Evaluation and comparison of NETosis biomarkers in sepsis and COVID-19 patients

Background: Neutrophils are involved in the defense of the body against pathogens through the formation neutrophil extracellular trap, a mechanism called NETosis. These pathogens can be fungi, bacteria, viruses or other microorganisms. However, neutrophils through NETs have a double-edged sword activity and can also be harmful. Aim(s): This study aims to evaluate biomarkers of NETosis in two different patient populations admitted to the intensive care unit, i.e. COVID-19 and sepsis patients. A control population of matched subjects have been included. Method(s): Among the individuals admitted to the ICU and included in this study, 46 were sepsis patients and 22 were COVID-19 patients. 48 controls were included. Nucleosome histone H3.1, nucleosome citrullinated histone H3R8, free citrullinated histone (citrullinated at R2, R8 and R17), neutrophil elastase an myeloperoxidase were measured. Blood samples were taken at the admission to the intensive care unit. The different groups were compared using ordinary two-way ANOVA with a Tukey's multiple comparison on log-transformed data. Result(s): A significant difference in the levels of Nu.H3.1 and NE was observed between sepsis and COVID-19 subjects. All NETosis parameters differs in ICU patients versus controls. A positive correlation was found between SOFA and APCHE-II score and Nu.H3.1 in sepsis patients. No positive correlation was observed in COVID-19 patients. Normalization of NETosis parameters according to the neutrophil count improves the sensitivity of Nu.H3.1 to discriminate between sepsis and COVID-19 patients. The other parameters were also influenced but to a lesser extent. NE and Nu.H3.1 correlates well in sepsis patients while it is not the case in COVID-19 patients. Conclusion(s): Nu.H3.1 appears to be an interesting marker of NETosis in sepsis and COVID-19 patients. Its correlation with NE in sepsis patients reveals that NE is important in generating circulating nucleosomes while its weak association in COVID-19 suggest different patterns between the diseases.

[Teaching during the COVID-19 pandemic: how do medical students evaluate interactive video-based distance bedside teaching in otorhinolaryngology?] / Ausbildung in COVID-19-Pandemie-Zeiten: Wie bewerten Medizinstudierende einen interaktiven, videobasierten Distanzunterricht am Patienten im Fach Hals-Nasen-Ohren-Heilkunde?

BACKGROUND: The first wave of the SARS-CoV­2 pandemic required substantial changes in the teaching of medical students, with strict avoidance of direct contact between students and patients. Therefore, the teaching format "bedside teaching" was implemented and conducted as an interactive video-based distance bedside teaching. OBJECTIVE: The objective of this study was to analyze a students' evaluation of this teaching concept in otorhinolaryngology. MATERIALS AND METHODS: From an ENT examination room, the situation was transmitted live to the students in a lecture hall, who could interact with the patients through a video connection. Macro-, micro-, and endoscopic images were transmitted into the lecture hall in real time. Evaluation was performed by means of an online questionnaire with 13 questions (Likert scale) as well as by free-text feedback. RESULTS: The response rate was 16.8% (42 of 250 students). Overall, 85.7% had a positive impression, and it was generally considered that the concept was well implemented in light of the special situation. However, students would rather not renounce direct patient contact, even if a certain compensation by video transmission was reported. Overall, this teaching concept was considered as educative, and students could imagine using such a teaching concept more often in the future. CONCLUSION: This teaching model cannot replace classical bedside teaching, but represents a good alternative-particularly in otorhinolaryngology-if classical bedside teaching is not possible due to the pandemic situation. Aspects of the interactive video-based distance bedside teaching could be implemented into classical teaching concepts in the future.

One year of COVID 19: Results of a national web-based survey on the SARS-CoV-2 infectious state of otorhinolaryngologists in Germany

Background Otorhinolaryngologists (ORL) are said to be at high risk due to a close professionally contact with the mucosa of the upper airway where SARS-CoV-2 can be detected to a high degree. Anyhow, only few data is available for German ORLs. Methods The German Society of ORL, Head and Neck Surgery and the German ENT Association addressed German ORLs to participate in a web-based survey about infection with SARS-CoV-2. Data of infections and concomitant parameters in German ORLs were compared to the total number of infections in Germany. An initial survey was launched May 2020 and a monthly follow-up survey was active until January 2021. Results 970 out of 6383 German ORLs (15%) participated in the initial survey and the June follow-up. Testing positive for SARS-CoV-2 until June 2020 was reported by 54 ORLs. The relative risk of contracting SARS-CoV-2 for ORLs is calculated as an OR of 3.67 (95% CI 2.82;4.79) compared to the total population of Germany. As treatment, 2 individuals were admitted to hospital without intensive care and domestic quarantine was conducted in 96.3% of cases. No casualties were reported. In 31 cases the source of infection was not identifiable whereas 23 had a clear etiology: infected patients: n = 5, 9.26% ;medical staff: n = 13, 24.1% . 9.26% (n = 5) of the identified cases were related to contact to infected family members (n = 3), closer neighborhood (n = 1) or general public (n = 1). There does not seem to be an increased risk of infection performing surgery. The follow-up data for 12 month of COVID-19 will be implemented in the presentation. Conclusion There is an almost 3.7-fold risk of contracting SARS-CoV-2 for German ORLs compared to the population baseline level. Appropriate protection appears to be necessary for this occupational group.

[The first year of the SARS-CoV-2 pandemic-impact on otorhinolaryngology]. / Das erste Jahr der Pandemie mit SARS-CoV-2 ­ Auswirkungen auf die Hals-Nasen-Ohren-Heilkunde.

BACKGROUND: The first year of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has already affected our public health care system to an enormous extent and will continue to do so in the future. Otorhinolaryngologists (ORLs) are suspected to be at high risk of infection, due to the high viral load in the mucosa of the upper airways. The current review evaluates the impact of the pandemic on ORLs' activities and assesses the risk infection. METHODS: A selective literature research was conducted using relevant English and German terms for ORL, SARS-CoV­2, risk, and infection at PubMed, medRxiv, and bioRxiv, as well as in the Deutsches Ärzteblatt and on the websites of the Robert Koch Institute and the Johns Hopkins University. RESULTS: Protection recommendations for ORL include general hygiene measures and wearing KN95 masks for routine professional activities. When in contact with coronavirus disease 2019 (COVID-19) patients, it is recommended to extend the personal protective equipment by eye protection, gloves, cap, and gown. International otorhinolaryngology societies have released guidelines for procedures (e.g., tracheostomy, sinus surgery), propagating personal protection for the surgical team and reduction of aerosols. Testing for SARS-CoV­2 in patients and medical staff can contribute to reducing the risk of infection. Vaccination would provide some additional protection for ORLs and other health care professionals with increased exposure to aerosols. There is increasing evidence that ORLs are at a high risk of contracting SARS-CoV­2. CONCLUSION: Consequent personal protection, frequent testing of patients and health care professionals, and the promised SARS-CoV­2 vaccinations may provide adequate protection for highly exposed persons.