Long COVID risk factors in a Portuguese cohort

Introduction: Long COVID is defined as the presence of symptoms that develop during or after COVID-19, continue for more than 12 weeks, and are not explained by an alternative diagnosis. Post-COVID radiological sequelae may occur and could be associated with dyspnea and cough. Decreased DLCO has been described as the main feature of PFTs abnormalities. Aims and objectives: The aim of this study was to identify potentially correlated with long COVID and its association with radiological and lung function sequelae in previously hospitalized patients. Method(s): We conducted a cross-sectional study with 93 patients that were evaluated in an outpatient setting following discharge from the hospital for COVID-19 pneumonia. Result(s): The mean age was 64 (+/-11) years old, 54 (59.1%) were male. The evaluation occurred on average 20 (+/-4) weeks after hospital discharge and 42 (45.2%) patients presented with long COVID. The most common symptoms were fatigue (31.2%) and dyspnea (26.9%). The prevalence of long COVID was higher in females (61%) (P=0.015). Obesity (OR 5.000, P=0.005), admission to ICU (OR 10.276, p=0.006), and the need for NIV (OR 7.85, p=0.01) were associated with long COVID. 65 patients performed CT scan and 43 (66%) had no or mild radiological sequelae. Radiological sequelae were more common in patients with long covid (n= 13, 30%) (p=0.024) and dyspnea/fatigue (p=0.04). Lung function was evaluated in 86 patients;decreased DLCO was the most common altered feature (n=32, 37%) and was associated with the presence of dyspnea/fatigue (p= 0.029). Conclusion(s): Obesity, ICU admission and the need for NIV were associated with a higher incidence of long COVID. The presence of radiological sequalae and/or decreased DLCO were associated with long COVID.

Detecting wildlife trafficking in images from online platforms: A test case using deep learning with pangolin images

E-commerce has become a booming market for wildlife trafficking, as online platforms are increasingly more accessible and easier to navigate by sellers, while still lacking adequate supervision. Artificial intelligence models, and specifically deep learning, have been emerging as promising tools for the automated analysis and monitoring of digital online content pertaining to wildlife trade. Here, we used and fine-tuned freely available artificial intelligence models (i.e., convolutional neural networks) to understand the potential of these models to identify instances of wildlife trade. We specifically focused on pangolin species, which are among the most trafficked mammals globally and receiving increasing trade attention since the COVID-19 pandemic. Our convolutional neural networks were trained using online images (available from iNaturalist, Flickr and Google) displaying both traded and non-traded pangolin settings. The trained models showed great performances, being able to identify over 90 % of potential instances of pangolin trade in the considered imagery dataset. These instances included the showcasing of pangolins in popular marketplaces (e.g., wet markets and cages), and the displaying of commonly traded pangolin parts and derivates (e.g., scales) online. Nevertheless, not all instances of pangolin trade could be identified by our models (e.g., in images with dark colours and shaded areas), leaving space for further research developments. The methodological developments and results from this exploratory study represent an advancement in the monitoring of online wildlife trade. Complementing our approach with other forms of online data, such as text, would be a way forward to deliver more robust monitoring tools for online trafficking. © 2023 The Author(s)

Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens

Objective: To evaluate whether critical SARS-CoV-2 infection is more frequently associated with signs of corticospinal tract dysfunction and other neurological signs, symptoms, and syndromes, than other infectious pathogens. Methods: This was a prospective cohort study with consecutive inclusion of patients admitted to intensive care units due to primary infectious acute respiratory distress syndrome requiring invasive mechanical ventilation > 48 hours. Eligible patients were randomly assigned to three investigators for clinical evaluation, which encompassed the examination of signs of corticospinal tract dysfunction. Clinical data, including other neurological complications and possible predictors, were independently obtained from clinical records. Results: We consecutively included 54 patients with acute respiratory distress syndrome, 27 due to SARS-CoV-2 and 27 due to other infectious pathogens. The groups were comparable in most characteristics. COVID-19 patients presented a significantly higher risk of neurological complications (RR = 1.98;95%CI 1.23 - 3.26). Signs of corticospinal tract dysfunction tended to be more prevalent in COVID-19 patients (RR = 1.62;95%CI 0.72 - 3.44). Conclusion: Our study is the first comparative analysis between SARS-CoV-2 and other infectious pathogens, in an intensive care unit setting, assessing neurological dysfunction. We report a significantly higher risk of neurological dysfunction among COVID-19 patients. As such, we suggest systematic screening for neurological complications in severe COVID-19 patients.

Satisfaction with telemedicine among anesthesiologists during the COVID-19 pandemic

The COVID-19 pandemic has rapidly changed the way that health care providers interact with patients, particularly through the widespread implementation of telemedicine. Previous studies in other medical specialties have examined the role of telemedicine and physician satisfaction with the modality [1], but no such studies have been reported in the field of anesthesiology. The purpose of the study was to evaluate the scope of use and satisfaction with telemedicine among anesthesiologists who were ASA and ESAIC members. We developed a survey that was sent out to anesthesia providers through the European Society of Anaesthesiology and Intensive Care (ESAIC) and the American Society of Anesthesiology (ASA). The survey was open for the duration of 30 days, after which it was closed and no new responses could be generated. The survey comprised three major sections and examined, (1) the characteristics of the anesthesia providers, (2) the settings within which they were using telemedicine, and (3) their satisfaction with the experience. We performed analyses to determine if there was a significant difference in satisfaction for those who used telemedicine prior to COVID-19 compared to those who started using it during the pandemic. There were a total of 708 responses from various provider demographics. Satisfaction with developing patient rapport was higher than satisfaction with airway and physical exam. Providers who were using telemedicine before the pandemic had consistently higher rates of satisfaction across all the subcategories. Familiarity with the software could have played a role in this result. Overall, satisfaction among users was high and the majority of practitioners, 86.3%, plan to continue using telemedicine in their practice.

Long ECMO runs in patients with COVID-19 disease. A subanalysis of the ECMOVIBER study

Objective: Describe the population of patients with COVID-19 disease needing long ECMO runs and compare characteristics and outcomes with shorter runs. Methods: Descriptive analysis of the ECMOVIBER registry, including 25 ECMO centers in Spain (23) and Portugal (2). All adult COVID-19 patients requiring VVECMO between 1stMarch and 1stDecember 2020 were included. Follow-up period ended 1stDecember. Patients still with support at this time point were excluded for the analysis. Long ECMO run was defined if lasted >30D. High volume center was defined as supporting >15 COVID-19 patients during the study period. Variables described as mean(SD)/median(IQR) or frequency(percentage). For comparisons, the Chi2, Fisher's exact or Mann-Whitney U were use. Results: Of 316 patients, 266 completed the ECMO run at the end of follow up. 46(17%) received long support and 220(83%) shorter runs. Comparisons between the two cohorts are detailed in the table-figure. Patients with longer runs were older and suffered more frequently hypertension but the respiratory condition prior to ECMO was similar. Interestingly, at day 3 of support tidal volume was lower and sweep gas flow was higher in the long run cohort. Supplemental therapies such as prone positioning and CRRT were more frequently implemented in long runs and complications occurred more frequently in this group. However, neither ECMO mortality, nor hospital mortality were higher. Conclusions: In patients with extracorporeal support due to COVID-19, tidal volume and gas flow at day 3 may discriminate those needing long runs. Long runs are not associated with worse survival despite having higher complication rates.

A characterization of the psychosocial impact of COVID-19 lockdown in post-bariatric surgery patients

Introduction: The lockdown caused by COVID-19 has an extreme impact on most people's lives. Notwithstanding, some individuals are more predisposed to experience deterioration in their psychological status and/or inaccessibility to adequate treatment and, consequently, they should be devoted with greater attention. Namely, for example, post-bariatric surgery patients who need continuous monitoring about eating behavior and psychological distress. Particularly in medium/long term post-surgery (≥ 36 months), a period of increased susceptibility to weight regain. The present study goals are to characterize the psychosocial impact of COVID-19 lockdown for post-bariatric patients and identify its associations with disordered eating behavior and psychological distress. Methods: Twenty-four post-bariatric surgery (M=42.88 months post-surgery, DP=4.73) women (M=50.92 years, DP=12.81) responded to an online questionnaire and a telephone-interview assessing the perceived impact of the lockdown, psychosocial, psychological, and eating behavior aspects during the first lockdown period. Results: Fourteen (58.3%) of the participants inquired reported perceived weight gain during the lockdown, thirteen (54.1%) reported limited access to social support, and twelve (50%) reported limited access to health care. Positive associations were found between the global psychosocial impact experienced during lockdown and difficulties in dealing with emotionally activating situations (rs=.45, p=.027) and stress symptoms (rs=.44, p=.030). Negative associations were found between co-habiting with more persons during lockdown and difficulties in dealing with emotionally activating situations (rs=-.49, p=.015), fear of getting fat (rs=-.48, p=.019), fear of losing control over eating (rs=-.56, p=.005), and disordered eating psychopathology (rs=-.47, p=.022). Conclusion: As clinical implications, the present findings highlighted the need to monitor post-bariatric surgery patients, facilitate health care access, and promote social support during lockdown periods.

Eating behaviors and weight outcomes in post-bariatric surgery patients during the COVID-19 pandemic: A three-year longitudinal study

Introduction: The lockdown imposed by many countries to curb the COVID-19 epidemic had an unprecedented impact on the general population's lives. Recent studies suggest that eating habits are one of the areas particularly affected by stay-at-home orders. Individuals that received bariatric surgery for weight loss may represent a particularly susceptible population to the adverse effects of the COVID-19 lockdown for its potential impact on eating, psychological and, weight loss outcomes. This study seeks to investigate the incremental impact of COVID-19 lockdown on bariatric surgery outcomes. Methods: The present investigation uses data from an ongoing longitudinal study of bariatric patients assessed before surgery (T0), 1.5 (T1), and 3 years after surgery (T2). Two independent groups were compared: the COVID-19-Group (n=35) - T0 and T1 assessment were conducted before the pandemic started, but T2 assessment was conducted at the end of the mandatory COVID-19 lockdown;and the NonCOVID-19-Group (n=66) - who completed the pre-surgery, 1.5-, and 3-year assessment before the epidemic began. Assessment included self-report measures for disordered eating, negative urgency, depression, anxiety, stress, and weight outcomes. General Linear Models for repeated measures were used. Results: General Linear Models for repeated measures showed that the COVID-19-Group presented significantly higher weight concern (F=8.403, p=.005, η2p=.094), grazing behavior (F=7.166, p=.009, η2p=.076), and negative urgency (F=4.522, p=.036, η2p=.05) than the NonCOVID-19-Group. The COVID-19-Group also showed less weight loss (F=4.029, p=.05, η2p=.04) and greater weight regain at T2, with more COVID-19-Group participants experiencing excessive weight regain (20% vs 4.5%).Conclusions: These results show evidence for the impact of the coronavirus outbreak on eating-related psychopathology and weight outcomes in post-bariatric surgery patients, making specialized and systematic care an urgent matter for this population.