Search

Purpose: Older patients with COVID-19 can present with atypical complaints, such as falls or delirium. In other diseases, such an atypical presentation is associated with worse clinical outcomes. However, it is not known whether this extends to COVID-19. We aimed to study the association between atypical presentation of COVID-19, frailty and adverse outcomes, as well as the incidence of atypical presentation., Methods: We conducted a retrospective observational multi-center cohort study in eight hospitals in the Netherlands. We included patients aged ≥ 70 years hospitalized with COVID-19 between February 2020 until May 2020. Atypical presentation of COVID-19 was defined as presentation without fever, cough and/or dyspnea. We collected data concerning symptoms on admission, demographics and frailty parameters [e.g., Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS)]. Outcome data included Intensive Care Unit (ICU) admission, discharge destination and 30-day mortality., Results: We included 780 patients, 9.5% (n = 74) of those patients had an atypical presentation. Patients with an atypical presentation were older (80 years, IQR 76-86 years; versus 79 years, IQR 74-84, p = 0.044) and were more often classified as severely frail (CFS 6-9) compared to patients with a typical presentation (47.6% vs 28.7%, p = 0.004). Overall, there was no significant difference in 30-day mortality between the two groups in univariate analysis (32.4% vs 41.5%; p = 0.173) or in multivariate analysis [OR 0.59 (95% CI 0.34-1.0); p = 0.058]., Conclusions: In this study, patients with an atypical presentation of COVID-19 were more frail compared to patients with a typical presentation. Contrary to our expectations, an atypical presentation was not associated with worse outcomes., (© 2023. The Author(s), under exclusive licence to European Geriatric Medicine Society.)

Background: The global push for the use of hydroxychloroquine (HCQ) and chloroquine (CQ) against COVID-19 has resulted in an ongoing discussion about the effectivity and toxicity of these drugs. Recent studies report no effect of (H)CQ on 28-day mortality. We investigated the effect of HCQ and CQ in hospitalized patients on the non-ICU COVID-ward., Methods: A nationwide, observational cohort study was performed in The Netherlands. Hospitals were given the opportunity to decide independently on the use of three different COVID-19 treatment strategies: HCQ, CQ, or no treatment. We compared the outcomes between these groups. The primary outcomes were 1) death on the COVID-19 ward, and 2) transfer to the intensive care unit (ICU)., Results: The analysis included 1064 patients from 14 hospitals: 566 patients received treatment with either HCQ (n = 189) or CQ (n = 377), and 498 patients received no treatment. In a multivariate propensity-matched weighted competing regression analysis, there was no significant effect of (H)CQ on mortality on the COVID ward. However, HCQ was associated with a significantly decreased risk of transfer to the ICU (hazard ratio (HR) = 0.47, 95% CI = 0.27-0.82, p =  0.008) when compared with controls. This effect was not found in the CQ group (HR = 0.80, 95% CI = 0.55-1.15, p =  0.207), and remained significant after competing risk analysis., Conclusion: The results of this observational study demonstrate a lack of effect of (H)CQ on non-ICU mortality. However, we show that the use of HCQ - but not CQ - is associated with a 53% reduction in risk of transfer of COVID-19 patients from the regular ward to the ICU. Recent prospective studies have reported on 28-day, all-cause mortality only; therefore, additional prospective data on the early effects of HCQ in preventing transfer to the ICU are still needed., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Wind and temperature data are important parameters in aircraft performance studies. The lack of accurate measurements of these parameters forces researchers to rely on numerical weather prediction models, which are often filtered for a larger area with decreased local accuracy. Aircraft, however, also transmit information related to weather conditions, in response to interrogation by air traffic controller surveillance radars. Although not intended for this purpose, aircraft surveillance data contains information that can be used for weather models. This paper presents a method that can be used to reconstruct a weather field from surveillance data that can be received with a simple 1090 MHz receiver. Throughout the paper, we answer two main research questions: how to accurately infer wind and temperature from aircraft surveillance data, and how to reconstruct a real-time weather grid efficiently. We consider aircraft as moving sensors that measure wind and temperature conditions indirectly at different locations and flight levels. To address the first question, aircraft barometric altitude, ground velocity, and airspeed are decoded from down-linked surveillance data. Then, temperature and wind observations are computed based on aeronautical speed conversion equations. To address the second question, we propose a novel Meteo-Particle (MP) model for constructing the wind and temperature fields. Short-term local prediction is also possible by employing a predictor layer. Using an unseen observation test dataset, we are able to validate that the mean absolute errors of inferred wind and temperature using MP model are 67% and 26% less than using the interpolated model based on GFS reanalysis data., Competing Interests: The authors have declared that no competing interests exist.