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1.
Boletin de Malariologia y Salud Ambiental ; 61(Edicion Especial II 2021):53-60, 2021.
Article in Spanish | CAB Abstracts | ID: covidwho-2033822

ABSTRACT

At the beginning of the pandemic, an excessive purchase of some products was observed, but this has not been evaluated if it is related to mental health. Therefore, the objective was to determine the factors associated with the purchase of basic necessities in the Peruvian population at the beginning of the first wave of the COVID-19 pandemic. An analytical cross-sectional study was carried out, based on a secondary data analysis. Information from 3379 Peruvians from all regions was used, they were asked about the purchases they made, crossing these with the results of the "KNOW-P-COVID-19", "F-COVID-19" and "MED-COVID-19" scales;obtaining descriptive and analytical results. The most purchased products were disinfectant (43.9%), followed by soap (43.6%) and alcohol (40.8%). In the multivariate analysis, the purchase of disinfectants (p=0.009), soap (p < 0.001) and alcohol (p=0.002) was found to be associated with sex;the purchase of personal protective equipment (p=0.027), antibacterial gel (p=0.010) and face masks (p=0.015) was associated with age;to the fatalism score the purchase of food (p=0.005), personal protective equipment (p < 0.001), soap (p=0.014), alcohol (p=0.043) and face masks (p < 0.001);to the score of fears and concern conveyed by the media the purchase of personal protective equipment (p=0.007), soap (p < 0.001) and face masks (p=0.005) and to the score of knowledge of the disease the purchase of soap (p < 0.001), antibacterial gel (p=0.011) and toilet paper (p=0.009). Significant associations were found with the purchase of supplies (p < 0.011).

2.
Voprosy Ginekologii, Akusherstva i Perinatologii ; 21(3):28-35, 2022.
Article in Russian | EMBASE | ID: covidwho-2033519

ABSTRACT

Objective. To assess the effectiveness of different preventive measures for novel coronavirus infection in pregnant women. Patients and Methods. This study included 125 pregnant women hospitalized with moderate to severe laboratory-confirmed SARS-CoV-2 infection between September and November 2021 (the fourth pandemic wave), and 175 pregnant women who were not infected with COVID-19 during the same period. All women in these two groups were comparable for gestational age (II–III trimesters, 24–39 weeks), age (20–40 years), social status, parity, body mass index, and had no known COVID-19 risk factors. Results. Our findings revealed that vaccination 3-5 months before pregnancy (OR = 4.12;95% CI 1.28–13.27;χ2 = 0.022), inconsistent use and/or non-timely replacement of face masks (OR = 5.71;95% CI 2.83–11.51) were associated with the increased risk of COVID-19 in the second and third trimesters of gestation. It was showed that systematic (once in the morning at 24–48-hour intervals) intranasal administration of recombinant interferon alpha-2b (IFN-α;Grippferon) as compared with a single application after exposure to COVID-19 reduced the disease incidence rate and there was no evident risk of illness (OR = 0.08;95% CI 0.05–0.14;19.2% vs 74,3%, p < 0.001). This can be explained by the fact that women were mostly infected in unpredictable conditions (e.g., 29.2% of pregnant women were infected from family members, 23.9% had unknown source of exposure). The use of umifenovir, not currently authorised for the medication-assisted prevention of COVID-19 in pregnant women, and rectal administration of IFN-α suppositories did not reduce the disease incidence rate. Rectal use of IFN-α suppositories by pregnant women off-label increased the incidence (32.0 vs 15.4%, p = 0.001) and risk of developing novel coronavirus infection (OR = 2.58;95% CI 1.48–4.50). Conclusion. There is a need to improve awareness among pregnant women about the mandatory and timely vaccination against COVID-19 during pregnancy and the importance of strict adherence to wearing face masks. Increased efforts should be made to monitor and inform pregnant women about the use of only authorised medication-assisted preventive measures of SARS-CoV-2 infection, such as intranasal administration of recombinant IFN α-2b (Grippferon). During the epidemic rise in COVID-19 cases, the systematic intranasal administration of recombinant interferon-based medication Grippferon (once in the morning at 24–48-hour intervals) is recommended for pregnant women.

3.
Erciyes Medical Journal ; 44(5):508-511, 2022.
Article in English | EMBASE | ID: covidwho-2033490

ABSTRACT

Objective: The aim of this study was to determine the methods of pain self-care used by patients in Türkiye with chronic musculoskeletal pain who could not access a healthcare provider during the coronavirus 2019 (COVID-19) pandemic. Materials and Methods: A total of 255 participants (mean age 40.8±13.2 years) diagnosed with chronic musculoskeletal pain were included in the study. The Nordic Musculoskeletal Questionnaire and a form created by the researchers were used to assess the prevalence of musculoskeletal symptoms and methods of pain management. Results: The primary site of symptoms during the previous 12-month period was the low back, neck, and upper back regions (69%, 64.7%, and 60% respectively). The detailed assessment revealed that in the prior 7 days, patients experienced symptoms most often in the lower back (56.9%), upper back (45.1%), and neck (43.9%). The most frequently used methods of pain self-care were massage (71%), pain relief medication (68.2%), and topical analgesics (55.3%). Conclusion: Patients most often reported symptoms in the spinal area, and the most used means of self-care for pain management were massaging the painful area, pain medication, and topical analgesics. Self-care initiatives can be very valuable, however, at least some initial guidance from health professionals is advisable. Additional exploration of technological means of intervention and awareness of appropriate self-care could be of substantial benefit individuals and society.

4.
Erciyes Medical Journal ; 44(5):501-507, 2022.
Article in English | EMBASE | ID: covidwho-2033488

ABSTRACT

Objective: The aim of this study was to evaluate the exposure and risk of contracting coronavirus disease (COVID-19), the infectious disease caused by severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), among healthcare workers (HCWs) at a tertiary hospital early in the pandemic. Materials and Methods: HCWs who presented at an occupational health outpatient clinic for COVID-19 contact tracing or assessment before returning to work between March 30, 2020 and May 31, 2020 were evaluated in this cross-sectional study. The dependent variable used was a COVID-19 diagnosis;the independent variables used were gender, marital status, age, occupation, smoking, presence of chronic disease, symptoms of COVID-19, source of contact, risk classification, and work in a COVID-19 unit. Logistic regression analysis was used to assess factors associated with the risk of COVID-19 and sources of infection. Results: A total of 603 HCWs presented at the clinic during the study period. The most frequent sources of contact with SARS-CoV-2 were infected co-workers (50.7%) and patients at work (28.2%), followed by household contacts (9.9%). Those who worked in a COVID-19 unit had a 3.55 times greater risk of a COVID-19 diagnosis than other HCWs when adjusted for age, gender, and risk classification. Conclusion: HCWs frequently face exposure to potential infection. Sufficient support for these workers to ensure adequate awareness of and compliance with protocols is of critical importance to protect public health. The results of this study also suggest consideration of the possibility of another source of contact for HCWs included in the no risk category. Regular screening for COVID-19 may be advisable.

5.
Journal of Reliability and Statistical Studies ; 15(2):535-552, 2022.
Article in English | Web of Science | ID: covidwho-2033429

ABSTRACT

Corona viruses, commonly called COVID-19, are a large family of viruses that can cause diseases ranging from the common cold to Severe Acute Respiratory Syndrome (SARS). Worldwide Covid-19 is affecting 210 countries and territories around the world and two international conveyances. As of 2 June 2020, there are 6,408,869 confirmed 2,935,368 recovered and 378,317 deaths cases has been reported in world of Coronavirus diseases, India is not untouched from this situation. Currently, it has reported infected 190,535 and 5,394 death cases due to COVID-19 in India. (https://covid19.who.in t/region/searo/country/in). The COVID-19 pandemic was first confirmed in the Indian state of Uttar Pradesh on 4 March 2020, with the first positive case in Ghaziabad. As of 1 June 2020, the state has 8361 confirmed cases, resulting in 222 deaths and 5030 recoveries. The situation is getting worst day by day as COVID-19 outbreaks and patients are increasing by every minute and become the most important issue for the whole world and So accessing knowledge and awareness among the people is very important. The present study using the exploratory data analysis we tried to demonstrate the knowledge and awareness of individuals about the COVID-19 pandemic in Uttar Pradesh, the most populous state of India. The findings of the present study can be utilized by the researchers and policy makers to handle this worst situation.

6.
Flora ; 27(2):345-352, 2022.
Article in Turkish | EMBASE | ID: covidwho-2033382

ABSTRACT

Introduction: Mucormycosis is an opportunistic filamentous fungal infection that can progress rapidly. Different clinical pictures may occur depending on tissue and organ where the involvement is seen. Rhinoserebral mucormycosis, is the most common clinical form. We aimed to examine the patients diagnosed with rhinocerebral mucormycosis followed in our hospital with literature. Materials and Methods: Patients treating in our hospital between August 2009 and November 2020 with microbiologically and / or histopathologically confirmed rhinocerebral mucormycosis were evaluated retrospectively. Results: 2 (25%) of the patients were female and 6 (75%) of them were male. The average age was 56.37 ± 9.318. All patients had at least one predisposing factor. Fever and headache symptoms were the most common. Surgical debridement and antifungal treatment were applied to all patients. 4 (50%) of the patients developed diffuse visual impairment and were discharged with sequelae. One (12.5%) of them was discharged with full recovery. 3 (37.5 %) of them died on the 12th day of hospitalization. Hemoglobin and Glaskow coma scores of patients with ex were significantly lower than the patients who were discharged, and SOFA scores were higher (p= 0.025, 0.031, 0.023, respectively). Conclusion: Nowadays, when the COVID-19 pandemic has not been controlled yet, most of the patients who receive immunosuppression due to COVID-19 also carry additional risk factors such as DM in terms of mucormycosis. Our article has contributed to raising awareness by drawing attention to risk factors, clinical signs and symptoms in mucormycosis. Training meetings should be organized for all medical doctors on this subject. In this way, mortality and sequelae rates can be improved with early diagnosis and treatment.

7.
Flora ; 27(2):286-295, 2022.
Article in Turkish | EMBASE | ID: covidwho-2033379

ABSTRACT

Introduction: Aspergillus species have begun to cause invasive pulmonary aspergillosis (IPA) with increasing frequency in patients with known risk factors in intensive care units (ICU). An international multicenter cohort study (AspICU) established criteria for diagnosis of invasive pulmonary aspergillosis (IPA) in intensive care units. In our study, patients with Aspergillus spp. growth in deep tracheal aspirate (DTA) samples in ICU were evaluated according to AspICU criteria. Materials and Methods: This study is a retrospective study. DTA samples were collected from the Pandemic and Reanimation ICU and performed in the Medical Microbiology Laboratory by separated two periods;pre-pandemic (1 March 2019-31 December 2019) and post-pandemic (1 March 2020-31 December 2020). Cases with Aspergillus spp. growth in the DTA samples in the Pandemic ICU were evaluated as COVID 19 associated pulmonary aspergillosis (CAPA) according to AspICU criteria. Results: While Aspergillus spp. was grown in the DTA of three patients in 2019 and five patients in 2020 in the Reanimation ICU, and 11 patients in the Pandemic ICU. Growths belonging to one patient from both Reanimation (2019) and Pandemic ICUs were considered as colonization. Other growths were interpreted as IPA according to AspICU criteria. When the incidence rates according to 10000 patient days were compared, the incidence rate increased significantly in 2020 (19.1) (p< 0.001) compared to 2019 (3.4);In 2020, it was determined that it increased significantly in the Pandemic ICU (40.4) (p< 0.001) compared to Reanimation ICU (9.2). Conclusion: It should not be forgotten that intensive care patients are also at risk for IPA, especially after viral infections (such as COVID-19, Influenza). Although the incidence of IPA was not very high, it was observed that it tended to increase according to our study. The diagnosis of IPA is problematic, therefore it is necessary to increase awareness and sample diversity and to use biomarkers more widely other than hematology patients.

8.
Open Access Macedonian Journal of Medical Sciences ; 10:437-443, 2022.
Article in English | EMBASE | ID: covidwho-2033201

ABSTRACT

BACKGROUND: Mobile health projects have been implemented worldwide, using mobile phones for record keeping, data collection, or patient communication. Further, mobile health tools have been used to promote behavior change in health workers and/or patients. For example, text message reminders have been shown to increase health-care-seeking behavior or medication adherence in some patients, and mobile data collection and communication tools for health workers have improved follow-up of patients and data reporting. METHODS: This literature review was conducted through a keyword search of the following databases to identify relevant peer-reviewed articles: Google Scholar, PubMed, Embase, and EKB. Keywords used in these searches included mHealth, mobile health, mobile phone, coverage, usage, delivery, vaccination, immunization, and COVID-19. RESULTS: Eleven studies that satisfied the inclusion criteria were included. They examined awareness, applications, challenges, and strengths of Mobile-Health applications. All studies showed some evidence that mHealth intervention had a positive impact on increasing the coverage and use of the COVID-19 vaccine. Bad awareness of people was strongly associated with declines in vaccination intent. The use of mobile applications has made a great revolution in tracking and data gathering about vaccination status. The main limitations were reporting bias and malfunctioning of mobile applications. The main strengths were getting real-time data, improving surveillance, using geographic mapping to monitor populations. CONCLUSION: Growing usage of smartphones and Internet penetration in African countries opens the door to mHealth applications such as health literacy, vaccine supply and control, disease monitoring and intervention, and virtual consultations with health professionals worldwide.

9.
Therapeutic Advances in Infectious Disease ; 9, 2022.
Article in English | EMBASE | ID: covidwho-2032594
10.
Anaesthesia ; 77:19, 2022.
Article in English | EMBASE | ID: covidwho-2032358

ABSTRACT

Sedation is integral to facilitating interventions on the intensive care unit (ICU), which would otherwise be intolerable;however, in excess it may prolong intubation and lead to brain dysfunction such as delirium [1]. This is a frequently under-diagnosed problem in the ICU, shown to result in worsened neurological outcomes [2]. The Critical Care Pain Observation Tool (CPOT), Richmond Agitation- Sedation Score (RASS), Confusion Assessment Method for the ICU (CAMICU) are validated to assess for pain, over-sedation and delirium, respectively. We explored how effectively these were used in a hospital in the Northeast of England to address over-sedation and delirium. Methods Adults intubated and ventilated on critical care were identified, and the most recent 24 h of bedside observation charts examined for completion of 4-h RASS, 4-h CPOT and 12-h CAM-ICU assessments. For those over-sedated during this time, we assessed whether sedation was appropriately titrated or held. Patients on neuromuscular blocking agents, with acute brain injury or with specific indication for deep sedation were excluded. Results Fifty-five patient-days were audited, during which sedation was utilised in 71% (n = 39). Overall, pain and RASS were monitored well, assessed at 88% and 91% of 4-h opportunities, respectively;however, CAM-ICU was recorded at only 15% of opportunities. Where documented, RASS scores were within target (-2 to 1) 45% of the time. Where out of range, this was almost exclusively due to oversedation (RASS ≤ -3). Eighty-five per cent (n = 33) of patients were over-sedated on at least one occasion in the last 24 h. Of these, 39% (n = 13) had their sedation neither titrated nor held during this time. Notably, this was the case for 55% (n = 11) of the 20 patients intubated for COVID-19, in contrast to only 15% (n = 2) of the 13 patients intubated for other reasons. Discussion Over-sedation in ICU remains prevalent despite adequate RASS surveillance. This is particularly true among COVID-19 patients. Further, infrequent CAM-ICU use may result in delirium being missed, carrying risk of adverse neurological outcomes and mortality [2]. We have implemented protocolled PAD pathways within each bed space, to empower nurses to titrate sedation and improve awareness of CAM-ICU. Additionally, we have disseminated education on the harms of over-sedation and unrecognised delirium, and we are evaluating re-audit data to ascertain if there has been a resulting improvement in PAD management for sedated patients.

11.
Anaesthesia ; 77:38, 2022.
Article in English | EMBASE | ID: covidwho-2032356

ABSTRACT

High cuff pressures are associated with postoperative airway complications [1]. It is paramount that anaesthetists avoid overinflating endotracheal tube cuff (ETTc). In the first audit, between October and November 2020, we noted unreliable cuff pressures using the inflation techniques routinely used and the tendency to increase cuff insufflation due to COVID-19. The Association of Anaesthetists recommends using a cuff manometer as standard [2]. In this re-audit, we wanted to assess if ETTc pressures and rates of postoperative complications improved following interventions. Methods Prospective data were gathered from the emergency patients at Glasgow Royal Infirmary between July and August 2021. In the month preceding this, anaeroid manometers were introduced. Anaesthetic staff were shown educational videos on the correct use as well as importance of checking the ETTc using a manometer. Among data collected were whether a manometer was used, the corresponding cuff pressure, if they were compliant with the recommended ETTc pressure and any associated postoperative complications. Results Of the 16 patients, the measured ETTc pressures ranged from 10 to 60 cmH2O (interquartile (IQ) range [24-31 cmH2O]), with 11 of 16 (68.8%) within the recommended range of 20-30 cmH2O. This is in comparison to the 22 patients in the first cycle where the pressures ranged from 12-120 cmH2O (IQ range [24-60 cmH2O]), of which 12 of 22 (54.5%) were above recommended pressures. In the first cycle, a manometer was never used to check pressures whereas in the reaudit, a manometer was used concurrently with pre-existing inflation techniques in 11 of 16 (68.8%) cases;one of which had ETTc pressure outside the recommended range (35 cmH2O). Varying results were obtained from five of 16 in which ETTc pressures were not checked using a manometer: three were overinflated, one was underinflated, and one was within recommended limits. Reasons for non-compliance include forgetting and not being able to locate the manometer. Six of the 10 who were within the recommended pressure had no postoperative complications compared to all of the 12 of 22 in the first cycle who had at least one complication. Discussion The ETTc pressures are lower than before, which highlights the progress we have made thus far in raising awareness among staff about the risks of overinflating cuffs. It also supports the correlation between higher cuff pressure and the experience of postoperative complication. Efforts will now be focused on reminding staff and making manometers more accessible.

12.
Anaesthesia ; 77:17, 2022.
Article in English | EMBASE | ID: covidwho-2032351

ABSTRACT

The COVID-19 pandemic has led to unprecedented challenges to surgical services in the UK. Government guidance on the usage of personal protective equipment (PPE) during theatre proceedings [1] has been adapted into local protocols by NHS Trusts across the UK, which is paramount to minimise the potential risk of exposure to staff and patients. We audited the adherence of members of staff working in operating theatres at a district general hospital to local COVID-19 PPE protocols. Methods This was a single-centre audit performed over a 2-month period between June and July 2021. Data were collected by direct observation of staff in the operating theatre environment. Eight staff roles representing members of the anaesthetic, surgical and nursing teams were observed in five different operating lists. The PPE items worn by staff in the presence of aerosol-generating procedures (AGPs) and during direct patient contact were recorded and compared to the local hospital protocols. Results We observed 365 members of staff during 46 patient encounters across the five theatre lists. During AGPs, overall staff adherence for PPE items was 59.1% for FFP3 masks, 25.1% for eye protection, 49.3% for gowns, 62.9% for gloves. For direct patient contact, adherence was 98.4% for surgical masks, 10.7% for eye protection, 37.8% for gowns, 0% for aprons and 80.8% for gloves. Adherence was lowest during emergency lists for patients with an unknown or positive COVID-19 status, with 51.1% of staff wearing FFP3 masks during AGPs here. The staff group with the worst adherence was the surgical team, with 0% of the correct PPE items being worn during AGPs. Discussion Poor adherence to local PPE protocols was demonstrated across all list types and staff member groups, which was worse in higher risk scenarios. This was likely due to suboptimal awareness of guidelines and mixed personal attitudes towards PPE. Recommendations were made for increased dissemination of protocols, introduction of visual prompts in theatre departments and inclusion of protocol signposting in theatre team briefings. Re-auditing is in progress to assess for sustained change following these interventions. Poor adherence to protocols could be contributing to ongoing COVID-19 transmission in hospitals if the results here are reflected nationally, so we recommend that this study is replicated in other hospital Trusts as part of quality-assurance initiatives to reduce COVID-19 transmission in hospitals.

13.
Anaesthesia ; 77:34, 2022.
Article in English | EMBASE | ID: covidwho-2032349

ABSTRACT

There have been at least three fires in intensive care units in the UK over the past 10 years, requiring full-scale evacuations. Fires have also occurred in operating theatres during the use of lasers, including in combination with high-flow nasal oxygen and as a result of diathermy reacting with chlorhexidine. In addition, the COVID-19 pandemic has brought increasing relevance to fire safety and the safe use of oxygen. As a result, the Association of Anaesthetists and Intensive Care Society have brought out new fire safety guidelines in May 2021, written by a multidisciplinary working group. Part of this guidance includes recommendations that all clinical staff have annual multidisciplinary training on the management of a fire and evacuation and biannual practical 'walk-through' training or simulation training. This should include where to find manual fire call points, evacuation aids, evacuation plans with routes and procedures and oxygen shut-off valves in their clinical areas. Methods We carried out a quality-improvement project, looking at qualitative data from surveying clinical staff at Newham University Hospital, before and after delivering our intervention. Our intervention consisted of delivering fire safety teaching, covering the national guidelines and local protocols on how to manage a fire and resulting patient evacuation. This was then followed by running a simulated practical session of a fire in an operating theatre at NUH and the evacuation of an anaesthetised patient down a set of stairs. This was delivered to anaesthetists of all grades, theatre staff including operating department practitioners and surgeons. This was achieved with the collaborative effort of the theatre department, the fire safety team and the simulation team. Results Our results highlight the necessity of this new guidance, as there was significant improvement reported in all categories of the survey after versus before our fire safety training and simulation, as well as positive feedback from colleagues. These categories included: (1) knowledge of where to find manual fire call points, patient evacuation aids, fire action cards and evacuation plans in your clinical area;(2) knowledge of the evacuation route from the operating theatres and (3) confidence in responding to a fire alarm and managing a patient evacuation. In addition, there was a lack of any similar organised fire safety teaching or simulation, as advised to occur bi-annually by the Association of Anaesthetists, prior to our quality-improvement project.

14.
IEEE Trans Cybern ; PP, 2022.
Article in English | Web of Science | ID: covidwho-2032323

ABSTRACT

Understanding the feedback loop that links the spatiotemporal spread of infectious diseases and human behavior is an open problem. To study this problem, we develop a multiplex framework that couples epidemic spreading across subpopulations in a metapopulation network (i.e., physical layer) with the spreading of awareness about the epidemic in a communication network (i.e., virtual layer). We explicitly study the interactions between the mobility patterns across subpopulations and the awareness propagation among individuals. We analyze the coupled dynamics using microscopic Markov chains (MMCs) equations and validate the theoretical results via Monte Carlo (MC) simulations. We find that with the spreading of awareness, reducing human mobility becomes more effective in mitigating the large-scale epidemic. We also investigate the influence of varying topological features of the physical and virtual layers and the correlation between the connectivity and local population size per subpopulation. Overall the proposed modeling framework and findings contribute to the growing literature investigating the interplay between the spatiotemporal spread of epidemics and human behavior.

15.
HemaSphere ; 6:3515, 2022.
Article in English | EMBASE | ID: covidwho-2032161

ABSTRACT

Background: Diagnosis of AL amyloidosis requires demonstration of amyloid in affected tissues along with clonal plasma cells in bone marrow or presence of monoclonal light chains in blood. With increasing awareness among physicians and availability of proper diagnostics, more cases of AL amyloidosis are being diagnosed. Here we present our experience of AL amyloidosis diagnosis and treatment in the era of modern diagnostics and therapy with novel agents. Aims: We aimed to describe the clinical presentations, laboratory features and outcomes of patients with AL amyloidosis in a single center using standard diagnostic tests and treatment with novel agents. Methods: A retrospective analysis of AL amyloidosis patients, diagnosed in our hospital, a tertiary care center in India from January 2016 to December 2021. The data was collected from departmental database. All statistical analyses were done by SPSS version 17. Results: Diagnosis of AL amyloidosis was done in 27 patients. Median age of presentation was 59 years. 22 (81.5%) were males. Major symptoms were pedal edema (37%), shortness of breath (22.2%), frothy urine (11.1%) and fatigue (11.1%). Twenty two (81.5%) presented with ECOG PS ≥ 2. Most common system involved was renal in 16 (59.2%), followed by cardiac in 13 (48.1%) and gastro-intestinal in 9 (33.3%). Fifteen (55.6%) had two or more system involvement while 12 (44.4%) had single system involvement. Lambda monoclonal light chain was present in 22/27 (81.5%) and kappa monoclonal light chain was present in 5/27 (18.5%). Median Hb was 11.6 g/dl (range 6.7- 14.8 g/dl), median M-protein was 0.69 g/dL (range 0-2 g/dL) and median bone marrow plasma cells were 7% (range- 1-18%). Fourteen patients were treated;cyclophosphamide, bortezomib and dexamethasone (CyBORD) in 10/14 (71.4%) and bortezomib + dexamethasone in 4/14 (28.6%). Among 14 patients followed up with median follow up of 13 months (range 6-60 months), 5 expired;3 due to COVID, one due to cardiac arrhythmia (during first cycle) and one due to relapse and rest 9 were alive. Among the 9 patients who were alive 6 were in complete hematological response and 3 were in partial response after 6 cycles of therapy. Summary/Conclusion: Our study presents the spectrum of clinical manifestations, management and outcomes of primary amyloidosis in Indian context. There is a need to increase the awareness among the physicians about amyloidosis so that early diagnosis can be made and timely treatment can be done with novel agents to improve the dismal historical results.

16.
HemaSphere ; 6:2679-2681, 2022.
Article in English | EMBASE | ID: covidwho-2032097

ABSTRACT

Background: Autoimmune haemolytic anaemia (AIHA) during pregnancy is a rare finding, and few is known about maternal and foetal outcomes. AIHA may either develop or relapse during gestation and postpartum or be an issue in a patient on active therapy who becomes pregnant. AIHA management during pregnancy and lactation is not standardized and drug use is often limited by safety concerns. Aims: We studied AIHA impact on pregnancy focusing on disease severity, treatment need and maternal/foetal outcome. Methods: Through a multicentric retrospective cohort study, we identified 38 pregnancies occurred in 28 women from 1997 to 2021 in 10 European centres in Italy, Denmark, France, the Netherlands, USA, and Spain. All included patients had a previous AIHA history or developed/exacerbated AIHA during gestation or postpartum. AIHA was classified according to the direct antiglobulin test. Results: We registered 18 warm AIHA (10 IgG;8 IgG+C3d), 2 cold agglutinin disease, 3 mixed and 5 atypical forms (Table 1). Evans syndrome (i.e., association of AIHA and immune thrombocytopenia or neutropenia) was present in 4. Mean age at AIHA diagnosis was 27 (3-39) and at pregnancy 32 (21-41) years. AIHA diagnosis predated pregnancy in 15 women and had required at least 1 therapy line in all of them, and >2 lines in 12 (rituximab, N=7;cytotoxic immunosuppressants, N=6;splenectomy, N=5). Among these 15 patients, 6 had a relapse during pregnancy, 3 during postpartum and 9 were on active treatment at the time of pregnancy (steroids, N=8;cyclosporine, N=1;azathioprine, N=1;the latter stopped after positive pregnancy test). A patient with a previous AIHA, relapsed as immune thrombocytopenic purpura during pregnancy. Further 8 patients had an AIHA onset during gestation and 2 postpartum. A patient had AIHA onset during the postpartum of the 1st pregnancy and relapsed during the 2nd one. In the 20 women experiencing AIHA during pregnancy/postpartum, median Hb and LDH levels were 6,4 g/dL (3,1 - 8,7) and 588 UI/L (269-1631), respectively. Management consisted in blood transfusions (N=10) and prompt establishment of steroid therapy+/-IVIG (N=20), all with response (complete N=13, partial N=7). After delivery, rituximab was necessary in 4 patients and cyclosporine was added in one. Anti-thrombotic prophylaxis was given in 7 patients. Overall, we registered 10 obstetric complications (10/38, 26%), including 4 early miscarriages, a premature rupture of membranes, a placental detachment, 2 preeclampsia, a postpartum infection and a biliary colic. Apart from the case of biliary colic and one of the two cases of preeclampsia, 8/10 complications occurred during active haemolysis and treatment for AIHA. Nine foetal adverse events (9/38, 24%) were reported: a transitory respiratory distress of the new-born in a mother with active AIHA, 3 cases of foetal growth restriction, a preterm birth, an infant reporting neurologic sequelae, a case of AIHA of the new-born requiring intravenous immunoglobulins, blood transfusions and plasma exchange, and 2 perinatal deaths. The latter both occurred in women on active AIHA therapy and were secondary to a massive placental detachment and a symptomatic SARS-CoV-2 infection. (Figure Presented ) Summary/Conclusion: AIHA developing/reactivating during pregnancy or postpartum is rare (about 5%) but mainly severe requiring steroid therapy and transfusions. Importantly, severe maternal and foetal complications may occur in up to 26% of cases mostly associated with active disease, pinpointing the importance of maintaining a high level of awareness. Passive maternal autoantibodies transfer to the foetus seems a rare event.

17.
Journal of Thoracic Oncology ; 17(9):S508-S509, 2022.
Article in English | EMBASE | ID: covidwho-2031530

ABSTRACT

Introduction: Lung cancer symptoms and secondary effects of cancer treatments impact quality of life and induce patients to excessive rest and lack of physical activity resulting in severe deconditioning. Exercise has been shown to increase performance status, strength, endurance and reduce emotional issues in lung cancer patients. Despite these benefit this approach is a poorly utilized strategy and several barriers must be overcome due to limited data, lack of awareness of the benefits of exercise, and limited patient motivation. Several programs of adapted physical activity are developing to support lung cancer patients during oncological treatments, adopting a personalized approaches. Rowing programs have been reported in cancer survivors to reduce risk factors and the impact of treatments complications, particularly lymphedema in breast cancer survivors. A pioneering program of adapted physical activity was developed by a multidisciplinary team in collaboration with an association for the support of cancer patients (Sicilian Association for Oncological Support), using rowing in patients with active metastatic cancer, to evaluate feasibility, response of patients, and to increase awareness of the benefits of physical activity in the fight against lung cancer. Methods: The program was launched in December 2019 from the idea of a young world rowing champion, but the advent of the COVID-19 pandemic led to the postponement of this project, which was subsequently developed from March 2021 to July 2021. The team was composed by oncologists, sports medicine specialists, two coaches specialised in adapted physical activity programs and a cardiologist. The voluntary logistic assistance was warranted by the rowing society “Canottieri Peloro”, which effectively allowed the project to be carried out, providing patients with equipment, a specialised team doctor and a well-equipped gym. In this preliminary experience we managed to include a small number of patients to assess the feasibility/validity of this approach and improve patients’ needs and satisfaction. Results: Four patients affected by metastatic lung adenocarcinoma with EGFR mutations joined the project (1 M/3 F;median age was 59.5, range 47-68;ECOG PS: 1). All patients presented well-controlled and mild symptoms related to the disease (cough, dyspnea, bone or chest pain) and were receiving active oncological treatments (first line EGFR-TKI: 2 patients;second line EGFR-TKI and maintenance chemotherapy). After a baseline clinical, oncological and cardiological evaluation personalized training program was developed. Briefly, indoor training and individual rowing sessions have been administered to patients. All patients reported full adherence to the training, developing a growing motivation and interest in improving physical performance. We did not recorded any worsening of symptoms or problems related to cancer treatments. The full contact with water and nature and the peculiar backwards motion of rowing had a positive impact on patients, that enjoyed the experience, reducing their anxiety for the future. Conclusions: This preliminary experience, previous developed as a support activity for lung cancer patients, might pave the way for further exploration of the role of rowing in this setting and promote a pivotal project to better define specific programs for metastatic cancer patients to improve compliance and response to cancer treatments. Keywords: Lung cancer, Adapted physical activity, Rowing

18.
Journal of Thoracic Oncology ; 17(9):S466, 2022.
Article in English | EMBASE | ID: covidwho-2031527

ABSTRACT

Introduction: Osimertinib is a selective third-generation EGFR-TKI inhibitor with an inhibitory effect on the T790M mutation. Interstitial lung disease (ILD) occurred in 3.9% of the Osimertinib-treated patients (with 0.4% fatal cases). Methods: Case report of fatal ILD induced by Osimertinib in a patient with metastatic lung adenocarcinoma. Results: We present the case of an 81-year-old female patient diagnosed with stage IVB lung adenocarcinoma (May 2020) with pulmonary, adrenal, and brain metastasis. Genetic sequencing showed an exon 19 deletion. She started erlotinib until documentation of disease progression in January 2021. In this context, she performed a liquid biopsy with the detection of a T790M resistance mutation. She started Osimertinib in February 2021. Her past medical history showed diabetes and dyslipidemia. Two months after starting Osimertinib, she went to the emergency department (ER) with a one-week evolution with progressive dyspnea, cough, and fever. Upon admission to the ER, she was conscious and cooperative, with respiratory distress signs, normal blood pressure, and hypoxemia. She had decreased breath sounds, and coarse crackles were audible bilaterally. In the blood sampling, Haemoglobin was 7.7 mmol/L, creatinine 0.08 mmol/L, platelets 257000x10ˆ9/L, C-reactive protein 28.6 nmol/L, and NT-proBNP 98 pmol/L. Rt-PCR for sars-CoV-2 detection was negative. X-ray showed bilateral diffuse infiltrates. She started oxygen therapy via nasal cannula at 3l/min and IV antibiotics. ABG values were pH 7.44, pCO2 37 mmHg, pO2 69 mmHg, HCO3 26 mEq/L, sO2 94%. On reassessment after 3 hours, she presented worsening dyspnea and dizziness, with higher oxygen needs (venturi mask, 60%). Chest CT angiography showed extensive bilateral diffuse ground-glass densification with crazy-paving areas. It also showed no signs of pulmonary embolism. We admitted her to a level 2 ICU unit for surveillance. Due to suspected drug toxicity, she started Methylprednisolone pulses (1000mg/3days). Six hours after admission, due to hypoxemia worsening, non-invasive ventilation was started with the need to escalate oxygen therapy to 100% FiO2. At 24h, she showed clinical and blood analysis improvement. Nonetheless, she still needed 100% fiO2 to maintain >92% oxygen saturation. On the 4th day of hospitalization, she was hypotensive, prostrated, and with little reaction to painful stimulation. She started palliative treatment and died on the same day. Conclusions: ILD is a rare adverse effect of the treatment with Osimertinib, and fatal ILD is even rarer. The time from starting Osimertinib to this side effect is variable between patients. Awareness is necessary for a rapid diagnosis and early treatment. [Formula presented] Keywords: Osimertinib, Intersticial Lung Disease, Adverse effect

19.
Journal of Thoracic Oncology ; 17(9):S24, 2022.
Article in English | EMBASE | ID: covidwho-2031502

ABSTRACT

Introduction: Unintentional weight loss is common in lung cancer, with 40-60% of patients presenting with this at diagnosis. Weight loss and depleted nutritional status have been identified as negative prognostic variables for survival and directly impact the effectiveness of cancer treatments. The Lung Oncology team at the University Hospital Southampton (UHS) received external funding from Bionical Solutions and AstraZeneca for a part time oncology Dietitian to join the team in treating this patient group. The aim was to determine if specialist Dietitian input improves patients’ nutritional outcomes in those diagnosed with Stage III Non-Small Cell Lung Carcinomas (NSCLC) undergoing radical treatment. Methods: Over 12 months (February 2021-February 2022) all patients with stage III NSCLC received specialist Dietitian input during their radiotherapy treatment. Non-patient identifiable data was collected, which included;whether patients were enterally fed, admission rates and reason, and their weights at the start, middle, end and 2 weeks post radiotherapy. This data was compared to previously collected data in 2018 with the same patient group. No ethical approval was required. Results: A total of 50 patient data sets and 11 feedback questionnaires were collected over 11 months. Between the start and end of radiotherapy, patients experienced;2.1% overall average weight loss, 64% experienced <3.0% unintentional weight loss and 0% experienced >9.6% unintentional weight loss. In 2021 patients reached their lowest weight earlier at 70% of their way through radiotherapy compared with 86% in 2018. Patients maximum unintentional weight loss was 3.2% in 2021 compared with 4.4% in 2018. This is likely due to closer monitoring and dietitian input in 2021. Admission rates were higher in 2021 (n=13, 26%) compared to 2018 (n=5, 18.5%). However, this may be due to changes to patients’ radiotherapy treatment plans in 2021 due to the covid pandemic, resulting in more intense treatments. Patients requiring nasogastric (NGT) feeding increased from 0 in 2018 to 6 in 2021. This is likely due to increased awareness of the importance of nutritional support attributable to dietetic involvement in the multidisciplinary team. All patients who completed the feedback questionnaire found dietetic consultations useful and were able to follow most, or all dietary advice. 91% felt well supported during their treatment with dietetic input. Final Outcomes: Patients experienced reduced weight loss during treatment with Dietitian input compared to 2018 data where there was minimal dietetic input. Increased number of patients required NGTs compared to 2018, therefore Dietitian input is required in this area of oncology. Most patients felt well supported receiving dietetic input during treatment. Increased admission rates compared to 2018, however more nutrition support related admissions in 2021. Conclusions: Overall, patients lost less weight during treatment with Dietitian involvement in their care which is a positive factor in the prognostic outcomes. In addition, most patients felt seeing a Dietitian during treatment improved their experience and felt well supported. The final outcomes support the British Dietetic Associations’ recommendation that there is a dedicated dietetic service for lung cancer patients’, and they are seen by a Dietitian during their treatment. Keywords: Dietitian involvement, Reduced weight loss, Improved patient outcomes

20.
Journal of the American Academy of Dermatology ; 87(3):AB130, 2022.
Article in English | EMBASE | ID: covidwho-2031388

ABSTRACT

Sun exposure is physiologically necessary, yet excessive amounts can be detrimental to skin, causing photoaging, sunburn, and skin cancer. Sunburn, presenting as delayed onset erythema, has been partially characterized for Caucasians, however the impact of excessive sun exposure has been less studied across race/ethnicity and skin tones. Herein, we present findings from a survey conducted across the United States, where sunburns were examined in a racially and ethnically diverse sample of 3597 participants spanning the Fitzpatrick skin phototype (FSP) scale. Individuals reporting sunburn were probed on the signs, severity, pain level, and anatomical location of their most recent sunburn and on the associated type of activity. Over the 8-month evaluation period (January-August 2020), sunburns were self-reported at rates generally consistent with those reported annually pre-COVID, with 39% Caucasian, 20% Asian, 12% African American and 32% Latino respondents reporting at least one sunburn. While average sunburn incidence among African American is low, a closer look reveals that African Americans with lighter skin tones (FSPs I-II) report higher sunburn rates (25.5%, n = 12), thus highlighting that sunburn risk does not depend on race/ethnicity alone. Furthermore, African Americans and Hispanics self-reported a significantly higher percentage of severe sunburns compared with Caucasians (27%, 20% and 11%, respectively) and African Americans, unlike Caucasians, indicated “peeling” as the top sign of their sunburn. This work provides a better understanding of the sunburn experience across race/ethnicity and skin tones and is a step toward enabling more personalized sun safety awareness and education.

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