The Incidence of Large Vessel Vasculitis in Norfolk

Background/Aims There are no data on the collective incidence of the large vessel vasculitides. The incidence of GCA and Takayasu arteritis in the UK has been based on clinical coding in routine administrative datasets. There are no data on the incidence of these diseases based on clinically verfied diagnoses. We studied the incidence of the large vessel vasculitides in a stable population with a predominant Northern European ancestry. Methods Individuals attending a secondary care hospital with a clinically verified diagnosis of primary systemic vasculitis made between 2011-2020, who lived within the NR postcode districts of Norfolk county were included if they met classification criteria for GCA or Takayasu arteritis, or had definite tissue or imaging evidence of large vessel vasculitis. Population above the age of 18 as in the 2011 census, available from the office of national statistics, was accepted as the denominator. If classification criteria for both GCA and TAK were met, physician judgement was accepted as final diagnosis. Results 272 adults were diagnosed with large vessel vasculitis out of a population of 454,316. The annual incidence of large vessel vasculitis in Norfolk is 59.9/million in the adult population. The annual incidence of GCA is 9.9/100,000 over the age of 50 using the ACR 1990 criteria and 10.6/100,000 using the ACR/EULAR 2022 criteria. The rise in the incidence from 2017 onwards coincides with the establishment of a fast-track pathway (Table 1). The dip in the incidence in 2020 coincides with suspension of services during the SARS-CoV-2 pandemic. The annual incidence peaks at 168.5/100,000 in the 9th decade and is commoner in females (12.3/100,000 vs 7.3/100,000). The annual incidence of Takayasu arteritis is 3.3/million in the adult population using the ACR 1990 criteria and 1.1/million using the ACR/EULAR 2022 criteria. Conclusion This is the first study that reports the incidence of all objectively diagnosed large vessel vasculitis in a stable population in Norfolk county. The incidence of GCA rose with the establishment of a fasttrack pathway and its peak may have been affected by the SARS-CoV- 2 pandemic. GCA is commoner in females and peaks in the 8th and 9th decades. (Table Presented).

Current status of the application of radiodiagnosis and radiotherapy resources in Huai'an City in 2020.

Objective: To investigate the current status of the radiodiagnosis and radiotherapy resources and medical exposure frequencies in Huai'an City. Method(s): According to the monitoring data in the " Radiological Health Information Management Platform of Jiangsu Province" in 2020, a descriptive analysis was conducted on the personnel, equipment, and exposure frequencies in the institutes engaged in radiation-based diagnosis and treatment in Huai'an. Result(s): A total of 181 hospitals were investigated in 2020, including 7 tertiary hospitals(3.9%), 24 secondary hospitals(13.3%), 126 primary hospitals(69.6%), and 24 ungraded hospitals(13.3%). There were 1 397 radiation workers, including 948 males and 449 females, and 459 pieces of radiation equipment, including 420 for radio diagnosis, 13 for radiotherapy, 4 for nuclear medicine, and 22 for interventional radiology. The hospitals of different grades greatly differed in the number of radiation workers and equipment. There were 80.1, 20.9, 2.2, and 2.0 radiation workers and 15.7, 5.5, 1.4, and 1.6 pieces of radiation equipment in the tertiary hospitals, secondary hospitals, primary hospitals, and ungraded hospitals, respectively on average. There were 2 903 246, 27 648, 8 087, and 17 874 receiving radiodiagnosis, radiotherapy, nuclear medicine, and interventional radiology, respectively in 2020. The medical exposure frequencies in the whole city were calculated to be 599.50 per 1 000 population, including 334.59 treated with conventional X-rays, 239.82 receiving CT scan, 14.18 for breast and dentistry, 3.62 receiving interventional radiology, 5.61 treated with radiotherapy, and 1.69 receiving nuclear medicine. Conclusion(s): The radiodiagnosis and radiotherapy resources are unbalanced in the hospitals of different grades in Huai'an City. Therefore, it is necessary to pay more attention to the reasonable allocation of medical resources. Meanwhile, radiation workers in secondary hospitals may be more prone to job burnout. Facing the normalization of the prevention and control of COVID-19 epidemic, the supervision and management of radiological health should be strengthened to ensure the legitimacy of radiological diagnosis and radiotherapy and theoptimization of protection. The frequencies of medical exposure are consistent with the local economic level. To analyze the differences in medical exposure frequencies and predict the developmental trends in different regions, it is necessary to establish a more accurate prediction model.Copyright © 2021 by the Chinese Medical Association.

RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS AND CLINICAL OUTCOMES IN COVID-19 PATIENTS WITH HYPERTENSION:A REPORT OF THREE PEAK WAVE PERIODS IN SEMARANG, INDONESIA

Objective: We aimed to assess the association between RAAS inhibitors (ACEi or ARB) and the clinical outcomes of COVID-19 patients with hypertension in the First Wave, Second Wave and Third Wave at Secondary Referral Hospital, Indonesia Methods: This cross sectional study was based on an electronic medical record in the Dr Adhyatma MPH Tugurejo General Hospital, Semarang, Indonesia. All patients more than 18 years old who confirmed COVID-19 case in the first wave (November 2020 to January 2021), second wave (May 2021 to July 2021) and third wave (January 2022 to February 2022) were included in this study. Data about demographic, comorbidities, features of antihypertensive drugs and clinical outcomes were collected. The clinical outcomes included mortality and prolonged hospitalization (length of stay (LOS) > 10 days). The statistical measures calculated were Chi square test and Fischer's exact test. Results: From three periods of peak wave, data from 1560 COVID-19 patients was collected in the first wave (304;19.5%), the second wave (1038;66.5%), and the third wave (218;14.0%). Subjects were dominated by males (50.4%) and a median of age 50 (19 -91) years old. The common comorbidities in studies were diabetes mellitus with 318 (20.4%) and hypertension with 254 (16.3%). In the main analysis, 99 (39%) patients with hypertension receiving RAAS inhibitors were compared with 155 (61%) patients receiving other antihypertensive drugs. Our results showed that RAAS inhibitors was not associated with a higher risk of COVID-19 mortality (RR:1.01;95% CI: 0.61-1.67;p:0.969) or prolonged LOS (RR:0.86;95%CI: 0.60-1.26;p:0.408). Conclusions: In COVID-19 patients with hypertension, the use of RAAS inhibitors showed no increased mortality or prolonged LOS compared to patients without RAAS inhibitors. COVID-19 patients and patients exposed to the COVID-19 pandemic should not discontinue ACEi or ARBs.

Nine Maternal Mortalities in 2 Weeks of Second COVID-19 Surge in Indonesia: A Case Series from One Large Tertiary Center

BACKGROUND: The fluctuating COVID-19 cases among the pregnant women’s population encountered increased of cases and maternal mortality. AIM: This research aimed to describe the case of maternal deaths caused by COVID-19. CASE REPORT: We present nine serial cases of maternal death caused by COVID-19 who were admitted to Dr. Soetomo General Academic Hospital for 14 days in June. We found 32 positive COVID-19 obstetric cases and reported nine maternal deaths with a fatality rate of up to 28%. Seven of nine patients had reverse transcription-polymerase chain reaction–confirmed SARS-CoV-2 infection, while two had a positive antigen swab. Half of the patients ≥35 years old, and five of nine patients had Class I obesity as preexisting comorbidity. This study reported the death of pregnant woman at their 2nd trimester and 3rd trimester presenting infected by severe COVID-19. The usual symptoms are dyspnea, cough, fever, and decreased consciousness. The result of chest X-ray examination among eight patients showed bilateral pneumonia. Most of cases were referrals from a secondary hospital due to overload hospital capacity. Three patients were directly transferred to the tertiary hospital without receiving initial treatment. Eight of 9 patients (88.9%) were transferred to intensive care unit and intubated due to low oxygen saturation. CONCLUSION: In conclusion, the limited hospital facility and lack of intensive care capacity for obstetric cases during the second wave of the COVID-19 pandemic may enhance the probability of mortality and morbidity in pregnant women infected by COVID-19.

Asymptomatic SARS-CoV-2 Infection in Children's Tonsils

Introduction: The SARS-CoV-2 pandemic killed over 6 million people worldwide. Children were described to have predominantly mild or asymptomatic infections and to be less exposed to the virus, at least for the initial variants. In the present study, we describe how SARS-CoV-2 can silently infect tonsils and adenoids in children undergoing adenotonsillectomy. Method(s): In this cross-sectional study we assessed children who underwent adenotonsillectomy between October 2020 and September 2021 in a secondary hospital in Brazil. All the caregivers denied any symptom of acute viral upper airway infection in the month prior to surgery. Briefly, nasal cytobrush (NC), nasal wash (NW) and tonsillar tissue fragments posttonsillectomy were tested by RT-PCR, immunohistochemistry (IHC), in situ immunofluorescence (IF), and flow cytometry. Result(s): A total of 48 children (18 females, median age 5.5 years) were enrolled. None of them had been vaccinated against COVID-19 at the time of surgery. Only 2 had a history of previous COVID-19 diagnosis, 3 and 5 months, respectively, before surgery. SARS-CoV-2 RNA was detected in 25% (12) of patients-20% in palatine tonsils, 16.27% in the adenoids, 10.41% in NC, and 6.25% in NW. IHC labeling showed viral nucleoprotein presence in both adenoids and palatine tonsils, in epithelial surface and lymphoid cells from extrafollicular and follicular regions. In 5 out of 7 patients, in situ IF showed the expression of ACE2 and TMPRSS2 and viral spike protein in the tonsillar tissue. Flow cytometry revealed that SARS-CoV-2 is predominantly observed in CD123+ dendritic cells (10.57% of all tested sites), followed by CD14+ monocytes (6.32%). Conclusion(s): According to these results, the prevalence of SARS-CoV-2 infection seems to be higher than expected and underdiagnosed in children at this age group. Palatine tonsils and adenoids are important sites of infection and may be a reservoir for the virus. Nevertheless, it is still unclear the impact of these results on virus transmission.

Incidence of Ocular Herpetic pathologies in a hospital setting, United Kingdom

Purpose : The incidence of ocular herpetic pathologies, in particular Herpes Zoster Ophthalmicus (HZO), has seemingly been on a rise over the past years, especially among the elderly and immunocompromised. The nature of this rise is likely multifactorial ranging from access to Shingles vaccination programmes, potential increase in immunocompromised individuals, social factors and most recently, Covid-19 infection. The relationship between Covid-19 and ocular herpetic pathologies has anecdotal basis. Certain studies have hypothesized T-cell dysfunction as a mechanism of Varicella Zoster virus reactivation in patients affected by Covid-19. This retrospective, observational study analyses the pattern of incidence of ocular herpetic pathologies in a secondary care centre, United Kingdom (UK). Methods : This study was set in an eye casualty clinic in Queens Hospital, Burton-on-Trent (University Hospitals Derby & Burton NHS, UK). Diagnoses of each patient was recorded in the Eye Casualty Patient Register. Data was extracted from three time periods-i. Precovid pandemic (July -December 2019), ii. Pandemic (July-December 2021) and iii. Post coronavirus vaccine introduction, UK (April and May 2021). Extracted data was pooled into the following groups-Herpes Simplex Keratits (HSK)/ HZO/ Shingles/Herpetic Kertatouveitis/ Herpes Zoster/Herpes Simplex/Herpes simplex endothelitis. Results : The data between pre-pandemic and post-pandemic periods highlighted an increasing incidence of certain ocular herpetic conditions. Highest number of diagnoses were recorded as HSK and HZO. HSK accounted for the highest incidence across all time periods-41% (pandemic), 34% (pre-pandemic) and 37.5% (after vaccine introduction). On the other hand, similar incidence is noted with HZO diagnoses-32.9% (pandemic), 32.7% (pre-pandemic) and 37.5% (after vaccine introduction). Conclusions : Overall, a gradual increase in incidence of ocular herpetic pathologies was observed from 2019-2021 at this centre. Multiple factors could be responsible for this rise, with Covid-19 infection as a potential factor. However, there is insufficient data to draw up a definitive association between the increasing incidence of such conditions and Covid-19, especially as the immune response to the infection and vaccinations are poorly understood. Larger, multi-centre studies would be required to assess the burden of incidence in the UK.

Clinical outcomes of critically ill COVID-19 patients seen through teleicu services in Pakistan

INTRODUCTION: As the surge of COVID-19 continues, low resource settings such as Pakistan have encountered an acute shortage of ICU facilities and trained intensivists. The dearth of resources is apparent in the remote region of Northern Pakistan. Therefore, we established a tele-ICU consultation service model to address these concerns and leverage critical care capacity in these remote settings. METHODOLOGY: This study was conducted in Gilgit and Chitral secondary care hospital in Northern Pakistan. Gilgit is a 46-bedded hospital with 6 ventilators, and Chitral is a 25-bedded hospital with 3 ventilators in their ICU. The study duration is 1 year from July 2020 till June 2021. This is a centralised and decentralised hub-and-spoke tele-ICU model. The main hub is located in Aga Khan University Hospital (AKUH) in the metropolitan city Karachi. The distance from the main hub to the remote facilities is approximately 1800km. The tele-ICU followed a 24/7 Scheduled Care Model (periodic consultations on a predetermined time) and Responsive Care Model (unscheduled teleconsultations prompted by an alert) to provide care. The mode of communication is teleconference calls, video calls, and text messaging. This service is provided by 24/7 AKUH trained intensivists. Patient information such as demographics, clinical course, teleconsultation interventions, and management were obtained from these remote ICUs. RESULTS: A total of 157 patients presented to the tele-ICU from Pakistan's remote regions of Gilgit and Chitral. Of these, 60% were male (n=95). 86% (n=135) patients presented with COVID-19. 64% (n=97) patients had comorbidities with hypertension (47%, n=46) being the most common. Invasive mechanical ventilation was provided to 12% (n=18) of the tele-ICU patients, while 62% patients (n=98) received noninvasive mechanical ventilation interventions. Average length of stay of patients in the tele-ICU was 9 days with a range of 1-41 days. 72% (n=113) patients were discharged home from the hospital. Tele-ICU mortality was 29% (n=44). CONCLUSION: We utilized a peer-to-peer tele-consult model to support critical care services in Northern Pakistan. The survival rate achieved by this model is comparable to national and international hospital published data. This was possible through use of multimodal information technology in Pakistan.

Hepatitis B immunity status and COVID-19 vaccination coverage among nurse aides working in the emergency department in a secondary hospital in Portugal

Introduction: Emergency healthcare workers (HCW) are the first point of contact for patients with traumatic injuries and acute illnesses. These professionals are at increased risk for respiratory and blood borne infections, as is the case of hepatitis B virus (HBV) infection and coronavirus disease 2019 (COVID-19). Vaccination is a major tool for preventing HBV infections. The protection provided by the COVID-19 vaccines are yet under evaluation. The objective of this study is to evaluate the HBV and COVID-19 vaccination coverage and the serological hepatitis B immunity among nurse aides working in the emergency department (EM) in a secondary hospital in Portugal. Material and Methods: A descriptive cross-sectional study was conducted by analyzing the Occupational Health Service database of Centro Hospitalar do Baixo Vouga in Aveiro, considering active nurse aides working in the EM in August 2021. Results and Conclusions: Of the total 71 workers included in the study, 61 (85.9%) had completed the vaccination against HBV. From these fully vaccinated HCW, 45 (73.7%) had confirmation of protective Hepatitis B surface antibody (HBsAb) levels (>10 mIU/mL) and 11 (18.3%) had unknown HBsAb levels. Regarding COVID-19 vaccination, 68 (95.7%) of the 71 total workers, had complete vaccination. From these, 43 (63.2%) had the last shot more than 6 months ago. Overall, there is a good adherence of nurse aides working in the EM to HBV and COVID-19 vaccination. In what concerns to HBV vaccination, it is important to implement a more robust system to diminish cases of workers only partially vaccinated or with unknown immunity status.

POSC324 Clinical Pharmacist Intervention to Improve the Administration of Injectable Antiviral Agents By Nurses in the Treatment of COVID-19 Infection

Objectives: To Analyse the impact of clinical pharmacist intervention on the administration of injectable anti-viral agents by nurses in the treatment of COVID-19 infection. Methods: A One-group pre-test, post-test experimental study was conducted during the month of May 2021 among the staff nurses of a secondary care hospital using a pre-structured and pre-validated questionnaire. The questionnaire was organized into 3 domains i.e, Knowledge, Attitude, and Practice (KAP) regarding injectable anti-viral agents including Remdesivir were evaluated. Demographic details, as well as the related information, were also collected. Paired-t-test and Chi-square tests were employed to evaluate the statistical significance of the study variables. Results: A total of 56 nurses were included in the study, among which the majority (59.7%) were diploma holders and the rest of them were degree holders in nursing. On analyzing the years of experience of study samples, it was found that the majority had 1-4 years experience (46.3%) followed by 4-8 years (28.6%) and the least percentage had experience for more than 12 years. The pre-test vs post-test values of the staff nurses shows a significant improvement in Knowledge (6.7vs.10.5, p<0.001), Attitude (6.7vs 8.9, p=0.003), and Practice domain (7.1604 vs 8.3, p<0.001). No statistically significant association was observed between knowledge and practice of the nurses with the baseline variables like level of education or years of experience (P=0.07). Conclusions: Clinical Pharmacist initiated continuing education programs for the nurses related to the administration practices of anti-viral agents like Remdesivir is very much crucial in assuring the proper clinical care to critically ill COVID-19 patients.

POSC1 The Influence of Diabetic History in the Prognosis of Hospitalized COVID-19 Patients: A Prospective Observational Study

Objectives: To evaluate the association between a known history of diabetes mellitus (DM) and its clinical outcomes in hospitalized COVID-19 diabetic patients. Methods: This prospective cohort study categorized COVID-19 positive patients admitted to a secondary care hospital in South India into DM patients and Non-DM patients. Data regarding the past medical and medication history was collected on the day of admission and the patients were regularly followed up till discharge or death. The outcome measures including duration of hospital stay, mortality, need for ICU care/mechanical ventilation were compared between the two groups. Data is extracted and statistically analyzed using Pearson correlation. Results: Out of a total of 118 patients observed, 53 patients were diabetic and 65 were non-diabetic. Out of the 53 hyperglycemic patients, 39 patients were on metformin therapy while 15 patients were on insulin before admission due to COVID-19. A higher mortality rate was observed in the DM group when compared with the Non-DM group [26.4% (14) vs 9.23% (6)]. An increased random blood glucose levels at the time of admission had a positive correlation with mortality (p = 0.003). While insulin administration prior to admission had negative correlation with mortality [R value is -0.282 (p = 0.02)], increased insulin requirement during hospitalization is associated with poor outcomes [R value is 0.327 (p = 0.002)]. Conclusions: People with diabetes when infected with COVID-19 are at a greater risk of morbidity and mortality. The study highlights the need for rational management of hyperglycemia in COVID patients with a history of diabetes mellitus.

POSA21 An In-Hospital Study to Trace the Risk Factors Associated with Adverse Drug Reactions during the Second Wave of COVID-19 in a Secondary Care Hospital in India

Objectives: To characterize the adverse drug reactions (ADRs) and the risk factors associated with COVID -19 treatment in a secondary care hospital in South India. Methods: A prospective observational study was carried out on 327 patients admitted between April 1 and May 15, 2021, using an in-person surveillance system. The demographic characters of all the patients including the time of admission, comorbid diseases, length of stay, history of drug allergies, and the number of medications used during hospitalization were collected. After identification of an adverse drug event, the causality, suspicious drugs, and prognosis of ADRs were also recorded. Descriptive statistics and multivariate logistic regressions were carried out to analyze the risk factors of ADRs. Results: Out of the 327 patients, 194 (59.3%) were men and the mean age was 45.7± 16.6 years. 122 ADRs were reported among 87 patients with an incidence rate of 26.6%. Most of the reactions were associated with dexamethasone (31.9%), remdesivir (18%), and favipiravir (14.7%) with dexamethasone-induced hyperglycemia being most prominent. The majority of the suspected ADR cases were categorized as probable (61.8%) according to the WHO-UMC causality assessment. When compared with the No ADRs group, the length of stay (p=0.004), history of drug allergies (p<0.001), number of drugs used in treatment (p<0.001) were significantly higher in the ADRs group. Multivariable analysis revealed that length of stay (OR: 2.03;95% CI 1.02–3.98;P = 0.04), comorbidities (OR: 2.08;95% CI 1.05–4.18;P = 0.04), number of drugs used for treatment (OR: 3.17;95% CI 1.60–6.27;P = 0.001) and were independent risk factor for ADRs in the patients. Conclusions: Active surveillance measures are important in case of all drugs used for COVID treatment to keep the living guidelines the most live one.

Hospital.Acquired Respiratory Viral Infections while Applying Droplet Precautions On-site (Drops)-Prospective Observational Study during the 2019/20 Influenza Season, Bern, Switzerland

Introduction: The guideline-driven and widely implemented single room isolation strategy for respiratory viral infections (RVI) such as influenza or respiratory syncytial virus (RSV) can lead to a shortage of hospital beds. Alternative strategies to prevent hospital-acquired respiratory viral infections (HARVI) are needed. Objectives: Based on promising results of a pilot study using droplet precautions on-site (DroPS) during the influenza season 2018/19, this strategy was implemented in multiple hospital wards. We assessed the "real-life" safety of DroPS by measuring the rate of HARVI after its implementation. Methods: Prospective observational study during the influenza season 2019/20 at a tertiary and secondary referral hospital. The study was prematurely stopped at the beginning of the COVID-19 pandemic (17th March 2020). DroPS was used for patients hospitalised with suspected or proven RVI. Hospitalised patients with no respiratory isolation in the two days following admission were considered "at risk" for the acquisition of HARVI. They were screened daily for the onset of new respiratory symptoms. Once an "at risk" patient developed symptoms, an influenza/RSV molecular rapid test was performed. The two main outcomes were the rate of clinical and laboratory-confirmed HARVI (influenza or RSV). Results: We included 1'996 hospitalisations with a total of 8'955 "at risk" hospital days for HARVI. Median age was 71 years [IQR 56.81]. HARVI was clinically diagnosed in 11/1'996 (0.6%) hospitalisations. All patients with clinical diagnosis were microbiologically screened and three confirmed (0.15%;2 × RSV, 1 × influenza B). Conclusion: Droplet precautions on site (DroPS) may represent a safe, simple and resource-saving alternative to the traditional pathogenbased single room strategy for RVI in non-pandemic circumstances.