Emergency Department-based monoclonal antibody therapy for patients with mild to moderate COVID-19

Objectives: To describe the implementation of an ED-based program to offer monoclonal antibody therapy to patients with mild-moderate COVID-19 disease. Background(s): Monoclonal antibody therapy (MOAB) has recently emerged as a treatment for mild to moderate COVID-19, potentially preventing those with underlying conditions from progressing to severe illness and hospitalization. Further, as EDs are the primary point of health care access for many at-risk individuals, offering MOAB in the ED may increase availability of treatment options for patients from traditionally underserved communities. Method(s): A retrospective chart review was conducted of patients 12 years and above who received treatment in our urban, academic, community hospital. Patients 12 years and older were screened for eligibility during ED visits or during follow-up calls providing positive test results. Staff was trained on specific consent, infusion, monitoring, and documentation procedures adherent to MOAB administration under the Emergency Use Authorization. Patients were contacted following MOAB and queried regarding symptom resolution and healthcare utilization. Data regarding patient demographics, ED course, and 7-day unscheduled visits were collected. Result(s): In this ongoing quality improvement initiative, from December 2020 to March 2021, there were 26,229 patient encounters at the pilot ED site. 84 patients were provided MOAB, 87% Bamlanivimab and 13% Bamlanivimab/Etesevimab. Patients had a mean age of 52.3 years (SD 24.4);21% were 12-17 years of age and 37% were >65 years old. 52% were male. 33% self-reported as Caucasian, 19% Black, 18% Asian/Pacific Islander, 21% as other, and 9% were unknown. 17% identified as Latinx. 19% of patients were insured by Medicaid, 36% Medicare, 39% commercially insured, and 6% were uninsured. Patients had symptoms a median of 3 days prior to MOAB. After age (46%), the most commonly reported eligibility criteria was obesity (20%), followed by hypertension (11%) and immunocompromised state (11%). 74% of infusions were administered during nights and weekends. No infusion reactions occurred. 8% returned to an ED within 7 days of MOAB, 5% were hospitalized. No patients required ICU admission or died. Conclusion(s): ED-based MOAB has been safely implemented and may be an effective treatment for patients with mild to moderate COVID-19. Health-system wide expansion of this program may provide opportunities to offer this life-saving therapy to underserved populations with poor access to care.Copyright © 2023

Thyroid Storm Triggered by Coronavirus Disease-19 (COVID-19) In a Patient With Graves’ Disease

Background: COVID-19 infection affects multiple organ systems including the endocrine system. Its effect on thyroid function has been reported in multiple studies and one of them observed overt thyrotoxicosis in 10.8% of COVID-19 hospitalized patients associated with higher mortality and longer hospital stays. There is paucity of data on the impact of COVID-19 in patients with pre-existing hyperthyroidism, with only few case reports highlighting the clinical course of such patients. We report a young woman diagnosed with Graves’ disease (GD) who was admitted 4 weeks later with thyroid storm precipitated by COVID-19. Case: An 18 year old woman presented to the Emergency Room (ER) with fatigue, palpitations, diaphoresis, and diarrhea for 2 weeks. She had sinus tachycardia with heart rate (HR) of 118 beats per minute (bpm). She had diffuse thyromegaly and fine tremors on exam. TSH was < 0.01 uIU/mL and free Thyroxine (FT4) >8 ng/dL. Thyroid Stimulating Immunoglobulin (TSI) was elevated consistent with GD. She was admitted and treated with intravenous fluids (IV), propranolol and methimazole with significant improvement. She was discharged on methimazole and propranolol. FT4 improved to 3.31 ng/dL 3 weeks later with 100% medication compliance. A week later, patient visited ER due to sore throat, left earache, and dry cough. Influenza PCR and COVID-19 nasal antigen tests were negative, and patient was discharged on amoxicillin-clavulanate for suspected otitis media and acute pharyngitis. Her symptoms worsened over the next few days and she was admitted again with nausea, vomiting, anxiety, palpitations, dyspnea and diarrhea. She was febrile to 101F, HR 135 bpm with agitation and reduced concentration. Burch-Wartofsky score was 65, highly suggestive of thyroid storm. FT4 was elevated at 4.46 ng/dL. COVID-19 PCR was positive. She was treated with propylthiouracil, propranolol and IV hydrocortisone with gradual improvement in symptoms. She was discharged on methimazole, propranolol and prednisone 10 mg for 10 days. Due to worsening hyperthyroid symptoms and rise in FT4, 1 week after stopping prednisone, it was restarted, and an urgent out-patient surgical referral was placed. She was advised to repeat thyroid labs in 1 week. Conclusion: Thyroid storm is a rare, life-threatening endocrine emergency with a mortality rate of 10-30% that demands prompt recognition and timely intervention. Our case highlights that there must be a high index of suspicion for COVID-19 with worsening hyperthyroidism in patients with GD who are compliant with anti-thyroid medication especially if they have upper or lower respiratory tract symptoms. Patients with GD should be closely monitored during COVID-19 infection for development of thyroid storm. Early initiation of steroids might be considered with worsening thyroid function despite normal respiratory status to counteract inflammatory thyroiditis. Further studies will be useful to see the effect of COVID-19 infection in patients with GD.Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

A Survey on Lung Disease Diagnosis using Machine Learning Techniques

Respiratory diseases are among the most severe diseases in the world. With the outbreak in 2020, the mortality rate among people affected by respiratory diseases has gone up by a significant amount. Early detection of these diseases could help the patients to be able to receive treatment and cure the disease at an earlier stage. Existing manual diagnoses methods take up a significant amount of time for the results to be obtained. The use of Machine Learning techniques in the medical profession has been made possible by recent developments in the disciplines of Image classification and Deep learning, as well as the availability of numerous open-source datasets. Machine learning models used in diagnoses of lung diseases have decreased the time needed for detection and reduced the amount of manual work required. This research examines how various machine learning algorithms can be used to diagnose various lung conditions. The key goal of this paper is to visualize the various trends in lung disease diagnoses using machine learning and recognize the existing issues and the in this domain's possible future. The potential future in this domain can be explored by increasing the accuracy of existing systems and increasing the number of lung diseases detection applications that are aided by machine learning. © 2022 IEEE.

The Psychological Impact of Covid-19 Pandemic among General Population

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging infection causing a widely spread pandemic of Coronavirus disease 2019 (COVID-19). The COVID-19 pandemic has a significant impact on public mental health. Therefore, monitoring and oversight of the population mental health is crucial during pandemic. Various psychological problems and important consequences in terms of mental health including stress, anxiety, depression, insomnia, fear, frustration, uncertainty during COVID 19 outbreak emerged progressively. Isolation and quarantine to reduce disease transmission have a negative impact on one’s mental health. The lockdown led to the closure of educational institutions and workplaces, loss of jobs, economic loss, lack of physical activity, restrictions on travel and gatherings. All these factors cumulatively affected the mental stamina of millions worldwide.

Emergency Department-Based Monoclonal Antibody Therapy for Patients With Mild to Moderate COVID-19

Study Objective: Monoclonal antibody therapy (MOAB) has recently emerged as a treatment for mild to moderate COVID-19, potentially preventing those with underlying conditions from progressing to severe illness and hospitalization. While MOAB administration has commonly been restricted to infusion centers or inpatient settings, the infection prevention needs of patients with acute COVID-19 and the ambulatory nature of the therapy make the emergency department (ED) a useful setting to offer this treatment. Further, as EDs are the primary point of health care access for many at-risk individuals, offering MOAB in the ED may increase availability of treatment options for patients from traditionally underserved communities. Methods: A retrospective chart review was conducted of patients 12 years and above who received treatment in our urban, academic, community hospital. A multidisciplinary group comprised of stakeholders in emergency medicine, pediatrics, infectious disease, nursing, informatics, and pharmacy developed a comprehensive ED-based MOAB program. Patients 12 years and older were screened for eligibility during ED visits or during follow-up calls providing positive test results. Staff was trained on specific consent, infusion, monitoring, and documentation procedures adherent to MOAB administration under the Emergency Use Authorization. Patients were contacted following MOAB and queried regarding symptom resolution and health care utilization. Data regarding patient demographics, ED course, and 7-day unscheduled visits were collected. Results: In this ongoing quality improvement initiative, from December 2020 to March 2021, there were 26,229 patient encounters at the pilot ED site. 84 patients were provided MOAB, 87% Bamlanivimab and 13% Bamlanivimab/Etesevimab. Patients had a mean age of 52.3 years (SD 24.4);21% were 12-17 years of age and 37% were >65 years old. 52% were male. 33% self-reported as Caucasian, 19% Black, 18% Asian/Pacific Islander, 21% as other, and 9% were unknown. 17% identified as Latinx. 19% of patients were insured by Medicaid, 36% Medicare, 39% commercially insured, and 6% were uninsured. Patients had symptoms a median of 3 days prior to MOAB. After age (46%), the most commonly reported eligibility criteria was obesity (20%), followed by hypertension (11%) and immunocompromised state (11%). 74% of infusions were administered during nights and weekends. No infusion reactions occurred. 8% returned to an ED within 7 days of MOAB, 5% were hospitalized. No patients required ICU admission or died. Conclusion: ED-based MOAB has been safely implemented and may be an effective treatment for patients with mild to moderate COVID-19. Health-system-wide expansion of this program may provide opportunities to offer this life-saving therapy to underserved populations with poor access to care.