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BackgroundSubstance use/misuse is a leading public health concern in the United States. In the midst of the COVID-19 pandemic, drug-related deaths exceeded 100,000 in a 12-month period for the first time in history. There is currently an urgent need for empirical evidence to inform community leaders and policy makers on the benefits of recovery-informed approaches to SUD prevention and treatment. The peer recovery support specialist (PRSS) is a certified professional who self-identifies as being in recovery from a substance use disorder (SUD), mental illness, or co-occurring disorder and may play an important role in positively affecting outcomes for persons with SUD. However, the evidence for PRSS services is limited in part due to methods that are ill-fitted to measure the dynamic process of recovery across time and within a complex service continuum.MethodsThis sequential exploratory mixed-methods study queried PRSS in five Central Appalachian states regarding their work roles and activities within the context of regional service networks also known as 'recovery ecosystems.'Results565 Central Appalachian PRSS respondents indicate that they frequently provide emotional support in a broad array of regional service settings but have few professional advancement opportunities. PRSS also report that their role is frequently misunderstood.ConclusionsThis study expands the existing literature providing information about training, remuneration, job satisfaction, work roles and activities within the context of existing recovery ecosystems. Inclusion of peer recovery support specialist's perspectives improved measurement of peer service delivery and should be considered when working with this vital recovery-supporting workforce.
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SESSION TITLE: Drug-Induced and Associated Critical Care Cases Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Drug-induced hepatotoxicity is a well-known occurrence from a variety of different medications. However, phenobarbital (PHB) induced hepatotoxicity has not been well studied, and acute liver injury from PHB even less so. In this case, although our patient had many reasons to develop acute liver failure, including alcohol and toluene exposure, timing and investigations seem to point to PHB being responsible. CASE PRESENTATION: Patient is a 39 y.o male with past medical history significant for hepatitis A and B, hyperlipidemia and alcohol abuse who was found unresponsive by EMS after friends reported witnessing patient drinking alcohol and sniffing paint thinner. Patient remained unresponsive on arrival and was intubated and transferred to the MICU. Patient was afebrile with BP 100/55 and otherwise normal vital signs. Significant labs on presentation included a WBC of 8.15, CO2 of 16, lactic acid of 3.6 and mildly elevated transaminases (ALT: 59, AST: 48). Urine toxicology was positive for marijuana. EKG, chest x-ray and CT Head without contrast unremarkable. COVID negative. Video EEG was negative except for generalized slowing. On hospital day 3, patient was increasingly agitated, at which point phenobarbital was started due to concerns for alcohol withdrawal. Hepatic function panel the following mornings showed significant increases in transaminases (ALT: 972 and 5,746, AST: 790 and 4,805) and total bilirubin (6.8 and 11.4), and mild increase in alkaline phosphatase (112 and 125), respectively. Hepatitis panel, acetaminophen level and salicylate level were unremarkable. RUQ ultrasound was also negative for pathology. Gastroenterology was consulted, who recommended starting NAC protocol. Phenobarbital was discontinued. Hepatic function panel the following morning showed significant improvement. Liver transplant was considered, however LFTs continued to downtrend and remainder of hospital course was unremarkable. DISCUSSION: PHB is an anticonvulsant developed primarily for seizure management. However its use has expanded to alcohol withdrawal and even sedative withdrawal. Studies have demonstrated in vitro liver toxicity as well as idiosyncratic reactions and acute liver failure in children (1) (2), with minimal documentation in adults. And while there has even been histological analysis with linkage of chronic phenobarbital use to hepatic necrosis and granulomatous formation (3), there has been minimal documentation regarding acute liver failure in an adults taking phenobarbital. CONCLUSIONS: In conclusion, it is clear that phenobarbital played a significant role in this patient's liver injury and may need to be considered in future episodes of acute liver injury with unclear etiology. Reference #1: Li AM, Nelson EA, Hon EK, Cheng FW, Chan DF, Sin NC, Ma KC, Cheung KL, Fok TF. Hepatic failure in a child with anti-epileptic hypersensitivity syndrome. J Paediatr Child Health. 2005 Apr;41(4):218-20. doi: 10.1111/j.1440-1754.2005.00591.x. PMID: 15813878;PMCID: PMC7166358. Reference #2: Roberts EA, Spielberg SP, Goldbach M, Phillips MJ. Phenobarbital hepatotoxicity in an 8-month-old infant. J Hepatol. 1990 Mar;10(2):235-9. doi: 10.1016/0168-8278(90)90058-y. PMID: 2332596. Reference #3: Di Mizio Di Mizio, G., Gambardella, A., Labate, A., Perna, A., Ricci, P., & Quattrone, (2007). Hepatonecrosis and cholangitis related to long-term phenobarbital therapy: An autopsy report of two patients. Seizure, 16(7), 653–656. https://doi.org/10.1016/j.seizure.2007.05.008 DISCLOSURES: No relevant relationships by Zachary Banbury No relevant relationships by Michael Basir No relevant relationships by Inessa Bronshteyn No relevant relationships by Kyle Foster No relevant relationships by Anna-Belle Robertson
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SESSION TITLE: Extraordinary Cardiovascular Reports SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: Hypercoagulability is a well-known complication of COVID-19, with the most common vascular events being pulmonary embolism and deep vein thrombosis (1). Arterial thrombotic events, specifically aortic thrombosis, are rarely observed in COVID-19 infections. Literature review reveals less than 10 cases of aortic thrombosis have been reported in patients with COVID-19 infection. Here, we report a unique case of acute aortic thrombosis despite administration of therapeutic anticoagulation. CASE PRESENTATION: A 77 y.o. female with no known medical history presented to the hospital after a diagnosis of COVID-19 five days prior. Upon arrival, she was hypoxic requiring supplemental oxygen via non-rebreather (NRB) mask. CT chest with contrast revealed bilateral ground-glass opacities without evidence of pulmonary embolism or aortic thrombus. She was treated with remdesivir, dexamethasone, baricitinib and enoxaparin 40mg BID (essentially therapeutic dosing based on patient's body weight of 45kg). Adequate oxygenation was maintained with nasal cannula and NRB. However, on day eight of admission she was noted to desaturate to 80% requiring BiPAP. D-dimer and CRP drastically increased from 0.36ug/ml to 1.75ug/ml and 13.0 to 102.2, respectively. Repeat CT chest with contrast revealed multiple intraluminal thrombi in the distal thoracic aorta. Treatment with clopidogrel was initiated, however patient remained BiPAP dependent. Due to DNR/DNI status, intubation was not pursued. Ultimately, patient was transitioned to comfort care and expired. DISCUSSION: Thrombotic events are poorly understood but remain a well-documented sequela of COVID-19 infection. The pathophysiology of thrombosis in COVID-19 patients has not been fully elucidated, however, it likely involves amplification of the hypercoagulable state due to viral infection. Some of the proposed theories regarding this effect include endothelial dysfunction secondary to direct virus invasion and immuno-thrombosis due to viral mediated endothelial inflammation with resultant platelet activation (2,3). Regarding COVID-19 associated arterial thrombi, myocardial infarction and stroke are the most commonly encountered events. The few reported cases of aortic thrombi occurred almost exclusively in males with significant cardiovascular risk factors and not on anticoagulation (1,3). CONCLUSIONS: Due to the increased risk of venous thromboembolic events, prophylaxis is routinely used in patients with COVID-19. However, in our case, the patient developed multiple aortic thrombi without any typical risk factors for endothelial lesions despite being fully anticoagulated. This case highlights the need for continued research and trials related to appropriate anticoagulation therapies in hospitalized patients with COVID-19. Additionally, physicians should be aware of potential arterial thrombi in patients infected with COVID-19. Reference #1: de Carranza M, Salazar DE, Troya J, et al. Aortic thrombus in patients with severe COVID-19: review of three cases. J Thromb Thrombolysis. 2021;51(1):237-242. doi:10.1007/s11239-020-02219-z Reference #2: Loo J, Spittle DA, Newnham MCOVID-19, immunothrombosis and venous thromboembolism: biological mechanismsThorax 2021;76:412-420. doi:10.1136/ thoraxjnl-2020-216243 Reference #3: Woehl B, Lawson B, Jambert L, Tousch J, Ghassani A, Hamade A. 4 Cases of Aortic Thrombosis in Patients With COVID-19. JACC Case Rep. 2020;2(9):1397-1401. doi:10.1016/j.jaccas.2020.06.003 DISCLOSURES: No relevant relationships by Chelsey Bertrand- Hemmings No relevant relationships by Alyssa Foster No relevant relationships by Kyle Foster No relevant relationships by Yelena Galumyan No relevant relationships by Veronica Jacome No relevant relationships by Viet Nguyen
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In early 2020, IAAO President Amy Rasmussen created the Artificial Intelligence Task Force with the goal of developing a white paper describing the impact and uses of artificial intelligence (AI) in government valuation offices. The COVID-19 pandemic in early 2020 forced government valuation offices to adapt overnight. Many jurisdictions rapidly virtualized tasks and duties, which accelerated ongoing efforts to utilize office automation and implement intelligent software solutions. More and more, workflows incorporating digital information and multiple sources of data are processed and analyzed using software and integrated applications. The fully integrated workflows facilitate the increased usage of AI in operations, assessment, and valuation. This white paper delivers an introduction and overview of AI through case and pilot studies and review of relevant analytic methods while touching on possible organizational impacts. The paper looks at the changing role of valuers and assessment administrators and the evolution of valuation offices where AI will be used to improve operations, value estimates, and administration. It provides illustrative examples of AI use in the conduct of tax assessment, including the administrative aspects not directly involved in valuation. While there is substantial fanfare around valuation with AI, many of the benefits to be realized from the technology are in areas of administration, validation, and oversight. This is reflected in the case studies included, with more than half involving AI applications outside of the explicit valuation function. The introduction provides a definition and brief history of AI. It also helps disentangle the raft of AI methods with how they are used and provides a concrete list of which assessment activities may benefit from those general classes of algorithms. More importantly, the first section helps put into context why AI is becoming more widespread and what that means for organizations from both staffing and administration standpoints. After the introduction’s overview of what AI is, why it has captured professional imagination, and the organizational changes it portends, we provide examples of current uses by assessing organizations and their partners. The first case study is about the Property Valuation Services Corporation’s (PVSC) foray as the first organization in Canada to publish a tax assessment roll using AI-based valuations. This case study highlights the multiyear process leading the organization to that accomplishment and the lessons it learned along the way. The second use case is a pilot study by PVSC. The section discusses the success of AI, particularly machine-learning methods, for the valuation of residential properties in the Netherlands. The third use case is from BC Assessment (BCA) and describes how valuations of manufactured homes were conducted using AI methods. For successful adoption of AI in an assessment office, this case study highlights the importance of communication and feedback from appraisers and integration of AI-modeled values with the computer-assisted mass appraisal (CAMA) system. The fourth case study comes from the City of New York and showcases applications using AI to better manage form intake and processing. Using optical character recognition (OCR), it is possible to process the volumes of senior exemption applications and condominium declaration forms received in paper and PDF formats. As with the other case examples, the results still require human oversight but provide a significant improvement over the existing process. The fifth use case also comes from the City of New York. This section discusses how geospatial data and AI methods are being integrated and leveraged to determine land use, detect building changes, and extract parcel data from images and may be used to automate data collection. This section also gives background on the geospatial data required to leverage land use and building change detection applications, which are growing increasingly familiar and important to tax assessment organ zations. The sixth application involves integrating AI-powered valuation as a feature within CAMA. To illustrate the potential of AI to automate sales-based valuation models, this study examines Tyler Technologies’ experience trying to provide an AI-powered valuation option for its users. It also clarifies the technology’s perceived limitations, which create headwinds for widespread adoption. This section ends with a discussion of international adoption of AI in property assessment offices in four African nations: Rwanda, Nigeria, Uganda, and Zambia. The full digitalization of their records and workflows using imagery and modern technology allows them to modernize their systems without going through and updating legacy records and operational processes found in more established assessment jurisdictions. Following the case studies, the reader will find a section delving deeper into the core machine learning (ML) and AI methods underpinning these applications. ML is covered in the first part of this section. Other methods discussed cover key concepts in artificial neural networks and search and optimization, which underpin virtually every AI application. Finally, the paper closes with recommendations. Key takeaways are that some tax assessment organizations and their partners are already cautiously adopting AI. The technology’s adoption will grow more widespread and touch every tax assessment organization. As such, familiarity with how it is being used, a basic understanding of what is driving these changes, and what they mean for your organization are important. © 2022 by the Author(s).
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Post-secondary education (PSE) is a vital part of civil society and any modern economy. When broadly accessible, it can enable socioeconomic mobility, improve health outcomes, advance social cohesion, and support a highly skilled workforce. It yields public benefits not only in improved well-being and economic prosperity, but also in reduced costs in health care and social services. Canada also relies heavily on the PSE sector for research. During the COVID-19 pandemic, PSE has supported research related to the pandemic response and other critical areas, including providing expert advice to support public health and government decision-making, while maintaining educational programs and continuing to contribute to local and regional economies. But the pandemic effort has stretched already strained PSE resources and people even further: for decades, declining public investment has driven increases in tuition and decreases in faculty complement, undermining Canada's research capacity and increasing student debt as well as destabilizing the sector through a growing reliance on volatile international education markets. Given the challenges before us, including climate change, reconciliation, and the pandemic, it is imperative that we better draw on the full range of experience, knowledge, and creativity in Canada and beyond through an inclusive, stable, and globally engaged PSE. Supporting PSE's recovery will be key to Canada's ongoing pandemic response and recovery. The recommendations in this report are guided by a single goal-to make the post-secondary sector a more effective partner and support in building a more equitable, sustainable, and evidence-driven future for Canada, through and beyond the COVID-19 pandemic.
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Background: DLBCL is highly heterogeneous in underlying biology and clinical behavior. Several high-risk disease features and poor prognostic factors are associated with a higher propensity for refractory disease or relapse after standard R-CHOP therapy;these subset patients require novel strategies to improve upon outcomes. Single-agent TAK-659, a novel oral SYK inhibitor, has demonstrated efficacy in heavily pre-treated DLBCL (Gordon et al., Clin Cancer Res, 2020). We report results of a phase I single institution, single arm dose escalation study that assessed safety of 1 st line treatment with R-CHOP and adjunctive TAK-659 for treatment naïve high-risk DLBCL. Methods: Patients aged ≥18 years, ECOG 0-2 with untreated stage I-IV DLBCL with high-risk features defined as, ABC/non-GCB subtype, high-intermediate or high-risk NCCN-IPI (score ≥4), MYC gene rearranged by FISH including double hit lymphoma (DHL), double expressing DLBCL (DEL;overexpression of MYC ≥40% AND BCL2 ≥50% by IHC respectively), or previously treated transformed low-grade lymphoma without prior exposure to anthracycline, were eligible. Patients were treated with R-CHOP for 1 cycle on or off study followed by combined treatment with R-CHOP and TAK-659 for an additional 5 cycles on study. TAK-659 was dosed daily with dosing escalated from 60mg (dose level 1), to 80mg (dose level 2) to 100mg (dose level 3) based on a 3+3 design. The primary objective was to determine the safety and establish the maximum tolerated dose of TAK-659 when combined with R-CHOP in the front-line treatment of high-risk DLBCL. Secondary objectives were to assess preliminary efficacy of this combination as determined by overall response rate (ORR) by PET-CT (Lugano 2014 criteria), progression free survival (PFS), overall survival (OS) and establish the pharmacokinetics of TAK-659 according to dose. Results: 12 pts were enrolled from Dec 2019 to Nov 2021. The median age was 64 yrs (range 25-75);8 (67%) had stage III/IV disease, 4 (33%) with high risk NCCN-IPI ≥ 4. Histology included 7 (58%) with de novo DLBCL (4 GCB, 3 non-GCB subtype DLBCL) including 7 (58%) with DEL, 3 (25%) with transformed FL, 1 (8%) with Richter's and 1 (8%) with DHL. Dose level 3 (100 mg) was established as the MTD. PKs were measured pre- and post-dose D1 and D15 of cycle 2;Cuzick's test signaled an increase in AUC by dose level on D1 (p = 0.01) but not on D15 (Fig 1). ORR was 100% (CR 92%;Fig 2). With a median follow-up of 14.2 months, 1 pt had primary refractory disease (ABC and DEL), 2 pts with CR subsequently progressed (1 non-GC DLBCL, 1 Richter's) and 1 died of cardiogenic shock unrelated to study drug. The 12-month PFS and OS rates were 82% and 90% respectively with estimated 18-month PFS and OS rates of 68% and 90% respectively. The most common treatment related adverse events (TRAEs) attributed to TAK-659 were lymphopenia (n=12, 100%), infection (6=, 50%), AST elevation (n = 12, 100%) and ALT elevation (n = 10, 83%) (Table). Incidence and severity of transaminitis was consistent with prior reports for this agent. Most common grade 3/4 toxicities were hematologic. Median number of cycles of TAK-659 delivered was 5 (range 3-5). TRAEs led to TAK-659 dose modifications in 8 (67%) pts, though none at dose level 1: 2 (17%) required permanent dose reductions (both for lung infections), while 5 (42%) required discontinuation (4 for infection, and 1 for febrile neutropenia). R-CHOP administration was delayed in 2 pts because of TAK-659 related TRAEs. Aside from dose modifications of vincristine for peripheral neuropathy, no additional dose modifications for R-CHOP were needed. Infections encountered included bacterial and opportunistic infections (1 each for PJP, CMV and aspergillosis) and 1 case of COVID. Growth factor prophylaxis and anti-fungal therapy were not mandated;PJP prophylaxis was advised for CD4 counts < 200 at initial diagnosis. Conclusion: TAK-659, a novel SYK inhibitor combined with R-CHOP in pts with newly diagnosed high-risk DLBCL including DLBCL transformed from follic lar lymphoma and DEL produces high CR rates;survival at 12 months appears promising. A dose of 60 mg was well tolerated, did not require dose modifications and maintained a similar AUC to the MTD of 100 mg with ongoing treatment. Opportunistic infections were noted with this treatment combination suggesting that patients should receive aggressive anti-microbial prophylaxis with future evaluation of this combination. [Formula presented] Disclosures: Karmali: BeiGene: Consultancy, Speakers Bureau;Morphosys: Consultancy, Speakers Bureau;Kite, a Gilead Company: Consultancy, Research Funding, Speakers Bureau;Takeda: Research Funding;Karyopharm: Consultancy;EUSA: Consultancy;Janssen/Pharmacyclics: Consultancy;AstraZeneca: Speakers Bureau;BMS/Celgene/Juno: Consultancy, Research Funding;Genentech: Consultancy;Epizyme: Consultancy;Roche: Consultancy. Ma: Beigene: Research Funding, Speakers Bureau;Juno: Research Funding;AstraZeneca: Honoraria, Research Funding, Speakers Bureau;Loxo: Research Funding;Janssen: Research Funding, Speakers Bureau;Abbvie: Honoraria, Research Funding;TG Therapeutics: Research Funding;Pharmacyclics: Research Funding, Speakers Bureau. Winter: BMS: Other: Husband: Data and Safety Monitoring Board;Agios: Other: Husband: Consultancy;Actinium Pharma: Consultancy;Janssen: Other: Husband: Consultancy;Epizyme: Other: Husband: Data and Safety Monitoring Board;Gilead: Other: Husband: Consultancy;Ariad/Takeda: Other: Husband: Data and Safety Monitoring Board;Karyopharm (Curio Science): Honoraria;Merck: Consultancy, Honoraria, Research Funding;Novartis: Other: Husband: Consultancy, Data and Safety Monitoring Board. Gordon: Zylem Biosciences: Patents & Royalties: Patents, No royalties;Bristol Myers Squibb: Honoraria, Research Funding. OffLabel Disclosure: TAK-659 will be discussed for the treatment of DLBCL (not FDA approved for this indication)
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Understanding the initial growth rate of an epidemic is important for epidemiologists and policy makers as it can impact their mitigation strategies such as school closures, quarantines, or social distancing. Because the transmission rate depends on the contact rate of the susceptible population with infected individuals, similar growth rates might be experienced in nearby geographical areas. This research determined the growth rate of cases and deaths associated with COVID-19 in the early period of the 2020 pandemic in Ohio, United States. The evolution of cases and deaths was modeled through a Besag-York-Molliè model with linear- and power-type deterministic time dependence. The analysis showed that the growth rate of the time component of the model was subexponential in both cases and deaths once the time-lag across counties of the appearance of the first COVID-19 case was considered. Moreover, deaths in the northeast counties in Ohio were strongly related to the deaths in nearby counties. © 2021 Selvitella et al
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Introduction: Telehealth is purported to be the wave of the future, offering improved access to care by overcoming geographical and other logistical challenges while simultaneously improving efficiencies within the healthcare system. As the global COVID-19 pandemic swept through our state, we were abruptly forced to take our burn clinic to a telehealth platform for most patients. The purpose of this study was to evaluate our experience with telehealth in managing burn wounds and other complex skin defects. Methods: A 16-item survey was developed using the framework outlined by the National Quality Forum for the development of telehealth measures. The survey was distributed to direct care providers and focused on the domains of experience and effectiveness and the subdomains of efficiency and satisfaction. Results: There were a total of 14 respondents, including physicians, allied healthcare professionals, therapists and nurses. Seventy-seven percent of participants felt that overall, the system was efficient in the 4 categories of time required for scheduling, check-in, visit conduct and care coordination. Telehealth was deemed moderately to very effective by 80% in providing the patient access to care and the provider's ability to educate the patient. However, providers, therapists and nurses uniformly found telehealth to be either not at all effective or slightly effective in assessing wounds, musculoskeletal function and developing a plan of care. When rating satisfaction with connectivity and overall quality of the clinic visit 70% of respondents were either dissatisfied/neither satisfied nor dissatisfied with the platform. Conclusions: The operational aspects of our burn clinic telehealth program implemented during the COVID-19 pandemic were found to be largely satisfactory, with the exception of connectivity issues. However, the clinical aspects of the program were found to be largely unsatisfactory and, notably, were judged to be inferior to in-person visits.
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This paper uses data from the Federal Reserve Bank of Atlanta’s 2019 Survey and Diary of Consumer Payment Choice and interim rapidresponse surveys in spring and late summer 2020 to give some insights into consumer cash holdings and payments behaviour during the COVID-19 pandemic. The paper describes several key findings from the survey, most notably that US consumers increased their cash holdings at the time of the pandemic lockdowns. More consumers held at least some cash, and almost half of consumers had more than US$100 in spring and late summer 2020, compared with one-third in autumn 2019. In spring, just onethird of consumers reported making an in-person payment, compared with almost everyone in autumn 2019. People who paid in person, however, were about as likely to use cash in the spring as they had been in the previous autumn. Payments of unemployment benefits appear to have affected cash holding for some consumers. Similar to the behaviour of some consumers in advance of hurricanes, some consumers reported getting precautionary amounts of cash. © Henry Stewart Publications,.
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SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: The coronavirus disease 2019 (COVID-19) is characterized by flu-like symptoms or complications related to pneumonia and acute respiratory distress syndrome. Later in the disease course, clinically significant thrombotic events, both venous and arterial, are being recognized. Our case describes ST elevation myocardial infarction (STEMI) as a complication of COVID-19. CASE PRESENTATION: A 38-year-old male with no medical history and non-smoker presented with 10 days of fever, cough, malaise, myalgia, and exertional dyspnea. He denied chest pain. He had completed a five-day course of azithromycin and steroids. No personal or family history of clotting disorders or heart disease. Exam revealed oxygen saturation of 89% on room air with bilateral crepitations. Chest x-ray showed bilateral patchy parenchymal airspace disease. Electrocardiogram (EKG) showed sinus tachycardia without ischemic changes. Labs showed C-reactive protein 179 mg/L and D-dimer 0.64 ug/mL. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction assay was positive. He was started on ceftriaxone, doxycycline, hydroxychloroquine, enoxaparin, and methylprednisolone. After 5 days, he was discharged on prophylactic apixaban. He returned 1 day later with substernal chest pain. EKG showed ST elevation in the inferior leads. Troponin T was 3.74 ng/mL, D-dimer 0.75 ug/mL, and coagulation profile was normal. Emergent coronary angiography revealed 100% occlusion of mid-right coronary artery and right posterolateral branch requiring extensive thrombectomy and placement of drug eluting stents. He was started on aspirin, ticagrelor, eptifibatide, high intensity statin, and metoprolol. Echocardiography revealed severe basal to mid- inferior and posterior wall hypokinesis with left ventricular ejection fraction of 40%. He was discharged on ticagrelor, apixaban, atorvastatin and metoprolol. Anti-phospholipid antibody panel testing results returned normal. DISCUSSION: It is becoming increasingly evident that SARS-CoV-2 predisposes to venous thromboembolism, but arterial thromboembolism, especially manifest as acute STEMI, is rare. A recent Dutch study of 184 ICU patients with COVID-19 demonstrated confirmed arterial thrombotic events in 3.7%.(1) The pro-coagulant pattern is characterized by increased clot strength, elevated platelet and fibrinogen contribution to clot strength, elevated D-dimer levels, and hyperfibrinogenemia.(2) In a recent case series, 67% of patients with COVID-19 undergoing coronary angiography for STEMI had obstructive coronary artery disease (CAD) with 83% requiring PTCA (3). Interestingly, none of these patients had a known prior history of CAD. CONCLUSIONS: Further discussion regarding prophylactic anti-platelet and anti-coagulation strategies in patients with COVID-19 and studies to identify risk factors for thrombotic disease is warranted. Reference #1: Kloka, F A, Kruipb M J H A, van der Meerc N J M, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis Research. 2020. doi:10.1016/j.thromres.2020.04.013 Reference #2: Ranucci, M, Ballotta, A, Di Dedda, U, et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. Journal of Thrombosis and Haemostasis. April 2020. doi:10.1111/jth.14854 Reference #3: Bangalore, S, Sharma, A, Slotwiner, A, et al. ST-Segment Elevation in Patients with Covid-19 — A Case Series. NEJM. April 17, 2020. doi: 10.1056/NEJMc2009020 DISCLOSURES: No relevant relationships by Juliann Allen, source=Web Response No relevant relationships by Aalap Chokshi, source=Web Response No relevant relationships by Kyle Foster, source=Web Response No relevant relationships by Rani Sittol, source=Web Response No relevant relationships by Matthew Tavares, source=Web Response
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We report key learning from the public health management of the first two confirmed cases of COVID-19 identified in the UK. The first case imported, and the second associated with probable person-to-person transmission within the UK. Contact tracing was complex and fast-moving. Potential exposures for both cases were reviewed, and 52 contacts were identified. No further confirmed COVID-19 cases have been linked epidemiologically to these two cases. As steps are made to enhance contact tracing across the UK, the lessons learned from earlier contact tracing during the country's containment phase are particularly important and timely.