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INTRODUCTION: A rise in the incidents of violence against Health Care Workers (HCWs) in recent years calls for improvement in modes of spreading awareness and educating the public. We aimed to conduct a large global cross-sectional survey called ViSHWaS- Violence Study of Healthcare Workers and Systems in the departments of Anesthesiology, Critical Care Medicine, and Emergency medicine. METHOD(S): A global survey after tool validation, was created using REDCap forms and distributed from June 5th to July 24th, 2022. Communication tools including emails, phone calls, SMS, and social media applications like WhatsApp, Twitter, and LinkedIn were used in securing responses. This study was deemed eligible for category-2 Institutional Review Board exempt status. RESULT(S): Total of 598 responses from 69 countries, out of these 445 (74%) were complete. The maximum responses were from India (N=49), followed by the USA (N=44) and while those from the other 67 countries ranged from N=1-30. Out of these, 221 (50%) were female, the majority (56%) were in the 26-35 years category, followed by (19%) in 36-45 years. The participants encompassed 156 (35%) consultants, 97 (22%) nurses and the rest were residents/fellows in training, auxiliary/ staff, advanced registered nurse practitioners (ARNP), physician assistants (PA), researcher and others. The vast majority (73%) reported facing violence within the past year;Verbal (63%) and physical (39%) were the most commonly reported. Total 126 (28.3%) reported that patient and/or family member as the type of aggressor they/ their colleague encountered most frequently. A majority (75%) reported that the incidence of violence has either stayed the same (39%) or increased (36%) during COVID-19 pandemic. Because of violent episodes, 48% felt less motivated/ had decreased job satisfaction;an additional 25% were willing to quit. While half of respondents were familiar with Occupational Safety and Health standards, only 20% felt prepared to handle aggressive situation. CONCLUSION(S): In this global cross-sectional survey, a majority of HCWs reported to have faced violence. They felt that it either increased or stayed the same during the COVID-19 pandemic. It has led to decreased job satisfaction. Majority of those, who responded, felt unprepared to handle the violence.
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SESSION TITLE: COVID-19 Infections: Issues During and After Hospitalization SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: COVID-19 pandemic is well studied, but it’s impact on hospitalization pattern is still unclear. We aim to study the hospitalizations pattern throughout the COVID-19 pandemic across 10 US Health and Human Services (HHS) regions. METHODS: This study was conducted using two publically and freely available databases;1. The COVID Tracking Project- manually aggregated data from available sources from official, public state government sites, and 2. The US Department of HHS – state wise patient impact and hospital capacity data. The state wise hospitalization data was extracted and collated by noting hospitalization for the complete time range (from March 1, 2020 to March 7th, 2021) for dataset-1 and data reported between the dates of March 7th, 2021, to March 12th, 2022, for dataset-2. The HHS wise regional hospitalization data was then calculated by adding the respective daily state statistics and scaled to per 100,000 population. A 7-day moving average filter was finally applied to the data before visualization and analysis, to account for repeated days of missing recordings in the data sources. No patient and hospital identifiers were utilized;thus, study was IRB exempted. RESULTS: Based on proximity of the spikes in each wave, data visualization tools grouped, HHS regions 1, 2, 3, 5 in group A;regions 4, 6, 9 in group B, and regions 7, 8. 10 in group C. The visualization of data determined total 6 spikes till date. The start and end of spikes were determined by placing a threshold (10 cases per day per 100,000 population) on the number of daily hospitalizations. The spikes were further divided when a given start/end date pair has multiple clear peaks. Maximum number of days difference observed between the occurrence of COVID-19 peaks in number of hospitalizations, were 47 days for spike-3 for HHS regions in group A (Compared to 2 and 12 days in group B and C, respectively). For Spike-5 it was highest in group C as 78 days (compared to 18 and 1 day in group A and B, respectively). CONCLUSIONS: In a latest COVID-19 hospitalization data analysis, after normalization of data, states in HHS regions, 4, 6, and 9 have the closest spikes throughout the pandemic. These regions included three most populous states of US (Florida, Texas, California) among others and consisted of 67M (region 4), 42M (region 6) and 51M (region 9) people, total of roughly 50% US population. CLINICAL IMPLICATIONS: The result of this study, first to be presented at CHEST conference will pave the way in adding to public health policy discussion in preparedness and resources allocations for hospitalized patients. A subset-analysis of ICU admission is underway, which will be included at CHEST meeting presentation. DISCLOSURES: No relevant relationships by Ramesh Adhikari no disclosure on file for Keerti Deepika;No relevant relationships by Taru Dutt No relevant relationships by Rahul Kashyap No relevant relationships by Arjun Rajasekar no disclosure on file for Shruti Srivnivasan;No relevant relationships by Salim Surani
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SESSION TITLE: Actionable Improvements in Safety and Quality SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The overall mortality rate for patients ‘transfered’ to the medical intensive care units is thought to be significantly higher than the mortality rate amongst those admitted directly. (1) It has also been suggested that uninsured critically ill patients have a higher probability of being ‘transferred’ to other hospitals as well as a higher mortality rate. (2, 3) We aim to determine whether insurance coverage impacts the transfer of critically ill patients. METHODS: This study was conducted at a quaternary care hospital which is also a regional transfer center. We accessed the public data for the year 2020 through our institutions Transfer Center Dashboard, System Analytics. The two aspects of transferred patients we focused upon were: 1) Hospital service (subspecialty care required) and 2) Financial class. Major subspecialties included in the study were: Pulmonology, Internal Medicine, Neurosurgery, Cardiology, and Neurology. Our study was a patient safety project, hence it qualified for IRB exemption. We classified the percentage of transfers as ‘Accepted’, ‘Declined’, or ‘Canceled’;and determined the insurance status of the patient. RESULTS: We found a total of 3552 patients transfers were initiated. 31.9% (1136) transfer patients were accepted, 46.79% (1662) transfers were declined, and 21.23% (754) were canceled due to reasons including unsafe transfer, acceptance at other institutions, or death prior to transfer. Major categories for transfers were Pulmonology (16.1%), other Internal Medicine related diseases (15.3%), and Neurosurgery (11.8%) were the subspecialties with the highest rate of transfers. In terms of financial class, we determined that 44.81% (n=509) of the ICU transfers had no insurance, 27.81% (n=316) had Medicare support, and 17.81% (n=202) had managed care through a health maintenance organization (HMO);the remaining 9.59% had other insurance plans. We used a binomial test to determine the probability of a transfer under no insurance (p) with the formula p + q=1, across the total number of transfer requests (n). K was the number of actual transfers that occurred. Total transfer requests were n=3552, actual transfers were k=1136 and transfers without insurance were 509/44.8%, converted into p=0.45 with a resulting q of 0.55.For z-test, we used the formula z = ((K - np) +- 0.5) / √npq = 15.58. Our one-tailed probability of exactly, or fewer than, 1136(K) out of 3552(n) was p <.000001. Our study was limited because of the COVID-19 pandemic occurring in the same year. CONCLUSIONS: Based on our results, we conclude that the ‘uninsured’ patients are more susceptible to getting transferred to other institutions. CLINICAL IMPLICATIONS: Critically ill ‘uninsured’ patients are selctively subjected to be transfered to other hospitals for higher level of care. These transfers may have significant health implications thereby resulting in higher morbidity and mortality in unisured populations. DISCLOSURES: No relevant relationships by Joodi Akhtar No relevant relationships by Sahar Fatima Advisory Committee Member relationship with Astra Zeneca Please note: 24 months Added 03/16/2022 by FAISAL MASUD, value=Honoraria Advisory Committee Member relationship with Teleflex Please note: 12 months Added 03/16/2022 by FAISAL MASUD, value=Consulting fee Advisory Committee Member relationship with La Jolla Please note: 12 months Added 03/16/2022 by FAISAL MASUD, value=Consulting fee No relevant relationships by Iqbal Ratnani No relevant relationships by Salim Surani No relevant relationships by Anza Zahid
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SESSION TITLE: Quality Improvement SESSION TYPE: Original Investigations PRESENTED ON: 10/17/22 1:30 pm - 2:30 pm PURPOSE: Organ transplant is the ultimate necessity in managing many end-stage organ pathologies. As per the health resource and service administration, 17 people die every day while waiting for an organ transplant. In the year 2020, 169 million Americans registered as organ donors, but due to the limitations of organ donation such as cause of death and condition of the organ at the time of death, only about 3 in 1000 people die in such a way that their organs are in an optimum condition for transplantation 1. The role of nurses in organ donation is critical in both acute and critical care settings 2. Educating nurses on certain aspects of organ donation, such as approaching the families and counseling regarding moral and legal considerations, will acclererate the process of organs retrieval from the interested donors. We hypothesized that in addition to Best Practice Alert (BPA) on Electronic Medical Record (EMR), educating nurses can optimize organ donation by timely referring the organs for transplantation. METHODS: ICU-wide nursing education sessions were conducted elucidating that when a ventilated patient qualifies for Life Gift notification and a BPA does not pop up in EMR, Nurses should immediately call the Houston Methodist organ donation service, Life Gift within one hour of the following two triggers: 1) Loss of one or more brainstem reflex(es), 2) Glasgow Coma Scale (GCS) ≤ 5. Nurses were also educated to start a timely discussion with the family proposing Life Gift prior to discussing the withdrawal of life-sustaining treatments, popularly known as terminal extubation. The data for timely organ referral from the preceding six months (January 2021 to June 2021) was compared to the four months (July 2021 to October 2021) following the nursing education sessions. RESULTS: The total number of timely referrals in the pre- and post-education period were n=23/33 Vs. n=29/31. The overall timely referral of the organ for transplantation increased from 69.2% to 95%. Out of four months post-education, two months record the compliance of 100%. Our chi-square statistic was 5.969 with a p-value of 0.01456. We performed Yates continuity correction due to small sample size and to compensate for deviations from the theoretical (smooth) probability distribution. Our chi-square statistic with Yates correction was 4.506, and the p-value was 0.034 (Significant at p < 0.05). Our study was limited by the small sample size, high nursing turnover due to the COVID-19 pandemic, and logistic restrictions due to the pandemic. CONCLUSIONS: The overall referring time for organs improved after nursing education sessions, including targeted triggers. CLINICAL IMPLICATIONS: Nursing education plays a crucial role in organ donation programs. Further studies are needed to better understand the issues that nurses face and develop new strategies that can be implemented to improve the organ and tissue referrals for organ donation. DISCLOSURES: No relevant relationships by Muhammad Mohsin Abid No relevant relationships by Sana Jogezai No relevant relationships by Iqbal Ratnani No relevant relationships by Salim Surani No relevant relationships by Muhammad Hassan Virk
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SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Latent Epstein-Barr virus (EBV) and cytomegalovirus (CMV) are commonly reactivated in critically ill patients with severe infections. This study aimed to evaluate the proportion of reactivation of EBV and CMV and its impact on length of stay, need for ventilation, and Ichikado CT scores in patients with coronavirus disease 2019 (COVID-19). METHODS: A retrospective study was conducted comprising adult patients admitted to our hospital with COVID-19 infection from June 2021 to September 2021. Patients were divided into groups: virus-free, EBV-only, CMV-only, and EBV and CMV detected. Primary outcomes were length of stay, need for ventilation, and Ichikado CT score. Descriptive statistics, one-way ANOVA, Games-Howell, and Kruskal-Wallis tests were used. RESULTS: 189 patients were included with a median age of 51 years [41 – 66], 80 (42.3%) were female and 109 (57.7%) were male. CD4(+) counts were lower in all viral reactivation groups. EBV-only (157 cell/µl [93 – 279.2] ), CMV-only (82.5 cell/µl [65.5 – 323.7] ), both viruses (62.5 cell/µl [47.5 – 135.5]) and virus-free (221 cell/µl [117 – 318]), (H(3) = 12.029, p = < 0.01). A significant increase in the Ichikado CT score was seen in the viral reactivation groups. EBV 186.5 [43.6], CMV 177.5 [41.6], both-viruses group 204 [50.3] vs. virus-free 161 [45.8],( H(3) = 15.770, p = < 0.01). There was an increase in days of hospitalization when comparing the virus-free and the viral reactivation groups. EBV (9 days [5.5-15.5]), CMV (17 days [3-33]), both viruses (23 days [8-31]) vs. virus-free (5 days [3.5-9]), (H(3) = 15.487, p = < 0.01). Regarding the need for assisted ventilation, there was no difference between groups. 7 (9.1%) patients in the virus-free group, 29 (29.9%) patients in the EBV group, 2 (33.3%) patients in the CMV group, and 2 (22.2%) patients in the both-viruses group needed mechanical ventilation (X2 (3, N=189) = 11.699, p= 0.08). Additionally, a statistically significant decrease in albumin levels on admission was found in the EBV-only patients compared to the virus-free group, (3.4 g/dL [0.44] vs 3.75 g/dL [0.46], F(3,185) = 5.483, p = < 0.01). CONCLUSIONS: Viral reactivation is associated with lower CD4(+) count, an increase in length of stay, and higher Ichikado CT scores. CLINICAL IMPLICATIONS: EVB and CMV reactivation is associated with low CD4(+) counts and longer hospital stay. DISCLOSURES: No relevant relationships by David Akinwale No relevant relationships by Angelica Almaguer No relevant relationships by Sushen Bhalla No relevant relationships by Ailine Canete Cruz No relevant relationships by Ndiya Emeaba Speaker/Speaker's relationship with johnson and johnson Please note: approx year 2000 Added 03/31/2022 by Joseph Gathe, value=Honoraria clinical research relationship with gilead Please note: since 1990 Added 03/31/2022 by Joseph Gathe, value=Grant/Research clinical research relationship with ansun Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support clinical research relationship with regeneron Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support No relevant relationships by Jesus Salvador Gonzalez Lopez No relevant relationships by Najia Hussaini No relevant relationships by Claudia Ramirez No relevant relationships by Salim Surani No relevant relationships by Daryelle Varon No relevant relationships by Joseph Varon No relevant relationships by Mohamed Ziad
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SESSION TITLE: Biological Markers in Patients with COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Severe COVID19 patients present with low CD8(+) T cell counts. A reduced number of T-cells seems to be correlated with high serum IL-6 and IL-10 levels, and a marked inflammatory state. This study aimed to assess if low CD8(+) counts were associated with inflammation markers, length of stay, and Ichikado CT scores in COVID-19 patients. METHODS: A retrospective study of adult patients admitted to our hospital with COVID-19 infection from June 2021 to September 2021. CD8(+) count was obtained, and patients were divided into less than 150 cells/μl and more than 150 cells/μl. Ferritin, c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), troponin, Lactate dehydrogenase (LDH), and d-Dimer values were also recorded. Primary outcomes were hospital length of stay (LOS), Ichikado CT score, and correlation of CD8(+) count and inflammatory markers. Descriptive statistics, and Mann-Whitney-U methods were utilized. RESULTS: 264 patients were included, median age was 50 years [41-61]. 143 (54.2%) patients were male. There was a statistically significant difference when assessing hospital LOS in patients with CD8(+) counts <150 cells/μl vs > 150 cells/μl (9 days [5-16] vs 5 days [4-9], U=(134, 84)=3742, z=-4.174, p<0.01). The Ichikado CT score was significantly different between groups (190 [150-220] vs [130-190], U=(128,80)=3394, z=-4.094, p<0.01). IL-6 and IL-10 values were higher in those patients with CD8(+) less than 150 μl, when compared to higher CD8(+) counts. IL-10 value was (23.8pg/ml [13.6-43.3] vs (6.6pg/ml [9.4-29.2]), U=(131,78)=3711.5, z=-3.305, p<0.01), and for IL-6 (23.8pg/ml [7.6-88.3] vs (11.9 [4.1-32.1]), U=(125,75)=3473.5, z=-3.064, P<0.01). Ferritin was increased in patients with CD8(+) counts lower than 150 cells/μl compared to more than 150 cells/μl (845.3ng/ml [381.6-1600] vs 480ng/ml [232.6-988.7], U=(133,83)=3939.5, z=-3.550, p=<0.01). Similarly, CRP (83mg/L [46.3-136.7] vs 60.2 mg/L [33.25-100.72], U=(134-82)=4208, z=-2.885, p=<0.01), d-Dimer (1.76mg/L [0.53-7] vs 0.64 mg/L [0.35-1.72], U= (134,84)=3635.5, z=-4.396, p<0.01), and LDH (555IU/L [361-849.2] vs 375.5IU/L [273.2-531.2], U=(122,72)=2740,z=-4.373,p<0.01). Troponin and ESR were not significantly different, median troponin (0.022ng/ml [0.011-0.039] vs 0.012ng/ml [0.007-0.032], U=(111,70)=3218, z=-1.944,P=0.052) and median ESR (78mm/hr [57.2-105] vs 76.5 mm/hr [55-108.7], U=(134,84)=5603, z=-0.055,P=0.95). CONCLUSIONS: CD8(+) counts below 150 cells/μl are associated with increased inflammatory markers, a longer hospital stay, and higher Ichikado CT scores. CLINICAL IMPLICATIONS: CD8(+) count below 150 cells/μl is other indicator of disease severity in COVID-19 DISCLOSURES: No relevant relationships by David Akinwale No relevant relationships by Angelica Almaguer No relevant relationships by Sushen Bhalla No relevant relationships by Ailine Canete Cruz No relevant relationships by Ndiya Emeaba Speaker/Speaker's relationship with johnson and johnson Please note: approx year 2000 Added 03/31/2022 by Joseph Gathe, value=Honoraria clinical research relationship with gilead Please note: since 1990 Added 03/31/2022 by Joseph Gathe, value=Grant/Research clinical research relationship with ansun Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support clinical research relationship with regeneron Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support No relevant relationships by Jesus Salvador Gonzalez Lopez No relevant relationships by Najia Hussaini No relevant relationships by Claudia Ramirez No relevant relationships by Salim Surani No relevant relationships by Daryelle Varon No relevant relationships by Joseph Varon No relevant relationships by Mohamed Ziad
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SESSION TITLE: Biological Markers in Patients with COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Common markers of inflammation in COVID-19 include erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and ferritin. We aimed to find an association between creatine Phosphokinase (CPK) and other inflammatory markers and enzymes, and their effect on length of hospital stay, and the Ichikado CT scores. METHODS: Retrospective study of the data of 264 adult patients admitted to our hospital between June and September 2021, with COVID-19. Patients were divided into groups with CPK of greater or less than 200mg/dL. Each was assessed for its association with CRP, ESR, ferritin, and lactate dehydrogenase (LDH), length of hospital stay, and Ichikado CT score. Descriptive statistics, Mann Whitney-U were used to address statistical significance. RESULTS: 264 patients were included, median age was 51.95 years [41-63]. 143(53.2%) were male. The median highest CRP value in patients with CPK of <200 mg/dL was (55 mg/L [24-96.4] vs 97.4 mg/L [50.1-139]) in those with CPK of >200 mg/dL, (U=(131,118) =5097, z=-4.638, p<0.01). The median highest ESR with CPK of <200 mg/dL was (72 mm/hr [51.0-102.5] vs 89 mm/hr [60-109]) in those with CPK of >200 mg/dL, (U= (133,119) =6862.5, z=-1.820, p=0.069). The median highest ferritin value in those with CPK of <200 mg/dL was (388.5 ng/mL [187.1-804.4] vs 1046 ng/mL [462.1-1600]) in those with CPK of >200 mg/dL, (U=(132,118) =4156.5, z=6.3985, p<0.01). The median highest phosphate level in patients with CPK of <200 mg/dL was (3.6 mg/dL [3.3-4.2] vs 3.8 mg/dL [3.4-5.2]) in those with CPK of >200 mg/dL,(U=(133,119) =6487.5, z=-2.471, p=0.013). The median highest LDH level in patients with CPK of <200 mg/dL was (352 IU/L [271.5-459] vs 673.5 IU/L[411.7-980.2]) in those with CPK of >200 mg/dL, (U=(113,106) = 2201, z =-8.084, p<0.01). The median highest Ichikado CT score in patients with CPK of <200 mg/dL was (150[130-190] vs 190[140-222.5]) in those with CPK of >200 mg/dL,(U= (142,209) =5188, z=-4.482, p<0.01). The length of hospital stay in patients with CPK of<200 mg/dL was (5 days [3-8] vs 9 days [5-17]) in those with CPK of >200 mg/dL, (U=(144,120) = 5533, z =-5.049, p<0.01). CONCLUSIONS: CPK has a statistically significant association with CRP and ferritin levels but not ESR. Imaging disease severity at presentation (Ichikado CT score) was associated with higher CPK levels. CLINICAL IMPLICATIONS: CPK is another marker of disease severity in COVID-19. DISCLOSURES: No relevant relationships by David Akinwale No relevant relationships by Angelica Almaguer No relevant relationships by Sushen Bhalla No relevant relationships by Ailine Canete Cruz No relevant relationships by Ndiya Emeaba Speaker/Speaker's relationship with johnson and johnson Please note: approx year 2000 Added 03/31/2022 by Joseph Gathe, value=Honoraria clinical research relationship with gilead Please note: since 1990 Added 03/31/2022 by Joseph Gathe, value=Grant/Research clinical research relationship with ansun Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support clinical research relationship with regeneron Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support No relevant relationships by Jesus Salvador Gonzalez Lopez No relevant relationships by Najia Hussaini No relevant relationships by Claudia Ramirez No relevant relationships by Salim Surani No relevant relationships by Joseph Varon No relevant relationships by Daryelle Varon No relevant relationships by Mohamed Ziad
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SESSION TITLE: Biological Markers in Patients with COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: A significant reduction of CD4(+) cells and marked inflammatory activity in moderate and severe COVID-19 cases are seen, both associated with a poor prognosis. This study aimed to assess the association of low CD4(+) counts with inflammatory markers, length of stay, and ICKIKADO scores in COVID-19 patients. METHODS: A retrospective study of adult patients admitted to our hospital with COVID-19 infection from June 2021 to September 2021. CD4(+) count was obtained and patients were divided into two categories: less than 200 cells/μl and more than 200 cells/μl. Ferritin, c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), troponin, Lactate dehydrogenase (LDH), and d-Dimer values were also recorded. Primary outcomes were hospital length of stay (LOS), Ichikado CT scores, and correlation of CD4(+) count and inflammatory markers. Descriptive statistics, and Mann-Whitney-U methods were used. RESULTS: 264 patients were included, median age was 50 years [41-61]. 143(54.2%) were male. There was a statistically significant difference in LOS for patients with CD4(+) counts <200 cells/μl vs > 200 cells/μl CD4(+) (9 days [5-18]vs 6 days [4-9]), U=(111,107)=4330, z=-3.466, p <0.01). The Ichikado CT score was significantly different between groups (190[150-220]vs 160[128.7-192.5], U=(106,102)=3706.5, z=-3.923, p<0.01). IL-10 values and IL-6 values were higher in those patients with CD4(+) less than 200 cells/μl, as compared to higher CD4(+) counts. median IL-10 was (25.2 pg/ml [17-72.45 ] vs 15.7 pg/ml [9.4-26.8 ], U=(109,100)=3463, z=-4.550, p<0.01), and median IL-6 was (23 pg/ml [10.5-99] vs 12 pg/ml [3.77-39], U=(104, 96)=3444.5, z=-3.785, p<0.01). Ferritin was increased in patients with CD4(+) counts lower than 200 cells/μl when compared to counts more than 200 cells/μl (850.2 ng/mL [373.3-1600] vs 541.5 ng/mL [245.1-1034.6], U=(110,106) =4543.5, z=-2.813, p=<0.01). CRP had a similar pattern (82 mg/L[49.5-138.2] vs 60.8 mg/L[30-114.2]), U=(111,105)=4478, z=-2.940, p=<0.01), d-Dimer (2.2 mg/L[0.55-7.14] vs 0.7mg/L[0.37-1.75], U=(111,107)=3992.5, z=-4.180, p<0.01), LDH (630 IU/L[371-888] vs 381 IU/L[276-520.2], U=(102,92)=2631.5,z=-5.227, p<0.01) and troponin (0.024 ng/mL[0.012-0.048] vs 0.012 ng/mL[0.007-0.027], U=(91,90)=2925, z=-3.321,P<0.01). The only inflammatory marker that was not statistically significant different was ESR (86 mm/hr[60-110] vs 72 mm/hr[50-100], U(111-107)=5113, z=-1.773,P=0.076). CONCLUSIONS: CD4(+) counts below 200 cells/μl are associated with increased inflammatory markers, a longer hospital stay, and higher Ichikado CT scores. CLINICAL IMPLICATIONS: CD4(+) count below 200 cells/μl is other indicator of disease severity in COVID-19 DISCLOSURES: No relevant relationships by David Akinwale No relevant relationships by Angelica Almaguer No relevant relationships by Sushen Bhalla No relevant relationships by Ailine Canete Cruz No relevant relationships by Ndiya Emeaba Speaker/Speaker's relationship with johnson and johnson Please note: approx year 2000 Added 03/31/2022 by Joseph Gathe, value=Honoraria clinical research relationship with gilead Please note: since 1990 Added 03/31/2022 by Joseph Gathe, value=Grant/Research clinical research relationship with ansun Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support clinical research relationship with regeneron Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support No relevant relationships by Jesus Salvador Gonzalez Lopez No relevant relationships by Najia Hussaini No relevant relationships by Claudia Ramirez No relevant relationships by Salim Surani No relevant relationships by Daryelle Varon No relevant relationships by Joseph Varon No relevant relationships by Mohamed Ziad
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Acute pericarditis is an inflammation of the pericardium accompanied by chest pain, pericardial effusion, and electrocardiographic (ECG) changes. It is mainly caused by viruses, followed by bacterial and other infections, tumors, underlying diseases, trauma, medications, and environmental factors. Several reports have emerged on pericarditis as a potential side effect associated primarily with mRNA vaccines, particularly in male adolescents after the second dose. However, the exact mechanism of COVID-19 vaccine-induced pericarditis remains elusive. The most common clinical presentation seen in patients is the elevation in troponin level, as well as C-reactive protein. To exclude other etiologies causing pericarditis, a meticulous diagnostic workup is performed. Thus, a detailed history and physical examination and the timing and type of the vaccine are important. Owning to the novel etiology of pericarditis caused by the COVID-19 vaccine, treatment is based on the patient's symptoms and diagnostic workup, including pain management and nonsteroidal anti-inflammatory agents with or without colchicine. However, dual therapy with intravenous immune globulins and/or corticosteroids may be beneficial in severe cases. This chapter will emphasize the emerging adverse events of vaccineinduced pericarditis, summarizing its epidemiology, pathogenesis, clinical presentation, diagnosis, management, and limitation. © 2022 Nova Science Publishers, Inc.
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With the ongoing COVID-19 pandemic catching the world off guard, billions of people around the world are currently dealing with its severe consequences. Patients of COVID-19 seldom present with respiratory tract infection symptoms, yet extra-pulmonary, particularly cardiac manifestations, have also been reported. The etiopathogenesis of COVID-19 induced acute pericarditis is attributed to local and systemic inflammatory response exacerbated due to the presence of virus and cellular debris. Clinically, it may present with chest pain, friction rub, fever, cough, numerous lab findings, and characteristic ECG changes. NSAIDs and colchicine remain the cornerstones of pericarditis treatment. Literature has suggested that its short-term prognosis oscillates from good to mild. This chapter will address the clinical and diagnostic features of COVID-19 induced pericarditis, as well as the therapeutic options. © 2022 Nova Science Publishers, Inc.
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This chapter discusses the pathophysiology and adverse effects of adenoviral vector vaccinations for SARS-CoV-2 and the importance of identifying the true epidemiology of adverse outcomes regarding promoting increased acceptance of COVID-19 vaccinations. This book chapter includes all published studies relating to outcomes after adenoviral-vector vaccination. The findings described show adenoviral vector vaccines are associated with an increased risk of thrombosis, typically with thrombocytopenia. This phenomenon has been termed vaccine-induced thrombotic thrombocytopenia (VITT). The rate of thrombotic adverse effects following vaccination remains lower than the rate of thrombosis following COVID-19 infection. At the current rate of reported severe adverse outcomes, the benefits of vaccination outweigh the risks of remaining unvaccinated regardless of the vaccine vector. © 2021 by Nova Science Publishers, Inc.
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TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Impairment of lung function test is well recognized among post-COVID-19 patients. The aim of our study is to assess the characteristics of patients found to have restrictive lung defect after having COVID-19 pneumonia. METHODS: Retrospective chart review of patients who completed spirometry test in a community pulmonary clinic in Corpus Christi, Texas from March 2020-March 2021 was conducted. All patients who had COVID-19 pneumonia prior to the test were included. Restrictive lung defect was defined by FEV1 < 80% or FVC < 80%. Patients were categorized into restrictive vs. non-restrictive lung defect groups. Baseline characteristics and spirometry parameters were compared. Multivariate analysis was performed using logistic regression. RESULTS: A total of 65 patients were included. Thirty-eight patients had restrictive lung defect (58.5%). Patients with restrictive lung defect had lower mean FEV1 (2.1±0.6 vs. 2.7±0.5 L, p<0.001), predicted FEV1 (70.4 vs 98.5%, p < 0.001), FVC (2.5±0.7 and 3.3±0.7 L, p< 0.001) and predicted FVC (65.9 vs 95.1%, p < 0.001). There was no significant difference in mean age (60 vs. 58 years), gender (male 63 vs. 41%), race (Caucasian 24 vs. 22, Hispanic 74 vs. 70%), body mass index (BMI) (36 vs. 35 kg/m2), hypertension (55 vs. 48%), hyperlipidemia (37 vs. 37%), asthma/COPD (18 vs. 30 %), obstructive sleep apnea (OSA) (29 vs 7%) and smoking (12 vs. 7%) among restrictive lung vs. non-restrictive lung groups. However, diabetes was higher in restrictive lung group (45 vs 15%, p=0.02) and remained significant after being adjusted for age, gender, race, BMI, asthma/COPD, OSA and smoking (p=0.03). CONCLUSIONS: Our study found restrictive lung defect in more than half of post-COVID patients. There is no significant difference between restrictive vs. non-restrictive lung groups in terms of age, gender, race and smoking. Diabetes is higher among post-COVID pneumonia patients with restrictive lung defect. CLINICAL IMPLICATIONS: Restrictive lung disease is seen commonly among post-COVID patients. Closer follow-up is suggested among the population with restrictive lung disease to ensure improvement. DISCLOSURES: No relevant relationships by Aiza Mominkhawaja, source=Web Response No relevant relationships by Pattharawin Pattharanitima, source=Web Response No relevant relationships by Munish Sharma, source=Web Response No relevant relationships by Salim Surani, source=Web Response No relevant relationships by Pahnwat Taweesedt, source=Web Response No relevant relationships by Joseph Varon, source=Web Response
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INTRODUCTION: 17 million cases & 0.6 million deaths are attributed to the novel Coronavirus disease (COVID 19). After decades of reluctance to implement pathogenreporting systems, the current pandemic has resulted in the formulation of comprehensive national reporting systems. We hypothesized that despite all efforts to improve reporting, fewer number of deaths are reported on weekends when compared to weekdays due to closure of health offices or lack of staffing on weekends, as reporting being highly dynamic. METHODS: Worldometer, a reliable database that reports real-time statistics on COVID-19 was used to retrieve the number of COVID-19 related deaths. We selected 9 worsthit countries from across the globe where reporting systems assumed to be robust. We observed the number of daily deaths over the course of 9 weeks, 4 weeks prior to their peak week, and 4 weeks afterwards. The average number of deaths/day on weekdays (WDs) and weekends (WEs) were recorded and compared. RESULTS: The WDs/WEs deaths/day for the USA, Sweden, Canada, Germany Spain, Italy, UK, Belgium and Netherlands were 1748/1142, 84/27, 150/113, 149/76, 445/386, 452/387, 594/441, 150/127 and 87/70. All countries showed data leaning towards fewer deaths on weekends. Data was first confirmed with the Kolmogorov-Smirnov Test of Normality. The test statistic (D) for Both Weekdays (WDs) and Weekends (WDs) was 0.27 & 0.26 with p values of 0.46 & 0.48 respectively, confirming that our data does not differ significantly from that which is normally distributed. T-value was calculated using the formula t = (M - μ)/SM. T-Test for two dependent means while comparing WDs and WEs deaths were significant at p < .05 (Two-tailed) for all countries except Canada and Spain. Our study was limited by data collection from a single-site though reliable, continuous updating of death counts by some countries, and limited number of countries though supposed to have proper reporting. CONCLUSIONS: Our review showed a statistically significant less number of deaths being reported on Weekends in all countries other than Spain and Canada, which may be due to the closure of administrative offices and the continuous mounting of high death counts. More research is warranted to quantify the extent of under-reporting of weekend deaths to effectively rectify the problem.
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Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the causative pathogen for the COVID-19, first emerged in Wuhan, China, in December 2019 and by March 2020, it was declared a pandemic. COVID-19 pandemic has overburdened healthcare systems in most countries and has led to massive economic losses. SARS-CoV-2 transmission typically occurs by respiratory droplets. The average incubation period is 6.4 days and presenting symptoms typically include fever, cough, dyspnea, myalgia or fatigue. While the majority of patients tend to have a mild illness, a minority of patients develop severe hypoxia requiring hospitalization and mechanical ventilation. Management is mostly supportive. However, several direct anti-viral agents, and immunomodulatory therapy with steroids and various cytokine blockers seem promising in early results. However, an effective vaccine has been established, which will help curb the pandemic.
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In this paper, we provide a consistent, inexpensive, and easy to use graphical user interface (GUI) smart phone application named Sleep Apnea Screener (SAS) that can diagnosis Obstructive Sleep Apnea (OSA) based on demographic data such as: gender, age, height, BMI, neck circumference, waist, etc., allowing a tentative diagnosis of OSA without the need for overnight tests. The developed smart phone application can diagnosis sleep apnea using a model trained with 620 samples collected from a sleep center in Corpus Christi, TX. Two machine learning classifiers (i.e., Logistic Regression (LR) and Support Vector Machine (SVM)) were used to diagnosis OSA. Our preliminary results show that at-home OSA screening is indeed possible, and that our application is effective method for covering large numbers of undiagnosed cases. © 2020 IEEE.
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SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: A recent surge of novel COVID-19 has diverted the focus from other microbial organisms as the etiology of respiratory illness. Causal agents for respiratory infections have been linked to different risk factors and clinical presentations. The propose of this study is to analyze the incidence of coinfection and the factors that determine it. METHODS: Respiratory Pathogen Panel (RPP), targeting 21 different organisms, was performed to randomized individuals undergoing testing for COVID-19 RT-PCR at four testing locations in Houston, Texas between March 2020 to May 2020. Tested subjects were inquired about their demographic information, positive exposure to COVID-19, current symptoms, and comorbidities. RESULTS: A total of 10,853 RPP tests were performed alongside COVID-19 RT-PCR (43,443) tests completed across the 4 locations. 4,195 (9.6%) patients had positive results for COVID-19. The total positive results for RPP was 1,276 (11%). Both RT-PCR and RPP were positive in 78 cases (0.7%), with 12 different organisms identified as the causal agents in these cases. The most common being Rhinovirus in 37.1% (n=29), followed by Staphylococcus Aureus in 33.3% (n=26) and Haemophilus influenzae 21.7%, (n=17). Other organisms included S. pneumonia, K. pneumonia, Influenza A, Influenza B, parainfluenza virus, metapneumovirus, adenovirus, enterovirus, and other strains of coronavirus. 7 cases were identified to have 2 positive organisms in RPP, in addition to being positive to COVID-19. 5 of which included rhinovirus and 4 of them had H. influenzae. Age was found to have a great influence on the incidence of different organisms of these concomitant infections. From the 11 cases that were 18 years old or younger, 45.4% had S. aureus as the causal agent and 27.2% were positive for H. influenzae. Cases among individuals >65 years old were positive only for rhinovirus. CONCLUSIONS: A positive test for respiratory pathogens does not exclude the coinfection with COVID-19 or vice versa. Age seemed to be the factor with the highest influence in determining the causal agent of these concomitant infections. CLINICAL IMPLICATIONS: Workup for respiratory infections should include testing for COVID-19, given that a positive RPP in a symptomatic or asymptomatic patient does not exclude concomitant infection with the novel coronavirus. Age range should also be considered as a determinant factor influencing causal agent of coinfection. DISCLOSURES: No relevant relationships by Frida Andrea Alvarez Velazquez, source=Web Response No relevant relationships by Valeria Demeneghi Aleman, source=Web Response No relevant relationships by JOSE ALFONSO GARNETT CARBAJAL, source=Web Response No relevant relationships by Mariya Mohiuddin, source=Web Response No relevant relationships by Salim Surani, source=Web Response No relevant relationships by Daryelle Varon, source=Web Response No relevant relationships by Joseph Varon, source=Web Response
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SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The covid19 crisis has rapidly become the most significant public health crisis of our times. It has particularly impacted students due to cancellation of school and having to adjust to online learning and anxiety about their future, as well as prolonged social isolation. All these factors has likely led to significant stress and anxiety. The purpose of this study was to study the prevalence and severity of covid19 associated anxiety and stress in high school (HS) students and undergraduate (UG) college students in the US during the period of the Covid19 pandemic METHODS: We created a covid19 anxiety and stress survey (CASS) by combining 2 abbreviated instruments – the Perceived Stress Scale (PSS-4) and the Patient Health Questionnaire for Depression and Anxiety (PHQ-4). We distributed the CASS survery in electronic format during the month of March/April at the peak of the covid19 pandemic, both directly, as well as through use of social media to students in HS and UG. We also collected limited information about grade level, age, gender, ethnicity and location. RESULTS: A total of 116 (72Male;44 Female) students completed the questionnaire - Grade distribution was15 HS (Gr 9,10), 41 HS (Gr 11,12), 41 UG (Yr 1,2), & 19 UG (Yr 3,4). 56 (48.2%) had an elevated perceived stress level (PSS-4 of >8). 66 of students (56.9%) screened positive for a mood disorder depression/anxiety based on PSQ4 of >4. When we examined the subscales we found 43(37%) had anxiety (PSQ-2 for anxiety of >3) and 36 (31%) had depression (PSQ-2 for depression >3). Both HS and UG had similar levels of stress, but both overall PSQ4 as well as subscales for anxiety and depression was significantly more prevalent in college than in high school students (Mean total PSQ4 scores was 5.4 +/- 4 for UG vs 3.9 +/- 3.3 HS respectively) Strong gender influence in both PSS and PSQ was seen – mean PSS for girls and boys was 8.7 +/- 2.6 vs 7.2 +/- 2.8;p <0.05 and PSQ4 was 6.1 +/- 3.2 vs 4.2 +/- 3.8 respectively) There was a strong correlation between PSS and PSQ scores (r = 0.68) CONCLUSIONS: The Covid19 pandemic has resulted in an extremely high level of stress and mental health morbidity in both high school and especially college students. There is a high prevalence of depression and anxiety in students, and this is more pronounced in girls. CLINICAL IMPLICATIONS: Specific screening measures and interventions to improve mental health of students especially in college is urgently warranted with a particular focus on women, due to the covid19 pandemic. DISCLOSURES: No relevant relationships by Akshar Aiyer, source=Web Response No relevant relationships by Yashdeep Gill, source=Web Response No relevant relationships by Iqbal Ratnani, source=Web Response No relevant relationships by Shaleen Sunesara, source=Web Response No relevant relationships by Salim Surani, source=Web Response
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SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The covid19 crisis has rapidly become the most significant public health crisis of our times. It has particularly impacted healthcare workers (HCW) due to overwhelming of healthcare resources, as well as a critical absence of protective equipment and risk to their own health as well as risk of exposure to their family. All these factors have likely resulted in significant levels of stress and anxiety. The purpose of this study was to study the prevalence and severity of covid19 associated anxiety and stress in healthcare workers in the US during the period of the Covid19 pandemic METHODS: We created a covid19 anxiety and stress survey (CASS) by combining 2 abbreviated instruments – the Perceived Stress Scale (PSS-4) and the Patient Health Questionnaire for Depression and Anxiety PHQ-4. We distributed the CASS survery in electronic format during the month of March/April at the peak of the covid19 pandemic, both directly, as well as through use of social media. We invited all HCW including nurses (RN) physicians (MD) medical and nursing assistants (MA, CNA) and respiratory therapists (RT). We also collected limited information about age, gender, ethnicity and location. RESULTS: A total of 313 (53Male;260 Female) HCW completed the questionnaire - 166 RNs, 95 MDs, 15 CNA/MA, & 16 RTs. Age distribution – 130 between 20-40, & 166 41-60. 151 (48.2%) had an elevated stress level (PSS-4 of >8). Both MD and RN had similar levels of high stress. 175 HCW (55.9%) screened positive for a mood disorder depression/anxiety based on PSQ4 of >4. When we examined the subscales we found 133(42.4%) had anxiety (PSQ-2 for anxiety of >3) whereas only 89 (28.4%) had depression (PSQ-2 for depression >3). Both MD and RN had similar levels of high stress. Age did not have a influence but a significance gender influence in both PSS and PSQ was seen – male gender representation was 10% of HCW for high stress vs 24% in normal stress and 9% for anxiety/depression vs 20.8% respectively (p <0.05). There was a strong correlation between PSS and PSQ scores (r = 0.70) There was no significant differences between MD and RN in stress or anxiety scales. CONCLUSIONS: The Covid19 pandemic has resulted in an extremely high level of stress and mental health morbidity. Over half of healthcare workers had significant anxiety and depression and nearly 50% had high levels of perception of stress, regardless of age. This was especially more pronounced in female gender for both stress as well as anxiety. CLINICAL IMPLICATIONS: Specific screening measures and interventions to improve mental health of HCW is urgently warranted with a particular focus on womens health due to the covid19 pandemic. DISCLOSURES: No relevant relationships by Akshar Aiyer, source=Web Response No relevant relationships by Mohammed Ali, source=Web Response No relevant relationships by Shaleen Sunesara, source=Web Response No relevant relationships by Salim Surani, source=Web Response No relevant relationships by Joseph Varon, source=Web Response
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SESSION TITLE: Cultural Diversity Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Health is greatly influenced by the resources of the population, and social determinants of health have always played a major role in health outcomes. It comes as no surprise that disparities have resulted in a major disproportion of incidences of COVID-19 in the most impoverished populations. The focus of the study is to correlate the incidence of COVID-19 to socioeconomic status and race. METHODS: Demographic information from positive test results of Covid-19 by RT-PCR from four testing locations in Houston, Texas between March 2020 to May 2020. These were correlated and ranked according to the 2020 SocioNeeds Index. The index value is a measurement and comparison of needs and health outcomes in communities across the United States. Zero indicating the lowest need and 100 indicating the highest need. RESULTS: A total of 39,505 tests were completed across the testing locations, out of those 2,306 (6%) were positive. A positive linear correlation was obtained between a higher SocioNeeds Index and the of incidence of Covid-19 to a given zip code, unstandardized B coefficient 0.215, p=<0.001. Populations were ranked based on their index value, with RANK 1 from 0.20 to 16.99, RANK 2 from 17 to 41, RANK 3 from 41 to 62.9, RANK 4 from 63 to 85 and RANK 5>85. RANK 1 had significantly less incidence compared to RANK 3 (p=0.036), RANK 4 (p=0.016) and RANK 5 (p=<0.001). RANK 2 showed less incidence compared to RANK 5 (p=<0.001). CONCLUSIONS: Social determinants of health such as socioeconomic status have a major influence in the incidence of Covid-19. As the data illustrates, the incidence of COVID-19 is proportional to the population need. CLINICAL IMPLICATIONS: People from communities with higher incidence of COVID-19 could be at a greater risk for complications, since health outcomes from these communities are poor due to multiple barriers. As challenging as the current COVID-19 pandemic could be, it is critical to address the prevailing social disparities between populations and close the gap in health inequity. This could serve for the future prioritization of needs among these populations and the implementation of further strategies to improve their health outcomes. DISCLOSURES: No relevant relationships by Valeria Demeneghi Aleman, source=Web Response No relevant relationships by Joseph Gathe, source=Web Response No relevant relationships by Estrella Gutierrez Fernandez, source=Web Response No relevant relationships by Salim Surani, source=Web Response No relevant relationships by Daryelle Varon, source=Web Response No relevant relationships by Joseph Varon, source=Web Response