Percutaneous Tracheostomy in Respiratory Failure Due to COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) can lead to hypoxemic respiratory failure resulting in prolonged mechanical ventilation. Typically, tracheostomy is considered in patients who remain ventilator dependent beyond 2 weeks. However, in the setting of this novel respiratory virus, the safety and benefits of tracheostomy are not well-defined. Our aim is to describe our experience with percutaneous tracheostomy in patients with COVID-19. MATERIALS AND METHODS: This is a single center retrospective descriptive study. We reviewed comorbidities and outcomes in patients with respiratory failure due to COVID-19 who underwent percutaneous tracheostomy at our institution from April 2020 to September 2020. In addition, we provide details of our attempt to minimize aerosolization by using a modified protocol with brief periods of planned apnea. RESULTS: A total of 24 patients underwent percutaneous tracheostomy during the study. The average body mass index was 33.0±10.0. At 30 days posttracheostomy 17 (71%) patients still had the tracheostomy tube and 14 (58%) remained ventilator dependent. There were 3 (13%) who died within 30 days. At the time of data analysis in November 2020, 9 (38%) patients had died and 7 (29%) had been decannulated. None of the providers who participated in the procedure experienced signs or symptoms of COVID-19 infection. CONCLUSION: Percutaneous tracheostomy in prolonged respiratory failure due to COVID-19 appears to be safe to perform at the bedside for both the patient and health care providers in the appropriate clinical context. Morbid obesity did not limit the ability to perform percutaneous tracheostomy in COVID-19 patients.

Symptoms and Glycemic Control in Young People with Type 1 Diabetes following SARS-CoV-2 Infection: an Observational Study

Objective: To describe clinical manifestations of SARS-CoV-2 infection in children, adolescents, and young adults with established type 1 diabetes and explore the effects of COVID-19 on glycemic control and disease course. Method(s): Observational study conducted at three pediatric diabetes clinics in Israel between mid-March-2020 and mid- March-2021. Included were young people with established type 1 diabetes, <30years, who tested positive for SARS-CoV-2 (qRTPCR). Data was collected from medical files, diabetes devices, and COVID-19 questionnaire. Outcome measures were analyzed by presence/absence of clinical symptoms (symptomatic/asymptomatic) and by age group (pediatric, <19years/young adults, 19-30years). Result(s): Of 132 patients, mean age 16.9+/-5.3years, with COVID- 19 confirmed infection, 103 (78%) had related symptoms;the most common were headaches, fatigue, fever and loss of sense of smell. All had mild disease course, but four required hospitalization and two cases were directly related to COVID-19 infection (pleuropneumonia in a patient with immunodeficiency syndrome, one case of diabetic-ketoacidosis). Logistic regression analysis showed that age (OR=1.11, 95%CI, 1.01, 1.23;P=0.033), elevated glucose levels (OR=5.23, 95%CI, 1.12, 24.41;P=0.035) and comorbidities (OR=8.21, 95%CI, 1.00, 67.51;P=0.050) were positively associated with symptomatic infection. Persistent symptoms occurred in 16.5% of the cohort over a median of 6.7 months;age (OR=1.14, 95%CI, 1.01, 1.29;P=0.030) and elevated glucose levels (OR=3.42, 95%CI, 1.12, 10.40;P=0.031) were positively associated with persistent symptoms. Usually, no change was reported in glucose levels (64%) except for a temporary deterioration in glycemic control during the short infection period. Conclusion(s): Young people with established type 1 diabetes experience mild COVID-19 infection. Elevated glucose levels during COVID-19 infection and older age were associated with prolonged disease course.

The Role of Religious Cooperation in Negative Emotions Experienced During Covid-19

This study was carried out to determine the negative emotions that arise during the Covid-19 process, to determine what kind of coping styles people use against the negative psychological factors, and to see how religion affects coping. In the research, answers were sought to three basic questions: In the first question, what kind of adverse psychological problems people experienced with the pandemic;in the second question, what type of coping styles are developed against the negative psychological situations they encounter;In the third question, an answer was sought on the position of negative coping among individuals' coping styles. For this purpose, data were obtained from 19 male and 41 female participants studying at the undergraduate level in different faculties, who themselves or someone from their close circles had Covid-19 experiences. The data obtained within the scope of the research were converted into text and analyzed with the help of Maxqda 20 Package Program. As a result of the analysis, various codes, sub-themes, and themes were reached. When the effects are examined, it is seen that individuals generally experience many negative emotions such as anxiety, fear, hopelessness, stress, fatigue, and depression. However, it has been concluded that individuals use religious coping the most against these adverse situations.

Cell-Type-Specific Immune Dysregulation in Severely Ill COVID-19 Patients.

Recent studies have demonstrated immunologic dysfunction in severely ill coronavirus disease 2019 (COVID-19) patients. We use single-cell RNA sequencing (scRNA-seq) to analyze the transcriptome of peripheral blood mononuclear cells (PBMCs) from healthy (n = 3) and COVID-19 patients with moderate disease (n = 5), acute respiratory distress syndrome (ARDS, n = 6), or recovering from ARDS (n = 6). Our data reveal transcriptomic profiles indicative of defective antigen presentation and interferon (IFN) responsiveness in monocytes from ARDS patients, which contrasts with higher responsiveness to IFN signaling in lymphocytes. Furthermore, genes involved in cytotoxic activity are suppressed in both natural killer (NK) and CD8 T lymphocytes, and B cell activation is deficient, which is consistent with delayed viral clearance in severely ill COVID-19 patients. Our study demonstrates that COVID-19 patients with ARDS have a state of immune imbalance in which dysregulation of both innate and adaptive immune responses may be contributing to a more severe disease course.

Cell type-specific immune dysregulation in severely ill COVID-19 patients (preprint)

Coronavirus disease 2019 (COVID-19) has quickly become the most serious pandemic since the 1918 flu pandemic. In extreme situations, patients develop a dysregulated inflammatory lung injury called acute respiratory distress syndrome (ARDS) that causes progressive respiratory failure requiring mechanical ventilatory support. Recent studies have demonstrated immunologic dysfunction in severely ill COVID-19 patients. To further delineate the dysregulated immune response driving more severe clinical course from SARS-CoV-2 infection, we used single-cell RNA sequencing (scRNAseq) to analyze the transcriptome of peripheral blood mononuclear cells (PBMC) from hospitalized COVID-19 patients having mild disease (n = 5), developing ARDS (n = 6), and recovering from ARDS (n = 6). Our data demonstrated an overwhelming inflammatory response with select immunodeficiencies within various immune populations in ARDS patients. Specifically, their monocytes had defects in antigen presentation and deficiencies in interferon responsiveness that contrasted the higher interferon signals in lymphocytes. Furthermore, cytotoxic activity was suppressed in both NK and CD8 lymphocytes whereas B cell activation was deficient, which is consistent with the delayed viral clearance in severely ill COVID-19 patients. Finally, we identified altered signaling pathways in the severe group that suggests immunosenescence and immunometabolic changes could be contributing to the dysfunctional immune response. Our study demonstrates that COVID-19 patients with ARDS have an immunologically distinct response when compared to those with a more innocuous disease course and show a state of immune imbalance in which deficiencies in both the innate and adaptive immune response may be contributing to a more severe disease course in COVID-19.