Integrate Ground Data and Remote Sensing to Monitor So2 and No2 Pollution over Northern Uae / Considering the Lockdown Period of the Covid-19 Pandemic

Sulfur dioxide and Nitrogen dioxide are two of the main air quality pollutants of concern generally in world countries. North of United Arab Emirates (UAE) urbanization and population growth are increasing all the daily activities related to pollution, which poses a threat to humans and the environment. The aim of this study was to investigate the Spatio-temporal distribution of SO2 and NO2 concentrations, resulting from seven ground stations and The Sentinel-5 Precursor multispectral sensor of the TROPOMI for the periods (2019,2020, and 2021). The data explained how the parameters have changed in the presence of the COVID-19 pandemic. SO2 and NO2 pollution monitoring and regulation assist to take proper steps to control the atmospheric concentration of SO2 and NO2 within the fair levels.

Reactive arthritis associated with COVID-19 infection: A review

Background: The incidence of COVID-19 infection is increasing globally with high mortality rate. Cytokine release syndrome might contribute to extra-pulmonary manifestations such as acute kidney injury, venous thrombosis, neurological complications, hepatic and myocardial injury. Reactive arthritis is an emerging musculoskeletal (MSK) manifestation post COVID-19 infection. Reactive arthritis manifests as asymmetrical, oligoarthritis mainly involving peripheral or axial joints of lower extremities and associated with extra-articular manifestations. Objectives: review the clinical presentation and management outcomes of COVID-19 associated reactive arthritis. Methods: A literature research was conducted using PubMed and Google scholar for published abstracts, case reports, and studies from January 2020 to January 2021. We used search keywords reactive arthritis, COVID-19 pneumonia, SARS CoV2 infection, and Musculoskeletal. Descriptive analysis was used due to small sample size. Results: COVID-19 associated reactive arthritis is rarely reported. In review of literature, 10 cases were identified and we included our case of hip arthritis and avascular necrosis post COVID-19 infection. The mean age of cases (n=11) was of 42.8 years and 54.5 % of patients were males. (Table 1) The median duration of reactive arthritis diagnosis from COVID-19 infection ranged from 1 to 8 weeks. The severity of COVID-19 infection varied from mild (n= 6) to severe disease (n=2) per description in each reported case. Majority of the patients had oligoarticular involvement (2 to 4 joints) 45.5%, followed by monoarticular 36.4%, and polyarticular (> 4 joints) in 18%. Extra-articular manifestations were identified in 54.5% of patients including skin rash (erythematous itchy rash), urticarial rash, wrist tendinitis, Achilles enthesitis /tendonitis and balanitis. HLA-B27 testing was done in five patients and only one patient had a positive result. Plain radiographs were normal. Therapy provided of such cases were NSAIDS (n=4), steroids (oral, intra-articular) (n=1) or combination of steroids and NSAIDS (n=3) with favorable outcomes. The median reported follow up period ranged from 1.5 to 8 weeks. Conclusion: Reactive arthritis is a rare MSK manifestations post COVID-19 infection. HLA-B27 positive testing might indicate severe and delayed form of arthritis with risk of recurrence. Larger studies are required to delineate the potential risk factors and long-term management outcomes for reactive arthritis associated with COVID-19 infection.

Telemedicine clinic for renal transplant patients during COVID-19 pandemic

Introduction: The global pandemic of COVID-19 has been a huge challenge for health care systems with an estimated mortality rate of 1.4%. Elderly population, oncology and immunocompromised patients are at high risks with variable severity of the disease. As the data regarding COVID-19 in transplant population is emerging and new insight need to directed toward reducing the risks and embracing new health care services and standards. Sharing such experience is fundamental for other health care systems to learn, adapt and innovate during this medically demanding period. We would like to shed a light on telemedicine service and innovative ways in dealing with renal transplant recipients in a tertiary hospital in United Arab Emirates. Method: We descripted our experience in dealing with outpatient services provided for renal transplant recipients during COVID-19 pandemic (Tawam Hospital, AlAin, UAE). The transition from clinic visit to telemedicine clinics, home delivery of medications and reducing risks of COVID-19 infection among such vulnerable patients. Results: More than 200 renal transplant recipients are following up regularly in our outpatient nephrology clinics. As the number of COVID-19 infected cases is increasing in UAE, rigorous measures at local, society and international levels have been implemented to contain and overcome this pandemic. Telemedicine clinics was considered a reasonable choice to reduce the follow of the renal transplant patients to hospital where they can acquire the infection. Scheduling of the patients, sending reminders, phone communication with nephrology consultant, laboratory orders and documentation on electronic health record were allocated. Medications prescribed was delivered to the patients' home free of charge and some patients might be eligible for refill medications over 3 months. Renal transplant patients with abnormal laboratory results and/ or symptoms of respiratory infections that required medical attention will be directed to clinic or emergency visit. Pretransplantation workups were not performed. With national regulation of 'Stay At Home' Initiative, renal transplant recipients were instructed to limit exposure with other people, avoid unnecessary out home activities and some were provided medical report to perform work at home. Hand hygiene, universal mask wearing, avoidance of sick patients along with infection control measures are essential. Through humanitarian UAE efforts: personal care supplies are provided for needy patients. Patients who came from outside UAE, they required to stay at home if asymptomatic for 2 weeks with repeated COVID- 19 screening per protocol. Several hospital polices and clinical pathways were considered. Medical personnel were at front line to accommodate and embrace such changes with continues monitoring. Conclusion: Medical innovations and telemedicine has positive impact on health care provided for renal transplant recipient during COVID-19 pandemic. Adopting high standard health practices along with other infection control measures resulted in less COVID-19 infected renal transplant cases.

SAT-028 ACUTE KIDNEY INJURY ASSOCIATED WITH MIDDLE EAST RESPIRATORY SYNDROME CORONAVIRUS (MERS-CoV) INFECTION

Introduction: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection is zoonotic infection that was first identified in 2012 with high mortality rate. It is linked to camel exposure or human-to-human transmission. Clinical presentation of MERS CoV infection ranges from mild disease to septic shock with multi organ failure and death. Acute kidney injury (AKI) has been described in cohorts of MERS CoV infected patients with variable degree of severity. We studied the clinical characteristics and outcomes of AKI in MERS CoV infected patients. Method(s): Ethical approval was obtained to conduct a retrospective multicenter chart review study for MERS CoV confirmed cases in Al Ain City over 7 years period (May 2012 - May 2019). We included patients who developed AKI and studied their outcomes. Demographic, clinical and laboratory data were collected and analyzed. Result(s): A total of 58 individuals with MERS CoV infection were identified during the study period. Ten patients developed AKI and were included in the study. The mean age was 54.5 years and majority were males 8 (80%). The comorbid conditions were hypertension (5), chronic kidney disease (4), diabetes mellitus (3), ischemic heart disease (2), nephrotic syndrome (1) and dyslipidemia (2). Risk factors for MERS CoV infection included close contact with infected patient (3), camel exposure (2) and travel history to Oman (2) or Saudi Arabia (1). MERS CoV PCR was detected in nasopharyngeal aspirate (8) and sputum (2) with mean viral shedding of 13.5 days. Majority of patients 9 (90%) had severe MERS CoV infection and required critical care. AKI episodes were classified as severe stage 3 in 9 patients, and stage 2 in one patient. Mild proteinuria and hematuria were noted in urine analysis of some patients. Autoimmune workups and hepatitis serology were done for three patients and were negative. Provisional diagnosis of acute tubular necrosis due to severe sepsis and shock was considered. Imaging renal studies in all patients were negative for hydronephrosis or stones. Renal replacement therapy were needed in 7 (70%) patients and duration of range from 3 to 14 days. MERS CoV PCR was not done in urine sample. Other complications related to severe MERS CoV infection including septic shock 6 (60%), acute respiratory failure required intubation 7 (70%) or non-invasive ventilation 2 (20%), supraventricular tachycardia 2 (20%), Anemia 3 (30%), acute ischemic stroke 1 (10%), and secondary pulmonary infections (Influenza B, Klepseilla pneumonia, Staph aureus). Mortality rate was high 7 (70%) among patient with severe MERS CoV and AKI. Two patients recovered from AKI and one patient became hemodialysis dependent as he has advanced CKD at baseline. Conclusion(s): AKI is commonly associated with severe MERS CoV infection in old patients with comorbid conditions. The mortality is high with severe infection and multi organ failure. Copyright © 2020