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Georgiades F, Summers DM, Butler AJ, Russell NKI, Clatworthy MR, Torpey N. Renal transplantation during the SARS-CoV-2 pandemic in the UK: Experience from a large-volume center. Clin Transplant 2020; 35:e14150. [PMID: 33170982 DOI: 10.1111/ctr.14150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 12/22/2022]
Abstract
There is uncertainty about the safety of kidney transplantation during the SARS-CoV-2 pandemic due to the risk of donor transmission, nosocomial infection and immunosuppression use. We describe organ donation and transplant practice in the UK and assess whether kidney transplantation conferred a substantial risk of harm. Data from the UK transplant registry were used to describe kidney donation and transplant activity in the UK, and a detailed analysis of short-term, single-center, patient results in two periods: during the pre-pandemic era from 30th December 2019 to 8th March 2020 ("Pre-COVID era") and the 9th March 2020 to 19th May 2020 ("COVID era"). Donor and recipient numbers fell by more than half in the COVID compared to the pre-COVID era in the UK, but there were more kidney transplants performed in our center (42 vs. 29 COVID vs. pre-COVID respectively). Overall outcomes, including re-operation, delayed graft function, primary non-function, acute rejection, length of stay and graft survival were similar between COVID and pre-COVID era. 6/71 patients became infected with SARS-CoV-2 but all were discharged without critical care requirement. Transplant outcomes have remained similar within the COVID period and no serious sequelae of SARS-CoV-2 infection were observed in the peri-transplant period.
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Affiliation(s)
| | | | - Andrew J Butler
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Neil K I Russell
- Department of Transplantation, Cambridge University Hospitals, Cambridge, UK
| | | | - Nicholas Torpey
- Department of Transplantation, Cambridge University Hospitals, Cambridge, UK
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52
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Freeman-Sanderson A, Ward EC, Miles A, de Pedro Netto I, Duncan S, Inamoto Y, McRae J, Pillay N, Skoretz SA, Walshe M, Brodsky MB. A Consensus Statement for the Management and Rehabilitation of Communication and Swallowing Function in the ICU: A Global Response to COVID-19. Arch Phys Med Rehabil 2020; 102:835-842. [PMID: 33166525 PMCID: PMC7648184 DOI: 10.1016/j.apmr.2020.10.113] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 01/10/2023]
Abstract
Objective To identify core practices for workforce management of communication and swallowing functions in coronavirus disease 2019 (COVID-19) positive patients within the intensive care unit (ICU). Design A modified Delphi methodology was used, with 3 electronic voting rounds. AGREE II and an adapted COVID-19 survey framework from physiotherapy were used to develop survey statements. Sixty-six statements pertaining to workforce planning and management of communication and swallowing function in the ICU were included. Setting Electronic modified Delphi process. Participants Speech-language pathologists (SLPs) (N=35) from 6 continents representing 12 countries. Interventions Not applicable. Main Outcome Measures The main outcome was consensus agreement, defined a priori as ≥70% of participants with a mean Likert score ≥7.0 (11-point scale: 0=strongly disagree, 10=strongly agree). Prioritization rank order of statements in a fourth round was also conducted. Results SLPs with a median of 15 years of ICU experience, working primarily in clinical (54%), academic (29%), or managerial positions (17%), completed all voting rounds. After the third round, 64 statements (97%) met criteria. Rank ordering identified issues of high importance. Conclusions A set of global consensus statements to facilitate planning and delivery of rehabilitative care for patients admitted to the ICU during the COVID-19 pandemic were agreed by an international expert SLP group. Statements focused on considerations for workforce preparation, resourcing and training, and the management of communication and swallowing functions. These statements support and provide direction for all members of the rehabilitation team to use for patients admitted to the ICU during a global pandemic.
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Affiliation(s)
- Amy Freeman-Sanderson
- Graduate School of Health, University of Technology, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; Critical Care Division, The George Institute for Global Health, Sydney, NSW, Australia.
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Anna Miles
- Speech Science, The University of Auckland, Auckland, New Zealand
| | - Irene de Pedro Netto
- Núcleo de Cardiologia/Centro de Reabilitação Cardiopulmomar, Hospital Sírio Libanês, Sao Paulo, Brazil; Comitê de Fonoaudiologia, BRASPEN/SBNPE (Sociedade Brasileira de Nutrição Parenteral e Enteral), Brazil
| | - Sallyanne Duncan
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Speech and Language Therapy, Belfast Health and Social Care Trust, Belfast, UK
| | - Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Nagoya, Japan
| | - Jackie McRae
- School of Allied Health, Midwifery and Social Care Faculty of Health, Social Care and Education, Kingston and St George's, University of London, London, UK; Speech and Language Therapy, University College London Hospitals NHS Foundation Trust, London, UK
| | - Natasha Pillay
- Life The Crompton Hospital, Pinetown, KZN, South Africa; Life Westville Hospital, Durban, South Africa
| | - Stacey A Skoretz
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Martin B Brodsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD
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De Backer D, Azoulay E, Vincent JL. Corticosteroids in severe COVID-19: a critical view of the evidence. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:627. [PMID: 33121512 PMCID: PMC7595567 DOI: 10.1186/s13054-020-03360-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Daniel De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint Louis University Hospital, APHP, Paris, France
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
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De la Hoz-Restrepo F, Alvis-Zakzuk NJ, De la Hoz-Gomez JF, De la Hoz A, Gómez Del Corral L, Alvis-Guzmán N. Is Colombia an example of successful containment of the 2020 COVID-19 pandemic? A critical analysis of the epidemiological data, March to July 2020. Int J Infect Dis 2020; 99:522-529. [PMID: 32791206 PMCID: PMC7417900 DOI: 10.1016/j.ijid.2020.08.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Colombia detected its first coronavirus disease 2019 (COVID-19) case on March 2, 2020. From March 22 to April 25, it implemented a national lockdown that, apparently, allowed the country to keep a low incidence and mortality rate up to mid-May. Forced by the economic losses, the government then opened many commercial activities, which was followed by an increase in cases and deaths. This paper presents a critical analysis of the Colombian surveillance data in order to identify strengths and pitfalls of the control measures. METHODS A descriptive analysis of PCR-confirmed cases between March and July 25 was performed. Data were described according to the level of measurement. Incidence and mortality rates of COVID-19 were estimated by age, sex, and geographical area. Sampling rates for suspected cases were estimated by geographical area, and the potential for case underestimation was assessed using sampling differences. RESULTS By July 25, Colombia (population 50 372 424) had reported 240 745 cases and 8269 deaths (case fatality rate of 3.4%). A total of 1 370 271 samples had been analyzed (27 405 samples per million people), with a positivity rate of 17%. Sampling rates per million varied by region from 2664 to 158 681 per million, and consequently the incidence and mortality rates also varied. Due to geographical variations in surveillance capacity, Colombia may have overlooked up to 82% of the actual cases. CONCLUSION Colombia has a lower case and mortality incidence compared to other South American countries. This may be an effect of the lockdown, but may also be attributed, to some extent, to geographical differences in surveillance capacity. Indigenous populations with little health infrastructure have been hit the hardest.
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Affiliation(s)
- Fernando De la Hoz-Restrepo
- Department of Public Health, Universidad Nacional de Colombia, Carrera 10 No. 93-51 apto 505, Bogotá, DC, Colombia
| | - Nelson J Alvis-Zakzuk
- Department of Economic Sciences, Universidad de la Costa - CUC, Calle 58 No. 55-66, Barranquilla, Colombia; Department of Health Technology Assessment, ALZAK Foundation, Crespo Calle 67 No. 5-44 edificio Costa de Marfil 101, Cartagena, Colombia.
| | - Juan Fernando De la Hoz-Gomez
- Bioinformatics Interdepartmental Program, University of California Los Angeles, UCLA, 621 Charles E Young Dr S, Los Angeles, CA 90024, USA
| | - Alejandro De la Hoz
- Grupo de Investigación en Enfermedades Infecciosas, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, DC, Colombia
| | | | - Nelson Alvis-Guzmán
- Department of Health Technology Assessment, ALZAK Foundation, Crespo Calle 67 No. 5-44 edificio Costa de Marfil 101, Cartagena, Colombia; Department of Economic Sciences, Universidad de Cartagena, Avenida del Consulado, Calle 30 No. 39 B-192, Cartagena, Colombia
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Kokoszka-Bargieł I, Cyprys P, Rutkowska K, Madowicz J, Knapik P. Intensive Care Unit Admissions During the First 3 Months of the COVID-19 Pandemic in Poland: A Single-Center, Cross-Sectional Study. Med Sci Monit 2020; 26:e926974. [PMID: 32979262 PMCID: PMC7526339 DOI: 10.12659/msm.926974] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Data on the outcomes of patients with coronavirus disease 2019 (COVID-19) requiring Intensive Care Unit (ICU) care in Poland are limited. There are no data on critically ill patients with COVID-19 who did not meet criteria for ICU admission. Material/Methods We analyzed patients admitted to the ICU and those ineligible for ICU admission in a large COVID-19-dedicated hospital, during the first 3 months of the pandemic in Poland. Data from 67 patients considered for ICU admissions due to COVID-19 infection, treated between 10 March and 10 June 2020, were reviewed. Following exclusions, data on 32 patients admitted to the ICU and 21 patients ineligible for ICU admission were analyzed. Results In 38% of analyzed patients, symptoms of COVID-19 infection occurred during a hospital stay for an unrelated medical issue. The mean age of ICU patients was 62.4 (10.4) years, and the majority of patients were male (69%), with at least one comorbidity (88%). The mean admission APACHE II and SAPS II scores were 20.1 (8.1) points and 51.2 (15.3) points, respectively. The Charlson Comorbidity Index and Clinical Frailty Scale were lower in ICU patients compared with those disqualified: 5.9 (4.3) vs. 9.1 (3.5) points, P=0.01, and 4.7 (1.7) vs. 6.9 (1.2) points, P<0.01, respectively. All ICU patients required intubation and mechanical ventilation. ICU mortality was 67%. Hospital mortality among patients admitted to the ICU and those who were disqualified was 70% and 79%, respectively. Conclusions Patients with COVID-19 requiring ICU admission in our studied population were frail and had significant comorbidities. The outcomes in this group were poor and did not seem to be influenced by ICU admission.
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Affiliation(s)
- Izabela Kokoszka-Bargieł
- Department of Anesthesiology and Intensive Therapy, Provincial Specialist Hospital, Tychy, Poland
| | - Paweł Cyprys
- Students' Scientific Society, Department of Cardiac Anesthesia and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Rutkowska
- Department of Anesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Jarosław Madowicz
- Provincial Specialist Hospital, Tychy, Poland.,Department of Health Sciences, Higher School of Strategic Planning, Dąbrowa Górnicza, Poland
| | - Piotr Knapik
- Department of Anesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases in Zabrze, Medical University of Silesia, Zabrze, Poland
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Fainardi V, Longo F, Chetta A, Esposito S, Pisi G. Sars-CoV-2 infection in patients with cystic fibrosis. An overview. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020035. [PMID: 32921729 PMCID: PMC7716958 DOI: 10.23750/abm.v91i3.10391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023]
Abstract
The novel coronavirus SARS-CoV-2 was first identified in China in December 2019 and has since spread worldwide. People with Cystic Fibrosis (CF) have reduced survival mainly because of respiratory failure due to chronic pulmonary infections. Therefore, CF patients should be considered to have an increased risk of developing severe manifestations in case of SARS-CoV-2 infection. Surprisingly, the results of recent studies concerning SARS-CoV-2 infection in patients with CF show that in these patients the infection rate was lower than that of the general population. Various factors have been considered to explain a possible protective effect of CF against SARS-CoV-2 infection.
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Affiliation(s)
| | - Francesco Longo
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy.
| | - Alfredo Chetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy..
| | | | - Giovanna Pisi
- Cystic Fibrosis Unit, Children University Hospital, Parma.
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57
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Noto PV, Giraffa CM, Ragusa E, Mangano G, Malatino L, Carpinteri G. COVID-19: a single experience in Intermediate Care Unit. ACTA ACUST UNITED AC 2020. [DOI: 10.23736/s2532-1285.20.00038-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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58
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Immovilli P, Morelli N, Rota E, Guidetti D. COVID-19 mortality and health-care resources: Organization. Med Intensiva 2020; 45:383-384. [PMID: 34629590 PMCID: PMC7298469 DOI: 10.1016/j.medin.2020.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- P Immovilli
- Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - N Morelli
- Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - E Rota
- Neurology Unit, ASL Alessandria, Italy
| | - D Guidetti
- Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
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