Gastroenterology Fellowship Virtual Interviews: Applicant and Faculty Perceptions on Virtual Interview Advantages and Barriers

Introduction: During the COVID-19 pandemic, virtual interviews for resident and fellowship applicants became the standard. However, studies evaluating the experience of virtual interviews format are lacking. Accordingly, we sought to survey both gastroenterology fellowship applicants and interviewing faculty members about their experiences with the virtual interview process. Method(s): Interviewees and faculty at 13 different gastroenterology fellowship programs at academic medical centers across the United States completed a post-interview survey. The online survey was conducted during the 2020 ERAS fellowship interview season via Google Forms. The survey responses were anonymously collected and reported. Result(s): A total of 177 gastroenterology fellowship applicants and 83 faculty members completed the electronic surveys. Most participants reported a positive experience with 91% and 84% of applicants and faculty respectively, scoring at least 4 points on a 5-point scale. Eighty-8 percent and 85% of applicants and faculty respectively, reported that they had enough insight about the applicant or the fellowship program during the interview. Over 67% of applicants reported cost-savings of greater than $1,000 per interview. Thirty-6 percent of applicants reported that they missed the personal interaction with the current gastroenterology fellows in the respective programs and the experience of physically touring the facility. Twenty-7 percent and 25% of applicants and faculty experienced technical difficulties during the interview process, respectively. Thirty-one percent and 22% of applicants and faculty would like for the virtual interviews to be the standard of future fellowship interviews, while 35% and 42% of applicants and faculty would consider it in the future, respectively. Figure 1 shows the ranking process for both applicants and faculty. Conclusion(s): Virtual interviews were perceived as effective and cost-saving by both gastroenterology fellowship applicants and faculty members. The virtual experience was widely accepted by most applicants and faculty, with high potential to become the standard of fellowship interview process in the future. However, a substantial portion experienced technical difficulty. Further improvements in technology are needed to optimize the process and increase the acceptance of the virtual interview experience. (Figure Presented).

ANALYSIS OF THE SPORTING BEHAVIOR OF THE JUNIOR ARABIC FENCERS DURING THE QUARANTINE AND CURFEW PERIOD DUE TO THE COVID-19 PANDEMIC

The aim of the current research is to investigate and analyzing behavior of the Arab Fencers during COVID-19 pandemic restrictions. The study has utilized a descriptive survey that covers 120 fencers from eight Arab countries. The Arab Fencing Association was a major mediator for distributing the developed electronic questionnaire to the fencers and clubs. The statistical results obtained from the questionnaire showed that curfew periods have harmed the training conditions for the fencers and consequently on their sporting behavior. Moreover, the periodical contact between the coaches and the players has contributed significantly to maintaining athletic behavior, physical skills, psychological stability, and commitment to ethics and traditions. The study recommends that it's important to continue the current successful approach by providing encouragement and support for the fencers, to maintain their mental and physical skills. Also, special alternative training programs should be developed and prepared for the fencers to be ready for the post-pandemic. Finally, it is necessary to conduct researches that tackle the negative psychological and social impacts of the COVID-19 pandemic. © (2023). All Rights Reserved.

Optic Neuritis in Children

Introduction Optic neuritis (ON) are rare in children. They are due to inflammation of the optic nerve which results in a sudden drop in visual acuity, or amputation of the visual field. They are often secondary to an infectious disease or vaccination, but they can be part of autoinflammatory, demyelinating or systemic diseases. The features of optic neuritis in children are different from adults as regards high rate of bilateral involvement, poor visual acuity, and papillitis. Aim Our aim is to describe the clinical and therapeutic outcomes of patients diagnosed with optic neuritis in the general pediatrics department at the CHU of Bab el Oued in Algiers. Methods It is a retrospective, descriptive study of patients who were treated for optic neuritis in our hospital over a period of three years (January 2018 to April 2021). Results There were 7 cases, 4 girls and 3 boys with F: M of 1.3:1, mean age of 10 years and age range of 6-13 years. The first manifestation was a decrease in visual acuity in all cases, 12 eyes affected, with bilateral involvement in 5 patients. Visual acuity decrease was severe < 3/10 in 80% of cases. The visual field was pathological in 2 cases (narrow, central scotoma). All patients had headaches. Retrobulbar involvement was confirmed by visual evoked potentials in all patients, they showed demyelinating involvement. Three patients presented papillitis. The diagnostic work-up included cerebral imaging which showed old nodular abnormalities of signal of the subcortical white matter in one patient. CSF analysis revealed anti-MOG antibodies in only one case. The infection investigations were negative in all cases except positive COVID 19 serology in one case The diagnosis retained in our patients were 2 cases of Behcet's disease, 1 monophasic neuritis, 1 optic neuritis with anti-MOG, 1 CRION, 1 case linked to COVID 19 in the absence of another plausible cause. In one case, no diagnosis was retained. Seventy percent of the patients benefited from treatment with corticosteroids pulse, only 2 did not receive treatment, the shortterm evolution was favorable in 5 patients with a total recovery of visual acuity, one patient has evolved into atrophy of the left optic nerve and kept visual acuity low to 1/10 of the left eye. The medium-term evolution was marked by recurrence in 3 patients, 5 episodes in the 2 patients with Behcet's disease and 8 episodes in CRION which required the use of immunosuppressive treatment and biotherapy for Behcet's disease and plasmapheresis for CRION. Conclusion Despite the fact that our small series of patients is not representative, we found similar characteristics described in children in other studies. The average onset age was 10 years, with a female predominance, the severe decrease in visual acuity with frequent bilateral involvement. The diagnosis of ON is clinical and must be considered in any sudden drop in visual acuity. The diagnosis of the underlying pathology is often difficult but it's important in order to propose an adequate specific treatment. The treatment of children's ON is controversial and usually extrapolated from adults. Most practitioners use corticosteroids pulse. The visual prognosis seems good in children, particularly in the case of bilateral involvement, but depends essentially on the aetiology.

PATIENTS WITH ASTHMA OR ATOPIC DERMATITIS TAKING BIOLOGIC THERAPIES HAVE REDUCED SARS-COV-2 VACCINE RESPONSE AT SIX MONTHS

SESSION TITLE: Late Breaking Insights In Management of Asthma and COPD SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 09:15 am - 10:15 am PURPOSE: SARS-CoV-2 vaccines have greatly reduced the impact of the COVID-19 pandemic. However, immune responses and their ability to protect against SARS-CoV-2 infection and severe clinical outcomes vary amongst vaccinees. Understanding who remains at high risk for severe infection despite vaccination and who may need additional vaccine boosters is critical for the control of this and future pandemics. We recently reported a reduced humoral immune response after mRNA SARS-CoV-2 vaccination in patients with severe asthma or atopic dermatitis on biologic therapies three months after the second vaccination, compared to healthy controls. The purpose of this study is to characterize the immune response of these patients six months after vaccination. METHODS: We conducted a prospective observational trial from February 2021 to February 2022 and enrolled 77 adults with severe asthma or atopic dermatitis treated with benralizumab, mepolizumab or dupilumab, receiving a SARS-CoV-2 mRNA vaccination, in addition to 45 healthy controls. We analyzed pseudovirus neutralization against wild-type, Delta variant and Omicron variant SARS-CoV-2, using a pseudotyped lentivirus. RESULTS: After excluding patients with prior COVID-19 or significant immunosuppression, we analyzed 28 patients (5 patients on benralizumab, 20 patients on dupilumab, 3 patients on mepolizumab) in addition to 34 healthy controls at 6 months after vaccination. We found that patients with severe asthma or atopic dermatitis treated with biologics had lower pseudovirus neutralization titer at 6 months, compared to healthy controls. The mean 50% inhibitory dilution against wild-type SARS-CoV-2 among patients on biologics were lower at 2.313 log10 compared to 2.743 log10 in the healthy control group, p-value <0.0001. Additionally, the patients on biologics had lower neutralizing antibody titers against Delta variant and Omicron variant SARS-CoV-2. CONCLUSIONS: Our data shows that patients with severe asthma or atopic dermatitis on biologic therapies have lower neutralization titer after SARS-CoV-2 mRNA vaccination compared to healthy controls 6 months after the second vaccination. Large population studies have recently shown that severe or active asthma is associated with worse COVID-19 outcomes and several studies have shown that lower humoral immunity after vaccination is associated with less protection against disease. It is therefore critical to provide booster vaccinations to these vulnerable patients. CLINICAL IMPLICATIONS: Clinicians should encourage patients with severe asthma or atopic dermatitis on biologic therapies to receive SARS-CoV-2 booster vaccinations as they may unknowingly remain at high risk for severe disease. DISCLOSURES: No relevant relationships by Fabliha Anam No relevant relationships by Suneethamma Cheedarla No relevant relationships by Narayanaiah Cheedarla No relevant relationships by John Daiss No relevant relationships by Natalie Haddad No relevant relationships by Ian Hentenaar No relevant relationships by Fernando Holguin No relevant relationships by Caroline Kim No relevant relationships by Pedro Lamothe No relevant relationships by Frances Lee No relevant relationships by ANDREW NEISH No relevant relationships by wendy neveu No relevant relationships by Rahulkumar Patel No relevant relationships by Carmen Polito No relevant relationships by Richard Ramonell No relevant relationships by Mayuran Ravindran No relevant relationships by John Roback No relevant relationships by Martin Runnstrom Consultant relationship with BLI, Inc. Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Royalty Consultant relationship with Bristol Meyers Squibb/Celgene Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Consulting fee Speaker/Speaker's Bureau relationship with Bristol Meyers Squibb/Celgene Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=H noraria Consultant relationship with GlaxoSmithKline Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Consulting fee Speaker/Speaker's Bureau relationship with GlaxoSmithKline Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Honoraria Consultant relationship with Janssen Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Consulting fee Speaker/Speaker's Bureau relationship with Janssen Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Honoraria Consultant relationship with Visterra Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Consulting fee Speaker/Speaker's Bureau relationship with Visterra Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Honoraria Consultant relationship with Kyverna Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Consulting fee No relevant relationships by Sunita Sharma No relevant relationships by Colin Swenson No relevant relationships by Robert Swerlick

Optic neuritis in children

Introduction Optic neuritis (ON) are rare in children. They are due to inflammation of the optic nerve which results in a sudden drop in visual acuity, or amputation of the visual field. They are often secondary to an infectious disease or vaccination, but they can be part of auto-inflammatory, demyelinating or systemic diseases. The features of optic neuritis in children are different from adults as regards high rate of bilateral involvement, poor visual acuity, and papillitis. Aim Our aim is to describe the clinical and therapeutic outcomes of patients diagnosed with optic neuritis in the general pediatrics department at the CHU of Bab el Oued in Algiers. Methods It is a retrospective, descriptive study of patients who were treated for optic neuritis in our hospital over a period of three years (January 2018 to April 2021). Results There were 7 cases, 4 girls and 3 boys with F: M of 1.3:1, mean age of 10 years and age range of 6–13 years. The first manifestation was a decrease in visual acuity in all cases, 12 eyes affected, with bilateral involvement in 5 patients. Visual acuity decrease was severe < 3/10 in 80% of cases. The visual field was pathological in 2 cases (narrow, central scotoma). All patients had headaches. Retrobulbar involvement was confirmed by visual evoked potentials in all patients, they showed demyelinating involvement. Three patients presented papillitis. The diagnostic work-up included cerebral imaging which showed old nodular abnormalities of signal of the subcortical white matter in one patient. CSF analysis revealed anti-MOG antibodies in only one case. The infection investigations were negative in all cases except positive COVID 19 serology in one case The diagnosis retained in our patients were 2 cases of Behcet's disease, 1 monophasic neuritis, 1 optic neuritis with anti-MOG, 1 CRION, 1 case linked to COVID 19 in the absence of another plausible cause. In one case, no diagnosis was retained. Seventy percent of the patients benefited from treatment with corticosteroids pulse, only 2 did not receive treatment, the short-term evolution was favorable in 5 patients with a total recovery of visual acuity, one patient has evolved into atrophy of the left optic nerve and kept visual acuity low to 1/10 of the left eye. The medium-term evolution was marked by recurrence in 3 patients, 5 episodes in the 2 patients with Behcet's disease and 8 episodes in CRION which required the use of immunosuppressive treatment and biotherapy for Behcet's disease and plasmapheresis for CRION. Conclusion Despite the fact that our small series of patients is not representative, we found similar characteristics described in children in other studies. The average onset age was 10 years, with a female predominance, the severe decrease in visual acuity with frequent bilateral involvement. The diagnosis of ON is clinical and must be considered in any sudden drop in visual acuity. The diagnosis of the underlying pathology is often difficult but it’s important in order to propose an adequate specific treatment. The treatment of children's ON is controversial and usually extrapolated from adults. Most practitioners use corticosteroids pulse. The visual prognosis seems good in children, particularly in the case of bilateral involvement, but depends essentially on the aetiology.

The impact of COVID-19 response measures on the quality of life for children in the Eastern Mediterranean Region using an exposome approach: a narrative review

Background: There is a consensus that children's needs have not been sufficiently prioritized during the COVID-19 pandemic, and their right to a safe and healthy childhood has been compromised to an extent, worldwide. A comprehensive assessment of population- and individual-level changes associated with COVID-19 and its pandemic response measures could be undertaken using the human exposome concept. The exposome is defined as the totality of environmental exposures from conception onwards, including the endogenous response. The objective of this study was to conduct a narrative review using an exposome approach exploring short-term changes in the children's exposome profile (< 18 years old) associated with the COVID-19 measures implemented in the Eastern Mediterranean region (EMR).

Vedolizumab treatment of refractory immune checkpoint inhibitor colitis

Introduction: Immune checkpoint inhibitors (ICI) are commonly associated with gastrointestinal adverse events including colitis. We present a case of severe immune checkpoint inhibitor colitis managed with vedolizumab after failing standard treatment with steroids and infliximab. Case Description/Methods: A 75-year-old male with metastatic melanoma status post brain tumor resection, radiation therapy and 2 cycles of ipilimumab/nivolumab presented with severe new onset diarrhea 3 weeks after his second cycle of ICI. Given concern for ICI induced colitis, oral prednisone was started with initial improvement of diarrhea. Severe diarrhea recurred with tapering and he was admitted to the hospital. After infectious workup was negative, he received a dose of infliximab for presumed immune-mediated colitis with mild improvement. He was discharged on prednisone 60 mg daily with a rapid 2-week taper before receiving COVID-19 vaccination. He received a second dose of infliximab 2 weeks after the first. However, a week later, he was readmitted to the hospital with grade 3 diarrhea, dehydration, weakness, hypotension, and continued weight loss. Flexible sigmoidoscopy revealed continuous mucosal ulceration with congestion and loss of vascular markings from anus to sigmoid colon (Figure 1). Biopsies showed moderate to severe active colitis with ulceration, increased crypt apoptosis, and crypt dropout-most compatible with immune checkpoint inhibitor colitis. After 1 week of poor response to high dose methylprednisolone, he was given 2 doses of vedolizumab 2 weeks apart which lead to a complete resolution of his GI symptoms. Four months later, he remains asymptomatic with a negative PET scan off vedolizumab and ICI therapy. Discussion: Immune checkpoint inhibitors (ICI) revolutionized therapeutics for malignancy in their enhancement of cytotoxic T cell survival, but the resulting robust immune response engenders adverse gastrointestinal events in 1/3 of patients around 1-2 months after the second or third dose. ICI colitis may result in abscess, perforation, and death, and it is imperative to undergo early endoscopy with biopsy plus initiation of steroids or immunotherapy, especially in severe cases. Our patient presented with grade 3 diarrhea and severe immune-mediated colitis refractory to steroids and infliximab, though vedolizumab was effective in resolution.

[Corona Virus, Breastfeeding and Guidelines - a Worldwide Review]

INTRODUCTION: The COVID-19 pandemic has forced countries worldwide to face major issues and challenges. Among those challenges is breastfeeding from the first hours after birth until late infancy, in hospitals and communities. There is a consensus throughout the world and among leading international professional medical associations that breastfeeding is of significant importance for short- and long-term health outcomes in mothers and infants, as well as for its public health impact and reduction of national health expenditures. Moreover, breastfeeding or human milk feeding have been shown to reduce morbidity, specifically respiratory infections, among infants and children. This is not the first time health systems are dealing with coronavirus outbreaks, although currently, in the COVID-19 pandemic, there is still much that is unknown. Dealing with the unknown can lead to guidelines that may not fully take into consideration relevant risk benefit ratios for individuals and groups. In this review, we aim to summarize the guidelines of different leading professional groups around the world dealing with the COVID-19 pandemic. Evidence-based medicine rests on relevant scientific evidence, patients' values and preferences and clinical judgment. We wish to propose guidelines based on available evidence concerning breastfeeding, the current pandemic and weighing in potential risks and benefits while highlighting the need for ongoing breastfeeding research.

[Quality of "crisis communication" media during the COVID-19 pandemic in the Great Maghreb countries]. / Qualité des supports de communication de crise lors de la pandémie de la COVID-19 au Grand Maghreb.

OBJECTIVE: To objectively assess the quality of "crisis communication" media, during the COVID-19 pandemic, in the three Greater Maghreb countries (Tunisia, Algeria, Morocco). METHODS: A compliance audit for press releases and epidemiological bulletins was analyzed against a quality benchmark, which had been specifically designed by the authors. This framework, made up of five dimensions and 50 items, graded (0/1), was applied by two researchers in preventive medicine. Multiplying the scores by a coefficient of two resulted in a partial score of 20 points for each dimension and a total score of 100 points for the checklist taken as a whole. The quality of the communication media was considered to be good when exceeding the thresholds of 15/20 for the different dimensions and 75/100 for the entire grid. RESULTS: A total of 141 information media were included in this audit (Tunisia: 60; Algeria: 60; Morocco: 21). The overall median quality score for these media was only 56/100 (IIQ: [46-58]), without major variability between countries. The most appreciated dimension was "maintaining the confidence of the population", with an overall median score of 14/20 (12/20 for epidemiological bulletins and 16/20 for press releases). The most poorly rated dimension was "strengthening community participation", with a median score of only 4/20 (6/20 for epidemiological bulletins and 4/20 for press releases). CONCLUSION: The quality of the Maghreb crisis communication media during COVID-19 was insufficient in most of its dimensions and items, particularly from a psychosocial standpoint. Reinforcement of the capacities of communication officers to develop information material and supports during health crises is indispensable and should be considered as an urgent matter.

Novel coronavirus disease 2019 pharmacological treatments: A review

The COVID-19 pandemic has caused an extraordinary need and challenge to identify effective therapeutic options for prevention and treatment. In this review, we summarize the major findings in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral characteristics and the novel coronavirus disease 2019 (COVID-19) pathophysiology, clinical presentation and outcomes. We then proceed to explain the mechanisms of action, outcomes, and adverse events identified for the front-running pharmacological treatments currently being used and/or investigated namely Remdesivir, Chloroquine/Hydroxychloroquine, Lopinavir/Ritonavir, Tocilizumab, and convalescent plasma. © 2020, American University of Beirut. All rights reserved.