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1.
Journal of Pharmaceutical Negative Results ; 13:598-605, 2022.
Article in English | EMBASE | ID: covidwho-2164821

ABSTRACT

Introduction: Statins are a group of lipid-lowering medications that have anti-inflammatory and immune system-modulating effects. Considering the existence of severe inflammatory reactions in patients with covid-19, this study aimed to investigate the effects of statins on the mortality rate of covid-19 patients. Material(s) and Method(s): The present research is a descriptive-analytical case-control study that was carried out in the first half of 2021 at Kowsar Hospital in Semnan, Iran. The study was conducted on 191 patients taking statins as the case group and 191 patients with no history of taking statins. Demographic and clinical information of the patients who met the inclusion criteria of the research were extracted from the files and collected in the researcher's questionnaire. Finally, the results were statistically analyzed using SPSS software version 26. Result(s): In this study, a case group of 191 people, who had a history of taking statins, and a control group of 191 people, who did not use statins, were investigated. The average age of people was 64.7 years. Among the studied patients, 51.7% were men and 48.3% were women. Most of the patients were hospitalized for 4 days. Also, 351 patients were discharged and 32 people died. After analyzing the data, no significant relationship was observed between the use of statin and mortality due to Covid-19. Discussion and Conclusion(s): According to the results of this study, no relationship was observed between the use of statins and the reduction of mortality caused by covid-19. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

2.
J Clin Med ; 11(23), 2022.
Article in English | PubMed | ID: covidwho-2163465

ABSTRACT

BACKGROUND: Since data on the safety and effectiveness of home telemonitoring and oxygen therapy started directly after Emergency Department (ED) assessment in COVID-19 patients are sparse but could have many advantages, we evaluated these parameters in this study. METHODS: All COVID-19 patients ≥18 years eligible for receiving home telemonitoring (November 2020-February 2022, Albert Schweitzer hospital, the Netherlands) were included: patients started directly after ED assessment (ED group) or after hospital admission (admission group). Safety (number of ED reassessments and hospital readmissions) and effectiveness (number of phone calls, duration of oxygen usage and home telemonitoring) were described in both groups. RESULTS: 278 patients were included (n = 65 ED group, n = 213 admission group). ED group: 23.8% (n = 15) was reassessed, 15.9% (n = 10) was admitted and 7.7% (n = 5) ICU admitted. Admission group: 15.8% (n = 37) was reassessed, 6.5% (n = 14) was readmitted and 2.4% (n = 5) ICU (re)admitted. Ten patients died, of whom 7 due to COVID-19 (1 in ED group;6 in the admission group). ED group: median duration of oxygen therapy was 9 (IQR 7-13) days;the total duration of home telemonitoring was 14 (IQR 9-18) days. Admission group: duration of oxygen therapy was 10 (IQR 6-16) days;total duration of home telemonitoring was 14 (IQR 10-20) days. CONCLUSION: it appears to be safe to start home telemonitoring and oxygen therapy directly after ED assessment.

3.
European Psychiatry ; 65(Supplement 1):S311, 2022.
Article in English | EMBASE | ID: covidwho-2153903

ABSTRACT

Introduction: Severe COVID-19 survivors experience long-term neuropsychiatric morbidity, particularly those who developed delirium, with a negative impact on health-related quality of life (HRQoL). Objective(s): To identify the cases of delirium in severe COVID-19 patients and to describe its association with post-hospital discharge HRQoL. Method(s): In the context of the longitudinal MAPA project, we included adult patients (>= 18 years old) admitted with COVID-19 to the Intensive Care Medicine Department (ICMD) of a Portuguese University Hospital (October 2020-April 2021). Exclusion criteria were: ICMD length of stay <=24h, terminal illness, major auditory loss, or inability to communicate at the time of assessment. Delirium during ICMD stay was ascertained based on patients' clinical records. HRQoL was evaluated using the 5-Level EQ-5D questionnaire (EQ-5D-5L), at a scheduled telephone follow-up appointment on average 1-2 months after hospital discharge. Result(s): Overall, 124 patients were included with a median age of 62 (range: 24-86) years, being mostly male (65%). About 19% had delirium, 42% were deeply sedated and 43% required invasive mechanical ventilation. Most survivors reported problems on the EQ-5D-5L domains: usual activities (85%), mobility (73%) and anxiety/depression (65%). Patients with delirium reported more pain/discomfort (75%vs46%;p=0.011) and considerably anxiety/ depression (83%vs60%;p=0.032). Conclusion(s): These findings pointed that COVID-19 patients who experienced delirium reported worse HRQoL, regarding pain/discomfort and anxiety/depression. This study highlights the importance of not only prevention but also early screening of delirium during hospital stay, as well as the crucial role of the timely interventions at discharge, in order to minimize delirium longterm impacts.

4.
Topics in Geriatric Rehabilitation ; 38(4):245, 2022.
Article in English | EMBASE | ID: covidwho-2152288
5.
British Journal of Surgery ; 109(Supplement 5):v27, 2022.
Article in English | EMBASE | ID: covidwho-2134902

ABSTRACT

Introduction: There is a drive within The National Health Service towards a more personalised approach to healthcare. Patient-centred care gives individuals more control over their mental and physical health. We have implemented a patient-initiated follow-up (PIFU) system, within our trust. This provides patients with autonomy for arranging follow-up appointments when needed and saves unnecessary routine reviews. Method(s): Two consultant surgeons have of fered a 'PIFU style' follow-up. Selected patients seen in clinic were discharged but provided with a PIFU card. Patients returned this card if they needed to be seen again in clinic for The same complaint. Result(s): During The study period 149 patients were discharged with a PIFU card. There were 1370 appointments (New and Follow-up) over The same period. Only 17% of PIFU patients (twenty-six) returned within six months. One hundred and twenty-three patients (83%) sought no further appointments. This reduced unnecessary, routine follow-up visits. If a greater proportion of patients were discharged in a timely fashion and of fered a PIFU card, then outpatient clinic efficiency would be further improved. Conclusion(s): The potential benefits of a PIFU system include: financial savings, patient autonomy, more clinic availability and fewer wasted Gp appointments for re-referrals. Adopting a PIFU based system, helps to reduce service waiting times. PIFU is an important tool both for improving outpatient clinic efficiency and increasing patient autonomy. PIFU should be used widely, to help recovery after CoVID-19.

6.
British Journal of Surgery ; 109(Supplement 5):v55, 2022.
Article in English | EMBASE | ID: covidwho-2134880

ABSTRACT

Aim: Day case surgeryisan effective and economical method tomanage patients while maintaining quality of care. During The COVID-19 pandemic and The reinstatement of non-cancerous elective surgery, efficient use of bed space capacity has been crucial. Strategies were implemented to reduce unplanned admission rates, including careful patient selection and preoperative assessment. We aimed to review rates of unplanned admissions (UA) following intended day case procedures and to identify methods of future prevention of UA. Method(s): A retrospective review was carried out of patients undergoing day case hernia repairs or laparoscopic cholecystectomy in a single district General hospital, between May 2021 and September 2021. Data was collated from an institutional data base with follow up data obtained from an electronic care record. Result(s):53patientsincluded,withamedianageof76years (range23-79), 56.6% male, 23 inguinal hernia repairs and 30 cholecystectomies. 30.2% were unexpectedly admitted post operatively (9 Cholecystectomies and 7 inguinal hernias). Of those admitted, median length of stay was 3.1 days (range2-10). Reason for admission included pain (43.8%), postoperative complications (18.8%) and urinary retention (18.8%). Patients requiring admission were significantly older (mean age 62 vs 49 years old), were more likely to be male (62.5% vs 37.5%) and had a significantly longer theatre time (1.46 vs 1.08 hours, p=0.0001). Conclusion(s): Our short review has identified older and male patient are more likely to require an overnight admission. Improvement in pain management, theatre planning and streamlining along with optimal discharge planning may reduce The volume of patient requiring UA.

7.
European Urology Open Science ; 44(Supplement 1):S38, 2022.
Article in English | EMBASE | ID: covidwho-2132861

ABSTRACT

Author of the study: Rezum is one of the most promising minimally invasive technologies for the treatment of BPH. During Covid pandemic era we used this technique extending the indication even in patients carryng urinary catheter or in patients with prostatic adenoma volume higher than 80 ml. In this short communication we report the preliminary results of our experience. Material(s) and Method(s): From January 2019 to September 2021 92 patients underwent a Rezum treatment. Of these patients 51 (55%) carrying catheter for urinary retention secondary to BPH. Inclusion criteria was: age >18 yo, catheterization time >3 months, prostate adenoma volume >30 cc. A 6 months follow up was offered to each patient including uroflometry and PSA. Result(s): Mean age was 75 yo (62-84), mean iPSA 3,7 ng/ml (1,9-5,8), mean adenoma volume 92 cc(65-270). Mean catheterization time before treatment 7,8 months (3-14). Mean operative time (12,5 min (11-14). All patients were discharged 4 hours after the treatment. Catheter removal was performed after 4/6 weeks. 48 (94%) patients obtained a spontaneous micturition. Mean Qmax at 6 months 12,5 cc/ sec, mean Post-void residual 120 cc. In 3 patients we observed post operative IVU treated with antibiotics. 21 (44%) patients continue alpha-litic therapy after Rezum treatment. In 2 patients it was necessary performing a disobstructive surgery. Conclusion(s): Rezum may represent a possible minimally invasive therapeutic strategy for BPH complicated by urinary chronic retention whenever other procedures aren't feasible. Despite the technical card indications, we successfully treated even prostate adenoma volumes higher than 80 ml. In some cases oral therapy was still necessary after the procedure. Our preliminary results are encouraging to continue to performing this procedure in these patients but further studies with longer follow up are needed Copyright © 2022 European Association of Urology. Published by Elsevier B.V.

8.
Indian Pediatrics ; 59(10):809-810, 2022.
Article in English | EMBASE | ID: covidwho-2129414

ABSTRACT

A sudden increase in the number of children with newly diagnosed type 1 diabetes mellitus (T1DM) was experienced during the third wave of COVID-19 epidemic in Hungary. The newly diagnosed T1DM patients had a significantly higher rate of anti-SARS-CoV-2 positivity as compared to prevalent T1DM children [OR (95% CI) 3.74 (1,08,13.55);P=0.04]. The relationship between SARS-CoV-2 infection and diabetes needs to be investigated further. Copyright © 2022, Indian Academy of Pediatrics.

9.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128166

ABSTRACT

Background: Coronavirus (COVID-19) infection is a pandemic caused by SARS-CoV- 2, appeared in Wuhan, in November 2019 and in March 2020 in Argentina. Initially it predisposes patients to thrombotic disease. Pregnancy is a hypecoagulable state and the optimal thromboprophylaxis in pregnancy is unknown. We work with the available information adapted to our hospital requirements. Aim(s): To describe 1. Venous thromboprophylaxis in hospitalized pregnant women with COVID-19 infection. 2. Maternal outcome. Method(s): 108 pregnant women were hospitalized between April 2020-july 2021 (6 in the Intensive Care Unit (ICU), 4 required mechanical ventilation, 6 in Medical Clinic Unit and the rest in the Obstetrics Unit, patients were not vaccinated). Median age 29 (range 16-41). Trimester 1st 3.7%(4);2nd 15.7%(17);3rd 79.7%(86) (>37 weeks: 47);postpartum 0.9%(1). Treatment: We elaborated local guides and low molecular weight heparin (LMWH) enoxaparin 40 mg/d was prescribed to all pregnant women with COVID-19 when hospitalized, 8 received intermediated doses and those more than 37 week received unfractionated heparin (UFH). Outpatient prolongation of thromboprophylaxis depends on risk stratification, those admitted to ICU continue with enoxaparin until delivery. Result(s): 41 patients were discharged pregnant and 64 postpartum, 1 ectopic pregnancy and 2 abortions. There were neither maternal deaths nor venous thromboembolism (VTE) during the acute period of infection or during hospitalization. One women that was admitted to de ICU and require ARM with a BMI >40 and with LMWH developed a deep vein thrombosis 2 months later at 34 week of gestation and was anticoagulated with full doses of LMWH. Conclusion(s): During the first period of COVID 19 infection in our country, hospitalized women received either LMWH enoxaparin at fixed doses of 40 mg/day or UFH if near delivery. No VTE or maternal death were observed during hospitalization. We suggest to continue VTE prophylaxis during the antenatal period in those patients admitted to ICU until delivery.

10.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128144

ABSTRACT

Background: Haemostatic impact of SARS-CoV- 2 infection and multisystem inflammation syndrome (MIS-C) in children is still under consideration. Aim(s): To investigate COVID-19 coagulopathy in hospitalized children due to SARS-CoV- 2 infection. Method(s): A retrospective review on coagulation parameters of children with SARS-CoV- 2 infection and MIS-C hospitalized from August 2020 until December 2021 was conducted in our Haemostasis and Thrombosis Centre. Values of D-dimers, fibrinogen, antithrombin, protein C, PT, APTT and the respective coagulation factors were recorded at hospital admission, in multiple time points during hospitalization and upon hospital discharge. Statistical analysis was performed with Mann-Whitney test and t-test. Result(s): In total, 733 children (boys: 62.7%) of mean age 4.9 +/- 5.4 years (0-18) were investigated. Patients were categorized as follows: Patients with mild/moderate (87.6%) or severe COVID-19 (6.3%) and patients with MIS-C (6.1%). Severe, in comparison with mild/moderate patients, had significantly increased admission D-Dimer values (34.3 vs. 2.9 mug/ml), PT (25.2 vs. 14.3, sec), APTT (62.5 vs. 34.6, sec), fibrinogen (362.5 vs. 259.5, mg %), and factor VIII values (165.4 vs. 126.9, %). MIS-C children had significantly increased admission values of fibrinogen (501 mg %), factor VIII (200.3, %) and statistically decreased factor VII values (38.2 vs. 56.6, %), antithrombin values (81.5 vs. 98.1, %) and protein C values (52.4 vs. 63.3, %) in comparison with mild/ moderate patients. Interestingly, MIS-C children had markedly increased fibrinogen and factor VIII values even in comparison with severe patients. During hospitalization, PT, APTT, fibrinogen, factor VIII values were significantly decreased and factor VII values increased. Also, D-Dimers values were markedly decreased but without statistical significance. No child died and thrombosis was noticed in three children, one of which was suffered from MIS-C. Conclusion(s): Our COVID19 hospitalized children showed a mild deterioration of coagulation parameters. However, in children with MIS-C and severe COVID19, these coagulation parameters were found mainly affected.

11.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128070

ABSTRACT

Background: Thromboinflammation in severe COVID-19 is associated with disease severity and inferior outcome. Evidence suggests that the kallikrein pathway potentially plays a vital role in COVID-19 associated thromboinflammation as it both activates downstream inflammatory pathways and contact-mediated coagulation. Aim(s): To investigate whether modulation of this pronounced thromboinflammatory response can improve outcomes in hospitalized patients with severe COVID-19. Method(s): This multicenter randomized clinical trial was approved by the ethics committee and supported by the KU Leuven COVID-19 fund and Research Foundation Flanders (FWO). After informed consent, eligible patients were 1:2 randomized to receive standard of care (SOC) or SOC plus study intervention (figure 1). The intervention consisted of off-label -kallikrein-inhibiting -aprotinin combined with low molecular weight heparin (LMWH). Additionally, patients with predefined hyperinflammation were treated with the interleukin-1 receptor antagonist anakinra. The primary endpoint was time to sustain a 2-point improvement in the WHO ordinal scale for clinical status. Result(s): Three hospitals in Belgium included 102 patients (35 SOC vs. 67 intervention). Twenty-five patients from the intervention group (37%) were treated with anakinra. Patients had elevated D-dimers (mean 1012.4 mug/L;SD 991.9 mug/L) and C-reactive protein (mean 81.4 mg/L;SD 59.6 mg/L) at admission confirming baseline activation of coagulation and inflammatory pathways. During hospitalization, 37% of patients were admitted to the ICU (29% SOC vs. 42% intervention), and 20% needed invasive ventilation (12% SOC vs. 25% intervention). The intervention did not affect the time to sustained clinical improvement or hospital discharge (figure 2), nor secondary clinical endpoints. Except for D-dimers at day 3, there was no significant C-reactive protein or D-dimer reductions. There were no differences in treatment-related adverse events. Conclusion(s): In hospitalized COVID-19 patients, additional modulation of thromboinflammation with high-dose aprotinin and LMWH with or without anakinra was feasible and safe but did not improve clinical nor biochemical outcomes.

12.
PM and R ; 14(Supplement 1):S159-S160, 2022.
Article in English | EMBASE | ID: covidwho-2127988

ABSTRACT

Case Diagnosis: A 66-year-old man with past medical history significant for alcohol use disorder, thoracic aortic aneurysm, and alcohol-induced peripheral neuropathy presented with transverse myelitis following COVID-19 mRNA-1273 vaccination. Case Description or Program Description: The patient presented with a 3 week history of gait dysfunction and bilateral lower extremity weakness while walking, following the second dose of his COVID-19 vaccination. The patient described his leg symptoms as a "squeezing" heaviness that caused tightness, pain, and weakness with walking, without paresthesias. Thoracic spine MRI demonstrated a probable demyelinating process at the T2-T4 levels. Setting(s): Tertiary care hospital Assessment/Results: This patient was diagnosed with transverse myelitis. By day 3 of his hospital stay, the patient started twice daily IV methylprednisolone. By day 4 of his hospital course, the patient's symptoms had improved (normal neurologic exam), and he underwent a diagnostic lumbar puncture showing no abnormalities. By day 7, the patient was discharged home with home health PT. Discussion (relevance): The patient's onset of bilateral lower extremity weakness and stiffness following a vaccination, accompanied by imaging suggestive of thoracic spine demyelination, all suggests a diagnosis of transverse myelitis following his COVID-19 vaccination. Transverse myelitis following COVID-19 vaccination exists as a rare but important adverse event, with 21 cases occurring to date after the mRNA-1273 vaccine, and neurologic symptoms making up 2.69% of all COVID-19 vaccination adverse effects. These events may occur due to several mechanisms observed in neurologic effects of other viral vaccines, such as vaccine-induced elevations in IL-6 & IL-17 levels or adjuvant proteins causing MHC class 1 reactivity to the spinal cord. Conclusion(s): Transverse myelitis is a rare yet severe adverse event after the mRNA-1273 COVID-19 vaccine. As this vaccine approaches FDA approval, further study is needed to characterize the mechanism of the event and the susceptibility of specific populations to that mechanism.

13.
PM and R ; 14(Supplement 1):S166-S167, 2022.
Article in English | EMBASE | ID: covidwho-2127984

ABSTRACT

Case Diagnosis: Patient is a 63-year-old male with Guillain-Barre Syndrome and Parsonage-Turner Syndrome following COVID-19 Vaccination Case Description or Program Description: Eight days after receiving a viral vector COVID-19 vaccination, the patient developed low back and left thigh pain with severe right shoulder pain developing the following day. He denied recent viral illnesses, gastrointestinal symptoms, or prior right shoulder pain. Pain, weakness, and sensory changes gradually involved all four extremities. He was hospitalized and Guillain-Barre Syndrome (GBS) was confirmed by lumbar puncture. He tested negative for Campylobacter jejuni. Cervical and lumbar spine MRIs showed mild degenerative changes without stenosis or neuroforaminal impingement. Right shoulder MRI showed no abnormality. He responded to a 5-day course of IVIG. His extremity pain gradually resolved but right shoulder weakness remained. Electrodiagnostic testing six months after symptom onset showed evidence of GBS in recovery. Right shoulder girdle muscles were not tested during the first EMG. After stays at an LTAC and SNF, the patient was admitted to IPR. While at IPR, he reported debilitating right shoulder weakness and limited ROM. On exam, significant atrophy of the right deltoid, infraspinatus, and supraspinatus muscles was observed. A repeat electrodiagnostic study showed evidence of a right Parsonage-Turner syndrome (PTS) in addition to the GBS in recovery. Setting(s): Inpatient Rehabilitation (IPR) Assessment/Results: Patient's presentation and EMG findings pointed to a concurrent occurrence of PTS and GBS after his COVID-19 vaccination. A right shoulder ultrasound-guided glenohumeral joint corticosteroid injection improved his shoulder ROM. The patient was discharged home with outpatient therapy after four weeks of IPR. Discussion (relevance): Rare instances of GBS and Parsonage-Turner Syndrome have been reported after a COVID-19 vaccination. This appears to be the first reported case where GBS and PTS have both occurred in a patient soon after receiving a COVID-19 vaccination. Conclusion(s): Concurrent PTS and GBS can develop after COVID-19 vaccine administration.

14.
PM and R ; 14(Supplement 1):S20, 2022.
Article in English | EMBASE | ID: covidwho-2127982

ABSTRACT

Case Diagnosis: A 65-year-old woman who developed multiple system atrophy as a sequelae of COVID-19 infection Case Description or Program Description: The patient developed progressive dizziness, blurriness, and unsteady gait immediately following hospitalization for COVID-19 infection. Formal evaluation noted rightward nystagmus, mild resting tremor of the right hand, slowed finger tapping test bilaterally, overshooting on right finger to nose, and shuffling gait. MRI of the brain revealed moderate cerebellar and pontine volume loss with crossed hyperintensity of the pons, or "hot cross bun sign", raising suspicion for degenerative disease. Lumbar puncture analysis was normal. The patient was diagnosed with multiple system atrophy with parkinsonism features and started on a trial of amantadine and carbidopa/levodopa. Videonystagmography confirmed cerebellar etiology of her symptoms. Vestibular rehabilitation and meclizine was initiated with subsequent improvement in dizziness and functionality. Setting(s): Acute inpatient rehabilitation facility. Assessment/Results: After 20 days of acute inpatient rehabilitation including vestibular therapy, amantadine, carbidopa/levodopa, and meclizine, there was improvement of dizziness, dysarthria, tremor, weakness, and gait. The therapy team noted good progress since admission regarding performance of self-care tasks as well as transfers and mobility. The patient was discharged home with outpatient vestibular therapy. Discussion (relevance): This is a case of newly diagnosed multiple system atrophy associated with "hot cross buns sign" on MRI with COVID19 infection as the implicated etiology. To our knowledge, this is the first case of central cerebellopontine degeneration associated with COVID19. Conclusion(s): New onset multiple system atrophy may be a sequelae of COVID19 infection.

15.
Journal of the American Society of Nephrology ; 33:733, 2022.
Article in English | EMBASE | ID: covidwho-2125922

ABSTRACT

Background: Access to nephrology care including dialysis in rural Alabama (AL) hospitals is lacking. The University of Alabama at Birmingham (UAB) with Sanderling Inc. started inpatient tele-nephrology (TN) services in 2019 and currently serves 3 rural AL hospitals. Since the COVID-19 pandemic, transfer to TN-equipped hospitals in AL played a pivotal role for patients needing nephrology services when primary referral centers were at capacity. Method(s): TN services were 100% virtual and video-based. Consults were completed by UAB nephrology faculty. Home hemodialysis machine (HHD) was used to provide kidney replacement therapy (KRT) in the hospital, with aid of inpatient dialysis technicians supervised remotely by TN dialysis nurses. TN consults were evaluated from Jun 2019 to Dec 2021. Retrospective chart review for pre-defined outcomes was performed and analyzed. Result(s): There were 694 inpatient TN encounters. Mean age was 64 (18-96) yr. 74% of consultations involved black patients. Mean stay was 6 d. 44% were ICU patients;18% were COVID-19 positive. AKI and known ESKD patients contributed to 48% and 44% consults, respectively. 11% had AKI necessitating KRT. 20% and 13% of consults involved hyperkalemia and dysnatremias, respectively. 792 dialysis treatments were performed with 11% complicated by intradialytic hypotension (IDH). Patients were discharged 64% and transferred to higher level of care 18% of the time. 90 patients expired. 66% of deaths were attributable to COVID-19. Preliminary economics analysis at the hospital with the most consults showed increase in case-mix index and higher census since implementation of TN services. Conclusion(s): Inpatient TN in community hospitals in rural AL provided essential nephrology care to underserved populations amidst a pandemic limiting transfer to nephrology-staffed medical centers at capacity. Most patient encounters resulted in discharge without need for transfer to bigger centers thus saving vital time and resources. Dialysis safety was favorable with low IDH prevalence likely given HHD use. TN services can be beneficial for nephrology care in remote community hospitals with further studies warranted.

16.
Journal of the American Society of Nephrology ; 33:341-342, 2022.
Article in English | EMBASE | ID: covidwho-2125785

ABSTRACT

Background: Kidney injury in acute COVID-19 infection has been associated with decreased survival and prolonged duration of hospitalization irrespective of patient population or severity of illness. Outcomes among hospitalized patients with COVID-19 and kidney injury in terms of recovery of renal function are insufficiently assessed. A good understanding of the same is vital to plan post-discharge renal care, and to estimate the potential burden that COVID-19 confers on the nephrology community. Method(s): In a cohort study, we included patients who received hemodialysis (HD) during hospital stay after infection with COVID-19 at our center following kidney injury during the second wave of the pandemic in New Delhi between June and December, 2021. Participants were excluded if they received dialysis following previously existing chronic renal failure. Participants were followed-up telephonically for a period of six months to assess renal function and need for HD. Recovery of renal function was considered early if serum creatinine improved by 33% of peak value during hospital stay, or late if a 33% reduction in follow-up evaluation was noted over the discharge serum creatinine. Result(s): A total of 62 patients (34 (54.8%) men and 28 (45.2%) women) with a mean age of 51.2 years (+16.3), and mean urea of 181 mg/dl (+95.7) and mean creatinine of 6.9 mg/dl (+3.5) at presentation were included in the cohort. Of these, 31 (50%) had presented with mild, 11 (17.7%) with moderate and 20 (32.3%) with severe disease. Ten (16.1%) succumbed to illness during hospital stay and another 12 (19.3%) patients died during the follow up period. 34 (54.8%) patients were discharged from hospital on HD, and 18 (29%) were not advised HD at discharge. While 30 (75%) of the survivors had indicated early renal recovery at discharge, none had recovered renal function at the end of follow up period. A median decline of 48% and 44% at follow up was noted from the peak and presentation values of creatinine recorded during hospital stay. Conclusion(s): Patients undergoing hemodialysis after hospitalization with acute COVID-19 infection had poor short-term outcome and survivors continued to have renal impairment after six months. It is important to recognize recovery rates and patterns to offer early comprehensive renal care.

17.
Journal of the American Society of Nephrology ; 33:886, 2022.
Article in English | EMBASE | ID: covidwho-2125073

ABSTRACT

Background: The alpha wave of COVID-19 brought death and dismay to patients and to providers respectively. Remdesivir nor plasma was available. We studied this cohort to evaluate the need for mechanical ventilation (MV) and Renal replacement therapy and the outcome of hospital discharge. Is well known that the covid-19 causes Cytokine Release Syndrome (CRS), therefore, producing dysregulation and an increase in the immune response, interleukine 6, plays and central role in triggering the (CRS) and stimulating other inflammatory markers. Method(s): A retrospective-observational study. We reviewed the patients admitted to the intensive care unit of a metropolitan hospital in the Los Angeles area from February 17th, 2020, till March 14th, 2020. There was 24 patient who was in the ICU. At the time, Remdesivir was not available at the hospital Results: Eight of the 24 patients received Kevzara. Of the 8 patients, 2 required RRT while of the 16 patients who did not receive Kevzara, 6 required RRT. All 8 patients who received RRT also had MV for varying number of days and all were alive at 28 days. Among the 16 patients who did not receive Kevzara, 11 required mechanical ventilation, and 6 got RRT. 5 patients got both MV and RRT. The number of days of RRT was required was 12 in the Kevzara group and 4.25 in the none-Kevzara group. Chi Square value of 5.3706 p value = <0.5 Conclusion(s): Kevzara reduced 28-d mortality in the alpha wave of covid-19. There is incremental value in the use of Kevzara and Organ support technologies such as MV and RRT in the ICU. As the patient's life is prolonged in critical care units, there is increased demand for renal replacement therapy resources.

18.
Journal of Endourology ; 36(Supplement 1):A181, 2022.
Article in English | EMBASE | ID: covidwho-2114576

ABSTRACT

Introduction &Objective: In the ongoing Covid-19 era where physical distancing is utmost important, we assessed the feasibility of ambulatory tubeless supine mini-PCNL under spinal anaesthesia for stone size between 1.5 - 3 cm to minimise hospitalisation. Method(s): Between June 2020 to August 2021, total 284 patients underwent PCNL out of which 122 underwent ambulatory tubeless mini-PCNL. The inclusion criteria were those consented for study, size of the stone 1.5 - 3 cm, pre-operative Covid-19 negative test (CT-chest and RT-PCR). Those excluded were with solitary kidney, morbidly obese, active UTI, congenital abnormalities. Patient's demographics, peri-operative parameters, stone free rate, blood loss, pleural complications and requirements of auxiliary procedures were prospectively evaluated Results: All the patients underwent supine mini-PCNL in FOSML (Flank-Oblique Supine Modified Lithotomy) position through a single tract of size 14/16 Fr. In, 18 (15%) patients' additional tracts were made for inaccessible secondary stones. Holmium laser and pneumatic source of energy were used for fragmentation of stones. Supra 12th rib tracts were made in 23 (19%) patients while in remaining 99 (81%) had infra-costal tracts. Complete SFR (stone-free rate) was achieved in 112 (92%) under fluoroscopy and the remaining 10 (8%) needed auxiliary procedure to render stone free. Average total operative time was 44 +/- 15 minutes and no nephrostomies were placed. All patients were discharged within 24 hours of operation with only 7 (6%) patients required readmission within 48 hours of discharge with hematuria and were managed conservatively. No other major complications occurred except for mild fever in few. Conclusion(s): Ambulatory supine tubeless mini-PCNL under spinal anaesthesia is safe and effective in this uncertain rapidly spreading COVID-19 era to minimise hospitalisation. It should be recommended whenever feasible, and it is easy to adapt to this newer approach especially for urologist already performing supine PCNL.

19.
Frontiers in Medicine ; 9 (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2114213

ABSTRACT

Background: A motley postacute symptomatology may develop after COVID-19, irrespective of the acute disease severity, age, and comorbidities. Frail individuals have reduced physiological reserves and manifested a worse COVID-19 course, during the acute setting. However, it is still unknown, whether frailty may subtend some long COVID-19 manifestations. We explored the prevalence of long COVID-19 disturbs in COVID-19 survivals. Method(s): This was an observational study. Patients aged 65 years or older were followed-up 1, 3, and 6 months after hospitalization for COVID-19 pneumonia. Result(s): A total of 382 patients were enrolled. Frail patients were more malnourished (median Mini Nutritional Assessment Short Form score 8 vs. 9, p = 0.001), at higher risk of sarcopenia [median Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) score 3 vs. 1.5, p = 0.003], and manifested a worse physical performance [median Short Physical Performance Battery (SPPB) score 10 vs. 11, p = 0.0007] than robust individuals, after hospital discharge following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Frailty was significantly associated with: (i) confusion, as a presenting symptom of COVID-19 [odds ratio (OR) 77.84, 95% CI 4.23-1432.49, p = 0.003];(ii) malnutrition (MNA-SF: adjusted B -5.63, 95% CI -8.39 to -2.87, p < 0.001), risk of sarcopenia (SARC-F: adjusted B 9.11, 95% CI 3.10-15.13, p = 0.003), impaired muscle performance (SPPB: B -3.47, 95% CI -6.33 to -0.61, p = 0.02), complaints in mobility (adjusted OR 1674200.27, 95% CI 4.52-619924741831.25, p = 0.03), in self-care (adjusted OR 553305.56, 95% CI 376.37-813413358.35, p < 0.001), and in performing usual activities of daily living (OR 71.57, 95% CI 2.87-1782.53, p = 0.009) at 1-month follow-up;(iii) dyspnea [modified Medical Research Council (mMRC): B 4.83, 95% CI 1.32-8.33, p = 0.007] and risk of sarcopenia (SARC-F: B 7.12, 95% CI 2.17-12.07, p = 0.005) at 3-month follow-up;and (iv) difficulties in self-care (OR 2746.89, 95% CI 6.44-1172310.83, p = 0.01) at the 6-month follow-up. In a subgroup of patients (78 individuals), the prevalence of frailty increased at the 1-month follow-up compared to baseline (p = 0.009). Conclusion(s): The precocious identification of frail COVID-19 survivors, who manifest more motor and respiratory complaints during the follow-up, could improve the long-term management of these COVID-19 sequelae. Copyright © 2022 Damanti, Cilla, Cilona, Fici, Merolla, Pacioni, De Lorenzo, Martinenghi, Vitali, Magnaghi, Fumagalli, Gennaro Mazza, Benedetti, Tresoldi and Rovere Querini.

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Open Access Macedonian Journal of Medical Sciences ; 10:217-221, 2022.
Article in English | EMBASE | ID: covidwho-2066680

ABSTRACT

INTRODUCTION: The first data for COVID-19 in pregnancy showed mild-to-moderate forms of the disease while the current data speak of severe forms in these subjects. Here, we present a case of a severe form of COVID-19 in a gemelar pregnant woman complicated with pneumomediastinum and pneumothorax, during her hospital stay, in a late stage of disease. CASE PRESENTATION: A 38-year-old multiparous woman was referred to university hospital at 25 weeks of gemelar pregnancy. On admission, the patient presented with signs of moderate respiratory insufficiency, which after 12 h progressed further to severe ARDS. She tested positive for SARS-CoV-2 on quantitative real-time polymerase chain reaction. Under these conditions, it was decided that the patient undergoes a cesarean section for termination of pregnancy. Remdesivir 200 mg/day and tocilizumab 8 mg/kg were administered, based on national guidelines. The patient’s fever subsided, but her SpO2 remained at 94%, even with a 15 L/min oxygen mask. After 12 days, the patient complains of a severe back pain and her respiratory condition rapidly worsened and reduced saturations up to 80% being under O2 therapy with facial mask with 15 l/min. Chest CT findings confirmed pneumomediastinum and pneumothorax, which deteriorated the patient’s status. Thereafter, tube thoracostomy was performed. There was a clinical and ABG analysis parameter’s improvement. The patient was discharged 34 days after cesarean delivery with a proper general health. CONCLUSION: Our case highlights even more convincingly the fact that, in pregnancy, can be severe to life-threating forms of COVID-19. Pneumothorax and pneumomediastinum are complications that can be encountered even in the late stages of severe forms cases with COVID-19 in pregnancy. Early diagnosis of these complications is essential in adequate management and treatment to avoid fatal outcome.

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