Physical activity and purpose in life of college students in confinement

Social isolation and generalized confinement in many countries has caused a decrease in physical activity (PA) and an increase in levels of stress, anxiety and depression. Purpose in life is part of people's psychological well-being, and having a clear purpose allows them to face adversities. In this sense, the influence of PA on psychological well-being in situations of confinement makes it necessary for educational and governmental entities to study and promote it. The objective of this work has been to evaluate the incidence with a PA intervention program (Move yourself at home) on the purpose in life during a period of mandatory confinement due to COVID-19. 360 university students participated divided into three groups, control (Sedentary, Sed), and experimental (group with low physical activity, BAct, and physically active, Act). The experimental groups were conducted on a PA intervention program for 11 weeks, from the beginning to the end of the mandatory confinement. A weekly online questionnaire was collected, recording the level of PA (min / week) and the results of the PIL test (purpose in life). The level of PA decreased significantly at the beginning of the confinement and increased significantly in the flexibilization phases. The intervention program was able to help maintain the PA level in participants. PA has a positive effect on the purpose in life and practicing some physical exercise on a regular basis could be a crucial tool to face a state of mandatory confinement. ©Copyright: Federación Española de Asociaciones de Docentes de Educación Física.

Incisional Hernia with Loss of Domain as a Consequence of Botulinum Toxin a and the Covid-19 Pandemic

Introduction: Abdominal wall surgery has been one of the major victims of the COVID-19 pandemic, with a large number of patients who have seen their surgery delayed and many are still waiting to be operated on today. On the other hand, botulinum toxin is one of the main protagonists in optimizing abdominal wall surgery, especially important in complex hernia, but we must not forget that it can have adverse effects. Case report: We present the case of a 54-year-old man with a history of obesity, diabetes, hypertension, chronic renal failure and kidney transplant in 2000, who presented a midline incisional hernia as a result of an epigastric hernia operated on in 2006 and subsequently two onlay permanent synthetic mesh in 2010 and 2015. In February 2020 he presented an incisional hernia M2-4W3R3 with a volume of 35%, botox was infiltrated as optimization for surgery and while awaiting placement of a pneumoperitoneum catheter, the surgery was suspended due to the COVID-19 situation. He returns to our clinics in 2022 with a growth of the hernia and a volume of 95%. Weight loss, botulinum toxin and preoperative pneumoperitoneum were indicated. We performed a reconstruction of the abdominal wall with bilateral transversus abdominal release and preperitoneal 45x60cm polyvinylidene fluoride mesh and abdominoplasty. Discussion(s): Botulinum toxin can facilitate abdominal surgery, especially in complex hernias, but we must not forget that blocking the abdominal muscles can have adverse effects. The COVID-19 pandemic has been especially hard on surgical waiting lists, delaying surgeries and aggravating pathologies.

[Evaluation of patients with long covid in the canarian population: study protocol.]

The current COVID-19 pandemic has generated a relevant changes in the normal development of human performance. Some changes detected in SARS-CoV-2 infected people have to do with possible effects of the infection in the bio-psycho-social sphere. The population in the Autonomous Community of the Canary Islands has not been oblivious to it and, therefore, a need demanded by society has roared. A multicentre observational study will be carried out to assess the physical and functional status of people from the Canary Islands who, after being infected with the SARS-CoV-2 virus, suffer sequelae that persist after twelve weeks of infection. With help from the Official Association of Physiotherapists of the Canary Islands a call will be made to the population. This association will oversee the dissemination of the information and will recruit among its members the collaborating/evaluating physiotherapists, also ensuring the protection and preservation of the data to be collected. People meeting the established criteria will be referred to the more accessible collaborating centre of the canarian community, where, after a preliminary interview, participating patients will self-complete scientifically validated questionnaires, and will be subjected to different validated tests to evaluate their physical and functional status. Patients will be individually informed of the results of their evaluation, and they will receive a dossier with individualized recommendations. After this evaluation, a follow-up of the participants for up to 6 months is anticipated. Data will be recorded, analysed, and interpreted, and the results will be disseminated through conventional means of communication to society and also by attempting publication in scientific journals.

IDENTIFICATION OF CLINICAL FEATURES ASSOCIATED WITH SARS-CoV-2 REINFECTIONS

Background: Over 600 million of COVID-19 cases have been reported. A remarkable fragment of these cases are reinfections, which are mostly explained by the genomic variability of the SARS-CoV-2 variants. However, little is known about other factors fostering these reinfections. Method(s): We recorded clinical and demographic data from subjects (N=3303, March 2020 - March 2022) with at least 2 PCR+ events separated by >=90 days, analyzed by the Microbiology Department, Northern Metropolitan Clinical Laboratory from Germans Trias i Pujol Hospital (Spain). Data collected included: age, sex, comorbidities, adjusted morbidity group (GMA), hospitalization, symptomatology, NAAT (PCR, TMA) tests, antigen tests, serology, and vaccination. Temporal data was encoded using Python, and demographic characterization was performed under R. Result(s): We identified 2344 cases of confirmed reinfections, where the 2 PCR+ events were separated by >=90 days and a negative test was obtained between episodes. 72.2% of reinfected subjects were females with a median age of 45 IQR [28-63] years. Age density analysis showed three peaks at 24, 45, and 85 years, probably mostly composed of young people, who usually are less cautious, healthcare workers, and people living in nursing homes, respectively, being all of them groups prone to be tested. Regarding health status, 86.2% of participants had at least one chronic condition, with 40.5% of patients having chronic conditions in >=4 systems based on GMA assessment. Interestingly, 75.2% of reinfected subjects < 26 years had at least one chronic condition. 121 (4.2%) participants were hospitalized during a COVID-19 episode, highlighting 8.3% (N=10) of them hospitalized during the reinfection (half of them vaccinated before hospitalization), and 5% (N=6) of them during both infections. The severity of the second infection may be caused by a diminished acquired immunity after the first infection. Time between reinfections density analysis provided three peaks at ~200, ~400, and ~600 days, corresponding with time between waves. A decrease of reinfections was observed between 40 and 100 days after vaccination, which would be the period of highest protection against reinfection. Conclusion(s): SARS-CoV-2 reinfections are more prevalent among women. Importantly, people with an undermined health status, independently of age, are more sensitive to reinfections, but in most of the cases no hospitalization was required. Finally, vaccination seems to have a short protective effect on reinfection.

Persistent Pneumonitis Post-COVID 19: description and risk factors

Background: Some patients present persistent ground glass opacities (GGO) and/or consolidations after an acute episode of SARS-CoV-2 pneumonia (COVID19). Risk factors for persistent pneumonitis (PPN) and potential response to corticosteroids remain unclear. Objective(s): To evaluate the clinical characteristics of patients with PPN, as well as to detect possible risk factors and the role of corticosteroids. Method(s): We conducted a prospective, controlled, multicenter analysis of patients hospitalized because of COVID19 with (n=152) or without (n=140) PPN. PPN was defined by the persistence of pulmonary opacities in a chest CT scan >14 days after admission. Characteristics of participants were obtained from their medical records. A CT score was used to quantify parenchymal abnormalities when PPN was suspected. Result(s): Compared to controls, patients with PPN were older and suffered more comorbidities, also D-dimer and Creactive protein levels were higher. The most frequent features observed in CT scans were GGO (97%), consolidation (95%), bronchial dilatation (93%) and reticular pattern (92%) with a CT score of 16.12+/-4.26. Multivariate logistic regression identified age and C-reactive protein levels on admission as independent risk factors for PPN. No significant differences were observed in thoracic CT scan one-month after discharge in patients treated with higher corticosteroids doses (>50 mg/day after discharge) compared to lower doses. Conclusion(s): Age and raised C-reactive protein levels on admission are significant risk factors of PPN after COVID19. Treatment with high doses of corticosteroids does not seem to add benefit.

Rare case of post-COVID transverse myelitis

Case Report: Acute transverse myelitis (TM) is a rare inflammatory disease that typically presents asweakness, sensory alterations, and bowel or bladder dysfunction. Among the causes of TM are infections, paraneoplastic syndromes, or autoimmune conditions of CNS. Postinfectious TM can develop secondary to a viral or bacterial infection. SARS-CoV-2 is a recently discovered viral illness, and sequelae due to COVID-19 infection are still being studied. There is scarce literature relating the two conditions, and it is imperative to raise awareness. A 72-year-old man with hypertension and GERD, completely independent in ADL, was brought to the ED with sudden onset of bilateral lower extremity weakness. He reported symptoms started with difficulty climbing stairs that rapidly progressed to inability to ambulate independently and were associated with bilateral thigh soreness. Nine days prior, he developed fever and generalized malaise, and two days later, SARS-CoV-2 PCR and Ag tests were positive. He received azithromycin, Paxlovid, and dexamethasone as treatment. Upon evaluation, the patient was afebrile and hemodynamically stable. Neurological examination was remarkable for spasticity and hyperreflexia at bilateral lower limbs, clonus, preserved motor strength with adequate sensation to soft touch, and intact vibration and proprioception in all extremities. Cranial nerves were intact. These findings were consistent with an upper motor neuron lesion. On imaging, the Head CT scan was unremarkable. Thoracic/Lumbar Spine MRI was significant for distal thoracic and conus areas with central homogeneous brightness compatible with nonspecific myelitis. Laboratories showed leukocytosis without neutrophilia or bandemia, thrombocytosis, and elevated CRP. HIV and RPR tests were negative. A lumbar puncture for CSF analysiswas remarkable for mild monocytic pleocytosis (7 cell/muL), an increased level of total proteins (56 mg/dL), and normal glucose (57 mg/dL). CSF culture and gram stain were negative. CSF cytology yielded few lymphocytes and few monocytes and was negative for malignant cells. The meningoencephalitis panel was negative. Based on these findings, a clinical diagnosis of postinfectious myelitis secondary to COVID-19was made. The patient was treated with intravenous Methylprednisolone 1 g daily for five days. On follow-up, lower extremity weakness resolved completely, and he resumed his daily physical activities. Patients with COVID-19 infection can present with neurologic manifestations such as headache, myalgias, dizziness, dysgeusia, and anosmia. This case hopes to raise awareness of less commonly known neurological manifestations of SARS-CoV-2 infection and how the early recognition of symptoms can help expedite the diagnosis and treatment of the condition to avoid long-term sequelae. [Figure presented] Copyright © 2023 Southern Society for Clinical Investigation.

Physical activity and purpose in life of college students in confinement

Social isolation and widespread confinement in many countries has caused a decrease in physical activity (PA) and an increase in levels of stress, anxiety and depression. The purpose in life is part of the psychological well-being of people, and having a clear purpose allows them to face adversity. In this sense, the influence of PA on psychological well-being in confinement situations makes it necessary to study and promote it by educational and government entities. The objective of this work was to evaluate the incidence of an intervention program with PA (Move at home) on the purpose in life during a period of mandatory confinement due to COVID-19.360 university students divided into three groups participated: control (Sedentary, Thirst), and experimental (group with low physical activity, BAct, and physically active, Act). The experimental groups underwent a PA intervention program for 11 weeks, from the beginning to the end of the mandatory confinement. A weekly online questionnaire was collected, recording the PA level (min/week) and the results of the PIL test (purpose in life). The PA level decreased significantly at the beginning of the confinement and increased significantly in the easing phases. The intervention program was able to contribute to maintaining the PA level in the participants. Physical activity has a positive effect on purpose in life and the practice of some physical exercise on a regular basis could be a crucial tool to face a state of mandatory confinement.

Implementation of a telerehabilitation program for children with neurodevelopmental disorders during the lockdown caused by COVID-19

Introduction: Telerehabilitation is a tool for patients who, for different reasons, cannot participate in person with their physical presence. We aimed to identify the factors associated with satisfaction with telerehabilitation in families with children with neurodevelopmental disorders through a program that included physiotherapy, occupational therapy, and speech therapy. Methods: The program was developed during the COVID-19 lockdown period. Outcome measures: Child's age, the school stage to which they belonged, the person of reference in their daily care at home. The resources provided to the families, as well as the frequency of activities and difficulties detected, were evaluated through a survey. Findings: One hundred thirteen families responded to the survey. The general assessment resources were classified as very good. The average frequency of carrying out the activities was two times a week, with an average of 30 minutes per session. The ability to understand the information in the manual was not affected by the academic status of the caregivers (p = 0.286). Conclusions: This is the first study to quantify the multidisciplinary approach to children with neurodevelopmental disorders using telerehabilitation. The results show high levels of participation and satisfaction. The resources could be shared for their applicability in other countries whose families have similar needs conditioned by COVID-19.

Outcomes of Patients Aged 85 Years or Older Admitted with Covid-19

INTRODUCTION: Advanced age is frequently cited as a prognostic indicator in critically ill patients. This study aimed to assess the association between outcomes in three age subgroups of older adults with COVID 19 patients. METHOD(S): Retrospective analysis of 994 adult patients admitted to our hospital between March 2020 and February 2022 with COVID-19. Patients with ages on admission >= 65 years were included and classified as young-old (65- 74 years), middle old (75-84 years), and oldest old (>= 85 years). Primary endpoints were survival, hospital length of stay (LOS), and need for mechanical ventilation. Secondary assessments included code status, ICHIKADO score, and the highest value of IL-6. Descriptive statistics, Pearson Chisquare, and Mann-Whitney-U methods were used. A p value <= 0.05 was considered statistically significant. RESULT(S): 293 patients with age on admission >= 65 years were included in this analysis. 183 (68.5%) were young old patients, 81(27.6%) middle old patients, and 29(9.9%) oldest old patients. The median age for non-survivors was 73[69- 78.2] years vs 72[68-78] years for survivors. 56(30.6%) patients from young old group died, 28 (34.6%) died in middle old group and 10(34.5%) in the oldest old (X2(2) =0.491, p=0.78). 22(12%) of the young old group were do not resuscitate (DNR), 11(13.6%) in the middle old group, and 7(24%) in the oldest old group(X2(2) =3.118, p=0.21). LOS for young old patients was 9[4-15] days, 10[5-16] days for middle old, and 8[5-13] days for oldest-old (H(2)=1.070 p=0.58). A total of 25(13.7%) young old patients required mechanical ventilation, 11(13.6%) middle old patients and 5(17.2%) oldest old patients (X2(2) =0.282, p= 0.86). ICHIKADO score was 160[121-200] in the young old group, 150 [110-230] in the middle old and 145[119.2-176.2] in the oldest old group (H(2) =1.426,p= 0.49). Regarding inflammatory markers, IL-6 wasn't different between the groups. In the young old IL-6 was 40.9[8.9-176.5]pg/ mL, 74.45[12-374.3]pg/mL in the middle old and 51.85 [14.25-812.2]pg/mL in the oldest old group (H(2) =3.336, p=0.189). CONCLUSION(S): Oldest old patients were not found to have increased IL6, worse computed tomography findings, increased risk of death, length of stay, or need for mechanical ventilation than their younger counterparts.

Acute Kidney Injury and Mortality Rates among Different Ethnicities in Covid-19 Patients

INTRODUCTION: Coronavirus disease 2019 (COVID-19) infection has been associated with the development of acute kidney injury (AKI) in some patients. The purpose of this study was to assess the mortality rates among different ethnicity of COVID-19 patients who developed AKI. METHOD(S): A retrospective study of adult patients admitted to our hospital with COVID-19 from March 2020 to February 2022 was performed. Patients were divided into three groups based increased creatinine levels compared to their baseline creatinine, according to the KDIGO Guidelines for AKI: Stage 1 (S1;1.5 -1.9 times baseline creatinine), Stage 2 (S2;2.0-2.9 times baseline creatinine), and Stage 3 (S3;>3.0 times baseline creatinine). Survival to hospital discharge was assessed for each individual. Descriptive statistics, Chisquare, and Mann-Whitney tests were utilized. A p value <= 0.05 was considered statistically significant. RESULT(S): 192 patients with AKI admitted to our hospital with COVID-19 were included in this study. The median age was 61 [18-95]. 75 (39.1%) were female.101 (52.6%) patients survived. 111 (57.8%) were Hispanic, 22 (11.5%) were African-American, 48 (25.0%) were Caucasian, and 8 (4.2%) had other ethnicities. 45 (23.4%) patients were classified in S1, 52 (27.1%) were in S2, and 95 (49.5%) were in S3. In S1, 15 (33.3%) patients died and 30 (66.7%) survived. In S2, 24 (46.2%) died and 28 (53.8%) survived. In S3, 52 (54.7%) died and 43 (45.3%) survived. There was no correlation between mortality and AKI staging. (chi2(2) = 5.655, p = 0.059). Of 48 Caucasians, 10 (20.8%) had S1 on admission, 14 (29.2%) S2, and 24 (50.0%) S3. Of 111 Hispanics, 25 (22.5%) had S1, 31 (27.9%) S2, and 55 (49.5%) S3. Of 22 African-Americans, 7 (31.8%) had S1, 5 (22.7%) had S2, and 10 (45.5%) S3. Of 8 in other ethnicities, 1 (12.5%) had S1, 2 (25.0%) S2, and 5 (62.5%) S3. There was no statistical significance between AKI staging on admission and race. (chi2(6) = 1.845, p = 0.933). CONCLUSION(S): The development of AKI is not associated with increased mortality for any specific ethnicity.

Correlation between Survival and Elevated D-Dimer Levels, Ichikado, Apache Ii, and Sofa Scores

INTRODUCTION: Elevated D-dimer levels are common in hospitalized COVID-19 patients. We aimed to investigate the correlation between D-dimer levels and survival, as well as ICHIKADO, APACHE II, and SOFA scores. METHOD(S): Retrospective study of adult patients with COVID-19 admitted to the hospital between March 2020 and February 2022. Patients were divided into three groups according to D-dimer levels: group 1 (G1) had levels less than 0.5 mg/L, group 2 (G2) had 0.5 to 3.99 mg/L and group 3 (G3) was above 4 mg/L. The primary outcome was survival to hospital discharge. Descriptive statistics, Chi-square, and Kruskal-Wallis tests were used. A p value <= 0.05 was considered statistically significant. RESULT(S): 830 patients were included in the study. 464 (55.9%) patients were men. Median age was 56 [45-66] years. There was a statistically significant association between D-dimer levels and survival rate. A total of 677 (81.6%) patients survived. 401 (89.3%), 235 (74.8%), and 41 (61.2%) patients survived in G1, G2, and G3 respectively, p < 0.001. There was also a statistically significant association between D-dimer levels and different severity scores. Median ICHIKADO scores across D-dimer levels;G1 had a median score of 140.00 [115-180]], G2 had a score of 157.50 [120-205], and G3 had a score of 200.00 [160- 245] (H (2) = 55.345, p < 0.001). APACHE II scores across the groups;G1 had a median score of 7.00 [5-11], G2 had a score of 10.50 [7-16], and G3 had a score of 12.00 [8-19] (H (2) = 76.817, p < 0.001). For SOFA scores, G1 had a median score of 2.00 [1-2], G2 had a score of 2.00 [1-3.25], and G3 had a score of 4.00 [2-6] (H(2)= 81.309, p < 0.001). CONCLUSION(S): In this cohort, elevation of D-dimer levels was associated with decreased survival rates as well as with increased ICHIKADO, APACHE II, and SOFA scores.

The Use of Invasive Mechanical Ventilation in Hospitalized Covid-19 Patients

INTRODUCTION: Increased mortality due to COVID-19 in the intensive care unit (ICU) raised questions about the best way and time to use invasive mechanical ventilation (IMV). The purpose of this study is to analyze effectiveness of IMV in COVID-19 patients. METHOD(S): We performed a retrospective analysis of adult patients admitted to our hospital with COVID-19 infection from May 2020 to December 2021. We reviewed the need of IMV in patients admitted to the ICU with APACHE II scores higher than 12.5. Outcomes from the IMV-receiving patients were compared to outcomes from patients on non-invasive mechanical ventilation (NIMV). The second analysis of IMV aimed to determine the best initiation time for IMV. Patients were divided into Group1: early intubation (IMV within the first 24hrs of admission) and Group2: late intubation (IMV later than 24hrs after admission). Primary outcomes included mortality and length of stay (LOS) in the ICU. Descriptive statistics, Mann-Whitney-U and Chi-square methods were used. RESULT(S): For the first part of the analysis, 82 patients were included. They were divided into 2 groups (IMV and NIMV) of 41 patients each. Median age in IMV group was 67 [51.5- 75.5] vs 64 [47.5-73.5]. 21 (51.2%) patients died in the IMV group vs 22 (53.7%) X2(1, N=82)=0.049, p=0.5. Median LOS in the IMV group was 10 [6-16] days vs 11 [5-19.5] days U(NIMV group=41, NNIMV group=41)=819, z=-0.2, p=0.84. For the second analysis, 68 patients were included. They were divided into 2 groups (Group1 and 2) of 34 patients each. Median age in group1 was 53.5 [25-90] vs 53.5 [37.75-65.25]. 19 (55.9%) patients in group1 were male vs. 26 (76.5%). The median APACHE II, SOFA and ICHIKADO scores on admission in group1 were 8 [6-10.5], 1.5 [1-2], 120 [110-165] points respectively vs 9.5 [6-16.5], 2 [1-4], 150 [132.5-200] points. 3 (8.8%) patients died in group1 vs 11 (32.4%) X2(1, N=68)=5.76,p=0.033. Median LOS in group1 was 4.5 [3-8.5] days vs 6 [3.75-10.5] days U(NGroup1=34, NGroup2=34)=450, z=-1.59, p=0.113. CONCLUSION(S): In COVID-19 patients admitted to the ICU with APACHE II score higher than 12.5, mortality and LOS were not significantly different in patients that received IMV vs those that received NIMV. Early intubation correlated with improved mortality, but not with length of ICU stay.

Remdesivir Use in Hospitalized Covid-19 Patients

INTRODUCTION: The antiviral efficacy of remdesivir is still controversial. We aimed to evaluate the impact of remdesivir use in patients admitted to our intensive care unit (ICU) with COVID-19. METHOD(S): A retrospective study of adult patients admitted to our hospital with COVID-19 infection from March 2020 to September 2021 was performed. Patients were divided into 2 groups;Group1 received remdesivir while Group2 did not. The primary outcomes studied were mortality rate, length of stay (LOS) in the ICU and the need of invasive mechanical ventilation (IMV). Additional outcomes assessed were highest APACHE II during stay and inflammatory markers (Ferritin, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)). Descriptive statistics, Mann-Whitney-U and Chisquare methods were used. RESULT(S): 227 patients were included, median age was 57 years [46-68]. 122 (53.7%) were male. 113 patients were in Group1 vs 114 in Group2. Median age in Group1 is 58 years [45.75-68] vs 57 years [46.5-68] in Group2. In Group1, 64 (56.1%) were male vs 58 (51.3%). The median APACHE II score on admission for group1 was 8 [5-12] vs 9 [6-12]. The median SOFA score on admission for group1 was 2 [2-3] vs 2 [1-2.75]. The median ICHIKADO score on admission for group1 was 160 [120-200] vs 140 [110-180]. 24 (21.1%) patients died in group1 vs 21 (18.6%) in group2 x2(1, 227) = 0.218, p = 0.74. The median LOS of group1 was 7 [4-10] vs 7 [5-11] U(NGroup1=114, NGroup2=113)=6400, z=- 0.083, p=0.934. 16 (14%) patients in group1 needed IMV vs 22 (19.5%) in group 2, x2(1, 227) = 0.273, p = 0.291. The median of the highest APACHE II score in group1 was 10 [6- 17.5] vs 11 [7-15] U(NGroup1=114, NGroup2=112)=6163, z=-0.45, p=0.652. In group1, median ferritin, CRP and ESR were 486.6 [246.75-1184.5] ng/ml, 90.35 [39.48-135] mg/L, 85 [60-106.5] mm/hr, respectively vs. 493.3 [174.6- 1025.5] ng/ml, 69.6 [35.25-116.75] mg/L, 77 [47.5-110] mm/hr, U(NGroup1=114, NGroup2=107)=5614.5, z=- 1.022, p=0.307, U(NGroup1=56, NGroup2=34)=854, z=- 0.816, p=0.415, U(NGroup1=113, NGroup2=110)=5644.5, z=-1.185, p=0.236, respectively. CONCLUSION(S): There is no difference in mortality, severity scales nor inflammatory markers in patients that were treated with remdesivir compared to those who were not.

Degree of Thrombocytopenia in Hospitalized Covid-19 Patients with Ebv and Cmv Coinfection

INTRODUCTION: Thrombocytopenia (TCP) can be caused by Epstein-Barr Virus (EBV), Cytomegalovirus (CMV), and Coronavirus Disease 2019 (COVID-19). This study aimed to evaluate the degree of TCP in COVID-19 patients with coinfection with EBV and/or CMV. METHOD(S): Retrospective study of adult patients admitted to our hospital with COVID-19 infection from March 2020 to February 2022 was conducted. Patients were divided into two groups. Group 1 (G1) had viral co-infection with EBV and/or CMV and group (G2) did not. These groups were analyzed based on the degree of TCP. Thrombocytopenia was classified into mild (100-150x103/uL), moderate (50- 99x103/uL), and severe (< 50x103/uL). Primary outcomes were mortality, need for ventilation (NFV), and length of stay (LOS). Descriptive statistics, crosstabulation, Chi-square, and Mann-Whitney tests were used. RESULT(S): Of 994 patients, 445 with a median age of 57 [45-68] years were tested for viral co-infection. 262 (58.9%) were male and 327 (73.5%) survived. There was a statistically significant association between co-infection and TCP, X2(3)= 22.335, p= <.001. Of 218 patients in G1, 98 (45.0%) had normal platelet count (NPC), 44 (20.2%) had mild TCP, 47 (21.6%) had moderate, and 29 (13.3%) had severe. Of 227 patients in G2, 132 (58.1%) had NPC, 59 (26.0%) had mild TCP, 26 (11.5%) had moderate, and 10 (4.4%) had severe. There was a statistically significant association between coinfection and mortality, X2(1)= 36.682, p= <.001. In G1, 86 (39.4%) died and 132 (60.6%) survived. In G2, 32 (14.1%) died and 195 (85.9%) survived. There was a significant difference in LOS between the groups, [U= 16935.50, p= <.001]. G1 had a median LOS of 12 [6-19] days and G2 had a median of 7 [4-11] days. There was no statistically significant association between co-infection and NFV, X2(1)= .033, p= .856. In G1, 34 (15.6%) patients were mechanically ventilated and 184 (84.4%) were not. In G2, 34 (15.0%) were ventilated and 193 (85.0%) were not. CONCLUSION(S): COVID-19 and viral co-infection with EBV and/or CMV is associated with the presence of thrombocytopenia, mortality, and longer LOS in hospitalized patients. The presence of co-infection is associated with moderate and severe TCP.

Impact of Bmi on Mortality, Mechanical Ventilation, and Length of Stay in Covid-19 Patients

INTRODUCTION: Weight-related health problems typically arise in those with a BMI higher than 30. This study aimed to evaluate the effect of BMI on COVID-19 outcomes. METHOD(S): Retrospective cohort study was conducted on patients in our hospital with COVID-19 from March 2020 to February 2022. Admission BMI was categorized into six classifications: underweight (< 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obese class 1 (30-34.9 kg/m2), obese class 2 (35-39.9 kg/m2), and obese class 3 (>40 kg/m2). Primary outcomes were mortality, days hospitalized, and need for mechanical ventilation. Descriptive statistics, Chi-square, and Kruskal-Wallis tests were performed. RESULT(S): 986 individuals were included with a median age of 56 years [45-67]. Overall median BMI was 29.3 kg/m2 [27- 34.5 kg/m2]. 554 (56.2%) patients were males. Median BMI for females was 30.3 kg/m2 [26.4-35.4 kg/m2], and for males was 29.1 kg/m2 [25.8-33.9 kg/m2]). A total of 799 (81%) survived. Survival in underweight patients was 13 (86.7%), normal weight was 143 (81.7%), overweight was 267 (79%), obese class 1 was 191 (84.1%), obese class 2 was 98 (79%), and obese class 3 was 87 (81.3%), (chi2 (5) = 3.032, p = .695). When assessing need of mechanical ventilation, 159 (16.1%) of all patients needed ventilation. In each category: 3 (20%) underweight patients, 24 (13.7%) normal weight patients, 61 (18%) overweight patients, 33 (14.5%) obese class 1 patients, 22 (17.7%) obese class 2 patients, and 16 (15%) obese class 3 patients required ventilation (chi2 (5) = 2.613, p = .759). Analyzing days hospitalized, length of stay in each category was: underweight - 6 [5-12] days, normal weight - 7 [3-12] days, overweight - 6.5 [4-12] days, obese class 1 - 7 [4-12] days, obese class 2 - 7.5 [4-14] days, and obese class 3 - 7 [5-12] days (H (5) = 3.093, p =.686). CONCLUSION(S): In this cohort, BMI is not associated with higher mortality rates, longer hospitalization time, or need of mechanical ventilation among patients with COVID-19.

The Prognostic Value of Ichikado Scores and Cci for Hospitalized Patients with Covid-19 Pneumonia

INTRODUCTION: As the world continues to experience waves of COVID-19 infections including new variants of the pathogen, it remains an important area of study to fully describe the etiology and associations of the severe disease. Recent studies have established correlations for Charlson Comorbidity Index (CCI) >3 with poor prognosis. Additionally, a previous study has shown that a high Ichikado CT score (ICTS) >172 predicts mortality. Here we further explore the validity of these prognostic tools when used together. METHOD(S): Single-center retrospective cohort data of patients with confirmed COVID pneumonia hospitalized between March 2020 and February 2022 was analyzed. Patients were included if, within 24 hours of admission, a CT Chest and full past medical history were obtained. ICTS was interpreted by 3 radiologists blinded to the outcomes. Thorough review of medical records provided information for CCI calculations. Primary outcomes measured were mortality and length of admission. Multivariate analysis performed using SPSS 28. RESULT(S): Data included eight hundred and seventythree patients (44.1% Female, mean age=55). Multivariate analysis for clinical outcomes of death comparing ICTS and CCI revealed a significant reduction in survival of patients with CCI>3 for ICTS>172 (log rank chi2=18.38, p< 0.001). Estimated survival time for these patients was 17.5 days (SE=0.996, 95%CI: 15.527-19.430) compared to CCI< 2 for ICTS>172 which estimated 26.4 days (SE=1.54, 95%CI: 23.405-29.441). For ICTS< 171, overall estimated survival was 33.5 days (SE=2.294, 95%CI: 28.972-37.966). ROC analysis using predicted survivability showed 75% sensitivity and 65% specificity (AUC=0.762, SE=0.021, p< 0.001, 95%CI: 0.720-0.804). CONCLUSION(S): As the number of confirmed COVID-19 cases continues to remain prevalent, practitioners may use these tools to guide the aggressiveness of their treatments and indications for tertiary care. ICTS and CCI are good predictors of COVID-19 prognosis especially when combined. Additionally, these tools can help firstline providers confidently assess and plan these seemingly complicated cases. Further research in this topic may lead to a prognostic tool specific to acute covid cases that is able to determine the prognosis for hospitalization, intubation, and mortality.

Echocardiographic Findings in Covid-19 Patients Admitted to the Hospital

INTRODUCTION: Cardiac abnormalities are frequently found in COVID-19 patients admitted to the intensive care unit. The purpose of this study was to describe echocardiographic findings in COVID-19 patients admitted with elevated troponin levels. METHOD(S): Retrospective study of adult patients admitted to our hospital with COVID-19 from March 2020 to February 2022. Troponin I was obtained on all admitted patients and levels >=0.04 ng/mL were included. Echocardiographic findings were analyzed and past medical history was reviewed. Descriptive statistics Chi-Square, and Kruskal- Wallis H tests were used. RESULT(S): 186 patients were included. Age was 63 [50- 75] years. 70 (37.6%) patients were female. The median Troponin I level was 0.095 ng/mL [0.053-0.329]. 4 (2.2%) patients had a history of myocardial Infarction, 89 (47.8%) patients had chronic hypertension, 10 (5.4%) had a history of congestive heart failure, and 14 (7.6%) patients had chronic kidney disease. 173 (93%) of these patients had echocardiography. Ejection fraction (EF) >50% was found in 135 (72.6%), EF 40-50% in 14 (7.5%), and less than 40% in 24 (12.9%) of the patients. Mortality for the patients that had EF >50% was 61 (45.5%), EF between 40-50% mortality was 6 (42%), and for EF < 40% was 10 (41%). (x2(2) = 0.145, p = 0.93). Patients with EF >50% had a length of stay (LOS) of 9 [5-19] days, patients with EF between 40- 50% 13 [6.2-23] days, and patients with EF < 40% LOS of 8 [5-18.2] days. (H(2) = 1.532, p = 0.46). Other findings reported in echocardiograms were ventricular or atrial enlargement in 73 (39.2%) of cases, 5 (2.7%) endocarditis, 4 (2.2%) myocarditis, 8 (4.3%) pericarditis, 5 (2.7%) findings compatible with pulmonary embolism (PE), 30 (16.1%) had pulmonary hypertension and 21 (11.3%) pleural effusion. CONCLUSION(S): Abnormal ejection fraction findings in patients with COVID-19 are not associated with increased mortality or length of hospitalized stay.

Prone Positioning in Severe Ards Due to Covid-19

INTRODUCTION: Studies have shown early application of prone-positioning in ARDS significantly decreased mortality. Our goal is to evaluate the effect of early prone-positioning specifically on COVID ARDS patients. METHOD(S): We performed a multicenter, retrospective observational analysis with a total of 1,335 patients with COVID ARDS that underwent prone positioning. Data was obtained from all HCA facilities within the dates of 1/1/2020- 6/20/2021. ARDS was defined using the Berlin criteria. Logistic regression was used to predict the likelihood of in-hospital all-cause mortality early vs late prone-positioning. Secondary outcomes were the relationship between age of the patient, MAP, days on ventilator and ICU length of stay (ICULOS) likelihood of in-hospital mortality. RESULT(S): From 1/1/2020-6/20/2021, a total of 3,407 patients with COVID ARDS were admitted to the participating facilities. 1,335 patients were included in the final analysis. Patients were mostly between ages 51-80 years old (77%), male (61.5%), white (55.4%), all of them admitted to ICU on mechanical ventilation. In-hospital allcause mortality was significantly lower in the shorter time to prone group (< 16 hours) than the longer time to prone group (>16, >24 hours), (p < 0.001, Exp(B) = 1.119, 95% C.I. [1.088, 1.151]). Mortality rate < 16 hours (46.53%), >16 hours (55%) vs >24 hours (68.1%). Patients that were prone in < 16 hours were less likely to experience an in-hospital mortality than those prone >16 hours (X2 (1, N= 1513) = 19.051, p < 0.001). There was not any statistically significant difference between the 16- and 24-hours group. For each one-day increase in days on the ventilator the likelihood of mortality is 0.978 times as likely. (p < 0.01, Exp(B) = 0.978, 95% C.I. [0.968, 0.989]). Expired rate by time to prone < 16 hours (55.45%) vs >16 hours (79.69%). For each one-year increase in age, patients are 1.045 times as likely to experience an in-hospital mortality (p < 0.001, Exp(B) =1.045, 95% C.I. [1.033,1.056]). CONCLUSION(S): We concluded through logistic regression that the time to prone had a statistically significant relation to in-hospital all-cause mortality and patients with COVID ARDS can benefit from early prone treatment.