Ornamental plant market in Dona Euzebia - MG: production, commercialization and impact of the COVID-19 pandemic

With the occurrence of the COVID-19 pandemic, different areas were affected, with positive or negative effects, as a function of the conditions imposed above all by gardening activities. This brought effects on the production of ornamental plants. In this context, the objective of this study was to analyse the situation of production, commercialization and the impact of the COVID-19 pandemic on the ornamental plants market in the city of Dona Euzebia-MG. A questionnaire with objective and discursive questions was applied to the city producers (30). The production of seedlings in Dona Euzebia is economically and socially important. Most producers have properties with 5 hectares, are in activity for a range of 5 to 19 years and have between 2 to 5 employees. With the onset of the pandemic, the market for seedlings and ornamental plants in Dona Euzebia was positively modified, with an increase in plant sales, which led to changes in production and in the sales process. During the period, producers took all measures to prevent the spread of the virus. The interviews showed that ornamental plants were among the main species cultivated and among the most sought during the pandemic period analyzed in this study. Furthermore, despite the restrictions and the uncertain scenario, there is optimism among producers, especially in terms of post-pandemic sales.

[Evaluation of the effectiveness of the new perioperative model to recover surgical activity during the COVID-19 pandemic]. / Evaluación de la efectividad del nuevo modelo perioperatorio para recuperar la actividad quirúrgica durante la pandemia de COVID-19.

INTRODUCTION: The first wave of the COVID-19 pandemic caused the cancellation of elective interventions. After the improvement of the epidemiological situation, new models of care were applied in hospitals to restart the programmed surgical activity. The aim was to evaluate the effectiveness of the organizational model established to recover surgical activity during the transition period of the COVID-19 pandemic. METHODS: Retrospective observational study comparing patients who underwent schedule surgery from September 1 until October 31, 2020, study group, with a control group of the same period of time corresponding to the year 2019 at the General Hospital from the Vall d'Hebron University Hospital. RESULTS: The total population included 1,825 patients, 888 in the study group and 937 in the control group. Global surgical activity decreased 6.43% during the study period compared to the same period in 2019, with a 25.5% decrease in cancer surgeries. Seven patients became infected with SARS-CoV-2 during their hospital stay. In hospital mortality was 0.9% in the study group compared to 0.7% in control group (p=0.8). The survival rate in cancer patients at 90 days was lower in the study group (95.7% vs 98.7%; p=0.02). CONCLUSIONS: The change in the management model during the transition period of the COVID-19 pandemic allowed the recovery of programmed surgical activity to levels similar to those existing prior to the pandemic with a greater impact on cancer surgery.

Mortality and Bleeding Complications of COVID-19 Critically Ill Patients with Venous Thrombo-Embolism

Introduction: Venous thrombo-embolism (VTE) disease in critically ill COVID-19 patients is a remarkable issue, especially its relationship with bleeding events and mortality. The objective of this study was to describe the outcomes of critically ill patients with COVID-19 hospitalised in the intensive care unit (ICU) in relationship with VTE during their stay. The secondary objective was to describe prognostic factors in relation with these outcomes. Methods: This was a prospective cohort study of critically ill COVID-19 patients in two Spanish university hospitals that underwent, at the beginning of the study, venous ultrasound of both lower limbs in April 2020. When there was clinical suspicion of new VTE during the 30 day follow up, additional ultrasound or thoracic computed tomography were performed. Global VTE frequency, major bleeding events, and survival were collected, and their predictors were studied. Results: In total, 230 patients were included. Mean age was 60.1 ± 9.9 years and 77% of them were men. After 30 days of follow up, there were 95 VTE events in 86 patients (37.4%). Of these, 60 patients (69.8%) presented with deep vein thrombosis (DVT), 17 patients with pulmonary embolism (PE;19.8%), and nine patients with DVT and PE (10.5%). VTE was related to a longer hospital stay: 50.3 days in VTE patients and 47.2 days in non-VTE patients (p =.014). D-dimer at admission was significantly related to VTE development (p =.007). Major bleeding complications were found in 13 patients (5.7%). None of the demographic variables, treatments, or classic risk factors were related to a higher risk of major bleeding. During the 30 day follow up, 42 patients (18.3%) died. Variables related to mortality were older age (67.4 vs. 58.4 years;p <.001), lower weight (77.9 vs. 87.5 kg;p <.001), lower body mass index (28.2 vs. 30,8 kg/m2;p =.006), hypertension (43.1% vs. 69% of patients;p =.002), lymphocyte count at admission < 0.45 ×109/L (p =.003) and D-dimer at admission > 1 500 ng/mL (p =.014). Patients with VTE at any moment during the follow up tended to die more frequently (50%) than non-VTE patients (34.6%), but this difference was not statistically significant (p =.062). Independent predictors of mortality in the regression model were older age (> 66 years), D-dimer at admission (> 1 500 ng/mL), and low lymphocyte count (< 0.45 ×109/L) with an area under the receiver operating curve of 0.81 (95% confidence interval 0.73 – 0.89). Patients presenting these three conditions presented a mortality of a 100% in the predictive model. Conclusion: VTE frequency in ICU COVID-19 patients is high and the risk of major bleeding is low. Comorbidities and laboratory parameters of admission in these patients can be a useful tool to predict mortality.

Predictors of left ventricular ejection fraction recovery after transcatheter aortic valve replacement (TAVR)

Introduction: Transcatheter aortic valve replacement (TAVR) has proven benefits in patients with reduced left ventricular ejection fraction (LVEF). A significant proportion of them shows recovery of systolic function Objective: To analyse the main baseline, electrocardiographic and echocardiographic characteristics that may predict LVEF recovery after TAVR. Methods: A cohort study was conducted. Consecutive patients undergoing TAVR in our center from January 2012 to December 2020 were included. Baseline clinical profile, electrocardiographic (EKG), echocardiographic (ECH) parameters were recorded, as well as MACE during followup (major adverse cardiovascular events including: all-cause mortality, myocardial infarction, cerebrovascular accident and heart failure hospitalization). Reduced systolic function was defined as LVEF <50%. We considered recovery of systolic function as LVEF ≥50% at follow-up. Results: A total of 292 patients were included. 48% were women and the median age was 81.07 years (77.63-86.22). 22.6% (66 patients) had reduced LVEF at baseline. Half of them showed recovered systolic function during follow-up. Patients who did not recovered LVEF had a higher prevalence of dyslipidemia and peripheral artery disease. History of cardiac surgery was more frequently found in this group, and they showed a higher surgical risk estimated by EuroScore II. They had lower LVEF and aortic valve mean gradient, and more frequently presented non-synus rhythm (NSR), left bundle branch block and right ventricular dysfunction (RVD). These characteristics are shown in figure 1. In univariate analysis lower Euroscore II, presence of synus rhythm, absence of LBBB and RVD, as well as higher aortic valve mean gradient were predictors of LVEF recovery. In multivariate analysis RVD and mean aortic gradient were independent predictors. Among all patients included in our study, those presenting with RV dysfunction were significantly associated with lower LVEF mean values (46,0% vs 57,2%;p<0,01) After a median follow-up of 21.3 (8.52-38.94) months, MACE were lower in recovered LVEF group (HR 0.25 95% CI: 0.05-1.21). There were no statistically significant differences in all-cause mortality, nevertheless there was a trend towards a higher non-cardiovascular mortality in this group, essentially at the expense of deaths from malignant neoplasms and SARS-COV- 2 infections. Survival curves for MACE are represented in figure 2. Conclusion: In our study, half of the patients with impaired ventricular function undergoing TAVR showed recovery of ejection fraction. Right ventricular function and aortic valve mean gradient at baseline were independent predictors of recovery. Identifying predictors of LVEF recovery is fundamental in the evaluation of potential candidates for TAVR, and can help clinicians assess risks and benefits, as well as long-term prognosis of these patients.

Hyponatremia in patients with COVID19

BACKGROUND: Among laboratory abnormalities described in the context of SARSCOV- 2 infection, hyponatremia seem to be the most common. The mechanism of this sodium disbalance is not well known. AIMS: Characterize the incidence, etiology and prognostic value of sodium disbalance in patients with COVID19. METHOD: Observational pilot study with 37 patients admitted to Hospital Ramon y Cajal in Madrid, Spain, between March and April 2020, with a confirmed diagnosis of COVID19. Patients were followed until discharge or death. Clinical and laboratory data were collected at admission and before the clinical outcome. Variables were analyzed comparing hyponatremic vs eunatremic patients. RESULTS: Distribution of patients according to their serum sodium was as follows: 16 patients with hyponatremia (44%), 19 with normal serum sodium (51%) and 2 with hypernatremia (5%). The average sodium level in hyponatremic patients was 130±3.2 mmol/l, median urine sodium was 36±3.2 mmol/l (only 6 urine sample available). Hyponatremia was associated with dyspnea at admission and with higher levels of LDH, neutrophil cells account and C reactive protein. However, no worse prognostic was associated with lower serum sodium. All patients recover sodium levels at discharge treated with salt supplementation and free water intake. CONCLUSION: mild hyponatremia is a common electrolyte disorder associated with COVID19. Sing as low urine sodium and recover with water and salt ingestion, point toward hydrosaline dehydration instead of SIADH as most common origin of hyponatremia.

Daily multidisciplinary COVID-19 meeting: Experiences from a French university hospital.

OBJECTIVES: In March 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic. In absence of official recommendations, implementing daily multidisciplinary team (MDT) COVID-19 meetings was urgently needed. Our aim was to describe our initial institutional standard operating procedures for implementing these meetings, and their impact on daily practice. METHODS: All consecutive patients who were hospitalized in our institution due to COVID 19, from March 31 to April 15, 2020, were included. Criteria to be presented at MDT meetings were defined as a proven COVID-19 by PCR or strongly suspected on CT scan, requiring hospitalization and treatment not included in the standard of care. Three investigators identified the patients who met the predefined criteria and compared the treatment and outcomes of patients with predefined criteria that were presented during MDT meeting with those not presented during MDT meeting. COVID-19 MDT meeting implementation and adhesion were also assessed by a hospital medical staff survey. RESULTS: In all, 318 patients with confirmed or suspected COVID-19 were examined in our hospital. Of these, 230 (87%) were hospitalized in a COVID-19 unit, 91 (40%) of whom met predefined MDT meeting criteria. Fifty (55%) patients were presented at a MDT meeting versus 41 (45%) were not. Complementary exploration and inclusion in the CorImmuno cohort were higher in MDT meeting group (respectively 35 vs. 15%, P=0.03 and 80 versus 49%, P=0.0007). Prescription of hydrocortisone hemisuccinate was higher in group of patients not presented during MDT meeting (24 vs. 51%, P=0.007). Almost half of the patients fulfilling the inclusion criteria were not presented at MDT meeting, which can be partly explained by technical software issues. CONCLUSIONS: Multidisciplinary COVID-19 meetings helped implementing a single standard of care, avoided using treatments that were untested or currently being tested, and facilitated the inclusion of patients in prospective cohorts and therapeutic trials.