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BackgroundIgA vasculitis (IgAV) is a rare autoimmune disease affecting small vessels. It is well established that the incidence is higher in children (3 to 26 per 100,000 children/year,) [1] than in adults (0.1 to 1.8 per 100,000 individuals/year) [1]. However others epidemiological data and impact of the COVID-19 on IgAV remain overlooked [2].ObjectivesTo collect and analyze epidemiological data on IgAV in both adults and children in France.MethodsWe conducted an observational study using a national database called "BNDMR” [3] (Banque Nationale de Données Maladies Rares) on IgA vasculitis (code ORPHA761), which gathered patients managed in the French rare disease expert network. The incidence was estimated from the date of diagnosis, and we calculated the median annual incidence over the period 2010-2022. We specifically assessed the north/south gradient (latitude of the residence higher/lower than the median of the latitudes), the seasonality, and the impact of the COVID-19 pandemic compared to other patients reported within the same period and addressed in the same expert centers used as controls.ResultsDuring this 12-year period, 1988 patients with IgAV were reported (1498 children;490 adults). The male to female ratio was 1.57 for adults and 1.05 for children. The median IgAV annual incidence was 15 cases/year [IQR 9-30] and 82 cases/year [IQR 72-86] for adult and children cases respectively. Time to diagnosis was less than 1 month for both. Compared with other patients reported in the same expert centers, IgAV was more frequently reported in the southern part of France than in the north (OR 4.88 [95% confidence intervals: 4.17 - 5.74] in adults and OR 1.51 [1.35 - 1.68] in children). IgAV was also more frequently observed in winter than during the rest of the year in both adults (OR 1.60 [1.39 - 1.82]) and children (OR 1.22 [1.01 - 1.48]). The incidence of IgAV decreased during the COVID-19 pandemic period (from March 2020 to September 2022) in children (OR 0.62 [0.47 - 0.81]) but not in the adult population (OR 0.90 [0.76 - 1.06]).ConclusionOur study confirms the winter seasonality and sex ratio in IgAV [4,5], but suggests that the incidence or the reporting of IgAV decreased in children during the COVID19 pandemia, possibly due to barrier measures [6]. The observed north/south gradient need confirmation. The main limitation of this study is a possible IgAV under-reporting as this study rely only on cases addressed in expert centers.References[1]Audemard-Verger A, Pillebout E, Guillevin L, Thervet E, Terrier B. IgA vasculitis (Henoch-Shönlein purpura) in adults: Diagnostic and therapeutic aspects. Autoimmun Rev. 2015;14(7):579-585. doi:10.1016/j.autrev.2015.02.003[2]Deshayes S, Moulis G, Pillebout E, Aouba A, Audemard-Verger A. Positive predictive value of hospital discharge diagnosis code to identify immunoglobulin A vasculitis in France: A validation study. Eur J Intern Med. 2017;43:e18-e19. doi:10.1016/j.ejim.2017.05.025[3]Jannot AS, Messiaen C, Khatim A, Pichon T, Sandrin A, BNDMR infrastructure team. The ongoing French BaMaRa-BNDMR cohort: implementation and deployment of a nationwide information system on rare disease. J Am Med Inform Assoc. 2022;29(3):553-558. doi:10.1093/jamia/ocab237[4]Piram M, Maldini C, Biscardi S, et al. Incidence of IgA vasculitis in children estimated by four-source capture-recapture analysis: a population-based study. Rheumatology (Oxford). 2017;56(8):1358-1366. doi:10.1093/rheumatology/kex158[5]Gardner-Medwin JMM, Dolezalova P, Cummins C, Southwood TR. Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet. 2002;360(9341):1197-1202. doi:10.1016/S0140-6736(02)11279-7[6]Kaya Akca U, Atalay E, Cuceoglu MK, et al. Impact of the COVID-19 pandemic on the frequency of the pediatric rheumatic diseases. Rheumatol Int. 2022;42(1):51-57. doi:10.1007/s00296-021-05027-7Figure.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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The successes of YOPP from the presentations and keynote presentations included * a better understanding of the impact of key polar measurements (radiosondes and space-based instruments such as microwave radiometers), and recent advancements in the current NWP observing system, achieved through coordinated OSEs in both polar regions (e.g., Sandu et al. 2021);* enhanced understanding of the linkages between Arctic and midlatitude weather (e.g., Day et al. 2019);* advancements in the atmosphere–ocean–sea ice and atmosphere–land–cryosphere coupling in NWP, and in assessing and recognizing the added value of coupling in Earth system models (e.g., Bauer et al. 2016);* deployment of tailored polar observation campaigns to address yet-unresolved polar processes (e.g., Renfrew et al. 2019);* progress in verification and forecasting techniques for sea ice, including a novel headline score (e.g., Goessling and Jung 2018);* advances in process understanding and process-based evaluation with the establishment of the YOPPsiteMIP framework and tools (Svensson 2020);* better understanding of emerging societal and stakeholder needs in the Arctic and Antarctic (e.g., Dawson et al. 2017);and * innovative transdisciplinary methodologies for coproducing salient information services for various user groups (Jeuring and Lamers 2021). The YOPP Final Summit identified a number of areas worthy of prioritized research in the area of environmental prediction and services for the polar regions: * coupled atmosphere, sea ice, and ocean models with an emphasis on advanced parameterizations and enhanced resolution at which critical phenomena start to be resolved (e.g., ocean eddies);* improved definition and representation of stable boundary layer processes, including mixed-phase clouds and aerosols;incorporation of wave–ice–ocean interactions;* radiance assimilation over sea ice, land ice, and ice sheets;understanding of linkages between polar regions and lower latitudes from a prediction perspective;* exploring the limits of predictability of the atmosphere–cryosphere–ocean system;* an examination of the observational representativeness over land, sea ice, and ocean;better representation of the hydrological cycle;and * transdisciplinary work with the social science community around the use of forecasting services and operational decision-making to name but a few. The presentations and discussions at the YOPP Final Summit identified the major legacy elements of YOPP: the YOPPsiteMIP approach to enable easy comparison of collocated multivariate model and observational outputs with the aim of enhancing process understanding, the development of an international and multi-institutional community across many disciplines investigating aspects of polar prediction and services, the YOPP Data Portal3 (https://yopp.met.no/), and the education and training delivered to early-career polar researchers. Next steps Logistical issues, the COVID-19 pandemic, but also new scientific questions (e.g., the value of targeted observations in the Southern Hemisphere), as well as technical issues emerging toward the end of the YOPP Consolidation Phase, resulted in the decision to continue the following three YOPP activities to the end of 2023: (i) YOPP Southern Hemisphere (YOPP-SH);(ii) Model Intercomparison and Improvement Project (MIIP);of which YOPPSiteMIP is a critical element;and (iii) the Societal, Economics and Research Applications (PPP-SERA) Task Team.
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Many viral diseases exhibit seasonal behavior and can be affected by environmental stressors. Using time-series correlation charts extrapolated from worldwide data, we provide strong support for the seasonal development of COVID-19 regardless of the immunity of the population, behavioral changes, and the periodic appearance of new variants with higher rates of infectivity and transmissibility. Statistically significant latitudinal gradients were also observed with indicators of global change. Using the Environmental Protection Index (EPI) and State of Global Air (SoGA) metrics, a bilateral analysis of environmental health and ecosystem vitality effects showed associations with COVID-19 transmission. Air quality, pollution emissions, and other indicators showed strong correlations with COVID-19 incidence and mortality. Remarkably, EPI category and performance indicators also correlated with latitude, suggesting cultural and psychological diversity in human populations not only impact wealth and happiness but also planetary health at latitudinal level. Looking forward, we conclude there will be a need to disentangle the seasonal and global change effects of COVID-19 noting that countries that go against the health of the planet affect health in general.
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Background: The conduct of clinical trials during COVID-19 created challenges to ensuring access to clinical trials, healthy clinical teams, and patients. Innovative methods such as remote patient follow-up and monitoring visits can lead to successful completion of device trials. Objective(s): The INGEVITY+ Active Fixation Pace/Sense Lead Study examined the safety/ efficacy of the INGEVITY+ Lead in a prospective, non-randomized, multicenter, post-approval study. Method(s): Subjects met indications for a pacing device with INGEVITY+ leads implanted in the RA and RV. The primary safety endpoint was the 3-month lead-related complication-free (LRC-free) rate. The primary efficacy endpoint evaluated the 3-month pacing capture threshold with the secondary efficacy endpoint evaluating the other lead-related electrical parameters. Implanter experience was assessed. Telephone visits with LATITUDE remote transmission of lead measurement data and remote monitoring visits were allowed. Result(s): A total of 201 leads were evaluated in 101 subjects, 46.8% female with a mean age of 73.2 years, at 13 centers in the United States. The study took 6.8 months, with a median follow-up of 3.4 months. The 3-month follow-up was completed by 98% of subjects, of which 36% were remote. A total of 98% of monitoring visits were done remotely. The study met all primary and secondary endpoints. The LRC-free rate through 3-months was 98.5% (lower CL 95.4%). Three leads were repositioned and reimplanted;two were RA dislodgements, and one was a RA perforation and hemothorax requiring thoracentesis. The pacing capture threshold was <= 2V in 98.9% of subjects with a mean of 0.77 V at 0.4-ms pulse width, mean pacing impedance of 712 ohms, and a median P-wave amplitude of 4.3 mV, and median R-wave amplitude of 15.9 mV at 3- months. No helix performance issues were reported. The mean turn count for helix extension was 6.7 and retraction was 7.6. More than 85% of physicians rated the lead as 'very good' or higher on all aspects of lead handling. Conclusion(s): The INGEVITY+ Lead was found to be safe and effective with a very favorable implant experience. This study was entirely conducted successfully during COVID-19 with remote follow-up and monitoring visits, and nearly half of the subjects were females.
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Background: Better delineation of COVID-19 presentations in different climatological conditions might assist with prompt diagnosis and isolation of patients. Objectives: To study the association of latitude and altitude with COVID-19 symptomatology. Methods: This observational cohort study included 12267 adult COVID-19 patients hospitalized between 03/2020 and 01/2021 at 181 hospitals in 24 countries within the SCCM Discovery VIRUS: COVID-19 Registry. The outcome was symptoms at admission, categorized as respiratory, gastrointestinal, neurological, mucocutaneous, cardiovascular, and constitutional. Other symptoms were grouped as atypical. Multivariable regression modeling was performed, adjusting for baseline characteristics. Models were fitted using generalized estimating equations to account for the clustering. Results: The median age was 62 years, with 57% males. The median age and percentage of patients with comorbidities increased with higher latitude. Conversely, patients with comorbidities decreased with elevated altitudes. The most common symptoms were respiratory (80%), followed by constitutional (75%). Presentation with respiratory symptoms was not associated with the location. After adjustment, at lower latitudes (<30º), patients presented less commonly with gastrointestinal symptoms (p<.001, odds ratios for 15º, 25º, and 30º: 0.32, 0.81, and 0.98, respectively). Atypical symptoms were present in 21% of the patients and showed an association with altitude (p=.026, odds ratios for 75, 125, 400, and 600 meters above sea level: 0.44, 0.60, 0.84, and 0.77, respectively). Conclusions: We observed geographic variability in symptoms of COVID-19 patients. Respiratory symptoms were most common but were not associated with the location. Gastrointestinal symptoms were less frequent in lower latitudes. Atypical symptoms were associated with higher altitude.
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BACKGROUND: The coronavirus disease 2019 (COVID-19) course may be affected by environmental factors. Ecological studies previously suggested a link between climatological factors and COVID-19 fatality rates. However, individual-level impact of these factors has not been thoroughly evaluated yet. AIM: To study the association of climatological factors related to patient location with unfavorable outcomes in patients. METHODS: In this observational analysis of the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: COVID-19 Registry cohort, the latitudes and altitudes of hospitals were examined as a covariate for mortality within 28 d of admission and the length of hospital stay. Adjusting for baseline parameters and admission date, multivariable regression modeling was utilized. Generalized estimating equations were used to fit the models. RESULTS: Twenty-two thousand one hundred eight patients from over 20 countries were evaluated. The median age was 62 (interquartile range: 49-74) years, and 54% of the included patients were males. The median age increased with increasing latitude as well as the frequency of comorbidities. Contrarily, the percentage of comorbidities was lower in elevated altitudes. Mortality within 28 d of hospital admission was found to be 25%. The median hospital-free days among all included patients was 20 d. Despite the significant linear relationship between mortality and hospital-free days (adjusted odds ratio (aOR) = 1.39 (1.04, 1.86), P = 0.025 for mortality within 28 d of admission; aOR = -1.47 (-2.60, -0.33), P = 0.011 for hospital-free days), suggesting that adverse patient outcomes were more common in locations further away from the Equator; the results were no longer significant when adjusted for baseline differences (aOR = 1.32 (1.00, 1.74), P = 0.051 for 28-day mortality; aOR = -1.07 (-2.13, -0.01), P = 0.050 for hospital-free days). When we looked at the altitude's effect, we discovered that it demonstrated a non-linear association with mortality within 28 d of hospital admission (aOR = 0.96 (0.62, 1.47), 1.04 (0.92, 1.19), 0.49 (0.22, 0.90), and 0.51 (0.27, 0.98), for the altitude points of 75 MASL, 125 MASL, 400 MASL, and 600 MASL, in comparison to the reference altitude of 148 m.a.s.l, respectively. P = 0.001). We detected an association between latitude and 28-day mortality as well as hospital-free days in this worldwide study. When the baseline features were taken into account, however, this did not stay significant. CONCLUSION: Our findings suggest that differences observed in previous epidemiological studies may be due to ecological fallacy rather than implying a causal relationship at the patient level.
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Humpback whales (Megaptera novaeangliae) are cosmopolitan and highly migratory animals. They are found in all ocean basins and annually migrate between low-latitude waters, where they breed and calve during the winter and spring, and high-latitude waters, where they feed during the summer and autumn. Commercial whaling resulted in a considerable reduction in all humpback whale populations. In the Southern Hemisphere alone, more than 200,000 whales were caught. Most populations, including the Western South Atlantic Ocean Breeding Stock "A" (BSA), have shown signs of recovery after the International Whaling Commission (IWC) enacted a moratorium in the late 1960s.
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The importance of two related factors _ latitude and solar ultraviolet radiation _ has been insufficiently recognized as determining the spread of pandemic Sars-CoV-2 outbreaks across the globe. In this study we provide evidence of the impact of latitude and investigate how daily RT-PCR diagnosed infections and deaths are quantitively correlated with the UV component of solar light. Here, we present regression analyses using daily national numbers from Austria and from Portugal with daily ultraviolet indexes of two selected locations in these territories, obtained from a satellite source. These countries, have similar surfaces areas and population size but Austria's mean latitude is 9° up-north. The equations derived from regression analyses of those two variables are comparable for both countries, fit best the fall (2nd) pandemic wave and can be a useful non-R(t) (ratio of transmission at a particular time) dependent predictive tool. Similar equations were derived for deaths that follow infections within a few weeks delay. Strong correlations depend on the size of the region/country from which infections are collected, the robustness of screening practices, ideally kept through weekends and holidays. Besides the forecasting usefulness of such correlations, these findings also suggest that covid-19 transmission co-exists with a Sars-Cov-2 specific UV-induced immunosuppression response. While in 2020, intensity of pandemic spring and fall waves reflect a solar UV-light modulation, we relate exceptional low temperature and humidity with additional waves, as the winter 2020/2021 3rd wave, felt in the western European countries. This work may help understanding this Pandemic phenomenon and dealing with similar catastrophes in the future.
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Keywords: mHealth;Applications;Arthroplasty Purpose: Length of hospital-stay following total knee arthroplasty (TKA) is approximately 1-3 days, with associated costs of revisions around £75,000 per patient. Patient control of recovery, self-management and compliance to home-based rehabilitation is therefore of utmost importance. The use of mHealth applications (apps), to promote independence and self-management, provides potential for a cost-effective, patient-centred strategy to achieve this. The objective of this study was to scope and review the quality of publicly available, patient-focused apps for TKA, with the aim of identifying and recommending one for trial and clinical implementation within a Hampshire hospital. Methods: A scoping review was chosen to systematically map, synthesise and review the latitude of apps available via the Apple Store and Google Play. Apps were identified if they were free of charge to the user, suitable for use within the UK and in English;due to the ubiquitous nature of app usage, apps were selected if they targeted both total knee or hip arthroplasty. Quality analysis of each app was conducted using the Mobile App Rating Scale (MARS);a simple 4-dimension, objective, and reliable tool for classifying and assessing quality of mhealth apps. Results: Nine apps, from 692 screened, met the inclusion criteria and were reviewed using MARS. The mean overall MARS score (where 1 = inadequate and 5 = excellent) was 3.57 (SD = ±0.87). Four apps had a score above 4, three of which were identified as utilising an app platform already in use by NHS Trusts. Five apps had a score of less than 3. The highest rated app was the Northumbria Orthopaedic NHS Trust App (4.57) which utilised the app platform ‘My Patient Journey’. This app was noted to consider features that ensured the app was engaging and also likely to promote positive rehabilitative behaviours. Conclusion(s): This study provides an overview of mHealth apps available to health-care professionals and patients post-TKA. Further investigation into the use of this platform is required, to personalise and adjust it for specific Trust use. Randomised trials are now required in order to characterise the use and efficacy of this app on health knowledge, behaviours and use. Moreover, to understand their effectiveness in rehabilitation and improve quality of life following TKA, hereby reducing its burden on public health and clinical systems. Impact: The NHS finds itself in the midst of an mHealth revolution and mobile technology offers the opportunity to access clinical apps, evidence-based resources and advanced mobile communication in one device. The mobility of such apps enables patients to use them in their home setting, reducing the need for face-to-face contact and, in light of the COVID-19 pandemic, has shown itself to be a technology that presents a future healthcare option. This study provides an overview of the mHealth apps available to a range of health-care professionals across all disciplines and patients post-TKA surgery;summarising their strengths and limitations to make recommendations for future implementation. The introduction of such management will take time, funding, a shift in clinician approach and patient expectation-management, in addition to further research to optimise delivery. Funding acknowledgements: This study is a final year physiotherapy dissertation, courtesy of University of Winchester. No funding was received from internal/external sources.
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Vitamin D [25 (OH)D] plays a role in many of biological processes, such as bone metabolism, immunomodulation, cell proliferation, differentiation, and regulation. Also, it has anti-inflammatory, antifibrotic, and antioxidant effects. Due to the immunomodulatory effects of 25 (OH)D, its deficiency is blamed for a higher risk for COVID-19 infection. Serum concentrations of 25 (OH)D were inversely associated with proinflammatory cytokines such as increased IL-6, CRP levels, and increased risk of pneumonia or ARDS. Lower 25 (OH)D concentrations are associated with a higher risk for infections, especially from the respiratory tract [1]. Chronic vitamin D deficiency can induce the renin-angiotensin system activation and leads to fibrotic changes that can cause lung injury by inducing proinflammatory cytokine production in human monocytes/macrophages (2). Increased frequency of COVID-19 infection at high latitudes and worse prognosis of these cases made clinicians to think that 25 (OH)D levels may affect the risk and prognosis of COVID-19 infection [3]. In previous reports, in the early pandemic, a higher prevalence of vitamin D deficiency has been reported to be related to high rates of COVID-19 infection, higher risk of invasive mechanical ventilation (IMV), and mortality [6]. Whilst, it is reported that 25 (OH)D may not protect against COVID-19 infection in recent studies. Moreover, it was not associated with disease severity or lethality [4-6]. The active form of vitamin D binds to its receptor (VDR) and modulates its responses. VDR is located on chromosome 12q13, consisting of 9 exons. Vitamin D-VDR signaling regulates the expression of a wide range of physiological functions. Herein, VDR polymorphisms cause a dysfunctional receptor that affects VDR activity. Both innate and adaptive immune responses can vary according to different polymorphisms of VDR. Also VDR polymorphisms have been previously found to be associated with bacterial infections such as tuberculosis [7] and severe Respiratory Syncytial Virus (RSV) bronchiolitis in respect to vitamin D deficiency [8]. Moreover, it was demonstrated that different VDR polymorphisms such as FokI, BsmI, ApaI, and TaqI could change the course of RSV infection in several studies, respectively [8-10]. This study aimed to evaluate if there is any association between the VDR gene polymorphism at FokI, TaqI, BsmI, and ApaI alleles and the prognosis of COVID-19 in respect to vitamin D deficiency. Two-hundred ninety-seven (n=297) patients with reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 who were admitted to Marmara University Education and Research Hospital between April and October 2020 were enrolled. The severity of COVID-19 patients was classified into 1-10 according to WHO criteria. The patients' requirement for noninvasive mechanical ventilation (NIMV) or reservoir mask, their requirement for admission to intensive care unit (ICU), mortality, and WHO clinical progression scales were reviewed. Four variant regions of vitamin D receptor (VDR);FokI, BsmI, ApaI, and TaqI were determined using the Restriction Fragment Length Polymorphism (RFLP) technique. To conclude;The effect of VDR polymorphisms on the receptor function causes intensive care unit treatment, disease severity and mortality differences among patients with covid-19 infection in the clinical set-up. VDR Ff genotype was related with disease severity, TT with disease severity and aa with mortality respectively. As a result we have detected that 25 (OH)D levels were not related to COVID-19 infection severity and mortality. Additionally, it indicated that VDR polymorphisms are independently associated with the severity of COVID-19 and the survival of patients. More extensive studies are needed to determine the impact of polymorphisms on COVID-19 and explain the underlying cause.
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Coronavirus disease (COVID-19) remains a serious issue, and the role played by meteorological indicators in the process of virus spread has been a topic of academic discussion. Previous studies reached different conclusions due to inconsistent methods, disparate meteorological indicators, and specific time periods or regions. This manuscript is based on seven daily meteorological indicators in the NCEP reanalysis data set and COVID-19 data repository of Johns Hopkins University from 22 January 2020 to 1 June 2021. Results showed that worldwide average temperature and precipitable water (PW) had the strongest correlation (ρ > 0.9, p < 0.001) with the confirmed COVID-19 cases per day from 22 January to 31 August 2020. From 22 January to 31 August 2020, positive correlations were observed between the temperature/PW and confirmed COVID-19 cases/deaths in the northern hemisphere, whereas negative correlations were recorded in the southern hemisphere. From 1 September to 31 December 2020, the opposite results were observed. Correlations were weak throughout the near full year, and weak negative correlations were detected worldwide (|ρ| < 0.4, p ≤ 0.05); the lag time had no obvious effect. As the latitude increased, the temperature and PW of the maximum confirmed COVID-19 cases/deaths per day generally showed a decreasing trend; the 2020-year fitting functions of the response latitude pattern were verified by the 2021 data. Meteorological indicators, although not a decisive factor, may influence the virus spread by affecting the virus survival rates and enthusiasm of human activities. The temperature or PW threshold suitable for the spread of COVID-19 may increase as the latitude decreases.
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The Latitude Hypothesis may explain seasonal variation in occurrence of flu and influenza-like illness, including SARS-CoV-2. We focus on one variable, vitamin D adequacy in the general population, and consider statistics of two sub-populations to propose a possible treatment to improve outcomes.Communicated by Ramaswamy H. Sarma.
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COVID-19 , Vitamin D , Humans , SARS-CoV-2ABSTRACT
B Introduction: b The severity of COVID-19 may be affected by environmental factors. While considering the altitude level, we found that it had a non-linear relationship with 28-day mortality (p=0.001, odds ratios for altitudes 75, 125, 400, and 600 m.a.s.l were: 0.96, 1.04, 0.49, and 0.51, respectively). [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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B Introduction: b Better delineation of COVID-19 presentations in different climatological conditions might assist with prompt diagnosis and isolation of patients. When adjusted for baseline differences, at lower latitudes (< 30°) patients presented less commonly with gastrointestinal symptoms (p< 0.001, odds ratios for latitudes 15°, 25°, and 30°: 0.32, 0.81, and 0.98, respectively). [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Background: Due to the current CoViD-19 pandemic, the number of outpatient hospital visits has significantly decreased, creating a fundamental need for telemedicine. Remote monitoring of implantable cardiac devices has emerged as a powerful and well-validated tool to follow patients with heart failure (HF) and cardiac resynchronization therapy (CRTs) devices. Purpose: The aim of our study was to evaluate the CRT HeartLogic algorithm performance in the detection of HF episodes in a real-life population followed with remote monitoring. Methods: Fifty-four patient (mean age 73±7 years, 72% males) with HF and reduced left ventricular ejection fraction were implanted with a Heart- Logic-enabled CRT device and were enrolled in the Boston Scientific Latitude remote monitoring platform. Remote data were reviewed every month and at the time of an alert. The HeartLogic nominal value of 16 was used to trigger an alert episode. Patients were then contacted by phone and actions were taken to manage the potential HF condition detected by the alert. Results: During a median follow-up of 12 (6-18) months, the HeartLogic alert was triggered in 9 patients (9/54, 17%). The median time between threshold crossing and a HF clinical event was 11 (2-19) days. The maximum HeartLogic index value was 43 (mean 29±8). Three events occurred after inappropriate discontinuation of HF therapy. All the events required clinical action. Four out of 9 patients required diuretic dosage increase, 1/9 electrical cardioversion for new onset atrial fibrillation, 3/9 hospitalization for i.v. therapy. One patient showed only mild HF symptoms but was found to have concomitant CoViD-19 infection. Conclusion: The HeartLogic algorithm is useful to detect HF worsening and undertake appropriate clinical actions. Telemedicine and device remote monitoring are very helpful tools allowing early detection of HFrelated clinical conditions. This is of utmost importance in the era of CoViD- 19 pandemic, when scheduled access to the hospital for routine follow-up appointments might be limited.
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The impact of COVID-19 varies markedly, not only between individual patients but also between different populations. We hypothesised that differences in human leukocyte antigen (HLA) genes might influence this variation. Using next generation sequencing, we analysed the class I and class II classical HLA genes of 147 individuals of European descent experiencing variable clinical outcomes following COVID-19 infection. Forty-nine of these patients were admitted to hospital with severe respiratory disease. They had no significant pre-existing comorbidities. We compared the results to those obtained from a group of 69 asymptomatic hospital workers who evidence of COVID exposure based on blood antibody testing. Allele frequencies in both the severe and asymptomatic groups were compared to local and national healthy controls with adjustments made for age and sex. With the inclusion of hospital staff who had reported localised symptoms only (limited to loss of smell/taste, n = 13) or systemic symptoms not requiring hospital treatment (n = 16), we carried out ordinal logistic regression modelling to determine the relative influence of age, BMI, sex and the presence of specific HLA genes on symptomatology. We found a significant difference in the allele frequency of HLA-DRB1*04:01 in the severe patient compared to the asymptomatic staff group (5.1% vs. 16.7%, P = .003 after adjustment for age and sex). There was a significantly lower frequency of the haplotype DQA1*01:01-DQB1*05:01-DRB1*01:01 in the asymptomatic group compared to the background population (P = .007). Ordinal logistic regression modelling confirmed the significant influence of DRB1*04:01 on the clinical severity of COVID-19 observed in the cohorts. These alleles are found in greater frequencies in the North Western European population. This regional study provides evidence that HLA genotype influences clinical outcome in COVID-19 infection. Validation studies must take account of the complex genetic architecture of the immune system across different geographies and ethnicities.
Subject(s)
COVID-19 , Alleles , Gene Frequency , Genotype , HLA-DQ Antigens/genetics , HLA-DQ alpha-Chains , HLA-DQ beta-Chains/genetics , HLA-DRB1 Chains/genetics , Haplotypes , Humans , SARS-CoV-2ABSTRACT
Despite being announced as a global health concern and emergency in January by WHO, designing specific treatment for SARS-CoV-2 is still a summit yet to be conquered. Currently, many drugs are being tested in the clinical scenario and vitamins play a significant role in therapeutic management. Based on the available evidence, we postulate that maintaining normal vitamin D3 levels may reduce severity, mortality risk of COVID-19. This review elucidates the alarming need for randomized clinical trials to determine the role of vitamin D in patient prognosis in COVID-19 infection and on latitude bases epidemiological outcome.
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BACKGROUND: A significant number of infectious diseases display seasonal patterns in their incidence, including human coronaviruses. Betacoronaviruses such as MERS-CoV and SARS-CoV are not thought to be seasonal. METHODS: We examined climate data from cities with significant community spread of COVID-19 using ERA-5 reanalysis, and compared to areas that are either not affected, or do not have significant community spread. FINDINGS: To date, Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, has established significant community spread in cities and regions along a narrow east west distribution roughly along the 30-50o N' corridor at consistently similar weather patterns consisting of average temperatures of 5-11oC, combined with low specific (3-6 g/kg) and absolute humidity (4-7 g/m3). There has been a lack of significant community establishment in expected locations that are based only on population proximity and extensive population interaction through travel. INTERPRETATION: The distribution of significant community outbreaks along restricted latitude, temperature, and humidity are consistent with the behavior of a seasonal respiratory virus. Additionally, we have proposed a simplified model that shows a zone at increased risk for COVID-19 spread. Using weather modeling, it may be possible to predict the regions most likely to be at higher risk of significant community spread of COVID-19 in the upcoming weeks, allowing for concentration of public health efforts on surveillance and containment.