Prognostic value of brain natriuretic peptide in COVID-19 with or without acute heart failure

Background: Although Brain Natriuretic Peptide (BNP) provides strong prognostic information of an unfavorable outcome in patients with acute heart failure (AHF), there is little information of its relevance as a biomarker for outcomes in COVID-19 and its complications Purpose: To evaluate the association of increased BNP levels with complications and in-hospital mortality in a cohort of hospitalized COVID-19 patients. Method(s): The study included COVID-19 patients with data on BNP levels included in the ISACS COVID-19 registry. The population was categorized according to the presence of peak BNP levels >=100 pg/mL during hospitalization. Primary outcomes included in-hospital mortality, AHF or acute respiratory failure (ARF, defined as PiO2/FiO2<300 mmHg or need for mechanical ventilation). Calculations were conducted using age and sex-adjusted multivariable logistic regression analyses. Results were also stratified according to presence or absence of cardiovascular disease (CVD) history. Differences between subgroups were verified for statistical significance using test for interaction. Result(s): Of the 1152 patients included in the study, 615 (53.4%) had elevated BNP levels. These subjects were older (69.9+/-13.8 vs 59.1+/-16.8, p-value<0.001), had higher rates of cardiovascular risk factors (82.9% vs 57.7%, p-value<0.001) and presented more frequently with a prior history of CVD (either ischemic heart disease, cerebrovascular disease, venous thromboembolism, atrial fibrillation or a history of revascularization) (50.1% vs 27.5%, p-value<0.001). No sex differences were observed. When considering outcomes, BNP levels >=100 pg/mL were associated with increased rates of in-hospital mortality (32.9% vs 4.9%, p-value<0.001), even after adjustment for demographic characteristics (OR: 7.35;95% CI: 4.75-11.40;p-value<0.001). High BNP levels were also strongly associated with an increased risk of AHF (OR 19.9;95% CI 8.6-45.9;pvalue< 0.001), a correlation that persisted both in patients with and without a prior CVD history (p for interaction=0.29). Of note, patients with elevated BNP also had a higher likelihood of developing ARF (OR 2.7;95% CI 2.1- 3.6;p-value<0.001), even in absence of AHF (OR 3.00;95% CI 2.20-4.1;p-value<0.001). Conclusion(s): In COVID-19, blood BNP level not only appears to be predictor of in-hospital mortality and AHF but was also independently associated with an increased risk of ARF. This finding supports the routine use of BNP in all patients admitted to hospital for COVID-19, regardless of a prior history of CVD.

P.0815 Internet-related variables negatively predicting quality of life and sleep during the pandemic

Introduction: The coronavirus disease of 2019 (COVID-19) pandemic is, in many ways, specific. In addition, the Internet usage during the pandemic has taken on a new dimension. On one hand, maintaining social contacts with friends/families to reduce psychological impacts of isolation, providing access to entertainment and even materials guiding physical exercises are all realized through information and communication technologies. All these are also the strategies recommended by the WHO. On the other hand, longer Internet hours coupled with the specifics of the Internet usage during a pandemic, could lead to exploring particular contents (pornography) as well activities (social networks, games). The aforementioned could negatively reflect on important mental health factors in daily living such as quality of life or insomnia.Aim: The aim of our study was to investigate if quality of life and sleep during the pandemic are predicted by Internet-related variables such as the general use of Internet. Methods and methods: This cross-sectional study is a part of a wider international multicenter research. The study was approved by Ethics Committee of the Clinical Centre of Serbia and the Board of Clinic of Psychiatry, Clinical Centre of Serbia. The study included 3330 participants (71.1% females, average age was 40.78 ±12.21 years). The participants filled in an anonymous online self-report questionnaire, comprising the following: 1) socio-demographic questionnaire;2) questionnaire on Internet use during the pandemic (designed for the purpose of this study), assessing whether participants had more frequent use of Internet, and performed any of the online activities more (e.g. playing online games, using Instagram, Facebook (FB)), or browsed any of the Internet contents more (e.g. sexual contents) during the pandemic;3) the Insomnia Severity Index (ISI);4) the COVID-19 - Impact on Quality of Life (COV19-QoL) scale. Multivariate liner regression was used to produce two models, with COV19-QoL during the pandemic and the ISI score as outcomes, and Internet-related variables as predictors, controlling for gender, age, and the number of persons living in the household. Results: Both linear regression models were significant, explaining about 6% of variance each. Worse QoL during the pandemic was predicted by more time on Internet during the pandemic, more frequent gaming, FB use, and searching for sexual content, whereas the more frequent use of Instagram had no predictive effect. Higher insomnia severity was predicted by more time spent on Internet during the pandemic, and more frequent search for sexual content, while other Internet-related variables had no predictive effects. Conclusions: The findings of this study speak in favor of the negative association between the general and specific use of Internet on side, and the quality of life and sleep during the pandemic, on the other. These findings may have important implication for both prevention and further research. No conflict of interest

Confronting a Compound Crisis: The School Principal’s Role During Initial Phase of the COVID-19 Pandemic

The COVID-19 pandemic, bringing to the forefront and catalyzing long-unconfronted racial and economic inequities, in addition to economic collapse and deep political divisions - which all impact students and schools – has resulted in a compound crisis requiring a novel conceptualization of school leadership during times of crisis. This qualitative study captures the leadership experience of principals during the apocalyptic crisis _ the COVID-19 pandemic - beginning from the time schools were closing in March 2020 to the end of the school year in June. Crisis leadership, transformative leadership and social capital constitute the overarching framework for this study. The purpose of this case study was to discover how principals engaged in their thinking and practice to handle the compound crisis, in order to generate a rich description and gain an understanding of school leadership during the first phase of the COVID 19 pandemic. Our research questions were: What were the challenges and complications of leading during the initial phase of the compound crisis from the perspective of principals? How did principals respond? What were the emergent leadership practices? For this case study, we used a purposeful, maximum variation sample of nine principals in Florida. We sought balance in gender, race and ethnicity, and grade level. In-depth interviews were conducted using a structured protocol. Analysis treated each principal as an individual case, then cross-case thematic analysis was employed to uncover common patterns and themes. Three findings emerged. First, participants drew upon their individual reservoirs of shared leader qualities, including personalized and pragmatic communicator;leading with flexibility, creativity and care;bending rules and shifting priorities;and showing resilience under pressure. Second, they tapped into their schools’ strengths, including school context and in-house expertise. Third, they made inter-school connections. The first phase of the compound crisis pushed principals to prioritize care, safety, and wellbeing of students, teachers, and communities above accountability measures and systemic institutional constraints. A call to action for equity is the next logical step for system consideration, and was echoed by participating principals, as well as a realization that going back to old ways is no longer an option. © Copyright © 2021 Reyes-Guerra, Maslin-Ostrowski, Barakat and Stefanovic.

Use of the risk analysis approach in the serbian army integration process against COVID-19

Current developments have contributed to organisations paying increasing attention to protecting resources, employee safety, and applying quality products and services. There is a need for increasing the application of standards that define the way of managing quality, safety at work, risk, and many others. One such organisation is the Serbian Army, a complex centralised system that requires integrating these standards, and often stricter, in all fields of its activities. The current situation in the world, and therefore in Serbia, is sufficient motivation for the project provided by this paper. This project aims to show the integration of risk management systems and occupational safety systems, through the level of protection and exposure of members of the army to the virus infection COVID-19 during the implementation of emergency tasks, by defining risks and proposing additional measures to reduce the level of risk and increase the protection of military personnel. © 2021 by the authors. It was submitted for possible open access publication under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

ECHOS survey on echocardiography in Serbia during the COVID-19 pandemic

Introduction/Objective The purpose of the current Echocardiographic Society of Serbia (ECHOS) survey was to assess echocardiography practice in Serbia during the Coronavirus disease 2019 (COVID-19) pandemic. Methods An online survey consisting of 12 questions about the usa of echocardiography, the availability of portable ultrasound devices and personal protective equipment (PPE) was sent to all ECHOS members. Results Overall, 126 ECHOS members (43%) answered the survey. One-third of respondents (36%) were physicians from specialized COVID-19 centers. During the pandemic, indications for echocardiographic examination were restricted in both COVID-19 and non-COVID-19 centers. In COVID-19 centers, 41% of respondents performed lung ultrasound to each patient versus 26% in non-COVID-19 centers. Transesophageal echocardiography was not performed in suspected or confirmed COVID-19 cases in any center. Portable ultrasound devices were available to 66% of respondents from COVID-19 versus 44% of respondents from non-COVID-19 centers (p = 0.018). The respondents reported regular use of PPE, regardless of the patient's COVID-19 status and found their personal knowledge about protective measures and use of PPE satisfactory. Conclusion During the COVID-19 pandemic in Serbia, indications for echocardiography were restricted to clinical scenarios in which the results of examination were expected to alter patient management. In both COVID-19 and non-COVID-19 centers, the use of PPE was in line with national and international recommendations. A wider availability of portable ultrasound devices and application of lung ultrasound could improve patient management in similar situations in the future.