Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 93
Filter
1.
Laryngo- Rhino- Otologie ; 101:S203, 2022.
Article in English | EMBASE | ID: covidwho-1967674

ABSTRACT

Introduction The imposed radical governmental restrictions to combat the pandemic and the overstrained medical resources affected greatly, not only those infected from the novel virus, but also miscellaneous patient groups. Aim of this study was the assessment of the efficacy of oncologic healthcare during Covid-19 pandemic on patients with head neck squamous cell carcinoma in a tertiary university hospital in Germany. Material and Methods This retrospective, cross-sectional, observational study included 94 patients with newly diagnosed head and neck squamous cell carcinoma during a two-year period. Patients were assigned to two date-dependent groups;referrals before (Group A) and during (Group B) the Covid-19 pandemic. Time intervals from symptom(s) onset to diagnosis, diagnosis to treatment and treatment initiation to completion were recorded. Furthermore, TNM-stages and application of reconstructive surgery with free tissue transfer were determined. Results Despite the challenges and burden of the pandemic, tumor upstaging and treatment delays could not be observed. Conclusion A timely diagnosis and treeatment initiation plays a major role in prognosis of patients withs head and neck squamous cell carcinoma.

2.
Radiotherapy and Oncology ; 170:S1024-S1025, 2022.
Article in English | EMBASE | ID: covidwho-1967471

ABSTRACT

Purpose or Objective external beam whole breast irradiation (WBI) for low-risk early-stage breast cancer patients after breast conserving surgery. We present the experience at our center treating patients with PBI using an IORT technic with Xoft® Axxent® Electronic Brachytherapy (eBx®) System®. Materials and Methods Between April 2019 and August 2021, 44 patients diagnosed with low-risk early-stage breast cancer who met international criteria for PBI, received IORT in a single fraction of 20 Gy to the tumor bed after lumpectomy. Toxicities and follow up were prospectively registered. Results 3 of the 44 initial patients were discarded for IORT due to non-compliance with the minimum safety distance (<1 cm) between the applicator and the skin. Of the remaining patients, 32/41 patients (78%) received a PBI, while 9/41 (22%) required adjuvant WBI due to adverse prognostic factors identified on the definitive biopsy. The most frequent risk factor was close resection margins (<2mm), present in 8/9 patients (88,8%). Two patients additionally presented sentinel node involvement and in 1 case no axillary sample was obtained. The most used IORT applicator was the 3-4 cm balloon, with most likely filling volumes between 30cc and 40 cc. For all treatments, the mean filling volume of the applicator was 45 cc and there were no complications during the irradiation procedure. Surgical bed seroma was the most common acute effect, observed in 29/41 patients (70,7%), although only 8/29 (27,5%) required drainage. We observed wound dehiscence in 7/41 cases (17%), inflammatory complications requiring antibiotics in 9/41 cases (19,5%), and 4/41 cases of hematoma (9,7%). Regarding late toxicity, at the time of the analysis it was only assessable for 37 patients. We observed low rates of local grade I fibrosis (21,6%) and only 1 case of tumor bed G2 fibrosis. Hyperpigmentation G1 was observed in 8,1% of patients and 10,8% presented occasional mild local discomfort. With median follow-up of 17.14 months (range 4-29 months), no relapses were observed, but 1 patient died from covid-19 pneumonia. Conclusion Intra operative PBI with Xoft® Axxent® Electronic Brachytherapy (eBx®) System® is a feasible approach to treat low-risk early-stage breast cancer patients. Our preliminary results show that it presents advantages over conventional WBI allowing for less toxic and shortened treatment courses while maintaining good local tumor control.

3.
Radiotherapy and Oncology ; 170:S629, 2022.
Article in English | EMBASE | ID: covidwho-1967461

ABSTRACT

Purpose or Objective Radiation therapy has an expanding role in the management of patients with advanced cancers, including in the palliative and oligometastatic settings. We previously described an inpatient radiation oncology consult (IROC) service created to deliver rapid, specialized metastatic cancer care to hospitalized patients. Here we report an 18-month update on IROC patient outcomes to test the hypothesis that IROC decreased hospital length of stay (LOS) and led to more prognosis-appropriate care, including during the first peak of the COVID-19 pandemic. Materials and Methods The IROC service started in January 2020 and comprises faculty, advanced practice providers, nurses and resident trainees. Faculty are specialists in palliative and metastatic cancer care with certification in ablative radiation techniques. We compared inpatient radiation oncology consults placed from January to December 2019 (pre-IROC, N = 1,507) to those placed from June 2020 to June 2021 (IROC, N = 1,509). In a separate analysis, we examined consults during a non-overlapping period from March to June 2020 (N = 302) to assess changes in IROC practice patterns related to the peak of the COVID-19 pandemic in New York City. Statistical significance was assessed using the Mann-Whitney test. Results Hospital LOS decreased among all inpatient radiation oncology consult patients after implementation of IROC (N = 1,509 patients) by an average of 1.0 day compared to patients treated prior to IROC (N = 1,507 patients;P = 0.045). With IROC, consults were staffed an average of 0.6 days sooner (P < 0.001). Death within 60 days of inpatient RT decreased under IROC (35.4%, N = 187/528 patients) compared to prior (43.7%, N =241/551 patients, P = 0.005). Among patients discharged to hospice, inpatient treatment duration decreased after IROC (median 4 vs. 2 days, pre-IROC (N = 64 patients) vs. IROC (N = 82 patients), respectively, P = 0.033). The IROC service received consults for 21 patients infected with SARS-CoV-2, and 17 patients had active COVID-19 during treatment. Notably, hospital LOS for patients receiving inpatient RT under IROC was significantly shorter during the COVID-19 peak (median LOS 9 days, P < 0.001), when time to treatment decreased by an (Figure Presented) Conclusion A dedicated inpatient radiation oncology consult (IROC) service was associated reduced hospital LOS, faster care delivery, and more prognosis-appropriate care. It enabled rapid implementation of emergency RT guidelines, including abbreviated treatment durations, during the first COVID-19 peak in a pandemic hotspot

4.
Radiotherapy and Oncology ; 170:S33, 2022.
Article in English | EMBASE | ID: covidwho-1967459

ABSTRACT

Purpose or Objective The high burden of COVID-19 in hospitals puts increased pressure on oncological care worldwide, forces prioritization of healthcare resources and causes delays in cancer treatment pathways. Prior research underlined the importance of timely oncological care, as longer waiting times from diagnosis to treatment could result in poorer outcomes for some common malignancies. The aim of this study was to determine the impact of waiting time from diagnosis to treatment on overall survival in patients with cervical cancer treated with surgery or radiotherapy with curative intent. Materials and Methods Patients from a nationwide population-based cohort with newly diagnosed cervical cancer between 2010 and 2019 were studied. Patients who underwent surgery or radiotherapy with curative intent were selected. Waiting time was defined as the time interval between first pathologic confirmation of carcinoma and the day of first treatment. Waiting time was modeled as continuous (i.e. linear per week), dichotomized (i.e. ≤8 versus >8 weeks), and polynomial (i.e. restricted cubic splines). The association between waiting time and overall survival was examined using Cox proportional hazard analyses. Results Among 6,895 patients with newly diagnosed cervical cancer, 2,831 patients treated with primary surgery and 1,898 patients who received primary radiotherapy were included. Waiting time to surgery was 8.5 (±4.2) weeks on average and >8 weeks in 1,287 patients (45%). Waiting to radiotherapy was 7.7 (±2.9) weeks on average and >8 weeks in 681 patients (36%). In the surgery group, a longer waiting time was associated with younger age, fertility treatment, adenocarcinoma histology, poor differentiation grade, LVSI, higher T- and N-stage, and previous conization or portio amputation. Adjusted for confounders, waiting time to surgery was not significantly associated with overall survival (continuous HR 0.99 [95%CI: 0.95- 1.02], dichotomized HR 0.93 [0.69-1.26], polynomial HR in Figure 1). In the radiotherapy group, a longer waiting time was associated with higher BMI, higher number of co-morbidities, and lower T-stage. Chemotherapy was administered concurrently with radiotherapy in 1,276 patients (67.2%) and was not associated with a longer waiting time. Adjusted for confounders, a longer waiting time to radiotherapy was not significantly associated with poorer overall survival (continuous HR 0.97 [95%CI: 0.93-1.00], dichotomized HR 0.91 [0.76-1.09], polynomial HR in Figure 2). Conclusion This large population-based cohort study demonstrates that a longer waiting time from diagnosis to treatment (of up to 12 weeks) in patients with cervical cancer treated with curatively intended surgery or radiotherapy does not negatively impact overall survival. These results could help inform and reassure patients regarding their waiting time, for example when time is needed for fertility preservation.

5.
Gastroenterology ; 162(7):S-1280, 2022.
Article in English | EMBASE | ID: covidwho-1967446

ABSTRACT

Background & Aims: Prior studies have indicated the presence of hepatic inflammation (as signified by elevated liver function test (LFT) values), as conferring an escalated risk toward adverse outcomes in patients admitted with COVID-19. In line with this hypothesis, we study the various thresholds of LFTs and its associated prognostic risks toward COVID- 19 related hospital deaths Method: This was a single-center retrospective study involving patients admitted with COVID-19. Univariate Cox regression analysis identified the LFT variables significantly associated with our primary endpoint, in-hospital death. Subsequently, 500 iterations of thresholds were generated for each biomarker to estimate the prognostic relationship between biomarker and endpoint. Multivariate Cox regression and event-analyses were performed for each threshold to identify the minimal cutoffs at which the prognostic relationship was significant. Event curves were drawn for each significant relationship. Results: A total of 858 patients with COVID-19 were included with a median follow-up time of 5 days from admission. From the total, 90 patients passed away during admission (10.5%). The deceased cases were more likely to be older (66.2 vs 55.3y p<0.001);however, there was no difference in gender (male: 66 vs 56.2% p=0.11). Between the cases and controls (no-death), deceased cases had higher incidence of nonalcoholic fatty liver disease (7.78 vs 2.99% p=0.042), COPD (18.9 vs 7.80% p=0.001), lung cancer (4.44 vs 0.65% p= 0.009), ICU admissions (81.1 vs 26% p<0.001), and intubation events (84.4 vs 19.5% p<0.001), however there was no difference in alcohol use (21.1 vs 30.6% p=0.083) and alcoholic liver disease (5.56 vs 2.08% p=0.097). Upon univariate Cox analysis, the following LFT parameters were associated with in-hospital death: Bilirubin (p<0.001), AST (p<0.001), ALT (p<0.001). However, alkaline phosphatase (p=0.449) was not associated with the primary endpoint. The iterations of event regression analyses using 500 sequences of LFT thresholds showed the following cutoffs to be significantly associated with in-hospital death (minimally significant values): ALT (281.71 IU/L), AST (120.94 IU/L), bilirubin (2.615 mg/ dL). On the multivariate analysis, while controlling for demographics and cardiopulmonary/ medical comorbidities, the following adjusted hazard ratios were derived for each cutoff: ALT (aHR: 6.43 95%CI 1.85-22.40), AST (aHR: 3.35 95%CI 1.84-6.11), and bilirubin (aHR: 2.77 95%CI 1.15-6.65). Conclusion: The delineated cutoffs for AST, ALT, and bilirubin levels can serve as clinical benchmarks to help determine when a COVID-19 infection poses significant risk. Given this finding, the cutoffs can be used as part of a risk assessment for patients to support early preventative therapies and medical management. (Table Presented)

6.
Gastroenterology ; 162(7):S-1279-S-1280, 2022.
Article in English | EMBASE | ID: covidwho-1967445

ABSTRACT

Background and Aims: While the relationship between elevated liver enzymes and COVID- 19 related adverse events is well-established, a liver-dependent prognostic model that predicts the risk of death is helpful to accurately stratify admitted patients. In this study, we use a bootstrapping-enhanced method of regression modeling to predict COVID-19 related deaths in admitted patients. Method: This was a single-center, retrospective study. Univariate and multivariate Cox regression analyses were performed using 30-day mortality as the primary endpoint to establish associated hepatic risk factors. Regression-based prediction models were constructed using a series of modeling iterations with an escalating number of categorical terms. Model performance was evaluated using receiver operating characteristic (ROC) curves. Model accuracy was internally validated using bootstrapping-enhanced iterations. Results: 858 patients admitted to hospital with COVID-19 were included. 78 were deceased by 30 days (9.09%). Cox regression (greater than 20 variables) showed the following core variables to be significant: INR (aHR 1.26 95%CI 1.06-1.49), AST (aHR 1.00 95%CI 1.00- 1.00), age (aHR 1.05 95%CI 1.02-1.08), WBC (aHR 1.07 95%CI 1.03-1.11), lung cancer (aHR 3.38 95%CI 1.15-9.90), COPD (aHR 2.26 95%CI 1.21-4.22). Using these core variables and additional categorical terms, the following model iterations were constructed with their respective AUC;model 1 (core only): 0.82 95%CI 0.776-0.82, model 2 (core + demographics): 0.828 95%CI 0.785-0.828, model 3 (prior terms + additional biomarkers): 0.842 95%CI 0.799-0.842, model 4 (prior terms + comorbidities): 0.851 95%CI 0.809-0.851, model 5 (prior terms + life-sustaining therapies): 0.933 95%CI 0.91-0.933, model 6 (prior terms + COVID-19 medications): 0.934 95%CI 0.91-0.934. Model 1 demonstrated the following parameters at 0.91 TPR: 0.54 specificity, 0.17 PPV, 0.98 NPV. Bootstrapped iterations showed the following AUC for the respective models: model 1: 0.82 95%CI 0.765-0.882, model 2 0.828 95%CI 0.764-0.885, model 3 0.842 95%CI 0.779-0.883, model 4: 0.851 95%CI 0.808-0.914, model 5: 0.933 95%CI 0.901-0.957, model 6: 0.934 95%CI 0.901- 0.961. Conclusion: Model 1 displays high prediction performance (AUC >0.8) in both regression-based and bootstrapping-enhanced modeling iterations. Therefore, this model can be adopted for clinical use as a calculator to evaluate the risk of 30-day mortality in patients admitted with COVID-19. (Table Presented)

7.
Gastroenterology ; 162(7):S-487, 2022.
Article in English | EMBASE | ID: covidwho-1967319

ABSTRACT

Background and Aims: Cancers are known to worsen the clinical course of SARS-CoV-2 infection. We aimed to assess health outcome effectors in Coronavirus 19 (COVID-19) cancer patients from different centers in the US. Methods: We retrospectively evaluated medical records of 364 COVID-19 cancer patients from 3 centers in the US (New York, Michigan, and DC) admitted to the hospital between Dec. 2019 to Oct. 2021. Outcomes, symptoms, labs, and comorbidities of cancer patients with COVID 19 (Cases), were analyzed and compared with non-cancer COVID-19 patients (Controls). Results: Among 1934 hospitalized COVID-19 patients, 18.7% (n=364) have an active or previous history of cancer. Cancer patients were older when compared with non-cancer controls (69.7 vs 61.3 years). Among these 364 cancer patients, 222 were African Americans (61.7%) and 121 were Caucasians (33.2%). Cancer patients had an increased length of hospitalization compared to controls (8.24 vs. 6.7 days). The most common types of cancer in cases are prostate cancer (41.5%) and hematological malignancies (10.1%) among males, and breast cancer (41.5%), and head and neck cancers (11.4%) in females. In both genders, lung cancer is associated with high mortality. Patients with a previous history of cancer were more prone to death (p=0.04) than active cancer patients. Cough (23.1%) and fever (19.5%) are the most common symptoms among the cases. In univariate and multivariate analyses, predictors of death among cancer patients were male sex, older age, African American ethnicity/race, asthma, presence or absence of fever, elevated troponin, mechanical ventilation, and previous history of cancer. There is no significant difference in mortality in cancer patients when compared to controls. Abdominal pain (2.2%), diarrhea (3.8%), and vomiting (2%) occurred both in cases and controls but did not associate with death. Albumin is also significantly associated with mortality in cases (p=0.042). AST (54.6%), ALT (12.5%), and Bilirubin (16%) were elevated in the majority of cases. Both AST and ALT alterations have an effect on mortality. Univariate analysis shows that AST is strongly and significantly associated with mortality in cases (p=0.001) but not in controls. ALT is also associated with mortality in cases at the 10% level (p=0.057). Diarrhea is strongly associated with mortality in control (p <0.001) but not in cases. Conclusion: In this retrospective cohort study, we found male sex, and African American race is associated with high mortality. Elevated troponin levels and LFT’s during the hospital stay were significantly associated with poor outcomes. Patients with a previous history of cancer were more prone to death when compared to active cancer COVID-19 patients. Early recognition of cancer COVID-19 patients can help determine appropriate treatment and management plans for better prognosis and outcome.

8.
Annals of Oncology ; 33:S400, 2022.
Article in English | EMBASE | ID: covidwho-1936039

ABSTRACT

Background: Malignant bowel obstruction (MBO) is common in advanced ovarian cancer (AOC). Treatment options are limited as majority of cases present with widespread, multilevel peritoneal dissemination and platinum-resistant disease. The benefit of Parenteral Nutrition (PN) in MBO is debated, given the limited overall survival (OS) of this patient group. Aim: to identify which clinical features correlate with improved survival in AOC and MBO, to support clinical decision-making. Methods: Retrospective review of patients admitted with MBO between April 2019 and October 2021 to a single tertiary cancer centre. Those with AOC established on PN with the aim to discharge home on PN were included. Univariate analysis for survival after commencing PN was performed using log-rank test. Results: 103 patients with MBO were identified with 33 patients excluded (PN not initiated, 15;PN withdrawn: covid service constraint, 5, acute medical event, 13). 70 patients were successfully established on PN and 49 discharged on PN;16 patients clinically deteriorated;5 returned to enteral diet. Median OS of patients that did not receive PN was 19 days, PN stopped due to general deterioration 39 days and 100 days (range 18-807) for those established on PN (p<0.0001). Clinical features associated with improved OS: no prior systemic therapy (p=0.0067), platinum sensitivity (p=0.043), ECOG performance status (PS) 1 vs 2-3 (p=0.004), falling modified Glasgow Prognostic Score (mGPS) during admission (p=0.0027). In the treatment naïve group, chemotherapy resolved MBO in 6/9 cases. In the pre-treated group, 60% of patients received subsequent chemotherapy (median duration 8 weeks), with early cessation due to toxicity and no clinical benefit. Only 1 patient achieved resolution of MBO on chemotherapy. Conclusions: PN may improve survival of patients with AOC in MBO. ECOG PS, platinum sensitivity and mGPS trend may be useful to select patients for PN. In those presenting with MBO at AOC diagnosis, PN can enable safe delivery of chemotherapy, which usually will resolve MBO. In pre-treated patients, PN is a life-long commitment and chemotherapy is largely ineffective in resolving MBO. Further research should focus on quality of life in patients receiving PN. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

9.
Journal of the Peripheral Nervous System ; 27, 2022.
Article in English | EMBASE | ID: covidwho-1935098

ABSTRACT

The proceedings contain 69 papers. The topics discussed include: chemotherapy induced peripheral neurotoxicy: why should we care?;studying the caudal nerve anatomy and physiology to refine detection of peripheral nerve damage in rodent models;anxiety and depression in Charcot-Marie-tooth disease: data from the Italian CMT National Registry;fatigue in CMT: a web based survey from the Italian CMT National Registry;early molecular diagnosis of mutations on the transthyretin gene as a strategy to improve the prognosis of hereditary transthyretin-mediated amyloidosis - an update of the GENILAM project;THR124MET myelin protein zero mutation mimicking motor neuron disease;torsional neuropathy in parsonage turner syndrome following anti-COVID19 vaccination. how to detect and manage with it?;isolated musculocutaneous involvement in parsonage-turner syndrome associated with SARS-COV2 vaccination;neonatal FC receptor expression in patients with chronic dysimmune neuropathy. a feasibility study;and peripheral neuropathies after common organ transplantations. literature review and the use of electrophysiological tests and ultrasound.

10.
Cytopathology ; 33(4):426-429, 2022.
Article in English | EMBASE | ID: covidwho-1937919
11.
Journal of Hypertension ; 40:e181, 2022.
Article in English | EMBASE | ID: covidwho-1937746

ABSTRACT

Objective: The aim of the study was to assess the clinical particularities and the lab tests in hypertensive patients with metabolic syndrome, admitted for SARSCOV2 infection. Design and method: We performed a retrospective study on 217 patients admitted to a Clinical Emergency Hospital between January 2021 and October 2021. Results: We had 217 patients admitted in internal medicine clinic for infection with SARS-COV2 virus, most of them with moderate and severe form of disease. From them, 148 patients (68.20%) had hypertension on admission and 114 patients (52.53%) had metabolic syndrome. Patients were aged between 23 and 99 (average age of 65 years). In comparison, the patients in the hypertensive subgroup were aged between 37 and 97 (average age of 70). The gender distribution was similar in the large group and hypertensive subgroup: 52.07% male, 47.92% female in the large group, and 52.03% male, 47.97% female in the hypertensive subgroup. At admission, the stages of SARS-COV2 infection in patients with metabolic syndrome, according CT examination, were severe in 54.41% of cases, moderate in 27.94%, and mild in 17.64%. According the IDF definition of the metabolic syndrome, 8.33% of the patients had 5 criteria, 35.29% patients had 4 criteria, and 58.82% patients had 3 criteria of disease. Hypertension was encountered in 80.95% of patients with metabolic syndrome, obesity in 56.75% and diabetes mellitus in 52.70% of cases. As comorbidities: cancer in 5.88% of patients, chronic heart failure in 26.47% of cases (72.22% NYHA II class and 27.78% NYHA III class), atherosclerosis in 55.88%, COPD in 7.35%, depression in 7.35% and dementia in 5.88% of cases. High levels of the inflammatory markers or specific lab tests were encountered: CRP in 98.53% of cases, pro-calcitonin in 86.76%, ferritin 80.88%, IL-6 in 83.33%, D-dimers in 85.29%, NT-proBNP 71.92%, troponin 70.59%, LDH in 91.17%, uric acid in 11.76%. Conclusions: The most reliable comorbidity factor who predict evolution/prognosis of SARS-COV2 infection in patients with metabolic syndrome was diabetes mellitus (the levels of glycaemia and the need of high units of insulin), despite the fact that hypertension and obesity were more prevalent.

12.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927773

ABSTRACT

Rationale. Invasive fungal infection secondary to the coronavirus disease 2019 (COVID-19) has been increasing. Whereas COVID-19-associated pulmonary aspergillosis has been shown to be associated with high mortality, less is known about COVID- 19-associated mucormycosis (CAM). The overall mortality of non-COVID-19 mucormycosis ranges from 20% to 100%, depending on the infection site. Delayed diagnosis, neurological symptoms, and pre-existing malignancies are associated with worse outcomes. Herein, our study aimed to elucidate the characteristics, risk factors, and outcomes of CAM. Methods. We searched all observational studies reporting CAM through PubMed and EMBASE on September 13th, 2021. Case reports, case series, and observational studies without clearly documented diagnostic criteria for COVID-19 or mucormycosis were excluded. We collected data on the comorbidities, initial symptoms, site of infection, treatment for COVID-19, frequency of orbital exenteration, and mortality. One-group meta-analyses were performed for the potential risk factors, orbital exenteration, and mortality. Results. Our systematic review identified 32 eligible observational studies. The largest number of studies were conducted in India, followed by Egypt, Iran, and Turkey. A total of 4,463 patients were included in the analysis. The most common initial presentation was ocular symptoms: 78%, followed by facial: 48%, nasal: 21%, constitutional: 12%, oral: 4.4%, neurological: 1.1%, and others: 0.4%. Diabetes mellitus (DM) and glucocorticoid therapy were present in 81% (95% CI, 76-86;I2=96%) and 79% (95% CI, 75-84;I2=91%), respectively. Among those with DM, the percentage of newly-diagnosed DM was 30% (216/711). Diabetic ketoacidosis, malignancy, and immunosuppression were found in 4.9% (165/3353), 0.7% (25/3471), and 0.6% (18/2921), respectively. Regarding the outcomes, orbital exenteration was performed in 17% (95% CI, 13-21;I2=83%) of the patients. Pooled estimate of mortality of CAM was 29% (95% CI, 22-36;I2=94%). Conclusion. The most prevalent type of CAM was rhino-orbital-cerebral mucormycosis. In addition to DM, severe hyperglycemia and immune dysregulation provoked by excessive corticosteroid therapy may have played a critical role in the recent rise of mucormycosis cases among COVID-19 patients. This systematic review and meta-analysis revealed a high frequency of orbital exenteration and mortality. The development of CAM can be associated with poorer prognoses in COVID-19 patients. Keeping the possible risk factors in mind and paying attention to the usual clinical presentation will be crucial to suspect CAM as early as possible.

13.
International Journal of Radiation Oncology Biology Physics ; 113(4):A12-A15, 2022.
Article in English | EMBASE | ID: covidwho-1926991
14.
Value in Health ; 25(7):S471, 2022.
Article in English | EMBASE | ID: covidwho-1926724

ABSTRACT

Objectives: The aim of the research was to assess the impact of the COVID-19 pandemic on patient turnover and the change in patient and medical delay. Methods: Retrospective study was performed in Veszprém County Lung Medical Institute, in Hungary. Between 01.01.2016-31.12.2020 active and chronic inpatient turnover data related to the care of patients with primary lung cancer, changes in patient and medical delay time were examined. Descriptive statistical analyses were applied (mean, standard deviation, absolute and relative frequency). Results: Between 2016 and 2019, total inpatient turnover ranged from 4,535 to 4,282 cases, which decreased to 3,167 in 2020. In the area of active inpatient care, the number of 3,141-3,052 cases decreased to 2,787 in 2020. The number of chronic inpatient care ranged from 1,492 to 1,327, which decreased to 380 cases in 2020. On a monthly basis, the higher number of cases occurred from September to November and until January between 2016 and 2019 (281-438 cases) while in 2020, the data of previous years decreased significantly (197-270 cases). The mean patient delay (62 cases) in the first (I) quarter (before constraints) was 39.34±53.42 days, 37.24±45.69 days in the second (II.) quarter (41 cases), 28.75±33.0 days (44 cases) in the third (III.) quarter, in the fourth (IV.) quarter 47.96±70.2 days (24 cases). The duration of the examination showed a decreasing trend (I.:53.47±36.5;II.:50.54±45.73;III.:48,91±46,44;IV:32±22,41 days). The time from diagnosis to the start of therapy also decreased (I.:19.27±21.61;II.:17.76 ± 17.03;III.:16.8±17.12;IV.:14.33±19.19). Conclusions: Restrictions due to the pandemic show a significant reduction in the number of patients. Patients treated in previous years were diagnosed and treated at the appropriate time. However, our results indicate that some patients have not entered the care system, which may significantly affect the prognosis of their disease.

15.
EXCLI Journal ; 21:906-920, 2022.
Article in English | EMBASE | ID: covidwho-1928939

ABSTRACT

Coronavirus disease 2019 (COVID-19) results in higher risks of hospitalization or death in older patients and those with multiple comorbidities, including malignancies. Patients with cancer have greater risks of COVID-19 onset and worse prognosis. This excess is mainly explained by thrombotic complications. Indeed, an imbalance in the equilibrium between clot formation and bleeding, increased activation of coagulation, and endothelial dysfunction characterize both COVID-19 patients and those with cancer. With this review, we provide a summary of the pathological mechanisms of coagulation and thrombotic manifestations in these patients and discuss the possible therapeutic implications of these phenomena.

16.
European Journal of Obstetrics and Gynecology and Reproductive Biology ; 270:e119, 2022.
Article in English | EMBASE | ID: covidwho-1926417

ABSTRACT

Introduction and aims of the study: In early vulvar cancer, lymph node status is the most important prognostic factor. Sentinel lymph node biopsy (SLNB) is the minimally invasive procedure that lead to the most significant reduction in the classical high morbidity associated with the sistematic inguinal-femoral lymphadenectomy. Besides quality control, the aim of this study is to document the overall experience around SLNB at this referral Centre before the Covid pandemic, in order to monitor and possibly prevent future related changes. Methods: Retrospective analysis of patient files in cases where SLNB was performed as part of the treatment for vulvar cancer at the authors’ Department, from January, 2016 to December, 2019. A single surgeon performed the SLNB with the combined technique (technetium and patent blue). Data collected included demographics, pathology, accuracy, surgery and perioperative results, feasibility and survival. Results: 18 patients with vulvar squamous cell cancer were enrolled in the study. Median age was 68 years, average BMI 27.5kg/m2, 61.1% were married and Charlson score ≥5 was 55.6%. Primary site was labia majora in 44.4% and mid-line was affected in 27.8%. FIGO stage IB in 72.2% of cases, mean tumour diameter was 20.2 (7-39)mm. SLNB was bilateral in 27.8%, 1 out of 38 nodes removed was positive and average number of nodes per patient was 2.1. Mean hospital stay was 13.2 days, blood loss 72ml and no surgical complications. There was a single case of groin recurrence in 45.1 months mean follow-up time and 2 cases of non-related deaths. 33.3% and 5.6% patients had short and long-term postoperative complications, respectively, mostly infectious. Conclusions: SLNB is a reliable and safe minimally invasive technique that should be performed by experienced gynaecological oncologists in well-equipped and multidisciplinary Centres. The Covid pandemic is believed to be causing severe difficulties in the management of patients with vulvar cancer, from diagnosis to follow-up and treatment of recurrences. This study allows a future comparison with positive results at this Centre, possibly reflecting other similar scenarios in Europe.

17.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925422

ABSTRACT

Objective: NA Background: Glioma classification evolved over the years but remains a diagnostic challenge. Primary spinal cord (PSC) glioblastoma is extremely rare and represents fewer than 1.5% of all spine tumors in adults. Presentation may mimic demyelinating or inflammatory disorders, but prognosis is significantly worse. We present two aggressive cases of extensive, total spinal cord gliomas with early metastases to brain. Design/Methods: NA Case #1: A 44-year-old woman with a diagnosis of demyelinating disorder with paraplegia, bladder and bowel incontinence presented with new appendicular ataxia. Previous MRI revealed unremarkable brain and hyperintensity in T7-10 concerning for multiple sclerosis. Empiric methylprednisolone and cyclophosphamide showed no improvement. Repeat MRI showed extensive intramedullary cystic lesions throughout cervical, thoracic, and lumbar spine, hyperintensities in the brainstem, and enhancing lesions in the corpus callosum and R frontal lobe. Biopsy revealed brain Glioblastoma, WHO grade IV, IDH wildtype. H3K27M test was not performed. Patient expired 13 months after initial symptom onset. Case #2: A 49-year-old man with a recent COVID-19 infection presented with 2 weeks of bilateral lower extremity numbness and weakness. MRI brain was unremarkable, and spine revealed intra-dural, extra-medullary nodular enhancing lesions throughout cervical and thoracic spine, and the cauda equina. Infectious, inflammatory, and rheumatologic causes were investigated until repeat imaging in 1 week (after a course of empiric methylprednisolone) demonstrated the rapid development of a non-enhancing expansile mass in the R temporal lobe. Biopsy revealed spinal Glioblastoma, WHO grade IV, IDH wildtype, negative for H3K27M mutation, and brain low grade glioma. The patient remains on palliative radiation with concurrent temozolomide and adjuvant temozolomide. Conclusions: Primary spinal cord glioblastomas are rare and devastating. Timely diagnosis remains a challenge since clinical and radiographic findings mimic demyelinating or inflammatory disorders. Our cases highlight the diagnostic challenge and importance of early suspicion in the diagnosis of malignant spinal glioma.

18.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925327

ABSTRACT

Objective: The aim of this study is to leverage advanced analytics to develop an accurate, individualized risk prediction paradigm for stroke in hospitalized patients with COVID-19. Background: Patients hospitalized with COVID-19 have significantly higher risk of developing stroke compared to the general population. Predicting stroke in these patients, particularly those who are encephalopathic or ventilator-dependent, remains a challenge. Design/Methods: Patients admitted to a network of hospitals in the Austin metropolitan area with laboratory-confirmed COVID-19 were analyzed from March 2020 to June 2021. Using each patient's demographic, medication, laboratory and clinical assessment data, several machinelearning algorithms were developed to predict probability of stroke. Results: A total of 8,183 patients hospitalized with COVID-19 met our inclusion criteria. Among this cohort, 174 patients experienced a stroke. Of the machine learning algorithms that were developed and evaluated for stroke prediction, the random forest model achieved the highest prediction accuracy with a strong overall discriminatory performance. The features with the most significant prognostic value include ventilator dependence, history of hyperlipidemia, history of cancer and administration of aspirin. Conclusions: Machine learning models are capable of multi-dimensional analysis and can be leveraged to predict risk of stroke in patients hospitalized with COVID-19. Further studies are underway to incorporate a final model into the clinical pipeline for automated, patient-specific risk stratification.

19.
Neumologia y Cirugia de Torax(Mexico) ; 81(1):52-56, 2022.
Article in Spanish | EMBASE | ID: covidwho-1918352

ABSTRACT

The pandemic due to the coronavirus disease 2019 (COVID-19) has had a variable presentation in the population, from mild to severe cases where large hospital supplies are required for its care. In the case of immunosuppressed patients this disease has had an uncertain behavior in terms of its presentation as well as its prognosis. This clinical case shows a presentation of a prolonged course of COVID-19 associated with a state of immunosuppression due to maintenance treatment with rituximab due to the diagnosis of follicular lymphoma, where a course of migratory pneumonia without the development of acute respiratory distress syndrome is observed (ARDS) being that unlike what has been published in the literature a control and maintenance of the disease is shown only with the use of remdesivir, however the prognosis of the patient is conclusively unknown.

20.
HemaSphere ; 6(SUPPL 2):26, 2022.
Article in English | EMBASE | ID: covidwho-1915870

ABSTRACT

Introduction: Patients with multiple myeloma (MM) have an inherently compromised humoral and cellular immunity predisposing to Covid-19 infection. Factors associated with increased risk of adverse COVID-19 outcome is unclear. The aim of our retrospective analysis was to evaluate COVID-19 infection outcome among our myeloma patients and to define the possible prognostic parameters. Patients And Methods: Between March 2020- February 2022, 10 myeloma patients were diagnosed with COVID infection confirmed by PCR test and computer tomography (CT). The severity of SARS-CoV-2 infection was classified according to WHO definition as: mild: symptomatic without pneumonia or hypoxia;moderate: with or without signs of pneumonia with SpO2 >90% on room air;severe disease: with symptoms of pneumonia and respiratory rate> 30/min, severe respiratory distress or SpO2 <90% on room air. Critical disease: with acute respiratory distress syndrome (ARDS), sepsis and septic shock. In addition, CALL (comorbidity-age-lymphocyte count-lactate dehydrogenase) score was used. All patients were given supportive care including heparin and 0.4 gr/kg/day intravenous immunoglobulin for those presenting with immunoparesis regardless of IgG treshold of 4.0 gr/L. Convalescent or monoclonal plasma was not used. All anti-myeloma treatments were discontinued until full recovery. Results: Baseline characteristics of our patients are summarized in Table 1. The median age at onset of COVID-19 was 62 years. Three patients were therapy naive, two newly diagnosed MM and one with smoldering MM. At the time point of COVID-19 diagnosis, eight patients were being followed without treatment. Twenty patients were followed out-patient without any treatment and with full recovery. Eighteen (16%) patients were admitted to ICU and 13 (12%) required invasive mechanic ventilation. Two patients received hydroxychloroquine, 68 received favipiravir, one patient received anakinra and two patients received tocilizumab. Full recovery from COVID-19 infection with regression of clinic symptoms and achievement of PCR negativity of COVID-19 was observed in 93 (84.5%) patients and 17 (15.5%) patients died due to severe COVID-19 pneumonia with respiratory and multi-organ failure. No death due to thromboembolic event was observed. As expected, high CALL risk score (HR:0.17 (95% CI: 0.06-0.48) and higher COVID severity grade (HR:0.26 (95% CI: 0.07- 0.97) were detrimental. Age did not have an impact. However response <VGPR (HR: 3.1 (95% CI: 1.0-9.6);p=0.04) or immunoparesis (HR: 6.59 (95% CI: 1.44-30.1);p=0.01) were correlated (Kappa CE: 0.212, p=0.03) and associated with worse COVID-19 outcome (Figure 1-2-3). In MVA with age, response, Call score, vaccine, immunoparesis entered in the model only immunoparesis was significant (HR: 6.5, p=0.016). Mortality prior to introduction of vaccines reduced to 3.6 % compared with 11.8 % at the pre-vaccine period. There was a trend to increase in Covid infection incidence recently due to the Omicron variant. Conclusion: Among 110 MM patients, the mortality rate is less than the one reported by IMS during the beginning of the pandemic. In our experience COVID-19 infection severity and mortality decreases with anti-Covid vaccination, response ≥VGPR or lack of immunoparesis. Importantly, MM patients with COVID-19 infection need close monitoring for severe COVID-19-related complications, and correction of humoral immunity may be life-saving. .

SELECTION OF CITATIONS
SEARCH DETAIL