Auburn Research Day 2021

1 Raj H. Patel, MBA; 2 Pablo M. Pella, MD; 3 Naeem Haider, MD; 2 Renato Blanco, MD 1 Edward Via College of Osteopathic Medicine, Monroe, LA, USA; 2 Memorial Hospital, Jacksonville, FL, USA; 3 Baptist Medical Center, Jacksonville, FL, USA Cl i n i ca l Case Repor t | Med i ca l St udent Treatment of Severe SARS-COV-2 Infection with Remdesivir in a Patient with End Stage Renal Disease 009

As research regarding coronavirus disease 2019 continues to evolve, there is a paucity of reports describing the management of COVID-19 in patients with acute kidney failure and end-stage renal disease (ESRD). These patients have increased susceptibility to developing severe clinical symptoms from SARS-CoV-2 infection due to their underlying comorbidities. Remdesivir has emerged as a promising antiviral drug against COVID-19. Unfortunately, data regarding the clinical benefits of remdesivir in patients with severe renal impairment is unavailable as they have been excluded from clinical trials due to the risk of sulfobutylether- β -cyclodextrin (SBECD) accumulation. We present the first case of a 47-year-old male with end-stage renal disease who was safely treated with remdesivir during hospitalization for acute respiratory distress syndrome and

respiratory failure arising from COVID-19. The patient’s worsening clinical progress led to the decision to use remdesivir, despite his eGFR being <15 ml/min per 1.73m2. The patient responded favorably to treatment but developed reversible hepatotoxicity after the five- day course of remdesivir was completed. We report the first instance of relatively safe use of remdesivir for COVID-19 treatment in the setting of end stage renal disease which led to a sequalae of severe clinical symptoms including ARDS.

Cl i n i ca l Resea rch | Med i ca l St udent Retrospective Review of Multitarget Stool DNA as a Screening Test for Colorectal Cancer

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Thomas K. Kleinschmidt, MD; Austin Clements; Mark A. Parker, MD; Steven D. Scarcliff, MD Brookwood Baptist Health; Edward Via College of Osteopathic Medicine-Auburn

Objectives: To review the effectiveness of noninvasive multitarget stool DNA testing as a screening test for colorectal cancer. Methods: We performed a retrospective review of patients referred to two high-volume outpatient procedural centers for colonoscopy for positive Cologuard test. Positive findings for colorectal cancer based on pathologic findings and also advanced adenomas were recorded. Positive predictive value was assessed. Results: Of the 1,585 patients evaluated and referred for colonoscopy from January 1, 2018, to November 1, 2019, for ICD- 10 codes R19.5 (Other Fecal Abnormalities) and K92.1 (Melena), 84 were referred for a positive Cologuard test. Out of the 84, six were excluded based on family history of colon cancer in 1st degree relative or personal history of inflammatory bowel disease. Of the remaining 78 patients, one patient (1.3%) had colorectal cancer and five (6.4%) had advanced adenomas (>1cm size, high grade dysplasia or villous). Positive predictive value (PPV) for colorectal cancer was 1.3% and for precancerous lesions plus colorectal cancer was 7.7%. A total of 53 (68.0%) patients had either totally normal colonoscopy or hyperplastic polyps. Out of the 78 individuals in our study, 70 (89.7%) had normal findings, hyperplastic polyps, or non-advanced adenomas.

Conclusions: Multitarget stool DNA testing carries an unacceptably low positive predictive value to be utilized as a screening test for colorectal cancer. The study fails to detect both adenomas and colon cancer at a higher rate than screening colonoscopy in selected studies. The advantage of being noninvasive has been noted to increase colorectal cancer screening in otherwise non-compliant Medicare patients.

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