The Effect of Resilience on Entrepreneurial Intention in Higher Education Students in a Post-Covid Stage 19

The situation resulting from the COVID-19 pandemic has affected several areas: economic, social, relational, and, of course, education. This article aims to determine the impact on education, transposed to Resilience and entrepreneurial intention. A quantitative study was carried out, and 550 undergraduate university students were surveyed by random probability sampling, and the data were analyzed by factor analysis for the reduction of dimensions, and subsequently, linear and correlational regressions were applied. We found that there is a positive impact between Resilience and the entrepreneurial intention of university students, and it was also demonstrated that the greater the Resilience, the greater the perceived control of the entrepreneurial intention. Both attitude and subjective norm showed the highest positive relationships. The present work provides essential findings on the effect of Resilience on students and supports the importance of including entrepreneurship in education as a post-pandemic triggering factor. Furthermore, it opens future lines of research related to the inclusion of entrepreneurship in university students and the specific social impacts that may affect entrepreneurial intention. © 2022, North American Business Press. All rights reserved.

Blood Rna Biomarkers Distinguish Immune Responses to Covid-19 Viremia Versus Comorbid Infections

INTRODUCTION: While the COVID-19 syndrome is triggered by infection and expansion of the SARS-CoV2 RNA virus, secondary opportunistic infections can be a significant contributor to morbidity. In prior studies, our group employed RNA sequencing of whole blood RNA to identify RNA biomarkers of COVID-19 infection and severity. In the present studies, those biomarkers were expanded. METHOD(S): We performed a single-center prospective cohort study of SARS-COV2 infected ICU patients (n=20) during the peak of the Omicron wave (Jan-Feb 2022). Participants were consented for a venous blood draw into an RNA preservative. Samples were stored at -80degree C. Stored blood was used for RNA purification and droplet digital PCR quantitation of 6 novel RNA biomarkers for bacterial (DEFA1), biofilm (ALPL, IL8RB/CXCR2), and viral infections (IFI27, RSAD2). Viral titer in blood was analyzed in parallel by ddPCR for SARS-CoV2 sequences (BioRad, EUA). RESULT(S): Among clinical biomarkers, Pearson correlational analysis with SOFA scores identified lactate (r=0.24), BMI (r=0.34), creatinine (r=0.58), and LDH (r=0.68), as the best predictors. Viremic titer was not associated with SOFA scores (r=-0.07). Among the RNA biomarkers ALPL (r=0.48), a biofilm marker, showed the best correlation with SOFA score. The RNA biomarkers of viral infection IFI27 (r=0.72) and RSAD2 (r=0.42) were positively correlated with SARSCoV2 viral titer, suggesting that the host immune response is proportional to the viremia of COVID-19. CONCLUSION(S): Collectively, the results suggest that whole blood RNA transcripts involved in the host immune response can indicate the presence and severity of infection, including unexpected comorbidities. Furthermore, these biomarkers can distinguish between viremia, biofilms, and other types of infections that may undermine recovery from COVID-19.

Impact of visiting restrictions for the dying during the COVID-19 pandemic on healthcare professionals' quality of life around the world (the CO-LIVE study)

Aims: The COVID-19 pandemic forced a trade-off between the interests of all versus those of individuals. Therefore, many healthcare organisations applied visiting restrictions, also for dying patients.Our aim was to explore, in an international context, if visiting restrictions for dying patients had an impact on the quality of life of healthcare professionals. Method(s): From April 2020 to June 2021, an open online survey was conducted among healthcare professionals in 14 countries;Belgium, Czech Republic, Norway, Slovenia, the Netherlands, United Kingdom, Argentina, Brazil, Chile, Colombia, El Salvador, Uruguay, Indonesia and Japan. The survey consisted of validated and purposively designed measures of perceived quality of care (CODE) and staff QoL. Data were analysed descriptively and inferentially, with regression analysis conducted for all countries, and the results pooled and analysed in a multilevel analysis using Cochrane Review Manager. Result(s): Among 2925 respondents (mean age 42 years), 2385 (81.8%) were female, 1601 (54.9%) were nursing staff, and 1560 (53.3%) worked in hospitals. Approximately half of the patients reported on were men (n = 1470, 50.4%) and 1202 (41.4%) were COVID-19 positive. In all countries, the majority of respondents rated medical and nursing care for the patient as sufficient (n = 2468, 84.6%, and n = 2426, 83.2%, respectively). In 1559 cases (53.9%), visitors were allowed with limitations during the last 2 days of the patient's life, and in 468 cases (16.2%) no visits were allowed at all. Most respondents rated their QoL during the past week as 4 or higher out of 7. Mean QoL was lowest in Brazil (M 3.94, SD 1.34) and highest in Indonesia (M 5.80, SD 1.21). Regression analyses showed that no or limited visiting in the last days of life, was associated with lower QoL scores of healthcare professionals compared with those who reported that visiting was unrestricted (OR 0.63, 95%CI 0.48-0.83, p<0.001). Heterogeneity between countries was high. Conclusion(s): Our results suggest that visiting restrictions are associated with QoL of healthcare professionals. It may be that restrictions resulted in staff feeling unable to provide the desired level of care, and in turn affected their role perception and QoL.

Patients rehabilitation with musculoskeletal sequel from covid-19 using vision artificial in the city of Huancayo

Technology and its applications are here to improve our lives, it is used ever more these days with the pandemic Covid-19. This article is aimed to reduce the attendance to Hospitals and clinics where you would be treated with musculoskeletal muscular treatments in the city of Huancayo. With the help of modern technology it is offered an alternative software with artificial vision in order to monitor most patients in real time. The development of this investigation is set in 5 stages, the first stage talks about a posture recognition with artificial vision with framework mediapipe. The second stage explains the design interface and the mathematics formula which controls a patient development, the third stage describes the integration from the first and the second stage with a treat method. The fourth stage describes de development of a webpage using services to develop and monitor in real time. The last stage describes the process of the software validation having the last usuary with a chart of questions. Finally, the results of validations show the patient acceptation, as so 63.6% of patients who had no difficulties doing the software exercises. As Such a monitoring from the initial stage from the patien is hey factor before starting the therapy. © 2022 IEEE.

The percentage of CD39+ monocytes is higher in pregnant COVID-19+ patients than in nonpregnant COVID-19+ patients.

Current medical guidelines consider pregnant women with COVID-19 to be a high-risk group. Since physiological gestation downregulates the immunological response to maintain "maternal-fetal tolerance", SARS-CoV-2 infection may constitute a potentially threatening condition to both the mother and the fetus. To establish the immune profile in pregnant COVID-19+ patients, a cross-sectional study was conducted. Pregnant women with COVID-19 (P-COVID-19+; n = 15) were analyzed and compared with nonpregnant women with COVID-19 (NP-COVID-19+; n = 15) or those with physiological pregnancy (P-COVID-19-; n = 13). Serological cytokine and chemokine concentrations, leucocyte immunophenotypes, and mononuclear leucocyte responses to polyclonal stimuli were analyzed in all groups. Higher concentrations of serological TNF-α, IL-6, MIP1b and IL-4 were observed within the P-COVID-19+ group, while cytokines and chemokines secreted by peripheral leucocytes in response to LPS, IL-6 or PMA-ionomicin were similar among the groups. Immunophenotype analysis showed a lower percentage of HLA-DR+ monocytes in P-COVID-19+ than in P-COVID-19- and a higher percentage of CD39+ monocytes in P-COVID-19+ than in NP-COVID-19+. After whole blood polyclonal stimulation, similar percentages of T cells and TNF+ monocytes between groups were observed. Our results suggest that P-COVID-19+ elicits a strong inflammatory response similar to NP-COVID19+ but also displays an anti-inflammatory response that controls the ATP/adenosine balance and prevents hyperinflammatory damage in COVID-19.

SUSTAINABILITY FACTORS IN THE FACE OF COVID-19 IN THE STATE OF PUEBLA, MEXICO

The purpose of this document is to review the components of sustainability in the face of the spread of the SARS-CoV-2 virus in the State of Puebla, Mexico, which, currently, occupies the eighth place (out of 32) of incidence of the disease caused by said virus. Because, more than a year after the first case of this disease in this Federal Entity, it is determined to study the active cases, that is, those that have presented the disease in the last 14 days. To detect these components, a Poisson count regression is performed for the active cases for the three regions into which the Federative Entity is divided. Two dates are taken as a sample for this study, October 28, 2020 and January 28, 2021, that is, before and after the December holidays. Within the results, it is verified that not all the components are significant from one region to another. In the conclusions, it is determined that, on the one hand, the presence of health institutions has helped to reduce the presence of the socalled Covid-19 and, on the other hand, the need for a greater number of natural areas has been a natural inhibitor for this sickness.

For whom does the bell toll? oneyear follow-up on ed responder burnout during the COVID-19 pandemic

BACKGROUND: The COVID-19 (COVID) pandemic has caused incalculable damages throughout the U.S., with over 34-million infections and 600,000 deaths as of July 2021. Many medical personnel on the frontline, especially within emergency departments, experienced immense burnout. Although the extent of the burnout at the beginning of the pandemic has been reported in the literature, there is a paucity of data on how that has evolved over time. We aimed to survey providers a year into the pandemic on stress and burnout in the setting of new vaccine availability. METHODS: Two online surveys were distributed among healthcare providers at a tertiary academic center between 2020 and 2021. The initial survey was composed of questions evaluating the level of burnout and risk perception. The latter had the same questions for comparison, as well as questions regarding vaccination status and the Professional Quality of Life Scale (PROQOL). Chi-squared tests were used to compare the results. RESULTS: There were 63 responses in 2020 and 78 responses in 2021. 94% received the COVID vaccine in 2021. Measures of risk perception, specifically “Feels job is imposing great risk” and “Afraid of falling ill with COVID” saw statistically significant decreases (87% to 62%, p= 0.001;76% to 45%, p< 0.001, respectively). Meanwhile, while the point estimate for “feeling extra stress at work” and “thinking about resigning” also decreased, neither were statistically significant (85% to 76%, p=0.148;11% to 9%, p= 0.673, respectively). The PROQOL results from 2021 showed most responders experienced either moderate or high levels of Burnout and Post-traumatic stress, but also Compassion Satisfaction (85%, 62%, and 96%, respectively). CONCLUSIONS: During the 1-year study period there were significant improvements in terms of risk perception, though burnout and stress remained high. The reduction in risk perception may be related to vaccination, given the high rate of vaccination among this group and temporal correlation. However further research is necessary to support this relationship, as well as identify other potential factors to help reduce burnout in future pandemics.

Are ultrasounds as safe as chest radiographs at assessing complications of endotracheal intubations?

INTRODUCTION: Endotracheal tube (ETT) complications are common in intensive care unit (ICU) settings due to ETT malpositioning and migration. Point-of-care ultrasound (POCUS) has shown promise in predicting accurate ETT position but the safety profile compared to chest x-rays (CXR) remains unknown. We assessed whether a POCUS-guided repositioning protocol was non-inferior to CXRs for adverse clinical outcomes. METHODS: Intubated patients enrolled from 4 multidisciplinary ICUs over a 1-month period were randomized into two arms: CXR-guided or POCUS-guided daily monitoring of ETT position. In the POCUS-arm, novice sonographers assessed ETT positioning daily (normal range: superior balloon border between the 3rd-7th tracheal rings) and recommended repositioning maneuvers accordingly. The protocol allowed clinicians to use CXR landmarks if they did not agree with POCUS recommendations. The CXR-arm used radiographic landmarks (normal range: ETT tip 5±2cm from carina) without sonography. Exclusion criteria included COVID-19 status, C-spine precautions, prone positioning, anterior neck wounds, or planned extubation within 24 hours. Investigators used Fisher's exact test (α-error 5%) to compare rates of ETT bronchial or vocal cord migration, balloon rupture, unplanned extubation, repositioning maneuvers, and ventilator associated pneumonia (VAP). RESULTS: 22 patients met inclusion criteria with 11 patients in the POCUS-arm (35 ventilator-days) and 11 patients in the CXR-arm (36 ventilator-days). There was no significant difference in adverse events between the CXRand POCUS-arms (7.50% v 3.13%;p=0.41). There were 6 instances of patients crossing-over from the POCUS-arm to the CXR-arm but a secondary intention-to-treat analysis showed no impact on significance (7.50% v 3.13%;p=0.41). 3 VAP episodes occurred in the CXR-arm and 1 vocal cord herniation occurred in the POCUS-arm. Repositioning was more common in the CXR-arm than the POCUS-arm (23.5% v 0.00%;p=0.02). CONCLUSIONS: The use of POCUS compared to daily CXRs to monitor ETT positioning appears similar in terms of the adverse clinical outcomes. Further investigation is needed to assess if this non-inferiority remains with higher sample sizes.

Endotracheal tube surveillance: Can point-of-care ultrasound replace chest radiographs?

INTRODUCTION: There are many potential complications associated with endotracheal tube (ETTs) malpositioning in critical care settings, such as bronchial migration or vocal cord herniation. These events can prolong patient recovery and lengthen ICU stays. The goal of this study is to demonstrate that point of care ultrasound (POCUS) is noninferior to chest x-ray (CXR) in identifying proper ETT depth. METHODS: We conducted an observational cohort study of intubated patients across 4 multidisciplinary ICUs at an urban academic hospital who underwent daily POCUS assessment of ETT positioning by novice sonographers (medical students). ICU/ED physicians led 4 hour-long informal trainings to teach medical students POCUS technique. Subjects were excluded if they were COVID positive, in c-spine precautions, had recent neck surgery or planned to be extubated within 24 hours. Patient ETT position was measured using POCUS assessment (balloon cuff border ending between 3-7 tracheal rings) and compared to daily radiographic CXR landmarks (5 cm ± 2 cm above carina). Recommendations based on sonographic and radiographic landmarks were compared to assess sensitivity and specificity of POCUS to evaluate need for ETT repositioning. Statistical significance was assessed using the Clopper-Pearson binomial confidence interval. RESULTS: 20 patients were enrolled for a total of 62 ventilator-days. The cohort was majority female (55%), Black/African American (75%) and mean age 55 ± 18 years. In 58 instances (93.5%), both sonographic and radiographic landmarks agreed on maintenance of ETT position. In 1 instance (1.6%), sonographers recommended ETT repositioning while radiographic landmarks did not. In 3 instances (4.8%), ETTs appeared in place by sonographic but not radiographic landmarks. The data yields a specificity of 98.31% CI [90.91,99.96] for proper ETT placement with a negative likelihood ratio of 1.02 CI [.98, 1.05] and NPV of 95.08% CI [94.92,95.24]. CONCLUSION: The high specificity and NPV values suggest that if ETT position appears within normal limits on POCUS (tip of ETT between 3-7 tracheal rings), ETT position is likely adequately positioned even when performed by novices. Further studies should investigate the use of POCUS as a monitoring alternative and as a reliable tool post-intubation to confirm ETT depth.

Anti-spike antibody responses in hemodialyzed patients vaccinated with anti-COVID-19 BNT162B2 mRNA vaccine

Background: Patients under hemodialysis are at higher risk of developing severe complications upon SARS-CoV-2 infection and were prioritized in the Portuguese vaccination campaign. Methods: We performed a longitudinal analysis of antibody responses upon vaccination with BNT162b2 mRNA (Pfizer/BioNTech, Comirnaty) in a cohort of 156 hemodialyzed patients. Direct ELISA was used to quantify IgG, IgM and IgA anti-fulllength Spike antibody levels against calibrated sera from naturally infected patients at three points: day of the first vaccine dose (t0);3 weeks later (day of the second dose, t1), and 3 weeks after the second inoculation (t2) for 143/156 patients. Anti-n was also measured in t0 and patients anti-n positive were excluded. Results: We observed that 90.9% of the patients developed anti-spike IgG antibodies after the second vaccine dose (t2). Seroconversion was remarkably low at t1 after the first vaccine dose with only 29.4% of patients developing anti-spike IgG antibodies. In addition to positivity, the second vaccine dose markedly increased IgG antibody levels. IgA levels were also higher at t2 with 83.9% of the patients achieving positivity while IgM positivity only reached 29.4%. Age showed a significant negative effect on the humoral response at t2 for anti-Spike IgG and for IgM, particularly over 60 years. Further analysis revealed that nine patients under immunosuppression therapies showed significantly lower humoral response along the vaccine schedule (p=0.005 at t1;p=0.008 at t2). Interestingly, the inability to develop anti-HBs antibodies upon hepatitis B vaccination frequently found in hemodialyzed patients was not correlated with lack of responsiveness to SARS-CoV-2 vaccination. Conclusions: The large majority hemodialyzed patients showed a significant humoral response to BNT162b2 mRNA vaccination, but a sizable proportion of patients showed low antibody levels when compared to responses in the general population (medRxiv 2021.03.19.21253680).

End-of-life care, dying and bereavement during the COVID-19 pandemic from Latin American perspective

The COVID-19 pandemic is a serious threat to public health. Latin American structural conditions are a propitious place for the spread of COVID-19. Argentina, Brazil, Chile, Colombia, Mexico and Peru are the countries with the most deaths on the continent. We aimed to explore the characteristics of EoL care practices as provided during the pandemic in 7 Latin American countries (Argentina, Brasil, Chile, Colombia, El Salvador, Perú, Uruguay) and the experiences from relatives and healthcare providers. Methods: Observational study of a convenience sample of people who have recently experienced the death of either a relative or a patient died or not from COVID-19 using 2 rounds of questionnaire surveys, with additional deep-interviews. Social Determinants of Health, working conditions, and QoL were assesed. Primary outcome: a descriptive assessment of the characteristics of EoL care during the pandemic, from the experience of relatives and HCP. Preliminary Results:1430 questionnaires completed until now (726 relatives/ 704 HCP) In-depth interviews analysis in progress. Most of the relatives perceived their loved ones were treated with respect and dignity during the last days of life by doctors 85% and nurses 81 % most of time. HCP rated their QoL average 5 (1 Very poor, 7 Excellent). Conclusion: Provision of best person-centred care for dying patients requires understanding of cross-cultural experiences of dying and bereavement. We provided international and multidimensional perspectives of the impact of this unprecedented pandemic from 7 Latin American countries.

ACADEMIC APPROACH ABOUT E-LEARNING MODULES FROM THE TEACHER/STUDENT PERSPECTIVE AT THE NATIONAL UNIVERSITY MAYOR DE SAN MARCOS, LIMA-PERU

The article examines the teacher/student perspective about E-learning modules that could be applied to the courses of the Administration career at the Universidad Nacional Mayor de San Marcos based on 2 methodologies that project a better vision of teaching. To carry out these methodologies, it is necessary to review the results obtained in a survey to determine the factors that influence student learning through the proposed E-learning modules. As a result, 6 factors were obtained to validate whether these E-learning modules are suitable for Flipped Classroom and B-learning Methodologies. It is important to highlight that due to the Covid-19 pandemic, different teaching methods have been chosen virtually, and the evaluation carried out;it was determined that 40% of the students who are virtually taking their courses feel satisfied and eager to continue studying using different technological tools.

Variations in disease monitoring between patients with inflammatory bowel disease receiving intravenous and subcutaneous biological agents

Background and Aim: The availability of subcutaneous administration devices for biologics, in addition to intravenous administration, has influenced patients' and clinicians' preferences towards initiating or transitioning to subcutaneous administration, particularly during the coronavirus disease 2019 pandemic. Although subcutaneous administration improves patient convenience and reduces demands on infusion centers, we hypothesized that the reduction in health care contact associated with subcutaneous therapies may reduce the opportunities available for objective disease assessment in patients with inflammatory bowel disease (IBD). We aimed to compare the uptake of objective assessment of disease activity between patients receiving intravenous and subcutaneous biological therapy. Methods: Patients receiving maintenance infusion-based or subcutaneous biological therapy for IBD between September 2020 and February 2021 were identified from a prospectively maintained database at an Australian tertiary IBD center. Patients scheduled for review in the IBD clinic for a prescription of maintenance biological therapy during the follow-up period were included. Clinic records were reviewed to determine whether patients had undergone objective disease assessment, including biochemical investigation (C-reactive protein [CRP] and fecal calprotectin [FCP] testing) within the preceding 8 weeks, and/or endoscopic/imaging assessment within the preceding 6 months of clinic review. Frequency of objective disease assessment was compared between patients who received intravenous versus subcutaneous maintenance biological therapy. Results: A total of 307 patients were included: 195 receiving intravenous maintenance (infliximab, 135;vedolizumab, 60) and 112 receiving subcutaneous maintenance (adalimumab, 54;ustekinumab, 54;golimumab, 4). Patients who received intravenous biologics were more likely than the subcutaneous cohort to have had biochemical assessment in the form of CRP (90% vs 72%, P < 0.001) and FCP (54% vs 46%, P = 0.16) testing. Patients in the subcutaneous biologic cohort were more likely not to have had investigations completed before their clinical review (20% vs 4%, P < 0.001). There was no difference in the overall rates of complete objective disease assessment (CRP/FCP and endoscopy/imaging) between the intravenous and subcutaneous cohorts (28% vs 30%, P = 0.74). Conclusion: Patients receiving subcutaneous biological therapies in our cohort were less likely to have had objective disease monitoring than those receiving intravenous biologics before scheduled IBD clinic review. Route of biological administration may influence rates of uptake of objective disease activity assessment. Tools that safeguard against the disparity of monitoring uptake, including messaging prompts and patient-centric mobile applications, may help standardize the approach to objective disease assessment independent of the route of biological therapy administration.

1494P Anxiety and depression during the COVID-19 pandemic in newly diagnosed advanced cancer patients

Background: Cancer patients are at high risk of psychological problems and COVID-19 infection, which makes them even more vulnerable to mood disorders. Our objectives were to analyze the level of anxiety and depression among patients with advanced cancer during the COVID-19 pandemic and to analyze the association between sociodemographic, clinical, and psychological factors in patients with advanced cancer. Methods: A prospective, cross-sectional, multicenter study was conducted in 15 oncology departments in Spain. Patients with locally advanced unresectable or metastatic cancer who were candidates for systemic treatment were included. Patients completed demographic information and the Brief Symptom Inventory (BSI), Michel´s Uncertainty in Illness Scale (MUIS), Mental Adjustment to Cancer (MAC), and Cancer Worry Scale (CWS). Results: A total of 374 patients were recruited (April 2020-2021). The mean age was 64.2 years (34-88) and 48.7% were women. The most frequent were lung (30.7%) and colon (14.2%) cancers and most had metastases (78.6%). The most frequent therapy was chemotherapy (57.9%). The prevalence of anxiety and depression was 35% and 34%, respectively. Anxiety and depression levels were higher in women (p=0.001 and p=0.003, respectively). Patients <65 years (p=0.017) and with an oncologist-estimated survival of >18 months (p=0.033) had more anxiety symptoms. Logistic regression analysis revealed that women, patients with coping based on anxious preoccupation and hopelessness had higher risk of anxiety and depression (all, p<0.001). Conclusions: Patients with advanced cancer who start treatment during the COVID-19 pandemic experience high levels of depression and anxiety. Early diagnosis and the development of intervention strategies are needed especially in specific patient subgroups such as young women with long survival estimated times. Legal entity responsible for the study: The authors. Funding: This work was funded by FSEOM (Spanish Society of Medical Oncology Foundation). Disclosure: B. Obispo: Financial Interests, Personal, Invited Speaker: Lilly;Financial Interests, Personal, Invited Speaker: Sanofi;Financial Interests, Personal, Invited Speaker: Fresenius;Financial Interests, Personal, Invited Speaker: Rovi. R. Hernandez: Financial Interests, Personal, Advisory Role: Amgen;Financial Interests, Personal, Invited Speaker: Servier;Financial Interests, Personal, Invited Speaker: Lilly;Financial Interests, Personal, Invited Speaker: Roche;Financial Interests, Personal, Invited Speaker: Merck;Financial Interests, Personal, Invited Speaker: Ipsen. P. Cruz: Financial Interests, Personal, Invited Speaker: Bristol;Financial Interests, Personal, Advisory Board: Boehringer Ingelheim. A. Fernandez Montes: Financial Interests, Personal, Advisory Role: BMS;Financial Interests, Personal, Advisory Role: MSD;Financial Interests, Personal, Invited Speaker: MSD;Financial Interests, Personal, Invited Speaker: Servier;Financial Interests, Personal, Invited Speaker: Lilly;Financial Interests, Personal, Advisory Role: Lilly;Financial Interests, Personal, Advisory Role: AstraZeneca;Financial Interests, Personal, Invited Speaker: Pierre Fabre;Financial Interests, Personal, Invited Speaker: Merck. N. Piera Molons: Financial Interests, Personal, Invited Speaker: Grunenthal;Financial Interests, Personal, Invited Speaker: Kyowa Hakko Kirin;Financial Interests, Personal, Expert Testimony: Ordesa. V. Pacheco-Barcia: Financial Interests, Personal, Invited Speaker: Eisai;Financial Interests, Personal, Invited Speaker: Merck;Financial Interests, Personal, Invited Speaker: Bristol-Myers Squibb;Financial Interests, Personal, Invited Speaker: MSD;Financial Interests, Personal, Invited Speaker: Leo Pharma;Financial Interests, Personal, Invited Speaker: Kiowa Hakko Kyrin;Financial Interests, Personal, Invited Speaker: Grunenthal;Financial Interests, Personal, Invited Speaker: Prostakan;Financial Interests, Personal, Invited Speaker: Lilly. M.H. López de Ceballos: Financial Interests, Personal, Invited Speak r: Roche;Financial Interests, Personal, Invited Speaker: Eisai;Financial Interests, Personal, Invited Speaker: Novartis;Financial Interests, Personal, Invited Speaker: AstraZeneca. M. Antoñanzas Basa: Financial Interests, Personal, Other, Personal fees: AstraZeneca;Financial Interests, Personal, Other, Personal fees and no financial support: Novartis;Financial Interests, Personal, Other, Personal fees: Pierre Fabre;Financial Interests, Personal, Other, Personal fees and non-financial support: MSD;Financial Interests, Personal, Other, Personal fees and non-financial support: Sanofi;Financial Interests, Personal, Other, Personal fees: Pfizer. D. Lorente: Financial Interests, Personal, Invited Speaker, Advisory, travel fees: Janssen;Financial Interests, Personal, Invited Speaker, Advisory, travel fees: Sanofi;Financial Interests, Personal, Invited Speaker: Bayer;Financial Interests, Personal, Invited Speaker, Advisory, travel fees: Astellas;Financial Interests, Personal, Invited Speaker, Consultancy, travel fees: BMS;Financial Interests, Personal, Invited Speaker, Advisory: AstraZeneca;Financial Interests, Personal, Invited Speaker, Travel fees: Pfizer. A. Manzano Fernández: Financial Interests, Personal, Invited Speaker: Roche;Financial Interests, Personal, Invited Speaker: MSD;Financial Interests, Personal, Invited Speaker: Leo Pharma;Financial Interests, Personal, Invited Speaker: Sanofi;Financial Interests, Personal, Invited Speaker: AstraZeneca;Financial Interests, Personal, Invited Speaker: Rovi;Financial Interests, Personal, Invited Speaker: Pharmamar;Financial Interests, Personal, Advisory Board: Grunenthal;Financial Interests, Personal, Advisory Board: AstraZeneca. S. Hernando Polo: Financial Interests, Personal, Invited Speaker, Advisory role: Pfizer;Financial Interests, Personal, Advisory Board: GlaxoSmithKline;Financial Interests, Personal, Advisory Board: Clovis;Financial Interests, Personal, Advisory Board: Pharmamar;Financial Interests, Personal, Invited Speaker, Advisory role: AstraZeneca. M. Gonzalez Moya: Financial Interests, Personal, Invited Speaker: Bristol;Financial Interests, Personal, Invited Speaker: MSD;Financial Interests, Personal, Invited Speaker: Sanofi;Financial Interests, Personal, Invited Speaker: Boehringer Ingelheim;Financial Interests, Personal, Invited Speaker: Roche;Financial Interests, Personal, Invited Speaker: Merck. All other authors have declared no conflicts of interest.

Correlational analysis of eaa with other inflammatory markers in critically ill SARS-CoV-2 patients

INTRODUCTION: The Endotoxin Activity Assay (EAA) is a lab analysis to detect primed neutrophils in inflammatory states such as sepsis. Its use as a potential biomarker in SARS-CoV-2 patients has not been previously studied. Other markers such as CRP, ESR, LDH, ferritin, d-dimer, WBC count, procalcitonin, and IL-6 have all been shown to be reliable predictors of inflammatory states. We sought to find out the correlation between EAA and other inflammatory markers in patients admitted to the ICU with SARS-CoV-2 infection. METHODS: This is a prospective cohort analysis of SARSCoV- 2 patients admitted to the ICU at a single academic hospital from March to June 2020. Values for all study variables were obtained from each COVID-positive patient on days 1, 2, and 7 of ICU stay, and also for the onset of mechanical ventilation, vasopressors, acute kidney injury, and increase in ferritin >50% from the level at admission. Logistic and linear regression analyses were used to compare EAA with IL-6, CRP, ferritin, ESR, LDH, d-dimer, WBC, and procalcitonin. RESULTS: A total of 214 EAA results were recorded from 99 patients, with characteristics of: median age 61.84, 45% female, 74% Black, 21% Hispanic, 4% White, and 1% Asian. A significant linear regression equation was found between EAA and CRP: F (1, 168)=19.20, p<.0001, with an R2 of 0.1031 and Pearson's r of 0.32109, indicating a moderate correlation. Significant Spearman Correlation Coefficients were found between EAA and CRP, LDH, and D-dimer: ρ (169)=0.2896, p=0.0001;ρ (180)=0.179, p=0.01;ρ (165)=0.169, p=0.03, suggesting a mild correlation. Other markers did not show a significant correlation with EAA: IL-6 ρ (35)=0.144, p=0.40;Ferritin ρ (173)=0.0533 p=0.48;ESR ρ (37)=0.067, p=0.69;WBC ρ (213)=0.057, p=0.40;Procalcitonin ρ (14)=0.014, p=0.96. CONCLUSIONS: EAA has a statistically significant positive correlation with CRP, LDH, and D-dimer, but not with IL-6, ferritin, ESR, WBC, and procalcitonin. Further studies exploring the relationship between EAA and other biomarkers can establish the validity and reliability of EAA in inflammatory states such as COVID sepsis. This can help identify the role of EAA as an adjunct biomarker to assess the efficacy of therapeutic strategies and to prognosticate and predict mortality in patients with SARS-CoV-19.

Endotoxin levels, as measured by eaa, are elevated in COVID-19 patients admitted to the ICU

INTRODUCTION/HYPOTHESIS: Endotoxin Activity Assay (EAA), which measures the chemiluminescent response of the neutrophils to endotoxin using an anti-endotoxin antibody, has been used to predict mortality in patients with gramnegative sepsis. Recent evidence has shown that this indirect method of endotoxin measurement does not account for other causes that may excite or depress neutrophil activity. We sought to evaluate the levels of EAA in patients with severe COVID-19 infections without bacteremia but rather a systemic inflammatory state and acute respiratory distress syndrome. METHODS: This is a single-center, prospective cohort analysis of SARS-CoV-2-positive patients admitted to the ICU at a single academic hospital, from March to June 2020. EAA levels were obtained from each COVID-positive patient at ICU admission. Demographics, as well as the development of bacteremia on blood culture, were abstracted from medical records. Initial EAA values were categorized into low EAA (<0.4), intermediate EAA (0.41-0.60), high EAA (0.61-0.80), and severely high EAA (>0.80). RESULTS: A total of 78 patients were included in the study, with baseline characteristics as follows: mean age 62.9 years, 46% female, with a racial distribution of 72% Black, 15% White, and 4% Asian. Of the 78 COVID-positive patients, only eight were confirmed positive for bacteremia, while the remaining patients had two negative blood cultures. Of the eight bacteremic patients, the EAA level was low in zero patients, intermediate in three, high in four, and severely high in one patient, resulting in 100% of patients with intermediate or higher EAA level. Of the 70 patients without bacteremia, the EAA level was low in 13, intermediate in 10, high in 34, and severely high in 13, resulting in 81.4% of patients with an intermediate or higher EAA level. CONCLUSIONS: Elevated levels of EAA representing significant endotoxemia are frequently observed in nonbacteremic patients with severe SARS-CoV-2 viral infection. The source of the endotoxemia is unidentified. Possible explanations include gut bacterial translocation from the endothelial cell dysfunction that is known to occur with COVID 19 infection, or that EAA is an indicator of a primed neutrophil state. Further investigation of the elevated EAA levels seen in COVID -19 infections is warranted.

Does intubation of COVID-19 patients save lives? a descriptive analysis of a prospective registry

INTRODUCTION: As the COVID-19 pandemic continues, respiratory management strategies emerged as a primary concern. The mortality rate for patients with COVID19 who require intubation, and the predictors of mortality for this specific population are poorly characterized with only a few case series and retrospective studies. Published mortality rates of patients requiring intubation have ranged from as low as 35% to as high as 80%. Given the overall high mortality rate associate with intubation, growing literature calls for further efforts to characterize this critical population. METHODS: Analysis of a single urban academic center prospective database of intubated patients with COVID-19, including transferred patients. Descriptive statistics were used to characterize the intubated patients. Logistic regression was performed to account for age, gender, BMI, race, history of diabetes, COPD, and asthma. RESULTS: From March 2020 to July 2020, 369 COVID-19 patients were included in the registry 93 of whom were intubated. Of those intubated, mean age was 57.3 years, with an average BMI of 32.5. 63.7% of the intubated patients were males, with 62.6% Black, 24.2% Hispanic, and 13.2% Caucasian. We report an overall mortality of 80%, with a crude odds ratio of 28.5 (95% CI: 14.5 - 55.8) for death associated with intubation. Logistic modeling revealed that age and gender are significantly associated with mortality, with mortality odds increasing approximately 9% for each year of age, and 2.8 times higher for males. BMI, race, and history of diabetes, COPD, and asthma did not meet statistical significance for association with mortality, nor were there any significant interaction effects. Holding age and gender constant, the odds ratio for death associated with intubation increases to 105.3 (95% CI: 38.5-287.8). CONCLUSIONS: We report a high mortality rate of intubated patients, which may be multifactorial from being a referral center accepts critically ill patients, including evaluation for ECMO. Furthermore, our institution was an early adopter of noninvasive ventilation methods in an attempt to avoid intubation whenever possible. Ultimately, further studies are needed to better characterize those COVID-19 patients that require intubation and what variables are more closely associated with morbidity and mortality.

Potential biomarkers for severe ards in the setting of SARS-CoV-2 ICU admission

INTRODUCTION: Acute respiratory disease syndrome (ARDS) is due to compromised lung oxygen exchange in the setting of severe alveolar inflammation. This can be assessed and diagnosed using the ratio of alveolar oxygen saturation (PaO2) to the fraction of inspired oxygen (FiO2), P-F ratio. In hospitalized COVID-19 patients, the role of trending inflammatory markers to categorize levels of ARDS severity in the clinical setting has yet to be established. In this study, we describe the correlational relationship of five biomarkers to the PaO2/FiO2 ratio (P-F ratio), a key diagnostic criterion, and a measure of severity in ARDS. METHODS: This is a prospective cohort analysis of SARs-CoV-2 patients admitted to the ICU at a single urban academic center from March to June 2020. Levels of Endotoxin activity assay (EAA), CRP, ferritin, LDH, and d-dimer were obtained from intubated patients throughout their ICU stay. PaO2 and FiO2 values matching the same days as the biomarkers and demographic information were abstracted from the medical record. The inflammatory markers were matched to the P-F ratios of the same day, and Spearman Correlation Coefficients were performed to detect the relationship between them. RESULTS: A total of 45 intubated COVID patients were included, with baseline characteristics of: median age 55 years and 33% female, 62% Black, 27% Hispanic, 9% Asian, and 2% White. Spearman Correlation Coefficient (ρ) showed statistically significant relationships between P/F ratios and EAA, IL-6, CRP, and ESR, with respective values of: ρ (89)=-0.2366, p=0.02;ρ (13)=-0.7143, p=0.006;ρ (77)=-0.3670, p=0.001;ρ (17)=-0.5569, p=0.02. ρ was also calculated between P/F ratios and Ferritin, D-dimer, WBC, and LDH with respective values of: ρ (77)=0.0819, p=0.47;ρ (78)=-0.2105, p=0.06;ρ (88)=-0.1046, p=0.33;ρ (73)=0.0420, p=0.72, showing no statistically significant relationship between these variables. CONCLUSIONS: EAA, IL-6, CRP, and ESR levels had a statistically significant negative correlation with the P-F ratio. Elevations in these biomarkers correlated with worsening P-F ratios, suggesting that they could serve as useful biomarkers to predict ARDS severity. Additional studies are needed to further understand the trend of these biomarkers and validate their clinical use in prognostication in ARDS.