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SESSION TITLE: COVID-19 Co-Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Over the past 2 years, SARS-CoV-2 has been undergoing research regarding its immunopathology, with its understanding continuously evolving. We present a case of severe respiratory failure from viral co-infection with SARS-CoV-2, parainfluenza virus III, influenza A, and adenovirus. CASE PRESENTATION: A 42-year-old female with no respiratory or immunological comorbidities, was admitted with respiratory failure that progressed within days to severe septic shock and refractory hypoxemia requiring venovenous extracorporeal membrane oxygenation (VV-ECMO). On initial laboratory evaluation, her nasopharyngeal swab sample tested positive for SARS-CoV-2, Parainfluenza virus III, Influenza A, and Adenovirus on our institute's ROCHE PCR detection test. This was then confirmed with an endotracheal sample and a BAL sample, each of which tested positive for the above 4 viruses. The patient had no prior history of lung disease, autoimmune disorder, immunodeficiency, or malignancy. Serum immunoglobulin levels were within normal range, and the patient tested negative for HIV. She was not on any immunomodulators, and had no known contacts with individuals with polyviral infection. Her presentation had been usual, with 6 days of fever, shortness of breath, extreme fatigue, coughing, and diarrhea. She had initially received treatment with remdesivir, tocilizumab, and dexamethasone. But these tests were noted to be positive prior to her receiving any therapies. Her hospital course was complicated by septic shock, refractory hypoxemia, secondary ventilator associated pneumonia, and fungemia, requiring invasive mechanical ventilation, inhaled nitric oxide, vasopressors, broad spectrum antimicrobials, and eventually rescue by VV-ECMO. She slowly recovered over 6 weeks, received a tracheostomy and was discharged to a long-term acute care hospital for continued rehabilitation and weaning from mechanical ventilation. At 1 year follow up, she has made a full recovery with no residual respiratory limitation. DISCUSSION: Co-infection is defined as infection at diagnosis within 7 days of initial primary infection, whereas, secondary infection develops after 7 days. Co-infection of respiratory viruses, though uncommon, has been reported. Their detection has improved with the use of PCR testing. Simultaneous infection of COVID-19 and usual respiratory viruses has also been documented. Effect of co-infection on disease severity is a result of interaction of viruses among themselves and with the host. CONCLUSIONS: COVID-19 research has mainly focused on SARS-CoV-2 effects on the human host, but with it evolving into an endemic, its interaction and co- and superinfection with other pathogens is imperative. Further research into such interactions of SARS-CoV2 are required to help develop preventative and therapeutic measures. Reference #1: Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with covid-19: A systematic review and meta-analysis. SSRN Electronic Journal. 2020. Reference #2: Kim D, Quinn J, Pinsky B, Shah NH, Brown I. Rates of co-infection between SARS-COV-2 and other respiratory pathogens. JAMA. 2020;323(20):2085. Reference #3: DaPalma T, Doonan BP, Trager NM, Kasman LM. A systematic approach to virus–virus interactions. Virus Research. 2010;149(1):1-9. DISCLOSURES: No relevant relationships by Vinita Kusupati No relevant relationships by Jyoti Lenka No relevant relationships by Rachel Tan
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The beginnings of the interview date back to 2019, the year when we commemorated the 50th anniversary of the publication of Ethnic Groups and Boundaries (Barth 1969). We used this event as a springboard for looking back at the rich professional trajectory of Professor Ulf Hannerz, in which ethnicity and other forms of collective identities play one of the key roles. The interview was started after a lecture by Professor Hannerz, ‘Fifty Years of Diversity Watching’, given at the Department of Ethnology of Charles University in Prague in September 2019, and it was finalised during the COVID-19 pandemic online via e-mailing the questions and answers back and forth between Stockholm and Prague.
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BACKGROUND: Digital smartphone assistants for the care and support of people with dementia (PwD) have great potential due to the wide availability of smartphones and a growing number of users aged above 65. Research has mainly focused on the development of applications for only one user group (patients, caregivers, or relatives respectively), and with only one or a few functions included (Yousaf et al., 2020). A more integrative, multi-user, and multifunctional application would be beneficial because it could be adapted to the users' needs more flexibly. This qualitative interview study was the first step in a co-creative process with a user-centered approach aimed at developing a multifunctional digital assistant. METHOD: Qualitative content analysis (Mayring, 2010) combining deductive and inductive techniques was applied to identify burdens, needs, functions, ethical considerations, and acceptance aspects. 14 semi-structured interviews were conducted with three participant groups (relatives of PwD; caregivers and nursing staff; psychologists). Interviews were conducted via video conferences due to Covid-19 restrictions. After the completion of all interviews, participants received several questionnaires on acceptance aspects (Technology Usage Inventory [TUI], acceptance rating of specific functions), and technological affinity (TA-EG questionnaire) via letter. Interviews were transcribed verbatim with the software MAXQDA. Coding was done by two independent researchers. A coding frame was generated using the interview guide as a theoretical basis and the collected data for building inductive categories. The coding frame was pilot-tested before the final analysis and intercoder reliability was sufficient (k=.81). RESULT: Preliminary results showed that dealing with symptoms of dementia in everyday life was burdening. Emotional needs in patients and needs for additional care resources in relatives and caregivers were the most important unanswered needs. 53 functions were suggested in the areas: digital care, support, training, monitoring, navigation, leisure activities, and social contacts. Participants had ethical requirements (i.e. data protection, privacy, and autonomy) that if met, would enhance acceptance. Results on questionnaires showed positive attitudes towards, curiosity about, and no insecurity with regards to technology. The overall acceptability of suggested functions was high. CONCLUSION: Participants showed a large interest in the digital assistant. The importance of data protection was underlined.
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SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Coronavirus disease 2019 (COVID-19) has overwhelmed healthcare systems across the state of New York (NY), the epicenter of the pandemic in the United States, with an influx of patients admitted to the Intensive Care Unit (ICU). There are limited reports describing critically ill patients in the US. We took up this project to describe the critical care management with a focus on ventilator settings in a cohort of 32 patients. METHODS: We conducted a retrospective analysis of 32 adult critically ill patients admitted to a tertiary center in upstate NY, between March 14th and April 12th, 2020. We collected demographic, clinical, laboratory, radiological, ventilator, and treatment data by review of electronic records. This abstract is a subgroup analysis with focus on ventilator parameters and critical care management. Results are current as of April 18th, 2020. RESULTS: Twenty-three (71.9%) of 32 patients received invasive mechanical ventilation (IMV) and 9 received noninvasive ventilatory (NIV) support of which 4 received high flow nasal cannula (HFNC). The median (IQR) PaO2/FiO2 ratio was 101 (75.8 - 183.8) consistent with moderate to severe Acute Respiratory Distress Syndrome (ARDS);median (IQR) FiO2 of 70% (50-80%) at 4 hours post-intubation. Pressure Control Ventilation (PCV) was the most common ventilator mode used. Median (IQR) PEEP used was 16 cmH2O (14-20 cmH2O).Median (IQR) plateau pressure was relatively high at 26 cmH2O (23 - 30.5) cm H2O. Median (IQR) static lung compliance was 44 (31 - 59) ml/cm H2O in 11 patients with data available, none were less than 10 ml/cmH2O. Median (IQR) driving pressure was 12 cmH2O (0 – 14) cmH2O. Seven (30.4%) underwent prone positioning and 8(34.8%) received epoprostenol. Three (13%) patients required ECMO and 12(36.3%) required vasopressor support. Nineteen (59.4%) received Hydroxychloroquine, 19 (59.4%) received Azithromycin, 5(15.6%) received lopinavir-ritonavir, 3 (9.38%) received tocilizumab, 15(46.9%) got steroids during ICU stay. By the time of analysis on April 18th,5 (15.6%)died (4 of 23 in the IMV group,1 of 9 in the NIV group),11 (34.4%) had been discharged home (5 of 23 in the IMV group,6 of 9 in the NIV group), and 16 (50%) remained hospitalized, 8 (25%) still in ICU with statistically different median ICU Stay between IMV and NIV groups (12.8 days vs 3.4 days, p<0.001). As of July 25th,10 (31.25%) of 32 patients had died (8 in the IMV group,2 in the NIV group). CONCLUSIONS: Ventilator management in these patients is an evolving field. Many are noted to have near normal lung compliance. Median FiO2 was 70% underscoring the profound hypoxia in these patients. CLINICAL IMPLICATIONS: As with other observational studies on coronavirus patients, our study also noted median driving pressures and static compliance values suggestive of near-normal compliance. Higher PEEP was used early on but with more experience, intensivists started using lower PEEP. DISCLOSURES: No relevant relationships by Leela Krishna Teja Boppana, source=Web Response No relevant relationships by Mamta Chhabria, source=Web Response No relevant relationships by Jyotirmayee Lenka, source=Web Response No relevant relationships by Naman Sharma, source=Web Response No relevant relationships by Damanpaul Sondhi, source=Web Response No relevant relationships by Bryan E-Xin Tan, source=Web Response No relevant relationships by Sharini Venugopal, source=Web Response