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1.
NeuroQuantology ; 20(9):1751-1763, 2022.
Article in English | EMBASE | ID: covidwho-2067287

ABSTRACT

Infectious disease Covid-19 is a fast-spreading virus that infects both human beings and animals. As a result of this condition, animals may get infected with the virus. This fatal viral illness has an impact on not only the day-to-day lives of people but also their health and the economy of the nation in which they live. There is currently no vaccination available for COVID-19, regardless of the fact it is a global epidemic that is growing rapidly across the globe. Since then, the virus has swiftly spread over the globe, turning into a pandemic (WHO, 2020), with the number of reported cases and fatalities connected with them continuing to rise on a daily basis. At the moment, more research on an efficient screening technique is necessary in order to diagnose instances of the virus and separate those who have been infected from the rest of the population. To limit the spread of the fatal virus and defend themselves from it, medical practitioners and specialists in many nations across the world are introducing multifunction testingto improve their treatment regimen and testing capacity. This is currently being done to enhance their capacity to detect the infection. When COVID-19-infected patients were studied in a clinical area, it was observed that they were often infected with respiratory illnesses. This conclusion was reached as a result of the findings of the study. Imaging techniques such as chest x- rays (also known as radiography) and chest CT scans are more accurate than other methods when it comes to detecting issues that are connected to the lungs. A thorough chest x-ray is less expensive than a chest CT, albeit. The most successful method of machine learning uses deep learning technologies. This is a great tool for analysing a large number of chest x-ray images, which could significantly affect the Covid-19 screening process. Copyright © 2022, Anka Publishers. All rights reserved.

2.
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.

3.
Pharmaceutical Journal ; 307(7956), 2022.
Article in English | EMBASE | ID: covidwho-2065006
4.
American Journal of Transplantation ; 22(Supplement 3):660, 2022.
Article in English | EMBASE | ID: covidwho-2063476

ABSTRACT

Purpose: Kidney transplantation (KT) from coronavirus disease 2019 (COVID-19) positive donors has been avoided due to concerns for donor-derived transmission and possibility of the kidney being a viral reservoir. There is no long-term safety data, and sensitive molecular testing for SARS-CoV-2 in donor kidney is not routinely performed. We report a case of successful KT from a deceased donor who died from severe COVID-19 respiratory illness whose donor kidney and aorta were probed for virus using in situ hybridization (ISH) and quantitative reverse transcriptionpolymerase chain reaction (qRT-PCR). Method(s): A 30-year-old female was admitted to the hospital with severe COVID-19 pneumonia with a positive RT-PCR test for SARS-CoV-2 on nasopharyngeal swab. With clinical worsening, she was placed on extracorporeal membrane oxygenation, but developed hypoxic brain injury and progressed to brain death. Renal function was stable during her hospital course with serum creatinine concentration of 0.7 mg/dL. SARS-CoV-2 RT-PCR on bronchoalveolar lavage and nasopharyngeal samples tested again three days prior to donation was negative. A 55-year-old male recipient with an end-stage renal disease secondary to hypertension was transplanted with the left kidney from the above donor. The donor kidney was studied using pre-implantation surgical biopsy tissues to investigate the presence of SARS-CoV-2 RNA. Aorta tissue with the kidney was also studied given high expression of angiotensin-converting enzyme 2 receptors in vasculature. Result(s): ISH analyses did not show any positive signal for SARS-CoV-2 RNA in the donor kidney sample compared to a SARS-CoV-2 positive lung control. All samples tested by qRT-PCR were also negative for SARS-CoV-2. We found no evidence of SARS-CoV-2 mRNA in the donor kidney and aorta. The recipient has been free of COVID-19 related signs or symptoms and tested negative for SARSCoV- 2 by nasopharyngeal swab RT-PCR on days 20, 30, and 90 following KT. After an initial period of delayed graft function requiring hemodialysis, the recipient now has excellent renal recovery over 6 months following the transplant, and the most recent creatinine is 1.3 mg/dL. Conclusion(s): Taken together with recent observations of successful KT outcomes from mild or asymptomatic COVID-19 donors, we believe that the transmission risk of SARS-CoV-2 through KT is likely to be very low. Use of deceased donors who died after severe COVID-19 can be considered for KT. Larger scale studies are needed to confirm our findings.

5.
Hypertension. Conference: American Heart Association's Hypertension ; 79(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2064363

ABSTRACT

Background: Connected health technology can enable healthcare professionals to provide multiple solutions to meet the growing demand of care and control of COVID-19 infected patients, by optimizing economic resources and extending the scope of monitoring beyond the hospital. An innovative mobile device, the BioBeat Watch, developed in Israel, with an APP that can be downloaded directly to the Smart Phone, is characterized by sensors already validated according to the regulations of the Food and Drug Administration for vital signs, the ECG track and the European Society Hypertension for the detection of blood pressure. Purpose(s): Wearable medical devices and the BioBeat software platform are appropriate for use in different settings for the management of acute, chronic cardiovascular, respiratory and inflammatory pathology, a tool capable of early identification of the instrumental signs of deterioration even before the exclusively clinical recognition that becomes even more difficult if we consider the patients at home.The aim of this study is to test the sensitivity and specificity of the biobeat wearable system applied in patients with paucisymptomatic COVID-19 infection (group A) and in those with previous SARS-COV2 disease discharged from the hospital who still needed post-acute monitoring (group B) and compared with clinical control, managing to determine early the clinical signs of worsening. Method(s): The data recorded by individual patients are systolic and diastolic blood pressure, heart and respiratory rate, peripheral oxygen saturation and body temperature. The criteria of deterioration or worsening of the clinical condition are represented by the need to hospitalize the patient, alteration of one of the criteria grouped in the ABCDE. Result(s): We calculated the sensitivity of the methodology related to the alerts detected and the outcome of the patients. Sensitivity was 86.3% with a 95% CI of 0.71 to 1.03 and a specificity of 7.7%. Conclusion(s): Continuous monitoring with biobeat watch showed a high sensitivity in detecting early any alerts predictive of worsening of the disease.

6.
Chest ; 162(4):A2473, 2022.
Article in English | EMBASE | ID: covidwho-2060948

ABSTRACT

SESSION TITLE: Unique Uses of Pulmonary Function Tests SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Asthma is one of the most common chronic respiratory illnesses affecting quality of life of patients, mortality as well as a high impact on health care utilization. In the era of the COVID19 pandemic, telemedicine and remote patient monitoring (RPM) have been heavily utilized by healthcare systems and providers for patient care. In our pilot program at a large US healthcare center, we enrolled patients known to have asthma to evaluate how RPM could be of value to both the patients and providers. METHODS: Patients included in the study had a confirmed diagnosis of moderate/severe asthma, were at least 18 years of age, and had access to an Android/iOS mobile device with internet access. The patients were excluded from the study for any conditions that would prevent them from using an app such as visual, cognitive, or other impairments that may prevent the patient from being able to participate. Patients were provided with a connected mobile spirometer, the KevaTalk app on their phones and educational introductory sessions during 9 months of the study. Each patient had their action plan and list of medications entered into the Keva365 platform by the nurse or the patient themselves. We provided a baseline patient questionnaire to assess usefulness and evaluate the app features, an ATAQ questionnaire for asthma control and a Smoking cessation questionnaire. Patients were asked to check in daily into the app as green (no symptoms), yellow (some symptoms) or red (bad symptoms). Patients were asked to perform spirometry using a connected spirometer. Remote monitoring protocols were set up for patients which included specific requirements for alerts being escalated to the pulmonologists. We monitored check-ins, alerts, and escalations during the study time window. RESULTS: A total of 25 patients were included in this pilot. Mean age was 57 and majority (23) were female. A baseline questionnaire rating the app, indicated that ease of check-in and ease of modification to the patient's asthma plan were the two highest rated features. 2066 total check ins (1550 green, 506 yellow and 10 red checkins) and 1155 spirometry sessions were recorded during this period. 484 alerts were recorded and evaluated by the monitoring team, of which 37% required an escalation to the physician requiring an intervention which included transfer to a medical facility, change in respiratory medication or further education. CONCLUSIONS: Patient driven engagement along with a well executed RPM program leads to increased compliance and improved outcomes among patients with respiratory illnesses. CLINICAL IMPLICATIONS: Our findings demonstrate preliminary evidence of the clinical impact of respiratory focused remote monitoring combined with a process for triaging our pulmonary patients. Adoption by pulmonolgists and allergists of these digital remote programs can pave the way for reduced physican burden, improved outcomes and reduced costs. DISCLOSURES: No relevant relationships by Karim Anis No relevant relationships by Jyotsna Mehta No relevant relationships by Shail Mehta No relevant relationships by Denzil Reid

7.
Chest ; 162(4):A2407, 2022.
Article in English | EMBASE | ID: covidwho-2060943

ABSTRACT

SESSION TITLE: Racial Disparities in Pulmonary Embolism Risk Factors and Mortality in the SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 1:30 pm - 2:30 pm PURPOSE: Racial disparities in pulmonary embolism (PE) related mortality rates have been reported for decades in the United States (US). The risk factors contributing to the observed disparity remain unclear. Our objective is to examine recent PE-related mortality trends and PE risk factors by race. We hypothesize racial disparity gap in PE-related mortality and risk factors has persisted and might have widened with the COVID 19 pandemic. METHODS: The Centers for Disease Control and Prevention (CDC) wide-ranging online data for epidemiologic research for both underlying cause of death (UCOD) and multiple causes of death (MCOD) in the US between the years 1999-2020 was used for this study. Non-Hispanic black (NHB) and non-Hispanic white (NHW) decedents aged 25 years and older with an ICD-10 code for PE (I26) were included. Age-adjusted mortality rates (AAMR) with 95% Confidence Intervals (CIs) were computed by race for age groups, year, Health & Human Services (HHS) regions, and urbanization and PE risk factors. Risk factors examined were trauma, cancer, cardiovascular diseases, obesity, sepsis, chronic lower respiratory diseases, and COVD-19 among PE decedents. RESULTS: Between the years 1999-2020, PE was the UCOD in 168,540 decedents, with 137,128 (81.4%) NHWs and 31,412 (18.6%) NHBs. The overall age-adjusted mortality rate (AAMR) decreased from 1999(5.3;95% CI, 5.2 - 5.4) to 2009(3.6;95% CI, 3.5 - 3.7), and then increased from 2010(3.8;95% (3.7 - 3.8) to 2020(4.2;95% CI, 4.1 - 4.3).There was a steep rise in the overall AAMR for 2020 (4.2;95% CI, 4.1 - 4.3) compared to the year prior 2019 (3.9;95% CI, 3.8 - 4.0) with highest annual % change among NHBs when compared to NHWs (NHB men (13%), NHB women (15%), NHW men (8.3%), NHW women (6%).) NHB men (AAMR 7.2;95% CI, 7.1-7.4) and NHB women (AAMR 6.6;95% CI, 6.5-6.7) had 2-fold higher AAMR compared to NHW men (AAMR 3.8;95% CI, 3.8-3-9) and NHW women (AAMR 3.7;95% CI, 3.7-3.7). Similar trends were also noted in geographical regions. The highest AAMRs were in HHS regions 3, 4, 5,6, 7, and 8. Within these HHS regions, NHBs and NHWs who resided in small metro and non-metropolitan areas had the highest AAMRs. However, NHB-NHW disparity in AAMR was seen in all 10 HHS regions and Urbanization. When risk factors such as trauma, cancer, obesity, cardiovascular diseases, sepsis, and chronic lower respiratory diseases were each mentioned as MCOD with PE decedents, rates varied by risk factor but NHBs had consistently higher AAMR than NHWs. CONCLUSIONS: We showed that PE-related mortality has increased over the past decade and racial disparities persisted and varied by gender, region, urbanization, and risk factors. The decades-long disparity observed in PE-related mortality may be narrowed by allocating resources to the management of common comorbidities. CLINICAL IMPLICATIONS: Racial disparity in PE-related mortality is related to comorbidities listed in MCOD data. DISCLOSURES: No relevant relationships by Isaac Ikwu No relevant relationships by Alem Mehari No relevant relationships by Lamiaa Rougui

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):A1868, 2022.
Article in English | EMBASE | ID: covidwho-2060878

ABSTRACT

SESSION TITLE: Drug-Induced Lung Injury Pathology Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Acute eosinophilic pneumonia (AEP) is an atypical cause of acute hypoxic respiratory failure in adults, however if not identified can prove to be fatal. It can all be a COVID19 mimic during the pandemic. AEP has several causes, such as inhalational drugs, infections and various pharmaceuticals. Often, patients will have an acute respiratory syndrome for less than one-month, pulmonary infiltrates on chest computed tomography (CT) or radiography (CXR), in addition to bronchoalveolar lavage (BAL) with more than 25% of eosinophils. CASE PRESENTATION: A 79 y/o man underwent an elective total knee replacement complicated by acute lower limb ischemia from an occluded bypass graft. He developed methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococcus (VRE) joint and soft tissue infection of the lower extremity. He was prescribed a 6-week course of Daptomycin. He presented about 3 weeks into treatment with shortness of breath. He was initially diagnosed with acute on chronic congestive heart failure (CHF) exacerbation and COVID negative. He was initially treated with diuretics. He developed acute renal failure requiring dialysis and acute hypoxic respiratory failure requiring intubation. CXR revealed bilateral lung infiltrates with BAL having 80% eosinophils, eosinophilia and urinalysis positive for eosinophils. Daptomycin was discontinued and he was started on systemic steroids for a two-week course. He was successfully extubated 5 days after diagnosis of AEP and was subsequently discharged to a rehabilitation facility on lifelong Doxycycline for MRSA prosthetic joint infection prophylaxis. DISCUSSION: AEP related to Daptomycin was first reported in 2007, in a patient that developed the condition after receiving treatment for endocarditis. Daptomycin caused an inflammatory reaction within the lungs, due to an accumulation of the drug within the pulmonary surfactant. Our case report patient met all components for AEP diagnosis, in addition to symptom onset being approximately 3 weeks into treatment. The ultimate treatment for AEP is to stop the reversible cause, if identifiable, along with glucocorticoids and symptomatic support. Prognosis for patients with AEP is excellent when diagnosis is prompt, and usually infiltrates are resolved within 1 month without long term adverse pulmonary effects. Our patient was discharged to an acute rehab facility without supplemental oxygen therapy and continues to improve from functional standpoint. This case a definite cause of AEP from Daptomycin presented as COVID19 pneumonia mimic. It highlights the importance of rapid diagnosis to prevent morbidity and mortality. CONCLUSIONS: The differential in a patient with acute hypoxic respiratory failure is numerous, especially during the COVID19 pandemic. During these challenging times, it is important to think of atypical causes, such as AEP to improve the patient's clinical status. Reference #1: Allen JN, Pacht ER, Gadek JE, Davis WB. Acute Eosinophilic Pneumonia as a Reversible Cause of Noninfectious Respiratory Failure. N Engl J Med. 1989;321:569-574 Reference #2: Hayes Jr. D, Anstead MI, Kuhn RJ. Eosinophilic pneumonia induced by daptomycin. J Infect. 2007;54(4):e211-213. Reference #3: Rachid M, Ahmad K, Saunders-Kurban M, Fatima A, Shah A, Nahhas A. Daptomycin-Induced Acute Eosinophilic Pneumonia: Late Onset and Quick Recovery. Case Reports in Pulmonology. 2017. DISCLOSURES: No relevant relationships by Moses Bachan No relevant relationships by Zinobia Khan No relevant relationships by Kaitlyn Mehern

10.
Chest ; 162(4):A1597, 2022.
Article in English | EMBASE | ID: covidwho-2060847

ABSTRACT

SESSION TITLE: Using Imaging for Diagnosis Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: The vaccines against SARS-CoV-2 or COVID-19 have been shown to be safe and effective at preventing severe disease and death. In a phase 3 trial the BNT162b2 mRNA COVID-19 vaccine showed a 52% and 95% efficacy after the first and second doses, respectively (1). Side effects following vaccination are common but are typically mild and self limited (2). The most common side effects are headache, fever, fatigue, arthralgias and pain at the injection site (2). More severe and devastating side effects have been reported including cerebral venous thrombosis and myocarditis (3) (4). Here we report a case of unilateral diaphragmatic paralysis following the second dose of the BNT162b2 mRNA COVID-19 vaccine. CASE PRESENTATION: The patient was a 56 year old female with a past medical history of reactive airways disease and hypertension who was seen in the pulmonology clinic shortly after receiving her second dose of the BNT162b2 mRNA COVID-19 vaccine. After her second dose she developed burning shoulder pain, erythema and swelling that extended to the neck and axilla. She went to an urgent care and was advised to treat with ice and NSAIDs, she had a chest radiograph performed which was reported to be negative. Her symptoms persisted and she was sent to the emergency room, chest x-ray showed interval development of an elevated left hemidiaphragm. A CT Chest with inspiratory and expiratory films was performed and the left diaphragm was noted to be in the same location during inspiration and expiration consistent with diaphragmatic paralysis. PFT showed a reduction in her FVC, TLC and DLCO compared to 13 years prior. DISCUSSION: Diaphragmatic paralysis is a well described clinical entity that is most often associated with cardiothoracic surgery where hypothermia and local ice slush application are thought to induce phrenic nerve injury (5). It has also been described as a complication of viral infections, including a recent report of unilateral diaphragm paralysis in a patient with acute COVID-19 infection (6). In a case series of 246 patients with amyotrophic neuralgia which can include diaphragm paralysis, 5 patients received a vaccine in the week before developing symptoms (8) Additionally, Crespo Burrilio et al recently described a case of amyotrophic neuralgia and unilateral diaphragm paralysis following administration of the Vaxzevri (AstraZeneca) COVID-19 vaccine (7). This case highlights a potential side effect of the BNT162b2 mRNA COVID-19 vaccine that has not been previously reported CONCLUSIONS: Reference #1: Polack FP, Thomas SJ, Kitchin N. Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine. N Engl J Med. 2020;383:2603–2615. Reference #2: Menni, C., Klaser, K., May, A., Polidori, L., Capdevila, J., Louca, P., Sudre, C. H., Nguyen, L. H., Drew, D. A., Merino, J., Hu, C., Selvachandran, S., Antonelli, M., Murray, B., Canas, L. S., Molteni, E., Graham, M. S., Modat, M., Joshi, A. D., Mangino, M., … Spector, T. D. (2021). Vaccine side-effects and SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study app in the UK: a prospective observational study. The Lancet. Infectious diseases, 21(7), 939–949. https://doi.org/10.1016/S1473-3099(21)00224-3 Reference #3: Jaiswal V, Nepal G, Dijamco P, et al. Cerebral Venous Sinus Thrombosis Following COVID-19 Vaccination: A Systematic Review. J Prim Care Community Health. 2022;13:21501319221074450. doi:10.1177/21501319221074450 DISCLOSURES: No relevant relationships by Jack Mann No relevant relationships by John Prudenti

11.
Chest ; 162(4):A1141, 2022.
Article in English | EMBASE | ID: covidwho-2060780

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: Several studies on COVID-19 have helped us better understand the dynamics of this viral illness. Initially considered to be a respiratory disease, research later showed that it was the initiation of an aggressive systemic inflammatory response including a prothrombotic state. Clinicians have used inflammatory markers such as D-dimer as an indicator for underlying thrombotic state. We present the case of a pulmonary embolism (PE) despite normal D-dimer levels. CASE PRESENTATION: A 73-year-old female with a past medical history of hypertension and recent hospitalization for COVID-19 pneumonia. D-dimer on initial admission was 150, patient was treated for COVID-19 pneumonia and discharged home on 2L of O2 via nasal cannula. She returned to the hospital 1 month later with complaints of palpitations. EKG on admission showed sinus tachycardia, the patient was found saturating at 98% on 2L of oxygen, unchanged from time of discharge, otherwise vitally stable. Patients’ wells score was calculated at 1.5 which pointed towards patients being low risk for PE, D-dimer measured at 645, was within normal limits when adjusted for age, indicating a low probability of VTE. Due to recent hospitalization and infection with COVID-19, CT Angiography was obtained and showed PE of the right main pulmonary artery extending into segmental right upper and lower lobe pulmonary arteries with no right ventricular strain. Patient was started on anticoagulation, and she was discharged home in stable condition. DISCUSSION: It is now well established that COVID 19 infection causes a hypercoagulable state, Initial recommendations for management of patients with Covid-19 included measurement of serial D-dimers throughout the course of illness. This recommendation has since changed. In our case, despite the rise in inflammatory marker, the age-adjusted value was within normal limits. In addition, Wells Score, which is used to predict DVT and PE, did not serve to be a reliable scoring system. CONCLUSIONS: Trending laboratory markers like D-dimers from previous admissions should be used as a valuable tool when post COVID disease is suspected. Any increase in D-dimer even if below the cutoff for age-adjusted D-dimer should be an indicator for further evaluation with imaging to rule out underlying clots. Reference #1: Logothetis CN, Weppelmann TA, Jordan A, et al. D-Dimer Testing for the Exclusion of Pulmonary Embolism Among Hospitalized Patients With COVID-19. JAMA Netw Open. 2021;4(10):e2128802. doi:10.1001/jamanetworkopen.2021.28802 DISCLOSURES: No relevant relationships by Kevser Akyuz No relevant relationships by Hanan Hannoodee No relevant relationships by verisha khanam No relevant relationships by Zain Kulairi No relevant relationships by DANYAL TAHERI ABKOUH

12.
Chest ; 162(4):A951, 2022.
Article in English | EMBASE | ID: covidwho-2060739

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: Multisystem inflammatory syndrome in adults (MIS-A) is a rare but clinically significant complication of COVID-19 infection characterized by severe illness with extrapulmonary organ dysfunction, markedly elevated inflammatory markers in the absence of severe respiratory illness or other obvious source of infection (1). We present a case of a 37-year-old male, with negative infectious evaluation and marked clinical improvement after administration of IVIG. CASE PRESENTATION: We present a 37-year-old black male with a past medical history of type 2 diabetes who was admitted to the hospital with shock and organ failure;prior to his presentation, he was diagnosed with COVID-19 pneumonia requiring outpatient therapy. On presentation, he was tachycardic, febrile, hypotensive with significant renal failure and lactic acidosis;inflammatory markers were elevated (CRP 640, ESR 108). Imaging was significant for mediastinal and hilar lymphadenopathy, with clear parenchyma (Figure 1). Broad coverage antibiotics, vasopressors, and stress dose steroids were initiated. Infectious evaluation was unrevealing with negative blood, urine, and sputum cultures;Echocardiogram revealed LVEF of 40% with mild RV dysfunction. His renal failure worsened, requiring CRRT. Vasculitis evaluation with ANA, ANCA, MPO, PR3, GBM, HIV, C3-C4 and cryoglobulins returned normal. Eventually, the patient was weaned from vasopressor support on hospital day four. Trials of weaning steroids resulted in recurrence of fevers and increasing vasopressor support. Given continued fevers without obvious infection there were concerns for MIS-A occurring shortly after COVID-19 infection. Antibiotics were discontinued and he received 2g/kg of IVIG with marked clinical improvement and was rapidly weaned from vasopressor support. We initiated methylprednisolone 1 mg/kg twice daily with steroid taper. He had improvement in inflammatory markers after IVIG and high dose steroids (CRP-6.7, ESR-49 prior to discharge). DISCUSSION: MIS-A is a rare disease that occurs after COVID-19 infection, with few reported cases in literature. Presentation is variable, but symptoms include high fever, dyspnea, lethargy, myalgias, and a diffuse maculopapular rash. Notably, hypoxia is not a prominent feature, a significant distinction from classic COVID-19 infection. Patel et al noted a predominance in young adults, males, and non-Hispanic black or Hispanic persons (2). The proposed mechanism stems from dysregulated immune response, with abnormal interferon production which drives macrophage activation and organ damage (3). There are no treatment guidelines available, and treatment of MIS-A is extrapolated from MIS-C and includes immunomodulatory therapies with IV IG, IL-1 receptor antagonist, and methylprednisolone. CONCLUSIONS: Prompt recognition of MIS-A critical given its potential for significant multi-organ dysfunction. Reference #1: Centers for Disease Control and Prevention. Multisystem Inflammatory Syndrome in Adults (MIS-A) Case Definition Information for Healthcare Providers. Available at Multisystem Inflammatory Syndrome in Adults (MIS-A) Case Definition Information for Healthcare Providers (cdc.gov). Accessed 3/19/2022 Reference #2: Patel, P., Decuir, J., Abrams, J., Campbell, A. P., Godfred-Cato, S., & Belay, E. D. (2021). Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults: A Systematic Review. In JAMA Network Open (Vol. 4, Issue 9). https://doi.org/10.1001/jamanetworkopen.2021.26456 Reference #3: Weatherhead, J. E., Clark, E., Vogel, T. P., Atmar, R. L., & Kulkarni, P. A. (2020). Inflammatory syndromes associated with SARS-cov-2 infection: Dysregulation of the immune response across the age spectrum. Journal of Clinical Investigation, 130(12). https://doi.org/10.1172/JCI145301 DISCLOSURES: No relevant relationships by Mohammed Al-Charakh No relevant relationships by John Pare t no disclosure on file for Maximiliano Tamae Kakazu;

13.
Chest ; 162(4):A789, 2022.
Article in English | EMBASE | ID: covidwho-2060689

ABSTRACT

SESSION TITLE: Outcomes Across COVID-19 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Fluid resuscitation confers protection against in-hospital mortality in heart failure (HF) patients with severe sepsis. SARS COV-2 infection can lead to a cytokine storm that is clinically similar to severe sepsis. Little is known about fluid balance in patients with HF admitted for covid 19. We aim to evaluate whether positive fluid balance is associated with in-hospital mortality in HF patients admitted for Covid-19. METHODS: This single center retrospective cohort study was conducted in patients admitted in the ICU for confirmed Covid 19 from 10/2020 to 3/2021 in a community hospital in Newark. The primary outcome was survival to discharge. Clinical SAS 9.4 was used to obtain summary statistics, perform chi-squared test and multivariable logistic regression analysis. RESULTS: We included 91 patients admitted in the ICU with covid 19. Out of these 33 patients were diagnosed with heart failure. Out of 33 people with HF 23 (69.70%) were male, 10 (30.3%) were females. Of the 33, 17(56.67%) were latino, 5(16.67%) were caucasian and 6(20%) were african-american. Mean age of population with and without Heart Failure was 70.78 yrs(?12.52) and 58.57 yrs(?13.37) respectively. Amongst them 18(54.55%) had DM, 27(81.82%) had HTN, 5 (15.15%) had chronic respiratory disease and 7(21.21%) had CKD. Amongst those with Heart Failure, 20(60.61%) had multiple comorbidities. The odds for negative survival are shown in table 1. Odds of negative survival outcome in those with positive fluid balance after adjusting for heart failure as compared to those with negative fluid balance in patients of COVID 19 was 12.958 (P value= 0.0183). CONCLUSIONS: Positive fluid balance in HF patients admitted with Covid 19 may be associated with adverse outcomes. Larger, prospective studies are needed to investigate the correlation between covid 19 and fluid balance in HF patients. CLINICAL IMPLICATIONS: This study creates awareness on the need of caution while fluid resuscitation in heart failure patients with Covid-19 as a positive fluid balance might be associated with unfavorable outcomes DISCLOSURES: No relevant relationships by Ruhma Ali no disclosure on file for Joaquim Correia;No relevant relationships by Neev Mehta No relevant relationships by Aditya Patel No relevant relationships by jihad slim, value=Honoraria Removed 03/25/2022 by jihad slim No relevant relationships by jihad slim, value=Honoraria Removed 03/25/2022 by jihad slim No relevant relationships by jihad slim, value=Honoraria Removed 03/25/2022 by jihad slim No relevant relationships by jihad slim, value=Honoraria Removed 03/25/2022 by jihad slim No relevant relationships by jihad slim, value=Honoraria Removed 03/25/2022 by jihad slim

14.
Chest ; 162(4):A612-A613, 2022.
Article in English | EMBASE | ID: covidwho-2060647

ABSTRACT

SESSION TITLE: TB and TB-Involved Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Pulmonary Aspergillus infection has a wide array of manifestations. Chronic Pulmonary Aspergillosis is an uncommon progressive respiratory disease, with the Subacute Invasive Pulmonary Aspergillosis form, one of the most challenging to manage. Typically it presents with rapidly progressive infection (of less than 3 months) in mild to moderately immunocompromised patients with underlying structural lung disease. We herein report the case of a 69-year old female with post-tuberculous cavity with disease progression, in approximately 6 weeks, associated with Aspergillus infection. CASE PRESENTATION: Patient is a 69-year old African American female, never smoker, with known history of Type 2 Diabetes Mellitus and previously treated mycobacterium tuberculosis with residual small right upper lobe cavity (measuring approximately 35 x 40 mm). She was being followed in our outpatient thoracic oncology clinic with serial imaging for surveillance, CT Chest initially every 3 - 6 months then annually thereafter with PET scan as clinically indicated. The cavity remained relatively unchanged for approximately 5 years. In October 2021, her CT Chest had revealed a stable cavity, even despite SARS-CoV-2 Pneumonia infection the previous year. The following month she was admitted to an outside hospital for hyperglycemia with notable significant increase in size of the right upper lobe cavity to 69 x 72 mm with surrounding nodularity. She completed a course of antibiotics and was seen in our clinic 3 months post discharge with a repeat CT Chest which now revealed a mass like area of consolidation with large area of lucency and superimposed fungus ball (now measuring 80 mm x 70mm). She underwent Electromagnetic Navigational Bronchoscopy with transbronchial biopsy and right upper lobe bronchoalveolar lavage. BAL culture identified Aspergillus niger, with no other pathogens (including acid fast bacilli isolated) or malignant cells observed. Biopsy revealed marked mixed inflammation and fungal hyphae. Patient is currently undergoing long-term oral antifungal therapy with plan for close surgical follow-up. DISCUSSION: The diagnosis of Chronic Pulmonary Aspergillosis requires a combination of clinical, radiological and histopathological characteristics present for atleast 3 months for diagnosis. This includes the presence of one or more cavities on thoracic imaging, evidence of aspergillus infection or an immunological response to aspergillus as well as excluding alternative diagnoses. Advances in diagnostic tools have improved early diagnosis and subsequent management as noted in our case. Surgical resection is recommended for simple aspergilloma, however rapidly progressive disease processes are recommended to be managed as invasive aspergillosis. CONCLUSIONS: Post-tuberculosis chronic pulmonary aspergillosis is an emerging disease with significant associated morbidity and likely health burden. Reference #1: Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management David W. Denning, Jacques Cadranel, Catherine Beigelman-Aubry, Florence Ader, Arunaloke Chakrabarti, Stijn Blot, Andrew J. Ullmann, George Dimopoulos, Christoph Lange European Respiratory Journal Jan 2016, 47 (1) 45-68;DOI: 10.1183/13993003.00583-2015 Reference #2: Bongomin F. Post-tuberculosis chronic pulmonary aspergillosis: An emerging public health concern. PLoS Pathog. 2020;16(8):e1008742. Published 2020 Aug 20. doi:10.1371/journal.ppat.1008742 DISCLOSURES: No relevant relationships by Omotooke Babalola No relevant relationships by Mark Bowling, value=Consulting fee Removed 04/02/2022 by Mark Bowling No relevant relationships by Mark Bowling, value=Consulting fee Removed 04/02/2022 by Mark Bowling No relevant relationships by Mark Bowling, value=Consulting fee Removed 04/02/2022 by Mark Bowling No relevant relationships by Sulaiman Tijani

15.
Chest ; 162(4):A498, 2022.
Article in English | EMBASE | ID: covidwho-2060613

ABSTRACT

SESSION TITLE: Critical Care in Chest Infections Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: The "common cold” is a syndrome defined by upper respiratory symptoms in addition to: rhinorrhea, fever, chills, headache, and/or malaise. Classically "colds” are thought of as a mild, self-limiting disease;however, they can cause severe respiratory symptoms in immunocompetent individuals. We present a case of severe acute respiratory distress syndrome (ARDS) caused by the Human Rhinovirus in an immunocompetent host. CASE PRESENTATION: 61-year-old gentleman with a past medical history significant for hypertension presented to an outside hospital for worsening shortness of breath, fatigue, and cough with production x 3 weeks. Social history is notable that he had a 12-pack-year history and quit smoking tobacco approximately 10 years ago. On arrival, the patient was noted to be hypoxic with percent saturation of 88% on 2 L nasal cannula. He rapidly deteriorated and required intubation 5 days after admission. The patient subsequently transferred to a tertiary care intensive care unit for further workup and management. Upon arrival at the tertiary care center, he was found to have a PaO2/FiO2 ratio of 71 and ARDS protocol was initiated. Despite pronation, paralyzation, dexamethasone, and nitric oxide, the patient continued to deteriorate. Three COVID-19 PCR's and COVID-19 antibody resulted negative. Extensive work-up including fungal, autoimmune, viral, and bacterial were negative with the exception of a positive rhinovirus PCR. MRI brain was completed due to patient's unequal pupils which demonstrated numerous recent infarcts of the bilateral cerebral and cerebellar hemispheres with mass-effect with mild leftward shift. The family ultimately decided to pursue comfort measures and the patient died. DISCUSSION: Human Rhinovirus is responsible for ? to ½ of common colds in adults making it the most common cause of "colds.” Due to its more than 100 serotypes, an average adult has approximately 2-3 Rhinovirus infections per year. Rhinovirus infections are classically thought to be self-resolving and mild, particularly in the immunocompetent. However, several recent studies have shown coinfection of the rhinovirus in patients with community acquired pneumonia;although these studies have been unable to tease out how clinically significant the rhinovirus infection was in these patients. The patient case above is an example that the Rhinovirus may be a more important culprit in community-acquired pneumonia than previously suspected. In addition to its possible respiratory conditions, studies have demonstrated an increase in risk of stroke. Currently, there are no FDA-approved antivirals for the Human Rhinovirus, treatment largely aimed to reduce symptomatology. CONCLUSIONS: The medical community, in large, thinks of the Rhinovirus as a relatively benign disease process. Though this may be the case in most patients, even immunocompetent individuals can suffer from serious complications of the virus. Reference #1: Chu HY;Englund JA;Strelitz B;Lacombe K;Jones C;Follmer K;Martin EK;Bradford M;Qin X;Kuypers J;Klein EJ;"Rhinovirus Disease in Children Seeking Care in a Tertiary Pediatric Emergency Department.” Journal of the Pediatric Infectious Diseases Society, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/26908489/. Reference #2: JO;, Proud D;Naclerio RM;Gwaltney JM;Hendley. "Kinins Are Generated in Nasal Secretions during Natural Rhinovirus Colds.” The Journal of Infectious Diseases, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/2295843/. Reference #3: Subramanian, A., et al. "Stroke Following Positive Biomarker for Viral Respiratory Illnesses.” B47. CRITICAL CARE: NON-PULMONARY CRITICAL CARE, 2020, https://doi.org/10.1164/ajrccm-conference.2020.201.1_meetings.a3566. DISCLOSURES: No relevant relationships by Philip Forys No relevant relationships by Brandon Pearce

16.
Chest ; 162(4):A419-A420, 2022.
Article in English | EMBASE | ID: covidwho-2060591

ABSTRACT

SESSION TITLE: COVID-19 Co-Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Herpes simplex type 1 (HSV-1) related respiratory tract infections have been described in critically ill or immunocompromised patients. We present a case of HSV-1 pneumonia in a mechanically ventilated and immunocompromised patient in the setting of SARS CoV-2 infection. CASE PRESENTATION: A 54-year-old female on Rituximab for Rheumatoid arthritis presented with shortness of breath and cough. She was afebrile, tachypneic and hypoxic. She was discharged 1 week prior after a 3 weeklong treatment for COVID-19 pneumonia. CT Angiogram showed extensive bilateral patchy consolidations with ground-glass infiltrates and subsegmental pulmonary emboli. Patient was initiated on heparin and broad-spectrum IV antibiotics with steroids for presumed ARDS with superimposed bacterial pneumonia. Her respiratory failure worsened requiring invasive mechanical ventilation. Failing oxygenation despite aggressive therapy prompted further workup that showed a normal echo and negative blood cultures. Sputum was negative for Pneumocystis pneumonia and Tuberculosis. Cytology from tracheal aspirate showed bronchial cells with inclusions and multinucleations consistent with HSV-associated cytopathic changes. A positive serum HSV-1 IgG and serum quantitative PCR of HSV-1 DNA solidified the diagnosis. Ganciclovir therapy was initiated to cover for HSV and Cytomegalovirus (CMV), however, a serum CMV PCR was negative. Within a day, her clinical course took a downward spiral. CT chest was repeated which showed worsening airspace disease. Despite ganciclovir therapy, the severity of lung disease led to eventual failure of oxygenation and patient demise. DISCUSSION: Prolonged mechanical ventilation due to ARDS is a risk factor for HSV bronchopneumonia in patients with COVID-19 and has shown an increased mortality 1,2. Diagnosis can be achieved by viral culture or observing cytopathic effects of HSV on cells in tracheobronchial aspirates, bronchoalveolar lavage, or biopsy3. In critically ill patients early treatment has been shown to prolong the ICU time to death and improved oxygenation4. It is important to test for co-infections as about 65% of HSV pneumonia cases are associated with pathogens like CMV and Pneumocystis5. CONCLUSIONS: Worsening respiratory disease in mechanically ventilated COVID-19 patients despite antibiotic therapy for suspected superimposed bacterial infection warrants a workup for secondary viral infections like HSV. Increased mortality is seen if not promptly treated. Reference #1: 1. Meyer A, Buetti N, Houhou-Fidouh N, et al. HSV-1 reactivation is associated with an increased risk of mortality and pneumonia in critically ill COVID-19 patients. Critical Care. 2021/12/06 2021;25(1):417. doi:10.1186/s13054-021-03843-8 Reference #2: Le Balc'h P, Pinceaux K, Pronier C, Seguin P, Tadié J-M, Reizine F. Herpes simplex virus and cytomegalovirus reactivations among severe COVID-19 patients. Critical Care. 2020/08/28 2020;24(1):530. doi:10.1186/s13054-020-03252-3 Reference #3: Shah JN, Chemaly RF. Herpes Simplex Virus Pneumonia in Patients with Hematologic Malignancies. Pulmonary Involvement in Patients with Hematological Malignancies. 2010:301-311. doi:10.1007/978-3-642-15742-4_24 DISCLOSURES: No relevant relationships by Andrew Cox No relevant relationships by Syeda Hassan No relevant relationships by Maria Khan No relevant relationships by Malik Muhammad Uzair Khan No relevant relationships by Rameesha Mehreen No relevant relationships by Rahat Ahmed Memon No relevant relationships by Ifrah Naeem No relevant relationships by Laura Walters

17.
Chest ; 162(4):A285, 2022.
Article in English | EMBASE | ID: covidwho-2060550

ABSTRACT

SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Beyond conventional risk factors, studies suggest acute viral infections, including influenza, are a potential risk factor for development of acute cardiovascular (CV) related events such as acute coronary syndrome (ACS) and stroke. On Mar 31st, 2020, the Texas state governor instated a shelter-in-place or quarantine order. With social distancing and masking the exposure respiratory viral illnesses dropped. This study seeks to evaluate the impact of reduced viral infections on CV related events. METHODS: A retrospective chart review of patients admitted to 18 affiliated Baylor Scott & White Texas hospitals in north and central Texas from January 20th, 2020 to Jun 1st, 2020 and between January 20th, 2019 to Jun 1st, 2019. We defined the pre-quarantine period as January 20, 2020 – March 31, 2020. The quarantine period was defined as April 1, 2020 – Jun 1st, 2020. We investigated ACS and stroke risk associated with lab-confirmed respiratory virus panel- PCR (RVP) positivity using a self-controlled case series. RVP positivity was reviewed to determine the presence or absence of increased risk interval. Risk intervals were identified as 7 days after respiratory specimen collection and associated control intervals were one year before and one year after the risk intervals. RESULTS: There were 3,782 patients who had ACS or stroke from January 20th, 2020 to June 1st, 2020. Average monthly rate of positive viral infection was significantly lower during the state mandate social distancing period than before social distancing mandate (5.5 ± 4.6 vs 19.7 ± 4.2, p<0.0001). During the prequarantine period, for stroke, there was a significant difference in positive RVP between the prequarantine and quarantine period (10.8% vs 0%, P=0.009). For ACS, there was a significant difference in positive RVP between the prequarantine and quarantine period (16.2% vs 1%, P<0.001). Rhinovirus infections accounted for 67% of patients of stroke prequarantine. Influenza accounted for 40% of infections in patients with ACS. Admissions for CV related events were higher in the pre-quarantine period compared to the quarantine period (893 vs 695 strokes;1,227 vs 967 ACS). Patients in the pre-quarantine and quarantine were similar in age and gender. For stroke, there was no significant difference in the type of stroke between the two time periods with ischemic stroke occurring in 67% of patients. For ACS, there was no significant difference in type with non ST-elevation MI occurring in 44% of patients. There was no statistical difference of survival to discharge or readmission at 30 days between the two periods. CONCLUSIONS: In our multicenter study, we note significant decline in cardiovascular events due to viral illness. This study strengthens the association between viral infections and cardiovascular events. CLINICAL IMPLICATIONS: This study reveals implications of cardiovascular events following viral illness. DISCLOSURES: No relevant relationships by Tayler Acton no disclosure on file for Alex Arroliga;No relevant relationships by Jason Ettlinger No relevant relationships by Shekhar Ghamande No relevant relationships by Mufaddal Mamawala No relevant relationships by Abirami Subramanian No relevant relationships by Heath White

18.
Embase; 2021.
Preprint in English | EMBASE | ID: ppcovidwho-344392

ABSTRACT

Background: COVID-19 disproportionately affects those with preexisting conditions, but little research has determined whether those with chronic diseases view the pandemic itself differently - and whether there are differences between chronic diseases. We theorized that while individuals with respiratory disease or autoimmune disorders would perceive greater threat from COVID-19 and be more supportive of nonpharmaceutical interventions (NPIs), those with autoimmune disorders would be less likely to support vaccination-based interventions. Method(s): We conducted a two-wave online survey conducted in February and November 2021 asking respondents their beliefs about COVID-19 risk perception, adoption and support of interventions, willingness to be vaccinated against COVID-19, and reasons for vaccination. Regression analysis was conducted to assess the relationship of respondents reporting a chronic disease and COVID-19 behaviors and attitudes, compared to healthy respondents adjusting for demographic and political factors. Result(s): In the initial survey, individuals reporting a chronic disease had stronger both stronger feelings of risk from COVID-19 as well as preferences for NPIs than healthy controls. The only NPI that was still practiced significantly more compared to healthy controls in the resample was limiting trips outside of the home. Support for community-level NPIs was higher among individuals reporting a chronic disease than healthy controls and remained high among those with respiratory diseases in sample 2. Vaccine acceptance produced more divergent results: those reporting chronic respiratory diseases were 6% more willing to be vaccinated than healthy controls, while we found no significant difference between individuals with autoimmune diseases and healthy controls. Respondents with chronic respiratory disease and those with autoimmune diseases were more likely to want to be vaccinated to protect themselves from COVID-19, and those with an autoimmune disease were more likely to report fear of a bad vaccine reaction as the reason for vaccine hesitancy. In the resample, neither those with respiratory diseases nor autoimmune diseases reported being more willing to receive a booster vaccine than healthy controls. Conclusion(s): It is not enough to recognize the importance of health in determining attitudes: nuanced differences between conditions must also be recognized. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. This article is a US Government work. It is not subject to copyright under 17 USC 105 and is also made available for use under a CC0 license.

19.
Journal of Comprehensive Pediatrics ; 13(Supplement 1):24-25, 2022.
Article in English | EMBASE | ID: covidwho-2058296

ABSTRACT

Pediatric acute respiratory distress syndrome (PARDS) is a life-threatening condition characterized by hypoxemia and is the most important cause of respiratory failure .It has been proposed that adult COVID-19 respiratory illness has two phenotypes: a low compliance ARDS- like phenotype and a normal compliance phenotype with low ventilation to perfusion ratio. The normal compliance phenotype is theorized to be due to a loss of hypoxic pulmonary vasoconstriction although the pediatric presentation in critical care has not been reported yet;the adult phenotype could be considered when managing pediatric patients with severe COVID-19. PARDS characterized by hypoxemia, radiographic haziness and decreased lung ,compliance per the criteria purposed by the pediatric acute lung injury consensus conference group (PALICC). High frequency nasal cannula or NIV by CPAP or BIPAP has been used successfully in pediatric patient with COVID-19 hypoxemia but increases risk of aerosolization and air born transmission that obligate strict airborne precautions. Management in ICU aims to maintain oxygenation while minimizing ventilation induced lung injury (VILI). For mechanical ventilation oxygen supplementation to maintain SPO2 > 92% and OI < 4 or OSI < 5 is recommended. Prone position and HFO ventilation (HFOV) are mostly utilized as rescue oxygenation. Prone position has been used as an adjunct therapy in adult patients with COVID 19 as chest computed tomography shows ground-glass appearance and depended lung injury. Pediatric evidence supp onorting prone position is scarce;however, there have been promising results with improved ventilation in dependent lung regions If HFOV is considered in patients with COVID-19, it should be used cautiously due to the high risk of aerosolization.

20.
Investigative Ophthalmology and Visual Science ; 63(7):2671, 2022.
Article in English | EMBASE | ID: covidwho-2058291

ABSTRACT

Purpose : SARS-CoV-2, the viral infection that causes COVID-19, is known to induce a hypercoagulable state in patients. While there have been isolated reports of retinal vascular occlusion among patients with a pre-existing COVID-19 infection, research into this topic remains scant. Therefore, the purpose of this study is to investigate the shortterm prevalence and risk for retinal vascular occlusion between COVID-19 and influenza A patients. Methods : TrinetX is a national, federated database that was utilized in this retrospective cohort analysis. At the time of the study, electronic medical records from over 80 million patients across 57 healthcare organizations were analyzed to create two cohorts of patients. At the time of the analysis, 1,224,770 patients with a previous history for COVID19 were compared to 61,555 patients with a previous history for influenza A. Then, 1:1 propensity score matching (PSM) was utilized to balance each cohort by demographics and comorbidities (age, sex, BMI, history of hypertension, chronic lower respiratory disease, diabetes mellitus, nicotine dependence, heart failure, and alcohol related disorders). Adjusted risk ratios (aRR) using 95% confidence intervals (CI) were used to assess risk of retinal vascular occlusion 120 days after initial diagnosis for COVID-19 or influenza A. Results : Before PSM, COVID-19 patients were at significantly lesser risk for retinal vascular occlusion within 120 days of initial diagnosis than influenza A patients (aRR [95% CI] = 0.58 [0.42,0.8];p<0.001). However, the incidence for influenza patients to develop retinal vascular occlusion was very small (0.1%). After PSM, two balanced cohorts of 61,555 patients were compared to one another and revealed that there is no significant difference in developing a retinal vascular occlusion after a previous diagnosis of COVID19 or influenza A (0.92 [0.58,1.46];p=0.725). Likewise, the incidence for retinal vascular occlusion remained very small (0.1% between both cohorts) (Table 1). Conclusions : This is the first large-scale study investigating the risk of retinal vascular occlusion among COVID-19 and influenza A patients. We found that each cohort was at similar risk for developing retinal vascular occlusion within 120 days. Likewise, the incidence for retinal vascular occlusion was miniscule among patients in this study.

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