Vitamin D levels in hospice in-patients.

OBJECTIVE: Serum 25-hydroxyvitamin D was obtained alongside routine blood tests in all suitable patients admitted to the St Cuthbert's Hospice Inpatient Unit for a period of 12 months. Supplementation was offered to exclude vitamin D insufficiency or deficiency as a contributor to the complex pain and symptom profile of our patients. METHODS: During admission, and alongside routine blood tests, a serum 25-hydroxyvitamin D test was requested for suitable patients. Supplementation was offered to patients with serum 25-hydroxyvitamin D less than 50 nmol/L. RESULTS: This audit identified that 79.73% of patients assessed had a 25-hydroxyvitamin D level less than 50 nmol/L and were therefore insufficient or deficient in vitamin D. The results of the audit were discussed within the clinical team at the hospice and guidance changed to obtain serum 25-hydroxyvitamin D levels in all suitable patients. A reaudit highlighted that some patients were missed from testing and therefore reminders were sent to the clinical team. CONCLUSIONS: Most patients admitted to St Cuthbert's Hospice had either insufficient or deficient levels of vitamin D. It seems reasonable for all suitable palliative care patients to have their vitamin D level checked and to be started on a suitable dose of vitamin D replacement therapy.

Higher levels of physical activity is associated with better walking ability and fall-related fitness of older adults during COVID-19 in China

This study analyzed the relationship of physical activity levels with walking ability and fall-related fitness in older adults in the Henan Provence, China. Physical activity levels of 288 older adults were assessed using the short form of the International Physical Activity Questionnaire. The participants were divided into low (LPAG, n = 81), moderate (MPAG, n = 106), and high physical activity groups (HPAG, n = 101). The 10-m walking test (10MWT), 3-m backward walking (3MBW), and Berg Balance Scale (BBS) were used to evaluate walking ability. Thirty seconds Sit to Stand Test (30SST), Time up and Go Test (TUGT), and figure-of-8 walk test (8WT) were evaluated for fall-related fitness. One-way ANOVA was used to detect between group differences, whilst Pearson's correlation was used to evaluate the relationship between total physical activity level and the measured variables. Logistic regression analyses were used to compute the odds ratios (ORs) of LPAG and MPAG relative to HPAG. There were significant differences between the groups for walking ability, 10MWT (p < 0.01), 3MBW, and BBS (p < 0.01), and also for variables of fall-related fitness, TUGT (p < 0.01), and 8WT (p < 0.01). Total physical activity levels had significant correlations with all variables except 30SST. In the walking ability, OR for 10MWT was 2.42 and 2.53 times for the LPAG compared to that for HPAG by model 1 and model 2. OR for BBS was 3.24 and 3.54 times for the LPAG and 9.31 and 9.65 times for the MPAG compared to for the HPAG by model 1 and model 2. In the fall-related fitness, OR for 8WT was 14.09 and 16.76 times for the LPAG compared to that for HPAG. High levels of physical activity are positively correlated with good walking ability and fall-related fitness. Increasing physical activity levels can reduce the risks associated with impaired walking ability and fall-related fitness.Copyright ©2023 The Author(s). Published by MRE Press.

Evaluation of Quality-of-Care Indicators Among Patients With Crohn's Disease and Ulcerative Colitis in the United States: 2019-2020

Introduction: Crohn's disease (CD) and ulcerative colitis (UC) can be difficult to manage and, due to a lack of meaningful quality measures, patient (pt) care may vary by provider. To understand where gaps in care may exist for these pts, this study assessed specific healthcare resource utilization (HRU) and medication metrics that may be potential quality of care (QOC) indicators. Method(s): Using a large commercial US claims database (2019-2020), pts with CD or UC were identified. Potential QOC indicators were selected based on clinical guidelines and recommendations from measures of quality organizations and included CD or UC prevalence;gastroenterologist (GE) and IBD-related non-GE outpatient visits;IBD-related emergency department visits or hospitalizations;excessive steroid use (prednisone equivalent >=10 mg/day for >=60 consecutive days or a single prescription of >=600 mg prednisone);excessive steroid users on corticosteroid (CS)-sparing therapy;excessive steroid users with central dual-energy X-ray absorptiometry (DEXA) or osteoporosis pharmacologic treatment;use of targeted immunomodulators (TIMs) and oral mesalamine (CD only);imaging assessments;and assessment of inflammatory biomarkers. National percentages of pts achieving each metric are reported. Result(s): In total, 41,555 CD and 52,507 UC pts were identified in 2019, resulting in a 0.3% and 0.4% prevalence, respectively (Table). Over a third of CD pts (39.8%) and almost half of UC pts (45.5%) did not visit a GE in 2019. Around 10% CD pts, and up to 6.4% of UC pts, had IBD-related ED visits or hospitalizations. 17.1% CD and 14.5% UC pts were excessive steroid users, yet < 9% CD and UC pts, received DEXA scans and/or bone treatments. A third of excessive steroid users with CD (34.5%), and over half (53.0%) of those with UC, did not receive CS-sparing therapy. The rate of TIM use was over two times higher in CD vs UC pts (CD: 44.3%;UC: 18.9%). Despite evidence that mesalamine is ineffective in CD, 18.7% of pts with CD were prescribed it. Inflammatory biomarker level testing rates were < 50% in both CD and UC. Similar outcomes were reported in 2020, with lower HRU, possibly due to COVID-19. Conclusion(s): This analysis of QOC indicators highlights various areas for improvement that may provide better treatment outcomes and reduce HRU for pts with CD and UC. Future research is needed to assess outcomes in pts that are not being routinely monitored. (Table Presented).

Comprehensive medication management services provided via telehealth or hybrid models: A scoping review

Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.

Investigating the moderating role of thwarted belongingness, perceived burdensomeness, and suicidal capability in suicidal behavior

Objective: Suicide is one of the leading causes of death in the world. The present research aimed to investigate the moderating role of thwarted belongingness, perceived burdensomeness, and suicidal capability in suicidal ideation, behavior, and attempts among the Iranian population. Method(s): The data were analyzed using cross-sectional regression models. The population of this study included 600 students of the University of Mohaghegh Ardabili. The tools used to collect the data in this study were the Patient Health Questionnaire-2, the Depressive Symptom Index-Suicidality Subscale (DSI-SS), the Suicide Attempt Questionnaire, the Interpersonal Needs Questionnaire (IPTS), the Suicide Capacity Scale-3, the Adverse Childhood Experiences, the Generalized Anxiety Disorder Questionnaire, and the Suicidal Behaviors Questionnaire-Revised. Result(s): The results of this study showed that there was an interaction between thwarted belongingness and perceived burdensomeness in suicidal behavior and DSI-SS. The results also showed that the acquired and practical capability subscales (suicidal capability) strengthen the relationship between suicidal behavior and the DSI-SS, on the one hand, and suicide attempt, on the other hand. Conclusion(s): The findings of the study showed that the interpersonal theory of suicide can pave the way to prevent suicidal ideation and behavior in Iranian society, and it is recommended that Iranian practitioners apply the theory in practice.Copyright © 2022 Yerkure Tanitim ve Yayincilik Hizmetleri A.S.. All rights reserved.

Impact of COVID-19 pandemic on hepatocellular carcinoma ultrasound surveillance volumes at a united states liver transplant center

Purpose: The COVID-19 pandemic led to nationwide postponement of outpatient preventative health services. The purpose of our study was to determine the effect of the COVID-19 pandemic on hepatocellular carcinoma ultrasound (HCC US) surveillance volumes at a liver transplant center. Material(s) and Method(s): This retrospective study examined ultrasound volumes across the first two years of the pandemic (March 1, 2020, to February 28, 2022) compared to a baseline year (March 1, 2019, to February 28, 2020). Monthly and annual surveillance volumes, cumulative number of positive ultrasound examinations, and rate of follow-up CT or MRI on an US-3 observation were compared using paired t-tests. Result(s): A total of 6765 ultrasound examinations for HCC at our institution were performed over the three-year study period: 2507 in the baseline year, 1943 in the first year, and 2345 in the second year, representing a 24% (p = 0.036) and 6% (p = 0.144) decline in volume, respectively, compared to baseline. The first pandemic year had the greatest decline (mean 159/month, range 8-217, versus baseline year mean 209/month, range 182-241/month;p = .0363). The most dramatic reductions were in March, April, and May, in which 111, 8, and 126 surveillance ultrasound examinations were performed, respectively. In the baseline year, 95 (4%) had an US-3 observation (1 cm or larger nodule at ultrasound) and 63 (66%) underwent followup CT or MRI. In the first pandemic year, 64 (3%, p = 0.016) patients had an US-3 observation and 48 (75.00%, p = 0.0584) underwent follow-up CT or MRI. In the second pandemic year, 65 (3%, p = 0.001) patients had an US-3 observation and 48 (74%, p = 0.040) underwent follow-up CT or MRI. Conclusion(s): The significantly decreased surveillance ultrasound volume during the pandemic led to fewer positive surveillance studies and therefore fewer recommendations for follow-up imaging. As frequent surveillance is critical to HCC management, the pandemic is expected to have a significant impact on HCC epidemiology in the future.

Cardiometabolic and psychocognitive features of the post-COVID period in patients with atrial fibrillation

The number of people with long-term consequences of COVID-19 is increasing worldwide. The long-term prognosis for patients remains poorly understood. Objective. To study cardiometabolic and psychocognitive features in comorbid elderly patients with atrial fibrillation (AF), de-pending on the presence of post-COVID syndrome (PCS). Material and methods. The observational analytical cohort study included 223 patients with AF and comorbidity (coronary artery disease, hypertension, obesity, type 2 diabetes mellitus) aged 60-74, who were divided into two groups: group 1 included 123 patients without COVID-19 and group 2 included 110 patients with a history of COVID-19 and the presence of PCS. The study evaluated laboratory and instrumental tests, and a general clinical study assessing psychocognitive disorders using the SPMSQ and HADS questionnaires was conducted. Results and discussion. In COVID-19 survivors, compared with patients of group 1, there were more pronounced atherogenic changes in total cholesterol (TC) (p=0.003), low-density lipoprotein cholesterol (p<0.001), and triglycerides (p=0.011). Lower dia-stolic blood pressure was found in COVID-19 survivors (p<0.001). In addition, patients in group 2 had higher median pulse pressure (p<0.001) and heart rate (p<0.001). In group 2 patients, a larger ascending aorta diameter was observed (p<0.001). The anx-iety-depressive syndrome was more common in COVID-19 survivors with comorbidities, and a statistically significant difference was found in clinical anxiety (24%, p=0.041) and subclinical depression (21%, p=0.015). When assessing cognitive function, mod-erate cognitive impairment was detected in 22% (p=0.005) of patients with PCS and severe cognitive impairment in 2% (p=0.007). Conclusion. In comorbid elderly patients with the post-COVID syndrome, a high prevalence of psychocognitive disorders and adverse cardiometabolic changes were observed, supporting the need for long-term monitoring of the general clinical condition and psychocognitive status of COVID-19 survivors.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Evaluating the Use of Patient Reported Outcome Measures to Assess Intra-Pandemic Psoriatic Arthritis Disease Activity and Comparing Them with Pre-Pandemic Clinical Assessments

Background/Aims In our department, patient reported outcome measures (PROMs), including RAPID-3 and PSAID12, were employed during the COVID-19 pandemic in asynchronous consultations for patients with psoriatic arthritis (PsA). We compared pre-pandemic DAS28-CRP with intrapandemic PROMs to assess changes in disease activity since the pandemic. Whilst previous studies have primarily compared PsA PROMs with clinician-assessed scores (e.g. PASDAS), we compare PsA PROMs with clinicians' overall assessment of disease activity;this judgement considers PROMs, serology studies and individual patient feedback. Finally, we assess whether patients with PROMs indicating active disease were followed up appropriately. Methods Clinician-assessed scores were collected between 01/01/2019-01/03/ 2020 (''pre-pandemic''). Between 01/12/2020-31/03/2022 (''intrapandemic''), patient data from electronic surveys were analysed in a secure database for calculation of PROMs. These data, alongside blood results and patient comments, informed clinicians' triage decisions. Clinical outcome data were collected from electronic patient records;>=3 months follow-up appointment allocation was the target for patients with active disease (moderate/high disease activity). Data analysis was performed using r (version 4.2.2). Results In our pre-pandemic cohort (n=393), 79.8% of patients were in remission (per DAS28-CRP). Conversely, the intra-pandemic cohort (n=231) showed remission rates of 14.3% (per PSAID12) and 0% (RAPID-3). Indeed, 33.7% (based on PSAID12) vs 75.8% (RAPID-3) had moderate/ high disease activity. These results were validated in a paired cohort (n=38, score recorded in both windows). Disease activity worsened during the pandemic for 63.2% (PSAID12) and 97.4% (RAPID-3) of patients. PSAID-12 correlated positively with RAPID-3 (r=0.52, p<0.001), especially when RAPID-3 >=6.5 (r=0.75, p<0.001). When comparing PROMs with clinicians' assessment of PsA activity in our paired cohort, PSAID12 and RAPID-3 accurately reflected disease status in 70.6% and 58.8% of patients respectively. 3/9 and 9/27 patients with active disease, based on PSAID12 and RAPID-3 respectively, were seen within three months. Conversely, 7/10 patients who clinicians had deemed to have active disease were seen within three months. Conclusion Despite approximately 80% of patients being in pre-pandemic remission, the majority reported active intra-pandemic PsA. Whilst RAPID-3 skewed patients towards active disease, PSAID12 skewed patients towards remission/low disease activity. PSAID-12 and RAPID- 3 have been previously correlated;however, here we suggest that they could be used interchangeably in patients with high disease activity. PSAID-12 was a better predictor of clinicians' assessment of disease activity, although neither PROM correlated well with >=3 months followup appointment allocation. Although RAPID-3 and PSAID12 helped inform clinicians' decisions, neither alone sufficiently reflects patients' disease states. Remote management is practicable, but future studies should validate these findings across a larger cohort and assess the utility of different PROMs across PsA disease activity categories. Furthermore, multivariate analysis is warranted to ascertain which (combination of) variable(s) (e.g., PROMs, serology results, tender/ swollen joint count) best correlates with clinician judgement.

Health Service Quality and its Relationship to Team Collaboration and Communication during the COVID-19 Pandemic

BACKGROUND: In the search for innovative methods to improve the quality and efficiency of health services, integrated clinical pathways (ICPs) have been introduced. AIM: As there is a gap in research on ICP efficiency, the aim of the study was to investigate the role and impact of collaboration and communication among three interprofessional ICP teams on the self-assessment of efficiency of ICPs. METHOD(S): A cross-sectional study was conducted using a descriptive quantitative with a survey (n = 152) and qualitative methods with a focus group (n = 27) and in-depth interviews (n = 22) in a typical general hospital in Slovenia. RESULT(S): The results showed that health-care professionals found patient health care and the work of healthcare professionals' better quality with ICP than without ICP. The ICPs team members assessed communication, cooperation, and effectiveness in the ICP team as relatively good but identified the lack of staff as the main reason for their limitations. The impact of ICP team collaboration and communication on ICP safety exists but it does not explain a sufficient proportion of the variance and the corelation is medium strong. The result also revealed that the COVID-19 pandemic did not primarily affect ICP team members' fear of possible infection, as studies have shown in the first wave of the COVID-19 pandemic, but rather staff shortages leading to increased fear of errors and possible complaints and lawsuits from patients and relatives. CONCLUSION(S): Measures are needed for the additional employment of team members and the retention of current staff through financial compensation and the promotion of supportive workplace characteristics.Copyright © 2023 Mateja Simec, Sabina Krsnik, Karmen Erjavec.

Impact of Glucocorticoid on Immunogenicity among Covid-19 Vaccines in Immune-Mediated Diseases

Objectives: The use of glucocorticoids (GC) has been associated with increased risk of hospitalization for coronavirus infection and reduced immunogenicity of SARS-CoV-2 vaccines in immune-mediated diseases (IMD) patients. However, there is still controversy of which dose of GC is correlated with impaired vaccine response on each of the diverse COVID-19 vaccines available, as well as the possible influence of other concurrent immunosuppressants. This study aimed at evaluating the effect of GC on serological response after two doses of BNT162b2 (Pfizer/BioNTech), CoronaVac (inactivated SARS-CoV-2 Vaccine) and ChadOx1 (AstraZeneca) and after the booster dose in patients with IMD. Method(s): The data were extracted from a multicenter longitudinal observational Brazilian cohort (SAFER: Safety and Efficacy on COVID19 Vaccine in Rheumatic Disease). Patients >18 years of age with IMD were evaluated after 2 doses of the same vaccine against COVID-19 and after a booster vaccine, applied according to Brazilian National Immunization Program. All patients underwent clinical examination and collected blood samples for immunogenicity tests. Serological response was evaluated by Anti-RBD titers (IgG) at baseline and 4 weeks after each vaccine dose. Result(s): Among the 1009 patients evaluated, 301 were using GC (196/401 SLE, 52/199 RA and 27/74 vasculitis). Patients using GC were younger (38.2 vs 40,8 years, p = 0,002), had higherBMI (27,6 vs 26,4 p = 0,008), higher prevalence of kidney disease (3,3% vs 0,5%, p = 0,001) and of thrombosis (11,6% vs 5,9%, p = 0,002) than non-users. Regarding the type of vaccine, most of the GC users received CoronaVac (61.7%), while only 31.9%of non-users received this vaccine (p alpha 0.001). Although there were similar rates of pre-vaccination infections among them, patients with GC tended to have a higher incidence of confirmed COVID-19 infection after the 2nd dose of the vaccine compared to non-users (4.5% vs 2.0% p = 0.054). The antibody titers after the 1st dose of COVID-19 vaccines were similar between groups, but there was a worse response in the GC group after the 2nd dose (p = 0.039). However, this difference was not statistically significant after the 3rd dose (Figure). Conclusion(s): GC use may compromise vaccine-induced immunogenicity after a 2-dose regimen;however, this effect does not remain significant after the booster dose. Multivariate analysis is still pending to assess the potential difference in the impact of GC on the immune response depending on GC dose, type of vaccine and associated drugs.

Carbapenem Heteroresistance Mdr Enterobacter Cloacae in a Post-Covid-19 Obese Patient: An Antibiotic Susceptibility Conversion

Intro: Background: Obesity affects drug delivery and clearance owing to the patient's altered pharmacokinetics. In treating infection, this presents as a conundrum antibiotic dosing to achieve optimal antibiotic concentration at the same time avoiding drug toxicity. Particularly in the case of antimicrobial agents, underdosing may lead to antibiotic resistance. Method(s): Case description: We report a case of a morbidly obese (BMI=58) COVID-19 patient infected with carbapenem-sensitive multi-drug resistant (MDR) Enterobacter cloacae bacteremia, treated with ertapenem 1g twice daily and intravenous polymyxin E 9MU stat and 4.5MU twice daily for MDR Acinetobacter baumanii co-infection. He had infected huge grade IV sacral sore one month later in which intraoperative tissue culture grew phenotypically heterogeneous colonies of MDR Enterobacter cloacae with carbapenem-sensitive and carbapenem-intermediate-resistant non-carbapenemase producing colonies. He responded well clinically and biochemically with an increased dose of intravenous ciprofloxacin 800mg BD based on his actual body weight. He was discharged with oral ciprofloxacin 750mg BD for a total of six weeks. Finding(s): Discussion: Obesity is a public health crisis that has reached epidemic proportions. Obesity affects the volume distribution and renal clearance of many drugs including antibiotics. Obese patients are shown to have higher drug clearance than normal-weighted patients resulting in inadequate systemic exposure. This puts patients at risk of developing antibiotic resistant organisms. Our patient, weighing 162kg was given three different beta-lactam antibiotics to treat his infection including ertapenem in which a standard adult dose was given without body weight consideration. Possible underdosing contributed to the conversion of carbapenem susceptibility from sensitive to resistant strain. Conclusion(s): Obese individuals may need a larger ertapenem dose than their non-obese counterparts. Clinical and laboratory assessment may help in monitoring treatment response in this group of patients.Copyright © 2023

Post-COVID syndrome in psychiatric practice

The novel coronavirus SARS-CoV-2 is associated with a significant incidence of neuropsychiatric disorders, which tend to have a long course in the post-COVID period. Objective(s): to study post-COVID mental disorders in clinical psychiatric practice. Patients and methods. 30 patients aged 37.75+/-14.07 years with anamnesis of SARS-CoV-2 infection were examined. Clinical scale assessment was carried out using the Hamilton Depression and Anxiety Scale. The Symptom-Checklist (SCL-90-R) was used to assess the psychopathological status of the patient. Patients' cognitive functioning was assessed using the Mini-Cog Cognitive Assessment Questionnaire. Patients' sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Results and discussion. Mental disorders associated with a previous coronavirus infection are observed in a wide time range from less than 1 month to a year after the previous disease, and in no case did the coronavirus infection have a severe course. Sleep disorders, anxiety and depressive disorders, which did not exceed a moderate degree of severity, and asthenia dominated in the structure of the post-COVID syndrome. The level of mental distress in patients with post-COVID syndrome increased 2 times. Post-COVID mental disorders are interrelated with female gender, age, and psychotraumatic factors associated with the pandemic. Cognitive impairment mediated by mental disorders was observed in approximately 60% of patients and did not reach the degree of dementia. Conclusion. The clinical picture of the post-COVID syndrome is represented by a wide range of mental disorders, the development of which involves not only biological, but also psychosocial factors associated with the COVID-19 pandemic, which determines the specifics of diagnostic approaches and the feasibility of complex treatment of the post-COVID syndrome.Copyright © 2022 Ima-Press Publishing House. All rights reserved.

HIV care during the SARS-COV-2 pandemic for Black people with HIV in the UK

Background: The COVID-19 pandemic disproportionally affected black communities but the impact on HIV care in this group remains poorly understood. We evaluated measures of HIV care during the COVID-19 pandemic in the GEN-AFRICA cohort of black people with HIV living in the U.K. Method(s): We evaluated interruptions to HIV care during the COVID-19 pandemic (01/2020-09/2022) in the GENAFRICA cohort at nine UK clinics who provided HIV outcomes for >80% of their participants. We ascertained death, transfers of care, loss to follow up for >12 months, the highest HIV viral load and interruptions to antiretroviral therapy (ART). We evaluated factors associated with the composite outcome of HIV viraemia (viral load >200 c/mL) and/or an ART interruption using logistic regression analysis;factors associated (P<0.1) in univariable analysis were included in the multivariable model. We also summarized reasons for ART interruptions where recorded. Result(s): 2321 participants (mean age 51.3 years;55.8% women;pre-pandemic current/nadir CD4 of 500/204 cells/mm3 and HIV RNA <200 c/mL in 92.3%) were in care on 01/01/2020. Thirty (1.3%) subsequently died, 24 (1.0%) transferred care and 48 (2.1%) became lost to follow up. 523 (22.7%) reported an episode of COVID-19 and 1771 (87.1%) having been vaccinated against SARSCoV- 2. The composite outcome could be evaluated in 2130 (91.8%);259 (11.2%) had a documented HIV VL >200 c/mL, 228 (9.8%) an ART interruption and 325 (14%) had HIV viraemia/ART interruption. In multivariable analysis, older age, a pre-pandemic HIV RNA <200 c/mL and being vaccinated against SARS-CoV-2 were associated with reduced odds of HIV viraemia/ART interruption (Table) while sex, CD4 (current/nadir), comorbid status and having had COVID-19 were not associated. Reasons for ART interruption were available for 52 participants;38% cited domestic logistic reasons, 27% issues related to foreign travel, 19% psychological reasons, 12% lockdown or changes to the daily routine and 4% personal choice. Conclusion(s): During the COVID-19 pandemic, one in seven black people with HIV experienced an ART interruption and/or HIV viraemia. Pre-pandemic measures of suboptimal engagement in care, pandemic restrictions, and wider health beliefs as reflected by COVID-vaccination, contributed to these undesirable HIV outcomes. (Table Presented).

Clinical and laboratory characteristics of new coronaviral infection (COVID-19) in children

Another rise in the incidence of a new coronavirus infection (COVID-19), due to the penetration of the SARS-CoV-2 delta strain into Russia in the second half of April 2021, is characterized by rapid spread, severe course in adults and an increase in cases of the disease among children. The aim of the work is to assess the clinical and laboratory parameters of a new coronavirus infection (COVID-19) in children. Material and methods. The results of clinical and laboratory examination and complex therapy of 95 children with moderate and severe forms of COVID-19, hospitalized in the Republican Clinical Infectious Diseases Hospital in Ufa from May to September 2021, are presented. Results. The anamnesis of the disease and life, epidemiological, clinical and laboratory, instrumental data obtained during the examination of children with COVID-19 in the course of the disease were studied. Among the clinical manifestations in children, symptoms of acute respiratory infection (37.9+/-4.98%), pneumonia without respiratory failure (26.3+/-4.52%), pneumonia with acute respiratory failure (33.7+/-4.85%). In 2 patients of the first months of life (2.1+/-1.47%), against the background of a aggravated premorbid background, immunodeficiency, COVID-19 proceeded in an extremely severe form with a fatal outcome. Conclusion. The clinical manifestations of COVID-19 are similar in children and adults, but differ in the frequency of respiratory symptoms. A severe course with a fatal outcome was registered in children in the first months of life with a burdened premorbid background.Copyright © Infectious Diseases: News, Opinions, Training 2022.

How to Build Confidence in Vaccines

Despite overwhelming evidence of vaccine effectiveness in preventing serious vaccine preventable diseases (VPDs), lack of confidence in vaccines is a major threat to the prevention and control of VPDs and antimicrobial resistance globally. Vaccine hesitancy and antimicrobial resistance are inter-related, with high levels of vaccination uptake being a vital pillar of antimicrobial stewardship. Parallel with the COVID-19 pandemic, another 'infodemic' of uncertainty, misunderstanding, lack of trust and loss of confidence in vaccines unfolded. While regulatory authorities are mandated to ensure the safety, efficacy and quality of all approved vaccines, public confidence in vaccine safety and effectiveness is compromised by social media reports, falsely blaming vaccines for serious adverse events following immunisation. Hence, transparent public communication and education on vaccine safety;the risk-benefit balance;and causality assessment outcomes, are essential. A key factor in this context is people's perception of risk, especially where the fear of vaccines has replaced the fear of a VPD. Understanding the factors driving vaccine hesitancy and moving people from the point of being hesitant to the point of accepting vaccination, requires collective multi-pronged strategies from all levels of society, including political, social, religious and educational role players. Targeted approaches should be evidence-based, context-specific, culturally sensitive and tailored for the community, integrating individual, social and environmental factors. While healthcare professionals are the public's most trusted source of information for vaccination decision- making, they are not immune against believing misinformation and developing vaccine hesitancy. Consequently, they must be empowered with the necessary knowledge, skills and confidence to respond appropriately to questions and persuade the public to demand vaccination for themselves and their children. This presentation will focus on strategies to build vaccine confidence and acceptance, promote trust in the healthcare system, and address fears about the consequences of vaccination, aimed at driving vaccine uptake and preventing antimicrobial resistance.Copyright © 2023

Autoimmune pulmonary alveolar proteinosis in an adolescent girl with rapidly progressive dyspnea

Autoimmune pulmonary alveolar proteinosis (PAP) is a rare disease, especially in pediatrics, but important to consider, as it may avoid unnecessary and/or invasive investigations and delayed diagnosis. This case report highlights an adolescent girl with rapid onset dyspnea but an unremarkable physical exam and initial testing. However, due to a high index of suspicion, a chest computed tomography (CT) scan was done, revealing a "crazy paving" pattern, which then prompted expedited assessment. This finding, however, is not as specific as often discussed and has a broad differential diagnosis, which will be reviewed in detail as part of this case. Furthermore, this report demonstrates a diagnostic approach for PAP that avoids lung biopsy, previously considered to be required for diagnosis of PAP, but is increasingly becoming unnecessary with more advanced blood tests and understanding of their sensitivity and specificity. Additionally, management strategies for PAP will be briefly discussed.Copyright © 2022 Canadian Thoracic Society.

Functional Impact of Telehealth Physical Therapy Services on Patients Post Hematopoietic Stem Cell Transplant

BACKGROUND AND PURPOSE: Stem cell transplantation (SCT) in patients with hematological cancers results in longstanding physical changes. Commonly reported symptoms include chronic fatigue, global weakness, interference with activities of daily living (ADLs) and aerobic deconditioning. Aside from the sequela of symptoms experienced post SCT, these patients remain in an immunosuppressed state for several months following discharge from the hospital. Patients are often advised by their medical team to isolate themselves unless to attend follow-up outpatient clinic appointments. With the COVID-19 pandemic, this functional gap in the continuum of care worsened. As a result, SCT patients are both hesitant and discouraged to pursue outpatient or home health physical therapy even when these services are warranted. Thus, there is great need for options to safely optimize function for people post-SCT that are suitable in today's ever-changing environment. The purpose of this case series is to describe the functional impact of incorporating telehealth into the continuum of care for post SCT patients. CASE DESCRIPTION: 9 patients post inpatient admission for SCT were triaged to telehealth PT based on their scores on the Short Physical Performance Battery (SPPB) and the Activity Measure for Post Acute Care (AM-PAC) at the time of discharge from inpatient care. Scores on the SPPB ranged from 5-11, and AMPAC scores ranged from 21-24, demonstrating physical impairment. Patients were scheduled to receive telehealth twice a week. Sessions consisted of therapeutic exercises monitored via secure video software. Lab values were monitored via electronic medical record to assess appropriateness for therapy prior to each session. Rating of perceived exertion (RPE) scale and patientowned pulse oximeter were used to monitor patient fatigue levels. Patients' progress was assessed via Lower Extremity Functional Scale (LEFS), Brief Fatigue Inventory (BFI) and 5-times sit to stand (5xSTS) scores. OUTCOME(S): One year post telehealth implementation, patients reported improved independence and achievement of selfselected goals. Notable patient quotes include, "I feel less fearful in climbing up and down the stairs, and I feel more independent with laundry and cooking.which was very important for me." Additionally, patients reported a decrease in LEFS and BFI scores. Initial LEFS scores averaged 40% and dropped to 20% by discharge. Similarly, BFI scores dropped by 2 points at discharge, reflecting improved self-reported functional performance and a return to pre transplant fatigue levels. 5xSTS scores decreased by greater than 3 seconds in 6 of 9 patients, with one patient performing where previously unable. DISCUSSION: Telehealth services provide an additional method of care delivery to those unable to seek it in the traditional sense. For the severely immunocompromised, physical therapy via telehealth provides direct connection to providers trained in oncology rehabilitation serving as a feasible bridge between inpatient and outpatient care for amelioration of side effects associated with SCT.

Comparing Ankylosing Spondylitis Disease Activity during the Covid-19 Pandemic Using Patient-Reported Outcome Measures with Face-Toface Clinical Evaluation of Disease Scores Prepandemic

Background/Aims During the COVID-19 pandemic, asynchronous consultations were introduced for patients with ankylosing spondylitis (AS). To assess disease activity in the absence of face-to-face clinical review and blood testing, patients submitted patient-reported outcome measures (PROMs) via electronic survey forms which were subsequently triaged by clinicians. We compared pre-pandemic clinician-reported scores with intra-pandemic self-reported scores and assessed clinical outcomes including allocation of follow-up and further management/ treatment escalation. Methods Clinician-reported scores were obtained in-person pre-pandemic (defined as 01/01/2019-01/03/2020). Self-reported BASDAI scores were submitted by patients via electronic forms sent out duringpandemic (defined as 01/12/2020-31/03/22). The responses were stored and analysed in a secure database. These scores are analogous to disease activity scores completed by clinicians during outpatient appointments. Score comparison was performed using Wilcoxon Sign Rank testing. We used the need for a follow-up within 3 months as target for those with severe disease. Data analysis was performed in Microsoft Excel and R (version 4.2.1). Results We noted a significantly higher overall level of patient-reported disease activity during the pandemic. In the total cohort of AS patients, the median BASDAI Score collected during-pandemic increased from 5.30 (n=124, range 0-10) compared to 2.80 pre-pandemic (n=590, range 0-12) (p<0.001). The proportion of patients with severe/active disease (defined as BASDAI >4) increased from 36% pre- to 65% during pandemic. In a smaller cohort of 34 patients for whom we had both pre- and during-pandemic scores, all patient parameters worsened during the pandemic. Notably, median BASDAI increased from 2.65 to 5.62 (p<0.0001). Patients with severe AS increased from 10 (29.4%) to 21 (61.8%) intra-pandemic. Follow-up data was available for 12/21 patients with severe AS during-pandemic. 7/12 patients (58%) received a follow-up appointment within one month;11/12 (91%) were seen within three months. On subsequent clinician assessment, only 7 (58%) of patients with self-reported severe AS were felt to have active disease;treatment was escalated for 3 patients. Conclusion There was a significantly higher reported level of AS disease activity during the COVID-19 pandemic, with 62 % of patients qualifying for biologic therapy (BASDAI >4). In a focussed sample, 91% of patients with new severe disease during-pandemic were followed up within the target of 3 months. The BASDAI score is independent from clinical examination and inflammatory markers, and therefore self-reported score should reliably reflect a patient's perception of disease activity. Further work is required to determine the reason for the increased disease activity observed during pandemic, and for the disparity between clinician impression and score results.

Rheumatic Autoimmune Diseases Following Covid-19 Infection: An Observational Study in Iraqi Kurdistan Region

Background/Aims In December 2019, a new type of novel coronavirus (COVID-19) was identified in Wuhan, China. The likelihood of developing an autoimmune and/or rheumatic diseases in COVID-19 survivors is high and a serious matter. The acute SARS-CoV-2 infection may unmask previously undiagnosed rheumatic conditions. We aimed to study rheumatic autoimmune disease manifestations diseases following COVID-19 infection survival. Methods The study was an observational case series study. The data collection was carried out in Iraqi Kurdistan region between the 1st of July 2021 and 20th of March 2022. Seventy-five patients were included: the patients who previously had confirmed COVID-19 infection who developed symptoms of rheumatic autoimmune diseases post COVID-19 cure. The study was conducted via a rigorous evaluation by two rheumatologists. Patients were investigated by (ESR (mm/h) and CRP (mg/L), some autoimmune screen panel for suspecting rheumatological disease patients were sent for ANA, anti-CCP (U/ML) and rheumatoid factor (IU/M) L. Then, patients were diagnosed according to the classification criteria for suspected autoimmune diseases and those with exacerbation were evaluated clinically and by laboratory;rheumatoid arthritis by DAS28, systemic lupus erythematosus by C3, C4. Results A total of seventy-five participants post-COVID-19 infection were enrolled in this study. Age of the participants was 47.15 +/-16.18 SD, more of the participants were female (69) out of 75. For most of the patients the ESR were high with p value of 0.012, which was statistically significant. ANA was high titre in SLE patients which was (3.05+/-2.4) and in antiphospholipid syndrome p-value was significant at 0.042, Anti-CCP were positive in RA patients and in those with exacerbation of RA (44+/-10, 31.7+/-5.7 respectively), DAS28 was (4.95+/-0.59) moderate and high disease activity in patients with exacerbations. C3, C4 were low in patients with exacerbation of SLE (0.47+/-0.22, 0.03+/-0.01, respectively). Most of the patients developed symptoms post-COVID-19 between 4-10 weeks (37 participants). Conclusion Rheumatic autoimmune diseases presenting post-COVID-19 survival most commonly were systemic lupus erythematous followed by rheumatoid arthritis. and previous autoimmune diseases presented with exacerbation. (Table Presented).

Inpatient Admission Pathway for Patients with Rheumatological Disorders

Background/Aims Rheumatology is a complex specialty covering many conditions of varying severity, from muscle pain through inflammatory arthritis such as Rheumatoid arthritis (RA) and connective tissue diseases. Most of the conditions can be managed in an outpatient/day case setting. However, acutely ill patients require safe and prompt inpatient management including specific intravenous infusions. This need to be done urgently and cannot wait to be accommodated through the Infusion unit at our hospital. Historically Medicine Acute Admission Unit has been the route to bring in these patients. However, operational bed pressures faced challenges leading to instances of delayed treatment with complications including fatality. This led to creating a direct inpatient admission pathway to the specialist ward. Methods Ward Matron designed the following robust pathway for direct patient admission to our specialist Rheumatology ward, Jevington ward. This was implemented in February 2022 after discussion and agreement with Clinical Lead consultant, pharmacist, clinical site managers and other colleagues. Rheumatology team and nurses covered the ward during working hours and by the on-call team out of hours. The overall responsibility remained with the rheumatology team. The referrals accepted only after completing appropriate paperwork. Patients carried out Lateral Flow Test (LFT) at home prior to admission. We ensured negative results and followed the Trust COVID 19 screening protocols. Subsequent screenings were done according to the updated guidelines. The planned assessment and treatments were carried out by the ward team complying with BSR/ EULAR Guidelines, infusion protocols such as standard and continuous Iloprost Infusion Protocols of the Trust. Results We assessed the delay in patient's admission, length of stay, patient outcome and experience after implementing the pathway. The significant change has been in the time to admit;from two weeks in 2018 & 19 to two days this year. This is reflected in the patient feedback. All our acutely ill patients were assessed, treated and discharged promptly on this specialist ward. Conclusion This pathway allowed safe and prompt treatment, prognosis and excellent experience for acutely ill patients with rheumatological disorders. This additionally enabled reduced length of stay supporting financial sustainability of the Trust. (Table Presented).