Characteristics of Hospitalized COVID-19 Patients at Admission and Factors Associated with Clinical Severity in Low- and Middle-Income Countries: An Observational Study

Despite the numerous articles published on the clinical characteristics and outcomes of COVID-19 with regard to high-income countries, little is known about patients in low- and middle-income countries (LMIC) in this context. The objective of this observational, prospective, hospital-based multicentric study was to describe clinical features and outcomes of laboratory-confirmed COVID-19 patients hospitalized in each of the participating centers in Bangladesh, Guinea, Ivory Coast, Lebanon, Madagascar, and Mali during the first year of the pandemic (March 5, 2020 to May 4, 2021). The study outcome was the clinical severity of COVID-19, defined as hospitalization in intensive care unit or death. Multivariate logistic regression models were performed to identify independent variables associated with disease severity. Overall, 1,096 patients were included. The median age was 49.0 years, ranging from 38.0 in Mali to 63.0 years in Guinea. The overall clinical severity of COVID-19 was 12.3%, ranging from 6.4% in Mali to 18.8% in Guinea. In both groups of patients <60 and ≥60 years old, cardiovascular diseases (adjusted odds ratio [aOR]: 1.99; 95% CI: 1.13-3.50, P = 0.02; aOR: 2.47; 95% CI: 1.33-4.57, P = 0.004) were independently associated with clinical severity, whereas in patients <60 years, diabetes (aOR: 2.13; 95% CI: 1.11-4.10, P = 0.02) was also associated with clinical severity. Our findings suggest that COVID-19-related severity and death in LMICs are mainly driven by older age. However, the presence of chronic diseases can also increase the risk of severity especially in younger patients.

Effect of Colchicine on Myocardial Injury in Acute Myocardial Infarction

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Background:

Inflammation is a key factor of myocardial damage in reperfused ST-segment–elevation myocardial infarction. We hypothesized that colchicine, a potent anti-inflammatory agent, may reduce infarct size (IS) and left ventricular (LV) remodeling at the acute phase of ST-segment–elevation myocardial infarction.

Methods:

In this double-blind multicenter trial, we randomly assigned patients admitted for a first episode of ST-segment–elevation myocardial infarction referred for primary percutaneous coronary intervention to receive oral colchicine (2-mg loading dose followed by 0.5 mg twice a day) or matching placebo from admission to day 5. The primary efficacy outcome was IS determined by cardiac magnetic resonance imaging at 5 days. The relative LV end-diastolic volume change at 3 months and IS at 3 months assessed by cardiac magnetic resonance imaging were among the secondary outcomes.

Results:

We enrolled 192 patients, 101 in the colchicine group and 91 in the control group. At 5 days, the gadolinium enhancement–defined IS did not differ between the colchicine and placebo groups with a mean of 26 interquartile range (IQR) [16–44] versus 28.4 IQR [14–40] g of LV mass, respectively (P=0.87). At 3 months follow-up, there was no significant difference in LV remodeling between the colchicine and placebo groups with a +2.4% (IQR, –8.3% to 11.1%) versus –1.1% (IQR, –8.0% to 9.9%) change in LV end-diastolic volume (P=0.49). Infarct size at 3 months was also not significantly different between the colchicine and placebo groups (17 IQR [10–28] versus 18 IQR [10–27] g of LV mass, respectively; P=0.92). The incidence of gastrointestinal adverse events during the treatment period was greater with colchicine than with placebo (34% versus 11%, respectively; P=0.0002).

Conclusions:

In this randomized, placebo-controlled trial, oral administration of high-dose colchicine at the time of reperfusion and for 5 days did not reduce IS assessed by cardiac magnetic resonance imaging.

Registration:

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03156816.

XPS analysis of the surface of leucite-reinforced feldspathic ceramics

OBJECTIVE

The bond of a silane-coupling agent to a ceramic surface is expected to be influenced by the composition and chemical state of the ceramic surface. The purpose of this study was to determine the variation in the composition and the chemical states of the surfaces of a range of leucite-reinforced feldspathic (LRF) ceramics using X-ray photoelectron spectroscopy (XPS).

METHODS

Five LRF ceramic discs (IPS Empress,Optec HSP,VMK 68, Mirage, and a modified Mirage) were produced and polished to a 1 microm finish. A further nine discs of the modified Mirage were produced. The discs were stored for 48h in a vacuum oven at 110 degrees C to remove absorbed water. The surfaces of these discs were analysed by XPS. Survey scans at 30 degrees take-off angle were taken and surface composition (in at%) was calculated from the narrow scans for Si 2p, O 1s, Al 2p, Mg 2s, K 2p, Na 1s, Ca 2p and N 1s.

RESULTS

Atomic concentration of elements (after exclusion of C) for the five LRF ceramics were in the range: O, 45.0-51.6%; Si, 26.7-35.6%; Al, 6.3-9.7%; Mg, 4.9-8.8%; K, 0.5-2.2%; N, 0.9-2.9% and less than 1% of Na and Ca. The shapes of the O 1s and Si 2p narrow scan core lines of the five LRF ceramics were virtually identical.

SIGNIFICANCE

All five LRF ceramics were found to have a silica-rich surface layer due to a reduction in K and Na relative to the bulk composition. Both the composition and chemical states of the surfaces for the five LRF ceramics were very similar.

Plasma copolymer surfaces of acrylic acid/1,7 octadiene: surface characterisation and the attachment of ROS 17/2.8 osteoblast-like cells

The purpose of this study was: (a) to examine the effect of plasma-gas composition on plasma polymer oxygen/carbon (O/C) ratio, functional group composition and stability in water, and then (b) to examine cell attachment to surfaces containing different concentrations of O/C and functional groups. Oxygen-functionalised surfaces were deposited by means of the plasma copolymerisation of acrylic acid/1,7-octadiene. The use of a diluent hydrocarbon allowed the deposition of surfaces with a range of O/C concentrations. Plasma copolymer surfaces were characterised by X-ray photoelectron spectroscopy (XPS). Changes in functional group composition with % acrylic acid monomer and the non-dispersive and dispersive parts of the surface energy of these plasma copolymers were measured. The solubility of the plasma copolymers was assessed by means of XPS. The degree of attachment of ROS 17/2.8 osteoblast-like cells to plasma copolymer surfaces deemed to be 'stable' in aqueous medium was measured. Tissue culture polystyrene (TCPS) was included as a control. Attachment was found to be greatest to the plasma copolymer surface with an O/C of 0.11. This surface had a carboxylic acid concentration of ca. 3%. Attachment did not correlate with increased surface wettability (i.e. the non-dispersive component of the surface energy).

District nurses' perceptions of palliative care at home

A postal survey of 148 district nurses (DNs) was carried out to explore their experiences of terminal care and their views of the palliative care team. Information was also gathered on DNs' perceived educational needs in relation to palliative care. The high response rate of 87% and the additional comments that many nurses offered illustrates their desire to provide high-quality care. Factors that appeared to hinder achievement of this goal and led to stress included size of caseload, lack of knowledge and experience in managing difficult symptoms as well as time constraints. High levels of satisfaction with the palliative care team were recorded but a need for further education and improved communication were identified.