LABORATORY PARAMETERS ASSOCIATED WITH CODIV-19 CYTOKINE STORM DEVELOPMENT

BackgroundSince the end of 2019, physicians became more and more familiar with SARS-CoV-2 infection and the variety of forms in which it may present and evolve. There have been a lot of studies trying to understand and predict why some patients develop a dysregulation of the immune response, with an exaggerated release of pro-inflammatory cytokines, called cytokine storm (1–4). There is scarce evidence in Romania regarding this aspect.ObjectivesThis study aims to verify the correlation between some laboratory parameters and the development of cytokine storm in SARS-CoV-2 infection in a cohort of over 200 patients admitted in a tertiary hospital from Romania, hoping that early identification of these risk factors of progression to a severe form of the disease can bring considerable benefit to patient care.MethodsThis is an analytical, observational, case-control study which includes 219 patients (all COVID-19 hospitalized patients on the Internal Medicine 3 department of Colentina Clinical Hospital, Bucharest, from 01 March 2020 to 1 April 2021). A series of data were collected, the laboratory parameters being the most important, including: albumin, lymphocyte (percentage), neutrophil (absolute value), aspartate aminotransferase, alanine aminotransferase, D-dimers, lactate dehydrogenase (LDH), anionic gap, chloremia, potassium and the BUN:creatinine ratio (BUN - blood urea nitrogen). The laboratory parameters used for the statistical analysis represent the average values of the first 7 days of hospitalization for those who did not develop cytokine storm, respectively until the day of its development, for the others. Patients were classified into these groups, those who developed cytokine storm, respectively those who did not have this complication taking into account the clinical and paraclinical criteria (impairment of respiratory function, elevations of certain markers 2-3 times above the upper limit of normal, those who died as a result of SARS-CoV-2 infection). Then Binary Univariate Logistic Regression was applied in order to verify the individual impact of every laboratory parameter on cytokine storm development. Furthermore, all laboratory parameters were subsequently included in the multivariate analysis, using the backward selection technique to achieve a model as predictive as possible.ResultsWe mention that the analysis of demographic data was previously performed, showing no statistically significant relationship between patient gender, age or comorbidities (history of neoplasm, lung diseases, cardiac pathology, obesity, type II diabetes and hypertension) and their evolution to cytokine storm. After performing binary univariate logistic regression we concluded that 8 of the 13 laboratory analyzes have had a significant change between groups (ferritin, PCR, albumin, Lymphocyte, Neutrophils, TGO, LDH, BUN:creatinine ratio). Only 150 patients were then included in the multivariate analysis. After the analysis, some of the variables lost their statistical significance, the final model including C-reactive protein, neutrophilia, LDH, ferritin and the BUN:creatinine ratio. This model correctly predicts the development of cytokine storm in 88% of cases.ConclusionHigh C-reactive protein, neutrophilia, LDH, ferritin and the BUN:creatinine ratio are risk factors for cytokine storm development and should be monitored in all COVID-19 patients in order to predict their evolution.References[1]Pedersen SF et all. SARS-CoV-2: A storm is raging[2]Mehta P et al. COVID-19: consider cytokine storm syndromes and immunosuppression[3]Hu B et al. The cytokine storm and COVID-19.[4]Caricchio R et al. Preliminary predictive criteria for COVID-19 cytokine stormAcknowledgements:NIL.Disclosure of InterestsNone Declared.

Covid-19 pandemic: Attachment, anxiety, emotions regulation and coping strategies among school-aged children

Introduction. - An impact of the COVID-19 pandemic on the emotions and behaviors of children has been found in several studies. However, this impact is not found in all studies. Attachment could be linked to different reactions and levels of anxiety. Objective. - The main aim of this study was to analyze the links between children's insecure attachment and variables related to anxiety, emotional and behavioral management of children during the pandemic. Method. - Study participants (n=83 parents and their child aged 6 to 12) completed anonymously online questionnaires assessing attachment insecurity, state-anxiety, coping strategies and emotional regulation. They also answered socio-demographic questions related to their context of life and experience of the pandemic. Results. - State-anxiety is significantly related to children's emotional dysregulation but not to emotion-oriented coping strategy. Significant links were observed between attachment insecurity on the one hand, and children's state-anxiety, emotion-oriented coping strategy and children's emotional dysregulation on the other hand. Emotional dysregulation mediates the link between disorganized attachment and state anxiety. Conclusion. - The links between attachment insecurity and children's state -anxiety on the one hand, and the emotion-oriented coping strategy on the other hand highlight the importance of taking individual and interactional factors into account in children's socio-emotional manifestations during the COVID-19 pandemic. (c) 2022 Societe Francaise de Psychologie. Published by Elsevier Masson SAS. All rights reserved.

Efficacy of medical face masks on birch-induced asthma in ALYATEC EEC

Background: Patients with rhinitis to pollen can exhibit asthma. To control the spread of SARS-CoV-2, the use of face masks has become widespread worldwide. There is no clinical evidence that medical masks are efficient in birch pollen-induced asthma. Objective(s): To study the efficacy of medical face masks in reducing asthma in patients allergic to birch in ALYATEC Environmental Exposure Chamber (EEC). Method(s): 24 GINA 1 birch-related asthma patients, were exposed to 60 ng/m3 of airborne Bet v 1 in ALYATEC EEC. All patients had positive skin prick tests and specific IgE to birch at screening. Baseline exposures lasted 1 hour to assess asthma responses (20% drop in Forced Expiratory Volume in 1 second (FEV1). Patients with asthma were randomized into 2 groups: with and without a KOLMI face mask (OP-Air), for a 6-hour exposure to birch allergen. Result(s): At baseline, asthma occurred within 30 minutes. In group without mask, the median time for drop in FEV1 was 37 minutes, and 67 min in the group with mask (p=0.219). There was a threshold difference of time for onset of asthma between the 2 groups. At 1 hour-exposure, patients with masks still present in the EEC was twice as much as the group without masks. Asthma questionnaire was not statistically significant in both groups, but was highly correlated with the drop in FEV1 at 30 min exposure. The Kaplan Meyer graph showed that survival probability in EEC was higher for the group with masks than without masks. Borg's scale for dyspnea suggest a difference between the 2 groups starting at 2 hour-exposure. Conclusion(s): This pilot study showed a tendency of face masks to increase the time to develop asthma. Some patients reported mask effectiveness during pollen season.

Efficacy of medical face masks on birch-induced asthma in ALYATEC EEC

Rationale: To control the spread of SARS-CoV-2, the use of face masks has become widespread worldwide. There is no clinical evidence that medical masks are efficient in pollen-induced asthma. We studied the efficacy of medical face masks in reducing asthma in patients allergic to birch in ALYATEC Environmental Exposure Chamber (EEC). Methods: 24 GINA 1 birch-related asthma patients were exposed to 60 ng/m3 of airborne Bet v 1 in ALYATEC EEC. All patients had positive skin prick tests and specific IgE to birch at screening. Baseline exposures lasted 1 hour to assess asthma responses (20% drop in Forced Expiratory Volume in 1 second (FEV1), then randomized into 2 groups: with and without a KOLMI® face masks (OP-Air), for a 6-hour birch allergen exposure. Results: At baseline, asthma occurred within 30 minutes. In the group without masks, the median time for drop in FEV1 was 37 minutes, and 67 min in the group with mask (p=0.219). There was a threshold difference of time for onset of asthma between the 2 groups. At 1 hour-exposure, patients with masks still present in the EEC was twice as much as the group without masks. Asthma questionnaire score was highly correlated with the drop in FEV1 at 30 min exposure. The Kaplan Meyer graph showed that survival probability in EEC was higher for the group with masks than without masks. Conclusions: This pilot study showed a tendency of face masks to increase the time to develop asthma. Some patients reported mask effectiveness during pollen season.

Clinical evaluation of surgical face mask efficacy in reducing asthma and rhinitis symptoms in birch-allergic subjects in ALYATEC environmental exposure chamber

Aim of the study: Currently, there is no clinical evidence that face masks are efficient in birch pollen-induced asthma. As the use of face masks has become widespread worldwide to limit the spread of SARS-CoV-2, it was chosen to demonstrate the clinical efficacy of medical masks in patients allergic to birch in the same way that clinical trial with drugs. Patients and Methods: 24 birch-related asthmatic patients, were exposed to 60 ng/m3 of airborne Bet v 1 in ALYATEC environmental exposure chamber. All patients had positive skin prick tests and specific IgE to birch at screening visit. Patients with asthma response during 1-hour baseline exposure were randomized into 2 groups: with and without a KOLMI surgical face mask (OP-Air), for a 6-hour exposure to birch allergen. Result(s): The median time to obtain an early asthma response in the group without mask was 37 minutes, and 67 min in the group with mask (P = 0.219). At 1 hour-exposure, patients with masks still present in the environmental exposure chamber was twice as much as the group without masks. Conclusion(s): This pilot study showed a tendency of face masks to increase the time to develop allergic symptoms. Copyright © 2022

Évaluation clinique de l’efficacité d’un masque chirurgical dans la réduction des symptômes d’asthme et de rhinite, chez des sujets allergiques au pollen de bouleau dans la chambre d’exposition environnementale ALYATEC

Résumé But de l’étude À ce jour, aucune étude clinique n’a mis en évidence l’efficacité des masques médicaux dans l’asthme induit par le pollen de bouleau. Suite à la généralisation de l’utilisation des masques dans le monde afin de limiter la propagation du SARS-CoV-2, il a été choisi de démontrer l’efficacité des masques chirurgicaux chez des patients allergiques au pollen de bouleau, en suivant les mêmes principes que les études cliniques avec médicaments. Patients et méthodes 24 patients asthmatiques au pollen de bouleau ont été exposés à 60ng/m3 de Bet v 1 dans la chambre d’exposition environnementale ALYATEC. Tous les patients avaient des tests cutanés et des taux d’IgE spécifiques au pollen de bouleau positifs lors de la visite de sélection. Les patients présentant une réponse asthmatique pendant l’exposition baseline de 1h ont été randomisés en 2 groupes : avec et sans masque chirurgical KOLMI® (OP-Air), pour une exposition de 6h aux allergènes de pollen de bouleau. Résultats Le temps médian d’apparition d’une réponse bronchique immédiate dans le groupe sans masque était de 37minutes, et de 67min dans le groupe avec masque (p=0,219). À 1h d’exposition, le nombre de patients dans le groupe avec masque encore présents dans la chambre d’exposition environnementale était deux fois plus important que dans le groupe sans masque. Conclusion Cette étude pilote a montré une tendance des masques à retarder le temps d’apparition des symptômes allergiques. Aim of the study Currently, there is no clinical evidence that face masks are efficient in birch pollen-induced asthma. As the use of face masks has become widespread worldwide to limit the spread of SARS-CoV-2, it was chosen to demonstrate the clinical efficacy of medical masks in patients allergic to birch in the same way that clinical trial with drugs. Patients and methods 24 birch-related asthmatic patients, were exposed to 60ng/m3 of airborne Bet v 1 in ALYATEC environmental exposure chamber. All patients had positive skin prick tests and specific IgE to birch at screening visit. Patients with asthma response during 1-hour baseline exposure were randomized into 2 groups: with and without a KOLMI® surgical face mask (OP-Air), for a 6-hour exposure to birch allergen. Results The median time to obtain an early asthma response in the group without mask was 37minutes, and 67min in the group with mask (P=0.219). At 1 hour-exposure, patients with masks still present in the environmental exposure chamber was twice as much as the group without masks. Conclusion This pilot study showed a tendency of face masks to increase the time to develop allergic symptoms.

Covid-19 pandemic: Attachment, anxiety, emotions regulation and coping strategies among school-aged children

Introduction: An impact of the COVID-19 pandemic on the emotions and behaviors of children has been found in several studies. However, this impact is not found in all studies. Attachment could be linked to different reactions and levels of anxiety. Objective: The main aim of this study was to analyze the links between children's insecure attachment and variables related to anxiety, emotional and behavioral management of children during the pandemic. Method: Study participants (n = 83 parents and their child aged 6 to 12) completed anonymously online questionnaires assessing attachment insecurity, state-anxiety, coping strategies and emotional regulation. They also answered socio-demographic questions related to their context of life and experience of the pandemic. Results: State-anxiety is significantly related to children's emotional dysregulation but not to emotion-oriented coping strategy. Significant links were observed between attachment insecurity on the one hand, and children's state-anxiety, emotion-oriented coping strategy and children's emotional dysregulation on the other hand. Emotional dysregulation mediates the link between disorganized attachment and state anxiety. Conclusion: The links between attachment insecurity and children's state-anxiety on the one hand, and the emotion-oriented coping strategy on the other hand highlight the importance of taking individual and interactional factors into account in children's socio-emotional manifestations during the COVID-19 pandemic. © 2022 Société Française de Psychologie

The impact of COVID-19 on sick leave of the persons working in nursing homes in Spain. usefulness of sick leave for the surveillance of the pandemic evolution

Background: The nursing homes represented high-risk settings for SARS-CoV-2 infection, both for residents and for the employees. The COVID-19 impact on long-term care facilities (LTCFs) is evaluated, measured through the employees sick leave (SL). The pandemic evolution in the general population aged between 16 and 65 years was analyzed together with the sick leave to assess the latter as a complementary indicator of the SARS-CoV-2 surveillance.

[The impact of COVID-19 on sick leave of the persons working in nursing homes in Spain. Usefulness of sick leave for the surveillance of the pandemic evolution.]

OBJECTIVE: The nursing homes represented high-risk settings for SARS-CoV-2 infection, both for residents and for the employees. The COVID-19 impact on long-term care facilities (LTCFs) is evaluated, measured through the employees sick leave (SL). The pandemic evolution in the general population aged between 16 and 65 years was analyzed together with the sick leave to assess the latter as a complementary indicator of the SARS-CoV-2 surveillance. METHODS: A descriptive study of all sick leave processes due to COVID-19 recorded between February 15th 2020 and May 1st 2021 in nursing homes was carried out. The close contact sick leave/infection sick leave ratios, the 100,000 affiliated/occupied sick leave rates were computed and compared with the COVID-19 cases cumulative incidence notified to the National Network of epidemiological Surveillance (RENAVE). RESULTS: 261.892 SL processes were recorded. The close contact sick leave/infection sick leave median ratio in nursing homes was 1.8 (Interquartile range, ICR: 1.1-3.3), with values lower than 1 at certain periods. The infection sick leaves were higher in number and ratio and prior to the cases recorded in RENAVE. The sick leave ratio ranged between 81.679/100.000 occupied in nursing homes with medical care and 4.895/100.000 in other residential facilities. CONCLUSIONS: The results confirmed the dramatic impact of COVID-19 in nursing homes and the inequalities characterizing this impact. They also confirmed the potential use of sick leave as an alternative source for epidemiological and public health surveillance, especially now, when the transition of the COVID-19 surveillance to a system not including universal individual surveillance is being discussed.

Contribution of the occupational health to the COVID-19 pandemic control

When the World Health Organization declared COVID-19 as a public health emergency of international concern, the Spanish Ministry of Health called the health, labor, social security authorities, Labor and Social Security Inspection, National Institute of Security and Occupational Health, employers, unions, occupational risk prevention services, mutual societies and scientific societies of occupational medicine and nursing, to collaborate in the control of the transmission of SARS-CoV-2 in companies. The Occupational Health Group of the Public Health Commission of the Interterritorial Council of the National Health System, developed the Procedure for the prevention of occupational risks in the face of exposure to SARS-CoV-2, which has been updated 15 times until the date. It contains the prevention measures to be implemented in the workplaces: organizational and collective protection, personal protection, especially vulnerable worker and risk level, study and management of cases and contacts that occurred in the company, collaboration in the management of temporary disability and, more recently, reincorporation and management of vaccinated workers. As a result of these cooperation and collaboration frameworks, a series of activities were deployed in the workplace, which are described in this article.

Contribution of the occupational health to the COVID-19 pandemic control

When the World Health Organization declared Covid-19 as a public health emergency of international concern, the Spanish Ministry of Health called the health, labor, social security authorities, Labor and Social Security Inspection, National Institute of Security and Occupational Health, employers, unions, occupational risk prevention services, mutual societies and scientific societies of occupational medicine and nursing, to collaborate in the control of the transmission of SARS-CoV-2 in companies. The Occupational Health Group of the Public Health Commission of the Interterritorial Council of the National Health System, developed the Procedure for the prevention of occupational risks in the face of exposure to SARS-CoV-2, which has been updated 15 times until the date. It contains the prevention measures to be implemented in the workplaces: organizational and collective protection, personal protection, especially vulnerable worker and risk level, study and management of cases and contacts that occurred in the company, collaboration in the management of temporary disability and, more recently, reincorporation and management of vaccinated workers. As a result of these cooperation and collaboration frameworks, a series of activities were deployed in the workplace, which are described in this article.