Posttraumatic-stress disorder, and others psychological impairment in COVID-19 surviving patients

Background: The post-COVID syndrome generates physical and respiratory complications that can be accompanied by psychological impairments, which can affect long-term mental and physical health. Objective(s): Know the prevalence and severity of PTSD, anxiety, and depression in surviving COVID-19 patients in a follow-up evaluation. Method(s): A cross-sectional descriptive study was conducted. 227 survivors COVID-19 patients participated, were assessed three months following discharge hospital. The following questionnaires were used: The Brief Davidson Trauma Scale, the General Anxiety Disorder Questionnaire, and the Patient Health Questionnaire. A descriptive and statically analysis was performed using the statistical software SPSS version 26. Result(s): The 64.5% of the patients were men, 60.9% required of invasive mechanical ventilation (IMV) during the hospitalization, the average age was about 48.23+/-14.33 years old. The 40% of the patients showed symptoms associated with PTSD, 38.4% anxiety symptoms, 36.6% depression symptoms. There were statistically significant differences between the type of treatment during hospitalization (IMV vs without IMV), in PTSD (t=2.482, df=223, p=.014, XIMV = 5.21, XWIMV = 6.08) and anxiety (t= -2.006, df=223, p=.046, XIMV = 4.05, XWIMV =5.44). Conclusion(s): Survivors of COVID-19 experience a high prevalence of PTSD, anxiety, and depression even three months after discharge from hospital. Patients who did not require IMV during hospitalization experienced a high prevalence and severity of PTSD and anxiety symptoms. Screening for PTSD and other emotional disturbances should be considered in follow-up evaluations in patients discharged from the hospital.

Sleep disturbances in post-Covid patients as a function of sex

Introduction: Within the post-Covid syndrome, sleep disturbances are one of the most persistent symptoms, in which women are more 50% vulnerable than men to insomnia. Objective(s): To compare the prevalence of sleep disorders in post-Covid patients according to sex. Method(s): A cross-sectional observational study was carried out. The participants were 264 post-Covid patients evaluated 3 months after hospital discharge, divided into men (n=156, G1) and women (n=108, G2). A general sleep habits survey and the Berlin SAOS questionnaire were used for sleep assessment. Statistical analyses were performed using SPSS v25. Result(s): Mean age was G1: 54.16 +/-11.751 and G2: 54.23 +/- 13.319. There were differences (p<0.05) between both sexes in the following disorders (G1 vs G2): snoring (73.1% vs 58.3%), primary snoring (45.6% vs 28.6%), unrefreshing sleep more than 3 times a week (28.2% vs 43.5%), tiredness or fatigue during the day at least 3 times a week (30.1% vs 51.9%), sudden movements in extremities: (37.2% vs 22.2%), onset insomnia: (34.0% vs 53.7%), intermediate insomnia (36.5% vs 58.3%), final insomnia: (39.7% vs 55.6%). No differences (p>0.05) were found in pauses in breathing, teeth grinding, feeling of paralysis and feeling of choking, with a prevalence greater than 20% in all cases. Conclusion(s): In our study, the affectation of most sleep disorders are more frequent in the female sex, with the predominance of different types of insomnia (onset, intermediate and final);which could be related to affective disorders. In men, the most prevalent disorders were snoring and sudden movements, mostly linked to respiratory disorders.

Anxiety and well-being amidst the COVID-19 outbreak and the moderating role of locus-of-hope: Evidence from a large sample in the Philippines

The COVID-19 pandemic has placed a heavy psychological burden on the lives of many individuals and created a rise in the prevalence of anxiety, which could be detrimental to people's well-being. Nevertheless, there have also been reports about having hope in overcoming the challenges brought about by the pandemic. The study intended to find out whether the different locus-of-hope dimensions (internal, family, peers, and spiritual locus-of-hope) would moderate the impact of anxiety symptoms on well-being (psychological, social, and emotional well-being). A nationwide survey was conducted among Filipino adults (N = 10,529). Results showed that anxiety symptoms were negatively associated with psychological, social, and emotional well-being. Moderation analyses show that internal, family, and spiritual locus-of-hope buffered the negative effect of anxiety symptoms on specific well-being outcomes, whereas peer locus-of hope did not. The study demonstrates the importance of hope as a viable resource in facilitating an individual's well-being amid adverse and uncertain circumstances, such as the COVID-19 pandemic. © The Author(s) 2023.

Cognitive alterations in COVID-19 survivors with and without invasive mechanical ventilation during hospital stay

Introduction: Cognitive impairment is observed in patients for Covid-19;derived from both multiple organic dysfunctions due to the disease and its management during hospital stay. Existing literature reports greater cognitive impairment (60-80%) in patients with invasive mechanical ventilation (IMV), compared to those who did not require it (50-70%). Objective(s): To compare cognitive impairment among COVID-19 survivors with and without IMV during hospital stay. Method(s): A cross-sectional observational study was conducted. A total of 211 COVID-19 survivors participated, 64.9% required IMV (G1) and 35.1% did not (G2). The Montreal Cognitive Assessment (MOCA) was used to assess cognitive functions at a 9 month follow-up after hospital discharge. Statistical analyses were performed in SPSS V25. Result(s): Patients presented the following characteristics: male sex (G1: 61.8%, G2: 54.1%), and average age G1: 54.05+/-11.89, G2: 57.21+/-11.90 years. In both groups (G1 vs. G2) no significant differences (p<0.05) were found in the prevalence of probable mild cognitive impairment (72.3% vs. 82.4%), neither in the mean of principal affections reports: attention (4. 70+/-1.23 vs. 4.80+/-1.03) and memory (2.69+/-1.53 vs. 2.86+/-1.59). Orientation (5.60+/-.71 vs. 5.82+/-.41), was the only value that reached statistically significant differences (p=.013), but without clinical significance. Conclusion(s): Both groups have high prevalence of patients with probable mild cognitive impairment yet nine months after discharge, contrasting with the prevalence reported to patients with IMV and to the recovery time (3-6 months). Cognitive sequelae have a greater impact than reported in all patients regardless of treatment.

Heart rate variability in post-COVID-19 patients with different anxiety levels

Introduction: More than 12% of COVID-19 hospitalized patients develop Generalized Anxiety Disorder (GAD) after discharged. High frequency band percentage of heart rate variability (hfHRV) is a reliable indicator of efficient functional coupling between autonomic branches across high-demanding adaptive situations. Objective(s): To compare hfHRV among post-hospitalized COVID-19 survivors by level of GAD. Method(s): We conducted an observational study with 211 post-COVID-19 participants (63.7% males;47.6y +/-14.3), 3 months after discharged. We registered their hfHRV with a computerized biofeedback equipment throughout four conditions: open-eyes (C1);closed-eyes (C2);closed-eyes+natural-relaxation (C3);and closed-eyes+deep-breathing (C4) (2.5 minutes per condition). Participants were classified into 3 categories using General Anxiety Disorder Scale (GAD-7): low anxiety (n=174, 67.5%, 47.2 yo +/-13.4;G1);moderate anxiety (n=24, 66.5%, 47.3 yo +/-15.3;G2) and severe anxiety (n=13, 60.5%, 46.1 yo +/-9;G3). Statistical analysis were performed with SPSS v28. Result(s): hfHRV percentage is higher at C3 in G1 (G1: 29.5 +/-21.1, G2: 21.1 +/-17.1, G3: 20.0 +/-20.4;p = 0.01). G3 display a 30% decrease in hfHRV during this condition in contrast with G1 (p = 0.006). Percentage of hfHRV in G1 (C1: 31 +/-22.6, C2: 29.2 +/-23.6, C4: 24.3 +/-20.7), and G3 (C1: 29.7 +/-22.8;C2: 27.9 +/-17.6;C4: 20 +/-20) didn't show any significant differences. Conclusion(s): C3 involve an adaptive challenge that demands an effective sympathetic-parasympathetic regulation. An increase in hfHRV during C3 in G1, indicates that the group with low anxiety exhibit a more effective psychophysiological adaptive feature than G2 and G3: a potential protective factor from GAD.

Impact of endothelial function on the prognosis of COVID19 patients

Introduction: The pathophysiological mechanisms related to the severity of the clinical picture of Sars-Cov-2 infection remain questions that the medical community seeks to resolve and whose knowledge will allow the design of therapeutic strategies. Purpose(s): To evaluate the association between endothelial function and mortality in patients with COVID-19. Material(s) and Method(s): Prospective cohort study. Patients with confirmed diagnosis of COVID-19, who required hospitalization, oxygen saturation <60% and laboratory data of endothelial function markers were included;all those with incomplete data were excluded. Result(s): The age of the population was 57.06 +/- 13.405, 69% were intubated, those who died had poorer ventilatory parameters;peak pressure (30.06 +/- 6.13 vs 24.82 +/- 6.06, p<0.001), Fi02 (57.5 [40 - 80] vs 45 [40 -80], p <0.001) and PaO2/FiO2 calculation (127.84 +/- 50.08 vs 163.36 +/- 45.47, p<0.001). In addition, they had greater laboratory alterations: procalcitonin (0.49 [0.16 - 4] vs. 18 [0.07 - 0.52], p=0.03) and CRP (13.34[7.67 - 19.03] vs 6.69 [2.4 - 15 89], p=0.05), higher levels of clotting times, PT(14.8 [14 - 16.6] vs 14.4 [13.7 -15.6], p=0.5) and INR (1.04 [0.98 - 1.17] vs 1.01 [.95 - 1.1], p=0.05). In blood biometry, higher numbers of leukocytes of (11.3 [8.65 - 14.4] vs. 9.9 [6.7 - 13], p=0.041), neutrophils (8.8 [7.4 - 12.5] vs. 8.1 [4.74 - 11.1], p=0.01) and lower numbers of lymphocytes (. 7 [.40 - 1.1] vs 1.1 [.7 - 1.5], p<0.001) and with significant statistical trend, hemoglobin(11.26 +/- 2.55 vs 12.42 +/- 2.4, p=0.07) compared to surviving subjects. Conclusion(s): Hematological and liver alterations are markers of higher mortality in patients with COVID-19 as an expression of multiorgan disease.

Cognitive impairment as a sequel to SARS-CoV-2 infection

Introduction: COVID-19 survivor patients report a complaint subjectively related to memory and attentionconcentration problems when carry out their daily activities. Objective(s): To investigate the presence of cognitive sequelae associated with COVID-19. Method(s): An observational cross-sectional study was conducted. Participated 229 COVID-19 survivor patients, who were evaluated with Montreal Cognitive Assessment (MoCA) and classified into three groups: a) severe cognitive impairment (G1, <13points, n=11), b) mild cognitive impairment (G2, 13-21 points, n=34), and c) without cognitive alterations (G3, 22-30 points, n=184). Statistical analyses were performed in SPSS V25. Result(s): Average age and male sex: G1: 67.36+/-10.71, 63.6%;G2: 58.76+/-11.55, 61.8%;G3: 53.32+/-11.39, 58.7%. G1 presented statistically differences (p <0.001) in all cognitive functions with the other groups (G1, G2, G3): visuospatial/executive ability (0.09+/-0.30, 0.53+/-0.50, 0.83+/-0.38), identification (2.00+/-0.89, 2.82+/-0.38, 2.92+/-0.32), attention (2.45+/-0.82, 3.97+/-1.16, 5.02+/-0.97), repetition (0.18+/-0.40, 0.29+/-0.46, 1.02+/-0.79), fluency (0.18+/-0.40, 0.68+/-0.47, 0.93+/-0.24), abstraction (0.18+/-0.40, 0.68+/-0.72, 1.41+/-0.77), deferred remembering (0.73+/-1.10, 1.44+/-1.37, 3.13+/-1.36) and orientation (4.64+/-0.92, 5.35+/-0.73, 5.79+/-0.49);except in executive ability, identification, repetition, abstraction and deferred remembering with respect to G2 (p<0.05). Conclusion(s): Cognitive alterations were found in patients post- COVID, especially in attention and deferred remembering, which could be related to errors of execution in other areas. In the case of the severe cognitive impairment, age may be a related variable. Necessary integrate this variable in the rehabilitation plan for a better prognosis and quality of life of patients.

Psychological affectation in surviving patients of COVID19, consideration of the use of invasive mechanical ventilation

Introduction: The presence of anxious, depressive and post-traumatic stress (PTSD) symptoms are the most reported psychological sequelae in post-COVID patients. The use of invasive mechanical ventilation (IMV) may contribute to the appearance of these symptoms. Objective(s): To know the differences in anxious, depressive, PTSD and fear of COVID symptoms among surviving COVID-19 patients with or without IMV, 3 months after hospital discharge. Method(s): An observational cross-sectional study was conducted. 239 surviving COVID-19 patients participated: 146 with IMV at hospitalization (67.80% men and 32.20% women) (G1) and 93 without IMV (61.29% men 38.70% women) (G2), who were evaluated with: GAD-7 for anxious symptomatology, PHQ-9 for depressive symptomatology, EMACOVID scale to measure fear of COVID-19, and the brief Davidson scale as screening for EPT. Statistical analyzes were performed in the statistical package SPSS V25. Result(s): Average age: G1= 48.62+/-13.62, G2= 48.49+/-15.43. There was a statistically significant difference in the EPT scores (G1: Md=4 [4.00-6.00];G2: Md=5 [4.00-7.00]). No statistically significant differences were found (P<0.05, G1 vs G2) in depression (Md=3 [0.00-6.00] vs Md=3 [0.00-8.50], anxiety (Md=2 [0.00-6.00] vs Md=3 [1:00-7:50]), nor fear of COVID (Md= 9 [7:00-15:00] vs Md=11.80 [7:00-14:00]), although there were clinical differences. Conclusion(s): Patients without IMV have a conscious experience of their hospitalization, which may lead to a higher level of PTSD compared to sedated patients with IMV.

EMBRACING THE DIVERSITY OF GRANDFAMILIES: UNDERSTANDING THE INFLUENCE OF CULTURE AND RACISM

In line with this year's conference theme, we examine diversity in different forms, such as racial, cultural, and familial diversity. We discuss the importance of diversity's influence on the experiences of grandfamilies and the impact it has on their members. Findings from a study with Latinx grandparent caregivers suggest that those raising grandchildren often do not view themselves as "raising,” but instead "helping.” Such findings highlight the importance of understanding cultural norms to appropriately tailor services and resources. In an exploration of the experiences of Korean custodial grandparents, findings demonstrated the influence of patrilineality and stigma surrounding divorce for Korean grandparent-headed families, indicating the importance of considering a grandparents' position in the family when providing services. In a study with custodial grandparents during the COVID-19 pandemic, researchers examined the role of racial discrimination on grandparents' depressive symptoms and access to health services. Results indicated a higher level of perceived racial discrimination was associated with more depressive symptoms. These results imply the need to address racial/ethnic disparities experienced by these caregivers. Similarly, in a study of emerging adults raised by grandparents, race moderated the influence of attachment on symptoms of racial discrimination. Findings support the use of interventions addressing attachment and ethnic identity to decrease symptoms of racial trauma in grandfamilies. Together these four studies reiterate the diversity of grandfamilies, enrich our understanding of these families, and encourage us to reimagine how to best serve them.

Computational modeling of the effect of five mutations on the structure of the ACE2 receptor and their correlation with infectivity and virulence of some emerged variants of SARS-CoV-2 suggests mechanisms of binding affinity dysregulation.

Interactions between the human angiotensin-converting enzyme 2 (ACE2) and the RBD region of the SARS-CoV-2 Spike protein are critical for virus entry into the host cell. The objective of this work was to identify some of the most relevant SARS-CoV-2 Spike variants that emerged during the pandemic and evaluate their binding affinity with human variants of ACE2 since some ACE2 variants can enhance or reduce the affinity of the interaction between the ACE2 and S proteins. However, no information has been sought to extrapolate to different variants of SARS-CoV-2. Therefore, to understand the impact on the affinity of the interaction between ACE2 protein variants and SARS-CoV-2 protein S variants, molecular docking was used in this study to predict the effects of five mutations of ACE2 when they interact with Alpha, Beta, Delta, Omicron variants and a hypothetical variant, which present mutations in the RBD region of the SARS-CoV-2 Spike protein. Our results suggest that these variants could alter the interaction of the Spike and the human ACE2 protein, losing or creating new inter-protein contacts, enhancing viral fitness by improving binding affinity, and leading to an increase in infectivity, virulence, and transmission. This investigation highlighted that the S19P mutation of ACE2 decreases the binding affinity between the ACE2 and Spike proteins in the presence of the Beta variant and the wild-type variant of SARS-CoV-2 isolated in Wuhan-2019. The R115Q mutation of ACE2 lowers the binding affinity of these two proteins in the presence of the Beta and Delta variants. Similarly, the K26R mutation lowers the affinity of the interaction between the ACE2 and Spike proteins in the presence of the Alpha variant. This decrease in binding affinity is probably due to the lack of interaction between some of the key residues of the interaction complex between the ACE2 protein and the RBD region of the SARS-CoV-2 Spike protein. Therefore, ACE2 mutations appear in the presence of these variants, they could suggest an intrinsic resistance to COVID-19 disease. On the other hand, our results suggested that the K26R, M332L, and K341R mutations of ACE2 expressively showed the affinity between the ACE2 and Spike proteins in the Alpha, Beta, and Delta variants. Consequently, these ACE2 mutations in the presence of the Alpha, Beta, and delta variants of SARS-CoV-2 could be more infectious and virulent in human cells compared to the SARS-CoV-2 isolated in Wuhan-2019 and it could have a negative prognosis of the disease. Finally, the Omicron variant in interaction with ACE2 WT, S19P, R115Q, M332L, and K341R mutations of ACE2 showed a significant decrease in binding affinity. This could be consistent that the Omicron variant causes less severe symptoms than previous variants. On the other hand, our results suggested Omicron in the complex with K26R, the binding affinity is increased between ACE2/RBD, which could indicate a negative prognosis of the disease in people with these allelic conditions.

COVID-19-ASSOCIATED PULMONARY MUCORMYCOSIS PRESENTING AS SPONTANEOUS PNEUMOTHORAX: A RARE PRESENTATION

SESSION TITLE: COVID-19 Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Mucormycosis is an angio-invasive fungal infection with substantial morbidity and mortality. While diabetes and immune suppression remain well-known risk factors for mucormycosis, COVID-19 is now emerging as its independent predictor. CASE PRESENTATION: A 43-year-old male, with a history of hyperlipidemia and alcoholism, presented to the hospital with complaints of progressive dyspnea on exertion, productive cough, intermittent fever, anorexia, and chest pain over the course of 2 weeks. About 5 weeks prior to the current presentation, he was tested positive for COVID-19 by a polymerase chain reaction (PCR) based test and remained in quarantine at home. He was not vaccinated against COVID-19. He had no known immunosuppressive disease. On initial examination, he was ill-appearing and had a temperature of 101 F, blood pressure 138/83 mmHg, respiratory rate 22/minute, pulse 102/minute, and saturation of 91% on 2 L nasal cannula oxygen. A computerized tomography (CT) scan of the chest revealed small bilateral pneumothorax (2 cm and 5mm) along with extensive ground-glass opacifications in all lobes. In the next 24 hours, the right-sided pneumothorax progressed to tension pneumothorax requiring pigtail pleural drainage catheter placement. The drained pleural fluid had more than 100,000/uL total nucleated cells (91% neutrophils, 2% lymphocytes, and 1% eosinophils) and ultimately cultures grew Rhizopus spp. He was started on intravenous liposomal amphotericin-B infusion (5 mg/kg daily). On hospital discharge, he was switched to oral posaconazole (started with loading 300 mg delayed-release tablet twice a day, followed by 300 mg dosing of delayed-release posaconazole tablets daily) to complete the long term treatment course. DISCUSSION: Most of the reported cases of mucormycosis in COVID-19 were in patients with either diabetes or receiving steroids. This is a rare presentation of COVID-19–associated pulmonary mucormycosis (CAPM) as spontaneous pneumothorax, in the absence of known immunosuppression history. COVID-19 results in a considerable increase in cytokines, particularly interleukin-6 (IL-6), which increase free iron by increasing ferritin levels due to increased synthesis and decreased iron transport. Also, concomitant acidosis increases free iron by reducing the ability of transferrin to chelate iron and this available iron becomes a considerable resource for mucormycosis. [1] Also, Mucorales adheres to and invades endothelial cells by specific recognition of the host receptor glucose-regulator protein 78 (GRP-78). Acidosis associated with severe COVID-19 triggers GRP-78 and fungal ligand spore coating homolog (CotH) protein expression on endothelial cells, both contributing to angioinvasion, hematogenous dissemination, and tissue necrosis. [2] CONCLUSIONS: Mucormycosis can present as spontaneous pneumothorax after recent COVID-19 and clinicians should be aware of rare clinical presentation. Reference #1: Singh AK, Singh R, Joshi SR, et al. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr Clin Res Rev 2021;15:102146. doi:10.1016/j.dsx.2021.05.019 Reference #2: Baldin C, Ibrahim AS. Molecular mechanisms of mucormycosis—The bitter and the sweet. PLOS Pathog 2017;13:e1006408. doi:10.1371/journal.ppat.1006408 DISCLOSURES: No relevant relationships by Faran Ahmad No relevant relationships by AYESHA BATOOL No relevant relationships by Zachary DePew No relevant relationships by Neil Mendoza

[Influence of risk factors on mortality from COVID-19]

Background: The main risk factors studied that have an influence on mortality from COVID-19 have so far been inconclusive in the world literature, mainly in relation to the male gender. Objective: To determine which are the main risk factors that influence a higher mortality from COVID-19. Material and methods: A case-control study was conducted, including 1190 patients with positive RT-PCR. The risk factors studied were: gender, age, systemic arterial hypertension (SAH), Diabetes mellitus (DM), obesity, Chronic Obstructive Pulmonary Disease (COPD), asthma, smoking, immunosuppressants, Human Immunodeficiency Virus (HIV), influenza vaccine. In the Group of Cases: they died from COVID-19 (n = 576), while in the Controls group: they survived (n = 614). The statistical plan included cross-tables and multivariate logistic regression model to determine the influence of these risk factors on mortality from COVID-19. Results: We found no statistically significant differences between cases and controls in relation to gender. However, the cases were aged >60 years, SAH, DM, obesity compared to controls. Conclusions: Male gender was not a risk factor for mortality from COVID-19, however, other risk factors such as age over 60 years, being hypertensive, diabetic and obese, were corroborated as such for a higher mortality from COVID-19.

Job satisfaction and burnout syndrome in teachers during confinement due to the COVID-19 pandemic

The work overload that teachers present in the current context is a risky situation, since it can generate prolonged states of stress causing a burnout syndrome and affecting theirj ob satisfaction. The objective was to determine the significant relationship between job satisfaction and the components of burnout syndrome during confinement due to the COVID -19 pandemic. The study had a cross-sectional correlational design. 205 teachers participated, who answered the Job Satisfaction Scale for Teachers (ESLA-Education) and the Maslach Burnout Inventory (MBI). The results indicate a statistically significant inverse correlation between job satisfaction and the components of burnout syndrome: emotional exhaustion (rho =-. 315 ;p = .000), depersonalization (rho =-.252;p = .000) and achievement personal (rho =-.254;p = .000). It is concluded that teachers who present high emotional fatigue, loss of sensitivity and empathy, deterioration of their abilities and a feeling of failure show job dissatisfaction. Therefore, it is necessary to have protective factors to prevent emotional distress for teachers.

Humanitarian Projects Development from Universidad del Zulia SIGHT Affinity Group

This work aims to divulge the volunteering experiences within humanitarian projects development from Universidad del Zulia SIGHT affinity group in Venezuela. At first, "Una mano por tu Facultad" project carried out in 2019 is described, which had the active participation of volunteers from the RE-IEEE-LUZ student branch and the SIGHT-LUZ affinity group and resulted in the recovery of twenty-six (26) classrooms and four (4) laboratories of the Faculty of Engineering. Furthermore, a new project is underway in response to COVID-19, which is focused on a distance education system using funds approved by the Humanitarian Activities Committee (HAC) and the Special Interest Group on Humanitarian Technology (SIGHT) of the Institute of Engineers Electrical and Electronic (IEEE). This group has the objective of bringing technologies-based solutions to problems existing in local communities in the Zulia State, Venezuela.

A case of burkholderia gladioli ventilator-associated pneumonia in a patient with COVID-19

INTRODUCTION: Burkholderia gladioli (B. gladioli) is primarily a plant pathogen but has been known to be pathogenic in patients with cystic fibrosis, chronic granulomatous disease or immunocompromised. METHODS: We hereby report a case of B. gladioli causing ventilator-associated pneumonia (VAP) in a patient with COVID-19. 68-year-old Hispanic man with a history of hypertension, type 2 diabetes mellitus, chronic kidney disease, and complete heart block with pacemaker presented to primary care office with fatigue, worsening shortness of breath, and decreased urine output for 2 days. He was found to be in acute respiratory distress with bilateral coarse breath sounds and saturating 60% on room air subsequently sent to ER for further evaluation. Transitioned to 100% high flow in the ER and was admitted to ICU. Pertinent work up showed pH of 7.2, bicarbonate (10 mmol/L), lactate (7.2 mmol/L), creatinine (5.5 mg/dl), d-dimer (2.0 mg/L), LDH (745 u/l), ferritin (5934 ng/mL). Chest x-ray showed bilateral infiltrates. Further increase in oxygen requirements required intubation. Intravenous ceftriaxone and azithromycin were started empirically for community-acquired pneumonia. Given his clinical presentation, PCR for SARS-Cov-2 was positive. He was treated with convalescent plasma and dexamethasone with decreasing ventilatory requirements and inflammatory markers. On day 13 of admission, the patient became febrile, WBC count of 24.4 k/ul, and increasing ventilatory requirements raising concern for VAP. Intravenous vancomycin and cefepime were started. Computed tomography pulmonary angiogram showed extensive pulmonary consolidation. Sputum culture grew B. gladioli. Based on susceptibilities levofloxacin was added to the antibiotic regime and cefepime was later switched to meropenem for double coverage in this critically ill patient. Despite aggressive management, he suffered multi-organ failure including acute respiratory distress syndrome (ARDS), acute renal injury requiring continuous renal replacement therapy, and shock unresponsive to vasopressors. The patient suffered cardiac arrest and died. RESULTS: COVID-19 pneumonia might have predisposed our patient to VAP with this rare organism. In spite of prompt recognition and aggressive treatment of infection, the outcome was fatal.

Health-related quality of life and resilience in peri- and postmenopausal women during Covid-19 confinement

Objective: To assess the impact of confinement due to the coronavirus (Covid-19) pandemic on health-related quality of life (HRQoL) and resilience in periand postmenopausal women. Material and Methods: We used an online questionnaire which was sent between April 30th and May 13th, 2020 to women aged 40-70 years who were perior postmenopausal according to STRAW criteria. We used the 16 item Cervantes short-form scale (Cervantes-SF) to measure HRQoL, and the 14-item Wagnild and Young Resilience Scale (RS-14) to measure resilience. High scores on the Cervantes-SF indicate low HRQoL and high scores on the RS-14 indicate high levels of resilience. Covid-19 status, sociodemographic descriptors, and lifestyle variables were also evaluated. Results: We included 2430 periand postmenopausal women with valid questionnaires. All items of the Cervantes-SF were completed in 2151 cases, whilst the RS-14 was completed in 2413 cases. There was a negative correlation between scores on the Cervantes-SF and RS-14 scales (Rho -0.350;p < 0.0001). Multiple linear regression analysis revealed a statistically significant association between Cervantes-SF scores and living with others (beta-coefficient -10.2;p < 0.001), use of antidepressants (beta 9.3;p < 0.001), physical activity (beta-8.6;p < 0.001) and sexual activity (beta-2.7;p < 0.001). Resilience was associated with the use of antidepressants (beta-5.9;p < 0.001), physical activity (beta 3.2;p < 0.001) and sexual activity (beta 1.7;p = 0.005). According to the multivariate analysis, there were no associations between either Covid-19 or menopausal status and HRQoL or resilience scores. Conclusions: During the period of mandatory Covid-19 confinement, periand postmenopausal women who engaged in physical and sexual activity had higher HRQoL and higher levels of resilience, whilst women who were using antidepressants had lower HRQoL and lower levels of resilience. HRQoL was greater in women who lived with others.