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Objectives: Reviewing current literature and case reports of patients placed on Venous-Venous ECMO support for HIV and AIDS, with confection with Pneumocystis pneumonia and covid-19 pneumonia. The use of extracorporeal membrane oxygenation (ECMO) in patients who have acute respiratory distress syndrome has been shown to have very good outcomes. However, there is limited data to support the initiation of ECMO in patients who have human immunodeficiency virus infection with or without acquired immune deficiency syndrome. Method(s): We present a unique and challenging case of a 30 year old male, with no known past medical history, unvaccinated against covid-19, who presented with one week of progressive shortness of breath. On admission he was found with moderate bilateral infiltrates and was diagnosed with covid-19 pneumonia. Despite appropriate medical therapy, patient developed worsening hypoxic respiratory failure. Found to have elevated (1- 3)-7beta;-d-glucan and tested positive for HIV. CD4 count 11, HIV viral load 70,000. The patient remained severely hypoxemic despite mechanical ventilation, sedation, paralytics and proning. Venous venous extracorporeal membrane oxygenation was initiated. Considering his non improvement with variety of antivirals and antibiotics and with elevated (1-3)-7beta;-d-glucan in the setting of AIDS he was treated for presumed Pneumocystis pneumonia. The patient tolerated proning while on VV ECMO and his course was complicated with bilateral pneumothorax necessitating chest tube placement. Result(s): The patient successfully completed 64 days on VV ECMO, where he was treated for PCP pneumonia, covid pneumonia, CMV viremia and tolerated initiation of anti-retroviral therapy. Patient was successfully decannulated, and ultimately discharged from the hospital. Conclusion(s): VV-ECMO can be a beneficial intervention with successful outcomes in severely immunocomprimised patients with AIDS. This case highlights the importance of minimizing sedation and early mobilization on ECMO support. (Figure Presented).
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Purpose : One of the most important clinical data points in evaluating ophthalmology patients is visual acuity (VA). During the COVID-19 pandemic, eye health providers are utilizing telehealth to decrease patient and provider risk related to in-person clinic visits, while still providing high-quality care. This study sought to compare at-home VA tests with in-office clinical VA measurements to determine the validity of at-home VA testing for telehealth visits. Methods : Patients from 1 comprehensive and 3 subspecialty ophthalmology clinics had VA greater than or equal to 20/200 in the study eye. The patients were prospectively randomized to perform 2 of 3 at-home VA tests (printed chart - University of Arizona/Banner Eye Care Letter Distance Chart;mobile phone app - Verana Vision Test;website test - Farsight.care) within 3 days of their standard of care clinic visit. Patients also completed a survey to assess usability of home tests. At the clinic visit, best corrected Snellen distance acuity was measured to serve as the reference standard. Results : Of the 44 patients (84 eyes) enrolled, 60% were female and the mean age was 66 years (range 22 to 80). The mean difference between printed chart and Snellen, website test and Snellen, and mobile app and Snellen acuity data was 0.10 (95% CI: 0.09-0.11), 0.13 (95% CI: 0.12-0.14), and 0.12 (95% CI: 0.11-0.13) LogMAR, respectively. The highest degree of correlation was between the website and Snellen tests (0.74, 95% CI: 0.59-0.84) (Table 1). Patients found the tests easy to perform at home and were neutral regarding confidence in their results and desire to continue with home testing. In the survey, there was no significant difference for between the 3 tests regarding any of the 4 questions (P = 0.32- 0.62), although there was a trend toward a more positive response with the printed chart (Table 2). Conclusions : These data suggest that some at-home visual acuity tests are comparable in accuracy to in-clinic Snellen visual acuity tests (within 1 line of difference). Patient surveys indicated the tests were easy to understand and complete at home. Further development and validation of at-home vision testing modalities are needed to provide accurate and accessible tele-ophthalmology care.