Identifying parent anxiety and family distress of critically ill children in response to changes in hospital visitation policies during the COVID-19 pandemic

This research study describes parent anxiety and family distress among three study groups of varying restrictions in parent presence for children in the PICU during a pandemic. A retrospective study was conducted to describe differences in parent anxiety and family distress for parents of children hospitalized before and during the COVID-19 pandemic. Participants fell into three study groups based on the dates of the child's hospital stay and the level of parent and family presence or restriction they experienced. Participants were asked to complete a survey that included basic demographic information along with utilization of the GAD-7 and FDI measures. The data were assessed using descriptive statistics, Fisher's exact test, and the Kruskal-Wallis test. A total of 82 parents of children hospitalized during the specified times in the PICU participated. There was a statistically significant difference among the three cohorts in diagnoses (respiratory, cardiovascular, and medical-surgical), p ≤0.001. A larger percentage of children of the study participants were hospitalized with respiratory illnesses (62.5%) in the unrestricted study group when compared to the other study groups with higher patient acuity. There was also a statistical significance among the three study groups regarding whether the second parent was able to visit the child during the PICU admission (p = 0.007). Our study suggests that restricting parent and visitor presence does not increase parent anxiety or family distress during a child's admission to the PICU. The literature widely supports that having a critically ill child is undoubtedly stressful for parents and families, but the most significant causation for the anxiety and stress remains unknown and is likely multifactorial. Parents who experienced rigid restrictions in parent and visitor presence did not have increased anxiety. Other impactful variables such as a child's mortality risk and the uncertainty of outcome may have impacted anxiety for parents whose children were critically ill. Further research is needed to understand which stressors are most significant, during a critically ill child's hospitalization, from a parent's perspective. Limiting staff and patient exposure to persons who may have contagious illness (restricting parent and family presence) may not in itself lead to increased anxiety and distress for parents and families. This study may provide context for careful development of hospital visitation policies to ensure balance between patient and family centered care and protection from infectious disease. • A child's admission to a pediatric intensive care unit (PICU) is one of the most stressful and anxiety-provoking situations for parents. • Restricting parent presence interrupts the social and emotional relationship and offers less time for bonding.. • Coronavirus-19 (COVID-19) forced hospitals to make abrupt changes to existing visitation policies. • This research provides context for support of careful development and implementation of hospital visitation policies.

Evaluation of Dentists' Anxiety Levels during the Coronavirus Pandemic

Objective: Coronavirus disease-2019 (COVID-19) is a highly contagious infection whose possible transmission routes are airborne droplets, close contact with an infected person or contaminated surface, blood, or saliva. These possible routes of transmission are closely related to the work conditions of dentists. The present study assessed the anxiety levels of dentists and related factors during the COVID-19 pandemic using the Beck Anxiety Inventory (BAI). Material(s) and Method(s): A questionnaire consisting of 33 questions on the anxiety levels of dentists related to infection COVID-19 was used. The questionnaires were sent to dentists via online platforms. Mann-Whitney U and Kruskal-Wallis tests were used to compare quantitative variables. Result(s): In total, 260 dentists were included in the study. The median (minimum-maximum) BAI score of participants was 28 (19-75), which displayed moderate anxiety. There was a statistically significant difference between the genders in terms of BAI scores (p<0.001). No statistically significant difference was found between ages (p=0.79). Of the participants, 64.6% (n=168) stated that the level of income decreased, and 69.2% stated that safe working conditions decreased. Conclusion(s): During the COVID-19 pandemic, dentists were one of the most affected groups by the pandemic due to dental settings. Gender and the presence of chronic disease were the main factors that negatively affected the anxiety level of dentists. As the developments regarding the pandemic are updated daily, dentists should follow them and update their information through various platforms. Copyright ©Meandros Medical and Dental Journal, Published by Galenos Publishing House.

Simulated Learning Experiences Impact on Acute Care Confidence Development in Students with Low Resiliency

PURPOSE/HYPOTHESIS: The COVID-19 pandemic has taken a toll on the psychological resilience of healthcare workers across the world but has also had a significant impact on healthcare professionals in training. The pandemic has required educators to adapt how they teach but also to take into consideration innovative learning activities to increase students' resiliency. The purpose of this study was to assess the impact of high-fidelity human simulation (HFHS) sessions on acute care confidence in a critical care setting in physical therapy students' who rate their resiliency at low levels. NUMBER OF SUBJECTS: Eighty-one DPT students. MATERIALS AND METHODS: One week prior to the HFHS sessions each subject completed the Acute Care Confidence Survey (ACCS) and the Brief Resiliency Scale (BRS). All subjects participated in 2 HFHS sessions in a 3-member team and were given objectives and a case history 1 week prior to each HFHS experience. The HFHS used the Laerdal's SimMan 3G manikin equipped with an oxygen delivery system, lines and tubes and a monitor displaying vitals. The format for each simulation lab included a 15-minute pre-brief session, a 20-minute SimMan encounter and an immediate 15-minute debrief session. Following the completion of the HFHS learning experience each student completed a second ACCS. RESULT(S): A Kruskal-Wallis test was used to compare confidence score across low, normal, and high resilience groups. Low and normal resiliency level students had significantly lower confidence in manual skills prior to simulation (P< 05) compared to their high resiliency counterparts. Following simulation, all resiliency groups demonstrated confidence improvement that resulted in no significant differences between the groups. A Wilcoxon Signed Ranks Test revealed significant improvement in all confidence scores for each group following simulation. CONCLUSION(S): Resiliency levels did not impact students' ability to gain confidence from simulation training. HFHS when graded has been shown to increase stress and decrease confidence in students. These HFHS learning activity exposures were not graded which may have allowed those students with lower resiliency to learn in a less stressful environment and still develop confidence. A positive change in student confidence may be more related to a graded exposure to an acute care setting that allows skill development in a low stress environment. CLINICAL RELEVANCE: The simulation sessions increased student confidence by providing a realistic clinical environment and expectations, with confidence being less impacted by a student's resiliency. This low stake learning environment provided a valuable opportunity for students to improve clinical confidence regardless of their self-rated resiliency level.

Evaluation of Dentists' Anxiety Levels during the Coronavirus Pandemic

Objective: Coronavirus disease-2019 (COVID-19) is a highly contagious infection whose possible transmission routes are airborne droplets, close contact with an infected person or contaminated surface, blood, or saliva. These possible routes of transmission are closely related to the work conditions of dentists. The present study assessed the anxiety levels of dentists and related factors during the COVID-19 pandemic using the Beck Anxiety Inventory (BAI). Material(s) and Method(s): A questionnaire consisting of 33 questions on the anxiety levels of dentists related to infection COVID-19 was used. The questionnaires were sent to dentists via online platforms. Mann-Whitney U and Kruskal-Wallis tests were used to compare quantitative variables. Result(s): In total, 260 dentists were included in the study. The median (minimum-maximum) BAI score of participants was 28 (19-75), which displayed moderate anxiety. There was a statistically significant difference between the genders in terms of BAI scores (p<0.001). No statistically significant difference was found between ages (p=0.79). Of the participants, 64.6% (n=168) stated that the level of income decreased, and 69.2% stated that safe working conditions decreased. Conclusion(s): During the COVID-19 pandemic, dentists were one of the most affected groups by the pandemic due to dental settings. Gender and the presence of chronic disease were the main factors that negatively affected the anxiety level of dentists. As the developments regarding the pandemic are updated daily, dentists should follow them and update their information through various platforms. Copyright ©Meandros Medical and Dental Journal, Published by Galenos Publishing House.

Comparative Analysis of the Characteristics of the YoY Inflation Rate Cities in Indonesia before and during the Covid-19 Pandemic

In this study, the identification of the characteristics of the Year of Year (YoY) inflation rates in cities throughout Indonesia is presented before the pandemic and during the Covid-19 pandemic. The data used are the YoY inflation rates from January 2018 to April 2022 using non-parametric statistical methods. At the time before the pandemic, the YoY inflation rate of cities in Indonesia tended to be unrelated to each other, but during the pandemic, data on the YoY inflation rate of cities in Indonesia tended to be related to one another. The results also obtained are that there are significant differences in the distribution of the YoY inflation rate before the pandemic and during the Covid-19 pandemic for cities in Indonesia. © 2022 IEEE.

Correlation between Survival and Elevated D-Dimer Levels, Ichikado, Apache Ii, and Sofa Scores

INTRODUCTION: Elevated D-dimer levels are common in hospitalized COVID-19 patients. We aimed to investigate the correlation between D-dimer levels and survival, as well as ICHIKADO, APACHE II, and SOFA scores. METHOD(S): Retrospective study of adult patients with COVID-19 admitted to the hospital between March 2020 and February 2022. Patients were divided into three groups according to D-dimer levels: group 1 (G1) had levels less than 0.5 mg/L, group 2 (G2) had 0.5 to 3.99 mg/L and group 3 (G3) was above 4 mg/L. The primary outcome was survival to hospital discharge. Descriptive statistics, Chi-square, and Kruskal-Wallis tests were used. A p value <= 0.05 was considered statistically significant. RESULT(S): 830 patients were included in the study. 464 (55.9%) patients were men. Median age was 56 [45-66] years. There was a statistically significant association between D-dimer levels and survival rate. A total of 677 (81.6%) patients survived. 401 (89.3%), 235 (74.8%), and 41 (61.2%) patients survived in G1, G2, and G3 respectively, p < 0.001. There was also a statistically significant association between D-dimer levels and different severity scores. Median ICHIKADO scores across D-dimer levels;G1 had a median score of 140.00 [115-180]], G2 had a score of 157.50 [120-205], and G3 had a score of 200.00 [160- 245] (H (2) = 55.345, p < 0.001). APACHE II scores across the groups;G1 had a median score of 7.00 [5-11], G2 had a score of 10.50 [7-16], and G3 had a score of 12.00 [8-19] (H (2) = 76.817, p < 0.001). For SOFA scores, G1 had a median score of 2.00 [1-2], G2 had a score of 2.00 [1-3.25], and G3 had a score of 4.00 [2-6] (H(2)= 81.309, p < 0.001). CONCLUSION(S): In this cohort, elevation of D-dimer levels was associated with decreased survival rates as well as with increased ICHIKADO, APACHE II, and SOFA scores.

Impact of Bmi on Mortality, Mechanical Ventilation, and Length of Stay in Covid-19 Patients

INTRODUCTION: Weight-related health problems typically arise in those with a BMI higher than 30. This study aimed to evaluate the effect of BMI on COVID-19 outcomes. METHOD(S): Retrospective cohort study was conducted on patients in our hospital with COVID-19 from March 2020 to February 2022. Admission BMI was categorized into six classifications: underweight (< 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obese class 1 (30-34.9 kg/m2), obese class 2 (35-39.9 kg/m2), and obese class 3 (>40 kg/m2). Primary outcomes were mortality, days hospitalized, and need for mechanical ventilation. Descriptive statistics, Chi-square, and Kruskal-Wallis tests were performed. RESULT(S): 986 individuals were included with a median age of 56 years [45-67]. Overall median BMI was 29.3 kg/m2 [27- 34.5 kg/m2]. 554 (56.2%) patients were males. Median BMI for females was 30.3 kg/m2 [26.4-35.4 kg/m2], and for males was 29.1 kg/m2 [25.8-33.9 kg/m2]). A total of 799 (81%) survived. Survival in underweight patients was 13 (86.7%), normal weight was 143 (81.7%), overweight was 267 (79%), obese class 1 was 191 (84.1%), obese class 2 was 98 (79%), and obese class 3 was 87 (81.3%), (chi2 (5) = 3.032, p = .695). When assessing need of mechanical ventilation, 159 (16.1%) of all patients needed ventilation. In each category: 3 (20%) underweight patients, 24 (13.7%) normal weight patients, 61 (18%) overweight patients, 33 (14.5%) obese class 1 patients, 22 (17.7%) obese class 2 patients, and 16 (15%) obese class 3 patients required ventilation (chi2 (5) = 2.613, p = .759). Analyzing days hospitalized, length of stay in each category was: underweight - 6 [5-12] days, normal weight - 7 [3-12] days, overweight - 6.5 [4-12] days, obese class 1 - 7 [4-12] days, obese class 2 - 7.5 [4-14] days, and obese class 3 - 7 [5-12] days (H (5) = 3.093, p =.686). CONCLUSION(S): In this cohort, BMI is not associated with higher mortality rates, longer hospitalization time, or need of mechanical ventilation among patients with COVID-19.

Cord blood and maternal cytokine levels following SARS-CoV-2 infection during pregnancy

Background. Pregnant people and fetuses are uniquely vulnerable to SARS-CoV-2, a driver of inflammation and immune dysregulation. Prior investigations have shown that pregnant people with SARS-CoV-2 are at higher risk of severe illness, mortality, and obstetric complications. We investigated the impact of SARS-CoV-2 infection severity and latency on maternal and infant cytokine levels. Methods. We collected maternal blood and cord blood at delivery from motherinfant dyads (Chicago, IL;3/2020-1/2022). A multiplex cytokine panel (IsoPlexis) was run on plasma from 93 SARS-CoV-2 infected dyads and 32 matched controls. Clinical data was ed by chart review, including latency (acute being <=14 days and distant >14 days from SARS-CoV-2 infection to delivery) and severity (NIH criteria: asymptomatic, mild, moderate, severe/critical). Kruskal-Wallis tests with post-hoc pairwise Dunn Tests were used (alpha=0.05). Results. SARS-CoV-2 exposed infants had lower levels of MIP-1b (p=0.037) and PDGF (p=0.008) than controls [Fig 1]. There were no differences in maternal blood cytokines at time of delivery following SARS-CoV-2 infection during pregnancy (pooled analysis of all SARS-CoV-2). Stratifying by latency, acutely exposed infants showed higher levels of MCP-1 than controls or those with distant maternal SARS-CoV-2 (p=0.016). There were no significant differences in maternal cytokines between control, acute, and distant SARS-CoV-2. In mothers with acute SARS-CoV-2, differences in levels of IL-1B (p=0.011) and IL-10 (p=0.046) were observed across severity groups, with a significant linear trend for each among severity groups (p for trend < 0.001, respectively). Severe/critical acute infection resulted in higher maternal granzyme and IL-8 than mild infection (p=0.037 and 0.047) [Fig 2]. There were no differences across severity groups in 1) mothers with distant infection, 2) infants with acute maternal infection, or 3) infants with distant maternal infection. Conclusion. Cytokine levels in SARS-CoV-2 positive dyads were altered only in the setting of acute or more severe infection and demonstrated anti-inflammatory, anti-viral, and anti-angiogenic responses. In acute infection, greater severity drives higher levels of both a pro- and anti-inflammatory cytokine in pregnant people.

Do lung ultrasound abnormalities change during hospitalization for COVID-19?

Background. While point-of-care ultrasound (POCUS) has been used to track disease resolution, temporal trends in lung ultrasound (LUS) findings among hospitalized patients with COVID-19 is not well-characterized. Methods. We studied 413 LUS scans in 244 participants >= 18 years of age hospitalized for COVID-19 pneumonia within 28 days of symptom onset from April, 2020 until September, 2021 at the Johns Hopkins Hospital, Baltimore Maryland. All patients were scanned using a 12-lung zone protocol and repeat scans were obtained in 3 days (N=114), 7 days (N=53), and weekly (N=9) from the initial scan. Participants were followed to determine clinical outcomes until hospital discharge and vital status at 28-days. Ultrasounds were independently reviewed for lung artifacts, and the composite mean LUS score (ranging from 0 to 3) across lung zones was determined. Trends of mean LUS scores and%lung fields with A-lines (indicating proportion of normal lung fields) were plotted by peak severity (mild, moderate, and severe defined by the World Health Organization Ordinal Scale) over time from symptom onset. Differences in mean LUS score or % A-lines changes over time between peak severity levels were evaluated using a Kruskal-Wallis test and linear mixed-effected models with an exchangeable correlation structure. Results. Among 244 patients in our cohort (mean age of 58.2 (SD 15.0) years, and 55.7% female) (Table 1), there was no change in average mean LUS scores between the first two visits by severity groups (Figure 1;Kruskal-Wallis p=0.63). Mean LUS scores were elevated by 0.22 (p< 0.001) in a dose-response manner regardless of duration of illness, but there was no change over time associated with peak severity (p=0.73). Similarly, percentage of A-lines were in 13.9% less lung fields for each increase in peak severity (p< 0.001;Figure 2) regardless of duration of illness. However, a change in mean LUS score did not differ significantly among peak severity levels (p=0.36). Conclusion. Mean LUS scores correlated with clinical severity among hospitalized adults when assessed cross-sectionally, however mean LUS score did not change or differ between peak severity levels over the time course of hospitalization. These results do not support serial LUS scans to monitor disease progression.

Tackling a post-COVID-19 cholecystectomy waiting list, are we meeting the challenge?

Background: The COVID-19 pandemic has led to a tremendous backlog in elective surgical activity, with over six million people on waiting lists and only 64% of patients meeting the 18-week elective standard. Our Hospital Trust adopted an innovative approach to dealing with elective waiting times for cholecystectomy during the recovery phase from COVID-19. This study aimed to evaluate trends in overall cholecystectomy activity and the effect on waiting times. Method(s): A prospective observational study was undertaken investigating patients who received a cholecystectomy at large UK hospital Trust, between February 2021 and February 2022. There were multiple phased strategies to tackle a 533 patient waiting list: Private sector, multiple sites including emergency operating, mobile theatre, and seven-day working. An additional 364 patients were added and 145 removed, for multiple reasons, from the list during the study period. Correlation of determination (R2) and Kruskal-Wallis analysis were used to evaluate trends in waiting times across the study period. Result(s): 657 patients underwent a procedure, of which 628 (95.6%) were completed electively. The median age was 49 years, 602 (91.6%) patients had an ASA of 1-2, and 494 (75.2%) were female. Thirty (4.6%) patients were listed post gallstone pancreatitis, 380 (57.8%) for cholelithiasis, and 228 (34.7%) for cholecystitis. The median length of stay was zero days (IQR 0-1), with 30-day complication (C-D >=3, 1.8%), readmission (3.0%) and mortality (0.0%) rates noted. The current waiting list includes 95 patients, with median waiting times reduced from 428 days (IQR 373-508) to 49 (IQR 34-96), R2=0.654, p<0.001. For pancreatitis specifically, waiting times have dropped from a median of 218 days (IQR 139-239) to 28 (IQR 24-40), R2=0.613, p<0.001. Conclusion(s):We have safely and effectively tackled the cholecystectomy waiting list locally utilising a number of phased strategies. Significant progress is being made towards once again meeting the gold-standard target for gallstone pancreatitis patients. The approach utilised here has potential to be adapted to other units, or other operation types in order to reduce elective waiting times.We have safely and effectively tackled the cholecystectomy waiting list locally utilising a number of phased strategies. Significant progress is being made towards once again meeting the gold-standard target for gallstone pancreatitis patients. The approach utilised here has potential to be adapted to other units, or other operation types in order to reduce elective waiting times.

Comparison of the prehospital altered respiratory parameters over the first two COVID-19 periods in Brussels: a retrospective cohort study

This retrospective cohort study analyses the impact of the COVID-19 pandemic on the prehospital pathology in 1 emergency response unit of Brussels. Three months of prehospital data with in total 1,030 interventions were analysed: 1 month in the first and second COVID-19 outbreak (April and November 2020 respectively) and 1 in the intermediate period (June 2020). The subtracted data contained altered respiratory signs as primary outcome parameter. Secondary outcome parameters were mean age, time from call to arrival of the intervention team, oxygen administration, medication administration, artificial ventilation and prehospital death. Statistical analyses are performed using SPSS, the cross table, the Chi-squared test and the Kruskal-Wallis test. Altered respiratory signs appeared in 31.9, 24.6 and 32.9% of the cases in April, June and November respectively (p-value: 0.039). Mean age was 59, 57 and 60 years (null hypothesis retained). Time from call to arrival of the intervention team was 11 minutes in all 3 periods (null hypothesis retained). Oxygen was administrated in 31.4, 27.4 and 32.6% of the cases (p-value: 0.315). Medication was given in 41.1, 39.7 and 41.2% (p-value: 0.908). Artificial ventilation was necessary in 2.8, 5.5 and 5.8% of the interventions (p-value: 0.115). Prehospital death was declared in 6.1, 4.9 and 6.9% of the cases. The COVID-19 pandemic had a significant impact on the prevalence of prehospital altered respiratory signs. Furthermore, no significant difference has been observed in the secondary outcome parameters. Copyright © 2022 The authors.

Knowledge, Attitude and Practice on prevention of COVID- 19 among nursing students in UniKL Royal College of Medicine Perak

Introduction: COVID-19 infection is a serious global public health problem and prevention activities are ultimately important to combat this infection. It is more important for the Health Care Workers (HCW) to know and follow the preventive measures effectively as they are front liners in attending the infective patients. Therefore, this study aims to evaluate Knowledge, Attitude and Practice (KAP) towards prevention on COVID-19 among nursing students in UniKL RCMP which can be an indicator of KAP level of health care worker and the community. Material(s) and Method(s): A cross-sectional study was conducted among Diploma course student nurses in January to February 2022 using online questionnaire on KAP towards prevention of COVID- 19. Descriptive statistics were used for elaborating demographic characteristics and the KAP levels. Knowledge, attitude and practice of the participants were assessed using a scoring system and categorized to level of KAP. Kruskal Wallis tests were performed as the data were not normally distributed, to determine significant differences among various group year of study with KAP scores while correlation test was used to identify relationship between knowledge with attitude and practice. The significant level is set as < 0.05. All analyses were performed using SPSS version 25. Result(s) and Conclusion(s): Two hundred and fifty questionnaires were distributed and 210 were returned which response rate was 84.0%. Median scores of knowledge, attitude and practice were 18.0 +/- 1.9, 8.0 +/- 1.7 and 7.0 +/- 1.25 respectively. There are significant association between year of study with knowledge (p=0.024) with attitude (p=0.002). However, there is no significant association between year of study practice (p=0.179). Significant positive linear correlations between knowledge-attitude (r=0.466, p<0.01) and knowledge-practice (r=0.575, p<0.01) were observed. Level of Knowledge, Attitude and Practice of nursing students on prevention of COVID-19 in this study were good. There were also positive linear correlations confirms that better knowledge can lead to positive attitude and subsequently in good practices. This is expected finding among healthcare workers as they are future health care workers. Therefore, continuous teaching and emphasize should be provided to ensure the KAP level are good among the nursing students.

Teleneurology as a tool to overcome disparities for access to multiple sclerosis care

Background: Utilization of teleneurology for MS care rapidly expanded during the COVID-19 pandemic to maintain healthcare access. Disparities in telehealth use have been described in other health conditions, but not in a MS population. Objectives/Aims: To evaluate longitudinal utilization of teleneurology across age, race, geographic factors, and insurance categories to identify potential disparities in utilization at a single academic MS center (Cleveland Clinic). Method(s): MS patients attending a specialty clinic in Cleveland, a medium-sized city, who completed >=2 visits at least 24 months apart from 1/2019 to 6/2021 were studied. Patients with fully inperson care were compared to patients with <50% or >50% teleneurology care. Categories of age, race, geographic factors, and insurance were compared using Kruskal-Wallis tests and pairwise Wilcoxon rank sum tests with Bonferroni correction for multiple comparisons. Result(s): 892 patients met the inclusion criteria and completed 3710 visits during the study timeframe: mean age 49.1+/-11.7 years, 73.7% female, 85.6% white, median disease duration 11.2 years [0.15;60.3], and relapsing-remitting 62.3%. 37% patients were fully in-person, 37.2% patients had <50% teleneurology care, and 25.8% patients had >50% teleneurology care. There were no significant differences for race (white, black, other), insurance type (Medicare, Medicaid, private, non/other), area deprivation index (ADI), and residence location (rural vs metropolitan) in the use of teleneurology. Use of teleneurology care varied based by age, with older patients utilizing more in-person care. In person care was 23.4% for ages 18-39, 38.5% for ages 40-60, and 47.8% for those greater than 60 (p<0.001). Patients residing in greater Cleveland had significantly more in-person care (55.3%) compared to residents residing in Ohio outside of the greater Cleveland area (34.7%) and outside of Ohio (10.1%) (p=0.031). Conclusion(s): There were no significant differences in teleneurology utilization across race, insurance, ADI or rural vs metropolitan residence, suggesting it is a broadly accessible tool to overcome disparities in access to MS care. Utilization of teleneurology care for older and local patients was lower, which may be due to decrease demand in these groups. Future studies should assess the optimal integration of teleneurology and in-person visits in MS management.

Assessment of Perception and Attitude of health care providers regarding COVID-19 Symptoms, Transmission, Progression, and Prevention in the UAE

Background: Health care workers (HCWs), being in the front line dealing with COVID-19 patients, are facing various challenges. Therefore, being aware about COVID-19 is of high importance. The overall aim of this study is to evaluate the HCWs' knowledge and attitude about COVID-19. The objectives of the study are assessment of HCWs' knowledge and attitude about COVID-19 and determining the significant factors that influence their knowledge. Methods and Materials: a descriptive cross-sectional study was carried out among convenient sample (n=353) of HCWs in the UAE by using an online self-administrated questionnaire. The data was analyzed using the SPSS version 26. Mann Whitney u test and Kruskal Wallis test were used to test the differences in quantitative variables across groups. Multivariate logistic regression analysis was used to investigate the association between the knowledge about COVID-19 and significant factors. A p value <0.05 was chosen as the criteria to make decisions regarding statistical significance. Result(s): A total of (353) HCWs participated in the study and completed the whole questionnaire. The average knowledge score was 76.3% with a 95% confidence interval (CI) [75.2%, 77.5%]. Of the total participants, 122 (34.6%) have poor knowledge, 81 (22.9%) have acceptable knowledge and 150(42.5%) have good knowledge. In the present study, significantly higher knowledge scores were observed in Western participants (OR 2.83;95% CI 1.51 - 5.29), General practitioners (OR 1.319;95% CI 1.03 - 1.69), participants working in Dubai (OR 1.47;95 % CI 1.28- 1.69) and participants who had been in contact with suspected or confirmed COVID-19 cases (OR 1.235;95% CI 1.11- 1.37). On the other hand, significantly lower knowledge scores were observed in participants aged 30-39 years (OR 0.760;95% CI 0.647- 0.893), Arabian participants (OR 0.76;95 % CI 0.58- 0.98) and participants with less than 1year experience (OR 0.729;95% CI 0.601- 0.883). Conclusion(s): This study revealed that HCWs working in the UAE have a good level of general knowledge about COVID-19 symptoms, transmission, progression, and prevention. Questions about deeper knowledge revealed a lower level of knowledge. Therefore, tailored awareness campaigns may be required in order to meet HCWs' needs and enhance their levels of deep knowledge. Copyright © RJPT All right reserved.

Kinetics of dd-cfDNA in Kidney Transplant Recipients Following Sars-CoV-2 Vaccination Booster Administration

Purpose: Evolving data suggests booster vaccine doses enhance the immunogenicity of SARS-CoV-2 vaccines in solid organ transplant recipients with higher IgG responses, neutralizing antibodies titers, and greater SARS-CoV-2-specific T-cell counts. Currently, there is no recommended framework for monitoring potential vaccine-related immunological graft injury. Here, we describe kinetics of dd-cfDNA pre- and post-booster vaccination in kidney transplant recipients (KTRs). Method(s): Electronic medical records were reviewed to identify KTRs that received a SARS-CoV-2 booster vaccine dose in 2021 and were monitored with dd-cfDNA pre- and post-vaccination. dd-cfDNA was collected as part of standard of care assessment. Pre-booster dd-cfDNA levels were defined as the most recent result prior to booster administration. Post-vaccination results were collected up to 30 days post-booster administration. Result(s): 116 KTRs were identified for analysis. Patient demographics are summarized in Table 1. Median time from transplant to SARS-CoV-2 booster administration was 463 days (IQR 333-787.25, Table 1). Pre-booster dd-cfDNA levels were established a median of 9 days (IQR 2.25 - 16) pre-booster. The median level of dd-cfDNA pre-booster was 0.17% (IQR 0.12% - 0.25%). There was no significant difference in median levels of dd-cfDNA up to 30 days post-booster administration (Kruskal Wallis test with multiple comparisons, all p values >0.99, Figure 1). No adverse clinical events or acute rejection episodes were reported within 30 days of SARS-CoV-2 booster administration in this cohort. Conclusion(s): Median dd-cfDNA levels were not impacted by SARS-CoV-2 booster administration, suggesting that patterns of subclinical injury that may potentiate inflammation, allosensitization or allograft rejection are unlikely in this setting. The stability of dd-cfDNA demonstrated here further reinforces the safety profile of SARS-CoV-2 vaccine booster administration in KTRs.

Physician Perspectives on Telemedicine Implementation in Radiation Oncology

Background: The use of telemedicine in radiation oncology increased dramatically during the COVID-19 pandemic. While prior surveys suggest high levels of satisfaction with telemedicine among radiation oncologists, the published literature is limited regarding provider-specific factors impacting satisfaction and provider preferences regarding how telemedicine is implemented. Objective(s): To assess provider characteristics associated with satisfaction and perceived adoption of telemedicine in radiation oncology, and to characterize implementation preferences of providers at our institution. Method(s): We distributed a survey to all attending radiation oncologists at our large academic institution in October 2021 to assess several measures of satisfaction with telemedicine. We also asked providers to estimate metrics suggestive of successful telemedicine use. Univariate logistic regressions were performed to assess the role of physician characteristics (including age, gender, years in practice, main vs satellite location, disease site treated, annual new patient volume, and selfreported comfort with technology) on satisfaction and on whether physicians reported telemedicine was easy to use. We also performed descriptive statistics to characterize provider-estimated time-savings and training preferences. Kruskal-Wallis tests were used to assess whether provider characteristics or scheduling strategy (telemedicine scheduled separately from in-person visits) were associated with the rate of missed video visits. Result(s): A total of 60 of 82 eligible radiation oncologists (73%) responded to the survey. 78% of respondents were satisfied with telemedicine in the radiation oncology department and 78% felt telemedicine was easy to use. None of the tested factors on univariate analysis were statistically significant predictors for these outcomes. 38% of providers believed telemedicine encounters resulted in time savings of at least 10% compared to in-person visits, while 20% of providers reported virtual encounters took at least 10% more time. A median (IQR) of 10% (5%-20%) of video visits were estimated to be missed, and none of the tested provider characteristics or scheduling preferences were associated with a significantly greater proportion of missed visits. 78% of respondents reported having adequate training and support to perform telemedicine. Text, video, and private instruction were nearly equally preferred training modalities (31%, 31%, 34% respectively). Conclusion(s): Nearly 80% of surveyed radiation oncologists were satisfied with telemedicine, felt it was easy to use, and reported adequate training and support to perform telemedicine. In this highly technologically advanced field, age and years in practice were not significantly associated with satisfaction or self-reported success rates with telemedicine. Future directions include addressing actionable concerns and correlating these findings with patient impressions.

REACTIVATION OF EPSTEIN-BARR VIRUS AND CYTOMEGALOVIRUS INFECTION IN PATIENTS WITH COVID-19

SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Latent Epstein-Barr virus (EBV) and cytomegalovirus (CMV) are commonly reactivated in critically ill patients with severe infections. This study aimed to evaluate the proportion of reactivation of EBV and CMV and its impact on length of stay, need for ventilation, and Ichikado CT scores in patients with coronavirus disease 2019 (COVID-19). METHODS: A retrospective study was conducted comprising adult patients admitted to our hospital with COVID-19 infection from June 2021 to September 2021. Patients were divided into groups: virus-free, EBV-only, CMV-only, and EBV and CMV detected. Primary outcomes were length of stay, need for ventilation, and Ichikado CT score. Descriptive statistics, one-way ANOVA, Games-Howell, and Kruskal-Wallis tests were used. RESULTS: 189 patients were included with a median age of 51 years [41 – 66], 80 (42.3%) were female and 109 (57.7%) were male. CD4(+) counts were lower in all viral reactivation groups. EBV-only (157 cell/µl [93 – 279.2] ), CMV-only (82.5 cell/µl [65.5 – 323.7] ), both viruses (62.5 cell/µl [47.5 – 135.5]) and virus-free (221 cell/µl [117 – 318]), (H(3) = 12.029, p = < 0.01). A significant increase in the Ichikado CT score was seen in the viral reactivation groups. EBV 186.5 [43.6], CMV 177.5 [41.6], both-viruses group 204 [50.3] vs. virus-free 161 [45.8],( H(3) = 15.770, p = < 0.01). There was an increase in days of hospitalization when comparing the virus-free and the viral reactivation groups. EBV (9 days [5.5-15.5]), CMV (17 days [3-33]), both viruses (23 days [8-31]) vs. virus-free (5 days [3.5-9]), (H(3) = 15.487, p = < 0.01). Regarding the need for assisted ventilation, there was no difference between groups. 7 (9.1%) patients in the virus-free group, 29 (29.9%) patients in the EBV group, 2 (33.3%) patients in the CMV group, and 2 (22.2%) patients in the both-viruses group needed mechanical ventilation (X2 (3, N=189) = 11.699, p= 0.08). Additionally, a statistically significant decrease in albumin levels on admission was found in the EBV-only patients compared to the virus-free group, (3.4 g/dL [0.44] vs 3.75 g/dL [0.46], F(3,185) = 5.483, p = < 0.01). CONCLUSIONS: Viral reactivation is associated with lower CD4(+) count, an increase in length of stay, and higher Ichikado CT scores. CLINICAL IMPLICATIONS: EVB and CMV reactivation is associated with low CD4(+) counts and longer hospital stay. DISCLOSURES: No relevant relationships by David Akinwale No relevant relationships by Angelica Almaguer No relevant relationships by Sushen Bhalla No relevant relationships by Ailine Canete Cruz No relevant relationships by Ndiya Emeaba Speaker/Speaker's relationship with johnson and johnson Please note: approx year 2000 Added 03/31/2022 by Joseph Gathe, value=Honoraria clinical research relationship with gilead Please note: since 1990 Added 03/31/2022 by Joseph Gathe, value=Grant/Research clinical research relationship with ansun Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support clinical research relationship with regeneron Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support No relevant relationships by Jesus Salvador Gonzalez Lopez No relevant relationships by Najia Hussaini No relevant relationships by Claudia Ramirez No relevant relationships by Salim Surani No relevant relationships by Daryelle Varon No relevant relationships by Joseph Varon No relevant relationships by Mohamed Ziad

*CHILDREN WITH ACUTE SEVERE HEPATITIS OF UNDETERMINED ETIOLOGY HAVE A SYSTEMIC T CELL ACTIVATION AND INTERFERON GAMMA (IFN-gamma) ACTIVITY REMINISCENT OF HEMOPHAGOCYTIC HISTIOCYTOSIS: A POTENTIAL ROLE FOR T CELL AND IFN-gamma DIRECTED THERAPIES

Background: 30-50% of pediatric acute liver failure (PALF) is of unknown cause, or indeterminate PALF (iPALF), which frequently results in transplantation. A subset of iPALF is characterized by T-cell activation. Some children with acute severe hepatitis of unknown etiology (SH-u) can evolve to iPALF. Hemophagocytic Lymphohistiocytosis (HLH) is a well-defined hyper-inflammatory condition characterized by marked T-cell activation and frequent severe liver involvement. We postulated SH-u evolving to iPALF has hyper-inflammatory immune signatures that are identifiable before fulfilling PALF criteria, and might overlap with those seen in HLH. We compared the immune dysregulation signatures of children with HLH to children with SH-u, PALF cases with known etiologies, and healthy pediatric controls (HC). Method(s): Between 2019-2021, we prospectively enrolled 14 patients hospitalized with SH-u and 7 patients with PALF of known etiologies. Age dependent standard of care diagnostic studies were performed. SH-u was defined as ALT> 500, INR < 2, and no hepatic encephalopathy. HLH enrollees fulfilled the 2004 diagnostic criteria. High dimension T-cell immunophenotyping, cytokine and chemokine profiling (71-plex) was done for SH-u, HLH (n=5), and HC (n= 16) peripheral blood samples. T cell activation was prospectively identified by co-expression of surface activation markers HLA-DR and CD38. Based on immune studies in HC, CD8 effector memory (EM) activation of >9% distinguished patients with significant T cell activation from HC. This cutoff of >9% was therefore used to identify SH-u patients with T cell activation. Normally distributed data were compared by either a two-tailed t-test or an ordinary One-Way Anova test with Turkey's multiple comparison test. Non-normally distributed data were compared by either the Mann-Whitney test or Kruskal-Wallis test with Dunn's multiple comparisons test. P Values < 0.05 were deemed significant. Result(s): Subjects ranged in age from 4 days to 19 years old. There were no age or sex differences between the groups. One SH-u patient had prior COVID infection, but no subject met MIS-c criteria. Two SH-u patients ultimately evolved to PALF criteria with INR> 2. All patients with SH-u had higher CD8 EM T-cell activation (mean +/- SEM = 43.7+/-6.3%;range 9.2 to 81.3;p<0.0001), which was significantly higher than HC (2.9+/-0.5%) and PALF of known etiology (4.0+/-0.9%) . However, the amplitude of T-cell activation was lower in the SH-u group relative to the HLH group (90.3+/-2.7%;p<0.0001), as shown in Figure 1. A similar trend in T cell activation was noted in the CD4 compartment. Overall, the activation in the CD8 compartment was much greater than in CD4. SH-u patients had a decreased CD4/CD8 ratio compared to the PALF group. Despite higher T cell activation in patients with SH-u compared to PALF, ferritin, often used to screen for hyper-inflammation, was lower in the SH-u group when compared to PALF group (1240+/-609 vs. 39517+/-32149;p<0.05) and very significantly lower than HLH (32415 +/- 14845;p =0.002). 50% of patients with SH-u etiology had ferritin < 500 mg/L. Cytopenia (hemoglobin < 9 g/dL, ANC < 1000/mL, platelets < 100,000/mL) is characteristic of patients with HLH. Despite overlapping T cell activation with HLH, the SH-u cohort had only 2 patients with this feature: one with thrombocytopenia and one with neutropenia. Supportive of this higher T cell activation, we noted chemokines driven by IFN-gamma, CXCL9 and CXCL10, to be elevated in SH-u compared to HCs and comparable to HLH patients. As a proof of concept, 1 patient with SH-u and thrombocytopenia underwent treatment with Emapalumab (an IFN-gamma blocking antibody) along with other immune modulators both with complete liver, immune, and platelet count recovery. Conclusion(s): Our cohort of SH-u was associated with significant T-cell activation. In addition, our patients with HLH and SH-u with T cell activation had similar increased IFN-gamma activity. Despite this T cell activation, ferritin values were significantly lower in SH-u compared to PALF without T cell activation. Ferritin may not be a reliable screening test to identify SH-u patients with significant T cell activation. If validated in a larger well-defined population of SH-u, the results may suggest a role for IFN-gamma blocking agents in a subgroup of SH-u prior to PALF or before bone marrow failure development.

Retinal findings and vessel caliber measurements in admitted patients with COVID-19

Purpose : The main purpose of this study is to describe the fundoscopic alterations and retinal vessel caliber measurements in SARS-CoV2 positive patients admitted to a tertiary referral hospital in Madrid (Spain) and to correlate the retinal vessel caliber with the severity of the disease. Methods : A single-center cross-sectional observational study to document the retinal vascular findings in SARS-CoV2 patients admitted to a tertiary Hospital during the first wave in Madrid, Spain. Fundoscopy was performed in both eyes (when possible) with a manual retinography Zeiss Visuscout 100. All patients signed a consent form to participate in the study. Pharmacological mydriasis prior to retinography was achieved by applying one drop of tropicamide 1% in each eye. Data collected included previous medical and ophthalmic history, prescribed medical and postural treatments, and laboratory findings at the time of admission. All cases were classified according to their outcome as per the WHO clinical progression scale on a scale of 0 to 10, with being 0 the uninfected state and 10 being death. All the retinal images were analysed by two medical retina experts independently. Retinal vessel calibers were measured by a single masked grader using a validated research software with high reproducibility.The relationship between the WHO clinical progression scale and retinal vessel caliber was assessed by Kruskal-Wallis test for independent samples. Results : In total, 81 patients and 154 eyes were included in the study. The fundus retinal assessment disclosed signs of hypertensive retinopathy in 8 right eyes (OD) (8/77) and 9 left eyes (OS) (9/77);vascular tortuosity was present in 13 OD (13/77) and 13 OS (13/77);age-related macular degeneration was found in 13 OD (13/77) and 12 OS (12/77);myopic retinopathy in 3 OD (3/77) and 3 OS (3/77);finally incidental choroidal nevi were found in 4 OD (4/77) and 2 OS (2/77). The retinal microvascular caliber assessment was performed in a total of 72 eyes from 72 subjects, the right eye was used in 61 cases, left eye in the rest. There was no statistically significant difference according to vessel caliber and WHO outcome score. Conclusions : COVID-19 has been linked to an increase risk of cardiovascular events. However, we could not find a correlation among retinal vascular findings and clinical outcome in our cohort.

IMPACT OF THE COVID-19 PANDEMIC ON THE EPIDEMIOLOGY OF ALCOHOLRELATED HEPATITIS

Background: Alcohol-related hepatitis (AH) is the most severe form of alcohol-related liver disease, with rising incidence. Stay-at-home orders for the COVID-19 pandemic were associated with increased alcohol consumption. Online sales reported a 262% increase from March 2019 to 2020. Aims: The purpose of this study was to track the epidemiology of hospitalizations for AH by sex before and after the COVID-19 pandemic. We hypothesized that AH would be more severe in females and younger individuals during the pandemic. Methods: Using the Discharge Database, we identified all hospitalizations in Alberta with international classification of disease-10 codes for AH between March 2018 and September 2020. We merged this dataset with provincial laboratory data to identify all inpatient lab values. We calculated Model for End-Stage Liver Disease (MELD) and Maddrey scores and validated a laboratory-based algorithm for AH. Severe AH was defined as Maddrey score > 32. Onset of the pandemic was defined as March 2020. Stratified by pandemic onset, descriptive statistics were done with Chi-squared and Kruskal Wallis tests. Inpatient mortality was assessed as a primary outcome. Binomial regression was used to assess changes in frequency of admission for AH with the denominator as all cirrhosis-related admissions over the same time-period. Results: We identified 991 hospitalizations for AH prior to the pandemic (n=381, 38.5% female) and 417 during the pandemic (n=144, 34.5% female). Hospitalizations for AH significantly increased during the pandemic (p = 0.04) (Figure 1). Median Maddrey score for females (30.5) before the pandemic was significantly higher than for males (22.9), p < 0.01. During the pandemic, median Maddrey for females (28.7) was higher than males 21.4, p = 0.07. Median age at admission was significantly lower for both males and females during the pandemic (age 44 and 41, respectively) as compared to prior (age 47 and 45, respectively) p < 0.05. There was no significant difference in MELD between sexes before (13.5 for females, 14.0 for males, p = 0.15) and during the pandemic (13.3 for females, 13.0 for males, p = 0.75). Additionally, there was no significant difference in mortality between sexes before (10.4% in females, 11.5% in males, p = 0.22) and after the pandemic (9.2% in females, 9.9% in males, p = 0.67). Conclusions: Hospitalizations for AH rose during the pandemic and occurred at younger ages. There was no significant difference in disease severity or mortality before and during the pandemic. Overall, females have more severe AH than males. Public health efforts should continue to be made to educate about the harms of alcohol excess and offer community support. Future studies will expand the trend through multiple pandemic waves. (Figure Presented).