Background: During COVID-19 pandemic, people who developed pneumonia and needed supplemental oxygen, where treated with low-flow oxygen therapy systems and non-invasive methods, including oxygen therapy using high flow nasal cannula (HFNC) and the application of bi-level or continuous positive airway pressure (BiPAP or CPAP). We aimed to investigate the outcomes of critical COVID-19 patients treated with HFNC and unveil predictors of HFNC failure. Methods:We retrospectively enrolled patients admitted to COVID-19 wards and treated with HFNC for COVID-19-related severe hypoxemic respiratory failure. The primary outcome of this study was treatment failure, such as the composite of intubation or death during hospital stay. The association between treatment failure and clinical features was evaluated using logistic regression models.Results: One hundred thirty-two patients with a median (IQR) PaO 2 /FiO 2 ratio 96 (63-173) mmHg at HFNC initiation were studied. Overall, 45.4% of the patients were intubated. Hospital mortality was 31.8%.Treatment failure (intubation or death) occurred in 50.75% and after adjustment for age, gender, Charlson Comorbidity index (CCI) score and National Early Warning Score 2 (NEWS2) score on admission and PaO 2 /FiO 2 ratio and acute respiratory distress syndrome (ARDS) severity at the time of HFNO initiation, it was significantly associated with the presence of dyspnea [adjusted OR 2.48 (95% CI: 1.01-6.12)], and higher Urea serum levels [adjusted OR 1.25 (95% CI: 1.03-1.51) mg/dL].Conclusions: HFNC treatment was successful in almost half of the patients with severe COVID-19related acute hypoxemic respiratory failure (AHRF). The presence of dyspnea and high serum Urea levels on admission are closely related to HFNC failure.

Background: Patients with COVID-19 commonly present at healthcare facilities with moderate disease, i.e., pneumonia without a need for oxygen therapy. Aim: To identify clinical/laboratory characteristics of patients with moderate COVID-19, which could predict disease progression. Methods: 384 adult patients presented with moderate COVID-19 and admitted to two hospitals were retrospectively evaluated. In a multivariate analysis gender, age, BMI, Charlson Comorbidity Index (CCI) and National Early Weaning Score 2 were treated as co-variates. The development of hypoxemic respiratory failure, intubation rate and risk of death were considered as dependent variables. Estimated values are presented as odds-ratio (OR) with 95% confidence interval (CI). Results: Most of the patients were male (63.28%) with a mean (standard deviation) age of 59 (16.04) years. Median (interquartile range) CCI was 2 (1–4). A total of 58.85% of the patients developed respiratory failure; 6.51% were intubated, and 8.85% died. The extent of pneumonia in chest X-ray (involvement of all four quartiles) [OR 3.96 (1.18–13.27), p = 0.026], respiratory rate [OR 1.17 (1.05–1.3), p = 0.004], SatO2 [OR 0.72 (0.58–0.88), p = 0.002], systolic blood pressure [OR 1.02 (1–1.04), p = 0.041] and lymphocyte count [OR 0.9993 (0.9986–0.9999), p = 0.026] at presentation were associated with the development of respiratory failure. The extent of pneumonia [OR 26.49 (1.81–387.18), p = 0.017] was associated with intubation risk. Age [OR 1.14 (1.03–1.26), p = 0.014] and the extent of pneumonia [OR 22.47 (1.59–316.97), p = 0.021] were associated with increased risk of death. Conclusion: Older age, the extent of pneumonia, tachypnea, lower SatO2, higher systolic blood pressure and lymphopenia are associated with dismal outcomes in patients presenting with moderate COVID-19.

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AIM: There is some evidence to suggest that exercise in the evening, compared with exercise in the morning, has a more beneficial impact on glycemia in patients with type 2 diabetes (T2D). The aim of this study was to examine a possible acute effect of aerobic exercise performed at different times of day on blood glucose levels during and after exercise in patients with T2D. MATERIAL & METHOD: Eight male T2D patients (61.8 ± 6.9 yrs, 27.7 ± 3.1 kg/m 2 , HbA1c: 6.5 ± 1.1%; mean ± SD), who did not receive insulin, performed 60-min cycling at about 75% maximal heart rate (HRmax) either at 10:30 (Morning-M), or at 17:30 (Evening-E), or 30-min cycling at 10:30 and 30-min cycling at 17:30 (ME). A control condition (C) was also included where volunteers did not exercise but had their blood glucose measured at day-time intervals similar to the time intervals of the three exercise trials. Two days before each condition no physical activity was allowed, while the day before and on the day of each trial participants controlled their diet. RESULTS: Compared to resting levels, blood glucose at the end of exercise decreased at similar levels in M (20 ± 12%), E (28 ± 14%), in the morning of ME (21 ± 10%) and in the evening of ME (26 ± 19%) (p > 0.05). Also, heart rate, blood lactate and rate of perceived exertion responses during exercise were similar between the 3 exercise conditions. Mean area under the blood glucose-time curve over the two-hour post-exercise period in exercise trials, and at similar time intervals in C, was different only between the morning in C (15,173 ± 1830 mg/dL·120 min) and the evening in ME (11,681 ± 1526 mg/dL·120 min, p = 0.045). In addition, overnight fasting serum glucose the morning after each trial was similar between conditions (p > 0.05). CONCLUSIONS: No acute effect of cycling at about 75% HRmax was observed on glycemia in patients with T2D when exercise was performed at different times of day.

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