Impact of steroid therapy on bacterial and fungal superinfections in patients with severe COVID-19 admitted to ICU

Introduction: Patients with severe COVID-19 admitted to ICU have an increased risk of bacterial and fungal superinfections [1,2]. Steroid therapy with dexamethasone is one of the recommended treatments for patients on oxygen therapy. The aim of this study is to evaluate the incidence of superinfections in patients treated with steroids. Methods: We performed an observational retrospective study, including patients with severe COVID-19 admitted to our ICU between March 2020 and February 2021. Data on bacterial and fungal superinfections and steroid therapy were collected. Results: Among the 152 patients enrolled, 82 (53.9%) received steroid therapy before admission to ICU, 50 (32.9%) did not receive steroids, for 20 (13.2%) the steroid treatment was not known. The clinical characteristics of the two groups of patients at admission are presented in Table 1. Comparing patients receiving steroids and those not receiving steroids, the incidence of superinfections due to fungi was respectively 29.6% vs 12.2% (RR 2.41, CI 95%: 1.06-5.50). The incidence of Gram- and Gram + superinfections was respectively 56% vs 55% (RR 1.03, CI 95%: 0.75-1.41) and 54% vs 38% (RR 1.40, CI 95% 0.93-2.09). Among Gram- superinfections, we observed a significant association between steroid therapy and Acinetobacter spp. superinfection (19.7% in patients on steroids and 6.1% in patients who did not receive steroids, p = 0.03). The duration of steroid therapy was directly correlated with the number of superinfections for each patient (Spearman's rho = 0.34, CI 95% 0.18-0.48, p < 0.001). Conclusions: In patients with severe COVID-19 admitted to ICU, steroid therapy seems to be a risk factor for fungal superinfections and associated with Acinetobacter spp. superinfections. The duration of the steroid therapy is directly correlated to the number of superinfections for each patient. (Table Presented).

Sanitizing of Confined Spaces Using Gaseous Ozone Produced by 4.0 Machines

A fundamental aspect of the fight against the Coronavirus and against any other virus, is represented by the sanitization of the sites and objects contained therein. This operation is normally carried out using mixtures of ozone and steam and it is certainly effective but also limited due the damages that the vapor can cause to rooms and objects. The following paper introduce machines able to overcome this issue thanks to innovative systems based on the principles of Engineering 4.0. Those systems reproduce the Chapman cycle in the to-be sanitized environments which allows producing ozone in a gaseous state, in the proper quantity and for the time necessary for sanitization. At the end of the operation, the ozone will be converted back into oxygen, leaving the environment re-habitable by humans and pets in a short time. The operation has low costs and times and guarantees positive results. This is therefore a real revolution to be considered today against the COVID-19. © 2021 Newswood Limited. All rights reserved.

Pragmatic Recommendations for the Prevention and Treatment of Acute Kidney Injury in Patients with COVID-19 in Low- and Middle-Income Countries

WATERLIT Abstract: Current recommendations for the management of patients with COVID-19 and acute kidney injury (AKI) are largely based on evidence from resource-rich settings, mostly located in high-income countries. It is often unpractical to apply these recommendations to resource-restricted settings. We report on a set of pragmatic recommendations for the prevention, diagnosis, and management of patients with COVID-19 and AKI in low- and middle-income countries (LMICs). For the prevention of AKI among patients with COVID-19 in LMICs, we recommend using isotonic crystalloid solutions for expansion of intravascular volume, avoiding nephrotoxic medications, and using a conservative fluid management strategy in patients with respiratory failure. For the diagnosis of AKI, we suggest that any patient with COVID-19 presenting with an elevated serum creatinine level without available historical values be considered as having AKI. If serum creatinine testing is not available, we suggest that patients with proteinuria should be considered to have possible AKI. We suggest expansion of the use of point-of-care serum creatinine and salivary urea nitrogen testing in community health settings, as funding and availability allow. For the management of patients with AKI and COVID-19 in LMICS, we recommend judicious use of intravenous fluid resuscitation. For patients requiring dialysis who do not have acute respiratory distress syndrome (ARDS), we suggest using peritoneal dialysis (PD) as first choice, where available and feasible. For patients requiring dialysis who do have ARDS, we suggest using hemodialysis, where available and feasible, to optimize fluid removal. We suggest using locally produced PD solutions when commercially produced solutions are unavailable or unaffordable

On using video lectures data usage to predict university students dropout

Technologies have changed many different aspects of people's life and the recent CoVid-19 pandemic proved that education is not an exception. But technologies in education go beyond the simple use of video lectures: technologies might be exploited to improve personal learning. In this paper, we focus on the dropout of studies, a global phenomenon that artificial intelligence techniques are trying to ameliorate. Here, we investigate whether data related to the consumption of video lectures might improve the students' dropout prediction. We consider first-year students enrolled in our Department and we characterize them with personal, scholastic, academic and technological features. Then, we measure the performance of three machine learning algorithms in terms of accuracy and sensitivity. The experimental evaluation shows that Random Forest and KNN perform better that Decision Tree and also shows that data related to the use of video lectures improves the prediction performance for some degree programs (reaching 73% in terms of accuracy and sensitivity). These preliminary results show that the approach is promising and worth exploring in future studies. © 2021 ACM.

Role of cardiac biomarkers in cardiovascular manifestation of covid-19

Since early December 2019, an outbreak of pneumonia of unknown etiology has been reported in Wuhan, China The pathogen was then named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by WHO, and the illness caused by it was termed as the Coronavirus Disease 2019 (COVID-19). Currently, the disease has rapidly spread to the whole world and become an international public health emergency. Although the SARS novel coronavirus (SARS-CoV-2) or COVID-19 is a viral illness, in fact it is systemic illness in which most of the organ systems are affected with varying degree. There are various patterns of cardiovascular involvement in COVID 19. First, cardiovascular disease present as pre-existing comorbidity which becomes apparent or becomes more complicated and decompensated during COVID 19. Second, cardiovascular system involvement results due to systemic inflammatory response during the course COVID 19. Third, cardiovascular system can be affected during treatment due to the side effects of some medication or secondary hospital-acquired infections and complications. Arrhythmias, acute coronary syndrome (ACS), myocarditis, Heart Failure and cardiomyopathy are the most common cardiovascular disease in COVID-19. The Fourth Universal Definition of Myocardial Infarction defines myocardial injury (acute or chronic) as cTn concentrations >99th percentile upper reference limit (URL). In COVID-19, cardiac injury is believed to be through multiple overlapping factors such as severe inflammatory response with uncontrolled cytokine activation and/or direct injury due to Virus infiltration in cardiomyocytes through angiotensin-converting enzyme 2 (ACE 2) receptors. Increases in cardiac biomarkers, especially, cardiac troponin (cTn) are common in patients with COVID-19, particularly in patients with underlying cardiovascular conditions and severe COVID-19 presentations, and are associated with worse outcomes and mortality. Thus, it is evident that cardiac injury plays a significant role in the disease progression and outcome associated with COVID-19. Thus, it is reasonable to include the indicators of cardiac injury in the patient's diagnosis, triaging, treatment, and prognosis, while recognizing that their abnormality may not be related to direct coronary involvement. Incorporation of cardiac biomarkers measurement (cTn and/or B-type natriuretic peptide [BNP]) to a set of other inflammatory and thrombotic markers may facilitate the understanding of COVID-19 stages, risk profiles, and disease phenotypes. Baseline measurements can facilitate stage classification and initial triage, and serial measurements help with short- and long-term risk stratification (likelihood for survival and/or adverse events). This information is likely to be most beneficial in patients in whom disease stage and risk status is uncertain, as well as in patients in whom risk is particularly high. In both cases, cardiac biomarkers can help with decisions about COVID19 patients' triage, management, therapeutic treatment and level of care.