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Background. We conducted a follow up study on patients previously diagnosed with COVID-19 one year ago in an urban community in Paterson, New Jersey. The purpose of the study was to evaluate the socioeconomic impact of COVID-19 as well as assess for receptiveness towards COVID-19 vaccination amongst various ethnic groups. Methods. This was a prospective cohort study consisting of patients who had COVID-19 in the months of March and April of 2020. This was a single institutional study conducted at St. Joseph's Hospital in Paterson, NJ from March to April of 2021. Patients included were either male or female aged 18 years or older. Patients were contacted by telephone to participate to completed the survey. Chi-square testing and multivariable logistic regression analysis were utilized for statistical analysis. Results. Of the 170 patients enrolled in the study, the most common ethnicity was Hispanic (79/170 [46.47%]), followed by African American (46/170 [27.05%]). 83 patients were male (83/170 [48.82%]). Caucasians were the most willing to receive a COVID-19 vaccine (28/30 [93.3%]), followed by Asians (13/14 [92.8%]), Hispanics (63/78 [80.7%]) and African Americans (29/46 [63.0%]). Hispanics had the highest rate of job loss (31/79 [39.24%]), followed by African Americans (16/46 [34.7%]). Hispanics were found to be in the most financial distress (31/79 [39.2%]), followed by African Americans (17/46 [36.9%]). Hispanics and African Americans were more likely to refuse COVID-19 vaccination (p: 0.02). Hispanics were more likely to lose their jobs compared to Caucasians (odds ratio,4.456;95% CI, 1.387 to 14.312;p: 0.0121). African Americans were also more likely to lose their jobs when compared to Caucasians (odds ratio, 4.465;95% CI, 1.266 to 15.747;p: 0.0200). Conclusion. Hispanics reported the most financial distress and with nearly 40% losing their jobs, the highest in our study group. 37% of African Americans experienced job loss and financial distress following their diagnosis with COVID-19. Only 63% of African Americans and 80.7% of Hispanics were willing to get vaccinated, mostly due to lack of trust in the vaccine. Statistical analysis showed Hispanics and African Americans were more likely to lose their jobs and refuse COVID-19 vaccination following diagnosis with COVID-19.
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TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Lung abscesses develop when necrosis of lung tissue caused by underlying infections form cavitary spaces of the lung parenchyma. A bronchopleural fistula (BPF) is a complication of cavitary lesions where a sinus tract forms between the bronchus and pleural space. We present the first reported case of a patient with severe COVID-19 who developed a lung abscess with a BPF and spontaneous pneumothorax requiring video-assisted thoracoscopic surgery (VATS). CASE PRESENTATION: A 60-year-old male with a history of hypertension and dyslipidemia presented to the hospital with shortness of breath after a recent diagnosis of COVID-19. The patient was hypoxic on room air and his chest x-ray (CXR) revealed bilateral infiltrates. The patient was admitted to the medical floors and treated with methylprednisolone, Remdesivir, piperacillin/tazobactam and DVT prophylaxis doses of enoxaparin. Methylprednisolone was increased to higher doses over the next few days in response to worsening inflammatory markers and hypoxia, as high as 125mg IV 4 times a day and was subsequently tapered to 160mg IV daily in divided doses for 30 days. On day 40, a new cavitary lesion of the right middle lobe (RML) was seen on CXR, and blood cultures grew methicillin sensitive staphylococcus aureus (MSSA) for which linezolid, meropenem and micafungin were started. On day 42, the patient developed a right sided pneumothorax which required chest tube insertion. On day 47 the patient developed respiratory distress and worsening pneumothorax, the pleural drainage system demonstrated continuous air leak and the patient was subsequently intubated due to worsening respiratory failure. VATS was performed which revealed a RML abscess;the procedure was converted to open thoracotomy with RML wedge resection. Histopathological analysis showed organizing pneumonia, interstitial fibrosis, alveolar damage and a BPF. Cultures taken from the abscess grew MSSA. On day 49, the patient became hypotensive and required the initiation of vasopressors. In the following days he developed a new air leak noted on the pleural drainage system. He remained in the ICU for several days and did not exhibit clinical improvement, thus his family transitioned him to comfort measures and he passed away soon after. DISCUSSION: High dose corticosteroids are used to treat severe COVID-19 with the goal of preventing cytokine storm and subsequent ARDS. Immunosuppression is a complication of prolonged treatment with high dose corticosteroids and may result in bacterial superinfection. Lung abscesses are typically treated conservatively with broad spectrum antibiotics. In cases such as those with BPF and pneumothorax, treatment with surgical intervention may be required. CONCLUSIONS: While corticosteroids have been used widely in the treatment of COVID-19, clinicians should be cautious in the consequences of prolonged utilization and should monitor for related complications. REFERENCE #1: Kuhajda, I., Zarogoulidis, K., Tsirgogianni, K., Tsavlis, D., Kioumis, I., Kosmidis, C.,… Kuhajda, D. (2015, August). Lung abscess-etiology, diagnostic and treatment options. Retrieved April 29, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543327/ REFERENCE #2: Salik, I. (2020, August 27). Bronchopleural fistula. Retrieved April 29, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK534765/ DISCLOSURES: No relevant relationships by Arslan Chaudhry, source=Web Response No relevant relationships by Rajapriya Manickam, source=Web Response No relevant relationships by Christopher Millet, source=Web Response No relevant relationships by Sushant Nanavati, source=Web Response No relevant relationships by Sherif Roman, source=Web Response No relevant relationships by Anish Samuel, source=Web Response
ABSTRACT
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Studies comparing the relationship between ethnicity and overall outcomes in individuals infected with COVID-19 have yielded diverse results. We conducted a retrospective observational study on hospitilized patients with COVID-19 at an urban hospital in New Jersey. We assesed for differences in clinical outcomes including mortality, need for invasive mechanical ventilation and length of stay based on ethnicity. METHODS: This was a retrospective observational study conducted at Saint Joseph’s University Hospital in Paterson, New jersey. The study was conducted from September 1, 2021 to November 30,2021 and was based on auditing electronic medical records who were admitted to the hospital with a diagnosis of COVID-19. Patients included in the study were male and females at least 18 years old who had a confirmed diagnosis with COVID-19 with PCR. Statistical analysis was performed with chi-squared analysis for categorical variables and Anova for continuous variables, statistics were performed in R language. RESULTS: A total of 440 patients were included in the study, of which 236 were Hispanic (50.3%), 131 were Caucasian (27.1%), 47 were African American (10.7%) and 26 were Asian (5.9%). Cuacasians had the higest mortality rate (21/131 [16%]), followed by hispanic (33/236 [13.9%]), Asian (3/26 [11.5%]), and african american (3/47 [6.3%]). Asians had the highest rate of intubation (5/26 [19.2%]) followed by Hispanic (29/236 [12.2%]), Caucasian (13/131 [9.9%]) and African American (2/47 [4.2%]). In regards to lengths of stay, the mean lentgh of stay for Caucasians was 8 (5-12), Hispanic 8( 5-13), African American 6 (5-12) and Asian 8 (5-17). There were no statistically significant differences noted in terms of mortality, need for invasive mechanical ventilation, or length of stay between all ethnicity groups (P > 0.05). CONCLUSIONS: In our study, there are no statistically significant differences when comparing mortality, need of invasive mechanical ventilation or length of stay between all of the ethnic groups. CLINICAL IMPLICATIONS: While there were no statistically significant differences in the various outcomes based on ethnicity in our study, more research is needed to further investigate this topic. Various other studies performed in the US have produced conflicting evidence on the impact of ethnicity on outcomes with COVID-19. Our study was limited to a relatively small sample size and the phase of the pandemic which may have affected the results. To further understand the varying degress of disease burden across ethnicities it may be useful to gather data on the biological interaction of SARS-COV2 on different ethnic groups, as well detailed in-hospital comparisons of management used to treat these patients. Reviewing these management plans may allow an in-depth assessment of the treatment modalities being used in specific patient populations, and may bring to light any racial or geographical disparities that affect their treatment during their hospital stay. DISCLOSURES: No relevant relationships by Rajapriya Manickam, source=Web Response No relevant relationships by Ashesha Mechineni, source=Web Response No relevant relationships by Christopher Millet, source=Web Response No relevant relationships by Spandana Narvaneni, source=Web Response
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TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Many patients diagnosed with COVID-19 develop a post-viral syndrome commonly known as Long COVID-19. Long COVID is described as when a patient experiences persistent symptoms for more than 12 weeks after their initial infection. Recent studies have shown that patients may experience long covid for as many as 6 months after initial infection. We conducted a follow up study on patients diagnosed with COVID-19 one year ago at one of the worst affected tertiary hospitals in the state of New Jersey. METHODS: This was a prospective cohort study consisting of patients with a confirmed positive COVID-19 test by PCR in the months of March and April of 2020 in the St. Joseph’s University Hospital network. Individuals who were either admitted to the hospital or tested positive in the outpatient setting with Sars- CoV2 were included in the study. Patients under 18 years of age or those with cognitive impairment or inability to complete the survey were excluded. Informed consent was taken over the telephone. The participants completed a comprehensive questionnaire including sociodemographic information and a review of systems to evaluate for persistent symptoms they have experienced over the past year directly due to COVID-19. All patient identifying information was de-identified in compliance with HIPAA rules and regulations. RESULTS: There were 91 inpatients ( 91/173 [52.6%]) and 82 outpatients (82/173 [47.4%]) with a mean age of 51.5. The most common ethnicities were Hispanic (80/173 [46.24%]) African American (48/173 [27.74%]), Caucasian (32/173 [18.49%]) and the most common comorbidities were hypertension (68/173 [39.5%]), obesity (45/173 [26.9%]) and diabetes (33/173 [19.1%]). There were 91 inpatients ( 91/173 [52.6%]) and 82 outpatients (82/173 [47.4%]), of which 85 were male (85/173 [49.42%]). Overall 83 patients (47.9%) still experienced at least one persistent symptom after initial infection. The most commonly reported symptoms were shortness of breath (44/173 [25.4%]), fatigue (43/173 [21%]), anxiety (36/173 [20.8%]), difficulty focusing/brain fog (32/173 [18.5%]), body aches (32/173 [18.5%]), headaches (29/173 [16.8%]), memory loss (25/173 [14.5%]), cough (23/173 [13.3%]), depression (22/173 [12.7%]), chest pain (19/173 [11%]), palpitations (15/173 [8.7%]), lightheadedness (15/173 [8.7%]), runny nose (12/173 [6.9%]) and loss of taste (11/173 [6.4%]). CONCLUSIONS: In our patient population nearly half of all patients (47.9%) still experienced at least one symptom 12 months after their initial infection. In both patient populations the most common persistent symptoms were shortness of breath, fatigue, anxiety and difficulty focusing/brain fog. The risk factors and pathophysiology of long covid remain unknown, highlighting the importance of further research into the topics. CLINICAL IMPLICATIONS: Nearly half of our patient population still experienced at least one symptom from their COVID-19 infection after one year. This further suggests that infection with COVID-19 may carry a risk of developing long term and possibly permanent sequelae from the virus. As more patients continue to be infected with COVID-19 and subsequently develop long covid, a public health crisis may be looming in the future. This highlights the need for continued public education on COVID-19 as well as the critical importance of widespread vaccination across the world to end the pandemic. DISCLOSURES: No relevant relationships by Polina Aron, source=Web Response No relevant relationships by Hamdallah Ashkar, source=Web Response No relevant relationships by Sohail Chaudhry, source=Web Response No relevant relationships by Arslan Chaudhry, source=Web Response No relevant relationships by Beenish Faheem, source=Web Response No relevant relationships by Alisa Farokhian, source=Web Response No relevant relationships by George Horani, source=Web Response No relevant relationships by Humberto Jimenez, source=Web Response No relevant relationships by Christina Kmiecik, source=Web Response No relevant relationships by Patrick Michael, source=Web Response No relevant relationships by Christopher Millet, source=Web Response No relevant relationships by Spandana Narvaneni, source=Web Response No relevant relationships by Sherif Roman, source=Web Response No relevant relationships by Fady Shafeek, source=Web Response No relevant relationships by Yezin Shamoon, source=Web Response No relevant relationships by Jin Suh, source=Web Response