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1.
International Journal of Clinical Dentistry ; 15(4):703-705, 2022.
Article in English | Scopus | ID: covidwho-2124784

ABSTRACT

The emergence of COVID-19 created several new challenges in the field of dentistry. New guidelines were published by various regulatory bodies to be followed in dental clinic. One such guideline was to wear visor facemasks while working, to avoid the chances of cross-infection. However, the major problem associated with wearing visor is “fogging” leading to impaired vision of the operator. In this article, certain ways to reduce the chances of fogging has been enlisted. © 2022 Nova Science Publishers, Inc.

2.
Indian Journal of Vascular and Endovascular Surgery ; 9(4):309-312, 2022.
Article in English | Web of Science | ID: covidwho-2144183

ABSTRACT

End-stage kidney disease (ESKD) patients who were on maintenance hemodialysis require a stable, permanent vascular access as a lifeline. Venous mapping during prearteriovenous fistula (AVF) construction does not include central vein assessment. The guidelines on angiographic assessment of central veins during pre-AVF construction are yet to be streamlined. Moreover, during COVID pandemic, assess difficulty in catheterization laboratory and interventional radiology created devastating situation. We report 15 ESKD cases of central venous stenosis presented during the COVID pandemic time from February 2020 to July 2021. Patients' basic details were collected and initial clinical examination findings were recorded;they were subjected to Doppler and fistulogram. After the combined decision of nephrologist, interventional cardiologist, and vascular surgeon, the management (fistula closure/repair) was planned. Of 15 patients, 13 were males. Basic disease is chronic glomerulonephritis in 9, diabetic nephropathy in 4, and chronic interstitial nephritis in 2. Average number of central vein cannulation prior to AVF creation was 2.6. The median time to the development of symptoms after fistula creation was 13 months. Major initial symptoms were swelling of the upper limb in 4, dilatation of outflow veins in 5, swelling and dilatation in 2, poor flow during dialysis in 3, and dilatation of neck and chest vein in 1. Arm elevation test was positive in most of the cases. On Doppler assessment, dilated veins (> 12 mm) with high outflow (> 2000 ml/min) in 5, 4 patients showed low flow (< 400 ml/min), and six patients showed normal findings. In fistulogram, the common location of stenosis/thrombosis was brachiocephalic vein (BV) in 5 and subclavian vein (SC) in 3, BV vein + SC vein in 4, and superior vena cava in 3. Out of 15, 3 underwent balloon dilatation, 7 underwent fistula closure, 1 no intervention done, 3 lost to follow-up, and 1 expired. This is the first case series of central vein stenosis (CVS) brought in light during COVID pandemic. CVS is a serious issue, which might result in permanent vascular access failure. Further study is needed on impact of previous central vein catheterization leading to stenosis and role of pre-AVF creation angiographic assessment to avoid this type of devastating AVF complication.

3.
Sustainability and climate change ; 15(5):298-306, 2022.
Article in English | Scopus | ID: covidwho-2134746
4.
International Conference on Nonlinear Dynamics and Applications, ICNDA 2022 ; : 1409-1415, 2022.
Article in English | Scopus | ID: covidwho-2128340

ABSTRACT

In the present paper, we have prophesied how much time will be required to vaccinate 18+ population of India with at least one dose of COVID-19 vaccines. We have used non-linear extrapolation technique to prophecy, for this polynomial function is used for extrapolation. We have Fitted a non-linear polynomial of degree six to the cumulative vaccination data from 16 January 2021 to 24 July 2021 to estimate the required time period. Non-linear extrapolation results are depicted through the graphs, shows that the entire 18+ population will be vaccinated with at least 1 dose by mid of December of this year and 25% population will be fully vaccinated. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

5.
Journal of Clinical and Diagnostic Research ; 16(8):BC19-BC23, 2022.
Article in English | EMBASE | ID: covidwho-2033410

ABSTRACT

Introduction: Lipids are fundamental biomolecules of the body. Infections like COVID-19 with intricate immune response in some patient’s leads to acute complications by affecting metabolic pathways at multiple levels. Metabolism of cholesterol, triglyceride and High Density Lipoprotein (HDL)-Cholesterol is deranged by cytokines and multiple inflammatory mediators. The sex differences in lipid metabolism may contribute in susceptibility, severity and outcome of Coronavirus Disease 2019 (COVID-19). Performing lipid profile in COVID-19 patient may help in assessing severity and prognosis of disease. Aim: To assess the relationship between lipid profile and inflammatory markers in COVID-19 patients and also to evaluate the gender wise differences in lipid parameters and their correlations with inflammatory markers. Materials and Methods: This retrospective study was conducted in Department of Biochemistry at SHKM, GMC, Mewat, Haryana, India (tertiary care health centre) on COVID-19 positive patients attending Outpatient Department (OPD) and Inpatient Department (IPD), from October 2020 to December 2020. The data of 85 patients with COVID-19 positive, confirmed by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) and who were prescribed for lipid profile along with C-Reactive Protein (CRP) and serum ferritin were included in the study. Serum total cholesterol, triglyceride, HDL-Cholesterol, CRP and ferritin were measured in the subjects. Data was statistically analysed using Student’s t test and Pearson correlation coefficient. results: Total 85 (46 males and 39 females) COVID-19 patients were included in the study. Mean age in male and female patients were 43.02±15.52 years and 42.02±15.25 years, respectively with a range of 5-82 years. Mean value of Serum triglycerides, HDL-C and total cholesterol was 204.94±141.27 mg/dL, 42.97±13.38 mg/ dL and 187.058±45.75 mg/dL, respectively. Serum triglycerides were statistically significantly higher in males than females (p-value=0.0413). The HDL-C however was significantly higher in females than males (p-value=0.0006). In male patients, r-value between cholesterol and CRP was -0.3538, and p-value was 0.016. Ferritin had a significant negative correlation with HDL-C (r-value=-0.3578, p-value=0.00079). Weak Positive correlation was noted between triglyceride and ferritin (r-value= 0.2285, p-value=0.035). conclusion: High levels of serum triglycerides, low total cholesterol, and low HDL-cholesterol correlates with inflammatory markers like CRP and ferritin in COVID-19 patients. Lipid profile may be used as a potential marker in all COVID-19 patients in assessing prognosis of disease.

6.
Archives of Acoustics ; 47(2):131-140, 2022.
Article in English | Web of Science | ID: covidwho-1918298

ABSTRACT

Most of the Indian cities and towns have been facing serious traffic noise pollution due to urbanization, substantial growth of new vehicles, inadequate road network, etc. Automotive traffic, railroads, and air traffic are the most common sources of noise pollution in cities, with vehicular traffic accounting for around 55% of overall metropolitan noise. Prolonged exposure to such loud noise causes anger, stress, mental diseases, discomfort, hypertension, concentration problems, and sleeplessness. This study aims to investigate the effects of COVID-19 societal lockdown on changes in the noise pollution levels before, during, and after the lockdown period in various industrial, commercial, residential, and silence zones in Bengaluru, India, in light of the recent imposition of COVID-19 societal lockdown. According to data acquired from the KSPCB (Karnataka State Pollution Control Board) online portal, the average noise levels before and during lockdown were determined to be in the range of 59.4 dB to 70.9 dB and 58.2 dB to 62.7 dB for different zones. During the lockdown, all commercial, industrial and educational activities were closed to limit the spread of infection, resulting in usage of private and commercial transportation declining dramatically. Reduction in the noise level was observed during the lockdown in all monitoring stations of Bengaluru, except for Indira Gandhi Institute of Child Health, where the noise level didn???t decline because of a COVID emergency. Maximum reduction was observed in the commercial area (11.56%) followed by industrial areas (8.34%). The result further indicated that only the industrial area experienced an increase of 8.41% in noise level, while other areas experienced a reduction in a noise level during the early post-lockdown. During the mid and late post-lockdown periods, most locations experienced a rapid spike in the noise intensity.

7.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880628
8.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880479
9.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880478
10.
Asian Journal of Pharmaceutical and Clinical Research ; 15(5):94-98, 2022.
Article in English | EMBASE | ID: covidwho-1863542

ABSTRACT

Objective: Rhinocereberal mucormycosis is an acute, fulminant, and often lethal opportunistic infection typically affecting diabetic or immunocompromised patients. Early diagnosis is vital in these infections because delay in initiation of the treatment can be life-threatening. Computed tomography (CT) with axial and coronal sections is a highly accurate and non-invasive modality to accurately image sinonasal mycosis. The aim of the study was to describe the imaging findings in suspected cases of mucormycosis on CT. Methods: This study was conducted in Radiodiagnosis Department of Rajindra Hospital, Patiala. The data of 22 patients who were referred for CT with a clinical suspicion of mucormycosis were collected and all these patients were followed up to know about the prognosis of the disease. Results: In our study, there were 54.60% females and 45.40% males. Maximum number of patients (45.45%) belonged to 40-49 year age group. Diabetes mellitus was found to be the most commonly (90.90%) found comorbidity followed by hypertension (36.36%). In our study, involvement of unilateral nasal cavity was observed in 36.36% cases. Among the paranasal sinuses, maxillary and ethmoid sinuses were the most commonly involved in 95.45% and 77.27% cases. Conclusion: Prompt diagnosis and treatment of rhino-orbital mucormycosis are the sine qua non as antifungal drugs and surgical debridement can successfully control the infection and thus reduce the high mortality and morbidity associated with mucormycosis.

11.
National Journal of Community Medicine ; 13(2):126-132, 2022.
Article in English | Scopus | ID: covidwho-1836715

ABSTRACT

The Covid pandemic brought a hard time for sexual and reproductive health. Lockdown and covid restrictions made it difficult to maintain healthy sexual life and relationship. Although Covid is not a sexually transmitted disease and but can get a transfer into others by close contact with suspected or confirmed positive partners. Sexual health is essential for couples to maintain trust, intimacy, and love in their relationships. Reportedly sexual practices of couples changed accordingly to avoid any possible risk of transfer of deadly Covid infection. This paper is a review of studies published during past two years of pandemic. Even when people showing high levels of resilience, the negative aspects of pandemic and lockdown could affect their quality of sexual life. We are witnessing a century’s crisis where the whole world is under threat of rapidly spreading the new infection COVID -19 and the overall global impact of this new pandemic is yet uncertain. © 2022, MedSci Publications. All rights reserved.

12.
National Journal of Community Medicine ; 13(3):200-202, 2022.
Article in English | Scopus | ID: covidwho-1812229

ABSTRACT

India is one of the world’s worst affected countries due to COVID-19 pandemic. The world is struggling to fight against centuries pandemic. Globally governments have been imposed lockdown and restrictions to control situation and minimize spread of infection. Social media was found the most practical and efficient medium to share information and opinions about pandemic. At time of social distancing, social media helped people to share their feelings and find support. Same time overuse of social media platform created panic and misinformation across countries. People sharing unconfirmed information about covid pandemic and governments were found it difficult to handle. © 2022, MedSci Publications. All rights reserved.

13.
5th International Conference on IoT in Social, Mobile, Analytics and Cloud (I-SMAC) ; : 1049-1054, 2021.
Article in English | Web of Science | ID: covidwho-1779070

ABSTRACT

Security across network has become a major concern during this Covid-19 scenario. Security threats happens due to variety of reasons like theft of analytical property, software attacks, identity theft, stealing of equipment or information, sabotage, and information extraction. The wrong use of protocols over network also causes security threat. Introduction of data mining techniques in network security field plays a major role with data extraction, data transformation and analysation of the huge amount of data. The various data mining algorithms provides an insight to analyse and predict the data and the threats over the computer networks. This paper focusses on the approaches to predict security threats over networks using various classification algorithms. The four-classification algorithm majorly focussed here is Naive Bayes Classifier, Decision Tree Classifier, K Nearest Neighbours and Logistic Regression. It compares the performance of the above-mentioned classification algorithms to detect the threats.

14.
2021 IEEE International Conference on Bioinformatics and Biomedicine, BIBM 2021 ; : 2471-2478, 2021.
Article in English | Scopus | ID: covidwho-1722866

ABSTRACT

COVID-19 pandemic has brought immense attention to SARS-CoV-2 and related microbiology studies. To defeat this deadly virus, its RNA is being studied by many researchers around the globe. This study primarily aims to compile a large RNA dataset to analyze RNA secondary structure of SARS-CoV-2 efficiently. We propose improvements on database creation and maintenance, and structure analysis tools. As a continuation of our previous works, we automate the creation of RNA secondary structures database in a new format by converting data collected from publicly available online resources. We present new secondary structure analysis algorithms that improve performance of existing tools. Results of GPU-based implementation are also presented for RNA search operations. We also introduce tools with new objectives, which answer fundamental RNA secondary structure queries. Our tools on the current database have been tested with SARS-CoV-2 related RNA secondary structures. A novel RNA secondary structure search-based multiple RNA comparison is introduced and tested too. Structural-only and structure-with-nucleotide search results particularly related to SARS-CoV-2 are presented in details. As a successful case study, the framework presented here offers some unique capabilities and is shown as a useful exploratory tool for future RNA analysis studies. © 2021 IEEE.

15.
Asian Journal of Atmospheric Environment ; 15(4):1-16, 2021.
Article in English | Scopus | ID: covidwho-1598439

ABSTRACT

Many countries shut their borders, imposed nationwide lockdown, and restricted several anthropogenic activities to arrest the spread of COVID-19. In the present study, the concentration of several air pollutants (PM10, PM2.5, NO2, NH3, SO2, CO and O3) during different phases of lockdown from monitoring stations of Patna was analyzed to assess the effect of lockdown restriction on air quality. Reduction in PM2.5, NH3, NO2, PM10 and CO concentration was observed by 59.79%, 58.2%, 49.49%, 39.57% and 24.04%, respectively during the lockdown period. National Air Quality Index (NAQI) value in the year 2020 had been observed to lower by 57.88% compared to the year 2019, during the same period. A more significant fall in the concentration of air pollutants was observed during the early phase of post-lockdown compared to the late stages of post-lockdown. The study reflects the significance of restriction on anthropogenic activities in improving air quality and provides clues for future action plans for improving air quality. © 2021. by Asian Association for Atmospheric Environment.

16.
Iranian Journal of Microbiology ; 13(6):748-756, 2021.
Article in English | Web of Science | ID: covidwho-1576635

ABSTRACT

Background and Objectives: The entire globe is undergoing an unprecedented challenge of COVID-19. Considering the need of rapid and accurate diagnostic tests for SARS-CoV-2, this study was planned to evaluate the cost effective extraction free RT-PCR technique in comparison to the standard VTM based RT-qPCR method. Materials and Methods: Paired swabs from nasopharynx and oropharynx were collected for SARS-CoV-2 testing, from 211 adult patients (>= 18 years) in VTM and plain sterile tubes (dry swabs). These samples were processed and RT-qPCR was carried out as per standard protocols. Results: 54.5% of the patients were females and 45.5% were males with sex ratio 1:1.19 (M: F). 38.86% were symptomatic, of which fever (86.59%), cough (79.23%) and breathlessness (46.34%) were the most common symptoms. The positivity by VTM based method and index method was 31.27% and 13.27% respectively. Of the 27 inconclusive results from index method, 37.04% were positive, 48.15% were negative by VTM based method. However, in 40 inconclusive results by VTM based method, 90% were negative and rest remained inconclusive by index method. The sensitivity and specificity of the index method were 39.39% and 85.71% respectively. The overall agreement between VTM based method and index method was 49.59% with estimated Kappa value of 0.19. Conclusion: VTM based method showed higher sensitivity compared to the index method. The higher positivity by VTM based method, suggests that VTM based method could plausibly be a better detection method of SARS-CoV-2. Still, the index method might add value in a resource limited setups for detection of SARS-CoV-2.

17.
Blood ; 138:1942, 2021.
Article in English | EMBASE | ID: covidwho-1582416

ABSTRACT

The impact of Coronavirus disease 2019 (COVID-19) on outcomes in patients with cancer remains unclear. Acute Myeloid Leukemia (AML)/high-risk myelodysplasia (MDS) are common hematological malignancies resulting in profound immunosuppression, which is exacerbated by intensive and less-intensive chemotherapy. Importantly, venetoclax based regimens have been increasingly used during the pandemic as a strategy to reduce patient hospitalization however, there is little information concerning the impact of such regimens on COVID-19 infection rates. We therefore opened a prospective clinical study (PACE), at the start of the current pandemic in April 2020 to characterize the risk of COVID-19 infection in patients with AML/MDS-EB2 receiving intensive or non-intensive treatment, including patients treated with venetoclax-based regimens. The primary aim was to determine the incidence of COVID-19 in patients with AML /MDS-EB2 including both, prior to study entry and during treatment until 4 weeks after the last cycle of treatment. Secondary aims were to: characterize the presentation of COVID-19;define the severity and type of both non-COVID-19 and COVID-19 infections;and undertake an exploratory analysis to quantify the incidence of COVID-19 infection in patients receiving (less-intensive) venetoclax based regimens. All analysis conducted to date has been descriptive. 211/230 recruited patients had full treatment histories available, of whom 116 patients received intensive chemotherapy and 95 low intensity regimens. 48 patients received a venetoclax-based regimen. The median age of the non-intensive treatment arm was 72 years;(range 19.1-86.5) and of the intensive arm was 59 years (range 16.1-76.1). There were more cases of secondary AML and relapsed disease in the non-intensive arm as compared to the intensive arm. 25/226 evaluable patients tested positive for COVID-19 as defined by positive SARS-CoV2 PCR test, 10 with a prior diagnosis at study entry and 15 tested positive during the study. The incidence of COVID-19 infection for patients with AML/MDS-EB2 was 11.1% (90%CI: 7.8%-15.1%) (Table). A lower proportion of patients (n=6/91 6.6%) undergoing non-intensive treatment suffered COVID-19 as compared to those undergoing more intensive chemotherapy regimens (n=19/116, 16.4%). Specifically, only 3/48 (6.3%) patients undergoing a venetoclax regimen were infected with SARS-CoV2. The most common presenting symptoms of COVID-19 in this study, regardless of the intensity of chemotherapy, was fever and cough with 6/25 patients asymptomatic. The risk of death at 30 days following study entry in patients who had prior COVID-19 infection or who contracted COVID-19 during this period was 13.6%, compared to 3.9% in the overall cohort without COVID-19 infection. There was a lower incidence of non-COVID-19 related infections in patients receiving venetoclax-based regimens, n=43 infections in 24 (50.0%) of patients;with 313 infections in 94 (81%) of intensively treated patients. The overall occurrence of non-COVID-19 infection in the non-intensive arm was 87 infections in 50 (54.9%) patients. Our multi-center study provides real-world estimates for the incidence and presentation of COVID-19 infection in a cohort of patients with AML/MDS-EB2, and indicates a higher risk of death at 30 days in patients with prior COVID-19 infection prior to, or during treatment. Venetoclax based, and other non-intensive, regimens, increasingly implemented during the pandemic, to minimize patient exposure and reduce usage of hospital beds, appeared to be associated with a low incidence of COVID-19. Further follow-up will be required to understand the long-term impact of this strategy. Analysis of immune responses to COVID-19 infection and vaccination is on-going. Acknowledgments: This study was funded by Cure Leukaemia under the Trials Acceleration Program (TAP), and grants from BMS and Blood Cancer UK. [Formula presented] Disclosures: Loke: Novartis: Other: Travel;Janssen: Honoraria;Amgen: Honoraria;Pfizer: Honoraria;Daichi Sankyo: Other: Travel. K apper: Pfizer: Consultancy, Speakers Bureau;Astellas: Ended employment in the past 24 months, Speakers Bureau;Jazz: Consultancy, Speakers Bureau;Novartis: Consultancy, Research Funding, Speakers Bureau. Khan: Abbvie: Honoraria;Astellas: Honoraria;Takeda: Honoraria;Jazz: Honoraria;Gilead: Honoraria;Novartis: Honoraria. Dillon: Amgen: Other: Research support (paid to institution);Astellas: Consultancy, Other: Educational Events, Speakers Bureau;Menarini: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Session chair (paid to institution), Speakers Bureau;Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: educational events;Jazz: Other: Education events;Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Research Support, Educational Events;Shattuck Labs: Membership on an entity's Board of Directors or advisory committees. Culligan: AbbVie Ltd: Honoraria, Speakers Bureau;Celgene Ltd: Honoraria, Speakers Bureau;Gilead: Honoraria, Speakers Bureau;Jazz Pharma: Honoraria, Speakers Bureau;Takeda UK Ltd: Honoraria, Speakers Bureau. McMullin: Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Other: clinical trial support, Research Funding;Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;AbbVie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;AOP Orphan: Research Funding, Speakers Bureau. Murthy: Abbvie: Other: support to attend educational conferences. Craddock: Novartis Pharmaceuticals: Other: Advisory Board;Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding.

18.
Chest ; 160(4):A619-A620, 2021.
Article in English | EMBASE | ID: covidwho-1458115

ABSTRACT

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Coronavirus disease 2019 (COVID-19) has initiated a global health-care crisis. It is known to cause multi-organ failure with respiratory failure at the helm of its clinical presentation. There is limited data known about patient's experiencing acute mesenteric thrombosis. We present a case of patient admitted with COVID-19 pneumonia who experienced pneumoperitoneum secondary to acute mesenteric ischemia. CASE PRESENTATION: 64-year-old male with past medical history of hypertension, chronic obstructive pulmonary disease, and former smoker presented with dyspnea, decreased appetite, nausea, and diarrhea for 10 days. On Admission he was hypoxic on room air. Lab work revealed polycythemia, lactic acidosis 3.3, D-dimer 0.87, ABG (respiratory alkalosis with underlying metabolic acidosis), elevated inflammatory markers, and positive COVID-19 PCR. Chest X ray showed diffuse pulmonary opacities. CT angiography of the chest ruled out pulmonary embolism but showed diffuse ground-glass opacities (GGOs). He was placed on High flow nasal cannula (HFNC) at 50% FiO2, and Dexamethasone 6 mg. On hospital day 8 he was tachycardic, more dyspneic and hypoxemic requiring escalation of HFNC. EKG revealed sinus tachycardia. He was empirically started on heparin drip for concern of pulmonary embolism and broad-spectrum antibiotics for suspected bacterial pneumonia. CT chest without contrast showed worsening GGOs and pneumoperitoneum not seen on prior images. He was taken to operating room for emergent exploratory laparotomy. Intraoperative findings revealed a thrombus at the branch of the mesenteric artery leading to perforated cecum with feculent peritonitis. Patient passed away several days post-op due to worsening clinical status. DISCUSSION: Pneumoperitoneum is usually caused by perforation of abdominal viscus. COVID19 tends to cause multi organ failure(6). Elevation of pro-inflammatory cytokines can damage the microvascular system leading to uncontrolled activation of coagulation cascades which can cause small-vessel vasculitis and extensive microthrombi. There are very few cases reported regarding perforation of abdominal viscus due to microvascular thrombosis from COVID19. It is perplexing if COVID19 infection can acutely trigger this mesenteric arterial thrombus leading to ischemia and eventually perforation. It has been proposed that it might be secondary to direct viral invasion of the enterocyte cells via ACE2 receptors or immune response leading to cytokine storms (7) and activation of pro-coagulant cascades or combination of both (1,2,3). Mesenteric Ischemia is a life threatening condition requiring resection of ischemic bowel, GI decompression, and fluid resuscitation (4). Sometimes, it can be managed conservatively (5). CONCLUSIONS: It is important to recognize that COVID19 can potentially increase the risk of bowel perforation and cause pneumoperitoneum at risk groups of patients. REFERENCE #1: Parry A.H., Wani A.H., Yaseen M. Acute Mesenteric Ischemia in Severe Coronavirus-19 (COVID-19): Possible Mechanisms and Diagnostic Pathway. Acad Radiol. 2020;27(8):1190 REFERENCE #2: Varga Z., Flammer A.J., Steiger P., Haberecker M., Andermatt R., Zinkernagel A.S. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417–1418 REFERENCE #3: Panigada M., Bottino N., Tagliabue P., Grasselli G., Novembrino C., Chantarangkul V. Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost. 2020;18(7):1738–1742 DISCLOSURES: No relevant relationships by Khoi Paul Dang-Ho, source=Web Response No relevant relationships by Louis Gerolemou, source=Web Response No relevant relationships by Aneeta Kumari, source=Web Response No relevant relationships by Kyaw Zaw Linn, source=Web Response No relevant relationships by Nabil Mesiha, source=Web Response No relevant relationships by Kunal Nangrani, source=Web Response No relevant relationships by Viswanath Vasudeva , source=Web Response

19.
Chest ; 160(4):A269-A270, 2021.
Article in English | EMBASE | ID: covidwho-1458114

ABSTRACT

TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Roseomonas genus was described in 1993 by Rihs et al. as a "pink coccoid", non-fermentative, aerobic, gram-negative bacteria. It has been isolated from environmental sources (e.g., water, soil, air, and plants);however, human infections are rare. We report a case of R. gilardii associated bacteremia in the setting of COVID-19 pneumonia. CASE PRESENTATION: 73-year-old man with history of HIV (on Bictarvy, well controlled), and diabetes presented with progressive shortness of breath. On admission he was tachypneic, hypoxic, and tachycardic. Lab findings showed lactic acidosis, leukocytosis, respiratory acidosis, elevated inflammatory markers, and COVID-19 PCR positive. He was in acute hypoxic respiratory failure requiring escalation of oxygen therapy with eventual intubation. CT angiography of the chest showed diffuse bilateral subpleural ground glass opacities and lower lobe consolidation with air bronchogram. He was started on Dexamethasone 6mg (10 days), Remdesevir (1 dose), and empiric antibiotics for pneumonia. After 5 days of above therapy patient continued to deteriorate and plasma exchange was given as a salvage therapy. Blood cultures from admission grew Roseomonas Gilardii, which was susceptible to Cefepime. After literature review cefepime was switched to imipenem, cilastatin and amikacin due to studies suggesting high amounts of resistance to Cephalosporins. DISCUSSION: Majority of infection due to R. spp occur in immunocompromised patients (e.g., ESRD, cancer and transplant). These organisms are susceptible to quinolones, carbapenems, and cephalosporins with recommended duration of treatment being 15 days. R. mucosa isolates are resistant to ceftazidime, cefepime, piperacillin, tazobactam, and colistin. R. gilardii is more susceptible than R. mucosa to tested antimicrobial agents. CONCLUSIONS: This is the first reported case of R. gilardii associated empyema in a COVID-19 patient. This underlines the impact of superinfections in COVID-19. R spp. infection in humans is rare and have an inherent resistance to cephalosporins, but high susceptibility to Amikacin and Imipenem. REFERENCE #1: Rihs JD, Brenner DJ, Weaver RE, Steigerwalt AG, Hollis DG, Yu VL. 1993. Roseomonas, a new genus associated with bacteremia and other human infections. J. Clin. Microbiol. 31:3275–3283. REFERENCE #2: Petros Ioannou, Vasiliki Mavrikaki & Diamantis P Kofteridis (2020). Roseomonas species infections in humans: a systematic review, Journal of Chemotherapy, 32:5, 226-236, DOI: 10.1080/1120009X.2020.1785742 REFERENCE #3: Dé I, Rolston KV, Han XY. Clinical significance of Roseomonas species isolated from catheter and blood samples: analysis of 36 cases in patients with cancer. Clin Infect Dis. 2004 Jun 1;38(11):1579-84. doi: 10.1086/420824. Epub 2004 May 7. PMID: 15156446. DISCLOSURES: No relevant relationships by Aneeta Kumari, source=Web Response No relevant relationships by Kunal Nangrani, source=Web Response No relevant relationships by Jose Orsini, source=Web Response No relevant relationships by Evgeny Pinelis, source=Web Response No relevant relationships by Priya Raju, source=Web Response No relevant relationships by Keerthi Reddy Ramireddy, source=Web Response Speaker/Speaker's Bureau relationship with Allergan Please note: $20001 - $100000 by Joshua Rosenberg, source=Web Response, value=Honoraria No relevant relationships by Waqqas Tai, source=Web Response No relevant relationships by Viswanath Vasudevan, source=Web Response No relevant relationships by John Zeibeq, source=Web Response

20.
Chest ; 160(4):A309-A310, 2021.
Article in English | EMBASE | ID: covidwho-1458113

ABSTRACT

TOPIC: Chest Infections TYPE: Global Case Reports INTRODUCTION: COVID-19 is still an emerging topic and co-existence in HIV patients presents its unique challenge. These patients can range from elite controllers to Acquired immunodeficiency syndrome (T cell CD4 < 200). Throughout our management, we noticed certain trends in our population. Those patients with CD4 T cell < 200 were rarely admitted to hospital with severe cases of COVID-19, requiring if anything minimal oxygen requirements. However, HIV patients who were admitted did not fare well after initiating their anti-retroviral therapy (ART) therapy during index hospitalization. We describe two such cases one in which ART was maintained and one in which ART was help with different outcomes. CASE PRESENTATION: Both patients on admission were admitted for progressive dyspnea with COVID PCR positive, started on ART therapy, given a 10-day course of Dexamethasone 6mg and 5 doses of Remdisivir.Case 1 - 55year old Hispanic male with a history of non-compliance on Triumeq (CD4 count of 34), lymphoma in remission after chemotherapy, and sulfa allergy. On admission he was started on Triumeq, Azithromycin, Clindamycin, Primaquine. Over next 3 days he experienced progressive hypoxia and worsening chest imaging eventually requiring mechanical ventilation.Case 2 - 66year old female non-compliant on ART, and polysubstance abuse. She was also noted to have MSSA pneumonia. She was started on Emricitabine, Tenofovir, Ritonavir, and Atazanorvir. Within 48 hours of ART initiation her oxygen requirement increased. At this time, her antiretrovirals were stopped and started on Solumedrol 40mg twice daily for suspected IRIS. Her respiratory status improved and her oxygen requirements were back to baseline. Upon restarting ART 2 weeks post treatment for IRIS, patient again required an increase in oxygen supplementation. ART was held for an extended period while maintaining opportunistic infection prophylaxis. DISCUSSION: We pose this discussion for the community, as COVID-19 pathophysiology has been hypothesized to be an inflammatory response mitigated by Interleukins and Interferon-gamma, released by CD4 and CD8 T cells {3} Theoretically those with lower CD4 T cells, such as those with AIDs, should produce a lesser inflammatory response;and therefore, be less symptomatic. IRIS is typically determined from clinical context and is seen more frequently in those with CD4 < 100. {1} Treatment is typically steroids with a prolonged taper, with an ongoing discussion on whether ART should be held. {4} CONCLUSIONS: Currently there are no guidelines regarding utilization of ART in HIV patients infected with COVID;which leads to following questions of whether ART be held transiently until the COVID-19 pneumonia has been sufficiently treated? When should ART be restarted in these patients? If a patient's condition is deteriorating, should the patient's ART be held and started on opportunistic infection prophylaxis? REFERENCE #1: Bosamiya, S.S. The immune reconstitution inflammatory syndrome (2011) 56(5) 476-9, Indian J Dermatology. doi : 10.4103/0019-5154.87114 REFERENCE #2: Brown, L.B, Spinelli, M.A., and Gandhi, M. The interplay between HIV and COVID-19: summary of the data and responses to date. (2021) 16(1) 63-73, Current opinion of HIV and AIDs. REFERENCE #3: Kalfaoglu, B., Almeida-Santos, J., Tye, C.A., Satou, Y., and Ono, M. T cell dysregulation in COVID-19 (2020) 29(530) 204-210, Biochem Biophys Res Commun. doi: 10.1016/j.bbrc.2020.10.079 DISCLOSURES: No relevant relationships by Obed Adarkwah, source=Web Response no disclosure on file for Anjali Bakshi;No relevant relationships by Louis Gerolemou, source=Web Response No relevant relationships by Aneeta Kumari, source=Web Response No relevant relationships by Nabil Mesiha, source=Web Response No relevant relationships by Steven Miller, source=Web Response No relevant relationships by Kunal Nangrani, source=Web Response No relevant relationships by Jose Orsini, source=Web Response No relevant relationships by Gaurav Parhar, source=We Response no disclosure on file for Dhruv Patel;No relevant relationships by Jason Ravidas, source=Web Response No relevant relationships by jad sargi, source=Web Response No relevant relationships by Viswanath Vasudevan, source=Web Response No relevant relationships by Kiran Zaman, source=Web Response No relevant relationships by John Zeibeq, source=Web Response

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