Mental disorders during the pandemic of a new coronavirus infection: causes and predisposing factors.

Objective: to study the causes and predictors of mental disorders during the COVID-19 epidemic in those who turned to psychiatrist for the first time, as well as in patients with already diagnosed mental illness. Patients and methods. We examined 100 patients who turned to a psychiatrist due to a deterioration in their mental state during the pandemic, 50 patients were newly diagnosed (Group 1) and 50 with previously diagnosed mental disorders (Group 2). The study was carried out by a clinical method using a specially designed map, followed by statistical processing of the obtained data. Results and discussion. Mental disorders caused by the COVID-19 pandemic more often occurred at a young age, in patients with higher and secondary specialized education, and in single patients. In the 1st group, as a result of exposure to psychogenic factors (the influence of the media, quarantine, economic changes), anxiety (36.8%) and depressive (21.1%) disorders occurred more often, and after the coronavirus infection, depressive disorders were in the first place (54.2%). The 2nd group mostly included patients with endogenous disorders (bipolar affective disorder - 24%, recurrent depressive disorder - 20%, schizophrenia - 20%), which were exacerbated more often as a result of COVID-19, to a lesser extent - psychogenic (experiences associated with a change in material status and illness of relatives). Obsessive-compulsive disorder, generalized anxiety disorder, somatoform disorders have been associated with epidemic factors. Conclusion. The results obtained indicate that there are differences between the mental disorders that first appeared during the pandemic and the exacerbations of the condition in mentally ill patients, which relate to the predictors, causes and clinical manifestations of these disorders.Copyright © 2022 Ima-Press Publishing House. All rights reserved.

Increase in traumatic injury burden amidst COVID-19 was disproportionately shouldered by racial and ethnic minority patients: An urban case study

Background: When the COVID-19 pandemic intersected with the longstanding global pandemic of traumatic injury, it exacerbated racial and ethnic disparities in injury burden. As Milwaukee, Wisconsin is a racially diverse yet segregated urban city due to historic and ongoing systemic efforts, this populace provided an opportunity to further characterize injury disparities. Method(s): We analyzed trauma registry data from the only adult Level 1 trauma center in Milwaukee, WI before and during the COVID-19 pandemic (N = 19,908 patients from 2015-2021). We retrospectively fit seasonal ARIMA models to monthly injury counts to determine baseline injury burden pre-COVID-19 (Jan 2015-Mar 2020). This baseline data was used to forecast injury by race and ethnicity from April 2020 to December 2021 and was compared to actual injury counts. Result(s): For all mechanisms of injury (MOI), counts during the pandemic were significantly higher than forecasted for Black or African American (mean absolute percentage error, MAPE = 23.17) and Hispanic or Latino (MAPE = 26.67) but not White patients (MAPE = 12.72). Increased injury for Black or African American patients was driven by increases in motor vehicle crashes (MVCs) and firearm-related injury;increased injury for Hispanic or Latino patients was driven by falls and MVCs. Conclusion(s): The exacerbation of injury burden disparities during COVID-19, particularly in specific MOI, underscores the need for primary injury prevention within specific overburdened communities. Injury prevention requires intervention through social determinants of health, including addressing the impact of structural racism, as primary drivers of injury burden disparities.Copyright © The Author(s) 2023.

Uncontrolled Acromegaly Resulting in the Need for LVAD as Bridge to Heart Transplant

Introduction: Acromegaly is an uncommon pituitary disorder with an incidence of six per million persons. While hypertension is often encountered in these patients, heart failure rarely is seen with an incidence rate under 10%. We describe a case of an individual who was diagnosed with acromegaly after an acute exacerbation of heart failure with subsequent management requiring an LVAD to perform Transsphenoidal Surgery (TSS). Case Description: 37-year-old male otherwise healthy initially presented to an emergency room and was found to be in acute heart failure exacerbation. Concerning acromegaly features included macrognathia, enlarged hands and feet, swollen phalanges, widened spacing of teeth, and frontal bossing. IGF-1 level was found 455 ng/mL. MRI showed a 10mm macroadenoma. A right heart catheterization showed elevated filling pressures. Cardiac MRI showed no defects or enhancement. Endomyocardial biopsy showed no inflammatory infiltrates or evidence of infiltrative diseases. Patient had an ejection fraction of 15% corroborated by cardiac MRI along with the presence of aortic root dilatation and mitral regurgitation. The patient started on 0.5mg of Cabergoline twice weekly and 120mg weekly Lanreotide injections. Patient stabilized with plans for further close monitoring and outpatient neurosurgical evaluation. The COVID-19 pandemic and insurance gaps led the patient to spend two years off his medicines and he was unable to be seen by his medical team. Patient was seen by our system after recurrent hospitalizations for heart failure at our sister hospital, AICD was unable to be placed due to the patient's anatomy, he was placed on wearable cardiac defibrillator and required milrinone infusion for progression to end-stage heart failure with cardiac cachexia. At our institution, the patient was evaluated for Orthotopic Heart Transplant (OHT) but due to active GH secreting macroadenoma there was concern for OHT failure without TSS. Decision was made to utilize LVAD as Bridge-to-Transplant for OHT so the patient could be stabilized and safely undergo TSS. The patient tolerated surgeries well and is currently on the active transplant list. Discussion(s): Heart failure is an uncommon presentation of severe acromegaly requiring multidisciplinary management. We describe a case of a patient who initially presented with heart failure too unstable for surgery. Due to the COVID-19 pandemic the patient's disease progressed resulting in end-stage heart failure requiring LVAD placement for further treatment. We would like to draw attention to the use of LVAD placement in acromegalic patients who develop severe cardiovascular disease who are not candidates for OHT.Copyright © 2023

COPD criteria-led discharge impacts on inpatient COPD management

Introduction/Aim: A chronic obstructive pulmonary disease (COPD) criteria-led discharge (CLD) pathway created on evidence-based guidelines was introduced at Canterbury Hospital to reduce unwanted clinical variation detected during a previous Agency for Clinical Innovation (ACI) audit. This audit aims to review whether adherence to COPD evidence-based guidelines improved after the CLD introduction. Method(s): The electronic medical records of patients admitted to Canterbury Hospital between 14/02/2022 and 01/08/2022 with a diagnosis of COPD, defined as DRG codes E65A and E65B, were reviewed. Data including patient demographics, admission dates, vaccination status, smoking status and cessation counselling, oxygen targets, inhalers, antibiotics, steroids and referrals on discharge were recorded in REDCap. Deidentified data was extracted into excel, grouped based on admission date being pre or post the CLD implementation date of 09/05/2022. The chi square test was used to determine significance. Result(s): A total of 66 patients were included for analysis (n = 25 pre-intervention, n = 39 post-intervention). Appropriate steroid discharge plans and inhaler technique reviews improved post CLD implementation. Antibiotic usage was more consistent with community acquired pneumonia guidelines rather than infective exacerbation of COPD for both groups. Vaccination documentation was generally poor aside from for Coronavirus disease (COVID-19), though there was significant improvement in the discussion of influenza vaccine post CLD. Documentation of oxygen targets did not improve. Referrals to outpatient respiratory services were high in both groups. Conclusion(s): Introduction of a COPD CLD improved adherence to some aspects of COPD evidence-based management at Canterbury Hospital. Further initiatives should be considered targeting appropriate antibiotic usage, oxygen targets and discussion of preventative measures such as vaccination.

Role of SARS-CoV-2 in asthma exacerbations

Asthma is one of the most common chronic respiratory diseases in the world and there is great concern about the effect of COVID-19 infection on asthma severity and control. Although the link between asthma and COVID-19 infection remains to be determined, available data indicate that asthma does not seem to be a risk factor for severe COVID-19. This review aims to summarize the updated data about the association between viral infections and asthma exacerbations including COVID infection and management of asthma flare-ups during the COVID pandemic, based on the recommended asthma guidelines.Copyright © 2020 Bilimsel Tip Yayinevi. All rights reserved.

Pneumomediastinum and pneumothorax as extrapulmonary complications of pneumonia due to SARS-CoV-2.

BACKGROUND: Barotrauma is a lesion generated for changes in the pressure and/or volume within a specific anatomic way;pneumo-mediastinum and pneumothorax are clear samples of this effect, frequently related to infectious symptoms. CLINICAL CASES: Two clinical cases are presented, 34 and 44 years old, that had pneumonia due to COVID-19, with subsequent exacerbation of the symptoms caused by barotrauma. Patients were evaluated at emergency unit of the Hospital Angeles Pedregal, Mexico City;their clinical presentation was similar and was unleashed by repeated cough in the context of pneumonia due to SARS-CoV-2. CONCLUSION(S): Now there is more experience on the complications associated during COVID-19, although more cases must be study to know their prognostic meaning and, in case it becomes a progression marker of the illness, to establish specific measures and therapeutic recommendations. The presentation of pneumonia stands out despite the vaccination, having to get the general population make consciousness of continuing with measures of respiratory isolation.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.

HFO versus usual care in pulmonary rehabilitation of post-COPD-exacerbation patients

Introduction/Aim: Early pulmonary rehabilitation (PR) is guideline-recommended for all chronic obstructive pulmonary disease (COPD) patients post-hospitalization for COPD exacerbation but many patients cannot participate in early PR due to significant breathlessness. High flow nasal oxygen (HFO) has been shown to improve ventilatory efficiency in stable COPD patients, but there is little data on HFO use during exercise training in PR of COPD patients post-exacerbation. Method(s): We conducted a pilot randomized controlled trial (RCT) to explore the feasibility of a prospective large-scale RCT to evaluate the impact of HFO in improving PR outcomes of COPD patients post-exacerbation. Patients recently hospitalized for acute COPD exacerbation were enrolled and randomized to either HFO application or usual standard care during an early 6-week outpatient, twice-weekly pulmonary rehabilitation program. Result(s): 22 patients were randomized between May 2019 and December 2019 and 18 patients completed the study. 2 patients in the HFO arm and 1 patient in the usual care arm withdrew for reasons unrelated to the study. The 22 nd patient (HFO arm) ceased participation due to research restrictions at the COVID pandemic onset. The HFO arm achieved a greater improvement in exercise capacity than the usual care arm, with the mean difference in the 6-min walk distance (6MWD) between the two arms being 30 m (95% CI: -23 to 84 m). All 18 patients in both arms were compliant to the pulmonary rehabilitation program (defined by attending >=75% of exercise sessions). HFO was well tolerated with no adverse events associated with its implementation. Conclusion(s): This RCT has shown preliminary evidence of the feasibility and high patient acceptability of HFO during early pulmonary rehabilitation on improving exercise capacity in COPD patients post-exacerbation These promising results would justify a larger RCT to confirm HFO's benefits and has the potential to change PR practice.

Alzheimer's disease and COVID-19.

In elderly patients with COVID-19 cognitive functions decline;it has been suggested that SARS-CoV-2 infection may lead to the development of Alzheimer's disease (AD) and other long-term neurological consequences. We review several parallels between AD and COVID-19 in terms of pathogenetic mechanisms and risk factors. Possible mechanisms through which COVID-19 can initiate AD are discussed. These include systemic inflammation, hyperactivation of the renin-angiotensin system, innate immune activation, oxidative stress, and direct viral damage. It has been shown that increased expression of angiotensin-renin receptors (ACE2) may be a risk factor for COVID-19 in patients with AD. When entering the central nervous system, the SARS-CoV-2 virus can directly activate glial cell-mediated immune responses, which in turn can lead to the accumulation of beta-amyloid and the subsequent onset or progression of current AD. The involvement of inflammatory biomarkers, including interleukins (IL): IL6, IL1, as well as galectin-3, as a link between COVID-19 and AD is discussed. The rationale for the use of memantine (akatinol memantine) in patients with COVID-19 in order to prevent the development of cognitive deficits is discussed. Memantine has been shown to have a positive effect on neuroinflammatory processes in the onset or exacerbation of cognitive deficits, in reducing cerebral vasospasm and endothelial dysfunction in viral infections. Memantine therapy may improve everyday activity and reduce the risk of severe SARS-CoV-2 infection.Copyright © 2022 Ima-Press Publishing House. All rights reserved.

Efficacy of Fuzheng Huayu Tablets for Treating Pulmonary Inflammation in COVID-19 Patients.

Objective:To observe the efficacy and safety of Fuzheng Huayu tabletsFHTfor treating pulmonary inflammation in patients with coronavirus disease 2019COVID-19. Method(s):A total of 704 cases were lost to follow-up, and 66 cases were finally completedCOVID-19 patients were recruited from February 1 to April 15 in 2020. They were assigned to a control group35 patientsand a FHT group31 patients. The patients in the control group received routine treatment alone and those in the FHT group received FHT in addition to routine treatment. The primary outcome was the ratio of patients showing improvement in chest computed tomographic manifestations after 14 days. The secondary outcome measures included remission rate or progression rate of critical illness,clinical remission rate of respiratory symptoms,routine blood examination, C-reactive proteinCPRlevel,procalcitoninPCTlevel,and blood oxygen saturationSPO2 . The safety was assessed based on liver and kidney functions and adverse events. Result(s): After the 14-day treatment,the ratio of patients showing improvement in the FHT group100%was higher than that in the control group 77.1%chi2 =8.063,P<0.01. The ratio of disease stages after treatment showed no significant difference between two groups. In the FHT group,the symptoms including cough,dyspnea,and fatigue were alleviated after treatmentP<0.01. In the control group,the symptoms including fever,cough,and dyspnea were alleviatedP<0.01,while the fatigue was not relieved after treatment. No significant difference was observed in the clinical symptoms between the two groups after treatment. After treatment,the FHT group showed decreased white blood cellWBCcount and neutrophil-to-lymphocyte ratioNLRP<0.01,elevated plateletPLTlevelP<0.05,lowered CRP levelP<0.05,and no significant difference in lymphocyte LYM,hemoglobinHb,SPO2 or PCT level. The control group showed decreased NLRP<0.05and WBC countP<0.01,elevated PCT levelP<0.05,and no significant change in LYM,Hb,PLT,SPO2 or CRP level after treatment. Furthermore,the FHT group had higher PLT level than the control groupP<0.05after treatment,and other indicators had no significant differences between the two groups. The liver and kidney functions had no significant difference between the two groups after treatment. Conclusion(s): FHT can safely promote the absorption of acute pulmonary inflammation in COVID-19 patients.Copyright © 2022, China Academy of Chinese Medical Sciences Institute of Chinese Materia Medica. All rights reserved.

Pulmonary sarcoidosis

The lung is the most common organ affected by sarcoidosis. Multiple tools are available to assist clinicians in assessing lung disease activity and in excluding alternative causes of respiratory symptoms. Improving outcomes in pulmonary sarcoidosis should focus on preventing disease progression and disability, and preserving quality of life, in addition to timely identification and management of complications like fibrotic pulmonary sarcoidosis. While steroids continue to be first-line therapy, other therapies with fewer long-term side-effects are available and should be considered in certain circumstances. Knowledge of common clinical features of pulmonary sarcoidosis and specific pulmonary sarcoidosis phenotypes is important for identifying patients who are more likely to benefit from treatment.Copyright © ERS 2022.

Longitudinal mental health trends in pediatric cystic fibrosis

Background: People with cystic fibrosis (CF) are more likely to have anxiety and depression symptoms than the general population, with psychological distress being associated with negative health outcomes. The Cincinnati Children's Hospital Medical Center CF Center has been screening people with CF aged 12 and older since 2016 for anxiety and depressive symptoms. Little is known about longitudinal mental health trends for youth with CF, especially during the COVID-19 pandemic. Method(s): Chart review was conducted for individuals aged 12 and older seen for routine care at our center with at least one General Anxiety Disorder (GAD-7) or Patient Health Questionnaire (PHQ-9) screening result between January 2016 and December 2021. Data included demographic characteristics;dates and scores of GAD-7 and PHQ-9;mental health encounters 12 months before each screening date;and clinical variables of disease severity, including percentage predicted forced expiratory volume in 1 second (FEV1pp), body mass index, CF-related diabetes (CFRD), antibiotics in the 28 days prior, and exacerbations in the 12 months prior. Descriptive statistics were used to summarize demographic variables, logistic regression and linear mixed modeling were used to identify predictive relationships, and t-testswere used to compare impact of COVID with that of prior years. Result(s): The sample included 150 individuals with at least one screen across the 6 years. An average of 83 people completed at least one GAD-7 or PHQ-9 in each year. Across the 6-year time period, the percentage of individuals with low scores increased, and the percentage of people with moderate to severe scores was stable (Figure 1). Approximately 35% of individuals were rescreened at least once in a given year because of a previously high symptom score. For thosewho screened in the moderate to severe range (>=10) on initial screens per year, an average of 32% (GAD-7) and 37% (PHQ-9) had a lower score (<10) on their second screen per year. Individuals who scored 10 or higher on initial GAD-7 or PHQ-9 screens in any year were statistically more likely to have a CFRD diagnosis ( p = 0.02, GAD-7;p = 0.02, PHQ-9) and more psychology or psychiatry visits 12 months before the screening date ( p < 0.01, GAD-7;p < 0.01, PHQ-9) than those with minimal scores. In addition, PHQ-9 scores of 10 or greater were significantly associated with lower FEV1pp than low scores. Adherence to screening protocols consistently increased over time. Of all eligible individuals, 56% completed a GAD-7 and 55% a PHQ-9 in 2016, increasing to 92% and 94%, respectively, by 2021, despite the impact of the COVID-19 pandemic on CF care visit frequency. GAD-7 scores were not significantly different before COVID and during COVID ( p = 0.06);PHQ-9 scores were higher before than during COVID ( p = 0.02) despite similar numbers of screens conducted per year. (Figure Presented)Figure 1. Percentage of initial Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) scores per year from 2016 to 2021 of people with cystic fibrosis seen at Cincinnati Children's Hospital Medical Center Conclusion(s): These longitudinal trends in mental health symptom scores over time are reassuring,with increasing frequency of lowscores and stable moderate to severe scores. This may be because of greater awareness of mental health symptoms, more interventions through care teams, or improved access to resources. Similarly, although general population data suggest worsening of anxiety and depressive symptoms during the COVID- 19 pandemic, we hypothesize thatwewere able to buffer the impact of the pandemic on mental health in our center by screening and responding to screens. These results highlight the importance of consistent monitoring and support for mental health symptoms in people with CFCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

A novel cystic fibrosis-pregnancy service: Two-year review after introduction of elexacaftor/tezacaftor/ivacaftor

Background: As a quality service improvement response since elexacaftor/ tezacaftor/ivacaftor (ELX/TEZ/IVA) became available and the yearly average number of cystic fibrosis (CF) pregnancies (n = 7 pre-2020, n = 33 in 2021) increased significantly at an adult CF center (~600 people with CF), a monthly multidisciplinary CF-maternal health virtual clinic was established with antenatal virtual CF exercise classes dedicated to providing adaptive, specialist support to this cohort, aswell as outreach guidance and education to local obstetric teams. Method(s): This was a single-center retrospective reviewof Royal Brompton Hospital CF-Maternal Health multidisciplinary team clinic records and a patient survey from March 2020 to March 2022. Result(s): Of 47 pregnancies in 41 women (median age 30;) eligible for ELX/ TEZ/IVA at start of pregnancy, 40% (n = 19) were unplanned, and 19% (n = 9) used assisted conception. Three women with a history of infertility conceived naturally, having required assisted conception for previous pregnancies, and five women had multiple pregnancies during the study period. ELX/TEZ/IVA was continued in 60% (n = 28), delayed in 28% (n = 13), and stopped in 13% (n = 6) of pregnancies through maternal choice and careful clinical counselling. Pre-pregnancy pulmonary status was poorer in women who continued than in those who delayed or stopped (Table 1). Of those who stopped, 85% (n = 5) restarted because of pulmonary deterioration by the third trimester. Prenatal CF complications included at least one episode of minor hemoptysis in 21% (n = 9/41) of women, at least one infective exacerbation in 55% of pregnancies (n = 26/47), and noninvasive ventilation in one woman. Other pregnancy-associated complications included one case of ovarian hyperstimulation syndrome, one case of sub-segmental pulmonary embolism, and two cases of pregnancy-induced hypertension. Excluding 10 first trimester terminations, 10 current pregnancies, and one patient relocation, obstetric outcomes available for 26 pregnancies confirmed a live birth rate of 85% (n = 22/26) and a 15% first-trimester miscarriage rate (n = 4). Obstetric complications included preterm delivery rate of 23% (n = 6/26), including two cases of COVID infection resulting in two neonatal intensive care unit admissions, one case of endometritis after cesarean section, and a fourthdegree perineal tear. There were no ectopic pregnancies, maternal or neonatal deaths, or reports of infant cataracts or congenital malformations. Median gestational age was 37/40 weeks (range 29-40). Mode of delivery was via cesarean section in 45% (n = 10/22, of which twowere emergency) and vaginal in 55% (n = 12/22), of which 83% (n = 10/12) were via induction of labor for diabetes (CF or gestational) indication. Deliveries were supported and occurred equally at local obstetric units and in tertiarycare obstetric hospital settings (50%, n = 11/22). Patient-experience survey responses cited high levels of confidence in health optimization and prioritization during pregnancy and praised excellent inter-health care provider communication and peer-to-peer emotional support provided among expectant mothers in the virtual prenatal exercise groups. Table 1. Baseline demographic and clinical characteristics of elexacaftor/tezacaftor/ivacaftoreligible expectant mothers according to therapeutic decision (Table Presented) Conclusion(s): In the absence of clinical trial safety data, the novel approach of a dedicated CF-maternal health multidisciplinary team clinic with local obstetric outreach support has ensured regular specialist clinical and emotional peer-to-peer support for this cohort of women eligible for ELX/ TEZ/IVA to ensure optimal outcomes and experiences of their pregnancies, where appropriate, close to home.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Parosmia and COVID-19 from the lens of google trends: infodemiology study

Parosmia is a subcategory of olfactory hallucinations and refers to a distorted ability to detect the right smell in the presence of a stimulus. The study aims to investigate the relationship between COVID-19 and parosmia by calculating the interest search volume of parosmia using google trends. Google trends was used to investigate trends in searches regarding parosmia and to track these search engine terms against the coronavirus outbreak in France, Sweden, the United States [USA], and Turkiye. The terms utilized in the search were "Parosmia" and "anosmia" and the data were collected between March 20, 2020, to July 25, 2021. Parosmia searches increase with time in all the countries and the correlation significance values were obtained for France, Sweden, USA, and Turkiye to be Rs 0.660, P-value 0.0038 "Moderate correlation";Rs 0.566, P-value 0.017 "Moderate correlation";Rs 0.842, P-value 0.0001 "Strong correlation";Rs 0.800, P-value 0.0001" Strong correlation" respectively. Relative search volume of parosmia and anosmia changed significantly with time may point out that there are some late COVID-19 complications that haven't been detected yet, and with the pandemic still ongoing, more complications could be discovered by analyzing the trends.Copyright © 2023, Istanbul Medipol University. All rights reserved.

COVID 19 infection in children with asthma

Background: The pandemic period demonstrated the epidemiological and clinical evolutionary differences between adult vs. child with asthma infected with COVID 19. One of the challenges for pediatricians was the risk of losing control of asthma but also the risk of serious complications in the asthmatic child. The aim of the study was to study the level of control of asthma in children and on the other hand the incidence of its severe complications in the pandemic period 2020-2021 vs the non-pandemic period 2018-2019. Method(s): Retrospective study on asthmatic patients hospitalized in the period 2020-2021 in the Emergency Clinical Hospital for Children "St Mary" Iasi. Result(s): Total number of cases of asthma-2018- 219, 2019-174, 2020-193,2021- 148;annual asthma control level: controlled asthma: 2018-63%, 2019-59%, 2020-67%, 2021-54%, partially controlled asthma: 2018-29%, 2019-35%, 2020-26%, 2021 -38%, uncontrolled asthma: 2018-8%, 2019-6%, 2020-7%, 2021-8%;annual incidence of exacerbations: controlled asthma -2018: 23%, 2019-27%, 2020-11%, 2021 -14% of which with COVID 19 infection-2%;partially controlled asthma-2018: 41%, 2019-54%, 2020-32% of which with COVID 19 infection-21%;2021-58% of which with COVID19 infection- 42%;uncontrolled asthma-2018- 77%, 2019-73%, 2020-86% of which with COVID19 infection -82%, 2021-81% of which with COVID 19 infection-74%;annual incidence of severe asthma complications hospitalized ICU: 2018-3%, 2019-2%, 2020-5% of which 4% with COVID 19 infection,2021-4% all associated with COVID 19 infection. Conclusion(s): The control rate of asthma in children did not register significant differences between the 2 studied periods;The incidence of severe complications and exacerbations in the context of SARS Cov 2 infection increased during the pandemic period, especially in the partial and especially uncontrolled therapeutic form of asthma in children.

A flare of EGPA after vaccination for COVID-19, description and follow-up of a clinical case

Background: Although rarely, vaccines can stimulate the immunological mechanisms underlying immune-mediated inflammatory diseases. in patients with COVID-19 there is also evidence that high titers of autoantibodies, with variable clinical relevance, can be detected. Method(s): We describe the case of a 71-year- old lady diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA) in 2010 with paraesthesia, myalgia, eosinophilia and severe asthma. After induction of remission, the patient has shown regression of the vasculitis but persistence of the uncontrolled asthma. For this reason, since February 2019 she started Mepolizumab 100 mg/month. In December 2020 she tested positive for the SARS-CoV- 2 virus, manifesting a mild form then she tested negative in January 2021. In April 2021 she was vaccinated with a single dose of BNT162b2 mRNA vaccine. After about 10 days, she started to complain arthromyalgia and after a week of gait alteration, paraesthesia, dyspnoea and worsening cough associated with chest pain. Blood tests showed an increase in creatinephosphokinase (CPK 955 U/L) and hypereosinophilia (4.3x10

The Efficacy, Safety, And Cost Savings Of High Dose IV Diuretics For Heart Failure Patients In An Outpatient Setting With Limited Hospital Bed Space Due To Covid-19

Introduction: Hospitalization is the greatest expenditure for heart failure treatment, estimated to be 8-15 billion dollars annually with the most common cost due to acute decompensation. An approach to manage this is an infusion clinic for outpatient diuresis and observation is an effective way to reduce the admission rate and improve patient outcomes. There are limited studies about high dose IV diuretics for outpatient treatment and outcomes. Bed availability during 2021 was severely limited due to COVID, and sicker patients were cared for outside of conventional hospital treatment. Hypothesis: High dose IV diuretics for heart failure patients in an infusion clinic can reduce admission rate effectively and safely. Method(s): Patient medical records were retrospectively reviewed. 83 patients with symptomatic decompensation underwent 117 treatments in 2021. They received an individualized, protocol driven bolus and infusion of IV diuretics at the clinic calculated on their baseline diuretic dosing. All but one patient was seen in follow up in 2 business days. Outcomes measured included hospital admission within 30 days, hospital days avoided, and costs saved. Adverse outcomes monitored included acute kidney injury, hypokalemia, symptomatic hypotension, and arrhythmia. Result(s): The patients had an average age of 73.6+/-12.9 years old, 64% male and 36% female. There were 80% of patients with HFpEF. The average weight gain above dry weight was 14.6 pounds. The patients had multiple comorbidities and all have chronic kidney disease stage 3 or higher. They were all on high dose diuretics. The results showed that following treatment the admission rate was 47% with 78% of those diagnosed with heart failure exacerbation. Only 1 patient was hospitalized for AKI and hypokalemia. Two patients had transient AKI at follow-up which resolved with diuretic adjustment. Estimated hospital days avoided was 372 days with a savings of 413,168 dollars based on FY21 direct cost/case. Conclusion(s): COVID-19 significantly limited the ability to provide care for patients with chronic issues in the hospital due to bed availability. Avoiding inpatient admissions on a medically complex, congested group of patients results in a significant cost saving while providing safe and effective care.Copyright © 2022

Clinical case of gastroesophageal reflux disease exacerbation in a middle-aged patient with covid-19.

Objective. To describe COVID-19 influence on gastroesophageal reflux disease (GERD) exacerbation using clinical case. Main points. COVID-19 infection remains an urgent problem for modern medicine due to its high contagiousness and rapid dis-tribution among the working population. We presented a clinical case of a 49-year-old female patient with respiratory complaints and extraesophageal manifestations of GERD. Conclusion. This clinical case showed that clinicians should consider various mechanisms of respiratory symptoms, which becomes exceptionally relevant during the COVID-19 pandemic. The development of atypical symptoms in a patient of working age without concomitant pathology causes difficulties in early diagnosis and timely treatment, in contrast to comorbid elderly and senile patients. Several mechanisms led to an exacerbation of GERD with the development of wheezing. Therefore, a clinician should meticulously take a medical history, form a trusting relationship with a patient, detect and correct early signs of anxiety and depression with a multidisciplinary team.Copyright © 2021, Media Sphera Publishing Group. All rights reserved.

Effects of COVID-19 vaccination on chronic urticaria patients: First results of the UCARE COVAC-CU study

Background: Chronic urticaria (CU) is a common chronic inflammatory disease. Vaccination against viral infections including COVID-19 can induce increased CU disease activity. As of now, it is unclear how often CU exacerbations occur after COVID-19 vaccination. Method(s): COVAC-CU is an international, multicenter, observational, cross-sectional study of the global network of urticaria centers of reference and excellence (UCAREs). COVAC-CU evaluates the effects of COVID-19 vaccination in patients with CU including rates and risk factors of CU exacerbation. Here, we analyzed 1857 patients with CU who had received at least one COVID-19 vaccination. Data were collected via a questionnaire and retrieved from patient charts. Result(s): Of 1857 patients with CU (median age: 42 years;range: 18-91 years), 72.1% were female and 71.2%, 14.4% and 14.4% had chronic spontaneous urticaria, chronic inducible urticaria, or both, respectively. Most patients had received two doses of COVID-19 vaccine (79.1%), compared to one (9.7%), three (11%), or four (0.3%). Vaccine type included: BTN162b2 (58.4%;BioNTech/Pfizer), ChAdOx1 nCOV-19 (13.8%;AstraZeneca), BBIBP-CorV (8.2%;Sinopharm), Gam-COVID- Vac (8%;Sputnik), mRNA-1273 (5.3%;Moderna), and Ad26.COV 2.5 (4.7%;Janssen/J&J). Less than 10% of patients used premedication, and less than half of patients (44.4%) reported one or more adverse reactions after vaccination. The most common adverse reactions were local injection site reactions (29.6%), fatigue (19.7%), fever (19%), muscle pain (17.9%), headache (14%), and exacerbation of CU (15%). Severe allergic reactions/anaphylaxis were reported by 0.4% of CU patients. In almost all patients who experienced exacerbation of their CU, this occurred within one week after receiving the vaccine, i.e. after 1 to 12 hours (25.8 %), after 12 hours to 48 hours (31.1%) or after 2-7 days (37.9%). Conclusion(s): Most CU patients tolerate COVID-19 vaccination well;severe allergic reaction (anaphylaxis) rates were similar or lower than the self-reported rates reported in the general population. Exacerbation of urticaria was reported in one in five patients, mostly in a week after receiving the vaccine.

Impact of COVID-19 on the course of allergic diseases in children

Background: to evaluate the impact of COVID-19 on the course of allergic diseases in children. Method(s): 32 children with allergic diseases who had a coronavirus infection or their parents were surveyed. The questionnaire consisted of questions about the severity of an allergic disease, the severity and complications of a SARS-CoV- 2 infection, the amount of therapy during infection and after infection. The age of patients is from 5 to 16 years (boys 62%, girls 38%). Result(s): Among the respondents were 53.1% (17 patients) with allergic rhinoconjunctivitis (AlRC), 34.3% (11) with atopic bronchial asthma (ABA), 9.5% (3) with atopic dermatitis (AtD) and 3.1% (1) with a history of acute spontaneous urticaria (OK). 71.9% of patients suffered COVID-19 in mild, 25% in moderate and 3.1% in severe forms. Complications: 11 patients were diagnosed pneumonia with lung damage of less than 25%, 1 case of acute urticaria. The analysis of the effect of COVID-19 on the course of allergic diseases was carried out among patients (25 people) who were in remission before infection: with AlRC -15, ABA -8, AtD-2 patients. Patients with AlRC against the background of COVID-19 disease in 40% cases had increase in symptoms, 33.3% noted a preservation of exacerbation after 1 month after the disease, 26.7% after 3 months. Patients with ABA had increase symptoms against the background of COVID-19 occurs in 37.5%, 25% of cases -1 month after the disease, 12.5% of cases after 3 months, Symptoms did not bother and after 6 months. 1 patient with AtD disease had an exacerbation of dermatitis during of COVID-19 and 1 month after infections. Patients who had an exacerbation of an allergic disease against the background of COVID-19, changed drug treatment on a step upper. Reducing the dose of the drugs and and the volume of drug therapy was possible only 3 months after the infection Conclusion(s): Children with allergic diseases have SARS-CoV- 2 occurs in a mild form in most cases. COVID-19 causes exacerbation of AlRC, ABA, AtD in more than 1/3 of patients. Acute urticaria was presented as a complication in one case. Exacerbation of allergopathology against the background of COVID 19 requires a transition to a step above drug therapy for 3 months. Control over the symptoms of allergic diseases is observed 3 to 6 months after the infection.