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The COVID-19 lockdown contributes to the improvement of air quality. Most previous studies have attributed this to the reduction of human activity while ignoring the meteorological changes, this may lead to an overestimation or underestimation of the impact of COVID-19 lockdown measures on air pollution levels. To investigate this issue, we propose an XGBoost-based model to predict the concentrations of PM2.5 and PM10 during the COVID-19 lockdown period in 2022, Shanghai, and thus explore the limits of anthropogenic emission on air pollution levels by comprehensively employing the meteorological factors and the concentrations of other air pollutants. Results demonstrate that actual observations of PM2.5 and PM10 during the COVID-19 lockdown period were reduced by 60.81% and 43.12% compared with the predicted values (regarded as the period without the lockdown measures). In addition, by comparing with the time series prediction results without considering meteorological factors, the actual observations of PM2.5 and PM10 during the lockdown period were reduced by 50.20% and 19.06%, respectively, against the predicted values during the non-lockdown period. The analysis results indicate that ignoring meteorological factors will underestimate the positive impact of COVID-19 lockdown measures on air quality. © 2023 by the authors.
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Airborne SARS-CoV-2 virus surveillance faces challenges in complicated biomarker enrichment, interferences from various non-specific matters and extremely low viral load in the urban ambient air, leading to difficulties in detecting SARS-CoV-2 bioaerosols. This work reports a highly specific bioanalysis platform, with an exceptionally low limit-of-detection (≤1 copy m-3 ) and good analytical accordance with RT-qPCR, relying on surface-mediated electrochemical signaling and enzyme-assisted signal amplification, enabling gene and signal amplification for accurate identification and quantitation of low doses human coronavirus 229E (HCoV-229E) and SARS-CoV-2 viruses in urban ambient air. This work provides a laboratory test using cultivated coronavirus to simulate the airborne spread of SARS-CoV-2, and validate that the platform could reliably detect airborne coronavirus and reveal the transmission characteristics. This bioassay conducts the quantitation of real-world HCoV-229E and SARS-CoV-2 in airborne particulate matters collected from road-side and residential areas in Bern and Zurich (Switzerland) and Wuhan (China), with resultant concentrations verified by RT-qPCR.
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Background: Many EP procedures are moving from the hospital to the ambulatory surgery center (ASC) outpatient setting. The COVID-19 pandemic and the CMS Hospitals Without Walls (HWW) program has been an impetus in accelerating this transition. Anesthesia provider perioperative management is critical in facilitating safe procedures with rapid, same-day discharge. Our EP-dedicated 2-OR ASC completed more than 3,000 procedures and more than 500 left-sided ablations utilizing general anesthesia with endotracheal intubation with same-day discharge. To our knowledge, this experience is unique within an ASC setting in both volume and complexity. Objective(s): We present our comprehensive anesthesia strategy and lessons learned to facilitate safe, efficient procedures and discharge in an EP ASC. Method(s): A nurse anesthesiologist with more than a decade of EP-dedicated experience developed and taught a perioperative anesthesia strategy to facilitate high volume, safe and quick discharge care. Fundamental to this is the avoidance of opioids and benzodiazepines whenever possible. Propofol or general anesthesia with sevoflurane and complete reversal with sugammadex allow for quick recovery. Mandatory video laryngoscope utilization minimizes airway trauma, while liberal antiemetic use eliminates most nausea. All femoral access is device closed. Positive inotropes are used liberally during anesthetic to avoid heart failure. The goal is to deliver all patients to PACU on room air with stable hemodynamics. Anesthesia providers manage the preop and recovery area. Result(s): More than 90% of all patients undergoing general anesthesia and heparinization for left-atrial ablation were discharged home in under 3 hours. Nearly all procedures not requiring femoral access were discharged within 30-60 minutes. High procedure volumes with efficiencies far exceeding our in-hospital experience were thus facilitated with improved patient safety. Since HWW began, five patients have required transfer to the hospital without any deaths. All others were discharged same day. Conclusion(s): We suggest that a dedicated anesthesia team with a tailored perioperative anesthesia plan facilitates performing nearly all EP-related surgical procedures in an ASC. This success is facilitated by appropriate patient selection, preoperative evaluation, intraoperative care prioritizing quick return to baseline, and end-to-end anesthesia perioperative management. We believe this type of anesthesia management is critical to the transition of EP procedures to ASCs.Copyright © 2023
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[Background] The coronavirus disease 2019 (COVID-19) was first detected in December 2019. To combat the disease, a series of strict measures were adopted across the country, which led of improved air quality. This provides an opportunity to discuss the impact of human activities on air quality. [Objective] This study investigates the air quality changes in Shijiazhuang, and analyzes the impacts of epidemic prevention and control measures on air quality, so as to provide reference and ideas for further improving air quality and prevention and control measures. [Methods] The air quality data were collected online from https://www.zq12369.com/ and https://aqicn.org/city/shijiazhuang/cn/. Comparisons in air quality index (AQI) and the concentrations of air pollutants (PM2.5, PM10, SO2, CO, NO2, and O3) were made between the period from December 2019 to June 2020 (reference) and the same period from 2016 to 2019 by t-test and chi-square test. [Results] The daily average AQI dropped by 25.38% in Shijiazhuang during the COVID-19 prevention and control compared with the some period from 2016 to 2019 (t=6.28, P < 0.05). The proportions of pollution days during the COVID-19 outbreak in Shijiazhuang were PM2.5 (44.56%), O3 (31.09%), PM10 (23.83%), and NO2 (2.59%) successively, the pollution days of PM10 decreased significantly (chi2=3.86, P < 0.05) compared with 2016-2019, but during traffic lockdown the numbers of pollution days of PM2.5 and in the mid stage of prevention the number of pollution days of O3 increased (P < 0.05). Compared with the control period, the concentrations of the six air pollutants decreased to varying degrees (P < 0.05), especially SO2 dropped by 55.36%. [Conclusion] The measures taken for COVID-19 control and prevention have reduced the pollution sources and emissions, which resulted in better general air quality of Shijiazhuang City, but have aggravated the pollution of O3 and other pollutants. It is necessary to further explore the causes for the aggravation of O3 pollution in order to formulate reasonable air quality control strategies.Copyright © 2021, Shanghai Municipal Center for Disease Control and Prevention. All rights reserved.
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Introduction: Orogastric tube insertion is a routine procedure in medical care. However, misplacement of the tube can cause a variety of complications, which can be life threatening in some instances. Case Description/Methods: 71-year-old male presented with dyspnea, fever, chills, cough, and myalgia for 2 weeks. He had tachycardia, tachypnea, and was hypoxic to 66% in room air. He was found to have acute hypoxic respiratory failure secondary to COVID-19 Pneumonia and was admitted to ICU. But, he continued to be hypoxic and was started on BiPAP. He eventually became altered, and was intubated. Post intubation orogastric tube (OGT) placement was unsuccessful on the first attempt due to resistance. On the second attempt, the nurse was able to advance partially (Figure). But, a chest XR showed OGT in the mediastinum, and OGT was removed. CT of neck and chest revealed pneumomediastinum with possible mid-thoracic esophageal perforation. The patient was started on broad-spectrum antibiotics and thoracic surgery was consulted. Given his mechanical ventilation requirement, surgery deemed him unfit to tolerate thoracotomy and the endoscopic procedure was not available in the hospital. So, recommendation was to manage conservatively. His hospital course was complicated by hypotension requiring vasopressors and metabolic acidosis in setting of acute renal failure requiring CRRT. Code status was changed by the family to Do Not Resuscitate due to his deteriorating condition. Eventually, he had a PEA arrest and was expired. Discussion(s): OGT intubation is performed at hospitals for feeding, medication administration or gastric decompression. Although it is considered a safe procedure, complications can arise due to OGT misplacement or trauma caused by the OGT itself or the intubation process. OGT misplacement is typically endotracheal or intracranial. Misplacement within the upper GI lumen is usually detected by a kink in the oropharynx or esophagus. The subsequent complications are identified by the structure that is perforated (e.g., mediastinitis or pneumothorax). Regardless of whether counteraction is perceived, the physician must be careful not to apply excessive force. The location of the OGT tip should be determined by a chest radiograph;visualization of the tip below the diaphragm verifies appropriate placement. Complications of OGT insertion are uncommon;however, the consequences are potentially serious, and the anatomy of the upper GI tract should be understood by all who are involved in the care.
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Introduction/Aim: We conducted an open label, randomized, controlled trial to assess whether fluvoxamine combined with bromhexine, given during mild to moderate SARS-CoV-2 illness, prevented clinical deterioration due to their proposed immune modulatory effects. Method(s): Participants had confirmed SARS-CoV-2 infection, experiencing mild to moderate symptoms and oxygen saturation of >=92%. Participants were randomly assigned to receive fluvoxamine (100 mg days 1 and 2, followed by 150 mg daily till day 14) with bromhexine (FLU/BRO) (16 mg daily till day 10) or favipiravir alone (FAV) (3600 mg day 1 followed by 1600 mg daily till day 5). Primary outcome was clinical deterioration within 30 days of randomization defined as shortness of breath or hospitalization for shortness of breath or pneumonia and oxygen saturation >=92%, on room air or need for supplemental oxygen to achieve oxygen saturation of >=92%. Result(s): 158 participants were randomized (average age 50 years (range 18-68 years);68 [43%] women), and 142 (89%) completed the trial. 0/78 participants experience clinical deterioration with FLU/BRO and 18/64 patients with FAV. TNF-alpha, IL-6 IL-8 and IL-1beta levels were significantly (p < 0.005) reduced with FLU/BRO compared to FAV at day 3, 5, 7 and 14. 0/78 participants had long COVID symptoms with FLU/BRO compared to 32/64 (50%) with FAV (p < 0.005). One serious (clumsiness or unsteadiness) and 10 other adverse events were reported with FLU/BRO compared to 5 serious and 12 other adverse events with FAV. Conclusion(s): Results suggest there was significantly less clinical deterioration in symptomatic COVID-19 participants treated with FLU/BRO.
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Administration of aerolized drugs to patients diagnosed with COVID-19 leads to the risk of transmission of patient-generated infectious aerosols to healthcare providers.While the COVID-19 pandemic is ongoing, in order to provide the best treatment for patients and at the same time to protect healthcare providers at the highest level, it is necessary to increase access to information and pay maximum attention to preventive measures.Copyright © 2020 Bilimsel Tip Yayinevi. All rights reserved.
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Background: Mortality in PWH has been markedly improved by antiretroviral therapy (ART) but there are few reports describing this in the ~5 million virally suppressed (VS) PWH in South Africa(SA). We describe cause of death(CoD) in adults admitted to hospital with suspected pneumonia in SA. Method(s): We enrolled patients from June 2019-October 2021 at four hospitals and then followed them up for >=1 year. Eligibility included: Age >18 years, >=2 signs/symptoms of pneumonia, < 48 hrs since admission. Medical records were reviewed. All had HIV status ascertained and sputum sent for Xpert Ultra and mycobacterial culture. In PWH CD4 count, viral load (VL) and urine lipoarabinomannan were assessed. For those who died, CoD were ed from medical charts and interview of family. We categorised deaths as early: while admitted or to < 30 days after discharge;or late: >=30 days after discharge. We report mortality and CoD in VSPWH (VL<=50 copies/ml), unsuppressed and HIV uninfected(HUI) adults. Result(s): Of 1999 adults, 54% were PWH;61.2% reported receiving ART of whom 43.1% were VS;55.5% were women. Overall median age of VS was 48 years (IQR: 40-55) at entry;34.3% had comorbidities: hypertension (70.1%, obesity 41.3%, diabetes 28.9%) . Only 11.3% were diagnosed with HIV in the past year, 35.0%, had prior TB. Median CD4 count of VS patients was 289 cells/ mm3 (IQR:133-490) and Hb, 12.5g/dL (IQR:10.5-14.0);53.0% had CRP >100mg/ dL and 69.6% had oxygen saturation < 93% on room air;14.8% had >=1 assay positive for TB;and 42.9% were SARS-CoV-2 positive. Overall 25.4% VSPWH died compared to 31.2% and 22.9% of unsuppressed and HUI, respectively;median ages at death were 49 (IQR:43-59), 38 (IQR: 32-47) and 62 (IQR: 53-69) years respectively. Overall median times to early and late death was 8 (IQR: 4-16) and 104 (IQR: 75-254) days, respectively. The leading CoD in VSPWH were: COVID-19 (22.9%), chronic lung disease(CLD) (17.1%),malignancy (12.9%),sepsis, (12.9%) and TB (8.7%);in HIV unsuppressed, CoD were: advanced HIV and opportunistic infections-(TB,PJP)(55.5%), sepsis(9.6%), COVID-19(8.6%);and in HUI: COVID- 19(43.0%), cardiovascular disease (9.0%), TB(9.0%), malignancy (8.5%). Conclusion(s): Mortality in VSPWH admitted with suspected pneumonia was higher than in HUI and occurred 12 years earlier. The challenge for clinicians is to screen for diseases that disproportionately affect VSPWH and to try to prevent recurrent lung infections thereby increasing their comorbidity-free years and reduce mortality gaps.
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Background: Antibodies (Ab) against the receptor-binding-domain of the spike protein (anti-S-RBD) elicited by SARS-CoV-2 infection or vaccination are deemed to be a correlate of protection. We aimed at assessing whether anti-S-RBD titer is associated with the outcome of subjects hospitalized with COVID-related pneumonia. Method(s): Adults hospitalized between Jul 2021 and Jul 2022 for COVID-19 with respiratory failure (SpO2 < 93% on room air) or radiological evidence of pneumonia were included if anti-S-RBD titer was measured within 72h of admission. Time between admission and death/need for intubation was described using Kaplan-Meier curves. Cox Regression analysis, stratified by vaccination status, was used to explore the association between anti-S-RBD titer and survival. Age, gender, days since symptom onset, immunosuppressive conditions and use of monoclonal Ab (mAb) were explored as possible confounders. Result(s): 534 patients were enrolled. Their mean age was 71 years, 63% were male and 61% vaccinated;42% had >=1 immunosuppressive condition among hematological or solid malignancy, HIV, diabetes, end-stage renal failure, liver cirrhosis, organ transplant or immunosuppressive treatment. Antibody titer was significantly higher among vaccinated than among unvaccinated patients (1166 vs 158 BAU/ml;p< 0.001). Among vaccinated subjects, lower titer of anti-S-RBD were measured among those with hematological malignancies (1282 vs 471 BAU/mL;p< 0.001) or who were receiving immunosuppressive therapy (1287 vs 537 BAU/ml;p< 0.001). Older age, shorter time between onset of symptoms and hospitalization and immunosuppressive conditions were associated with higher rates of death or intubation (Fig 1). Using Cox regression stratified for vaccination, a significant association between anti-S-RBD titer and risk of death/intubation was observed (per log2 BAU/ml increase, HR 0.93;95%CI 0.88-0.99;p=0.020), independently of age (per year increase, HR 1.03;95%CI 1.01-1.04), male gender (HR 1.00;95%CI 0.70-1.42) and presence of immunosuppressive conditions (HR 1.46;95%CI 1.01-2.10). Adjustment for mAb treatment did not change the results to a significant Extent. Conclusion(s): Low anti-S-RBD titer was associated with poor outcome among patients hospitalized for COVID19-related pneumonia, regardless of vaccination. In addition, older age and presence of immunosuppressive conditions remain important predictors of mortality. Kaplan-Meier Curves for intubation-free survival according to age, days from symptoms' onset, presence of immunosuppressive conditions and anti-S-RBD titer. (Figure Presented).
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Purpose of study COVID-19 primarily affects the respiratory system from flu-like syndrome to acute hypoxic respiratory failure. Neurological manifestations are uncommon and can result in serious complications. We report a unique case of sudden onset of rapidly progressive encephalopathy in the setting of COVID-19. Methods used Reviewed the manifestations, clinical course, and outcome for a patient presenting with altered mental status secondary to COVID-19. Summary of results A 48-year-old with no significant past medical history presented to the emergency department complaining of severe headache for four days. His vital signs on presentation showed a blood pressure of 154/90, pulse of 114 bpm, temperature of 99.6 degreeF, and oxygen saturation of 97% on room air. Physical exam was unremarkable. Lab work showed elevated D-dimer 8,500 ng/L, Elevated ESR:42, LDH:340 and Ferritin:692. White blood count: 7.59 uL, Platelets 50 x 103 uL. Computer tomography angiography (CTA) of the chest showed bilateral multifocal pneumonia. CT Head was performed and was negative for an acute hemorrhage, hydrocephalus or territorial infarcts. Patient spiked a fever shortly after admission 103degreeF. Patient was started on Ceftriaxone and Azithromycin. Blood and urine cultures were positive for Klebsiella pneumonia. Patient was re-evaluated in the morning and was found altered with associated neck stiffness. Antibiotics were switched to cover for suspected meningitis. Neurology was consulted and recommended lumbar puncture. Within a few hours, the patient's mental status deteriorated and was found to be hypertensive with a blood pressure of 220/110. Repeat CT Head was negative. The patient was tested and found to be positive for COVID-19. Patient further decompensated within a few hours and became unresponsive, pulseless. ACLS was performed and the patient was transferred to the intensive care unit. Conclusions This case report highlights the heterogenous presentation in patients with COVID-19 and the importance of recognizing a new onset, severe headache as the only initial presentation. Headaches in some cases may precede the respiratory symptoms or may be the only manifestations in COVID-19 patients and it is crucial to be aware of the neurological complications and the rapid decompensation these patients may undergo if not recognized early.
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The variation in ambient air pollution hampers indoor air quality (IAQ), and even the short-term variation is very hazardous for the exposed population. Technological interventions including sensors, smartphones and other gadgets are implemented to build smart environments. However, these interventions are still not fully explored in developing countries like India. The COVID-19 pandemic has made it very important to keep a tab on the air we breathe in as those already suffering from respiratory troubles are prone to fall victim to the deadly disease. In such a scenario, even a rise in pollution for a short duration is dangerous to the exposed pollution. Such short-term exposure facilitated by the meteorological creates a disaster for environmental health. The short-term rise in the concentration of pollutants makes things worse for the exposed people, even indoors. It is therefore critical to come up with a concrete solution to predict the IAQ instantly and warn the exposed population which can be only achieved by technological interventions and futuristic Internet of Things-based computational predictions. This chapter is intended to elaborate the health hazards linked to short-term rise in pollutants, which often goes unnoticed but has a critical impact and how with the help of IoT-based applications, the short-term variation can be predicted through different strategies. Similarly, the assessment of the health impact associated with short-term exposure to air pollution is also significant, and different exposure assessment models and computational strategies are discussed in the course of the study. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Introduction/Aim: We previously reported impaired pulmonary gas exchange in acute COVID-19 patients resulting from both increased intrapulmonary shunt (SH) and increased alveolar dead space (AD) 1 . The present study quantifies gas exchange in recovered patients. Method(s): Unvaccinated patients diagnosed with acute COVID-19 infection (March-December 2020) were studied 15 to 403 days post first SARS-CoV-2 positive PCR test. Demographic, anthropometric, acute disease severity and comorbidity data were collected. Breathing room air, steady-state exhaled gas concentrations were measured simultaneously with arterial blood gases. Alveolar CO 2 and O 2 (P A CO 2 and P A O 2 ;mid-exhaled volume) determined;AaPO2, aAPCO2, SH% and AD% calculated. 2 Results: We studied 59 patients (33 males, Age: 52[38-61] years, BMI: 28.8[25.3-33.6] kg/m 2 ;median[IQR]). Co-morbibities included asthma (n = 2), cardiovascular disease (n = 3), hypertension (n = 12), and diabetes (n = 9);14 subjects smoked;44 had experienced mild-moderate COVID-19 (NIH category 1-2), 15 severe-critical disease (NIH category 3-5). PaCO 2 was 39.4[35.6-41.1] mmHg, PaO 2 92.1[87.1-98.2] mmHg;P A CO 2 32.8[28.6-35.3] mmHg, P A O 2 112.9[109.4-117.0] mmHg, AaPO 2 18.8[12.6-26.8] mmHg, aAPCO 2 5.9[4.3-8.0] mmHg, SH 4.3 [2.1-5.9]% and AD 16.6 [12.6-24.4]%. 14% of patients had normal SH (<5%) and AD (<10%);1% abnormal SH and normal AD;36% both abnormal SH and AD;49% normal shunt and abnormal AD. Previous severe-critical disease was a strong independent predictor for increased SH (OR 14.8[2.28-96], [95% CI], p < 0.01), increasing age weakly predicted increased AD (OR 1.18[1.01, 1.37], p < 0.04). Time since infection, BMI and comorbidities were not significant predictors (all p > 0.11). Conclusion(s): Prior COVID-19 was associated with increased intrapulmonary shunt and/or increased alveolar dead space in 86% of this cohort up to ~13 months post infection, with those with more severe acute disease, and older patients, at greater risk. Increased intrapulmonary shunt suggests persistent alveolar damage, while increased alveolar dead space may indicate persistent pulmonary vascular occlusion.
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Covid19, a novel coronavirus rapidly spread throughout the world, resulting in a global pandemic. The virus was designated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the illness it caused coronavirus disease 2019 (COVID-19). The spectrum of COVID-19 in adults ranges from asymptomatic infection to mild respiratory tract symptoms to severe pneumonia with acute respiratory distress syndrome (ARDS) and multiorgan dysfunction. Here we present a case of 26 year old male with no known underlying comorbidity, started with complaints of fever, body aches, generalised weakness, anosmia, for 4 days, He visited a general practitioner at periphery where his vitals were found to be stable maintaining saturation of 96% at room air, was send home on acetaminophen 650, 2 days later in the morning patient developed sudden onset breathlessness & was rushed to GMC SRINAGAR, on preliminary examination He was having vitals of Bp = 70mmhg systol, Pulse 140b/m, Tem: 98 feh, R/R 26 with normal CXR, Ecg S/o sinus tachycardia, CTPA was done which showed PTE, Patient was thrombolysed on further investigations patient tested positive for COVID 19, with high antibody titers for covid & High inflammatory markers in the form of Il6, D-dimmer, Crp, Esr, Ferritin etc.
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Background: The potential aerosol spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) has been suggested. While indoor air sampling for SARS-CoV- 2 has demonstrated detectable viral RNA and has been related to virus transmission, the contribution of outdoor air to the spread of the viral infection is not yet known. We aimed at developing a methodology to detect the virus in outdoor air. Method(s): T he s ampling w as p erformed u sing a C HEMVOL v olumetric impactor (Butraco) equipped with 2 stages (PM > 10 & 2.5 > PM > 10um). Filters were collected and preserved at -80 degreeC. Total RNA extraction was performed directly from the collected filters with the Phenol-Chloroform method using TRItidy GTM reagent according to the manufacturer's instructions. For total RNA purification samples were purified with the commercial kit E.Z.N.A. Total RNA Kit I. Real-Time Reverse Transcription PCR was executed to detect the N gene from the Sarbecovirus family and RdRp gene from SARS-CoV- 2 using the ViroReal Kit SARS-CoV- 2 Multiplex. A protein-rich fraction was obtained with ammonium bicarbonate buffer extraction followed by lyophilization. SARS-CoV- 2 spike protein was assessed by specific immunological detection (SARS-CoV- 2 Antigen Test Kit). Result(s): RT-PCR for N gene results, identifying Sarbecovirus family, were positive and Cq > 33, in the samples from the last week of December 2020 and the first and second weeks of January 2021, in both PM > 10 and 2.5 > PM > 10. The RdRp gene was undetectable, probably due to low virus concentration. The protein samples from the same days tested positive for the specific antigen spike protein. All results combined confirm the detection of SARS-CoV- 2 in outdoor air. Conclusion(s): Airborne SARS-CoV- 2 was detected in ambient air. These results will contribute to an early detection of SARS-Cov- 2 in ambient air, thus eventually providing the base for early alert systems allowing the implementation of preventive measures to control outbreaks.
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The rapid growth of urban areas and population as well as associated development over recent decades have been a major factor controlling ambient air quality of the urban environment in Kerala (India). Being located at the southwestern fringe of the Indian peninsula, Kerala is one of the regions that has been significantly influenced by the activities in the Indian Ocean. The present study focuses on the effect of the COVID-19 lockdown (in 2021) on ambient air quality in the selected coastal metropolitan areas of Kerala. Although previous research studies reported improvement in ambient air quality in Kerala during the lockdown period, this study demonstrates the potential of onshore transport of air pollutants in controlling the air quality of coastal urban regions during the lockdown period. Data from the ambient air quality monitoring stations of the Kerala State Pollution Control Board in the urban areas of Thiruvananthapuram (TM), Kollam (KL), Kozhikode (KZ), and Kannur (KN) are used for the analysis. Temporal variation in the concentration of air pollutants during the pre-lockdown (PRLD), lockdown (LD), and post-lockdown (PTLD) periods (i.e., 1 March to 31 July) of 2021 is examined to assess the effect of lockdown measures on the National Air Quality Index (AQI). Results indicate a significant decline in the levels of air pollutants and subsequent improvement in air quality in the coastal urban areas. All the effect of lockdown measures has been evident in the AQI, an increase in the concentration of different pollutants including CO, SO2, and NH3 during the LD period suggests contributions from multiple sources including onshore transport due to marine traffic and transboundary transport. © 2023, The Author(s) under exclusive licence to Institute of Earth Environment, Chinese Academy Sciences.
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Case report Background: With the continued rise of COVID-19 hospitalizations due to variants, breakthrough infections and vaccine hesitancy, current treatment regimens must be evaluated. Corticosteroids (CS) have been shown to decrease mortality in patients who require oxygen, especially those on invasive mechanical ventilation [Pinzo et al. 2021]. Steroids also lower intubation rates and transfer to intensive care units [Ahmad et al. 2021]. Methylprednisolone (MP) and dexamethasone (DEX) have been used for the treatment of COVID-19 patients with varied data on outcomes. Having obtained the patient's consent, the case below aims to highlight the use of both MP and DEX in the management of COVID-19 ARDS. Case: A 61-year- old male with a history of prostate cancer in remission presented with fever for 2 weeks and cough and dyspnoea for 2 days. He denied any gastrointestinal or neurological symptoms. He was unvaccinated to COVID-19 and reported recent exposure. On examination his oxygen saturation was 89% on room air and on auscultation, decreased air entry and crepitations were noted bilaterally. COVID-19 infection was confirmed by a positive nasopharyngeal swab. Lab investigations revealed an elevated C-Reactive Protein (CRP) of 26 mg/L, with a normal leukocyte count and renal function. Chest radiograph showed scattered consolidations bilaterally. A diagnosis of ARDS was made and non-invasive ventilation via dual oxygen therapy was initiated. He was later admitted to the High Dependency Unit (HDU) for continuous positive airway pressure ventilation. A tapering dose of MP was administered starting with a loading dose of 1g intravenously (IV) followed by 250 mg IV daily for 3 days and then 1 mg/kg twice daily until discharged from the HDU. MP was then switched to DEX 8mg IV daily and continued until supplemental oxygen was no longer needed. Serial blood draws noted a gradual decline in the CRP value. He was subsequently discharged and followed up in an outpatient setting. Conclusion(s): Current guidelines recommend fixed dosing regimens of CS in COVID-19 ARDS. This case demonstrates the effectiveness of using tapered MP followed by DEX in the management of COVID-19 ARDS. As such CS should not be a fixed dose regimen but rather tailored to the patient's requirements with dose adjustments guided by supplemental oxygen demand and CRP values. Further research is required on CS potency and dosing in COVID-19 associated pulmonary disease.
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Ecological studies suggested a link between air pollution and severe COVID-19 outcomes, while studies accounting for individual-level characteristics are limited. In the present study, we aimed to investigate the impact of short-term ambient air pollution exposure on disease severity among a cohort of 569 laboratory confirmed COVID-19 patients admitted to designated hospitals in Zhejiang province, China, from January 17 to March 3, 2020, and elucidate the possible biological processes involved using transcriptomics. Compared with mild cases, severe cases had higher proportion of medical conditions as well as unfavorable results in most of the laboratory tests, and manifested higher air pollution exposure levels. Higher exposure to air pollutants was associated with increased risk of severe COVID-19 with odds ratio (OR) of 1.89 (95% confidence interval (CI): 1.01, 3.53), 2.35 (95% CI: 1.20, 4.61), 2.87 (95% CI: 1.68, 4.91), and 2.01 (95% CI: 1.10, 3.69) for PM2.5, PM10, NO2 and CO, respectively. OR for NO2 remained significant in two-pollutant models after adjusting for other pollutants. Transcriptional analysis showed 884 differentially expressed genes which mainly were enriched in virus clearance related biological processes between patients with high and low NO2 exposure levels, indicating that compromised immune response might be a potential underlying mechanistic pathway. These findings highlight the impact of short-term air pollution exposure, particularly for NO2, on COVID-19 severity, and emphasize the significance in mitigating the COVID-19 burden of commitments to improve air quality. © 2022
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Introduction: Air pollutant exposure constitutes a serious risk factor for the emergence or aggravation of (existing) pulmonary disease. Aim(s): In this study, we wanted to investigate if recent and chronic exposures to ambient air pollution (AP) is associated with COVID-19 disease severity in a cohort of hospitalized COVID-19 patients. Method(s): 283 COVID-19 patients were recruited at the time of admission to hospital. Several clinical parameters and outcomes were collected from medical records, including the duration of stay, the early-warning score (EWS), oxygen saturation in blood at admission, admission to the intensive care unit (ICU), and clinical improvement at 30 and at 90 days after the day of admission. Daily exposure levels for PM , PM , NO and black carbon (BC) were modeled using a high-resolution spatiotemporal model. Based on daily exposure levels, average exposures 2 days and 1 week before admission and chronic exposure. Result(s): We observed a significant association between the duration of stay and exposure to PM , PM and NO (recent and chronic exposure). For BC, only chronic exposure (CP) was significantly associated with the duration of stay. On average, the duration of stay increased by 1 to 6 days for an inter-quartile range increase in average exposure to AP in the week before admission. CP was associated with 2 to 3 days increased duration of stay. An increase in PM2.5 and PM10 exposure 1 week before admission was associated with higher EWS. Conclusion(s): Exposure to AP was associated with duration of stay and EWS at the time of admission, which implies a potential link between AP exposure and COVID-19 disease severity, and a significant influence of AP exposure on the pressure of care systems.
ABSTRACT
Aim: To evaluate risk factors for barotrauma development in COVID-19 patients treated with HFNC. Method(s): 34 COVID-19 patients are studied retrospectively, 24 males, mean age 61,74 years. Symptoms (dyspnoea, cough, fever, hemoptoe, fatigue), comorbidities (arterial hypertension (AH), COPD, asthma, diabetes, heart and kidney diseases, bronchiectasis), blood tests (total blood count, neutrophils to lymphocytes (Neu:Ly) ratio, lactate dehydrogenase (LDH), ferritin, interleukin-6, C-reactive protein), chest X-ray findings at admission are assessed. Need for oxygen therapy (ambient air, low flow therapy, HFNC) during the hospitalisation, barotrauma development (pneumothorax (PT), pneumomediastinum (PM), subcutaneous emphysema (SE)) and disease outcome are analysed. Result(s): Age decrease by 1 year leads to increased risk of SE by 17% (hazard ratio (HR)0.852,p=0.018). LDH increase by 1 U/l leads to 0.4% increased risk of SE (HR1.004,p=0.020). Age and LDH level are proved as risk factors for SE. AH increases the risk of PM by 27.5% (HR1.275,p=0.087). Ferritin increase by 1 ug/l leads to 0.2% higher risk of PT (HR1.002,p=0.019). Multivariate model reveals AH (HR1.777,p=0.057) and ferritin level (HR1.004,p=0.013) as risk factors for barotrauma. Multivariate model shows LDH (HR1,003,p=0,023), ferritin (HR1,004,p=0,007), and Neu:Ly (HR1,123,p=0,059) as main risk factors for PT,PM, SE. Dyspnoea increases the death risk 11 times (HR11.2,p=0.034) while LDH increase by 1 U/l leads to 0.1% increased death risk (HR1.001,p=0.087). Conclusion(s): AH, age, ferritin, LDH, Neu:Ly levels are proved as risk factors for PT, PM and SE. Dyspnoea is a risk factor for death outcome.