Monitoring SARS CoV-2 antibodies positivity in healthcare workers after inactivated CoronaVac vaccine

Introduction In this study, we aimed to monitor anti-spike and anti-nucleocapsid antibodies positivity in healthcare workers (HCWs) vaccinated with two doses of inactivated CoronaVac (Sinovac, China) vaccine. Methods Overall, 242 volunteer HCWs were included. Of the participants, 193 were HCWs without history of prior documented COVID-19 (Group 1), while 49 had history of prior documented COVID-19 before vaccination (Group 2). The participants were followed up for SARS-CoV-2 antibodies positivity at four different blood sampling time points (immediately before the second vaccine dose and at the 1st, 3rd months and 141-150 days after the second dose). We investigated the serum IgG class antibodies against SARS-CoV-2 RBD region and IgG class antibodies against SARS-CoV-2 nucleocapsid antigen by chemiluminescent microparticle immunoassay (CMIA) method using commercial kits. Results We found positive serum anti-RBD IgG antibody in 76.4% of the participants (71% in Group 1;98% in Group 2) 28 days after the first dose. When the antibody levels of the groups were compared at the four blood sampling time points, Group 2 anti-RBD IgG levels were found to be significantly higher than those in Group 1 at all follow-up time points. Although anti-RBD IgG positivity persisted in 95.6% of all participants in the last blood sampling time point, a significant decrease was observed in antibody levels compared to the previous blood sampling time point. Anti-nucleocapsid IgG antibody was positive in 12 (6.2%) of participants in Group 1 and 32 (65.3%) in Group 2 at day 28 after the first dose. At the fourth blood sampling time point, anti-nucleocapsid antibodies were found to be positive in a total of 20 (9.7%) subjects, 10 (6.1%) in Group 1 and 10 (23.8%) in Group 2. Conclusions In this study, it was determined that serum antibody levels decreased in both groups after the third month after the second dose in HCWs vaccinated with CoronaVac vaccine.Copyright © GERMS 2022.

A Multicenter Microcosting Study for COVID-19 in Brazil

Objectives: This study aims to evaluate COVID-19 in-hospital costs and identify predictors at a patient-level in Brazil. Method(s): This is multicenter, prospective cohort study that applied time-driven activity-based costing (TDABC) method in five Brazilian reference centers for COVID-19 treatment. Patients hospitalized between March and August 2020 (first wave of the disease) and had their COVID-19 status confirmed by reverse transcription-polymerase chain reaction (RT-PCR) at arrival were included in our sample. The cost information was calculated at the patient level and multivariable analyses were applied to identify clinical predictors of cost variability, considering ICU admissions and patient's comorbidities. Result(s): 830 patients were included into the analysis. The median cost per patient was I$4,428 (IQR 2,019;11,464), and patients hospitalized in ICU demonstrated significative higher costs (p<0.001). Patients hospitalized in ICU the median was I$11,596 (IQR 6,016;23,374), while for those who were hospitalized in ward was 1,895 (IQR 1,050;3,317). Median cost per day was I$ 455 (IQR 308;711) for the total sample, I$690 (IQR I,528;1,046) for ICU patients and I$350 (IQR 255;449) for non-ICU. Gender (p<0.001), Obesity (p = 0.005) and Chronic pulmonary diseases (p = 0.044) were identified as clinical predictors for hospital costs. Conclusion(s): By developing a multicenter microcosting study for COVID-19 this study allowed to measure the variability in resource consumption per patients' according their clinical characteristics. These findings can sustain the development of financially sustainable health policies in middle-income countries such as Brazil.Copyright © 2023

Comorbidities in people living with HIV in the north east who are unvaccinated against COVID-19: a descriptive study

Background: People living with HIV (PLWH) are at increased risk of severe or critical COVID-19. This is in addition to the increased risk associated with any coexisting conditions such as chronic pulmonary disease (CPD), chronic kidney disease and cardiovascular disease. Vaccination against COVID-19 is therefore strongly recommended for PLWH. Method(s): We conducted a descriptive study to evaluate comorbidities among PLWH attending for HIV care at two NHS Trusts in North East England and who were under- or unvaccinated against COVID-19, defined as having received either zero or 1 doses of any COVID-19 vaccine by 01/10/2022. PLWH under active care were identified using the HIV and AIDS Reporting System (HARS) dataset. Vaccination data were obtained from regional integrated care records (RICR) and cross-referenced with HARS. Information on comorbidities was collated for any patients who were under- or unvaccinated. To quantify risk and clinical vulnerability, we calculated the Charlson Comorbidity Index (CCI) for each of these patients. A CCI score >=1 is associated with mortality/poor outcomes in patients with COVID-19. Result(s): 141 under- or unvaccinated patients were identified out of a total cohort of 1492 patients who attended for HIV care (9.5%);of these, 96 (68.1%) and 45 (31.9%) had received zero and one vaccination respectively. The median age of this under-/unvaccinated cohort was 41 years and 91 (64.5%) were male. 62 patients (44.0%) had a CCI score of 1 or more;13 patients (9.2%) had a diagnosis of AIDS during the time period evaluated;11 (84.6%) of the patients with an AIDS diagnosis were completely unvaccinated. Non-HIV comorbidities included liver disease (10/141, 7.1%), solid organ cancer (5/141, 3.5%), CPD (4/141, 2.8%) and connective tissue disease (3/141, 2.1%). Six patients (4.3%) had >=2 comorbidities. Conclusion(s): Nearly half of the under-/unvaccinated PLWH attending our services were identified as being at an increased risk of having a poor outcome in the event of contracting COVID-19. Proactively identifying these individuals would allow services to offer tailored support in making informed decisions about vaccinations. Useful strategies may include the use of patient information leaflets and targeted discussion with patients explaining their individual risk from COVID-19.

Risk Factors for Supraventricular Tachycardia among Covid-19 Positive Octogenarians and Potential Outcomes

Background: COVID-19 tends to have a harsher course in the elderly population, which can include the development of arrhythmias, including supraventricular tachycardia (SVT). Due to lack of sufficient data, we studied baseline patient characteristics, comorbidities, and outcomes of SVT in octogenarians admitted with COVID-19, using the 2020 National Inpatient Sample (NIS). Objective(s): We aimed to study the patient characteristics and outcomes of SVT in octogenarians admitted with COVID-19, using the 2020 National Inpatient Sample (NIS). Method(s): Octogenarians (ages 80-89 years, inclusive) with COVID-19 were recruited from the 2020 NIS (April 1st 2020 - December 31st 2020). A diagnosis of SVT was identified via the ICD-10 code "I47. 1". Patient characteristics that can influence the presence of SVT were identified via logistic regression models. The adjusted odds ratios (aOR) having cardiogenic shock or mortality among COVID-19 positive octogenarians with SVT were also explored. Result(s): Our study consisted of 240570 octogenarians who tested positive for COVID-19. 2.2% of them (5250 cases) also had a diagnosis of SVT during their hospitalization. Among them, Females (aOR 0.919, 95%CI 0.868-0.973, p<0.01) were more likely to develop SVT. Racial disparities were also observed as Blacks (aOR 1.234, 95%CI 1.137-1.338, p<0.01) had higher odds of having SVT, whereas Hispanics (aOR 0.898, 95%CI 0.819-0.984, p=0.021) had lower odds compared to Whites. Comorbidities such as chronic pulmonary disease (aOR 1.106, 95%CI 1.037-1.179, p<0.01), and heart failure (aOR 1.122, 95%CI 1.053-1.195, p<0.01) also led to higher odds of SVT. Lower odds were seen among those with diabetes (aOR 0.852, 95%CI 0.802-0.905, p<0.01), obesity (aOR 0.839, 95%CI 0.764-0.921, p<0.01), or smoking history (aOR 0.892, 95%CI 0.835-0.954, p<0.01). The use of mechanical ventilation (aOR 2.829, 95%CI 2.638-3.034, p<0.01) or non-invasive ventilation (aOR 1.755, 95%CI 1.615-1.907, p<0.01) showed higher odds of developing SVT. Finally, patients with SVT had increased risk of cardiogenic shock (aOR 1.510, 95%CI 1.206-1.891, p<0.01) and mortality (aOR 1.166, 95%CI 1.085-1.253, p<0.01). Conclusion(s): Multiple factors influenced the presence of SVT among octogenarians who had COVID-19. SVT in these patients was associated with higher incidences of cardiogenic shock and mortality. Additional focus targeting patient care and further research to better understand the mechanisms behind these variations may help improve outcomes. [Formula presented]Copyright © 2023

Features of the diagnosis and course of COVID-19 in HIV-infected patients hospitalized in a hospital

The global pandemic of coronavirus infection (COVID-19) has set complex diagnostic tasks for doctors of polyclinics and hospitals. Considering the simultaneous pandemic spread of two infectious diseases - COVID-19 and HIV infection, the problem of studying the clinical features of combined COVID-19/HIV infection becomes urgent. The aim of the study was to determine the features of the diagnosis and course of COVID-19 against the background of HIV infection in patients undergoing inpatient treatment. Material and methods. The study was conducted on the basis of the temporary Clinical Medical Center COVID-19 of the A.I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation in Moscow from October 2020 to January 2022. The study included 31 233 patients with COVID-19 complicated by pneumonia. To analyze the features of the course of combined COVID-19/HIV infection, a group of 51 HIV-infected patients was identified. The diagnosis of COVID-19 was determined based on the detection of SARS-CoV-2 RNA by PCR in nasal/oropharyngeal smears and/or according to computed tomography of the lungs (CT). During the study, age, gender, anamnesis, objective examination data were analyzed, taking into account the results of CT scans of the chest organs, data from routine laboratory blood tests, oxygen support regimens, treatment outcomes and duration of detection of SARS-CoV-2 RNA. All patients were treated according to the Temporary Clinical Guidelines for the Diagnosis and Treatment of COVID-19, 14 version dated 12/27/2021. Results. The number of patients with combined HIV infection and SARS-CoV-2 out of the total number of hospitalized COVID-19 patients (n=31 233) was 0.16%. Upon admission, 30 (59%) patients reported having HIV infection and receiving antiretroviral therapy (ART). HIV infection was first diagnosed in 21 patients at 2-3 weeks of inpatient treatment. The average age of patients with SARS-Cov-2/HIV co-infection was 1.5 times less than in patients without HIV (41.1+/-5.3 and 64.4+/-10.1, respectively) (p<=0.05). Concomitant pathology (hypertension, type 2 diabetes mellitus, chronic kidney disease and chronic lung diseases) was less common (51%) in the group of combined infection than in the group without HIV (83%). However, in 41% of patients with coinfection, chronic viral hepatitis B, C was detected, in contrast to 0.3% of cases of COVID-19 patients without HIV. 26 (51%) patients were discharged with improvement, while the average bed-day did not differ from patients without HIV infection (13.4+/-4.5 days and 11.7+/-5.2, respectively) (p>=0.05). 7 (24%) patients at the time of discharge (16.8+/-4.2 days) with clinical and laboratory improvement maintained a positive result of PCR RNA on SARS-Cov-2. In 22 (43%) patients with coinfection, hospitalization was fatal for 3 to 21 days of treatment, with ARDS with respiratory and multiple organ failure, which is 3.6 times higher than in patients without HIV infection. The analysis showed that, regardless of the result of PCR on SARS-CoV-2 RNA, in non-specialized hospitals, HIV testing is indicated for young patients with fever for more than 14 days, with lung damage in the form of bilateral interstitial changes according to CT, a history of chronic hepatitis C, B, with progressive severity of the condition on against the background of COVID-19 therapy. Early consultation of an infectious disease specialist, examination of sputum/lavage by PCR for pathogens of opportunistic infections and the appointment of ART and drugs for the treatment of opportunistic diseases will improve the quality of medical care for patients in a non-core HIV hospital will improve the prognosis of COVID-19.Copyright © Eco-Vector, 2022.

Features and characteristics of publicly available mHealth apps for self-management in chronic obstructive pulmonary disease.

Mobile health applications (mHealth apps) may be able to support people living with chronic obstructive pulmonary disease (COPD) to develop the appropriate skills and routines for adequate self-management. Given the wide variety of publicly available mHealth apps, it is important to be aware of their characteristics to optimize their use and mitigate potential harms. Objective: To report the characteristics and features of publicly available apps for COPD self-management. Methods: MHealth apps designed for patients' COPD self-management were searched in the Google Play and Apple app stores. Two reviewers trialed and assessed the eligible apps using the MHealth Index and Navigation Database framework to describe the characteristics, qualities, and features of mHealth apps across five domains. Results: From the Google Play and Apple stores, thirteen apps were identified and eligible for further evaluation. All thirteen apps were available for Android devices, but only seven were available for Apple devices. Most apps were developed by for-profit organizations (8/13), non-profit organizations (2/13), and unknown developers (3/13). Many apps had privacy policies (9/13), but only three apps described their security systems and two mentioned compliance with local health information and data usage laws. Education was the common app feature; additional features were medication reminders, symptom tracking, journaling, and action planning. None provided clinical evidence to support their use. Conclusions: Publicly available COPD apps vary in their designs, features, and overall quality. These apps lack evidence to support their clinical use and cannot be recommended at this time.

Comorbidities That Increase Risk for Severe Acute Covid-19 in Pediatric Population

Background: Little is understood about which comorbidities are associated with severe outcomes in children hospitalized with acute COVID-19. Some confusion lies especially for cancer or diabetes. Method(s): Data from 2 multicenter prospective cohort studies of hospitalized children (aged 0-18 years) with confirmed SARS-CoV-2 in Spain and Colombia were combined for this analysis. Data were obtained from 116 hospitals. Outcome was classified as (in decreasing order of severity): death, mechanical ventilation (MV), pediatric intensive care unit (PICU) admission, high flow/CPAP, oxygen therapy with nasal prong (NP) and hospitalization without respiratory support. Risk factors for severity, adjusting for age and gender, were identified using multinominal logistic regression and a backwards selection process. Result(s): A total of 1,753 patients were included, 734 (41.8%) in Spain and 1,019 (58.1%) in Colombia. The most frequent comorbidities were asthma (9.0%), chronic neurological disorder (NRL) (7.4%), immunosuppressive medication (7.2%), malignant neoplasms (5.4%) and chronic lung disease (not asthma) (CLD) (4.5%). Comorbidities associated with the different endpoints are summarized in Figure 1. Asthma was associated with a significantly increased risk of death (OR: 4.17;95%CI 1.34-12.97), MV (OR: 7.94 (3.59-17.56)), PICU admission (OR: 3.37 (1.91- 5.96)), high flow/CPAP (OR: 6.65 (2.69-16.46)), and NP (OR: 3.85 (2.57-5.77)) compared to hospitalization without respiratory support. NRL was associated with increased risk of death (OR: 7.34 (3.01-17.90)), MV (OR: 3.07 (1.20-7.82)) and high flow/CPAP (OR: 4.36 (1.68-11.29)). CLD was associated with increased risk of death (OR: 6.22 [2.28-16.94]) and NP (OR: 3.1 (1.74-5.58)) and in addition, chronic cardiac disease was associated with increased risk of MV (OR: 5.21 (1.76-15.41)) and PICU (OR: 2.78 (1.27-6.08)). Risks of death (OR: 4.49 (2.03-9.05)), MV (OR: 2.97 (1.52-5.81)), PICU (OR: 4.27 (2.89-6.33)), and NP (OR: 4.67 (3.64-5.99)) were higher in the Colombia Cohort. Conclusion(s): Asthma, chronic neurological, cardiac and lung disease;and belonging to the Colombia cohort were consistently associated with multiple severe outcomes of COVID-19. Cancer and diabetes association with selected endpoints rather than with most endpoints may be more related to the baseline disease than with the actual COVID-19.

Covid-19 Outcome in Patients with and without Cirrhosis

Background: Severe outcomes of COVID-19 are associated with advancing age, and multiple medical comorbidities. The impact of COVID-19 on the clinical course of patients with cirrhosis has not been well studied. We determined the effect of SARS-CoV-2 infection on the hospitalization and survival rates of patients with cirrhosis. Method(s): Using ICD-10-CM codes, we identified all Veterans with a diagnosis of cirrhosis in the VA Corporate Data Warehouse and COVID-19 Shared Data Resource. Study cohort included Veterans who were tested for SARS-CoV-2 and had no history of organ transplantation or malignancies. Each SARS-CoV-2 positive case was propensity-score matched by demographics and comorbidities with up to two SARS-CoV-2 negative controls. The primary endpoints were acute care hospitalization, admission to intensive care, respiratory support, or death. Result(s): Of 1,115,037 individuals tested for SARS-CoV-2, 31,680 were noted to have cirrhosis and among them 5,047 (16%) were SARS-CoV-2 positive. After exclusions and propensity-score matching, 5,047 SARS-CoV-2 positive and 9,913 propensity score matched SARS-CoV-2 negative individuals were included in the analysis cohort. Median age was 67 years, 95% were men and 25% were of black race. Median BMI was 30 and history of hypertension, diabetes, cardiovascular and chronic pulmonary disease was noted among 81%, 54%, 56% and 32% respectively. Among all cirrhotic individuals, SARS-CoV-2 positive individuals less frequently progressed to hepatic decompensation (3.1% vs 4.8%, P< 0.0001) or hospitalization (35.7% vs 38.2%, P=0.002), but more frequently required ICU admission 15% vs 12.2%, P< 0.0001) or respiratory support (7.3% vs 8.4%, P=0.01). Among those admitted, length of hospital stay was longer among SARS-CoV-2 positive individuals (7 vs 4 days, P< 0.0001). In Cox regression analysis, SARS-CoV-2 positivity was associated with a higher risk of all-cause mortality (HR 1.37, 95% CI 1.19,1.56). Conclusion(s): Although patients with cirrhosis and COVID-19 were less often hospitalized, they had longer duration of hospitalization and were at higher risk of severe or critical illness and death. (Figure Presented).

Ai-Based Prediction of Lung Tissue Involvement Is Predicitive of Covid-19 Severity

Background: During COVID-19 epidemics several artificial-intelligence neural networks (ANN) systems were developed classify the risk of disease progression to respiratory failure and death, providing aid for clinical decision. However, for optimal results these models should link multiple medical data in a simple model. In this study we analyse the in-hospital mortality and mechanical ventilation risk using combination ANN based rapid computed tomography assessment tool and selected clinical variables. Method(s): Data of 4317 COVID-19 hospitalized patients including 266 cases required mechanical ventilation were analysed using newly constructed and locally trained ANN algorithm. Demographic, clinical, laboratory, and ANNbased lung inflammation data were analysed using proportional Cox Hazards model and estimate in-hospital mortality and intensive care admission risk. Result(s): Overall in-hospital mortality associated with ANN-assigned percentage of the lung involvement (HR 5.72 (95%CI: 4.4-7.43), p< 0.001 for the patients with >50% of lung tissue affected by COVID-19 pneumonia), age category (HR 5.34 (95%CI: 3.32-8.59) for cases >80 years, p< 0.001), procalcitonin > 2 (HR: 2.1 (95%CI: 1.59-2.76) ng/ml p< 0.001, C-reactive protein level category (max. HR 2.11 (95%CI: 1.25-3.56) for CRP >100 mg/dL, p=0.004), estimated glomerular filtration rate (max HR 1.82 (95%CI: 1,37-2,42), p< 0.001 for eGFR < 30 ml/min) and troponin increase above upper limit normal level (HR: 2.14 (95%: 1.69-2.72, p< 0.001) (Figure 1). Furthermore, risk of mechanical ventilation also associated with ANN-based percentage of lung inflammation (HR 13.2 (8.65-20.4), p< 0.001 for patients with >50% involvement), age, procalcitonin > 2 ng/ml (HR: 1.91 (95%CI: 1.14-3.2), p=0.14 estimated glomerular filtration rate (HR 1.82 (1.2-2.74), p=0.004 for eGFR < 30 ml/min) but also clinical variables, including (HR: 2.5 (95%CI: 1.91-3.27), p< 0.001), cardiovascular and cerebrovascular disease (HR: 3.16 (95%CI: 2.38-4.2), p< 0.001), and chronic pulmonary disease (HR: 2.31 (95%CI: 1.44-3.7), p< 0.001). Conclusion(s): ANN-based lung tissue involvement was the strongest predictor of unfavorable outcomes in COVID-19, and represent valuable support tools for clinical decisions. (Figure Presented).

High Mortality in Hospitalised Virally Suppressed Adults with Hiv in South Africa

Background: Mortality in PWH has been markedly improved by antiretroviral therapy (ART) but there are few reports describing this in the ~5 million virally suppressed (VS) PWH in South Africa(SA). We describe cause of death(CoD) in adults admitted to hospital with suspected pneumonia in SA. Method(s): We enrolled patients from June 2019-October 2021 at four hospitals and then followed them up for >=1 year. Eligibility included: Age >18 years, >=2 signs/symptoms of pneumonia, < 48 hrs since admission. Medical records were reviewed. All had HIV status ascertained and sputum sent for Xpert Ultra and mycobacterial culture. In PWH CD4 count, viral load (VL) and urine lipoarabinomannan were assessed. For those who died, CoD were ed from medical charts and interview of family. We categorised deaths as early: while admitted or to < 30 days after discharge;or late: >=30 days after discharge. We report mortality and CoD in VSPWH (VL<=50 copies/ml), unsuppressed and HIV uninfected(HUI) adults. Result(s): Of 1999 adults, 54% were PWH;61.2% reported receiving ART of whom 43.1% were VS;55.5% were women. Overall median age of VS was 48 years (IQR: 40-55) at entry;34.3% had comorbidities: hypertension (70.1%, obesity 41.3%, diabetes 28.9%) . Only 11.3% were diagnosed with HIV in the past year, 35.0%, had prior TB. Median CD4 count of VS patients was 289 cells/ mm3 (IQR:133-490) and Hb, 12.5g/dL (IQR:10.5-14.0);53.0% had CRP >100mg/ dL and 69.6% had oxygen saturation < 93% on room air;14.8% had >=1 assay positive for TB;and 42.9% were SARS-CoV-2 positive. Overall 25.4% VSPWH died compared to 31.2% and 22.9% of unsuppressed and HUI, respectively;median ages at death were 49 (IQR:43-59), 38 (IQR: 32-47) and 62 (IQR: 53-69) years respectively. Overall median times to early and late death was 8 (IQR: 4-16) and 104 (IQR: 75-254) days, respectively. The leading CoD in VSPWH were: COVID-19 (22.9%), chronic lung disease(CLD) (17.1%),malignancy (12.9%),sepsis, (12.9%) and TB (8.7%);in HIV unsuppressed, CoD were: advanced HIV and opportunistic infections-(TB,PJP)(55.5%), sepsis(9.6%), COVID-19(8.6%);and in HUI: COVID- 19(43.0%), cardiovascular disease (9.0%), TB(9.0%), malignancy (8.5%). Conclusion(s): Mortality in VSPWH admitted with suspected pneumonia was higher than in HUI and occurred 12 years earlier. The challenge for clinicians is to screen for diseases that disproportionately affect VSPWH and to try to prevent recurrent lung infections thereby increasing their comorbidity-free years and reduce mortality gaps.

Patients with interstitial lung disease are high-risk of COVID-19 morbidity with implications on access to early oral anti-viral treatments

Introduction/Aim: Patients with interstitial lung disease (ILD) are at higher risk of COVID-19 infection associated morbidity and mortality, and hence may benefit from early anti-viral therapy. The access criteria for early oral anti-viral therapies for COVID-19 varied in early 2022 due to limited supplies nationally. We created a live clinical database of ILD patients in a tertiary hospital setting, stratifying them by measurable risk factors and therefore accessibility by state or national criteria to anti-viral therapy. Method(s): A list of active ILD clinic patients was generated from the WEBPAS clinic database. Data on patient demographics, co-morbidities and immunosuppressive medications relevant to access to anti-viral medications via the PBS criteria and state-based criteria was gathered by medical records review. Demographic information included age, BMI, ethnicity, residential care living and rurality. Co-morbidity risk factors included congestive cardiac failure, neurological disease, diabetes mellitus, chronic kidney disease, liver cirrhosis, chronic lung disease and immunodeficiencies. Medications of relevance included glucocorticoids, steroid-sparing immunomodulators and chemotherapy. Combinations of the above risk factors equate to eligibility to treatment. Result(s): Between the data capture dates of 1 February 2021 and 31 January 2022, 526 patients were identified. Of these 457 fit the inclusion criteria. Median age was 71.4 years (range 20-92), ratio of F:M was 1.09. 11% of patients were on long term oxygen therapy. Commonest conditions were idiopathic pulmonary fibrosis (26.3%), connective-tissue disease ILD (18%) and sarcoidosis (13.4%). 92 (20%) of patients fit into 'moderate or severely immunocompromised' criteria. 346 (75%) of patients fit criteria for early anti-virals by the first iteration of PBS criteria. Using the second iteration of PBS criteria, 374 (82%) of the ILD patients fit criteria for early anti-viral treatment. Notably, some patients qualify for anti-virals on multiple eligibility PBS criteria. Conclusion(s): A large proportion of our ILD cohort is deemed 'high risk' for COVID-19 morbidity and would qualify for early anti-viral therapies (regardless of vaccination status).

Assessing the performance of the scoring for the use of antiviral therapy to prevent COVID-19 disease progression in primary care setting

Introduction: Nirmatrelvir/ritonavir (Paxlovid) was approved in December 2021 for infected individuals at high risk of progressing to severe COVID-19 and require hospitalization. A scoring was established in the local COVID-19 treatment guideline to select those infected and at high risk at primary care setting for Paxlovid therapy. The scoring quantified risk based on age, comorbidities, vaccine doses, body mass index (BMI), and chest radiograph changes. This study aimed to assess the performance of the scoring and parameters. Method(s): A case was an infected individual who progressed and being hospitalized. A total 551 patients (98.7% symptomatic infections without pneumonia and 1.3% with mild pneumonia) were recruited including 260 (47.2%) cases and 291 (52.8%) controls between January and February 2022. Receiver-operating-characteristic (ROC) was applied to investigate performance and optimal cut-points for the scoring, as well as individual parameter. Result(s): The existing scoring presented a poor accuracy of 65.0% with 3 as the cut point score. The accuracy can be improved to 70.0% when using 2 as the cut point score. The accuracy would improve further to 74% by modifying the age cut point from 60 to 35 years, BMI from 30.0 to 35.0 kg/m2 and applying 100 days as the cut point for duration from the last vaccine dose. Hypertension, cardiovascular diseases, and chronic lung diseases presented a relatively high risk for disease progression and hospitalization, therefore should be assigned more points. Conclusion(s): The existing scoring was suboptimal and should be optimized by incorporating new cut points for age, BMI and vaccine duration, and giving more weightage to more significant comorbidities.

Comparison between in-person and remote assessment of four field tests for people with chronic lung diseases

Introduction: COVID-19 pandemic has driven an abrupt shift from centre-based pulmonary rehabilitation to home-based or telerehabilitation models in order to safely deliver this important treatment. However, functional capacity assessment is still carried out with in-person supervision. Aim(s): To compare remote and in-person assessment of four field tests for patients with chronic lung diseases. Method(s): People with chronic respiratory diseases underwent timed up and go test (TUG), 5-repetitions sit-to-stand test (5-repStS), 1-minute STS (1-minStS), and modified incremental step test (MIST). Tests were carried out at participants' home with in-person or remote (Skype or WhatsApp) assessment, in random order. During the remote assessment, the physiotherapist was at the pulmonary rehabilitation centre. The order of the tests was also randomized and was the same for in-person and remote supervision. Each test was performed twice and the test with best performance was used for comparison between remote and in-person supervision. A kit containing a finger pulse oximeter, tape measure, and a step was provided. Pair t -test expressed as mean difference (95% CI), intraclass correlation coefficient (ICC 2:1), and Bland-Altman method were used for analysis. Result(s): Forty-four participants (23 COPD, 18 bronchiectasis, three cystic fibrosis, FEV 1 47 +/- 19%, 56 +/- 15 years old) were assessed. There was no difference between in-person and remote supervision for all tests (TUG 0.04(-0.2-0.2) s, 5-repStS: 0.3(-0.1-0.7) s, 1-minStS: -0.9 (-1.9-0.1) repetitions, and MIST: -3.1 (-9.9-3.7) steps). High reproducibility was observed by ICC (95% CI) (TUG: 0.94 (0.89-0.97), 5-repStS: 0.96 (0.92-0.98), 1-minStS: 0.87 (0.77-0.93), and MIST: 0.94 (0.88-0.96). Limits of agreement were narrow for TUG (-0.8-1.7), 5-repStS (-2.3-2.9), and 1-minStS (-7.4-5.5), but wide for MIST (-46-40). Conclusion(s): Remote assessment provides similar results to in-person assessment for four field tests commonly used in people with chronic lung diseases.

Chronic lung disease in children due to SARS-CoV-2 pneumonia: Case series.

The reported prevalence of chronic lung disease (CLD) due to coronavirus 2 (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2)]) pneumonia with the severe acute respiratory syndrome in children is unknown and rarely reported in English literature. In contrast to most other respiratory viruses, children generally have less severe symptoms when infected with SARS-CoV-2. Although only a minority of children with SARS-CoV-2 infection require hospitalization, severe cases have been reported. More severe SARS-CoV-2 respiratory disease in infants has been reported in low- and middle-income countries (LMICs) compared to high-income countries (HICs). We describe our experience of five cases of CLD in children due to SARS-CoV-2 collected between April 2020 and August 2022. We included children who had a history of a positive SARS-CoV-2 polymerase chain reaction (PCR) or antigen test or a positive antibody test in the serum. Three patterns of CLD related to SARS-CoV-2 were identified: (1) CLD in infants postventilation for severe pneumonia (n = 3); (2) small airway disease with bronchiolitis obliterans picture (n = 1) and (3) adolescent with adult-like post-SARS-CoV-2 disease (n = 1). Chest computerized tomography scans showed airspace disease and ground-glass opacities involving both lungs with the development of coarse interstitial markings seen in four patients, reflecting the long-term fibrotic consequences of diffuse alveolar damage that occur in children post-SARS-CoV-2 infection. Children with SARS-CoV-2 infection mostly have mild symptoms with little to no long-term sequelae, but the severe long-term respiratory disease can develop.

Presentation Traits Of Vaccinated Versus Unvaccinated Heart Failure Patients At Acute Covid-19 Hospitalization

Introduction: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) exhibits 25-30% mortality in hospitalized patients with heart failure (HF). Cardiovascular disease is the most significant comorbidity associated with increased mortality in COVID-19 patients with data suggesting local and systemic inflammation play a critical role in cardiac functional abnormalities. SARS-CoV-2 vaccination reportedly reduces severity of infection. We sought to characterize if vaccination had any protective effect on patients with HF hospitalized for acute COVID-19. Hypothesis: Baseline cardiac biomarkers including CRP, ferritin, high sensitivity cardiac troponin I (hs-cTnI), and pro-brain natriuretic peptide (pBNP) may be lower in vaccinated COVID-19 HF patients revealing the impact of vaccination on reducing inflammation by SARS-CoV-2 infection. Method(s): Electronic health records underwent IRB exempted extraction of demographics, anthropometrics, vital signs, laboratory tests, and ICD-10-CM-based Elixhauser comorbidity categories. Continuous data summarized with median [IQR] were compared using Kruskal-Wallis test and discrete data with chi-squared test. Result(s): Among HF patients with a recorded vaccine status admitted between July 3, 2021 and March 17, 2022, 206 underwent acute COVID-19 hospitalization. Vaccinated (n=91, 44%) and unvaccinated (115, 56%) patients exhibited statistically similar distribution of males (56%), aged 78[69-86] years with comorbidities 5[4-7] distributed across Whites (88%), Blacks (8%), and other races (4%). There were no intergroup differences with most prevalent comorbidities at admission including hypertension (99%), diabetes (41%), chronic pulmonary disease (37%), obesity (36%), deficiency anemia (31%), and renal failure (25%). There were no intergroup differences in initiation of COVID-19 directed treatments. Baseline biomarkers in vaccinated versus unvaccinated were CRP 6.0[1.3-9.5] vs. 6.9[2.7-11.3] mg/dL (p=.25), ferritin 171[76-552] vs. 432[79-876] ng/mL (p=.13), LDH 245[192-317] vs. 338[260-439] U/L (p=.003), D-dimer 0.89[0.53-1.73] vs. 1.36[0.95-2.80] mg/L FEU (p=.06), hs-cTnI 27[14-67] vs. 28[16-81] ng/L (p=.39), and pro-BNP 3487[1516-7162] vs. 3278[1549 vs. 9001] pg/mL (p=.90). Clinical visit criteria respectively were hospital LOS 4.9[2.9-10.3] vs. 5.4[3.4-10.3] days (p=.27), ICU admission 10% vs. 17% (p=.15), and discharge disposition expired or Hospice 15% vs. 16% (p=.48). Rehospitalization occurred similarly between groups and was not significant. Conclusion(s): Acute and chronic inflammation are pathogenic drivers of HF. Inflammatory biomarkers lower among vaccinated patients with HF included CRP, ferritin, D-dimer, and hs-cTnI, although not significant. LDH, however, was significantly lower suggesting improved host widespread tissue perfusion as one mechanism of reduced severity in patients with HF undergoing SARS-CoV-2 vaccine breakthrough infection. One study caveat is that despite inclusion of all patients, these preliminary findings are likely not sufficiently powered to validate our hypothesis.Copyright © 2022

Clinical Characteristics of Deceased with COVID-19 Infection: Data from the Largest COVID-19 Dedicated Hospital in Bangladesh

The death t toll of the coronavirus disease 2019 (COVID-19) has been considerable. Several risk factors have been linked to mortality due to COVID-19 in hospitals. This study aimed to describe the clinical characteristics of patients who either died from COVID-19 at Dhaka Medical College Hospital in Bangladesh. In this retrospective study, we reviewed the hospital records of patients who died or recovered and tested positive for COVID-19 from May 3 to August 31, 2020. All patients who died during the study period were included in the analysis. A comparison group of patients who survived COVID-19 at the same hospital during the same period was systematically sampled. All available information was retrieved from the records, including demographic, clinical, and laboratory variables. Of the 3115 patients with confirmed COVID-19 during the study period, 282 died.The mean age of patients who died was higher than that of those who survived (56.7 vs 52.6 years). Approximately three-fourths of deceased patients were male. History of smoking (risk ratio 2.3;95% confidence interval: 1.6-3.4), comorbidities (risk ratio: 1.5;95% confidence interal:1.1-2.1), chronic kidney disease (risk ratio: 3.2;95% confidence interval: 1.7-6.25), and ischemic heart disease (risk ratio:1.8;95% confidence interval: 1.1-2.9) were higher among the deceased than among those who survived. Mean C-reactive protein and D-dimer levels [mean (interquartile range), 34 (21-56) vs. 24 (12-48);and D-dimer [1.43 (1-2.4) vs. 0.8 (0.44-1.55)] were higher among those who died than among those who recovered. Older age, male sex, rural residence, history of smoking, and chronic kidney disease were found to be important predictors of mortality. Early hospitalization should be considered for patients with COVID-19 who are older, male, and have chronic kidney disease. Rapid referral to tertiary care facilities is necessary for high-risk patients in rural settings.Copyright © 2023 Hoque MM.

GDF15 as a key disease target and biomarker: linking chronic lung diseases and ageing.

Growth differentiation factor 15 (GDF15), a member of the transforming growth factor-beta superfamily, is expressed in several human organs. In particular, it is highly expressed in the placenta, prostate, and liver. The expression of GDF15 increases under cellular stress and pathological conditions. Although numerous transcription factors directly up-regulate the expression of GDF15, the receptors and downstream mediators of GDF15 signal transduction in most tissues have not yet been determined. Glial cell-derived neurotrophic factor family receptor α-like protein was recently identified as a specific receptor that plays a mediating role in anorexia. However, the specific receptors of GDF15 in other tissues and organs remain unclear. As a marker of cell stress, GDF15 appears to exert different effects under different pathological conditions. Cell senescence may be an important pathogenetic process and could be used to assess the progression of various lung diseases, including COVID-19. As a key member of the senescence-associated secretory phenotype protein repertoire, GDF15 seems to be associated with mitochondrial dysfunction, although the specific molecular mechanism linking GDF15 expression with ageing remains to be elucidated. Here, we focus on research progress linking GDF15 expression with the pathogenesis of various chronic lung diseases, including neonatal bronchopulmonary dysplasia, idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease, and pulmonary hypertension, suggesting that GDF15 may be a key biomarker for diagnosis and prognosis. Thus, in this review, we aimed to provide new insights into the molecular biological mechanism and emerging clinical data associated with GDF15 in lung-related diseases, while highlighting promising research and clinical prospects.

COVID-19 in Patients with Chronic Lung Disease.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes an acute respiratory tract infection known as coronavirus disease 2019 (COVID-19). SARS-CoV-2 enters cells by binding the ACE2 receptor and coreceptors notably TMPRSS2 or Cathepsin L. Severe COVID-19 infection can lead to acute lung injury. Below we describe the current evidence of the impact of common chronic lung diseases (CLDs) on the development of COVID-19. The impact of treatment of CLD on COVID-19 and any risk of vaccination in patients with CLD are considered.

Effect of the COVID-19 Pandemic on Bronchoscopy Indication and Bronchial Microbiology

Background: Lockdowns and mask wearing have impacted infectious disease patterns during the COVID-19 pandemic. We investigated changes in the use of bronchoscopy and the results of routine microbiology in bronchial lavage. Method(s): We included bronchoscopies from 2017-2021 at the LMU University Department of Pulmonology. In this we present an initial cohort comparing bronchoscopies in 2017-2018 to the initial phase of the COVID-19 pandemic in 2020. Comparisons used chi-squared and Fischer's exact tests in SPSS. Result(s): We analysed 480 bronchoscopies from before and 85 during the COVID-19 pandemic. Mean age: 62.6 y (+/-14.1) before vs. 55.2 y (+/-16.3) during the pandemic (p<0.001). Indication for bronchoscopy: secretions/atelectasis (n=122), suspected tumor (n=89) and intervention/therapy (n=80) before;suspected tumor (n=30), respiratory deterioration after lung transplant (n=19) and infection (n=7) during the pandemic. Staphylococcus aureus and Pseudomonas aeruginosa were common in both groups. Frequencies of EBV (p<0.001), CMV (p=0.003) and HHV6 (p<0.001) differed significantly. Conclusion(s): There were clinically relevant differences in the use of bronchoscopy before vs. during the COVID-19 pandemic: pandemic patients were younger and interventions such as bronchial stenting and recanalisation less common. Bacterial results were similar but the frequency of common viruses differed. The effect of lockdowns, mask wearing and social distancing on bronchial microbiology in patients with lung cancer or chronic lung disease will be investigated in further detail in this cohort. Clinical relevant differences may support continued mask wearing in some high-risk situations post-pandemic.

Therapeutic stategies in hospitalised patients with SarsCov-2 hipoxemic pneumonia

Objective: Evaluate the impact of real life use of remdesivir (RDV) as treatment for hypoxemic SarsCoV2 Pneumonia. Method(s): Of 1155 consecutive adult subjects hospitalised with SarsCov2 infection, we selected only those with cumulative evidence of: 1. positive PCR test;2. Radiologically confirmed pneumonia;3. Hypoxemia and need of supplementary O2 (>= 24%). We compared those treated with RDV versus those receiving Standard of Care (SoC), in terms of mortality, length of hospital stay and secondary effects of treatment. Result(s): 843 subjects were treated with RDV and 312 with SoC. In the RDV group, 97.1% patients were also receiving Dexamethasone (DEXA) and mean age was 69.7 (+/-14.4) years with 61.8% male prevalence, as opposed to the SoC group that registered 73.9 (+/-14.5) years and 49.7% male prevalence. Both groups had similar prevalence of Diabetes, Hypertension and Chronic Lung Disease;Overweight was more prevalent in the RDV group whereas Immunosuppressant conditions and Smoking were more frequent in the SoC subjects. Concerning the proposed outcomes: a) RDV patients had a mean Hospital Stay 4.25 days inferior than SOC subjects (p=0.002);b)The relative risk of death during hospital stay in the RDV group was 0.47 [0.38;0.60] when compared to those in the SoC group;c) 9 subjects in the SoC group (0.03%) and 12 patients in the RDV group (0.014%) had secondary effects attributable to treatment drugs, all resolved with treatment interruption. Conclusion(s): The use of RDV with DEXA in SARSCoV-2 Hypoxemic Pneumonia significantly reduced mortality and hospital stay, and registered no significant side effects in a real life cohort of consecutively enrolled patients.