ABSTRACT
Background: Filter paper (FP) or dried blood spot testing is the preferred method of monitoring blood levels of phenylalanine and tyrosine for patients diagnosed with phenylketonuria (PKU) in the state of Georgia. This cost effective and convenient at-home approach simplifies the nutritional assessment and management of patients with PKU and lessens the burden on patients and caretakers. Emory and a local specialty laboratory had a long-standing contract for FP testing, which included patient insurance and grant billing. When this laboratory abruptly ended FP testing in September 2020, an emergent alternative plan became essential to prevent potential disruptions in patient care while working on a sustainable solution for PKU monitoring, especially given the ongoing COVID-19 pandemic. Method(s): Emory's in-house laboratory was not contracted with outside laboratories to process FP testing and bill insurance. To mitigate any delays in FP testing, the MNT4P program conducted a vendor search and selected ARUP Laboratories to perform PKU FP testing. Eligible patients included those referred, enrolled, and consented to the MNT4P program. To streamline the FP submission process, customized FP cards and business reply envelopes were developed and distributed in collaboration with PerkinElmer, Emory Mail Services and the United States Postal Service. Patient outreach efforts were facilitated through email campaigns, MNT4P website updates, and in collaboration with Georgia PKU Connect. Result(s): 95 patients were referred to MNT4P program for FP paper monitoring. During the 4-month period, a total of 239 FPs were collected from patients with PKU and processed with corresponding results reported to Emory Clinic, allowing registered dietitians to continue nutrition management without disruption. Once the patient-centered business prototype was established, FP testing was successfully transferred from the MNT4P program to Emory's inhouse laboratory. FP testing is now a part of Emory's test catalog, and results are available to providers through electronic health records. Conclusion(s): The MNT4P program successfully worked with Emory's in-house laboratory to develop a sustainable solution for FP monitoring. It prevented interruption in long-term follow up of patients with PKU. MNT4P continues to be the payor of FP tests for uninsured and underinsured patients.Copyright © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
Background: Fungal infections are increasingly being seen and mucormycosis is increasingly being isolated in COVID-19 patients, especially in those needing prolonged hospitalization. This cross-sectional study was carried out to isolate different fungi and identify their species in COVID-19 patients admitted for more than one month.
ABSTRACT
SESSION TITLE: Post-COVID-19 Infection Complications SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Chest CT features in COVID-19 pneumonia include scattered ground-glass infiltrates in milder cases to confluent ground-glass change, dense consolidation, and crazy paving in the critically ill. However, cavitary lesions are uncommon in these patients. We present a case of lung cavity in a patient who had recent COVID-19 pneumonia. CASE PRESENTATION: A 33-year-old male diagnosed with COVID-19 four weeks ago presented with hemoptysis and exertional dyspnea. He had pleuritic chest pain without fever, night sweats, weight loss, skin rashes, hematemesis, or epistaxis. He had COVID-19 in Brazil, where he had received dexamethasone, hydroxychloroquine, ivermectin, colchicine, azithromycin, and rivaroxaban. The last dose of rivaroxaban was three days prior to the presentation. He had no history of travel to caves or exposure to birds or animals. His past medical history included hypertension, diabetes, and bariatric surgery. He had no history of smoking or IV drug use. He had moved from Brazil to the United States six years ago and worked as an interpreter. Physical examination was notable for stable vitals with O2 sat of 99%. Systemic examinations were unremarkable. Blood work including CBC, platelet count, PT/INR was within normal limits. COVID-19 testing (PCR) was negative. A chest CT revealed bilateral scattered ground-glass opacities with central cavitation in the left lower lobe concerning for septic pulmonary emboli. HIV 1/2, ANA, rheumatoid factor, and Quantiferon TB gold were negative. Blood cultures showed no growth. An echocardiogram was negative for any vegetations. Bronchoalveolar lavage from the left lower lobe was negative for AFB and gram staining. Sputum cultures, fungal cultures, and NAAT for Mycobacterium tuberculosis were negative, as was the cytology. He was started on amoxicillin-clavulanic acid during his hospital stay. He did not experience any recurrence of hemoptysis and was discharged home. The subsequent follow-up chest CT scans showed resolving cavitation at one month and a complete resolution of the cavity at 3 months. DISCUSSION: Cavitary lung lesions are usually related to fungal, mycobacterial, autoimmune, parasitic, thrombotic, or neoplastic etiologies. While not often seen in patients with viral pneumonia, lung cavitation can rarely occur in COVID-19. Mycobacterium tuberculosis and Nocardia were suspected given the history of being an immigrant and a recent trip to Brazil. As these tests were negative and the lung cavity resolved over a few months with conservative treatment, the etiology of the cavity was attributed to a late presentation of COVID-19 pneumonia. CONCLUSIONS: COVID-19 has variable complications which are still to be explored. The lung cavity in a COVID patient is an under-recognized entity. This case report highlights the need for further studies to determine the cause of cavitation, which could be related to COVID infection or its treatment. Reference #1: Selvaraj V, Dapaah-Afriyie K Lung cavitation due to COVID-19 pneumonia. BMJ Case Reports CP 2020;13:e237245. Reference #2: Chen Y, Chen W, Zhou J, Sun C, Lei Y. Large pulmonary cavity in COVID-19 cured patient case report. Ann Palliat Med 2021;10(5):5786-5791. doi: 10.21037/apm-20-452 Reference #3: Zoumot, Z., Bonilla, MF., Wahla, A.S. et al. Pulmonary cavitation: an under-recognized late complication of severe COVID-19 lung disease. BMC Pulm Med 21, 24 (2021). https://doi.org/10.1186/s12890-020-01379-1 DISCLOSURES: no disclosure on file for Raul Davaro;No relevant relationships by Susant Gurung No relevant relationships by Bijay Khanal No relevant relationships by Anil Phuyal No relevant relationships by Kamal Pokhrel No relevant relationships by REGINA SHRESTHA No relevant relationships by Mithil Gowda Suresh
ABSTRACT
To investigate a superspreading event at a fitness center in Hong Kong, China, we used genomic sequencing to analyze 102 reverse transcription PCR-confirmed cases of severe acute respiratory syndrome coronavirus 2 infection. Our finding highlights the risk for virus transmission in confined spaces with poor ventilation and limited public health interventions.