Improved outcomes over time and higher mortality in CMV seropositive allogeneic stem cell transplantation patients with COVID-19; An infectious disease working party study from the European Society for Blood and Marrow Transplantation registry.

Introduction: COVID-19 has been associated with high morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. Methods: This study reports on 986 patients reported to the EBMT registry during the first 29 months of the pandemic. Results: The median age was 50.3 years (min - max; 1.0 - 80.7). The median time from most recent HCT to diagnosis of COVID-19 was 20 months (min - max; 0.0 - 383.9). The median time was 19.3 (0.0 - 287.6) months during 2020, 21.2 (0.1 - 324.5) months during 2021, and 19.7 (0.1 - 383.9) months during 2022 (p = NS). 145/986 (14.7%) patients died; 124 (12.6%) due to COVID-19 and 21 of other causes. Only 2/204 (1%) fully vaccinated patients died from COVID-19. There was a successive improvement in overall survival over time. In multivariate analysis, increasing age (p<.0001), worse performance status (p<.0001), contracting COVID-19 within the first 30 days (p<.0001) or 30 - 100 days after HCT (p=.003), ongoing immunosuppression (p=.004), pre-existing lung disease (p=.003), and recipient CMV seropositivity (p=.004) had negative impact on overall survival while patients contracting COVID-19 in 2020 (p<.0001) or 2021 (p=.027) had worse overall survival than patients with COVID-19 diagnosed in 2022. Discussion: Although the outcome of COVID-19 has improved, patients having risk factors were still at risk for severe COVID-19 including death.

Long-Term Assessment of a Set of CO2 Concentration Sensors in an In-Use Office Building.

The measurement of the CO2 concentration has a wide range of applications. Traditionally, it has been used to assess air quality, with other applications linked to the experimental assessment of occupancy patterns and air renewal rates. More recently, the worldwide dissemination of COVID-19 establishing a relationship between infection risk and the mean CO2 level has abruptly led to the measurement of the CO2 concentration in order to limit the spread of this respiratory disease in the indoor environment. Therefore, the extensive application of this measurement outside of traditional air quality assessment requires an in-depth analysis of the suitability of these sensors for such modern applications. This paper discusses the performance of an array of commercial wall-mounted CO2 sensors, focusing on their application to obtain occupancy patterns and air renovation rates. This study is supported by several long-term test campaigns conducted in an in-use office building located in south-eastern Spain. The results show a spread of 19-101 ppm, with a drift of 28 ppm over 5 years, an offset of 2-301 ppm and fluctuations up to 80 ppm in instantaneous measurements not related to concentration changes. It is proposed that values averaged over 30 min, using a suitable reference value, be used to avoid erroneous results when calibration is not feasible.

Anxiety, Distress and Stress among Patients with Diabetes during COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

The prevalence of mental health disorders has increased during the COVID-19 pandemic. Patients with chronic diseases, such as diabetes, are a particularly vulnerable risk group. This study aims to assess the levels and prevalence of anxiety, distress, and stress in patients with diabetes during the COVID-19 pandemic. A systematic review was conducted in CINAHL, Cochrane, LILACS, Medline, SciELO, and Scopus in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Thirty-seven articles with a total of 13,932 diabetic patients were included. Five meta-analyses were performed. The prevalence of anxiety was 23% (95% CI = 19-28) in T1DM and 20% (95% CI = 6-40) in T2DM patients. For diabetes distress it was 41% (95% CI = 24-60) for T1DM and 36% in T2DM patients (95% CI = 2-84). For stress, the prevalence was 79% (95% CI = 49-98) in T1DM patients. People with diabetes have significant psychiatric comorbidity as well as psychological factors that negatively affect disease management, increasing their vulnerability in an emergency situation. To establish comprehensive care in diabetic patients addressing mental health is essential, as well as including specific policy interventions to reduce the potential psychological harm of the COVID-19 pandemic.

Suitability Evaluation of Different Measured Variables to Assess the Occupancy Patterns of a Building: Analysis of a Classroom of a School in Madrid during the COVID-19 Pandemic

Building occupancy is one of the relevant variables to understand the energy performance of buildings and to reduce the current gap between simulation-based and actual energy performance. In this study, the occupancy of a classroom in an educational center monitored over a full year was experimentally assessed. The classroom had different occupancy levels during the school year, with a theoretical minimum of eleven students, and no occupancy during vacations and weekends. Different variables such as indoor air temperature, relative humidity, CO2 concentration, overall electrical energy consumption of the educational center, electrical energy consumption of the building in which the monitored classroom is located, and heating energy consumption were recorded. We analyzed which of these variables were possible indicators of classroom occupancy, using the school timetable as a theoretical reference value for the validation of the results. Based on previous studies, one-hour moving averages are used to better identify the occupancy patterns by smoothing the fluctuations that are not a consequence of a change in the classroom occupancy. Histograms of each variable are used to identify the variable ranges associated within the occupancy: occupied or empty. The concentration of CO2 and electric measurements, identified in previous works as suitable to assess the occupancy patterns of rooms like offices with lower levels of occupancy, are recognized as potential occupancy indicators. It is therefore concluded that a higher level of space occupancy does not affect the result, and the same variables are identified as potential occupancy indicators.

Thoracic Anesthesia during the COVID-19 Pandemic: 2021 Updated Recommendations by the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) Thoracic Subspecialty Committee.

The novel coronavirus pandemic has radically changed the landscape of normal surgical practice. Lifesaving cancer surgery, however, remains a clinical priority, and there is an increasing need to fully define the optimal oncologic management of patients with varying stages of lung cancer, allowing prioritization of which thoracic procedures should be performed in the current era. Healthcare providers and managers should not ignore the risk of a bimodal peak of mortality in patients with lung cancer; an imminent spike due to mortality from acute coronavirus disease 2019 (COVID-19) infection, and a secondary peak reflecting an excess of cancer-related mortality among patients whose treatments were deemed less urgent, delayed, or cancelled. The European Association of Cardiothoracic Anaesthesiology and Intensive Care Thoracic Anesthesia Subspecialty group has considered these challenges and developed an updated set of expert recommendations concerning the infectious period, timing of surgery, vaccination, preoperative screening and evaluation, airway management, and ventilation of thoracic surgical patients during the COVID-19 pandemic.

Behavioral Risk Factors and Adherence to Preventive Measures: Evidence From the Early Stages of the COVID-19 Pandemic.

Behavioral risk factors, such as smoking, excessive alcohol consumption, physical inactivity, obesity, and unhealthy food intake are added risk factors for severe outcomes of COVID-19 infections. Preventive measures to avoid infections are therefore particularly important for individuals engaging in behavioral risk factors. We seek to determine whether behavioral risk factors (BRFs) play a significant role in the adherence to preventive COVID-19 measures in a population aged 50 and above. The SHARE wave 8 (Survey of Health, Ageing and Retirement in Europe) and SHARE COVID-19 Survey served as the database, resulting in an analytical sample of 17,588 respondents from 23 European countries plus Israel. Of these 36.04% engaged in at least one BRF and 16.68% engaged in 3 or more BRFs. Multilevel logistic regressions revealed that engagement in one BRF was significantly associated with less adherence to hygiene preventive measures, i.e., hand-sanitizing, hand-washing and covering coughs and sneezes (OR: 0.86; 95% CI: 0.78; 0.94), as was engagement in two BRFs (OR: 0.85; 95% CI: 0.74; 0.97) and three or more BRFs (OR: 0.72; 95% CI: 0.59; 0.88). No such association was found between engagement in BRFs and adherences to social isolation preventive measures, i.e., avoiding meeting more than five people, visiting others or going shopping, or regulated preventive measures, i.e., wearing a mask and keeping physical distance. The found association was also stronger when three or more BRFs were engaged in (1 vs. 3 BRFs: χ2 = 3.43, p = 0.06; 2 vs. 3 BRFs: χ2 = 6.05; p = 0.01). The study gives insight into the protective behavior of a population with inherent vulnerability during a global health emergency. It lays the foundation for follow-up research about the evolution of adherence to preventive measures as the pandemic progresses and about long-term behavioral changes. In addition, it can aide efforts in increasing preventive compliance by raising awareness of the added risk behavioral risk factors pose.

COVID-19 and stem cell transplantation; results from an EBMT and GETH multicenter prospective survey.

This study reports on 382 COVID-19 patients having undergone allogeneic (n = 236) or autologous (n = 146) hematopoietic cell transplantation (HCT) reported to the European Society for Blood and Marrow Transplantation (EBMT) or to the Spanish Group of Hematopoietic Stem Cell Transplantation (GETH). The median age was 54.1 years (1.0-80.3) for allogeneic, and 60.6 years (7.7-81.6) for autologous HCT patients. The median time from HCT to COVID-19 was 15.8 months (0.2-292.7) in allogeneic and 24.6 months (-0.9 to 350.3) in autologous recipients. 83.5% developed lower respiratory tract disease and 22.5% were admitted to an ICU. Overall survival at 6 weeks from diagnosis was 77.9% and 72.1% in allogeneic and autologous recipients, respectively. Children had a survival of 93.4%. In multivariate analysis, older age (p = 0.02), need for ICU (p < 0.0001) and moderate/high immunodeficiency index (p = 0.04) increased the risk while better performance status (p = 0.001) decreased the risk for mortality. Other factors such as underlying diagnosis, time from HCT, GVHD, or ongoing immunosuppression did not significantly impact overall survival. We conclude that HCT patients are at high risk of developing LRTD, require admission to ICU, and have increased mortality in COVID-19.

Risk factors and outcome of COVID-19 in patients with hematological malignancies.

BACKGROUND: Prognostic factors of poor outcome in patients with hematological malignancies and COVID-19 are poorly defined. PATIENTS AND METHODS: This was a Spanish transplant group and cell therapy (GETH) multicenter retrospective observational study, which included a large cohort of blood cancer patients with laboratory-confirmed SARS-CoV-2 infection through PCR assays from March 1st 2020 to May 15th 2020. RESULTS: We included 367 pediatric and adult patients with hematological malignancies, including recipients of autologous (ASCT) (n = 58) or allogeneic stem cell transplantation (allo-SCT) (n = 65) from 41 hospitals in Spain. Median age of patients was 64 years (range 1-93.8). Recipients of ASCT and allo-SCT showed lower mortality rates (17% and 18%, respectively) compared to non-SCT patients (31%) (p = 0.02). Prognostic factors identified for day 45 overall mortality (OM) by logistic regression multivariate analysis included age > 70 years [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.2-3.8, p = 0.011]; uncontrolled hematological malignancy (OR 2.9, 95% CI 1.6-5.2, p < 0.0001); ECOG 3-4 (OR, 2.56, 95% CI 1.4-4.7, p = 0.003); neutropenia (< 0.5 × 109/L) (OR 2.8, 95% CI 1.3-6.1, p = 0.01); and a C-reactive protein (CRP) > 20 mg/dL (OR 3.3, 95% CI 1.7-6.4, p < 0.0001). In multivariate analysis of 216 patients with very severe COVID-19, treatment with azithromycin or low dose corticosteroids was associated with lower OM (OR 0.42, 95% CI 0.2-0.89 and OR 0.31, 95% CI 0.11-0.87, respectively, p = 0.02) whereas the use of hidroxycloroquine did not show significant improvement in OM (OR 0.64, 95% CI 0.37-1.1, P = 0.1). CONCLUSIONS: In most patients with hematological malignancies COVID-19 mortality was directly driven by older age, disease status, performance status, as well as by immune (neutropenia) parameters and level of inflammation (high CRP). Use of azithromycin and low dose corticosteroids may be of value in very severe COVID-19.

Thoracic Anesthesia of Patients with Suspected or Confirmed 2019 Novel Coronavirus Infection: Preliminary Recommendations for Airway Management by the EACTA Thoracic Subspecialty Committee

The novel coronavirus has caused a pandemic around the world. Management of patients with suspected or confirmed coronavirus infection who have to undergo thoracic surgery will be a challenge for the anesthesiologists. infection who have to undergo thoracic surgery will be a challenge for the anesthesiologists. The thoracic subspecialty committee of European Association of Cardiothoracic Anaesthesiology (EACTA) has conducted a survey of opinion in order to create recommendations for the anesthetic approach to these challenging patients. It should be emphasized that both the management of the infected patient with COVID-19 and the self-protection of the anesthesia team constitute a complicated challenge. The text focuses therefore on both important topics.