COVID-19 in recent heart transplant recipients: Clinicopathologic features and early outcomes.

BACKGROUND: The impact of COVID-19 on heart transplant (HTx) recipients remains unclear, particularly in the early post-transplant period. METHODS: We share novel insights from our experience in five HTx patients with COVID-19 (three within 2 months post-transplant) from our institution at the epicenter of the pandemic. RESULTS: All five exhibited moderate (requiring hospitalization, n = 3) or severe (requiring ICU and/or mechanical ventilation, n = 2) illness. Both cases with severe illness were transplanted approximately 6 weeks before presentation and acquired COVID-19 through community spread. All five patients were on immunosuppressive therapy with mycophenolate mofetil (MMF) and tacrolimus, and three that were transplanted within the prior 2 months were additionally on prednisone. The two cases with severe illness had profound lymphopenia with markedly elevated C-reactive protein, procalcitonin, and ferritin. All had bilateral ground-glass opacities on chest imaging. MMF was discontinued in all five, and both severe cases received convalescent plasma. All three recent transplants underwent routine endomyocardial biopsies, revealing mild (n = 1) or no acute cellular rejection (n = 2), and no visible viral particles on electron microscopy. Within 30 days of admission, the two cases with severe illness remain hospitalized but have clinically improved, while the other three have been discharged. CONCLUSIONS: COVID-19 appears to negatively impact outcomes early after heart transplantation.

Assessment of New York City Urgent Care Centers' Emergency Preparedness and Infection Prevention and Control Practices, 2016-2017.

BACKGROUND: Urgent care centers (UCCs) have become frontline healthcare facilities for individuals with acute infectious diseases. Additionally, UCCs could potentially support the healthcare system response during a public health emergency. Investigators sought to assess NYC UCCs' implementation of nationally-recommended IPC and EP practices. METHODS: Investigators identified 199 eligible UCCs based on criteria defined by the Urgent Care Association of America. Multiple facilities under the same ownership were considered a network. As part of a cross-sectional analysis, an electronic survey was sent to UCC representatives assessing their respective facilities' IPC and EP practices. Representatives of urgent care networks responded on behalf of all UCCs within the network if all sites within the network used the same policies and procedures. RESULTS: Of the respondents, 18 representing 144 UCCs completed the survey. Of these, 8 of them (44.4% of the respondents) represented more than 1 facility that utilized standardized practices (range = 2-60 facilities). Overall, 81.3% have written IPC policies, 75.0% have EP policies, 80.6% require staff to train on IPC, and 75.7% train staff on EP. CONCLUSION: Most UCCs reported implementation of IPC and EP practices; however, the comprehensiveness of these activities varied across UCCs. Public health can better prepare the healthcare system by engaging UCCs in planning and executing of IPC and EP-related initiatives.

Computer-aided analysis of 64- and 320-slice coronary computed tomography angiography: a comparison with expert human interpretation.

Routine use of CCTA to triage Emergency Department (ED) chest pain can reduce ED length of stay while providing accurate diagnoses. We evaluated the effectiveness of using Computer Aided Diagnosis in the triage of low to intermediate risk emergency chest pain patients with Coronary Computed Tomographic Angiography (CCTA). Using 64 and 320 slice CT scanners, we compared the diagnostic capability of computer aided diagnosis to human readers in 923 ED patients with chest pain. We calculated sensitivity, specificity, Positive Predictive Value and Negative Predictive Value for cases performed on each scanner. We calculated the area under the Receiver Operator Curve (ROC) comparing results for the two scanners to Computer Aided Diagnosis performance as compared to the human reader. We examined index and 30 Day outcomes by diagnosis for each scanner and the human reader. 60% of cases could be triaged by the computer. Sensitivity was approximately 85% for both scanners, with specificity at 50.6% for the 64 slice and at 56.5% for the 320 slice scanner (per person measures). The NPV was 97.8 and 97.1 for the 64 and 320 slice scanners, respectively. Results for the four major vessels were similar with negative predictive values ranging from 97 to 100%. The ROC for Computer Aided Diagnosis for the 64 and 320 Slice Scanners, using the human reader as the gold standard was 0.6794 and 0.7097 respectively. The index and 30 day outcomes were consistent for the human reader and Computer Aided Diagnosis interpretation. Although Computer Aided Diagnosis with CCTA cannot serve completely as a substitute for human reading, it offers excellent potential as a triage tool in busy EDs.

Combined aquaretic and diuretic therapy in acute heart failure.

INTRODUCTION: Acute heart failure (AHF) is a leading cause of hospitalization and readmission in the US. The present study evaluated maximum diuresis while minimizing electrolyte imbalances, hemodynamic instability, and kidney dysfunction, to achieve a euvolemic state safely in a shorter period of time. METHODS AND RESULTS: A protocol of combined therapy with furosemide, metolazone, and spironolactone, with or without tolvaptan and acetazolamide, was used in 17 hospitalized patients with AHF. The mean number of days on combination diuretic protocol was 3.8 days. The mean daily fluid balance was 3.0±2.1 L negative. The mean daily urine output (UOP) was 4.1±2.0 L (range 1.8-10.5 L). There were minimal fluctuations in serum electrolyte levels and serum creatinine over the duration of diuretic therapy. There was no statistically significant change in patients' creatinine from immediately prior to therapy to the last day of therapy, with a mean increase in creatinine of 0.14 mg/dL (95% CI -0.03, +0.30, p=0.10). CONCLUSION: Our strategy of treating AHF by achieving high UOP, while maintaining stable electrolytes and creatinine in a short period to euvolemic state, is safe.