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Background: Infancy is an important developmental period when the human microbiome is shaped. Given links between young age at antiretroviral treatment (ART) initiation and smaller persisting viral reservoirs, we hypothesized that earlier ART initiation may leave distinct microbial signatures in the oral cavity detectable in children living with HIV (CLWH). Method(s): Oral swab samples were collected from 477 CLWH and 123 children without HIV at two sites in Johannesburg, South Africa. CLWH had started ART < 2 years of age with 60% starting < 6 months of age. Most were wellcontrolled on ART at a median of 10 years of age when the swab was collected. Controls were age-matched and recruited from the same communities. Sequencing of the V4 amplicon of the 16S rRNA gene was done using established protocols. DADA2, decontam, and phyloseq were used for sequence inference, contaminant removal, and subsequent analyses. All p-values were adjusted for multiple testing using Benjamini-Hochberg false discovery rate method. Statistical analyses were performed with R. Result(s): CLWH had lower alpha diversity than uninfected children (Shannon index p< 0.0001). Genus-level abundances of Granulicatella, Streptococcus and Gemella were greater and Neisseria and Haemophilus were less abundant among CLWH compared to uninfected children. Associations were strongest among boys. There was no evidence of attenuation of associations with earlier ART initiation. In fact, decreased bacterial diversity and differences in taxa abundances in CLWH versus controls were consistent regardless of whether ART was started before or after 6 months of age. Shifts in genus-level taxa abundances relative to uninfected controls were most marked in children on regimens containing lopinavir/ritonavir;with few shifts seen if on regimens containing efavirenz. Conclusion(s): A distinct profile of less diverse oral bacterial taxa was observed in school-age CLWH on ART versus uninfected age-matched children suggesting persisting interference of HIV and its treatments on microbiota in the mouth. Any effects of earlier ART initiation were not detectable at this age. Studies of treated adults with HIV have observed similar shifts in taxa abundances. Oral microbiota have been linked to salivary cytokine levels with associations between Granulicatella and IL-8 and Neisseria and IL-6. Declines in Neisseria abundances in oral samples have been associated with more severe outcomes in influenza and COVID-19.
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Background We present a unique case of a female who developed a large pericardial effusion (PEff) from a rare cause. Case A 36-year-old female with recent COVID-19 infection presented with acute dyspnea. She had undergone liposuction, rectus plication and breast augmentation two months ago. Heart rate was 90/min and blood pressure 86/57mmHg. CT angiogram of the chest revealed a massive PEff with tamponade. She had large right-sided pleural effusion also. She underwent ultrasound-guided pericardiocentesis with the removal of 950 milliliters of serosanguineous fluid. Follow-up echocardiogram showed re-accumulation of fluid. Due to the rapid onset of PEff, she underwent a pericardial window and bilateral chest tube placement. Decision-making Pleural and pericardial fluid analysis showed silicone-gel particles (Figure. 1). Pericardial biopsy showed nonspecific chronic inflammation. Autoimmune workup was unremarkable. Elevated ESR and CRP in the presence of embolized gel particles indicated foreign body reaction from silicone embolism. Plastic surgery advised implant removal. Silicone embolism is known to cause silicone thorax, pleural effusions, and anaplastic large cell lymphoma. To our knowledge, this is the first reported case of PEff due to silicone embolism from breast implants. Conclusion Cardiologists should be aware of this rare but serious complication. Silicone embolism should be considered in the differential of PEff in patients with breast implants. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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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: Pneumomediastinum is the presence of air or other gas in the mediastinum which can be due to trauma related to mechanical ventilation or spontaneous in preexisting lung diseases. Here, we present the case of Covid-19 pneumonia, who developed pneumomediastinum without any trauma or other risk factors. CASE PRESENTATION: A 56-year-old male COVID unvaccinated with a history of essential hypertension presented to the ED with shortness of breath and worsening cough for one week. He was living with his father, who was admitted to the ICU and receiving treatment for COVID pneumonia. The patient appeared to be in respiratory distress. His initial vital signs were temperature of 99.6 F, respiratory rate of 26 breaths per minute, blood pressure 125/71 mm Hg, heart rate 109 beats per minute with a regular rhythm, and oxygen saturation of 50% while he was breathing ambient air. Pulmonary examination revealed use of respiratory accessory muscle and widespread bilateral coarse rhonchi on auscultation. The rest of the physical examination was within normal limits. RT- PCR COVID -19 test was positive. The blood gas analysis reported respiratory alkalosis. Inflammatory markers were elevated: erythrocyte sedimentation rate (35.2 mg/L), C-Reactive Protein (17.70 mg/dL), Ferritin (1108.1 ng/mL), Lactate Dehydrogenase (813 U/L), Lactate (2.4 mg/dL), D-Dimer (35.20 mg/L) and Troponin High Sensitivity-236.6 ng/L. His CBC, electrolytes, and kidney function were normal. Chest X-ray showed Pneumomediastinum with dense basilar predominant consolidation. CT Angio Chest with contrast reported Pneumomediastinum likely from the left central airway source and bilateral dense ground glass consolidation. An echocardiogram showed an ejection fraction of 60-65%, no valvular abnormalities. He was placed on vapotherm(Oxygen 40L/min) with 100% FiO2. He was given Dexamethasone 6mg for ten days, Remdesivir, Barcitinib, and a 7-day course of Azithromycin and Ceftriaxone for community-acquired pneumonia. He was advised to practice prone positioning for 12 hours or more per day. Pulmonology, Infectious Disease, and Cardiology were consulted. Gradually, his oxygen requirement was weaned down and Pneumomediastinum resolved on serial chest x rays. He was discharged on home oxygen in a clinically stable condition. DISCUSSION: Pneumomediastinum in viral pneumonia is rare. The exact mechanism is unknown. Covid-19 pneumonia causes diffuse alveolar wall damage, which might cause air leakage into the mediastinum. The development of pneumomediastinum is an ominous sign in these patients. Fortunately, our patient did not worsen and was weaned off high flow oxygenation requirement. CONCLUSIONS: Few isolated reported cases of pneumomediastinum in a COVID-19 patient have been associated with life-threatening complications. It should be used as a prognostic marker, and close monitoring of these patients is advisable. Reference #1: Damous, S.H.B., dos Santos Junior, J.P., Pezzano, Á.V.A. et al. Pneumomediastinum complicating COVID-19: a case series. Eur J Med Res 26, 114 (2021) DISCLOSURES: No relevant relationships by Saad Ansari No relevant relationships by Akshit Chitkara No relevant relationships by Sudeshna Ghosh No relevant relationships by Femina Patel
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Introduction In 2019 the ABN delivered the first Acute Neurology Boot Camp. This addressed an unmet need in postgraduate training. We designed a one-day series of seminars covering common or critical presentations for neurology registrars on-call. In 2020, face-to-face events weren't feasible, and while having to adapt to a new model of working including tele-neurology, virtual radiology meetings, we adapted the boot camp to this model. Methods We designed an online version of the boot camp over two weeks. Videos were recorded for repeat viewing. All delegates were encouraged to complete surveys on confidence levels, before and after each session, and with reference to the course as a whole. Results 77 participants provided feedback. 289 logged-in live and YYY have viewed the videos on-demand. This compares to XYZ in the 2019 iteration. 30% of respondents were confident or very confident at being the neurology registrar oncall prior to the course, compared to 88% at the end of the course (p< 0.00001). Participants were very happy with the delivery, content and format of the talks, with 'very good' ratings for 60%, 56% and 57% respectively. Conclusion The Covid-19 pandemic brought tumultuous shifts in practice that were uncharted waters for the entire neurological community. As we all tried to stay afloat, we also provided a necessary life-raft to trainees who were negotiating the challenge of the transition to being a neurology registrar.
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Introduction: A 10 year-old girl was referred to paediatric rheumatology with a six-month history of a painful, swollen left wrist associated with functional limitation and disturbed sleep. She initially had a minor fall, X-rays at the time showed no bony abnormalities. Objectives: Blood tests were normal including inflammatory markers and autoimmune screen. Wrist MRI showed significant synovial thickening and avascular necrosis of the left lunate (figure 1). Methods: Our patient received non-steroidal anti-inflammatories and physiotherapy, but a year later continued to have chronic regional pain with allodynia and hyperalgesia. Despite this, she remains upbeat and continues to live a normal childhood and has coped well with the recent increase in computer usage and typing associated with remote-schooling as a consequence of closures during the COVID-19 pandemic. Results: Kienböck disease;an eponym for avascular necrosis of the lunate bone, is of unknown aetiology and incidence[1]. The proposed trigger is trauma in those with a susceptibility due to natural skeletal and vascular variations[2]. It is the commonest cause of adult aseptic osteonecrosis of the upper extremity, usually in dominant hands of men aged 20-40[3]. Paediatric Kienböck is rare;presenting as pain, stiffness, swelling and reduced power often after an innocuous fall. Diagnostically this is challenging because the mechanism suggests a soft-tissue injury whereas the chronicity mimics Juvenile Idiopathic Arthritis. Radiographic severity is defined by Lichtman classification and used to guide non-curative surgical or conservative management[4]. This aims to relieve pressure on the lunate bone and restore perfusion. Anti-inflammatory medications are offered prior to surgical jointlevelling to reduce pain, swelling and deformity[5]. Conclusion: We emphasise that clinicians consider this rare, destructive pathology in their differential diagnosis for paediatric chronic wrist pain and swelling, especially in those presenting weeks after a seemingly innocuous hand trauma.
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Context: COVID-19 outbreak has had a huge impact on health-care facilities, and challenges of health-care providers would compromise their physical and mental well-being during this epidemic. Aims: This study aimed to find out stress, anxiety, insomnia, and depression among the health-care workers during COVID-19 outbreak. Settings and Design: This was a 3-month, cross-sectional, observational, single-center study of health-care workers of designated COVID-19 hospital. Subjects and Methods: Study objectives were explained to health-care workers, and written consent was obtained. Participants were approached in their department as per their convenience and requested to fill the pro forma. Depression, Anxiety, and Stress Scale-21 and Insomnia Severity Index were used to detect psychological issues in the form of stress, anxiety, insomnia, and depression. Statistical Analysis: Descriptive statistics and Chi-square test were used for analysis of variables in the study. Results: Overall 27.41% and 29.18% of the health-care workers reported stress and anxiety symptoms, respectively, while 18.78% reported clinically significant insomnia and depression. Among them, being female, married, elderly, presence of medical illness, frontline workers, frequently watching COVID news, and excessive fear of COVID emerged as statistically significant variables associated with stress, anxiety, insomnia, and depression. Conclusions: Health-care workers experienced many mental health issues while performing duties during COVID-19 outbreak. Such issues are alarming and need to be addressed with appropriate health-care policy.
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In this article, the authors propose a scheme, BloCoV6, that integrates sixth-generation (6G)-assisted unmanned aerial vehicles (UAVs) and blockchain (BC) to monitor mass surveillance of persons in dense areas, and implement a trust-based contact-tracing ecosystem in BC. The scheme operates in two phases. In the first phase, based on the area density, and the number of users, UAVs swarms are mounted with thermal imaging sensors that monitor the body temperature of persons. The collected data are sent to ground stations in real-time, through 6G network services. Once, the images are analyzed, the details of potential COVID-19 patients are identified, and their travel and contact records are fetched and stored in BC. Then, in the second phase, the contact-tracing information is validated in BC. The proposed scheme is simulated for smart contracts (SC) functionalities, UAV observations, latency, spectral efficiency, and transaction and signing costs. The obtained results indicate the scheme viability. For example, 6G has a low latency of 330.8 milliseconds (ms), which outperforms 1200.1 ms in fifth-generation (5G) channels. The observed spectral efficiency of 6G channels is 5-10× higher than 5G, and the average signing and transaction cost is 3.473 seconds (s), and 6.873 s respectively, which outperforms the conventional schemes. © 2021 IEEE.
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A 20-year-old asymptomatic Caucasian female has been screened to the clinic for COVID-19 testing due to the recent pandemic. She works in the primary care clinic where covid-19 patients are not seen. She has a past medical history of diabetes Mellitus and thyroid nodule. Her vitals are Temp 96.2 F, BP 123/89, RR 18, spo2 99% on air. On physical examination, her nasal turbinates were pale bilaterally, with no throat congestion. She denies any cough, congestion, fever, muscle aches, shortness of breath, sore throat, loss of taste, or smell sensation. On Investigation: Early march IgG antibody positive for covid-19 and in late May, she was tested positive for RT-PCR covid-19 without symptoms both times. On both occasions, she was working with healthcare workers without strict preventive protocols, who came negative for tests. Her family and close contacts tested negative for COVID-19. Diagnosis: Asymptomatic covid 19 carriers. Treatment: Close monitoring for symptoms. Discussion: Over the last year, the COVID-19 pandemic has caused significant concern worldwide due to its rapid spread. There are few notable symptomatic cases that are hospitalized and two months after discharge, they still tested positive on the RT-PCR COVID-19 test. It means they are a dormant carrier for COVID-19. But, in our case, the patient was asymptomatic and positive for COVID-19 antibody and RT-PCR test. Surprisingly, all healthcare workers in the clinic came negative on repeated testing. We presumed that she encountered some covid-19 strain, which remains dormant in the body and non-contagious. We need further studies to evaluate the COVID-19 dormant stage like hepatitis-B and tuberculosis.
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Aims: Study aimed to find out the prevalence and risk factors of depression among the health care workers during COVID-19 outbreak. Methods and Material: This was a four month, cross-sectional, observational, single center study of heath care workers of a notified COVID-19 hospital. Study objectives were explained to health care workers, and written consent was obtained. Patient health questionnaire-9 (PHQ-9), DSM-5 criterion of major depressive disorder and Structured Clinical Interview for DSM-5 were used to diagnose the depression. Descriptive statistics, chi-square test, and Binary logistic regression were used for analysis of variables Results: Overall 18.78% health workers reported major depressive disorder. Nearly three fourth of the old age participants had moderate to severe depression. 20.69% of married subjects had major depression. Medical health workers reported more depression. One third of the front line workers had major depression. 51% of the participants with medical co-morbidities reported major depression as compared to only 12% in those without any medical co-morbidity.33% of subjects watching COVID-19 news very frequently in a day had major depression Discussion: The prevalence of depression ranges from 9 to 35% in various studies. Among them living in joint family, married, elderly, presence of medical illness, frontline work, frequently watching COVID-19 news, excessive fear of COVID-19, and medical health worker emerged as statistically significant variables associated with major depression Conclusions: The prevalence of depression is high among health care workers while performing duties during COVID-19 outbreak. Early diagnosis and treatment of depression would be crucial during this difficult time. © 2021 Polish Psychiatric Association. All rights reserved.
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Background & objectives The Covid-19 pandemic has revolutionised how we receive services, with a huge shift to online delivery. Online health promotion tools could be a cost-effective and safe way to improve population health. We used mixed methods to explore user responses to an online cognitive health tool. Methods 15–28 months after completing an online tool, comprising a cognitive test, lifestyle questionnaire;and dietary and lifestyle behaviour feedback, 4826 participants completed an online survey about their perceptions of it;and questions about their capability, opportunity and motivation for behavioural change developed using the COM-B behaviour change model. We reported how responses to the behaviour change questionnaire predicted decisions to make lifestyle and dietary changes. 24 participants attended focus groups to further explore their responses. Results Most users reported that the tool was useful (88%), with 37% reporting they made lifestyle or dietary changes after using it. More positive responses to questions regarding capability and motivation predicted making changes. Over a third (36%) felt more fearful after completing the tool. In qualitative findings, we identified barriers to engagement across the three COM-B domains: a sense that information was “nothing new” (so did not enhance capability);that “experts don’t agree” and that the tool may not be credible (influencing motivation), and a lack of support from peers and lower availability of healthy food (reducing opportunities for change). Conclusions Future e-health tools will be most effective if they have high credibility, demonstrate advice is evidence-based and provide opportunities for support and follow up.
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The rapid development in digital infrastructure such as computing power and less expensive mobile devices and explosive growth of the internet has made an impact on digital processing. This revolution has bought many new applications and new technologies, now aiming at replacement with improving effectiveness and efficiency of manual contact tracing with new approaches with maintaining user privacy. The successful containment of the Coronavirus pandemic (COVID-19) depends on the ability to identify quickly and reliably those who have been in close proximity to a contagious positive-tested individual. This can be made possible with contact tracing method. The information about interaction which happens between two users should be revealed only to themselves to maintain privacy of individuals. Users which are detected positive should not share any of their contact details or personal information or history with the authority or any other party but pass the anonymous IDs and help in tracing out the contacted people. This paper presents the most popular contact tracing data privacy techniques. © 2020 IEEE.