Multidisciplinary Center Care for Long COVID Syndrome - a Retrospective Cohort Study

BACKGROUND

Persistent multi-organ symptoms after COVID-19 have been termed "long COVID" or "post-acute sequelae of SARS-CoV-2 infection" (PASC). The complexity of these clinical manifestations posed challenges early in the pandemic as different ambulatory models formed out of necessity to manage the influx of patients. Little is known about the characteristics and outcomes of patients seeking care at multidisciplinary post-COVID centers.

METHODS

We performed a retrospective cohort study of patients evaluated at our multidisciplinary Comprehensive COVID-19 Center (CCC) in Chicago, IL, between May 2020 and February 2022. We analyzed specialty clinic utilization and clinical test results according to severity of acute COVID-19.

RESULTS

We evaluated 1802 patients a median of 8 months from acute COVID-19 onset, including 350 post-hospitalization and 1452 non-hospitalized patients. Patients were seen in 2361 initial visits in 12 specialty clinics, with 1151 (48.8%) in neurology, 591 (25%) in pulmonology, and 284 (12%) in cardiology. Among patients tested, 742/878(85%) reported decreased quality of life, 284/553(51%) had cognitive impairment, 195/434(44.9%) had alteration of lung function, 249/299(83.3%) had abnormal CT chest scans, and 14/116(12.1%) had elevated heart rate on rhythm monitoring. Frequency of cognitive impairment and pulmonary dysfunction was associated with severity of acute COVID-19. Non-hospitalized patients with positive SARS-CoV-2 testing had similar findings than those with negative or no test results.

CONCLUSIONS

The CCC experience shows common utilization of multiple specialists by long COVID patients, who harbor frequent neurologic, pulmonary, and cardiologic abnormalities. Differences in post-hospitalization and non-hospitalized groups suggest distinct pathogenic mechanisms of long COVID in these populations.

[Intensity modulated radiotherapy for head and neck cancers: ethics and patients selection]

PURPOSE

Intensity modulated radiotherapy (IMRT) allows a better coverage of the target volume and a better saving of organs at risk with a decrease of toxicity in head and neck cancers. It requires more human labor and materials compared to conformational radiotherapy. If they are insufficient, a selection of the patients receiving IMRT may be necessary, raising an ethical problem.

MATERIAL AND METHODS

We collected the motives guiding the choice of the technique of radiotherapy for head and neck cancers during a month of physicists' shortage.

RESULTS

Nineteen patients received IMRT and eight conformational radiotherapy. Conformational irradiation was chosen in palliative and postsurgery treatments, to reduce delay, in laryngeal tumors and re-irradiation. IMRT was preferred for complex target volumes and the localizations at risk of important xerostomia following conformational radiotherapy. These choices were confronted with the bioethics criteria of Beauchamp and Childress. The beneficence justified the use of IMRT or conformational radiotherapy depending on the circumstances. The non-maleficence attempted to decrease the toxicity with IMRT. Justice was questioned by the selection. The autonomy of patients was not totally respected in the choice.

CONCLUSION

To help in the choice of the patients receiving an IMRT in a crisis situation, we proposed a hierarchical organization of selection criteria: complex volumes close to critical organs at risk, localization with high risk of xerostomia, long life expectancy and postoperative delay constraints.

The detection of meningococcal household clusters and their prophylaxis in the changing epidemiological situation of invasive meningococcal disease in Poland, 2003-2006

Binary file ES_Abstracts_Final_ECDC.txt matches

Epidemiology of meningococcal meningitis and changes in the surveillance system in Poland, 1970-2006

The objective of this study was to describe the general features of meningococcal meningitis epidemiology in 1970-2006 in Poland, in the context of changes made in surveillance system methods. Because of limited availability of case-based data, a more detailed analysis was performed only for the period 1994-2006 with special focus on case-fatality and diagnostic certainty. The reported annual number of meningococcal meningitis cases reached its peak of 416 (incidence 1.2 per 100,000) in 1981, after which it decreased to 76 cases in 2003 (incidence 0.2), and then increased to 151 cases in 2006 (incidence 0.4 per 100,000). The observed decrease was consistent with the decline in the number of live births and the drop in mortality from meningococcal disease observed using an independent reporting of death certificates. In 1994-2006, 1,677 cases of meningococcal meningitis were registered, with annual incidence varying between 0.2 and 0.5 per 100,000 inhabitants. Median age of patients was 4 years and 73% of cases were under 18 years of age. The majority of cases were caused by group B meningococci, but a trend towards increasing proportion of serogroup C has been identified. Meningococcal meningitis only was reported in 79% of cases, and meningitis with concomitant septicaemia in 21%. The overall case fatality was 3.7% - 4.5% in cases of meningitis only, and 7.1% in cases of meningitis with septicaemia. Based on the case definition introduced in 2005, 88.1% of the cases would be classified as confirmed and 4.8% as probable, whereas 7.1% would not fulfil the criteria of the case definition >Although diagnostic certainty of reported cases has improved in recent years, it is still problematic. Further efforts are needed to increase the proportion of serogrouped cases and assess the burden of meningococcal disease in Poland.

Evaluation of tickborne encephalitis case classification in Poland

Central European tickborne encephalitis (TBE) is a viral disease of the central nervous system. Despite a surveillance system for TBE existing in Poland since 1970, there are no standardised case definitions and different diagnostic tests are used in various regions. The purpose of this study was to summarise four years of surveillance data using standardised case definitions. From 1999 to 2002, 607 cases of TBE were reported to Poland’s national surveillance system: 386 (63.6%) were males, 331 (54.5%) lived in rural areas, and 186 (30.6%) were between 30 and 50 years old. Of 606 diagnosed cases, 453 (74.7%) had aseptic meningitis, 109 (18.0%) had meningoencephalitis, and 44 (7.3%) had meningoencephalomyelitis. Of the 607 reported cases, 602 (99.2%) could be classified: 153 (25.4%) as confirmed, 343 (57.0%) as probable, and 106 (17.6%) as possible cases. There was a significant difference in classified cases by gender: 28.6% of male cases were classified as confirmed, compared with 19.7% of female cases (chi2= 10.48, p=0.0053). There was a significant difference in case classification by clinical diagnosis: 32.4% of cases with meningoencephalitis were classified as confirmed cases, compared with 24.7% of cases with aseptic meningitis (chi2=11.79, p=0.019). There were also significant differences in the distribution by case definition group across geographical regions. For appropriate monitoring of TBE, a uniform and valid case definition should be used in European countries. With only 25% of reported cases meeting the definition for confirmed cases, there is a need for more complete follow-up and standardised testing of suspect cases.

Evaluation of tickborne encephalitis case classification in Poland

Central European tickborne encephalitis (TBE) is a viral disease of the central nervous system. Despite a surveillance system for TBE existing in Poland since 1970, there are no standardised case definitions and different diagnostic tests are used in various regions. The purpose of this study was to summarise four years of surveillance data using standardised case definitions. From 1999 to 2002, 607 cases of TBE were reported to Poland's national surveillance system: 386 (63.6%) were males, 331 (54.5%) lived in rural areas, and 186 (30.6%) were between 30 and 50 years old. Of 606 diagnosed cases, 453 (74.7%) had aseptic meningitis, 109 (18.0%) had meningoencephalitis, and 44 (7.3%) had meningoencephalomyelitis. Of the 607 reported cases, 602 (99.2%) could be classified: 153 (25.4%) as confirmed, 343 (57.0%) as probable, and 106 (17.6%) as possible cases. There was a significant difference in classified cases by gender: 28.6% of male cases were classified as confirmed, compared with 19.7% of female cases (chi2= 10.48, p=0.0053). There was a significant difference in case classification by clinical diagnosis: 32.4% of cases with meningoencephalitis were classified as confirmed cases, compared with 24.7% of cases with aseptic meningitis (chi2=11.79, p=0.019). There were also significant differences in the distribution by case definition group across geographical regions. For appropriate monitoring of TBE, a uniform and valid case definition should be used in European countries. With only 25% of reported cases meeting the definition for confirmed cases, there is a need for more complete follow-up and standardised testing of suspect cases.

A pilot study of pain management during rehabilitation for hip and knee arthroplasty

{\it

OBJECTIVE

} To evaluate the efficacy of pain management in a clinical pathway for rehabilitation after hip and knee arthroplasty, in which scheduled medications are rapidly tapered and prn medications are continued throughout the inpatient stay. {\it

STUDY DESIGN

} A prospective cross-sectional study. {\it

SETTING

} General rehabilitation unit of a regional acute rehabilitation center. {\it

PATIENTS

} Twenty-nine patients admitted consecutively to the rehabilitation unit in three months. {\it

OUTCOME MEASURES

} Number of pills/day of prn pain medication, pain scores at admission and discharge, frequency of constipation and nausea, Functional Independence Measure (FIM) gain, and length of stay (LOS). {\it

RESULTS

} For all patients, prn pain medication use was 2.4 pills/day/patient; the mean FIM gain was 22.1; and the average LOS was 9.8 days. In comparison to the Vicodin group, patients on Darvocet N-100 had significantly fewer requests for prn pain medication each day (3.1 vs. 1.1, p < 0.01), significantly better FIM gains better (18.9 vs. 24.1, p < 0.05), and fewer side effects (nausea and constipation). {\it

CONCLUSION

} Choosing the right pain medication is imperative for achieving optimal efficiency in clinical pathways for orthopedic rehabilitation. In this pilot study, Darvocet N-100 is the preferred narcotic over codeine and its derivatives.

[Neurological syndromes in HIV patients. Part III -- HIV-related diffuse diseases of the central nervous system]

The last part of the review of the neurological syndromes observed among people who are HIV-infected deals with AIDS Dementia Complex, viral (CMV, HSV, VZV) encephalitides and cryptococcal meningitis and other less frequent diseases. Clinical presentation, neuropathology, diagnostic procedures and treatments are described. Diagnostic algorithm for central nervous system diseases in people with HIV is included. The main purpose of the present reviews is to pursue the common ground regarding treatment and diagnostic procedures with consulting neurologists and neurosurgeons for future cooperation in a growing area of HIV related neurology.

Demonstration of renal tubular flow by selective angiographic computed tomography

A high-speed computed tomography scanner was used to study the bulk flow of a small bolus of nonionic contrast medium through the renal tubules of five dogs. A 0.5-mL bolus of iohexol 300 (150 mg iodine) was injected rapidly into the renal artery, and transverse images of the kidney were obtained at 15-second intervals over 300 seconds. The mean attenuation values measured in regions of interest in the papilla and the cortex were displayed as a function of time. Curves from the papillary regions of interest showed two peaks, the first corresponding to the passage of the bolus through the loops of Henle that extend into the papilla and the second to the passage of the bolus through the terminal collecting tubules. The cortical regions of interest showed the cortical return peak, which corresponded to the passage of the bolus through the distal convoluted tubules. The peaks generated by this method can be used to measure the transit times of the bolus from the glomeruli to the loops of Henle in the papilla, from the loops of Henle to the distal convoluted tubules, and from the distal convoluted tubules to the distal collecting tubules. The mean total transit time in dehydrated dogs was 169 seconds. The method is compared with contrast-enhanced magnetic resonance imaging (with gadolinium diethylenetriaminepentaacetic acid), which has been used by other researchers for the same purpose.

Vascular exchange in the kidney. Regional characterization by multiple indicator tomography

In previous work with the method of multiple indicator dilution (MID), we have established that a spatially distributed model of transcapillary exchange proposed by Goresky, Ziegler, and Bach (GZB) accurately describes, at the in vivo whole-organ level, the handling of extracellular indicators in the canine renal cortex. To date, however, it has not been possible to assess the key hypothesis that GZB corresponds to the actual local mechanism of exchange in vivo and is not just a compact summary of the kidney's average whole-organ behavior. By adapting the MID method to high speed computed tomography (CT), we are now able to report that the GZB mechanism is an accurate description of renal cortical transcapillary exchange down to volumes of cortical tissue comprising no more than a few per cent of the total cortical mass, i.e., containing no more than a few thousand nephrons. A small bolus of iohexol (radiopaque extracellular indicator) or iodipamide ethyl ester microparticles (radiopaque plasma indicator) injected into the renal artery was followed by CT as it passed through the kidney and into the renal vein. Time-attenuation value curves of the two contrast media obtained from the renal vein and from regions of interest in the cortex were then modeled with the GZB mechanism and with a more complex formulation that includes GZB as a limiting case. When applied to the data, the models converged to GZB as the best fit for each region examined. The GZB mechanism is found to provide excellent agreement with the regional data.

An electronic method for measuring joint tenderness in rheumatoid arthritis

OBJECTIVE

To test the precision of a new electronic method for measuring joint tenderness.

METHOD

Joint tenderness was measured in 30 patients with rheumatoid arthritis, using an electronic dolorimeter. The results were compared with joint tenderness counts, which were made according to the American Rheumatism Association (ARA) methods.

RESULTS

The intra-observer variability using the electronic method was significantly decreased compared with the conventional ARA joint tenderness counts.

CONCLUSION

The electronic method is more efficient for use in clinical trials than is the conventional ARA joint tenderness count.

Self-stimulation of an 'aversive' brain structure: the mesencephalic central gray area

Four experiments were performed in BALB/c mice implanted either in the lateral hypothalamus (LH) or in the dorsal part of the mesencephalic central gray area (CG) or both in LH and CG. In the first 3 experiments the animals were placed in a Y-maze where they could successively trigger and turn off continuous electrical stimulation. Expt. 1 showed that mice stimulated in CG (like animals stimulated in LH) are able to discriminate between the reinforced and the non-reinforced arm of the Y-maze in order to self-administer the stimulation. This behavior was observed whether the experimental situation was a simple spatial discrimination or a more complex light-dark discrimination. During the second experiment, the animals could choose between stimulation of low intensity (in one arm) or high intensity (in the other arm). We observed that, like LH animals, CG implanted mice chose the higher stimulation, despite its strong aversive component. On the other hand, Expt. 3 showed that when the animals could chose between CG stimulation, whose intensity was progressively increased, and LH stimulation whose intensity remained constant (low) they preferred the latter. When the mice were placed in a lever-press box where they could obtain 0.2 s of electrical stimulation (last experiment), LH animals showed vigorous self-stimulation behavior, whereas CG animals showed only a weak response rate. These results show that, in spite of its aversiveness, dorsal CG stimulation has an appetitive component whose magnitude may vary under different experimental conditions.

Lymphocyte populations and subpopulations in some lymphoproliferative dermatoses

We present a study of lymphocyte populations and subpopulations as seen in histological cuts of skin with malignant and benign lymphoproliferative alterations using the immunological and histochemical techniques later described. Disclosed are the results of samples obtained of lymphocyte populations which were used to help differentiate between said alterations. It is proven that in T cell lymphomas. The infiltrate is dominated by markers for EA IgM which correlates with the results of other authors in peripheral blood.

A Y-maze test reveals the positively reinforcing properties of electrical stimulation of the mesencephalic central gray area

Animals stimulated in the dorsal part of the mesencephalic central gray area (CG) are able, as are animals stimulated in the lateral hypothalamus, to discriminate between the reinforced and the non-reinforced arm of an Y-maze to trigger a continuous electrical stimulation. This result clearly demonstrates that stimulation of the dorsal part of CG has an appetitive component.

Binding of myasthenia gravis antibodies to different acetylcholine receptor preparations

A group of myasthenia gravis (MG) patients was studied in order to demonstrate the differential ability of acetylcholine receptor (AChR) antibodies to bind to AChRs from different sources. Four different AChR sources were used: human muscle, denervated rat muscle, normal rat muscle and the electric organ of the electric ray, Torpedo californica. We demonstrated that AchR antibodies from MG patients tested reacted best with receptors from human muscle, and least with the electric ray receptor. The patients were classified into three categories, each representing an antibody level pattern. THe most common pattern was that in which the antibody level for human AchR is highest, followed by decreasing values for AchRs of denervated rat muscle, normal rat muscle, and that of the electric organ of the electric ray. No correlation was found between the patient-specific antibody pattern and a clinical description of the MG patient.