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1.
Sexually Transmitted Infections ; 98:A60-A61, 2022.
Article in English | EMBASE | ID: covidwho-1956932

ABSTRACT

Background The British Association for Sexual Health and HIV guidelines for the management of rectal chlamydia recommend 1 week of doxycycline and testing for Lymphogranuloma venereum (LGV). Any difficulties in recalling LGV positive patients to extend the script to three weeks could cause treatment gaps or necessitate restarting treatment. Alternatively, a 3-week prescription can be given immediately, and the patient then instructed to stop if LGV negative. However, this approach raises concerns about potential antibiotic overuse if patients are hard to contact. This audit considers whether this proactive approach is indicated. Method Electronic patient records were reviewed to identify patients coded as C4 in 2020 and the first half of 2019 in one hospital and two community clinics. From these, patients with rectal chlamydia were selected. The following were recorded;rectal symptoms/signs, LGV swabs taken before/at time of treatment, treatment regime/duration, LGV results, HIV status, whether patients were contacted with LGV results. Results In 2020, of the 146 rectal chlamydia positive patients 75% were tested for LGV and 30% were prescribed 3 weeks of doxycycline. 4 patients tested positive with LGV. In the 2019 sample, 78% of the 55 rectal chlamydia positive patients were tested for LGV and 20% were prescribed 3 weeks of doxycycline. Only 1 tested LGV positive. Conclusion Low rates of LGV positivity suggest adhering to the recommendation of 1 week of doxycycline is advisable to avoid antibiotic overuse and potential associated resistance.

2.
Sexually Transmitted Infections ; 98:A49, 2022.
Article in English | EMBASE | ID: covidwho-1956924

ABSTRACT

Introduction During COVID-19, the sexual health service introduced telephone triage to reduce face-to-face consultations but maintain BASHH standards of clinical care. The service does not have TV PCR testing and relies on laboratory diagnosis of TV alone. This audit examines the impact of COVID- 19 changes on presentation and treatment of TV. Method Electronic patient records were searched for patient coded with TV and compared for the periods 01/01/2019 - 01/01/2020 and 01/01/2021-01/01/2022. The year 2020-2021 was not included due to the reduced capacity of services and concerns of data quality during this period. Results 43 cases were identified in 2019 compared to 47 in 2021. All patients were treated with antibiotics as recommended by BASHH guidelines. The most common symptom for females both years was discharge, however males were identified through contact tracing. More patients waited with symptoms and were incorrectly treated for other conditions following service changes due to COVID-19. Cure rates also lower in the 2021 data compared with the 2019 data. The results are summarised in the table attached. Discussion The frequency of Trichomonas diagnosis did not decrease during COVID despite reduced testing overall. The delay in diagnosing and treating TV had increased however with patients having symptoms longer and being treated for other infections first. This could be improved by incorporating PCR testing into local triage algorithms.

3.
Journal of Clinical Periodontology ; 49:348-349, 2022.
Article in English | EMBASE | ID: covidwho-1956766

ABSTRACT

Background: Necrotizing periodontal diseases (NPD) are fuso-spirochetal infections causing ulceration and destruction of periodontal tissues and associate with impaired host response. Elevated bacterial levels of Prevotella intermedia, Veillonella and Streptococci present in NPD lesions were detected in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Description of the procedure: A 40-year-old female, non-smoker patient was referred to the clinic with complaints of fever, halitosis, bad taste, severe gingival pain and bleeding. The patient reported a history of COVID-19 a month prior to any symptoms. Extra and intraoral examinations revealed submandibular lymphadenopathy, plaque accumulation, necrotic areas covered with pseudo-membranes, spontaneous gingival bleeding and suppuration. Alveolar bone loss was detected in the radiographic examination. Since periodontal pocket formation was present, the clinical diagnosis of the case was necrotizing gingivitis as a result of previously occurred periodontitis. During the first visit, necrotic areas were gently swabbed with 3% H2O2 moistened cotton pellets and oral hygiene instructions were given. Systemic antibiotic (metronidazole 500 mg 2 × 1) was prescribed for 5 days and rinsing with 0.12% chlorhexidine and 3% H2O2 was recommended. Three days later, since the acute complaints were reduced, clinical periodontal parameters were recorded and nonsurgical periodontal treatment (NSPT) was performed in 4 sessions in 2 weeks. One month after NSPT, all clinical periodontal parameters were recorded again. Outcomes: Following NSPT with the combination of systemic antibiotic regimen, all symptoms were resolved leading to the dissolution of necrotic areas. All clinical parameters were improved after NSPT. Conclusions: This case may be an evidence that COVID-19 could be a contributing factor for the appearance of NPD. Since COVID-19 leads to an altered immune response of the patient, a suitable environment becomes present orally for bacteria causing infections that result in NPD. The importance of routine intra-oral examination for COVID-19 patients is highlighted.

4.
Journal of Clinical Periodontology ; 49:225-226, 2022.
Article in English | EMBASE | ID: covidwho-1956764

ABSTRACT

Background and Aim: Many obstacles have risen during the lockdown period due to the COVID-19 pandemic, including the provision of urgent dental care. The Rothschild hospital had to establish a balance between providing a core service and limiting patient admission through a fair sorting system. This study aims to assess the efficacy of the dental emergency protocol implemented during the first lockdown. Methods: The protocol was applied for patients who arrived at the hospital between March 18 and May 11, 2020. First, they underwent a sorting diagnosis (A) based on self-reported symptoms. If deemed as urgent, they were oriented towards dental professionals, who performed an intraoral examination leading to a clinical diagnosis (B). Diagnoses (A and B) were categorized into four groups: infectious, prosthetic, traumatic, and other emergencies. The agreement between diagnoses A and B was tested (Cohen's Kappa score). Positive predictive value, negative predictive value, sensitivity and specificity among diagnostic categories were assessed to evaluate the performance and efficacy of the sorting diagnosis. Results: Out of 1651 dental visits, 1064 were included for this analysis. The most frequent reported symptom at the sorting diagnosis was pain (40%), whereas the most frequent clinical diagnosis was endodontic emergency (30%). Periodontal emergency concerned 6% of patients. Tooth extraction was required in 32% of cases;systemic antibiotics were prescribed for 49.2% of patients. Infectious emergency diagnosis had the higher sensitivity (94.2%), whereas prosthetic emergency diagnosis had the higher specificity (99.1%). The level of agreement was substantial (kappa > 0.6) for the majority of diagnoses. No Covid-19 contamination occurred. Conclusions: This study demonstrates that the implemented protocol during the first COVID-19 lockdown to manage dental emergencies was effective, establishing an appropriate patient orientation prior to clinical examination to minimize the risk of COVID-19 exposure whilst safeguarding professionals and patients.

5.
British Journal of Dermatology ; 186(6):e246, 2022.
Article in English | EMBASE | ID: covidwho-1956707

ABSTRACT

With the outbreak of the emergent coronavirus, there have been sparse reports of severe cutaneous adverse reactions in some severely ill patients (Chen XY, Yan BX, Man XY. TNFα inhibitor may be effective for severe COVID-19: learning from toxic epidermal necrolysis. Ther Adv Respir Dis 2020;14: 1753466620926800). It is thought that this is due to clonal expansion of CD8+ cytotoxic T lymphocytes and natural killer cells that occurs during the cytokine storm elicited by the virus or the use of unconventional drugs to treat patients (Rossi CM, Beretta FN, Traverso G et al. A case report of toxic epidermal necrolysis (TEN) in a patient with COVID-19 treated with hydroxychloroquine: are these two partners in crime? Clin Mol Allergy 2020;18: 19;Saha M, D'Cruz A, Paul N et al. Toxic epidermal necrolysis and co-existent SARS-CoV-2 (COVID-19) treated with intravenous immunoglobulin:'Killing 2 birds with one stone'. J Eur Acad Dermatol Venereol 2020;35: e97-8). In a minority of cases, viral or autoimmune forms of toxic epidermal necrolysis (TEN) may be implicated (Chen et al.;Rossi et al.). However, very little research, has been done to decipher the association or pathogenesis with TEN and the novel virus. We report an interesting case of a 51-year-old woman who developed a rash on her face, flanks and periumbilical area immediately after an intensive care admission with respiratory failure secondary to confirmed COVID-19 pneumonitis. The patient had a background of gout on allopurinol and type 2 diabetes. There were no changes in medications. While admitted, she was started on broad spectrum antibiotics. On examination, there were large, confluent patches of erythema with a targetoid appearance on the face, upper limbs and trunk, and tense blistering over the forearms. Biopsy showed full thickness epidermal necrosis and subepidermal bullous formation. An autoimmune and bullous screen was negative. Prognosis was poor with the critical care team considering end-of-life management. However, with the diagnosis of a reversible condition, supportive therapy was continued. With continued intensive care intervention, steroids and barrier protection, her TEN gradually resolved as she recovered from COVID-19, and she had a favourable outcome with only residual milia and signs of re-epithelialization.

6.
British Journal of Dermatology ; 186(6):e253, 2022.
Article in English | EMBASE | ID: covidwho-1956703

ABSTRACT

We present the case of a severe cutaneous reaction following COVID-19 vaccination. A 60-year-old white woman presented to our service with an extensive painful, pruritic rash affecting her bilateral lower limbs. This was on a background of psoriasis, psoriatic arthritis and notably inoculation against COVID-19 with the Johnson & Johnson vaccine hours prior to onset. There was no history of new medications, illicit drug use or infections. On examination, extensive palpable purpura was noted circumferentially at both lower limbs from the knee distally. Tense bullae were described at her bilateral ankles. She was apyrexial. Her cardiopulmonary and gastrointestinal examinations were normal. A punch biopsy taken from her right lower limb demonstrated findings consistent with leucocytoclastic vasculitis (LCV). Direct immunofluorescence demonstrated IgA deposits within the vasculature. IgA LCV secondary to COVID-19 vaccination was proposed on the basis of histological and clinical findings. Treatment consisted of oral steroids, oral antibiotics for secondary infection and wound dressings. Opioid analgesia and nitrous oxide were implemented for severe pain associated with dressing changes. As her urinary protein creatinine ratio was in excess of 100 mg dL-1 and microscopic haematuria was noted on urine microscopy, she was referred to nephrology. We note case reports of patients diagnosed with LCV up to 2 weeks following COVID-19 vaccination (Cavalli G, Colafrancesco, De Luca G et al. Cutaneous vasculitis following COVID- 19 vaccination. Lancet Rheumatol 2021;3: E743-4). In this case, onset of symptoms occurred within hours. While this presentation may have been coincidental, the relationship between immune complex vasculitis, COVID-19 infection (Iraji F, Galehdari H, Siadat AH, Bokaei Jazi S. Cutaneous leukocytoclastic vasculitis secondary to COVID-19 infection: a case report. Clin Case Rep 2020;9: 830-4) and vaccination (Cavalli et al.) has been reported in the literature and represents the most likely diagnosis.

7.
BJOG: An International Journal of Obstetrics and Gynaecology ; 129:174, 2022.
Article in English | EMBASE | ID: covidwho-1956661

ABSTRACT

Objective: Sustainability in a QIP is a pivotal domain of quality in healthcare. It induces the need of implementing changes in a QIP which add value to the results. In a secondary level hospital of Qatar, a quality improvement project was proposed to reduce the SSIs from 8.3% in 2013. SSI rates were reduced to 1.47% in 2016. However, it was noted that in women with high risk for wound infection, the SSIs rate increased to 10.71% in the last quarter of 2016. To make the project sustainable, in the second quarter of the year 2017, changes were implemented, and antibiotic prophylaxis was given to high-risk cases and the results were evaluated. Design: Quality Improvement Project (QIP) Methods: PDSA cycle was implemented. All women operated at our hospital by either elective or emergency Cesarean from third quarter of 2017 to 2020 were included. Women who were operated in other facilities with SSIs were excluded. A total of 8372 women were delivered by Cesarean section during the study period. Extended use of antibiotics was implemented for 48 h in patients with high risk of SSI. SSIs rate was considered as the key performance indicator and statistical evaluation (odds' ratio) was carried out using online statistical software. Results: The overall SSIs rate observed after implementation of changes was 1.51%. Significant decrease was noted (3.26% vs. 1.51%) (p < 0.001). In the first quarter of 2017, the SSIs rate was 2.73%. After the completion of 14 quarters of the project in 2020, results were analyzed. In the last two quarters of 2019, a significant decrease in SSIs was noted and the SSIs rate reduced to less than one percent. Due to the COVID-19 pandemic, post-operative wound evaluation was done by telephonic consultation by midwives. During this period the rate of SSIs increased to 2.60% in the last quarter of 2020. However, there was insignificant increase in the annual rate of SSIs (1.8% vs. 1.51%). Face to face appointments were re-started as the cases of COVID-19 decreased in the country in 2021. Conclusion: The project led to a great impact on quality. It reduced the rates of SSRIs significantly. Reduced the duration of hospital stay and the cost of care. It also reduced the re-admissions due to SSIs. This project clearly proves that sustainability improves quality by immediate benefits and motivates changes that redefine value.

8.
Journal of Investigative Dermatology ; 142(8):S66, 2022.
Article in English | EMBASE | ID: covidwho-1956221

ABSTRACT

The impact of the COVID-19 pandemic caused dermatology providers to use telemedicine to safely arrange clinic appointments during lockdowns. This study aimed to evaluate the impact of telehealth on antibiotic prescription length. Specifically, we sought to compare antibiotic length prescription for virtual vs. in-person visits before, during, and after COVID-19 shutdowns. A retrospective cohort study was performed using all documented pharmaceutical prescriptions of tetracycline in 2019-2021 prescribed by dermatology providers at a large academic tertiary referral center. Results show an increase in telemedicine visits from 0.75% (2019) to 18.51% (2020), with a decrease to 3.98% in 2021 (p<0.0001). Analysis demonstrates that a tetracycline prescription of over 91 days was given in 37.90% vs. 28.83% of visits for virtual vs. in-person visits respectively (p<0.0001). Interestingly, 52.64% of antibiotic prescriptions written by staff physician dermatologists exceeded 91 days vs. 18.18% for dermatology fellows, 25.74% for resident physicians, and 21.35% for physician-assistants (p<0.001). The demonstrated increase in duration of tetracycline prescription during virtual visits is perhaps indicative of less data available for clinical decision-making, longer wait times between provider appointments during this era of lockdowns, and providers desire to make the visit worthwhile. Future studies should explore factors related to provider decision-making in virtual compared to in-person visits. This research is important in laying a foundation for how virtual visits may play a greater role in dermatologic care as we move towards a post-COVID world.

9.
European Journal of Clinical Pharmacology ; 78:S32, 2022.
Article in English | EMBASE | ID: covidwho-1955962

ABSTRACT

Introduction: Antimicrobial resistance is recognized as one of the top 10 threats to public health.Due to recent circumstanceswith the 2019 Covid pandemic worldwide, the urgency of monitoring antibiotic consumption and rational use of medications has increased. According to WHO recommendations, countries should aim to increase the proportion of Access group antibiotics consumption to 60% and higher in AWaRe classification system (Access,Watch and Reserve). The ABC/VEN analysis (80%, 15%, 5% of spending) is the simplest and most relevant method for evaluating the effectiveness of antibiotic therapy expenditures. Objectives: Evaluating the cost-effectiveness of antibiotic therapy in the Department of Pulmonology. Methods: ABC/VEN analysis was performed with data on antibiotic costs in the pulmonology department (30 beds) of a multidisciplinary regional hospital (844 beds in total) with 1 full-time clinical pharmacologist for no clinical pharmacy or pharmacology service. To analyze antibiotic consumption patterns according to the AWaRe 2021 classification, we used data on the number of antibiotics procured. Results: The results of the antibiotics spending analysis from 2019-2021 showed that all antibiotics from the most costly group A (80% of total spending) are in the Watch group (J01DH Carbapenems - Ertapenem, Doripenem, Meropenem;J01MA Fluoroquinolones - Levofloxacin;J01DD Third-generation-cephalosporins - Ceftazidime, Ceftriaxone and J01DE Fourth-generation-cephalosporins: Cefepime). Meanwhile, there has been an increase in the share of spending on the most consumed group of antibiotics, J01DH Carbapenems, from 42.9% in 2019 to 62.8% by 2021. On the contrary, there is downward trend in spending on the third-generation-cephalosporins which was 35.6% in 2019 and only 6.7% by 2021. Assessment of antibiotic prescription patterns in the pulmonology department based on classification AWaRe 2021 and WHO Model List of Essential Medicines (EML) 2021 (22nd edition) revealed a negative trend in the use of the most costly group (A) of antibiotics with a low level of evidence of efficiency or safety in pulmonology: Doripenem, Ertapenem, Levofloxacin, Cefepime. However, there is a positive result in the work of the clinical pharmacology service - the drugs mentioned above were moved into group B (medium-cost) by 2021, except for Cefepim, which was not purchased at all. Conclusion: Despite the positive trend in antibiotic consumption patterns (transfer of antibiotics with efficiency proof from gr A to gr B), current antibiotic therapy in the pulmonology department needs comprehensive optimization of approach to rational antibiotic use, strengthening pharmaceutical care by implementing a clinical pharmacy service that will conduct regular systematic evaluation and contribute to the pharmacoeconomic expediency of antibiotic therapy. Suchmeasures lead to an improvement of the quality of medical care for the population and reduce the cost of this nosology, which proves that there is a need for a comprehensive detailed analysis.

10.
European Journal of Clinical Pharmacology ; 78:S79, 2022.
Article in English | EMBASE | ID: covidwho-1955957

ABSTRACT

Introduction: Drug-drug interactions (DDI) are generally a significant cause of morbidity and mortality, as well as increased costs and length of hospital stay. In Sweden today, electronic health records with integrated DDI warnings have been implemented in virtually all hospitals, with the exception of the intensive care units, where the medications charts are either still on paper or, if electronic, still not connected to DDI warning systems. However, in the ICU, it may well be that the clinical relevance of interaction warnings differ from ordinary care, due to the type of medications used, as well as the close monitoring of the patients. Objectives: This study aimed to determine the frequency of potential DDIs and clinically relevant DDIs during the hospitalization of patients in three different Swedish ICUs at the same university hospital. Methods: This observational pilot study was conducted at a mixed ICU, a cardiothoracic ICU and a neurosurgical ICU over the course of a total of 5 months during the covid-19 pandemic year 2021. The investigator visited the ward once weekly and checked all prescribed medications on that day for each patient against the DDI database SFINX/Janusmed Interactions. The result was communicated to the physician in charge. Results: The sample size included 172 patients. A total of 53 patients (31%) were found to have at least one potential DDI (pDDI). The most common pDDIs in all three ICUs were drugs with risk of QT prolongation and drugs with increased risk of serotonergic toxicity. 29-41% of the pDDIs in the different ICUs were drugs with risk of QTprolongation, the most frequent drugs being amiodarone, antibiotics (erythromycin, moxifloxacin and ciprofloxacin) and ondansetrone. 7-24% of the pDDIs in the different ICUs were drugs with increased risk of serotonergic toxicity, the most frequent drugs being selective serotonin reuptake inhibitors (SSRI), fentanyl, remifentanil, pethidine and metoclopramide. Neurosurgical intensive care patients were exposed to higher frequency of pDDI with serotonergic toxicity compared with the other intensive care unit-patients. Observed pDDIs led to dose-adjustment in 6 cases and exchange of drugs in 4 cases. No adverse drug reactions (ADRs) were observed. Conclusion: Potential DDIs are common in ICU patients, but far from all are clinically relevant.We need to learn more about the clinical relevance of the pDDIs in this patient setting, as a basis for customized either manual or computerized decision support algorithms to decrease the risk of unfavorable outcomes due to DDIs.

11.
European Journal of Clinical Pharmacology ; 78:S30-S31, 2022.
Article in English | EMBASE | ID: covidwho-1955953

ABSTRACT

Introduction: Antibiotic resistances are among themost threatening public health issues worldwide, being highly associated with inadequate antibiotic use. To tackle this challenge, it is crucial to educate health professionals to appropriately prescribe and dispense antibiotics. Thus, out team developed eHealthResp, an educational intervention composed by two online courses and a clinical decision support system in the form of a mobile app directed to primary care physicians and community pharmacists, aiming to improve antibiotic prescribing and dispensing in respiratory tract infections. Objectives: The main goal of this pilot study is to validate the eHealthResp online courses and the clinical decision support system (mobile app), involving a small group of health professionals. Methods: Aproximately 15 physicians and 15 pharmacists will be recruited to participate in the study. Participants will have complete autonomy to explore and evaluate the eHealthResp mobile app and online courses, composed by six modules on respiratory tract infections for physicians (i) acute otitis media, ii) acute rhinosinusitis, iii) acute pharyngotonsilitis, iv) acute tracheobronchitis, v) community-acquired pneumonia, and vi) COVID-19), and three modules for pharmacists (i) common cold and flu, ii) acute rhinosinusitis, acute pharyngotonsilitis, and acute tracheobronchitis, and iii) acting protocol). Each online course is also composed by four clinical cases and the most recommended pharmacological therapy. Additionally, for the the global validation of the online course and the mobile app, participants will be invited to complete a questionnaire including three sections of questions. The first part, consisting of five brief questions, will allow the collection of sociodemographic data. The second part contains four groups of closed questions, and the third part consists of four open-answer questions, both aiming to evaluate the online course and mobile app elements. Results: After the assessment made by the physicians and pharmacists who agreed to participate in the pilot study, the data obtained will be duly analyzed and integrated by the research team. The appropriate changes will be incorporated into the e-Health platforms to improve the quality of both the online courses and the eHealthResp mobile app. Conclusions: The findings of this pilot study will provide important information for the next stage of the project, ensuring the feasibility of the educational interventions in a group of primary care physicians and community pharmacists from the Centre region of Portugal, using a randomized controlled trial designed by clusters.

12.
Pakistan Paediatric Journal ; 46(2):229-232, 2022.
Article in English | EMBASE | ID: covidwho-1955740

ABSTRACT

Staphylococcal aureus infection in children is a major public health problem globally. It causes a varied spectrum of clinical disease including bacteremia, endocarditis, skin and soft tissue infection, pleuro-pulmaonry and osteo-articular infection. Deep vein thrombosis (DVT) is a known complication of staphylococcal infection. We report a case series which included, 10-year old boy developed DVT, septic pulmonary emboli and Methicillin-resistant Staphylococcal aureus (MRSA) bacteremia following a furuculosis and 13 year old girl with thrombosis of internal and external jugular vein, cavernous sinus with pulmonary emboli and MRA bacteremia. Both patients are previously healthy showed complete recovery after aggressive appropriate antibiotics, anticoagulants and supportive care. The high index of suspicion of DVT in MRSA infection is needed, prompt diagnosis and aggressive appropriate therapies improve the outcomes and minimize the complications.

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14.
Supportive Care in Cancer ; 30:S77, 2022.
Article in English | EMBASE | ID: covidwho-1935803

ABSTRACT

Introduction Granulocyte colony stimulating factor (G-CSF) is a crucial supportive care medication, used for the prevention of febrile neutropenia in patients undergoing chemotherapy. Early in the COVID-19 pandemic, experts began discussing whether increased use of G-CSF in cancer patients and the minimization of the neutropenic period could provide benefit in that patient population. Concerns were soon raised, however, regarding the potential synergy between the pro-inflammatory COVID-19 disease process and immune stimulation from G-CSF administration. It was noted that COVID-19 patients exposed to G-CSF were developing markedly elevated Neutrophil to Lymphocyte Ratios (NLR), indicating an excessive inflammatory response and an increased risk of ARDS and inhospital mortality. The purpose of this study is to better understand the potential harm caused by this synergy. Methods We used TriNetX, a global health research network providing access to electronic medical records from approximately 85 million patients in 64 large healthcare organizations. The platform only contains de-identified data as per the de-identification standard defined in Section 164.514(a) of the HIPAA Privacy Rule. SARS-CoV-2 infection was determined by laboratory codes 9088, 94309-2, and 94500-6, indicating the presence of COVID-19 RNA. Use of G-CSF was determined by J-code J1442, indicating its administration through having been billed to the patient. Two neutropenic (ANC <1,000/microliter) cohorts were then generated, one having COVID-19 infection and G-CSF administration within the subsequent 2 weeks, and the other with COVID-19 infection and no G-CSF administration. Both cohorts were balanced for age, gender, race, and ethnicity. Most importantly, the cohorts were balanced for average initial neutrophil count to rule out the potential sampling error of more severely neutropenic patients having worse outcomes. These criteria resulted in cohorts of 715 patients each. The cohorts were then evaluated for the outcome of “ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing” via procedure code 1014859. Results Patients who received G-CSF within 2 weeks following COVID-19 infection were 3.7 times more likely to end up on a ventilator (p<0.0001), and had 3.5 times greater 60-day mortality (6.557% vs 1.878%, p<0.0001). Conclusions SARS-CoV-2 infection is associated with a significant inflammatory response, and the use of G-CSF in neutropenic patients within 2 weeks of infection is associated with a significant increased risk of need for mechanical ventilation and increased risk of 60-day mortality. Use of G-CSF in this patient population should be discouraged in favor of broadspectrum antibiotic coverage.

15.
Congenital Heart Disease ; 17(4):399-419, 2022.
Article in English | EMBASE | ID: covidwho-1939710

ABSTRACT

Background: Adult patients with congenital heart disease (ACHD) might be at high risk of Coronavirus disease-2019 (COVID-19). This study aimed to report on a one-year tertiary center experience regards COVID-19 infection in ACHD patients. Methods: This is a one-year (March-2020 to March-2021) tertiary-center retrospective study that enrolled all ACHD patients;COVID-19 positive patients’ medical records, and management were reported. Results: We recorded 542 patients, 205 (37.8%) COVID-19-positive, and 337 (62.2%) COVID-19-negative patients. Palliated single ventricle and Eisenmenger syndrome patients were more vulnerable to COVID-19 infection (P < 0.05*). Cardiovascular COVID-19 complications were arrhythmias in 47 (22.9%) patients, heart failure in 39 (19.0%) patients, cyanosis in 12 (5.9%) patients, stroke/TIA in 5 (2.4%) patients, hypertension and infective endo-carditis in 2 (1.0%) patients for each, pulmonary hypertension and pulmonary embolism in 1 (0.5%) patient for each. 11 (5.4%) patients were managed with home isolation, 147 (71.7%) patients required antibiotics, 32 (15.6%) patients required intensive care unit (ICU), 8 (3.9%) patients required inotropes, 7 (3.4%) patients required mechanical ventilation, and 2 (1.0%) patients required extracorporeal membrane oxygenation (ECMO). Thromboprophylaxis was given to all 46 (22.4%) hospitalized patients. American College of Cardiology/American Heart Association classification revealed that complex lesions, and FC-C/D categories were more likely to develop severe/critical symptoms, that required mechanical ventilation and ECMO (P < 0.05*). Mortality was reported in 3 (0.6%) patients with no difference between groups (P = 0.872). 193 (35.6%) patients were vaccinated. Conclusions: COVID-19 infection in ACHD patients require individualized risk stratification and management. Eisenmenger syndrome, single ventricle palliation, complex lesions, and FC-C/D patients were more vulnerable to severe/critical symptoms that required ICU admission, mechanical ventilation, and ECMO. The vaccine was mostly tolerable.

16.
Journal of the Nepal Medical Association ; 60(251):625-630, 2022.
Article in English | EMBASE | ID: covidwho-1939705

ABSTRACT

Introduction: Antimicrobial resistance is a global health problem. The widespread and improper antibiotics use is the leading cause of antimicrobial resistance. Bacterial co-infection in COVID-19 patients is the basis for the use of antibiotics in the management of COVID-19. COVID-19 pandemic has seriously impacted antibiotic stewardship and increased the global usage of antibiotics, worsening the antimicrobial resistance problem. The use of antibiotics among COVID-19 patients is high but there are limited studies in the context of Nepal. This study aimed to find out the prevalence of antibiotic use among hospitalised COVID-19 patients in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted on hospitalised COVID-19 patients from April 2021 to June 2021 in a tertiary care centre. Ethical approval was taken from the Institutional Review Committee (Reference number: 2078/79/05). The hospital data were collected in the proforma by reviewing the patient’s medical records during the study period of 2 months. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 106 hospitalised COVID-19 patients, the prevalence of antibiotics use was 104 (98.11%) (95.52-100, 95% Confidence Interval). About 74 (71.15%) of patients received multiple antibiotics. The most common classes of antibiotics used were cephalosporins, seen in 85 (81.73%) and macrolides, seen in 57 (54.81%) patients. Conclusions: The prevalence of antibiotics use among hospitalised COVID-19 patients was found to be higher when compared to other studies conducted in similar settings.

17.
Journal of Pure and Applied Microbiology ; 16(2):867-875, 2022.
Article in English | EMBASE | ID: covidwho-1939573

ABSTRACT

Klebsiella pneumoniae is a common bacterial pathogen causes wide range of infections all over the world. The antimicrobial resistance of K. pneumoniae is a global concern and expresses several virulence factors contributing to the pathogenesis. The incidences of bacterial co-infection in viral pneumonia are common. Increased risk of K. pneumoniae co-infection in viral respiratory tract infection should be alerted in COVID-19 pandemic period. The study aims to detect the association between antimicrobial resistance and factors causing pathogenicity of K. pneumoniae. For the current study, 108 K. pneumoniae clinical isolates were included. Antimicrobial susceptibility test was done by Kirby-Bauer disc diffusion method according to CLSI guidelines. Virulence factors such as biofilm formation, haemagglutination, haemolysins, hypermucoviscocity, siderophore, amylase, and gelatinase production were determined by phenotypic method. In this study K. pneumoniae showed high level of antimicrobial resistance towards ampicillin (92.59%) followed by amoxicillin-clavulanic acid (67.59%) and cotrimoxazole (47,22%). An important association between biofilm formation and antimicrobial resistance was found to be statistically significant for cotrimoxazole (P-value 0.036) and amoxicillin-clavulanic acid (P-value 0.037). Other virulence factors like hypermucoviscocity, haemagglutination, amylase, and siderophore production were also showed a statistically significant relation (P-value <0.05) with antimicrobial resistance. Further molecular studies are necessary for the identification of virulence and antimicrobial resistance genes, for the effective control of drug-resistant bacteria.

18.
Journal of Acute Disease ; 11(3):123-126, 2022.
Article in English | EMBASE | ID: covidwho-1939145

ABSTRACT

Rationale: The mechanism of sudden cardiac death in COVID-19 can be multifactorial. Cardiac hypersensitivity to 5-ASA therapy leading to myocarditis has been reported in some cases. Cytokine storm syndrome and idiosyncratic reaction with mesalazine use may lead to sudden cardiac death in COVID-19. Use of immunosuppressants in hospitalized COVID-19 patients should be continued with caution, especially in patients with inflammatory bowel disease. Patient's concern: A 75-year-old man who was tested positive for SARS-CoV-2 was admitted with a history of shortness of breath for the last two days. He was a known case of Crohn's disease treated with mesalazine. Diagnosis: COVID-19 pneumonia with underlying Crohn's disease leading to sudden cardiac death. Intervention: Remdesivir, antibiotics, steroids, low molecular weight heparin, tablet zinc, tab vitamin C, and other supportive treatment were started. Because of increased inflammatory markers, itolizumab was given to the patient on the 2nd day. Outcome: On the 5th day of the intensive care unit, the patient complained of sudden chest pain with respiratory distress leading to bradycardia and asystole and could not be resuscitated. Lessons: Causes for sudden cardiac death in COVID-19 pneumonia patients with Crohn's disease is multifactorial. Although mesalazine may be a safe and effective drug in the management of inflammatory bowel disease, it can induce sytokine strom syndrome and idiosyncratic reactions that could be one of the reasons of sudden cardic death. Therefore, we should be aware of its serious and potentially life-threatening complications, especially in COVID-19 infected patients.

19.
Open Access Macedonian Journal of Medical Sciences ; 10:1383-1391, 2022.
Article in English | EMBASE | ID: covidwho-1939099

ABSTRACT

BACKGROUND: No gold standard therapy was approved globally for COVID-19 pneumonia to the date of this study. The pathophysiology of SARS-CoV-2 infection displayed the predominance of hyperinflammation and immune dysregulation in inducing multiorgan damage. Therefore, the potential benefits of both immune modulation and suppression in COVID-19 have been extensively discussed as a modality to control cytokine release syndrome (CRS). Abnormally high levels of interleukin-6 (IL-6) are a common finding in COVID-19 patients with pneumonia and acute respiratory distress syndrome, so the use of IL-6 antagonist was tested as a therapeutic option in controlling the disease. Tocilizumab is a recombinant humanized anti-human IL-6 receptor monoclonal antibody that can specifically bind the membrane-bound IL-6 receptor and soluble IL-6 receptor, thereby inhibiting signal transduction. Tocilizumab is currently FDA approved for the management of rheumatoid arthritis, giant cell arthritis, polyarticular juvenile idiopathic arthritis, and systemic juvenile idiopathic arthritis. This study is a retrospective analysis of data polled during Phase I of COVID pandemic, adopted by the isolation hospital of Kasr Al-Ainy Medical School, Cairo University, during the period from May to September 2020. AIM: The aim of this study is to evaluate tocilizumab influence in the outcome;in terms of reducing the hospital stay, risk and duration of mechanical ventilation (invasive and noninvasive), mortality, and the incidence of complications related to drugs use (secondary bacterial infection and GIT bleeding) in patients with moderate-to-severe COVID-19. METHODS: This retrospective, observational cohort study included adults (between 18 and 80 years) with moderate-to-severe COVID-19 pneumonia, who were admitted to isolation hospital of Kasr Al-Ainy Medical School, Cairo University, between May and September 2020. We segregated the patients into two groups: Group A: In addition to the standard care protocol according to the local guidelines of the Egyptian Ministry of Health and Population in that period (supplemental oxygen, steroids in a dose of 1–2 mg/kg methylprednisolone for 5–10 days, broad-spectrum antibiotics, vitamins, and prophylactic dose of anticoagulation with low-molecular-weight heparin, proton-pump inhibitor, and poly-vitamins), they received tocilizumab intravenously in a dose of 8 mg/kg bodyweight (up to a maximum of 800 mg per dose), divided in two shots 12–24 h apart. Group B: Those received the standard care protocol alone, noting that guidelines were adjusted later on according to the updated scientific publications and WHO recommendations. The primary endpoint was to evaluate the effect of different regimens in controlling the disease, the need for mechanical ventilation and its duration (either invasive or non-invasive), length of ICU stay, hospital stay, and in-hospital mortality. Comparisons between quantitative variables were done using the non-parametric Mann–Whitney U-test. For comparison of serial measurements within each patient, the non-parametric Wilcoxon signed-rank test was used. For comparing categorical data, Chi-square (2) test was performed. Exact test was used instead when the expected frequency was <5. Correlations between quantitative variables were done using Spearman correlation coefficient. RESULTS: During this period, 166 patients were admitted to ICU, suffering from severe hypoxemia with moderate to severe COVID-19 pneumonia, 10 of them were excluded (three were over 80 years old, other three had advanced stages of malignancy, two were on steroids therapy and non-invasive home ventilation due to chronic chest condition, and two were presented with MODs and deceased in <48 h from admission), thus, 156 were included in the study. Group A: Seventy-six patients (49%) received tocilizumab in addition to standard therapy, Group B: Eighty patients (51%) received standard therapy only. In Group A, the mean length of ICU stay was 8.96 days with mean length of hospital stay 13.76, compared to mean length f ICU stay 9 days in Group B (p = 0.57) and mean length of hospital stay 12.46 days (p = 0.117). In Group A, 35 patients (46%) needed non-invasive mechanical ventilation (MV),12 patients of the 35 needed invasive MV in later stage, compared to 26 patients (32%) in Group B, 14 patients of the 26 needed invasive MV in later stage (p = 0.16). In Group A, 14 patients (18.4%) needed invasive mechanical ventilation, compared to 19 patients (23.7%) in Group B (p = 0.213). In Group A, 6 (7.9%) of 76 patients died, compared to 13 (16.3%) of 80 in Group B p = 0.11. The incidence of secondary bacterial infection in Group A was 16 patients (21%) compared to 21 (26%) in Group B (p = 0.44). CONCLUSION: In this study, we did not detect statistical difference in both groups of patients coming during CRS-associated COVID-19 pneumonia, regarding (ICU stay, need for and length of MV, the incidence of secondary bacterial infection, and in-hospital mortality) for COVID-19 moderate-to-severe pneumonia.

20.
Circulation: Cardiovascular Quality and Outcomes ; 15, 2022.
Article in English | EMBASE | ID: covidwho-1938114

ABSTRACT

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

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