COVID-19 in Single Kidney Patient

The COVID-19 pandemic has affected all people in the world, especially those at risk of kidney disorders. Early kidney damage in patients born with unilateral renal agenesis (URA) or solitary kidney can happen. These patients are at risk of chronic kidney disease (CKD), high blood pressure, and developing proteinuria. Unilateral renal agenesis is a cause of CKD. Therefore, it is very interesting that observe a unilateral renal Patient that Suffers from COVID-19. Hence, the management of these patients with COVID‐19 is an area of interest, and a unique approach is warranted. A 43-year-old male patient with unilateral renal presented to our hospital for corona disease. The case was discussed between the nephrologists, Infectious disease specialists, and nursing head nurses for a care plan daily. The patient had unilateral renal disease, and COVID-19 could have a detrimental effect on the renal, but renal tests were normal, and the patient recovered without acute renal complications. The treatment of such patients is the need for teamwork contain nephrologists, critical care nurses, and specialists in infectious and tropical diseases. This was a new experience in Iran.

PREDICTION OF THE OCCURRENCE AND DEVELOPMENT OF FATAL VASCULAR COMPLICATIONS IN COVID-19 USING FUZZY MATHEMATICAL MODELS

Целью исследования является разработка метода прогнозирования возникновения и развития тромботических осложнений (тромботических прецедентов), провоцируемых действием новой коронавирусной инфекции (COVID-19) на организм человека, позволяющего усовершенствовать лечебно-диагностические мероприятия для пациентов с данной патологией. В качестве базового математического аппарата была выбрана методология синтеза гибридных нечетких решающих правил, хорошо зарекомендовавшая себя в процессе решения задач с нечётким описанием исследуемых классов со структурой данных аналогичной решаемой в работе задачи. В ходе проводимых исследований были синтезированы математические модели прогнозирования возникновения и развития тромботических прецедентов. Экспертное оценивание и математическое моделирование показали, что уверенность в правильном принятии решений по прогнозу появления и развития исследуемого класса тромботических осложнений превышает величину 0,9. В работе получены нечёткие математические модели прогнозирования возникновения и развития тромботических прецедентов у людей с подтверждённой коронавирусной инфекцией, для которой ведущим фактором риска является вторичный антифосфолипидный синдром с возникновением микроангиопатии. В ходе проведенных исследований была показана целесообразность использования полученных результатов в практике работы таких врачей, как иммунологи, инфекционисты, пульмонологи, кардиологи и сердечно-сосудистые хирурги The aim of the study is to develop a method for predicting the occurrence and development of thrombotic complications (thrombotic precedents) provoked by the action of a new coronavirus infection (COVID-19) on the human body, which allows improving therapeutic and diagnostic measures for patients with this pathology. The methodology of synthesis of hybrid fuzzy decision rules was chosen as the basic mathematical apparatus, which proved itself well in the process of solving problems with a fuzzy description of the classes under study with a data structure similar to the problem being solved in the work. In the course of the research, mathematical models for predicting the occurrence and development of thrombotic precedents were synthesized. Expert evaluation and mathematical modeling have shown that confidence in the correct decision-making on the prognosis of the occurrence and development of the studied class of thrombotic complications exceeds 0.9. The paper presents fuzzy mathematical models for predicting the occurrence and development of thrombotic precedents in people with confirmed coronavirus infection, for which the leading risk factor is secondary antiphospholipid syndrome with the occurrence of microangiopathy. In the course of the conducted studies, the expediency of using the results obtained in the practice of such doctors as immunologists, infectious disease specialists, pulmonologists, cardiologists and cardiovascular surgeons was shown

Presumed Urinary Tract Infection in Patients Admitted with COVID-19: Are We Treating Too Much?

Despite the low rates of bacterial co-/superinfections in COVID-19 patients, antimicrobial drug use has been liberal since the start of the COVID-19 pandemic. Due to the low specificity of markers of bacterial co-/superinfection in the COVID-19 setting, overdiagnosis and antimicrobial overprescription have become widespread. A quantitative and qualitative evaluation of urinary tract infection (UTI) diagnoses and antimicrobial drug prescriptions for UTI diagnoses was performed in patients admitted to the COVID-19 ward of a university hospital between 17 March and 2 November 2020. A team of infectious disease specialists performed an appropriateness evaluation for every diagnosis of UTI and every antimicrobial drug prescription covering a UTI. A driver analysis was performed to identify factors increasing the odds of UTI (over)diagnosis. A total of 622 patients were included. UTI was present in 13% of included admissions, and in 12%, antimicrobials were initiated for a UTI diagnosis (0.71 daily defined doses (DDDs)/admission; 22% were scored as ‘appropriate’). An evaluation of UTI diagnoses by ID specialists revealed that of the 79 UTI diagnoses, 61% were classified as probable overdiagnosis related to the COVID-19 hospitalization. The following factors were associated with UTI overdiagnosis: physicians who are unfamiliar working in an internal medicine ward, urinary incontinence, mechanical ventilation and female sex. Antimicrobial stewardship teams should focus on diagnostic stewardship of UTIs, as UTI overdiagnosis seems to be highly prevalent in admitted COVID-19 patients.

952. Validating a Novel Framework to Classify Inpatient Infectious Diseases Consultation Requests

Background Consistent classification of consult requests may lead to more efficient and collegial conversations about patient care, which could improve work satisfaction and enhance the learning environment. The authors propose a framework of 7 consultation types (Table 1). We aimed to obtain validity evidence for this rubric to consistently classify consultation requests. Table 1. Framework for classifying consults into 7 types Methods A randomly selected sample of 100 de-identified infectious diseases (ID) consult requests from a single academic center were independently coded as 1 of the 7 consultation types by 3 ID specialists and 3 hospitalists. Perfect concordance (6/6 coders) and partial concordance (4/6 or 5/6 coders) was calculated. Total (3/3 coders) and partial (2/3 coders) concordance based on consult subtypes and provider specialty was also calculated. We compared proportions between groups using a chi square test. Results Perfect concordance was 30%, and partial concordance was 60% (Figure 1). Total concordance among ID specialists was 44% and among hospitalists was 54% (Table 2). In cases without perfect concordance (n=70), ID specialists had 20% total concordance and 70% partial concordance, while hospitalists had 34% total concordance and 59% partial concordance. ID specialists were less likely than hospitalists to have perfect concordance for ideal consults (52% vs 73%, P=0.01). ID specialists and hospitalists were similarly likely to classify a consult as ideal (65% vs 69%, P=0.34), but ID specialists were more likely to classify a consult as S.O.S. (25% vs. 17%, p=0.02), and less likely to classify a consult as confirmatory (3% vs 7%, P=0.02) (Table 3). Figure 1. Concordance overall by consensus consult type among hospitalists and infectious disease specialists Table 2. Concordance by consult type stratified among infectious disease specialists and hospitalists Table 3. Consult type by physician subspecialty, among infectious disease specialists and hospitalists Conclusion ID consults can be classified into a novel rubric of 7 subtypes. Overall, partial or perfect concordance between hospitalists and ID consultants was 90%. ID specialists were more likely to classify consult requests as S.O.S than hospitalists, and hospitalists were more likely to classify consults as confirmatory. Opportunities exist to utilize the rubric to improve provider communication and interprofessional education. Disclosures All Authors: No reported disclosures

Leprosy chemoprophylaxis of household contacts: A survey of Canadian infectious disease and tropical medicine specialists

BACKGROUND: Leprosy is uncommon in Canada. However, immigration from leprosy-endemic areas has introduced the infection to a Canadian context in which most doctors have little knowledge of the disease. Although post-exposure chemoprophylaxis (PEP) is reported to decrease leprosy transmission, no Canadian guidelines advise clinical decision making about leprosy PEP. Here, we characterize the practice patterns of Canadian infectious disease specialists with respect to leprosy PEP and screening of household contacts by yearly physical examinations. METHODS: Canadian infectious disease specialists with known experience treating leprosy were identified using university faculty lists. An online anonymous survey was distributed. Certain questions allowed more than one response. RESULTS: The survey response rate was 46.5% (20/43). Thirty-five percent responded that PEP is needed for household contacts, 40.0% responded that PEP is not needed for household contacts, and 25.0% did not know whether PEP is needed (multinomial test p = 0.79). Twenty-five percent responded that PEP should be given to all household contacts, 62.5% responded that PEP should be given to contacts of multibacillary cases, and 25.0% responded that PEP should be given to contacts who are genetically related to the index case. For specialists who prescribe PEP, 57.1% use rifampicin, ofloxacin (levofloxacin), and minocycline; 14.3% prescribe single-dose rifampicin; and 28.6% prescribe multiple doses of rifampicin (multinomial test p = 0.11). In addition, 68.4% recommend yearly screening of household contacts, whereas 31.6% do not (multinomial test p = 0.17). CONCLUSION: Consensus among Canadian infectious diseases specialists is lacking regarding leprosy PEP and screening of household contacts.

Pseudomembranous colitis after COVID-19 antibacterial therapy

A new coronavirus infection poses a challenge to infectious disease specialists, health care administrators, and subspecialty physicians in the search for the most eff ective treatment options. The past year has allowed us to clarify the main aspects of pathogenesis with a focus on the most severe versions of the COVID-19 course. Most signifi cant is to understand that the severe course is associated with prolonged viremia and T-cell lymphocyte defi ciency leading to activation of innate immunity, manifested by a burst of macrophage activity known as the “cytokine storm”. This inadequate response is a major factor in both pulmonary and multiple organ failure. Fever, pulmonary infi ltrates with leukocytosis and neutrophilia are traditionally perceived by doctors as indications for antibiotic therapy, which is nevertheless erroneous in the absence of signs of bacterial infection. We present a case that illustrates the severe course of pseudomembranous colitis and secondary myocarditis in an elderly woman with comorbid pathology and massive antibiotic therapy received during hospitalization for COVID-19.

Patient with systemic emboli in the setting of Klebsiella oxytoca tricuspid valve endocarditis and patent foramen ovale treated with NobleStitch and AngioVac

A 34-year-old man with a medical history of injection drug use presented with 2 weeks of weakness, nausea, vomiting and septic shock secondary to infective endocarditis of a native tricuspid valve. On admission, CT chest demonstrated multiple cavitary lesions as well as numerous small infarcts seen on MRI brain concerning for systemic septic emboli. Subsequent transthoracic echo with bubble study revealed a large patent foramen ovale (PFO). The patient later received surgical debulking of his tricuspid valve vegetation with AngioVac. Subsequently, PFO closure was performed with a NobleStitch device. The case presented here demonstrates the importance of having a high index of suspicion with right-sided endocarditis and the development of other systemic signs and symptoms. It also underscores the necessity of a multidisciplinary team of cardiologists, surgeons, infectious disease specialists and intensivists in the treatment of these complicated patients.

Testing Practices for Fungal Respiratory Infections and SARS-CoV-2 among Infectious Disease Specialists, United States

In an online poll, 174 infectious disease physicians reported that testing frequencies for coccidioidomycosis, histoplasmosis, blastomycosis, and cryptococcosis were similar before and during the COVID-19 pandemic, indicating that these physicians remain alert for these fungal infections and were generally not concerned about the possibility of under-detection.

METHOD FOR PREDICTING FATAL COMPLICATIONS IN THE DEVELOPMENT OF CORONAVIRAL INFECTION ON THE BACKGROUND OF SYSTEMIC LUPUS ERYTHEMATOSUS

Целью исследования является разработка метода прогнозирования возникновения и развития фатальных осложнений, провоцируемых действием на организм человека новой коронавирусной инфекции (COVID-19) на фоне иммунопролиферативных заболеваний, который позволит усовершенствовать лечебно-диагностические мероприятия при данной патологии. В качестве базового математического аппарата была выбрана методология синтеза гибридных нечетких решающих правил, которая хорошо зарекомендовала себя при решении задач с нечётким описанием исследуемых классов и схожим типом неопределенности. Предлагаемый метод прогнозирования позволяет учесть мультипликативный эффект воздействия на организм человека существенных факторов риска, характерных для рассматриваемого заболевания, с учетом его тяжести и скорости развития патологического процесса. В ходе проводимых исследований были синтезированы математические модели прогнозирования возникновения и развития фатальных осложнений. В ходе экспертного оценивания, математического моделирования и статистических испытаний показано, что уверенность в правильном принятии решений по прогнозу появления и развития исследуемого класса фатальных осложнений превышает величину 0,85. В работе получены нечёткие математические модели прогнозирования возникновения и развития фатальных осложнений у людей при развитии коронавирусной инфекции на фоне системной красной волчанки, для которых ведущими факторами риска являются вторичный антифосфолипидный синдром с нарушением микроциркуляции и гипоксемия. В ходе проведенных исследований была показана целесообразность использования полученных результатов в практике работы таких врачей, как иммунологи, инфекционисты, пульмонологи The aim of the study is to develop a method for predicting the occurrence and development of fatal complications provoked by the effect on the human body of a new coronavirus infection (COVID-19) against the background of immunoproliferative diseases, which will improve diagnostic and treatment measures for this pathology. The methodology for the synthesis of hybrid fuzzy decision rules was chosen as the basic mathematical apparatus, which has proven itself well in solving problems with a fuzzy description of the classes under study and a similar type of uncertainty. The proposed forecasting method allows one to take into account the multiplicative effect of exposure to the human body of significant risk factors characteristic of the disease under consideration, taking into account its severity and the rate of development of the pathological process. In the course of the research, mathematical models were synthesized for predicting the occurrence and development of fatal complications. In the course of expert assessment, mathematical modeling and statistical tests, it was shown that confidence in the correct decision-making on the prediction of the appearance and development of the studied class of fatal complications exceeds 0.85, which makes it possible to recommend the results obtained during the study for implementation into the practice of such doctors. as immunologists, infectious disease specialists, pulmonologists. The work obtained fuzzy mathematical models for predicting the occurrence and development of fatal complications in people with the development of coronavirus infection against the background of systemic lupus erythematosus, for which the leading risk factors are secondary antiphospholipid syndrome with microcirculation disorders and hypoxemia. In the course of the studies, the expediency of using the results obtained in the practice of the work of such doctors as immunologists, infectious disease specialists, pulmonologists was shown

Malignant Transformation in Chronic Stage IV Sacral Pressure Ulcer: A Case of Marjolin Ulcer

A Marjolin ulcer (MU) is a rare type of skin cancer that most commonly occurs in burns and other traumatic scars, and it also may arise in chronic, poorly healing wounds. Typically, MU presents as a squamous cell carcinoma and has a high rate of metastasis resulting in poor prognosis. The mechanism of the aggressive and metastatic potential of MU has not been clearly defined. This malignancy is more common in patients who are elderly or immunocompromised and has also been characterized as a disease of economically developing nations in which health care resources are less abundant and treatment is delayed. Marjolin ulcer is a challenging, although rare, disease. This article presents a case of MU that arose in a chronic sacral pressure ulcer. This was a rare, multifactorial case; the patient’s many comorbidities required coordinated efforts by wound care, oncology, and infectious disease specialists. As seen in this case, MU can be insidious and may not become apparent until considerable progression has occurred. This article discusses the multidisciplinary treatment measures undertaken for this patient, the strategies for prophylaxis and early detection of MU, and ultimately, the poor prognosis of MU in such a scenario where diagnosis is delayed.