COVID pneumoniae: Clinical and radiological follow-up of a prospective cohort

Introduction: COVID-19 has led to a rise in hospitalized patients with viral pneumonia and we are still learning about the follow-up process. Objective(s): To describe a cohort of hospitalized patients with COVID-19 pneumonia and their clinical and radiological evolution. Method(s): Prospective cohort study. COVID pneumonia patients from August 2020 to August 2021 were analyzed (n=125), with a standardized follow up. We describe clinical and radiological features during hospital stay and 1st and 3rd months after discharge. Extent Pneumonia: affection of 3 of 5 lobes in CT. Result(s): Table1: Cohort's description. Clinical follow-up: 39 patients(31,2%) persist symptomatic after 3 months from discharge(dyspnea 37). Radiological follow-up: 49 patients(39.2%) remain with extent pneumonia at third month CT. Table2: ILD pattern Vs No-ILD comparison at third month control. Conclusion(s): We present a detailed description of a COVID pneumonia cohort through a standardized follow-up process. Our findings suggest that ILD pattern associates with symptom persistence.

Estructura urbana y movilidad como factores de vulnerabilidad. Lima y Bogotá en tiempos de cuarentena

The COVID-19 pandemic and the preventive measures that were adopted have had a wide range of consequences that went beyond health problems for the inhabitants of many cities around the world. In order to understand why the impacts on the dwellers' lives were so different within the city, we looked at pre-existing socio-spatial vulnerabilities, taking as an example the metropolises of Lima and Bogota. We investigated the relationship between urban structure, daily mobility patterns and the effects of COVID-19 during the 2020 quarantines. We adopted a multidimensional approach using census data, the latest available origin-destination surveys, and the levels of contagion in both cities during 2020. Based on a factor analysis and a cluster analysis, we devised a typology and a synthetic map of pre-existing vulnerability factors. The results allow us to understand the role of these factors in the difficulties that the populations had to face during the quarantine, and why people living in the low-income outskirts suffered the worst disruptions in their daily lives. © 2022 Universidad Nacional de Colombia. All rights reserved.

Urban structure and mobility as vulnerability factors. Lima and Bogota in times of quarantine

The COVID-19 pandemic and the preventive measures that were adopted have had a wide range of consequences that went beyond health problems for the inhabitants of many cities around the world. In order to understand why the impacts on the dwellers' lives were so different within the city, we looked at pre-existing socio-spatial vulnerabilities, taking as an example the metropolises of Lima and Bogo-ta. We investigated the relationship between urban struc-ture, daily mobility patterns and the effects of COVID-19 during the 2020 quarantines. We adopted a multidimen-sional approach using census data, the latest available ori-gin-destination surveys, and the levels of contagion in both cities during 2020. Based on a factor analysis and a clus-ter analysis, we devised a typology and a synthetic map of pre-existing vulnerability factors. The results allow us to understand the role of these factors in the difficulties that the populations had to face during the quarantine, and why people living in the low-income outskirts suffered the worst disruptions in their daily lives.

Covid-19 Distance Teaching-Learning Modes: Which do Mathematics Education Students Appreciate and Prefer?

The study determined which distance teaching-learning mode of instruction during COVID-19 pandemic period is best appreciated and preferred by mathematics education students. It utilized a qualitative method of research which does not use standard instruments. It used the actual mode of instruction the respondents received from their teachers which they have listed and from among the list, they chose one as the best. It utilized BSED mathematics major students for school year 2020-2021 and 2021-2022, taking mathematics subjects of the University of Science and Technology of the Philippines, Cagayan de Oro City campus. Frequency, percentages and qualitative analysis of the data from respondents' feedback on the mode of online instruction they experienced and the results revealed that the distance teaching-learning mode using Work text with whiteboard in Google meet for discussion and recording of classroom discourse was chosen the best mode of instruction. The researchers recommend that teachers in distance teaching-learning process may use the mode which uses Work text, whiteboard for discussion with recording of the whole classroom discourse episodes.

Impact of vaccination on the epidemiology and prognosis of pneumonia.

Adults with lung diseases, comorbidities, smokers, and elderly are at risk of lung infections and their consequences. Community-acquired pneumonia happen in more than 1% of people each year. Possible pathogens of community-acquired pneumonia include viruses, pneumococcus and atypicals. The CDC recommend vaccination throughout life to provide immunity, but vaccination rates in adults are poor. Tetravalent and trivalent influenza vaccine is designed annually during the previous summer for the next season. The available vaccines include inactivated, adjuvant, double dose, and attenuated vaccines. Their efficacy depends on the variant of viruses effectively responsible for the outbreak each year, and other reasons. Regarding the pneumococcal vaccine, there coexist the old polysaccharide 23-valent vaccine with the new conjugate 10-valent and 13-valent conjugate vaccines. Conjugate vaccines demonstrate their usefulness to reduce the incidence of pneumococcal pneumonia due to the serotypes present in the vaccine. Whooping cough is still present, with high morbidity and mortality rates in young infants. Adult's pertussis vaccine is available, it could contribute to the control of whooping cough in the most susceptible, but it is not present yet in the calendar of adults around the world. About 10 vaccines against SARS-CoV-2 have been developed in a short time, requiring emergency use authorization. A high rate of vaccination was observed in most of the countries. Booster doses became frequent after the loss of effectiveness against new variants. The future of this vaccine is yet to be written.

Microsystems of interaction. Attacks on health personnel in the COVID-19 pandemic in Mexico

This article proposes a conceptual framework to describe interaction as social microsystems in which aggressions to health workers are framed as specific types of interactions. To describe aggressions, a review of 81 press releases and 39 interviews were done to understand the experiences of health workers. Three types of aggressions were identified;rational exclusion, stigmatization and hostile outbreak. The findings showed that rational choice for distancing in interaction and wearing a white coat or uniform as a symbolic element of risk propitiate specific forms of violence against public health workers. The prominence of time for the disappearing of confrontations is also explained. Finally, the research provides a general framework for understanding the pandemic as an object of sociological study.

Long covid syndrome: Why efforts like aftercor are needed

Introduction: The AFTERCOR study was developed by the COVID-19 Critical Care Consortium (>7000 intensive care unit [ICU] and >400 extracorporeal membrane oxygenation [ECMO] patients currently) to enhance understanding of occurrence and progression of long-term dysfunction post-COVID-19. Design: Prospective longitudinal (24 months) study of ICU survivors of COVID-19 to describe recovery of the following aspects: a) health-related quality of life b) dynamics of organ dysfunction and recovery and c) pulmonary function. Countries involved Italy, Spain, Ireland, Austria, South Africa, Australia, USA, Argentina, Brazil, Colombia. Protocol specifics available at https://www.aftercorstudy.com. Inclusion Criteria: 1) COVID-19 infection requiring ICU admission;2) informed consent;3) age ≥18 years. Exclusion Criteria: 1) pregnancy;2) pre-COVID paralysis;3) history of pulmonary resection;4) prior lung transplant;5) inability to perform 6-min walk test or participate in interview. Methods: Goal enrollment is 1000 patients. Follow-up visits are at 3, 6, 12, 18 and 24-month post-ICU discharge. Assessments include: 1) Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36);2) Montreal Cognitive Assessment;3) any subsequent admission 4) St. George's Respiratory Questionnaire;5) Pulmonary function testing;6) chest radiography;7) 6-minute-walk test;8) Patient Health Questionnaire 9 (PHQ-9) and 9) full blood count and biochemistry. CT chest at 6 months and repeat ECHO at 3, 12 and 24 months if performed during COVID-19 hospitalization. If results are normal, subsequent testing will not be performed. Summary: The AFTERCOR study represents a comprehensive evaluation for long-term effects from COVID-19. Interested centers are sought and invited to participate.

An appraisal of respiratory system compliance in mechanically ventilated COVID-19 patients

Rationale Heterogeneous respiratory system static compliance (CRS) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous smallcase series or studies conducted at a national level.Methods We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe the impact of CRS on the ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide.Results We enrolled 318 COVID-19 patients enrolled into the study from January 14th through September 31th, 2020 in 19 countries and stratified into two CRS groups. CRS was calculated as: tidal volume/[airway plateau pressure-positive endexpiratory pressure (PEEP)] and available within 48h from commencement of MV in 318 patients. Patients were mean±SD of 58.0±12.2, predominantly from Europe (54%) and males (68%). Median CRS (IQR) was 34.1 mL/cmH2O (26.5-45.5) and PaO2/FiO2 was 119 mmHg (87.1-164) and was not correlated with CRS. Female sex presented lower CRS than in males (95% CI:-13.8 to-8.5 P<0.001) and higher body mass index (34.7±10.9 vs 29.1±6.0, p<0.001). Median (IQR) PEEP was 12 cmH2O (10-15), throughout the range of CRS, while median (IQR) driving pressure was 12.3 (10-15) cmH2O and significantly decreased as CRS improved (p<0.001). No differences were found in comorbidities and clinical management between CRS strata. In addition, 28-day ICU mortality and hospital mortality did not differ between CRSgroups.Conclusions This multicentre report provides a comprehensive account of CRS in COVID-19 patients on MV-predominantly males or overweight females, in their late 50s-admitted to ICU during the first international outbreaks. Phenotypes associated with different CRS upon commencement of MV could not be identified.

Factors associated with mortality in patients with COVID-19 requiring mechanical ventilation: An international cohort study from 139 intensive care unit across 6 continents

Rationale: Patients with COVID-19 commonly develop severe hypoxemic respiratory failure and require invasive mechanical ventilation (MV). The disease burden and predictors of mortality in this population remain uncertain. Methods: Prospective observational cohort study from 139 intensive care units of the international COVID-19 Critical Care Consortium. Patients enrolled from January 14th through November 31st 2020 were included in the analysis. Patient's characteristics and clinical data were assessed. Multivariable Cox proportional hazards analysis was conducted to identify indipendent predictors of mortality within 28 days from commencement of MV. Results: 1578 patients on MV were included into the analysis. Mean±SD age was 59 years±13 and patients were predominantly males (66%). 542 Patients (34.4%) died within 28 days from commencement of MV. Nonsurvivors were slightly older (mean age±SD 62±13 vs. 59±13) and presented more frequently hypertension, chronic cardiac disease and diabetes. Median (IQR) PaO2/FiO2 upon commencement of MV was 96 (68-135) and 111 (81-173) in patients who did not survive vs. survivors, respectively (p=0.04). ECMO (13% vs 25%, p<0.01), inhaled nitric oxide (11% vs 15%, p=0.02) and recruitment manoeauvres (26% vs 31%, p<0.01) were used less frequently in patients who did not survive. Independent risk factors associated with 28-day mortality included age older than 70 years (hazard ratio [HR], 2.83;95% CI, 1.32-6.07), higher creatinine levels upon ICU admission (HR, 1.20;95% CI, 1.03-1.40), and lower pH within 24h from commencement of MV (HR, 0.12;95% CI, 0.02-0.62), while a shorter period (day) from early symptoms to hospitalisation reduced mortality risks (HR, 0.96;95% CI, 0.93-0.99). Conclusions: Our findings from a large international cohort of critically-ill COVID-19 patients on mechanical ventilation emphasises that elderly patients, not promptly admitted to the hospital, and who present higher creatinine levels and acidosis are at higher risk of mortality.

Prognostic value of static and dynamic biomarkers in COVID-19 patients: a prospective cohort study.

OBJECTIVE: The aim of this study was to analyze in a prospective cohort of hospitalized COVID-19 patients the relationship between biomarkers levels and their variation within the first 4 days since admission, and prognosis. METHODS: Prospective cohort study. Individuals with confirmed diagnosis of covid-19 admitted in our hospital were included. Blood samples were obtained systematically on days 1 and 4 of hospitalization. Levels of RCP, LDH, Ferritin and D-dimer, together with platelets, lymphocytes and neutrophils counts were measured. A combined outcome that included ICU admission and death was considered the primary outcome. Logistic regression analysis was performed. RESULTS: We included 335 patients with confirmed COVID-19. During their hospitalization, 23 (6.8%) needed ICU admission, and 10 (2.9%) died. In the multivariate analysis, a value of RCP greater than 10 mg/dl (OR 8.69, CI95% 1.45-52), an increase in RCP greater than 20% (OR 26.08, CI 95% 3.21-211.3), an increase in LDH greater than 20% (OR 6.29, CI 95% 1.84-21.44), a count of lymphocytes lower than 1500/mm3 (OR 2.74, CI 95% 1.04-7.23), a D-dimer value greater than 550 ng/ml (OR 9.8, CI 95% 1.78-53.9) and a neutrophil/lymphocyte index greater than 3(OR 4.5, CI 95% 1.43-14.19) were all associated with the primary outcome. CONCLUSIONS: Our study shows that the utilization of static and dynamic biomarkers may represent an important tool to assess prognosis of COVID-19 patients.