A Review of Heart Failure in Patients with COVID-19.

The interplay of COVID-19 and heart failure is complex and involves direct and indirect effects. Patients with existing heart failure develop more severe COVID-19 symptoms and have worse clinical outcomes. Pandemic-related policies and protocols have negatively affected care for cardiovascular conditions and established hospital protocols, which is particularly important for patients with heart failure.

Analysis of a forced blended-learning program in social sciences higher education during the COVID-19 post-pandemic

PurposeThe main goal of this investigation is to analyze the implementation of a forced blended-learning program in social sciences higher education in a post-pandemic COVID-19 context. To reach that target, the authors suggest two specific objectives (S.O.): S.O.1 To analyze the motivation, the resources and the learning effectiveness of the program. S.O.2 To establish the differences emerged between the participants.Design/methodology/approachThe blended-learning program selected was based on the flipped-classroom model (Krasulia, 2017). The implementation consisted of a 20-min flipped classroom to flexibly follow the theoretical contents through self-elaborated videos uploaded on YouTube and adapted to all kinds of devices, two online theoretical hours driven by the teacher on the Zoom application per week with the whole group to augment explanations and solve doubts and two hours of face-to-face interaction to work cooperatively in small groups of 4–5 students per week. During these practical lessons, the students completed exercises, research reports, oral presentations and a gamification quiz developed each week through the Socrative application to keep the students engaged.FindingsAll the participants agree in very positively valuating the small-group seminars and the teacher's role in the process. This is surely caused because of the pandemic fatigue and the restrictions (Mali and Lim, 2021) that were running during the fall semester of year 2020/2021 when in Spain lived the in-between of the second and third wave of SARS-CoV2. So, as educators and investigators, the authors encourage teachers to incorporate face-to-face interaction elements in forced blended-learning programs, to include seminars in small groups to work cooperatively and to provide the students support and a quick resolution of doubts.Originality/valueThis study provides a significant value in support of a number of studies cited in the study. The study highlights the need for a standardised application of active methods in a standardised way.

A Review of Heart Failure in patients with COVID-19

Synopsis Synopsis can be substituted with our conclusion. The interplay of COVID-19 and heart failure is complex and involves direct and indirect effects. Patients with existing heart failure develop more severe COVID-19 symptoms and have worse clinical outcomes. Pandemic related policies and protocols have negatively impacted care for cardiovascular conditions and established hospital protocols, which is particularly important for heart failure patients.

Impact of COVID-19 on Acute Myocardial Infarction Care.

The global health crisis caused by the COVID-19 pandemic has evolved rapidly to overburden health care organizations around the world and has resulted in significant morbidity and mortality. Many countries have reported a substantial and rapid reduction in hospital admissions for acute coronary syndromes and percutaneous coronary intervention. The reasons for such abrupt changes in health care delivery are multifactorial and include lockdowns, reduction in outpatient services, reluctance to seek medical attention for fear of contracting the virus, and restrictive visitation policies adopted during the pandemic. This review discusses the impact of COVID-19 on important aspects of acute MI care.

Mechanical Circulatory Support in COVID-19.

Despite aggressive care, patients with cardiopulmonary failure and COVID-19 experience unacceptably high mortality rates. The use of mechanical circulatory support devices in this population offers potential benefits but confers significant morbidity and novel challenges for the clinician. Thoughtful application of this complex technology is of the utmost importance and should be done in a multidisciplinary fashion by teams familiar with mechanical support devices and aware of the particular challenges provided by this complex patient population.

Digital mental health outcome monitoring for a structured text-based youth counselling intervention: Demographic profile and outcome change.

BACKGROUND: Digital mental health interventions comprise a potentially effective and accessible form of support for young people, particularly at times when traditional face-to-face service delivery is reduced, as in the COVID-19 pandemic. AIMS: This study assessed the demographic profile of young people using a digital mental health support service and evaluated outcome change over the course of a structured online counselling intervention (synchronous text-chat sessions with a practitioner). MATERIALS AND METHODS: The data were collected from 23,260 young people aged between 10 and 25 years engaging with the intervention between April 2019 and June 2021. RESULTS: Young people accessing these services had high levels of mental health needs, particularly those identifying with non-binary gender identity. Service users were mostly female, with equitable rates of access for young people from racialised communities. Overall outcome change demonstrated small effect sizes according to the YP-CORE (0.19) and CORE-10 (0.38), which increased to a moderate level when young people remained engaged with a dedicated practitioner for at least seven sessions (0.38, 0.58). Regression analysis illustrated the effect of the number of sessions on outcome change, but this can be also influenced by other variables such as age and gender. DISCUSSION AND CONCLUSION: Further research is required to explore ways to engage with young people using digital web-based services for a longer period and to collect and analyse single-session outcome data.

Cardiac Registries During the COVID-19 Pandemic: Lessons Learned.

PURPOSE OF THIS REVIEW: We discuss the role of observational studies and cardiac registries during the COVID-19 pandemic. We focus on published cardiac registries and highlight contributions to the field that have had clinical implications. RECENT FINDINGS: We included observational studies of COVID-19 patients published in peer-reviewed medical journals with defined inclusion and exclusion criteria, defined study design, and primary outcomes. A PubMed and MEDLINE literature review results in 437 articles, of which 52 include patients with COVID-19 with cardiac endpoints. From July 2020 to December 2021, the average time from last data collected to publication was 8.9 ± 4.1 months, with an increasing trend over time (R = 0.9444, p < 0.0001). Of the 52 articles that met our inclusion criteria, we summarize main findings of 4 manuscripts on stroke, 14 on acute coronary syndrome, 4 on cardiac arrest, 7 on heart failure, 7 on venous thromboembolism, 5 on dysrhythmia, and 11 on different populations at risk for cardiovascular. Registries are cost effective, not disruptive to essential health services, and can be rapidly disseminated with short intervals between last data point collected and publication. In less than 2 years, cardiac registries have filled important gaps in knowledge and informed the care of COVID-19 patients with cardiovascular conditions.

Mechanical Circulatory Support in Patients With COVID-19 Presenting With Myocardial Infarction.

ST-segment elevation myocardial infarction (STEMI) complicating COVID-19 is associated with an increased risk of cardiogenic shock and mortality. However, little is known about the frequency of use and clinical impact of mechanical circulatory support (MCS) in these patients. We sought to define patterns of MCS utilization, patient characteristics, and outcomes in patients with COVID-19 with STEMI. The NACMI (North American COVID-19 Myocardial Infarction) is an ongoing prospective, observational registry of patients with COVID-19 positive (COVID-19+) with STEMI with a contemporary control group of persons under investigation who subsequently tested negative for COVID-19 (COVID-19-). We compared the baseline characteristics and in-hospital outcomes of COVID-19+ and patients with COVID-19- according to the use of MCS. The primary outcome was a composite of in-hospital mortality, stroke, recurrent MI, and repeat unplanned revascularization. A total of 1,379 patients (586 COVID-19+ and 793 COVID-19-) enrolled in the NACMI registry between January 2020 and November 2021 were included in this analysis; overall, MCS use was 12.3% (12.1% [n = 71] COVID-19+/MCS positive [MCS+] vs 12.4% [n = 98] COVID-19-/MCS+). Baseline characteristics were similar between the 2 groups. The use of percutaneous coronary intervention was similar between the groups (84% vs 78%; p = 0.404). Intra-aortic balloon pump was the most frequently used MCS device in both groups (53% in COVID-19+/MCS+ and 75% in COVID-19-/MCS+). The primary outcome was significantly higher in COVID-19+/MCS+ patients (60% vs 30%; p = 0.001) because of very high in-hospital mortality (59% vs 28%; p = 0.001). In conclusion, patients with COVID-19+ with STEMI requiring MCS have very high in-hospital mortality, likely related to the significantly higher pulmonary involvement compared with patients with COVID-19- with STEMI requiring MCS.

Frequency and outcomes of STEMI patients presenting between 12 and 24 h after symptom onset: Late-presenting STEMI.

OBJECTIVES: To assess the characteristics and prognosis of ST-elevation myocardial infarction (STEMI) patients, presenting between 12 and 24 h after symptom onset, in contemporary regional STEMI systems of care in the United States. BACKGROUND: Previous observational studies have been inconsistent regarding the benefit of primary percutaneous coronary intervention (PCI) compared with conservative management for late-presenting STEMI patients and the majority of randomized trials are from the fibrinolytic era. METHODS: Using a two-center registry-based cohort from March 2003 to December 2020, we evaluated the frequency, clinical characteristics, and outcomes of STEMI patients, stratified by symptom onset to balloon time: <3, 3-6, 6-12, and 12-24 h (late presenters). RESULTS: Among 5427 STEMI patients with available symptom onset time, 6.2% were late presenters, which increased to 11% during the early phase of the Covid-19 pandemic. As symptom onset to balloon time increased, patients were more likely to be older, female, and have a history of hypertension and diabetes mellitus. Late presenters with an identifiable culprit lesion were less likely to be revascularized with PCI (96%, 96%, 95%, and 92%; p for trend = 0.004) and had a longer median door-to-balloon time (82, 109, 107, and 117 min; p for trend < 0.001). In-hospital and 1-year death risks were comparable between late and earlier presenters. CONCLUSION: Despite the unfavorable risk profile and longer door-to-balloon time, clinical outcomes of late presenters were similar to those presenting within 12 h of symptom onset.

Monitoring and Tracking the Spread of SARS-CoV-2 in Asturias, Spain

Mutational analysis of SARS-CoV-2 can quantify their relative importance over time, enable the dominant mutations to be identified and facilitate near real-time detection, comparison, and tracking of evolving variants. Collected samples in Asturias an autonomous community of Spain with a large aged population, and high levels of migration and tourism was monitored and tracked from its beginning in February 2020 until its decline and stabilization in August 2021, were characterized using whole genomic sequence and single nucleotide polymorphism. Data held in the GISAID database was analyzed to establish patterns in the appearance and persistence of SARS-CoV-2 strains. Only 138 non-synonymous mutations occurring in more than 1% of the population of SARS-CoV-2 were found, identifying 10 major variants worldwide (7 arose before January 2021), 19 regional and 1 local. In Asturias only 17 different variants were found. After vaccination, no further regional majority variants were found. Only half of the defined variants circulated and no new variants were generated, indicating that infection control measures (fast diagnosis, prevention measures and vaccination) were efficient.

Cerebrospinal fluid leak postnasopharyngeal swab for SARS-CoV-2 testing: A case report.

Background: Due to the SARS-CoV-2 virus pandemic and its rapid spread worldwide, an early and effective detection strategy was the nasopharyngeal reverse transcription polymerase swab tests, a procedure still performed today. A relatively safe procedure when done correctly, however, one of the rare complications reported in the literature includes a cerebrospinal fluid (CSF) leak. Case Description: A 69-year-old female patient presented to the emergency department with clear fluid rhinorrhea, clinically diagnosed with a CSF fistula after a SARS-CoV-2 nasopharyngeal swab. Resulting computed tomography and magnetic resonance images did not report any abnormalities; however, persistence of clear fluid rhinorrhea obligated pharmacological treatment without resolution, requiring insertion of a lumbar catheter to achieve clinical resolution. Conclusion: It is essential to train staff to correctly administer nasopharyngeal swabs and thus reduce the rate of complications, as well as early recognition of symptoms and signs of CSF fistula.

Engagement of individuals aged 14–25 years with a digital mental health service during the COVID-19 pandemic in the UK: a cohort study of service usage data

Background Public use of digital mental health technologies has informed several studies focusing on patterns of engagement within user-led digital support systems. General engagement with these services has increased since the start of the COVID-19 pandemic. However, to the best of our knowledge, this is the first study to explore how user engagement patterns with these platforms changed during the pandemic. Methods In this cohort study, we included individuals aged 14–25 years who signed up to the online mental health platform Kooth in the UK before the pandemic (May 1, 2019 to March 10, 2020) and during the pandemic (March 11, 2020 to Oct 31, 2021). Routinely collected usage data were assessed for consenting users who returned to Kooth at least once after sign-up. We used logistic regression to compare service component usage and overall engagement across cohorts. Findings 5048 individuals (mean sign-ups per day 9·0 [12·0]) were included in the pre-pandemic cohort and 13 841 (mean sign-ups per day 11·5 [13·9]) in the pandemic cohort, representing a significant increase in sign-ups per day during the pandemic compared with the pre-pandemic period (Welch's t-test p=0·0001). Compared with users pre-pandemic, users during the pandemic were less likely to have a drop-in chat with a practitioner (odds ratio [OR] 0·50 [95% CI 0·47–0·54], p<0·0001) but were more likely to journal (1·92 [1·77–2·07], p<0·0001) and comment on existing content (1·10 [1·03–1·18], p=0·008). Users who signed up to Kooth during the pandemic and requested a chat with a practitioner (7816 [56·5%] of 13 841 users) were also less likely to receive a chat than users who requested a chat pre-pandemic (3791 [75·1%] of 5048 users;OR 0·68 [0·63–0·74], p<0·0001). Interpretation During the COVID-19 pandemic, people with the ability and resources to access digital mental health support were diverted from face-to-face services to digital mental health services. This change might have resulted in an unmet need for drop-in practitioner chats, with users probably resorting to asynchronous support through community interaction or journaling. Funding Kooth Digital Health.

Mechanical Circulatory Support in COVID-19.

Despite aggressive care, patients with cardiopulmonary failure and COVID-19 experience unacceptably high mortality rates. The use of mechanical circulatory support devices in this population offers potential benefits but confers significant morbidity and novel challenges for the clinician. Thoughtful application of this complex technology is of the utmost importance and should be done in a multidisciplinary fashion by teams familiar with mechanical support devices and aware of the particular challenges provided by this complex patient population.

Emergence of New SARS-CoV2 Omicron Variants after the Change of Surveillance and Control Strategy.

In January 2022, there was a global and rapid surge of the Omicron variant of SARS-CoV-2 related to more transmission. This coincided with an increase in the incidence in Asturias, a region where rapid diagnosis and containment measures had limited the circulation of variants. METHODS: From January to June 2022, 34,591 variants were determined by the SNP method. From them, 445 were characterized by the WGS method and classified following pangolin program and phylogenic analysis. RESULTS: The Omicron variant went from being detected in 2438 (78%) samples in the first week of January 2021 to 4074 (98%) in the third week, according to the SNP method. Using the WGS method, 159 BA.1 (35.7%), 256 BA.2 (57.6%), 1 BA.4 (0.2%) and 10 BA.5 (2.2%) Omicron variants were found. Phylogenetic analysis detected that three new sub-clades, BA.2,3.5, BA.2.56 and BF1, were circulating. CONCLUSIONS: The increase in the incidence of SARS-CoV2 caused the circulation of new emerging variants. Viral evolution calls for continuous genomic surveillance.

Change on the Circulation of Respiratory Viruses and Pediatric Healthcare Utilization during the COVID-19 Pandemic in Asturias, Northern Spain.

(1) Background: The COVID-19 pandemic and the implementation of restrictions and nonpharmaceutical interventions (NPIs) changed the trends in respiratory viral circulation and the pattern in pediatric healthcare utilization; (2) Methods: A retrospective, multicenter observational study designed to analyze the impact of the pandemic on pediatric healthcare utilization and the viral circulation pattern in children in a region in Northern Spain was carried out. Viral diagnostics data from all nasal or pharyngeal swabs collected in children in Asturias during the periods of March 2018-September 2019 and March 2020-September 2021 were analyzed, as well as the number of pediatric hospitalizations and emergency visits; (3) Results: A total of 14,640 samples were collected during the pandemic period. Of these, at least one respiratory virus was detected in 2940 (20.1%) while 5568/10,298 samples were positive in the pre-pandemic period (54.1%); p < 0.001. The detection of both enveloped and non-enveloped viruses decreased among periods (p < 0.001). After week 14, 2020, enveloped viruses were no longer detected until one year later, while non-enveloped viruses continued to be detected in children. Overall, a mean of 4946.8 (95% CI 4519.1-5374.4) pediatric emergency visits per month during the period 2018-2019 as compared to 2496.5 (95% CI 2086.4-2906.5) for 2020-2021 occurred (p < 0.001). The mean of pediatric hospitalizations also significantly decreased between periods, as follows: 346.6 (95% CI 313-380.2) in 2018-2019 vs. 161.1 (95% CI 138.4-183.8); p < 0.001; (4) Conclusions: Our study showed a remarkably reduction in pediatric hospitalizations and emergency visits and a change in the pattern of viral circulation during the COVID-19 pandemic in Asturias. The usual seasonal respiratory viruses, namely influenza or RSV were nearly absent in the pediatric population during the pandemic.

Analysis of a forced blended-learning program in social sciences higher education during the COVID-19 post-pandemic

Purpose The main goal of this investigation is to analyze the implementation of a forced blended-learning program in social sciences higher education in a post-pandemic COVID-19 context. To reach that target, the authors suggest two specific objectives (S.O.): S.O.1 To analyze the motivation, the resources and the learning effectiveness of the program. S.O.2 To establish the differences emerged between the participants. Design/methodology/approach The blended-learning program selected was based on the flipped-classroom model (Krasulia, 2017). The implementation consisted of a 20-min flipped classroom to flexibly follow the theoretical contents through self-elaborated videos uploaded on YouTube and adapted to all kinds of devices, two online theoretical hours driven by the teacher on the Zoom application per week with the whole group to augment explanations and solve doubts and two hours of face-to-face interaction to work cooperatively in small groups of 4-5 students per week. During these practical lessons, the students completed exercises, research reports, oral presentations and a gamification quiz developed each week through the Socrative application to keep the students engaged. Findings All the participants agree in very positively valuating the small-group seminars and the teacher's role in the process. This is surely caused because of the pandemic fatigue and the restrictions (Mali and Lim, 2021) that were running during the fall semester of year 2020/2021 when in Spain lived the in-between of the second and third wave of SARS-CoV2. So, as educators and investigators, the authors encourage teachers to incorporate face-to-face interaction elements in forced blended-learning programs, to include seminars in small groups to work cooperatively and to provide the students support and a quick resolution of doubts. Originality/value This study provides a significant value in support of a number of studies cited in the study. The study highlights the need for a standardised application of active methods in a standardised way.

Impact of COVID-19 on Acute Myocardial Infarction Care.

The global health crisis caused by the COVID-19 pandemic has evolved rapidly to overburden health care organizations around the world and has resulted in significant morbidity and mortality. Many countries have reported a substantial and rapid reduction in hospital admissions for acute coronary syndromes and percutaneous coronary intervention. The reasons for such abrupt changes in health care delivery are multifactorial and include lockdowns, reduction in outpatient services, reluctance to seek medical attention for fear of contracting the virus, and restrictive visitation policies adopted during the pandemic. This review discusses the impact of COVID-19 on important aspects of acute MI care.

North American COVID-19 Myocardial Infarction (NACMI) Risk Score for Prediction of In-Hospital Mortality.

Background: In-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is higher in those with COVID-19 than in those without COVID-19. The factors that predispose to this mortality rate and their relative contribution are poorly understood. This study developed a risk score inclusive of clinical variables to predict in-hospital mortality in patients with COVID-19 and STEMI. Methods: Baseline demographic, clinical, and procedural data from patients in the North American COVID-19 Myocardial Infarction registry were extracted. Univariable logistic regression was performed using candidate predictor variables, and multivariable logistic regression was performed using backward stepwise selection to identify independent predictors of in-hospital mortality. Independent predictors were assigned a weighted integer, with the sum of the integers yielding the total risk score for each patient. Results: In-hospital mortality occurred in 118 of 425 (28%) patients. Eight variables present at the time of STEMI diagnosis (respiratory rate of >35 breaths/min, cardiogenic shock, oxygen saturation of <93%, age of >55 â€‹years, infiltrates on chest x-ray, kidney disease, diabetes, and dyspnea) were assigned a weighted integer. In-hospital mortality increased exponentially with increasing integer risk score (Cochran-Armitage χ2, P â€‹< â€‹.001), and the model demonstrated good discriminative power (c-statistic â€‹= â€‹0.81) and calibration (Hosmer-Lemeshow, P â€‹= â€‹.40). The increasing risk score was strongly associated with in-hospital mortality (3.6%-60% mortality for low-risk and very high-risk score categories, respectively). Conclusions: The risk of in-hospital mortality in patients with COVID-19 and STEMI can be accurately predicted and discriminated using readily available clinical information.