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1.
Eur J Cancer Care (Engl) ; : e13762, 2022 Oct 28.
Article in English | MEDLINE | ID: covidwho-2097737

ABSTRACT

OBJECTIVE: We aim to evaluate anxiety, depression and fear of cancer progression in newly diagnosed patients with breast cancer when cancer care was returning to normal after COVID-19 by comparing them with the pre-COVID patients and explore the association of worries about further cancer care and loneliness with them. METHODS: Two hundred and eighteen newly diagnosed patients with breast cancer during the pandemic were surveyed using questionnaires, and 153 patients before the pandemic were included in the control group. Logistic regression analyses were used. RESULTS: There were 51.8%, 44.0% and 30.7% of patients during the pandemic reported anxiety symptoms, depressive symptoms and clinically significant fear of cancer progression, respectively. The risks of anxiety symptoms (OR 2.24, 95% CI 1.43-3.51), depressive symptoms (1.61, 1.04-2.50) and clinically significant fear of cancer progression (4.65, 2.49-8.70) were higher in patients during the pandemic than pre-COVID patients. Worries about further cancer care and loneliness were associated with 1.40-2.52 times higher risks of these psychological problems among the patients during the pandemic. CONCLUSIONS: The newly diagnosed patients with breast cancer during COVID-19 are at elevated risks of depression, anxiety and fear of cancer progression, and those who are worried about further cancer care and felt loneliness during the pandemic were more likely to experience psychological problems.

2.
G Chir ; 42(2): e02, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2097497

ABSTRACT

Background: The present study aims to evaluate how the measures to contain the SARS-CoV-2 spreading affected the surgical site infections (SSIs) rate in patients who underwent nondeferrable breast cancer surgery (BCS). Methods: This study is a retrospective analysis of prospectively collected data from a consecutive series of patients underwent nondeferrable BCS in a regional Italian Covid-free hub during two different period: March to April 2020 (pandemic cohort [PC]) and March till April 2019 (control cohort [CC]). SSIs were defined according to the criteria established by the Center for disease control and prevention (CDC) and additional treatment, serous discharge, erythema, purulent exudate, separation of deep tissues, isolation of bacteria, and stay (ASEPSIS) scoring systems. Results: One hundred ninety-nine patients were included in the present study: 100 and 99 patients who underwent nondeferrable BCS from March to April 2020 (PC) and from March to April 2019 (CC), respectively. The overall SSIs rate in this series was 9.1% according to CDC criteria and 6.5% according to ASEPSIS criteria. The SSIs incidence decreased during the pandemic period. Moreover, the SSIs rate according to ASEPSIS criteria was statistically lower in the PC than in the CC. We observed significant evidence of higher SSIs, both in terms of CDC and ASEPSIS score, in patients having undergone breast reconstruction compared with patients not undergoing immediate reconstruction. Conclusions: The restrictive measures issued during the lockdown period seemed to lower the SSIs rates in patients undergoing nondeferrable BCS.

3.
Clin Endocrinol (Oxf) ; 2022 Oct 22.
Article in English | MEDLINE | ID: covidwho-2088148

ABSTRACT

OBJECTIVE: Aromatase inhibitor (AI) therapy provides oncological benefits in postmenopausal women with oestrogen receptor-positive breast cancer. However, AI treatment has been associated with increased cardiovascular risk. In nonbreast cancer populations, experimentally induced low oestrogen states and natural transition to menopause have been associated with increases in visceral adipose tissue (VAT), a known surrogate marker for cardiometabolic risk. Given that AI treatment blocks oestradiol production, we hypothesized that AI treatment would increase VAT. METHODS: We conducted a prospective 12-month cohort study of 52 postmenopausal women newly initiating AI treatment (median age: 64.5 years) and 52 women with breast pathology not requiring endocrine therapy (median age: 63.5 years). VAT area and other body composition parameters were measured at baseline, 6 months and 12 months using dual X-ray absorptiometry. Other risk markers of cardiometabolic health were also assessed. RESULTS: In women initiating AI treatment, there was no statistically significant difference in VAT area after 12 months when compared to controls, with a mean adjusted difference of -5.00 cm2 (-16.9, 6.91), p = .55. Moreover, changes in total fat mass, lean mass, subcutaneous adipose tissue area, hepatic steatosis and measures in endothelial function were also not statistically different between groups after 12 months. Findings were similar after adjustments for activity levels and coronavirus disease 2019 lockdown duration. CONCLUSIONS: These data provide reassurance that over the initial 12 months of AI therapy, AI treatment is not associated with metabolically adverse changes in body composition, hepatic steatosis or vascular reactivity. The impact of extended AI therapy on cardiometabolic health requires further study.

4.
Journal of Surgical Research ; JOUR
Article in English | ScienceDirect | ID: covidwho-2082664

ABSTRACT

Introduction The COVID-19 pandemic caused interruptions in the delivery of medical care across a wide range of conditions including cancer. Trends in surgical treatment for cancer during the pandemic have not been well described. We sought to characterize associations between the pandemic and access to surgical treatment for breast, colorectal, and lung cancer in Illinois. Methods We performed a retrospective cohort study evaluating inpatient admissions at Illinois hospitals providing surgical care for lung cancer (n=1913 cases, n=64 hospitals), breast cancer (n=910 cases, n=108 hospitals), and colorectal cancer (n=5339 cases, n=144 hospitals). Using discharge data from the Illinois Health and Hospital Association’s Comparative Health Care and Hospital Data Reporting Services database, average monthly surgical case volumes were compared from 2019 to 2020. We also compared rates of cancer surgery for each cancer type, by patient characteristics, and hospital type across the three time periods using Pearson chi-squared and ANOVA testing as appropriate. Three discrete time periods were considered: pre-pandemic (7-12/2019), primary pandemic (4-6/2020), and pandemic recovery (7-12/2020). Hospital characteristics evaluated included hospital type (academic, community, safety net), COVID-19 burden, and baseline cancer surgery volume. Results There were 2096 fewer operations performed for breast, colorectal, and lung cancer in 2020 than 2019 in Illinois, with the greatest reductions in cancer surgery volume occurring at the onset of the pandemic in April (colorectal, -48.3%;lung, -13.1%) and May (breast, -45.2%) of 2020. During the pandemic, breast (-14.6%) and colorectal (-13.8%) cancer surgery experienced reductions in volume whereas lung cancer operations were more common (+26.4%) compared to 2019. There were no significant differences noted in gender, race, ethnicity, or insurance status among patients receiving oncologic surgery during the primary pandemic or pandemic recovery periods. Academic hospitals, hospitals with larger numbers of COVID-19 admissions, and those with greater baseline cancer surgery volumes were associated with the greatest reduction in cancer surgery during the primary pandemic period (all cancer types, p<0.01). During the recovery period, hospitals with greater baseline breast and lung cancer surgery volumes remained at reduced surgery volumes compared to their counterparts (p<0.01). Conclusions The COVID-19 pandemic was associated with significant reductions in breast and colorectal cancer operations in Illinois, while lung cancer operations remained relatively consistent. Overall, there was a net reduction in cancer surgery that was not made up during the recovery period. Academic hospitals, those caring for more COVID-19 patients, and those with greater baseline surgery volumes were most vulnerable to reduced surgery rates during peaks of the pandemic and to delays in addressing the backlog of cases.

5.
J Mammary Gland Biol Neoplasia ; 2022 Oct 15.
Article in English | MEDLINE | ID: covidwho-2075491

ABSTRACT

The thirteenth annual workshop of the European Network for Breast Development and Cancer (ENBDC) Laboratories Annual Workshop took place on the 28-30 April 2022 in Weggis, Switzerland and focused on methods in mammary gland biology and breast cancer. Sixty scientists participated in the ENBDC annual workshop which had not been held in person since 2019 due to the global COVID-19 pandemic. Topics spanned the mammary gland biology field, ranging from lactation biology and embryonic development, single cell sequencing of the human breast, and stunning cutting-edge imaging of the mouse mammary gland and human breast as well as breast cancer research topics including invasive progression of the pre-invasive DCIS stage, metabolic determinants of endocrine therapy resistance, models for lobular breast cancer, and how mutational landscapes of normal breast during age and pregnancy determine cancer risk. The latest findings from participating researchers were presented through oral presentations and poster sessions and included plenty of unpublished work.

6.
Eur J Radiol ; 152: 110334, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-2076083

ABSTRACT

BACKGROUND: Axillary lymph node characteristics on axillary ultrasound (US), breast MRI and 18F-FDG PET/CT are relevant at breast cancer diagnosis. Axillary lymphadenopathy after COVID-19 vaccination has been frequently reported. This may cause a diagnostic dilemma, particularly in the ipsilateral axilla in women who have a either a recent diagnosis of breast cancer or a history of breast cancer. This review provides an overview of the current evidence regarding axillary lymph node characteristics at breast cancer diagnosis versus "post-COVID-19 vaccination". METHODS: A non-systematic narrative review was performed. Studies describing axillary lymph node characteristics per imaging modality (axillary US, breast MRI and 18F-FDG PET/CT) in breast cancer patients versus post-COVID-19 vaccination were selected and used for the current study. RESULTS: The morphologic characteristics and distribution of abnormal nodes on US may differ from the appearance of metastatic adenopathy since diffuse cortical thickening of the lymph nodes is the most observed characteristic after vaccination, whereas metastases show as most suspicious characteristics focal cortical thickening and effacement of the fatty hilum. Current evidence on MRI and 18F-FDG on morphologic characteristics of axillary lymphadenopathy is missing, although it was suggested that vaccine related lymphadenopathy is more likely to be present in level 2 and 3 nodes than metastatic nodes. Reported frequencies of lymphadenopathy post-COVID-19 vaccination range from 49% to 85% (US), 29% (breast MRI) and 14.5% to 53.9% (18F-FDG PET/CT). Several factors may impact the presence or extent of lymphadenopathy post-COVID-19 vaccination: injection site, type of vaccine (i.e., mRNA versus vector), time interval (days) between vaccination and imaging, previous history of COVID-19 pneumonia, and first versus second vaccine dose. CONCLUSION: Although lymph node characteristics differ at breast cancer diagnosis versus post-COVID-19 vaccination, clinical information regarding injection site, vaccine type and vaccination date needs to be documented to improve the interpretation and guide treatment towards the next steps of action.


Subject(s)
Breast Neoplasms , COVID-19 , Lymphadenopathy , Axilla/pathology , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Fluorodeoxyglucose F18 , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/etiology , Lymphadenopathy/pathology , Positron Emission Tomography Computed Tomography , Vaccination
7.
International Journal of Stress Management ; 2022.
Article in English | Web of Science | ID: covidwho-2069866

ABSTRACT

This study seeks to expand previous research by examining (a) the prevalence rates of posttraumatic growth (PTG) and its potential predictors (posttraumatic stress symptoms [PTSS], perceived stress, adaptive coping strategies, social support) during the first and second lockdown in the general population of Greece, and (b) the mediating role of the stress indicators (PTSS/perceived stress) in the relationship between positive reframing and PTG. A sample of 1,361 participants (1.009 in the first lockdown and 352 in the second lockdown) completed the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), The Perceived Stress Scale (PSS-10), the Posttraumatic Growth Inventory, the Brief Coping Orientation to Problems Experienced Inventory and the ENRICHD Social Support Instrument (ESSI). Moderate levels of PTG were found during both lockdowns. PTG did not significantly increase during the second lockdown. PTG was associated with PTSS during the first lockdown and with perceived stress during the second one;these two stress indicators partially mediated the positive reframing-PTG relationship in the first and second lockdown, respectively. Both adaptive and maladaptive coping strategies predicted PTG during the first lockdown, whereas only adaptive coping strategies predicted PTG during the second lockdown. Perceived social support, emotional during the first lockdown and instrumental during the second one, predicted PTG during the two lockdowns, respectively. The results of this study may enhance our understanding of PTG and its predictor to inform the design of interventions moving beyond growth cognitions into growth actions.

8.
Eur J Breast Health ; 18(4): 306-314, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2066929

ABSTRACT

Objective: To assess the impact of the coronavirus disease-2019 (COVID-19) pandemic screening restrictions on the diagnosis and treatment of breast cancer in a single health system. Materials and Methods: We performed a retrospective, cohort investigation of breast cancer patients at a multi-institution health system from March 1, 2019 to December 31, 2020 with two time periods related to the pandemic: "Early phase" (March 18 - June 7) reflecting the time of the screening mammography moratorium and "Late phase" (June 8 - December 31) to reflect the time once screening mammography resumed. 2020 was compared to 2019 to exclude potential differences from temporal or seasonal changes. Variables included demographics, COVID related-deferral, cancer specific data, method of detection, type of treatment recommended and received. Results: Fewer patients presented with a breast cancer diagnosis during Early phase 2020 when compared to any other time period. Numbers increased significantly in Late phase 2020; total numbers of patients seen in 2020 approached but did not completely reach that of 2019. When compared to other time periods, patients who presented during the moratorium on screening were younger, more likely to be black, had a higher Body Mass Index, and were more likely to have a human epidermal growth factor receptor 2 positive tumor. There was a slight increase in size of presenting tumor and node positivity, although no differences in breast or axillary surgical management were identified. Conclusion: Despite an increase in tumor size and positive nodal status seen during the screening moratorium, surgical treatment was not negatively impacted.

9.
Oncologist ; 2022 Oct 11.
Article in English | MEDLINE | ID: covidwho-2062950

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic affected millions of individuals, and patients with cancer are known to be more susceptible. Vaccines against SARS-CoV-2 have been developed and used for patients with cancer, but scarce data are available on their efficacy in patients under active anti-cancer therapies. MATERIALS AND METHODS: In this study, we semi-quantitatively measured the titers of the immunoglobulin G against the anti-spike protein subunit 1 of SARS-CoV-2 after vaccination of patients with early breast cancer undergoing concurrent chemotherapy, endocrinal or targeted non-cytotoxic treatments, and no treatments. RESULTS: Standard doses of COVID-19 vaccines provided sufficient immune responses in patients with early breast cancer, regardless of the type of anticancer therapies. However, the post-vaccination serum anti-spike antibody titers were significantly lower in the patients under cytotoxic chemotherapy. CONCLUSION: Our study emphasizes the importance of the personalized risk stratification and consideration for booster doses in more vulnerable populations.

10.
The British Journal of Nutrition ; 128(8):1459-1469, 2022.
Article in English | ProQuest Central | ID: covidwho-2062085

ABSTRACT

Vitamin D is both a nutrient and a neurologic hormone that plays a critical role in modulating immune responses. While low levels of vitamin D are associated with increased susceptibility to infections and immune-related disorders, vitamin D supplementation has demonstrated immunomodulatory effects that can be protective against various diseases and infections. Vitamin D receptor is expressed in immune cells that have the ability to synthesise the active vitamin D metabolite. Thus, vitamin D acts in an autocrine manner in a local immunologic milieu in fighting against infections. Nutrigenetics and nutrigenomics are the new disciplines of nutritional science that explore the interaction between nutrients and genes using distinct approaches to decipher the mechanisms by which nutrients can influence disease development. Though molecular and observational studies have proved the immunomodulatory effects of vitamin D, only very few studies have documented the molecular insights of vitamin D supplementation. Until recently, researchers have investigated only a few selected genes involved in the vitamin D metabolic pathway that may influence the response to vitamin D supplementation and possibly disease risk. This review summarises the impact of vitamin D supplementation on immune markers from nutrigenetics and nutrigenomics perspective based on evidence collected through a structured search using PubMed, EMBASE, Science Direct and Web of Science. The research gaps and shortcomings from the existing data and future research direction of vitamin D supplementation on various immune-related disorders are discussed.

11.
Bull Cancer ; 2022 Sep 27.
Article in French | MEDLINE | ID: covidwho-2060483

ABSTRACT

INTRODUCTION: The COVID-19 pandemic had a profound impact on health-care systems and reduced access to care. This study assays the mid-term effects of the COVID-19 pandemic on breast cancer management over a 2-year-period in a single French Comprehensive Cancer Center. METHODS: We performed, in a French comprehensive cancer center, an observational study including all patients with newly diagnosed breast cancer between 2019 and 2021. We collected the number of first consultations for breast cancer, the number of breast and axillary surgeries, pTNM and ypTNM cancer staging, the therapeutic sequence (surgery or neoadjuvant chemotherapy as a primary treatment), patients' age and their place of residence. RESULTS: In total, 14,772 patients had a first consultation for breast cancer. Among these 9058 breast and axillary surgeries were performed, 1798 patients had neoadjuvant chemotherapy as a primary treatment. During the first COVID-19 lockdown ( March17, 2020-May 10, 2020), we observed a reduction in the number of first consultations for breast cancer and breast cancer surgeries giving respectively a 42.3% and 27% rate of change. Subsequently, we observed a resumption of consultations and surgeries with a slight increase in early 2021 compared to 2019. In addition, we did not find any difference in terms of therapeutic sequence, pTNM and ypTNM stages, age at diagnosis or place of residence between the reference year 2019 and the years 2020 and 2021. CONCLUSION: Our study shows a decrease in activity during the first lockdown of 2020, then a resumption of activity. These reassuring results only concern patients with breast cancer, and are specific to our institution, whose oncology activity was preserved during the COVID-19 pandemic.

12.
Chest ; 162(4):A2338, 2022.
Article in English | EMBASE | ID: covidwho-2060935

ABSTRACT

SESSION TITLE: All About the CLOT: VTE SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: Pulmonary embolism (PE) is a disorder of coagulation that results in significant morbidity, mortality and emergency department visits. The usage of advanced imaging for the diagnosis of PE has increased greatly, almost 400% from 1998 to 2008. The Well’s Criteria for PE uses historical features, clinician gestalt, and heart rate to risk stratify patients for PE. The score ranges from 0-12.5 and is broken down into low risk 0-2, intermediate risk 3-6, and high risk 7+. The current American College of Emergency Physician guidelines advise that a patient suspected to be at risk for PE with a low or intermediate risk can undergo age adjusted D-Dimer testing. A further addition was the PERC rule. This rule applies 8 questions to the low risk PE patient and 8 negative responses mean the clinician can forgo D-Dimer testing. How well are we adhering to this guidance, and are deviations leading to unnecessary testing which could expose our patients to harm? METHODS: 280 sequential patients receiving diagnostic testing for PE were evaluated and 156 were excluded due to known, suspected, or history of COVID-19 infection. The work-up for the included patients was reviewed and Well’s criteria and the PERC rule were applied by retrospective review. Descriptive statistics were used to describe the proportion of patients evaluated with tests not suggested for their risk strata. RESULTS: Of the 124 patients evaluated, 31/124 (25%) had potentially unnecessary testing. 18 low risk patients underwent advanced imaging—17 CTAs and 1 VQ scan– without being tested by D-Dimer. 11 low risk, PERC rule negative patients still received D-Dimers–all negative, and 1 underwent CTA. One negative age-adjusted D-Dimer still lead to a CTA. One patient with a negative D-Dimer received CTA. These 18 CTAs and 1 VQ scan were all interpreted negative for PE. CONCLUSIONS: Patients undergoing evaluation in emergency departments in the United States may be undergoing unnecessary diagnostic testing based on current guidelines and the summation of the highest quality evidence available for directing the choice of how best to evaluate this patient population. CLINICAL IMPLICATIONS: The utilization of CTA for the diagnosis of PE is not without risk. Some estimate 20 additional breast cancers per 100,000 women undergoing the test. CTA studies for PE also pose the risk of unnecessary anticoagulation. A meta-analysis of imaging for PE showed an over diagnosis rate as high as 60% for subsegmental PE when these studies were re-reviewed by a panel of expert chest radiologists. This is quite high, but even more modest meta-analyses have shown a 10% false positive rate. Patients placed on anticoagulation have an annual bleeding risk attributed to anticoagulation of 7% and mortality attributed to anticoagulation of 0.4%. Creative strategies aimed at reducing unnecessary testing can help mitigate some of this risk and protect our patients. DISCLOSURES: No relevant relationships by Parth Gandhi research support relationship with Bristol Myers Squibb Please note: 2021-2022 Added 03/31/2022 by Jason Nomura, value=Grant/Research Consultant relationship with Philips Please note: 2020-2022 Added 03/31/2022 by Jason Nomura, value=Consulting fee No relevant relationships by Dustin Slagle

13.
Chest ; 162(4):A1961-A1962, 2022.
Article in English | EMBASE | ID: covidwho-2060881

ABSTRACT

SESSION TITLE: Obstructive Lung Disease Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Individual cases of pneumothorax, pneumomediastinum and subcutaneous emphysema have been reported in asthma attacks, but rarely coincide. Pathophysiology is secondary to obstruction in the minor airways leading to air-trapping and barotrauma of distal airways with subsequent alveolar rupture. This case illustrates a case of asthma exacerbation with a synchronous triad of rare complications. CASE PRESENTATION: 65-year-old female with a history of breast cancer, asthma and hypertension presented with shortness of breath, wheezing, and productive cough since four days ago. Vital signs were remarkable for tachypnea and saturation of 91%. Physical examination revealed respiratory distress, and auscultation disclosed diffuse inspiratory and expiratory wheezing. Limited bedside ultrasound showed B-lines compatible for pulmonary edema. Arterial blood gases were compatible with respiratory acidosis and hypoxemia. Laboratories showed leukocytosis, hypotonic hyponatremia, normal brain natriuretic peptide, and negative COVID-19 PCR test. Chest Xray (CXR) demonstrated changes concerning for pneumonia with superimposed pleural effusion. The patient was admitted with the impression of asthma exacerbation versus community acquired pneumonia. Initially, the patient was placed in bi-level positive airway pressure to aid in respiratory discomfort, broad spectrum antibiotic regimen, and diuresis therapy. On follow up, she was found hypoxic with periorbital edema, dyspnea, and subcutaneous emphysema in neck, upper extremities, and thorax for which emergent intubation was performed. CXR and Thoracic CT confirmed pneumomediastinum, large right sided pneumothorax and a moderate left sided pneumothorax requiring tube thoracostomy. At the Intensive Care Unit, treatment included combination therapies with levalbuterol, ipratropium, terbutaline, theophylline, budesonide, IV steroids and magnesium without appropriate response. Mechanical ventilator was set to protective lung parameters to avoid worsening barotrauma. Subsequently, she was paralyzed for 48 hours to aid in synchrony and allow adequate pulmonary gas exchange. Nonetheless, severe bronchoconstriction was persistent along with depressed neurological status. Two months later, the patient passed away. DISCUSSION: We believe our patient developed barotrauma secondary to a cough attack combined with positive airway pressure. Similarities in presentation such as dyspnea, tachycardia, and hypoxia may prove difficult in differentiation. Although each of these pathologies separately can generally be self-limiting depending on size and hemodynamic compromise, the combination can be mortal and clinical suspicion is important in fast diagnosis and treatment. CONCLUSIONS: Our case demonstrates the importance of suspicion of barotrauma in patients with asthma attacks not responding adequately to therapy or developing worsening hypoxia which can be detrimental. Reference #1: Franco, A. I., Arponen, S., Hermoso, F., & García, M. J. (2019). Subcutaneous emphysema, pneumothorax and pneumomediastinum as a complication of an asthma attack. The Indian journal of radiology & imaging, 29(1), 77–80. https://doi.org/10.4103/ijri.IJRI_340_18 Reference #2: Zeynep Karakaya, Şerafettin Demir, Sönmez Serkan Sagay, Olcay Karakaya, Serife Özdinç, "Bilateral Spontaneous Pneumothorax, Pneumomediastinum, and Subcutaneous Emphysema: Rare and Fatal Complications of Asthma", Case Reports in Emergency Medicine, vol. 2012, Article ID 242579, 3 pages, 2012.https://doi.org/10.1155/2012/242579 Reference #3: Subcutaneous Emphysema in Acute Asthma: A Cause for Concern? Patrick D Mitchell, Thomas J King, Donal B O'Shea Respiratory Care Aug 2015, 60 (8) e141-e143;DOI: 10.4187/respcare.03750 DISCLOSURES: No relevant relationships by Juan Adams-Chahin No relevant relationships by Gretchen Marrero No relevant relationships by natalia Mestres No relevant relationships by Are is Morales Malavé No relevant relationships by Carlos Sifre No relevant relationships by Paloma Velasco No relevant relationships by Mark Vergara-Gomez

14.
Chest ; 162(4):A1780, 2022.
Article in English | EMBASE | ID: covidwho-2060861

ABSTRACT

SESSION TITLE: Drug-Induced and Associated Critical Care Cases Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Lung toxicity due to antineoplastic therapy is reported with both cytotoxic and molecularly targeted agents [1]. We present one such case of lung injury induced by capecitabine. CASE PRESENTATION: A 79-year-old female with history of triple negative infiltrating duct carcinoma of the right breast (status post mastectomy and adjuvant chemotherapy with docetaxel and cyclophosphamide 3 years prior) presented to the hospital with dyspnea on exertion following her fourth cycle of capecitabine therapy for breast cancer recurrence. Patient developed nausea, vomiting, and malaise with cycles 1, 2, and 3 of capecitabine therapy with onset of severe dyspnea on exertion, cough, and hypoxia following cycle 4. Computed tomography (CT) scan of the chest on admission showed consolidative opacities in the right upper, right middle, and anterior right lower lobe along with smaller opacities in the left lung apex and small subcentimeter nodules;no pulmonary embolism. Antibiotics were given for a short duration for suspected pneumonia without improvement. Capecitabine was held on discharge. She presented again to the emergency room with worsening shortness of breath, diarrhea, fatigue, and dizziness. COVID test was negative. Chest x-ray redemonstrated patchy airspace disease involving the right apical, lateral, mid lower lung field. Oral steroids were recommended for suspected organizing pneumonia, but the patient refused due to concerns about side effects. Her hospital course was complicated by Clostridium difficile infection (treated with oral vancomycin) and left lower extremity deep venous thrombosis (treated with anticoagulation). Subsequently she followed up with pulmonology outpatient. Repeat imaging showed evolving infiltrates in the same areas with elevated aspergillus IgG level (18.0 mcg/ml) and IgE (178 kU/L) but negative galactomannan and sputum bacterial/fungal/acid fast cultures. Oral steroids were initiated with clinical and symptomatic improvement. DISCUSSION: Capecitabine is a prodrug of fluorouracil (antimetabolite). It is used as a chemotherapy agent in multiple types of cancer including breast cancer. Respiratory side effects include cough (<7%) and bronchitis (<5%). Lung injury/pneumonitis is a rare complication with only a few cases reported to date [2,3]. The timing of symptoms with chemotherapy administration and the negative infectious work-up supports capecitabine as the inciting etiology of lung injury. Withholding chemotherapy and starting systemic steroids were effective treatments in this case of chemotherapy induced lung toxicity. CONCLUSIONS: Capecitabine induced lung injury is a rare but important entity and should always be kept in mind while evaluating dyspnea in cancer patients. Reference #1: Capri G, Chang J, et al. An open-label expanded access study of lapatinib and capecitabine in patients with HER2-overexpressing locally advanced or metastatic breast cancer. Ann Oncol. 2010;21(3):474. Epub 2009 Oct 8. DOI: 10.1093/annonc/mdp373 Reference #2: C. J. Benthin, G. Allada. Capecitabine-Induced Lung Injury. American Journal of Respiratory and Critical Care Medicine 2016;193:A1653. Reference #3: Andrew K Chan, Bok A Choo, John Glaholm. Pulmonary toxicity with oxaliplatin and capecitabine/5-Fluorouracil chemotherapy: a case report and review of the literature. Onkologie. 2011;34(8-9):443-6. doi: 10.1159/000331133. Epub 2011 Aug 19. DISCLOSURES: No relevant relationships by William Karkowsky No relevant relationships by Chahat Puri No relevant relationships by Sahib Singh

15.
Chest ; 162(4):A1029, 2022.
Article in English | EMBASE | ID: covidwho-2060756

ABSTRACT

SESSION TITLE: Drug-Induced Critical Care SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Intravenous magnesium sulfate (MgSo4) is commonly used for inpatient magnesium repletion. However, it is infrequently shown to be associated with the development of pulmonary edema. We present a case of acute hypoxic respiratory failure due to pulmonary edema after starting magnesium infusion in a patient recovering from COVID-19. CASE PRESENTATION: 60 year old female with a history of metastatic breast cancer presented with hypoxic respiratory failure due to COVID-19. CT angiogram of her chest showed diffuse bilateral ground-glass opacities with no evidence of pulmonary embolism. She had prolonged weaning from high flow nasal cannula and was treated with antibiotics, remedesivir, and dexamethasone. Following treatment, her inflammatory markers significantly improved. On day thirty, she was on 25 L at 45% FiO2 on high flow nasal cannula. Her magnesium level was low at 1.5 mg/dl, and 2 grams of intravenous MgSo4 was given for replacement. A few minutes after starting the infusion, the patient complained of metallic taste, severe shortness of breath, and tachypnea with a drop in oxygen saturation to 67%, which improved with increasing oxygen. CXR showed worsening perihilar infiltrates compared to prior, suggesting acute pulmonary edema. An echocardiogram showed normal function without evidence of structural abnormalities. Thyroid function was normal. She did not receive any blood products or opioids prior to this event. She responded very well to diuresis, was weaned to 5L nasal cannula in three days, and was eventually discharged on 2L supplemental oxygen. DISCUSSION: Pulmonary edema is due to the movement of excess fluid into the alveoli. It can be due to cardiogenic and noncardiogenic causes. Noncardiogenic pulmonary edema is due to a rise in transcapillary filtration, causing an increase in capillary permeability due to several factors, most importantly direct endothelial damage due to inflammation. Mechanisms for MgSo4 induced pulmonary edema are unknown, but theories include direct capillary damage or transient cardiac depression. It is seen in studies to be an independent risk factor for the development of pulmonary edema in pregnancy. Higher risk is associated with faster MgSo4 infusion, less concentrated MgSo4, and infection[1]. She was on abemaciclib for breast cancer before her admission, known to cause pneumonitis but was thought unlikely to cause her acute decompensation. The lack of other etiologies explaining sudden respiratory failure, her rapid improvement on stopping magnesium, and her response to diuretics supported our diagnosis. CONCLUSIONS: Treatment of noncardiogenic pulmonary edema involves addressing the underlying cause of the event and is mainly supportive. Given how commonly Mgso4 is used for repletion in the inpatient setting, MgSo4 induced pulmonary edema should be in the differential for acute hypoxic respiratory failure and promptly addressed. Reference #1: Samol JM, Lambers DS. Magnesium sulfate tocolysis and pulmonary edema: the drug or the vehicle? Am J Obstet Gynecol. 2005 May;192(5):1430-2. doi: 10.1016/j.ajog.2005.02.093. PMID: 15902128. DISCLOSURES: No relevant relationships by Nasir Alhamdan No relevant relationships by Harshitha Mergey Devender No relevant relationships by Abira Usman No relevant relationships by Vishruth Vyata No relevant relationships by Harika Yadav

16.
Chest ; 162(4):A399, 2022.
Article in English | EMBASE | ID: covidwho-2060584

ABSTRACT

SESSION TITLE: Infectious Complications with Obstructions and Connections SESSION TYPE: Case Reports PRESENTED ON: 10/17/2022 03:15 pm - 04:15 pm INTRODUCTION: Invasive pulmonary fungal infections are a challenge for diagnosis. One of the most common types is Invasive pulmonary aspergillosis. It occurs usually among immunocompromised patients [1], so an early diagnosis is warranted for potential better outcome. Evidence of calcium oxalate can be an early diagnostic tool for such an infection. The presence of calcium oxalate crystals can be detected within 24 hours under polarized light in the microbiology labs. We present this case to highlight the potential importance of pulmonary oxalosis in diagnosing pulmonary aspergillosis. CASE PRESENTATION: A 62-year-old-woman with limited breast cancer was admitted to the hospital seven days after her last cycle of docetaxel and cyclophosphamide with COVID-19 pneumonia and hypoxemic respiratory failure. She was not neutropenic. She received a full course of dexamethasone and remdesivir. Sputum cultures subsequently grew Klebsiella aerogenes for which she was treated with antibiotics but failed to significantly improve over four weeks. Repeat chest computed tomography (CT) showed progressive multifocal airspace opacities with new areas of cavitation. Patient underwent bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy. Transbronchial biopsy specimen from the right upper lobe showed bronchial mucosa and lung parenchyma with calcium oxalate crystals and no organisms. Biopsy specimen from the right middle lobe showed fungal organisms consistent with Aspergillus invading bronchial mucosa and lung parenchyma. Several days later, serum beta-D-glucan returned within normal limits, serum galactomannan was significantly elevated, and BAL culture grew Aspergillus niger. Patient improved with antifungal therapy. DISCUSSION: Fungal pneumonia has high morbidity and mortality. It is essential to start antifungal therapy as soon as possible. Pulmonary oxalosis or calcium oxalate has been seen among Aspergillus Fumigatus and Aspergillus Niger [2-3]. It is a combination of oxalic acid which is produced by Aspergillus spp. and calcium from blood supply of an invaded tissue. Further progression of lesions can be due to calcium oxalate toxicity itself [4-5]. In our case, clinical suspicion for pulmonary aspergillosis was high and we were able to document fungal invasion of lung parenchyma on one of the lung specimens. Though fungal culture is very sensitive and specific, it can take several days to result. Tissue staining for crystals can be performed quickly and provide more timely information when deciding about starting anti-fungal therapy. CONCLUSIONS: Pulmonary oxalosis, calcium oxalate deposition, can be seen in aspergillus infection and should be considered as an early diagnostic tool for invasive pulmonary aspergillosis. Reference #1: Kousha M, Tadi R, Soubani AO. Pulmonary aspergillosis: a clinical review. Eur Respir Rev. 2011;20(121): 156–174, doi: 10.1183/09059180.00001011 Reference #2: U. Pabuccuoglu, Aspects of oxalosis associated with aspergillosis in pathology specimens, Pathol. Res. Pract. 201 (2005) 363–368 Reference #3: Osholowu OS, Kak V, Singh H. Pulmonary oxalosis in pulmonary aspergillosis syndrome. Adv Respir Med. 2020;88(2):153-156. doi: 10.5603/ARM.2020.0090. PMID: 32383468. DISCLOSURES: No relevant relationships by Mohammed Alsaggaf No relevant relationships by Daniel Baram No relevant relationships by Ivana Milojevic

17.
Chest ; 162(4):A390, 2022.
Article in English | EMBASE | ID: covidwho-2060580

ABSTRACT

SESSION TITLE: Complications of Thoracic Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: Serratia marcescens is a gram negative bacteria known to colonize the human GI tract. While infections of urinary tract, respiratory tract, and CNS can occur, it is usually associated with immunocompromised hosts or patients who undergo invasive procedures or surgeries. Here, we present a 21-year-old immunocompetent male with Serratia marcescens cavitary pneumonia following COVID-19 infection. CASE PRESENTATION: A 21-year-old obese male with no past medical history presented with shortness of breath, cough and fevers for one week. In the emergency department (ED), he was febrile to 38.8°C, tachycardic, saturating 90% on room air. He was recently admitted to an outside hospital two weeks prior with COVID-19 pneumonia. He was treated with Remdesivir and decadron and discharged after five days. No invasive procedures were performed during his hospital stay and he never required advanced oxygen support other than simple nasal cannula. CTA of his chest in the ED showed thick walled bilateral lower lobe cavitary lesions and multifocal ground glass alveolar opacities. No pulmonary embolism was seen. Sputum cultures were collected but inadequate. Bronchoscopy with bronchoalveolar lavage (BAL) was performed and fluid studies showed white blood cell count of 70,029 cell/uL, with 94% neutrophils. BAL fluid cultures grew Serratia marcescens. He was originally placed on vancomycin and cefepime and discharged on oral Levaquin for four weeks based on sensitivities. HIV testing was negative. DISCUSSION: Serratia is a rod shaped gram negative bacteria found in soil, water, and human gut flora. It is known to be an opportunistic pathogen that can cause urinary, respiratory, CNS and blood stream infections in immunocompromised patients. Infections in immunocompetent are usually associated with invasive devices such as mechanical ventilation or central venous catheters. While superimposed bacterial infections in COVID-19 illness are well known, they are usually seen in patients with severe disease requiring mechanical ventilation and prolonged hospitalization. Those with underlying systemic illness, advanced age and impaired immune systems are particularly susceptible. Our patient was young, immunocompetent and only required minimal oxygen support while hospitalized for COVID-19. CONCLUSIONS: Serratia marcescens pneumonia is rarely seen in immunocompetent hosts, but should remain on the differential in patients with recent hospitalization and COVID-19 infection, regardless of severity of disease. Reference #1: Hidron, A., Quiceno, W., Cardeño, J. J., Roncancio, G., & García, C. (2021). Post-COVID-19 Necrotizing Pneumonia in Patients on Invasive Mechanical Ventilation. Infectious Disease Reports, 13(3), 835–842. https://doi.org/10.3390/idr13030075 Reference #2: Fazio, G., Galioto, F., Ferlito, A., Coronella, M., Palmucci, S., & Basile, A. (2021). Cavitated pulmonary nodules in a female patient with breast cancer: Keep in mind Serratia marcescens’ infections. Respiratory Medicine Case Reports, 33, 101441. https://doi.org/10.1016/j.rmcr.2021.101441 Reference #3: Jose, M., & Desai, K. (2020). Fatal Superimposed Bacterial Sepsis in a Healthy Coronavirus (COVID-19) Patient. Cureus. https://doi.org/10.7759/cureus.8350 DISCLOSURES: No relevant relationships by Lucy Checchio No relevant relationships by Syeda Hassan No relevant relationships by Jaclyn Rosenzweig No relevant relationships by Stephanie Tzarnas No relevant relationships by Laura Walters

18.
Annals of Oncology ; 33:S1358, 2022.
Article in English | EMBASE | ID: covidwho-2060389

ABSTRACT

Background: Patient satisfaction is a goal that is part of the Swedish initiative for cancer care pathway (CCP). A questionnaire has been developed specifically to request patients‘ experiences (PREM) of care and an overall goal is that the patient perspective has a clear influence in the follow-up and evaluation of CCP. The purpose of this project is to describe patient reported experiences from CCP in the Stockholm-Gotland Region, during the period 2017 to q1 2021. It includes patients’ experiences from CCP, comparisons between groups and whether it differs before and during the COVID-19 pandemic. Methods: An invitation letter to complete a validated PREM questionnaire consisting of 34 questions, is sent to patients 8-10 weeks after CCP has ended. The main questions consist of seven dimensions and own comments can be shared. Results: A total of 14,141 persons responded to the questionnaire with an average response rate of 57%. Representativeness is good for patients where the investigation led to a cancer diagnosis, among the elderly and among patients who have undergone care processes for breast cancer, colon and rectal cancer, prostate cancer, bladder cancer or skin melanoma. Most of the patients are satisfied with CCP regarding overall impression, respect & treatment, continuation & coordination, information & knowledge, and availability. However, areas that can be improved are emotional support as well as participation & involvement. Where the investigation did not lead to a cancer diagnosis and during the COVID-19 pandemic has affected the relative’s situation negatively, both in terms of relatives' opportunity to participate in care and the relative's opportunity to get in touch with health care regarding their own issues or need of support. Conclusions: Most of the patients are satisfied with CCP. Areas that might be improved are emotional support as well as participation & involvement. The COVID-19 pandemic has affected the relatives' situation negatively. Legal entity responsible for the study: Region Stockholm-Gotland. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

19.
Breast Cancer Res Treat ; 195(3): 311-323, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2059914

ABSTRACT

PURPOSE: Vaccination is an essential strategy to prevent infection in the SARS-CoV-2 pandemic. However, there are concerns about vaccine efficacy and the impact of vaccination on cancer treatment. Additionally, the emergence of novel variants may affect vaccination efficacy. This multi-center, prospective, observational study investigated the efficacy and impact of vaccination against SARS-CoV-2 variants on treatment among breast cancer patients in Japan. METHODS: Patients with breast cancer scheduled to be vaccinated with the SARS-CoV-2 vaccine from May to November 2021 were prospectively enrolled (UMIN000045527). They were stratified into five groups according to their cancer treatment: no treatment, hormone therapy, anti-human epidermal growth factor receptor (HER)2 therapy, chemotherapy, and cyclin-dependent kinase 4/6 (CDK4/6) inhibitor. Serum samples for assessing serological responses were collected before the first vaccination and after the second vaccination. RESULTS: Eighty-five breast cancer patients were included. The overall seroconversion rate after second vaccination was 95.3% and the lowest seroconversion rate was 81.8% in the patients under chemotherapy. The overall positivity rate of neutralizing antibodies against the wild-type, α, Δ, κ, and omicron variants were 90.2%, 81.7%, 96.3%, 84.1%, and 8.5%, respectively. Among the patients under chemotherapy or CDK4/6 inhibitors, various degrees of decreased neutralizing antibody titers against SARS-CoV-2 variants were observed. Withdrawal or reduction of systemic therapy because of vaccination was observed in only one patient. CONCLUSION: Our data support SARS-CoV-2 vaccination for breast cancer patients. However, a reduction in neutralizing antibody titers was suggested during chemotherapy and CDK4/6 inhibitors, raising concerns about the impact on long-term infection prevention.


Subject(s)
Breast Neoplasms , COVID-19 , Viral Vaccines , Antibodies, Neutralizing , Antibodies, Viral , Breast Neoplasms/drug therapy , COVID-19/prevention & control , COVID-19 Vaccines , Female , Humans , Prospective Studies , SARS-CoV-2 , Vaccination , Vaccines, Inactivated , Viral Vaccines/pharmacology
20.
BMC Proceedings. Conference: Student Medical Summit ; 16(Supplement 5), 2022.
Article in English | EMBASE | ID: covidwho-2057512

ABSTRACT

The proceedings contain 29 papers. The topics discussed include: targeting mutant p53 for the treatment of triple negative breast cancer: a pre-clinical study;senior sign-off in an Irish emergency department: is it feasible?;microfluidic-microwave platforms for real-time, non-invasive and sensitive monitoring of bacteria and antibiotic susceptibility testing;cancer diagnosis using imaging and artificial intelligence applications;enhancing the management of long covid in general practice: a scoping review;feasibility of using a hand-held device to characterize tendon tissue biomechanics;cross sectional study of wristband compliance in St Vincent's University Hospital;man vs machine: do mechanical chest compression devices improve survival outcomes in patients with out-of-hospital cardiac arrest - a systematic review;and investigating the necessity of pediatric emergency medicine in resource limited settings.

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