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1.
New Armenian Medical Journal ; 16(2):25-32, 2022.
Article in English | EMBASE | ID: covidwho-2067787

ABSTRACT

Objectives: to assess the effect-related inflammatory and coagulation biomarkers in pregnancy and their connection with the coronavirus disease of 2019 (COVID-19). Method(s): A prospective case-control study was carried out among normal third-trimester pregnant women admitted to the labor room of Dr. Soetomo General Academic Hospital between January until June 2021. Two classified groups of patients were established in accordance with the result of the RT-PCR test. Demographic, clinical and laboratory results data of the two groups were collected and compared. Result(s): Platelet-to-lymphocyte ratio (PLR) was shown to be the only significant biomarkers found in the expectant with COVID-19, which was 35.8% higher compared to the ones free of COVID-19 [212.25 (157.57-269.37) vs 156.29 (128.55-195.3), p=0.048]. Logistic regression analysis of PLR between groups showed that the level of PLR was an independent factor in pregnant women with COVID-19 (OR 4.483, 95%CI 1.262-15.926). The ROC analysis showed that the PLR cut-off among the expectant was 171.335, with both sensitivity and specificity were 66.7% (p=0.021). The result shows no significant differences in leukocyte count, absolute neutrophils - lymphocyte count and percentage, neutrophil-to-lymphocyte ratio (NLR) and D-Dimer level between pregnant women infected with COVID-19 and free of the virus (p>0.05). Conclusion(s): Intriguingly, physiological adaptation during the course of the third trimester of pregnancy found no difference in most inflammation and coagulation markers, both in the condition of infected COVID-19 or not. The evidence from this single-centre study supports the viewpoint that elevated PLR was associated with independent biomarkers and thereby might be helpful to detect expectant with COVID-19. Copyright © 2022, Yerevan State Medical University. All rights reserved.

2.
Open Access Macedonian Journal of Medical Sciences ; 10:2029-2033, 2022.
Article in English | EMBASE | ID: covidwho-2066705

ABSTRACT

BACKGROUND: Mycobacterium tuberculosis infection causes the release of pro-inflammatory cytokines affecting hemostasis. Although the plasminogen activator inhibitor-1 (PAI-1) has a vital role in the fibrinolysis system, little is known about its profile among people with latent tuberculosis (TB). METHODS: This is a cross-sectional study that involves 80 healthcare workers. The study was conducted in two academic medical centers of Makassar city, Indonesia, from September to October 2021. PAI-1 levels were measured using the enzyme-linked immunosorbent assay technique. The statistical test results were significant if p < 0.05. RESULTS: Although there was no statistically significant difference (p > 0.05) in PAI-1 levels, PAI-1 level among participants in the latent TB infection (LTBI) group was found to be lower (4.9 ng/mL) than in the healthy control group (6.0 ng/mL). In addition, participants in the LTBI group with a history of being infected (9.6 ng/mL) with the COVID-19 had higher PAI-1 levels than those who had never been infected (2.3 ng/mL), which is statistically significant (p = 0.004). Although there was no statistically significant difference (p > 0.05) in PAI-1 levels among participants in the healthy control group, those with a history of being infected (6.7 ng/mL) demonstrated higher PAI-1 levels than those who had never been infected (4.8 ng/mL). CONCLUSIONS: PAI-1 levels were lower in LTBI participants, which potentially is due to more participants in the healthy control group having a history of COVID-19 infection.

3.
Open Access Macedonian Journal of Medical Sciences ; 10:1914-1921, 2022.
Article in English | EMBASE | ID: covidwho-2066688

ABSTRACT

BACKGROUND: The fluctuating COVID-19 cases among the pregnant women’s population encountered increased of cases and maternal mortality. AIM: This research aimed to describe the case of maternal deaths caused by COVID-19. CASE REPORT: We present nine serial cases of maternal death caused by COVID-19 who were admitted to Dr. Soetomo General Academic Hospital for 14 days in June. We found 32 positive COVID-19 obstetric cases and reported nine maternal deaths with a fatality rate of up to 28%. Seven of nine patients had reverse transcription-polymerase chain reaction–confirmed SARS-CoV-2 infection, while two had a positive antigen swab. Half of the patients ≥35 years old, and five of nine patients had Class I obesity as preexisting comorbidity. This study reported the death of pregnant woman at their 2nd trimester and 3rd trimester presenting infected by severe COVID-19. The usual symptoms are dyspnea, cough, fever, and decreased consciousness. The result of chest X-ray examination among eight patients showed bilateral pneumonia. Most of cases were referrals from a secondary hospital due to overload hospital capacity. Three patients were directly transferred to the tertiary hospital without receiving initial treatment. Eight of 9 patients (88.9%) were transferred to intensive care unit and intubated due to low oxygen saturation. CONCLUSION: In conclusion, the limited hospital facility and lack of intensive care capacity for obstetric cases during the second wave of the COVID-19 pandemic may enhance the probability of mortality and morbidity in pregnant women infected by COVID-19.

4.
Open Access Macedonian Journal of Medical Sciences ; 10:217-221, 2022.
Article in English | EMBASE | ID: covidwho-2066680

ABSTRACT

INTRODUCTION: The first data for COVID-19 in pregnancy showed mild-to-moderate forms of the disease while the current data speak of severe forms in these subjects. Here, we present a case of a severe form of COVID-19 in a gemelar pregnant woman complicated with pneumomediastinum and pneumothorax, during her hospital stay, in a late stage of disease. CASE PRESENTATION: A 38-year-old multiparous woman was referred to university hospital at 25 weeks of gemelar pregnancy. On admission, the patient presented with signs of moderate respiratory insufficiency, which after 12 h progressed further to severe ARDS. She tested positive for SARS-CoV-2 on quantitative real-time polymerase chain reaction. Under these conditions, it was decided that the patient undergoes a cesarean section for termination of pregnancy. Remdesivir 200 mg/day and tocilizumab 8 mg/kg were administered, based on national guidelines. The patient’s fever subsided, but her SpO2 remained at 94%, even with a 15 L/min oxygen mask. After 12 days, the patient complains of a severe back pain and her respiratory condition rapidly worsened and reduced saturations up to 80% being under O2 therapy with facial mask with 15 l/min. Chest CT findings confirmed pneumomediastinum and pneumothorax, which deteriorated the patient’s status. Thereafter, tube thoracostomy was performed. There was a clinical and ABG analysis parameter’s improvement. The patient was discharged 34 days after cesarean delivery with a proper general health. CONCLUSION: Our case highlights even more convincingly the fact that, in pregnancy, can be severe to life-threating forms of COVID-19. Pneumothorax and pneumomediastinum are complications that can be encountered even in the late stages of severe forms cases with COVID-19 in pregnancy. Early diagnosis of these complications is essential in adequate management and treatment to avoid fatal outcome.

5.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P69-P70, 2022.
Article in English | EMBASE | ID: covidwho-2064500

ABSTRACT

Introduction: Early literature describes an array of laryngotracheal complications in patients who were hospitalized with COVID-19. Laryngotracheal stenosis (LTS), in particular, is difficult to manage, requiring multiple procedures, frequent follow-up, and long-term reliance on tracheostomy. We aim to characterize the timeline and challenges associated with surgical management of LTS in this patient population. Method(s): We conducted a retrospective review of patients who presented to laryngology clinic after hospitalization with COVID-19 at a tertiary academic medical center from June 2020 to September 2021. Those who were diagnosed with LTS, intubated during their hospitalization, and underwent surgical management were included. Data on patient demographics, duration of intubation and tracheostomy, access to specialty clinic, and timeline of surgical care were collected. Result(s): A total of 9 patients were identified. Six patients had posterior glottic stenosis (PGS) (67%), 1 had subglottic stenosis (SGS) (11%), and 2 had tracheal stenosis (22%). The median duration of intubation was 21 days (IQR: 15-30). Of the patients, 67% underwent tracheostomy during the study period. Median duration of time between tracheostomy placement and decannulation was 75 days (IQR: 59.5-117). The median duration between COVID-19 diagnosis and presentation to laryngology clinic was 150 days (IQR: 65-209). All 6 patients with PGS underwent at least 1 laser cordotomy procedure. Those with SGS and tracheal stenosis underwent endoscopic procedures, while the latter patients also underwent tracheal resection. The median duration between COVID-19 diagnosis and the first operating room (OR) procedure was 201 days (IQR: 83.5-308.5). The median number of OR procedures per patient was 2 (IQR: 1-3.5). Conclusion(s): LTS after hospitalization with COVID-19 represents a significant challenge for both patients and their providers, often requiring multiple surgeries and delays in tracheostomy decannulation. Studies characterizing surgical management and long-term outcomes in these patients are imperative.

6.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P51-P52, 2022.
Article in English | EMBASE | ID: covidwho-2064493

ABSTRACT

Introduction: The COVID-19 pandemic has led to an increased burden being placed on our health care system. In this study, we aim to expand upon the impact of COVID-19 on a head and neck cancer population by examining the number of patients presenting to a university emergency department with an initial presentation of head and neck cancer during the pandemic and immediately before it. Method(s): A retrospective analysis of medical records of patients presenting to the emergency department (ED) at Baylor University Medical Center (BUMC) who received a diagnosis of head and neck cancer (HNC) either in the ED or in the admission immediately after was performed for a 6-month pre- COVID-19 time period (September 2019-February 2020) and a 6-month post-COVID-19 time period (April 2020-September 2020). Data analysis of patient presentation and final diagnosis was performed. Analysis of total ED encounters at BUMC per month over both time periods was also performed. Result(s): A chart review of 892 patients found 217 HNCrelated admissions in the pre-COVID-19 period and 228 in the post. In the pre-COVID-19 period, 9 patients presented with a primary diagnosis of HNC either in the ED or upon subsequent admission, accounting for 4.1% of HNC-related admissions. In the post-COVID-19 period, 14 patients presented with a primary diagnosis of HNC either in the ED or upon subsequent admission, accounting for 6.1% of HNCrelated admissions. In the pre-COVID-19 period, 1.9 per 10,000 ED visits resulted in a diagnosis of HNC. Comparatively, in the post-COVID-19 period, 3.8 per 10,000 ED visits resulted in a diagnosis of HNC. There was a sharp increase in ED-related HNC diagnoses in May of 2020, with 6.9 per 10,000 ED visits resulting in a diagnosis of HNC. Of ED-related HNC diagnoses, 75% made in May of 2020 were stage IV at the time of diagnosis. Conclusion(s): There has been a significant increase in the amount of primary HNC diagnoses made in the ED or upon subsequent admission since the start of the COVID-19 pandemic. HNC diagnosed at ED presentation or upon subsequent admission are more likely to be late stage, highlighting delays in care secondary to the COVID-19 pandemic.

7.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P162, 2022.
Article in English | EMBASE | ID: covidwho-2064426

ABSTRACT

Introduction: The rate of clinic no-show visits has been implicated in delays of care, lost clinical time, increased stress, and disrupted productivity for the provider and the practice. This is the first study looking at the trend of clinic no-show rates and associated factors prior to and during the COVID-19 pandemic for an academic otolaryngology practice. Method(s): This is a retrospective review of the Epic practice management and billing reports from all scheduled outpatient visits at a multiphysician, academic, general, and subspecialty otolaryngology practice at an academic medical center from January 2019 to December 2021. The rate of no-show visits and demographic and socioeconomic factors were collected. Result(s): Over 3 years, 121,347 clinic visits were scheduled in the otolaryngology practice. The mean age of the patients was 50.9 years;51.8% were female and 48.2% were male. The overall rate of no-show and late cancellations (nonattendance rate) was 18.3%. New, return, and postoperative visits comprised 39.7%, 54.8%, and 4.99% of all clinic visits, with nonattendance rates of 17.4%, 18.4%, and 13.9%, respectively. A statistically significant increase in nonattendance was noted during COVID-19 pandemic (16.8% vs 19.8%, P<.001). Head and neck clinics were found to have the lowest nonattendance rates while pediatric otolaryngology clinics had the highest (12.6% vs 21.3%). Sinus and pediatric clinics saw the largest increase in nonattendance rates during the pandemic (both at 3.9%). On multivariate regression, a significant association between nonattendance was younger age (P<.001), female gender (P=.01), afternoon appointments (P<.001), and online self-scheduling (P<.001) was noted. Conclusion(s): Both patient and appointment-related factors were found to impact rates of nonattendance in this academic otolaryngology practice. In this study, young age, female gender, afternoon appointments, and online self-scheduling were associated with increased nonattendance. In addition, the COVID-19 pandemic significantly impacted no-show rates across all otolaryngologic subspecialties.

8.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P282, 2022.
Article in English | EMBASE | ID: covidwho-2064404

ABSTRACT

Introduction: COVID-19 is known to cause olfactory dysfunction (OD). African American individuals have been disproportionately impacted by the COVID-19 pandemic. To reduce health disparities related to OD, it is important to have accurate objective testing, especially for African American individuals, who have a higher disease burden. Our objective is to examine olfactory performance in African American and White study participants by comparing individual scent scores to assess potential cultural appropriateness of scent selection. Method(s): This was a cross-sectional study of healthy participants from June 2021 to April 2022. Two smelling tests were used: Affordable Rapid Olfactory Measurement Array (AROMA) and Sniffin' Sticks (SST-12). Pearson correlation and chi2 tests were used to detect statistical differences. African American and White participants without sinonasal disease aged 18+ were recruited from outpatient clinics at Kansas University Medical Center and the community. The main outcome for our study is olfactory performance on smelling tests. Result(s): Of the 102 participants, 46 were African American and 56 were White. AROMA and SST-12 scores were significantly correlated in African American (P<.01) and White (P<.01) participants. African American participants scored significantly lower than their White counterparts on both tests (P<.01). AROMA, mean scores were 64.2 and 75.5 for African American and White participants, respectively. SST-12 mean scores were 84.2 and 89.9 for African American and White participants, respectively. On SST-12, 60.9% of African American and 30.4% of White participants were hyposmic, (P<.05). For 6 AROMA scents (licorice, orange, lavender, cinnamon, clove, and rosemary) and 1 SST-12 scent (pineapple) African American participants scored significantly lower than White participants (P<.05). Conclusion(s): When compared with White participants, African American participants performed worse on both smelling tests and a greater proportion were considered hyposmic. African American participants performed significantly worse than their White counterparts on several scents, raising the issue of cultural appropriateness of scents used in olfactory testing.

9.
American Journal of Transplantation ; 22(Supplement 3):644-645, 2022.
Article in English | EMBASE | ID: covidwho-2063525

ABSTRACT

Purpose: Immunocompromised hosts are at risk for severe complications or death from SARS-CoV-2 infection. Few studies describe the clinical features, outcomes and treatment strategies in this population across multiple sites. Method(s): A multi-center retrospective analysis from academic medical centers in the Midwestern US was conducted for hospitalized patients with SARS-CoV-2 infection. Data was collected electronically using standardized intake and 28-day follow up case report forms. The centers included Northwestern University, University of Nebraska, Cleveland Clinic, University of Chicago, Indiana University and University of Kansas. Result(s): The cohort included 272 patients hospitalized from March 2020 to November 2021. Demographics are in Table 1. Mean admission was 6.84 +/- 6.42 days after symptom onset. The most commonly reported symptoms were cough (71.4%), dyspnea (59.6%), fatigue (55.3%), fever (54.9%), and diarrhea (43.9%). Admission CXR had pneumonia in 31.6%;63% with multifocal or patchy opacities. 87 patients had a chest CT;72 (82.7%) showed pneumonia. 97 patients (36.1%) required ICU admission. Treatments included remdesivir (58.5%), dexamethasone (54.4%), convalescent plasma (3.0%), IL-6 inhibitor (4.5%). Immunosuppression management included holding (44.2%) or decreasing (26.6%) the dose of antimetabolite. 76 patients (28.3%) had documented bacterial co-infection, in blood (34.1%), lung (30.6%) and urine (30.6%). 6 (2.2%) patients experienced rejection within 30 days and 8 patients (3.0%) developed CMV viremia. 26 patients (9.7%) died by day 28. Conclusion(s): This cohort had high rates of ICU admission (36.1%), bacterial coinfection (28.3%), rehospitalization (31.5%) and mortality (9.7%).

10.
American Journal of Transplantation ; 22(Supplement 3):842, 2022.
Article in English | EMBASE | ID: covidwho-2063433

ABSTRACT

Purpose: To determine the incidence of de novo donor-specific antibodies (DSAs) in recipients of orthotopic heart transplants (OHT) who received an mRNA vaccine against SARS-CoV-2. Method(s): This was a case series that followed 112 OHT recipients (mean age 61.5 years [SD 14.5];77 men (68.75%)) from Dec 2020 to Nov 2021 at Emory University Hospital in Atlanta, GA (single site) after receiving at least 2 doses of SARS-CoV-2 mRNA vaccinations (Moderna or Pfizer). The median time between transplantation and initial vaccination was 9.6 years (IQR 4.27 to 18.2). HLA antibodies were assayed by blood test to monitor for de novo development of DSAs. Statistical analyses were performed using SPSS, Inc v27.0. Result(s): During a median follow-up time of 100 days (range 20-225), de novo DSAs were detected in 8 patients (7.08%) with a median time to detection of 75 days (12-138). Of those that developed de novo DSAs, 7 (87.5%) were HLA class II. 20 (18%) patients had pre-formed DSAs prior to vaccination and these remained unchanged during the follow-up period. Conclusion(s): Based on this limited series, we report that the SARS-CoV-2 mRNA vaccine may not be a significant source of allosensitization. The rate of de novo DSA development in our post-vaccination population was not elevated when compared to previously estimated rates among OHT recipients (25-35%). Based on these findings, we recommend transplant centers continue to encourage vaccination among heart transplant candidates. Limitations to this study include not having a parallel population of unvaccinated patients to directly compare DSA incidence/prevalence. Further monitoring of DSA development after a third booster SARS-CoV-2 mRNA vaccine may be necessary.

11.
Cardiology in the Young ; 32(Supplement 2):S241, 2022.
Article in English | EMBASE | ID: covidwho-2062124

ABSTRACT

Background and Aim: MIS-C is a hyperinflammatory syndrome caused by Sars-CoV-2 virus. Cardiovascular system impairment is observed up to 100 % of all MIS-C patients with a wide spectrum and severity of symptoms. It is important to identify the course of the disease and its outcome, which could significantly improve public health. Method(s): A single-centre study, prospective cohort study, con-ducted in the Children's Clinical University hospital in Latvia from January to December 2021. Patients between the ages of one to seventeen years who met the MIS-C criteria were included in the study. We evaluated blood pressure, left ventricular heart func-tion, size of coronary arteries and hospital course. Result(s): Thirty-one patients were included who met the MIS-C criteria. The median age was 8.0 years, 52% were boys. Of all patients 77% initially presented with hypotension of whom 42% required inotropic support. Treatment in PICU was required in 58% of all patients. Reduced left ventricular ejection fraction was observed in 35% of all patients. Mildly decreased ventricular ejection fraction (lt;55%) was observed in 19% of cases but mod-erate dysfunction (ejection fraction lt;45%) was observed in 16% of patients. Twelve percent of patients received milrinone to improve left heart function. Left heart function significantly improved in all patients during the hospitalisation. In 6 % of all patients coronary artery dilations was observed. All patients had dilations resolution at the time of discharge. Median length of hospitalisation was twelve days and median length of PICU stay was three days. Conclusion(s): All patients cardiovascular symptoms had resolved at the time of discharge. Whether patients will have chronic cardiac impairment is unknown therefore it is crucial to perform long-term follow-up.

12.
Cardiology in the Young ; 32(Supplement 2):S228, 2022.
Article in English | EMBASE | ID: covidwho-2062122

ABSTRACT

Background and Aim: The European Medicines Agency has approved mRNA vaccines developed by Pfizer/BioNTech and Moderna for the vaccination of adolescents against the SARS-CoV-2 infection. Cases of myocarditis and pericarditis have been described as rare postvaccination complications. We describe the Latvian experience with adolescents suffering from myocarditis following COVID-19 vaccination. Method(s): From June to December 2021 four cases consistent with postvaccination myocarditis were admitted to the Children's Clinical University Hospital, which is the only centre with special-ized paediatric cardiology care in Latvia. The Pfizer/BioNTech vaccine had been used in all. An ECG, Holter monitoring and ECHO was done, HS Troponin I levels checked, the most common infectious causes of myocarditis were excluded, and a cardiac MRI was performed in all cases. Result(s): Case 1: 12-year-old girl, developed chest pain on postvac-cination day Nr 4 (PVD4) after the 1st dose. Holter monitoring revealed rare non-sustained ventricular tachycardia (NSVT), ECHO showed moderate mitral insufficiency, and a hyperecho-genic papillary muscle, troponin level peaked at 5339 pg/ml (PVD6), MRI (PVD 7) showed widespread myocardial oedema, transmural fibrosis. Symptoms resolved in 1 day, metoprolol suc-cinate and lisinopril were prescribed. Mitral insufficiency persists 5 months later. Case 2: 15-year-old boy, developed chest pain after the 2nd dose on PVD2 and lasted for 7 days, he was admitted on PVD11 with a peak troponin level of 19pg/ml. MRI (PVD15) showed widespread myocardial oedema. Metoprolol succinate was prescribed. Case 3: 15-year-old boy, developed chest pains on the day of the 1st dose and persisted for 35 days, he was admitted on PVD24 with peak troponin level 15ng/ml. MRI (PVD29) showed mild myocardial oedema, myocardial and pericardial fib-rosis. Case 4: 13-year-old boy, developed chest pain on PVD2, which lasted for 65 days, he had an episode of syncope. Holter monitoring showed frequent PVCs, and NSVT, on PVD34 tro-ponin level was 2,5pg/ml. The child received a course of NSAIDs and was referred to us on PVD68. MRI (PVD69) revealed wide-spread myocardial oedema, fibrosis, and pericarditis. Methylprednisolone was given, and betaxolol was prescribed. Conclusion(s): Our case series show that some cases of postvaccination myocarditis develop complications requiring long-term treatment.

13.
Chest ; 162(4 Supplement):A1586-A1587, 2022.
Article in English | EMBASE | ID: covidwho-2060846

ABSTRACT

SESSION TITLE: Technological Innovations in Imaging SESSION TYPE: Original Investigations PRESENTED ON: 10/17/22 1:30 PM - 2:30 PM PURPOSE: Central airway stenosis (CAS) is an important cause of pulmonary morbidity and mortality. Current grading and classification systems include subjective qualitative components, with limited data on reproducibility. We propose a novel radiographic segmentation approach to more objectively quantify CAS. Inter-rater reliability of this novel outcome, which is used in an ongoing randomized controlled trial (NCT04996173), has not been previously assessed. METHOD(S): Computed tomography (CT) scans demonstrating tracheal stenoses were identified in the Vanderbilt University Medical Center Benign Tracheal Stenosis registry. CTs were analyzed in OsiriX (Geneva, Switzerland) after upload via a secured cloud transfer service. Four independent readers with variable experience in CT interpretation were chosen (one chest radiologist, one pulmonary fellow, two internal medicine residents). Readers identified the point of nadir airway lumen, measured 1.5 cm above and below that point, then manually segmented visible tracheal lumen area on the soft tissue window of each axial CT slice within that 3 cm length. Missing ROI's were then generated in-between manual segmented areas. The Repulsor function was used to manually adjust the boundaries of the ROI to achieve fit. Intraclass correlation (ICC) was used to calculate the inter-rater reliability of the tracheal lumen volume of between readers. Other data collection variables included the type of CT scan, axial slice interval, the suspected underlying cause of CAS, and average stenotic volume. RESULT(S): Fifty CT scans from 38 individual patients identified in the registry from 2011-2021 were randomly chosen for inclusion. Most (22 of 38, 57.9%) had iatrogenic BCAS (either post-intubation or post-tracheostomy) and 10 (26.3%) had idiopathic subglottic stenosis. Half of the scans (n=25, 50%) were contrasted neck CT and half were non contrasted chest CTs. Scan slice thickness ranged 1 to 5 mm, median 2 mm (1.25-2.875). The median stenotic volume across all readers was 3.375 cm3 (2.52-4.51). The average ICC across all four readers was 0.969 (95% CI 0.944 - 0.982). CONCLUSION(S): Our proposed volume rendering and segmentation approach to BCAS proves to have substantial precision and agreement amongst readers of different skill levels. CLINICAL IMPLICATIONS: A NOVEL METHOD TO ASSESS SEVERITY OF BENIGN CENTRAL AIRWAY STENOSIS DISCLOSURES: No relevant relationships by Leah Brown No relevant relationships by Alexander Gelbard no disclosure on file for Robert Lentz;PI ofan investigator-initiated study relationship with Medtronic Please note: >$100000 by Fabien Maldonado, value=Grant/Research Support PI on investigator-initiated relationship with Erbe Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Consulting relationship with Medtronic Please note: $5001 - $20000 by Fabien Maldonado, value=Honoraria co-I industry-sponsored trial relationship with Lung Therapeutics Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Board of director member relationship with AABIP Please note: $1-$1000 by Fabien Maldonado, value=Travel No relevant relationships by Khushbu Patel No relevant relationships by Ankush Ratwani Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee No relevant relationships by Evan Schwartz Copyright © 2022 American College of Chest Physicians

14.
Chest ; 162(4):A1152, 2022.
Article in English | EMBASE | ID: covidwho-2060781

ABSTRACT

SESSION TITLE: Acute COVID-19 and Beyond: from Hospital to Homebound SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: The aim of this study was to determine risk factors for residual pulmonary radiological and functional abnormalities and assessment of possible treatment approaches for reducing such complications in survivors with post-ARDS related to COVID-19. METHODS: There were 97 survivors enrolled, 12 weeks after severe ARDS who were intubated in COVID-19. All survivors admitted to pulmonary and critical care departments of university hospital from 30 August to 30 November 2021. 39 patients with lung radiographic abnormalities between 50-75%;58 patients with lung abnormalities more than 75%. RESULTS: At 12 weeks after discharge all patients reported persistent symptoms: dyspnea 100.0%, cough 42.3%, chest pain 51.1%, fever 29.0%, and hemoptysis 18.5%. More severe dyspnea (increased by exertion and at rest) was found with lung involvement more than 75%(OR 4.25[0.94-10.34]95%CI;p<0.0001).Pulmonary function tests were abnormal in all patients, however,more severe functional abnormalities were with lung involvement more than 75% and median FVC predicted was (46.3+_11.9 vs 64.7+_10.6;p<0.001),DLCO also was significantly lower (54.6+_9.3 vs 70.4+_8.4;p<0.01).Comorbidities such as diabetes milletus (DM) (OR 2.87[0.86-7.34]95%CI;p<0.002), obesity(OR2.44[0.79-6.98]95%CI;p=0.003), older age (OR 2.12[0.72-5.88]95%CI;p<0.004), and kidney failure (OR2.01[0.70-5.22]95%CI;p=0.005) were common in lung involvement more than 75%. Lack of dexamethasone at ICU admission with ARDS was significantly associated with more severe residual pulmonary abnormaliries: organizing pneumonia (OR 4.82[0.99-12.32]95%CI;p<0.0001),usual interstitial pneumonia(UIP)(OR 3.22[0.85-9.23]95%CI;p<0.0004),traction bronchiectasis(OR2.38[0.74-6.12]95%CI;p<0.001),and cystic changes (p<0.001) were commonest. In contrast, ground galss opacity (GGO) was commonest in use of dexamethasone (OR 2.95[0.79-7.54]95%CI;p<0.001). Multi-drug-resistant (MDR) pahtogen caused ventilator associated pneumonia (VAP) at the time intubation was significantly associated with residual OP (OR 4.76[0.91-11.66]95%CI;p<0.0001). CONCLUSIONS: There were several risk factors found for development of more severe residual pulmonary functional and radiological abnormalities: older age, and comorbidities such as DM, obesity, and kidney failure. Lack of use of dexamethasone was associated with development OP,UIP,traction bronchiectasis,and cystic changes.OP was common in patients with history of MDR-pathogen-caused VAP at intubation.The use of dexamethasone was associated with non-severe residual pulmonary functional and radiological abnormalities. CLINICAL IMPLICATIONS: The result of our investigation might be helpful for clinicians in COVID-19 practice.Our findings also may be helpful for pulmonologists, respiratory therapist, and nurses. Also our discussion may aid in correct management of ARDS and minimalizing of residual pulmonary functional and radiological abnormalities. DISCLOSURES: No relevant relationships by Alizamin Sadigov

15.
Chest ; 162(4):A995, 2022.
Article in English | EMBASE | ID: covidwho-2060746

ABSTRACT

SESSION TITLE: Hot Topics in Critical Care SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: Recent data from the national American Heart Association Get with the Guidelines Resuscitation registry suggests substantial hospital-to-hospital variation in airway management during in-hospital cardiac arrest (IHCA), with most patients undergoing endotracheal intubation. Less than 5% of IHCA patients receive a supraglottic airway (SGA). Over the past several years, SGAs have been studied extensively in out-of-hospital cardiac arrests (OHCA) with promising results and are widely used in the OHCA setting. In this study, we describe factors and airway characteristics at a center encouraging either SGA or endotracheal intubation (ETI) for IHCA advanced airway management. METHODS: We performed a retrospective observational study examining all cardiac arrests occurring at a multi-campus academic medical center between August 3, 2020 to July 11, 2021. Locations studied included general medical wards, telemetry units, and intensive care units (both medical and specialty ICUs, such as surgical or cardiac). Patients were excluded if they possessed an invasive airway at time of arrest, suffered an arrest in the ED or procedural areas (e.g., operating room, catheterization lab), or were SARS-CoV-2 positive. Of note, SGAs were not specifically discouraged during the COVID-19 pandemic at this institution. We compared patient, arrest, and airway characteristics between the SGA and endotracheal intubation (ETI) groups using t-tests or Fisher’s exact tests where appropriate. Given risk for confounding by indication, we did not compare patient outcomes between groups. RESULTS: A total of 97 patients were included in the study, of whom 82 (84.5%) received an advanced airway during cardiopulmonary resuscitation. Of these the initial airway was ETI in 46 (56.1%) arrests and SGA in 36 (43.9%) arrests. As compared to SGA, patients receiving ETI were younger (66.1 [±2.0] vs. 71.2 [±2.1], p=0.08), more likely to be obese (11.0% vs. 5.6%), and more likely to have pre-existing lung conditions (19.6% vs 11.1%)—although no difference reached the a priori defined α<0.5 level of significance. Other hypothesized differences were not as extreme including for body mass index (28.3 [±1.4] vs. 28.4 [±1.6]) and respiratory cause of arrest (34.8% vs. 47.2%). First pass success rate was 84.8% for ETI. Complications of airway management were rare with one patient in each group suffering vomiting, one instance of oropharyngeal bleeding in the SGA group, and one pneumothorax in the ETI group. CONCLUSIONS: At a center using both SGA and ETI during IHCA response, patients who were younger, more obese, and more commonly had underlying lung disease tended to receive ETI—although these associations were not statistically significant. Complications of both advanced airway modalities were rare. CLINICAL IMPLICATIONS: DISCLOSURES: No relevant relationships by jonathan daich No relevant relationships by Alex Li No relevant relationships by Ari Moskowitz No relevant relationships by Aron Soleiman

16.
Chest ; 162(4):A963, 2022.
Article in English | EMBASE | ID: covidwho-2060742

ABSTRACT

SESSION TITLE: Post-COVID-19 Infection Complications SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) is the causative agent of coronavirus disease-2019 (COVID-19). Post-infectious encephalitis secondary to SARS-CoV-2 may present with delirium, seizures, or transient comatose state. The mechanism of encephalitis in patients with COVID-19 is multifactorial. Cytokine release syndrome, a systemic hyperinflammatory condition, might have an integral part in the pathophysiology of this manifestation. Beneficial effects of pulse dose glucocorticoid therapy, with and without plasma exchange or IVIG, have been described. (1, 2) In this case report, we disclose a case of a young healthy male that presented with acute encephalopathy after 10 days of contracting SARS-CoV-2 and aim to discuss the potential role of IVIG and pulse dose steroid. CASE PRESENTATION: A 37-year-old previously healthy Caucasian man initially presented to urgent care with fatigue and generalized weakness and was diagnosed with acute COVID-19 infection through positive PCR. Four days later, he developed shortness of breath, syncope and vomiting. He was taken to the ER, where he had a witnessed seizure complicated by status epilepticus requiring endotracheal intubation for airway protection. He was then airlifted to our University Hospital. Upon arrival, labs were notable for elevated troponin, leukocytosis, and mildly elevated liver enzymes. An echocardiogram revealed stress induced (Takotsubo) cardiomyopathy. CT head was normal and continuous EEG showed focal electrographic seizures of left temporal onset. MRI of brain with/without contrast showed subtle areas of cortical diffusion hyperintensity involving left cerebral hemisphere including left posterior temporal lobe, lateral occipital lobe, posterior lateral frontal lobe and posterior lateral parietal lobe with subtle patchy areas of cortical enhancement on postcontrast T1-weighted images. CSF analysis was benign and CSF PCR for SARS-CoV-2 was negative. One gram daily IV methylprednisolone and IVIG therapy was given for total 5 days. On Day 2 of therapy, seizures subsided, and patient was successfully extubated after. Repeat MRI brain with/without contrast done after day of therapy showed improvement in previously demonstrated findings. He improved clinically and was discharged home on hospitalization day. DISCUSSION: Post-infectious COVID-19 encephalitis falls under the spectrum of disease described under neurological syndromes related to SARS-CoV-2 infection.(3) Diagnosis is based on Clinical presentation, positive COVID PCR on nasopharyngeal swab and Imaging demonstrating cortical enhancement on post contrast T1-weighted imaging. Out of various treatment options described in literature (1,2), our patient responded well to pulse dose steroids and IVIG therapy for 5 days. CONCLUSIONS: Careful selection of patients and therapies should be considered when post-infectious COVID-19 encephalitis is suspected. Reference #1: Cao A, Rohaut B, Le Guennec L, et al. Severe COVID-19-related encephalitis can respond to immunotherapy. Brain. 2020;143(12):e102. doi:10.1093/brain/awaa337 Reference #2: Pugin D, Vargas MI, Thieffry C, et al. COVID-19-related encephalopathy responsive to high-dose glucocorticoids. Neurology. 2020;95(12):543-546. doi:10.1212/WNL.0000000000010354 Reference #3: Al-Ramadan A, Rabab'h O, Shah J, Gharaibeh A. Acute and Post-Acute Neurological Complications of COVID-19. Neurol Int. 2021;13(1):102-119. Published 2021 Mar 9. doi:10.3390/neurolint13010010 DISCLOSURES: No relevant relationships by Ali Ahmad No relevant relationships by Varun Halani No relevant relationships by Michael Lasky No relevant relationships by Posan Limbu

17.
Chest ; 162(4):A840, 2022.
Article in English | EMBASE | ID: covidwho-2060703

ABSTRACT

SESSION TITLE: Sepsis: Beyond 30cc/kg and Antibiotics SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Sepsis is the leading cause of hospitalization and mortality in the United States. In addition, sepsis is, by volume, the leading cause of 30 day readmissions across all payer mix in the United States. The risk factors for 30 day readmissions are multifactorial and often portends poor outcomes and increase hospitalization costs. We trialed a pilot program of enhanced sepsis discharge education which consisted of direct patient education prior to discharge, providing a Sepsis Education brochure with tips on self management at home as well as a QR code to direct patients to institutional website in case they needed further assistance, and finally a disposable thermometer to maintain an accurate temperature log to aid in monitoring for signs and symptoms of sepsis. Our primary goal was educate patients about their diagnosis and reduce sepsis readmissions in all non-medicare patients being discharged home. METHODS: The pilot was implemented at on one med/surg unit in our 550-bed tertiary, academic medical center starting in March 2021 and progressively expanded hospital wide over the next six months. The sepsis administrative coordinator screens new in-patient admissions for sepsis (non-Medicare) patients daily and informs medical/surgical unit coordinators of potential candidates. Med/surg coordinators will confirm if patients meet criteria for follow-up (non-Medicare, being discharged to home), provide discharge education and enter the patient in a log for continued surveillance. Subsequently, the administrative coordinator then follows up with a phone call 7-10 days after discharge during which, they assess the patient for worrisome symptoms, confirms follow up appointments, medication compliance and review of temperature log. If the patient needs clinical assistance, they will refer to the patient to the hospital sepsis clinical coordinator or patient’s outpatient physicians. RESULTS: We compared sepsis discharges and 30day readmissions (all excluding COVID-19 cases) from March 1, 2019 – Dec 31, 2019 to March 1, 2021 – Dec 31, 2021. Readmissions amongst Medicare patients discharged home was 15.9 % (110 / 962) in 2019 vs 11.9% (83 / 696) in 2021. For non-medicare patients, the rate was 13.2% (41/311) in 2019 vs 13.1% (51/390) in 2021. In our pilot program, the readmission rate in medicare patients was 17.2% (28/163) versus 5.6% (5/90) in non-medicare patients. CONCLUSIONS: This program captures a patient population which may have been lost to follow-up. Implementation of the enhanced Sepsis Discharge Education led to at least a 30 patient reduction in readmissions yielding an approximate cost savings of $594,000. CLINICAL IMPLICATIONS: Providing educational support, instructions, and follow up calls upon discharge improves medication adherence, compliance, and maintains patient follow up thus reducing readmissions and improving hospital resource utilization and overall cost. DISCLOSURES: No relevant relationships by Laura Freire No relevant relationships by Nirav Mistry No relevant relationships by Caitlin Tauro

18.
Chest ; 162(4):A738, 2022.
Article in English | EMBASE | ID: covidwho-2060678

ABSTRACT

SESSION TITLE: ECMO and ARDS in COVID-19 Infections SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The purpose of the study is to determine the incidence of bloodstream infections in COVID19 patients treated with ECMO in relation to steroid days and days of ECMO cannulation. METHODS: Retrospective analysis of data for COVID19 patients treated with ECMO in a tertiary academic medical center from January 2020 until July 2021 was performed. Data including baseline patients’ characteristics, type, and duration of ECMO support, type and days of steroids used, blood culture results, and organism type were collected. An institutional review board (IRB) approval was obtained before data collection. A two-tailed T-test was used to calculate the P-value, P-value of <0.05 was considered significant. RESULTS: A Total of 34 patients were analyzed, 3 of them were on (Veno-Arterial) VA ECMO and 31 on (Veno-Venous) VV ECMO, 32 out of 34 (94%) patients received steroids (Dexamethasone alone 16 patients, Methylprednisolone 1 patient and 15 patients received multiple steroid types). Seventeen patients had positive blood cultures (50%), average steroid days for patients with positive blood cultures was 21.6 days compared to 11.8 days for patients with negative blood cultures (P-Value:0.01), Average ECMO days for patients with positive blood cultures was 40.5 days compared to 18.8 days for patients with negative blood cultures ( P-Value:0.01). Staphylococcus epidermidis was found in 47% of the cultures, Enterococcus Faecalis was found in 24% of cultures while MRSA, MSSA, and Candida Albicans were found in 6% of cultures. CONCLUSIONS: Bloodstream Infections during ECMO cannulation are common and carry significant morbidity and mortality in patients. Longer ECMO days and longer duration of steroid use were found to be associated with higher rates of bloodstream infections in our patient’s sample. This could be related to the instrumentation risk or immunosuppression from steroids or other factors not evaluated in this study. CLINICAL IMPLICATIONS: Bloodstream infections are common in patients treated with ECMO, the risk of infections increases with longer ECMO and steroid days. Knowledge of such risks and trying to minimize them such as cautious use of steroids might help in the prevention of infections. Further studies are needed to better assess this risk. DISCLOSURES: No relevant relationships by Varun Halani No relevant relationships Added 03/21/2022 by Ghassan Kamel, value=Honoraria Removed 03/21/2022 by Ghassan Kamel No relevant relationships Added 03/22/2022 by Ghassan Kamel, value=Honoraria Removed 03/22/2022 by Ghassan Kamel No relevant relationships by Ahmad Sharayah

19.
Chest ; 162(4):A686, 2022.
Article in English | EMBASE | ID: covidwho-2060668

ABSTRACT

SESSION TITLE: ECMO and ARDS in COVID-19 Infections SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an important salvage therapy for patients with severe COVID-19 associated acute respiratory distress syndrome (ARDS). Whether gas exchange after initiation of ECMO predicts survival remains unknown. The present study aims to investigate if gas exchange parameters are associated with survival during ECMO support of COVID-19 associated ARDS. METHODS: We retrospectively evaluated all ARDS patients initiated on VV-ECMO according to ELSO guidelines between 2018 and 2021 at a tertiary academic medical center. ECMO sweep and ventilator fraction of inspire oxygen (FiO2) were catalogued every eight hours for all patients and compared between COVID-19 survivors and non-survivors at Days 0, 7, 14, 21, and 28 of ECMO using the Mann-Whitney U test. Cohort characteristics were compared between patients with and without COVID-19 using the chi-squared test for categorical comparisons and the Mann-Whitney U test for comparison of non-parametric continuous variables. Statistical significance was considered as p<0.05 for all tests. RESULTS: Forty-two ARDS patients were initiated on VV-ECMO during the study period, including 30 patients with COVID-19. Mortality was similar between patients with and without COVID-19 (43.3% vs 41.7%, p=0.92). ECMO duration (31 [33.5] vs 9.5 [7.0] days, p=0.002), median sweep (7.0 [4.5] vs 4.3 [4.0], p< 0.001), and median ventilator FiO2 (0.55 [0.50] vs 0.45 [25], p < 0.001) were significantly increased in patients with COVID-19 compared to those without. Among COVID-19 patients, median sweep did not differ between survivors and non-survivors at Day 0 (3.5 [1.0] vs 4.0 [1.0], p=0.20), Day 7 (6.0 [3.0] vs 7.5 [2.3], p=0.38), Day 14 (6.0 [2.5] vs 8.0 [3.3], p=0.14), Day 21 (8.0 [3.5] vs 9.0 [3.0], p= 0.97), or Day 28 (7.5 [3.5] vs 8.0 [3.0], p=0.74). Median ventilator FiO2 was significantly lower in COVID-19 survivors compared to non-survivors at Day 28 (0.50 [0.16] vs 0.81 [0.40], p=0.03), but not at Day 0 (0.75 [0.52] vs 0.60 [0.25], p= 0.98), Day 7 (0.90 [0.50] vs 1 [0.45], p = 0.54), Day 14 (0.90 [0.50] vs 1 [0.08], p=0.08), or Day 21 (0.80 [0.10] vs 0.90 [0.40], p=0.62). CONCLUSIONS: Survival was similar between ARDS patients with and without COVID-19 despite significantly increased ECMO duration and gas exchange support in patients with COVID-19. Early gas exchange parameters after initiation of ECMO were not associated with survival in patients with COVID-19. At Day 28 of ECMO, COVID-19 survivors had significantly lower ventilator FiO2 requirements compared to non-survivors. CLINICAL IMPLICATIONS: Gas exchange parameters did not discriminate survivors from non-survivors until day 28 of ECMO in patients with COVID-19 associated ARDS. Given the need for increased gas exchange support and duration of ECMO therapy in this population, gas exchange parameters prior day 28 of ECMO may not be suitable markers for prognostication. DISCLOSURES: No relevant relationships by Andrew Davis No relevant relationships by Malcolm DeCamp No relevant relationships by Hilary Faust No relevant relationships by James Maloney No relevant relationships by Daniel McCarthy No relevant relationships by Michael Peliska

20.
Chest ; 162(4):A509, 2022.
Article in English | EMBASE | ID: covidwho-2060616

ABSTRACT

SESSION TITLE: Not the Normal Host: Infections Still Matter SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The purpose of this study is to determine the incidence of hospital acquired and ventilator associated pulmonary infections in patients on ECMO for SARS-CoV-2 related ARDS in relation to steroids and ECMO cannulation days. METHODS: A retrospective analysis of COVID19 patients treated with ECMO admitted to a tertiary care academic medical center from January 2020 until July 2021 was conducted. Data including baseline patient characteristics, type, and duration of ECMO support, type and days of steroids use and sputum culture results were collected. An institutional review board (IRB) approval was obtained prior to data collection. A two-tailed T-test was used to calculate the P-value, P-value of <0.05 was considered significant. RESULTS: A total of 34 patients were included in the analysis, of which 3 of them were on (Veno-Arterial) VA-ECMO and 31 were on (Veno-Venous) VV-ECMO. 32 out of 34 (94%) patients received steroids during their hospital course. Total of 20 patients had positive sputum cultures (59%) and average steroid days for patients with positive sputum cultures was 20.75 days as compared to 10.75 days for patients with negative sputum cultures (P-Value: 0.01). Average ECMO days for patients with positive sputum cultures was 26 days as compared to 14.4 days for patients with negative sputum cultures (P Value: 0.0003). Amongst the patients with positive sputum cultures, pseudomonas aeruginosa and methicillin-sensitive staphylococcus aureus (MSSA) were the most isolated organisms (25% of positive cultures), methicillin-resistant staphylococcus aureus (MRSA) and Serratia Marcescens were isolated in 20% of positive cultures, Klebsiella aerogenes was isolated in 15% of positive cultures. CONCLUSIONS: Hospital acquired and ventilator associated pulmonary infections are common in patients on ECMO for SARS-CoV2 related ARDS. Longer ECMO days and a longer duration of steroid use were found to be associated with higher rates of bacterial growth in sputum cultures. Common organisms included Pseudomonas, MSSA, and MRSA. CLINICAL IMPLICATIONS: Our analysis describes the most common bacterial organisms isolated on sputum cultures in this study population. It may also serve as a guide for empiric antibiotics choice when bacterial pneumonia is suspected in similar patients while awaiting sputum culture results. DISCLOSURES: No relevant relationships by Varun Halani No relevant relationships Added 03/21/2022 by Ghassan Kamel, value=Honoraria Removed 03/21/2022 by Ghassan Kamel No relevant relationships Added 03/22/2022 by Ghassan Kamel, value=Honoraria Removed 03/22/2022 by Ghassan Kamel No relevant relationships by Ahmad Sharayah

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