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1.
Annals of Medicine and Surgery ; 84 (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2176139

ABSTRACT

Introduction: Herpetic Esophagitis is caused by the Herpes Simplex virus, which generally affects immunocompromised individuals and is rarely seen in healthy individuals. Symptoms are usually self-limiting. Case presentation: We report the case of a 68-year-old female who presented with odynophagia, dysphagia, and epigastric pain with no other underlying disease. Endoscopic findings of soft, nodular, and friable growths just above the squamocolumnar junction with diffuse ulcerations in the distal esophagus, led to the diagnosis. It was confirmed with a histopathological report which revealed multinucleated giant cells with eosinophilic intranuclear inclusions. During follow-up, laboratory investigations revealed iron deficiency anemia, which was the consequence of GI bleeding. Clinical discussion: Herpes Simplex virus esophagitis can occur in immunocompetent individuals and even it can cause food impaction and GI bleeding, which can lead to Iron deficiency anemia. Conclusion(s): Hence, follow-up of patients is important for early diagnosis and intervention of any complications that may arise. Copyright © 2022 The Authors

2.
Chest ; 162(4):A1506-A1507, 2022.
Article in English | EMBASE | ID: covidwho-2060835

ABSTRACT

SESSION TITLE: Respiratory Care: Oxygen, Rehabilitation, and Inhalers SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Background More than 1.5 million Americans live with supplemental oxygen that improves quality of life in adults living with chronic lung disease. After hospitalization for serious illness such as pneumonia (especially COVID), heart failure, COPD exacerbation or other lung disease, patients are discharged on supplemental oxygen. Hypoxemia often resolves after recovery from the illness and supplemental oxygen is no longer needed. As a part of “Choosing Wisely” campaign from ABIM, ATS/ACCP recommends “For patients recently discharged on supplemental home oxygen following hospitalization for an acute illness, don’t renew the prescription without assessing the patient for ongoing hypoxemia within 90 days after discharge. Objectives The primary objective of the study is to improve home oxygen reassessment after discharge from the hospital. METHODS: Study Design Subjects will be identified by electronic medical records (EMR) report and will include data from the 1st of January 2021 to 30th June 2021 (period of 6 months) Inclusion Criteria Subjects 18 years and older who were discharged from the RPH on supplemental oxygen Exclusion: Subjects 18 years and older on oxygen for palliation and hospice Study Outcomes The primary outcome measure will be assessed as percent of patients in whom oxygen requirement reassessed and percent in whom oxygen requirement was not reassessed. The secondary outcome measure will be assessed as percent of patients who had PCP follow up and percent of patients on continuous oxygen without reassessment Quality improvement PDSA: Phase I: pre-intervention data Phase II: Intervention-> education session to the providers and new epic order inclusion (BPA for reassessment and discontinuation) Phase III: post-intervention survey RESULTS: Based on chart review, 155 patients qualified for the study criteria. Among 155 patients, regarding the primary outcome-> 63 patients (40.6%) 90 days oxygen reassessment was done, 64 patients (41.2%) oxygen reassessment was not done, 10 patients (6%) died within the 90 days reassessment period and 19 patients were 90 days reassessment was not applicable (12%- 19 patients-on long term oxygen). Regarding the secondary outcomes, 113 patients (72.9%) were followed up with PCP, 16 patients (10.3%) did not have follow up, 19 patients (12.2%- no information available) had outside PCP follow up, 7 patients (4.5%- 2 died on same admission, 5 opted for hospice). Regarding patient who continued to use oxygen, 74 patients (47.7%) were continued on oxygen, 47 patients (30.3%) were discontinued of oxygen and 34 patients (22%) did not have any information available regarding oxygen use. CONCLUSIONS: From the above data, There is room for improvement regarding oxygen reassessment by educating primary care providers. Post intervention survey will be done in 6 months. CLINICAL IMPLICATIONS: Improve oxygen reassessment in patients after discharge with oxygen DISCLOSURES: No relevant relationships by Anam Aqeel No relevant relationships by Mansur Assaad No relevant relationships by Apurwa Karki No relevant relationships by Shobha Mandal No relevant relationships by Rajamurugan Meenakshisundaram

3.
Chest ; 162(4):A641, 2022.
Article in English | EMBASE | ID: covidwho-2060655

ABSTRACT

SESSION TITLE: Pathology Identifying Chest Infections Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Coronavirus disease 2019 (COVID-19) patients presented in a wide variety and had multiple complications. The well-known associations found are myocardial infraction, pulmonary embolism, meningitis, encephalitis. We are presenting a new diagnosis of Hairy cell leukemia in COVID 19 patients. CASE PRESENTATION: We present a 55-year-old pleasant female with no significant past medical history;non immunocompromised who presented with 7 days history of shortness of breath on exertion, fever, fatigue, and cough. Her physical exam was unremarkable, but she was desaturating on presentation hence was placed on oxygen via nasal canula. On work up she tested positive for COVID-19. Initial chest Xray revealed bilateral diffuse pulmonary infiltrates. Complete blood count (CBC) showed pancytopenia with white blood cell count (WBC) 0.8 × 103/μL (4–10 × 103/μL), absolute neutrophil count (ANC) 0.5 × 103/μL (2–7 × 103/μL), hemoglobin (Hgb) 10.4 g/dL (13.0–17.0 g/dL), and platelet count 156× 103/μL (150–400 × 103/μL). She received treatment for COVID 19 pneumonia as per the protocol. On repeat CBC check there was minimal improvement in her counts. The rest of her WBC differential showed a lymphopenia with ALC ranging from 350–500 with no other obvious immature cells or blasts to suggest a myeloid neoplasm such as acute leukemia. Work-up including vitamin B12, folate, TSH, EBV, ANA, and hepatitis were unremarkable. She also received treatment with supportive granulocyte colony-stimulating factor (G-CSF) but there was minimal improvement. As her pancytopenia persisted for 1 week the peripheral blood smear was done which showed pancytopenia (with prominent red cell agglutination, with rare, atypical lymphoid cells with multiple hairy projections. A bone marrow (BM) aspirate was hypocellular showing markedly decreased trilineage hematopoiesis with atypical lymphoid cells with oval or indented nuclear borders, unclumped chromatin, absent or inconspicuous nucleoli, and moderate to abundant pale blue cytoplasm with multiple circumferential cytoplasmic projections (hairy cells) [Figure:1]. The hairy cells showed strong positivity for CD20[Figure:2]. She was followed up by hematology and was started on treatment. DISCUSSION: Hairy cell leukemia (HCL) is a rare B cell lymphoproliferative disease with marked cytopenia and circulating leukemia cells. Multiple viruses (EBV, HTLV1) were found to be associated with multiple different malignancies. It is found that COVID19 is not associated with any malignancy so far, but our patient got diagnosed with HCL during COVID19 illness. CONCLUSIONS: The association of HCL could be an incidental finding but we need to do further studies to clarify the associations Reference #1: Kohla, Samah et al. "A Rare Case of Hairy Cell Leukemia with Unusual Loss of CD123 Associated with COVID-19 at the Time of Presentation.” Case reports in oncology vol. 13,3 1430-1440. 4 Dec. 2020, doi:10.1159/000512830 DISCLOSURES: No relevant relationships by Apurwa Karki No relevant relationships by Shobha Mandal No relevant relationships by Rajamurugan Meenakshisundaram

4.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927867

ABSTRACT

RATIONALE: The Center for Medicare and Medicaid requires hospitals to report compliance with a sepsis treatment bundle as part of its Inpatient Quality Reporting Program. Cleveland Clinic Foundation (CCF) Fairview hospital reported a Sepsis Core Measure Compliance (SEP-1) of 25% and a mortality averaging 20% in 2017. Both were very dismaying. METHODS: Starting in 2018 a sepsis committee was convened with a plan for several quality initiatives. Real-time audits and peer to peer education were provided to caregivers on the failed cases. A sepsis alert in the Electronic medical record system and a sepsis checklist were initiated. In 2020 a Code sepsis team was created with 24 hours response and follow-up on all sepsis alerts. As the CCF enterprise decided in 2020 to focus on mortality reviews, our hospital adopted rather a hybrid model reviewing all failed compliance cases of the one hour antibiotic in addition to mortality cases reviews. Several educational and awareness sessions were entertained with the residents, advanced practice providers, hospitalists, intensivists and nursing teams. Seventy Registered Nurses received training in 2018 and forty-three in 2021. Sepsis Champions were designated encompassing all stakeholders. Collaboration with Emergency Room caregivers to provide hand-off communication on sepsis alert patients to the medical-surgical providers ensured continuity of care. A sepsis order set was revised and went live in September 2021. Beginning of 2022, A dedicated full time quality coordinator and program manager for sepsis was appointed. RESULTS: Despite the Coronavirus 19 infection (COVID 19) pandemic where Cleveland Clinic Fairview Hospital was designated as the tertiary referral academic center for northwestern Ohio and despite the inclusion of COVID 19 mortality within the sepsis mortality data, comparing 2017 to 2021, SEP-1 measures compliance improved from 25% to 60.4% and sepsis mortality decreased from 20% to 15.38%. The one hour antibiotic compliance averaged 78.89% in 2021. With the above performance and impact on survival, Cleveland Clinic Fairview Hospital was leading the CCF Hospitals both in compliance and Mortality. Several of the above Fairview hospital quality initiatives and approaches were later adopted across the Cleveland Clinic Hospitals. CONCLUSION: A sepsis dedicated committee, quality/program manager and a code sepsis team with a focus on the evidence base components of the sepsis core measures, all helped improve compliance and decrease mortality. Future research is needed to highlight the impact of each of those quality and educational initiatives on outcomes and performance. Word Count: 400 (Figure Presented).

5.
International Journal of Early Childhood Special Education ; 14(3):1338-1347, 2022.
Article in English | Web of Science | ID: covidwho-1856298

ABSTRACT

Every country around the world is now working and pushing itself to provide citizen satisfaction, which is possible only through good governance, and people are expecting better services and better facilities from the government. The citizens keep up with their hope of expecting services from the government as they have chosen them to represent them in different situations and at different calibers. Although the government used to have a felicitous plan, this quandary may not work in situations like COVID-19, and the government has to come up with different plans and policies within a few days as it is not a facile task. Similar things happened in the Mizoram state of India, where the government of Mizoram needs to make a different effort so that people can avail government facilities from their homes through mobile phones, laptops, tablets, and computers. A reliable mixed approach is used to collect qualitative and quantitative data. Sample sizes of both men and women were taken from different officials of the Indian Police Service, Mizoram Police Service, Government College Professor, Gorkhali, and Mizo tribes, consisting of thirty respondents. The researcher also used descriptive research to expound on a population, situation, or phenomenon being studied. This research is conducted in the northeast state of Mizoram with special reference to Aizawl.

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