Ehealth Intervention Via Line Social Media as an Adjunct for Postoperative Care after Bariatric-Metabolic Surgery - Single Institution Experience

Background/Introduction: Applying eHealth interventions via social media is common in modern medicine. LINE is a popular communication app in Taiwan that can deliver messages 24 hours a day. In addition to being free-of-charge, it also allows bariatric nurses (BNs) and patients to enjoy bidirectional communication via telecommunication services instead of direct, face-to-face contact for patients undergoing bariatric-metabolic surgery (BMS). Objective(s): We conducted this retrospective study to determine the frequency and reasons for early post-discharge of LINE messages/calls and investigate the relationship between this frequency and contents of these messages and postoperative outcomes after BMS. Method(s): A retrospective review of prospectively collected data was conducted in an Asian weight management center. The study period ran from August 2016 to December 2021, and a total of 143 native patients with severe obesity were enrolled. All patients were informed of the necessity of a postoperative dietitian consultation before bariatric surgery. The patterns of LINE communication with the BN and associated actions to resolve patients' needs within 180 days after index BMS were analyzed. Result(s): Among the 143 enrolled patients, 100 underwent laparoscopic sleeve gastrectomy and 43 underwent laparoscopic Roux-en-Y gastric bypass. A total of 1,205 messages/calls were analyzed concomitantly;most LINE communications focused on diet problems (47.97%;n = 578), weight problems (11.54%;n = 139), and medications (9.21%;n = 111). Most problems could be resolved by LINE communications directly, and only a small portion (5.6%) was directed to local clinics or emergency departments. During the COVID-19 pandemic, the usage of LINE communications significantly increased (12.2 +/- 10.4 vs. 6.4 +/- 4.9;p < 0.01);nonetheless, a higher frequency of LINE communications would not hinder the regular clinic visits (r = 0.359;p = 0.01). Conclusion(s): Based on our limited experience, the LINE consultation service operated by the BN could effectively address patients' problems. Moreover, it might reduce the need for emergency department visits or unexpected clinic appointments for patients after BMS.

Low Incidence of COVID-19 Infection in Patients with Acute Myeloid Leukemia Undergoing Reduced Intensity/Venetoclax Based Treatment: Initial Results of the PACE Prospective Clinical Study from the UK Trials Acceleration Program

The impact of Coronavirus disease 2019 (COVID-19) on outcomes in patients with cancer remains unclear. Acute Myeloid Leukemia (AML)/high-risk myelodysplasia (MDS) are common hematological malignancies resulting in profound immunosuppression, which is exacerbated by intensive and less-intensive chemotherapy. Importantly, venetoclax based regimens have been increasingly used during the pandemic as a strategy to reduce patient hospitalization however, there is little information concerning the impact of such regimens on COVID-19 infection rates. We therefore opened a prospective clinical study (PACE), at the start of the current pandemic in April 2020 to characterize the risk of COVID-19 infection in patients with AML/MDS-EB2 receiving intensive or non-intensive treatment, including patients treated with venetoclax-based regimens. The primary aim was to determine the incidence of COVID-19 in patients with AML /MDS-EB2 including both, prior to study entry and during treatment until 4 weeks after the last cycle of treatment. Secondary aims were to: characterize the presentation of COVID-19;define the severity and type of both non-COVID-19 and COVID-19 infections;and undertake an exploratory analysis to quantify the incidence of COVID-19 infection in patients receiving (less-intensive) venetoclax based regimens. All analysis conducted to date has been descriptive. 211/230 recruited patients had full treatment histories available, of whom 116 patients received intensive chemotherapy and 95 low intensity regimens. 48 patients received a venetoclax-based regimen. The median age of the non-intensive treatment arm was 72 years;(range 19.1-86.5) and of the intensive arm was 59 years (range 16.1-76.1). There were more cases of secondary AML and relapsed disease in the non-intensive arm as compared to the intensive arm. 25/226 evaluable patients tested positive for COVID-19 as defined by positive SARS-CoV2 PCR test, 10 with a prior diagnosis at study entry and 15 tested positive during the study. The incidence of COVID-19 infection for patients with AML/MDS-EB2 was 11.1% (90%CI: 7.8%-15.1%) (Table). A lower proportion of patients (n=6/91 6.6%) undergoing non-intensive treatment suffered COVID-19 as compared to those undergoing more intensive chemotherapy regimens (n=19/116, 16.4%). Specifically, only 3/48 (6.3%) patients undergoing a venetoclax regimen were infected with SARS-CoV2. The most common presenting symptoms of COVID-19 in this study, regardless of the intensity of chemotherapy, was fever and cough with 6/25 patients asymptomatic. The risk of death at 30 days following study entry in patients who had prior COVID-19 infection or who contracted COVID-19 during this period was 13.6%, compared to 3.9% in the overall cohort without COVID-19 infection. There was a lower incidence of non-COVID-19 related infections in patients receiving venetoclax-based regimens, n=43 infections in 24 (50.0%) of patients;with 313 infections in 94 (81%) of intensively treated patients. The overall occurrence of non-COVID-19 infection in the non-intensive arm was 87 infections in 50 (54.9%) patients. Our multi-center study provides real-world estimates for the incidence and presentation of COVID-19 infection in a cohort of patients with AML/MDS-EB2, and indicates a higher risk of death at 30 days in patients with prior COVID-19 infection prior to, or during treatment. Venetoclax based, and other non-intensive, regimens, increasingly implemented during the pandemic, to minimize patient exposure and reduce usage of hospital beds, appeared to be associated with a low incidence of COVID-19. Further follow-up will be required to understand the long-term impact of this strategy. Analysis of immune responses to COVID-19 infection and vaccination is on-going. Acknowledgments: This study was funded by Cure Leukaemia under the Trials Acceleration Program (TAP), and grants from BMS and Blood Cancer UK. [Formula presented] Disclosures: Loke: Novartis: Other: Travel;Janssen: Honoraria;Amgen: Honoraria;Pfizer: Honoraria;Daichi Sankyo: Other: Travel. K apper: Pfizer: Consultancy, Speakers Bureau;Astellas: Ended employment in the past 24 months, Speakers Bureau;Jazz: Consultancy, Speakers Bureau;Novartis: Consultancy, Research Funding, Speakers Bureau. Khan: Abbvie: Honoraria;Astellas: Honoraria;Takeda: Honoraria;Jazz: Honoraria;Gilead: Honoraria;Novartis: Honoraria. Dillon: Amgen: Other: Research support (paid to institution);Astellas: Consultancy, Other: Educational Events, Speakers Bureau;Menarini: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Session chair (paid to institution), Speakers Bureau;Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: educational events;Jazz: Other: Education events;Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Research Support, Educational Events;Shattuck Labs: Membership on an entity's Board of Directors or advisory committees. Culligan: AbbVie Ltd: Honoraria, Speakers Bureau;Celgene Ltd: Honoraria, Speakers Bureau;Gilead: Honoraria, Speakers Bureau;Jazz Pharma: Honoraria, Speakers Bureau;Takeda UK Ltd: Honoraria, Speakers Bureau. McMullin: Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Other: clinical trial support, Research Funding;Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;AbbVie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;AOP Orphan: Research Funding, Speakers Bureau. Murthy: Abbvie: Other: support to attend educational conferences. Craddock: Novartis Pharmaceuticals: Other: Advisory Board;Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding.

Skin manifestation and diagnosis of febrile diseases by COVID-19 and other ribonucleic acid viruses: The diagnostic clues

Many febrile diseases caused by ribonucleic acid virus infection demonstrate ctutaneous manifestations with preceding prodromes. Ibis review provides a flowchart highlighting the diagnostic clues of viral exanthan. Besides febrile prodromes, patients with chikungunya virus have severe arthralgias and macular hyperpigmentation on the noses. Coronavirus disease 2019 demonstrates unique actocyanosis and pseudotiostbite besides elythematous rash and urticaria, suggesting abnormal coagulation. Dengue fever should be suspected when patients in the tropical region present with biphasic fever, headache, retroorbital pain, and centrifugal morbillifonn rash. Dengue hemorrhagic fever, a potentially fatal complication, results from systemic vascular leakage. High-temperature fever and sudden-onset severe headache raise the possibility of Ebola virus infection. Patients with hand-foot-and-mouth di,wase may experience morbillifonn or vesicular eruption, especially over the hands, feet, and oral mucosa. In acute human immunodeficiency virus infection, maculopapular eruptions often appear on the face and neck after prodromes. Primary human T-lymphotropic-III virus infection can induce widespread maculopapular or naseola-like exanthem, sparing the hands and feet. Cutaneous manifestations of natavirus include generalized maculopapular rash, Sweet's syndrome, Henoch-Schonlein purpura, Gianotti-Crosti syndrome, and acute hemorrhagic edema. Rubella is usually suspected when low-grade fever and lymphadenopathy are accompanied by a discrete pinpoint-sized maculopapular rash, which spreads and diminishes faster than measles. Cough, coryza, and conjunctivitis followed by morbilliform eruptions and Koplik's spots are diagnostic of measles. Exanthem of Zika virus comprised of small pruritic papules that extend downwards. Laboratoty testing is helpful in making a definitive diagnosis. Viral isolation, measurement of immunoglobulin M (IgM) or IgG, and/or reverse transcription polymerase chain reaction are useful diagnostic tools with favorable sensitivity and specificity.

Driving Forces of Changes in Air Quality during the COVID-19 Lockdown Period in the Yangtze River Delta Region, China

During the COVID-19 lockdown period (from January 23 to February 29, 2020), ambient PM2.5 concentrations in the Yangtze River Delta (YRD) region were observed to be much lower, while the maximum daily 8 h average (MDA8) O-3 concentrations became much higher compared to those before the lockdown (from January 1 to 22, 2020). Here, we show that emission reduction is the major driving force for the PM2.5 change, contributing to a PM2.5 decrease by 37% to 55% in the four YRD major cities (i.e., Shanghai, Hangzhou, Nanjing, and Hefei), but the MDA8 O-3 increase is driven by both emission reduction (29%-52%) and variation in meteorological conditions (17%-49%). Among all pollutants, reduction in emissions mainly of primary PM contributes to a PM2.5 decrease by 28% to 46%, and NOx emission reduction contributes 7% to 10%. Although NOx emission reduction dominates the MDA8 O-3 increase (38%-59%), volatile organic compounds (VOCs) emission reduction lead to a 5% to 9% MDA8 O-3 decrease. Increased O-3 promotes secondary aerosol formation and partially offsets the decrease of PM2.5 caused by the primary PM emission reductions. The results demonstrate that more coordinated air pollution control strategies are needed in YRD.