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1.
Sci Rep ; 11(1): 17331, 2021 08 30.
Article in English | MEDLINE | ID: covidwho-1379338

ABSTRACT

This time-to-event study examines social factors associated with health-seeking and diagnosis of 165 COVID-19 cases in response to the pandemic spread in Shaanxi Province, China. In particular, we investigate the differential access to healthcare in terms of delayed time from symptom onset to first medical visit and subsequently to diagnosis by factors such as sex, age, travel history, and type of healthcare utilization. We show that it takes more time for patients older than 60 (against those under 30) to seek healthcare after developing symptoms (+ 2.5 days, [Formula: see text]), surveillance on people with living or travel history to Wuhan helps shorten the time to the first doctor visit (- 0.8 days) and diagnosis (- 2.2 days, [Formula: see text]). A delay cut is associated with the adoption of intermediary and large hospitals rather than community-based care as primary care choices (- 1.6 days, [Formula: see text] and - 2.2 days, [Formula: see text]). One unit increase of healthcare workers per 1000 people saves patients 0.5 days ([Formula: see text]) for diagnosis from the first doctor visit and 0.6 days ([Formula: see text]) in total. Our analysis of factors associated with the time delay for diagnosis may provide a better understanding of the health-seeking behaviors of patients and the diagnosis capacity of healthcare providers during the COVID-19 pandemic.


Subject(s)
COVID-19/diagnosis , Delayed Diagnosis/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Risk Assessment/methods , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , China , Female , Help-Seeking Behavior , Humans , Male , Middle Aged , Young Adult
2.
PLoS One ; 16(7): e0253854, 2021.
Article in English | MEDLINE | ID: covidwho-1309959

ABSTRACT

BACKGROUND: We identify socioeconomic disparities by region in cancer morbidity and mortality in England for all-cancer and type-specific cancers, and use incidence data to quantify the impact of cancer diagnosis delays on cancer deaths between 2001-2016. METHODS AND FINDINGS: We obtain population cancer morbidity and mortality rates at various age, year, gender, deprivation, and region levels based on a Bayesian approach. A significant increase in type-specific cancer deaths, which can also vary among regions, is shown as a result of delay in cancer diagnoses. Our analysis suggests increase of 7.75% (7.42% to 8.25%) in female lung cancer mortality in London, as an impact of 12-month delay in cancer diagnosis, and a 3.39% (3.29% to 3.48%) increase in male lung cancer mortality across all regions. The same delay can cause a 23.56% (23.09% to 24.30%) increase in male bowel cancer mortality. Furthermore, for all-cancer mortality, the highest increase in deprivation gap happened in the East Midlands, from 199 (186 to 212) in 2001, to 239 (224 to 252) in 2016 for males, and from 114 (107 to 121) to 163 (155 to 171) for females. Also, for female lung cancer, the deprivation gap has widened with the highest change in the North West, e.g. for incidence from 180 (172 to 188) to 272 (261 to 282), whereas it has narrowed for prostate cancer incidence with the biggest reduction in the South West from 165 (139 to 190) in 2001 to 95 (72 to 117) in 2016. CONCLUSIONS: The analysis reveals considerable disparities in all-cancer and some type-specific cancers with respect to socioeconomic status. Furthermore, a significant increase in cancer deaths is shown as a result of delays in cancer diagnoses which can be linked to concerns about the effect of delay in cancer screening and diagnosis during the COVID-19 pandemic. Public health interventions at regional and deprivation level can contribute to prevention of cancer deaths.


Subject(s)
Delayed Diagnosis/statistics & numerical data , Intestinal Neoplasms/mortality , Lung Neoplasms/mortality , Prostatic Neoplasms/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Bayes Theorem , Child , Child, Preschool , England/epidemiology , Female , Health Status Disparities , Humans , Incidence , Infant , Infant, Newborn , Male , Middle Aged , Sex Characteristics , Socioeconomic Factors , Young Adult
3.
Eur J Gen Pract ; 27(1): 142-151, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1294616

ABSTRACT

BACKGROUND: The COVID-19 pandemic has resulted in the rapid reorganisation of health and social care services. Patients are already at significant risk of healthcare-associated harm and the wholesale disruption to service delivery during the pandemic stood to heighten those risks. OBJECTIVES: We explored the type and nature of patient safety incidents in French primary care settings during the COVID-19 first wave to make tentative recommendations for improvement. METHODS: A national patient safety incident reporting survey was distributed to General Practitioners (GPs) in France on 28 April 2020. Reports were coded using a classification system aligned to the WHO International Classification for Patient Safety (incident types, contributing factors, incident outcomes and severity of harm). Analysis involved data coding, processing, iterative generation of data summaries using descriptive statistical analysis. Clinicaltrials.gov: NCT04346121. RESULTS: Of 132 incidents, 58 (44%) related to delayed diagnosis, assessments and referrals. Cancellations of appointments, hospitalisations or procedures was reported in 22 (17%) of these incidents. Home confinement-related incidents accounted for 13 (10%) reports and inappropriate medication stopping for five (4%). Patients delayed attending or did not consult their general practitioner or other healthcare providers due to their fear of contracting COVID-19 infection at an in-person visit in 26 (10%) incidents or fear of burdening their GPs in eight (3%) incidents. CONCLUSION: Constraints from the first wave of the COVID-19 pandemic have contributed to patient safety incidents during non-COVID-19 care. Lessons from these incidents pinpoint where primary care services in France can focus resources to design safer systems for patients.


Subject(s)
COVID-19/epidemiology , Infection Control/organization & administration , Patient Safety/statistics & numerical data , Primary Health Care/organization & administration , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/prevention & control , COVID-19/transmission , Child , Child, Preschool , Communication , Delayed Diagnosis/statistics & numerical data , Female , France , Humans , Incidence , Infant , Male , Middle Aged , Referral and Consultation , Surveys and Questionnaires , Young Adult
5.
PLoS One ; 16(5): e0249171, 2021.
Article in English | MEDLINE | ID: covidwho-1242244

ABSTRACT

AIMS OF THE STUDY: The novel coronavirus pandemic has affected emergency department consultations for surgical pathologies. The aim of our study was to compare the number of acute appendicitis cases and the proportion of complicated appendicitis before and during the COVID-19 pandemic. METHODS: We retrospectively analyzed all data collected from a multi-center database of patients presenting to the emergency department for acute appendicitis during the COVID-19 pandemic from March 12 to June 6, 2020, and compared these data with those from the same periods in 2017, 2018, and 2019. The number of acute appendicitis cases, proportion of complicated appendicitis, and pre- and postoperative patient characteristics were evaluated. RESULTS: A total of 306 patients were included in this evaluation. Sixty-five patients presented during the 2020 COVID-19 pandemic lockdown (group A), and 241 patients in previous years (group B: 2017-2019). The number of consultations for acute appendicitis decreased by almost 20 percent during the pandemic compared with previous periods, with a significant increase in complicated appendicitis (52% in group A versus 20% in group B, p < 0,001.). Comparing the two groups, significant differences were also noted in the duration of symptoms (symptoms > 48h in 61% and 26%, p < 0,001), the intervention time (77 vs 61 minutes, p = 0,002), length of hospital stay (hospitalization of > 2 days in 63% and 32%, p < 0.001) and duration of antibiotic treatment (antibiotics > 3 days in 36% and 24% p = 0.001). CONCLUSIONS: The COVID-19 pandemic resulted in a decreased number of consultations for acute appendicitis, with a higher proportion of complicated appendicitis, most likely due to patient delay in consulting the emergency department at symptom onset. Patients and general practitioners should be aware of this problem to avoid a time delay from initial symptoms to consultation.


Subject(s)
Appendicitis/diagnosis , COVID-19/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Appendicitis/complications , Appendicitis/epidemiology , Appendicitis/surgery , C-Reactive Protein/analysis , COVID-19/complications , COVID-19/epidemiology , COVID-19/virology , Child , Databases, Factual , Delayed Diagnosis/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Length of Stay , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2/isolation & purification , Young Adult
6.
J Pediatr Hematol Oncol ; 43(8): e1244-e1246, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1234172

ABSTRACT

The COVID-19 pandemic impacted the health care system in unprecedented ways. We reviewed the registry of new cancer patients who presented to the Children's of Mississippi Center for Cancer and Blood Disorders and showed the average number of new pediatric cancer diagnoses dropped during the initial COVID-19 months and rose significantly in June 2020. We must encourage families to seek health care when needed and keep scheduled appointments for routine vaccinations and health maintenance as we know the long-term sequela of delaying health maintenance far outweighs risks at present.


Subject(s)
COVID-19/complications , Delayed Diagnosis/statistics & numerical data , Neoplasms/diagnosis , SARS-CoV-2/isolation & purification , Adolescent , Adult , COVID-19/transmission , COVID-19/virology , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Mississippi/epidemiology , Neoplasms/epidemiology , Neoplasms/virology , Young Adult
8.
J Laryngol Otol ; 135(4): 344-347, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1146477

ABSTRACT

OBJECTIVE: This prospective study aimed to evaluate possible diagnostic delays in head and neck squamous cell carcinoma recurrences due to the changed follow-up protocol during the coronavirus disease 2019 pandemic. METHODS: The follow-up appointments of head and neck squamous cell carcinoma patients treated more than one year prior to the pandemic were changed to telephone appointments in order to reduce physical visits to the hospital. All contacts, reasons for contact and recurrent cancers were recorded. RESULTS: There were 17 recurrences during a seven-month study period among 178 patients treated in the previous year (10 per cent); 14 of these recurrences occurred in patients whose treatment had ended less than one year previously and 3 occurred more than one year after treatment had ended. There was no delay in diagnoses of recurrent tumours or treatment despite reduced visits because of the coronavirus disease 2019 pandemic. CONCLUSION: According to our analyses, no delay was caused in the diagnoses of recurrent diseases. Follow up by telephone or telemedicine can be considered as part of the follow-up protocol one year after the treatment of head and neck squamous cell carcinoma when necessary.


Subject(s)
COVID-19/epidemiology , Carcinoma, Squamous Cell/diagnosis , Delayed Diagnosis/statistics & numerical data , Head and Neck Neoplasms/diagnosis , Neoplasm Recurrence, Local/diagnosis , Aftercare/statistics & numerical data , Carcinoma, Squamous Cell/epidemiology , Finland/epidemiology , Head and Neck Neoplasms/epidemiology , Humans , Neoplasm Recurrence, Local/epidemiology , Prospective Studies
9.
Age Ageing ; 50(2): 317-325, 2021 02 26.
Article in English | MEDLINE | ID: covidwho-1114821

ABSTRACT

BACKGROUND: There is little evidence about the utilisation of healthcare services and disease recognition in the older population, which was urged to self-isolate during the COVID-19 lockdown. OBJECTIVES: We aimed to describe the utilisation of physician consultations, specialist referrals, hospital admissions and the recognition of incident diseases in Germany for this age group during the COVID-19 lockdown. DESIGN: Cross-sectional observational study. SETTING: 1,095 general practitioners (GPs) and 960 specialist practices in Germany. SUBJECTS: 2.45 million older patients aged 65 or older. METHODS: The number of documented physician consultations, specialist referrals, hospital admissions and incident diagnoses during the imposed lockdown in 2020 was descriptively analysed and compared to 2019. RESULTS: Physician consultations decrease slightly in February (-2%), increase before the imposed lockdown in March (+9%) and decline in April (-18%) and May (-14%) 2020 compared to the same periods in 2019. Volumes of hospital admissions decrease earlier and more intensely than physician consultations (-39 versus -6%, respectively). Overall, 15, 16 and 18% fewer incident diagnoses were documented by GPs, neurologists and diabetologists, respectively, in 2020. Diabetes, dementia, depression, cancer and stroke were diagnosed less frequently during the lockdown (-17 to -26%), meaning that the decrease in the recognition of diseases was greater than the decrease in physician consultations. CONCLUSION: The data suggest that organisational changes were adopted quickly by practice management but also raise concerns about the maintenance of routine care. Prospective studies should evaluate the long-term effects of lockdowns on patient-related outcomes.


Subject(s)
COVID-19 , Delayed Diagnosis , Delivery of Health Care , Noncommunicable Diseases , Patient Acceptance of Health Care/statistics & numerical data , Quarantine/methods , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/therapy , Communicable Disease Control/organization & administration , Cross-Sectional Studies , Delayed Diagnosis/adverse effects , Delayed Diagnosis/statistics & numerical data , Delivery of Health Care/methods , Delivery of Health Care/organization & administration , Female , Germany/epidemiology , Humans , Male , Noncommunicable Diseases/epidemiology , Noncommunicable Diseases/therapy , Organizational Innovation , SARS-CoV-2
10.
J Fr Ophtalmol ; 44(3): 299-306, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1078009

ABSTRACT

OBJECTIVES: To investigate the effects of the COVID-19 pandemic on the treatment course of neovascular age-related macular degeneration (nAMD) patients who received anti-VEGF injection therapy with real-life data. METHODS: This retrospective study consisted of 116 eyes of 106 patients. Ophthalmic examination, assessment of best-corrected visual acuity (BCVA), optical coherence tomography (OCT) findings and data of last two visits before restrictions (V-2 and V-1) and the first visit (V0) after the release of national lockdown and subsequent visits (V1 and Vlast) were recorded. The lockdown period was determined by the time interval between March 11 and June 1, 2020. MAIN RESULTS: The injection interval before V-1 was significantly longer than the interval after V0 (2.56±0.9 vs. 2.14±0.8 months, P=0.02). While the median central macular thickness (CMT) was significantly increased at V0 compared to V-1 [274(132-711) vs. 238(136-628), P<0.001], the median CMT was significantly lower at V1 compared to V0 [256 (136-591) vs. 274(132-711), P=0.003]. The median BCVA was 0.67(0.1-1.1) logMAR at V-1 and significantly worsened to 0.78 (0.1-1.2) logMAR at V0 (P=0.003). Although the median BCVA improved to 0.69 logMAR (0.1-1.2) at Vlast, the difference did not reach statistical significance compared to V0 (P=0.08). CONCLUSION: Treatment delay due to the COVID-19 pandemic cause progression of nAMD and visual impairment. To plan more frequent anti-VEGF treatments and visits may be an appropriate approach until the disease stabilizes. However, it should be kept in mind that despite the improvement in OCT findings, the desired success in VA could not be achieved in the short term.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , COVID-19/epidemiology , Macular Degeneration , Pandemics , Retinal Neovascularization , Time-to-Treatment , Aged , Aged, 80 and over , Angiogenesis Inhibitors/administration & dosage , Delayed Diagnosis/statistics & numerical data , Disease Progression , Female , Humans , Intravitreal Injections , Macular Degeneration/diagnosis , Macular Degeneration/drug therapy , Macular Degeneration/epidemiology , Macular Degeneration/pathology , Male , Pandemics/statistics & numerical data , Physical Examination/statistics & numerical data , Prognosis , Retinal Neovascularization/diagnosis , Retinal Neovascularization/drug therapy , Retinal Neovascularization/epidemiology , Retinal Neovascularization/pathology , Retrospective Studies , SARS-CoV-2 , Time-to-Treatment/statistics & numerical data , Tomography, Optical Coherence , Treatment Outcome , Turkey/epidemiology , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Vascular Endothelial Growth Factor A/immunology
11.
Epidemiol Prev ; 44(5-6 Suppl 2): 344-352, 2020.
Article in Italian | MEDLINE | ID: covidwho-1068157

ABSTRACT

OBJECTIVES: to describe the course of Italian organized cancer screening programmes during the COVID-19 emergency; to provide estimates of the diagnosis of malignant or pre-malignant lesions that will face a diagnostic delay due to the slowing down of screening activities. DESIGN: quantitative survey of aggregated data for each Region and overall for Italy relating to screening tests carried out in the period January-May 2020 compared to those of the same period of 2019; estimate of diagnostic delays starting from the calculation of the average detection rate of the last 3 years available (specific by Region). SETTING AND PARTICIPANTS: Italian mass screening programmes. Data on the tests carried out in the target population of the breast (women 50-69 years old), cervix (women 25-64 years old), and colorectal (women and men 50-69 years old) cancer screening. MAIN OUTCOME MEASURES: the cumulative delay (in absolute numbers and as a percentage) in the period January-May 2020 compared to the same period of 2019, by Region; the difference of screening tests (in absolute number and in percentage) performed in May 2020 compared to May 2019; the estimate of the fewer lesions diagnosed in 2020 compared with 2019 with relative 95% confidence intervals (95%CI); the 'standard months' of delay (proportion of fewer tests carried out from January to May 2020 for the corresponding number of months). RESULTS: 20 Regions out of 21 participated. In the period January-May 2020, the fewer screening tests performed in comparison with the same period of 2019 were: 472,389 (equal to 53.8%) with an average delay of standard months of 2.7 for mammography screening; 585,287 (equal to 54.9%) with an average delay of standard months of 2.7 for colorectal screening; 371,273 (equal to 55.3%) with an average delay of 2.8 standard months for cervical screening. The estimated number of undiagnosed lesions is 2,201 (95%CI 2,173-2,220) breast cancers; 645 (95%CI 632-661) colorectal carcinomas; 3,890 (95%CI 3,855-3,924) advanced colorectal adenomas and 1,497 (95%CI 1,413-1,586) CIN2 or more serious lesions. CONCLUSIONS: mass screenings need to be restarted as quickly as possible. In order to make up for the delay that is accumulating, it is necessary to provide for wider delivery times, greater resources, and new organizational approaches. It will also be essential to develop communication strategies suitable for promoting participation during this emergency.


Subject(s)
Appointments and Schedules , Breast Neoplasms/diagnosis , COVID-19/epidemiology , Colorectal Neoplasms/diagnosis , Delayed Diagnosis , Early Detection of Cancer , Pandemics , Quarantine , SARS-CoV-2 , Uterine Cervical Neoplasms/diagnosis , Adult , Aged , Breast Neoplasms/epidemiology , Colorectal Neoplasms/epidemiology , Delayed Diagnosis/statistics & numerical data , Early Detection of Cancer/statistics & numerical data , Female , Health Care Surveys , Health Services Accessibility/statistics & numerical data , Humans , Italy/epidemiology , Mammography/statistics & numerical data , Middle Aged , Procedures and Techniques Utilization/statistics & numerical data , Uterine Cervical Neoplasms/epidemiology
12.
J Am Coll Surg ; 232(4): 600-605, 2021 04.
Article in English | MEDLINE | ID: covidwho-988252

ABSTRACT

BACKGROUND: Low-dose CT (LDCT) screening reduces lung cancer mortality by at least 20%. The COVID-19 pandemic required an unprecedented shutdown in our institutional LDCT program. The purpose of this study was to examine the impact of COVID-19 on lung cancer screening and subsequent cancer diagnosis. STUDY DESIGN: We analyzed our prospective institutional LDCT screening database, which began in 2012. In all, 2,153 patients have participated. Monthly mean number of LDCTs were compared between baseline (January 2017 to February 2020) and COVID-19 periods (March 2020 to July 2020). RESULTS: LDCT was suspended on March 13, 2020 and 818 screening visits were cancelled. Phased reopening began on May 5, 2020 and full opening on June 1, 2020. Total monthly mean ± SD LDCTs (146 ± 31 vs 39 ± 40; p < 0.01) and new patient monthly LDCTs (56 ± 14 vs 15 ± 17; p < 0.01) were significantly decreased during the COVID-19 period. New patient monthly LDCTs have remained low despite resuming full operations. Three- and 6-month interval follow-up LDCTs were prioritized and were significantly increased compared with baseline (11 ± 4 vs 30 ± 4; p < 0.01). The "no-show" rate was significantly increased from baseline (15% vs 40%; p < 0.04). Most concerning, the percentage of patients with lung nodules suspicious for malignancy (Lung-RADS 4) were significantly increased after screenings resumed (8% vs 29%; p < 0.01). CONCLUSIONS: COVID-19 caused significant disruption in lung cancer screening, leading to a decrease in new patients screened and an increased proportion of nodules suspicious for malignancy once screening resumed. Using lung cancer and the LDCT screening program as a model, this early analysis showed the unrecognized consequences related to the pandemic for screening programs and cancer care.


Subject(s)
COVID-19/epidemiology , Early Detection of Cancer/statistics & numerical data , Lung Neoplasms/diagnosis , Lung Neoplasms/epidemiology , Aged , Delayed Diagnosis/statistics & numerical data , Female , Humans , Male , Middle Aged , No-Show Patients/statistics & numerical data , Retrospective Studies , Tomography, X-Ray Computed
13.
Am J Perinatol ; 38(4): 398-403, 2021 03.
Article in English | MEDLINE | ID: covidwho-968305

ABSTRACT

OBJECTIVE: The 2020 COVID-19 pandemic has been associated with excess mortality and morbidity in adults and teenagers over 14 years of age, but there is still limited evidence on the direct and indirect impact of the pandemic on pregnancy. We aimed to evaluate the effect of the first wave of the COVID-19 pandemic on obstetrical emergency attendance in a low-risk population and the corresponding perinatal outcomes. STUDY DESIGN: This is a single center retrospective cohort study of all singleton births between February 21 and April 30. Prenatal emergency labor ward admission numbers and obstetric outcomes during the peak of the first COVID-19 pandemic of 2020 in Israel were compared with the combined corresponding periods for the years 2017 to 2019. RESULTS: During the 2020 COVID-19 pandemic, the mean number of prenatal emergency labor ward admissions was lower, both by daily count and per woman, in comparison to the combined matching periods in 2017, 2018, and 2019 (48.6 ± 12.2 vs. 57.8 ± 14.4, p < 0.0001 and 1.74 ± 1.1 vs. 1.92 ± 1.2, p < 0.0001, respectively). A significantly (p = 0.0370) higher rate of stillbirth was noted in the study group (0.4%) compared with the control group (0.1%). All study group patients were negative for COVID-19. Gestational age at delivery, rates of premature delivery at <28, 34, and 37 weeks, pregnancy complications, postdate delivery at >40 and 41 weeks, mode of delivery, and numbers of emergency cesarean deliveries were similar in both groups. There was no difference in the intrapartum fetal death rate between the groups. CONCLUSION: The COVID-19 pandemic stay-at-home policy combined with patient fear of contracting the disease in hospital could explain the associated higher rate of stillbirth. This collateral perinatal damage follows a decreased in prenatal emergency labor ward admissions during the first wave of COVID-19 in Israel. KEY POINTS: · Less obstetrical ER attendance is observed during the pandemic.. · There is a parallel increase in stillbirth rate.. · Stillbirth cases tested negative for COVID-19.. · Lockdown and pandemic panic are possible causes..


Subject(s)
COVID-19 , Communicable Disease Control , Delivery, Obstetric , Obstetrics , Pregnancy Complications , Stillbirth/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Delayed Diagnosis/psychology , Delayed Diagnosis/statistics & numerical data , Delivery, Obstetric/methods , Delivery, Obstetric/statistics & numerical data , Emergency Medical Services/methods , Emergency Medical Services/statistics & numerical data , Female , Humans , Infant, Newborn , Israel/epidemiology , Obstetrics/methods , Obstetrics/organization & administration , Obstetrics/trends , Perinatal Mortality , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/epidemiology , Prenatal Care/methods , Prenatal Care/statistics & numerical data , Retrospective Studies , SARS-CoV-2
14.
J Neurol Sci ; 418: 117114, 2020 11 15.
Article in English | MEDLINE | ID: covidwho-850023

ABSTRACT

Recently, during the pandemic infection of the novel SARS-CoV-2, some cases of Guillan-Barré Syndrome (GBS) have been reported. The aim of this work is to report the natural history of patients with GBS, both COVID and not-COVID related, hospitalized in Liguria region, during lock down period, in order to assess clinical features of both groups and possible managements pitfalls due to pandemic emergency. Fifteen GBS patients were admitted to the Hospitals of Liguria, from February 15th to May 3rd 2020, six with SARS-CoV-2 infection and nine without infection. In COVID-19 related GBS five patients presented with classical GBS and one with variant. Two patients presented neurologic symptoms during or shortly after the viral syndrome, suggesting the pattern of a para-infectious profile. Multi-organ involvement, delay in the diagnosis, incomplete work up and start of therapy, were registered in 50% of cases with a GBS-Disability scale ≥4 at follow-up evaluation. In not-COVID-19 related GBS, main problem was diagnostic delay. In three patients the first neurological observation took place after a mean of 33,6 days. Moreover, five patients went to emergency room after an average of 30 days since the onset of neurological symptoms because of fear of contagion. In conclusion, not only SARS-CoV-2 infection can cause GBS, but it can also, due to effects of pandemic on the health organization, affect the outcome of patients with not COVID-19 related GBS.


Subject(s)
COVID-19/epidemiology , Guillain-Barre Syndrome/epidemiology , Social Isolation , Aged , Case-Control Studies , Comorbidity , Delayed Diagnosis/statistics & numerical data , Disease Management , Female , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/therapy , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics , SARS-CoV-2 , Time-to-Treatment/statistics & numerical data
15.
J Cardiovasc Med (Hagerstown) ; 21(11): 869-873, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-810031

ABSTRACT

AIMS: The purpose of this study was to verify the impact on the number and characteristics of coronary invasive procedures for acute coronary syndrome (ACS) of two hub centers with cardiac catheterization facilities, during the first month of lockdown following the COVID-19 pandemic. MATERIALS AND METHODS: Procedural data of ACS patients admitted between 10 March and 10 April 2020 were compared with those of the same period of 2019. RESULTS: We observed a 23.4% reduction in ACS admissions during 2020, with a decrease for both ST-elevation myocardial infarction (STEMI) (-5.6%) and non-ST-elevation myocardial infarction (-34.5%), albeit not statistically significant (P = 0.2). During the first 15 days of the examined periods, the reduction in ACS admissions reached 52.5% (-25% for STEMI and -70.3% for non-ST-elevation myocardial infarction, P = 0.04). Among STEMI patients, the rate of those with a time delay from symptoms onset longer than 180 min was significantly higher during the lockdown period (P = 0.01). Radiograph exposure (P = 0.01) was higher in STEMI patients treated in 2020 with a slightly higher amount of contrast medium (P = 0.1) and number of stents implanted (P = 0.1), whereas the number of treated vessels was reduced (P = 0.03). Percutaneous coronary intervention procedural success and in-hospital mortality were not different between the two groups and in STEMI patients (P NS for all). CONCLUSION: During the early phase, the COVID-19 outbreak was associated with a lower rate of admissions for ACS, with a substantial impact on the time delay presentation of STEMI patients, but apparently without affecting the in-hospital outcomes.


Subject(s)
Acute Coronary Syndrome , Coronavirus Infections , Hospitalization/statistics & numerical data , Myocardial Infarction , Pandemics , Percutaneous Coronary Intervention , Pneumonia, Viral , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/epidemiology , Acute Coronary Syndrome/etiology , Acute Coronary Syndrome/therapy , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Delayed Diagnosis/statistics & numerical data , Female , Hospital Mortality , Humans , Infection Control/methods , Italy/epidemiology , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Myocardial Infarction/mortality , Myocardial Infarction/surgery , Outcome and Process Assessment, Health Care , Pandemics/prevention & control , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , Percutaneous Coronary Intervention/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Time-to-Treatment/statistics & numerical data
18.
Gut ; 70(6): 1053-1060, 2021 06.
Article in English | MEDLINE | ID: covidwho-733147

ABSTRACT

OBJECTIVE: To evaluate the impact of faecal immunochemical testing (FIT) prioritisation to mitigate the impact of delays in the colorectal cancer (CRC) urgent diagnostic (2-week-wait (2WW)) pathway consequent from the COVID-19 pandemic. DESIGN: We modelled the reduction in CRC survival and life years lost resultant from per-patient delays of 2-6 months in the 2WW pathway. We stratified by age group, individual-level benefit in CRC survival versus age-specific nosocomial COVID-19-related fatality per referred patient undergoing colonoscopy. We modelled mitigation strategies using thresholds of FIT triage of 2, 10 and 150 µg Hb/g to prioritise 2WW referrals for colonoscopy. To construct the underlying models, we employed 10-year net CRC survival for England 2008-2017, 2WW pathway CRC case and referral volumes and per-day-delay HRs generated from observational studies of diagnosis-to-treatment interval. RESULTS: Delay of 2/4/6 months across all 11 266 patients with CRC diagnosed per typical year via the 2WW pathway were estimated to result in 653/1419/2250 attributable deaths and loss of 9214/20 315/32 799 life years. Risk-benefit from urgent investigatory referral is particularly sensitive to nosocomial COVID-19 rates for patients aged >60. Prioritisation out of delay for the 18% of symptomatic referrals with FIT >10 µg Hb/g would avoid 89% of these deaths attributable to presentational/diagnostic delay while reducing immediate requirement for colonoscopy by >80%. CONCLUSIONS: Delays in the pathway to CRC diagnosis and treatment have potential to cause significant mortality and loss of life years. FIT triage of symptomatic patients in primary care could streamline access to colonoscopy, reduce delays for true-positive CRC cases and reduce nosocomial COVID-19 mortality in older true-negative 2WW referrals. However, this strategy offers benefit only in short-term rationalisation of limited endoscopy services: the appreciable false-negative rate of FIT in symptomatic patients means most colonoscopies will still be required.


Subject(s)
COVID-19 , Colonoscopy , Colorectal Neoplasms , Cross Infection/prevention & control , Delayed Diagnosis , Occult Blood , Risk Assessment/methods , COVID-19/epidemiology , COVID-19/prevention & control , Colonoscopy/methods , Colonoscopy/standards , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/mortality , Critical Pathways , Delayed Diagnosis/adverse effects , Delayed Diagnosis/statistics & numerical data , Early Detection of Cancer , Humans , Immunochemistry/methods , Infection Control/methods , Life Tables , Mortality , SARS-CoV-2 , United Kingdom/epidemiology
19.
Diabetes Care ; 43(11): 2870-2872, 2020 11.
Article in English | MEDLINE | ID: covidwho-709393

ABSTRACT

OBJECTIVE: To evaluate whether the diagnosis of pediatric type 1 diabetes or its acute complications changed during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Italy. RESEARCH DESIGN AND METHODS: This was a cross-sectional, web-based survey of all Italian pediatric diabetes centers to collect diabetes, diabetic ketoacidosis (DKA), and COVID-19 data in patients presenting with new-onset or established type 1 diabetes between 20 February and 14 April in 2019 and 2020. RESULTS: Fifty-three of 68 centers (77.9%) responded. There was a 23% reduction in new diabetes cases in 2020 compared with 2019. Among those newly diagnosed patients who presented in a state of DKA, the proportion with severe DKA was 44.3% in 2020 vs. 36.1% in 2019 (P = 0.03). There were no differences in acute complications. Eight patients with asymptomatic or mild COVID-19 had laboratory-confirmed severe acute respiratory syndrome coronavirus 2. CONCLUSIONS: The COVID-19 pandemic might have altered diabetes presentation and DKA severity. Preparing for any "second wave" requires strategies to educate and reassure parents about timely emergency department attendance for non-COVID-19 symptoms.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Delayed Diagnosis/statistics & numerical data , Diabetes Mellitus, Type 1/diagnosis , Diabetic Ketoacidosis/diagnosis , Pneumonia, Viral/diagnosis , Adolescent , COVID-19 , COVID-19 Testing , Child , Child, Preschool , Clinical Laboratory Techniques , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Cross-Sectional Studies , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/virology , Diabetic Ketoacidosis/epidemiology , Diabetic Ketoacidosis/virology , Emergency Service, Hospital , Female , Humans , Infant , Italy/epidemiology , Male , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , SARS-CoV-2
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