604. Impact of COVID-19 Pandemic on Telehealth Practices in Pediatric Infectious Diseases

Background The COVID-19 pandemic has led to changes in clinical practice, including a significant increase in the use of telehealth (TH). We sought to assess the impact of the pandemic on the use and perceptions of TH by pediatric infectious diseases (PID) clinicians. Figure 1. Modalities Figure 2. Comfort Methods The PIDS* Telehealth Working Group developed a 26-question online survey to assess telehealth practices among PID clinicians. The survey was available via Survey Monkey® from 12/6/2020-2/26/2021 to members of PIDS, PICNIC*, AAMI and AAP*. Clinicians in active practice in North America were included in the analysis. Figure 3. Platforms Figure 4. Barriers Results The response rate was 10% (n=253) of 2,550 PID clinicians. Physicians accounted for 98.4% of the cohort. The remaining 1.6% were allied health professionals. 81 survey respondents (32%) were in 4 US states (CA, TX, OH and NY) and the province of Quebec. 62.8% of respondents were women, 37% of respondents were 36-45 years old, with 42.7% devoting about 50-99% of their time to direct patient care. TH usage increased during the pandemic with the most gain in provider-patient communications with 65.6% increase for synchronous and 22.1% for asynchronous TH (Figure 1). Gains in provider-provider TH were less than 20%. Respondents reported a 6-fold gain in comfort with TH usage versus pre-pandemic level (Figure 2). Most respondents report being satisfied with their current platform and modality. Once the COVID-19 waivers expire, 70% of respondents plan to continue using TH. The most common TH modality used was an EMR-integrated TH platform (Figure 3). The main perceived barriers to TH adoption were lack of complete physical examination (73.7%), dealing with new technology (21.5%), and insufficient reimbursement (20.8%) (Figure 4). Conclusion The COVID-19 pandemic has resulted in a significant increase in the use of TH by PID specialists versus pre-pandemic usage. Respondents gained comfort with use of different telehealth modalities during the pandemic. This data can help clinicians and organizations in planning and resource allocation for telehealth programs in a post-pandemic environment. Disclosures All Authors: No reported disclosures

46, XY DSD (Disorder of Sex Development) : Diagnosis dan Tatalaksananya.

Disorder of Sex Development (DSD) is a congenital disorder that occurs in the development of chromosomes, gonads, and internal or external genital organ. DSD of 46 XY is a condition where the children with XY genotype is not able to have complete virilization of external genital. Determination phase is an initial phase of reproductive system development. Disruption of this phase may potentially lead to DSD. Optimal care for children with Disorder of Sex Development requires a multidisciplinary team starting since neonatal period. Family and pregnancy history, complete physical examination and assessment of genital organ are the first step of ensuring the diagnose. Management of children with DSD are focusing on gender determination, hormone support therapy and surgical management. On the other hand, Children with XY genotype should be raised as a boy however if there is no responsive evidence in administration of androgen the children should be raised as a girl. Subsequent to prescribe the gender of the children, surgical management is a required treatment for removing unnecessary genital afterward. Keywords: Disorders of Sex Development, DSD, 46 XY DSD

Etiological profile of short stature in rural Rajasthan

Background: Short stature is one of the most common referrals to pediatric endocrinology clinics. Approximately 3% of children in any population are found to be short. Aim: This study aims to determine the etiology of short stature and their frequency of occurrence in 2–18 years old rural pediatric population and to classify the patients with short stature using anthropometric measurements. Materials and Methods: A total of 400 patients (age: 2–18 years) were diagnosed with short stature and admitted in pediatric ward. After meticulous history collection and complete physical examination, relevant investigations were performed in all the study subjects. Appropriate statistical analysis was carried out with the collected data. Results: Out of 400 study subjects, 70.50% were boys (male: female=2.33:1). Majority (n=241, 60.5%) of the affected children were in the age group of 2–<6 years and 7–<10 years. Of the 400 study subjects, 95% of cases (n=380) were classified as having proportionate short stature and the rest (n=20, 5%) had disproportionate short stature. Undernutrition (n=117, 29.25%) and familial short stature (n=90, 22.50%) were the leading causes of short stature. Conclusion: The current study helped to determine the etiological profile of short stature in children of adjoining rural population and in devising appropriate strategies for management and prevention.

ALGORITHM FOR STRATIFICATION OF CARDIOVASCULAR RISK IN MEN AGED 18-29 YEARS WITH ARTERIAL HYPERTENSION SYNDROME

Background: Arterial hypertension (AH) is a leading factor of cardiovascular risk (CVR), and stratification of CVR in young patients with AH is an important area of clinical research. Aim: to develop an algorithm for CVR stratification in men aged 18-29 years with AH syndrome (AHS). Materials and methods: 165 men underwent a complete physical examination, which included standard clinical, laboratory and instrumental methods, ergomtry test, analysis of heart rate variability, pulse wave velocity determination. Results: The clinical characteristics and features of the cardiovascular system functioning at rest and during ergometry test have been determined, depending on the nosological form of AHS and the established CVR. The algorithm has been developed based on the assessment of the type of hemodynamic response and determination of the probability of cardiovascular outcomes within 10 years. Conclusion: the proposed algorithm enables to optimize therapeutic, diagnostic and preventive measures in men aged 18-29 years with AHS.

Brachial Plexus Injury: Recent Diagnosis and Management

Brachial plexus injury is known to be one of the most serious upper limb injuries, causes paralysis of the upper limbs and changes in activity of daily living, with the consequence disruption of activity of daily living, socio-economic problems, depression, and hopelessness. Management must be done properly. The evaluation and examination consist of detailed anamnesis on chronological events, complete physical examination, imaging studies, and electrophysiology study. Management can be done nonsurgically and surgically. Knowledge of the history of injury, timing of surgery, priority in restoring function, and managing patient expectations are important concepts in treating patient with brachial plexus injury. Timing is a very important thing. The results of these interventions vary depending on several parameters. Recognizing the basic principles of managing brachial plexus injuries is indispensable for all clinicians who treat these injuries.

Electrocardiographic Findings in Bitches Affected by Closed Cervix Pyometra

Pyometra is considered the most common disease in intact bitches, being associated with potentially life-threatening disorders. Myocardial damage is a potentially life-threatening consequence of pyometra. The aim of this study was to describe the electrocardiographic patterns in bitches affected by closed cervix pyometra, to assess the clinical relevance of electrocardiographic changes with the occurrence of pyometra, and to relate their severity with laboratory and clinical findings. A total of 39 bitches with closed cervix pyometra and 10 healthy female dogs were included in this study. During the hospitalization, bitches underwent a complete physical examination. An electrocardiographic examination before the ovariohysterectomy was performed. Blood samples for biochemical and hematological analysis were also evaluated. Bitches suffering pyometra at least one arrhythmia 31/39 (79.4%), sinus tachycardia (22/39, 56.4%), ventricular premature complexes (9/39, 23%), increased amplitude of T wave (7/39, 17.9%), ST depression (4/39, 10.2%), second-degree atrioventricular block (2/39, 5.1%), increase of QT interval (2/39, 5.1%), sinus bradycardia (2/39, 5.1%), and first-degree atrioventricular block (1/39, 2.5%). Some bitches were also detected with low wave amplitude (17/39, 43.5%). Cardiac arrhythmias associated with canine pyometra are frequent events. These data suggest that arrhythmias may be the consequence of one or more factors that can occur during pyometra, such as myocardial damage, electrolyte/metabolic disorders, and/or sepsis.

Effect of vivisection on haematobiochemical parameters of experimental dogs: Towards improved animal welfare

Introduction: Vivisection could lead to the derailment of vital body functions and hence severe health consequences. The effect of multiple vivisections on haematobiochemical parameters of dogs was investigated with a perspective to improve animal welfare. Methods: Fifteen healthy Nigerian indigenous dogs that were to be used for student wet-labs were recruited for this study. The dogs were acclimatized for four weeks and then exposed to four (4) weeks (bi-weekly) vivisection. Complete physical examination and blood sampling were carried out on days 0, 14, and 28 post-vivisection. Blood samples were analysed for blood and serum biochemical profiles. Results: Post-vivisections results were compared to pre-vivisection results using ANOVA. Physical examination also reveals loss of body weight, body condition score, decreased skin elasticity, sunken eyeballs, dry oral and nasal mucous membrane, as well as percent dehydration on post-vivisection parameters. Findings also revealed a decrease in haematocrit, haemoglobin, and erythrocyte count (p < 0.05), coupled with hyperproteinaemia, hyperalbuminemia, and azotaemia (p < 0.05) which are generally accepted as indices for dehydration. Significance: Conclusively, the reported anaemia and dehydration in this study could potentiate serious adverse medical effects and it was therefore recommended that the use of animals for multiple surgical procedures should be guided by standard surgical protocols with a perspective of improving animal welfare.

Peritoneovaginal Fistula and Appendicitis-Related Pelvic Abscess in Pregnancy

Appendicitis in pregnancy is the most common nonobstetric surgical emergency. Pregnancy causes changes in anatomy, which could lead to uncertainty regarding the diagnosis of appendicitis. This case report describes a case of appendicitis presenting with peritoneovaginal fistula in a pregnant woman in the second trimester, with interesting finding of isolated appendiceal endometriosis on pathology. The importance of complete physical examination, including speculum examination, is emphasized in the pregnant patient presenting with acute-onset abdominal pain. Imaging criteria for diagnosis of appendicitis should be adjusted to account for the gravid uterus, which may cause appendiceal abscess to appear in a variety of locations, such as posterior to the cervix, as in this case.

109 Hyperthyroidism-induced Psychosis

Objective:To describe the presence of psychotic symptomatology in a patient with hyperthyroidismAbstract:Psychiatric-spectrum symptoms associated with thyrotoxicosis has been well reported in the past. However, psychosis in a patient with a thyroid nodule is a rare find. Here, the case of twenty four-year-old, single, unemployed, Albanian American male with self-reported history of Attention Deficit Disorder (ADD) and Cannabis use disorder was brought in to the Comprehensive Psychiatric Emergency Program (CPEP) due to new onset psychosis. Patient was paranoid, disorganized with labile mood. He had poor insight, judgement and impulse control. The event coincided with a period of unemployment in his life and new onset of hallucinations from past few days. He was brought in to the hospital after he was found pacing and having lack of sleep. Patient was treated with antipsychotic for acute psychosis. He was started on Risperidone initially to which he did not respond to. Blood work showed low TSH and elevated T4. Physical exam was noted for palpable thyroid nodule. Further labs resulted in high thyroid peroxidase antibody. Ultrasound of thyroid with color flow showed single nodule in the left lobe and iodine uptake activity localized to the left lobe. Patient was started on Methimazole 5 mg along with Haldol 5mg orally twice a day which improved his symptoms tremendously. Patient was stabilized and after 1 week was discharged on Haldol 5 mg by mouth two times a day for Psychosis, Cogentin 1 mg by mouth two times a day for extrapyramidal system (EPS), and Methimazole 5 mg by mouth daily for overactive thyroid nodule.Conclusion:Psychosis associated with thyroid nodule is rare but possible. The onset of psychotic syndrome is an important clinical element whose underlying medical cause must be promptly clarified. Psychosis can present in a number of ways and can have different causes. Apart from psychiatric causes, underlying medical causes should always be considered. In this case it was important to get a full clinical history of the patient as well as complete physical examination. The differential diagnosis of a psychotic disorder in light of a medical disease should always be considered in order to promptly diagnose and treat the underlying cause to reduce the morbidity and possibly the mortality associated with it.

Calculation of Drug Dosage In Chronic Kidney Disease

Kidneys are the main organ in fluid and electrolyte homeostasis. It also have an important role in eliminating various types of drugs. Drug elimination in the kidney is affected by plasma drug concentrations, plasma protein binding, and kidney function. Glomerular filtration rate (GFR) represents the kidney function. Thus by knowing it, drug dosage can be determined.Chronic kidney disease alter the effect of drug, some decrease drug effect but more often increase drug toxicity. Chronic kidney disease affect the pharmacodynamic and pharmacokinetic of drug. Therefore, providing an optimal treatment for CKD patient, knowledge of the pharmacokinetic and pharmacodynamic changing in CKD is needed.Exploring the patient's history and carrying out complete physical examination is important before giving the drug to patients with impaired kidney function. In addition, identifying drugs that have the potential to cause nephrotoxicity and drug interactions is also important.The body response to drugs in patient with CKD is very varied, complex, and individual. Dosage must be based on several factors, not only glomerular filtration rates but also other comorbid diseases, interactions with other drugs and clinical condition of the patient.