Covid-19 with Respect to Protection or Risk at High Altitude: A Global Perspective

Severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) has affected every demography disproportionately, including even the native highland populations. Hypobaric-hypoxic settings at high altitudeS (HAS, >=2500 m) present an extreme environment that impacts the survival of permanent residents, possibly including SARS-CoV-2. Conflicting hypotheses have been presented for coronavirus disease 2019 (COVID-19) incidence and fatality at HA. To evaluate protection or risk against COVID-19 incidence and fatality in humans under hypobaric-hypoxic environment of HA (>=2501 masl). Global COVID-19 data for March 2020-2021 obtained from official websites of the Indian Government, John Hopkins University, and Worldometer were clustered into six altitude categories. Clinical cofactors and comorbidities data were evaluated with COVID-19 incidence and fatality. Extensive comparisons and correlations using several statistical tools estimated the risk and protection. Of relevance, data analyses revealed four distinct responses, namely, partial risk, total risk, partial protection, and total protection from COVID-19 at HA, indicating a mixed baggage and complexity of the infection. Surprisingly, it included the countries within the same geographic region. Moreover, body mass index, hypertension, and diabetes correlated significantly with COVID-19 incidence and fatality rate (p <= 0.05). Varied patterns of protection and risk against COVID-19 incidence and fatality were observed among the HA populations. However, it is premature to generalize COVID-19 effects on any particular demography without further extensive studies.

Study of Metadata Impact on COVID-19 Detection using Convolutional Neural Networks

COVID-19 is a lethal viral disease that attacks the respiratory system. This contagious disease started spreading all around the world in December 2019. A Computerized chest Tomography (CT) scan is a trusted and recommended imaging tool to detect the COVID-19. Although manual CT image examination is an option, it takes significant time to get analyzed by a technician. Automating this process can be done by deep Convolutional Neural Networks (CNN). Applying these networks in analyzing the CT images could result in great success. There are several works focused on detecting COVID-19 by applying CNN uses different algorithms to classify COVID-19 patients from normal or pneumonia patients. The proposed models in these works mostly use limited and small data sets that could lead to generalization issues or biased predictions. In this paper we explore three methods for training a classifier for COVID-19 detection tasks using a large-scale public data set. In our first method, we only rely on CT images with training the CNN models. In the second method, we use pre-trained CNN models for image feature extraction and use those features for training classical machine learning models. In the last method, we propose an end-to-end model that gets both image and the metadata such as age and gender to experiment with the impact of metadata on COVID-19 detection task. We conclude that adding metadata improves the accuracy. © 2022 IEEE.

A RARE CASE OF DISSEMINATED MYCOBACTERIAL SEPTICEMIA (LANDOUZY SEPTICEMIA) IN AN HIV-NEGATIVE PATIENT

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Landouzy septicemia or disseminated mycobacterial septicemia is an uncommon diagnosis. Especially in immunocompetent individuals but one we must not forget. CASE PRESENTATION: 33-year-old Guatemalan woman, with no known history of disease presented with headache, fever, chills, abdominal pain, weakness & shortness of breath for the past two months. Physical examination(PE) was significant for a temperature of 39.4 C, heart rate 128 bpm & blood pressure 96/55 mmHg. Ill-appearance, breath sounds were diminished bilaterally, rest of the PE unremarkable. At admission, CBC and renal function within normal limits, AST/ALT within normal limits, ALP elevated. A day after admission, she developed acute encephalopathy, hypotension & neck stiffness, with Kernig and Brudzinski signs. She was in septic shock, transferred to the ICU for mechanical ventilation, vasopressor support, and broad-spectrum antibiotics. COVID PCR resulted negative. Lactate was 12.6 mmol/L, AST: 549 ALT: 118 U/L. Cr: 1.7 BUN: 36. Bronchoalveolar lavage was positive for rifampin-sensitive Mycobacterium tuberculosis (MTB). Influenza A was positive via intranasal PCR. CT of the chest demonstrated bilateral reticulonodular interstitial infiltrates, suggesting atypical pneumonia, and a T11 vertebral body hypodense lesion. CT of the abdomen & pelvis revealed a nodular liver. Lumbar puncture showed an opening pressure of 29cm H20, CSF studies with hazy appearance, protein 594 mg/dL, glucose <20 mg/dL, & elevated WBC, negative for Toxoplasma, CMV, VDRL, VZV, HIV, HSV-1, enterovirus, cryptococcus, & JC virus, but positive for MTB. MRI of the thoracolumbar spine revealed T11-T12 osteomyelitis, with leptomeningeal and epidural enhancement. An echocardiogram showed a diffuse LV hypokinesis with an EF of 20%. HIV was negative, though she had an absolute CD4 count of 48 cel/mcL. Immunoglobulins were within normal limits. Repeated blood cultures were negative during the hospitalization. We started RIPE therapy and dexamethasone. The patient's mentation did not recover, off sedation. Subsequently, MRI of the brain demonstrated ischemic infarction in the subcortical region with hemorrhagic transformation, & MRV of the head was notable for cortical venous thrombosis. Despite adequate treatment after AFB identification, she expired 11 days into her hospitalization. DISCUSSION: The patient had a rare presentation of a common disease. She ultimately succumbed to landouzy septicemia. A rare manifestation of disseminated tuberculosis resulting in multiorgan failure & carries a high mortality, usually seen in immunocompromised patients, unlike our case. The CD4+ lymphocytopenia associated with influenza A infection might have unmasked the latent disease. CONCLUSIONS: Landouzy septicemia is a rare and severe manifestation of MTB. It should be in the differential even in immunocompetent individuals given the high mortality. REFERENCE #1: Floyd K, Glaziou P, Zumla A, Raviglione M. The global tuberculosis epidemic and progress in care, prevention, and research: an overview in year 3 of the End TB era. The Lancet Respiratory Medicine. 2018;6(4):299-314. REFERENCE #2: Hagan G, Nathani N. Clinical review: Tuberculosis on the intensive care unit. Critical Care. 2013;17(5):240. REFERENCE #3: Nichols JE, Niles JA, Roberts NJ. Human Lymphocyte Apoptosis after Exposure to Influenza A Virus. Journal of Virology. 2001;75(13):5921-9. DISCLOSURES: No relevant relationships by Baher AL Abbasi, source=Web Response No relevant relationships by Carlos Dorta, source=Web Response No relevant relationships by Adam Friedlander, source=Web Response No relevant relationships by Katherine Hodgin, source=Web Response No relevant relationships by Christopher Siriphand, source=Web Response No relevant relationships by Carlos Vergara-Sanchez, source=Web Response

Investigation of COVID-19 lockdown effects on water quality in natural bodies of water in the great lakes region

The purpose of this preliminary investigation is to find the effect of the COVID-19 pandemic on water quality parameters in rivers, especially in the Great Lakes Basins. Several rivers and coastal areas in the Great Lakes region are highly polluted due to industrial and agricultural activities. The lockdown has caused industrial activities to shut down, people to work from home, and less waste to be introduced into natural bodies of water. Several studies show that air quality has improved during the lockdown in a variety of places, especially in big cities, but there are fewer studies on water quality parameters. Recent studies, using satellite images, show there are improvements in the water quality of lakes and bays due to less traffic and industrial activities. In this study, with the collaboration of two high schoolers, we want to find rivers with dissolved oxygen data, in the Great Lakes region, and compare the period of lockdown with the same period of time in 2019. The outcome of this study will provide a better understanding of the role of human activities on water quality in natural systems and can be used for public education and awareness of environmental protection. © ASCE.

VALIDATION OF SOFA SCORE IN CRITICALLY ILL PATIENTS WITH COVID-19

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Multiple metrics like SOFA score, APACHE II, AND SAPS III have been validated to predict mortality in critically ill patients. However, there is limited data about the applicability and validation of the SOFA score in critically ill patients with COVID-19 METHODS: This is a retrospective cohort study aimed to evaluate and validate the applicability of SOFA score in critically ill patients with COVID 19. SARS-CoV-2 was diagnosed via PCR, and full SOFA score (6 system variables) was performed on days 1, 3 and 5 of critical care admissions with estimation of standard variation RESULTS: A total of 125 with PCR confirmed SARS-CoV-2 infection admitted between March 9, 2020, to April 5, 2020 in a tertiary care center were identified and analyzed. In-hospital mortality or discharge to hospice occurred in 17% (9 and 13 patients respectively) of the population. A further analysis of 28 patients that required ICU care was performed with a subsequently mortality/discharge to hospice of 76% (18). A SOFA score was estimated at day 1, 3 and 5 with subsequent averaging among the 18 patients in which 6 ± 4, 8 ± 5, 11 ± 4 points were obtain respectively. Patients who died where older in age (70 years), had multiple comorbidities (diabetes mellitus, coronary disease). Among predictors of poor outcomes we found any increase in the SOFA score over 48 hours, and a total of 11 points at day 1. A linear correlation was suggested among SOFA and ICU mortality CONCLUSIONS: An increase on SOFA score in the first 48 hours after admission is associated with a significant ICU mortality in critically ill patients with COVID-19. These correlate with similar findings in no COVID19 patients. Thus, suggesting that SOFA score is an excellent tool to predict mortality in critically ill patients with COVID 19 CLINICAL IMPLICATIONS: As normal SOFA Score this information can be used to provide the family with prognosis, and clinical trials to improve decision making and quality of care. DISCLOSURES: No relevant relationships by Ahmed Abdallah, source=Web Response No relevant relationships by Baher AL Abbasi, source=Web Response No relevant relationships by Andres Chacon Martinez, source=Web Response no disclosure on file for Robert Chait;No relevant relationships by Kai Chen, source=Web Response no disclosure on file for Kepler De Almeida;No relevant relationships by Nakeya Dewaswala, source=Web Response no disclosure on file for Jesus Pino;No relevant relationships by Fergie Ramos Tuarez, source=Web Response No relevant relationships by Renuka Reddy, source=Web Response No relevant relationships by Pedro Torres, source=Web Response