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1.
Journal of Clinical and Diagnostic Research ; 16(4):ZC28-ZC34, 2022.
Article in English | EMBASE | ID: covidwho-1822594

ABSTRACT

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic had not only developed as a key challenge to public health all around the world but also instigated physical and mental constraints on the health care professionals especially on the education of dental students with the sudden switch from traditional teaching methods to e-learning platforms thereby shutting all means of clinical experiences. Aim: To assess the effects of lockdown on clinical practice among undergraduate dental students in Tamil Nadu, India. Materials and Methods: A cross-sectional observational study was done among undergraduate dental students in Tamil Nadu, India, from June 1, 2021 to July 1, 2021, using convenience sampling method to yield a total of 510 responses for a self-administered online questionnaire that aimed at evaluating the consequence of lockdown on clinical practice. Statistical Package for the Social Sciences (SPSS) version 19.0 was used to analyse the data. Results: A total of 510 responses (mean age: 21.72±2.2827 years;323 female and 187 male) were analysed in the present study. Majority of the students felt that COVID-19 lockdown had a negative impact on clinical exposure. Inspite of following infection control measures, only 35.1% of students felt imperative to practice during pandemic. With over 82.7% of patient flow reduced due to fear of disease spread. 85.1% revealed being stressed in completing clinical quota in a short duration. Further questions on prospects in improvising their clinical knowledge;showed 45% recommending e-workshops, 29.4% opting for video demonstration followed by 22.2% on exposure to Objective Structured Clinical Examination (OSCE) to compensate for the loss of clinical practice. Conclusion: New teaching protocols have to be adopted taking into account the changing aspects of the pandemic to improve their wellbeing, overcome mental stress and to enhance the sustainability of dental education. Focus on video demonstrations, lectures provoking their clinical reasoning, simulations on phantom heads and conducting workshops enhancing preclinical skills as well as following appropriate safety protocols must be implemented.

2.
Journal of Acute Disease ; 11(2):77-84, 2022.
Article in English | EMBASE | ID: covidwho-1822498

ABSTRACT

Objective: To evaluate patient demographic characteristics and risk factors for mortality during the first and the second wave among COVID-19 patients in a tertiary care hospital of India. Methods: Data were taken from the hospital's electronic system for COVID-19 patients from August 2020 to December 2020, and the second from January 2021 to May 2021. The mortality rate, demographic and clinical characteristics, laboratory profile, and reasons for the death of the two waves were retrieved and compared, and the risk factors of the two waves were determined. Results: In the first wave, 1 177 COVID-19 cases visited the hospital and 96 (8.2%) died. In comparison, the death rate in the second wave was significantly higher (244/2 038, 12.0%) (P<0.001). No significant difference in age [60 (50-69) vs. 60.5 (53-70), P=0.11] or gender (P=0.34) was observed between the two waves. Compared to the first wave. there were significantly more cases with fever, cough, weakness, loss of taste and smell, and sore throat during the second wave (P<0.05), but significantly fewer cases with kidney disease (6.6% vs. 13.5%, P=0.038) and diabetes mellitus (35.7% vs. 50.0%, P=0.015). Besides, during the second wave, more patients had abnormal X-ray findings, higher levels of lymphocytes and serum ferritin (P<0.05). In addition, there were significant differences in the rate of death cases with acidosis, septic shock, acute kidney injury, diabetes mellitus, cardiovascular events, hypothyroidism (P<0.05). Multivariate regression showed that during the first wave, age (OR: 1.10;95% CI: 1.02-1.21), diabetes mellitus (OR: 3.16;95% CI: 2.08-3.53), and abnormal X-ray (2.67;95% CI: 2.32-2.87) were significant independent risk factors of mortality;while in the second wave, age (OR: 1.13;95% CI: 1.12-1.28), diabetes mellitus (OR: 8.98;95% CI: 1.79-45.67), abnormal X-ray (OR: 12.83;95% CI: 2.32-54.76), high D-dimer (OR: 10.89;95% CI: 1.56-134.53), and high IL-6 (OR: 7.89;95% CI: 1.18-47.82) were significant independent risk factors of mortality. Conclusion: Overall mortality and incidence of severe diseases are higher in the second wave than the first wave. Demographic characteristics, co-morbidities, and laboratory inflammatory parameters, especially D-dimer and IL-6, are significant risk facors of mortality during the COVID-19 pandemic.

3.
Vaccines ; 10(4), 2022.
Article in English | EMBASE | ID: covidwho-1822475

ABSTRACT

Background: Longitudinal surveys to monitor the seroprevalence are required to support efforts for assessment of the levels of endemic stability in certain countries. We investigated seroprevalence of anti-SARS-CoV-2-S1 receptor-binding domain (RBD)-specific antibodies in the serum samples in 2011–2021, including a cohort study of 2019–2021, to evaluate the vaccination and anti-IgG-SARS-CoV-2–S1 RBD-positive statuses to assess the resistance and severity of COVID-19. Materials and Methods: Anti-SARS-CoV-2-S1 RBD-specific antibodies were assayed in the serum samples (N = 565) randomly selected from various cohorts previously recruited from 2011 to 2021 from the city of Moscow and Moscow Region. Among them there were the participants (N = 310) recruited in 2019–2021 with an endpoint of 30 October 2021 when these participants were interviewed over phone with relevant questionnaire. Results: Obtained data indicated a percentage of 3–6% of SARS-CoV-2-S1 RBD-specific antibodies detected in participants recruited in 2011–2019. The percentage of SARS-CoV-2-S1 RBD-specific antibodies was increased to 16.5% in 2020 and to 46% in 2021. The vaccination rate of 238 respondents of this cohort was 58% from August 2020 to October 2021. In total, 12% of respondents were hospitalized. The morbidity rate in the subgroup of anti-SARS-CoV-2-S1 RBD-positive respondents was 5.4-fold higher than that in the subgroup of vaccinated respondents. Conclusions: A small percentage of SARS-CoV-2-S1 RBD-specific antibodies detected in 2011–2019 indicated possible spreading of coronaviruses during the pre-pandemic period. Collective immunity in Moscow and the Moscow region was able to reach 69% from August 2020 to October 2021 if this rate is added to the rate of not vaccinated SARS-CoV-2-S1 RBD-positive subjects.

4.
Vaccines ; 10(4), 2022.
Article in English | EMBASE | ID: covidwho-1822466

ABSTRACT

The COVID-19 pandemic continues to be a worldwide health issue. Among hemodialysis (HD) patients, two-dose immunization schemes with mRNA vaccines have contributed to preventing severe COVID-19 cases;however, some have not produced a sufficient humoral response, and most have developed a rapid decline in antibody levels over the months following vaccination. This observational, prospective, multi-center study evaluated the humoral response in terms of presence and levels of IgG antibodies to the receptor-binding domain of the S1 spike antigen of SARS-CoV-2 (anti-S1-RBD IgG) to the third dose of SARS-CoV-2 mRNA vaccines, either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer), in 153 patients from three dialysis units affiliated to Hospital Clínic of Barcelona (Spain). Most hemodialysis patients responded intensely to this third vaccine dose, achieving the seroconversion in three out of four non-or weak responders to two doses. Moreover, 96.1% maintained the upper limit or generated higher titers than after the second. BNT162b2 vaccine, active cancer, and immunosuppressive treatment were related to a worse humoral response. Every hemodialysis patient should be administered a third vaccine dose six months after receiving the second one. Despite the lack of data, immunosuppressed patients and those with active cancer may benefit from more frequent vaccine boosters.

5.
Vaccines ; 10(4), 2022.
Article in English | EMBASE | ID: covidwho-1822458

ABSTRACT

The presence of neutralizing antibodies (NAbs) against SARS-CoV-2 represent a surrogate marker of immunologic protection in populations at high risk of infection such as healthcare workers caring for hospitalized patients with COVID-19. As recommended by CDC and the European CDC, the use of rapid diagnostic tests during population-based evaluations offers an opportunity to identify individuals with serologic evidence of natural infection or who have undergone vaccination. We carried out a cross-sectional study to assess the presence of neutralizing antibodies against SARS-CoV-2 among medical providers at an intensive care unit of a large referral hospital in Alicante, Spain. In addition, we tested for the presence of neutralizing antibodies compared to serum of uninfected individuals from a Biobank. We were also interested in evaluating the use of a rapid lateral flow immunochromatography (LFIC) test against a surrogate ELISA viral neutralization test (sVNT). This rapid test demonstrated a specificity of 1.000 95% CI (0.91–1.00) and the sensitivity of 0.987 95% CI (0.93–1.00). The negative predictive value was 95%. After six months, this rapid test demonstrated that those immunized with two doses of BioNTech/Pfizer vaccine, maintained optimal levels of neutralizing antibodies. We concluded that all Health Care Workers develop NAbs and the use of this rapid immunochromatographic test represents a potential tool to be used in population-based studies to detect serological antibody responses to vaccination. Vaccination policies could benefit from this tool to assess additional doses of vaccine or boosters among high-risk populations.

6.
International Journal of Environmental Research and Public Health ; 19(9), 2022.
Article in English | EMBASE | ID: covidwho-1822423

ABSTRACT

This study analyses the obstetric–neonatal outcomes of women in labour with symptomatic and asymptomatic COVID-19. A retrospective, multicenter, observational study was carried out between 1 March 2020 and 28 February 2021 in eight public hospitals in the Valencian community (Spain). The chi-squared test compared the obstetric–neonatal outcomes and general care for symptomatic and asymptomatic women. In total, 11,883 births were assisted in participating centers, with 10.9 per 1000 maternities (n = 130) infected with SARS-CoV-2. The 20.8% were symptomatic and had more complications both upon admission (p = 0.042) and during puerperium (p = 0.042), as well as transfer to the intensive care unit (ICU). The percentage of admission to the Neonatal Intensive Care Unit (NICU) was greater among offspring of symptomatic women compared to infants born of asymptomatic women (p < 0.001). Compared with asymptomatic women, those with symptoms underwent less labour companionship (p = 0.028), less early skin-to-skin contact (p = 0.029) and greater mother–infant separation (p = 0.005). The overall maternal mortality rate was 0.8%. No vertical transmission was recorded. In conclusion, symptomatic infected women are at increased risk of lack of labour companionship, mother–infant separation, and admission to the ICU, as well as to have preterm births and for NICU admissions.

8.
Infection ; 2022.
Article in English | EMBASE | ID: covidwho-1821023

ABSTRACT

Objective: The aim of our study was to build a predictive model able to stratify the risk of bacterial co-infection at hospitalization in patients with COVID-19. Methods: Multicenter observational study of adult patients hospitalized from February to December 2020 with confirmed COVID-19 diagnosis. Endpoint was microbiologically documented bacterial co-infection diagnosed within 72 h from hospitalization. The cohort was randomly split into derivation and validation cohort. To investigate risk factors for co-infection univariable and multivariable logistic regression analyses were performed. Predictive risk score was obtained assigning a point value corresponding to β-coefficients to the variables in the multivariable model. ROC analysis in the validation cohort was used to estimate prediction accuracy. Results: Overall, 1733 patients were analyzed: 61.4% males, median age 69 years (IQR 57–80), median Charlson 3 (IQR 2–6). Co-infection was diagnosed in 110 (6.3%) patients. Empirical antibiotics were started in 64.2 and 59.5% of patients with and without co-infection (p = 0.35). At multivariable analysis in the derivation cohort: WBC ≥ 7.7/mm3, PCT ≥ 0.2 ng/mL, and Charlson index ≥ 5 were risk factors for bacterial co-infection. A point was assigned to each variable obtaining a predictive score ranging from 0 to 5. In the validation cohort, ROC analysis showed AUC of 0.83 (95%CI 0.75–0.90). The optimal cut-point was ≥2 with sensitivity 70.0%, specificity 75.9%, positive predictive value 16.0% and negative predictive value 97.5%. According to individual risk score, patients were classified at low (point 0), intermediate (point 1), and high risk (point ≥ 2). CURB-65 ≥ 2 was further proposed to identify patients at intermediate risk who would benefit from early antibiotic coverage. Conclusions: Our score may be useful in stratifying bacterial co-infection risk in COVID-19 hospitalized patients, optimizing diagnostic testing and antibiotic use.

9.
International Journal of Pharmaceutical and Clinical Research ; 14(4):178-184, 2022.
Article in English | EMBASE | ID: covidwho-1820636

ABSTRACT

Introduction: COVID-19 spread was due to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Even today, COVID cases are being continually recorded. On this basis, it can be said that there is still the danger of COVID-19 cases getting increased at a rapid rate. There is no way of distinguishing the clinical findings and radiological findings of secondary fungal infection from that of COVID-19 pneumonitis and pneumonia. Aim: To Assess the MRI Evaluation of Cases of Mucormycosis after COVID-19”. Material and Methods: In the current study, the researcher conducted an observational study at Pacific Medical College, Udaipur, Rajasthan, India. Data for all the confirmed mucormycosis cases among patients with and without COVID-19 reported from September 2020 to December 2020, for the current study was collected. The researcher used SPSS Statistics 21.0 for performing an analysis of the data obtained from the health care centre. The descriptive statistics were measured and analysed using frequencies, mean, standard deviations, and median. Results: Out of the 286 cases, 65% (N = 185) had CAM (COVID-19 Associated Mucormycosis), with the mean age of 52 (SD = 16) years. Furthermore, 75% (N = 214) of the entire study population was male;and the remaining 25% (N = 72) were female. The prevalence of CAM was 0.28% and the range was 0.04% to 0.60%;on the other hand, CAM prevalence in ICU patients was determined to be 1.9% and the range was o.68% to 2%. Conclusion: From the current results, it can be concluded that Uncontrolled Diabetes Mellitus, found to be among 63% of the participants, was one of the common diseases in both CAM as well as non-CAM groups. In addition, the rhino-orbital area was among the most well-known sites of mucormycosis, with 58% participants, followed by rhino-orbital-cerebral, pneumonic, and other such areas.

10.
European Journal of Molecular and Clinical Medicine ; 9(3):1672-1678, 2022.
Article in English | EMBASE | ID: covidwho-1820632

ABSTRACT

Introduction: Globally anemia is one of the most important health problems. Adolescents are young people between the ages of 10 to 19 years. Anemia in adolescence may cause a wide range of functional consequences across the life course, including reduced resistance to infection, impaired physical performance and neurodevelopment, and suboptimal schooling outcomes. Aims and objectives: To estimate the prevalence of anemia, to determine the morphological types and patterns of anemia and to assess the etiological factors for different types of anemia among adolescent age group of Eastern India. Materials and methods: It is a retrospective observational study conducted in the department of Hematology at a tertiary care center in Bihar with a sample size of 200 cases. All patients belonging to adolescent age group (10-19 years) having sign and symptoms of anemia were chosen for study whereas children less than 10 years, patients on hematinic and Covid and viral positive cases were excluded. Clinical and demographic data along with hematological findings were retrieved from medical records and data were analysed by SPSS version 25. Results: 55% (n=110) patients were males while 45% (n=90) were females. Amongst males, 31.9% (n=23) were anemic in early adolescent age group and 39.4% (n=15) were anemic in age group 15-19years. While in females, 48.8% (n=21) were anemic in early adolescents and 78.7% (n=37) were anemic in late adolescent age group. Overall prevalence of anaemia among the study subjects was found to be 40.9 %. The prevalence of mild and moderate anaemia was almost similar, each comprising of 39.1% and 39 % respectively whereas 3.1% cases had severe anaemia. Conclusion: The prevalence of anemia amongst adolescents was a moderate public health problem. Factors associated with anemia were low socioeconomic status, rural background, larger family size, poor dietary habits and personal hygiene.

11.
European Journal of Molecular and Clinical Medicine ; 9(3):2605-2612, 2022.
Article in English | EMBASE | ID: covidwho-1820595

ABSTRACT

Introduction: Mortality rates for COVID-19-related mucormycosis vary greatly in reported studies. A systematic evaluation of 101 cases revealed a fatality rate of 30.7 percent. However, research on the determinants of death in COVID-19 associated mucormycosis is insufficient. The purpose of this study was to find out what factors contributed to in-hospital mortality in patients with COVID-19-related mucormycosis. Objectives: To study the the Clinical profile, Haematological,Biochemical and Radiological changes associated with mortality in patients with covid-19 associated mucormycosis. Methodology: In this single-center, observational study, 130 patients diagnosed with COVID-19 associated mucormycosis were recruited from a tertiary level intensive care unit from Bowring and Lady Curzon hospital, Bangalore, India. Results: Proportion of HTN, IHD, CKD and HIV was significantly more in non survivors compared to survivors. ICU admission and Oxygen requirement was scientifically higher in Non Survivors and had significant association with the outcome.. There was no significant difference in the levels of Hb, Neutrophils, Lymphocytes, Monocytes, Eosinophils, and Platelets as p>0.05. Total count (17191±7764), ESR (57.6±12.4), CRP levels (199.0±69.5), and S.Ferritin (624.6±268.0) were significantly higher among the Non survivors. S.LDH (355.7±108.9), S.Free Iron (51.7±13.3), HBA1C (11.4±2.4), and S.Urea (36.9±35.3) were also found to be significantly higher among the non survivors. Conclusion: The current study highlights that a multidisciplinary approach in COVID-19 associated mucormycosis patients that includes timely and effective surgical debridement coupled with appropriate antifungal therapy and diligent sugar monitoring with intrahospital glycemic control may help to lower mortality.

12.
Andes Pediatrica ; 93(2):174-183, 2022.
Article in Spanish | EMBASE | ID: covidwho-1819098

ABSTRACT

Objective: To describe a cohort of critically ill adult patients suffering from COVID-19, admitted to a pediatric intensive care unit managed by a pediatric intensive care team (ICU-MP). Patients and Method: Retrospective observational study of adults admitted to the ICU-MP due to COVID-19 from May 11 to July 26, 2020. Demographic, clinical, biochemical, ventilatory support characteris-tics, and complications were recorded. Disease severity was characterized by Acute Physiology and Chronic Health Evaluation II score (APACHE II) using data from the first 24 hours of admission to the ICU-MP. Results: Ninety-three patients over 18 years with suspected or confirmed COVID-19 were admitted to the ICU-MP. The median age was 60.3 years (SD 13.9), and 59 (63.4%) patients were male. Eighty-two (88.1%) patients had at least 1 medical comorbidity. The median APACHE II score was 9.4 points (SD 5.6). Fifty-one (54.8%) patients were invasively ventilated, for a median of 13.7 days (SD 17.9). Inotropic support was used in 45 (48%) patients. Thirty-three (35.5%) patients presented acute kidney injury (AKI) and 14 (15.1%) patients received continuous renal replacement therapy. Twenty-nine (31.2%) patients had healthcare-associated infections. The median ICU-MP stay was 10.8 days (SD 11.8). 25 (26.9%) patients died, ten of them (40%) had adequacy of thera-peutic effort. Conclusions: The mortality rate of critically ill patients with COVID-19 is high. Older patients (> 70 years), those who require invasive mechanical ventilation and who develop AKI are at increased risk of death. Although this is not a comparative study, our mortality rate and complications seem to be similar to those reported in adult case series.

13.
Research in Cardiovascular Medicine ; 11(1):6-12, 2022.
Article in English | EMBASE | ID: covidwho-1818466

ABSTRACT

Aim: Despite concerns about cardiovascular implications in coronavirus disease-2019 (COVID-19) patients, not all COVID-19 patients are visited by cardiologists and recommended to perform comprehensive cardiovascular assessments including measurement of biomarkers and echocardiography. We aimed to investigate the reasons for seeking cardiology care and to assess our cardiologists' diagnostic approaches to COVID-19 patients with potential cardiovascular involvement. Methods and Results: In this prospective, observational study, data of all consecutive COVID-19 patients admitted to six designated hospitals for COVID-19 in Iran in whom bedside cardiology consultation was requested were collected. A total of 148 patients including 105 (71%) males were included. The mean age was 57 ± 17 years. The most common reasons for cardiology consultation were dyspnea (56.7%), chest pain (12.8%), and suspected arrhythmias (10.8%). The most common comorbidities were hypertension (40.5%), diabetes mellitus (19.6%), and coronary heart disease (18.9%). A 12-lead electrocardiography (ECG) was obtained in all patients. Point-of-care ultrasonography or limited transthoracic echocardiography (TTE) was performed in 106 (71.6%) patients, and complete TTE was performed in 35 (23.4%) patients. Cardiac troponin was measured in 63 (42.6%) patients, and N-terminal pro B-type natriuretic peptide level was measured in 34 (23%) patients. Overall, 51 (34.5%) patients underwent invasive mechanical ventilation, inotropes were used in 29 (19.6%) patients, and 40 (27%) patients died. Conclusions: While preventing unnecessary investigations, the cardiologists should not overlook the lifesaving role of ubiquitous diagnostic modalities (such as ECG and TTE) in early detection and management of cardiac involvement in COVID-19.

14.
Vaccines ; 10(3), 2022.
Article in English | EMBASE | ID: covidwho-1818228

ABSTRACT

Background: Several countries are implementing COVID-19 booster vaccination campaigns. The objective of this study was to model the impact of different primary and booster vaccination strategies. Methods: We used a compartmental model fitted to hospital admission data in France to analyze the impact of primary and booster vaccination strategies on morbidity and mortality, assuming waning of immunity and various levels of virus transmissibility during winter. Results: Strategies prioritizing primary vaccinations were systematically more effective than strategies prioritizing boosters. Regarding booster strategies targeting different age groups, their effectiveness varied with immunity and virus transmissibility levels. If the waning of immunity affects all adults, people aged 30 to 49 years should be boosted in priority, even for low transmissibility levels. Conclu-sions: Increasing the primary vaccination coverage should remain a priority. If a plateau has been reached, boosting the immunity of younger adults could be the most effective strategy, especially if SARS-CoV-2 transmissibility is high.

15.
Vaccines ; 10(3), 2022.
Article in English | EMBASE | ID: covidwho-1818226

ABSTRACT

The COVID-19 vaccination has been the subject of unprecedented misinformation, false news, and public concerns. This study presents a unique analysis comprising persons who were not vaccinated and became ill. It investigates reasons for not vaccinating and evaluates how the personal experience of COVID-19 affected further attitudes and decisions related to health. The study included 730 consecutive unvaccinated patients hospitalized in 12 centers in Poland during the autumn 2021 pandemic wave. The most frequent reason behind the refusal to receive the vaccine was concern over the adverse effects, disbelief that the vaccine was sufficiently tested, and one’s conviction that COVID-19 will not affect a patient. Online information, friends, spouse, children/grandchildren, and other family members were most often the source of discouragement from vaccination. Most individuals regretted their decision not to receive a vaccine (66.0%), declared to promote COVID-19 vaccination after discharge (64.0%), and to receive a COVID-19 vaccine in the time recommended for convalescents (69.5%). Individuals expressing no regrets of vaccine refusal more frequently revealed conspiracy beliefs. The study shows that personal experience with severe COVID-19 can influence the perception of vaccination, but approximately one-third of unvaccinated hospitalized patients still appear to express vaccine hesitancy.

16.
Journal of Clinical Medicine ; 11(9), 2022.
Article in English | EMBASE | ID: covidwho-1818162

ABSTRACT

We performed an updated meta-analysis to robustly quantify admission trends of patients with ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI) during the first wave of the pandemic and to characterize on a large basis the risk profile and early prognosis. Studies having the same observation period for the comparison between SARS-CoV-2 outbreak in 2020 versus control period in 2019 were included. Primary endpoints were the relative variation of hospital admissions, the difference of in-hospital mortality for STEMI and NSTEMI. Secondary were: mortality according to countries, income levels and data quality;cardiogenic shock, mechanical complications, door-to-balloon time, time from symptom onset to first medical contact, left ventricular ejection fraction (LVEF) and troponin. In total, 61 observational studies with 125,346 patients were included. Compared with 2019, during the pandemic for STEMI were observed: a 24% reduction of hospitalizations with an impact on early survival (OR = 1.33 in-hospital mortality);the time from symptom onset to first medical contact was 91.31 min longer, whereas door-to-balloon time was increased (+5.44 min);after STEMI, the rate of cardiogenic shock was 33% higher;LVEF at discharge was decreased (−3.46);elevated high-sensitivity troponin levels (1.52) on admission. For NSTEMI, in the COVID-19 period, we observed a 31% reduction of hospitalizations and higher in-hospital deaths (OR = 1.34). The highest mortality rates among countries were: Italy OR = 3.71 (high income), Serbia OR = 2.15 (upper middle) and Pakistan OR = 1.69 (lower middle). Later hospital presentation was associated with larger infarctions, as well as with increased cardiogenic shock and in-hospital mortality.

17.
Cancers ; 14(9), 2022.
Article in English | EMBASE | ID: covidwho-1818053

ABSTRACT

Observational studies have shown increased COVID-19 risk among cancer patients, but the causality has not been proven yet. Mendelian randomization analysis can use the genetic variants, independently of confounders, to obtain causal estimates which are considerably less confounded. We aimed to investigate the causal associations of cancers with COVID-19 outcomes using the MR analysis. The inverse-variance weighted (IVW) method was employed as the primary analysis. Sensitivity analyses and multivariable MR analyses were conducted. Notably, IVW analysis of univariable MR revealed that overall cancer and twelve site-specific cancers had no causal association with COVID-19 severity, hospitalization or susceptibility. The corresponding p-values for the casual associations were all statistically insignificant: overall cancer (p = 0.34;p = 0.42;p = 0.69), lung cancer (p = 0.60;p = 0.37;p = 0.96), breast cancer (p = 0.43;p = 0.74;p = 0.43), endometrial cancer (p = 0.79;p = 0.24;p = 0.83), prostate cancer (p = 0.54;p = 0.17;p = 0.58), thyroid cancer (p = 0.70;p = 0.80;p = 0.28), ovarian cancer (p = 0.62;p = 0.96;p = 0.93), melanoma (p = 0.79;p = 0.45;p = 0.82), small bowel cancer (p = 0.09;p = 0.08;p = 0.19), colorectal cancer (p = 0.85;p = 0.79;p = 0.30), oropharyngeal cancer (p = 0.31;not applicable, NA;p = 0.80), lymphoma (p = 0.51;NA;p = 0.37) and cervical cancer (p = 0.25;p = 0.32;p = 0.68). Sensitivity analyses and multivariable MR analyses yielded similar results. In conclusion, cancers might have no causal effect on increasing COVID-19 risk. Further large-scale population studies are needed to validate our findings.

18.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816876

ABSTRACT

Introduction: More than 200 treatments have been tested for COVID-19 in over 7000 clinical trials. Most of these treatments are repurposed generic drugs, many of which have been studied extensively for the treatment of cancer. As cancer patients are particularly vulnerable, there is a need to understand how COVID-19 treatments might affect a patient's cancer. As part of the Reboot: COVID-Cancer Project, a living and freely available resource of clinical studies that report outcomes for cancer patients, we have developed a semi-automated pipeline to identify all relevant published clinical studies and registered clinical trials where COVID-19 drugs were tested for the treatment of cancer. Methods: Published clinical studies were assembled using targeted search queries in PubMed, rule-based approaches, and machine learning models. Machine learning models applied to natural language processing tasks were used to predict the drug, cancer type, study type, and therapeutic association. We used domain-specific rules and post-processing steps to further refine results, including determining whether a drug was used alone or in combination. Registered clinical trials were compiled from clinicaltrials.gov using targeted search queries, automated mapping, and rule-based screening. We extracted key information about each trial, such as the drug, cancer type, phase, location, trial status, age, gender, and availability of results. We applied our pipeline to a curated set of 202 drugs being tested for the treatment of COVID-19 in at least two interventional clinical trials worldwide, of which 27 are FDA-approved drugs that are standard of care for cancer, and 115 are FDA-approved drugs primarily used for non-cancer indications. Results: We found 28,138 published clinical studies and 9,118 registered clinical trials where the 202 drugs were tested for cancer. The published clinical studies include 5,286 case studies, 2,559 randomized controlled trials (RCTs), and 20,294 non-RCT clinical trials or observational studies. In 37% of the cases, the drug was used alone and not in combination. Lymphoid cancers were the most commonly tested, comprising 30% of studies. Possible benefit of the drug was found in 64% of publications. Of the 115 FDA-approved non-cancer drugs being tested for COVID-19, there is at least one published clinical study for 84 (73%) drugs. An additional 12 FDA-approved non-cancer drugs have been tested for the treatment of cancer in clinical trials, but have no results reported. Of the registered clinical trials, 39% are currently active, 66% are Phase 2 or later, and lymphoid cancers are again the most common, representing 29% of the trials. Discussion: Given the interconnection between COVID-19 and cancer, it is essential to understand how drugs used for COVID-19 might impact a patient's cancer. We have created a living resource for rapid review of information. The datasets are updated monthly and are freely available via an interactive dashboard.

19.
Respirology ; 27(SUPPL 1):40, 2022.
Article in English | EMBASE | ID: covidwho-1816633

ABSTRACT

Introduction/Aim: Pulmonary tele-rehabilitation (PTR) became a way of providing exercise training and education for people with respiratory conditions during the COVID- 19 pandemic. To determine if PTR was safe, improved exercise capacity, breathlessness and health-related quality of life. Methods: Retrospective observational study. Participants had COPD, bronchiectasis, interstitial lung disease, asthma or recent lung surgery. As well as access to WIFI and a home device for videoconferencing. Outcomes: five time sitto- stand (5STS), 1 min sit-to-stand (1MinSTS);St George's Respiratory Questionnaire (SGRQ);COPD assessment test (CAT);Hospital Anxiety and Depression Scale (HADS);Modified Medical Research Council (mMRC) dyspnoea scale, number of adverse events. PTR used a zoom platform, ran for 40 min twice per week for 8 weeks, with a maximum of 10 participants in each class. An experienced physiotherapist led the exercise sessions with support from physiotherapy students. Results: Seventy-five people (66 females) commenced PTR [mean (SD): Age 67 (11) years, FEV1 63 (20) % pred] and 52 (70%) completed. Statistically significant improvement (mean change (SD) [95% CI]) for 5STS: -4 (7) [-6 to -1] s;1MinSTS: 5 (8) [2-9] times;SGRQ total: -7 (12) [-11 to -3] points;mMRC: -0.3 (0.7) [-0.6 to -0.7] score;CAT: -2.4 (6) [-4 to -0.5] score. No adverse events were reported. Conclusions: PTR improved exercise capacity, healthrelated quality of life and dyspnoea with no adverse events reported. Outpatient-based PR remains the gold standard;however, PTR could be provided during COVID lockdowns and incorporated as a flexible option for people who find it difficult to attend outpatient-based PR.

20.
Clinical Neurosurgery ; 67(SUPPL 1):138, 2020.
Article in English | EMBASE | ID: covidwho-1816191

ABSTRACT

INTRODUCTION: Neuroimaging in the intensive care unit (ICU) may be difficult to acquire given the safety concerns and challenges involved in moving critically ill patients. We report on the safety and clinical findings of a portable magnetic resonance imager (MRI) in a cohort of ICU patients who had Covid 19 with suspected neurologic injury. METHODS: This is a prospective, non-randomized, observational study at one institution utilizing portable MRI in patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, known as Covid-19. Patients selected for imaging had any of the following: 1) unexplained encephalopathy or coma, 2) seizures, 3) focal neurologic deficit, and 4) abnormal head CT. Imaging was performed in each patient's ICU room with a portable, selfshielding, 0.064 Tesla (T) MRI. RESULTS: Among 19 patients, a total of 20 MRI scans in seven ICUs were acquired between April 13 and April 23, 2020. No adverse events to patients or staff from MRI acquisition were reported. In 12 patients, abnormal findings were seen, which included increased fluid attenuated inversion recovery (FLAIR) signal (n = 12), hemorrhage (n = 3), and diffusion-weighted imaging (DWI) positivity (n = 3). Imaging led to a change in clinical management in five patients, including 3 lumbar punctures, a resumption of anticoagulation therapy, and one previously unplanned move to palliative care. CONCLUSION: This study provides the first report on the use of a novel, portable, self-shielding MRI to image patients. In critically ill patients, the use of portable MRI is safe, feasible, and leads to changes in clinical management. This technique can be applied to any ICU patients whose care requires imaging of the brain.

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