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Introduction and purpose Atrial fibrillation (AF) is common in patients admitted with severe COVID-19. However, there is limited data about the management of chronic anticoagulation therapy in these patients. We assessed the anticoagulation and incidence of major cardiovascular events in hospitalized patients with AF and COVID-19. Methods We retrospectively investigated all consecutive patients with AF admitted with COVID-19 between March and May 2020 in 9 Spanish hospitals. We selected a control group of non-AF patients consecutively admitted with COVID-19. We compared baseline characteristics, incidence of major bleeding, thrombotic events and mortality. We used propensity score matching (PSM) to minimize potential confounding variables, as well as a multivariate analysis to predict major bleeding and death. Results 305 patients admitted with AF and COVID-19 were included. After PSM, 151 AF patients were matched with 151 control group patients. During admission, low-molecular-weight heparin was the principal anticoagulant and the incidence of major bleeding and mortality were higher in the AF group [16 (10.6%) vs 3 (2%), p = 0.003;52 (34.4%) vs 35 (23.2%), p = 0.03, respectively]. The multivariate analysis showed the presence of AF as independent predictor of in-hospital major bleeding and mortality in COVID-19 patients. In AF group, a secondary multivariate analysis identified high levels of D-dimer as independent predictor of in-hospital major bleeding. Conclusions AF patients admitted with COVID-19 represent a population at high risk for bleeding and mortality during admission. It seems advisable to individualize anticoagulation therapy during admission, considering patient specific bleeding and thrombotic risk.
ABSTRACT
El edadismo es una forma de maltrato que tiene influencia negativa en las personas mayores. Aunque la COVID-19 afecta a personas de todos los grupos de edad, ha incrementado el efecto del mismo, limita el acceso de los mayores a diversos recursos, entre ellos, los sanitarios. El edadismo se asocia con sobrecostes, con peor salud y mortalidad precoz. Desde el «Grupo de Trabajo (GdT) de Atención al Mayor de la Sociedad Española de Medicina de Familia y Comunitaria (semFYC)» realizamos una serie de propuestas para combatirlo basándonos en actividades comunitarias que favorezcan las relaciones intergeneracionales y la educación en envejecimiento que permitan una correcta integración de los mayores en la sociedad.
ABSTRACT
INTRODUCCIÓN. El confinamiento de la población provocado por la pandemia del coronavirus obligó al profesorado y a las familias a hacer una transición casi instantánea de la enseñanza presencial a la enseñanza a distancia. Pero, ¿cómo ha incidido esta transición en la denominada brecha digital? El objetivo del estudio fue conocer el impacto del cierre de los centros educativos en las siguientes tres brechas digitales de acceso, cognitiva y escolar. Y hacerlo desde la perspectiva del profesorado y de las familias. MÉTODO. Participaron 9567 ciudadanos españoles, 3700 docentes y 5867 progenitores. El estudio siguió un diseño de investigación ex post facto con una metodología cuantitativa de encuesta. El muestreo se realizó con la técnica no-probabilística de “bola de nieve”. La recogida de datos se realizó virtualmente entre el 15 de abril al 8 de mayo del 2020. RESULTADOS. Pusieron de manifiesto una “brecha de acceso” que el profesorado achaca a una conexión deficiente y a un número insuficiente de medios técnicos en las casas, pero que las familias no comparten y señalan las limitaciones impuestas por el teletrabajo como la principal dificultad. DISCUSIÓN. Existe claramente una “brecha cognitiva” reconocida por el profesorado y por las familias y una “brecha escolar” que el primero sitúa en insuficientes recursos puestos a su disposición por las administraciones y los centros y en una insuficiente experiencia en enseñanza online. En conclusión, el confinamiento provocado por la pandemia de la COVID-19 ha sacado a la luz una brecha digital que se creía superada o al menos minimizada, pero que en sus vertientes cognitiva y escolar demanda medidas.Alternate : INTRODUCTION. The population confinement caused by coronavirus pandemic forced teachers and families to make an almost instant transition from traditional teaching to on-line teaching. But how did it work regarding the digital gap? The aim of the study was to assess the impact of the schools’ lockdown on the three existing digital gaps, access, cognitive and school, from the teachers and the families’ perspectives. METHOD. 9567 Spanish citizens, 3700 teachers and 5867 parents, agreed to participate. The study followed an ex post facto research design within a questionnaire quantitative methodology. A “snowball” non-probabilistic sampling was used to recruit participants. Data collection was performed virtually from April 15th to May 8th, 2020. RESULTS. They uncovered an “access gap” that teachers blame on a deficient internet connection and not enough resources at home, but families do not share it and point to telecommuting as the main limitation. DISCUSSION. There is a clear “cognitive gap” acknowledged by teachers and families and a “school gap” that teachers blame on insufficient resources provided by the administration and the schools, and an insufficient experience on on-line education. In conclusion, the confinement caused by the COVID-19 pandemic has brought to light a “digital gap” that many believe overcame or at least minimized. However, the cognitive and the school gaps need actions.
ABSTRACT
Infections caused by SARS-CoV-2 may cause a severe disease, termed COVID-19, with significant mortality. Host responses to this infection, mainly in terms of systemic inflammation, have emerged as key pathogenetic mechanisms, and their modulation is the only therapeutic strategy that has shown a mortality benefit. Herein, we used peripheral blood transcriptomes of critically-ill COVID-19 patients obtained at admission in an Intensive Care Unit (ICU), to identify two transcriptomic clusters characterized by expression of either interferon-related or immune checkpoint genes, respectively. These profiles have different ICU outcome, in spite of no major clinical differences at ICU admission. A transcriptomic signature was used to identify these clusters in an external validation cohort, yielding similar results. These findings reveal different underlying pathogenetic mechanisms and illustrate the potential of transcriptomics to identify patient endotypes in severe COVID-19, aimed to ultimately personalize their therapies.
Subject(s)
COVID-19 , InflammationABSTRACT
Due to the highly variable clinical phenotype of Coronavirus disease 2019 (COVID-19), deepening the host genetic contribution to severe COVID-19 may further improve our understanding about underlying disease mechanisms. Here, we describe an extended GWAS meta-analysis of 3,260 COVID-19 patients with respiratory failure and 12,483 population controls from Italy, Spain, Norway and Germany, as well as hypothesis-driven targeted analysis of the human leukocyte antigen (HLA) region and chromosome Y haplotypes. We include detailed stratified analyses based on age, sex and disease severity. In addition to already established risk loci, our data identify and replicate two genome-wide significant loci at 17q21.31 and 19q13.33 associated with severe COVID-19 with respiratory failure. These associations implicate a highly pleiotropic ~0.9-Mb 17q21.31 inversion polymorphism, which affects lung function and immune and blood cell counts, and the NAPSA gene, involved in lung surfactant protein production, in COVID-19 pathogenesis.
Subject(s)
COVID-19 , Respiratory InsufficiencyABSTRACT
Background: Intensive care unit workers are at high risk of acquiring COVID-19 infection, especially when performing invasive techniques and certain procedures that generate aerosols (<5 µm). Therefore, one of the objectives of the health systems should implement safety practices to minimize the risk of contagion among these health professionals. Monitoring environmental contamination of SARS-CoV-2 may help to determine the potential of the environment as a transmission medium in an area highly exposed to SARS-CoV-2, such as an intensive care unit. The objective of the study was to analyze the environmental contamination by SARS-CoV-2 on surfaces collected in an intensive care unit, which is dedicated exclusively to the care of patients with COVID-19 and equipped with negative pressure of -10 pascals and an air change rate of 20 cycles per hour. Furthermore, all ICU workers were tested for COVID-19 by quantitative RT-PCR and ELISA methods. Results: A total of 102 samples (72 collected with pre-moistened swabs used for collection of nasopharyngeal exudates and 30 with moistened wipes used in the environmental microbiological control of the food industry) were obtained from ventilators, monitors, perfusion pumps, bed rails, lab benches, containers of personal protective equipment, computer keyboards and mice, telephones, workers' shoes, floor and other areas of close contact with COVID-19 patients and healthcare professionals who cared for them. The analysis by quantitative RT-PCR showed no detection of SARS-CoV-2 genome in environmental samples collected by any of the two methods described. Furthermore, none of the ICU workers was infected by the virus. Conclusions: Presence of SARS-CoV-2 on the ICU surfaces could not be determined supporting that a strict cleaning protocol with sodium hypochlorite, a high air change rate and a negative pressure in the ICU are effective in preventing environmental contamination. These facts together with the protection measures used could also explain the absence of contagion among staff inside ICUs.
Subject(s)
COVID-19ABSTRACT
Background: Living in the time of the COVID-19 means experiencing not only a global health emergency but also extreme psychological stress with potential emotional side effects such as sadness, grief, irritability and mood swings. Crucially, lockdown and confinement measures isolate people who become the first and the only ones in charge of their own mental health: people are left alone facing a novel and potentially lethal situation, and, at the same time, they need to develop adaptive strategies to face it, at home. In this view, easy-to-use, inexpensive, and scientifically validated self-help solutions aiming to reduce the psychological burden of coronavirus are extremely necessary. Aims: This pragmatic trial aims to provide the evidence that a weekly self-help virtual reality (VR) protocol can help overcome the psychological burden of the Coronavirus by relieving anxiety, improving well-being and reinforcing social connectedness. The protocol will be based on the “Secret Garden” 360 VR video online (www.covidfeelgood.com) which simulates a natural environment aiming to promote relaxation and self-reflexion. 360° or spherical videos allow the user to control the viewing direction. In this way, the user can explore the content from any angle like a panorama and experience presence and immersion. The “Secret Garden” video is combined with daily exercises that are designed to be experienced with another person (not necessarily physically together), to facilitate a process of critical examination and eventual revision of core assumptions and beliefs related to personal identity, relationships and goals. Methods: This is a multicentric, pragmatic pilot randomized controlled trial involving individuals who experienced the COVID-19 pandemic and underwent a lockdown and quarantine procedures. The trial is approved by the Ethics Committee of the Istituto Auxologico Italiano. Each research group in all the countries joining the pragmatic trial, aims at enrolling at least 30 individuals in the experimental group experiencing the self-help protocol, and 30 in the control group, over a period of 3 months to verify the feasibility of the intervention. Conclusion: The goal of this protocol is for VR to become the “surgical mask” of mental health treatment. Although surgical masks do not provide the wearer with a reliable level of protection against the coronavirus compared with FFP2 or FFP3 masks, surgical masks are very effective in protecting others from the wearer’s respiratory emissions. The goal of the VR protocol is the same: not necessarily to solve complex mental health problems but rather to improve well-being and preserve social connectedness.
Subject(s)
Coronavirus Infections , Anxiety Disorders , COVID-19ABSTRACT
Background. Respiratory failure is a key feature of severe Covid-19 and a critical driver of mortality, but for reasons poorly defined affects less than 10% of SARS-CoV-2 infected patients. Methods. We included 1,980 patients with Covid-19 respiratory failure at seven centers in the Italian and Spanish epicenters of the SARS-CoV-2 pandemic in Europe (Milan, Monza, Madrid, San Sebastian and Barcelona) for a genome-wide association analysis. After quality control and exclusion of population outliers, 835 patients and 1,255 population-derived controls from Italy, and 775 patients and 950 controls from Spain were included in the final analysis. In total we analyzed 8,582,968 single-nucleotide polymorphisms (SNPs) and conducted a meta-analysis of both case-control panels. Results. We detected cross-replicating associations with rs11385942 at chromosome 3p21.31 and rs657152 at 9q34, which were genome-wide significant (P<5x10-8) in the meta-analysis of both study panels, odds ratio [OR], 1.77; 95% confidence interval [CI], 1.48 to 2.11; P=1.14x10-10 and OR 1.32 (95% CI, 1.20 to 1.47; P=4.95x10-8), respectively. Among six genes at 3p21.31, SLC6A20 encodes a known interaction partner with angiotensin converting enzyme 2 (ACE2). The association signal at 9q34 was located at the ABO blood group locus and a blood-group-specific analysis showed higher risk for A-positive individuals (OR=1.45, 95% CI, 1.20 to 1.75, P=1.48x10-4) and a protective effect for blood group O (OR=0.65, 95% CI, 0.53 to 0.79, P=1.06x10-5). Conclusions. We herein report the first robust genetic susceptibility loci for the development of respiratory failure in Covid-19. Identified variants may help guide targeted exploration of severe Covid-19 pathophysiology.