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1.
Neurosciences (Riyadh) ; 26(2): 158-162, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1170592

ABSTRACT

OBJECTIVES: To assess and quantify the impact COVID-19 has had thus far on ischemic stroke admission rate and severity (National Institutes of Health Stroke Scale (NIHSS) score) at a single tertiary center in Makkah, Saudi Arabia. METHODS: This is a retrospective analysis performed on admitted cases with definitive final diagnoses of transient ischemic attack (TIA) and ischemic stroke at King Abdullah Medical City in Makkah between January 1, 2020 and July 2020. RESULTS: Sixty-nine patients were included in our study, 41 of whom presented at our facility before the pandemic and 29 during the pandemic. No statistical significance was observed between rate of admission, stroke severity, and rate of thrombolysis before the COVID-19 pandemic and after the outbreak. We observed a reduction of mean arrival time after the pandemic began, as well as a reduction of hospital stay days. CONCLUSION: A 29% reduction of admission secondary to acute ischemic stroke was noted during the pandemic. However, COVID-19 did not affect acute stroke care at our institute. The study is limited because of its small sample size, as we assessed just one medical center.


Subject(s)
Ischemic Attack, Transient/epidemiology , /epidemiology , Adult , Aged , Aged, 80 and over , Female , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Ischemic Attack, Transient/therapy , Length of Stay/statistics & numerical data , Male , Middle Aged , Retrospective Studies , Saudi Arabia/epidemiology , Severity of Illness Index , Sex Distribution , Stroke/epidemiology , Stroke/therapy , Tertiary Care Centers , Thrombolytic Therapy/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Young Adult
2.
J Orthop Surg Res ; 16(1): 237, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1166922

ABSTRACT

BACKGROUND: Concerns of contracting the highly contagious disease COVID-19 have led to a reluctance in seeking medical attention, which may contribute to delayed hospital arrival among traumatic patients. The study objective was to describe differences in time from injury to arrival for patients with traumatic hip fractures admitted during the pandemic to pre-pandemic patients. MATERIALS AND METHODS: This retrospective cohort study at six level I trauma centers included patients with traumatic hip fractures. Patients with a non-fall mechanism and those who were transferred in were excluded. Patients admitted 16 March 2019-30 June 2019 were in the "pre-pandemic" group, patients were admitted 16 March 2020-30 June 2020 were in the "pandemic" group. The primary outcome was time from injury to arrival. Secondary outcomes were time from arrival to surgical intervention, hospital length of stay (HLOS), and mortality. RESULTS: There were 703 patients, 352 (50.1%) pre-pandemic and 351 (49.9%) during the pandemic. Overall, 66.5% were female and the median age was 82 years old. Patients were similar in age, race, gender, and injury severity score. The median time from injury to hospital arrival was statistically shorter for pre-pandemic patients when compared to pandemic patients, 79.5 (56, 194.5) min vs. 91 (59, 420), p = 0.04. The time from arrival to surgical intervention (p = 0.64) was statistically similar between groups. For both groups, the median HLOS was 5 days, p = 0.45. In-hospital mortality was significantly higher during the pandemic, 1.1% vs 3.4%, p = 0.04. CONCLUSIONS: While time from injury to hospital arrival was statistically longer during the pandemic, the difference may not be clinically important. Time from arrival to surgical intervention remained similar, despite changes made to prevent COVID-19 transmission.


Subject(s)
/epidemiology , Hip Fractures/epidemiology , Patient Admission , Time-to-Treatment , Aged , Aged, 80 and over , Cohort Studies , Female , Hip Fractures/surgery , Hospital Mortality , Humans , Length of Stay/statistics & numerical data , Long-Term Care , Male , Pandemics , Patient Discharge , Retrospective Studies , Skilled Nursing Facilities , Trauma Centers , United States/epidemiology
3.
Cardiovasc Diabetol ; 20(1): 69, 2021 03 23.
Article in English | MEDLINE | ID: covidwho-1148218

ABSTRACT

BACKGROUND: During COVID-19 pandemic, elective invasive cardiac procedures (ICP) have been frequently cancelled or postponed. Consequences may be more evident in patients with diabetes. OBJECTIVES: The objective was to identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome. METHODS: We included 2,158 patients in whom an elective ICP was cancelled or postponed during COVID-19 pandemic in 37 hospitals in Spain. Among them, 700 (32.4%) were diabetics. Patients with and without diabetes were compared. RESULTS: Patients with diabetes were older and had a higher prevalence of other cardiovascular risk factors, previous cardiovascular history and co-morbidities. Diabetics had a higher mortality (3.0% vs. 1.0%; p = 0.001) and cardiovascular mortality (1.9% vs. 0.4%; p = 0.001). Differences were especially important in patients with valvular heart disease (mortality 6.9% vs 1.7% [p < 0.001] and cardiovascular mortality 4.9% vs 0.9% [p = 0.002] in patients with and without diabetes, respectively). In the multivariable analysis, diabetes remained as an independent risk factor both for overall and cardiovascular mortality. No significant interaction was found with other clinical variables. CONCLUSION: Among patients in whom an elective invasive cardiac procedure is cancelled or postponed during COVID-19 pandemic, mortality and cardiovascular mortality is higher in patients with diabetes, irrespectively on other clinical conditions. These procedures should not be cancelled in patients with diabetes.


Subject(s)
Coronary Angiography , Diabetes Mellitus , Heart Diseases/diagnostic imaging , Heart Diseases/therapy , Percutaneous Coronary Intervention , Time-to-Treatment , Waiting Lists , Age Factors , Aged , Aged, 80 and over , Comorbidity , Databases, Factual , Diabetes Mellitus/diagnosis , Diabetes Mellitus/mortality , Female , Heart Diseases/mortality , Humans , Male , Middle Aged , Prevalence , Risk Assessment , Risk Factors , Spain/epidemiology , Time Factors , Waiting Lists/mortality
4.
Medicine (Baltimore) ; 100(10): e25005, 2021 Mar 12.
Article in English | MEDLINE | ID: covidwho-1138018

ABSTRACT

ABSTRACT: The role of thoracic CT (computerized tomography) in monitoring disease course of COVID-19 is controversial. The purpose of this study is to investigate the risk factors and predictive value of deterioration on repeatedly performed CT scan during hospitalization.All COVID-19 patients treated in our isolation ward, from January 22, 2020 to February 7, 2020, were reviewed. Patients included were categorized into RD (Radiological Deterioration) group or NRD (No Radiological Deterioration) group according to the manifestation on the CT routinely performed during the hospitalization. All clinical data and CT images were analyzed.Forty three patients were included in our study. All are moderate cases with at least 4 CT scans each. Eighteen (42.9%) patients had radiological deteriorations which were all identified in CT2 (the first CT after admission). Patients in RD group had lower leukocyte count (P = .003), lymphocyte count (P = .030), and higher prevalence (P = .012) of elevated C-reactive protein (CRP) at admission. NRD patients had a lower prevalence of reticulations (P = .034) on baseline CT (CT1, performed within 2 days before admission) and a longer duration between symptom onset and the time of CT2 (P < .01). There was no significant difference in hospital stay or fibrotic change on CT4 (follow-up CT scan performed 4 weeks after discharge) between 2 groups. Shorter duration between symptom onset and CT2 time (odds ratio [OR], 0.436; 95% confidence interval: 0.233-0.816; P < .01) and lower leukocyte count in baseline evaluation (OR, 0.316; 95% CI: 0.116-0.859; P < .05) were associated with increased odds of radiological deterioration on CT image during hospitalization.For moderate COVID-19 patients, the value of routinely performed CT during the treatment is limited. We recommend avoiding using CT as a routine monitor in moderate COVID-19 patients.


Subject(s)
/diagnostic imaging , Disease Progression , Tomography, X-Ray Computed/statistics & numerical data , Adolescent , Adult , Aged , C-Reactive Protein/analysis , Clinical Deterioration , Female , Humans , Length of Stay , Leukocyte Count , Lymphocyte Count , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Risk Factors , Severity of Illness Index , Time-to-Treatment , Young Adult
5.
Crit Care Med ; 49(3): 482-489, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1135906

ABSTRACT

OBJECTIVES: To investigate the potential influence of racial differences in outcomes of patients infected by coronavirus disease 2019-positive patients who require intensive care in an urban hospital. DESIGN: Retrospective cohort study. SETTING: Henry Ford Health System Multidisciplinary ICU, a total of 156 beds spread throughout the hospital in Detroit, MI. PATIENTS: We obtained data from the electronic medical record of all adult severe acute respiratory syndrome coronavirus-2-positive patients managed in the ICU of Henry Ford Hospital in Detroit, MI, between March 13, 2020, and July 31, 2020. Included patients were divided into two groups: people of color (including Black, Asian, Hispanic/Latino, and Arab) and White. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 365 patients were evaluated: 219 were Black (60.0%), 129 were White (35.3%), two were Asian (0.6%), eight were Hispanic/Latino (2.2%), and seven were Arab (1.9%). People of color were younger (62.8 vs 67.1; p = 0.007), with equal distribution of sex. People of color had less coronary artery disease (34 [14.4%] vs 35 [27.1%]; p =0.003) and less self-reported use of regular alcohol consumption (50 [21.2%] vs 12 [9.3%]; p = 0.004) than Whites, with no differences in diabetes (125 [53.0%] vs 66 [51.2%]; p = 0.742), hypertension (188 [79.7%] vs 99 [76.8%]; p = 0.516), congestive heart failure (41 [17.4%] vs 32 [24.8%]; p = 0.090), or chronic kidney disease (123 [54.1%] vs 55 [42.6%]; p = 0.083).There was no difference in ICU length of stay between people of color (18 d [CI, 7-47 d]) and Whites (18 d [CI, 6-48 d]; p = 0. 0.979). Neither frequency (72.5% vs 71.3%; p = ns) nor median time to mechanical ventilation between people of color (9 d [CI, 6-15 d]) and Whites (10 d [CI, 5-16 d]; p = 0.733) was different. Overall, 188 patients (51.5 %) died in the hospital. The 28-day mortality was lower in people of color (107/236; 45.3%) versus Whites (73/129; 56.6%) (adjusted odds ratio 0.60; p = 0.034), and there was an increased median survival time in people of color (20 d) versus Whites (13.5 d; hazard ratio 0.62; p = 0.002). The inhospital mortality was lower in people of color versus White, but the difference was not statistically significant (113 [47.9%] vs 75 [58.1%], respectively; p = 0.061). Finally, there was no significant difference in days of symptoms prior to admission, frequency of presenting symptoms, or frequency or severity of acute respiratory distress syndrome between the two groups. CONCLUSIONS: In critically ill patients infected with coronavirus disease 2019, people of color had a lower 28-day mortality than Whites with no difference in hospital mortality, ICU length of stay, or rates of intubation. These findings are contrary to previously held beliefs surrounding the pandemic.


Subject(s)
/ethnology , Critical Care Outcomes , Critical Care , Ethnic Groups , Hospitalization , Race Factors , Aged , Female , Hospital Mortality , Humans , Length of Stay , Male , Michigan/epidemiology , Middle Aged , Retrospective Studies , Tertiary Care Centers , Time-to-Treatment
6.
Medicine (Baltimore) ; 100(5): e23925, 2021 Feb 05.
Article in English | MEDLINE | ID: covidwho-1125827

ABSTRACT

ABSTRACT: The World Health Organization (WHO) classified the spread of COVID-19 (Coronavirus Disease 2019) as a global pandemic in March. Scholars predict that the pandemic will continue into the coming winter and will become a seasonal epidemic in the following year. Therefore, the identification of effective control measures becomes extremely important. Although many reports have been published since the COVID-19 outbreak, no studies have identified the relative effectiveness of a combination of control measures implemented in Wuhan and other areas in China. To this end, a retrospective analysis by the collection and modeling of an unprecedented number of epidemiology records in China of the early stage of the outbreaks can be valuable.In this study, we developed a new dynamic model to describe the spread of COVID-19 and to quantify the effectiveness of control measures. The transmission rate, daily close contacts, and the average time from onset to isolation were identified as crucial factors in viral spreading. Moreover, the capacity of a local health-care system is identified as a threshold to control an outbreak in its early stage. We took these factors as controlling parameters in our model. The parameters are estimated based on epidemiological reports from national and local Center for Disease Control (CDCs).A retrospective simulation showed the effectiveness of combinations of 4 major control measures implemented in Wuhan: hospital isolation, social distancing, self-protection by wearing masks, and extensive medical testing. Further analysis indicated critical intervention conditions and times required to control an outbreak in the early stage. Our simulations showed that South Korea has kept the spread of COVID-19 at a low level through extensive medical testing. Furthermore, a predictive simulation for Italy indicated that Italy would contain the outbreak in late May under strict social distancing.In our general analysis, no single measure could contain a COVID-19 outbreak once a health-care system is overloaded. Extensive medical testing could keep viral spreading at a low level. Wearing masks functions as favorably as social distancing but with much lower socioeconomic costs.


Subject(s)
Communicable Disease Control , Hospitalization/statistics & numerical data , Outcome Assessment, Health Care/methods , /isolation & purification , /economics , /prevention & control , China/epidemiology , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Communicable Disease Control/standards , Contact Tracing/statistics & numerical data , Disease Transmission, Infectious/prevention & control , Disease Transmission, Infectious/statistics & numerical data , Humans , Models, Theoretical , Mortality , Systems Analysis , Time-to-Treatment/statistics & numerical data
7.
Medicine (Baltimore) ; 100(5): e24409, 2021 Feb 05.
Article in English | MEDLINE | ID: covidwho-1125185

ABSTRACT

ABSTRACT: Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients.A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the "pandemic" cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the "control" cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients.The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).


Subject(s)
Digestive System Diseases , Digestive System Surgical Procedures , Emergency Treatment , Infection Control , Postoperative Complications , Time-to-Treatment , Adult , /prevention & control , Digestive System Diseases/diagnosis , Digestive System Diseases/epidemiology , Digestive System Diseases/mortality , Digestive System Diseases/surgery , Digestive System Surgical Procedures/adverse effects , Digestive System Surgical Procedures/methods , Digestive System Surgical Procedures/mortality , Emergencies/epidemiology , Emergency Treatment/adverse effects , Emergency Treatment/methods , Emergency Treatment/mortality , Female , Humans , Incidence , Infection Control/methods , Infection Control/statistics & numerical data , Male , Mortality , Multicenter Studies as Topic , Observational Studies as Topic , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Research Design , Risk Assessment/methods
8.
PLoS Med ; 18(3): e1003415, 2021 03.
Article in English | MEDLINE | ID: covidwho-1115283

ABSTRACT

BACKGROUND: Convalescent plasma (CP), despite limited evidence on its efficacy, is being widely used as a compassionate therapy for hospitalized patients with COVID-19. We aimed to evaluate the efficacy and safety of early CP therapy in COVID-19 progression. METHODS AND FINDINGS: The study was an open-label, single-center randomized clinical trial performed in an academic medical center in Santiago, Chile, from May 10, 2020, to July 18, 2020, with final follow-up until August 17, 2020. The trial included patients hospitalized within the first 7 days of COVID-19 symptom onset, presenting risk factors for illness progression and not on mechanical ventilation. The intervention consisted of immediate CP (early plasma group) versus no CP unless developing prespecified criteria of deterioration (deferred plasma group). Additional standard treatment was allowed in both arms. The primary outcome was a composite of mechanical ventilation, hospitalization for >14 days, or death. The key secondary outcomes included time to respiratory failure, days of mechanical ventilation, hospital length of stay, mortality at 30 days, and SARS-CoV-2 real-time PCR clearance rate. Of 58 randomized patients (mean age, 65.8 years; 50% male), 57 (98.3%) completed the trial. A total of 13 (43.3%) participants from the deferred group received plasma based on clinical aggravation. We failed to find benefit in the primary outcome (32.1% versus 33.3%, odds ratio [OR] 0.95, 95% CI 0.32-2.84, p > 0.999) in the early versus deferred CP group. The in-hospital mortality rate was 17.9% versus 6.7% (OR 3.04, 95% CI 0.54-17.17 p = 0.246), mechanical ventilation 17.9% versus 6.7% (OR 3.04, 95% CI 0.54-17.17, p = 0.246), and prolonged hospitalization 21.4% versus 30.0% (OR 0.64, 95% CI, 0.19-2.10, p = 0.554) in the early versus deferred CP group, respectively. The viral clearance rate on day 3 (26% versus 8%, p = 0.204) and day 7 (38% versus 19%, p = 0.374) did not differ between groups. Two patients experienced serious adverse events within 6 hours after plasma transfusion. The main limitation of this study is the lack of statistical power to detect a smaller but clinically relevant therapeutic effect of CP, as well as not having confirmed neutralizing antibodies in donor before plasma infusion. CONCLUSIONS: In the present study, we failed to find evidence of benefit in mortality, length of hospitalization, or mechanical ventilation requirement by immediate addition of CP therapy in the early stages of COVID-19 compared to its use only in case of patient deterioration. TRIAL REGISTRATION: NCT04375098.


Subject(s)
/therapy , Early Medical Intervention/methods , Time-to-Treatment , Adult , Aged , Aged, 80 and over , /mortality , Chile , Disease Progression , Early Medical Intervention/statistics & numerical data , Female , Hospital Mortality , Humans , Immunization, Passive/methods , Immunization, Passive/mortality , Length of Stay/statistics & numerical data , Male , Middle Aged , Mortality , Respiration, Artificial/mortality , Respiration, Artificial/statistics & numerical data , Time-to-Treatment/standards , Treatment Outcome
9.
JCO Glob Oncol ; 7: 342-352, 2021 02.
Article in English | MEDLINE | ID: covidwho-1115261

ABSTRACT

PURPOSE: Delays and disruptions in health systems because of the COVID-19 pandemic were identified by a previous systematic review from our group. For improving the knowledge about the pandemic consequences for cancer care, this article aims to identify the effects of mitigation strategies developed to reduce the impact of such delays and disruptions. METHODS: Systematic review with a comprehensive search including formal databases, cancer and COVID-19 data sources, gray literature, and manual search. We considered clinical trials, observational longitudinal studies, cross-sectional studies, before-and-after studies, case series, and case studies. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the included studies was assessed by specific tools. The mitigation strategies identified were described in detail and their effects were summarized narratively. RESULTS: Of 6,692 references reviewed, 28 were deemed eligible, and 9 studies with low to moderate methodological quality were included. Five multiple strategies and four single strategies were reported, and the possible effects of mitigating delays and disruptions in cancer care because of COVID-19 are inconsistent. The only comparative study reported a 48.7% reduction observed in the number of outpatient visits to the hospital accompanied by a small reduction in imaging and an improvement in radiation treatments after the implementation of a multiple organizational strategy. CONCLUSION: The findings emphasize the infrequency of measuring and reporting mitigation strategies that specifically address patients' outcomes and thus a scarcity of high-quality evidence to inform program development. This review reinforces the need of adopting standardized measurement methods to monitor the impact of the mitigation strategies proposed to reduce the effects of delays and disruptions in cancer health care because of COVID-19.


Subject(s)
/epidemiology , Cancer Care Facilities , Health Status Disparities , Healthcare Disparities , Medical Oncology/trends , Neoplasms/therapy , Cross-Sectional Studies , Decision Making , Humans , Medical Oncology/organization & administration , Models, Organizational , Outcome Assessment, Health Care , Pandemics , Time-to-Treatment
10.
BMJ Case Rep ; 14(3)2021 Mar 02.
Article in English | MEDLINE | ID: covidwho-1115111

ABSTRACT

We describe a case of retrovesical liposarcoma in a male patient with concurrent COVID-19. A 50-year-old man had lower urinary tract symptoms and dull pain along his right gluteus. Due to COVID-19 infection, management was delayed. During self-isolation, the patient developed urinary retention and his pain level was an eight on the Visual Analogue Scale. A urinary catheter and an epidural catheter were inserted without any difficulty. Abdominal-pelvic MRI revealed a retrovesical mass suspected of liposarcoma with clear borders from surrounding organs. Following two consecutive negative SARS-CoV-2 PCR tests, we proceeded with surgery. Histopathology was dedifferentiated liposarcoma. Postoperatively, the patient suffered reactivation of COVID-19, and he was eventually discharged after two consecutive negative results on the PCR test on Post Operative Day (POD)-10. Retrovesical dedifferentiated liposarcoma is rare and considered as high-grade liposarcoma. Although surgery may exacerbate COVID-19 infection, surgical resection of symptomatic high-grade sarcoma is prioritised and performed as soon as no infection detected.


Subject(s)
/diagnosis , Liposarcoma , Lower Urinary Tract Symptoms , Pelvic Neoplasms , Surgical Procedures, Operative/methods , Urinary Retention , /therapy , Chemoradiotherapy, Adjuvant/methods , Dissection/methods , Humans , Liposarcoma/pathology , Liposarcoma/physiopathology , Lower Urinary Tract Symptoms/diagnosis , Lower Urinary Tract Symptoms/etiology , Magnetic Resonance Imaging/methods , Male , Middle Aged , Neoplasm Grading , Pelvic Neoplasms/pathology , Pelvic Neoplasms/physiopathology , Time-to-Treatment , Treatment Outcome , Urinary Retention/diagnosis , Urinary Retention/etiology
11.
Medicine (Baltimore) ; 100(9): e24604, 2021 Mar 05.
Article in English | MEDLINE | ID: covidwho-1114903

ABSTRACT

ABSTRACT: Mortality of critically ill patients with coronavirus disease 2019 (COVID-19) was high. Aims to examine whether time from symptoms onset to intensive care unit (ICU) admission affects incidence of extra-pulmonary complications and prognosis in order to provide a new insight for reducing the mortality. A single-centered, retrospective, observational study investigated 45 critically ill patients with COVID-19 hospitalized in ICU of The Third People's Hospital of Yichang from January 17 to March 29, 2020. Patients were divided into 2 groups according to time from symptoms onset to ICU admission (>7 and ≤7 days) and into 2 groups according to prognosis (survivors and non-survivors). Epidemiological, clinical, laboratory, radiological characteristics and treatment data were studied. Compared with patients who admitted to the ICU since symptoms onset ≤7 days (55.6%), patients who admitted to the ICU since symptoms onset >7 days (44.4%) were more likely to have extra-pulmonary complications (19 [95.0%] vs 16 [64.0%], P = .034), including acute kidney injury, cardiac injury, acute heart failure, liver dysfunction, gastrointestinal hemorrhage, hyperamylasemia, and hypernatremia. The incidence rates of acute respiratory distress syndrome, pneumothorax, and hospital-acquired pneumonia had no difference between the 2 groups. Except activated partial thromboplastin and Na+ concentration, the laboratory findings were worse in group of time from symptoms onset to ICU admission >7 days. There was no difference in mortality between the 2 groups. Of the 45 cases in the ICU, 19 (42.2%) were non-survivors, and 16 (35.6%) were with hospital-acquired pneumonia. Among these non-survivors, hospital-acquired pneumonia was up to 12 (63.2%) besides higher incidence of extra-pulmonary complications. However, hospital-acquired pneumonia occurred in only 4 (15.4%) survivors. Critically ill patients with COVID-19 who admitted to ICU at once might get benefit from intensive care via lower rate of extra-pulmonary complications.


Subject(s)
Critical Care , Critical Illness , Symptom Assessment , Time-to-Treatment/statistics & numerical data , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , /diagnosis , /physiopathology , China/epidemiology , Critical Care/methods , Critical Care/statistics & numerical data , Critical Illness/mortality , Critical Illness/therapy , Digestive System Diseases/diagnosis , Digestive System Diseases/etiology , Female , Healthcare-Associated Pneumonia/diagnosis , Healthcare-Associated Pneumonia/mortality , Heart Diseases/diagnosis , Humans , Hyperamylasemia/diagnosis , Hyperamylasemia/etiology , Hypernatremia/diagnosis , Hypernatremia/etiology , Male , Middle Aged , Outcome and Process Assessment, Health Care , Prognosis , Survival Analysis , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data
12.
Dig Surg ; 38(2): 158-165, 2021.
Article in English | MEDLINE | ID: covidwho-1105564

ABSTRACT

BACKGROUND: This survey aimed to register changes determined by the COVID-19 pandemic on pancreatic surgery in a specific geographic area (Germany, Austria, and Switzerland) to evaluate the impact of the pandemic and obtain interesting cues for the future. METHODS: An online survey was designed using Google Forms focusing on the local impact of the pandemic on pancreatic surgery. The survey was conducted at 2 different time points, during and after the lockdown. RESULTS: Twenty-five respondents (25/56) completed the survey. Many aspects of oncological care have been affected with restrictions and delays: staging, tumor board, treatment selection, postoperative course, adjuvant treatments, outpatient care, and follow-up. Overall, 60% of respondents have prioritized pancreatic cancer patients according to stage, age, and comorbidities, and 40% opted not to operate high-risk patients. However, for 96% of participants, the standards of care were guaranteed. DISCUSSION/CONCLUSIONS: The first wave of the COVID-19 pandemic had an important impact on pancreatic cancer surgery in central Europe. Guidelines for prompt interventions and prevention of the spread of viral infections in the surgical environment are needed to avoid a deterioration of care in cancer patients in the event of a second wave or a new pandemic. High-volume centers for pancreatic surgery should be preferred and their activity maintained. Virtual conferences have proven to be efficient during this pandemic and should be implemented in the near future.


Subject(s)
/prevention & control , Health Services Accessibility/trends , Pancreatectomy/trends , Pancreatic Neoplasms/surgery , Practice Patterns, Physicians'/trends , Aftercare/methods , Aftercare/standards , Aftercare/trends , Attitude of Health Personnel , Europe/epidemiology , Health Care Surveys , Health Services Accessibility/standards , Humans , Infection Control/methods , Infection Control/trends , Neoplasm Staging , Pancreatectomy/standards , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/pathology , Pandemics , Patient Acceptance of Health Care , Perioperative Care/methods , Perioperative Care/standards , Perioperative Care/trends , Practice Guidelines as Topic , Practice Patterns, Physicians'/standards , Time-to-Treatment/standards , Time-to-Treatment/trends
15.
Br J Surg ; 108(1): 97-103, 2021 Jan 27.
Article in English | MEDLINE | ID: covidwho-1104800

ABSTRACT

BACKGROUND: The COVID-19 response required the cancellation of all but the most urgent surgical procedures. The number of cancelled surgical procedures owing to Covid-19, and the reintroduction of surgical acivirt, was modelled. METHODS: This was a modelling study using Hospital Episode Statistics data (2014-2019). Surgical procedures were grouped into four urgency classes. Expected numbers of surgical procedures performed between 1 March 2020 and 28 February 2021 were modelled. Procedure deficit was estimated using conservative assumptions and the gradual reintroduction of elective surgery from the 1 June 2020. Costs were calculated using NHS reference costs and are reported as millions or billions of euros. Estimates are reported with 95 per cent confidence intervals. RESULTS: A total of 4 547 534 (95 per cent c.i. 3 318 195 to 6 250 771) patients with a pooled mean age of 53.5 years were expected to undergo surgery between 1 March 2020 and 28 February 2021. By 31 May 2020, 749 247 (513 564 to 1 077 448) surgical procedures had been cancelled. Assuming that elective surgery is reintroduced gradually, 2 328 193 (1 483 834 - 3 450 043) patients will be awaiting surgery by 28 February 2021. The cost of delayed procedures is €5.3 (3.1 to 8.0) billion. Safe delivery of surgery during the pandemic will require substantial extra resources costing €526.8 (449.3 to 633.9) million. CONCLUSION: As a consequence of the Covid-19 pandemic, provision of elective surgery will be delayed and associated with increased healthcare costs.


Subject(s)
/epidemiology , Elective Surgical Procedures/economics , Elective Surgical Procedures/statistics & numerical data , Hospital Costs , Pandemics , /diagnosis , England/epidemiology , Facilities and Services Utilization/economics , Hospitalization/statistics & numerical data , Humans , Models, Statistical , Personal Protective Equipment , Preoperative Care , Time-to-Treatment/economics
16.
Acta Biomed ; 91(4): e2020150, 2020 11 10.
Article in English | MEDLINE | ID: covidwho-1100490

ABSTRACT

BACKGROUND: The emergency caused by COVID-19 Pandemia has resulted in a complete suspension and consequent delay of common planned surgery such total hip replacement in patients affect by osteoarthritis. At the same time, the issue of the quarantine imposed changes to the normal lifestyle of these patients. The purpose of our study is to evaluate how the presence of these two factors affect the quality of live of patients living in the Italian red zone. METHODS: From outpatient pre-operative assessment we collect data about: demographic data, WOMAC score, NRS (Numeric rating scale 0-10), PCS SF12 and MCS SF12 score. Selected patients were therefore contacted by telephone call and re-assess using the same score. In addition, patients were asked if they intended to undergo the planned surgery again despite the current emergency Results:  14 patient have been recruited for the study. Male/female ration was 10/4, mean age was 70 years. Pre operative outpatient assessment mean WOMAC score was 44,86 (SD ± 8,52) , mean NRS was 8,07 (SD ± 1,33), PCS SF12 was  30,33 (SD ± 5,0) and MCS SF12 was 40,95 (SD ± 3,51).  At re-evalutation the mean WOMAC score was 32,86 (SD ± 17,88) , mean NRS was 5,79 (SD ± 3,66), PCS SF12 was  39,9 (SD ± 3,70) and MCS SF12 was 50,14 (SD ± 6,86) Conclusion:  The exceptionale pandemic from Covid-19 has profoundly changed our lifestyle, impacting normal daily activities but also on regular surgical activity in patients affected by osteoarthritis. Our study suggested that the lifestyle changes imposed by the situation led to an improvement of clinical score. This shows how an exceptional event can affect many aspects of daily life.


Subject(s)
Life Style , Osteoarthritis, Hip , Osteoarthritis, Knee , Quality of Life , Quarantine , Time-to-Treatment , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Osteoarthritis, Hip/surgery , Osteoarthritis, Knee/surgery
17.
Reprod Biol Endocrinol ; 19(1): 28, 2021 Feb 23.
Article in English | MEDLINE | ID: covidwho-1097192

ABSTRACT

BACKGROUND: On March 17, 2020 an expert ASRM task force recommended the temporary suspension of new, non-urgent fertility treatments during an ongoing world-wide pandemic of Covid-19. We surveyed at the time of resumption of fertility care the psychological experience and coping strategies of patients pausing their care due to Covid-19 and examined which factors were associated and predictive of resilience, anxiety, stress and hopefulness. METHODS: Cross sectional cohort patient survey using an anonymous, self-reported, single time, web-based, HIPPA compliant platform (REDCap). Survey sampled two Northeast academic fertility practices (Yale Medicine Fertility Center in CT and Montefiore's Institute for Reproductive Medicine and Health in NY). Data from multiple choice and open response questions collected demographic, reproductive history, experience and attitudes about Covid-19, prior infertility treatment, sense of hopefulness and stress, coping strategies for mitigating stress and two validated psychological surveys to assess anxiety (six-item short-form State Trait Anxiety Inventory (STAl-6)) and resilience (10-item Connor-Davidson Resilience Scale, (CD-RISC-10). RESULTS: Seven hundred thirty-four patients were sent invitations to participate. Two hundred fourteen of 734 (29.2%) completed the survey. Patients reported their fertility journey had been delayed a mean of 10 weeks while 60% had been actively trying to conceive > 1.5 years. The top 5 ranked coping skills from a choice of 19 were establishing a daily routine, going outside regularly, exercising, maintaining social connection via phone, social media or Zoom and continuing to work. Having a history of anxiety (p < 0.0001) and having received oral medication as prior infertility treatment (p < 0.0001) were associated with lower resilience. Increased hopefulness about having a child at the time of completing the survey (p < 0.0001) and higher resilience scores (p < 0.0001) were associated with decreased anxiety. Higher reported stress scores (p < 0.0001) were associated with increased anxiety. Multiple multivariate regression showed being non-Hispanic black (p = 0.035) to be predictive of more resilience while variables predictive of less resilience were being a full-time homemaker (p = 0.03), having received oral medication as prior infertility treatment (p = 0.003) and having higher scores on the STAI-6 (< 0.0001). CONCLUSIONS: Prior to and in anticipation of further pauses in treatment the clinical staff should consider pretreatment screening for psychological distress and provide referral sources. In addition, utilization of a patient centered approach to care should be employed.


Subject(s)
Adaptation, Psychological , Infertility/therapy , Stress, Psychological/psychology , Adult , Cross-Sectional Studies , Female , Health Services Accessibility , Humans , Infertility/psychology , Male , Pandemics , Surveys and Questionnaires , Time-to-Treatment
20.
Med Care ; 59(4): 288-294, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1091180

ABSTRACT

BACKGROUND: This qualitative research explored the lived experiences of patients who experienced postponement of elective cardiac and vascular surgery due to coronavirus disease 2019 (COVID-19). We know very little about patients during the novel coronavirus pandemic. Understanding the patient voice may play an important role in prioritization of postponed cases and triage moving forward. METHODS: Utilizing a hermeneutical phenomenological qualitative design, we interviewed 47 individuals who experienced a postponement of cardiac or vascular surgery due to the COVID-19 pandemic. Data were analyzed and informed by phenomenological research methods. RESULTS: Patients in our study described 3 key issues around their postponement of elective surgery. Patients described robust narratives about the meanings of their elective surgeries as the chance to "return to normal" and alleviate symptoms that impacted everyday life. Second, because of the meanings most of our patients ascribed to their surgeries, postponement often took a toll on how patients managed physical health and emotional well-being. Finally, paradoxically, many patients in our study were demonstrative that they would "rather die from a heart attack" than be exposed to the coronavirus. CONCLUSIONS: We identified several components of the patient experience, encompassing quality of life and other desired benefits of surgery, the risks of COVID, and difficulty reconciling the 2. Our study provides significant qualitative evidence to inform providers of important considerations when rescheduling the backlog of patients. The emotional and psychological distress that patients experienced due to postponement may also require additional considerations in postoperative recovery.


Subject(s)
/prevention & control , Cardiovascular Surgical Procedures/standards , Elective Surgical Procedures/standards , Psychological Distress , Time-to-Treatment , Adult , Aged , /psychology , Cardiovascular Surgical Procedures/psychology , Elective Surgical Procedures/psychology , Female , Humans , Male , Middle Aged , Pandemics/prevention & control , Patient Preference , Qualitative Research , Time Factors , Triage/standards
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