Inhaled Nitric Oxide in Acute Severe Pulmonary Hypertension and Severe Acute Respiratory Distress Syndrome Secondary to COVID-19 Pneumonia: A Case Report.

BACKGROUND Inhaled nitric oxide (iNO) is used as a treatment for pulmonary arterial hypertension (PAH). Severe hypoxia with hypoxic vasoconstriction caused by severe acute respiratory distress syndrome (ARDS) can induce pulmonary hypertension with hemodynamic implications, mainly secondary to right ventricle (RV) systolic function impairment. We report the case of the use of iNO in a critically ill patient with bilateral SARS-CoV-2 pneumonia and severe ARDS and hypoxemia leading to acute severe PAH, causing a ventilation/perfusion mismatch, RV pressure overload, and RV systolic dysfunction. CASE REPORT A 36-year-old woman was admitted to the Intensive Care Unit with a severe ARDS associated with SARS-CoV-2 pneumonia requiring invasive mechanical ventilation. Severe hypoxia and hypoxic vasoconstriction developed, leading to an acute increase in pulmonary vascular resistance, severe to moderate tricuspid regurgitation, RV pressure overload, RV systolic function impairment, and RV dilatation. Following 24 h of treatment with iNO at 15 ppm, significant oxygenation and hemodynamic improvement were noted, allowing vasopressors to be stopped. After 24 h of iNO treatment, echocardiography showed very mild tricuspid regurgitation, a non-dilated RV, no impairment of transverse free wall contractility, and no paradoxical septal motion. iNO was maintained for 7 days. The dose of iNO was progressively decreased with no adverse effects and maintaining an improvement of oxygenation and hemodynamic status, allowing respiratory weaning. CONCLUSIONS Sustained acute hypoxia in ARDS secondary to SARS-CoV-2 pneumonia can lead to PAH, causing a ventilation/perfusion mismatch and RV systolic impairment. iNO can be considered in patients with significant PAH causing hypoxemia and RV dysfunction.

Anxiety, gender, and social media consumption predict COVID-19 emotional distress

Fear and anxiety about COVID-19 have swept across the globe. Understanding the factors that contribute to increased emotional distress regarding the pandemic is paramount—especially as experts warn about rising cases. Despite large amounts of data, it remains unclear which variables are essential for predicting who will be most affected by the distress of future waves. We collected cross-sectional data on a multitude of socio-psychological variables from a sample of 948 United States participants during the early stages of the pandemic. Using a cross-validated hybrid stepwise procedure, we developed a descriptive model of COVID-19 emotional distress. Results reveal that trait anxiety, gender, and social (but not government) media consumption were the strongest predictors of increasing emotional distress. In contrast, commonly associated variables, such as age and political ideology, exhibited much less unique explanatory power. Together, these results can help public health officials identify which populations will be especially vulnerable to experiencing COVID-19-related emotional distress.

Ozone therapy for patients with COVID-19 pneumonia: Preliminary report of a prospective case-control study.

BACKGROUND: There is still no specific treatment strategies for COVID-19 other than supportive management. DESIGN: A prospective case-control study determined by admittance to the hospital based on bed availability. PARTICIPANTS: Eighteen patients with COVID-19 infection (laboratory confirmed) severe pneumonia admitted to hospital between 20th March and 19th April 2020. Patients admitted to the hospital during the study period were assigned to different beds based on bed availability. Depending on the bed the patient was admitted, the treatment was ozone autohemotherapy or standard treatment. Patients in the case group received ozonated blood twice daily starting on the day of admission for a median of four days. Each treatment involved administration of 200 mL autologous whole blood enriched with 200 mL of oxygen-ozone mixture with a 40 µg/mL ozone concentration. MAIN OUTCOMES: The primary outcome was time from hospital admission to clinical improvement. RESULTS: Nine patients (50%) received ozonated autohemotherapy beginning on the day of admission. Ozonated autohemotherapy was associated with shorter time to clinical improvement (median [IQR]), 7 days [6-10] vs 28 days [8-31], p = 0.04) and better outcomes at 14-days (88.8% vs 33.3%, p = 0.01). In risk-adjusted analyses, ozonated autohemotherapy was associated with a shorter mean time to clinical improvement (-11.3 days, p = 0.04, 95% CI -22.25 to -0.42). CONCLUSION: Ozonated autohemotherapy was associated with a significantly shorter time to clinical improvement in this prospective case-control study. Given the small sample size and study design, these results require evaluation in larger randomized controlled trials. CLINICAL TRIAL REGISTRATION NUMBER: NCT04444531.

Emotional responses to prosocial messages increase willingness to self-isolate during the COVID-19 pandemic.

The COVID-19 pandemic may be one of the greatest modern societal challenges that requires widespread collective action and cooperation. While a handful of actions can help reduce pathogen transmission, one critical behavior is to self-isolate. Public health messages often use persuasive language to change attitudes and behaviors, which can evoke a wide range of negative and positive emotional responses. In a U.S. representative sample (N = 955), we presented two messages that leveraged either threatening or prosocial persuasive language, and measured self-reported emotional reactions and willingness to self-isolate. Although emotional responses to the interventions were highly heterogeneous, personality traits known to be linked with distinct emotional experiences (extraversion and neuroticism) explained significant variance in the arousal response. While results show that both types of appeals increased willingness to self-isolate (Cohen's d = 0.41), compared to the threat message, the efficacy of the prosocial message was more dependent on the magnitude of the evoked emotional response on both arousal and valence dimensions. Together, these results imply that prosocial appeals have the potential to be associated with greater compliance if they evoke highly positive emotional responses.