scholarly journals COVID-19 Pulmonary Pathology: The Experience of European Pulmonary Pathologists throughout the First Two Waves of the Pandemic

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 95
Author(s):  
Francesco Fortarezza ◽  
Federica Pezzuto ◽  
Paul Hofman ◽  
Izidor Kern ◽  
Angel Panizo ◽  
...  
Keyword(s):  
Patient Management ◽  
Severe Disease ◽  
Lung Lesion ◽  
Short Report ◽  
Therapeutic Approaches ◽  
Good Opportunity ◽  
Pathological Lesions ◽  
Pulmonary Pathology ◽  
Second Wave ◽  
Over Time

Autoptic studies of patients who died from COVID-19 constitute an important step forward in improving our knowledge in the pathophysiology of SARS-CoV-2 infection. Systematic analyses of lung tissue, the organ primarily targeted by the disease, were mostly performed during the first wave of the pandemic. Analyses of pathological lesions at different times offer a good opportunity to better understand the disease and how its evolution has been influenced mostly by new SARS-CoV-2 variants or the different therapeutic approaches. In this short report we summarize responses collected from a questionnaire survey that investigated important pathological data during the first two pandemic waves (spring-summer 2020; autumn-winter 2020–2021). The survey was submitted to expert lung pathologists from nine European countries involved in autoptic procedures in both pandemic waves. The frequency of each lung lesion was quite heterogeneous among the participants. However, a higher frequency of pulmonary superinfections, both bacterial and especially fungal, was observed in the second wave compared to the first. Obtaining a deeper knowledge of the pathological lesions at the basis of this complex and severe disease, which change over time, is crucial for correct patient management and treatment. Autoptic examination is a useful tool to achieve this goal.

scholarly journals Outpatient Management of COVID-19 Disease: A Holistic Patient-Centered Proposal Based on the Greek Experience

2021 ◽  
Vol 11 (8) ◽  
pp. 709
Author(s):  
Adamantia Liapikou ◽  
Eleni Tzortzaki ◽  
Georgios Hillas ◽  
Miltiadis Markatos ◽  
Ilias C. Papanikolaou ◽  
...  
Keyword(s):  
Preventive Measures ◽  
Severe Disease ◽  
Hospital Setting ◽  
Guidance Document ◽  
Outpatient Management ◽  
Patient Centered ◽  
Mild Disease ◽  
Novel Coronavirus ◽  
Second Wave ◽  
Close Contacts

Novel coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a worldwide pandemic and affected more than 227 countries or territories, resulting in more than 179 million cases with over 3.890.00 deaths, as of June 25, 2021. The Hellenic Thoracic Society (HTS) during the second wave of COVID-19 pandemic released a guidance document for the management of patients with COVID-19 in the community and in hospital setting. In this review, with guidance the HTS document, we are discussing the outpatient management of COVID-19 patients, including the preventive measures, the patients’ isolation and quarantine criteria of close contacts, the severity and risk stratification, including the decisions for advanced hospitalization, and the disease management at home in patients with mild disease and after hospital discharge for those with more severe disease.

scholarly journals Visualising regional disparities in the risk of COVID-19 at different phases of lockdown in England

2021 ◽  
pp. 0308518X2098416
Author(s):  
Yu-Wang Chen ◽  
Lei Ni ◽  
Dong-Ling Xu ◽  
Jian-Bo Yang
Keyword(s):  
United Kingdom ◽  
Sharp Increase ◽  
Regional Disparities ◽  
Local Authorities ◽  
The North ◽  
Second Wave ◽  
Over Time

Since late January 2020 when the first coronavirus case reached England, United Kingdom, the coronavirus disease 2019 (COVID-19) has spread rapidly and widely across all local authorities (LAs) in England. In this featured graphic, we visualise how COVID-19 severity changes nationally and locally from 30 January to 23 November 2020. The geo-visualisation shows that there have been large regional disparities in the severity of the outbreak, and the epicentres have shifted from Greater London, Leicester, to the North of England and remained in the North during pre-lockdown, post-lockdown, easing lockdown and second national lockdown phases. We further find that the increase in the testing capacity may partially explain the sharp increase in the confirmed cases during the second wave of the pandemic. However, the disparities in the severity of COVID-19 (i.e., confirmed cases and deaths) among LAs in England become more significant over time. It further sheds light on the necessity of establishing decisive and timely responses to cope with local pandemic situations.

scholarly journals Development of a Closed Chest Model of Chronic Myocardial Infarction in Swine: Magnetic Resonance Imaging and Pathological Evaluation

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Verónica Crisóstomo ◽  
Juan Maestre ◽  
Manuel Maynar ◽  
Fei Sun ◽  
Claudia Báez-Díaz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Function ◽  
Ethanol Administration ◽  
Chronic Myocardial Infarction ◽  
Therapeutic Approaches ◽  
Closed Chest ◽  
Postoperative Mri ◽  
Pathological Evaluation ◽  
And Training ◽  
Over Time

Our aim was to develop an easy-to-induce, reproducible, and low mortality clinically relevant closed-chest model of chronic myocardial infarction in swine using intracoronary ethanol and characterize its evolution using MRI and pathology. We injected 3-4 mL of 100% ethanol into the mid-LAD of anesthetized swine. Heart function and infarct size were assessed serially using MRI. Pigs were euthanized on days 7, 30, and 90 (n=5 at each timepoint). Postoperative MRI revealed compromised contractility and decreased ejection fraction, from 53.8% ± 6.32% to 43.79% ± 7.72% (P=0.001). These values remained lower than baseline thorough the followup (46.54% ± 11.12%, 44.48% ± 7.77%, and 40.48% ± 6.40%, resp., P<0.05). Progressive remodeling was seen in all animals. Infarcted myocardium decreased on the first 30 days (from 18.09% ± 7.26% to 9.9% ± 5.68%) and then stabilized (10.2% ± 4.21%). Pathology revealed increasing collagen content and fibrous organization over time, with a rim of preserved endocardial cells. In conclusion, intracoronary ethanol administration in swine consistently results in infarction. The sustained compromise in heart function and myocardial thinning over time indicate that the model may be useful for the preclinical evaluation of and training in therapeutic approaches to heart failure.

scholarly journals P488 The COVID19 pandemic impact on Inflammatory Bowel Disease Patients Management in a Romanian Tertiary Gastroenterology Centre

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S474-S475
Author(s):  
R Costache ◽  
R Iacob ◽  
R Vadan ◽  
T Stroie ◽  
L Gheorghe ◽  
...  
Keyword(s):  
Patient Management ◽  
Biological Therapy ◽  
Hospital Admissions ◽  
Severe Disease ◽  
Time Frame ◽  
Biological Agent ◽  
Significant Shift ◽  
Newly Diagnosed ◽  
Aminosalicylic Acid ◽  
Significant Difference

Abstract Background The IBD patients management has been challenging during the ongoing COVID-19 pandemic, due to lockdowns, limitation of access to medical facilities and new recommendations regarding patient management. The implications of the COVID-19 pandemic on IBD patient’s management were assessed in our Tertiary Gastroenterology Centre in Bucharest, Romania. Methods Using the hospital’s medical system, records of IBD patients admitted between 15th of March and 15th of August 2020 have been retrospectively reviewed and compared to a control cohort of consecutive IBD patients admitted to our unit during the corresponding period of 2019, registering the epidemiological features, patient management and the incidence of COVID-19 infection. Results 410 individual IBD cases were managed in our unit in 2020 compared to 532 in 2019, with a significant shift towards one-day hospitalization: 1059 admissions (9% ward hospitalizations, 91% one-day hospitalizations) compared to 1327 cases in the corresponding period of 2019 (17.8% ward hospitalizations, 82.2% one day hospitalizations). There was no statistically significant difference between the distribution of patient’s gender, IBD phenotype or newly diagnosed IBD cases between the two periods. A significantly lower proportion of admitted patients received 5-aminosalicylic acid (29% vs. 41.2%, p=0.0001), whereas a substantially higher number pf patients were prescribed biological therapy in 2020 in comparison to the corresponding 2019-time frame (79.5% vs 57.9%, p&lt;0.0001). The distribution of the biological agent used was significantly different, mainly due to the increase of vedolizumab prescription in 2020 (p&lt;0.0001). Among the newly diagnosed cases 50.0% had a severe disease requiring a biological agent (vs 30.2% in 2019, p&gt;0.05). Moreover, from our previously diagnosed patients, 7.1% needed the initiation of biological therapy due to disease flare-up (vs. 4.3% in 2019, p=0.003). During the study period in 2020, seven IBD patients (1.7%) were diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection, all of them with mild symptoms without impact on the IBD course. Conclusion The COVID-19 pandemic led to reorganizing medical care, restricting the hospital admissions in favour of severe IBD cases, favouring telemedicine for mild disease and optimization of treatment for moderate to severe IBD with an increased use of biologicals aimed to maximize the risk/benefit ratio. Incidence of SARS-Cov2 infection during the first wave of COVID-19 infection in our study group was 1.7% and did not adversely impact the IBD disease course.

scholarly journals Hypovitaminosis D and COVID-19

2020 ◽  
Vol 14 (4) ◽  
pp. 216-218
Author(s):  
Gabriele A. Vassallo ◽  
Sirio Fiorino ◽  
Simone Mori ◽  
Tommaso Dionisi ◽  
Giuseppe Augello ◽  
...  
Keyword(s):  
Hypovitaminosis D ◽  
Point Of View ◽  
Diagnostic Tools ◽  
Therapeutic Approaches ◽  
Front Line ◽  
New Therapeutic Approaches ◽  
Global Pandemic ◽  
Infection Disease ◽  
Coronavirus Infection ◽  
Second Wave

As the main title ‘COVID-19 revolution: a new challenge for the internist’ states, the global coronavirus infection disease 2019 (COVID-19) pandemic represented a new challenge for the internists. This paper is part of a series of articles written during the difficult period of the ongoing global pandemic and published all together in this fourth issue of the Italian Journal of Medicine, with the aim of sharing the direct experiences of those who were the first to face this severe emergency, expressing each point of view in the management of COVID-19 in relation to other diseases. Each article is therefore the result of many efforts and a joint collaboration between many colleagues from the Departments of Internal Medicine or Emergency Medicine of several Italian hospitals, engaged in the front line during the pandemic. These preliminary studies therefore cover diagnostic tools available to health care personnel, epidemiological reflections, possible new therapeutic approaches, discharge and reintegration procedures to daily life, the involvement of the disease not only in the lung, aspects related to various comorbidities, such as: coagulopathies, vasculitis, vitamin D deficiency, gender differences, etc.. The goal is to offer a perspective, as broad as possible, of everything that has been done to initially face the pandemic in its first phase and provide the tools for an increasingly better approach, in the hope of not arriving unprepared to a possible second wave. This paper in particular deals with hypovitaminosis D and COVID-19.

scholarly journals Web Application for Statistical Tracking and Predicting the Evolution of Active Cases with the Novel Coronavirus (SARS-CoV-2)

2021 ◽  
pp. 70-74
Author(s):  
Iulia Clitan ◽  
◽  
Adela Puscasiu ◽  
Vlad Muresan ◽  
Mihaela Ligia Unguresan ◽  
...  
Keyword(s):  
Neural Network ◽  
Mathematical Model ◽  
Web Application ◽  
Point Of View ◽  
The Novel ◽  
End User ◽  
First Case ◽  
Novel Coronavirus ◽  
Second Wave ◽  
Over Time

Since February 2020, when the first case of infection with SARS COV-2 virus appeared in Romania, the evolution of COVID-19 pandemic continues to have an ascending allure, reaching in September 2020 a second wave of infections as expected. In order to understand the evolution and spread of this disease over time and space, more and more research is focused on obtaining mathematical models that are able to predict the evolution of active cases based on different scenarios and taking into account the numerous inputs that influence the spread of this infection. This paper presents a web responsive application that allows the end user to analyze the evolution of the pandemic in Romania, graphically, and that incorporates, unlike other COVID-19 statistical applications, a prediction of active cases evolution. The prediction is based on a neural network mathematical model, described from the architectural point of view.

scholarly journals Quantifying the relationship between lockdowns, mobility, and effective reproduction number (Rt) during the COVID-19 pandemic in the Greater Toronto Area

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christopher Dainton ◽  
Alexander Hay
Keyword(s):  
Public Health ◽  
Secular Trend ◽  
Reproduction Number ◽  
Time Lag ◽  
Correlation Coefficients ◽  
Greater Toronto Area ◽  
Global Mobility ◽  
The Relationship ◽  
Second Wave ◽  
Over Time

Abstract Background The effectiveness of lockdowns in mitigating the spread of COVID-19 has been the subject of intense debate. Data on the relationship between public health restrictions, mobility, and pandemic growth has so far been conflicting. Objective We assessed the relationship between public health restriction tiers, mobility, and COVID-19 spread in five contiguous public health units (PHUs) in the Greater Toronto Area (GTA) in Ontario, Canada. Methods Weekly effective reproduction number (Rt) was calculated based on daily cases in each of the five GTA public health units between March 1, 2020, and March 19, 2021. A global mobility index (GMI) for each PHU was calculated using Google Mobility data. Segmented regressions were used to assess changes in the behaviour of Rt over time. We calculated Pearson correlation coefficients between GMI and Rt for each PHU and mobility regression coefficients for each mobility variable, accounting for time lag of 0, 7, and 14 days. Results In all PHUs except Toronto, the most rapid decline in Rt occurred in the first 2 weeks of the first province-wide lockdown, and this was followed by a slight trend to increased Rt as restrictions decreased. This trend reversed in all PHUs between September 6th and October 10th after which Rt decreased slightly over time without respect to public health restriction tier. GMI began to increase in the first wave even before restrictions were decreased. This secular trend to increased mobility continued into the summer, driven by increased mobility to recreational spaces. The decline in GMI as restrictions were reintroduced coincides with decreasing mobility to parks after September. During the first wave, the correlation coefficients between global mobility and Rt were significant (p < 0.01) in all PHUs 14 days after lockdown, indicating moderate to high correlation between decreased mobility and decreased viral reproduction rates, and reflecting that the incubation period brings in a time-lag effect of human mobility on Rt. In the second wave, this relationship was attenuated, and was only significant in Toronto and Durham at 14 days after lockdown. Conclusions The association between mobility and COVID-19 spread was stronger in the first wave than the second wave. Public health restriction tiers did not alter the existing secular trend toward decreasing Rt over time.

scholarly journals Evolution of case fatality rates in the second wave of coronavirus in England: effects of false positives, a Variant of Concern and vaccination.

2021 ◽  
Author(s):  
James A Ackland ◽  
Graeme J Ackland ◽  
David J Wallace
Keyword(s):  
False Positive ◽  
Age Groups ◽  
Case Fatality ◽  
Potential Effect ◽  
Time To Death ◽  
New Variant ◽  
Government Data ◽  
The Uk ◽  
Second Wave ◽  
Over Time

Objective: To track the statistical case fatality rate (CFR) in the second wave of the UK coronavirus outbreak, and to understand its variations over time. Design: Publicly available UK government data and clinical evidence on the time between first positive PCR test and death are used to determine the relationships between reported cases and deaths, according to age groups and across regions in England. Main Outcome Measures: Estimates of case fatality rates and their variations over time. Results: Throughout October and November 2020, deaths in England can be broadly understood in terms of CFRs which are approximately constant over time. The same CFRs prove a poor predictor of deaths when applied back to September, when prevalence of the virus was comparatively low, suggesting that the potential effect of false positive tests needs to be taken into account. Similarly, increasing CFRs are needed to match cases to deaths when projecting the model forwards into December. The growth of the S gene dropout VOC in December occurs too late to explain this increase in CFR alone, but at 33% increased mortality, it can explain the peak in deaths in January. On our analysis, if there were other factors responsible for the higher CFRs in December and January, 33% would be an upper bound for the higher mortality of the VOC. From the second half of January, the CFRs for older age groups show a marked decline. Since the fraction of the VOC has not decreased, this decline is likely to be the result of the rollout of vaccination. However, due to the rapidly decreasing nature of the raw cases data (likely due to a combination of vaccination and lockdown), any imprecisions in the time-to-death distribution are greatly exacerbated in this time period, rendering estimates of vaccination effect imprecise. Conclusions: The relationship between cases and deaths, even when controlling for age, is not static through the second wave of coronavirus in England. An apparently anomalous low case-fatality ratio in September can be accounted for by a modest 0.4% false-positive fraction. The large jump in CFR in December can be understood in terms of a more deadly new variant B1.1.7, while a decline in January correlates with vaccine roll-out, suggesting that vaccine reduce the severity of infection, as well as the risk.

Empirically Treated Pneumocystis Carinii Pneumonia in London, 1983–1989

1992 ◽  
Vol 3 (4) ◽  
pp. 285-287 ◽  
Author(s):  
E J Beck ◽  
P D French ◽  
M H Helbert ◽  
D S Robinson ◽  
F M Moss ◽  
...  
Keyword(s):  
Pneumocystis Carinii Pneumonia ◽  
Lymphocyte Count ◽  
Severe Disease ◽  
Pneumocystis Carinii ◽  
Fatal Outcome ◽  
Case Fatality ◽  
Medical Intervention ◽  
Arterial Oxygen ◽  
Oxygen Gradient ◽  
Over Time

For 227 episodes of Pneumocystis carinii pneumonia (PCP) treated at St Mary's between 1983 and 1989, factors predictive of fatal outcome were age, haemoglobin levels, peripheral lymphocyte count and alveolar-arterial oxygen gradient. Case fatality for the 47 empirically-treated episodes was significantly higher compared with the 180 cytologically proven episodes (55% vs 18%, χ2 = 25.7, P<0.0001). Case fatality for episodes which could not be bronchoscoped was significantly higher compared with bronchoscopy negative cases (66% vs 25%, χ2 = 4.5, P<0.05). Predictive factors for fatal outcome differed significantly for cases which could not be bronchoscoped and cytologically proven cases: haemoglobin level (10.7 g/dl vs 12.0 g/dl, P<0.001), lymphocyte count (0.64 × 109/l vs 0.87×109/l, P=0.05) and oxygen gradient (77.7 mmHg vs 58.9 mmHg, P<0.02). Such differences were not observed between bronchoscopy negative and cytologically proven cases. Case fatality decreased significantly over time ( b = –0.39, SE=0.14, P<0.05). Total and non-fatal first time episodes displayed an inverse relationship between oxygen gradient and time ( r = −0.22, P<0.006 and r = −0.24, P<0.01, respectively). Mean oxygen gradient of fatal episodes for sequential years increased significantly from 73 mmHg in 1983 to 102 mmHg in 1989 ( r = 0.92, P<0.01). This suggests that medical intervention as well as presentation with less severe disease both contributed to improved case fatality over time.

The Influence of Inhomogeneous Input Data from Different Waves on Predictive Model Development for COVID-19 ICU Patients (Preprint)

2021 ◽  
Author(s):  
Sebastian Johannes Fritsch ◽  
Konstantin Sharafutdinov ◽  
Moein Einollahzadeh Samadi ◽  
Gernot Marx ◽  
Andreas Schuppert ◽  
...  
Keyword(s):  
Machine Learning ◽  
Convex Hull ◽  
Prediction Models ◽  
Model Development ◽  
Predictive Performance ◽  
Support Vector ◽  
Good Prediction ◽  
The Impact ◽  
Second Wave ◽  
Over Time

BACKGROUND During the course of the COVID-19 pandemic, a variety of machine learning models were developed to predict different aspects of the disease, such as long-term causes, organ dysfunction or ICU mortality. The number of training datasets used has increased significantly over time. However, these data now come from different waves of the pandemic, not always addressing the same therapeutic approaches over time as well as changing outcomes between two waves. The impact of these changes on model development has not yet been studied. OBJECTIVE The aim of the investigation was to examine the predictive performance of several models trained with data from one wave predicting the second wave´s data and the impact of a pooling of these data sets. Finally, a method for comparison of different datasets for heterogeneity is introduced. METHODS We used two datasets from wave one and two to develop several predictive models for mortality of the patients. Four classification algorithms were used: logistic regression (LR), support vector machine (SVM), random forest classifier (RF) and AdaBoost classifier (ADA). We also performed a mutual prediction on the data of that wave which was not used for training. Then, we compared the performance of models when a pooled dataset from two waves was used. The populations from the different waves were checked for heterogeneity using a convex hull analysis. RESULTS 63 patients from wave one (03-06/2020) and 54 from wave two (08/2020-01/2021) were evaluated. For both waves separately, we found models reaching sufficient accuracies up to 0.79 AUROC (95%-CI 0.76-0.81) for SVM on the first wave and up 0.88 AUROC (95%-CI 0.86-0.89) for RF on the second wave. After the pooling of the data, the AUROC decreased relevantly. In the mutual prediction, models trained on second wave´s data showed, when applied on first wave´s data, a good prediction for non-survivors but an insufficient classification for survivors. The opposite situation (training: first wave, test: second wave) revealed the inverse behaviour with models correctly classifying survivors and incorrectly predicting non-survivors. The convex hull analysis for the first and second wave populations showed a more inhomogeneous distribution of underlying data when compared to randomly selected sets of patients of the same size. CONCLUSIONS Our work demonstrates that a larger dataset is not a universal solution to all machine learning problems in clinical settings. Rather, it shows that inhomogeneous data used to develop models can lead to serious problems. With the convex hull analysis, we offer a solution for this problem. The outcome of such an analysis can raise concerns if the pooling of different datasets would cause inhomogeneous patterns preventing a better predictive performance.

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