Rheumatoid Vasculitis Complicated With Acute Inflammatory Demyelinating Polyneuropathy in an Older Female: A Case Report.

Rheumatoid vasculitis (RV) causes various complications in the heart, lungs, kidneys, and nerves that require intensive treatment. Rapid RV-related peripheral nerve involvement progression is critical and requires prompt treatment. We report the case of a 73-year-old female with RV, with a chief complaint of difficulty walking without any infectious symptoms for several months. We diagnosed Guillain-Barré syndrome (GBS) accompanied by RV and treated the patient with intravenous immunoglobulin and cyclophosphamide. Previous impairments of activities of daily living (ADLs) were resolved. Diagnosing the neurological manifestations of RV and GBS in older patients with an active RV is challenging because of the various patterns of the progression. For effective management, considering both diseases and implementing immunosuppressive and modulatory treatments is critical to stop the progression of neurological symptoms and prevent the deterioration of ADLs.

Implementation of national tuberculosis infection prevention and control guidelines in rural hospitals, Papua New Guinea

Introduction: Tuberculosis (TB) is a significant public health problem in Papua New Guinea (PNG). Poor infection prevention and control (IPC) measures in healthcare settings may partly contribute to the high burden of TB in PNG. This study examines the implementation of the TB infection prevention and control (TBIPC) policy introduced by the national health department in 2011 in rural hospitals in the Highlands and Momase region of PNG. Method(s): A self-administered structured questionnaire adapted from the WHO TBIPC framework and site observations were undertaken to assess the TBIPC activities. Questionnaires and observation data were analysed using SPSS. Fishers' exact test was performed to determine the similarities and differences in TBIC practices between the health facilities. Significance was assessed at p<=.05. Ethics approval was given by Griffith University Human Research Ethics Committee (GU Ref No: 2021/921). Result(s): Ten of thirteen rural hospitals in the Highlands and Momase region (78%) were surveyed. The majority (N=8,80%) of rural hospitals have inadequate TBIPC programs. Two (20%) facilities have intermediate or advanced TBIPC programs. The facility with advanced TBIPC employed a doctor with public health training. COVID-19 pandemic has provided the impetus to strengthen IPC programs in rural health facilities. Significant differences in TBIPC practices were identified across the two regions (p=0.03). Conclusion(s): Overall, TBIPC guidelines were inadequate in rural hospitals in PNG. The significant differences in TBIPC practices in rural hospitals remain a severe challenge to the TB control efforts. Public health training for health workers could play an important role in IPC programs.Copyright © 2022

Timing of Treatment for Cytomegalovirus Infection in an Immunocompetent Middle-Aged Woman With Fulminant Ulcerative Colitis: A Case Report.

Viral infections, such as cytomegalovirus (CMV) infection, may affect the clinical course of ulcerative colitis (UC). CMV can cause chronic inflammation of the intestinal mucosa. In inflammatory bowel disease, chronic inflammation caused by CMV can deter the regeneration of the mucosa of the colon. However, the relationship between CMV and inflammatory bowel disease still needs to be clarified, especially in immunocompetent patients, such as younger patients not treated with immunosuppressants. Herein, we describe our experience with a middle-aged immunocompetent female patient diagnosed with fulminant UC positive for myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA). Her initial response to high-dose prednisolone was favorable; however, remission was not achieved. Immunohistochemical staining revealed the presence of CMV. Subsequently, the patient was successfully treated with prednisolone, adalimumab, and azathioprine, along with the anti-CMV treatment comprising valganciclovir. This case shows that the presence of CMV in the mucosa and blood may make patients with UC refractory to immunosuppression; furthermore, the positivity of MPO-ANCA in patients with UC can necessitate the administration of high-dose immunosuppressants to taper the dose of prednisolone.

Contributing and hindrance factor to seek health care services in COVID-19 Pandemic

Introduction: In an effort to alleviate the outbreak of COVID-19, many countries have imposed drastic Lockdown, movement control or shelter in place orders on their residents. Aim(s): The attitudes and factors of people hold towards visiting health care services play an integral role in determining a society's readiness to accept behavioral change measures from health authorities. Material(s) and Method(s): A cross-sectional online survey of 220 Indian residents was conducted between 3rd April 2020 and 15th may 2020.1 Result: Findings showed that 79.09% is not visited to health facilities for COVID-19 and 20.91% sought medical help. Out of that majority 39.39% want to visit government hospital, 34.85% are visited private hospital, 15.15% are community health center, 6.06% are primary health center, and 3.03% are in rural Hospital and 1.52% private clinic. Contributing factor distribution shows that 98.18% are aware about COVID-19 disease condition majority 22.71% from Health Professionals. 74.09%, person acknowledges availability of health facility and 80% persons acknowledge advice and guidance from Government, friends, relatives made them to seek medical help for COVID-19. Hindrance factors shows 66.82% peoples hesitate to contact health facility for COVID-19 among them 41.26% due to Fear of isolation or quarantine and other factors like How to tell, Whom to tell, Fear of relationships with family and neighbors and. 49.55% people not visiting health care facilities due to fear of covid-19 positive diagnosis. 46.39% peoples are having fear of Quarantine foe so many days so not approaching to health care facilities. Conclusion(s): There are some other factors not to seek medical help are Responsibility of family, Fear of isolation by society, Somebody may discuss about them & Others health issues will open, Fear of breaking of relationship, Social stigma, Specialty doctors are available only in big cities, Lack of society support.Copyright © 2020 Ubiquity Press. All rights reserved.

Possible autoimmune pediatric encephalitis following COVID-19 infection with focal cerebral dysfunction in a young female: A case report

Introduction: Post-COVID-19 autoimmune encephalitis is a rare manifestation following COVID-19. Most cases have not demonstrated solid evidence regarding their pathogenesis. Some believe it to be an immune process. Case presentation: In this case report, we present a case of a young female who presented to our emergency department with visual, auditory, and olfactory hallucinations after successfully treating COVID-19 two weeks prior to this visit. On examination, her vital signs were stable, but she was agitated, distressed, and hallucinating. Neurological examinations were normal. Laboratory investigations, including autoimmune profiles, were all negative. Magnetic resonance imaging of the brain showed non-specific changes in the bilateral frontal area. Electroencephalography (EEG) showed lateralized rhythmic delta activity (LRDA) arising more from the right occipital lobes. Autoimmune psychosis was suspected due to psychosis, abnormal imaging, and abnormal EEG findings. She was given corticosteroids and antipsychotic medication. Her symptoms improved within ten days. On follow-up, she remained well without any return of psychosis. Conclusion(s): Possible autoimmune pediatric encephalitis following COVID-19 is a rare entity that has scarcely been reported. The majority of the cases were reported to have been related to stress following the infection. To establish the correct diagnosis, an extensive workup, including an autoimmune profile, lumbar puncture, magnetic resonance imaging, and electroencephalography, is recommended.Copyright © 2022 The Author(s)

Clinico-Epidemiological Profile of Cutaneous Adverse Drug Reactions at Rural Tertiary Care Centre

Background: Cutaneous adverse drug reactions (CADRs), also known as toxidermia, are skin manifestations resulting from systemic drug administration and it constituted 10%-30% among all reported adverse drug reactions (ADRs). These reactions range from mild morbilliform drug rash to much more severe reactions. Material(s) and Method(s): A retrospective observational study was conducted at dermatology outpatient department of rural based tertiary care center for a duration of 03 years from August 2019 to July 2022, a total of 211 patients who had been clinically diagnosed or were suspected to have drug reactions were studied. Result(s): In this observation there was male preponderance (59.72%) and majority of patients were in their 3rd and 4th decade (40.28%) with maculopapular drug rash (33.17%) being most common clinical profile of CADRs, followed by urticaria (23.70%). Less frequently seen CADRs were acneiform eruptions (21), hair Loss (9), photodermatitis (9), generalised pruritus (7), erythroderma (2), pityriasis rosea (2), Stevens Johnson Syndrome-Toxic Epidermal Necrolysis (SJS-TEN) (4), lichenoid drug eruptions (3), Vasculitis (1) and pustular drug eruption (1). The most common group of drugs causing CADRs were antibiotics (40.28%), followed by NSAIDs (28.43%). Conclusion(s): Cutaneous Adverse Drug Reactions (CADRs) are price we pay for the benefits of modern drug therapy;knowledge of these reactions is important for treating physician as prompt recognition and treatment can prove lifesaving.Copyright © 2022 Academic Medicine and Pharmacy

Heyde Syndrome Complicated by Essential Thrombocythemia: A Case Report.

Heyde syndrome is a multisystem disorder characterized by the triad of aortic stenosis (AS), gastrointestinal bleeding, and acquired von Willebrand syndrome. Age-related degeneration is the most common cause of aortic stenosis and is frequently encountered in today's aging society. Approximately 20% of patients with severe aortic stenosis have Heyde syndrome. We encountered an older patient with primary thrombocytosis who was brought to a rural community hospital with bloody stools and was diagnosed with bleeding from an intestinal arteriovenous malformation. A final diagnosis of Heyde syndrome was made based on the presence of severe aortic stenosis and the presence of schistocytes in peripheral blood smears. Valvular diseases can complicate chronic hematological diseases. When the rapid progression of anemia and segmented red blood cells in the peripheral blood are observed in patients with severe aortic stenosis, Heyde syndrome should be considered based on peripheral blood smears and clinical course.

Metabolism-Mediated Thrombotic Microangiopathy in an Older Patient Without Malnutrition.

Vitamin B12 deficiency can cause thrombotic microangiopathy (TMA)-like symptoms such as purpura caused by platelet reduction, general fatigue caused by anemia, and renal and hepatic abnormalities caused by malnutrition. TMA-like symptoms are known as metabolism-mediated TMA (MM-TMA). In MM-TMA, blood cell production is altered, and both pancytopenia and schistocytes appear. The initial presentation of MM-TMA makes it challenging to distinguish between primary and secondary TMA when patients do not present risk factors for malnutrition. We encountered an older female patient with a chief complaint of unconsciousness and loss of appetite for two days. Laboratory tests revealed pancytopenia with schistocytes. Moreover, the laboratory data revealed low serum levels of vitamin B12, indicating MM-TMA. The patient was successfully treated with intravenous vitamin B12 supplementation and discharged home. The patient had atrophic gastritis, which could have impeded the absorption of vitamin B12 from food. Among older patients without prolonged appetite loss, TMA-like symptoms should be investigated as MM-TMA induced by vitamin B12 deficiency, and prompt initiation of appropriate treatment is essential to differentiate between MM-TMA and true TMA.

Appearance of Ankylosing Spondylitis in a Middle-Aged Female Patient With a Long History of Rheumatoid Arthritis.

Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial bones, primarily affecting the spine. AS is classified as spondyloarthritis because it affects the spine and other joints. AS has several presentations and, in some cases, can be insidious, making it difficult to diagnose. We encountered a patient on long-term follow-up for rheumatoid arthritis with an appearance of AS. This case suggests that patients with long-term rheumatoid arthritis can develop AS during follow-up and that the seropositivity of rheumatoid factors and anti-cyclic citrullinated peptide antibodies cannot rule out AS. Therefore, the possibility of AS should be considered, even in patients diagnosed with rheumatoid arthritis.

Small rural hospitals in the United States and the impact of COVID: A cross-sectional study.

BACKGROUND: Rural hospitals in the United States face staffing and financial challenges, low patient volumes, and aging infrastructures among others. In addition, they deal with such crises as the opioid epidemic, natural disasters, and the coronavirus. METHODS: The analyses presented in this study are based on two databases: (1) the 2019 annual survey data published by the American Hospital Association (AHA) and (2) US Department of Health and Human Services (HHS) database of US hospitals containing information related to COVID-19 for the week of November 27, 2020. Using a subset of the 2019 AHA annual survey data to which the authors acquired access, this study develops a profile of rural hospitals in America. The data are proprietary property of AHA. The authors are permitted to use the data in published research but only in aggregate form. No individual hospital metrics can be used in this report. The HHS database is public data and as such is available to all. HHS recognizes the importance of providing high-quality, accessible, and timely information for entrepreneurs, researchers, and policy makers to help drive insights and better health outcomes for all. Employing this HHS database, a cross-sectional view of the impact of COVID on small, rural hospitals in the United States is undertaken. In this study, data found in the HHS database are presented only in the aggregate form. RESULTS AND DISCUSSION: The average small, rural hospital has 20.8 beds, 10 weekly admissions, a daily census of 6.6 patients, 145 full-time personnel, 67 part-time personnel, and a total facility expense of $27 million of which payroll expense was 41%. Due to COVID, there was an increase in admissions and outpatient visits.

Association of Rural Residence with Short-Term Mortality in Critically Ill Patients with Covid-19

INTRODUCTION: Rural residence has been associated with increased risk of COVID-19-related mortality. However, the population-level prognostic implications of rural residence among critically ill patients with COVID-19 are lacking, and the impact of inter-hospital transfer and hospitals' location on the outcomes of these patients is unknown. METHOD(S): We used a statewide dataset to identify ICU admissions aged >=18 years with a diagnosis of COVID-19 in Texas during April 1-December 31, 2020. COVID-19 was defined by ICD-10 code U07.1. We used dichotomized (rural vs urban) ZIP Code-level Rural-Urban Commuting Area categories, linked to hospitalization data, to identify rural residence. Hierarchical, mixed-effects models were fit to estimate the association of rural residence with shortterm mortality (defined as in-hospital death or discharge to hospice) for the whole cohort and among hospitalizations with and without transfer from another hospital. Similar modeling was used to examine the association of care in rural hospitals among rural residents without transfer to another facility with short-term mortality. RESULT(S): Among 58,485 ICU admissions with COVID-19, 9,495 (16.2%) were rural residents. Among rural residents, 8,607 (90.6%) were managed in non-rural hospitals, and 1,827 (19.2%) were transferred from another hospital. The unadjusted short-term mortality among rural and urban residents was 25.9% vs 23.9%, respectively. Following adjustment for confounders, rural residence was associated with higher short-term mortality for the whole cohort (adjusted odds ratio [aOR] 1.093 [95% CI 1.003-1.191]) and among those transferred from another hospital (aOR 1.349 [95% CI 1.106-1.646]), but not among those without inter-hospital transfer (aOR 1.052 [95% CI 0.955-1.159]). Management of critically ill rural residents with COVID-19 in rural hospitals, without inter-hospital transfers was not associated with shortterm mortality on adjusted analyses (aOR 0.672 [95% CI 0.393-1.149]). CONCLUSION(S): The observed increased short-term mortality among critically ill patients with COVID-19 residing in rural areas is confounded by inter-hospital transfers and the geographic location of hospitals, with no adverse prognostic impact of rural residence in non-transferred patients and those managed in rural facilities.

Hypoglossal Nerve Palsy Following COVID-19 Vaccination in a Young Adult Complicated by Various Medicines.

Mononeuritis multiplex is a rare form of cerebral nerve palsy caused by various factors. Coronavirus disease 2019 (COVID-19) vaccination could be an etiology of mononeuritis multiplex, which can affect various nerves. Post-COVID-19 and vaccination-related neurological impairments involve cranial nerves such as the facial, trigeminal, and vagal nerves. We report our experience with a 34-year-old man who developed hypoglossal nerve palsy following COVID-19 vaccination, complicated by progressive mononeuritis multiplex. Hypoglossal nerve palsy may occur following COVID-19 vaccination. The symptoms vary and may progress without treatment. Physicians should consider the possibility of mononeuritis multiplex after COVID-19 vaccination and provide prompt treatment for acute symptom progression.

The NSW Telestroke Service: A cross-agency collaboration to implement and sustain a virtual care hyperacute stroke service at 23 regional and rural hospitals

Background: The $21.7 million NSW Telestroke Service was a 2019 NSW Government election commitment. Implementation of the service is a collaboration between South Eastern Sydney Local Health District, the NSW Agency for Clinical Innovation, eHealth NSW and the NSW Ministry of Health. Between March 2020 and June 2022, the telestroke service launched at 23 sites across regional and rural NSW, providing access to specialist stroke physicians for rapid assessment, diagnosis and treatment through virtual care. The service has treated over 2200 patients with a reperfusion rate for acute ischaemic stroke patients of 34%. Aim(s): To understand the factors driving the successful implementation of a major project led by multiple health organisations in a complex environment. Interrogating and documenting the success factors will help NSW Health agencies implement similar large-scale, complex projects. Method(s): The implementation team adopted a reflective approach to draw out key lessons during the implementation at each site. Lessons learnt discussions were held at a local and program-wide level, focusing on areas including resourcing, leadership, education and training, and sustainability. Result(s): Key elements of successful implementation highlighted by the reflective lessons learnt approach include: * Division of responsibility that reflected the strengths of each partner agency * Clear implementation roadmap including comprehensive implementation and training packages * Flexibility to adapt the implementation approach based on contextual factors and intervening events * Strong executive support at each partner agency * Upfront focus on sustainability to identify and mitigate issues early on The telestroke service was implemented by the target schedule, despite the significant impacts caused by the COVID-19 pandemic and natural disasters. The service was a finalist in the 2021 NSW Premier's Awards. Conclusion(s): The implementation of telestroke can offer insights for partner agencies into the key factors driving success of transformative projects to improve access to healthcare.

Impact of Kidney Allocation Change on Low Volume Kidney Transplant Centers

Purpose: Effective March 15, 2021, the OPTN launched a new policy for matching kidney and pancreas transplant candidates with organs from deceased donors. The new policy was projected to increase equity in transplant access for candidates nationwide by using a scoring system based on a reference of 250 nautical mile radius from donor hospital. Various factors can influence the transplant rates including wait list size, organ acceptance practices as well as access to transplant centers in rural and socio-economically disadvantaged parts of the country. Small volume centers have short waitlist and candidates lower on the national list. With the current change in allocation, they may be forced to accept high risk kidneys. The new allocation may impact outcomes for such centers to stay active and maintain volumes. We propose to evaluate the impact of the allocation change on the kidney transplant practices at our center situated in rural setting. Method(s): A cohort study was designed comparing transplant characteristics of all patients undergoing kidney transplant at our center. The study population was all patients who had a kidney transplant after March 15, 2021. The cohort group was all patients who underwent a kidney transplant at our center from Jan 1, 2019 to Dec 31, 2019. The year 2020 was not considered because of COVID-19 pandemic. Data collected included donor demographics, recipient demographics, donor quality indices and recipient allograft function, transplant related complications. Result(s): There were 66 patients in the pre and the 49 in post allocation group. The most common cause of renal failure was diabetes in both. There were no statistically significant differences in recipient demographics. There was a dramatic increase in the number of DCD donors (48% pre vs 80% post, p 0.007). The cold ischemia time was significantly increased (20hr 5m pre vs 23hr 45m post, p 0.002). The serum creatinine trend showed higher serum creatinine at 1, 3 and 6 months post transplant in the post allocation group. Delayed graft function was seen in 3% in pre vs 10% in post group. There was an increase in hospital stay (6 days vs 8 days). Conclusion(s): The new allocation system may increase utilization DCD kidneys. It also prolongs cold ischemia time. This can result in prolonged hospital stay and DGF rates and result in higher serum creatinine levels. The impact of this on low volume centers and rural hospital systems may decrease organ transplant rates in such areas and lead to disparity in transplant access.

Secondary Failure of Tocilizumab in Treating Elderly-Onset Rheumatoid Arthritis With Systemic Symptoms Complicated by Diverticulum Perforation.

The treatment of rheumatoid arthritis (RA) has advanced from the use of steroids to disease-modifying anti-rheumatic drugs (DMARDs) and biologics such as tumor necrosis factor (TNF) and interleukin-6 (IL-6) inhibitors. Historically, steroids have been the mainstream in the clinical treatment of RA; however, the development of DMARDs has changed the RA treatment structure. In addition, biologics can alleviate RA symptoms. This case report describes the secondary failure of tocilizumab in treating RA with fatigue symptoms. Treatment with tocilizumab decreases C-reactive protein (CRP) levels, which may make detecting RA exacerbation difficult; therefore, obtaining the patient's precise history and thorough physical examinations are necessary. This case demonstrates the complexity of treating elderly-onset RA and reports practical methods for effective treatment.

Use of high-flow nasal oxygenation outside COVID-19: a rural hospital experience

Background: Before the COVID-19 pandemic, there was an increasing interest in the use of high-flow nasal oxygenation (HFNO) due to the way it delivers oxygen and because of its impact on respiratory mechanics. Its use extends from the operating room, e.g. pre-oxygenation, apnoeic oxygenation in ENT surgery, electroconvulsive therapy, to the emergency room and intensive care unit, e.g. acute respiratory failure, cardiogenic shock in adults and paediatrics. It has also been advocated as a useful method to prevent reintubation. However, it has not always shown to be a superior approach to other oxygenation methods. Currently, the medical literature is inundated with the use of HFNO in the management of COVID-19. Yet, the picture may differ outside this ambit. Methods: We describe two complex cases in which this therapy was used and was decisive toward a positive outcome. Results: We describe two complex cases in which HFNO therapy was used and was decisive toward a positive outcome. In our first described case, it was an effective tool to bypass the need of endotracheal intubation in a high-risk OSA patient. In the second case the traditional epidural with invasive or noninvasive ventilation was challenged. The higher tolerability of HFNO, absence of sedation, better mobility and easier access to enteral nutrition resulted in the quick, successful recovery of the patient despite the combination of chronic restrictive pulmonary disease and severe thoracic-abdominal trauma. Conclusion: In our opinion, both cases may illustrate a significant potential for the use of HFNO in different clinical scenarios.

SASA 2022 Virtual Conference Abstracts

The proceedings contain 23 papers. The topics discussed include: petroleum jelly as an alternative coupling medium in focus assessed transthoracic echocardiography;perspectives on desflurane;use of high-flow nasal oxygenation outside COVID-19: a rural hospital experience;fitness for purpose of South African anesthesiologists;the effect of caregiver's recorded voice on emergence delirium in children undergoing dental surgery;perioperative outcomes of mitral valve surgery at Charlotte Maxeke Johannesburg Academic Hospital;comparison of a novel low-cost hyperangulated optic intubation stylet with the Bonfils fiberscope: a simulated difficult airway manikin study;the awareness of local anaesthetic systemic toxicity amongst registrars from surgical disciplines in a tertiary hospital, South Africa;and SARS-CoV-2 infection prevalence in healthcare workers, administrative and support staff: the first wave experience at three academic hospitals in the Tshwane District of Gauteng.

ELEVATING THE HIV/HCV SCREENING GAME: AN OPT OUT PROGRAM FOR A HEALTHCARE SYSTEM

STATEMENT OF PROBLEM/QUESTION: HIV and HCV infections remain a significant cause of morbidity and mortality, yet despite recommendations from numerous agencies (including the CDC and USPTF) screening rates for both HIV and HCV as well as linkage to care remain suboptimal. DESCRIPTION OF PROGRAM/INTERVENTION: The Allegheny Health Network is a ten-hospital health care system located in Western PA in and around Pittsburgh/Allegheny county. The Center for Inclusion Health's, a division within AHN, received funding from Gilead Sciences to implement the Frontlines of Communities in the United States (FOCUS) program to expand HIV and HCV screening in an "opt out" model and provide linkage to care fo patients who test positive. As of June 2021, FOCUS project was integrated into 5 EDs and one outpatient IM clinic. The EDs range from 2 inner city, 2 urban and 1 rural hospital. All patients entering the participating ED's are screened for eligibility automatically utilizing an EMR BPA. If the patient is eligible, the BPA will alert the nursing staff of the need for testing. It utilizes an “opt-out script” to offer the testing, consistent with CDC/WHO guidelines and with Act 148 (the PA law that covers permission for HIV consent). Patients who test positive are then linked to care through a Linkage Coordinator who provides notification of results, disease education, appointment scheduling and support to FOCUS screened patients. MEASURES OF SUCCESS: Measures of success are: Number of patients screened for HIV and HCV infection, Number of patients who screen positive for HIV or HCV infection, Number of patients who screen positive for HIV or HCV infection who are linked to care. FINDINGS TO DATE: The volume for both HIV and HCV testing rose progressively in all years after conception of the project, until 2020. A similar pattern occurred for HCV testing. We then assessed the percent of those eligible for HIV and HCV screening who underwent testing. In the year prior to implementation, only 1.3% of those eligible for HIV screening had testing completed. This increased steadily to 16% of those eligible completing testing in 2019. HCV testing had a similar trend going from 1.5% in 2016 to 13.3% in 2019. In 2016, 0.8% of those screened for HIV were positive. This number stayed between 0.1-0.5%. For HCV, the positivity rate was 1.7% in 2016 and ranged from 2.4% to 4.0% afterwards. Linkage to care was variable during the study period, with 46% to 85.7% for HIV positive patients linked and 33% to 73% for HCV positive patients. KEY LESSONS FOR DISSEMINATION: Our program showed that HIV and HCV screening can be successfully integrated into a variety of settings. Education to staff and additions to the EMR are needed. However, barriers do exist including competing clinical demands and reliance on providers adopting it into usual care. Also, the stress to the medical system from the Coronavirus pandemic led to a decrease in screening for HIV and HCV seen in 2020. Implementing HIV and HCV screening into unusal settings takes buy-in, effort, and champions to help the program be successful.

Hemodialysis-Related Pericarditis With Cardiac Tamponade.

Pericarditis can cause chest symptoms in dialysis patients. Moreover, it tends to present with various symptoms other than chest pain in patients with end-stage renal disease (ESRD) than in non-ESRD patients. Here, we present the case of an 86-year-old man on maintenance dialysis who was admitted to the hospital with chest discomfort and dyspnea, which led to cardiac tamponade due to unexplained pericardial effusion. The patient underwent pericardial drainage with an epigastric approach. Based on his medical history and pericardial fluid examination, his condition was diagnosed as dialysis-related pericarditis. Non-steroidal anti-inflammatory drugs and prednisolone administration improved the patient's condition. There are various causes of pericarditis in patients undergoing hemodialysis. It is crucial to examine the patient's clinical presentation and pericardial fluid volume to clarify the cause of the disease.

16th INASH AbstractT Book

The proceedings contain 45 papers. The topics discussed include: neuropeptide levels effect on blood pressure in chronic kidney disease patients with hypertension;dry weight gain and incidence of intradialytic hypertension: a cross-sectional study in rural hospital;why they don't take the pill: a qualitative study of antihypertensive medication nonadherence in East Borneo primary health care;antihypertensive effect of nigella sativa (Habbatus Sauda) supplementation in population with cardiometabolic risk factors: a systematic review and meta-analysis of randomized controlled trials;risk factors of peripheral artery disease in the hypertensive chronic kidney disease patients on hemodialysis;impact of day-to-day blood pressure variability to in-hospital mortality in patients with COVID-19 and efficacy of antihypertensive agents;and systolic blood pressure as risk factor associated with persisting proteinuria after delivery in women with preeclampsia.