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Purpose: To evaluate the clinical efficacy of including Ivermectin (single dose on day 1 of 400 mug/kg PO) in the standard of care in hospitalized adults with severe COVID-19. Method(s): Double-blinded, parallel, placebo-controlled, single-center, randomized clinical trial. Seventy-five patients were randomly assigned (1:1) to receive standard of care plus ivermectin or placebo and were followed up for 21 days. Primary outcome measure was admission to ICU and secondary outcomes were the requirement of intensive mechanical ventilation (IMV) and in-hospital death. Intention-to-treat analyses, estimated risk differences (RD), and Hazard ratios (HR) with Cox regression were performed. Result(s): Enrollment stopped due to the lack of eligible patients. Thirty-seven patients were assigned to intervention and 38 to placebo. Patients in the ivermectin group were 54.5 years on average, 62.2% were male. Comorbidities were more prevalent in the control group (78.9% vs. 56.8%). There was no difference in the 21-day risk of admission to the ICU between ivermectin (21.6%) and placebo (15.8%) (RD= 5.8%;95%CI: -11.8%-23.5%);neither in the risk of requirement of IMV (18.9% vs 13.2%), mortality (5.4% vs 10.5%) or in adverse events (32.4% vs. 28.9%). Discussion(s): Ivermectin showed no significant benefit in reducing the requirement of ICU, IMV, or mortality for severe COVID-19 patients.Copyright © 2022 Asociacion Colombiana de Infectologia. All rights reserved.
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The effects of the pandemic produced by COVID-19 have caused many changes in the protocols of care and operation of medical equipment, due to the need to be able to have less contact with the patient, while ensuring patient care, In the present work, a solution is implemented to be able to control medical equipment remotely, avoiding contact with patients to a minimum, the proposed methodology makes use of a power outlet that has the ability to connect to a wireless network and thus allow the on and off by means of an application installed on any mobile device, the results demonstrate the applicability in various equipment, as well as being able to work in many connections, each equipment connected to a specific power outlet. One of the necessary recommendations is security in the wireless network, because no unauthorized user can access the network and be able to connect, in this way you have to have a specific wireless network for the use of these devices, the proposal is Applicable and scalable according to the needs and uses that may be given to it. © 2022 IEEE.
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SESSION TITLE: Drug-Induced Lung Injury Pathology Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Daptomycin is an antibiotic that exerts its bactericidal effect by disrupting multiple aspects of bacterial cell membrane function. It has notable adverse effects including myopathy, rhabdomyolysis, eosinophilic pneumonitis, and anaphylactic hypersensitivity reactions. CASE PRESENTATION: A 46-year-old male with a history of type 2 diabetes presented with a 1-week history of dyspnea and productive cough. 2 weeks prior, he was started on vancomycin for MRSA osteomyelitis of the right foot, but was switched to daptomycin due to vancomycin induced nephrotoxicity. On presentation he was afebrile, tachycardic 100, hypertensive 183/109, tachypneic to 26, hypoxemic 84% on room air, which improved to 94% on nasal cannula. Chest exam noted coarse breath sounds in all fields and pitting edema of lower extremities were present. Labs showed leukocytosis of 15.2/L, Na of 132 mmol/L, and creatinine 3.20mg/dL (normal 1 month prior). COVID-19 testing was negative. Chest X-ray noted new bilateral asymmetric opacifications. Daptomycin was discontinued on day 1 of admission, he was started on IV diuretics and ceftaroline. Further study noted peripheral eosinophilia. Computed tomography of the chest showed bilateral centrally predominant ground-glass infiltrates with air bronchograms and subcarinal and paratracheal lymphadenopathy. On day 4, he underwent bronchoscopy with bronchoalveolar lavage. Cytology noted 4% eosinophil with 43% lymphocytes. Eventually, oxygen requirements and kidney function returned to baseline. He was discharged on ceftaroline for osteomyelitis DISCUSSION: Daptomycin-induced acute eosinophilic pneumonitis (AEP) often results in respiratory failure in the setting of exposure to doses of daptomycin >6mg/kg/day. It is characterized by the infiltration of pulmonary parenchyma with eosinophils and is often associated with peripheral eosinophilia. AEP has been associated with certain chemicals, non-steroidal anti-inflammatory agents, and antibiotics including daptomycin. Renal dysfunction is associated with an increased risk for developing AEP. The mechanism for daptomycin-induced lung injury is unknown but is believed to be related to daptomycin binding to pulmonary surfactant culminating in epithelial injury. Diagnostic criteria include recent daptomycin exposure, fever, dyspnea with hypoxemic respiratory failure, new infiltrates on chest radiography, BAL with > 25% eosinophils, and clinical improvement following daptomycin discontinuation. Our patient met four out of six criteria;we believe that BAL results were due to discontinuing daptomycin days before the procedure was performed. Sometimes stopping daptomycin is enough for recovery, however, steroids may be beneficial and were used in some of the cases reported in the literature CONCLUSIONS: Clinicians should consider AEP in a patient on Daptomycin presenting with respiratory failure, as timely discontinuation favors a good prognosis Reference #1: Uppal P, LaPlante KL, Gaitanis MM, Jankowich MD, Ward KE. Daptomycin-induced eosinophilic pneumonia - a systematic review. Antimicrob Resist Infect Control. 2016;5:55. Published 2016 Dec 12. doi:10.1186/s13756-016-0158-8 Reference #2: Kumar S, Acosta-Sanchez I, Rajagopalan N. Daptomycin-induced Acute Eosinophilic Pneumonia. Cureus. 2018;10(6):e2899. Published 2018 Jun 30. doi:10.7759/cureus.2899 Reference #3: Bartal C, Sagy I, Barski L. Drug-induced eosinophilic pneumonia: A review of 196 case reports. Medicine (Baltimore). 2018;97(4):e9688. doi:10.1097/MD.0000000000009688 DISCLOSURES: No relevant relationships by Chika Winifred Akabusi No relevant relationships by Shazia Choudry No relevant relationships by Hector Ojeda-Martinez No relevant relationships by Mario Torres
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SESSION TITLE: Challenging Cases of Hemophagocytic Lymphohistiocytosis SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of excessive immune activation in response to a variety of insults including malignant, autoimmune and infectious processes. The most common infectious trigger is a viral infection, but other pathogens have also been implicated including Mycobacterium tuberculosis (MTB) CASE PRESENTATION: 62-year-old male from Bangladesh presented due to lethargy, weakness, and anorexia for several weeks. He also reported fevers, diarrhea, and unintentional weight loss. On examination, he appeared acutely ill with diffuse bibasilar crackles on lung exam. Labs showed platelets of 132, ESR 45 mm/hr, CRP 9.6mg/dL, ferritin 1,765ng/mL and transaminitis. A viral panel was positive for Rhinovirus. Computed tomography (CT) of the chest showed diffuse bilateral ground-glass opacities and he was started on antibiotics for pneumonia. On day 3, his respiratory status worsened and he was emergently intubated. He underwent bronchoscopy and bronchoalveolar lavage (BAL) and started on high-dose steroids for possible hypersensitivity pneumonitis. On day 5, he was extubated to nasal cannula, however, his condition worsened despite treatment. Extensive infectious workup, including HIV, Covid and P jirovecii PCR, sputum, and blood cultures, and preliminary AFB smear were negative. Subsequent labs noted rising ferritin levels (4,164 ng/mL), high triglycerides, pancytopenia and transaminitis. Calculated H score was 211 which gave a 93-96% probability of HLH. Initiation of Etoposide was discussed but family deferred. He was later transferred to another facility. On follow-up, IL-2 receptor antibodies were elevated, bone marrow biopsy showed hemophagocytosis and necrotizing granulomas. He was intubated for worsening hypoxemia. Repeat bronchoscopy and BAL analysis showed many acid-fast bacilli. Anti TB treatment (ATT) was deferred due to his critical state. He further declined and eventually expired. DISCUSSION: The exact mechanism for which MTB triggers HLH is unclear, however, it is thought that MTB serves as an obligate intracellular pathogen after phagocytosis by phagocytic cells to induce TH1-mediated cytotoxicity, activating macrophages and NK cells, further releasing a large quantity of cytokines and chemokines. The lack of specific clinical signs, low sensitivity for acid-fast staining, and time-consuming culture make the diagnosis of TB-HLH difficult. However, the use of NAATs has improved the yield of sputum testing. Exceedingly high ferritin levels should serve as a red flag in cases of undetermined diagnosis. Moreso, Cytopenias, elevated LFTs, and coagulation dysfunction are other clues that a diagnosis of HLH should be on the differential. It is believed that early and effective ATT is the key to preventing HLH in TB patients. CONCLUSIONS: It is paramount to both recognize the features of TB as well as HLH as early diagnosis and treatment favor better outcomes. Reference #1: Padhi S, Ravichandran K, Sahoo J, Varghese RG, Basheer A. Hemophagocytic Lymphohistiocytosis: An Unusual Complication in Disseminated Mycobacterium Tuberculosis. Lung India (2015) 32(6):593–601. doi: 10.4103/0970-2113.168100 Reference #2: Dalugama, C., Gawarammana, I.B. Fever with pancytopenia: unusual presentation of extrapulmonary tuberculosis: a case report. J Med Case Reports 12, 58 (2018). https://doi.org/10.1186/s13256-018-1596-0 Reference #3: O M P Jolobe, Timely recognition of hematophagocytosis attributable to coexistence of lymphoma and tuberculosis, QJM: An International Journal of Medicine, Volume 112, Issue 4, April 2019, Page 315, https://doi.org/10.1093/qjmed/hcy198 DISCLOSURES: No relevant relationships by Katherine Acosta No relevant relationships by Chika Winifred Akabusi No relevant relationships by Uma Medapati No relevant relationships by Hector Ojeda-Martinez No relevant relationships by Busala Oke No relevant relationships by Mar o Torres
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At a challenging juncture in the midst of the coronavirus pandemic (SARS-Cov-2- COVID-19), Global Health faces one of the greatest challenges in history to control the spread of the virus, whose main characteristic is the speed of contagion and high mortality rates. Risk communication is a fundamental component of any emergency response. Analyze the risk communication strategy developed by New Zealand in response to COVID-19. Qualitative research, based on the argumentation theory seeking to understand the production of symbolic phenomena, their social role, effects and meanings of the Risk Communication Strategy (RCS) developed in New Zealand. The collection consisted of 19 publications from the official website of the New Zealand government and 7 open access videos with statements made by the Prime Minister Jacinda Ardern, during the period from March to December 2020. The whole documentary corpus was analyzed using webQDA content analysis. In response to COVID-19 New Zealand developed a solid RCS, in which each of the components suggested by WHO were dynamically and creatively included, with a strong focus on community/diverse actor participation and promotion of solidarity as a core value of the New Zealand society, using clear and consistent messaging. The RCS gave relevance to decisions based on the best scientific evidence, with a marked promotion of non-pharmacological interventions. Qualitative research and CAQDAS such as webQDA are fundamental tools for studying relevant topics such as risk communication, emphasising political discourse and its implications in the development of strategies to control COVID-19 and the infodemic. A modern approach to argumentation theory and the pragmatic analysis of language allows both the assessment and critique of the forms of communication in health and offer elements for the search for answers to health crises, seeking to compensate for the asymmetry of knowledge and power. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Introduction: The COVID-19 pandemic can alter the moods and mental health of university students, making it difficult for them to achieve their goals and purposes. Objective: To describe the moods and mental health of students from a Peruvian university in the context of the COVID-19 pandemic. Methods: An observational, cross-sectional and descriptive study was carried out in a Peruvian university, during March and May 2020. With the participation of 302 university students, socio-educational data were collected and the Mood Assessment Scale was used, together with the 12-item General Health Questionnaire. The study variables were described and it was considered to evaluate differences. Results: 58.6% of the participants were female. Regarding their marital status, 76.8% were single, while 71.2% were Catholic. 48.3% presented an anxious mood;33.1%, hostile and 38.5%, depressed. In addition, 50.7% presented poor mental health;52.6%, general dysphoria and 74.8%, social dysfunction. Conclusions: In the context of the COVID-19 pandemic, there is a high prevalence of negative moods and mental health problems. These findings demonstrate the situation of social vulnerability, which influences the health and life projects of university students. It is necessary to promote group actions that contribute to the well-being of the student population. © 2021, Editorial Ciencias Medicas. All rights reserved.
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Resumen—The COVID-19 pandemic has underlined that Emergency Department (ED) overcrowding is a critical factor in care services. Getting an approximation of the number of patients attending the department can assist in service resources planning and prevent overcrowding. In this manuscript we present the forecasting results for the admissions, inpatients and discharges series in ED by using different time aggregations (eight hours, twelve hours, one day and the service workers official shifts) and classical time series algorithms. Moreover, series forecasting is performed in two terms: long (four months ahead) and short (seven days ahead). The results show that time aggregations strongly influence the forecast quality, decreasing the effectiveness for one-day aggregations. In addition, best metrics are not obtained in the same aggregation, so there is no best aggregation for all cases. Therefore, it is essential to analyse the ED-related problem faced for the time aggregation selection. ©2021 IEEE
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Background/Aims: Digestive symptoms are common in patients with COVID-19. Neverthe-less, the evidence available so far is based on retrospective and observational studies. This prospective multicenter cohort study aimed to describe the frequency, intensity, evolution, and impact of digestive symptoms and complications, during hospitalization and after dis-charge, of patients with COVID-19. Methods: Patients hospitalized due to COVID-19 (posi-tive PCR for SARS-CoV-2) from May to August 2020, were prospectively recruited in 31 centers. Follow-up included the period between admission and 15 days after discharge. Results: 829 patients (mean age 56.7±17.9 years;42% of females) were enrolled in this study. Of these, 7.2% were active smokers and the mean BMI was 29.1±5.7. Proton pump inhibitors were used by 21.5% (n=178). The most prevalent symptoms on admission were diarrhea (39.4%), nausea (27.4%), and abdominal pain (20.7%). Anorexia, a non-specific symptom, was present in 49.8% of hospitalized patients. At discharge and 15 days after discharge, most symptoms resolved, returning to the baseline prevalence of patients (<5%). Digestive complications during admission were infrequent, except for liver injury defined as hypertransaminasemia which was present in 267 patients (32.3%). The mean length of hospital stay was 8 days (5-12) and 13.6% needed ICU admission. Death happened in 5.2%of patients. On multivariate analysis, diarrhea on admission was associated with a shorter hospital stay (<10 days) ORa 0.508 (0.350-0.739) p=0.000. During hospitalization, diarrhea, constipation, and abdominal bloating were associated with shorter hospital stay ORa 0.531 (0.298-0.946) p=0.032, ORa 0.384 (0.167-0.885) p=0.025, ORa 0.163 (0.057-0.466) p= 0.00, respectively.Odynophagia and dysphagia during hospitalization were associated with a higher need for ICU admission, ORa 6.518 (2.255-18.835) p=0.001 and ORa 4.035 (1.453-11.204) p=0.007, respectively. Liver injury during hospitalization was associated with a higher hospital stay (>10 days) ORa 1.442 (1.019-2.041) p=0.039. In the linear regression analysis, the set of GI symptoms and complications, along with age, comorbidity, and respiratory symptoms, were able to predict 43% (R2 0.43) of the observed variability in the speed of ICU admission;in this case, digestive symptoms slowed it down (more days until ICU admission). Conclusions: Gastrointestinal manifestations of COVID-19 are common in hospitalized patients, while complications are infrequent. Gastrointestinal symptoms seemed to predict a shorter hospital stay and slower speed of ICU admission. These tend to resolve to their baseline prevalence 15 days after discharge, while elevated transaminases were associated with a longer hospital stay. Odynophagia and dysphagia during hospitaliza-tion were associated with an increased need for ICU admission.
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Updated analysis confirms sustained poor prognosis of COVID-19 in patients with lymphoma in Latin America: A cohort of 160 patients from GELL. Introduction: Ongoing SARS-COV-2 pandemic has impacted the management of cancer patients worldwide. Several reports have demonstrated inferior outcomes of patients with hematological malignancies, including higher rates of intensive care unit admission, need for mechanical ventilation and death. The impact of COVID-19 is profound in resource-restricted countries, including Latin America. Most cohorts reported have not included patients from Latin America, and there is paucity of data of the outcome of cancer patients with COVID-19 in low- and middle-income countries. Grupo de Estudio De Linfoproliferativos En Latino-America (GELL )is a collaborative network of hematological centers in 13 countries in Latin America. We report updated outcomes of lymphoma patients diagnosed with COVID-19 in Latin America. Methods: We conducted a retrospective study including patients with a diagnosis of lymphoma and COVID-19 infection. Patients with chronic lymphocytic leukemia/small lymphocytic lymphoma were excluded from the analysis We defined active disease as follow: (1) patients with detectable disease either prior to initiating therapy or upon relapse, and/or (2) patients undergoing active cancer treatment. The primary outcome was overall survival at 100 days. Survival curves were estimated using the Kaplan Meier method. Uni and multivariable analysis were carried out with Cox model. Results: A total of 160 patients were available for analysis. Median age was 60 years old. Hypertension was the most common comorbidity (33%). Most patients had aggressive lymphomas (62%), including 43% of patients with diffuse large B-Cell lymphoma (DLBCL). Follicular lymphomas were observed in 13% of patients and Hodgkin lymphoma in 12.5% of patients. With a median follow-up of 37 days, the 100-day OS was 64% (95CI 56-74%, fig. 1). In univariate analysis, age (HR 1.03, p=0.0025), hypertension (HR 2.01, p=0.017), >1 number of prior lines (HR 2.78, p=0.011), patients currently on treatment (HR 1.83, p=0.043), ferritin >2000 ng/mL (HR 4.74 p=0.00047) were associated with inferior OS. In multivariate analysis, age (HR 1.03, p=0.0026) and patients currently on treatment (HR 1.82, p=0.04) had inferior OS. There was a trend towards inferior outcomes in patients receiving monoclonal antibodies in univariate analysis (HR 1.82, p=0.081) but not in multivariable analysis (HR=1.29, p=0.48). Use of steroids was not statistically related to mortality (HR 1.79, p=0.074). Finally, contrary to other cohorts, no improvement in OS was observed in patients diagnosed later on the pandemic (fig. 2). Conclusion: In this large cohort of Latin American patients with lymphoma malignancies, our updated analysis showed a maintained dismal prognosis with COVID-19 infection. With a median follow up of 37 days, the 100-day OS was 64%. Older age and ongoing active cancer treatment were significantly associated with mortality. The use of monoclonal antibodies and systemic corticosteroids were not statistically associated to poor survival. Current efforts are focused on improving immunization in the Latin American population. There is an unmet need for improving survival in patients with hematologic malignancies and COVID-19 infection. [Formula presented] Disclosures: Perini: Janssen: Honoraria, Speakers Bureau;Takeda: Honoraria, Speakers Bureau;Astra Zeneca: Honoraria, Speakers Bureau;MSD: Honoraria, Speakers Bureau. Otero: ASTRA ZENECA: Current Employment. Abello: Dr Reddy's: Research Funding;Amgen: Honoraria;Janssen: Honoraria. Castillo: Abbvie: Consultancy, Research Funding;BeiGene: Consultancy, Research Funding;Pharmacyclics: Consultancy, Research Funding;Janssen: Consultancy;Roche: Consultancy;TG Therapeutics: Research Funding.
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Background/Introduction: COVID-19 has had a significant impact in the last year. Research and implementation of new vaccines against SARS-Cov-2 have given hope of preventing its spread. They have not been tested in the entire population, hence the importance of events presumably attributable to vaccination and immunization (ESAVI's), the results will contribute to the biosafety of the vaccine, improve-ment in the effectiveness of pharmacovigilance of ESAVI's, implementation of measures to combat it. The institutional pharmacovigilance center was fundamental to carry out this study. Objective/Aim: Evaluation of events supposedly attributable to vaccination and immunization by Pfizer vaccine applied in front-line personnel of the National Institute of Cardiology (INC). Methods: Retrospective observational passive pharmacovigilance study of a cohort of first-line health personnel, all of whom worked in the care of patients with COVID-19 in a tertiary level hospital. The data obtained were captured in a database submitted for validation to the pharmacovigilance department and were analyzed. Results: The present study was conducted during the period December 2020 to March 2021, initial doses of Pfizer vaccine were administered to 1950 workers, reporting 59 events;1570 second doses, of which 63 ESAVI's were reported. Of the 127 reports obtained, 5 were discarded due to follow-up problems. The most frequent findings in relation to the total number of doses administered were headache (2.4%), pain/sensitivity at the site of application, asthenia and myalgia with 1.8% respectively, arthralgias (1.6%), fever and adynamia (1.4%). Conclusion: The Pfizer vaccine presented a very low incidence of ESAVI's in the first line personnel of the INC Ignacio Chavez. Symptoms appeared from 30 min to 4 h after application, 75% of the population that presented reaction in the first application, repeated in the subsequent application and it was observed that the persistence of symptoms was longer lasting. The most affected age group was 30-40 years old. Therefore, it is concluded that the analysis of ESAVI's in all vaccines is of great importance to evaluate the safety of each one of them.
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Introduction: Nowadays, Covid-19 pandemic seriously impact in general population mental status and quality of life. It is uncertain how these situation affect Multiple Sclerosis patients. Objectives: Analyze impact of Covid-19 pandemic in the quality of life in patients of a monographic Multiple Sclerosis Unit in a Spanish third level Hospital after one year Methods: Descriptive prospective study which analyzes changes in employment status, smoking habit, patient report outcomes (PROs) and Covid-19 incidence. Demographic variables (sex, age, employment status, smoking habit), and clinical (disease duration, EDSS, Covid-19 symptoms and PROs) were analyzed. Results: 100 patients Multiple Sclerosis. Median age 42.2 (SD 8.8). 74 % women. Disease duration: 11 years (1 - 37). EDSS 2 (0 - 7.5). 31 % was smoking in first evaluation. 83.3 % will not change after one year. In first assesment 47 % has an employment;1 % sick leave, 29 % inactive because disability;8 % pensioner, 9 % unemployement, 6 % another situation. In second evaluation 89.8 % does not change. 90.8 % have not Covid symptoms after one year and 3.1 % has infected SARS-Cov-2. 36 patients completed PROs in first evaluation and 25 in both. First MFIS median 34.8 (SD 17.13): physical 17.2 (SD 8.76), cognitive 15.75 (SD 9.25). Final MFIS median 38.4 (SD 17.38): physical 17.2 (SD 8.66), cognitive 17.56 (SD 10.3). Initial BDI 13.66 (SD 9.43);final BDI 11.21 (SD 9). Initial EuroQol 0.73 (SD 0.23);final 0.76 (SD 0.19). Conclusion: It does not seem that pandemic situation would have a negative impact about depression or anxiety in our patients. However, we observe a change in fatigue (physical and cognitive). It would be because of increase of sedentary life or the recently described “pandemic fatigue”.