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1.
EJIFCC ; 33(2): 75-78, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2092798
2.
Pulmonologiya ; 32(2):151-161, 2022.
Article in Russian | EMBASE | ID: covidwho-2067423

ABSTRACT

Bronchial asthma occurs in 0.9 - 17% of patients hospitalized with COVID-19. However, it is not clear whether asthma is a risk factor for the development and severity of COVID-19. Studies have shown that patients with asthma appear to be more susceptible to COVID-19 infection, but severe disease progression is not related to medication use, including asthma biologics, but rather to older age and comorbidities. Aim. To evaluate the clinical course of SARS-CoV-2 infection in elderly patients with asthma, to examine the effect of asthma and comorbidities on COVID-19-related outcomes, and to determine predictors of mortality. Methods. Elderly patients [WHO, 2020] (> 60 years, n = 131, median age 74 (67;80) years;59 men, 72 women) with asthma hospitalized for COVID-19 were included in the study. COVID-19 was confirmed by laboratory tests (PCR smear) and/or clinical and radiological examinations. All patients had a history of a documented diagnosis of asthma (GINA, 2020). Results. Out of 131 patients, 30 (22.9%) died in the hospital, and 15 (14.9%) died after discharge from the hospital (within 90 days). The group of patients with lethal outcome showed the following differences from those who recovered: values of Charlson index, respiration rate, degree of lung damage on CT scan, absolute number of leukocytes, neutrophils and neutrophils-to-lymphocytes ratio, C-reactive protein on the 5th day of hospitalization, and LDH were statistically significantly higher, while absolute number of eosinophils, total protein content, SpO2 and SpO2/FiO2 levels were lower;steroid intake during the year and non-atopic asthma were more common. Multivariate and ROC analysis revealed the most significant predictors of hospital mortality and their thresholds: Charlson comorbidity index ≥ 6 points, neutrophil/lymphocyte ratio ≥ 4.5, total protein ≤ 60 g/l, eosinophil level ≤ 100 cells/μL. Conclusion. The most significant predictors of hospital mortality in elderly patients with severe COVID-19 against asthma are Charlson comorbidity, neutrophil/lymphocyte ratio;lower eosinophil and total protein levels. Survival time of patients has an inverse correlation with the number of mortality risk factors present.

3.
Journal of Clinical Outcomes Management ; 29(5):39-48, 2022.
Article in English | EMBASE | ID: covidwho-2067257

ABSTRACT

Objective: The COVID-19 pandemic has been a challenge for hospital medical staffs worldwide due to high volumes of patients acutely ill with novel syndromes and prevailing uncertainty regarding optimum supportive and therapeutic interventions. Additionally, the response to this crisis was driven by a plethora of nontraditional information sources, such as email chains, websites, non-peer-reviewed preprints, and press releases. Care patterns became idiosyncratic and often incorporated unproven interventions driven by these nontraditional information sources. This report evaluates the efforts of a health system to create and empower a multidisciplinary committee to develop, implement, and monitor evidence-based, standardized protocols for patients with COVID-19. Method(s): This report describes the composition of the committee, its scope, and its important interactions with the health system pharmacy and therapeutics committee, research teams, and other work groups planning other aspects of COVID-19 management. It illustrates how the committee was used to demonstrate for trainees the process and value of critically examining evidence, even in a chaotic environment. Result(s): Data show successful interventions in reducing excessive ordering of certain laboratory tests, reduction of nonrecommended therapies, and rapid uptake of evidence-based or guidelines-supported interventions. Conclusion(s): A multidisciplinary committee dedicated solely to planning, implementing, and monitoring standard approaches that eventually became evidence-based decision-making led to an improved focus on treatment options and outcomes for COVID-19 patients. Data presented illustrate the attainable success of a committee that is both adaptable and suitable for similar emergencies in the future. Copyright © 2022 Turner White Communications Inc.. All rights reserved.

4.
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.

5.
Journal of Interdisciplinary Medicine ; 7(2):44-46, 2022.
Article in English | EMBASE | ID: covidwho-2065359

ABSTRACT

Background: BNT162b2 is a widely used mRNA COVID-19 vaccine for which 8.2% of participants above the age of 56 years have reported diarrhea as an adverse event. This case report highlights the possibility of eosinophilic colitis in post-vaccination diarrhea. Case report: A 72-year-old male patient presented with generalized colicky abdominal pain and acute diarrhea after receiving the first dose of the BNT162b2 vaccine. Laboratory examination revealed peripheral blood eosinophilia with cecal and ascending colon mucosal eosinophilia with 100-130 cells/HPF and eosinophilic cryptitis. The patient's symptoms and eosinophilia resolved spontaneously and did not recur after the second dose of vaccination. More research is needed to confirm eosinophilic colitis as a possible vaccine adverse reaction. Copyright © 2022 Selva Yuwaraj Vadioaloo et al., published by Sciendo.

6.
American Journal of Transplantation ; 22(Supplement 3):764-765, 2022.
Article in English | EMBASE | ID: covidwho-2063421

ABSTRACT

Purpose: To investigate the mortality risk factors of COVID-19 infection among kidney transplant recipients (KTRs) in Thailand due to data scarcity in Asian populations. Method(s): We analyzed the data from the Thai Transplant Registry which collected data from all transplant centers from March 2020 to November 2021. The outcomes were the mortality rate over time, ICU admission rate and mortality risk factors including patients' demographic data, comorbidities, vaccination, immunosuppression, and laboratory tests. Result(s): Seventy-two KTRs were infected with COVID-19. The mortality rate was 16.7% (12/72) which was highest (6/12) in July 2021 when the B.1.617.2 variant became most dominant strain. All dead patients were deceased donor kidney transplant (DDKT, 100%). 33.3% (24/72) need to be admitted to the ICUs. The mean age of patients in non-survivor group was significantly higher than those in survivor group (53.4 +/- 10.3 vs 44.5 +/- 9.9 years, p=0.006). The underlying diseases including diabetes and hypertension did not increased mortality. However, hypertension significantly increased ICU admission risk (OR 6.8, 95%CI 1.8-30.6). The mean BMI among non-survivor group was similar to survivor group (25.0 +/- 3.9 vs 23.3 +/- 4.5 kg/m2, p=0.23). The transplantation vintage was not different among both groups (73.5 [12.5-180.5] in the non-survivor vs 52.0 [29.0-97.0] months in the survivors p=0.77). Baseline immunosuppressive regimens were not associated with mortality. The non-survivor group had significantly higher baseline serum creatinine (2.87 +/- 2.63 vs 1.68 +/- 0.82 mg/dL, p=0.006). The area under the ROC curve for mortality was 0.62 for neutrophil to lymphocyte ratio (NLR). The NLR of 3.3 showed highest sensitivity (71%) and specificity (53%) in predicting mortality. Higher IL-6 was associated with requiring ICU admission (23.2 [15.4-70.6] vs 10.4 [4.1-24.2], p=0.04). In non-survivor group, 9 (75%) KTRs were unvaccinated and 3 (25%) KTRs were incomplete vaccinated (1 dose of ChAdOx1 nCoV-19 vaccine in 2 KTRs, and 1 dose of CoronaVac vaccine in 1 KTRs). In non-survivor group, most common medical complications were bacterial pneumonia (58.3%) and lifethreatening bleeding (16.7%). Conclusion(s): In Thailand, the mortality rate of COVID-19 infected KTRs was comparable to worldwide reports which was 10-32%. Higher patients' age, DDKT as well as admission serum creatinine and IL-6 were associated with increasing disease severity. Both unvaccinated and not fully vaccinated KTRs were significantly at higher risk of death.

7.
American Journal of Transplantation ; 22(Supplement 3):441, 2022.
Article in English | EMBASE | ID: covidwho-2063357

ABSTRACT

Purpose: Rapid evolution of the SARS-CoV-2 pandemic over the past 24 months has demanded agility in managing selection criteria for deceased organ donors, with the goal of saving every possible life while avoiding disease transmission to recipients. At 1 large organ procurement organization (OPO), the detection of any SARS-CoV-2 in a naso-pharyngeal (NP) specimen by polymerase chain reaction (PCR) was initially an absolute contraindication to organ donation. That approach gradually became more refined utilizing clinical evidence along with detection of low levels of viremia. Method(s): A retrospective analysis of all patients with authorization for organ donation after brain death or circulatory death from 3/16/2020 - 11/9/2021 was undertaken. Patients with any positive result for a COVID-19 test were identified. Donors with any positive result of an NP +/- broncho-alveolar fluid (BAL) PCR were selected for this analysis. Organ allocation was accompanied by the expectation of written confirmation that the recipient had provided informed consent for use of an organ from a SARS-CoV-2 donor. Result(s): A total of 18 deceased donors from whom 49 organs were transplanted, were identified. Multiple test results were often available for a single patient. Results were mixed in all 18 donors. At least one of the positive NP PCR test results included a cycle threshold in 16/18 patients and ranged from 31.4 to 42.5. In 2 donors a BAL PCR was also positive;1 heart was donated from one of these donors. With a follow-up of > 53 days for all transplants, no known transmission of SARS-CoV-2 to recipients or transplant teams has been reported. Conclusion(s): Available laboratory testing for SARS-CoV-2 and deepening understanding of COVID-19, increasing treatment options, and evolution of infection prevention practices have facilitated a growing confidence in safely transplanting non-lung organs from donors with a positive SARS-CoV-2 test. (Figure Presented).

8.
Chest ; 162(4):A2250, 2022.
Article in English | EMBASE | ID: covidwho-2060920

ABSTRACT

SESSION TITLE: Systemic Diseases with Deceptive Pulmonary Manifestations SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Amyloidosis of the respiratory tract is rare. We present a case of tracheobronchial amyloid presenting as multifactorial cough with syncope. CASE PRESENTATION: The patient is a 65-year-old man with history of hypertension, hyperlipidemia, and allergic rhinitis who presented to the ED after a syncopal event. Two weeks prior, he had a new-onset myalgias and severe persistent cough, not resolving with over-the-counter medications. During a coughing paroxysm, he experienced a brief loss of consciousness. On arrival, his vital signs and physical exam were within normal limits except for Mallampati II, BM of 38.8 kg/m2. Basic laboratory testing was also unremarkable except for troponin T of 251 nl/dL and NT-ProBNP of 1181 pg/mL. NP swab for Sars-CoV-19 (PCR), Influenza A and B were not detected. CT of the chest revealed an area of circumferential mural soft tissue thickening in the left lower lobe bronchi. Cardiac MRI showed an area of subepicardial delayed enhancement, suggestive of myocardial inflammation or edema. Flexible bronchoscopy confirmed that the left lower lobe bronchus and proximal subsegmental bronchi had an infiltrative process with a friable, erythematous irregular mucosal surface. Forceps biopsy sampling and staining with Congo red, sulfate Alcian blue and Trichome stain were positive for amyloid deposits. Immunostain revealed predominantly CD3 positive T-Cells. Mass spectometry showed AL (lamda)-type amyloid deposition. GMS and AFB stains were negative. Telemetry showed 2-3 second pauses, correlated with episodes of cough. DISCUSSION: Amyloidosis is a disorder caused by misfolding of proteins and fibril accumulation in the extracellular space. It can present as a diffuse or localized process to one organ system. Several patterns of lung involvement have been described: nodular pulmonary, diffuse alveolar-septal, cystic, pleural, and tracheobronchial amyloidosis. Tracheobronchial amyloidosis is usually limited and not associated with systemic disease or hematologic malignancy. It can be asymptomatic, or can present with cough, dyspnea or signs of obstruction, including postobstructive pneumonia. Congo Red stained samples reveal green birefringence under polarized light microscopy. Further analysis of proteins usually reveals localized immunoglobulin light chains (AL). Cough syncope is due to increased intrathoracic pressure, decreased venous return and cardiac output, stimulation of baroreceptors, decreased chronotropic response, arterial hypotension and decreased cerebral perfusion. Our patient presented with multifactorial cough (possible viral infection, upper airway cough syndrome, amyloidosis) causing sinus pauses and syncope, on underlying myocarditis. CONCLUSIONS: Amyloid infiltration of the respiratory system is rare, but it should be considered in the differential diagnosis of airway disorders, nodular or cystic lung diseases, and pleural processes. Reference #1: Milani P, Basset M, Russo F, et al. The lung in amyloidosis. Eur Respir Rev 2017;26: 170046 [https://doi.org/10.1183/16000617.0046-2017]. Reference #2: Utz JP, Swensen SJ, Gertz MA. Pulmonary amyloidosis. The Mayo Clinic experience from 1980 to 1993. Ann Intern Med. 1996 Feb 15;124(4):407-13. doi: 10.7326/0003-4819-124-4-199602150-00004 Reference #3: Dicpinigaitis PV, Lim L, Farmakidis C. Cough syncope. Respir Med. 2014 Feb;108(2):244-51. doi: 10.1016/j.rmed.2013.10.020. Epub 2013 Nov 5. PMID: 24238768. DISCLOSURES: No relevant relationships by Amarilys Alarcon-Calderon No relevant relationships by Ashokakumar Patel

9.
Chest ; 162(4):A2245, 2022.
Article in English | EMBASE | ID: covidwho-2060918

ABSTRACT

SESSION TITLE: Systemic Disease with Diffuse Lung Symptoms Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Rapidly progressive interstitial lung disease (RP-ILD) is a rare and potentially fatal manifestation of dermatomyositis (DM) and has considerable impact in terms of the prognosis. CASE PRESENTATION: A 52-year-old male demonstrated DM-typical rash, fever, mialgias, and mild muscle weakness 3 months after asymptomatic COVID-19 infection. Two weeks later dysphonia and progressive dyspnea appeared. Lung CT scan showed the picture of organizing pneumonia. His COVID-19 PCR test was negative multiple times. Laboratory tests revealed the following numbers: ALT 210 IU/L, AST 748 IU/L, LDH 613 IU/L, CPK 1165 IU/L, ferritin 1145ϻg/l, CRB 11 mg/l. The patient was tested positive for anti-Ro52 antibodies, while anti-synthetase and scleroderma-associated antibodies were not discovered. Anti-melanoma differentiation-associated gene 5 (MDA5) test was not available due to the lack of the necessary test systems in the country. The patient was diagnosed with DM. Combined immunosuppressive therapy was administered, including: oral prednisolone 60 mg per day and 720 mg intravenously, dexamethasone 64-24 mg intravenously per diem, ciclosporin 200 mg и cyclophosphamide 600 mg, and 3 plasmapheresis sessions followed by an intravenous immunoglobulin. As a result of the therapy, muscle weakness disappeared and CPK levels returned to normal limits, however dyspnea progressed and ferritin levels hit 3500ϻg/l. After the following 3 weeks of intensive combined immunosuppressive therapy, the patient demonstrated symptoms of severe respiratory failure (RF). CT scan showed multiple traction bronchiectasis, wide areas of ground glass opacity, pneumomediastinum and subcutaneous emphysema of a neck and supraclavicular regions. Ciclosporin was replaced with tofacitinib with the dose of 10 mg per diem, IL-6 inhibitor (olokizumab 256 mg) was injected intravenously, massive broad-spectrum antibiotic therapy was administered. RF progressed and the patient was put on mechanical ventilation. The patient died of acute RF and sepsis a week later. DISCUSSION: RP-ILD is a common manifestation of severe MDA5+ DM, which is also associated with necrotizing vasculitis and amyopathic/hypomyopathic muscle involvement. In this case acute ILD in a patient with typical DM could also have been provoked by previous COVID-19 infection. CONCLUSIONS: The courses of disease for COVID-19 and MDA5+ DM have several similarities, which means it can be the same for their pathogenesis and clinical manifestations. In spite of early screening and intensive immunosuppressive therapy in such cases, the prognosis of patients with DM and RP-ILD is still poor and is associated with high mortality. Reference #1: Wang G, Wang Q, Wang Y, et al. Presence of Anti-MDA5 Antibody and Its Value for the Clinical Assessment in Patients With COVID-19: A Retrospective Cohort Study. Front Immunol. 2021 Dec 20;12:791348. doi: 10.3389/fimmu.2021.791348. PMID: 34987516;PMCID: PMC8720853. DISCLOSURES: No relevant relationships by Lidia Ananyeva No relevant relationships by Maria Aristova No relevant relationships by Liudmila Garzanova No relevant relationships by Anna Khelkovskaya-Sergeeva No relevant relationships by Dmitry Kulikovsky

10.
Chest ; 162(4):A1854-A1855, 2022.
Article in English | EMBASE | ID: covidwho-2060873

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: This report describes the case of a patient presenting with pneumothorax and Severe Acute Respiratory Syndrome (SARS) Coronavirus-2 (SARS-cov-2) infection leading to Coronavirus Disease 2019 (COVID-19) pneumonia, with worsening presentation, later found to have underlying Pleuroparenchymal Fibroelastosis (PPFE). CASE PRESENTATION: A 68 year old male with a past medical history of hypertension and type 2 diabetes presented to his primary care clinic with shortness of breath. He underwent a Chest X-Ray as an outpatient which revealed a moderate right-sided pneumothorax (PTX), and he was sent to the Emergency Department by his primary care provider. He was found to be COVID positive on initial workup, also requiring supplemental oxygen. Other routine laboratory tests did not reveal any significant abnormalities. His shortness of breath worsened and on repeat X-rays his pneumothorax increased in size therefore a chest tube was placed by Cardiothoracic Surgery. Computerized Tomography of the chest revealed moderate right pneumothorax, bilateral diffuse ground glass opacities and pulmonary micronodules [Figure 1]. The patient had mild initial improvement and the chest tube was removed but he had recurrence of the PTX and he underwent urgent Video Assisted Thoracoscopic Surgery (VATS), with right upper lobe wedge resection and talc pleurodesis. A biopsy of the resected lung revealed a benign lung with fibroelastotic scarring, diffusely involving subpleural tissue and prominently extending into and entrapping areas of underlying alveolated tissue, with no inflammation, granulomas or pneumonia noted. Workup for tuberculosis, autoimmune disorders, HIV was negative. He eventually was discharged home with close pulmonology and cardiothoracic surgery follow ups, planned for disease surveillance and malignancy workup. DISCUSSION: PPFE is a rare entity, and classified amongst rare causes of idiopathic interstitial pneumonias (IIP) [1]. It is characterized by upper lobe fibrosis, supleural and parenchymal scarring. It can occur at any age, and the usual presentation is of pneumothorax in a thin male, with a shortened anteroposterior diameter of the chest. Radiographic findings typically include subpleural nodular or reticular opacities in the upper lobes, usually sparing the middle and lower lobes. Pathology reveals increased elastic tissue and dense collagen fibers, along with subpleural fibrosis [2]. Pulmonary function testing reveals a restrictive pattern with reduced diffusion capacity and it is usually resistant to steroids [3]. CONCLUSIONS: PPFE is an uncommon cause of insidious, slowly progressive fibrotic lung disease often limited to the upper lobes. It should be suspected in any person presenting with recurrent pneumothorax or blebs without other known inciting causes. Lung biopsy helps establish the diagnosis. Patients with this condition need close pulmonology follow up to assess progression. Reference #1: Travis WD, Costabel U, Hansell DM, King TE Jr, Lynch DA, Nicholson AG, Ryerson CJ, Ryu JH, Selman M, Wells AU, Behr J, Bouros D, Brown KK, Colby TV, Collard HR, Cordeiro CR, Cottin V, Crestani B, Drent M, Dudden RF, Egan J, Flaherty K, Hogaboam C, Inoue Y, Johkoh T, Kim DS, Kitaichi M, Loyd J, Martinez FJ, Myers J, Protzko S, Raghu G, Richeldi L, Sverzellati N, Swigris J, Valeyre D;ATS/ERS Committee on Idiopathic Interstitial Pneumonias. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2013 Sep 15;188(6):733-48. doi: 10.1164/rccm.201308-1483ST. PMID: 24032382;PMCID: PMC5803655. Reference #2: Frankel SK, Cool CD, Lynch DA, Brown KK. Idiopathic pleuroparenchymal fibroelastosis: description of a novel clinicopathologic entity. Chest. 2004 Dec;126(6):2007-13. doi: 10.1378/chest.126.6.2007. PMID: 1559 706. Reference #3: Watanabe K. Pleuroparenchymal Fibroelastosis: Its Clinical Characteristics. Curr Respir Med Rev. 2013 Jun;9(4):299-237. doi: 10.2174/1573398X0904140129125307. PMID: 24578677;PMCID: PMC3933942. DISCLOSURES: No relevant relationships by FNU Amisha No relevant relationships by Perminder Gulani No relevant relationships by Hyomin Lim No relevant relationships by paras malik No relevant relationships by Divya Reddy

11.
Chest ; 162(4):A858, 2022.
Article in English | EMBASE | ID: covidwho-2060710

ABSTRACT

SESSION TITLE: Management of COVID-19-Induced Complications SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Up to 17% of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been shown to develop pancreatic lesions (1). We present 2 cases of coronavirus disease 2019 (COVID-19) patients that presented with pancreatic lesions. CASE PRESENTATION: Case1 A 47-year-old lady with a history of type 2 diabetes mellitus present to the emergency department (ED) with complaints of flu-like symptoms for ten days. She tested positive for COVID-19 by rapid PCR. Computed tomography (CT) scan without contrast on admission shows an incidental finding of a pancreatic mass (see Figure 1). Abdominal CT with contrast shows a large, multiloculated cystic mass in the pancreatic tail (see Figure 2). Laboratory examination depicted lipase: 27 U/L, CA19-9: 72 U/mL, CEA: 6.5 ng/mL, CA125: 24 U/mL, erythrocyte sedimentation rate (ESR):2 mm/h, Total Bilirubin: 0.6 mg/dl, Direct Bilirubin: 0.1 mg/dl. Following treatment, the patient recovered fully and is discharged from the hospital 10 days later with home oxygen therapy. Case2 An 81-year old Caucasian lady presented to the outpatient clinic with complaints of fecal incontinence. She tested positive for COVID-19, four months before her visit. CT scan of the abdomen with oral contrast revealed multiple hypodense masses on the pancreas measuring 0.3cm in diameter (see Figure 3). Laboratory tests reveal CA19-9: 57 U/mL, CA125: 8 U/mL, CEA: 1.9 ng/mL, erythrocyte sedimentation rate (ESR):11 mm/h, C-reactive protein: 0.7 mg/L, Total Bilirubin: 1.5 mg/dl, Direct Bilirubin: 1.3 mg/dl. Following outpatient treatment and follow-up, the patient's symptoms were relieved. DISCUSSION: Pancreatic lesions in COVID-19 patients can be caused directly by the cytopathic effects of the viral infection, or indirectly by systemic responses to inflammation or respiratory failure. Several studies have shown that ACE2 is the functional receptor used by SARS-CoV-2 to gain access to target cells (2) and ACE-2 receptors are expressed in significant amounts in the pancreas (3). In the first case, an incidental finding of a multi-cystic pancreatic mass on admission was reported. There was no pancreatic ductal dilation on the CT scan, which may indicate a direct injury caused by cytopathic effects of the virus rather than inflammation resulting in exocrine secretions forming cysts. In the second case, multiple masses on the pancreas were found after recovering from COVID-19. These lesions could be remnants of a previous pancreatic injury during the acute phase of the infection. CONCLUSIONS: COVID-19 infection may trigger pancreatic injury in some patients. Reference #1: Yong, Shin Jie. Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infectious diseases. 2021 Oct;53(10): 737–754. Reference #2: Ma C, Cong Y, Zhang H. COVID-19, and the Digestive System. Vol. 115, American Journal of Gastroenterology. Wolters Kluwer Health;2020. p. 1003–6. Reference #3: Liu F, Long X, Zhang B, Zhang W, Chen X, Zhang Z. ACE2 Expression in Pancreatic Damage After SAERS-CoV-2 Infection. Gastroenterology. 2020 Aug 1;18(9): 2128 – 2130.e2. DISCLOSURES: No relevant relationships by Ailine Canete Cruz No relevant relationships by Claudia Ramirez No relevant relationships by Joseph Varon No relevant relationships by Mohamed Ziad

12.
Chest ; 162(4):A836, 2022.
Article in English | EMBASE | ID: covidwho-2060701

ABSTRACT

SESSION TITLE: Unique Inflammatory and Autoimmune Complications of COVID-19 Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Coronavirus disease 2019 (COVID-19) can manifest as a severe immunologic syndrome known as hemophagocytic lymphohistiocytosis (HLH). HLH is a hyper-inflammatory state with a lethal mortality rate, especially when discovered late in the disease process. The optimal timely approach to diagnosis and treatment of secondary HLH in COVID-19 is unclear, however, risk stratification with Hscore using biomarkers can be useful to increase confidence in an HLH diagnosis. CASE PRESENTATION: A 36-year-old morbidly obese male with a history of well controlled mild intermittent asthma presented to the hospital complaining of a one week history of dyspnea and cough after failing outpatient COVID-19 treatment. Upon arrival, he was hypoxic on room air and was placed on non-invasive ventilation. He unfortunately decompensated further and was transferred to the intensive care unit where he was intubated for severe hypoxia and increased work of breathing. His course was complicated by superimposed bacterial pneumonia, vasopressor dependent septic shock, and anuric acute kidney injury requiring continuous renal replacement therapy. He remained profoundly hypoxic despite rescue therapy with multiple sessions of prone ventilation. On hospital day seventeen his platelets declined acutely and a serotonin release assay confirmed heparin-induced thrombocytopenia. His clinical status remained tenuous into the third week of admission. Notably, he developed persistent fever with associated bicytopenia and elevated lactate dehydrogenase, D-dimer, fibrinogen, triglycerides, and aspartate aminotransferase. His calculated Hscore was 189. Hematology recommended initiating HLH therapy with daily dexamethasone and etoposide, however the latter was held due to the patient's rapid hemodynamic decline. The patient succumbed to illness after a twenty-day hospitalization. His HLH was confirmed with a positive postmortem soluble-IL-2-receptor test. DISCUSSION: Proposals of routine HLH screening in critically ill patients are endorsed to promote early detection of this morbid condition. Calculating Hscore using vital signs, imaging, laboratory tests, and patient history can guide suspicion of diagnosis, since HLH-specific markers are often not feasible. Hscores more than 169 correspond to 93% sensitivity and 86% specificity in HLH diagnosis. Immunosuppression is standard therapy with hematology guidance due to the complex pathophysiology and limited research. CONCLUSIONS: This case emphasizes the importance of understanding the relationship between COVID-19 and secondary HLH. A timely diagnosis is vital in order to attempt to effectively treat a syndrome that carries a 65% mortality rate. Reference #1: Dimopoulos G, Mast Q. de, Markou N, et al. Favorable Anakinra responses in severe COVID-19 patients with secondary hemophagocytic lymphohistiocytosis. Cell Host Microbe 2020;doi: 10.1016/j.chom.2020.05.007. PubMed PMID: 32411313. Reference #2: Bauchmuller K, Manson JJ, Tattersall R, et al. Haemophagocytic lymphohistiocytosis in adult critical care. J Intensive Care Soc 2020;21:256–68. Reference #3: Schnaubelt, Sebastian MDa,∗;Tihanyi, Daniel MDb;Strassl, Robert MDc;Schmidt, Ralf MDc;Anders, Sonja MDb;Laggner, Anton N. MDa;Agis, Hermine MDd;Domanovits, Hans MDa Hemophagocytic lymphohistiocytosis in COVID-19, Medicine: March 26, 2021 - Volume 100 - Issue 12 - p e25170 doi: 10.1097/MD.0000000000025170 DISCLOSURES: No relevant relationships by Kristina Catania No relevant relationships by Katie Kennedy No relevant relationships by Josef Kinderwater No relevant relationships by MaryKate Kratzer no disclosure submitted for Ogugua Obi;

13.
Chest ; 162(4):A496, 2022.
Article in English | EMBASE | ID: covidwho-2060612

ABSTRACT

SESSION TITLE: Pathologies of the Post-COVID-19 World SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: Tuberculosis, caused from infection by M. tuberculosis, affects 2.7 per 100,000 people in the United States. 1 Miliary, or disseminated, TB is a progressive disease characterized by lymphohematogenous dissemination of TB infection that occurs in only 1-2% of TB cases. Little research has gone into pulmonary complications post recovery from COVID-19 infection, especially reactivation of latent TB. Here we present a case of reactivation of latent TB and progression to miliary TB in the setting of post COVID infection. CASE PRESENTATION: A 49-year-old male presented to the ER with fever, shortness of breath, and chest pain. His CXR showed diffuse bilateral, multifocal infiltrates and laboratory testing later came back positive for COVID-19. Two days later, he came back to the ED with acute respiratory failure with 87% oxygen saturation with ambulation. A CT chest done that showed diffuse lung disease consistent with COVID-19 infection, and a right upper lobe lesion likely a granuloma (image 1). He was treated for COVID pneumonia for ten days in the hospital with Decadron, Lasix, and tocilizumab. He required high flow nasal canula during the hospitalization and was discharged when his respiratory status had improved. One year later, he returns with few days of hemoptysis, fever, and chills. He had a progressive cough and 19 pound weight loss overt the last month. Clinically, he appeared mildly diaphoretic without acute distress. He had a room-air oxygen saturation of 95% without labored respiration and did not have increased oxygen demand. CT of the showed diffuse pulmonary parenchymal abnormalities and uniform nodular consolidative changes in the upper lobes bilaterally with areas of cavitation and multiple areas of lung parenchymal changes consistent with miliary TB (image 2). Sputum culture was positive for acid-fast bacilli, and he was started on RIPE therapy with rifampin, isoniazid, pyrazinamide, and ethambutol. He was symptomatically improved within one week of admission and was hospitalized until three negative sputum cultures were drawn. DISCUSSION: This case report gives us novel understanding of the extent of possible complications post recovery from COVID-19 infection. We have already started to see many patients who have recovered from an initial COVID infection, but progressed to secondary lung disease due to this. In our patient particularly, during his initial presentation he was seen to have upper lobe granulomatous disease with concern for latent TB. It is likely that due to the extent of damage done to his lung parenchyma over time it led to reactivation of his latent TB. As we see more patients recovering from COVID infections, we are likely to see more of similar cases of latent infection reactivation. CONCLUSIONS: Patients with latent TB are likely at a high risk of reactivation post recovering from COVID-19 infection, due to immunosuppression and lung parenchymal damage Reference #1: Trends 2019 ;Data & Statistics ;TB ;CDC. Cdc.gov. https://www.cdc.gov/tb/publications/factsheets/statistics/tbtrends.htm. Published 2021. Accessed September 25, 2021. Reference #2: Rodriquez-Morales AJ et al. Clinical, laboratory, and imaging features of COVID-19: a systemic review and meta-analysis. Travel Med Infect Dis. 34: 101623 Reference #3: Colditz GA, Brewer TF, Berkey CS, et al. Efficacy of BCG vaccine in the prevention of tuberculosis. Meta-analysis of the published literature. JAMA. 1994;271(9):698-702 DISCLOSURES: No relevant relationships by Sharmin Asha No relevant relationships by Heather Bernstein no disclosure on file for zachary brittingham;no disclosure on file for Vedee Ramdass;

14.
International Journal of Toxicological and Pharmacological Research ; 12(9):274-280, 2022.
Article in English | EMBASE | ID: covidwho-2058612

ABSTRACT

Introduction: The emergence of the COVID-19 pandemic in 2020, have similar effect on pregnant women as influenza or other coronavirus infections. The impact of the COVID-19 pandemic is likely to be context specific and differ depending on a variety of country-specific factors. A global pandemic is likely to only reveal its consequences after significant time passes, and literature published before or immediately after policies are implemented may not capture all relevant outcomes. Material(s) and Method(s): The study was conducted in the Department of Obstetrics and Gynaecology, Gandhi Medical College, Bhopal. It included all antenatal COVID 19 patients which reported to the hospital during April 2020 to May 2021, 1st wave from April 2020 to December 2020 and second wave from Jan 2021 to May 2021 after taking due informed consent. The detailed history and full clinical and general examination were performed using a predesigned proforma. The antenatal patients were categorized into mild, moderate and severe COVID. Data on clinical manifestations, laboratory tests, maternal and perinatal outcomes were extracted and analysed. The comparisons of 1st wave and second wave was done. Result(s): There were 210 confirmed pregnant women with coronavirus disease (COVID-19). 26 maternal deaths occurred from these confirmed cases. Compared to pregnant women without COVID-19, pregnant women with a confirmed COVID-19 diagnosis had an increased risk of maternal complications and caesarean section. In initial months (April 20 to December 20) there were 89 confirmed cases of covid 19 and 4 maternal mortality and from January 21 to May 21 there were 121 cases and 22 maternal deaths. The second wave has taken greater toll on life of pregnant women. Conclusion(s): In the second wave, pregnant women with severe or critical coronavirus disease were admitted to the ICU, intubated if they require mechanical ventilation, and were at increased risk of composite morbidity. Thus, the second wave affected the pregnant women in a much serious way and the maternal as well as fetal outcome were very poor. Copyright © 2022, Dr. Yashwant Research Labs Pvt. Ltd.. All rights reserved.

15.
Medical Forum Monthly ; 33(5):99-103, 2022.
Article in English | EMBASE | ID: covidwho-2058224

ABSTRACT

Objective: To evaluate radiological features of Covid-19 and early lung cancer through High-resolution computed tomography (HRCT) and demonstrate the disparity between them. Study Design: A retrospective study Place and Duration of Study: This study was conducted at the Covid-19 ward, Oncology, Radiology Ward of Nishtar Medical University & Hospital Multan from 12th Nov 2019 to 12th Nov 2020. Materials and Methods: A total of 100 Covid-19 patients and 300 patients with pulmonary ground-glass opacities undergoing lung surgery (control group) were included in the study. After propensity score-matched analysis, patients were divided into two groups with 80 matched pairs each. The clinical, pathological, epidemiological, and radiological characteristics (evaluated through HRCT) of both groups were compared. Results: It was observed that Covid-19 patients presented more definite symptoms, were mostly younger men, and had higher BMI (body-mass index). After the radiological analysis of the matched patients, it was revealed that single lesion patients constituted 17% of Covid-19 cases and 89% of lung cancer cases. Patients in both groups mostly presented peripheral lesions. Covid-19 lesions had more lobes, segments and had various types with patchy forms. On the other hand, lung cancer tended to have only one type and had an oval form. Conclusion: Both Covid-19 and lung cancer showed ground-glass opacities with similar but independent characteristics. These characteristics combined with pathogen detection, short-term CT examination, and laboratory tests will aid in improved diagnosis.

16.
European Journal of Molecular and Clinical Medicine ; 9(4):2279-2285, 2022.
Article in English | EMBASE | ID: covidwho-2057977

ABSTRACT

Background: The COVID- 19 infections are associated with wide range of bacterial and fungal co-infections. They may be associated with various comorbidities. Definite diagnosis requires demonstration of fungi in tissue sections or in culture. Yield of organism in culture is suboptimal. Hence histopathology plays critical role in establishing the diagnosis and provide evidence of tissue invasion. Objective(s): To study the histopathological features of fungal infections in sino nasal, oral and orbital area associated with COVID-19 patients. Material(s) and Method(s): One hundred twenty cases of fungal infections involving sinonasal, oral and orbital area in laboratory confirmed COVID-19 positive patients between June-September 2021 were taken for study. Clinical data was recorded, histopathological examination was done along with periodic acid Schiff stain and culture report was obtained. Result(s): The study included 92(76.6%) males and 28(23.3%) females with age ranging from 13 to 78 years. The tissues included debridement, biopsy and excision specimen. Acute inflammation was seen in 8(6.66%) cases, chronic inflammation in 112(93.33%), granulomas in 25, thrombosis in 14, necrosis in 104, angioinvasion in 13, perineuritis in 10 and bone invasion in 18 cases. Mixed fungal infection was seen in 11cases. Conclusion(s): Histopathology remains the mainstay in diagnosis of invasive fungal infections especially when culture is negative. Copyright © 2022 Ubiquity Press. All rights reserved.

17.
Medical Journal of Malaysia ; 77(Supplement 1):31-34, 2022.
Article in English | EMBASE | ID: covidwho-2057521

ABSTRACT

Introduction: Although CD4 and CD8 T-cells are the main subset of T-lymphocytes, their roles in COVID-19 infection and severity remain unclear. This study aimed to determine the role of increased CD4/CD8 T-cells ratio as a risk factor for cases of 28-days in-hospital mortality in COVID-19 patients. Material(s) and Method(s): This study employed a prospective cohort design. Inclusion criteria were confirmed COVID-19 cases with a positive polymerase chain reaction report. CD4 and CD8 T-cells absolute counts were measured by flow cytometry. The CD4/CD8 ratio was calculated by dividing the absolute count of CD4 by that of CD8 T-cells. Result(s): A total of 85 subjects were followed for 28 days. The mean age of the subjects was 52.64 years, and majority of them were females (51.8%). Twenty-eight (32.9%) subjects died within 28 days of follow-up. Receiver operating characteristics analysis obtained an area under curve of 0.68 with the cut-off value 1.26 with p = 0.005. Kaplan-Meier's analysis obtained Hazard Ratio 2.91 (95%CI 1.377-6.161;p = 0.0052). Conclusion(s): Subjects with an increase in CD4/CD8 T-cells ratio >1.26 had a 2.91-times risk of 28 days in-hospital mortality. Copyright © 2022, Malaysian Medical Association. All rights reserved.

18.
T-Labs Series in Telecommunication Services ; : 81-96, 2023.
Article in English | Scopus | ID: covidwho-2048003

ABSTRACT

In this chapter, research about the assessment of video quality for gaming content will be provided. At first, a dataset that was used for the development of the ITU-T Rec. G.1072 will be presented. The dataset was created in a laboratory environment using the passive test paradigm described in Chap. 3. Next, some results of the collected video quality ratings will be illustrated. While QoE assessment studies traditionally make use of controlled laboratory environments, there are also other possibilities to conduct user studies without a laboratory environment. Especially during the COVID-19 pandemic, which prevented many researchers from performing lab studies, the concept of supervised and unsupervised remote studies got lots of attention. By using such a remote study design, two studies assessing video quality ratings of similar conditions as in the previously mentioned dataset were conducted. These two studies allow to address three research topics that will be the focus of the remainder of this chapter. At first, it will be investigated whether video quality ratings obtained using the remote study design are comparable to those collected in the lab environment. Second, a comparison between video quality ratings collected using a stimulus duration of 20 s instead of 30 s will be performed, which tries to answer whether it is enough to use a shorter stimulus duration as proposed in ITU-T Rec. P.809. Lastly, the differences between using a discrete 5-point ACR scale and the extended continuous 7-point scales will be investigated. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

19.
129th ASEE Annual Conference and Exposition: Excellence Through Diversity, ASEE 2022 ; 2022.
Article in English | Scopus | ID: covidwho-2045264

ABSTRACT

Because of the Covid-19 Pandemic during academic year 2020-2021, many of the classes and laboratories in our undergraduate Electrical Engineering (EE) program were conducted remotely, making tremendous use of videoconferencing technologies such as Microsoft Teams, and simulation engines such as National Instruments' MultiSimTM. As we began to move back to “in person” learning for the Fall of 2021, our EE faculty observed some early weaknesses in student achievement of ABET EE student outcome #6 (an ability to develop and conduct appropriate experimentation, analyze and interpret data, and use engineering judgment to draw conclusions). We found that while students demonstrated excellent proficiency in using modern tools such as MATLABTM and MultiSimTM (which had been used extensively during remote classes), they appeared considerably weaker in making independent measurements using laboratory hardware such as oscilloscopes, dynamic signal analyzers (FFT analyzers), RF analyzers, and even commonly used voltage and current meters (which had not been used much during remote learning). Here we highlight specific student shortcomings we observed in laboratory skills as students began their in-person lab experiences during the Fall 2021 semester. We then discuss our approaches to remedy these shortcomings during the Fall 2021 semester to improve student confidence and proficiency in the use of laboratory instrumentation. We also highlight the improvements we saw in achievement of ABET student outcomes. While computer simulation has its place in undergraduate education, practical testing and measurement of electronic systems does require physical measurement and interaction using modern test equipment, and we identified some areas for timely improvement. Our focus in this paper is on improved student performance in using laboratory test equipment in Linear Circuits and Antennas courses. In the Linear Circuits course, students use the Oscilloscope and Dynamic Signal Analyzer to identify the characteristics of several op-amps and circuits (e.g, op-amp open-loop frequency response, gain-bandwidth product, slew rate, output impedance, closed-loop frequency response of an inverting amplifier), and in the in the Antennas course students use the RF analyzer to characterize the behavior of RF circuits, transmission lines and antennas. We show how our increased emphasis on lab skills for the Fall 2021 semester, coupled with unique assessment tools, significantly improved achievement of student outcome #6. More specifically we share the successes we experienced in using oral individual quizzes during lab meetings, group classroom quizzes, individual student observation of setup and measurement, and adding questions related to lab skills and experiences on hourly examinations. © American Society for Engineering Education, 2022

20.
Journal of Pure and Applied Microbiology ; 16(3):1628-1632, 2022.
Article in English | EMBASE | ID: covidwho-2044322

ABSTRACT

Strongyloidiasis is a neglected parasitic disease caused by the intestinal parasite, Strongyloides stercoralis. Most patients with strongyloidiasis are asymptomatic, but few present with varied clinical manifestations such as cutaneous, gastrointestinal, pulmonary, and disseminated disease. It creates a diagnostic dilemma and undue delay in the diagnosis of patients. We report the case of a 79-yearold male who presented with fever and abdominal pain due to strongyloidiasis with no history of immunosuppression. The infection resolved entirely on treatment with ivermectin.

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