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SESSION TITLE: Acute COVID-19 and Beyond: from Hospital to Homebound SESSION TYPE: Original Investigations PRESENTED ON: 10/18/22 2:45 pm - 3:45 pm PURPOSE: Coronavirus-19 (COVID-19) infection associated hypercoagulability places patients at a risk of developing of pulmonary embolism (PE) [1]. This study aims to determine the utility of traditional risk stratification tools in this patient population. METHODS: This is a retrospective analysis of non-pregnant patients, >=18 years admitted to UPMC Community Osteopathic and UPMC West Shore Hospitals with acute PE between September 2019 and June 2021. We used Student’s t-test to analyze group differences, Welch-Satterthwaite t-test for the unequal continuous data, and chi-square test to analyze group differences for the categorical variables. RESULTS: A total of 309 patients were included (52 patients diagnosed with COVID-19, and 115 patients tested negative. 142 patients were not tested and hence not included in the analysis. The mean age was 61.7 years in COVID-19 patients and 63.8 years in non-COVID-19 patients. There was no difference in the severity of PE when classified as massive (1.92% vs 3.48%, p=1.0000), sub-massive (17.31% vs 29.57%, p=0.0934), non-massive (88.77% vs 66.96%, p=0.0678). No difference was seen in shock index (0.5-0.7: 73.08% vs 66.09%;>0.8: 26.92% vs 33.91%, (p=0.3688)). PESI score was also similar with PESI Class I 25% vs 21.74%, Class II 21.15% vs 17.39%, Class III 21.15% vs 26.96%, class IV 19.23% vs 13.04%, Class V 13.36% vs 20.87% (p=0.5757). Simplified PESI identifying PE risk was similar in groups with high risk in 56.86% vs 66.09%, and low risk in 43.14% vs 33.91% (p=0.1734). No difference was seen in the outcomes of COVID-19 vs non-COVID-19 patients including the length of hospital stay (<1 day: 21.15% vs 12.17%, p=0.1230;>=6 days 21.15% vs 32.17%, p=0.1451) and ICU admission (11.54% vs 20%, p=0.1813). There was no difference in the occurrence of right heart strain (21.15% vs 32.17%, p=0.1451), saddle PE (5.77% vs 6.09%, p=1), and intubation (0% vs 1.74%, p=1.0000). Mortality rate was similar (5.77% vs 0.87%, p=0.0900). Readmission rate at 30 days was higher in non-COVID-19 patients at 30 days (9.62% vs 24.35%, p=0.0268) with no difference at 3 months (5.77% vs 6.09%, p=1.0000). Differences in laboratory findings in COVID-19 vs non-COVID-19 patients included BNP>100 (20% vs 38.46%, p=0.0276) and elevated troponin level > 0.03 (26% vs 42.86%, p=0.0408) which were more frequently observed in COVID-19. CONCLUSIONS: Our study is limited in the sense that it is retrospective in nature, and we assessed the patient population admitted to 2 of our hospitals. Despite the lab studies discrepancies in troponin and BNP levels, PE in COVID-19 patients was not associated with fatal or near fatal outcomes as compared to non-COVID-19 patients. CLINICAL IMPLICATIONS: Scoring metrics including Shock Index and PESI along with sPESI scoring systems, if utilized, can help with management and decrease length of stay among COVID-19 and non-COVID-19 patients with pulmonary embolism. DISCLOSURES: No relevant relationships by Ahmed Aladham No relevant relationships by Konstantin Golubykh No relevant relationships by Iuliia Kovalenko No relevant relationships by Kriti Lnu No relevant relationships by Navitha Ramesh No relevant relationships by Yijin Wert
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SESSION TITLE: Problems in the Pleura Case Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Severe COVID 19 has now been known to cause devastating damage to the lungs. The manifestations include severe pneumonia, acute respiratory distress syndrome, spontaneous pneumothorax, etc. As we were learning about the pathogenesis of the infection, we were also learning rapidly about the therapeutics targeted against it. A report a case of severe COVID 19 ARDS in a non-vaccinated young male, who later developed empyema during his hospital course. CASE PRESENTATION: A 29-year-old male with no past medical history presented to the emergency department complaining of chest pain and shortness of breath. He was not vaccinated against COVID-19. He was discharged from the hospital on 2 liters of supplemental oxygen two days ago after undergoing treatment for COVID-19 pneumonia with dexamethasone and remdesivir. Physical examination revealed bilateral diminished lung sounds on auscultation. His blood pressure was 112/75 mm Hg, heart rate (HR) 120 per minute, respiratory rate 25 per minute, the temperature of 38.5 Celsius and he was saturating 91% on 15 L of oxygen via a non-rebreather mask. Initial CT scan revealed bilateral ground-glass opacities (figure 1.). Due to high oxygen requirements and CRP of 10.5 MG/DL, the patient was started on Sarilumab. Given his escalating oxygen requirements and worsening respiratory distress, he was intubated and transferred to the intensive care unit. Despite intermittent prone positioning, he became progressively hypoxemic and eventually required Veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO). One week later he developed intermittent fever spikes up to 39.5 C with HR of 120 per minute and leukocytosis of 40.8 K/µL. Bedside point of care ultrasound revealed new bilateral complex pleural effusions. Chest CT-scan showed moderate bilateral pleural effusions with new cystic changes and worsening consolidations (figure 2). Pleural fluid analysis showed lactate dehydrogenase of 2798, pH of 7.11, and cell count of 100 with 98% neutrophils. Despite aggressive therapy with chest tube placements and broad-spectrum antibiotics his condition continued to worsen over the next month with the development of hydropneumothoraxes and traction bronchiectasis (figure 3). Given the clinical deterioration despite aggressive care, his family decided to pursue a comfort-oriented treatment approach and he eventually passed away. DISCUSSION: COVID-19 related pleural effusion is a reported complication of COVID-19 pneumonia in up to 2-11% of the cases [1]. Most cases are associated with comorbid conditions, such as heart failure, superimposed bacterial infections, and pulmonary embolism [2]. CONCLUSIONS: Our case indicates that bacterial empyema may complicate COVID-19 pneumonia later in the disease course even in young immune-competent patients, it is unclear if empyema is directly related to the disease process itself r the therapeutic used to treat the COVID 19 infection. Reference #1: Chong WH, Saha BK, Conuel E, Chopra A. The incidence of pleural effusion in COVID-19 pneumonia: State-of-the-art review. Heart Lung. 2021;50(4):481-490. doi:10.1016/j.hrtlng.2021.02.015 Reference #2: Zhang L, Kong X, Li X, et al. CT imaging features of 34 patients infected with COVID-19. Clin Imaging. 2020;68:226-231. doi:10.1016/j.clinimag.2020.05.016 DISCLOSURES: No relevant relationships by Rimsha Ali No relevant relationships by Konstantin Golubykh No relevant relationships by Iuliia Kovalenko No relevant relationships by Maidah Malik No relevant relationships by Taaha Mirza No relevant relationships by Navitha Ramesh
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SESSION TITLE: Chest Infections in Immunocompromised Patients Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Pneumocystis pneumonia (PCP) is a life-threatening opportunistic infection caused by Pneumocystis jirovecii. HIV-negative patients with PCP are primarily individuals receiving immunosuppressive therapy for other disease processes. In rare instances, PCP could be an initial manifestation of underlying defected or suppressed cell-mediated immunity that needs to be diagnosed to prevent morbidity and mortality. CASE PRESENTATION: 75-year-old female with a history of hypertension and hypothyroidism presented to the emergency department for evaluation of cough, fever, and shortness of breath gradually worsening over the last few weeks. She received outpatient treatment with no improvement. She was vaccinated against covid-19. On presentation, the temperature was 103F, heart rate was 108 bpm, blood pressure was 163/93 mm Hg, and oxygen saturation was 86% on room air. Hemogram showed leukocytosis with left shift with elevated inflammatory markers. Chest X-ray revealed bilateral ground glass opacities. She was started on broad-spectrum antibiotics, but symptoms worsened over the next few days. CT chest showed diffuse bilateral ground glass opacities with prominent interstitial markings. BAL obtained from bilateral upper lobes was lymphocyte predominant with pneumocystis jirovecii diagnosed on Gomori methenamine silver (GMS) staining. She was started on PCP-directed antibiotics with intravenous glucocorticoids, and workup for an underlying immunodeficiency was started. Subsequent BATS biopsy revealed diffuse organizing alveolar damage, with possible associated acute interstitial pneumonia pattern. This could be a rare manifestation of PCP or a primary presentation in the appropriate clinical setting. Autoimmune panel, leukemia, and lymphoma panel came back negative. AFB smear, HIV, EBV, CMV, HTLV I/II also returned negative. The lymphocyte subset panel revealed a CD4 count of 205 and a subsequent count a few days later of 64 with decreased total IgG. The patient was treated with high dose steroids for an extended period along with treatment for PCP however continued to decline clinically. The patient and family eventually decided to pursue comfort care. DISCUSSION: The predisposition to PCP in patients is primarily due to a decrease in cell-mediated immunity regardless of HIV infection. In our patient, the etiology of idiopathic CD4+ T cell lymphocytopenia cannot be determined due to the lack of serial laboratory data measurement. One of the proposed etiologies of ICL is systemic persistent immune activation in the setting of exogenous mRNA, the current technology that is being widely used for vaccine development. CONCLUSIONS: In this era of biotechnology, with advancements in immunosuppressive therapy and mRNA-based vaccines, increased awareness around the potential immune system activation and potential downstream complications needs to be further highlighted to raise awareness among physicians. Reference #1: Li, Y., Ghannoum, M., Deng, C., Gao, Y., Zhu, H., Yu, X., & Lavergne, V. (2017). Pneumocystis pneumonia in patients with inflammatory or autoimmune diseases: usefulness of lymphocyte subtyping. International Journal of Infectious Diseases, 57, 108-115. Reference #2: Pardi, N., Hogan, M. J., Porter, F. W., & Weissman, D. (2018). mRNA vaccines - a new era in vaccinology. Nature reviews. Drug discovery, 17(4), 261–279. https://doi.org/10.1038/nrd.2017.243 Reference #3: Vijayakumar, S., Viswanathan, S., & Aghoram, R. (2020). Idiopathic CD4 Lymphocytopenia: Current Insights. ImmunoTargets and therapy, 9, 79–93. https://doi.org/10.2147/ITT.S214139 DISCLOSURES: No relevant relationships by Santhosh Gheevarghese John No relevant relationships by Konstantin Golubykh No relevant relationships by Iuliia Kovalenko No relevant relationships by Maidah Malik No relevant relationships by Hafiz Muhammad Siddique Qurashi No relevant relationships by Taj Rahman No rel vant relationships by Tabinda Saleem
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Aim: to assess the results of chest computer tomography (CT) of patients with novel coronavirus infection in correspondence with their outcomes, clinical and laboratory data. Methods: retrospective analysis of 962 chest CT scans, outcomes, clinical and laboratory data of all 354 COVID-19 patients hospitalized from April to June 2020. Results: Sensitivity and specificity of CT with polimerase chain reaction (PCR) as a reference were: 98.0 % and 5.7 % respectively;for PCR with CT as a reference: 54.6 % and 70.7 % respectively. Patients with positive and negative PCR tests had no significant differences in mean CT score and CO-RADS score. Cumulative survival was better in patients with lower CT score (significant only for maximal, not baseline scores). CT score changed during hospitalization in survived patients clinically insignificant (from 2 (1-2) to 2 (1-2), p=0.001), and increased in dead (from 2 (1,5-3) to 4 (4-4), p <0.001). Lower CT score and better survival was in females, patient younger than 59 years, with NEWS score <3, without atrial fibrillation. Diabetes mellitus and obesity was associated with higher CT score, but not with survival. Chronic obstructive pulmonary disease, coronary heart disease and chronic heart failure was associated with lower survival, but not CT score. Conclusion: chest CT significantly increases diagnostic accuracy and assessment of the prognosis in COVID-19 patients.
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AIM: To present the results of work of National Medical Research Center of Treatment and Rehabilitation, reassigned for COVID-19 patients treatment during pandemic. Run-up methodology, procedures and working process organization are detailed. MATERIALS AND METHODS: 354 COVID-19 patients were treated from 13.04.2020 to 10.06.2020 [age 59 (470) years, 56% women, body mass index 28.5 (24.932.2) kg/m2]. Patients were admitted at 8 (611) day of sickness. In-hospital stay was 16 (1420) days. RESULTS: NEWS scale at the day of admittance was 2 (14); 2 (13) in patients discharged alive and 6 (47) in died patients, p=0.0001. So prognostic accuracy of NEWS scale was confirmed as very well (area under ROC-curve = 0.819). 69 patients (19.5%) were treated at intensive care department for 7 (413) days. 13 patients died, 11 of them had COVID-19 as direct or indirect cause of death. Total in-hospital mortality was 3.67%, in-hospital mortality of COVID-19 patients 3.1%. 17 healthcare workers (HCW), contacted with COVID-19 patients were infected (2.67%). 4 HCW, who had no direct contact with patients were also infected and 7 HCW were infected before the first patient was admitted. No one of them died. CONCLUSION: Complex tasks of healthcare organization during COVID-19 pandemic can be solved quickly with acceptable quality, characterized by low levels of patients; mortality and HCW infection.