Inexpensive Multipatient Respiratory Monitoring System for Helmet Ventilation During COVID-19 Pandemic

Helmet continuous positive applied pressure is a form of noninvasive ventilation (NIV) that has been used to provide respiratory support to COVID-19 patients. Helmet NIV is low-cost, readily available, provides viral filters between the patient and clinician, and may reduce the need for invasive ventilation. Its widespread adoption has been limited, however, by the lack of a respiratory monitoring system needed to address known safety vulnerabilities and to monitor patients. To address these safety and clinical needs, we developed an inexpensive respiratory monitoring system based on readily available components suitable for local manufacture. Open-source design and manufacturing documents are provided. The monitoring system comprises flow, pressure, and CO2 sensors on the expiratory path of the helmet circuit and a central remote station to monitor up to 20 patients. The system is validated in bench tests, in human-subject tests on healthy volunteers, and in experiments that compare respiratory features obtained at the expiratory path to simultaneous ground-truth measurements from proximal sensors. Measurements of flow and pressure at the expiratory path are shown to deviate at high flow rates, and the tidal volumes reported via the expiratory path are systematically underestimated. Helmet monitoring systems exhibit high-flow rate, nonlinear effects from flow and helmet dynamics. These deviations are found to be within a reasonable margin and should, in principle, allow for calibration, correction, and deployment of clinically accurate derived quantities. Copyright © 2022 by ASME.

Increased rate of hospitalisation for COVID-19 amongst rituximab treated multiple sclerosis patients in Sweden: New data from the 2021 update

Introduction: This study group has previously demonstrated a significantly increased risk of hospitalisation for COVID-19 amongst rituximab-treated patients in Sweden. Objective: The primary objective of this study was to analyse the association between multiple sclerosis (MS) disease modifying therapy (DMT) exposure and hospitalisation in patients infected with COVID-19. Methods: Nationwide registry-based cohort study. Associations between MS DMT exposure and COVID-19 hospitalisation were analysed using univariable and multivariable clustered propensity score weighted logistic regression, where the models were clustered on the individual patients to control for patients contributing multiple COVID-19 episodes. Results: As of 4th June 2021, a total of 950 reported COVID-19 cases had been recorded in MS patients in the Swedish MS registry. Of these, 697 (73.4%) had confirmed COVID-19. The mean (SD) age at infection was 44.4 years (11.2). Of the 697 confirmed infections 117 (16.8%) required hospitalisation. A total of 73 of the 308 confirmed COVID-19 patients on rituximab at baseline (23.7%) required hospitalisation, compared to a rate of 11.3% for all other DMTs combined. Rituximab in confirmed COVID-19 patients was associated with 3.10 times the odds of hospitalisation relative to any other DMT combined (adjusted Odds Ratio 3.10;95% CI 1.68-5.74), controlling for age, sex, EDSS and MS course and duration of treatment at baseline. There was no difference in the rate of hospitalisation between any of the non-rituximab DMTs when compared to one another. Amongst rituximab treated patients only, the duration of rituximab at baseline was not associated with a changed risk of hospitalisation. Conclusions: Rituximab treatment, known to increase the risk of severe infections in general, also confers such a risk for MS patients with COVID-19, in comparison with other MS DMTs.

Novel findings from a beta coronavirus outbreak on an American Miniature Horse breeding farm in upstate New York.

This case report describes an outbreak and novel findings associated with a beta coronavirus (BCoV) infection that occurred on an American Miniature Horse (AMH) breeding farm in upstate New York, in January and February of 2013. Twenty-nine AMH and one donkey were present on the farm when the outbreak occurred. One 10-year-old Quarter Horse mare, stabled at a separate location and owned by an employee of the farm, also tested positive. A polymerase chain reaction (PCR) assay for the detection of BCoV was performed at the Animal Health Diagnostic Center (AHDC) at Cornell on all faecal samples. The PCR assay used detects multiple beta coronaviruses, including, but not limited to, equine enteric coronavirus (ECoV). Novel findings regarding this BCoV infection in horses were recognised in this outbreak study. To the authors' knowledge, this is the largest outbreak of BCoV described thus far in a closed herd on a single premise. The case fatality rate was 0% unlike that described in a previous outbreak of ECoV involving miniature horses and a miniature donkey (Fielding et al. 2015). The morbidity rate was lower in this outbreak than in previously described studies (Oue et al. 2013; Pusterla et al. 2013). This outbreak also demonstrated the potential for BCoV transmission via farm personnel. The duration of shedding of virus in the faeces among some asymptomatic horses in this outbreak was longer than previously described clinical cases of ECoV (Pusterla et al. 2013; Nemoto et al. 2014). This study suggests that asymptomatic animals may play a role in the maintenance of BCoV during an outbreak; therefore, the need for diagnostic testing of both clinically affected and apparently clinically normal horses on a premises followed by appropriate biosecurity and control measures.