Undiagnosed Obstructive Sleep Apnea and Acute COVID-19 Infection—A Case Series

A recently published study on coronavirus disease 2019 (COVID-19) and obstructive sleep apnea (OSA) suggested that there might be an association between certain risk factors and comorbidities associated with OSA, which are also associated with poor COVID-19 outcomes. However, it is unclear whether undiagnosed OSA correlates with COVID-19 severity in a South Korean population. We identified 7 patients who presented with nocturnal hypoxemia during hospitalization due to COVID-19. All patients underwent polysomnography 5–9 weeks after the infection. We retrospectively collected the patients’ baseline characteristics, hospital admission data, and polysomnography findings. Of the 7 patients, all were diagnosed with OSA after COVID-19 infection. Their mean (±SD) age was 45.4±16.3 years, 57.1% were men, and their mean (±SD) body mass index was 33.4±6.0 kg/m2. Six patients presented with COVID-19-related pneumonia on chest X-rays, 3 of whom were admitted to the intensive care unit during the acute phase. The overnight polysomnography showed a mean AHI of 59.0±38.5/h and an oxygen desaturation index of 57.6±39.7/h. Undiagnosed OSA is a prevalent condition associated with moderate to severe COVID-19 infection. The study patients with sleep apnea and COVID-19 had obesity and severe oxygen desaturation but did not complain of daytime sleepiness.

Evaluating COVID-19 booster vaccination strategies in a partially vaccinated population: a modeling study.

Background. Several countries are implementing COVID-19 booster vaccination campaigns. The objective of this study was to model the impact of different primary and booster vaccination strategies. Methods. We used a compartmental model fitted to hospital admission data in France to analyze the impact of primary and booster vaccination strategies on morbidity and mortality, assuming waning of immunity and various levels of virus transmissibility during winter. Results. Strategies prioritizing primary vaccinations were systematically more effective than strategies prioritizing boosters. Regarding booster strategies targeting different age groups, their effectiveness varied with immunity and virus transmissibility levels. If waining of immunity affects all adults, people aged 30 to 49 years should be boosted in priority, even for low transmissibility levels. Discussion. Increasing the primary vaccination coverage should remain a priority. If a plateau has been reached, boosting immunity of younger adults could be the most effective strategy, especially if SARS-CoV-2 transmissibility is high.

Evaluating COVID-19 booster vaccination strategies in a partially vaccinated population: a modeling study.

Background. As evidence shows that vaccine immunity to COVID-19 wanes with time and decreases due to variants, several countries are implementing booster vaccination campaigns. The objective of this study was to analyze the morbidity and mortality burdens of different primary and booster vaccination strategies against COVID-19, using France as a case study. Methods. We used a deterministic, age-structured, compartmental model fitted to hospital admission data and validated against sero-prevalence data in France to analyze the impact of primary and booster vaccination strategies on morbidity and mortality assuming waning of immunity and increased virus transmissibility during winter. Findings. Strategies prioritizing primary vaccinations were systematically more effective than strategies prioritizing boosters. Regarding booster strategies targeting different age groups, their effectiveness varied with the levels of virus transmissibility, and according to the assumed loss of immunity for each age group. If the immunity reduction affects all age groups, people aged 30 to 49 years should be boosted in priority, even for low transmissibility levels. If the immunity reduction is restricted to people older than 65 years, boosting younger people becomes effective only above certain levels of transmissibility. Interpretation. Increasing the primary vaccination coverage should remain a priority to reduce morbidity and mortality due to COVID-19. If a plateau of primary vaccination has been reached, boosting immunity in younger age-groups could prevent more hospitalizations and deaths than boosting the immunity of older people, especially under conditions increasing SARS-CoV-2 transmissibility, or when facing new variants. Funding. The study was partially funded by the French national research agency through project SPHINX-17-CE36-0008-0.

Analysis of Covid-19 Hospital Admissions in Ivano-Frankivsk, Ukraine

The Covid-19 pandemic has a substantial impact on socioeconomic, political, demographic, and other aspects of life. Effective healthcare is, however, a primary determinant of successful fighting against Covid-19. The analysis of local healthcare indicators serves as a source for estimating pandemic magnitude and the adaptation of healthcare at a national level. In this study, the rates of Covid-19 hospital admissions to the Ivano-Frankivsk City Hospital, Ukraine, from April 2020 to May 2021 were analysed. All cases were grouped by age, sex, and the type of admission; data were analyzed monthly and seasonally. The peaks of hospital admissions were observed in November 2020 and March 2021; however, the highest mortality rates were seen from August to November 2020. The analysis of age- and sex-disaggregated Covid-19 mortality data showed the predominance of elderly males (61.9%, 66.6 ± 3.9 years) over females (38.1%, 71.8 ± 2.3 years). The ratio of hospital admissions was unstable: the percentage of emergency, GP-referred and self-referred admissions was similar from April to May 2020; however, GP-referred admissions prevailed, and the number of self-referral patients decreased twice between March and May 2021. In conclusions, the trends in hospital admissions were similar to those reported in other studies. However, the differences in time frames and socio-demographic characteristics were observed that highlights the importance of considering regional, social and geographic aspects of the population when improving the capacity of healthcare system and establishing effective preventive measures against the pandemic at the local level.

Short and Long-term Recovery after Moderate/Severe Acute Kidney Injury in patients with and without COVID-19

Introduction: Severe AKI is strongly associated with poor outcomes in COVID-19, but data on renal recovery is lacking. Methods: We retrospectively analyzed these associations in 3,299 hospitalized patients (1,338 with COVID-19 and 1,961 with acute respiratory illness but tested negative for COVID-19). Uni- and multi-variable analyses were used to study mortality and recovery after KDIGO Stage 2&3 AKI and Machine Learning (ML) for predicting AKI and recovery using admission data. Long-term renal function and other outcomes were studied in a sub-group of AKI-2/3 survivors. Results: Among the 172 COVID-19 negative patients with AKI-2/3, 74.4% had partial & 44.2% complete renal recovery, while 11.6% died. Among 255 COVID-19 positive patients with AKI-2/3, lower recovery and higher mortality were noted (50.6% partial, 24.7% complete renal recovery, 23.9% died). On multivariable analysis, ICU admission and ARDS were associated with non-recovery, and recovery was significantly associated with survival in COVID-19 positive patients. With ML, we were able to predict recovery from COVID-19-associated AKI-2/3 with an average precision of 0.62 and the strongest predictors of recovery were initial arterial paO2 & CO2, SCr, K, lymphocyte count, & CPK. At 12 months follow-up, among 52 survivors with AKI-2/3, 25.7% COVID-19 positive and 23.5% COVID-19 negative had incident or progressive CKD. Conclusions: Recovery from COVID-19-associated moderate/severe AKI, can be predicted using admission data and is associated with severity of respiratory disease and in-hospital death. The risk of CKD might be similar between COVID-19 positive and negative patients.

Hospital admission trends due to respiratory diseases in England and Wales between 1999 and 2019: an ecologic study

Background Identifying trends of hospital admissions for respiratory diseases is crucial for public health and research to guide future clinical improvements for better outcomes. This study aims to define the trends of respiratory disease-related hospital admissions (RRHA) in England and Wales between 1999 and 2019. Methods An ecological study was conducted using hospital admission data taken from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Hospital admissions data for respiratory diseases were extracted for the period between April 1999 and March 2019. The trend in hospital admissions was assessed using a Poisson model. Results Hospital admission rate increased by 104.7% [from 1535.05 (95% CI 1531.71–1538.38) in 1999 to 3142.83 (95% CI 3138.39–3147.26) in 2019 per 100,000 persons, trend test, p < 0.01]. The most common causes were influenza and pneumonia, chronic lower respiratory diseases, other acute lower respiratory infections, which accounted for 26.6%, 26.4%, and 14.9%, respectively. The age group 75 years and above accounted for 34.1% of the total number of hospital admissions. Males contributed to 50.5% of the total number of hospital admissions. Hospital admission rate in females increased by 119.8% [from 1442.18 (95% CI 1437.66–1446.70) in 1999 to 3169.38 (95% CI 3163.11–3175.64) in 2019 per 100,000 persons, trend test, p < 0.001]. Hospital admission rate increased by 92.9% in males [from 1633.25 (95% CI 1628.32–1638.17) in 1999 to 3149.78 (95% CI 3143.46–3156.09) in 2019 per 100,000 persons, trend test, p < 0.001]. Conclusion During the study period, hospital admissions rate due to respiratory diseases increased sharply. The rates of hospital admissions were higher among males for the vast majority of respiratory diseases. Further observational studies are warranted to identify risk factors for these hospital admissions and to offer relevant interventions to mitigate the risk.

Effect of the Covid-19 Pandemic on Well-Baby Nursery

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is associated with fewer deliveries and premature births; however, the impact of this pandemic on the well-baby nursery (WBN) is unknown. OBJECTIVE: To evaluate the impact of the COVID-19 pandemic on infants admitted to the WBN by comparing pandemic and pre-pandemic cohorts. STUDY DESIGN: We performed a retrospective study of infants admitted to a WBN during the pandemic period (March 18, 2020-to-March 17, 2021) and compared them to those during the pre-pandemic period (March 18, 2019-to-March 17, 2020). Maternal (age, parity, gestation, method of delivery, and COVID-19 status) and neonatal (sex, weight, Apgar score, feeding pattern, urine toxicology, and neonatal intensive care unit [NICU] admission) data were collected and compared between the two periods. The results were statistically analyzed, and significance was set at P < 0.05. RESULTS: There were 824 and 859 WBN admissions during the pandemic and pre-pandemic periods, respectively; a 4% decrease in WBN admissions during the pandemic period. During the pandemic period, the number of deliveries among nulliparous women increased (from 40.3% to 45.1%; p=0.01), and deliveries among multiparous women decreased (from 59.2% to 53.1%; p=0.01). The number of infants exposed to marijuana in-utero increased (24/149 screened vs. 12/146 screened; p=0.038), and transfers from WBN to NICU decreased (from 9% to 6%; p=0.044) during the pandemic period. CONCLUSIONS: Compared to the pre-pandemic period, the number of WBN admissions, multiparous deliveries, and NICU admissions decreased, while the number of nulliparous deliveries and infants exposed to marijuana in-utero increased during the pandemic period.

Estimating the direct Covid-19 disability-adjusted life years impact on the Malta population for the first full year

Background Disability-adjusted life years (DALYs) combine the impact of morbidity and mortality, allowing for comprehensive comparisons of the population. The aim was to estimate the DALYs due to Covid-19 in Malta (March 2020–21) and investigate its impact in relation to other causes of disease at a population level. Methods Mortality and weekly hospital admission data were used to calculate DALYs, based on the European Burden of Disease Network consensus Covid-19 model. Covid-19 infection duration of 14 days was considered. Sensitivity analyses for different morbidity scenarios, including post-acute consequences were presented. Results An estimated 70,421 people were infected (with and without symptoms) by Covid-19 in Malta (March 2020–1), out of which 1636 required hospitalisation and 331 deaths, contributing to 5478 DALYs. These DALYs positioned Covid-19 as the fourth leading cause of disease in Malta. Mortality contributed to 95% of DALYs, while post-acute consequences contributed to 60% of morbidity. Conclusions Covid-19 over 1 year has impacted substantially the population health in Malta. Post-acute consequences are the leading morbidity factors that require urgent targeted action to ensure timely multidisciplinary care. It is recommended that DALY estimations in 2021 and beyond are calculated to assess the impact of vaccine roll-out and emergence of new variants.

EP.TH.917An Audit of Compliance with NICE guidelines for Acute Cholecystitis

Background Gallstone disease is common and affects approximately 10-15% of adults. Laparoscopic Cholecystectomy (LC) is the definitive management of cholecystitis. NICE and RCS guidance recommend that in patients diagnosed with acute cholecystitis a LC should be performed during the same admission or within 7 days. We audited our compliance against these national guidelines. Methods Retrospective audit of all patients admitted with uncomplicated acute cholecystitis over a 4 month period. Patient demographics, admission details, timing of cholecystectomy, complications, follow-up, and re-admission data were collected. Results 50 patients (60% female, 40% male; mean age: 60.7 years) with acute cholecystitis were included. Mean length of stay was 4.8 days. Only 10% had a cholecystectomy within 1 week of diagnosis. Of those discharged without a LC on the index admission, 14% were readmitted with further gallstone related complications (cholangitis, pancreatitis) within 48.6 days from initial discharge. The mean time to surgery after initial discharge was 125.8 days. Conclusion There is poor compliance with NICE guidelines to perform an early LC in our cohort of patients, primarily because of the lack of Trust based guidelines. This audit demonstrates the need to develop a robust ‘hot gallbladder’ pathway within our hospital to improve current practice.