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1.
Ibnosina Journal of Medicine and Biomedical Sciences ; 2022.
Article | Web of Science | ID: covidwho-1967694

ABSTRACT

Background Coronavirus disease 2019 (COVID-19) causes significant mortality and morbidity in severe patients. Objective In this study, we aimed to examine the relationship between COVID-19 disease severity and peripheral perfusion index (PPI). Patients and Methods This prospective observational study included COVID-19 patients admitted to the tertiary hospital emergency department. Basal clinical and demographic data of the patients and PPI values at the time of admission were recorded. The patients were categorized to severe and nonsevere groups according to clinical severity. The relationship between COVID-19 severity and PPI was examined in comparison with the control group. Results A total of 324 patients who met the inclusion criteria were analyzed. COVID-19 (+) was detected in 180 of these patients. Ninety-two of the COVID-19 (+) patients were in the severe group, and 88 of them were in the non severe group. Note that 164 COVID-19 (-) patients were in the control group. PPI average was found to be 1.44 +/- 1.12 in the severe group, and 3.69 +/- 2.51 in the nonsevere group. PPI average was found to be significantly lower in the severe group than the nonsevere group ( p < 0.01) As for the nonsevere group and control group, PPI averages were found to be 3.69 +/- 2.51 and3.54 +/- 2.32, respectively, and a significant difference was determined between the two groups ( p < 0.05). PPI COVID-19 severity predicting activity was calculated as area under the curve: 0.833, sensitivity:70.4%, andspecificity:71%( p = 0.025) at 2.2 cutoff value. Conclusion The results of our study showed that PPI is an easy-to-apply and useful parameter in the emergency department in determining the severity of COVID-19 patients.

2.
Journal of Pediatric Intensive Care ; 2022.
Article in English | Web of Science | ID: covidwho-1967691

ABSTRACT

In response to the burden of coronavirus disease 2019 (COVID-19) and overwhelmed intensive care unit (ICU) resources, some pediatric intensive care units (PICUs) have had to adapt. The purpose of this study was to assess the criticality, scope of diagnosis, and outcomes of an adult cohort admitted to a Canadian PICU. A retrospective chart review was completed on all patients between 17 and 50 years of age admitted to the PICU between June 2020 and December 2021. Admission data included body mass index (BMI), admission sequential organ failure assessment score (SOFA), COVID-19 status, diagnosis, and comorbidities. The duration of ventilatory support, PICU and hospital admission, and mortality and discharge disposition were assessed. Discrete variables were reported as percentages and continuous data as means with standard deviations or medians with interquartile range. Sixty-five adult patients were admitted to the PICU for a total of 437 days, with a mean SOFA score of 6.6 and the overall mortality rate of 4.6%. Six patients were diagnosed with COVID-19 pneumonia, were admitted with a mean SOFA score of 11.8 and a BMI of 38.3 kg/m(2) , and all were discharged to the ward. During the COVID-19 pandemic, pediatric intensivists in a Canadian PICU managed adult patients up to 50 years of age with high criticality and broad-ranging diagnoses with a low mortality rate. PICUs may be a safe critical care decompression option for adult ICUs during future endemics or pandemics.

3.
Laryngo- Rhino- Otologie ; 101:S320, 2022.
Article in English | EMBASE | ID: covidwho-1967682

ABSTRACT

Introduction We report on three patients, who presented themselves at our clinic between February and June 2021 with impaired voice, which resulted in an aphonia after having had Covid-19 infection. Material & methods Indirect laryngoscopy and videostroboscopy were performed in all patients. The voice quality was limited in all patients. Voice analysis was performed perceptively (RHB scheme) and objectively by computer-assisted analysis (Göttingen hoarseness diagram, voice field). Self-assessment was performed using the Voice Handicap Index (VHI). Results Laryngoscopically, all patients showed laterally mobile vocal folds, non-irritant mucosal conditions and a wide glottis. All patients showed wide, irregular vibration amplitudes and incomplete glottis closure by videostroboscopy. Objective voice analysis revealed pathological values for the irregularity and noise components as well as the Dysphonia Severity Index (DSI). In the VHI all patients documented a high-grade voice disorder with a mean score > 62. Our patients continued to suffer from dysphonia 6-9 months after initial presentation. Voice therapy did not provide satisfactory voice improvement. Discussion Whether glottic hypofunction is due to sensorimotor dysfunction caused by neurotropic coronavirus remains a conjecture. In addition, the hy-pofunction may be related to the general reduced performance of the patients in post-covid-syndrome. Conclusion According to our literature research, this is the first description of dysphonia as a possible symptom in post-covid-syndrome.

4.
Laryngo- Rhino- Otologie ; 101:S243, 2022.
Article in English | EMBASE | ID: covidwho-1967666

ABSTRACT

Aim The project aims to examine chemosensory dysfunction in long-COVID with a focus on olfactory function about 9 months after SARS-CoV-II-infection. Material and Methods In this population-based cross sectional study, PCR-confirmed SARS-CoV-2 outpatients were examined between November and June 2020 at Kiel university hospital. Data on medical history and chemosensory function were collected via questionnaires and a Visual Analogue Scale (VAS), olfactory performance was psychophysically objectified using the Sniffin' Sticks test. Results A total of 376 female and 290 male patients were included with a mean age of 48.2 years ranging from 19 to 87 years. The mean follow-up was 9.09 months (range 1.64-15.18) after initial positive PCR-testing. The prevalence for olfactory dysfunction (OD) during infection was 66,1 %. 33,7 % of the subjects reported persistent OD subjectively at the time of examination (female 28,8 %, male 42,3 %). T-test analysis showed a significant decline of reported olfactory evaluation from before COVID-19 to the time of examination based on VAS (p < 0.001). 34,6 % of the subjects were tested hyposmic or anosmic by Sniffin' Sticks. A significant correlation was shown between a subjective estimation of OD by the patients and an objectively tested OD (p < 0.001). The TDI-score correlated positively with the amount of time (in months) that passed since PCR-testing (p < 0.001). Discussion OD in SARS-CoV-II-infection is frequent and can be persistent long beyond the acute phase of ilness. We demonstrated that anamnestic OD is significantly related to psychophysically tested OD. Therefore one can conclude that a subjective OD is a likely predictor of an actual objective OD. Furthermore, OD shows a tendency to improve over time.

5.
Laryngo- Rhino- Otologie ; 101:S242, 2022.
Article in English | EMBASE | ID: covidwho-1967662

ABSTRACT

Background This study aims to investigate the prevalence and long-term development of gustatory dysfunction (GD) after COVID-19. Methods In the population-based cross-sectional COVIDOM-study, 667 patients above the age of 18 years (mean 48.2) who tested positive for SARSCoV- 2 via PCR-testing on average 9.09 months ago were examined between November 2020 and June 2021. Extensive medical history taking was conducted via questionnaires. Participants were asked to rate their ability to taste before, during and after COVID-19 on a Visual Analogue Scale (VAS) ranging from 0 to 10. Whole mouth gustatory testing with Taste Strips for the qualities sweet, sour, salty, and bitter was performed. Results 60.9 % (406 of 667) participants reported gustatory impairment during their infection. Out of those, 56.9 % perceived this symptom as severe and 13.3 % noticed it as the earliest symptom. At the time of our examination, 36.2 % had a persistent subjective GD, defined as a lower score on the VAS than before COVID-19 (mean difference -0.9 points). This difference was significant (p < 0.001). In the testing, 7.3 % (47 of 667) participants had a GD, defined as the correct identification of less than three out of four Taste Strips. No signifi- cant correlation was found between subjectively persistent and tested GD (p = 0.250). Conclusions SARS-CoV-2 seems to frequently affect the gustatory function in the long term as well, what might have an influence on patients' everyday-life. However, Patients' own perception does not always correspond with psychophysiological testing which might be caused by the common difficulty to differentiate between the chemosensory senses of taste and smell.

6.
Laryngo- Rhino- Otologie ; 101:S180, 2022.
Article in English | EMBASE | ID: covidwho-1967655

ABSTRACT

Introduction The use of biologics has been described as an effective therapy in phase 3 studies in severe CRSwNP. Relatively unexplored is the post-covid syndrome in CRSwNP patients. Method Case presentation. Results Presentation of a 75-year-old patient with CRSwNP, asthma, ASA intolerance and eosinophilic granulomatosis with polyangiitis. Drug therapy with daily 1-5 mg prednisolone oral and inhalation therapy with formoterol/ beclomethasone. In February 2021, the patient was diagnosed with SARS-CoV-2 infection. For four days, the patient was admitted to a hospital with pronounced physical weakness without respiratory insufficiency. Anosmia has long been known because of CRSwNP. After Covid-19 illness, the patient reported severe sleep impairment and a severe state of exhaustion compatible with a post-covid syndrome. In addition, the patient was impaired by a severe nasal obstruction. At presentation in the rhinological consultation 7 months after Covid-19 illness, severe nasal polyps (NP overall score 8) and anosmia were detected. Dupilumab therapy (anti IL-4/IL-13 antibody) was initiated for severe CRSwNP. In the course of 2 months, an improved quality of life with less nasal obstruction as well as a reduced NP overall score of 6 were shown. Furthermore, the sleep impairment and exhaustion of the patient did not improve. Conclusion Dupilumab therapy improves quality of life in patients with severe CRSwNP, which may be especially important in post-covid syndrome.

7.
Diabetologie und Stoffwechsel ; 2022.
Article in German | Web of Science | ID: covidwho-1967651

ABSTRACT

The present study gives an overview on the effects caused by the ongoing COVID-19 pandemic on the living and care situation of people with diabetes in Germany. For this purpose, a systematic search was conducted using the scoping review methodology. On the one hand, a systematic literature search was accomplished in scientific databases for empirical studies and in other search areas for other non-empirical publications. On the other hand, routinely collected electronic health data (routine data;e.g., health insurers' administrative data, data from patient registers, medical billing, and drug care data from contractual physicians) were requested from health insurance companies, patient registries or other institutions to gain insight into the care situation of people with diabetes. The literature search identified a total of 53 publications (12 empirical studies and 41 other publications) which were included in the data extraction. Additionally, the methodological quality of the empirical studies was assessed. Due to the small number of empirical studies and their low methodological quality, the evidence gaps regarding the impact of the COVID-19 pandemic on care of people with diabetes are large. However, the empirical studies provide little evidence that the pandemic had a negative impact on the use of diabetes-specific services. The studies show fewer new and re-enrolments in disease management programs for diabetes;fewer changes in prescriptions of blood glucose-lowering drugs;fewer diabetes diagnoses and a higher rate of diabetic ketoacidosis in children and adolescents. Additionally, the COVID-19 pandemic has encouraged the use of digital tools for the care of people with diabetes. The search for routine data remained without results. In summary, very limited reliable data on the effects of the COVID-19 pandemic on the care of people with diabetes in Germany was available.

8.
Social Policy and Society ; : 1-15, 2022.
Article in English | Web of Science | ID: covidwho-1967573

ABSTRACT

The current article provides comparative analysis of policy capabilities in COVID-19 response in Russia and Finland by examining key challenges and impacts of the pandemic, and effects of anti-crisis socio-economic measures. It finds that the two countries adopted diverse policy responses that prioritised different segments of society with corresponding budget allocations. Such policy choice has been underpinned by pre-existing national priorities, while largely leveraging established policy legacy, institutions, and instruments within their welfare models. Russia has focused on supporting households through pro-natalist social assistance in line with its demographic concerns and persistent poverty, whereas Finland concentrated on protecting employment via social insurance and labour market interventions amid declining working-age population and labour supply. It is further suggested that improving policy capabilities via investments in comprehensive social security, welfare systems and gender-responsive policies can contribute to better development outcomes, while addressing gender power imbalances in the post-COVID-19 era.

9.
Social Policy and Society ; : 1-12, 2022.
Article in English | Web of Science | ID: covidwho-1967572

ABSTRACT

The Covid-19 pandemic has prompted manifold social policy responses all around the world. This article presents the findings of a meta-analysis of thirty-six in-depth country reports on early Covid-19 social policy responses in the Global South. The analysis shows that social policy responses during the early phase of the pandemic have been predominantly focused on expanding temporary and targeted benefits. In terms of policy areas, next to labour market and social assistance measures, the focus has also been on unconventional social policy instruments. The social policy responses of developing economies were often rudimentary, focusing on cash transfers and food relief, and heavily relied on external funding. In contrast, many emerging economies introduced a much broader array of social policies and were less reliant on external support.

10.
Ageing and Society ; : 1-19, 2022.
Article in English | Web of Science | ID: covidwho-1967568

ABSTRACT

Health authorities worldwide address older adults as a risk group for more serious illness and health complications associated with COVID-19, while social gerontologists have warned that addressing older adults as a risk group of COVID-19 bears the risk of reinforcing ageism. This paper empirically explores to what extent older adults perceive themselves as part of a COVID-19 risk group and how these perceptions influence their everyday lives and experiences of age and ageing. This paper draws upon data from a mixed-methods study on older adults' risk perceptions during COVID-19 in Lower Austria, including a representative survey on 521 adults (60+ years) and data from 20 semi-structured interviews. Approximately two-thirds of the respondents consider themselves at risk of COVID-19 and name age, in addition to pre-existing illness, as a contributing factor in this risk perception. Older adults with health constraints, and especially older men, have a higher probability of perceiving risk due to COVID-19. Additionally, older adults report that they experience being 'suddenly seen as old' or 'being put into a box' during the pandemic, which influenced their experiences and images of ageing. Our study provides insights into how perceived COVID-19 risk affects the everyday lives of older adults. Age-based categorisations of risk contribute to a shift in images of age and ageing, drawing on insecurity and risk, rather than successful and active ageing, to conceptualise later life.

11.
Business and Human Rights Journal ; : 1-12, 2022.
Article in English | Web of Science | ID: covidwho-1967565

ABSTRACT

Drawing on the work of Donaldson and Walsh, this article explains why for-profit companies in industries denominated by intrinsic values such as health, education and justice, have heavier responsibilities when it comes to honouring the human rights reflected in their industry identity. Optimized collective value, the overarching aim of any system of business, is defined in terms of the satisfaction of intrinsic values, a definition that gives special meaning to firms operating in industries themselves defined in terms of intrinsic values. Nor are such companies' responsibilities to human rights, such as the right to healthcare, conveniently reducible to the 'enlightened' pursuit of profit. For example, a pharmaceutical company such as Pfizer or Moderna may be required to make its COVID-19 vaccine more accessible to COVID-19 victims in developing countries at the expense of optimizing profits over the long run. Such companies have a special and mandatory correlative duty to honour the right to healthcare that derives from their corporate constitutional purpose.

12.
Gastroenterology ; 162(7):S-1138, 2022.
Article in English | EMBASE | ID: covidwho-1967413

ABSTRACT

Background There is limited data on the efficacy of SARS-CoV-2 vaccinations on the immunosuppressed population—especially in the liver transplant (LT) population. A study in Israel found that only 47% of LT recipients developed adequate antibodies against the virus while another study in Baltimore, MD found an immune response of 81%. Moreover, early studies in San Diego, CA and Miami, FL on the outcomes of COVID-19 disease among solid organ transplant recipients showed reductions in symptomatic disease of 75 to 80%. We aim to identify the incidence and outcomes of COVID-19 disease in fully vaccinated LT recipients in a large cohort of LT recipients. Methods In a large integrated healthcare system in Southern California with a population of 4.3 million active members aged 18 or older, data was extracted from the electronic health record (EHR) and transplant registry. COVID-19 disease was identified by a positive polymerase chain reaction (PCR) test for SARS-CoV-2. We defined fully vaccinated as 14 days after the 2nd dose of Pfizer or Moderna vaccines or after the 1st dose of Johnson and Johnson vaccine. Chi square analysis was used to compare the difference between 2 groups. Results We identified 1271 active members who had received a LT as of 12/1/2021. Among LT recipients, 90.6% (1152/1271) had received at least one dose of a COVID-19 vaccination, 89.1% (1132/1271) were fully vaccinated, and 58.6% (745/1271) had received booster vaccinations. Between 3/1/20 and 11/30/21, 172 (13.5%) LT recipients had been infected with COVID-19 disease, of which, 37 (3.3%) were infected after being fully vaccinated. Of those infected after being fully vaccinated, 38.9% (15/37) were female. The mean age was 58.7 ± 9.8. 62.2% had diabetes, 73.0% had hypertension, and the mean body mass index (BMI) was 29.3 ± 5.8. 24.3% (9/37) were hospitalized for COVID-19-related illness. The case fatality of COVID-19 was 2.7% (1/37) in post-vaccinated LT recipients compared with 7.4% (10/135) who were unvaccinated prior to infection (OR 0.35, 95% CI 0.04-2.80, p = 0.27). The patient who passed away from COVID-19 after vaccination (diagnosed 4 months after receiving the second dose) had chronic kidney disease and obesity (BMI 42). Conclusions In our large cohort of LT recipients, a significant proportion were fully vaccinated, and the majority had received a booster vaccination dose. A small proportion of LT recipients were infected with COVID-19 disease after being fully vaccinated for COVID-19. The case fatality rate, although not statistically significant, of patients infected post-vaccination was lower compared to unvaccinated patients. More research is needed on the long-term outcomes of COVID-19 and vaccine efficacy in this high-risk population.

13.
Gastroenterology ; 162(7):S-1137, 2022.
Article in English | EMBASE | ID: covidwho-1967411

ABSTRACT

INTRODUCTION Patients with liver disease, notably cirrhosis, are at a higher risk for hospitalizations and mortality after COVID-19. However, previous studies did not report long-term outcomes;furthermore, the effect of COVID-19 on underlying liver disease and long-term prognosis and risk for decompensation is hitherto unknown. We aimed to compare the short and long-term outcomes of patients with compensated cirrhosis with and without COVID-19. METHODS A retrospective cohort study was performed using TriNetX (a multiinstitutional research network). Patients with compensated cirrhosis who were tested for COVID-19 were identified between January 2020 and December 2020. These patients were then stratified into two groups based on results of COVID-19 testing;compensated cirrhosis who tested positive (COVID-19 group) and compensated cirrhosis who tested negative and were never diagnosed with COVID-19 (non-COVID-19 group). The primary outcomes were risk for decompensation of cirrhosis, need for inpatient/ ICU services and mortality. Clinical outcomes were compared at 3 months in the two groups (short term outcomes). Patients who survived at 3 months were then followed up to 1 year (long term outcomes). Outcomes were compared after 1:1 propensity score matching (PSM) to account for the confounding variables (age, gender, race, diabetes, ischemic heart disease, hypertension, chronic kidney disease, chronic lower respiratory disease and nicotine dependence). RESULTS We identified a total of 18228 patients with compensated cirrhosis who were tested for COVID-19 during the study period. Of these, 1217 patients tested positive for COVID-19 and were included in the COVID-19 group, and the remaining 17011 were included in the non-COVID-19 group. There were significant differences in characteristics, however, after PSM, both groups were well matched (Table 1). Patients in the COVID-19 group had a significantly higher risk of mortality at 3 months and the risk remained high even after PSM (Table 2). COVID- 19 group had a higher risk for decompensation, inpatient or ICU care. However, follow up of survivors at 1 year did not show an increased risk of mortality, decompensation, inpatient or ICU care in both unmatched and matched analysis (Table 2). . CONCLUSION Our study showed that patients with compensated cirrhosis who tested positive for COVID-19 are at higher risk of decompensation and poor outcomes in the short-term secondary to acute insult from COVID-19 disease. However, for patients who survive the acute COVID-19 insult, long-term outcomes including the risk of decompensation, mortality or need for hospitalization are similar when compared to cirrhosis patients who never acquired COVID- 19 disease. This study demonstrates that patients with cirrhosis who survive COVID-19 may not have worsening of their underlying liver disease or long-term prognosis. (Table Presented)Baseline characteristics of the two study cohorts before and after propensity score matching (Table Presented) Clinical outcomes of the two study cohorts before and after propensity score matching

14.
Gastroenterology ; 162(7):S-1027-S-1028, 2022.
Article in English | EMBASE | ID: covidwho-1967397

ABSTRACT

Background: The COVID-19 pandemic has led to major disruptions in healthcare and delays in endoscopy. While recent AGA guidelines suggest against routine pre-endoscopy SARSCoV2 testing, many endoscopy practices continue to require testing of all asymptomatic individuals. We hypothesized that SARS-CoV2 testing may disproportionately affect minority groups. The aim of this study was to assess racial differences in endoscopy cancellation rates attributable to SARS-CoV2 testing requirements. Methods: We conducted a retrospective chart review of cancelled endoscopic procedures between 3/1/21 to 9/7/21 from our hospital which mandated a negative SARS-CoV2 RT-PCR test within 72-hours prior to endoscopy. Data was collected on age, race (based on self-report), gender, procedure type/location, primary language, indication, and source of referral. Cancellations related to SARS-CoV2 testing included: test not completed, test not resulted, patient declined to obtain test, or positive test result. Multiple logistic regression was used to control for potential confounders on race and cancellation. Statistics were performed in JMP Pro 14.0.0. This project was IRB approved. Results: Of 847 cancelled procedures, 300 were randomly selected for chart review (for feasibility purposes). After excluding repeat patients and erroneous cancellations, 255 cases remained for analysis (Table 1). SARS-CoV2 testing requirements accounted for 19% of cancellations (Table 2). Of 112 completed tests, only 7 were positive leading to procedure cancellation. Non-Hispanic Black patients were significantly more likely to have procedure cancellations related to SARS-CoV2 testing (OR: 3.4, 95% CI 1.7, 6.7). This group was also less likely to present for their procedure (OR: 2.3, 95% CI 1.2, 4.1);however, there was no difference in provider initiated cancellations. Other factors including age, gender, procedure type, procedure location, primary language, gastroenterology referral, and indication (screening or diagnostic) were not associated with testing-related cancellations. Controlling for potential confounders of age, gender, endoscopy location, and language did not change the association of race and testing-related cancellations. Discussion: Blacks had higher rates of pre-endoscopy cancellations due to SARS-CoV2 testing requirements compared to non-Blacks which may lead to further delays in care. Similar to prior studies, Blacks also had higher no show rates for endoscopy, which is partly explained by socioeconomic factors. However, the additional requirement of pre-procedure testing disproportionately impacted Black patients. Health care systems mandating pre-endoscopy testing should recognize how this requirement may worsen inequities in care and contribute to poor health outcomes among people of color or other marginalized groups. (Table Presented) (Table Presented)

15.
Gastroenterology ; 162(7):S-837, 2022.
Article in English | EMBASE | ID: covidwho-1967373

ABSTRACT

Background and Aims: Long COVID is a syndrome affecting patients infected with SARSCoV- 2 who show a broad spectrum of symptoms, such as fatigue and dyspnoea, persisting for several months after the initial infection. Patients with type 2 diabetes (T2D) have frequent co-morbidities affecting multiple organs. Both long COVID and T2D are multi-system conditions associated with abnormalities in organ structure and function. Therefore, multi-organ assessment is critical for monitoring organ health and early detection of co-morbidities in both conditions. This study aimed to define the prevalence of multi-organ abnormalities in patients with long COVID and patients with T2D with a rapid, non-contrast, magnetic resonance imaging (MRI) scan. Methods: Overall, 135 long COVID patients without diabetes were recruited in the COVERSCAN study (NCT04369807) at a median of 183 days since first COVID-19 symptoms. 135 patients with established T2D were recruited in the MODIFY study (NCT04114682). MRI data were acquired to derive abdominal organ-specific measures of size, fat deposition and fibroinflammation (CoverScan®, Perspectum Ltd.). Reference values of MRI metrics were based on 92 healthy volunteers and published literature. The prevalence of abnormalities for each measure was assessed using Fisher's exact tests in the whole cohort and in a subset of patients with obesity (BMI≥30 kg/m2). Results: The demographics of the three cohorts were as follows: long COVID: median age 54 yrs [interquartile interval 46–60], 56% male, BMI 27 kg/m2 [26–31];T2D: 62 yrs [54–70], 59% male, BMI 32 kg/m2 [28–35], median T2D duration 11 yrs;healthy volunteers: 44 yrs [32–53], 66% male, BMI 23 kg/m2 [21–25]). There was a high prevalence of abdominal organ abnormality in both long COVID and T2D patient groups (Figure, left), including increased fat deposition (steatosis) in the liver, pancreas, and kidney (Figure, right). 35% of patients with T2D had clustering of abnormalities involving at least 2 organs, compared to 23% in long COVID. Abnormalities affecting the liver (steatosis, fibroinflammation and hepatomegaly) and renomegaly were more common in T2D than in long COVID (p<0.001). Considering only patients with obesity, liver fibroinflammation, hepatomegaly, and renomegaly remained significantly more prevalent in T2D than in long COVID (p<0.05). Conclusion: Long COVID and established T2D have distinct profiles of multi-organ impairment, more prevalent with obesity but not fully explained by it. Multi-organ MRI assessment can enrich the current blunt assessment of multi-system/multi-organ abnormalities in diverse disease states to inform earlier intervention and treatments. (Figure Presented) Left: Prevalence (%) of organ abnormalities in long COVID patients (black numbers) and T2D patients (grey numbers) (liver, pink;pancreas, yellow;kidney, green;spleen, blue). Right: Prevalence of organ steatosis, fibroinflammation and increased organ size by patient group. Colour per organ as in left figure.

16.
Gastroenterology ; 162(7):S-291-S-292, 2022.
Article in English | EMBASE | ID: covidwho-1967287

ABSTRACT

Background: Post-COVID-19 conditions are defined as new, recurring, or ongoing health issues which present weeks after SARS-CoV-2 infection. The gastrointestinal (GI) involvement of COVID-19 suggests that a group of patients with lingering GI symptoms may develop Post-COVID-19 DGBI including irritable bowel syndrome (IBS) (Schmulson M et al. Am J Gastroenterol. 2021;116:4-7). In this study, we aimed to determine the epidemiological features of Post-COVID-19 DGBI. Methods: Subjects with confirmed COVID-19 at least 6 months before the study who had sustained GI symptoms were invited to complete an internet-based survey on Qualtrics, between March and August 2021. The survey included demographics, acute symptoms, comorbidities, as well as Rome IV questionnaire, Generalized Anxiety Disorder questionnaire (GAD-7) and Patient Health Questionnaire (PHQ)-9 for depression. Data was analyzed using ANOVA and multivariate analysis. Findings were reported as percentage or [p-value;(95% odds ratio CI)]. Results: Overall, 164 subjects (70% female, 14% male, and others unknown) with a positive COVID-19 test completed the survey. Among them, 4% were >65 years old and 24% reported hospitalization. Body mass index ³30 was present in 38%, diabetes in 6.7%, and vitamin D deficiency in 11% of the participants. In total, 108 (66%) subjects fulfilled Rome IV criteria for at least one DGBI. Of 108 with DGBI, only 27 (25%) had DGBI before COVID-19;DGBI developed in 81 subjects after COVID-19. The most common Post-COVID-19 DGBI were functional dyspepsia observed in 38 (postprandial distress syndrome n=31, epigastric pain syndrome n=22) followed by IBS in 26 subjects (IBS with Diarrhea n=7, IBS with Constipation n=4, Mixed-IBS n=14, Unsubtyped IBS n=1) (Table-1). The risk factors of severe COVID-19 including age >65, diabetes, and obesity were not associated with developing Post-COVID- 19 DGBI. Seventy (86%) of subjects with Post-COVID-19 DGBI had at least one GI symptom (abdominal pain, nausea/vomiting, and/or diarrhea) in the acute phase of COVID-19. Nausea/ vomiting during the acute illness increased [p-value of 0.02 with 95% OR CI (0.7-10.4)], and BMI less than 25 also increased the odds [p-value of 0.03 (95% OR CI: 0.26-8.4)] for Post-COVID-19 IBS. Anxiety was present in 48% and depression in 65% of subjects with Post-COVID-19 DGBI. Conclusions: Post-COVID-19 DGBI are new entities associated with a high rate of anxiety and depression. Although the majority of those with Post-COVID-19 DGBI reported having GI symptoms in the acute illness, some appeared in subjects without acute GI symptoms. (Table Presented)

17.
Gastroenterology ; 162(7):S-277, 2022.
Article in English | EMBASE | ID: covidwho-1967262

ABSTRACT

Background: Although respiratory failure is the hallmark of severe disease, it is increasingly clear that Coronavirus Disease 2019 (COVID-19) is a multi-system disorder. The presence of gastrointestinal (GI) involvement by Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been suggested by epidemiological, clinical, non-human primate, in-vitro (enteroid) and ex-vivo (human biopsy) studies. Having recently documented persistence of SARS-CoV-2 within the intestinal epithelium 7 months after infection, here we aimed to study mucosal immune cell abnormalities in individuals with prior history of COVID-19. Methods: Individuals with previous COVID-19 diagnosis (by either RT–PCR or seroconversion) and controls (without RT-PCR or serological evidence of prior COVID-19 infection) undergoing endoscopic evaluation were recruited into the study (Table 1). Colonic and small intestinal (duodenal and ileal) biopsies were analyzed by multiparameter flow cytometry for mucosal immune cell populations including myeloid cells (classical and non-classical monocytes, dendritic cell subsets), T cells (subsets and activation state), B cells (including plasma cells) and NK cells. Persistence of viral antigens was determined by immunofluorescence microscopy (n=30) using a previously published anti-nucleocapsid (NP) antibody. Results: Thirty subjects with a previous history of COVID-19 (post-COVID), median of 4 months from diagnosis (range 1-10 months), were recruited and compared with 40 normal volunteer (NV) controls. Relative to controls, post-COVID subjects displayed higher frequencies of classical (CD14+) monocytes in both, the colon and the small bowel, while significantly higher frequencies of conventional dendritic cells (cDC)1 (lin-HLA-DRhiCD14- CD11c+CD141+) and cDC2 (lin-HLA-DRhiCD14-CD11c+CD1c+) were noted in the colon. Among NK subsets, CD56bright CD16- NK cells were significantly higher in the colon of post-COVID subjects. Among T cell subsets, CD8+ tissue resident memory T cells (CD8+CD69+CD103+) were significantly increased in colon of post-COVID subjects compared to NV. Among B cell subsets, plasma cells (CD3-CD27+CD38hi) trended higher (p= 0.06), while mucosal B cells (CD3-CD19+) were significantly lower in the terminal ileum of post-COVID subjects compared to NV. Finally, with IF, we detected SARS-CoV-2 NP in 10 out of 30 (33%) of post-COVID subjects (Figure 1). Conclusion: Innate and adaptive immune cell abnormalities persist in the intestinal mucosa of post-COVID subjects for up to 10 months and may reflect viral persistence or immune cell dysregulation in the intestines. These findings have major implications for understanding the pathogenesis of long-term sequelae of COVID-19, including long-haul COVID.(Table Presented)(Figure Presented)

18.
Gastroenterology ; 162(7):S-159, 2022.
Article in English | EMBASE | ID: covidwho-1967248

ABSTRACT

Objective: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been detected in multiple organ systems including the gastrointestinal (GI) tract using standard PCR techniques. However, whether the human gut supports active SARS-CoV-2 replication leading to shedding of infectious virions is still a matter of debate. Our study aimed to determine whether SARS-CoV-2 could be recovered from the GI tract of asymptomatic outpatients to assess the risk of SARS-CoV-2 exposure for healthcare workers performing routine endoscopies. Methods: Between April 2020 and February 2021, we enrolled 112 patients aged 19 – 70 years undergoing elective endoscopic procedures who had no known SARS-CoV-2 exposure or recent COVID-19 test result (n=100) or who had a history of previous SARS-CoV-2 infection but had recovered at the time of the procedure (n=12). None of the patients had gastrointestinal symptoms at the time of COVID-19 infection or respiratory complaints at the time of the endoscopy. Liquids and biopsies from the colon, ileum, duodenum, and stomach were collected during endoscopy following standard bowel preparation protocols. Samples were analyzed for SARS-CoV-2 by PCR, and PCR-positive samples were analyzed for the presence of infectious virus by VeroE6 plaque assays. We also used plaque assays to assess whether endoscopic colonic liquids could inactivate SARSCoV- 2. Results: Interestingly, one colonic biopsy out of the 255 tissue samples collected from patients with no known SARS-CoV-2 exposure tested positive for SARS-CoV-2 by PCR. Out of 12 patients who had recovered from COVID-19 between 2 and 21 weeks before the endoscopic procedure, three colonic fluid samples tested positive for SARS-CoV-2 (Fig. 1A). Positive PCR results were confirmed by an independent laboratory. Importantly, no replication-competent virus was detected in any of the tissue or liquid samples. In vitro treatment of SARS-CoV-2 with colonic liquid showed that SARS-CoV-2 was completely inactivated after 24 hours, but at 10 minutes and 1-hour viral inactivation varied considerably between samples (Fig. 1B). Discussion: In 25% (3 out of 12) of patients with previous COVID-19 history, virus was detected by PCR for up to 5 months following resolution of symptoms. Viral genomes were also detected in colonic biopsies from one subject with no known SARS-CoV-2 infection, consistent with a large proportion of asymptomatic infections in the US population. The persistent detection of SARS-CoV-2 genomes in endoscopy samples after resolution of COVID-19 points to the gut as a reservoir for SARS-CoV-2 and confirms previous reports of long-term SARS-CoV-2 shedding in fecal samples. However, the absence of infectious virions in the samples and the rapid inactivation of SARS-CoV-2 in colon liquids suggests that the risk to healthcare workers involved in endoscopy procedures is likely low. (Figure Presented)

19.
Vaccine ; 2022.
Article in English | ScienceDirect | ID: covidwho-1967209

ABSTRACT

In December 2020, the first coronavirus disease 2019 (COVID-19) vaccines received emergency use authorization from the Food and Drug Administration (FDA). To strategically allocate the limited availability of COVID-19 vaccines, the Advisory Committee on Immunization Practices (ACIP) developed a phased approach for eligibility that prioritized certain population groups that were more vulnerable to infection and severe outcomes. Public K-12 teachers and staff were included in Phase 1b. The Arkansas Department of Health (ADH) sought to evaluate the uptake of COVID-19 vaccines within this priority group. In partnership with the Arkansas Department of Education (ADE), ADH received a list of 66,076 certified staff, classified staff, and teachers within the public K-12 school system. This list was matched to the state immunization registry via deterministic methods across three identifiers: first name, last name and date of birth. Uptake was assessed and the population was characterized using descriptive analyses. After 13 weeks of availability, 34,783 (51.2%) of public K-12 teachers and staff had received at least one dose and 29,870 (44.0%) had completed the series. School districts with the least robust uptake of COVID-19 vaccines tended to be in more rural areas, with some districts having less than 10% of teachers and staff with at least one dose. The proportion of public K-12 teachers and staff with at least one dose of any COVID-19 vaccine grew quickly between January 18th and February 14th (4% to 43%) but has plateaued in the most recent seven weeks (45% to 51%). Although not directly measured, it is possible that vaccine hesitancy could be a factor in the attenuated uptake of COVID-19 vaccines within certain factions of the Arkansas public K-12 teacher and staff population. Overcoming vaccine hesitancy during the COVID-19 vaccine rollout will be critical in bringing an end to the pandemic.

20.
Teaching and Learning in Nursing ; 2022.
Article in English | ScienceDirect | ID: covidwho-1967172

ABSTRACT

Competency-based education that relies on nurses’ and healthcare professionals’ needs assessment is crucial to tackling healthcare crises such as COVID-19. Strengthening the capacities of human resources by implementing customized infection control training programs is therefore mandatory. This study aims to measure the effectiveness and satisfaction of the Competency Outcomes and Performance Assessment (COPA)-based training program. The study implemented a single group pretest-posttest experimental design. A single-stage cluster sampling technique was used. All field hospitals in Jordan were listed, and one hospital was randomly selected. A total of 87 personnel from different disciplines agreed to participate after reading the letter of information and signing the informed consent. A panel of experts representing different disciplines and hospital units initially met and agreed upon a list of competencies required for the training program, and the program was accordingly developed. The study measured the healthcare professionals’ competencies in infection control and prevention before and after the administration of the competency-based training program. The results revealed significant differences between participants’ pretest and posttest scores in all infection control domains and the total scores. For example, the increase in participants’ total competency scores after the training was statistically significant (P < 0.007). The mean total satisfaction score was 61.18 + 7.00 reflecting that the participants were highly satisfied with the provided training. In conclusion, it is imperative to provide healthcare professionals with adequate clinical training to ensure that healthcare services are going to be delivered in the highest possible quality and minimize the possible adverse events.

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