pre-COVID Period Research Articles

Barriers in the identification and diagnosis of hereditary colon cancer.

e13524 Background: Lynch Syndrome (LS), the most common form of hereditary colorectal cancer (CRC), is due to germline pathogenic variant (PV) in mismatch repair genes (MMR). Since 2009, the National Comprehensive Cancer Network (NCCN) recommends MMR screening for LS for all CRCs regardless of age. The American College of Medical Genetics and Genomics recommends patients with MMR deficiency or microsatellite instability (MSI) be referred for genetic testing. Despite these recommendations, compliance is low. The aim of this study was to evaluate compliance with LS screening and genetic testing in CRC. Methods: A single institution retrospective review of patients diagnosed with CRC from 2018-2021 was performed. A chart review of those diagnosed in 2018 and 2021 was analyzed and combined as a single population from pre and post COVID periods. A student’s T-Test was used to compare continuous variables and chi square for categorical variables within the two populations. The compliance with either MSI or MMR screening was calculated. Meeting criteria for genetic testing was defined as age less than 50, MSI-L/H or MMR deficient. These patients were then analyzed to determine the proportion of genetic referrals, genetic counseling, genetic testing and identification of LS. Results: 276 patients with CRC were reviewed, 153 in 2018, 123 in 2021. 71.2% were Caucasian and 58% male. There was no statistically significant difference in gender, race or ethnicity, however, there was a difference in age, with a younger average age in 2021 (67, 63; p = 0.014). 146 (53%) patients were screened for LS. 44 (16%) with MSI, 19 (7%) MMR and 82 (30%) with both. 78 patients met criteria for genetic testing; 47 due to age alone, 6 age and positive LS screening and 25 screening alone. 35% (27/78) of those meeting criteria were referred to genetics, of which 63% (17/27) completed their appointment, 63% (17/27) were tested, and 37% (10/27) had a PV identified. Conclusions: Despite guidelines for LS screening, compliance is low with only half of CRC patients appropriately screened at our institution. Even patients with positive screening and those less than 50 were not referred for genetic testing. However, of referred patients, 63% completed their appointment and all those were tested. This supports the idea that poor compliance with genetic testing is not due to patient compliance, but shows a systems issue at a higher level. To improve LS identification, reflex screening and genetic referrals are paramount. In our study, 59% of patients with germline testing had a PV, however 65% of those meeting criteria were never referred, which could reflect a proportion of patients with LS going unidentified. This validates the 2022 NCCN guidelines recommending genetic testing for all CRCs despite age or MSI/MMR status. By removing the barrier of MMR testing, more genetic testing will likely be done. [Table: see text]

Analysis of patients at the Memphis VA Medical Center with positive FIT testing and incomplete GI evaluation during the COVID-19 pandemic.

e15542 Background: In 2020, colorectal cancer was the second leading cause of cancer death in the United States 1. In March 2020, the COVID pandemic began which led to widespread disparities in health care, such as surveillance colonoscopies 2. A Veterans Health Administration large data review revealed completion rates of colonoscopy for high risk individuals, including positive fecal immunochemical test (FIT) to be unchanged pre-pandemic and during the pandemic at 27% vs 26.5% 3. Another study reports a non-VA population completion rate within 360 days pre-COVID compared to COVID was 53.9% vs 44% 4. This research sought to analyze data through a retrospective chart review from the Memphis VA Medical Center, the timing of screening colonoscopies after a positive FIT and reasons for delay in obtaining these. Thereby, evaluating effectiveness in completing the procedures and change effected by the COVID pandemic. Methods: A retrospective cohort study designed to detect rates of completed colonoscopy during and before the COVID pandemic after a positive FIT. Records were reviewed of all positive FIT from 2 specified time frames at the Memphis VA to evaluate completion of colonoscopy after a positive FIT. The charts of 157 VA patients with positive FIT during the pandemic were compared to the charts of 115 VA patients with positive FIT pre-pandemic for colonoscopy completion, evaluating both completion rates within 180 days and chart identified reasons for lack of completion. Both community (CITC) and VA procedures for veterans were included. One tailed Fisher’s exact test was applied to calculate the completion rate difference. Results: Overall completion rate of colonoscopy was 46% in the pre-COVID and rose to 56% in the COVID period [p-value < .05 (.0665)]. Percentage of timely completion ( < 180 days) was 26% pre-COVID, compared to 47% during COVID. Percentage of delay ( > 180 days) in pre-Covid was 74%, compared to 53% during COVID. [p-value < .05 (.0004)]. Reasons for delay both pre-COVID and during COVID are listed below. Conclusions: It can be concluded that there is a statistically significant increase in timely colonoscopy completion during the studied COVID period when compared to the pre-COVID period. The total completion rate was higher at our institution than in the literature, likely due to our inclusion of community colonoscopies and our aggressive case management system. A common reason for delay in all groups was delay/lack of referral. This cause for delay should be improved with additional steps in our case management policy. [Table: see text]

Different approaches to explore the impact of COVID-19 lockdowns on carbonaceous aerosols at a European rural background site

To prevent the fast spread of COVID-19, worldwide restrictions have been put in place, leading to a reduction in emissions from most anthropogenic sources. In this study, the impact of COVID-19 lockdowns on elemental (EC) and organic (OC) carbon was explored at a European rural background site combining different approaches: − “Horizontal approach (HA)” consists of comparing concentrations of pollutants measured at 4 m a.g.l. during pre-COVID period (2017–2019) to those measured during COVID period (2020-2021); − “Vertical approach (VA)” consists of inspecting the relationship between OC and EC measured at 4 m and those on top (230 m) of a 250 m-tall tower in Czech Republic. The HA showed that the lockdowns did not systematically result in lower concentrations of both carbonaceous fractions unlike NO2 (25 to 36 % lower) and SO2 (10 to 45 % lower). EC was generally lower during the lockdowns (up to 35 %), likely attributed to the traffic restrictions whereas increased OC (up to 50 %) could be attributed to enhanced emissions from the domestic heating and biomass burning during this stay-home period, but also to the enhanced concentration of SOC (up to 98 %). EC and OC were generally higher at 4 m suggesting a greater influence of local sources near the surface. Interestingly, the VA revealed a significantly enhanced correlation between EC and OC measured at 4 m and those at 230 m (R values up to 0.88 and 0.70 during lockdown 1 and 2, respectively), suggesting a stronger influence of aged and long distance transported aerosols during the lockdowns. This study reveals that lockdowns did not necessarily affect aerosol absolute concentrations but it certainly influenced their vertical distribution. Therefore, analyzing the vertical distribution can allow a better characterization of aerosol properties and sources at rural background sites, especially during a period of significantly reduced human activities.

Impact of the COVID-19 Pandemic on Ambulatory Care Antibiotic Use in Hungary: A Population-Based Observational Study.

The COVID-19 pandemic and related restrictions have potentially impacted the use of antibiotics. We aimed to analyze the use of systemic antibiotics (J01) in ambulatory care in Hungary during two pandemic years, to compare it with pre-COVID levels (January 2015-December 2019), and to describe trends based on monthly utilization. Our main findings were that during the studied COVID-19 pandemic period, compared to the pre-COVID level, an impressive 23.22% decrease in the use of systemic antibiotics was detected in ambulatory care. A significant reduction was shown in the use of several antibacterial subgroups, such as beta-lactam antibacterials, penicillins (J01C, -26.3%), and quinolones (J01M, -36.5%). The trends of antibiotic use moved in parallel with the introduction or revoking of restriction measures with a nadir in May 2020, which corresponded to a 55.46% decrease in use compared to the previous (pre-COVID) year's monthly means. In general, the systemic antibiotic use (J01) was lower compared to the pre-COVID periods' monthly means in almost every studied pandemic month, except for three months from September to November in 2021. The seasonal variation of antibiotic use also diminished. Active agent level analysis revealed an excessive use of azithromycin, even after evidence of ineffectiveness for COVID-19 emerged.

Impact of COVID-19 situation on non COVID cardiological admissions

Abstract Funding Acknowledgements Type of funding sources: None. Background The COVID-19 outbreak led to a redistribution of resources in order to provide care to coronavirus patients, taking those resources from other areas such as cardiology, specially from ambulatory patients. Moreover, the fear to the contagious disease, made people to avoid seeking hospital aid. This two factors may have had impact on hospital parameters such as length of stay, readmissions or mortality, with short and mid term effect. Scope: To demonstrate that the factors exposed in the introduction had led to more complex admissions, higher mortality rates, more readmissions and longer stays. Methods we performed a descriptive study comparing hospital parameters from a secondary hospital in Spain using to different periods: a pre-COVID period (01/2019 to 02/2020) and a COVID period (03/2020-01/2022). Only non-COVID cardiological patients where analyzed. Data where extracted form the hospital database and benchmarking tool "Iasist". Results Despite the fact that %readmissions, length of stay (specially form patients awaiting surgery) and complications increased after the outbreak, there was not an increase in mortality . As additional finding, we observed a decrease in admissions complexity according to coding weight parameters. Conclusions Non COVID cardiological admissions have varied since the outbreak, some of those variations where expected such as increase in complications or readmissions, but there was no deleterious impact on mortality.

Exploring the impact of COVID-19 on reported maternal and neonatal complications and access to maternal health care in five government health facilities in Blantyre, Malawi.

There is a dearth of studies assessing the effects of SARS-CoV-2 on the healthcare system and access to care, especially in lower- and middle-income countries such as Malawi. We aimed to assess the impacts of COVID-19 on reported maternal and neonatal complications as well as potential changes in maternal care access to care among five primary care health facilities in Blantyre, Malawi. This retrospective cohort study assessed maternal and neonatal register data from five participating health centers in Blantyre, Malawi using the Malawi District Health Information Software 2 (DHIS2) to compare outcomes from 15 months before COVID-19 emerged, defined as the pre-Covid period (January 2019 -March 2020) with nine months after COVID-19 (April 2020 -December 2020). There was a significant decrease in reported use of vacuum extraction, which went from <0.01%in the pre-COVID period to 0% in the COVID period (p = 0.01). The proportion of births reporting fetal distress almost tripled from 0.46% to 1.36% (p = 0.001) during the COVID-19 period. Additionally, reported anticonvulsant use significantly increased from 0.01% to 1.2% (p<0.01), and antibiotic use significantly increased from 0.45% to 1.6% (p = 0.01). Asphyxia was the only significant neonatal complication variable reported, increasing from 2.80% to 3.45% (p = 0.01). Our findings suggest that significant outcomes were mainly due to the indirect effects of COVID-19 rather than the virus itself. Based on our findings and the contextual qualitative interviews with two Malawian expert midwives, we concluded that mothers may have been affected more due to understaffing and shortage of skilled personnel in the study health facilities. Therefore, the development of highly skilled health workers may contribute to better outcomes, along with adequate staffing and a streamlined referral process.

Impact of the COVID-19 pandemic on some modifiable risk factors of dementia in an aging, rural Indian population.

The impact of the COVID-19 pandemic and associated lockdowns is likely to have caused adverse changes in lifestyle-related/cardiovascular risk factors and other such modifiable risk factors of dementia. We aimed to examine the pandemic's impact on some modifiable risk factors of dementia among rural Indians belonging to a large, prospective aging cohort-Srinivaspura Aging, NeuoSenescence, and COGnition (SANSCOG). This was a cross-sectional study among adults aged ≥ 45 years (n = 3,148; 1,492 males and 1,656 females) residing in the villages of Srinivaspura in Karnataka state, India. SANSCOG study data (clinical and biochemical assessments) of these participants were obtained from three distinct periods: (i) the "pre-COVID period"-before India's nationwide lockdown on 24 March 2020, (ii) the "COVID period"-during the first and second waves of the pandemic, wherein the social restrictions were prominent (25 March 2020 to 30 September 2021), and (iii) the "post-COVID period"-after easing of restrictions (from 1 October 2021 onward). Proportions of participants with diabetes, hypertension, obesity, dyslipidemia (diagnosed using standard criteria), and depression (diagnosed using the Geriatric Depression Scale) were compared between the above three periods. The odds of having obesity, abnormal triglycerides, and depression among individuals in the COVID period were 1.42 times, 1.38 times, and 2.65 times more than the odds in the pre-COVID period, respectively. The odds of having hypertension, obesity, abnormal total cholesterol, abnormal triglycerides, abnormal LDL, and depression among individuals in the post-COVID period were 1.27 times, 1.32 times, 1.58 times, 1.95, 1.23, and 3.05 times more than the odds in the pre-COVID period, respectively. The odds of diabetes did not differ between any of the three periods. We found significantly higher odds of some of the studied risk factors in the COVID and post-COVID periods compared to the pre-COVID period, suggesting that the pandemic adversely impacted the physical and psychological health of this marginalized, rural Indian population. We call for urgent public health measures, such as multimodal, lifestyle-based, and psychosocial interventions, to mitigate this negative impact and reduce the future risk of dementia.

A Study on the Impact of COVID on Farm Sector Higher Education and Employment

The issue of the COVID-19 and its impact on higher education is an emergent focus of debate across the globe. Higher education sectors all over the world are exceptionally disordered and disrupted radically and students are struggling a lot to navigate this crisis. An Analysis of Higher Education, Placement, Employment and Earning Contours of TNAU Farm graduates during the Pre and Post COVID 19 Regimes was conducted with the following objectives.&#x0D; For the present study, 372 past candidates were contacted. Data was collected by mailed Questionnaire. The issue of the COVID-19 and its impact on higher education is an emergent focus of debate across the globe. Higher education sectors all over the world are exceptionally disordered and disrupted radically and students are struggling a lot to navigate this crisis.&#x0D; Among the respondents 57 per cent were girls and 43 percent were boys. Around 42 per cent of the graduates were from rural background, 31% from urban and remaining from peri-urban areas. Over 61 per cent of the passed out graduates were preparing for competitive examinations, 26 per cent were pursuing higher education and only 13 per cent were employed. The percentage of graduates doing higher education and employed has reduced by nearly 50 percent during the COVID. All the students were employed within India during the pre and post COVID period and the difference between these periods was negligible. However it could be noted that the number of graduates being employed in private sector reduced drastically in the first year of Covid while it increased by 35 percent during the second year after CoVID. The choice of jobs were prioritized in the following preference. They were Salary, passion and job security. However it can be found that the job security aspect has reduced by 20 percent in the Covid situation. About 59 per cent indicated that their jobs were not secured and 36 per cent expressed that they found it difficult to get admission in national and international institutions due to covid pandemic and 17.2 per cent indicated that they were not able to pursue education in National and International institutions even after getting admissions and fellowships. COVID has impacted higher education and job prospect in abroad and far way places.

Trends in Mental Health Utilization Before and During the COVID-19 Pandemic: Federally Qualified Health Centers As a Case Study.

This study examined differential mental health utilization patterns before and during the COVID-19 pandemic. Data were obtained from 12 Federally Qualified Health Center (FQHC)-behavioral health clinics and included 65,561 visits between February 2019 and November 2020 for adults aged 18-64 years. To allow for a year-over-year comparison, the pre-COVID-19 period was flagged as visits between February 2019 and November 2019 and the peri-COVID-19 period as visits between February 2020 and November 2020. A difference-in-difference model with Poisson regression was used to predict racial/ethnic differences in the number of visits between the pre- and peri-COVID-19 periods. Overall, the average number of visits per patient increased from 5.45 visits in the pre-COVID period to 5.78 visits in the peri-COVID-19 period. Hispanics had +0.6 visits, Blacks had +0.3 visits, and other racial groups had +0.9 visits during the peri-COVID-19 period than the pre-COVID-19 period. In contrast, Whites (-0.6 visits) and Asians (-1.7 visits) were less likely to use mental health services in these FQHC clinics in the peri-COVID-19 period as compared with the pre-COVID-19 period. Peri-COVID-19 utilization rates were significantly higher for virtual visits (incident-rate ratio [IRR] = 1.15, P < 0.01) and residence in a metropolitan area (IRR = 1.14, P < 0.01), but lower for persons aged 55+ years (IRR = 0.92, P < 0.01) and males (IRR = 0.87, P < 0.01). Racial/ethnic minority patients, except Asians, were more likely to use mental health services during the COVID-19 pandemic than in the preceding year. This may be attributable to policy changes such as the CARES Act, which expanded health care access options to include telemedicine.

Sentiment and emotion in financial journalism: a corpus-based, cross-linguistic analysis of the effects of COVID

Sentiment and emotion play a crucial role in financial journalism, influencing market perceptions and reactions. However, the impact of the COVID-19 crisis on the language used in financial newspapers remains underexplored. The present study addresses this gap by comparing data from specialized financial newspapers in English and Spanish, focusing on the years immediately prior to the COVID-19 crisis (2018–2019) and during the pandemic itself (2020–2021). We aim to explore how the economic upheaval of the latter period was conveyed in these publications and investigate the changes in sentiment and emotion in their language compared to the previous timeframe. To this end, we compiled comparable corpora of news items from two respected financial newspapers (The Economist and Expansión), covering both the pre-COVID and pandemic periods. Our corpus-based, contrastive EN-ES analysis of lexically polarized words and emotions allows us to describe the publications’ positioning in the two periods. We further filter lexical items using the CNN Business Fear and Greed Index, as fear and greed are the opposing emotional states most often linked to financial market unpredictability and volatility. This novel analysis is expected to provide a holistic picture of how these specialist periodicals in English and Spanish have emotionally verbalized the economic havoc of the COVID-19 period compared to their previous linguistic behaviour. By doing so, our study contributes to the understanding of sentiment and emotion in financial journalism, shedding light on how crises can reshape the linguistic landscape of the industry.

Reviewing the 3C’s of blended learning for police education: assessing capacity, building capability, and conquering challenges

ABSTRACT Police education and training, in common with education at all levels, was seriously affected by the onset of lockdown during the COVID-19 pandemic. Police organisations in England and Wales sought to cope by moving training and education programmes online, almost overnight. This paper presents findings from interviews conducted with Learning and Development leaders in 17 police forces in England and Wales to gauge the capacity of organizations to provide blended learning (BL) in the pre COVID period and plans for the future. Findings indicated that although there are challenges, the appetite and capacity to adopt BL methods in forces range on a spectrum. The paper and makes recommendations to support the rollout and use of BL in police education generally and proposes a theory of change to assist the introduction of BL in police organisations.

Effectiveness of Online Pedagogy of welding Skills during the COVID-19 Period: A Systematic Review

Online learning was created as a result of the huge industry disruption that occurred in March of 2020. Online education presented unique difficulties for learning in an entirely virtual setting with a concentration on psychomotor skill development, calling into doubt its efficacy. Finding a practical replacement for lab-based hands-on activities and group or team-based learning experiences was extremely difficult for technology education. This study compares the COVID-19 time to the pre-COVID period to assess how effective online teaching and learning experiences were in technology-based education. Just 20 randomized controlled trial publications, out of which 15 studies were used in the meta-analysis, were included in the review after an electronic search of the literature. Using Review Manager 5.3 to examine the data, Cochrane’s 2 test and I2 were used to determine heterogeneity. The meta-analysis shows a very reliable sensitivity analysis and a substantial pooled effect size of (SMD = 4.49 @ 95%, CI = 2.37 – 3.63 @ p.00001) from the test scores in favor of the experimental group. The results of the included studies’ sub-item achievement test results reveal a statistically positive difference in every category of welding skill tested. Studies demonstrating the effectiveness of online pedagogy in the covid era are the source of the current statistics. These results point to the need for additional investigation into the development of psychomotor skills in other technology education courses.

Impact of the COVID-19 pandemic on the glycemic control in people with diabetes mellitus: A retrospective cohort study.

To investigate the impact of the COVID-19 pandemic and its preventive measures on the glycemic and lipid control in people with diabetes mellitus (DM). We conducted this retrospective cohort study from April 2019 to March 2021; we termed the period from April 2019 to March 2020 as the pre-COVID-19 period, and the period from April 2020 to March 2021 as the COVID-19 period, and divided each of these two periods into four quarters. In the 1st quarter of the COVID period, when the Japanese government declared the first public health emergency, 3,465 people with diabetes mellitus were receiving treatment, which was 10.4% lower than that in the pre-COVID period. The annual mean HbA1c level was significantly elevated in the COVID-19 period. The annual mean total cholesterol (TC) and triglyceride (TG) levels were also significantly higher in the COVID-19 period. Although there were no significant differences in the glycemic control or annual medication between the two periods in people with type 1 diabetes mellitus, the annual mean HbA1c, TC, and TG levels were significantly higher in the COVID-19 period in people with type 2 diabetes mellitus. Furthermore, a significant increase in the percentage of prescriptions for glinides, biguanides, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists for people with type 2 diabetes mellitus was observed in the COVID period. It appears from our study that COVID-19 and its preventive measures had a negative impact on the glycemic and lipid control in people with diabetes mellitus.

Vitamin D Levels in the Pre- and Post-COVID-19 Pandemic Periods and Related Confinement at Pediatric Age

Coronavirus disease 2019 (COVID-19) restrictions have been correlated with vitamin D deficiency in children, but some uncertainties remain. We retrospectively studied vitamin 25-(OH) D blood levels in 2182 Italian children/adolescents hospitalized for various chronic diseases in the year before (n = 1052) and after (n = 1130) the nationwide lockdown. The type of underlying disease, gender, and mean age (91 ± 55 and 91 ± 61 months, respectively) of patients included in the two periods were comparable. Although mean levels were the same (p = 0.24), deficiency status affected a significantly higher number of subjects during the lockdown period than in the pre-COVID period (p = 0.03), particularly in summer (p = 0.02), and there was also a smoothing of seasonal variations in vitamin D levels. Particularly at risk were males (OR = 1.22; p = 0.03), the 1–5 year age group (OR = 1.57; p &lt; 0.01) and the 6–12 year age group (OR = 1.30; p = 0.04). Infants appeared not to be affected (p = 1.00). In the post-COVID period, the risk of vitamin D deficiency was unchanged in disease-specific groups. However, the proportion of deficiency or severe deficiency differed significantly in the subgroup with endocrinopathy (higher; Chi-square p = 0.04), and with respiratory problems and obesity (lower; Chi-square p = 0.01 and p &lt; 0.01, respectively). Conflicting/opposite literature results advocate for further studies to clearly indicate the need for supplementation during possible future periods of confinement.

Comparison of the healthcare-associated infections in intensive care units in Turkey before and during COVID-19

BackgroundSecondary bacterial infections are an important cause of mortality in patients with coronavirus disease 2019 (COVID-19). All healthcare providers acted with utmost care with the reflex of protecting themselves during the COVID-19 period. We aimed to compare the rates of ventilator-associated pneumonia (VAP) and bloodstream infections (BSIs) in our intensive care units (ICUs) before and during the COVID-19 outbreak surges.MethodsThis multicenter, retrospective, cross-sectional study was performed in six centers in Turkey. We collected the patient demographic characteristics, comorbidities, reasons for ICU admission, mortality and morbidity scores at ICU admission, and laboratory test data.ResultsA total of 558 patients who required intensive care from six centers were included in the study. Four hundred twenty-two of these patients (males (62%), whose mean age was 70 [IQR, 58–79] years) were followed up in the COVID period, and 136 (males (57%), whose mean age was 73 [IQR, 61–82] years) were followed up in the pre-COVID period. BSI and VAP rates were 20.7 (19 events in 916 patient days) and 17 (74 events in 4361 patient days) with a −3.8 difference (P = 0.463), and 33.7 (31 events in 919 patient days) and 34.6 (93 events in 2685 patient days) with a 0.9 difference (P = 0.897), respectively. The mortality rates were 71 (52%) in pre-COVID and 291 (69%) in COVID periods.ConclusionProtective measures that prioritize healthcare workers rather than patients and exceed standard measures made no difference in terms of reducing mortality.

Foreign exchange market efficiency during COVID-19 pandemic

The main objective of this paper is to examine the efficiency of the foreign exchange (FX) markets before and during the turbulent periods surrounding the COVID-19 pandemic. Our efficiency tests are based on the Unbiasedness Forward Rate Hypothesis (UFRH). We use a pooled sample that contains 26 developed and emerging market currencies spanning the pre-COVID period (from November 30, 2018 to November 29, 2019), as well as the COVID period (from December 2, 2019 to November 30, 2020) as the key event which represents the time of tension. Our central finding in this paper is that FX market efficiency fails to hold during the COVID period, suggesting that the pandemic is a destabilizing event for the currency markets.

Impact of COVID-19 on Breast Cancer Management in a Multiethnic Middle-Income Asian Country Setting.

Coronavirus disease-2019 (COVID-19) has caused hospitals to suspend routine procedures. As the world recovers, there is concern that the outcome of many diseases has been impaired. This study aimed to assess the impact of the pandemic on breast cancer demography, clinicopathological characteristics and patient management at a teaching hospital in Kuala Lumpur, Malaysia. Pre-COVID data were collected between January 1, 2019, to March 18, 2020, when a national lockdown was implemented, which caused the suspension of services at the breast clinic of University Malaya Medical Centre (UMMC). COVID data was obtained from March 2020 until June 2021. This study compared 374 breast cancer patients in the COVID-19 period with 382 patients in the pre-COVID period. There was no significant difference in the median (range) time to surgery between pre-COVID [45 (26.50-153.50) days] and COVID [44 (24.75-156.25) days] periods. The clinicopathological features of breast cancer showed reduction in in situ carcinoma and increase in Stage 4 diagnoses during the COVID period. There was a reduction in screening-detected carcinoma (9% vs. 12.3%), mastectomy followed by immediate reconstruction (5.6% vs. 14.5%) and adjuvant chemotherapy (25.8% vs. 32.9%) in the COVID period. In this center COVID-19 caused operational changes in breast cancer management, including a reduction in reconstructive procedures and adjuvant treatment. Healthcare disruption and fear of COVID may have caused delayed diagnosis, resulting in a higher frequency of Stage 4 disease and lower proportion of in situ carcinoma during the pandemic. However, there was no delay in the time to surgery, reduction in surgical volume, or change in surgery types.

SARS‐CoV‐2‐related polyradiculitis must be preceded by PCR‐confirmed COVID‐19

We read with interest the article by Pourbahtyaran et al. about a prospective study on seven pediatric patients with SARS-CoV-2-associated Guillain Barre syndrome (GBS) recruited between March 2020 and August 2021 in a single Iranian center.1 These patients were compared with 15 GBS patients who were negative for SARS-CoV-2 mRNA as well as antibodies recruited during the same period.1 It was found that the prevalence of GBS did not increase during the pandemic compared with previous years but that the outcome of SARS-CoV-2-related GBS was worse compared with non-COVID-related GBS.1 The study is appealing but carries limitations that raise concerns and should be discussed. The main limitation of the study is that SARS-CoV-2 infection was diagnosed in six patients with SARS-CoV-2-related GBS only by determination of antibodies against SARS-CoV-2.1 It was not communicated whether these antibodies were of the IgG or IgM subtype.1 It was also not discussed that these antibodies can persist for months, why establishing a causal relationship between SARS-CoV-2 infection and GBS is not reliable in these six patients. They should be excluded from the evaluation. Given the fact that the latency between the onset of infection and the onset of neurological manifestations ranged between 2 and 30 days, it is surprising that only one-seventh of patients was PCR-positive for SARS-CoV-2.1 A second limitation of the study is that no information about the cerebrospinal fluid (CSF) findings was provided.1 GBS is usually diagnosed according to the Brighton criteria2 and for level 1 diagnosis of GBS it is mandatory that patients have typical CSF findings. We should be told how many of the seven patients with SARS-CoV-2-related GBS had dissociation-cyto-albuminique and how many did not show this abnormality. Furthermore, CSF can be examined for cytokines, chemokines, glial factors, and 14-3-3, which have been shown elevated in patients with neuro-COVID.3 We disagree with the conclusion that the prevalence of GBS did not increase during the pandemic. First, the number of patients is too small to draw such conclusions. Strictly speaking, only a single patient had SARS-CoV-2-related GBS. In the remaining patients, the acute SARS-CoV-2 infection remained unconfirmed. Second, the pandemic is ongoing and thus lasts more than 3 years. To compare prepandemic prevalences with those during the pandemic patients from the entire pandemic period should be recruited. Third, the pre-COVID period with which COVID patients were compared with is not mentioned. Because GBS prevalences may have undulated in the pre-COVID era, it is crucial to know the exact time of recruitment. Regarding the 15 years old female with lupus erythematosus, we should know about her long-term immunosuppressive treatment. Immuno-suppressed patients are more susceptible to infectious diseases, and since she was SARS-CoV-2 negative, another pathogen is more likely to be the cause. Overall, the interesting study has limitations that call the results and their interpretation into question. SARS-CoV-2-related GBS should only be diagnosed in patients with a PCR-confirmed SARS-CoV-2 infection time linked with the onset of GBS. JF: design, literature search, discussion, first draft, critical comments, final approval. None. No funding was received. The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. All data are available from the corresponding author.

MP10-12 FOLLOW-UP 24-URINE STUDIES DURING AND POST-COVID-19 PANDEMIC

You have accessJournal of UrologyCME1 Apr 2023MP10-12 FOLLOW-UP 24-URINE STUDIES DURING AND POST-COVID-19 PANDEMIC Jennifer Lu, Brian Shkolnik, Kelley Zhao, Pankti Kothari, Scott Herfel, Hailey Schulsinger, Yefim Sheynkin, and David Schulsinger Jennifer LuJennifer Lu More articles by this author , Brian ShkolnikBrian Shkolnik More articles by this author , Kelley ZhaoKelley Zhao More articles by this author , Pankti KothariPankti Kothari More articles by this author , Scott HerfelScott Herfel More articles by this author , Hailey SchulsingerHailey Schulsinger More articles by this author , Yefim SheynkinYefim Sheynkin More articles by this author , and David SchulsingerDavid Schulsinger More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003225.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In New York State, March 16, 2020 marked the end of any in-restaurant dining due to the COVID-19 pandemic. The general population was forced to do more cooking at home and less dining out. Dietary modifications like this are considered first line therapy for calcium stone formers due to an effort to reduce dietary sodium intake which is known to affect lithogenic risk factors including hypernatriuria and hypercalciuria. This study aims to see if dietary changes made during the pandemic changed the risk of stone disease as evidenced in 24-hour urine studies and if these changes ceased after the end of widespread shutdowns. METHODS: All patients with nephrolithiasis seen for an outpatient visit from April 1, 2020-December 31, 2020 were queried and included if they had a 24-hour urine study pre-COVID (before March 16, 2020) and during-COVID (March 16, 2020-December 31, 2020); a post-COVID study was included if available (January 1, 2021- October 31, 2022). Values were compared using paired, 2-tailed t-tests. RESULTS: 93 patients (54 males, 39 females, mean age 60.1) were studied pre-COVID, during-COVID, and post-COVID time periods with 24-hour urine studies. Stone analysis revealed calcium oxalate (61%), calcium phosphate (15%), uric acid (15%), other (9%). The 24-hour urine revealed a significant reduction in urinary sodium (uNa) and urinary calcium (uCa) in these patients. uNa levels decreased from 166.15±7.5 mEq/L pre-COVID to 149.09±7.6 mEq/L during-COVID (p=0.015) and maintained improved at 138.55±6.83 mEq/L post-COVID era (p=0.0035). uCa levels decreased from 214.18±13.05 mEq/L pre-COVID to 191.48±13.03 mEq/L during-COVID levels (p=0.010) and remained improved at 185.33±12.61 mEq/L post-COVID (p=0.012). There were no significant differences in 24-hour urine total volume, magnesium, or citrate levels. CONCLUSIONS: During the COVID-19 lockdown, dietary choices limited to home cooked meals allowed patients to better identify their food choices. This study demonstrates that known urinary risk factors for lithogenesis, such as urinary sodium and calcium, improved during the lockdown and these improvements were maintained even after restrictions in restaurants were lifted. Moving forward, it will be imperative to monitor patient’s 24-hour urine to ensure these dietary modifications are continued in the post-pandemic era and to see if these improved urinary parameters will impact stone formation in these patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e119 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer Lu More articles by this author Brian Shkolnik More articles by this author Kelley Zhao More articles by this author Pankti Kothari More articles by this author Scott Herfel More articles by this author Hailey Schulsinger More articles by this author Yefim Sheynkin More articles by this author David Schulsinger More articles by this author Expand All Advertisement PDF downloadLoading ...

Epidemiological shift of paediatric fracture characteristics during COVID-19 in Hong Kong – a reflection on bone health crisis

Introduction Since the beginning of Coronavirus disease 2019 (COVID-19) pandemic, schools in Hong Kong were suspended intermittently as part of the anti-epidemic measure. This study aims to investigate the impact of COVID-19 pandemic on the epidemiology of paediatric fracture and bone health of children. Methods We recruited patients aged 3–17 admitted to tertiary paediatric orthopaedic trauma centres for fractures from 1st February 2020 till 4th March 2021 during COVID-19 period as study group and compared with patients admitted from 1st February 2019 till 31st January 2020 before COVID-19 as control group. Results Total number of admissions due to fracture was reduced by 49% (pre-COVID period: 345, COVID period: 177). Demographic data such as age, age group distribution, sex, location of fractures, energy of injury, prior history of fracture were comparable in the two groups. There was no statistically significant difference in the proportion of patients requiring operative treatment. Significant change was found in injury mechanisms, with injury related to body-powered vehicles (33.7%, n = 58) becoming the leading cause of injury during COVID period ( p &lt; 0.001). There was significant drop in proportion of patient with injury from level ground fall ( p &lt; 0.001) and sports ( p &lt; 0.001). The percentage of obese children increased significantly ( p = 0.009) during the COVID period (32.7%, n = 48) than pre-COVID period (21.0%, n = 67). The proportion of patients with hypocalcaemia was found to be higher ( p = 0.002) during COVID period. Conclusions This study reflects paediatric bone health issues during COVID-19 pandemic. We postulate the reduction in fracture incidence, change in the distribution of injury mechanisms, and more obesity could be related to a more sedentary lifestyle during COVID period. Hypocalcaemia can be associated with reduced sunlight exposure, obesity, and lack of physical activities. If the problem is left neglected, it can lead to long-term bone health problems.