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Opportunistic infections (OIs) are the growing concern as the microbe takes advantage when the immune system is weak. Even the microbes that reside in us for many years may cause serious disease when the immune system has weakened. Also, certain microbes get reactivated and cause opportunistic infections. Such common OIs include oral and pharyngeal candidiasis, Tuberculosis, Herpes Zoster, Bacterial pneumonia, Cryptoccal meningitis, Taxoplasmasis. Such secondary infections are common in immunocompromised and long term hospitalized severely ill patients. Currently, the incidence of secondary infections is increased world-wide in COVID-19 infected patients. The interface of biology, chemistry, computer science and mathematics has shown tremendous innovations in infectious diseases. In this book, such interdisciplinary approaches have been focused for the management of OIs. The edited book would be helpful for scientists, scholars, industrialist to obtain updated key information about interdisciplinary approaches to tackle opportunistic infections. © 2022 by Nova Science Publishers, Inc.
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SESSION TITLE: Critical Diffuse Lung Disease Cases 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 12:45 pm INTRODUCTION: Acute exacerbations (AE) of idiopathic pulmonary fibrosis (IPF) are well recognized in the progression of this uniformly fatal disease. Here we describe a case of AE of undiagnosed IPF after ankle surgery. Our aim is to discuss the role of non-pulmonary surgery as a precipitating factor and its outcome. CASE PRESENTATION: The patient is a 61-year-old male with a medical history of chronic smoking, recent open reduction internal fixation of left ankle 5 days before the presentation, comes to the emergency room with acute onset, gradually worsening shortness of breath along with non-productive cough and pleuritic chest pain. He denied any sick contacts, COVID exposure, travel history, inhalation of toxic fumes, or any chemical/pets/bird exposure. He was saturating around 85% on room air, was switched to a nasal cannula with improvement in saturation. Computed tomography (CT) of the chest showed no evidence of pulmonary embolism but diffuse ground-glass opacities (GGO) were noted bilaterally with no effusion or emphysematous changes, which were new compared to CT chest 10 days prior (that is 5 days before ankle surgery) which showed only mild reticular opacity along anterior convexity of the lungs bilaterally. He was started on intravenous steroids with gradual improvement in clinical status. Bronchoscopy biopsies revealed no malignant cells, bronchoalveolar lavage with no infections, and a negative serum autoimmune panel. He was discharged with outpatient follow-up for a repeat CT chest 6 weeks later which showed improvement in GGO (not back to baseline) and he was still requiring oxygen support. DISCUSSION: The most common triggers for IPF are smoking, environmental toxins, viral (COVID infection) or bacterial infections, medications like antidepressants, beta-blockers, NSAIDs. There is increasing evidence that surgery can cause acute respiratory worsening in IPF, presumably through increased mechanical stress to the lungs. Prolonged mechanical ventilation, high tidal volume, and high concentration of supplemental oxygen during surgery have been proposed as potential causes(1). As per the results from the retrospective study, the incidence of postoperative AE of IPF in patients undergoing non-pulmonary surgery is slightly lower than in patients undergoing pulmonary surgery (2,3). As in our case, non-pulmonary surgery procedures can pose risk for IPF exacerbation, but at this time we have limited research evidence to conclude if this exacerbation can alter the course of the disease. Some studies showed preoperative elevated C-reactive protein as a possible risk factor for AE of IPF after a non-pulmonary surgery but a multicenter study is needed to clarify the preoperative risk factors for AE of IPF after non-pulmonary surgery. CONCLUSIONS: We need further studies to check risk factors and disease course alteration, to have better guidance to classify preoperative risk in our IPF patients. Reference #1: Acute Exacerbation of Idiopathic Pulmonary Fibrosis: A Proposal, PMID: 2441663 Reference #2: Exacerbations in idiopathic pulmonary fibrosis triggered by pulmonary and non-pulmonary surgery: a case series and comprehensive review of the literature, PMID: 22543997 Reference #3: Postoperative acute exacerbation of interstitial pneumonia in pulmonary and non-pulmonary surgery: a retrospective study DISCLOSURES: No relevant relationships by Arundhati Chandini Arjun No relevant relationships by Harshil Fichadiya no disclosure submitted for Boning Li;No relevant relationships by Gaurav Mohan No relevant relationships by Rana Prathap Padappayil No relevant relationships by Raghu Tiperneni
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SESSION TITLE: COVID-19 Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: We describe the clinical course of a COVID-19 patient with Streptococcus Dysgalactiae (SD) infective endocarditis, managed with six weeks of antibiotics and valve replacement surgery. CASE PRESENTATION: A 50-year-old previously healthy man presented with two weeks of fever, congestion, and diarrhea, and one day of acute change in mentation. On arrival, the patient's heart rate was 130/min, respiratory rate 25/min, and temperature 103.5 F. On physical examination, he appeared lethargic. Initial labs showed a white blood count of 16 k/mm with bands and platelets of 64 k/cmm. The patient was treated empirically for severe sepsis with intravenous vancomycin and cefepime. Blood cultures grew SD. Antibiotics were narrowed to intravenous ceftriaxone. A CAT scan of the chest, abdomen, and pelvis identified multiple splenic infarcts. A transesophageal echocardiogram was performed to evaluate the potential source of the splenic emboli, and this showed mild to moderate mitral regurgitation and a large globular mobile vegetation on the anterior mitral valve. Intravenous gentamicin was added to the treatment regimen. Subsequent cultures remained negative, and he underwent bioprosthetic mitral valve replacement on hospital day 11. He received a total of 6 weeks of outpatient intravenous antibiotic therapy. DISCUSSION: SD is a normal commensal of the skin, upper airway, and gastrointestinal tract. It can cause localized and invasive infections. Major risk factors for invasive infections include malignancy, diabetes mellites, and other cardiovascular diseases. Besides a recent COVID-19 infection, our patient was healthy. The COVID-19 infection causes a hypercoagulable state, and when combined with COVID-19 related diarrhea, can lead to the translocation of the gut bacteria, and subsequent infective endocarditis (IE) [1]. SD is a rare cause of IE, but the incidence of IE in bacteremic patients is about 10% [2]. Clinicians should have a low threshold to suspect IE in cases of SD bacteremia. American Heart Association Guidelines on IE [3] state that systemic embolization occurs in 22% to 50% of cases of IE, and the highest incidence of embolism occurs when the vegetation is mobile, on the anterior mitral valve and > 10 mm, like in our case. In such patients, early cardiac surgery should be considered. SD bacteremia recurrence occurs in about 10% of patients within the first year, and patients should be informed about this risk. CONCLUSIONS: Clinicians should suspect IE in the setting of SD bacteremia. COVID-19 infection increases the chances of the development of infective endocarditis. Prolonged intravenous antibiotic therapy and prompt replacement of the involved valve is necessary. SD IE is associated with a high rate of recurrence, and clinicians should be cognizant of this risk. Reference #1: "COVID-19 INFECTION PREDISPOSING ENDOCARDITIS ….” https://www.scienceopen.com/document?vid=02f2bbbe-479d-4d11-ad60-2ceba336a4e1. Accessed 4 Apr. 2022. Reference #2: "Bacteremia caused by group G Streptococci, taiwan - PubMed.” https://pubmed.ncbi.nlm.nih.gov/18439377/. Accessed 4 Apr. 2022. Reference #3: "Clinical relevance of vegetation localization by … - Semantic Scholar.” https://www.semanticscholar.org/paper/Clinical-relevance-of-vegetation-localization-by-in-Rohmann-Erbel/0106e26e3f2102eb6dd2fd7e086210c0a44ebf45. Accessed 4 Apr. 2022. DISCLOSURES: No relevant relationships by Husam Bader No relevant relationships by Poorva Bhide No relevant relationships by Gaurav Mohan No relevant relationships by Muhammad Tayyeb No relevant relationships by Charmee Vyas No relevant relationships by Siva Naga Yarrarapu
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Optical techniques are becoming increasingly popular for the analysis of body fluids, particularly so after the onset of the COVID-19 pandemic. Raman spectroscopy has found special significance among them due to its ability to perform label-free investigations of biological solutions with high sensitivity and specificity. The integration of Raman spectroscopy with optical tweezers-Raman Tweezers-has been explored in conducting biochemical investigations on individual red blood cells. We present in this chapter an evaluation of various stress agents, such as intravenous fluids, certain chemicals, and metal nanoparticles, on live, human red blood cells using the Raman Tweezers technique. The technique found efficacy in monitoring hemoglobin deoxygenation, heme aggregation, heme degradation, and membrane damage in red blood cells under the influence of exogenous agents. © 2022 Elsevier Inc. All rights reserved.
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Introduction: Coagulopathy in COVID-19 progresses from initialpulmonary microthrombi without systemic coagulation activation to asystemic hypercoagulable stage with widespread activation of coagulation and then to a hypocoagulable picture seen in later phases ofthe disease.Aims &Objectives: We decided to conduct this study because of thesevere infections in 2021 compared to 2020 to understand theCoagulopathy in COVID-19 among our population using Thromboelastography (TEG) and V curve.Materials &Methods: All adult patients with a confirmed COVID-19 and TEG report were recruited in the study and followed up fortwo months. Citrated Kaolin TEG parameters included were R and Ktime, alpha angle, maximum amplitude, clotting index, lysis 30. Thefirst-degree velocity curve of (V curve) TEG which extrapolatesthrombin generation potential with maximum rate of thrombin generation and time as well as thrombin generated. Comparison betweensurvivors and thromboembolisms were made with TEG parameters.Result: Study included 43 patients after excluding three patients.Average age was 58.34 (± 15.35) and majority of them were males(34/43). TEG as well as V-curve were hypercoagulable compared toage matched reference range. Systemic hypercoagulable stage (34/43)and interestingly 13/34 patients had secondary fibrinolysis activity.Mortality rate and thrombotic incidents was 32.56% and 30.23%respectively. Risk factors for mortality were MA, LY 30, TG,Hypercoagulable TEG (OR-7.36), D Dimer (OR-1.40) and Thrombosis (OR-1.37). Incidents of Thrombosis in decreasing order wasacute coronary syndrome (n = 10), DVT with PTE (n = 2) and MCAinfarction (n-1). LY 30 was associated with an increased thromboticrisk (OR-15.3, r = 0.122, Correlation-0.40, P = 0.02). Repeat TEGwas performed in 11 patients which was consistent with a hypercoagulable picture even after 5 days of thromboprophylaxis.Conclusions: TEG is useful in diagnosing and categorizing Coagulopathy associated with COVID-19.
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Respiratory symptoms are the most common presen-tation of an acute COVID-19 infection, but thrombo-embolic phenomena, encephalopathy and other neurological symptoms have been reported. With these case series, we present multiple presentations of COVID-19 induced vestibular symptoms namely diz-ziness, vertigo and nystagmus. The patients reported in this case series are from different parts of the world, be-long to different age groups and had manifested these symptoms in different periods of the pandemic. The pathophysiology of vestibular neuritis induced by COVID-19 is similar to any other viral infection. Whether in the inpatient or outpatient settings, CO-VID-19 should be considered in the differential diag-nosis for patients presenting with these symptoms, irrespective of the presence of respiratory symptoms or hypoxia. © 2021, EDIMES Edizioni Medico Scientifiche. All rights reserved.
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Along with outbreak of the pandemic COVID-19 caused by SARS-CoV-2, the problem of biomedical wastewater disposal has caused widespread public concern, as reportedly the presence is confirmed in wastewater. Keeping in mind (i) available evidence indicating need to better understand potential of wastewater mediated transmission and (ii) knowledge gaps in its occurrence, viability, persistence, and inactivation in wastewater, in this present work, we wanted to re-emphasize some strategies for management of SARS-CoV-2 contaminated wastewater to minimise any possible secondary transmission to human and environment. The immediate challenges to consider while considering wastewater management are uncertainty about this new biothreat, relying on prediction based treatments options, significant population being the latent asymptomatic carrier increased risk of passing out of the virus to sewage network, inadequacy of wastewater treatment facility particularly in populated developing countries and increased generation of wastewater due to increased cleanliness concern. In absence of regulated central treatment facility, installation of decentralized wastewater treatment units with single or multiple disinfection barriers in medical units, quarantine centre, isolation wards, testing facilities seems to be urgent for minimizing any potential risk of wastewater transmission. Employing some emerging disinfectants (peracetic acid, performic acid, sodium dichloro isocyanurate, chloramines, chlorine dioxide, benzalconium chloride) shows prospects in terms of virucidal properties. However, there is need of additional research on coronaviruses specific disinfection data generation, regular monitoring of performance considering all factors influencing virus survival, performance evaluation in actual water treatment, need of augmenting disinfection dosages, environmental considerations to select the most appropriate disinfection technology.