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1.
Ann Intern Med ; 2022.
Article in English | PubMed | ID: covidwho-2164140

ABSTRACT

BACKGROUND: In the EPIC-HR (Evaluation of Protease Inhibition for Covid-19 in High-Risk Patients) trial, nirmatrelvir plus ritonavir led to an 89% reduction in hospitalization or death among unvaccinated outpatients with early COVID-19. The clinical impact of nirmatrelvir plus ritonavir among vaccinated populations is uncertain. OBJECTIVE: To assess whether nirmatrelvir plus ritonavir reduces risk for hospitalization or death among outpatients with early COVID-19 in the setting of prevalent SARS-CoV-2 immunity and immune-evasive SARS-CoV-2 lineages. DESIGN: Population-based cohort study analyzed to emulate a clinical trial using inverse probability-weighted models to account for anticipated bias in treatment. SETTING: A large health care system providing care for 1.5 million patients in Massachusetts and New Hampshire during the Omicron wave (1 January to 17 July 2022). PATIENTS: 44 551 nonhospitalized adults (90.3% with ≥3 vaccine doses) aged 50 years or older with COVID-19 and no contraindications for nirmatrelvir plus ritonavir. MEASUREMENTS: The primary outcome was a composite of hospitalization within 14 days or death within 28 days of a COVID-19 diagnosis. RESULTS: During the study period, 12 541 (28.1%) patients were prescribed nirmatrelvir plus ritonavir, and 32 010 (71.9%) were not. Patients prescribed nirmatrelvir plus ritonavir were more likely to be older, have more comorbidities, and be vaccinated. The composite outcome of hospitalization or death occurred in 69 (0.55%) patients who were prescribed nirmatrelvir plus ritonavir and 310 (0.97%) who were not (adjusted risk ratio, 0.56 [95% CI, 0.42 to 0.75]). Recipients of nirmatrelvir plus ritonavir had lower risk for hospitalization (adjusted risk ratio, 0.60 [CI, 0.44 to 0.81]) and death (adjusted risk ratio, 0.29 [CI, 0.12 to 0.71]). LIMITATION: Potential residual confounding due to differential access to COVID-19 vaccines, diagnostic tests, and treatment. CONCLUSION: The overall risk for hospitalization or death was already low (1%) after an outpatient diagnosis of COVID-19, but nirmatrelvir plus ritonavir reduced this risk further. PRIMARY FUNDING SOURCE: National Institutes of Health.

2.
Advances in Human Biology ; 12(2):168-173, 2022.
Article in English | Web of Science | ID: covidwho-2155510

ABSTRACT

Introduction: Patient satisfaction in health care describes the degree to which patients' needs 'meet their expectations and provide an acceptable standard of care'. Therefore, their opinion should be incorporated to understand factors affecting patients' satisfaction with the health-care setting. The recent COVID-19 pandemic has posed a significant challenge for the field of dentistry owing to its working characteristics. It is difficult for dentists to provide optimum satisfaction to patients receiving dental care with such changes proposed. A study aiming to evaluate the patient's satisfaction receiving treatment in the Department of Dentistry during the pandemic was planned. Materials and Methods: A cross-sectional observational study from September to November 2020 was conducted. A self-administered printed questionnaire drafted in English/Gujarati was provided to 225 patients on completion of their dental treatment. Thirteen close-ended questions were included in determining the patient's satisfaction. Descriptive statistical analysis was used to describe the parameters of the questionnaire. The Chi-square test was used to find a significant association between parameters, and P < 0.05 was considered statistically significant. Results: About 74.3% of the participants were satisfied with dentist-patient communication. Positive response (80%) by patients where they were able to get an appointment as per their suitability and were informed in advance by the department if there were any changes. One hundred and sixty-eight (84%) patients responded that the waiting area was hygienic. One hundred and thirty-seven (68.5%) patients assured that their arrival was intimated to the respective dentist by supporting staff and that they were taken into an operatory for treatment within 10 min of arrival. Participants said that they were informed about the delay from their allotted appointment schedule with reasons;hence, better compliance (79%) was obtained from them. Conclusions: This cross-sectional study indicated that with proper communication, a positive response by participants over satisfaction was obtained even due to changing treatment patterns due to pandemic.

3.
Pilot Feasibility Stud ; 8(1):245, 2022.
Article in English | PubMed | ID: covidwho-2153699

ABSTRACT

BACKGROUND: Dental caries in childhood is a burden on the daily lives of children and their families, and associated with poor oral health in adulthood. In England, dental caries is the most common reason for young children to be admitted to hospital. It is believed that most tooth extractions (due to decay) for children aged 10 years and under, could be avoided with improved prevention and early management. National public health policy recommendations in England include specific oral health initiatives to tackle tooth decay. One of these initiatives is delivered as part of the Healthy Child Programme and includes providing workforce training in oral health, integrating oral health advice into home visits, and the timely provision of fluoride toothpaste. This protocol seeks to assess the delivery of the First Dental Steps intervention and uncertainties related to the acceptability, recruitment, and retention of participants. METHODS: This study seeks to explore the feasibility and acceptability of the First Dental Steps intervention and research methods. First Dental Steps intervention will be delivered in local authority areas in South West England and includes oral health training for health visitors (or community nursery nurses) working with 0-5-year-olds and their families. Further, for vulnerable families, integrating oral health advice and the provision of an oral health pack (including a free flow cup, an age appropriate toothbrush, and 1450 ppm fluoride toothpaste) during a mandated check by a health visitor. In this study five local authority areas will receive the intervention. Interviews with parents receiving the intervention and health visitors delivering the intervention will be undertaken, along with a range of additional interviews with stakeholders from both intervention and comparison sites (four additional local authority areas). DISCUSSION: This protocol was written after the start of the COVID-19 pandemic, as a result, some of the original methods were adjusted specifically to account for disruptions caused by the pandemic. Results of this study will primarily provide evidence on the acceptability and feasibility of both the First Dental Steps intervention and the research methods from the perspective of both families and stakeholders.

4.
Asian Journal of Pharmaceutical and Clinical Research ; 15(11):121-125, 2022.
Article in English | EMBASE | ID: covidwho-2146051

ABSTRACT

Objectives: Cytokine release syndrome (CRS) is believed to be responsible for death in COVID-19. Tocilizumab is an interleukin (IL)-6 receptor antagonist, IL-6 being identified as a major component of the CRS cascade. The objective of the study was to determine if tocilizumab can prevent mortality and morbidity in moderate-to-severe COVID-19 pneumonia. Method(s): Patients admitted to the ICU between the time period of June 2020-August 2020 were included in this retrospective and cohort study conducted at GCS medical college, hospital and research center. Patients had to be more than 18 years of age and were required to have a positive reverse transcription polymerase chain reaction report for COVID-19. After applying the inclusion/exclusion criteria, 119 patients were considered for final analysis. Tocilizumab was administered as a single dose of 8 mg/kg in 22 patients. Rest of the patients received standard of care regime. The primary outcome was either discharge or death of the patients and the requirement of invasive mechanical ventilation during their hospital stay. The secondary outcome was the length of hospital stay. Appropriate demographic, clinical, and laboratory data were documented. Statistical analysis was done with appropriate clinical tests with significance set at p<0.05. Result(s): Tocilizumab significantly reduced deaths in patients as well as the need for mechanical ventilation with NNT=3 and 5, respectively. The same held true even when the data were adjusted for age, gender, and number of comorbidities. Number of comorbidities had a negative association with mortality and need for mechanical ventilation irrespective of administration of tocilizumab as evidenced by multivariable logistic regression. There was no effect of tocilizumab in shortening the hospital stay in patients. Conclusion(s): Tocilizumab seems to be a promising agent for the treatment of moderate to severe COVID-19 pneumonia and similar agents hold promise for any similar future emerging infections. Copyright © 2022 The Authors.

5.
PM and R ; 14(Supplement 1):S81-S82, 2022.
Article in English | EMBASE | ID: covidwho-2127977

ABSTRACT

Case Diagnosis: A 71-year-old female developed C7-C8 radiculitis with left hand weakness 4 days after receiving her booster dose of SARS-CoV-2 vaccine. Case Description or Program Description: Patient with a significant past medical history of cervical fusion and bilateral carpal tunnel releases over 20 years ago presented to outpatient office because of decreased hand grip strength 4 days after receiving her booster dose of Pfizer-BioNTech SARS-CoV-2 vaccine. Her left hand weakness was spontaneous in onset, making her unable to flex her index finger and type. No pain or paresthesia. No trauma, swelling, color or temperature change in her left hand. Nerve conduction study and electromyography performed 19 days after the onset of her symptoms revealed acute greater than chronic changes mainly in distal muscles innervated by C7-C8 nerve roots, compatible with left C7-8 radiculopathy. MRI findings were chronic and compatible with her history of cervical fusion. Her clinical presentation was thought to be an inflammatory rather than mechanical etiology associated with the booster. Patient was referred to outpatient occupational therapy to help her restore hand function. Setting(s): Outpatient office of acute rehabilitation hospital Assessment/Results: Patient underwent occupational therapy and reported mild improvement in hand strength and function after 3 months of therapy. Discussion (relevance): The clinical course of this patient suggested an association between her symptoms and the booster dose of SARS-Cov-2 vaccine. It is possible that some component of the booster might have triggered an immune response and cross-reacted to the peripheral nerve system, leading to acute neuritis and the weakness of her hand. Conclusion(s): Neurologic complications after SARSCov- 2 vaccination is usually mild and self-limiting. We present a rare case of acute radiculitis that was associated with SARS-Cov-2 vaccination with residual impairment in function. Although the causality cannot be confirmed due to the lack of a biological marker, this case may help guide further research into a potential pathogenic mechanism.

6.
J Endocr Soc ; 6(Suppl 1):A105, 2022.
Article in English | PubMed Central | ID: covidwho-2119614

ABSTRACT

Introduction: Bilateral adrenal hemorrhage (BAH) has been noted in several conditions. Bilateral adrenal infarcts (BAI) are rarer but have been seen in anti-phospholipid syndrome (APS). Adrenal insults are not commonly associated with myelodysplastic syndrome (MDS). We present a patient who developed BAI as initial presentation of APS in the setting of MDS and discuss management considerations. Case: A 58-year-old female with MDS diagnosed one month prior presented with abdominal pain, present for one year but acutely worse in the past week. CT A/P showed nodularity of bilateral adrenal glands. She was treated conservatively but continued to experience nausea, vomiting, and abdominal pain – repeat CT A/P one month later was suspicious for bilateral peri-adrenal hemorrhages. MRI with adrenal protocol demonstrated bilateral non-hemorrhagic adrenal infarcts. VS were negative for hypothermia or hypotension. Labs showed Na 136 (135-145 mmol/L), K 3.5 (3.4-5.1 mmol/L), BG 108 (mg/dL), DHEA-S 9.3 (8.0-391 mcg/dL), renin 6.7 (0.5-4.0 ng/mL/hr), aldosterone 6.2 (<31.0 ng/dL), 60-minute cortisol after ACTH stimulation test 34.3 (5.2-22.5 mcg/dL), plasma metanephrines <0.10 (0.00-0.49 nmol/L), plasma normetanephrines 0.34 (0.00-0.89 nmol/L), Hgb 11.8 (12.0-15.5 g/dL), and plts 129K (140-450 K/mcL). No history of anticoagulant use, trauma, or VTE. COVID-19 PCR was negative on two separate tests. Hypercoagulability testing noted positive lupus anticoagulant. Anticoagulation was deferred due to underlying bone marrow abnormalities and thrombocytopenia;aspirin was recommended instead by hematology. Outpatient testing revealed 12pm cortisol of 12.6 (5.2-22.5 mcg/dL), ACTH 108.3 (7.2-63.0 pg/mL), and DHEA-S 6.2 (8.0-391 mcg/dL). Patient was empirically started on hydrocortisone for glucocorticoid replacement therapy. Conclusion: BAI is not typically associated with MDS but can occur in the setting of a concurrent hypercoagulable process such as APS. The adrenal glands are the most commonly involved glands in APS. Patients often present in adrenal crisis but can present in stable condition as in this case. The adrenal glands are particularly vulnerable due to the "vascular dam" near the zona reticularis. Imaging and laboratory investigation can clarify the nature of the adrenal insult and guide management. Treatment strategy may include anticoagulation to prevent further VTE events, but bleeding risk must be considered. Both glucocorticoid and mineralocorticoid replacement should be considered until residual adrenal reserve can be fully elucidated, which may take several months from initial diagnosis. References: Rao RH. Bilateral massive adrenal hemorrhage. Med Clin North Am 1995;79(1): 107-29. Aron DC, Findling JW, Tyrrell JB. Glucocorticoids and adrenal androgens. In: Greenspan's Basic and Clinical Endocrinology. Gardner DG, Shoback D (eds). Mc Graw Hill 2007;pp 367-378. Caron P, Chabannier MH, Cambus JP, Fortenfant F, Otal P, Suc JM. Definitive adrenal insufficiency due to bilateral adrenal hemorrhage and primary antiphospholipid syndrome. J Clin Endocrinol Metab 1998;83(5): 1437-9.Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

7.
American Journal of Cardiology ; 187:76-83, 2023.
Article in English | EMBASE | ID: covidwho-2114432

ABSTRACT

ST-segment elevation myocardial infarction (STEMI) complicating COVID-19 is associated with an increased risk of cardiogenic shock and mortality. However, little is known about the frequency of use and clinical impact of mechanical circulatory support (MCS) in these patients. We sought to define patterns of MCS utilization, patient characteristics, and outcomes in patients with COVID-19 with STEMI. The NACMI (North American COVID-19 Myocardial Infarction) is an ongoing prospective, observational registry of patients with COVID-19 positive (COVID-19+) with STEMI with a contemporary control group of persons under investigation who subsequently tested negative for COVID-19 (COVID-19-). We compared the baseline characteristics and in-hospital outcomes of COVID-19+ and patients with COVID-19- according to the use of MCS. The primary outcome was a composite of in-hospital mortality, stroke, recurrent MI, and repeat unplanned revascularization. A total of 1,379 patients (586 COVID-19+ and 793 COVID-19-) enrolled in the NACMI registry between January 2020 and November 2021 were included in this analysis;overall, MCS use was 12.3% (12.1% [n = 71] COVID-19+/MCS positive [MCS+] vs 12.4% [n = 98] COVID-19-/MCS+). Baseline characteristics were similar between the 2 groups. The use of percutaneous coronary intervention was similar between the groups (84% vs 78%;p = 0.404). Intra-aortic balloon pump was the most frequently used MCS device in both groups (53% in COVID-19+/MCS+ and 75% in COVID-19-/MCS+). The primary outcome was significantly higher in COVID-19+/MCS+ patients (60% vs 30%;p = 0.001) because of very high in-hospital mortality (59% vs 28%;p = 0.001). In conclusion, patients with COVID-19+ with STEMI requiring MCS have very high in-hospital mortality, likely related to the significantly higher pulmonary involvement compared with patients with COVID-19- with STEMI requiring MCS. Copyright © 2022 Elsevier Inc.

8.
European Journal of Molecular and Clinical Medicine ; 9(7):2028-2033, 2022.
Article in English | EMBASE | ID: covidwho-2102177

ABSTRACT

Background: COVID-19 pandemic originated in the city of Wuhan in Hubie province of China and within three months of its origin the disease extended to nearly 221 countries in the world. Objective(s): The objective is Study of hematological and various biochemical Markers in COVID-19 patients admitted in a tertiary care centre . Methodology: In this single-center study, records of 170 patients hospitalized with COVID-19 were studied for hematological profile and biochemical markers. Records of patients with laboratory-confirmed COVID-19 disease hospitalized between April 2020, to August 2020, were included in the analysis. Result(s): A total of 170 patients were enrolled of Age Group 20-80 year of which 80% (136/170) were asymptomatic and 20% (34/170) symptomatic. 17% patients had co-existing illnesses. Clinical spectrum among COVID-19 patients varied from being asymptomatic to having symptoms like fever, dry cough, breathlessness with few progressing to respiratory failure and multi-organ failure. In our study, 96.0% (163/170) recovered while 4.0% (7/170) died. Mean age, total leucocyte count (TLC), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lactate dehydrogenase (LDH),Procalcitonin, CRP, D dimer of severely ill patients were significantly higher than those of patients with non-severe illness. Conclusion(s): The clinicians may consider the hematological and biochemical parameters in the patients with COVID-19 in future decision-making. Elevated NLR, TLC, LDH, C-Reactive Protein, Procalcitonin, D dimer and lymphopenia were seen in the symptomatic patients especially manifesting severe disease. Early intervention and periodic monitoring of these parameters in patients, especially with severe disease may help in improving disease outcome. Copyright © 2022 Ubiquity Press. All rights reserved.

10.
Epilepsia ; 63:229-230, 2022.
Article in English | Web of Science | ID: covidwho-2067971
11.
Chest ; 162(4):A2652-A2653, 2022.
Article in English | EMBASE | ID: covidwho-2060978

ABSTRACT

SESSION TITLE: Late Breaking Insights In Management of Asthma and COPD SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 09:15 am - 10:15 am PURPOSE: SARS-CoV-2 vaccines have greatly reduced the impact of the COVID-19 pandemic. However, immune responses and their ability to protect against SARS-CoV-2 infection and severe clinical outcomes vary amongst vaccinees. Understanding who remains at high risk for severe infection despite vaccination and who may need additional vaccine boosters is critical for the control of this and future pandemics. We recently reported a reduced humoral immune response after mRNA SARS-CoV-2 vaccination in patients with severe asthma or atopic dermatitis on biologic therapies three months after the second vaccination, compared to healthy controls. The purpose of this study is to characterize the immune response of these patients six months after vaccination. METHODS: We conducted a prospective observational trial from February 2021 to February 2022 and enrolled 77 adults with severe asthma or atopic dermatitis treated with benralizumab, mepolizumab or dupilumab, receiving a SARS-CoV-2 mRNA vaccination, in addition to 45 healthy controls. We analyzed pseudovirus neutralization against wild-type, Delta variant and Omicron variant SARS-CoV-2, using a pseudotyped lentivirus. RESULTS: After excluding patients with prior COVID-19 or significant immunosuppression, we analyzed 28 patients (5 patients on benralizumab, 20 patients on dupilumab, 3 patients on mepolizumab) in addition to 34 healthy controls at 6 months after vaccination. We found that patients with severe asthma or atopic dermatitis treated with biologics had lower pseudovirus neutralization titer at 6 months, compared to healthy controls. The mean 50% inhibitory dilution against wild-type SARS-CoV-2 among patients on biologics were lower at 2.313 log10 compared to 2.743 log10 in the healthy control group, p-value <0.0001. Additionally, the patients on biologics had lower neutralizing antibody titers against Delta variant and Omicron variant SARS-CoV-2. CONCLUSIONS: Our data shows that patients with severe asthma or atopic dermatitis on biologic therapies have lower neutralization titer after SARS-CoV-2 mRNA vaccination compared to healthy controls 6 months after the second vaccination. Large population studies have recently shown that severe or active asthma is associated with worse COVID-19 outcomes and several studies have shown that lower humoral immunity after vaccination is associated with less protection against disease. It is therefore critical to provide booster vaccinations to these vulnerable patients. CLINICAL IMPLICATIONS: Clinicians should encourage patients with severe asthma or atopic dermatitis on biologic therapies to receive SARS-CoV-2 booster vaccinations as they may unknowingly remain at high risk for severe disease. DISCLOSURES: No relevant relationships by Fabliha Anam No relevant relationships by Suneethamma Cheedarla No relevant relationships by Narayanaiah Cheedarla No relevant relationships by John Daiss No relevant relationships by Natalie Haddad No relevant relationships by Ian Hentenaar No relevant relationships by Fernando Holguin No relevant relationships by Caroline Kim No relevant relationships by Pedro Lamothe No relevant relationships by Frances Lee No relevant relationships by ANDREW NEISH No relevant relationships by wendy neveu No relevant relationships by Rahulkumar Patel No relevant relationships by Carmen Polito No relevant relationships by Richard Ramonell No relevant relationships by Mayuran Ravindran No relevant relationships by John Roback No relevant relationships by Martin Runnstrom Consultant relationship with BLI, Inc. Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Royalty Consultant relationship with Bristol Meyers Squibb/Celgene Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Consulting fee Speaker/Speaker's Bureau relationship with Bristol Meyers Squibb/Celgene Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=H noraria Consultant relationship with GlaxoSmithKline Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Consulting fee Speaker/Speaker's Bureau relationship with GlaxoSmithKline Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Honoraria Consultant relationship with Janssen Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Consulting fee Speaker/Speaker's Bureau relationship with Janssen Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Honoraria Consultant relationship with Visterra Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Consulting fee Speaker/Speaker's Bureau relationship with Visterra Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Honoraria Consultant relationship with Kyverna Please note: past 36 months Added 07/18/2022 by Ignacio Sanz, value=Consulting fee No relevant relationships by Sunita Sharma No relevant relationships by Colin Swenson No relevant relationships by Robert Swerlick

12.
Chest ; 162(4):A1418, 2022.
Article in English | EMBASE | ID: covidwho-2060815

ABSTRACT

SESSION TITLE: Pneumothorax, Chylothorax, and Pleural Effusion Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: An alveolopleural fistula (APF) is a pathological communication between the pulmonary alveoli and the pleural space. If pneumothorax persists beyond five days, it is labeled as a prolonged air leak (PAL). Herein, we present a patient with respiratory failure, spontaneous pneumothorax with persistent air leak resulting in functional pneumonectomy despite CTS intervention. CASE PRESENTATION: A 60-year-old female with PMH of diabetes, hypertension was initially admitted for right lower extremity cellulitis. About ten days into the admission, patient started becoming progressively hypoxic and was noted to be saturating 82% on room air with crackles noted bilaterally. A CT angiogram showed findings suggestive of multifocal pneumonia. Covid-19 pneumonia was initially suspected despite negative testing and a course of remdesivir and steroids was administered. All other infectious workup returned negative. Patient's oxygenation requirements worsened over the next two weeks eventually requiring intubation. Bronchoscopy with bronchoalveolar lavage showed growth of stenotrophomonas and patient received a course of trimethoprim-sulfamethoxazole. Patient was subsequently extubated and transitioned to high flow nasal cannula. Two weeks later, she developed acute respiratory deterioration due to a right sided pneumothorax requiring emergent pigtail placement and subsequent intubation. She was noted to have a persistent airleak from the chest tube and imaging showed a persistent pneumothorax with possible malpositioning of the chest tube. Despite repositioning of the previous chest tube and a second chest tube insertion, patient's PAL persisted and she underwent video assisted thoracoscopic surgery (VATS) that showed a large bronchopleural fistula emanating from the right upper and middle lobes requiring stapling and surgical pleurodesis. Bronchoscopy prior to VATS did not show any signs of obstruction. Due to prolonged intubation, she underwent tracheostomy placement followed gradually by chest tube removal when no air leak was appreciated. After the removal of the chest tube, her lung gradually formed multiple bullae with no functional residual lung. Despite this, her respiratory status stabilized and she was discharged to a LTACH. DISCUSSION: The likely cause of APF here was the emergent chest tube insertion. APF and PALs are most seen following pulmonary resection or biopsy but can also be seen following spontaneous pneumothorax or traumatic chest tube insertions. Although an endobronchial valve was entertained, the lung damage was extensive enough to have no change in patient's outcome. CONCLUSIONS: Our case demonstrates a rare but complicated hospital course of a patient where a chest tube insertion resulted in non-resolving APF with PAL despite therapeutic interventions in an unfortunate case of "functional pneumonectomy". Underlying pneumonia may have also contributed to the APF resulting in PAL. Reference #1: 1. Liberman M, Muzikansky A, Wright CD, et al. Incidence and risk factors of persistent air leak after major pulmonary resection and use of chemical pleurodesis. Ann Thorac Surg 2010;89:891. Reference #2: 2. DeCamp MM, Blackstone EH, Naunheim KS, et al. Patient and surgical factors influencing air leak after lung volume reduction surgery: lessons learned from the National Emphysema Treatment Trial. Ann Thorac Surg 2006;82:197. Reference #3: 3. Rivera C, Bernard A, Falcoz PE, et al. Characterization and prediction of prolonged air leak after pulmonary resection: a nationwide study setting up the index of prolonged air leak. Ann Thorac Surg 2011;92:1062. DISCLOSURES: No relevant relationships by Mohammed Halabiya No relevant relationships by Rajapriya Manickam No relevant relationships by Rutwik Patel

13.
Chest ; 162(4):A562-A563, 2022.
Article in English | EMBASE | ID: covidwho-2060632

ABSTRACT

SESSION TITLE: COVID-19 Co-Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Pneumocystis jirovecii pneumonia (PJP) remains a significant cause of morbidity and mortality in the immunocompromised population. It can be difficult to discern the radiographic imaging of COVID-19 from PJP. This case describes a noncompliant HIV positive male with remote history of PCP pneumonia and COVID-19 pneumonia who presents with simultaneous recurrence of both disease processes. CASE PRESENTATION: A 45-year-old male with PMH of HIV/AIDS noncompliant on ART (CD4+ 10) presented for evaluation of exertional dyspnea and productive cough for the past 2 weeks. Of note, patient had a history of covid-19 pneumonia about 15 months ago when he was treated with remdesivir and steroids and required supplemental oxygen support. He was also admitted about 8 months prior for PJP pneumonia and underwent treatment with steroids and TMP-SMX for 21 days also requiring supplemental oxygen support. During this presentation, initial vital signs showed: T 36.5 C HR 98 BP 112/63 RR 20 saturating 95% breathing ambient air. ABG on presentation showed PaO2 65 while breathing room air. Physical exam suggested bilateral crackles diffusely with chest radiography significant for increased interstitial markings bilaterally. CT chest showed bilateral groundglass changes suggestive of inflammatory process. He was initially started on antibiotic coverage with azithromycin, ceftriaxone, and TMP-SMX as the initial differential included PJP recurrence since he was noncompliant on secondary prophylaxis after recent infection. He was also started on steroids due to low PaO2. SARS-CoV-2 PCR returned positive however, the low CD4+ count, and a positive serum B-D-glucan assay prompted us to schedule a bronchoscopy to evaluate for PJP pneumonia. BAL showed positive silver stain along with bronchial wash was elevated PCR for PJP (5.6 million copies/mL). A diagnosis of concurrent COVID-19 pneumonia and PJP pneumonia was made. Patient did not receive remdesivir during this admission since his oxygenation began to improve during the hospitalization. Patient was discharged on appropriate regiment for PJP pneumonia and continued steroid taper. He was seen as a follow-up in outpatient clinic about 2 months later compliant on his ART regimen and secondary PJP prophylaxis (CD4 120). DISCUSSION: If it wasn't for the serum B-D-glucan, we likely would not have pursued further causes for hypoxia in an otherwise COVID-19 positive patient with characteristic radiographic findings. The sheer co-incidence and concurrent nature of presentation of these two disease processes make our case extremely unique. Going forward, it is reasonable to keep PJP in the differential when treating a hypoxic immunocompromised patient even if an alternative cause for hypoxia is present. CONCLUSIONS: Herein we present a case of a patient with remote history of COVID-19 pneumonia and PJP pneumonia now presenting with a simultaneous co-infection. Reference #1: Mouren, D., Goyard, C., Catherinot, E., Givel, C., Chabrol, A., Tcherakian, C., Longchampt, E., Vargaftig, J., Farfour, E., Legal, A., Couderc, L. J., & Salvator, H. (2021). COVID-19 and Pneumocystis jirovecii pneumonia: Back to the basics. Respiratory medicine and research, 79, 100814. https://doi.org/10.1016/j.resmer.2021.100814 Reference #2: Huang, L., Cattamanchi, A., Davis, J. L., Boon, S. d., Kovacs, J., Meshnick, S., Miller, R. F., Walzer, P. D., Worodria, W., & Masur, H. (2011). HIV-associated Pneumocystis pneumonia. Proceedings of the American Thoracic Society, 8(3), 294–300. https://doi.org/10.1513/pats.201009-062wr Reference #3: Tasaka, S. (2015). pneumocystis pneumonia in human immunodeficiency virus–infected adults and adolescents: Current concepts and Future Directions. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, 9s1. https://doi.org/10.4137/ccrpm.s23324 Group, T. R. C. (2020). Dexamethasone in hospitalized patients with covid-19. (2021). New England Journal of Medicine, 384(8), 693–704. https://doi.org/10.1056/nejmoa2021436 KOLDITZ, M., HALANK, M., BANDT, D., SPORNRAFT-RAGALLER, P., & HÖFFKEN, G. (2009). Early recurrence ofPneumocystis jirovecipneumonia in two HIV-infected patients: Linking infection relapse and immune reconstitution syndrome. Respirology, 14(6), 910–912. doi:10.1111/j.1440-1843.2009.01583.x Mussini C, Pezzotti P, Antinori A, Borghi V, Monforte Ad, Govoni A, De Luca A, Ammassari A, Mongiardo N, Cerri MC, Bedini A, Beltrami C, Ursitti MA, Bini T, Cossarizza A, Esposito R;Changes in Opportunistic Prophylaxis (CIOP) Study Group. Discontinuation of secondary prophylaxis for Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients: a randomized trial by the CIOP Study Group. Clin Infect Dis. 2003 Mar 1;36(5):645-51. doi: 10.1086/367659. Epub 2003 Feb 12. PMID: 12594647. DISCLOSURES: No relevant relationships by Mourad Ismail No relevant relationships by Carlos Palacios No relevant relationships by Rutwik Patel

14.
Chest ; 162(4):A222, 2022.
Article in English | EMBASE | ID: covidwho-2060545

ABSTRACT

SESSION TITLE: Cardiovascular Complications in Patients with COVID-19 SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: It is well established that SARS-CoV-2 infection predisposes patients to develop thromboses. Here we present an elderly Hispanic male with who was hospitalized for COVID-19 pneumonia and was on therapeutic anticoagulation, yet still developed an acute right coronary artery occlusion secondary to thrombus formation. CASE PRESENTATION: An 81 year-old Hispanic male with hypertension, coronary artery bypass graft (LIMA to LAD and SVG to OM), congestive heart failure was admitted to the hospital for SARS-CoV-2 pneumonia. Inflammatory markers were elevated with a D-Dimer level of 2.95 mg/mL. An EKG at that time showed normal sinus rhythm with a heart rate of 69 bpm and no ST-T wave abnormalities. Troponin-I level was unremarkable. He was started on remdesivir, steroids, and continuous heparin infusion. During hospital stay, the patient’s overall clinical status continued to improve. On day 9, the patient started complaining of 9/10 intensity, non-radiating substernal squeezing chest pain. He appeared diaphoretic. A STAT 12-lead EKG showed ST elevations in the inferior leads concerning for Inferior Wall MI (IWMI). The patient was immediately taken to the catheterization lab. The right coronary artery (RCA) had 99% stenosis with filling defect secondary to thrombus in its proximal, middle, and distal portion. Thrombus removal was achieved with a thrombectomy catheter and patient received two drug eluting stents (DES) in the proximal and distal RCA. The patient was continued on heparin infusion, aspirin 81mg daily, clopidogrel 75mg daily, and atorvastatin 80mg daily. He was discharged home two weeks later and had good outpatient follow up. DISCUSSION: ST-segment elevation myocardial infarction (STEMI) is commonly encountered in patients with COVID-19 infection. About 40% of COVID-19 patients with STEMI had no evidence of coronary artery disease (CAD) which excludes Type I Myocardial Infarction (MI). This suggests that a large proportion of patients had Type II MI. Our patient developed an occlusive thrombus requiring thrombectomy. It is difficult to know in this case whether the patient may have still suffered a STEMI without the hypercoagulable state from COVID-19 infection since he already had underlying CAD. Incidence rates of STEMI in patients with COVID-19 infection are variable (0.3-11%). Nonetheless, we can highlight the fact that SARS-CoV-19 remains a significant risk factor for STEMI. Acute thrombus formation causing STEMI is an uncommon occurrence. CONCLUSIONS: This case emphasizes the hypercoagulable state in the setting of SARS-CoV-2 infection and encourages clinicians to be mindful of the potential complications that can affect nearly all organ systems. It is important for clinicians to acknowledge that patients with COVID-19 infection may develop blood clots despite systemic anticoagulation. Further investigation is needed to address the management of these patients after thrombectomy. Reference #1: Kermani-Alghoraishi, M. (2021). A Review of Coronary Artery Thrombosis: A New Challenging Finding in COVID-19 Patients and ST-elevation Myocardial Infarction. Current Problems in Cardiology, 46(3), 100744. https://doi.org/10.1016/j.cpcardiol.2020.100744 Reference #2: Green, C., Nadir, A., Lester, W., & Dosanjh, D. (2021). Coronary artery thrombus resulting in ST-elevation myocardial infarction in a patient with COVID-19. BMJ Case Reports, 14(8), e243811. https://doi.org/10.1136/bcr-2021-243811 Reference #3: Genovese, L., Ruiz, D., Tehrani, B., & Sinha, S. (2021). Acute coronary thrombosis as a complication of COVID-19. BMJ Case Reports, 14(3), e238218. DISCLOSURES: No relevant relationships by Utku Ekin No relevant relationships by Rajapriya Manickam No relevant relationships by Rutwik Patel

15.
Cyber-Physical Systems: AI and COVID-19 ; : 231-240, 2022.
Article in English | Scopus | ID: covidwho-2048756

ABSTRACT

Ultraviolet (UV) sterilization technology is widely used to reduce microorganisms that may remain on the surfaces after a standard cleaning to the minimum number. In this chapter we have proposed a robot named for disinfection, which consists of the UV light and hence the robot is a disinfection robot. It can be deployed at a variety of locations, especially due to the COVID-19 pandemic. Our UV bot has six 15W of UV lamps mounted on top of the UV bot platform covering 360 degrees. Our UV bot employs an embedded system based on a Raspberry Pi to aid in navigation and obstacle avoidance. © 2022 Elsevier Inc. All rights reserved.

16.
European psychiatry : the journal of the Association of European Psychiatrists ; 64(Suppl 1):S38-S39, 2021.
Article in English | EuropePMC | ID: covidwho-2046397

ABSTRACT

Background Remote consultation technology has been rapidly adopted due to the COVID-19 pandemic. However, some healthcare settings have faced barriers in implementation. We present a study to investigate changes in rates of remote consultation during the pandemic using a large electronic health record (EHR) dataset. Methods The Clinical Record Interactive Search tool (CRIS) was used to examine de-identified EHR data of people receiving mental healthcare in South London, UK. Data from around 37,500 patients were analysed for each week from 7th January 2019 and 20th September 2020 using linear regression and locally estimated scatterplot smoothing (LOESS) to investigate changes in the number of clinical contacts (in-person, remote or non-attended) with mental healthcare professionals and prescribing of antipsychotics and mood stabilisers. The data are presented in an interactive dashboard: http://rpatel.co.uk/TelepsychiatryDashboard. Results The frequency of in-person contacts was substantially reduced following the onset of the pandemic (β coefficient: -5829.6 contacts, 95% CI -6919.5 to -4739.6, p<0.001), while the frequency of remote contacts increased significantly (β coefficient: 3338.5 contacts, 95% CI 3074.4 to 3602.7, p<0.001). Rates of remote consultation were lower in older adults than in working age adults, children and adolescents. Despite the increase in remote contact, antipsychotic and mood stabiliser prescribing remained at similar levels. Conclusions The COVID-19 pandemic has been associated with a marked increase in remote consultation, particularly among younger patients. However, there was no evidence that this has led to changes in prescribing. Further work is needed to support older patients in accessing remote mental healthcare. Disclosure All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: RS has received funding from Janssen, GSK and Takeda outside the submitted work. RP has received funding from Janssen, Induction Healthcare and H

17.
Transplantation ; 106(8):121-122, 2022.
Article in English | EMBASE | ID: covidwho-2040847

ABSTRACT

Background: This study aimed to assess the impact of the recently (02/2020) implemented Acuity Circles (AC) liver allograft allocation policy on MELD at transplant and Donation after Circulatory Death (DCD) rates. Methods: Study period: 01/2016- 08/2021. Data retrieved from SRTR database. Inclusion criteria: All DCD liver transplants (LT). The cohort was dichotomized into a pre- and post-AC era. DCD rate (defined as DCD/ 50k population/year) was calculated for each State. The change (Δ) on the DCD rate (ΔDCD) and the MELD (ΔMELD) between the two periods was also calculated. Results: 1. Total LT increased in the post-AC era (26%/50k vs. 15%/50k, p=0.0567). 2. DCD LT increased in the post-AC era (15%/50k vs.10%/50k, p=0.0885). 3. MELD increased in the post-AC era in nearly all States (ΔMELD, fig.1, 2 & 3). 4. Uneven distribution of pre- & post-AC DCD activity, with a few States driving DCD LT in the US (fig.4 & 5). 5. Arizona and Louisiana had the highest pre-AC DCD rates (58%/50k & 31%/50k, respectively;fig.3). 6. The top post-AC DCD rate was reached in Arizona (78%/50k, fig.5). 7. Top post-AC ΔDCD was noted in Arkansas & Arizona (fig.6). 8. The highest ΔMELD was noted in low DCD/ negative ΔDCD areas (fig.7). 9. The lowest ΔMELD was noted in areas with the highest DCD rate (fig.7) 10. The State with the highest DCD rates pre-AC had the highest ΔDCD (fig.5). 11. 10/11 States with negative ΔDCD were located North of the 35o. Conclusions: AC implementation coincided with an increase in the overall LT & DCD LT activity. However, causation remains to be clarified, given the concurrent opioid crisis and SARS-CoV-2 pandemic. There was remarkable DCD rate variation. States with high DCD rates/ΔDCD demonstrated greater adaptability in the allocation change, maintaining low ΔMELD across eras. (Figure Presented).

18.
Pharmaceutical Journal ; 308(7957), 2022.
Article in English | EMBASE | ID: covidwho-2032632
19.
3rd International Conference on Intelligent Engineering and Management, ICIEM 2022 ; : 274-278, 2022.
Article in English | Scopus | ID: covidwho-2018839

ABSTRACT

Still in many countries COVID19 virus is changing its structure and creating damages in terms of economy and education. In India during the period of January 2022 third wave is on its high peak. Many colleges and schools are still forced to teach online. This paper describes how cyber security actionable or practical fundamental were taught by school or college teachers. Various cyber security tools are used to explain the actionable insight of the subject. Main Topics or concepts covered are MITM (Man In the Middle Attack) using ethercap tool in Kali Linux, spoofing methods like ARP (Address Resolution Protocol) spoofing and DNS (Domain Name System) spoofing, network intrusion detection using snort , finding information about packets using wireshark tool and other tools like nmap and netcat for finding the vulnerability. Even brief details were given about how to crack password using wireshark. © 2022 IEEE.

20.
Innovation in Aging ; 5:958-958, 2021.
Article in English | Web of Science | ID: covidwho-2012447
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