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1.
Frontiers in Pharmacology ; 13 (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2199118

ABSTRACT

Due to the fact that coronavirus disease 2019 (COVID-19) is still prevalent, and current reports show that some parts of the world have seen increase in incidence, it is relevant that health professionals and scientists know about recent or novel trends, especially drug treatments. Additionally, the safety profiles of these drug treatments need to be documented and shared with the public. Some studies have demonstrated the clinical benefits of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in COVID-19 treatment. On the contrary, others have also reported that NSAIDs and corticosteroids may worsen symptoms associated with COVID-19. While some researchers have suggested that corticosteroids may be helpful if used in the early stages of COVID-19, there are still some conflicting findings regarding the use of corticosteroids in certain viral infections. Our review suggests that methylprednisolone, dexamethasone, and ibuprofen have therapeutic potential in reducing mortality due to COVID-19 among hospitalized patients. This review also highlights the fact that the use of NSAIDs is not associated with adverse outcomes of COVID-19. In reality, evidence suggests that NSAIDs do not increase the risk of COVID-19 infections. Also, the literature reviewed suggests that corticosteroid treatment in COVID-19 was linked with a decrease in all-cause mortality and disease progression, without increase in adverse events when compared to no corticosteroid treatment. Copyright © 2022 Amponsah, Tagoe, Adams and Bugyei.

2.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194395

ABSTRACT

Introduction: Current estimates show that, globally, there are 531 million cases and 6.3 million deaths due to COVID-19. Studies have shown that COVID-19 could lead to deep vein thrombosis (DVT) resulting in increased morbidity and mortality. In this study we sought to estimate the prevalence of DVT among COVID-19 hospitalizations as well as its effects on hospital outcomes using a large administrative database. Hypothesis: The adverse in-hospital outcomes of COVID-19 will be significantly higher among DVT hospitalizations. Method(s): We conducted a retrospective analysis of the 2020 California State Inpatient Database. All hospitalizations with age 18 and above and primary diagnosis of COVID-19 were included for the study. They were classified into those with and without DVT. The main outcomes of the study were in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission. Length of stay >=75th percentile was grouped as prolonged length of stay. Multivariate logistic regressions with covariate adjustments were conducted to compare COVID-19 related outcomes between those with and without DVT. Result(s): We included a total of 94,114 primary COVID-19 hospitalizations for the analysis. Among them 1575 (1.7%) had DVT. The prevalence of mortality (27.5% versus 11.1%, P<0.001), prolonged length of stay (62.2% versus 27.8%, P<0.001), vasopressor use (7.9% versus 2.1%, P<0.001), mechanical ventilation (36.2% versus 9.7%, P<0.001), and ICU admission (35.7% versus 9.3%, P<0.001) were significantly higher among those with DVT. After adjusting for covariates, regression analysis showed that those with DVT had significantly greater odds for mortality (aOR, 2.34, 95% CI: 2.07-2.65), prolonged length of stay (aOR, 3.51, 95% CI: 3.16-3.91), vasopressor use (aOR, 4.23, 95% CI: 3.78-4.74), mechanical ventilation (aOR, 2.90, 95% CI: 2.38-3.53), and ICU admission (aOR, 4.32, 95% CI: 3.85-4.84). Conclusion(s): In our cohort, only few COVID-19 hospitalizations had a diagnosis of DVT. However, among those with DVT, the risk for adverse outcomes were significantly higher. Since DVT among COVID-19 is uncommon but associated with adverse hospital outcomes, healthcare providers should promptly monitor for DVT and manage it.

3.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194394

ABSTRACT

Introduction: According to recent global estimates there are nearly 530 million cases and 6.3 million deaths due to novel coronavirus disease 2019 (COVID-19) pandemic. Studies have shown that COVID-19 disproportionately affects males than females. In this study we looked at differences in in-hospital outcomes of COVID-19 based on sex using a larger administrative database. Hypothesis: The adverse in-hospital outcomes of COVID-19 will be significantly higher among males. Method(s): This was a retrospective analysis of the California State Inpatient Database 2020. All COVID-19 hospitalizations with age 18 years and above were included for the analysis. These hospitalizations were classified into males and females. The main outcomes of the study were inhospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission. Any length of stay >=75th percentile value for the entire cohort was considered as prolonged length of stay. Logistic regression analyses after adjusting for covariates were used to compare COVID-19 related outcomes between males and females. Result(s): A total of 95,180 primary COVID-19 hospitalizations were included for the analysis. Of these 52465 (55.1%) were males and 42715 (44.9%) were females. Among these hospitalizations, mortality (12.4% versus 10.1%, P<0.001), prolonged length of stay (30.6% versus 25.8%, P<0.001), vasopressor use (2.6% versus 1.6%, P<0.001), mechanical ventilation (11.8% versus 8.0%, P<0.001), and ICU admission (11.4% versus 7.8%, P<0.001) were significantly higher among males. Logistics regression analysis showed that males had significantly greater odds for mortality (aOR, 1.38, 95% CI: 1.32-1.44), prolonged length of stay (aOR, 1.35, 95% CI: 1.31-1.39), vasopressor use (aOR, 1.59, 95% CI: 1.51-1.66), mechanical ventilation (aOR, 1.62, 95% CI: 1.47- 1.78), and ICU admission (aOR, 1.58, 95% CI: 1.51-1.66). Conclusion(s): Adverse outcomes such as mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission were independently associated with male sex. These findings could be due differences to both biological and social factors between the sexes. Future studies should explore these factors to efficiently control COVID-19.

4.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194363

ABSTRACT

Introduction: Current guidelines for invasive coronary angiography (ICA) in patients presenting with NSTE-ACS outline two treatment pathways: early (within 24 hours [hrs]);or late (>24 hrs). Time of hospital admission is used as the start time, however, we hypothesize that pre-hospital time of symptom onset may be a more optimal starting time. This study was designed to test optimal symptom onset-to-angiography time (OAT) and its association with the presence of coronary occlusion and adverse outcomes. Method(s): Secondary data analysis in NSTE-ACS patients (pre-COVID-19) who underwent ICA. We tested the optimal cutoff point of OAT in classifying coronary occlusion using Youden-index analysis. We tested the association of OAT and in-hospital complication (i.e., myocardial infarction [MI] after admission, unplanned transfer to the cardiac intensive care unit, pulmonary edema, cardiogenic shock, dysrhythmia with intervention) and hospital length of stay [LOS]) using regression models. Result(s): In 163 patients: 124 (76%) had an occluded artery;37 (23%) had an in-hospital complication. Overall, the mean OAT was 26+/-22 hrs (24+/-22 vs. 31+/-21, with and without occluded artery, respectively), and the median LOS was 55 hrs. The Youden-index optimum OAT cutoff point was 13.4 hrs. In the two logistic models, the adjusted OAT was associated with the presence of coronary occlusion (Figure A). OAT, as a continuous variable, was associated with LOS (beta=0.64, 95% CI 0.08-1.21, p=0.025), no other in-hospital complications were significant (Figure B) Conclusion(s): In patients presenting with NSTE-ACS, OAT at both 13.4 and <24 hrs is a significant predictor of the presence of coronary artery occlusion. Every hour of delayed OAT was associated with a prolonged hospital LOS 0.64 hrs (38 min). Symptom onset appears to be an important starting point in determining optimal timing of ICA in patients with NSTE-ACS, but requires further study with a large sample of patients.

5.
International Journal of Gynecological Cancer ; 32(Supplement 3):A10, 2022.
Article in English | EMBASE | ID: covidwho-2193892

ABSTRACT

Objectives The magnitude of adverse outcomes caused by the disrupted surgical cancer care during the COVID-19 pandemic is unclear. Our aim was to evaluate the changes in care and short-term outcomes of surgical patients with gynecological cancers during the initial phase of the COVID-19 pandemic internationally. Methods A multicenter, international prospective cohort study including consecutive patients with gynecological cancers who were initially planned for non-palliative surgery. Primary Outcome: 30-day postoperative SARS-CoV-2 infection rate. Secondary Outcomes: 30-day perioperative mortality and morbidity, COVID-19-related treatment modifications. Results We included 3973 patients (52 countries;7 world regions). Lower-than-reported rate (22/3778;0.6%) of perioperative SARS-CoV-2 infections was observed. This group had higher morbidity (63.6% vs 19.1%;p<0.0001) and mortality (18.2% vs 0.7%;p<0.0001), compared to the uninfected cohort. In 20.7% (823/3973), standard of care was adjusted. Significant delay (>8 weeks) was observed in 11.2% (424/ 3784), particularly in those with ovarian cancer (213/1355;15.7%). This delay was associated with a composite of adverse outcomes including disease progression and death (95/ 424;22.4% versus 601/3360;17.9%, p=0.024), compared to those who had operations within 8 weeks of their MDT decisions. One in thirteen did not receive their planned operations (189/2430;7.9%), in whom 1 in 20 (5/189;2.7%) died and 1 in 5 (34/189;18%) experienced disease progression or death within 3 months of decisions for surgery. Conclusions One in five surgical patients with gynecological cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operationscoordinated mitigating strategies are urgently needed.

6.
Critical Care Medicine ; 51(1 Supplement):536, 2023.
Article in English | EMBASE | ID: covidwho-2190660

ABSTRACT

INTRODUCTION: Chronic kidney disease (CKD) is an important risk factor for severe COVID-19 disease associated with increased intensive care unit (ICU) admission and mortality. Studies demonstrate an increased mortality rate among advancing CKD stages in patients without COVID-19 infection. However, it is unknown whether a graded association exists between the stages of CKD and COVID-19 mortality. We aim to compare the rates of ICU admission, mechanical ventilation (MV), and survival amongst COVID-19 patients with Stage IIIb -V CKD. METHOD(S): We conducted a retrospective cohort study on non-dialysis adults with Stages IIIb, IV, and V CKD without previous renal transplant hospitalized for COVID-19 infection in a community hospital. Patients were categorized into two groups, Stage IIIb CKD and Stages IV&V CKD, based on their pre-admission glomerular filtration rate (GFR 30-44ml/ min vs < 30ml/min). The primary endpoints were rates of ICU admission, MV, non-invasive mechanical ventilation (NIMV), and survival. The Mann-Whitney U test for continuous variables and the chi-square test for categorical variables were used for analysis. RESULT(S): We screened 228 patients and 153 met the inclusion criteria. Baseline demographics were distributed equally between the two groups. There were statistically significant differences in the ICU admission rate (45.2% vs 25.3%,p-0.01), MV rate (37.1% vs 16.5%,p-0.004) and NIMV rate (50% vs 28.6%,p-0.007) in patients with Stage IIIb versus Stages IV&V CKD respectively. However, there was no significant difference in the survival rates (79.1% vs 67.7%,p-0.1128) between the two groups. CONCLUSION(S): The association between reduced baseline eGFR and increased risk of severe COVID-19 infection has been established with multiple studies evaluating the prognostic impact of pre-existing CKD in patients with COVID-19. Our study illustrates the greater incidence of adverse outcomes, such as ICU admission rate, MV rate, and NIMV rate, in patients with Stages IV&V CKD versus Stage IIIb CKD. With recent guidelines recommending management of COVID-19 infection based on the presence of risk factors, these results will aid in risk stratification among CKD patients with COVID-19, and encourage future prospective studies to explore disease-modifying treatments for the vulnerable CKD population.

7.
Critical Care Medicine ; 51(1 Supplement):449, 2023.
Article in English | EMBASE | ID: covidwho-2190633

ABSTRACT

INTRODUCTION: Guidelines advocate caution against the use of non-invasive ventilatory (NIV) support in the management of de novo hypoxemic respiratory failure, especially acute respiratory distress syndrome (ARDS). However, NIV support was used extensively during the COVID-19 pandemic. We hypothesized that the use of NIV, especially bi-level positive airway support (BiPAP), is associated with adverse outcomes in COVID-19 induced ARDS, as it may delay intubation and expose patients to harmful effects of ventilation induced lung injury. METHOD(S): This is a retrospective, single-center study of adult patients admitted to a tertiary medical center's ICUs with COVID-19 induced respiratory failure between March- September 2020 who required BiPAP support. We excluded patients who were using BiPAP at home prior to admission or required BiPAP after extubation. NIV failure is defined as the need for intubation after a trial of BiPAP. RESULT(S): A total of 35 patients (out of 129) fulfilled the criteria for inclusion in the study. The mean (standard deviation, SD) age was 63.5 (13.8) years, and the majority were Caucasian men (60%). The mean (SD) BMI was 35.4 (9.6) kg/m2, and the mean (SD) APACHE II score was 16 (6.4). 18 out of 35 patients (51%) had NIV failure. Patients who failed BiPAP support had increased ICU and hospital mortality compared to those who did not require intubation after BiPAP therapy (66.6% vs. 11.7% and 72.2% vs. 17.6%, respectively;P< 0.001). ICU and hospital lengths of stay were also higher for the patients with NIV failure (17 vs. 3.4 days and 23.5 vs. 13.1 days, respectively;P< 0.001). CONCLUSION(S): NIV failure was associated with adverse clinical outcomes in the management of COVID-19 induced ARDS.

8.
Critical Care Medicine ; 51(1 Supplement):366, 2023.
Article in English | EMBASE | ID: covidwho-2190595

ABSTRACT

INTRODUCTION: Inhaled epoprostenol (iEPO) is adjunctive therapy for acute respiratory distress syndrome (ARDS) in addition to prone positioning and neuromuscular blockade. Previous studies report mixed improvement in PaO2/FiO2 (P:F) ratios using fixed-dose and weight-based protocols. The aim of this study was to evaluate patient response rate to fixed-dose iEPO via palladium vibrating mesh nebulizer and the rate of rebound hypoxemia following abrupt iEPO discontinuation without titration per local protocol. METHOD(S): Single-center, retrospective, descriptive study of adult patients admitted to an ICU at a Veterans Affairs hospital who received iEPO for ARDS between 5/23/14 and 4/1/21. Patients were included if they received iEPO 1500 mcg/75 mL (120 mcg load, then 160 mcg/hr continuous nebulization) for at least 12 hours. Patients receiving iEPO for an indication other than ARDS were excluded. Response was defined as an increase in P:F >10% within 12 hours. Safety was assessed via decline in P:F after iEPO stop. RESULT(S): Of the 29 patients included, 72.4% had a baseline P:F < 100 mmHg (median 76.8, range 38-250). Diagnosis included direct ARDS in 44.8% and COVID ARDS in 24.1%. Adjunctive therapies included paralytics (58.6%), corticosteroids (44.8%) and pronation (27.6%). Seventeen patients (58.6%) were responders with a median P:F increase of 41.6% (range 11.6-322.1) at 3.8 hours (0.1-20.3) after iEPO initiation. iEPO was given for a median of 3 days (0.5-18.6) overall, and 3.4 days (0.5-8.7) in non-responders. The median best P:F during iEPO was 140 mmHg (59.9-423.0) at 24 hours (1.1-299). Eight of 14 patients with an ABG drawn a median of 7.6 hours after iEPO cessation had a drop in P:F. Other adverse outcomes following iEPO initiation included ICU mortality in 65.5% and new hypotension in 67%. CONCLUSION(S): In a small heterogenous cohort of patients with ARDS, fixed-dose iEPO had a modest response rate. A majority of patients who survived to iEPO cessation without down-titration experienced a drop in P:F. Protocol revision to include guidance on therapeutic response and down-titration may be warranted.

9.
Open Forum Infectious Diseases ; 9(Supplement 2):S859, 2022.
Article in English | EMBASE | ID: covidwho-2190009

ABSTRACT

Background. Despite extensive studies of human immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) vaccination, research examining protective correlates of vertical transmission following maternal exposure in pregnancy remain limited. Here, we characterized antibody and cytokine responses in maternal and cord blood following infection or vaccination at various timepoints during gestation. Methods. Spike S1 protein-specific binding antibodies and antibodies capable of blocking the interaction between the receptor binding domain (RBD) and the angiotensin converting enzyme 2 (ACE2) were measured in maternal and cord blood by ELISA. Serum concentrations of 74 cytokines/chemokines were measured by multiplex assay. Humoral responses and cytokine levels from matched maternal and fetal cord sera were compared and examined for potential correlations. Results. We observed a highly significant correlation between Spike S1-specific antibody titer and RBD-ACE2 blocking antibody activity between maternal and fetal cord serum (p < 2.2e-16, R > 0.90). Blocking antibody activity was significantly higher for mothers infected during the 3rd trimester compared to earlier trimesters;however, vaccinated mothers developed and transferred higher antibody titers with greater RBD-ACE2 blocking antibody activity to their neonates than infected mothers. Furthermore, vaccine-induced Spike S1 IgG transfer ratios (fetal cord/maternal) were significantly higher than those induced by infection (p = 0.002). Multiplex assay showed significantly elevated levels of 33 cytokines/chemokines, mainly pro-inflammatory in infected maternal serum samples, while the paired fetal cord samples exhibited an anti-inflammatory cytokine predominance. Conclusion. Our data support selective vertical transmission of potentially protective humoral responses against SARS-CoV-2, especially following vaccination in the 3rd trimester. The anti-inflammatory cytokine predominance in cord blood that persists despite maternal SARS-CoV-2 infection may offset the adverse outcomes of inflammation in pregnancy for the neonate.

10.
Open Forum Infectious Diseases ; 9(Supplement 2):S499, 2022.
Article in English | EMBASE | ID: covidwho-2189812

ABSTRACT

Background. Therapeutic vaccination following SARS-CoV-2 infection might stimulate anti-viral immunity and improve patient outcomes. We investigated, amongst previously unvaccinated patients, whether vaccination with the Pfizer, Moderna, or Johnson & Johnson vaccines within 14 days of a positive SARS-CoV-2 test affected 30-day patient outcomes. Methods. Using a deidentified national electronic health record dataset (Optum, Inc.), we identified previously unvaccinated patients who tested positive forCOVID-19 between 12/11/2020 and 12/19/2021. Among this cohort, 1,909 patients received a first vaccine dose within 14 days (vaccinated) while 446,309 did not receive a first dose of vaccine within 30 days of their first positive test (unvaccinated). We performed 1:1 propensity score matching based on age, gender, race, ethnicity, region, BMI, insurance, and comorbidities from the Charlson Comorbidity Index. Next, we compared odds of severe outcomes within 30 days between vaccinated and unvaccinated groups using a partial proportional odds model with the following ordinal severity outcome: no hospitalization, hospitalization, ICU stay, or death (Stata version 17.0, alpha = 0.05). Results. 1,909 vaccinated patients were propensity score-matched to 1,909 unvaccinated patients. The final matched cohort was statistically indistinguishable (p > 0.05) for all metrics used in propensity score calculation. This matched cohort (n = 3,818) was 58.6% female, 67.7% white, 12.6% Hispanic, and 56.4% commercially insured, with a mean age of 50.6 years and a similar comorbidity profile. A partial proportional odds model showed that unvaccinated patients were at increased risk for hospitalization and higher ordered outcomes (OR = 1.19, 95% CI: 1.02-1.39), ICU stay and higher ordered outcomes (OR 1.63, 95% CI: 1.21-2.20), and death (OR 4.57, 95% CI: 2.50-8.37). Conclusion. Among previously unvaccinated patients, those who received a first dose vaccine within 14 days of a positive COVID-19 test were less likely to experience hospitalization, ICU stay, or death compared to matched peers who did not receive a first dose in the acute phase of infection. The sample size of patients vaccinated during the acute phase is limited, so further studies are indicated to evaluate the safety and efficacy of this practice.

11.
Open Forum Infectious Diseases ; 9(Supplement 2):S488-S489, 2022.
Article in English | EMBASE | ID: covidwho-2189794

ABSTRACT

Background. Patients with hematological malignancy or other cancers as well as immunosuppression bear a high risk for severe COVID-19. Monoclonal antibodies (mAb) are efficient at early stages of the disease but may lose potency with new variants. Trials on plasma from convalescent donors in unselected patients have not shown clinical benefit. No randomized trials focussing on patients with underlying disease have been published. Methods. We conducted an open-label, multicenter, randomized controlled trial to evaluate efficacy of plasma (CVP - convalescent or after vaccination) in patients with COVID-19 at high risk for adverse outcome in Germany. We assessed the effect of high-titer CVP (2 units from different donors, 238-337 ml each, on subsequent days). Patients with hematological or other malignancy (group 1), immunosuppression (group 2), age >50 and <=75 years and lymphopenia and/or high D-dimers (group 3) or age >75 years (group 4) who were hospitalized with confirmed SARS-CoV-2 infection and with an oxygen saturation <=94% were included. Primary outcome measure was time to clinical improvement on a seven-point ordinal scale, secondary outcome was mortality (Janssen et al. Trials 2020 Oct 6;21(1):828). Results. Overall, 133 patients were randomized, 68 received CVP with an additional 10 patients as a crossover on day 10. Median age (range) was 68 years (39-95) in the CVP group and 70 (38-90) in controls. For the entire cohort, no significant difference was seen in time to improvement (median days: CVP 12.5 vs. control 18;HR 1.24 (95% confidence interval (CI) 0.83-1.85), p=0.29). Subgroup analysis (group 1+2) revealed shortened time to improvement (median days CVP 13 vs. control 32;HR 2.03 (95%CI 1.17-3.6), p=0.01) and mortality was reduced (mortality CVP n=6 (18%) vs. control n=10 (29%). No significant differences in time to improvement were observed in group 3 or 4 (HR 0.72 (95%CI 0.41-1.28), p=0.26). No relevant adverse events were observed. Conclusion. CVP improves time to clinical improvement and mortality for COVID-19 patients with underlying hematological disease/cancer or other reasons of impaired immune response. Even with new variants, high-titer CVP may offer a widely available and inexpensive therapy option in high-risk groups. Funding. BMBF FKZ 01KI20152;EudraCT 2020-001632-10.

12.
Open Forum Infectious Diseases ; 9(Supplement 2):S478, 2022.
Article in English | EMBASE | ID: covidwho-2189773

ABSTRACT

Background. We studied the safety and efficacy of the use of monoclonal antibodies (MAB) against SARS-CoV-2 in pregnant women who developed COVID-19 infection. Methods. We conducted a cross-sectional descriptive multi-center study of pregnant patients who developed SARS-CoV-2 infection from January 2021 to January 2022 and received MAB therapy. Primary outcomes assessed were infusion-related adverse events and pregnancy outcomes within one month of MAB infusion. The secondary outcomes assessed were hospitalization and ICU admission for COVID19 infection and thirty-day all-cause mortality. Results. 141 patients were included in the study (median age 33 +/- 5.3 SD, median BMI 28.9 +/- 8.42 SD). In terms of COVID vaccination status, 49.6% received one dose, 36.1% were fully vaccinated, and 7% received the booster dose. Most patients received casirivimab/imdevimab (105, 74.5%) followed by sotrovimab (33, 23.4%). Four patients developed adverse reactions to MAB infusion (two grade-2 reactions and two grade-1 reactions as per the National cancer institute infusion reaction grading criteria). Only one patient (0.7%) was hospitalized for COVID-19 infection, however, she was not hypoxic nor required ICU admission. Five patients delivered within four weeks of MAB administration, however, four of those patients were of gestational age > 37 weeks. Data for 30-day all-cause mortality was available on 88.7% (125) of the patients and data for 30-day pregnancy adverse outcomes was available on 86.5% (122) of the patients due to lack of follow-up within the Health System. There was no reported 30-Day all-cause mortality within the cohort. Two patients (1.4%) had premature rupture of the membrane and one patient (0.7%) had premature delivery within 30 days of receiving MAB. Two patients had preeclampsia (1.4%) and one patient (0.7%) was admitted for evaluations of decreased fetal movements. Conclusion. Administration of monoclonal antibodies against SARS-CoV-2 was well tolerated during pregnancy. Only 4 out of 141 (2.8%) had mild to moderate infusion-related reactions. The 30-day pregnancy adverse outcomes observed were well below the mean background rate. There was no reported mortality among MAB recipients and only one patient was hospitalized for mild COVID19 infection.

13.
Open Forum Infectious Diseases ; 9(Supplement 2):S200, 2022.
Article in English | EMBASE | ID: covidwho-2189619

ABSTRACT

Background. The Coronavirus disease 2019 (COVID-19) pandemic continues to threaten many countries globally. Large-scale vaccination exercises have helped to reduce transmission and severity of disease. We sought to modify an existing clinical score (the ISARIC-4C mortality score) to include serological status to better prognosticate hospitalized patients with COVID-19. Methods. We examined the first 1781 consecutive hospitalized patients with polymerase chain reaction (PCR) confirmed COVID-19 in a tertiary academic centre. We divided the study population into those requiring intensive care and those who did not require throughout their inpatient stay. Baseline characteristics examined include medical comorbidities, vaccination status, SARS-CoV-2 serology spike protein, duration of fever and haemodynamics were compared. Adverse outcomes were defined as patients who required intensive care or mortality. Performance of the risk scores were measured by the area under receiver operating characteristic curves (AUC) in predicting adverse outcomes. Results. The 55 patients requiring intensive care during their inpatient stay tended to have persistent fever beyond 72 hours and had lower titres of spike protein antibodies. (58.9 (+/-105.3) U/mL vs 144.2 (+/-116.2) U/mL, p = 0.007). A high spike protein antibody titre >75 U/mL was independently protective for adverse outcomes (adjusted OR 0.15, 95% CI 0.04-0.53), even after adjusting for the ISARIC-4C score and the presence of persistent fever. Adding the serological status and presence of persistent fever to the ISARIC-4C score improved its performance in predicting adverse outcomes (AUC 0.84, 95% CI 0.78-0.89). Conclusion. Addition of the SARS-CoV-2 serology spike protein titre and prolonged fever to the ISARIC-4C mortality score helps to better prognosticate adverse clinical outcomes in hospitalized patients with COVID-19.

14.
Open Forum Infectious Diseases ; 9(Supplement 2):S169, 2022.
Article in English | EMBASE | ID: covidwho-2189558

ABSTRACT

Background. The empiric prescription of antibiotics in COVID 19 ICU patients is frequent due to the severity of disease and presentation of patients with septic shock. In this study we compared two approaches of antimicrobial prescription: empiric use vs. FilmArray pneumonia (FAP) panel guided treatment. We evaluated costs of intervention, clinical outcomes as development of hospital acquired infections (HAI), length of stay and mortality. Methods. Retrospective study. Patients with severe COVID-19 infection hospitalized in ICU of two institutions in Pereira were included. The prescription of antibiotic without FAP panel was defined as empiric. The prescription according to FAP panel results was defined as guided. Data analysis was performed in Epiinfo version 7.5.2.0. The study protocol was approved by the ethics committee of Universidad Tecnologica de Pereira. Results. 252 patients were included, 180 received empiric therapy and 72 were FAP panel guided. The median age was 65 years (IQR 53-73), the PaO2/FiO2 ratio mean was 108 (IQR 64-130). In the group of empiric treatment, 21 (11.67%) patients presented confirmed bacterial infection. Patients on guided antimicrobial therapy presented less HAI (RR 0,54 (IC 95% 0.30-0.95) p 0.02). The median length of stay in ICU was 16 days for both groups. Klebsiella pneumoniae was the most frequent bacteria identified during the first episode of infection followed of Pseudomonas aeruginosa. Mortality on guided group was 54% Vs. 42% on empiric group (p< 0,3). Meropenem was the main antibiotic prescribed (DDD empiric 3.17 Vs. 1.8DDDguided) followed of cefepime (DDD empiric 0.9 Vs. DDD guided 0.12). The median cost of antimicrobial treatment in the empiric group was US$530 (US$30-US$1579) per patient compared to the median cost of guided prescription that was US$292 (US$16-US $8767). When including the cost of FAP panel, the median cost per patient treatment course was US$429 (US$153-US$8904) p< 0.7. Conclusion. Implementation of a guided antimicrobial therapy using FAP panel could be useful and cost effective in COVID-19 ICU patients to reduce antimicrobial consumption and adverse outcomes related to the inappropriate use of antibiotics without significant impact on mortality or length of stay.

15.
British Journal of Surgery ; 109(Supplement 9):ix56, 2022.
Article in English | EMBASE | ID: covidwho-2188335

ABSTRACT

Background: Surgical consent forms can be difficult for patients to read and understand. Important points including procedure details, relevant complications and alterative treatment options are often lost in the communication process. Furthermore, surveys have found that patients struggle to grasp basic surgical concepts. Procedure specific consent forms (PSCFs) have been shown to improve the process of surgical consent. This is partly because they provide a standardised list of complications and their incidence, presented in a uniform, legible format without any abbreviations. However, despite their benefits, PSCFs are nationally underused. Cholecystectomy is one of the most common operations performed in the United Kingdom. Due to the pandemic disrupting elective surgical lists, the backlog of patients with biliary pathology has increased. More patients are therefore presenting to the on-call surgical team with biliary disease. Many trusts employ an Emergency Surgery Ambulatory Care (ESAC) list to offload the stretched emergency service. Our aim was to assess the variability of cholecystectomy consent forms amongst this cohort of patients, subsequently review patient understanding and evaluate whether the introduction of a procedure specific consent form improved this understanding. Method(s): We performed a prospective audit of laparoscopic cholecystectomy consent forms using the ESAC service. These consent forms were all obtained from patient's paper notes and assessed individually for variables. The first loop of the audit assessed the consent form used for the first 20 patients allocated to the ESAC list. Subsequently, each patient was telephoned post-operatively and asked a series of standardised questions which were adapted from a published questionnaire. Following this, we introduced a Procedure Specific Consent Form (PCSF) for laparoscopic cholecystectomies, with the agreement of all consultant surgeons who perform this operation in the trust. The second loop of the audit assessed another 20 patients from the emergency list, after the introduction of the PCSF. Similarly, patients were later telephoned to assess understanding. Over both loops, each consent form was assessed for the scope of their included complications and measured against the NHS-recognised list of potential adverse outcomes. Secondly, the legibility of the consenter's writing and the use of any abbreviations was noted. Legibility was evaluated by two doctors independently to reduce subjectivity. Result(s): The first loop revealed that all forms contained infection and bleeding;90% included injury to bile duct;80% included injury to viscera and risks from general anaesthetic;75% included blood clots and bile leak;and only 55% included post-cholecystectomy syndrome. The additional complications included were pain, herniae, covid risk, retained stone, collection, pancreatitis, failure and death;with an even higher degree of variability. The 20 forms were 95% legible, with 50% of them containing one or more acronyms. Relating to the post-op questionnaire, >80% of patients remembered details surrounding their operation, however only 60% could recall basic potential complications. After PCSF introduction, itwas used in 10 of the second loop cases,with the remaining 10 using traditional Consent Form 1 (non-PSCF). The non-PSCF group demonstrated similar variability in the complications included, with identical legibility rates and acronym usage. Again, only 60% of patients were able to accurately define the associated complications. Of the PSCFs, 100% were legible and 0% used acronyms, and the list of complications was standardised with 100% compliance with NICE and RCS England guidance. Notably, 90% of patients accurately recalled potential complications and nearly all were satisfied with their level of understanding prior to signing the consent form. Conclusion(s): This Quality Improvement Project demonstrated that hand written Consent Forms are highly variable, especially regarding the list of complications. We also found that while the were largely legible, half of the consent forms contained acronyms. Lastly, patients were satisfied with the information provided to them and could recall knowledge on the nature of the surgery, but many were not able to recollect important potential complications. The use of a PSCF allowed for a standardised, easily accessible, legible consent form devoid of misinterpretable acronyms. This was reflected in the patient questionnaire, where patients were able to recall details of the surgery and were satisfied with their level of understanding. This was reaffirmed by their grasp of the complications, where 90% of patients could recall potential adverse risks, compared to 60% in the Form 1 groups. This audit demonstrates the benefit of PSCFs from a legislative and litigative standpoint, but more importantly from the standpoint of patient understanding and holistic care. We recommend the use of PSCFs in the process of all surgical consent, to help ensure patient understanding and subsequent satisfaction.

16.
British Journal of Surgery ; 109(Supplement 9):ix33, 2022.
Article in English | EMBASE | ID: covidwho-2188328

ABSTRACT

Background: The COVID-19 pandemic was declared the greatest challenge the NHS would face since its creation. As a means of combatting the unprecedented strains COVID-19 was expected to force upon hospitals and their staff, NHS England sanctioned the postponement of all non-urgent elective surgery during the first wave of the COVID-19 pandemic. Approximately 70 000 cholecystectomies are performed every year in the UK, with the vast majority of these being elective laparoscopic cholecystectomies (LC). However, in the early stages of the pandemic, both national and international surgical bodies warned of the potential risks of aerosol virus transmission with the use of laparoscopy. Therefore, conservative management for emergency general surgical pathologies was recommended where possible. Delays in performing LC are associated with recurrent cholecystitis, pancreatitis and cholangitis;all of which present as emergencies with significant associated morbidity and mortality. This in turn has an economic impact on the NHS. We aimed to evaluate if patients undergoing emergency LC during the COVID-19 pandemic at our site, had different outcomes compared to those treated prior to the pandemic. Has the COVID-19 pandemic negatively impacted their patient journey? Furthermore, has the pandemic led to increased costs for our site? Methods: A retrospective data collection was performed to identify all patients who had an emergency LC from March 2019 - March 2021. Patients were subsequently categorised into 'pre-COVID-19' and 'during COVID-19' groups. Hospital computer systems were used to review operative admission length of stay (LoS), rate of conversion to open surgery/subtotal cholecystectomy, operative time, post-operative complications/return to theatre and readmission rate. Histopathology reports were analyzed to assess if the 'during COVID-19' cohort had a higher rate of complicated cholecystitis. Finally costs of the operative admission and associated admissions (pre and post-operatively), as well as the tariff for investigations performed for gallstone disease were calculated for each cohort of patients. Result(s): 158 patients were included in the study. A 42% reduction in emergency LC cases was observed during the COVID-19 pandemic compared to pre-pandemic. No statistically significant differences were seen between the two groups when reviewing the rate of conversion to open surgery or the incidence of post-operative complications/need to return to theatre. The rate of subtotal cholecystectomy was higher in the 'during COVID-19' group (12% vs. 3%) and this was found to be statistically significant (p-value 0.024). Operating times were longer during the pandemic (93 vs. 80 mins), as was the LoS for the operative admission (5 vs. 6 days), however these results were not statistically significant. Interestingly, same day emergency care (SDEC) reviews were more frequent in the 'during COVID-19' group (13.1 vs. 29.3%) and this was statistically significant (p-value 0.015). There was no statistically significant difference between the groups in relation to histopathology results. The most prevalent histopathology of both cohorts was chronic cholecystitis (58 vs. 48.28%). Acute on chronic cholecystitis (23 vs. 25.86%) and necrotising/gangranous changes (11 vs. 12.07%) were more prevalent in the 'during COVID-19' group. When reviewing costs between the two groups, no statistically significant differences in LoS, nor investigation tariffs was observed. Conclusion(s): Our study shows that the COVID-19 pandemic has had a negative impact on two clinical aspects of emergency LC - an increase in the rate of subtotal cholecystectomy, as well as SDEC reviews. This could be explained by delays in elective surgery encountered during the pandemic, leading to patients experiencing recurrent infections, or other associated complications of gallstone disease and consequently requiring more frequent clinician/SDEC reviews. These complications can also result in unclear anatomy, diffuse scarring, necrosis and abscess formation, all of which n lead to increasingly complex cases encountered intra-operatively. If surgeons are unable to safely achieve a critical view of safety, guidance recommends subtotal cholecystectomy as a bail out procedure, in order to avoid serious damage to the bile duct or blood vessels. This could justify the statistically significant higher rate of subtotal cholecystectomy in the 'during COVID-19' group. Currently, there are approximately 6 million patients on NHS surgical waiting lists and this issue must be addressed urgently in the COVID-19 recovery phase, so as to prevent adverse outcomes for both patients and the NHS.

17.
Safety and Health at Work ; 13(4):379-386, 2022.
Article in English | EMBASE | ID: covidwho-2183294

ABSTRACT

Emergency medical services (EMS) personnel are at high risk for adverse mental health outcomes during disease outbreaks. To support the development of evidence-informed mitigation strategies, we conducted a scoping review to identify the extent of research pertaining to EMS personnel's mental health during disease outbreaks and summarized key factors associated with mental health outcomes. We systematically searched three databases for articles containing keywords within three concepts: EMS personnel, disease outbreaks, and mental health. We screened and retained original peer-reviewed articles that discussed, in English, EMS personnel's mental health during disease outbreaks. Where inferential statistics were reported, the associations between individual and work-related factors and mental health outcomes were synthesized. Twenty-five articles were eligible for data extraction. Our findings suggest that many of the contributing factors for adverse mental health outcomes are related to inadequacies in fulfilling EMS personnel's basic safety and informational needs. In preparation for future disease outbreaks, resources should be prioritized toward ensuring adequate provisions of personal protective equipment and infection prevention and control training. This scoping review serves as a launching pad for further research and intervention development. Copyright © 2022 Occupational Safety and Health Research Institute

18.
Seminars in Arthritis and Rheumatism ; 58 (no pagination), 2023.
Article in English | EMBASE | ID: covidwho-2183262

ABSTRACT

Objective: The Omicron variant of the coronavirus SARS-CoV-2 (COVID-19) had milder clinical impacts than prior variants. This study aimed to describe the impact of COVID-19 on Autoimmune Rheumatic Disease (ARD) patients during the Delta and Omicron variants waves. Method(s): We used data from Clalit Health Services (CHS), the largest health service in Israel. ARD patients diagnosed with COVID-19 between July 1, 2021, to December 1, 2021, were included in the Delta group. Patients diagnosed between December 2, 2021, to March 31, 2022, were included in the Omicron group based on the predominance of COVID-19 in Israel. The study outcomes were COVID-19-related hospitalization or death. Result(s): The final study cohort included 8443 actively treated ARD patients diagnosed with COVID-19. 1204 patients were positive during the predefined Delta variant period, and 7249 were positive during the predefined Omicron variant period). Compared to the Delta group, the Omicron group showed a lower rate of COVID-19-related hospitalization (3.9% vs. 1.3% for the Delta Vs. Omicron accordingly, p<0.001) and COVID-19-related death (3.2% vs. 1.1% for the Delta Vs. Omicron accordingly, p<0.001). After applying multivariable regression models, the Omicron group showed a lower risk for COVID-19-related hospitalization (Relative risk 0.4, 95% CI 0.27-0.59) and COVID-19-related mortality (RR 0.48, 95% CI 0.31-0.75). Conclusion(s): ARD patients infected with the COVID-19 Omicron variant had a lower risk of developing COVID-19-related adverse outcomes compared to the Delta variant. Copyright © 2022 Elsevier Inc.

19.
European Geriatric Medicine ; 13(Supplement 1):S180, 2022.
Article in English | EMBASE | ID: covidwho-2175556

ABSTRACT

Introduction: Regular physical activity is consistently associated with reduced risk of chronic diseases, cognitive decline, and mortality. In 2020 to reduce COVID-19 transmission, lockdowns were imposed and people instructed to stay at home, with many services suspended, thereby limiting opportunities for physical activity. Method(s): Understanding Society is a longitudinal survey of approximately 40,000 UK households. Some 3,660 older adults (aged >= 65) took part in annual surveys pre-2020 and specific COVID-19 studies. We examined changes in proportion of older adults that were achieving physical activity recommendations for health maintenance at several time points before and after COVID-19 lockdowns were imposed. We stratified these trends by the presence of health conditions, age, neighbourhood deprivation, and pre-pandemic activity levels. Result(s): There was a marked decline in older adults' physical activity levels during the national lockdowns to January 2021. The proportion achieving physical activity recommendations decreased from 47% pre-pandemic to 33% in January 2021. This decrease in physical activity occurred regardless of health condition, age, neighbourhood deprivation, or pre-pandemic activity levels. Those doing the least activity pre-lockdown increased their activity during initial lockdowns and those doing the most decreased their activity levels. Conclusion(s): Reductions in older adults' physical activity levels during COVID-19 lockdowns have put them at risk of becoming deconditioned and developing adverse health outcomes. Resources to promote the uptake of physical activity in older adults to reverse the effects of deconditioning are needed and we describe the Greater Manchester response.

20.
European Geriatric Medicine ; 13(Supplement 1):S196, 2022.
Article in English | EMBASE | ID: covidwho-2175422

ABSTRACT

Introduction: We aimed to study the changes that might have occured after COVID-19 in terms of sarcopenia, frailty and nutrition in older adults. Method(s): This study is a retrospective, longitudinal study performed in Post-COVID-19 Monitoring Center in a tertiary health center. Community-dwelling older adults aged 65 and over who recovered from their illness, diagnosed with probable or confirmed COVID-19 and admitted to the Post-COVID-19 Monitoring center, were enrolled and admitted to the follow-up unit between May 2020 and August 2021. We evaluated frailty status via FRAIL scale and screened sarcopenia via SARC-F questionnaire. In order to evaluate the effects of infection on the frailty status and sarcopenia risk, we asked participants to answer the questions by first considering their situation retrospectively (two weeks before the infection), and then considering their current situation. Hence, we obtained two different FRAIL and SARC-F scores: Pre-COVID-19 and post-COVID-19. We made measurements at the monitoring center during each application. We asked for sleep disorders, by asking whether they had trouble falling asleep, staying asleep, or if they thought they were having insufficient sleep or excessive sleepiness. In addition, we asked the patients whether they had a memory problem or depressive symptoms and/or anhedonia that would affect their daily life activities. Result(s): There were 120 patients (52% were women;mean age: 72.8 +/- 6.5 years). Patients having inpatient treatment had a rate of 83.8% and the average hospital stay was 10 (1-41) days. 59% had positive PCR test results and 56.1% had severe/moderate pneumonia. It was determined that the patients' post-COVID-19 frailty and sarcopenia scores were statistically higher (p<0.05), and COVID-19 disease increased weight loss significantly (p<0.001). Sleep disturbance (30%) and memory problems (35%) were among the most common geriatric syndromes. Conclusion(s): Our study reports that older adults mostly suffer from sleep and memory problems after COVID-19 infection. We also found that COVID-19 was associated with adverse outcomes in weight loss, frailty, and sarcopenia in the elderly. These consequences have detrimental effects in older adults and should be managed in post covid era.

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