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1.
Curr Dev Nutr ; 6(10): nzac107, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2097323

ABSTRACT

Background: Comanagement of glycemia and adiposity is the cornerstone of cardiometabolic risk reduction in type 1 diabetes (T1D), but targets are often not met. The intestinal microbiota and microbiota-derived short-chain fatty acids (SCFAs) influence glycemia and adiposity but have not been sufficiently investigated in longstanding T1D. Objectives: We evaluated the hypothesis that an increased abundance of SCFA-producing gut microbes, fecal SCFAs, and intestinal microbial diversity were associated with improved glycemia but increased adiposity in young adults with longstanding T1D. Methods: Participants provided stool samples at ≤4 time points (NCT03651622: https://clinicaltrials.gov/ct2/show/NCT03651622). Sequencing of the 16S ribosomal RNA gene measured abundances of SCFA-producing intestinal microbes. GC-MS measured total and specific SCFAs (acetate, butyrate, propionate). DXA (body fat percentage and percentage lean mass) and anthropometrics (BMI) measured adiposity. Continuous glucose monitoring [percentage of time in range (70-180 mg/dL), above range (>180 mg/dL), and below range (54-69 mg/dL)] and glycated hemoglobin (i.e., HbA1c) assessed glycemia. Adjusted and Bonferroni-corrected generalized estimating equations modeled the associations of SCFA-producing gut microbes, fecal SCFAs, and intestinal microbial diversity with glycemia and adiposity. COVID-19 interrupted data collection, so models were repeated restricted to pre-COVID-19 visits. Results: Data were available for ≤45 participants at 101 visits (including 40 participants at 54 visits pre-COVID-19). Abundance of Eubacterium hallii was associated inversely with BMI (all data). Pre-COVID-19, increased fecal propionate was associated with increased percentage of time above range and reduced percentage of time in target and below range; and abundances of 3 SCFA-producing taxa (Ruminococcus gnavus, Eubacterium ventriosum, and Lachnospira) were associated inversely with body fat percentage, of which two microbes were positively associated with percentage lean mass. Abundance of Anaerostipes was associated with reduced percentage of time in range (all data) and with increased body fat percentage and reduced percentage lean mass (pre-COVID-19). Conclusions: Unexpectedly, fecal propionate was associated with detriment to glycemia, whereas most SCFA-producing intestinal microbes were associated with benefit to adiposity. Future studies should confirm these associations and determine their potential causal linkages in T1D.This study is registered at clinical.trials.gov (NCT03651622; https://clinicaltrials.gov/ct2/show/NCT03651622).

2.
Materials Express ; 12(3):518-526, 2022.
Article in English | Web of Science | ID: covidwho-2070648

ABSTRACT

Few works studied the levels of vitamins and minerals in Saudi Arabia among COVID-19 patients, especially in the region of Taif (high altitude). So, this work aims to study the serum vitamin D, vitamin B12, calcium, Phosphorous, Magnesium and hemoglobin levels in recovered patients with COVID-19 and compare them to mortalities. The levels of a sample of 100 recovered patients and 93 mortalities were chosen from the Covid 19 patient records between March 2020 and February 2021 in King Faisal Hospital, Taif, Saudi Arabia. Vitamins and Minerals data wereIP: 182.75.distilled for48 10 statisticalOn: Fr, 12 analysis.Aug The2022 results10:57:33reported that vitamin D was the highest in recovered patients compared with coronvirus mortalities, whilt vitamin B12 was the highest in Copyright: American Sc entific Publshers mortalities compared with recovered patients with coronavirus. Calcium, as well as hemoglobin, were relaDelive ed by Ingena tively elevated in recovered patients with coronavirus compared to mortalities with coronavirus. The results indicated that there is a significant difference between recovered patients and mortalities in age, Vitamin B12, Calcium, Phosphorous, Magnesium and hemoglobin. There is a significant positive correlation between Age and Vitamin B12 and Phosphorous. There is a significant negative correlation between Age and Magnesium and Hemoglobin. On the other hand, there is a significant positive correlation between Vitamin D and Vitamin B12. Finally, there is a significant positive correlation between Calcium and Phosphorous and between Calcium Hemoglobin. As a result, deficiency of vitamin D, calcium, phosphorus and hemoglobin levels may cause a failure in the immune system against COVID-19 and cause a quick transfer to severe disease.

3.
Pathophysiology ; 29(4): 583-594, 2022 Oct 11.
Article in English | MEDLINE | ID: covidwho-2071678

ABSTRACT

Cytokines are expressed by various cells after several stimuli such as surgical tissue damage, producing a systemic inflammatory response (SIR). C-reactive protein (CRP) is used extensively in clinical practice after operative injury, but proinflammatory cytokines, iron status, albumin, neutrophil-to-lymphocyte (N/L) ratio and hemoglobin, as acute phase reactants, have been poorly documented. This study aims to show how they behave after surgery, comparing laparoscopic (LC) versus open cholecystectomy (OC). In total, 55 patients were included in a prospective non-randomized form to undergo a cholecystectomy: 8 patients OC (50% females) and 47 patients LC (68% females). Before (A1) and 24 h after surgery (A2), blood samples were taken for an ordinary analysis and IL6, IL8 and TNFα determination. There were no differences between LC and OC groups concerning age, CRP, IL6 and TNFα at day A1. In the LC group at day A2, CRP, IL6, IL8, TNF, ferritin, leukocytes and N/L ratio increased; hemoglobin, lymphocytes, prothrombin and albumin decreased (p < 0.05). In the OC group at day A2, only IL6 (p < 0,07), ferritin, leukocytes, N/L ratio and CRP (p < 0.05) increased; serum iron, hemoglobin, lymphocytes and albumin (p < 0.05) decreased. At day A2, OC vs. LC group, higher values were observed in IL6, ferritin and CRP (p ≤ 0.05), and lesser values were observed in serum iron and prothrombin (p < 0.05). In conclusion, classic markers of inflammation are altered after surgery, in a milder way in laparoscopic surgery. Ferritin can be used as an inflammatory marker, as has been described in COVID-19 infection.

4.
Pakistan Journal of Medical Sciences ; 38(8), 2022.
Article in English | EMBASE | ID: covidwho-2067241

ABSTRACT

Objective: To describe presentations, comorbidities, investigations, and surgical treatment of patients with mucormycosis amid the COVID-19 pandemic in a tertiary care hospital in Khyber Pakhtunkhwa, Pakistan. Methods: This descriptive study was conducted at the department of ENT, and Head and Neck Surgery, Medical Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan from June 2020 to June 2021. All the patients fulfilling the inclusion criteria were included. Patients with COVID-19 were diagnosed based on real-time polymerase chain reaction (RT-PCR). After diagnosing mucormycosis computed tomography (CT) scan and/or magnetic resonance imaging (MRI) were performed for subsequent surgical clearance. After taking informed consent demographic data were collected on a proforma and analyzed using SPPS version 25. Results: Out of 23 patients males were 14(60.9%), females were 9 (39.1%) with a male: female ratio of 1.5:1. Mean ± SD age was 51.26 ± 1.41 years. Nasal obstruction and headache were the most common (8, 34.8%) presentations. The commonest co-morbidities were hypertension with diabetes mellitus (8, 34.8%). Out of 23 patients, 16(69.6%) had COVID-19 PCR positive. The majority of patients (17, 73.9%) were not vaccinated against COVID-19. Most of the patients (9, 39.1%) had HbA1c levels of 7% to 8.9%. The commonest surgery was endoscopic debridement of paranasal sinuses (9, 39.1%), while the commonest CT scan finding was a heterogeneous lesion involving the nose, maxillary and ethmoid sinuses (12, 52.2%). Conclusion: Mucormycosis of paranasal sinuses with/or without intracranial extension is frequently seen in unvaccinated patients having uncontrolled diabetes and COVID-19 infection.

5.
Journal of Clinical and Diagnostic Research ; 16(9):ED01-ED03, 2022.
Article in English | EMBASE | ID: covidwho-2067193

ABSTRACT

Sickle Cell Disease (SCD) is an inherited disorder with variable clinical presentation and low immunity. Coronavirus Disease-2019 (COVID-19)is a pandemic disease with a high-risk in chronic disease patients and older adults. SCD is widely distributed in Sudan;many SCD patients are infected with COVID-19. Despite this, no published data is available. This case report demonstrated the haematological and clinical course of a Sudanese sickle cell anaemia patient with COVID-19. A 20-year-old male patient was admitted to a hospital for 15 days. Demographic and clinical data were obtained from his medical records. A blood sample was taken at the time of admission and during hospitalisation. Tests were performed during admission, including Complete Blood Count (CBC), liver function test, renal function test, coagulation studies, viral screening, and urine general. The patient was diagnosed with COVID-19 using the Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test based on the nasopharyngeal swab and COVID-19 IgG and IgM using Enzyme Linked Immunosorbent Assay (ELISA) for the previous infection. The patient received intravenous fluids, antibiotics, analgesia, oxygen supplementation, and blood transfusion two times during hospitalisation, and there was no need for Intensive Care Unit (ICU) admission. The patient's prognosis was good;he was discharged on day 16 with no symptoms and a negative result of the COVID-19 PCR test. A severe illness was expected because he was infected twice by COVID-19, the patient showed mild clinical symptoms with a good prognosis, so further studies are required to understand COVID-19 among Sudanese SCD patients.

6.
Open Veterinary Journal ; 12(5):602-611, 2022.
Article in English | EMBASE | ID: covidwho-2067053

ABSTRACT

Background: The mouse model of human diseases is commonly used for biomedical study, including beta-thalassemia (beta-thal), an inherited hemoglobin disorder. Maintaining the mice strain by natural mating systems is costly and seems impractical, especially during the COVID-19 pandemic. Sperm-freezing is a cost-effective solution for beta-thal mouse colony management. Aim(s): To determine appropriate cryopreservation media for beta-thal mouse spermatozoa to establish a beta-thal mouse sperm bank. Method(s): The epididymal spermatozoa of C57BL/6 wild-type (WT) and beta-globin gene knockout thalassemia (BKO) mice were frozen in four freezing media: I) raffinose-skim milk-monothioglycerol (MTG), II) raffinose-skim milk- glutamine, III) raffinose-egg yolk-glycerol, and IV) egg yolk-TES-Tris. The sperm quality was assessed prior to and following freeze-thawing. Result(s): Compared with WT counterparts, the viable spermatozoa before freezing exhibiting elevated levels of oxidative stress were significantly greater in BKO (p = 0.01). After thawing, the membrane integrity of BKO spermatozoa preserved in I was significantly lower (p = 0.001). The sperm viability and membrane integrity of BKO males were also inferior when media III and IV were used (p = 0.008-0.027). The amount of oxidative stress in the spermatozoon of BKO mice was significantly greater when preserved in I, III, and IV (p = 0.002-0.044). Comparing freezing media, the motility and acrosome integrity of WT and BKO spermatozoa preserved in IV were significantly higher than those in other media (p < 0.001 to p = 0.01). Spermatozoa with the highest mitochondrial membrane potential were observed in I in both genotypes (p = 0.012 to p > 0.05). The viability, membrane integrity, and oxidative stress of post-thaw BKO spermatozoa did not significantly differ among freezing solutions. Conclusion(s): Irrespective of freezing media, spermatozoa of BKO males are rather more sensitive to cryopreservation than those of WT. Raffinose-skim milk-MTG/glutamine, raffinose-egg yolk-glycerol, and egg yolk-TES-Tris can all be used to preserve BKO mouse spermatozoa. However, with slightly better sperm characteristics, egg yolk-TES- Tris may be a diluent of choice for BKO mouse sperm cryopreservation. The addition of a reducing agent to thawing media is also strongly recommended to efficiently prevent oxidative stress and therefore improve frozen-thawed sperm survival. Copyright © 2022, Faculty of Veterinary Medicine, University of Tripoli. All rights reserved.

7.
Journal of Acute Disease ; 11(4):140-149, 2022.
Article in English | EMBASE | ID: covidwho-2066825

ABSTRACT

Objective: To identify helpful laboratory paprameters for the diagnosis and prognosis of COVID-19. Methods: An observational retrospective study was conducted to analyze the biological profile of COVID-19 patients hospitalized in the Unit of Pulmonology at Setif hospital between January and December 2021. Patients were divided into two groups: the infection group and the control group with patients admitted for other pathologies. The infected group was further divided according to the course of the disease into non-severe and severe subgroups. Clinical and laboratory parameters and outcomes of admitted patients were collected. Results: The infection group included 293 patients, of whom 237 were in the non-severe subgroup and 56 in the severe subgroup. The control group included 88 patients. The results showed higher white blood cells, neutrophils, blood glucose, urea, creatinine, transaminases, triglycerides, C-reactive protein, lactate dehydrogenase, and lower levels of lymphocyte, monocyte and platelet counts, serum sodium concentration, and albumin. According to ROC curves, urea, alanine aminotransferase, C-reactive protein, and albumin were effective diagnosis indices on admission while neutrophil, lymphocyte, monocyte, glycemia, aspartate aminotransferase, and lactate dehydrogenase were effective during follow-up. Conclusions: Some biological parameters such as neutrophil, lymphocyte, monocyte, glycemia, aspartate aminotransferase, and lactate dehydrogenase are useful for the diagnosis of COVID-19.

8.
Sri Lankan Journal of Anaesthesiology ; 30(2):118-123, 2022.
Article in English | EMBASE | ID: covidwho-2066752

ABSTRACT

Background and aims:The ongoing Covid pandemic has burdened the medical system, more so due to the limited availability of ventilators. Our study aims at identifying the role of hematological markers in the risk stratification and the need for ventilator support among ICU admitted COVID-19 patients. Method(s): A single centre prospective study was conducted on 100 Covid positive patients admitted in the ICU to determine association between the haematological markers such as Hb, Platelet count, Total and Differential leukocyte count, CRP, AST, ALT, LDH, Ferritin and D-Dimer with the need for oxygen therapy with or without invasive ventilatory support. Comparative analysis was performed between the 2 groups. Result(s): Neutrophilia, a mean of 76.7% among those ventilated and 71.6% among those non ventilated (p value 0.002;highly significant) and Lymphocytopenia (p value 0.004) with a mean of 14% and 18.6% respectively was noted. Hemoglobin levels were lower in ventilated (mean 11.6g/dl) as against those non ventilated (mean 12.58%) p value 0.046 which was significant. D-dimer was increased in COVID-19 patients;mean 5380 ng/ml in ventilated patients and mean 949ng/ml in those non ventilated (P < 0.001 highly significant). Elevated D-dimer and presence of diabetes correlated with increased chances of mechanical ventilation, while higher hemoglobin levels and associated COPD have a negative association with the need of mechanical ventilation. Conclusion(s): Hypercoagulability along with neutrophilia and lymphocytopenia can be used as positive associations for the need for invasive mechanical ventilation. Copyright © 2022, College of Anaesthesiologists of Sri Lanka. All rights reserved.

9.
Open Access Macedonian Journal of Medical Sciences ; 10:1818-1826, 2022.
Article in English | EMBASE | ID: covidwho-2066696

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome has led to a pandemic of coronavirus disease 2019 (COVID-19). Malnutrition either biochemically or anthropometrically is a well-known risk factor for COVID-19 and may be the vice versa AIM: The objectives of this study were to investigate the prevalence of malnutrition in children infected with COVID-19 through evaluating the nutritional biomarkers such as serum electrolytes, serum albumin, and hemoglobin together with the anthropometric assessment. METHODS: A cross-sectional study that was conducted at El-Matria Teaching Hospital for all children admitted with confirmed COVID-19 for 6 months from February 1, 2021 to the end of July, 2021. Nutritional biochemical evaluation included serum electrolytes particularly the potassium and other nutritional biomarkers such as serum albumin and hemoglobin. Nutritional anthropometric evaluation depended on body mass index, the height/length, weight for length, and weight for height. The prevalence of malnutrition esp. hypokalemia was the main outcome. RESULTS: Hypokalemia was present in 21.8% of the study participants. Other nutritional biomarkers were found as hyponatremia, hypocalcemia, hypophosphatemia, and hypomagnesemia were detected in 49.1%, 38.2%, 21.8%, and 34.5% of the study subjects, respectively. Anthropometric malnutrition was present in most of the enrolled children with COVID-19 in the study (65.5 % [n = 36]) through which overweight and obese children occupied a greater percentage. CONCLUSION: Malnutrition either biochemically or anthropometrically could be linked to COVID-19 in children. COVID-19 could have negative outcomes on the nutritional status such as electrolytes disturbances. Both malnutrition and COVID-19 are considered synergistic associations.

10.
Obstetric Medicine ; 15(1 Supplement):33-34, 2022.
Article in English | EMBASE | ID: covidwho-2064395

ABSTRACT

Background: During the COVID-19 pandemic, the model of care for gestational diabetes mellitus (GDM)management at Bankstown-LidcombeHospital was adapted to include telehealth consultations to minimise unnecessary face to face interactions and mitigate contagion risk. Aim(s): Assessment of pregnancy outcomes before and during the COVID-19 pandemic. Method(s): We analysed prospectively collected data of singleton GDM pregnancies (International Association of the Diabetes and Pregnancy Study Groups (IADPSG)/WHO2013 criteria). The pre-COVID period defined as March 2016 to February 2020 and COVID period from March 2020 to March 2021. Baseline characteristics evaluated included age, ethnicity, pre-pregnancy body mass index (BMI), gestational age at GDM diagnosis, diagnosis of GDM <20 weeks, HbA1c and 75 g OGTT result. Outcomes assessed were need for insulin therapy, number of medical reviews, incidence of excessive weight gain (EGWG) during pregnancy (per IOM), pre-term delivery (<37 weeks) and caesarean section. Neonatal outcomes included infant gender, birthweight, small for gestational age (SGA, <10th percentile) and large gestational age (LGA, >90th percentile), shoulder dystocia, neonatal hypoglycaemia and jaundice. Independent sample t-tests and chi-square/Fisher's exact tests were used for continuous and categorical data, respectively. P < 0.05 indicated statistical significance. Result(s): A total of 1896 GDM women were included in this study, 292 (15.4%) during COVID and 1604 (84.6%) pre-COVID. During COVID, there was lower mean 1 h glucose (p < 0.0001), 2 h glucose (p < 0.001), HbA1c (p < 0.001), later diagnosis of GDM (p < 0.001) and a lower proportion diagnosed before 20 weeks (p < 0.05) compared to pre-COVID. There were no other differences in baseline characteristics. During the COVID period, there were similar rates of insulin use (48.6% vs. 43.0%), number of medical reviews (7.0 vs. 6.9 episodes), rates of EGWG (39.4% vs. 36.0%), pre-term delivery (6.2 vs. 6.1), caesarean section (37.0% vs. 34.6%), SGA (8.6% vs. 8.4%), LGA (14.4% vs. 11.4%), shoulder dystocia (1.0% vs. 0.2%), neonatal hypoglycaemia (9.2% vs. 10.2%) and neonatal jaundice (3.8% vs. 5.0%) compared to pre-COVID (all outcomes, p =NS). Conclusion(s): Increased use of teleconferencing during the initial 12 months of the COVID pandemic lead to similar pregnancy outcomes compared to the pre-COVID period. A model of care involving teleconferencing is likely to be retained as the 'new-normal' in a post-COVIDworld. Future audits will ascertain whether comparable outcomes are maintained.

11.
Archives of Disease in Childhood ; 107(Supplement 2):A274-A275, 2022.
Article in English | EMBASE | ID: covidwho-2064035

ABSTRACT

Aims NICE guidance suggests that children with diabetes have HbA1c measurements taken 4 times a year.1 However, a change to practice brought in by restrictions during the COVID 19 pandemic meant clinics were by telephone rather than face to face (F2F). We sought to evaluate what affect this change had on the regularity of HbA1c monitoring and of HbA1c targets in our hospital population. Methods HbA1c levels for all patients with diabetes seen at Musgrove Park Hospital, Taunton, were reviewed over 2 time periods. Pre covid, March 2019-March 2020 when F2F clinics were held and during covid, March 2020-March 2021. Telephone clinics were used between March-October 2020, with F2F resuming after this date. Patients were excluded if they had been diagnosed since March 2020 or had transferred to our hospital. Results 78 patients pre covid and 83 patients during covid were included in analysis. Duration between HbA1c blood tests pre covid showed a mean of 3.1 months with a range of 1-7months. During covid the mean duration between tests was 10.9 months with a range of 7-18 months. See figure 1 Change in HbA1c in each patient was measured from baseline. Baseline was considered to be the first measurement from March 2019 in the 'pre covid group' and the last pre covid measurement in the 'during covid group'. The majority of patients (78%) in the year pre covid and 65% during covid stayed within -10 and +10 mmol/ml of their baseline. However, during covid there were more large increases in HbA1c. This demonstrated in figure 2. A comparison was also made with the national targets for HbA1c. The most striking difference is the number of patients with HbA1c >80mmol/ml. Increasing from 9 pre covid (11.5%) to 28 during covid (34%). There were also fewer patients reaching the target of <48mmol/ml halving from 14 to 7 (18% to 8%).Conclusion As suspected, the interval between HbA1c measurements increased during the covid pandemic whilst telephone consultations were used and the target of 4 times per year was not reached. Patients were sent kits to test HbA1c at home but these were used rarely. The results also show that during this period of covid restrictions and telephone clinics, there is a wider spread of HbA1c measurements. There were a small number of patients who saw a rapid and large rise in HbA1c measurements. In particular and most concerning is an increase in the number of patients with HbA1c >80mmol/ml (11.5% of patients pre covid to 34% after covid). We can only speculate as to what may have caused this. Perhaps the lack of direct contact with the clinical team, a change in activity levels and diet during the lockdown restrictions, or the psychological impact of the lockdown restrictions.

12.
Archives of Disease in Childhood ; 107(Supplement 2):A272-A273, 2022.
Article in English | EMBASE | ID: covidwho-2064034

ABSTRACT

Aims Our aim is to assess whether Covid-19 had an overall impact on diabetic control within the paediatric type 1 diabetic population who attend Causeway Hospital. We retrospectively compared baseline HbA1cs of patients between the years 2019 - 2021 to assess for change in the mean HbA1c throughout all paediatric T1DM patients as well as to compare patients with and without an insulin pump. We planned to retrospectively assess the percentage of newly diagnosed diabetic patients who were in DKA on initial presentation. Finally, we wanted to assess HbA1c control of patients with a libre 2 sensor to assess whether patients who scanned more frequently have better overall HbA1c and/or time in target glucose range. Methods NIECR, TWINKLE and LIBREVIEW systems were used to collect data from all Causeway diabetic patients from 2019-2021 to compare HbA1c, number of libre scans and data including whether patients presented in DKA. For data collected on patients with a libre sensor - this was analysed using an unpaired t-test and a p-value subsequently calculated to assess statistical significance. Results In total data was collected from 92 patients throughout the years 2019 - 2021. The median HbA1c of all T1DM patients increased from 65.2 in 2019 to 65.7 in 2020 then improved in 2021 to 64.07mmol/mol. In 2020, there were fewer overall patients with a new diagnosis of T1DM (n=8) compared with 2019 (n=11) and 2021 (n=11). In 2020 37.5% of newly diagnosed patients were in DKA on initial presentation compared with 18% in 2019 and 27% in 2021. Total number of T1DM patients with an HbA1c <48 was 5.6% in 2019, 3.8% in 2020 and 11.8% in 2021. Mean HbA1c from all T1DM patients increased from 65.24mmol/mol in 2019 to 65.72mmol/mol in 2020 and improved to 64.08mmol/mol in 2021. Mean HbA1c in T1DM patients with an insulin pump also increased from 57.76mmol/ mol in 2019 to 59.63mmol/mol in 2020 and improved to 57.56mmol/mol in 2021. In patients with a libre 2 sensor, percentage time within target glucose range (3.9-10mmol/L) increased from 31.25% in those who scanned <4 times/day(n=12) to 59.44% in those who scanned >12 times/day(n=18) resulting in a pvalue of 0.0001. In patients with a libre 2 sensor, mean HbA1c values in those who scanned <4 times per day was 76.5 compared to 55mmol/mol for patients who scanned >12/day resulting in a p-value of 0.0003. Conclusion Throughout all T1DM paediatric patients, we noted an increased HbA1c in 2020 and an improvement in 2021. There was also an increase in incidence of DKA at presentation in newly diagnosed patients who presented in 2020 compared to 2019/2021. Our patients with an insulin pump had better overall HbA1c control than those who self-inject. Patients with a libre 2 sensor who scan more frequently are more likely to have an increased amount of time within the target glucose range of 3.9-10mmol/L and are more likely to have a lower HbA1c.

13.
Archives of Disease in Childhood ; 107(Supplement 2):A267-A268, 2022.
Article in English | EMBASE | ID: covidwho-2064033

ABSTRACT

Aims To assess if there is any temporal association between the sudden high incidence of newly diagnosed Type 1 Diabetes Mellitus (T1DM) in children and the onset of Coronavirus Disease 2019 (CoviD19) in Harlow, Essex UK. Methods Design An observational study Setting Princess Alexandra Hospital NHS Trust (PAH), District General Hospital Over a period of 6 weeks between end April to start of June 2020, there were 10 cases of new onset T1DM who presented to our paediatric department. We reviewed the demographics, symptomatology and biochemical presentations of these patients (table 1). Bloods including SARS-CoV-2 IgG antibody were taken at first presentation and patients had nasal swabs for SARS-COV-2 PCR. Families of patients provided written consent to take part in the project. Antibody testing with HSL Roche kit (sensitivity of 97% at D14-21 and 100% at D40) was processed at PAH microbiology laboratory. All data collators had updated training in Good Clinical Practice GCP and Consenting in paediatric e-learning modules on NIHR Learning Management Systems platform. Primary outcomes assessed the association of new onset T1DM with COVID-19 IgG positivity. Secondary outcomes assessed the degree of severity of T1DM at presentation through severity of acidosis and level of HbA1c. Clinical presentations were evaluated to assess any patterns through the cases. We also aimed to check for any demographic similarities. We derived interquartile ranges (IQR = Q3-Q1) between Q1 25% to Q3 75% to adjust for outliers in the dataset Results Only one case was detected to have IgG antibodies at the time of presentation (not in DKA). Median age of presentation was 9.5 years. The youngest being 11 months and oldest, 14 years. There were 7 males, and 3 females in the cohort. 50% of cases were not in DKA. Of those who presented with ketosis, 2 were in severe DKA (most severe at pH 6.94). None needed intensive care management. Median HbA1c at presentation was 123.5 mmol/mol. Median duration of symptoms was 23.8 days, with those not in DKA presenting on average 17 days and those in DKA (20%) presenting longer (30 days). Those in severe DKA had higher HbA1c values (143 and 151 mmol/mol). There were comorbidities of previously diagnosed autism and hypothyroidism at diagnosis of T1DM in one solitary case (not in DKA). Covid19 antibody positive patient had a history of parent succumbing to COVID-19. Demographics - 30% cases hailed from Harlow, 20% from Broxbourne and Bishops Stortford. 10% were from Waltham abbey, Waltham cross and Epping areas each. Conclusion Our small study represents an exponential rise (three-fold increase) in cases of new onset T1DM shortly following the first pandemic peak in April 2020. Only one case showed presence of past COVID-19 infection. The sampling of antibodies was limited by lack of widespread rollout of coronavirus testing at the time. Our findings support the observation that delay in diagnosis resulted in increasing patient numbers presenting in DKA. There was no association between CoVId-19 infection and new onset T1DM in children. We look forward to outcomes of larger scale studies examining this issue.

14.
Archives of Disease in Childhood ; 107(Supplement 2):A267, 2022.
Article in English | EMBASE | ID: covidwho-2064032

ABSTRACT

Aims To review the glycaemic control of type 1 diabetic patients attending the paediatric and transition adolescent diabetes clinic within NHS Lanarkshire during the coronavirus pandemic. Methods A quantitative analysis of 348 patients attending the paediatric and transition adolescent diabetes clinics within NHS Lanarkshire was carried out. Data collected included age, sex, date of diagnosis and insulin delivery device. Comparing these measures to the Scottish Index of Multiple Deprivation (SIMD) of the patient. Patient data was anonymised within a single data collection sheet. Results 94% of patients across both clinics (n=298) attended a consultation during lockdown, before returning to school in August. Within the paediatric diabetes clinic, results from 199 patients were analysed. 30.65% (n=61) patients experienced a rise in their HbA1c over lockdown whilst 65.32% (n=130) of patients reduced their HbA1c. In this cohort, the mean HbA1c before lockdown compared to after lockdown was 3.77mmol/mol (95% CI 1.93, 5.61;P=0.000). 90 sets of patient data were analysed from the transition adolescent diabetes clinic. 27.78% (n=25) of patients had a rise in their HbA1c and whilst patients from this clinic gained tighter glycaemic control over lockdown. The mean HbA1c pre-lockdown compared to post-lockdown in this clinic reduced by 4.67mmol/mol (CI: +1.35, +7.99, P= 0.006). Patients residing in SIMD quintiles 3-5 had the greatest improvement in HbA1c over lockdown. Conclusion Glycaemic control of patients within the NHS Lanarkshire paediatric diabetes clinics improved over lockdown. There was a mean reduction in HbA1c over the lockdown period. Repeating this audit in a year would be beneficial to see how returning to school and further local lockdowns affected the glycaemic control of paediatric patients.

15.
American Journal of Transplantation ; 22(Supplement 3):381, 2022.
Article in English | EMBASE | ID: covidwho-2063378

ABSTRACT

Purpose: mRNA SARS-CoV-2 vaccines are highly efficacious in the general population but have shown a diminished response in immunosuppressed adolescent kidney allograft recipients. We investigated immunological parameters that could be associated with a blunted antibody response. We also analyzed whether a third vaccine dose could improve the antibody response. Method(s): Adolescent kidney transplant recipients who received mRNA SARSCoV- 2 vaccine had SARS-CoV-2 spike protein antibody levels measured 4-8 weeks after their second vaccine dose and again after the third vaccine dose. Immunological labs including lymphocyte subsets, immunoglobulin levels, and vaccine titers and immunosuppressive medication dosing were evaluated prior to vaccination. Patients were compared in groups of vaccine responders vs non-responders via a Mann-Whitney U test. The impact of mycophenolate mofetil dosage on immune parameters was analyzed via a linear regression model. Result(s): 14 of 27 (52%) vaccinated pts had a positive spike antibody level. There was no significant difference in immunoglobulin levels, T-cell populations, or vaccine titers. There was a trend toward negative spike antibodies with higher doses of mycophenolate mofetil, MMF, at 91 mg/m2/day median difference (p=0.06). All four patients receiving azathioprine instead of MMF developed spike antibodies. Non-responders had lower hemoglobin levels (beta=-1.30, p=0.009) and lower platelet count (beta=-56.00, p=0.057). MCV levels were normal in both groups. Non-responders showed a trend toward increased naive B-cell percentage (beta= 12.50, p=0.11) and decreased total memory B-cell percentage (beta=-12.54, p=0.080). Increasing MMF dosage was associated with an increase in naive B-cell percentage (beta=0.016, p=0.0032) decrease in total memory B-cell percentage (beta=-0.016, p=0.0034), and decreased in IgG level (beta=-0.35, p=0.012). Of the 13 patients that did not develop spike antibodies after the second vaccine dose, 9 pts (69%) developed antibodies after the third dose. In total, 23/27 (85%) patients vaccinated developed spiked antibodies. Conclusion(s): Disruption in B-cell population could be due to immunosuppression with MMF. Non-responders showed trends toward high MMF dosage, increased naive B-cell percentage, and decreased total memory B-cell percentage. Increasing MMF dosage was associated with all trends as well as decreased IgG levels. Decreased hemoglobin levels and normal MCV supports that anemia could be due to bone marrow suppression caused by MMF. Altered B-cell populations and MMF therapy are a potential biomarker for reduced efficacy of SARS-CoV-2 vaccine in adolescent kidney allograft recipients. Interestingly, a third vaccine dose can overcome the immunosuppressive effects and improve vaccine efficacy.

16.
Chest ; 162(4):A2387, 2022.
Article in English | EMBASE | ID: covidwho-2060941

ABSTRACT

SESSION TITLE: Variety in Risk Factors and Treatment of VTE SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: The year of 2020 will be a year never forgotten when the COVID-19 pandemic began. The healthcare system is going into a crisis facing a disease that is unknown and overwhelming. Companies were frantic to find a solution to help prevent so many unnecessary deaths. Pfizer mRNA COVID-19 vaccine was granted emergency use by the FDA after proving efficacy in early trials. Many side effects were unknown and discovered as time went on. Unprovoked isolated pulmonary embolisms are rare. CASE PRESENTATION: A 24 year old male with no significant past medical history presented to the emergency department due to shortness of breath, hemoptysis and chest pain. He denied any family history or personal history of clotting disorders. He received the mRNA COVID-19 Pfizer vaccine 5 days prior to symptom onset. He describes it as constant sharp pain with varying intensity that he rates a 6/10 and can reach a 10/10 pain exacerbated with lying flat and deep breathing. He also states he has been coughing up a teaspoon amount of blood with this chest pain. Physical examination revealed reduced breath sounds in the left lower lobe. Patient was hemodynamically stable. Labs were stable and hemoglobin was stable throughout the hospital course. Fibrinogen was elevated and hypercoagulable work-up was negative. CTA of chest was performed and revealed left-sided pulmonary emboli involving the left lower lobe with pulmonary infarction. Therefore, he was managed by Eliquis. DISCUSSION: Pfizer released a safety and efficacy report of the BNT162b2 mRNA Covid-19 Vaccine. Many of the common side effects reported were pain at the injection site, fatigue, headache, and fever [1]. Adverse events that were reported were shoulder injury, right axillary lymphadenopathy, paroxysmal ventricular arrhythmia, and right leg paresthesia [1]. Isolated PE in a young healthy patient was never reported as an adverse event from the Pfizer safety and efficacy report. Severe acute respiratory syndrome-coronavirus-2 has been proven to increase the risk of venous thromboembolism because it is a prothrombotic virus [2]. Vaccination reports of pulmonary embolism are increasing, however, isolated PE without a DVT is still very underreported and rare. The literature states that a lot of patients that are having PE after mRNA vaccine also have associated thrombocytopenia, however, this is not what this patient demonstrates [3]. A total of 43, 548 participants were observed for the safety and efficacy report of the Pfizer COVID-19 report and not a single patient demonstrated an isolated pulmonary embolism event [1]. CONCLUSIONS: This case is a demonstration of a rare occurrence of isolated PE with no evidence of DVT in such close proximity to receiving the mRNA COVID-19 Pfizer vaccination.There are few reports of pulmonary embolism in healthy patients with no history of clotting disorders and further data are needed to support this association. Reference #1: Polack FP, Thomas SJ, Kitchin N, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020;383(27):2603-2615. doi:10.1056/NEJMoa2034577 Reference #2: Hesam-Shariati S, Fatehi P, Abouzaripour M, Fathi F, Hesam-Shariati N, Hesam Shariati MB. Increased pulmonary embolism in patients with COVID-19: a case series and literature review. Trop Dis Travel Med Vaccines. 2021;7(1):16. Published 2021 Jun 12. doi:10.1186/s40794-021-00145-3 Reference #3: Muster V, Gary T, Raggam RB, Wölfler A, Brodmann M. Pulmonary embolism and thrombocytopenia following ChAdOx1 vaccination. Lancet. 2021;397(10287):1842. doi:10.1016/S0140-6736(21)00871-0 DISCLOSURES: No relevant relationships by Muhammad Azaz Cheema No relevant relationships by Morcos Fahmy No relevant relationships by Christina Gearges No relevant relationships by Asma Iftikhar

17.
Chest ; 162(4):A2300, 2022.
Article in English | EMBASE | ID: covidwho-2060934

ABSTRACT

SESSION TITLE: Rare Cases of Nervous System and Thrombotic Complication Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Covid 19 virus has impacted nearly 450 million people across the globe;ranging from an asymptomatic carrier state to respiratory symptoms, cardiovascular symptoms, hematologic manifestations and multiorgan failure to death. Thrombotic events are one of its devastating complications. CASE PRESENTATION: A 66 year old man with a history of diabetes mellitus, hypertension and 30 pack years smoking history presented to the emergency room with hypoxia and altered mental status. On exam, his GCS was 8/15 and oxygen saturation was 85% on room air. He was subsequently intubated. CTA chest demonstrated bilateral diffuse ground glass opacities and left pulmonary embolism (PE). CT abdomen and pelvis showed multifocal infarcts in the right kidney with findings suggestive of renal artery thrombosis. Initial platelet count was 80,000/ul with creatinine of 3.9 mg/dl and creatine kinase (CK) of 3977 u/l. His INR was 1.4. Patient was not a candidate for thrombolysis given his thrombocytopenia. He was started on intravenous (IV) heparin and given IV hydration. On day 3 of his admission, he developed dry gangrene of the toes. Ankle brachial index of the right lower extremity (LE) was 1.16 and left LE was 0. Duplex ultrasonography of left LE showed mid to distal popliteal artery thrombus occluding below knee popliteal and tibial arteries. Echocardiogram showed ejection fraction of 55% and bubble study was negative for any intra atrial or pulmonary shunting. On day 4 of his admission, he developed oliguria and his gangrene got worse. His platelet counts decreased to 36,000/ul. Other pertinent labs showed INR 1.2, PT 15.3, PTT 34, D dimer 14.82, fibrinogen 498, CK 6434 mg/dl, hemoglobin 13.2 g/dl, haptoglobin 243 mg/dl and LDH 1041 U/l. Given his poor prognosis in the setting of ventilator dependent respiratory failure, multiple thrombosis and kidney failure requiring hemodialysis, the family decided to withdraw care. DISCUSSION: There are multiple hypotheses of thrombus formation in Covid 19 infection such as interleukin 6 and other cytokines induced endothelial injury, angiogenesis and elevated prothrombotic factors such as factor VIII and fibrinogen. Our patient had PE, renal artery thrombosis and popliteal artery thrombosis. Despite being on full dose anticoagulation, he developed gangrene of the toes. His lab results were not consistent with disseminated intravascular coagulation, thrombotic thrombocytopenic purpura and he was not known to have any baseline hypercoagulable disorder. He did not have any intra cardiac shunts. Hence, it is most likely Covid 19 induced multiple arterial and venous thrombosis. CONCLUSIONS: The treatment of Covid 19 related thrombosis has become very challenging especially in the setting of multiple clots. It is crucial to have large multicenter studies to investigate vascular complications of Covid-19 and to formulate management strategies to ensure good patient outcomes. Reference #1: https://www.nejm.org/doi/full/10.1056/nejmoa2015432 Reference #2: https://journal.chestnet.org/article/S0012-3692(21)01126-0/fulltext DISCLOSURES: No relevant relationships by Devashish Desai No relevant relationships by Swe Swe Hlaing no disclosure on file for Jean Marie Koka;No relevant relationships by Hui Chong Lau No relevant relationships by Subha Saeed No relevant relationships by Anupam Sharma No relevant relationships by Muhammad Moiz Tahir

18.
Chest ; 162(4):A2241, 2022.
Article in English | EMBASE | ID: covidwho-2060916

ABSTRACT

SESSION TITLE: Pulmonary Manifestations of Infections SESSION TYPE: Case Reports PRESENTED ON: 10/17/2022 03:15 pm - 04:15 pm INTRODUCTION: Diffuse alveolar hemorrhage (DAH) due to an undiagnosed autoimmune condition is rare and can be life-threatening. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been described as a viable rescue therapy in severe cases, providing time to establish a diagnosis and begin remission induction therapy (1). We report a patient who presented during the Omicron surge with hypoxemic respiratory failure due to pulmonary hemorrhage ultimately diagnosed with antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) who was supported with VV-ECMO without systemic anticoagulation. CASE PRESENTATION: A 46-year-old woman presented with subacute fatigue and two days of cough and brown sputum. She was found to have normocytic anemia (hemoglobin 3.5 g/dL), renal failure (serum creatinine 17.4 µmol/L), and bilateral pulmonary infiltrates on chest roentgenogram. Though vaccinated, nasal molecular testing detected SARS-CoV-2. She was intubated for progressive hypoxic respiratory failure and bronchoalveolar lavage fluid was consistent with DAH. She received empiric antibiotics, remdesivir, and pulse dose intravenous methylprednisolone as well as continuous renal replacement therapy and plasma exchange. Due to refractory hypoxemia she was cannulated for VV-ECMO. Systemic anticoagulation was deferred due to concerns that it may exacerbate her underlying pathology and due to a small subcortical bleed seen on computed tomography of the head. Perinuclear ANCA (titer >1:1280) was confirmed by immunofluorescence analysis with elevated myeloperoxidase serologies and cyclophosphamide was initiated. Glomeruli with cellular crescent formation consistent with AAV was later identified on renal biopsy. Her course was complicated by recurrent DAH while tapering steroids and an iliac vein thrombus, extracted during decannulation. Her respiratory failure resolved and she was discharged to rehab. DISCUSSION: Traditionally, VV-ECMO obligates systemic anticoagulation to prevent circuit thrombosis, however this may be viewed as a barrier to its use in patients with prohibitive bleeding risk and may contribute to the therapy's overall morbidity. Some institutions have begun to demonstrate the safety of ECMO with low- or prophylactic doses of anticoagulation (2), but this practice remains controversial. Detection of SARS-CoV-2 posed diagnostic and management challenges and its significance to this case remains uncertain. There are many past examples of infectious triggers for both DAH and AAV, and there is emerging evidence for an association between SARS-CoV-2 and ANCA (3). Concerns regarding the risk of B-cell depletion influenced the selection of remission induction therapy. CONCLUSIONS: In the case described, a patient with severe DAH was successfully supported with VV-ECMO. Withholding systemic anticoagulation did not prevent recurrent bleeding and may have contributed to a deep vein thrombosis. Reference #1: Arnold S, Deja M, Nitschke M, Bohnet S, Wallis S, Humrich JY, Riemekasten G, Steinhoff J, Lamprecht P. Extracorporeal membrane oxygenation in ANCA-associated vasculitis. Autoimmun Rev. 2021 Jan;20(1):102702. doi: 10.1016/j.autrev.2020.102702. Epub 2020 Nov 11. PMID: 33188916. Reference #2: Kurihara C, Walter JM, Karim A, et al. Feasibility of Venovenous Extracorporeal Membrane Oxygenation Without Systemic Anticoagulation. Ann Thorac Surg. 2020;110(4):1209-1215. doi:10.1016/j.athoracsur.2020.02.011 Reference #3: Kadkhoda, K., Laurita, K. Antineutrophil cytoplasmic antibodies and their association with clinical outcomes in hospitalized COVID-19 patients. Cell Death Discov. 7, 277 (2021). DISCLOSURES: No relevant relationships by Nathaniel Nelson No relevant relationships by Radu Postelnicu no disclosure on file for Antonio Velez;

19.
Chest ; 162(4):A1289-A1290, 2022.
Article in English | EMBASE | ID: covidwho-2060797

ABSTRACT

SESSION TITLE: COVID-19 Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Much has been learned about the immune dysregulation and release of pro-inflammatory cytokines since the emergence of the COVID-19 pandemic.1 Patients with interstitial lung disease are often on immunosuppressive agents, such as rituximab, which is a B-cell depleting agent. There has been a large retrospective cohort study showing that rituximab therapy was the only immunosuppressive medication with a trend towards in-hospital death.2 We present a case of COVID-19 in a patient on rituximab with ANCA vasculitis. CASE PRESENTATION: A 51-year-old male, never smoker, with ANCA positive vasculitis (positive MPO and PR3) and interstitial lung disease (on 4-5L of oxygen) presented to the hospital with nausea and fever for 2 days and was found to have a positive SARS-CoV-2 PCR. At the time of presentation, he was on rituximab 1000 mg x 2 doses every 6 months with last infusion one month prior to presentation, azathioprine 150 mg daily, prednisone 15 mg daily, nintedanib 100 mg BID, and IVIG monthly. Spirometry showed FVC of 1.60L/37% predicted and an FEV1 1.28L/39% predicted. Patient had 2 COVID vaccinations and one booster (all Pfizer mRNA), the latter 3 months prior to presentation. On admission, he was saturating at 55% on 4L and placed on 15L non-rebreather;he was afebrile, normotensive, and with a pulse of 110 BPM. Exam was notable for a cough, wheezing, and tachypnea. Lab work was notable for positive SARS-COV-2 PCR, a total white blood cell count of 5.3x103 uL, and a normal hemoglobin and platelet count. He had a CO2 of 34, normal creatinine, and no transaminitis. Lactate dehydrogenase (LDH) was elevated at 318 U/L, and lactate was elevated at 3.5 mmol/L. His chest x-ray on admission demonstrated patchy filling opacities and low lung volumes. He received dexamethasone, remdesivir, and the monoclonal antibodies casirivimab and imdevimab (REGEN-COV) on the first day of admission. Patient also received his monthly IVIG dose inpatient. After a week, he was weaned back to his home oxygen and symptomatically back to baseline. Most recent PFTs on the same outpatient immunosuppressive regimen as prior to admission are unchanged. Patient received two doses of preventative monoclonal antibodies (EVUSHELD) 3 months after admission. DISCUSSION: Here we discuss a case of a patient with severe COVID-19 pneumonia requiring inpatient hospitalization despite three COVID mRNA vaccinations, likely secondary to difficulty in mounting an immune response to the vaccinations given his use of immunosuppressive medications. This is also an example of the early use of monoclonal antibodies in an inpatient with long term preservation of his underlying lung function.3 CONCLUSIONS: We recommend counseling and close observation of patients on rituximab due to risk of severe COVID-19 infection as well the use of preventative monoclonal antibodies (EVUSHELD). Reference #1: Jamal M, Bangash HI, Habiba M, Lei Y, Xie T, Sun J, Wei Z, Hong Z, Shao L, Zhang Q. Immune dysregulation and system pathology in COVID-19. Virulence. 2021 Dec;12(1):918-936. doi: 10.1080/21505594.2021.1898790. PMID: 33757410;PMCID: PMC7993139. Reference #2: Andersen, K. M., Bates, B. A., Rashidi, E. S., Olex, A. L., Mannon, R. B., Patel, R. C., Singh, J., Sun, J., Auwaerter, P. G., Ng, D. K., Segal, J. B., Garibaldi, B. T., Mehta, H. B., Alexander, G. C., Haendel, M. A., & Chute, C. G. (2022). Long-term use of immunosuppressive medicines and in-hospital COVID-19 outcomes: A retrospective cohort study using data from the National COVID Cohort Collaborative. The Lancet Rheumatology, 4(1), e33–e41. https://doi.org/10.1016/S2665-9913(21)00325-8 Reference #3: Weinreich, D. M., Sivapalasingam, S., Norton, T., Ali, S., Gao, H., Bhore, R., Xiao, J., Hooper, A. T., Hamilton, J. D., Musser, B. J., Rofail, D., Hussein, M., Im, J., Atmodjo, D. Y., Perry, C., Pan, C., Mahmood, A., Hosain, R., Davis, J. D., Yancopoulos, G. D. (2021). Regen-cov antibody combination and outcomes in outpatients with covid-19. New England Journal of Medicine, 385(23), e81. https://doi.org/10.1056/NEJMoa2108163 DISCLOSURES: Advisory Committee Member relationship with Genentech Please note: 2019-2022 Added 06/06/2022 by Ayodeji Adegunsoye, value=Consulting fee Advisory Committee Member relationship with Boehringer Ingelheim Please note: 2018-2022 Added 06/06/2022 by Ayodeji Adegunsoye, value=Consulting fee Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: 2018-2022 Added 06/06/2022 by Ayodeji Adegunsoye, value=Honoraria Consultant relationship with Genentech Please note: 2018-2020 by Ayodeji Adegunsoye, value=Consulting fee Removed 06/06/2022 by Ayodeji Adegunsoye No relevant relationships by Cathryn Lee No relevant relationships by Kavitha Selvan PI relationship with Boehringer-Ingelheim Please note: >$100000 by Mary Strek, value=Grant/Research Support PI relationship with Galapagos Please note: $70,000-100,00 by Mary Strek, value=Grant/Research Support Endpoint Adjudication Committee Member relationship with Fibrogen Please note: $1-$1000 by Mary Strek, value=Honoraria No relevant relationships by Rachel Strykowski

20.
Chest ; 162(4):A1265, 2022.
Article in English | EMBASE | ID: covidwho-2060791

ABSTRACT

SESSION TITLE: Diagnosis of Lung Disease through Pathology Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Usual interstitial pneumonia (UIP) is a histological term used to describe a pattern of interstitial fibrosis with alternating areas of the normal lung with temporal fibrosis and architectural alteration due to chronic scarring or honeycomb change. It is a subset of idiopathic interstitial pneumonias (IPF) that usually presents in the sixth and seventh decades of life with progressive dyspnea on exertion and productive cough. CASE PRESENTATION: We present a 46 y/o man with a history of thyroid disease, hypertension and a former smoker of 20 pack-year smoking. Presented to ED complaining of low oxygen saturation with pulse oximetry at home with readings between 60-80%. Accompanied with progressive dyspnea on exertion and unintentional weight loss of 80 pounds in the last year. Also referred productive cough of white sputum that was worse in the morning. Home nebulized Albuterol therapy did not provide improvement. Denied recent viral respiratory infections, night sweats, environmental exposures nor family history of lung disease. DISCUSSION: Physical exam demonstrated bilateral expiratory dry crackles and pulse oximetry oxygen saturation at room air of 78%. RBBB evidenced on EKG. Bloodwork showed polycythemia with hemoglobin of 17.8;ABG's with pH: 7.40, Pco2: 42.2, PO2: 59.8, HCO3: 26, O2 sat: 90.8 and ideal PO2: 85.6 consistent with metabolic alkalosis with BMP CO2 of 30, A/a gradient: 43.0. Mycoplasma IgM, Influenza A & B and COVID-19 antigen test were negative. CXR with increased vascular markings, chest CT demonstrated small pericardial effusion, bilateral coarse interstitial pulmonary markings and bronchiectasis suggestive of chronic interstitial lung disease with no specific pattern. Left heart catheterization revealed right ventricular hypertrophy, normal EF >55%, and no evidence of coronary disease. Alpha-1 antitrypsin: 158, EPO: 6.5, HIV, and hepatitis panel were all negative. Rheumatology work up with only an ANA antibody positive, with titer 1:160. Patient underwent VATS procedure with wedge biopsy of the right upper and middle lobe that revealed usual interstitial pneumonia pattern. Patient improved and was discharged on home oxygen 3L. At follow-up, treatment was started with Nintedanib and Sildenafil Citrate. He had clinical improvement and oxygen requirements decreased to intermittent oxygen. CONCLUSIONS: Patients with interstitial pulmonary fibrosis experience slow progressive decline with typical clinical presentation over 60 years of age. This case remarks the importance of the need for stratification of interstitial lung disease classification, when pattern and history are non specific, with the use of VATS procedure for early start of treatment. Our patient with no environmental exposure or connective tissue disease had an uncommon early presentation of usual interstitial pneumonia. Reference #1: Tibana, R.C.C., Soares, M.R., Storrer, K.M. et al. Clinical diagnosis of patients subjected to surgical lung biopsy with a probable usual interstitial pneumonia pattern on high-resolution computed tomography. BMC Pulm Med 20, 299 (2020). https://doi.org/10.1186/s12890-020-01339-9 DISCLOSURES: No relevant relationships by Jesse Aleman No relevant relationships by Carlos Martinez Crespí no disclosure submitted for Jean Ramos;No relevant relationships by Alexandra Rodriguez Perez No relevant relationships by Paola Vazquez No relevant relationships by Nahomie Veguilla Rivera

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