Concurrent COVID-19 Research Articles

Euglycemic Ketoacidosis in Pregnancy Complicated by COVID-19

Euglycemic ketoacidosis (EKA) is an uncommon yet serious complication during pregnancy, which is precipitated by illness or other stressors. EKA in particular, requires a high index of suspicion. There have been reports of COVID-19 infection precipitating EKA in pregnancy as described in the literature. Our patient is a gravida 1 para 0 female at 28 weeks, 0 days who presented with gastrointestinal symptoms and concurrent acute COVID-19 illness. At time of admission, she did not have her glucose screening yet.

Concurrent SARS-COV-19 and acute appendicitis: Management and outcomes across United States children's hospitals.

Nonoperative management of acute appendicitis is a safe and effective alternative to appendectomy, though rates of treatment failure and disease recurrence are significant. The purpose of this study was to determine whether COVID-19-positive children with acute appendicitis were more likely to undergo nonoperative management when compared to COVID-19-negative peers and to compare clinical outcomes and healthcare use for these groups. A retrospective cohort study of children <18 years with acute appendicitis across 45 US Children's Hospitals during the first 12 months of the COVID-19 pandemic was performed. Operative management was defined as appendectomy or percutaneous drain placement, whereas nonoperative management was defined as admission with antibiotics alone. Multivariable hierarchical logistic regression using an exact matched cohort was used to determine the association between COVID-19 positivity and nonoperative management. The secondary outcomes included intensive care unit admission, mechanical ventilation, length of stay, nonoperative management failure rates, and hospital variation in nonoperative management. Of 17,481 children in the cohort, 581 (3.3%) were positive for COVID-19. The odds of nonoperative management was significantly higher in the COVID-19-positive group (adjusted odds ratio [95% confidence interval]: 13.4 [10.7-16.8], P < .001). Patients positive for COVID-19 had increased odds of intensive care unit admission (adjusted odds ratio [95% confidence interval]: 3.78 [2.01-7.12], P < .001) and longer length of stay (median 2 days vs 1 day, P < .001). Hospital rates of nonoperative management ranged from 0% to 100% for COVID-19-positive patients and 0% to 42% for COVID-19-negative patients. Children with concurrent acute appendicitis and COVID-19 positivity are significantly more likely to undergo nonoperative management. Both groups experience infrequent nonoperative management failure rates and rare intensive care unit admissions. Marked hospital variability in nonoperative management practices was demonstrated.

PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN COVID-19 PATEINTS

Background: Coronavirus Disease 2019 is global pandemic having high morbidity and mortality. It is thought that COVID-19 can predispose high thrombus burden and lead to Acute Coronary Syndrome. The aim of this study was to compare the symptoms, angiographic characteristics and procedural outcome in COVID-19 positive and COVID-19 negative patient undergoing percutaneous coronary intervention for acute coronary syndrome. Methods: All the data of 121 patients who were admitted at Chitwan Medical College on April 2020 to September 2020, suffering from acute coronary syndrome who underwent PCI were collected and compared with COVID-19 positive and negative patients using SPSS version 22. The categorical variables were presented as numbers or percentages (%) and continuous variables were presented as mean ± standard deviation. Results: Patient suffering with acute coronary syndrome with concurrent COVID-19 infections have more symptoms of fever (27.3% Vs 0.9%) and cough (27.3% Vs 2.8%, complications (45.5% Vs 7.3%), Mortality (36.4% Vs 0.9%), multi vessels thrombosis (27.3% Vs 2.8%) glycoprotein IIb/IIIa inhibitors use (27.3% Vs 0.14%) than non-COVID infection. Conclusions: Patient with acute coronary syndrome with concurrent COVID-19 infections have high complication rate, multivessel thrombosis and death.

Anaesthetic challenges of coronavirus disease (COVID-19) associated mucormycosis: A case series

During the second wave of COVID -19 Indian subcontinent suffered another pandemic of covid associated mucormycosis (CAM) which further burderned the already overexhausted health care infrastructure. To share our experience of anaesthetic management of eighteen patients with covid associated mucormycosis who underwent surgical resection of necrotized tissues at a tertiary care hospital of North India. : Eighteen patients with COVID-19 infection or previous history of COVID-19 infection based on RT-PCR and histopathologically proven rhino orbital mucormycosis, presented for endoscopic and open surgeries during May and June 2021. According to institutional protocol, institutional ethical committee clearance was not required for a case series. Data regarding the demographic details, clinical manifestations, COVID-19 course, laboratory parameters, imaging reports, pre-operative evaluation, airway management, intraoperative and postoperative management, and complications were collected. Out of eighteen patients 12(66.7%) were male and six (33.33%) were female, with a median age of 51 years. Six patients (33.33%) had a past history of COVID-19, twelve patients had concurrent COVID-19 (66.66%). Most of the patients presented with unilateral facial swelling, retro-orbital pain, ptosis and headache. Fifteen (83.33%) patients had high blood sugars, seven (46.66%) were known type 2 diabetics and eight (53.33%) developed new-onset diabetes after taking prolong systemic corticosteroids. All eighteen patients received antifungal treatment,eight (44.44%)patients had derranged renal function tests with raised serum creatininine (2.4-2.8) and normal blood urea nitrogen. Eight (44.44%) of them had difficult airway because of swelling on face and limited mouth opening, two patients were reoperated (n=2/18). Three (27.27%) patients deveoped arrythmias and ST changes intraoperatively, two(n=2/18) patients were extubated next day after surgery, one patient was tracheostomised in view of preoperative difficult airway and extensive surgery. One fiftyfive year old covid positive female patient died on fifth postoperative day. : In our case series, all 18 patients had covid associated rhino-orbital mucormycosis, most of them had diabetes and hypertension, cerebrovascular accident, coronary artery disease, asthma and post KTP status. Twelve patients were covid positive and 6 had recent history of covid. One patient developed hemiparesis and one patient died because of intracranial extension of mucormycosis. Disseminated or cerebral mucormycosis, severe covid, elderly age group, associated comorbidities like uncontrolled diabetes and renal failure have been found to increases mortality in CAM patients. : Physicians caring for covid associated mucormycosis patients must be aware of the severity of the covid-19 as well as mucormycosis, associated comorbidities and various side effects of the medications used for treatment. Early diagnosis and timely medical and surgical management are necessary to improve outcome in covid associated mucormycosis.

Periocular necrotising fasciitis after traumatic laceration and concurrent COVID-19 infection: a case report

Periocular necrotising fasciitis after traumatic laceration and concurrent COVID-19 infection: a case report

EFFECTS OF SARS COVID-19 POSITIVITY STATUS ON VENOUS THROMBOSIS AND PULMONARY EMBOLISM RATES IN TRAUMA PATIENTS.

Introduction : COVID-19-induced coagulopathy (CIC) can increase the risk of thromboembolism without underlying clotting disorders, even when compared with other respiratory viruses. Trauma has a known association with hypercoagulability. Trauma patients with concurrent COVID-19 infection potentially have an even greater risk of thrombotic events. The purpose of this study was to evaluate venous thromboembolism (VTE) rates in trauma patients with COVID-19. Methods : This study reviewed all adult patients (≥18 years of age) admitted to the Trauma Service from April through November 2020 for a minimum of 48 hours. Patients were grouped based off COVID-19 status and compared for inpatient VTE chemoprophylaxis regimen, thrombotic complications defined as deep vein thrombosis, pulmonary embolism, myocardial infarction, and cerebrovascular accident, intensive care unit (ICU) length of stay, hospital length of stay, and mortality. Results : A total of 2,907 patients were reviewed and grouped into COVID-19-positive (n = 110) and COVID-19-negative (n = 2,797) groups. There was no difference in terms of receiving deep vein thrombosis chemoprophylaxis or type, but a longer time to initiation in the positive group ( P = 0.0012). VTE occurred in 5 (4.55%) positive and 60 (2.15%) negative patients without a significant difference between the groups, as well as no difference in type of VTE observed. Mortality was higher ( P = 0.009) in the positive group (10.91%). Positive patients had longer median ICU LOS ( P = 0.0012) and total LOS ( P < 0.001). Conclusion : There were no increased rates of VTE complications between COVID-19-positive and -negative trauma patients, despite a longer time to initiation of chemoprophylaxis in the COVID-19-positive group. COVID-19-positive patients had increased ICU LOS, total LOS, and mortality, which are likely due to multifactorial causes but primarily related to their underlying COVID-19 infection.

Brain and Blood Vessel Imaging for Ischemic Stroke in Patients with Covid-19—Data from the Literature and Clinical Cases

Abstract This study explores the relationship between patients diagnosed with ischemic stroke and SARS-CoV-2 infection. The focus is on the role of neuroimaging in confirming the diagnosis of ischemic stroke and guiding patient care. The COVID-19 pandemic has posed challenges in di-agnosing and treating patients with neurological pathologies due to the time-sensitive nature of stroke management. The objective of this study was to analyze cases of patients with ischemic stroke and SARS-CoV-2 infection, emphasizing the importance of neuroimaging in confirming the diagnosis. The study aimed to provide insights into the characteristics and clinical manifestations of these patients, contributing to our understanding of the neurological impacts of COVID-19. A retrospective analysis of hospitalized patients with a diagnosis of ischemic stroke and SARS-CoV-2 infection was conducted. The study focused on five representative cases, including patient demographics, medical histories, clinical symptoms, and imaging findings. Brain CT and MRI scans were performed to confirm the diagnosis of ischemic stroke. Among the 120 cases analyzed, 5 representative cases are presented. These cases include patients of varying age and gender with concurrent neurological pathologies and COVID-19 infections. Neuroimaging, such as CT and MRI, confirmed the diagnosis of ischemic stroke in these patients. Patients with SARS-CoV-2 in-fection and ischemic stroke often present with moderate to severe strokes, frequently involving large vessel obstructions. Neuroimaging plays a critical role in diagnosing and characterizing ischemic stroke in these patients. Identifying thrombotic angiopathy, vascular injury, and im-paired vascular autoregulation are essential for prompt diagnosis and treatment. This study emphasizes the significance of neuroimaging in managing patients with both COVID-19 and neurological pathologies, contributing to our understanding of the neurological implications of COVID-19.

Clinical course and outcome of Covid-19 in patients with myasthenia gravis

ABSTRACT Patients with myasthenia gravis (MG) may be at a greater risk of developing a severe course in coronavirus disease 2019 (Covid-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Objectives To analyze the prognosis and outcomes of COVID-19 in patients with MG and to determine factors associated with COVID-19 severity in patients with MG. Methods Information concerning COVID-19 occurrence in patients with MG was collected in this single-center observational study. Univariate and multivariate analyses were used to identify factors associated with severe Covid-19. Results Two hundred seventy-five of the 386 records of MG were included in this study. Eighty-two (29.8%) patients had concurrent COVID-19 . The patients’ mean age was 50.3 ± 1.6 years, and the mean duration of MG was 6.7 ± 5.4 years. MG was diagnosed after COVID-19 in five cases. Covid-19 was mild in 45 patients (54.9%), moderate in 23 (28.1%), and severe in 14 (17.07%), while mortality occurred in four of the severe cases (4.9%). Three of the exitus patients were receiving rituximab therapy. Pre-Covid MG Activity of Daily Living (MG-ADL) severity scores were significantly high in severe cases. A history of myasthenic crisis was also higher in severe cases. Similarly, univariate and multivariate analyses revealed an association between severe COVID-19 and myasthenic crisis history and high pre-Covid MG-ADL. The type of MG treatment had no independent effect on COVID-19 severity. Conclusion The vast majority of the MG patients made a good recovery from Covid-19. The risk of severe COVID-19 is high in patients with high MG-ADL severity scores and a history of myasthenic crisis.

Initial clinical presentation of multiple sclerosis with concurrent COVID-19 infection: Case report and literature review.

The Article Abstract is not available.

An Outcome Analysis of Asymptomatic COVID-19 Patients Presenting with Angina- A Retrospective Study

Introduction: Cardiovascular disorders have long been considered as one of the leading causes of mortality in India, which when presented with concurrent Coronavirus Disease (COVID-19) infection becomes even more fatal. Evidence suggests that COVID-19 affects the cardiovascular system by causing exuberant cytokinaemia, which results in endothelial inflammation and microvascular thrombosis, leading to multiorgan failure. Aim: To analyse the outcome of the asymptomatic COVID-19 patients presenting with cardiac angina during the second wave of COVID-19 in India. Materials and Methods: This is a retrospective data analysis of asymptomatic COVID-19 patients hospitalised with angina was conducted between April 2021 to June 2021 at Bardhhaman Medical College and Hospital located at Bardhdhaman district of West Bengal, India. A total of 1235 patients underwent all regular biochemical, haematological and cardiac investigations after undergoing test for COVID-19 test. Data was retrospectively collected. The outcome of these patients was analysed. Estimation of mean, standard deviation, percentage, p-value (from Pearson’s correlation) was performed to establish the aim of the study. Results: Seventy six out of 1235 patients tested positive for asymptomatic COVID-19. The mean age of this study population was 55.075±10.95 years, of which were 55 male and 21 female. Hypertension was the most prevalent co-morbidity followed by diabetes, 73 (96%) presented with chest pain. A total of 47(62%) of these 76 patients had ST Elevated Myocardial Infarction (STEMI). Eleven (14.4%) underwent Percutaneous Coronary Intervention (PCI) whereas 36 (47.3%) underwent fibrinolytic therapy with tenecteplase, followed by secondary PCI in 27 (75%) of them. Rest 29 (38%) were medically managed for unstable angina. Mortality rate was as low as 6.5%. Age and comorbidity were the contributing factors for STEMI among asymptomatic COVID-19 patients. Conclusion: The results indicate that age and comorbidity are the factors, which lead to death or increases the life risk among patients with asymptomatic COVID-19. In this study, we have established that for the current patient population STEMI and age are negatively corelated. Medical management with thrombolytic agent became a lot more accepted in this scenario. PCI still remains the gold standard to treat myocardial infarction. It is recommended that there should be an ICMR guided protocol for the management of such cases with the concurrent COVID-19.

The impact of COVID-19 on clinical outcomes of burn patients

Abstract Background Multiple studies have shown the SARS-CoV-2 virus (COVID-19) to be associated with deleterious outcomes in a wide range of patients. The impact of COVID-19 has not been well investigated among burned patients. We suspect that patients will have worsened respiratory and thrombotic complications, ultimately leading to increased mortality. The objective of this study is to determine the impact a concurrent infection of COVID-19 has on clinical outcomes after a burn injury. Methods This is a retrospective, propensity matched, cohort study. We examined a de-identified database of electronic medical records of over 75 million patients across 75 health care associations in the United States for patients treated for thermal burns from 1 January 2020, to 31 July 2021, and those who also were diagnosed with COVID-19 infection within one day before or after injury based on International Classification of Disease, tenth revision (ICD-10) codes. Study participants included adults who were treated for a burn injury during the study period. Results We included 736 patients with burn injury and concomitant COVID-19 infection matched to 736 patients with burn injury and no concurrent COVID-19 infection (total 1472 patients, mean age 36.3 ± 24.3). We found no significant increase in mortality observed for patients with concurrent COVID-19 (OR 1.203, 95% CI 0.517–2.803; p = 0.6675). We did observe significant increase in infections (OR 3.537, 95% CI 2.798–4.471; p = 0.0001), thrombotic complications (OR 2.342, 95% CI 1.351–4.058; p = 0.0018), as was the incidence of hypertrophic scarring (OR 3.368, 95% CI 2.326–4.877; p = 0.0001). Conclusions We observed that concurrent COVID-19 infection was associated with an increase in infections, thrombosis and hypertrophic scarring but no increase in mortality in our cohort of burn patients.

241 LEFT ATRIAL SEPTAL POUCH THROMBOSIS AFTER COVID19 INFECTION: IS IMMUNOTHROMBOSIS THE CULPRIT MECHANISM?

Abstract Aims The atrial septal pouch (ASP) is an incomplete fusion between septum primum (SP) and septum secundum (SS), resulting in a kangaroo pouch, that has a high prevalence in general populations (47%) and it is a potential site of blood stasis and thrombosis. After the novel coronavirus disease (COVID19) -related thrombotic complications, immunothrombosis has been widely investigated and proposed as key pathogenic mechanism linking coagulation and inflammation, leading sometimes to intracardiac thrombosis. In this paper we describe a case of thrombus in the ASP interestingly developed after COVID19 and made a literature review. Methods and Results A 85 years old woman with a history of hypertension and chronic atrial fibrillation (AF) in therapy with dabigatran, was admitted to our hospital for dyspnea, atypical chest pain and fever. Laboratory exams showed only mild leukocytosis and elevated levels of d-dimer; EKG confirmed AF with a normal ventricular rate and CT scan excluded pulmonary embolism. Transthoracic and transesophageal echocardiogram (TEE) (Figure 1) showed a mobile ovoid mass (13×26 mm) attached to a left-sided ASP mimicking a myxoma, no mass was seen in the left atrial appendage (LAA). Four months earlier she had been hospitalized for idiopathic thrombocytopenia and concurrent COVID19 infection with mild symptoms, therefore dabigatran was discontinued for a month. The patient underwent surgery and histopathology confirmed it was a thrombus. In the PubMed search we conducted for reports demonstrating ASP masses, or alleged thromboembolism (TE) from this site, we found 25 reports, whose characteristics are briefly summarized in Table 1. Interestingly mild thrombocytopenia was described just in one case. Conclusions In addition to the LAA, the atrial septal pouch is a newly described, common anatomic entity of the interatrial septum, that potentially serves as a site of stasis and thrombus formation. Despite its high prevalence, the finding of a thrombus in this site is very rare. According to Virchow triad, we assume that in this case an endothelial injury and hypercoagulability could have played a pivotal role, since the concomitant thrombocytopenia and high levels of d-dimer. This could be the first case of a thrombus in the ASP associated with COVID19-immunothrombosis.

Association between thromboembolic events and COVID-19 infection within 30 days: a case-control study among a large sample of adult hospitalized patients in the United States, March 2020-June 2021.

The association between thromboembolic events (TE) and COVID-19 infection is not completely understood at the population level in the United States. We examined their association using a large US healthcare database. We analyzed data from the Premier Healthcare Database Special COVID-19 Release and conducted a case-control study. Thestudy population consisted of men and non-pregnant women aged ≥ 18years with (cases) or without (controls) an inpatient ICD-10-CM diagnosis of TE between 3/1/2020 and 6/30/2021. Using multivariable logistic regression, we assessed the association between TE occurrence and COVID-19 diagnosis, adjusting for demographic factors and comorbidities. Among 227,343 cases, 15.2% had a concurrent or prior COVID-19 diagnosis within 30days of their index TE. Multivariable regression analysis showed a statistically significant association between a COVID-19 diagnosis and TE among cases when compared to controls (adjusted odds ratio [aOR] 1.75, 95% CI 1.72-1.78). The association was more substantial if a COVID-19 diagnosis occurred 1-30days prior to index hospitalization (aOR 3.00, 95% CI 2.88-3.13) compared to the same encounter as the index hospitalization. Our findings suggest an increased risk of TE among persons within 30days of beingdiagnosed COVID-19, highlighting the need for careful consideration of the thrombotic risk among COVID-19 patients, particularly during the first month following diagnosis.

Malaria, HIV and Malnutrition among Internally Displaced People in Mozambique During COVID-19 Pandemic: Results from a Community-Based Intervention.

The spread of COVID-19 poses an unprecedented challenge to care delivery in post-disaster and conflict situations. In Mozambique, the 2019 cyclone Idai and the violence by Non-State-Armed-Groups devastated the province of Sofala and Cabo Delgado respectively and led to the displacement of thousands of people living in poor and overcrowded conditions. The pandemic has further aggravated the situation. Doctors with Africa CUAMM (University college for aspiring missionary doctors) implemented surveillance activities in these regions between October 2020 and September 2021. The aim of this study is to give an overview of the prevalence of malaria, malnutrition, COVID-19 related symptoms and access to HIV testing. Data were collected in targeted internally displaced people (IDP) sites in Sofala and Cabo Delgado province between 31st January and 25th September 2021. The tool used enabled to assess COVID-19 symptoms, risk of HIV infection, malaria cases and malnutrition in children under five. The project reached 93 503 people. During the study period, 13.6% people reported at least one symptom suggestive of COVID-19 infection. Malaria Rapid Diagnostic Tests (RDT) were administered to 86% of the recruited people (n = ?), with a positive diagnosis in the 4.5% of them (n = ?). Among the recruited Internally Displaced Persons (IDP), 23.1% were considered eligible for HIV screening, but only 1.4% were referred for testing. Acute malnutrition was found in 6.3% of children screened and, among these, a higher prevalence of concurrent COVID-19 symptoms was reported. Our study highlights the importance of mass clinical screening for COVID-19 infection in this target population to enact prevention behavior, although this may not be enough, due to the pivotal role played by asymptomatic transmissions. Considering the overlap of the symptoms of COVID-19 and malaria, a combined diagnostic algorithm is urgently needed to avoid underdiagnosing malaria. Moreover, the high prevalence of respiratory symptoms in malnourished children confirmed the known correlation between malnutrition and respiratory infection. Finally, access to HIV screening needs to be implemented, given the high prevalence of people with HIV risk factors to avoid diagnostic delay. Population-specific needs make necessary to develop new screening methods that respond to the specific characteristics of the target population.

Original Research: TikTok's 'Dancing Nurses' During the COVID-19 Pandemic: A Content Analysis.

Amid the challenges of the ongoing COVID-19 pandemic, health care workers are using social media to publish increasing numbers of posts, memes, and videos. On TikTok, a rapidly growing and widely used social networking platform, videos labeled "dancing nurses" have recently been trending. Whether nurses or the general public consider such videos to breach professional ethical standards is unknown. The aim of this study was to analyze and describe the use of the social media platform TikTok by nurses whose videos featured dancing nurses during the ongoing pandemic. Between March 1 and December 31, 2020, we conducted a search on TikTok using terms such as dancing nurse and hashtags such as "#dancingnurse." For each identified video, the numbers of followers, views, likes, concurrent COVID-19 morbidity and mortality rates, and other data were collected. For videos meeting the inclusion criteria, content analysis was performed to evaluate dancing nurse behaviors and apply the American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements, ANA social networking principles, and National Council of State Boards of Nursing social media guidelines. A total of 52 videos met all inclusion criteria and were included for analysis. These videos had a mean of 1.51 million views each. Among these videos, there were 356 violations of Code of Ethics provisions, social networking principles, and social media guidelines. Forty of the videos (77%) included a choreographed dance; 24 (46%) contained twerking and three (6%) featured dance moves such as pelvic thrusts and gyrations. The findings offer insight into how nurses are using TikTok, specifically with regard to posting videos that feature dancing nurses. Some of the analyzed videos included content that could be construed, in our view, as inappropriate and even sexually suggestive. The concern is that such videos could damage the professional image of nurses and downplay the seriousness of the current pandemic. It's essential that nurses who use social media consider the content and presentation of what they post. There is an urgent need for nurses to understand professional and workplace guidelines and policies regarding the use of social media, and how these may apply to content developed and posted on platforms such as TikTok.

Abstract 13815: SARS-CoV-2 and Plasmodium Falciparum Co-Infection A Lethal Combination to the Heart

Introduction: COVID-19 pandemic has had an unprecedented impact worldwide, co-infections with neglected tropical diseases like Malaria can occur and affect the heart. Objective: Describe a unique case of Malaria and SARS CoV2 infection occurring concurrently with cardiac complications. Clinical Case: A 69-year-old male, retired canoeing athlete, with well-controlled arterial hypertension, presented odynophagia, cough, and dyspnea on slight exertion for 2 days. On examination, O2 saturation was 91%, blood pressure 100/60 mmHg, regular heart rate of 110 bpm, positive PCR for SARS-CoV-2, elevated D-Dimer, and chest X-ray with evidence of viral pneumonia. He received supplemental oxygen, steroids, and paracetamol. Two days later, he presented with choluria, afternoon episodes of high fever preceded by chills and myalgia, and a thick blood smear showed Plasmodium falciparum (PF) trophozoites. Antimalarial treatment was started with primaquine 15mg, 20 mg of artemether, and 120 mg of Lumefantrine daily with the disappearance of fever until day 14 of onset of symptoms when he presented with acute heart failure (AHF) with a reduced ejection fraction of 45%. NYHA Class IV, arterial hypotension, sudden onset palpitations, and afternoon febrile episode. The electrocardiogram showed atrial fibrillation (AF) with a rapid irregular ventricular response of 120 bpm; The echocardiogram revealed a 7mm circumferential pericardial effusion, right ventricular dysfunction. Treatment with colchicine, enoxaparin, spironolactone, and bisoprolol was started. A new thick smear demonstrated the persistence of PF. A new antimalarial regimen was restarted, with the disappearance of the fever 48 hours after its onset, with the reversion of AF to sinus rhythm. Discussion: A unique case of concurrent COVID-19 and Malaria, which cause challenges to the heart and lead to cardiovascular complications. Conclusion: An exceptional case is presented, the coexistence of SARS-CoV-2 and PF infection-associated complications of myocarditis, pericarditis, new-onset AF, and AHF. This interaction should not go unnoticed, physicians’ awareness is key, and early diagnosis and treatment can be lifesaving, mitigate and offer the best chance of cure.

Cholera epidemic amidst the COVID-19 pandemic in Moroto district, Uganda: Hurdles and opportunities for control.

On 21st March 2020, the first COVID-19 case was detected in Uganda and a COVID-19 pandemic declared. On the same date, a nationwide lockdown was instituted in response to the pandemic. Subsequently, more cases were detected amongst the returning international travelers as the disease continued to spread across the country. On May 14th, 2020, a cholera epidemic was confirmed in Moroto district at a time when the district had registered several COVID-19 cases and was in lockdown. This study aimed to describe the cholera epidemic and response activities during the COVID-19 pandemic as well as the hurdles and opportunities for cholera control encountered during the response. In a cross-sectional study design, we reviewed Moroto district's weekly epidemiological records on cholera and COVID-19 from April to July 2020. We obtained additional information through a review of the outbreak investigation and control reports. Data were analyzed and presented in frequencies, proportions, attack rates, case fatality rates, graphs, and maps. As of June 28th, 2020, 458 cases presenting with severe diarrhea and/or vomiting were line listed in Moroto district. The most affected age group was 15-30 years, 30.1% (138/458). The females, 59.0% [270/458], were the majority. The Case Fatality Rate (CFR) was 0.4% (2/458). Whereas home use of contaminated water following the vandalization of the only clean water source in Natapar Kocuc village, Moroto district, could have elicited the epidemic, implementing COVID-19 preventive and control measures presented some hurdles and opportunities for cholera control. The significant hurdles were observing the COVID-19 control measures such as social distancing, wearing of masks, and limited time in the community due to the need to observe curfew rules starting at 6.00 pm. The opportunities from COVID-19 measures complementary to cholera control measures included frequent hand washing, travel restrictions within the district & surrounding areas, and closure of markets. COVID-19 preventive and control measures such as social distancing, wearing of masks, and curfew rules may be a hurdle to cholera control whereas frequent hand washing, travel restrictions within the district & surrounding areas, and closure of markets may present opportunities for cholera control. Other settings experiencing concurrent cholera and COVID-19 outbreaks can borrow lessons from this study.

Does vitamin D supplementation for COVID-19 increase the chances of fertility in women with polycystic ovary syndrome?

Summary: COVID-19 has been associated with factors such as inflammation, obesity, low vitamin D levels, and hyperandrogenism. These factors are also directly related to Polycystic ovary syndrome (PCOS). We hypothesize that concurrent COVID-19 and high dose vitamin D supplement will decrease the inflammation, and can increase the chances of fertility in these women.&#x0D; Key words: Polycystic ovary syndrome; COVID-19; SARS-CoV-2; Vitamin D; Inflammation; Infertility&#x0D; Citation: Heidarzadeh H, Bahrami-Vazir E, Mohammadi A, Mohammadnejad S. Does vitamin D supplementation for COVID-19 increase the chances of fertility in women with polycystic ovary syndrome? Anaesth. pain intensive care 2022;26(4):574-575.&#x0D; DOI: 10.35975/apic.v26i4.1969

Comparison of thrombus burden in patients with COVID-19 presenting with ST-segment elevation myocardial infarction across the three waves of outbreak in the United Kingdom

Abstract Background It has been previously reported during the first COVID outbreak that patients presenting with ST-Segment Elevation Myocardial Infarction (STEMI) and concurrent COVID-19 infection have increased thrombus burden and poorer outcomes [1]. Subsequently, there have been multiple further waves of the pandemic with the emergence of at least two new COVID-19 variants and the emergence of vaccinations. To-date, there have been no reports comparing the outcomes of COVID-19-positive STEMI patients across all waves of the pandemic. Purpose The purpose of this study was to compare the baseline demographic, procedural and angiographic characteristics alongside the clinical outcomes of patients presenting with STEMI and concurrent COVID-19 infection across the COVID-19 pandemic in the UK. Methods This was a single-centre, observational study of 1250 consecutive patients admitted with confirmed STEMI treated with primary percutaneous coronary intervention (PCI) at Barts Heart Centre between 01/03/2020 and 10/03/2022. COVID +ve patients were split into 3 groups based upon the time course of the pandemic (Wave 1: March 2020-June 2020, Wave 2: Sept 2020-March 2021, Wave 3: October 2021-March 2022). Comparison was made between waves and with a control group of COVID-ve patients treated during the same timeframe. Results A total of 135 COVID +ive patients with STEMI (1st Wave: 39 patients, 2nd Wave: 60 patients, 3rd wave 35 pts) were included in the present analysis; and compared with 1115 COVID negative patients. Significant changes in the baseline characteristics, angiographic features and clinical outcomes of COVID +ive patients occurred over time. Early during the pandemic (Wave 1 2020), STEMI patients presenting with concurrent COVID-19 infection had high rates of cardiac arrest, evidence of increased thrombus burden (higher rates of multi-vessel thrombosis, stent thrombosis, higher modified thrombus grade higher use of GP IIb/IIIa inhibitors and thrombus aspiration, coagulability (more heparin for therapeutic ACT), bigger infarcts (lower myocardial blush grade and left ventricular function) and worse outcomes (mortality). However, by wave 3 (late 2021/2022), no differences existed in clinical characteristics, thrombus burden, infarct size or outcomes between COVID +ive patients and those without concurrent COVID-19 infection with significant differences compared to earlier COVID +ve patients. Poor outcomes later in the study period were predominantly in unvaccinated individuals. Conclusions Significant changes have occurred in the clinical characteristics, angiographic features and outcomes of STEMI patients with COVID-19 infection treated by primary PCI during the course of the pandemic. Importantly it appears that angiographic features and outcomes of recent waves are no different to a non-COVID-19 population. Funding Acknowledgement Type of funding sources: None.

S3148 Seronegative Autoimmune Hepatitis: A Rare Manifestation of COVID-19

Introduction: Hepatic dysfunction is seen in 14-53% of patients with COVID-19, particularly in those with significant comorbidities. There have been reports of the development of autoimmune hepatitis (AIH) following COVID-19 vaccination and/or infection. AIH is usually associated with circulating autoantibodies but 10-20% of AIH patients are initially seronegative. We present the first reported episode to our knowledge of a case of seronegative AIH in the setting of concurrent COVID-19 infection. Case Description/Methods: A 39-year-old otherwise healthy female with a family history of mother with rheumatoid arthritis presented with 2 weeks of nausea, diarrhea, abdominal pain, and jaundice. She had significant transaminitis in the 1000 s and a conjugated hyperbilirubinemia. Despite previous vaccination and no respiratory symptoms, the patient tested positive for COVID-19. The patient denied taking hepatotoxic agents, and the workup was negative for acute viral hepatitis. The antinuclear, alpha-1-antitrypsin, ceruloplasmin, IgG, anti-smooth muscle, anti-mitochondrial, anti-neutrophil cytoplasmic, and anti-liver/kidney microsomal-1 antibodies were all unremarkable. Imaging was only remarkable for hepatic hemangiomas. Liver biopsy was ultimately performed showing active lymphoplasmacytic hepatitis with prominent regenerative changes and areas of confluent necrosis, consistent with autoimmune hepatitis. The patient’s symptoms and transaminitis improved following initiation of steroids (Figure 1). Discussion: We present a unique case of AIH as a manifestation of COVID-19 infection despite negative serology. Hepatic injury from COVID-19 is thought to be mediated by multitude of mechanisms including upregulation of ACE2 and DPP4 receptors, which are involved in RAS signaling pathways and regulation of the immune system. Further research is needed to better understand if there is a causal link between COVID-19 and hepatic autoimmune dysfunction and the underlying molecular mechanisms. Identifying autoimmune dysfunction following COVID-19 infection may allow us to recognize and treat these cases early on, leading to better hospitalization outcomes.Figure 1.: Liver biopsy showing marked interface activity and areas of confluent necrosis consistent with autoimmune hepatitis (AIH). A representative portal tract (PT) and central vein (CV) are illustrated.