AAPOS Pediatric Uveitis Committee: COVID-19-infection, inflammation, and challenges in children with noninfectious uveitis

Purpose/Relevance: Pediatric cases of COVID-19 have increased in the setting of the highly transmissible delta variant which has impacted the care of children by ophthalmologists. Inflammatory ocular manifestations of acute COVID-19 infections have been observed and are important to recognize and expeditiously manage. Further, ocular involvement has been recognized in MIS-C. Finally, new challenges in treating and monitoring patients with non-infectious uveitis (NIU) evolved. Guidance is needed regarding immunosuppression, reducing clinic visits/in-hospital exposures while maintaining disease control, and vaccination. Target Audience: Pediatric ophthalmologists, fellows, residents. Current Practice: Ocular inflammatory manifestations are reported in children during or after symptomatic or asymptomatic COVID-19 infection and may go unrecognized. Guidelines for managing children with NIU on immunosuppressive treatment (IMT) continues to evolve, and updated information is needed. Best Practice: Knowledge of ocular manifestations of acute and post-infectious COVID-19 including Multisystemic Inflammatory Syndrome in Children (MIS-C) will improve clinical care of children. Patients may present with conjunctivitis, optic neuritis, transient myasthenia-like syndrome, acute anterior uveitis, keratitis, pan-uveitis and papilledema. Ophthalmic management often involves systemic work-up and coordination of care amongst a multidisciplinary team. Consensus guidelines for monitoring uveitis and preventing COVID-19 infection in children with NIU on IMT may be applied to clinical practice. Expected Outcomes: Clinicians will develop an understanding of (1) Ophthalmic manifestations of acute and post-infectious COVID-19 infection and MIS-C (2) Challenges and strategies to manage NIU during a pandemic (3) Updates on infection risk and vaccination strategies for children on IMT. Format: Didactic, case presentations, rheumatology, ophthalmology panel discussion with audience participation. Summary: COVID-19-related ocular manifestations such as conjunctivitis, uveitis, pan-uveitis and optic neuritis are rare but are important to recognize. Children with NIU on IMT represent a unique patient population balancing ophthalmic follow-up and control of ocular/systemic disease and preventing infection.Copyright © 2022

Vaccine hesitancy educational tools for healthcare providers and trainees: A scoping review.

In the era of vaccine hesitancy, highlighted by the current SARS-CoV2 pandemic, there is an acute need to develop an approach to reduce and address apprehension towards vaccinations. We sought to map and present an overview of existing educational interventions for healthcare providers (HCPs) on strategies to engage in effective vaccine discussion. We applied the Joanna Briggs Institute methodology framework in this scoping review. We searched five relevant databases (MEDLINE, CINAHL, EMBASE, PsycInfo, and SCOPUS) and grey literature through the Google search engine using keywords and subject headings that were systematically identified. We identified 3384 citations in peer-reviewed literature and 41 citations in grey literature. After screening for our inclusion criteria, we included 28 citations from peer reviewed literature and 16 citations from grey literature for analysis. We identified a total of 41 unique education interventions. Interventions were available from multiple disciplines, training levels, clinical settings, and diseases/vaccines. Interventions predominantly centered around two foci: knowledge sharing and communication training. Most interventions identified from peer-reviewed literature were facilitated and were applied with multiple modes of delivery. Interventions from grey literature were more topical and generally self-directed. We identified several gaps in knowledge. Firstly, accessibility and generalizability of interventions was limited. Secondly, distribution of interventions did not adequately address nursing and pharmacy disciplines, and did not cover the breadth of medical specialties for whom vaccine discussions apply. Thirdly, no interventions addressed self monitoring and the clinicians' recognition and management of emotions during difficult conversations. There is a need to address this gap and provide available, credible and comprehensive educational interventions that will support our healthcare providers in effective communication with vaccine hesitant patients.

A CASE OF GRANULOMATOSIS WITH POLYANGIITIS

SESSION TITLE: Critical Systemic Disease Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Granulomatosis with polyangiitis(GPA) is an autoimmune small vessel vasculitis that is included in the group of anti-neutrophilic cytoplasmic antibody(ANCA)- associated small vessel vasculitides (AAVs). GPA is a systemic disease, however acronym ELK is used to describe the most common involvement of Ear, nose, throat, Lungs, and Kidneys. We report a case of GPA, highlighting its presentation. CASE PRESENTATION: 59-year old female presented with vaginal bleeding, malaise, blurry vision, non productive cough and shortness of breath few days after receiving COVID-19 vaccine. Physical exam was remarkable for bilateral conjunctival injection with right sided ptosis and inguinal lymphadenopathy. Laboratory findings were significant for acute kidney injury and anemia. Computed tomography (CT) of chest revealed bilateral bronchovascular nodules and masses with interlobular septal thickening and enlarged mediastinal lymph nodes. Fine needle aspiration of left inguinal lymph node was negative for malignancy. Bronchoscopy with bronchial brush revealed alveolar hemorrhage with capillaritis;bronchoalveolar lavage(BAL) showed hemosiderin laden macrophages. Tissue biopsy was negative for malignancy. Testing for pulmonary renal syndrome was positive for C-ANCA and proteinase-3 (PR-3) antibodies. Anti-GBM antibody and anti-MPO antibody was negative. Plasmapheresis (PLEX) and pulse dose steroids were initiated however the patient was unable to tolerate the treatment. Her clinical condition continued to decline requiring multiple pressors, broad spectrum antibiotics and continuous renal replacement therapy. She was transitioned to comfort care per family's wishes and passed away. DISCUSSION: GPA is a rare necrotizing granulomatous vasculitis of small to medium sized vessels that can affect any organ but mainly involves the upper and lower respiratory tract. Necrotizing glomerulonephritis is common. Pulmonary involvement can include consolidation, tracheal or subglottic stenosis, diffuse alveolar hemorrhage, pleural effusion and interstitial lung disease. Lymphadenopathy, as seen in our patient is a rare presentation. Tissue biopsy is crucial for the diagnosis. Association with PR-3 ANCA is seen in more than 80% of GPA patients. Cases of AAVs after administration of COVID vaccine have been reported in the literature, although it is difficult to demonstrate causal relationship. Treatment of GPA with immunosuppression, usually corticosteroids, rituximab or cyclophosphamide, is recommended. The role of PLEX continues to evolve with emerging data, but use of this therapy is reasonable for patients with severe kidney injury and DAH secondary to active vasculitis refractory to immunosuppressive therapy. CONCLUSIONS: Early diagnosis of GPA is challenging as it can mimic metastatic lung malignancy. It should be considered in a broad range of differentials when evaluating patients presenting with pulmonary nodules. Reference #1: Greco A, Marinelli C, Fusconi M, Macri GF, Gallo A, De Virgilio A, Zambetti G, de Vincentiis M. Clinic manifestations in granulomatosis with polyangiitis. Int J Immunopathol Pharmacol. 2016 Jun;29(2):151-9. doi: 10.1177/0394632015617063. Epub 2015 Dec 18. PMID: 26684637;PMCID: PMC5806708. Reference #2: Kitching, A. R., Anders, H. J., Basu, N., Brouwer, E., Gordon, J., Jayne, D. R., Kullman, J., Lyons, P. A., Merkel, P. A., Savage, C., Specks, U., & Kain, R. (2020). ANCA-associated vasculitis. Nature reviews. Disease primers, 6(1), 71. https://doi.org/10.1038/s41572-020-0204-y Reference #3: Szymanowska-Narloch, A., Gawryluk, D., Błasińska-Przerwa, K., & Siemińska, A. (2019). Atypical manifestations of granulomatosis with polyangiitis: the diagnostic challenge for pulmonologists. Advances in respiratory medicine, 87(6), 244–253. https://doi.org/10.5603/ARM.2019.0062 DISCLOSURES: No relevant relationships by Sean Davidson No relevant relationships by Eric Flenaugh No relevant relationships by Marilyn Foreman No relevant relationships by KOMAL KAUR No relevant relationships by Gabriela Oprea-Ilies

Remote ischaemic conditioning: defining critical criteria for success-report from the 11th Hatter Cardiovascular Workshop.

The Hatter Cardiovascular Institute biennial workshop, originally scheduled for April 2020 but postponed for 2 years due to the Covid pandemic, was organised to debate and discuss the future of Remote Ischaemic Conditioning (RIC). This evolved from the large multicentre CONDI-2-ERIC-PPCI outcome study which demonstrated no additional benefit when using RIC in the setting of ST-elevation myocardial infarction (STEMI). The workshop discussed how conditioning has led to a significant and fundamental understanding of the mechanisms preventing cell death following ischaemia and reperfusion, and the key target cyto-protective pathways recruited by protective interventions, such as RIC. However, the obvious need to translate this protection to the clinical setting has not materialised largely due to the disconnect between preclinical and clinical studies. Discussion points included how to adapt preclinical animal studies to mirror the patient presenting with an acute myocardial infarction, as well as how to refine patient selection in clinical studies to account for co-morbidities and ongoing therapy. These latter scenarios can modify cytoprotective signalling and need to be taken into account to allow for a more robust outcome when powered appropriately. The workshop also discussed the potential for RIC in other disease settings including ischaemic stroke, cardio-oncology and COVID-19. The workshop, therefore, put forward specific classifications which could help identify so-called responders vs. non-responders in both the preclinical and clinical settings.

Teaching Translation and Interpreting in Virtual Environments

Interest in online teaching and learning has grown rapidly since the start of the global COVID-19 pandemic. As universities across the world decided to transfer their teaching provision online, translation and interpreting (T&I) educators faced the daunting task of delivering their courses effectively in this new mode. Common challenges included: designing and administering suitable assessments, ensuring student engagement, and fostering peer collaboration and interaction. Research in the field of online and distance learning provides a rich source of information to address these challenges, and yet, it remains underexplored despite its potential to inform and enhance T&I teaching practices. We introduce this special issue by presenting some fruitful research areas that could provide new directions for T&I pedagogy and improve our students' remote learning experiences in the future. It is against this backdrop that the special issue was conceived. Contributions cover teaching translation and interpreting at a distance, and contextual issues and trends resulting from the act of teaching T&I online. © 2021 University of Roehampton. All rights reserved.

Allelic variation in class I HLA determines CD8(+) T cell repertoire shape and cross-reactive memory responses to SARS-CoV-2

[Figure: see text].

Emergency presentations of colorectal cancer during the COVID 19 Era

Aims: COVID19 has reduced the ability to provide red flag investigations for colorectal patients. The aim of this study is to assess the number of emergency presentations of new colorectal malignancies during the COVID19 era and if there is an increase in palliative cases. Methods: A retrospective review of all patients presenting to unscheduled care with a new diagnosis of colorectal malignancy from 31st March 2020-25th January 2021 in a single UK Trust. An institutional data base and electronic care records were used to review patient demographics, management and curative intent. Data points for the same period in 2019-2020 were recorded for comparison. Results: 45 patients were diagnosed with new colorectal malignancy during an unscheduled admission to hospital within the study timeframe. 22% (10/45) presented in January 2021. 29 diagnosed during the same time interval 2019-2020. Median age at presentation was 77.5 and 79 respectively. 40% (18/45) of patients in 2020-2021 proceeded to emergency surgery, compared to 58% (17/29) in 2019-2020 (P = 0.12). 10.3% (3/29) of 2019-2020 patients were managed with colonic stenting. This increased in 2020-2021 to 17.8% (8/45) (P = 0.38). 77.8% (35/45) patients in 2020/2021 presented at a palliative stage of disease compared to 62.1% (18/29) in 2019-2020 (P = 0.15). Conclusions: Overall the data has not shown a statistically significant difference in patients presenting as an emergency with new colorectal malignancy. However, there was a rise in admissions noted in January 2021;should this trend continue, alongside the persistent pressures of COVID19, ongoing research is needed to assess the true impact.

Colonic stenting in colorectal malignancy-a single centre 3 year review

Aim/Background: Colonic stent insertion is a minimally invasive management option for patients requiring colonic decompression in colorectal malignancy (CRC). Acute colonic obstruction is a common presentation in patients with CRC, and approximately 20% present with distant metastases. Emergency primary resection carries increased morbidity and mortality and decreases likelihood of primary anastomosis. Our objective was to review the use of colorectal stents, examine survival in the palliative setting and determine interval time to surgery. Methods: A retrospective institutional review of all patients undergoing colonic stenting in a single centre between January 2018 and January 2021 was carried out. Data was retrieved from an institutional database search and patient follow up obtained from up to date regional care records. Results: A total of 58 patients were identified, 50 of which underwent attempted stenting for a colonic malignancy, with a 92% success rate. Median age 81.5years (54-95), 60.8% male and median follow up time 545 ± 353 days. Thirty three (64.8%) were performed in the emergency setting. Thirteen patients underwent stenting as a bridge to surgery, with median time interval 20 days (2018/2019) and 30.5 days (2020/2021). Thirty-three patients underwent stenting with palliative intent, with a median survival time of 96 days. There were no major stent related complications or mortality. Conclusion: Colonic stents offer an alternative management pathway in obstructed colorectal malignancies, in both the palliative and curative setting. Our study has illustrated high success rates, with no major complications seen. COVID-19 has expectedly impacted the length of time to surgery following stent insertion.

A Systems Thinking Methodology for Studying Prevention Efforts in Communities

The turn to complexity in public health over the past 20 years has come as practitioners, policy makers and scholars lament the lack of progress in addressing wicked problems such as obesity, chronic disease and the social determinants of health. Systems science may be well suited to tackle such wicked problems. While there is a growing application of systems thinking tools and resources in public health, there are fewer examples that incorporate both systems tools and systemic inquiry processes. Prevention Tracker offered an opportunity to trial the combination of systems tools and systems thinking at the level of community chronic disease prevention efforts. Our methodology comprised four Domains of Inquiry. 1. Describing a prevention system 2. Guiding system change efforts 3. Monitoring change 4. Cross case comparison. We applied systems tools and methods to investigate each domain of inquiry such as group model building, social network analysis, graphic illustration, causal loop diagrams and system action learning. These methods were connected through the application of systemic inquiry processes that elevated the ongoing interrogation of boundary judgments, awareness of diverse and multiple perspectives, interrelationships and the importance of social learning. Prevention Tracker demonstrated that it is possible to apply a range of systems methods while also keeping focus on the overall systems science and the need for theoretical consistency. The four domains of inquiry enabled flexibility to adapt our approach in each context to learn and improve. This methodological capacity to learn and adapt may also be useful in tackling other health and social problems, such as the COVID19 pandemic. The overall findings from the study will be presented in separate publications. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.