POSITIVE SELF-PERCEPTIONS OF AGING AS PREDICTORS OF COVID-RELATED PREVENTIVE BEHAVIOR AND RESILIENCE

Individuals have faced extraordinary challenges throughout the COVID-19 pandemic. Psychosocial strengths may promote individuals' resilience during this time. Positive self-perceptions of aging (SPA) have been found to predict a variety of health and well-being indicators. We examined SPA as a predictor of COVID-19-related behavior, adaptation, and resilience in a sample of 3,620 adults (Mage=65.88;61.1% women;65.4% white) from the 2016 and 2020 waves of the Health and Retirement Study. Linear regression results revealed that more positive SPA in 2016 was associated with more preventative health behavior (β=.03, p=.04), a higher likelihood of staying at home (β=.07, p<.001), less worry (β=-.27, p<.001), less stress (β=-.24, p<.001), less loneliness (β=-.27, p<.001), and greater resilience (β=.20, p<.001) during the first year of the pandemic (2020). Associations held after controlling for demographic covariates. Findings support SPA theories, suggesting linkages between SPA and adaptive behaviors and outcomes in the face of external challenges.

CAN THE SYSTEMIC IMMUNE-INFLAMMATION INDEX, THE NEUTROPHIL-LYMPHOCYTE RATIO, AND THE PLATELET-LYMPHOCYTE RATIO HELP ASSESS PROGNOSIS OF SARS-COV-2 PNEUMONIA?

SESSION TITLE: Late Breaking Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: To identify the association between SII, NLR and PLR and the prognosis in SARS-CoV-2 pneumonia. METHODS: A cross-sectional study that took place in Tacuba General Hospital, Mexico City. Adults hospitalized with SARS-CoV-2 infection were included. Descriptive statistic was made using Mann-Whitney's U test. Spearman’s Rank correlation coefficient was calculated. The risk of invasive mechanical ventilation (IMV) and mortality was calculated for each index with logistic regression. The analysis was made using the STATA 14.0 program. RESULTS: The current analysis included 295 subjects, 64% men. There was difference in SII and NLR levels between subjects who died and those who did not. Females with acute respiratory distress syndrome had a positive correlation for each index and length of stay: for SII rs=0.739;for NLR rs=0.689;for PLR rs=0.649. Males had weak correlations. The risk of IMV with SII exceeding its cutoff value had an odds ratio of 2.50 (95% CI 1.38-4.51);a higher risk for IMV with NLR above its reference was detected (OR 2.34, 95% CI 1.36-4.05). Also, the elevated SII and NLR levels had an increased risk of mortality;for SII an OR 2.54 (95% CI 1.55-4.15);for NLR an OR 2.16 (95% CI 1.35-3.46). Statistical significance was considered with p=<0.05. CONCLUSIONS: These indexes are an accessible and low-cost tool that can help assess the prognosis of patients hospitalized for SARS-CoV-2 pneumonia. CLINICAL IMPLICATIONS: The SII, NLR and PLR could be useful in identifying patients at risk of death or severe illness who require invasive mechanical ventilation in the earlier phase of SARS-CoV-2 pneumonia. As these indexes are easily quantified from blood sample data, they can reflect the body’s immune status and help assess the prognosis of SARS-CoV-2 pneumonia. DISCLOSURES: No relevant relationships by Amaury Bravo Rodríguez No relevant relationships by JAVIER FIESCO PIÑA No relevant relationships by José Antonio García Cuéllar No relevant relationships by Ruben Antonio Gomez Mendoza No relevant relationships by Damayanty Gomez villanueva No relevant relationships by Karen Hopf Estandía No relevant relationships by Eduardo León Guadarrama No relevant relationships by Alma Daniela Martinez Carrillo No relevant relationships by José Peña Ramírez No relevant relationships by José Pérez Nieto No relevant relationships by Mariela Rosas García No relevant relationships by Fernando Sánchez Mata No relevant relationships by Damayanty Solis Contreras

A RARE CASE OF HISTOPLASMA CAUSING OBLITERATION OF THE SUPERIOR VENA CAVA AND SUBSEQUENT DEVELOPMENT OF COLLATERAL CIRCULATION

SESSION TITLE: Critical Cardiovascular Disorders SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: Physicians are educated on the traditional pathways of sanguineous return of the head and neck through the superior vena cava (SVC). There are known causes of disruption of this system such as SVC syndrome and malignancy causing compression, delayed transit or invasion of these vessels. While compensatory angiogenesis is not a new concept, it has been primarily documented in cases involving coronary artery circulation or congenital heart defects. Here, we present a rare case of the development of left-sided collateral flow in lieu of a right sided SVC with connection to the IVC as a complication of histoplasma infection. CASE PRESENTATION: Our patient was a 67-year female with a past medical history of histoplasmosis, asthma and diabetes who presented with a chief complaint of shortness of breath. Shortly following admission, she was diagnosed with COVID19. In the course of her diagnostic evaluation, she was noted to have significant abnormalities of her thoracic vasculature. More specifically, she had developed calcified granulomas that included a large old calcified granuloma of her right hilum that caused a complete obliteration of her SVC and right middle lobe airways. Her right middle lobe airways had evidence of chronic scarring with development of left sided collateral circulation. Her collateral flow went through her innominate vein into her azygos system and from there into her inferior vena cava and back to her heart. DISCUSSION: It is well established in the literature that histoplasma can lead to scarring and granulomatous changes within lung parenchyma. Our case is unique in the location where the patient developed a granuloma. The close proximity to the SVC over time led to the complete obliteration of the vessel and as a compensatory mechanism her body developed collateral circulation to the left side via her azygous vein and IVC. While we were unable to find similar cases in the literature specifically caused by histoplasma, other phenomena have led to the development of collateral circulation within the lungs. Specifically, Genta et. al. published a case report of an acute pulmonary vein occlusion leading to the development of collateral circulation through the patients' bronchial veins and into the azygous & hemiazygos system similar to our patient. One of the clinical implications for this patient during her hospitalization was the severity of her illness with COVID19. She did require treatment in the intensive care unit. This prompted a discussion among the treatment team regarding developing a plan of action for central line placement should this patient have required vasopressor support. CONCLUSIONS: This case stresses the importance of understanding primary anatomy in order to comprehend potential variants and predict future consequences for patients. It also highlights how sequela of chronic conditions can impact treatment plans. Reference #1: Yu CH, Chen MR. Clinical investigation of systemic-pulmonary collateral arteries. Pediatr Cardiol. 2008 Mar;29(2):334-8. doi: 10.1007/s00246-007-9086-y. Epub 2007 Sep 18. PMID: 17876652. Reference #2: Schaper W. Development of the collateral circulation: History of an idea. Exp Clin Cardiol. 2002 Fall;7(2-3):60-3. PMID: 19649224;PMCID: PMC2719163. Reference #3: Genta PR, Ho N, Beyruti R, Takagaki TY, Terra-Filho M. Pulmonary vein thrombosis after bilobectomy and development of collateral circulation. Thorax. 2003 Jun;58(6):550-1. doi: 10.1136/thorax.58.6.550. PMID: 12775876;PMCID: PMC1746717. DISCLOSURES: No relevant relationships by Alessandra Carrillo No relevant relationships by Chetachi Odelugo No relevant relationships by Shil Punatar No relevant relationships by Ravi Sundaram

PREDICTING FACTORS OF PROLONGED MECHANICAL VENTILATION AFTER ENDOVASCULAR TREATMENT IN LARGE VESSEL OCCLUSION STROKE

Background and aims: Intensive Care Units(ICUs) are a necessary resource for many patients with large vessel occlusion stroke(LVOS) after endovascular treatment(EVT). However, ICUs have a limited availability of beds and ventilators, situation that has been worsened by the current Covid-19 pandemic. We analyze predicting factors for prolonged mechanical ventilation(PMV) after EVT in patients with LVOS. Methods: Retrospective study of patients admitted to our stroke center from 2012-2019 for LVOS who were treated with EVT. We identified patients that required PMV(defined as >24h intubation with admission in ICU) after EVT, and evaluated the association with clinical and radiological factors on admission. Results: N=438. 236(53.9%) women. Mean age 69(DE 14.6). 411(93.8%) anterior circulation stroke, 27(6.2%) posterior. 82(19%) required general anesthesia and intraprocedural intubation, and 47 of them(10.7%) required PMV. Median length of stay(LOS) in ICU: 3 days(1-7). 12/47(25.5%) had prolonged LOS for another reason (6 neurological worsening, 4 hemodynamic instability, 1 respiratory infection, 1 no available beds at Stroke Unit). 19/47(44%) died and 22/47(52.4%) were functionally dependent at three months. Factors associated to a higher risk of PMV after EVT were: basilar occlusion (OR=12.3, IC95%[5.3-28.4],p<0,001);ASPECTS ≤7 (OR=3, IC95%[1.4-6.1],p=0,003) and NIHSS ≥18 (OR=2.8, IC95%[1.3- 5.8],p=0,006). Patients with PMV had a higher risk of mortality (OR=6.5, IC95%[3.3-12.8],p<0,001) and functional dependence (OR=5.1, IC95%[2.4-1],p<0,001) at three months. Conclusions: In our study, patients with basilar occlusion, high NIHSS and lower ASPECTS had higher probability of requiring PMV after EVT, which also led to worse outcome. These are aspects to consider in scenarios with limited availability of ICU beds.

Communication strategies on risk and disaster management in South American countries

Planned communication is widely recognized as a fundamental tool for risk and disaster management (RDM). This study aimed to analyze the communication strategy of RDM systems in the context of seven Spanish-speaking countries of South America (sscSA), specifically: Argentina, Bolivia, Colombia, Chile, Ecuador, Paraguay, and Peru. This involved the review of 29 documents related to RDM planning. This study is part of a larger research project called Integral communication system in critical events which have previous results already published. The computerassisted qualitative data analysis methodology was used to analyze the textual corpus. The qualitative analysis was complemented with statistical models such as principal component analysis and hierarchical cluster analysis. A total of 203 ideas for good communication were identified and classified into five components: i) early communication planning, ii) information and communication system management planning, iii) communication and communicator quality management planning, iv) RDM awareness raising, and v) stakeholder consolidation. Ecuador, Chile and Paraguay correlated mostly with pre-disaster communication. Colombia and Bolivia correlated with communication during a disaster. While post-disaster communication was not well represented in sscSA planning.

Integrated Lean BPM model to increase customer loyalty in a last-mile courier

With the accelerated growth of online shopping, especially as a result of the Covid 19 pandemic, concern about offering a good quality delivery service has also grown. This has increased competition in this sector from the emergence of new proposals such as Uber or Rappi, which is why Courier companies are having problems maintaining the loyalty of their customers. It is important then, to differentiate yourself and a good way to do it is by improving the management of non-conforming orders, since several studies indicate that if you sell online, you must be prepared to receive an average returns ratio of 20% of the products depending on the sector. A good way to improve this process is with the application of the lean philosophy to eliminate activities that do not generate value, in conjunction with the BPM methodology to have a better global control of the process, identify repetitive activities and determine the relevant KPIs for the company. That is why this paper proposes a model with the application of these 2 methodologies to improve customer loyalty in a courier company. The implementation of the proposed model and its improvements were simulated using the software Arena and compared with the initial situation. The results showed the effectiveness of the method, reducing the service time of non-compliant orders by 37%. In addition, an increase in customer loyalty is expected taking it up to 60.81%. © 2022 ACM.

ANALYSIS OF STATE TWEETS POSTED IN 2020, DURING COVID-19, IN SOUTH AMERICA WITHIN THE FRAMEWORK OF PUBLIC HEALTH

Communication as an essential component for risk management receives renewed interest with the Sendai Framework for Disaster Risk Reduction 2015-2030 and the recent COVID-19 pandemic. The research aim was to analyze the most relevant factors of the communication issued by the Ministries of Health of eight Spanish-speaking countries in South America on Twitter, one of the most important social networks today. Particularly: a) an exploratory analysis of 40,082 tweets was carried out by detecting word communities;b) the communicational behavior was contrasted in the analyzed countries;c) the individual and collective communication behavior of these countries was analyzed in different stages of the pandemic in 2020;d) significant relationships between reported issues and the evolution of positive cases due to COVID-19 in 2020 were analyzed. Consequently, this study allowed the detection of 18 communication issues linked to the pandemic, such as the containment of the virus or communication in the face of deficiencies in the pandemic response system. In addition, it allowed to highlight some positive aspects such as early communication, communicational flexibility, inclusive communication or communication redundancy. © 2021 by the authors

Experiences in Developing and Testing BBC Micro: Bit Games in a K-12 Coding Club during the COVID-19 Pandemic

The COVID-19 pandemic has changed the traditional teaching and learning process, moving students' educational hands-on activities carried out in the classroom to home activities that include the use of online tools. Here we describe an after-class online coding club conducted for a month, where elementary (primary) school students programmed and tested games running on the BBC Micro: bit microcontroller board. By developing gaming mini-projects, the students learned computing topics such as logic, sensors, random number generation, game development and programming, and how small physical computing mini-projects were conducted. In this paper, we describe how students and an instructor developed and tested games made for the Micro: bit, running an online simulator and physically using the Micro: bit at home. The paper shows lessons learned on developing games with the BBC Micro: bit in the coding club, and challenges that students encountered in the game development with the BBC Micro: bit. Future work includes multisensory educational gaming projects with the BBC Micro: bit. © 2021 IEEE.

Optimal Anticoagulant Dosing in Patients with COVID-19, a Retrospective Review

Background Hospitalized patients with coronavirus disease 2019 (COVID-19) infection have higher rates of venous thromboembolism (VTE).Higher mortality rates have been reported in severe cases of COVID-19 including those who have elevated D-dimer levels and have thromboembolic phenomena. Objective The objective of this retrospective and observational study was to ascertain which type and dosages of anticoagulation provide a mortality benefit and decrease the risk of developing VTE. Methods We evaluated the risk factors for VTEs in patients with a confirmed polymerase chain reaction test positive for COVID-19 who were admitted to our facility from April 1 to July 1, 2020. In addition, we performed a logistic regression to examine the relationship between mortality and intensive care unit (ICU) admission, specific risk factors outlined in the study, D-dimer, ferritin, prothrombin time (PT) and international normalized ratio (INR). Patients with a history of VTE, those already on anticoagulation (AC) prior to hospitalization, and patients on comfort care were excluded from study. Results There were originally 331 patients in the data set. Of those, 111 patients were excluded based on exclusion criteria and 4 additional patients were removed as they were the only individual patients in their specific AC covariant group. The analysis was performed on the remaining 216 patients. We divided the AC medications administered to the patients into five separate covariates: 1. enoxaparin 40 mg subcutaneous (sq) daily, 2. enoxaparin 40 mg sq every 12 hours (q12h), 3. heparin 5000 mg sq q12h, 4. heparin 5000 mg sq every 8 hours (q8h), 5. Patients taking multiple AC or deep venous thrombosis (DVT) prophylaxis medications. 6. No AC and examined them via logistic regression for mortality at 28 days and 60 days (Table 1). Patients in enoxaparin 40 mg daily group had statistically significant lower 28 day mortality. There was no statistically significant relationship between the use of enoxaparin 40 mg q12h and 28 day mortality rate. Patients in both heparin groups did not have significantly lower 28 day mortality rates. Patients in groups 5 & 6 had significantly higher 28 day mortality rates (Table 1). It is important to note that 33 patients underwent a pulmonary computed tomography angiography due to concern for pulmonary embolism and 38 patients underwent an ultrasound of their lower extremities to rule out the development of DVT. For patients with additional risk factors defined as chronic kidney disease, chronic obstructive pulmonary disease, organ transplant recipient, obesity (BMI > 30), cardiac disease (heart failure, coronary artery disease or cardiomyopathy), sickle cell disease, diabetes mellitus and smoking history, the odds of death at 28 days increased by a factor of 1.71, at 60 days by a factor of 1.63 and being admitted to the ICU by a factor of 1.41. Patients with 3-5 risk factors are 2.48 times more likely to be admitted to the ICU than patients with 0-2 risk factors. Patients with 4 or 5 risk factors are 3.56 times more likely to be admitted to the ICU than patients with 0-3 risk factors (Table 2). Predictably, patients that were admitted to the ICU had a significantly increased rate of mortality compared to those who were not (Table 3). Per our analysis, there was no relationship between PT or INR and mortality. At 28 days and 2 months, the D-dimer > 4000 was indicative of a higher odds of death versus patients with a D-dimer < 4000. An increased ferritin was also indicative of a higher mortality rate (Table 4). Conclusion Patients receiving enoxaparin 40 mg daily benefited more than any other AC regimen with respect to the development of VTE at both 28 days and 2 months. Increasing the dosing to twice daily did not decrease mortality. Additionally, patients receiving heparin did not have a decreased mortality. It is important to note that there was no standard protocol used to determine which patients received daily or twice daily dosing. The type and dose of AC was determined based on the clinical judgment of int nsivists in each case. It is also possible that patients with severe COVID-19 infection were more likely to be given twice daily dosing which could account for the lack of mortality benefit with more frequent dosing. We did not report bleeding rates in AC groups in our study and this can be a possible reason for no mortality benefit among higher dose AC groups. [Formula presented] Disclosures: No relevant conflicts of interest to declare.

Influence of vitamin d status on the prognosis of COVID 19 in patients with kidney transplant

Purpose: The protective role of Vitamin D as an immunomodulator has been demonstrated in different pathologies included the viral etiology. This effect has been described by different mechanisms among these acting as an immunoprotein inducer, participates in growth and cell differentiation and acts as a mediator of apoptosis. Some evidence suggests that it could influence the SARS-COV 2 infection and its prognosis. Kidney transplant (KT) patients are more susceptible to 25 (OH) VitD (Calcidiol) deficiencies. The purpose of this study is to evaluate the Vitamin D status in transplant patients who have been diagnosed with COVID-19 and its possible correlation with prognosis. Methods: It is an observational, retrospective, cross-sectional and descriptive study that includes kidney transplant patients diagnosed with COVID-19 and with serum 25 (OH) Vit D Results: 79 patients were evaluated. The mean age was 58 years, 60.8% were men. 86% were KT, 11% were simultaneous pancreas and kidney transplant (SPK). 39 (48%) presented neumonia, 22 (28%)flu-like syndrom. 14 (17%) asyntomatic and 2(2,5%) fever. From this patients 39,2% had not changes in the antiinflamatorie therapy, 20.3%, required increased dose of corticosteroids, and 30.4% required methylprednisolone bolus or initiation of anti-interleukin therapy. The mean of Vit D was 21.41+/- 11% we found that 52% has Vit D <20 ng/ dl. 25% between 20 -30 ng / dl and 21,51% > 30 ng / dl In 32 patientes who required intensification of treatment we found that 73% had Vit D levels <20 ng. 11 patients need an citical care unit, of these 62.5% had levels below <20 ng / dl. There were 12 deaths. 66% of deaths had vitamin D values <20 ng / dl. Conclusions: We were able to observe that vitamin D levels could influence in the prognosis of SARS-COV 2 infection. Vitamin D deficiency was found in a high percentage of transplant patients with COVID 19. Low levels of 25 OH Vit D were evidenced in patients who required greater intensification of antiinflamatory treatment and in deaths.

[Multiple cerebral haemorrhages secondary to disseminated intravascular coagulation in a patient with COVID-19]. / Hemorragias cerebrales múltiples secundarias a coagulación intravascular diseminada en un paciente con COVID-19.

TITLE: Hemorragias cerebrales múltiples secundarias a coagulación intravascular diseminada en un paciente con COVID-19.

PMU12 How Are Quarantine Impacting on the Health-Related Quality of Life?

Objectives: In order to limit the spread of Covid-19, many countries, Spain included, have implemented unprecedented restrictions, such as quarantines, curfew, isolation, school closings, restricted opening hours in stores, business closures, etc. On March 15th 2020, the Spanish government implemented “nationwide lockdown” (general curfew) for at least the end of April. The impact of such measures on the (HR)QoL of the general public is unknown. Our study aim was assed the changes of utilities through quarantine in Spain. Methods: We implemented a quota based online survey starting previous of lockdown with two follow-ups within the curfew using EQ-5D-5L (rounds sample size was 500 adults). For each round, we asked HRQoL, Age, gender and region. Results comparing the pre-quarantine survey and the two first in-quarantine surveys were analyses overall and stratified by age, sex and prevalence information of Covid-19 by region from government sources. This information was compared with previous data from the national health survey conducted in 2011-2012 as a “normal situation” information. Results: Sample size was representative of Spanish population by age, gender and region. Slightly less than half of the respondents were female (47.78%). Elderly respondents were 13.3%, 40-60 age responders were43.1% and less 40 years responders were 43.6%. 26% of respondents resided in more affected regions (300 cases per 100.000 hab.). Non-significant results were found when comparing the evolution of HRQL over the different follow-ups within the quarantine period. About 50% of participants reported Anxiety/depression (AD) problems. Females reported more AD problems than males. The percentage of population reporting AD problems in a “normal situation” is 15%. Conclusions: Our results shown that while there is no evidence supporting a decrease of HRQL over the quarantine period. However, there is a clear decrease when comparing with a normal situation.

Impact of the COVID-19 pandemic on the organisation of stroke care. Madrid Stroke Care Plan. / Impacto de la pandemia de COVID-19 en la organización asistencial del ictus. Plan Ictus Madrid.

INTRODUCTION: The overload of the healthcare system and the organisational changes made in response to the COVID-19 pandemic may be having an impact on acute stroke care in the Region of Madrid. METHODS: We conducted a survey with sections addressing hospital characteristics, changes in infrastructure and resources, code stroke clinical pathways, diagnostic testing, rehabilitation, and outpatient care. We performed a descriptive analysis of results according to the level of complexity of stroke care (availability of stroke units and mechanical thrombectomy). RESULTS: The survey was completed by 22 of the 26 hospitals in the Madrid Regional Health System that attend adult emergencies, between 16 and 27 April 2020. Ninety-five percent of hospitals had reallocated neurologists to care for patients with COVID-19. The numbers of neurology ward beds were reduced in 89.4% of hospitals; emergency department stroke care pathways were modified in 81%, with specific pathways for suspected SARS-CoV2 infection established in 50% of hospitals; and SARS-CoV2-positive patients with acute stroke were not admitted to neurology wards in 42%. Twenty-four hour on-site availability of mechanical thrombectomy was improved in 10 hospitals, which resulted in a reduction in the number of secondary hospital transfers. The admission of patients with transient ischaemic attack or minor stroke was avoided in 45% of hospitals, and follow-up through telephone consultations was implemented in 100%. CONCLUSIONS: The organisational changes made in response to the SARS-Co2 pandemic in hospitals in the Region of Madrid have modified the allocation of neurology department staff and infrastructure, stroke units and stroke care pathways, diagnostic testing, hospital admissions, and outpatient follow-up.