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1.
Radiotherapy and Oncology ; 170:S120-S121, 2022.
Article in English | EMBASE | ID: covidwho-1967460

ABSTRACT

Purpose or Objective The role of perioperative treatment in radiation-induced and in-field recurrent sarcomas (RIS/IFRS) is unknown. Reirradiation may be associated with a risk of significant toxicity;thus, it is rarely used. We hypothesized that the combination of preoperative or definitive 12x 3 Gy radiotherapy (RT) with or without integrated 3.5 Gy to 42 Gy boost combined with regional hyperthermia twice a week will enable satisfactory local control without significant late toxicity in patients with RIS/IFRS. Materials and Methods A prospective phase II, single-arm clinical trial was conducted. We included patients with locally advanced RIS/IFRS without distant metastases. Treatment combined three weeks of radiotherapy, four fractions per week, 3 or 3.5 Gy per fraction, with regional hyperthermia, followed by surgery or observation. The choice of the boost or no-boost regimen was based on resectability (Figure 1). The intervention would be deemed tolerable if significant RT-related (grade 3+ CTCAE 5.0) late adverse events occur in less than 20% of patients. We planned to enroll 20 patients based on Wilson’s method for calculation of confidence intervals. (Figure Presented) Results We recruited 20 patients. All patients completed the treatment without interruptions. Eight of them had RIS whereas twenty were diagnosed with IFRS. Patients’ characteristics were provided in Table 1. Twelve patients from planned 15 underwent surgery. Two patients with potentially resectable tumors did not undergo surgery due to COVID-related reasons. One patient preferred not to undergo surgery after the preoperative no-boost regimen. The remaining five patients were deemed unresectable at the enrollment and received the simultaneous boost. In five patients who underwent resection, we observed extensive pathological response according to the European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group recommendations for pathological examination and reporting, namely grade A in two cases and grade C in three cases. In four patients we observed complete radiological response. The median follow-up was 13 months. In 14 patients we noted mild or moderate radiation dermatitis. One patient experienced grade 2 gastrointestinal toxicities. From the late toxicities, we observed restricted limb mobility (grade 1) in one patient and chronic skin ulceration (grade 2) in one patient. None of the patients who developed grade 3 or higher late toxicity. Two patients who received the no-boost regimen and did not undergo resection developed local progression. One patient experienced borderline local relapse after surgery. None of the patients who received the boost regimen developed local progression. Three patients developed distant metastases. One patient was lost to follow-up. (Figure Presented) Conclusion Preliminary data suggest that the tolerance of the regimen is acceptable;however, data regarding late toxicity may change during the follow-up period. Boost may play a significant role in achieving local control in non-resected tumors.

2.
Sleep Medicine ; 100:S104-S105, 2022.
Article in English | EMBASE | ID: covidwho-1967122

ABSTRACT

Introduction: The hypothalamus plays a crucial role in regulating vital functions and circadian rhythms. Both the tumor involving the hypothalamic area and its treatment can lead to hypothalamic dysfunction, resulting in disturbances in sleep-wake patterns, sleep fragmentation, and increased daytime sleepiness. We describe two patients with craniopharyngioma who came to our attention due to the occurrence of episodes characterized by psychomotor slowing and afinalistic limb movements, temporal and spatial disorientation, psychomotor agitation, and oneiric stupor like episodes diagnosed as severe sleep disturbances. Case reports: Patient 1 is a 19-year-old male diagnosed with surgically treated craniopharyngioma. Subsequently, episodes of psychomotor slowing, afinalistic movements of the upper limbs diagnosed as seizures in another neurological center appeared;antiepileptic treatment was started without improvement. At the first examination in our center, excessive daytime sleepiness (EDS), fragmented nighttime sleep, episodes characterized by bimanual automatic gestures occurring during drowsy state, hypnagogic hallucinations, and sudden loss of muscle tone while awake were recognized. Actigraphy demonstrated irregular bedtimes, frequent nocturnal activity, and inappropriate daytime rest episodes. The Epworth Sleepiness Scale (ESS) showed subjective EDS (ESS=19). At PSG, hypersomnolence, severe sleep-related breathing disorder (SRBD), and no interictal and ictal seizure abnormalities were found. A BiPAP NIV was started, and antiepileptic therapy was discontinued. In the following months, PSG revealed marked improvement in SRBD and 1 SOREMP, and the MSLT a mean SOL of 6 min and 10 sec and 3 SOREMPs. These data allowed the diagnosis of secondary narcolepsy, and treatment with pitolisant was initiated with clinical improvement and reduced daytime sleepiness (ESS=9). Patient 2 is a 12-year-old male, surgically treated for craniopharyngioma at the age of 4 years, who developed episodes of myoclonic jerks, temporal and spatial disorientation, and psychomotor agitation during the lockdown period for COVID-19 emergency. Surmising paroxysmal epileptic episodes, the patient was hospitalized. The anamnestic data collection revealed a sleep-wake rhythm dysregulation, fragmented nighttime sleep, EDS, oneiric stupor-like episodes during which the patient performed simple automatic gestures mimicking daily-life activity, and severe impairment of alertness. The Long-term video-EEG, including polygraphic measurements, showed destruction of the wake-NREM sleep-REM sleep boundaries, episodes of undetermined state of vigilance, and concurrence of elements typical of different sleep stages. Moreover, a severe SRBD (AHI 19/h) has been observed. The MRI showed a volumetric increase in the post-surgical interpeduncular fossa and right paramedian cysts. Therefore, a multifactorial therapeutic plan including sleep hygiene and slow-release melatonin was started with improvement in nighttime sleep, but EDS persisted. Surgical treatment of cyst fenestration improved sleep-wake rhythm and behavior;BiPAP NIV was initiated with very poor adherence. Discussion: We aim to focus on sleep disorders as a possible complication of tumors involving the hypothalamic region. Our cases highlight that the clinical manifestation of these dysfunctions can be challenging to diagnose and can lead to misdiagnosis and inappropriate treatment that can harm patients' health and the quality of life of patients and their families. Conclusion: These findings support the need to incorporate comprehensive sleep assessment in survivors from childhood brain tumors involving the suprasellar/hypothalamic region.

3.
Journal of the American College of Surgeons ; 233(5):e236-e237, 2021.
Article in English | EMBASE | ID: covidwho-1966795

ABSTRACT

INTRODUCTION: Ultrasound examination is an essential component in the preoperative evaluation of patients needing creation of an arteriovenous access. This test is not usually incorporate as part of the initial outpatient visit. Point of care ultrasound examination as part of the initial physician visit decrease cost, generate a surgical planning, as a one-time stop before scheduling. We the experience of incorporation POCUS examination of the upper extremities, in the initial consultation visit of patients needing creation of an arteriovenous access. METHODS: A retrospective review of a prospectively maintain database of dialysis access patients;from which data was collected from patients which have point of care ultrasound as planning imaging during their initial visit, and then underwent a surgical access creation. Data was extracted from periprocedural and clinical follow-up records. RESULTS: Nineteen patients underwent point of care ultrasound examination at vascular surgery visit and underwent creation of an arteriovenous access. The mean age of patients 50.5 years (24-70 years). Twelve patients were male (63%), and seven patients were female (37%). An arteriovenous fistula was successfully created on 18 patients (95%). Thirteen patients are using their access for hemodialysis (68%). CONCLUSION: This preliminary study demonstrates that performance of POCUS examination by operating surgeon in office, is a suitable technique which allows for a successful rate for arteriovenous access creation, allowing savings in healthcare costs of the patient, allowing the visit as a one-stop evaluation and surgical planning. This study was performed during the COVID-19 pandemic.

4.
J Cardiol ; 2022 Jul 28.
Article in English | MEDLINE | ID: covidwho-1966860

ABSTRACT

BACKGROUND: The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2, has overwhelmed healthcare systems. Patients with lower extremity artery disease are at high risk of cardiovascular events, of whom chronic limb-threatening ischemia (CLTI) is the most severe manifestation of peripheral artery disease with an increased risk of mortality compared to patients with intermittent claudication. However, the clinical course of CLTI patients with COVID-19 has not been reported. METHODS: We retrospectively surveyed clinical course for 25 CLTI patients who developed COVID-19 during the "sixth wave" of the pandemic in Japan, which started in January 2022. The primary outcome measure was the 30-day mortality after the diagnosis of COVID-19. We also compared the mortality risk of the 18 COVID-19 patients who underwent initial endovascular treatment with that of 1867 CLTI patients who received initial endovascular treatment before December 2019 (i.e. before the COVID-19 pandemic) (control group). Cox proportional hazard regression model was used to evaluate the effect of COVID-19 on the mortality. To confirm the robustness of these results, we added the analysis with inverse probability weighting (IPW) based on the propensity score for the COVID-19. RESULTS: The 30-day mortality after the diagnosis of COVID-19 reached 20 %; the 95 % confidence interval (CI) of the proportion was calculated to be 7 % to 41 % by the Clopper-Pearson exact method. Cox regression analysis demonstrated the mortality risk was significantly higher in patients developing COVID-19 than in control group [adjusted hazard ratio, 3.08 (95 % CI, 1.13-8.37); p = 0.027]. The IPW analysis also confirmed the significant association of COVID-19 with the mortality risk [hazard ratio, 3.97 (95 % CI 1.54-10.21, p = 0.004)]. CONCLUSION: In CLTI patients, the 30-day mortality after the diagnosis of COVID-19 reached 20 % (95 % CI, 7 % to 41 %) under the pandemic in January 2022, and patients developing COVID-19 had a significantly higher mortality risk than those treated before the pandemic.

5.
Hum Mov Sci ; 85: 102977, 2022 Aug 03.
Article in English | MEDLINE | ID: covidwho-1966610

ABSTRACT

BACKGROUND: Impairments of upper limb (UL) sensory-motor functions are common in Parkinson's disease (PD). Virtual reality exercises may improve sensory-motor functions in a safe environment and can be used in tele-rehabilitation. This study aimed to investigate the effects of supervised and non-supervised UL virtual reality exercises (ULVRE) on UL sensory-motor functions in patients with idiopathic PD. METHODS: In this clinical trial study, 45 patients with idiopathic PD (29 male) by mean ± SD age of 58.64 ± 8.69 years were randomly allocated to either the control group (conventional rehabilitation exercises), supervised ULVRE or non-supervised ULVRE. Interventions were 24 sessions, 3 sessions/week. Before/after of interventions and follow-up period all assessment was done. Hand Active Sensation Test and Wrist Position Sense Test were used for assessing UL sensory function. Gross and fine manual dexterity were assessed by Box-Block Test and Nine-Hole Peg Test, respectively. Grip and pinch strength were evaluated by a dynamometer and pinch gauge, respectively. RESULTS: The results showed significant improvement in discriminative sensory function (HAST-weight and HAST-total), wrist proprioception, gross manual dexterity and grip strength of both less and more affected hands as well as fine manual dexterity of the more affected hand in the three groups in patients with idiopathic PD (P < 0.05). CONCLUSION: The results of this study indicated that both supervised and non-supervised ULVRE using the Kinect device might potentially improve some aspects of UL sensory-motor functions in patients with PD. Therefore, ULVRE using the Kinect device can be used in tele-rehabilitation, especially in the current limitations induced by the COVID-19 pandemic, for improving UL functions in patients with PD.

6.
2nd International Conference on Electronics, Biomedical Engineering, and Health Informatics, ICEBEHI 2021 ; 898:479-490, 2022.
Article in English | Scopus | ID: covidwho-1958939

ABSTRACT

The physical therapy generally requires direct assistance from therapists continuously, however, the time is very limited. Moreover, the social distancing policy in the COVID-19 pandemic period made the patient could not come to rehabilitation center for physical therapy. Remote physical therapy is suggested to reduce dependency of therapist for conducting the physical therapy. However, there is few information about the necessary parameters in lower limb monitoring of post-stroke patient. Therefore, in this paper, a review for designing a low-cost online homecare physical therapy monitoring system is proposed. Article finding had been done using online search engine Google Scholars to conclude the design of the online monitoring system. Several keywords had been used, such as “online stroke rehabilitation monitoring,” “stroke rehabilitation parameters,” “stroke monitoring Internet of Things,” and “lower limb stroke monitoring.” The results show that the necessary monitor parameters are lower limb kinematics and dynamics, which can be complimented by bio-signal data, such as EMG. The lower limb monitoring system can use IMU, muscle sensor, and footswitches to measure the necessary parameters. IMU measures the lower limb kinematics because it provides wide range of measurement. Muscle sensor, which compatible to microcontroller, measures the EMG. Lastly, the footswitches detect the gait phases, which classify the measured data for more in-depth analysis. The mentioned sensors are cheap and available in the online market of Indonesia, which is suitable to realize a low-cost lower limb monitoring system. The research finding also suggests quick and accurate feedback mechanism for improving the training quality, which the feedback is combination of therapist opinion and artificial intelligence prediction. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

7.
British Journal of Dermatology ; 186(6):e246, 2022.
Article in English | EMBASE | ID: covidwho-1956707

ABSTRACT

With the outbreak of the emergent coronavirus, there have been sparse reports of severe cutaneous adverse reactions in some severely ill patients (Chen XY, Yan BX, Man XY. TNFα inhibitor may be effective for severe COVID-19: learning from toxic epidermal necrolysis. Ther Adv Respir Dis 2020;14: 1753466620926800). It is thought that this is due to clonal expansion of CD8+ cytotoxic T lymphocytes and natural killer cells that occurs during the cytokine storm elicited by the virus or the use of unconventional drugs to treat patients (Rossi CM, Beretta FN, Traverso G et al. A case report of toxic epidermal necrolysis (TEN) in a patient with COVID-19 treated with hydroxychloroquine: are these two partners in crime? Clin Mol Allergy 2020;18: 19;Saha M, D'Cruz A, Paul N et al. Toxic epidermal necrolysis and co-existent SARS-CoV-2 (COVID-19) treated with intravenous immunoglobulin:'Killing 2 birds with one stone'. J Eur Acad Dermatol Venereol 2020;35: e97-8). In a minority of cases, viral or autoimmune forms of toxic epidermal necrolysis (TEN) may be implicated (Chen et al.;Rossi et al.). However, very little research, has been done to decipher the association or pathogenesis with TEN and the novel virus. We report an interesting case of a 51-year-old woman who developed a rash on her face, flanks and periumbilical area immediately after an intensive care admission with respiratory failure secondary to confirmed COVID-19 pneumonitis. The patient had a background of gout on allopurinol and type 2 diabetes. There were no changes in medications. While admitted, she was started on broad spectrum antibiotics. On examination, there were large, confluent patches of erythema with a targetoid appearance on the face, upper limbs and trunk, and tense blistering over the forearms. Biopsy showed full thickness epidermal necrosis and subepidermal bullous formation. An autoimmune and bullous screen was negative. Prognosis was poor with the critical care team considering end-of-life management. However, with the diagnosis of a reversible condition, supportive therapy was continued. With continued intensive care intervention, steroids and barrier protection, her TEN gradually resolved as she recovered from COVID-19, and she had a favourable outcome with only residual milia and signs of re-epithelialization.

8.
British Journal of Dermatology ; 186(6):e248, 2022.
Article in English | EMBASE | ID: covidwho-1956704

ABSTRACT

A 58-year-old man known to dermatology services, established on guselkumab for psoriasis and methotrexate for psoriatic arthritis, attended with an acute onset purpuric rash distributed over both his lower limbs, one day after his third dose of SARS-CoV-2 Pfizer-BioNTech vaccine (booster). He had received his initial vaccinations 6 months prior with no reported reactions. He denied any previous SARS-CoV-2 infection or recent symptoms suggestive of COVID-19. There had been no new recent medications and no systemic symptoms were reported. Examination revealed a nonblanching, palpable, purpuric rash distributed over both lower limbs, clinically in keeping with cutaneous vasculitis. Baseline observations were satisfactory including blood pressure and temperature. Bedside investigations included a urinalysis which revealed no proteinuria or haematuria. Punch biopsies were taken and were consistent with a leucocytoclastic vasculitis (LCV). He was managed symptomatically with potent topical steroids with good clinical response. LCV is classified as a cutaneous, small vessel vasculitis, exclusively characterized by deposition of immune complexes in the dermal capillaries and venules (Baigrie D, Bansal P, Goyal A, Crane JS. Leukocytoclastic vasculitis. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing, 2021). LCV following both first and second SARS-CoV-2 vaccinations has been documented in recent literature with a few reports following a third booster dose, and in particular within an immunocompromised population. This particular case has raised questions regarding delayed immune response following SARS-CoV-2 vaccine in this subgroup. The pathophysiology of SARS-CoV-2 vaccine-induced LCV has not been extensively researched;however, it is felt to be caused by offtarget immune activation after the vaccination (Dicks AB, Gray BH. Images in vascular medicine: leukocytoclastic vasculitis after COVID-19 vaccine booster. Vasc Med 2022;27: 100-1).

9.
British Journal of Dermatology ; 186(6):e253, 2022.
Article in English | EMBASE | ID: covidwho-1956703

ABSTRACT

We present the case of a severe cutaneous reaction following COVID-19 vaccination. A 60-year-old white woman presented to our service with an extensive painful, pruritic rash affecting her bilateral lower limbs. This was on a background of psoriasis, psoriatic arthritis and notably inoculation against COVID-19 with the Johnson & Johnson vaccine hours prior to onset. There was no history of new medications, illicit drug use or infections. On examination, extensive palpable purpura was noted circumferentially at both lower limbs from the knee distally. Tense bullae were described at her bilateral ankles. She was apyrexial. Her cardiopulmonary and gastrointestinal examinations were normal. A punch biopsy taken from her right lower limb demonstrated findings consistent with leucocytoclastic vasculitis (LCV). Direct immunofluorescence demonstrated IgA deposits within the vasculature. IgA LCV secondary to COVID-19 vaccination was proposed on the basis of histological and clinical findings. Treatment consisted of oral steroids, oral antibiotics for secondary infection and wound dressings. Opioid analgesia and nitrous oxide were implemented for severe pain associated with dressing changes. As her urinary protein creatinine ratio was in excess of 100 mg dL-1 and microscopic haematuria was noted on urine microscopy, she was referred to nephrology. We note case reports of patients diagnosed with LCV up to 2 weeks following COVID-19 vaccination (Cavalli G, Colafrancesco, De Luca G et al. Cutaneous vasculitis following COVID- 19 vaccination. Lancet Rheumatol 2021;3: E743-4). In this case, onset of symptoms occurred within hours. While this presentation may have been coincidental, the relationship between immune complex vasculitis, COVID-19 infection (Iraji F, Galehdari H, Siadat AH, Bokaei Jazi S. Cutaneous leukocytoclastic vasculitis secondary to COVID-19 infection: a case report. Clin Case Rep 2020;9: 830-4) and vaccination (Cavalli et al.) has been reported in the literature and represents the most likely diagnosis.

10.
British Journal of Dermatology ; 186(6):e250-e251, 2022.
Article in English | EMBASE | ID: covidwho-1956700

ABSTRACT

Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) is a novel condition which has recently emerged during the COVID-19 pandemic, consisting of persistent fever, inflammation, and evidence of single- or multiorgan dysfunction, with additional features where any other microbial causes has been excluded (https://www.rcpch.ac.uk/resources/paediatric-multisysteminflammatory- syndrome-temporally-associated-covid-19-pimsguidance). A 16-year-old healthy male presented with a 48-h history of headache, fever, diarrhoea, vomiting and a widespread rash. One month prior he had contracted SARS-CoV-2 with no complications. On examination there was a maculopapular rash across the trunk and buttocks with petechiae present on the lower limbs and flexural folds in addition to an erythematous rash across the nasal dorsum and cheeks. Blood tests revealed lymphopaenia, thrombocytopenia, hypertriglyceridaemia and raised C-reactive protein and ferritin. Autoimmune screen and SARS-CoV-2 polymerase chain reaction tests were negative. A skin biopsy revealed features of a SARS-CoV-2 related urticarial reaction pattern. The patient was treated for myocarditis, fulfilling the diagnosis of PIMS-TS. He was transferred to a specialist intensive care unit and treated with intravenous immunoglobulins and steroids, infliximab, aspirin and topical steroids. He is currently undergoing investigations for encephalitis post admission. PIMS-TS is a rare syndrome that shares features with Kawasaki disease, toxic shock syndrome, macrophage activation syndrome and bacterial sepsis. Haemophagocytic lymphohistiocytosis has also been linked to SARS-CoV-2 (Retamozo S, Brito-Zerón P, Sisó- Almirall A et al. Haemophagocytic syndrome and COVID-19. Clin Rheumatol 2021;40: 1233-44). Clinicians should consider PIMS-TS as a differential in any child presenting with a fever, rash and evidence of systemic inflammation. Early recognition, involvement of a multidisciplinary team and prompt referral to critical care is essential in managing this life-threatening condition.

11.
British Journal of Dermatology ; 186(6):e249, 2022.
Article in English | EMBASE | ID: covidwho-1956691

ABSTRACT

Bullous pemphigoid (BP) triggered by vaccination is a rare but recognized phenomenon. We report two cases of BP triggered by covid-19 vaccinations. A 64-year-old woman was referred with a recurrent blistering rash, erupting within 7 days of both her first and second doses of the Pfizer COVID-19 vaccine. She presented with widespread annular erosions and some targetoid lesions on an urticated background across her torso and limbs. Full blood count reported significant eosinophilia. Skin biopsies were consistent with BP, demonstrating linear deposition of IgG and C3 at the dermoepidermal junction. Treatment with prednisolone 60 mg once daily and topical clobetasol propionate was commenced. Her condition progressed leading to the addition of mycophenolate mofetil 500 mg twice daily, later increased to 1 g twice daily. This was effective;autoimmune bullous skin disorder intensity scores improved from 44 to 16.5 within 1 month. An 82-year-old man presented with a 5-month history of a widespread blistering rash, with onset 2 weeks following his second dose of the AstraZeneca COVID-19 vaccine. Skin histopathology confirmed BP. He was treated with topical clobetasol propionate, a 30-day course of doxycycline and prednisolone 40 mg once daily, which is being reduced in correlation with clinical response. There have been 13 reported cases of BP triggered by COVID-19 vaccinations;these two cases highlight more are likely to occur. We need to be prepared to manage these patients with long-term immunosuppressive therapies and support them in making a shared decision to complete their vaccination programme, including booster doses during the ongoing pandemic.

12.
British Journal of Dermatology ; 186(6):e252, 2022.
Article in English | EMBASE | ID: covidwho-1956690

ABSTRACT

A 44-year-old man of Pakistani origin presented to emergency 6 days following his first dose of the AstraZeneca (AZ) SARSCoV- 2 vaccine. He developed flu-like symptoms followed by erythematous pruritic rash. Physical examination showed a maculopapular rash associated with purpura and targetoid lesions affecting his distal extremities, trunk and mucous membranes. He also had crusting and ulceration of his oral and genital mucosal areas. He had no other significant past medical history. A biopsy was taken from his right arm and sent for urgent histology and direct immunofluorescence. Histology revealed parakeratotic scale with interface dermatitis comprising basal layer vacuolation and lymphocyte exocytosis. The epidermis showed prominent dyskeratotic keratinocytes scattered throughout the epidermis. The papillary dermis showed a mild perivascular lymphocytic infiltrate including eosinophils and melanophages. Other investigations showed leucocytosis (12 × 109 L-1), high eosinophils (0.9 × 109 L-1), raised liver enzymes with alkaline phosphatase 159 U L-1 and alanine aminotransferase 172 U L-1. A full infection screen, including herpes simplex virus, SARS-CoV-2 and atypical viral infection, was negative. Immunology was also reported as negative. Based on the findings, a diagnosis of erythema multiforme (EM) secondary to AZ vaccine was made. He was treated with topical steroids and emollients, leading to resolution of his skin and mucosal areas in 4-6 weeks. Recently, there have been a few reported cases of EM in patients with COVID-19 (Jimenez-Cauhe J, Ortega-Quijano D, Carretero- Barrio I et al. Erythema multiforme-like eruption in patients with COVID-19 infection: clinical and histological findings. Clin Exp Dermatol 2020;45: 892-5) and two patients who have had the Pfizer-BioNTech vaccine [Kim M, Kim J, Kim M et al. Generalized erythema multiforme-like skin rash following the first dose of COVID-19 vaccine (Pfizer-BioNTech). J Eur Acad Dermatol Venereol 2021], but the information is limited. Our case emphasizes the need for further studies into the cutaneous adverse effects related to COVID-19vaccines.

13.
American Journal of Cardiovascular Disease ; 12(3):149-152, 2022.
Article in English | EMBASE | ID: covidwho-1955690

ABSTRACT

The COVID-19, actual pandemic due to SARS COV 2 is associated with numerous thromboembolic compli-cations. Although venous thrombosis including pulmonary embolisms have been widely described, arterial localiza-tion seems rarely reported. Acute limb ischemia and myocardial infarction are two major consequences of arterial thrombosis and their concomitant occurrence among COVID-19 patients is extremely rare. It is an evident aspect of hypercoagulability and a real challenge to physicians. We herein describe the management of a 77 years old COVID-19 patient presenting an acute lower limb ischemia with concomitant myocardial infarction. He underwent coronary angiography with subsequent stent placement then was transferred to the operating room where a throm-bectomy was performed. The outcome was poor as the cardiogenic shock persisted in addition to a reperfusion syndrome with multiorgan failure.

14.
Thromb Res ; 217: 73-75, 2022 Jul 26.
Article in English | MEDLINE | ID: covidwho-1956355
15.
BMC Health Serv Res ; 22(1): 593, 2022 May 03.
Article in English | MEDLINE | ID: covidwho-1951206

ABSTRACT

BACKGROUND: People living with chronic conditions and physical disabilities face many challenges accessing healthcare services. In Lebanon, in 2020, the COVID-19 pandemic and concomitant economic crisis further exacerbated the living conditions of this segment of the population. This study explored the barriers to accessing healthcare services among people living with diabetes and lower-limb amputation during the pandemic. METHODS: We conducted semi-structured, in-depth phone interviews with users of the Physical Rehabilitation Program, offered by the International Committee of the Red Cross. We used a purposive sampling technique to achieve maximum variation. Interviews were audio-recorded, transcribed, translated, and analyzed using thematic analysis following the "codebook" approach. Transcripts were coded and grouped in a matrix that allowed the development of themes and sub-themes inductively and deductively generated. RESULTS: Eight participants (7 males, 1 female) agreed to be interviewed and participated in the study between March and April, 2021. Barriers to healthcare services access were grouped according to five emerging themes: (1) economic barriers, included increasing costs of food, health services and medications, transportation, shortage of medications, and limited income; (2) structural barriers: availability of transportation, physical environment, and service quality and availability; (3) cultural barriers: marginalization due to their physical disabilities; favoritism in service provision; (4) personal barriers: lack of psychosocial support and limited knowledge about services; (5) COVID-19 barriers: fear of getting sick when visiting healthcare facilities, and heightened social isolation due to lockdowns and physical distancing. CONCLUSION: The underlying economic crisis has worsened the conditions of people living with diabetes and lower-limb amputation. The pandemic has made these individuals more vulnerable to external and contextual factors that cannot be addressed only at an individual level. In the absence of a protective legal framework to mitigate inequalities, we provide recommendations for governments and nongovernmental institutions to develop solutions for more equitable access to healthcare for this segment of the population.


Subject(s)
COVID-19 , Diabetes Mellitus , Amputation , COVID-19/epidemiology , Communicable Disease Control , Female , Health Services , Health Services Accessibility , Humans , Lebanon/epidemiology , Male , Pandemics
16.
Journal of Vascular Surgery ; 75(6):e208-e209, 2022.
Article in English | EMBASE | ID: covidwho-1936910

ABSTRACT

Objective: Endovascular popliteal artery aneurysm (PPA) repair has acceptable outcomes compared with open repair for elective therapy. However, endovascular repair for urgent PAA causing acute limb ischemia (ALI) has not been well studied. This project compares the outcomes of urgent endovascular and open repair of PAA presenting with ALI. Methods: The Vascular Quality Initiative database for peripheral vascular interventions and infrainguinal bypass was reviewed for popliteal artery aneurysms presenting with ALI. The characteristics and outcomes of patients undergoing urgent open and endovascular repair were compared. Results: Urgent PAA repair for ALI constituted 10.5% (N = 571) of all PAA repairs with no change in proportion during the study period. The majority (80.6%, n = 460) of urgent repairs were open. However, the proportion of endovascular repair significantly increased from 16.7% in 2010 to 85.7% in 2021 with a sharp increase after 2019 (Fig). Patients undergoing endovascular repair were more likely to be African American (3.6% vs 3.3%, P =.044) and older (71.2 ± 12.5 vs 68.0 ± 11.8) than patients undergoing open repair. They were also more likely to have coronary artery disease (32.4% vs 21.7%, P =.006) but less likely to have chronic kidney disease (66.1% vs 69.6%, P =.027) compared with patients undergoing open repair (Table). Open PAA repair was more likely to be associated with bleeding (20.8% vs 2.7%, P <.001), longer postoperative length of stay (8.1 ± 9.3 days vs 4.9 ± 5.6 days, P <.001), and less likelihood of discharge home (64.9% vs 70.3%, P =.051). The perioperative major amputation rate was 7.5% with no difference in major amputations between the two treatment strategies even at 1 year. However, patients receiving endovascular repair had significantly higher inpatient (1.1% vs 0%, P <.001), 30-day (6.3% vs 0.4%, P <.001), and 1-year (16.5% vs 8.4%, P =.02) mortality compared with open repair (Table). Multivariable regression analysis suggested that endovascular repair was independently associated with increased 30-day mortality, but not 1-year mortality compared with open repair. Conclusions: The utilization of endovascular PAA has exponentially increased during the coronavirus pandemic. Even though endovascular repair is associated with decreased complications and resource utilization, it should be offered selectively in the urgent setting for ALI because of concern with perioperative mortality. [Formula presented] [Formula presented]

17.
Indian Pediatrics ; 59(5):427-428, 2022.
Article in English | EMBASE | ID: covidwho-1935887
18.
J Vasc Surg Cases Innov Tech ; 8(3): 345-348, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1936917

ABSTRACT

A persistent sciatic artery (PSA) is a rare embryologic variant that usually presents with aneurysmal degeneration. This report describes a 66-year-old man with severe comorbidities who presented with right forefoot gangrene and severe acute respiratory syndrome coronavirus 2 infection. Imaging revealed a unilateral PSA with a chronic occlusion at the level of the knee joint with no aneurysm. After coronavirus disease 2019 resolution, he underwent CO2 angiography with successful recanalization of the PSA, followed by transmetatarsal amputation that healed uneventfully. At follow-up after 16 months, he was noted to have asymptomatic thrombosis of his stent and, hence, no intervention was performed.

19.
J Gynecol Obstet Hum Reprod ; 51(8): 102443, 2022 Jul 21.
Article in English | MEDLINE | ID: covidwho-1936852

ABSTRACT

We report a case of right upper limb ischaemia diagnosed at birth in a neonate whose mother had presented with paucisymptomatic COVID-19 four weeks previously. Typical causes were investigated and excluded. Maternal morbidity and mortality resulting from COVID-19 during pregnancy is well recognised and documented, however, foetal and neonatal complications are increasingly being reported. Our case sheds further light on the diverse nature of such complications, and in particular this type of possible association related to their delayed onset.

20.
Clinical and Experimental Surgery ; 10(2):19-25, 2022.
Article in Russian | EMBASE | ID: covidwho-1939718

ABSTRACT

The course of the reparative process in surgical pathology directly depends on hemomicrocirculation, nutrition and oxygen supply in tissues, as well as the activity of lipid peroxidation processes. A novel coronavirus infection can slow down the reparative process and potentiate the development of wound complications. Aim - to study the features of the tissue healing process in patients with deep vein thrombosis of the lower extremities against the background of a new coronavirus infection. Material and methods. 130 patients were monitored: group 1 - 48 patients with acute thrombosis of the veins of the lower extremities, group 2 - 82 patients with acute deep vein thrombosis of the lower extremities, combined with coronavirus infection. Patients underwent thrombectomy followed by plication. On the 2nd, 4th and 7th days, a comprehensive study of the state of the tissues of the area of surgical intervention was carried out to determine the nature and rate of healing, the development of wound complications. Results. In a quantitative analysis of the developed complications on the side of the wound after surgery, it turned out that their number in patients with coronavirus infection was more than 7 times higher (p<0.001). A feature of the wound process as a whole was prolonged lymphorrhea. Cytological signs of impaired tissue healing in the wound area were established. So, in group 2 two days after the operation the number of neutrophilic leukocytes in the wound exudate was 48.2% more than in the group 1, by day 7th - 69.5% more. Weak dynamics of the regenerative-degenerative index was noted. The number of tissue polyblasts in patients of group 2, was 4.2-100.2% lower than those of group 1 at all stages of observation, and lymphoid polyblasts - 47.0-159.1% higher. Patients with coronavirus infection have more significant microcirculatory disorders. According to thromboelastography data, in patients of group 2, an imbalance in the blood coagulation system was registered with a predominance of thrombosis. Conclusion. In patients with acute deep vein thrombosis of the lower limb against the background of coronavirus infection, the wound healing process, which underlies the development of wound complications, slows down. One of the factors that reduce the rate of tissue healing are microcirculation disorders against the background of pronounced disorders in the hemostasis system. The most significant changes in the microenvironment of regenerating structures occur in the first 2-4 days after surgery.

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