Pulmonary Functional Outcomes at 3 Months in Critical COVID-19 Survivors Hospitalized during the First, Second, and Third Pandemic Waves.

INTRODUCTION: Despite improved management of patients with COVID-19, we still ignore whether pharmacologic treatments and improved respiratory support have modified outcomes for intensive care unit (ICU) surviving patients of the three first consecutive waves (w) of the pandemic. The aim of this study was to evaluate whether developments in the management of ICU COVID-19 patients have positively impacted respiratory functional outcomes, quality of life (QoL), and chest CT scan patterns in ICU COVID-19 surviving patients at 3 months, according to pandemic waves. METHODS: We prospectively included all patients admitted to the ICU of two university hospitals with acute respiratory distress syndrome (ARDS) related to COVID-19. Data related to hospitalization (disease severity, complications), demographics, and medical history were collected. Patients were assessed 3 months post-ICU discharge using a 6 min walking distance test (6MWT), a pulmonary function test (PFT), a respiratory muscle strength (RMS) test, a chest CT scan, and a Short Form 36 (SF-36) questionnaire. RESULTS: We included 84 ARDS COVID-19 surviving patients. Disease severity, complications, demographics, and comorbidities were similar between groups, but there were more women in wave 3 (w3). Length of stay at the hospital was shorter during w3 vs. during wave 1 (w1) (23.4 ± 14.2 days vs. 34.7 ± 20.8 days, p = 0.0304). Fewer patients required mechanical ventilation (MV) during the second wave (w2) vs. during w1 (33.3% vs. 63.9%, p = 0.0038). Assessment at 3 months after ICU discharge revealed that PFTs and 6MWTs scores were worse for w3 > w2 > w1. QoL (SF-36) deteriorated (vitality and mental health) more for patients in w1 vs. in w3 (64.7 ± 16.3 vs. 49.2 ± 23.2, p = 0.0169). Mechanical ventilation was associated with reduced forced expiratory volume (FEV1), total lung capacity (TLC), diffusing capacity for carbon monoxide (DLCO), and respiratory muscle strength (RMS) (w1,2,3, p < 0.0500) on linear/logistic regression analysis. The use of glucocorticoids, as well as tocilizumab, was associated with improvements in the number of affected segments in chest CT, FEV1, TLC, and DLCO (p < 0.01). CONCLUSIONS: With better understanding and management of COVID-19, there was an improvement in PFT, 6MWT, and RMS in ICU survivors 3 months after ICU discharge, regardless of the pandemic wave during which they were hospitalized. However, immunomodulation and improved best practices for the management of COVID-19 do not appear to be sufficient to prevent significant morbidity in critically ill patients.

Ocular surface manifestations and SARS‐CoV‐2 RNA detection in conjunctival swabs of patients hospitalized for COVID‐19 pneumonia: A Belgian cohort

Purpose: Previous studies show a great variability of SARS‐CoV‐2 RNA detection rates in tear fluids. The aim of this study was to investigate the presence of SARS‐CoV‐2 in the tear fluid of hospitalized COVID‐19 patients and to evaluate systemic and ophthalmic clinical features in a Belgian cohort. Methods: Adult patients hospitalized for COVID‐19 pneumonia confirmed by a chest computer tomography (CT) were included. Patients with a recent diagnosis or exacerbation of an ocular pathology were excluded. After completing an ocular symptom questionnaire, patients underwent a macroscopic ocular exam and a conjunctival swab. A reverse transcriptase polymerase chain reaction (RT‐PCR) was performed on the swabs to identify SARS‐CoV‐2 RNA. Clinicobiological data (C reactive protein, lymphocyte count, CT scan, risk factors and symptoms) and PCR results of both ocular and nasopharyngeal samples were collected. Results: Fifty‐eight patients were included between September 2020 and May 2021. 43 (74.1%) were male, the median age was 56 (min 32 ‐max 93). 54 (93.1%) of the nasopharyngeal swabs were positive. Two (3.45%) had a positive conjunctival PCR: one with <10 E3 copies/ml, the second highly positive with > = 10E3 ‐ < 10 E5 copies/ml. Both were males without any ocular symptoms. 13 patients (22%) presented ocular symptoms such as tearing (69.23%), redness (53.85%), burning 38% or itching 15.38%. All but one reported that the symptoms started at the beginning of their SARS‐CoV‐2 infection (92.31%). Statistical analysis by linear regression found that there was a significant statistical correlation between the presence of ocular symptoms and neurological symptoms (p = 0.021). Conclusions: It is possible to find tear fluids with a high viral load but the probability of this occurrence appears to be rather low. The presence of SARS‐CoV‐2 in tears was however not associated with the presence of symptoms in this study. Ocular symptoms may not be related to the presence of the virus itself.

Telemonitoring for the Follow-Up of Obstructive Sleep Apnea Patients Treated with CPAP: Accuracy and Impact on Therapy.

Continuous positive airway pressure (CPAP) telemonitoring (TMg) has become widely implemented in routine clinical care. Objective measures of CPAP compliance, residual respiratory events, and leaks can be easily monitored, but limitations exist. This review aims to assess the role of TMg in CPAP-treated obstructive sleep apnea (OSA) patients. We report recent data related to the accuracy of parameters measured by CPAP and try to determine the role of TMg in CPAP treatment follow-up, from the perspective of both healthcare professionals and patients. Measurement and accuracy of CPAP-recorded data, clinical management of these data, and impacts of TMg on therapy are reviewed in light of the current literature. Moreover, the crucial questions of who and how to monitor are discussed. TMg is a useful tool to support, fine-tune, adapt, and control both CPAP efficacy and compliance in newly-diagnosed OSA patients. However, clinicians should be aware of the limits of the accuracy of CPAP devices to measure residual respiratory events and leaks and issues such as privacy and cost-effectiveness are still a matter of concern. The best methods to focus our efforts on the patients who need TMg support should be properly defined in future long-term studies.

IoT snoring sound detector prototype as a model of future participatory healthcare.

BACKGROUND: Traditional healthcare is centred around providing in-hospital services using hospital owned medical instruments. The COVID-19 pandemic has shown that this approach lacks flexibility to insure follow-up and treatment of common medical problems. In an alternative setting adapted to this problem, participatory healthcare can be considered centred around data provided by patients owning and operating medical data collection equipment in their homes. OBJECTIVE: In order to trigger such a shift reliable and price attractive devices need to become available. Snoring, as a human sound production during sleep, can reflect sleeping behaviour and indicate sleep problems as an element of the overall health condition of a person. METHODS: The use of off-the-shelf hardware from Internet of Things platforms and standard audio components allows the development of such devices. A prototype of a snoring sound detector with this purpose is developed. RESULTS: The device, controlled by the patient and with specific snoring recording and analysing functions is demonstrated as a model for future participatory healthcare. CONCLUSIONS: Design of monitoring devices following this model could allow market introduction of new equipment for participatory healthcare, bringing a care complementary to traditional healthcare to the reach of patients, and could result in benefits from enhanced patient participation.

High SARS-CoV-2 Seroprevalence in Healthcare Workers in Bukavu, Eastern Democratic Republic of Congo.

Among 359 healthcare workers (HCW) employed in Panzi General Referral Hospital located in Bukavu in the Democratic Republic of Congo, 148 (41.2%) tested positive for SARS-CoV-2 antibodies. Thirty-three (22.3%) of the 148 personnel with positive serology reported symptoms evoking a prior COVID-19 illness. None of the infected HCWs reported COVID-related hospitalization, and all of them recovered. Our findings indicate high and underestimated circulation of SARS-CoV-2 within the Bukavu area.

Post-discharge critical COVID-19 lung function related to severity of radiologic lung involvement at admission.

Lung function impairment persists in 55% of critical COVID-19 patients three months after ICU discharge. Patient lung function, exercise capacity, radiologic, and quality of life data suggest impairment is related to radiologic lung involvement at admission.