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1.
J Racial Ethn Health Disparities ; 2022 Jan 13.
Article in English | MEDLINE | ID: covidwho-1943619

ABSTRACT

BACKGROUND: This study aims to add to the body of evidence linking obesity as an established risk factor for COVID-19 infection and also look at predictors of mortality for COVID-19 in the African-Americans (AA) population. METHODS: A retrospective cohort study of patients with confirmed COVID-19 infection was done in a community hospital in New York City. The cohort was divided into two groups, with the non-obese group having a BMI < 30 kg/m2 and the obese group with a BMI ≥ 30 kg/m2. Clinical predictors of mortality were assessed using multivariate regression analysis. RESULTS: Among the 469 (AA) patients included in the study, 56.3% (n = 264) had a BMI < 30 kg/m2 and 43.7% (n = 205) had a BMI ≥ 30 kg/m2. Most common comorbidities were hypertension (n = 304, 64.8%), diabetes (n = 200, 42.6%), and dyslipidemia (n = 74, 15.8%). Cough, fever/chills, and shortness of breath had a higher percentage of occurring in the obese group (67.8 vs. 55.7%, p = 0.008; 58.0 vs. 46.2%, p = 0.011; 72.2 vs. 59.8%, p = 0.005, respectively). In-hospital mortality (41.5 vs. 25.4%, p < 0.001) and mechanical ventilation rates (34.6 vs. 22.7%, p = 0.004) were also greater for the obese group. Advanced age (p = 0.034), elevated sodium levels (p = 0.04), and elevated levels of AST (0.012) were associated with an increase in likelihood of in-hospital mortality in obese group. CONCLUSIONS: Our results show that having a BMI that is ≥ 30 kg/m2 is a significant risk factor in COVID-19 morbidity and mortality. These results highlight the need for caution when managing obese individuals.

2.
Journal of Vascular Surgery ; 75(6):e208-e209, 2022.
Article in English | EMBASE | ID: covidwho-1936910

ABSTRACT

Objective: Endovascular popliteal artery aneurysm (PPA) repair has acceptable outcomes compared with open repair for elective therapy. However, endovascular repair for urgent PAA causing acute limb ischemia (ALI) has not been well studied. This project compares the outcomes of urgent endovascular and open repair of PAA presenting with ALI. Methods: The Vascular Quality Initiative database for peripheral vascular interventions and infrainguinal bypass was reviewed for popliteal artery aneurysms presenting with ALI. The characteristics and outcomes of patients undergoing urgent open and endovascular repair were compared. Results: Urgent PAA repair for ALI constituted 10.5% (N = 571) of all PAA repairs with no change in proportion during the study period. The majority (80.6%, n = 460) of urgent repairs were open. However, the proportion of endovascular repair significantly increased from 16.7% in 2010 to 85.7% in 2021 with a sharp increase after 2019 (Fig). Patients undergoing endovascular repair were more likely to be African American (3.6% vs 3.3%, P =.044) and older (71.2 ± 12.5 vs 68.0 ± 11.8) than patients undergoing open repair. They were also more likely to have coronary artery disease (32.4% vs 21.7%, P =.006) but less likely to have chronic kidney disease (66.1% vs 69.6%, P =.027) compared with patients undergoing open repair (Table). Open PAA repair was more likely to be associated with bleeding (20.8% vs 2.7%, P <.001), longer postoperative length of stay (8.1 ± 9.3 days vs 4.9 ± 5.6 days, P <.001), and less likelihood of discharge home (64.9% vs 70.3%, P =.051). The perioperative major amputation rate was 7.5% with no difference in major amputations between the two treatment strategies even at 1 year. However, patients receiving endovascular repair had significantly higher inpatient (1.1% vs 0%, P <.001), 30-day (6.3% vs 0.4%, P <.001), and 1-year (16.5% vs 8.4%, P =.02) mortality compared with open repair (Table). Multivariable regression analysis suggested that endovascular repair was independently associated with increased 30-day mortality, but not 1-year mortality compared with open repair. Conclusions: The utilization of endovascular PAA has exponentially increased during the coronavirus pandemic. Even though endovascular repair is associated with decreased complications and resource utilization, it should be offered selectively in the urgent setting for ALI because of concern with perioperative mortality. [Formula presented] [Formula presented]

3.
Journal of Adolescent Health ; 70(4):S98, 2022.
Article in English | EMBASE | ID: covidwho-1936646

ABSTRACT

Purpose: The global COVID pandemic, social uprisings, and a wave of discriminatory policy proposals have highlighted the ways in which structural oppression contributes to health disparities facing youth of color and those identifying as LGBTQ. Young people living at the intersection of multiple types of oppression face the greatest burden, yet also have unique strengths and supports. Existing research has demonstrated persistent substance use disparities across sexual orientation, gender identity, and racial/ethnic groups – as individual categories. However, very little research has examined substance use among those with multiple stigmatized identities. Capitalizing on two very large datasets and a novel analytic technique, this study seeks to identify groups with the highest prevalence of past 30-day alcohol, e-cigarette, and marijuana use. This first step in a larger project will determine key intersecting identities for qualitative interviews regarding interpersonal and community supports that can reduce health disparities. Methods: Data come from the 2019 Minnesota Student Survey and the 2017-2019 California Healthy Kids Survey, two surveillance programs with a combined sample of 892,664 students in grades 6-12. Data were harmonized across sources to create compatible variables including race/ethnicity (non-Hispanic Native American, Asian/Pacific Islander, Black/African/African American, White, Multiracial;Latina/x/o), sexual orientation (straight, gay/lesbian, bisexual, questioning, something else [e.g. pansexual, queer]), gender identity (cisgender, transgender/gender diverse [TGD], questioning), sex assigned at birth (male, female), state, and past 30-day substance use (yes/no for alcohol, e-cigarettes, marijuana). Exhaustive Chi-square Automatic Interaction Detection (CHAID) analysis, a decision tree approach, was used to examine all interactions among social positions with the goal of identifying distinct groups with significantly different rates of substance use behaviors (Bonferroni adjusted p<.05). The groups with the highest prevalence for each substance were examined. Results: The overall prevalence of past 30-day substance use was 10.4% for alcohol, 9.7% for e-cigarettes, and 9.7% for marijuana, with substantial disparities across intersecting groups. For example, although 10.5% of Latina/x/o-identified youth and 20.8% of TGD-identified youth reported drinking alcohol, Latina/x/o TGD youth were among those with the highest prevalence of use, particularly those who also identified with a newer sexual orientation label (e.g. pansexual, queer) and were assigned male at birth (26.2%) or Latina/x/o TGD youth who did not indicate their sexual orientation (31.7%). This pattern was also evident for e-cigarette and marijuana use. Similarly, Black TGD youth had significantly higher rates of alcohol (26.9%), e-cigarette (29.2%, in California), and marijuana use (24.4%, straight-identified;29.5%, missing sexual orientation). Conclusions: Using the power and diversity of large population-based datasets and an innovative analytic technique specifically recommended for studies of intersectionality, we found significant disparities in substance use, with the burden varying by unique intersecting marginalized identities. This approach is recommended to examine disparities in groups often treated as homogeneous, as a precursor to developing relevant and appropriate prevention strategies. Further research is needed to identify structural factors contributing to these high rates. Clinicians, educators, and others working with youth should address intersecting types of stigma and oppression that may contribute to substance use. Sources of Support: National Institute of Minority Health and Health Disparities grant #R01MD015722.

4.
Journal of Adolescent Health ; 70(4):S69-S70, 2022.
Article in English | EMBASE | ID: covidwho-1936616

ABSTRACT

Purpose: Juvenile court involved youth (JCIY) experience unique psychosocial challenges. The COVID-19 pandemic generated additional stressors for this vulnerable population. Promoting mindfulness strategies may increase well-being among JCIY, but few such interventions have been developed. We sought to evaluate the impact of a longitudinal mindfulness intervention incorporating healing-centered, anti-oppression yoga delivered through a virtual platform on multiple psychological outcomes among JCIY involved in community-based monitoring. Methods: We partnered with YogaRoots on Location (YROL), a healing-centered, anti-oppression yoga instruction group, to implement a longitudinal mindfulness training program to youth aged 11-21 involved in the Allegheny County Community Intensive Supervision Program (CISP). Starting in March 2020, this program transitioned to a remote format in light of the COVID-19 pandemic. Sessions were delivered via Zoom and incorporated Raja yoga practice, breathing techniques, meditation and mindfulness exercises, and strengths-based social justice exploration. Sessions lasted one hour and occurred weekly. Youth attending nine sessions completed end-of-program (EOP) evaluations. Baseline surveys assessed demographic characteristics and prior experiences with racism and trauma. EOP surveys were administered to assess for changes in multiple psychological outcomes: mindfulness, acceptance and action, resilience, future orientation, emotion dysregulation, and psychological distress. Demographic data were summarized with descriptive statistics. McNemar or Wilcoxon signed rank tests were used to compare outcomes at baseline and EOP. Results: 99 youth completed baseline assessments. Mean age of participants was 16.2 (SD: 1.4). 85 (86%) were male. 60 (61%) identified as Black/African-American, 17 (17%) White, and 14 (14%) other racial identities. 7 (7%) were Hispanic/Latino. 74 (75%) youth reported prior experiences of trauma, with 47 (47%) reporting three or more. Perceptions of racism were common, with 63 (64%) youth reporting being treated unfairly by a police officer and 67 (68%) being accused of something they did not do at school. 16 youth (16%) completed EOP surveys. No significant changes in any psychological outcomes were noted from baseline to EOP among this cohort of youth who completed nine or more sessions. Many reported likelihood of using yoga in the future to deal with stress (11;69%), to calm down (12;75%), and to deal with racism (8;50%). Conclusions: JCIY face significant psychosocial stressors, and many report histories of trauma and discrimination. The COVID-19 pandemic may exacerbate existing challenges for these youth, and further supports are needed to engender well-being in this population, including strategies to retain youth in programming. Despite its feasibility and acceptability among JCIY, mindfulness training, particularly in a virtual format, may have limited immediate impact on psychological outcomes due to broader structures of oppression and situational factors. Reflecting the transiency of this population, changing living situations, going “on the run,” and other challenges, retaining youth in ongoing programming is challenging. Additional follow-up is needed to determine the effects of such interventions on long-term youth coping and resilience as well as to elucidate implementation facilitators to increase receipt of such skills-building programs for this population. Sources of Support: Heinz Endowments.

5.
JOURNAL OF CLINICAL IMAGING SCIENCE ; 12, 2022.
Article in English | Web of Science | ID: covidwho-1939656

ABSTRACT

Background: Health disparities among minority groups, especially African Americans, can limit their access to quality medical care and lead to disproportionate medical management and disease outcomes. The aim of this study was to compare the COVID-19-related change in mammogram volumes and cancer detection at two affiliated academic breast centers, one that serves a predominantly African American patient population and one that serves a predominantly non-African American patient population. Materials and methods: For the purpose of anonymity, racial demographics were collected and the center with a higher African American patient population was designated as institution A, while the center with a higher non-African American patient population was designated as institution B. Careful selection of the two breast centers was instituted in order to limit the impact of potential confounders other than race. An Institutional Review Board (IRB) exemption was obtained and two Mammography Quality Standards Act (MQSA) reports were generated;one for March 2020 through September 2020, during the height of the COVID-19 pandemic, and one for March 2019 through September 2019 to serve as the pre-pandemic control group. The i2b2 Query Analysis Tool((R)) was used to obtain racial demographic data and compare the percent change in screening and diagnostic mammograms, image-guided biopsies, total cancers diagnosed by imaging, and percent of minimal cancers for both institutions. Results: Screening mammograms and breast cancer detection decreased in 2020 compared to 2019 at both institutions. However, the percent change from 2019 to 2020 was greater at institution A than at institution B. Percent minimal cancers, an indicator of early-stage breast cancer also decreased more drastically at institution A than at institution B. Interestingly, the total number of diagnostic exams and image-guided biopsies increased in 2020 at institution B, whereas both decreased at institution A. Conclusion: The COVID-19 pandemic may lead to worsening racial disparities in breast cancer screening. In an effort to narrow future disparity, it is crucial for radiologists and other health care providers to be aware of this inequality and educate all women on the importance of obtaining routine screening mammography. More studies are needed.

6.
Circulation: Cardiovascular Quality and Outcomes ; 15, 2022.
Article in English | EMBASE | ID: covidwho-1938114

ABSTRACT

Background: Patients hospitalized with COVID-19 who develop cardiopulmonary arrest often have poor prognosis, prompting discussions with families about goals of care. The relationship between clinical and social determinants of code status change is poorly understood. Methods: This retrospective study included adult COVID-19 positive patients admitted to the intensive care unit with cardiac arrest in a multihospital center over the first 9 months of the pandemic (3/1/2020-12/1/2020). Data on medical and social factors was collected and adjudicated. Results: We identified 208 patients over the study timeline. The mean age was 63.7 ± 14.5 years and 54.3% (n=113) were male. The majority of patients with cardiopulmonary arrest had pulseless electrical activity (PEA) as their initial rhythm (91.3%, n=190). Code status was changed in 56.3% (n=117) of patients. The majority of COVID-19 patients with cardiac arrest were Hispanic (53.4%, n=111), followed by African American (27.9%, n=58), and White patients (13.5%, n=28). Race/ethnicity did not affect the rate of code status change. COVID-19 patients who had a code status change were statistically more likely to have a lower salary ($54,838 vs $62,374), have a history of stroke/transient ischemic attack (15.4 vs 4.4%, 18:4), or heart failure (28.2 vs 15.6%, 33:14), all with P<0.05. Patients with code status change had shorter courses of cardiopulmonary resuscitation (11.9 vs 16.9 minutes, P<0.05). Both groups had similar levels of aggressive care received including continuous renal replacement therapy, vasopressor and broad-spectrum antibiotics requirements. Insurance status, ethnicity, religion, and education did not lead to statistically significant changes in code status in COVID patients. Conclusion: Patients hospitalized with cardiopulmonary arrest and positive for COVID-19 are more likely to have a change in code status. This code status change is affected by cardiovascular comorbidities such as stroke and heart failure, along with lower income but not by insurance status, ethnicity, religion, and educational level.

7.
J Am Coll Health ; : 1-4, 2022 Jul 14.
Article in English | MEDLINE | ID: covidwho-1931622

ABSTRACT

OBJECTIVE: To examine fear levels of COVID-19 among dental students at a Historically Black College and University (HBCU). Participants-162 first through fourth year dental students who were enrolled at the HBCU dental school between January 27, 2021 and May 3, 2021. METHODS: Students completed an online survey that included the Fear of COVID-19 Scale (FCV-19S) and information on demographic variables. RESULTS: Associations were observed between the fear of COVID-19 and the dental student's gender, ethnicity, marital status and self-rated health. Those in the highest quartile for the fear scale were less likely to be African American and more likely to be Asian or Pacific Islander, Hispanic or of Middle Eastern descent as compared to those in the lowest quartile. CONCLUSION: Dental students at an HBCU are a population particularly vulnerable to fear of COVID-19 possibly due to the high demands and mental stress of dental school.

8.
European Stroke Journal ; 7(1 SUPPL):172, 2022.
Article in English | EMBASE | ID: covidwho-1928140

ABSTRACT

Background and aims: Administration of thrombolytics (tPA) within the first 60 minutes of presentation for acute Ischemic Stroke is recommended. We utilized a computerized clinical decision support (CCDS) software to identify such patients and created timely alerts to coordinate teams and optimize workflow through a plan-do-study-act (PDSA) based approach. Methods: We reviewed all patients who received thrombolytics for Ischemic Stroke after prospectively implementing the DECISIOInsight software which digitized our institutional stroke protocol in acute Ischemic Stroke patients. The software displayed a countdown doorto- needle (DTN) timer at bedside while sending out automated alerts via TigerConnect (a HIPAA compliant communication tool) every 15 minutes to key patient care providers. We performed PDSA cycles to address systemic issues affecting the delay of care in real time using this CCDS software and workflow modification tool. The primary outcome was DTN time. The secondary outcome was DTN <30 or <45 minutes. Results: 76 patients (46% females, 50% African American, average age of 67 years, median NIHSS of 7.5 and ASPECTS score of 10) received tPA between January 2020 and November 2021. The average time to tPA decreased from 84 minutes (1st Quarter 2020) to 39 minutes (3rd Quarter 2021) (p for trend =0.01). Similarly, the proportion of patients receiving tPA within 45 minutes and within 30 minutes improved from 27.3% to 83.3% (p for trend =0.01) and 0.0% to 41.7% (p for trend =0.006), respectively. Conclusions: Despite the COVID-19 pandemic, the CCDS-based stroke identification and alerting system significantly improved DTN time in ischemic stroke patients.

9.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927899

ABSTRACT

Rationale: The early recognition of COVID-19 patients at high risk of clinical deterioration is important to help triage, allocate resources, and improve patient care. In this study, we aimed to compare the performance of the Charlson Comorbidity Index (CCI), mSOFA, MEWS, qCSI, and PRIEST COVID-19 Clinical Severity scores in predicting risk of admission to the intensive care unit (ICU) and in-hospital mortality. Methods: This was a multicenter retrospective cohort study which included a random sample of confirmed COVID-19 patients admitted to three academic medical centers. All patients were admitted in July 2021. Patients with a positive COVID-19 polymerase chain reaction at time of admission were included. All scores were calculated within the first 24 hours of admission to the hospital. A univariate and backward multivariate logistic regression analysis were used to evaluate correlation of CCI, mSOFA, MEWS, qCSI, and PRIEST COVID-19 Clinical Severity score to the primary outcome, ICU admission, and secondary outcome, death (in-hospital). Results: One-hundred and three patients were included in this study with a median age of 59 years old (IQR 51-70). The majority were male (64.1%, n = 66) and Caucasian (81.6%, n = 84). Twenty-six patients (25.2%) required ICU admission with an in-hospital death occurring in nine patients (8.7%). In the multivariate analysis, patients admitted to the ICU were more likely to be African-American (12.96 OR;95% CI 1.49, 155.91), and of the five scores assessed, mSOFA (1.61 OR;95% CI 1.13, 2.41), MEWS (1.74 OR;95% CI 1.06, 3.09), and qCSI (1.52 OR;95% CI 1.12, 2.16) scores were associated with ICU admission. However, only mSOFA score (1.93 OR;95% CI 1.34, 3.11) was associated with in-hospital mortality. Conclusions: There are multiple scores for COVID-19 clinical deterioration that are accurate in predicting the need for ICU admission. Despite the ability to predict clinical deterioration, other scores were not associated with an increased in-hospital mortality. Interestingly, the CCI was not associated with an increased in-hospital mortality. This study provides evidence to use the mSOFA, along with other scores to accurately triage patients to a higher level of care.

10.
Sleep ; 45(SUPPL 1):A325, 2022.
Article in English | EMBASE | ID: covidwho-1927441

ABSTRACT

Introduction: Central to the pathophysiology of SARS-CoV-2 is immune dysregulation and systemic inflammation, however, it is yet unknown whether sleep-related hypoxemia-which we have recently noted to be associated with worse COVID-19 clinical outcomes-is mediated by these biomarkers and pathways. Methods: Data from patients who tested positive for SARS-CoV-2 and part of the integrated Cleveland Clinic COVID-19 and sleep laboratory registries from March-November 2020 were included. To assess the mediation effect of biomarkers, the relationship between sleep-related hypoxia measures (% sleep time<90%SaO2,T90) and moderate/severe WHO-7 COVID-19 score (use of supplemental oxygen, non-invasive ventilation, mechanical ventilation/ ECMO or death) was first tested. The mediation effect, or natural indirect effect, of biomarkers of inflammation (C-Reactive Protein (CRP), white blood cell (WBC) count (with a focus on lymphocyte count) and lactate) was then estimated by logistic regression models adjusted for demographics, comorbidities, smoking pack year and site location using PROC CAUSALMED statement in SAS software (version 9.4, Cary, NC). Results: The analytic sample included 446 patients hospitalized due to COVID-19: age:63.3.±13.8 years,51.3% female,39% African American with body mass index(BMI)=36.1±9.3kg/ m2. Thirty-six percent used supplemental oxygen, 4% used highflow or non-invasive ventilation,5% required ECMO or mechanical ventilation and 2% died. Hypoxic measures were associated with moderate/severe WHO-7 COVID-19 outcome: T90 median (>1.8%vs.≤1.8%) (OR=2.04, 95%CI:1.28-3.23,p=0.003), 5% increases in both mean SaO2 (OR=0.43, 95%CI: 0.26-0.70,p=<0.001) and minimum SaO2 (OR=0.84, 95%CI: 0.72-0.99,p=0.03). CRP was associated with mean SaO2 (p=0.040) and minimum SaO2 (p=0.029), likewise mediation analysis showed that there was a significant natural indirect effect of CRP in both hypoxia measures (OR=0.86,95%CI 0.73-0.99,p=0.036;OR=0.95,95%CI 0.90- 1.00,p=0.034 respectively). WBC count, but not lymphocyte count subset, was associated with mean SaO2 (p=0.044), but the natural indirect effect was not significant (p=0.23. Lactate was associated with minimum SaO2 (p=0.044), but the natural indirect effect was not significant (p=0.23). T90 median was not associated with CRP(p=0.13), WBC count(p=0.87) or lactate(p=0.28). Conclusion: CRP appears to represent a relevant mediator of sleep-related hypoxia and WHO-7 clinical outcomes. Further investigation is needed to elucidate if treatment of sleep-related hypoxia downregulates biomarkers of systemic inflammation to modify disease course.

11.
Sleep ; 45(SUPPL 1):A254-A255, 2022.
Article in English | EMBASE | ID: covidwho-1927422

ABSTRACT

Introduction: Recent studies indicate Obstructive Sleep Apnea (OSA) patients have higher severity of respiratory compromise after COVID19 infection due to their sleep related hypoxemic burden. The pro-inflammatory state associated with OSA, sympathetic excitation, and recurrent hypoxemia may predispose to poorer post-COVID19 outcomes. We compared COVID19 infection outcomes in a cohort of hospitalized Veterans with and without OSA. Methods: We used Jesse Brown Veteran Affairs Medical Center (JBVAMC) Registry for Research on Risk Factors and Outcomes of Veterans Evaluated for COVID19. The registry includes all patients who received a test for COVID19 at JBVAMC through November 8th,2021. Data are from the VA COVID19 Shared Data Resource and chart review, and include demographic data, pharmacological and non-pharmacological interventions, clinical outcomes, and preexisting conditions. The study was approved by the Institutional review board (IRB). STATA v16 was used for data analysis. Results: Of the 13,385 patients included in the registry, 1890 patients were found to have a positive COVID19 test, of which 625 were hospitalized and included in our study. The sample was older (mean age of 66.8 years), predominantly men (583, 93.3%) and African Americans (461, 73.8%). 18.7% (117, 18.7%) were European American, and (47, 7.5%) were of other race categories. The group with OSA was 37.8% (n=236) and without OSA was 62.2% (n=389) of the total sample. Elixhauser comorbidity index was higher in OSA group compared to those without OSA (p:0.00001, mean (SD): 16.73(14.6) vs. 12.03 (13.1)). Univariate analysis demonstrated a higher rate of readmission at 60 days (p=0.02, Odds ratio (95% CI): 1.69 (1.1-2.6)) and use of mechanical ventilation (p=0.05, Odds ratio (95% CI): 1.65 (0.99-2.75) in OSA vs. without OSA. These associations were attenuated in multivariate logistic regression models including age, gender, race, Elixhauser index and body mass index. OSA did not affect the length of stay or inpatient mortality. Conclusion: In hospitalized COVID19 patients, OSA increases the probability of readmission and risk of mechanical ventilation, but this effect is likely due to higher comorbidity and obesity rates in OSA. In the future, we plan to examine larger samples of Veterans hospitalized with COVID19 and assess the effect of positive airway pressure treatment to understand the impact of OSA on COVID19 outcomes.

12.
Journal of Diversity in Higher Education ; : 7, 2022.
Article in English | Web of Science | ID: covidwho-1927069

ABSTRACT

The COVID-19 pandemic impacted all components of higher education, with current inequities within the campus setting exacerbated, creating larger disparities between individuals with and without readily available access to needed resources. Utilizing data collected from a national survey, this article highlights the perceptions and experiences of disability resource professionals (DRPs) employed at minority-serving institutions (MSIs) on how students with disabilities fared during the COVID-19 pandemic, as well as potential recommendations for supporting students with disabilities at MSIs for the future. The experiences of DRPs working at MSIs during the COVID-19 pandemic reveal challenges for students with disabilities that may complicate or significantly impact their academic experience within the MSI setting.

13.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925576

ABSTRACT

Objective: To describe a case of rhombencephalitis secondary to severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) Background: Rhombencephalitis is an inflammation of the brainstem and cerebellum. Etiologies include infectious, inflammatory, and autoimmune causes. Rhombencephalitis has varied presentations but frequently includes encephalopathy, cranial neuropathies, long tract signs and cerebellar dysfunction. To date, SARS-CoV-2 has been reported as the cause of rhombencephalitis in 4 cases. Design/Methods: Authors searched PubMed and Google Scholar for articles using the keywords: “COVID-19”, SARS-CoV-2', “Rhomboencephalitis”, “Rhombencephalitis”. Results: 30-year-old African American man with poorly controlled type 1 diabetes mellitus presented with dysgeusia, slurred speech, night sweats, left-sided hypoesthesia, paresthesias, ataxic gait, and light-headedness. Exam was notable for, left-sided hypoesthesia of the face and left upper extremity weakness as well as ataxia. MRI brain revealed diffuse pontine edema and central areas of diffusion restriction. COVID-19 nasal PCR and COVID-19 IgG antibodies were positive. Extensive infectious, autoimmune and paraneoplastic workup was unrevealing. Pulse-dose steroids resulted in improvement of edema and patient was discharged with diagnosis of a monophasic infectious rhombencephalitis due to COVID-19. Patient re-presented 8 days following discharge with acute left-sided headache and vomiting. Exam was notable for mild cranial nerve seven palsy and ataxia in all extremities. MRI brain displayed increased edema, mass effect and enhancement throughout the brainstem extending superiorly to include optic tracts and hypothalamus. CSF studies were remarkable for leukocytosis and increased protein. Repeat infectious, autoimmune and paraneoplastic studies again negative. Re-treatment with pulse-dose steroids followed by prolonged taper resulted in clinical and radiographic improvement at 1 month follow-up. Conclusions: The complete picture of neurological sequelae from COVID-19 is developing as the pandemic continues. Our case adds to the literature of SARS-CoV-2 associated rhombencephalitis and highlights the need for close monitoring and slow titration of immunotherapies such as steroids to minimize the potentially devasting effects of rhombencephalitis.

14.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925330

ABSTRACT

Objective: We aim to investigate the prevalence, characteristics and outcomes of COVID-19 patients with neurological manifestations Background: To date, SARS-CoV2 has infected 213 million population worldwide. It is a multisystem disease affecting primarily the respiratory system, but neurological manifestations have been increasingly described in the literature. Design/Methods: Consecutive patients diagnosed with SARS-CoV2 admitted to 5 hospitals in Detroit Medical Center from March 3rd, 2020-May 1st, 2020 were included. Basic demographics and clinical manifestations were included. Relevant laboratory findings and neuroimaging were reported. Results: 413 patients were included in the study. Patients' demographics were as follows: mean age-66 years, 212 (51%) male, 346 (87%) African-American. 219(53%) patients had neurological symptoms at presentation, 32 patients presented purely with neurological symptoms. Other symptoms at onset include-respiratory 312(76%), constitutional 250(61%) and gastrointestinal 104(25%). 121(29%) patients were admitted to ICU, mean days from admission to ICU was 3.14 days. Incidence of neurological presentations were as follows: Encephalopathy 191(46.25%), myalgia 51(12.35%), headache 27 (6.54%), vertigo 20 (4.84%), hypogeusia 14 (3.39%), anosmia 12 (2.9%), stroke 13(3.14%), seizure 11 (2.9%). For patients with encephalopathy, median GCS at the onset of encephalopathy was 13 with IQR4. 94 (49.21%) of these patients were admitted to ICU;53(27.75%) were without coexisting toxic, metabolic or hypoxic factors contributing to encephalopathy. For patients with stroke, 12 patients presented with acute ischemic stroke, 2 with hemorrhagic conversion and 1 patient had cerebral venous sinus thrombosis. Characteristics of stroke were as follows: 8-multiple vascular territory, 11-cryptogenic etiology, 3-concurrent thromboembolic event. Median D-dimer was 5.76mg/LFEU(IQR3.74) and fibrinogen 550mg/dl(IQR 2.1). 2 patients received thrombolysis and 1 underwent thrombectomy. Mortality was 77%, Modified Rankin Scale (MRS)at baseline was 0-2 and all except 1 patient had MRS of 4-6 on discharge. Conclusions: Neurological manifestation is common amongst patients with SARS-CoV-2. Presence of encephalopathy or stroke confers an increased risk of mortality and morbidity.

15.
Obstetrics and Gynecology ; 139(SUPPL 1):68S, 2022.
Article in English | EMBASE | ID: covidwho-1925197

ABSTRACT

INTRODUCTION: Virtual prenatal care has spiked during the COVID-19 pandemic, yet most research has neglected to consider care satisfaction from individuals at highest risk for poor health care experiences and outcomes. METHODS: We recruited economically marginalized, pregnant individuals of color to share their experiences with telehealth prenatal care for a survey- and text-message-based study. A pre-study survey assessed level of trust in providers (1-5 score) and overall care satisfaction (CSAT score;1-10). After individual appointments, participants assigned appointment-based CSAT scores alongside narrative feedback. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using directed thematic analysis. RESULTS: A total of 13 participants engaged in the study from May to July 2020. Most participants identified as Black/African American, with reported household income below $50,000/year. Most participants rated trust in providers positively. For care satisfaction, telehealth delivery was generally viewed negatively within the scope of overall care. For individual appointments, CSAT scores for in-office visits were higher (median, 9;IQR, 1;n=35) than for telehealth visits (median, 6;IQR, 4;n=11). Participants' narratives reflected three themes: relationship/trust with provider, information sharing/support, and maternal/fetal assessment. In-person appointment narratives contained more positive language, while telehealth narratives contained more negative language. CONCLUSION: Most participants report feeling negative and less satisfied with telehealth with dissatisfaction centered on level of information provided and inability to physically evaluate their health and their baby's health. As remote prenatal care expands, there is an urgent need to engage patients as partners in the design and evaluation of its use and to augment telehealth with technology to objectively measure maternal and fetal health.

16.
Obstetrics and Gynecology ; 139(SUPPL 1):29S-30S, 2022.
Article in English | EMBASE | ID: covidwho-1925159

ABSTRACT

INTRODUCTION: This study seeks to study how the pandemic affected access to hysterectomy within one tertiary care hospital system, specifically evaluating racial breakdown. METHODS: This study is a retrospective observational study within one hospital system. Institutional review board (IRB) approval was exempt. All hysterectomy cases were compiled for 7 months before the COVID-19 pandemic, during the pandemic, and 7 months after. The records for each patient were accessed to find patient demographics. RESULTS: Of the 840 hysterectomies performed in 7 months prior to the pandemic, 37.66% were performed on patients identifying as “White,” 27.77% on “Black/African-American” patients, 20.26% on “Hispanic” patients, and 7.63% on “Asian American” patients. Of the 54 hysterectomies performed during the pause on elective surgeries, 50.00% were per- formed on patients identifying as “White,” 35.19% on “Black/African- American” patients, 7.41% on “Hispanic” patients, and 7.41% on “Asian American” patients. There was a significant 12.85% (P<.001, CI 5.36- 20.35) decrease in cases performed on those identifying as “Hispanic” during the pandemic. Of the 860 hysterectomies performed in the 7 months after the pandemic, 40.93% were performed on those identifying as “White,” 29.07% on “African-American” patients, 14.88% on “Hispanic” patients, and 8.02% on “Asian-American” patients. CONCLUSION: The racial percentages did drastically change during the COVID-19 pandemic. The percentage of hysterectomy cases performed on those identifying as “White” increased 12.34%. The percentage of hysterectomies performed on those identifying as “Hispanic” decreased 12.85%. This shift in racial breakdown in hysterectomy cases performed before and during the pandemic may allow a glimpse into how hospitals prioritized certain gynecologic surgeries as “elective.”.

17.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925125

ABSTRACT

Objective: To investigate associations of COVID-19 illness severity in individuals who have developed objective or subjective neurologic findings after infection. Background: Following recovery from acute COVID-19 illness many patients report onset of new cognitive and neurological symptoms which can be disabling. Design/Methods: Early in the pandemic, in response to clinical experience and emerging research on post-acute neurological sequelae (PANS) of COVID-19, we created an IRB-approved patient registry in the Department of Neurology. Participants included are both retrospectively identified patients located through a search of all existing patients from Neurology outpatient practices at Columbia University Irving Medical Center with any COVID-19 related diagnosis, plus newly referred patients with PANS. Those included met CDC criteria of either suspected, probable, or confirmed COVID-19 (N=121). Information was obtained retrospectively through chart review and prospectively through symptom questionnaire and mini-MoCA. Analysis was performed with Chi-squared test and Pearson's correlation. Results: Our cohort was 72.7% women, mean age 47.9, 54.2% white, 16.7% Hispanic/Latino, 6.7% Black/African American, and 5% Asian. 55.45% had a prior neurological diagnosis, most commonly headache (23.1%). 68.8% had both clinical and lab definite COVID-19 infection, 23.1% required hospitalization, and 9.1% ICU care. 72.2% reported no worsening of prior neurological symptoms but 81.8% developed new neurological symptoms including general cognitive complaints (47.9%), attention difficulty (42.1%), word finding difficulty (36.4%), vestibular complaints (23.1%), and fatigue (19.8%). Mini-MoCAs were administered to 37 subjects (median score 12/15). Hospitalization for COVID-19 correlated with subjective “brain fog” (p= .009) and attention difficulty (p= .011). ICU requirement correlated with subjective word finding difficulty (p= .049), “brain fog” (p= .034), and attention difficulty (p= .020). There was a relationship between length of hospitalization and mini MoCA score (p= .006). Conclusions: In this patient sample, severity of infection assessed through surrogate measures of hospitalization and ICU requirement are associated with subjective and objective post COVID19 neurological dysfunction.

18.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925113

ABSTRACT

Objective: To analyze rates of COVID vaccination in patients of different race/ethnicities receiving care at NYU Multiple Sclerosis Comprehensive Care Center (MSCCC) in NYC;and to identify factors associated with non-vaccination status. Background: SARS Cov2 Vaccines are the mainstay of protection against severe COVID-19. Vaccination is especially important in those at higher risk for COVID complications and death, such as minorities, older patients, patients with comorbidities and disability, and those on immunosuppressive therapies. Limited information is available on vaccination rates and reasons for vaccine hesitancy in patients with chronic neurologic conditions, such as MS. Design/Methods: From July 1 2021, COVID-19 vaccination status was systemically ascertained on consecutive patients with MS or related disorders seen at NYU MSCCC by the first author. Data was collected by standard questionnaire, including questions on reasons for nonvaccination and review of medical record. Results: Data from 168 patients were analyzed to 9.30.2021 (ages 8-82, mean 37, SD 16.8, 72% female, 38% white, 28% African American, 13% Hispanic). 132 (78.5%) were vaccinated and 36 (21.4%) were unvaccinated. Among the unvaccinated, 39% were planning to receive vaccine which were delayed because of timing of anti-CD20 therapies or other reasons, 38% indicated delay related to countervailing considerations ('deliberation'), 8.3% expressed disagreement with medical advice to vaccinate ('dissent') and 8.3% expressed concerns about vaccine safety ('distrust'). Vaccination rates were similar among Whites (83%), AA, (72%, p=0.244 compared to whites), and Hispanics (82%, p= 1.00). Conclusions: We observed very high COVID vaccination rates among all race/ethnic groups in our Center, which exceeded local vaccination rates (65% to date). Patients with chronic conditions who attend specialized centers where vaccine importance is emphasized may be more likely to be vaccinated. Reasons of deliberation were the most cited among non-vaccinated and represent a point of intervention. Additional strategies for improving vaccination rates will be discussed.

19.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925101

ABSTRACT

Objective: Report a COVID-19 related encephalopathy from selective white matter involvement of corpus callosum. Background: A 26-year-old African American female tested positive for SARS - COV 2 in April 2020. Her medical morbidities included uncontrolled type 1 DM (on insulin), obesity, and CKD stage III (diabetic nephropathy). She presented with fever, headache, dyspnea, myalgia, nausea, and loss of appetite. She was tachypneic, tachycardic, hypertensive, had a temperature of 39.2deg;C and saturating 98% at room air. Pertinent lab values included a glucose of 212 mg/dl, creatinine of 2.7 mg/dl, BUN of 34 mg/dl, and lipase 771 IU/L. CRP was 66.9 mg/L, with a normocytic anemia of 7.9 gm/dl, ferritin 1784 ng/ml, fibrinogen of 651 mg/dl and a peak D-dimer of 10,180 ng/ml. CXR was hypoinflated with mild bibasilar airspace opacities. A NCCT head obtained for a stroke alert, revealed a hypodense corpus collosum. She was admitted to the ICU with worsening hypoxia, kidney injury, metabolic acidosis, and alteration of consciousness. She received tocilizumab, steroids, remdesivir and convalescent plasma exchange for a severe COVID-19 infection. After extubation she developed a dysexecutive syndrome. Design/Methods: Case report Results: A contrast enhanced MR brain confirmed an expansile T2 hyperintense signal along the complete length of corpus callosum associated with restriction of diffusion, and T1 prolongation. There was no superimposed susceptibility or pathologic enhancement. No large vessel occlusions were identifiable from gradient echo (GRE), turbo spin echo (TSE), susceptibility weighted imaging (SWI) and post contrast MR sequences. A repeat MRI brain post discharge demonstrated an improving leukoencephalopathy by virtue of normalizing ADC values. Conclusions: Like prior coronaviridae, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) affects the brain over a spectrum of injury. Until we clarify direct neurotropism of SARS-CoV-2;this case is supportive of a cytokine mediated excitotoxic injury concomitant with the severity of disease.

20.
Cureus ; 14(6): e25621, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1924647

ABSTRACT

Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is a global health threat that has affected patient care enormously. Moderate to severe asthma was listed as a risk factor for severe SARS-CoV-2 disease by the Centers for Disease Control. Little is known about the impact of the pandemic on asthma control in children, particularly African American children. Objective The present study sought to determine how changes during the coronavirus disease 2019 (COVID-19) pandemic affected asthma metrics in a majority African American pediatric population at a pediatric pulmonology clinic in a community hospital in New York. Methods This is a retrospective, pre-post, comparative cross-sectional study that included children three to 18 years of age with a known diagnosis of asthma followed in a pulmonary clinic. Data were gathered from electronic medical records. Subjects were selected if they presented to a pulmonology clinic within a certain time window both before and after the outbreak of the COVID-19 pandemic. Outcome variables included asthma medication statistics and healthcare utilization statistics. Results Inclusion criteria were met by 104 pediatric patients. The majority were African American. Emergency department visits, primary physician visits, and hospitalizations significantly decreased in the post-COVID study group compared to the pre-COVID control group. Conclusion Among a majority African American pediatric population, there were significant improvements in asthma outcomes after COVID-19 societal changes when compared to before COVID-19 based on outcome variables.

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