Ultrasonography on the non-living. Current approaches.

The vast majority of clinicians associate diagnostic ultrasound with a tool that is designed for the living patient. However, it is of course possible to apply this imaging technology to evaluate the recently deceased patient for postmortem diagnosis, or even just examine postmortem tissue. We describe several cases in which ultrasound-enabled providers obtain answers in postmortem examinations and discuss potential future strategies and applications. In addition, we will also illustrate the use of sonography in minimally invasive post-mortem tissue sampling (MITS), an approach that can be used in post-mortem minimally invasive autopsies as well as for establishing ultrasound diagnostic parameters in new medical fields such as periodontal and dental implant specialties.

Relative COVID-19 Viral Persistence and Antibody Kinetics

A total of 15 RT-PCR confirmed COVID-19 patients were admitted to our hospital during the in-itial outbreak in Taiwan. The average time of virus clearance was delayed in seven patients, 24.14 ± 4.33 days compared to 10.25 ± 0.56 days post-symptom onset (PSO) in the other eight pa-tients. There was strong antibody response in patients with viral persistence at the pharynx, with peak values of serum antibody 677.2 ± 217.8 vs. 76.70 ± 32.11 in patients with delayed versus rapid virus clearance. The patients with delayed viral clearance had excessive antibodies of compromised quality in an early stage with the delay in peak virus neutralization efficacy, 34.14 ± 7.15 versus 12.50 ± 2.35 days PSO in patients with rapid virus clearance. Weak antibody re-sponse of patients with rapid viral clearance was also effective, with substantial and comparable neutralization efficacy, 35.70 ± 8.78 versus 41.37 ± 11.49 of patients with delayed virus clearance. Human Cytokine 48-Plex Screening of the serial sera samples revealed elevated concentrations of proinflammatory cytokines and chemokines in a deceased patient with delayed virus clear-ance and severe disease. The levels were comparatively less in the other two patients who suf-fered from severe disease but eventually survived.

Outbreak of SARS-CoV-2 Lineage 20I/501Y.V1 in a Nursing Home Underlines the Crucial Role of Vaccination in Both Residents and Staff

Elderly residents in nursing homes are at very high risk of life-threatening COVID-19-related outcomes. In this report, an epidemiological and serological investigation of a SARS-CoV-2 outbreak in an Italian nursing home is described. Among the residents, all but one (19/20) were regularly vaccinated against SARS-CoV-2. In mid-February 2021, a non-vaccinated staff member of the nursing home was diagnosed with the SARS-CoV-2 infection. Following the outbreak investigation, a total of 70% (14/20) of residents aged 77–100 years were found positive. The phylogenetic analysis showed that the outbreak was caused by the SARS-CoV-2 variant of concern 202012/01 (the so-called “UK variant”). However, all but one positive subjects (13/14) were fully asymptomatic. The only symptomatic patient was a vaccinated 86-year-old female with a highly compromised health background and deceased approximately two weeks later. The subsequent serological investigation showed that the deceased patient was the only vaccinated subject that did not develop the anti-spike protein antibody response, therefore being likely a vaccine non-responder. Although the available mRNA SARS-CoV-2 vaccine was not able to prevent several asymptomatic infections, it was able to avert most symptomatic disease cases caused by the SARS-CoV-2 variant of concern 202012/01 in nursing home residents.

Association between absolute eosinopenia and mortality in SARS-COV-2 infection on the 70+, a discussed observation

Background: This study aimed to seek for an association between absolute eosinopenia (eosinophils count < 10 /mm3) and mortality in an older adults suffering from COVID-19 hospitalized in a specific geriatric ward. Methods: This observational retrospective study was conducted in a French geriatric ward from March 17 to April 18, 2020. All 118 patients hospitalized for COVID-19 over 70 yo in acute stay care were enrolled. Patients with a treatment or a pathology which could interfere with eosinophil count were excluded. Results: No statistical difference was found between surviving or deceased patient regarding age (mean age (SD): 87 years (7)) and sex (34% of males). Differences for the most frequent acute events were statically different: Quick Sepsis-related Organ Failure Assessment (qSOFA) score was ≥ 2 at admission for 23% in the survivor group vs. 23 (72%) in the deceased (p < .001); acute kidney injury concerned 17% of the survivors vs. 69% of the decease (p< .001). Eosinopenia < 10/mm3 was significantly associated with mortality (OR (CI95%)) = 3.5 (1.2-11.4) after adjustment on age, gender, and activity of daily living. Conclusion: Absolute eosinopenia was associated with in hospital mortality in older adults. This result, if confirmed in other study, may help to predict the outcome of a SARS-COV-2 infection on geriatric patients and calls for immunologist to explore more globally the impact of inflammaging on the SARS-CoV-2 infection.

Dostęp do dokumentacji medycznej pacjenta w świetle orzecznictwa sądów administracyjnych

<p>This study contains an analysis of legal regulations on the access to patient’s medical records and the compliance with these regulations in Poland. Based on the extensive case-law of the administrative courts, the following were examined, i.a., the forms of making medical records available, with particular respect to the making available of the original of these records, the possibility of charging fees for the provision of medical records, the form of the request for access to medical records and the time within which the provider of health services is required to make that documentation available. The list of entities authorised to get access to patient’s medical records has been discussed and attention has been drawn to problems in gaining access to the medical records of a deceased patient.</p>

Clinical Characteristics of COVID-19 Related Deaths in Ethiopia

BACKGROUND: Since the occurrence of COVID-19 in the world, it has claimed nearly 1.39 million human lives in the world and more than 1500 lives in Ethiopia. The number of deaths is increasing with variable distribution in the world. Despite its increasing fatality, the clinical characteristics of the deceased patients are not yet fully known. Analyzing the clinical characteristics of deceased patients will help to improve the outcome of infected patients. Hence, this study aimed to determine the clinical characteristics of patients who died due to COVID-19 in Ethiopia.METHODS: Hospital based multi-center cross-sectional study was conducted using chart review of deceased patients. Since the number of COVID-19 related deaths was limited, all consecutive COVID-19 related hospital deaths were analyzed. The data was entered into and analyzed using SPSS version 25.0. Descriptive statistics was used to explain the data collected from the survey.RESULT: A total of 92 deceased patient charts were analyzed. Of these patients, 65(71%) were males. Age ranged from 17 to 92 years (mean age being 59 years). On arrival vital signs, 60.5% of them had hypoxia, 49% had tachycardia and only 32% of patients had fever. Three fourth of the patients 64/85 had at least one comorbidity. Diabetes mellitus (DM) was the commonest comorbidity accounting for 445.9%, followed by hypertension, 23/85(27%), and HIV/ AIDS, 15/85 (17.5%).CONCLUSION: The results of this study showed that COVID-19 deceased patients presented with respiratory failure and hypoxia. However, less than a third of these patients had fever. In addition, the presence of comorbid illnesses and non-COVID-19 diseases like AIDS defining illness in significant amount needs further study to identify their level of contribution to the increasing burden of COVID-19 deaths in Ethiopia.

FORMS OF CRIMINAL LIABILITY IN CASE OF DEATH OF THE PATIENT

The aim: Establishing the forms of criminal liability in case of death of the patient and the presence of such a condition as the desire of the relatives of the deceased to reconcile with the subject of the criminal offense. Materials and methods: In the course of the study, 62 court judgements were used. Comparative, systematic, analytic, and empiric research methods have been used in this research. Results: The position of the victims – relatives of the deceased – has a direct influence on the choice of the form of criminal liability. A medical worker who is the subject of a criminal offense may reconcile with the relatives of the deceased patient and enter into a reconciliation agreement. It is the parties of the agreement who consent to the punishment and the possible exemption from it. At the same time, the court cannot exempt a medical worker from criminal liability in case of a patient’s death. This thesis is based on the fact that the possibility of such exemption is directly related to the reconciliation with the victims who are patients that were provided with medical service. Besides, death is a consequence that is irreversible. Conclusions: The exemption from criminal liability according to the reconciliation of the guilty person with the victim in case of death of a patient is stated to be impossible. At the same time, the possibility of concluding a reconciliation agreement in this case has been established.

The course of COVID-19 in four patients with HIV during the pandemic

Background: The clinical spectrum of SARS-CoV-2 infection may vary from simple colds to severe acute respiratory syndrome, metabolic acidosis, septic shock, and multiple organ failure. Current evidence indicates that the risk of severe illness increases with age, male sex, and with certain chronic medical problems. Many people living with HIV have other conditions that increase their risk. Case presentation: In the first 3 months of the pandemic, four patients with HIV were hospitalized in our clinic because of COVID-19. The disease severity was mild in two patients with normal CD4+ T count. However, one patient with a low CD4+T count died and the other developed retinal detachment one month after discharge. The deceased patient had a malignancy. Conclusion: In this study, the effect of the immunological status of the patients on the course of COVID-19 and the developing vascular complications were evaluated in 4 patients with HIV.

Violence against Health Care Professionals and Facilities—Local Insights about a Global Malady

Acts of violence against health care professionals (especially doctors) as well as facilities are a growing global problem. In our country, it has taken an unfortunate dramatic turn of the involvement of a mob—a ragtag group of persons who organize and perpetrate the crime based on community, caste, religion, or political affiliations. This crucial factor is the fundamental difference in what we face as compared with the so-called Yi Nao phenomenon of China. In India, the mob gathers and indulges in acts of violence, intimidation, and blackmail at the behest of its “leader,” often having no direct relationship with the deceased patient. It is premeditated and systematic vandalism. Often it is also associated with financial gain to the perpetrators through extortion and blackmail, adding to the woes of the health care professionals and hospital facility. We discuss what is the primary goal and what is a byproduct in this cycles of violence against the people who are doing their best to save the lives of patients. Unless the governments and the courts take this matter seriously as well as follow-up with corrective measures, the future looks bleak for all stakeholders.

Modeling the Spread of COVID-19 Infection Using a Multilayer Perceptron

Coronavirus (COVID-19) is a highly infectious disease that has captured the attention of the worldwide public. Modeling of such diseases can be extremely important in the prediction of their impact. While classic, statistical, modeling can provide satisfactory models, it can also fail to comprehend the intricacies contained within the data. In this paper, authors use a publicly available dataset, containing information on infected, recovered, and deceased patients in 406 locations over 51 days (22nd January 2020 to 12th March 2020). This dataset, intended to be a time-series dataset, is transformed into a regression dataset and used in training a multilayer perceptron (MLP) artificial neural network (ANN). The aim of training is to achieve a worldwide model of the maximal number of patients across all locations in each time unit. Hyperparameters of the MLP are varied using a grid search algorithm, with a total of 5376 hyperparameter combinations. Using those combinations, a total of 48384 ANNs are trained (16128 for each patient group—deceased, recovered, and infected), and each model is evaluated using the coefficient of determination (R2). Cross-validation is performed using K-fold algorithm with 5-folds. Best models achieved consists of 4 hidden layers with 4 neurons in each of those layers, and use a ReLU activation function, with R2 scores of 0.98599 for confirmed, 0.99429 for deceased, and 0.97941 for recovered patient models. When cross-validation is performed, these scores drop to 0.94 for confirmed, 0.781 for recovered, and 0.986 for deceased patient models, showing high robustness of the deceased patient model, good robustness for confirmed, and low robustness for recovered patient model.