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Introduction: The COVID-19 pandemic caused significant decreases in outpatient procedures, many of which are required before to antireflux operation (ARS). The purpose of this study was to add functional luminal imaging probe (FLIP) to esophagogastroduodenoscopy (EGD) and esophageal pH monitoring to assess its utility in decreasing the need for follow up studies in patients being evaluated for ARS. Method(s): Retrospective observational study was performed on 81 patients being evaluated for GERD who underwent EGD, pH monitoring, and FLIP. Data collected included average distensibility index (DI) at 60 mL, presence of repetitive anterograde or retrograde contractions, hiatal hernia dimensions, pathology results, pH data, and need for follow-up testing. Result(s): Based on FLIP results, HRM was recommended in 35 patients (43.2%). This included 14 patients with DI suggestive of significant esophagogastric junction outflow obstruction, eight of whom completed HRM with four confirmed as achalasia. FLIP results were suspicious for eosinophilic esophagitis (EoE) in four patients of which one was confirmed as EoE on biopsy. Gastric emptying study was felt to be necessary for 11 patients before to ARS. Conclusion(s): FLIP identified patients with possible alternative pathologies including achalasia and EoE that would otherwise be a contraindication to ARS. FLIP at the time of EGD and pH monitoring is useful as it guides the clinical decision on need for additional outpatient procedures, which may be difficult to obtain in pandemic conditions. FLIP was effective at reducing the requirements for further follow-up testing in the majority of patients being evaluated for potential ARS.
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Aim: This study examines the changes in gastroesophageal reflux disease (GERD) symptom frequency among patients with GERD throughout the COVID-19 pandemic. Methods: A structured questionnaire was distributed among 198 GERD patients. The questionnaire consisted of a demographic characteristic assessment, the GerdQ questionnaire, and a reflux symptom index (RSI) questionnaire. Result & conclusion: A statistically significant increase in GerdQ score was identified among participants during the COVID-19 pandemic (t = 7.055, df = 209, p < 0.001), who had experienced an increase in the frequency of positive predictors of GERD and a decrease in the frequency of negative predictors of GERD. The COVID-19 pandemic and its related lockdown countermeasures may have led to exacerbating and worsening GERD symptoms.
There is a lack of decisive research into the impacts of the COVID-19 pandemic and its lockdown countermeasures on patients with GERD. We investigated the changes in symptomatic frequency among GERD patients in Jordan during the COVID-19 pandemic in a cross-sectional study involving 198 GERD patients. A statistically significant number of participants experienced an increase in the frequency of positive predictors of GERD, and a decrease in the frequency of negative predictors of GERD. In addition, the impacts of GERD itself were also found to have increased during the pandemic, with patients struggling to sleep or attain additional medication to treat their condition.
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Case Report: It is well documented that Coronavirus Disease 19 (COVID-19) patients who suffer cardiac injury have a higher mortality rate, however the exact mechanism of cardiac injury and potential complications are still unknown. Takotsubo Cardiomyopathy (TCM), which was first described in 1990 in Japan, is characterized by a transient systolic and diastolic left ventricular dysfunction with a range of wall motion abnormalities predominantly affecting women often following an emotional or physical trigger. Though TCM is seen less commonly as a cardiac complication of COVID-19, with increasing rates of cardiovascular events due to COVID-19, TCM should be taken into consideration as a potential diagnosis for a COVID-19 positive patient. Case Description: The case of a 75-year old female with a history significant for hypertension, type 2 diabetes mellitus, hyperlipidemia, and gastroesophageal reflux disease presented to the Emergency Department after a ground level fall and subsequent left hip pain. Upon primary survey, EKG showed persistent sinus tachycardia in the 130-150s, with intermittent borderline dynamic changes and a troponin that was mildly elevated at 0.10, and an initial false negative COVID-19 test. Preoperative echocardiogram showed normal left ventricle size, no regional wall abnormalities, and a left ventricular ejection fraction (LVEF) of 60-65%. In post-operative care, EKG illustrated dynamic changes in the form of ST elevation in the lateral precordial leads, as well as an increase in the cardiac troponins, from 0.07 to 3.51. A subsequent echocardiogram illustrated a drop in her ejection fraction from 60-65% to 30-35%, with evidence of left ventricular systolic dysfunction that was not noted on previous echocardiograms. Following the Mayo clinic diagnostic criteria, this patient met the diagnostic criteria for TCM, as evident by new electrocardiograph findings, non-obstructive cardiac catherization findings, echocardiogram findings illustrating transient left ventricular systolic dysfunction, modest elevations in cardiac troponins as well as the patient being a post-menopausal female. Subsequent echocardiogram on 2 week follow up showed a rebound in her ejection fraction to 50-55%. Discussion(s): Possible outcomes of TCM include cardiogenic shock, respiratory failure, and death. It is imperative that clinicians consider TCM as a possible diagnosis when treating COVID-19 patients that may be exhibiting cardiac complications. Frequent ECG monitoring and a vigilant differential should include TCM in patients presenting with COVID-19.
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Objective. To describe COVID-19 influence on gastroesophageal reflux disease (GERD) exacerbation using clinical case. Main points. COVID-19 infection remains an urgent problem for modern medicine due to its high contagiousness and rapid dis-tribution among the working population. We presented a clinical case of a 49-year-old female patient with respiratory complaints and extraesophageal manifestations of GERD. Conclusion. This clinical case showed that clinicians should consider various mechanisms of respiratory symptoms, which becomes exceptionally relevant during the COVID-19 pandemic. The development of atypical symptoms in a patient of working age without concomitant pathology causes difficulties in early diagnosis and timely treatment, in contrast to comorbid elderly and senile patients. Several mechanisms led to an exacerbation of GERD with the development of wheezing. Therefore, a clinician should meticulously take a medical history, form a trusting relationship with a patient, detect and correct early signs of anxiety and depression with a multidisciplinary team.Copyright © 2021, Media Sphera Publishing Group. All rights reserved.
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Background: The importance of vaccination in today's world is extremely important given the COVID-19 epidemic. About 30% of the world's population suffers from allergies. Among them, 25% of patients according to the WHO, had an episode of urticaria at least once in their life. Urticaria is one of the most common allergic diseases, which is the highest in-patient admission toll at Dnipro Allergy Center. During the year 2021, 600 patients with urticaria were treated in the hospital. Patients with chronic recurrent urticaria do not want to be vaccinated because of the fear of complications such as anaphylaxis.Vaccination of urticaria patients without complications. Method(s): The study involved 45 patients aged 18 to 65 years, with a mean age of 34.3 +/- 1.0 (13 males and 32 females). The average experience of the disease is 3.6 +/- 0.8 years. Patients with chronic recurrent urticaria were admitted to the in-patient unit. Prior to vaccination, they were tested for tryptase levels, a detailed platelet blood test, coagulogram, D-dimer, and ECG. Result(s): Many patients had concominant gastrointestinal pathology in the form of gastro-esophageal reflux disease (GERD) -20 patients (44.4%), peptic ulcer disease disease -17 patients (37.7%), or stomach pathology in 45 patients (100%), which required proton pump inhibitors (PPI). Given that PPIs are a risk factor for anaphylaxis, according to EAACI documents, PPIs were discontinued three days before vaccination. Serum tryptase levels were elevated in 3 patients (13 mug/l, 16 mug/l, 32 mug/l). All patients underwent premedication. At normal serum tryptase levels, patients received 1-fold dose of desloratadine, and at high serum tryptase levels: 13 mug/l, 16 mug/l and 32 mug/l, patients received 4-fold dose of desloratadine. After 30 minutes vaccination shot was carried out without side effects and without complications of allergic nature. The second vaccination shot was also protected by antihistamines, so all the patients we observed had received 2 shots of the vaccine not complicated by side effects such as fever or allergic reactions. Conclusion(s): All patients were vaccinated without complications. In urticaria patients, serum tryptase levels should be determined prior to vaccination. Depending on the level of tryptase, appropriate premedication is prescribed: with a high level of tryptase -4- fold dose of desloratodine, with a normal level -1- fold dose. All patients with urticaria should be diagnosed with concomitant pathology in order to correct the basic therapy before vaccination.
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Neuroendocrine cell hyperplasia of infancy (NEHI) is a rare interstitial lung disease in children. The clinical features of the disease are characterized by tachypnea, moist rales/crepitus, retraction of compliant chest areas and delayed weight gain. The disease is diagnosed using the NEHI clinical scale coupled with the computed tomography of the chest organs. The clinical manifestations of NEHI regress as the child grows, but may persist up to the age of 10 y/o. The purpose of the research was to characterize the course of NEHI including the features of COVID-19 and the impact of passive smoking in children below the age of 8 y/o. Material(s) and Method(s): a single-center longitudinal study with follow-up observation of 29 patients with NEHI in January 2012 - December 2022 aged 8 months to 8 years old, 21 of which had COVID-19. Result(s): 20 of 29 patients with a known follow-up have undergone the long-term oxygen therapy (LTOT) at home lasting from 2 weeks up to 5.5 years (Me 1 year and 2 months;IQR 6 months - 4.5 years). Bronchial asthma was diagnosed in 2. 8 (28%) were diagnosed with atopic dermatitis, 6 (21%) with mental retardation, 3 (10%) with acute urticaria, and 2 (7%) with allergic rhinitis. Gastroesophageal reflux disease (GERD) was diagnosed in 7, all requiring LTOT. The frequency of episodes of respiratory infection was maximum in the first 2 years of life, amounting to 16 episodes per 2 years (Me 7;IQR 4 to 10), and the maximum frequency of hospitalizations during this age period was 5 (Me 2;IQR 1 to 2). Children-passive smokers were diagnosed with malnutrition more often (75%, p=0.449) and required LTOT more often (75%, p=0.694), were more often hospitalized (42%, p=0.422). Despite the possible need for LTOT patients with NEHI had COVID-19 in the form of nasopharyngitis in the majority of cases (89%). Only 8 out of 14 patients had symptoms of NEHI after 5 years of age, and only 1 out of 5 after 7 years. Malnutrition (body mass index for the age<-2) in the first year of life was diagnosed in 13 (45%) children. Malnutrition persisted in 9 out of 24 (37%) by the second year of life, in 5 out of 19 (26%) by the third year, and in 2 out of 14 (14%) by the fourth year of life. Not a single child died. Conclusion(s): the course of NEHI is characterized by the absence of lethal outcomes, frequent respiratory infections that led to hospitalizations in the first 2 years of life, mild course of COVID-19, regression of clinical symptoms and malnutrition as the child grows, comorbidity with atopic diseases and GERD. The priority should be given to the prevention of passive smoking in children with NEHI.Copyright © 2023, Pediatria Ltd. All rights reserved.
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The novel coronavirus disease 2019 (COVID-19) has given rise to a global pandemic, as well as a multitude of long-term sequelae that continue to perplex physicians around the world, including in the United States. Among the most common and impactful long-haul symptoms experienced by survivors is COVID-19 fatigue. This review will use long COVID-19, post-acute COVID-19 syndrome (PCS), and PostAcute Sequelae of COVID-19 (PASC) as synonymous terms to refer to the chronic symptomatology;chronic fatigue associated with PASC will be referred to as COVID-19 fatigue. While the knowledge and research on the exact pathophysiological mechanisms involved in the disease is still limited, parallels have been drawn between fatigue as a component of long COVID-19 and myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS). Current studies suggest applying principles of pathophysiology, diagnosis, and treatment similar to those for ME/CFS in order to aid in managing chronic fatigue in COVID-19 survivors, particularly in the primary care setting. The osteopathic family physician can use the proposed pharmacologic agents, along with osteopathic manipulative treatment (OMT), as therapeutic modalities that can be tailored to each patient's unique case. Nevertheless, research on proven successful treatments is still scarce. For that reason, it is essential that COVID-19 fatigue is recognized early, especially since its longitudinal impacts may be debilitating for many. This review of the available literature on COVID-19 fatigue aims to help provide quality care and lessen the disease burden experienced by patients.Copyright © 2023 by the American College of Osteopathic Family Physicians. All rights reserved.
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Background: Although vaccines have been launched, COVID-19 has not been effectively curbed, and the number of infections is increasing. Compared with western medicine, Traditional Chinese Medicine has made some achievements in the treatment of COVID-19, which should be paid attention to and play a greater role. As a classical Chinese medicine prescription for treating pestilence, Lianhuaqingwen (LHQW) has gone to many countries with the Chinese medical team to participate in the local fight against the epidemic, which has been widely recognized. Method(s): We searched MEDLINE, EMBASE, AMED, Chchrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science, Chinese National Knowledge Infrastructure (CNKI), VIP Information Database (VIP), Chinese Biomedical Literature Database (CBM), and Wanfang Database from inception up to November 24, 2021, which formed the basis for evidence used to formulate recommendations. Sixteen randomized controlled trials (RCTs) involving 1896 patients were enrolled. LHQW is a traditional Chinese medicine compound preparation, which contains 13 traditional Chinese medicine (TCM) components. Two dosage formulations of LHQW were included: granule and capsule. The most commonly used dosage formulation was granule (15/17, 88.24%), followed by capsule (2/17, 11.76%). Conclusion(s): This systematic review and Meta analysis suggested that, in the treatment of COVID-19, LHQW Capsule (Granule) could not only significantly improve the fever symptoms, shorten the fever time, but also reduce the cough and fatigue symptoms, improve the clinical efficiency, improve the lung CT, significantly reduce the number of patients with mild to severe diseases, and have certain anti-inflammatory effect. And there is no server adverse events which support the safety of LHQW Capsule (Granule) for the treatment of COVID-19. As a classic formula of TCM, LHQW Capsule (Granule) could be used as potential candidates for COVID-19 in this battle.Copyright © 2022
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Health care-associated infections (HAIs) are a significant cause of morbidity and mortality in the United States. Common examples include catheter-associated urinary tract infections, central line-associated bloodstream infections, ventilator-associated pneumonia, surgical site infections, and Clostridioides difficile infections. Standardized infection control processes and precautions have been shown to reduce the rate of HAIs, and targeted practices for HAIs have shown further reductions. Patient safety tools have been developed for various HAIs to help guide administrators and are free for public use through the Centers for Disease Control and Prevention STRIVE (States Targeting Reduction in Infections via Engagement) initiative. The Choosing Wisely initiative makes best practice recommendations for physicians to improve quality of care and reduce costs;targeted recommendations were developed to reduce the risk of HAIs. For example, using invasive devices only when indicated and for the shortest time possible reduces the risk of device-related HAIs. The goal of antibiotic stewardship is to reduce C. difficile infections and further development of multidrug-resistant organisms such as vancomycin-resistant Enterococcus and carbapenem-resistant Enterobacteriaceae. Antibiotic stewardship targets physician behaviors such as reviewing antibiotic therapy choices every 48 to 72 hours, reviewing culture results as soon as available, de-escalating antibiotic therapy when appropriate, and documenting the indications for initiating and continuing antibiotic therapy.Copyright © 2022 American Academy of Family Physicians.
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Over the last few years, we have seen 11 patients presenting with proton pump inhibitor (PPI) photosensitivity at our tertiary referral photodiagnostic service and in our local dermatology department. Many adverse effects, including the discovery in 2020 of an almost twofold increased risk of severe COVID-19, of this widely used group of drugs have been noted (Lee SW, Ha EK, Yeniova AO et al. Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching. Gut 2020;DOI: 10.1136/gutjnl-2020-322248). Although PPIinduced phototoxicity has been described, phototest results have not been reported and all clinical presentations have not been described. We aimed to identify all patients with PPI photosensitivity who presented to our unit. We sought to better understand their clinical characteristics, blood test results and photodiagnostic results. We retrospectively reviewed all case notes and investigation results of patients who were diagnosed with PPI photosensitivity. Eleven patients were identified to have been seen between 2014 and 2019. Two patients were male and nine were female. Mean duration of disease was 3 6 years and mean duration of PPI ingestion was 5 years. Five patients presented with a drug-induced lupus pattern [subcutaneous lupus erythematosus (SCLE;n = 2), papulosquamous SCLE and discoid (n = 1), tumid (n = 1) and acute cutaneous (n = 1)], four with drug-induced phototoxicity (sunburn-like) and two with a drug-induced solar urticaria relating to a lupus mechanism. The majority of patients reported symptoms on sun-exposed sites. The most common indication for PPI prescription was gastroesophageal reflux disease with omeprazole being the most commonly prescribed PPI. All patients underwent phototesting. Three patients were not on an PPI while undergoing phototesting and did not demonstrate photosensitivity. Of the remaining patients who underwent phototesting the most common finding was delayed sensitivity to ultraviolet A and to visible light. Druginduced photosensitivity can be a challenging diagnostic entity owing to the varied clinical presentation and heterogeneous time to onset. We present this case series to further help clinicians in recognizing the clinical and diagnostic pattern of photosensitivity present with PPI use.
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By contrast, most neutralising antibodies target the viral spike protein's relatively mutable S1 region, with which the virus binds to host-cell receptors. Known as the "Düsseldorf patient”, the 53-year-old man was treated at the University Hospital Düsseldorf for his HIV infection and received a stem cell transplant due to a blood cancer. Preventing maternal sepsis A multicountry clinical trial with more than 29 000 women in seven low and middle-income countries found only 1·6% of women who received a single dose of the antibiotic azithromycin during labour developed sepsis or died within six weeks after delivery, compared with 2·4% of those who received placebo.
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Rationale: Vocal cord dysfunction (VCD) is often under-recognized and/or misdiagnosed as asthma. Although post-viral syndrome has been suggested as a contributing factor in VCD, there is little data on infectious-associated VCD and no information with COVID-19. The purpose of this ongoing, prospective registry study is to characterize risk factors contributing to VCD. Methods: Subjects age ≥ 12 years referred for VCD assessment at the time of provocation challenge-rhinolaryngoscopy were eligible to participate. Enrollment initiated September, 2021. An investigator designed questionnaire of potential risk factors for VCD including COVID-19 infection was administered with data chart collection. Results: Of 31 subjects currently enrolled, 52% (N=16) reported VCD symptoms either 1) onset following respiratory infection (N=9, 29%) or 2) worsened following COVID-19 infection (N=7, 23%). Those reporting infectious-associated VCD symptoms were more likely to report gastroesophageal reflux disease (p=0.017) with approaching significance for symptoms of throat clearing (p=0.097), chronic sinus infections (p=0.095), and age > 40 years (p=0.097) when compared to subjects who denied infectious-associated VCD symptoms. Additionally, the noninfectious-associated VCD group was approaching significance for reporting increasing number of triggers over time (p=0.051) versus infectious-associated VCD. There was no difference (p>0.05) between groups in Pittsburgh VCD Index scores, BMI, sex, co-morbid asthma, smoking status, environmental allergy history, or symptoms of shortness of breath, cough, wheezing, or throat tightness. Conclusions: Our early results suggest an important role for infectious etiologies, including COVID-19, in triggering and/or worsening VCD. Clinical awareness of these associations is warranted to rapidly address and provide appropriate therapeutic care.
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Case Report: Acute transverse myelitis (TM) is a rare inflammatory disease that typically presents asweakness, sensory alterations, and bowel or bladder dysfunction. Among the causes of TM are infections, paraneoplastic syndromes, or autoimmune conditions of CNS. Postinfectious TM can develop secondary to a viral or bacterial infection. SARS-CoV-2 is a recently discovered viral illness, and sequelae due to COVID-19 infection are still being studied. There is scarce literature relating the two conditions, and it is imperative to raise awareness. A 72-year-old man with hypertension and GERD, completely independent in ADL, was brought to the ED with sudden onset of bilateral lower extremity weakness. He reported symptoms started with difficulty climbing stairs that rapidly progressed to inability to ambulate independently and were associated with bilateral thigh soreness. Nine days prior, he developed fever and generalized malaise, and two days later, SARS-CoV-2 PCR and Ag tests were positive. He received azithromycin, Paxlovid, and dexamethasone as treatment. Upon evaluation, the patient was afebrile and hemodynamically stable. Neurological examination was remarkable for spasticity and hyperreflexia at bilateral lower limbs, clonus, preserved motor strength with adequate sensation to soft touch, and intact vibration and proprioception in all extremities. Cranial nerves were intact. These findings were consistent with an upper motor neuron lesion. On imaging, the Head CT scan was unremarkable. Thoracic/Lumbar Spine MRI was significant for distal thoracic and conus areas with central homogeneous brightness compatible with nonspecific myelitis. Laboratories showed leukocytosis without neutrophilia or bandemia, thrombocytosis, and elevated CRP. HIV and RPR tests were negative. A lumbar puncture for CSF analysiswas remarkable for mild monocytic pleocytosis (7 cell/muL), an increased level of total proteins (56 mg/dL), and normal glucose (57 mg/dL). CSF culture and gram stain were negative. CSF cytology yielded few lymphocytes and few monocytes and was negative for malignant cells. The meningoencephalitis panel was negative. Based on these findings, a clinical diagnosis of postinfectious myelitis secondary to COVID-19was made. The patient was treated with intravenous Methylprednisolone 1 g daily for five days. On follow-up, lower extremity weakness resolved completely, and he resumed his daily physical activities. Patients with COVID-19 infection can present with neurologic manifestations such as headache, myalgias, dizziness, dysgeusia, and anosmia. This case hopes to raise awareness of less commonly known neurological manifestations of SARS-CoV-2 infection and how the early recognition of symptoms can help expedite the diagnosis and treatment of the condition to avoid long-term sequelae. [Figure presented] Copyright © 2023 Southern Society for Clinical Investigation.
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INTRODUCTION: Inguinal hernia repair is one of the most common surgical procedures performed by general surgeons. Numerous articles have shown that robotic inguinal hernia repair is safe and effective, but also more costly than other hernia repair techniques. The robotic platform uses high-definition visualization and articulating instruments. A growing number of surgeons are using this technology to refine and obtain a critical view of the myopectineal orifice for hernia repair while lessening the pain associated with the open surgical approach. Lower insufflation pressures and good results without Foley catheterization have been reported. This report presents an update, with a focus on the past 3 years during the SARS COVID-19 pandemic, of a series of robotic, laparoscopic inguinal hernia repairs by a single surgeon with extensive laparoscopic hernia experience at a single institution, along with a review of the recent current literature. METHOD(S): Over 3000 laparoscopic inguinal hernia operations have been performed by the author since 1990. One hundred-fifty-eight were performed from April 2020 to November 2022, in addition to the previously reported 420 robotic TAPP (trans-abdominal pre-peritoneal) procedures performed from April 2012 to March 2020. Hospital records and follow-up care were prospectively reviewed and the patient's age, sex, American Society of Anesthesia (ASA) class and operative time were obtained. Follow-up was done at 2 weeks and 6 weeks following surgery. All patients consented to the use of their data in the study. RESULT(S): Ninety-four percent (94%) of the patients were male. The average age was 64.3 years (range 18-91). Co-morbidities included hypertension, hypercholesterolemia, prostatism and GERD, among others. BMI was between 19 and 37.1 (mean 26.1). In 23 patients (15%), an umbilical hernia repair was performed concomitantly. OR time ranged from 25 to 90 minutes (mean 51.8). Complications were uncommon and urinary retention (2.5%) was an infrequent post-operative occurrence. CONCLUSION(S): 1) Use of a lower insufflation pressure (8-12 mm Hg) was routine. 2) Use of a structural mesh (4x6 inches) gave satisfactory results. 3) While fixation of the mesh was not necessary, fibrin sealant was used routinely. 4) Urinary retention was infrequent, and did not require pre- or intra-op Foley catheterization if the patient voided immediately prior to surgery. Finally, 5) OR time was consistently less than 1 hour. These results support the conclusion that robotic inguinal hernia repair is safe and effective.
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Background: India has seen more than 43 million confirmed cases of COVID-19 as of April 2022, with a recovery rate of 98.8%, resulting in a large section of the population including the healthcare workers (HCWs), susceptible to develop post COVID sequelae. This study was carried out to assess the nature and prevalence of medical sequelae following COVID-19 infection, and risk factors, if any. Methods: This was an observational, multicenter cross-sectional study conducted at eight tertiary care centers. The consenting participants were HCWs between 12 and 52 weeks post discharge after COVID-19 infection. Data on demographics, medical history, clinical features of COVID-19 and various symptoms of COVID sequelae was collected through specific questionnaire. Finding: Mean age of the 679 eligible participants was 31.49 ± 9.54 years. The overall prevalence of COVID sequelae was 30.34%, with fatigue (11.5%) being the most common followed by insomnia (8.5%), difficulty in breathing during activity (6%) and pain in joints (5%). The odds of having any sequelae were significantly higher among participants who had moderate to severe COVID-19 (OR 6.51; 95% CI 3.46-12.23) and lower among males (OR 0.55; 95% CI 0.39-0.76). Besides these, other predictors for having sequelae were age (≥45 years), presence of any comorbidity (especially hypertension and asthma), category of HCW (non-doctors vs doctors) and hospitalisation due to COVID-19. Interpretation: Approximately one-third of the participants experienced COVID sequelae. Severity of COVID illness, female gender, advanced age, co-morbidity were significant risk factors for COVID sequelae. Funding: This work is a part of Indian Council for Medical Research (ICMR)- Rational Use of Medicines network. No additional financial support was received from ICMR to carry out the work, for study materials, medical writing, and APC.
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Nanomedicine has already revolutionized medicine through the development of materials that can prolong circulation in the body, avoid immune system clearance, penetrate cells and bacteria, invade tumors, promote tissue growth, inhibit infection, and so much more. New fields have emerged such as 4D printing which can enhance the performance of nanomaterials by 3D printing them into desirable shapes, implant them, and control their shape through external stimuli (such as near infrared excitation, temperature control, and others). This presentation will provide an overview of 25 years of commercializing University based research into real products helping human health. It will cover the promises and pitfalls of commercializing University based research and even discuss if this is the right model to advance science and research into the medical industry. It will also highlight new areas emerging for commcerialization such as the use of 4D printing in medicine for straightening the spine for scoliosis patients, closing of sphincters that weaken as one ages (for example, to decrease acid reflux from the stomach to the esophagus), promote intervertebral tissue growth by increasing pressure on such tissue during regeneration, deliver stem cells on the same materials in which they are cultured to enhance stem cell viability, and more. It will cover additional new areas like picomedicine, implantable sensors and more. It will cover in vitro and in vivo assessment of such materials and discuss what is needed to experience full application of nanomedicine throughout all of medicine.
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Case Diagnosis: Lupus patient develops transverse myelitis status post COVID-19 infection Case Description: A 24-year-old female with history of lupus, GERD, COVID (one year prior), presented with bilateral lower extremity weakness for one day, "penguin walking", paresthesia below the waist, fever, chills, and diarrhea. Setting(s): Acute Rehabilitation, Community Hospital - Brooklyn, NY Assessment/Results: Initially, patient's temperature was 102.7F. Sensation was intact, strength was decreased in right more than left lower extremity. Labs were positive for ANA, dsDNA, Smith, and RNP antibodies. Lumbar puncture showed elevated WBC, neutrophilia, increased IgG, and elevated protein: albumin ratio. MRI demonstrated ill-defined spinal cord areas of signal alteration at T2, T4, and T10-11 suggestive of transverse myelitis/lupus myelitis. Symptoms improved after steroids, and cyclophosphamide drip. During her rehabilitation course, lower extremity strength, ambulation, and endurance returned to baseline. Daily plaquenil and prednisone continued as well as outpatient cyclophosphamide monthly for 4 months. Discussion(s): Systemic lupus erythematosus (SLE), is rarely associated with transverse myelitis (TM). It occurs in 1-2% of patients within the first 5 years of SLE and reoccurs in 18-50%. Often, TM involves 3 or more contiguous spinal levels. The pathophysiology of TM in lupus is believed to be caused by thrombosis of the small vasculature supplying the thoracic spinal cord. Post-COVID hypercoagulable states could increase the risk. Motor involvement is usually bilateral, with spastic paraparesis being the most common. T5 to T8 are most frequently affected. T2 MRI signal intensity with spinal cord swelling, in the cervical or thoracic regions, is the gold standard test to confirm TM. A combination of methylprednisolone and cyclophosphamide is recommended. Conclusion(s): Transverse myelitis should be considered in lupus patients presenting with fever and a new or recurrent neurologic deficit. Radiologic findings present contiguously in the thoracic spinal cord and are less commonly discontiguous as in our patient. Early diagnosis and treatment are essential to achieve the best outcome.
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Introduction: SARS-CoV-2 infection, known as COVID-19, may lead to persistent gastrointestinal dysfunction resembling aspects of post-infection disorders of gut-brain interaction (DGBI). However, the long-term consequences of COVID-19 on the gastrointestinal tract remain unclear. Aims & Methods: We aimed to evaluate the prevalence of gastrointestinal symptoms and post-infection disorders of gut-brain interaction (DGBI) up to 12 months after hospitalization and the factors associated with their presence. The GI-COVID19 is a prospective, multicenter, controlled study. Patients with and without COVID-19 diagnosis were assessed at hospital admission and followed up after 1, 6, and 12 months to assess gastrointestinal symptoms using the Gastrointestinal Symptoms Rating Scale, the Rome IV Diagnostic Questionnaire for Functional Gastrointestinal Disorders in Adults, and the hospital anxiety and depression scale. ClinicalTrials. gov number, NCT04691895. Result(s): The study included2183 hospitalized patients. After excluding patients with pre-existing gastrointestinal symptoms and/or surgery, a total of 883 patients (614 COVID-19 and 269 controls) were included in the primary analysis, of whom 435 COVID-19 and 188 controls completed 12 months of follow-up. At enrollment, gastrointestinal symptoms occurred more frequently in COVID-19 patients than in the control group (59.3% vs. 39.7%, P<0.001). Symptoms more frequently complained by COVID-19 patients at enrollment were nausea, diarrhea, loose stool, and urgency. At 1-month follow-up evaluation, nausea and acid regurgitation were significantly more prevalent in COVID-19 patients than in the control group (8.7% vs. 1.7%, P=0.015 and 8.4% vs. 2.1%, P=0.006, respectively). At 6 months, COVID-19 patients reported lower rates of flatus (17.6% vs. 19.1%, P=0.024), constipation (8.9% vs. 17.1%, P<0.001) and hard stools (9.6 vs. 17.2%, P=0.030) as compared with the control group. At 12 months, constipation and hard stools were significantly less prevalent in COVID-19 patients than in the control group (9.6% vs. 16%, P=0.019 and 10.9% vs. 17.7%, P=0.011, respectively). COVID-19 patients reported higher rates of DGBI during follow-up compared to controls (Table), although statistically significant differences were found only for irritable bowel syndrome (IBS) according to Rome III criteria (4.4% vs 1.1%, P=0.036) and Rome IV criteria (3.2% vs 0.5%, P=0.045). The rate of COVID-19 patients depressed at 6 months and with anxiety at 12 months was higher compared to controls (4.1% vs 2.7%, P=0.014 and 4.5% vs 1.1%, P=0.088, respectively). Factors significantly associated with IBS diagnosis were anamnestic allergies (OR 10.024, 95% CI 1.766-56.891, P=0.009), chronic intake of proton pump inhibitors (OR 4.816, 95% CI 1.447-16.025, P=0.010) and dyspnea (OR 4.157, 95% CI 1.336-12.934, P=0.014). Conclusion(s): Hospitalized COVID-19 patients complain less constipation and hard stools than control at 12 months after acute infection. COVID-19 patients are also more likely to develop IBS.
ABSTRACT
SESSION TITLE: Lung Transplantation Cases SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: A shortage of lungs persists despite the addition of increased-risk donors to the transplantation pool. Waitlist mortality increased from 14.7 to 16.1 deaths per 100 waitlist years from 2019 to 2020. (1) Novel strategies are needed to further expand the donor pool. We report a case of intentional transplant of recently infected acute respiratory virus syndrome 2 (SARS-CoV-2) donor lungs to a patient with end-stage Idiopathic Pulmonary Fibrosis (IPF). CASE PRESENTATION: A 67 year old man with IPF, former tobacco and alcohol abuse, hypertension and gastroesophageal reflux disease underwent a sequential bilateral lung transplant on cardiopulmonary bypass. His post-operative course was complicated by Pseudomonas Aeruginosa pneumonia and bilateral pleural effusions status-post bilateral chest tube placement. He was extubated 4 days after surgery and had his chest tubes removed within 1 week. He discharged on room air 17 days after transplant and appeared well at his 3 week post-operative clinic visit. The donor lungs came from a 28 year old woman with chronic hepatitis C and recent asymptomatic SARS-CoV-2 infection. She tested positive for SARS-CoV-2 on reverse transcriptase polymerase chain reaction (RT-PCR) nasopharyngeal (NP) swabs at 12 and 7 days prior to surgery. She had negative SARS-CoV-2 results on lower respiratory tract testing via bronchioalveolar lavage (BAL) at 7 and 2 days prior to surgery. Recipient RT-PCR NP testing was negative on post-operative days 3, 10, and 17. Two subsequent BAL samples were negative in the first week post-operation. The recipient consented to transplant and was aware of the donor's recent SARS-CoV-2 and chronic hepatitis C infections. Infectious disease did not recommend any SARS-CoV-2 anti-viral therapy or post-exposure prophylaxis. Hepatology prescribed treatment for donor derived hepatitis C viremia on discharge. DISCUSSION: Emerging pathogens present a challenge in minimizing donor-derived diseases. The utilization of lungs, including patients with recent SARS-CoV-2 infection, should be considered carefully. Institutional guidelines vary in donor exclusion criteria based on history of prior SARS-CoV-2 infection, severity of prior infection, timing of last SARS-CoV-2 result, and type of screening test. (2,3) We report a case of intentional lung transplant with asymptomatic SARS-CoV-2 infection on NP swab 1 week prior to transplant and negative lower respiratory tract testing 2 days prior to transplant. Our recipient patient has remained SARS-CoV-2 free at 3 weeks post-operation on serial testing. We propose that the timing of recent donor infection, even within 10 days of positive results, is less important as infectious status based on lower respiratory tract testing at the time of transplant. CONCLUSIONS: We demonstrate that donor lung donation following very recent asymptomatic SARS-CoV-2 infection can be done safely with good short-term outcomes. Reference #1: (1) 2020 Annual Data Report. Scientific Registry of Transplant Recipients https://srtr.transplant.hrsa.gov/annual_reports/2020/Lung.aspx Accessed [03/23/22] Reference #2: (2) Querrey, M, Kurihara, C, Manerikar, A, et al. Lung donation following SARS-CoV-2 infection. Am J Transplant. 2021;21: 4073– 4078. https://doi.org/10.1111/ajt.16777 Accessed [03/23/22] Reference #3: (3) Summary of Current Evidence and Information– Donor SARS-CoV-2 Testing & Organ Recovery from Donors with a History of COVID-19. Version Release Date: January 21, 2022. US Department of Health & Human Services. Organ Procurement and Transplantation Network https://optn.transplant.hrsa.gov/media/kkhnlwah/sars-cov-2-summary-of-evidence.pdf Accessed [03/23/22] DISCLOSURES: No relevant relationships by Thomas Meehan No relevant relationships by Jagadish Patil No relevant relationships by Huddleston Stephen