scholarly journals Impact of the COVID-19 Pandemic on Kidney Diseases Requiring Renal Biopsy: A Single Center Observational Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Samy Hakroush ◽  
Désirée Tampe ◽  
Peter Korsten ◽  
Björn Tampe

BackgroundThe coronavirus disease-2019 (COVID-19) pandemic impacted healthcare services for kidney disease patients. Lockdown and social distancing were mandated worldwide, resulting in closure of medical services. The diagnosis of various kidney diseases may have been delayed during the COVID-19 pandemic because non-urgent tests and visits were postponed due to closure of medical services during the lockdown.MethodsWe here report the impact of the COVID-19 pandemic on a total number of 209 native kidney diseases requiring renal biopsy for diagnosis in a retrospective observational study from a tertiary hospital in Germany.ResultsThe lockdown period in March and April 2020 primarily affected patients admitted to the normal medical ward with a compensatory increased rate of renal biopsies in the postlockdown phase. In addition, there was a shift toward more patients admitted with hemoglobinuria during the COVID-19 pandemic. This phenomenon of an increased number of patients with hemoglobinuria during the COVID-19 pandemic was specifically observed in a subgroup with hypertensive nephropathy requiring renal biopsy and associated with increased proteinuria, not attributed to the COVID-19 lockdown period itself.ConclusionTo our knowledge, this is the first report of identifying a subpopulation susceptible to closure of medical services during the COVID-19 pandemic and diagnostic delay of specific kidney diseases. Therefore, the COVID-19 pandemic should be regarded as a risk factor especially in patients with diseases other than COVID-19 primarily admitted to the normal medical ward.

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Björn Tampe ◽  
Samy Hakroush

Abstract Background and Aims The coronavirus disease-2019 (COVID-19) pandemic impacted healthcare services for kidney disease patients. Lockdown and social distancing were mandated worldwide, resulting in closure of medical services. The diagnosis of various kidney diseases may have been delayed during the COVID-19 pandemic because non-urgent tests and visits were postponed due to closure of medical services during the lockdown. Based on previous reports, this afftects especially kidney diseases requiring renal biopsy and histological analysis for diagnosis. We have previously reported that during the lockdown period in March and April 2020, an incidence-shift with a COVID-19 gap of no diagnosed antineutrophil cytoplasm antibodies (ANCA)-associated vasculitis (AAV) and ANCA glomerulonephritis (GN) based on renal biopsy was followed by a postlockdown phase in subsequent months with a compensatory increased incidence rate. This has been attributed to a decreased number of renal biopsies during the lockdown period and a compensatory increased number in the postlockdown phase. We here expanded our analysis to evaluate the effect of the COVID-19 pandemic on kidney diseases requiring renal biopsy. Furthermore, we aimed to identify effects of the COVID-19 pandemic on clinical outcomes in patients with kidney diseases, including ANCA GN. With multiple vaccines currently undergoing human trials to combat this pandemic, there is an urgent need for a clear sense for patient populations most susceptible to shutdown of medical services. We here report the impact of the COVID-19 pandemic on native kidney diseases requiring renal biopsy for diagnosis in a retrospective observational study from a tertiary hospital in Germany. Method A total number of 209 renal biopsies performed on native kidneys of patients hospitalized at the University Medical Center Göttingen in 2019 and 2020 were included. Variables were tested for normal distribution using Shapiro-Wilk test. Non-normally distributed continuous variables are expressed as median and interquartile range (IQR), categorical variables are presented as frequencies and percentages. Statistical comparisons were not formally powered or prespecified. For group comparisons, the Mann-Whitney U-test was used to determine differences in medians. Non-parametric between-group-comparisons were performed with Pearson’s Chi-square test. Data analyses were performed with GraphPad Prism (version 8.4.0 for MacOS, GraphPad Software, San Diego, California, USA). Results The lockdown period in March and April 2020 primarily affected patients admitted to the normal medical ward with a compensatory increased rate of renal biopsies in the postlockdown phase. In addition, there was a shift towards more patients admitted with hemoglobinuria during the COVID-19 pandemic. This phenomenon of an increased number of patients with hemoglobinuria during the COVID-19 pandemic was specifically observed in a subgroup with ANCA GN and hypertensive nephropathy requiring renal biopsy. Conclusion To our knowledge, this is the first report of identifying a subpopulation susceptible to closure of medical services during the COVID-19 pandemic and diagnostic delay of specific kidney diseases. Therefore, the COVID-19 pandemic should be regarded as a risk factor especially in patients with diseases other than COVID-19 primarily admitted to the normal medical ward.


Vestnik ◽  
2021 ◽  
pp. 289-292
Author(s):  
Л.Ж. Алекешева ◽  
К.К. Тогузбаева ◽  
К.О. Джусупов

COVID-19 нанес серьезный удар по системам здравоохранения многих стран мира, включая Республику Казахстан. Чтобы справиться с пандемией, Казахстан разработал план, содержащий три стратегические цели: 1) предотвращение вспышки болезни; 2) Обеспечение оптимального ухода для всех пациентов и 3) Сведение к минимуму воздействия пандемии на системы здравоохранения, социальные услуги и экономическую деятельность. Однако неравномерное распределение финансовых ресурсов по регионам, нерегулярное потребление медицинских услуг и различия в показателях здоровья препятствуют этим усилиям. Другие проблемы - это нехватка медицинских сил, неожиданность ситуации, отсутствие знаний о коронавирусной инфекции и бессилие перед этой новой болезнью. Были трудности с массовым тестированием, поскольку стигма и страх перед карантином вынуждали людей не проходить тестирование. После отмены чрезвычайного положения и строгой изоляции страну охватила эйфория, которая привела к резкому увеличению числа случаев заболевания. Чтобы взять ситуацию под контроль в июне 2020 года был экстренно введен второй локдаун, постепенно стало уменьшаться количество больных и инфицированных. Пандемия показала, насколько хрупка и зависима система: была отложена плановая вакцинация детям до 1 года, временно приостановлено медицинское обследование и оказание медицинских услуг больным хроническими, онкологическими заболеваниями, плановая госпитализация. Многие врачи и медсестры заразились и заболели. На момент написания этой статьи эпидемиологическая ситуация в стране с COVID-19 находится под контролем и надзором, однако давать какие-либо прогнозы относительно его завершения пока рано. Казахстан готовится к вакцинации от коронавирусной инфекции, в первую очередь вакцинации должны подвергаться группы риска, медицинские и социальные работники, а также люди с хроническими заболеваниями. Пока коллективный иммунитет не сформирован, казахстанцы должны проявлять осторожность при снятии ограничений, чтобы предотвратить взрыв новых случаев заболевания. COVID-19 has strained the healthcare systems of many countries worldwide including the Republic of Kazakhstan. To cope with the pandemic, Kazakhstan mounted a plan containing three strategic objectives: 1) Preventing the outbreak of the disease; 2) Ensuring optimal care for all patients, and 3) Minimizing the impact of the pandemic on health systems, social services, and economic activities. However, the uneven distribution of financial resources across regions, irregular consumption of medical services, and inconsistent health indicators hamper these efforts. Other issues are the lack of medical forces, the unexpectedness of the situation, lack of knowledge on coronavirus infection, and powerlessness in front of this new disease. There were difficulties in mass testing as stigma and fear from quarantine forced people not to get tested. The euphoria enveloped the country after abolishing the emergency state after an intense lockdown which resulted in increased cases. A second lockdown was urgently introduced in June 2020 to take control of the situation. The number of patients and those infected gradually began to decline. The pandemic showed the fragility and inter-dependence of the health system- planned vaccinations against many infectious diseases were postponed. Medical examination and provision of medical services to patients with chronic, oncological diseases, planned hospitalization were temporarily halted. Many doctors and nurses became infected and ill. The country's COVID-19 epidemiological situation is somewhat under the control and supervision as of this writing. However, to give any forecasts for its completion is still too early. Kazakhstan is preparing to vaccinate against coronavirus infection. First of all, risk groups, medical and social workers, and people with chronic diseases should be subject to vaccination. Until herd immunity is not formed, Kazakhstanis must keep caution when the restrictions are taken off to prevent an explosion of new disease cases.


2018 ◽  
Vol 16 (1) ◽  
pp. 49 ◽  
Author(s):  
Alicia R. Gable, MPH ◽  
Claudia Der-Martirosian, PhD ◽  
Laura N. Pinnock, MSPH, PMP ◽  
Aram Dobalian, PhD, JD, MPH

Objective: To identify the communication preferences of homeless (H) and nonhomeless (NH) Veterans Affairs (VA) patients for receiving information about the impact of natural disasters on VA healthcare services. Design: Probability-based sampling design stratified on age categories, urban/rural, coastal/noncoastal, and homelessness. Setting: Northeast United States.Participants: Eligible NH and H participants included those who lived in and had at least one healthcare visit to a VA medical center/clinic in the region in the previous 24 months. Homeless participants included those receiving VA homeless services or having ICD9-CM V60.0 (Lack of Housing). 2,264/6,088 NH and 383/2,000 H completed the survey.Intervention: Cross-sectional, mixed-mode survey administered August-November 2015.Main Outcome Measures: Helpfulness of ten communication modes for receiving information about the impact of natural disasters on VA healthcare services.Results: Despite sociodemographic and health status differences, the top five communication modes rated extremely/very helpful were the same for both groups: telephone (76 percent H; 81 percent NH), TV (63 percent H; 60 percent NH), text (62 percent H; 50 percent NH), e-mail (56 percent H; 58 percent NH), radio (54 percent H; 47 percent NH). Newspaper and online modes (VA/other Web sites, Twitter, Facebook, MyHealtheVet) were rated substantially lower. Conclusions: H and NH patients prefer similar communication modes for receiving updates about the impact of natural disasters on VA healthcare services. Findings suggest that a multimodal communication strategy that incorporates phone, TV, text, e-mail, and radio will help Veterans Affairs (VA) reach its diverse patient population during natural disasters. Dissemination of messages via online modes, while rated less helpful, may augment the number of patients reached.


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Joel N Briard ◽  
Rahel T Zewude ◽  
Mahesh Kate ◽  
Ken Butcher ◽  
Laura C Gioia

Introduction: The impact of prehospital triage of stroke mimics to designated stroke centers may be considerable, yet little information exists regarding stroke mimics in the prehospital setting. We aimed to describe the rate and clinical characteristics of neurological and non-neurological stroke mimics transported by Emergency Medical Services (EMS) to the Emergency Department (ED) for acute stroke evaluation. Methods: A retrospective, cross-sectional, observational analysis of a centralized EMS database of patients transported by EMS to the ED for suspected stroke during an 18-month period. Hospital charts and neuroimaging were utilized to determine the final diagnosis (acute stroke, stroke mimic, as well as specific underlying diagnoses). Results: A total of 960 patients were transported by EMS to the ED with suspected stroke, among whom 405 (42.2%) were stroke mimics (mean age ± SD: 66.9 ± 17.1 years; 54% male). Stroke mimics were neurological in origin in 223 (55.1%) patients and non-neurological in 182 (44.9%). Most common neurological diagnoses were seizures (n=44,19.7%), migraines (n=42,18.8%) and peripheral neuropathies (n=25, 11.2%). Most common non-neurological mimics included cardiovascular (15.9%), psychiatric (11.9%), and infectious (8.9%) diagnoses. Neurological mimics were younger (64.1 ± 17.3 years) than non-neurological mimics (70.5 ± 16.1 years, p<0.001). Median prehospital Glasgow Coma Scale scores were similar between groups (15 vs. 15, p=0.26). Mean prehospital systolic blood pressure was slightly higher in neurological (147.8±24.2 mmHg) than non-neurological mimics (141.2±26.2 mmHg, p=0.01). Conclusions: Stroke mimics represent a substantial number of patients transported by EMS for suspected stroke, with a considerable amount being non-neurological in origin. Prospective prehospital studies are warranted to help refine prehospital identification of acute stroke and thus minimize the number of stroke mimics transported by EMS for acute stroke evaluation.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xuechen Xiong ◽  
Xiaolin Cao ◽  
Li Luo

Abstract Background To better understand the distribution and consumption patterns of resources in different ethnic groups and at different levels of economic development, this paper chose to describe the healthcare seeking behavior in Shanghai. Methods The data are from the Sixth Health Service Survey of Shanghai, which encompasses 23,198 permanent residents. Descriptive analyses were conducted to estimate the number of patients who reported health-related symptoms and healthcare-seeking behaviors per 1,000 residents. Logistic regression analyses were conducted to examine differences in reporting health-related symptoms and healthcare-seeking behaviors by age, gender and area of residence. Results This paper have mapped the ecology of healthcare in Shanghai in 2018. Of 1000 individuals considered during a 1-month period, 444 reported sickness, 433 received treatment, 288 went to medical institutions, 195 went to primary medical institutions, 86 took a self-healing approach, 26 received TCM services, 7 were hospitalized, and 3 underwent surgery. Conclusions Age is a risk factor leading to disease, medical treatment, self-medication, medical institution visits, TCM service, hospitalization and surgery. But age is a protective factor in the use of primary health care services. By gender, the number of people receiving medical services was similar, but women were statistically more likely to have surgery. As the income level increased, the number of patients and people receiving medical services showed a decreasing trend. Compared with the local population, the probability of non-local people visiting medical institutions was lower and statistically significant. Compared with the people who had health insurance, fewer uninsured people reported sickness and utilized healthcare services.


2016 ◽  
Vol 26 (5) ◽  
pp. 5-12
Author(s):  
Vinsas Janušonis

The aim of the study – to estimate patients, who gave thanks for medics – doctors and nurses opinion changes and singularity of right healthcare, satisfaction and fruition their expectations. Material and methods. From January 2004 to December 2015 a survey was performed in Klaipeda University Hospital (KUH). The study included 197755 patients who were undergoing treatment in KUH. Information was collected via questionnaires (response rate 81,4%). The patients who gave thanks for medics group was analyzed apart. The survey was analyzed and compared for the periods 2004-2006 and 2013-2015. Results and discussion. The most part of patients who gave thanks for medics was aged 50-69 (15, 8%), at work, women. The time of healthcare services, information for patients, good contact and communication between patients and medics, patients’ satisfaction influenced the number of thanks. The number of thanksgiving have not direct correlation with healthcare quality. Conclusions. Patients thanksgiving has confirmed the KUH provided healthcare for the majority of patients are appropriate to meet their expectations and they are satisfied with it. Comparison of both analyzed periods has shown that over 10 years fell acknowledgments for medics. Age, gender and social status had the impact on the number of acknowledgments - more thanksgiving was from women, patients 50-59 year age, retired and persons with disabilities. The right cooperation between medics and patients, provision of healthcare information to patients increased the number of thanksgiving. The number of patients who satisfied with healthcare results and meet their expectations directly correlated with number of patients who gave thanks for medics.


2020 ◽  
pp. 33-34
Author(s):  
Subhash Chander ◽  
Ritin Sharma ◽  
Ankit Chaudhary ◽  
Rakesh Chauhan

Aim: To see the impact of lockdown in Covid19 Pandemic on Tubercular patients in a Tertiary care Centre of hilly area. Material and Methods: The study was conducted among adult patients in a tertiary health centre in a rural area. Study was conducted through lockdown period, comparing it with corresponding period in 2019. Tuberculosis patients or suspects were categorized in two groups. Group A was designated for participants in the year 2020 during lockdown period. Group B was data taken from time period similar to lockdown period in the year 2019. Data from two groups was compared. Observations: There was a 44.1% decline in number of male patients, whose sputum was examined by microscopy for tuberculosis. In case of female patients, decline was 68.6%. This decrease was present in all phases, more in 1st phase, 69.1%. During lockdown period number of patients presenting to medicine department were 45% compared to previous year ( 5129 vs 11280), sputum positive diagnosed during lockdown and similar period in 2019 were (84.4%) 27 vs 32 ( p 0.016). OPD declined by 54.5% during lockdown, however diagnosed tubercular cases by CBNAAT declined by 44.4%. Conclusion: COVID 19 pandemic greatly affected the routine healthcare services. Lockdown period saw a decline in number of patients presenting to outdoor as well as indoor patients. There was a decline in number of tuberculosis suspects as well as number of diagnosed tuberculosis patients. However decline in tuberculosis patients was less as compared to overall patients.


PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250060
Author(s):  
Ana Paula Loch ◽  
Simone Queiroz Rocha ◽  
Mylva Fonsi ◽  
Joselita Maria de Magalhães Caraciolo ◽  
Artur Olhovetchi Kalichman ◽  
...  

Objective To evaluate the impact of an intervention improving the continuum of care monitoring (CCM) within HIV public healthcare services in São Paulo, Brazil, and implementing a clinical monitoring system. This system identified three patient groups prioritized for additional care engagement: (1) individuals diagnosed with HIV, but not receiving treatment (the treatment gap group); (2) individuals receiving treatment for >6 months with a detectable viral load (the virologic failure group); and (3) patients lost to follow-up (LTFU). Methods The implementation strategies included three training sessions, covering system logistics, case discussions, and development of maintenance goals. These strategies were conducted within 30 HIV public healthcare services (May 2019 to April 2020). After each training session, professionals shared their experiences with CCM at regional meetings. Before and after the intervention, providers were invited to answer 23 items from the normalization process theory questionnaire (online) to understand contextual factors. The mean item scores were compared using the Mann–Whitney U test. The RE-AIM implementation science framework (evaluating reach, effectiveness, adoption, implementation, and maintenance) was used to evaluate the integration of the CCM. Results In the study, 47 (19.3%) of 243 patients with a treatment gap initiated treatment, 456 (49.1%) of 928 patients with virologic failure achieved suppression, and 700 of 1552 (45.1%) LTFU patients restarted treatment. Strategies for the search and reengagement of patients were developed and shared. Providers recognized the positive effects of CCM on their work and how it modified existing activities (3.7 vs. 4.4, p<0.0001, and 3.9 vs. 4.1, p<0.05); 27 (90%) centers developed plans to sustain routine CCM. Conclusion Implementing CCM helped identify patients requiring more intensive attention. This intervention led to changes in providers’ perceptions of CCM and care and management processes, which increased the number of patients engaged across the care continuum and improved outcomes.


2021 ◽  
Vol 11 (1) ◽  
pp. 94
Author(s):  
Jiyoung Kim ◽  
Choongrak Kim ◽  
Song Yi Park

The purpose of this retrospective observational study was to identify the impact of COVID-19 on emergency medical services (EMS) processing times and transfers to the emergency department (ED) among patients with acute stroke symptoms before and during the COVID-19 pandemic in Busan, South Korea. The total number of patients using EMS for acute stroke symptoms decreased by 8.2% from 1570 in the pre-COVID-19 period to 1441 during the COVID-19 period. The median (interquartile range) EMS processing time was 29.0 (23–37) min in the pre-COVID-19 period and 33.0 (25–41) minutes in the COVID-19 period (p < 0.001). There was a significant decrease in the number of patients transferred to an ED with a comprehensive stroke center (CSC) (6.37%, p < 0.001) and an increase in the number of patients transferred to two EDs nearby (2.77%, p = 0.018; 3.22%, p < 0.001). During the COVID-19 pandemic, EMS processing time increased. The number of patients transferred to ED with CSC was significantly reduced and dispersed. COVID-19 appears to have affected the stroke chain of survival by hindering entry into EDs with stroke centers, the gateway for acute stroke patients.


2021 ◽  
Vol 8 (22) ◽  
pp. 1786-1791
Author(s):  
Chethana Warad ◽  
Arvind Tenagi ◽  
Arya Wakankar ◽  
Pranitha Satarasi ◽  
Umesh Harakuni ◽  
...  

BACKGROUND COVID-19, caused by a new strain of corona virus 2019-nCoV led to a global pandemic after first manifesting in humans in December 2019 in Wuhan, China. The government of India ordered a nationwide lockdown for 21 days, which was then extended. Hence, ophthalmology, being a branch which largely deals with elective surgeries, was majorly affected. We need to evaluate the impact of the COVID-19 crisis on ophthalmology trainees during pandemic in India. METHODS A prospective, observational study in which an online questionnaire (on Google forms) was circulated between 9 th September and 15th September 2020 among ophthalmologists in training. RESULTS 260 of the 550 training ophthalmologists who were approached responded. They were given 31 questions to answer. The average age of the respondents was 27.39 ± 1.92 years of which 72.69 % (189 / 260) were females. 68.08 % (177 / 260) of the respondents had been posted on COVID-19 related duties. 76.5 % (198 / 260) of the respondents agreed that the outpatient load had dropped to < 50 patients per day and 100 % (260 / 260) of the respondents stated that there had been a reduction in number of patients posted for elective surgery. As a result, 64.23 % (167 / 260) responded that it had led to a loss of interest in their daily activities. 74.23 % reported different levels of stress, 73.46 % reported anxiety and some 24.23 % even experienced sleep deprivation. CONCLUSIONS This study has demonstrated that majority of the training ophthalmologists were affected psychologically during the COVID-19 pandemic to varying degrees which included both groups of training ophthalmologists who did or did not perform any COVID related duties. The study therefore has highlighted the increased need for psychologists to identify and help these individuals who may suffer from severe depression, insomnia and high stress levels and provide the necessary help. KEYWORDS COVID-19, Pandemic, Psychological Impact, Ophthalmology Trainees


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