Prolonged unconsciousness in severe COVID-19 infection with veno-venous ECMO support

Objectives: Patients with severe COVID-19 infections have been shown to have prolonged periods of coma followed by meaningful neurological recovery. Therefore, neurological prognostication is challenging, particularly in those who require veno-venous extracorporeal membrane oxygenation (VV-ECMO) support. We hoped to evaluate which variables can be considered when trying to predict neurological recovery. Method(s): We conducted a case-control retrospective chart review of patients on VV-ECMO from March 2020 to January 2022. This time-frame was selected to limit the effect of post-pandemic changes in sedation practices. Our outcome was duration of unconsciousness, defined as days with GCS motor score <6. We first conducted a matched cohort analysis, comparing COVID and non-COVID patients. We then performed a Classification and Regression Tree (CART) analysis to determine the Relative Variable Importance (RVI) of clinical variables associated with duration of unconsciousness. Result(s): Our matched analysis included 52 patients, 27 (52%) of whom had COVID-19. There were no significant differences in the baseline characteristics of the groups (Table 1). Patients with COVID-19 had a significantly longer median duration on ECMO (p<0.001) and hospital length of stay (p=0.003). The median duration of unconsciousness was similar between COVID-19 and non-COVID patients (p=0.58). The CART analysis results (Figure 1) showed that the most important variables to predict duration of unconsciousness were successive variations in GCS (RVI 100%) and GCS standard deviation (RVI 99%). COVID positivity only had a weak predictability (RVI 4%). Conclusion(s): Our analysis has shown that in patients on VV-ECMO, those with COVID-19 spent a longer time on ECMO and in the hospital. While there was no significant difference in the duration of unconsciousness, we found that patients who had high fluctuations of GCS during ECMO had a shorter duration of coma. (Figure Presented).

Prolonged Unconsciousness in Severe Covid-19 Pneumonia with Venovenous Ecmo Support

INTRODUCTION: Neurological prognostication is an important part of caring for critically ill patients and can help guide goals of care. This has become a challenge when caring for patients with severe COVID-19 pneumonia, as they have been shown to often have prolonged periods of coma followed by meaningful neurological recovery. However, this has not been studied in patients who require venovenous extracorporeal membrane oxygenation (VV-ECMO) support. We hypothesize that patients with COVID-19 pneumonia on VV-ECMO will have a more prolonged period of unconsciousness when compared to their COVID-negative counterparts. METHOD(S): We conducted a retrospective chart review of all patients who received VV-ECMO support at our institution from March 2020 to January 2022. This timeframe was selected to limit the effect of any changes in sedation practices that were brought about by the COVID-19 pandemic. We compared the daily Glascow Coma Scale (GCS) of patients with COVID-19 pneumonia to those who were cannulated for other etiologies. Our outcomes were duration of unconsciousness, which was defined as time from intubation to GCS motor score=6 for 48 hours, as well as changes in GCS over time. RESULT(S): Our preliminary analysis included 84 patients, 57 (68%) of whom were COVID-19 positive. There were no significant differences in the baseline characteristics of the groups, including initial Sequential Organ Failure Assessment score and need for renal replacement therapy. Patients with COVID-19 pneumonia had a significantly longer duration on ECMO in hours (952 vs 312, p< 0.001) and hospital length of stay in days (42 vs 30, p=0.01). There was no significant difference in the duration of unconsciousness (days) between the two groups (11 vs 9, p=0.21). However, the trend in GCS over time was notable as we found that patients with COVID-19 spent more days unresponsive, defined as a GCS=3 (8 vs 5, p=0.04). CONCLUSION(S): Our preliminary analysis found that in patients on VV-ECMO, those with COVID-19 pneumonia spent a longer time on ECMO and in the hospital. While there was no difference in the duration of unconsciousness, patients with COVID-19 spent more of that period unresponsive prior to recovery. While additional analysis is needed, this finding may assist providers when prognosticating neurological recovery.

Addressing intimate-partner violence during COVID-19 in the EU: challenges, responses and areas of improvement

Natural disasters and pandemics bring new risks and dangers to women and their children. In particular, various factors stemming from the COVID-19 pandemic, such as economic instability, additional stress and increased control over victims led to an increase in both prevalence and severity of intimate partner violence. Based on the findings of a study conducted by the European Institute for Gender Equality (EIGE), this article examines the main challenges during the first months of the COVID-19 crisis (March–September 2020) and analyses institutional responses to facilitate access to support services for victims. Relying on a combination of qualitative and quantitative methods, the study highlights the role of European Union (EU) Member States in improving long-term responses to gender-based violence in times of crises. The study also gives particular attention to emerging promising practices and holistic approaches towards the gender-based violence crisis stemming from the pandemic, describing selected examples of initiatives adopted across the EU and identifying main areas of improvement. © Centre for Gender and Violence Research.

Incidence of [18F]FDG PET/CT lung findings suspected for COVID-19 in asymptomatic oncological patients after the first pandemic peak in Italy

Background-Aim: The SARS-CoV-2 infection was declared a global pandemic in March 2020 and initially had a wide diffusion in Northern Italy, especially in area of Bergamo. From December 2019 to May 2020 (peak of pandemic period), an increase of interstitial pneumonia cases was observed at [18F]FDG PET/CT in oncological patients in Bergamo area. Further, a significant increase of PETpositive interstitial lung alterations was found with higher incidence compared to the pre-pandemic period. These observations suggested the use of [18F]FDG PET/CT as a sentinel method to identify suspected cases of COVID-19 in asymptomatic oncological patients. This observational prospective multicentric study aimed at confirming the usefulness of [18F]FDG PET/CT in the occasional diagnosis of COVID-19. Methods: [18F]FDG PET/CT performed in oncological patients from May 2020 to January 2021 (post pandemic peak period) in 8 Nuclear Medicine Departments in Lombardy (Humanitas Gavazzeni Bergamo, IRCCS Humanitas Rozzano, IRCCS San Raffaele Milano, Ospedale San Gerardo Monza, IRCCS Ca'Granda Ospedale Maggiore Milano, IRCCS Istituto Nazionale Tumori, Milano) and Tuscany (Azienda USL Nord Ovest Livorno, Azienda Ospedaliera Universitaria Pisana, Pisa) were assessed. The PCR test was proposed to all patients with lung alterations suspected for COVID-19 to confirm the diagnosis of SARS-CoV-2 infection. Results: Overall 19814 patients were studied with [18F]FDG PET/CT for various oncological diseases in the Nuclear Medicine Departments of the Centers involved in the study. We identified 54 out of 19,814 (0.27%) [18F]FDG PET/CT with lung alterations suspected for COVID-19 interstitial pneumonia. 45/54 suspected patients underwent rhinopharyngeal swab for confirmation. 9 patients with lung imaging alterations did not undergo PCR confirmation. PCR test detected 11 positive cases (24% of patients who underwent PCR test). The incidence of PCR confirmed COVID-19 was 11 out of 19,814 (0.06%). Conclusions: Among oncological asymptomatic patients who underwent PET/CT, we identified by PCR test very few cases of COVID-19 pneumonia. This could result from two main reasons: firstly, the low incidence of COVID-19 in the examined period, as confirmed by the epidemiological curve, and, secondly, the effectiveness of environmental and personal hygiene, social distancing, the use of personal protective equipment. However, although PET/CT imaging is not a reference test for the diagnosis of COVID-19 pneumonia, this study demonstrated that [18F]FDG PET/CT can identify lung manifestations of COVID-19.

Systems Theory and Algorithmic Futures: Interview with Elena Esposito

By introducing us into core concepts of Niklas Luhmann's theory of social systems, Elena Esposito shows their relevance for contemporary social sciences and the study of unsettled times. Contending that society is made not by people but by what connects them - as Luhmann does with his concept of communication - creates a fertile ground for addressing societal challenges as diverse as the Corona pandemic or the algorithmic revolution. Esposito more broadly sees in systems theory a relevant contribution to critical theory and a genuine alternative to its Frankfurt School version, while extending its reach to further conceptual refinement and new empirical issues. Fueling such refinement is her analysis of time and the complex intertwinement between past, present and future - a core issue that runs throughout her work. Her current study on the future as a prediction caught between science and divination offers a fascinating empirical case for it, drawing a thought-provoking parallel between the way algorithmic predictions are constructed today and how divinatory predictions were constructed in ancient times.

Social inequalities and nutritional disparities: the link between obesity and COVID-19.

OBJECTIVE: Cohort studies, clinical audits of patients with COVID-19 in hospital and routine primary care records provided evidence-based insights on the relationship between excess weigh, obesity and COVID-19. The purpose of this umbrella review is to highlight the relationship between nutritional quality and social inequalities related to CDNCD, obesity and SARS-CoV-2 infection. MATERIALS AND METHODS: Only articles published from 2008 to the present were included in the search to show an updated picture of the topic. The search for published studies was conducted in February 2021 in the scientific databases PubMed (MEDLINE). The terms used for the search were "COVID-19", "Obesity", "Disparities", "Nutritional inequalities", "Chronic degenerative non-communicable diseases" and "review" OR "systematic review" OR "meta-analysis" separated by the Boolean operator AND. RESULTS: 1874 reviews were found, but only 99 met the objective. Obese or dysmetabolic patients are those who had a worse course of disease following COVID-19. This data was observed not only for Chinese and Caucasians, but also and above all among Africans, African Americans, Latinos and indigenous people. Plausible mechanisms to explain the association between obesity and COVID-19 outcomes, included the role of excess adipose tissue on respiratory function, metabolic dysfunction, the cardiovascular system, enhanced inflammatory response and impaired response to infection. CONCLUSIONS: Today, chronic non-communicable degenerative diseases (CDNCDs) are responsible for 70% of public health expenditure, affecting 30% of the population (one or more chronic diseases). Unfortunately, given the health emergency due to SARS-CoV-2, infectious diseases are currently more at the center of attention. However, the spread of infectious communicable diseases and CDNCDs is facilitated in situations of social disparity. In fact, in the poorest countries there are the highest rates of malnutrition and there is a greater risk of contracting viral infections, as well as, paradoxically, a risk of comorbidity, due to access to cheaper food and qualitatively poor, with high caloric density.

A potential risk assessment tool to monitor pathogens circulation in coastal waters.

The present study reports data on a 20 months campaign monitoring enteric viruses (hepatitis A, norovirus, rotavirus, astrovirus, sapovirus, and aichivirus) and bacteria (Salmonella spp.) in seawater. The aim of this work was to assess the potential correlation among the presence of viruses/bacteria and different environmental factors like seasonality, water discharge sources (treated and untreated wastewater, mixed waters and raw water) as well as influence of the Italian lockdown measure against COVID-19 pandemic. Results showed different prevalence of the investigated viruses with values equal to 16 % for norovirus GI, 15.1 % for norovirus GII, followed by 13.8 % for astrovirus, and 13.3 % for sapovirus. Rotavirus was detected in the 8.4 % of samples and aichivirus was detected with the lowest prevalence of 3.5 %. Hepatitis A virus was never identified in the monitoring campaign. Salmonella spp. was detected with a prevalence of 36.6 %. Statistical analysis displayed a high correlation for the two noroviruses simultaneous detection (NGI and NGII) while a lower correlation was found for co-presence of noroviruses with astrovirus, sapovirus or Salmonella spp. A significant decrease of enteric pathogens in seawater was observed during the restrictions period. Results on seasonality highlighted a higher viral prevalence correlated to the wet season for all the pathogens but rotavirus and aichivirus, which instead showed an opposite trend and a higher incidence in the dry season. With respect to discharge typology, some viruses displayed a higher prevalence in treated waters (astrovirus, rotavirus, sapovirus and aichivirus) while the other investigated pathogens (noroviruses and Salmonella spp.) showed a higher prevalence in mixed waters. The main observations of this work were used to define a potential monitoring strategy that could be useful for sanitary Authorities to implement surveillance plans aimed at preventing possible sanitary outbreaks and/or environmental quality deterioration.

A pandemic of prediction: On the circulation of contagion models between public health and public safety

Digital prediction tools increasingly complement or replace other practices of coping with an uncertain future. The current COVID-19 pandemic, it seems, is further accelerating the spread of prediction. The prediction of the pandemic yields a pandemic of prediction. In this paper, we explore this dynamic, focusing on contagion models and their transmission back and forth between two domains of society: public health and public safety. We connect this movement with a fundamental duality in the prevention of contagion risk concerning the two sides of being-at-risk and being-a-risk. Both in the spread of a disease and in the spread of criminal behavior, a person at risk can be a risk to others and vice versa. Based on key examples, from this perspective we observe and interpret a circular movement in three phases. In the past, contagion models have moved from public health to public safety, as in the case of the Strategic Subject List used in the policing activity of the Chicago Police Department. In the present COVID-19 pandemic, the analytic tools of policing wander to the domain of public health - exemplary of this movement is the cooperation between the data infrastructure firm Palantir and the UK government's public health system NHS. The expectation that in the future the predictive capacities of digital contact tracing apps might spill over from public health to policing is currently shaping the development and use of tools such as the Corona-Warn-App in Germany. In all these cases, the challenge of pandemic governance lies in managing the connections and the exchanges between the two areas of public health and public safety while at the same time keeping the autonomy of each. Copyright © 2021 Maximilian Heimstädt, Simon Egbert, Elena Esposito

High Resolution Air Quality Monitoring with IoT Intelligent Multisensor devices during COVID-19 Pandemic Phase 2 in Italy

COVID19 Pandemic impacts have been associated with Air Quality (AQ) with its mortality index being significantly affected by high pollution levels. Significant mobility limitations have contributed to slow down the pandemic in Italy having as a side effect a definite decrease of pollution levels. Phase 2 while easing those limits still see a significant reduction of commuting and schools related car traffic emissions. High resolution AQ monitoring can now allow to obtain a picture of AQ if smart cities will be capable to reach long sought emissions goals. Furthermore, it could support the identification and forecasting of possible future local SARS-COV-2 outbursts. In this work, we present the outcomes of a high resolution AQ monitoring opportunistic campaign. These have been achieved through the deployment of field data driven calibration trough machine learning and a smartphone centered IoT infrastructure, capable to store, visualize and give exposome feedback to monitoring volunteers. © 2020 AEIT.

Coronavirus e cronicità, due battaglie da vincere sullo stesso campo (il territorio) e anche con una “nuova” figura (l’infermiere di famiglia e di comunità)

Until just a month ago, it was clear a challange against chronic diseases. It is useless to extend life if you cannot increase the quality, both in a social and more strictly sanitary sense. Today, due to Covid-19, much of the resources and attention are concentrated on the hospital phase. In addition, people make fewer visits, resulting in their health worsening. But if it is in the territory that we must continue “to hold on” for the fight against chronic diseases, it is always in the territory that we can win the “battle” against the infectious emergency, favoring home management as much as possible. Furthermore, it has been shown that patients with obesity-related diseases, such as hypertension, diabetes and cardiovascular disease, have an increased risk of developing complications if affected by Covid-19. But obesity itself can be a risk factor for the development of complications related to the pro-inflammatory state. The problem is that most Healthcare Systems do not consider it a disease and are therefore not focused on its management. At this point the battles against Coronavirus and chronic diseases are faced with widely overlapping tools and organizational models. This document proposes the Chronicity Plan relaunch and the investment in the figure of the family and community nurse. Copyright © FrancoAngeli.

Short Report - Medical nutrition therapy for critically ill patients with COVID-19.

No Abstract Available.