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1.
Surgery for Obesity and Related Diseases ; 18(8):S60, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2004518

RESUMO

Katarina Bade Hartford CT CT1, Richard Seip Hartford CT1, Tara McLaughlin Vernon Rockville CT1, Darren Tishler Glastonbury CT1, Ilene Staff Hartford CT2, Connie Santana Glastonbury CT1, Aziz Benbrahim MERIDEN CT3, Meagan Moskowitz Meriden CT3, Pavlos Papasavas Hartford CT1 Hartford Hospital1 Hartford Hospital2 Mid State Medical Center3 Introduction: Safe and effective weight loss immediately following bariatric surgery occurs in concert with both social and medical support. Interruption of support networks may threaten weight loss. During the COVID19 pandemic, a Connecticut state-mandated “lockdown” from 3/15 to 5/18/2020 suspended in-person services and interrupted social support. We investigated the effect of exposure to 63 days of COVID lockdown within 12 months of index sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) on weight loss. Methods: This single center, retrospective chart review identified 1057 patients with 1 year follow-up data who underwent SG or RYGB from 1/9/2016 to 12/30/20. Controls (Group C) (SG n750, RYGB n130) completed surgery and follow up from 1/9/2016 to 3/15/20, before lockdown. Lockdown patients (Group L) (SG n159, RYGB n18) completed surgery before 3/15/20, and follow up after the lockdown (5/20/20 to 12/31/2020). Weight loss (WL) was compared between C and L, within surgery types. Results: Within surgery type, pre-surgery characteristics differed little between L and C (Table 1, top). Days to follow-up, and absolute and relative weight changes did not differ between L and C. Within L, 16% of SG patients and 20% of RYGB patients experienced virtual (telemedicine) visits with bariatric clinicians during follow-up, compared to 0.6% in Group C. Conclusion: We detected no effect of 63 days of COVID lockdown on measures of weight change at 1 year post SG or RYGB. Telemedicine visits may be useful to maintain/improve clinical management of surgical weight loss during suspension of live health services.

2.
JACCP Journal of the American College of Clinical Pharmacy ; 5(7):743, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2003602

RESUMO

Introduction: Conservative fluid management is a cornerstone of therapy for Acute Respiratory Distress Syndrome (ARDS). Existing studies of loop diuretics have had difficulty achieving goal urine output (UOP) and evaluations of adjunctive albumin have been limited by heterogeneous cohorts. Research Question or Hypothesis: Hypoalbuminemic patients with ARDS are more likely to exhibit a positive response to loop diuretics with adjunctive albumin than patients with normal serum albumin. Study Design: Single-center, retrospective observational study Methods: Adult patients were included if admitted to an intensive care unit (ICU) from January 2016 to September 2021 and received loop diuretic and albumin within one hour of each other. Exclusion criteria included liver failure, dialysis, pregnancy, trauma or positive test for SARS-COV-2. Patients were divided into two groups (low and normal) by baseline serum albumin, where low albumin was defined as ≤ 3.5g/dL. The primary outcome was the percentage of patients with a positive response to combination therapy, defined as UOP ≥ 600mL within six hours of the last agent being administered. Secondary outcomes included UOP at six hours and change in body weight, oxygenation, and serum albumin at 24 hours. Chi-squared and Mann- Whitney U tests were used for nominal and continuous variables, respectively with alpha <0.05 used to determine significance. Results: 102 patients were in the low-albumin group and 73 in the normal-albumin group. 61 (56%) were positive responders in the lowalbumin group, compared to 43 (64%) in the normal-albumin group (p=0.313). Patients in low-albumin group had a greater change in serum albumin (p<0.001) at 24 hours. No other secondary outcomes were statistically significant. Conclusion: Patients with low albumin were no more likely to have a positive response to adjunctive albumin therapy with loop diuretics than patients with normal albumin. Heterogeneity of administration exist and should be further explored.

3.
Cytotherapy ; 24(5):S24-S25, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1996711

RESUMO

Background & Aim: Cytokine Release Syndrome (CRS) and Immune effector Cell-Associated Neurotoxicity Syndrome (ICANS) are related side effects of immunotherapies seen in up to 76% of patients treated with CAR-T and 48% of those treated with BiTEs. In up to 27% of the patients, these syndromes may lead to severe consequences. Current treatments for severe CRS are ineffective in >30% of the cases and can worsen ICANS prognosis, calling for novel treatments, especially in light of the expanding use of immunotherapies. Despite their obvious potential, mesenchymal cell (MSC) therapies were seldom investigated in this context. In the present study, Bonus BioGroup has set to assess the potential for treating CRS with MesenCure™, our allogeneic MSC platform, professionalized to enhance the cells’ potency and shown safe and effective in severe COVID patients. Methods, Results & Conclusion: A highly translational and validated CRS model was established in humanized NSG mice bearing human PBMCs, B-cell lymphoma, and CAR-T cells. CAR-T introduction significantly increased the serum levels of proinflammatory cytokines in model animals, indicative of CRS (Fig. 1A). Two IV MesenCure injections were well-tolerated in this model (Fig. 1B) and did not obstruct the CAR-Ts’ ability to inhibit tumor growth by 89% (Fig. 1C, p<0.0001). Remarkably, significant reductions in all proinflammatory cytokines tested (excluding IL-6) were measured in model animals treated with MesenCure, substantiating its potential to treat CRS (Fig. 1A). Interestingly, the magnitudes of these reductions resembled those observed in 50 severe COVID patients treated with MesenCure. MesenCure’s robust immunomodulatory capacity was further demonstrated in vitro by its ability to inhibit the proliferation of activated CD4 T cells with an IC50 of 6k MSC/200k PBMCs, twice more effectively than non-professionalized MSCs. Comparable results were also obtained with CD8 T cells. Similarly, MesenCure inhibited neutrophils’ ROS production by up to 80% within an hour following activation (IC50 19k MSC/200k neutrophils). These effects are likely mediated, in part, by IDO, whose RNA levels were found to be 6.8-fold higher in MesenCure cells than in non-professionalized MSCs (p<0.05), two hours after activation with IFNγ. Moreover, IDO inhibition by 1-MT (1 mM) reduced MesenCure’s (Figure Presented) Fig. 1 (A) The levels of serum proinflammatory cytokines measured in tumor-bearing NSG mice after CRS induction by injection of human PBMCs/CAR-Ts (or saline control) and MesenCure treatment (or saline control). Experimental groups’ designation: Control – not injected with PBMCs/CAR-Ts and not treated by MesenCure;CAR-T – CRS model animals, injected with PBMCs/CAR-Ts but not treated with MesenCure;MesenCure – treated with MesenCure but not injected with PBMCs/CARTs;and CAR-T + MesenCure – CRS model animals treated with MesenCure. (B) Relative change in body weight from the day of tumor induction (Day 0) and (C) IVIS analysis of tumor burden (dorsal aspect) in the above four experimental groups. Statistical significance indicators: ns – not significant, * p<0.05, *** p<0.001, **** p<0.0001. Statistical tests: Holm-Šídák’s multiple comparisons test (A) and two- sided t-test (C). ability to inhibit T cells’ proliferation by 73%. In conclusion, we provide the first evidence for the potential of MSCs and MesenCure, in particular, for treating immunotherapy-related CRS.

4.
Journal of Adolescent Health ; 70(4):S19-S20, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1936659

RESUMO

Purpose: Eating disorders in male populations are underrecognized and undertreated, leading to delays in identification, diagnosis, and treatment. Although male adolescents and young adults generally have greater energy requirements than females due to greater body weights, metabolic response, and exercise, current inpatient nutritional refeeding protocols support a single caloric prescription regardless of sex. The objective of this study was to determine sex differences in nutritional refeeding outcomes among adolescents and young adults hospitalized for eating disorders. Methods: We retrospectively reviewed electronic medical records of 601 patients aged 9-25 years admitted to a tertiary care center for medical and nutritional management, between May 2012 and August 2020. We collected demographic, clinical, and nutritional characteristics (including initial calorie prescription, discharge kilocalories [kcals], weight change, and length of stay) from the electronic medical record. Descriptive statistics, unadjusted, and adjusted linear regression models were used to assess the association between sex and nutritional outcomes, as well as length of stay. Results: A total of 588 adolescents and young adults met eligibility criteria, [16% male, mean (SD) age 15.96±2.75, 71.6% anorexia nervosa, admission percent median body mass index (%mBMI) 87.1±14.1]. In unadjusted comparisons, there were no significant sex differences in prescribed kilocalories (kcal) per day at admission (2013 vs. 1980 kcal, P=0.188);however, males had higher Estimated Energy Requirements (EER) (3694 vs. 2925 kcal, P<0.001). In linear regression models adjusting for potential confounders including age, race/ethnicity, and diagnosis, male sex was associated with higher prescribed kcals at discharge (B=855 kcal, p<0.001), greater weight change (B=0.50 kg, p=0.016), and longer length of stay (B=1.83 days, p=0.001) than females. Older age, lower admission weight, lower prescribed kcal at admission, higher EER, and lower heart rate at admission were factors associated with longer length of stay in linear regression models. In these adjusted models, every 1000 lower kcal prescribed at admission was associated with a 3.99 day longer length of stay while every 1000 greater kcal in the EER was associated with a 1.61 day longer length of stay. Conclusions: We report for the first time that males hospitalized for eating disorders require higher kcal/day at discharge than females despite clinical protocols that standardize the beginning kcal/day regardless of sex. This may lead to longer hospitalizations for male adolescents and young adults with eating disorders. These findings suggest that current refeeding approaches may be insufficient for male patients and support the development of individualized treatment protocols for males with eating disorders. Given the rise in hospitalizations for eating disorders during the COVID-19 pandemic, these findings can improve quality of care and healthcare efficiency among an underserved population in a post-pandemic world. Sources of Support: K08HL159350.

5.
Journal of Hypertension ; 40:e179-e180, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1937741

RESUMO

Objective: Since 2019, the rapid spread of the SARS-CoV-2 virus and the resulting pandemic, has influenced daily life significantly. Hypertensive patients were amongst the affected group due to psychological reasons and the sudden change in daily routine. In this study we present a group of patients from our hypertension outpatient clinic and we showcase the effect of the current pandemic to their daily life aspects. Design and method: We contacted 647 patients from our hypertension management outpatient clinic and through a questionnaire we assessed changes in body activity and body weight in the past six months. The patients were then divided in four groups according to their answers: 1. No change in body weight, but exercised daily (NC/E) 2. No change in body weight, but did not follow a routine exercise schedule (NC/NE) 3. Increase in body weight, but exercised daily (I/E) 4. Increase in body weight, but did not follow a routine exercise schedule (I/ NE) Results: The results of our study are presented in the graphs bellow: It is worth noting that all groups but the first one (NC/E) reported an average increase in systolic blood pressure (SBP) of at least 15 mmHg. This increase was most apparent in the fourth group (I/NE), which also reflected most of the patients, where the average increase of SBP was greater than 25 mmHg. Conclusions: The aim of this study is to shed a light in the possible effects of the SARS-CoV-2 pandemic in the life of the patients and more importantly how that affects the management of conditions such as hypertension. The resulting difference in body weight and SBP regulation between the groups can be attrib- uted to an inconsistent exercise schedule, a known factor of SBP management and also a possible by-product of the current pandemic.

6.
Journal of Paediatrics and Child Health ; 58(SUPPL 2):89, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1916248

RESUMO

Background: Obesity and excessive gestational weight gain are associated with adverse pregnancy outcomes. The impact of the COVID-19 pandemic on weight and weight gain during pregnancy are unknown. Methods: Retrospective cohort study of all singleton pregnancies before (January 2018-January 2020) and during the low prevalence first year of COVID-19 (February 2020-January 2021). Demographic data, booking BMI and rate of weight gain were compared between time periods. Results: 14908 patients (9544 before and 5364 during the COVID-19 first year) met the inclusion criteria. There was a trend towards higher booking BMI (25.5 ± 0.1 kg/m2 during vs 25.3 ± 0.1 kg/m2 before COVID-19, p = 0.08) and higher rate of obesity (17.0% vs 16.5%, p = 0.08) during the COVID-19 first year. Rate of weight gain in pregnancy was greater during COVID-19 (0.539 ± 0.006 kg/week vs 0.505 ± 0.004 kg/week, p < 0.001), driven by the greater difference in rate of 2nd trimester weight gain (0.664 ± 0.010 kg/week during vs 0.571 ± 0.007 kg/week before COVID-19, p < 0.001). After adjusting for maternal age, ethnicity, socioeconomic status and booking BMI, the COVID-19 first year was associated with significantly greater rate of weight gain (β = 0.02, p = 0.001). Rate of weight gain recommended for BMI was achieved in fewer pregnancies during COVID-19 (14.4% vs 16.3%, p = 0.007). Conclusions: The first year of COVID-19 was associated with a greater rate of gestational weight gain and a lower proportion of patients achieving recommended weight gain. This likely reflects the impact of COVID-19 restrictions in the community of Western Sydney and may have contributed to adverse pregnancy outcomes during the low prevalence first year of the COVID-19 pandemic.

7.
Journal of the Formosan Medical Association ; 121(7):1183-1187, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1914594
8.
Journal of Oncology Pharmacy Practice ; 28(2 SUPPL):31-32, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1868962

RESUMO

Background: With an increasing use of parenteral systemic anti-cancer therapy (SACT) for a growing cancer population, cytotoxic aseptic units in theUKare experiencing an increase in workload. Having finite production capacity, it is imperative to use resources efficiently to meet the growing demand for SACT. UCLH (University College London Hospitals) Macmillan Cancer Center is one of the largest cancer centers in London, providing chemotherapy treatment for around 350 patients with haematology or oncology conditions in day care unit each week. SACT provided at UCLH are either manufactured locally in UCLH cytotoxic unit or outsourced from commercial aseptic units. Nurses working in the day care unit noticed and reported increases in daily SACT wastage. Wastage of 1 item had increased to around 5 items since the Covid-19 pandemic. The aim of this improvement work was therefore to reduce wastage, and this would be achieved using quality improvement (QI) methodology. QI team was formed, and SMART objective agreed: reduce parenteral SACT wastage by 50% for day case treatments by 31st May 2021. Methods: During the pandemic new patient pathways were established. Using process mapping of these: doctor consultation to administration of SACT, it was identified that wastage was occurring due to 1) patients being unwell on the day of treatment, 2) unsatisfactory blood results and 3) weight changes. As a team we decided that the process to improve would involve obtaining advance weights for patients. We adopted the IHI (Institute for Healthcare Improvement) model for improvement with a series of PDSA (Plan-do-study-act) cycles. Our first change for PDSA cycle 1 was regular weight documentation by day care staff using a checklist To improve on these results we educated the oncology pharmacy team on weight checking when preparing for clinics and during SACT verification. Daily wastage and compliance to weight documentation were recorded throughout a three-week baseline data collection period and the two PDSA cycles. Results: The baseline data showed average daily wastage of 4 infusions. Following PDSA cycle 1 the number of SACT wastage reduced to 3 infusions a day. After PDSA cycle 2, this reduced to 2.2. The compliance to weight documentation improved from a baseline of 30% (n=80) to 95% (n=215). Discussion: There was a reduced SACT wastage following the PDSA cycles. It is unclear whether regular weight documentation and education on weight check have led to the improvement. Although the project aim has not been achieved, PDSA cycle 1 and 2 were thought to be good practice to ensure appropriate SACT dose prescribed while reducing patient waiting time in the unit. Therefore, both changes are likely to be sustainable. Similar improvement work can be carried out over a longer timeframe in the future to establish whether these changes can make a positive impact on improving SACT wastage.

9.
Journal of the Hong Kong College of Cardiology ; 28(2):91, 2020.
Artigo em Inglês | EMBASE | ID: covidwho-1743732

RESUMO

Objectives: Cardiac rehabilitation is the key component in optimizing physical function, reducing the cardiovascular risk and mortality for cardiac patients. However, as the coronavirus disease 2019 (COVID- 19) pandemic has begun since the end of 2019, usual service is affected. Patients' compliance and attendance to exercise training is worth concern and the general recommendation of 150-minute per week of moderate intensity exercise is almost unachievable. The limitation of routine health care delivery is explored. In order to increase patients' physical activity and prevent secondary complication, the Cardiac Society of Australia and New Zealand (CSANZ) recommended health care profession continued to deliver evidencedbased strategies with the use of electronic health platforms as it was more accessible during the pandemic. This study sought to examine the value of home virtual exercise in cardiac rehabilitation during COVID-19. Methods: Twenty-eight patients were recruited from the Cardiac Rehabilitation program (CRP) in Tseung Kwan O Hospital between December 2019 and August 2020. Patients who attended the CRP were under usual care receiving 1.5-hour center-based training 1-2 times per week. The home virtual exercise which was circuit training was given via QR code. All patients completed 12-sessions of CRP. Patients' safety, body weight and body mass index (BMI), 6 Minutes Walk Test (6MWT) distance, Five Times Sit To Stand (FTSTS) and Cardiac Exercise Self-Efficacy Instrument (CESEI) were measured at baseline and at end of 12th session. Results: No adverse events were reported in relation to home virtual exercise. Although there were no statistically changes in body weight and BMI (p>0.109), there were significant improvement in 6MWT distance (p=0.000), FTSTS (p=0.000) and CESEI (p=0.007). Conclusion: Home virtual exercise appears to be safe and effective for patients to exercise at home during COVID-19. Improvement in functional capacity and self-efficacy were observed, therefore, suggesting that home virtual exercise could be used in addition to center-based training to improve cardiovascular risk. Cardiac rehabilitation specialists should consider using electronic platforms during the pandemic to deliver exercise regimes. Future study is needed to explore the long-term effects of virtual exercise after program completion.

10.
Obesity ; 29(SUPPL 2):74, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1616085

RESUMO

Background: Due to the rising number of positive COVID-19 cases in the US, a national emergency was declared on March 13, 2020, and Tarrant County issued a stay-at- home order on March 24, 2020 to limit the spread of the new novel virus. The purpose of this study was to assess lifestyle changes across various categories of nutrition knowledge and BMI classifications in response to the global pandemic. Methods: For this mixed-methods cross-sectional study, 150 undergraduate students (n = 75 had not taken a nutrition class;n = 75 taken at least 1 nutrition class, mean age 20.8 ± 4.1yrs) completed a 59-question survey (∼29.9 ± 121.0min). The survey was adapted from the validated, shortened version of REAPS (Rapid Eating Assessment for Participants) and PLifeCOVID-19, and it included two open-ended questions. Results: Majority of participants reported a healthy BMI (56%), while 30% of individuals were overweight. The mean weight change in those who took nutrition classes was 0.55 ± 2.89kg, and the mean change in those with no nutrition classes was 0.65 ± 1.13kg. Of those that completed one or more nutrition class(es), 45% indicated they rarely or never skipped breakfast, alcohol consumption increased by 37% and 12% decreased the amount of moderative activity they were doing. Of those participants who had no nutrition classes, 28% skipped breakfast rarely or never skipped breakfast, alcohol consumption increased in 24% of participants, and 19% reduced the amount of moderate activity they were doing. Conclusions: The COVID-19 pandemic has differentially impacted health behaviors of college students, some for the better and some for the worse.

11.
Obesity ; 29(SUPPL 2):86, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1616064

RESUMO

Background: Growing interest in very low carbohydrate diets, and in particular the ketogenic diet, has been met with some resistance. Important gaps exist regarding what diet to compare to the ketogenic diet. The objective of this study was to compare a Well Formulated Ketogenic Diet (WFKD) with a Mediterranean-Plus diet (Med-Plus;Mediterranean with emphasis on eliminating added sugars and refined grains), in a crossover study, stratified by diabetes status (T2D vs Prediabetes). Methods: The intervention involved having participants follow the WFKD and Med-Plus, for 12 weeks each, in random order. All meals were provided for the first 4 weeks of each diet phase (food delivery);then participants were responsible for purchasing and preparing their own foods (self-provided). The primary outcome was glycosylated hemoglobin (HbA1c). Secondary outcomes included weight, glucose as measured by continuous glucose monitor (CGM), and cardiometabolic risk factors, such as fasting insulin, glucose, and lipids. Results: Among participants randomized (n = 42), 33 had complete data at both diet phases (some missing data attributable to COVID disruptions). Participants were 60 ± 9 (mean ± sd) years of age, 61% men, with BMI 31 ± 5 kg/m2. Adherence for both diets was higher during the food delivery than the self-provided phase, but similar between diets for both phases. HbA1c concentrations were not significantly different between diets, but average CGM glucose levels were significantly lower during the WFKD compared to Med-Plus (p = 0.03). Additionally, WFKD induced a significantly greater decrease in triglycerides (-16% vs -5%, p = 0.02) and greater increase in LDL-C levels (10% vs -5%, p = 0.01), compared to Med-Plus. Weight change on WFKD vs Med-Plus was -8% vs -7% (p = 0.05). Sensitivity analyses largely confirmed the main findings. Conclusions: Participants improved in glucose control and weight management on both diets relative to baseline;however, glucose control was superior on the WFKD. Some caution is warranted when interpreting these results due to pandemic disruptions and a small sample size. A fair comparison of the two diets should also take into consideration non-glycemic effects.

12.
Pediatric Diabetes ; 22(SUPPL 30):111-112, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1571011

RESUMO

Introduction: Kids In Control Of Food (KICk OFF) has been conducted in Kuwait since 2015. The Kuwait team adapted and modified the course to a 3-day format instead of a 5- day, due to the attendees preferences. Objectives: To pilot a modified educational program KICk-OFF for children and adolescents (11-16 years old) with T1D and to evaluate the HbA1C and weight change, when compared with usual care Methods: The team successfully conducted 4 modified courses from July- September 2019 at Damsan diabetes institute (DDI). Prior to the trial courses that were conducted;the team responded to the requests of the previous graduates by piloting a shorter format (3-day). Also, the following modifications were made: 1)Ongoing follow up individual sessions, 2) Group booster sessions 4 weeks post course,3) Sending biweekly text messages, 4) Fasting Ramadan sessions and 5) Flash glucose monitoring devices were distributed throughout the courses instead of the classical SMBG. Glycaemic control measured by HbA1c and body weight calculated by body mass index (BMI) were taken at baseline, 6, and 12 months for intervention groups and compared with controls. Results: Due to the Covid-19 pandemic, the trail outcomes were tracked up to 6months instead of 12months. For the intervention group, there was a significant reduction in mean HbA1c (n =22, pre: 9.6 ± 2.0%vs. post 8.6 ± 0.9%;P = 0.01), whereas, there was no significant BMI differences (n=22, pre 23.52±4.6 vs. post-I 23.74±4.2;P =0.8). Moreover, no episodes of severe hypoglycemia, DKA, or hospitalization occurred after 6 months for all graduates. In addition, three graduates started insulin pump therapy. Finally, there were no changes in HbA1c (n=21, pre: 9.6 ±1.9% vs. post 9.2 ±1.2%;P= 0.19) and BMI (n=21 pre22.7 ±5.6 vs. post23.1 ±5.9, P=0.37) in the control group. Conclusions: Joining a 3-day KICk-OFF Kuwait format was associated with significantly improved in Glycaemic control at 6 months compared with control group. These outcomes need to be confirmed in a study with a longer duration.

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