Epidemiological and clinics characteristics of 414 cases of oral lesions and sensorial functions of COVID-19 in Brazil

Introduction: Several studies have evaluated the occurrence of oral lesions and changes in sensory functions in patients positive for COVID-19. Objective(s): To evaluate the manifestations of COVID-19, emphasizing olfactory and gustatory changes, xerostomia, and oral lesions. Material(s) and Method(s): A cross-sectional and observational study was conducted. Approved by the Institutional Ethics Committee (#46151121.6.0000.5141). All patients were diagnosed by reverse transcription-polymerase chain reaction assay (RT-PCR) and considered to have mild symptoms, according to the latest WHO joint report. The patients were evaluated at a reference Service for COVID-19 in Minas Gerais, Brazil. The oral cavity was evaluated for each patient on the second and seventh days. Result(s): A total of 414 patients older than 18 years were evaluated. One hundred thirty-nine presented at least one of the studied conditions, oral lesions (19.08%) were the most frequently observed, followed by gustatory disorders (18.11%), xerostomia (14.25%), and olfactory dysfunction (14%). Among the oral lesions, there were various anatomical locations and clinical presentations. The occurrence involving lips and tongue represented 49 oral lesions, the most prevalent being, respectively, ulcerations (n=51), candidiasis (n=8), and erythema or red plaques (n=7). Fifty patients died. Conclusion(s): This study represents, to date, the largest case series of oral lesions in Brazilian patients with COVID-19, and oral alterations were observed in an expressive percentage of patients with COVID-19. However, it cannot be concluded that SARS-CoV-2 directly causes them.

A Rare Case of Congenital Choledochal Cyst (CCC) Resulting in Recurrent Acute Pancreatitis in an Otherwise Healthy Young Woman

Introduction: Congenital choledochal cyst (CCC) is a rare cystic dilatation of intrahepatic or extrahepatic biliary ducts. We present a case of a type IVb choledochal cyst presenting as recurrent acute pancreatitis in a young healthy female with initial negative screenings. Case Description/Methods: An 18-year-old-female with a history of COVID-19 presented to the emergency department with one month of persistent abdominal pain, nausea, and vomiting. She was hospitalized once prior for similar symptoms and was diagnosed with acute pancreatitis. This admission, blood work showed elevated lipase, elevated liver enzymes, mild bilirubinemia with a normal lipid panel and urine was significant for infection. She received fluids, antiemetics and was started on prophylactic antibiotics for ascending cholangitis. A right upper quadrant ultrasound ruled out cholelithiasis or acute cholecystitis, but showed dilation of the common bile duct. MRCP confirmed dilation with bulbous termination in the periampullary region diagnosed as type IVb choledochal cyst. Discussion(s): CCCs are rare in Western countries with an incidence between 1 in 100,000 to 150,000. 80% of these cysts are diagnosed in patients under the age of 10. They are difficult to diagnose due to variable clinical presentations. A study of 214 CCC patients demonstrated the most common symptom was abdominal pain, followed by jaundice and fever. When cysts are found in adults, symptoms resemble atypical acute biliary tract disease. Surgical cyst removal may be needed for patients with significant risk factors such as older age and age of symptom onset, due to increased risk of malignant transformation. Longer periods of observation have been documented to be associated with an increased chance of developing late complications, such as anastomotic stricture, biliary calculi and recurrent cholangitis. Type IVb CCCs, as seen in this case, consist of multiple extrahepatic cysts and hepaticojejunostomy is the treatment. This patient's young age and recurrent acute pancreatitis combined with her lab and imaging findings strongly suggest the diagnosis of CCC. The anatomical location of the CCC impeded flow of pancreatic enzymes through the ampulla of vater, leading to recurrent pancreatitis in an otherwise healthy young female. CCC, although very rare, should be considered in the differential of acute pancreatitis when other causes such as gallstones and heavy alcohol consumption cannot be identified, as prompt diagnosis and surgical removal is imperative.

Blood, nasal and airway immune responses to SARS-COV2 vaccination in COPD patients and healthy subjects

Background: Immune response to vaccination differs between individuals. We compared SARS-COV-2 vaccine specific immune responses in COPD patients versus healthy controls (HC) following vaccination. Systemic, nasal and sputum samples were used to examine different anatomical locations. Method(s): Blood, plasma, nasal and sputum samples were collected from COPD patients (n=11) and HC (n=16) at least 3 weeks post their 2nd SARS-COV-2 vaccination. Spike-specific immunoglobulin (Ig) A and G levels in plasma, nasal and sputum samples were measured by ELISA, while cellular immunity in blood was assessed by measuring spike-protein induced IFNgamma. All subjects had no history of SARS-COV-2 infection. Immune response levels were compared to samples from unvaccinated subjects. Result(s): Anti-spike IgG and IgA levels were increased in plasma from vaccinated individuals, as was cellular immunity. IgG, but not IgA, was increased in nasal (IgG: 0.8 Vs 9.1 ng/ml p=0.02;IgA: 11.6 Vs 11.6 p=0.5) and sputum (IgG: 0.9 Vs 11.0 ng/ml p<0.01;IgA: 31.7 Vs 27.0 p=0.12) samples from vaccinated individuals. Levels of immune responses to vaccination were similar in both COPD patients and HC (Table 1). Plasma IgG levels correlated with nasal (Rho: 0.86 p<0.001) and sputum (Rho: 0.78 p<0.001) levels. Conclusion(s): Vaccination induced immune responses in the lungs, as well as blood and nose, equally in both COPD patients and healthy subjects. (Table Presented).

Vascular Accesses Used in the Administration of Antineoplasic Therapy in an Oncological Day Hospital

Introduction: Antineoplasic chemotherapy in intravenous infusion is one of the most common therapeutic modalities in cancer patients. The vast majority of antineoplasic drugs have an Osmolarity >900 mOsm/l, so its administration must be done through central venous routes. However, the channelling of central routes is limited to patients with difficulty in peripheral venous approach or long-term treatments. Objective(s): Describe the vascular accesses used at the University Hospital of La Ribera for the administration of antineoplastic drugs, assess the adequacy of the same and determine if the type of vascular access used varied during the COVID-19 pandemic. Methodology: A quantitative, observational and analytical cross-sectional study of the vascular accesses used in the administration of antineoplasic therapy in cancer day hospital was carried out. Data collection was carried out through direct observation and consultation of the medical history. The pre-pandemic period was executed from 20 to 21/1/2020(n=125), the pandemic sample from 8 to 12/2/21(n=121). Result(s): Although 70% of the drugs administered had the capacity for tissue aggression, the peripheral venous route was established in 69.9% of cases, the forearm being the most frequent anatomical location (n=102) and the peripheral venous catheter the most commonly used device (n=172). The expected duration of treatment was medium-term in 74.8% of patients. The use of central venous routes during the pandemic increased by 30.7%,(p=0.017), being the subcutaneous venous reservoir the one with the highest representation(RVSC 75.5 %, IPCC 24.5 %). Conclusion(s): Short peripheral venous catheter was the most used device in the administration of chemotherapy in oncology HDD of the UHLR, even administering drugs with high tissue aggression and establishing a medium duration of treatment, being this an area of improvement in the care of cancer patients. During the pandemic, the use of central routes increased in the administration of antineoplasic treatment on an outpatient basis.

ROLE OF DEBULKING FOR BENIGN ENDOBRONCHIAL LESIONS: A CASE OF CHRONICALLY ASPIRATED FOREIGN BODY PRESENTING AS NECROTIZING PNEUMONIA

SESSION TITLE: Case Reports of Procedure Treatments Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Foreign body aspiration can affect ventilation-oxygenation dynamics causing significant morbidity and mortality in children and adults. Patient presentation can range from asymptomatic to life-threatening hypoxia. A thorough history and physical examination helps in narrowing differential diagnosis and provision of timely management. A myriad of complications can occur from aspirated Foreign body including recurrent pneumonia, lung abscess, obstructive emphysema, and death. Here we present a case of a patient with recurrent pneumonia from a chronically aspirated foreign body. CASE PRESENTATION: 37-year-old male with past medical history of a recent COVID-19 infection and bronchus intermedius endobronchial mass (squamous metaplasia on biopsy 2009) who presented with fever, chest pain, worsening dyspnea. Initial workup was consistent with severe sepsis. A CT chest showed complete collapse, cavitation in right lower lobe and presence of right bronchus stent. Patient was treated with IV fluids and antibiotics during the hospitalization. He underwent bronchoscopy for airway examination and bronchoalveolar lavage. Airway exam showed a large endobronchial mass in the bronchus intermedius. Endobronchial biopsies were taken, followed by tissue debulking using flexible forceps and cryoprobe. A yellow plastic foreign object was then visualized dislodged in the right lower lobe. This was successfully removed with grasping forceps. Patient had to be extubated and be reintubated to remove foreign object in one piece as it did not fit the endotracheal tube. Post debulking, bronchus intermedius and right lower lobe were patent and procedure was completed. Our patient responded well to treatment he was ultimately transitioned to oral antibiotics and discharged home with outpatient follow up. Repeat bronchoscopy 6 weeks later showed normal airways. DISCUSSION: Our case illustrated the importance of thorough investigation while treating patients with recurrent pneumonia, and this sometimes should include bronchoscopy with airway exam. In our case a bronchoscopy was done several years ago, however the foreign body was not identified as the cause of the endobronchial lesion. A lingering foreign body in the long run has significant morbidity as seen in our case despite appropriate treatment with antibiotics patient continued to have recurrent post obstructive pneumonias. Bronchoscopy remains the gold standard in definitive diagnosis and management of foreign body. Since the refinement of bronchoscopy and debulking, the rate of mortality from foreign body aspiration has been remarkably reduced. CONCLUSIONS: In summary patients with history suggestive of potential foreign body aspiration presenting with recurrent pneumonias at a particular anatomical location should prompt physicians to perform diagnostic bronchoscopy, which remains the gold standard for diagnosing of foreign body aspiration Reference #1: Foreign Body Aspiration Natan Cramer;Noel Jabbour;Melissa M. Tavarez;Roger S. Taylor. DISCLOSURES: No relevant relationships by Maria Abril No relevant relationships by Bilal Bangash No relevant relationships by Imran Tarrar

Retroclival hematomas in adult patients: A systematic review of a rare intracranial hematoma

Objective: Adulthood retroclival hematomas (RCHs) are a rare condition characterized by intracranial bleeding along the posterior aspect of the clivus. There are few reports in the literature that describe these hematomas. There is no agreement on how to treat these hematomas. Methods: An extensive literature review was performed, and the data was classified and analyzed on this topic from January 2000 to January 2022. A systematic review was carried out in accordance with the PRISMA and CARE Guidelines. Results were analyzed and potential clinical links were extracted. Results: Twenty-seven RCHs in adulthood were reported in twenty high-quality articles. 12/27 RCHs in adults were spontaneous. Epidural retroclival hematomas were present in 12/27 patients, while subdural hematomas were present in 13/27 patients. 15 of 22 adult RCHs observed were small in size. Epidural hematomas are typically associated with trauma (9/15 traumatic RCHs), whereas subdural hematomas are more frequently associated with spontaneous bleeding (8/12 spontaneous RCHs). There was one case of hydrocephalus, six cases of cranial nerve palsies (five of which were traumatic), and thirteen cases of intraspinal extension of the hematoma. Seven individuals exhibited craniovertebral instability (100 percent traumatic). Most hematomas were conservatively treated (77.8 percent). 21 hematomas had favorable clinical outcomes. Conclusions: There is a lack of agreement on management protocols for RCHs in adulthood. These hematomas occur almost equally in both the extradural and the subdural spaces, and they are typically small in size. When an RCH occurs in the epidural space, it is more likely to result in cranial nerve palsies and craniospinal instability. Associated craniovertebral anomalies must be thoroughly analyzed in trauma patients. Only patients with a significant mass effect on the brainstem are candidates for surgical hematoma evacuation. It is imperative that future studies on this rare entity adhere to strict publication guidelines.

A cross sectional examination of sunburn incidence in the context of race/ethnicity and skin type

Sun exposure is physiologically necessary, yet excessive amounts can be detrimental to skin, causing photoaging, sunburn, and skin cancer. Sunburn, presenting as delayed onset erythema, has been partially characterized for Caucasians, however the impact of excessive sun exposure has been less studied across race/ethnicity and skin tones. Herein, we present findings from a survey conducted across the United States, where sunburns were examined in a racially and ethnically diverse sample of 3597 participants spanning the Fitzpatrick skin phototype (FSP) scale. Individuals reporting sunburn were probed on the signs, severity, pain level, and anatomical location of their most recent sunburn and on the associated type of activity. Over the 8-month evaluation period (January-August 2020), sunburns were self-reported at rates generally consistent with those reported annually pre-COVID, with 39% Caucasian, 20% Asian, 12% African American and 32% Latino respondents reporting at least one sunburn. While average sunburn incidence among African American is low, a closer look reveals that African Americans with lighter skin tones (FSPs I-II) report higher sunburn rates (25.5%, n = 12), thus highlighting that sunburn risk does not depend on race/ethnicity alone. Furthermore, African Americans and Hispanics self-reported a significantly higher percentage of severe sunburns compared with Caucasians (27%, 20% and 11%, respectively) and African Americans, unlike Caucasians, indicated “peeling” as the top sign of their sunburn. This work provides a better understanding of the sunburn experience across race/ethnicity and skin tones and is a step toward enabling more personalized sun safety awareness and education.

Shades of COVID-19 vaccine

SARS-CoV-2 infection is associated with a wide spectrum of skin manifestations and few may appear after immunization with vaccines expressing the SARS-CoV-2 spike protein. The COVID-19 pandemic has led to the rapid invention and approval of vaccines and, like any vaccination programme, reports of side-effects have begun to emerge. Though initial reports were about mild side-effects, reports of varied other moderate to severe side-effects have now started to emerge. Although these side-effects seem to be rare, the symptoms can be severe and data on them are scarce. We report a case of a 49-year-old woman with Fitzpatrick skin type VI developing coin-shaped well-defined, round to oval, erythematous to violaceous plaques with central dusky appearance along with vesicles and bullae on her right cheek, left cheek and left posterior thigh. This was seen a few days following each dose of AstraZeneca COVID vaccine but self-resolved in about 2 weeks with hyperpigmentation. There was no cutaneous disease elsewhere and no mucosal involvement. We considered a diagnosis of fixed drug eruption (FDE) based on history and clinical features. FDEs represent a cutaneous adverse drug reaction characterized clinically by the appearance of recurrent, quasiidentical, cutaneous eruptions in the same anatomical location on exposure and re-exposure to the offending drug.

19 PATIENTS IN INTENSIVE CARE AND THEIR SKIN LESIONSCOVID

COVID-19 is an infection caused by the SARS-CoV2 virus, which has debuted with mild disease or severe acute respiratory syndrome that has caused hospitalizations in the Intensive Care Unit (ICU). This article aims to describe skin lesions in patients in the ICU caused by prolonged hospitalization through updated information for better management and approach to future sequelae. The research approach is qualitative, the scope is descriptive, and the external purpose will be of the applied type, the method used is the analysis of documents such as scientific articles, books, and updated theses. The results were favorable since the cutaneous lesions were described according to the anatomical location, analyzing that these lesions predominate in the face, trunk and extremities, characterized by changes in coloration up to more worrisome compli-cations such as gangrene and vasculopathy. © 2022, University of Cienfuegos, Carlos Rafael Rodriguez. All rights reserved.

PC-578-02 JUNCTIONAL TACHYCARDIA

Background: Junctional ectopic tachycardia (JET) is a rare tachyarrhythmia in adults. The precise site of origin within the AV junction is unknown. Objective: N/A Methods: N/A Results: A 71-year-old male presented with dyspnea on exertion and recently diagnosed tachycardia in March 2021. He had a history of diabetes mellitus, obesity, hypertension, obstructive sleep apnea, and COVID-19 in 2020. A 14-day monitor demonstrated 43% supraventricular ectopy SVE burden and short runs of SVT. He presented for an electrophysiology (EP) study. He presented to the EP lab in sinus rhythm with frequent SVE. Multipolar catheters were placed in the His bundle region, right atrium, coronary sinus, and right ventricle. The SVE beats had the same QRS morphology, and an identical HV interval and His-right bundle activation sequence as in sinus rhythm and no retrograde conduction, consistent with premature junctional complexes (PJCs). Occasional short bursts of junctional tachycardia were noted. Isoproterenol was titrated to a maximum dose of 8 mcg/min. No other SVT was inducible with atrial overdrive pacing or programmed stimulation or with isoproterenol infusion. A 6 mm tip cryoablation catheter was advanced to the right atrium to the anatomical location of the slow pathway in the inferior triangle of Koch using an electroanatomic mapping system (EnSite NavX). Signals immediately prior to ablation (Figure 1) were notable for a pre-potential 26 ms prior to the His with PJCs. Cryoablation was performed at this site (Figure 2) with resolution of the PJCs at the onset of the freeze. After thawing, a second freeze was administered. No further PJCs were noted at baseline or with isoproterenol infusion. Conclusion: JET could originate from anywhere within the AV node or proximal His bundle. The application of cryoablation at a typical AV nodal slow pathway location with a preceding pre- potential and immediate obliteration of PJCs suggests that the origin in this case was from this region rather than a true His bundle extrasystole. Identification of pre-potentials to the junctional ectopy can guide safe ablation of this dysrhythmia. [Formula presented] [Formula presented]