Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 906
Filtrar
Adicionar filtros

Intervalo de ano
1.
International Journal of Radiation Oncology, Biology, Physics ; 114(3):e267-e267, 2022.
Artigo em Inglês | Academic Search Complete | ID: covidwho-2036098

RESUMO

To analyze the impact of body mass factors (BMFs) including body mass index (BMI), umbilical circumference (UC), and hip circumference (HC), on setup errors in gynecological tumors, and whether the planned tumor volumes (PTVs) are adequate for obese patients. A retrospective study was conducted among 46 consecutive women with gynecological tumors, who were treated with Volumetric Modulated Arc Therapy (VMAT) at the radiotherapy (RT) unit. Setup accuracy was verified using daily cone-beam computed tomography (CBCT). BMFs were measured at baseline for all patients, and at fractions #10 and #20. Total vector errors (TVEs) were computed and linear regression was used to analyze their relationship with baseline BMFs. Accuracy was determined for each fraction by testing two different PTVs (Cutoff I: ≤0.7cm and II: ≤1.0cm). A pooled analysis was conducted to test the association of accuracy levels (within vs beyond-PTV) with the mean and variance of BMI, UC, and HC, considering the repeated measures. Receiver operating characteristics (ROC) curve analysis was carried out to test the sensitivity of BMI, UC, and HC in predicting inaccurate setup The mean (SD) TVE was 0.86 (0.34) cm and 0.79 (0.30) cm in systematic and random settings respectively. Random TVE showed weakly positive relationships with BMI (B=0.005 [95%CI=0.001-0.010];R2=0.090;p=0.042) and UC (B=0.013 [95%CI=0.002-0.025];R2=0.119;p=0.019. The pooled analysis showed a higher mean BMI with setups beyond the PTV compared to within PTV, with a mean difference of approximately 3.50 kg/m2, (p=0.001), in the lateral direction. Similarly, measures of UC (mean difference ∼10 cm) and HC (∼8 cm) were significantly higher in setups beyond the PTV compared with accurate setups (p<0.001). With respect of the vertical direction, BMI (mean difference=7.4 kg/m2, p=0.001), UC (5.3 cm, p<0.001), and HC (16.0 cm, p<0.001) were higher in setups beyond the PTV versus those within PTV;however, this was only observed using Cutoff I. Using Cutoff II, only HC showed a statistically significant difference, with a mean difference of 11.7 cm between inaccurate setups and accurate setups (0=0.041). ROC curve analysis showed that a BMI>31.4 kg/m2 was predictive for inaccurate setup in the vertical direction with 90.0% sensitivity, with respect of Cutoff I. Furthermore, a BMI>30.3 kg/m2 was predictive for inaccurate setup in the lateral direction with 92.5% sensitivity, with respect of Cutoff II. The accuracy of RT setups in gynecological tumors are highly sensitive to patients' BMI, notably in the lateral and vertical directions. To facilitate workflow during the Covid-19 crisis, we suggest that daily CBCT should be applied on patients with a BMI>30.3 kg/m2 or the PTVs should be adapted for obese patients to enhance setup accuracy of RT [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

2.
Boletin de Malariologia y Salud Ambiental ; 62(2):306-312, 2022.
Artigo em Espanhol | CAB Abstracts | ID: covidwho-2033962

RESUMO

COVID-19 has generated considerable morbidity and mortality worldwide, particularly among those with chronic comorbidities: hypertension, diabetes, and cardiovascular disease. Research has shown that sleep apnea can worsen the vital prognosis, by causing or exacerbating endothelial dysfunction, inflammation, oxidative stress, microaspiration and lung damage, which amplifies the risk of hospitalization and even respiratory failure. A retrospective and cross-sectional descriptive study was carried out, 187 heart patients with clinical signs suggestive of obstructive sleep apnea were evaluated and were positive for SARS-CoV-2, between 2020-2021. The methodology of Castro et al., 2021 and questionnaire were applied. STOP-BANG to assess dyspnea and characterize OSA, respectively. The strong association between heart disease and the presence of OSA was confirmed;More than half of the patients studied presented severe disease due to COVID-19, with moderate-severe dyspnea, which required hospitalization with intensive care, with a higher frequency observed in males, over 50 years of age and with BMI >30. However, females presented significant STOP-BANG values, which suggests hypertension and obesity as risk factors for OSA, regardless of gender. It is recommended to rule out OSA as a medical routine, which allows establishing the epidemiology and strategies for an adequate approach to these patients.

3.
Boletin de Malariologia y Salud Ambiental ; 62(2):233-240, 2022.
Artigo em Espanhol | CAB Abstracts | ID: covidwho-2033888

RESUMO

The objective of the study was to determine the factors associated with hospital mortality in patients with coronavirus disease 2019 (COVID-19). An observational, analytical, case-control study was conducted. Hospitalized patients diagnosed with COVID-19 by serological test and/or molecular test between March and August 2020 were included. The Mann Whitney test was used for statistical analysis and logistic regression was used for the analysis of associated factors. The significance of p-value was < 0.05. A total of 814 patients were included, 556 (68.3%) were men and 246 (30.2%) were older than 60 years. The presence of some comorbidity was evidenced in 29.6% (241 patients);35.8% (292) died. The median age of the deceased was higher compared to the survivors (59 vs. 49;p >0.01). The comorbidities associated with COVID-19 were: obesity (OR= 2.14;95% CI: 1.38-3.32) and arterial hypertension (OR=1.86;95% CI: 1.06- 3.24). Likewise, oxygen saturation levels less than 85% at hospital admission (OR= 3.58;95% CI: 2.82-4.53);age over 60 years (OR=1.96;95% CI: 1.54-2.50) and male gender (OR= 1.64;95% CI: 1.12-2.39) were associated with greater mortality. Finally, the factors associated with hospital mortality were oxygen saturation less than 85% at hospital admission, older than 60 years of age, obesity, and arterial hypertension.

4.
Boletin de Malariologia y Salud Ambiental ; 61(3):486-495, 2021.
Artigo em Espanhol | CAB Abstracts | ID: covidwho-2033877

RESUMO

Persistent COVID is characterized by functional and psychological symptoms and sequelae that persist for more than 12 weeks post infection, such as: fatigue, dyspnea, anxiety, depression;generating inconveniences in the resumption of work activities of workers. A descriptive, cross-sectional epidemiological study was carried out, evaluating the reincorporation of workers operating in metalworking industries in Lima, Peru;recovered and persistent COVID, between the third quarter 2020 and the first quarter 2021. The Borg dyspnea scales and the modified dyspnea scale of the Medical Research Council (mMRC) were applied, in addition to the Goldberg anxiety and depression scale. The results were analyzed using descriptive statistics, using measures of central tendency and dispersion. It was observed that more than 80% of recovered workers are reinstated;and for persistent COVID, between 75% and 43% are reinstated for charges 8121 and 8122, respectively. Respiratory effort at rest was normal by the Borg scale for each group, while in effort a value R2 = 0.2986 was obtained, indicating no reincorporation in 74.51% and 43.33% in categories 8121 and 8122, respectively;also 45.12% and 42.68% of the recovered workers and persistent COVID showed symptoms of fatigue;36.25% and 35.26% anxiety;25.4% and 15.21% of depression, respectively;Likewise, the total of workers were overweight with an average BMI> 26 Kg/m2;being higher in women (27.4 Kg/m2). COVID-19 affects the health of workers (recovered and persistent COVID), reduces return to work and consequently the productivity of companies.

5.
Indian Journal of Forensic Medicine and Toxicology ; 16(3):208-213, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2033603

RESUMO

Background: The COVID-19 pandemic has spread worldwide, forcing governments to implement quarantines as a preventive measure against the spread of the virus. Quarantine causes changes in lifestyle and anthropometry status among communities. Objective: To describe the lifestyle and anthropometric status of medical students batch 2018 FM UA during the pandemic. Methods: This was a descriptive study using online questionnaires from September 2020 to February 2021. Results: There were variations in students’ anthropometry. Students’ average height is 161.110 cm, the average weight is 60.308 cm, the average body mass index is 23.193 cm, the average upper arm circumference is 27.846 cm, and the average abdominal circumference is 79.621 cm. Furthermore, 145 respondents (81.9%) stated that they experienced changes in their lifestyle during the pandemic. A total of 89 respondents (50.3%) continued to exercise and the other 88 respondents (49.7%) did not. Regarding the sleep pattern, 108 respondents (61%) had quite good sleep quality and 50 respondents (28.2%) had quite poor sleep quality. For the food consumption pattern, 46 respondents (26%) ate more sweet foods. Furthermore, 156 respondents (88.1%) did sedentary activities, with 77 respondents (43.5%) doing sedentary behavior for more than 6 hours a day. Conclusion: During the COVID-19 pandemic, the anthropometric status of medical students batch 2018 FMUA varied;and tend to maintain their physical activity, have quite good sleep quality, prefer eating sweet foods, and do a sedentary behavior for a longer duration

6.
Voprosy Ginekologii, Akusherstva i Perinatologii ; 21(3):28-35, 2022.
Artigo em Russo | EMBASE | ID: covidwho-2033519

RESUMO

Objective. To assess the effectiveness of different preventive measures for novel coronavirus infection in pregnant women. Patients and Methods. This study included 125 pregnant women hospitalized with moderate to severe laboratory-confirmed SARS-CoV-2 infection between September and November 2021 (the fourth pandemic wave), and 175 pregnant women who were not infected with COVID-19 during the same period. All women in these two groups were comparable for gestational age (II–III trimesters, 24–39 weeks), age (20–40 years), social status, parity, body mass index, and had no known COVID-19 risk factors. Results. Our findings revealed that vaccination 3-5 months before pregnancy (OR = 4.12;95% CI 1.28–13.27;χ2 = 0.022), inconsistent use and/or non-timely replacement of face masks (OR = 5.71;95% CI 2.83–11.51) were associated with the increased risk of COVID-19 in the second and third trimesters of gestation. It was showed that systematic (once in the morning at 24–48-hour intervals) intranasal administration of recombinant interferon alpha-2b (IFN-α;Grippferon) as compared with a single application after exposure to COVID-19 reduced the disease incidence rate and there was no evident risk of illness (OR = 0.08;95% CI 0.05–0.14;19.2% vs 74,3%, p < 0.001). This can be explained by the fact that women were mostly infected in unpredictable conditions (e.g., 29.2% of pregnant women were infected from family members, 23.9% had unknown source of exposure). The use of umifenovir, not currently authorised for the medication-assisted prevention of COVID-19 in pregnant women, and rectal administration of IFN-α suppositories did not reduce the disease incidence rate. Rectal use of IFN-α suppositories by pregnant women off-label increased the incidence (32.0 vs 15.4%, p = 0.001) and risk of developing novel coronavirus infection (OR = 2.58;95% CI 1.48–4.50). Conclusion. There is a need to improve awareness among pregnant women about the mandatory and timely vaccination against COVID-19 during pregnancy and the importance of strict adherence to wearing face masks. Increased efforts should be made to monitor and inform pregnant women about the use of only authorised medication-assisted preventive measures of SARS-CoV-2 infection, such as intranasal administration of recombinant IFN α-2b (Grippferon). During the epidemic rise in COVID-19 cases, the systematic intranasal administration of recombinant interferon-based medication Grippferon (once in the morning at 24–48-hour intervals) is recommended for pregnant women.

7.
GERMS ; 12(2):253-261, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2033512

RESUMO

Introduction Prior evidence found that bloodstream infections (BSIs) are common in viral respiratory infections and can lead to heightened morbidity and mortality. We described the incidence, risk factors, and outcomes of BSIs in patients with COVID-19. Methods This was a single-center retrospective cohort study of adults consecutively admitted from March to June 2020 for COVID-19 with BSIs. Data were collected by electronic medical record review. BSIs were defined as positive blood cultures (BCs) with a known pathogen in one or more BCs or the same commensal organism in two or more BCs. Results We evaluated 290 patients with BCs done;39 (13.4%) had a positive result. In univariable analysis, male sex, black/African American race, admission from a facility, hemiplegia, altered mental status, and a higher Charlson Comorbidity Index were positively associated with positive BCs, whereas obesity and systolic blood pressure (SBP) were negatively associated. Patients with positive BCs were more likely to have severe COVID-19, be admitted to the intensive care unit (ICU), require mechanical ventilation, have septic shock, and higher mortality. In multivariable logistic regression, factors that were independent predictors of positive BCs were male sex (OR=2.8, p=0.030), hypoalbuminemia (OR=3.3, p=0.013), ICU admission (OR=5.3, p<0.001), SBP<100 mmHg (OR=3.7, p=0.021) and having a procedure (OR=10.5, p=0.019). Patients with an abnormal chest X-ray on admission were less likely to have positive BCs (OR=0.3, p=0.007). Conclusions We found that male sex, abnormal chest X-ray, low SBP, and hypoalbuminemia upon hospital admission, admission to ICU, and having a procedure during hospitalization were independent predictors of BSIs in patients with COVID-19.

8.
Acta Medica Iranica ; 60(6):338-344, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2033505

RESUMO

Dyspnea and decreased O2 saturation are the most common causes of hospitalization in noncritical COVID-19 patients. Breathing exercises and chest physiotherapy are used for managing the patients. These treatments are, however, not well supported by scientific evidence. In a randomized controlled trial, 80 patients were randomly assigned to planned breathing exercises (n=40) and control groups (n=40). The participants in the intervention group were instructed to blow into a balloon five times a day while lying down. Other therapies were similar in both groups. The severity of dyspnea at rest/after activity and peripheral oxygen saturation (SpO2) with/without O2 therapy were compared between the two groups on the first, second, and third days. The study findings showed no statistically significant difference in SpO2 with/without O2 therapy on the first, second, and third days between the two groups. Although the severity of dyspnea showed no significant difference between the two groups, the mean score of dyspnea at rest (2.72±2.25 vs. 1.6±1.21, P=0.007) and after activity (4.53±2.04 vs. 3.52±1.66, P=0.017) improved in the intervention group on the third day. Balloon-blowing exercise improves dyspnea in noncritical Covid-19 patients, but it does not significantly improve oxygenation.

9.
ASAIO Journal ; 68:140, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2032190

RESUMO

Background: Timing of tracheostomy in COVID-19 patients supported with extracorporeal oxygenation membrane (ECMO) remains unclear. This study aims to compare the short-term outcomes in early (≤7 days from ECMO insertion) (ET) versus late (LT) tracheostomy. Methods: Charts of COVID-19 patients with tracheostomy from 2020 to 2021 were reviewed, retrospectively. Primary endpoint was in-hospital mortality. Secondary endpoints were analgesics/sedatives doses, length of treatment (LOT), and initiation of physiotherapy (PT). Results: Eight patients with ET were compared to six patients with LT. Mean age was 41.4±12.5 (ET) and 49.5±6.9 (LT) years. In both groups, 50% were male with comparable BMI. Twelve patients received venovenous (VV) and two received veno-arterial (VA) ECMO. Tracheostomy post ECMO cannulation was performed in 12 [ET:6(75%);LT:6(100%)] patients, whereas in the remaining two patients, it was performed immediately after initiation of ECMO support. Average duration of ECMO support was 48.0±21.3 (ET) than 42.2±27.0 (LT) days, P=0.34. Requirement of sedatives before [ET:6.4±4.6;LT:9.3±5.3;P=0.15] and after [ET:21.6±11.9;LT:12.2±14.0;P=0.11] along with analgesics before [ET:6.3±4.9;LT:7.0±6.5;P=0.41] and after [ET:19.0±6.9;LT:14.8±15.5;P=0.28] tracheostomy was comparable. No difference was observed in the LOT during sedatives/ analgesics dosing after tracheostomy. However, the LOT before tracheostomy was significantly longer in sedatives [ET:2.9±3.1;LT:11.8±6.2, P<0.01] and analgesics [ET:2.9±2.8;LT:9.8±3.5, P<0.01], explained by the longer interval between ECMO insertion and tracheostomy in LT group. Compared to LT, number of days from ECMO insertion to first PT session was significantly shorter in ET patients [ET:13.6±5.6;LT:26.5±4.5, P<0.01]. In-hospital mortality rate was 21.4% [ET:1(13%);LT:2(33%), P=0.33] patients with comparable ICU stay [ET:56.9±18.6;LT:50.2±26.4, P=0.30] between groups. Conclusion: Although the advantages of ET to reduce the requirement of analgesics and sedatives amongst COVID19 patients supported with ECMO were like LT group, ET was associated with early initiation of PT and improved survival.

10.
ASAIO Journal ; 68:65, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2032184

RESUMO

Objectives: The purpose of this study was to compare the outcomes of chest tubes (CT) inserted via three approaches in COVID-19 patients undergoing extracorporeal membrane oxygenation (ECMO): open thoracostomies (OT), percutaneously at bedside (PERC), and percutaneously by interventional radiology (PERC IR). Methods: We conducted an institutional review board - approved retrospective study of all COVID-19 patients who required CT placement while undergoing ECMO in our institution from February 2020 till February 2022. Insertions prior to ECMO cannulation or after decannulation, and those related to post-operative lung transplantation during ECMO were excluded from our analysis. Depending on the insertion approach, eligible CT insertion events were divided in three groups: OT, PERC and PERC IR. Data regarding patients' demographics and CT characteristics, clinical indications and associated complications for each group were collected and analyzed. Bleeding related to CT insertion was diagnosed based on requirement of blood transfusion, cessation of anticoagulation and/or ongoing bloody CT output. Results: Study criteria were met by 43 patients, with 35 (83.7%) of male sex. Mean age was 45 years. Mean BMI was 31.6 kg/m2. Forty patients (93.0%) had COVID-related acute respiratory distress syndrome as primary diagnosis. All patients but one had been receiving therapeutic anticoagulation which was held prior to CT insertion. Eighty-seven CT insertion events were recorded, of which 34 (39.1%) comprised the OT group, 20 (23.0%) the PERC group, and 33 (37.9%) the PERC IR group. Table 1 demonstrates a descriptive comparison of CT and insertion data among the three groups. Table 2 depicts the major outcomes among the three groups. Conclusions: For COVID-19 patients on ECMO, insertion of CTs percutaneously by IR is associated with significantly fewer bleeding episodes, transfusions, thoracic consults and explorations in the operating room compared to bedside OT or percutaneous CTs. One third of the percutaneously placed CTs by IR required tube upsizing in the IR suite, a rate still lower compared to the overall CT manipulations or repeat interventions required for CTs inserted via OT or percutaneously at bedside. (Table Presented).

11.
ASAIO Journal ; 68:64, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2032183

RESUMO

Background: Patients requiring extracorporeal membrane oxygenation (ECMO) frequently necessitate tracheostomy due to prolonged mechanical ventilation. SARS-CoV-2 infection has been associated with different coagulation disorders and may increase the risk of bleeding in high risk patients such as those requiring ECMO. Here, we aim to determine if SARS-CoV-2 increases the risk of bleeding after tracheostomy in ECMO patients. Methods: A retrospective review of all patients requiring ECMO at our institution between March 20 of 2020 and December 31 of 2021 was conducted. Patients requiring tracheostomy after ECMO were included. Demographics, COVID-19 status, tracheostomy approach and post-procedure bleeding events were collected. Statistical analysis was performed using student T-test for nominal variables and Chi-Square test for categorical variables. Results: A total of 267 patients required ECMO during the defined study period. Of these, 112 patients had tracheostomy placement and were included for analysis. Seventy-five percent (84/112) of tracheostomies were done percutaneously and 25% (28/112) were done using surgical open technique. Mean age was 46.2 years ±14.3, 68% were male, mean BMI was 29.9Kg/m2 ±5.5. Seventy patients (63%) had COVID-19. The remaining 42 (37%) required ECMO due to polytrauma, cardiogenic shock, and respiratory failure after other operations such as heart and lung transplant. Of the 112 tracheostomies performed, 34% (38/112) had severe bleeding after tracheostomy placement requiring blood transfusion or additional interventions to control the bleeding. Of the 70 patients with COVID-19, 47% had severe bleeding compared to 12% in the non-COVID-19 group (p=<0.001) (Table). Conclusion: The rate of severe bleeding after tracheostomy was significantly higher in patients with COVID-19 compared with those that did not have SARS-CoV-2 infection. COVID-19 status should be considered before tracheostomy in ECMO patients as it may increase the risk of bleeding complications (Table Presented).

12.
ASAIO Journal ; 68:63, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2032181

RESUMO

Background: In patients with COVID-19 and respiratory failure, class 3 obesity (body mass index > 40 kg/m2) has been associated with worse survival. Obese patients on mechanical ventilation with progressively more severe acute respiratory syndrome (ARDS) may be offered venovenous (VV) extracorporeal membrane oxygenation (ECMO) therapy. The impact of morbid obesity on the outcome of COVID-19 patients supported with VV ECMO has been underexplored. Methods: This is a multicenter, retrospective observational cohort analysis of critically ill adults with COVID-19 ARDS requiring advanced mechanical ventilation with or without VV ECMO. Data was collected from 236 international institutions forming the COVID-19 Critical Care Consortium international registry. Patients were admitted between January 2020 to December 2021. Included patients were stratified by ECMO status and a BMI threshold at 40 kg/m2. Median values with interquartile range (IQR) were used to summarize continuous variables and multi-state analysis was used to explore the effect of Class 3 obesity on the study endpoints of patient survival to discharge or death. Results: Complete data was available on 8851 of 9059 patients on mechanical ventilation, of which 767 patients required VV ECMO. For the entire study group, older age and male gender were associated with an increased risk of death. The demographics and comorbidities of the higher BMI (H >40 kg/m2) and lower BMI (L ≤40 kg/m2) cohorts were similar with the exception of age and weight. Patients with a higher BMI were younger. The median age of the H, non-ECMO cohort was 56 years (46-64), and the H, ECMO cohort was 41 years (35-51) versus the L, non-ECMO cohort of 64 years(55-71), and the L, ECMO cohort of 53years (45-60). Patients requiring VV ECMO had higher SOFA scores, experienced longer ICU and hospital lengths of stay, and a longer duration of total mechanical ventilation. Table The median time to intubation was longer in the mechanical ventilation only group (2 versus 0 days). Predictors for requiring ECMO included younger age, higher BMI and male gender. Risk factors for death included advancing age (every 10 years), male gender and increasing BMI (every 5kg/m2). The association between BMI and a higher rate of death was reduced in the mechanical ventilation only group (HR 0.92, 95% confidence interval 0.85 to 0.99). Conclusion: In patients with severe ARDS due to COVID-19 requiring mechanical ventilation, the likelihood of progressing to VV ECMO therapy or experiencing death is impacted by age, gender and higher BMI. The cohort of COVID-19 patients that ultimately required ECMO appear to be sicker at time hospital admission owing to the shorter time until mechanical ventilation. It appears the association between increasing BMI and death differs among the ECMO and mechanical ventilation alone cohorts. We would advocate for a prospective study to determine the benefit of VVECMO for the obese patient requiring VV-ECMO for COVID-19 ARDS. (Figure Presented).

13.
ASAIO Journal ; 68:61-62, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2032179

RESUMO

Background: Patients with severe COVID-19 related respiratory failure may require veno-venous extracorporeal membrane oxygenation (VV ECMO). After decannulation, patients on VV ECMO have historically had high percentages of cannula-associated deep vein thrombosis (CaDVT). Due to their hypercoagulable state and prolonged course on VV ECMO, we hypothesized that patients with COVID-19 would experience a higher rate of CaDVT when compared to their non-COVID-19 counterparts. We also described the association between location and size of cannula in the development of CaDVTs. Methods: This was a single center retrospective review of patients ≥ 18 years old who were treated with VV ECMO and decannulated from January 1, 2014, to January 10, 2022. Patients who were placed on VV ECMO due to trauma and patients who were cannulated for veno-arterial ECMO were excluded. Patients were managed in a dedicated Lung Rescue Unit and anticoagulated with a heparin infusion at a goal partial thromboplastin time (aPTT) of 45-55 or 60-80 depending on the presence of clotting complications. Post-decannulation venous duplexes were performed 24 hours after decannulation and if positive for DVT, performed again in 2 weeks. Univariate and multivariate analyses were conducted to analyze our primary outcome of the development of CaDVT. Results: A total of 291 patients met our inclusion criteria: 76 COVID-19 VV ECMO patients and 215 non-COVID-19 VV ECMO patients. Decannulated COVID-19 VV ECMO patients had a significantly higher body mass index (BMI) (35.8, 32.9, p= 0.03) and length of ECMO run (hours) (660, 312, p< 0.001) than their non-COVID-19 counterparts. Most decannulated patients in both groups received post-decannulation duplexes (96%, 99%, p= 0.45). COVID-19 and non-COVID-19 patients decannulated from VV ECMO both experienced high incidences of CaDVT on initial post-decannulation ultrasound (95%, 88%, p= 0.13). COVID-19 patients were more likely to have multiple CaDVTs (32%, 11%, p< 0.001). Patients with COVID- 19 experienced a higher rate of right common femoral CaDVT (47%, 17%, p< 0.001) and a higher percentage of 25 French drainage cannula CaDVT (48%, 18%, p< 0.001). COVID-19 VV ECMO patients had a significantly higher incidence of persistent CaDVT on repeat ultrasound (78%, 56%, p= 0.03). A logistic regression was performed with all decannulated patients. Age, BMI, hours on ECMO, COVID-19 status, and size and location of ECMO cannulas did not predict the presence of DVT. Conclusion: Both COVID-19 and non-COVID-19 VV ECMO patients had high rates of CaDVTs. The utilization of VV ECMO in COVID-19 respiratory failure was associated with a higher incidence of CaDVTs on repeat ultrasound as compared to patients with non-COVID-19 related respiratory failure. Regular post-decannulation screening, treatment, and follow up imaging should be performed. Further investigation into the effect of anticoagulation strategy is needed. (Table Presented).

14.
ASAIO Journal ; 68:5, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2032177

RESUMO

Hypercapnia and respiratory acidosis lead to increased morbidity and mortality in critically ill patients. Extracorporeal CO2 removal (ECCO2R) can rapidly correct pH and PaCO2 as a treatment for refractory, hypercapnic respiratory failure. Current clinical evidence for the benefits of ECCO2R is primarily limited to case series and single-center studies. The Hemolung (ALung Technologies, Inc., Pittsburgh, PA) is the only FDA cleared ECCO2R system and has been utilized to treat greater than 1,000 patients world-wide. The purpose of this study was to evaluate real-world evidence of the Hemolung ECCO2R system for the treatment of hypercapnic respiratory failure across a range of primary diagnoses. Methods: The Hemolung Registry was queried for patients with a baseline, pre-Hemolung pH < 7.35. Patients receiving either noninvasive or invasive ventilation were included in the analysis. Physiological benefits of Hemolung therapy were evaluated using a mixed model for repeated measures based on changes in pH and PaCO2 after 4-6 hrs and 16-35 hrs of Hemolung therapy compared to the baseline value. The model was used to calculate two-sided 95% confidence intervals and associated nominal p-values. Additional markers of clinical improvement included avoidance of intubation, survival to decannulation, and Hemolung CO2 removal rate and duration of use. Adverse events were also analyzed based on patient harm. Results: 176 Hemolung patients were included in the analysis. Multiple primary diagnoses were represented: 31% ARDS, 22% COPD exacerbation, 32% COVID-19, and 15% Other. Median CO2 removal by the Hemolung during the first day of therapy was 88 mL/min and resulted in a concomitant correction of pH from a median of 7.20 to 7.35 (p<0.001) and median PaCO2 correction of 81.7 to 57.0 mmHg (p<0.001). Correction of respiratory acidosis was independent of primary diagnosis, age, and BMI. 69% (112/162) of patients survived to de-cannulation. 86% (19/22) of patients failing NIV avoided intubation. There were no unanticipated complications, and the majority of adverse events did not require medical intervention or discontinuation of Hemolung therapy. 3 deaths associated with Hemolung therapy occurred. Conclusion: These data represent the largest reported analysis of ECCO2R therapy to treat a diverse population of hypercapnic respiratory failure patients. The results demonstrate significant correction of pH and PaCO2 within the first day of Hemolung therapy without significant adverse events. Data from forthcoming RCTs will shed further light on whether these physiologic benefits translate to improved outcomes compared to current standard of care.

15.
HemaSphere ; 6:373-375, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2032169

RESUMO

Background: Patients with red blood cell disorders (RBCD), are likely to be at increased risk of complications from SARS-Co-2 (Coid-19), but eidence in this population is scarce due to its low frequency and heterogeneous distribution. Aims: ERN-EuroBloodNet, the European Reference Network in rare hematological disorders, established a European registry to determine the impact of COVID-19 on RBCD patients and identify risk factors predicting seere outcomes. Methods: The ERN-EuroBloodNet registry was established in March 2020 by VHIR based on Redcap software in accordance with the Regulation (EU) 2016/679 on personal data. The local Research Ethics Committee confirmed that the exceptional case of the pandemic justifies the waier of informed consent. Eligible patients had confirmed RBCD and COVID-19. Data collected included demographics, diagnosis, comorbidities, treatments, and COVID-19 symptoms and management. For analysis of COVID-19 seerity, two groups were established 1) Mild: asymptomatic or mild symptoms without clinical pneumonia and 2) Seere: pneumonia requiring oxygen/respiratory support and/or admission to intensie care unit. Continuous ariables were compared using the Wilcoxon rank-sum test or Kruskall Wallis test, while categorical ariables were analyzed using the Chi-square test or Fisher's Exact test. Releant factors influencing disease or seerity were examined by the logistic regression adjusted for age. Results: As of February 25, 2022, 42 medical centers from 10 EU countries had registered 428 patients: 212 Sickle cell disease (SCD), 186 Thalassemia major and intermedia (THAL). The mean age of SCD was lower (22y) than of THAL (39.4y). Splenectomy and comorbidities were higher in THAL (51.4% and 61,3%) than in SCD (16,3% and 46,8%) (p<0.001, p=0.004). Age and BMI correlated with COVID-19 seerity, as described in the general population (p=0.003, p<0.001). Fig 1 shows age distribution and COVID-19 seerity by disease seerity groups. The mean age for seere COVID-19 was lower in patients with seere SCD (SS/SB0 s SC/SB+: 23y s 67.5y) and THAL (major s intermedia: 43.5 s 51.3y) (p<0.001). Potential risk factors such as eleated ferritin, current chelation or history of splenectomy did not confer additional risk for deeloping seere COVID-19 in any patient group. Only diabetes as a comorbidity correlated with seerity grade in SCD (p=0.01) and hypertension in THAL (p=0.009). While seere COVID-19 infection in SCD was associated with both ACS (p<0.001) and kidney failure requiring treatment (p<0.001), this was not predicted by a history of preious ACS or kidney disease in steady state. Oerall, 14,6% RBC patients needed oxygen/respiratory support, 4% were admitted to ICU with an oerall mortality rate of 1%, much lower than reported in other similar cohorts. Hospital Son Espases, Palma de Mallorca, Spain;54 Clinical Pharmacology Serice, Hospital Uniersitari Vall d'Hebron, Barcelona, Spain;55 Vall d'Hebron Institut de Recerca, Barcelona, Spain;56 Diision of Hematology and Oncology, Department of Internal Medicine, American Uniersity of Beirut Medical Center, Beirut, Lebanon;57 UOC Pediatric Hematology Oncology, Uniersity of Padoa, Padoa, Italy;58 Department of Haematology, Oxford Uniersity Hospitals NHS Foundation Trust, Oxford, United Kingdom;59 Translational Research in Child and Adolescent Cancer, Vall d'Hebron Institut de Recerca, Barcelona, Spain Background: Patients with red blood cell disorders (RBCD), are likely to be at increased risk of complications from SARS-Co-2 (Coid-19), but eidence in this population is scarce due to its low frequency and heterogeneous distribution. Aims: ERN-EuroBloodNet, the European Reference Network in rare hematological disorders, established a European registry to determine the impact of COVID-19 on RBCD patients and identify risk factors predicting seere outcomes. Methods: The ERN-EuroBloodNet registry was established in March 2020 by VHIR based on Redcap software in accordance with the Regulation (EU) 2016/679 on personal data. The local Research Ethics Committee confirm d that the exceptional case of the pandemic justifies the waier of informed consent. Eligible patients had confirmed RBCD and COVID-19. Data collected included demographics, diagnosis, comorbidities, treatments, and COVID-19 symptoms and management. For analysis of COVID-19 seerity, two groups were established 1) Mild: asymptomatic or mild symptoms without clinical pneumonia and 2) Seere: pneumonia requiring oxygen/respiratory support and/or admission to intensie care unit. Continuous ariables were compared using the Wilcoxon rank-sum test or Kruskall Wallis test, while categorical ariables were analyzed using the Chi-square test or Fisher's Exact test. Releant factors influencing disease or seerity were examined by the logistic regression adjusted for age. Results: As of February 25, 2022, 42 medical centers from 10 EU countries had registered 428 patients: 212 Sickle cell disease (SCD), 186 Thalassemia major and intermedia (THAL). The mean age of SCD was lower (22y) than of THAL (39.4y). Splenectomy and comorbidities were higher in THAL (51.4% and 61,3%) than in SCD (16,3% and 46,8%) (p<0.001, p=0.004). Age and BMI correlated with COVID-19 seerity, as described in the general population (p=0.003, p<0.001). Fig 1 shows age distribution and COVID-19 seerity by disease seerity groups. The mean age for seere COVID-19 was lower in patients with seere SCD (SS/SB0 s SC/SB+: 23y s 67.5y) and THAL (major s intermedia: 43.5 s 51.3y) (p<0.001). Potential risk factors such as eleated ferritin, current chelation or history of splenectomy did not confer additional risk for deeloping seere COVID-19 in any patient group. Only diabetes as a comorbidity correlated with seerity grade in SCD (p=0.01) and hypertension in THAL (p=0.009). While seere COVID-19 infection in SCD was associated with both ACS (p<0.001) and kidney failure requiring treatment (p<0.001), this was not predicted by a history of preious ACS or kidney disease in steady state. Oerall, 14,6% RBC patients needed oxygen/respiratory support, 4% were admitted to ICU with an oerall mortality rate of 1%, much lower than reported in other similar cohorts. Summary/Conclusion: Results obtained so far show that seere COVID-19 occurs at younger ages in more aggressie forms of SCD and THAL. Current preentie approaches focus on age oer disease seerity. Our data highlights the risk of seere COVID-19 infection in some young patients, particularly those with SS/SB0 SCD, suggesting that immunization should be considered in this pediatric group as well. Results between similar sized cohorts of RBCD patients ary between each other and those presented here, highlighting the importance of collecting all of these small cohorts together to ensure adequate statistical power so that definitie risk factors can be reliably identified and used to guide management of patients with these rare disorders in the light of the ongoing pandemic. (Figure Presented).

16.
HemaSphere ; 6:3524-3525, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2032095

RESUMO

Background: Infections contribute to an early mortality risk of 15 percent in newly diagnosed multiple myeloma(NDMM) cases. There is a limited literature on the type of infections in fully vaccinated NDMM patients. Aims: To study epidemiology, clinical profile and predictors of infection in NDMM who are immunised against pneumococci and influenza. Methods: NDMM patients were prospectively studied for 6 months for the pattern of infections . All patients were vaccinated with pneumococcal and Influenza vaccine at diagnosis. PJP prophylaxis and fluconazole prophylaxis was given for patients receiving high dose steroids while acyclovir was given to all. Infections were classified as microbiologically defined, clinically defined and fever of unknown focus according to definitions published by the International Immunocompromised Host Society. Severity of infections were graded according to the NCI CTCAE Ver5. Results: Forty-eight NDMM patients with a median age 55 years comprising of 26 males and 22 females were enrolled. Renal involvement was noted in 42% of enrolled patients and two third of them required renal replacement therapy. ISSIII and R-ISS III were 70.8 % and 62.5 % respectively. 85% had poor performance status(ECOG ≥2) at baseline. RVD was the most common regimen (37%)used. 6 patients received daratumumab based regimen. Treatment response of atleast VGPR was seen in 97 % of NDMM patients. A total of 19 episodes of infections were observed during 6 months. All episodes of infections were reported in the first 45 of myeloma diagnosis(Median 6 days;Range 0-45). Ten of these episodes of infection were diagnosed during the initial evaluation for myeloma defining events. Microbiological diagnosis was possible in 63 %. Commonest infectious agent was COVID 19(n=8) followed by Gram negative bacteria (n=5) viz E.coli and Klebsiella pneumoniae . None of the eight patients who developed COVID 19 infection had received COVID vaccine as they antedated the operationalisation of national guidelines for immunisation. Respiratory and the urinary tract were the most common focus of infection. All critically ill COVID patients succumbed to progressive respiratory failure and all patients with mild and moderate COVID illness recovered uneventfully. Early mortality in our cohort of forty eight patients was twenty percent(n=10). Three fourths of infections in our cohort were Grade≥3 severity. A total of seven deaths were attributable to infectious diseases in this cohort of NDMM patients. Imune paresis was seen in eighty four percent of patients at diagnosis. On follow up at 6 months;immune paresis had persisted in only thirty seven percent. Regression analysis of variables with odds of infection is shown in Table 1 Baseline BMI<18.5 kg/m2;albumin<3g/dl and ISS or R-ISS stage ≥ 2 was found to be have statistically significant odds of predicting infection risk in the cohort of patients. The choice of myeloma regimen, presence of high risk cytogenetics and response to therapy did not correlate with increased odds of infection in our cohort. Summary/Conclusion: Conclusion In this prospective study of NDMM patients vaccinated against pneumococci and influenza at baseline;infection attributable early mortality was 14.5 %. Advanced stage of presentation, hypoalbuminemia and baseline BMI < 18.5 kg/m2 correlated with increased odds of infection. COVID vaccination and COVID appropriate behavioural practices may mitigate COVID related outcomes including deaths in myeloma patients.

17.
Stigma and Health ; 2022.
Artigo em Inglês | Web of Science | ID: covidwho-2031816

RESUMO

As weight status is frequently associated with health and the COVID-19 pandemic has raised attention to weight status, we used a cross-sectional mixed-methods design to explore how weight status or body size is described when defining health. We recruited 288 participants who were 18 years and older and living in the United States to complete a study about health and health behaviors during the pandemic. First, we used directed content analysis to explore if and how weight status/body size is described when asked to define health. Next, we used intensity sampling and a constant comparison approach to assess whether descriptions of health differed by diagnosis of a chronic disease, sex, and weight bias internalization. Seventy percent (n = 202) of participants described an aspect of weight, body size, or shape when defining health, the majority of which (65%) indicated someone could be unhealthy due to their weight or size. Only 29% (n = 84) of participants implied or directly stated a person could be healthy regardless of weight or size. There 4 were no significant differences in the description of health by chronic disease status or weight bias internalization. Women included health behaviors more frequently than men. Our findings indicate that weight was inextricably linked with health among most adults in the United States. To promote health and reduce the damaging effects of weight stigma, it is imperative that preventive interventions and policies include weight-inclusive messages that underscore the importance of the multiple indicators of health, beyond weight and size.

18.
Gynecologic Oncology ; 166:S251, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2031758

RESUMO

Objectives: To determine (1) if health disparities experienced by rural, obese endometrial cancer survivors (ECS) were exacerbated by the COVID-19 pandemic and (2) preferred components and delivery methods for behavioral interventions. Methods: A cross-sectional survey was distributed to obese, early- stage ECS to ascertain demographic information, physical activity (PA level), self-efficacy, lifestyle intervention preferences, as well as the impact of COVID-19 on PA, diet, and mental health. Responses were compared between obese (BMI= 30-39.9 kg/m2) and morbidly obese (BMI= 40+ kg/m2) survivors as well as those who did or did not meet national PA recommendations. Results: Among 335 eligible survivors, only 70 (20.9%) completed the survey. The median age was 63 years (IQR: 14 years). Survivors were 37 months from diagnosis (IQR: 37 months). The median BMI was 39.2 kg/m2 (IQR: 8.4 kg/m2). Overall, only one-quarter of ECS were fairly or fully confident in their ability to undertake moderate PA. More morbidly obese survivors reported low self-efficacy in performing moderate PA than obese survivors (90% vs 65%;p= 0.02). Pre COVID-19, 66% of survivors did not meet PA guidelines and were more likely to be morbidly obese than obese, but the difference was not significant (78% vs 58%;p=0.08). Post COVID-19, 83% of survivors did not meet PA guidelines, with no difference between BMI groups (82% vs 84%;p>0.05). After COVID-19, 54% of survivors reported a decrease in PA, 32% made poorer nutritional choices, and 47% reported worsening mental health. Post COVID-19, no difference in the nutrition or mental health changes was seen between survivors who were meeting PA guidelines and those who were not (p>0.05). Regarding lifestyle interventions, survivors preferred information delivered electronically (online (56%) or via email (41%)) versus in person (30%) or via text (21%). Preferences for PA included exercising at home (46%) or online with a coach (33%) versus with a group fitness class (18%) or at the gym (17%). Combining health promotion with exercise was appealing to the majority of participants (37%), while others were not interested (27%) or unsure (31%). Responses were similar between patients meeting and not meeting PA recommendations (p>0.05). The most preferred lifestyle intervention components included tracking progress (56%), health recipes (56%), one-on-one counseling (46%), tips for cheap and healthy eating (41%), exercising alone (41%), and online sessions (39%). Conclusions: As a result of COVID-19, rural, obese ECS experienced a decrease in PA, worse nutritional decision-making, and poorer mental health. Preferred components of lifestyle interventions in this patient population were identified and can be used to develop future, evidence-based behavioral interventions. These interventions may be scalable in rural communities with limited access during the COVID-19 pandemic and beyond.

19.
Gynecologic Oncology ; 166:S152-S153, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2031754

RESUMO

Objectives: Obesity is an epidemic in gynecologic oncology, leading to an increased risk of surgical complications and poor cancer outcomes. Cognitive-behavioral therapy (CBT) is an effective weight loss strategy. We aimed to determine whether group CBT is an effective weight loss tool when offered in an outpatient gynecologic oncology setting. Methods: We established a CBT-based weight management intervention for gynecologic oncology patients at an NCI-designated cancer center. The intervention was a 12-week group-based weight loss program offered to patients from the gynecologic oncology clinic with body mass indices (BMI) between 25-50 kg/m2. Sessions were free of charge, led by a psychologist and dietitian, and transitioned from in-person to tele-visits due to the COVID-19 pandemic. The program combined nutritional education, lifestyle changes, and CBT approaches, with 12 weekly group visits followed by three monthly individual follow-up visits. Each participant was given a goal weight loss of 7% total body weight (TBW). Retrospective data were collected from patients enrolled in the intervention from September 2019 through March 2021. Paired t-tests were performed to compare the pre-program and ending weights for all participants. Weight loss data were tested for normality using the Shapiro-Wilk test. Results: A total of 29 patients were enrolled in four cohorts during the study timeframe. Fifty-nine percent of participants were White, 38% were Black. The mean age among participants was 56 years, and the mean BMI was 41 kg/m2. Most participants had a history of endometrial hyperplasia or malignancy (58%) and had stage I disease (59%). Among the participants, 22 (76%) completed the program. The average weight loss among all participants during the 12-week program was 5.6 pounds (CI: -8.9- -2.1, p = 0.002), equivalent to an average 2% change in TBW. Among the 22 participants who completed the program, the average weight loss was 7.4 pounds (CI: -11.1- -3.8, p <0.001), equivalent to an average 3% change in TBW. Weight loss was sustained at the 6-month mark, with an average change in TBW of 2-3% when comparing weight at 6 months to pre-program weight. Conclusions: This CBT-based weight loss intervention was feasible and acceptable to gynecologic oncology patients. While the average weight loss fell short of the goal of 7% TBW, the 2-3% change in TBW achieved on average with this intervention was stable over six months. Additionally, retention within the intervention was high and maintained during COVID-19 with tele-visits. Given that weight loss plateaued when transitioning from weekly to monthly sessions, our findings suggest that longer, more intensive treatment may be needed to promote sustainable weight loss among gynecologic oncology patients. Collaboration between psychologists, oncology dietitians, and gynecologic oncologists, with continued support for psychologists and dieticians at cancer centers, is critical to the success of such programs. CBT is a feasible behavioral intervention to add further multidisciplinary efforts to tackle the complexity of obesity in cancer survivors. [Formula presented]

20.
Gynecologic Oncology ; 166:S7, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2031752

RESUMO

Objectives: To evaluate the surgical volume, surgical outcomes, and the evolving role of gynecologic oncologists in peripartum hysterectomies (PPH). Methods: We conducted an IRB-approved retrospective chart review of PPH cases performed at our institution from June 1, 2014, to June 30, 2021. Clinical-pathologic information was ed into a REDCap database. All analyses were conducted using STATA 17. Results: A total of 109 cases were performed over the 7-year period. Gynecologic oncologists (GYO) involvement in the cases increased from 33% in 2014 to 80% in 2021. The mean age was 36 (range: 23-47) years. Most patients were White (81/109, 74.3%), and the median BMI was 30.7 (range: 21-57) kg/m2. Surgical indications included placenta accreta syndrome (PAS) in 84 (77%) cases, uterine atony in ten (9.2%), uterine rupture in three (2.8%), malignancy in five (4.6%), and hemorrhage other than atony in seven cases (6.4%). Intraoperative complications included bladder injury (or intentional dissection) in eight (7.3%), ureter injury in four (3.7%), vascular injury in three (2.8%), and femoral pseudoaneurysm in one (0.9%) of the cases. Postoperative complications included urinary tract infection in 11 (10.1%), nerve injury in one (0.9%), surgical site infection in 13 (11.2%), and venous thromboembolism in five (4.6%) cases. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) usage started in 2019 with one case followed by six cases in 2020 (31.6%) and 3/16 cases in the first half of 2020 (15.8%). A higher REBOA usage in 2020 corresponded with blood products shortages during the COVID crisis.[Formula presented] Conclusions: Overall volume and complexity of peripartum hysterectomy are increasing. This trend is likely driven by an increased incidence of placenta accreta syndrome cases. Gynecologic oncologists are increasingly delegated as primary surgeons in many institutions. Fellowship training programs should strongly consider training in peripartum hysterectomy for trainees.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA