Respiratory Outcomes in COVID-19 patients 3-6 months after admission to Public Health Hospital Maciel. Montevideo, Uruguay. A Follow up Cohort Study

To date, millions of people worldwide have recovered from COVID19, but concern remains on long-term impairment. We aimed to determine 3-6 months respiratory outcomes in a Latin American Public Health Hospital. Method(s): COVID-19 patients referred (April-June 2021,gamma variant breakdown) were enrolled, recalling epidemiology, demographic, comorbidities, laboratory, radiology, treatment and outcomes, performing spirometry, lung volumes, diffusing capacity (DLCO), walking test (6MWT);values< 80% of predicted were considered abnormal. Logistic regression analysis were performed to evaluate covariates associated with DLCO abnormality. Result(s): 56 patients followed 6 months make up the cohort. 56,9 +/- 13,0 years, 58,9% female,46,4% ever smokers, 42,9% obesity (BMI >30), 37,5% hypertension, 23,2% diabetes, 16,1% heart disease, 16,1% asthma. 64% dyspnea (MRC>1), 50% fatigue, sit to stand Sp02% 94,7 +/- 3,9. Lymphocites103 /muL 413,3 +/- 625,7,D-dimer ng/ml 3050,9 +/-7226,1,ferritin ng/ml 641,8 +/- 1173,4, 21.4% radiology abnormality, 35.7% admitted to ICU, days stay 17,1 +/- 10,5. 3 vs 6 months: TLC 5,3 +/- 1,9 vs 5,16 +/- 2,3 p=0.05;FVC 3,10 +/- 0,9 vs 3,16 +/- 1,0 p=0.04;DLCO:17,2 +/- 6,0 vs 17,8 +/- 6,2 7 p=0.006;Sp02% in 6MWT 90,1 +/- 98,2 vs 91,1 +/- 3,6 p=0.05. 6 months: dyspnea 28.6%, fatigue 26.8%, abnormality in: FVC 12,5%,FEV1 16,1%,DLCO 58,9%,distance 6MW 28,6%. Abnormal DLCO correlations: age > 65 p=0.02,smoking p=0.04,heart disease p=0.04,dyspnea MRC>1 p=0.002, persistent fatigue p=0.05. Conclusion(s): At 6 months some COVID-19 patients maintain symptoms and impaired DLCO and are the main target for further follow up and intervention.

Pandemic, tourism, and the economy: a tourism-revenue target zone approach

The COVID-19 pandemic has negatively affected the tourist markets of many countries. This study develops a small, open macro model of tourism to analyze the price and revenue effects of establishing tourism target zones on tourism revenue in response to industry disturbances resulting from the pandemic. Such target zones improve tourism revenue and stabilize the economy by stabilizing tourism goods prices and exchange rates when domestic or foreign demand is strong and regardless of whether national borders are open. A tourism goods price subsidy can be employed to revitalize the tourism industry and improve tourism revenue after the pandemic. © 2023 City University of Hong Kong and National Taiwan University.

Private health insurance consumption and public health-care provision in OECD countries: Impact of culture, finance, and the pandemic

In this paper, we investigate private health insurance (PHI) spending in Organization for Economic Co-operation and Development (OECD) economies for the period 2000–2020, with a focus on the impact of financial, cultural, and health-environment factors. PHI consumption is positively associated with financial development and cultural–social–economic factors, such as income, education, individualism, uncertainty avoidance, and long-term orientation, whereas it is negatively associated with public health spending, masculinity, indulgence, and power distance. In addition, factors related to the health environment, such as the COVID-19 pandemic, have a negative influence on PHI consumption in the selected OECD economies owing to losses in income. Our findings can serve as guidance for consumers and recommendations for health insurers and policymakers in designing health insurance policies and programs in developed and developing countries. © 2022 Elsevier Inc.

PLASMAPHERESIS FOR HYPERTRIGLYCERIDEMIA-INDUCED PANCREATITIS

SESSION TITLE: Critical Renal and Endocrine Disorders Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: About 7% of acute pancreatitis (AP) cases are caused by hypertriglyceridemia (HTG). In such cases bowel rest, IV fluids, symptomatic therapy, and triglyceride (TG) lowering interventions are initiated. Plasmapheresis is one of the treatment options, but it has specific indications. We present a case of severe hypertriglyceridemia-induced pancreatitis that required plasmapheresis. CASE PRESENTATION: A 30 y/o man with type 2 diabetes, hyperlipidemia, multiple previous admissions for HTG-AP, presented with severe abdominal pain, nausea, and vomiting x 1 day. On admission, he was tachycardic, hypotensive, afebrile, SpO2 > 96% on RA. Labs: Glu 491 mg/dL, TG > 1000 mg/dL, Cholesterol 509 mg/dL, Lipase 987 U/L, Cr/BUN 2.4 mg/dL /20 mg/dL, VBG pH 7.25/PCO2 36.2 mmHg/PO2 19.4 mmHg/Ca 0.8/lactate 5.6;WBC 13.07 K/cm;COVID PCR positive. CXR: diffuse patchy opacities. CTAP with contrast was deferred because of AKI. He was admitted to the ICU and started on insulin drip with no improvement over 24hrs. He was still acidotic, Ca persistently low, TG still >1000, and kidney function worsened. Plasmapheresis was initiated. After one session his TG lowered to 700. He was restarted on insulin drip and in the next 24hr TG decreased to < 500 and metabolic acidosis resolved. Once AKI resolved, CT abdomen/pelvis with contrast confirmed acute pancreatitis, with focal hypodensities within the uncinate process and the proximal body, concerning infarcts as well as large phlegmon surrounding the pancreas, but no evidence of necrotizing or hemorrhagic pancreatitis. His hospital course was complicated with sepsis and DVT, which resolved with therapy. He was discharged home with TG lowering agents, Apixaban, and his previous T2DM regimen. DISCUSSION: Plasmapheresis is indicated in patients with severe HTG (>1000- 2000 mg/dl), severe HTG-AP, and when standard treatment options are inadequate. It lowers the lipid levels and removes proinflammatory markers and cytokines stopping further inflammation and damage to the pancreas and other organs faster compared to conservative therapy. Most patients need only one session which lowers TG level by 50-80%, as seen in our patient. CONCLUSIONS: Plasmapheresis should be considered in cases of HTGP with worrisome features such as lactic acidosis, hypocalcemia, worsening inflammation, and multi organ failure. Reference #1: Rajat Garg, Tarun Rustagi, "Management of Hypertriglyceridemia Induced Acute Pancreatitis", BioMed Research International, vol. 2018, Article ID 4721357, 12 pages, 2018. https://doi.org/10.1155/2018/4721357 Reference #2: Pothoulakis I, Paragomi P, Tuft M, Lahooti A, Archibugi L, Capurso G, Papachristou GI. Association of Serum Triglyceride Levels with Severity in Acute Pancreatitis: Results from an International, Multicenter Cohort Study. Digestion. 2021;102(5):809-813. doi: 10.1159/000512682. Epub 2021 Jan 21. PMID: 33477149. Reference #3: Gavva C, Sarode R, Agrawal D, Burner J. Therapeutic plasma exchange for hypertriglyceridemia induced pancreatitis: A rapid and practical approach. Transfus Apher Sci. 2016 Feb;54(1):99-102. doi: 10.1016/j.transci.2016.02.001. Epub 2016 Feb 20. PMID: 26947356. DISCLOSURES: No relevant relationships by Adam Adam No relevant relationships by Moses Bachan No relevant relationships by Chen Chao No relevant relationships by Vaishali Geedigunta No relevant relationships by Zinobia Khan No relevant relationships by Jelena Stojsavljevic

TUBERCULOUS PLEURAL EFFUSION MASQUERADING AS DRUG-INDUCED LUPUS

SESSION TITLE: Critical Care Presentations of TB SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: TNFα plays a pivotal role in inflammation and maintenance of immune response against tuberculosis. The use of TNF inhibitors (TNFi) is associated with a significant increase in the incidence of tuberculosis (TB). TNFi may cause drug-induced lupus (ATIL) presenting as constitutional symptoms, rashes, pericardial and pleural effusions with positive autoantibodies. We present a case of pleural TB masquerading as drug-induced lupus. CASE PRESENTATION: A 68y/o woman with a history of ulcerative colitis (on infliximab, mesalamine), hypertension, T2DM, CAD, complained of low-grade fever, rashes, left-sided chest pain, dyspnea, and arthralgias for two weeks. Chest pain- worse with inspiration and cough. She emigrated from India to the USA 40 years ago. Six months before infliximab therapy, Quantiferon gold was negative. Exam: faint hyperpigmentation over shins, minimal swelling of MCPs and ankles, dullness to percussion over the left chest with decreased breath sounds. Labs: CRP 101 mg/dL, Hb 10.8 iron deficient, rheumatoid factor and anti-CCP negative, ANA 1:40, dsDNA 1:640, a reminder of ENA negative, anti-histone negative, C3/C4 normal, UA bland, protein/Cr 0.4 mg/gm, negative blood cultures, SPEP and LDH normal. CXR: opacification of the left lung up to midfield. CT chest: moderate left and small right pleural effusions, enlarged mediastinal lymph nodes. COVID and Quantiferon: negative. Thoracentesis: 850 ml of exudative fluid (2 out of 3 Light's criteria), lymphocytic predominance (76% of 4148 nucleated cells), adenosine deaminase (ADA) 42 U/L, gram stain, culture, acid-fast and MTB PCR negative, cytology negative. Thoracoscopy with biopsy of the parietal pleura: necrotizing granulomatous pleuritis with acid-fast bacilli. Sensitivity: pan-sensitive M. tuberculosis. Sputum: negative for TB. She was discharged on RIPE treatment for reactivation of TB. DISCUSSION: The incidence of infliximab-induced lupus is approximately 0.19% and confirming the diagnosis is challenging. The immunogenicity of infliximab is high, 66% of patients develop positive ANA. Anti-histone antibodies are less commonly associated with ATIL as opposed to classic drug-induced lupus and dsDNA is positive in up to 90% of cases of ATIL. Renal involvement is rare. The diagnostic usefulness of ADA (over 40 U/L) in lymphocytic pleural effusions for the diagnosis of tuberculosis in an immunosuppressed individual is demonstrated here. In countries with low TB burden, such as the USA, the positive predictive value of ADA in pleural fluid declines but the negative predictive value remains high. CONCLUSIONS: Tuberculous pleuritis is not always easily diagnosed since AFB smears and sputum may remain negative. When ADA level in lymphocytic pleural fluid is not low thorough search for TB with thoracoscopy and biopsy is justified. Reference #1: Shovman O, Tamar S, Amital H, Watad A, Shoenfeld Y. Diverse patterns of anti-TNF-α-induced lupus: case series and review of the literature. Clin Rheumatol. 2018 Feb;37(2):563-568. Reference #2: Benucci, M., Gobbi, F. L., Fossi, F., Manfredi, M. & Del Rosso, A. (2005). Drug-Induced Lupus After Treatment With Infliximab in Rheumatoid Arthritis. JCR: Journal of Clinical Rheumatology, 11 (1), 47-49. Reference #3: Valdés L, San José ME, Pose A, Gude F, González-Barcala FJ, Alvarez-Dobaño JM, Sahn SA. Diagnosing tuberculous pleural effusion using clinical data and pleural fluid analysis A study of patients less than 40 years-old in an area with a high incidence of tuberculosis. Respir Med. 2010 Aug;104(8):1211-7. DISCLOSURES: No relevant relationships by Adam Adam No relevant relationships by Moses Bachan No relevant relationships by Chen Chao No relevant relationships by Zinobia Khan No relevant relationships by Milena Vukelic

Improve Chit-Chat and QA Sentence Classification in User Messages of Dialogue System using Dialogue Act Embedding

In recent years, dialogue system is booming and widely used in customer service system, and has achieved good results. Viewing the conversation records between users and real customer service, we can see that the user's sentences are mixed with questions about products and services, and chat with customer service. According to the experience of professionals, it is helpful in improving the user experience to mix some chats in customer service conversations. However, users' questions are expected to be answered, while chatting is expected to interact with customer service. In order to produce an appropriate response, the dialogue system must be able to distinguish these two intentions effectively. Dialog act is a classification that linguists define according to its function. We think this information will help distinguishing questioning sentences and chatting sentences. In this paper, we combine a published COVID-19 QA dataset and a COVID-19-topic chat dataset to form our experimental data. Based on the BERT (Bidirectional Encoder Representation from Transformers) model, we build a question-chat classifier model. The experimental results show that the accuracy of the configuration with dialog act embedding is 16% higher than that with only original statement embedding. In addition, it is found that conversation behavior types such as "Statement-non-opinion", "Signal-non-understanding" and "Appreciation" are more related to question sentences, while "Wh-Question", "Yes-No-Question" and "Rhetorical-Question" questions are more related to chat sentences. © 2021 ROCLING 2021 - Proceedings of the 33rd Conference on Computational Linguistics and Speech Processing. All rights reserved.

Recommendations for the respiratory follow-up of patients with pulmonary complications due to COVID-19: Chair of Pulmonology, Faculty of Medicine, UDELAR Uruguayan Society of Pulmonology. (Pautas nacionales para la atenci..n de pacientes adultos con COVID-19.) [Spanish]

The objectives of this study were to Identify patients who require follow-up to prevent and treat medium- and long-term pulmonary sequelae of COVID-19. Based on the analysis of this evidence and the SEPAR (17), BTS (18) and NICE Guidelines (19) Consensus Guidelines, the following recommendations were drawn up with the aim of providing criteria for the clinical management of this new respiratory entity associated with SARS-CoV-2 infection.

A RARE CASE OF MYOPERICARDITIS IN POST-COVID-19 PNEUMONIA

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Myopericarditis is inflammation of pericardium and myocardium caused by inflammatory and non-inflammatory etiologies. COVID-19 is known to cause multiple organ complications, including cardiovascular. Cases of myopericarditis have been reported, and believed to be one of the culprits of death in this disease. We present a case of myopericarditis in the setting of post-COVID-19 pneumonia CASE PRESENTATION: 56-year-old female with history of hypertension, hyperlipidemia, insulin-dependent type 2 diabetes and COVID-19 pneumonia (requiring hospitalization and nasal canula oxygenation one month prior, received 5 days of Remdesivir and 10 days of Dexamethasone);presented with four days of substernal pain, radiating to right neck and chest. On the day of admission, electrocardiogram (ECG) was sinus rhythm without ST changes and troponin was negative two times. During hospitalization, patient had episodes of fever with increased intensity of chest pain. Repeated ECG showed ST elevation in lead I, aVL, V3-V6 with ST depression in lead III;and significantly elevated troponin and pro-BNP. Echocardiogram showed mild diffuse hypokinesis with regional variations, slightly reduced left ventricular ejection fraction and normal right ventricle size and function. Patient was started on heparin drip, and underwent emergency left heart catheterization that demonstrated non-obstructive CAD. Cardiac MRI was inconclusive for late gadolinium enhancement due to respiratory motion artifact, but biventricular global hypokinesis and small pericardial effusion were evidenced. Patient persistently had high fever and elevated inflammatory markers (CRP was 406 mg/dL) despite on antibiotics, hence empiric methylprednisolone and IVIG were started. She was planned to get endomyocardial biopsy, however she improved symptomatically with concurrent decreased of inflammatory markers and troponin. Repeat echocardiogram showed normal biventricular function. Patient was discharged from the hospital after 6 days of hospitalization with cardiology and rheumatology follow up. DISCUSSION: Manifestations of myopericarditis are varied, from fatigue and shortness of breath, to severe chest pain and chest tightness. Some patients may develop right-sided heart failure, or even fulminant myocarditis with sepsis. Interestingly, manifestations may occur weeks after recovery from COVID-19. Elevations of both troponin and pro-brain natriuretic peptide (pro-BNP) are expected, but ECG may not show ST changes. Echocardiogram may show thickening of the wall, dilatation, and pericardial effusion. Gold standard for diagnosing myocarditis is endomyocardial biopsy (EMB), as recommended by AHA. However, practice is limited due to expertise requirement, risk of contagious spread, and false-negative rate. CONCLUSIONS: Differential diagnosis should always include myopericarditis in acute coronary syndrome, especially after viral infection. REFERENCE #1: Zeng J.-H., Liu Y.-X., Yuan J. First case of COVID-19 infection with fulminant myocarditis complication: case report and insights. Published online April 10. Infection. 2020. REFERENCE #2: Siripanthong B, Nazarian S, Muser D, Deo R, Santangeli P, Khanji MY, Cooper LT, Chahal AA. Recognizing COVID-19–related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm. 2020 Sep;17(9): 1463–1471. REFERENCE #3: Inciardi R.M., Lupi L., Zaccone G., Italia L., Raffo M., Tomasoni D. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19) JAMA Cardiol. 2020;5:819–824. DISCLOSURES: No relevant relationships by Chen Chao, source=Web Response No relevant relationships by Nahla Shihab, source=Web Response No relevant relationships by Milena Vukelic, source=Web Response

Non-traded goods, firm dynamics and wages in a service economy

By considering the term-of-trade and volume-of-trade effects, Jones (2012) examines the distributive effect in a competitive economy with non-traded goods. This paper reexamines the effect in an imperfectively competitive economy with firm dynamics. A rise in foreign demand can generate revenue and also mitigate market distortion, whereas skilled-unskilled wage inequality can be magnified or mitigated via the effect on firm entry or exit. Thus, how to achieve the trade-off among growth, inequality and the environment becomes an important task for government decision-makers, especially so during the pandemic of Covid-19. © 2021 Elsevier Inc.

Epithelial-mesenchymal transition induced by SARS-CoV-2 required transcriptional upregulation of Snail

The engagement of human angiotensin-converting enzyme 2 (hACE2) and SARS-CoV-2 spike protein facilitate virus spread. Thus far, ACE2 and TMPRSS2 expression is correlated with the epithelial-mesenchymal transition (EMT) gene signature in lung cancer. However, the mechanism for SARS-CoV-2-induced EMT has not been thoroughly explored. Here, we showed that SARS-CoV-2 induces EMT phenotypic change and stemness in breast cancer cell model and subsequently identified Snail as a modulator for this regulation. The in-depth analysis identifies the spike protein (S), but not envelope (E), nucleocapsid (N), or membrane protein (M), of SARS-CoV-2 induces EMT marker changes. Suppression of Snail expression in these cells abrogates S protein-induced invasion, migration, stemness, and lung metastasis, suggesting that Snail is required for SARS-CoV-2-mediated aggressive phenotype in cancer. This study reveals an important oncogenic role of SARS-CoV-2 in triggering breast cancer metastasis through Snail upregulation.