ABSTRACT
BackgroundUpadacitinib (UPA), a Janus kinase inhibitor, was effective and well tolerated in patients (pts) with non-radiographic axial spondyloarthritis (nr-axSpA) through 14 weeks (wks) of treatment.[1]ObjectivesThis analysis assessed the efficacy and safety of UPA vs placebo (PBO) through 1 year.MethodsThe SELECT-AXIS 2 nr-axSpA study included a 52-wk randomized, double-blind, PBO-controlled period. Enrolled adults had a clinical diagnosis of active nr-axSpA fulfilling the 2009 ASAS classification criteria, objective signs of inflammation based on MRI sacroiliitis and/or elevated C-reactive protein, and an inadequate response to NSAIDs. One-third of pts had an inadequate response to biologic DMARDs. Pts were randomized 1:1 to UPA 15 mg once daily or PBO. Concomitant medications, including NSAIDs, had to be kept stable through wk 52. The study protocol outlined that pts who did not achieve ASAS20 at any two consecutive study visits between wks 24 to 52 should receive rescue therapy with NSAIDs, corticosteroids, conventional synthetic/biologic DMARDs, or analgesics. Cochran-Mantel-Haenszel (CMH) test with non-responder imputation incorporating multiple imputation (NRI-MI) was used to handle missing data and intercurrent events for binary efficacy endpoints. Mixed-effect model repeated measures (MMRM) was used to assess continuous efficacy endpoints. NRI was used for binary endpoints after rescue and as observed analysis excluding data after rescue for continuous endpoints. Treatment-emergent adverse events (TEAEs) are reported through wk 52.ResultsOf the 314 pts randomized, 259 (82%;UPA, n=130;PBO, n=129) completed wk 52 on study drug. More pts achieved an ASAS40 response with UPA vs PBO from wks 14 to 52 with a 20% treatment difference at wk 52 (63% vs 43%;nominal P <.001;Figure 1). The proportion of pts achieving ASDAS inactive disease with UPA remained higher than PBO at wk 52 (33% vs 11%;nominal P <.0001;Figure 1). Consistent improvements and maintenance of efficacy were also seen across other disease activity measures. Between wks 24 and 52, fewer pts on UPA (9%) than PBO (17%) received rescue therapy. A similar proportion of pts in each treatment group had a TEAE (Table 1). Infections were the most common TEAE;the rates of serious infections and herpes zoster were higher with UPA vs PBO, although no new serious infections were reported from wks 14 to 52. COVID-19 events were balanced between treatment groups. No opportunistic infections, malignancy excluding non-melanoma skin cancer, adjudicated major adverse cardiovascular events, inflammatory bowel disease, or deaths were reported. Two pts (1.3%) on PBO had adjudicated venous thromboembolic events.ConclusionUPA showed consistent improvement and maintenance of efficacy vs PBO through 1 year across multiple disease activity measures. No new safety risks were identified with longer-term UPA exposure. These results continue to support the benefit of UPA in pts with active nr-axSpA.Reference[1]Deodhar A, et al. Lancet. 2022;400(10349):369–379.Table 1.Safety through week 52Event, n (%)PBO (n = 157)UPA 15 mg QD (n = 156)Any AE103 (66%)107 (69%)Serious AE6 (3.8%)6 (3.8%)AE leading to D/C4 (2.5%)6 (3.8%)COVID-19-related AE22 (14%)24 (15%)Deaths00Infection60 (38%)68 (44%) Serious infection1 (0.6%)2 (1.3%) Herpes zoster1 (0.6%)5 (3.2%)Malignancy other than NMSC00NMSC1 (0.6%)0Hepatic disorder7 (4.5%)6 (3.8%)Neutropenia1 (0.6%)8 (5.1%)MACE (adjudicated)00VTE (adjudicated)2 (1.3%)a0Uveitisb3 (1.9%)2 (1.3%)Inflammatory bowel disease00aBoth patients had non-serious events of deep vein thrombosis in the lower limb with risk factors including obesity and prior deep vein thrombosis in one patient and concomitant COVID-19 infection in the other patient.bThree events of uveitis occurred in each treatment group (among n = 3 patients in the PBO group and n = 2 patients in the UPA group);two events in the PBO group and one in the UPA group occurred in patients with a history of uveitis.AcknowledgementsAbbVie funded this study and participated in the study design, res arch, analysis, data collection, interpretation of data, review, and approval of the . All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship. Medical writing support was provided by Julia Zolotarjova, MSc, MWC, of AbbVie.Disclosure of InterestsFilip van den Bosch Speakers bureau: AbbVie, Amgen, Galapagos, Janssen, Lilly, Merck, MoonLake, Novartis, Pfizer, and UCB., Consultant of: AbbVie, Amgen, Galapagos, Janssen, Lilly, Merck, MoonLake, Novartis, Pfizer, and UCB., Atul Deodhar Consultant of: AbbVie, Amgen, Aurinia, BMS, Celgene, GSK, Janssen, Lilly, MoonLake, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Bristol Myers Squibb, Celgene, GSK, Lilly, Novartis, Pfizer, and UCB, Denis Poddubnyy Speakers bureau: AbbVie, Biocad, BMS, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, MSD, Medscape, MoonLake, Novartis, Peervoice, Pfizer, Roche, Samsung Bioepis, and UCB, Consultant of: AbbVie, Biocad, BMS, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, MSD, Medscape, MoonLake, Novartis, Peervoice, Pfizer, Roche, Samsung Bioepis, and UCB, Grant/research support from: AbbVie, Lilly, MSD, Novartis, and Pfizer., Walter P Maksymowych Consultant of: AbbVie, BMS, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Novartis, Pfizer, and UCB, Employee of: Chief Medical Officer of CARE Arthritis Limited, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, and UCB, Employee of: Director of Imaging Rheumatology BV, Tae-Hwan Kim Speakers bureau: AbbVie, Celltrion, Kirin, Lilly, and Novartis., Mitsumasa Kishimoto Consultant of: AbbVie, Amgen, Asahi-Kasei Pharma, Astellas, Ayumi Pharma, BMS, Chugai, Daiichi Sankyo, Eisai, Gilead, Janssen, Lilly, Novartis, Ono Pharma, Pfizer, Tanabe-Mitsubishi, and UCB., Xenofon Baraliakos Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, and UCB, Consultant of: AbbVie, BMS, Chugai, MSD, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie and Novartis, Yuanyuan Duan Shareholder of: AbbVie, Employee of: AbbVie, Kristin D'Silva Shareholder of: AbbVie, Employee of: AbbVie, Peter Wung Shareholder of: AbbVie, Employee of: AbbVie, In-Ho Song Shareholder of: AbbVie, Employee of: AbbVie.
ABSTRACT
Background: This study aimed to identify the incidence rate of post-coronavirus disease-2019 (COVID-19) conditions in the Republic of Korea (ROK) Army and to investigate the trend of the incidence rate according to changes in dominant variants. Method(s): We used the results of a 19-item, self-completed survey of those who had recovered from COVID-19 in the ROK Army between March 24, 2020, and April 30, 2022. We used both descriptive and multiple logistic regression analyses to identify factors associated with the incidence rate of post-COVID-19 conditions. Result(s): Among the total of 48,623 COVID-19 episodes in the ROK Army, the overall incidence rate of post-COVID-19 conditions was 32.9%. Based on the survey, the incidence of cough was the highest at 15.4%, followed by fatigue (15.1%) and sputum (13.8%). The delta variant had the highest incidence rate of post-COVID-19 conditions at 50.7%, whereas the omicron variant had the lowest at 19.7%. Concerning the type of post-COVID-19 condition, the neuropsychiatric symptoms had the highest incidence at 27.4% when the delta variant was dominant, and the respiratory symptoms were highest at 37.3% when the omicron variant was dominant. In the case of smell and taste symptoms, the incidence rate was high at 21.1% only when the delta variant was predominant. Conclusion(s): The overall incidence rate of post-COVID-19 conditions in the ROK Army was 32.9%. When the delta variant was dominant, the overall incidence as well as the proportion of neuropsychiatric symptoms were high. However, as the omicron variant became dominant, the overall incidence decreased, but the proportion of respiratory symptoms increased.Copyright © Korean Medical Association.
ABSTRACT
Research has examined the detrimental effects of the coronavirus disease (COVID-19) pandemic on health and physical fitness in adolescents;however, studies comparing these parameters before and after the COVID-19 outbreak have been scarce. Therefore, this study investigated differences in perceived health status, perceived physical fitness, and participation in physical activity among adolescents in the Republic of Korea before and after the COVID-19 outbreak. We chose a sample of data from 2102 adolescents aged 14-19, collected as part of a national survey by the Republic of Korea Ministry of Culture, Sports, and Tourism from 2019 to 2021. We focused on five items from the survey related to health awareness and physical activity. Although perceived health status was lower in 2021 than in 2019 or 2020, there were no differences in perceived physical fitness during the three years of the study. Regular participation in physical activity was less common in 2020 than in 2019 or 2021. The proportion of adolescents reporting sufficient rest and sleep was lower in 2021 than in 2020. In addition, fewer adolescents reported eating regular meals and engaging in nutritional supplementation in 2021 than in 2019 and 2020. Rates of abstinence from alcohol and smoking cessation were higher in 2021 than in 2019 or 2020. For all three years, adolescents reported the following as the primary reasons for engaging in regular physical activity (in order): "maintenance of mental health", "maintenance of physical health", "help in daily life", and "reduction of medical expenses". In preparation for the post-COVID-19 era, these results highlight the need to prepare measures and countermeasures to promote health and physical activity among adolescents in the Republic of Korea.Copyright ©2023 The Author(s). Published by MRE Press.
ABSTRACT
Background: This study aimed to identify the incidence rate of post-coronavirus disease-2019 (COVID-19) conditions in the Republic of Korea (ROK) Army and to investigate the trend of the incidence rate according to changes in dominant variants. Method(s): We used the results of a 19-item, self-completed survey of those who had recovered from COVID-19 in the ROK Army between March 24, 2020, and April 30, 2022. We used both descriptive and multiple logistic regression analyses to identify factors associated with the incidence rate of post-COVID-19 conditions. Result(s): Among the total of 48,623 COVID-19 episodes in the ROK Army, the overall incidence rate of post-COVID-19 conditions was 32.9%. Based on the survey, the incidence of cough was the highest at 15.4%, followed by fatigue (15.1%) and sputum (13.8%). The delta variant had the highest incidence rate of post-COVID-19 conditions at 50.7%, whereas the omicron variant had the lowest at 19.7%. Concerning the type of post-COVID-19 condition, the neuropsychiatric symptoms had the highest incidence at 27.4% when the delta variant was dominant, and the respiratory symptoms were highest at 37.3% when the omicron variant was dominant. In the case of smell and taste symptoms, the incidence rate was high at 21.1% only when the delta variant was predominant. Conclusion(s): The overall incidence rate of post-COVID-19 conditions in the ROK Army was 32.9%. When the delta variant was dominant, the overall incidence as well as the proportion of neuropsychiatric symptoms were high. However, as the omicron variant became dominant, the overall incidence decreased, but the proportion of respiratory symptoms increased.Copyright © Korean Medical Association.
ABSTRACT
Background: This study aimed to identify the incidence rate of post-coronavirus disease-2019 (COVID-19) conditions in the Republic of Korea (ROK) Army and to investigate the trend of the incidence rate according to changes in dominant variants.Methods: We used the results of a 19-item, self-completed survey of those who had recovered from COVID-19 in the ROK Army between March 24, 2020, and April 30, 2022. We used both descriptive and multiple logistic regression analyses to identify factors associated with the incidence rate of post-COVID-19 conditions.Results: Among the total of 48,623 COVID-19 episodes in the ROK Army, the overall incidence rate of postCOVID-19 conditions was 32.9%. Based on the survey, the incidence of cough was the highest at 15.4%, followed by fatigue (15.1%) and sputum (13.8%). The delta variant had the highest incidence rate of postCOVID-19 conditions at 50.7%, whereas the omicron variant had the lowest at 19.7%. Concerning the type of post-COVID-19 condition, the neuropsychiatric symptoms had the highest incidence at 27.4% when the delta variant was dominant, and the respiratory symptoms were highest at 37.3% when the omicron variant was dominant. In the case of smell and taste symptoms, the incidence rate was high at 21.1% only when the delta variant was predominant.Conclusion: The overall incidence rate of post-COVID-19 conditions in the ROK Army was 32.9%. When the delta variant was dominant, the overall incidence as well as the proportion of neuropsychiatric symptoms were high. However, as the omicron variant became dominant, the overall incidence decreased, but the proportion of respiratory symptoms increased.
ABSTRACT
The COVID-19 pandemic has dramatically altered the way how we communicate with others. From ZOOM to Meta-verse, an increasing number of people are shifting to the virtual world for work and personal life. However, as a technology, virtual reality is still considered merely a device for immersive gaming for the young generation. Thus, despite itspotential, virtual reality is hardly discussed as acore technology enabling Metaverse, which provides a virtual world for everyone. Therefore, it is necessary to examine prior studies for an understanding full spectrum of virtual reality research. There are three primary aims of this study: 1. To trace the history of virtual reality research for providing a holisticview oftheresearch trajectory. 2. Todiscover prevalent topics during the last 34 years as well as highly cited papers and authors. 3. To find hub topics for identifying the direction of interdisciplinary research. © 2022, Tamkang University. All rights reserved.
ABSTRACT
Telemedicine has long been of interest to the U.S. general public. Yet, despite the advent of high-speed internet and mobile device technology, telemedicine did not reach its full potential until the COVID-19 pandemic spurred its unparalleled adoption. This sudden shift in the setting of healthcare delivery raises questions regarding possible changes in clinical decision-making. Using a unique set of patient-provider encounter data from the U.S. in 2020 and 2021, we examine the effect of telemedicine on antibiotic prescription errors for urinary tract infections. After accounting for potential endogeneity issues using provider fixed effects and an instrumental variable approach, we find a significantly lower likelihood of prescription errors with telemedicine relative to in-person encounters. We also find heterogeneous effects by a provider's patient volume and the patient-provider relationship. © 2023 IEEE Computer Society. All rights reserved.
ABSTRACT
Currently, in the domestic construction market, several companies are actively investing in the proptech sector to develop real estate development and high-tech technology, and the domestic proptech sector is continuously growing. However, the construction market is still dominated by sales projects that rely on short-term finance, and there is a lack of discussion between the government and companies on ways to improve productivity. In addition, productivity improvement, operation, and management are vulnerable due to reckless investment focused only on profitability of small companies, and there are significant differences in productivity, operational efficiency, and size among domestic companies. This study aims to study the operational status and productivity improvement measures of domestic proptech construction companies. Therefore, among domestic construction companies, construction companies belonging to the Korea PropTech Forum were selected as analysis targets and an analysis of corporate productivity was conducted. As an analysis method, the Malmquist productivity index analysis, which can analyze changes in productivity and efficiency over a specific period through various outputs, was used. As variables used in the analysis, capital and number of employees was derived from input factors, assets, operating income, and net income were derived from output factors. Through the Mamquist productivity index analysis, trend analysis was conducted according to time point changes, and the degree of change in productivity between different time points was compared and analyzed. Results show that productivity improved due to the overall increase in MPI by year, but the index of flows such as MPI during the entire period was different by period. This means that the factors affecting productivity improvement have changed by period, sensitively reacting to external factors such as the construction industry or the COVID-19 situation. This study is significant because it identifies changes in the productivity index of proptech construction companies and suggests efficient operation of companies and ways to improve productivity. © 2023, Success Culture Press. All rights reserved.
ABSTRACT
Recently, with the outbreak of the COVID-19 pandemic, various quarantine measures have been implemented to reduce the spread of the virus. As a part of efforts, the preference for touchless technology has been emerging. In this paper, we propose a touchless elevator control system using CNN-based hand gesture recognition. Experimental results show that the hand recognition AP and FPS on the Jetson TX2 board are 81.87% and 11.8FPS, respectively. We demonstrate that an elevator model could be controlled by virtual elevator buttons utilizing CNN-based hand gesture recognition. The proposed method can be applied to commercial elevators as an approach to prevent the spread of viruses from elevator buttons. © 2023 IEEE.
ABSTRACT
Purpose: This research aims to understand consumer responses to corporate social responsibility (CSR) during an unprecedented public health crisis. Specifically, two studies were conducted to investigate how companies' different CSR initiatives in the early stage of COVID-19 would influence consumers' advocacy intention according to their focus (i.e. targets of institutional CSR). The first study examined the moderating role of individuals' CSR expectancy on the effects of companies' CSR initiatives on consumers' brand advocacy intention. The second study further extends the findings of Study 1 by examining the mediating role of perceived brand motive. Design/methodology/approach: Two between-subject online experiments were conducted to explore the impact of three types of institutional CSR initiatives (i.e. community, employee and consumer-centered CSRs) on brand advocacy. Study 1 (N = 380) examined the moderating role of CSR expectancy in influencing consumer responses to institutional CSR initiatives. Study 2 (N = 384) explored the underlying mechanism through examining the mediating role of a company's value-driven motivation in the process. Findings: Study 1 indicated that institutional CSR, regardless of type, was more effective in generating a more significant brand advocacy intention than a promotional message, measured as a baseline. The impact of different kinds of institutional CSR on consumers' brand advocacy intentions was significantly moderated by their CSR-related expectations. Specifically, individuals with moderate to high CSR expectancy showed higher brand advocacy intentions in both consumer- and employee-centered CSR initiatives than the promotional message. In comparison, those with low CSR expectancy only showed higher brand advocacy intentions in the community-centered CSR initiative. In addition, as individuals' CSR expectations rose, the mediation effect of the perceived value-driven motivation became stronger. Research limitations/implications: The current study includes guiding principles to help companies effectively respond to COVID-19 as corporate citizens by demonstrating the importance of individuals' CSR expectancy across three CSR initiatives. This study used real-life examples of how leading companies were stepping up CSR efforts and suggested an approach that aligns CSR behaviors with the urgent and fundamental human needs of COVID-19. Originality/value: In line with the CSR goal of maximizing benefits for stakeholders, this study's findings signal that situational changes determine CSR expectations and that companies must be highly susceptible to the changes in consumers' expectations of CSR and their appraisal process of CSR motives to maximize its CSR value. © 2022, Emerald Publishing Limited.
ABSTRACT
The COVID-19 pandemic has accelerated the use of contactless service robots in hospitality industries. However, the key drivers of consumer behaviors against service robots have been ill-understood. This study examines the interactive relationships between the physical (visual features) and psychological (service autonomy) dimensions of service-robot anthropomorphism and their impacts on consumer acceptance of service robots. Adopting an experimental vignette method (EVM) with 402 participants, the study reveals that the impacts of visual features on consumers' intention are affected by the level of service robots' autonomy;particularly, consumers showed the highest intention when the robots have medium visual features and high autonomy while their intention became lower for the same level of visual features with low autonomy. Interestingly, consumers showed the lowest intention with high level visual features, regardless of the levels of autonomy. Our results also show that human identity threats and consumer resistance play a significant counterproductive mechanism between service robot anthropomorphism and consumers' intention. © 2022 Elsevier Ltd
ABSTRACT
Introduction: Access to efficient and affordable transportation options has long been a challenge for many individuals with vision loss. In spring 2020, the COVID-19 pandemic caused a quick shift in the availability and safety of transportation. Methods: Using the constant comparison method, open-ended responses from 1,162 participants in the Flatten Inaccessibility study were coded. Responses were from participants who had concerns about transportation. Results: Ten themes and corresponding subthemes emerged from the data. Themes were interdependent in that the extent of concerns differed based on respondents' support networks, transportation availability, and financial circumstances. Discussion: The COVID-19 pandemic brought to the forefront both systemic and COVID-19 transportation challenges about which those with visual impairments experienced or had concerns or both. Implications for Practitioners: It is imperative that professionals support those with visual impairments to develop alternative plans for when their typical transportation options are disrupted.
ABSTRACT
Warning: This paper contains content that may be offensive or upsetting. Social media has become an essential data source for understanding many aspects of our lives, from personal opinions to local patterns. However, it also contains more subjective and biased information than traditional media due to community bubbles and echo chambers. This study aims to examine the correlation between media bias on Twitter and COVID-19-related critical events. We used an open-Access dataset of COVID-19 tweets from March 2020 to July 2021. We first developed a classification model to identify media bias using an attention-based bidirectional long short-Term memory (BiLSTM) model. Using this classification model, we classified 350k geo-Tagged tweets into two classes: "biased"and "unbiased", focusing on four countries: The US, UK, Canada, and India. In our study, we found that critical events, such as the sharp increase of the coronavirus death toll, would exert the rise of biased information on Twitter. Additionally, we found that in the US, the states' bachelor degree per capita correlated with the ratio of biased tweets, which is consistent with the Dunning-Kruger effect. The unemployment rate was only found positively correlated with the ratio of biased tweets in the UK. Presumably, other factors (e.g., income inequality, social trust, etc.) should be introduced to understand the dissemination of biased tweets. © 2022 ACM.
ABSTRACT
Background. The coronavirus disease 2019 (COVID-19) outbreak reached peak levels in South Korea as the Delta variant, dominant from late August until the end of 2021, was rapidly overtaken by the Omicron variant at the start of 2022. In studies conducted near the start of the pandemic, the occurrence of bacteremia in COVID-19 patients was relatively low. We aimed to determine if there was a change in the rate of bacteremia in COVID-19 patients with the progression of the pandemic. Methods. We performed a retrospective study of patients who were diagnosed with COVID-19 at a referral hospital between September 2021 and March 2022. Blood culture results were recorded, along with demographic characteristics and clinical outcomes. Contamination was considered when a single blood culture was positive for coagulase-negative staphylococci (CoNS), Corynebacterium species, or Bacillus species. Clinically relevant bacteremia was defined as bacteremia due to clinically significant pathogens between 7 days before COVID-19 diagnosis to 14 days after diagnosis. Results. Among the 360 patients included in the study, 46 cases from 43 (11.9%) patients were considered to be clinically relevant bacteremia. Enterococcus faecalis (17.4%) and CoNS (17.4%) were the most common pathogens, followed by Acinetobacter baumannii (15.2%), Staphylococcus aureus (10.7%) and Escherichia coli (10.7%). The median number of days from COVID-19 diagnosis to identification of bacteremia was 2 days. There was no significant difference in the rate of bacteremia between the Delta (September-December 2021) and Omicron variant eras (January-March 2022) (12.2% vs. 11.7%, P = .88). In the subgroup analysis of patients who received more than 2 days of intensive care, there was no statistical difference in the rate of bacteremia (14.5% [9/62] in the Delta variant era vs. 16.9% [14/83] in the Omicron variant era;P = .70). Mortality was significantly higher in patients with clinically relevant bacteremia (48.8% vs. 19.2%, P < .001). Conclusion. Many COVID-19 patients had bacteremia in the Omicron variant era, especially in the intensive care unit. Clinicians should suspect bacterial coinfection when a COVID-19 patient is clinically aggravated.
ABSTRACT
Because disinfectants have been essential during the COVID-19 pandemic, the global demand for benzalkonium chlorides (BACs) has significantly increased. BACs can inactivate coronaviruses, but are known as toxic. In this study, we investigated the adsorption mechanisms of BAC12, BAC14, and BAC16 in water using powdered activated carbon (PAC). The effects of the reaction time, pH, and temperature on the adsorption kinetics of BACs were examined. The adsorption reaction followed pseudo-second-order kinetics, and better fitted to the Langmuir isotherm than the Freundlich isotherm. The best adsorption of BACs was achieved at neutral pH conditions. Thermodynamic analysis revealed that adsorption of BACs onto PAC is a spontaneous and endothermic process. Competitive adsorption experiments revealed that BACs with longer alkyl chains were adsorbed more effectively onto PAC than shorter alkyl chain BACs, implying that, while the electrostatic interaction is an important adsorption mechanism for BAC12, van der Waals interaction plays a more important role during the adsorption of BAC14 and BAC16. Finally, we observed the partial detoxification (69%) BAC in adsorption treated water with PAC using a Microtox test. © 2022 Korean Society of Environmental Engineers.
ABSTRACT
Background: As COVID-19 is associated with a prothrombotic condition and some critically ill patients may even undergo extracorporeal oxygenation treatment, heparin is the essential for treatment in these situations. The prevalence of anti-platelet factor 4 (PF4)/heparin antibodies associated with thrombotic tendency may be present in patients hospitalized for COVID-19 without heparin therapy. Lupus anticoagulant (LA) included in the diagnostic criteria for antiphospholipid syndrome, which is one of the common causes of thrombophilia, is also commonly detected during SARS-CoV- 2 infection. Most patients hospitalized for COVID-19 showed elevated D-dimer and prolonged activated partial thromboplastin time (aPTT), However, there were no studies on the association of SARS-CoV- 2 infection with LA and anti-PF4/ heparin antibodies. Aim(s): The purpose of this study was to analyze the expression of LA and anti-PF4/ heparin antibodies associated with thrombotic tendency in COVID-19 patients. Method(s): We performed LA test (Instrumentation Laboratory, Bedford, MA) and LIFECODES PF4 IgG assay (Immucor, Norcross, GA) on 46 COVID-19 patients admitted to Asan Medical Center and analyzed their frequency. Result(s): Of a total of 46 COVID-19 patients, 26 patients (56.5%) were positive for LA test, 3 patients (6.5%) for anti-PF4/ heparin antibodies. In particular, anti-PF4/ heparin antibodies was detected only in LA-negative patients and showed low optical density values (3 out of 20 LA-negative patients, 15.0%). All three patients positive for anti-PF4/ heparin antibodies had no history of heparin treatment. Conclusion(s): In COVID-19- patients, anti-PF4/ heparin antibody test does not predict clinically relevant HIT antibodies. Anti-PF4/ heparin antibodies appear in LA-negative COVID-19 patients, so they are carefully expected to serve as LA-independent indicators. (Table Presented).
ABSTRACT
Background: Sarcopenia is a prevalent complication in chronic kidney disease (CKD) and a central component of the frailty phenotype associated with adverse clinical outcomes. In the era of COVID, there is a critical need for practical, safe, interactive, and personalized home-based exercise targeting improvements in physical function in vulnerable patients living with CKD. Method(s): The ESTEEM-VIDA CKD pilot randomized clinical trial tests the efficacy of a home-based, video-supervised, and personalized exercise program on cardiorespiratory fitness (CRF) and physical performance in patients with moderatesevere CKD. Exercise (EX, n=12) consisted of 30-40min exercise sessions, thrice a week for 12 weeks: high-intensity interval training, strength training, and moderate intensity walking. One week of video-supervised exercise alternates with one week of self-directed exercise. Each one-week video-supervised session was conducted by exercise trainers using a videoconference tool, while self-directed exercise weeks used pre-recorded exercise videos. Controls (CTL, n=5) received diet and exercise counseling at baseline. Pre- and post-intervention CRF (VO2peak) and total work were measured using a graded cycle ergometer test and physical performance was assessed by the 6-minutes walking distance (6MWT) test. The effect of exercise on change in CRF and 6MWT using linear mixed effects models was tested. Result(s): Mean age was 62 +/-10y with 47% females and 53% with diabetes. Mean eGFR was 34.4+/-11.8 ml/min per 1.73m2. Mean total work and 6MWT at baseline were 31.7 +/-17kJ and 494 +/-51m, respectively. EX was associated with a 6.9kJ increase in total work (95% CI 2, 12;p=0.008) compared to CTL independent of change in VO2peak, suggesting improved muscular efficiency following training. EX was associated with a 43m increase in 6MWT (95% CI 11, 75;p=0.008) compared to CTL. VO2peak did not differ between groups (p=0.99). Conclusion(s): Preliminary findings suggest a home-based, video supervised, personalized exercise program is feasible and efficacious in improving muscular and physical performance in CKD. It provides a tool for studying metabolic and molecular health and may shed new light on the pathophysiology of sarcopenia in CKD.
ABSTRACT
"The review highlights the relevance and significance of the new coronavirus infection, characterizes the virus, the route of invasion, and organ damage. The attention is focused on the risk factors of viral invasion, and the premorbid background of patients. Special attention is paid to the virus interaction with the ACE-2 receptors and the role of the latter in multiorgan dysfunction. The role of the immune system in the antiviral response is covered. We also considered independent predictors of death in new coronavirus infection. The mechanisms of lung damage in COVID-19 are reviewed with particular attention to the pathophysiological mechanism of the synthesis of pro-inflammatory cytokines and the role of the latter in organ dysfunction. A definition of the ""cytokine storm"" that is usually understood as an overactive immune response with the release of a large number of interferons, interleukins, chemokines, and other mediators is given. The review highlights the most significant and currently known pathogenetic chains of cytokine production. Among them are proinflammatory cytokines, the most significant are Il-1, Il-6, TNF. High cytokine levels are associated with poor outcomes. Special attention is paid to the feasibility and role of anti-cytokine therapy with drugs tocilizumab and sarilumab. It has been noted that treatment aimed at the pathogenetic mechanisms of the development of the ""cytokine storm"" by antagonists of the Il-6 receptor can interrupt this life-threatening inflammatory response and, consequently, multiorgan dysfunction. The main pathogenetic pathways and risk factors for the development of acute kidney injury (Acute Kidney Injury – AKI) in SARS-CoV-2 have been analyzed. The use of extracorporeal treatment methods, possibly the main methods of combating the massive release of the pool of medium-molecular compounds during the development of a ""cytokine storm"" are reviewed. It is noted that along with anti-cytokine therapy, extracorporeal methods can effectively reduce the level of proinflammatory cytokines and prevent multiple organ damage. The main issues of expediency, role and place of application of various extracorporeal methods in complex intensive care for new coronavirus infection (SARS-CoV-2) are highlighted. © 2022 JSC Vidal Rus. All rights reserved."