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1.
Medical Science ; 26(122):8, 2022.
Article in English | Web of Science | ID: covidwho-1887480

ABSTRACT

COVID-19 (Coronavirus infectious disease 2019) denotes an ever changing and varied disease which has crippled the health care systems throughout the world. There have been studies conducted across the globe to establish the important factors for severity and mortality associated with COVID-19. We tried to study the effect of chronic obstructive pulmonary disease (COPD) on the severity as well as outcome of COVID-19. Material and methods: A total of 180 patients with COVID-19 were enrolled in this study and were then screened for history of COPD. There were 49 patients with history of COPD and 131 patients with no history of COPD. Inflammatory markers and HRCT scores were assessed for all the patients and they were followed up to study the outcome. Result: COPD was significantly associated HRCT Score, inflammatory markers and outcome. The mean HRCT Score for patients with COPD was more in COPD group (15.39 +/- 4.65) when compared with Non-COPD group (9.39 +/- 3.98). Mortality was also significantly higher in patients with COPD (67.3%) when compared to the patients without COPD (3.3%). Conclusion: We conclude that COPD is an important factor which has to be considered while treating the patients of COVID-19 especially in the rural India where lockdown restrictions and lack of knowledge have provided hinderance in achieving optimal follow up as there is increased severity and mortality associated with it.

2.
Gastroenterology and Hepatology from Bed to Bench ; 15(2):153-157, 2022.
Article in English | EMBASE | ID: covidwho-1887404

ABSTRACT

Aim: This study aimed to evaluate the prevalence and outcome of COVID-19 among Iranian celiac disease patients. Background: Patients with celiac disease (CD) might be at greater risk for opportunistic viral infections. Coronavirus disease-2019 (COVID-19) is a new coronavirus (SARS-CoV-2) cause of respiratory disorder which spread around the world at the end of 2019. The question is does COVID-19 infection increase the risk of severe outcome and/or a higher mortality in treated celiac disease?. Methods: Data regarding demographic details, clinical history, and COVID-19 infection symptoms among treated celiac disease patients was collected from July 2020 to January 2021 and analyzed using SPSS version 25. Results A total of 455 celiac disease patients were included in this study. The prevalence of Covid-19 infection among celiac disease patients was 2.4%. Infection among women (72.7%) was higher than the men, and only one overweight man who smoked was hospitalized. Among COVID-19 infected celiac disease patients, the most common symptoms were myalgia 90.9% (10/11), fever, body trembling, headache, shortness of breath, loss of smell and taste, and anorexia (72.7%). Treatments for COVID-19, included antibiotics (90.9%), pain analgesics (54.5%), antihistamines (27.3%), antivirals (9.1%) and hydroxychloroquine (9.1%). Conclusion: This study shows that treated celiac disease is not a risk factor for severity or higher mortality in patients infected with COVID-19. Women, however, might need extra-protection to prevent COVID-19 infection.

3.
Academic Journal of Second Military Medical University ; 43(3):239-245, 2022.
Article in Chinese | EMBASE | ID: covidwho-1887362

ABSTRACT

Objective To study the dynamic trajectories of quantitative immunoglobulin G (IgG) titers of hospitalized coronavirus disease 2019 (COVID-19) patients and reveal the immune process of the organism after infection. Methods The clinical data and quantitative IgG titers at different time points of hospitalized COVID-19 patients in Wuhan Huoshenshan Hospital and Guanggu Branch of Maternity and Child Healthcare Hospital of Hubei Province from Feb. 5 to Apr. 15, 2020 were retrospectively analyzed. Group-based trajectory modeling was used to identify the subgroups from time-series data of patients’ antibody titers, and then the clinical characteristics and outcomes were compared among these trajectory groups. Results Totally, 734 patients who met the criteria were included. Three IgG trajectory groups were identified from the antibody data: group 1 (consistently low group, 60 cases[8.17%]), group 2 (moderate group, 38 cases [5.18%]) and group 3 (high group, 636 cases[86.65%]). The hospitalization days and the virus clearance time of patients in the 3 groups were significantly different (both P<0.001), those in group 1 were the shortest, while the all-cause mortality and disease deterioration rate had no significant difference in the 3 groups (both P>0.05). Conclusion Patients with different IgG antibody developmental trajectories may have heterogeneous prognosis and immune process. Patients with consistently higher longitudinal antibody titers may require more medical attention.

4.
Journal of Medical Sciences (Taiwan) ; 42(3):127-133, 2022.
Article in English | EMBASE | ID: covidwho-1887283

ABSTRACT

Background: Acute kidney injury (AKI) is one of the most common complications associated with mortality. Aim: This study aims to find the correlation between renal dysfunction and inflammatory markers and their outcome in COVID-19 patients. Methods: The study was carried out in 100 patients whose inflammatory markers were available on the day of admission among the 814 patients with COVID-19. Results: Fifty-six percent of patients had moderate, and 36% of patients had severe disease outcomes including mortality in nine patients. Out of all the factors studied, advanced age, presence of chronic liver disease, increased levels of blood urea, serum creatinine and lactate dehydrogenase (LDH), decreased creatinine clearance were found to be significantly associated with risk of mortality (P < 0.05). Out of all the factors studied, advanced age increased interleukin (IL)-6 values, increased serum ferritin values, and known cases of hypertension (HTN) were found to be significantly associated with the occurrence of AKI (P < 0.05). The death rate among those with AKI was more than double, i.e., 13.3% compared to only 5.5% without AKI. It was found that only IL-6 was significantly more in those who died having AKI compared to those who recovered with AKI (P < 0.05) but other inflammatory markers were not significantly associated with this (P > 0.05). Conclusion: Significant risk factors of AKI were advanced age, increased IL-6 values, increased serum ferritin values, and known cases of HTN. Significant risk factors for mortality were advanced age, presence of chronic liver disease, increased levels of blood urea, serum creatinine and LDH, decreased creatinine clearance.

5.
Open Access Macedonian Journal of Medical Sciences ; 10:972-977, 2022.
Article in English | EMBASE | ID: covidwho-1887256

ABSTRACT

BACKGROUND: Approximately 14–50% of severe COVID-19 patients are admitted to the Intensive Care Unit (ICU) that acquires a multidrug-resistant bacterial infection (MDR) and worsens clinical outcomes of patients. AIM: We aim to determine the increased risk of MDR infection in the ICU including large-spectrum antibiotic administration, invasive procedure performance (mechanical ventilation), and clinical outcomes of patient. METHODS: We analyzed 227 patients with a primary diagnosis of COVID-19 on mechanical ventilation who were admitted to ICU COVID-19 RSUP Dr. M. Djamil from 2020 to 2021. Demographic information, sputum culture results, intubation, and clinical outcomes were all collected in the medical records for this retrospective cohort study. Patients who were hospitalized for <48 h in the ICU were excluded from the study. An independent t-test and a Chi-square test were used to analyze the data. RESULTS: In sixty patients (26.4%), bacteria were found in the sputum culture, 40 patients (66.7%) of them were MDR. The most common bacteria found was Acinetobacter baumanii (35%) followed by Klebsiella pneumonia (21.7%). There is a significant relationship between MDR (p-value 0.000) and intubation (p-value, 000) to clinical outcomes of patients (improvement or death). There is a significant relationship between intubation and MDR (p-value 0.009). CONCLUSION: MDR patient status affected the outcomes of COVID-19 patients in the ICU. Patients with MDR were more likely to have a poor clinical outcome.

6.
Journal of Urology ; 207(SUPPL 5):e724-e725, 2022.
Article in English | EMBASE | ID: covidwho-1886527

ABSTRACT

INTRODUCTION AND OBJECTIVE: In particular after the onset of the COVID-19 pandemic, there was a precipitous rush to implement virtual and online learning strategies in surgery and medicine. It is essential to understand whether this approach is sufficient and adequate to allow the development of robotic basic surgical skills. The main aim of the authors was to verify if the quality assured eLearning is sufficient to prepare individuals to perform a basic surgical robotic task. METHODS: A prospective, randomized and multi-center study conducted in September 2020 in the ORSI Academy, International surgical robotic training center. 47 participants with no experience but a special interest in robotic surgery, were matched and randomized into 4 groups who underwent a didactic preparation with different formats before carrying out a robotic suturing and anastomosis task. Didactic preparation methods, ranged from a complete eLearning path to peer-reviewed published manuscripts describing the suturing, knot tying and task assessment metrics. RESULTS: The primary outcome was the percentage of trainees who demonstrated the quantitatively defined proficiency benchmark after learning to complete an assisted but unaided robotic vesico-urethral anastomosis task. The quantitatively defined benchmark was based on the objectively assessed performance (i.e., procedure steps completed, errors and critical errors) of experienced robotic surgeons for a proficiency based progression (PBP) training course. None of the trainees in this study demonstrated the proficiency benchmarks in completing the robotic surgery task (Figure 1a-c). CONCLUSIONS: Quality assured online learning is insufficient preparation for robotic suturing and knot tying anastomosis skills.

7.
Journal of Urology ; 207(SUPPL 5):e608-e609, 2022.
Article in English | EMBASE | ID: covidwho-1886518

ABSTRACT

INTRODUCTION AND OBJECTIVE: Prostate abscess (PA) is uncommon and the diagnosis is often delayed or missed. Traditionally, PA has resulted from acute prostatitis or ascending genitourinary (GU) infection due to gram-negative bacilli but S. aureus is an emerging cause. The objective is to study the clinical features, management and outcomes of PA in COVID 19 period. METHODS: A prospective review of all adult patients admitted with a diagnosis of PA between April 2020 and July 2021(in COVID period) were conducted. Inclusion criteria included age ≥18 years, a GU infection syndrome, and imaging consistent with PA. RESULTS: Fifteen patients with PA were identified. The median age was 54 years. Four patients (22.7%) were immunosuppressed and 11 (50%) had diabetes. Fever (66.6%), dysuria (60%), and urinary retention (20%) were the most common presenting symptoms. Pelvic CT revealed PAs in all patients with 8/15 (53.3%) were >2 cm in greatest diameter. Urine cultures were positive in 13/15 (86.6%) patients with 4/13 (30.7%) growing S. aureus (MRSA). Fourteen patients (93.3%) were managed with antibiotics alone whereas 1 (6.6%) underwent abscess drainage. The median duration of antibiotic therapy was 32 days. CONCLUSIONS: PA is relatively uncommon and may be difficult to distinguish clinically from conditions like acute prostatitis. Optimal management usually requires both antibiotics and drainage. With the advancement in the field of radiology, newer antibiotics and early diagnosis, effective conservative management of PA has become possible. Noticing the trend of frequent occurrence of S. aureus as a cause, coverage for MRSA should be a component of empiric treatment for PA.

8.
Journal of Urology ; 207(SUPPL 5):e491, 2022.
Article in English | EMBASE | ID: covidwho-1886510

ABSTRACT

INTRODUCTION AND OBJECTIVE: Patients with non-muscleinvasive bladder cancer (NMIBC) that recurs after treatment with intravesical Bacillus Calmette-Guerin (BCG) must weigh the risk of progression of bladder cancer and loss of a window of potential cure with medical therapy against the risk of morbidity and loss of quality of life (QOL) with radical cystectomy. The CISTO Study (NCT03933826) is a pragmatic, prospective observational cohort study comparing medical therapy (i.e., intravesical therapy or systemic immunotherapy) with radical cystectomy for recurrent highrisk NMIBC. Here we report on the design and progress of the CISTO Study. METHODS: 900 patients with recurrent high-risk NMIBC that has failed first-line BCG and who have chosen to undergo standard of care treatment will be enrolled. Patient stakeholders helped determine the primary outcome: 12-month patient-reported QOL using the EORTC QLQ-C30. Secondary outcomes include urinary and sexual function, decisional regret, financial distress, healthcare utilization, return to work/normal activities, progression, and recurrence-free, metastasis-free, and overall survival. Participants will be followed for up to 3 years. RESULTS: Enrollment is active at 32 sites across the US, including 23 university-based centers and 9 community sites. As of November 1, 2021, 173 participants have been enrolled, 104 of whom chose medical therapy and 69 of whom chose radical cystectomy. The completion rate for the primary outcome of QOL at 12 months is 94% (15 out of 16 participants to date). The inclusion of electronic consent and collection of PROs allowed recruitment and follow-up to continue remotely during the COVID-19 pandemic. Significant pandemic-related challenges have included slow study start-up at sites, staffing, periods of suspension, and delays in patients obtaining care. Strategies to address these challenges include improved methods for onboarding and training sites, all-site communication, confirming study eligibility, ing EHR data, and remote monitoring while adhering to the highest study standards. CONCLUSIONS: The CISTO Study will compare patient reported outcomes for those undergoing medical therapy with radical cystectomy for recurrent high-risk NMIBC. The CISTO Study has the potential to fill critical evidence gaps and provide for personalized, patient-centered care.

9.
Journal of Urology ; 207(SUPPL 5):e482, 2022.
Article in English | EMBASE | ID: covidwho-1886508

ABSTRACT

INTRODUCTION AND OBJECTIVE: COVID-19 has caused significant disruption to the management of urological cancer, this study aims to assess 30-day postoperative outcomes for patients undergoing urological cancer surgery during the COVID-19 pandemic. METHODS: COVIDSurg study is the largest international, multicentre study of COVID-19 in surgical patients performed to date. COVIDSurg-Cancer explored the safety of performing elective cancer surgery during the pandemic. All bladder, kidney, UTUC and prostate cancer patients who underwent elective cancer surgery between March 2020 and July 2020 were included. Univariable and multivariable regression was performed to assess association of patient factors with mortality, respiratory complications and operative complications. RESULTS: A total of 1,902 patients from 36 countries were included. 658 (34.6%) patients had bladder cancer, 590 (31.0%) kidney cancer or UTUC, and 654 (34.4%) prostate cancer. These patients underwent elective curative surgery for their cancers (prostatectomies, nephrectomies, cystectomies, nephroureterectomy, TURBTs). 62% of sites were not designated “hot” COVID-19 sites (i.e. did not actively admit patients with COVID-19).A total of 42/1902 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay. 21 (0.1%) mortalities were observed;of those, 8 (38.1%) were diagnosed with COVID-19. Mortalities were found to be more likely in patients with concurrent COVID-19 infection (OR 31.7, 95% CI 12.4- 81.42, p<0.001), aged over 80, ASA grade 3+ and ECOG grade 1+. 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30 days of surgery. Respiratory complications were more likely in patients aged with concurrent COVID-19 infection (OR 40.6, 95%CI 11.41-144.45, p<0.001), over 70, from an area with high community risk or with a revised cardiac risk index of 1+. There were 84 major complications (Clavien-Dindo score ≥3). Patients with a concurrent COVID-19 infection (OR 7.45, 95% CI 2.73-20.3, p<0.001) or aged 80 or above were more likely to experience major complications. CONCLUSIONS: Elective urological cancer surgeries are safe to perform during the COVID-19 pandemic. This study highlights important risk-factors associated with worse outcomes. Our data can inform health services to safely select patients for surgery during the pandemic. Patients with concurrent COVID-19 infection have a higher risk of mortality and respiratory complications and should not undergo surgery if possible.

10.
Journal of Urology ; 207(SUPPL 5):e382-e383, 2022.
Article in English | EMBASE | ID: covidwho-1886500

ABSTRACT

INTRODUCTION AND OBJECTIVE: In situation with the COVID-19 outbreak, the EAU guidelines Rapid Reaction Group provided recommendations to guide muscle invasive bladder cancer (MIBC) priorities, and they recommended that neoadjuvant chemotherapy should be considered omitted in T2/3 focal N0M0 MIBC patients. This meta-analysis aims to evaluate the efficacy of neoadjuvant chemotherapy compared to radical cystectomy alone in improving overall survival of T2-4aN0M0 MIBC patients. METHODS: Following the PRISMA guideline, PubMed, EMBASE, and Cochrane Library were searched up to September 2021. The articles were searched with keywords muscle-invasive bladder cancer, neoadjuvant chemotherapy, cystectomy, and overall survival. Participants, patients with T2-4aN0M0 MIBC;Interventions, T2- 4aN0M0 MIBC patients who underwent neoadjuvant chemotherapy;Outcomes, comparison of overall survival included for analysis. The overall survival was analyzed as hazard ratio (HR) and 95% confidence interval (CI) and presented in a forest plot. We also conducted a sub-analysis of only T2N0M0 MIBC patients. Quality assessments were performed independently by two reviewers using the Scottish Intercollegiate Guidelines Network. RESULTS: A total of 8 studies were included in the metaanalysis. 8 studies were intermediate risk for detection bias and there were no major problems. In T2-4aN0M0 MIBC patients, the overall survival was significantly better in the neoadjuvant chemotherapy + radical cystectomy group than in the radical cystectomy alone group (HR, 0.79;95% CI, 0.69-0.92;p=0.002) (Fig. 1A). A subgroup analysis was performed on only T2N0M0 MIBC patients and 5 studies were included. There was no difference in overall survival between the neoadjuvant chemotherapy + radical cystectomy group and the radical cystectomy alone group (HR, 0.83;95% CI, 0.69-1.02;p=0.06) (Fig. 1B). CONCLUSIONS: As recommended by the EAU guidelines Rapid Reaction Group, it is thought that patients with T2N0M0 MIBC should strongly consider omitting neoadjuvant chemotherapy until the end of the COVID-19 pandemic. Whether to omit neoadjuvant in T2- 4aN0M0 MIBC should be discussed further, and studies targeting only T2-3N0M0 MIBC are expected to proceed further.

11.
Journal of Urology ; 207(SUPPL 5):e227-e228, 2022.
Article in English | EMBASE | ID: covidwho-1886488

ABSTRACT

INTRODUCTION AND OBJECTIVE: The use of telemedicine in management of genitourinary malignancies has expanded greatly in the context of the COVID-19 pandemic. We aimed to evaluate patient perspectives across the first year of widespread telemedicine use at our institution. METHODS: We conducted a prospective survey study from July 2020 through June 2021 of patients who had telemedicine visits with urology, medical oncology, or radiation oncology for management of genitourinary malignancies. Patients received a questionnaire regarding the telemedicine experience. Responses were scored on a 5- point Likert scale. The primary outcome was patient satisfaction. RESULTS: We received 134 survey responses. Overall, 100 patients (75%) reported being “extremely satisfied” with the telemedicine encounter, and 100 patients (75%) “strongly agreed” that they were able to discuss sensitive topics about cancer care as well as they could at an in-person visit. On ordinal logistic regression adjusting for patient age and gender, patient satisfaction scores decreased over time (OR 0.88 per month, 95% CI 0.78-0.99, p=0.042, Figure). In particular, patients were less satisfied over time with the explanations they received about their condition, the concern their physicians showed for their questions, the information they received about treatment options, the instructions they received about follow-up care, and the amount of time the physicians spent with them (all p<0.05). Technological barriers to telemedicine were encountered by 16 patients (12%), and these were associated with lower patient satisfaction (p<0.001). The rate of technological barriers did not significantly change over time, though it was associated with increasing patient age. CONCLUSIONS: While the majority of patients are satisfied with telemedicine for management of genitourinary malignancies, satisfaction has decreased after the early months of the COVID-19 pandemic, particularly with regard to patient counseling and time spent. Additionally, technological barriers to telemedicine implementation remain common, particularly among the elderly. (Figure Presented).

12.
Journal of Urology ; 207(SUPPL 5):e169, 2022.
Article in English | EMBASE | ID: covidwho-1886483

ABSTRACT

INTRODUCTION AND OBJECTIVE: Nephrectomy and venous thrombectomy is a challenging procedure with potential morbidity and mortality. Despite the increasing use of immune checkpoint inhibitors (ICI) in the management of advanced renal cell carcinoma (RCC), data regarding the outcomes of venous thrombectomy following ICI is limited. We evaluated the feasibility and perioperative outcomes of nephrectomy and venous thrombectomy following ICIs. METHODS: Patients with locally advanced or metastatic RCC with venous thrombus undergoing nephrectomy following ICI therapy were evaluated in four high-volume US academic centers between June 2017 and June 2021. Clinical data, perioperative outcomes, and 90-day complications were recorded. RESULTS: Out of 79 patients who received post-ICI nephrectomy, 27 had venous thrombus. Median (IQR) age was 64 (55-71) years. ICI regimens were Nivolumab ± Ipilimumab (n=19), and Pembrolizumab± Axitinib (n=8). Nephrectomy was indicated following either a good clinical response to ICI (n=24) or as a palliative surgery (n=3). Venous thrombi levels are shown in Table-1. Among all patients, 26 (96%) underwent radical and 1 (4%) partial nephrectomy;12 (44.5%) open, 12 (44.5%) robotic and 3 (11%) laparoscopic. One robotic case converted electively to open. Vascular procedures included renal vein thrombectomy (n=6), IVC thrombectomy and primary repair (n=19), IVC patch repair (n=1), and suprarenal cavectomy (n=1). No intraoperative complications were reported. Nine patients showed no viable tumor in the thrombus, of whom 2 had complete response in the primary tumor as well (ypT0N0). 90-day complication rate was 33% (n=9), with 8 patients (30%) requiring readmission (Table-2). One death was reported within 90 days due to COVID-19 infection. CONCLUSIONS: Nephrectomy and venous thrombectomy following systemic immune checkpoint inhibitor therapy is feasible. One third of patients show no viable tumor in the thrombus. Larger studies are needed to predict pathological response.

13.
Journal of Urology ; 207(SUPPL 5):e12, 2022.
Article in English | EMBASE | ID: covidwho-1886478

ABSTRACT

INTRODUCTION AND OBJECTIVE: Urinary tract infection (UTI), one of the most common reasons women seek acute care, is responsible for 15% of all community-prescribed antibiotics. The effects of the pandemic and telemedicine on UTI treatment are largely unknown. Here, we evaluated the impact of Covid-19 and telemedicine on empiric UTI treatment in women. We hypothesized that increased use of telemedicine during the pandemic would increase the rate of empiric UTI treatment. METHODS: This is a retrospective cohort study of treatment patterns of female patients aged 18-65 using ICD-10 codes for acute cystitis with (N30.00) and without (N30.01) hematuria during the first 6 months of the pandemic (March 2020 - August 2020) versus the 6 months preceding the pandemic (September 2019 - February 2020). Our primary outcome was presence of empiric antibiotic treatment, defined by treatment based on clinical picture with or without pending urine testing. Secondary analysis included determining which antibiotics were most commonly prescribed and treatment adjustment. To reach 80% power to detect a 10% difference with p≤0.05, we included 222 patients. Exclusion criteria included inpatient encounter, long-term facility residence, urinary procedure in last 2 weeks, previous UTI treatment within 30 days. RESULTS: The average age of participants was 42 years. Fiftytwo percent were white, 23% Black, and 23% Hispanic. No demographic differences existed between cohorts. During the pandemic, 36.6% of UTI encounters were conducted via telemedicine, compared to 1.5% pre-pandemic (p<.0001). The rate of empiric treatment increased from 58.2% pre-pandemic to 70.5% during the pandemic (p=.055). The rate of treatment based on clinical picture with no pending urine testing was significantly higher during the pandemic (p<.0001). Nitrofurantoin or trimethoprim/ sulfamethoxazole was used in 79% of patients prescribed an antibiotic. The overall rate of treatment adjustment was 17.1%;there was no significant difference by time period. CONCLUSIONS: Covid-19 dramatically increased telemedicine utilization by women with UTI symptoms. Empiric treatment approached significance and confirmatory urine testing was done significantly less during the pandemic. Given the importance of antibiotic stewardship, it is important to further characterize telemedicine's impact on treatment of this common condition. (Table Presented).

14.
Journal of Urology ; 207(SUPPL 5):e3, 2022.
Article in English | EMBASE | ID: covidwho-1886477

ABSTRACT

INTRODUCTION AND OBJECTIVE: BPH affects tens of millions of men across the world. Most procedures require either general or regional anesthesia or a transurethral approach. Herein, we present the 3 & 6 months results of NCT04760483 is a phase I prospective, single center, interventional pilot study evaluating transperineal laser ablation (TPLA) of BPH tissues, carried in Office setting under local anesthesia. A detailed step by step video depiction of this procedure is available at the AUA video library. The objectives call for safety, feasibility, and impact in pertinent outcomes measures, such as Uroflowmetry, IPSS, Hematuria, Erectile function, and ejaculation METHODS: The study contemplated accrual of 20 men between 50 and 80 years with prostate volumes between 30 and 120 cc, IPSS scores >9, peak flows between 5 and 15 cc/s and void residuals under <250 ml. Any patient neurological conditions, history of any surgical intervention or urinary retention were excluded. IPSS assessments, Flow studies and prostate volume measures were conducted at 3 months. Herein we present the results. Bayesian analysis for continuous measurements were performed and non-parametric differences were evaluated using chi2 tests. RESULTS: Patients enrolled between December 2020 and February of 2021. The median (IQR) for age and BMI was 68 (58,73) and 29 (27,31), respectively. These parameters for room time, ablation time, watts and total joules were 29 (23,32), 9 minutes (7,12), 6 (5,7) watts and 3,400 (2,600, 3600) joules, respectively. 8(40%) were discharged with a Foley due to elevated residuals. 16 patients had erections and ejaculations before and 3 months after TPLA. 17/20 (85%) had significant improvement in their urinary profile after TPLA (See TABLE for details). One of the initial responders suffered from COVID- 19 infection and developed a CVA that hindered his urinary function. CONCLUSIONS: TPLA in the office setting is feasible and safe. Three month outcomes showed subjective and objective sustained improvement in over 80% of patients for at least 6 months. Furthermore, erections or ejaculations were not affected. This novel and promising approach demands further evaluation in phase II-III trials. (Figure Presented).

15.
Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine ; 77(sup1):1-33, 2022.
Article in English | EMBASE | ID: covidwho-1886341
16.
Gastrointestinal Endoscopy ; 95(6):AB367-AB368, 2022.
Article in English | EMBASE | ID: covidwho-1885786

ABSTRACT

DDW 2022 Author Disclosures: Daniel Scanlon: NO financial relationship with a commercial interest ;Brianna Shinn: NO financial relationship with a commercial interest ;Zachary Lieb: NO financial relationship with a commercial interest ;Brian Jacobs: NO financial relationship with a commercial interest ;Divya Chalikonda: NO financial relationship with a commercial interest ;Jason Ho: NO financial relationship with a commercial interest ;Abhishek Agnihotri: NO financial relationship with a commercial interest ;Anand Kumar: YES financial relationship with a commercial interest;Olympus:Consulting ;Anthony Infantolino: NO financial relationship with a commercial interest ;Christina Tofani: NO financial relationship with a commercial interest ;Alexander Schlachterman: NO financial relationship with a commercial interest Introduction: Endoscopic submucosal dissection (ESD) is a minimally invasive technique used for removal of superficial dysplastic or early cancerous esophageal lesions. Many of these lesions arise in a background of Barrett’s esophagus (BE) which is a known precursor of dysplasia and adenocarcinoma. Large lesions not amenable to endoscopic mucosal resection often have superficial forceps biopsies taken prior to referral for ESD. This study aims to evaluate the accuracy of superficial forceps biopsies compared with pathology from ESD. Methods: A retrospective medical record review was performed that included consecutive patients who underwent ESD for esophageal lesions at a tertiary care center between 6/2018 and 9/2021. Pathology results from outside hospital and same institution superficial forceps biopsies as well as ESD pathology reports were reviewed. The primary outcome measured was the number of patients found to have higher disease severity on ESD pathology compared with pre-ESD superficial forceps biopsies. Results: The 28 patients included in the study received superficial forceps biopsies at outside hospitals (n=9), the same institution (n=14), or both (n=5). An average of 99 days occurred between outside hospital superficial forceps biopsies and ESD compared with an average of 30 days between superficial forceps biopsies and ESD performed at the same institution. Delays between superficial forceps biopsies and ESD may be related to the COVID-19 pandemic leading to prolonged time between procedures. In the entire cohort, ESD pathology differed from superficial forceps biopsies in 13/28 patients (46%). 10 patients (36%) had their disease severity upgraded and 3 were newly diagnosed with cancer on ESD pathology. Findings were similar for patients with lesions arising in a background of BE (21/28) (Table 1). Of those with BE, 9/21 (43%) patients had ESD pathology that differed from superficial forceps biopsies with 6 patients (29%) receiving increased disease severity and 2 patients receiving a new cancer diagnosis on ESD pathology. Conclusion: Superficial forceps biopsies taken prior to resection of esophageal lesions via ESD were concordant with ESD pathology in the majority of cases, however 36% of patients received upgraded disease severity on ESD pathology. Findings were similar for patients with or without a background of Barrett’s esophagus. These results highlight the importance of en bloc resection not only for therapeutic benefit (60% of patients in this cohort achieved R0 resection), but for accurate staging of esophageal lesions. [Formula presented]

17.
Gastrointestinal Endoscopy ; 95(6):AB189, 2022.
Article in English | EMBASE | ID: covidwho-1885785

ABSTRACT

DDW 2022 Author Disclosures: Dennis Jensen: NO financial relationship with a commercial interest ;Rome Jutabha: NO financial relationship with a commercial interest ;Gareth Dulai: NO financial relationship with a commercial interest ;Noam Jacob: NO financial relationship with a commercial interest ;Jeffrey Gornbein: NO financial relationship with a commercial interest Background and Aims: The best strategy to prevent DPPIUH is controversial. Some colonoscopists recommend hemoclip closure of PPIU’s but this has mixed success rates in different RCT’s and is reported not to be cost effective. In addition to known risks, arterial blood flow detected in PPIU’s is an important predictor of DPPIUH. Our AIMS are to report study methods and interim results of a RCT of blood flow monitoring to prevent DPPIUH. Methods: This is an ongoing blinded RCT at several major Los Angeles Medical Centers by experienced colonoscopists. Outpatients having colonoscopies are screened and consented for enrollment. Sessile and multilobulated polyps are removed by EMR techniques. Thermal coagulation is used for polypectomies in this study. Randomized patients are stratified by whether they take chronic anti-platelet or anti-thrombotic drugs and have PPIU’s of 10-40 mm;or those without bleed drugs and have PPIU’s between 15-40 mm. By opening a sealed envelope after polypectomies, randomization is to either standard management (e.g. following ASGE guidelines of bleed drugs) or DEP interrogation of the PPIU and guided treatment of the artery with hemoclips or multipolar probe coagulation in the PPIU until blood flow is eradicated. Patients and their care givers were blinded to treatments allocated during colonoscopy. Prospective follow-up is by a research coordinator contacting each patient at 7, 14, and 30 days to record whether any complications (e.g. pain, vomiting, or bleeding);or rectal bleeding and its severity (e.g. # and days of bloody BM’s);whether they sought ER, clinic, or telemedicine care for bleeding;or were hospitalized. Major DPPIUH was diagnosed in patients with hospitalization for severe bleeding and/or for 3 or more days of ongoing severe rectal bleeding but refusal of hospitalization because of high rates of COVID here. Demographic, laboratory, colonoscopic, and pathology results are recorded on standard forms along with 30-day outcomes. Patients are assigned a code, data are entered onto HIPAA compliant computer files by a data manager and managed with SAS. With half the projected sample size randomized and followed up (e.g. 133 of 268 total), this is a planned interim analysis of the primary outcome - rates of DPPIUH by treatment. Severe adverse events (SAE’s) were also reviewed. Results: For 133 high risk patients randomized to date, 67 are in the standard group and 66 in the DEP group. The groups were well matched in risk factors – see Table 1. Overall, the Doppler group had lower rates of delayed PPIU bleeding – both major and total- see Table 2. There were no SAE’s. Conclusions: The major DPPIUH rate was higher with standard treatment than DEP treatment (7.46 % vs. 0 %), as was the rate of Total DPPIUH (10.45 % vs. 1.52%). Based upon these promising results, this RCT will continue. [Formula presented] [Formula presented]

18.
Gastrointestinal Endoscopy ; 95(6):AB128-AB129, 2022.
Article in English | EMBASE | ID: covidwho-1885781

ABSTRACT

DDW 2022 Author Disclosures: Jukkaphop Chaikajornwat: NO financial relationship with a commercial interest ;Rapat Pittayanon: NO financial relationship with a commercial interest ;Prooksa Anancheunsook: NO financial relationship with a commercial interest ;Rungsun Rerknimitr: NO financial relationship with a commercial interest Introduction: Esophagogastroduodenoscopy (EGD) has been considered as an aerosol-generating procedures (AGP) with high risk of transmission of respiratory aerosols similar to an endotracheal intubation during COVID-19 pandemic. However, the risk of AGP at different distances to the patient’s mouth and the benefit of the protective measure such as the head box have never been fully studied. We performed a randomized control trial to evaluate the efficacy of acrylic head box for preventing the aerosol spreading to personnel standing at different distances to the patient’s mouth during EGD. Method: This trial is a randomized, open-label, single center, in adult patients scheduled for EGD between September and November 2021. Patients were randomly assigned with 1:1 allocation to either head box group or without head box group (control group). The 0.3- and 0.5-micron aerosol particles were measured with particle counters (PCE-PCO 1;PCE Deutschland GmbH, Meschede, Germany) at nurse anesthetist’s and endoscopist’s position for 2 minutes before EGD, and every 30 seconds automatically entire the procedure. The primary composite outcomes were the mean difference of aerosol particle level between during and before EGD at the nurse anesthetist’s face position (40 cm from the patient’s mouth) and at the endoscopist’s face position. (Figure) Result: The analysis included 50 patients undergoing EGD in each arm. The baseline characteristics were not difference between the 2 groups. The mean distance between the endoscopist’s face and the patient’s mouth was 66.1 ± 4.9 cm. (Figure) The mean differences of both 0.3- and 0.5-micron particle levels between during the procedure and baseline before the procedure measuring at the nurse anesthetist's position decreased in the head box group whereas those particle level increased in the control group (-491.9 versus 1095.8 particle/L (P=0.008) and -366.7 versus 249.8 particle/L (P=0.004), respectively). There was no significant difference of the mean differences of either 0.3- or 0.5-micron particle levels between during the procedure and baseline before the procedure measuring at the endoscopist’s position whether with or without headbox. (Table) Conclusion: EGD with the head box can reduce significant aerosolization to the endoscopy personnel including nurse anesthetist who standing near the patient’s mouth. However, those who stand further away such as the endoscopist who stands about 2 feet away from the patient’s mouth is already safe from aerosolization and does not get benefit from the head box because AGP from EGD affects only to the short-distant area. [Formula presented] [Formula presented]

20.
Clinica Chimica Acta ; 530:S203, 2022.
Article in English | EMBASE | ID: covidwho-1885645

ABSTRACT

Background-aim: SARS coronavirus 2 (SARS-CoV-2) is responsible for high morbidity and mortality worldwide, mostly due to the exacerbated inflammatory response observed in critically ill patients. However, little is known about the kinetics of the systemic immune response and its association with survival in Covid-19 patients admitted in ICU Methods: We performed a retrospective multicenter study including all patients with SARS-Cov-2 infection admitted in 3 ICUs between March 1st and April 15th 2020, with at least 2 measurements of Interleukin 6 (IL6) in 4 days (baseline and day 3-4). Patients who received immunomodulatory treatment were excluded. IL6 was measured on serum by ELISA (Quantikine R&D Systems) and results were expressed at median [25th – 75th percentile]. The relationship between IL6 and CRP, organ failure severity (SOFA score) or in-ICU mortality was analyzed. Results: From the 140 patients admitted in the 3 ICU for SARS-Cov2 infection (PCR diagnosis), 101 patients were included, the mean age was 59 ± 11 years with a high proportion of men (82%). Patients had severe respiratory disease with media SOFA score of 4 [3-7] and 83 required endotracheal intubation/mechanical ventilation at baseline. An increase of SOFA score between baseline and day3-4 was observed in 32 patients (worsening group). Baseline measurements were done 14 days [11-20] after onset of symptoms. At the end of the study, on April 15th 2020, 47 patients had been discharged from ICU, 35 were still in ICU, and 19 had died in ICU. Baseline IL6 concentrations were positively associated with SOFA score. Moreover, baseline IL-6 and CRP concentrations were significantly higher in the worsening group vs the non-worsening: 278 [70-622] vs 71 [29-153] pg/mL (P<0.01) for IL6 and 178 [100-295] vs 100 [37-213] mg/L (P<0.05) for CRP. However, IL6 concentrations were not correlated with CRP. Il6 and CRP concentrations were higher in non-survivors at baseline and at day 3-4. CRP significantly decreased in survivors (190 [80-248] to 108 [45-185], P<0.05) whereas IL6 decreased in both groups. Conclusions: In this multicenter cohort of ICU patients with SARS-CoV-2 infection, we found that Il6 was associated with organ failure severity, worsening and poor outcome.

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