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SESSION TITLE: Case Reports of Procedure Treatments Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Broncholiths are calcifications in the tracheobronchial tree that are most commonly associated with indolent infections. Disease manifestations range from asymptomatic stones in the airway to major complications such as massive hemoptysis or post-obstructive pneumonias. Depending on severity of the disease, patient management can range from conservative strategies to surgical interventions. We report successful reduction of a large obstructive broncholith in the right middle lobe via Holmium-yttrium aluminum garnet (Ho:YAG) laser lithotripsy. CASE PRESENTATION: Patient is a 55 year old male who presented with on going purulent cough, fever and pleuritic chest pain for 3 months. He had associated weight loss (>10 lbs in 3 months), malaise, increased fatigue, and scant hemoptysis. Initial chest x-ray was evident of right middle lobe consolidation. Respiratory infection panel, COVID PCR, AFB cultures and fungal cultures were negative. Subsequent CT of his chest showed right middle lobe opacities with areas of obstruction with a broncholith. Subsequently, patient underwent rigid bronchoscopy to allow for left sided airway protection via direct tamponade if patient develops massive hemoptysis. A bronchoscopic inspection was performed through the rigid scope that confirmed the broncholith. Obliteration of broncholith was then performed via Ho:YAG. After multiple laser treatments, we noted improvement in the size of the broncholith. Patient admitted to significant improvement in chest pain, hemoptysis and cough since the procedure. DISCUSSION: Broncholithiasis refers to calcified material eroding the tracheobronchial tree and causing inflammation and obstruction. Etiology of broncholiths include calcified peribronchiolar lymph nodes that erode into the airway lumen. Lymph node calcifications in the thorax are associated with lymphadenitis from fungal or mycobacterial infections. Management depends on the size of broncholiths. For larger stones, flexible bronchoscopy is often used to confirm diagnosis. When forceps extraction is not feasible, stone fragmentation with Ho:YAG is generally utilized, but they carry the risk of massive hemoptysis or bronchial injury. Surgical interventions, such as lobectomy or pneumonectomy, are reserved for patients with recurrent pneumonias, bronchiectasis, bronchial stenosis or broncho-esophageal or aorto-tracheal fistulas. In our case, we demonstrate successful reduction of a non-mobile broncholith by protecting the airway using rigid bronchoscopy by interventional pulmonology and subsequently avoiding surgical intervention in a patient with repeated post-obstructive pneumonia. CONCLUSIONS: Management of broncholiths should be individualized for symptomatic patients. A comprehensive assessment with appropriate imaging and involvement of interventional pulmonology can result in successful reduction of the stone and minimizing complications. Reference #1: Dakkak, M., Siddiqi, F., & Cury, J. D. (2015). Broncholithiasis presenting as bronchiectasis and recurrent pneumonias. Case Reports, 2015, bcr2014209035. Reference #2: Krishnan, S., Kniese, C. M., Mankins, M., Heitkamp, D. E., Sheski, F. D., & Kesler, K. A. (2018).Management of broncholithiasis. Journal of thoracic disease, 10(Suppl 28), S3419. Reference #3: Olson, E. J., Utz, J. P., & Prakash, U. B. (1999). Therapeutic bronchoscopy in broncholithiasis. American journal of respiratory and critical care medicine, 160(3), 766-770 DISCLOSURES: No relevant relationships by Jalal Damani No relevant relationships by Joseph Gatuz No relevant relationships by Fereshteh (Angel) Yazdi
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SESSION TITLE: Post-COVID-19 Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Organizing pneumonia (OP) is well known complication of severe viral infections. Recent reviews of postmortem biopsies and CT imaging suggest that a subset of patients develop secondary organizing pneumonia following infection with SAR-COV2. High dose steroids have previously been proven efficacious in post viral OP following infections such as H1N1, severe acute respiratory syndrome and MERS. This study aims to discover the incidence and impact of high dose steroids in treatment of Covid 19 patients who have characteristics of OP following initial infection. METHODS: We reviewed records of adult patients over age 18 hospitalized with respiratory failure due to COVID-19 pneumonia between 3/1/20 and 6/30/21 in our institution. We isolated patients who survived initial presentation but developed persistent hypoxia and CT evidence of progression to OP. Of these, we reviewed those treated with high dose prednisone, the usual dexamethasone, or no steroid treatment. We documented age, gender, timing of initiation of steroids, timing of steroid tapering, oxygen requirements at initiation, at day 30, and day 90, and overall outcomes. RESULTS: We identified 881 patients with COVID of which 46 patients met the criteria of having OP. Age ranged from 18-73, median age of 60.5. 52% were male. 3 patients had lung biopsy to confirm OP. All other patients were diagnosed based on CT and clinical presentation. 23 patients were treated with Prednisone after the initial 10-day course of dexamethasone. 24 patients were treated with just 10 days of dexamethasone. 5 patients were not treated with steroids. CONCLUSIONS: The incidence of post-covid OP appears to be lower than anticipated, with an incidence rate of roughly 0.05% in our study population. A significant proportion of patients had at least 2 underlying medical conditions. Patients on lower supplemental oxygen requirement (<2 L NC) were not continued on steroids and did well with only 2 of the 23 requiring oxygen at 30 days with mortality. Patients on higher supplemental oxygen at 10 days (>2L NC) were continued on steroids and the mortality rate was high, ~40%. We would conclude the incidence of post-Covid associated OP seems to be low in this small cohort of patients, and the decision to continue steroids should be based on individual patient characteristics such as supplemental oxygen requirements at 10 days, rather than CT findings of OP and that they seem to have higher mortality. In the future, larger multicenter cohort studies would help to understand further treatment. CLINICAL IMPLICATIONS: Although our incidence of post-covid OP is low, the mortality and morbidity in select patients appears to be high. Anticipating specific populations who may be at higher risk and starting treatment earlier could help reduce mortality. Larger cohort studies are needed to help develop better treatment strategies. DISCLOSURES: No relevant relationships by Hajra Channa No relevant relationships by Cesar Davila-Chapa No relevant relationships by Prathik Krishnan No relevant relationships by uzoamaka ogbonnah No relevant relationships by arunima sharma no disclosure on file for Diana Song;No relevant relationships by Fereshteh Yazdi
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Purpose Adopting digital technology could facilitate the public health response to the COVID-19 pandemic. Some analysts argue that countries that adopted digital technology in their health sector have managed to control the virus better (Whitelaw et al., 2020). For instance, countries with more comprehensive contact tracing have significantly lower fatality rates (Yalaman et al., 2021). Moreover, World Health Organization (WHO) believes this technology is a crucial enabler for countries to meet the current challenge (WHO. Regional Office for the Western Pacific & University of Melbourne, 2021). In this regard, this study aims to quantitatively find the relationship between the technological advancement of countries and COVID-19 health outcomes, using seven technological indices that measure technological advancement. Design/methodology/approach The authors used the multiple linear regression method to answer the research questions. The first analysis focuses on a cross section of all countries worldwide, and the second focuses on European countries for which weekly death statistics exist after the pandemic. Findings The findings support those countries with more technological abilities managed to control the virus's mortality better, as evidenced by the negative link between the mortality rate of COVID-19 and the technological factors at the national level. Results also reveal that technology adoption decreases the death risk due to COVID-19 in countries with more elderly people. The authors may argue that technological advancement positively correlates with the number of deaths and diagnosed cases because the authors can better collect data or because the virus spreads due to higher economic and business activities. However, such technological advancement significantly decreases the death risk (lower mortality rate in the first analysis and lower mortality rate for elderly people in the second analysis). Research limitations/implications Three important conclusions could be made from the results: a lower mortality rate is generally expected for countries adopting advanced technology;technological advancement significantly decreases the death risk for elderly people;and a higher technology adoption level does not necessarily result in fewer diagnosed cases of/death due to COVID-19. Originality/value Although some studies have focused on e-health applications in the public health response to the COVID-19 pandemic, no studies, to the best of the authors' knowledge, have tried to quantify its efficacy, most especially on the global level.