Observational Study: Application of Therapy with Equine Serum for Patients Diagnosed with COVID-19 in Tucumán, Argentina

Purpose: The objective of this work is to make an observational study of the usage in moderate or severe state COVID-19 patients of a new therapeutic commercial product obtained after immunization of horses: CoviFab® ELEA F(ab')2 fragmented equine immunoglobulins anti SARS-CoV2.Methods: Participant Centres depend on the Public Health System of Tucumán, Argentina were recruitment. Subjects were assigned to the Moderate Patient Group (MPG) and the Severe Patient Group (SPG), classified according to WHO criteria.In total, n = 84 were enrolled for this study. The subjects were divided into MPG and SPG. All participants were evaluated by physical examination and COVID-19 infection was diagnosed with positive RT-PCR. Each subject received two doses of 0.16 ml / kg, according to the subject's body weight. A generalized linear model with binomial distribution was adjusted for the number of symptoms. Data was analysed using proportion, bivariate and logistic regression. P-value was considered significant at the p< 0.05 threshold.Results: Both groups were similar in age, sex, and comorbidities. A higher proportion of patient with medical discharge was observed in MPG (91.4%) vs. SPG (55.3%) (p= 0.004). MPG showed 9 times more chance of receiving medical discharge than SPG (9.33 CI= [1.65, 52.81]; p= 0.012). Then, the chance to get medical discharge was independent of variables sex, age, and comorbidities. Conclusions: Treatment with Equine Serum in patients with moderate and severe disease of COVID-19 managed to slightly reduce hospitalization time. This treatment improved the clinical state to obtain medical discharge. The bivariate analysis showed 8 times more chance in MGP versus SGP to receive of medical discharge and this chance was independent of the pre-existent comorbidities.

Early predictors and screening tool developing for severe patients with COVID-19

Background Coronavirus disease 2019 (COVID-19) is a declared global pandemic, causing a lot of death. How to quickly screen risk population for severe patients is essential for decreasing the mortality. Many of the predictors might not be available in all hospitals, so it is necessary to develop a simpler screening tool with predictors which can be easily obtained for wide wise. Methods This retrospective study included all the 813 confirmed cases diagnosed with COVID-19 before March 2nd, 2020 in a city of Hubei Province in China. Data of the COVID-19 patients including clinical and epidemiological features were collected through Chinese Disease Control and Prevention Information System. Predictors were selected by logistic regression, and then categorized to four different level risk factors. A screening tool for severe patient with COVID-19 was developed and tested by ROC curve. Results Seven early predictors for severe patients with COVID-19 were selected, including chronic kidney disease (OR 14.7), age above 60 (OR 5.6), lymphocyte count less than < 0.8 × 109 per L (OR 2.5), Neutrophil to Lymphocyte Ratio larger than 4.7 (OR 2.2), high fever with temperature ≥ 38.5℃ (OR 2.2), male (OR 2.2), cardiovascular related diseases (OR 2.0). The Area Under the ROC Curve of the screening tool developed by above seven predictors was 0.798 (95% CI 0.747–0.849), and its best cut-off value is > 4.5, with sensitivity 72.0% and specificity 75.3%. Conclusions This newly developed screening tool can be a good choice for early prediction and alert for severe case especially in the condition of overload health service.

Cytokine storm in severe patient COVID-19 and curative plasmapheresis

Background: In the intensive care unit, the curative plasmapheresis technique is widely applied among severe patients, who show signs of both endogenous and exogenous intoxication. The impact of isovolemic isooncotic curative plasmapheresis on the status of hemoleukogram and immunological markers has not been studied yet. Material and methods: The study is retrospective, observational. The medical records of 34 COVID-19 patients from the COVID intensive care units of Timofei Mosneaga Republican Clinical Hospital who benefited from isovolemic, curative isooncotic plasmapheresis were analyzed. There were 25 complete, analyzed data sets. General data were recorded: preplasmapheresis, postplasmaphesis hemoleukogram. Results: Isovolemic, isooncotic plasmapheresis, performed in patients with severe COVID-19, SARS-CoV2 showed effects of improving the status of laboratory indices that denote the evolution and favorable prognosis of the disease. The activity of the cytokine storm decreased in both groups of patients, both in those with a mean age of up to 60 years and in those over 60 years of age, with p = 0.001. Patients over 60 years of age had a marked improvement in serum ferritin index, compared to patients in the age group up to 60 years, in the period after plasmapheresis, p = 0.043. Analogously, the level of C-reactive protein was analyzed, which clearly decreases in patients <60 years of age, compared to those> 60 years of age, p = 0.037 Conclusions: Isovolemic, isooncotic plasmapheresis is a procedure performed in severe COVID-19 (SARS-CoV-2) patients to improve the status of the cytokine storm. Moreover, the performance of the procedure in different age groups induced an improvement in the satiety of hemoleukogram and proinflammatory indices.

The Identification of the SARS-CoV-2 Whole Genome: Nine Cases Among Patients in Banten Province, Indonesia

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the strain of virus that causes coronavirus disease 2019 (COVID-19), the respiratory illness responsible for the current pandemic. Viral genome sequencing has been widely applied during outbreaks to study the relatedness of this virus to other viruses, its transmission mode, pace, evolution and geographical spread, and also its adaptation to human hosts. To date, more than 90,000 SARS-CoV-2 genome sequences have been uploaded to the GISAID database. The availability of sequencing data along with clinical and geographical data may be useful for epidemiological investigations. In this study, we aimed to analyse the genetic background of SARS-CoV-2 from patients in Indonesia by whole genome sequencing. We examined nine samples from COVID-19 patients with RT-PCR cycle threshold (Ct) of less than 25 using ARTIC Network protocols for Oxford Nanopore’s Gridi On sequencer. The analytical methods were based on the ARTIC multiplex PCR sequencing protocol for COVID-19. In this study, we found that several genetic variants within the nine COVID-19 patient samples. We identified a mutation at position 614 P323L mutation in the ORF1ab gene often found in our severe patient samples. The number of SNPs and their location within the SARS-CoV-2 genome seems to vary. This diversity might be responsible for the virulence of the virus and its clinical manifestation.

ICD-11 Personality Disorders: Utility and Implications of the New Model

The ICD-11 classification of personality disorders represents a paradigm shift in diagnosis. This was felt necessary because previous personality disorder classifications had major problems. These included unnecessary complexity, inconsistency with data on normal personality traits, and minimal consideration of severity despite this being shown to be the major predictor of outcome. The ICD-11 classification abolishes all categories of personality disorder except for a general description of personality disorder. This diagnosis can be further specified as “mild,” “moderate,” or “severe.” Patient behavior can be described using one or more of five personality trait domains; negative affectivity, dissociality, anankastia, detachment, and disinhibition. Clinicians may also specify a borderline pattern qualifier. The ICD-11 shows considerable alignment with the DSM-5 Alternative Model for Personality Disorders. Early evidence around the reliability and validity of the new model appear promising, although at present there is still limited specific evidence due to the model being so recently finalized. However, for the model to be successful, it needs to be embraced by clinicians and used widely in normal clinical practice.

A Retrospective Comparison of Hemodynamic and Clinical Outcomes between Two Differently Designed Aortic Bioprostheses for Small Aortic Annuli

The Trifecta valve has externally mounted leaflets; it differs from classic internally mounted valves (e.g., Carpentier-Edwards [C-E]). We evaluated post-implantation hemodynamics and clinical outcomes of these bioprostheses in small aortic annuli. From January 2015 to April 2019, 490 patients who underwent aortic valve replacement (AVR) were reviewed retrospectively. Altogether, 183 patients received 19 or 21 mm diameter C-E (n = 121) or Trifecta (n = 62) prostheses. To minimize confounding variables, we performed propensity-score matching analysis. The mean transvalvular pressure gradient (TVPG) was significantly lower in the Trifecta than in the C-E group at discharge (12.9 ± 4.8 vs. 15.0 ± 5.3 mmHg, p = 0.044). TVPG change over time was not significantly different between groups (p = 0.357). Left ventricular mass index decreased postoperatively (reduction: C-E, 28.1%; Trifecta, 30.1%, p = 0.879). No late mortality, severe patient–prosthesis mismatch, moderate-to-severe paravalvular leakage, structural valve degeneration, or valve thromboses were observed. Freedom from valve-related events at 3 years were similar for C-E (97.9% ± 2.1%) and Trifecta (97.7% ± 2.2%) patients (log-rank p = 0.993). Bioprosthesis design for small annuli significantly affected TVPG immediately after AVR. However, hemodynamics over time and clinical outcomes did not differ between the two designs.

Evaluation of Interaction Between Emergency Medical System and Hospital Network During a Train Derailment in Milano

On January 25, 2018 a 5-car train derailed in Pioltello, 10 kilometers North-East of Milano City. A standardized post-hoc form was distributed to the hospitals involved in the management of the victims and allowed for an evaluation of the response to the incident. The management of the incident by EMS (Emergency Medical System) was effective in terms of organization of the scene and distribution of the patients, although the time for the first severe patient to reach the closest appropriate hospital was very long (2 hours). This can be partially explained by the extrication time. None of the alerted hospitals exceeded their capacity, as patients were distributed carefully among the hospitals. The overall outcome was quite satisfactory; no deaths were reported except for those on scene. Some responding hospitals reported that there was an over-activation based on the services ultimately needed. However this is common in MCIs, as an over-activation is preferable to an under-estimation. To address this concern, as more data are available, activation should be scaled down based on a plan established prior to it; this mechanism of scaling down seems to have failed in this event. It is of note that the highest performing hospitals underwent recently to an educational program on MCI management.

PATIENT-PROSTHESIS MISMATCH IS A PREVENTABLE DISEASE BUT HOW TO PREVENT IT IS A STORY NOT YET WRITTEN

Large studies demonstrated that moderate or severe patient-prosthesis mismatch (PPM) occurs in 44.2% to 65% of patients undergoing aortic valve replacement. If there is general agreement that patients with PPM have worse outcome than patients without, it is difficult to understand how to prevent this dangerous complication. The formula used to calculate the effective orifice area (EOA) of an implanted aortic prosthesis has many weak points that produce inconsistent results using the same prosthetic valve (type and size). The observed EOA (3 to 6 months postoperatively) of a #23 biological prosthesis can range from 0.9 to 3.5 cm², making PPM prevention impossible using projected EOA, where only the mean value is reported (1.83 cm² for the same #23 biological prosthesis). An EACTS-STS-AATS Valve Labelling Task Force has been established to suggest the manufacturers to present essential information on valvular prosthesis characteristics in standardized Valve Charts. For valves used in the aortic position, Valve Charts should include a standardized PPM chart to assess the probability of PPM after implantation. This will not solve completely the conundrum of prevention, but most likely it will be a step ahead.