Author Interviews, Brigham & Women's - Harvard, Cancer Research, COVID -19 Coronavirus, Prostate, Prostate Cancer, Surgical Research, Urology / 01.02.2021
COVID-19: Does Surgical Delay for Intermediate and High Risk Prostate Cancer Affect Prognosis?
MedicalResearch.com Interview with:
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Mr. Nguyen[/caption]
David-Dan Nguyen
Research Fellow | Center for Surgery and Public Health, Brigham and Women's Hospital
MPH (Health Policy) Student | Harvard T.H. Chan School of Public Health
Medical Student | McGill University
MedicalResearch.com: What is the background for this study?
Response: The COVID-19 pandemic has forced hospitals to delay the definitive treatment of cancers via surgery or radiation therapy. While previous evidence has shown that delaying the treatment of low-risk prostate cancer is not associated with worse outcomes, treatment delays for intermediate-risk and high-risk prostate cancer are more controversial. As such, we sought to determine if delays for these disease states negatively impacted oncological outcomes.
Mr. Nguyen[/caption]
David-Dan Nguyen
Research Fellow | Center for Surgery and Public Health, Brigham and Women's Hospital
MPH (Health Policy) Student | Harvard T.H. Chan School of Public Health
Medical Student | McGill University
MedicalResearch.com: What is the background for this study?
Response: The COVID-19 pandemic has forced hospitals to delay the definitive treatment of cancers via surgery or radiation therapy. While previous evidence has shown that delaying the treatment of low-risk prostate cancer is not associated with worse outcomes, treatment delays for intermediate-risk and high-risk prostate cancer are more controversial. As such, we sought to determine if delays for these disease states negatively impacted oncological outcomes.
Dr. Cano[/caption]
Marlene Cano MD. PhD.
Post-Doctoral Research Fellow in Pulmonary Transplant Immunology
Division of Pulmonary and Critical Care
Department of Medicine
Washington University/Barnes-Jewish Hospital
Saint Louis, MO
MedicalResearch.com: What is the background for this study? How does this test differ from other tests for COVID-19?
Response: We know COVID-19 causes a wide spectrum of disease, and that while many develop only mild uncomplicated illness, others develop severe respiratory failure, multi-organ failure and death. These patients often require prolonged hospitalization, ICU level care and even mechanical intubation for respiratory support. However, we still do not have a great way to identify which patients are likely to develop severe disease. We felt it was important to have a test that could act as sort of a ‘biomarker’ that we could measure early in COVID-19 patients and would help predict which patients would develop severe disease. From prior work, we knew that mitochondrial DNA, which are proinflammatory molecules that are released into the circulation from damaged organs could be this such ‘biomarker’. So, we measured the levels of mitochondrial DNA circulating in the plasma of patients with COVID-19 at the time they first presented to the hospital. Then we investigated if higher levels of mitochondrial DNA indeed predict the development of more severe disease.
Currently there are no ‘biomarker’ tests specific for COVID-19. We do currently measure levels of other markers in the hospital that we feel might help us assess overall how sick patients may be, but these are very non-specific and assess only level of inflammation. This test instead can measure level of tissue injury.
Dr. Wei Shan Hoong[/caption]
Dr Caroline Wei Shan Hoong, MBBS, MRCP
Associate Consultant Endocrinologist
Department of General Medicine
Woodlands Health Campus
National Healthcare Group, Singapore
MedicalResearch.com: What is the background for this study?
Response: In the course of our clinical work, we have noticed a predominance of musculoskeletal complaints among some of COVID-19 patients who are otherwise clinically well, and a small subset of them who develop a viral arthralgia (joint pains) sometimes occurring separately from the onset of acute respiratory symptoms. Besides a few isolated case reports, there was not much described about COVID-19 associated viral arthralgia in the literature.
Clinicians are well aware of the need to test for COVID-19 when patients present with cough or shortness of breath. However, when they present as joint pains without any respiratory symptoms, a diagnosis of COVID-19 could easily be missed. Due to overlapping clinical features like low platelet count and elevated liver enzymes, they could easily be misdiagnosed as having other vector-borne infections such as dengue fever, if clinicians do not have a high clinical suspicion of COVID-19. Hence we decided to describe the epidemiology and various presentations of musculoskeletal manifestations of COVID-19 in our cohort of patients.
Dr. Conway Morris[/caption]
Dr Andrew Conway Morris
Wellcome Trust Clinical Research Career Development Fellow
University of Cambridge
Hon Consultant in Intensive Care Medicine
Addenbrookes Hospital, Cambridge
MedicalResearch.com: What is the background for this study?
Response: Patients with COVID-19 frequently need to come to the intensive care unit (ICU), where we use mechanical ventilation to support their lungs as they get over the intense inflammation caused by the virus. During the first wave of the virus we noted that a lot of our patients appeared to be developing secondary infections (infections they didn’t have when they came into the ICU).
We therefore rolled out a rapid diagnostic test for these secondary bacterial infections that we had developed previously, and this study reports the use of this diagnostic and also describes the types of bacteria seen. To see if the increase in secondary infections was due to COVID specifically, we compared them to patients who were managed in the same ICU but who did not have COVID.
Dr. Butler[/caption]
Jay C. Butler, MD, FAAP, MACP, FIDSA
Deputy Director for Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, GA 30333
MedicalResearch.com: What is the background for this study?
Response: There are still disagreements about the significance of transmission of SARS-CoV-2 from asymptomatic persons. It has been known since at least March 2020 that, unlike the closely related coronavirus that causes SARS, transmission of COVID-19 from asymptomatic and presymptomatic persons occurs and that at least 30% of infected persons do not develop symptoms. Estimating the proportion of transmissions from persons without symptoms informs the decision analysis for prioritization of community mitigations opportunities: wearing of masks, social distancing, and hand hygiene. If only a low proportion of transmission occurs from people without symptoms, these interventions would be less likely to control transmission when broadly applied in the community. On the other hand, if a significant proportion of spread is from infected persons without symptoms, the value of these measures is enhanced.
Additionally, obtaining strategic and systematic screening tests for SARS-CoV-2 to identify and isolate persons without symptoms in selected settings, such as congregational housing settings, will have greater potential impact if spread from persons without symptoms is common.
Dr. McGahan[/caption]
Anita M. McGahan PhD, MBA
University Professor
Professor of Strategic Management
Professor, Munk School of Global Affairs & Public Policy
George E. Connell Chair in Organizations & Society
Rotman School of Management
University of Toronto
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The article by Phebo Wibbens, Wesley Wu-Yi Koo, and me that came out today in PLOS ONE at
Dr. Chua[/caption]
Isaac Chua, MD, MPH
Division of General Internal Medicine and Primary Care
Brigham and Women's Hospital
MedicalResearch.com: What is the background for this study?
Response: Patient surveys have shown that most people prefer to die at home at the end-of-life. However, during the initial wave of the COVID-19 pandemic, anecdotal evidence from our colleagues and findings from a prior study published in the Journal of the American Geriatrics Society suggested that majority of COVID-19 decedents died in a medical facility. However, less is known about care intensity at the end-of-life according to place of death among patients who died of COVID-19. Therefore, we characterized end-of-life care by place of death among COVID-19 decedents at Mass General Brigham (MGB), the largest health system in Massachusetts.
Dr. Maru[/caption]
Sheela Maru, MD, MPH
Department of Health System Design and Global Health and
Arnhold Institute for Global Health and
Department of Obstetrics, Gynecology and Reproductive Science
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study?
Response: Universal screening for SARS-CoV-2 infection on Labor and Delivery (L&D) units is a critical strategy to manage patient and health worker safety, especially in a vulnerable high-prevalence community. We describe the results of a SARS-CoV-2 universal screening program at the L&D Unit at Elmhurst Hospital in Queens, NY, a 545-bed public hospital serving a diverse, largely immigrant and low-income patient population and an epicenter of the global pandemic.
Asimanshu Das[/caption]
Asimanshu Das, Ph.D. student
Brown University School of Engineering
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Driving in a car with ride-share or car-pool is a widely prevalent social interaction. The study aimed to address the airflows inside cars in various window open/closed configurations using computer simulations, and also looking into the possibility of movement of aerosol-type of particles from one occupant to other.
The main findings are that opening windows provides a likely benefit to reduce the potentially pathogenic aerosols inside the cabin. Generally, more windows the better, but at the least it would be advisable to have one rear side window and one frontside window open.
Sitara Weerakoon[/caption]
Sitara Weerakoon, MPH (she/her)
PhD Candidate | Epidemiology & Biostatistics
Graduate Research Assistant
Center for Pediatric Population Health
UTHealth
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Measures to control the spread of COVID-19 included stay-at-home mandates and business lockdown policies which resulted in many facing a loss of income or employment and more time spent isolated at home. Life stressors (like job loss and social isolation) have been shown to be associated with increased drinking at unhealthy levels. Those with a history of mental health problems may be even more at risk.
We aimed to see if binge drinking (5 or more drinks [male] or 4 or more drinks [female] in one session) and levels of alcohol consumption among binge drinkers were impacted by these pandemic-related factors. We found that increased time spent at home (in weeks) was associated with a 19% increase in the odds of binge drinking and binge drinkers with a previous diagnosis of depression and current depression symptoms (during the early months of the pandemic) had a 237% greater odds of drinking more alcohol (vs drinking the same amount) compared to those with no history and current symptoms of depression.