bluuebunny/crossref_metadata_2025_split huggingface dataset:
368. Clinical Characteristics of Hospitalized COVID-19 American Indian Patients in Rural Arizona
Authors: Nham Amy , Close Ryan M 
Published: January 2021

Abstract

Background
American Indians have an increased risk of serious complications from COVID-19 due to the high prevalence of comorbidities such as diabetes, heart disease, obesity, and asthma. To date, there has been limited analysis of COVID-19 in the AI population. This study describes the characteristics of hospitalized COVID-19 patients from a well-defined AI population in eastern Arizona. Additionally, we explored the impact of early referral via contact tracing versus those who self-presented.

Methods
Retrospective chart reviews were completed for patients hospitalized for COVID from March 29 to May 16, 2020. Summary statistics were used to describe demographics, symptoms, pre-existing conditions, and hospitalization data.

Results
We observed 447 laboratory-confirmed cases of COVID-19, resulting in 71 (15.9%) hospitalizations over a 7-week period and a hospitalization rate of 159 per 1,000 persons. Of the 50 hospitalizations reviewed sequentially, 56% were female, median age of 55 (IQR 44–65). Median number of days hospitalized was 4 (2–6), with 16% requiring intensive care unit support, 15% intubated, 12% readmitted, and 10% deceased. 67% had an epidemiological link, and 32% had an emergency department or outpatient clinic visit within 7 days of hospitalization. All patients were symptomatic; the most common symptoms were cough (90%), shortness of breath (78%), and subjective fever (66%). 86% of patients had a pre-existing condition; the most common pre-existing conditions were diabetes (66%), obesity (58%), and hypertension (52%, Figure 1). All patients had elevated LDH, 94% had elevated CRP, 86% had elevated d-dimer, and 40% had lymphopenia; only 10% had an elevated WBC count and 26% had thrombocytopenia (Table 1). 26% of the patients were referred in by the tracing team (Table 2). Analysis of 500 hospitalizations will be available in October 2020.

Conclusion
Most AI patients hospitalized had a pre-existing condition, symptoms of cough or shortness of breath, and elevated LDH, CRP, and d-dimer. More research is needed to understand the patterns of COVID-19 related disease in vulnerable populations, like AI/AN, and to examine the utility of early referral by contact tracing teams in rural settings which may guide future tracing strategies.

Disclosures
All Authors: No reported disclosures
369. Clinical Characteristics of the First 177 Patients Admitted with COVID-19 at a Bronx Community Hospital
Authors: Bengualid Victoria , Martinez Maria , Hysenaj Zhenisa , Willner Debra M , Berger Judith 
Published: January 2021

Abstract

Background
The first case of COVID-19 was admitted on March 15th 2020 to our community based hospital in the Bronx, NY. The aim of this study is to describe the clinical characteristics and outcome of these first COVID-19 patients.
Patient Characteristics and Outcome

Methods
IRB approved retrospective chart review study of all COVID-19 patients admitted during March 2020 focusing on patient characteristics, co-morbidities, clinical manifestations and outcome.

Results
A total of 177 patients were admitted during March 2020: 57% African American 23.1% Hispanic and 16.9% White. 44.9% female, average age 60 years, and 90% had at least one comorbidity. Outcome was available on all patients except for one who was transferred to another institution for ECMO. Overall mortality was 33%.
Clinical presentation: 69.4% presented with cough or shortness of breath, 15.8% with diarrhea, nausea, vomiting or abdominal pain, and 14.6% with myalgia, dizziness or altered mental status. 6.2% presented only with fever. However 59.8% of patients presented with fever and respiratory or gastrointestinal symptoms.

Mortality
The table compares patients who died vs discharged (either home or to a short term facility). Those that were 65 years or older, hypertensive or presented to the ER with an oxygen saturation of 94% or lower, were more likely to die.
Ventilated patients: 31.6% of patients were intubated with a mortality rate of 77%. 22% of these patients were intubated in the first 24 hours. Compared to non-intubated patients, there was no difference in BMI, diabetes, hypertension, COPD/Asthma, use of statins, aspirin or calcium channel blockers. Intubated patients older than 64 years had significantly higher mortality rates (p=0.0001).

Conclusion
This cohort of COVID-19 patients is unique as almost all received Hydroxychloroquine and Azithromycin. Only 9% received steroids and even fewer received an interleukin-6 inhibitor, convalescent plasma or Remdesivir. African Americans and Hispanics accounted for 80% of patients. Greater than 90% received Medicaid. Overall mortality was 33%. The most common presentation was respiratory followed by gastrointestinal symptoms. The overall mortality was 33% but increased to 77% in intubated patients. Age, hypertension, and ER oxygen saturation correlated with mortality.

Disclosures
All Authors: No reported disclosures
372. Comparing the Outcome of COVID-19 in Cancer and Non-Cancer Patients: an International Multicenter Study
Authors: Hachem Ray Y , Datoguia Tarcila , Siddiqui Bilal , Cruz Ana Fernandez , Mori Nobuyoshi , Fakhreddine Suha , Lee Dong-Gun , Gorak Edward , Somer Robert , Bhinder Arvinder , Shelanski Samuel , Dragivich Tomislav , Bayle Arnaud , Chemaly Roy F , Mulonovich Victor , Adachi Javier , Malek Alexandre , Slavin Monica , Jiang Ying , Chaftari Anne-Marie , Raad Issam I , Raad Issam I 
Published: January 2021

Abstract

Background
Our objective was to describe the clinical course, risk factors and outcomes of patients infected with COVID-19 around the globe comparing cancer to non-cancer patients.

Methods
We conducted a retrospective cohort study of COVID-19 confirmed cases through an international multicenter collaboration including 17 centers around the world including the United States of America, Brazil, Europe, Far East, Middle East and Australia from January to date. We evaluated the patients’ clinical characteristics, clinical course of the disease, hospitalization and outcome. Death was considered to be COVID-associated if it occurred within 30 days from the time of diagnosis.

Results
Preliminary data on 571 patients included 186 cancer patients and 385 non-cancer patients.
Cancer patients were more likely to have COPD and received steroids but were less likely to have COVID-related symptoms compared to non-cancer patients (84% vs 97%, p&lt; 0.0001). The rate of pneumonia with hypoxia, non-invasive ventilation and mechanical ventilation were similar in both groups. Despite the fact that hospital admissions were significantly higher in non-cancer patients (70% vs 56%, p&lt; 0.001), promising antiviral and immune-related therapy including remdesivir, convalescent plasma and immunomodulators were more commonly used in cancer patients compared to non-cancer patients (P=0.04). Cancer patients had a higher COVID-associated mortality rate compared to non-cancer patients (20% vs 11%, p=0.006).

Conclusion
Despite the fact that cancer patients received more frequent antiviral and immune-related therapy, the mortality rate among cancer patients was significantly higher than non-cancer patients.

Disclosures
Roy F. Chemaly, MD, MPH, FACP, FIDSA, Chimerix (Consultant, Research Grant or Support)Clinigen (Consultant)Merck (Consultant, Research Grant or Support)Novartis (Research Grant or Support)Oxford Immunotec (Consultant, Research Grant or Support)Shire/Takeda (Research Grant or Support)Viracor (Research Grant or Support) Issam I. Raad, MD, Citius (Other Financial or Material Support, Ownership interest)Cook Medical (Grant/Research Support)Inventive Protocol (Other Financial or Material Support, Ownership interest)Novel Anti-Infective Technologies (Shareholder, Other Financial or Material Support, Ownership interest)
375. COVID 19 infection in a Massachusetts community hospital
Authors: Davaro Raul , rapose alwyn 
Published: January 2021

Abstract

Background
The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16.

Methods
The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included.

Results
A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma.

Conclusion
In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %.

Disclosures
All Authors: No reported disclosures
378. E-cigarette or Vaping Associated Lung Injury in the Time of COVID-19
Authors: Downey Rachel D , Murphey Donald , Fernandez Marisol , Sapozhnikov Julia , Hauger Sarmistha Bhaduri 
Published: January 2021

Abstract

Background
Pediatric providers have been caring for two new and similar respiratory illnesses: E-cigarette or vaping use associated lung injury (EVALI) beginning in 2019 and Coronavirus Disease 19 (COVID-19) in 2020. Similarities include prodrome, presentation, imaging, and laboratory testing. While EVALI often improves with steroid treatment, steroids can be detrimental early in the course of COVID-19.
Although a positive SARS CoV-2 polymerase chain reaction (PCR) test is helpful, this result does not definitively identify SARS CoV-2 as the primary cause of symptoms in patients with a history of vaping, as both processes may be coexistent. Coinfection with other infectious agents is commonly found in children with COVID-19 infection, and the majority of children with PCR positive SARS CoV-2 are asymptomatic or mildly symptomatic.

Methods
In hopes of better defining EVALI versus COVID-19 clinical syndromes, we reviewed charts of pediatric patients admitted to a freestanding children’s hospital in Texas diagnosed with EVALI over a year period from June 1, 2019 and June 1, 2020. Cases were identified through a local patient registry. We compared findings in these cases with literature regarding pediatric patients with acute COVID-19 and EVALI. Variables included presenting symptoms, timing of symptoms, vital signs, imaging, and laboratory results.

Results
Twelve patients with EVALI diagnosis were included. Clinical presentation, imaging, and laboratory findings were similar to those described with acute COVID-19 and are included in figures 1 and 2. Repeated interviewing regarding vaping revealed a history of vaping in all EVALI cases; frequency reported varied from multiple times daily to remote use. Some cases with EVALI also had a significant psychiatric history, positive urine drug screen, or significant weight loss prior to hospitalization. Cases with EVALI and steroid treatment improved within days of treatment. In a review of literature, BAL sampling often reveals lipoid pneumonia in EVALI cases, which would not be expected in COVID-19. Of note, the single case in our group tested did not have lipoid pneumonia on bronchoalveolar lavage (BAL) cytology.

Conclusion
Presence of prolonged preceding weight loss, or BAL cytology could help differentiate these clinical states.

Disclosures
All Authors: No reported disclosures
380. First Reports of Salivary Gland Involvement in Corona Virus Disease 2019
Authors: Anmolsingh Roopa , Keenan Elizabeth , Kannangara Don 
Published: January 2021

Abstract

Background
Many viruses infect salivary glands. These include mumps, Epstein-Barr, herpes virus 6, parainfluenza, influenza, adeno virus, boca virus and others. Almost all coronavirus disease 2019 (COVID -19) infected patients carry the virus in saliva. Salivary duct epithelium were the early target cells in macaque monkeys infected with severe acute respiratory syndrome corona virus (SARS-COV). Here we present 2 COVID-19 cases with the involvement of salivary glands. Salivary gland involvement has not been reported in COVID-19.

Methods
We followed the COVID 19 clinical findings in a Pennsylvania long term care facility with 190 residents. Thirty tested polymerase chain reaction (PCR) positive. However, 48 were presumed infected. Eighteen likely cases were not tested due to shortage of swabs. Thirty four employees also tested positive. Two out of 48 patients aged 78 and 88 developed unilateral sialadenitis during the course of the illness. Both were Hispanic females. We studied the Clinical presentations, co-morbidities, lab and imaging results and the outcome.

Results
Case 1: Two days after the first confirmed case, a 88 year old Hispanic female developed fever and fatigue and tested COVID-19 positive. Fever lasted 5 days. Twenty days later the patient developed a 5x3 cm tender left parotid mass and hypoxia treated with oxygen via nasal cannula. (Table 1)
Case 2: A 78 year old Hispanic female developed high fever and cough 7 days after the index case. Six days later she had persistent fever and presented with a tender 8.5x3.5 cm right submandibular mass. The patient was intubated for 3 days to protect the airway due to the size of the mass. Both made an uneventful recovery. (Table 1 and Figure 1)

Conclusion
New clinical findings of COVID -19 have been gradually added during the course of the pandemic. The virus is almost universally present in the saliva. In experimental Chinese macaques with SARS-COV early target cells were the salivary duct epithelium. Salivary gland inflammation and swelling should be included amongst the clinical features of COVID-19.

Disclosures
All Authors: No reported disclosures
382. Incidence of Hospital-Acquired and Ventilator-Associated Pneumonia in Patients with Severe COVID 19 on High Flow Oxygen
Authors: Papamanoli Aikaterini , Nakamura Jacquelyn , Fung Jenny , Abata Joshua , Karkala Nikitha , Tsui Stella T , Yoo Jeanwoo , Grewal Prabhjot , Mojahedi Azad , Dhaliwal Simrat , Jacob Robin , Hotelling Jessica , Rawal Sahil , Coritsidis Alexandra , Psevdos George , Kalogeropoulos Andreas , Marcos Luis 
Published: January 2021

Abstract

Background
Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) can be serious complications of coronavirus disease 19 (COVID-19). Co-infections may worsen outcomes and prolong hospitalization. This risk may be exacerbated by systemic corticosteroids (steroids) and other adjunctive therapies.

Methods
We reviewed the records of all adults admitted to Stony Brook University Hospital, NY, from 3/1 to 4/15, 2020 with severe COVID-19 pneumonia, requiring high-ﬂow O2 (non-rebreather mask, Venturi mask with FiO2 &gt;50%, or high-ﬂow nasal cannula). We excluded patients who received mechanical ventilation (MV) or died within 24h. Patients were followed until death or hospital discharge. We reviewed positive sputum cultures (PSC) for pathogenic microorganisms and calculated the incidence of HAP and VAP (nosocomial pneumonia, [NP]), rates of MV and impact on mortality. Fungi isolated from sputum, were considered colonization unless associated with fungemia. We also examined the impact of adjunctive therapies with immunosuppressive potential (steroids and tocilizumab), on HAP or VAP.

Results
A total of 469 patients were included (Table 1). Of these, 199 (42.4%) required intensive care and 172 (36.7%) MV. Median length of stay was 13 days (8–22) and 105 (22.4%) had PSC. Of these, 59 were considered true pathogens (HAP: 11, VAP: 48), with predominance of S. aureus (MSSA) 38.9%, Enterobacteriaceae 33.8% and Pseudomonas species 18.6%. 39 isolates were considered colonization (Table 2); Patients with PSC &lt; 48h (N=7) from admission, were not considered NP. The incidence of NP was 7.0 per 1000 patient-days (95%CI 5.5–8.5). Of 11 patients with HAP, 9 needed MV. NP was more frequent among patients receiving steroids (9.0 vs 5.7 per 1000 patient-days; P=0.023). Use of tocilizumab was not associated with NP (6.2 vs 8.4 per 1000 patient-days; P=0.11). Mortality was nonsignificantly higher in patients with (20/59, 33.9%) vs. without (103/410, 25.1%) NP (P=0.16). Intubation and length of stay were the strongest predictors of NP in multivariable models.
Cohort Characteristics of Patients with Severe COVID -19 Pneumonia on High Flow Oxygen (N= 469)

All Microbes Isolated from Sputum Cultures

Conclusion
Among high risk COVID-19 patients, NP is a common complication. MSSA and Enterobacteriaceae were the most frequent isolates. The risk increases with intubation, longer hospital stay and use of steroids but not tocilizumab.

Disclosures
All Authors: No reported disclosures
383. Increased Need for Antimicrobial Stewardship during a COVID-19 Outbreak in New York City
Authors: Policar Maurice , Barber Peter , Malik Yesha 
Published: January 2021

Abstract

Background
The impact of COVID-19 on the health care system in New York City (NYC) cannot be overstated. The first documented cases of COVID-19 in Queens NYC occurred in early March of 2020. The total number of patients with proven or suspected COVID-19 at Elmhurst Hospital peaked in early April. A dramatic increase in the use of antimicrobials occurred in April, and correlated with the increased number of intubated COVID-19 patients at Elmhurst Hospital.

Methods
Antimicrobial Stewardship Committee activities and meetings had been suspended for the months of March and April due to the increased clinical demands associated with the COVID-19 outbreak. In preparation for the May meeting, a retrospective analysis of antimicrobial use for March and April of 2020 was performed.

Results
The analysis revealed a 30% increase in the use of antimicrobials. The average total days of antimicrobials per 1000 patient days (TDA/TPD) was 445 for January through March of 2020. In April, this number climbed to 580. TDA/TPD increased from 57 to 90 (58%) for vancomycin, 25 to 35 (40%) for meropenem, and 31 to 89 (187%) for cefepime. The number of intervention by the Antibiotic Stewardship team remained low during this time period.
Total Days of Antimicrobials per 1000 Patient Days (TDA/TPD)

Conclusion
A dramatic increase in the use of antimicrobials correlated with an increase in the number of intubated patients at Elmhurst Hospital during a COVID-19 outbreak. It is likely that the frequent appearance of fever and leukocytosis in intubated patients with COVID-19 prompted an increase in empiric antimicrobial use. The 48 hour time outs and prospective review of antimicrobial use may be necessary to maintain stewardship efforts during the COVID-19 epidemic. Further review of antibiotic usage in critically ill COVID-19 patients is needed to help define stewardship practices as we go forward in this pandemic.

Disclosures
All Authors: No reported disclosures
385. Kawasaki’s Disease and Sars-Cov-2: an Unexpected Pediatric Global Crisis?
Authors: Giarola Lucca G , Couto Braulio Roberto Gonçalves Marinho , Starling Carlos Ernesto Ferreira , de Carvalho Handerson Dias Duarte 
Published: January 2021

Abstract

Background
Infection by SARS-CoV-2 can lead to dyspnea, edema, deposition of intra alveolar fibrin, thrombosis and hemorrhages. During the COVID-19.
outbreak, several questions were raised about the risks for the pediatric population. Pediatric patients appeared to be relatively safe, with only minor symptoms and a quick recovery. However,
there have been reports of a relationship between COVID 19 and a Kawasaki-like inflammatory disease in this population. Kawasaki’s disease (KD) is a rheumatological vasculitis prevalent in childhood characterized mainly by diffuse inflammation of the arteries associated with skin rash, changes in the mucosa and its main complication is coronary aneurysms.

Methods
A systematic literature review was performed in the PubMED database using the keywords “Kawasaki disease”, “COVID-19” and “Pediatrics”. The selected filters were “Case reports”, “Multicenter study”, “Clinical Study”, “Observational study”, “Human” and “English”. A total of 18 articles were seleted.

Results
There seems to be a convergence between the literature published so far, pointing to a greater propensity for pediatric patients infected with Sars-Cov-2 to develop KD. The number of patients with KD symptoms seen at a specific center increased from 2 to 17 in 11 days (MOREIRA, 2020). In a sample space of 21 patients diagnosed with KD, 91% had previous contact with SARS-CoV-2 (TOUBIANA, 2020) whereas other studies point to a 30-fold increase in the prevalence of KD since the beginning of 2020 (VERDONI, 2020).
There is already an established relationship between DK and HCoV-NH, describing that 4.5% of patients with this infection develop KD. Therefore, it was suggested that infection with another Coronavirus strain could have a similar relationship.

Conclusion
Despite the relationship described between pediatric patients infected with COVID-19 being more likely to develop KD, further studies are needed to prove a statistical relationship between both condition.

Disclosures
All Authors: No reported disclosures