Vitamin D3 Supplementation at 5000 IU Daily for the Prevention of Influenza-Like Illness in Healthcare Workers: A Randomized Clinical Trial (preprint)

ABSTRACT Importance Vitamin D supplementation has been shown to reduce the incidence of acute respiratory infections in populations at risk. The COVID-19 pandemic has highlighted the importance of preventing viral infections in healthcare workers. Objective The aim of this study was to assess the hypothesis that vitamin D3 supplementation at 5000 IU daily reduces influenza-like illness (ILI), including COVID-19, in healthcare workers. Design We conducted an open label, randomized clinical trial wherein a random group of healthcare workers was invited to receive 5000 IU daily vitamin D3 supplementation for nine months, while other random healthcare workers served as passive controls. All healthcare workers were required to self-monitor and report to employee health for COVID-19 testing when experiencing symptoms of ILI. COVID-19 test results were retrieved. Setting The trial was conducted at a tertiary university hospital. Participants Out of 7,600 healthcare workers, two groups of 4,708 and 2,892 subjects were pre-randomized to the vitamin D3 intervention and passive control groups, respectively. Out of 4,708 intervention subjects approached, 299 with no history of hypercalcemia or nephrolithiasis were enrolled. Subjects who completed at least 2 months of supplementation to ensure adequate vitamin D levels were included in the analysis (n=255). Intervention Daily oral vitamin D3 gel capsules at 5000 IU for 9 months. Main Outcome and Measure The primary analysis compared the incidence rate of all ILI, while secondary analyses examined incidence rates of COVID-19 ILI and non-COVID-19 ILI. Incidence rates were compared between the vitamin D and control groups. Results Between October 2020 and November 2021, 255 healthcare workers (age 47±12 years, 199 women) completed at least two months of vitamin D3 supplementation. Five subjects were withdrawn due to adverse effects. The control group consisted of 2,827 workers. Vitamin D3 5000 IU supplementation was associated with lower risk of ILI (incidence rate difference: - 1.7×10 -4 /person-day, 95%-CI: -3.0×10 -4 to -3.3×10 -5 /person-day, P = 0.015) and a lower incidence rate for non-COVID-19 ILI (incidence rate difference: -1.3×10 -4 /person-day, 95%-CI - 2.5×10 -4 to -7.1×10 -6 /person-day, P = 0.038). COVID-19 ILI incidence was not statistically different (incidence rate difference: -4.2×10 -5 /person-day, 95%-CI: -10.0×10 -5 to 1.5×10 -5 /person-day, P = 0.152). An intention-to-treat analysis could not be performed due to low enrollment in the pre-randomized intervention group. Conclusion and Relevance Daily supplementation with 5000 IU vitamin D3 reduces influenza-like illness in healthcare workers. Trial Registration Clinicaltrials.gov , NCT04596657 Key Points Question Can 5,000 IU of daily vitamin D3 prevent influenza-like illness in healthcare workers? Findings In this randomized controlled trial, 5,000 IU of once daily vitamin D3 over a 9-month period revealed that vitamin D3 supplementation was associated with a statistically significant lower risk of influenza-like illness (incidence rate difference -1.7 × 10 -4 / person-day, 95%-CI - 3.0 × 10 -4 to -3.3 × 10 -5 / person-day, P = 0.0147). Meaning Daily supplementation with 5,000 IU vitamin D3 reduces influenza-like illness in healthcare workers.

Changes in practice patterns of nephrolithiasis in the era of the coronavirus disease 2019 pandemic: a review.

PURPOSE OF REVIEW: The coronavirus disease 2019 (COVID-19) pandemic led to a drastic change in healthcare priorities, availability of resources and accommodation of different needs and scenarios. We sought to review the effect of the pandemic on different aspects of nephrolithiasis. RECENT FINDINGS: The pandemic resulted in a significant impact on management of patients with nephrolithiasis around the world. A significant decrease in patient presentation and differences in strategies of management to truncate exposure and surgery time and expedite patient discharge deferring definitive management has been noted. Moreover, new safety measures such as COVID-19 PCR testing prior to surgery and limiting any intervention for COVID-19 positive patients to only life-saving scenarios has been implemented. Different emergency triaging proposals are being used, mainly including high risk patients with septic shock or complete obstruction/renal injury. Moreover, the emergence of telehealth has changed outpatient practice dramatically with a significant adoption to minimize exposure. Lastly, the effect of COVID-19 on renal physiology has been described with significant potential to cause morbidity from immediate or delayed acute kidney. No physiological effect on stone formation has yet been described, and transmission through urine is rare. SUMMARY: The COVID-19 pandemic has markedly shifted the treatment of nephrolithiasis in many ways, including emergency triage, outpatient care, and definitive management. Although various approaches and algorithms proposed are meant to optimize management in the time of the pandemic, further studies are required for validation.

Exacerbation of Congenital Hydronephrosis as the First Presentation of COVID-19 Infection in Children: A Case Series (preprint)

Background: Congenital hydronephrosis is one of the most common abnormalities of the upper urinary tract, which can be exacerbated by a variety of intrinsic or extrinsic triggers. The urinary tract system is one of the major organs complicated by COVID-19 infection. Case presentations: Here we report five patients with an established diagnosis of congenital hydronephrosis, who presented with acute abdominal pain and fever and an abrupt increase in the anteroposterior pelvic diameter (APD). Patients had a previous stable course and were under regular follow-up with serial ultra-sonographic studies. They underwent surgery or supportive treatment due to the later exacerbation of hydronephrosis. Based on the clinical and imaging findings, no plausible etiologies for these exacerbation episodes, including infection, nephrolithiasis or abdominal masses, could be postulated. The common aspect in all these patients was the evidence of a COVID-19 infection. Conclusions: : Infection with COVID-19 in children with antenatal hydronephrosis may exacerbate the degree of hydronephrosis and renal APD in ultrasonography, which itself may be mediated by the increase in inflammatory mediators.

Unstable Angina and Renal Colic in a Patient with Ankylosing Spondylitis -- A Challenge during the COVID- 19 Pandemic (preprint)

Ankylosing spondylitis (AS) a seronegative inflammatory disease that often presents with co-existing issues like bilateral hip replacements, nephrolithiasis, skin lesions, peripheral vascular disease and coronary artery disease.. We describe a patient with ankylosing spondylitis with bilateral hip replacements in the past who was waiting for an elective coronary artery bypass grafting (CABG) but needed urgent admission with renal colic and unstable angina. In the current COVID pandemic in order to reduce hospital stay and risk of hospital acquired COVID infection we decided to perform simultaneous CABG and removal of ureteric stone. In this case report we discuss the issues in relation to management of patients with coronary artery disease and ankylosing spondylitis.

Methodology for Triage of Urologic Surgical Cases in the Setting of A Pandemic (preprint)

Purpose: The COVID-19 pandemic forced our healthcare system in the Bronx, New York to cancel nearly all surgeries. With the possible second wave approaching, we developed a framework for the prioritization of Urologic surgeries that can be used as a model for those experiencing surges elsewhere. Methods: Each surgeon in the department was asked to rank their cancelled surgeries by priority (Level 1 – least urgent; Level 2 – moderately urgent; Level 3 – most urgent). A committee of urologists assigned a subclass to Level 3 and 2 cases (3a – least urgent; 3b – moderately urgent; 3c – most urgent; 2a – lower priority; 2b – higher priority). The committee then reviewed cases by urgency to arrive on a final priority ranking. Results: A total of 478 total cases were categorized: 250 Level 1, 130 Level 2, 98 Level 3 (73 adult, 25 pediatric). Level 3c involved renal cell carcinoma ≥ T2b, high-grade bladder urothelial carcinoma, adrenal mass/cancer > 6 cm, testicular cancer requiring radical orchiectomy, and penile cancer. Level 3b involved T2a renal masses requiring nephrectomy; high-risk prostate cancer and symptomatic nephrolithiasis were classified as 3a. Level 2 included testicular cancer requiring retroperitoneal lymph node dissection and complicated benign prostatic hyperplasia. Surgeries for urologic reconstruction, erectile dysfunction, and incontinence were considered Level 1. Conclusions: Our disease-specific approach to surgical rescheduling offers appropriate guidance for triaging Urologic surgeries. Our system can provide guidance to other institutions as COVID-19 surges in different regions and with the growing possibility of a second wave.

Methodology for the Triage of Urologic Surgical Cases in the Setting of a Pandemic (preprint)

Purpose: The COVID-19 pandemic forced our healthcare system in the Bronx, New York to cancel nearly all surgeries. With the possible second wave approaching, we developed a framework for the prioritization of Urologic surgeries that can be used as a model for those experiencing surges elsewhere. Methods: Each surgeon in the department was asked to rank their cancelled surgeries by priority (Level 1 – least urgent; Level 2 – moderately urgent; Level 3 – most urgent). A committee of urologists assigned a subclass to Level 3 and 2 cases (3a – least urgent; 3b – moderately urgent; 3c – most urgent; 2a – lower priority; 2b – higher priority). The committee then reviewed cases by urgency to arrive on a final priority ranking. Results: A total of 478 total cases were categorized: 250 Level 1, 130 Level 2, 98 Level 3 (73 adult, 25 pediatric). Level 3c involved renal cell carcinoma ≥ T2b, high-grade bladder urothelial carcinoma, adrenal mass/cancer > 6 cm, testicular cancer requiring radical orchiectomy, and penile cancer. Level 3b involved T2a renal masses requiring nephrectomy; high-risk prostate cancer and symptomatic nephrolithiasis were classified as 3a. Level 2 included testicular cancer requiring retroperitoneal lymph node dissection and complicated benign prostatic hyperplasia. Surgeries for urologic reconstruction, erectile dysfunction, and incontinence were considered Level 1.Conclusions: Our disease-specific approach to surgical rescheduling offers appropriate guidance for triaging Urologic surgeries. Our system can provide guidance to other institutions as COVID-19 surges in different regions and with the growing possibility of a second wave.