SeroNet Pooling Project of immunocompromised populations

Introduction: COVID-19 vaccination substantially reduces morbidity and mortality associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe illness. However, despite effective COVID-19 vaccines many questions remain about the efficacy of vaccines and the durability and robustness of immune responses, especially in immunocompromised persons. The NCI-funded Serological Sciences Network (SeroNet) is a coordinated effort including 11 sites to advance research on the immune response to SARS-CoV-2 infection and COVID-19 vaccination among diverse and vulnerable populations. The goals of the Pooling Project are: (1) to conduct real-world data (RWD) analyses using electronic medical records (EMR) data from four health care systems (Kaiser Permanente Northern California, Northwell Health, Veterans Affairs-Case Western, and Cedars-Sinai) to determine vaccine effectiveness in (a) cancer patients;(b) autoimmune diseases and (c) solid organ transplant recipients (SOTR);(2) to conduct meta-analyses of prospective cohort studies from eight SeroNet institutions (Cedars-Sinai, Johns Hopkins, Northwell Health, Emory University, University of Minnesota, Mount Sinai, Yale University) to determine post-vaccine immune responses in (a) lung cancer patients;(b) hematologic cancers/hematopoietic stem cell transplant (HSCT) recipients;(c) SOTR;(d) lupus. Method(s): For our RWD analyses, data is extracted from EMR using standardized algorithms using ICD-10 codes to identify immunocompromised persons (hematologic and solid organ malignancy;SOTR;autoimmune disease, including inflammatory bowel disease, rheumatoid arthritis, and SLE). We use common case definitions to extract data on demographic, laboratory values, clinical co morbidity, COVID-19 vaccination, SARS-CoV-2 infection and severe COVID-19, and diseasespecific variables. In addition, we pool individual-level data from prospective cohorts enrolling patients with cancer and other immunosuppressed conditions from across network. Surveys and biospecimens from serology and immune profiling are collected at pre-specified timepoints across longitudinal cohorts. Result(s): Currently, we have EMR data extracted from 4 health systems including >715,000 cancer patients, >9,500 SOTR and >180,000 with autoimmune conditions. Prospective cohorts across the network have longitudinal data on >450 patients with lung cancer, >1,200 patients with hematologic malignancies, >400 SOTR and >400 patients with lupus. We will report results examining vaccine effectiveness for prevention of SARS-CoV-2 infection, severe COVID-19 and post-acute sequelae of COVID-19 (PAS-C or long COVID) in cancer patients compared to other immunocompromised conditions. Conclusion(s): Our goal is to inform public health guidelines on COVID-19 vaccine and boosters to reduce SARS-CoV-2 infection and severe illness in immunocompromised populations.

The Uni Currency Project: Democratic Finance for Public Higher Education After COVID-19

This chapter describes a novel policy mechanism for revitalizing U.S. public higher education in the age of COVID-19. In place of the current tuition-as-revenue model, we propose the "Uni” model, whereby public colleges and universities tap their latent fiscal authority to issue and circulate complementary currencies. Like their U.S. dollar counterparts, Uni currencies will obtain value because they will be accepted by colleges and universities in payment for tuition, fees, meal plans, and rents. To outline the full potential of the Uni, a thought experiments situates it between local municipalities and receivability in property taxes and as an instrument guaranteed by the Federal Reserve. When implemented, the Uni system will enable colleges to keep workers paid and students safe throughout and beyond the current crisis. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Emergency medicine resident involvement in emergency medical services

Introduction: Emergency medical services (EMS) are a critical component to Emergency Medicine (EM) residency training. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) has established minimum training requirements for EM residency programs. Since the last study exploring resident EMS involvement was performed, there have been over 100 new EM resident programs started. Given the rapid increase in new EM programs, we sought to determine EMS experiences provided to current EM residents. Materials and Methods: A 22-question anonymous online survey was distributed through E-mail to program directors of approved EM residencies in October 2020. A follow-up reminder was sent 3 weeks later. Results: In total, 51 of 257 programs responded (20% response rate). Forty-five percent of EM residents experience between 10 and 25 EMS calls during their residency, 31% experience 26-50, and 20% experience >50 calls. The majority of programs (53%) have a separate EMS rotation where residents function as observers, 24% of residents function as providers, and 25% also have residents respond in a dedicated physician response vehicle. Aeromedical exposure is limited (47% have none and 43% average only 1-9 flights). Two-thirds of programs (67%) have residents provide online medical command during their ED shifts and 61% require residents to provide didactics to EMS clinicians. Despite ACGME requirements, only two-thirds of programs (69%) provide training about disaster/mass casualty incident (MCI) management and 67% have them participate in a disaster/MCI drill. About one-third of programs (31%) have decreased EMS experiences due to limited time in the residency curriculum, and 20% of programs have limited EMS experiences due to the COVID pandemic. Conclusions: The majority of responding EM residency programs meet ACGME EMS-related requirements. There is an opportunity for improvement around disaster education based on these data. Limited time in the curriculum and the COVID pandemic were cited as reasons that programs have limited their EMS experiences. The following core competencies are addressed in this article: Practice-Based Learning and Improvement, Medical Knowledge. © 2022 The authors.

Evaluating the Effect of Donepezil on Mortality Among Alzheimer's Disease Patients With and Without COVID-19 Infection

Background. Dementia has been identified as an independent risk factor for increased severity of COVID-19 infection. Donepezil, a cholinesterase inhibitor approved for Alzheimer's disease (AD), has anti-inflammatory properties. Previous studies have found that donepezil reduced all-cause mortality for people living with AD. The anti-inflammatory effects of donepezil have not been studied in patients with COVID-19 and AD. Here, we compare mortality rates of patients with AD to assess the impact of donepezil on the severity of COVID-19 infections. Survival following SARS-CoV2-2 test, stratified by result and Donepezil Kaplan-Meier curves of all-cause mortality for Veterans with Alzheimer's Disease taking donepezil (black) compared to those who were not taking donepezil (grey), further stratified by those with a positive SARS-CoV-2 PCR test (solid lines) or no evidence of a COVID-19 infection during the study period (dashed lines). While donepezil has a positive effect on survival, the adjusted survival odds ratio is not greater among those with vs. without a COVID-19 infection. Methods. Using administrative data from the Veterans Healthcare Administration (VHA), we conducted a national retrospective cohort study of Veterans with AD who were tested for SARS-CoV-2 between March 1, 2020 and December 31, 2021 in the VHA. Among these patients, we assessed all-cause 30-day mortality stratified by COVID-19 infection and donepezil use and considered the interaction of these two factors. For Veterans with a positive test, the date of first positive test was used to assess mortality;for Veterans without a COVID-19 diagnosis or positive test, date of first negative test was used. Results. During the study period, 582 Veterans with Alzheimer's disease were positive for COVID-19 and 14430 had no test or diagnosis indicating COVID-19 infection. Among people with AD and COVID-19, all-cause 30-day mortality was 29% (47/163) for people taking donepezil compared to 38% (159/419) for those who were not. Among people with AD without COVID-19, all-cause 30-day mortality was 5% (189/4189) for people taking donepezil compared to 7% (712/10241) for those who were not. In a multivariable logistic regression, the decrease in mortality associated with donepezil did not differ between people with and without COVID-19 (OR (95% CI) = 0.71 (0.47, 1.07) vs. OR (95% CI) = 0.68 (0.57, 0.80), interaction P = 0.818). Conclusion. While all-cause mortality was lower for patients taking donepezil compared to those not taking donepezil, the protective effect of donepezil was not increased in AD patients with COVID-19 over those without COVID-19. The population differences and inflammatory biomarkers of AD patients treated with and without donepezil merit further study.

Impact of COVID-19 on Mortality Associated with Pseudomonas aeruginosa Bloodstream Infection in the Veterans Health Administration System

Background. Pseudomonas aeruginosa bloodstream infection (PA-BSI) is associated with high mortality. The extent to which the COVID-19 pandemic has introduced challenges to diagnosis and treatment of this infection is unknown. In this study, we examined the direct and indirect effects of COVID-19 on PA-BSI associated mortality in the Veterans Health Administration (VHA) population. Methods. We identified patients within the VHA database with PA-BSI identified between January 1, 2009 and December 31, 2019 (pre-COVID) and January 1, 2020 to December 31, 2021 (COVID). Extracted data included age, race, ethnicity, Charlson Comorbidity Index (CCI), susceptibility testing, treatment, and COVID-19 infection. Antimicrobial resistance was characterized as pan-susceptible, any unclassified resistance, multi-drug resistant (MDR), difficult to treat resistant (DTR), and extremely or pan-drug resistant (XDR/PDR). Active therapy was defined as an effective antibiotic initiated within 48 hours of blood culture collection. We used logistic regression to assess the impact of each factor on 30-day mortality. Results. We identified 7,578 patients with PA-BSI and known 30-day mortality status, which was 24% overall (Table 1). Age and CCI were higher during COVID, while effective treatment and resistance improved (Table 2). In the multivariate analysis, concomitant COVID infection tripled the odds of mortality (odds ratio [OR] 3.00, 95% confidence interval [CI] 1.40-6.37) (Figure 1). However, the COVID period itself was not associated with higher mortality. Effective treatment was associated with 19% lower odds of mortality (OR 0.81, 95% CI 0.66-1.01), while DTR and XDR/PDR nearly doubled mortality (OR 1.75, 95% CI 1.23-2.47 and OR 2.06, 95% CI 1.25-3.34, respectively). Conclusion. We observed higher odds of mortality in patients with PA-BSI and COVID-19 coinfection, supporting the hypothesis that COVID-19 directly impacts PA-BSI outcomes. Annual PA-BSI incidence and associated 30-day mortality, however, were similar during the COVID period. Favorable resistance trends, effective treatment, and a low rate of PA-BSI and COVID-19 coinfection may explain these findings, despite increased age and comorbidities in this vulnerable population. (Table Presented).

The third vaccine dose significantly reduces susceptibility to the B.1.1.529 (Omicron) SARS-CoV-2 variant.

The main coronavirus disease 2019 (COVID-19) vaccine formulations used today are mainly based on the wild-type severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike glycoprotein as an antigen. However, new virus variants capable of escaping neutralization activity of serum antibodies elicited in vaccinated individuals have emerged. The Omicron (B.1.1.529) variant caused epidemics in regions of the world in which most of the population has been vaccinated. In this study, we aimed to understand what determines individual's susceptibility to Omicron in a scenario of extensive vaccination. For that purpose, we collected nasopharynx swab (n = 286) and blood samples (n = 239) from flu-like symptomatic patients, as well as their vaccination history against COVID-19. We computed the data regarding vaccine history, COVID-19 diagnosis, COVID-19 serology, and viral genome sequencing to evaluate their impact on the number of infections. As main results, we showed that vaccination in general did not reduce the number of individuals infected by Omicron, even with an increased immune response found among vaccinated, noninfected individuals. Nonetheless, we found that individuals who received the third vaccine dose showed significantly reduced susceptibility to Omicron infections. A relevant evidence that support this finding was the higher virus neutralization capacity of serum samples of most patients who received the third vaccine dose. In summary, this study shows that boosting immune responses after a third vaccine dose reduces susceptibility to COVID-19 caused by the Omicron variant. Results presented in this study are useful for future formulations of COVID-19 vaccination policies.

Impact of Early Pandemic SARS-CoV-2 Lineages Replacement with the Variant of Concern P.1 (Gamma) in Western Bahia, Brazil.

BACKGROUND: The correct understanding of the epidemiological dynamics of COVID-19, caused by the SARS-CoV-2, is essential for formulating public policies of disease containment. METHODS: In this study, we constructed a picture of the epidemiological dynamics of COVID-19 in a Brazilian population of almost 17000 patients in 15 months. We specifically studied the fluctuations of COVID-19 cases and deaths due to COVID-19 over time according to host gender, age, viral load, and genetic variants. RESULTS: As the main results, we observed that the numbers of COVID-19 cases and deaths due to COVID-19 fluctuated over time and that men were the most affected by deaths, as well as those of 60 or more years old. We also observed that individuals between 30- and 44-years old were the most affected by COVID-19 cases. In addition, the viral loads in the patients' nasopharynx were higher in the early symptomatic period. We found that early pandemic SARS-CoV-2 lineages were replaced by the variant of concern (VOC) P.1 (Gamma) in the second half of the study period, which led to a significant increase in the number of deaths. CONCLUSIONS: The results presented in this study are helpful for future formulations of efficient public policies of COVID-19 containment.

A balancing act: changing the referral pathway following remote consultations for dizziness during the coronavirus disease 2019 pandemic.

BACKGROUND: This paper reports our experience in managing dizzy patients remotely during the coronavirus disease 2019 pandemic, and explored its safety as an alternative to face-to-face consultations. METHODS: Dizzy patients referred by their general practitioner were contacted to answer a validated questionnaire. Clinicians recorded the time needed for consultations, and the diagnosis at each of the following assessment stages: after review of the electronic general practitioner letter; following completion of the questionnaire; following the telephone consultation; and/or at follow up. Patients were telephoned no earlier than three months later to determine satisfaction with the service and symptom resolution. Electronic patient records were checked for presentation to hospital because of dizziness. RESULTS: Seventy patients had telephone consultations. None presented to the emergency department or were admitted. The majority of consultations took 15-30 minutes. The most diagnosed condition was benign positional paroxysmal vertigo. Seventy-nine per cent of patients were satisfied with the service. The questionnaire and telephone consultations demonstrated the greatest diagnosis agreement (κ = 0.40). CONCLUSION: Validated questionnaire and telephone consultations are a safe alternative to face-to-face consultations. Our patient referral pathway has now changed to include elements of the questionnaire.

From Inferior Vena Cava to Right Atrium: A Rare Case of a Unique Large Burden Thrombus in a Patient with Antiphospholipid Syndrome

Introduction: Antiphospholipid Syndrome is a condition where self-antibodies are directed against phospholipid binding proteins resulting in thrombosis and/or pregnancy loss. Diagnosis is made via history, physical, positive anticardiolipin and anti-beta-2-glycoprotein antibodies. We describe a case of a large thrombus in a previously diagnosed patient with antiphospholipid syndrome and discuss the need for prophylaxis in these patients. Case Report: 34-year-old G7P1161 Hispanic female with past medical history of uncontrolled diabetes mellitus type 2 presents with an acute onset of sharp abdominal pain radiating to the back associated with nausea, non-bloody non-bilious emesis and dysuria. Vital signs on admission are significant for tachycardia and hypertension. Labs are noteworthy for elevated Creatinine at 1.7 mg/dl, thrombocytopenia, transaminitis, elevated Ddimer at 14272 ng/ml. Urine analysis is positive for nitrites, trace leukocytes and bacteria. Her serum pregnancy test and COVID PCR are negative. CT Abdomen/Pelvis with contrast revealed an extensive thrombus in the Inferior Vena Cava (IVC) to the Right Atrium (RA), also extending into the hepatic veins and upper lumbar veins. Moderate perinephric fat stranding is also noted around bilateral kidneys. Ultrasound of the abdomen reveals cholelithiasis without evidence of acute cholecystitis. Venous Doppler of lower extremities reveals patent deep veins. Patient was started on heparin drip immediately and intravenous Cefepime. Interventional Radiology performed mechanical thrombectomy. Hematology was consulted and converted patient to Warfarin with an INR goal of 2.5-3. Patient was discharged and instructed to follow up with hematology. Discussion: There are few case reports of extensive thrombi ranging from IVC to RA with most cases occurring in elderly population. We present a unique case of an extensive thrombus ranging not only from the IVC to RA but also extending into the hepatic veins and the upper lumbar veins. The patient described has a history of multiple spontaneous abortions with her only successful preterm birth required daily therapeutic Lovenox during pregnancy. Her recurrent pregnancy loss and current large burden thrombus can be attributed to her antiphospholipid syndrome. This begs the question whether these patients should be started on prophylaxis anticoagulation. There have been limited studies with aspirin and warfarin which at times demonstrated positive results. Our patient had her thrombus identified incidentally due to an admission for pyelonephritis. If her thrombus was not recognized in time, outcomes could have been devastating. In conclusion, there should be further studies to determine the efficacy of anticoagulation prophylaxis in patients with positive antiphospholipid antibodies. (Figure Presented).

Psychoeducation for Cancer Survivors in a Clinical Setting during the COVID-19 Pandemic

Background/Purpose: Provision of education about selfmanagement to cancer survivors is a critical component of quality survivorship care and may improve survivors' ability to understand common/distressing symptoms, learn self-management strategies, and improve quality-of-life. Traditionally, education about psychosocial issues has occurred in clinical settings via in-person meetings with health care professionals. However, social-distancing restrictions from the COVID-19 pandemic, particularly in hospital settings, have significantly limited survivors' access to educational experiences. Methods: To address this issue, members of a survivorship center at a large healthcare system developed and delivered a 3-part series of psychoeducational webinars for cancer survivors addressing 1) Health Behaviors, 2) Mental Health, and 3) Long-term Late-Effects. Each webinar was 1-h long and offered at time deemed convenient for survivors based on pre-seminar surveys administered to 50 survivors inquiring about preferences for webinar content, format, length, and timing. All sessions were delivered via password-enable Zoom meetings, which were recorded and posted online, allowing attendees to review sessions and reach those who were unable to attend original presentations. Results: The virtual webinars were attended by 19, 18, 25 (total = 62) survivors respectively. A post-webinar survey was completed by 15 attendees (breast = 4, colorectal = 3, gynecological = 1, healthcare professional = 4, and other = 3). Most attendees were within 5 years of their diagnosis (94%), over the age of 50 (80%), and female (95%). Results of the survey indicated that attendees felt the Zoom platform was acceptable (100%), information was helpful (75%), well-organized (75%), and speakers were knowledgeable (75%). Importantly, attendees indicated they learned important survivorship self-management skills (90%). Conclusions and Implications: Results indicate survivors were satisfied with the format, content, and speakers, and learned important survivorship skills. However, respondents also suggested allowing more time for the sessions (90 vs. 60 min) and for Q and A. Future efforts will focus on attracting more, diverse attendees, increasing the length of the webinars, including patient/survivor/ advocate presenters, and adding new topics.

ACUTE REVERSAL OF SYSTOLIC HEART FAILURE IN A CASE OF COXSACKIEVIRUS MYOCARDITIS

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Viral Myocarditis is generally a self-limiting condition. Patients usually recover from viral myocarditis within a few weeks to months. Some patients can develop hemodynamic instability and may require critical care management. We present a unique case of acute systolic heart failure secondary to Coxsackievirus myocarditis which recovered within a few days. CASE PRESENTATION: A 19-year-old male came to ER for vomiting and abdominal pain for five days. Initial vitals were Temperature of 98 F, BP of 80/47 mm Hg HR of 124/min, and oxygen saturation of 93% on room air. EKG showed sinus tachycardia without ischemic changes. Initial labs were creatinine-2.6 mg/dl, troponin-2.15 ng/ml. CT of abdomen was unremarkable. CT of chest showed bilateral pulmonary edema and pleural effusion. Lung perfusion scan showed no perfusion defect. He did not respond to intravenous(IV) fluid. Initially it required IV vasopressor support- norepinephrine, phenylephrine, and dobutamine. Echocardiogram showed ejection fraction(EF) of 20-24% with severe global hypokinesis. COVID-19 PCR was negative. The pleural fluid study revealed transudative in nature. On day 3, he was weaned off from vasopressors. Acute kidney injury also resolved. Cytomegalovirus, HIV, autoimmune panel, and respiratory virus panel were negative. Coxsackievirus antibody came back positive. It was consistent with viral myocarditis. Patient showed clinical improvement, and we decided to repeat echocardiogram before discharge. On day 6, repeat echocardiogram showed significant improvement of EF to 54%. The patient was discharged on low dose carvedilol and lisinopril. Clinic follow up showed the patient's significant clinical recovery within a few weeks. DISCUSSION: In case of severe cardiomyopathy secondary to viral myocarditis, patient generally recovers within a few weeks to months. However, in our case, the patient developed acute systolic heart failure from Coxsackievirus myocarditis recovered within a few days after aggressive hemodynamic support. Repeat echocardiogram on the same admission also showed significant improvement in ejection fraction from 24% to 54%. It is a rapid recovery as per our knowledge and published data. CONCLUSIONS: Our case highlights that viral myocarditis has the potency to recover quickly, even from severe systolic dysfunction. This case also emphasizes the importance of repeating an echocardiogram on the same admission rather than waiting for a couple of months to ensure cardiac function recovery, particularly with very low ejection fraction on presentation. REFERENCE #1: Tschöpe, C., Cooper, L., Torre-Amione, G., & Van Linthout, S. (2019). Management of Myocarditis-Related Cardiomyopathy in Adults. Circulation Research, 124(11), 1568-1583. https://doi.org/10.1161/circresaha.118.313578 REFERENCE #2: 3. Schultz J, Hilliard A, Cooper L, Rihal C. Diagnosis and Treatment of Viral Myocarditis. Mayo Clin Proc. 2009;84(11):1001-1009. doi:10.4065/84.11.1001 DISCLOSURES: No relevant relationships by Gnananandh Jayaraman, source=Web Response No relevant relationships by Ramesh Babu Kesavan, source=Web Response No relevant relationships by Tusharkumar Pansuriya, source=Web Response No relevant relationships by Hytham Rashid, source=Web Response No relevant relationships by Sivatej Sarva, source=Web Response No relevant relationships by Aswin Srinivasan, source=Web Response No relevant relationships by BRANDEN WILSON, source=Web Response

Nurses' Wages and Hours of Work in the COVID-19 Era

The differential quantile impact of COVID-19 on the relative wages and hours of work of U.S. registered nurses in 2020 was measured. Overall, and by separate quantiles, nurses' weekly wages increased 2% when COVID-19 cases increased. Weekly hours of work fell by nearly 1%, so hourly wage rates rose by almost 3% on average. The ongoing impact of COVID-19 will likely continue to affect hours worked, overall wages, and the physical and psychological well-being of frontline workers.

Pneumomediastinum in COVID-19: Interplay between infection, inflammation and ventilation-a case series

Introduction: Pneumomediastinum is a rare clinical finding defined by air occupying a potential space in the mediastinum. Bilateral pulmonary opacities including consolidations and ground glass opacifications are some of the radiological manifestations of COVID-19 infection. There has been recent sporadic reports of pneumomediastinum in patients with COVID-19. Spontaneous or primary pneumomediastinum generally occurs when no underlying factors can be identified. Secondary pneumomediastinum occurs due to traumatic causes or non-traumatic respiratory diseases or infections. In this case series, we report seven patients with COVID-19 who developed secondary pneumomediastinum and also discuss the lung protective strategies. Case Description: We present this case series in a table format. Seven patients ages 45-77 (63.7+/-) were included. Reverse transcription polymerase chain reaction (RT-PCR) of SARS-CoV-2 nucleic acid was positive and chest X-ray performed in the Emergency Department showed bilateral subpleural opacities in all. All patients required supplemental oxygen and were transferred from medical floor to the Intensive Care Unit due to worsening respiratory distress. Patients were treated according to individual medical requirements and institutional standard of care. None of the patients had any history of smoking or pneumothorax. Five patients presented with constitutional and respiratory symptoms. Six patients (Patients 1, 3-7) were treated with non-invasive ventilation (BiPAP) prior to diagnosis of pneumomediastinum. Two patients (Patients 4, 7) required intubation and mechanical ventilation. Interestingly, patient 2 had pneumomediastinum on admission. Patient 6 developed both pneumomediastinum and pneumothorax (PTX). Five patients developed pneumomediastinum on noninvasive ventilation. BiPAP pressure varied and these patient's IPAP/EPAP values were in the range of 12-18/6-12. Patient 7 developed pneumomediastinum while mechanically ventilated on pressure control mode. Pneumomediastinum for patients 1-7 was managed conservatively. Patient 4 had pneumomediastinum and pneumothorax and so a chest tube was placed. Pneumomediastinum resolved in patients 3-7. Patients 1,2, and 4 died of multi-organ failure. Discussion: Pneumomediastinum has several known causes including trauma of the trachea or esophagus and positive pressure ventilation associated barotrauma. Viral pneumonia has rarely been associated with pneumomediastinum, but inflammatory lung parenchyma damage may also cause alveolar rupture. We postulate that the patients in this case series suffered pneumomediastinum secondary to SARS CoV-2-related inflammatory lung damage which lowered the threshold for non-invasive positive pressure ventilation-mediated barotrauma. Weaning patients off BiPAP to high flow system or intubation and mechanical ventilation should be considered as a potential strategy. Finally, more studies are needed regarding occurrence of pneumomediastinum in COVID-19 to understand the mechanism and prognostic value.

The Deleterious Effects of COVID-19 in the Peripartum Period: A Case Report.

While the Coronavirus Disease 2019 (COVID-19) pandemic continues to wreak havoc across the nation and the globe as one of the most significant global health crises of our time, recent attention has been turned to the effects of COVID-19 on pregnancy and the puerperium. Although most cases have been asymptomatic, for some patients, the disease may be accompanied by serious complications such as pneumonia, acute respiratory distress, multi organ failure, and death. Several case studies have noted that patients with co-morbidities are at a significant risk of these complications. In a recent systematic review and meta-analysis, authors conclude that cardiovascular disease was associated with increased composite poor outcome in patients with COVID-19. The following case report highlights the multi-system complications and severity of symptoms that can take place after childbirth in a patient with co-morbid obstetric and prenatal conditions and an initially asymptomatic COVID-19 infection.

Are audiences changing in the digital congress era? Findings from publicly available data

Objective: The rapid digitization of medical congresses due to COVID-19 may allow the research presented to reach a more geographically diverse audience. We assessed publicly available data to determine if the magnitude and geographic scope of attendance has increased for virtual vs pre-pandemic in-person meetings. Research design and methods: The largest five congresses across eight disease areas, as previously determined, one were searched. Only congresses with publicly available attendance information for both a 2020 virtual meeting and their most recent in-person meeting were included1. Numbers of attendees and their countries, if available, were extracted. A threshold of 10% was used to indicate change in attendee numbers or number of countries represented. Results: Of the congresses initially identified, 12/40 (30%) met all criteria. 5/12 (42%) showed increased attendance virtually and 4/12 (33%) showed no change compared with the most recent inperson meeting. 7/12 (58%) reported the number of countries represented, and of these, 4/7 (57%) and 3/7 (43%) showed an increase or no change, respectively. The European Hematology Association (EHA) and American Association for Cancer Research (AACR) annual meetings reported double (26,890 vs 12,614) and nearly triple (61,000 vs 21,000) the attendees, respectively;AACR also reported approximately double the number of represented countries (140 vs 71). Conclusions: This analysis may suggest that the current live-to-virtual transition is linked to heightened congress attendance, but data are limited and variation is seen between congresses. This has implications for transparency, compliance, and planning;congresses should provide more data to allow publication professionals to strategize how to amplify the reach and impact of novel and encore research.