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Background: Cancer patients have increased risk for severe outcomes related to SARS-CoV-2 infection (COVID-19), due to their increased vulnerability to infection, older age, and comorbidities in comparison to the general population. While multiple studies have been completed examining outcomes of COVID-19 infection in cancer patients overall, there has been limited investigation into the outcomes of COVID-19 infection in patients with genitourinary (GU) cancers. Method(s): We completed a single institution retrospective study to examine the outcomes of adults with GU cancers and COVID-19 infection from March 10, 2020 to June 15, 2022. Baseline data included age, sex, BMI, type of malignancy, cancer status (stable or progressive disease, in remission), current and previous anticancer therapy received, and comorbidities. Result(s): Eighty-four patients with a GU cancer diagnosis and laboratory-confirmed SARS-CoV-2 infection were identified. Seventy-nine (94%) were male and the median age was 64 years (range 24-91). Forty-four (52%) were non-Hispanic white, 28 (33%) were Hispanic, and 11 (13%) were African-American. Prostate cancer was the most common (n = 45), followed by renal cell carcinoma (n = 20), testicular (n = 9), bladder (n = 6), and penile cancer (n = 3). Eight patients had >=2 episodes of COVID-19 infection. Sixty-three percent of patients were unvaccinated at the time of infection, while 37% of patients had breakthrough infection. Hospitalization was required for 39.3% (n = 33), with 4.8% (n = 4) requiring ICU admission. Of the patients requiring hospitalization, 26.2% (n = 22) died. Hospitalization was associated with having>=2 comorbidities (OR 18.6 [95% CI, 3.1-111.8], p<0.01) and receiving active cancer treatment (OR 12.4 [95% CI, 1.92- 79.7], p, 0.01). Mortality was associated with advanced age (OR 21.7 [95% CI, 1.40-341.7], p=0.03) and >=2 comorbidities (OR 19.2 [95% CI, 3.02-122.5], p=0.02). Vaccination was negatively associated with both hospitalization (OR 0.04 [95% CI, 0.02-0.91], p=0.04) and mortality (OR 0.14 [95% CI, 0.02-0.84], p=0.03). Conclusion(s): Among patients with GU cancer, advanced age and comorbidities are associated with adverse outcomes of COVID-19 infection;vaccination is protective. With the emergence of variants and waning immunity of vaccines, our findings highlight the importance of development and implementation of enhanced mitigation strategies in cancer patients, especially those undergoing active cancer treatment.
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INTRODUCTION: Fungal co-infection in ICU patients hospitalized with COVID-19 pneumonia has been described. Biomarkers such as galactomannan (GM) from serum and bronchoalveolar lavage have low sensitivity. 1,3 Beta-d-glucan (BdG) may have higher sensitivity, but it lacks specificity. In this study, we examined the clinical outcome and utility of fungal biomarkers in the diagnosis of fungal co-infections in ICU COVID-19 patients. METHOD(S): Intensive care Unit (ICU) COVID-19 patients treated for fungal co-infections (COVID+ Fungal co-infection) were compared to ICU COVID-19 patients without fungal co-infections as controls. The primary outcome of this study were to determine the utility of fungal biomarkers in COVID+ Fungal-co-infected patients compared to similar patients without fungal infection (control group). Patients were entered into a spreadsheet and then analyzed using SPSS (ver. 27, IBM, Inc.). Mean (+/- SD) and percentages were reported. RESULT(S): A total of 76 ICU COVID-19+ patients were identified. 54 were COVID+ fungal co-infected, 22 were COVID+ control patients. 53 (69.7%) were male. Most patients were Caucasian (76%), with 7.9% Hispanic and 6% African American. Mean (+/- SD) age was 59.6 +/- 12.0. Eightysix percent of patients received mechanical ventilation, 59% underwent bronchoscopy and expired during hospitalization, respectively. COVID associated pulmonary aspergillosis (CAPA) was diagnosed in 21% of COVID+ Fungal coinfected group. BdG was obtained in 17 (31.5%) COVID+ Fungal+ compared to 4.5% in control patients (p=0.012). Fungal culture was obtained in 40 (74%) COVID+ Fungal+ group compared to 5.4% in control group (p< 0.001). Aspergillus antigen in BAL in 52% COVID+ Fungal+ patients compared to 5.4% in controls (p< 0.001). Similarly, 54 (71%) patients received antifungal therapy (97% with positive fungal culture was treated compared to 41% with negative culture, p< 0.001). Most patients (84%) with positive fungal culture were treated with voriconazole. CONCLUSION(S): Fungal biomarkers including BdG and GM were more likely to be positive in COVID-19+ Fungal-coinfection. Use of the fungal biomarkers (BdG, GM) were used in a minority COVID+ patients for diagnosis. Fungal culture did prompt anti-fungal therapy, mainly voriconazole treatment.
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SESSION TITLE: COVID-19: Other Considerations in Management SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: To evaluate the incidence of fungal co-infections clinical characteristics, and outcomes in patients with COVID-19. METHODS: We conducted a retrospective chart review of electronic medical records of 2,639 adult patients admitted for COVID -19 to our health system from April 1, 2020 to December 31, 2021. Demographic data, comorbidities, length of hospital stay, laboratory results including fungal diagnostics, COVID therapeutics and antifungals, need for ICU admission, mechanical ventilation and in-hospital mortality were collected. RESULTS: A total of 45 of 2,639 (1.7%) COVID-19+ patients had a positive fungal test or culture of fungal pathogen and subsequently received antifungal treatment. Of these 25 (55.6%) cases of Aspergillus species were the most prominent, followed by Candida species at 12 (26.7%). Of note, there was one case each of Cryptococcus and Histoplasma (2.2%). COVID-19+ patients with fungal co-infection who survived (18;40%) were significantly younger compared to COVID-19+ patients with fungal co-infection who died (27;60%, p=0.014). Majority of COVID-19+ patients with fungal co-infection were white with average length of hospitalization of 24 days. Those patients who survived had a significantly longer length of hospitalization compared to COVID-19+ patients who died (survived 31 ± 21.5 compared to 19.6 ± 10.4 days, p<0.05). Majority of COVID-19+ patients received steroids, and remdesivir therapy for COVID-19. Antifungal treatment consisted of either voriconazole or micafungin as predominate fungal pathogens were either Aspergillus or Candida spp. CONCLUSIONS: Pulmonary aspergillosis followed by invasive candidiasis were the most common fungal co-infections in COVID-19 patients treated at our institution. In-hospital mortality from all fungal co-infections was 60%. Patients that survived were younger and hospitalized longer compared to those who expired. Need for mechanical ventilation, ICU admission and COVID therapeutics were not significantly different between the survived and expired group of COVID-19 patients with fungal co-infections. CLINICAL IMPLICATIONS: The increased risk and incidence of COVID-19 and fungal co-infection has been noted in a handful of studies with invasive aspergillosis being the most commonly reported fungal co-infection. There have been very few reports of other fungal co-infections including invasive candidiasis, mucormycosis, histoplasmosis, and cryptococcosis. Minimal incidence data has been reported on co-infection with other opportunistic fungal pathogens such as Histoplasma spp., Pneumocystis jirovecci, or Cryptococcus neoformans. This study supports previous findings of increase risk of Aspergillosis, but also show incidence of Histoplasmosis and Crytpococcal fungal infections. These fungal infections may be under reported in COVID-19 and may warrant further research. DISCLOSURES: No relevant relationships by Christopher Destache No relevant relationships by Rutendo Jokomo-Nyakabau No relevant relationships by Dorothy Kenny No relevant relationships by Paul Millner No relevant relationships by Anny Nguyen No relevant relationships by Mohammad Selim No relevant relationships by Richard Swaney No relevant relationships by Manasa Velagapudi
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In the efforts to ensure the health of the Australian population during the COVID pandemic, social, economic, and environmental aspects of people's life were impacted. In addressing the pandemic risks, a number of governments prioritized people's health and well-being over GDP growth. The Genuine Progress Indicator (GPI) is used to account for factors that influence well-being. We used the GPI to assess the pandemic's impact on well-being and we examined our results in relation to the GDP. We estimated the GPI for the first 6 months of 2019 and the same period in 2020, during which the first stages of the COVID pandemic and the first nationwide lockdown in Australia took place. We examined two scenarios, in the first we found that in Q1 the GDP growth (1.4%) was accompanied by a significant GPI growth (5.3%), showing a positive relation to the GDP;but in Q2 the significant drop (-6.3%) in the GDP was not followed by the GPI, instead the GPI growth remained almost steady with even a relatively small increase (0.33%), indicating a negative relation to the GDP growth. Whereas in the second scenario, the GPI growths (7.12%) in Q1 and (-2.60%) Q2 were positively related to the GDP growths (4.6%) in Q1 and (−0.25%) Q2.We discuss the reasons for the divergence between the two indicators and one of the limitations of the GPI as a measure of well-being. Lastly, we discuss the behavioural and policy lessons of the lockdown and their relevance to what is proposed by degrowth economists. © 2022 The Author(s)
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TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Aortic root abscess is a lethal complication of infective endocarditis. Here, we report a case of aortic root abscess that occurred as a complication of S. epidermidis prosthetic valve endocarditis, which is a rare cause of aortic abscess. CASE PRESENTATION: 71-year-old woman with complex cardiac history including a bioprosthetic aortic valve replacement, ascending aorta aneurysm repair, and coronary artery bypass graft x4 presented to the ER with worsening chest pain, fevers, chills and rigors. On arrival, temperature was 97.5°F heart rate was 61 beats/min, respiratory rate was 20 per minute and blood pressure was 139/82 mm Hg. On exam, she had a grade 4/6 ejection systolic murmur, heard best at the right upper sternal border radiating to carotids. Laboratory investigations showed hemoglobin, 10.5 g/ dL;total leukocyte count, 10 k/uL with 80% neutrophils;platelet count, 311 k/uL;and sedimentation rate, 74 mm/hr. Rest of the labs were normal. She tested negative for SARS-Cov-2 by polymerase chain reaction (PCR). Blood cultures grew isolated Staphylococcus epidermidis. She was persistently bacteremic on vancomycin monotherapy and required ceftaroline and daptomycin combination therapy for clearance of bacteremia. Transesophageal echo cardiography was obtained which showed an area of echolucency adjacent to the posterior aortic valve annulus suggestive of abscess. PET CT was obtained, confirmed the diagnosis of aortic abscess. She was referred to Mayo Clinic. She underwent, extensive debridement of previously implanted tissue aortic valve and entire root complex, coronary artery bypass grafting and aortic root replacement. DISCUSSION: Aortic root abscess is a life-threatening complication of aortic valve endocarditis, known to occur in patients with native and prosthetic aortic valves. Staphylococcus aureus is the reported as most common cause. Persistent fever, shortness of breath, chest pain and other signs of severe aortic regurgitations are the most common presentation. Aggressive surgical debridement and medical therapy are the key to treatment. If untreated, can result in severe valvular dysfunction, fistula formation, perforation of cusps, pseudoaneurysm, obstruction of coronary flow or fatal arrhythmia. Even with surgery, reported mortality remains high 12.2-30%. CONCLUSIONS: Aortic root abscess should be considered as a diagnosis in persistently febrile and bacteremic patients with prosthetic valve endocarditis and should be treated promptly with surgical debridement and reconstruction. REFERENCE #1: Chen G-J, Lo W-C, Tseng H-W, Pan S-C, Chen Y-S, Chang S-C. Outcome of surgical intervention for aortic root abscess: a meta-analysis. Eur J Cardiothorac Surg 2018;53:807–14 DISCLOSURES: No relevant relationships by Rosa Cruz Torres, source=Web Response No relevant relationships by Dorothy Kenny, source=Web Response No relevant relationships by Sanu Rajendraprasad, source=Web Response No relevant relationships by Manasa Velagapudi, source=Web Response
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INTRODUCTION: Poverty and deprivation can harm children's future health, learning, economic productivity and societal participation. The Australian Healthier Wealthier Families project seeks to reduce the childhood inequities caused by poverty and deprivation by creating a systematic referral pathway between two free, community-based services: universal, well-child nursing services, which provide health and development support to families with children from birth to school entry, and financial counselling. By adapting the successful Scottish 'Healthier Wealthier Children' model, the objectives of this Australian pilot are to test the (1) feasibility of systematising the referral pathway, and (2) short-term impacts on household finances, caregiver health, parenting efficacy and financial service use. METHODS AND ANALYSIS: This pilot randomised controlled trial will run in three sites across two Australian states (Victoria and New South Wales), recruiting a total of 180 participants. Nurses identify eligible caregivers with a 6-item, study-designed screening survey for financial hardship. Caregivers who report one or more risk factors and consent are randomised. The intervention is financial counselling. The comparator is usual care plus information from a government money advice website. Feasibility will be evaluated using the number/proportion of caregivers who complete screening, consent and research measures, and access financial counselling. Though powered to assess feasibility, impacts will be measured 6 months post-enrolment with qualitative interviews and questionnaires about caregiver-reported income, loans and costs (adapted from national surveys, for example, the Household, Income and Labour Dynamics in Australia Survey); health (General Health Questionnaire 1, EuroQol five-dimensional questionnaire, Depression, Anxiety, Stress Scale short-form); efficacy (from the Longitudinal Study of Australian Children); and financial service use (study-designed) compared between arms. ETHICS AND DISSEMINATION: Ethics committees of the Royal Children's Hospital (HREC/57372/RCHM-2019) and South West Sydney Local Health District (2019/ETH13455) have approved the study. Participants and stakeholders will receive results through regular communication channels comprising meetings, presentations and publications. TRIAL REGISTRATION NUMBER: ACTRN12620000154909; prospectively registered. Pre-results.