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1.
Indo Global Journal of Pharmaceutical Sciences ; 12:237-244, 2022.
Article in English | EMBASE | ID: covidwho-2218123

ABSTRACT

Cases of Monkeypox continue to rise and the World Health Organization (WHO), declared it a public health emergency of international concern (PHEIC). A virus called monkey pox causes the disease and it is zoonotic. The epidemiological surveillance from 1981-1986 in the Democratic Republic of Congo (DRC) a country in Africa were the disease is endemic, documented only 338 cases. Previously, 90% of the affected persons were children approximately 15 years of age at least in the endemic countries in Africa. Beyond Africa, 99% cases of the current outbreak were found in men and of those, 98% involved men who have sex with men implying it is being transmitted through sexual activities. Crowded living quarters, poor hygiene, discontinuation of the smallpox vaccination, amongst others were implicated in the human to human transmission. The symptoms of the disease includes, viremia with 1-2 days of fever and lymphadenopathy before lesions appear. Patients at this stage may be contagious. For treatments, there are no known clinically proven treatments for the disease. Polymerase chain reaction (PCR) amplification are used for specific diagnosis and smallpox vaccines are effective against the disease. Table 1 shows cases from Africa union member countries (AUMC), and Congo Republic, Cameroon and DRC, have a high cumulative frequency (CFR) of occurrence (43, 5.6 and 4.1%), respectively (see Fig 2). The vaccine is not readily available in these endemic countries thus, donors countries needs to collaborate with researchers and health officials to determine what these endemic countries in the global south requires towards enabling scale up in response to this disease. Copyright © 2022 iGlobal Research and Publishing Foundation. All rights reserved.

2.
J Med Internet Res ; 24(10): e37258, 2022 10 31.
Article in English | MEDLINE | ID: covidwho-2065305

ABSTRACT

BACKGROUND: Sexually transmitted diseases (STDs) are common and costly, impacting approximately 1 in 5 people annually. Reddit, the sixth most used internet site in the world, is a user-generated social media discussion platform that may be useful in monitoring discussion about STD symptoms and exposure. OBJECTIVE: This study sought to define and identify patterns and insights into STD-related discussions on Reddit over the course of the COVID-19 pandemic. METHODS: We extracted posts from Reddit from March 2019 through July 2021. We used a topic modeling method, Latent Dirichlet Allocation, to identify the most common topics discussed in the Reddit posts. We then used word clouds, qualitative topic labeling, and spline regression to characterize the content and distribution of the topics observed. RESULTS: Our extraction resulted in 24,311 total posts. Latent Dirichlet Allocation topic modeling showed that with 8 topics for each time period, we achieved high coherence values (pre-COVID-19=0.41, prevaccination=0.42, and postvaccination=0.44). Although most topic categories remained the same over time, the relative proportion of topics changed and new topics emerged. Spline regression revealed that some key terms had variability in the percentage of posts that coincided with pre-COVID-19 and post-COVID-19 periods, whereas others were uniform across the study periods. CONCLUSIONS: Our study's use of Reddit is a novel way to gain insights into STD symptoms experienced, potential exposures, testing decisions, common questions, and behavior patterns (eg, during lockdown periods). For example, reduction in STD screening may result in observed negative health outcomes due to missed cases, which also impacts onward transmission. As Reddit use is anonymous, users may discuss sensitive topics with greater detail and more freely than in clinical encounters. Data from anonymous Reddit posts may be leveraged to enhance the understanding of the distribution of disease and need for targeted outreach or screening programs. This study provides evidence in favor of establishing Reddit as having feasibility and utility to enhance the understanding of sexual behaviors, STD experiences, and needed health engagement with the public.


Subject(s)
COVID-19 , Sexually Transmitted Diseases , Social Media , Humans , COVID-19/epidemiology , Pandemics , Communicable Disease Control , Sexually Transmitted Diseases/epidemiology
3.
Annals of Clinical Psychiatry ; 34(3):15-16, 2022.
Article in English | EMBASE | ID: covidwho-2030805

ABSTRACT

BACKGROUND: Cotard syndrome is a rare neuropsychiatric condition in which individuals have delusions of being deceased or losing their organs. It is often seen in patients with severe depression and is associated with catatonia.1 Neurosyphilis is a severe sequelae of untreated treponema pallidum infection in which the paretic form of this disorder commonly has a psychiatric presentation. 2 We present a rare case of Cotard syndrome in a patient with neurosyphilis with successful treatment. OBJECTIVE: To understand Cotard syndrome and underlying neuropsychiatric conditions, and characterize the diagnosis and management of psychiatric symptoms in a patient with neurosyphilis. METHODS: Review of a case using electronic medical records and relevant literature. Key terms searched: 'Cotard syndrome,' 'neurosyphilis,' 'COVID-19 infection' using Medscape and Google Scholar. RESULTS: We present a 49-year-old male with a history of alcohol use disorder in remission, depression, and history of COVID-19 (asymptomatic) 6 months prior. The patient presented to the emergency department for recent changes in behavior. He was agitated, threatening, and required chemical and physical restraint. Evaluation was notable for illogical thought processes with somatic delusions. He repeatedly stated, 'I am already dead, my organs have died,' and had an episode of catatonia. All tests including drug screen and COVID-19 were negative. Rapid plasma regain (RPR) titer was 1:64. Neurology and Infectious Disease were consulted. Lumbar puncture revealed positive venereal disease research laboratory (VDRL) titer of 1:4. The patient was diagnosed with neurosyphilis and major depressive disorder with psychosis with Cotard syndrome. He was treated with intravenous (IV) penicillin G and was discharged on oral mirtazapine 30 mg and olanzapine 20 mg nightly at bedtime, oral donepezil 5 mg daily, thiamine, and folate. CONCLUSIONS: Cotard syndrome is often seen in depression with psychotic features.1 Neurosyphilis can present with depression, anxiety, psychosis, and dementia. Early identification is the key for successful treatment. This is a unique case of neurosyphilis with features of Cotard syndrome in a patient with a history of depression with treatment noncompliance. Studies show that quetiapine and risperidone improve psychosis in neurosyphilis.5 In this case, neurosyphilis was successfully treated with IV penicillin G for 2 weeks. The patient was also tried on antipsychotics and mood stabilizers ' specifically aripiprazole, valproic acid, and haloperidol ' and was eventually stabilized on oral olanzapine 20 mg taken nightly at bedtime. Our differential diagnosis also included COVID-19 delirium with Cotard syndrome, which was ruled out due to a negative COVID test. To our knowledge, there are 2 cases of COVID-19 delirium with Cotard syndrome.6 We present this case to inform clinicians of rare manifestations of neurosyphilis in patients with comorbid psychiatric illness and to advance research into treatment options for psychosis in neurosyphilis.

4.
Drug Topics ; 166(4):28-29, 2022.
Article in English | EMBASE | ID: covidwho-2030711
5.
Journal of General Internal Medicine ; 37:S592-S593, 2022.
Article in English | EMBASE | ID: covidwho-1995827

ABSTRACT

STATEMENT OF PROBLEM/QUESTION: Societal and cultural barriers that prevent ethnic minorities from achieving health equity include lack of access and misinformation. COVID-19 vaccine hesitancy among ethnic minorities has limited vaccination rates thus hindering the establishment of herd immunity. Vaccination rates in college students aged 18-24 in New York state (NYS) is high (80%). However, in minority populations, college students are much less likely to be vaccinated with rates of 15% in African Americans (AA) and 21% in Latinx individuals. Access to health care also limits young minority populations from sexual health screenings, contributing to a significantly higher rate of sexually transmitted infections (STI) and HIV infection. One in five people in the United States (US) have a STI, and almost half of new STIs occur in teens aged 15-24, with a disproportionately high percentage occurring in AA. Sexual health education and screenings should therefore be focused on this at risk population. Health inequity is often grounded by multiple historical and personal factors, but access to medical professionals is an important element for intervention. DESCRIPTION OF PROGRAM/INTERVENTION: The Ally Care Center at Westchester Medical Center partnered with a local college in New Rochelle, New York to provide a multi-pronged community event. On July 22, 2021 we conducted a virtual session to address questions for the college community. We subsequently brought our multidisciplinary team of medical providers, case managers and psychologists to the college on five occasions to provide COVID-19 vaccinations and sexual health screenings. MEASURES OF SUCCESS: Vaccination rates and STI screening rates FINDINGS TO DATE: Over a total of five visits, 109 members of a predominantly minority college population received the first dose of the COVID vaccine and 98 received the second dose indicating an 89.9% rate of full vaccination. This is about 10% higher compared to NYS COVID vaccination rates in the age group 18-24 years which is 80.9% as of November 2021. Vaccination rates with atleast one dose in minority group adults older than 15 years of age are 15% for AA, 14.6% for Asians, and 21% for Latinx. Fourteen students opted for sexual health screenings, of whom two were found to be positive for chlamydia and treated. KEY LESSONS FOR DISSEMINATION: Health disparities may in part be driven by medical misinformation and lack of access to healthcare providers. Community level outreach events can ensure that routine preventative health strategies are made available to minority populations. These can be most effective when tackling multiple health care needs. These events also provide an opportunity to address misniformation and cultivate trust in medical professionals.

6.
Journal of General Internal Medicine ; 37:S148, 2022.
Article in English | EMBASE | ID: covidwho-1995726

ABSTRACT

BACKGROUND: Bacterial sexually transmitted infections (bSTI) and HIV outbreaks are on the rise nationally. Early diagnosis, which reduces individual and community morbidity, requires ready access to symptomatic and asymptomatic testing. The coronavirus 2019 (COVID-19) pandemic drove a shift towards telemedicine and the prioritization of symptomatic treatment over asymptomatic screening, raising concern about potential reductions in testing. The impact in safety-net settings, which faced disproportionate baseline bSTI/HIV rates rooted in structural inequities, and where many patients lacked telemedicine resources, is not yet known. This study describes the impact of COVID-19 on bSTI/HIV testing at an urban, safety-net hospital located in one of the federal Ending the HIV Epidemic priority counties. METHODS: The study took place at Boston Medical Center (BMC) in Suffolk County, MA. Medical center-wide chlamydia, gonorrhea, syphilis, and HIV testing volume and positivity rates were ed from July 1 2019-August 31 2021. On the basis of institutional modified COVID-19 operations, we defined the following study periods: pre-pandemic (July 1 2019 - February 29 2020), peak-pandemic (March 1 2020 -May 31 2020), and post-peak (June 1 2020 - August 31 2021). Descriptive statistics were used to characterize testing trends. RESULTS: Testing Volume Bacterial STI and HIV test volume dropped sharply beginning in March 2020. bSTI testing peak-pandemic (mean 1,145 tests/mo) was 42% of pre-pandemic baseline (mean 2,738 tests/mo) and nadired in April 2020 (766 tests). Similarly, peak-pandemic HIV testing (mean 711 tests/mo) was 43%of pre-pandemic baseline (mean 1635 tests/mo) and nadired in April 2020 with 438 tests concentrated in inpatient and ED settings. Post-peak bSTI (mean 2,551 tests/ mo) and HIV (mean 1585 tests/mo) testing did not return to baseline until March 2021. Positivity Rate Peak-pandemic bSTI tests were 10% more likely to be positive compared to the pre-pandemic period (4.64% vs 4.10%). Gonorrhea and chlamydia tests were 13% more likely to be positive (5.64% vs 4.98%), reaching peak positivity of 7.33% in April 2020. HIV tests were 35% more likely to be positive (1.76% vs 1.30%). CONCLUSIONS: Bacterial STI and HIV testing rates at an urban safety-net hospital declined precipitously at the onset of the pandemic and did not return to baseline levels until 1 year later. Increased positivity rate further supports the inadequacy of peak-pandemic testing. Facing another winter surge in COVID-19 cases, safety-net settings should develop low-barrier alternatives to traditional office-visit based testing, including walk-in and home testing pathways to mitigate testing gaps, high positivity rates, and associated morbidity.

7.
Emerg Microbes Infect ; 11(1): 1664-1671, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1978179

ABSTRACT

To reach the WHO target of hepatitis C virus (HCV) elimination by 2025, Taiwan started to implement free-of-charge direct-acting antiviral (DAA) treatment programme in 2017. Evaluating the progress of HCV microelimination among people living with HIV (PLWH) is a critical step to identify the barriers to HCV elimination. PLWH seeking care at a major hospital designated for HIV care in Taiwan between January 2011 and December 2021 were retrospectively included. For PLWH with HCV-seropositive or HCV seroconversion during the study period, serial HCV RNA testing was performed using archived samples to confirm the presence of HCV viremia and estimate the prevalence and incidence of HCV viremia. Overall, 4199 PLWH contributed to a total of 27,258.75 person-years of follow-up (PYFU). With the reimbursement of DAAs and improvement of access to treatments, the prevalence of HCV viremia has declined from its peak of 6.21% (95% CI, 5.39-7.12%) in 2018 to 2.09% (95% CI, 1.60-2.77%) in 2021 (decline by 66.4% [95% CI, 55.4-74.7%]); the incidence has declined from 25.94 per 1000 PYFU (95% CI, 20.44-32.47) in 2019 to 12.15% per 1000 PYFU (95% CI, 8.14-17.44) (decline by 53.2% [95% CI, 27.3-70.6%]). However, the proportion of HCV reinfections continued to increase and accounted for 82.8% of incident HCV infections in 2021. We observed significant declines of HCV viremia among PLWH with the expansion of the DAA treatment programme in Taiwan. Further improvement of the access to DAA retreatments is warranted to achieve the goal of HCV microelimination.


Subject(s)
HIV Infections , Hepatitis C, Chronic , Hepatitis C , Antiviral Agents/therapeutic use , HIV Infections/drug therapy , HIV Infections/epidemiology , Hepacivirus/genetics , Hepatitis C/drug therapy , Hepatitis C/epidemiology , Hepatitis C, Chronic/drug therapy , Humans , Retrospective Studies , Taiwan/epidemiology , Viremia/drug therapy , Viremia/epidemiology
8.
Sexually Transmitted Infections ; 98:A62, 2022.
Article in English | EMBASE | ID: covidwho-1956933

ABSTRACT

Introduction Men and gender diverse people who have sex with men (MGDSM) are at higher risk of sexually transmitted infections (STIs). COVID-19 related lockdown restrictions at the beginning of the pandemic might have altered their sexual behaviours and thus their susceptibility to STIs. We examined the impact of the first UK-wide lockdown on sexual behaviours and explored factors related to casual sexual activity at the time when it was discouraged by official guidelines. Methods In April-May 2020, we conducted an online 40-item survey, promoted on social media and Grindr, which assessed engagement in various sexual activities, anxiety about COVID- 19 and relevant demographic factors. We performed regression analyses to identify changes in sexual behaviour during the lockdown and characteristics of those who engaged in casual sex. Results Out of 1429 respondents (mean age=36, 84% White), 76% reported not having any casual sex, 12% engaged in casual sex with only one person and 5% with four or more sexual partners during lockdown. Reporting casual sex during lockdown was associated with: lower level of education OR=2.37[95%CI:1.40-4.01];identifying as a member of an ethnic minority OR=2.27[1.40-3.53];more frequent (daily) usage of sexual networking apps OR=2.24[1.54-3.25];being less anxious about contracting COVID-19 through sex OR=1.66[1.12-2.44];using PrEP before lockdown OR=1.75 [1.20-2.56];continuing to use PrEP OR=2.79[1.76-4.57];and testing for STIs during lockdown OR=2.65[1.76-3.99]. Discussion Three-quarters of respondents ceased sexually activity with casual sex partners and those sexually active were also more likely to use PrEP and utilise sexual health screening, which may partially explain the temporary decline in STIs.

9.
Sexually Transmitted Infections ; 98:A49, 2022.
Article in English | EMBASE | ID: covidwho-1956922

ABSTRACT

Background Online sexual health services (e-services) are being increasingly used for STI testing. Reduced sexual health clinic capacity due to the Covid-19 pandemic prompted our regional e-service to widen eligibility and enable individuals with mild symptoms to access our service. Prior to placing a kit order, information was shown to all symptomatic service users, advising them of the benefits of attending a sexual health clinic and/or to attend a clinic if symptoms persist/worsen. Method A retrospective analysis was performed of service users that ordered a testing kit between March 2020, and December 2021. Kit return rates were compared according to symptom status. Results Of 888,619 kit orders 163,023 (18.3%) came from symptomatic users. The most common symptom reported was vaginal discharge (41.1%), followed by dysuria/frequency (18.4%) and itching (13.8%). The kit return rate among asymptomatic service users was significantly higher (79.3%) compared to symptomatic users (74.3%) (X2 6.04. p =0.01401). The highest return rates were seen among individuals with itching (75.8%), dysuria/frequency (75.7%) and vaginal discharge (74.6%). The lowest return rate was seen by individuals with genital lumps (71.2%). Discussion Significantly fewer kits were returned by symptomatic e-service users compared to asymptomatics. It is plausible the e-service advisory information deterred some users from returning kits, encouraging them to instead test at a clinic. However, many users opted to complete testing online or perhaps did so because of difficulty accessing a sexual health clinic. Further work is needed to explore the preferred modality of testing provider and the suitability of online services for symptomatic individuals.

10.
Sexually Transmitted Infections ; 98:A41, 2022.
Article in English | EMBASE | ID: covidwho-1956915

ABSTRACT

Introduction DA/V increased over the pandemic Our e-service widened access during the crisis and introduced three questions to adult SUs enquiring about DA/V. An analysis of SUs triggering these questions is provided. Method E-notes review of SUs who triggered question(s) about current DA/DV, whilst ordering a kit between 17.8.21- 28.2.22. SUs that trigger are automatically offered access to supportive online information. The e-service team don't directly contact these SUs unless there's another reason (e.g. relaying positive STI results). If safe to do so, the triggers are discussed during these calls and further support/counselling offered. Results 3846/231460(1.7%) SU triggered DA/V question(s) between 17.8.21-28.2.22. The first 202 SU e-notes were reviewed: median age 28yrs (18-73yrs);66%(134/202) female;72%(145/202) heterosexual;75%(152/202) UK born. 264 triggers were selected: 27%(55/202) physical/emotional abuse, 81%(164/202) coercive control, and 22%(45/202) sexual abuse. Ten (5%) SUs triggered three DA/V questions, 42(21%) two and 150(74%) one. STI positivity was 4%. 77%(156/202) engaged in high-risk activity. 26%(52/202) had never visited a clinic. Telephonic discussion with the e-service took place in 10%(20/202) SUs: 50%(10/20) received counselling/signposting;10%(2/20) referred to independent DA/V advocate, 30% (6/20) stated historic abuse, 10%(2/20) mistakenly triggered, 5%(1/10) declined support for current abuse and 5%(1/10) disengaged. Of 29%(58/202) SUs who ordered further e-kit(s) 38%(22/58) continued to trigger and 9%(5/58) disclosed sexual assault. Discussion 1.7% SUs reported current DA/V. After attempted contact a supportive DA/V discussion was accepted by 80% SUs. Despite providing online support 38% continued to disclose abuse. Efforts to explore/evaluate safe methods of engaging and supporting DA/V survivors using e-services are required.

11.
Sexually Transmitted Infections ; 98:A40-A41, 2022.
Article in English | EMBASE | ID: covidwho-1956914

ABSTRACT

Introduction During the COVID19 pandemic, TEC Cymru purchased Attend Anywhere video consulting software and made implementation and training available for all Welsh clinical services. Many services used video consulting software to reduce face-to-face contact and maintain services whilst staff were otherwise redeployed. Methods Data were collated from questionnaires from clinician and patients after their video consultation and collated by the research team at TEC Cymru. Results 654 questionnaires were collected between March 2020 and January 2022 with 42% from Cardiff & Vale. Video consultations were reported as excellent by 302 (47%). 439 (75%) of respondents reported a face-to-face visit was prevented. Most patients were white British (90.8%) and most were in the 25-44 age range (71.1%). More patients reported excellent ratings than clinicians suggesting a discrepancy between expectation. 69.7% of patients reported benefits of not taking time off work for consultations and 83.0% reported that video consultations would reduce rates of sexually transmitted infections. Further data can be presented comparing patient and clinician ratings. The responses to each patient enablement statement are presented in the attached table. Discussion Those that used video consulting during the pandemic had high satisfaction ratings and felt empowered by this mode of delivery of care. Clinician data focused on technical challenges and concern remains of those without technological capability. (Table Presented).

12.
Sexually Transmitted Infections ; 98:A26, 2022.
Article in English | EMBASE | ID: covidwho-1956904

ABSTRACT

Introduction The government issued strict guidance issued on social distancing and not mixing out of pre-defined groups. Since social contact and mixing is required for the transmission of sexually transmitted infections (STIs), STI rates would be expected to be lower during this time. We look at experiences from a busy London clinic serving a diverse population throughout COVID. Methods We reviewed acute STI rates, defined as chlamydia, gonorrhoea, mycoplasma, trichomoniasis, LGV, primary herpes and primary syphilis in the year preceding COVID (April 2019 - March 2020) with the first year of COVID and the restrictions on behaviour and movement (April 2020 - March 2021). The clinic electronic patient record was investigated retrospectively. STI rates were compared between the two groups. Results There was a reduction in clinical attendances during this time 14,424 (2019-2020) down to 9,133 (2020-2021), but STI rates remained stable at 2,408/14,424 (17%) in 2019- 2020 vs 1,383/9,133 (15%) in 2020-2021. Discussion There was no significant difference between the year preceding COVID and the first year of the pandemic. There were likely confounding factors including clinic access across the region, and reduced clinic access within our own clinic.

13.
Sexually Transmitted Infections ; 98:A25, 2022.
Article in English | EMBASE | ID: covidwho-1956903

ABSTRACT

Introduction We know vaccine uptake varies by demographic group1. We considered behavioural associations between those who accepted vaccination and followed the social distancing guidelines. We compared those symptomatic patients with an acute sexually transmitted infection (STI) screens to those asymptomatic patients with a negative screen who may have been more likely to follow guidance and looked at STI rates. Methods We reviewed vaccine uptake amongst patients diagnosed with an acute STI, defined as chlamydia, gonorrhoea, mycoplasma, trichomoniasis, LGV, primary herpes and primary syphilis. The clinic electronic patient record, NHS Summary Care Record (SCR) and London Care Record were investigated retrospectively. Uptake was compared to asymptomatic patients with negative results. Vaccine uptake was compared between the two groups. Results 508 had acute STI, 388 had negative STI screens. 132/508 (27%) in acute STI group were fully vaccinated, and 132/388 (34%) in non-STI group. 2,408/14,424 (17%) had acute STI in 2019-2020, and 1,383/9,133(15%) in 2020-2021. There was a 2% drop in acute STI incidence. Discussion Vaccine uptake was higher amongst those the negative asymptomatic patients compared to those with acute STI. Only a small drop in acute STI was observed, suggesting sexual contact outside of social bubbles. Further analysis is needed to determine if patient behaviours predisposing to STI acquisition are associated with reduced vaccine uptake, which in part may be due to perception of COVID risk.

14.
British Journal of Dermatology ; 186(6):e253, 2022.
Article in English | EMBASE | ID: covidwho-1956715

ABSTRACT

A 24-year-old man presented with a 7-day history of oral ulceration and 3-day history of erythema at the urethral meatus with one erythematous papule on the scrotum. The patient had tested positive for COVID-19 on polymerase chain reaction test. The patient had not eaten for 6 days, managing only sips of water. There were no new medications and no recent vaccinations. On examination his lips were ulcerated with haemorrhagic crust. His tongue had significant swelling and ulceration. There was erythema and superficial ulceration surrounding the urethral meatus. Thus, the patient had mucosal involvement only, with no target lesions, blisters or epidermal detachment. Inflammatory markers were raised. The initial impression was that of reactive infectious mucocutaneous eruption (RIME) associated with COVID-19 infection, given the likely viral cause, in a systemically well, young patient. The differential included erythema multiforme major, Stevens-Johnson syndrome and pemphigus vulgaris. Bacterial and viral swabs, septic screen, sexually transmitted infection screen including HIV, circulating skin antibodies were all negative. The patient was treated with topical and systemic steroids, with a catheter to prevent urethral stenosis, intravenous Pabrinex®, oral nutritional supplements, analgesia, Difflam™ mouthwash, betamethasone mouth rinse and lidocaine mouth spray. The patient's symptoms had resolved after 6 weeks. This case demonstrates the multispecialty management of a patient presenting acutely with RIME secondary to COVID-19, who was treated successfully with oral and topical steroids.

15.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927702

ABSTRACT

Introduction: Acute interstitial pneumonia (AIP) also known as Hamman-Rich Syndrome is an uncommon, acute, and rapidly progressive idiopathic pulmonary disease that often leads to acute respiratory distress syndrome (ARDS). We present a case of a 52-year-old male who developed this condition. Case: A 52-year-old male with no past medical history presented to the emergency department with a 3-day history of progressively worsening dyspnea, dry cough, and chills. Prior to symptom onset, he was in his usual state of health but did report having polyarthralgia mainly involving large joints with no other associated symptoms. He denied a history of sick contacts including COVID exposure, sexually transmitted infections, incarceration, intravenous drug abuse, or travel to tuberculosis endemic countries. He denied tobacco use and any other form of illicit drug use. On physical examination, he was afebrile, tachycardic, and hypoxic on room air. He appeared to be in no respiratory distress and chest was clear to auscultation. There were no joint abnormalities, skin rashes, or lymphadenopathy. Lab workup revealed elevated D-Dimer (2140 ng/mL), CRP (50 mg/L), lactate dehydrogenase (296 IU/L), ferritin (578 ng/mL). His SARSCoV2 PCR was negative. Chest X-ray and CT chest both revealed right pleural effusion and diffuse reticular and ground-glass opacities. He underwent thoracentesis and fluid analysis revealed lymphocytic exudate with negative cultures. Antibiotics and steroids were initiated. He underwent a complete rheumatologic workup including myositis panel, due to concern for possible autoimmune etiologies and it was negative. His respiratory status worsened, and he eventually required intubation. At this point given unclear etiology, he underwent bronchoscopy with transbronchial cryobiopsy. Cryobiopsy revealed evidence of organizing phase of diffuse alveolar damage (Figure 1) and in the setting of negative cultures, COVID-19 and autoimmune panel, there was a growing concern for acute interstitial pneumonia. The patient was started on pulse dose of steroids and transferred to a transplant center for lung transplantation evaluation. Discussion: Acute interstitial pneumonia is a rare idiopathic clinicopathological condition that is characterized clinically by rapid onset of respiratory failure in patients with no past medical history of pre-existing lung disease. Histopathological findings are identical to those of diffuse alveolar damage. Closely resembling ARDS, it is frequently confused with other clinical entities characterized by rapidly progressive interstitial pneumonia. Considering this a high index of suspicion is required to diagnose these patients and institute appropriate management as mortality is as high as 70%. (Figure Presented).

16.
Drug Topics ; 166(6):16-17, 2022.
Article in English | EMBASE | ID: covidwho-1925358
17.
Journal of Urology ; 207(SUPPL 5):e613, 2022.
Article in English | EMBASE | ID: covidwho-1886519

ABSTRACT

INTRODUCTION AND OBJECTIVE: Vaccine hesitancy is a major public health obstacle to fighting the ongoing COVID-19 epidemic. Due to studies that show COVID-19 infection can affect sperm parameters and lead to orchitis, the public are concerned about how the COVID vaccines may impact male reproduction. In this study, we investigated the association between COVID-19 vaccination and risk of developing orchitis and/or epididymitis outcomes in a cohort of men using a large, US-based, electronic health record database (TriNetX). METHODS: We queried the database for male patients ages 12 years and older who received a single-dose COVID-19 vaccine or at least 1 dose of a 2-dose regimen using specific ICD-10 medication and procedure codes and compared them to a cohort of men who had no record of any COVID-19 vaccination in their health record. The outcome for analysis was diagnosis of orchitis and/or epididymitis (ICD-10-CM: N45-N45.4, N51) between 1-9 months after the index event of COVID-19 vaccination. The two cohorts were balanced for the following potentially confounding variables through propensity score matching: age at index event, race, urinary tract infection, and unspecified sexually transmitted disease. We determined the association between COVID-19 vaccination and orchitis and/or epididymitis using logistic regression analysis with statistical significance assessed at p<0.05. RESULTS: We identified 663,774 men in the database who had received at least one dose of a COVID-19 vaccine, and 9,985,154 who did not. Prior to propensity score matching, 0.051% of men in the vaccinated cohort and 0.083% in the unvaccinated cohort received a diagnosis of orchitis and/or epididymitis in the time window (OR =0.619;95% CI: 0.556 - 0.690;p<0.0001). After balancing for potentially confounding variables, the COVID-19 vaccine remained protective against development of orchitis and/or epididymitis (OR =0.568;95% CI: 0.497 - 0.649;p<0.0001). CONCLUSIONS: In this retrospective cohort study, we demonstrated that receiving a COVID-19 vaccine is associated with a decreased risk of developing orchitis and/or epididymitis. These findings have important implications in the counseling of patients that are hesitant to receive the COVID-19 vaccine and refute misinformed claims on social media regarding the effect of the vaccines on male fertility.

18.
Topics in Antiviral Medicine ; 30(1 SUPPL):370-371, 2022.
Article in English | EMBASE | ID: covidwho-1880147

ABSTRACT

Background: This study explores the effects of COVID-19 restrictions on sexual healthcare use, pre-exposure prophylaxis (PrEP) use, and sexually transmitted infection (STI) incidence among men who have sex with men (MSM) participating in a PrEP demonstration project in Amsterdam, the Netherlands (AMPrEP). Methods: We retrieved data from 2019-2020 for AMPrEP participants with ≥1 study visit in 2019 (n=305), and two questionnaires on COVID-19 measures and sexual behaviour in 2020 and 2021 (n=203;n=160). Analyses were stratified for three periods of COVID-19 restrictions (first: 15/3/2020-15/6/2020;second: 16/6/2020-15/9/2020;third: 16/9/2020-31/12/2020 or 1/4/2021 for COVID-19 questionnaire data). Evaluated endpoints included proportion returning for sexual healthcare during COVID-19, change in PrEP use (increased/unchanged vs. deceased/stopped;relative to 2019), and incidence of any STI (chlamydia, gonorrhoea, or syphilis;diagnosed at clinic/study visit) or HIV. We modelled determinants of care and PrEP use via multivariable logistic regression, and STI incidence using piecewise Poisson regression;comparing 2020 periods to those in 2019. Results: Of the 305 included in the analysis, 72.8% (n=222) of participants returned for care during COVID-19, among which 147, 190, and 148 visits took place during the first, second, and third period of COVID-19 restrictions, respectively. Daily (versus event-driven) PrEP use was significantly associated with returning for care across periods (p<0.001). Increased/unchanged PrEP use was reported by 55.2% (n=112), 58.1% (n=93), and 55.6% (n=89) during the first, second, and third periods, respectively. Increased/unchanged PrEP use was more likely among those reporting chemsex in the first (p=0.001) and third (p=0.020) periods, and those reporting increased/unchanged number of sex partners relative to 2019 during the second period (p=0.010). STI incidence was significantly lower in 2020 than 2019 during the first (IRR=0.43, 95%CI=0.28-0.68), yet seemed higher during the second (IRR=1.38, 95%CI=0.95-2.00) and third periods (IRR=1.42, 95%CI=0.86-2.33), albeit non-significantly (figure 1). No new HIV infections were diagnosed. Conclusion: COVID-19 restrictions coincided with reduced care and PrEP use. The significantly lower STI incidence during the first period of COVID-19 restrictions and subsequent increase suggests a delayed diagnosis effect. We need ways to ensure continued access to sexual healthcare during restrictions.

19.
Topics in Antiviral Medicine ; 30(1 SUPPL):54-55, 2022.
Article in English | EMBASE | ID: covidwho-1880082

ABSTRACT

Background: The COVID-19 pandemic led to significant disruptions in the provision of routine medical services. Myriad pandemic-related factors such as access to healthcare facilities, virtual care delivery, social distancing, changes in sexual behaviors, and periodic swab shortages may have affected detection rates for HIV and other sexually transmitted infections (STIs). Thus, we evaluated trends in testing and diagnoses of chlamydia, gonorrhea, syphilis, and HIV from 2017 to 2020 in a large integrated health system in the United States. Methods: We conducted a retrospective study using electronic health records among individuals ages ≥12 years enrolled in the Kaiser Permanente Southern California (KPSC) system. For each year from 2017 to 2020, we assessed the rates per 100,000 person-years of tests conducted and new positive results for genital and extragenital chlamydia, gonorrhea, syphilis, and HIV. Case definitions for chlamydia and gonorrhea included newly positive laboratory results in the absence of any other positive test within the past 30 days, or a positive test after a negative test within a 30-day period. Case definitions for syphilis included any new four-fold increase in RPR titer compared to the immediate prior RPR titer obtained within a 1-year period. We used Poisson regression to estimate rate ratios (RR) for each outcome, comparing pre-pandemic periods (January 2017 to February 2020) to the pandemic period (March to December 2020). Results: The study included a population of more than 4 million KPSC members yearly. During the pre-pandemic period, rates of testing remained stable or modestly increased, whereas case rates increased for syphilis and chlamydia, and decreased for gonorrhea and HIV (Table 1). Compared to the pre-pandemic period, testing rates were significantly lower from March to December 2020 for all STIs and HIV (range of RR 0.69-0.83). HIV/STI diagnosis rates were 7-29% lower during the pandemic for HIV (RR 0.74 [0.66-0.83]), chlamydia (RR 0.71 [95% CI.70-0.73]), and gonorrhea (RR 0.93 [0.89-0.96]), but higher for syphilis (RR 1.32 [1.27, 1.37]). Conclusion: We observed profound reductions in testing and diagnosis rates for chlamydia, gonorrhea, and HIV during the COVID-19 pandemic in Southern California compared to the pre-pandemic period. Despite lower pandemic period testing rates, syphilis diagnoses increased. These findings suggest the pandemic had an adverse impact on identification of STIs, which may impede efforts to curb STIs and the HIV epidemic.

20.
Topics in Antiviral Medicine ; 30(1 SUPPL):350, 2022.
Article in English | EMBASE | ID: covidwho-1880027

ABSTRACT

Background: Sexually transmitted infection (STI) diagnosis serves as an important linkage to HIV testing and pre-exposure prophylaxis (PrEP) for adolescents. The COVID-19 pandemic disrupted sexual health services for young people, with a potential consequence of increasing undiagnosed STIs. This study aimed to describe STI testing changes and estimate undiagnosed STI cases during the pandemic. Methods: We analyzed electronic medical records for chlamydia, gonorrhea, and trichomonas testing encounters from six pediatric primary care clinics in Philadelphia, July 2014-November 2020. We assessed whether testing was asymptomatic screening, risk-based testing, or symptomatic testing, and whether any result was positive. We evaluated STI trends over time, comparing pre-pandemic (before March 1st, 2020) and pandemic periods (after March 1st, 2020). Missed STI cases during the pandemic were estimated using decreases in patient volume and asymptomatic screening as compared to the previous year. Generalized linear mixed-effects models estimated the effects of patient-level and neighborhood-level characteristics on STI outcomes. Results: 35,548 STI testing encounters were analyzed, including 2,958 during the pandemic period. The median patient age was 17.5 years, 57% of patients were female, and 84% were Black/African American. Mean monthly STI testing encounters decreased from 479/month pre-pandemic to 329/month during the pandemic. Test positivity increased from 12.5% pre-pandemic to a peak of 27.5% in April 2020. The percent of STI tests performed as asymptomatic screening dropped from 72.5% pre-pandemic to a nadir of 54.5% in April 2020 (Figure). We estimate that the decrease in asymptomatic screening in the pandemic period would be associated with 159 missed cases (23.8% of expected cases) based on patient volume from the previous year. In multivariate models controlling for testing type (asymptomatic screening, risk-based testing, or symptomatic testing), the odds of test positivity were 50% higher during the pandemic (OR: 1.50, p<0.001). Conclusion: STI test positivity increased during the pandemic while asymptomatic screening decreased. Test positivity was higher for asymptomatic patients, suggesting increased STI prevalence. These changes likely resulted in a substantial number of undiagnosed STIs, representing missed opportunities for PrEP linkage. Efforts are needed to re-establish and sustain access to STI services for adolescents in response to disruptions caused by the pandemic.

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