Single breath counting as a respiratory muscle function assessment test

Background: Spirometry may be used as a surrogate marker of respiratory muscle strength in patients with neuromuscular disorders. However, it is an aerosol-generating procedure, not readily conducted during remote consultation, and its use has been limited by infection control guidance during the COVID-19 pandemic. Single breath counting (SBC) has been reported to predict vital capacity (VC). We aimed to evaluate the utility of SBC in our clinic. Method(s): We conducted an evaluation to compare SBC and VC measurements in healthy volunteers and patients with respiratory muscle weakness. To perform SBC, individuals were asked to maximally inhale and then count every second in time with a metronome from 1 to the highest number they could manage in a single breath. SBC was repeated 3 times and the mean and maximum results were recorded. Individuals performed spirometry for slow VC in accordance with ERS guidelines. Results were compared using Spearman's rank correlation coefficient. Result(s): 31 healthy controls and 18 cases were included. The correlation between VC and SBC were rho=0.697 (p<0.001) and rho=0.694 (p<0.001) for mean and maximal efforts respectively (Figure). Conclusion(s): Primary findings highlight the potential usefulness of SBC for respiratory muscle function assessment. This promising technique is simple and feasible with current infection control guidelines and may be useful in remotely conducted appointments.

A rare but mortal condition: case series of three COVID-19 patients with spontaneous rectus sheath hematoma

Coronavirus disease 2019 (COVID-19) could emerge not only as viral pneumonia but also as a cardiovascular disease. Thromboprophylaxis has been recommended by the current guidelines, especially COVID-19 patients who are hospitalized. On the other hand, these drugs might cause serious bleeding complications. Hereby, we aimed to report three cases with spontaneous rectus sheath hematoma (RSH) developed after being administered thromboprophylaxis for severe COVID-19 pneumonia. In this case series, we draw attention to the rare, but mortal complication of the COVID-19 thromboprophylaxis regimen.

Clinical outcome of pcr-negative covid-19 patients: A retrospective study

OBJECTIVE: To evaluate the clinical features and outcomes of patients who were admitted with a diagnosis of coronavirus disease 2019 (COVID-19) but who were not confirmed with polymerase chain reaction (PCR) positivity. MATERIAL AND METHODS: This is a retrospective analysis of all patients admitted to two tertiary care centers between March 15 and May 15, 2020, with a diagnosis of COVID-19. From a common database prepared for COVID-19, we retrieved the relevant data and compared the clinical findings and outcomes of PCR-positive patients with those of PCR-negative cases who had been diagnosed on the basis of typical clinical and radiographic findings. RESULTS: A total of 349 patients were included in the analysis, of which 126 (36.1%) were PCR-negative. PCR-negative patients were younger (54.6 ± 20.8 vs. 60.8 ± 18.9 years, P = .009) but were similar to PCR-positive patients in terms of demographics, comorbidities, and presenting symptoms. They had higher lymphocyte counts (1519 ± 868 vs. 1331 ± 737/mm3, P = .02) and less frequently presented with bilateral radiographic findings (68.3% vs. 79.4%, P = .046) than PCR-positive patients. Besides, they had less severe disease and better clinical outcomes regarding admission to the intensive care unit (9.6% vs. 20.6%, P = .023), oxygen therapy (21.4% vs. 43.5%, P < .001), ventilatory support (3.2% vs. 11.2%, P = .03) and length of hospital stay (5.0 ± 5.0 vs. 9.7 ± 5.9 days, P < .001). CONCLUSION: This study confirms that about one-third of the COVID-19 patients are PCR-negative and diagnosed based on clinicaand radiographic findings. These patients have a more favorable clinical course, shorter hospital stays, and are less frequently admitteto the intensive care unit.

Pneumonia severity indices predict prognosis in coronavirus disease-2019.

BACKGROUND: Early recognition of the severe illness is critical in coronavirus disease-19 (COVID-19) to provide best care and optimize the use of limited resources. OBJECTIVES: We aimed to determine the predictive properties of common community-acquired pneumonia (CAP) severity scores and COVID-19 specific indices. METHODS: In this retrospective cohort, COVID-19 patients hospitalized in a teaching hospital between 18 March-20 May 2020 were included. Demographic, clinical, and laboratory characteristics related to severity and mortality were measured and CURB-65, PSI, A-DROP, CALL, and COVID-GRAM scores were calculated as defined previously in the literature. Progression to severe disease and in-hospital/overall mortality during the follow-up of the patients were determined from electronic records. Kaplan-Meier, log-rank test, and Cox proportional hazard regression model was used. The discrimination capability of pneumonia severity indices was evaluated by receiver-operating-characteristic (ROC) analysis. RESULTS: Two hundred ninety-eight patients were included in the study. Sixty-two patients (20.8%) presented with severe COVID-19 while thirty-one (10.4%) developed severe COVID-19 at any time from the admission. In-hospital mortality was 39 (13.1%) while the overall mortality was 44 (14.8%). The mortality in low-risk groups that were identified to manage outside the hospital was 0 in CALL Class A, 1.67% in PSI low risk, and 2.68% in CURB-65 low-risk. However, the AUCs for the mortality prediction in COVID-19 were 0.875, 0.873, 0.859, 0.855, and 0.828 for A-DROP, PSI, CURB-65, COVID-GRAM, and CALL scores respectively. The AUCs for the prediction of progression to severe disease was 0.739, 0.711, 0,697, 0.673, and 0.668 for CURB-65, CALL, PSI, COVID-GRAM, A-DROP respectively. The hazard ratios (HR) for the tested pneumonia severity indices demonstrated that A-DROP and CURB-65 scores had the strongest association with mortality, and PSI, and COVID-GRAM scores predicted mortality independent from age and comorbidity. CONCLUSION: Community-acquired pneumonia (CAP) scores can predict in COVID-19. The indices proposed specifically to COVID-19 work less than nonspecific scoring systems surprisingly. The CALL score may be used to decide outpatient management in COVID-19.

Democracy in flux: a systemic view on the impact of COVID-19

Purpose: The purpose of this paper is to demonstrate how a systemic view of democracy can provide insights into the myriad ways in which the COVID-19 pandemic affects democracies worldwide. This enables the authors to offer practical suggestions for strengthening democracy through meaningful participation in the spaces where deficits are most apparent. Design/methodology/approach: The authors use the systems approach that has emerged from the deliberative and participatory democracy literature in recent years to map out the impacts of COVID-19. In this paper, the authors set out this approach as an agenda for future, more comprehensive research. Findings: The authors’ preliminary overview suggests that democratic spaces are reconfigured during COVID-19, with participatory spaces shrinking, overlapping and invading each other. Based on the systemic overview, the authors suggest participatory interventions to address particular points of weakness such as accountability. Originality/value: Taking a systemic approach to analysing COVID-19’s impacts on democracy enables the authors to understand the pressure points where democratic values and participation are under strain and where citizens’ participation is essential not only for strengthening democracy but also addressing the public health challenge of COVID-19. © 2020, Emerald Publishing Limited.

Energetic and exergetic costs of COVID-19 infection on the body of a patient

Viral infections hijack metabolism of patients and start managing allocation of the cellular energy and exergy and the material reserve to the life processes to optimise their interests. Unlike most of the other viral infections, COVID-19 can cause severe pneumonia, pulmonary inflammation and fibrosis that decrease gas exchange between the alveoli and pulmonary capillaries. This results in diminished oxygenation of haemoglobin to transport oxygen between the lungs and the tissues. When the metabolic rate of the patient decreases by 33%, exergetic and energetic magnitude of the incurring damages would be 0.46 and 0.45 W/kg, respectively. In the case of 66% of decrease in the metabolic activity, the exergetic and energetic magnitude of the damage, based on the metabolic cost to an 18-year-old person, may be 0.92 and 0.90 W/kg, respectively. If a 70-year-old person should collect the same energetic and exergetic damages with that of an 18-year-old person, his/her metabolism must generate 17% more energy or exergy to compensate the incurred damage. If a person should have additional health problems, the energetic and exergetic cost of fixing the damage will probably increase. Copyright © 2020 Inderscience Enterprises Ltd.