Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 42
Filter
1.
Journal of Translational Internal Medicine. ; 2022.
Article in English | EMBASE | ID: covidwho-2065372

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has brought severe challenges to global public health. Many studies have shown that obesity plays a vital role in the occurrence and development of COVID-19. Obesity exacerbates COVID-19, leading to increased intensive care unit hospitalization rate, high demand for invasive mechanical ventilation, and high mortality. The mechanisms of interaction between obesity and COVID-19 involve inflammation, immune response, changes in pulmonary dynamics, disruptions of receptor ligands, and dysfunction of endothelial cells. Therefore, for obese patients with COVID-19, the degree of obesity and related comorbidities should be evaluated. Treatment methods such as administration of anticoagulants and anti-inflammatory drugs like glucocorticoids and airway management should be actively initiated. We should also pay attention to long-Term prognosis and vaccine immunity and actively address the physical and psychological problems caused by longterm staying-At-home during the pandemic. The present study summarized the research to investigate the role of obesity in the incidence and progression of COVID-19 and the psychosocial impact and treatment options for obese patients with COVID-19, to guide the understanding and management of the disease. Copyright © 2022 Sijia Fei, Xinyuan Feng, Jingyi Luo, Lixin Guo, Qi Pan, published by Sciendo 2022.

2.
Pharmaceutical Journal ; 309(7964), 2022.
Article in English | EMBASE | ID: covidwho-2065050
3.
Pharmaceutical Journal ; 306(7950), 2022.
Article in English | EMBASE | ID: covidwho-2064956
4.
Chest ; 162(4):A2242, 2022.
Article in English | EMBASE | ID: covidwho-2060917

ABSTRACT

SESSION TITLE: Post-COVID-19 Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Obesity, a risk factor for severe COVID-19 disease, multiplies the risk of hospitalization and mortality. Its impact in lung disease is mediated by altered inflammatory responses and respiratory mechanics. Studies of lung function among COVID-19 disease survivors have identified reduced TLC and DLCO as prominent changes in this population. Obesity, however, is associated with elevated DLCO in otherwise healthy individuals. The objective of this study was to evaluate whether this relationship was preserved among COVID-19 disease survivors. Additionally, we sought to analyze whether maximum FiO2, peak neutrophil-to-lymphocyte ratio (NLR), diabetes or smoking status had any effect in DLCO. METHODS: The charts of adult patients hospitalized with confirmed SaRS-CoV-2 infection between 3/20/2020 and 12/31/2021 were reviewed. Those who survived and later had a PFT were selected, and 73 patients met these criteria. Eighteen were excluded due to radiographic or prior PFT findings of emphysema (COPD or AATD) or ILD, and missing diffusion study data. Patients were stratified by BMI class. Patient characteristics were compared using ANOVA and Pearson correlation. Other outcomes were analyzed using linear regression. RESULTS: A total of 55 patients were included. Average age was 55.6 years. Average BMI and DLCO were distributed as follows: healthy (23.76;16.94), overweight (28.3;17.50), obesity classes I (32.3;18.86), II (37.8;17.68), and III (48.2;24.56). ANOVA shows a significant effect of BMI class on DLCO (F4,50=4.067, p=0.006). A significant positive correlation between BMI and DLCO was observed (r=0.392, p=0.003). When comparing BMI classes, Tukey’s HSD test shows that there was a significant difference only when patients classified as overweight (-22.9, p=0.01), or with obesity classes I (-20.2, p=0.02) or II (-24.0, p=0.005), were individually compared to obesity class 3. Regression analysis showed no significant effect of peak FiO2 (-0.056, p=0.07), NLR (-0.051, p=0.60), diabetes (-0.932, p=0.50), or smoking status (0.764, p=0.505). Overall regression between dependent and independent variables is not significant (F4,50=2.21, p=0.082). CONCLUSIONS: These findings suggest that higher obesity is associated with higher DLCO. This is consistent with the known effect of obesity on diffusion capacity, resulting from increased blood volume in the pulmonary circulation. The relationship was preserved even though most patients had DLCO below the percent predicted, as observed in studies of lung function among COVID-19 survivors. Notably, FiO2 and NLR did not have a significant effect on DLCO. CLINICAL IMPLICATIONS: Though patients surviving a COVID-19 hospitalization may have a reduced DLCO, the positive relationship between BMI and DLCO is similar to that observed in otherwise healthy obese individuals. DISCLOSURES: No relevant relationships by Mohammad Arabiat No relevant relationships by Justin Horner No relevant relationships by Harold Matos Casano No relevant relationships by Doug McElroy No relevant relationships by Karan Singh No relevant relationships by Michael Smith

5.
Chest ; 162(4):A664, 2022.
Article in English | EMBASE | ID: covidwho-2060663

ABSTRACT

SESSION TITLE: A Look Into Poisoning and Drug Overdoses SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: We present a case of a 64-year-old woman with severe obesity (BMI 53) who presented with shock after beta-blocker (BB) and calcium channel-blocker (CCB) overdose. CASE PRESENTATION: The patient presented after an intentional suicide attempt, taking multiple antihypertensive medications, including tablets of nifedipine 90mg, carvedilol 25mg, and losartan 100mg. She had also been experiencing shortness of breath and lower extremity pain for several days. Upon arrival, she was lethargic and minimally responsive, and was found to be in shock with a heart rate 63. She was intubated for airway protection and started on multiple vasopressors including norepinephrine, phenylephrine, vasopressin, dopamine and epinephrine for circulatory support. She was also found to be positive for SARS-CoV-2. She was given activated charcoal, received gastric lavage, and whole bowel irrigation. She received a bolus of regular insulin at 1U/kg, and subsequently started on a high-dose insulin infusion titrated to 11U/kg/h along with dextrose infusion and calcium gluconate. By day four of admission, vasopressor requirements had been reduced to only norepinephrine and the insulin infusion had been successfully discontinued. However, her hospital course was further complicated MRSA and Pseudomonas pneumonia, and renal failure requiring hemodialysis. She continued to develop refractory shock, and remained over 50 liters net positive. Her condition progressively deteriorated and her gross volume overload was difficult to manage, and ultimately expired on day ten of admission. DISCUSSION: The management of CCB and BB overdose has been studied, with hyperinsulinemic euglycemic therapy (HIET)1,2 as our choice. Our patient's decline was likely secondary to the high volumes of dextrose infusion required after HIET. With underlying renal failure, insulin clearance proved to be a significant challenge. Such severe obesity with a weight-based regimen resulted in over 1500U insulin/hr at any given point with our patient. Renal clearance is governed by a proportion of t/V, where t denotes length of a dialysis session and V the volume of fluid in the patient's body.3 Patients with significant volume would require extensive dialysis sessions and fluid balances would be challenging. Continuous renal replacement therapy (CRRT) was attempted later in her hospital course. However, the patient was not able to tolerate it as she had progressed to multiorgan failure. CONCLUSIONS: HIET has shown to be a successful management strategy for CCB and BB overdose. However, weight-based dosing can prove to be a challenge in patients with severe obesity. CRRT should be considered early in severely obese patients that undergo HIET, given the rapid accumulation of fluid secondary to the large-volume insulin and dextrose infusions. Further investigations should look into identifying maximal safe dosages of HIET, especially in severely obese patients. Reference #1: Cole JB, Arens AM, Laes JR, Klein LR, Bangh SA, Olives TD. High dose insulin for beta-blocker and calcium channel-blocker poisoning. Am J Emerg Med. 2018 Oct;36(10):1817-1824. doi: 10.1016/j.ajem.2018.02.004 Reference #2: Krenz JR, Kaakeh Y. An Overview of Hyperinsulinemic-Euglycemic Therapy in Calcium Channel Blocker and β-blocker Overdose. Pharmacotherapy. 2018 Nov;38(11):1130-1142. doi: 10.1002/phar.2177 Reference #3: Turgut F, Abdel-Rahman E, M: Challenges Associated with Managing End-Stage Renal Disease in Extremely Morbid Obese Patients: Case Series and Literature Review. Nephron 2017;137:172-177. doi: 10.1159/000479118 DISCLOSURES: No relevant relationships by Alejandro Garcia No relevant relationships by Vishad Sheth no disclosure on file for Andre Sotelo;

6.
Journal of the Intensive Care Society ; 23(1):112, 2022.
Article in English | EMBASE | ID: covidwho-2043020

ABSTRACT

Introduction: Nutritional optimisation is recognised as having significant impact on clinical and functional outcomes of critically ill patients.1 Clinical recommendations suggest use of indirect calorimetry guided nutrition in the intensive care unit (ICU),2 and a recent systematic review demonstrated improved outcomes from its use.3 The COVID-19 pandemic has seen a greater proportion of patients with prolonged critical illness, a cohort for whom nutritional optimisation is a key unmet need.4 Objectives: To assess rates of over and underfeeding in a tertiary centre ICU and how these relate to markers of catabolism and persistent critical illness. Methods: Serial measurements of REE (resting energy expenditure) and RQ (respiratory quotient) by indirect calorimetry were performed using Q-NRG+ device (COSMED, Rome, Italy). Nutritional intake and estimations of requirements were recorded concurrently together with routine clinical observations, and markers of critical illness, catabolism and over or underfeeding. Results: Across 30 patients, REE was lower than estimated energy requirements, 24.2 (IQR 20.0-28.1) kcal/ day/kg IBW vs. 29.1(IQR 25.4-33.1) kcal/day/kg IBW, p<0.001. 41.8% of measurements showed overfeeding (actual calorie intake >110% of REE), and 23.3% showed underfeeding (actual calorie intake <85% of REE). Obese patients (n=15) were underfed (-98kcal/day deficit) compared to non-obese patients (n=15), who were on average overfed (+256kcal/day surplus), p=0.021. Overfeeding was also associated with greater length of ICU admission (R2 0.159, p<0.005). Median day of ICU admission in overfed patients was 39 days (IQR 24-56), and in underfed patients 21.5 (IQR 7.5-45.25). However, there was no significant association between calorie surplus or deficit, and other markers of overfeeding PaCO2, insulin use, ureacreatinine-ratio. Conclusion: This service evaluation recorded measurements of REE and RQ in critically ill patients with high lengths of ICU stay (up to 66 days). We observed increased rates of overfeeding with increased duration of ICU admission, and increased overfeeding in non-obese patients.

7.
Journal of the Intensive Care Society ; 23(1):58-60, 2022.
Article in English | EMBASE | ID: covidwho-2042954

ABSTRACT

Introduction: Prior to the COVID-19 pandemic, evidence in favour of prone positioning was mainly limited to mechanically ventilated patients with ARDS.1 Although there were some reports of oxygenation improvement following conscious prone positioning (CPP) in non ventilated patients, 2,3 this intervention was largely unknown outside of critical care units. The pandemic imposed extraordinary pressures on hospitals, encouraging medical teams to innovate and consider CPP in patients with increasing oxygen requirements.4 In April 2020, the Intensive Care Society (ICS) issued guidance for CPP of patients presenting respiratory failure secondary to COVID-19.5 Objectives: The objectives of the study were to assess the practice of CPP and the compliance to ICS guidance in the Northwest of England. We also aimed to evaluate the feasibility of proning and to appraise the impact of position changes on oxygenation. The study was also an opportunity to encourage multidisciplinary teams to consider CPP as a therapeutic tool for patients admitted with COVID-19 pneumonitis in non-critical care areas. Methods: This was a pragmatic observational prospective cohort study conducted over five weeks in May and June 2020 across seven different hospitals in the Northwest of England. We attempted to capture as many episodes of CPP as possible during this period. We collected various demographics and clinical data related to the patients and to the intervention of proning. We followed up the patients for 28 days from their first episode of CPP. A descriptive statistical analysis was performed using Excel. Results: Overall, 107 patients were included. Their mean age was 66 years and 55% were candidates for escalation to level 3 care. Among these patients 25% were eventually intubated. Table 1 shows more patients characteristics. A total of 246 episodes of CPP were recorded. Table 2 provides details about CPP episodes. The median duration was 4 hours. Proning was often conducted by patients and physiotherapists, as most (73%) didn't need assistance. CPAP was used simultaneously in a significant proportion (38%). One fifth of the CPP had to be discontinued, mostly because of discomfort. We focused on the first episode to assess practicalities and effect on oxygenation (Table 3). Only 9% of episodes were reported to follow ICS guidance as most interventions had to be tailored to local logistics and to patients' comfort. Thirteen per cent of CPP were initiated in morbidly obese patients despite it being mentioned as a relative contraindication. In terms of oxygenation, desaturation occurred within the first 15 minutes in 21% of cases. There was a tendency to improvement of FiO2 and SF ratio after 24 hours of the first CPP. Conclusion: In summary, a pragmatic approach often dictated departure from intensive care soceity guidance. Although CPP was largely feasible, it had to be adapted in most cases to the patients, their environment, the logistics, and their ventilatory support. It was often self-administered and didn't seem to be limited by morbid obesity for example. While the results and experience suggest a positive impact of CPP on oxygenation, only a well-designed comparative trial could determine the role of position changing in preventing intubation or death. The authors would like to thank the NWRAG and all the local team members, physiotherapists, nurses and doctors, who endeavoured to collect invaluable data under unprecedented clinical circumstances.

8.
ASAIO Journal ; 68:63, 2022.
Article in English | EMBASE | ID: covidwho-2032181

ABSTRACT

Background: In patients with COVID-19 and respiratory failure, class 3 obesity (body mass index > 40 kg/m2) has been associated with worse survival. Obese patients on mechanical ventilation with progressively more severe acute respiratory syndrome (ARDS) may be offered venovenous (VV) extracorporeal membrane oxygenation (ECMO) therapy. The impact of morbid obesity on the outcome of COVID-19 patients supported with VV ECMO has been underexplored. Methods: This is a multicenter, retrospective observational cohort analysis of critically ill adults with COVID-19 ARDS requiring advanced mechanical ventilation with or without VV ECMO. Data was collected from 236 international institutions forming the COVID-19 Critical Care Consortium international registry. Patients were admitted between January 2020 to December 2021. Included patients were stratified by ECMO status and a BMI threshold at 40 kg/m2. Median values with interquartile range (IQR) were used to summarize continuous variables and multi-state analysis was used to explore the effect of Class 3 obesity on the study endpoints of patient survival to discharge or death. Results: Complete data was available on 8851 of 9059 patients on mechanical ventilation, of which 767 patients required VV ECMO. For the entire study group, older age and male gender were associated with an increased risk of death. The demographics and comorbidities of the higher BMI (H >40 kg/m2) and lower BMI (L ≤40 kg/m2) cohorts were similar with the exception of age and weight. Patients with a higher BMI were younger. The median age of the H, non-ECMO cohort was 56 years (46-64), and the H, ECMO cohort was 41 years (35-51) versus the L, non-ECMO cohort of 64 years(55-71), and the L, ECMO cohort of 53years (45-60). Patients requiring VV ECMO had higher SOFA scores, experienced longer ICU and hospital lengths of stay, and a longer duration of total mechanical ventilation. Table The median time to intubation was longer in the mechanical ventilation only group (2 versus 0 days). Predictors for requiring ECMO included younger age, higher BMI and male gender. Risk factors for death included advancing age (every 10 years), male gender and increasing BMI (every 5kg/m2). The association between BMI and a higher rate of death was reduced in the mechanical ventilation only group (HR 0.92, 95% confidence interval 0.85 to 0.99). Conclusion: In patients with severe ARDS due to COVID-19 requiring mechanical ventilation, the likelihood of progressing to VV ECMO therapy or experiencing death is impacted by age, gender and higher BMI. The cohort of COVID-19 patients that ultimately required ECMO appear to be sicker at time hospital admission owing to the shorter time until mechanical ventilation. It appears the association between increasing BMI and death differs among the ECMO and mechanical ventilation alone cohorts. We would advocate for a prospective study to determine the benefit of VVECMO for the obese patient requiring VV-ECMO for COVID-19 ARDS. (Figure Presented).

9.
Journal of the Formosan Medical Association ; 121(9):1617-1621, 2022.
Article in English | Scopus | ID: covidwho-2015654
10.
Obshchaya Reanimatologiya ; 18(4):4-10, 2022.
Article in Russian | EMBASE | ID: covidwho-2010541

ABSTRACT

The aim of the study was to identify the risk factors of spontaneous pneumomediastinum and to determine its management strategy in patients with the novel coronavirus infection. Material and methods. Eighteen patients with spontaneous pneumomediastinum (SPM) hospitalized in the Center for Novel Coronavirus Infection of the Mechnikov Northwestern State Medical University from 2020 to 2021 were examined. The control group consisted of 18 persons selected using matched sampling. We analyzed symptoms, medical and life history, comorbidities, physical examination results, laboratory and instrumental data, and disease management of patients in both groups Results. The groups were comparable by age and sex. Among all patients hospitalized with the novel coronavirus infection, spontaneous pneumomediastinum was registered in 1.3% (n=18). Analysis of symptoms, medical and life history, comorbidities, physical examination results, laboratory and instrumental data and disease management did not reveal significant differences between the groups. At the same time, the proportion of obese patients in the main group was lower than in the control group. Estimation of HR showed that the risk of spontaneous pneumomediastinum development was significantly lower in obesity (HR=0.14;95% CI: 0.033–0.63, P=0.010). Conclusion. The risk of spontaneous pneumomediastinum is significantly lower in obese patients.

11.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009655

ABSTRACT

Background: Obesity is a leading cause of preventable death in the United States. The incidence of most obesity associated malignancies are increasing. Novel interventions to combat the obesity epidemic are greatly needed. Here we investigate the effect of a virtual clinical intervention on medical providers & other medical staff at a comprehensive cancer center. Methods: Physicians (MD), nurses (RN), & other medical staff (MS) were enrolled in an IRB approved, prospective single arm clinical trial. We assessed the effect of NCCN & ASCO guideline recommendations for weight loss & healthy lifestyle on overweight (OW) & obese (OB) providers & medical staff. Primary outcome: to assess change in body mass index (BMI) over a 3-month (mo.) intervention. Secondary outcomes: To assess changes in nutrition and exercise habits over time b) evaluate other lifestyle factors over time: stress, self-image, barriers to weight loss. Participants (Pts) filled out two 16 question (Q) pre & post survey (at 1, 90 days) relating to study outcomes. The virtual intervention consisted of giving information & advice over 3 months: A comprehensive handout e-mailed on day 1 + Motivational/info e-mails q 2 weeks/3 mo. Statistical analysis: students' paired T test used to compare changes in weight & survey responses day 0-90. P- value α = 0.05. Inclusions: age > 18 yo males & females, MD, RN, ARNP, & MS who are OW (BMI > 25Kg/m2) or OB (BMI > 30Kg/m2). Exclusions: non-OW/OB, Pts with uncontrolled cardiovascular, pulmonary, orthopedic, or cerebrovascular disease, pregnancy. Results: 106 participants enrolled;26 subjects completed study. Demographics: 6/26 = 23% (MD/ARNP), 12/26 = 46% (RN), 8/ 26 = 31% (MS). 4/26 = 15% male, 22/26 = 85% female, m age 45 (25-67). 3/26 = 12% Asian, 5/26 = 19% Black, 18/26 = 69% White. 100% not Hispanic. m BMI = 33.9 kg/m2 (25.1-44.5). Intervention: 26/26 (100%) Pts lost weight/3 mo., m D kg = -5.2kg (p < 0.0001), m D BMI = - 1.67 kg/m2 (p = 0.002). Survey results: Significant improvements were seen in: self-image (p = 0.0012), physical activity (p < 0.0001), healthy diet (p < 0.0001), days/week exercise (p = 0.0008), m D minutes exercise/ week = +65 min/week (p = 0.0046), decreased stress levels (p < 0.0001). Limitations: significant participant drop out seen. Conclusions: All participants who completed the study lost weight & improved healthy lifestyle parameters. To our knowledge this is the first all virtual clinical weight loss & lifestyle intervention executed. Also, this is the first weight loss & lifestyle intervention executed in providers. Our intervention was cost effective, easy to execute, & warrants further study in both medical staff & patient populations. Last, this novel virtual intervention is highly relevant during the covid 19 pandemic due to social distancing requirements.

12.
Journal of the ASEAN Federation of Endocrine Societies ; 37:13, 2022.
Article in English | EMBASE | ID: covidwho-2006552

ABSTRACT

Introduction Obesity and diabetes mellitus are often regarded as risk factors for poorer outcomes in various infections. This study was conducted to determine the impact of diabetes mellitus and obesity on clinical outcome of COVID-19 infected patients. METHODOLOGY A prospective study was conducted from April 2021 to October 2021 among patients aged >18 years, admitted to Hospital Sarikei with confirmed SARS-CoV-2 infection stratified as categories 4 and 5. Pregnant women and patients with existing lung pathology were excluded. Demographic data, comorbidities, BMI, and clinical outcome parameters such as number of days on oxygen supplementation, need for mechanical ventilation and mortality were recorded. Results A total of 458 patients were included, mean age was 61.6 ± 14.2 years and 231 (50.4%) participants were male. Almost half, 211 (46.1%) were diabetics and 165 (36.0%) were found to be obese. Diabetic patients were on oxygen supplementation for a mean duration of 7.30 ± 5.63 days, significantly longer than nondiabetic patients with a mean duration 6.01 ± 4.90 days, p=0.009. There was no significant difference in number of days on oxygen between obese and non-obese patients. A higher proportion of obese patients were mechanically ventilated, 38.2% vs 25.3% non-obese patients, p=0.004. There was no increase in mechanical ventilation among diabetic patients. The rate of mortality in the obese group was also significantly higher than non-obese patients, 23.0% vs 12.6% respectively, p=0.009. The mortality rate among diabetics was not significantly different from that of nondiabetics. Conclusion Diabetic patients required oxygen supplementation for a significantly longer duration than nondiabetics. The rates of mechanical ventilation and mortality were significantly higher among obese patients compared to non-obese patients. These findings suggest that vigilant monitoring and better management for obese and diabetic patients with COVID-19 infection are important to improve clinical outcome.

13.
Indian Journal of Critical Care Medicine ; 26:S51-S52, 2022.
Article in English | EMBASE | ID: covidwho-2006347

ABSTRACT

Introduction: Macroglossia is defined as an enlargement of the tongue in the resting position, protruding beyond the teeth. Many cases have been reported secondary to patient positioning while under anesthesia, post oro-pharyngeal packing, trauma or surgery, and allergic or non-allergic angioedema. However, acute macroglossia in the ICU is a rare situation. In COVID-19 related severe ARDS, endotracheal intubation and prolonged proning is an important part of management of hypoxemic respiratory failure Prone positioning also has the potential to independently cause macroglossia. Awareness of this complication of proning could help mitigate morbidity in patients. Case report: A 53-year-old diabetic, hypertensive overweight female with OSA presented with progressive shortness of breath and productive cough. She was mechanically ventilated in ICU in view of respiratory distress secondary to COVID-19 pneumonia. Intubation was minimally traumatic with minimal oral bleeding settling over few minutes. Though managed with medications as per COVID-19 management protocol, she progressed to severe ARDS hence proned on hospital day 1 for 16 hours - PaO2/FiO2 ratio improved. She was not proned further. Acute macroglossia (3 inches outside the oral cavity) with lower facial edema was noted 4 days post proning. Saline moistened gauze was loosely wrapped around the tongue every hour. Circumferential ecchymosis was noticed around her neck on the 6th day. On day 8, macroglossia did not show signs of resolution. Hence, the tongue was pushed in manually every 2 hourly and the position was maintained manually for 10 minutes. The swelling decreased gradually with the tongue staying in a retracted position on treatment day 2. On day 3, there was a complete resolution of the swelling. However, she had persistent swallowing difficulty causing difficulty in weaning from tracheostomy. MRI of neck and chest showed large pre-vertebral collection from the upper border of C2 inferiorly across the thoracic inlet to the posterior mediastinum with thin linear extension up to the lower border of T4. Mass effect with airway compression, displacement, and compression of esophagus and neck vessels was seen. Trans-oral exploration revealed mucosal rent and bulge in the posterior pharyngeal wall. The hematoma was evacuated by ENT specialists. She was discharged on tracheostomy and feeding tube. Tracheostomy decannulation was done after 1 month. Discussion: In our practice of proning patients with ARDS for >10 years, this is the first case of macroglossia as a complication of proning that we encountered. Other factors that could have contributed to this patient are obesity and mildly traumatic intubation. Development of macroglossia 4 days after proning and resolution over a short period of time is rare and suggests lymphatic and vascular compression as the cause. Later development of ecchymosis and dysphagia may be due to the posterior pharyngeal injury. Conclusion: Proning, especially in obese patients, can be a challenge. Positioning of the face and avoidance of injury to any of the structures is vital to the care of the proned patient. Medical staff involved in patient care should be aware and vigilant to pick up this condition early to avoid further injury.

14.
Clinical Nutrition ESPEN ; 48:515-516, 2022.
Article in English | EMBASE | ID: covidwho-2003970

ABSTRACT

Critically ill patients often face progressive and rapid losses of body and muscle mass due to hypermetabolism and increased protein catabolism. Certain population groups (such as obese patients or those requiring Continuous Renal Replacement Therapy (CRRT) require a higher protein provision as advised by both ASPEN1 and ESPEN2. Furthermore, critically ill patients often receive significant energy provision from non-nutritional sources such as propofol. As a consequence, calorie provision via enteral feed is commonly restricted to avoid overfeeding, and protein provision to the patient is further compromised. Retrospective data was collected for 58 patients who were either confirmed or suspected of COVID-19 and admitted to the Intensive Care Unit (ICU) during April 2020. 31% (n=18) of patients were unable to meet their protein requirements from the feed formula alone, based on initial dietetic assessment. Recommended protein requirements were not achieved in any patients who were obese (n=10;defined as BMI ≥30 kg/m2) or receiving CRRT (n=6). The maximum protein provision for obese patients was 1.5g/kg IBW and 1.6g/kg for patients receiving CRRT. The situation was exacerbated for patients receiving high dose propofol (defined as >10 ml/hr), where protein provision decreased to 0.8 – 1.2g/kg and 1.1 – 1.3g/kg respectively. [Formula presented] In the non-obese, non-CRRT ICU population, the available enteral feeding regimes were appropriate to meet the majority of patients’ protein requirements (as shown in Figure 1). However the review almost certainly overestimates protein provision, as percentage feed delivery was not assessed and the results assume 100% feed delivery. We know from previous audits on our unit that feed delivery is often <80% of target, and although this review was based on COVID-19 patients, the ‘typical’ patients in ICU often have specific nutrition requirements, which includes high protein. The challenges faced during COVID-19 has raised awareness of the importance of protein delivery in ICU and our review highlights the need to continually monitor and augment protein delivery in critically ill patients. The findings support the need for a high protein supplement in specific population groups;particularly those who may be obese, require CRRT or are receiving high dose propofol in an ICU setting. 1 McClave S A, Taylor B E, Martindale R G et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) J Parenter Enteral Nutr 2016;40(2): 159-211. 2 Singer P, Blaser A R, Berger M M et al. ESPEN Guideline on clinical nutrition in the intensive care unit Clin Nut 2019;38: 48-79

15.
Clinical Nutrition ESPEN ; 48:499, 2022.
Article in English | EMBASE | ID: covidwho-2003955

ABSTRACT

It has been a hugely challenging task proving nutritional support in adult intensive care units during the COVID-19 pandemic. We therefore reviewed the nutritional parameters of patients admitted to intensive care during both surges of the virus to provide detailed information and to ensure we are fully informed to provide the best service in future surges. Retrospective data was collected from 168 patients using dietetic electronic handovers from 04.10.20 to 04.04.21 and compared to the data collected for 122 patients in surge one, (data collected 20.03.20 to 8.5.20). This was analysed using an excel spreadsheet. The results are outlined in table one below: [Formula presented] The critical care ventilation plan for these patients had been reviewed1 and this impacted the route of feeding as follows: Nasogastric feeding on admission: 50.6% (96%), oral nutritional support: 35% (4%), oral nutritional support with subsequent NG feeding: 11% (3%), parenteral nutrition: 1.8% (0), PEG: 0.62% (0). Using data collected from surge one, we were able to prepare training for the dietetic team with regards to the demographics of the patient and the impact on nutritional care. This is particularly important with regards to the challenge of meeting energy and protein requirements of obese patients2. We reviewed the difficulties gathering accurate weights from the first wave and purchased new patient transfer scales®. This allowed us to gain weights that we would not have been able to. More patient heights were available as dietitians were present on the unit in surge two (remote working in surge one) and were able to do bedside measures of ulna length where a height was unavailable. Using surge one data we were prepared for high numbers of patients requiring enteral feeding on admission. However there was a different picture in surge two with more patients awake, using high flow oxygen therapy or on a CPAP hood. This brought different challenges with meeting macro and micronutrients orally. Patients with breathing difficulties were not keen to consent to an NGT and when they did, the NGT insertion procedure was tricky in those patients with high Fi02. We reviewed our range of macronutrient supplements and started using an oral protein supplement containing 30 mls, 10 g protein and 100 kcal to help with this. We attended MDT meetings to discuss feeding route and for further surges we plan to implement a standard operating procedure for enteral feeding patients on CPAP. 1. Intensive Care Society (2021) Clinical Guideline for the management and care of critically ill adults with COVID-19 during the coronavirus pandemic. Faculty of Intensive care Medicine. 2. Singer et al (2019) ESPEN guideline on clinical nutrition in the intensive care unit: Clinical Nutrition 38:48-79

16.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003284

ABSTRACT

Purpose/Objectives: Understand the rates of pediatric obesity in the Inland Empire of Southern California, in the context of COVID quarantine, to improve counseling and treatment of these patients. Design/Methods: A retrospective chart review was performed on all patients seen at a FQHC in Southern California. Patients between 5 and 18, who had a clinic visit between 6/1/2020 to 7/31/2020 for a well-child visit, with at least one other well-child visit in calendar year 2019 and 2018 were included. Patients with congenital heart disease, short gut syndrome, ADHD on stimulant medications, G tube dependence, diseases affecting growth or stature, complex syndromes (CHARGE, VACTERL, DiGeorge), syndromes affected growth, oncologic conditions, intellectual disability, transplant recipients, incomplete BMI data or malnutrition (BMI Z score <= -1) were excluded. BMI values, Z-scores, and percentiles, as well as relative changes from 2018 to 2019, and 2019 to 2020 were analyzed using one-way ANOVA and Tukey post hoc test. Results: There was a statistical difference in BMI between years as determined by a one-way ANOVA (F(2,509) = 2.811, P = 0.05). A Tukey post hoc test revealed that the BMI of students in 2020 was statistically higher (19.87.65, p = 0.05) compared to the BMI in 2018 (18.25.71). There was no statistical difference in BMI between 2020 and 2019, and 2019 and 2018 (Figure 1). When groups were stratified into morbidly obese (BMI >= 99%), obese (BMI >=95% & <99%), overweight (BMI >=85% & <95%), and healthy weight (BMI >=5% & < 85%), patients who were not at a healthy weight increased from 36.8% in 2018 to 40.4% in 2019, to 44.7% in 2020 (Figure 2). As shown in the SANKEY diagram (Figure 3), while there was an initial decline in morbidly obese patients in 2018 to 2019 (-8.3%), there was a relatively large increase from 2019 to 2020 (+45.5%). From 2018 to 2019, 75 out of 141 patients (53.2%) had a decrease in BMI, while in 2019 to 2020 there were 56 out of 141 patients (39.7%) who had a decrease in BMI. Out of the 75 patients who had a decrease in BMI from 2018 to 2019, 49 (65.3%) had a rebound increase in BMI from 2019 to 2020. Conclusion/Discussion: There was a significant increase in overall BMI from 2018 to 2020 with an overall increase in patients who fall into the obese and overweight categories in 2020. 65.3% of patients who had a decreasing BMI from 2018 to 2019 have a rebound increase in BMI in 2020. This can likely be contributed to the COVID-19 pandemic and stay-at-home orders leading to a more sedentary lifestyle. More research should be performed to elicit multifactorial (physical activity, diet, and psychosocial factors) etiology of the worsening obesity epidemic during the COVID-19 pandemic.

17.
Journal of General Internal Medicine ; 37:S269, 2022.
Article in English | EMBASE | ID: covidwho-1995864

ABSTRACT

BACKGROUND: COVID-19 continues to be an ongoing problem worldwide, especially for those who are disproportionately affected due to their social determinants of health, as they are often at a socioeconomic disadvantage. We are primarily interested in evaluating how education level, income, race, ethnicity, and obesity are correlated with acute COVID-19 severity, and anxiety, depression, and quality of life ≥ 6 months post-infection. Specifically, obesity (BMI > 30), has been previously identified as a risk factor for COVID- 19 regarding severity and mortality. We found it imperative to further investigate these demographic variables, as they are vital in understanding how social determinants of health are impacting COVID-19 outcomes. Insights from this study can assist with identifying gaps in care for those with poor social determinants of health, as well as help shape care for those who have been disproportionately affected. METHODS: We examined records of COVID-19 patients through the COVID-19 Recovery Clinic at George Washington University in Washington, D.C. that has been collecting data on patient short and long-term COVID-19 outcomes in various domains along with demographic information since November 2020. Using RStudio with calculations of descriptive data, odds ratios, and p-values using Fisher's exact test, we assessed education level, income, race, ethnicity, and obesity and looked at how they correlated with COVID-19 severity at diagnosis, presence of anxiety, depression and quality of life ≥ 6 months after acute infection. RESULTS: From our sample (n=150), we found African Americans had greater acute COVID-19 severity (OR=7.56, 95% CI 2.22, 25.68, p=0.0015) relative to white individuals. We also found that obesity was associated with higher levels of acute COVID-19 severity (OR=4.89, 95% CI 1.36, 17.60, p=0.022).Additionally, during acute COVID-19 infection, 7/32 (21.9%) obese patients compared to 9/112 (8.0%) non-obese patients were hospitalized (OR=3.79, 95%CI=1.23, 11.68, p=0.03).No significant association was found between anxiety, depression, quality of life or COVID- 19 severity and persistent symptoms. CONCLUSIONS: We observed associations between the African American race and more severe acute COVID-19 infection. Further, in the acute phase, we observed that obese patients were more likely than non-obsese patients to have more severe infection and be hospitalized. These findings highlight preexisting gaps in healthcare outcomes regarding social determinants of health. It is essential to analyze many of the potential longer-term effects of COVID-19 infection, as they remain poorly understood. We conclude that larger studies are necessary to better understand the effects of social determinants of health on both short and long-term outcomes of COVID-19.

18.
Journal of the Korean Medical Association ; 65(7):423-429, 2022.
Article in Korean | EMBASE | ID: covidwho-1979547

ABSTRACT

Background: Since December 2019, most countries have struggled with the novel coronavirus, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). During the coronavirus disease-2019 (COVID-19) pandemic, weight gain became prevalent because the preventive measures against the spread of SARS-CoV-2 infection resulted in decreased physical activity and increased consumption of unhealthy food among the general public. Current Concepts: Several mechanisms have been proposed for the association between obesity and COVID-19. SARS-CoV-2 infection aggravates inflammation and hypoxia in obese people, which can lead to severe COVID-19 disease. COVID-19 affects the immune system, resulting in various complications. Several cytokines, including interleukin-6, are integral to the progression of COVID-19. Thus, COVID-19-associated inflammation and immune dysfunction predispose patients to the complications of obesity, such as cardiovascular diseases and diabetes mellitus. Discussion and Conclusion: Obese patients are commonly prescribed antidiabetic agents, blood pressure lowering medications, and lipid-lowering medications such as statins. The routine intake of these drugs is a protective factor against all-cause mortality. During the COVID-19 pandemic, preventive measures, such as minimizing team sports and closing public exercise facilities, might have contributed to the weight gain in obese individuals. Thus, an active lifestyle with regular home exercise and a healthy diet should be advised for obese patients.

19.
Gastroenterology ; 162(7):S-836, 2022.
Article in English | EMBASE | ID: covidwho-1967372

ABSTRACT

Background and Aims: In patients with COVID-19, obesity may increase risk of hospitalisation, use of mechanical ventilation and patient mortality. High liver fat, body mass index (BMI) and male sex are significant predictors of hospitalisation risk following COVID-19. However, BMI is a poor indicator of body fat distribution. Here, we studied ectopic fat accumulation within the liver and pancreas and body composition through multiparametric magnetic resonance (mpMR) and compared participants with and without hospitalisation for COVID-19. Method: Participants with laboratory-confirmed or clinically suspected SARSCoV- 2 infection were recruited to the COVERSCAN study (NCT04369807;median time from initial symptoms = 177 days) and underwent a multi-organ mpMR scan (CoverScan®, Perspectum Ltd). Measures of liver and pancreatic fat (PDFF), liver fibroinflammation (cT1) and body composition [visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), skeletal muscle index (SMI)] were analysed. Differences between participants hospitalised (n = 59) and not hospitalised (n = 348) for COVID-19 were assessed using Wilcoxon signedrank tests. Univariate and multivariate analyses were performed on all biomarkers to assess the hospitalisation risk. Data presented are median values. Results: Approximately 6-months after initial symptoms, participants hospitalised following COVID-19 had significantly elevated pancreatic fat (3.8 % vs 2.8 %, p < 0.01), liver fat (3.8 % vs 2.4 %, p < 0.01) and liver cT1 (735ms vs 706ms, p < 0.01) compared to those who convalesced at home. Though hospitalised participants had a significantly elevated BMI (27 kg/m2 vs 25 kg/m2, p = 0.014), it was VAT, but not SAT, that was significantly elevated (132 cm2 vs 86 cm2, p < 0.01). Univariate analysis revealed that male sex, advanced age and elevated BMI, VAT, pancreatic fat, liver fat, and liver cT1 were all significantly predictive of hospitalisation following COVID- 19. In multivariate analysis, only age remained significantly predictive of hospitalisation. In hospitalised people with obesity (³ 30 kg/m2), VAT, liver cT1 and liver fat, but not BMI nor pancreatic fat, remained significantly elevated [VAT: 220 cm2 vs 152cm2, p = 0.01 (Figure 1);liver fat: 9.9 % vs 4.2 %, p = 0.003;liver cT1: 782ms vs 742ms, p = 0.012]. Conclusion: mpMR revealed significantly elevated visceral and ectopic fat deposition within the liver and pancreas in hospitalised participants following COVID-19. In obese participants, BMI was not significantly different in hospitalised, and non-hospitalised patients, whereas visceral fat, liver fibroinflammation and liver fat were significantly elevated. Our work highlights body fat distribution an important consideration for COVID-19 risk profiling, which cannot be sufficiently evaluated based on BMI alone. (Figure Presented) Figure 1. Comparison of liver fat (left), pancreatic fat (middle) and visceral adipose tissue (right) between participants hospitalised and not hospitalised following COVID-19.

20.
Journal of the American College of Surgeons ; 233(5), 2021.
Article in English | EMBASE | ID: covidwho-1965238

ABSTRACT

The proceedings contain 629 papers. The topics discussed include: barriers to Covid-19 vaccination in underserved minorities: impact of health care access and sociodemographic perspectives;concomitant cholecystectomy during initial bariatric surgery does not increase risk of postoperative complications or bile duct injuries;identifying behavioral facilitators to weight loss after bariatric surgery: are there differences between Medicaid and non-Medicaid patients?;impact of post-discharge phone calls on nonurgent hospital returns;laparoscopic heller myotomy is associated with fewer postoperative complications compared to the thoracoscopic approach: a NSQIP study;population-wide analysis of the effect of bariatric surgery on idiopathic intracranial hypertension in obese patients;reducing operating room inefficiencies via a novel surgical app shortens the duration of laparoscopic Roux-en-y gastric bypass;subtotal gastrectomy vs gastroenterostomy in duodenal obstruction secondary to peptic ulcer disease: results of a retrospective nationwide study;and enhanced recovery after bariatric surgery: further reduction in opioid use with the introduction of dexmedetomidine and transverse abdominis plane block.

SELECTION OF CITATIONS
SEARCH DETAIL