Second Wave Research Articles

Acute intracranial hemorrhage in 76 COVID-19 patients during the first and second pandemic waves

Background/Aim. There is limited data on the frequency of intracranial hemorrhage (ICrH) in the first wave [beta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] and second wave (delta variant of SARS-CoV-2) coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to analyze the appearance of ICrH in COVID-19 patients (CP). Methods. Among 505 CP treated at the Special Hospital for Cerebrovascular Diseases ?Sveti Sava? intermittently during the 2020-2021 period, ICrH was diagnosed in 76 (15.1%) patients. The available information from the medical records regarding clinical, demographic, as well as radiological data (multislice computed tomography examination of the endocranium) was collected and analyzed. Results. In the first wave, out of 308 CP, 63 (20.5%) were diagnosed with ICrH. In the second wave, out of 197 CP, ICrH was diagnosed in 13 (6.6%) patients, which was a statistically significant difference (p < 0.002). There was no statistically significant difference for the presence of hyper-tension (p = 0.271), diabetes mellitus (p = 0.558), and chronic obstructive pulmonary disease (p = 0.794) among CP with ICrH comparing the two waves of the pandemic. However, a statistically significant difference was proven in the frequency of patients with atrial fibrillation and anticoagulant drug therapy (p = 0.021 each). There was no statistically significant difference in the frequency of patients with fever (p = 0.637), fatigue (p = 0.587), hemiparesis (p = 0.831), respiratory symptoms (p = 0.289), and loss of consciousness (p = 0.247). D-dimer values in the second pandemic wave were statistically significantly lower (p = 0.003). The combina-tion of ischemic stroke and ICrH was six times more common in the second wave (p = 0.003). However, cer-ebral parenchymal hemorrhage was two times less frequent (p = 0.001) in the second wave but with statisti-cally higher frequencies of multifocal (23.1%) and dif-fuse type (36.4%) of ICrH (p = 0.007). Combined hem-orrhages, as well as subarachnoid and subdural subtypes, were more common in the second wave (23.1% each). Fatal outcomes occurred in 38.1% of patients in the first wave compared to 69.2% in the second wave (p = 0.039). Conclusion. In the first pandemic wave of COVID-19, ICrH in CP was significantly more frequent and D-dimer was singled out in laboratory analyses, the values of which were statistically significantly higher in comparison with second wave. In the second wave of COVID-19, parenchymal ICrH was less frequent and multifocal and diffuse ICrH were more common in CP with ICrH. The mortality rate was very high in the sec-ond wave.

Clinico-demographic profile of COVID-19 positive patients - first wave versus second wave – an experience in north-east India

India witnessed two distinct COVID-19 waves. We evaluated the clinico-demographic profile of patients infected during first wave (FW) and second wave (SW) in a hospital in north-east India. Patients who tested positive for severe acute respiratory syndrome-coronavirus-2 specific gene by reverse transcriptase polymerase chain reaction across FW and SW were diagnosed as COVID-19 positive. The clinico-demographic data of these positive patients were retrieved from the specimen-referral-form. Vital parameters including respiratory rate, SpO2, data on COVID-19-associated mucormycosis (CAM), COVID-19-associated acute respiratory distress syndrome (CARDS) were obtained from hospital records for in-patients. Patients were categorized based on disease severity. The data obtained in both waves were analyzed comparatively. Out of a total of 119,016 samples tested, 10,164 (8.5%) were SARS-CoV-2 positive (2907 during FW, 7257 during SW). Male predominance was seen across both waves (FW: 68.4%; SW:58.4%), with more children infected during SW. Patients with travel history (24%) and contact with laboratory confirmed cases (61%) were significantly higher during SW relative to FW (10.9% and 42.1% respectively). Healthcare worker infection was higher in SW (5.3%). Symptoms like vomiting [14.8%], diarrhea [10.5%], anosmia [10.4%] and aguesia [9.4%] were more in SW. More patients developed CARDS in SW (6.7%) compared to FW (3.4%) with 85% and 70% patients expiring across FW and SW respectively. No case of CAM is documented in our study. This was probably the most comprehensive study from north-east India. Industrial oxygen cylinder usage may have been the source of CAM in the rest of the country.

First and second wave dynamics of emergency department utilization during the COVID-19 pandemic: A retrospective study in 3 hospitals in The Netherlands.

During certain phases of the COVID-19 pandemic, a decrease was observed in emergency department (ED) utilization. Although this phenomenon has been thoroughly characterized for the first wave (FW), second wave (SW) studies are limited. We examined the changes in ED utilization between the FW and SW, compared to 2019 reference periods. We performed a retrospective analysis of ED utilization in 3 Dutch hospitals in 2020. The FW and SW (March-June and September-December, respectively) were compared to the reference periods in 2019. ED visits were labeled as (non-)COVID-suspected. During the FW and SW ED visits decreased by 20.3% and 15.3%, respectively, when compared to reference periods in 2019. During both waves high urgency visits significantly increased with 3.1% and 2.1%, and admission rates (ARs) increased with 5.0% and 10.4%. Trauma related visits decreased by 5.2% and 3.4%. During the SW we observed less COVID-related visits compared to the FW (4,407 vs 3,102 patients). COVID-related visits were significantly more often in higher need of urgent care and ARs were at least 24.0% higher compared to non-COVID visits. During both COVID-19 waves, ED visits were significantly reduced. ED patients were more often triaged as high urgent, the ED length of stay was longer and ARs were increased compared to the reference period in 2019, reflecting a high burden on ED resources. During the FW, the reduction in ED visits was most pronounced. Here, ARs were also higher and patient were more often triaged as high urgency. These findings stress the need to gain better insight into the motives of patients to delay or avoid emergency care during pandemics, as well as to better prepare EDs for future outbreaks.

Management of Breast Cancer during COVID-19 Pandemic: Trends of the Intervals to Radiotherapy in a Single Center Cohort

Background: COVID-19 pandemic led to a drastical rearrangement within healthcare staff and facilities. Due to its high incidence, management of breast cancer (BC) was particularly critical during the COVID-19 pandemic, and the reduction of healthcare staff and facilities influenced the timing in BC care. The aim of the present report was to analyze the timing from diagnosis to surgery, from diagnosis to radiotherapy (RT) start and from surgery to RT start during the COVID-19 pandemic. Methods: We retrospectively collected data of women with BC treated with Radiotherapy (RT) after surgery at our Institution (Department of Oncology, Radiation Oncology, S. Anna Hospital, Turin, Italy), during the COVID-19 pandemic. To evaluate patients’ data according to the different stages of the pandemic, we identified 4 periods: first wave (FW), first reopening (FR), second wave (SW) and second reopening (SR). Among the 4 periods, we divided patients in 2 groups: patients who underwent adjuvant chemotherapy (CT) before RT (CT-group), and those who received exclusive adjuvant RT (non-CT group). Results: from early March 2020 to 31 March 2022, 464 patients were treated. After patients’ selection, data from 390 patients were analyzed. Overall, the average interval between biopsy and RT in the non-CT group was 202 days during the FW (101–386), 172 days (85–242) during the FR, 136 days (69–366) during the SW, 159 days (77–455) during the SR. In the CT group, the average interval from biopsy to RT start was 337 days (224–495) during the FW, 277 days (209–496) during FR, 297 days (220–419) during the SW, and 261 days (169–447) during the SR. Conclusions: we reported our experience during these two years of the pandemic and how COVID-19 impacted the timing of the management of patients with BC. Overall, during the viral waves there was a remarkable increase in the interval between biopsy/surgery and RT. Nonetheless, we managed to keep optimal BC care and favorable interval trends were observed with reopening phases.

Probability of hospitalisation and death among COVID-19 patients with comorbidity during outbreaks occurring in Mexico City.

We compared the probability of hospitalization and death caused by COVID-19 in patients with comorbidities during three periods defined for this study: first-wave (FW), interwave period (IP), and second-wave (SW) observed in Mexico City. In this registry-based study, we included individuals over 20 years of age. During the FW (symptomatic), the IP, and the SW (symptomatic and asymptomatic), participants were diagnosed using nasopharyngeal swabs. Symptomatic individuals with risk factors for serious disease or death were referred to the hospital. SARS-CoV-2 infection was defined by RT-qPCR in all hospitalized patients. All data were added to the SISVER database. Bayesian analysis and False Discovery Rate were used for further evaluation. The study included 2 260 156 persons (mean age of 43.1 years). Of these, 8.6% suffered from DM, 11.6% arterial hypertension, and 9.7% obesity. Of the total, 666 694 persons tested positive (29.5%). Of the infected persons, a total of 85 587 (12.8%) were hospitalized: 24 023 in the FW; 16 935 in the IP, and 44 629 in the SW. Of the hospitalized patients, there were 42 979 deaths (50.2%), in the FW, 11 964 (49.8%), in the IP, 6794 (40.1%), and in the SW 24 221 (54.3%). The probability of death among individuals hospitalized with or without comorbidities increased consistently in all age groups. A significant increase in the Fatality Rate was observed in individuals with comorbidities (1.36E-19< = FDR< = 3.36E-2). A similar trend was also observed in individuals without comorbidities (1.03E-44< = FDR< = 5.58E-4). The data from this study show a considerable increase in the number of detected cases of infection between the FW and SW. In addition, 12.8% of those infected were hospitalized for severe COVID-19. A high mortality rate was observed among hospitalized patients (>50%). An age-dependent probability of death was observed with a positive trend in hospitalized patients with and without comorbidities.

Patterns of Emergency Department visits for acute and chronic diseases during the two pandemic waves in Italy.

Evidence is lacking about the impact of subsequent COVID-19 pandemic waves on Emergency Departments (ED). We analyzed the differences in patterns of ED visits in Italy during the two pandemic waves, focusing on changes in accesses for acute and chronic diseases. We conducted a retrospective study using data from a metropolitan area in northern Italy that includes twelve ED. We analyzed weekly trends in non-COVID-19 ED visits during the first (FW) and second wave (SW) of the pandemic. Incidence rate ratios (IRRs) of triage codes, patient destination, and cause-specific ED visits in the FW and SW of the year 2020 vs. 2019 were estimated using Poisson regression models. We found a significant decrease of ED visits by triage code, which was more marked for low priority codes and during the FW. We found an increased share of hospitalizations compared to home discharges both in the FW and in the SW. ED visits for acute and chronic conditions decreased during the FW, ranging, from -70% for injuries (IRR = 0.2862, p < 0.001) to -50% and - 60% for ischemic heart disease and heart failure. The two pandemic waves led to a selection of patients with higher and more urgent needs of acute hospital care. These findings should lead to investigate how to improve systems' capacity to manage changes in population needs.

MO891HEMODIALYSIS PATIENTS AMID COVID-19 PANDEMIC: A COMPARISON BETWEEN FIRST AND SECOND WAVE

Background and AimsData about HD patients and how to best dialyze them during the COVID-19 pandemic are scarce. The aim of the study is to describe the organizational model and clinical outcomes of patients confirmed COVID-19 needing renal replacement therapy, admitted in a COVID Hospital in Southern Italy during the first and second pandemic wave.MethodAll the consecutive patients requiring chronic HD, during the first and second wave were considered. Due to local resources, we have implemented an organizational model based on the HD bedside with Genius system. The machine was prepared in the Dialysis Unit and then transferred to the COVID Hospital. After treatment, the monitor was sterilized and carefully cleaned with chlorine wipes and re-transferred into the dialysis Unit to be prepared for the next dialysis. Demographic data, clinical symptoms at presentation, and laboratory results were extracted by the electronic medical record. Patients hospitalized during the first wave (FW) and second wave (SW) were compared.ResultsFrom March 10 through December 31 2020, we enrolled a cohort of 40 patients (37.5% F), with COVID-19 infection requiring HD; 11 (27.5%) during first and 29 (72.5%) during second wave. The phenotype and clinical symptoms at the admission were not different between two groups. Compared to FW, the SW patients were younger (70.1±9.5 vs 77.3±5.9 years; p<0.03) with lower dialysis vintage (35±18 vs 60±48 months; p<0.05), and lower Charlson Comorbidity Index scores (2.8 ± 1.8 vs 5.09 ± 2.0; p<0.05). No differences were observed between the first and second wave as far as inflammatory markers IL6 (51.9 ± 44.8 vs 55.45 ± 40.52 pg/mL; ns) and C-reactive protein (4.74 ± 3.8 vs 6.70 ± 5.44 mg/L; ns) as well as the hospital stay (21.1±10 vs 24.4.8±10 days; ns) and in-hospital mortality (28.1% vs 18.2%; ns). Overall, 354 bedside treatments were performed; mean session time and mean weekly sessions were 3.64 ± 0.40 hours, and 3.4 ± 0.45 HD/week, with no differences between FW and SW patients.ConclusionOur data show that the higher spread of Sars-cov2 during the second wave has infected younger and less comorbid HD patients, with no significant differences in clinical and laboratory parameters. Our organizational model based on the HD bedside with the Genius system, allowed a personalized treatment with efficacy and safety for the patients and staff.

Coronavirus Disease 2019 (COVID-19): Do Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers Have a Biphasic Effect?

Coronavirus Disease 2019 (COVID-19): Do Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers Have a Biphasic Effect?

Beauvoir's Time/Our Time: The Renaissance in Simone De Beauvoir Studies

SINCE THE EARLY SECOND WAVE, Simone de Beauvoir and her work have provided something of a Rorschach test for feminist theory, with dif ferent generations and genres of feminism each projecting their own pre occupations upon her. First hailed as Mother of Us All and as the author of the so-called Bible of Second Wave feminism, she was mainly treated in the 1970s as an icon or held up as an ideal. But although in the 1970s many feminists found personal inspiration in The Second Sex as well as in Beau voir's life, relatively few engaged seriously with the book as a major theo retical work. Mary Dietz's later observation that like the Bible, The Second Sex seems to have been much worshiped, often quoted, and little read clearly had some truth to it.1 For many it seems to have been Beauvoir's life that was the more important. This was a life that (at least as Beauvoir presented it in her autobiographical volumes) appeared as an ideal for the would-be liberated woman. Her free union with Jean Paul Sartre; her re fusal of housework, marriage, and motherhood; and her intellectual seri ousness and creativity-all were worthy of emulation. However, in 1979, a scholarly conference was held in New York to com memorate the thirtieth anniversary of the original French publication of The Second Sex in 1949; and twenty-five years ago, in the summer of 1980, the

The Emergence and First Years of a Grassroots Women's Movement in Northwest Arkansas, 1970-1980

THE SECOND WAVE OF THE WOMEN'S MOVEMENT was one of most important cultural and social phenomena of twentieth century.1 The movement's mobilization was a result of grassroots organizing undertaken by national feminist organizations and hundreds of local women's groups. Although, as Myra Marx Ferree and Patricia Yancey Martin have argued, this mobilization produced many organizations that have worked for social change, few of them have been studied in depth and detail they deserve.2 Even more importantly, existing studies of women's move-ment have been largely limited to large metropolitan areas in North or on East and West Coasts.3 This focus on large metropolitan areas has created a bias in our understanding of movement's history. First, as Nancy Whittier notes, [p]eriodization based on national movement and on major cities does not. . . accurately describe course of movement at grassroots level in smaller cities.4 Second, lack of attention to what happened outside large cities has obscured centrality of grassroots movement to development of women-oriented services and greater integration of women into economic and political structure in mid-size urban areas. This study seeks to rectify this situation by examining emergence and first years of grassroots women's movement in Fayetteville, Arkansas.5 In doing so, it focuses on similarities and differences between local movement and those movements that emerged in larger cities. At beginning of 1960s, so-called woman's issue moved to center of public debate in U.S. John F. Kennedy's creation of President's Commission on Women in 1961, nearly simultaneous publication of commission's report and Betty Friedan's The Feminine Mystique in 1963, and establishment of National Organization for Women in 1966 helped focus national attention on existing gender inequalities and fostered development of more mainstream, women's rights-oriented, feminist movement. On other hand, civil rights and New Left movements served as midwife to more radical, grassroots feminist movement. Unlike national women's organizations, radical grassroots groups operated outside of mainstream politics, sought to transform existing institutions, and emphasized importance of creating women's-only groups and building egalitarian organizations, rather than structuring its activities more bureaucratically and creating mixed organizations and groups.6 In 1960s, civil rights movement in South and various antiwar student groups concentrated in North, including Students for a Democratic Society, offered women opportunities for activism. In South, as Sara Evans has argued, feminist consciousness first emerged within network of women involved in Student Non-violent Coordinating Committee. To become activists in civil rights movement, these women had to challenge ideals of southern femininity and create a new sense of self. In turn, participation in civil rights movement brought to their attention the tangled relationship between race and as well as recognition that racial equality required fundamental changes in sex roles.7 This changing consciousness, which was reinforced by disparaging treatment women activists received from some male comrades, prepared many southern women to become active participants in impending women's liberation movement. The mobilization of women in other parts of country resulted from their growing awareness of gender oppression, especially as they experienced gender discrimination and inequality within New Left itself. Between 1967 and 1968, Evans argues, women activists within civil rights and New Left movements became main constituency of radical feminist groups, which, in turn, gave birth to massive grassroots feminist movement.8 In Northwest Arkansas, however, majority of grassroots feminist activists did not have such experiences. …