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1.
Sci Rep ; 11(1): 11832, 2021 06 04.
Article in English | MEDLINE | ID: covidwho-1258590

ABSTRACT

Among the myriad of challenges healthcare institutions face in dealing with coronavirus disease 2019 (COVID-19), screening for the detection of febrile persons entering facilities remains problematic, particularly when paired with CDC and WHO spatial distancing guidance. Aggressive source control measures during the outbreak of COVID-19 has led to re-purposed use of noncontact infrared thermometry (NCIT) for temperature screening. This study was commissioned to establish the efficacy of this technology for temperature screening by healthcare facilities. We conducted a prospective, observational, single-center study in a level II trauma center at the onset of the COVID-19 outbreak to assess (i) method agreement between NCIT and temporal artery reference temperature, (ii) diagnostic accuracy of NCIT in detecting referent temperature [Formula: see text] and ensuing test sensitivity and specificity and (iii) technical limitations of this technology. Of 51 healthy, non-febrile, healthcare workers surveyed, the mean temporal artery temperature was [Formula: see text] ([Formula: see text] confidence interval (CI) = [Formula: see text]). Mean NCIT temperatures measured from [Formula: see text], [Formula: see text], and [Formula: see text] distances were [Formula: see text] [Formula: see text], [Formula: see text] [Formula: see text], and [Formula: see text] [Formula: see text], respectively. From statistical analysis, the only method in sufficient agreement with the reference standard was NCIT at [Formula: see text]. This demonstrated that the device offset (mean temperature difference) between these methods was [Formula: see text] ([Formula: see text]) with 95% of measurement differences within [Formula: see text] ([Formula: see text]) and [Formula: see text] ([Formula: see text]). By setting the NCIT screening threshold to [Formula: see text] at [Formula: see text], we achieve diagnostic accuracy with [Formula: see text] test sensitivity and specificity for temperature detection [Formula: see text] by reference standard. In comparison, reducing this screening criterion to the lower limit of the device-specific offset, such as [Formula: see text], produces a highly sensitive screening test at [Formula: see text], which may be favorable in high-risk pandemic disease. For future consideration, an infrared device with a higher distance-to-spot size ratio approaching 50:1 would theoretically produce similar results at [Formula: see text], in accordance with CDC and WHO spatial distancing guidelines.


Subject(s)
COVID-19/diagnosis , Fever/diagnosis , Thermometry/instrumentation , Adult , Aged , Body Temperature , Female , Humans , Male , Middle Aged , Prospective Studies , Sensitivity and Specificity , Young Adult
2.
Psychosom Med ; 83(4): 304-308, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1211452

ABSTRACT

ABSTRACT: The biopsychosocial model provides a useful perspective for understanding the development and characteristics of the COVID-19 pandemic and its anticipated long-term consequences for society as well as individuals. This article provides a biopsychosocial perspective on the COVID pandemic and an editorial comment on the articles in this Special Issue of Psychosomatic Medicine. Based on analysis of the PubMed database, it is shown that the attention to psychological and social factors is 74% higher in COVID-19-related articles compared to all other health-related scientific articles published during the same time-period (between 1/1/2020 and 4/18/2021). Specifically, 18.6% of the ≈123,500 articles addressing COVID-19-related topics also included psychological or social factors in their content vs. 10.7% of articles that did not address COVID-19. The biopsychosocial model is relevant to understanding the interrelationships among risk factors and the multidimensional clinical and psychosocial COVID-19 outcomes. Clinical outcomes directly related to COVID-19 range from severe but rare events (mortality and intensive care treatment) to less severe common outcomes such as positive screening tests for COVID-19 with or without symptoms. In addition, psychosocial outcomes range in severity from frequently observed reduced psychological wellbeing to less common clinical mood and anxiety disorders and, in rare cases, suicidality. The COVID-19 pandemic is characterized by an unusually strong and short-term link between social factors and biological aspects of the disease, without mediating psychological factors. After a review of the articles presented in this Special Issue, this editorial concludes with suggestions for biopsychosocial models in research on COVID-19 and other large-scale health threats.


Subject(s)
COVID-19 , Pandemics , Anxiety Disorders/epidemiology , Humans , SARS-CoV-2
3.
Cardiovasc Interv Ther ; 37(2): 264-268, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1188201

ABSTRACT

Healthcare systems worldwide have been overburdened by the coronavirus disease 2019 (COVID-19) outbreak. Accordingly, hospitals have had to implement strategies to profoundly reorganize activities, which have affected procedures such as primary percutaneous coronary interventions (PCIs). This study aimed to describe changes in PCI practices during the health emergency at the national level. The Japanese Association of Cardiovascular Intervention and Therapeutics performed provided serial surveys of institutions throughout Japan during the pandemic. The data obtained on December, 2020 and February 2021 (during the 2nd wave of pandemic) were compared with the data obtained on August 2020 (1st wave). Primary PCI for STEMI was performed as usual in 99.1%, 98.7%, and 97.5% of institutions in mid-August, mid-December, 2020 and mid-February, 2021, respectively. The COVID-19 screening tests rates in patients were significantly higher during the third wave than during the second wave (54.0% in mid-August, 2020 and 64.6% in mid-February, 2021, P = 0.002). In addition, hospitals reported that personal protective equipment was more available over time (66.4% in mid-August, 2020 and 83.8% in mid-February, 2021, P < 0.001). In conclusion, most institutions surveyed in Japan continued to perform primary PCI as usual for STEMI patients during the second and third waves of the COVID-19 pandemic. In addition, the COVID-19 screening tests were more frequently performed over time.


Subject(s)
COVID-19 , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , Japan/epidemiology , Pandemics/prevention & control , Percutaneous Coronary Intervention/methods , SARS-CoV-2 , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/surgery
4.
Syst Biol Reprod Med ; 67(2): 144-150, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1172615

ABSTRACT

The SARS-CoV-2 pandemic peak around March 2020 led to temporary closures of most fertility clinics. Many clinics reopened but required universal SARS-CoV-2 screening. However, the rate of positive results and the necessity for such testing is unknown. We report here on early results from asingle-center academic NewYork fertility practice utilizing universal SARS-CoV-2 screening. This mixed prospective retrospective cohort included 164 patients who underwent at least one SARS-CoV-2 screening test for fertility treatment between May and July2020. Patients completed 1 to 3 nasopharyngeal SARS-CoV-2 tests per cycle and remained symptom-free to continue fertility treatments. SARS-CoV-2 test results, past results, history of Covid-19 infection, and patient/cycle characteristics were recorded and tabulated through October2020. Outcomes included positive SARS-CoV-2 RNA tests, rate of prior Covid-19 infections, and clinical courses of patients testing positive. Patients underwent 263 cycles entailing 460 total SARS-CoV-2 screening tests. Fifteen patients reported astrong prior clinical history of Covid-19. Six patients experienced apositive SARS-CoV-2 test (2.3% of all cycles). Among 77 cycles (n = 58 patients) entailing one SARS-CoV-2 test, 2 cases (2.6%) were noted. Among 173 cycles (n = 121 patients) entailing two SARS-CoV-2 tests, 4 cycles (2.3%) were noted. Zero (0%) of 13 cycles (n = 13 patients) entailing 3 SARS-CoV-2 tests were positive. All patients were cleared to resume treatment within one month. Overall, anew asymptomatic infection was identified in 2 cycles (0.8%), while 4 of the 6 positive SARS-CoV-2 tests were among patients with aprior history of Covid-19. 3 of 4 also had adocumented prior positive RNA test. Our data suggest that universal SARS-CoV-2 screening among fertility patients is feasible, with an approximately 2% positive rate per cycle among the patients of this study. Most positive patients had aprior remote infection, but their infectiousness while being screened remains unclear.Abbreviations: REI: reproductive endocrinology and infertility; IUI: intrauterine insemination; IVF: in vitro fertilization; sono: sonography; cryo: cryopreservation; FET: frozen embryo transfer.


Subject(s)
COVID-19 Testing , COVID-19/diagnosis , Endocrinology , Fertility Clinics , Adult , COVID-19/epidemiology , Diagnostic Tests, Routine , Female , Humans , Practice Patterns, Physicians' , SARS-CoV-2
5.
Monaldi Arch Chest Dis ; 2021 Mar 19.
Article in English | MEDLINE | ID: covidwho-1167835

ABSTRACT

The Coronavirus Disease 2019 (COVID-19) represents the first medical catastrophe of the new millennium. Although imaging is not a screening test for COVID-19, it plays a crucial role in evaluation and follow-up of COVID-19 patients. In this paper, we will review typical and atypical imaging findings of COVID-19.

6.
MMWR Morb Mortal Wkly Rep ; 70(5): 155-161, 2021 Feb 05.
Article in English | MEDLINE | ID: covidwho-1063528

ABSTRACT

Exposure to lead, a toxic metal, can result in severe effects in children, including decreased ability to learn, permanent neurologic damage, organ failure, and death. CDC and other health care organizations recommend routine blood lead level (BLL) testing among children as part of well-child examinations to facilitate prompt identification of elevated BLL, eliminate source exposure, and provide medical and other services (1). To describe BLL testing trends among young children during the coronavirus disease 2019 (COVID-19) pandemic, CDC analyzed data reported from 34 state and local health departments about BLL testing among children aged <6 years conducted during January-May 2019 and January-May 2020. Compared with testing in 2019, testing during January-May 2020 decreased by 34%, with 480,172 fewer children tested. An estimated 9,603 children with elevated BLL were missed because of decreased BLL testing. Despite geographic variability, all health departments reported fewer children tested for BLL after the national COVID-19 emergency declaration (March-May 2020). In addition, health departments reported difficulty conducting medical follow-up and environmental investigations for children with elevated BLLs because of staffing shortages and constraints on home visits associated with the pandemic. Providers and public health agencies need to take action to ensure that children who missed their scheduled blood lead screening test, or who required follow-up on an earlier high BLL, be tested as soon as possible and receive appropriate care.


Subject(s)
COVID-19/epidemiology , Diagnostic Tests, Routine/statistics & numerical data , Lead/blood , Child, Preschool , Humans , Infant , United States/epidemiology
7.
Diabetes Metab Syndr ; 15(1): 391-395, 2021.
Article in English | MEDLINE | ID: covidwho-1062313

ABSTRACT

BACKGROUND AND AIMS: Gestational diabetes (GDM) is one of the most common medical complications of pregnancy and associated with significant perinatal and long-term morbidity. Temporary changes to the diagnostic testing for GDM have been recommended for the COVID-19 pandemic. This study aims to identify what proportion of women with GDM would be missed by the COVID-19 GDM screening criteria. Secondly an analysis of the relationship between HbA1c, fasting blood glucose (FBG) and pregnancy outcomes will be completed. METHODS: This was a retrospective analysis of all GDM patients at an Australian secondary hospital between January 2019 and February 2020. The proportion of women with GDM who would have been missed using the COVID-19 guidelines was assessed. Patients were divided into groups according to how their GDM was managed during the pregnancy: Diet, Metformin (MF), Insulin and MF + Insulin groups. Differences between the groups were compared using one-way ANOVA and post-hoc analysis was completed using the Bonferroni test. Logistic regression was employed to further compare the differences between the groups. RESULTS: The study group comprised 237 patients. Sixty patients (25.3%) would not have had GDM detected in their pregnancy using the COVID-19 guidelines. FBG was the most significant predictor for intervention with medication for GDM (p = 0.001). CONCLUSION: HbA1c and FBG are poor screening tests for GDM. During the COVID-19 pandemic, the OGTT should be given clinical priority in high risk patients. Elevated FBG is a significant predictor for needing medical management and could be used in the future to better enable individualised treatment.


Subject(s)
COVID-19/diagnosis , Diabetes, Gestational/diagnosis , Mass Screening/standards , Practice Guidelines as Topic/standards , Adult , Australia/epidemiology , Blood Glucose/metabolism , COVID-19/blood , COVID-19/epidemiology , Cohort Studies , Diabetes, Gestational/blood , Diabetes, Gestational/epidemiology , Female , Humans , Mass Screening/methods , Pregnancy , Retrospective Studies
8.
Lancet Digit Health ; 3(2): e78-e87, 2021 02.
Article in English | MEDLINE | ID: covidwho-1053906

ABSTRACT

BACKGROUND: The early clinical course of COVID-19 can be difficult to distinguish from other illnesses driving presentation to hospital. However, viral-specific PCR testing has limited sensitivity and results can take up to 72 h for operational reasons. We aimed to develop and validate two early-detection models for COVID-19, screening for the disease among patients attending the emergency department and the subset being admitted to hospital, using routinely collected health-care data (laboratory tests, blood gas measurements, and vital signs). These data are typically available within the first hour of presentation to hospitals in high-income and middle-income countries, within the existing laboratory infrastructure. METHODS: We trained linear and non-linear machine learning classifiers to distinguish patients with COVID-19 from pre-pandemic controls, using electronic health record data for patients presenting to the emergency department and admitted across a group of four teaching hospitals in Oxfordshire, UK (Oxford University Hospitals). Data extracted included presentation blood tests, blood gas testing, vital signs, and results of PCR testing for respiratory viruses. Adult patients (>18 years) presenting to hospital before Dec 1, 2019 (before the first COVID-19 outbreak), were included in the COVID-19-negative cohort; those presenting to hospital between Dec 1, 2019, and April 19, 2020, with PCR-confirmed severe acute respiratory syndrome coronavirus 2 infection were included in the COVID-19-positive cohort. Patients who were subsequently admitted to hospital were included in their respective COVID-19-negative or COVID-19-positive admissions cohorts. Models were calibrated to sensitivities of 70%, 80%, and 90% during training, and performance was initially assessed on a held-out test set generated by an 80:20 split stratified by patients with COVID-19 and balanced equally with pre-pandemic controls. To simulate real-world performance at different stages of an epidemic, we generated test sets with varying prevalences of COVID-19 and assessed predictive values for our models. We prospectively validated our 80% sensitivity models for all patients presenting or admitted to the Oxford University Hospitals between April 20 and May 6, 2020, comparing model predictions with PCR test results. FINDINGS: We assessed 155 689 adult patients presenting to hospital between Dec 1, 2017, and April 19, 2020. 114 957 patients were included in the COVID-negative cohort and 437 in the COVID-positive cohort, for a full study population of 115 394 patients, with 72 310 admitted to hospital. With a sensitive configuration of 80%, our emergency department (ED) model achieved 77·4% sensitivity and 95·7% specificity (area under the receiver operating characteristic curve [AUROC] 0·939) for COVID-19 among all patients attending hospital, and the admissions model achieved 77·4% sensitivity and 94·8% specificity (AUROC 0·940) for the subset of patients admitted to hospital. Both models achieved high negative predictive values (NPV; >98·5%) across a range of prevalences (≤5%). We prospectively validated our models for all patients presenting and admitted to Oxford University Hospitals in a 2-week test period. The ED model (3326 patients) achieved 92·3% accuracy (NPV 97·6%, AUROC 0·881), and the admissions model (1715 patients) achieved 92·5% accuracy (97·7%, 0·871) in comparison with PCR results. Sensitivity analyses to account for uncertainty in negative PCR results improved apparent accuracy (ED model 95·1%, admissions model 94·1%) and NPV (ED model 99·0%, admissions model 98·5%). INTERPRETATION: Our models performed effectively as a screening test for COVID-19, excluding the illness with high-confidence by use of clinical data routinely available within 1 h of presentation to hospital. Our approach is rapidly scalable, fitting within the existing laboratory testing infrastructure and standard of care of hospitals in high-income and middle-income countries. FUNDING: Wellcome Trust, University of Oxford, Engineering and Physical Sciences Research Council, National Institute for Health Research Oxford Biomedical Research Centre.


Subject(s)
Artificial Intelligence , COVID-19 , Hematologic Tests , Mass Screening , Predictive Value of Tests , Triage , Adult , Emergency Service, Hospital , Hospitalization , Hospitals , Humans , Middle Aged , Prospective Studies
9.
J Vasc Surg Venous Lymphat Disord ; 9(2): 289-298.e5, 2021 03.
Article in English | MEDLINE | ID: covidwho-1026314

ABSTRACT

BACKGROUND: Emerging clinical evidence has shown that patients with the novel coronavirus disease-2019 (COVID-19) have complications that include venous thromboembolism (VTE), consisting of deep vein thrombosis (DVT) and pulmonary embolism (PE). The prevalence of VTE in patients hospitalized with COVID-19 is unclear. METHODS: Eligible studies on COVID-19 were collected from PubMed, Web of Science, and Embase. Patient characteristics and information were extracted for three categories of patients: consecutive, ICU, and non-ICU group. All PEs and DVTs were diagnosed by computed tomographic pulmonary arteriography and duplex ultrasound examination, respectively. A subgroup analysis of testing strategies in ICU and non-ICU patients for PE and DVT was also performed. RESULTS: Forty clinical studies involving 7966 patients hospitalized with COVID-19 were included. Pooled VTE prevalence was 13% in consecutive patients (95% confidence interval [CI], 0.05-0.24; I2 = 97%), 7% in non-ICU patients (95% CI, 0.01-0.18; I2 = 93%), and 31% in ICU patients (95% CI, 0.22-0.42; I2 = 91%). ICU patients had the highest prevalence of PE among the three groups (17% [95% CI, 0.12-0.23] vs 8% in consecutive patients [95% CI, 0.04-0.13], 4% in non-ICU patients [95% CI, 0.01-0.08]). ICU patients also had the highest DVT prevalence (25% [95% CI, 0.14-0.37] vs 7% in consecutive patients [95% CI, 0.03-0.14], and 7% in non-ICU [95% CI, 0.02-0.14]). The subgroup analysis showed a three-fold improvement in the PE and DVT detection rates in both ICU and non-ICU patients with COVID-19 when the screening test for VTE was applied. In the settings of screening tests for VTE, ICU patients have a significantly higher prevalence of PE (37% vs 10%; P < .0001) and DVT (40% vs 12%; P = .0065) compared with non-ICU patients. CONCLUSIONS: VTE is common in patients hospitalized with COVID-19, especially among ICU patients. Screening tests for PE and DVT may significantly improve detection rates in both ICU and non-ICU patients with COVID-19 than tests based on clinical suspicion.


Subject(s)
COVID-19/complications , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiology , Humans , Prevalence
10.
Diabetes Metab J ; 44(6): 897-907, 2020 12.
Article in English | MEDLINE | ID: covidwho-1005674

ABSTRACT

BACKGROUND: This study aimed to determine the infection risk of coronavirus disease 2019 (COVID-19) in patients with diabetes (according to treatment method). METHODS: Claimed subjects to the Korean National Health Insurance claims database diagnosed with COVID-19 were included. Ten thousand sixty-nine patients with COVID-19 between January 28 and April 5, 2020, were included. Stratified random sampling of 1:5 was used to select the control group of COVID-19 patients. In total 50,587 subjects were selected as the control group. After deleting the missing values, 60,656 subjects were included. RESULTS: Adjusted odds ratio (OR) indicated that diabetic insulin users had a higher risk of COVID-19 than subjects without diabetes (OR, 1.25; 95% confidence interval [CI], 1.03 to 1.53; P=0.0278). In the subgroup analysis, infection risk was higher among diabetes male insulin users (OR, 1.42; 95% CI, 1.07 to 1.89), those between 40 and 59 years (OR, 1.66; 95% CI, 1.13 to 2.44). The infection risk was higher in diabetic insulin users with 2 to 4 years of morbidity (OR, 1.744; 95% CI, 1.003 to 3.044). CONCLUSION: Some diabetic patients with certain conditions would be associated with a higher risk of acquiring COVID-19, highlighting their need for special attention. Efforts are warranted to ensure that diabetic patients have minimal exposure to the virus. It is important to establish proactive care and screening tests for diabetic patients suspected with COVID-19 for timely disease diagnosis and management.


Subject(s)
COVID-19/economics , COVID-19/epidemiology , Diabetes Mellitus/economics , Diabetes Mellitus/epidemiology , Population Surveillance , Social Class , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , Databases, Factual/trends , Diabetes Mellitus/diagnosis , Female , Humans , Male , Middle Aged , National Health Programs/trends , Republic of Korea/epidemiology , Risk Factors , Young Adult
12.
Eur J Trauma Emerg Surg ; 47(3): 647-652, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-897943

ABSTRACT

PURPOSE: The aim of this paper is to investigate the effect of COVID-19 pandemic on general surgical emergencies as well as analyzing the effectiveness of measures taken in reducing the incidence of COVID-19 in patients and healthcare professionals. METHODS: Patients who underwent emergency surgery between the pandemic period of March 14th to May 15th 2020 and within the same period from the previous year were reviewed retrospectively. COVID-19 incidence in patients and health professionals working in the general surgery department during these periods was questioned. RESULTS: Demographic data were similar between the two time periods. The number of patients who underwent surgery in the pandemic group (n = 103) was lower than the control group (n = 252). There was a 59.1% reduction in emergency surgeries. The biggest decreases were the admissions of incarcerated hernia, uncomplicated appendicitis and acute cholecystitis (92%, 81.3%, 47.3%, respectively). During the pandemic, an increase was of patient rates who underwent surgery for complicated appendicitis and AMIO (p = 0.001, p = 0.019, respectively). The rate of mortality was higher in patients who underwent emergency surgery during pandemic (p = 0.049). The results of COVID-19 screening were positive in 6 (6/103, 5.82%) patients undergoing emergency surgery. None of the doctors working in the ward were infected with COVID-19 infection (0/20). The screening tests were positive in only two nurses working on the ward (2/24, 8.33%). CONCLUSION: In this and similar pandemics, we suggest that a new algorithm is necessary to approach emergencies and the results of this study can contribute to that end.


Subject(s)
COVID-19 , Emergencies/epidemiology , Infection Control , Surgical Procedures, Operative , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Emergency Service, Hospital/statistics & numerical data , Female , General Surgery/methods , General Surgery/organization & administration , Health Services Needs and Demand , Humans , Incidence , Infection Control/methods , Infection Control/organization & administration , Male , Middle Aged , Mortality , Occupational Exposure/prevention & control , SARS-CoV-2 , Surgery Department, Hospital/statistics & numerical data , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/statistics & numerical data , Turkey/epidemiology
13.
Wien Klin Wochenschr ; 133(7-8): 331-335, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-888199

ABSTRACT

BACKGROUND: Body temperature control is a frequently used screening test for infectious diseases, such as Covid-19 (Sars-CoV-2). We used this procedure to test the body temperature of staff members in a hospital in Tyrol (Austria), where the Covid-19 disease occurred in March 2020. The hospital is located in a mountain area at 995 m above sea level with low outdoor temperatures during early spring season. Under these conditions, we analyzed whether forehead temperature control offers a sufficient screening tool for infectious diseases. METHODS: Forehead temperature of 101 healthy male and female employees was measured with an infrared thermometer directly after entering the hospital (0 min), followed by further controls after 1 min, 3 min, 5 min and 60 min. We also tracked the outside temperature and the temperature at the entrance hall of the hospital. RESULTS: Complete data of body temperature were available for 46 female and 46 male study participants. The average forehead temperature measured directly after entrance to the hospital was the lowest (0 min) 33.17 ± 1.45 °C, and increased constantly to 34.90 ± 1.49 °C after 1 min, 35.77 ± 1.10 °C after 3 min, 36.08 ± 0.79 °C after 5 min, and 36.6 ± 0.24 °C after 60 min. The outside temperature ranged between -5.5 °C and 0 °C, the indoor temperature had a constant value of 20.5 °C. CONCLUSION: Our results indicate that forehead infrared temperature control is not an appropriate tool to screen for infectious disease directly at the entrance of a building, at least during early spring season with cold outdoor temperatures.


Subject(s)
COVID-19 , Forehead , Austria , Body Temperature , Female , Fever , Humans , Male , SARS-CoV-2 , Temperature
15.
Cureus ; 12(9): e10555, 2020 Sep 20.
Article in English | MEDLINE | ID: covidwho-836393

ABSTRACT

Since the declaration of coronavirus disease 2019 (COVID-19) disease as a pandemic by the World Health Organization (WHO), it has been a challenge to the whole medical community. Researchers and clinicians have been trying to explain and explore its mechanism and pathophysiology to get a better understanding of this disease, as it has exhausted the healthcare resources and has impacted human life in general. Many tests have been developed including polymerase chain reaction (PCR) of the virus and rapid diagnostic testing in patients based on IgM/IgG serology. But owing to variable sensitivity and specificity of these tests, it has created a challenging situation to proceed with the further management plan. We are reporting a case series where we experienced the dilemma of diagnosing COVID-9 disease in our patients and further plan of care.

16.
Clin Pediatr (Phila) ; 60(2): 119-126, 2021 02.
Article in English | MEDLINE | ID: covidwho-796688

ABSTRACT

BACKGROUND: The overall severity of cardiac disease secondary to acute SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection in children appears to be much lower when compared with adults. However, the newly described multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been associated with cardiac complications. METHODS: We reviewed the clinical course and cardiac testing results in pediatric patients hospitalized with MIS-C at 2 large hospital systems in the New York City metropolitan area over a 3-month period. RESULTS: Of the 33 patients (median age 2.8 years) in the study cohort, 24 (73%) had at least one abnormality in cardiac testing: abnormal electrocardiogram (48%), elevated brain natriuretic peptide (43%), abnormal echocardiogram (30%), and/or elevated troponin (21%). Electrocardiogram and echocardiogram abnormalities all resolved by the 2-week outpatient follow-up cardiology visit. CONCLUSION: While 73% of pediatric patients with MIS-C had evidence of abnormal cardiac testing on hospital admission in our study, all cardiac testing was normal by outpatient hospital discharge follow-up. Cardiac screening tests should be performed in all patients diagnosed with MIS-C given the high rate of abnormal cardiac findings in our study cohort.


Subject(s)
COVID-19/complications , Cardiovascular Diseases/virology , Systemic Inflammatory Response Syndrome/complications , COVID-19/epidemiology , Child , Child, Preschool , Female , Humans , Infant , Male , New York City/epidemiology , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/epidemiology
17.
J Korean Med Sci ; 35(37): e333, 2020 Sep 21.
Article in English | MEDLINE | ID: covidwho-789268

ABSTRACT

BACKGROUND: There is limited information on the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) who are asymptomatic or have mild symptoms. METHODS: We performed a retrospective case series of patients with COVID-19 enrolled from February 22 to March 26, 2020. Forty cases of COVID-19 were confirmed using real-time reverse-transcription polymerase chain reaction among patients who underwent screening tests and were consecutively hospitalized at Ulsan University Hospital, Ulsan, Korea. The final follow-up date was May 19, 2020. All COVID-19 cases in Ulsan were included. Demographic and epidemiological information, comorbidities, clinical signs and symptoms, laboratory and radiologic findings, medications, treatments, outcomes, and main durations of patients with COVID-19 were compared according to supplemental oxygen requirement. RESULTS: Forty patients were included (median age, 30 years; interquartile range [IQR], 25-57 years; 58% female). Six (15%) patients required supplemental oxygen. The prevalence of asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection was 5% and that of presymptomatic infection was 13%. Cough, fever, myalgia, rhinorrhea or nasal congestion, and diarrhea were the screening criteria for diagnosing symptomatic and presymptomatic SARS-CoV-2 infections. Sputum production, chest discomfort, a large number of symptoms, abnormal procalcitonin and C-reactive protein levels, and abnormal chest X-ray or chest computed tomography findings were more common in patients requiring supplemental oxygen than in those not requiring supplemental oxygen. Overall mortality rate was 3% (1/40). Four patients (10%) were readmitted after testing positive by reverse-transcription polymerase chain reaction again. Incubation period was 5 days (IQR, 4-6 days), and the duration of viral shedding was 21 days (IQR, 14-28 days; maximum, 51 days). CONCLUSION: The prevalence of asymptomatic SARS-CoV-2 infection was 5%, which is much lower than that previously reported. This finding suggests that careful interviews and follow-ups should be performed to identify SARS-CoV-2 infections. Cough, fever, myalgia, rhinorrhea or nasal congestion, and diarrhea are adequate screening criteria for covering all symptoms of SARS-CoV-2 infection. Further evaluation is required to create representative screening criteria for COVID-19.


Subject(s)
Asymptomatic Infections/epidemiology , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Adult , Aged , Betacoronavirus , COVID-19 , Comorbidity , Cough/epidemiology , Diarrhea/epidemiology , Female , Fever/epidemiology , Hospitalization , Humans , Korea/epidemiology , Male , Middle Aged , Myalgia/epidemiology , Pandemics , Prevalence , Real-Time Polymerase Chain Reaction , Retrospective Studies , SARS-CoV-2 , Symptom Assessment , Treatment Outcome
18.
Yeungnam Univ J Med ; 37(4): 349-355, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-782487

ABSTRACT

Active and prompt scale-up screening tests are essential to efficiently control the coronavirus disease 2019 (COVID-19) outbreak. The goal of this work was to identify shortcomings in the conventional screening system (CSS) implemented in the beginning of the outbreak. To overcome these shortcomings, we then introduced a novel, independently developed system called the Yeungnam University type drive-through (YU-Thru), and distributed it nationwide in Korea. This system is similar to the drive-throughs utilized by fast food restaurants. YU-Thru system has shortened the time taken to test a single person to 2-4 minutes, by completely eliminating the time required to clean and ventilate the specimen collection room. This time requirement was a major drawback of the CSS. YU-Thru system also reduced the risk of subjects and medical staff infecting one another by using a separate and closed examination system. On average, 50 to 60 tests were conducted per day when using the CSS, while now up to 350 tests per day are conducted with the YU-Thru system. We believe that the YU-Thru system has made an important contribution to the rapid detection of COVID-19 in Daegu, South Korea. Here, we will describe the YU-Thru system in detail so that other countries experiencing COVID-19 outbreaks can take advantage of this system.

19.
J Matern Fetal Neonatal Med ; 34(23): 3952-3957, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-740130

ABSTRACT

OBJECTIVE: To evaluate the accessibility of pregnant women to prenatal screening and diagnostic tests during the COVID-19 pandemic process and analyze the effect of the pandemic process on acceptance-rejection rates of fetal diagnostic procedures for high risk pregnancies. MATERIALS AND METHODS: As part of this cross-sectional study, during the pandemic, between the dates of 11 March 2020-30 June 2020 at Karadeniz Technical University Faculty of Medicine Perinatology Clinic, fetal structural anomaly detected by ultrasonography or with increased risk in screening test in the first and second trimester of high risk pregnancies, who were therefore recommended a prenatal diagnosis test, were defined as the control group and retrospectively compared with high risk pregnancies of the same periods (11 March 2019-30 June 2019) in the previous year. RESULTS: A total of 267 cases were evaluated within the scope of the study. The rate of pregnant women undergoing the first and second trimester screening tests was 83% in the control group and 56% for pregnant women in the study group. When the total number of prenatal diagnostic procedures and the year each of the procedures performed are compared, a statistically significant difference was found between the study and control groups (p: .041 and p < .001, respectively). When evaluating the rates of performed prenatal diagnostic procedures during the first patient visit in comparison to years, a statistically significant difference was observed in the A/S group and in the total number of cases (p = .023, p < .001, respectively). Similarly, the rate of performed prenatal diagnostic procedure during the first patient visit and the patient's city of residence was similarly statistically significant from year to year (p < .05). CONCLUSIONS: The decrease in number of prenatal diagnosis and screening tests during the COVID-19 pandemic draws attention. Prenatal care services are a serious issue that cannot be overcome by any deficiencies in both maternal and fetal care.


Subject(s)
COVID-19 , Pandemics , Cross-Sectional Studies , Female , Humans , Pregnancy , Prenatal Diagnosis , Retrospective Studies , SARS-CoV-2
20.
World J Clin Cases ; 8(15): 3305-3313, 2020 Aug 06.
Article in English | MEDLINE | ID: covidwho-740594

ABSTRACT

BACKGROUND: Patients with critical coronavirus disease 2019 (COVID-19), characterized by respiratory failure requiring mechanical ventilation (MV), are at high risk of mortality. An effective and practical MV weaning protocol is needed for these fragile cases. CASE SUMMARY: Here, we present two critical COVID-19 patients who presented with fever, cough and fatigue. COVID-19 diagnosis was confirmed based on blood cell counts, chest computed tomography (CT) imaging, and nuclei acid test results. To address the patients' respiratory failure, they first received noninvasive ventilation (NIV). When their condition did not improve after 2 h of NIV, each patient was advanced to MV [tidal volume (Vt), 6 mL/kg ideal body weight (IBW); 8-10 cmH2O of positive end-expiratory pressure; respiratory rate, 20 breaths/min; and 40%-80% FiO2] with prone positioning for 12 h/day for the first 5 d of MV. Extensive infection control measures were conducted to minimize morbidity, and pharmacotherapy consisting of an antiviral, immune-enhancer, and thrombosis prophylactic was administered in both cases. Upon resolution of lung changes evidenced by CT, the patients were sequentially weaned using a weaning screening test, spontaneous breathing test, and airbag leak test. After withdrawal of MV, the patients were transitioned through NIV and high-flow nasal cannula oxygen support. Both patients recovered well. CONCLUSION: A MV protocol attentive to intubation/extubation timing, prone positioning early in MV, infection control, and sequential withdrawal of respiratory support, may be an effective regimen for patients with critical COVID-19.

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