Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 220
Filter
1.
Neurology Asia ; 27(3):725-735, 2022.
Article in English | EMBASE | ID: covidwho-2067764

ABSTRACT

Background & Objective: Tension-type headache (TTH) is the most common primary headache. TTH worsens quality of life and is related to various psychosocial factors. We aimed to examine the severity of headache (intensity, frequency, and duration), analgesic use, quality of life (QoL), and the impact of COVID pandemic-induced stress in TTH patients. Method(s): TTH cases seen at neurology outpatient clinics in 15 centers in Turkey were included in the study. A questionnaire incorporating sociodemographic and medical information, headache features, sleep quality, general quality of life, and impact of the pandemic event was administered to the subjects. Result(s): A total of 975 TTH patients were evaluated. Headache severity was higher in women as well as in patients with a history of COVID-19 contact. Women, those with chronic diseases, and cases with a COVID-19 contact history had worse perceptions of quality of life and were affected to a greater extent by the pandemic. The factors affecting the impact of the pandemic were female gender and difficulty in access to health services for headache. Co-existing chronic diseases and lost productive time due to headaches were negative determinants for both QoL and the impact of the pandemic. Conclusion(s): Our results show that the COVID pandemic severely worsened the headache burden, quality of life and mental health of TTH patients. These findings can guide us in the clinical approach to TTH cases. Copyright © 2022, ASEAN Neurological Association. All rights reserved.

2.
Haseki Tip Bulteni ; 60(4):325-329, 2022.
Article in English | EMBASE | ID: covidwho-2066930

ABSTRACT

Aim: Bell's palsy is an acute peripheral facial nerve paralysis affecting one side of the face and can be associated with various causes, such as infectious and autoimmune conditions. In line with this, an increase has been observed in the incidence of peripheral facial paralysis during the coronavirus disease-2019 (COVID-19) infection pandemic. We aimed to investigate whether the incidence of Bell's palsy increased before and after the COVID-19 in the pre-vaccine period. Method(s): All cases diagnosed with Bell's palsy in a tertiary hospital aged 18 and up in 2020 were analyzed, and to compare these numbers to pre-pandemic numbers, patients' data from 2019 was accessed. Excluding those who had recurrent facial palsy, those whose conditions were due to central causes, and those who were misdiagnosed, the frequency of the disease was calculated by proportioning it to the total number of patients presenting to Neurology, and Ear, Nose, and Throat Diseases Outpatient Clinics and the Green Zone of the Emergency Department at that time;and the Bell's palsy distribution within three-month periods and whether this distribution is correlated with the distribution of COVID-19 infection were examined. Result(s): Three hundred twenty five cases from 2019 and 291 cases from 2020 were included in the study. No significant difference was detected between those years in terms of age and sex. The frequency of Bell's palsy in 2019 was 0.059% while it was 0.071% in 2020, which suggested a significant difference between the years. The significant difference could be clearly observed in the second and fourth quarters when the cases of COVID-19 infection were at their peak. Conclusion(s): This study suggests that patients with complaints of peripheral facial paralysis should also be examined for COVID-19 infection. Copyright © 2022, Galenos Publishing House. All rights reserved.

3.
Open Access Macedonian Journal of Medical Sciences ; 10:1698-1705, 2022.
Article in English | EMBASE | ID: covidwho-2066674

ABSTRACT

BACKGROUND: The rapid worldwide spread of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) or COVID-19 pandemic from its epicenter;Wuhan was first reported in December 2019. Egypt reported its first COVID-19 case on February 14, 2020. Thereafter, Egypt scaled-up preventive measures, with a partial lockdown starting on March 25. Several therapeutic agents along with convalescent plasma transfusion (CPT) are under investigation and data from CPTs have been receiving a lot of attention, after Emergency approvals from the Food and Drug Administration suggesting that it may provide a clinical effect in the treatment of SARS-COV-2. IMPORTANCE: Early and effective treatment of COVID-19 is vital for control of SARS-CoV-2 infection. METHODS: Designs: An interventional, single-arm, and non-randomized clinical trial conducted in Egypt from April 15 to July 21, 2020. Settings: This was a multi-center study conducted in three hospitals in Egypt. Participants: A total of 94 COVID-19 laboratory-confirmed patients using quantitative real-time polymerase chain reaction were enrolled in the study. Intervention: All patients were administered with two plasma units (each unit is 200 cc). The volume of donated plasma was 800 cc. Main Outcome and measures: Primary measure was the degree of clinical improvement among the COVID-19 patients who received CPT within 7 days. RESULTS: A total of 94 patients were enrolled who received CPT either within 7 days or after 7 days of hospitalization. 82 were severely ill and 12 were critically ill. The average age remained 58 years (±standard deviation 15.1 years). Male were 69% and 49% patients got cured while 51% died with case fatality rate 51%. Seventy-five percent deaths were above 45 years of age. The symptoms were dyspnea (55%), fever (52%), cough (46%), and loss of taste and smell (21%), and cyanosis (15%). The most common co-morbidities among the <40 years remained diabetes mellitus (21%) and asthma (14%). Among 40–60 years hypertension (56%), diabetes mellitus (39%) and among >60 years age group hypertension (57%), and chronic heart disease (24%) were reported. CPT within 7 days remained significant as compared with the CPT after 7 days with the number of days to cure (p=0.007) and ICU stay (p = 0.008) among severely ill cured cases. CONCLUSIONS: Among patients with COVID-19 and severe or critical illness, the use of CPT along with routine standard therapy resulted in a statistically significant improvement when administered within seven days of hospital admission. However, plasma transfusion, irrespective of days to transfusion may not help treat critically ill patients. The overall mean time to cure in severely ill patients was 15 days if CPT provided within 7 days with 65% cure rate. TRIAL REGISTRATION: Clinical Intervention identifier: MOHP_COVID-19_Ver1.1 registered April 2020.

4.
RMD Open ; 8(2) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2064276

ABSTRACT

Objectives Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are overlapping autoinflammatory diseases affecting people over 50 years. The diseases are treated with immunosuppressive drugs such as prednisolone, methotrexate, leflunomide and tocilizumab. In this study, we assessed the immunogenicity and safety of SARS-CoV-2 vaccinations in these diseases (based on humoral and cellular immunity). Methods Patients (n=45 GCA, n=33 PMR) visited the outpatient clinic twice: pre-vaccination and 4 weeks after the second dose (BNT162b2 or ChAdOx1 vaccine). Patients with previous SARS-CoV-2 infection were excluded. In both pre-vaccination and post-vaccination samples, anti-Spike antibody concentrations were assessed and compared with age-, sex-and vaccine-matched control groups (n=98). In addition, the frequency of SARS-CoV-2 Spike-specific T-cells was assessed by IFN-gammaELIspot assay, and side effects and disease activity were recorded. Results GCA/PMR patients did not have reduced antibody concentrations compared with controls. However, linear regression analysis revealed a significant association of methotrexate and >10 mg/day prednisolone use with lower antibody concentrations in GCA/PMR patients. Evidence of cellular immunity, as assessed by ELIspot assay, was found in 67% of GCA/PMR patients. Patients using >10 mg/day prednisolone had reduced cellular immunity. Importantly, vaccination did not lead to significant side effects or changes in disease activity. Conclusions SARS-CoV-2 vaccination was safe for GCA/PMR patients and immunogenicity was comparable to other older individuals. However, patients using methotrexate and particularly >10 mg/day prednisolone did show lower vaccine responses, which corroborates findings in other autoinflammatory patient populations. These patients may therefore be at higher risk of (potentially even severe) breakthrough SARS-CoV-2 infection. Copyright ©

5.
Archives of Disease in Childhood ; 107(Supplement 2):A482-A483, 2022.
Article in English | EMBASE | ID: covidwho-2064063

ABSTRACT

Aims Established in response to the COVID-19 pandemic, a trainee-led outpatient clinic aimed to provide children with continuation of care following discharge from hospital. The service was created as a safe alternative to the long-standing practice of ward attenders, while reducing mounting pressures on appointments at consultant-led clinics. Several issues arose in its implementation with insights from service users identifying the breakdown in written communication as the single most detrimental factor in its success. With wasted journeys, missed appointments and opportunities lost - children, young people and consultant teams found themselves left in the dark. Initial analysis found significant issues at various stages in referral, booking and follow-up management. The project aimed to improve communication to ensure all clinic attendees underwent timely referral and outpatient review with decisions effectively communicated to all parties. Methods Process maps, fishbone and pareto diagrams allowed our problem to be understood and defined. Four domains were recognised as key components in improving communication among service users to include the inclusion of an indication for review, a lead consultant, the successful clinic attendance, and the provision of an outcome letter. The project aimed to improve compliance across the four criteria by February 2022. Using the clinic diary and the electronic care records system (NIECR), outcomes concerning the four domains were ascertained for patients attending the clinic during a six-month period. A baseline measure derived from 20 patients was established and measurements were collected for a further 44 patients whilst changes were initiated. Five interventions were tested in PDSA cycles to include the phased development and distribution of a clinic guideline, referral proforma, trainee troubleshooting sessions and appointment cards. Improvement could be detected and visualised in run charts illustrating the number of criteria met following introduction of an intervention. Results A baseline measure of 20 patients found only 2 patients met the compliance standard of 100% (mean criteria: 1.4;SD: 1.2). The inclusion of a lead consultant and clinic letter provision were met in 25% and 10% of patients respectively. Following initiation of interventions, the run chart illustrated improvement leading to meaningful change at patient and service level. Interventions resulted in an 80% increase in clinic letter provision and a 50% reduction in the clinic's Did Not Attend (DNA) rate. The median number of criteria met increased from 1 out of 4 to 3 out of 4. 100% compliance across all four criteria was achieved for 13% of patients attending the clinic from our baseline measure of 10%. Conclusion Introducing frequent, small change ideas through PDSA cycles allowed us quickly to identify our most successful interventions to address the frustration surrounding communication breakdown shared by all service users. This process will also be useful in the induction of new trainees managing the clinic. Targeted interventions resulted in a safer, more efficient service. Ongoing feedback continues to guide strategies for change as we strive towards improving the quality of post-discharge care for children and young people. Future work will focus on capturing patient experience and improving patientcentred outcomes.

6.
Archives of Disease in Childhood ; 107(Supplement 2):A40-A41, 2022.
Article in English | EMBASE | ID: covidwho-2064012

ABSTRACT

Aims Attendance to hospital for children and young people with complex medical needs and autism can be frightening and stressful, due the unfamiliar setting and unknown people, communication difficulties and sensory overload. Currently at our Trust, there are no specific resources for this patient group, and we have received informal and formal feedback that the needs of these young people and their families are not being met. We aim to improve the experiences of children and young people with complex medical needs and autism at our Trust by creating a new patient pathway, involving children and families early to drive change. Methods We designed a focus group for parents of children with complex medical needs and autism. We identified families from the neurology clinic, and wrote to them to explain the project and our aims and to invite them to take part in the focus group. We followed this up with a phone call to discuss the project further and to answer their questions. The focus group took place in September 2021. Results Five parents and one grandparent attended the focus group. Between them, they had experience of emergency hospital attendances, inpatient admissions, outpatient appointments, paediatric intensive care, multiple investigations and care across multiple sites in the UK and abroad. Their children attended both mainstream and special schools. There was a wide range of complexity of need, and input from health, school, therapies and social care. The range of experience made for a highly insightful and interesting discussion. Positive feedback was received for the neurology consultant, epilepsy clinical nurse specialist, play specialists and hospital school team, with a particular focus on parents knowing who to contact when they needed advice and support. Key areas for change identified included more privacy for adolescents, a leaflet detailing what to expect during an admission, sensory toys, a patient passport and iPads for the emergency department. Families also commented that specific changes could be made to improve their children's experiences of outpatient clinics, including minimising the wait to be seen, considering whether the child needs to be brought to a face-to-face appointment, the presence of a sensory room and improvements to the phlebotomy room, including the presence of play specialists. They also identified opportunities to join up care between secondary and tertiary services, for example arranging for pre-admission COVID-19 swabs at the local hospital, rather than at the tertiary hospital where the admission was planned. The next phase will be to apply for funding to achieve these aims. We are devising a Makaton passport and a system to help children to communicate using symbols. We will involve the children, young people and families at every stage of our project. Conclusion Patients and families have a much greater insight into the challenges faced than professionals, and their input is the most valuable tool to drive change. Relationships between patients and professionals have a huge impact on experience of care. We will continue to work with families in order to bring about meaningful and impactful change.

7.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P282, 2022.
Article in English | EMBASE | ID: covidwho-2064404

ABSTRACT

Introduction: COVID-19 is known to cause olfactory dysfunction (OD). African American individuals have been disproportionately impacted by the COVID-19 pandemic. To reduce health disparities related to OD, it is important to have accurate objective testing, especially for African American individuals, who have a higher disease burden. Our objective is to examine olfactory performance in African American and White study participants by comparing individual scent scores to assess potential cultural appropriateness of scent selection. Method(s): This was a cross-sectional study of healthy participants from June 2021 to April 2022. Two smelling tests were used: Affordable Rapid Olfactory Measurement Array (AROMA) and Sniffin' Sticks (SST-12). Pearson correlation and chi2 tests were used to detect statistical differences. African American and White participants without sinonasal disease aged 18+ were recruited from outpatient clinics at Kansas University Medical Center and the community. The main outcome for our study is olfactory performance on smelling tests. Result(s): Of the 102 participants, 46 were African American and 56 were White. AROMA and SST-12 scores were significantly correlated in African American (P<.01) and White (P<.01) participants. African American participants scored significantly lower than their White counterparts on both tests (P<.01). AROMA, mean scores were 64.2 and 75.5 for African American and White participants, respectively. SST-12 mean scores were 84.2 and 89.9 for African American and White participants, respectively. On SST-12, 60.9% of African American and 30.4% of White participants were hyposmic, (P<.05). For 6 AROMA scents (licorice, orange, lavender, cinnamon, clove, and rosemary) and 1 SST-12 scent (pineapple) African American participants scored significantly lower than White participants (P<.05). Conclusion(s): When compared with White participants, African American participants performed worse on both smelling tests and a greater proportion were considered hyposmic. African American participants performed significantly worse than their White counterparts on several scents, raising the issue of cultural appropriateness of scents used in olfactory testing.

8.
American Journal of Clinical Oncology: Cancer Clinical Trials ; 45(9):S60-S61, 2022.
Article in English | EMBASE | ID: covidwho-2063017

ABSTRACT

Background: In response to the COVID-19 pandemic, our radiation oncology department was forced to rapidly integrate telemedicine into its practice. While there has been investigation into the implementation, effectiveness, cost, and perceptions of telemedicine, the environmental impact of telemedicine within radiation oncology has not yet been established. This is particularly relevant as climate change is recognized as one of the largest threats to human health, including oncologic outcomes. Yet, the healthcare sector significantly contributes to global carbon emissions, in part due to patient travel. Objective(s): The aim of this study was to assess the impact of telemedicine on travel-related greenhouse gas (GHG) emissions for a large, academic radiation oncology outpatient clinic located in a densely population suburban setting. Method(s): All in-person and telehealth visits over a consecutive 7-day period in June 2021 scheduled at our main outpatient clinic were retrospectively reviewed. Care visits with patients who resided outside of the state were excluded. Travel distance for in-person visits and miles saved for virtual visits was estimated based on patients' reported home address in the electronic medical record. Associated GHG emissions were calculated with the Greenhouse Gases, Regulated Emissions, and Energy Use in Transportation tool (https://greet.es.anl. gov) using a well-to-wheel model, which accounts for all emissions related to fuel (ie. gas, electricity) production and use. Gas, hybrid, plug-in hybrid, and electric vehicle utilization were accounted for per published statewide vehicle registration statistics. GHG emissions were converted into carbon dioxide equivalents (CO2e) using 100-year global warming potentials. Result(s): A total of 158 clinic visits were conducted over the time period. Table 1 describes visit type, telemedicine status, and primary cancer site of the included patients. Total miles traveled for in-person visits was 5,775 miles and an estimated 13,892 potential miles saved were attributed to telemedicine visits. On average, 118 travel miles were saved per telemedicine visit (CO2e, 55 kg). The forecasted annual savings of CO2e attributed to telemedicine visits is 339 metric tons, the equivalent emissions of 61.6 homes' electricity use for one year. Conclusion(s): The integration of telemedicine within a radiation oncology outpatient clinic reduces the environmental impact of patient care. Telemedicine should be considered where feasible and appropriate to establish and promote environmentally sustainable practices within the field.

9.
Cardiology in the Young ; 32(Supplement 2):S107-S108, 2022.
Article in English | EMBASE | ID: covidwho-2062098

ABSTRACT

Background and Aim: The Coronavirus disease 2019/COVID-19/exerts an unprecedented global impact on public health and health care delivery. The aim of this study was to evaluate the knowledge on SARS-CoV-2, epidemiology, clinical presentation including cardiovascular and immunological status in postCovid children. Method(s): A group of 70 children/previously healthy or with no pre-existing heart disease/from Sarajevo with positive postcovid history, formed this study. Patients were evaluated at the Polyclinic Eurofarm in Sarajevo, from October 2020 till April 2021. Following history and epidemiological data, a detailed cardio-vascular examination has been performed including oxygen satu-ration, pulse, blood pressure, electrocardiogram/ECG/, values of polymerase chain reaction (PCR), serological tests for corona, lab-oratory blood tests and echocardiography. Result(s): The group consisted of 70 children/40 boys/: infants: 10, 1-5 years: 20;6-10:12;11-15:21;16-18 years: 7;forming five groups. Symptoms differ depending on age group, younger chil-dren had no or mild symptoms in comparison to the older group of children. The values of immunoglobulin G were significantly higher in the older group of children with (p lt;0.05;p = 0.043) indicating that the immune system with age is more responsive to the virus. PCR test was negative in 9/70 children. The majority of children/64.3 %/were asymptomatic. Two boys aged 14 years, had palpitation on exertion, shortness of breath, ECG changes, lower oxygen saturation/91% and 94%/, elevated creatinine phosphokinase miofibrilae/CPKMB/: 38 and 45, in one patient the diameter of left coronary artery/LCA/was enlarged up do 3.8mm, no aneurysm, no skin changes, with normal ejection frac-tion of left ventricle. They were on short period/10-15days/of treatment with nonsteroids including low doses of Aspirin, vita-mins/C and D/, rest and no sport activities. After treatment and a regime of no activities, they were fully recovered, free of symptoms, with normal oxygen saturation, normal values of CPKMB, diameter of LCA was within a normal range according to age and body weight of the patient. Conclusion(s): Practitioners should consider the possibility of COVID-19 in children with atypical symptomatology and posi-tive or suspicious epidemiological survey, paying special attention to coronary and immunological status.

10.
Chest ; 162(4):A2486, 2022.
Article in English | EMBASE | ID: covidwho-2060952

ABSTRACT

SESSION TITLE: What Lessons Will We Take From the Pandemic? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Post COVID pulmonary complications can be attributed to severe inflammatory response that can result in pulmonary fibrosis. It is somewhat predictable in patients with severe illness, advanced age and comorbidities. However, a little is known about pulmonary complications in younger patients with mild illness followed up at outpatient clinics. We aim to shed light on post COVID pulmonary complications in patients who did not require hospitalization but had significant outpatient visits. METHODS: This study is based upon a retrospective chart review of patients who presented to Pulmonology Clinic at Cayuga Medical Associates with respiratory symptoms associated with COVID-19 disease. Mild illness was defined as symptoms of dyspnea on exertion or fatigue or shortness of breath that have not required oxygen and lasted for less than or equal to two months. Moderate illness was defined as symptoms of mild illness lasting for more than two months without oxygen supplementation. Severe illness was defined as hypoxia requiring home oxygen. We have excluded the patients who were hospitalized for COVID pneumonia. RESULTS: Of 23 patients (56.52% female) with COVID illness seen at Pulmonology Clinic in one-year duration, 13.04% had COPD, 26.09% had asthma and 21.74% had OSA. Median age was 33 with mean BMI 27.61.13.04% were current smokers. 39.13% required a PFT among which 77.78% had normal results. 21.74% of the total patients who never had OSA as an underlying diagnosis, required sleep study, among which 60% had mild OSA and 20% had severe OSA. 13.04% were already on oral steroids for other diseases. Majority of the patients had normal chest x-ray findings. 39.13% had CT chest, majority of which showed normal findings and few with diffuse ground glass opacities. 8.70% developed palpitations along with respiratory symptoms. At six months follow up, 43.48% had mild illness who were managed with conservative management such as incentive spirometry, deep breathing techniques, prone positioning and as needed short acting bronchodilator treatments. 43.48% had moderate illness who were treated with short course of oral steroids in addition to conservative management. 13.04% had severe illness who required home oxygen up to 2 L for two months maximum. Most common pulmonary complaint was dyspnea on exertion, seen in 43.48%. 17.39% had fatigue. 21.74% had sleep apnea symptoms. Median duration of symptoms was two months. CONCLUSIONS: Our study outlines the incidence of post COVID pulmonary complications in patient group where these complications are least expected. CLINICAL IMPLICATIONS: Post COVID pulmonary complications appear to be of significant concern in patients visiting outpatient clinics. The heterogeneity in management of those complications needs a serious attention. The feasibility and implementation strategy of post COVID-19-care-clinic with proper management guidelines should be brought to streamline practice. DISCLOSURES: No relevant relationships by Sameer Acharya No relevant relationships by Ali AKRAM No relevant relationships by Samjhauta Bhattarai No relevant relationships by Lavanya Kodali

11.
Chest ; 162(4):A1999, 2022.
Article in English | EMBASE | ID: covidwho-2060884

ABSTRACT

SESSION TITLE: Occupational and Environmental Lung Disease Cases SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Sodium hydroxide and ammonium salt vapor exposure are known to cause epithelial necrosis of the tracheobronchial tree, but no pathologic descriptions exist of subsequent inflammatory pneumonitis. CASE PRESENTATION: A 56-year-old man presented to the outpatient clinic with 2 months of progressive scant hemoptysis and dyspnea on exertion. He had a mild smoking history, a history of longstanding stable UC, and had a history significant only for recently performing multiple weeks of cleaning work on a large, enclosed HVAC system with chemicals containing sodium hydroxide and ammonium. He wore no respiratory protection at work. CXR was significant for streaky bilateral lower lobe opacities and CT Chest revealed bilateral basilar ground-glass opacities with a small left pneumothorax. His PFT demonstrated mild restriction with a diffusion defect. Infiltrates persisted after treatment with levofloxacin. A broad autoimmune panel was normal. Bronchoscopy with cryobiopsy showed organizing pneumonia with foreign body reaction. BAL showed primarily mast cells and no organisms were found. Prednisone at 60mg daily with Bactrim prophylaxis and a subsequent prolonged wean was initiated with marked improvement. DISCUSSION: Industrial HVAC cleaning agents are widely used with the proliferation of HVAC systems in the post-COVID world. Other examples exist of prolonged cleaning product use and lung function decline (Svanes et al). Our case report hypothesizes a link between inhalational exposure to sodium hydroxide and ammonium salts with organizing pneumonia with foreign body features, a previously unknown effect. Prednisone led to improvement. CONCLUSIONS: High suspicion for occult pneumonitis should exist when patients present with prolonged exposure to cleaning/noxious chemical vapors exist. Respiratory protection should be emphasized as a public health policy to prevent lung damage among any type of cleaner use including high-skilled (HVAC) cleaners. Reference #1: Advenier, A., & Grandmaison, G. (2022). PULMONARY ACUTE LESIONS AFTER CAUSTIC EXPOSURE. Retrieved 31 March 2022, from https://www.lungdiseasesjournal.com/articles/pulmonary-acute-lesions-after-caustic-exposure.html Reference #2: Svanes, Ø., Bertelsen, R. J., Lygre, S., Carsin, A. E., Antó, J. M., Forsberg, B., García-García, J. M., Gullón, J. A., Heinrich, J., Holm, M., Kogevinas, M., Urrutia, I., Leynaert, B., Moratalla, J. M., Le Moual, N., Lytras, T., Norbäck, D., Nowak, D., Olivieri, M., Pin, I., … Svanes, C. (2018). Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction. American journal of respiratory and critical care medicine, 197(9), 1157–1163. https://doi.org/10.1164/rccm.201706-1311OC Reference #3: Gorguner, M., & Akgun, M. (2010). Acute inhalation injury. The Eurasian journal of medicine, 42(1), 28–35. https://doi.org/10.5152/eajm.2010.09 DISCLOSURES: no disclosure on file for Ai-Yui Maria Tan;No relevant relationships by Sudha Misra No relevant relationships by Amrik Ray

12.
Chest ; 162(4):A858, 2022.
Article in English | EMBASE | ID: covidwho-2060710

ABSTRACT

SESSION TITLE: Management of COVID-19-Induced Complications SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Up to 17% of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been shown to develop pancreatic lesions (1). We present 2 cases of coronavirus disease 2019 (COVID-19) patients that presented with pancreatic lesions. CASE PRESENTATION: Case1 A 47-year-old lady with a history of type 2 diabetes mellitus present to the emergency department (ED) with complaints of flu-like symptoms for ten days. She tested positive for COVID-19 by rapid PCR. Computed tomography (CT) scan without contrast on admission shows an incidental finding of a pancreatic mass (see Figure 1). Abdominal CT with contrast shows a large, multiloculated cystic mass in the pancreatic tail (see Figure 2). Laboratory examination depicted lipase: 27 U/L, CA19-9: 72 U/mL, CEA: 6.5 ng/mL, CA125: 24 U/mL, erythrocyte sedimentation rate (ESR):2 mm/h, Total Bilirubin: 0.6 mg/dl, Direct Bilirubin: 0.1 mg/dl. Following treatment, the patient recovered fully and is discharged from the hospital 10 days later with home oxygen therapy. Case2 An 81-year old Caucasian lady presented to the outpatient clinic with complaints of fecal incontinence. She tested positive for COVID-19, four months before her visit. CT scan of the abdomen with oral contrast revealed multiple hypodense masses on the pancreas measuring 0.3cm in diameter (see Figure 3). Laboratory tests reveal CA19-9: 57 U/mL, CA125: 8 U/mL, CEA: 1.9 ng/mL, erythrocyte sedimentation rate (ESR):11 mm/h, C-reactive protein: 0.7 mg/L, Total Bilirubin: 1.5 mg/dl, Direct Bilirubin: 1.3 mg/dl. Following outpatient treatment and follow-up, the patient's symptoms were relieved. DISCUSSION: Pancreatic lesions in COVID-19 patients can be caused directly by the cytopathic effects of the viral infection, or indirectly by systemic responses to inflammation or respiratory failure. Several studies have shown that ACE2 is the functional receptor used by SARS-CoV-2 to gain access to target cells (2) and ACE-2 receptors are expressed in significant amounts in the pancreas (3). In the first case, an incidental finding of a multi-cystic pancreatic mass on admission was reported. There was no pancreatic ductal dilation on the CT scan, which may indicate a direct injury caused by cytopathic effects of the virus rather than inflammation resulting in exocrine secretions forming cysts. In the second case, multiple masses on the pancreas were found after recovering from COVID-19. These lesions could be remnants of a previous pancreatic injury during the acute phase of the infection. CONCLUSIONS: COVID-19 infection may trigger pancreatic injury in some patients. Reference #1: Yong, Shin Jie. Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infectious diseases. 2021 Oct;53(10): 737–754. Reference #2: Ma C, Cong Y, Zhang H. COVID-19, and the Digestive System. Vol. 115, American Journal of Gastroenterology. Wolters Kluwer Health;2020. p. 1003–6. Reference #3: Liu F, Long X, Zhang B, Zhang W, Chen X, Zhang Z. ACE2 Expression in Pancreatic Damage After SAERS-CoV-2 Infection. Gastroenterology. 2020 Aug 1;18(9): 2128 – 2130.e2. DISCLOSURES: No relevant relationships by Ailine Canete Cruz No relevant relationships by Claudia Ramirez No relevant relationships by Joseph Varon No relevant relationships by Mohamed Ziad

13.
Chest ; 162(4):A562-A563, 2022.
Article in English | EMBASE | ID: covidwho-2060632

ABSTRACT

SESSION TITLE: COVID-19 Co-Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Pneumocystis jirovecii pneumonia (PJP) remains a significant cause of morbidity and mortality in the immunocompromised population. It can be difficult to discern the radiographic imaging of COVID-19 from PJP. This case describes a noncompliant HIV positive male with remote history of PCP pneumonia and COVID-19 pneumonia who presents with simultaneous recurrence of both disease processes. CASE PRESENTATION: A 45-year-old male with PMH of HIV/AIDS noncompliant on ART (CD4+ 10) presented for evaluation of exertional dyspnea and productive cough for the past 2 weeks. Of note, patient had a history of covid-19 pneumonia about 15 months ago when he was treated with remdesivir and steroids and required supplemental oxygen support. He was also admitted about 8 months prior for PJP pneumonia and underwent treatment with steroids and TMP-SMX for 21 days also requiring supplemental oxygen support. During this presentation, initial vital signs showed: T 36.5 C HR 98 BP 112/63 RR 20 saturating 95% breathing ambient air. ABG on presentation showed PaO2 65 while breathing room air. Physical exam suggested bilateral crackles diffusely with chest radiography significant for increased interstitial markings bilaterally. CT chest showed bilateral groundglass changes suggestive of inflammatory process. He was initially started on antibiotic coverage with azithromycin, ceftriaxone, and TMP-SMX as the initial differential included PJP recurrence since he was noncompliant on secondary prophylaxis after recent infection. He was also started on steroids due to low PaO2. SARS-CoV-2 PCR returned positive however, the low CD4+ count, and a positive serum B-D-glucan assay prompted us to schedule a bronchoscopy to evaluate for PJP pneumonia. BAL showed positive silver stain along with bronchial wash was elevated PCR for PJP (5.6 million copies/mL). A diagnosis of concurrent COVID-19 pneumonia and PJP pneumonia was made. Patient did not receive remdesivir during this admission since his oxygenation began to improve during the hospitalization. Patient was discharged on appropriate regiment for PJP pneumonia and continued steroid taper. He was seen as a follow-up in outpatient clinic about 2 months later compliant on his ART regimen and secondary PJP prophylaxis (CD4 120). DISCUSSION: If it wasn't for the serum B-D-glucan, we likely would not have pursued further causes for hypoxia in an otherwise COVID-19 positive patient with characteristic radiographic findings. The sheer co-incidence and concurrent nature of presentation of these two disease processes make our case extremely unique. Going forward, it is reasonable to keep PJP in the differential when treating a hypoxic immunocompromised patient even if an alternative cause for hypoxia is present. CONCLUSIONS: Herein we present a case of a patient with remote history of COVID-19 pneumonia and PJP pneumonia now presenting with a simultaneous co-infection. Reference #1: Mouren, D., Goyard, C., Catherinot, E., Givel, C., Chabrol, A., Tcherakian, C., Longchampt, E., Vargaftig, J., Farfour, E., Legal, A., Couderc, L. J., & Salvator, H. (2021). COVID-19 and Pneumocystis jirovecii pneumonia: Back to the basics. Respiratory medicine and research, 79, 100814. https://doi.org/10.1016/j.resmer.2021.100814 Reference #2: Huang, L., Cattamanchi, A., Davis, J. L., Boon, S. d., Kovacs, J., Meshnick, S., Miller, R. F., Walzer, P. D., Worodria, W., & Masur, H. (2011). HIV-associated Pneumocystis pneumonia. Proceedings of the American Thoracic Society, 8(3), 294–300. https://doi.org/10.1513/pats.201009-062wr Reference #3: Tasaka, S. (2015). pneumocystis pneumonia in human immunodeficiency virus–infected adults and adolescents: Current concepts and Future Directions. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, 9s1. https://doi.org/10.4137/ccrpm.s23324 Group, T. R. C. (2020). Dexamethasone in hospitalized patients with covid-19. (2021). New England Journal of Medicine, 384(8), 693–704. https://doi.org/10.1056/nejmoa2021436 KOLDITZ, M., HALANK, M., BANDT, D., SPORNRAFT-RAGALLER, P., & HÖFFKEN, G. (2009). Early recurrence ofPneumocystis jirovecipneumonia in two HIV-infected patients: Linking infection relapse and immune reconstitution syndrome. Respirology, 14(6), 910–912. doi:10.1111/j.1440-1843.2009.01583.x Mussini C, Pezzotti P, Antinori A, Borghi V, Monforte Ad, Govoni A, De Luca A, Ammassari A, Mongiardo N, Cerri MC, Bedini A, Beltrami C, Ursitti MA, Bini T, Cossarizza A, Esposito R;Changes in Opportunistic Prophylaxis (CIOP) Study Group. Discontinuation of secondary prophylaxis for Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients: a randomized trial by the CIOP Study Group. Clin Infect Dis. 2003 Mar 1;36(5):645-51. doi: 10.1086/367659. Epub 2003 Feb 12. PMID: 12594647. DISCLOSURES: No relevant relationships by Mourad Ismail No relevant relationships by Carlos Palacios No relevant relationships by Rutwik Patel

14.
Chest ; 162(4):A491, 2022.
Article in English | EMBASE | ID: covidwho-2060608

ABSTRACT

SESSION TITLE: COVID-19 Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: The SARS-CoV-2 pandemic quickly spread throughout the world after it was first identified in Wuhan, China in 2019. Severe cases of hypoxic respiratory failure have since filled hospitals over the past few years. We present a case of an immunosuppressed patient with persistent respiratory failure from SARS-CoV-2, with a failure to mount antibody response, treated with convalescent plasma. CASE PRESENTATION: We present a 54-year-old female with a past medical history significant for rheumatoid arthritis on immunosuppression with methotrexate, prednisone, sulfasalazine, and rituximab who presented with diarrhea, cough, and shortness of breath. She was unvaccinated and tested positive for COVID-19 pneumonia, which was treated with corticosteroids and Remdesevir. CT thorax revealed diffuse infiltrates (Figure-1). She had progressive hypoxia requiring ICU stay and her course was complicated by inferior wall STEMI, requiring Intra-aortic balloon pump and intubation given worsening hypoxia. She had progressive improvement and was discharged from the hospital on 4 L of supplemental oxygen after a 30-day hospital stay. She presented two days after discharge with cough, fevers and increasing oxygen requirements up to 100% high flow nasal cannula. She was septic and was treated with steroids and antibiotics. She was febrile despite broad spectrum antibiotics. CT thorax demonstrated diffuse infiltrates worsened from the previous and steroid dosing was increased (Figure-2). No obvious source of infection was found, and further evaluation revealed positive Covid-19 RT-PCR. Despite her initial infection occurring two months prior, COVID-19 anti-spike and anti-nucleocapsid antibodies were negative. She was treated with two doses of convalescent plasma and had improvement in her oxygenation, going from 80% high-flow nasal cannula to 6L of supplemental oxygen within two days of administration. DISCUSSION: It's unclear whether immunosuppressed patients with rheumatologic disease are at an increased risk of severe SARS-CoV-2 infection. However, the use of immunosuppressants places patients at risk of an improper immune response to infection. In immunocompetent patients, the typical time to negative SARS-CoV-2 RT-PCR is 3 weeks after positivity (1), and most patients develop antibodies within 2-3 weeks after viral exposure (2). Anti-CD20 monoclonal antibodies like rituximab, commonly used for rheumatologic diseases, can hinder humoral immunity, and impair vaccine response (3). Given our patient's immunosuppressive regimen, we suspect she failed to mount an immune response to COVID-19, resulting in 56 days of infection without an adequate antibody response, successfully treated with convalescent plasma. CONCLUSIONS: Patients with significant immunosuppression regimens may fail to produce antibody responses to SARS-CoV-2, resulting in prolonged infection. Reference #1: Rodríguez-Grande, C., Adán-Jiménez, J., Catalán, P., Alcalá, L., Estévez, A., Muñoz, P., Pérez-Lago, L., de Viedma, D. G., Adán-Jiménez, J., Alcalá, L., Aldámiz, T., Alonso, R., Álvarez, B., Álvarez-Uría, A., Arias, A., Arroyo, L. A., Berenguer, J., Bermúdez, E., Bouza, E., … de la Villa, S. (2021). Inference of active viral replication in cases with sustained positive reverse transcription-PCR results for SARS-CoV-2. Journal of Clinical Microbiology, 59(2). https://doi.org/10.1128/JCM.02277-20 Reference #2: Boechat, J. L., Chora, I., Morais, A., & Delgado, L. (2021). The immune response to SARS-CoV-2 and COVID-19 immunopathology – Current perspectives. In Pulmonology (Vol. 27, Issue 5). https://doi.org/10.1016/j.pulmoe.2021.03.008 Reference #3: Eisenberg, R. A., Jawad, A. F., Boyer, J., Maurer, K., McDonald, K., Prak, E. T. L., & Sullivan, K. E. (2013). Rituximab-treated patients have a poor response to influenza vaccination. Journal of Clinical Immunology, 33(2). https://doi.org/10.1007/s10875-012-9813-x DISCLOSURES No relevant relationships by Issa Makki No relevant relationships by John Parent No relevant relationships by Jay Patel No relevant relationships by Ruchira Sengupta

15.
Annals of Oncology ; 33:S1367, 2022.
Article in English | EMBASE | ID: covidwho-2060390

ABSTRACT

Background: The PICC in our Day Hospital (DH) has become the central line of choice for the therapeutic management of oncological and hematological patients when the duration does not exceed 6 months. The impact of COVID-19 in these patients led to an increase in risk factors for the occurrence of venous thrombosis (VT) and catheter-related venous thrombosis (CRVT), forcing admission-like immobility, intensification of supportive treatment with granulocyte colony growth factors (G-CSF) and a higher number of PICC insertions in metastatic patients. Given these circumstances, it was decided to use the Blue Advance PICC with antithrombogenic coverage. The objective was record the incidence of symptomatic CRVT related to Blue Advance PICC in oncological and hematological patients in active treatment, as well as the incidence of other complications and causes of withdrawal. Methods: A retrospective observational study was performed, in a consecutive series of patients from November 2019 to June 2021. All catheters were inserted in DH for oncospecific treatment, using PICC Blue Advance Teleflex Medical®, 4'5Fr, 1 lumen, by ultrasound-guided puncture and tip confirmation by fluoroscopy. Variables recorded: demographic data, diagnosis and stage, treatment administered, date of insertion and removal, vein diameter, cause of removal and complications. Results: A total of 295 blue PICC were analyzed, with a total length of stay of 46,150 days and a mean of 156 days per catheter. Ninety-eight percent of the PICCs were placed at the first attempt, and the predominant access was the basilic and brachial veins, with diameter between 2.9-5.6mm. There were 9 cases of symptomatic CRVT (3%, 0.19/1000 catheter days), confirmed by Echo-Doppler, which did not require catheter removal and treatment was completed. Six CRVT were diagnosed between the first and third week of insertion in female patients, with cytostatic Adriamycin and G-CSF. The main cause of withdrawal was end of treatment in 94.9%. Conclusions: The use of the antithrombogenic Blue Advance PICC during the pandemic period, despite the increase in risk factors, kept the incidence rate of symptomatic CRVT unchanged in our historical pre-COVID cohort. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

16.
Investigative Ophthalmology and Visual Science ; 63(7):1982-A0312, 2022.
Article in English | EMBASE | ID: covidwho-2058589

ABSTRACT

Purpose : A prospective observational clinical study was performed to evaluate ocular symptoms related to dry eye disease (DED) in patients infected with COVID-19. Methods : The staff of an University Hospital in Londrina city, Brazil, who presented respiratory symptoms and underwent nasal swab PCR test for SARS-CoV-2 detection at the outpatient unit during November to December 2020 was assessed by electronic messages and separated in two groups (PCR test negative or control group-CG, and PCR test positive or COVID-19 group-COVG). Sociodemographic data, presence of ocular and systemic comorbidities, place of treatment (home, infirmary or intensive care unit), and the Ocular Surface Disease Index (OSDI) questionnaire, translated and validated to Portuguese for DED evaluation were performed. OSDI contains 3 subsections including visual-related function (category A), ocular symptoms (category B) and environmental triggers (category C). Scores range from 0 to 100 with 0 to 12 representing normal, 13 to 22 mild DED, 23 to 32 moderate DED and 33 severe DED. The data was submitted to statistical analysis. Results : From 450 electronic messages sent, 113 patients were included. 62(54,85%) had laboratory-confirmed (RT-PCR) Covid-19. The mean age was 36 years, ranging from 21 to 60 years. 83 (73.4%) patients were female. The main systemic comorbidity was smoking (23%), followed by obesity (3.5%) and hypertension (1.76%). The mean OSDI score was 13.85 in the COVG and 5.37 in the CG (p=0.002). The COVG had a mean score of 3.50 related to category A, 1.05 to category B and 2.13 to category C while the CG presented a mean score of 1.41, 0.39 and 0.80 respectively (p = 0.003;p=0.04;p=0.01). Patients who required hospitalization for treatment presented OSDI score proportionally greater than those who were treated at home (25.67) (p=0.052). Conclusions : OSDI score was higher in the COVG and among patients who required hospitalization for treatment. These results suggest association of COVID infection and DED;and increase of DED according to the severity of respiratory symptoms.

17.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S6-S7, 2022.
Article in English | EMBASE | ID: covidwho-2058077

ABSTRACT

Background: Enteral tubes, including nasogastric (NG) tubes, are an important tool in managing multiple medical conditions in which oral feeding cannot be successfully accomplished due to feeding ability or safety, and these devices are commonly employed at children's hospitals worldwide. While these devices are life-saving, they can develop are a significant burden on families and the healthcare system. There is relatively little published data on the practices of pediatric enteral tube outpatient management, including whether primary outpatient management is undertaken by pediatric gastroenterologists or other medical practitioners (e.g. primary care providers and other pediatric subspecialists), and if a primary management team would affect overall clinical outcomes. In the late fall of 2019, at the American Family Children's Hospital (AFCH), a tertiary care children's hospital, pediatric outpatient enteral tube management, with the exception of tubes in patients under the primary care of Pediatric Hematology/Oncology (PHO), was fully assumed by the Pediatric Gastroenterology (PGI) division, with previous management divided or shared among the PGI division, primary care providers, and other pediatric subspecialists. Due to the division having subspecialty nurses, nurse practitioners, and physicians who had expertise managing enteral tubes on an inpatient and outpatient basis, we hypothesized that primary outpatient management by Pediatric GI would reduce ED utilization for nasogastric tube evaluation. Method(s): We performed a retrospective chart review of all patients discharged from AFCH with a nasogastric tube in place from March 1 2018 to October 31 2019 and June 1 2020 to January 31 2022. The study was reviewed by the University of Wisconsin-Madison Minimal Risk Research Institutional Review Board and met criteria for exempt human subjects. We left a 7-month temporal gap to allow for complete implementation of the policy of pediatric GI management to be uniformly practiced within the hospital, and to account for the beginning of the COVID-19 pandemic, when outpatient clinics were closed and ED evaluation was required for all hands-on non-inpatient medical care at our institution. Patients were grouped and analyzed according to being pre-intervention or post-intervention, and they were followed until either their NG tube was permanently removed, or until their NG tube was replaced with a gastrostomy tube. Patients were excluded if they were primarily managed by PHO, lost to followup, still had NG tube in place at time of data analysis, died during the study period, or had their tube converted to a postpyloric tube. Our primary outcome was the incidence rate of ED visits for nasogastric tube evaluation per patient-weeks between the pre- and post-intervention groups. Patient demographics and diagnoses were also recorded and analyzed. Statistical analysis was conducted. Result(s): There were 130 patients identified after applying inclusion and exclusion criteria, with 56 in the pre-intervention group and 74 in the post-intervention group. The median chronological age of patients in the pre-intervention group was 5 months, and it was 6 months for the post-intervention group. The mean time from initial hospital discharge to either NG tube removal or conversion to gastrostomy tube was 6.2 weeks in the pre-intervention group and 8.8 weeks in the post-intervention group. In the pre-intervention group, the incidence rate of ED visits for NG tube evaluation was 15.6 visits per 100 patient-weeks (95% Confidence Intervals (CI): 11.7-20.3), and in the post-intervention group, the rate was 9.7 visits per 100 patient-weeks (95% CI: 7.4-12.4). Discussion(s): This study demonstrated that at our institution, there appeared to be a decrease in ED utilization for nasogastric tube evaluation after outpatient tube management was assumed by the PGI division, but this decrease was not quite enough to reach statistical significance. This study is limited by multiple factors including the retrospective nature of the study, modest sample size limiting statistical power, and, potentially, lingering effects of the COVID-19 pandemic affecting patient care decisions. Identifying balancing measures from this intervention, as well as identifying alternative changes that could further decrease ED evaluation rates, can be explored in future quality improvement initiatives.

18.
U.S ; Pharmacist. 47(9):41-46, 2022.
Article in English | EMBASE | ID: covidwho-2057848

ABSTRACT

The global health crisis of coronavirus disease 2019 (COVID-19) continues to challenge the standard of care in both the inpatient and outpatient setting. One area that has been heavily impacted is effective management of anticoagulation. COVID-19 has led to new and innovative ways to manage vitamin K-antagonist therapy in the ambulatory care clinics, with increased utilization of drive-through testing sites, home international normalized ratio monitoring, and conversions to direct oral anticoagulants. The COVID-19 infection has been found to have an increased risk in venous thromboembolism events due to its complex inflammatory response. Since 2019, multiple strategies have been trialed in the inpatient setting, including therapeutic, intermediate, and prophylaxis anticoagulation using heparin or low-molecular-weight heparin. Vaccines and therapeutics for COVID-19 have added complexity to the clinical situation, including an FDA warning for a vaccine-induced immune thrombocytopenia with the adenoviral vector vaccine (Ad26.COV2.S) and the potential for drug interactions between COVID-19 therapeutics and anticoagulation therapy. Copyright © 2022, Jobson Publishing Corporation. All rights reserved.

19.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S454-S455, 2022.
Article in English | EMBASE | ID: covidwho-2057565

ABSTRACT

Background: Patients with Disorders of Gut-Brain Interaction (DGBI) respond best to multidisciplinary treatment. With the emergence of the Coronavirus disease 2019 (COVID-19) pandemic in 2020 and the implemented lockdown in large areas of the United States, the multidisciplinary functional abdominal pain program (FAPP) at Boston Children's Hospital for the first time switched to providing care via telemedicine. We aimed to evaluate patient satisfaction and outcomes of patients seen in a multidisciplinary telemedicine visit compared to in-person care at the time of initial evaluation and follow-up. Method(s): Prospective study in which families were given a questionnaire to evaluate the visit and treatment (satisfaction, improvement overall, of abdominal pain (Abdominal Pain Index, API) and of daily functioning (Functional Disability Index, FDI) since initial visit in the FAPP. Patients <= 18 years seen for an initial visit in the FAPP between 4/1/20 and 6/20/21 were recruited. Multidisciplinary evaluation was performed in-person or via zoom (Gastroenterology, Pain medicine, Psychology, Social services, Dietician). Initially all visits were done via telemedicine (4/1/20-7/1/2020) due to the temporary closure of outpatient clinics. Thereafter, in-person visits restarted but telemedicine visits were continued to be offered. Result(s): Patient population: 41 patients completed the study. Two groups were defined based on initial visit type: Group A (Gr-A = Telemedicine, n=26) and group B (Gr-B = in-person, n=15). For Gr-A, follow-up visits were via telemedicine (n=17), in-person (n=2) and 7 patients had no follow-up. For Gr-B, the follow-up visits were via telemedicine (n=9), in-person (n=4) and 2 patients had no follow up visit. Mean age of participants was 14.5+/-2.8 years with female predominance (73.2%). No significant difference was found in age, gender, race, DGBI diagnosis, presence of extra-intestinal symptoms, number of follow-up visits, baseline API or FDI between groups. Patient satisfaction with multidisciplinary care at initial visit (Figure 1): No significant differences were detected between Gr-A and Gr-B (p>0.05). Patient visit type preference: Families preferred in-person visits (73%) for the first visit, but telemedicine (46%) or no preference (47%) for follow-up visits. When asked if patients were equally satisfied with telemedicine and in-person visits, 81.9% agreed, 9.1% were undecided and 9.1% disagreed. 81.9% were not worried about somethinig being missed during the telemedicine visit, while18.2% were undecided about this. When asked if patients felt telemedicine was more efficient than in-person visits, 54.6% agreed, 27.3% were undecided and 45.5% disagreed. 90.9% of patients agreed that telemedicine visits were more convenient, where 9.1% were undecided. Patient outcomes: There was no clinically significant improvement of the API score in either group (Gr-A: 2.7+/-0.8 to 2.4+/-1.1, p=0.04;Gr-B: 2.6+/-0.9 to 2.4+/-1.0, p=0.5) or FDI (Gr-A: 13.4+/-11.2 to 13.9+/-10.5,p=0.8, Gr-B: 15.4+/-10.7 to 14.3+/-8.0, p=0.8) between the initial and follow-up visit. When asked how patients felt subjectively at the time of study, there was improvement but no difference between groups: Much better (Gr-A: 52.6% vs Gr-B: 84.6%), Better (Gr-A: 47.4% vs Gr-B: 15.4% ), no patients in either group reported feeling worse (p=0.07). Subjective improvement of functioning was reported in Gr-A: 58.5% fair to excellent, 29.4% poor and 11.8% none, whereas in Gr-B 58.3% felt fair to excellent improvement of functioning and 41.7% continued to function poorly (p=0.4). Conclusion(s): Patients are equally satisfied with delivery of multidisciplinary care for pediatric DGBI via telemedicine and in-person, suggesting this may be a promising route for expanding delivery of care even in the post-pandemic era. Limitations of this study are the small sample size. Further the lock-down promoted lack of functioning and measures of disability such as the FDI may not be representative.

20.
Rossiyskiy Vestnik Perinatologii i Pediatrii ; 67(3):23-33, 2022.
Article in Russian | EMBASE | ID: covidwho-2044315

ABSTRACT

This study presents the results of treatment of 98 patients with risk of development of severe coronavirus disease (hereinafter COVID-19) with the first positive result of polymerase chain reaction test for SARS-CoV-2 in a day clinic of the multidisciplinary Z.A. Bashlyaeva Children’s Municipal Clinical Hospital. To prevent the clinical manifestation of COVID-19 and the progression of the main disease all these children were treated with virus-neutralizing monoclonal antibodies (sotrovimab 500 mg dissolved in 92 mL of 0.9% sodium chloride solution intravenously for 30 minutes, once, for children over 12 years old and with body weight over 12 kg;balanivimab 700 mg + etesivimab 1400 mg pre-dissolved in 250 mL of 0.9% sodium chloride solution intravenously for 30 minutes, once). Patients underwent a comprehensive clinical, laboratory and instrumental examination both initially and in dynamics for 3–7–11 days after therapy according to the developed clinical algorithm. The effectiveness of biological therapy in children with a risk of severe COVID-19 was noted in 100% of cases. None of the observed patients had either a clinical manifestation of COVID-19 or a relapse of the main chronic disease.

SELECTION OF CITATIONS
SEARCH DETAIL