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1.
Endocrine Practice ; 27(6):S63, 2021.
Article in English | EMBASE | ID: covidwho-1859542

ABSTRACT

Introduction: Starvation ketoacidosis represents one of the three metabolic acidoses caused by the accumulation of ketone bodies within the bloodstream. Outside of late pregnancy, it is a relatively rare condition. In late pregnancy, the placental production of the hormones estrogen, cortisol, and human placental lactogen combined with increased lipolysis causes greater insulin resistance and an overall catabolic state which improves nutrient availability for vital fetal growth. However, this also allows for a magnified response to fasting that results in increased ketone production and in rare cases “accelerated starvation.” In this case, we present a 25-year-old pregnant patient who presented with nausea, vomiting, and poor oral intake, who was found to be in starvation ketoacidosis. Case Description: A 25-year-old G2P1001 cis female with a previous medical history of migraines presented at 33 weeks gestation with nausea, vomiting, and poor oral intake for four days prior to admission in the setting of COVID-19 infection. Patient presented hemodynamically stable and in no acute distress. Fetal non stress test on admission was reactive. Initial lab work revealed a glucose of 95, anion gap of 21, and a bicarbonate level of 7. A beta hydroxybutyrate (BHB) level was elevated at 5.26. Arterial blood gas showed a pH of 7.2 and a PCO2 of 23, consistent with an anion gap metabolic acidosis. Urinalysis revealed 3+ ketones. Overall labs were consistent with starvation ketoacidosis and the patient was immediately resuscitated with dextrose containing intravenous fluids and an insulin drip to help shunt away from ketoacidosis. Her BHB rapidly downtrended to 1.28 within 12 hours and within 24 hours it normalized. Her metabolic acidosis continued to improve throughout her hospitalization. She was able to tolerate a regular diet prior to being discharged home. A few weeks later, she had an uncomplicated full term delivery of a healthy baby. Discussion: Starvation ketoacidosis outside of pregnancy is rare and takes at least two weeks to manifest as a mild ketoacidosis. In pregnancy, patients are in an insulin resistant state which increases with gestational age, making them prone to ketoacidosis particularly in the second and third trimesters. Ketoacidosis in pregnancy is not only harmful for the pregnant individual, but for the developing fetus as well. Ketones can cross the placental barrier, leading to neurological impairment and even fetal demise if the acidosis is not addressed quickly. Prompt treatment with IV fluids, dextrose, and insulin is imperative to prevent neurodevelopmental compromise. Patients with appropriate and timely treatment can continue on to have uncomplicated pregnancies and deliveries.

2.
Indian Pediatrics ; 58(10):951-954, 2021.
Article in English | Web of Science | ID: covidwho-1509359

ABSTRACT

Objective To identify clinical and laboratory features that differentiate dengue fever patients from MIS-C patients and determine their outcomes. Methods This comparative cross-sectional study was done at a tertiary care teaching institute. We enrolled all hospitalized children aged 1 month-18 years and diagnosed with either MIS-C and/or dengue fever according to WHO criteria between June and December, 2020. Clinical and laboratory features and outcomes were recorded on a structured proforma. Results During the study period 34 cases of MIS-C and 83 cases of Dengue fever were enrolled. Mean age of MIS-C cases (male, 86.3%) was 7.89 (4.61) years. MIS-C with shock was seen in 15 cases (44%), MIS-C without shock in 17 cases (50%) and Kawasaki disease-like presentation in 2 cases (6%). Patients of MIS-C were younger as compared to dengue fever (P=0.002). Abdominal pain and erythematous rash were more common in dengue fever. Of the inflammatory markers, mean C reactive protein was higher in MIS-C patients [100.2 (85.1) vs 16.9 (29.3) mg/dL] (P<0.001). In contrast, serum ferritin levels were higher in dengue fever patients (P=0.03). Mean hospital stay (patient days) was longer in MIS- C compared to dengue fever (8.6 vs 6.5 days;P=0.014). Conclusions Clinical and laboratory features can give important clues to differentiate dengue fever and MIS-C and help initiate specific treatment.

3.
Journal of Urology ; 206(SUPPL 3):e342-e343, 2021.
Article in English | EMBASE | ID: covidwho-1483603

ABSTRACT

INTRODUCTION AND OBJECTIVE: COVID-19 has drastically changed didactic residency education. The urologic community displayed its resilience and adaptability by swiftly converting in-person education to webinar events in response to the pandemic. The goal of this study was to analyze the trends of urology webinars since the declaration of the COVID-19 pandemic. METHODS: The official social media accounts for all AUAregistered urology residency and urologic-oncology fellowship programs were systematically searched for webinar listings. All of the free webinars available to the greater urologic community posted between January 1, 2020 and June 1, 2020 were included in this study. Data was abstracted from each webinar including the date of delivery, topic of discussion, and number of speakers. Temporal trends were analyzed via join-point regression modelling. RESULTS: A total of 450 webinars were offered in the initial 18 weeks following the pandemic declaration. A total of 629 speakers from 96 academic institutions were involved in at least one webinar. The mean webinar duration was 58.7 minutes. At the peak of the “webinar frenzy,” a mean of 7.1 webinars/day were offered with 12.7 speakers/day involved. Urologic webinars increased in availability significantly from weeks 1 to 9 and decreased in availability non-significantly from weeks 10 to 18. Urologic-oncology was the most commonly discussed sub-specialty, representing 113 (25.1%) separate lectures with 151 speakers. Urologic-oncology increased in interest significantly over weeks 1 to 9 (AWPC: 110.7%;p<0.001) with a stable trend (AWPC -5.5, p=0.3) from weeks 10 to 18. Prostate cancer (33.9%) was the most discussed subject, followed by bladder cancer (29.5%), kidney cancer (12.5%), testis cancer (8%), upper urinary tract cancer (7.2%) and penile cancer (3.5%). CONCLUSIONS: In conclusion, our analysis demonstrates impressive and immediate reaction of the academic urologic community and specifically, the urologic-oncologic community, to continuing medical education amidst a pandemic. While webinars have some limitations, they have the opportunity to increase educational access across geographical and financial barriers. Time will show if webinars have a permanent role in the future of medical education or if we have witnessed the rise and fall of a “webin-era.”. (Table Presented).

4.
Journal of Urology ; 206:E342-E343, 2021.
Article in English | Web of Science | ID: covidwho-1411287
5.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-290553

ABSTRACT

Vaccine-induced neutralizing antibodies (nAbs) are key biomarkers considered to be associated with vaccine efficacy. In United States Government-sponsored phase 3 efficacy trials of COVID-19 vaccines, nAbs are measured by two different validated pseudovirus-based SARS-CoV-2 neutralization assays, with each trial using one of the two assays. Here we describe and compare the nAb titers obtained in the two assays. We observe that one assay consistently yielded higher nAb titers than the other when both assays were performed on the World Health Organizationa TMs anti-SARS-CoV-2 immunoglobulin International Standard, COVID-19 convalescent sera, and mRNA-1273 vaccinee sera. To overcome the challenge this difference in readout poses in comparing/combining data from the two assays, we evaluate three calibration approaches and show that readouts from the two assays can be calibrated to a common scale. These results may aid decision-making based on data from these assays for the evaluation and licensure of new or adapted COVID-19 vaccines.

6.
European Urology ; 79:S1357-S1358, 2021.
Article in English | Web of Science | ID: covidwho-1357815
7.
Indian Pediatr ; 2021.
Article in English | PubMed | ID: covidwho-1321152

ABSTRACT

OBJECTIVE: To identify clinical and laboratory features that differentiate dengue fever patients from MIS-C patients and determine their outcomes. METHODS: This comparative cross-sectional study was done at tertiary care teaching institute. We enrolled all hospitalized children aged 1 month - 18 years and diagnosed with either MIS-C and/or dengue fever according to WHO criteria between June and December, 2020. Clinical and laboratory features and outcomes were recorded on a structured proforma. RESULTS: During the study period 34 cases of MIS-C and 83 cases of Dengue fever were enrolled. Mean age of MIS-C cases (male, 86.3%) was 7.89 (4.61) years. Of 34 cases, MIS-C with shock was seen in 15 cases (44%), MIS-C without shock, 17 cases (50%) and Kawasaki disease-like presentation in 2 cases (6%). Patients of MIS-C were younger as compared to dengue fever (P=0.002). Conjunctival injection and swelling of hand and feet were more commonly seen in MIS-C. Abdominal pain and erythematous rash were more common in dengue fever. Of the inflammatory markers, mean C reactive protein was higher in MIS-C patients, than dengue fever patients [100.2 (85.1) vs 16.9 (29.3) mg/dL (P<0.001). In contrast, serum ferritin levels were higher in dengue fever patients (P=0.03). Need for mechanical ventilation was significantly more in MIS-C cases. Mean hospital stay was longer in MIS- C patients days compared to dengue fever (8.6 vs 6.5 days;P=0.014). CONCLUSION: Clinical and laboratory features can give important clues to differentiate dengue fever and MIS-C and help initiate specific treatment.

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