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1.
Profilakticheskaya Meditsina ; 24(12):79-83, 2021.
Article in Russian | EMBASE | ID: covidwho-1818838

ABSTRACT

The article describes a clinical case of death of a 57-year-old patient from idiopathic AL-amyloidosis after infection with SARS-CoV-2. Histological examination revealed signs of pneumonia with symptoms of pneumosclerosis, histologically determined di-apedesic hemorrhages, necrosis and desquamation of the alveolar epithelium, along the contours of the alveolar passages, al-veolar sacs — hyaline membranes. In many areas, the histoarchitectonics of the pulmonary parenchyma was sharply disturbed, connective tissue was determined in the alveolar passages, in the lumens of the alveoli. The interalveolar septa were thickened due to the proliferation of connective tissue. Positive Congo red staining was visualized mainly in the perivascular and interalveo-lar septa, along the vessels;in the heart — between cardiomyocytes, in the kidneys — in the capillary loops of the glomeruli, base-ment membranes of individual tubules of the cortical layer, in the walls of blood vessels. Thus, the cause of death of the patient was the severe course of infection with SARS-CoV-2;the presence of a concomitant disease in the form of idiopathic AL-amyloi-dosis of internal organs and chronic diseases, obviously, aggravated the patient’s condition and contributed to the onset of death.

2.
Gastroenterology Insights ; 13(1):77, 2022.
Article in English | ProQuest Central | ID: covidwho-1818066

ABSTRACT

(1) Background: Currently available guidelines require upper gastrointestinal (GI) endoscopy with biopsy sampling for adult celiac disease (CD) diagnosis. Based on the pediatric experience, there has been a growing interest if serology-based diagnosis would be possible for adult CD also. Our aim was to analyze the associated upper GI tract lesions in newly diagnosed CD patients, to see if significant associated pathology is detected during index endoscopy, which might impact patient management not related to CD. (2) Methods: We performed a retrospective analysis of newly diagnosed CD cases diagnosed over a period of 7 years (2014–2020). Demographic, clinical, laboratory, endoscopy and histopathology data were collected from the patients’ charts. Diagnosis was set according to ACG Guideline 2013. (3) Results: Altogether 79 patients were recruited for this study purpose, 75.9% female, median age 39 years. All patients had positive CD-specific serology and atrophic mucosal injury in duodenal biopsy samples. Besides villous atrophy, associated endoscopic findings were detected in 42/79 (53.16%) of patients. Most of the gastric lesions were minor endoscopic findings—small sliding hiatal hernias, non-specific chronic gastritis, but we also found two cases of peptic ulcers, one case of metaplastic gastritis, six cases of atrophic gastritis and one subepithelial lesion. Only one patient had changes in the duodenum except CD-related findings—an inflammatory polyp in the duodenal bulb. No malignancies were found. (4) Conclusions: In our cohort, there was a significant number of newly diagnosed CD patients who had associated lesions during the index upper GI endoscopy, but most of them were minor endoscopic findings.

3.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816939

ABSTRACT

Background: Previous reports indicate that lung cancer patients are at an increased risk of severe COVID-19 disease and higher mortality rate compared to general population. However, prognostic factors are not yet clearly identified. The LunG canceR pAtients coVid19 Disease (GRAVID) study aimed to describe clinical characteristics, outcomes and predictors of poor prognosis in patients with lung cancer and COVID-19. Methods: In this large nationwide prospective study, medical records of lung cancer patients with COVID-19 diagnosis from 65 spanish hospitals were included. Clinical features, treatments and disease outcomes were collected. The primary endpoint was to determine any-cause mortality;secondary endpoints were hospitalization and admission at intensive care units (ICU). Risk factors of poor prognosis were identified by univariable and multivariable logistic regression models. Results: Overal, 447 patients were analysed. Mean age was 67.1 ± 9.8 years, and the majority were men (332, 74.3%) and current/former smokers (383 (85.7%). NSCLC was the most frequent cancer type (377, 84.5%), being adenocarcinoma (228, 51.0%) the predominant histology. 354 patients (79.2%) had unresectable stage III or metastatic disease, and 266 (59.5%) where receiving anticancer treatment, mostly first-line chemotherapy. 350 (78.3%) patients were hospitalized for a mean of 13.4 ± 11.4 days, 9 (2.0%) patients were admitted to ICU, and 146 (32.7%) patients died. Advanced disease and corticosteroid treatment at hospitalization were predictors of mortality. Non-terminal stage hospitalized patients with lymphocytopenia and high LDH showed an increased risk of death. Severity of COVID-19 correlated to mortality, admission at ICU and mechanical ventilation. Conclusion: With underlying comorbidities and immunocompromised status, patients with lung cancer and COVID-19 present high hospitalization and mortality rates. These outcomes, alongside the identification of prognostic factors, may inform physicians on risks and benefits for this population to provide individualized oncological care.

4.
Wound Repair and Regeneration ; 30(2):A56-A57, 2022.
Article in English | EMBASE | ID: covidwho-1816664

ABSTRACT

Background: Antiviral and anti-inflammatory activity of a unique solution of Ag released from Acticoat was tested in standard lab and animal models. Clinical effects of nebulized inhalation of the Ag solution in ventilated patients with MDR bacterial pneumonia, TENS, and COVID-19 were assessed. Methods: Ag release kinetics was determined using integration of absorption spectra at 350-650 nm. Inactivation of hHSV1 and SARSCoV- 2 by the Ag solution, colloidal silver, or stable silver nanoparticles was assessed using the ASTM E1052-20 protocol for antiviral testing of agents in solution. Rat lungs infected for 24 hours with Pseudomonas aeruginosa were treated with lavage of silver solution, tobramycin, or water, and rat survival and lung histology were assessed at 48 hours. Anti-inflammatory activity of the Ag solution was assessed using a pig contact dermatitis model. Eight patients, six with burn wounds who developed MDR pneumonia, one with burns who developed COVID-19, and one with TENS, all of whom were placed on ventilators, were treated with nebulized inhalation of the Ag solution and clinical parameters were measured. Results: Silver species (Ag0, Ag+, Ag3+) were rapidly released from the nanocrystalline silver dressing into distilled water at RT, reaching 50% saturation at 24 hours and 90% saturation at 48 hours with a concentration of γ400 mg/mL. The Ag solution inactivated hHSV1 by 4-logs and 5-logs at 4 and 24 hours, and inactivated 1-log and 6-logs of SARS-CoV-2 after 4 and 24 hours, respectively. Neither a colloidal silver product nor a stable Ag nanoparticle product inactivated hHSV1 or SARS-Cov-2 viruses. Lavage of infected rat lungs with the Ag solution prevented death and preserved normal lung tissue histology. Silver nitrate or tobramycin treatments did not prevent death, and massive inflammation and lung tissue destruction was observed histologically. The Ag solution was highly anti-inflammatory in the pig contact dermatitis model. Nebulized inhalation of the Ag solution via ventilator rapidly reversed clinical parameters in all six patients with MDR pneumonia, in the TENS patient, and the COVID-19-infected burn patient. Chest x-rays showed no evidence of silver deposits in lung tissues of any treated patients. Conclusions: Nebulized inhalation of a unique solution of Ag species released from the nanocrystalline silver wound dressing appears to be a highly effective new treatment for patients with MDR pneumonia, TENS, and COVID-19 due to its unique triple combination of antimicrobial, anti-inflammatory, and anti-viral actions.

5.
Experimental Dermatology ; 31(2):e80-e81, 2022.
Article in English | EMBASE | ID: covidwho-1816549

ABSTRACT

COVID-19 still has a big impact on health care and economics all over the world. The major task is to protect the most vulnerable persons from being infected. Skin lesions have been reported since the beginning of the pandemic more or less systematically. Data to their general prevalence differ a lot. A wide variety of lesions have been described: early appearing popular or pustular rash, maculopapulous or urticarial rash during the course of the disease and late appearing perniosis like acral lesions. The latter are associated with childhood, a mild course of the disease and appear around 4 weeks after the onset of COVID-19 symptoms. Here we report histologic results of perniosis like acral lesions and the comparison of immune histochemic results in these cases. Skin biopsies were formalin fixed and paraffin embedded sections were stained with hematoxylin/eosine and immune histochemically with antibodies against lymphocytic antigens. Kryosections were analysed by immunofluorescence for pathologic deposits of immunglobulins or complement. We could confirm association of perniosis like lesions with mild COVID-19. The inflammatory differs a lot in the specimens of different patients with being nearly absent in some cases whereas showing dense dermal lymphocytic infiltrates with a pronouncement around adnexial structures in others. IgG deposits in small blood vessels could be detected in one patient. In general our data are in line with others that perniosis like lesions are more common in young patients, after mild disease and that there are no specific histologic signs for the diagnosis, hence histology must be interpreted in the context of anamnestic data.

6.
Antibiotics ; 11(4):452, 2022.
Article in English | ProQuest Central | ID: covidwho-1809656

ABSTRACT

Multidrug resistant organisms (MDRO) are commonly isolated in respiratory specimens taken from mechanically ventilated patients. The purpose of this narrative review is to discuss the approach to antimicrobial prescription in ventilated patients who have grown a new MDRO isolate in their respiratory specimen. A MEDLINE and PubMed literature search using keywords “multidrug resistant organisms”, “ventilator-associated pneumonia” and “decision making”, “treatment” or “strategy” was used to identify 329 references as background for this review. Lack of universally accepted diagnostic criteria for ventilator-associated pneumonia, or ventilator-associated tracheobronchitis complicates treatment decisions. Consideration of the clinical context including signs of respiratory infection or deterioration in respiratory or other organ function is essential. The higher the quality of respiratory specimens or the presence of bacteremia would suggest the MDRO is a true pathogen, rather than colonization, and warrants antimicrobial therapy. A patient with higher severity of illness has lower safety margins and may require initiation of antimicrobial therapy until an alternative diagnosis is established. A structured approach to the decision to treat with antimicrobial therapy is proposed.

7.
Journal of Clinical and Diagnostic Research ; 16(SUPPL 2):50, 2022.
Article in English | EMBASE | ID: covidwho-1798732

ABSTRACT

Introduction: Anatomy is the science of structure of body and forms basis for understanding function. It is taught in first year and is a prerequisite for any branch of health care system. COVID-19 pandemic has brought challenges to learn anatomy for the students. Aims: In this COVID-19 era, an attempt to consolidate and enhance learning of the vast subject, it is necessary to assess the benefits and pitfalls of various available teaching and learning methodologies. Materials And Methods:100 medical students who had just completed their first-year syllabus in both offline and online methods, before and after lockdown, were given a questionnaire(offline), comprising of questions regarding T/L methodologies of anatomy. Results: Students have opted for traditional teaching like chalk & board along with PPT Presentation. Gross anatomy was mainly learned by the dissections involved by the students and faculty side by side. Histology, mainly learned by spending more time on the microscope. Embryology, mainly understood by small group teaching with the help of 3D models. Conclusion: Present study concludes that proper utilization of newer technologies along with the traditional teaching methods will certainly lead to enhanced understanding of gross anatomy and will ultimately improve students performance in this covid-era.

8.
Pharmacy Education ; 22(2):213-217, 2022.
Article in English | EMBASE | ID: covidwho-1798552

ABSTRACT

Introduction: Those suffering from diabetes mellitus (DM) form one of the high-risk groups for developing severe illness from COVID-19. Steeping okra coffee (Abelmoschus esculentus [L.] Moench) is empirically used in DM treatment. Objective: To determine the pancreatic histology in mice induced by alloxan and steeping okra coffee (SOC). Method: This was an experimental research using 16 mice that were divided into four groups, 1) control group (alloxan and aquades) and SOC Group;2-4), treated with steeping okra coffee at 1820, 3640, and 5460 mg/KgBW concentration for ten days. Results: The treatment groups 2 and 3 showed an improvement in the damage of acinar cells and islets of Langerhans by 100%. On the other hand, there was still 25% vacuolisation on the islets of Langerhans in the group 4 treatment group. Conclusion: The steeping okra coffee repaired the islets of Langerhans cells and acinar cells that were vacuolised.

9.
British Journal of Surgery ; 109(SUPPL 2):ii6, 2022.
Article in English | EMBASE | ID: covidwho-1778892

ABSTRACT

Aim: The Covid-19 pandemic encouraged prompt modification to clinical practice to minimise hospital attendances in an aim to minimize exposure and protection of the NHS whilst maintaining the standards of patient care. Current literature advocates that Four-Dimensional Computerised Tomography (4DCT) has equal diagnostic value as ultrasound alone or a combination of ultrasound and Sestamibi scan in the identification of abnormal parathyroid glands in the work up for surgical management of hyperparathyroidism. In response to the evolving pandemic at Addenbrookes we modified our practice and escalated 4DCT as our first line imaging. In light of this we had a unique opportunity to evaluate the diagnostic value of the currently used imaging modalities. Methods: This is a retrospective study of 270 parathyroidectomies who underwent pre-operative 4DCT (n=270), ultrasound (n= 254) and sestamibi scan (n=253). Subsequently, we assessed the accuracy of these three modalities with the of intra-operative findings, histology, postoperative calcium and PTH. Results: The sensitivity of the 4DCT was 77% in comparison to 43% sensitivity of the ultrasound alone. (p.0.05). The combined sensitivity of ultrasound and Sestamibi scan was found to be 69%. Conclusion: The implementation of 4DCT as a single modality diagnostic imaging can be considered equally effective and accurate in the diagnosis of parathyroid abnormality. Implementing this would reduce the number of diagnostic tests improving the likelihood of successful operative planning and reduce financial cost.

10.
Malaysian Family Physician ; 17(1):52-56, 2022.
Article in English | ProQuest Central | ID: covidwho-1776915

ABSTRACT

Non-retractile prepuce is one of the most prevalent reasons for referring a child to a paediatric surgeon in many countries, owing to parental anxieties and general practitioner misperceptions.3 Data from the American Association of Paediatrics regarding circumcision is not sufficient to conclude the true advantages of male circumcision.4 Most infants have a physiological non-retractile prepuce that resolves spontaneously by 4 or 5 years of age5;however, a subset of children develop symptoms, such as ballooning of prepuce with dribbling and dysuria. [...]long-term followup is needed given the recurrent nature of adhesions and to evaluate the long-term effects of BXO. Adhesiolysis is difficult with a tight prepuce and may lead to skin abrasions, tears, and can result in scarring. The foreskin eventually becomes fully retractile, a process that occurs by 5 years of age, though it may rarely take longer.9 Histopathologically, BXO is characterised by moderate lymphocytic infiltration of the superficial dermis and basal epidermis and is associated with epidermal basal vacuolar changes.10 BXO is rare in children, with a prevalence of 0.01% to 0.07% in the prepubertal age group.11 Circumcision is the treatment of choice in cases of BXO, with or without adjuvant topical steroids.

11.
Kidney360 ; 2(4): 639-652, 2021 Apr 29.
Article in English | MEDLINE | ID: covidwho-1776889

ABSTRACT

Background: Kidney damage has been reported in patients with COVID-19. Despite numerous reports about COVID-19-associated nephropathy, the factual presence of the SARS-CoV-2 in the renal parenchyma remains controversial. Methods: We consecutively performed 16 immediate (≤3 hours) postmortem renal biopsies in patients diagnosed with COVID-19. Kidney samples from five patients who died from sepsis not related to COVID-19 were used as controls. Samples were methodically evaluated by three pathologists. Virus detection in the renal parenchyma was performed in all samples by bulk RNA RT-PCR (E and N1/N2 genes), immunostaining (2019-nCOV N-Protein), fluorescence in situ hybridization (nCoV2019-S), and electron microscopy. Results: The mean age of our COVID-19 cohort was 68.2±12.8 years, most of whom were male (69%). Proteinuria was observed in 53% of patients, whereas AKI occurred in 60% of patients. Acute tubular necrosis of variable severity was found in all patients, with no tubular or interstitial inflammation. There was no difference in acute tubular necrosis severity between the patients with COVID-19 versus controls. Congestion in glomerular and peritubular capillaries was respectively observed in 56% and 88% of patients with COVID-19, compared with 20% of controls, with no evidence of thrombi. The 2019-nCOV N-Protein was detected in proximal tubules and at the basolateral pole of scattered cells of the distal tubules in nine out of 16 patients. In situ hybridization confirmed these findings in six out of 16 patients. RT-PCR of kidney total RNA detected SARS-CoV-2 E and N1/N2 genes in one patient. Electron microscopy did not show typical viral inclusions. Conclusions: Our immediate postmortem kidney samples from patients with COVID-19 highlight a congestive pattern of AKI, with no significant glomerular or interstitial inflammation. Immunostaining and in situ hybridization suggest SARS-CoV-2 is present in various segments of the nephron.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/diagnosis , Aged , Aged, 80 and over , COVID-19/complications , Capillaries/pathology , Humans , In Situ Hybridization, Fluorescence , Kidney Glomerulus/pathology , Male , Middle Aged , Necrosis , SARS-CoV-2
12.
Blood ; 138(SUPPL 1):3525, 2021.
Article in English | EMBASE | ID: covidwho-1770434

ABSTRACT

Background - The WINDOW-1 regimen introduced first-line ibrutinib with rituximab (IR) followed by 4 cycles of R-HCVAD for younger mantle cell lymphoma (MCL) patients (pts) demonstrating 90% CR on IR alone and we aimed to improve the CR rate with the addition of venetoclax. We therefore investigated the efficacy and safety of IR and venetoclax (IRV) followed by risk-stratified observation or short course R-HCVAD/MTX-ARA-C as consolidation in previously untreated young patients with mantle cell lymphoma (MCL). Our aim was to use a triplet chemotherapy-free induction to reduce the toxicity, complications and minimize chemotherapy exposure in MCL pts. Methods - We enrolled 50 previously untreated pts in this single institution, single arm, phase II clinical trial - NCT03710772. Pts received IR induction (Part-1) for initial 4 cycles. Pts were restaged at cycle 4 and received IRV for up to eight cycles (Cycle 5 to Cycle 12) starting with ramp up venetoclax dosing in Cycle 5. All pts who achieved CR prior to cycle 12 continued to receive IRV for 4 cycles (maximum 12 cycles) and then moved to part 2. Pts were stratified into three disease risk groups: high, moderate and low risk categories from the baseline data for assignment to R-HCVAD/MTX-ARA-C as consolidation in part 2 (4 cycles, 2 cycles, or no chemotherapy for high, medium and low risk pts respectively). Briefly, low risk pts were those with Ki-67 ≤30%, largest tumor mass <3 cm, low MIPI score and no features of high risk disease (Ki-67 ≥50%, mutations in the TP53, NSD2 or in NOTCH genes, complex karyotype or del17p, MYC positive, or largest tumor diameter >5 cm or blastoid/pleomorphic histology or if they remain in PR after 12 cycles of part 1. Medium risk are pts which did not belong to low or high-risk category. Those who experienced progression on part 1 went to part 2 and get 4 cycles of part 2. Patient were taken off protocol but not off study, if they remained in PR after 4 cycles of chemotherapy, these patients were followed up for time to next treatment and progression free survival on subsequent therapies. After part 2 consolidation, all pts received 2 years of IRV maintenance. The primary objective was to assess CR rates after IRV induction. Adverse events were coded as per CTCAE version 4. Molecular studies are being performed. Results - Among the 50 pts, the median age was 57 years (range - 35-65). There were 20 pts in high-risk group, 20 pts in intermediate-risk group and 10 pts in low-risk group. High Ki-67 (≥30%) in 18/50 (36%) pts. Eighteen (36%) had high and intermediate risk simplified MIPI scores. Six (12%) pts had aggressive MCL (blastoid/pleomorphic). Among the 24 TP53 evaluable pts, eight pts (33%) had TP53 aberrations (mutated and/or TP53 deletion by FISH). Forty-eight pts received IRV. Best response to IRV was 96% and CR of 92%. After part 2, the best ORR remained unaltered, 96% (92% CR and 4% PR). The median number of cycles of triplet IRV to reach best response was 8 cycles (range 2-12). Fifteen pts (30%) did not receive part 2 chemotherapy, two pts (4%) received 1 cycle, 16 pts (32%) 2 cycles and 13 pts (26%) got 4 cycles of chemotherapy. With a median follow up of 24 months, the median PFS and OS were not reached (2 year 92% and 90% respectively). The median PFS and OS was not reached and not significantly different in pts with high and low Ki-67% or with/without TP53 aberrations or among pts with low, medium or high-risk categories. The median PFS and OS was inferior in blastoid/pleomorphic MCL pts compared to classic MCL pts (p=0.01 and 0.03 respectively). Thirteen pts (26%) came off study - 5 for adverse events, 3 for on study deaths, and 2 for patient choice, 2 patients lost to follow up and one for disease progression. Overall, 5 pts died (3 on trial and 2 pts died off study, one due to progressive disease and another due to COVID pneumonia). Grade 3-4 toxicities on part 1 were 10% myelosuppression and 10% each with fatigue, myalgia and rashes and 3% mucositis. One pt developed grade 3 atrial flutter on part 1. None had grade 3-4 bleeding/bruising. Conclusions - Chemotherapy-free induction with IRV induced durable and deep responses in young MCL pts in the frontline setting. WINDOW-2 approach suggests that pts with low risk MCL do not need chemotherapy but further follow up is warranted. This combined modality treatment approach significantly improves outcomes of young MCL pts across all risk groups. Detailed molecular analyses will be reported. (Figure Presented).

13.
Breast ; 56:S12-S13, 2021.
Article in English | EMBASE | ID: covidwho-1768660

ABSTRACT

Neoadjuvant treatment (NAT) has become a standard treatment in locally advanced breast cancer and an option in early stage (stage I–II) breast cancer (EBC). It is known that patients who achieve a pathologic complete response (pCR) have better long-term out comes, especially Her2 positive and triple negative (TN) breast cancer. Selection of patients for NAT in early stage breast cancer rely in several factors, as patient characteristics (i.e., age and comorbid ities), tumor histology, stage at diagnosis and the potential changes in surgical or adjuvant treatments when NAT is administered. Early stage breast cancer patients that are not candidates for breast conservative surgery (BCS) at front, may benefit from NAT to reduce tumor size and facilitate surgery. In other cases, as young patients with TN tumors between 1–2 cm may benefit from NAT, even if BCS can be performed up front, as chemotherapy will be given anyway along the treatment and there is a high likelihood of pCR. Patients with a positive axilla at diagnosis, regardless of tumor size, may also benefit from less axillary surgery if axillary pCR is achieved. Rates of axillary pCR are especially high in TN and Her2 positive tumors. A distinct approach is suggested in luminal tumors subtypes. In these patients, besides the factors already mentioned, intensity of hormone receptor expression would help to decide on neoadjuvant hormone or chemotherapy treatment. Immunohistochemistry differentiation between luminal A and B by Ki67 assessment and in some cases, the use of genomic platforms may help defining type of NAT. Assessing breast cancer patients for NAT include incorporating all factors into the decision making process. In the COVID era, we have witnessed the use of NAT in patients who may be directed to surgery, unable to have it performed, as surgery has been reserved for emergency cases only. In this situation, it has been a great challenge managing breast cancer patients and tailoring individualized treatment decisions. Besides physical examination, breast imaging is performed to assess extent of disease and to determine BCS eligibility before NAT. Breast imaging should include mammogram with tomosynthesis, breast and axillary US and in most of cases MRI. MRI may be omitted in S12 Speakers’ s / The Breast 56S1 (2021) S1–S16 selected cases (i.e. fatty breasts, neoadjuvant hormone therapy). Contrast enhanced mammogram is an emerging technique, whether it will add accuracy to the MRI findings or replace it in selected cases is still to be defined. Shear wave elastography is under investigation for assessment of response to neoadjuvant therapy as well as for predicting response. Generally, in EBC no further body imaging (CT or bone scan) is needed unless metastatic disease is suspected. PET scan is reserved for patients with inconclusive metastatic dissemination or with more advanced disease. Pathology confirmation by core biopsy and evaluation of estrogen and progesterone receptor, Her2, and Ki67 must be obtained before treatment. Axillary US will characterize axillary lymph nodes and will guide biopsy of axillary nodes. If planning NAT, markers need to be placed in breast tumor/s and in biopsy proven positive axillary node. Same breast imaging should be repeated after NAT to assess response and to determine type of breast and axillary surgery. Sentinel lymph node biopsy after NAT is the preferred method. After NAT, surgical plan is delineated taking into account baseline characteristics, tumor response and patient desire. Conflict of Interest: Honoraria: Agendia. Advisory Board: Sirius medical.

14.
Osteoarthritis and Cartilage ; 30:S81-S82, 2022.
Article in English | EMBASE | ID: covidwho-1768336

ABSTRACT

Purpose: Altered bone turnover is a factor in many diseases including osteoarthritis (OA), osteoporosis, inflammation, and viral infection. The absence of obvious symptoms and insufficiently sensitive biomarkers in the early stages of bone loss limits early diagnosis and treatment. Therefore, it is urgent to identify novel, more sensitive, and easy-to-detect biomarkers which can be used in the diagnosis and prognosis of bone health. Our previous data using standard micro-computed tomography (μCT) measurements showed that SARS-CoV-2 infection in mice significantly decreased trabecular bone volume at the lumbar spine, suggesting that decreased bone mass, increased fracture risk, and OA may be underappreciated long-haul comorbidities for COVID patients. In this study, we applied integrated state-of-the-art radiomics and machine learning models to identify more sensitive image-based biomarkers of SARS-CoV-2-induced bone loss from μCT images. These radiomic biomarkers can potentially provide a non-invasive way of quantifying and monitoring systemic bone loss and evaluating treatment efficacy in both research and clinical practices. Methods: All animal use was performed with approval of the Institutional Animal Care and Use Committee. To quantify SARS-CoV-2-induced bone loss, 6-week-old transgenic mice (16 male, 16 female) expressing humanized ACE2 receptors were inoculated with a 2020 strain of SARS-CoV-2 or phosphate-buffered saline (Control) [Fig. A]. Viral infection was confirmed by detection of infectious SARS-CoV-2 in throat swabs and histological identification of SARS-CoV-2 labeled cells. At 6-14 days post-infection, lumbar vertebral bodies (L5) were scanned with μCT (μCT 35, SCANCO Medical AG;6 μm nominal voxel size). The open-source research platform 3D Slicer v2020 with a built-in Python console v3.8 was used for medical image computing and fully automated segmentation of cortical and trabecular bone. Standard μCT assessment of bone microstructure was performed. Radiomic feature extraction and data processing were performed using python based PyRadiomics v3.0.1. A total of 120 radiographic features were extracted from the segmented images [Fig. B]. Principle component analysis (PCA) for feature selection, a support vector machine learning (SVML) predictive model for classification, holdback method for model validation, and all statistical analyses (significance at p<0.05) were performed using JMP Pro v15 (SAS). Results: Using standard μCT methods, SARS-CoV-2 infection significantly reduced the bone volume fraction (BV/TV) by 10 and 10.5% (p= 0.04) and trabecular thickness (Tb.Th) by 8 and 9% (p= 0.02) in male and female mice, respectively, compared to PBS control mice [Fig. C]. Radiomics detected a 20-fold greater magnitude in change over standard methods. SARS-CoV-2 infection significantly changed radiographic parameters with the largest change being a 300% increase in the second-order parameter: cluster shade [Fig. D]. The 45 radiomic features comprising the first 3 principal components were selected for inclusion in the SVML model. The SVML Model (radial basis function kernel;cost = 4.8;gamma = 0.46) produced an area under the receiver operating characteristic curve (AUC) of 1.0 which reflects a perfectly accurate test [Fig. E]. Conclusions: SARS-CoV-2 infection of humanized ACE2 expressing mice caused significant bone changes, suggesting that decreased bone mass, increased fracture risk, OA, and other musculoskeletal complications could be long-term comorbidities for people infected with COVID-19. We developed an open-source, fully automated segmentation and radiomics system to assess systemic bone loss using μCT images. When coupled with machine learning, this system was able to identify novel radiographic biomarkers of bone loss that better discriminate differences in bone microstructure between SARS-CoV-2 infected and control mice than standard bone morphometric indices. The high accuracy of the SVML model in classifying SARS-CoV-2 infected mice opens the possibility of translating these biom rkers to the clinical setting for early detection of skeletal changes associated with long-haul COVID. The methods presented here were demonstrated using SARS-CoV-2 as a model system and can also be adapted to other diseases associated with altered bone turnover. Development of machine-learning methods for radiomic applications is a crucial step toward clinically relevant radiomic biomarkers of bone health and provides a non-invasive way of quantifying and monitoring systemic bone loss and evaluating treatment efficacy. [Formula presented]

15.
Przeglad Dermatologiczny ; 108(5):443-444, 2021.
Article in English | EMBASE | ID: covidwho-1766848

ABSTRACT

Lymphangiomas (LG) are uncommon, rare congenital anomalies or acquired lymphatic dilations of a benign flow that can involve the skin [1, 2]. There are main groups of lymphangiomas: 1) a superficial variant, characterized by grouped vesicles (circumscriptum lymphangioma), 2) a deeper variant in the form of a cavernous lymphangioma. The prevalence of LG may be focal or diffuse. Secondary acquired LG with a rarer frequency are known [3, 4]. LG can be one of the manifestations of a symptom complex, for example, Gorham-Stout syndrome, which is characterized by progressive osteolysis [5]. The rare occurrence of LG, clinical diversity, undulating course of congenital forms, the possibility of an acquired nature of the disease causes a high risk of diagnostic errors in establishing the final diagnosis. At the Department of Dermatovenereology, Cosmetology and Additional Professional Education of Smolensk State Medical University for the period from 2018 to 2021, 5 patients (age from 5 to 17 years) with LG were observed. Of these: in four children, the disease existed from birth, in one girl it had an acquired character and developed after covid infection [4]. Gender characteristics: 4 girls (5, 6, 12 and 17 years old) and 1 boy (9 years old). All patients are urban residents. The time to establish the final diagnosis from the moment of seeking medical help ranged from 15 months to 12 (!) years, the average value being 6.5 years. The range of diagnoses of LG 'masks': herpetic infection, molluscum contagiosum, atopic dermatitis, contact dermatitis, epidermolysis bullosa. A frequent change in diagnoses was established in the same patient. Clinical case 1. The boy is 12 years old. The debut of skin lesions from birth and progression to 3 years of age, then spontaneous regression within 4 years (without signs of dermatosis). From 7 years to the present, there has been an increase in the number of rashes. Localization: the skin of the lateral surface of the trunk. Features of the rash: flesh-colored and/or reddish- purple bubbles. A pathognomonic symptom of 'frog calves' is found. The frequent autodestructive effect on the rash provokes its subsequent progression. Family history: his father is a liquidator of the atomic catastrophe in Chernobyl. Previous diagnoses: molluscum contagiosum, herpes zoster. Clinical case 2. The girl is 17 years old. The debut of the disease from birth. Lack of progression up to 5 years of age (up to 5 years of age did not apply to dermatologists). At the age of 5, she began to engage in rhythmic gymnastics (she continues to practice professionally at the present time) and noted an active increase in the number and size of the elements of the rash. She repeatedly consulted dermatologists: diagnoses of molluscum contagiosum (laser removal), herpetic infection (courses of antiherpetic therapy without effect) were assumed. The diagnosis was established 12 years after the moment of seeking medical help. Unilateral location of the rash along the inner surface of the right upper limb with transition to the axillary region;on the right lateral surface of the body, the right inguinal-femoral fold and the inner surface of the right thigh. Focuses of a rash in the form of different sizes of vesicular elements with a tendency to lymphorrhea and oozing, areas of maceration around. Single elements with a hemorrhagic component. The patient notes an increase in the inflammatory response and vesicle lymphorrhea after each workout. Dermatoscopy: yellow-pink lacunae alternating with single dark red lacunae. Histological examination: multiple dilated lymphatic vessels in the papillary and reticular dermis. Clinical case 3. Girl 6 years old. Sick from birth. The diagnosis of LG of the genitals was established at the age of 1, 5 years. Due to the localization of the rash in the external genital area, the girl's parents (at the age of 1 month) consulted an obstetrician-gynecologist, who suggested a hemangioma and referred to a dermatologist. The disease is of a family nature her grandmother (on the maternal side) and her lder brother have similar rashes on the skin of the trunk and in the mouth. The diagnosis was verified by histological examination. The pathological process is localized in the area of the labia majora and labia minora: multiple vesicular rashes with translucent contents, easily traumatized and accompanied by itching, were found. Conclusions: LG is a multidisciplinary problem, which is caused by mimicry of manifestations, varied localization and prevalence of the rash. To verify the diagnosis, the following algorithm should be followed: 1) the debut more often at birth or in the first months of life (with the exception of acquired forms of LG);2) the nature of evolution: a stable state or slow progression in the absence of traumatic factors;3) clinical features: the formation of grouped deep vesicles that resemble 'frog eggs'. The color of the bubbles is transparent or red-purple due to the hemorrhagic component. LG lesions may have hemangioma components. It should be remembered about the frequent localization of LG on the mucous membrane of the cheeks, tongue and floor of the oral cavity, which can manifest itself as bleeding from the elements of the rash when chewing or when providing dental care;4) biopsy reveals dilated lymphatic vessels in the upper layers of the dermis.

16.
International Journal of Morphology ; 40(1):102-106, 2022.
Article in English | Web of Science | ID: covidwho-1766746

ABSTRACT

The shift to online learning due to the COVID-19 pandemic sheds light on the need for innovative approaches to medical education, making it more interactive and effective. Histology is a challenging subject because it is known to be image intensive. In this study, we compared two methods of online teaching of practical histology: an interactive method using the Poll Everywhere Audience Response System and a traditional method without the use of Poll Everywhere. We performed a randomized controlled crossover trial. One hundred and forty students were divided into two groups. The first group was taught using the interactive method and the second group was taught using the traditional method. Each group was then taught using the other method for a second subject. Students' performance and preferences were assessed using tests and questionnaires. The examination scores were significantly higher for Poll Everywhere group. All students' responses were overwhelmingly in favor of the use of Poll Everywhere, with regard to their engagement, enjoyment, and morphology understanding, in addition to the applicability of the interactive approach. Interactive sessions of practical histology using applications such as Poll Everywhere can be an effective way to increase students' engagement, enjoyment, and knowledge retention during distance learning.

17.
Jp Journal of Biostatistics ; 19(1):95-106, 2022.
Article in English | Web of Science | ID: covidwho-1761350

ABSTRACT

Purpose of this paper: In this article we have analyzed the relationship among clinical variables: age, sex, pathological history of interest of the deceased;medicolegal: initial cause of death, immediate cause of death, origin of death and medicolegal etiology of death, and histological or anatomopathological: anthracosis, arteriosclerosis, congestion, fatty degeneration, edema, emphysema, sclerosis, hemorrhage, inflammation, necrosis and other casual or incidental findings from the study of medicolegal autopsies chosen at random from no Covid-19 victims in pandemic times. Design/methodology/approach: For the analysis of the relationships among the different variables, parametric and non-parametric techniques have been used: t-Student, ANOVA, contingency coefficient and Kruskal-Wallis. Findings: The relationship among these variables has been significant (p-value <= 0.05): Sex-age (0.005), Sex-pathological history (0.000), Sex-immediate cause of death (0.037), Pathological history-initial cause of death (0.036), Pathological history-medicolegal etiology (0.043), Initial cause of death-immediate cause of death (0.000) and Initial cause of death-origin of death (0.000), Immediate cause of death-origin of death (0.000). Research limitations/implications: We intend to expand the study in the future.

18.
European Urology ; 79:S1016, 2021.
Article in English | EMBASE | ID: covidwho-1747419

ABSTRACT

Introduction & Objectives: Day-case Transurethral Resection of Bladder Tumour (TURBT) is currently only performed in 18% cases across the United Kingdom. Concerns exist regarding the quality of TURBT, early recurrence rate and the high-risk patient cohort that makes this approach less popular in some centers. The Primary Outcome was to determine 30-day readmission rate and 30-day morbidity using the Clavien-Dindo classification. The Secondary Outcomes were to determine patient cohort selection, quality of TURBT and early recurrence rate and to report patient feedback following day-case TURBT. Materials & Methods: A retrospective audit of day-case TURBTs in a District General Hospital (DGH) over 3 years pre-COVID19 (January 2017 - March 2020) was performed. We only included patients who underwent a TURBT and excluded any cystoscopy, biopsy or fulguration. A day-case TURBT pathway is in place, for postoperative recovery, instillation of intravesical chemotherapy postoperatively if required and re-admission for trial without catheter when indicated in the hospital. Case notes were reviewed manually. Feedback was obtained from patients who had new tumour TURBT in the last year using hospital patient feedback forms. Results: We included 77 patients who underwent TURBT in the day-case theatre, of these 5 patients required in-patient stay after the surgery. Of the remaining 72 discharged on the same day, 8 were re-admitted (11%) for Clavien-Dindo I complications. The mean age of the patients was 71 years (34-94 years);77% (59/77) were male;reported ASA scores were 3/77 ASA 1 (4%), 43/77 ASA 2 (56%), 28/77 ASA 3 (36%);30% (23/77) patients were on anticoagulants or antiplatelets;the average tumour size was 2cm (1mm – 5cm), 69% (53/77) were papillary in nature and 36/77 were newly diagnosed tumours (47%) and the remainder were recurrences or re-resections. Of the new tumours, 32/36 (89%) received mitomycin C as indicated. On final histology, muscle was present in specimen in 50/77 (65%). The readmission/failed discharge group had a higher rate of older patients, with higher ASA scores and longer operative times, however resection quality and tumour characteristics were not different from the day-case TURBTs. The recurrence rate at first check cystoscopy for the newly diagnosed tumours was 3% (1/36) while 1 patient had residual disease in a bladder diverticulum. All patients reported an overall positive experience. Conclusions: In the first of its kind audit patients reported outcomes after day-case TURBT, though readmission rate was relatively higher than previous reports in the literature, the overall patient experience was favorable and the outcomes of TURBT quality and early recurrence were satisfactory. The data obtained can provide guidance to employ better patient selection to reduce readmission rates. Hence, day-case TURBT can be a feasible option in appropriately selected patients, with a suitable pathway in place.

19.
European Urology ; 81:S911, 2022.
Article in English | EMBASE | ID: covidwho-1747402

ABSTRACT

Introduction & Objectives: More evidence is emerging with regards to the low sepsis rate in relation to Local Anaesthesia Transperineal (LATP) prostate biopsy. The acceptable rate for sepsis is 2% in relation to prostate biopsy procedure in general. LATP biopsy upon latest systematic reviews and peer evidence has a sepsis rate of 0.16 percent which is relatively low which allows for conversion of this procedure into forgoing the use of prophylactic antibiotics. We present our study, a retrospective analysis of outcome of selected low risk patients who has had LATP prostate biopsy initiated in the BHRUT trust without the need for antibiotics prophylactically in line with the antibiotic stewardship initiative of the Urology department during Covid era. Materials & Methods: Data from 23.12.2020 to 10.05.2021 was collected from electronic medical recordings of 160 consecutive LATPs without antibiotics using PrecisionPoint™ Transperineal Access System performed under local anaesthesia in King George Hospital Goodmayes, London. Various parameters like PSA, pain score, number of cores, MRI findings, histology findings, MDT outcome and complications, focusing more on infection rates were analysed. Results: Of the 160 consecutive LATPs without antibiotics, the mean for age, PSA, cores and average visual analog scale scores were 65 years, 10.9ng/mL, 26 cores and 1.6, respectively. The overall cancer detection rate was 58%, and for Likert scores 3-5, the cancer detection rates were 40%, 79%, and 95%, respectively. Complication rates of sepsis, acute urinary retention, clot retention, and perianal abscess were 0%(0/160), 1%(1/ 160), 1.25%(2/160) and 0%(0/160) respectively. Conclusions: Our study group of patients undergoing TP biopsy under local anaesthesia without antibiotic administrations has no complications of post biopsy sepsis. So, is it safe to perform LATP in a selected group of low risk patient without prophylactic antibiotics with implementation of antibiotic stewardship. With rising antibiotics resistance LATP may avoid use of antibiotics.

20.
Colorectal Disease ; 24(SUPPL 1):86-87, 2022.
Article in English | EMBASE | ID: covidwho-1745952

ABSTRACT

Purpose/Background: To investigate the effectiveness of a one-stop colorectal cancer (CRC) staging pathway using faecal immunochemical test (FIT) as stratification tool. Methods/Interventions: The OSCARS pathway, which uses FIT as a triage tool to identify 'high risk' patients, was formally introduced in March 2020 in our Hospital Trust. A major driving force for this was to deal with the increased pressures on diagnostic services resulting from the COVID-19 pandemic. 2 week wait colorectal cancer referrals deemed appropriate to proceed to diagnostic testing prior to a clinic review ('straight to test') who had a FIT > 100 μg Hb/g faeces were allocated to the OSCARS pathway. This involved a single hospital visit during which they would have an endoscopy, a staging CT or completion CT colonography if needed, and be assessed and counseled by a colorectal cancer surgeon. Notes of all patents referred with suspected colorectal cancer between 01/01/2020 and 16/03/2021 (prior to the introduction of the pathway) and 16/03/2021 and 31/07/2021 (post introduction of the pathway) were reviewed to evaluate outcomes of the pathway. Time from referral to investigations, histological diagnosis and discussion at multidisciplinary team (MDT) meeting was compared before and after the introduction of the OSCARS pathway. Results/Outcomes: There were a total of 748 patients referred with suspected colorectal cancer in the pre-OSCARS group and 1194 in the OSCARS group. of those who were referred with an increased FIT, 43 (8.0%) and 86 (7.9%) were diagnosed with colorectal cancer (CRC) respectively. CRC diagnoses established on a 'straight to test' pathway increased from 69.8% in pre-OSCARS to 86.0% in the OSCARS groups, likely due to better stratification to a 'straight to test' pathway through the use of FIT. Despite the COVID-19 pandemic coinciding with the introduction of the OSCARS pathway, time for 'referral to first investigation' and 'referral to endoscopy' were similar between the groups (13 vs 12 days, p = 0.511 and 13 vs 13, p = 0.988). All patients diagnosed with cancer in the OSCARS group had staging CT scan on the same day (as opposed to 4 days pre-OSCARS, p = 0.002) but the difference in time for 'endoscopy to MRI' (8 vs 5 days, p0.271) or 'endoscopy to histopathology (4 vs 5 days, p = 0.236) did not change significantly. Time for 'endoscopy to MDT' was significantly reduced from 14.5 to 9 days (p = 0.019). Conclusion/Discussion: Time from referral to diagnostic test on 'straight to test' pathway remained unchanged in our Trust despite COVID-19 pandemic as a result of stringent stratification using FIT. Time from 'endoscopy to MDT' was significantly reduced with introduction of the OSCARS pathway due to same day access to CT scanner. It is likely that this section of the 2ww pathway would further be reduced with improved access to MRI and histopathology reporting services. Although OSCARS pathway reduces the number of hospital visits, its effect on patients' experience needs to be formally assessed.

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