Characteristics and Outcomes of Patients with COVID-19 in Intensive Care in the First Year of the Pandemic: A Colombian Observational Study

Background: The COVID-19 pandemic has had a devastating impact on the world, mainly during the first year of the pandemic, where strategies such as vaccination were not available. Information on the outcomes of patients admitted to the intensive care unit (ICU) in Colombia is scarce. Our main objective was to characterize critically ill patients with COVID-19 in our region. Methods: We conducted a single-centre retrospective observational study in which we included patients with COVID-19 confirmed by RT-PCR who were admitted to the adult ICU between March 18, 2020 and March 18, 2021, in Quindío, Colombia. We identify the clinical and laboratory characteristics at admission, the support used, and their relationship with mortality during ICU hospitalization. Results: Three hundred and fifty-nine patients with a confirmed diagnosis of COVID-19 were admitted, 64% men, mean age was 62.7 years (SD±12.3), body mass index 27.9Kg/m2 (±5.8), SOFA score was 7.6 (±3.12), Pa/FiO2 96.2 (±62.3), and lung compliance 30.5 ml/cmH2O (±18.4). Mortality was 60%. The variables with the highest mortality association were obesity OR: 2.38 (95% CI:1.39 – 4.09, p: <.001), Glasgow coma scale at admission <12 : 17.5, (5.21 – 58.8, p: <.001), PaFiO2 <100: 5.63, (3.38 – 9.39, p: <.001), static lung compliance less than 50 ml / cmH2O: 3.54, (3.38 – 9.39, p: <.001), SOFA score >5: 3.75 (2.19– 6.42, p: <0.001), ferritin > 1000: 2.58, (1.66 – 4.02, p: <.001), C-reactive protein > 5: 2.52 (1.42 – 4.26, p: <.001), and LDH > 280: 2.71 (1.55 – 4.74, p: <.001). Patients who required PEEP > 10cmH2O: 2.34 (1.48 – 3.70, p: <.001), FiO2 > 60%: 4.01, (2.46 – 6.53, p: <.001), and ventilation in the prone position. Conclusion: Mortality in the first year of the pandemic in our region was high, mainly associated with obesity, inflammation, altered mental status upon admission, and increased lung elastance. Resumen Contexto: La pandemia de COVID-19 ha tenido un impacto devastador en el mundo, principalmente durante el primer año de la pandemia, donde no se disponía de estrategias como la vacunación. La información sobre los resultados de los pacientes ingresados ​​en la unidad de cuidados intensivos (UCI) en Colombia es escasa. Nuestro principal objetivo fue caracterizar a los pacientes críticos con COVID-19 en nuestra región. Métodos: Realizamos un estudio observacional retrospectivo unicéntrico donde incluimos pacientes confirmados con RT-PCR para COVID-19 que ingresaron a la UCI de adultos entre el 18 de marzo de 2020 y el 18 de marzo de 2021, en Quindío, Colombia. Identificamos las características clínicas y de laboratorio al ingreso, los soportes utilizados y su relación con la mortalidad durante la hospitalización en UCI. Resultados: Ingresaron 359 pacientes con diagnóstico confirmado de COVID-19, 64% hombres, edad 62,7 años (DE±12,3), índice de masa corporal 27,9Kg/m2 (±5,8), SOFA score 7,6 (±3,12), Pa /FiO2 96,2 (±62,3) y distensibilidad pulmonar 30,5 ml/cmH2O (±18,4). La mortalidad fue del 60%. Las variables con mayor asociación a mortalidad fueron la obesidad OR: 2,38 (IC 95%: 1,39 – 4,09, P: <0,001), escala de coma de Glasgow al ingreso <12: 17,5, (5,21 – 58,8, P: <0,001), PaFiO2 <100 : 5,63, (3,38 – 9,39, P: <0,001), distensibilidad pulmonar estática inferior a 50 ml/cmH2O: 3,54, (3,38 – 9,39, P: <0,001), puntuación SOFA >5: 3,75 (2,19– 6,42, P: <0,001), ferritina > 1000: 2,58, (1,66 – 4,02, P: <0,001), proteína C reactiva > 5: 2,52 (1,42 – 4,26, P: <0,001) y LDH > 280: 2,71 (1,55 – 4,74), P: <0,001). Pacientes que requirieron PEEP > 10cmH2O: 2,34 (1,48 – 3,70, P: <0,001), FiO2 > 60%: 4,01, (2,46 – 6,53, P: <0,001) y ventilación en decúbito prono. Conclusión: La mortalidad en el primer año de la pandemia en nuestra región fue alta, asociada principalmente a obesidad, inflamación, alteración del estado mental al ingreso y aumento de la elastancia pulmonar.

Impact of Isolation During the COVID-19 Pandemic on the Patient Burden of Parkinson's Disease: A PMD Alliance Survey.

Purpose: As the COVID-19 pandemic resulted in social restrictions around the globe, this cross-sectional survey aimed to assess the impact of social isolation on self- or proxy-reported symptoms of Parkinson's disease (PD) during the pandemic. Patients and Methods: The survey was distributed among 7109 subscribers of the Parkinson and Movement Disorders Alliance (PMD Alliance) News and Information list and was open only to people with PD (PwP) and care partners (CP, defined as main caregivers of PwP and serving as proxy respondents). No attempt was made to identify PwP and CP pairs. The survey was distributed online using Survey Monkey between 01/06/2021 and 02/27/2021. Respondents were grouped by level of social support from outside of their household during the pandemic (decreased or maintained [ie, the same as pre-pandemic or increased]). Results: Of 7109 invited participants, 718 responded to the survey (response rate 10.1%). PwP (self-reports) accounted for 70.6% of respondents and CP (proxy reports) for 29.4%. Decreased social support from outside of the household during the COVID-19 pandemic (58.5% of all responses) was significantly associated with increases in sadness/depression and anxiety, compared with maintained levels of social support (p < 0.0001 for both comparisons). It was also associated with increased burden of several non-motor (decline in memory, problem solving, or communication, p = 0.0009; new or worsening confusion, p < 0.0001; new or worsening delusions, p = 0.018) and motor PD symptoms. Conclusion: Decline in social support from outside of the household during the COVID-19 pandemic showed a statistically significant and negative association with the burden of mood and non-motor symptoms of PD. These results call for increased vigilance towards non-motor symptoms in PwP experiencing social isolation and highlight the need for stronger provider focus on encouraging PwP and their CPs to build and maintain social connections and engagements.

Feasibility of establishing a Canadian Obstetric Survey System (CanOSS) for severe maternal morbidity: a study protocol.

INTRODUCTION: Severe maternal morbidity (SMM)-an unexpected pregnancy-associated maternal outcome resulting in severe illness, prolonged hospitalisation or long-term disability-is recognised by many, as the preferred indicator of the quality of maternity care, especially in high-income countries. Obtaining comprehensive details on events and circumstances leading to SMM, obtained through maternity units, could complement data from large epidemiological studies and enable targeted interventions to improve maternal health. The aim of this study is to assess the feasibility of gathering such data from maternity units across Canadian provinces and territories, with the goal of establishing a national obstetric survey system for SMM in Canada. METHODS AND ANALYSIS: We propose a sequential explanatory mixed-methods study. We will first distribute a cross-sectional survey to leads of all maternity units across Canada to gather information on (1) Whether the unit has a system for reviewing SMM and the nature and format of this system, (2) Willingness to share anonymised data on SMM by direct entry using a web-based platform and (3) Respondents' perception on the definition and leading causes of SMM at a local level. This will be followed by semistructured interviews with respondent groups defined a priori, to identify barriers and facilitators for data sharing. We will perform an integrated analysis to determine feasibility outcomes, a narrative description of barriers and facilitators for data-sharing and resource implications for data acquisition on an annual basis, and variations in top-5 causes of SMM. ETHICS AND DISSEMINATION: The study has been approved by the Mount Sinai and Hamilton Integrated Research Ethics Boards. The study findings will be presented at annual scientific meetings of the Society of Obstetricians and Gynaecologists of Canada, North American Society of Obstetric Medicine, and International Network of Obstetric Survey Systems and published in an open-access peer-reviewed Obstetrics and Gynaecology or General Internal Medicine journal.

Feasibility and Acceptability of Comprehensive Virtual Treatment in Eating Disorders: Perspectives from Patients, Parents and Therapists During the COVID-19 Pandemic. / Viabilidad y Aceptabilidad del Tratamiento Integral Virtual en Trastornos Alimentarios: Perspectiva de Pacientes, Padres y Terapeutas Durante la Pandemia por COVID-19.

BACKGROUND: Lockdowns and social distancing as a result of the COVID-19 pandemic have brought about the need to continue treatment virtually in patients with Eating Disorders (ED). OBJECTIVE: To evaluate feasibility, acceptability and adherence to virtual treatment in patients, families and therapists. METHODS: Fourteen patients, 10 family members and eight therapists from an intensive outpatient program for ED answered online surveys and a SWOT analysis was performed with the responses. RESULTS: Virtual treatment during lockdown was considered feasible and useful by all respondents. Fear of contagion and the presence of parents in the home were identified as strengths. Parents reported problems with nutritional plan compliance, especially in anorexia patients. Therapists highlighted the importance of methodological adaptations in sessions to improve participation. Adherence to sessions was 100% for family members and 90% for patients. CONCLUSIONS: Adaptation to a virtual program is a valid and useful option during lockdowns. It improves family participation, but does not replace face-to-face treatment.

Public health measures to reduce the risk of SARS-CoV-2 transmission in Canada during the early days of the COVID-19 pandemic: a scoping review.

OBJECTIVE: The main objectives of this study were to synthesise and compare pandemic preparedness strategies issued by the federal and provincial/territorial (P/T) governments in Canada and to assess whether COVID-19 public health (PH) measures were tailored towards priority populations, as defined by relevant social determinants of health. METHODS: This scoping review searched federal and P/T websites on daily COVID-19 pandemic preparedness strategies between 30 January and 30 April 2020. The PROGRESS-Plus equity-lens framework was used to define priority populations. All definitions, policies and guidelines of PH strategies implemented by the federal and P/T governments to reduce risk of SARS-CoV-2 transmission were included. PH measures were classified using a modified Public Health Agency of Canada Framework for Canadian Pandemic Influenza Preparedness. RESULTS: A total of 722 COVID-19 PH measures were issued during the study period. Of these, home quarantine (voluntary) (n=13.0%; 94/722) and retail/commerce restrictions (10.9%; n=79/722) were the most common measures introduced. Many of the PH orders, including physical distancing, cancellation of mass gatherings, school closures or retail/commerce restrictions began to be introduced after 11 March 2020. Lifting of some of the PH orders in phases to reopen the economy began in April 2020 (6.5%; n=47/722). The majority (68%, n=491/722) of COVID-19 PH announcements were deemed mandatory, while 32% (n=231/722) were recommendations. Several PH measures (28.0%, n=202/722) targeted a variety of groups at risk of socially produced health inequalities, such as age, religion, occupation and migration status. CONCLUSIONS: Most PH measures centred on limiting contact between people who were not from the same household. PH measures were evolutionary in nature, reflecting new evidence that emerged throughout the pandemic. Although ~30% of all implemented COVID-19 PH measures were tailored towards priority groups, there were still unintended consequences on these populations.