scholarly journals Incidence of Sars-COV-2 Infection in Sickle Cell Patients Presenting with a Painful Crisis, a 12 Month Prospective Cohort Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 969-969
Author(s):  
Kadère Konté ◽  
Erfan Nur ◽  
Man Wai Tang ◽  
Jarom Heijmans ◽  
Charlotte F.J. Van Tuijn ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sickle Cell ◽  
Respiratory Symptoms ◽  
Upper Airway ◽  
Ct Scans ◽  
Acute Chest Syndrome ◽  
Rt Pcr ◽  
High Incidence ◽  
Polymerase Chain ◽  
Low Incidence

Abstract Background: Sickle cell disease (SCD) is frequently complicated by painful vaso-occlusive crises (VOCs) often resulting in healthcare utilization including hospital admission. A vaso-occlusive crisis (VOC) can be induced by multiple factors including infection, exposure to cold, physical exercise, dehydration and stress. Given the current SARS-CoV-2 pandemic, we hypothesized that SARS-CoV-2 (even without symptoms of upper airway infection) might play a major causal role in VOC. However, our data suggests that COVID-19 is not a frequent provoking factor for clinical VOCs during the pandemic. Methods: In order to test this hypothesis, consecutive SCD patients presenting to the emergency department in our centre with symptoms compatible with VOC between March 16 th 2020 and March 16 th 2021, were tested for SARS-CoV-2 by real-time polymerase chain reaction (RT-PCR) of nasopharyngeal swabs irrespective of respiratory symptoms. Given the limited sensitivity of the RT-PCR in SARS-CoV-2 high incidence groups, low-dose non-contrast chest CT-scans were initially performed in addition to the RT-PCR.In addition, data comprised of temperature, oxygen saturation and laboratory results, was collected through chart review, from the visit at the emergency department. Presentations of SCD patients with a proven prior SARS-CoV-2 infection were excluded. Results: In total 122 VOCs in 70 adult SCD patients, presenting to the emergency department between March 16 th 2020 and March 16 th 2021, were evaluated. (Figure 1) Five presentations in two individual patients were excluded due to a prior RT-PCR proven SARS-CoV-2 infection. Furthermore, 13 presentations in six patients were excluded due to non-protocol adherence (not obtaining a RT-PCR at presentation). In total 104 episodes of VOC in 62 patients with SCD were prospectively analyzed on SARS-CoV-2 by RT-PCR irrespective of respiratory symptoms. In 104 consecutive presentations, five presentations tested positive on SARS-CoV-2 (4.8%). Only one of these five patients presented with respiratory symptoms in addition to the symptoms of a VOC and one patient was diagnosed with acute chest syndrome (ACS). Five of the 99 presentations of patients with a negative SARS-CoV-2 PCR, presented with respiratory symptoms. In this group, seven patients developed an ACS during admission. From March 16 th till May 31 st 2020, routine CT-scans were performed, in 23 out of 27 presentations with a VOC at the emergency department in addition to the RT-PCR in order to increase the diagnostic accuracy. In 19 of these presentations, that were tested negative for SARS-COV-2, no CT-abnormalities suggestive for COVID-19 were found. One of four CT-scans performed in patients with a positive RT-PCR, showed abnormalities that were not specific for COVID-19. Conclusion: In conclusion, we found a low incidence of SARS-CoV-2 infections in our cohort of consecutive SCD patients presenting with VOCs in 12 months during the COVID-19 pandemic. This suggests that COVID-19 is not a frequent provoking factor for clinical VOCs during the pandemic and may even be considered a coincidental finding given the low incidence and the fact that only one of the five patients with a positive RT-PCR presented with pulmonary symptoms. Figure 1 Figure 1. Disclosures Nur: Celgene: Speakers Bureau; Roche: Speakers Bureau; Novartis: Research Funding, Speakers Bureau.

scholarly journals On Cancer, COVID-19, and CT Scans: A Monocentric Retrospective Study

2020 ◽  
Vol 9 (12) ◽  
pp. 3935
Author(s):  
Francesca Martini ◽  
Andrea D’Alessio ◽  
Federico Bracchi ◽  
Daniela Di Mauro ◽  
Anna Fargnoli ◽  
...  
Keyword(s):  
Severe Disease ◽  
Protective Role ◽  
Northern Italy ◽  
Chest Ct ◽  
Ct Scans ◽  
Rt Pcr ◽  
Cardiovascular Comorbidities ◽  
Oncological Patients ◽  
High Incidence

Background The use of computed tomography (CT) for coronavirus disease 2019 (COVID-19) diagnosis in an area of northern Italy with a high incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may have identified more patients with this disease than RT-PCR in the very early onset of the COVID-19 pandemic. Methods We retrospectively reviewed 148 chest CT scans of oncological patients who were referred to the Radiological Unit of Policlinico S. Marco from 1 February 2020 to 30 April 2020, during the COVID-19 outbreak in Bergamo area. In parallel, we analyzed RT-PCR tests of these 148 patients. Results Among 32 patients with a diagnosis of COVID-19, 17 patients were asymptomatic or had mild symptoms (53.1%), while 15 developed severe disease (46.8%). The incidence of SARS-CoV-2 infection was 22.9%, the mortality rate was 18.8%. We did not find any correlation between disease severity and age, sex, smoking, or cardiovascular comorbidities. Remarkably, patients who were on treatment for cancer developed a milder disease than patients who were not on treatment. Conclusions The acceptance of CT-defined diagnoses in COVID-19 high-incidence areas like Bergamo region highlighted a larger oncological population affected by COVID-19 than RT-PCR, in particular, asymptomatic and mildly symptomatic patients, because only symptomatic patients underwent nasopharyngeal swabbing at the onset of the COVID-19 pandemic. We observed that patients actively treated for their cancer had a milder disease, in agreement with previous studies that suggested a protective role of immunosuppression. Admittedly, the sample of patients in our study was heterogeneous regarding the oncological disease, their prognosis, and the type of treatment; therefore, other studies are needed to confirm our data.

scholarly journals Perspective of Arguments in Public Health

2021 ◽  
Vol 9 (1) ◽  
pp. 44-45
Author(s):  
Dinesh Kumar
Keyword(s):  
Polymerase Chain Reaction ◽  
Real Time ◽  
Respiratory Symptoms ◽  
False Negative ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Negative Report ◽  
Polymerase Chain ◽  
Time Of Admission ◽  
Pcr Test

Recently, an argument was put forth because a symptomatic and positive patient for CoVID-19 turned tested negative after 7 days, so discharged from the hospital. Both at the time of admission and discharge real-time reverse transcriptase Polymerase Chain Reaction (RT-PCR) was done for testing of CoVID-19. Immediately, patient again developed respiratory symptoms and was admitted to hospital again. Amidst of current CoVID-19 pandemic, a question was asked “What is the specificity of the Real Time-Polymerase Chain Reaction (RT-PCR) test for COVID-19?” with an assumption that what if at the time of discharge the disease is present in patient but test turned out to be negative? In response to that a counter statement was posed that “It is the sensitivity that should be asked rather than specificity”. It was based on the implication of primary question that was implying false negative report of the RT-PCR. It means, since patient was discharged with negative result that could be false negative.

scholarly journals Febrile infants without respiratory symptoms or sick contacts: Are chest radiographs or RSV/influenza testing indicated?

2020 ◽  
Author(s):  
Ali Ozcan ◽  
Evelyn Laskowski ◽  
Shashi Sahai ◽  
Kelly Levasseur
Keyword(s):  
Emergency Department ◽  
Respiratory Symptoms ◽  
Demographic Data ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Infection Rates ◽  
Statistical Software ◽  
Routine Testing ◽  
Syncytial Virus ◽  
Low Incidence

Abstract Objectives: Serious bacterial infection rates in febrile infants <60 days are about 8-11%. Less than 1% of febrile infants with no respiratory symptoms will have pneumonia however, chest radiography (CXR) rates remain between 30-60%. Rapid Respiratory Syncytial Virus (RSV) and influenza (flu) testing is common, however, there is not enough data to determine if febrile infants without any respiratory symptoms should be tested. The goal of this study is to determine the rate of positive CXR and RSV/flu results in febrile infants with no respiratory symptoms and no sick contacts. Methods: Well-appearing febrile infants between 7-60 days of age who presented to the pediatric emergency department (PED) from September 1 st , 2015 through October 30 th , 2017 were enrolled. Demographic data, respiratory symptoms, CXR findings and RSV/flu results were collected. SAS statistical software was used for analysis. Results: 129 infants met enrollment criteria. Of the 129 infants, 58 (45.0%) had no respiratory symptoms and no sick contacts. Of these 58, 36 (62%) received a CXR and none of them had any abnormal findings, 48 (83%) had RSV/flu testing, no patients tested positive for RSV and only one patient tested positive for flu. Costs of CXR and RSV/flu testing for this cohort was $19,788. Conclusion: The absence of positive CXRs in this patient population reinforces the current recommendations that CXR is not indicated. The low incidence of RSV/flu indicate that routine testing may not be necessary in this population especially outside of the flu season. Reduced testing could decrease overall costs to the healthcare system as well as radiation exposure to this population.

scholarly journals Assessment of Sickle Cell Disease Pain Management in the Whittington Hospital Emergency Department

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5822-5822
Author(s):  
Leena Al Shaman ◽  
Layan Akkielah ◽  
Katharine Orf ◽  
Jonathan Massie ◽  
Jiexin Zheng ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Pain Relief ◽  
Sickle Cell ◽  
Globin Gene ◽  
Autosomal Recessive Disorder ◽  
Clinical Excellence ◽  
Quality Standard ◽  
Acute Chest Syndrome ◽  
The Uk

Abstract Background and aims Sickle cell anaemia (SCA) is an autosomal recessive disorder caused by point mutation of the β-globin gene, resulting in abnormal forms of hemoglobin that cause increased red blood cell rigidity and hemolysis. It is one of the most common hereditary blood conditions, affecting over 14,000 adults in the UK (Dormandy el al, 2017). One of the manifestations of SCA is vaso-occlusive crises. These typically cause severe pain that may require emergency department (ED) attendance for pain management, typically with opioids. Pain relief should be given quickly and response to this assessed on a regular basis to ensure pain management is optimized. Those patients in whom pain relief is not well-controlled are at risk of further complications including acute chest syndrome. The UK National Institute of Clinical Excellence (NICE) published a quality standard in 2014 stating that patients presenting to hospital with an acute painful sickle cell episode should have a pain assessment, a clinical assessment and appropriate analgesia within 30 minutes of presentation (NICE, 2014). This study was performed to assess the Whittington Hospital's compliance to national recommendations and to establish which aspects of care in ED contributed to delays in management. Methods If a Whittington SCA patient attends ED, an automated email is generated that notifies the haematology team of the attendance. This system was used to identify acute sickle cell presentations to ED. Criteria for inclusion in the study was Whittington SCA patients that presented to ED with acute painful sickle cell crises between August 2017 to January 2018. Patients who received analgesia in the ambulance and patients with no documentation available were excluded. The time of presentation, analgesia prescription and administration for each attendance were noted from ED documentation. Results A total of 104 ED SCA attendances were included. 41% of patients presenting with an acute painful sickle cell crisis received analgesia during their first 30 minutes in ED. The average wait for analgesia was 47 minutes, with 75% of SCA patients receiving analgesia within 1 hour of arrival. The time taken to triage SCA patients was on average 8 minutes (range 0 to 29 minutes). Time from arrival to prescription of pain relief was much more variable with an average wait 40 minutes (range 10 minutes to 2 hours 22 minutes). Time from prescription to administration also varied, with 56% administered within 10 minutes of prescription and 87% within 30 minutes Patients who frequently attended Whittington ED (defined as 7 or more attendances within the 6 month period studied) had a shorter average wait for analgesia. Analgesia was given 36 minutes after arrival on average for frequent attenders, whereas patients presenting 6 or fewer times had an average wait of 53 minutes. Conclusions We are not currently meeting our audit standard for provision of analgesia in the emergency department, and performance appears to have worsened progressively since our earliest available date from 2012 (although methodological differences may have contributed to this). In 2015 49% of patients received analgesia within 30 minutes compared to 41% in 2017/18. Most of the delay appears to be due to the time taken for medication to be prescribed, although the time taken to triage the patient and administer the medication was also not insignificant and often amounted to greater than 30 minutes. It is unclear what is contributing to this delay, although it appears that performance is improved when the patient is a repeat attender and therefore known to the department. Educations sessions with the ED department and availability of a SCA specialist nurse may improve management of SCA painful crises in ED. Disclosures Shah: Novartis: Honoraria, Speakers Bureau; Sobi/Apotex: Honoraria; Celgene Corp: Other: Steering committee; Roche: Other: Advisory board meeting.

scholarly journals Targeted Education after an Emergency Department Visit Increases Hydroxyurea Initiation in Children with Sickle Cell Anemia

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 868-868
Author(s):  
Sarah Kappa ◽  
Lydia Pecker ◽  
Deepika S. Darbari ◽  
Robert Nickel
Keyword(s):  
Emergency Department ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Conflicts Of Interest ◽  
National Health System ◽  
Clinic Visit ◽  
Acute Chest Syndrome ◽  
Hemoglobin F ◽  
History Of ◽  
One Year

Abstract Introduction: Hydroxyurea decreases many complications of sickle cell anemia (SCA) but is underused in treatment-eligible patients. Barriers to hydroxyurea initiation occur on the health care system, provider, and patient level. Novel strategies to increase hydroxyurea use in patients with SCA are needed. To address this challenge at our center, we implemented the Quick Start Hydroxyurea Initiation Project (Q-SHIP). Methods: Patients with SCA were eligible to participate in Q-SHIP if they presented to the Children's National Health System (CNHS) emergency department (ED) for pain or acute chest syndrome and were not taking hydroxyurea. Patients &lt;9 months old, on chronic transfusions, pregnant, or not followed by CNHS hematology were excluded. Eligible patients were referred to a weekly Q-SHIP clinic visit focused on hydroxyurea education and were offered initiating treatment at the visit's conclusion. Participants completed a pre-session questionnaire, discussed hydroxyurea with a hematologist using a handbook developed by CNHS, and watched videos featuring patients and parents of children with SCA sharing their experience with hydroxyurea. Subjects were classified as starting hydroxyurea if they had a clinic visit for hydroxyurea monitoring within 3 months of participation in a Q-SHIP session. Results: Over 13 months (2/1/2016 - 3/31/2017) 65 eligible patients participated in Q-SHIP a median of 5 days (IQR 2, 20 days) after ED or hospital discharge. Although 44% (28/64) of participants reported no previous hydroxyurea offer, provider clinic documentation indicated that 61% (17/28) of these families had declined a previous hydroxyurea offer. After Q-SHIP, 55% (36/65) of participants started hydroxyurea. Subjects who started hydroxyurea after Q-SHIP were similar to those who did not, except subjects who started were more likely have a history of an intensive care unit admission (Table 1). After a median follow-up of 11 months, 81% (29/36) of participants who started hydroxyurea after Q-SHIP continued on therapy. Among Q-SHIP participants continuing treatment, mean corpuscular volume increased by a median of 8.6 fL (IQR +5.4, +17.7, p&lt;0.0001) and hemoglobin F increased by a median of 5.8% (IQR +3.0, +11.3, p&lt;0.001). One year after implementation of Q-SHIP, the proportion of treatment-eligible patients with SCA who presented to the ED with pain or ACS who were receiving hydroxyurea increased; February 2016: 56% (32/57) vs. February 2017: 73% (43/59), p=0.059. Conclusion: Addressing indications for hydroxyurea therapy in a clinic encounter exclusively for this purpose soon after a SCA complication is a meaningful time to meet with families of children with SCA to initiate treatment. Disclosures No relevant conflicts of interest to declare.

scholarly journals Low incidence of peach latent mosaic viroid in peach mother blocks in Serbia

2014 ◽  
Vol 29 (2) ◽  
pp. 109-114
Author(s):  
Darko Jevremovic ◽  
Svetlana Paunovic
Keyword(s):  
Polymerase Chain Reaction ◽  
Reverse Transcription ◽  
Mosaic Disease ◽  
Causal Agent ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Polymerase Chain ◽  
Low Incidence

Peach latent mosaic viroid (PLMVd) is the causal agent of peach latent mosaic disease that is common on peaches and nectarines worldwide. Most of the isolates do not cause any symptoms on the foliage and the disease may be latent for years. A survey to investigate the presence of PLMVd in selected peach mother blocks in 9 Serbian districts was carried out in 2011 through 2013. A total of 315 trees/samples originating from 43 mother blocks, representing 35 peach and nectarine varieties and 2 rootstocks, were tested by Reverse Transcription - Polymerase Chain Reaction (RT-PCR). PLMVd was detected in 13 samples (4.13%) belonging to 7 varieties and one vineyard peach rootstock. Infected samples were found in 7 mother blocks from 3 districts. Our results indicated a low incidence of PLMVd in the analyzed peach mother blocks.

Are we missing the mark? Fever, respiratory symptoms, chest radiographs, and acute chest syndrome in sickle cell disease

2016 ◽  
Vol 91 (8) ◽  
pp. E332-E333 ◽  
Author(s):  
Sarah G. Lazarus ◽  
Michael Kelleman ◽  
Olufolake Adisa ◽  
April R. Zmitrovich ◽  
Robert Hagbom ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Respiratory Symptoms ◽  
Chest Radiographs ◽  
Acute Chest Syndrome ◽  
Cell Disease

scholarly journals 452. Familial Cluster of COVID-19 Cases Associated with High Prevalence of Anosmia, Ageusia, and Gastrointestinal Symptoms

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S293-S293
Author(s):  
Bethany E Ho ◽  
Andrea P Ho ◽  
Michaela A Ho ◽  
Elizabeth C Ho
Keyword(s):  
Disease Transmission ◽  
Respiratory Symptoms ◽  
Index Case ◽  
Gastrointestinal Symptoms ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Familial Cluster ◽  
Gi Symptoms ◽  
High Prevalence ◽  
Polymerase Chain

Abstract Background Patients with COVID-19 most commonly report respiratory symptoms, with a minority reporting gastrointestinal (GI) symptoms in currently available reports. Additionally, little is known about the symptoms of anosmia/hyposmia, ageusia, and dysgeusia anecdotally seen in COVID-19 patients, which may be considered both GI and sensory/neurological manifestations of infection. Methods We interviewed 7 patients via oral inquiries and a questionnaire, collecting data on subject symptoms and their durations. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to confirm 2 of these cases. Results We report a familial cluster of 7 COVID-19 cases, 5 of whom reported sensory symptoms of anosmia/hyposmia (5/7), ageusia/hypogeusia (5/7), and/or dysgeusia (3/7). All 7 cases reported GI involvement with one or more symptom of: nausea (5/7), diarrhea (4/7), abdominal pain (3/7), anorexia (3/7), and emesis (2/7). Figure 1. Timeline of Symptoms and Exposure to Index Case in Familial COVID-19 Cluster Conclusion This frequency of GI symptoms is high relative to currently available epidemiological reports, which also infrequently report on sensory symptoms. The mechanistic underpinnings of GI and sensory symptoms in COVID-19 warrant close consideration and analysis, especially as it relates to reducing disease transmission. COVID-19 exhibits wide variation in duration, severity, and progression of symptoms, even within a familial cluster. Disclosures All Authors: No reported disclosures

scholarly journals Low Incidence of Symptomatic Thrombotic Events in Adult Patients Hospitalized with Coronavirus 19: A Retrospective Cohort Study

2021 ◽  
Vol 27 ◽  
pp. 107602962110517
Author(s):  
Marcelo G. Vallone ◽  
Carolina Vazquez ◽  
Fernando A. Chuliber ◽  
Verónica Privitera ◽  
Augusto Ferraris ◽  
...  
Keyword(s):  
Cohort Study ◽  
General Ward ◽  
Adult Patients ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Polymerase Chain ◽  
Low Incidence ◽  
Overall Mortality

Background Since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic, there have been many reports of increased incidence of venous thromboembolism and arterial events as a complication. Objective To determine the incidence of symptomatic thrombotic events (TEs) in patients hospitalized for SARS-CoV2 disease (coronavirus 19 [Covid-19]). Methods A retrospective single-center cohort study with adult patients with a positive reverse transcriptase-polymerase chain reaction (rt-PCR) for SARS-CoV2, included from the date of diagnosis of Covid-19 and followed for 90 days or until death. Results A total of 1621 patients were included in this study. The median age was 73 years (interquartile range25th-75th [IQR] 53-87 years) and 57% (913) were female. Overall mortality was 21.6% (348). The overall incidence of symptomatic TEs within 90 days of diagnosis was 1.8% (30 of 1621) occurring in 28 patients, including an incidence of pulmonary embolism of 0.9% (15, 95% confidence interval [CI] 0.60%-1.6%), deep venous thrombosis of 0.61% (10, 95% CI 0.2%-1%), ischemic stroke of 0.25% (4, 95% CI 0.09%-0.65%), and ischemic arterial events of 0.06% (1, 95% CI 0.008%-0.43%). No acute coronary syndrome events were recorded. The incidence of symptomatic TEs was significantly lower in the general ward than in intensive care units (1.2% vs 5.7%; p < .001). The median time since positive rt-PCR for SARS-CoV2 to symptomatic TE was 22.5 days (IQR 19-43 days). There was no significant difference in the proportion of patients receiving (53.6%) and not receiving thromboprophylaxis (66.5%) and the development of TEs. Conclusion The overall incidence of symptomatic TEs among these patients was lower than the incidence previously reported.

scholarly journals Genetic diversity of Raspberry leaf blotch emaravirus in red raspberries from Serbia

2019 ◽  
Vol 17 (1) ◽  
pp. e1004 ◽  
Author(s):  
Darko Jevremović ◽  
Aleksandar Leposavić ◽  
Svetlana A Paunović
Keyword(s):  
Phylogenetic Analysis ◽  
Large Scale ◽  
Pcr Analysis ◽  
Rt Pcr ◽  
Leaf Blotch ◽  
High Incidence ◽  
Long Time ◽  
Large Scale Survey ◽  
Polymerase Chain ◽  
Degree Of Association

Raspberry leaf blotch emaravirus (RLBV) is a recently characterised virus infecting raspberries reported in several European countries. RLBV causes yellow blotching, the distortion of leaf margins, and the twisting of raspberry leaves. For a long time, similar symptoms were attributed to the feeding damage caused by raspberry leaf and bud mite (Phyllocoptes gracilis). From 2014−2017, a large-scale survey was conducted in Serbia to investigate the degree of association of the observed symptoms with the RLBV infection. A total of 98 symptomatic and asymptomatic samples were collected from 30 locations. All collected samples were tested on the RLBV presence by reverse transcription and polymerase chain reaction (RT-PCR) using three sets of RNA-specific primers targeting RNA-1, RNA-3, and RNA-5 of the RLBV genome. RT-PCR analysis revealed high incidence of RLBV in tested samples (68.7%). RLBV was confirmed in raspberries ‘Fertödi Zamatos’, ‘Glen Ample’, ‘Meeker’, ‘Polana’, ‘Tulameen’ and ‘Willamette’. Twenty-one isolates were selected for sequencing the portion of the nucleocapsid (NC) gene. The nucleotide sequences of the isolates showed 93.2−100% identity. Phylogenetic analysis confirmed significant genetic variability of the Serbian RLBV isolates based on the nucleocapsid-encoding sequences and revealed the existence of two main clusters. Phylogenetic analysis of the 45 RLBV sequences from Finland, Slovakia, Scotland, and this study also confirmed the existence of two main clusters of isolates.

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