bluuebunny/crossref_metadata_2025_split huggingface dataset:
411. Comparison of clinical outcomes between early and delayed transplantation after SARS-CoV-2 infection
Authors: Reum Kim A , Chang Eui Jin , Bae SeongMan , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Kim Sung-Han 
Published: November 2023

Abstract

Background
Thera is limited data comparing the clinical outcomes between early and delayed transplantation after SARS-CoV-2 infection. We thus compared the clinical outcomes in solid organ transplant (SOT) and hematopoietic stem cell transplant (HCT) recipients who recently experienced SARS-CoV-2 infection depending on the timing after SARS-CoV-2 infection.

Methods
We retrospectively reviewed the medical records of adult patients who underwent SOT or HCT with a history of COVID-19 infection prior to transplantation at a tertiary hospital, Seoul, South Korea from January 2021 to August 2022. Patients transplanted within 3 months after COVID-19 infection were classified into the early transplantation group, and those transplanted after 3 months were classified into the delayed transplantation group.

Results
A total of 53 patients who underwent SOT and 28 patients underwent HCT with a history of COVID-19 infection prior to transplantation were reviewed. Of the SOT patients, 48 (91%) were classified in the early group (median 50.0, range 12.0-89.0 days) and 5 (9%) in the delayed group (median 105.0, range 93.0-117.0 days). In the early group, 45 patients were uneventful, 2 patients had rejection, and 2 patients died. In the delayed group, 4 patients were uneventful, and 1 patient. Of the HCT patients, 19 (68%) were identified in the early group (median 34.0, range 2.0-90.0 days) and 9 (32%) in the delayed group (median 102.0, range 92.0-188.0 days). In the early group, 15 patients were uneventful, 2 patients relapsed, and 2 patients died. In the delayed group, 4 patients were uneventful, 3 patients had acute graft-versus-host disease, 1 patient relapsed, and 1 patient died. A total of 6 patients died among SOT and HCT recipients, 5 of whom died due to bacteremia caused by multidrug-resistant bacteria and 1 from acute rejection. None of the patients who underwent SOT and HCT developed COVID-19 PCR re-positivity or COVID-19 compatible symptoms after transplant.

Conclusion
Our data suggest that the early transplantation after SARS-CoV-2 infection may be performed without increased risk of COVID-19-associated complications.

Disclosures
All Authors: No reported disclosures
412. Comparison of Outcomes in Pneumonia Patients Hospitalized with COVID-19 and Influenza in Connecticut, 2015-2020
Authors: Kim Daewi , Yousey-Hindes Kimberly 
Published: November 2023

Abstract

Background
Since the start of the Coronavirus Disease 2019 (COVID-19) pandemic, comparisons between hospitalized COVID-19 and influenza patients diagnosed with pneumonia are scarce. The objective of this study was to compare characteristics and outcomes among the two.

Methods
Cases for this analysis came from FluSurv-NET and COVID-NET, population-based surveillance platforms of the Connecticut Emerging Infections program for laboratory-confirmed influenza and COVID-19 hospitalizations. FluSurv-NET pneumonia cases occurred during 4 seasons (2015-16 – 2018-19), COVID-NET cases occurred during March-December 2020. Chart reviews were completed for all FluSurv-NET cases and a sample of all COVID-NET cases. Pneumonia was defined as having radiographic key terms on chest x-ray/CT and a discharge diagnosis of pneumonia in the medical record. Outcomes used for comparison included length of stay, intensive care unit (ICU) admission, death, and the following 3 discharge diagnoses: acute respiratory distress syndrome (ARDS), respiratory failure and sepsis.

Results
A total of 1361 pneumonia cases were identified, 652 from COVID-NET (COVID-19 pneumonia[C-19-pna]) and 709 from FluSurv-NET (Influenza pneumonia [I-pna]). C-19-pna cases had a longer median length of stay compared to I-pna cases (9 days vs 5 days; p&lt; .001) and were more likely to have a diagnosis of acute respiratory failure (64% vs 26.3%, p&lt; .001) across all adult age groups (≥18 years). C-19-pna cases were also more likely to die and have an ARDS diagnosis compared to I-pna cases (25% vs 6.1%, p&lt; .001; 10.8% vs 1.7%, p&lt; .001 respectively); this was observed across age groups ≥ 50 years (p &lt; .001). C-19-pna cases ≥65 years were more likely to be admitted to the ICU compared to I-pna cases ≥65 years (35.8% vs 22.2%, respectively p&lt; .001). Conversely, a greater proportion of I-pna cases ≥65 years had a sepsis diagnosis compared to C-19-pna cases in the same age group (24% vs 16.9%, respectively p&lt; .001).

Conclusion
C-19-pna cases were younger, more obese and had more chronic metabolic disease than I-pna cases. I-pna cases were more likely to have chronic lung disease and be immunocompromised than C-19-pna cases. C-19-pna resulted in a significantly longer median length of stay, greater in-hospital mortality, and greater morbidity.

Disclosures
All Authors: No reported disclosures
415. Misdiagnosis of multisystem inflammatory syndrome in children: A diagnostic challenge
Authors: Avcu Gülhadiye , Arslan Aslı , Arslan Sema Yildirim , Sahbudak Zumrut , Turan Caner , Ersayoglu Irem , Cebeci Kübra , Kurugol Zafer , Ozkınay Ferda 
Published: November 2023

Abstract

Background
As the COVID-19 pandemic continues, multisystem inflammatory syndrome in children (MIS-C) maintains its importance in the differential diagnosis of common febrile diseases. MIS-C should be promptly diagnosed because corticosteroid and/or intravenous immunoglobulin treatment can prevent severe clinical outcomes. In this study, we aimed to evaluate clinical presentation, diagnostic parameters and management of MIS-C and compare its clinical features of common febrile disease.

Methods
This study was conducted at a tertiary-level hospital between December 2020 and October 2022. One hundred and six children who were initially considered to have MIS-C disease were included in the study. During the follow-up period in the hospital, when the clinical and laboratory findings were re-evaluated, 38 out of 106 children were diagnosed differently. The clinical and laboratory findings of 68 children followed up with the diagnosis of MIS-C and 38 children who were initially misdiagnosed as MIS-C but with different final diagnoses were retrospectively compared.

Results
We identified 68 patients with MIS-C and 38 patients misdiagnosed as MIS-C during the study period. Infectious causes (71%), predominantly bacterial origin, were the most frequently confused conditions with MIS-C. Patients with MIS-C were older and had a more severe clinical course with high rates of respiratory distress, shock, and paediatric intensive care unit admission. While rash and conjunctivitis were more common among patients with MIS-C, cough, abdominal pain, diarrhoea were observed more frequently in patients misdiagnosed as MIS-C. Lower absolute lymphocyte counts, platelet counts and higher C-reactive protein and fibrinogen levels, pathological findings on echocardiography were the distinctive laboratory parameters for MIS-C. Multivariate analysis showed that older age, presence of conjunctivitis, high level of serum CRP and lower platelets were the most discriminative predictors for the diagnosis of MIS-C.

Conclusion
There are still no specific findings to diagnose MIS-C, which therefore can be confused with different clinical conditions. Further data are needed to assist the clinician in the differential diagnosis of MIS-C and the diagnostic criteria should be updated over time.

Disclosures
All Authors: No reported disclosures
418. Possible Risk Factors and Clinical Features of Post-COVID-19 Syndrome in a Veteran Affairs population
Authors: Lum Michael D , Sajib Monirul I , Lier Audun 
Published: November 2023

Abstract

Background
Post-COVID-19 syndrome (PCS) refers to debilitating physical and neuropsychiatric symptoms for at least ≥ 4 weeks following the recovery from COVID-19 infection. The goal of this study is to identify shared epidemiological and clinical features among patients with PCS to identify possible risk factors that can guide studies in the prevention of PCS.

Methods
Chart reviews of patients referred to the post-COVID clinic of Northport VA Medical Center, NY between January 2021 to March 2023 were performed. 57 patients with mild COVID-19 infection without requiring hospitalization that met CDC definition of PCS were included. Cases were reviewed and demographics, comorbidities, treatment/vaccine status, common symptoms reported and baseline inflammatory markers were recorded and analyzed.

Results
The mean age was 56 years, and most patients were between the ages of 46-60 years old (28.1%, table 1). More male patients reported symptoms of PCS compared to females (56.1% vs. 43.9%, table 1). Common comorbidities included pre-existing psychiatric diagnoses (47.4%), obesity (40.4%), hypertension (40.4%), hyperlipidemia (43.9%), and chronic lung disease (36.9%), with an average Charlson comorbidity index of 1.9. Most patients (59.6%) reported only being infected with COVID-19 once (table 1). Most patients (75.4%) did not receive outpatient therapy against COVID-19 and most had only two vaccines against COVID-19 (38.6%, table 2). Predominant symptoms included fatigue (56.1%), brain fog (56.1%), dyspnea on exertion/decreased exercise tolerance (42.1%), and cough (24.6%) (table 3). Of those with values measured, baseline ESR, CRP, ferritin values were normal and a small percentage had elevated D-dimer &gt;150 ng/mL D-DU (table 4).

Conclusion
Majority had comorbidities such as hypertension, hyperlipidemia, pre-existing mental health conditions and obesity. Most had only 2 doses of a COVID-19 vaccine and did not receive any outpatient treatment for COVID-19. This suggests that these features may serve as potential risk factors for PCS and further study is needed to elucidate the relationship between these attributes and PCS.

Disclosures
All Authors: No reported disclosures
421. Impact of SARS-CoV-2 Infection on Physical Fitness in Air Force Basic Trainees
Authors: Crouch Elena M , Marcus Joseph , Yun Heather , Casey Theresa , Kieffer John , Winkler Erin , Kasper Korey , Kiley John 
Published: November 2023

Abstract

Background
The impact of SARS-CoV-2 infection on physical fitness in previously healthy adults is not well known. In this study we assess the impact of SARS-CoV-2 infection on the physical fitness test scores of Air Force basic trainees

Methods
SARS-CoV-2 testing data and trainee fitness test scores for the calendar year 2021 were obtained from US Air Force basic military trainees. Trainees perform a standardized fitness test involving push-ups, sit-ups, and a 1.5 mile run at the beginning and end of their training. Basic trainees who performed two fitness tests in 2021 and also tested positive for SARS-CoV-2 were defined as the infected (Inf) cohort and were 1:1 matched by sex to an uninfected control (Ctl) group of basic trainees. Categorical variables were compared using Chi-squared or Fisher’s exact test and continuous variables were compared using Mann-Whitney-U.

Results
23,450 basic trainees performed a fitness test in calendar year 2021, 975 (4%) of whom tested positive for SARS-CoV-2. 621 (64%) had completed two fitness tests during the defined study period and were included in the Inf cohort. There were 96 females (15.5%) in each group and 525 males (84.5%) in each group. There was no difference in body mass index between the Inf and the Ctl group (24.0 (IQR 21.8 – 36.0) vs 24.3 (IQR 21.7-36.9), p=0.253). The Inf group had a higher rate of failing their physical fitness test at the end of training when compared to Ctl (15.7% vs. 4.3%, p&lt; 0.001). When comparing those who passed their first fitness test and went on to fail their second fitness test, this occurred more frequently in the Inf group (2.3% vs. 0.81%, P = 0.037). When comparing trainees who failed their first fitness test and went on to pass their second fitness test, this occurred more frequently in the Ctl group (46.3% vs. 39.6%, P = 0.016). Amongst the Inf group, there were no differences in 2nd test failure rates when comparing symptomatic to asymptomatic trainees (16.9% vs. 11.8%, P = 0.143).

Conclusion
SARS-CoV-2 infection was associated with an increased risk of physical fitness test failure as well as conversion from a passing to failing test score. The presence of symptoms was not associated with failing test two. Possible confounders include lost fitness training time due to illness.

Disclosures
All Authors: No reported disclosures
426. The diagnosis and treatment of COVID Associated Pulmonary Aspergillosis in patients requiring Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) in the Republic of Ireland during the COVID-19 pandemic: A Retrospective Review
Authors: O’Regan Rhea , Crowe Gillian , Lynch Maureen , Muldoon Eavan , Hastings Jennifer 
Published: November 2023

Abstract

Background
During the advent of the COVID-19 pandemic, multiple cases were reported of the association between SARS-CoV-2 and invasive pulmonary aspergillosis. The diagnosis of Covid associated pulmonary aspergillosis (CAPA) remains difficult, especially in critically unwell patients. We describe those treated with VV ECMO and diagnosed with CAPA in the national centre for ECMO in Ireland during the COVID-19 pandemic, as well as their treatment course and outcomes.

Methods
We retrospectively collected data on all patients who received ECMO during the COVID-19 pandemic in Ireland’s national ECMO centre between May 2020 and January 2022. Data was collected from electronic health care records and cross referenced with positive microbiological samples. The 2020 ECMM/ ISCHAM consensus criteria was used to classify CAPA diagnoses.

Results
37 patients with diagnosed SARS-CoV-2 infection were treated using ECMO. The average age was 46 years (SD 9.3). 15 (41%) of those were female. The mean number of days spent in an intensive care unit (ICU) was 50 (IQR 45-67). 14 (38%) had diagnosed Hypertension, 10 (27%) had Diabetes Mellitus and 1 (2.7%) had known Chronic Kidney Disease requiring dialysis. CAPA was diagnosed in 7 (19%) cases. Using the criteria, no cases were proven as histology samples were not obtained. 1 (14%) case fitted the criteria for possible diagnosis while 6 (86%) cases fitted criteria for probable diagnosis based on biochemical, microbiological and radiological findings. Of these, all received steroids prior to diagnosis, while 3 (43%) also received tociluzumab. 6 (86%) patients received dual antifungal agents and 1 (14%) patient received voriconazole alone. In terms of outcome, 15 (41%) were discharged to another intensive care unit, 1 (3%) discharged to another acute hospital and 2 (5%) to a rehabilitation unit. 16 (43%) patients died while 3 (8%) were discharged home. Of the 7 patients diagnosed with CAPA, 5 (71%) patients died in ICU while 2 (29%) were transferred to other units with final outcome unknown.

Conclusion
Although 2020 guidelines available from ECMM/ISCHAM are used to define strict diagnostic criteria of CAPA, our study demonstrates the need for further research into how other factors may contribute to this diagnosis, including pre-determined risk factors or the use of ECMO.

Disclosures
All Authors: No reported disclosures
431. Title Implementing a Comprehensive Care Model as a Proposal for Long Covid Syndrome Care in a Latin American Country
Authors: Capera Jaime Andres Pineda , Alvarez Carlos , Alvarado Nathali Carolina Gonzalez , Hernandez Juan Manuel Correa , Bobadilla Paola Andrea Rengifo , Aparicio Patrick Francois Tarquino 
Published: November 2023

Abstract

Background
Post-COVID-19 long syndrome or "LONG COVID" is defined by WHO criteria according to the Post-COVID Functional Score (PCFS) and Barthel scales and classified by the persistence of symptoms up to 12 weeks after initial infection. Through a survey conducted in a population of 33500 adults in Bogotá, Colombia, and the confirmatory of SARSCoV2 infection via (PCR or antigen test), we demonstrated 63% of people reported some persistent symptoms after three months of the acute event. With its high frequency, this new clinical condition makes a breach where comprehensive care centers for its management and rehabilitation were necessary. We designed an innovative, individualized, comprehensive transdisciplinary model to provide integral attention to patients diagnosed with Long COVID.

Methods
Patients identified by the questionnaire as a Long COVID were scheduled for submission and care at the Center for Comprehensive Care Post Covid (CAIP). An integral evaluation included the assessment by several specialties, such as physiatry, physiotherapy, psychology, nutrition, nursing, social work, and internal medicine practitioners, according to an established attention model in our clinic (Fig 1).Figure 1.Follow up route of patients with suspected Long COVID. A. Screening questionnaire.

Results
448 patients with long covid were screened between September 2022 and March 2023 in the CAIP. The average age of the population served was 52.6 years. The Barthel average score was 97.8. Patients classified as PCFS grade 1 were 282, 133 were grade 2, and 32 were grade 3. A total of 2230 physical and occupational therapy interventions were performed and 120 psychotherapy sessions with positive findings in functional and aerobic capacity between circuits (Fig 2). With the successful discharge of 50 patients, without remaining limitations to perform their basic activities, 48% were asymptomatic with PCFS: 0 and the remaining with PCFS 1, with a minimum symptomatic compromise.

Conclusion
There are governmental and clinical challenges to the comprehensive care of the population with disabilities related to Long COVID. CAIP, as a transdisciplinary health care and recovery model, which was born in response to long COVID patients, showed great effectiveness in return people great improvement in functionality to reincorporate into our society from the pandemic COVID19 in Colombia.

Disclosures
All Authors: No reported disclosures
436. SARS-CoV-2 Seropositivity and Association with Dengue Severity in Adults
Authors: Priyadarshi Megha , Soneja Manish , Paul Saurav Sekhar , Agarwal Ayush , Tirlangi Praveen Kumar , Sachan Shilpa , Gupta Nimesh , Wig Naveet 
Published: November 2023

Abstract

Background
The effect of SARS-CoV-2 on the pathogenesis and virulence of the dengue virus is unknown. The cross-reactivity of the immune responses in these infections is an emerging concern, as it may influence the clinical outcomes by establishing cross-immunity or antibody-dependent enhancement. This study evaluated the association between SARS-CoV-2 seropositivity and clinical severity in dengue patients.
Fig 1
SARS-CoV-2 cases in the region where the study was conducted and adults with dengue presenting to the study site

Methods
We performed a cross-sectional study on confirmed dengue cases admitted at a tertiary care hospital in North India. Baseline demographic data, clinical severity, past history of symptomatic COVID infection, and COVID-19 vaccination were noted. IgG antibodies against the receptor binding domain (RBD) of the SARS-CoV-2 virus were measured in all patients. The association between the SARS-CoV-2 antibody titer and severity of dengue was statistically analyzed using one-way ANOVA - Kruskal Wallis followed by Dunn's multiple comparisons, with a p-value less than 0.05 considered statistically significant.

Results
A total of 62 confirmed dengue patients were enrolled in the study (September 2021–December 2021). The median age of the study population was 27 years (IQR: 21–35 years), with a male preponderance of 64.5%. According to WHO dengue severity criteria, 30.6% of patients had dengue without warning signs, 50% had dengue with warning signs, and 19.3% had features suggestive of severe dengue. All patients were seropositive for IgG COVID antibodies, with a median titer of 2700 AU/ml (IQR 900–8100). We observed no statistically significant difference in overall SARS-CoV-2 antibody responses among the three dengue severity groups (p-value 0.9).
Table 1
Demographic and clinical characteristics of study population and comparison of presentation with varying severity of dengue
Table 2
Association of SARS CoV2 infection and COVID vaccination with dengue severity
Fig 2
Effect of COVID-19 vaccination on SARC-CoV-2 specific antibodies in acute dengue patients. Acute dengue patients categorized as non-vaccinated (Green circles, N=12), single (Red circles, N=12) and double dose vaccinated (Blue circles, N=24) with SARS-CoV-2 vaccines. Yellow triangle represents severe dengue (N=11). (A-B) Graph demonstrates the spread of SARS-CoV-2 binding IgG in three groups respectively. Dotted line represents the cut-off for IgG positivity

Conclusion
This study concludes that SARS-CoV-2 seropositivity is not associated with clinical severity in dengue patients. This may imply that past infection with COVID or vaccination against COVID does not alter the severity of dengue.
Fig 3
Association of SARS CoV2 infection COVID vaccination and COVID antibody titer with dengue severity

Disclosures
All Authors: No reported disclosures
439. Impact of viral load in HIV adult patients hospitalized with COVID-19
Authors: Garcia Alberto Romero , Lim Chee Yao , Gutierrez Jorge , Afzal Afsheen , Miller Dwayvania , La Fortune Alexander , Feinstein Addi , Menon Vidya 
Published: November 2023

Abstract

Background
There is no difference in mortality in COVID-19 patients with and without HIV. The purpose of our study was to assess the outcomes of patients with HIV (PWH) and COVID-19 when stratified by their viral load (VL).

Methods
In this retrospective single center study, data was collected from electronic medical records from March 2020 to December 2021. All adult patients admitted with a diagnosis of COVID-19 pneumonia were included. They were stratified according to their HIV status and subsequently PWH were stratified and analyzed according to their VL. We compared mortality rate, length of stay (LOS), incidence of septic shock, and severity of COVID-19 infection (by Quick COVID-19 Severity Index) using chi-square and we performed a multivariate analysis.

Results
During this period a total of 1902 patients were admitted for COVID-19 infection and 78 patients were PWH. 32 patients had undetectable VL vs 46 with detectable VL. Baseline characteristics are described in table 1. PWH had a mortality rate of 15% (12 out of 77) compared with 27% (508 out of 1824) of the rest of population P=0.016. Among PWH, when stratified by their viral load, patients with detectable viral load had lower mortality incidence (4.3% vs 32.4% p=0.001), lower incidence of septic shock (5% vs 23%, p=0.015), and lower rates of severe and critical COVID-19 infection (52% vs 80.6%, p=0.011). Analysis by logistic regression was conducted to determine the impact of age and other comorbidities on mortality risk.. No association was found between VL status and incidence of mortality, septic shock, or severity of COVID-19. Length of stay and COVID-19 severity had no significant difference between these groups.

Conclusion
It was thought that PWH with detectable viral load experienced less severe COVID-19 disease course due to the unsuppressed disease by the defective immunity and ART, as evidenced by observed lower rates of mortality and complications like septic shock. However, our study found no significant impact of VL in PWH on COVID-19 outcomes when accounting for age and comorbidities. These findings emphasize the need to consider the higher prevalence of comorbidities in PWH and other social determinants of health when examining the course of COVID-19 infection in an aging HIV population.

Disclosures
All Authors: No reported disclosures