Outcome Predictors for Interhospital Obstetric Patients Transferred Directly to Intensive Care Units

INTRODUCTION: Medical complications among pregnant peripartum patients are not common. However, certain disease such as obstetric hemorrhage or respiratory failure could be associated with poor outcome among obstetric patients whose biological systems are already stretched. When a peripartum patients encounter a severe medical condition, they are frequently transferred to a tertiary center for management of these patients' complex conditions. Our study investigated the outcomes of the peripartum patients who were transferred from other hospitals (Interhospital transfer [IHT]) to the Intensive Care Unit at an academic quaternary center. METHOD(S): We retrospectively analyzed all adult IHT peripartum patients to our institution's ICU between Jan. 2017 to Dec. 2021. We presented descriptive analysis for our patients and used multivariable ordinal regressions for association between demographic, clinical factors, and patients' length of stay (LOS) in the ICU (ICULOS), hospital (HLOS). RESULT(S): Among 1794 IHT peripartum patients, 59 patients were transferred directly to an ICU, 8 (13.6%) to Medical ICU, 2 (3.4%) Neuro ICU, 2 (3.4%) Surgical ICU and 47 (79.7%) to our Critical Care Resuscitation Unit. Patients' mean (Standard Deviation) age was 32 (6) years, SOFA score 3 (3), APACHE II 8 (4), median Respiratory Oxygenation (ROx) index was 13 [Interquartile Range 4-22], and serum lactate 11 [9-15] mmol/L. Respiratory failure occurred in 19 (32%), postpartum hemorrhage 9 (15%), sepsis 8 (14%) patients. 16 (27%) patients were infected with COVID-19. 24 (41%) needed intubation, 13 (22%) vasopressor, 4 (7%) Extracorporeal Membrane Oxygenation. Median ICULOS and HLOS was 5 [2-12], 8 [5-17] days. Only 1 (1.7%) died, while 45 (76.3%) were discharged home directly. Having COVID-19 infection was associated with both ICULOS (Correlation Coefficient -2,23, OR 0.06, 95%CI 0.02-0.65, P = 0.016) and HLOS (Corr. Coeff. -2.75, OR 0.06, 95%CI 0.01-0.37, P = 0.002). CONCLUSION(S): Although severe medical conditions were uncommon among interhospital transferred peripartum patients, they could be severe, especially during the COVID-19 pandemic. Fortunately, the mortality rate for peripartum patients in our study was very low. Further studies with larger sample sizes are needed to confirm our observation.

Prolonged Unconsciousness in Severe Covid-19 Pneumonia with Venovenous Ecmo Support

INTRODUCTION: Neurological prognostication is an important part of caring for critically ill patients and can help guide goals of care. This has become a challenge when caring for patients with severe COVID-19 pneumonia, as they have been shown to often have prolonged periods of coma followed by meaningful neurological recovery. However, this has not been studied in patients who require venovenous extracorporeal membrane oxygenation (VV-ECMO) support. We hypothesize that patients with COVID-19 pneumonia on VV-ECMO will have a more prolonged period of unconsciousness when compared to their COVID-negative counterparts. METHOD(S): We conducted a retrospective chart review of all patients who received VV-ECMO support at our institution from March 2020 to January 2022. This timeframe was selected to limit the effect of any changes in sedation practices that were brought about by the COVID-19 pandemic. We compared the daily Glascow Coma Scale (GCS) of patients with COVID-19 pneumonia to those who were cannulated for other etiologies. Our outcomes were duration of unconsciousness, which was defined as time from intubation to GCS motor score=6 for 48 hours, as well as changes in GCS over time. RESULT(S): Our preliminary analysis included 84 patients, 57 (68%) of whom were COVID-19 positive. There were no significant differences in the baseline characteristics of the groups, including initial Sequential Organ Failure Assessment score and need for renal replacement therapy. Patients with COVID-19 pneumonia had a significantly longer duration on ECMO in hours (952 vs 312, p< 0.001) and hospital length of stay in days (42 vs 30, p=0.01). There was no significant difference in the duration of unconsciousness (days) between the two groups (11 vs 9, p=0.21). However, the trend in GCS over time was notable as we found that patients with COVID-19 spent more days unresponsive, defined as a GCS=3 (8 vs 5, p=0.04). CONCLUSION(S): Our preliminary analysis found that in patients on VV-ECMO, those with COVID-19 pneumonia spent a longer time on ECMO and in the hospital. While there was no difference in the duration of unconsciousness, patients with COVID-19 spent more of that period unresponsive prior to recovery. While additional analysis is needed, this finding may assist providers when prognosticating neurological recovery.

LY3041658/ interleukin-8 complex structure as targets for IL-8 small molecule inhibitors discovery using a combination of in silico methods.

Since interleukin-8 (IL-8/CXCL8) and its receptor, CXCR1 and CXCR2, were known in the early 1990s, biological pathways related to these proteins were proven to have high clinical value in cancer and inflammatory/autoimmune conditions treatment. Recently, IL-8 has been identified as biomarker for severe COVID-19 patients and COVID-19 prognosis. Boyles et al. (mAbs 12 (2020), pp. 1831880) have published a high-resolution X-ray crystal structure of the LY3041658 Fab in a complex human CXCL8. They described the ability to bind to IL-8 and the blocking of IL-8/its receptors interaction by the LY3041658 monoclonal antibody. Therefore, the study has been designed to identify potential small molecules inhibiting interleukin-8 by targeting LY3041658/IL-8 complex structure using an in silico approach. A structure­based pharmacophore and molecular docking models of the protein active site cavity were generated to identify possible candidates, followed by virtual screening with the ZINC database. ADME analysis of hit compounds was also conducted. Molecular dynamics simulations were then performed to survey the behaviour and stability of the ligand-protein complexes. Furthermore, the MM/PBSA technique has been utilized to evaluate the free binding energy. The final data confirmed that one newly obtained compound, ZINC21882765, may serve as the best potential inhibitor for IL-8.

A Pilot Trial of Thymalfasin (Thymosin-alpha-1) to Treat Hospitalized Patients With Hypoxemia and Lymphocytopenia Due to Coronavirus Disease 2019 Infection

Background. Thymosin-alpha-1 (T alpha 1) may be a treatment option for coronavirus disease 2019 (COVID-19), but efficacy and safety data remain limited. Methods. Prospective, open-label, randomized trial assessing preliminary efficacy and safety of thymalfasin (synthetic form of T alpha 1), compared with the standard of care, among hospitalized patients with hypoxemia and lymphocytopenia due to COVID-19. Results. A total of 49 patients were included in this analysis. Compared with control patients, the incidence of clinical recovery was higher for treated patients with either baseline low-flow oxygen (subdistribution hazard ratio, 1.48 [95% confidence interval, .68-3.25] ) or baseline high-flow oxygen (1.28 [.35-4.63]), although neither difference was significant. Among patients with baseline low-flow oxygen, treated patients, compared with control patients, had an average difference of 3.84 times more CD4(+) T cells on day 5 than on day 1 (P = .01). Nine serious adverse events among treated patients were deemed not related to T alpha 1. Conclusions. T alpha 1 increases CD4(+) T-cell count among patients with baseline low-flow oxygen support faster than the standard of care and may have a role in the management of hospitalized patients with hypoxemia and lymphocytopenia due to COVID-19.

Social isolation and loneliness among old people during Covid-19 pandemic

The sanitary crisis due to the Covid-19 pandemic limited the social network of elderly people, already at risk of social isolation and loneliness (SIL). Isolated and lonely people have a higher mortality risk and suffer from severe health repercussions. The management of SIL faces multiple difficulties, such as the lack of consensus on the definitions, as well as the absence of reliable screening tools and intervention strategies. SIL have a significant impact on individual health and the overall health system, they should be considered as a distinct geriatric syndrome. Taking care of this condition is necessary and should include the development of preventive strategies to limit its deleterious consequences.

Factors motivating students' intention to accept online learning in emerging countries: the case study of Vietnam

Purpose: This paper, employing the model integrated from Theory of Planned Behaviour (TPB) and Technology Acceptance (TAM), will examine factors affecting Vietnamese students' acceptance behaviour towards online learning. The research aims at finding out the motivating factors and measuring their influence on students' intention to accept digital transformation in learning. Based on the results, the authors propose some valuable suggestions to encourage acceptance of online learning behaviour, to enhance and apply digital transformation to higher education in Vietnam, especially in the Covid-19 pandemic, when most of the schools all over the world were forced to close. Design/methodology/approach: The research team used 913 responds' non-convenient probability sampling method, focusing on students currently studying at undergraduate education institutions across the country, studying different training majors, in different academic years. With the questionnaire designed through qualitative research, a preliminary quantitative study with 53 responses has been conducted. Based on the results, the authors completed the questionnaire then conducted a formal quantitative survey. Cronbach alpha, EFA, CFA and SEM have been used to explore the meanings of data collected. Findings: The results from analysing 913 undergraduates reveal that Attitude (influenced by Perceived Usefulness and Perceived Ease of Use), IT Ability and Self-study Ability impact the intention of accepting online learning at the beginning and digital transformation in the future. Meanwhile, Subjective Norm and Financial Ability do not have any role in fostering the intent of accepting new studying mode among Vietnamese students because of IR4.0 and the low expense for online learning. Research findings are the premise for the authors to provide suggestions for students, institutions on enhancing their digital transformation process through their changing behaviours in the relationship with other stakeholders surrounding the learning process of students. Research limitations/implications: The authors found that previous studies only focused on one or two factors according to the TAM or TPB model;or have not clarified all the stages in the process of changing learning methods behaviour. Therefore, this study combined both models to analyse in more detail the above process as well as exploit new influencing factors to complete the research scale. The main limitation of this study was that the sample has been taken in 2020 when the Covid-19 pandemic is forcing all students to online learning, even they are willing or not. Practical implications: The research is conducted in the context of Covid-19 outspread, the society has inevitably transitioned to digital transformation, especially with the education sector. Based on the results of analysing the changing process among students from accepting online learning to their intention to change the learning behaviour, the authors proposed some recommendations for universities that build the landscape for study;for lecturers – the most important factor in connecting the students to the working world with knowledge and skills;and especially for students, who need to have actively in receiving knowledge and self-study in the era of IR4.0. Originality/value: This study adds to the existing literature related to solutions to motivate intention to accept online learning in higher education institutions. With online learning gradually being adopted around the world, the study examined the factors driving the intention to study online in emerging countries. In particular, the study focuses specifically on the case of Vietnam. This result from this study can serve as a guide for higher education institutions as a premise to develop future research directions. It may be useful for studies at higher education institutions in emerging countries similar to Vietnam;in-depth research into research subjects at higher education institutions;or study countries with cultures, customs and habits equivalent to Vietnam, etc. Fi ally, we are certain that the material presented in this manuscript will not infringe any statutory copyright and that the manuscript will not be submitted elsewhere while being reviewed by the Journal of Applied Research in Higher Education assessment. © 2022, Emerald Publishing Limited.

The impact of green finance, economic growth and energy usage on CO2 emission in Vietnam – a multivariate time series analysis

Purpose: This study aims to examine the relationship between green finance, economic growth, renewable energy consumption (energy efficiency), energy import and CO2 emission in Vietnam using multivariate time series analysis. Design/methodology/approach: The data were collected from 1986 to 2018 since Vietnam initiated the economic reforms, namely “Doi Moi” in 1986. The concept and methods of cointegration, Granger causality and error correction model (ECM) were employed to establish the relationship between the variables of interest. Findings: Our results confirmed the existence of cointegration among the variables. The Granger causality test revealed unidirectional causality running from renewable energy consumption to CO2 emission and green investment to CO2 emission. Originality/value: This study results confirm the existence of cointegration among the variables. The results of the study imply that policies on economic development impose a significant impact on pollution in Vietnam. This study has described Vietnam, its economic development, green manufacturing practices, its environmental health and level of carbon dioxide emission which was enhanced due to COVID-19. © 2021, Emerald Publishing Limited.

Endoscopy service-back on track between covid-19 surges: A global evaluation

Aims An outbreak of coronavirus disease 19 (COVID-19) has altered the dynamic of endoscopic practices. Many guidelines, questionnaires have been published addressing service resumption during the pandemic. Curious about the situation indifferent endoscopic units across the globe, the study was designed to evaluate different aspects of practice resumptionworldwide and their adherence to guidelines. Methods An online questionnaire was created and distributed by national/regional representatives and societies. Redcapplatform was used as the interface;afterwards, Microsoft Excel 2016 and Prism 5 were utilized for data analysis. Results From a total of 307 responses from 47 countries/regions was collected, 290 valid answers were analyzed. Almosthalf (47 %) were in post-peak period by August, 2020. Many units were not designated to be COVID-oriented facility. About15.5 % of centers remained unrecovered, mainly in North and South America;those were recovered, training was still withheld significantly. Nevertheless, opened centers kept safety measurements strictly. Patient load was decreased by 37 %,but waiting list was increased 0-25 %. Among many surveillance methods, body temperature, PCR and chest CT were themost common. 74.8 % increased post-procedural disinfection time and 68.2 % increase in per-case inspection were noted.PPE usage was implemented highly and shortage of these posed as one of the resumption barriers. Post-procedural patientsurveillance was not reinforced. Conclusions The study represented real-time global endoscopic service's adaptation to COVID-19 pandemic. Previouslypublished barriers upon practice resumption remained. Despite Delphi consensus' emphasis on post-procedural surveillance, application was not widely reinforced, raising concerns in disease control.

Intubation rate of patients with hypoxia due to COVID-19 treated with awake proning: A meta-analysis

BACKGROUND: Awake prone positioning (PP), or proning, is used to avoid intubations in hypoxic patients with COVID-19, but because of the disease's novelty and constant evolution of treatment strategies, the efficacy of awake PP is unclear. We conducted a meta-analysis of the literature to assess the intubation rate among patients with COVID-19 requiring oxygen or noninvasive ventilatory support who underwent awake PP. METHODS: We searched PubMed, Embase, and Scopus databases through August 15, 2020 to identify relevant randomized control trials, observational studies, and case series. We performed random-effects meta-analyses for the primary outcome of intubation rate. We used moderator analysis and meta-regressions to assess sources of heterogeneity. We used the standard and modified Newcastle-Ottawa Scales (NOS) to assess studies' quality. RESULTS: Our search identified 1043 articles. We included 16 studies from the original search and 2 in-press as of October 2020 in our analysis. All were observational studies. Our analysis included 364 patients;mean age was 56.8 (SD 7.12) years, and 68% were men. The intubation rate was 28% (95% CI 20%-38%, I² = 63%). The mortality rate among patients who underwent awake PP was 14% (95% CI 7.4%-24.4%). Potential sources of heterogeneity were study design and setting (practice and geographic). CONCLUSIONS: Our study demonstrated an intubation rate of 28% among hypoxic patients with COVID-19 who underwent awake PP. Awake PP in COVID-19 is feasible and practical, and more rigorous research is needed to confirm this promising intervention.