Association of New-Onset Atrial Fibrillation With All-Cause Mortality in COVID-19 Patients

Background The COVID-19 pandemic has brought about unprecedented global health challenges, with its impact extending beyond respiratory manifestations to encompass cardiovascular complications, including arrhythmias. Dysrhythmias in COVID-19 are multifactorial, ranging from direct myocardial insult due to the cytokine storm to metabolic derangements. Objective In this study, we aim to examine the incidence of new-onset atrial fibrillation and to study its association with all-cause mortality of COVID-19. Methods A cross-sectional study was conducted at Cabell Huntington Hospital, West Virginia, utilizing electronic medical records of COVID-19 patients from 2020 to 2021. Inclusion criteria comprised patients aged >18 years with COVID-19 diagnosis and cardiac arrhythmias during hospitalization. Logistic regression analysis was employed to examine the relationship between demographic and clinical variables and in-hospital mortality. Results Of the 264 eligible patients, those aged >66 years had lower odds of in-hospital mortality (p < 0.001), while gender, ejection fraction, and diabetes mellitus did not significantly predict mortality. Atrial fibrillation (p = 0.011) and heart failure (p = 0.030) were associated with increased odds of mortality, while hypertension showed no significant predictive power (p = 0.791). Conclusion This study highlights the significance of atrial fibrillation and heart failure as predictors of in-hospital mortality in COVID-19 patients. Our findings underscore the importance of recognizing and managing arrhythmias in COVID-19 and call for further research on the mechanisms and long-term effects of these cardiac complications in the context of the pandemic. These insights can guide clinical practice and interventions to optimize patient outcomes.

The association of prior paracetamol intake with outcome of very old intensive care patients with COVID-19: results from an international prospective multicentre trial

BACKGROUND

In the early COVID-19 pandemic concerns about the correct choice of analgesics in patients with COVID-19 were raised. Little data was available on potential usefulness or harmfulness of prescription free analgesics, such as paracetamol. This international multicentre study addresses that lack of evidence regarding the usefulness or potential harm of paracetamol intake prior to ICU admission in a setting of COVID-19 disease within a large, prospectively enrolled cohort of critically ill and frail intensive care unit (ICU) patients.

METHODS

This prospective international observation study (The COVIP study) recruited ICU patients ≥ 70 years admitted with COVID-19. Data on Sequential Organ Failure Assessment (SOFA) score, prior paracetamol intake within 10 days before admission, ICU therapy, limitations of care and survival during the ICU stay, at 30 days, and 3 months. Paracetamol intake was analysed for associations with ICU-, 30-day- and 3-month-mortality using Kaplan Meier analysis. Furthermore, sensitivity analyses were used to stratify 30-day-mortality in subgroups for patient-specific characteristics using logistic regression.

RESULTS

44% of the 2,646 patients with data recorded regarding paracetamol intake within 10 days prior to ICU admission took paracetamol. There was no difference in age between patients with and without paracetamol intake. Patients taking paracetamol suffered from more co-morbidities, namely diabetes mellitus (43% versus 34%, p < 0.001), arterial hypertension (70% versus 65%, p = 0.006) and had a higher score on Clinical Frailty Scale (CFS; IQR 2-5 versus IQR 2-4, p < 0.001). Patients under prior paracetamol treatment were less often subjected to intubation and vasopressor use, compared to patients without paracetamol intake (65 versus 71%, p < 0.001; 63 versus 69%, p = 0.007). Paracetamol intake was not associated with ICU-, 30-day- and 3-month-mortality, remaining true after multivariate adjusted analysis.

CONCLUSION

Paracetamol intake prior to ICU admission was not associated with short-term and 3-month mortality in old, critically ill intensive care patients suffering from COVID-19.

TRIAL REGISTRATION

This prospective international multicentre study was registered on ClinicalTrials.gov with the identifier "NCT04321265" on March 25, 2020.

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

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 Registration NCT04321265 , registered 19 March 2020, https://clinicaltrials.gov .

The effect of bio-banding on academy soccer player passing networks: Implications of relative pitch size

The primary aims of this study were to examine the effects of bio-banding players on passing networks created during 4v4 small-sided games (SSGs), while also examining the interaction of pitch size using passing network analysis compared to a coach-based scoring system of player performance. Using a repeated measures design, 32 players from two English Championship soccer clubs contested mixed maturity and bio-banded SSGs. Each week, a different pitch size was used: Week 1) small (36.1 m2 per player); week 2) medium (72.0 m2 per player); week 3) large (108.8 m2 per player); and week 4) expansive (144.50 m2 per player). All players contested 12 maturity (mis)matched and 12 mixed maturity SSGs. Technical-tactical outcome measures were collected automatically using a foot-mounted device containing an inertial measurement unit (IMU) and the Game Technical Scoring Chart (GTSC) was used to subjectively quantify the technical performance of players. Passing data collected from the IMUs were used to construct passing networks. Mixed effect models were used with statistical inferences made using generalized likelihood ratio tests, accompanied by Cohen's local f2 to quantify the effect magnitude of each independent variable (game type, pitch size and maturation). Consistent trends were identified with mean values for all passing network and coach-based scoring metrics indicating better performance and more effective collective behaviours for early compared with late maturation players. Network metrics established differences (f2 = 0.00 to 0.05) primarily for early maturation players indicating that they became more integral to passing and team dynamics when playing in a mixed-maturation team. However, coach-based scoring was unable to identify differences across bio-banding game types (f2 = 0.00 to 0.02). Pitch size had the largest effect on metrics captured at the team level (f2 = 0.24 to 0.27) with smaller pitch areas leading to increased technical actions. The results of this study suggest that the use of passing networks may provide additional insight into the effects of interventions such as bio-banding and that the number of early-maturing players should be considered when using mixed-maturity playing formats to help to minimize late-maturing players over-relying on their early-maturing counterparts during match-play.

Clinical Outcome of Acute Ischemic Strokes in Patients with COVID-19

INTRODUCTION

Acute ischemic stroke (AIS) and thrombotic events (TEs) were reported in patients with COVID-19. Clinical outcome of AIS in the course of COVID-19 remains unknown. We compared early clinical outcome and mortality of COVID-positive (+) patients admitted for AIS with COVID-negative (-) ones. We hypothesized that COVID+ patients would have poorer clinical outcomes and present a higher rate of TEs and mortality compared with COVID- ones.

METHODS

In this multicentric observational retrospective study, we enrolled patients over 18 years old admitted for AIS in 3 stroke units of the Parisian region during lockdown from March 17, 2020, to May 2, 2020. COVID-19 status as well as demographic, clinical, biological, and imaging data was collected retrospectively from medical records. Poor outcome was defined as modified Rankin score (mRS) 3-6 (3-6) at discharge. We also compared TE frequency and mortality rate through a composite criterion in both groups.

RESULTS

Two hundred and sixteen patients were enrolled; mean age was 68 years old, and 63% were male. Forty patients were CO-VID+ (18.5%) and 176 were COVID-. Obesity was statistically more frequent in the COVID+ group (36 vs. 13% p < 0.01). The percentage of patients with mRS (3-6) at discharge was higher in the COVID+ group compared with the COVID- group (60 vs. 41%, p = 0.034). The main predictor of presenting a mRS (3-6) at discharge was high NIHSS score at admission (OR, CI 95%: 1.325, 1.22-1.43). Mortality rate was higher in the COVID+ group (12 vs. 3.4%, p = 0.033) as well as TE frequency (15 vs. 2.8%, p < 0.01).

CONCLUSION

In this study, patients with AIS infected by SARS-CoV-2 showed a poorer early outcome than COVID- ones. However, when compared to other factors, COVID-19 was not a significant predictor of poor outcome. Vascular morbidity and mortality rates were significantly higher in the COVID+ group compared with the COVID- group.

Urban Pulse: Capturing the Rhythm of Cities

Cities are inherently dynamic. Interesting patterns of behavior typically manifest at several key areas of a city over multiple temporal resolutions. Studying these patterns can greatly help a variety of experts ranging from city planners and architects to human behavioral experts. Recent technological innovations have enabled the collection of enormous amounts of data that can help in these studies. However, techniques using these data sets typically focus on understanding the data in the context of the city, thus failing to capture the dynamic aspects of the city. The goal of this work is to instead understand the city in the context of multiple urban data sets. To do so, we define the concept of an "urban pulse" which captures the spatio-temporal activity in a city across multiple temporal resolutions. The prominent pulses in a city are obtained using the topology of the data sets, and are characterized as a set of beats. The beats are then used to analyze and compare different pulses. We also design a visual exploration framework that allows users to explore the pulses within and across multiple cities under different conditions. Finally, we present three case studies carried out by experts from two different domains that demonstrate the utility of our framework.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Segmentation of angiodysplasia lesions in WCE images using a MAP approach with Markov Random Fields

This paper deals with the segmentation of angiodysplasias in wireless capsule endoscopy images. These lesions are the cause of almost 10% of all gastrointestinal bleeding episodes, and its detection using the available software presents low sensitivity. This work proposes an automatic selection of a ROI using an image segmentation module based on the MAP approach where an accelerated version of the EM algorithm is used to iteratively estimate the model parameters. Spatial context is modeled in the prior probability density function using Markov Random Fields. The color space used was CIELab, specially the a component, which highlighted most these type of lesions. The proposed method is the first regarding this specific type of lesions, but when compared to other state-of-the-art segmentation methods, it almost doubles the results.

Interobserver agreement of EUS elastography in the evaluation of solid pancreatic lesions

Background and Objectives:

Previous reports assessing the reproducibility of endoscopic ultrasound elastography (EUS-E) in evaluation of solid pancreatic lesions (SPL) involved only experienced endosonographers. We aimed to assess the interobserver agreement (IOA) of EUS-E in the evaluation of SPL by endoscopists with different levels of experience in EUS and EUS-E.

Materials and Methods:

A cross-sectional observational multicenter study was designed and included 11 endoscopists who were divided into four groups: Group A (long experience in EUS and EUS-E); Group B (short experience in EUS and EUS-E); Group C (long experience in EUS and no experience in EUS-E); and Group D (no experience in EUS or EUS-E). The observers independently classified the patterns of 60 video sequences of EUS-E, after a 20-min training session. For each group, we calculated IOA (kappa statistic, κ) of EUS-E and the diagnostic accuracy of EUS-E for pancreatic malignancy, by comparing the pattern of EUS-E indicative of malignancy (heterogeneous or homogenous blue) with the final diagnosis.

Results:

The overall IOA was moderate (κ = 0.42; 95% confidence interval (CI) 0.33-0.52). The IOA of Group A (κ = 0.80; 95% CI 0.65-1.00) was significantly higher than that of Groups B (κ = 0.54; 95%CI 0.40-0.71), C (κ = 0.54; 95%CI 0.39-0.68), and D (κ = 0.28; 95%CI 0.14-0.40). IOA of Groups B and C was not significantly different, but it was significantly higher than that of Group D. The diagnostic accuracy of Group A (area under the curve under summary receiver operating characteristic (AUROC) = 0.83; 95%CI 0.75-0.90) was not significantly different from that of Group B (AUROC = 0.77; 95%CI 0.71-0.83), but it was significantly higher than that of Groups C (AUROC = 0.74; 95%CI 0.67-0.81) and D (AUROC = 0.74; 95%CI 0.67-0.81). No significant difference was seen between Groups B, C, and D for diagnostic accuracy.

Conclusion:

EUS-E is reproducible in the evaluation of SPL, even between endoscopists with no or limited experience in EUS and/or EUS-E. Reproducibility and diagnostic accuracy increase with experience in EUS and EUS-E.

Modeling vaccination campaigns and the Fall/Winter 2009 activity of the new A(H1N1) influenza in the Northern Hemisphere

The unfolding of pandemic influenza A(H1N1) for Fall 2009 in the Northern Hemisphere is still uncertain. Plans for vaccination campaigns and vaccine trials are underway, with the first batches expected to be available early October. Several studies point to the possibility of an anticipated pandemic peak that could undermine the effectiveness of vaccination strategies. Here, we use a structured global epidemic and mobility metapopulation model to assess the effectiveness of massive vaccination campaigns for the Fall/Winter 2009. Mitigation effects are explored depending on the interplay between the predicted pandemic evolution and the expected delivery of vaccines. The model is calibrated using recent estimates on the transmissibility of the new A(H1N1) influenza. Results show that if additional intervention strategies were not used to delay the time of pandemic peak, vaccination may not be able to considerably reduce the cumulative number of cases, even when the mass vaccination campaign is started as early as mid-October. Prioritized vaccination would be crucial in slowing down the pandemic evolution and reducing its burden.

Seasonal transmission potential and activity peaks of the new influenza A(H1N1): a Monte Carlo likelihood analysis based on human mobility

BACKGROUND

On 11 June the World Health Organization officially raised the phase of pandemic alert (with regard to the new H1N1 influenza strain) to level 6. As of 19 July, 137,232 cases of the H1N1 influenza strain have been officially confirmed in 142 different countries, and the pandemic unfolding in the Southern hemisphere is now under scrutiny to gain insights about the next winter wave in the Northern hemisphere. A major challenge is pre-emptied by the need to estimate the transmission potential of the virus and to assess its dependence on seasonality aspects in order to be able to use numerical models capable of projecting the spatiotemporal pattern of the pandemic.

METHODS

In the present work, we use a global structured metapopulation model integrating mobility and transportation data worldwide. The model considers data on 3,362 subpopulations in 220 different countries and individual mobility across them. The model generates stochastic realizations of the epidemic evolution worldwide considering 6 billion individuals, from which we can gather information such as prevalence, morbidity, number of secondary cases and number and date of imported cases for each subpopulation, all with a time resolution of 1 day. In order to estimate the transmission potential and the relevant model parameters we used the data on the chronology of the 2009 novel influenza A(H1N1). The method is based on the maximum likelihood analysis of the arrival time distribution generated by the model in 12 countries seeded by Mexico by using 1 million computationally simulated epidemics. An extended chronology including 93 countries worldwide seeded before 18 June was used to ascertain the seasonality effects.

RESULTS

We found the best estimate R0 = 1.75 (95% confidence interval (CI) 1.64 to 1.88) for the basic reproductive number. Correlation analysis allows the selection of the most probable seasonal behavior based on the observed pattern, leading to the identification of plausible scenarios for the future unfolding of the pandemic and the estimate of pandemic activity peaks in the different hemispheres. We provide estimates for the number of hospitalizations and the attack rate for the next wave as well as an extensive sensitivity analysis on the disease parameter values. We also studied the effect of systematic therapeutic use of antiviral drugs on the epidemic timeline.

CONCLUSION

The analysis shows the potential for an early epidemic peak occurring in October/November in the Northern hemisphere, likely before large-scale vaccination campaigns could be carried out. The baseline results refer to a worst-case scenario in which additional mitigation policies are not considered. We suggest that the planning of additional mitigation policies such as systematic antiviral treatments might be the key to delay the activity peak in order to restore the effectiveness of the vaccination programs.

Magnetic reversal time in open long-range systems

Topological phase space disconnection has been recently found to be a general phenomenon in many-body spin system with anisotropic interaction. We show that the power law divergence of magnetic reversal time at the energy signaling such disconnection is generic for long-range interacting systems with an exponent proportional to the number of particles. We also study the modifications induced putting the system in contact with a thermal bath. Using the canonical formalism we analyze the magnetic reversal times at any temperature. Moreover, due to the divergence of reversal time at the energy disconnection threshold we can recover, using saddle point approximation, a simple exponential dependence on the inverse temperature showing the explicit relevance of the energy disconnection threshold for finite many-body interacting systems at finite temperature. This sets a general framework to understand the emergence of ferromagnetism in finite magnetic systems starting from microscopic models without phenomenological on-site barriers.

Raised levels of interleukin 6 in systemic lupus erythematosus correlate with anaemia

OBJECTIVES

Raised levels of the cytokines interleukin (IL) 6 and IL10 have been reported in patients with systemic lupus erythematosus (SLE).

OBJECTIVE

To determine if levels of IL6 and IL10 correlate with organ/system-specific disease activity in SLE, using the British Isles Lupus Assessment Group (BILAG) Disease Activity Index.

METHODS

Levels of IL6 and IL10 in serum samples from 171 patients with SLE and 50 normal controls were determined by enzyme linked immunosorbent assay (ELISA). Levels of cytokines in individual patients with SLE were compared with the presence or absence of active disease in eight organ/systems using the BILAG index.

RESULTS

Levels of IL6 were significantly higher (p = 0.005) in patients with active compared with inactive haematological disease, as scored by the BILAG index. Further analysis showed that this association was dependent on an inverse correlation (p = 0.002, r = -0.26) between IL6 levels and haemoglobin levels in patients with SLE. In contrast, IL10 levels did not correlate with individual organ/system disease activity.

CONCLUSIONS

Raised levels of IL6 in SLE may influence the development of anaemia in this disease. These findings are in agreement with an increasing number of studies, which support physiological links between IL6 and anaemia. Importantly, with the exception of the haematological system, our studies do not provide evidence of any individual organ/system which would respond to therapeutic manipulation of either IL6 or IL10 levels.