Scientific Connotation and Clinical Value of Traditional Chinese Medicine Lianhua Qingke Improving Ventilation Function Through "Reducing Phlegm".

[] Airway mucus is an important part of the defense barrier function of the airway. Abnormal secretion of airway mucus is closely related to recurrent attacks,delay or aggravation of respiratory infectious or infectious diseases such as chronic obstructive pulmonary disease(COPD),community-acquired pneumonia, and coronavirus disease 2019(COVID-19). Lianhua Qingke tablets,an innovative traditional Chinese medicine (TCM)developed under the guidance of the theory of collateral disease of TCM,has the function of reducing phlegm and relieving cough,which can reduce the generation and viscosity of sputum and promote sputum excretion. Clinical studies have shown that it can significantly improve the symptoms of expectoration and cough in patients with acute bronchitis or COVID-19,confirming its scientific connotation and clinical value of reducing phlegm and relieving cough to improve ventilation and exchanging function.Copyright © 2021, China Academy of Chinese Medical Sciences Institute of Chinese Materia Medica. All rights reserved.

Altea:Improving Long COVID affected people's quality of life by knowledge and experience sharing

Long COVID (LC), a new multiple-symptom syndrome, may occur in a large number of people after SARS-CoV-2. Most frequent symptoms include breathing problems, fatigue and cognitive impairments. LC needs to be in focus: research to understand its causes and develop appropriate therapies is needed. Yet, affected people have for long felt alone, with concerns and without guidelines. Altea Long COVID Network was developed to address these needs. The goal of Altea is to improve the quality of life of people with LC by providing science- and practice-based expertise, professional and empathetic support, and by enabling the free exchange of experiences between all target audiences. Altea was built with the contribution of those affected, health professionals and researchers, and provides practical tips for symptom management, information on the last updates regarding LC, as well as a Community, where all target audiences can communicate with each other in an interdisciplinary, respectful, and safe environment. Altea was launched in January 2021. The Website went live in April 2021. By now 1'496 people subscribed to the Newsletter, there were 50'000 visits, 221'000 page views, and 11'000 downloads. Countries where people visit from are CH, DE, IT, USA, AUT, FR, NL, GB, ES, and many others. In July 2021 the Altea Community was opened and has today 1146 subscribers. A survey is planned to examine to what extent Altea contributed to improve people's quality of life and develop therapies. Altea acts as mediator among the different target audiences that can use it to share knowledge and experiences. This accelerates the processes to develop therapies and treatments for people with Long COVID.

Home cardiorespiratory sleep studies in children and young people: experience of a UK Regional Service

Background: Cardiorespiratory sleep studies (CRSS) consisting of effort, flow, oxygen saturation, ECG traces and video is traditionally undertaken in hospital with an attendant physiologist. Over the last 10 years our service has increasingly undertaken such studies in the child or young person's (CYP) home. This is now our default means of undertaking such studies. Objective(s): To determine the technical adequacy and clinical utility of home cardiorespiratory sleep studies in our patient group. Method(s): Retrospective data service evaluation. Patient demographics, underlying diagnosis and clinical question were recorded for those for whom home video CRPSG was attempted between July 2020-August 2021. The adequacy of each study component was scored (1=inadequate;2=variable;3=excellent) using the narrative in the study report. A total adequacy score (TAS) was calculated for each study. Result(s): 50 studies were identified (mean age of CYP was 5.5 years (IQR=8.5)). A clinical conclusion was possible for 96% of studies. 36% of studies were positive for a breathing disorder. Electrocardiography had the highest percentage (85.7%) of 'excellent' scores. Nasal thermistor had the highest percentage (32.7%) of 'inadequate' scores. Age of CYP and adequacy scores were not related. There was no association between underlying diagnosis and clinical utility/adequacy of study. Conclusion(s): For a service without access to in-hospital attended studies, we can achieve a high rate of technical adequacy and clinical utility for home CRSS irrespective of age and underlying diagnosis for CYP. We have been able to continue our service despite the COVID pandemic.

Application of urinary proteomics for biomarker discovery in respiratory diseases

Background: To search for molecular biomarkers of pulmonary pathologies using non-invasive samples, such as urine, is of high clinical relevance. However, there are almost no proteomic studies using urine applied to respiratory diseases. Aim(s): To develop a biomarker discovery strategy using non-targeted proteomics in urine with applicability to different pulmonary diseases. Method(s): Urine samples were centrifuged and DTT treated to decrease uromodulin (THP). Low-THP samples were concentrated (ultrafiltration), ultracentrifugated, and exosome free urine was analysed using LC-MS/MS. GO terms/Pathway analyses were performed using STRING database. Result(s): Urine proteome (765 proteins) was enriched (FDR < 0.05) in proteins from different tissues, including respiratory system (N = 124), lung (N = 107), and immune system (N = 88). We detected an enrichment of relevant pathways for respiratory diseases, including several innate (e.g., TLR and NFkB pathways, complement system), and adaptive (e.g., interleukin signalling) immune system pathways. Some of these proteins have been previously studied in respiratory system disease (e.g., MPO, NAPSA, CHL1, FREM2, PLG), lower respiratory tract disease (e.g., NCAM1, MTOR, SERPINA1), viral infectious disease (e.g., ITIH4, CD209, CLEC4M, CD55), or specific pathologies such as coronavirus infection (e.g., ACE2, TMPRSS2), bronchiectasis (e.g., SAA1, SAA2, ELANE) or asthma (e.g., IGFALS, IGFBP7, HSPG2, DPP4, CD44, IL6R, MASP1). Conclusion(s): We have developed a protocol for the detection of proteomic biomarkers in urine. This proteome is enriched in proteins from the immune and respiratory systems, with a potential clinical and translational relevance.

Phenotyping dyspnea in patients suffering from postCOVID syndrome

Introduction: Post COVID dyspnea is considered one of the most troublesome symptoms, even after the acute phase of COVID-19 disease. Few data are currently available describing features post-COVD dyspnea. Aims and objectives: To phenoype dyspnea in patients with post-COVID syndrome. Method(s): We enrolled 309 patients who suffered from COVID-19 disease. All patients were screened with a complete blood workup, body plethysmography, arterial blood gas analysis and 6 minute walking test (6MWT). Moreover, 80 patients underwent chest Computed Tomography (CT) according to their clinical status. Result(s): Half of the enrolled patients (51.8%) reported residual dyspnea, both at rest and during their daily activities. Among them, 56.7% of patients had also dyspnea as the first symptom at COVID-19 onset (p=0.04). Patients referring dyspnea showed a lower PaO2 (p=0.02) and an increased pre-post test BORG scale difference (p<0.0001), without significant desaturations (>=3%) during the 6MWT. We also found a decreased 6 minute walking distance in these patients (p=0.004), as well as a reduction in diffusing capacity (DLCO, p=0.0005). After performing a multivariate logistic regression, only DLCO resulted to be statistically significant (OR=0.97, p=0.03). Moreover, among our patients who performed chest CT, 76.2% of them were found to have residual abnormalities such as ground glass opacities (50%), lung scars (26.2%) and parenchymal consolidations (12.5%). Conclusion(s): DLCO reduction is the most influencing factor for the development of post-COVID dyspnea. Moreover, PaO2, 6MWT parameters and chest CT alterations can also increase the breathing discomfort in these patients.

Impact of breathlessness on quality of life and healthcare use in Australia

Background and Aim: This study aimed to understand the impact of breathlessness on quality of life, productivity loss and healthcare use of Australian adults. Method(s): The National Breathlessness Survey was a nationwide cross-sectional web-based survey in Oct 2019, recruiting Australians aged >=18 years stratified by age-group, gender and state of residence. Severity of breathlessness using the modified Medical Research Council (mMRC) dyspnoea scale (0-5), quality of life (QoL) using EQ-VAS and EQ-5D-5L, and healthcare use (HCU) and productivity loss associated with having a "breathing problem" in the past 12 months were analysed. Quintile regression was conducted to analyse QoL and binary logistic regression for HCU and productivity loss outcomes. Effect sizes were adjusted for age, gender, Indigenous background, self-reported heart and lung disease, high PHQ-4 score, multimorbidity and smoking. Result(s): 10,072 adults completed the survey. The prevalence of clinically important breathlessness (mMRC>=2) was 9.54%. mMRC>=2 was associated with worse QoL, and greater healthcare use and productivity loss compared with mMRC=1 (Table). Despite COVID-19 impacts, similar prevalence (8.15%) and associations were seen in a repeat cross-sectional survey in December 2020 (n=10,024). Conclusion(s): Breathlessness carries a significant burden for patients, the healthcare system, and the economy.

Sleep disturbances in children with cystic fibrosis and primary ciliary dyskinesia at the beginning and in the first year of COVID-19 pandemic

Introduction: During the COVID-19 pandemic, the lifestyle and sleep habits of children with chronic lung disease have changed. Aims and objectives: To evaluate the differences in sleep habits in the first year of the pandemic in children with cystic fibrosis (CF) and primary ciliary dyskinesia (PCD). Method(s): Primary caregivers of children with CF and PCD aged 3-16 years who were evaluated for sleep habits at the beginning of the pandemic were re-evaluated at the end of the first year of the pandemic. The Sleep Disturbance Scale for Children (SDSC) was used and questions were asked about sleep habits and weight changes during the first year of the pandemic. Result(s): Primary caregivers of 31 children with CF and 14 children with PCD were included in the study. The median age of the children were 10.0 (7.5-12.0) years, 42.2% of the children were female. The mean BMI of children with CF was 15.8+/-1.8, and 20.0+/-3.5 in children with PCD (p:0.001). The mean daily screen time was 2h (1-3) at the beginning and 5h (4-6) in the first year of the pandemic among children with CF, 2h (1-2.2) at the beginning and 5h (4.7-6) in the first year of the pandemic among children with PCD (p<0.001, p:0.001, respectively). There were no differences in terms of disorders of initiating and maintaining sleep, sleep breathing disorders, disorders of arousal, sleep-wake transition disorders, disorders of excessive somnolence, sleep hyperhidrosis scores between two groups during first year of pandemic. Conclusion(s): While daily screen time increased in children with CF and PCD, sleep disturbances and changes in daily habits continued in the first year of the pandemic.

Clinical Spectrum, Geographical Variability of COVID-19, and its Implications

The coronavirus disease 2019 (COVID-19) pandemic has triggered a worldwide unprecedented public health crisis. Initially, COVID-19 was considered a disease of the respiratory system, as fever and at least one respiratory symptom was used to identify a suspected COVID-19 case. But there are now numerous reports of COVID-19 patients presenting with myriads of extra-pulmonary symptoms, however, a substantial number of patients are asymptomatic. Additionally, there are significant clinical and epidemiological variations of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection across different geographical locations. The updated re-search, thus, challenges the existing surveillance system that is mainly based on fever and respiratory symptoms. As countries are coming out of lockdown to save economic fallout, a revised surveillance strategy is required to effectively identify and isolate the infected patients. Besides, since developing countries are becoming the new epicenters of pandemic and there are limited resources for RT-PCR based tests, documenting the clinical spectrum can play a vital role in the syndromic clinical diagnosis of COVID-19. A plethora of atypical symptoms also aids in guiding better treatment and remains as a source for further research. It is, therefore, crucial to understand the com-mon and uncommon clinical manifestations of SARS-COV-2 infection and its variability across different geographic regions.Copyright © 2021 Bentham Science Publishers.

Scientific Connotation and Clinical Value of Traditional Chinese Medicine Lianhua Qingke Improving Ventilation Function Through "Reducing Phlegm".

[] Airway mucus is an important part of the defense barrier function of the airway. Abnormal secretion of airway mucus is closely related to recurrent attacks,delay or aggravation of respiratory infectious or infectious diseases such as chronic obstructive pulmonary disease(COPD),community-acquired pneumonia, and coronavirus disease 2019(COVID-19). Lianhua Qingke tablets,an innovative traditional Chinese medicine (TCM)developed under the guidance of the theory of collateral disease of TCM,has the function of reducing phlegm and relieving cough,which can reduce the generation and viscosity of sputum and promote sputum excretion. Clinical studies have shown that it can significantly improve the symptoms of expectoration and cough in patients with acute bronchitis or COVID-19,confirming its scientific connotation and clinical value of reducing phlegm and relieving cough to improve ventilation and exchanging function.Copyright © 2021, China Academy of Chinese Medical Sciences Institute of Chinese Materia Medica. All rights reserved.

Highly accurate multiclass classification of respiratory system diseases from chest radiography images using deep transfer learning technique

Chest X-ray radiographic (CXR) imaging aids in the early and accurate diagnosis of lung disease. The diagnosis process can be automated and accelerated by analyzing chest CXR images with artificial intelligence tools, particularly Convolutional Neural Network (CNN). Due to few medical images have been labeled, the most significant obstacle is utilizing these images accurately for diagnosing and tracking disease progression, and accordingly, the difficulty of automating the classification of these images into positive and negative cases. To address this issue, a deep CNN model was proposed to classify respiratory system diseases from X-ray images using a transfer learning technique based on the EfficientNetV2 model that acts as a backbone to enhance the efficacy and accuracy of Computer-Assisted Diagnosis (CAD) performance. Moreover, the latest data augmentation methods and fine-tuning for the last block in the convolutional base have also been carried out. In addition, Grad-CAM is used to highlight the important features and make the deep learning model more comprehensible. The proposed model is trained to work on the triple classification, COVID-19, normal, and pneumonia. It uses CXR images from three publicly accessible datasets. The following performance was achieved on the testing set: sensitivity = 98.66 %, specificity = 99.51 %, and accuracy = 99.4 %. Thereby, the proposal outperforms the four most recent classification techniques in the literature.Copyright © 2023 Elsevier Ltd

Application of machine learning approaches to predict the impact of ambient air pollution on outpatient visits for acute respiratory infections

With a remarkable increase in industrialization among fast-developing countries, air pollution is rising at an alarming rate and has become a public health concern. The study aims to examine the effect of air pollution on patient's hospital visits for respiratory diseases, particularly Acute Respiratory Infections (ARI). Outpatient hospital visits, air pollution and meteorological parameters were collected from March 2018 to October 2021. Eight machine learning algorithms (Random Forest model, K-Nearest Neighbors regression model, Linear regression model, LASSO regression model, Decision Tree Regressor, Support Vector Regression, X.G. Boost and Deep Neural Network with 5-layers) were applied for the analysis of daily air pollutants and outpatient visits for ARI. The evaluation was done by using 5-cross-fold confirmations. The data was randomly divided into test and training data sets at a scale of 1:2, respectively. Results show that among the studied eight machine learning models, the Random Forest model has given the best performance with R2 = 0.606, 0.608 without lag and 1-day lag respectively on ARI patients and R2 = 0.872, 0.871 without lag and 1-day lag respectively on total patients. All eight models did not perform well with the lag effect on the ARI patient dataset but performed better on the total patient dataset. Thus, the study did not find any significant association between ARI patients and ambient air pollution due to the intermittent availability of data during the COVID-19 period. This study gives insight into developing machine learning programs for risk prediction that can be used to predict analytics for several other diseases apart from ARI, such as heart disease and other respiratory diseases. © 2022 Elsevier B.V.

Post-Acute Sequelae of Sars-Cov-2 Infection in Solid Organ Transplant Recipients

Purpose: Post-acute sequelae of SARS-CoV-2 infection (PASC) is an increasingly recognized phenomenon manifested by long lasting cognitive, mental, and physical symptoms. We aimed to estimate the prevalence of PASC symptoms in solid organ transplant recipients (SOTRs) in the short (1- 6 months) and long-term (> 6 months) periods after SARS-CoV-2 infection. We also compared the prevalence of these symptoms between those with SARS-CoV-2 infection requiring hospitalization and those not requiring hospitalization. Method(s): We surveyed 111 SOTRs with self-reported SARS-CoV-2 infection diagnosed more than 4 weeks prior to survey administration. The survey consisted of 7 validated questionnaires ("Quick Dementia Rating System (QDRS)", "Patient Health Questionnaire (PHQ9)", "Generalized Anxiety Disorder 7 (GAD-7)", "Impact of Events Scale (IES-6)", "EuroQol- 5 Dimension (EQ-5D)", "PROMIS global physical health scale (GHS) "and "Breathlessness, Cough and Sputum Scale (BCSS)"). Result(s): Of the 111 survey participants, 32 (33%) had been hospitalized and 35 (36%) had SARS-CoV-2 infection >6 months ago. Median (IQR) age was 58 years (46, 65). Median time from SARS-CoV-2 diagnosis was 167 days (138, 221). Cognitive impairment, anxiety, depression, insomnia, feeling of trauma, fatigue, pain, breathing problems, cough, abnormal smell, abnormal taste, and diarrhea were reported by 40%, 23%, 36%, 55%, 53%, 41%, 19%, 33%, 33%, 21%, 22%, and 32% of patients respectively. Hospitalized patients had poorer scores in cognition (QDRS survey score of 2 versus 0.75, p=0.048) (Figure 1), quality of life (EQ-5D survey score of 2 versus 1, p=0.043), physical health (PROMIS GHS survey score of 10 versus 11, p=0.013), respiratory status (BCSS survey score of 1 versus 0, p=0.056), and pain (Pain score of 3 versus 0, p 0.006). Among patients who had SARS-CoV-2 infection >6 months ago, abnormal breathing, cough, abnormal smell, abnormal taste, and diarrhea continued to be reported by 31%, 31%, 29%, 32%, and 32% of patients respectively. Conclusion(s): After SARS-CoV-2 infection, SOTRs had a high prevalence of PASC symptoms. Some of the symptoms are more severe in patients who had required hospitalization and persist beyond 6 months. Further studies are needed to understand the long term sequalae of SARS-CoV-2 infection in SOTRs and to develop an evidence-based multidisciplinary approach for caring for these patients beyond the acute phase. (Table Presented).

Fabrication of single piece definitive obturator for post surgical maxillectomy defect during covid-19 pandemic-A Literature review with Clinical case report

Background: Impacts of primary oncology surgical procedure can impede restoration objectives. Restoring oral function, comfort and aesthetics is a challenge due to limitations in the restorative treatment options. Methodology: Literature review on the responsibilities, role of maxillofacial prosthodontist, materails and retentive aids used for prosthesis, classification of maxillofacial prostheses, recent advancements in MFP and Workflow for the fabrication of obturator prostheses in the COVID-19 pandemic scenario. Case report on the fabrication of Holllow bulb definitive obturator during pandemic crisis. A 47 years old male patient reported for post-surgical evaluation in maxillary posterior region of oral cavity. The patient had partial maxillectomysurgical procedure of squamous cell carcinoma in the palate 5 years back. To replace the gap created, the patient was using interim obturator. He had facial asymmetry and collapse. Prosthodontic rehabilitation with one piece closed hollow bulb obturator was planned & subsequently fabricated for the patient. For our case considering the feasibility & ease of manipulation, heat activated acrylic resin was used for this particular patient for rehabilitation. The method described is easy, simple, time saving & economical. Bulb portion was hollow & made of heat cure resin, so weight was less & less chances of tissue irritation. Results: With the Covid-19 infection protocol measures taken definitive obturator was given to the maxillectomy patient to restore aesthetics, function and comfort as well. After insertion of prostheses mastication, deglutition and phonetics were improved. Breathing problems were resolved and aesthetics was improved. Conclusion: A simplified technical approach for the treatment of a patient with palatal defect of and other supportive structure has been presented in Covid-19 situation following the described infection prevention protocols. The technique presented offers a method of obtaining a detailed impression of the defect and promptly provides the patient with a light weight, easyto-use and flexible tissue-tolerant obturator.

Changes in Positive Airway Pressure Use in Adults with Sleep-Related Breathing Disorder During the COVID-19 Pandemic: A Cross-Sectional National Community-Based Survey.

Purpose: To better understand: (i) a positive airway pressure (PAP) therapy use during the pandemic, (ii) how PAP use may relate to sleep, health, and COVID-19-related outcomes, and (iii) factors associated with PAP use during the pandemic. Methods: This study is based on data collected between Apr 2020 and Jan 2021 as part of an online cross-sectional national community-based survey. The included participants were located in North America, 18 years and older, with self-reported sleep-related breathing disorder (SBD) and usage of a PAP device in the last month before the COVID-19 pandemic. Results: Of all respondents, 7.2% (41/570) stopped using PAP during the pandemic over a median time since the pandemic declaration of 62.0 days (IQR = 8.0). There were no significant differences between individuals who continued and stopped using PAP in the time elapsed since the pandemic declaration, age, sex, education level, occupational status, family income, or the proportions of individuals endorsing symptoms that could be related to COVID-19. Compared to individuals who continued using PAP, those who stopped had significantly shorter sleep time, lower sleep efficiency, and poorer sleep quality. Higher stress levels and living with someone who experienced symptoms that could be attributable to COVID-19 were independently associated with stopping PAP use. Conclusions: In this survey study, most individuals with SBD continued PAP therapy during the pandemic. However, even 7% of participants who stopped using PAP cannot be ignored. Identifying individuals at risk of discontinuing PAP treatment may help design targeted interventions for people with SBD and health professionals to improve PAP use.

Yogic Breathing and Guided Meditation for Post-COVID Syndrome (PCS)

Methods: This is a six-week, waitlisted, Randomized Controlled Trial where participants are referred to study team by physicians at the BIDMC COVID clinic. Consenting participants are blindly randomized into either the intervention group or the waitlisted control. Intervention group participants learn the practices in the first week while waitlisted participants receive the intervention at the third week. Assessments evaluating changes in stress (Perceived Stress Scale), mood disturbance (Profile of Mood States), quality of life (SF-12), breathing discomfort (Multidimensional Dyspnea Profile) and physical symptoms (Somatic Symptoms Scale) were collected at 3 timepoints for both groups. Results: Currently, 57 participants are enrolled, of which 17 completed the study. Of the 17 completed participants, 88% routinely practiced Isha Kriya, 82% Simha Kriya & 94% Nadi Shuddhi. Average overall study satisfaction was reported as 7.6 on a scale on 1-10. Testimonials suggest that the intervention has been useful in managing symptoms. Data collection is ongoing. Background: Of those that are diagnosed with COVID-19, 10- 20% experience Post-COVID-19 Syndrome (PCS), where they continue to have symptoms such as fatigue, dyspnea, brain fog, stress, anxiety, and depression for months post-infection. Simha Kriya, Nadi Shuddhi, and Isha Kriya are yogic breathing and guided meditation practices that help maintain physical and mental wellbeing and reduce stress, anxiety, and fatigue.We hypothesized that these simple, safe, and scalable online practices may hold significant potential to improve the quality of life of PCS patients. Conclusion: To our knowledge, this is the first RCT to study the feasibility of a multicomponent, online delivered yogic practices for PCS. Results from this study will provide a better understanding of the impact of complementary treatments on PCS symptoms. The protocol for this study (2021P000552) was approved by BIDMC's IRB. This trial (NCT05139979) was registered with US NIH on clinicaltrails.gov. There were no conflicts of interest.

Chronic Indolent Community-acquired Pneumonia due to Pseudomonas Infection in an Immunocompetent Patient- A Case Report

Pseudomonas is an uncommon cause of community-acquired pneumonia in immunocompetent patients. It is an opportunistic pathogen resulting in serious infection in patients who are hospitalised, mechanically ventilated, or immunocompromised. A 47-year-old male, forest worker without any co-morbidities presented with a history of chronic cough, fever, and shortness of breath complicated with pseudohemoptysis for 45 days. This patient was admitted and treated as a lower respiratory tract infection. Work-up for tuberculosis, invasive fungal balls, was negative but sputum culture revealed Pseudomonas aeruginosa growth. This case report demonstrates a rare Pseudomonas infection which can also cause chronic indolent respiratory illness in immunocompetent.

Living with Pompe disease in the UK: Characterizing the patient journey and burden on physical, emotional and social quality of life

Pompe disease is a rare, progressive, multisystemic disease with heterogenous presentation. We evaluated the burden, unmet needs and evolving management landscape for people living with late-onset Pompe disease (LOPD) based on their own experiences. The objective was to better understand the experiences of people living with LOPD in the UK, including their diagnostic and treatment journeys;the potential impact of LOPD on their quality of life;and the impact of COVID-19 on their lives, HCP interactions and the care they received. Following an invitation from a patient advocacy organization and completion of an eligibility questionnaire, in-depth qualitative interviews were conducted with 27 participants living with LOPD (male, n = 13 [48%];mean age, 56 years;mean age at diagnosis, 43 years;received ≥1 misdiagnosis, n = 9 [33%]). Participants' diagnostic journeys typically included the following phases: undetected symptoms;noticeable symptoms;HCP visits and misdiagnosis;diagnosis. The diagnostic process was typically long and distressing, with most participants emphasizing a desire for reduced times to diagnosis, referral to a specialist HCP and treatment initiation. The most frequent LOPD-associated symptoms mentioned by participants were walking difficulties (n = 27, 100%), fatigue (n = 26, 96.3%) and balance issues (n = 22, 81.5%);participants stated the most important symptoms to treat were walking difficulties (n = 15, 55.6%), fatigue (n = 10, 37.0%) and breathing problems (n = 10, 37.0%). For most participants, the COVID-19 pandemic has been a period of increased anxiety, low mood and physical deterioration. The results of these interviews provide a very full understanding of the emotional journey experienced by individuals living with LOPD in the UK and enabled the construction of a unique infographic visually representing an archetypal patient journey. Findings from this study further characterize challenges faced by people living with LOPD (e.g., delays in diagnosis and/or treatment initiation, treatment satisfaction) and the impact of these challenges on daily life. Supported by Amicus Therapeutics.

POSA32 Early COVID-19 Pandemic in Germany: Patient Characteristics and Clinical Outcomes

Objectives: The presence of COVID-19 was first confirmed in Germany in January 2020 and ICD-10-GM codes for COVID-19 were introduced in February 2020. We used claims data from AOK PLUS, a large regional sickness fund covering around half the population in Saxony and Thuringia (6.2 million inhabitants), to describe the COVID-19 patient population during the beginning of the pandemic. Methods: Using data from 01/01/2020 to 30/06/2020, inpatient and outpatient cases of COVID-19 were identified using ICD-10-GM code U07.1. All inpatient cases with code U07.1 in any position were included. Two-sample t-tests and chi-square tests were used to compare patient populations. Results: A total of 15,596 COVID-19 patients (≈0.25% sickness fund population) were identified (93.4% outpatient, 6.6% inpatient;58.7% female, 41.3% male). The mean age was 44.9 (age <18: 7.2%, 18-44: 45.9%, 45-64: 31.4%, >65: 15.5%). There were 188 in-hospital deaths (18.2%), of which 65 (34.6%) received ICU treatment and 58 (30.9%) received intubation. Of the inpatient cases, there were 148 ICU cases (14.3%, 65 deaths) and 98 intubations (9.5%, 58 deaths). There was a larger proportion of females in outpatient (59.6%) vs. inpatient cases (52.8%, p<0.001). Inpatients were significantly older than outpatients (71.0 vs. 43.0, p<0.001) and in-hospital deaths were significantly older than non-fatal inpatient cases (81.3 vs. 68.7, p<0.001). Mean length of stay was significantly longer for patients in the ICU (25.4 days) vs. normal ward (12.3, p<0.001). Of the inpatient cases, the most frequent main diagnoses associated with COVID-19 were respiratory system diseases (codes J00-J99, 620 cases, 59.9%), of which the most prevalent diagnosis was “Other viral pneumonia” (code J12.8, 435 cases). Conclusions: While our data came from only two regions in Germany, claims data can be used to gain insight on the characteristics and evolution of the COVID-19 population, and to accurately estimate HCRU/costs and mortality.

Echocardiography and ECG monitoring not very beneficial in COVID-19 follow-up even in long haulers

Objective: To evaluate the need for cardiac evaluation of unselected patients recovered from COVID-19. Methods: Prospective observational cohort study, which included 105 patients recently recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The diagnosis was established by reverse transcription polymerase chain reaction on swab test of the upper respiratory tract. Demographic parameters, patient history, clinical evaluation, cardiac blood markers, ambulatory 7-day ECG monitoring and echocardiography have been performed to determine possible cardiac injury. Results: The study group (n=105) included 58% women, mean age was 46 years (range 18-77 years). Mean time interval between the onset of the infection and the follow-up visit was 107 days. One quarter of the patients required hospitalisation during the acute phase of the disease, the rest recovered at home. 74% suffered from mild form, 3.8% moderate, 18.3% severe and 2.9% of critical form of the disease. At the time of evaluation 63.5% of the patients were referring the ongoing symptoms, fulfilling the criteria of postcovid syndrome, while more than half of the whole group mentioned at least one symptom of possible cardiac origin (breathing problems, palpitations, exercise intolerance, fatigue). One patient was diagnosed with paroxysmal atrial fibrillation (woman, 73 years old, dilated left atrium), one patient with atrioventricular block with indication for implantation of the pacemaker (man, 71 years, cardiac MRI didn't found any signs of myocardial inflammation);in one subject (man, 69 years) was diagnosed coronary artery disease due to atherosclerosis with the necessity of revascularization by percutaneous coronary intervention;one woman was prescribed beta-blocker for inadequate sinus tachycardia and palpitations. All these findings are not suspected to be the result of SARS-CoV-2 infection. In three patients mild pericardial effusion was found with no intervention necessary. There was not found any left or right ventricle dysfunction on echocardiography. Only three findings on ECG monitoring mentioned above need a therapeutic intervention. Conclusion: Despite the significant proportion of the patients with ongoing symptoms beyond the 12 weeks after the onset of the infection SARS-CoV-2, confirmed cardiac impairment is quite rare and distributed mostly among older patients and those with other risk factors.