The impact of age and gender on mortality from COVID19 at A UK Hospital

Rationale: Age poses greater mortality risk to COVID-19 patients. This may be due to co-morbidities and age-related impairment of immunity. It has been shown that females are more likely to be infected however, severe disease is more often seen in males, which could be explained by greater levels of interferon-gamma promoter activity driven by oestrogen in females in addition to higher levels of IgG antibody providing more protection. We aim to investigate the effects of age and gender on the mortality rate in patients with COVID-19. Method(s): A retrospective study of all in-patients aged >= 18 years with a confirmed diagnosis of COVID-19 during the first and second waves of the pandemic. Admission CXRs were analysed. Statistical analysis was performed using the Chi-Squared Test for independence. Result(s): 1759 COVID-19 patients were included in the study, of which 481 were aged <65 years and 982 were aged > 65 years. The study had 967 males and 792 females. We found a higher mortality rate in those aged > 65 (41%) compared to those aged <65 years (18%) (P<0.001). There were no significant differences in the mortality rates between both genders. However, interestingly males had a greater severity of pneumonitis (22%) on CXRs compared to females (13%) (P=0.01). Conclusion(s): Our study demonstrated a positive correlation between increasing age and mortality with males showing a greater disease severity. This data should be considered when stratifying at risk groups and prioritising them for early intervention.

To assess the diagnostic and prognostic ability of CXRs in COVID-19 pneumonitis

Rationale: The COVID-19 pandemic has led to the deaths of millions with its ability to cause severe pneumonia. Diagnosis is based on PCR testing which has many limitations: lengthy turnaround times, lack of universal availability and variance in sensitivity. Imaging such as CXR could be a valuable and faster aid in diagnosing COVID-19 compared to PCR. It is widely available, cheap and can be performed at the bedside- enabling a rapid turnover of patients whilst minimising cross-link infection. However only a few studies have assessed its prognostic value. We aim to analyse the diagnostic accuracy of CXR in COVID-19 and to assess if severity of COVID pneumonitis on CXR correlated with mortality. Method(s): A retrospective study of all in-patients aged >= 18 years with a confirmed diagnosis of COVID-19 during the first and second waves of the pandemic. Admission CXRs and in-patient CT Thorax scans were analysed. Statistical analysis was performed using the Chi-Squared Test for independence. Result(s): 999 COVID-19 patients were included in the study. Severity of COVID pneumonitis on CXR correlated with mortality when patients were grouped into the following categories: normal (n=161, mortality=42%), mild (n=220,mortality=33%) moderate, (n=328, mortality=42%) and severe (n=290, mortality=58%) (P<0.001). 251 patients had both CT and CXRs. CT scans were superior in diagnosing COVID pneumonitis (63%) compared to CXR (47%) (P<0.001). Conclusion(s): Our study showed a positive correlation between the severity of COVID pneumonitis on CXR and mortality, supporting the use of CXR in the ED to help rapidly identify and treat patients at high risk of death.

Comparison of mortality and radiological changes during the first two COVID-19 waves within a UK District General Hospital

P162 Table 1Comparison of CXR changes between initial CXR and follow-up CXRWe found 4.5% of patients received a follow-up CXR in 6–12 weeks. This study demonstrates that awareness and compliance with BTS guidelines falls short, supported by similar studies. Additionally, monitoring could be improved through the use of machine learning and universal CXR scoring tools to stratify CXR severity, which could reduce clinician workload and the need for CT scans.2X. Han, Y. Fan, O. Alwalid, N. Li, X. Jia, M. Yuan, Y. Li, Y. Cao, J. Gu, H. Wu and H. Shi, ‘Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia,’ Radiology, vol. 299, no. 1, pp. E177-E186, April 2021.J. Cohen, L. Dao, K. Roth, P. Morrison, Y. Bengio, A. Abbasi, B. Shen, H. Mahsa, M. Ghassemi, H. Li and T. Duong, ‘Predicting COVID-19 Pneumonia Severity on Chest X-ray With Deep Learning,’ Cureus, vol. 12, no. 7, p. e9448, 28 July 2020.

Moderate Versus High Dose Corticosteroids in Adult Patients with Severe COVID-19: Less Is More

Background. The early administration of corticosteroids (CS) in patients with severe COVID-19 (hospitalized with need for supplemental oxygen) has been the only therapy to improve survival. However, the optimal dosing of CS remains unclear. Beginning March 2020 methylprednisolone (MP) in a dose of 40mg twice daily (high dose CS - HDC) was adopted at our institution. Based on emerging trials, this dose of MP was reduced to 16mg twice daily (moderate dose CS - MDC) in November 2020. The study aims to evaluate the outcome difference in patients receiving HDC versus MDC. Methods. This pre-post quasi-experimental study was done at Henry Ford Hospital, an 877-bed tertiary care hospital in Detroit, Michigan. Consecutive patients in the HDC group from September 1, 2020 to November 15, 2020 were compared to the MDC group from November 30, 2020 to January 20, 2021. Only hospitalized patients with severe COVID-19 were included. The primary outcome was 28-day mortality. Secondary outcomes included progression to mechanical ventilation, length of hospital stay, discharge on supplemental oxygen and CS-associated adverse events. Patient demographics were evaluated using descriptive statistics. Bivariate and multivariable logistic regression analysis was planned to test the association between primary outcome and exposure. Results. 470 patients were evaluated, 218 and 252 in the HDC and MDC groups respectively. Clinical characteristics and severity of illness on admission were comparable in both groups (Table 1). Among comorbidities - lung disease, cardiovascular disease and hypertension were higher in MDC. Antibiotic and tocilizumab use were lower in MDC. Significantly more patients in MDC group received oral CS. There was no difference in mortality between HDC and MDC through bivariate and multivariate analysis (14.7% and 13.5%, p < 0.712, adjusted OR 0.913 [0.514-1.619]) (Table 2,3). Median length of hospital stay was 5 and 6 days in HDC and MDC respectively (p < 0.001). There was no difference in CS-associated adverse events. Conclusion. The survival in severe COVID-19 patients treated with MDC is comparable to HDC. Oral corticosteroids are an equally effective option.

Unusual neurological manifestations in children during the COVID-19 pandemic

Objective: To present paediatric cases of unusual neuroinflammatory conditions encountered during the COVID-19 pandemic in Trinidad & Tobago. Methods: Retrospective study design. Inpatient paediatric patients (aged 0-16 years) hospitalized for neurological complaints from June 2020 - August 2021 at EWMSC. Outcome measures were age at presentation, sex, ethnicity, diagnosis, radiological findings, blood/CSF findings, COVID-19 PCR and antibodies testing, treatment, outcomes and other systems involved. Results: Twenty (20) patients (aged 4-months-old to 15-years-old) had documented neurological involvement. 50% had a diagnosis of ADEM/ADS/AHNE;45% had a diagnosis of either CNS vasculitis (n=3), autoimmune encephalitis (n=3) or GBS (n=3);5% had a diagnosis of acute COVID-19 encephalitis. 70% were of African descent. The youngest age group (0-4 years) (n=11) constituted more males (82%) whereas the eldest age group (10-15 years) (n=3) were all females. Neuroimaging findings were corpus callosal lesions;deep white matter T2 hyperintensities;cerebellar involvement;area postrema and brainstem/C-spine involvement;microhaemorrhages and necrotizing/haemorrhagic lesions (peripheral/central). 70% of patients were either SARS-CoV-2 PCR or COVID-19 antibodies positive. Other systems were involved in 40% to 62.5% (n=5) had cardiac involvement (myocarditis, coronary arteries dilatation, valve regurgitation) and 37.5% (n=3) had pancreatic involvement (autoimmune pancreatitis, type 1 diabetes mellitus). Treatment modalities for CNS manifestations (n=17) were clinically based - 24% (n=4) 3rd line treatment, 29% (n=5) 2nd line treatment, 41% (n=7) 1st line treatment and 6% (n=1) requiring no treatment. All 3 patients with a diagnosis of GBS responded appropriately to IVIG. Developmental outcomes were worst in patients with a diagnosis of autoimmune encephalitis. Conclusion: We have had an explosion of neuro-inflammatory cases since the COVID-19 pandemic began. The range of neuroradiological diagnoses and other systemic involvement (including criteria for PIMS) are interesting, alluding to a neuroinflammatory mechanism. Effects on long-term sequelae and developmental outcomes are concerning in some cases, however, still unknown at this stage.

Quick learn approach for load forecasting during COVID 19 lockdown

Load forecasting is extremely important for day to day operations and trading of any distribution utility. In recent times due to pandemic situation, the imposition of lockdown has caused all the commercial and industrial activities to shutdown. This has profoundly impacted the entire nation's electrical demand consumption. The consumption levels as well as the profiles have changed drastically. This has affected the forecast accuracy of the utilities exposing them to financial and technical risks. This paper presents and analyses the impact of COVID 19 on load consumption of a urban distribution utility. It also proposes a new forecasting model called 'Quick Learn Approach' (QLA) developed specifically for such lockdown period. Its main aim is to quickly learn and adapt to the constantly changing load consumption pattern while giving fairly accurate forecasts. The performance of the QLA model is compared with several other standard forecasting models so as to ensure its effectiveness. © 2020 IEEE

Remdesivir and favipiravir for COVID -19: An update

COVID-19 pandemic due to SARS-CoV-2 infection has already resulted in more than 6 lakhs death worldwide. Various drugs like hydroxychloroquine, lopinavir/ritonavir, dexamethasone, ivermectin etc are examples of drugs currently used to treat COVID-19 with varying results. Remdesivir is a broad spectrum anti-viral agent, which is active against Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-1, Ebola virus etc. Favipiravir had been widely used for treating influenza pandemics in Japan in 2014 .Studies showed that it was effective for treating many RNA viruses like arenavirus, bunyavirus, flavivirus, and filoviruses causing hemorrhagic fever and Ebola virus. Remdesivir and favipiravir are anti-viral agents tried in patients with COVID-19 with varying results. Currently Remdesivir is recommended in hospitalized patients with COVID-19 requiring supplemental oxygen and favipiravir in patients with mild to moderate disease. In this article we are reviewing the pharmacological features and clinical use of Remdesivir and favipiravir in COVID-19.