Colchicine reduces the activation of NLRP3 inflammasome in COVID-19 patients.

OBJECTIVE: To evaluate whether colchicine treatment was associated with the inhibition of NLRP3 inflammasome activation in patients with COVID-19. METHODS: We present a post hoc analysis from a double-blinded placebo-controlled randomized clinical trial (RCT) on the effect of colchicine for the treatment of COVID-19. Serum levels of NOD-like receptor protein 3 (NLRP3) inflammasome products-active caspase-1 (Casp1p20), IL-1ß, and IL-18-were assessed at enrollment and after 48-72 h of treatment in patients receiving standard-of-care (SOC) plus placebo vs. those receiving SOC plus colchicine. The colchicine regimen was 0.5 mg tid for 5 days, followed by 0.5 mg bid for another 5 days. RESULTS: Thirty-six patients received SOC plus colchicine, and thirty-six received SOC plus placebo. Colchicine reduced the need for supplemental oxygen and the length of hospitalization. On Days 2-3, colchicine lowered the serum levels of Casp1p20 and IL-18, but not IL-1ß. CONCLUSION: Treatment with colchicine inhibited the activation of the NLRP3 inflammasome, an event triggering the 'cytokine storm' in COVID-19. TRIAL REGISTRATION NUMBERS: RBR-8jyhxh.

Designing a Cyber-Physical-Systems and Human Factors Engineering Course for Industry 4.0

This research presents a novel methodology and instructional, curricular design for the Cyber-Physical Systems and Human Factors Engineering course for an Industrial Engineering program in Higher Education. The research proposal offers a Competency-Based Education Model, Challenge-based Learning, and Experiential Learning design to create a curricular adaptation to prepare the future workforce for Industry 4.0, driven by digital technologies and strengthening the structure of Education 4.0 in pandemic times. The curricular design was explored and implemented in a national Industrial Engineering virtual course in five different facilities of a Higher Education Institution. Five professors participated in the exploratory study with 265 students in four country regions. The quantitative analysis provided positive findings regarding knowledge delivery and student competency development, confirming the good practices and standards in the proposed curricular design methodology. The final student evaluation results for the course have been favorable. They emphasized the importance of developing skills and knowledge about the enablers and components of Industry 4.0, such as Cyber-Physical-Systems and machine learning. Moreover, they remarked on the importance of human factors to develop a more sustainable society. The research contributes new ideas and perspectives for professors and instructional designers to shape the future of Higher Education. Furthermore, these new research paradigms for competencies in educational innovation shape the emerging virtual and hybrid educational practices in the COVID-19 pandemic and post-pandemic era.

Treatment of acute promyelocytic leukemia (APL) in a symptomatic patient with Coronavirus disease 19 (COVID-19) pneumonia

Introduction: In December 2019, a new variant of a coronavirus led to a pandemic outbreak. Patients with haematological malignancies are at high risk for a severe progression of COVID-19 with high mortality rates. Case report: 54-year-old patient was tested positive for COVID-19 upon admission. The CT scan showed bilateral ground-glass pulmonary opacities. He received dexamethasone and remdesivir. Due to severe thrombocytopenia and detection of blasts in peripheral blood a bone marrow biopsy was done. Cytological and molecular results confirmed the diagnosis intermediate risk APL. We started a therapy with arsenic trioxide and all-trans retinoic acid (ATO/ATRA). The white blood cells (WBC) increased and the respiratory situation worsened. The patient developed a thrombophlebitis. Bleeding complications appeared as an epistaxis, which required an intervention. 28 days after starting the induction, the bone marrow biopsy showed < 5% blasts. A complete peripheral remission was documented on day 50. Discussion: A major concern in treating APL is the differentiation syndrome, which can ultimately result in pulmonary failure. This patient presented with severely impaired lung function due to simultaneous COVID-19 pneumonitis. Therapy of APL had to consider both clinical conditions. Key decisions were (beyond antiviral therapy and supportive measures) a consequent dosing of glucocorticoids and early cytoreductive therapy using hydroxyurea (HU). The pulmonary function was critical during days 7-15 after start of APL therapy, consistent with differentiation syndrome being the main cause of worsening, and clinically met by stop of ATO/ATRA. Another concern was coagulation dysfunction, given the high risk of thromboembolic complications associated with COVID-19, the severe thrombocytopenia and plasmatic coagulation disorder caused by APL. In this case - besides supportive platelet transfusions - we treated by low dose heparin only when a thrombophlebitis occurred. Overall in this patient presenting with COVID-19 and simultaneously APL, the most challenging problem was overcoming pulmonary worsening in the initial phase of APL therapy.

A remote and immersive setup for pandemic-safe surgical education

Existing challenges in surgical education (See one, do one, teach one) as well as the Covid-19 pandemic make it necessary to develop new ways for surgical training. This is also crucial for the dissemination of new technological developments. As today's live transmissions of surgeries to remote locations always come with high information loss, e.g. stereoscopic depth perception, and limited communication channels. This work describes the implementation of a scalable remote solution for surgical training, called TeleSTAR (Telepresence for Surgical Assistance and Training using Augmented Reality), using immersive, interactive and augmented reality elements with a bi-lateral audio pipeline to foster direct communication. The system uses a full digital surgical microscope with a modular software-based AR interface, which consists of an interactive annotation mode to mark anatomical landmarks using an integrated touch panel as well as an intraoperative image-based stereo-spectral algorithm unit to measure anatomical details and highlight tissue characteristics.We broadcasted three cochlea implant surgeries in the context of otorhinolaryngology. The intervention scaled to five different remote locations in Germany and the Netherlands with lowlatency. In total, more than 150 persons could be reached and included an evaluation of a participant's questionnaire indicating that annotated AR-based 3D live transmissions add an extra level of surgical transparency and improve the learning outcome. © 2021 by Walter de Gruyter Berlin/Boston.

A remote and immersive setup for pandemic-safe surgical education

Introduction Existing challenges in surgical education (See one, do one, teach one) as well as the Covid-19-pandemic make it necessary to develop new ways for surgical training. This is also crucial for the dissemination of new technological developments. As todays live transmissions of surgeries to remote locations always come with high information loss, e.g. depth perception, this work describes the implementation of a scalable remote solution for surgical training, called TeleSTAR, using immersive, interactive and augmented reality elements tested during 3 ENT surgeries. Methods The system uses a full digital surgical microscope (ARRISCOPE, Munich Surgical Imaging, Munich, Germany). The microscope has a modular software augmented reality interface, which consists of an interactive annotation mode to mark anatomical landmarks using an integrated touch panel as well as an intraoperative image-based stereo-spectral algorithm unit to measure and highlight anatomical details and tissue characteristics. The stereo measurement unit computes a complete depth map allowing to perform precise distance measurements by setting markers. In addition, the system comes with a bi-lateral audio pipeline to foster direct communication. Results We evaluated the new educational paradigm during the 3D broadcast of three live AR-based cochlea implant surgeries. The system scaled to five different remote locations with low latency and offering a delayed 2D YouTube stream. In total, more than 150 persons could be trained including healthcare professionals, biomedical engineers and medical students. It was demonstrated by a participants survey, that annotated 3D live transmissions improve the learning outcome by adding an extra level of surgical transparency. Conclusion TeleSTAR provides a highly scalable solution for surgical training solving limitations for current educational programs and during pandemic situations by using an adaptive combination of modular software and hardware modules. Furthermore, it can be used as an intraoperative assistance system by support from remote experts and it can be easily adapted to other surgical domains.

Reproductive medicine during sars-cov-2-pandemic

The SARS-CoV-2-pandemic has had a worldwide impact on every human being. The health system in Germany had to adapt in the shortest possible time. Reproductive medicine was greatly affected already early during the pandemia: many university based IVF-units were closed by order of the health ministries to gather human resources for treating potential patients infected by COVID-19. Many private centers reduced the number of patients or stopped treating patients altogether due to the fact that information on the potentially harmful effects of COVID-19 on pregnancy or gametes was sparce. The German IVF-registry (D·I·R) has performed a special analysis on the situation of ART in 2020. 113 German IVF-centers have responded by exporting their data. This paper shows the most important results, the complete results can be requested at the D·I·R-Geschäftsstelle. J Reproduktionsmed Endokrinol 2021;18 (1): 40–4.

High psychological burden of young family physicians early in the COVID-19 pandemic: Results from an exploratory survey

Background Previous pandemics such as SARS in 2002 revealed an especially high psychological burden of frontline healthcare professionals in hospitals directly involved in the treatment of confirmed cases. As family physicians are among the first exposed to the SARS-CoV-2 virus, assessing their psychological burden and needs for support is important. Methods A web-based survey was distributed among family physicians of a German university teaching practice network. The questionnaire consisted of validated instruments to evaluate symptoms of psychological distress, i.e., the patient health questionnaire (PHQ-9), generalized anxiety disorder 7 (GAD-7), peritraumatic distress inventory (PDI), and insomnia severity index (ISI). Additional self-developed items addressed sociodemographic and professional characteristics including professional duties and protective equipment available. Effects between the symptoms were examined using bivariate Pearson correlation. Results The participation rate was 31 % (36 of 116) with 33 valid cases. About 47 % (n = 17) of the respondents were 56 years old or more. 66.7 % (n = 22) physicians reported moderate to severe depressive symptoms (PHQ-9 ≥ 10) and 51.5 % (n = 17) moderate to severe signs of anxiety (GAD-7 _ 10). Physicians with depressive symptoms showed more signs of anxiety (p <.001) and insomnia (p <.001). There is a negative correlation between age and severity of depressive symptoms (p =.041) and insomnia (p =.002). The regression analysis showed that younger participants were more likely to show depressive symptoms (β = –.358, p =.046), even after correcting for gender (R2 =.402). Conclusions Depressive symptoms were frequent among family physicians, especially in younger physicians who were also more likely to report symptoms of insomnia. The symptoms of psychological distress are unlikely to be explained by a lack of protective equipment, because the majority had sufficient supplies. © 2021, Deutscher Arzte-Verlag GmbH. All rights reserved.

Transforming operating rooms into an intensive care unit to manage the COVID-19 outbreak

This article is a descriptive analysis of the organizational steps undertaken to transform eight OR (operating rooms) of the University Hospital Lausanne CHUV into a dedicated ICU (intensive care unit) during the COVID-19 pandemic. An efficient response of our institution was mandatory to timely increase the number of ICU beds. The transformation of an entire floor of a functioning operating ward was deemed the most appropriate solution to provide rapidly a significant number of beds. The newly created ICU was the first additional ICU to open and admitted its first patient 48 hours after the beginning of the transformation.

[Urological care in practices and clinics during the corona virus pandemic in Germany]. / Versorgungssituation urologischer Patienten in Praxen und Kliniken während der Coronaviruspandemie in Deutschland.

The coronavirus pandemic has had an immediate and far-reaching effect on the care of urological patients. The pandemic monitor of the German Society for Urology was able to record the restrictions on patient care in urological practices and clinics by means of regular surveys of the members. A total of 689 responses at four survey time points were included. In April there was a reduction in urological inpatients to 44% and the number of patients in practices dropped to 50%. Available operating theater capacities for urological patients were 45% in April, normalized to 90% in June and fell again to 50% in December. Elective operations could not be performed at all or only to a very limited extent in most hospitals in April and December. While urgent operations could be treated to 100% in more than 75% of the clinics in April, in December more than half of the clinics stated that they could not treat all patients with urgent indications. To some extent (8-19%) practices and clinics had to resort to a pandemic-related supraregional referral of patients. The reduction of outpatients in urological practices in April normalized to 95% in June and remained stable during the second wave of the pandemic. The increase in urological emergencies in practices observed at the beginning of the pandemic did not show up in November and December. The coronavirus pandemic has led to a significant reduction in the care of urological patients, which in particular in the second wave also affects urgent operations.

Assessing the impact of coordinated COVID-19 exit strategies across Europe

As rates of new coronavirus disease 2019 (COVID-19) cases decline across Europe owing to nonpharmaceutical interventions such as social distancing policies and lockdown measures, countries require guidance on how to ease restrictions while minimizing the risk of resurgent outbreaks. We use mobility and case data to quantify how coordinated exit strategies could delay continental resurgence and limit community transmission of COVID-19. We find that a resurgent continental epidemic could occur as many as 5 weeks earlier when well-connected countries with stringent existing interventions end their interventions prematurely. Further, we find that appropriate coordination can greatly improve the likelihood of eliminating community transmission throughout Europe. In particular, synchronizing intermittent lockdowns across Europe means that half as many lockdown periods would be required to end continent-wide community transmission.

Geneva airport in 2020 and beyond: Validating our strategy to develop a sustainable airport and maintaining this in the new normal

How can airports today find the right balance between accommodating the demand for air travel, the needs of airlines and also address a framework that imposes more and more constraints on the environmental impact of the airport’s activities? We will present the results after three years of implementing our strategy to address this in the context of Geneva Airport, a 17.9-million passenger airport in Switzerland. We will also discuss the impact of the COVID-19 crisis and how we will move ahead. © HENRY STEWART PUBLICATIONS.

Short-term rentals, housing markets and covid-19: Theoretical considerations and empirical evidence from four austrian cities

Prior to the onset of the pandemic, evidence on the conversion of regular rental housing into permanent holiday homes has fuelled concerns that Airbnb and other short-term rentals contribute to the shortage of affordable homes and to the displacement of regular residents in cities with high housing demand. When the pandemic set in, the media was quick to speculate that holiday homes would be returned to the regular rental market. This paper provides some theoretical reflections on the factors that are driving and impeding such a development and presents preliminary results from an ongoing research project that empirically traces the impacts of COVID-19 on the rental housing market based on an analysis of real estate listings in four large Austrian cities. We argue that a current shift to the regular rental market is likely, but that the medium-and long-term development is uncertain. Empirically, we demonstrate that such a shift has occurred in all four cities considered. We do not find evidence, however, that the increased rental housing supply has dampened rent levels. © 2020, Academy of Sciences of the Czech Republic, Institute of Sociology. All rights reserved.

The Covid-19 patients’ characteristics upon admission to intensive care and response to nutrition differ from other patients - Preliminary data

Rationale: The COVID pandemic has resulted in a high number of intensive care (ICU) admissions, generally for respiratory distress. While research has focused on respiratory and infectious characteristics, little is known about their metabolic and nutritional status compared to other categories of patients. The aim was to compare COVID patients’ characteristics and metabolic response to long-stayer patients (LSP) Methods: Prospective observational study in two consecutive cohorts admitted to the ICU: Only ventilated LSP and COVID-19 patients were included. Variables: demographic data, severity score (SAPS2), NRS score, C-reactive protein (CRP), prealbumin values on admission (adm) and D6-9 (delta calculated), nutritional management, length of stay and outcome. Nutritional recommendations were for both groups: energy goal 20 kcal/kg first week (then adapted following indirect calorimetry for LSP, no calorimetry for COVID), protein 1.2 g/kg, enteral nutrition privileged. The confined dieticians worked on computer basis. Statistics: median (interquartiles), percentage Results: Altogether 52 of 55 LST and 74 of 104 COVID were mechanically ventilated. Characteristics in Table. Gender was evenly distributed (75% men). COVID patients were significantly older and heavier. Median NRS was 5 in both groups, 1-3 points coming from reduced eating in COVID. Mortality was higher in COVID. Admission prealbumin was significantly lower in COVID vs LST, unrelated to NRS score, and negatively correlated to CRP (r2=0.082). Prealbumin increased significantly more in COVID, but also in survivors of both groups where difference over time was 0.03 (0;0.09) g/l (p<0.0001). Enteral nutrition initiated earlier in COVID. Energy & substrate data not yet available [Formula presented] Conclusion: Mechanically ventilated COVID patients were older and heavier. Prealbumin values on admission were lower and reverted faster to normal values, which might be due to a more rapid clearance of inflammation and catabolism Disclosure of Interest: None declared

Factors associated with intubation and prolonged intubation in hospitalized patients with COVID-19. (Special issue on COVID-19.)

Objective: To identify risk factors associated with intubation and time to extubation in hospitalized patients with coronavirus disease 2019 (COVID-19). Study Design: Retrospective observational study. Setting: Ten hospitals in the Chicago metropolitan area. Subjects and Methods: Patients with laboratory-confirmed COVID-19 admitted between March 1 and April 8, 2020, were included. We evaluated sociodemographic and clinical characteristics associated with intubation and prolonged intubation for acute respiratory failure secondary to COVID-19 infection.

Case numbers and challenges in southern bavarian primary care practices during the COVID-19 pandemic

Background The COVID-19 pandemic poses major challenges to family medicine practices. In a cross-sectional survey we investigated the caseload and the perceived challenges in Southern Bavarian primary care practices during the first phase of the pandemic. Methods A four-page questionnaire was sent to all 210 practices accredited for under-graduate teaching of family medicine at the Medical Faculty of the Technical University of Munich. Answers on closed questions were analyzed using descriptive statistics;free text answers were categorized inductively. Results A total of 160 questionnaires were available for analysis (response rate 76 %). 92 % of participants had seen at least one patient with a SARS-CoV-2 infection, two colleagues saw more than 100 infected patients;the median number was 10. 63 % had at least one patient hospitalized and 31 % at least one death associated with SARS-CoV-2 infection. In contrast, only 23 % of the nursing homes looked after by the participants were affected by infections;in individual nursing homes, however, there were numerous hospitalizations and deaths. In 18 % of practices at least one member of the team was tested positive for SARS-CoV-2. The most important challenges were the lack of protective equipment and the adaptation of the practice process to the pandemic situation. With regard to a possible “second wave”, the need for protective equipment and a better flow of information were central issues. Conclusions The caseload and consequences of the SARS-CoV-2 infections experienced by participants were highly variable. A large proportion of the nursing homes remained without cases of infection. The risk of infection for physicians and practice employees in the early phase was considerable. © Deutscher Ärzteverlag.