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PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-333831


BACKGROUND: Heparin, in addition to its anticoagulant properties, has anti-inflammatory and potential anti-viral effects, and may improve endothelial function in patients with Covid-19. Early initiation of therapeutic heparin could decrease the thrombo-inflammatory process, and reduce the risk of critical illness or death. METHODS: We randomly assigned moderately ill hospitalized ward patients admitted for Covid-19 with elevated D-dimer level to therapeutic or prophylactic heparin. The primary outcome was a composite of death, invasive mechanical ventilation, non-invasive mechanical ventilation or ICU admission. Safety outcomes included major bleeding. Analysis was by intention-to-treat. RESULTS: At 28 days, the primary composite outcome occurred in 37 of 228 patients (16.2%) assigned to therapeutic heparin, and 52 of 237 patients (21.9%) assigned to prophylactic heparin (odds ratio, 0.69;95% confidence interval [CI], 0.43 to 1.10;p=0.12). Four patients (1.8%) assigned to therapeutic heparin died compared with 18 patients (7.6%) assigned to prophylactic heparin (odds ratio, 0.22;95%-CI, 0.07 to 0.65). The composite of all-cause mortality or any mechanical ventilation occurred in 23 (10.1%) in the therapeutic heparin group and 38 (16.0%) in the prophylactic heparin group (odds ratio, 0.59;95%-CI, 0.34 to 1.02). Major bleeding occurred in 2 patients (0.9%) with therapeutic heparin and 4 patients (1.7%) with prophylactic heparin (odds ratio, 0.52;95%-CI, 0.09 to 2.85). CONCLUSIONS: In moderately ill ward patients with Covid-19 and elevated D-dimer level, therapeutic heparin did not significantly reduce the primary outcome but decreased the odds of death at 28 days. Trial registration numbers: NCT04362085 ;NCT04444700.

EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-294726


Objectives To assess the effectiveness of prone positioning to reduce the risk of death or respiratory failure in non-critically ill patients hospitalized with COVID-19 Design Pragmatic randomized clinical trial of prone positioning of patients hospitalized with COVID-19 across 15 hospitals in Canada and the United States from May 2020 until May 2021. Settings Patients were eligible is they had a laboratory-confirmed or a clinically highly suspected diagnosis of COVID-19, required supplemental oxygen (up to 50% fraction of inspired oxygen [FiO2]), and were able to independently prone with verbal instruction. ( NCT04383613 ). Main Outcome Measures The primary outcome was a composite of in-hospital death, mechanical ventilation, or worsening respiratory failure defined as requiring at least 60% FiO2 for at least 24 hours. Secondary outcomes included the change in the ratio of oxygen saturation to FiO2 (S/F ratio). Results A total of 248 patients were included. The trial was stopped early on the basis of futility for the pre-specified primary outcome. The median time from hospital admission until randomization was 1 day, the median age of patients was 56 years (interquartile range [IQR] 45,65), 36% were female, and 90% of patients were receiving oxygen via nasal prongs at the time of randomization. The median time spent prone in the first 72 hours was 6 hours total (IQR 1.5,12.8) for the prone arm compared to 0 hours (0,2) in the control arm. The risk of the primary outcome was similar between the prone group (18 [14.3%] events) and the standard care group (17 [13.9%] events), odds ratio 0.92 (95% CI 0.44 to 1.92). The change in the S/F ratio after 72 hours was similar for patients randomized to prone compared to standard of care. Conclusion Among hypoxic but not critically patients with COVID-19 in hospital, a multifaceted intervention to increase prone positioning did not improve outcomes. Adherence to prone positioning was poor, despite multiple efforts. Subsequent trials of prone positioning should aim to develop strategies to improve adherence to awake prone positioning. What is already known on this topic Prone positioning is considered standard of care for mechanically ventilated patients who have severe acute respiratory distress syndrome. Recent data suggest prone positioning is beneficial for patients with COVID-19 who are requiring high flow oxygen. It is unknown of prone positioning is beneficial for patients not on high flow oxygen. What this study adds Prone positioning is generally not well tolerated and innovative approaches are needed to improve adherence. Clinical and physiologic outcomes were not improved with prone positioning among hypoxic but not critically ill patients hospitalized with COVID-19.

Journal of the Neurological Sciences ; 429, 2021.
Article in English | EMBASE | ID: covidwho-1466714


Background and aims: Although neuropsychiatric manifestations have been reported after COVID-19, little is known about fine motor difficulties after mild infection. We evaluate fine motor impairment, fatigue, depression, anxiety and somnolence after COVID-19. Methods: We applied the 9-hole peg and the “box and blocks” tests to fine motor skills;and Hanoi tower test to evaluate executive functions. Individuals answered the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Chalder fatigue questionnaire (CFQ) and Epworth sleepiness Scale (ESS). We used SPSS26 with Mann-Whitney U-test to compare variables between groups and partial correlations to correlate the continuous variables. Results: We evaluated 23 subjects recovered from COVID-19 (after 4 months from diagnosis) (16 women;median of 39 years)) and 35 healthy controls (23 women;median 33 years) balanced for sex (p = 0.8), age (p = 0.3) and education (p = 0.6). COVID group presented excessive sleepiness (ESS, median 10 points (range 0–18)), and fatigue (CFQ, median 18 points (range 0–32)). Fatigue correlated with depression symptoms (r = 0.5;p = 0.018), with anxiety (r = 0.49;p = 0.021), and with sleepiness (r = 0.4;p = 0.06). COVID group was slower on the 9-Hole Peg Test for dominant (p = 0.004) and non-dominant hands (p = 0.002), and performed poorer on Box and blocks test (p = 0.047). They were slower on the Hanoi Tower test with 3 pieces (p = 0.04). Conclusions: We identified persistent neurological symptoms (mainly fatigue and somnolence) motor slowness and difficulties in patients with mild infection and without hospital treatment. Fatigue associated with other neuropsychiatric symptoms. The longitudinal evaluation and neuroimaging correlations in a larger sample may clarify the duration of deficits and the associated cerebral abnormalities.

Holos ; 37(4):14, 2021.
Article in Portuguese | Web of Science | ID: covidwho-1374699


The study aimed to explain the opinion of school principals regarding the influence of COVID-19 on the socio-emotional-affective aspect of students, teachers, coordinators and the school community in order to contribute to public policies in the field of health and education, in networks teaching institutions. This was a descriptive exploratory cross-sectional study carried out in a public municipal and state education network, in a Brazilian capital, from 06/02/2020 to 07/02/2020. 172 directors participated in the survey, who answered an electronic form via Google Form, sent by email. The data were treated using simple descriptive statistics by the program IBM SPSS Statistics 20.0 for Windows 10. In the perception of the directors of the municipal and state education network, COVID-19 "influenced a lot" in the socio-emotional-affective aspects of students, teachers, coordinators and school community. It is therefore necessary to work in a network with contributions linked to new technologies and emotional health in education.