[SARS-CoV-2 antibodies after booster vaccination. Identification of subgroups with poor response]. / Anticuerpos contra el SARS-CoV-2 tras la dosis de vacuna de recuerdo. Identificación de subgrupos con respuesta insuficiente.

Objective: To determine which patients within the high-risk group are most likely to have insufficient post-vaccination immunity. Methods: Determination of IgG titers against SARS-CoV-2 after the booster dose. Vaccine response was categorized as negative (IgG titers < 34 BAU/ml), indeterminate (titers 34 - 259 BAU/ml) or positive (≥ 260 BAU/ml). Results: 765 patients were included (31.25% of those vaccinated). 54 (7.1%) on treatment with biologics, 90 (11.8%) with hematologic disease, 299 (39.1%) with oncologic pathology, 304 (39.7%) with solid organ transplant and 18 (2.4%) with immunosuppression for other reasons. 74 patients (9.7%) had negative serology and 45 (5.9%) had indeterminate titers. By diagnostic group, the patients with the highest proportion of negative or indeterminate serology were patients with biologic treatment (55.6%, mainly at expense of antiCD20), hematologic (35.4%) and transplant patients (17.8%, mainly lung and kidney). Oncology and other immunosuppressed patients had a favorable response to vaccination. Conclusion: Patients treated with antiCD20 drugs, hematologic patients and transplanted patients (mainly lung and kidney) have a higher risk of not achieving post-vaccination immunity. It is essential to identify them in order to individualize and optimize their management.

Competitive cause of death in elderly breast cancer survivors

Background: Breats cancer is a major health problem in elderly ( >= 70 years) women. Increase incidence with age and the progressive increase in life expectancy mean that the numbers in elderly breast cancer diagnosis are increasing. These patients do not always receive the proper treatment and despite this the survival of this population is not always depends on cancer, there are other competing causes of death typical of the aging population. Method(s): A retrospective observational analysis of women >= age 70 diagnosed with breast carcinoma in HUPHM between 2014 and 2020 was made. Clinical, pathological data and stages at diagnosis were analyzed. We checked our patients with the national death center (official national registry) thus obtaining an exact date of death and the cause of death. Data updated in January 2023 , ensuring a minimum follow-up of 24 months. We excluded deaths from Covid or of unknown cause to avoid bias. Result(s): A total of 421 patients were analyzed, mean age of 78.6 years and median follow-up of 48 months. 28% of patients had died at the time of analysis, 11% due to cancer and 17% from other causes. If we analyze the population deceased by cancer, no deaths are detected in patients diagnosed with carcinoma in situ (4% of the population), in stage I (30% of the population) the cumulative incidence of cancer death at 5 years is 3%, 7% In stage II (30% of the population), 15% in stage III (16%) and 70% in stage IV (12%). Death by other causes are more frequent in early breast cancer, the cumulative incidence at 5 years are 10% in stage I, 22% in stage II, 44% in satge III and just 10% in stage IV. The most frequent causes of death in this population were caridovascular events and infections. There are no differences in 5-year mortality according to histological subtypes 20%, 12%, 25% and 12% for triple negative, Rh+/HER2-, RH+/her2+ and RH-/HER2+ respectively. Conclusion(s): Although elderly patients do not receive optical treatments, mortality from cancer in early stages is incidental at 5 years, a different scenario is seen in metastatic disease in which the patient's prognosis depends mainly on the oncological disease, Therefore, an effort should be made in the treatment of these patients with metastatic breast cancer since adequate treatments can have a clearly positive impact on the survival of patients. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.Copyright © 2023

SARS-COV-2 antibodies after booster vaccination. Identification of subgroups with poor response Anticuerpos contra el SARS-COV-2 tras la dosis de vacuna de recuerdo. Identificación de subgrupos con respuesta insuficiente

Objective To determine which patients within the high-risk group are most likely to have insufficient post-vaccination immunity. Methods Determination of IgG titers against SARS-CoV-2 after the booster dose. Vaccine response was categorized as negative (IgG titers < 34 BAU/ml), indeterminate (titers 34–259 BAU/ml) or positive (≥260 BAU/ml). Results 765 patients were included (31.25% of those vaccinated). 54 (7.1%) on treatment with biologics, 90 (11.8%) with hematologic disease, 299 (39.1%) with oncologic pathology, 304 (39.7%) with solid organ transplant and 18 (2.4%) with immunosuppression for other reasons. 74 patients (9.7%) had negative serology and 45 (5.9%) had indeterminate titers. By diagnostic group, the patients with the highest proportion of negative or indeterminate serology were patients with biologic treatment (55.6%, mainly at expense of antiCD20), hematologic (35.4%) and transplant patients (17.8%, mainly lung and kidney). Oncology and other immunosuppressed patients had a favorable response to vaccination. Conclusion Patients treated with antiCD20 drugs, hematologic patients and transplanted patients (mainly lung and kidney) have a higher risk of not achieving post-vaccination immunity. It is essential to identify them in order to individualize and optimize their management.

SARS-COV-2 antibodies after booster vaccination. Identification of subgroups with poor response.

OBJECTIVE: To determine which patients within the high-risk group are most likely to have insufficient post-vaccination immunity. METHODS: Determination of IgG titers against SARS-CoV-2 after the booster dose. Vaccine response was categorized as negative (IgG titers < 34 BAU/ml), indeterminate (titers 34-259 BAU/ml) or positive (≥260 BAU/ml). RESULTS: 765 patients were included (31.25% of those vaccinated). 54 (7.1%) on treatment with biologics, 90 (11.8%) with hematologic disease, 299 (39.1%) with oncologic pathology, 304 (39.7%) with solid organ transplant and 18 (2.4%) with immunosuppression for other reasons. 74 patients (9.7%) had negative serology and 45 (5.9%) had indeterminate titers. By diagnostic group, the patients with the highest proportion of negative or indeterminate serology were patients with biologic treatment (55.6%, mainly at expense of antiCD20), hematologic (35.4%) and transplant patients (17.8%, mainly lung and kidney). Oncology and other immunosuppressed patients had a favorable response to vaccination. CONCLUSION: Patients treated with antiCD20 drugs, hematologic patients and transplanted patients (mainly lung and kidney) have a higher risk of not achieving post-vaccination immunity. It is essential to identify them in order to individualize and optimize their management.

Prospective study of pulmonary embolism in patients with SARS CoV-2 pneumonia with high levels of D Dimer

Pulmonary embolism (PE) is common among hospitalized adults with SARS CoV-2 pneumonia. D-dimer (DD)>1 mug/mL has been found to be a severity risk factor. However, most of the studies are based on retrospective data and the real prevalence is unknown Objectives: To evaluate the prevalence of PE in patients with SARS CoV-2 pneumonia, regardless clinical suspicion. Demographic and laboratory data, comorbidities, and clinical outcomes were compared between patients with and without PE Methods: Single-center prospective study. All consecutive cases of SARS CoV-2 pneumonia with DD>1 mug/mL underwent computed tomography pulmonary angiography Results: 179 patients (64 (55-74 years), 65% male) were included. PE was diagnosed in 71 patients (39.7%), mostly with a peripheral location and low thrombotic load (Qanadli score 10%). We did not find disparity in PE prevalence between men and women, and between obese and not obese patients. There were no differences in the intensive care unit admission rate. Mortality rate was 8.5% in patients with PE vs. 3.7% in those without PE, but the differences were not significant. Patients with PE had more history of cardiovascular disease and required more fractional inspired oxygen. DD, platelet distribution width (PDW), neutrophil-lymphocyte ratio (NLR), DD-lactate dehydrogenase ratio (DD/LDH), and DD-ferritin ratio values were significantly higher among PE patients. ROC analysis showed that PDW and DD/LDH had the greatest area under the curve Conclusion(s): Patients with SARS CoV2 pneumonia and DD>1mug/mL presented a high prevalence of PE, regardless of clinical suspicion. PDW, NLR, DD/LDH and DD/Ferritin may help to identify patients with high risk of PE.

Guillain-Barre syndrome associated with SARS-CoV-2 infection: A case series from 4 Colombian cities during the pandemic

SARS-CoV-2 infection has been associated with multiple neurological manifestations. One such manifestation, which has been described since the early stages of the COVID-19 pandemic and is relevant for current neurological practice, is Guillain-Barre syndrome (GBS). The literature describes neurotoxic mechanisms of the virus itself and the possible pathways by which it may affect the peripheral nerves in experimental studies;however, we still lack information on the mechanisms causing the immune response that gives rise to GBS in the context of SARS-CoV-2 infection. Colombia is one of the Latin American countries worst affected by the pandemic, with the third-highest number of cases in the region;thus, it is essential to recognise GBS, as this potential postinfectious complication may severely compromise the patient's functional status in the absence of timely diagnosis and treatment. We present a series of 12 cases of GBS associated with SARS-CoV-2 infection from hospitals in 4 different Colombian cities and describe the clinical presentation, laboratory and electrophysiological study findings, and treatment.Copyright © 2022 Sociedad Espanola de Neurologia

AN INNOVATIVE PROTOCOL FOR THE DEVELOPMENT AND EVALUATION OF THE TEAMWORK COMPETENCY IN VIRTUAL ENVIRONMENTS

Under COVID scenario, it has been observed that the constraints derived from remote teaching makes harder an already challenging task: the achievement of teamwork skills and their assessment. This study, which is part of the UPC-ICE "EQUIPA'T” teaching innovation project, aims to design a new protocol for the development of academic projects and the individualized evaluation of university students regardless the field of knowledge within engineering. To that end, eight functionalities have been identified: (i) quantification of the individual contribution;(ii) group dynamics and individual roles;(iii) internal team management;(iv) communication;(v) creativity (brainstorming/concept map);(vi) design thinking;(vii) repository;(viii) content development (previous ideas about concepts). For each of them, a series of indicators, activities, and tools have been defined to allow the development of the aforementioned functions in face-to-face and remote environments. In addition, an analysis has been carried out to determine the implementation of the protocol by professors in the pilot stage of the project. © 2022 by the authors. Licensee AEIPRO, Spain.

Evolution of pancreatic ductal adenocarcinoma diagnosis during the last decade

Background: Pancreatic Ductal Adenocarcinoma (PDAC) has historically been an important diagnostic and therapeutic challenge. The multidisciplinary approach and new diagnostic techniques' implementation have modified this process. Method(s): We conducted a retrospective analysis based on clinical data of patients with PDAC between the years 2010 to 2021, analyzing the diagnosis and initial treatment evolution. Result(s): 673 patients between 2010-2021 with a suspected diagnosis of pancreatic adenocarcinoma were reviewed. Most of them were metastatic (n=362;53.8%), followed by locally advanced unresectable (n=166;24.7%) and resectable or borderline resectable (n=145;21.5%). Regarding the pathological diagnosis, it was not possible in 62 patients (9.2%), varying over time from 21.2%in 2010-2012 to 1% in 2019-2021 (p<0,0001). Moreover, the number of biopsies has decreased with a mean number of biopsies to obtain a pathological diagnosis of 1.55 (2010-2012) vs 1.31 (2019-2021). During this last period, most of the diagnoses were made by cytological analysis (61.4%;n=121). Specifically in the 2019-2021 patients subgroup, we found that 18 NGS (9,1%) were performed in this period (solid tumor), with 4 patients having actionable mutations (22.2%;3 KRAS G12C). Germline (g) mutational panels were carried out in 89 patients, finding only 9 positive cases (10.1%), being 3 of them gBRCA1/2 mutated (3,4%). In our study, a decrease in palliative management was evidenced over time. In 2010-2012, 28,8% of patients received exclusively palliative care against 9,6% in 2019-21 (p, 0.0001). An increase in PDAC diagnosis was observed since 2010, 44 patients/year in 2010-12 vs. 66 patients/year in 2019-21 (including COVID-19 pandemic period). All previous results are summarized. Conclusion(s): The diagnosis of PDAC has changed throughout the last decade, increasing the percentage of patients with a pathological diagnosis without increasing the number of invasive procedures. The number of patients suitable for anti-cancer therapy has also increased among time. In our cohort, the implementation of molecular testing would change the therapeutic approach in more than 20% of patients.

Term placenta transcriptomic atlas identifies cells with discrete transcription programs implicated in gestational diabetes subtypes

Objective: Single-cell RNA-sequencing (scRNA-seq) and spatial transcriptomics have identified novel cell subtypes and microenvironments which compartmentalize diverse functions at the maternal-fetal interface. We aimed to combine these high-resolution technologies with a rigorous classification of transcription alterations associated with diabetes subtypes in pregnancy. We hypothesized characteristic transcriptome profiles in specific cell populations would be linked to these classifications. Study Design: We clinically validated gestational diabetes mellitus type 1 (GDMA1), GDMA2, and type 2 diabetes (T2DM) classes within a cohort of placentae and compared them to healthy controls by bulk RNA-seq (N=53). We then integrated our non-diabetic term placentae spatial transcriptomics data (N=12) with 273,944 publicly available transcriptomes from term placenta scRNA-seq or single-nuclei RNA-seq (snRNA-seq) datasets (accessions phs001886, GSE173193, EGAS00001002449) with control, GDM, or SARS-CoV-2 positive subjects to create a placental transcriptomic catalog. Result(s): In bulk, we identified 104 significantly differentially expressed transcripts (-2< log2fold-change >2,p< 0.05) in our GDMA1 samples, 102 with GDMA2, and 121 with T2DM (Fig. 1a). Comparisons revealed 88 transcripts uniquely marking GDMA1, 68 for GDMA2, and 85 for T2DM, while FGA and CYP1A1 perturbations were shared across diabetes classes (Fig. 1b). We then compared these bulk GDM subtype markers with the 5,211 significantly differentially expressed transcripts associated with 22 cell-type clusters in our term placenta atlas (Fig. 2), and 20 unique GDM bulk markers aligned with extravillous trophoblast, stromal, endometrial epithelia, endothelial, NK, and dendritic single-cell placental markers. Conclusion(s): Together, these results detail the gene expression profiles and the cell types in the maternal-fetal milieu of pregnancies affected by diabetes. Consistent with their distinct clinical outcomes, GDM and T2DM have unique cellular transcriptomes and would thus be targets for new therapeutics. [Formula presented] [Formula presented] Copyright © 2022

Exploring How Engineering Students Respond to Challenges While Working in Global Virtual Teams

This Research Full Paper aims to understand student experiences on global virtual teams in depth by exploring the challenges that students face, how they approach them, and how they assess their response to overcoming these challenges. During the COVID-19 pandemic, intercultural learning opportunities such as study abroad were limited, and many universities implemented global virtual team projects as an alternative approach to developing intercultural skills. Prior research of these programs has focused on identifying best practices, challenges, and learning outcomes, but has provided few insights into students' experiences in these projects. To explore these experiences, we collected written reflections from 65 students participating in global virtual team projects in the middle and at the end of the semester. We analyzed these data using a thematic analysis approach. We identified three main types of challenges that students experienced: group cohesion, communication, and project management. Students approached these challenges by making changes at the personal and the team level. Most notably, students tended to take a positive view of their approaches to addressing the challenges by suggesting that they found a solution, had a positive learning experience, or identified skills they wanted to improve in future projects. The results of this study can inform the design of global virtual project courses and encourage conversations about team conflict and how to address it while working in virtual cross-cultural environments. © 2022 IEEE.

Antibiotic Prescription in COVID Intensive Care Unit (ICU): Empiric Treatment vs. FilmArray Pneumonia (FAP) Panel Guided Treatment

Background. The empiric prescription of antibiotics in COVID 19 ICU patients is frequent due to the severity of disease and presentation of patients with septic shock. In this study we compared two approaches of antimicrobial prescription: empiric use vs. FilmArray pneumonia (FAP) panel guided treatment. We evaluated costs of intervention, clinical outcomes as development of hospital acquired infections (HAI), length of stay and mortality. Methods. Retrospective study. Patients with severe COVID-19 infection hospitalized in ICU of two institutions in Pereira were included. The prescription of antibiotic without FAP panel was defined as empiric. The prescription according to FAP panel results was defined as guided. Data analysis was performed in Epiinfo version 7.5.2.0. The study protocol was approved by the ethics committee of Universidad Tecnologica de Pereira. Results. 252 patients were included, 180 received empiric therapy and 72 were FAP panel guided. The median age was 65 years (IQR 53-73), the PaO2/FiO2 ratio mean was 108 (IQR 64-130). In the group of empiric treatment, 21 (11.67%) patients presented confirmed bacterial infection. Patients on guided antimicrobial therapy presented less HAI (RR 0,54 (IC 95% 0.30-0.95) p 0.02). The median length of stay in ICU was 16 days for both groups. Klebsiella pneumoniae was the most frequent bacteria identified during the first episode of infection followed of Pseudomonas aeruginosa. Mortality on guided group was 54% Vs. 42% on empiric group (p< 0,3). Meropenem was the main antibiotic prescribed (DDD empiric 3.17 Vs. 1.8DDDguided) followed of cefepime (DDD empiric 0.9 Vs. DDD guided 0.12). The median cost of antimicrobial treatment in the empiric group was US$530 (US$30-US$1579) per patient compared to the median cost of guided prescription that was US$292 (US$16-US $8767). When including the cost of FAP panel, the median cost per patient treatment course was US$429 (US$153-US$8904) p< 0.7. Conclusion. Implementation of a guided antimicrobial therapy using FAP panel could be useful and cost effective in COVID-19 ICU patients to reduce antimicrobial consumption and adverse outcomes related to the inappropriate use of antibiotics without significant impact on mortality or length of stay.

EDITORIAL: TRAINING IN TEACHING INNOVATION. ENGINEERING 2030

Since the Sorbonne declaration in 1998, much has been published about the implementation of the European Higher Education Area, which, among other things, proposes the creation of a system of European credits that measure the student's workload. This places the core of the process in the student's learning rather than in the teacher's teaching. Numerous changes have been taking place, but the culture of teaching innovation does not seem to have penetrated sufficiently (Paricio et al., 2019). On the other hand, the COVID-19 pandemic has accelerated the digital transformation of the university (Martín-Barbero, 2020). However, the use of technologies does not necessarily entail a pedagogical change (Bhagat & Spector, 2017), for which it seems necessary to deepen teaching innovation processes supported by technology © Article's contents are provided on an Attribution-Non Commercial 4.0 Creative commons International License. Readers are allowed to copy, distribute and communicate article's contents, provided the author's and JOTSE journal's names are included. It must not be used for commercial purposes. To see the complete licence contents, please visit https://creativecommons.org/licenses/by -nc /4.0/

Spain's Law No. 10/2021 on Teleworking: Strengths and Weaknesses

One of the effects of COVID-19 has been the increase in the number of people who telework. Against this background, the Spanish government, trade unions and employers' association adopted a new provision regulating this way of working. Based on these considerations, this paper provides an overview of telework in Spain. To this end, Law No. 10/2021 will be analyzed, particularly its scope of application and teleworker's rights. This analysis will be carried out to assess the legal value of this new piece of legislation.

INTERSTITIAL LUNG DISEASE IN SERONEGATIVE RHEUMATOID ARTHRITIS

SESSION TITLE: Autoimmune Diffuse Lung Disease Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Interstitial lung disease (ILD) associated with connective tissue diseases (CTD) present with varying degrees of severity and functional impairment. Patients with CTD-ILD may often initially present for pulmonary evaluation. Pulmonologists must be familiar with the spectrum of CTD syndromes, the associated serologic testing, and referral criteria to rheumatology. CASE PRESENTATION: A 62-year-old never-smoking female with prior mild COVID-19 infection, previously vaccinated, presented to clinic with a diagnosis of pulmonary fibrosis. She endorsed three years of progressive shortness of breath and dyspnea on exertion walking only eight blocks and with light household chores. The patient had worked as a professional chef in poorly ventilated kitchens. Review of systems was notable for morning stiffness and pain in bilateral hand joints with associated difficulty opening medication bottles secondary to symptoms. Previous computed tomography (CT) of the chest demonstrated peripheral, subpleural, and basal predominant reticulations accompanied by bronchiectasis and bronchioloectasis consistent with probable usual interstitial pneumonia (UIP). Envisia® genomic testing was performed and results were negative for idiopathic pulmonary fibrosis. Extensive serologic testing for CTD was performed, including rheumatoid factor and anti-cyclic citrullinated peptides which were normal. The patient was referred to rheumatology, and hand x-rays demonstrated diffuse MCP joint narrowing. The patient was diagnosed with seronegative rheumatoid arthritis (RA) with RA-ILD and started on treatment. DISCUSSION: Multiple society guidelines recommend serologic testing to rule out CTD-ILD in patients with new ILD. ILD has been reported to occur in 20-60% of patients with RA with multiple patterns. Patients with seronegative RA are more likely to develop extraarticular manifestations of RA including fibrotic lung disease. Patients who are asymptomatic from RA-ILD may be monitored clinically for worsening RA-ILD. The selection of patients for treatment with an immunosuppressive agent or glucocorticoids should be done with a multidisciplinary team. Patients with RA-ILD and a UIP pattern may not respond to immunosuppressive medications but are typically trialed on treatment for worsening lung disease. Randomized controlled trials that included patients with RA-ILD with fibrosis have suggested a role for nintedanib, an anti-fibrotic agent, in slowing the progression of forced vital capacity decline. CONCLUSIONS: CTD-ILD is a common diagnosis in pulmonary clinics, and ILD symptoms may be the chief complaint at presentation. Providers must be familiar with diagnostic criteria for CTD and obtain a detailed review of systems that might suggest the diagnosis of CTD. Early diagnosis of CTD-ILD and monitoring of disease activity is important to prevent progression of CTD-ILD. Reference #1: Yoo H, Hino T, Han J, et al. Connective tissue disease-related interstitial lung disease (CTD-ILD) and interstitial lung abnormality (ILA): Evolving concept of CT findings, pathology and management. Eur J Radiol Open. 2020;8:100311. Published 2020 Dec 16. doi:10.1016/j.ejro.2020.100311 Reference #2: Sahatciu-Meka V, Rexhepi S, Manxhuka-Kerliu S, Rexhepi M. Extra-articular manifestations of seronegative and seropositive rheumatoid arthritis. Bosn J Basic Med Sci. 2010;10(1):26-31. doi:10.17305/bjbms.2010.2729 Reference #3: Cottin V. Pragmatic prognostic approach of rheumatoid arthritis-associated interstitial lung disease. Eur Respir J. 2010 Jun;35(6):1206-8. doi: 10.1183/09031936.00008610. PMID: 20513909. DISCLOSURES: No relevant relationships by Brenda Garcia No relevant relationships by Zein Kattih No relevant relationships by Priyanka Makkar No relevant relationships by Jonathan Moore

A NONINVASIVE RETRIEVAL METHOD FOR RETAINED GUIDEWIRE AFTER CENTRAL VENOUS LINE (CVL) PLACEMENT

SESSION TITLE: Imaging, ECMO, and other Procedures in the ICU Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Central Venous Catheter placement is a common procedure in the ICU setting and provides a valuable route for medication delivery and venous access. The Seldinger method is the most commonly used method for placement of the catheter, and is the standard of care [1] with current recommendations. However, central line placement is still associated with complications including infection, thrombotic events, and mechanical malfunctions. Guidewire related complications are less common, but can occur [2]. Wire retention is a known, but avoidable complication of central venous catheter placement. Guidewire errors have been associated with operator fatigue, inexperience, and inadequate supervision of trainees. CASE PRESENTATION: An immunocompromised 40 year old female who presenting with hypoxia secondary to COVID-19, ultimately requiring intubation. She required initiation of continuous sedatives, analgesics, and vasopressors, for which a CVC was placed. The procedure proceeded in usual fashion with ultrasound and sterilization. Standard seldinger technique with US guidance was utilized. However, during advancement of the catheter, the wire was also advanced and lost within the catheter. DISCUSSION: Using ultrasound the wire could be seen within the lumen of the catheter and approximately 1-2 cm deep. A chest plain film was obtained and displayed above (Figure 1). Given the superficial location of the wire, bedside removal was attempted. Counter-traction was applied anterior to the catheter entry site with a second operator while suction was applied to the terminal catheter port using a 30 cc syringe. A debakey hemostat was utilized to clamp the catheter as it penetrated the dermis. The catheter was removed 2 cm and then the hemostat was released while still applying suction and then again replaced at the same site. This process was repeated three subsequent times and then the catheter was completely removed revealing the guidewire protruding from the initial entry site. The wire was safely removed. The patient was otherwise unharmed and would later discharge to rehab facility. CONCLUSIONS: Central venous catheter placement is a common ICU procedure than can be associated with complications. The above case reflects one complication that occurs per few thousands [3]. Fortunately, bedside retrieval was possible and further invasive procedures were avoided. The above method represents one possible method for removal of a guidewire that is only superficially buried. Finally, this case demonstrates that a thoughtful approach to procedural complications and use of available resources can avoid more invasive procedures, increased risk of further complications, and increased costs to the patient and healthcare system. Reference #1: Thaut L, Weymouth W, Hunsaker B, Reschke D. Evaluation of Central Venous Access with Accelerated Seldinger Technique Versus Modified Seldinger Technique. J Emerg Med. 2019 Jan;56(1):23-28. doi: 10.1016/j.jemermed.2018.10.021. Epub 2018 Nov 30. PMID: 30503723. Reference #2: Kornbau C, Lee KC, Hughes GD, Firstenberg MS. Central line complications. Int J Crit Illn Inj Sci. 2015;5(3):170-178. doi:10.4103/2229-5151.164940 Reference #3: Bessoud B, de Baere T, Kuoch V, Desruennes E, Cosset MF, Lassau N, Roche A. Experience at a single institution with endovascular treatment of mechanical complications caused by implanted central venous access devices in pediatric and adult patients. AJR Am J Roentgenol. 2003 Feb;180(2):527-32. doi: 10.2214/ajr.180.2.1800527. PMID: 12540466. DISCLOSURES: No relevant relationships by John Craver Scientific Medical Advisor relationship with Synspira Please note: 3 years Added 03/29/2022 by Bryan Garcia, value=Salary Speaker/Speaker's Bureau relationship with Insmed Please note: 3 years Added 03/29/2022 by Bryan Garcia, value=Honoraria Advisory Committee Member relationship with Zambon Pharmaceuticals Please note: 2 ears Added 03/29/2022 by Bryan Garcia, value=Honoraria No relevant relationships by John Murphy

CRYPTIC CRYPTO: PULMONARY CRYPTOCOCCOSIS IN AN IMMUNOCOMPETENT HOST

SESSION TITLE: Uncommon Presentations and Complications of Chest Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: Cryptococcus is a ubiquitous fungus in the environment. Infections can occur in humans when Cryptococcus is aerosolized and inhaled. Severity of clinical presentation varies from asymptomatic pulmonary colonization to disseminated life-threatening infection such as meningitis. These infections usually occur with deficiencies in T-cell-mediated immunity, including those with HIV/AIDS and immunosuppression due to transplantation. Herein we present a case of isolated pulmonary cryptococcosis in an immunocompetent host. CASE PRESENTATION: The patient is a 36-year-old never-smoker male with history of recurrent left spontaneous pneumothorax status post VATS blebectomy, negative for alpha-1 antitrypsin deficiency and cystic fibrosis. A year later, he presented with fatigue, shortness of breath, and dry cough after a recent trip to Ohio. Viral panel including COVID-19 was negative. A chest x-ray showed a new 4 cm rounded opacity in the right middle lobe (RML). A CT scan of the chest showed 2 mass-like and nodular areas of consolidation with surrounding GGOs within the RML (Figure 1). He underwent navigational bronchoscopy with transbronchial biopsy (TBBx) of RML, BAL, and EBUS with transbronchial needle aspiration (TBNA). Cytology was negative for malignant cells. BAL showed rare yeast. Pathology of the TBBx showed the airway wall with chronic inflammation including granulomatous inflammation, positive for yeast, most consistent with Cryptococcus with positive Grocott methenamine silver (GMS) stain (Figure 2). Culture of the TBNA grew C. neoformans var. grubii. Other cultures were negative. Serum Cryptococcal antigen was positive. HIV test was negative. He started treatment with oral fluconazole with improvement of symptoms. DISCUSSION: Clinical presentation of pulmonary cryptococcosis can include a variety of symptoms in which immune status is critical for determining the course of infection. Infection can vary from asymptomatic infection to severe pneumonia and respiratory failure, and meningitis. Similarly, imaging findings can also vary and be characterized as pulmonary nodules, consolidations, cavitary lesions, and/or a diffuse interstitial pattern. The diagnosis of Cryptococcus is made using histology, fungal cultures, serum cryptococcal antigen, and radiography in the appropriate clinical and radiological context. Treatment recommendations are determinant on immune status of the patient as well as symptoms. Asymptomatic and localized disease in immunocompetent patients can be monitored and mild/moderate disease can be treated with fluconazole. Those with severe or disseminated infection warrant induction therapy with an amphotericin B and flucytosine CONCLUSIONS: Clinical and radiological presentation of cyptococcosis varies depending on immune status. Disease can occur in both immunocompromised and competent hosts. Immune status determines disease course and treatment. Reference #1: Huffnagle GB, Traynor TR, McDonald RA, Olszewski MA, Lindell DM, Herring AC, et al. Leukocyte recruitment during pulmonary Cryptococcus neoformans infection. Immunopharmacology. 2000 Jul 25;48(3):231–6. Reference #2: Kd B, Jw B, Pg P. Pulmonary cryptococcosis. Semin Respir Crit Care Med [Internet]. 2011 Dec [cited 2022 Apr 2];32(6). Available from: https://pubmed.ncbi.nlm.nih.gov/22167400/ Reference #3: Ms S, Rj G, Ra L, Pg P, Jr P, Wg P, et al. Practice guidelines for the management of cryptococcal disease. Infectious Diseases Society of America. Clin Infect Dis Off Publ Infect Dis Soc Am [Internet]. 2000 Apr [cited 2022 Apr 1];30(4). Available from: https://pubmed.ncbi.nlm.nih.gov/10770733/ DISCLOSURES: No relevant relationships by Mina Elmiry No relevant relationships by Brenda Garcia No relevant relationships by Zein Kattih no disclosure on file for Priyanka Makkar;No relevant relationships by Jonathan Moore

A Virtual Reality Serious Game for Children with Dyslexia: DixGame

Children with reading and writing difficulties, such as dyslexia, have been directly affected by the Covid-19 situation because they could not have the teacher’s face-to-face support. Consequently, new devices and technological applications are being used in educational contexts to improve the interest of learning. This paper presents the design of a Virtual Reality Serious Game called DixGame. This game is a pedagogical tool specifically oriented to children between 8 and 12 years old with dyslexia. Two immersive mini-games are included in this game: a Whack-a-mole and a Memory, which try to improve different skills keeping the children focused on tasks. Whack-a-mole aims to work on the attention and visual and reading agility by recognizing correct letters and words. Memory aims to improve memory and attention ability by pairing letter-cards. The mini-game structure permits to incorporate new levels or games and the progressive increment of difficulty allows the autonomous treatment. © 2022, Springer Nature Switzerland AG.

Tracheostomy Patient Care Unit. An innovative Otorhinolaryngology solution of a transversal nature for the hospital

Background and objective: The care of tracheostomized patients are high risk skills and low incidence. Strategies for improvement of health care in hospital wards and specialties other than otolaryngology based solely on training have not been able to offer an adequate solution. A tracheostomized patient unit is presented directed by the otolaryngology service to attend all tracheostomized hospitalized patients of all specialties. Material and methods: Background: Third level public hospital with 876 hospitalization beds and 30 ICU beds for 481,296 inhabitants. Unit model: Transversal unit for the hospital providing attention to all tracheostomized patients, adults, and children, of all specialties, with dedication of 50% of a ENT nurse of hospitalization that moves to the hospitalization bed of the specialty of each patient and 50% of another office ENT nurse for ambulatory patients care, with the consultancy of an ENT specialist and coordinated by the ENT supervisor. Results: 572 patients between 2016 and 2021, 80% men, aged 63 ± 14 years, were attended in the unit. 14.7 ± 2 tracheostomized patients daily and 96 ± 4 complication annual consultations were attended, rising up to 19 tracheostomized patients daily by 2020 and 141 ± 8.4 consultations by complications in 2020 and 2021, during the COVID-19 pandemic. The mean stay of the non-ENT specialties was reduced in 13 days, increasing the satisfaction of the ENT and non-ENT professionals and the satisfaction of the users. Conclusions: A Tracheostomized Patient Care Unit proactively directed from the Otorhinolaryngology Service to transversally care for all tracheostomized patients improves the quality of health care by reducing stay, complications, and emergencies. Improves the satisfaction of non-otolaryngological professionals by reducing the anxiety of facing care of patients who lack knowledge and experience and that of ENT specialists and nurses by reducing unplanned extemporaneous demands for care. Improves user satisfaction by perceiving adequate continuity of care. The Otorhinolaryngology Services provide their experience in the management of laryngectomized and tracheostomized patients and in teamwork with other specialists and professionals without the need to create new structures outside otorhinolaryngology.

Impacto de la Covid19 en las barreras percibidas para practicar actividad física en las personas usuarias de centros fitness en España

Esta investigación pretende conocer las barreras percibidas, así como posibles variables predictoras, en personas que practican actividad física en centros fitness que se encontraban confinadas en el hogar por la pandemia de COVID19. La muestra estuvo conformada por 8.087 practicantes de actividad física. Se administró un cuestionario en línea por correo electrónico. Se realizó un análisis descriptivo de las barreras percibidas y un análisis de regresión logística para determinar posibles variables predictoras. Las barreras percibidas más importantes fueron el precio y la suerte de la seguridad. La edad, el sexo, la frecuencia de práctica física vigorosa y la observación de las recomendaciones de la OMS serían las variables predictoras en mayor medida de las barreras percibidas. Los resultados son relevantes para que las organizaciones deportivas planifiquen su oferta de servicios después del confinamiento.Alternate :This research intends to know the perceived barriers, as well as their predictor variables, in people who practice Physical Activity in fitness centers and were home confined due to the COVID-19 pandemic. The sample was conformed of 8,087 physical activity practitioners. An online questionnaire was administered by email. A descriptive analysis of the perceived barriers was done, and logistic regression analysis to determine possible predictor variables. The most important perceived barriers were price and a lack of safety. Age, gender, the vigorous physical practice frequency and the observation of the WHO recommendations would be the predictor variables to a larger extend for the perceived barriers. The results are relevant for sport organizations to plan their services offer post lockdown.Alternate :Esta pesquisa tem como objetivo conhecer as barreiras percebidas, bem como possíveis variáveis preditivas, em pessoas que praticam atividade física em academias de ginástica que ficaram confinadas em casa pela pandemia do COVID-19. A amostra foi composta por 8.087 praticantes de atividade física. Um questionário online foi administrado por e-mail. Uma análise descritiva das barreiras percebidas e uma análise de regressáo logística foram realizadas para determinar possíveis variáveis preditoras. As barreiras percebidas mais importantes foram o preçõ e a sorte na seguranęa. Idade, sexo, frequencia de prática física vigorosa e observancia das recomendações da OMS seriam as variáveis preditoras em maior extensáo das barreiras percebidas. Os resultados são relevantes para que as organizações esportivas planejem sua oferta de serviçõs após o confmamento.