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Bains SS, Hameed D, Dubin JA, Chen Z, Rizzo SA, Van Nielen DL, Delanois RE, Nace J. The temporal effects of asymptomatic COVID-19 infection on peri-operative complications in patients receiving total joint arthroplasty. Arch Orthop Trauma Surg 2023; 143:6799-6804. [PMID: 37432496 DOI: 10.1007/s00402-023-04969-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Recent coronavirus disease 2019 (COVID-19) infection may pose increased risk of post-operative complications after total joint arthroplasty (TJA). Current recommendations suggest waiting four-weeks before elective surgery in asymptomatic patients. The purpose of this study was to propensity-score-match patients who had positive COVID-19-test between (1) 0-2 weeks and (2) 2-4 weeks before TJA with a matching group without COVID-19 history to determine rates of complications at 90-days and 1-year post-operatively. MATERIALS AND METHODS We queried a national-database for patients who tested positively for COVID-19 within 1-month (n = 1749) before TJA. A propensity-score-match analysis was conducted to limit influence of confounders. They were separated into mutually exclusive asymptomatic cohorts based on time of positive COVID-19-test before TJA: within 2-weeks (n = 1749) and between 2-to-4 weeks (n = 599). Asymptomatic patients were patients with positive test without symptoms of fever, shortness of breath, nausea, vomiting, diarrhea, loss of taste or smell, cough, bronchitis, pneumonia, lung infections, septic shock, and multiple-organ-dysfunction. Complications analyzed: 90-day and 1-year periprosthetic-joint infections (PJIs), surgical-site infections(SSIs), wound complications, cardiac complications, transfusions, and venous thromboembolisms. RESULTS Asymptomatic patients who have COVID-19 demonstrated increased incidence of PJI in patients who had TJA performed within two weeks from positive test at 90-days compared to patients who did not test positive for COVID-19 (3.0 vs. 1.5%; p = 0.023). Upon totaling all 90-day post-operative complications, no significant difference was found amongst asymptomatic patients who tested positive for COVID-19 for total complications at 90-days (p = 0.936). CONCLUSIONS Asymptomatic patients who test positive for COVID-19 don't have increased risk for post-operative complications after TJA. However, two-fold increased risk in PJI for patients who tested positive for COVID-19 in first 2-weeks cannot be ignored. These results should be taken into consideration when surgeons consider performing TJA. We recommend asymptomatic patients consider waiting two-weeks before TJA to mitigate risk of PJI. Nevertheless, there's reassurance these patients are not at increased total complication risk.
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Affiliation(s)
- Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Jeremy A Dubin
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Salvatore A Rizzo
- Department of Orthopaedic Surgery, WellSpan Health, York Hospital, York, PA, USA
| | - Dominic L Van Nielen
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - James Nace
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
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Liu L, Ross NM, Handorf EA, Meeker CR, Chen G, Baldwin D, Vijayvergia N. Incidence of asymptomatic COVID-19 positivity in cancer patients and effects on therapy. J Cancer Res Clin Oncol 2023; 149:3243-3247. [PMID: 35904602 PMCID: PMC9334983 DOI: 10.1007/s00432-022-04231-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic is posing unprecedented challenges for patient care, especially for cancer patients. This study looks at asymptomatic (AS) COVID-19 positivity in cancer patients and its effects on their care. METHODS We conducted a retrospective chart review of AS patients testing positive for COVID-19 upon screening at Fox Chase Cancer Center between January 2020 and September 2020. Relationships between positive tests and demographics, clinical characteristics, and treatment delays were investigated using conditional logistic regression or Mantel-Haenszel tests. RESULTS Among 4143 AS patients who underwent COVID-19 testing, 25 (0.6%) were COVID-19 positive (cases) and these were matched to 50 controls. The median age was lower in the cases compared to that of the controls (64 vs 70 years old, p = 0.04). Of the cases, 10 patients (40%) never underwent their planned oncologic intervention [6/10 (60%) did not require the planned intervention once deemed okay to proceed]. Of the controls, only 1 patient (2%) did not undergo the planned intervention. Of these 15 COVID-19 positive patients who underwent the planned intervention, 11 (73.3%) had a delay related to COVID-19, with a mean delay duration of 18 days (range: 0-49, SD: 16.72). CONCLUSION Cancer patients had lower incidence of AS COVID-19 than general population. Delays that occur due to AS COVID screening are not very long and serve as a tool to limit spread of virus. Further studies will be important in addressing delays in cancer care and concerns of patient safety as the pandemic continues.
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Affiliation(s)
- Lisa Liu
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19128, USA
| | - Nicole M Ross
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19128, USA
| | - Elizabeth A Handorf
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19128, USA
| | - Caitlin R Meeker
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19128, USA
| | - Giana Chen
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19128, USA
| | - Donald Baldwin
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19128, USA
| | - Namrata Vijayvergia
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19128, USA.
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Williams JO, Nash J, Whelan C, Raven BM, Davies AJ, Evans J, Watkeys L, Morris K, James PE. Early but reversible haemostatic changes in a-symptomatic females expressing COVID-19 antibodies. Thromb Res 2022; 217:76-85. [PMID: 35908384 PMCID: PMC9313537 DOI: 10.1016/j.thromres.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/07/2022] [Accepted: 07/21/2022] [Indexed: 01/08/2023]
Abstract
The coronavirus, COVID-19 pandemic spread across the globe in 2020, with an initial high case mortality in those requiring intensive care treatment due to serious complication. A vaccine programme was quickly developed and currently the UK is one of highest double vaccinated and boosted countries in the world. Despite tremendous efforts by the UK, new cases of COVID-19 are still occurring, due to viral mutation. A major problem associated with COVID-19 is the large a-symptomatic spread within the population. Little investigation into the a-symptomatic population has been carried out and therefore we pose that the residual effects of a-symptomatic infection is still largely unknown. Prior to mass vaccination, a multi-phased single cohort study of IgM and IgG COVID-19 antibody prevalence and the associated haemostatic changes were assessed in a Welsh cohort of 739 participants, at three time points. Positive antibody participants with age and gender matched negative antibody controls were assessed at 0, 3 and 6 months. Antibody positive females appeared to have lower antibody responses in comparison to their a-symptomatic male counterparts. Despite this initial testing showed a unique significant increase in TRAP-6-induced platelet aggregation, prothrombin time (PT) and clot initiation time. Despite coagulation parameters beginning to return to normal at 3 months, significant decreases are observed in both haemoglobin and haematocrit levels. The production of extracellular vesicles (EV) was also determined in this study. Although the overall number of EV does not change throughout the study, at the initial 0 months' time point a significant increase in the percentage of circulating pro-coagulant platelet derived EV is seen, which does not appear to be related to the extent of platelet activation in the subject. We conclude that early, but reversible changes in haemostatic pathways within the a-symptomatic, female, antibody positive COVID-19 individuals are present. These changes may be key in identifying a period of pro-coagulative risk for a-symptomatic female patients.
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Affiliation(s)
- J O Williams
- School of Sport and Health Science, Cardiff Metropolitan University, Llandaff Campus, CF52YB, United Kingdom of Great Britain and Northern Ireland.
| | - J Nash
- School of Sport and Health Science, Cardiff Metropolitan University, Llandaff Campus, CF52YB, United Kingdom of Great Britain and Northern Ireland
| | - C Whelan
- School of Sport and Health Science, Cardiff Metropolitan University, Llandaff Campus, CF52YB, United Kingdom of Great Britain and Northern Ireland
| | - B M Raven
- School of Sport and Health Science, Cardiff Metropolitan University, Llandaff Campus, CF52YB, United Kingdom of Great Britain and Northern Ireland
| | - A J Davies
- School of Sport and Health Science, Cardiff Metropolitan University, Llandaff Campus, CF52YB, United Kingdom of Great Britain and Northern Ireland
| | - J Evans
- Independent Specialist Virology Centre, University Hospital Wales, United Kingdom of Great Britain and Northern Ireland
| | - L Watkeys
- School of Sport and Health Science, Cardiff Metropolitan University, Llandaff Campus, CF52YB, United Kingdom of Great Britain and Northern Ireland
| | - K Morris
- School of Sport and Health Science, Cardiff Metropolitan University, Llandaff Campus, CF52YB, United Kingdom of Great Britain and Northern Ireland
| | - P E James
- School of Sport and Health Science, Cardiff Metropolitan University, Llandaff Campus, CF52YB, United Kingdom of Great Britain and Northern Ireland
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Romeih M, Mahrous MR, El Kassas M. Incidental radiological findings suggestive of COVID-19 in asymptomatic patients. World J Radiol 2022; 14:1-12. [PMID: 35126873 PMCID: PMC8788167 DOI: 10.4329/wjr.v14.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/09/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
Despite routine screening of patients for coronavirus disease 2019 (COVID-19) symptoms and signs at hospital entrances, patients may slip between the cracks and be incidentally discovered to have lung findings that could indicate COVID-19 infection on imaging obtained for other reasons. Multiple case reports and case series have been published to identify the pattern of this highly infectious disease. This article addresses the radiographic findings in different imaging modalities that may be incidentally seen in asymptomatic patients who carry COVID-19. In general, findings of COVID-19 infection may appear in computed tomography (CT), magnetic resonance imaging, positron emission tomography-CT, ultrasound, or plain X-rays that show lung or only apical or basal cuts. The identification of these characteristics by radiologists and clinicians is crucial because this would help in the early recognition of cases so that a rapid treatment protocol can be established, the immediate isolation to reduce community transmission, and the organization of close monitoring. Thus, it is important to both the patient and the physician that these findings are highlighted and reported.
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Affiliation(s)
- Marwa Romeih
- Department of Radiodiagnosis, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Mary R Mahrous
- Department of Radiodiagnosis, National Heart institute, Cairo 11795, Egypt
| | - Mohamed El Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
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Sisakian H, Martirosyan S, Shekoyan S, Terteryan A, Hovhannisyan M. Asymptomatic COVID-19 and ST-elevation myocardial infarction in young adults: lessons learned from two similar cases. ESC Heart Fail 2021; 9:775-781. [PMID: 34779152 PMCID: PMC8653304 DOI: 10.1002/ehf2.13690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/24/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022] Open
Abstract
We present two cases of acute myocardial infarction in young patients with asymptomatic COVID‐19 infection and ST‐elevation myocardial infarction (STEMI), complicated by severe acute heart failure and ventricular fibrillation, resulting cardiopulmonary resuscitation and mechanical ventilatory support. Urgent primary percutaneous coronary intervention with further complex treatment was effective in both cases with critical cardiovascular state and co‐morbid COVID‐19 infection. This report illustrates the challenges in clinical severity of STEMI with COVID‐19 infection, despite of young age and absence of clinical symptoms and chronic co‐morbidities. STEMI patients with even asymptomatic COVID‐19 infection may be presented with significantly higher rates of severe acute heart failure.
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Affiliation(s)
- Hamayak Sisakian
- Clinic of General and Invasive Cardiology, University Hospital #1, Yerevan State Medical University, Koryun Street 2, Yerevan, 375025, Armenia
| | - Seda Martirosyan
- Clinic of General and Invasive Cardiology, University Hospital #1, Yerevan State Medical University, Koryun Street 2, Yerevan, 375025, Armenia
| | - Seda Shekoyan
- Clinic of General and Invasive Cardiology, University Hospital #1, Yerevan State Medical University, Koryun Street 2, Yerevan, 375025, Armenia
| | - Aram Terteryan
- Clinic of General and Invasive Cardiology, University Hospital #1, Yerevan State Medical University, Koryun Street 2, Yerevan, 375025, Armenia
| | - Mariam Hovhannisyan
- Clinic of General and Invasive Cardiology, University Hospital #1, Yerevan State Medical University, Koryun Street 2, Yerevan, 375025, Armenia
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Ochiai T, Ando J, Harada S, Hiki M, Ando M, Komatsu N. [Immune thrombocytopenia preceded by asymptomatic COVID-19 infection]. Rinsho Ketsueki 2021; 62:58-60. [PMID: 33551428 DOI: 10.11406/rinketsu.62.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Immune thrombocytopenia (ITP) may occur following a viral infection. We report the case of a 30-year-old woman with thrombocytopenia who was subsequently diagnosed with ITP. Although she was asymptomatic, chest computed tomography (CT) showed ground-glass opacities in the lower lung regions. The patient had a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) real-time polymerase chain reaction (RT-PCR) test. She responded well to 400 mg/kg of intravenous immunoglobulin therapy. Coronavirus disease of 2019 or COVID-19 should be considered as a cause of ITP during the pandemic, and chest CT scans and RT-PCR tests should be performed in patients suspected of ITP.
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Affiliation(s)
- Tomonori Ochiai
- Department of Hematology, Juntendo University School of Medicine
| | - Jun Ando
- Department of Hematology, Juntendo University School of Medicine
| | - Sakiko Harada
- Department of Hematology, Juntendo University School of Medicine
| | - Makoto Hiki
- Department of Cardiology, Juntendo University School of Medicine
| | - Miki Ando
- Department of Hematology, Juntendo University School of Medicine
| | - Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine
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7
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Carroll C, Conway R, O'Donnell D, Norton C, Hogan E, Browne M, Buckley CM, Kavanagh P, Martin J, Doyle S. Routine testing of close contacts of confirmed COVID-19 cases - National COVID-19 Contact Management Programme, Ireland, May to August 2020. Public Health 2020; 190:147-151. [PMID: 33386140 PMCID: PMC7577651 DOI: 10.1016/j.puhe.2020.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/10/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The objective of this study was to inform public health practitioners who are designing, adapting and implementing testing and tracing strategies for Coronavirus disease (COVID-19) control. STUDY DESIGN The study design is monitoring and evaluation of a national public health protection programme. METHODS All close contacts of laboratory-confirmed cases of COVID-19 identified between the 19th May and 2nd August were included; secondary attack rates and numbers needed to test were estimated. RESULTS Four thousand five hundred eighty six of 7272 (63%) close contacts of cases were tested with at least one test. The secondary attack rate in close contacts who were tested was 7% (95% Confidence Interval [CI]: 6.3 - 7.8%). At the 'day 0' test, 14.6% (95% CI: 11.6-17.6%) of symptomatic close contacts tested positive compared with 5.2% (95% CI: 4.4-5.9%) of asymptomatic close contacts. CONCLUSIONS The application of additional symptom-based criteria for testing in this high-incidence population (close contacts) is of limited utility because of the low negative predictive value of absence of symptoms.
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Affiliation(s)
- C Carroll
- Joint First Author; COVID-19 Contact Management Programme, Health Service Executive, Ireland
| | - R Conway
- Joint First Author; COVID-19 Contact Management Programme, Health Service Executive, Ireland.
| | - D O'Donnell
- COVID-19 Contact Management Programme, Health Service Executive, Ireland
| | - C Norton
- COVID-19 Contact Management Programme, Health Service Executive, Ireland
| | - E Hogan
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; National Quality Improvement Team, Health Service Executive, Ireland
| | - M Browne
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; National Quality Improvement Team, Health Service Executive, Ireland
| | - C M Buckley
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; School of Public Health, University College Cork, Cork, Ireland
| | - P Kavanagh
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; Health Intelligence Unit Strategic Planning and Transformation, Dublin, Ireland; Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Martin
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; National Quality Improvement Team, Health Service Executive, Ireland
| | - S Doyle
- COVID-19 Contact Management Programme, Health Service Executive, Ireland
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