in those who deceased later, were: Bilirubin >5mg/dl for > 7 days, pulmonary compliance <10ml/mbar for >14 days, and repeated serum concentrations of interleukin 8 >150ng/L. Conclusion(s): Long-term extracorporeal lung support in patients with COVID-19 resulted in 50 % survival and subsequently lead to a satisfactory quality of life and functionality in the majority of patients. It should preferably be performed in experienced centers because of a high incidence of complications. Several findings during the early course were associated with late mortality but need validation in large prospective studies.
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Severe pneumonia is a condition with a high risk of death and mandatory hospitalization in the intensive care unit. The incidence of severe pneumonia has increased dramatically during the pandemic of new coronavirus infection. Timely diagnosis and early initiation of adequate treatment of severe pneumonia are crucial for improving survival of critically ill patients. The aim of this review was to analyze published scientific research on molecular markers that allow to objectively assess the severity of pneumonia and to determine treatment tactics based on the predicted outcome upon admission to the hospital. A systematic search was conducted in the electronic databases PubMed, Medline, Web of Science for the period 2019 - 2022. Conclusion. The review focuses on the prognostic role of a number of markers of immune response, vascular transformation, as well as angiotensin II and angiotensin converting enzyme-2. Further prospective studies of potential predictors of severe pneumonia will enable using marker molecules in a comprehensive clinical and laboratory diagnosis for early prediction of the hospitalized patient's condition and expected outcome.Copyright © Volchkova E.V. et al., 2023.
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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: COVID-19 has appeared as a pandemic and public health issue at a universal level. First documented as a respiratory disease, COVID-19 has been found to interrelate with and disturb the cardiovascular system causing myocardial injury and also cardiac dysfunction. Initial documentation of cardiac pathology can play a substantial role in dropping the death rate. This study emphasizes on the relationship between the serum levels of cardiac Trop I and prognosis in patients with and without pre-existing CAD in COVID-19 patients. Aims and Objectives: The first objective was to explore the association among the serum levels of cardiac Trop I and bad prognosis in patients with antiquity of CAD and without CAD. The secondary objective was to explore and understand whether increased Trop I is an appreciated prognostic indicator for COVID-19 patient antagonistic prognosis. Material(s) and Method(s): This was conducted as a retrospective observational study in which a whole of 45 patients admitted in COVID Hospital of Malabar Medical College and Research Center category C were studied. The medical record of the patients whose COVID-19 confirmation done by combined conclusions of reverse transcription PCR, symptoms, and chest X-ray was studies by the team. Result(s): Mean age of the study participants was 59.3 +/- 13.7. Every study participants had elevated Trop I levels with a median Trop I in study subjects being 397.9. There was a statistically significant elevation in Trop I levels in patients with CAD linked with non-CAD patients with a median IQR of 641.6 and P = 0.003 and there was a significant increase in Trop I levels in patients who expired related to patients who got discharged with a median IQR of 587.3 and P = 0.003. Conclusion(s): From this study, we accomplish that rise in cardiac troponin-I level is connected with elevated mortality in patients with COVID-19. Hence, it can be used as significant biomarker of disease evolution, hospitalization, and worse prognosis in COVID-19 patients.Copyright © 2023, Mr Bhawani Singh. All rights reserved.
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Aims: Trauma is particularly prevalent amongst Early Intervention (EI) patients and is associated with adverse clinical and prognostic outcomes. To determine the feasibility of a large-scale randomized controlled trial (RCT) of an 'EMDR for psychosis' intervention for trauma survivors with active psychotic symptoms supported by EI services, we conducted a single-blind RCT comparing 16 sessions of EMDRp + TAU versus TAU only. Method(s): EMDRp therapy and trial assessments were completed both in-person and remotely during the COVID-19 pandemic, and key feasibility outcomes (recruitment & retention, therapy attendance/ engagement, adherence to EMPRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes) were examined at 6- and 12-month post-randomization assessments. Results and Conclusion(s): 60 participants (100% of the recruitment target) received TAU or EMDR + TAU. The feasibility criteria examined in this trial were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable post-treatment outcomes, including improved psychotic symptoms (PANSS), subjective recovery (QPR), post-traumatic symptoms (PCL-5;ITQ), depression (PHQ-9), anxiety (GAD-7) and general health status (EQ-5D-VAS) at the 6-month assessment. Signals of efficacy at 12-month were less pronounced, but remained robust for trauma symptoms and general health status. The findings will be discussed with relevance to future clinical trials of trauma-focused therapy in clients with early psychosis, and the provision of more tailored trauma therapies for EI service users.
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INTRODUCTION. The aetiology of Kawasaki disease (KD) remains unknown. Changes in infectious exposure during the COVID-19 pandemic owing to infection prevention measures may have affected the incidence of KD, supporting the pathogenic role of an infectious trigger. The purpose of this study was to evaluate the incidence, phenotype and outcome of KD before and during the COVID-19 pandemic in Denmark. METHODS. This was a retrospective cohort study based on patients diagnosed with KD at a Danish paediatric tertiary referral centre from 1 January 2008 to 1 September 2021. RESULTS. A total of 74 patients met the KD criteria of whom ten were observed during the COVID-19 pandemic in Denmark. Alof these patients were negative for SARS-CoV-2 DNA and antibodies. A high KD incidence was observed during the first six months of the pandemic, but no patients were diagnosed during the following 12 months. Clinical KD criteria were equally met in both groups. The fraction of intravenous immunoglobulin (IVIG) non-responders was higher in the pandemic group (60%) than in the in the pre-pandemic group (28.3%), although the rate of timely administered IVIG treatment was the same in both groups (>= 80%). Coronary artery dilation was observed in 21.9% in the pre-pandemic group compared with 0% in KD patients diagnosed during the pandemic. CONCLUSION. Changes in KD incidence and phenotype were seen during the COVID-19 pandemic. Patients diagnosed with KD during the pandemic had complete KD, higher liver transaminases and significant IVIG resistance but no coronary artery involvement.Copyright © 2023, Almindelige Danske Laegeforening. All rights reserved.
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Background: Studies suggest perinatal infection with SARSCoV- 2 can induce adverse birth outcomes, but studies published to date have substantial limitations. Most have identified cases based upon their presentation for clinical care, and very few have examined pandemic-related stress which may also impact adverse birth outcomes. Objective(s): To evaluate the relationships between SARSCoV- 2 infection in pregnancy and pandemic-related stress with birth outcomes. Study Design: We conducted an observational study of 211 mother-newborn dyads in three urban cohorts participating in the Environmental Influences on Child Health Outcomes (ECHO) Program. Serology for SARS-CoV-2 was assessed in a convenience sample of prenatal maternal, cord serum or dried blood spots from births occurring between January 2020-September 2021. Specimens were assessed for IgG, IgM, and IgA antibodies to nucleocapsid, S1 spike, S2 spike, and receptor-binding domain. A Pandemic-related Traumatic Stress (PTS) scale was based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Acute Stress Disorder criteria. Result(s): 36% were positive for at least one antibody type, chiefly IgG. Self-report of infection was not significantly correlated with combined serology. There were no differences in gestational age (GA), birth weight, preterm birth (PTB), or low birth weight (LBW) among seropositive mothers. However, IgM seropositive mothers had children with lower BW (434g, 95% CI: 116- 752), BW Z score-for-GA (0.73 SD, 95% CI 0.10-1.36) and were more likely to deliver preterm (OR 8.75, 95% CI 1.22-62.4). Associations with LBW sustained in sensitivity analyses limited to pre-vaccine samples, and PTS symptoms were not associated with birth outcomes. The addition of PTS did not substantially change associations with BW, although associations with PTB attenuated to near-significance. Conclusion(s): We identified decreased birth weight and increased prematurity in mothers IgM seropositive to SARS-CoV-2, independent of PTS. Though there are limits to interpretation, the data support efforts to prevent SARS-CoV-2 infections in pregnancy.