LOCUS (LOng Covid-Understanding Symptoms, events and use of services in Portugal): A three-component study protocol.

Approximately 10% of patients experience symptoms of Post COVID-19 Condition (PCC) after a SARS-CoV-2 infection. Akin acute COVID-19, PCC may impact a multitude of organs and systems, such as the cardiovascular, respiratory, musculoskeletal, and neurological systems. The frequency and associated risk factors of PCC are still unclear among both community and hospital settings in individuals with a history of COVID-19. The LOCUS study was designed to clarify the PCC's burden and associated risk factors. LOCUS is a multi-component study that encompasses three complementary building blocks. The "Cardiovascular and respiratory events following COVID-19" component is set to estimate the incidence of cardiovascular and respiratory events after COVID-19 in eight Portuguese hospitals via electronic health records consultation. The "Physical and mental symptoms following COVID-19" component aims to address the community prevalence of self-reported PCC symptoms through a questionnaire-based approach. Finally, the "Treating and living with Post COVID-19 Condition" component will employ semi-structured interviews and focus groups to characterise reported experiences of using or working in healthcare and community services for the treatment of PCC symptoms. This multi-component study represents an innovative approach to exploring the health consequences of PCC. Its results are expected to provide a key contribution to the optimisation of healthcare services design.

Forecasting Omicron Variant of Covid-19 with ANN Model in European Countries – Number of Cases, Deaths, and ICU Patients

Accurate predictions of time series are increasingly required to support judgments in a variety of decisions. Several predictive models are available to support these predictions, depending on how each field offers a data variety with varied behavior. The use of artificial neural networks (ANN) at the beginning of the COVID-19 pandemic was significant since the tool may offer forecasting data for various conditions and hence assist in governing critical choices. In this context, this paper describes a system for predicting the daily number of cases, fatalities, and Intensive Care Unit (ICU) patients for the next 28 days in five European countries: Portugal, the United Kingdom, France, Italy, and Germany. The database selection is based on comparable mitigation processes to analyze the impact of safety procedure flexibilization with the most recent numbers of COVID-19. Additionally, it is intended to check the algorithm's adaptability to different variants throughout time. The network's input data has been normalized to account for the size of the countries in the study and smoothed by seven days. The mean absolute error (MAE) was employed as a comparing criterion of two datasets, one with data from the beginning of the pandemic and another with data from the last year, since all variables (cases, deaths, and ICU patients) may be tendentious in percentage analysis. The best architecture produced a general MAE prediction for the 28 days ahead of 256,53 daily cases, 0,59 daily deaths, and 1,63 ICU patients, all numbers normalized by million people. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

4-Organ Sofa Score as Tool to Triage Crrt Use in Covid-19 Patients during Crisis Standards of Care

INTRODUCTION: Acute kidney injury requiring renal replacement therapy (AKI-RRT) is associated with high mortality, especially in the setting of COVID-19. During the peak of the delta wave in New Mexico in late 2021, crisis standards of care were declared and strategies to ration care were explored. Our hypothesis is that a simplified SOFA score in patients with COVID-19 and AKI-RRT may predict short-term mortality. METHOD(S): We retrospectively analyzed all COVID-19 patients started on CRRT for AKI in the medical ICU at our center between April 2020 and July 2021. A 4-organ SOFA score (4OSS), with renal and neurologic sub-scores excluded, was calculated at the time of CRRT initiation. Neurologic sub-score was excluded because it is subjective, inconsistently documented, and confounded by the frequent use of sedation and paralysis in severe COVID-19. ECMO patients were included and assigned the maximum respiratory sub-score. Patients started on RRT at an outside hospital, found to be incidentally COVID-positive, or on chronic dialysis were excluded. P values were obtained using 1-sided Mann-Whitney U tests. RESULT(S): 63 total COVID-19 patients on CRRT were identified with 73% 30-day mortality and 83% in-hospital mortality. The median 4OSS was 8 in both in-hospital survivors and non-survivors with interquartile range [IQR] of 4-9 and 7-9.75, respectively (difference between groups non-significant, p = 0.075). The median 4OSS was 7 [5.5- 8.5] and 8 [7-10] in 30-day survivors and non-survivors, respectively (p = 0.018). Those with 4OSS of >=10 (n=13, 20.6%) had 100% in-hospital mortality. CONCLUSION(S): Similar to other analyses of SOFA score in COVID-19, 4OSS at CRRT initiation in patients with COVID-19 and AKI-RRT appears to have limited prognostic ability, with substantial overlap in scores between survivors and non-survivors. However, while additional multicenter studies are needed, 4OSS of >=10 may identify a group of about 20% of COVID-19 patients with AKI-RRT and mortality approaching 100%. Given the absence of a superior validated metric, a 4OSS of >=10 may be a reasonable tool for triage of CRRT in the setting of crisis standards of care and CRRT machine or supply shortages. At a minimum, 4OSS could inform goals of care discussions prior to CRRT initiation in patients with COVID-19 complicated by AKI-RRT.

P22-05 In vitro toxicity assessment of paints with antimicrobial properties - a comparative study

In this work, the in vitro cytotoxicity of self-disinfecting wall paints containing antimicrobial substances was assessed, using skin and lung cell lines. Self-disinfecting surfaces have appeared as an alternative to common cleaning and disinfection protocols applied in different scenarios. These surfaces are even more trend nowadays due to the Covid-19 pandemic. We developed a wall paint formula with antimicrobial properties to be applied in areas with high propensity for infection spreading. To do so, substances with known activity against microorganisms were incorporated on a commercial wall paint. Both paints containing Bacitracin (0.6 g/L) or Colophony (3.2 g/L) showed good antimicrobial activity against several bacteria, namely Staphylococcus aureus and Escherichia coli. However, an important step of our work is to assure these surfaces' safety, both for people contacting with it and for workers handling the products. Following ISO 109931, direct contact and extracts tests were performed. The surfaces were placed in direct contact with in vitro cell cultures of HaCaT skin cells for 24h at 37°C, 5% CO2. In parallel, the surfaces were lixiviated in culture media and their extracts at several concentrations were exposed to HaCaT cells and A549 human alveolar epithelial cells, for 24h at 37°C, 5% CO2. Then, neutral red uptake (NRU), cell proliferation reagent WST-1 and lactate dehydrogenase activity (LDH) assays were performed, both on direct contact and extracts tests, for quantitative evaluation of cytotoxicity. For direct contact tests on HaCaT cells, both surfaces containing Bacitracin or Colophony showed cell viabilities of around 90%, with NRU and WST-1 showing similar results. LDH release was around 25% for both surfaces. Regarding the tests with the extracts on HaCaT cells, cell viability fluctuated between 85-70% for Bacitracin and between 80-90% for Colophony, according to the extract concentration. A proportional response was detected when decreasing the concentration of extract. LDH release was around 5-15% for Bacitracin and around 5-20% for Colophony. On A549 cells, the test on extracts demonstrated a cell viability of 100% for both surfaces and a LDH release of 15-25% for Bacitracin and 10% for Colophony. These results suggest that the extract forms of the Bacitracin and Colophony are more toxic to HaCaT cells comparing to the direct contacting surfaces containing the same compounds, however, with lower LDH release levels. Comet assay, measuring DNA damage is being performed to further evaluate the formulas' toxicity.

Proliferative glomerulonephritis with monoclonal immunoglobulin deposition (PGNMID) associated with COVID-19

Introduction: Renal disease in COVID-19 is often due to acute tubular injury but can include multiple glomerular lesions such as collapsing glomerulopathy. This is the first reported case of COVID-19-associated PGNMID. Case Description: A 71-year-old woman with normal baseline creatinine (Cr) was admitted with COVID-19 and discharged on oxygen and dexamethasone (Dex). She improved but returned a month later with edema and nausea. She was found to have nephrotic syndrome, hematuria, and AKI (peak Cr 8.5 mg/dL) requiring HD. Kidney biopsy revealed PGNMID with clonal IgG3-kappa. SPEP, serum free light chains (sFLC), 24h urine UPEP, bone marrow biopsy with flow cytometry, fat pad biopsy, and PET-CT were negative for monoclonal immunoglobulin (Ig) or cell line, amyloid, or malignancy. Though symptoms had long since resolved, she was still PCR-positive for SARS-CoV-2 on nasal swab. Upon discharge she was given cyclophosphamide (Cy). Her renal function improved (Cr 2.5) and she came off HD 2 weeks later. Her outpatient oncologist opted not to continue therapy. However, 2 months later she was readmitted with nausea, dyspnea, and anasarca with recurrent AKI (Cr 6.7) and nephrotic syndrome. HD was restarted. Repeat kidney biopsy [Figure] was noted to be a carbon copy of the first. SPEP, spot UPEP, and sFLC were again negative. She was started on Cy, bortezomib, and Dex with similar partial response (Cr <2.5). Discussion: PGNMID is a rare type of monoclonal gammopathy of renal significance (MGRS) that often has no detectable extrarenal monoclonal Ig or cell line. MGRS and PGNMID, though usually not postinfectious, have been reported with other viruses (e.g., viral hepatitis, parvovirus-B19). However, though causality is unclear, this is the first case of MGRS reported in association with COVID-19.

Covid-19 time series prediction

The Artificial Neural Network (ANN) is a computer technique that uses a mathematical model to represent a simpler form of the biologic neural structure. It is formed by many processing units and its intelligent behavior comes from the iterations between these units. One application of the ANN is for time series prediction algorithms, where the network learns the behavior of time dependent data and it is able to predict future values. In this work, the ANN is applied in predicting the number of COVID-19 confirmed cases and deaths and also the future seven days for the time series of Brazil, Portugal and the United States. From the simulations it is possible to conclude that the prediction of confirmed cases and deaths from COVID-19 have been successfully made by the ANN. Overall, the ANN with a specific test set had a Mean Squared Error (MSE) 50% higher than the ANN with a random test set. The combination of the sigmoidal and linear activation functions and the Levenberg-Marquardt training function had the lowest MSE for all cases. © 2021 The Authors. Published by Elsevier B.V.