Neutrophil Elastase Inhibitor (Sivelestat) in the Treatment of Acute Respiratory Distress Syndrome Induced by COVID- 19: A Multicenter Retrospective Cohort Study (preprint)

Background Recent studies suggest that neutrophil elastase inhibitor (Sivelestat) may improve pulmonary function and reduce mortality in patients with acute respiratory distress syndrome. We examined the association between receipt of sivelestat and improvement in oxygenation among patients with acute respiratory distress syndrome (ARDS) induced by COVID-19.Methods A large multicentre cohort study of patients with ARDS induced by COVID-19 who had been admitted to intensive care units (ICUs). We used propensity score matching to compare the outcomes of patients treated with sivelestat to those who were not. The differences in continuous outcomes were assessed with the Wilcoxon signed-rank test. Kaplan-Meier method was used to show the 28-day survival curves in the matched cohorts. A log-rank P-test stratified on the matched pairs was used to test the equality of the estimated survival curves. A Cox proportional hazards model that incorporated a robust sandwich-type variance estimator to account for the matched nature of the data was used to estimate hazard ratios (HR). All statistical analyses were performed with SPSS 26.0 and R 4.2.3. A two-sided p-value of < 0.05 was considered statistically significant.Results A total of 387 patients met inclusion criteria, including 259 patients (66.9%) who were treated with sivelestat. In 158 patients matched on the propensity for treatment, receipt of sivelestat was associated with improved oxygenation, decreased Murray lung injury score, increased non-mechanical ventilation time within 28 days, increased alive and ICU-free days within 28 days (HR, 1.85; 95% CI, 1.29 to 2.64; log-rank p < 0.001), shortened ICU stay and ultimately improved survival (HR, 2.78; 95% CI, 1.32 to 5.88; log-rank p = 0.0074).Conclusions Among patients with ARDS induce by COVID-19, sivelestat administration is associated with improved clinical outcomes.

Telemedicine in Vascular Surgery During COVID-19 Pandemic: A Systematic Review and Narrative Synthesis.

BACKGROUND: The COVID-19 pandemic resulted in seismic changes to healthcare service delivery. The use of telemedicine was widely adopted during the pandemic, although its value in the safe care of vascular patients is unknown. METHODS: A systematic review was undertaken to identify studies that described outcomes or patient/clinician views of telemedicine (telephone or video) services in vascular surgery during or after the pandemic. Two reviewers independently searched medical databases, selected studies, extracted data, and undertook a narrative synthesis. RESULTS: Twelve studies were included. Most studies reported increased telemedicine use during the pandemic. Most patients (80.6%-100%) were satisfied with telephone or video consultation. More than 90% of the patients felt that telemedicine was a good substitute during the pandemic to avoid travelling and reduce transmission risk. Three studies showed patients had a strong preference for continuing telemedicine consultations postpandemic. Two studies evaluating patients with arterial ulceration and venous diseases reported no significant difference in clinical outcome between patients reviewed face-to-face and those seen remotely. One study showed clinicians preferred face-to-face consultations. No study conducted cost analysis. CONCLUSIONS: Patients and clinicians viewed telemedicine favorably as an alternative to face-to-face clinics during the pandemic and included studies did not identify any safety concerns. Its role postpandemic is not clearly defined, although these data suggest a significant proportion of patients would appreciate, and be suitable for, such consultations in the future.

Deep Venous Thrombosis and Risk of Consequent Sepsis Event: A Retrospective Nationwide Population-Based Cohort Study.

Deep vein thrombosis causes several acute and chronic vessel complications and puts patients at risk of subsequent sepsis development. This unique study aimed to estimate the risk of sepsis development in DVT patients compared with non-DVT patients. This population-based cohort study used records of a longitudinal health insurance database containing two million patients defined in Taiwan's National Health Insurance Research Database (NHIRD). Our study included patients aged over 20 years with a new diagnosis of DVT with at least two outpatient department visits or an admission between 2001 and 2014. Patients with a diagnosis of sepsis before the index date were excluded. Propensity score matching (PSM) was used to homogenize the baseline characteristics between the two groups. To define the independent risk of the DVT group, a multivariate Cox proportional hazard model was used to estimate the hazard ratios. After PSM, the DVT group (n = 5753) exhibited a higher risk of sepsis (adjusted hazard ratio, aHR, 1.74; 95% CI, 1.59-1.90) compared with non-DVT group (n = 5753). Patients with an increased risk of sepsis were associated with being elderly aged, male, having diabetes, chronic kidney disease, chronic obstructive pulmonary disease, stroke, malignancy, and use of antibiotics. In conclusion, this population-based cohort study demonstrated an increased risk of sepsis in DVT patients compared with non-DVT patients. Thus, early prevention and adequate treatment of DVT is necessary in clinical practice.

Environmental Factors Contribute to the Transmissibility of COVID-19: Evidence from an Improved SEIR Model (preprint)

COVID-19 is ravaging Brazil, and its spread shows spatial heterogeneity. Changes in the environment have been implicated as potential factors involved in COVID-19 transmission. However, considerable research efforts have not elucidated the risk of environmental factors on COVID-19 transmission from the perspective of infectious disease dynamics. The aim of this study is to model the influence of the environment on COVID-19 transmission and to analyze how the socio-ecological factors affecting the probability of virus transmission in 10 states dramatically shifted during the early stages of the epidemic in Brazil. First, this study used a Pearson correlation to analyze the interconnection between COVID-19 morbidity and socio-ecological factors, and identified factors with significant correlations as the dominant factors affecting COVID-19 transmission. Then, the time-lag effect of dominant factors on the morbidity of COVID-19 was investigated by constructing a distributed lag nonlinear model, and the results were considered to be an improvement over the SEIR model. Lastly, a machine learning method was introduced to explore the nonlinear relationship between the environmental propagation probability and socio-ecological factors. By analyzing the impact of environmental factors on virus transmission, it can be found that population mobility directly caused by human activities had a greater impact on virus transmission than temperature and humidity. The heterogeneity of meteorological factors can be accounted for by the diverse climate patterns in Brazil. The improved SEIR model was adopted to explore the interconnection of COVID-19 transmission and the environment, which revealed a new strategy to probe the causal links between them.

Recurrence of Positive SARS-CoV-2 Viral RNA in Recovered COVID-19 Patients During Medical Isolation Observation (preprint)

Recently, the recurrence of positive SARS-CoV-2 viral RNA in recovered COVID-19 patients get more attention. Here we report a cohort study on the follow up of 182 recovered patients under medical isolation observation. There are 20 (10.99 %) patients out of the 182 were detected SARS-CoV-2 RNA turned positive, but none of them shows any clinical symptomatic recurrence indicating that COVID-19 has a good prognosis. Females and young patients aged under 15 have higher re-positive rate than the average, and none of the severe patients turned re-positive. Notably, most of the re-positive cases turn negative in the followed tests, suggesting that the importance of dynamic surveillance of SARS-CoV-2 RNA for infectivity assessment.

Epidemiological Characteristics of 417 patients infected with COVID-19 and 368 discharged cases among them in Shenzhen City, China (preprint)

The outbreak of Coronavirus Disease 2019 (COVID-19) is getting worse every day all over the world. The present study aimed to review the epidemiological characteristics of patients infected with COVID-19 in Shenzhen city, a super megacity of China, to provide some references for fighting to the coronavirus. We collected data of 417 patients with laboratory-confirmed COVID-19 of Shenzhen through March 7th, 2020. The epidemiological characteristics of the patients were analyzed. Besides, we collected the governmental measures of Shenzhen city, and the the dynamic changes of the epidemic outbreak. Governmental strategies such as early detection, early hospitalization and popular science etc. are effective for the prevention and control of the epidemic. Nearly 80% confirmed patients with COVID-19 in Shenzhen were in normal or mild conditions, and the mortality was less than 1%. Age, gender, exposure to source of transmission within 14 days and basic diseases are major risk factors for severe patients. Patients in characters of elder, male, with exposure of Wuhan and carried basic diseases had higher risk to be in severe condition (P<0.01; P<0.001). There were 368 patients discharged from hospital by the end of March 7th, 2020. Patients in severe conditions took more time from onset to discharge (P<0.001), so as those elder one (P<0.001) or who carried basic diseases (P<0.01). The differences of epidemiological characteristics between children and the elderly are still not clear. The nucleic acid test of some discharged patients returned to positive again, and the potential mechanisms need to be further explored. In conclusion, timely administrative intervention is necessary for prevention and control of the COVID-19 outbreak. Patients in characters of elder, male and carried basic diseases worthy more attention. The management of discharged patients, especially the investigation of the recurrence of positive SARS-CoV-2 RNA will be the focus on for the next step. Authors Bo Yuan and Ya-Wen An contributed equally to this work.