Activity

The best area under the ROC curve (AUC) was obtained with the 14-area score, with a result of 0.88 (95% CI 0.75-0.99). Its sensitivity and specificity for a cut-off score of 13.5 were 100% and 61.5%, respectively.

The use of scores to quantify lung involvement measured by thoracic ultrasound provides useful information, facilitating risk stratification in patients hospitalized with COVID-19.

The use of scores to quantify lung involvement measured by thoracic ultrasound provides useful information, facilitating risk stratification in patients hospitalized with COVID-19.

To evaluate the diagnostic capacity of pulmonary angiography with multidetector computed tomography (MDCT) and iodine mapping in the diagnosis of pulmonary thromboembolism (PTE) in patients with Covid-19 disease.

Retrospective observational study of 81 consecutive patients admitted with Covid-19 respiratory infection who underwent MDCT for clinical suspicion of PTE (sudden dyspnea, chest pain, hemoptysis, severe respiratory failure (SRF) not corrected with high O

flow) and/or raised D-dimer.

Of the 81 patients studied [64 (79.01%) men], acute PTE was identified in 22 (27.16%), bilaterally in 13 (59.09%), and 13 (59,09%) showed areas of hypoperfusion. Of the 59 (72.83%) patients without PTE, hypoperfusion was observed in 41 (69.49%) (attributable in one case to pulmonary emphysema). In 18 (22.2%) of the total number of patients, neither PTE nor hypoperfusion were seen. A crazy paving pattern is a risk factor for developing PTE (OR 1.94; 95% CI 0.28-13.57), as are consolidations (OR 1.44; 95% CI 0.24-8.48) and septal thickening/bronchiectasis (OR 1.47; 95% CI 0.12-17.81).Patients with O

-refractory SRF showed a 6.36-fold higher risk for hypoperfusion on the iodine map.

By adding the functional image to the anatomical image, pulmonary angiography with MDCT and iodine mapping can demonstrate not only PTE in main, lobar and segmental arteries, but also the presence of hypoperfusion in distal vessels. This makes it a highly useful tool for the accurate diagnosis and therapeutic orientation of patients with Covid-19 lung involvement.

By adding the functional image to the anatomical image, pulmonary angiography with MDCT and iodine mapping can demonstrate not only PTE in main, lobar and segmental arteries, but also the presence of hypoperfusion in distal vessels. This makes it a highly useful tool for the accurate diagnosis and therapeutic orientation of patients with Covid-19 lung involvement.

Spain is one of the countries with the highest number of COVID-19 patients. Unfortunately, few data for regions are available.

This study aimed to describe the characteristics and independent risk factors associated with COVID-19 mortality in Castilla-La Mancha, Spain.

Cohort and multicenter study in all 14 public hospitals of the Castilla-La Mancha Health Service. Baseline characteristics, preexisting comorbidities, symptoms, clinical features and treatments were included. Multivariable logistic regression was used to evaluate factors associated with death and Kaplan-Meier test to examine survival probability. Statistical significance was considered with

<0.05 (95% CI). SPSS (version 24.0 for Windows) and R 4.0.2 (R Statistics) software were used.

The cohort comprised 12,126 patients sequentially attended between February 11 and May 11, 2020. The mean age of patients was 66.4 years; 5667 (46.7%) were women. Six protective factors against exitus were defined female sex, anosmia, cough, chloroquine and azithromycin. The risk factors were age over 50, obesity, cardiac pathology, fever, dyspnea, lung infiltrates, lymphopenia, D-dimer above 1000ng/mL, and mechanical ventilation requirement. Survival analysis showed higher survival rate in women (75.7%) than men (72.1%). Cumulative survival was 87.5% for non-hospitalized patients, 70.2% for patients admitted to hospital and 61.2% in ICU patients. Additionally, survival probability decreased with increasing age range.

Determination of protective or death-promoting factors could be useful to stratify patients by severity criteria and to improve COVID-19 care management.

Determination of protective or death-promoting factors could be useful to stratify patients by severity criteria and to improve COVID-19 care management.

With the current COVID-19 pandemic, concerns have raised regarding the risk for NIV to promote airborne transmission. In case of hospital admission, continuation of therapy in patients undergoing chronic NIV is necessary and several protective circuit configurations have been recommended to reduce the risk of aerosol dissemination. However, all these configurations increase instrumental dead space. We therefore designed this study to evaluate their effects on the tidal volume (VT

) required to preserve stable end-tidal CO

partial pressure (P

CO

) with constant respiratory rate.

A bench consisting of a test lung connected to an adult-sized mannequin head was set up. The model was ventilated through usual domiciliary configuration (single limb circuit with facial vented mask) which was used as reference. Then, five different circuit configurations including non-vented facial mask with viral/bacterial filter, modification of leak position, and change from single to double-limb circuit were evaluated. For each configuration, pressure support (PS) was gradually increased to reach reference P

CO

. Resulting VT

was recorded as primary outcome.

Reference P

CO

was 38(0)mmHg, with a PS set at 10cmH

O, resulting in a VT

of 432(2)mL. Compared to reference, all the configurations evaluated required substantial increase in VT

to preserve alveolar ventilation, ranging from +79(2) to +216(1)mL.

Modifications of NIV configurations in the context of COVID-19 pandemic result in substantial increase of instrumental dead space. Re-evaluation of treatment efficiency and settings is crucial whenever protective measures influencing NIV equipment are considered.

Modifications of NIV configurations in the context of COVID-19 pandemic result in substantial increase of instrumental dead space. Re-evaluation of treatment efficiency and settings is crucial whenever protective measures influencing NIV equipment are considered.

The SARS-CoV-2 pandemic is the most important health challenge observed in 100 years, and since its emergence has generated the highest excess of non-war-related deaths in the western world. Since this disease is highly contagious and 33% of cases are asymptomatic, it is crucial to develop methods to predict its course. We developed a predictive model for Covid-19 infection in Spanish provinces.

We applied main components analysis to epidemiological data for Spanish provinces obtained from the National Centre of Epidemiology, based on the epidemiological curve between 24 February and 8 June 2020. Using this method, we classified provinces according to their epidemiological progress (worst, intermediate, and good).

We identified 2 components that explained 99% of variability in the 52 epidemiological curves. The first component can be interpreted as the crude incidence rate trend and the second component as the speed of increase or decrease in the incidence rate during the period analysed. We identified 10 provinces in the group with the worst progress and 17 in the intermediate group. The threshold values for the 7-day incidence rate for an alert 1 (intermediate) were 134 cases/100,000 inhabitants, and 167 for alert 2 (high), respectively, showing a high discriminative power between provinces.

These alert levels might be useful for deciding which measures may affect population mobility and other public health decisions when considering community transmission of SARS-CoV-2 in a given geographical area. This information would also facilitate intercomparison between healthcare areas and Autonomous Communities.

These alert levels might be useful for deciding which measures may affect population mobility and other public health decisions when considering community transmission of SARS-CoV-2 in a given geographical area. This information would also facilitate intercomparison between healthcare areas and Autonomous Communities.

The aim of this study was to determine if tobacco use in patients with Covid-19 is associated with a negative disease course and adverse outcome, and if smoking, current and past, is associated with a greater possibility of developing COVID-19.

A systematic review (SR) and meta-analysis (MA) of previously published works were performed. CDK inhibition The search strategy included all known descriptors for Covid-19 and tobacco and was conducted in different databases. Appropriate statistical models were used to address the effect size in meta-analysis, namely random effects and fixed effects model.

Thirty-four articles were identified in the SR of which 19 were included in the MA. Being a smoker or former smoker was shown to be a risk factor for worse progression of Covid-19 infection (OR 1.96, 95% CI, 1.36 – 2.83) and a greater probability of presenting a more critical condition (OR 1.79 95% CI, 1.19 – 2.70). As limitations of the MA, we found that most of the studies analyzed were observational with limited publication bias. Two studies that disagreed with the rest were included, although after withdrawing them from the MA, smoking was maintained as a risk factor for worse progress.

Current and past smoking produces a more serious clinical form of Covid-19 and more frequently leads to intensive care admission, intubation, and death.

Current and past smoking produces a more serious clinical form of Covid-19 and more frequently leads to intensive care admission, intubation, and death.

Patients with pre-existing respiratory diseases in the setting of COVID-19 may have a greater risk of severe complications and even death.

A retrospective, multicenter, cohort study with 5847 COVID-19 patients admitted to hospitals. Patients were separated in two groups, with/without previous lung disease. Evaluation of factors associated with survival and secondary composite end-point such as ICU admission and respiratory support, were explored.

1,271 patients (22%) had a previous lung disease, mostly COPD. All-cause mortality occurred in 376 patients with lung disease (29.5%) and in 819 patients without (17.9%) (

<0.001). Kaplan-Meier curves showed that patients with lung diseases had a worse 30-day survival (HR=1.78; 95%C.I. 1.58-2.01;

<0.001) and COPD had almost 40% mortality. Multivariable Cox regression showed that prior lung disease remained a risk factor for mortality (HR, 1.21; 95%C.I. 1.02-1.44;

=0.02). Variables independently associated with all-cause mortality risk in patients with lung diseases were oxygen saturation less than 92% on admission (HR, 4.35; 95% CI 3.08-6.15) and elevated D-dimer (HR, 1.84; 95% CI 1.27-2.67). Age younger than 60 years (HR 0.37; 95% CI 0.21-0.65) was associated with decreased risk of death.

Previous lung disease is a risk factor for mortality in patients with COVID-19. Older age, male gender, home oxygen therapy, and respiratory failure on admission were associated with an increased mortality. Efforts must be done to identify respiratory patients to set measures to improve their clinical outcomes.

Previous lung disease is a risk factor for mortality in patients with COVID-19. Older age, male gender, home oxygen therapy, and respiratory failure on admission were associated with an increased mortality. Efforts must be done to identify respiratory patients to set measures to improve their clinical outcomes.