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1.
Acta Phlebologica ; 22(3):79-83, 2021.
Article in English | EMBASE | ID: covidwho-1818990

ABSTRACT

BACKGROUND: This preliminary study aimed to evaluate the safety of radiofrequency (RF) thermoablation of the great saphenous vein (GSV) with immediate foam sclerotherapy of superficial tributary veins performed in the outpatient clinic (Hospital Department). Further, we also evaluated the cost reduction compared to the same procedure performed in the operating room. METHODS: Thirty patients were evaluated for RF thermoablation of the GSV. Foam sclerotherapy was performed with 1-3%sodium-tetra-decyl-sulphatefoam (Tessari’s method). We evaluated the possible risks of the procedure and methods to resolve them. We compared the costs of both procedures performed in the operating room and in the outpatient clinic. RESULTS: We had complete occlusion of the GSV in 28/30 patients (93.3%). Periodic check-up revealed a reflux through an anterior lateral saphenous vein in one patient and a long saphenous stump in another patient. There were no severe intraoperative complications. In two cases, it was necessary to convert the radiofrequency procedure into foam sclerotherapy (using the hollow probe as a long catheter in one case and using needle injection in the second case). In another case, it was necessary to perform surgical cannulation of the GSV. There were no severe postoperative complications. Moreover, the cost of the operating room procedure was € 1226.50, while that of the outpatient clinic procedure was € 1082.65 (cost reduction, 12.5%). CONCLUSIONS: This procedure is safe and sufficiently cost-effective to perform in an outpatient clinic and the operating room can hence be reserved for patients with more serious pathologies. These results should be validated in further studies with larger sample size.

2.
Neurological Sciences and Neurophysiology ; 39(1):40-47, 2022.
Article in English | EMBASE | ID: covidwho-1818461

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) is known to have higher morbidity and mortality rates, parallel to the increased risk factors in the elderly. We aimed to define the risk factors related to mortality and morbidity in older patients hospitalized with COVID-19 disease in this study. Materials and Methods: This retrospective cross-sectional study included patients aged ≥65 years who were hospitalized with a confirmed diagnosis of COVID-19. We analyzed their demographic data, clinical findings, comorbidities, laboratory and radiologic findings, treatment protocols, and outcomes. Results: A total of 58 patients were included in the study. A total of eight (13.8%) patients died during the clinical follow-up and treatment, and 50 (86.2%) patients were discharged. The most common comorbidities among all patients were hypertension (HT) (69%) and diabetes mellitus (39.7%). The most common symptoms include fever (51.7%), cough (44.8%), and dyspnea (43.1%), and the most common neurologic findings were headache (27.6%) and impaired consciousness (27.6%). Intensive care unit admission was significantly higher among patients with comorbidities of HT, cerebrovascular disease, atrial fibrillation (AF), and chronic obstructive pulmonary disease. The rate of death was significantly higher in patients with a history of smoking, cerebrovascular disease, AF, and HT. Although there was a statistically significant positive correlation between the death rate and leukocyte, neutrophil, C-reactive protein, lactate dehydrogenase, D-dimer, interleukin-6, and procalcitonin levels, a negative correlation was observed in lymphocyte levels. Conclusion: Age-related comorbid conditions, especially HT, cerebrovascular disease, and AF, caused increased morbidity and mortality rates in older patients with COVID-19.

3.
Lung India ; 39(2):191-194, 2022.
Article in English | EMBASE | ID: covidwho-1818451

ABSTRACT

Pulmonary veno-occlusive disease (PVOD) is an important cause of pulmonary arterial hypertension (PAH) and is classified under idiopathic cause of PAH. Over a period of time, PVOD has been studied in detail in the western countries and various diagnostic criteria are formulated. Being a rapidly progressive disease, early diagnosis is of utmost importance which helps to initiate appropriate treatment. Recent studies suggest that PVOD has a genetic predisposition and has an autosomal recessive pattern of inheritance. Here, we discuss the case of siblings diagnosed with PVOD to have such genetic predisposition for this disease.

4.
J Int Bioethique Ethique Sci ; Vol. 32(4):87-100, 2022.
Article in French | EuropePMC | ID: covidwho-1818263

ABSTRACT

The COVID epidemic has changed the way monitoring and management of patients with amyotrophic lateral sclerosis (ALS) is organized. Teleconsultations (TLC) have become essential to maintain medical surveillance. The practice of TLC required adapting the computer system to the patients’disability and the intervention of a TLC assistant professional with the ALS patient. When the confinement was lifted, many patients asked to maintain this monitoring modality. Nevertheless, the experience raised several ethical questions. This article raises four sets of questions based on the analysis of a clinical case. These questions concern the relevance of TLC in the ALS patient’s care pathway and the quality of information provided to the patient about it, the respect of patients’rights during TLC, the quality of the caregiver-patient relationship and finally the impact of TLC on the healthcare system.

5.
Journal of Personalized Medicine ; 12(3), 2022.
Article in English | EMBASE | ID: covidwho-1818175

ABSTRACT

There is a lack of data on patient and diagnostic factors for prognostication of complete recovery in patients with peripheral facial palsy. Thus, the aim of this study was to evaluate the role of a telerehabilitave enhancement through the description of a case report with the use of short-wave diathermy and neuromuscular electrical stimulation combined to facial proprioceptive neuromuscular facilitation (PNF) rehabilitation in unrecovered facial palsy, in a COVID-19 pandemic scenario describing a paradigmatic telerehabilitation report. A 43-year-old woman underwent a facial rehabilitation plan consisting of a synergistic treatment with facial PNF rehabilitation, short-wave diathermy, and neuromuscular electrical stimulation (12 sessions lasting 45 min, three sessions/week for 4 weeks). Concerning the surface electromyography evaluation of frontal and orbicularis oris muscles, the calculated ratio between amplitude of the palsy side and normal side showed an improvement in terms of movement symmetry. At the end of the outpatient treatment, a daily telere-habilitation protocol with video and teleconsultation was provided, showing a further improvement in the functioning of a woman suffering from unresolved facial paralysis. Therefore, an adequate telerehabilitation follow-up seems to play a fundamental role in the management of patients with facial palsy.

6.
Biomedicines ; 10(4):9, 2022.
Article in English | Web of Science | ID: covidwho-1818048

ABSTRACT

Although the lungs are the primary organ involved, increasing evidence supports the neuroinvasive potential of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study investigates the potential relationship between coronavirus disease (COVID-19)-related deterioration of brain structure and the degree of damage to lung function. Nine COVID-19 patients were recruited in critical condition from Jin Yin-tan Hospital (Wuhan, China) who had been discharged between 4 February and 27 February 2020. The demographic, clinical, treatment, and laboratory data were extracted from the electronic medical records. All patients underwent chest CT imaging, Xe-129 gas lung MRI, and H-1 brain MRI. Four of the patients were followed up for 8 months. After nearly 12 months of recovery, we found no significant difference in lung ventilation defect percentage (VDP) between the COVID-19 group and the healthy group (3.8 +/- 2.1% versus 3.7 +/- 2.2%) using Xe-129 MRI, and several lung-function-related parameters-such as gas-blood exchange time (T)-showed improvement (42.2 ms versus 32.5 ms). Combined with H-1 brain MRI, we found that the change in gray matter volume (GMV) was strongly related to the degree of pulmonary function recovery-the greater the increase in GMV, the higher degree of pulmonary function damage.

7.
Journal of Asthma and Allergy ; 15:353-362, 2022.
Article in English | EMBASE | ID: covidwho-1817663

ABSTRACT

Background and Objective: Objectively differentiating between wheezing episodes and other respiratory disorders will be helpful in treatment in office practice. The impulse oscillometry system has been useful in assessing airway resistance in children 3–6 years old. As the reference values are different in geographical regions the use of the impulse oscillometry is still limited. Comparison between the percent change in IOS parameters as compared to reference standards and changes in actual IOS parameters was done to diagnose wheezing episodes. Methodology: Three to six years old children with a history of fever, cough, cold, and/or breathlessness with noisy breathing and who were not on any regular medications, whose parents gave consent were recruited in the study. The children underwent an impulse oscillometry system examination as per the guidelines. The test was repeated after they were given nebulization by salbutamol (2.5 mg) (before COVID 19 pandemic). Final diagnosis was done by following patients for 7 days. Results: About 106 children were recruited in the study. Five children could not perform the IOS test. Eighteen children did not complete the follow-up. Hence, 83 children were analyzed. There were 47 males and 36 female patients. The change in actual values of AX, R5, and X20 showed statistically significant difference in wheezing episode group (p-value<0.001). The percentage change as compared to predicted values of R5 and X20 also showed a statistically significant difference in the wheezing episode group and the others group (p-value<0.001). Conclusion: The change in actual values of AX, R5, X20, and resonant frequency may help to differentiate wheezing episode from other respiratory diseases.

8.
BMC Rheumatology ; 5(1), 2021.
Article in English | EMBASE | ID: covidwho-1817296

ABSTRACT

Background: Adult-onset Still’s disease (AOSD) is an autoinflammatory multi-systemic syndrome. Macrophage activation syndrome (MAS) is a potentially life-threatening complication of AOSD with a mortality rate of 10–20%. Especially viral infection is thought to be a common trigger for development of MAS. On the other hand, the occurrence of MAS following vaccinations is extremely rare and has been described in a few cases after measles or influenza vaccinations and more recently after ChAdOx1 nCoV-19 (COVID-19 viral vector vaccine, Oxford-AZ). Case presentation: We report the case of a twenty-year-old female with adult-onset Still’s disease (AOSD), who developed a MAS six days after receiving her first COVID-19 vaccine dose of BNT162b2 (mRNA vaccine, BioNTech/Pfizer) with ferritin levels of 136,680 µg/l (ref.: 13–150 µg/l). Conclusions: To the best of our knowledge, this is the first case report of development of MAS in a patient with preexisting AOSD after vaccination in general, and SARS-CoV-2 vaccination in particular. The new mRNA vaccines have generally shown a reassuring safety profile, but it has been shown that nucleic acids in general, including mRNA can act as pathogen-associated molecular patterns that activate toll-like receptors with extensive production of pro-inflammatory cytokines and further activation of immune cells. Proving an interferon 1 response in our patient directly after vaccination, we think that in this particular case the vaccination might have acted as trigger for the development of MAS. Even if it remains difficult to establish causality in the case of rare adverse events, especially in patients with autoimmune or autoinflammatory conditions, these complications are important to monitor and register, but do not at all diminish the overwhelming positive benefit-risk ratio of licensed COVID-19 vaccines.

9.
Allergy, Asthma and Clinical Immunology ; 18(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1817250

ABSTRACT

Background: COVID-19 symptoms overlap with allergic rhinitis (AR) and asthma, potentially impacting mental well-being [1]. Research regarding the effects of anxiety and stress on Health Care Professional (HCP) students throughout the COVID-19 pandemic is beginning to emerge. It is currently unknown if trainees with atopic conditions experience different stress levels than their non-atopic peers. In Canadian adults, the estimated prevalence for AR and food allergy(FA) is 44% and 6.1%, respectively [2,3]. Methods: Between August 2020 to June 2021, Faculty of Health Sciences students (n = 266) completed a one-time questionnaire using the QualtricsXMTMsurvey platform of which 114 respondents disclosed their atopic status. The following data was collected: Self-reported atopy status, Generalized Anxiety Disorder-7(GAD-7), Patient Health Questionaire-9(PHQ-9), and Perceived Stress Score-10(PSS-10). Participants were then classified based on the type and number of atopic conditions they reported. A follow-up visit involving skin prick testing (SPT) to a standard panel of 9 aeroallergen and food extracts, and/or fresh fruits, where applicable, was completed (n = 34) to determine how accurately allergies were self-reported. Statistical analyses were performed using SPSS 27. Results: Having a self-reported allergic condition or asthma did not impact GAD-7, PSS, and PHQ-9 scores, in HCP students. Further stratifying the dataset by the type and number of allergic conditions also did not impact GAD-7, PSS, and PHQ-9 scores or severity. The self-reported prevalence of asthma, AR and FA was 5.71%, 64.71%, and 29.41%, respectively. SPT confirmed 64.71% and 8.82% of participants were sensitized to AR and food allergens, respectively. Generally, seasonal AR allergies were underreported whereas, perennial AR and FA were overreported. Conclusions: Atopic conditions did not impact mental health scores in HCP student's which suggests that they are generally aware of their atopic conditions and able to differentiate allergy and COVID-19 symptoms. Self-reported accuracy varied and may be impacted by the specific allergic condition.

10.
Journal of the International Association of Providers of AIDS Care ; 21:16, 2022.
Article in English | EMBASE | ID: covidwho-1817142

ABSTRACT

Background: In sub-Saharan Africa, people living with HIV (PLHIV) face challenges accessing quality health care services, including barriers to care associated with widespread stigma and discrimination in health settings. Here, we present the results and lessons from a training program on stigma elimination rolled out in the city of Yaoundé, Cameroon within the framework of the joint IAPAC-UNAIDS Fast-Track Cities initiative. Method: Trainings were conducted as hybrid on-line and in-person for health workers and paraprofessional navigators employing self-narrated audio-visual training modules approved by the Cameroon National Aids Control Committee (NACC). Pre- and post-training questionnaires were administered to assess knowledge change across two modules: Human Rights and Integrating Stigma Elimination into Daily Practice. Results: A total of 417 health workers across 70 health facilities enrolled for the onsite training, while 671 across 37 health facilities registered for online training. For the onsite training sessions, average pre- and post-test scores for the module covering basics on human rights were 56% and 73%, respectively. Baseline score average for self-administered online trainings on human rights was 83% and 85% for post-training assessments. For the module covering integration of stigma elimination into daily practice, health worker overall knowledge gain in the pre- and post-test assessments was 49% to 69% for onsite trainees, and 85% to 87% for health workers enrolled online. Conclusion: Despite the COVID-19 pandemic, a blend of onsite and online training contributed to knowledge gains, especially among onsite trainees. Gauging the degree of knowledge improvement among self-administered online trainees was limited as health workers could repeat trainings over an extended period when compared to their onsite counterparts. Although the training of health workers is an entry point for stigma elimination, ongoing capacitation and follow up with the facility managers is critical for the attainment of stigma free health facilities.

11.
Journal of the International Association of Providers of AIDS Care ; 21:8, 2022.
Article in English | EMBASE | ID: covidwho-1817141

ABSTRACT

Background: There are patients with Hepatitis C Virus (HCV) infection previously diagnosed and lost to follow-up (LTFU). Strategies to identify and linkage to care are necessary to achieve HCV elimination. The aims were to evaluate the impact of COVID-19 pandemic on LTFU patients in searching and retrieving HCV-RNA+ve individuals (ReLink-C strategy) and perform a health economic evaluation. Method: ReLink-C strategy was based on a retrospective search of the microbiology databases of Barcelona north health area (450,000 inhabitants), followed by medical records review to identify and retrieve LTFU of HCV-RNA +ve individuals. Individuals were called (five times) to offer them a medical visit, re-evaluation, and subsequent treatment. The search was done into two periods: pre-COVID, Jan 2019 to Feb 2020 and COVID, Mar 2020 to Dec 2020. The costs of ReLink-C strategy were calculated, and a Markov model was used to estimate lifetime cases of liver complications, liverrelated mortality and costs associated, compared to non-intervention. Results: Overall 1,415 HCV-RNA+ve individuals were detected, 158 candidates for contact, 99 individuals located and 47 agreed to a visit. 41 individuals attended the visit and 38 started DAA treatment. During COVID period, a higher percentage of individuals were selected for retrieval (65 vs 51%) and a lower percentage were candidates for contact (6 vs 13%) and located (4 vs 8%) comparing to pre- COVID period. A similar percentage of cases started treatment. The cost of ReLink-C strategy was €23.830. During lifetime horizon, for a cohort of 133 viremic patients ReLink-C avoided 10 cases of decompensated cirrhosis, 6 hepatocellular carcinomas and 1 liver transplant, saving €423,372 associated to their management;deaths were reduced by 26%. Conclusion: Relink-C strategy retrieved and treated a high number of LTFU patients and showed to be cost-effective. COVID had a relevant impact on the linkage to care and treatment of HCV patients.

12.
Journal of the International Association of Providers of AIDS Care ; 21:15, 2022.
Article in English | EMBASE | ID: covidwho-1817140

ABSTRACT

Background: The goal of HIV treatment is sustained viral load suppression. Early initiation of ART and access to clientcentered, differentiated, high-quality, stigma-free care is a prerequisite of long-term retention and viral load suppression. Method: 2,374 PLHIV from 5 cities (Lagos, Kinshasa, Yaoundé, Lusaka, and Kigali) were surveyed about their perceptions of the quality of care they receive across the eight domains of HIV understanding, linkage to HIV care, engagement in HIV care, ART adherence, HIV counseling, secondary HIV prevention, whole person care, and interpersonal communication. Implementation took place between January-April 2020. Results: Among 2,374 respondents, there was a similar gender distribution across both regions with women comprising 47-70%. InWCA, 37-50% reported initiated ART on the same day as HIV diagnosis, with 63-73% reporting initiation within the WHO-recommended seven days. Lagos, Kinshasa, and Yaoundé reported same-day and within seven days of ART initiation ranging from 51% and 68%. In terms of differentiated service delivery, in WCA, 37%- 50% reported having initiated ART on the same day, with 63-73% reporting it same day or within less than seven days. In Lusaka and Kigali, respondents reported same-day ART initiation at 34-56%, with 47-65% having received ART on same day or in less than seven days from HIV diagnosis. 37%-53% of respondents reported they were either not virally suppressed or they did not know if that had an undetectable viral load. Conclusion: A third to a half of respondents reported not initiating ART within the WHO-recommended seven days of HIV diagnosis. In two cities, respondents reported continuation of 1-2 monthly clinic visits despite the WHO recommendation of 3-6 monthly visits. A third to a half reported not being undetectable or not knowing their viral load status. A follow-up survey looking closely at the impact of COVID-19 on HIV services and perceived QoC is recommended to clearly assess impact on WHO recommendations for ART initiation.

13.
Journal of Investigative Medicine High Impact Case Reports ; 10, 2022.
Article in English | EMBASE | ID: covidwho-1817132

ABSTRACT

Coccidioidomycosis (CM) is a fungal disease that results from inhalation of spores of Coccidioides immitis and C posadasii. If symptomatic, disease primarily manifests as community-acquired pneumonia;however, additional pulmonary manifestations such as pleural effusion, empyema, and cavitation may occur. Diabetic patients have an increased risk of severe and cavitary CM. Cavitary disease may erode vasculature and pulmonary parenchyma leading to further complications. Furthermore, chronic cavities can become colonized as well and develop superimposed infections. This is a case of cavitary CM in uncontrolled diabetic nonadherent to treatment presenting with hemoptysis and mycetoma.

14.
Geriatric Orthopaedic Surgery and Rehabilitation ; 12:16-17, 2021.
Article in English | EMBASE | ID: covidwho-1817127

ABSTRACT

Introduction: The multidisciplinary model of management for fragility hip fractures has only been recently introduced in the Philippines. Its development at the national and local level is made more difficult by the COVID-19 pandemic. To our knowledge, this is the first study to provide a comprehensive report on the clinical characteristics, current management and early outcomes of fragility hip fracture patients admitted during the COVID-19 pandemic in the setting of a country with an emerging economy. Methods: A multicenter prospective cohort study was conducted in the Philippines involving 12 hospitals from June 16, 2020 to February 28, 2021 during the Extended Community Quarantine Period during the COVID-19 pandemic. The clinico-demographic characteristics, treatments, and follow-up data at 30 days post-injury were gathered using the Research Electronic Data Capture (REDCAP) database system, using a minimum common data (MCD) which was adopted from the FFN MCD. Results: A total of 158 elderly patients (>60 years old) with fragility hip fractures were eligible for the study. 9 patients (5.7%) were confirmed or suspected to have COVID-19 infection. The median time of injury-to-admission was at least 3 (IQR: 1.0-13.7) days. 80% of the patients underwent surgical intervention with a median time from admission-to-surgery of at least 5 (IQR: 2.5-13.6) days. Notably, all non-COVID admitted patients had not been reported to have contracted the virus during their hospital stay. The 30-day mortality and morbidity rate for acute fragility fractures were 3.7%. Only the presence of a COVID-19 infection was found to be an independent and poor predictor for early mortality (P = 0.010). Conservatively managed patients had a significantly higher morbidity rate than surgically treated patients (13.6% vs 1.8%;P = 0.031). All five deaths occurred in non-surgical patients with an ASA grade of at least III. Conclusion: We recommend prompt admission and multidisciplinary care for elderly hip fracture patients even during the COVID-19 pandemic. Short-term outcomes remain favorable for non-COVID patients with acute fragility fractures treated with surgery. While a suspected or confirmed COVID-19 infection was the only significant and independent pre-operative risk factor for early mortality, there is evidence in the literature as well as in this study that the benefit of surgery may well outweigh the risk of conservatively treating COVID-19 patients provided that they can be optimized appropriately for surgery.

15.
Geriatric Orthopaedic Surgery and Rehabilitation ; 12:77, 2021.
Article in English | EMBASE | ID: covidwho-1817116

ABSTRACT

Introduction: The covid19 pandemic has forced the health system to restructure to prevent contagion of our patients. In this context, the members of the Orthogeriatric Group of the Catalan Society of Geriatrics and Gerontology (SCGiG) created a document that collected all the considerations to take into account during the pandemic, based on the current guides and scientific societies, in order to perform a correct follow-up, enhance adherence and prevent future falls. Methods: A bibliographic review was performed, defining the key points in the care of the fractured patient through telemedicine (document is available at http://scgig.cat/docs/gt-orto-covid.pdf). Results: During hospital admission, antiosteoporotic treatment should be started, evaluating indications with the patient and family, to ensure adherence. Diet intake of calcium and vitamin D will be assessed. Discharge report includes evaluation of treatment and monitoring plan, to be useful for liaison nurse, rehabilitator and general practitioner. Six-monthly follow up is recommended for patients with comorbidities, polypharmacy, confusion, fall-risk, or parenteral anti-osteoporotic treatment. With denosumab or teriparatide, annual laboratory tests are recommended, with GFR <20, every six months, at home if possible. Bisphosphonates can be followed by the GP. Zoledronate is not recommended due to delayed administration after surgery, and possibility of transient flu-like simptoms. In the telematic follow-up visit, in patients undergoing zoledronic acid treatment, the new dose can be delayed for 6-12 months, without risk. Consider sequential treatment. Denosumab treatment cannot be delayed, so the patient and family will be trained in self-administration. Support materials from laboratories will be useful to patient and caregivers. Conclusion: Telemedicine is a good strategy for a follow-up, to avoid hospital contact, and starts on hospital admission. Patient and caregivers need access to new technologies and able to understand medical instructions.

16.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816929

ABSTRACT

Introduction Little is known about the rates of asymptomatic COVID-19 carriers among cancer patients. The rate of asymptomatic carriers is important to understand in this population given the use of myelosuppressive and immunomodulating therapies and the risk of transmission to other patients in shared infusion centers. At UC San Diego, in June 2020, we implemented a COVID-19 asymptomatic screening protocol in which cancer patients receiving anti-cancer therapy in an infusion center must undergo symptom-based screening and then SARS-CoV-2 PCR testing prior to their infusion. Here, we describe the results of this asymptomatic screening protocol. Methods This was a single-center retrospective analysis of patients with active cancer receiving infusional anti-cancer therapy in 5 infusion centers who underwent at least 1 asymptomatic SARS-CoV-2 PCR test between 6/1- 12/1/2020. The primary endpoint was the rate of COVID-19 positivity among asymptomatic patients. Symptomatic patients were excluded. Secondary endpoints included COVID-19-related outcomes and patterns of oncologic management for asymptomatic COVID-19 positive patients. Results A cohort of 2,202 cancer patients received at least 1 asymptomatic SARS-CoV-2 PCR test prior to receipt of infusional anti-cancer therapy. 0.95% (N=21/2202) of patients were found to be PCR-positive on asymptomatic screening. Among positive patients, 9.5% (N=2/21) had hematologic malignancies and 90.5% (N=19/21) had solid tumors. In terms of therapy, 76.2% (N=16) were treated with cytotoxic chemotherapy, 9.5% (N=2) with targeted therapy, 4.7% (N=1) with immunotherapy, and 9.5% (N=2) were on a clinical trial. With a median follow-up of 122 days from positive PCR test (range: 8-186), only 2 of 21 (9.5%) of the cohort ultimately developed COVID-related symptoms. Both patients had a diagnosis of acute leukemia and 1 patient required hospitalization for COVID-related complications. No patients died from COVID-related complications. With regards to oncologic management, 95.2% (N=20/21) of patients had their therapy delayed or deferred with a median delay of 21 days (range: 7- 77 days). Only 1 patient proceeded with cytotoxic chemotherapy on schedule in the setting of adjuvant chemoradiation for oropharyngeal squamous cell carcinoma. Among the overall cohort, an additional 26 patients (1.2%) developed cases of symptomatic COVID-19 infection during the study period. Conclusions A strategy of asymptomatic screening of cancer patients receiving anti-cancer therapy in an infusion center detected an extremely low rate of asymptomatic carriers of COVID-19. This low rate of asymptomatic carriers may be due to a number of factors including multiple symptom-based screenings prior to infusion, behavior modification among patients, and/or differential immune responses to COVID-19 infection. Asymptomatic carriers in this cohort appeared to have favorable outcomes with few developing symptoms or requiring hospitalization, though the number of positive patients in our cohort is low, precluding definitive conclusions in this population.

17.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816927

ABSTRACT

Introduction Treatment of B-lineage lymphoma with B-cell depleting immunotherapy causes B-cell aplasia and impairs immune response. Case studies have reported patients treated with anti-CD20 therapy who suffered from persistent Covid-19. We aimed to assess the incidence, risk factors and long-term outcomes of persistent Covid-19 in patients with lymphoma. Patients and methods This retrospective multicentric study was conducted in 16 French hospitals. All adult patients with lymphoma who were admitted for Covid-19 in March and April 2020 were included. Persistent Covid-19 was defined as persisting severe Covid-19 symptoms requiring in-hospital stay for >30 days. Patients who re-experienced severe Covid-19 symptoms after initial improvement, requiring repeated hospitalizations for a total in-hospital length of stay >30 days were added to the persistent Covid-19 cases. Results One hundred eleven patients were included. Thirty days after admission for Covid-19, 24 patients had died, 55 had been definitively discharged from hospital, 31 were still hospitalized and 1 was later rehospitalized for Covid-19 recurrence. The incidence of persistent Covid-19 was 32/111 (29%). Patients with persistent Covid-19 had a median age of 64 years (range, 43-87) and 63% were male. Twenty-two patients (69%) had at least one significant comorbidity. None of the patients with T-cell (n=8) lymphoma or classical Hodgkin's disease (n=8) experienced persistent Covid-19. In the 32 patients with persistent Covid-19, the median time between first admission and final discharge was 58 days (range, 31-235) and the median duration of Covid-19 symptoms was 83 days (range, 32-237). Eight patients received corticosteroids and 9 convalescent plasma: all patients recovered from their symptoms, except one. Overall, 9 patients with persistent Covid-19 died (27%). After a median follow-up of 191 days (range, 3-260), the 6-month overall survival was 69% (95% CI 60-78%) for the whole cohort. In multivariate analysis, administration of anti-CD20 monoclonal antibody within 12 months before admission to hospital for Covid-19 was both associated with decreased overall survival (HR 2.13, 95% CI 1.03-4.44, p = 0.043) and prolonged in-hospital stay (HR 1.97, 95% CI 1.24-3.13, p = 0.004). The two other significant factors associated with decreased overall survival and prolonged in-hospital stay: age ≥ 70 years and refractory or relapsed lymphoma. Conclusion Patients with B-cell non-Hodgkin lymphoma hospitalized for Covid-19 have a high incidence of prolonged evolution of SARS-CoV-2 infection. Administration of anti-CD20 therapy within the last 12 months is one of the main risk factors for longer in-hospital stay and death of Covid-19. The risk of persistent Covid-19 was also higher in patients older than 70 years or with refractory or relapsed disease. These findings may contribute to guide the management of lymphoma patients during the Covid-19 pandemic.

18.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816924

ABSTRACT

Introduction: Patients with thoracic malignancies are susceptible to severe outcomes from coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the disruption to care of patients with thoracic malignancies during the COVID-19 pandemic. Methods: The COVID-19 and Cancer Outcomes Study (CCOS) is a multicenter prospective cohort study comprised of adult patients with a current or past history of hematological malignancy or invasive solid tumor who had an outpatient medical oncology visit on the index week between March 2 and March 6, 2020 at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai in New York, NY (MSSM) or the Dana-Farber Cancer Institute in Boston, MA (DFCI). An electronic data capture platform was used to collect patient-, cancer-, and treatment-related variables during the three months prior to the index week (the baseline period) and the following three months (the pandemic period). Two-by-three contingency tables with Fisher's exact tests were computed. All tests were two-tailed and considered statistically significant for p<0.05. All analyses were done in the R statistical environment (v3.6.1). Results: The overall cohort included 2365 patients, of which 313 had thoracic malignancies, 1578 had other solid tumors, and 474 had hematological malignancies. At a median follow-up of 84 days (95% confidence interval, 82-84), 13 patients with thoracic malignancies (4.1%) had developed COVID-19 (vs. other solid: 63 [4.0%] and hematological: 52 [11.0%];p<0.001). When comparing data from the pandemic period to the baseline period, patients with thoracic malignancies had a decrease in the number of in-person outpatient visits (thoracic: 209 [66.8%] vs. other solid: 749 [47.5%] vs. hematological: 260 [54.9%];p<0.001) and an increase in the number of telehealth visits (thoracic: 126 [40.3%] vs. other solid: 465 [29.5%] vs. hematological: 168 [35.4%];p<0.001). During the pandemic period, 33 (10.5%) patients with thoracic malignancies experienced treatment delays due to the pandemic (vs. other solid: 127 [8.0%] and hematological: 79 [16.7%];p<0.001), and 26 (8.3%) patients with thoracic malignancies experienced delays in cancer imaging or diagnostic procedures (vs. other solid: 63 [4.0%] and hematological: 26 [5.5%];p=0.003). Discussion: In this prospective cohort study, patients with thoracic malignancies were not at increased risk of developing COVID-19 compared to patients with other cancers, but experienced significant cancer care disruption during the COVID-19 pandemic with a higher likelihood of decreased in-person visits and increased telehealth visits compared to patients with other malignancies. Focused efforts to ensure continuity of care for this vulnerable patient population are warranted.

19.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816911

ABSTRACT

Background: The Coronavirus disease 2019 (COVID-19) pandemic continues to have a significant impact on the treatment of cancer patients. Understanding the clinical course, potential risk factors for severe infection and excess mortality, is essential to improve patient outcomes. We previously presented preliminary results from 156 SARS-CoV-2 positive cancer patients from Guy's Cancer Center, which suggested that increased COVID-19 mortality was associated with a diagnosis of cancer for over 2 years, Asian ethnicity and being on palliative treatment. Herein, we present an updated analysis using data from Guy's Cancer Centre and a partner Hospital Trust (King's College Hospital), with an increased number of patients and an extended follow up. Methods: We performed an analysis of all cancer patients who had a positive RT-PCR nasal/throat swab for SARS-CoV-2 infection at our Centers between 29th February and 31st July 2020. Associations between patients' demographics, clinical characteristics, and laboratory investigations with COVID-19 severity and mortality, were assessed using Logistic regression and Cox proportional hazards models. Results: 306 SARS-CoV-2 positive cancer patients were included in the analysis with a median follow up of 134 days (IQR 32-156). 184 (60%) were male and 217 (71%) were aged over 60 (mean age: 66). The most common malignancies were haematological (38%) and urological-gynaecological (20%). 218 (71%) had mild/moderate COVID-19 and 88 (29%) had severe disease. The overall COVID-related mortality rate was 24%;19% in solid and 32% in haematological cancers. Male sex [OR: 1.84 (95%CI:1.08-3.13)], Asian ethnicity [3.86 (1.20-12.36)], haematological cancer type [2.16 (1.18-3.95)], being diagnosed with cancer for 2-5 years [3.74 (1.80-7.78)] or ≥5 years [3.06 (1.50-6.26)] and a ferritin > 1964 mcg/l [54.92 (5.90-511.33)] were all associated with a risk of developing severe COVID-19 disease. Similarly, male sex [HR:1.97 (95%CI:1.15-3.38)], Asian ethnicity [3.42 (1. 59-7.35)], haematological cancer type [2.03 (1.16-3.56)] as well as a cancer diagnosis for >2-5 years [2.81 (1.41-5.59)] or ≥5 years [2.13 (1.06-4.27)] and a ferritin > 1964 mcg/l [16.11 (3.81-68.17)] were associated with an increased risk of death from COVID-19. Age >60 [2.14 (1.15-3.98)] and a raised CRP [4.10 (1.66-10.10)] were also associated with COVID-19 death. An inverse relationship was observed between a raised albumin and COVID-19 related death [0.12 (0.03- 0.51)]. Performance status and treatment paradigm were not associated with COVID-19 severity or mortality. Conclusions: This study further substantiates the evidence for an increased risk of severe COVID-19 infection and mortality for male and Asian patients with cancer, and those with haematological malignancies or with a diagnosis of cancer for over 2 years. These risk factors should be taken into account when making clinical decisions for cancer patients during the pandemic.

20.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816899

ABSTRACT

Background Patients with cancer appear to have poor outcomes with COVID-19 infection. Cohort analyses of short-term outcomes of COVID-19 (C19)-infected cancer patients (pts) have reported mortality rates ranging from 10 to 30%. Little is known about the long-term outcomes of cancer pts infected with C19. Here, we present an analysis of long-term outcomes of a cohort of active cancer pts with C19 infection. Methods This was a single center retrospective analysis of active cancer pts who tested positive for SARS-CoV-2 virus between 3/1/20- 9/30/20. Key inclusion criteria included a positive SARS-CoV-2 PCR test and an active cancer diagnosis within 90 days of a positive C19 test. We examined the rates of hospitalization for C19 infection, readmission, and C19-related mortality at 30-, 60-, 90-, and 120-day follow-up. Rates of persistent symptoms and systemic complications of C19 infection were described. Results We identified 81 active cancer pts with PCR-confirmed SARS-CoV-2 infection. Among this cohort, the median age was 55 years (range: 19- 89). 77% (N=62) had solid tumors and 23% (N=19) had a hematologic malignancy. 75% (N=61) were receiving an anti-cancer therapy at the time of C19 diagnosis. Median follow-up time from C19 diagnosis to last follow-up was 4.8 months (range: 0.1-9.0 mos). 32% (N=26) of the cohort required hospitalization for C19-related complications within 30 days of C19 diagnosis. Among those hospitalized, 35% (N=9/26) died from C19-related complications. Of the 17 pts who were discharged, 2 pts required readmission with a median time to readmission of 37 days. For these 2 pts, readmission was due to persistent dyspnea and hypoxia and both were treated for pneumonia with presumed bacterial superinfection. There were no additional hospitalizations for C19-related complications at 60-, 90-, and 120-day follow-up. At 90- day follow-up, 6 pts (7.4%) had been diagnosed with PE/DVT. No long-term cardiac, neurologic, or renal complications were observed. With regards to C19-related mortality, 30-day mortality was 8.6% (N=7) and 90-day mortality was 11.1% (N=9). No further C19-related deaths were observed after 90 days. All pts who died were hospitalized within 30 days of initial C19 diagnosis and remained hospitalized at the time of death. Persistent C19-related symptoms were noted in 8.2% (N=6/73) of the cohort at 60-days and 2.8% (N=2/71) at 90-day follow-up. Dyspnea was the most common symptom. Conclusions Among a cohort of active cancer pts with C19 infection, these data suggest that much of the morbidity and mortality associated with C19 infection appears to occur early, with decreased incidence of late complications beyond 30 days. Cancer pts who do not require hospitalization early in their infection course appear to have a decreased rate of late complications. Readmissions for C19-related complications were low, but this analysis was limited by a low number of pts. Achieving a better understanding of long-term outcomes of C19 pts with cancer will help us to better approach oncologic care as the pandemic continues.

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