Objective To assess the introduction of telemedicine as an alternative to the traditional face-to-face encounters with Vascular Surgery patients in the era of the Coronavirus Disease 2019 (COVID-19) pandemic. Methods Retrospective review of prospectively collected data on face-to-face and telemedicine interactions at a multi-site health care system from January to August 2020 in Vascular Surgery patients during the COVID-19 pandemic. The end point is direct patient satisfaction comparison between face-to-face and telemedicine encounters/interactions prior and during the pandemic. Results There were 6,262 patient encounters from 01/01/2020 to 08/06/2020. Of the total encounters, 790 (12.6%) were via telemedicine, which were initiated on 03/11/2020 after the World Health Organization’s (WHO) declaration of the COVID-19 pandemic. These telemedicine encounters were readily adopted and embraced by both the providers and patients and remain popular as an option to patients for all types of visits. 78.7% of patients rated their overall health care experience during face-to-face encounters as “very good” and 80.6% of patients rated their health care experience during telemedicine encounters as “very good” (p=0.78). Conclusion Although the COVID-19 pandemic has produced unprecedented consequences to the practice of Medicine and specifically of Vascular Surgery, our multi-site health care system has been able to swiftly adapt and adopt telemedicine technologies for the care of our complex patients. Most importantly, the high quality of patient reported satisfaction and health care experience has remained unchanged.
Objective We assessed the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in hospitalized patients with coronavirus disease 2019 (COVID-19) compared with that in a matched cohort with similar cardiovascular risk factors and the effects of DVT and PE on the hospital course. Methods We performed a retrospective review of prospectively collected data from COVID-19 patients who had been hospitalized from March 11, 2020 to September 4, 2020. The patients were randomly matched in a 1:1 ratio by age, sex, hospital of admission, smoking history, diabetes mellitus, and coronary artery disease with a cohort of patients without COVID-19. The primary endpoint was the incidence of DVT/PE and the odds of developing DVT/PE using a conditional logistic regression model. The secondary endpoint was the hospitalization outcomes for COVID-19 patients with and without DVT/PE, including mortality, intensive care unit (ICU) admission, ICU stay, and length of hospitalization (LOH). Multivariable regression analysis was performed to identify the variables associated with mortality, ICU admission, discharge disposition, ICU duration, and LOH. Results A total of 13,310 patients had tested positive for COVID-19, 915 of whom (6.9%) had been hospitalized across our multisite health care system. The mean age of the hospitalized patients was 60.8 ± 17.0 years, and 396 (43.3%) were women. Of the 915 patients, 82 (9.0%) had had a diagnosis of DVT/PE confirmed by ultrasound examination of the extremities and/or computed tomography angiography of the chest. The odds of presenting with DVT/PE in the setting of COVID-19 infection was greater than that without COVID-19 infection (0.6% [5 of 915] vs 9.0% [82 of 915]; odds ratio [OR], 18; 95% confidence interval [CI], 8.0-51.2; P < .001). The vascular risk factors were not different between the COVID-19 patients with and without DVT/PE. Mortality ( P = .02), the need for ICU stay ( P < .001), duration of ICU stay ( P < .001), and LOH ( P < .001) were greater in the DVT/PE cohort than in the cohort without DVT/PE. On multivariable logistic regression analysis, the hemoglobin (OR, 0.71; 95% CI, 0.46-0.95; P = .04) and D-dimer (OR, 1.0; 95% CI, 0.33-1.56; P = .03) levels were associated with higher mortality. Higher activated partial thromboplastin times (OR, 1.1; 95% CI, 1.00-1.12; P = .03) and higher interleukin-6 (IL-6) levels (OR, 1.0; 95% CI, 1.01-1.07; P = .05) were associated with a greater risk of ICU admission. IL-6 (OR, 1.0; 95% CI, 1.00-1.02; P = .05) was associated with a greater risk of rehabilitation placement after discharge. On multivariable gamma regression analysis, hemoglobin (coefficient, −3.0; 95% CI, 0.03-0.08; ...
Background: Coronavirus disease 2019 (COVID-19) is a global pandemic, which is associated with venous thromboembolism and pulmonary embolism (PE). This study aimed to estimate the pooled incidence of PE among patients hospitalized with COVID-19 within the published literature. Methods: This systematic review and meta-analysis was performed according to PRISMA guidelines. An electronic search using MEDLINE /PubMed, ScienceDirect, Cochrane, and OpenGray databases was conducted May 19th, 2020. Search terms included "COVID 19", "SARS-CoV-2”, "coronavirus disease 2019", "2019-nCoV", "Wuhan coronavirus", “Pulmonary embolism”, "pulmonary thromboembolism", “Pulmonary embol*”, “pulmonary thrombo*” and “PE”. Eligible studies included sufficient data to calculate the incidence of PE diagnosed during hospitalization in patients with COVID-19. Case reports were excluded. Quality was assessed using the Newcastle-Ottawa scale (observational cohort and case-control), AXIS tool (cross-sectional), and quality assessment tool (case series). Demographics and PE incidence data were extracted from the included studies and analyzed with R language. The pooled incidence of PE in patients hospitalized with COVID-19 was calculated. Results: The database search identified 128 records. Ten observational studies were eligible and were included in the meta-analysis with a total of 1722 patients (mean age= 63.36). The pooled PE incidence in patients hospitalized with COVID-19 was 17% (95% CI: 0.1-0.26). There was a high degree of study heterogeneity (I2 = 94%, p<0.01). Conclusion: The pooled PE incidence in patients hospitalized with COVID-19 is 17%. This increased incidence is greater than that previously reported in the general population of non-COVID-19. Attention and further investigation of this risk is warranted.
Introduction Bed bugs are commonly encountered by emergency medical service (EMS) providers. The objective of this study was to determine the frequency with which EMS providers encountered bed bugs, assess their knowledge about bed bugs, and analyze the actions they take after finding bed bugs. Methods
Background: Patients with novel coronavirus disease-2019 , present a systemic inflammatory response with vascular endothelial damage and an increased risk of thromboembolic complications. Sulodexide can help restore venous and arterial endothelial glycocalyx integrity lost in certain chronic diseases, which can downregulate or limit the response to inflammatory molecules. It has an antithrombotic effect that could help reduce the incidence of thromboembolic complications which can be beneficial in these patients. We hypothesize that sulodexide, instituted in the early symptomatic stages of COVID-19, would improve the clinical outcomes with decreased hospital admission, decrease morbidity, and mortality.Methods: Prospectively, patients were recruited with early clinical symptoms of COVID-19 (shortness of breath, fever, headache, cough, etc), and screened for inclusion criteria, age 40 to 80 years, male or female, and risk of developing a severe presentation of the disease >50% given by the IMSS (Mexican Social Security Institute) COVID-19 health risk calculator. Exclusion criteria were negative COVID-19 test result, chronic use of steroid medication or anticoagulation. Patients were randomized for allocation into control group to received placebo + standard of care, or study group to receive an oral dose of 500 lipase releasing units sulodexide two times per day. The treatment lasted 21 days. A follow-up visit was scheduled via electronic media at 7 days intervals or as needed. Primary end points variables to measure were, days of hospital care, the need for supplemental oxygen, D-dimer, and C-reactive protein serum levels, and mortality rate.Results: A total of 243 patients were randomly assigned to the sulodexide group (n ¼ 124) or the placebo group (n ¼ 119). The demographics and clinical characteristics of the patients were similar in both groups. The symptoms that presented a significant improvement in the sulodexide group were body aches at week 2 (P ¼ .002), malaise/fatigue at week 3 (P ¼ .003), and shortness of breath at week 2 (P ¼ .001) and week3 (P ¼ .031). A total of 37 patients (29%) developed respiratory symptoms that warrant the need for in-home oxygen support in the sulodexide group versus 50 (42%) in the control group (P ¼ .047). A total of 56 patients (24%) required hospital admission, 22 (17.7%) in the sulodexide group and 35 (29.4%) in the placebo group (P ¼ .032), with an average length of stay of 6.4 days in the sulodexide group versus 7.8 control group (P ¼ .211). A total of 3 patients (2.4%) died in the sulodexide group versus 7 (5.8%) in the placebo group (P ¼ .121).Conclusions: Our findings supported the effectiveness of sulodexide in the prevention of a severe clinical progression of COVID-19 when used in the early symptomatic stages compare to the standard of care, reducing the need for hospital care of these patients.
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