Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne virus endemic to a vast geographical area spanning from Africa to the shores of the Mediterranean Sea and north to the Balkans. The infection carries a high case fatality rate, which prompts the development of new treatment and prophylactic measures. This review explores the different treatment and prophylactic measures found in recent literature. For this purpose, we used Medical Subject Headings (MeSH) as well as PubMed advanced search. The inclusion criteria included full-text studies conducted on humans and in the English language. We found that plasma exchange was associated with a decrease in mortality rates. Similarly, the use of immunoglobulins proved effective in decreasing the severity and mortality risk. Ribavirin use was determined as a post-exposure prophylaxis drug with no statistically significant difference in oral or intravenous routes of administration. More studies should be conducted on CCHF as the number of outbreaks and endemic areas seem to be on the rise. For the time being, supportive therapy along with adjuvant antivirals appear to be the main course of management of CCHF. However, the need for definitive therapeutic agents and guidelines is warranted.

Background The Crimean-Congo Hemorrhagic Fever (CCHF) is a tick-borne virus infection that has been reported in about 30 countries worldwide. Clinical presentation is divided into three phases: pre-hemorrhagic, hemorrhagic, and convalescence. Ribavirin is standard of care treatment for acute infection and prophylaxis. However, the use of other treatments beyond ribavirin is largely unknown. Methods We conducted a systematic review using MOOSE protocol. The inclusion and exclusion criteria are seen in the Prisma diagram. For Bias Analysis we use a Robin-1 tool. Literature review algorithm Results We gathered a total of 10 studies, which included 4 therapeutic plasma exchange (TPE), 2 corticosteroids, 2 IVIG, and 1 with convalescent plasma (CP). TPE in one study showed decreased mortality rate and increased efficacy in patients with severe CCHF. While the other study reported pulmonary embolism related to the use of TPE. Nevertheless, the patients had good outcome in the end. Two case reports used TPE plus ribavirin and supportive measures. Both were discharged home and recovered without sequela. Corticosteroids were found to be beneficial in one study were the case fatality rate was lower with the addition of corticosteroids to ribavirin in severely ill patients (p=0.0014). In a case series of six patients, who received the combination in early stages of the disease had good clinical outcomes with improved survival. IVIG was shown to increase platelet counts in two studies. In the first study, platelet count increased above 150,000/mL in 8.5 +/- 2.5 days. While in the other study the normalization of platelets was seen in 4 - 4.8 days, with no significant difference (P = 0.49). In addition, there was a decrease in the duration of symptoms but there was no statistically significant difference in mortality rates (P = 0.171). CP treatment showed a survival rate of 86% in treated patients. CP was more useful in high-risk patients, defined as having a viral load of 108 copies/mL or more. The main limitations of the studies were the sample size and heterogenicity among the outcomes of the studies. Conclusion TPE, CP, IVIG, and corticosteroids were effective in improving the clinical outcomes of the patients. The use of these treatments beyond ribavirin should be explored in future studies. Disclosures All Authors: No reported disclosures

With the increasing medicinal use of cannabis and potential anti-inflammatory role, we aimed to assess the odds and in-hospital mortality of septic shock with vs. without cannabis use among geriatric sepsis patients with chronic kidney or liver diseases (CKD/CLD) using a nationally representative cohort. METHODS:We queried the National Inpatient Sample (2017) to identify geriatric sepsis patients with concomitant CKD/CLD complicated by septic shock. Primary outcomes (septic shock and associated inpatient mortality) and secondary outcomes (patient discharge and length of stay) were compared between cannabis users vs. non-users. Multivariable analysis was performed adjusting for confounders to assess the odds of septic shock and associated in-hospital mortality. A propensity score-matched analysis was performed to confirm outcomes observed in unmatched cohorts. A two-sided p-value<0.05 was considered statistically significant.

Background: COVID-19, being a prothrombotic state, has been linked to ischemic infarcts. Pooled data on impact of COVID-related stroke on mortality are sparse. We conducted a meta-analysis to assess the risk of stroke-related inpatient mortality (SRIM) during the COVID pandemic vs. pre-pandemic. Methods: Pubmed/Medline, SCOPUS & EMBASE were searched for articles till August 2021 reporting stroke and SRIM during COVID-19 pandemic vs. pre-pandemic. Random-effects model for odds ratio (OR), I 2 statistics for heterogeneity assessment and leave-one-out method for sensitivity analysis were employed. Results: A total of 31 studies with 455,073 stroke hospitalizations; 365253 pre-pandemic and 89820 pandemics (mean age 72 vs 70 yrs) were analyzed. With a comparable distribution of males, AF, and thrombolysis, the meta-analysis showed a nearly 40% higher risk of mortality during pandemic vs. pre-pandemic admissions (OR 1.42, 95%CI:1.06-1.92, p=0.018, I 2 =98.59). Further subgroup analysis showed a slightly higher risk of mortality in cohorts with mean age <70 years of age vs. ≥70 yrs [mean <70 years (n=11): OR:1.48, p=0.020 vs. ≥70 years (n=17): OR:1.27, p<0.001]. Cross-continental subgroup analysis revealed significantly higher mortality in Europe (n=14, OR:1.31, p<0.001) during pandemic vs. pre-pandemic, and non-significantly higher association in Asia (OR 1.13, p=0.57), USA (OR 1.59, p=0.23), Africa (OR 1.20, p=0.46) (Fig. 1). Subgroup analysis of 16 studies with n=100-1000 showed significantly higher OR (1.31) for SRIM during the pandemic vs. pre-pandemic, whereas studies with n<100 or >1000 did not show any significant difference. Sensitivity analysis showed overall and subgroup stability in OR. Conclusions: This largest meta-analysis to date on the subject found that hospitalized stroke patients, elderly or non-elderly, had nearly 40% higher risk of mortality during the COVID pandemic vs. pre-COVID era across the globe, more significantly in Europe.

Background and Objectives There is a paucity of data regarding the impact of acute heart failure (AHF) on the outcomes of aspiration pneumonia (AP). Methods Using National Inpatient Sample datasets (2016 to 2019), we identified admissions for AP with AHF vs. without AHF using relevant International Classification of Diseases, Tenth Revision codes. We compared the demographics, comorbidities, and outcomes between the two groups. Results Out of the 121,097,410 weighted adult hospitalizations, 488,260 had AP, of which 13.25% (n=64,675) had AHF. The AHF cohort consisted predominantly of the elderly (mean age 80.4 vs. 71.1 years), females (47.8% vs. 42.2%), and whites (81.6% vs. 78.5%) than non-AHF cohort (all p<0.001). Complicated diabetes and hypertension, dyslipidemia, obesity, chronic pulmonary disease, and prior myocardial infarction were more frequent in AHF than in the non-AHF cohort. AP-AHF cohort had similar adjusted odds of all-cause mortality (adjusted odds ratio [AOR], 0.9; 95% confidence interval [CI], 0.78–1.03; p=0.122), acute respiratory failure (AOR, 1.0; 95% CI, 0.96–1.13; p=0.379), but higher adjusted odds of cardiogenic shock (AOR, 2.2; 95% CI, 1.30–3.64; p=0.003), and use of mechanical ventilation (MV) (AOR, 1.3; 95% CI, 1.17–1.56; p<0.001) compared to AP only cohort. AP-AHF cohort more frequently required longer durations of MV and hospital stays with a higher mean cost of the stay. Conclusions Our study from a nationally representative database demonstrates an increased morbidity burden, worsened complications, and higher hospital resource utilization, although a similar risk of all-cause mortality in AP patients with AHF vs. no AHF.