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1.
Deterioro cognitivo en personas con COVID-19 con síntomas leves-moderados en Ecuador. ; 23(4):126-129, 2022.
Article in English | Academic Search Complete | ID: covidwho-1955374

ABSTRACT

Background: Complications of COVID-19 can include neurological, psychiatric, psychological, and psychosocial sequelae. Little is known about the consequences of COVID-19 on the cognitive functions of patients in the subacute phase of the disease. Objective: The objective of the study was to determine if there is an incidence of cognitive impairment in patients with COVID-19 with mild to moderate symptoms in the remission phase. Method: This is a cross-sectional study conducted between April 2021 and August 2021 at the Eugenio Espejo Hospital in Quito, Ecuador. The Montreal Cognitive Assessment test was applied to COVID-19 patients with mild to moderate symptoms. Results: A total of 50 subjects were recruited, 88% (n = 44) presented cognitive deterioration and only 12% (n = 6) showed a normal score. Conclusions: In our cohort study, patients with COVID-19 with mild-moderate symptoms are at high risk of cognitive impairment. (English) [ FROM AUTHOR] Antecedentes: Las complicaciones de COVID-19 pueden incluir secuelas neurológicas, psiquiátricas, psicológicas y psicosociales. Se sabe poco sobre las consecuencias del COVID-19 en las funciones cognitivas de los pacientes en la fase subaguda de la enfermedad. Objetivo: Determinar si existe incidencia de deterioro cognitivo en pacientes con COVID-19 con síntomas leves a moderados en la fase de remisión. Método: Se trata de un estudio de tipo transversal realizado entre abril de 2021 y agosto de 2021 en el Hospital Eugenio Espejo de Quito, Ecuador. Se aplicó el MoCA test a los pacientes con COVID-19 con síntomas de leve a moderado. Resultados: Un total de 50 sujetos fueron reclutados, el 88% (n = 44) presentó deterioro cognitivo y apenas el 12% (n = 6) evidenció una puntuación normal. Conclusiones: En nuestro estudio de cohorte los pacientes con COVID-19 con sintomatología leve-moderada tienen un alto riesgo de presentar deterioro cognitivo. (Spanish) [ FROM AUTHOR] Copyright of Revista Mexicana de Neurociencia is the property of Academia Mexicana de Neurologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

2.
BMJ Open ; 12(7), 2022.
Article in English | ProQuest Central | ID: covidwho-1950192

ABSTRACT

IntroductionThe WHO End-TB Strategy calls for the development of novel diagnostics to detect tuberculosis (TB) earlier and more accurately. Better diagnostics, together with tools to predict disease progression, are critical for achieving WHO End-TB targets. The Early Risk Assessment in TB Contacts by new diagnoStic tEsts (ERASE-TB) study aims to evaluate novel diagnostics and testing algorithms for early TB diagnosis and accurate prediction of disease progression among household contacts (HHCs) exposed to confirmed index cases in Mozambique, Tanzania and Zimbabwe.Methods and analysisA total of 2100 HHCs (aged ≥10 years) of adults with microbiologically-confirmed pulmonary TB will be recruited and followed up at 6-month intervals for 18–24 months. At each time point, a WHO symptom screen and digital chest radiograph (dCXR) will be performed, and blood and urine samples will be collected. Individuals screening positive (WHO symptom screen or dCXR) will be requested to provide sputum for Xpert MTB/Rif Ultra. At baseline, HHCs will also be screened for HIV, diabetes (HbA1c), chronic lung disease (spirometry), hypertension and anaemia. Study outcomes will be coprevalent TB (diagnosed at enrolment), incident TB (diagnosed during follow-up) or no TB at completion of follow-up. Novel diagnostics will be validated using fresh and biobanked samples with a nested case–control design. Cases are defined as HHCs diagnosed with TB (for early diagnosis) or with incident TB (for prediction of progression) and will be matched by age, sex and country to HHCs who remain healthy (controls). Statistical analyses will include assessment of diagnostic accuracy by constructing receiver operating curves and calculation of sensitivity and specificity.Ethics and disseminationERASE-TB has been approved by regulatory and ethical committees in each African country and by each partner organisation. Consent, with additional assent for participants <18 years, is voluntary. Attestation by impartial witnesses is sought in case of illiteracy. Confidentiality of participants is being maintained throughout. Study findings will be presented at scientific conferences and published in peer-reviewed international journals.Trial registration numberNCT04781257.Cite Now

3.
Journal of Adolescent Health ; 70(4):S47, 2022.
Article in English | EMBASE | ID: covidwho-1936674

ABSTRACT

Purpose: During the COVID-19 pandemic, telemedicine emerged as an alternative option for preventive care for adolescents and young adults (AYAs) when in-person care was not safe or feasible. Yet, it is unclear how the quality of virtual services might differ from in-person. In this quality assessment of Between Us Program data, we compared receipt of recommended reproductive health services (RHS) and human papillomavirus (HPV) vaccination during in-person and telemedicine preventive encounters among AYAs in the Hennepin Healthcare System (HHS) throughout the COVID-19 pandemic. Methods: We conducted a retrospective cohort study including adolescents (ages 10-18) and young adults (YAs, ages 19-26) receiving preventive care at HHS, between January 1st and December 31st, 2020. Patients receiving orders for RHS (contraceptive prescriptions, sexually transmitted infection [STI] screenings) and HPV vaccination were followed to determine if they received the recommended procedures. The rate of ordered procedures (patients receiving order/total patients attending a preventive visit) and completed orders (completed order/patients receiving order) were compared between in-person preventive visits and telemedicine visits using χ2 tests. Stratified analyses were conducted comparing adolescents and YAs. P-values < 0.05 were considered statistically significant. Results: A total of 3,677 adolescents and 1,119 YAs received a preventive visit during 2020. Among them, 4,666 (97.8%) were in-person and 106 (2.2%) were virtual. During these visits, 7.7% of AYAs received orders for contraception (n=368);10.9%, STI screening (n=521), and 36.0%, HPV vaccinations (n=1,720). Contraceptive prescriptions and STI screening orders were similar between in-person and telemedicine visits (7.7% vs. 11.3%, p=0.2982 for contraceptive prescriptions;11.2% vs. 11.3%, p=0.9601 for STI screenings), whereas in-person had higher rates of HPV vaccination orders compared to telemedicine (36.6% vs. 10.4%, p<0.0001). The vast majority of STI screening (86.3%) and vaccination orders (95.8%) were completed, though we were unable to assess contraception order completion. There was a similar rate of STI screenings completed and a higher rate of HPV vaccinations completed during in person visits, when compared to telemedicine (86.2% vs. 91.7%, p=0.5847 for STI screenings, and 95.9% vs 81.8%, p=0.0201 for HPV vaccinations). Stratified analyses revealed no differences in rates of orders or orders completed comparing adolescents and YAs. Conclusions: Telemedicine allowed AYAs who were unable to be seen in-person to receive preventive care during the COVID-19 pandemic. During telemedicine visits, there were similar rates of contraceptive prescriptions and STI screening orders, suggesting that telemedicine may be a viable option for AYA preventive care and should be promoted as an alternative for those with barriers to accessing in-person care during and after the pandemic. Notably, HPV vaccination orders were lower when compared to in-person visits, suggesting that virtual care could lead to gaps in vaccination status. Innovative solutions to ensure vaccine access, such as mobile vaccine outreach, could be paired with telemedicine to help navigate these challenges and were implemented at HHS. Future directions include more comprehensive analyses of recommended preventive services during routine adolescent preventive care. Sources of Support: The Between Us program is funded by the Family Planning Special Projects of the Minnesota Department of Health.

4.
Journal of Adolescent Health ; 70(4):S20-S21, 2022.
Article in English | EMBASE | ID: covidwho-1936660

ABSTRACT

Purpose: Despite greatly reduced roadway travel during the COVID-19 shelter-in-place orders, alcohol and drug use among seriously and fatally injured roadway users in the U.S. increased in 2020. Motor vehicle crashes are the leading cause of death for U.S. youth. As travel resumes to pre-pandemic levels, it remains essential to identify novel strategies to prevent driving while impaired (DWI) and riding with an impaired driver (RWI). This qualitative study explored how youth avoid DWI and RWI during and after high school to inform prevention efforts. Methods: In 2020, virtual in-depth individual interviews were conducted with a geographically diverse sample of 105 young adults. Participants were purposively sampled from the NEXT Generation Health Study, a nationally representative longitudinal cohort study, and had varying levels of experience with DWI/RWI during and after high school (mean age 26.36±0.52 y/o, 47.7% ♀). A semi-structured interview guide explored pre-pandemic experiences with DWI/RWI. Using directed content analysis approaches, guided by ecodevelopment theory, a six-member multidisciplinary team systematically applied inductive and deductive codes to each transcript;agreement was achieved by team consensus. Themes were derived using data immersion (with coded data and transcripts), investigator reflexivity and team dialogue. We present themes derived from the codes “Chose not to DWI”, “Chose not to RWI”, and “Missed Opportunities for Prevention”. Results: Participants avoided DWI by trusting their self-assessment of impairment, defined as poor physical ability to drive, “I knew I could barely stand up and coherently walk through the sand …. [it’s] probably not the best idea for me to get behind the wheel.” Some relied on trusted, close friends to intervene: “My perspective is like ‘I'm good to drive but I'm swirling’. [My friends] will make those decisions for me to prevent what could happen”. Perceived police presence on the roadways also prevented potential DWI, “You always consider that there’s gonna be more cops on the road or not”. Additional factors included party pre-planning, past experiences with law enforcement, and easy access to alternative transportation or post-party housing. Participants described avoiding RWI by observing severe driver intoxication: “They were falling down trying to get in the truck — that was a telltale sign”. They also described the need for “better options”, which more often included rides from sober friends than rides from family or ride-share. Bystander interventions were a common technique to avoid RWI (and prevent DWI) during high school. For example, when asked how they avoided RWI, one participant reported “I've stopped several of my friends that have been drinking and I told them they weren't going nowhere”. Conclusions: As youth return to pre-pandemic levels of social activity, DWI/RWI prevention initiatives should bolster protective and prevention strategies that youth are already using, such as peer-to-peer bystander interventions and proactive planning for multiple transportation or housing options among peers. Youth may benefit from prevention and education efforts that enhance awareness of the cognitive impacts of alcohol and drug use on driving. Future research should identify optimal strategies for DWI/RWI prevention intervention delivery, both during and after high school. Sources of Support: R01AA026313.

5.
Journal of Adolescent Health ; 70(4):S88, 2022.
Article in English | EMBASE | ID: covidwho-1936639

ABSTRACT

Purpose: Adolescent obesity continues to rise, with body mass index (BMI) commonly used as an adiposity surrogate. While obesity correlates with metabolic syndrome risk, individuals with the same BMI do not have equivalent health risks. In 2018, the first pediatric consensus definition for metabolically healthy obesity (MHO) was proposed. Identifying MHO patients is clinically relevant for personalizing interventions by cardiometabolic phenotype. The objective of this study was to examine baseline MHO and metabolically unhealthy obesity (MUO) prevalence and identify metabolic and anthropomorphic predictors among adolescents enrolled in weight management. Methods: This study uses baseline data from 1,316 patients ≥ 11 years of age enrolled in a weight management program for obese adolescents in Baltimore, Maryland between 2005-2018. Anthropometric measures (including body fat by bioimpedance (%fat)), vital signs, and fasting labs were performed at intake. MHO definition was: glucose <100, HDL > 40, triglycerides < 150, systolic blood pressure < 120, diastolic blood pressure < 80. MUO was defined as ≥ 1 abnormal value among MHO variables. Independent samples t-tests were used to compare mean %fat and BMI z-score of MHO and MUO groups. Bivariate logistic regression was performed to determine effects of age, sex, %fat, BMI, and BMI z-score on likelihood of MHO. Results: Mean age in the MHO group was 13.48 years (SD 1.88);mean age in the MUO group was 13.98 years (SD 2.03). 444 (33.7%) patients met criteria for MHO;872 patients had MUO. MHO teens had statistically significantly lower mean %fat (46.7% +/- 8.0% SD) vs. MUO (47.8% +/- 8.2% SD) (p = 0.034) and lower BMI z-score (2.37 +/- 0.33 SD vs 2.51 +/- 0.34 SD;p < 0.001) vs MUO. The MHO group was 66.9% female vs 54.5% females in MUO, with 38.9% lower odds of MHO for males vs. females (OR 0.611;CI 0.467 - 0.800). For every 1% increase in %fat, odds of MHO increased by 3.1%, (OR 1.031;CI 1.008 - 1.053). Each 1-year age increase led to 10.9% decrease in MHO odds (OR 0.891;CI 0.823 - 0.965). In addition, each 1 unit increase in BMI z-score was associated with a 64.5% decrease in odds of MHO (OR 0.355;CI 0.166 - 0.759). BMI change did not significantly change MHO odds. Conclusions: Among this cohort of obese adolescents enrolled in weight management, one-third had MHO. Factors associated with higher likelihood of MHO include: female sex, younger age, and lower BMI z-score. Notably, BMI was not predictive of metabolic phenotype. These findings suggest potential for risk prediction for MUO profile to tailor interventions and resources accordingly. Next, we will evaluate metabolic profiles of patients enrolled during the COVID-19 pandemic. Sources of Support: NICHD T32HD052459 (PI: Trent), The Mount Washington Foundation.

6.
Annals of Oncology ; 33:S375-S376, 2022.
Article in English | EMBASE | ID: covidwho-1936046

ABSTRACT

Background: Despite the occurrence of HER2 amplification/overexpression (HER2+) in ~3% to 5% of all patients with metastatic colorectal cancer (mCRC) and up to ~10% of patients with RAS/BRAF wild-type mCRC, there are currently no FDA- or EMA-approved HER2-directed therapies for HER2+ mCRC. Patients with mCRC who progress on early lines of chemotherapy regimens receive limited clinical benefit from current standard-of-care treatments. Tucatinib is a highly selective, HER2-directed, tyrosine kinase inhibitor. The MOUNTAINEER trial (NCT03043313) was initiated to evaluate the efficacy and safety of the investigational combination of tucatinib with trastuzumab in patients with HER2+ mCRC. Here we present results from the primary analysis of MOUNTAINEER. Methods: MOUNTAINEER is a multi-center, open-label, randomised, phase 2 trial conducted in the US and Europe. Eligible patients had HER2+ (one or more local tests: 3+ immunohistochemistry, 2+ immunohistochemistry with amplification by in situ hybridization, or amplification by next‑generation sequencing of tumor tissue) and RAS wild-type mCRC with progression on or intolerance to fluoropyrimidine, oxaliplatin, irinotecan, and an anti-VEGF antibody. Measurable disease and an ECOG performance status of 0–2 were required. Previous HER2-directed therapies were not permitted. The trial initially consisted of a single cohort (Cohort A) to be treated with tucatinib (300 mg PO BID) and trastuzumab (8 mg/kg IV then 6 mg/kg IV every 3 weeks). The trial was expanded to include patients randomised 4:3 to receive tucatinib + trastuzumab (Cohort B) or tucatinib monotherapy (Cohort C). The primary endpoint is confirmed objective response rate (ORR) per RECIST 1.1 by blinded independent central review (BICR) in Cohorts A+B. Secondary endpoints include duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety and tolerability. Results: MOUNTAINEER enrolled 117 patients between 08Aug2017 and 22Sept2021. Data cutoff was 28Mar2022. The median age was 56.0 years (range, 24, 77), and baseline characteristics were balanced across cohorts. Eighty-six patients received at least 1 dose of study treatment in Cohorts A+B, and 30 patients received tucatinib monotherapy in Cohort C (total, 116). The overall median duration of follow-up was 16.3 months (IQR, 10.8, 28.2). In Cohorts A+B, the confirmed ORR by BICR was 38.1% (95% CI, 27.7, 49.3). The median DOR was 12.4 months (95% CI, 8.5, 20.5). The median PFS was 8.2 months (95% CI, 4.2, 10.3), and the median OS was 24.1 months (95% CI, 20.3, 36.7). The most common adverse events (AEs) in Cohorts A+B were diarrhoea (64.0%), fatigue (44.2%), nausea (34.9%), and infusion-related reaction (20.9%);the most common AE of grade ≥3 was hypertension (7.0%). Adverse events leading to tucatinib discontinuation in Cohorts A+B occurred in 5.8% of patients and included alanine amino transferase increase (2.3%), COVID-19 pneumonia (1.2%), cholangitis (1.2%), and fatigue (1.2%). No deaths resulted from AEs. Conclusions: In patients with chemotherapy-refractory HER2+ mCRC, tucatinib in combination with trastuzumab was well tolerated with clinically meaningful antitumor activity including durable responses and a median overall survival of 2 years. Tucatinib in combination with trastuzumab has the potential to become a new standard of care for patients with HER2+ mCRC. Clinical trial identification: NCT03043313. Editorial acknowledgement: The authors thank Joseph Giaconia of MMS Holdings, Michigan, USA for providing medical writing support/editorial support, which was funded by Seagen Inc., Bothell, WA, USA in accordance with Good Publication Practice (GPP3) guidelines. Legal entity responsible for the study: Seagen Inc. Funding: Seagen Inc. Disclosures: J. Strickler: Advisory / Consultancy: Seagen, Bayer, Pfizer;Research grant / Funding (institution): Amgen, Roche/Genentech, Seagen. A. Cercek: Advisory / Consultancy: Bayer, Merck, Seagen;Research grant / Funding (institution): Seagen, GSK, Rgenix. T. André: Honoraria (self : Amgen, Astra-Zeneca, Bristol-Myers Squibb, Gritstone Oncology, GlaxoSmithKline, Haliodx, Kaleido Biosciences, Merck & Co., Inc., Pierre Fabre, Sanofi, Servier, Merck & Co., Inc, Servier;Advisory / Consultancy: Astellas Pharma, BMS, Gritstone Oncology, Transgène, Roche/Ventana, Seagen, Merck & Co., Inc, Servier;Research grant / Funding (institution): BMS, Seagen, GSK;Travel / Accommodation / Expenses: BMS, Merck & Co., Inc. K. Ng: Advisory / Consultancy: Seattle Genetics, Bicara Therapeutics, GlaxoSmithKline;Research grant / Funding (institution): Pharmavite, Evergrande Group, Janssen. E. Van Cutsem: Advisory / Consultancy: AbbVie, Array, Astellas, AstraZeneca, Bayer, Beigene, Biocartis, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Daiichi, Halozyme, GSK, Helsinn, Incyte, Ipsen, Janssen Research, Lilly, Merck Sharp & Dohme, Merck KGaA, Mirati, Novartis, Pierre Fabre, Roche, Seattle Genetics, Servier, Sirtex, Terumo, Taiho, TRIGR, Zymeworks;Research grant / Funding (institution): Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Ipsen, Lilly, Merck Sharp & Dohme, Merck KGaA, Novartis, Roche, Servier. C. Wu: Research grant / Funding (institution): Seagen. A. Paulson: Research grant / Funding (institution): Seattle Genetics. J. Hubbard: Research grant / Funding (institution): Seattle Genetics. H. Lenz: Honoraria (self): BMS, Bayer, Roche;Advisory / Consultancy: Bayer, Merck, Roche;Travel / Accommodation / Expenses: BMS, Bayer, Merck KG;Shareholder / Stockholder / Stock options: Fulgent. M. Stecher: Full / Part-time employment: SeaGen. W. Feng: Full / Part-time employment: Seagen. T. Bekaii-Saab: Honoraria (self): Royalties: Uptodate;Advisory / Consultancy: Consulting (to institution): Ipsen, Arcus, Pfizer, Seattle Genetics, Bayer, Genentech, Incyte, Eisai and Merck., Consulting (to self): Stemline, AbbVie, Boehringer Ingelheim, Janssen, Daichii Sankyo, Natera, TreosBio, Celularity, Exact Science, Sobi, Beigene, Kanaph, Astra Zeneca, Deciphera, MJH Life Sciences, Aptitude Health, Illumina and Foundation Medicine, IDMC/DSMB: Fibrogen, Suzhou Kintor, Astra Zeneca, Exelixis, Merck/Eisai, PanCan and 1Globe;Research grant / Funding (institution): Agios, Arys, Arcus, Atreca, Boston Biomedical, Bayer, Eisai, Celgene, Lilly, Ipsen, Clovis, Seattle Genetics, Genentech, Novartis, Mirati, Merus, Abgenomics, Incyte, Pfizer, BMS.;Licensing / Royalties: WO/2018/183488: HUMAN PD1 PEPTIDE VACCINES AND USES THEREOF – Licensed to Imugene, WO/2019/055687: METHODS AND COMPOSITIONS FOR THE TREATMENT OF CANCER CACHEXIA – Licensed to Recursion. All other authors have declared no conflicts of interest.

7.
Annals of Oncology ; 33:S331, 2022.
Article in English | EMBASE | ID: covidwho-1936045

ABSTRACT

Background: Colorectal cancer (CCR) is the third most common and the second most deadly cancer with 1.9 million new diagnoses worldwide in 2020. COVID-19 pandemic placed an unprecedented burden on health systems worldwide, directly impacting cancer patients’ management. Health-care systems reorganization led to a decrease on all non-urgent surgical and medical procedures, delaying cancer screening protocols. This study aims to access the impact of COVID-19 on Colorectal Cancer management in a Portuguese Oncology Department. Methods: A retrospective cohort study comparing the new colorectal cancer diagnosis between March/2019 and March/2022. New diagnosis between March/2019 and March/2020 were assigned to Cohort 1 “Before COVID-19 Pandemic” and new diagnosis between March/2020 and March/2022 assigned to Cohort 2 “During COVID-19 Pandemic”. Data was collected from digital medical records and statistical analysis performed using SPSS V.25 IBM®. Results: Between March/19 and March/22 were diagnosed 313 new colorectal cancers, 116 (37%) assigned to Cohort 1 “Before COVID-19 Pandemic” and 197 (63%) to Cohort 2 “During COVID-19 Pandemic”. Analysing the new diagnosis in Cohort 2, 105 (34%) occurred between March/20-21 and 92 (29%) between March/21-22. Mean age at diagnosis of 69 (30-96) years for Cohort 1 and 68 (32-94) years for Cohort 2. 42% (n=49) females and 58% (n=68) males in Cohort 1 compared to 38% (n=77) females and 62% (n=123) males in Cohort 2. Colorectal cancer screening diagnosed 36% (n=42) patients in Cohort 1 and 35% (n=69) in Cohort 2. Clinical presentation with bowel obstruction was seen in 25% (n=29) in Cohort 1 and 37% (n=74) in Cohort 2 (p=0.02). Metastatic disease at diagnosis in 13% (n=14) for Cohort 1 and 26% (n=52) for Cohort 2 (p=0.07). Regarding management, 39% (n=46) underwent adjuvant systemic treatment in Cohort 1 compared to 28% (n=55) in Cohort 2 (p=0.03). Palliative systemic treatment was agreed for 7% (n=10) in Cohort 1 and 17% (n=36) in Cohort 2 (p=0.02). At diagnosis, best supportive care was decided for 2% (n=2) in the first Cohort and 15% (n=30) (p=0.03). Overall survival of 25 (1-36) months for Cohort 1 and 10 (1-23) months for Cohort 2. Conclusions: Comparison between pre-pandemic and in-pandemic periods revealed a numeric reduction on new cases of colorectal cancer in each 12 months period. Despite similar rate of diagnosis by colorectal cancer screening, statistical significance was found when comparing clinical presentation with bowel obstruction or metastatic disease. Despite that, less patients underwent adjuvant systemic treatment in cohort 2 and more were evaluated for best supportive care at diagnosis. These findings may be explained by more advanced disease in more fragile patients in the Cohort 2 population. The results of our study contribute to the evidence on the impact of COVID-19 pandemics on colorectal cancer with fewer diagnosis, more advanced disease, and lack of re-establishment of pre-pandemic rate of new diagnosis. Legal entity responsible for the study: The author. Funding: Has not received any funding. Disclosures: All authors have declared no conflicts of interest.

8.
Annals of Oncology ; 33:S288, 2022.
Article in English | EMBASE | ID: covidwho-1936043

ABSTRACT

Background: The ongoing COVID-19 pandemic has disrupted worldwide cancer care delivery, leading to a decline in cancer screening, delayed diagnostic tests, and treatment modifications. Little has been reported on the care delivery impact of COVID-19 on patients (pts) with rare tumours, such as squamous cell carcinoma of the anus (SCCA). Our study aimed to evaluate the impact of the pandemic on care delivery of SCCA pts in two comprehensive cancer centres. Methods: We performed a retrospective study of two consecutive cohorts of adult pts diagnosed with SCCA at AC Camargo Cancer Center (AC) and Princess Margaret Cancer Center (PM) from the peri-COVID-19 period (1 February 2020- 31 January 2021) to the same period in the year prior (1 February 2019- 31 January 2020), utilizing electronic medical records to collect data on pts demographics and patterns of care in the six months following their first consultation. Comparisons of patterns of care between the peri- and pre-COVID-19 (control) cohorts were conducted using two-sided t-tests, Wilcoxon rank-sum tests, χ2 tests, or Fisher’s exact tests, as appropriate;p < 0.05 were deemed significant. Results: Overall, 73 pts were included: peri-COVID-19: n = 35 and pre-COVID-19: n = 38;both cohorts had similar demographic compositions in terms of age and sex [control: median age = 61.4 (IQR: 41.8 – 92.1), 55% female;peri-COVID-19: median age = 66.9 (IQR: 41-91.1), 63% female]. Pts from both institutions presented similar characteristics in both peri- and pre-COVID-19 periods. At AC, the number of pts diagnosed with SCCA during the peri-COVID-19 period was half of that prior to the pandemic. In the peri-COVID-19 period, the proportion of pts who received radiation therapy decreased in both institutions, when compared with the pre-pandemic period, however, the decrease was not found to be significant: 100% vs 83% at AC (p=0.32) and 84% vs 76% at PM (p=0.52). A similar proportion of pts received chemotherapy in the peri- and pre-COVID-19 periods, respectively: 80% vs 82%. Disease stage III at diagnosis was the most common (pre-COVID: 46%, peri-COVID: 46%). The proportion of pts who were operated on was similar between both cohorts (peri-COVID-19: 23%;control: 21%). Conclusions: Our multicenter study shows that during the peri-COVID-19 pandemic, the number of pts who received radiotherapy therapy to treat SCCA was numerically inferior, albeit not statistically significant. In one of the cancer centers, the number of new SCCA cases dropped by 50%. Longer follow-up is needed to understand the impact of the treatment modifications on SCCA clinical outcomes. Legal entity responsible for the study: The author. Funding: The study was funded by a grant from the Global Oncology Program at Princess Margaret Cancer Centre. Disclosures: All authors have declared no conflicts of interest.

9.
Annals of Oncology ; 33:S260, 2022.
Article in English | EMBASE | ID: covidwho-1936041

ABSTRACT

Background: Effective Cancer screening is critical in reducing cancer related mortality in CRC by increasing the detection in earlier stages. Worldwide, practically all cancer pathways have been negatively affected by the implications of the COVID-19 pandemic. Oncological care has not escaped the effects of reprioritization of health care services to handle the surge of COVID-19 patients adequately. Cancer screening programs are no exception as many were temporarily halted to alleviate the pressure on overwhelmed health care systems. In Uruguay, the first COVID patients were detected in March 2020, and since then, the country’s Public Health policies have been marked by the COVID-19 public health emergency. The aim of this study is to assess the impact of the COVID-19 pandemic on CRC diagnosis. We further aimed to analyze the effect on the clinical presentation and stage at diagnosis during 2020-2021 compared with previous years. Methods: This was a single center retrospective cohort study performed at a tertiary center. Patients diagnosed and managed with colorectal adenocarcinoma during the years 2020-2021 were compared with patients from 2018 and 2019. Those enrolled in 2018-2019 were classified as the “pre-pandemic group”, and those enrolled in 2020-2021 were classified as the “pandemic group”. The primary outcome was the rate of stage IV disease at the time of diagnosis. Mann-Whitney test was used in the comparison of quantitative variables and Fisher’s exact test was used for qualitative variables. Results: A total of 369 patients were included in this study. From March 2018 to 2019 (pre-pandemic), 217 patients were considered, and from March 2020 to 2021 (pandemic), 152 patients. Median age of pre-pandemic and pandemic group was 64.4 and 65.6 years, respectively. There was no statistically significant difference in cancer obstruction or perforation at diagnosis. Other patient demographics were comparable (p˃0.05). The percentage of surgical candidates was lower during the pandemic (69% vs 62%). There was a significant difference in TNM tumor distribution between pre-pandemic and pandemic subgroups with a higher incidence of advanced (cT4 or cN+ or M1) tumors. T4 tumors and node positive disease were equivalent in both groups but the incidence of disseminated disease (cM1) was significantly higher in the pandemic group (48% vs 36%, p < 0.001). Conclusions: Our study demonstrates how cancer diagnostic variables, mainly stage at diagnosis, have been affected by the impact of the COVID-19 pandemic on cancer screening programs. Therefore, it is of utmost importance that cancer diagnosis and treatment pathways be reinstalled in full to return to and build on pre-pandemic priority to ensure the Uruguayan population benefits from earlier diagnosis and treatment. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosures: All authors have declared no conflicts of interest.

10.
Annals of Oncology ; 33:S239, 2022.
Article in English | EMBASE | ID: covidwho-1936040

ABSTRACT

Background: During the COVID-19 pandemic, a profound decrease in the number of cancer diagnoses was observed. For patients with esophagogastric cancer, a diagnostic delay may have resulted in more advanced disease at the time of diagnosis. Also, downscaling of oncological care during COVID-19 may have resulted in postponed or different treatments. Therefore, we aimed to investigate the effects of the COVID-19 pandemic in 2020 on the stage at diagnosis and oncological care of esophagogastric cancer. Methods: Patients who were diagnosed in 2020 and included in the Netherlands Cancer Registry were allocated to 5 periods that correspond to the severity of the COVID-19 pandemic in the Netherlands. These were compared to patients diagnosed in the same period in the years 2017-2019. The number of diagnoses, tumor characteristics, type of treatment, time until the start of treatment and, in case of resection, the time between neoadjuvant therapy and resection were evaluated for esophageal cancer (EC) and gastric cancer (GC) separately. Results: The 2020 cohort in the Netherlands consisted of 2388 EC patients and 1429 GC patients. The absolute number of diagnoses decreased most prominently in the months March and April of 2020 for both EC and GC. The total number of EC diagnoses in 2020 decreased significantly compared to 2017-2019 (n=2522, p=0.027), whereas the total number of GC diagnoses did not decrease (n=1442, p=0.270). In the weeks after the first COVID-19 case in the Netherlands and before the COVID-19 lockdown, the percentage of incurable diagnoses increased from 52.5% to 67.7% for GC (p=0.011) and did not increase for EC (33.0% to 40.8%, p = 0.092). The percentage of patients with potentially curable EC receiving neoadjuvant chemoradiotherapy with resection decreased from 35.0% in 2017-2019 to 27.4% in 2020 (p < 0.001), whereas the percentage of patients receiving neoadjuvant chemoradiation without resection increased from 9.5% in 2017-2019 to 13.9% in 2020 (p < 0.001). The percentage of patients receiving definitive chemoradiation did not change significantly (p=0.119). For GC patients, no significant changes in type of treatment were found. The time between neoadjuvant chemotherapy and gastric resection decreased in 2020 with four days (p=0.006), while the time between neoadjuvant therapy and esophageal resection increased with 5 days (p=0.005). For both tumor types, the time between diagnosis and start of treatment was significantly shorter for patients diagnosed during and after the COVID-19 lockdown. Conclusions: We found a significant decrease in the number of EC diagnoses in 2020 and a shift in the type of treatment in potentially curable EC patients, with fewer resections being performed. Yet, it is unclear whether this is the result of the COVID-19 pandemic or due to an ongoing trial which implements watchful waiting after chemoradiotherapy. The oncological care for GC patients did not change during the COVID-19 pandemic. The shorter time between diagnosis and start of treatment may have been the result of a sense of urgency, since it was unknown in what way COVID-19 might affect the continuity of care in the upcoming future. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosures: All authors have declared no conflicts of interest.

11.
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.

12.
Supportive Care in Cancer ; 30:S105-S106, 2022.
Article in English | EMBASE | ID: covidwho-1935789

ABSTRACT

Introduction Osteoradionecrosis (ORN) is a side effect after head and neck radiotherapy (RT) that is difficult to control. Antimicrobial photodynamic therapy (aPDT) promotes bacterial lysis through photosensitization, aiming at stimulating the affected area, promoting healing of the oral mucosa. Methods We performed a retrospective cohort analysis of patients with head and neck cancer, treated with RT, who developed ORN after RT and who underwent the treatment with aPDT concomitant with irrigation with 0.12% chlorhexidine digluconate and surgical debridement. Results Thirty-six patients who had lesions by ORN in the mandible or maxilla, with a mean development time of 30.9 months, were included. Of them, 77.8% were male, with a median age of 58 years. All of them were diagnosed with malignant neoplasms of oral cavity and oropharyx that received local RT as part of cancer treatment. In 22 patients, chemotherapy was used as part of the treatment. The main etiologie of ORN was prosthetic trauma (61.2%). All patients underwent the proposed protocol and 75% of patients were successful in treatment with total healing of the affected area and presented with no symptoms. Conclusions The protocol used suggests successful healing of the area in 75% of cases. The others suffered some complication of the ORN, such as pathological fracture, oro-cutaneous fistula and bucosinusal fistula and 16.6% patients treatment were affected by the COVID-19 pandemic and had the continuity of treatment impaired, still maintaining, a chronic ORN.

13.
Journal of Epidemiology and Community Health ; 75, 2021.
Article in English | EMBASE | ID: covidwho-1935090

ABSTRACT

The proceedings contain 194 papers. The topics discussed include: comparative analysis of risk factors for excess and usual mortality during the first 2020 COVID-19 pandemic phase in England;differences in the rates of new diagnoses reported pre and during the COVID-19 pandemic;a counterfactual analysis of the effects of lockdown timing on cases of COVID-19 across Europe;evaluating social and spatial inequalities of large scale rapid lateral flow SARS-COV-2 antigen testing in covid-19 management: an observational study of Liverpool, UK (November 2020 to January 2021);evaluating the impacts of tiered restrictions introduced in England, during October and December 2020 on covid-19 cases: a synthetic control study;socioeconomic position and sex-specific trajectories of metabolites from childhood to early adulthood: a prospective cohort study;association between cardiovascular health and heart failure in older British men;findings from the British regional heart study;and implementing a national weight-reduction lifestyle intervention to the NHS health checks population: long-term outcomes micro-simulation modelling of the NHS diabetes prevention program.

14.
JNCCN Journal of the National Comprehensive Cancer Network ; 20(505):557-558, 2022.
Article in English | EMBASE | ID: covidwho-1939357

ABSTRACT

Background: Chronic lymphocytic leukemia (CLL) and other Non-Hodgkin's lymphomas (NHLs) are associated with broad immunosuppression, conferring a greater risk for infection-related morbidity and mortality. During the SARS-CoV-2 pandemic, patients with these conditions have been shown to be more susceptible to severe cases of infection. Vaccination against SARS-CoV-2 generally protects against severe disease, but there is scarce data on immune response in those with lymphoid malignancies. Our study aims to analyze antibody (Ab) response to vaccination against SARS-CoV-2 in patients with CLL, Waldenstrom macroglobulinemia (WM) and other NHLs. Methods: 398 patients with lymphoid malignancies seen between January and October 2021 were screened for eligibility. Ab titers using the Access SAR-COV-2 assay developed by Beckman Coulter Inc were obtained after the completion of a vaccination series with Pfizer (n=146), Moderna (n=90), Johnson & Johnson (n=1) or multiple brands (n=3). A response was defined as a positive total Ab or spike protein Ab. Groups were compared using chi-square tests, and a p-value of <0.05 was statistically significant. Results: 240 patients with postvaccination SARS-CoV-2 Ab results were included. Ab response was 50% in CLL, 67% in WM, and 71% in the remaining NHLs. In the CLL cohort (n=181), current or prior cancer therapy at any time led to a lower rate of positive Ab's compared to treatment-naïve patients (36% vs. 68%;p=0.000019), and response was particularly low in patients who had received anti-CD20 immunotherapy at any time (28% vs. 61%;p=0.000032). There was a trend towards lower Ab response in patients who received anti-CD20 agents within a year from vaccination compared to those who had these therapies more than one year prior (20% vs. 37%;p=0.14). For CLL patients, there was a significant difference in Ab response when receiving the Moderna series (61%) compared to Pfizer (44%) (p=0.028). More information is summarized in Table 1. Conclusions: This study provides data from a large cohort of patients with CLL and other NHLs on Ab response to SARS-CoV-2 vaccination. Active or prior therapy for CLL was associated with lower rates of Ab response to vaccination, especially when treated with anti-CD20 therapy, which is consistent with prior publications. However, we also found a significant increase in Ab response rates after Moderna SARS-CoV-2 vaccination in treated CLL patients compared to other vaccination series.

15.
Iranian Journal of Pharmaceutical Research ; 21(1), 2022.
Article in English | EMBASE | ID: covidwho-1939347

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) affects the pediatric population. Objectives: Due to limited data, this study aimed to evaluate the safety and efficacy of favipiravir in the hospitalized pediatric population diagnosed with COVID-19. Methods: The present retrospective cohort study was conducted on pediatric patients aged 1-18 years with a diagnosis of COVID-19 admitted to Mofid Children’s Hospital, Tehran, Iran. Favipiravir was administrated at a dose of 60 mg/kg/day (max: 3200 mg/day) on the first day and then 23 mg/kg/day (max: 1200 mg/day) for 7 to 14 days. The patients were evaluated regarding the need for invasive mechanical ventilation, intensive care unit admission, duration of hospital stay, and mortality. Safety was measured by the occurrence of related adverse drug reactions (ADRs). Results: A total of 95 patients were included in the study. Favipiravir was administered to 25 patients. The need for invasive mechanical ventilation was reported in 4 (16.00%) and 11 (15.71%) patients in the favipiravir and control groups, respectively (P = 1.000). The median duration of hospital stays was significantly higher in patients who received favipiravir than in the controls (P = 0.002). No difference was observed in the mortality rate (P = 0.695). The ADRs, including decreased appetite, hypotension, and chest pain, were more prevalent in patients who received favipiravir than in the controls (P < 0.05). Conclusions: The administration of favipiravir in the pediatric population is associated with higher ADR occurrence with no pos-itive effect on the need for invasive mechanical ventilation, hospital stay, and mortality. Further randomized controlled trials are necessary for better judgment.

16.
Open Access Macedonian Journal of Medical Sciences ; 10:1419-1425, 2022.
Article in English | EMBASE | ID: covidwho-1939105

ABSTRACT

BACKGROUND: Most coronavirus disease 2019 (COVID-19) patients are still experiencing persistent clinical symptoms even after being discharged from the hospital. The previous studies have reported the remaining symptoms in 29–93% of patients. This condition can have a major impact on a patient’s ability to perform daily activities and have a deleterious effect on their quality of life (QoL). AIM: This study aimed to evaluate persistent symptoms and QoL of COVID-19 patients 3 months after discharge from Dr. Kariadi Hospital Semarang, Central Java, Indonesia. METHODS: Confirmed COVID-19 patients were enrolled in this prospective cohort study after discharge from Dr. Kariadi Hospital Semarang from March 1, 2021, to May 15, 2021. Telephone interviews were conducted each week in the 1st month, and every 2 weeks in the 2nd and 3rd months regarding persistent symptoms. EQ-5D-5L questionnaires were completed and evaluated every month for 3 months after hospital discharge. RESULTS: Of the 104 patients enrolled, 52.9% were male, with a mean age of 48.96 years. The incidence of persistent symptoms in the 1st, 2nd, and 3rd months was 49%, 31.7%, and 25%, respectively. The most common persistent symptoms were fatigue, cough, shortness of breath, and nausea. The characteristics of the patients included being overweight/obese, having one or more comorbidities, having five or more symptoms classified as moderate COVID-19, and requiring supplemental oxygen during hospitalization. Based on the EQ-5D questionnaire, most patients reported worsening in the quality of their ability to perform usual activities, feelings of pain/discomfort, and anxiety/depression. The total values of the EQ-5D and EQ-VAS indices were lower than those of the Indonesian general population, indicating a decrease in QoL. CONCLUSION: The patients developed persistent symptoms and decreased quality of life during the 3-month following hospital discharge.

17.
Open Access Macedonian Journal of Medical Sciences ; 10:911-915, 2022.
Article in English | EMBASE | ID: covidwho-1939102

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19 has been spread quickly and caused 5 million deaths until February 2022. Severe symptoms of the infection may lead to death that prompts appropriate clinical diagnosis and adequate treatment going to be necessary. COVID-19 shows a severe inflammatory response which causes an imbalance in the immune response. Therefore, circulating biomarkers that can represent inflammation and immune status are potential predictors for the prognosis of COVID-19 patients. AIM: The purpose of this study was to discover the role of neutrophil-lymphocyte ratio (NLR), neutrophil-monocyte ratio (NMR), and lymphocyte-monocyte ratio (LMR) as inflammatory biomarkers for the severity of COVID-19. METHODOLOGY: This study is a single-center retrospective cohort study. The sample of this study was taken by consecutive sampling with complete clinical data from 1035 patients from Andalas University Teaching Hospital from April 2020 to September 2021. This study used SPSS Version 25.0 for data management and analysis. RESULTS: There was a relationship between the degree of COVID-19 infection and the NLR value (p = 0.001), as well as the LMR (p = 0.001), NMR (p = 0.001), and ANC (p = 0.001). There was no relationship between the degree of infection in the negative PCR patient group and the NLR value (p = 0.144), as well as the LMR (p = 0.700), NMR (p = 0.120), and ANC (p = 0.90). CONCLUSION: The severity of COVID-19 symptoms could be predicted through inflammatory biomarkers such as NLR, LMR, and NMR.

18.
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.

19.
Open Access Macedonian Journal of Medical Sciences ; 10:332-339, 2022.
Article in English | EMBASE | ID: covidwho-1939097

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a health problem that is still engulfing the world that contributes to the high mortality rate globally. Death arises from the severity of the disease due to complications in important organs such as the heart. AIM: The purpose of this study was to systematically review the manifestations of cardiovascular disease in COVID-19 patients and their management in terms of published articles. METHODS: This research is a systematic review research. The research was conducted using the PRISMA method. Article searches are carried out by online publications through PubMed, Science Direct, and Google Scholar that meet the inclusion and exclusion criteria. The population is articles about the manifestations of cardiovascular disease in COVID-19 patients and their management between 2011 and 2021. Inclusion criteria are studies that examine the manifestations of cardiovascular disease in COVID-19 patients and their management using primary data in the form of cohort research designs in English and full text available. The exclusion criteria were a case study, review study, and used secondary data. The data were analyzed by univariate analysis by calculating the frequency and percentage. RESULTS: The results show that several manifestations of cardiovascular disease in COVID-19 patients include cardiac injury, heart failure, myocardial infarction, myocarditis, cardiomegaly, and others. Complications of these diseases occur with or without comorbidities, and the risk increases with comorbid cardiovascular disease. The management of COVID-19 patients is basically done with antiviral agents, reducing symptoms and protecting important organs such as the heart. CONCLUSION: In the treatment of COVID-19 patients with cardiovascular complications, the use of antiviral agents such as lopinavir or ritonavir should be used with caution because: may interact with cardiovascular drugs. Mechanical circulation support is suggested, and the use of extracorporeal membrane oxygenation can also be performed to treat cardiovascular complications in COVID-19 patients.

20.
Egyptian Journal of Radiology and Nuclear Medicine ; 53(1), 2022.
Article in English | EMBASE | ID: covidwho-1938375

ABSTRACT

Background: Chest radiographs are frequently used to evaluate pediatric patients with COVID-19 infection during the current pandemic. Despite the minimal radiation dose associated with chest radiography, children are far more sensitive to ionizing radiation's carcinogenic effects than adults. This study aimed to examine whether serum biochemical markers could be potentially used as a surrogate for imaging findings to reduce radiation exposure. Methods: The retrospective posthoc analysis of 187 pediatric patients who underwent initial chest radiographs and serum biochemical parameters on the first day of emergency department admission. The cohort was separated into two groups according to whether or not the initial chest radiograph revealed evidence of pneumonia. Spearman's rank correlation was used to connect serum biochemical markers with observations on chest radiographs. The Student's t-test was employed for normally distributed data, and for non-normally distributed data, the Mann–Whitney U test was used. A simple binary logistic regression was used to determine the importance of LDH in predicting chest radiographs. The discriminating ability of LDH in predicting chest radiographs was determined using receiver operating characteristics (ROC) analysis. The cut-off value was determined using Youden's test. Interobserver agreement was quantified using the Cohen k coefficient. Results: 187 chest radiographs from 187 individual pediatric patients (95 boys and 92 girls;mean age ± SD, 10.1 ± 6.0 years;range, nine months–18 years) were evaluated. The first group has 103 patients who did not have pneumonia on chest radiographs, while the second group contains 84 patients who had evidence of pneumonia on chest radiographs. GGO, GGO with consolidation, consolidation, and peri-bronchial thickening were deemed radiographic evidence of pneumonia in group 2 patients. Individuals in group 2 with radiological indications of pneumonia had significantly higher LDH levels (p = 0.001) than patients in group 1. The Spearman's rank correlation coefficient between LDH and chest radiography score is 0.425, showing a significant link. With a p-value of < 0.001, the simple binary logistic regression analysis result validated the relevance of LDH in predicting chest radiography. An abnormal chest radiograph was related to LDH > 200.50 U/L (AUC = 0.75), according to the ROC method. Interobserver agreement between the two reviewers was almost perfect for chest radiography results in both groups (k = 0.96, p = 0.001). Conclusion: This study results show that, compared to other biochemical indicators, LDH has an 80.6% sensitivity and a 62% specificity for predicting abnormal chest radiographs in a pediatric patient with confirmed COVID-19 infection. It also emphasizes that biochemical measures, rather than chest radiological imaging, can detect the pathogenic response to COVID-19 infection in the chest earlier. As a result, we hypothesized LDH levels might be potentially used instead of chest radiography in children with COVID-19, reducing radiation exposure.

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