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This study aimed to investigate the usefulness of cerebral regional oxygen saturation (rSO2) during the initial 5 and 10 minutes of cardiopulmonary resuscitation (CPR) compared with an initial rSO2 and mean rSO2 during entire CPR to predict the futility of resuscitation for patients without of-hospital-cardiac arrest (OHCA). This was a prospective study involving 52 adult patients presenting in OHCA and whose cerebral rSO2 values were measured until either CPR was terminated or sustained return of spontaneous circulation (ROSC) was achieved. Receiver operating characteristics analyses were used to evaluate which time and type of measurement is better to predict non-ROSC. The area under the curve (AUC) of each rSO2 value according to measurement time (overall, initial 5 minutes and 10 minutes) were the highest value of 0.743, 0.724, and 0.739, mean values of 0.724, 0.677 and 0.701 and rSO2 (Changes in values of regional cerebral oxygen) value of 0.722, 0.734 and 0.724, respectively, while all of the initial values had a poor AUC (<0.7) and also were not statistically significant. The optimal cut-off value of each rSO2 values during overall, initial 5 minutes and 10 minutes were the highest value of 26% (sensitivity, 53.9% specificity, 92.3%), 24% (sensitivity, 56.4% specificity, 92.3%), and 30% (sensitivity, 61.5% specificity, 84.6%), mean value of 15.2%, 15.3% and 16%, respectively. None of the patients with a persistent rSO2 <=18% during the overall period achieved ROSC. Initial 5 minutes and 10 minutes cerebral rSO2 values an out-of-hospital-cardiac arrest (OHCA) are a better predictor in deciding the futility of CPR, compared to initial and overall measurements.Copyright © 2023 The Author(s). Published by MRE Press.
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Background. The superinfection of multidrug-resistant bacteria is an important complication in critically ill COVID-19 patients. An outbreak of carbapenemresistant Acinetobacter baumannii (CRAB) occurred in an isolation ward for COVID-19. We performed an outbreak investigation, and successfully controlled the outbreak with the enhanced environmental cleaning and additional gowning and gloving. Methods. This study analyzed all COVID-19 patients with CRAB in any specimen, who admitted to an isolation ward for COVID-19 of a tertiary hospital in South Korea from October to November 2021. Results. During the outbreak period, a total of 23 patients with COVID-19 and CRAB were identified (Figure 1). Index case was 85-year old female patient who was referred from a long-term care facility. The mean age of cases was 72.9 and 14 (60.9%) patients were male. In most patients (91.3%), CRAB were identified in sputum culture, two were identified in blood culture at initial, and four patients were identified in sputum and blood culture at the same time. Most of the patients were applying high flow nasal cannula (26.1%) or mechanical ventilation (60.9%)(Table1). As shown in figure2, CRAB outbreak occurred mainly in the wards around the index case, and in particular, environmental culture was carried out in the area marked with a rectangle. CRAB was cultured on the floor, air inlet, air outlet, and window frame of the ward except for wards 3305 and 3319. Phenotypic antimicrobial resistance patterns of CRAB isolates from patients and environment were identical, and additional whole genome sequencing analyses are ongoing to find the clonality of isolates. We applied the infection control measures with the enhanced environmental cleaning using sodium hypochlorite(NaClO) 1000ppm and phenolic compounds more than twice a day, enhanced hand hygiene, and additional gowning and gloving over personal protective equipment (PPE) mandatory for COVID-19 on 29th October. No additional CRAB cases occurred since 2nd November 2021 for two weeks. Conclusion. Even when PPEs and precautions for COVID-19 are applied to isolation wards for COVID-19, it is helpful for preventing transmission of multidrug-resistant bacteria to apply additional contact precautions and environmental cleaning.
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Background. Invasive aspergillosis (IA) is a great threat to the severely immunocompromised and patients with coronavirus disease (COVID-19). However, diagnosis of IA is often difficult due to need for invasive biopsy and low sensitivity of other diagnostic tests. Next-generation sequencing (NGS) of plasma cell free DNA (cfDNA) can be a novel non-invasive diagnostic modality. We evaluated the clinical accuracy and utility of microbial cfDNA NGS for the diagnosis of IA in patients with hematologic malignancy (HM) and COVID-19. Methods. A single-center prospective study of plasma microbial cfDNA NGS was conducted in a tertiary-care hospital in South Korea. We enrolled adult patients with HM and COVID-19, who suspected IA and performed conventional diagnostic tests for IA. The results of NGS were compared with the diagnosis of IA through conventional methods. IA cases were diagnosed according to EORTC/MSG definitions in patients with HM, and modified AspICU criteria in patients with COVID-19. (Figure 1). Figure 1. Flow chart for the participant selection method used in this study Results. Between March 2021 and January 2022, a total of 33 participants (22 [64.7%] male, median age 66.0 [50.5, 72.0]) were enrolled;19 participants with HM and 15 with COVID-19 were analyzed (Figure1 and Table1). In participants with HM, aspergillus cfDNA was detected in 100% of both proven (1/1) and probable (12/12) IA cases, and 33.3% of both possible (1/3) and no IA (1/3) cases. In participants with COVID-19, 46.2% of probable IA (6/13) showed positive aspergillus cfDNA. Detection rate of aspergillus cfDNA was significantly higher in proven/probable IA cases in participants with HM compared to participants with COVID-19. (100% vs 46.2%, p=0.005) (Figure 2). As shown in Table 2, among proven/probable IA cases, participants with positive aspergillus cfDNA showed significantly higher rate of having uncontrolled hematologic disease, receiving stem cell transplantation and recent chemotherapy. In three participants with HM, non-aspergillus strains confirmed by cfDNA NGS were in accordance with pathogens identified through conventional culture methods. Conclusion. Detection of aspergillus cfDNA showed high concordance in the results of conventional diagnostic methods in proven/probable IA of patients with HM and could be a helpful non-invasive approach to IA diagnosis in those populations.
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Background. COVID-19 increase the risk of invasive pulmonary aspergillosis. However, the risk factors and fungal origin of COVID-19 associated pulmonary aspergillosis (CAPA) is not fully defined yet. We aim to identify the risk factors for CAPA in severe COVID-19 and evaluate association between fungal contamination within the air of negative pressure rooms and diagnosis of CAPAs. Methods. We performed a retrospective case-control study to identify risk factors for CAPA with 420 severe COVID-19 patients from March 2020 to January 2022 who admitted to a tertiary care hospital in South Korea. CAPA was defined with modified AspICU criteria. Control, matched by admission date and severity of COVID-19 at admission, was selected for each case. Air sampling and fungal culture was done on Jan 2022 with a microbial air sampler (MAS-100NT) at 11 spaces in the COVID-19 designated isolation ward including 9 negative pressure isolation rooms (IRs). A cross-sectional comparison between rooms with and without airborne fungal contamination was performed. Results. A total of 420 COVID-19 patients were hospitalized during the study period, and 51 patients were diagnosed with CAPA (prevalence 12.14%, incidence 6.26 per 1000 patient.day). Multivariate analysis showed that older age (odds ratio [OR] 1.051, 95% confidence intervals [CI] 1.006-1.009, p=0.025), mechanical ventilator use (OR 2.692, 95% CI 1.049-6.911, p=0.04), and lymphopenia (OR 4.353, 95% CI 1.727-10.975, p=0.02) were independent risk factors for CAPA. (Table 1, 2) Aspergillus spp. was identified within the air from 7 out of 11 spaces including 6 IRs and 1 doctors' room. (Figure 1). All 6 IRs with positive aspergillus culture were being occupied by patients at least 8 days. Among 6 patients, 3 had already been diagnosed with CAPA whereas the other 3 were not diagnosed with CAPA through the observation period. Among 4 patients in isolation rooms without airborne aspergillus contamination, one patient had been diagnosed as CAPA before air sampling. (Table 3). Conclusion. Association between CAPA and airborne aspergillus contamination within the negative pressure room could not be demonstrated in this study. Rather than environmental factors, patient factors such as older age, ventilator care, and lymphopenia were found to be associated with CAPA diagnosis.
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Background. During the novel coronavirus SARS-CoV-2 pandemic, a considerable number of pneumothorax and pneumomediastinum associated with COVID-19 have been reported, and the incidence was higher in critically ill patients. Despite using a protective ventilation strategy, barotrauma still occurs in COVID-19 patients with invasive mechanical ventilation. This study aims to identify the risk factors and clinical characteristics of pneumothorax and pneumomediastinum in COVID-19 by a matched case-control study. Methods. This retrospective study enrolled adult patients diagnosed with a COVID-19, admitted to a critical care unit in South Korea from 2020 March 1st to 2022 January 31st. COVID-19 patients with pneumothorax and pneumomediastinum were compared, in a 1 to 2 ratio, to a control group of COVID-19 patients without pneumothorax and pneumomediastinum, matched on age, gender, and worst National Institute of Allergy and Infectious Diseases ordinal scale (NIAID-OS). Conditional logistic regression analysis was performed to assess the risk factors for pneumothorax and pneumomediastinum in COVID-19. Results. A total of 427 patients with COVID-19 were admitted during the study period. Of these patients, 24 patients were diagnosed as pneumothorax or pneumomediastinum. When comparing the characteristics of both groups, body mass index (BMI) was significantly lower in the case group (22.8 kg/m2 and 24.7 kg/m2;P = 0.048). BMI was statistically significant risk factor for barotrauma in univariate conditional logistic regression analysis (Odds ratio (OR), 0.85;Confidence interval (CI), 0.72-0.996;P = 0.044) but not in multivariate analysis. For the patients with invasive mechanical ventilation, the period from symptom onset to intubation was longer in the case-patients (13 and 9.5 days;P = 0.032). Univariate conditional logistic regression analysis showed the statistical significance of the period from symptom onset to intubation (OR, 1.14;CI, 1.006-1.293;P = 0.041). Conclusion. In this case-control study with age, gender, severity matching, lower BMI was associated with the pneumothorax in COVID-19, and delayed application of invasive mechanical ventilation might contribute to this complication.
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This study reports on patients with severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) presenting with sudden sensorineural hearing loss (SSNHL) during the coronavirus disease 2019 (COVID-19) pandemic. The study included four adult patients who presented with the complaint of unilateral SSNHL after testing positive for SARS-CoV-2 by RT-PCR from January to April 2022. Of the four patients, only one young adult recovered his hearing following a combination of oral and intratympanic steroid therapy. It is a challenge to confirm evidence of association between COVID-19 and SSNHL. Nevertheless, the early screening and diagnosis for SSNHL following COVID-19 enables prompt treatment with steroids, which offers the best chance of hearing recovery. Copyright © 2022 Korean Society of Otorhinolaryngology-Head and Neck Surgery.
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This study examines the core factors that determine consumer choices of distribution channels for fresh food during the COVID-19 pandemic, focusing on online distribution channels and the substitution patterns between online and offline distribution channels. Using 1436 responses to a survey conducted by Gallup Korea, a specialized survey agency in Korea, we adopted a multivariate probit model for the empirical analysis. The results show that consumers who pursued ease of use or had high awareness of online food delivery tended to choose online distribution channels for fresh food, unlike consumers who were sensitive to high quality or low prices. Consumers with high consumer spending, who are living in Seoul or a metropolitan area, have children of 10 years old or younger, and have a high educational level had positive relationships with the choice of an online distribution channel. Additionally, the estimates of the variance-covariance matrix showed a complementary relationship between large markets and small and medium-sized markets, with the possibility of a weak substitution effect between small and medium-sized markets and online distribution channels. © 2022 John Wiley & Sons Ltd
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Background: There is limited data on the safety and efficacy of SARS-CoV-2 mRNA vaccines in kidney transplant recipients (KTRs). Methods: We conducted a prospective, multi-center study of 58 adult KTRs receiving mRNA-BNT162b2 or mRNA-1273 vaccines to assess vaccine safety and efficacy. Primary outcome was biopsy-proven rejection within 3 months of vaccination. Secondary outcomes included adverse events, serum creatinine, proteinuria, donor-derived cell-free DNA (ddcfDNA) levels, and antibody and cellular immunity generation against SARSCoV-2. Results: Median age was 62 with 41% females. Median time post-transplantation was 48 months. Only one patient (2%) developed acute cellular rejection though patient had been recently converted to belatacept. There were no severe adverse events or deaths during follow-up. Two patients (3%) developed SARS-CoV-2 infection, one of whom required hospitalization. There was no significant change in serum creatinine, proteinuria or ddcfDNA during the study. Following vaccination, 36%, 25% and 20% of KTRs developed anti-spike, anti-S1 and anti-RBD antibodies. KTRs on mycophenolate-based and steroid-maintenance regimens were less likely to develop an anti-spike antibody response. 100% of KTRs with anti-spike and anti-RBD antibodies had a neutralizing response, compared to 44% in KTRs with anti-spike but without anti-RBD antibodies (RR 2.25, 95% CI 1.08-4.67). There was a significant increase in IFN-gamma spots per 106 PBMCs incubated with S1 peptides following vaccination (p=0.0143). Conclusions: SARS-CoV-2 vaccination in KTRs was safe and associated with the generation of cellular immune response and in a third of patients with anti-spike antibody response. The degree of protection gained by these responses needs to be evaluated in future studies.
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As SARS-CoV-2 spread throughout the world military units had to develop ways of combatting risk to ensure force health protection and deployability of their soldiers. Medical functions were impacted and solutions needed to be found in order to incorporate these items as functioning medical platforms. In the following article, we address one unit's individual response to the difficulties faced as a Military Police Brigade in Europe. Lessons learned from the initial wave of COVID-19 across medical operations, medical readiness, virtual health, and behavioral health initiatives can be utilized for better planning and response in the future.
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Background: Human kidney organoids have been utilized as a model to study genetic kidney diseases and kidney development. Innate or adaptive immune responses in organoids are currently poorly defined. Kidney transplant rejection and activation of complement pathways are two common renal immune phenomena. SARS-CoV-2 virus, the pathogen of the recent pandemic, leads to complement pathway activation in human kidneys and can infect kidney organoids. Here, we investigated (i) the alloimmunogenicity of kidney organoids in a humanized mice model, and (ii) the responses to exogenous complement C5a and spike protein (S1) of SARS-CoV-2 in kidney organoids. Methods: Kidney organoids were generated from human embryonic stem cells using protocols developed in our laboratory, and transplanted under the kidney capsule in humanized (BLT) mice. Immunophenotype, mixed lymphocyte reaction, and intracellular cytokine staining were analyzed from grafts and mouse splenocytes collected after 30 days of transplantation. In other experiments organoids were treated with S1 protein and human recombinant C5a for 24 hours or 3 days respectively, followed by qPCR and immunofluorescence analysis. Results: Transplanted organoids were extensively infiltrated by lymphocytes. Graft CD8+ T cells demonstrated a switch from naïve to memory T cells. Splenocytes isolated from transplanted BLT mice showed increased IFN-γ and TNF-α. Splenocytes proliferated after exposure to 2D kidney organoids (MLR) for 72 hours ex vivo, and organoids were markedly injured as reflected by DNA damage (γ-H2AX) and cleaved caspase 3. Reflecting innate responses, robust interstitial fibrosis was found in nontransplanted organoids after direct activation of C5aR by exogenous C5a. We confirmed ACE2 expression on proximal tubules and parietal epithelium of glomeruli, consistent with human autopsy results. Non-transplanted organoids treated with S1 protein showed transcriptionally upregulated C5a1 receptors. Conclusions: Our results indicate the alloimmunogenicity of kidney organoids and the deleterious effects of C5a in kidney organoids. Human kidney organoids represent a novel platform to study renal immunology including adaptive and innate immunity and the inflammatory responses to coronavirus disease (COVID-19).
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We evaluated the neutralizing activity in serum from three patients >1 year after recovery from Middle East respiratory syndrome (MERS) associated with mild pneumonia treated with antivirals during the MERS outbreak in South Korea at 2015. The neutralizing activity in serum was measured by pseudovirus inhibition assays. Three-fold diluted serum of subjects showed only 9.7%, 10.3%, and 2.2% reductions in relative light units. So, significant neutralizing activity was not demonstrated in any sera of three patients with mild pneumonia >1 year after being successfully treated with antiviral agents and recovering from MERS coronavirus infection. FAU - Choi, Jun Yong
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BACKGROUND: Identifying the extent of environmental contamination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential for infection control and prevention. The extent of environmental contamination has not been fully investigated in the context of severe coronavirus disease (COVID-19) patients. AIM: To investigate environmental SARS-CoV-2 contamination in the isolation rooms of severe COVID-19 patients requiring mechanical ventilation or high-flow oxygen therapy. METHODS: Environmental swab samples and air samples were collected from the isolation rooms of three COVID-19 patients with severe pneumonia. Patients 1 and 2 received mechanical ventilation with a closed suction system, while patient 3 received high-flow oxygen therapy and non-invasive ventilation. Real-time reverse transcription-polymerase chain reaction (rRT-PCR) was used to detect SARS-CoV-2; viral cultures were performed for samples not negative on rRT-PCR. FINDINGS: Of the 48 swab samples collected in the rooms of patients 1 and 2, only samples from the outside surfaces of the endotracheal tubes tested positive for SARS-CoV-2 by rRT-PCR. However, in patient 3's room, 13 of the 28 environmental samples (fomites, fixed structures, and ventilation exit on the ceiling) showed positive results. Air samples were negative for SARS-CoV-2. Viable viruses were identified on the surface of the endotracheal tube of patient 1 and seven sites in patient 3's room. CONCLUSION: Environmental contamination of SARS-CoV-2 may be a route of viral transmission. However, it might be minimized when patients receive mechanical ventilation with a closed suction system. These findings can provide evidence for guidelines for the safe use of personal protective equipment.