Noninvasive ventilation in COVID-19 patients aged ≥ 70 years—a prospective multicentre cohort study

Funding Information: COVIP study did not have any funding. Publication of this article was funded by the Priority Research Area qLife under the program “Excellence Initiative – Research University” at the Jagiellonian University in Krakow (06/IDUB/2019/94). Publisher Copyright: © 2022, The Author(s).Background: Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. Methods: This is a substudy of COVIP study—an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. Results: Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36–5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06–2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI − 2.27 to − 0.46 days) compared to primary IMV group (n = 1876). Conclusions: Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV. Clinical Trial RegistrationNCT04321265, registered 19 March 2020, https://clinicaltrials.gov.publishersversionpublishe

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Does vitamin D deficiency worsen the hospital outcome in patients with acute exacerbation of chronic obstructive pulmonary disease?

Background There are limited data about the hospital outcome in hospitalized patients diagnosed as chronic obstructive pulmonary disease (COPD) with concomitant deficiency of vitamin D. Objectives To assess the level of serum 25-hydroxyvitamin D in patients with severe exacerbation of COPD and to find if there is any correlations between vitamin D and clinical, functional parameters, as well as survival, days of hospital stay, and need for ICU admission. Patients and methods In this case–control study, 60 patients with acute exacerbation COPD requiring hospital admission were recruited and 24 healthy controls. Chest radiography, spirometry, arterial blood gases, 6 min walking distance, modified Medical Research Council dyspnea scale, and St George Respiratory Questionnaire were assessed. Serum 25-hydroxyvitamin D level was measured by enzyme-linked immunosorbent assay. Results About 90% COPD patients had vitamin D deficiency. Serum vitamin D levels were statistically significantly lower in COPD with and without comorbidities when compared with normal controls (P0.05). No significant correlation was found between serum 25-hydroxyvitamin D and survival; days of hospital stay or need for mechanical ventilation. As well, no significant correlation between vitamin D and forced expiratory volume in the 1 s %, 6 min walking distance, modified Medical Research Council, or St George Respiratory Questionnaire scores was found. Conclusion Vitamin D deficiency is found in most COPD patients. However, in patients suffering from severe exacerbation, the presence of low vitamin D levels did not have any effect on survival, days of hospital stay, or need for mechanical ventilation

Prevalence and characteristics of COVID-19 vaccine breakthrough infection in Upper Egypt

Abstract Background Infection breakthrough after COVID-19 vaccination is a point of conflict in current literature not only because of the estimation of the potential hazards and symptoms severity but also due to establishing a vaccination policy and measuring the extent of immunity after vaccination in addition to the waning of the humoral immunity over time. To our knowledge, this is the first study to stratify the risk of post-COVID-19 vaccination breakthroughs in Upper Egypt. Methods In this cross-sectional observational study, we enrolled 369 vaccinated patients registered in our facility either admitted or in out-patient clinic. Patients were interviewed and any proven history of COVID-19 infection after vaccination was recorded. Results In the current study, 18.97% (70 patients) of the 369 subjects enrolled in the study had COVID-19breakthrough infection. Students were the high-risk group representing 18.6% of the study subjects. Hypertension, diabetes, and cardiac disease were the most comorbidities associated with a prevalence of 15.7%, 8.6%, and 4.3% respectively. Prior to COVID-19, confirmed infection was present in 42.9% of the study group. Fever, headache, myalgia, and cough were among the most common symptoms of the post-COVID vaccination breakthrough with a prevalence of 90%, 75.7%, 84.3%, and 74.3% respectively. Conclusion Breakthrough infection after COVID-19 vaccination is not uncommon. Most cases are mild and don’t require hospitalization. All types of vaccines tested in the current study offer adequate immunity and guard against severe COVID-19 infection. We encourage the current global policy of full vaccination. Trial registration ClinicalTrials.gov. NCT05033834. Registered September 5, 2021. COVID-19 Infection in After Vaccination-Full Text View-ClinicalTrials.gov

Emergence of Nosocomial Pneumonia Caused by Colistin-Resistant Escherichia coli in Patients Admitted to Chest Intensive Care Unit

(1) Background: Colistin is a last-resort antibiotic used in treating multidrug-resistant Gram-negative infections. The growing emergence of colistin resistance in Escherichia coli (E. coli) represents a serious health threat, particularly to intensive care unit (ICU) patients. (2) Methods: In this work, we investigated the emergence of colistin resistance in 140 nosocomial E. coli isolated from patients with pneumonia and admitted to the chest ICU over 36 months. Virulence and resistance-related genes and E. coli pathotypes in colistin-resistant and colistin-sensitive isolates were determined. (3) Results: Colistin resistance was observed in 21/140 (15%) of the nosocomial E. coli isolates. The MIC50 of the resistant strains was 4 mg/L, while MIC90 was 16 mg/L. Colistin-resistant isolates were also co-resistant to amoxicillin, amoxicillin/clavulanic, aztreonam, ciprofloxacin, and chloramphenicol. The mechanism of colistin resistance was represented by the presence of mcr-1 in all resistant strains. Respectively, 42.9% and 36.1% of colistin-resistant and colistin-sensitive groups were extended-spectrum β-lactamase (ESBL) producers, while 23.8% and 21% were metallo β-lactamase (MBL) producers. blaTEM-type was the most frequently detected ESBL gene, while blaIMP-type was the most common MBL in both groups. Importantly, most resistant strains showed a significantly high prevalence of astA (76.2%), aggR (76.2%), and pic (52.4%) virulence-related genes. Enteroaggregative E. coli (76%) was the most frequently detected genotype among the colistin-resistant strains. (4) Conclusion: The high colistin resistance rate observed in E. coli strains isolated from patients with nosocomial pneumonia in our university hospital is worrisome. These isolates carry different drug resistance and virulence-related genes. Our results indicate the need for careful monitoring of colistin resistance in our university hospital. Furthermore, infection control policies restricting the unnecessary use of extended-spectrum cephalosporins and carbapenems are necessary

Interleukin-18 and interferon-γ single nucleotide polymorphisms in Egyptian patients with tuberculosis.

BackgroundInterleukin-18 (IL-18) and interferon-γ (IFN-γ) are cytokines of crucial role in inflammation and immune reactions. There is a growing evidence supporting important roles for IL-18 and IFN γ in tuberculosis (TB) infection and anti-tuberculosis immunity.ObjectiveTo evaluate the role of polymorphisms in IL-18-607 and -137 and INF-γ +874 in susceptibility to TB infection among Egyptian patients.MethodsA case control study was conducted to investigate the polymorphism at IL-18-607, -137 and INF-γ+874 by sequence specific primer-polymerase chain reaction (SSP- PCR) in 105 patients with pulmonary and extra pulmonary tuberculosis and 106 controls.ResultsA significant protective effect against TB was found in homozygous CC genotype at IL-18 -137G/C, in addition to a 7-fold risk with GG and GC genotypes in the recessive model. Apart from a decreased risk with the AC genotype, no association was detected between the susceptibility to TB and different genotypes or alleles at the IL-18 -607A/C site. The homozygous AA genotype in INF-γ+874 showed a significant higher risk to TB than the homozygous TT or heterozygous AT genotypes with nearly a 2-fold risk of TB infection with the A allele. Regarding haplotype association, the GC haplotype was strongly associated with TB infection compared to other haplotypes.ConclusionThese findings suggest; for the first time in Egypt; a significant risk to TB infection with SNP at the IL-18-137G/C with no LD with SNP at the IL-18-607 site. The homozygous AA genotype in INF-γ+874 showed a significant higher risk to TB than the homozygous TT or heterozygous AT genotypes

COVID-19 pandemic: perception, attitude, and practices of university students from health sector faculties

Abstract Background Adherence to preventive control measures is influenced by perception, attitudes, and practices toward the disease prevention. Aim To assess the perceptions, attitude, and practices of university students in three health sector faculties (Medicine, Nursing, and Pharmacy) from six Egyptian universities towards COVID-19 pandemic prevention. Methods An electronic online survey was distributed to students of 3 faculties (Medicine, Pharmacy, and Nursing) in six Egyptian universities from March to July 2021. The questionnaire consists of the following parts: socio-demographic data of participants, student perception and attitude towards the COVID-19 pandemic and its consequences, as well as practices of preventive measures in the community. Results The study included 1990 participants. Most respondents perceived the seriousness of the COVID-19 pandemic (88.2%). The rates of practicing precautionary measures were mostly high (approximately 90% or above). Significantly high attitude scores toward the pandemic were detected in people with quite-to-extremely concerned, very good/excellent status, aware of infection risk, willing to report positive cases and avoiding contact with them, and seeking medical advice regarding infection. The attitude to protective measures followed a similar pattern along with average health status, female students, and avoidance of contact when experiencing flu symptoms. Significantly higher practice scores were observed in those with bad health status, rural areas, perceiving the risk of infection, willing to report positive cases, and avoiding contact with positive cases. Conclusion The effectiveness of precautionary measures should be stressed to promote positive student practices