Collaboration between pharmacists in community pharmacy and ambulatory clinic settings: Current state and future directions

Pharmacists in the community and ambulatory settings are primed for collaboration that can optimize care. Now is the time to capitalize on the momentum and positive disruption of the COVID-19 pandemic that propelled pharmacists and their organizations to respond with agility to deliver care in new ways, pivot to develop new partnerships, and leverage technology. The growth of collaborative practice agreements within ambulatory care settings, the enhancement of clinically integrated networks, and the growth in professional organization support create an environment ripe for implementation of pharmacist-to-pharmacist collaborations. The American College of Clinical Pharmacy 2022 Clinical Practice Affairs B Committee sought out literature, as well as prepublication contemporary examples, demonstrating models of intraprofessional collaboration among pharmacists in community and ambulatory settings. The committee formulated six key recommendations to optimize pharmacist collaborations in the community and ambulatory settings and formed a framework for practical implementation strategies at the levels of individual pharmacists, organizations, and educational institutions and for legislative advocacy.Copyright © 2023 Pharmacotherapy Publications, Inc.

CUMULATIVE INCIDENCE OF COVID-19 AND VACCINE PROFILES AMONG ASEAN PERITONEAL DIALYSIS POPULATIONS: A PRELIMINARY RESULT OF THE "InCoV-PD" STUDY GROUP

Introduction: Although there are several reports of COVID-19 in patients on peritoneal dialysis (PD), all of them were retrospective and mono-national-state designs, and none reported vaccination profiles. Method(s): The incidence of COVID-19 infection among PD patients and vaccination profiles of COVID-19 from 1 January 2020 to 30 September 2021 were retrieved from the survey of PD leaders in the ASEAN countries. Countries were excluded if their infection rates (IR) in PD populations were smaller than the lower limit value of 95% confidence interval (CI) of the overall pooled prevalence of 1.25 reported in kidney failure patients with COVID-19 infection globally, considering the possibility of under-reporting and if the number of PD population is less than 50 cases. Thus, Burma (45 cases, unknown IR), Cambodia (1 case, IR 0%), Indonesia (2,692 cases, unknown IR), Laos PDR (3 cases, IR 33%), and Vietnam (PD 1,500 cases, IR <1%) were excluded. Result(s): Figure 1 demonstrates the incidence of COVID-19 infection in PD populations in selected ASEAN members. The cumulative incidence of COVID-19 has gradually increased in all reported countries. The cumulative incidence rate of Singapore reached a plateau in the second quarter of 2020 but has since seen a surge in the third quarter of 2021 with an average incidence of 0.5-1.5 cases per 100 population. Overall IR ranged from 0.1% in Singapore to 23.8% in the Philippines with an average ASEAN IR of 2.6%. The majority of ASEAN had less than half of their populations fully vaccinated, ranging from only 13% in Vietnam to 46% in Brunei. Despite Laos being a low-income country, it was the first ASEAN to vaccinate its population. Singapore had the highest vaccination rates, with 83% and 81% of its population partially and completely vaccinated, respectively. Brunei, albeit being a high-income country, is the last country to roll out vaccination with a tardy vaccination rate, possibly due to the under-preparedness of the government and a false sense of security as Brunei had 15 months of zero cases before the latest wave. The incidence of ASEAN PD patients with COVID-19 infection surged during the second and third quartiles of 2021 despite the vaccine roll-out (Table 1). [Formula presented] Abbreviations: Ad26, Ad26.COV2.S;BBIBP, BBIBP-CorV;BNT, BNT162b2;Covishield, ChAdOx1 nCoV-19 (Covishield);Gam, Gam-COVID-Vac;mRNA, mRNA-1273;Vaxzeria, ChAdOx1 nCoV-19 (Vaxzeria) Remarks: Yellow, Conventional inactivated vaccines (BBIBP-CorV [Sinopharm], CoronaVac [Sinovac]);Green, RNA vaccines (BNT162b2 [Pfizer-BioNTech], mRNA-1273 [Moderna]);Pink, Viral vector vaccines (Gam-COVID-Vac [Sputnik], ChAdOx1 nCoV-19 [Covishield], ChAdOx1 nCoV-19 [Vaxzeria] and Ad26.COV2.S [Johnson & Johnson]) [Formula presented] Figure 1. Cumulative incidence of COVID-19 infected PD patients in selected ASEAN Conclusion(s): Overall IR of the ASEAN PD population varied widely among countries. However, the rollout rate of vaccination lagged behind that of western countries. This should increase efforts to educate their population on the benefits of timely vaccination. There remain a lot of uncertainties regarding COVID-19, and hence there is an urgent need for large prospective studies with international collaboration, to address these questions. No conflict of interestCopyright © 2023

A Comparative Study of Question Answering over Knowledge Bases

Question answering over knowledge bases (KBQA) has become a popular approach to help users extract information from knowledge bases. Although several systems exist, choosing one suitable for a particular application scenario is difficult. In this article, we provide a comparative study of six representative KBQA systems on eight benchmark datasets. In that, we study various question types, properties, languages, and domains to provide insights on where existing systems struggle. On top of that, we propose an advanced mapping algorithm to aid existing models in achieving superior results. Moreover, we also develop a multilingual corpus COVID-KGQA, which encourages COVID-19 research and multilingualism for the diversity of future AI. Finally, we discuss the key findings and their implications as well as performance guidelines and some future improvements. Our source code is available at https://github.com/tamlhp/kbqa.

A Comparative Study of Question Answering over Knowledge Bases

Question answering over knowledge bases (KBQA) has become a popular approach to help users extract information from knowledge bases. Although several systems exist, choosing one suitable for a particular application scenario is difficult. In this article, we provide a comparative study of six representative KBQA systems on eight benchmark datasets. In that, we study various question types, properties, languages, and domains to provide insights on where existing systems struggle. On top of that, we propose an advanced mapping algorithm to aid existing models in achieving superior results. Moreover, we also develop a multilingual corpus COVID-KGQA, which encourages COVID-19 research and multilingualism for the diversity of future AI. Finally, we discuss the key findings and their implications as well as performance guidelines and some future improvements. Our source code is available at https://github.com/tamlhp/kbqa. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

HUMORAL IMMUNOGENICITY OF THREE SARS-COV-2 MRNA VACCINE DOSES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Background: Initial studies have shown that patients with inflammatory bowel disease (IBD) have a humoral immune response rate of 95–99% to a two-dose SARS-CoV-2 mRNA vaccine series. A third mRNA vaccine dose has been recommended for the IBD population. The aim of our study was to evaluate the humoral immunogenicity a third SARS-CoV-2 mRNA vaccine dose in patients with IBD. Methods: This was a multicenter, prospective, nonrandomized study comprised of patients with IBD and healthy controls (HC) in the HERCULES cohort. IBD subject eligibility criteria included a diagnosis of IBD, stable doses of maintenance therapy (≥ 2 months), and completion of a two-dose mRNA vaccines series. IBD subjects may have received a third mRNA vaccine dose. HC eligibility criteria included absence of immunosuppressive therapy and completion of a two-dose mRNA vaccine series. HC did not receive a third dose. Those with prior COVID-19 infection were excluded. The primary outcome was total serum SARS-CoV-2 anti-spike IgG antibody concentrations following a third dose compared to antibody concentrations following the two-dose series in IBD subjects. In IBD subjects, we measured antibody concentrations at 28–35 days following completion of the two-dose series and 28–65 days following the third dose. In HC, we measured antibody concentrations at 180 days following completion of the twodose series. Antibody concentrations between groups were compared using Mann-Whitney U tests. Results: One hundred thirty-nine IBD subjects and 46 HC were enrolled. Eightyfive IBD subjects received a third dose (Table 1). One hundred thirty-five IBD subjects (97.1%) had detectable antibody concentrations post-two-dose series, while 85 IBD subjects (100%) had detectable antibody concentrations post-third dose. For IBD subjects that received a third dose, antibody concentrations were significantly higher post-third dose compared to post-two-dose series (median 68 (IQR 32–147) vs 31 (IQR 16–61), p<0.001) (Figure 1). Post-third dose, IBD subjects on systemic corticosteroids or anti-TNF combination therapy had significantly lower antibody concentrations than IBD subjects that were not (median 29 (IQR 10–39) vs 72 (IQR 37–164), p<0.001). For HC, antibody concentrations were significantly lower 180 days compared to 30 days post-two-dose series (median 17 (IQR 11–22) vs 120 (IQR 88–190), p<0.001). HC had lower antibody concentrations 180 days post-two-dose series compared to IBD subjects post-third dose (median 17 (IQR 11– 22) vs 68 (IQR 32–147), p<0.001). Conclusion: All patients with IBD receiving a third SARS-CoV-2 mRNA vaccine dose were seropositive, and median antibody concentrations were higher than those measured after the two-dose series. Patients on corticosteroids and anti-TNF combination therapy had lower antibody concentrations than patients not on such therapy following a third dose. (Table Presented) (Figure Presented)

Relationship Between the Fear of Missing Out and Loneliness Among Vietnamese University Students In COVID-19 Pandemic

Fear of missing out (FOMO) is a relatively new syndrome that has emerged in recent years due to the rapid development of social media platforms. It is becoming increasingly prevalent, particularly during the current COVID-19 pandemic. The goal of this study was to evaluate the relationship between fear of missing out and loneliness and predict loneliness by examining two degrees of fear of missing out in participants. 354 Vietnamese undergraduate students from three universities responded to the Fear of Missing Out questionnaire, with 349 of those responses being valid for study purposes. It was discovered through the study's findings that there is a positive association between loneliness and the fear of missing out (FOMO), with two components of FOMO, namely the personal and societal aspects, being predictive of loneliness. The outcomes of this study will have implications for our understanding of loneliness and the fear of missing out, as well as for the treatment of mental illnesses. © 2022. Pegem Egitim ve Ogretim Dergisi.All Rights Reserved

MATERNAL SARS-COV-2 INFECTION IN THE SECOND TRIMESTER AND VENTRICULOMEGALY AND DEVELOPMENTAL DELAY IN AN INFANT

Case Report History: Mother is a 23 year old gravida 4 para 1021, with a history of type 1 diabetes since 12 years of age. Prenatal sonogram at 20 weeks of gestation showed normal fetal anatomy with an EFW 21st percentile & 2-vessel cord. She was admitted at 23 weeks of gestation for acute hypoxic respiratory failure secondary to SARS-CoV-2 pneumonia, diabetic ketoacidosis & acute kidney failure. She refused intubation in spite of saturations in low 80s & was treated with high flow nasal cannula, non-rebreather mask, & nasal CPAP. She received convalescent plasma, Remdesivir, Tocilizumab, steroids, hydroxychloroquine, ceftriaxone & azithromycin, and was discharged home on oxygen after 29 days. Prenatal sonogram at 29 weeks of gestation demonstrated severe IUGR (abdominal & head circumference, fetal weight and femur length all < 3rd percentile), ventriculomegaly & a 2-vessel cord. Fetal MRI showed severe lateral ventriculomegaly of the brain, diffuse white matter parenchymal edema, bilateral germinal matrix & intraventricular hemorrhage & severe parenchymal volume loss. Mother was lost to follow up until time of delivery. Physical examination An infant female was born at 39 weeks of gestation via repeat cesarean-section. She was admitted to NICU for severe IUGR. The newborn's birth weight was 2126 g, head circumference 30 cm, length 43.5 cm (all <3rd percentile). Baby had mild hypertonia and tremors, rest of the exam was normal. The newborn was treated for TTN with NCPAP, hypoglycemia requiring IVF and hyperbilirubinemia requiring phototherapy and was extremely slow to feed. Diagnostic work-up CBC, BMP, LFT & CSF microscopy were normal, SARS-CoV-2 PCR was negative. SARS-CoV-2 IgM was negative in serum & CSF, but IgG was positive in serum & CSF. Baby's titers were slightly higher than mother's. US & MRI confirmed ventriculomegaly due to volume loss, a component of hydrocephalus was suspected due to presence of intraventricular hemorrhage, however there was no evidence of raised ICP. Retinal exam, hearing and BAER were normal. Chromosome analysis was normal & Zika titers were negative. The newborn was discharged home after 20 days with weighing 2580 g and head circumference of 32 cm. Placental was 222 g with <10% infarction and moderate acute chorioamnionitis. Infant has significant developmental delay at 1 year of age. Discussion There is definitive evidence of adverse neonatal outcomes in third trimester maternal SARS-CoV-2 infection, effects of earlier infections are not well reported. In our case the neurological injury can't be attributed definitively to fetal SARS-CoV-2 infection as IgM was negative, but the interval of 16 weeks between maternal infection and delivery need to be taken into account. Maternal illness likely contributed to severe acute on chronic fetal hypoxia which resulted in IUGR and in utero IVH with resultant CNS tissue loss and ventriculomegaly. (Figure Presented).

THE IMPACT OF COVID-19 ON OLDER ADULTS' FINANCES, WELL-BEING AND FEAR

The COVID-19 pandemic outbreak and subsequent lockdowns impacted the mental health of numerous sociodemographic groups globally. This crisis can produce stress, overwhelm, and powerful emotions in susceptible people, especially older persons. Our study examined the relationship between well-being and fear of COVID-19 among older persons residing in Ho Chi Minh City, Vietnam, during the pandemic. A sociodemographic survey was undertaken. Two scales are used for a month of the COVID-19 outbreak: the Mental Health Continuum Short Form (MHC-SF) and the Fear of COVID-19 Scale (FCV-19S). We surveyed 158 senior citizens in Ho Chi Minh City between February and April 2021. There was no lockdown in Ho Chi Minh before the fourth wave of infection. Despite this, citizens have maintained high compliance with coronavirus prophylaxis. Sociodemographic data were described using descriptive statistics. A one-way MANOVA assessed the financial impact on older individuals' well-being. The Pearson correlation was employed to find the link between happiness and COVID-19 dread. During the COVID-19 pandemic, older persons who received various monthly allowances had statistically significant emotional and psychological well-being differences. There was no association between well-being and COVID-19 dread. The COVID-19 epidemic has disproportionately affected vulnerable groups. Older individuals are a risk population that requires material and mental care.

WAYS TO IMPROVE VIETNAM’S COMPETITIVENESS AND ECONOMIC RECOVERY IN THE CONTEXT OFA PANDEMIC

There is currently no official research and publication by an authoritative organization on the state of the world economy in crisis. The economic downturn and negative growth of many leading countries show the huge impact of the COVID-19 pandemic on the world economy. Solving the problem of Vietnam’s economy’s recovery from this situation actualizes the issue of justifying effective development strategies. This is indeed a complex process that results in achieving a competitive position compared to the ASEAN region. The content of the scientific paper is based on the materials from current sources, i.e. international organizations and periodicals, summary data from publications of the Vietnamese statistical office, as well as historical and economic literature. The factors ensuring the country’s competitiveness were analyzed on the basis of ratings of international organizations whereby it is possible to determine the most competitive elements of the Vietnamese economy and propose priority directions for state development. Key recommendations include structural reforms aimed at changing the growth model from a factor to productivity, improving the quality of technologies and human resources, as well as improving the business environment, ensuring macroeconomic stability, upgrading infrastructure and encouraging innovation.Alternate : В настоящее время нет официального исследования и публикации авторитетной организации о состоянии мировой экономики, находящейся в кризисе. Но экономический спад и отрицательный рост многих ведущих стран показывают огромное влияние пандемии COVID-19 на мировую экономику. Решение проблемы выхода экономики Вьетнама из этой ситуации актуализирует вопрос обоснования эффективных стратегий развития. Это действительно сложный процесс, который приводит к достижению конкурентных позиций по сравнению с регионом АСЕАН. Контент научной статьи основан на материалах текущих источников, исходящих из международных организаций и периодики, сводных данных изданий статистического управления Вьетнама, а также на литературе историко-экономического характера. На основе результатов рейтинговых оценок международных организаций определены наиболее конкурентоспособные элементы экономики Вьетнама и предложены приоритетные направления развития государства. Ключевые рекомендации включают структурные реформы, направленные на изменение модели роста с фактора на производительность, повышение качества технологий и людских ресурсов, а также улучшение бизнес-среды, обеспечение макроэкономической стабильности, модернизацию инфраструктуры и поощрение инноваций.

Industry 4.0 technologies and sustainable warehousing: a systematic literature review and future research agenda

Purpose: Robust and efficient warehouse management is pivotal to the success of contemporary logistics and business productivity. Given the recent technological revolutions and the rising pressure for sustainable warehouse activities, the recent literature continues to grow on Industry 4.0 technologies and sustainable warehousing. Following this, the review aims to explore current state-of-the-art, knowledge development, the focus of research, methodological development and knowledge gaps for more impactful future research on this important yet underexplored topic. Design/methodology/approach: A widely accepted systematic literature review (SLR) methodology was employed on a sample of 46 articles retrieved from multiple search queries in the three large databases: Scopus, Web of Science and Google Scholar. Findings: The authors’ analysis unveils several interesting findings: the positive linkage between various Industry 4.0 technologies and the three main pillars (economic, social, environmental) of sustainable warehousing;the paucity of large scale empirical research, specifically in the context of COVID-19;imbalance amid studies on three main aspects of warehouse sustainability;partial application of Industry 4.0 technologies;and disproportion in scholarly focus between numerous warehouse activities and Industry 4.0 technologies. Practical implications: The authors integrate research findings from a pool of studies, thereby improving the understanding of practitioners on how different Industry 4.0 technologies relate to sustainable warehousing. Originality/value: To the best of the authors’ knowledge, this is the first SLR at the intersection of Industry 4.0 technologies and sustainable warehousing. Our review expands the existing knowledge base, devises a conceptual framework and suggests avenues for fruitful future research on this emerging area. © 2022, Emerald Publishing Limited.

Lives and livelihoods trade-offs: Which COVID-19 strategies for which countries?

Are COVID-19 non-pharmaceutical interventions (NPIs) at the expense of economic outcomes? Furthermore, given the heterogeneities in macroeconomic conditions, should countries follow a unified COVID-19 strategy such as “No-COVID”? This study provides cross-country evidence that attempts to address these critical questions during the pandemic era. Given the substantial heterogeneity in unemployment rates of OECD countries, it is necessary to understand the effects of NPIs’ implementation, which could vary widely across conditional quantiles of unemployment rates. Using monthly data from OECD countries from February 2020 to June 2021 and quantile regression analysis for panel data (QRPD), we explore the impacts of NPIs on economic outcomes. The results indicate that NPIs effectively contained the pandemic and had substantial positive impacts on low quantiles of unemployment rates. However, at high quantiles of unemployment rates, the trade-off is viable and significant. In addition, countries’ vaccination policies and scales also predict their economic outlooks, especially when combined with non-pharmaceutical interventions. Based on these findings, this study suggests different COVID-19 strategies for different groups of countries according to their macroeconomic settings. The trade-off between lives and livelihoods is much more troublesome and prevalent in countries with unfavorable macroeconomic conditions and hinders them from pursuing strategies such as “No-COVID”. © 2022 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.

Tweet Sentiment Analysis for Predicting the Symptoms Effect Level Regarding COVID-19

From the end of 2019, numerous comments and opinions relating to the COVID-19 pandemic have been posted on Twitter. The number of opinions rapidly increased since the countries began implementing social isolation and reduction. In these comments, users often express different emotions regarding COVID-19 signs and symptoms, the majority of which are sadness and fear sentiments. It is important to determine the symptom effect level for the emotions of symptomatic persons based on their opinions. However, no study analyzes the tweets' sentiment related to the COVID-19 topic to predict the symptoms effect level. Therefore, in this study, we present a method to predict the symptoms effect level based on the sentiment analysis of symptomatic persons according to the following steps. First, the sentiments in tweets are analyzed by using a combination of the text representation model and convolutional neural network. Second, a topic modeling model is built based on the latent Dirichlet allocation algorithm to group symptoms into small clusters that conform to sadness and fear sentiments. Finally, the symptom effect level is predicted based on the probability distribution of the symptoms in each sentiment cluster. Experiments using tweets promise that the proposed method achieves significant results toward the accuracy and obtained information.

Air pollution in Vietnam during the COVID-19 social isolation, evidence of reduction in human activities

The COVID-19 (COronaVIrus Disease) pandemic has been spreading globally and social isolation has been implemented as an effective solution to limit the spread of the pandemic before vaccines are developed successfully. The reduction of human activities during social isolation is leading to an improvement in air quality being observed worldwide. In this study, we analysed satellite TROPOMI (TROPOspheric Monitoring Instrument) NO2 (Nitrogen Dioxide) and OMI (Ozone Monitoring Instrument) NO2 products obtained from Sentinel-5P and Aura satellites, respectively, during the social isolation from 1 April 2020 to 22 April 2020 in Vietnam where air pollution is a serious environmental issue. Both TROPOMI and OMI NO2 have shown low agreement with local on-ground NO2 concentration (the correlation coefficient r equals 0.4 and 0.3 in 2020, respectively) but have had moderate correlation with each other in 2020 (r equals 0.81 for two annual averaged maps). In addition, the moderate available data ratio over cloudy northern areas were observed, especially for TROPOMI datasets. During social isolation, the national average NO2 decreased by 9.3% for TROPOMI and 7.2% for OMI, respectively, in comparison with the same periods in the previous years. The reduction was stronger in the North than in the South and lasted for one more month after the lockdown period. The decrease of NO2 density during the lockdown was observed strongly in urban areas associated with dense population, traffic density, and industrial zones. Further analysis of NO2 density for Ho Chi Minh city revealed a decreasing trend of NO2 during social isolation (16.62% and 11.77% compared with the previous month and the same period in 2019, respectively). Furthermore, we used a random forest model to estimate the NO2 density (normal life situations) based on daily meteorological data at station. During social isolation, NO2 density observed in Ho Chi Minh city decreased by 26% down to that of normal life situations. The NO2 reduction has shown strong anthropogenic impact on air pollution over the study area. Besides, the first use of TROPOMI and OMI NO2 products together has highlighted potentials of satellite observation for air quality monitoring and analysis in Vietnam where on-ground measurements are very limited. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

Comparisons in early and late presentation to Hospital in covid-19 patients

Background The clinical presentation and disease severity in SARS-Cov-2 infection ranges from asymptomatic carriage to death. There is little data regarding the timeframe of symptom onset to presentation to hospital, and disease outcomes. Therefore, we aim to investigate differences between 'early presenters' (< 7 days of symptom onset) and 'late presenters' (>7 days) and their clinical and radiological outcomes. Methods In this retrospective cohort study, symptom onset, epidemiological, and clinical characteristics were collected from patient electronic medical records at University Hospital Southampton Foundation Trust with laboratory confirmed SARS-Cov-2 infection. Logistical regression models were used to explore the relationships between these data and time of presentation to hospital. Results Between March and July 2020, symptom onset data was collected for 626 SARS-Cov-2 positive patients, 574 of whom had chest radiographs (CXR). Early presenters comprised 388 (62%) and 238 (38%) were late presenters. Early presenters were significantly older (p<0.001), more likely to have significant comorbidities-hypertension, thromboembolic and renal disease (p<0.001)- A nd also significantly less likely to report cardinal symptoms of Covid-19;fever, cough, SOB, myalgia, fatigue/malaise, headache (p<0.001). In the cohort overall, the presence of infiltrates was not predictive of adverse outcome (ICU admission, ventilation or death) (p=0.214). Although early presenters were less likely to have infiltrates on their CXR (58% vs 76.8%), (p<0.001), the presence of CXR infiltrates in early presenters demonstrated an increased risk of adverse outcome (OR 1.90, 95% CI 1.11, 3.25). Conclusion We have demonstrated that SARS-Cov-2 infection presents in an heterogenous manner that varies with symptom duration. Atypical presentation of SARS-Cov-2 infection is more common earlier on in disease course, where viral shedding is likely to be higher, and this finding is of note in the context of national criteria for self-isolation and testing. Late presentation is more likely to be associated with radiological change, but this does not reflect an increased likelihood of adverse outcome. Patients who present early in their illness with radiological changes are at increased risk of adverse clinical outcome, suggesting that symptom onset and detection of CXR infiltrates are important for clinical assessment of severity at presentation to hospital in Covid-19.

S3 Comparisons in early and late presentation to hospital in COVID-19 patients

BackgroundThe clinical presentation and disease severity in SARS-Cov-2 infection ranges from asymptomatic carriage to death. There is little data regarding the timeframe of symptom onset to presentation to hospital, and disease outcomes. Therefore, we aim to investigate differences between ‘early presenters’ (< 7 days of symptom onset) and ‘late presenters’ (>7 days) and their clinical and radiological outcomes.MethodsIn this retrospective cohort study, symptom onset, epidemiological, and clinical characteristics were collected from patient electronic medical records at University Hospital Southampton Foundation Trust with laboratory confirmed SARS-Cov-2 infection. Logistical regression models were used to explore the relationships between these data and time of presentation to hospital.ResultsBetween March and July 2020, symptom onset data was collected for 626 SARS-Cov-2 positive patients, 574 of whom had chest radiographs (CXR). Early presenters comprised 388 (62%) and 238 (38%) were late presenters. Early presenters were significantly older (p<0.001), more likely to have significant comorbidities – hypertension, thromboembolic and renal disease (p<0.001) – and also significantly less likely to report cardinal symptoms of Covid-19;fever, cough, SOB, myalgia, fatigue/malaise, headache (p<0.001). In the cohort overall, the presence of infiltrates was not predictive of adverse outcome (ICU admission, ventilation or death) (p=0.214). Although early presenters were less likely to have infiltrates on their CXR (58% vs 76.8%), (p<0.001), the presence of CXR infiltrates in early presenters demonstrated an increased risk of adverse outcome (OR 1.90, 95% CI 1.11, 3.25).ConclusionWe have demonstrated that SARS-Cov-2 infection presents in an heterogenous manner that varies with symptom duration. Atypical presentation of SARS-Cov-2 infection is more common earlier on in disease course, where viral shedding is likely to be higher, and this finding is of note in the context of national criteria for self-isolation and testing. Late presentation is more likely to be associated with radiological change, but this does not reflect an increased likelihood of adverse outcome. Patients who present early in their illness with radiological changes are at increased risk of adverse clinical outcome, suggesting that symptom onset and detection of CXR infiltrates are important for clinical assessment of severity at presentation to hospital in Covid-19.

Inflammatory phenotyping predicts clinical outcome in COVID-19.

BACKGROUND: The COVID-19 pandemic has led to more than 760,000 deaths worldwide (correct as of 16th August 2020). Studies suggest a hyperinflammatory response is a major cause of disease severity and death. Identitfying COVID-19 patients with hyperinflammation may identify subgroups who could benefit from targeted immunomodulatory treatments. Analysis of cytokine levels at the point of diagnosis of SARS-CoV-2 infection can identify patients at risk of deterioration. METHODS: We used a multiplex cytokine assay to measure serum IL-6, IL-8, TNF, IL-1ß, GM-CSF, IL-10, IL-33 and IFN-γ in 100 hospitalised patients with confirmed COVID-19 at admission to University Hospital Southampton (UK). Demographic, clinical and outcome data were collected for analysis. RESULTS: Age > 70 years was the strongest predictor of death (OR 28, 95% CI 5.94, 139.45). IL-6, IL-8, TNF, IL-1ß and IL-33 were significantly associated with adverse outcome. Clinical parameters were predictive of poor outcome (AUROC 0.71), addition of a combined cytokine panel significantly improved the predictability (AUROC 0.85). In those ≤70 years, IL-33 and TNF were predictive of poor outcome (AUROC 0.83 and 0.84), addition of a combined cytokine panel demonstrated greater predictability of poor outcome than clinical parameters alone (AUROC 0.92 vs 0.77). CONCLUSIONS: A combined cytokine panel improves the accuracy of the predictive value for adverse outcome beyond standard clinical data alone. Identification of specific cytokines may help to stratify patients towards trials of specific immunomodulatory treatments to improve outcomes in COVID-19.