Exploring the experiences of COVID-19 survivors with a history of admission to the respiratory intensive care unit (RICU): A phenomenological study in Iran (preprint)

COVID-19 is still spreading around the world. To this end, the present study sought to explore the experiences of COVID-19 survivors with a history of admission to ICUs in southern Iran. This study was conducted using descriptive phenomenology on twelve COVID-19 survivors with a history of admission to the ICU. The patients were selected using purposive sampling. The data were collected through face-to-face semistructured interviews with the patients. The collected data were analyzed using the seven steps of Colaizzi analysis. Data analysis revealed 3 main themes: better resources and facilities, unpleasant physical and psychological experiences, and pain relievers. COVID-19 survivors who were admitted to the RICU reported that they had many positive and negative experiences. Thus, health officials, experts, nurses, and physicians need to pay special attention to the problems faced by COVID-19 patients admitted to ICUs.

Optimization of Ventilation Therapy Prioritization Strategies among Patients with COVID-19: Lessons Learned from Real-World Data of nearly 600,000 Hospitalized Patients (preprint)

Summary Objective To investigate the benefit of ventilation therapy among various patient groups with COVID-19 admitted to hospitals, based on the real-world data of hospitalized adult patients. Methods Data used in the longitudinal study included 599,340 records of hospitalized patients. All participants were categorized based on demographics and their date of hospitalization. Two models were used in this study: firstly, participants were assessed by their probability of receiving ventilation therapy during hospitalization using mixed-effects logistic regression. Secondly, the clinical benefit of receiving ventilation therapy among various patient groups was quantified while considering the probability of receiving ventilation therapy during hospital admission, as estimated in the first model. Findings Among participants, 60,113 (10.0%) received ventilation therapy, 85,158 (14.2%) passed away due to COVID-19, and 514,182 (85.8%) recovered. Among all groups with sufficient data for analysis, patients aged 40-64 years who had chronic respiratory diseases (CRD) and malignancy benefitted the most from ventilation therapy; followed by patients aged 65+ years who had malignancy, cardiovascular diseases, and diabetes; and patients aged 18-39 years who had malignancy. Patients aged 65+ who had CRD and cardiovascular disease gained the least benefit from ventilation therapy. Conclusion This study promotes a new aspect of treating patients for ventilators: it could be suggested that rather than focusing on the scarcity of ventilators, guidelines focus on decision-making algorithms to also take the usefulness of the intervention into account, whose beneficial effect is dependent on the selection of the right time in the right patient. Funding This work was supported by the World Health Organization (WHO) Eastern Mediterranean Regional Office (EMRO) (Grant No. 202693061). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Research in context What was already known Research has been ongoing to investigate the main principles for allocating scarce medical resources during pandemics. Medical experts working at the COVID-19 care units interact with patients of different socioeconomic, clinical, paraclinical, and overall health statuses. While physicians should not be faced with situations where they would be obliged to decide which patient to treat due to the risk of human error as well as the double-burden of life-long emotional toll, the pandemic has increased the likelihood of such dilemmas, especially in settings with limited resources. Serious discussions on the ethical considerations of ventilator allocation were also raised during the pandemic. Utility (maximizing benefits) and equity (distributive justice) were two concerns raised in decision making in such dilemma which has also been considered to be “the toughest triage”. What new knowledge the manuscript contributes This longitudinal study provides new insights on optimizing the strategies for ventilation therapy prioritization among patients with COVID-19, based on the real-world data of nearly 600,000 hospitalized patients with COVID-19. So far, there has been focus on how to prioritize patients with COVID-19 for ventilation therapy. Nevertheless, there has not been much evidence on how much patients of different age groups with various underlying conditions actually benefitted from ventilation therapy based on real-world data. The results of this study could have a significant message: should the prioritization guidelines for ventilators allocation take no notice of the real-world data, patients might be deprived of ventilation therapy, who could benefit the most from it. This would pave the way to capture clearer picture in the possible future pandemics.

Clinical Features of COVID-19 Hospitalized Patients with and without Chronic Kidney Disease: A Single-Center, Cross-Sectional Study

Background and Objectives: The severity and mortality of coronavirus disease 19 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 are positively associated with underlying diseases such as hypertension, diabetes, and chronic kidney disease (CKD). In this regard, the current study aimed to evaluate the clinical characteristics, laboratory findings, and outcomes of coronavirus disease 2019 (COVID-19) hospitalized patients with and without CKD. Methods: This cross-sectional matched study was conducted on hospitalized confirmed COVID-19 patients with and without CKD admitted to Baqiyatallah Hospital in Tehran, Iran, from February 26, 2020 to March 26, 2020. The patients were homogenized in terms of age, gender, body mass index, and underlying diseases such as hypertension and diabetes. Demographic data, clinical symptoms, and laboratory and radiological findings were collected from patients' medical records and compared between the patients based on their CKD status. Results: Among the COVID-19 patients, 56 and 97 cases with and without CKD were investigated, respectively. In general, 111 (72.5%) patients with a mean age of 55 years were males. Patients with CKD had higher levels of blood urea nitrogen, creatinine, and red cell distribution width (p<0.05). No differences were found regarding chest computed tomography findings, ICU admission, and death among COVID-19 patients with and without CKD. Conclusions: Overall, the findings support the use of red cell distribution width, blood urea nitrogen, and creatinine for monitoring the COVID-19 patients with CKD and assessing the risk of disease progression. Eventually, managing comorbidities including hypertension and diabetes will reduce COVID-19 severity in CKD patients. [ FROM AUTHOR] Copyright of Electronic Journal of General Medicine is the property of Modestum Publications 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.)

Omicron-Based Vaccine Candidate Elicits Potent Neutralizing Antibodies in the Animal Model (preprint)

The B.1.1.529 (Omicron) variant of SARS-CoV-2 with multiple novel mutations has reduced the neutralization potential of vaccinated individuals' sera. World Health Organization has suggested that a vaccination strategy based on repeated booster doses is unlikely to be sustainable. The objective of this commentary was to investigate the safety and neutralizing antibody induction of the Omicron-based SARS-CoV-2 vaccine candidate, BIV1-CovIran Plus, against the Omicron variant on mice and guinea pig models. After isolation and characterization, the Omicron variant underwent chemical inactivation, purification, and was then formulated with alum adjuvant. A full human dose of BIV1-CovIran Plus was injected intraperitoneally to five female mice and two Guinea pigs for abnormal toxicity reactions evaluation and pathologic investigations. For potency evaluation, four groups of ten mice received two doses of BIV1-CovIran Plus or phosphate-buffered-saline at 7-day and 14-day intervals. The conventional virus-neutralizing test was conducted on sera acquired from vaccinated mice groups seven days after the second injection. There was no evidence of abnormal clinical symptoms macroscopic or microscopic tissue alterations among the animal models. In all samples from the study group that received two doses of BIV1-CovIran Plus at a 7-day interval, the sera at [≥]1/32 times dilution would neutralize the Omicron variant SARS-CoV-2. Similarly, the sera of all samples from the study group, which received two doses of BIV1-CovIran Plus at a 14-day interval, at [≥]1/64 times dilution, would neutralize the Omicron variant SARS-CoV-2. Moreover, six out of ten (60%) of the samples in this group would neutralize the Omicron variant of SARS-CoV-2 at 1/128 times dilution. CPE formation was observed in all samples from the control group, and no neutralizing activity was detected at any sera dilutions. BIV1-CovIran Plus was well-tolerated in the animal models, and no safety concerns were raised. Moreover, the vaccine candidate elicited protective neutralization against the Omicron variant. Future reports will focus on the use of the updated vaccine as a booster dose and the potency of the vaccine candidate on other SARS-CoV-2 variants.