An Unprecedented Challenge: The North Italian Gastroenterologist Response to COVID-19

Background: COVID-19 pandemic has profoundly changed the activities and daily clinical scenarios, subverting organizational requirements of our Gastroenterology Units. AIM: to evaluate the clinical needs and outcomes of the gastroenterological ward metamorphosis during the COVID-19 outbreaks in a high incidence scenario. Methods: we compared the pertinence of gastroenterological hospitalization, modality of access, mortality rate, days of hospitalization, diagnostic and interventional procedures, age, Charlson comorbidity index, and frequency of SARS-CoV-2 infections in patients and healthcare personnel across the first and the second COVID-19 outbreaks in a COVID-free gastroenterological ward in the metropolitan area of Milan, that was hit first and hardest during the first COVID-19 outbreak since March 2020. Results: pertinence of gastroenterological hospitalization decreased both during the first and, to a lesser degree, the second SARS-CoV2 waves as compared to the pre-COVID era (43.6, 85.4, and 96.2%, respectively), as occurred to the admissions from domicile, while age, comorbidities, length of stay and mortality increased. Endoscopic and interventional radiology procedures declined only during the first wave. Hospitalized patients resulted positive to a SARS-CoV-2 nasopharyngeal swab in 10.2% of cases during the first COVID-19 outbreak after a median of 7 days since admission (range 1–15 days) and only 1 out of 318 patients during the second wave (6 days after admission). During the first wave, 19.5% of healthcare workers tested positive for SARS-CoV-2. Conclusions: a sudden metamorphosis of the gastroenterological ward was observed during the first COVID-19 outbreak with a marked reduction in the gastroenterological pertinence at the admission, together with an increase in patients’ age and multidisciplinary complexity, hospital stays, and mortality, and a substantial risk of developing a SARS-CoV-2 test positivity. This lesson paved the way for the efficiency of hospital safety protocols and admission management, which contributed to the improved outcomes recorded during the second COVID-19 wave.

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Evaluation of a home-based 7-day infection control strategy for healthcare workers following high-risk exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2): A cohort study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1389 ◽

2020 ◽

pp. 1-4

Author(s):

Carla Benea ◽

Laura Rendon ◽

Jesse Papenburg ◽

Charles Frenette ◽

Ahmed Imacoudene ◽

...

Keyword(s):

High Risk ◽

Infection Control ◽

Control Strategy ◽

Healthcare Workers ◽

Control Strategies ◽

Risk Exposure ◽

Nasopharyngeal Swab ◽

Home Based ◽

Respiratory Coronavirus ◽

Second Wave

Abstract Objective: Evidence-based infection control strategies are needed for healthcare workers (HCWs) following high-risk exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2). In this study, we evaluated the negative predictive value (NPV) of a home-based 7-day infection control strategy. Methods: HCWs advised by their infection control or occupational health officer to self-isolate due to a high-risk SARS-CoV-2 exposure were enrolled between May and October 2020. The strategy consisted of symptom-triggered nasopharyngeal SARS-CoV-2 RNA testing from day 0 to day 7 after exposure and standardized home-based nasopharyngeal swab and saliva testing on day 7. The NPV of this strategy was calculated for (1) clinical coronavirus disease 2019 (COVID-19) diagnosis from day 8–14 after exposure, and for (2) asymptomatic SARS-CoV-2 detected by standardized nasopharyngeal swab and saliva specimens collected at days 9, 10, and 14 after exposure. Interim results are reported in the context of a second wave threatening this essential workforce. Results: Among 30 HCWs enrolled, the mean age was 31 years (SD, ±9), and 24 (80%) were female. Moreover, 3 were diagnosed with COVID-19 by day 14 after exposure (secondary attack rate, 10.0%), and all cases were detected using the 7-day infection control strategy: the NPV for subsequent clinical COVID-19 or asymptomatic SARS-CoV-2 detection by day 14 was 100.0% (95% CI, 93.1%–100.0%). Conclusions: Among HCWs with high-risk exposure to SARS-CoV-2, a home-based 7-day infection control strategy may have a high NPV for subsequent COVID-19 and asymptomatic SARS-CoV-2 detection. Ongoing data collection and data sharing are needed to improve the precision of the estimated NPV, and here we report interim results to inform infection control strategies in light of a second wave threatening this essential workforce.

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Visualising regional disparities in the risk of COVID-19 at different phases of lockdown in England

Environment and Planning A Economy and Space ◽

10.1177/0308518x20984165 ◽

2021 ◽

pp. 0308518X2098416

Author(s):

Yu-Wang Chen ◽

Lei Ni ◽

Dong-Ling Xu ◽

Jian-Bo Yang

Keyword(s):

United Kingdom ◽

Sharp Increase ◽

Regional Disparities ◽

Local Authorities ◽

The North ◽

Second Wave ◽

Over Time

Since late January 2020 when the first coronavirus case reached England, United Kingdom, the coronavirus disease 2019 (COVID-19) has spread rapidly and widely across all local authorities (LAs) in England. In this featured graphic, we visualise how COVID-19 severity changes nationally and locally from 30 January to 23 November 2020. The geo-visualisation shows that there have been large regional disparities in the severity of the outbreak, and the epicentres have shifted from Greater London, Leicester, to the North of England and remained in the North during pre-lockdown, post-lockdown, easing lockdown and second national lockdown phases. We further find that the increase in the testing capacity may partially explain the sharp increase in the confirmed cases during the second wave of the pandemic. However, the disparities in the severity of COVID-19 (i.e., confirmed cases and deaths) among LAs in England become more significant over time. It further sheds light on the necessity of establishing decisive and timely responses to cope with local pandemic situations.

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Successful treatment of arthritis induced by checkpoint inhibitors with tocilizumab: a case series

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-211560 ◽

2017 ◽

Vol 76 (12) ◽

pp. 2061-2064 ◽

Cited By ~ 73

Author(s):

Sang Taek Kim ◽

Jean Tayar ◽

Van Anh Trinh ◽

Maria Suarez-Almazor ◽

Salvador Garcia ◽

...

Keyword(s):

Checkpoint Inhibitors ◽

Case Reports ◽

Unmet Need ◽

Case Series ◽

Receptor Antibody ◽

Improved Outcomes ◽

Clinical Scenarios ◽

Significant Clinical Improvement ◽

Tnfα Inhibitor ◽

Factor Α

BackgroundImmune checkpoint inhibitors (ICIs) have significantly improved outcomes for patients with numerous cancers. However, these therapies are associated with immune-related adverse events (irAEs), which are inflammatory side effects potentially affecting any organ. Cases of ICI-induced inflammatory arthritis have also been reported. In general, mild irAEs are treated with corticosteroids, while tumour necrosis factor-α (TNFα) inhibitors are reserved for refractory cases. However, prolonged use of TNFα inhibitor (TNFαi) can induce widespread, significant immunosuppression, which can negatively impact the antitumour efficacy of ICI therapy. Therefore, in clinical scenarios where patients develop severe immunotherapy-induced irAEs, an unmet need exists for alternative therapeutic strategies that are effective and without immune dampening effects.Case reportsThe anti-interleukin (IL)−6 receptor antibody, tocilizumab, is a biological agent Food and Drug Administration approved for the treatment of rheumatoid arthritis and juvenile idiopathic arthritis. Here, we report on three patients who developed severe polyarthritis while receiving ICI therapy and were treated with tocilizumab. All three patients demonstrated significant clinical improvement; one patient maintained a durable antitumour response derived from checkpoint inhibition.ConclusionsThese three cases suggest that anti-IL-6 receptor antibody may be an effective alternative to corticosteroids or TNFαi for the treatment of arthritis irAEs.

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Remdesivir as a tool to relieve hospital care systems stressed by COVID-19: A modelling study on bed resources and budget impact

10.1101/2021.02.24.21252355 ◽

2021 ◽

Author(s):

Guillaume Béraud ◽

Jean-François Timsit ◽

Henri Leleu

Keyword(s):

Epidemiological Data ◽

High Flow ◽

Low Flow ◽

Bed Occupancy ◽

Agent Based ◽

High Flow Oxygen ◽

Hospital Bed ◽

Care Systems ◽

Hospital Stays ◽

Second Wave

AbstractRemdesivir and dexamethasone are the only drugs providing reductions in the lengths of hospital stays for COVID-19 patients. We assessed the impacts of remdesivir on hospital-bed resources and budgets affected by the COVID-19 outbreak. A stochastic agent-based model was combined with epidemiological data available on the COVID-19 outbreak in France and data from two randomized control trials. Strategies involving treating with remdesivir only patients with low-flow oxygen and patients with low-flow and high-flow oxygen were examined. Treating all eligible low-flow oxygen patients during the entirety of the second wave would have decreased hospital-bed occupancy in conventional wards by 4% [2%; 7%] and intensive care unit (ICU)-bed occupancy by 9% [6%; 13%]. Extending remdesivir use to high-flow-oxygen patients would have amplified reductions in ICU-bed occupancy by up to 14% [18%; 11%]. A minimum remdesivir uptake of 20% was required to observe decreases in bed occupancy. Dexamethasone had effects of similar amplitude. Depending on the treatment strategy, using remdesivir would, in most cases, generate savings (up to 722€) or at least be cost neutral (an extra cost of 34€). Treating eligible patients could significantly limit the saturation of hospital capacities, particularly in ICUs. The generated savings would exceed the costs of medications.

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Sex differences in susceptibility, severity, and outcomes of coronavirus disease 2019: Cross-sectional analysis from a diverse US metropolitan area

PLoS ONE ◽

10.1371/journal.pone.0245556 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245556 ◽

Cited By ~ 2

Author(s):

Farhaan S. Vahidy ◽

Alan P. Pan ◽

Hilda Ahnstedt ◽

Yashasvee Munshi ◽

Huimahn A. Choi ◽

...

Keyword(s):

Mechanical Ventilation ◽

Nasopharyngeal Swab ◽

Median Income ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Time Period ◽

Hypoxic Respiratory Failure ◽

Comorbidity Index ◽

Sex Disparities ◽

Sectional Analysis

Introduction Sex is increasingly recognized as an important factor in the epidemiology and outcome of many diseases. This also appears to hold for coronavirus disease 2019 (COVID-19). Evidence from China and Europe has suggested that mortality from COVID-19 infection is higher in men than women, but evidence from US populations is lacking. Utilizing data from a large healthcare provider, we determined if males, as compared to females have a higher likelihood of SARS-CoV-2 susceptibility, and if among the hospitalized COVID-19 patients, male sex is independently associated with COVID-19 severity and poor in-hospital outcomes. Methods and findings Using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, we conducted a cross-sectional analysis of data from a COVID-19 Surveillance and Outcomes Registry (CURATOR). Data were extracted from Electronic Medical Records (EMR). A total of 96,473 individuals tested for SARS-CoV-2 RNA in nasopharyngeal swab specimens via Polymerized Chain Reaction (PCR) tests were included. For hospital-based analyses, all patients admitted during the same time-period were included. Of the 96,473 patients tested, 14,992 (15.6%) tested positive, of whom 4,785 (31.9%) were hospitalized and 452 (9.5%) died. Among all patients tested, men were significantly older. The overall SARS-CoV-2 positivity among all tested individuals was 15.5%, and was higher in males as compared to females 17.0% vs. 14.6% [OR 1.20]. This sex difference held after adjusting for age, race, ethnicity, marital status, insurance type, median income, BMI, smoking and 17 comorbidities included in Charlson Comorbidity Index (CCI) [aOR 1.39]. A higher proportion of males (vs. females) experienced pulmonary (ARDS, hypoxic respiratory failure) and extra-pulmonary (acute renal injury) complications during their hospital course. After adjustment, length of stay (LOS), need for mechanical ventilation, and in-hospital mortality were significantly higher in males as compared to females. Conclusions In this analysis of a large US cohort, males were more likely to test positive for COVID-19. In hospitalized patients, males were more likely to have complications, require ICU admission and mechanical ventilation, and had higher mortality than females, independent of age. Sex disparities in COVID-19 vulnerability are present, and emphasize the importance of examining sex-disaggregated data to improve our understanding of the biological processes involved to potentially tailor treatment and risk stratify patients.

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“THE BRIDES OF DECONSTRUCTION AND CRITICISM” AND THE TRANSFORMATION OF FEMINISM IN THE NORTH AMERICAN ACADEMY

Modern Intellectual History ◽

10.1017/s1479244318000318 ◽

2018 ◽

Vol 17 (2) ◽

pp. 413-442

Author(s):

GREGORY JONES-KATZ

Keyword(s):

American Academy ◽

North American ◽

Yale University ◽

Gay Liberation ◽

Informal Group ◽

The North ◽

French And English ◽

French Theory ◽

Second Wave ◽

Scholarly Inquiry

“The Brides of Deconstruction and Criticism,” an informal group of feminist literary critics active at Yale University during the 1970s, were inspired by second-wave feminist curriculum, activities, and thought, as well as by the politics of the women's and gay liberation movements, in their effort to intervene into patterns of female effacement and marginalization. By the early 1980s, while helping direct deconstructive reading away from the self-subversiveness of French and English prose and poetry, the Brides made groundbreaking contributions to—and in several cases founded—fields of scholarly inquiry. During the late 1980s, these feminist deconstructionists, having overcome resistance from within Yale's English Department and elsewhere, used their works as social and political acts to help pave the way for the successes of cultural studies in the North American academy. Far from a supplément to what Barbara Johnson boldly called the “Male School,” the Brides of Deconstruction and Criticism arguably were the Yale school. Examining the distinct but interrelated projects of Yale's feminist deconstructive moment and how local and contingent events as well as the national climate, rather than the importation of so-called French theory, informed this moment gives us a clearer rendering of the story of deconstruction.

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Validation of the Tokyo guideline 2018 treatment proposal for acute cholecystitis from a single-center retrospective analysis

10.21203/rs.2.16352/v1 ◽

2019 ◽

Author(s):

Tomoaki Bekki ◽

Tomoyuki Abe ◽

Hironobu Amano ◽

Keiji Hanada ◽

Tsuyoshi Kobayashi ◽

...

Keyword(s):

Blood Transfusion ◽

Acute Cholecystitis ◽

Treatment Strategy ◽

Early Laparoscopic Cholecystectomy ◽

Physical Status Classification ◽

Severity Grading ◽

Hospital Stays ◽

Comorbidity Index ◽

American Society ◽

American Society Of Anesthesiologists

Abstract Background Based on the revised Tokyo guideline 2018 (TG18), early laparoscopic cholecystectomy (LC) is recommended in patients who satisfy the Charlson Comorbidity Index (CCI) criteria and the American Society of Anesthesiologists Physical Status Classification (ASA-PS). Our study aims to determine the efficacy of TG18 treatment strategy. Methods We enrolled 324 patients with acute cholecystitis (AC) diagnosed by TG18 who underwent cholecystectomy between 2010 and 2018. Perioperative variables and surgical outcomes were analyzed according to the TG18 treatment strategy and severity grading. Results ASA-PS scores and CCI were significantly higher in patients with Grade II (GII) and GIII AC. Higher severity grading resulted in failed LC, requiring blood transfusion and bailout surgery. The TG18 within group showed a higher proportion of GI and GII AC and their ASA-PS scores were also significantly lower. TG18 within group demonstrated significant differences in the achievement of LC, bailout surgery, postoperative hospital stays, and 90-day mortality rates. Intraoperative blood loss and blood transfusion were significantly higher in the TG18 outside group than that in the TG18 within group. Conclusions Our study shows that the TG18 treatment strategy is well-designed and efficacious. Novel findings Our study established the feasibility and efficacy of TG18. The usefulness of performing aggressive surgery beyond the TG18 strategy requires further study.

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Drug-Induced Kidney Disease Associated With Selected Antibiotics

The Senior Care Pharmacist ◽

10.4140/tcp.n.2020.225 ◽

2020 ◽

Vol 35 (5) ◽

pp. 225-229

Author(s):

Alexia S. Alvarez ◽

Oluseyi Oyerinde ◽

Justin P. Reinert

Keyword(s):

Acute Kidney Injury ◽

Kidney Disease ◽

Older People ◽

Hospital Costs ◽

Kidney Injury ◽

Clear Understanding ◽

First Line ◽

Drug Induced ◽

Improved Outcomes ◽

Hospital Stays

Structural and functional degeneration of the kidneys occur as the human body ages, making oler people especially susceptible to the consequences of acute kidney injury. Furthermore, the use of nephrotoxic agents, combined with the increased incidence of acute kidney injury and likelihood of an intensive-care unit admission, makes geriatric patients prone to develop drug-induced kidney disease. Vancomycin is routinely used as the first-line treatment for methicillin-resistant Staphylococcus aureus, but is known to be nephrotoxic; studies have shown that an early switch from vancomycin to alternatives does not necessarily prevent renal insult. Therefore, we aim to discuss the mechanisms of drug-induced kidney disease with regard to vancomycin, daptomycin, and ceftaroline and to provide insight as to their safety profiles with regard to older people. A clear understanding of this topic will aid clinicians in selecting drug therapy and may lead to shortened hospital stays, lower hospital costs, and improved outcomes of critically ill older people.

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Carfilzomib (K) in relapsed and refractory multiple myeloma (RRMM): Frailty subgroup analysis from phase III ASPIRE and ENDEAVOR.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.8028 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 8028-8028 ◽

Cited By ~ 1

Author(s):

Thierry Facon ◽

Ruben Niesvizky ◽

Katja Weisel ◽

Sara Bringhen ◽

P. Joy Ho ◽

...

Keyword(s):

Performance Status ◽

Progression Free Survival ◽

Phase Iii ◽

Ecog Performance Status ◽

Free Survival ◽

Frailty Status ◽

Improved Outcomes ◽

Comorbidity Index ◽

Post Hoc ◽

Frailty Score

8028 Background: K-based regimens improved progression-free survival (PFS) and overall survival (OS) in RRMM patients (pts) in ASPIRE (K [27 mg/m2]-lenalidomide-dexamethasone [KRd] vs Rd) and ENDEAVOR (K [56 mg/m2]-dexamethasone [Kd56] vs bortezomib-dexamethasone [Vd]), regardless of age. Frailty scores have been developed based on age, comorbidities, and functional status (Palumbo Blood 2015;125:2068–74; Facon Blood 2015;126:4239). We assessed post hoc pt outcomes by frailty status. Methods: PFS, OS, and safety were assessed by treatment arm and frailty score (based on age, medical history-derived Charlson Comorbidity Index, and ECOG performance status); frailty scores: 0 = fit, 1 = intermediate (int), and ≥2 = frail. Results: Pt frailty status was balanced between treatment arms in ASPIRE and ENDEAVOR. Median PFS and OS were longer with K-based regimens vs controls in ASPIRE and ENDEAVOR across frailty subgroups (Table). Rates of treatment-emergent adverse events are summarized in the Table. Conclusions: Kd56 and KRd consistently improved outcomes vs Vd and Rd, respectively, in all frailty subgroups as defined by the algorithm above. These findings support the favorable benefit-risk profile of KRd and Kd56 regardless of frailty score. Clinical trial information: NCT01080391 and NCT01568866. [Table: see text]

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FOLK MEDICINE OF THE LOWER TEREK COSSACKS (19th - EARLY 20th CC.)

History Archeology and Ethnography of the Caucasus ◽

10.32653/ch132119-132 ◽

2017 ◽

Vol 13 (2) ◽

pp. 119-132 ◽

Cited By ~ 1

Author(s):

M B Gimbatova

Keyword(s):

Folk Medicine ◽

Gunshot Wounds ◽

Healthcare Personnel ◽

Animal Origin ◽

North Caucasus ◽

The North ◽

Medical Institutions ◽

Children's Diseases ◽

Ethnographic Data ◽

Methods Of Treatment

The article deals with an underinvestigated problem of ethnography of the Lower Terek Cossacks - folk medicine. The author of the article considers the methods of treatment of the most common diseases among the Lower Terek Cossacks in the 19th-early 20th cc. - the diseases of heart, gastrointestinal tract, genitourinary system, head, musculoskeletal system, skin, as well as neuropsychic, children’s diseases and others. It is shown that using the medicines of vegetable and animal origin, hirudotherapy, diets, physical action and accumulated empirical knowledge, healers managed to treat many diseases, thereby compensated for a shortcoming of medical institutions and healthcare personnel. The analysis of the collected field ethnographic data testifies to the wide use of irrational methods of treatment in folk medicine. The popularity of healing magic is explained by the fact that in most cases it achieved the desired result and had a certain psychotherapeutic effect. Folk medicine of the Lower Terek Cossacks has much in common with that of the Dagestan peoples in the methods of treating various diseases and its close connection with the ecological characteristics of the environment. Ethnographic materials show that in extreme cases (bullet wounds, puncture wounds), the Lower Terek Cossacks sought treatment from mountain physicians who were skilled in treating gunshot wounds. Examples of interaction between the Lower Terek Cossacks and mountain peoples in various spheres, including folk medicine, indicate that the Lower Terek Cossacks have blended in with the North Caucasus cultural space and become an integral part of it though they were not the indigenous population of the region.

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