When Aways Went Away: How the Elimination of Away Rotations During Covid-19 was Perceived by Applicants Across Specialties

Introduction: COVID-19's emergence and subsequent social distancing guidelines resulted in severe restrictions on away rotations (ARs). This multi-institutional cross-sectional study investigated how these restrictions were perceived by residency applicants across specialties. Method(s): In fall, 2020, an online survey regarding COVID-19's impact on graduating medical students' education was distributed to ACGME Medical Schools. Demographics, specialty choice, and pre- COVID plans to participate in ARs verses one's participation post- COVID were collected. Respondents who provided e-mails received a post-Match follow-up survey in which retrospective thoughts on ARs were explored. Participants were grouped by specialty choice (medical, procedural, surgical) and answers were compared between groups using Kruskal-Wallis test. Result(s): 58 Institutions distributed the initial survey to 8200 graduating students. 1473 responded (18%). 81% were 25-29;65% were female. 49% were medical, 24% procedural and 26% surgical. Surgical and procedural applicants were more likely to have planned to participate in ARs (p<0.001) and be concerned that limitations on ARs would negatively impact their match (p<0.001). Of 1221 initial survey respondents who provided e-mails, 458 participated in the follow-up survey (37.5%). Demographics were similar to the index survey. Post-Match, surgical and procedural applicants were more likely to wish they could have participated in ARs and to propose that future ARs only be offered in-person (p<0.001). Conclusion(s): This multi-institutional survey across specialties highlights the perceived value of ARs for surgical and procedural candidates. Should opportunities for ARs continue to be limited, alternative opportunities for applicants to connect with programs and optimize successful matches should be investigated.

P.0279 Neural underpinnings of depressive and post-traumatic symptomatology in covid-19 survivors: a voxel-based morphometry study

Background: A high prevalence of depression, anxiety, insomnia and PTSD has been reported in COVID-19 survivors [1]. This is similar to what previously observed in other Coronavirus-related diseases such as SARS and MERS [2]. The pathophysiology of post-infection neuropsychiatric symptoms is likely to be multifactorial, with a role played by inflammatory and immunological factors [3], but it is still largely unknown;we thus investigated COVID-19 survivors via 3T MRI imaging to identify neural underpinnings of post-infection neuropsychiatric symptoms in order to further elucidate their complex pathophysiology. Methods: Covid-19 survivors were recruited during an ongoing prospective cohort study at IRCCS San Raffaele Hospital in Milan;psychopathology was initially measured via several self-report questionnaires (Impact of Events Scale-Revised (IES-R), Zung Self-Rating Depression Scale (ZSDS), 13-item Beck's Depression Inventory (BDI));subsequently patients (n=28) underwent 3T MRI scanning (Philips 3T Ingenia CX scanner with 32-channel sensitivity encoding SENSE head coil). T1 weighted images were processed using Computational Anatomy Toolbox (CAT12) for Statistical Parametric Mapping 12 (SPM12) in Matlab R2016b;segmentation into Gray Matter, White Matter and cerebrospinal fluid, bias regularization, non-linear modulation and normalization to MNI space were performed;measures of Total Intracranial Volume (TIV) were obtained and images were smoothed with an 8-mm full width at half maximum Gaussian filter. Multiple regressions were performed using SPM12 software package: with no a priori regions of interest selected, whole-brain gray matter volumes were used as dependent variables, psychometric scales scores as independent variables, and age, sex and TIV as nuisance covariates. Results: After VBM regression analysis covarying for age, sex and TIV, ZSDS Index scores were inversely correlated with gray matter volume in the Bilateral Anterior Cingulate Cortex (MNI 2, 24, 28, cluster level pFWE = 0.045, k=767);furthermore 3 cluster were identified comprising again the anterior cingulate cortex and the insular cortex bilaterally in which IES-R scores were inversely correlated with gray matter volumes (Cluster 1: MNI -30, 9, 3, cluster level pFWE = 0.005, k=1284;Cluster 2: MNI 36, -3, -3, cluster level pFWE = 0.037, k=773;Cluster 3: MNI 9, 30, 28, cluster level pFWE = 0.038, k=766). No other statistical significant result was found. Conclusions: Our study identified an inverse correlation between anterior cingulate cortex volumes and depressive symptomatology, measured via ZSDS, and between bilateral insulae and anterior cingulate cortex volumes and the degree of distress in response to the traumatic event, measured via the IES-R. Analogous findings have already been reported in patients with Major depression [4] and PTSD [5], and our study confirms the role of volumetric reductions of these brain regions in depressive and post-traumatic symptomatology. Given the nature of our study it is not possible to infer whether the reduction of gray matter volume is a consequence of the Covid-19 infection itself or, as it appears more likely, precede the infection acting as predisposing factor for the subsequent development of depressive and post-traumatic symptomatology. No conflict of interest

[COVID-19 in adults with antibody deficiencies]

COVID-19, caused by SARS-CoV-2, emerged in late 2019 in Wuhan, China. Its clinical course is variable, as well as the mortality rate, which is higher among people over 65 years of age and persons with underlying conditions. Immunodeficiencies are potential risk factors for severe forms of COVID-19. Furthermore, patients with immunodeficiencies often undergo non-infectious complications, which could bear additional risk. So far, few reports of patients with COVID-19 and humoral immunodeficiencies have been published. Considering the importance of the study of this new viral disease and its potential health impact on patients with immunodeficiency disorders, we present six cases of COVID-19 in patients with impaired humoral immunity. Three were women and three were men. The average age was 48.5 years (range 20-67). Four had been diagnosed with primary antibody deficiency: three had common variable immunodeficiency and one had X-linked agammaglobulinemia. The other two patients had secondary hypogammaglobulinemia, one was associated with thymoma (Good's syndrome), and the other was associated with rituximab treatment. The evolution was favorable in all except the patient with Good's syndrome, who presented a marked decline in clinical status before contracting COVID-19.