Frequency and burden of neurological manifestations in hospitalized patients with COVID-19: findings from a large Brazilian cohort

Background Scientific data regarding the prevalence of COVID-19 neurological manifestations and prognosis in Latin America countries is still lacking. Therefore, the study aims to understand neurological manifestations of SARS-CoV 2 infection in the Brazilian population and its association with patient outcomes, such as in-hospital mortality. Methods This study is part of the Brazilian COVID-19 Registry, a multicentric COVID-19 cohort, including data from 37 Brazilian hospitals. For the analysis, patients were grouped according to the presence of self-reported vs. clinically-diagnosed neurological manifestations and matched with patients without neurological manifestations by age, sex, number of comorbidities, hospital, and whether or not patients ha neurological underlying disease. Results From 7,232 hospitalized patients with COVID-19, 27.8% presented self-reported neurological manifestations, 9.9% were diagnosed with a clinically-defined neurological syndrome and 1.2% did not show any neurological symptoms. In patients with self-reported symptoms, the most common ones were headache (19.3%), ageusia (10.4%) and anosmia (7.4%). Meanwhile, in the group with clinically-defined neurological syndromes, acute encephalopathy was the most common diagnosis (10.5%), followed by coma (0.6%1) and seizures (0.4%). Men and younger patients were more likely to self-report neurological symptoms, while women and older patients were more likely to develop a neurological syndrome. Patients with clinically-defined neurological syndromes presented a higher prevalence of comorbidities, as well as lower oxygen saturation and blood pressure at hospital admission. In the paired analysis, it was observed that patients with clinically-defined neurological syndromes were more likely to require ICU admission (46.9 vs. 37.9%), mechanical ventilation (33.4 vs. 28.2%), to develop acute heart failure (5.1 vs. 3.0%, p=0.037) and to die (40.7 vs. 32.3%, p<0.001) when compared to controls. Conclusion Neurological manifestations are an important cause of morbidity in COVID-19 patients. More specifically, patients with clinically defined neurological syndromes presented a poorer prognosis for the disease when compared to matched controls.

Risk factors for acute bronchiolitis-related return visits to the emergency department

Purpose: Acute bronchiolitis (AB)-related return visits incur overuse of emergency medicine resources, crowding of emergency departments (EDs), and deterioration of rapport with the guardians. The authors aimed to analyze factors associated with the return visits to the ED.Methods: This study was conducted based on the medical records of 447 children aged 24 months or younger with AB who visited the ED from January 2019 through December 2020. A return visit was defined as an AB-related visit to the ED within 7 days of index visit. According to the return visit, we compared the clinical features. Multivariable logistic regression was conducted to identify independent factors for the return visit.Results: Of the 323 children with AB, 77 (23.8%) made return visits. The returning children showed a younger median age (6 [interquartile range, 2-10] vs. 8 months [3-14]; P < 0.001), a lower mean oxyhemoglobin saturation (92.9 ± 4.3% vs. 97.1 ± 1.8%; P < 0.001), and higher frequencies of congenital heart diseases (22.1% vs. 10.6%; P = 0.009) and bronchopulmonary dysplasia (11.7% vs. 5.7%; P = 0.013), and respiratory syncytial virus infection (57.1% vs. 37.0%; P = 0.002). No other variables, such as the hospitalization rate, differed as per return visits. The factors associated with return visits were respiratory syncytial virus infection (adjusted odds ratio, 9.41; 95% confidence interval, 2.13-41.57), lower oxygen saturation (2.00; 1.64-2.43), and age younger than 3 months (1.25; 1.07-1.24).Conclusion: AB-related return visits may be associated with age younger than 3 months, lower oxygen saturation, and respiratory syncytial virus infection.

Recent Advances in Hollow Cathode Technology for Plasma-Enhanced ALD—Plasma Surface Modifications for Aluminum and Stainless-Steel Cathodes

Recent designs have allowed hollow cathode gas plasma sources to be adopted for use in plasma-enhanced atomic layer deposition with the benefit of lower oxygen contamination for non-oxide films (a brief review of this is provided). From a design perspective, the cathode metal is of particular interest since—for a given set of conditions—the metal work function should determine the density of electron emission that drives the hollow cathode effect. However, we found that relatively rapid surface modification of the metal cathodes in the first hour or more of operation has a stronger influence. Langmuir probe measurements and hollow cathode electrical characteristics were used to study nitrogen and oxygen plasma surface modification of aluminum and stainless-steel hollow cathodes. It was found that the nitridation and oxidation of these metal cathodes resulted in higher plasma densities, in some cases by more than an order of magnitude, and a wider range of pressure operation. Moreover, it was initially thought that the use of aluminum cathodes would not be practical for gas plasma applications, as aluminum is extremely soft and susceptible to sputtering; however, it was found that oxide and nitride modification of the surface could protect the cathodes from such problems, possibly making them viable.

Effectiveness of Regdanvimab in Patients With Mild-to-moderate COVID-19: A Retrospective Cohort Study

BackgroundMonoclonal antibodies are a treatment option for patients with mild-to-moderate coronavirus disease (COVID-19). We investigated the effectiveness of regdanvimab, an anti-SARS-CoV-2 monoclonal antibody approved in South Korea, in the treatment of patients with mild-to-moderate COVID-19. MethodsMedical records of mild-to-moderate COVID-19 patients admitted to a COVID-19 designated hospital were reviewed to assess baseline characteristics (age, gender, BMI, and comorbidities) and clinical outcomes such as supplemental oxygen requirements, mortality, and length of hospitalization.ResultsFour hundred seventy-four COVID-19 patients were included in the study, and 66 of them were administered regdanvimab. The proportion of patients requiring supplemental oxygen was significantly lower in the regdanvimab group than in control group without statistical significance (6.1% vs. 22.8%, P = 0.001). There was no significant difference in mortality (0% vs 1.2%, P > 0.999) and the length of hospitalization (median: 10.5 days vs. 7.5 days, P = 0.067) between both groups. Increasing age, male sex, chest X-ray abnormality, underlying chronic kidney disease and administration of regdanvimab were found to have a significant univariate association with oxygen requirement. The multivariate analysis demonstrated that increasing age (OR: 1.03, 95% CI: 1.01-1.05, P < 0.001) and chest X-ray abnormality (OR: 4.40, 95% CI: 2.49-8.21, P < 0.001) were independently associated with higher requirement of oxygen and administration of regdanvimab was independently associated with lower oxygen supplement (OR: 0.17, 95% CI: 0.05-0.47, P < 0.002). ConclusionsRegdanvimab reduced the need for supplemental oxygen and fatalities in mild-to-moderate COVID-19 patients who matching the indications for administration of regdanvimab.

Soluble ST2 concentrations associate with in-hospital mortality and need for mechanical ventilation in unselected patients with COVID-19

ObjectiveSoluble ST2 (sST2) reflects inflammation, endothelial dysfunction and myocardial fibrosis, is produced in the lungs and is an established biomarker in heart failure. We sought to determine the role of sST2 in COVID-19 by assessing pathophysiological correlates and its association to in-hospital outcomes.MethodsWe enrolled 123 consecutive, hospitalised patients with COVID-19 in the prospective, observational COVID-19 MECH study. Biobank samples were collected at baseline, day 3 and day 9. The key exposure variable was sST2, and the outcome was ICU treatment with mechanical ventilation or in-hospital death.ResultsConcentrations of sST2 at baseline was median 48 (IQR 37–67) ng/mL, and 74% had elevated concentrations (>37.9 ng/mL). Higher baseline sST2 concentrations were associated with older age, male sex, white race, smoking, diabetes, hypertension and chronic kidney disease. Baseline sST2 also associated with the presence of SARS-CoV-2 viraemia, lower oxygen saturation, higher respiratory rate and increasing concentrations of biomarkers reflecting inflammation, thrombosis and cardiovascular disease. During the hospitalisation, 8 (7%) patients died and 27 (22%) survivors received intensive care unit (ICU) treatment. Baseline sST2 concentrations demonstrated a graded association with disease severity (median, IQR): medical ward 43 (36–59) ng/mL; ICU 67 (39–104) ng/mL and non-survivors 107 (72–116) ng/mL (p<0.001 for all comparisons). These associations persisted at day 3 and day 9 .ConclusionssST2 concentrations associate with SARS-CoV-2 viraemia, hypoxaemia and concentrations of inflammatory and cardiovascular biomarkers. There was a robust association between baseline sST2 and disease severity that was independent of, and superior to, established risk factors. sST2 reflects key pathophysiology and may be a promising biomarker in COVID-19.Trial registration numberNCT04314232.

Oxygen Consumption of Resuspended Sediments of the Upper Elbe Estuary: Process Identification and Prognosis

The resuspension of sediment leads to an increased release of nutrients and organic substances into the overlying water column, which can have a negative effect on the oxygen budget. Especially in the warmer months with a lower oxygen saturation and higher biological activity, the oxygen content can reach critical thresholds in estuaries like the upper Elbe estuary. Many studies have dealt with the nutrient fluxes that occur during a resuspension event. However, the sediment properties that influence the oxygen consumption potential (OCP) and the different biochemical processes have not been examined in detail. To fill this gap, we investigated the biogeochemical composition, texture, and OCP of sediments at 21 locations as well as the temporal variability within one location for a period of 2 years (monthly sampling) in the upper Elbe estuary. The OCP of sediments during a seven-day resuspension event can be described by the processes of sulphate formation, nitrification, and mineralisation. Chlorophyll, total nitrogen (Ntotal), and total organic carbon showed the highest correlations with the OCP. Based on these correlations, we developed a prognosis model to calculate the OCP for the upper Elbe estuary with a single sediment parameter (Ntotal). The model is well suited to calculate the oxygen consumption of resuspended sediments in the Hamburg port area during the relevant warmer months and shows a normalised root mean squared error of < 0.11 ± 0.13. Thus, the effect of maintenance measures such as water injection dredging and ship-induced wave on the oxygen budget of the water can be calculated.

Pediatric Sickle Cell Disease and the COVID-19 Pandemic: A Year in Review at Children's National Hospital

Background: Over the past year, COVID-19 was declared a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulting in over 100 million cases and &gt;3 million deaths worldwide according to the World Health Organization (WHO). Morbidity and mortality have been highest in adults, particularly in those with underlying conditions including hypertension, diabetes, and obesity. Children, thus far, have largely remained either asymptomatic or presented with mild symptoms. However, sickle cell disease (SCD) was classified as a risk factor for severe COVID-19 disease in both adults and pediatric patients. Objective: To describe the one-year experience of the clinical course, management, and treatment of COVID-19 in children, and young adults with SCD at Children's National Hospital (CNH). Methods: This was a single-center, observational cohort study of 55 children (age &lt;18 years) and young adult (age ≥ 18 years) patients with SCD and PCR confirmed SARS-CoV-2 infection at CNH between March 31, 2020, and February 12, 2021 (Figure 1A). Results: Sixty-nine percent were children (N=38) and 31% were young adults (N=17). The mean age was 11.6 years with 51% females (N=28) and 49% males (N=27). Seventy-five percent of cases were Hgb SS, 15% Hgb SC, and 11% Hgb SBeta Thalassemia Zero (Table 1). Fever (45%) was the most common presenting symptom; only 9% had a loss of taste or smell (Figure 1B). Twenty-two percent were asymptomatic at presentation. Among the 40 patients who presented to the emergency department (ED) or were hospitalized, 50% (N=20) presented with vaso-occlusive pain crisis (VOC), 42% with Acute Chest Syndrome (ACS), 2% with splenic sequestration, and 2% with Venous Thromboembolism. Only 3% were admitted to the ICU (N=2 young adults, N=1 children); none of whom were on hydroxyurea. There were no differences in hospitalization rates between Hgb SS and Hgb SC patients (Table 1). Lower oxygen saturation (02 Sat)(02 Sat &lt;95%: 62% vs 16% p=0.004), fevers (69% vs 16%, p=0.001), VOC pain crisis (50% vs 24%, p=0.047), and ACS (65% vs 3%, p&lt;0.001) were more common in hospitalized patients vs. non-hospitalized patients. Patients with ACS experienced a longer length of stay (6 days vs. 3 days p=0.008), lower oxygen saturation (02Sat&lt;95%: 81% vs 13% p&lt;0.001), higher white blood cell count (13.3 vs 9.0 K/mcL, p=0.009), lower hemoglobin nadir (6.8 vs. 9.6 gm/dL, p= 0.049), and elevated D-dimers (4.1 vs. 0.8 ug/mL, p=0.002) compared to those without ACS. The types of treatment received by patients requiring hospitalization or ED visits included ceftriaxone (N=28, 70%), azithromycin (N=15, 37.5%), remdesivir (N=6,15%) convalescent plasma(N=1,2.5%). Blood transfusion was required in 29% of the 55 SCD COVID-19 cases (N=16) and 76% (N=13) of the ACS patients. Twenty-six percent (N=17) of hospitalized patients were anticoagulated with either enoxaparin or rivaroxaban according to CNH's COVID-19 anticoagulation treatment protocol. There were similar rates of healthcare utilization, SCD modifying therapies, acute COVID-19 clinical presentation, respiratory support, and laboratory findings (hematologic, inflammatory) between the children and young adults. However, young adults were more likely to be on crizanlizumab treatment (18% vs 0%, p=0.026) and have an elevated D-Dimer (4.0 vs 1.0, p=0.012) on laboratory evaluation. Conclusion: Our case series reveals that the demographics and clinical presentation between our SCD children and young adult patients with COVID-19 were similar overall. While the morbidity was high, there was no mortality. Those that were hospitalized had lower oxygen saturation levels, higher incidences of fever, and higher morbidity presenting with VOC and ACS. Patients with ACS and/or an oxygen requirement had significantly higher WBC count, lower nadir hemoglobin, and higher D-dimers in a small subset of patients supporting a pro-inflammatory and coagulopathic picture. Our study will add to a growing body of literature on SCD COVID-19 cases. Figure 1 Figure 1. Disclosures Darbari: Global Blood Therapeutics: Consultancy; Hilton Publishing Inc.: Consultancy; Novartis: Consultancy. Majumdar: Asklepion Pharma: Consultancy, Patents & Royalties: IV L-Citrulline in the use of sickle cell pain crisis. Campbell: Novartis Pharmaceuticals Corporation: Consultancy, Research Funding.

Study on coal to methanol of Arutmin coal

The Indonesian government has encouraged coal mining companies to expand into coal downstream industries. In response to this policy, PT. Arutmin Indonesia has conducted a pre-feasibility study on the construction of a coal-to-methanol plant. The plant was located in the Pulau Laut Utara Coal Terminal (NPLCT). The plant is designed to produce 3.0 million tons of methanol/year. The raw material is supplied from the Sarongga coal mine, about 5 km away from NPLCT. The coal-to-methanol process was simulated using ChemCad to solve chemical and energy problems. Based on heat & material balance simulation results, the plant requires coal of 6.0 million tons/year as a raw material. Air Product technology was chosen for coal gasification and Davy Technology for methanol synthesis. Air product gasifier requires lower oxygen to produce syngas than other technologies, thereby reducing oxygen production costs. The plant needs an investment cost of USD 3.0 billion. With the assumption of a methanol price of 311 USD/ton and 20 years of tax holiday incentives, the financial analysis results show that the construction of coal-to-methanol plant is financially feasible with an NPV value of 289.7 million USD and an IRR of 13.35%.

Application of Leg, Vertical, and Joint Stiffness in Running Performance: A Literature Overview

Stiffness, the resistance to deformation due to force, has been used to model the way in which the lower body responds to landing during cyclic motions such as running and jumping. Vertical, leg, and joint stiffness provide a useful model for investigating the store and release of potential elastic energy via the musculotendinous unit in the stretch-shortening cycle and may provide insight into sport performance. This review is aimed at assessing the effect of vertical, leg, and joint stiffness on running performance as such an investigation may provide greater insight into performance during this common form of locomotion. PubMed and SPORTDiscus databases were searched resulting in 92 publications on vertical, leg, and joint stiffness and running performance. Vertical stiffness increases with running velocity and stride frequency. Higher vertical stiffness differentiated elite runners from lower-performing athletes and was also associated with a lower oxygen cost. In contrast, leg stiffness remains relatively constant with increasing velocity and is not strongly related to the aerobic demand and fatigue. Hip and knee joint stiffness are reported to increase with velocity, and a lower ankle and higher knee joint stiffness are linked to a lower oxygen cost of running; however, no relationship with performance has yet been investigated. Theoretically, there is a desired “leg-spring” stiffness value at which potential elastic energy return is maximised and this is specific to the individual. It appears that higher “leg-spring” stiffness is desirable for running performance; however, more research is needed to investigate the relationship of all three lower limb joint springs as the hip joint is often neglected. There is still no clear answer how training could affect mechanical stiffness during running. Studies including muscle activation and separate analyses of local tissues (tendons) are needed to investigate mechanical stiffness as a global variable associated with sports performance.

Oxygen K-edge X-ray absorption spectra of liquids with minimization of window contamination

Oxygen K-edge X-ray absorption spectroscopy is used routinely to study a range of solid materials. However, liquid samples are studied less frequently at the oxygen K-edge due to the combined challenges of high-vacuum conditions and oxygen contamination of window materials. A modular sample holder design with a twist-seal sample containment system that provides a simple method to encapsulate liquid samples under high-vacuum conditions is presented. This work shows that pure silicon nitride windows have lower oxygen contamination than both diamond- and silicon-rich nitride windows, that the levels of oxygen contamination are related to the age of the windows, and provides a protocol for minimizing the background oxygen contamination. Acid-washed 100 nm-thick silicon nitride windows were found to give good quality oxygen K-edge data on dilute liquid samples.