ABSTRACT
Background: SARS-CoV-2 displays high affinity for ACE2 receptors, expressed on type 2 alveolar cells. These cells produce pulmonary surfactant - a crucial thin layer of surface-active lipid rich fluid - fundamental for proper gas exchange. Aims and objectives: To investigate changes in surfactant lipid composition and the relationship to prolonged symptoms of post covid-19 among patients treated in intensive care unit for covid-19 infection. Method(s): Patients (n=43, 17 female, aged 44-80 years) treated in an intensive care unit with covid-19 infection in average six months prior to enrollment were recruited. Particles in exhaled air were collected with PExA-instrument (PExA AB) and we also conducted body plethysmograph and diffusion capacity of the lungs for carbon monoxide. Twenty-two healthy, non-infected, age- and gender-matched controls were also enrolled. Lipids were analysed using liquid chromatography with a triple quadrupole mass spectrometer. Statistical analyses were performed with Qlucore. Result(s): Preliminary results suggest a significant change in the composition of surfactant lipids. Analysis show significant reductions of all measured phosphatidyl-glycerols (PG, n=14) an increase of all measured phosphatidyl- inositols (PI, n=4), e.g. PG 18:1-18:1 22 % lower (p<0.001, q=0.04) and PI:16:0:18:1 67% higher (p<0.001, q=0.0003) among the post-covid patients compared to controls. Conclusion(s): Our findings suggest that surfactant composition is altered also in the recovery phase after covid-19 infection which could be a key component in the post-covid syndrome with lingering effects on the respiratory system.
ABSTRACT
Purpose: The purpose of this paper is to explore waiting times in improving access to psychological therapies (IAPT) services before and throughout the COVID-19 pandemic. The paper aims to help develop a better understanding of waiting times in IAPT so that interventions can be developed to address them. Design/methodology/approach: IAPT national data reports was analysed to determine access and in-treatment waiting times before, during and after the COVID-19 pandemic. Time-series data was used to examine referral patterns, waiting list size and waiting times between the period of November 2018 and January 2022. The data covers all regions in England where an IAPT service has been commissioned. Findings: There was a dramatic drop in referrals to IAPT services when lockdown started. Waiting list size for all IAPT services in the country reduced, as did incomplete and completed waits. The reduction in waiting times was short-lived, and longer waits are returning. Practical implications: This paper aims to contribute to the literature on IAPT waiting times both in relation to, and outside of, COVID-19. It is hoped that the conclusions will generate discussion about addressing long waits to treatment for psychological therapy and encourage further research. Originality/value: To the best of the authors’ knowledge, there is no published research examining the performance of IAPT waiting times to second appointment. The paper also contributes to an understanding of how IAPT waiting times are measured and explores challenges with the system itself. Finally, it offers an overview on the impact of the COVID-19 pandemic on waiting time performance nationally. © 2022, Emerald Publishing Limited.
ABSTRACT
Background: SARS-CoV-2 displays high affinity for ACE2 receptors as a vector of pathogenesis. ACE2 receptors are highly expressed on surfactant producing type 2 alveolar cells. These cells produce pulmonary surfactant - a crucial thin layer of surface-active fluid mainly composed of lipids, lining the alveolar epithelial surface. The main function, to reduce the surface tension, is fundamental for proper gas exchange. Aims and Objectives: To investigate changes in surfactant lipid composition and the relationship to longstanding symptoms of post Covid-19 among patients treated in intensive care for Covid-19 infection. Methods: We recruited 43 patients (17 women, aged 44-80 years) who had previously been treated in ICU in a major Swedish hospital, in average 6 months before inclusion. The participants answered a questionnaire regarding symptoms, we collected particles in exhaled air with PExA-instrument (PExA AB) and conducted pulmonary function tests, body plethysmography, and diffusion capacity of the lungs for carbon monoxide. Twenty-two healthy, non-infected, ageand gender-matched controls were enrolled. Lipids were analysed using liquid chromatography with a triple quadrupole mass spectrometer. Statistical analyses were performed with Qlucore. Results: Early results suggest a significant change in the composition of surfactant lipids among post-Covid -19 patients treated in intensive care compared to controls. Early analysis show significant reductions of all measured phosphatidyl-glycerols (PG, n = 14) an increase of all measured phosphatidyl-inositols (PI, n = 4), for example were PG 18:1-18:1 22% lower (p < 0.001, q = 0.04) and PI:16:0:18:1 67% higher (p < 0.001, q = 0.0003) in subjects post-Covid compared to controls. Conclusions: Our findings suggest that surfactant composition is altered also in the recovery after Covid-19 infection, which could be a key component in the post-Covid syndrome and the lingering effects on the respiratory system.