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1.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194402

ABSTRACT

Introduction: Troponin I test has been used as a biomarker for the diagnosis of ACS since 1965. Troponin I has a prognostic value in hospitalized patients with non-cardiac diagnosis. In 2019, The WHO declared COVID-19 as a deadly infectious disease. Given the global impact of this disease, there is a need to identify biomarkers associated with mortality in hospitalized patients. Biomarkers associated with mortality are an important tool for escalation of care in patients deemed at risk of clinical decompensation. The following study demonstrated an association between troponin I elevation and increased mortality among COVID-19 patients. Hypothesis: We sought to determine if Troponin I elevation within 24 hours of admission is associated with increased mortality in COVID-19 patients. Method(s): In a retrospective, multicenter study at Atlantic Health System in New Jersey, we analyzed 10,980 first-drawn troponin I values within 24 hours of admission in 34,625 patients between 12/2020-02/2021. Data was analyzed using logistic regression and cox proportional hazard ratio to determine our primary outcome, which is the association of troponin elevation and mortality among COVID-19 patients. Result(s): The characteristic of 10,980 patients that survived COVID-19 and patients that expired due to COVID-19 during the hospitalization were analyzed. Total of 6,083 were male and 4897 were females. In the survival group, the mean age was 60 with STD 17.2, while in the deceased group the mean age was 74 with STD 13. Logistic regression revealed thatpatients with elevated troponin have increased odds of death compared to others with non-elevated troponin levels (Point estimate 3.301665). Females with elevated troponin have greater odds of death than males with elevated troponin (point estimate 4.484406 in females vs point estimate men 3.301665). Patients with elevated troponin have increased hazard by a factor of 1.78 or increased chance of death by 78%. As supporting evidence of our hypothesis patients with an elevated troponin in the first 24 hours have 3.74 increase odds of death. Conclusion(s): In conclusion, Troponin I elevation within 24 hours of admission is associated with increased mortality in hospitalized COVID-19 patients with 3.7 increase odds of death.

2.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194370

ABSTRACT

Background: The conduct of clinical trials during COVID-19 created challenges to ensuring access to clinical trials, healthy clinical teams, and patients. Innovative methods such as remote patient follow-up and monitoring visits can lead to successful completion of device trials. Objective(s): The INGEVITY+ Active Fixation Pace/Sense Lead Study examined the safety/ efficacy of the INGEVITY+ Lead in a prospective, non-randomized, multicenter, post-approval study. Method(s): Subjects met indications for a pacing device with INGEVITY+ leads implanted in the RA and RV. The primary safety endpoint was the 3-month lead-related complication-free (LRC-free) rate. The primary efficacy endpoint evaluated the 3-month pacing capture threshold with the secondary efficacy endpoint evaluating the other lead-related electrical parameters. Implanter experience was assessed. Telephone visits with LATITUDE remote transmission of lead measurement data and remote monitoring visits were allowed. Result(s): A total of 201 leads were evaluated in 101 subjects, 46.8% female with a mean age of 73.2 years, at 13 centers in the United States. The study took 6.8 months, with a median follow-up of 3.4 months. The 3-month follow-up was completed by 98% of subjects, of which 36% were remote. A total of 98% of monitoring visits were done remotely. The study met all primary and secondary endpoints. The LRC-free rate through 3-months was 98.5% (lower CL 95.4%). Three leads were repositioned and reimplanted;two were RA dislodgements, and one was a RA perforation and hemothorax requiring thoracentesis. The pacing capture threshold was <= 2V in 98.9% of subjects with a mean of 0.77 V at 0.4-ms pulse width, mean pacing impedance of 712 ohms, and a median P-wave amplitude of 4.3 mV, and median R-wave amplitude of 15.9 mV at 3- months. No helix performance issues were reported. The mean turn count for helix extension was 6.7 and retraction was 7.6. More than 85% of physicians rated the lead as 'very good' or higher on all aspects of lead handling. Conclusion(s): The INGEVITY+ Lead was found to be safe and effective with a very favorable implant experience. This study was entirely conducted successfully during COVID-19 with remote follow-up and monitoring visits, and nearly half of the subjects were females.

3.
Colorectal Disease ; 23(Supplement 2):62, 2021.
Article in English | EMBASE | ID: covidwho-2192489

ABSTRACT

Aim: This quality improvement project's aim is to see the difference in number of appointments and investigations between patients presenting via telephone or face to face (F2F) clinics. Method(s): We reviewed 61 referrals to Colorectal clinic between January and February 2021, 34 were telephone appointments, 22 F2F appointments and 5 were excluded due to unidentifiable patient data or incorrect referral. We assessed 14 different parameters. Result(s): The first phase data showed F2F clinic patients were older (n = 66.91 years vs 56.21 years), had more appointments (n = 1.72 vs 1.38) and a shorter RTT (Referral To Treatment) (n = 26.65 days vs 136 days). The shorter RTT correlates with the larger number of 2 week wait referrals that were seen in F2F clinic (n = 11) vs in the Telephone group (n = 3). Adjusting for patients with ongoing treatment in the F2F group (O-F2F) or telephone patients that awaited a F2F appointment for further investigation (T to F2F) the data showed that the O-F2F patients had 1.76 appointments vs 2.2 average appointments in the T to F2F patient group. Investigations were higher in the O-F2F group (n = 3 versus n = 0.5) vs the T to F2F group. There was a higher rate of DNA (Did Not Attend) (n = 11.7% versus 4.5%) and discharge (n = 20.5% versus n = 18%) in Telephone clinics vs F2F clinics. The most common reason for more appointments in the Telephone group was the inability to properly assess the patient's pathology and plan accordingly especially in benign proctological disease which was seen more commonly in the Telephone group. Conclusion(s): Risk stratification may be appropriate when deciding patients to attend telephone vs F2F clinics. A combination of red flag symptoms and increased age may be appropriate tools to start identifying suitable patients for F2F clinics. Patients with chronic or complex proctological disease likely need F2F appointments to reduce overall number of appointments which will expedite investigation and treatment. Telephone clinics may be appropriate for benign disease follow-up.

4.
Pediatric Critical Care Medicine Conference: 11th Congress of the World Federation of Pediatric Intensive and Critical Care Societies, WFPICCS ; 23(11 Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2190753

ABSTRACT

BACKGROUND AND AIM: Admission to PICU due to SARS-CoV2 infection in children is unfrequent. However there are few pediatric patients who may require intensive care management. The aim of our study was to describe characteristics and evolution of those patients admitted to Spanish PICUs due to SARS-CoV2 infection. METHOD(S): A multicentre nationwide prospective registry involving all Spanish PICUs was carried out between 1st of march 2020 and 30 November 2021. RESULT(S): During the study period 299 patients where admitted to the participating units. Median age was 8.9 years (IQR 4.4 -12.2). 208 patients (69,6%) where diagnosed of Multisystem Inflamatory Syndrome associated to SARS-CoV2 (MIS-C). 225 patients (75.3%) where previously healthy. Main reason for admission was shock (which was present in 55.9% of patients). Respiratory difficulty was present only in 40.8% of patients. 50.5% of patients required vasoactive drugs, which was more frequent among those presenting with MIS-C (66.5% vs 20.9%, p<0.001). Only 17.4% of patients required mechanical ventilation, which was less frequent in patients with MIS-C (11.1% vs 34.1% p<0.001). 9 patients (3%) included in the registry died. Death was more frequent among patients with previous diseases (9.6% vs 0.9%, p<0.001) and less frequent in those admitted due to MIS-C (0.5% vs 9.3%, p<0.001). CONCLUSION(S): MIS-C was the most frequent cause of admission to PICU in Spain related to SARS-CoV2 infection. Most patients were admitted presenting shock and required vasoactive drugs, but only a few mechanical ventilation. Mortality rate was low. Prognosis was more favourable in those admitted due to MIS-C.

5.
Critical Care Medicine ; 51(1 Supplement):608, 2023.
Article in English | EMBASE | ID: covidwho-2190687

ABSTRACT

INTRODUCTION: Thiamine (TH) is a co-factor for pyruvate dehydrogenase, an enzyme necessary for pyruvate entry into the Krebs cycle, and without this enzyme, pyruvate would be converted to lactate. Elevated lactate, which is often used as a marker of perfusion, is proportionally associated with increased mortality in septic shock. The few publications on TH in septic shock are inconclusive. This study aims to ascertain if there is benefit to adding TH to standard of care (SOC) in the management of septic shock. METHOD(S): IRB-approved, multicenter, retrospective review from 2016 to 2021. Adult patients admitted to the ICU for septic shock and receiving >= 400 mg a day of IV TH (in divided doses) were included. Patients < 18, pregnant, admitted for SARS-COV-2, or whom received < 400 mg of TH daily were excluded. Two matched cohorts were evaluated, SOC plus TH versus SOC alone. The primary endpoint is time to shock reversal, defined as off vasopressors for at least 12 hrs and alive. Secondary endpoints include time to lactate clearance (< 2 mmol/L), lactate trends at 6, 12, 24, 48 hrs, and end of therapy, hospital and ICU lengths of stay, new end organ dysfunction, and in-hospital mortality. RESULT(S): Data from 50 patients were analyzed: 25 in the SOC plus TH and 25 in the SOC arm. The TH arm had greater number of vasopressors (2 vs. 1, p=.019), and greater utilization of stress-dose steroids (72% vs. 8%, p<.001), however there was no difference in cumulative vasopressor dose in norepinephrine equivalents at baseline (BL) (30.1 vs. 25.8 mcg/min, p=.248). There was no difference in SOFA score at ICU admission (10 vs. 8.5, p=.106) or lactate level at ICU admission (5.9 vs. 3.9 mmol/L, p=.055). There was a longer time to shock reversal from vasopressor initiation time in the TH arm (93 vs. 37.1 hrs, p=.023). Lactate clearance was slower in the TH arm (44.75 vs. 15.8 hrs, p=.027), and there was increased in-hospital mortality in the TH arm (13 vs. 5, p=.018). CONCLUSION(S): Compared to SOC alone, TH treated patients had longer times to shock reversal. However, this outcome may have been confounded by differences at BL with regard to number of vasopressors, and stress-dose steroid utilization, which indicate these patients were sicker at BL. Larger, prospective studies are required to confirm these findings.

6.
Critical Care Medicine ; 51(1 Supplement):136, 2023.
Article in English | EMBASE | ID: covidwho-2190506

ABSTRACT

INTRODUCTION: The Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 (STOP-VIRUS) Collaborative was a virtual adaptation to healthcare collaboration and quality improvement during COVID-19 pandemic. The learning that happens in this space is complex, nuanced, and multi-dimensional, best explained using Wenger's social learning theory of the Landscape of Practice, where one needs knowledgeability and the ability to identify and cross the boundaries to achieve learning. METHOD(S): We conducted a qualitative study using thematic analysis to explore STOP-VIRUS participants' perspective on their experience. We used identified themes to inform the creation of the continuum of readiness for change to better characterize common challenges that institutions face at different QI readiness stages. We used a blended framework of the ADKAR model for changes start at the individual level, McKinsey's 7S framework to focus our efforts on different components necessary for change at the organizational level, and the overarching theory of landscape of practice to guide analysis and development of our conceptual framework. RESULT(S): We constructed a blended conceptual framework based on the ADKAR stages of change and the necessary components for successful change implementation based on the McKinsey's 7S framework. The 7S framework effectively demonstrates a systematic and comprehensive approach to change on an organizational level, including the 7 constructs: staff, style/culture, skills, strategy, systems, structure, with shared culture at the center of change. However, change starts at the individual level. Within the STOP-VIRUS Collaborative, the participants from each site are the catalyst for change. As a result, this is reflected through the stages of change embodied in the ADKAR model: awareness, desire, knowledge, ability, and reinforcement. Together, they provided a continuum that enable individual healthcare providers to impact change on an organization level. CONCLUSION(S): STOP-VIRUS collaborative was a multicenter, interprofessional, and diverse learning environment that re-emphasized best-practice guidelines. It provides valuable support to institutions at various stages of readiness for quality improvement initiatives, with important lessons that can be applied to future virtual collaboratives.

7.
Critical Care Medicine ; 51(1 Supplement):117, 2023.
Article in English | EMBASE | ID: covidwho-2190501

ABSTRACT

INTRODUCTION: ICU admission occurs for active treatment (ventilation, vasopressors) and to monitor patients at risk. The Acute Physiology and Chronic Health Evaluation (APACHE) IVb defines Low Risk Monitor (LRM) as not actively treated on ICU day 1 and < 10% prospective risk of ever needing active treatment. LRM patients potentially fill ICU beds required by acutely ill patients. We investigated if unprecedented ICU demand during the COVID-19 pandemic decreased LRM admissions during COVID surges. METHOD(S): Retrospective analysis of hospitals tracking COVID-19 status and consistently contributing to the APACHE database March 23, 2020 to December 31, 2021. Baseline pre-pandemic data was also assessed. Patients with primary surgical and trauma diagnoses were removed to eliminate incidental COVID diagnoses. Pearson's correlation coefficient (r) assessed the weekly relationship between %COVID and LRM patients. RESULT(S): 117,004 patients were admitted to ICU at 43 hospitals. Baseline LRM averaged 28.6% pre-COVID. During successive COVID peaks in April, July and December 2020 and April, August and December 2021, there was high inverse correlation (r=-0.90) between COVID census and LRM percentage. For example, in September 2020 COVID% was 7.81 and LRM was 28.2%. In December 2020, COVID surged to 31.1% and LRM dropped to 21.3%. These percentages returned to COVID 9.5% and LRM 28.2% during the March 2021 trough. Hospital mortality was 10.9% pre-pandemic, and 14.69% actual/13.66 predicted (SMR=1.08) from April 2020 through December 2021. Mean ventilator days were 4.08 pre- and 5.58 pandemic. ICU LOS increased from 3.52 to 4.16 days (ratio 1.11). CONCLUSION(S): LRM admissions decreased dramatically during successive COVID-19 surges, demonstrating considerable elasticity in ICU triage decisions. Mortality, ventilator days and ICU LOS all increased during the pandemic compared to baseline. Consistent measurement of % LRM may be helpful in recognizing opportunities to reduce inappropriate ICU bed utilization and as a marker of strained capacity.

8.
Critical Care Medicine ; 51(1 Supplement):60, 2023.
Article in English | EMBASE | ID: covidwho-2190474

ABSTRACT

INTRODUCTION: Cardiac function is known to be negatively impacted by sepsis. Monitoring Cardiac Output (CO) and Stroke volume (SV) trends over the course of treatment may provide insight into cardiac function and may be used to predict patient outcome. In the FRESH study, we have previously shown that patients who improve CO and SV exhibit improved outcome such as decreased mortality and decreased need for ventilation. The goal of this study was to explore the relationship between the change in stroke volume and cardiac output in patients with LV and RV Dysfunction. METHOD(S): The Starling Registry study is an observational registry study evaluating trends in CO and SV over time as related to patient outcome (NCT04648293). Patients that exhibited an overall improvement in CO (first CO measurement compared to last CO measurement) were compared to those who did not exhibit improvement. RESULT(S): 71 patients with LV/RV dysfunction received hemodynamic monitoring during their stay across 4 units at 3 hospitals. 48% were female, and the average age was 68 years. 67% of the patients had sepsis, and 17% of patients were positive for COVID. Notably, in this population of LV/ RV dysfunction, patients with COVID (p=0.016), pneumonia (p=0.034) and those that required oxygen treatment (p=0.034) were less likely to improve Cardiac Output following fluid challenge. CONCLUSION(S): Patients with LV/RV dysfunction represent a vulnerable population. We have previously shown the benefits of trending cardiac output and stroke volume in this patient population (ATS, 2018). Trends observed in this population may help indicate which patients may be at risk for more negative outcome.

9.
Paediatrics and Child Health (Canada) ; 27(Supplement 3):e28, 2022.
Article in English | EMBASE | ID: covidwho-2190145

ABSTRACT

BACKGROUND: There are limited data on outcomes of SARS-CoV-2 infection among infants (<1 year of age). In the absence of approved vaccines for infants, understanding characteristics associated with hospitalization and severe disease from COVID-19 in this age group will help inform clinical management and public health interventions. OBJECTIVE(S): The objective of this study was to describe the clinical manifestations, disease severity, and characteristics associated with hospitalization among infants infected with the initial strains of SARS-CoV-2. DESIGN/METHODS: This is a nationwide prospective observational study using the infrastructure of the Canadian Paediatric Surveillance Program. All cases of infants aged <1 year of age with microbiologically confirmed SARS-CoV-2 infection were reported from April 8th 2020 to May 31st 2021, and were classified by disease severity and primary cause of hospitalization. Multivariable logistic regression was performed to identify infants' characteristics associated with hospitalization. RESULT(S): A total of 531 cases were reported, including 332 (62.5%) non-hospitalized and 199 (37.5%) hospitalized infants. Among hospitalized infants, 141 of 199 infants (70.9%) were admitted because of COVID-19-related illness, and 58 (29.1%) were admitted for reasons other than acute COVID-19. Amongst all cases with SARS-CoV-2 infection, the most common presenting symptoms included fever (66.5%), coryza (47.1%), cough (37.3%) and decreased oral intake (25.0%). In our main analysis, infants with a comorbid condition had higher odds of hospitalization compared to infants with no comorbid conditions, and infants <1 month had higher odds of hospitalization than infants aged 1-3 months (Table). In total, 20 infants (3.8%) met criteria for severe disease. CONCLUSION(S): We describe one of the largest cohorts of infants with SARS-CoV-2 infection. Overall, severe COVID-19 in this age group is uncommon with most infants having mild disease. Comorbid conditions and younger age were associated with COVID-19-related hospitalization amongst infants.

10.
Open Forum Infectious Diseases ; 9(Supplement 2):S823, 2022.
Article in English | EMBASE | ID: covidwho-2190001

ABSTRACT

Background. Despite HIV test and treat initiatives, the World Health Organization (WHO) estimates that 25% to 40% of persons living with HIV (PLWH) have advanced HIV disease (CD4< 200 cells/mcL). The objective of this study is to understand how the Covid-19 pandemic affected identification of persons with advanced HIV disease in Ugandan HIV clinics. Methods. We retrospectively reviewed data from 67 HIV clinics surrounding Kampala, Uganda. As part of routine data collection for PEPFAR reporting, number of persons entering care by clinic and number of persons presenting with CD4< 200 cells/mcL were summarized by month between July 2019 and January 2022. We used the Johns Hopkins Coronavirus Resource Center website to summarize Ugandan Covid-19 cases by month. Covid-19 lockdown dates were taken from the Ugandan government's COVID-19 information website. Specifically, between March and May 2020, there was a period of strict lockdown where public transportation was halted. Between May and July 2020 there was a less stringent lockdown (public transportation was available, but schools and many businesses remained closed). Again between June and July 2021 a strict lockdown occurred. Results. Prior to the Covid-19 pandemic, between July 2019 and February 2020, an average of 16% (265/1675) of PLWH presented monthly with advanced HIV disease. During Covid-19 lockdowns from March 2020 to July 2020, only 9% (102/1124) of PLWH presented with advanced HIV disease. During the period of lockdown, there was a 33% reduction in the monthly average number of PLWH presenting to HIV clinics, and a 62% reduction in the monthly average number of PLWH presenting with advanced HIV disease. From February 2021 to January 2022, 18% (185/987) of PLWH presented with advanced HIV disease. During this period, there was a 42% reduction in the number of persons presenting to HIV care;of those who presented, a larger portion presented with advanced HIV disease. Conclusion. The Covid-19 lockdowns negatively affected presentation of PLWH to care, most significantly among persons with advanced HIV disease. This reduction in presentation to care has persisted and not recovered to pre-Covid levels. In the past year, 18% of PLWH presented with advanced HIV disease.

11.
Open Forum Infectious Diseases ; 9(Supplement 2):S774-S775, 2022.
Article in English | EMBASE | ID: covidwho-2189963

ABSTRACT

Background. New adjuvanted recombinant protein vaccines against coronavirus disease 2019 (COVID-19) as heterologous boosters could maximize the benefits of vaccination against SARS CoV-2. Methods. In this randomized, single-blinded, multicenter trial, adults who had received two doses of Pfizer-BioNTech mRNA vaccine (BNT162b2) 3-7 months before were randomly assigned to receive a boost of BNT162b2, Sanofi/GSK SARS-CoV-2 adjuvanted recombinant protein MV D614 (monovalent parental formulation) or SARS-CoV-2 adjuvanted recombinant protein MV B.1.351 vaccine (monovalent Beta formulation). The primary endpoint was the percentage of subjects with a >= 10-fold increase in neutralizing antibody titers for the Wuhan (D614) and B.1.351 (Beta) SARS-CoV-2 viral strains between D0 and D15. Results. The percentages of participants whose neutralizing antibody titers against the Wuhan (D614) SARS-CoV-2 strain increased by a factor >= 10 between Day 0 and Day 15 was 55.3% (95% CI 43.4-66.7) in MV(D614) group (n=76), 76.1% (64.5-85.4) in MV(Beta) group (n=71) and 63.2% (51.3-73.9) in BNT162b2 group (n=76). These percentages were 44.7% (33.3-56.6), 84.5% (74.0-92.0) and 51.3% (39.6-63.0) for the B.1.351 (Beta) viral strain, respectively. Higher neutralizing antibodies rates against Delta and Omicron BA.1 variants were also elicited after Sanofi/GSK MV(Beta) vaccine compared to the other vaccines. Comparable reactogenicity profile was observed the three vaccines. Conclusion. All three vaccines boosted antibodies and neutralizing response after BNT162b2 initial course. Heterologous boosting with the Sanofi/GSK SARS-CoV-2 adjuvanted recombinant protein vaccine B.1.351 (Beta formulation) provided higher neutralizing antibodies response rates against variants, including Omicron BA.1, compared with the mRNA BNT162b2 vaccine.

12.
Open Forum Infectious Diseases ; 9(Supplement 2):S737-S738, 2022.
Article in English | EMBASE | ID: covidwho-2189890

ABSTRACT

Background. Environmental surveillance of SARS-CoV-2 via wastewater has become an invaluable tool for population-level surveillance of COVID-19. More highly resolved environmental sampling approaches may also be useful for surveillance. Built environment sampling may provide a spatially refined approach for surveillance of COVID-19 in congregate living settings. Methods. We conducted a prospective study of 10 long-term care homes (LTCHs) in both urban and rural settings in Ontario Canada between September 2021 and April 2022. Floor surfaces were sampled weekly at multiple locations within each building and were analyzed for the presence of SARS-CoV-2 using qPCR. The exposure variable was detection of SARS-CoV-2 on floors. The primary outcome was the presence of a COVID-19 outbreak. We calculated the test characteristics of the presence of SARS-CoV-2 on floors for detection of COVID-19 outbreaks. Results. We followed 10 LTCHs for 214 cumulative weeks, and collected 3,219 swabs from 183 unique locations. Overall, 15 COVID-19 outbreaks occurred with 74.9 cumulative weeks of outbreaks. During time periods when there were outbreaks of COVID-19 the proportion of floor swabs positive for SaRS-CoV-2 was 50.8% (95% CI: 47.7-53.9). During time periods where there were no outbreaks of COVID-19 the proportion of floor swabs positive was 15.8% (95% CI:14.3-17.3). Using the proportion of positive floor swabs for SARS-CoV-2 to predict COVID-19 outbreak status for a given week, the area under the receiver operating curve was 0.84 (95% CI: 0.76-0.92). Using thresholds of >=10%, >=30%, and >=50%, the prevalence of floor swabs positive for SARS-CoV-2 yielded positive predictive values for outbreak of 0.52 (0.43-0.61), 0.65 (0.53-0.75), and 0.72 (0.58-0.83) respectively, and negative predictive values of 0.93 (0.86-0.97), 0.85 (0.78-0.91), and 0.80 (0.73-0.86) respectively (Figure 1). 13 outbreaks had floor sampling performed in the week prior to them being identified, and of these 7 (54%) had positive swab proportions exceeding 30% in the week prior to the outbreak. Figure 1. Test characteristics of built environment floor swabs for predicting COVID-19 outbreaks in LTCH. Figure 1. Test characteristics of different thresholds for percentage of floor swabs positive for SARS-CoV-2 at a given LTCH for predicting active COVID-19 outbreak in the same building in the same week. NPV = negative predictive value, PPV = positive predictive value, Sens = sensitivity, Spec = specificity. Conclusion. Detection of SARS-CoV-2 on floors is strongly associated with COVID-19 outbreaks in LTCHs. These data suggest a potential role for floor sampling in improving early outbreak detection and management.

13.
Open Forum Infectious Diseases ; 9(Supplement 2):S505, 2022.
Article in English | EMBASE | ID: covidwho-2189814

ABSTRACT

Background. There is growing recognition of metagenomic next-generation sequencing (mNGS) as a valuable diagnostic tool capable of providing unbiased pathogen detection, but data on performance in low-resource settings remains scant. Here, we use mNGS of nasopharyngeal (NP) swabs taken from subjects in Cambodia to identify potential pathogens causing acute febrile illness. Methods. Febrile subjects aged 2 months to 65 years were enrolled in a crosssectional study conducted across 4 tertiary hospitals in Cambodia. NP swabs were collected at hospital presentation. Depending on reported symptom constellations, sera was also taken in a subset of subjects for comparison of mNGS results. RNA was isolated from biosamples, converted to cDNA libraries, and sequenced on a NextSeq2000 (Illumina). Raw sequence reads were stripped for host reads and aligned to NCBI nucleotide and protein databases using a cloud-based bioinformatics platform (CZID). Results. NP swabs were collected from 97 subjects between April 2020 and June 2021. Subjects were predominantly male (53.6%) and young (median age 3 years [IQR 1-25]). Pathogens were identified in 42 (43.2%) NP swabs;of these, 26 (61.9%) were respiratory viruses including 9 rhinovirus, 7 coronavirus (1 SARS-CoV-2), and 5 respirovirus cases. Co-infection was identified in 3 subjects with coronavirus and respirovirus (N=2) and coronavirus and rhinovirus (N=1). Of subjects with paired sera and NP samples (N=61), 18 (29.5%) had positive NP swabs but negative sera, 7 (11.5%) had negative NP swabs but positive sera, 12 (19.7%) had positive NP swabs and sera, and 24 (39.3%) had negative NP swabs and sera. Pathogen hits correlated in NP swabs and sera in 10 of 12 subjects, including six subjects with chikungunya. Conclusion. mNGS can be successfully implemented in low-resource settings to identify emerging pathogens and common respiratory pathogens, including coinfecting pathogens, from NP swabs of febrile patients. mNGS may also be able to detect chikungunya from NP swab alone, raising the possibility of non-invasive diagnostics for infections associated with high viremic states.

14.
Open Forum Infectious Diseases ; 9(Supplement 2):S472-S473, 2022.
Article in English | EMBASE | ID: covidwho-2189762

ABSTRACT

Background. The COVID-19 pandemic has caused a major public health crisis and is now a leading cause of death. At the start of the COVID-19 pandemic, treatment was limited to supportive care and off-label use of a variety of agents as we awaited the results of randomized controlled trials (RCTs). Our understanding of the disease has evolved and multiple evidence-based (EBM) treatment strategies supported by RCTs are now approved for use. Interpreting emerging data while responding to the pandemic can been challenging. We seek to understand the use of common medications during the COVID-19 pandemic. Methods. A survey was developed and disseminated through Infectious Diseases Society of America (IDSA) IDea network, IDSA Antimicrobial Stewardship Centers for Excellence and the Society for Healthcare Epidemiology messaging boards. Data collected included city, therapeutic options including convalescent plasma (CP), hydroxychloroquine (HCQ), baricitinib and tocilizumab during each COVID-19 wave. Results. A total of 78 responses were collected, representing wide geographic reach in the US (Figure 1). Use of HCQ declined by 96% and use of CP declined by 85% (Figure 2). The decline in CP was gradual each wave despite RCTs showing lack of benefit. Tocilizumab was used in 71% and 76% of hospitals during the first wave, prior to RCT data supporting its use. Baricitinib was used in 42% of hospitals prior to RCT data supporting its use. There was a 90% increase in baricitinib use after RCT data emerged. (Figure Presented) Conclusion. The use of therapies before proven benefit was common through the pandemic. Similarly, the use of therapies after benefit was in question continued. Hydroxychloroquine was widely used in the first wave and then halted by the majority of hospitals in subsequent COVID-19 surges. IL-6 and JAK-2 inhibitors were commonly used prior to evidence of benefit and were more widely adopted once evidence emerged. Convalescent plasma use was common despite lack of evidence and its use continued despite multiple negative RCTs. Overall, our survey shows a gap between evidence and practice. Communicating evidence-based treatment strategies is a vital priority for major professional societies. Translating evidence into practice remains challenging during public health emergencies like the COVID-19 pandemic.

15.
Open Forum Infectious Diseases ; 9(Supplement 2):S436, 2022.
Article in English | EMBASE | ID: covidwho-2189692

ABSTRACT

Background. The COVID-19 pandemic has overwhelmed health systems around the world, causing access problems. The patient referral system in Caracas, Venezuela has no interinstitutional coordination, patients are given a note by the referring center and thereafter seeking care relies on themselves. We studied primarily to what extent the Caracas healthcare system satisfied the demand for hospitalization of severe COVID-19 during periods of congestion, measured in proportion of patients not hospitalized;and secondly how difficult it was for patients with severe COVID-19 to meet their need of hospitalization, measured in number of days and visits made to health centers until hospitalization or desisting from further searching. Methods. This study was approved by national bioethics committee. We included all symptomatic patients who attended the University Hospital of Caracas COVID-19 testing center, whose nasopharyngeal swab PCR was positive for SARS-CoV-2, and whose SpO2 was 93% or less between 07/01/2020 and 07/24/2020, the period in which we referred patients due to unavailability of beds in our center. Results. Ninety-four patients were included, 66 (70%) were men, the mean age was 58 years (range, 25-87 years), the median number of comorbidities was 1 (range, 0-3), and the median SpO2 was 90% (range, 30%-93%). Fourty-three (46%) patients were never admitted following referral from our center. Referred patients required a median of 1 day (range, 1-15 days) and 2 visits (range, 1-41 visits) to being admitted, or a median of 2 days (range, 1-17 days) and 5 visits (range, 1-31 visits) to desisting from further searching for admission. Conclusion. These data show that the healthcare system did not meet the hospitalization needs of half of the patientswith severe COVID-19 during the peak of the first wave of the pandemic in Caracas. The data also show that referred patientsfaced a major delay in being hospitalized, and that referred patients had to perform multiple visits to healthcare centers accross the city as a consequence of insufficient system capacity, increasing their urban mobility and therefore their probabilities of transmitting SARS-CoV-2 to others.

16.
Open Forum Infectious Diseases ; 9(Supplement 2):S370, 2022.
Article in English | EMBASE | ID: covidwho-2189671

ABSTRACT

Background. The COVID pandemic shifted antimicrobial stewardship resources at community hospitals. One reason for this shift was new COVID treatments, the first of which was remdesivir, which received initial emergency use authorization (EUA) for the treatment of COVID-19 in May 2020. The UNC Health Southeastern (UNC SEH) pharmacy director stewarded remdesivir by reviewing patients to ensure they met emergency use authorization (EUA) and guideline-based appropriateness criteria. The infectious diseases physician resolved any disputes regarding patient candidacy for remdesivir. The goal of remdesivir stewardship was to optimize care;however, the shift in workflow presented an unrecognized opportunity for stewards to reduce remdesivir costs. Methods. The percentage of COVID patient admissions receiving remdesivir at UNC SEH for calendar years 2020 and 2021 was benchmarked against 32 community hospitals in the Duke Antimicrobial Stewardship Outreach Network (DASON) (Figure 1). UNC SEH purchasing data were used to calculate remdesivir expenditures for 2020 and 2021. Next, the anticipated cost if the hospital had prescribed remdesivir to the same percentage of admissions as the DASON mean was calculated. The difference was calculated to determine the cost avoidance achieved by having below average use of remdesivir (Table 1). Results. At UNC SEH, 28.1% of COVID admissions received remdesivir in 2020 and annual remdesivir expenditures were $693,680. In 2021, 47.45% of COVID-19 admissions received remdesivir and drug expenditures were $1,248,000. The DASON mean % of COVID admissions receiving remdesivir in 2020 was 44.08% and 60.07% in 2021. A total cost avoidance of $726,407 was calculated based on the hospital's below-benchmark use of remdesivir (Table 1). Conclusion. UNC SEH achieved significant cost-savings in 2020 and 2021 due to active remdesivir stewardship. The team created a patient-centered model that focused on using drugs for the right patients and the organization realized cost-savings while ensuring that patients received therapy in accordance with remdesivir EUAs and published guidelines.

17.
European Heart Journal, Supplement ; 24(Supplement K):K142, 2022.
Article in English | EMBASE | ID: covidwho-2188678

ABSTRACT

Background: Several reports have described the negative prognostic impact of ageing in patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary angioplasty. During the COVID-19 pandemic, increased mortality was observed in patients admitted for STEMI. However, there are no data on the impact of ageing on the outcome of this high-risk patients during the pandemic. Objective(s): The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving primary PCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 11920 of March until June 30, 2019 and 2020). Primary study endpoint of this analysis was in-hospital mortality. Secondary endpoints was 30-day mortality. Result(s): Our population is represented by 16083 STEMI patients undergoing mechanical reperfusion, who were divided according to age (< 55 years, n = 4179 (25,98%);55-65 years, n = 4814 (29,93%);65-75 years, n = 4016 (24,97%);75-65 years, n = 2226 (13,84%);>85 years, n = 821 (5,10%). Ageing was linearly and independently associated with in-hospital (figure 1) and 30-day mortality (adjusted p < 0.0001). The COVID pandemic had a significant impact on in-hospital and 30-day mortality (adjusted p < 0.001), that was linearly related to age, particularly for inhospital mortality (Figure 1). Conclusion(s): Our study showed that among STEMI patients undergoing primary angioplasty, age was linearly associated to mortality in both precovid and covid era. The COVID-19 pandemic had a significant impact on mortality, especially in more advanced age.

18.
Methods of information in medicine ; 09, 2023.
Article in English | EMBASE | ID: covidwho-2186475

ABSTRACT

BACKGROUND: Digitalization is playing a major role in mastering the current coronavirus 2019 (COVID-19) pandemic. However, several outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in German hospitals last year have shown that many of the surveillance and warning mechanisms related to infection control (IC) in hospitals need to be updated. OBJECTIVE(S): The main objective of the following work was to assess the state of information technology (IT) systems supporting IC and surveillance in German university hospitals in March 2021, almost a year into the SARS-CoV-2 pandemic. METHOD(S): As part of the National Research Network for Applied Surveillance and Testing project within the Network University Medicine, a cross-sectional survey was conducted to assess the situation of IC IT systems in 36 university hospitals in Germany. RESULT(S): Among the most prominent findings were the lack of standardization of IC IT systems and the predominant use of commercial IC IT systems, while the vast majority of hospitals reported inadequacies in the features their IC IT systems provide for their daily work. However, as the pandemic has shown that there is a need for systems that can help improve health care, several German university hospitals have already started this upgrade independently. CONCLUSION(S): The deep challenges faced by the German health care sector regarding the integration and interoperability of IT systems designed for IC and surveillance are unlikely to be solved through punctual interventions and require collaboration between educational, medical, and administrative institutions. Copyright The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/

19.
J Neuroradiol ; 2023.
Article in English | PubMed | ID: covidwho-2181827

ABSTRACT

BACKGROUND AND PURPOSE: Cerebral hypoperfusion has been reported in patients with COVID-19 and neurological manifestations in small cohorts. We aimed to systematically assess changes in cerebral perfusion in a cohort of 59 of these patients, with or without abnormalities on morphological MRI sequences. METHODS: Patients with biologically-confirmed COVID-19 and neurological manifestations undergoing a brain MRI with technically adequate arterial spin labeling (ASL) perfusion were included in this retrospective multicenter study. ASL maps were jointly reviewed by two readers blinded to clinical data. They assessed abnormal perfusion in four regions of interest in each brain hemisphere: frontal lobe, parietal lobe, posterior temporal lobe, and temporal pole extended to the amygdalo-hippocampal complex. RESULTS: Fifty-nine patients (44 men (75%), mean age 61.2 years) were included. Most patients had a severe COVID-19, 57 (97%) needed oxygen therapy and 43 (73%) were hospitalized in intensive care unit at the time of MRI. Morphological brain MRI was abnormal in 44 (75%) patients. ASL perfusion was abnormal in 53 (90%) patients, and particularly in all patients with normal morphological MRI. Hypoperfusion occurred in 48 (81%) patients, mostly in temporal poles (52 (44%)) and frontal lobes (40 (34%)). Hyperperfusion occurred in 9 (15%) patients and was closely associated with post-contrast FLAIR leptomeningeal enhancement (100% [66.4%-100%] of hyperperfusion with enhancement versus 28.6% [16.6%-43.2%] without, p=0.002). Studied clinical parameters (especially sedation) and other morphological MRI anomalies had no significant impact on perfusion anomalies. CONCLUSION: Brain ASL perfusion showed hypoperfusion in more than 80% of patients with severe COVID-19, with or without visible lesion on conventional MRI abnormalities.

20.
Clinical Neurophysiology ; 141(Supplement):S127, 2022.
Article in English | EMBASE | ID: covidwho-2177660

ABSTRACT

Introduction: This study was aimed to assess the clinical features and electrophysiological subtypes of patients with Guillain-Barre syndrome (GBS) in Istanbul, as well as to analyze the probably different characteristics of COVID-associated GBS. Method(s): From the patients who were admitted to the major hospitals in Istanbul between April 2019 and November 2021, those aged over 18 years and diagnosed as having GBS within the 21 days after the initial symptoms were selected for the study. Electrophysiologic examinations were performed twice within the first 6 weeks along with close clinical observation throughout the acute illness. The patients were divided into groups as those admitted in the pre-pandemic and pandemic periods. The characteristics of the patients who developed GBS after COVID infection (C-GBS) were also evaluated separately. Axonal and demyelinating subtypes were determined according to the previously described electrophysiologic criteria. Result(s): From 12 centers, 134 patients were included in the study. The number of patients diagnosed in the pre-pandemic and pandemic periods were 61 and 73, respectively. Eighteen patients developed C-GBS in the pandemic era. According to Uncini's criteria, 33.6% of the patients were classified as axonal GBS (29/45 patients had reversible conduction failure) and electrophysiological distinction could not be made in 8.2% of the patients. In the second electrophysiological examination performed in 116 patients, the subtype diagnosis was changed in 29 who had been classified according to the Hadden's criteria in the first examination and in 17 who had been categorized by using Rajabally's criteria. Sensory symptoms were found in all C-GBS patients and in only 67.9% of all patients diagnosed during the pandemic (p = 0.006). The frequency of demyelinating subtype was 83.3% in the C-GBS group, and this rate was 47.8% in the patients without recent COVID infection (p = 0.026). While MRC sum score, Hughes score, and modified Erasmus outcome score were not found to be different in the pre-pandemic and post-pandemic groups, C-GBS had lower Hughes score (<3) than the other patients diagnosed during the pandemic (p = 0.040). Conclusion(s): The frequency of axonal GBS in Istanbul, a large metropole inhabiting people from every region of Turkey, seems to be placed in between the values reported from high and low incidence countries. The second electrophysiologic examination is important for precise determination of the subtypes. C-GBS seems to cause more frequent sensory symptoms, demyelinating electrophysiologic characteristics, and moderate clinical features. Copyright © 2022

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