Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 134
Filter
1.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816884

ABSTRACT

The COVID-19 pandemic brought with it TX changes for many patients (pts) with AMEL, as it did for other pts with cancer. The long-term impacts of mandated area lockdowns, social distancing, medical society guidelines, and patient preference will not be fully understood for some time. The first step to learning from the pandemic is to assess how AMEL care was rendered in 2020. We performed a retrospective analysis of systemic TX for AMEL in KPNC, an integrated community healthcare system with approximately 4 million pts and about 150 de novo diagnoses of AMEL annually. We performed a chart review of pts with AMEL who were treated with standard of care systemic therapy, either immune-checkpoint inhibitors (ICI) or BRAF/MEK inhibitors (BRAF/MEKi), from January 1 to March 15, 2020, as a control group, and between March 15 and May 20, during the first wave of the COVID-19 pandemic in California with follow-up through November 4, 2020. Between January 1 and March 15, 26 pts started palliative ICI of whom 11 started combination PD1 (PD1i) and CTLA4 inhibitors. Among 15 pts who started on single-agent PD1i, 14 pts received short-interval TX (SIT), while 1 started long-interval TX (LIT). All 21 pts who started perioperative PD1i pre-pandemic, started on SIT. Between March 15 and May 20, 21 pts started palliative ICI, of whom only 3 started combination TX. Among pts who started palliative single-agent PD1i 40% started on LIT in this initial phase of the pandemic. 27 pts started perioperative ICI during this time. We found 3 started with neoadjuvant therapy and 78% started on LIT. Among 78 pts who were already on palliative single-agent ICI at the start of the COVID-19 pandemic, 15% remained on SIT and 24% changed to LIT. Sixteen pts (21%) also interrupted palliative ICI between March 15 and April 15 after a median time on TX of 45 weeks and for 63% the cited reason for interruption on chart review was the COVID 19 pandemic. Three of these pts who stopped ICI changed to BRAF/MEKi, the remainder continue in active follow-up as of November 2020. Among 72 pts already receiving perioperative ICI in March 2020, 19% remained on SIT, 35% changed to LIT, and 11% were already on LIT. 39% of pts interrupted perioperative ICI after a median time of 20 weeks on TX and 46% of these cited COVID 19 as the reason for interruption. Three pts have since resumed peri-operative TX, but the others remain in active follow-up off therapy. Between 3/15 and 5/30/2020, we noted a 325% increase in pts started on BRAF/MEKi;69% of pts received therapy for palliative intent. The start of the COVID-19 pandemic saw many different changes in AMEL TX in KPNC, with increased use of single-agent ICI, LIT, and oral therapy, in line with public health guidance, oncology societal guidelines and patient preference. It will be important to assess the long-term outcomes relating to these changes, including the impact of early discontinuation of ICI, to help guide future Melanoma care during and after the pandemic.

2.
Clinical Neurosurgery ; 67(SUPPL 1):194-195, 2020.
Article in English | EMBASE | ID: covidwho-1816194

ABSTRACT

INTRODUCTION: There are increasing reports of a pediatric multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) that presents with varying clinical features, but includes features of Kawasaki disease or toxic shock syndrome. Symptoms include fever, rash, abdominal pain, vomiting, and diarrhea. Many patients present without any respiratory symptoms and testing for SARS-CoV-2 is often negative. METHODS: A retrospective chart review was performed. RESULTS: A 7-year-old previously healthy male presented with 3 days of fevers up to 102.4F, headaches, abdominal pain, and intractable vomiting. Both parents had tested positive for SARS-CoV-2 four weeks prior. Nasopharyngeal swab tested positive for SARS-CoV-2 RNA. Echocardiogram was normal. CT venogram of his head was negative for any pathology. He developed severe neck pain and persistent headache during his hospitalization. Soon after receiving hydroxychloroquine, he developed a facial rash and altered mental status with episodes of aphasia, agitation, and pinpoint pupils. He then became unresponsive with left gaze deviation. A non-contrast head CT and CT angiography were negative. He was given levetiracetam and cefazolin and transferred to the pediatric intensive care unit. An electroencephalogram (EEG) showed no epileptiform activity. Over the following 7 hours, the EEG demonstrated left frontotemporal slowing, which progressed into a loss of fast activity over the right hemisphere with increased delta activity in the left hemisphere, then abruptly changed to generalized voltage attenuation.He rapidly lost brainstem reflexes, developing fixed and dilated pupils. Repeat CT scan revealed diffuse cerebral edema with loss of gray-white differentiation. Lab results then were consistent with severe inflammation. An intracranial pressure monitor revealed pressures greater than 76 mmHg. His exam soon became consistent with brain death. Pathologic evaluation showed diffuse cerebral edema with perivascular mononuclear infiltrates. CONCLUSION: The cause of this pediatric multi-system inflammatory syndrome is unclear and the mechanism by which SARS-CoV-2 affects the nervous system is unknown. Pediatric patients with COVID-19 and neurologic symptoms should be closely monitored as they can rapidly decline due to fulminant cerebral edema.

3.
Journal of Parenteral and Enteral Nutrition ; 46(SUPPL 1):S145, 2022.
Article in English | EMBASE | ID: covidwho-1813570

ABSTRACT

Background: Screening tools to assess both the risk of malnutrition (such as the Malnutrition Screening Tool, MST) and wound development (Braden scale) are frequently utilized in the hospital setting. Hospital-acquired pressure injuries (HAPIs) result in considerable patient harm, including expensive treatments, increased length of stays, and increased mortality. Malnutrition is a significant risk factor in the development and progression of HAPIs. Therefore, identifying malnutrition risk and prevalence is an important step in preventing HAPIs. However, processes which involve multiple screening steps consume resources such as staff and time which have become scarce during the COVID-19 pandemic. While the Braden scale contains a nutrition component as a sub-score, little is known about the validity of this sub-scale to capture malnutrition risk. We aimed to explore the association between a validated malnutrition screening tool (MST) and the Braden nutrition scale to determine their use in generating nutrition consults. Methods: We conducted a retrospective chart review of adult patients who developed a HAPI during hospital admission. Baseline MST scores (0-6) and Braden nutrition sub-scale score (1-4) were collected. Higher MST scores represent increased risk of malnutrition, while lower Braden nutrition sub-scores represent poor nutrition status. Documentation of a malnutrition diagnosis using the ASPEN guidelines (yes/no) was also collected for each patient. Pearson correlation coefficients and linear regression were used to assess the association between the MST and Braden nutrition sub-score in the entire cohort. A sub-analysis was conducted in the patients with a diagnosis of malnutrition. Logistic regression was performed to evaluate the association between the Braden nutrition sub-scores and a malnutrition diagnosis. Results: The cohort included 133 patients with a mean age of 69.3 years, with 69.9% being male. 77 patients had malnutrition status recorded, with 64.9% diagnosed with malnutrition. There was a significant correlation between Braden nutrition sub-score and MST (R = -0.28;p < 0.001) in the overall cohort and in subjects with malnutrition (R = -0.35;p = 0.01). Linear regression confirmed that low Braden scale nutrition subscores (poor nutrition status) were predicted by high MST scores (risk for malnutrition) (p = < 0.001). Logistic regression modeling showed a higher Braden nutrition sub-score (better nutrition status) was associated with a diagnosis of malnutrition (OR: 0.45;p=0.057). Conclusion: The results of this study demonstrate that the MST and the Braden nutrition sub-scores are correlated in a cohort of hospitalized patients who developed a HAPI. Use of both screening tools may not be necessary for identifying those that warrant further assessment and interventions for malnutrition.

4.
Journal of Parenteral and Enteral Nutrition ; 46(SUPPL 1):S127-S128, 2022.
Article in English | EMBASE | ID: covidwho-1813569

ABSTRACT

Background: The consequences of the COVID-19 pandemic in long-term care facilities could be severe for frail and immunocompromised older adults.1 These older adult patients are hypermetabolic due to pressure ulcers, infection, fever, and elevated inflammatory labs such as CRP.1 They experience decreased appetite due to taste and smell changes. The inadequate intake, fat, and muscle loss due to prolonged hospitalization and increased nutrition demands create a negative nutrient balance, leading to unintentional weight loss (UWL).1 According to the Center for Medicare and Medicaid Services (CMS), UWL is defined as a weight loss of 5% in 30 days, 7.5% in 90 days, and 10% in 180 days.2 In this proposal, our focus was unintentional weight loss (UWL) in long-term skilled care patients and how collaborative nursing and dietitian intervention impacts the UWL in this specific population. Methods: The data were collected retrospectively for all patients admitted between May 2020 to March 2021. The patient's demographic data was collected from the chart review using the point click care program. The top five patient diagnoses were retrieved using MDS coding for the study period. Additionally, the most common chronic disease in the geriatric population was used. The red napkin program was initiated in Oct 2020. The red napkin program was initiated to alert the nursing staff for patients with UWL and who also have pressure ulcers. Results: The results indicated that the average census was 152 patients during the study period. The majority of the patients (84%) were long-term care, with more females than males (59 vs 40%). Most of the patients were African American and Caucasian ethnic group. Nearly 40-45% of patients had diabetes, hypertension;one-fourth of the patients had CHF, dialysis, and dementia. During this period, there was a total of 77 patients who had unintentional weight loss as defined by CMS criteria. There were 60 patients before the intervention, and the numbers declined significantly to 33 patients post-intervention. Out of these 33 post-intervention patients, only 17 patients were new, and 16 were from the previous months of the preintervention period. The number has also declined from 12 to 7 expected weight loss related to hospice and comfort care patients. Most patients received oral nutrition supplements to halt weight loss. Four patients received alternate routes of nutrition support (TPN/EN) in addition to an oral diet. Almost 40% of patients had COVID-19 infection, and 38% of patients had pressure ulcers, which may have affected unintentional weight loss. Conclusion: The results indicated that appropriate and timely collaborative dietitian and nursing efforts improve patient outcomes or quality of care to halt unintentional weight loss in long-term skilled care facilities.

5.
Journal of Parenteral and Enteral Nutrition ; 46(SUPPL 1):S78-S79, 2022.
Article in English | EMBASE | ID: covidwho-1813563

ABSTRACT

Background: Critically ill COVID-19 patients are suspected to have high caloric needs.1 Indirect calorimetry (IC) is the gold standard used to measure resting energy expenditure (mREE), but it is expensive and not widely available. Predictive equations are often used to assess metabolic requirements and the Pennsylvania State University (PSU) equation has demonstrated comparable results to IC in identifying caloric requirements for critically ill patients. This article describes a simple, comparative retrospective presentation of PSU calculations to that of the study published in 2020 by Whittle et al. on Longitudinal Energy Expenditure in Critically Ill Patients with COVID-19 (LEEP-COVID).1 PSU measurements were compared to the IC data by the LEEP-COVID study to ascertain similarities in calories per kilogram (kcal/kg) of body weight for ventilator-dependent COVID-19 patients over a duration of 30 days. Methods: A retrospective chart review was performed on critically ill COVID-19 patients between March and June of 2020 to collect their PSU calculations. Patients on extracorporeal membrane oxygenation (ECMO) and volumetric diffusive respirator (VDR), were excluded as these devices could skew the minute ventilation and yield an inaccurate PSU calculation. Patients for whom the PSU data was not clearly labeled were also removed, leaving 38 adult ventilator-dependent COVID-19 patients for review. PSU data was then compared to the LEEP-COVID 2020 study by Whittle et al. Results: Out of the 38 ventilator-dependent COVID-19 patients, the median age was 65 years old, 65.8% were male and 48% had a BMI >30. As illustrated in figure 1, kcal/kg of actual body weight (ABW) for the non-obese group (BMI < 30) from days 0 - 3: 21.9 kcal/kg, days 4 - 6: 23.5 kcal/kg, days 7 - 9: 23.4 kcal/kg, days 10 - 12: 24 kcal/kg, days 13 - 15: 23.1 kcal/kg, days 16 - 18: 22.4 kcal/kg, days 19 - 21: 21.3 kcal/kg, days 22 - 24: 24.6 kcal/kg, days 25 - 27: 19.5 kcal/kg and days 28 - 30: 22.9 kcal/kg. Figure 1 also shows the kcal/kg of ABW for the obese group (BMI 30 - 40) from days 0 - 3: 19 kcal/kg, days 4 - 6: 18.1 kcal/kg, days 7 - 9: 18.2 kcal/kg, days 10 - 12: 19.6 kcal/kg, days 13 - 15: 18.6 kcal/kg, days 16 - 18: 20.4 kcal/kg, days 19 - 21: 19.2 kcal/kg, days 22 - 24: 21.0 kcal/ kg, days 25 - 27: 17.8 kcal/kg and days 28 - 30: 19.4 kcal/kg. Compared to the LEEP-COVID 2020 study, non-obese ventilated COVID-19 patients from days 0 - 14 had a mREE using IC of 19.2 - 26 kcal/kg ABW and obese patients: 17.5 - 21 kcal/kg ABW. Our retrospective study using the PSU equation from days 0 - 15 revealed caloric needs of 21.9 - 24 kcal/kg ABW for non-obese patients and 18 - 19.8 kcal/kg ABW for obese patients. Conclusion: In performing a simple comparative review of the LEEP-COVID study to our retrospective data, we identified that the PSU equation may be useful in estimating the caloric needs for ventilated COVID-19 patients from days 0 - 15.

6.
Journal of Heart and Lung Transplantation ; 41(4):S198, 2022.
Article in English | EMBASE | ID: covidwho-1796798

ABSTRACT

Purpose: During the COVID-19 pandemic, inpatient cardiothoracic transplant pharmacists expanded clinical services to include remote telehealth visits to increase patient access to pharmacy services and streamline visits for providers. Pharmacist visit activities included adherence and medication access assessments, adverse effect assessment and management, chart reviews, and medication reconciliation. Methods: A single center retrospective chart review of 80 heart transplant recipients transplanted between January 2020 and December 2020 was completed. From July 2020 - March 2021, pharmacists called patients within the first year of transplant prior to scheduled provider clinic visits. Patients were not called if they had been called within the prior 4 weeks. Activities from clinic visits before and after pharmacist involvement were compared at 1 month, 3 months, 6 months, and 12 months post-transplant. The goal of this analysis was to describe the number and types of interventions made by the pharmacist. Results: A total of 100 patients and 272 clinic visits were analyzed, baseline clinical characteristics did not differ in the two cohorts. Pharmacists performed 233 tele-health visits which resulted in 394 interventions from July 2020 - March 2021, summarized in Figure 1. The most common interventions included adverse effect management (34%) and renal dose adjustment (17.8%). An analysis of outpatient visits before and after pharmacist involvement found no significant difference in reported adherence, appropriate renal dosing of medications or reported neurotoxicity (Table 1). Conclusion: Close to 400 interventions were made by our transplant pharmacy team through tele-health visits over a period of 8 months. Use of pre-visit pharmacist tele-health assessments allowed for expansion of clinical pharmacy services while facilitating more focused provider clinic visits. more consistency in clinic may yield improved post-pharmacist outcomes, though further analysis is warranted.

7.
Journal of Sexual Medicine ; 19(4):S66, 2022.
Article in English | EMBASE | ID: covidwho-1796415

ABSTRACT

Introduction: Inflatable penile prosthesis (IPP), an implantable device for treatment of ED, historically have always been done in a hospital setting or outpatient setting. These surgeries are now done more frequently around the world as an in-office procedures. With the increase risk of COVID infections and the improvement of IPP technique we began performing this procedure in the office under local and total intravenous anesthesia. Objective: To present the nuances of office based 3 piece penile prosthesis and the outcome data for the feasibility of in-office implants while minimizing complications. Methods: A retrospective chart review was performed on the 10 IPP patients who had surgery in the office based setting in our clinic. The age ranges varied from 34-58 years of age. All pateints who opted for IPP in the office were screened for any and history of pelvic surgery, renal failure, cardiac stents or heart failure. Preoperatively, Antibiotics used were Vancomycin, Amikacin and oral Fluconazole and oral Neurontin for analgesia. All patients had a preoperative COVID nasal swab or had the vaccine prior to surgery. Intraoperatively Vancomycin, Amikacin and Fluconazole were used for irrigation and implant prep. Smaller table sets with stacking sterile field was used with headlights and loupes. IV sedation was used with the assistance of an anesthesiologist who used Propofol for sedation. A propofol bolus was given prior to entering the space of retzius. The patients also received a penile and pudendal block with a mixture of 1% Lidocaine, 0.5% Marcaine and 1mg Solumedrol for post-op pain management. Postoperatively, Neurontin and Tylenol were given PO and Toradol was given IV. Results: Of the 10 patients selected, 0 patients had infections we had even with a drain being in place 2 patients suffered a hematoma. 1 patient suffered urinary retention, resolving after 24 hours. Patients were cleared for device use between 5 to 8 weeks. 1 patient's implant was recalled;however, the patient did not have a desire for re-operation and has the device and works around the valve. The average procedure time was 53.5 minutes. Incision size range was 1.7 cm to 2.5 cm in length.Drains were placed in all patients for 24 to 48 hours with out puts of 90-160cc. Patients were discharged after 90 minutes in recovery phase. Conclusions: Office based penile prosthesis is safe and feasible in the post COVID world. Nuances such was headlights, loupes and adequate block-aid and sterile field efficiency with preloading and stacking are a necessity. With careful patient selection, in-office implantable penile prosthesis implant can be a safe feasible alternative for patients that have severe ED, have gone through alternative therapies, but either cannot afford and or insurance does not cover this procedure. Disclosure: Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast

8.
Clinical and Experimental Obstetrics and Gynecology ; 49(3), 2022.
Article in English | EMBASE | ID: covidwho-1780431

ABSTRACT

Background: Ectopic pregnancy is a potential cause of morbidity and mortality among women and is a common diagnosis for women presenting to the emergency room. During the height of the COVID-19 pandemic in New York City (NYC) in the spring of 2020, emergency room visits for all non-COVID related health problems appeared to decrease. We examined visits for ectopic pregnancies and pregnancies of unknown location (PUL) in the emergency department (ED) of three NYC hospitals during the height of the early pandemic and compared them to the same months in the prior year. Methods: Our study is an IRB-approved retrospective chart review of all patients who presented to the ED with a positive pregnancy test during the months of March–June 2020 (pandemic period) and March–June 2019 (pre-pandemic). Demographic data, history, labs, imaging, number of visits and treatment and outcomes were measured. Results: We found that there were 324 ED visits for PUL in 2019 (pre-pandemic) compared to 195 in 2020 (pandemic). Ectopic pregnancies remained somewhat stable and were diagnosed in 59 patients in 2019 and 51 patients in 2020. The percentage of patients diagnosed with ectopic pregnancy increased from 25.1% of all patients with PUL in 2019 to 39% of all patients diagnosed with PUL in 2020. Rates of complications were similar between the two cohorts. Conclusion: Although the number of visits to the ED for PUL fell dramatically from the pre-pandemic to the pandemic time period, the number of patients actually diagnosed with ectopic pregnancy was similar between the two time periods.

9.
Journal of Clinical Oncology ; 40(6 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779693

ABSTRACT

Background: TMPRSS2 is one of the two key enzymes that SARS-CoV-2 requires for its entry to the cell. TMPRSS2 is regulated by androgen receptor. It is well described Androgen Receptor Directed Therapy (ARDT) downregulates the expression of TMPRSS2. We hypothesized that the ARDT has a protective role in patients with prostate cancer (PCa) from poor outcome of COVID-19. Methods: A retrospective chart review of PCa patients with COVID-19 between March to October 2020 in the Yale-New Haven Health System was performed. Demographics, comorbidities, home medications, laboratory data, treatment, and clinical outcomes of COVID-19 were collected. ARDT was defined as the use of GnRH agonist, GnRH antagonist, or androgen receptor antagonist. This study was reviewed and approved by the Institutional Review Boards of Yale University. Results: A total of 146 (1.1%) prostate cancer cases were identified from the 13,642 cases of COVID-19. The clinical characteristics are summarized in the table. Twenty-five (17%) were on active ARDT and 121 (83%) not on ARDT (non-ARDT). The rates of hospitalization were the same: 52%, between the ARDT and non-ARDT group. Of those admitted, mean duration of hospitalization were 9.2 days (Range 1-25) and 14.9 days (Range: 2-47) in ARDT and non-ARDT groups, respectively (p=0.14). Rates of hospital stay >30 days were 0% versus 14.3% (9/63) in ARDT and non-ARDT groups, respectively (p=0.15). Intubation rates were 0% versus 11% (7/63) for ARDT and non-ARDT groups, respectively (p=0.21). Mortality rates were 8% and 13.2%, in ARDT and non-ARDT groups, respectively (p=0.47). Conclusions: The prevalence of PCa was infrequent. Despite advanced stage of the cancer in ARDT group, there was a trend toward decreased severity of COVID-19 and mortality rates compared to non-ARDT group.

10.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779474

ABSTRACT

Background: CDK 4/6 inhibitors have transformed the landscape of breast oncology. A CDK 4/6 inhibitor in combination with endocrine therapy is recommended as 1st line therapy for patients with metastatic hormone receptor positive breast cancer. CDK 4/6 inhibitors have purported immunomodulatory effects and while effective, myelosuppression is a common adverse effect of CDK 4/6 inhibitor treatment of breast cancer. The impact of CDK 4/6 inhibitor therapy on immunogenicity of vaccines is not known. In this study, we evaluated the spike antibody response to SARS-CoV-2 vaccines among patients with breast cancer receiving endocrine therapy with or without CDK 4/6 inhibitors. Methods: In the Cancer COVID and Vaccine (CANVAX) study eligible patients included patients with breast cancer who had completed all scheduled doses of SARS-CoV-2 vaccines. Chart review was conducted to identify patients who had received endocrine therapy with or without CDK 4/6 inhibitor. We used validated assays to measure anti-SARS-CoV-2 total IgA/M/G spike antibodies and virus neutralization. We evaluated the magnitude of antibody response based on geometric mean concentrations (GMCs) as well as the % of patients with inadequate seroconversion (defined as levels <100 U/ml). Independent T-test based on log-transformed antibody values was utilized to compare the spike antibody levels and p value of ≤ 0.05 Swas considered statistically significant. Results: Between April 2021 and June 2021, 203 patients with breast cancer were enrolled. As of the cut-off date (2nd July 2021), results were available for 73 patients treated with endocrine therapy alone (N = 23), or with CDK 4/6 inhibitor-based therapy (N = 50). Most were females (98.6%), white (83.6%), and had metastatic breast cancer (68.5%). 49.3% had received BNT162b2 (Pfizer), 37% mRNA1273 (Moderna), and 13.7% Ad26.COV2.S (Johnson and Johnson/Janssen) vaccines. Overall, the mean spike antibody levels were similar between patients treated with endocrine therapy alone vs CDK 4/6 inhibitor-based therapy (GMC: 326 vs. 719 U/mL;p=0.704). Mean spike antibody levels were higher in patients with early breast cancer vs. metastatic breast cancer (GMC: 555 vs. 465 U/mL;p=0.031). However, patients who received Ad26.COV2.S had lower levels of mean spike antibody levels (GMC 47 U/ml), compared with patients treated with BNT162b2 (GMC 400 U/ml) or mRNA1273 (GMC 2203 U/mL;P<0.01 for both comparisons). Comparison of neutralization titers in 66 individuals supported the above results. 11 (15.1%) patients had low antibody titers (<100U/ml) of seroconversion and 3 received a booster vaccine, with 1 having available repeat titer results thus far demonstrating a significant improvement. Conclusions: The majority of patients receiving CDK 4/6 inhibitor have adequate antibody response to SARS-CoV-2 vaccines, particularly mRNA vaccines. However, a minority of patients may require booster vaccine to augment immunity. Monitoring spike antibody levels could be helpful to identify patients with inadequate seroconversion and guide mitigation strategies for patients with breast cancer.

11.
Biological Psychiatry ; 91(9):S242, 2022.
Article in English | EMBASE | ID: covidwho-1778004

ABSTRACT

Background: The COVID pandemic adversely impacted the mental health of the country. We compared the change in depression symptoms before and after the onset of the pandemic in our clinic using standardized screening forms. Methods: All patients at an outpatient psychiatric clinic were given a series of screening tests to take prior to their first visit. The tests included among others the PHQ-9 depression screening, the SCL-90, and a pyschosocial history. Patients also complete the PHQ-9 at every visit. A retrospective chart review was performed on all patients seen since 2017. Results: A total of 440 patients completed the intake screening, 309 before the start of COVID, 131 after (post March 2020). Patients reported more severe symptoms on their intake screenings in the time of COVID. Obsessive-compulsive (1.71 vs 1.48), hostility (.94 vs.77), and psychoticism (9.88 vs.74) were all significantly higher on the SCL-90, as were trouble concentrating (1.7 vs 1.4) and thoughts of suicide (.62 vs.42) on the PHQ-9. Despite patients reporting more serious symptoms at intake, patients who started treatment after the start of COVID had lower PHQ-9 scores during their first year (9.5 vs. 10.2). Among patients who had already started treatment pre-pandemic, their average scores showed a significant improvement. The total score for these patients averaged 9.9 across all visits prior to March 2020, compared to 6.3 after (p<.001). Conclusions: The COVID pandemic affected the severity and response to treatment in depressed outpatients. Several factors including psychosocial support may have contributed to the improved outcomes during COVID. Keywords: COVID-19, Screening Tools, Depression

12.
British Journal of Surgery ; 109(SUPPL 1):i47, 2022.
Article in English | EMBASE | ID: covidwho-1769152

ABSTRACT

Aim: The COVID-19 pandemic continues to present unprecedented challenges for healthcare systems. This has resulted in the pragmatic shift in practice of plastic surgery units worldwide. Many units reported a significant fall in urgent melanoma referrals, leading to patients presenting with advanced disease. Our objective was to evaluate our unit's experience with both non-invasive and invasive melanoma during the COVID-19 pandemic and compare it to the UK, mainland Europe and North America. Method: A Retrospective chart review was performed on all patients diagnosed with invasive and non-invasive cutaneous melanoma between March to December of 2019 (control) compared to 2020 (COVID-19 pandemic) in a single plastic surgery unit in Ireland. Results: A total of 589 patients were included in the study. Of these, 314 (53%) with invasive melanoma, compared to 275 (47%) with noninvasive disease. Overall, more patients were diagnosed with both invasive and non-invasive melanoma in 2020 than 2019 (p<0.05). However, significantly longer waiting times in 2020 (64 days) compared to 2019 (28 days) (p<0.05) with the majority of referral being from GP in 2019 (83%) compared to 61% in 2020. Positive sentinel lymph node was higher in 2019 at 56% (n=28) compared to 24% (n=22) in 2020. There was no statistically significant difference in the tutor characteristics or metastasis status. Conclusions: Our study highlights that with prompt efficient restructuring of services, including governmental agreement to utilise private sector to continue urgent elective surgery, virtual triaging and follow-up and most importantly virtual complex skin multidisciplinary team meeting, we could reserve successful management of skin cancer even in the most devastating times.

13.
Journal of the American College of Cardiology ; 79(9):2136, 2022.
Article in English | EMBASE | ID: covidwho-1768638

ABSTRACT

Background: Since the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a new multisystem inflammatory syndrome in children (MIS-C) has been described amongst patients with recent past SARS-CoV-2 infection. The primary objective of this study is to describe a single center experience in relation to cardiac manifestations of MIS-C in an ethnically diverse pediatric population. Methods: We conducted a retrospective chart review of pediatric patients less than 21 of age meeting MIS-C criteria who presented to a tertiary care children's hospital from May 2020 to March 2021. Results: Seventy-eight patients diagnosed with MIS-C (average age 9.7 +/- 4.6 years, 57% male) were included in this study (60 Hispanic, 9 non-Hispanic White, 7 Black, and 1 American Indian). The most common presenting symptoms were nausea and vomiting (76%), abdominal pain (71%), appetite changes (69%), fatigue (64%), and conjunctivitis (63%). The average length of intensive care unit stay was 2.5 days while average total hospitalization was 7.3 days. Forty-nine patients (62%) underwent echocardiography. Of those evaluated, there was systolic dysfunction in 45% with an average ejection fraction of 48%, diastolic dysfunction in 14%, valvular disease in 53%, coronary involvement in 16%, and pericardial effusion in 22%. Electrocardiogram was completed on 37 patients (47%) which revealed heart block in 23% and arrhythmia in 3%. Troponin T was elevated in 32% and pro-BNP was elevated in 89%. Ninety-five percent of patients received immunomodulators during their hospitalization, while 94% received methylprednisolone, 59% received intravenous immunoglobulin, and 19% received Anakinra. There was one mortality. Conclusion: The results of this retrospective study contribute to a growing knowledge base in the literature that MIS-C can exhibit a wide spectrum of cardiac manifestations further underscoring the importance of thorough cardiac workup and regular outpatient follow-up in patients diagnosed with MIS-C.

14.
Journal of the American College of Cardiology ; 79(9):407, 2022.
Article in English | EMBASE | ID: covidwho-1768620

ABSTRACT

Background: Transthyretin cardiac amyloidosis (ATTR-CM) is important comorbidity associated with severe aortic stenosis (AS). Multiple studies have shown that ATTR-CM was present in 10-15% of all cases with severe AS. The purpose of this quality improvement project is to raise awareness of ATTR-CM in patients who underwent transcatheter aortic valve replacement (TAVR) for severe AS amongst the healthcare providers and patients. Methods: We retrospectively reviewed all TAVR cases performed at our institution in 2019 (Total cases 87). We screened for the presence of predefined high-risk features for ATTR-CM based on prior literature (Presence of diastolic dysfunction, left ventricular hypertrophy on echocardiogram, low voltage-mass ratio, low limb lead voltage on EKG, arrhythmia/bundle branch block, or systemic symptoms of amyloidosis). We subsequently contacted the patients to discuss our clinical suspicion of ATTR-CM and offered clinical referral to a cardiac amyloid specialist. Results: Of the total of 87 patients who underwent TAVR in 2019, 12 patients were deceased at chart review. We have identified 50 patients (66.7%) who had high-risk features of ATTR-CM. A total of 17 patients (34% of 50 patients) agreed to be referred to cardiac amyloid specialist. Six patients (12%) were tested with 99m Technetium Pyrophosphate imaging, and all were negative for ATTR-CM. Eleven patients (22%) are still pending testing. Six patients did not wish for referral due to personal reasons. We were not able to reach 15 patients via phone (30%). In addition, we have found additional 12 patients who were deceased (Total mortality count of 24, 27.5%) in two years. Conclusion: Our project has increased awareness within structural cardiologists as we have implemented a prospective screening process within our institution. While we expected to diagnose ATTR-CM in 10% of severe AS who underwent TAVR, we had multiple difficulties contacting them, coordinating referrals due to the COVID-19 pandemic and higher 2-year mortality. We are hypothesizing whether the higher 2-year mortality is secondary to undetected ATTR-CM. We are planning for screening and timely referral for patients who underwent TAVR more recently.

15.
Journal of Clinical Neuromuscular Disease ; 23(1 SUPPL):S11, 2022.
Article in English | EMBASE | ID: covidwho-1766839

ABSTRACT

Background: Little is known about the immune response to COVID vaccination in immune suppressed patient. A multiple studies showed variable data regarding the effect of immunosuppression on the immune response to the vaccination. Objective: To report on COVID spike antibody levels in patients with various neuromuscular conditions who received vaccination and assess the effect of immunosup-pressive therapies on antibody levels. Methods: We performed a retrospective chart review on patients in neuromuscular clinic who had COVID antibody testing. We collected demographic, clinical and treatment information. Descriptive statistics was performed on the data obtained. Results: One hundred six patient charts were reviewed to date. There were 53 male and 53 female included in this study. The mean age of the patients enrolled was 65.60 6 14.51 and the mean duration of antibody acquisition since last date of vaccination was 156. High antibody titer.250 was seen in 61 patients (57.55%), low titer was seen in 32 patients (30.19%) and the antibody titer was not detected in 9 patients (8.49%). Four patients showed detected unmeasured antibody titer. From the 61 patients with high antibody titers 36 patients (59.01%) were on immunosuppressive medications compared to 26 of 32 patients (81.25%) with low antibody titer and 8 of 9 patients (88.88%) with undetected titer. Fifty percent of undetected antibody titer patients were on rituximab and around 23% of immunosuppressed patients in the low titer group were on azathioprine. Conclusion: The analysis and enrolment of patients is still ongoing. Up till now around 60% of the patients on immunosuppressive drugs did develop adequate antibodies level against COVID-19 virus and around 80% of the low titer group were on immunosuppression.

16.
Gynecologic Oncology ; 164(1):28-29, 2022.
Article in English | EMBASE | ID: covidwho-1757942

ABSTRACT

Objectives: To investigate the delay in surgical management of abnormal uterine bleeding with endometrial sampling during the peak of the COVID-19 pandemic at a single, urban tertiary medical center. Methods: We conducted a retrospective chart review of 868 patients, 466 who received an endometrial biopsy in 2019 and 402 between January 1–March 23, 2020 (during the first peak of COVID-19) at a tertiary academic medical center in Philadelphia. We collected baseline patient characteristics including: age, self-identified race or ethnicity, and BMI. We assessed the time from an abnormal endometrial biopsy to surgical management, use of at least one telemedicine appointment between biopsy and surgical management, and resulting pathology results. Chi-squared test was used to compare proportions of populations and two-tailed student's T-test was used to compare days between biopsy and surgical management. P-value was set at 0.05. Results: 466 and 402 patients underwent an endometrial biopsy in 2019 and between January 1 – March 23, 2020, respectively. In 2019, 4.94% were diagnosed with an endometrial malignancy and 95.1% had resulting benign pathology;while in 2020, 5.22% had a diagnosed endometrial malignancy and 94.8% had benign pathology (p-value = 0.84). Median age was 51.0 years (range, 19.0–89.0) in 2019 and 51.0 years (range 24–89) in 2020. Median BMI was 31.4 (range, 17.6–66.9) in 2019 and 31.1 (range, 16.3–74.2) in 2020. Median time between endometrial biopsy and surgical management was 66.5 days (range, 0–453 days) in 2019 and 94.0 days (range 13.0–335) in 2020 (p-value = 0.57). Median time from biopsy to surgery for patients with a resulting pathology of endometrial malignancy was 53 days (range, 0–441) in 2019 and 87.5 days (range 13.0–323) in 2020 (p-value = 0.50). Median time for patients with resulting benign pathology was 69.0 days (range, 9.00–453) in 2019 and 112 days (range, 33.0–335) in 2020 (p-value = 0.48). 57.4% of patients in 2020 had at least one telemedicine appointment with their physician between the initial encounter for abnormal uterine bleeding and surgical treatment, while no patients had a telemedicine appointment in 2019. Conclusions: During the COVID-19 pandemic, individual patients with abnormal uterine bleeding may have experienced delays between initial abnormal endometrial biopsy and surgical management. However, comparing the populations as a whole, there was not a statistical difference in time between biopsy and surgical management for abnormal uterine bleeding, reinforcing the quality of care given to our patients. However, further studies are needed to examine the effects of COVID-19 on possible delay in surgical treatment from first symptoms in patients with abnormal uterine bleeding to biopsy and to surgical management.

17.
Annals of Allergy, Asthma and Immunology ; 127(5):S43, 2021.
Article in English | EMBASE | ID: covidwho-1748293

ABSTRACT

Introduction: A single tertiary care center has offered oral immunotherapy (OIT) as a clinical service since 2018 using commercial products and subsequently has offered FDA-approved Peanut (Arachis- hypogaea) Allergen Powder-dnfp (PNAP) since July 2020. Shared decision making regarding OIT was based on previous IgE testing, history, and family preference. Methods: A retrospective chart review was performed in REDCap database. Results: A total of 37 patients initiated OIT (21 commercial products and 16 PNAP). The mean age was 9.25 for commercial product and 7.25 for PNAP with more males than females participating. Co-morbid conditions included allergic rhinitis, asthma, and eczema. Mean peanut IgE prior to starting was 49.75 and Ara h2 was 32.73. Prior reactions to peanut included skin, GI and anaphylaxis. Three children failed an oral challenge prior to starting OIT. There were 5 children that had never ingested peanuts but completed OIT. Minor intermittent side effects including stomach upset and itchy mouth were reported during escalation of both products. Dose adjustment was required for 1 PNAP patient for complaint of dysphagia and pain. There were 4 patients who dropped out of OIT: refusal to eat (1), unrelated GI disease (1) and the COVID-19 pandemic (2). All patients upon reaching maintenance are daily dosing with peanuts or chocolate-covered peanut candy. Lifestyle changes reported since reaching maintenance include eating in restaurants previously avoided and ingesting foods with labels stating: “may contain peanuts,” and “foods processed in a facility with peanuts.” Conclusions: Peanut OIT is safe and well tolerated in our patient population.

18.
Annals of Emergency Medicine ; 78(4):S117-S118, 2021.
Article in English | EMBASE | ID: covidwho-1748247

ABSTRACT

Study Objective: HIV screening in the ED is an effective means of identifying new cases of HIV. The COVID-19 pandemic caused significant disruptions to both ED operations and outpatient care, yet little is known about the impact of the COVID-19 pandemic on ED-based HIV screening programs. We hypothesized that our electronic medical record (EMR) triggered HIV screening program would continue to identify new HIV positive patients and link them to care during the COVID-19 pandemic. Methods: We conducted a retrospective chart review of ED patients screened for HIV and compared the average monthly tests performed, number of confirmed HIV positive cases, and rates of linkage to care before and after the onset of the COVID-19 pandemic. We used 3/13/2020 as the start date for the pandemic and compared data in a 5-month period prior to the pandemic (limited to initiation of EMR triggered HIV screening) and a 9-month period during the pandemic. Two tailed t-tests were used for comparison of means. Results: A total of 20,825 patients were screened for HIV from 11/18/2019 to 12/12/2020 (8,417 pre-pandemic and 12,408 during the pandemic). On average, more HIV screening tests were performed in the pre-pandemic period compared to the pandemic period (1,683/month pre-pandemic versus 1,379/month during pandemic). However, when accounting for ED volume changes, a similar rate of patients in the pre-pandemic period (35.8% of all patients seen in the ED) were screened compared to during the pandemic (34.7% of all patients seen). In the pre-pandemic period 11/18/2020 – 3/12/2020, a total of 25 patients were diagnosed with HIV and all patients were linked to care. In the pandemic period 3/13/2020 – 12/12/2020, 27 patients were diagnosed with HIV. Of the 27 patients diagnosed, 22 (81%) were linked to care. Two patients died prior to attending specialist appointments during the pandemic (88% linkage to care accounting for deaths). The average time to the first attended specialist appointments for non-admitted patients was not significantly greater during the pandemic period (6.0 days pre-pandemic vs. 6.9 days during pandemic, p=0.55). Conclusion: EMR-generated HIV screening allows for continued efforts to diagnose and link patients to care despite the global disruptions caused by the COVID-19 pandemic. The lack of disruption to screening rates may be partly due to the minimal disruption of the screening and the linkage to blood tests being performed for clinical care. These efforts are critical to the mission to end the HIV epidemic by 2030. [Formula presented]

19.
Annals of Emergency Medicine ; 78(4):S142-S143, 2021.
Article in English | EMBASE | ID: covidwho-1748236

ABSTRACT

Study Objective: The SARS-CoV-2 (which causes COVID-19) pandemic has resulted in lower emergency department (ED) volumes. It has precipitated business and school closures along with the implementation of physical distancing measures, which culminated in a Shelter in-Place Order (SIPO) issued for a major urban area county in March 2020. The objective of this study was to determine the effect on access to healthcare by patients of different socioeconomic status by examining differences in ED volume by zip code stratified by the SocioNeeds Index. Methods: This retrospective chart review examines whether there was a quantitative change in patient visits to an urban, tertiary county hospital ED from 2019-2020 by zip codes. The inclusion criterion was any ED visits from a county resident, and the exclusion criterion was any blank, alphanumeric, or PO box zip codes including zip codes located outside of Dallas County. We mapped daily patient visits by zip code for four phases: Phase 1 was the 3 months preceding the first COVID-19 case’s announcement in Dallas, Phase 2 began with the first COVID case, Phase 3 encompassed when the SIPO was in effect for Dallas County, and Phase 4 included the three months following the expiration of the SIPO. The SocioNeeds Index rates each zip code by socioeconomic status, specific to this county. We compared this data to records over the same time period from the previous year to control for seasonal variation in the absence of a pandemic. Results: There were 275,756 ED patient visits included in this study. The results indicate a statistically significant decrease in ED visits occurred in all zip codes during the pandemic: 24% between Phase 1 and 4 (p<0.0001) in 2020. Additionally, there was a decrease in visits after the first case in Dallas: Phase 2 (-14%, p<0.0001), Phase 3 (-41%, p<0.0001) and Phase 4 (-25%, p<0.0001) when compared to 2019 but an increase in visits (36%, p<0.0001) in 2020 once the SIPO expired. Zip codes with highest need based on poverty, income, unemployment, occupation, education and language (weighted to correlate with preventable hospitalization and premature death rates) were found to have greater reductions in visits whereas zip codes which with the lowest needs saw a 15% increase in visits during the SIPO. The geographic distribution of visits indicate that most zip codes saw a reduction in visits over Phases 2 and 3 (especially zip codes further from the ED) and an increase in visits during Phase 4 but never recovered to pre-pandemic values. Conclusion: Overall, a significant decrease in ED visits per zip code was observed relative to a non-pandemic year in most zip codes except those with the highest socioeconomic status, suggesting that the virus and SIPO deterred patients disproportionately from the higher needs communities from accessing healthcare. These results could have implications for future pandemic public health messaging and targeted outreach to communities with barriers to healthcare access. [Formula presented]

20.
Open Forum Infectious Diseases ; 8(SUPPL 1):S33, 2021.
Article in English | EMBASE | ID: covidwho-1746794

ABSTRACT

Background. Little is known about how race and ethnicity, imperfect (albeit accessible) proxies for structural racism, impact COVID-19 incidence among people with HIV (PWH). We report the cumulative incidence and incidence rate ratios (IRR) for COVID-19 in a long-term multi-site cohort of PWH across the US Figure 1. Cumulative incidence of COVID-19 in the CNICS cohort Methods. We examined COVID-19 cumulative incidence and IRR among PWH in care between 3/1/2020 and 12/31/2020 at seven sites in the CFAR Network of Integrated Clinical Systems (CNICS) cohort. We define COVID-19 incident case as having a laboratory-confirmed (RT-PCR/Ag) SARS-CoV-2 positive result or diagnosis verified by chart review. Reinfections were excluded. Results are presented as monthly and quarterly cumulative incidence and IRR with 95% CI stratified by CD4 count, self-reported race/ethnicity, and site. Follow-up was censored on the earliest of diagnosis of COVID-19 disease, loss to follow up, or 12/31/2020 Results. Among 15,780 PWH in care in the CNICS cohort during the study period, 62% were non-white, with a median (IQR) age of 52 (IQR 40-59), 95% were on antiretroviral therapy, 17% had a CD4 count less than 350, and 6% less than 200. Overall, 651 PWH tested positive for COVID-19 for a cumulative incidence of 4.13%. COVID-19 cumulative incidence increased from 0.77% at the end of the first quarter to 4.12% by the end of December 2020. At the peak of the pandemic in December 2020, the cumulative incidence in Black PWH was 1.68 fold higher than in white PWH (p=.033) and 2.35 fold higher in Hispanics than in whites (P< .0001), figure 1. Similarly, the IRR for COVID-19 was 1.71 (95% CI 1.42-2.07) for Black and 2.40 (95% CI 1.91-3.01) for Hispanic PWH relative to white. Although there was variation across sites, reflecting geographic differences in pandemic waves and access to COVID-19 testing, overall individual trends remained the same. COVID-19 cumulative incidence was similar across CD4 cell count strata Conclusion. Our results suggest effects of structural racial disparities on COVID-19 incidence in this diverse population of PWH across the US, with higher and disproportionate rates of COVID-19 in Black and Hispanic PWH. Incidence estimates are conservative because testing was not uniform, and no systematic testing was conducted.

SELECTION OF CITATIONS
SEARCH DETAIL