541. Comparing Patients with Severe COVID-19 Who Improve to the Point of Discharge Following an Abbreviated Course (< 5 Days) of Remdesivir (RDV) Versus a Standard Course (≥5 Days)

Background The COVID-19 pandemic has negatively affected our healthcare system. Our hospitals have reached maximum capacity on several occasions. Because of the need to make beds available to new patients, some patients with severe COVID-19 who were on low flow O2 supplementation have been discharged home prior to completion of the standard (≥ 5-day) RDV course. To date, data are limited regarding clinical outcomes on these patients. Because of this, we conducted a retrospective study to assess the clinical outcomes of patients who received an abbreviated treatment course of RDV. Methods Retrospective (chart review) study Subject population All nonpregnant adult patients who were hospitalized at Kaiser Permanente Riverside Medical Center and Kaiser Permanente Moreno Valley Medical Center in 2020 with severe COVID-19 who required low flow O2 supplement during hospitalization who received RDV and discharged from hospital alive. Severe COVID-19 = positive SARS-CoV-2 PCR + evidence of lung involvement on lung imaging (X-ray or CT) + O2 saturation ≤ 94% on room air or requirement of O2 supplement. Inclusion criteria Age ≥ 18 years; Hospitalized with severe COVID-19; Given RDV Exclusion criteria Pregnancy; O2 requirement &gt; 6 L including high flow and mechanical ventilation (noninvasive or invasive); discontinuation of RDV due to adverse effects Figure 1. Patient Section. Results Mortality rate: no difference (2.1% vs 1.8%, p=0.84). 30 day post-discharge ED visit: twice more likely in the abbreviated RDV group as compared to the group receiving the standard duration (16.1% vs 8.5%, p=0.03). 30 day readmission: almost 10 times more likely in the abbreviated RDV group as compared to the group receiving the standard duration (11.9% vs 1.2%, p=&lt; 0.001). Table 1. Patient's Characteristics Table 2. Clinical Outcomes. *8 Patients Who Died Within 30-Day from Discharge Were Excluded Conclusion Though there is no difference in 30 day mortality rate, the patients who received the abbreviated RDV course are twice more likely to have ER visit and 10 times more likely to have readmission within 30 day post discharge despite more patients in the abbreviated course receiving steroids. The findings suggest that completing an at least 5-day course of RDV may be beneficial even in patients who demonstrate a clinical response earlier in course. Disclosures All Authors: No reported disclosures

An Individual Participant Data Population Pharmacokinetic Meta-analysis of Drug-Drug Interactions between Lumefantrine and Commonly Used Antiretroviral Treatment

ABSTRACT Treating malaria in HIV-coinfected individuals should consider potential drug-drug interactions. Artemether-lumefantrine is the most widely recommended treatment for uncomplicated malaria globally. Lumefantrine is metabolized by CYP3A4, an enzyme that commonly used antiretrovirals often induce or inhibit. A population pharmacokinetic meta-analysis was conducted using individual participant data from 10 studies with 6,100 lumefantrine concentrations from 793 nonpregnant adult participants (41% HIV-malaria-coinfected, 36% malaria-infected, 20% HIV-infected, and 3% healthy volunteers). Lumefantrine exposure increased 3.4-fold with coadministration of lopinavir-ritonavir-based antiretroviral therapy (ART), while it decreased by 47% with efavirenz-based ART and by 59% in the patients with rifampin-based antituberculosis treatment. Nevirapine- or dolutegravir-based ART and malaria or HIV infection were not associated with significant effects. Monte Carlo simulations showed that those on concomitant efavirenz or rifampin have 49% and 80% probability of day 7 concentrations <200 ng/ml, respectively, a threshold associated with an increased risk of treatment failure. The risk of achieving subtherapeutic concentrations increases with larger body weight. An extended 5-day and 6-day artemether-lumefantrine regimen is predicted to overcome these drug-drug interactions with efavirenz and rifampin, respectively.

Hedonic eating behaviors and food preferences associated with medication-assisted treatment for opioid use disorder

Objective: To characterize hedonic eating behaviors such as sugar cravings, food preferences, and appetitive responsiveness for sweet and hyper-palatable foods, and to determine the prevalence of addictive like eating behaviors and food addiction (FA) in individuals receiving medication-assisted treatment (MAT) for opioid use disorder (OUD).Design: Quasi-experimental.Setting: Outpatient MAT center.Participants: Nonpregnant adult patients undergoing MAT (n = 116) receiving either buprenorphine/naloxone or methadone for at least 6 months.Main outcome measures: Hedonic eating, FA, and food craving.Results: Of the aggregate sample, 13.3 percent met criteria for FA. More than onethird of all subjects endorsed consuming larger amounts of highly palatable food than intended, unsuccessful attempts to quit or cut down on eating such foods, and a great deal of time spent on consuming or recovering from consuming such foods. Both medication groups demonstrated greatest cravings for sweets and fast foods followed by carbohydrates and fats (p 0.001). Similarly, subjects reported “giving in” most frequently to sweets and fast foods followed by carbohydrates then fats (p 0.001). Greater appetitive responsiveness was noted in the presence of hyper-palatable foods. No group differences were found. Weight change was not associated with addictive like eating, food craving, or appetitive responsiveness.Conclusions: Individuals receiving MAT exhibit preferences for sweet and fast foods that appear to be influenced by the proximity of such foods. FA was present. Collectively, such eating behaviors and food preferences may pose additional adverse health consequences and associated co-morbidities. This underlies the importance of comprehensive healthcare for patients with OUD, including nutrition education and evaluation of eating behaviors and food preferences.

99 Effect of application of seminal plasma on Day 0, 5, or 7 postmating on pregnancy rate and embryonic survival in alpacas (Lama pacos)

Alpacas, similar to other camelids, are classified as induced ovulators, as an external stimulus is required for the occurrence of ovulation. A protein identified as β-nerve growth factor, present in the seminal plasma (SP), has the capacity to induce ovulation and corpus luteum formation. Alpacas exhibit poor reproductive efficiency, with birth rates below 50% due in part to high embryo mortality before 35 days post-mating. A study was carried out to evaluate the effect of the application of SP on Day 0, 5, or 7 post-mating on pregnancy rate and embryo survival, defined as the difference in the numbers of pregnant females between Day 35 and 25. Nonpregnant adult alpaca females (n=124) between 5 to 6 years old were evaluated by transrectal ultrasonography to determine presence of a follicle ≥7mm, and then 2 days later to confirm permanence of the follicle. Alpacas were then bred by natural mating and assigned randomly to 1 of 4 treatments: 1mL of SP IM at mating; 1mL of SP IM Day 5 post-mating; 1mL of SP IM Day 7 post-mating; and control. Semen was collected from adults male and ejaculates were diluted 1:1 with PBS and then centrifuged for 30min at 3000 rpm. Supernatant was separated and a drop evaluated to determine absence of spermatozoa and SP-free sperm was stored at −20°C. Twenty adult males with optimal reproductive performance were used for mating with females assigned to the different treatments. Animals were evaluated by ultrasound with an Aloka SSD 500 (Aloka, Tokyo, Japan) and 5.0-MHz linear transducer on Day 25 and 35 to determine pregnancy rate and embryonic survival. Data were analysed by chi-square. Results are present in Table 1. The results differ from our initial hypothesis and a possible explanations may be that additional application of SP IM could saturate receptors and block the action of the seminal plasma present in the ejaculate of males. Table 1.Pregnancy rate and embryonic survival in alpacas with application of seminal plasma on Day 0, 5, or 7 Study was supported by project no. 405-PNICP-PIAP-UNMSM.

Thyroid Function Status in Indian Adult Nonpregnant Females in Ranchi, India

ABSTRACT Aim Thyroid disorders are one of the most common endocrine diseases in India. Thyroid disorders are more common in women than in men and contribute to significant morbidity. In this postiodization era, there is paucity of pan-Indian data of thyroid disorder status among adult nonpregnant women. This study was done to analyze the thyroid hormone levels in women of Jharkhand region, which is traditionally known to be an iodine-deficient area. Materials and methods Three hundred and forty nonpregnant adult females in Ranchi area who were consuming iodized salt formed part of the study group. Clinical evaluation was done by a gynecologist pertaining to thyroid illness. Thyroid function tests encompassing triiodothyronine, thyroxine, and thyroid-stimulating hormone were carried out by quantitative enzyme immunoassay method. Thyroid status of the population was defined as per kit reference range. Results Subjects with age range 20 to 67 years were divided into three groups as per clinical status of thyroid disorder, viz. total, disease free, and control. A total of 19.6% had biochemical evidence of thyroid disorder and 82.4% were euthyroid as per reference ranges in kit literature. Out of hypothyroid subjects, 3.2% had clinical and 14.4% had subclinical hypothyroidism. In the study group, no subjects were detected to have overt or subclinical hyperthyroidism. Multiple comparison analysis was done with Statistical Package for the Social Sciences version 20.0, a statistical software package. Discussion This is the first study in Jharkhand area on nonpregnant adult female population that are getting iodine sufficient foods in an iodine-deficient region. The study showed high prevalence of thyroid disorders in the study group. Hypothyroidism, predominantly subclinical hypothyroidism, is prevalent among women in this region. How to cite this article Chakrabarty BK, Mitra B, Shahbabu B, Hazra N, Singh S. Thyroid Function Status in Indian Adult Nonpregnant Females in Ranchi, India. Indian J Med Biochem 2017;21(1):25-29.

Group B Streptococcal Septic Arthritis of the Shoulder and Potential Association with Pelvic Examination and PAP Smear

Group B streptococcal (GBS) infection of a native joint in a nonpregnant adult is uncommon. While many women are colonized with this flora, it rarely becomes pathogenic in its adult host. GBS associated joint infections have been reported, most of which have been related to hematogenous seeding from unknown sources. To our knowledge, there are no published case reports of a GBS joint infection in association with a pelvic exam and Papanicolaou (PAP) smear. In this case report, we present a case of GBS sepsis of a native shoulder, possibly resulting from a routine pelvic exam and PAP smear.