Stroke and Thromboprophylaxis in the Era of COVID-19

e18682 Background: COVID-19 Pandemic has impacted the diagnosis and treatment of breast cancer and has been shown to increase the late stage cancer at presentation. Most of studies has made year-wise comparison with 2019 for this conclusion. Same studies have also concluded that there was no difference in treatment duration after the diagnosis. Methods: We conducted an IRB-approved retrospective chart review of 505 (255 in 2018 and 250 in 2019) patients diagnosed with Breast Cancer from January 2018 to December 2019 for pre-COVID era and 206 patients diagnosed from March to December 2020 i.e. COVID era. We compared the race, histology, and stage at presentation. Patients from COVID era were compared with newly diagnosed breast cancer in 2018, 2019 patients individually and together. All the above characteristics. were compared between COVID and Pre-COVID era. Continuous variable was compared by T-test and Categorical variable were compared with details were recorded. Descriptive statistics were used in the analysis. Results: Median age of diagnosis for 2018, 2019, and COVID era was 62 (38-83), 59 (37-80) and 64(39-97) respectively. The proportion of white Race during pre-COVID era was 87.52% compared to 89.32% during the COVID era without any significant difference between all 3 years. For Histology, there was significant difference between proportion of histology between 2019 and 2020 (p-value 0.003) whereas no difference between 2018 and 2020 (p-value – 0.21) or combined pre-COVID and COVID era. Incase of staging, significantly more late stage cancer was seen in the COVID era compared to 2019 but there was no significant difference (p-value – 0.225). Same finding was seen between combined pre-COVID and COVID era (p-value - 0.94). Conclusions: Findings from our study suggest that a longer-term trend analysis is required for to find out the accurate impact of COVID-19 pandemic on breast cancer and cancer in general. A population-based study incorporating data from multicenter and multiple year should be done to assess the real effect of COVDI pandemic.[Table: see text]

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

ObjectiveInterfacility transfers represent a large proportion of neurosurgical admissions to tertiary care centers each year. In this study, the authors examined the impact of the COVID-19 pandemic on the number of transfers, timing of transfers, demographic profile of transfer patients, and clinical outcomes including rates of surgical intervention.MethodsA retrospective review of neurosurgical transfer patients at a single tertiary center was performed. Patients transferred from April to November 2020 (the “COVID Era”) were compared with an institutional database of transfer patients collected before the COVID-19 pandemic (the “Pre-COVID Era”). During the COVID Era, both emergent and nonemergent neurosurgical services had resumed. A comparison of demographic and clinical factors between the 2 cohorts was performed.ResultsA total of 674 patients were included in the study (331 Pre-COVID and 343 COVID-Era patients). Overall, there was no change in the average monthly number of transfers (P = 0.66) or in the catchment area of referral hospitals. However, COVID-Era patients were more likely to be uninsured (1% vs. 4%), had longer transfer times (COVID vs. Pre-COVID Era: 18 vs. 9 hours; P < 0.001), required higher rates of surgical intervention (63% vs. 50%, P = 0.001), had higher rates of spine pathology (17% vs. 10%), and less frequently were admitted to the intensive care unit (34% vs. 52%, P < 0.001). Overall, COVID-Era patients did not experience delays to surgical intervention (3.1 days vs. 3.6 days, P = 0.2). When analyzing the subgroup of COVID-Era patients, COVID infection status did not impact the time of transfer or rates of operation, although COVID-infected patients experienced a longer time to surgery after admission (14 vs. 2.9 days, P < 0.001).ConclusionThe COVID-19 pandemic did not reduce the number of monthly transfers, operation rates, or catchment area for transfer patients. Transfer rates of uninsured patients increased during the COVID Era, potentially reflecting changes in access to community neurosurgery care. Shorter time to surgery seen in COVID-Era patients possibly reflects institutional policies that improved operating room efficiency to compensate for surgical backlogs. COVID status affeted time to surgery, reflecting the preoperative care that these patients require before intervention.

BACKGROUND The advent of coronavirus disease 2019 (COVID-19) unveiled the worst national blood crisis that the United States had witnessed in over a decade. With the pandemic influencing the different stages of the acquisition of blood products outside the hospital setting, we aimed to explore the possible barriers contributing to the shortage of blood products within the medical community. AIM To assess the adherence to restrictive blood transfusion practices for patients in the COVID era and pre-COVID era. METHODS We conducted a retrospective cross-sectional study on hospitalized patients distinguishing the pattern of blood transfusion during the COVID and pre-COVID era in a community hospital. Data was tabulated to include the number of red blood cell (RBC) transfusions and if transfusions met restrictive blood transfusion criteria as per institutional guidelines. Chi-square was applied to test the statistical association between qualitative variables. Unpaired t test and Mann Whitney U test were applied respectively to test the mean difference of quantitative variables. RESULTS A total of 208 patients were included in the study, of which 108 were during COVID era and 100 were during pre-COVID era. The leading reason for admission in both the COVID era and pre-COVID era transfused patients was shortness of breath (53.7% and 36% P = 0.001), followed by gastrointestinal bleeding (25.9% and 21% P = 0.001). There was a higher percentage of RBC transfusions in the intensive care unit in the COVID-era group than in the pre-COVID era group (38.9% vs 22%, P = 0.008). The restrictive transfusion criteria were met in 62% vs 79% in the COVID and pre-COVID eras, respectively (P = 0.008). CONCLUSION The COVID-era group received RBC transfusions with less stringent adherence to restrictive blood transfusion practices in comparison to pre-COVID era group.

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM ObjectivesTo compare the prevalence and clinical presentation of Mucormycosis in pre-COVID era (January 2017-December 2019) and COVID era (January 2020-till date).To compare the AFST pattern of the zygomycetes causing Mucormycosis in pre-COVID era and COVID era.MethodsThis is a retrospective, hospital-based descriptive study. This study included patients admitted during the pre-COVID and COVID era at a tertiary care center, Chennai. The cases were categorized into two: (1) possible mucormycosis cases which included direct microscopy [Potassium hydroxide (KOH) and histopathological examination] positives and (2) confirmed cases which included direct microscopy and culture positives. Direct microscopic examinations like KOH wet mount and histopathological examination (H and E stain and special stains) were performed. Samples were cultured on Sabourauds dextrose agar and identification was done by analyzing the microscopic morphology using lactophenol cotton blue mount. AFST was performed for culture positive isolates with amphotericin B, itraconazole, posaconazole, voriconazole and isavuconazole by microbroth dilution method according to CLSI M38-A2.ResultsDuring the Pre-COVID era, out of the 365 samples received in the laboratory, 35 were possible mucormycosis cases. Only 17 were confirmed cases, out of which 16 grew Rhizopus oryzae and 1 grew Apophysomyces elegans. During the COVID era, among 886 samples received in the laboratory, 143 were possible mucormycosis cases, and 31 were confirmed cases that grew Rhizopus oryzae (26), Rhizomucor pusillus (2), Mucor sp (2), and Basidiobolus ranarum (1). Though the risk factors were common during the pre-COVID and COVID era, additional risk factors like steroid therapy (19.2%), and COVID infection (28.7%) were seen during the COVID era. Though clinical presentations were common during both pre-COVID and COVID era, additional complications like epistaxis (0.57%), orbital cellulitis (32.7%), and loss of smell (8.04%) were seen during COVID era. The prevalence of complications was more during COVID era compared to pre-COVID era. Treatment received during the pre-COVID era was only amphotericin B, whereas during the COVID era majority of the patients received posaconazole (74.5%) followed by liposomal amphotericin B (25.5%). The antifungal susceptibility test showed the following mean minimum inhibitory concentration (MIC) values: amphotericin B (1.8 μg/ml), itraconazole (3.6 μg/ml), posaconazole (0.31 μg/ml), and voriconazole (1.61 μg/ml) during the pre-COVID era while the mean MIC values during the COVID era had the following variations: amphotericin B (0.97 μg/mL), itraconazole (13.6 μg/ml), Posaconazole (13.4 μg/ml), voriconazole (14.5 μg/ml), and isavuconazole (1.10 μg/ml).ConclusionHigh incidence of Mucormycosis during the COVID-19 era may be related to common risk factors of COVID and mucormycosis. Though most of the risk factors and clinical presentations were similar during the pre-COVID and COVID era, serious complications like loss of vision and the percentage of complications were more during COVID era which may be attributed to the increased invasiveness of Zygomycetes during COVID infection. The high mean MIC value of amphotericin B during pre-COVID era and higher mean MIC value of posaconazole during COVID era may be contributed to the higher usage of these antifungals. Usage of the antifungal agents is the main contributor toward the resistance. Newer azole like isavuconazole which had a low mean MIC in our study, can be considered as a good therapeutic option for the future management of resistant infections. Hence timely management of the patients with an appropriate antifungal agent by performing AFST will help in the reduction of resistance in the future.

The COVID-19 pandemic has presented many challenges to colorectal cancer (CRC) care. Many organisations opted to perform CRC resections in 'cold' sites. Infrastructure in Northumbria Healthcare NHS Foundation Trust (NHCT) necessitated co-locating CRC care with 'hot' COVID streams but with additional precautions. This study aimed to evaluate that approach for a consecutive series of CRC cases, diagnosed before and during the COVID-19 pandemic. A prospectively populated data set of CRC patients diagnosed between 1 April 2019 and 30 September 2020 was used. Patients presenting before 1 April 2020 were considered 'pre-COVID' and those presenting subsequently as 'COVID era'. Some 344 cases were diagnosed in the 12 months 'pre-COVID' and 166 in the 6 months of the 'COVID era'. The median numbers of days from referral to diagnosis (21 vs 20, p=0.373) and operation (63 vs 61, p=0.208) were unchanged. The 'COVID era' saw an increase in the proportion of radiological diagnoses (39.5% vs 53.0%, p=0.004) with an associated decrease in endoscopic diagnoses (56.7% vs 45.8%, p=0.021). Rates of inoperable (1.5% vs 1.2%, p=0.821), obstructing (11.0% vs 16.2%, p=0.272) and perforated tumours (0.6% vs 1.5%, p=0.492) remained the same. One patient developed COVID-19 perioperatively. Rates of laparoscopic operation (59.5% vs 61.8%, p=0.751), anastomotic leak (6.4% vs 5.9%, p=0.891), re-operative surgery (10.4% vs 4.4%, p=0.138), primary stoma (40.5% vs 32.4%, p=0.244) and 90-day mortality (0.6% vs 1.5%, p=0.492) did not change. With appropriate infection control measures, it may be safe to continue providing standard elective and urgent CRC care without access to a 'COVID clean' site.

Covid-19 pandemic: Economic burden on patients with musculoskeletal injuries in a tertiary care hospital of LMIC; retrospective cross sectional study

COVID-19 lockdown restrictions in conjunction with the pervasive hospital fear endured by the vast majority of the population played a fundamental role in discouraging access to emergency departments (EDs). We aimed at investigating whether and how the COVID-19 outbreak limited the access to ED and affected urgent surgical activities during and immediately after the 2-month pandemic-related national lockdown. Data regarding patients who accessed to the surgical ED were retrospectively collected. Analyzed time-periods included: "pre-COVID-19 era," "COVID-19 era" considered as the period of full national lockdown and "post-COVID-19 era" after easing of lockdown measures. Consecutive emergency surgical procedures and ED admissions before, during and after COVID-19-lockdown were retrieved and analyzed. There was a significant decrease in overall ED admissions and in all-specialty surgical consultations (P<0.01) throughout the outbreak. Once national lockdown was eased, we recorded a subsequent rebound 5-fold rise of emergency surgical procedures compared to COVID-19 group (P=0.011). Time-to-surgery was significantly greater in "COVID-19 era" and "post-COVID-19 era" compared to "pre-COVID-19" group (22.56±4.78, 75.99±15.89 and 16.73±1.76 hours, respectively) (P<0.01). A raised incidence of postoperative complications emerged in the "COVID-19 era" group (37.5%) compared to pre- and post-COVID groups (9.1% and 12.5%, respectively; P<0.001). Mortality rate in the "COVID-19 era" was 31.3% and 7.5% in "post-COVID-19" group (<0.0001). This study demonstrates the major reduction of emergency surgical procedures and overall, ED admissions caused by COVID-19 pandemic. The raised rate of postoperative complications and mortality might be likely due to the superior severity of surgical conditions observed in the "COVID-19 era" subjects together with a probable deferred pursuit of medical attention.

The coronavirus disease-2019 (COVID-19) pandemic caused disruptions in cancer screening and diagnosis, including colorectal cancer. Given disparities in cancer and COVID-19 faced by historically disadvantaged minorities, we examined changes in disparities in colorectal cancer screening and diagnosis in the COVID era. In a cohort study using the Veterans' Affairs Health Care System (VAHCS) from 2018 through 2021, we quantified colonoscopies, fecal occult blood tests (FOBT), and new diagnoses of colorectal cancer (CRC) by month from 1 March 2018 to 31 December 2021. We compared the pre-COVID (before 1 March 2020) to the COVID (1 March 2020 and after) era. We graphed temporal trends by age, sex, race, ethnicity, rural-urban, and socioeconomic status (SES). Logistic regression was used to evaluate temporal trends after adjusting for confounders. During the study period, there were about 900,000 colonoscopies, 1.4 million FOBTs, and > 30,000 new diagnoses of CRC. Colonoscopies and new CRC decreased dramatically during the early COVID era to < 10% and < 60% of pre-COVID rates, respectively. Although we identified a modest increase in disparities of colonoscopy use among Black and Latino patients in the early COVID era, these increased disparities did not persist in adjusted analysis. We did not identify changes in disparities in FOBT use or new CRC diagnoses. We did not identify increased disparities in CRC screening or diagnoses by age, sex, race, ethnicity, geographic region, or SES in the VAHCS. These results indicate a potential strength of the VAHCS and require further study in additional cancers and healthcare systems.

Background: Tuberculosis (TB), one of the leading infectious diseases of global health concern has drawn the attention of researchers towards investigating the trends of the infection, its resistance and associated risk factors in Nigeria in the pre-COVID-19 era and during the COVID-19 era to understand how the pandemic may have possibly influenced the prevalence trends of TB infection. Objective: This review was aimed at examining the trend of TB infection, the resistant patterns and associated risk factors before COVID-19 era and then during COVID-19 era in Nigeria Methodology: Following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocol, a systematic review and meta-analysis was conducted. A total of 4 electronic databases (African journal online library (AJOL), PubMed, ScienceDirect and Semantic scholar) were searched using Boolean functions and search filters to streamline the search results to the research focus. A total of 563 studies were gathered from the databases and imported to EndNote, from where they were exported to Covidence via XML file. The exported studies underwent two levels of screenings; title and abstract screening, and full article screening based on the inclusion criteria. A total of 14 studies passed the screening and were eligible for data extraction, quality assessment and risk of bias using Newcastle Ottawa Scale (NOS) for cross-sectional studies. Results: The mean prevalence of TB before and during COVID-19 era were 15.8% and 28.8% respectively. The pooled prevalence rifampicin (RIF) resistance was 20.8% in both pre-COVID-19 and COVID-19 eras among TB patients. The pooled prevalence of multi-drug resistant TB (MDR-TB) before the COVID-19 era was 1.01% while in the COVID-19 era it was 10.1%. The prevalent assocated risk factors before COVID-19 era were age and settlement while in COVID-19 era were age and sex. Conclusion: This review has shown an upward trend in TB and MDR-TB rates during the pandemic in Nigeria with age appearing as the leading risk factors in both eras.

PurposeOne of the most significant threats of COVID-19 in the world is the closure of universities, schools, training courses and even companies and organizations. In such a situation and with the free time that has arisen, this threat of education closure can become a golden opportunity for learning and progress in virtual education. E-learning uses information technology (IT) to distribute knowledge and information for training and education. Also, cloud computing is a technology utilized in the IT domain. It can be employed in performing e-learning. Therefore, the main goal of this study is to assess the impact of cultural characteristics, economic situations, skills and knowledge on the development and success of CELS in the COVID-19 era.Design/methodology/approachCloud-based e-learning system (CELS) provides all e-learning requirements like software and hardware resources to promote conventional e-learning technologies. The CELS stands on several factors of diverse aspects that have been of high significance in CELS success. So, these systems must be checked to analyze their significance rate and successfully carry out their effectiveness. On the other hand, these days, the 2019 coronavirus disease (COVID-19) changes our daily lifestyles. Therefore, the present investigation provides a new model investigating the development and success of CELS in the COVID-19 era. Also, an online questionnaire was used to gather the data. The content validity of the questionnaire was obtained by applying the opinions of ten experts from e-learning specialists. The collected data are analyzed using LISREL and Smart PLS software.FindingsThe results from the path coefficient and the sample t-test have implied that skills and knowledge positively influence CELS in the COVID-19 era. In addition, the relationship between cultural characteristics and CELS in the COVID-19 era has been positive and significant. The relationship between the economic situations and the CELS in the COVID-19 era is positive and significant.Practical implicationsThe proposed model helps managers get a big picture of CELS necessities and more effectively in the COVID-19 era. This research has a unique impact on universities to develop an e-learning platform to facilitate the education process in the COVID-19 era. It provides guidelines for educational institutions to effectively implement the learning management system to facilitate students' education.Originality/valueCELS are getting increasingly essential to offer training courses more efficiently in educational institutions. Although the intersection between cloud computing and e-learning has increasingly grown in both practical and academic contexts, few studies on the impact of cultural characteristics, economic situations, skills and knowledge on the development and success of CELS in the COVID-19 era. This paper explores the ignored but critically important subject of CELS. This paper's main contribution is to present a new and integrated model containing the essential aspects of the development and success of CELS in the COVID-19 era. The proposed framework comprises cultural characteristics, economic situations, skills and knowledge aspects simultaneously, as well as sub-criteria denoting each element.

IntroductionSuicide is one of the leading causes of death worldwide, (Centiti et al. 2020). Presentations to the emergency department (ED) with suicidal ideation (SI) or deliberate self-harm (DSH), and admissions following same, are a major part of unscheduled adult mental health service activity.ObjectivesTo evaluate how suicidal presentations to the emergency department (ED), and admission following same have been affected by the COVID era thus far. To evaluate how key patient characteristics affect admission during the COVID era and pre-COVID, namely whether presentations were with suicidal ideation (SI) or deliberate self-harm (DSH), whether the patient was previously known to a community mental health team (CMHT), and whether the patient was intoxicated at the time of presentation.MethodsData is routinely collected on all adults presenting with SI/DSH to the ED. We looked at presentations, admissions and key patient characteristics over the 12 months of the COVID era thus far (March 2020-February 2021) and compared them to the preceding 12 months.ResultsPresentations over the two 12 month periods were similar (pre-COVID n=819, COVID era n=823). However, admission increased by 27% (139 to 177) over the COVID era as a whole. For nine months of the COVID era monthly numbers of admissions were higher than their pre COVID comparison. Admission rates during the COVID era were found to be increased across all patient groups examined, but were particularly increased in those presenting sober or with SI. Admission rates rose equivalently for those known or unknown to a CMHT.Image:Image 2:ConclusionsThe number of admissions following suicidal presentations to the ED has risen significantly in the COVID era. This may be due to more severe presentations in terms of risk of suicide without admission or increased psychiatric morbidity requiring admission. Limitations of service provision in the community due to COVID era restrictions may also partially explain these findings.Disclosure of InterestNone Declared

PurposeThe teenager community is the most affected community by cybercrime in the COVID-19 era. Increasing social networks and facilitating teenager access to the Internet have increased the probability of cybercrimes. On the other hand, entertainment such as mobile and computer games is top-rated among teenagers. Teenagers' tendency to cybercrime may be influenced by individual, parent, social, economic and political factors. Studying the impact of social networks, mobile games and parents' religious attitudes on teenagers' tendency to cybercrimes in the COVID-19 era is the primary goal of this paper.Design/methodology/approachThe outbreak of COVID-19 caused a considerable change in the world and the lifestyle of all people. Information and Communication Technology (ICT) was also affected by the special conditions of this virus. Changes in ICT and rapid access to it have empowered individuals and organizations, and people have increased civic participation and interaction through ICT. However, the outbreak of COVID-19 has created new challenges for the government and citizens and may cause new crimes. Cybercrime is a type of crime that occurs in a cyber environment. These crimes range from invasions of privacy to crimes in which the offender vaguely paralyzes the macroeconomic. In this research, 265 students of high schools and universities are used for collecting data by utilizing a survey. Measuring actions have been done in all surveys employing a Likert scale. The causal pattern is assessed through a constructional equation modeling procedure to study the scheme's validity and reliability.FindingsThe outcomes have indicated that social networks have no significant relationship with teenagers' tendency to cybercrimes in the COVID-19 era. Mobile games have a mild effect on teenagers' tendency to cybercrimes in the COVID-19 era, and parents' religious attitudes significantly impact teenagers' tendency to cybercrimes in the COVID-19 era.Research limitations/implicationsCurrent research also has some restrictions that must be noticed in assessing the outcomes. First, sample research was selected from high schools and universities in one city. So, the size of the model is small, and the generalization of results is limited. Second, this research may have ignored other variables that affect the tendency of teenagers' to cybercrime. Future researchers intend to investigate the parents' upbringing system's impact on teenager's trend to cybercrime in the COVID-19 era. Future research can also examine practical factors such as parental upbringing, attitudes toward technology development and virtual addiction in the COVID-19 era.Originality/valueIn this study, teenagers' tendency to cybercrimes in the COVID-19 era is investigated, and a procedure is applied depending on a practical occasion. This article's offered sample provides a perfect framework for influencing parents' social networks, mobile games and religious attitudes on teenagers' tendency to cybercrimes in the COVID-19 era.

Global and Country-Level Impact of COVID-19 on Heart Transplant Volumes

Background and Aims: Corona virus disease COVID 2019 is considered as serious pandemic. Esophagogastroduodenoscopy (EGD) is an aerosol generating process and may precipitate its transmission. The aim of this study is to assess new location for the endoscopist and supporting team during this era of COVID19. Methods: This study included 43 patients. Patients were classified into two groups, group 1 included 21 patients in which classic position of endoscopic staff members was done, maintaining the personal protective equipment and the group 2 included 22 patients in which the endoscopist and staff members stand behind the patient. Results: There is no significant statistical difference between groups regarding the time needed for completing the endoscopic process, the success of the maneuver or the satisfaction of the patient about the maneuvers (P = 0.839, P = 1, P = 0.721) respectively, the endoscopist has to do additional movements by his shoulders or his wrists in group II more significantly than in group I (p=0.012) Conclusions: Standing of the endoscopist behind the patient while performing EGD is as effective as the standard classic one. In simple upper gastrointestinal UGI endoscopic maneuvers, it may be more protective for endoscopic staff members in the era of pandemic COVID19.