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Rationale: Childhood food insecurity was exacerbated during the COVID-19 pandemic, with burdens falling disproportionately on minority children. This study aims to describe the prevalence of food insecurity in food-allergic children of an urban minority community and examine the association between food insecurity and food allergy. Methods: We conducted a retrospective review of electronic medical records of all patients aged 6 months to 18 years seen in a primary care pediatric clinic at NYC Health + Hospitals/Kings County, from 10/2020 to 06/2022. Pediatricians at this clinic in Central Brooklyn routinely screen for food insecurity using the Hunger Vital Sign™, a validated tool recommended by the American Academy of Pediatrics. Data was collected based on ICD-10 diagnosis codes for food insecurity (Z59.41) and food allergy (Z91.01). Logistic regression was used for analysis. Results: Among 7,856 children included in the study, 84.9% were Black or African American, 6.0% Hispanic/Latinx, 1.2% white, and 1.1% were Asian/Pacific Islander. Of 275 children diagnosed with a food allergy by a primary care pediatrician, 4.7% screened positive for food insecurity. Of 7,581 children without a diagnosed food allergy, 2.6% screened positive for food insecurity (p=0.029). Children with food allergy (adjusted odds ratio: 2.14, 95% confidence interval: 1.19-3.85) were significantly more likely to be food insecure than those without a food allergy, adjusted for age, gender, and race/ethnicity. Conclusions: Childhood food allergy is associated with increased odds of food insecurity. This study highlights the importance of assessing and addressing food insecurity in children with food allergies.
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Healthcare-associated COVID-19 among vulnerable patients leads to disproportionate morbidity and mortality. Early pharmacologic intervention may reduce negative sequelae and improve survival in such settings. This study aimed to describe outcome of patients with healthcare-associated COVID-19 who received early short-course remdesivir therapy. We reviewed the characteristics and outcome of hospitalized patients who developed COVID-19 during an outbreak that involved two wards at a non-acute care hospital in Japan and received short-course remdesivir. Forty-nine patients were diagnosed with COVID-19, 34 on a comprehensive inpatient rehabilitation ward and 15 on a combined palliative care and internal medicine ward. Forty-seven were symptomatic and 46 of them received remdesivir. The median age was 75, and the median Charlson comorbidity index was 6 among those who received it. Forty-one patients had received one or two doses of mRNA vaccines, while none had received a third dose. Most patients received 3 days of remdesivir. Of the patients followed up to 14 and 28 days from onset, 41/44 (95.3%) and 35/41(85.4%) were alive, respectively. Six deaths occurred by 28 days in the palliative care/internal medicine ward and two of them were possibly related to COVID-19. Among those who survived, the performance status was unchanged between the time of onset and at 28 days. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases
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Background: Data are limited regarding the safety of and antibody response to the BNT162b2 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger ribonucleic acid vaccine in adolescents and young adults with underlying disease. Methods: This prospective observational study enrolled patients age 12–25 years with chronic underlying disease who received 2 doses of BNT162b2. A 18-item questionnaire was used to assess adverse events within 7 days post-vaccination, and data regarding severe adverse events were collected from electronic medical records. An antibody titer for the receptor-binding domain of the spike protein in SARS-CoV-2 was used to assess antibody response after the second vaccine dose. Results: Study participants were 429 patients (241 [56.2%] age 12–15 years;188 [43.8%] age 16–25 years). The most common underlying diseases were genetic or chromosomal abnormalities and/or congenital anomalies, followed by endocrine or metabolic diseases;32% of participants were immunocompromised. Severe adverse events were observed after the second dose in 1 (0.4%) patient age 12–15 years and in 2 (1.1%) patients age 16–25 years;all patients recovered. Seropositivity after the second vaccine dose was 99.0%. The geometric mean antibody titer was higher in patients age 12–15 years versus 16–25 years (1603.3 [1321.8–1944.7] U/mL vs. 949.4 [744.2–1211.0] U/mL). Compared with immunocompetent patients, immunocompromised patients had a lower antibody titer (2106.8 [1917.5–2314.7] U/mL vs. 467.9 [324.4–674.8] U/mL). Conclusions: Vaccination with BNT162b2 was acceptably safe and immunogenic for adolescents and young adults with underlying disease. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases
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Objective: We aimed to assess the association between RAAS inhibitors (ACEi or ARB) and the clinical outcomes of COVID-19 patients with hypertension in the First Wave, Second Wave and Third Wave at Secondary Referral Hospital, Indonesia Methods: This cross sectional study was based on an electronic medical record in the Dr Adhyatma MPH Tugurejo General Hospital, Semarang, Indonesia. All patients more than 18 years old who confirmed COVID-19 case in the first wave (November 2020 to January 2021), second wave (May 2021 to July 2021) and third wave (January 2022 to February 2022) were included in this study. Data about demographic, comorbidities, features of antihypertensive drugs and clinical outcomes were collected. The clinical outcomes included mortality and prolonged hospitalization (length of stay (LOS) > 10 days). The statistical measures calculated were Chi square test and Fischer's exact test. Results: From three periods of peak wave, data from 1560 COVID-19 patients was collected in the first wave (304;19.5%), the second wave (1038;66.5%), and the third wave (218;14.0%). Subjects were dominated by males (50.4%) and a median of age 50 (19 -91) years old. The common comorbidities in studies were diabetes mellitus with 318 (20.4%) and hypertension with 254 (16.3%). In the main analysis, 99 (39%) patients with hypertension receiving RAAS inhibitors were compared with 155 (61%) patients receiving other antihypertensive drugs. Our results showed that RAAS inhibitors was not associated with a higher risk of COVID-19 mortality (RR:1.01;95% CI: 0.61-1.67;p:0.969) or prolonged LOS (RR:0.86;95%CI: 0.60-1.26;p:0.408). Conclusions: In COVID-19 patients with hypertension, the use of RAAS inhibitors showed no increased mortality or prolonged LOS compared to patients without RAAS inhibitors. COVID-19 patients and patients exposed to the COVID-19 pandemic should not discontinue ACEi or ARBs.
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Background: Mortality associated with COVID-19 varies in various reports, with minimal data on the factors associated with in-hospital mortality. Objective: To identify the risk factors for in-hospital death of patients with COVID-19 in an intensive care unit (ICU) in Qatar. Methods: A retrospective observational study of patients confirmed with COVID-19 and admitted to the medical-surgical ICU at The Cuban Hospital was carried out from April 12, 2020, to September 12, 2020. From patients' electronic medical records, demographic, clinical, laboratory, and radiology data was collected. Results: 275 patients with COVID-19 were admitted to the ICU, and 32 (11.6%) died. 56.1% were men, and the mean age was 52.2 years. According to the univariate analysis, patients with diabetes mellitus with end-organ damage (37.5%), cardiovascular disease (31.3%), dementia (9.4%), kidney disease (28.1%), chronic obstructive pulmonary disease (31.3%), and higher Charlson index had higher mortality. According to the multivariate analysis, an increase of mortality risk by 9% was observed for each additional year of age (Odds ratio [OR] 1.09;95% confidence interval [CI] 1.04-1.14), patients on mechanical ventilation (OR 27.33;95% CI 3.21-232.46), and those with adult respiratory distress (OR 15.85;95% CI 1.45-172.82) and elevated procalcitonin (OR 7.30;95% CI 1.25-42.58), and the PiO2/FiO2 ratio between 100 and 299 decreased the risk of death by 92% (OR 0.08;95% CI 0.02-0.39), in comparison to a PiO2/FiO2 ratio less than 100 or greater than 300. Conclusion: The study provides evidence about the risk of mortality among COVID-19 patients with a significant contribution of age, respiratory failure, and co-infections.
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Purpose: Transgender and gender-diverse (TGD) youth are highly susceptible to negative health sequelae including high rates of depression, suicidal ideation, self-harm, and suicide attempts. Rural TGD youth have the added difficulties of living amid people who may hold more negative views toward gender diversity, and a dearth of TGD care, leaving them with far less support than their urban counterparts. The rapid expansion of telemedicine during the initial months of the coronavirus pandemic of 2019 enhanced access to many populations but it is not clear how this has impacted access for rural TGD youth, particularly those living in areas with limited broadband access. As such, the purpose of this research was to explore access to care for TGD youth by determining how telemedicine impacts appointment attendance for rural TGD youth. Methods: We used a retrospective quantitative design and an encounter-level dataset to evaluate the study purpose. We extracted a secondary data set from the electronic medical record (EMR) of an adolescent and young adult (AYA) clinic that provides gender-affirming (GA) care. The clinic is the only one of its kind in the state, and serves both rural and urban populations. In addition to EMR data, address data was used to develop rurality and distance to care variables. All visits to the clinic from March 2020 through December 2021 were included in the data. Descriptive statistics and bivariate analyses were conducted to characterize the population and multivariate analysis were used to model the association between visit attendance and covariates of interest. Specifically, logistic regression with GEE was implemented to account for repeated measurements and within-patient correlation. Results: Nearly 3000 unique patients were identified from over 18,000 visits during the study period, with 984 visits (5.5%) identified as related to GA care;386 (39.2%) of these visits were by patients from rural areas. During the study period 4917 (27.4%) of all encounters were scheduled for telehealth compared with 149 (15.1%) of GH visits. Although the overall no-show rate for the clinic was 10.9%, the rate for GA visits was significantly lower (6.5%;p<.001) and the rate for GA visits for patients from rural counties was even lower (5.7%, compared with 8.93% for non-GA rural visits). The NS rate for GA telemedicine visits was 0.0%. In multivariable analysis, GA visits were associated with a 42% reduction in odds of NS after adjusting for rurality, telemedicine visit, age (over 18 vs. under 18), travel time, and patient's gender identity. Conclusions: AYA from rural areas who are seeking GA care are less likely to no-show for clinic and telemedicine visits than patients seeking other types of care and from non-rural areas, suggesting that this care is highly valuable to patients. Our results indicate that ensuring a reliable telemedicine connection for rural AYA is an important component of providing access to GA care. Sources of Support: This project was supported by a grant from the Daisy Foundation.
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AIM: The aim of the study was to analyze the clinical characteristics of death cases with Coronavirus Disease 2019 (COVID-19). METHOD(S): We collected clinical characteristics of confirmed COVID-19 patients who died from January 01, 2022, to March 31, 2022, in Prof. Dr. R. D. Kandou General Hospital, Manado, Indonesia. The patient's clinical features were obtained from the electronic medical records: Age, sex, history of COVID-19 vaccination, type of vaccine, s-gene target failure (SGTF) result, duration of hospitalization, comorbidities, and cause of death. RESULT(S): Seventy-nine medical records of COVID-19 patients treated and died at Prof. Dr. R. D. Kandou General Hospital, Manado, Indonesia, from January 01, 2022, to March 31, 2022. The mean age of patients was 56-years-old, 57% were males, and 43% were females. The mean duration of hospitalization was 5 days. Most patients (73%) had not received any COVID-19 vaccine. SGTF results showed a probable Omicron variant in 53% of the subject, 13% of non-probable Omicron, and 13% of others who did not have the test. A third of the deceased patients had at least one type of comorbid condition. Diabetes mellitus was the most common comorbidity in 66% of our subjects. Most of the issues died due to respiratory failure (63%), and the rest died due to multiple organ failures, septic shock, and cerebrovascular accidents. CONCLUSION(S): One-third of COVID-19 patients who died at least had one type of comorbidity, commonly diabetes mellitus. Most of the subjects died due to respiratory failure. Most of the deceased patients had not received any COVID-19 vaccination. Copyright © 2022 Erling David Kaunang, Erwin Gidion Kristanto, Jimmy Panelewen, Ivonne Elisabeth Rotty.
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Purpose: To describe the outcome of Covid-19 infected patients with underlying rheumatic diseases in a rheumatology center in Malaysia. Introduction: Several risk factors for Covid-19 infection have been recognized since the onset of pandemic. Whether patients with rheumatic diseases are more susceptible to severe Covid-19 infection remain unclear. Method(s): This was a retrospective study. The electronic medical records of all Covid-19 infected patients with underlying rheumatic diseases who follow up in rheumatology clinic Hospital Sultan Ismail from March 2020 to December2021 were reviewed and identified. Result(s): There were total of 40 patients with 95% of them were female (38/40). Majority of them were Malay (31/40) followed by Chinese (6/40), Indian (2/40) and others (1/40). The mean age group was 46 (range from 21 to 75). 55% of them were diagnosed to have Systemic Lupus Erythematosus (SLE), followed by Rheumatoid Arthritis (RA, 27.5%), scleroderma (Ssc,5%) and 2.5 % each for Sjogren syndrome (Sjog), psoriatic arthritis (PsA), gout, antisynthetase syndrome and dermatomyositis (DM) overlap RA. 72.5% of them were unvaccinated and only 7.5% of them were completed 2 doses of covid-19 vaccine whereas the rest of them only had single dose. The results showed 17.5% of them succumbed to covid-19 infection and 5 of them succumbed for Covid-19 pneumonia stage 5. 70% of the patients who succumbed were unvaccinated during covid-19 infection. Conclusion(s): There were 5 patients from chronic inflammatory arthritis and 2 from systemic autoimmune conditions succumbed due to Covid-19 infection. Whether patients with chronic inflammatory arthritis more prone to infection required more data. Majority of patients who succumbed were unvaccinated. (Table Presented).
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BACKGROUND: Health information technology (HIT) is being increasingly necessary to manage the ever-increasing amount of data generate by the health system in general, including primary health care (PHC). AIM: This study aimed to provide an overview of HIT being currently use in the health systems and PHC as well as to highlight the advantages and disadvantages of HIT options. METHOD(S): This is a narrative literature review of papers, documents, and websites that address and discuss HIT for the health systems. The analysis of the retrieved materials provided an overview of the importance of HIT for the health system, the various options of health technology currently available, as well as the future trends. Strengths and weaknesses have been highlighted as well. RESULT(S): HIT is being increasingly used in the health sector, as an indispensable tool to handle the extraordinary amount of data being generated by the health system but also as an instrument to improve the quality of health care through the reduction of medical errors and health care-associated costs, improvement of patient follow-up and monitoring, and also as a tool that informs and guides clinical decision-making. A large variety of HIT options is available, including telehealth, telemedicine, mobile health, electronic medical records, electronic health records, personal health records, electronic prescriptions (e-prescriptions), wearables, metadata, and even artificial intelligence. Each HIT option has its own advantages and disadvantages. PHC could benefit from the implementation of various HIT options. CONCLUSION(S): The decision which HIT option(s) to employ will depend on many factors, but the process needs to employ small steps, strong political will, cooperation, and coordination between all stakeholders. Copyright © 2022 Erion Dasho, Loreta Kuneshka, Ervin Toci.
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Background: A proportion of patients with COVID-19 become critically ill, but few studies describe the functional outcomes and rehabilitation process of these patients. Objective(s): To describe the complications encountered and functional outcomes of critically ill COVID-19 patients requiring intubation and subsequent intensive care unit (ICU) management and rehabilitation. Method(s): Retrospective case note review was conducted on all patients requiring intubation and ICU admission and subsequently discharged from our hospital from February 15, 2020 to May 1, 2020. Demographics, preexisting medical conditions, complications encountered in ICU, ICU and General Ward Length of Stay, number of therapy sessions delivered, nutritional data, and functional outcomes on discharge were collected from electronic medical records and entered in a deidentified database. Result(s): Most patients developed significant breathlessness affecting post-ICU rehabilitation, a few patients developed ICU associated delirium while no patient developed ICU-associated weakness. All patients survived and could walk 20 m within 12 days post-extubation. Conclusion(s): Early ICU and sustained post-ICU rehabilitation of critically ill, intubated COVID-19 patients is feasible. Further studies could look into the outcomes of this group of patients, in particular the effect of nutrition and pulmonary training on functional outcomes. We strongly recommend an interdisciplinary rehabilitation team approach in managing critically ill COVID-19 patients. Copyright © The Author(s) 2022.
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Background: Rheumatoid Arthritis (RA) flare post-COVID- 19 vaccination has been reported and poses a great concern among patients. This study aims to evaluate the prevalence of RA flare post COVID-19 vaccination and its associated risk factors. Method(s): This was a cross-sectional questionnaire-based study assessing RA flare based on patient self-report disease flare or documented physician assessment (physician-reported flare). The study was conducted from May to July 2022 in Hospital Putrajaya and recruited RA patients who received at least one dose of COVID-19 vaccine under the Malaysian National Vaccination Programme. Patient self-reported disease flare was defined as 'a sudden worsening of rheumatology condition or arthritis within 1 month post-vaccination' while physician-reported flare was defined as 'an increment of disease activity score 28-joint (DAS28 CRP/ESR) documented within 3 months post-vaccination' from either a scheduled or unscheduled clinic visit. Demographic data, vaccination history and disease parameters were retrieved from electronic medical records. Statistical analysis included descriptive and univariate analyses were performed using SPSS. Result(s): A total of 186 patients were enrolled. Majority (93%) were female with the mean age of 58 years old (standard deviation, SD 12.2). Most patients were seropositive (66% Rheumatoid factor, 63% anti-citrullinated peptide antibodies) with mean disease duration of 12 years (SD 7.7). Majority were on methotrexate (MTX) (71%), 21.5% were on leflunomide and only 4.8% were on biologics or targeted synthetic disease modifying anti-rheumatic drugs. A small proportion of patients were on steroids (14%). Half of the patients were in remission prior to vaccination. All patients completed 2 doses of vaccination in which 62% received Pfizer-BioNTech vaccine followed by Sinovac (coronaVac) vaccine (24.6%) and Oxford-AstraZaneca vaccine (13.4%). Only 80% received booster dose, of which 88.7% was Pfizer-BioNTech vaccine. A total of 52 patients who were on MTX therapy discontinued the drug post-vaccination for a week duration. The prevalence of flare was only 12.9% (n: 24) in which 14 were self-reported and 10 were physician-reported flares (4 severe flare, 6 mild-moderate flare). Majority of flares occurred during the first and second dose of vaccination with 29.2% respectively, and only 12.5% were reported after booster vaccination. There were no significant differences in the occurrence of flare post-vaccination between age, gender, disease activity prior to vaccination, types of vaccine, usage of MTX and steroids, and discontinuation of MTX post-vaccination. Conclusion(s): Prevelance of RA flare post-COVID- 19 vaccination is low and there were no significant associated risk factors identified in this study.
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Background: The Internet of Medical Things (IoMT) is now being connected to medical equipment to make patients more comfortable, offer better and more affordable health care options, and make it easier for people to get good care in the comfort of their own homes. Objective(s): The primary purpose of this study is to highlight the architecture and use of IoMT (Internet of Medical Things) technology in the healthcare system. Method(s): Several sources were used to acquire the material, including review articles published in various journals that had keywords such as, Internet of Medical Things, Wireless Fidelity, Remote Healthcare Monitoring (RHM), Point-of-care testing (POCT), and Sensors. Result(s): IoMT has succeeded in lowering both the cost of digital healthcare systems and the amount of energy they use. Sensors are used to measure a wide range of things, from physiological to emotional responses. They can be used to predict illness before it happens. Conclusion(s): The term "Internet of Medical Things" refers to the broad adoption of healthcare solutions that may be provided in the home. Making such systems intelligent and efficient for timely prediction of important illnesses has the potential to save millions of lives while decreasing the burden on conventional healthcare institutions, such as hospitals. patients and physicians may now access real-time data due to advancements in IoM. Copyright © 2022 Wal et al.
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Background: According to newspaper Bernama, 87.6% of adolescents in Malaysia aged between 12 and 17 have completed their vaccination and 97.7% of the adult population have completed theirs as of 2nd January 2022.The acceptance of patients with rheumatic diseases on Covid-19 vaccination are crucial in the successful long term protection against Covid-19 infection. We conducted a phone interview to determine the acceptance of Covid-19 vaccination amongst adolescents with underlying rheumatic diseases. Objective(s): To determine the acceptance of Covid-19 vaccination amongst adolescents with underlying rheumatic diseases. Method(s): This was a phone survey. The electronic medical records of all rheumatology patients follow up in rheumatology clinic Hospital Sultan Ismail, Malaysia from 1st January 2012 to 31th December 2021 were reviewed and patients with age group from 12 to 21 were identified. Demographic and diagnosis of the patients collected. Result(s): Phone survey was done after data extracted from medical records. For those under the age of 18, guardian of the patients was interviewed. A total of 50 patients were identified. 36 of them were having systemic lupus erythematosus (SLE), 5 of them were having juvenile idiopathic arthritis (JIA),2 of them were having psoriatic arthritis (PSA) and another 2 of them were having Rheumatoid arthritis (RA), followed by rheumatoid arthritis (RA) overlapped SLE, juvenile dermatomyositis, Henoch-Schonlein purpura, SLE overlapped with JIA and mixed connective tissue disease, 1 each respectively. Most of the patients were female (46/50) and majority of them were Malay (33/50). This was followed by Chinese (10/50), Indian (4/50) and others (3/50). The mean age group was 18 (range from 13 to 21). Majority of them patients are keen or already completed Covid-19 vaccination with the acceptance rate as high as 92% (46/50). Only 8% of them not keen for vaccination with the reason of worrying the risk of myocarditis post vaccination. Conclusion(s): The overall acceptance rate of Covid-19 vaccination amongst adolescents with rheumatic diseases are very encouraging with the percentage of >90% despite of lacking knowledge about vaccine Covid-19. This result can assist our Ministry of Health plan for future battle to improve vaccine uptake that hopefully can lead to herd immunity against COVID-19 infection.