Changes in surface activity of lung surfactant and bronchoalveolar cell profile upon COVID-19-related Acute Respiratory Distress Syndrome

A contribution of Lung Surfactant (LS) inactivation to COVID-19-related ARDS (cvARDS) has been argued, but not been clearly demonstrated to date. In the present study, we have characterised the extent of lung neutrophil infiltration along with the surface-active properties and protein composition of LS in bronchoalveolar lavages (BALs) collected from 12 cvARDS patients. A control group of 9 subjects without respiratory diseases was also enrolled. BAL cell sorting was performed by flow cytometry. The adsorption of LS at the air-liquid interface was assessed by Surfactant Adsorption Test (SAT), whereas the level of surfactant hydrophobic proteins was measured by Western Blot analysis. Results were normalised by phosphatidylcholine (PC) total amount. Significant increase in neutrophil [61.3(47.5-84.6)% vs 1.6(0.9-4.9)%, p<0.0001] and decrease in macrophage percentages [13.6(6.1-28.9)% vs 90.8(87.1-92-6)%, p<0.0001] of total BAL cells were detected in cvARDS patients. A lower overtime LS adsorption/accumulation at the air-liquid interface was also observed in those patients compared to the control group from 60min onward [14003(10232-19736) vs 24501(16386-28489) RFU, p=0.0471]. Moreover, cvARDS patients under the acute phase showed the lowest surfactant activity at the end of SAT (12191(11588-20159) RFU, p=0.048). An increase in both SP-B and SP-C/PC was also evident in cvARDS BALs. Here, we report for the first time on the reduction of LS surface-active properties during the acute period and even under the recovery phases of cvARDS. This may confirm how LS inactivation may be involved in both early and late consequences of severe cvARDS.

Stance Trees: A Novel Approach for Assessing Politically Polarized Issues in Twitter

Social and political polarization, which sometimes is the result of misinformation, is a common obstacle that can be harmful at the moment of communicating government policies. Intelligent tools that aid critical thinking in the light of different opinions and standpoints available in social media can help ameliorate this obstacle. This paper presents preliminary research work toward developing such tools by proposing a methodology for building stance trees based on tweets collected from social media. Stance trees are hierarchical structures where nodes represent arguments pro, anti, or uncertain about a target issue and edges stand for attack relations between those arguments. The proposed methodology includes retrieving tweets relevant to the target issue, manually labeling a sample set of the collected tweets, developing and applying a model for stance detection, and finally building a stance tree. We illustrate the expected results through a case study on the politically polarized "COVID-19 vaccine"issue. Our preliminary results demonstrate the feasibility of the proposal and highlight the utility of stance trees as a tool for aiding critical thinking. © 2022 ACM.

MDW IN COVID-19

BACKGROUND: Sepsis is a major cause of mortality in hospitalization, and better recognition could lead to improved prognosis in critically-ill patients. This study evaluated the use of monocyte distribution width (MDW) to diagnose and predict the prognosis of patients with sepsis in the setting of Covid-19 infections. METHODS: This is a retrospective, observational, single-center cohort study of adult patients with confirmed COVID-19 requiring hospital admission over a 14 month period. MDW was evaluated as a biomarker to predict disease severity, determination of sepsis, and prediction of inpatient mortality. Additionally, it was compared to existing inflammatory markers including ferritin, d-dimer, and procalcitonin. RESULTS: Average MDW was found to be significantly higher in the detection of sepsis (25.50 ± 5.93) vs. patients without (23.13 ± 4.46). An MDW value of 24.9 was shown to be the best cut-off value in determining fatal outcomes;ROC curve analysis revealed an AUC value of 0.69 (95%CI: 0.55- 0.71) with a sensitivity of 83% and specificity of 71%. A Chi-square test was performed, which detected a significant association between MDW values and clinical outcome of Covid-19 (OR =3.52, 95% CL 1.78-7.11, p <0.001). MDW did not correlate with any of the existing inflammatory markers. CONCLUSIONS: MDW is a novel and reliable biomarker in identifying sepsis in patients with Covid-19 infection. High MDW values are associated with a mortality rate or absolute risk of about 25%. MDW is easily obtained from routine laboratory evaluation in the emergency room and maybe a benefit to clinical practice.

SCHOOL AND FAMILY FACTORS ASSOCIATED WITH THE LEARNING AND PERFORMANCE OF EDUCATIONAL SCIENCES STUDENTS AT A PUBLIC UNIVERSITY OF HIDALGO DURING THE COVID-19 PANDEMIC

From a sociocultural and holistic view, it is analyzed how school and family factors influence the teaching-learning processes of Mexican university students during confinement due to pandemics. From a qualitative approach, a case study and focus groups were used. The results show that, in the school context, teachers have little preparation and show difficulties in managing electronic resources. Moreover, it was found that teacher's evaluation criteria do not take into account the social conditions related to the pandemics. Regarding the family factors, the economic conditions and the family and contextual environment of the students, such as the provision of a suitable place and environment, electronic resources and the quality of the internet, could be decisive during their education. Students in their reflections and discussions offer alternative solutions to problems that arise at school and at home as solution.

Automatic Identification of COVID-19 in Chest X-Ray Images Based on Deep Features and Machine Learning Models

In 2020, the novel coronavirus (COVID-19), spread around the world and became a pandemic. It is diagnosed by a Real-Time Reverse Transcriptase Polymerase Chain reaction (RT-PCR) test, which requires a specialized laboratory to confirm the presence of the virus. Due to the insufficient availability of these labs, medical images have been used as an alternative diagnosis, being the most easily available and least expensive option the Chest X-Ray. As COVID-19 infected patients display very similar respiratory affections like other kinds of pneumonia, distinguish them is difficult even for experienced radiologists. In this paper, two popular deep learning architectures are used to extract deep features, which are then used for training multi-class classification machine learning models to distinguish COVID-19 from healthy, bacterial, and other viral pneumonia infections. The evaluation was performed on a dataset of 7732 images, including 1575 healthy patients, 2801 diagnosed with bacterial pneumonia, 1493 with a viral (no COVID) infection, and 1863 subjects with COVID-19 confirmed diagnosis. The general area under the ROC curve was between 93 % ± 2 % for general categories;and 99 % ± 1 % with a sensitivity of 83 % ± 2 % to identify COVID-19 infected patients. © 2022, Springer Nature Switzerland AG.

Engagement, community and crowdfunding: journalistic product on demand in the environment of Covid-19

Digitalization has removed the key elements of the traditional media business model. In this context, this article analyzes the relationship between the presence and the value of engagement in journalistic projects and crowdfunding. The case study is Ballena Blanca magazine and its 'Special Greenwashing' campaign, which was developed during the home confinement period of the Covid-19 pandemic. The methodological basis is the case study and the quantitative and content analysis. Thanks to these instruments, the 371 publications -posts- of the campaign result in a total of 6,248 actions of the metrics considered for measuring engagement, which are distributed into 68.89% of likes;1.92% of comments and 29.19% of retweets;and a general engagement/publication ratio of 16.84. We can conclude that Ballena Blanca is a media that covers a very defined need in an increasingly polyhedral market with endogenous barriers to entry. Confinement, as an atmosphere, the networks, as engines, and the search for financing, as an end, have facilitated that a slow journalism initiative has seen the light, and it has shown that the correlation between private interests and the media makes the engagement to financing transferable. © 2021 Obercom. All rights reserved.

eP236: TeleKidSeq: Incorporating telehealth into clinical care of children from diverse backgrounds undergoing clinical genome sequencing

Introduction: The global pandemic required healthcare institutions and clinical research programs to adapt quickly to non-traditional care models. TeleKidSeq is a pilot study that emerged from the NYCKidSeq program, an NIH-funded Clinical Sequencing Evidence-Generating (CSER) Consortium site focused on incorporating genomic medicine into the care of diverse New York City children with suspected genetic disorders. Embracing the opportunity to study the use of telehealth in delivering genomic results, TeleKidSeq will examine the impact of innovative remote genetic counseling modalities in medically underserved populations. Studies focusing on the use of telehealth performed before the COVID-19 pandemic have shown that patients prefer in-person visits to virtual visits;however, with the increased familiarity and widespread use of virtual platforms, we anticipate an increase in the preference for telehealth visits. TeleKidSeq aims to fill the gaps in current knowledge on the impact of visual aids in telehealth in diverse urban patient populations. Methods: TeleKidSeq will recruit 496 pediatric participants (aged 0-21 years) with neurologic, immunologic, or cardiac conditions suspected to have an underlying genetic cause who receive care predominantly within two large health systems in the New York metropolitan area. The Mount Sinai Genomics Stakeholder Board, consisting of diverse stakeholders and key community advisors, provided guidance about our study design and materials. Participants will be English- or Spanish-speaking, and based on prior enrollment data from NYCKidSeq study, we expect more than 65% will be from populations underrepresented in medical research. Prior to enrollment, participants will be randomized to receive their genomic results from a genetic counselor via telehealth either with screen sharing (ScrS) or without screen sharing (NScrS). All participants will receive genome sequencing (GS) from a clinically validated laboratory. Additionally, we will use GUÍA, a web-based application designed to enhance the delivery of genomic test results, in both the ScrC and NScrS arms to facilitate delivery of individualized genomic results and clinical information in a personalized, highly visual, and narrative manner. Surveys administered at baseline, after results disclosure, and 6-months post-results disclosure will be used to evaluate study outcomes. The primary outcome of the TeleKidSeq study will be participants’ perceived understanding of their GS results with a comparison between the results disclosed via videoconferencing with ScrS and NScrS arms. Secondary outcomes will include: objective understanding of GS results;understanding of medical follow-up recommendations and the actionability of genome sequencing results;adherence to medical follow-up recommendations made based on genomic results;and satisfaction with and ease of use of the telehealth experience, compared across the two arms. Diagnostic yield, clinical utility and cost of GS will also be assessed. Results: Not applicable. Conclusion: Overall, the TeleKidSeq pilot study will contribute to innovations in communicating genomic test results to diverse populations through telehealth technology. In conjunction with NYCKidSeq, this work will inform best practices for the implementation of genomic medicine in diverse, English- and Spanish-speaking populations.

IMPLICATIONS OF FALSE POSITIVE SARS-COV-2 BY PCR TEST IN THE HEALTH CARE WORK FORCE

The novel nature of the SARS-CoV-2 virus inherently creates a paucity of reliable and validated data. Implementing evidence-based and data-driven protocols have been exceedingly difficult. As new information is released and integrated into the complex system, the health care delivery workflow must adapt. Incorporating changes on a frequent, if not daily basis, has led to confusion, frustration and loss of confidence among clinicians across the nation. This report illustrates the negative impact that false-positive COVID-19 results can have on the health delivery workforce and the emotional implications that false-positive results cast on health care providers. © 2021 by the American College of Osteopathic Family Physicians. All rights reserved.

Joint involvement secondary to recurrent COVID-19 infection

COVID-19 is a disease caused by the SARS-CoV-2 coronavirus. Its etiopathogenic mechanism is based on an immunological alteration that conditions a torrent of inflammatory cytokines that combines with local coagulation disorders to produce the clinical manifestations and complications of the disease. Immunological involvement causes involvement of different organs and organ systems where the osteomyoarticular system is found. The rare and previously unreported image is presented showing degenerative joint changes secondary to a recurrent COVID-19 infection. Clinically, it is accompanied by limitation of mobility, synovitis of the knees, functional disability and impairment of the quality of life related to health.

Online communities and dating apps: The effects of social presence, trust, and Covid-19

The Covid-19 pandemic changed the dynamics of socialization by restricting one of its main avenues: in-person gatherings. This pushed people towards digital technology to fulfill their socialization needs. In this paper, we take steps to explore whether features of online communities can contribute to innovative dating app designs, given how dating app business models currently focus on independent one-on-one interactions. We conducted an exploratory survey of 200 participants concerning dating app use habits, perceptions of dating apps, as well as degrees of trust, social presence, and perceived ease of finding dates using three dating methods. We found that social presence and trust consistently predicted the perceived ease of finding dates for each method, and that the perceived ease of finding dates influenced whether participants reported increased use of the method during Covid-19. Together with the growth in online community participation, these results suggest that dating app platforms might benefit from incorporating social features in their designs. © AMCIS 2021.

The relevance of urinalysis in the hospitalization of patients with COVID-19 and nephrology early intervention

Background: Multidisciplinary management of the COVID's patients is essential for their evolution, and the early detection ok AKI is a important role to avoid morbimortality. In March 2020, the pandemic by COVID-19 appeared in Mexico, and it led all the health system to change the intrahospital management. Methods: In a retrospective, observational analysis of all the patients >18 Y that were hospitalized at the Hospital Universitario de Monterrey, in the COVID area, from March to August 2020, we notice how the urinary sedimentation evaluation from the beginning could detect patients who could develop AKI or the need of RRT. All data were analyzed using SPSS statistical software (version 25;IBM Corporation, Armonk, New York). Results: A total of 344 patients hospitalized from March to August 2020. 220 patients with EGO since the beginning (obtained when our nephrology team take place on the presential participation on AEMA) 102 did not have proteinuria, and, on the other hand, the rest (61 or 37%) reported it. 95 patients (41.7%) had hematuria. Hematuria were more likely to be treated with KRT. Patients with hematuria demonstrated an increased tendency to require RRT: 38.2% of patients with hematuria versus 11.6% without hematuria, the greater chance that needs RRT (P<.001). Conclusions: The presence of active sedimentary urinary on COVID patients is frequent. The patients who present the combination of hematuria and proteinuria develop severe AKI (KDIGO 3 without RRT) or the need for RRT. Factors in patients such as to be on their upper edge of 40 years old, the presence of hyperkalemia, metabolic acidosis, also the hematuria and proteinuria, suggest the AKI risk that required RRT.

THE USE OF 5% IV ALBUMIN IN PATIENTS WITH SHOCK: DOES IT DECREASE VASOPRESSOR REQUIREMENT?

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Circulatory shock often requires large volume fluid resuscitation as a part of treatment. While crystalloid fluids are more commonly used, many patients in intensive care are unable to receive crystalloid fluids due to conditions such as congestive heart failure and end stage renal disease. Utilizing traditional fluids in such patients often complicates hospital courses. There are many studies regarding the benefits, effects and potential harms of using IV albumin for fluid resuscitation. The 2004 SAFE study suggested some benefit of using IV albumin in sepsis but equivocal to conventional management in morbidity and mortality. The 2014 ALBIOS Study of IV albumin use resulted in 90 day mortality benefit and decreased vasopressor need in severely septic patients. Despite these studies, the use of IV albumin in the critically ill remains controversial with consensus or guidelines being established regarding its use. METHODS: We conducted a retrospective study of 70 critically ill patients admitted to MICU from 7/2019 to 5/2020 to assess the effects of IV albumin. Patients diagnosed with shock who received 5% IV albumin were included. Patients who received 25% IV albumin were excluded. We analyzed cases by type of shock, conditions limiting crystalloid bolus, serum albumin level before IV albumin, MAP pre- and post- albumin infusion, pressor requirement (type/duration), development of ARDS, HD/CRRT requirement, COVID status and mortality. RESULTS: Septic shock patients received IV albumin most, followed by cardiogenic shock. Those unable to receive fluid boluses were due to primarily cardiac etiology, followed by renal & hepatic. Increased MAP was observed after IV albumin infusion in many cases. Serum albumin <2.7-2.8 on ICU admission was associated with frequent vasopressor use, higher vasopressor requirement and multi-agent use. Serum albumin >2.8 on ICU admission responded better to IV albumin and had lower vasopressor requirements.IV albumin was not related with renal dysfunction and those receiving IV Albumin did not need HD/CRRT. 69.6% did not develop ARDS, 5.8% developed ARDS, 24.6% tested positive for COVID and they were excluded from the ARDS incidence rate. Survival rate was 65.7%, mortality rate 24.3% and 10% went to hospice CONCLUSIONS: The use of 5% IV albumin for volume resuscitation in patients with different forms of shock in ICU showed favorable results, especially in those with serum albumin >2.7-2.8. Our retrospective study showed low incidence of adverse events such as cardiogenic pulmonary edema, ARDS or a need for HD/CRRT, lower vasopressor requirement, in both duration and agents used. Further research should be done in this regard to solidify these findings and to establish clear guidelines/protocols regarding the use of albumin as a resuscitative fluid in the ICU setting. CLINICAL IMPLICATIONS: When treating patients with shock and specially patients with hypoalbuminemia, 5% IV albumin can potentially be used as a means to decrease vasopressor requirements and duration without increasing the risk of pulmonary edema, ARDS and renal dysfunction. Further research should be done in this regard to solidify these findings and to establish clear guidelines/protocols regarding the use of albumin as a resuscitative fluid in the ICU setting. DISCLOSURES: No relevant relationships by Andrew Ajemian, source=Web Response No relevant relationships by Muhammad Umer Altaf, source=Web Response No relevant relationships by Christopher Bowman, source=Web Response No relevant relationships by Gabriel Diaz, source=Web Response No relevant relationships by Jessica Obeahon, source=Web Response No relevant relationships by Travis Yamanaka, source=Web Response

Guillain-Barre syndrome preceded by SARSCoV-2 Infection in setting of L2-L4 radiculopathy/plexopathy

Objective: Present a unique case of Guillain-Barre Syndrome after SARS-CoV-2 infection in the setting of multiple etiologies Background: There is currently a worldwide pandemic involving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), more commonly known as coronavirus disease 19 (COVID-19). Due to the novelty of this disease, there is still much unknown about it. It has been commonly shown to affect the respiratory system, but can also have neurological manifestations. Guillain-Barre Syndrome (GBS) is an acute immune-mediated polyneuropathy. It is often preceded by infection, and likely due to the immune-response cross-reacting with peripheral nerves. Design/Methods: NA Results: A 70 year-old-male presents with complaints of bilateral lower extremity (BLE) weakness and paresthesia. About two months prior, he was positive for COVID-19 requiring intubation. Neurological examination was significant for BLE weakness proximal>distal, areflexia throughout BLE. CSF analysis showed albuminocytologic dissociation. Patient had allergic reaction to IVIG. Plasmapheresis for 5 doses showed mild improvement. CT abdomen/pelvis showed bilateral iliac seromas and right hematoma. Electromyography (EMG) and nerve conduction studies (NCS) showed active denervation of bilateral muscles supplied by the L2-L4 suggesting a radiculopathy/plexopathy. Patient underwent drainage of right hematoma, but not left due to poor window. Patient was discharged to a rehabilitation facility and will follow-up outpatient. Conclusions: As COVID-19 is a novel disease, there is much to be learned about it. It has been shown to lead to GBS. Although a clinical picture of symmetrical symptoms, areflexia, and albuminocytologic dissociation on CSF can support the diagnosis, a multifactorial etiology can exist. Bilateral L2-L4 radiculopathy/plexopathy due to compression was contributing this patient's symptoms. The development of bilateral compressive hematoma/seromas may have been related to COVID-19, as it can affect the complement cascade and coagulation system. It is important to keep a wide differential if treatment of GBS does not provide expected relief.

Imagenological Evolution of Pulmonary Secuelae after SARS CoV2 Infection

INTRODUCTION: due to the fact that lung disease due to SARS COV 2 infection is of recent appearance and the lack of knowledge about its natural history, it is not clear the moment of adequate follow-up by diagnostic images, this being suggested after 3 months of the onset of the symptoms according to the evolution of the patient. We present the variation of image findings of a patient with severe COVID-19 pneumonia. DESCRIPTION:we present the case of a 56-year-old male patient who required initial hospitalization of 14 days because of symptoms secondary to multilobar severe pneumonia due to SARS-COV-2 infection with initial tomographic findings of classic pattern given by ground glass opacities of subpleural distribution predominantly in the lower lobes. The patient was discharged with low flow oxygen supplementation and attended the pulmonology consultation a month later reporting improvement in dyspnea with medical research council score grade 1 and complete withdrawal of oxygen support. A control chest computed tomography was taken 6 weeks since initial evaluation reporting subpleural bullae of recent appearance in the upper and lower right lobe with diameters of up to 80 mm. It was also described a small residual laminar pneumothorax adjacent to the lingula with pleural effusion with apparent septae. Given these findings, an intervention by thoracic surgery was requested who decided to schedule a surgical procedure and performed a new control image corresponding to 8 weeks from the initial one with findings of complete and spontaneous resolution of the pneumothorax as well as the pleural effusion although persistence of the bullas. It was decided there was not required further interventions and patient was discharged from follow-up.DISCUSSION: SARS-CoV2 infection manifests itself in different patterns of lung damage and can have long term pulmonary sequelae that are only identified with judicious and strict follow-up during the first months after infection. Nevertheless, the British Thoracic Society (BTS) has recommended the first image follow-up to be preformed after 3 months of the initial symptoms because of the high incidence of image alterations in that period of time and lesser probability of occult malignancy. This case described a rare presentation of lung damage with equally spontaneous resolution of the complications confirming the timeframe proposed by the BTS.