non-COVID Patients Research Articles

Clinical Characteristics and Outcomes of Patients With COVID-19 Treated in Mayo Clinic’s Advanced Care at Home Program

Objectives Mayo Clinic’s hospital-at-home program, Advanced Care at Home (ACH), launched in 2020. While hospital-at-home literature reported safe and effective care for the general patient population and those with COVID, comparative outcomes between these two groups were unknown. The aim of this retrospective analysis was to compare the outcomes of COVID and non-COVID patients enrolled in ACH and evaluate if COVID patients can be safely treated in this setting. Methods Demographics, clinical characteristics, and safety outcomes were retrospectively analyzed to compare COVID and non-COVID patients discharged from ACH between November 2020 and May 2022. Patient characteristics analyzed included severity of illness (SOI) and risk of mortality (ROM), calculated using All Patient Refined Diagnosis Related Groups (APR-DRG). Hospitalization-specific variables included length of stay (LOS), escalation of care, and 30-day readmission rates. Results Of 1051 patients, 173 (16%) had COVID, and 878 (84%) were non-COVID patients. The average age in the COVID cohort was 66.6 (15.3) years, compared with 72.2 (14.0) in the non-COVID cohort. Extreme SOI was higher in the COVID group (43.3% versus 17.4%), as was extreme ROM (46.2% versus 16.2%), but LOS was shorter (5.7 versus 7 days). Escalation of care (7.5% in COVID cohort versus 8.4%) and 30-day readmission outcomes (9.2% for COVID patients versus 12.9%) were not statistically different between the groups. Conclusions Despite higher SOI and ROM, COVID patients had shorter LOS with outcomes that were not statistically different from non-COVID patients. COVID patients can be safely and efficiently cared for in ACH.

Evaluation of the Diagnostic Utility of Urine Biomarkers Tissue Inhibitor of Metalloproteinases-2 (TIMP-2) and Insulin-like Growth Factor Binding Protein-7 (IGFBP-7) in Predicting Acute Kidney Injury and Short-term Outcomes among High-risk, Critically Ill Patients in a Tertiary Government Hospital in the Philippines.

Acute kidney injury (AKI) is a common complication of critical illness that often leads to increased mortality and morbidity. Biomarkers detect AKI earlier, providing a window of opportunity for timely intervention. Of the recent biomarkers in literature, the cell cycle arrest biomarkers tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) were found to be superior in predicting AKI. Our study aimed to evaluate the diagnostic performance of urine TIMP-2/IGFBP-7 in its ability to predict AKI and major adverse kidney events within 30 days (MAKE30) among high-risk patients for AKI. MAKE30 is a composite outcome comprised of all-cause mortality, use of renal replacement therapy (RRT), or persistent renal dysfunction at hospital discharge truncated at 30 days. We conducted a prospective, cross-sectional study which included 135 adult, non-COVID ICU patients. Baseline urine TIMP-2/IGFBP-7 results were used to dichotomize the population into low risk (<0.3 ng/mL) or high risk (≥0.3 ng/mL) for AKI. Participants were then observed for 30 days and monitored for MAKE30 outcomes. ROC curves were created to calculate the sensitivity, specificity, NPV, PPV, and the AUC of the 0.3 ng/mL cut-off to predict the AKI and MAKE30. Urine TIMP-2/IGFBP-7 cutoff of 0.3 ng/mL predicted AKI with a sensitivity of 82.4%, specificity of 79.2%, PPV of 57.1%, NPV of 93% and AUC of 0.81. MAKE30 was detected with a sensitivity of 62.8%, specificity of 76.1%, PPV of 55.1%, NPV of 81.4% and AUC of 0.69. Elevated levels of urine TIMP-2/IGFBP-7 were found to be associated with AKI (p<0.01), MAKE30 (p<0.01) and all of its subcomponents. Survival or discharge after 30 days were found to be associated with lower urine TIMP-2/IGFBP-7 levels (p<0.01). Urine TIMP-2/IGFBP-7, at its current cut-off at 0.3 ng/mL, can predict the likelihood of developing AKI and major adverse kidney events among high-risk patients for AKI. It can serve as a useful adjunct to existing methods, such as serum creatinine, in the early diagnosis and prognosis of acute kidney injury and expanding the therapeutic window to prevent disease progression and improve outcomes.

Identification of host endotypes using peripheral blood transcriptomics in a prospective cohort of patients with endocarditis

ObjectivesHost responses to infection are a major determinant of outcome. However, the existence of different response profiles in patients with endocarditis has not been addressed. Our objective was to apply transcriptomics to identify endotypes in patients with infective endocarditis. MethodsA total of 32 patients with infective endocarditis were studied. Clinical data and blood samples were collected at diagnosis and RNA sequenced. Gene expression was used to identify two clusters (endocarditis endotype 1 [EE1] and endocarditis endotype 2 [EE2]). RNA sequencing was repeated after surgery. Transcriptionally active cell populations were identified by deconvolution. Differences between endotypes in clinical data, survival, gene expression, and molecular pathways involved were assessed. The identified endotypes were recapitulated in a cohort of COVID-19 patients. ResultsA total of 18 and 14 patients were assigned to EE1 and EE2, respectively, with no differences in clinical data. Patients assigned to EE2 showed an enrichment in genes related to T-cell maturation and a decrease in the activation of the signal transducer and activator of transcription protein family pathway, with higher counts of active T cells and lower counts of neutrophils. A total of 14 patients (nine in EE1 and five in EE2) were submitted to surgery. Surgery in EE2 patients shifted gene expression toward a EE1-like profile. In-hospital mortality was higher in EE1 (56% vs 14%, P = 0.027), with an adjusted hazard ratio of 12.987 (95% confidence interval 3.356-50). Translation of these endotypes to COVID-19 and non–COVID-19 septic patients yielded similar results in cell populations and outcome. ConclusionsGene expression reveals two endotypes in patients with acute endocarditis, with different underlying pathogenetic mechanisms, responses to surgery, and outcomes.

Decreased Protein C Pathway Activity in COVID-19 Compared to Non-COVID Sepsis: An Observational and Comparative Cohort Study.

Sepsis-associated coagulopathy increases risk of mortality. Impairment of the anticoagulant protein C (PC) pathway may contribute to the thrombotic phenotype in coronavirus disease 2019 (COVID-19) sepsis. This study assessed the functionality of this pathway in COVID-19 and non-COVID sepsis by measuring its key enzymes, thrombin and activated PC (APC). The study population included 30 patients with COVID-19, 47 patients with non-COVID sepsis, and 40 healthy controls. In healthy controls, coagulation activation and subsequent APC formation was induced by 15 µg/kg recombinant activated factor VII one hour before blood sampling. APC and thrombin in plasma were measured using oligonucleotide-based enzyme capture assays. The indirect thrombin markers prothrombin-fragment 1+2 (F1+2) and thrombin-antithrombin complex (TAT) were also measured. Compared with stimulated healthy controls, median thrombin, F1+2, and TAT levels were higher in patients with COVID-19 (up to 6-fold, p < 2 × 10-6) and non-COVID sepsis (up to 4.7-fold, p < 0.010). APC levels were 2.4-fold higher in patients with COVID-19 (7.44 pmol/L, p = 0.011) and 3.4-fold higher in non-COVID sepsis patients (10.45 pmol/L, p = 2 × 10-4) than in controls (3.08 pmol/L). Thrombin markers and APC showed correlation in both COVID-19 (r = 0.364-0.661) and non-COVID sepsis patients (r = 0.535-0.711). After adjustment for PC levels, median APC/thrombin, APC/F1+2, and APC/TAT ratios were 2-fold (p = 0.036), 6-fold (p = 3 × 10-7) and 3-fold (p = 8 × 10-4) lower in the COVID-19 group than in the non-COVID sepsis group, and the latter two were also lower in the COVID-19 group than in stimulated healthy controls. In conclusion, it was found that a comparatively lower anticoagulant APC response in COVID-19 patients as compared to non-COVID sepsis patients, potentially linked to endothelial dysfunction, contributes to the prothrombotic phenotype of COVID-19 sepsis.

Is it possible to predict persistent acute kidney injury in critically ill patients with COVID-19 infection?

Critically ill patients with coronavirus disease 2019 (COVID-19) often face a heightened risk of morbidity and mortality, particularly due to complications such as acute kidney injury (AKI). While the persistent acute kidney injury risk index (PARI) has shown promise in predicting the risk of persistent AKI (pAKI) in non-COVID patients, its effectiveness in critically ill COVID-19 patients remains to be explored. We aimed to evaluate the predictive power of the PARI in identifying pAKI and its prognostic significance in terms of clinical outcomes. This was a single-center retrospective study of patients with COVID-19 admitted at our 36-bed tertiary intensive care unit between April and December 2020. There were 152 patients who fulfilled our inclusion criteria. Fifty seven (37.5%) had developed AKI and 16 (10.25%) had developed pAKI. Vasopressor, mechanical ventilation and renal replacement therapy (RRT) requirement, sequential organ failure assessment (SOFA), and PARI were significantly higher in patients who developed pAKI than those who did not. The PARI were significantly higher in patients with short-term mortality compared to survivors. The area under the receiver operating characteristic (ROC) curve (AUC) of the PARI score for predicting pAKI was 0.66 (95% CI: 0.53-0.79), whereas short-term mortality was 0.733 (95% CI, 0.65-0.81). The PARI score was evaluated as simple, useful, and reliable in predicting pAKI in severe cases with COVID-19; and therefore, pAKI and its related RRT complications can be prevented with protective interventions. Further comprehensive studies are warranted to deepen our understanding of this relationship.

Acute Vascular Complications of VA-ECMO in COVID-19 Patients. Does COVID-19 Affect the Outcome?

Extracorporeal membrane oxygenation (ECMO) through the femoral artery and vein can lead to significant vascular complications. We retrospectively studied the acute vascular complications of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) in COVID-19 patients compared to non-COVID patients during the period from January 2020 to July 2023. Seventy-eight patients underwent VA-ECMO for various indications from January 2020 to July 2023. The studied patients had a mean age of 59.6 ± 6.9 years for non-COVID patients (38 patients), and 62.2 ± 7.6years for COVID patients (40 patients), with a P = 0.268. In non-COVID patients, The baseline characteristics were similar in both groups. The primary indications for ECMO were cardiac diseases, followed by respiratory failure (78.9% vs 10.5%). Conversely, in COVID patients, respiratory failure due to COVID-19 infection was the main indication (45% vs 40%). The overall incidence of general complications, including cerebrovascular stroke, acute kidney injury, intracardiac thrombi, and wound infection, was comparable in both groups (31.6% vs 45%). The overall incidence of vascular complications in both groups was 33.3%. Ipsilateral acute lower limb ischemia occurred in 5.3% vs 10% of non-COVID and COVID patients, respectively. Thrombosis of the distal perfusion catheter (DPC) occurred in 10.5% vs 15%, respectively. During the COVID-19 pandemic, an increasing number of patients required VA-ECMO due to associated respiratory failure. Patients undergoing VA-ECMO are at high risk of developing various vascular complications. COVID-19 significantly increases the risk of acute limb ischemia and distal perfusion catheter thrombosis in both upper and lower limbs. However, other VA-ECMO-related vascular complications are comparable between COVID-19 and non-COVID patients.

Tele-medicine controlled hospital at home is associated with better outcomes than hospital stay.

Hospital-at-home (HAH) is increasingly becoming an alternative for in-hospital stay in selected clinical scenarios. Nevertheless, there is still a question whether HAH could be a viable option for acutely ill patients, otherwise hospitalized in departments of general-internal medicine. This was a retrospective matched study, conducted at a telemedicine controlled HAH department, being part of a tertiary medical center. The objective was to compare clinical outcomes of acutely ill patients (both COVID-19 and non-COVID) admitted to either in-hospital or HAH. Non-COVID patients had one of three acute infectious diseases: urinary tract infections (UTI, either lower or upper), pneumonia, or cellulitis. The analysis involved 159 HAH patients (64 COVID-19 and 95 non-COVID) who were compared to a matched sample of in-hospital patients (192 COVID-19 and 285 non-COVID). The median length-of-hospital stay (LOS) was 2 days shorter in the HAH for both COVID-19 patients (95% CI: 1-3; p = 0.008) and non-COVID patients (95% CI; 1-3; p < 0.001). The readmission rates within 30 days were not significantly different for both COVID-19 patients (Odds Ratio (OR) = 1; 95% CI: 0.49-2.04; p = 1) and non-COVID patients (OR = 0.7; 95% CI; 0.39-1.28; p = 0.25). The differences remained insignificant within one year. The risk of death within 30 days was significantly lower in the HAH group for COVID-19 patients (OR = 0.34; 95% CI: 0.11-0.86; p = 0.018) and non-COVID patients (OR = 0.38; 95% CI: 0.14-0.9; p = 0.019). For one year survival period, the differences were significant for COVID-19 patients (OR = 0.5; 95% CI: 0.31-0.9; p = 0.044) and insignificant for non-COVID patients (OR = 0.63; 95% CI: 0.4-1; p = 0.052). Care for acutely ill patients in the setting of telemedicine-based hospital at home has the potential to reduce hospitalization length without increasing readmission risk and to reduce both 30 days and one-year mortality rates.

The role of telemedicine during and beyond the COVID-19 pandemic: shaping our future health organisations and practices

Purpose In France, telemedicine was integrated into the Code of Public Health in 2009, but adoption and use were slow until the beginning of the COVID-19 health crisis, when telemedicine arguably became the only way to ensure continuity of care for non-COVID patients, reduce viral transmission and streamline strained medical resources. Despite growing enthusiasm, criticism persists. Design/methodology/approach User satisfaction will be essential for the sustainability and development of telemedicine, yet this remains an under-researched area. Framed by the first lockdown in France (March–May 2020), this two-step mixed-methods study uses secondary quantitative data (n users = 2,511; n doctors = 254; n nurses = 248) and primary qualitative interviews (n = 5) among healthcare professionals and patients in France to analyse satisfaction levels among telemedicine users. Implementing an inductive approach, it identifies key themes in the adoption and use of telemedicine, the impact on user satisfaction and evolution in perceptions over time. Findings The findings contribute to the literature by identifying and explaining the shift in telemedicine practices and offering recommendations for addressing ongoing obstacles through pragmatic strategies. Originality/value This research addresses a gap in knowledge to examine the impact of the COVID-19 pandemic on the uptake, perception and satisfaction of telemedicine experienced by users. Recognising telemedicine as a complex innovation in conceptual and practical terms, this paper investigates the degree of acceptance among users and the process of assimilation in the system.

The Impact of the COVID-19 Pandemic and Lockdown on the Outcome of Glioblastoma.

Rapid spread of the SARS-CoV-2 pandemic in 2020 led to an indirect effect on non-COVID patients. Since neuro-oncology cases are unique and brain tumors need a specific therapeutic protocol at proper doses and at the right times, the effects of the pandemic on health care services for patients with glioblastomas (GBs) and their impact on overall survival (OS) and quality of life are not yet known. We conducted a retrospective study of 142 GB patients who underwent surgery, radiation, and chemotherapy before and after the lockdown period, aiming to determine the differences in access to care, treatment modality, and adjuvant therapies, and how the lockdown changed the prognosis. The number of procedures performed for GB during the pandemic was comparable to that of the prepandemic period, and patients received standard care. There was a significant difference in the volume of lesions measured at diagnosis with a decreased number of "accidental" diagnoses and expression of a reduced use by the patient for a checkup or follow-up examinations. Patients expressed a significantly lower performance index in the lockdown period with longer progression-free survival (PFS) in the face of a comparable mean time to OS. Patients treated surgically for GB during the pandemic period had a more pronounced and earlier reduction in performance status than patients treated during the same period the year before. This appears to be primarily due to lower levels of care in the rehabilitation centers and more frequent discontinuation of adjuvant care.

A Retrospective Cohort Analysis of Analgosedation Requirements in COVID-19 Compared to Non-COVID-19 Extracorporeal Membrane Oxygenation Patients.

Reports have described increased sedation requirements in patients with acute respiratory distress syndrome (ARDS) while on extracorporeal membrane oxygenation (ECMO) and for intubated COVID-19 patients. Thus, the objective of this study was to assess the analgosedation requirements of COVID-19 patients receiving ECMO compared to non-COVID-19 ECMO patients. This retrospective, observational cohort study included adult patients with ARDS requiring venovenous or venopulmonary arterial ECMO admitted to a single intensive care unit from January 2017 to December 2021. Patients were categorized as COVID-19 ECMO or non-COVID-19 ECMO. The primary outcome was median daily dosing of parenteral analgosedative medications. Pertinent secondary outcomes included incidence of extubation or tracheostomy and change in sedation following tracheostomy or addition of oral agents. A total of 109 patients were evaluated; 63 COVID-19 ECMO patients and 46 non-COVID ECMO patients. The primary outcome was statistically higher in the COVID-19 compared to non-COVID-19 patients for propofol (4131.0 mg vs 2704.8 mg, P < .001), dexmedetomidine (1581.4 mcg vs 1081.3 mcg, P = .016), and parenteral morphine equivalents ([PME], 209.3 mg vs 154.1 mg, P = .027), but only propofol remained significant after adjustment for weight (31.1 mcg/kg/day vs 37.7 mcg/kg/day, P = .014). COVID-19 was significantly associated with increased propofol and PME requirements after adjustment for confounders on linear regression analysis. COVID-19 patients had more days with non-zero dose for propofol (8 days vs 7 days), dexmedetomidine (13 days vs 8.5 days), and PME (17 days vs 8.5 days). The only interventions that were associated with reductions in propofol dose were tracheostomy and antipsychotics. COVID-19 patients on ECMO had significantly longer durations and higher doses of propofol, dexmedetomidine, and parenteral opioids over the first 28 days of cannulation. The only interventions that were associated with statistical reductions in propofol were antipsychotics and tracheostomy.

Aspergillosis in Critically Ill Patients with and Without COVID-19 in a Tertiary Hospital in Southern Brazil.

The impact of invasive pulmonary aspergillosis (IPA) on non-neutropenic critically ill patients in intensive care units (ICU) has been demonstrated in recent decades. Furthermore, after the start of the COVID-19 pandemic, COVID-19 associated with pulmonary aspergillosis (CAPA) has become a major concern in ICUs. However, epidemiological data from different regions are scarce. We evaluated the prevalence and clinical-epidemiological data of IPA in patients with COVID-19 requiring mechanical ventilation (MV) in the ICU ("severe COVID-19") and non-COVID ICU patients in MV of a tertiary hospital in the southern region of Brazil. Eighty-seven patients admitted between June 2020 and August 2022 were included; 31 with severe COVID-19. For the diagnosis of IPA or CAPA, algorithms including host factors and mycological criteria (positive culture for Aspergillus spp., immunoassay for galactomannan detection, and/or qPCR) were utilized. The overall incidence of IPA and CAPA in our ICU was 73 cases/1000 ICU hospitalizations. Aspergillosis occurred in 13% (4/31) of the COVID-19 patients, and in 16% (9/56) of the critically ill patients without COVID-19, with mortality rates of 75% (3/4) and 67% (6/9), respectively. Our results highlight the need for physicians enrolled in ICU care to be aware of aspergillosis and for more access of the patients to sensitive and robust diagnostic tests by biomarkers detection.

COVID vs. non-COVID oncology patient cohorts: Demographics and cancer variables.

e23046 Background: This study aimed to compare demographics and cancer-specific variables in oncology patients hospitalized with (n = 551) and without COVID-19 (n = 3674) during the first year of the pandemic. Methods: We analyzed prospectively collected data from March 2020 to February 2021 at a major US cancer center, comparing age, sex, cancer category, race, metastasis, treatments within one month prior to admission, and smoking history. Results: The study found no significant difference in mean age between COVID and non-COVID cohorts (60.7% vs. 60.9%; p = 0.830). Significant differences (p = 0.002) in cancer categories were noted between COVID and non-COVID cohorts. Hematological cancers had the highest hospitalization rates in both groups (38.8% vs 29.2%). Statistically significant racial differences were observed between COVID and non-COVID cohorts (p &lt; 0.001). Whites had the highest hospitalization rates in both groups, yet COVID-related admissions were lower for Whites (COVID cohort: 51.2% vs non-COVID cohort: 61.9%) and Asians (COVID cohort: 2.7% vs non-COVID cohort: 5.9%) compared to non-COVID admissions, while higher for Blacks (COVID cohort: 15.4% vs non-COVID cohort: 14%) and Hispanics (COVID cohort: 28.3% vs non-COVID cohort: 15.7). Significant differences (p &lt; 0.001) were noted in metastasis prevalence between COVID and non-COVID hospitalizations, with rates of 81.3% and 86.0%, respectively. Conversely, non-metastatic cancer was more prevalent in COVID hospitalizations (18.1%) than in the non-COVID cohort (8.7%). In the COVID cohort, 30.5% received chemotherapy within one month before admission, compared to 43.8% in the non-COVID cohort, showing a significant difference in admission rates (p &lt; 0.001). Similarly, recent immunotherapy (8.0% vs. 10.9%) and recent surgery (3.6% vs. 6.6%) were associated with higher hospitalization rates in the non-COVID cohort (p = 0.046 and p = 0.010, respectively). We observed significant differences (p &lt; 0.001) in the smoking history of the COVID and. non-COVID cohorts. While 2.5% of COVID patients were current smokers, 5.4% of non-COVID patients were, more than double the COVID rate. In the COVID cohort, 36.3% were former smokers, slightly lower than the 37.6% in the non-COVID cohort. Additionally, 59.3% of COVID patients were never smokers, compared to 56.3% in the non-COVID group. Conclusions: COVID-related admissions were lower for Whites and Asians compared to non-COVID admissions, while higher for Blacks and Hispanics. Lower rates of metastasis were noted in COVID cohort. Lower rates of hospitalizations among patients who received chemotherapy, immunotherapy, and surgery were observed in the COVID cohort. The smoking prevalence was higher in the non-COVID group, former smoking rates were similar across cohorts, and a higher proportion of COVID patients were never smokers.

Specific sequelae symptoms of COVID-19 of Omicron variant in comparison with non-COVID-19 patients: a retrospective cohort study in Japan.

The specific long-term sequela of coronavirus disease 2019 (COVID-19), also known as long COVID of the Omicron variant remain unclear, due to a lack of cohort studies that include non-COVID patients with cold-like symptoms. The study was conducted to examine specific sequelae symptoms after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, which is considered the Omicron variant, compared with patients who were never-infected. In this retrospective cohort study, we sent questionnaires in November 2022, targeting those who visited our fever outpatient unit of a single institution from July to September 2022. SARS-CoV-2 infection status was determined by SARS-CoV-2 polymerase chain reaction (PCR) test results during the study period collected in electronic medical records. Clinical characteristics at 30 days or more since the date of SARS-CoV-2 PCR test were assessed by the questionnaires. Multiple logistic regression was performed to investigate the independent association between SARS-CoV-2 infection and possible sequelae symptoms. In total, valid responses were received from 4,779 patients (mean age: 41.4 years, standard deviation: 19.8 years old). Among them, 3,326 (69.6%) and 1,453 (30.4%) were SARS-CoV-2 PCR test positive and never-infected, respectively. We found that patients with SARS-CoV-2 infection were more likely to have a loss of taste or smell [odds ratio (OR) 4.55, 95% confidence interval (CI): 1.93, 10.71], hair loss (OR 3.19, 95% CI: 1.67, 6.09), neurocognitive symptoms (OR 1.95, 95% CI: 1.43, 2.65), and respiratory symptoms (OR 1.23, 95% CI: 1.03, 1.47) than never-infected patients. SARS-CoV-2 infection was not associated with common cold symptoms, chronic physical distress, or diarrhea as sequelae symptoms. Further, SARS-CoV-2 vaccination showed protective effects on sequelae of loss of taste or smell and hair loss. Loss of taste or smell, hair loss, neurocognitive symptoms, and respiratory symptoms were found to be specific sequelae of the SARS-CoV-2 Omicron variant. It is important not to miss these symptoms that follow SARS-CoV-2 infection and to recognize and manage the long COVID.

Comparing effectiveness of physiotherapy versus drug management on fatigue, physical functioning, and episodic disability for myalgic encephalomyelitis in post-COVID-19 condition: a study protocol of randomized control trial

BackgroundPhysiotherapy interventions effectively improved fatigue and physical functioning in non-COVID patients with myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). There is a research gap on the effectiveness of physiotherapy interventions versus drug management on ME/CFS in post-COVID-19 conditions (PCC).MethodsWe planned a three-arm prospective randomized control trial on 135 PCC cases with ME/CFS who are diagnosed between 20 November 2023 and 20 May 2024 from a population-based cohort. The study aims to determine the effectiveness of physiotherapy interventions as adapted physical activity and therapeutic exercise (APTE) provided in institution-based care versus telemedicine compared with drug management (DM). Participants will be assigned to three groups with the concealed location process and block randomization with an enrollment ratio of 1:1:1. The post-treatment evaluation will be employed after 2 months of interventions, and follow-up will be taken after 6 months post-intervention. The Chalder fatigue scale will measure the primary outcome of fatigue. SF-36 and the disability-adjusted life years (DALYs) will measure the secondary outcome of physical functioning and episodic disability.DiscussionThis study will address the research gap to determine the appropriate approach of physiotherapy or drug management for ME/CFS in PCC cases. The future direction of the study will contribute to developing evidence-based practice in post-COVID-19 condition rehabilitation.Trial registrationThe trial is registered prospectively from a primary Clinical Trial Registry side of WHO CTRI/2024/01/061987. Registered on 29 January 2024.

Sonographic assessment of the diaphragm in COVID 19 and non-COVID ICU patients

BackgroundSonographic evaluation of the diaphragm has gained popularity in the ICU due to the necessity of assessing diaphragmatic function in a variety of clinical situations. The sonographic examination of diaphragmatic dynamics in ICU patients by measuring diaphragmatic thickness and excursion in connection to various modalities of mechanical ventilation (MV) and patient outcomes was the objective of this study.MethodsThis prospective observational study was carried out on 50 patients in respiratory ICU in Kafr Elsheikh and Benha University Hospitals. Patients were classified into 2 equal groups: COVID-19 group and non-COVID group. All patients underwent ultrasound assessment included the diaphragm thickness fraction and excursion in ICU patients on admission and on weaning.ResultsSuccessful weaning (SW) was higher in group I compared to group II. In group I (COVID), diaphragm excursion, thickness at end inspiration and at end expiration in NIV at weaning were significantly higher in patients with SW but thickness at end expiration on admission was significantly lower. In group II (non-COVID) MV patients, excursion at weaning was significantly higher in patients with SW, also were thickness at end inspiration and end expiration on admission, thickness at end inspiration and end expiration at weaning in NIV patients but thickness at end inspiration in MV on admission was significantly lower.ConclusionWeaning success and mortality were significantly predicted by excursion in NIV at weaning, thickness at end inspiration in MV at weaning, thickness at end inspiration in NIV at weaning, and thickness at end expiration in MV at weaning.

Efficacy of Blood Utilization in Elective Surgery for Non-COVID Patients during COVID-19 Outbreaks

Objective: This study aimed to evaluate the pattern of blood transfusion requests and utilization in non-coronavirus disease (COVID) patients having undergone elective surgeries during the COVID-19 pandemic. Material and Methods: The pattern of blood transfusion requests and utilization for elective surgical procedures in six departments of a University Hospital; between January 2020 and December 2021, were retrospectively evaluated. The cross-match-to transfusion (C/T) ratio, transfusion probability (%T), transfusion index (Ti), and maximum surgical blood order schedule (MSBOS) were calculated. Results: A total of 15,030 patients underwent elective surgery. Among the 14,426 units of blood requested, 12,776 (89%) units were cross-matched preoperatively for 5,799 (39%) patients, and an additional 1,650 (11%) units were requested for 394 (2.6%) patients intraoperatively. Among these, 4,588 (32%) units were transfused to 1,710 (11.4%) patients. The overall C/T ratio, %T, and Ti were 2.78, 29.5%, and 0.79, respectively. Blood utilization indices for each department varied substantially according to the type of surgery, with blood utilization indices being unfavorable for 68 (80%) of the 85 procedures. The MSBOS was 0 for 32 procedures. Conclusion: Over-ordering of blood units for elective surgical procedures remained common during the COVID-19 pandemic. The blood utilization indices showed substantial variations according to the type of surgical procedures. The MSBOS has been formulated to assist in future decision-making.

Comparable Psychotropic Prescription Rates After Hospital Discharge Between Patients with COVID-19 and Those With Non-COVID-19-Related Respiratory Infection.

Whether psychiatric symptoms after recovery from coronavirus disease 2019 (COVID-19) are specific to this illness remains unclear. In this retrospective study, the Diagnosis Procedure Combination data and outpatient clinic data were used for patients who received inpatient treatment in Saiseikai-affiliated hospitals for COVID-19 or other respiratory tract infections (non-COVID) from 2020 to 2022. The primary outcome was new prescriptions of psychotropic drugs after discharge (i. e., prescriptions of psychotropics to patients who had not received them before or during their hospitalization). Values of interest were compared between groups using the chi-square test or Fisher's exact test. A COX proportional-hazards model was used to examine factors associated with psychotropic prescriptions after discharge in age- and sex-matched COVID-19 and non-COVID patients. Of 31,993 chart records, 19,613 were excluded due to a positive history with psychiatric disorders (n=2,445), prescriptions of psychotropics (n=744), and no follow-ups (n=16,424). Thus, 3,648 COVID-19 and 8,732 non-COVID patients were included (mean [range] duration of follow-up, days: 146.9 [1-727] and 239.2 [1-729], respectively). Two hundred and four (5.6%) of the 3,648 patients with COVID-19 received psychotropic prescriptions after discharge. No statistically significant differences were observed in the prescription rates of any psychotropic category between the COVID-19 and non-COVID groups. An increase in severity during hospitalization was significantly associated with more frequent psychotropic prescriptions (hazard ratio 1.83, p<0.001). The development of psychiatric symptoms should be closely observed, especially in patients who experienced increased severity during hospitalization, regardless of whether they suffered from COVID-19.

Impact of COVID-19 on posttraumatic stress disorder in ICU survivors: a prospective observational comparative cohort study

BackgroundPosttraumatic stress disorder (PTSD) after a stay in the intensive care unit (ICU) can affect one in five ICU survivors. At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, admission to the ICU for COVID-19 was stressful due to the severity of this disease. This study assessed whether admission to the ICU for COVID-19 was associated with a higher prevalence of PTSD compared with other causes of ICU admission after adjustment for pre-ICU psychological factors.MethodsThis prospective observational comparative cohort study included 31 ICUs. Eligible patients were adult ICU survivors hospitalized during the first wave of COVID-19 pandemic in France, regardless of the reason for admission. The prevalence of presumptive diagnosis of PTSD at 6 months was assessed using the PTSD Checklist for DSM-5 (PCL-5). Sociodemographics, clinical data, history of childhood trauma (Childhood Trauma Questionnaire [CTQ]), and exposure to potentially traumatic events (Life Events Checklist for DSM-5 [LEC-5]) were assessed.ResultsOf the 778 ICU survivors included during the first wave of COVID-19 pandemic in France, 417 and 361 were assigned to the COVID-19 and non-COVID-19 cohorts, respectively. Fourteen (4.9%) and 11 (4.9%), respectively, presented with presumptive diagnosis of PTSD at 6 months (p = 0.976). After adjusting for age, sex, severity score at admission, use of invasive mechanical ventilation, ICU duration, CTQ and LEC-5, COVID-19 status was not associated with presumptive diagnosis of PTSD using the PCL-5. Only female sex was associated with presumptive diagnosis of PTSD. However, COVID-19 patients reported significantly more intrusion and avoidance symptoms than non-COVID patients (39% vs. 29%, p = 0.015 and 27% vs. 19%, p = 0.030), respectively. The median PCL-5 score was higher in the COVID-19 than non-COVID-19 cohort (9 [3, 20] vs. 4 [2, 16], p = 0.034).ConclusionAdmission to the ICU for COVID-19 was not associated with a higher prevalence of PTSD compared with admission for another cause during the first wave of the COVID-19 pandemic in France. However, intrusion and avoidance symptoms were more frequent in COVID-19 patients than in non-COVID-19 patients.Trial Registration: Clinicaltrials.gov Identifier NCT03991611, registered on June 19, 2019.

Symptom intensity of post-COVID and long COVID syndromes in patients entering rehabilitation treatment.

The problem of post-COVID symptoms is still being analysed. Many of them may be related to other conditions, but the new appearance and greater intensity of some of them, e.g. fatigue, musculoskeletal pain, and neuropathic pain, seem to be related to a previous viral infection. Efforts are being made to determine in more detail the most characteristic symptoms of post-COVID syndrome. The conditions of rehabilitation after COVID-19 provide an opportunity for such observations. In rehabilitation centres and sanatoriums, it is possible to compare patients with post-COVID syndrome and other patients referred for rehabilitation, who constitute a natural control group. Such a comparison is the aim of the present work. The study included 59 post-COVID-19 patients and 57 sanatorium patients without COVID (non-COVID group) as a control group. The 31-element questionnaire ("Post-COVID syndrome symptoms assessment card") was part of the routine management of post-COVID patients referred for rehabilitation after symptomatic SARS-CoV-2 infection in Polish conditions. In the control group, the questionnaire was introduced as a part of a physical examination and an interview regarding the symptoms reported by the patient before standard rehabilitation. The questions were scored in the scale from 0 to a maximum of 10 points. Each patient gave informed consent to the use of the questionnaire for research purposes. Symptoms of the highest intensity in the COVID-19 group were: feeling unwell after physical effort (avg. 6.25 points), chronic fatigue (avg. 5.97 points), dyspnoea on exertion (avg. 5.83 points), concentration disturbances (avg. 4.93), muscle pain (avg. 4.92), joint pain (avg. 4.86), memory disorders (avg. 4.81 points), sleep disorders (avg. 4.05 points), numbness of the limbs (avg. 3.73 points), tingling in the limbs (avg. 3.68 points).Symptoms of highest intensity in patients in the non-COVID-19 group: joint pain (avg. 4.61 points), tingling in the limbs (avg. 2.84 points), numbness of the limbs (avg. 2.79 points), muscle pain (avg. 2.11 points).There was no statistically significant difference between the group under examination and the control group in the following symptoms: fever, diarrhoea, abdominal pain, resting dyspnoea, olfactory disorders, joint pain, tingling in the limbs and numbness of the limbs. The results of this study show symptoms of the highest intensity with post-COVID syndromes. However, also symptoms that are a problem both in post-COVID and non-COVID patients, i.e. joint pain, tingling in and numbness of the limbs were identified. This confirms that the control non-COVID group consisted of patients referred for rehabilitation treatment mainly due to musculoskeletal problems and chronic pain.

Outcome Comparison in Hospitalized COVID-19 Patients With and Without AKI.

Patients hospitalized with COVID-19 have a higher incidence of Acute Kidney Injury (AKI) compared with non-COVID patients. Previous observational studies showed AKI in hospitalized patients with COVID-19 was associated with significant increased mortality rate. We conducted a retrospective cohort study in a large mid-Atlantic health system to investigate whether COVID-19 associated AKI during hospitalization would lead to worse outcomes in a predominant Black patient population, compared to COVID-19 without AKI. We reviewed health records of patients (aged≥18 years) admitted with symptomatic COVID-19 between March 5, 2020, and Jun 3, 2020, in 9 acute care facilities within the MedStar Health system. Patients were followed up until 3 months after discharge. Primary outcome was inpatient mortality. Secondary outcomes were need for ICU level of care, need for intubation, length of ICU stay, length of hospital stay, need for renal replacement therapy, recovery of renal function. Among 1107 patients admitted with symptomatic COVID-19, the AKI incidence rate was 35 %. African American patients made up 63 % of the total patient population and 74 % of the total AKI population. Inpatient mortality in the AKI group and the non-AKI group was 163 (41.9 %) and 71 (9.9 %), respectively. COVID-19 patients with AKI had significant higher risk of in-patient mortality (OR, 4.71 [95 % CI, 3.38-6.62], P < 0.001), ICU admission (OR, 4.27 [95 % CI, 3.21-5.72], P < 0.001) and need of intubation (OR, 6.18 [95 % CI, 4.45-8.68], P < 0.001). AKI in hospitalized patients with COVID-19 was associated with higher mortality rate, need for intubation and ICU admission compared to COVID-19 patients without AKI group.