Objective To determine predictors of in-hospital mortality related to COVID-19 in older patients. Design Retrospective cohort study. Setting and Participants Patients aged 65 years and older hospitalized for a diagnosis of COVID-19. Methods Data from hospital admission was collected from the electronic medical records. Logistic regression and Cox proportional-hazard models were used to predict mortality, our primary outcome. Variables at hospital admission were categorized according to the following domains: demographics, clinical history, comorbidities, previous treatment, clinical status, vital signs, clinical scales and scores, routine laboratory analysis and imaging results. Results Of a total of 235 Caucasian patients, 43% were male, with a mean age of 86 ± 6.5 years. Seventy-six patients (32%) died. Non-survivors had a shorter number of days from initial symptoms to hospitalization (p=0.007) and the length of stay in acute wards than survivors (p<0.001). Similarly, they had a higher prevalence of heart failure (p=0.044), peripheral artery disease (p=0.009), crackles at clinical status (p<0.001), respiratory rate (p=0.005), oxygen support needs (p<0.001), C-reactive protein (p<0.001), bilateral and peripheral infiltrates on chest radiographs (p=0.001) and a lower prevalence of headache (p=0.009). Furthermore, non-survivors were more often frail (p<0.001), with worse functional status (p<0.001), higher comorbidity burden (p<0.001) and delirium at admission (p=0.007). A multivariable Cox model showed that male sex (HR 4.00, 95% CI 2.08-7.71, p=0.0001), increased fraction of inspired oxygen (HR 1.06, 95% CI 1.03-1.09, p<0.0001) and crackles (HR 2.42, 95% CI 1.15-6.06, p=0.0190) were the best predictors of mortality, while better functional status was protective (HR 0.98, 95% CI 0.97-0.99, p=0.0013). Conclusions and implications In older patients hospitalized for COVID-19 male sex, crackles, a higher fraction of inspired oxygen and functionality were independent risk factors of mortality. These routine parameters, and not differences in age, should be used to evaluate prognosis in older patients.

Foremost amongst the diseases preventable by vaccination is influenza. Worldwide, influenza virus infection is associated with serious adverse events leading to hospitalization, debilitating complications, and death in elderly individuals. Immunization is considered to be the cornerstone for preventing these adverse health outcomes, and vaccination programs are timed to optimize protection during the annual influenza season. Trivalent inactivated influenza virus vaccines are believed to be both effective and cost-saving; however, in spite of widespread influenza vaccination programs, rates of hospitalization for acute respiratory illness and cardiovascular diseases have been increasing in this population during recent annual influenza seasons. From meta-analyses summarizing estimates of influenza vaccine effectiveness from available observational clinical studies, this review aims to examine how effective current influenza vaccine strategies are in the aging and older adult population and to analyze which are the most important biases that interfere with measurements of influenza vaccine effectiveness. Furthermore, consideration is given to strategies that should be adopted in order to optimize influenza vaccine effectiveness in the face of immune exhaustion.

Shrimp head waste is a major byproduct of crustacean processing in Northeastern Brazil and represents an interesting source of bioactive molecules. Additionally, its use increases the sustainability of processing fishery products. The present study reports a process developed for recovering bioactive molecules from shrimp heads through autolysis. A protein hydrolysate (120 ± 0.4 g) formed by a 9% (w/v) solution was recovered and lyophilized from 1 kg of shrimp heads. Approximately 195 ± 0.5 mg of carotenoids was recovered as an ethanolic extract. The recovery of chitin and chitosan were 25 ± 2 g kg −1 and 17 ± 4 g kg −1 wet processing waste, respectively. Chitosans were characterized by 13 C NMR, and FT-IR analysis and exhibited a variable degree of deacetylation (60-80%). Sulfated glycosaminoglycans that exhibited electrophoretic migration similar to mammalian standards were also recovered (79 ± 2 mg kg −1 wet processing waste), and their degradation products suggested the presence of C6sulfated heparan sulfate. These data point to the feasibility of an integrated process for isolating highly bioactive molecules, such as sulfated-and amino-polysaccharides, with a broad spectrum of applications from shrimp processing waste.

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Background Delirium prevalence increases with age and is associated with poor outcomes. We aimed to investigate the prevalence and risk factors for delirium in older patients hospitalized with COVID-19, as well as its association with length of stay and mortality. Methods Retrospective study of patients aged ≥ 65 years hospitalized with COVID-19. Data were collected from computerized medical records and all patients had delirium assessment at admission. Risk factors for delirium as well as the outcomes mentioned above were studied by two-group comparison, logistic regression and Cox proportional-hazard models. Results Of a total of 235 Caucasian patients, 48 (20.4%) presented with delirium, which was hypoactive in 41.6% of cases, hyperactive and mixed in 35.4% and 23.0%, respectively. Patients with cognitive impairment had a nearly four times higher risk of developing delirium compared to patients that were cognitively normal before SARS-CoV-2 infection (OR 3.7; 1.7-7.9 95% CI, p=0.001). The presence of delirium did not modify the time from symptoms’ onset to hospitalization nor the length of stay in acute care, but it was associated with an increased risk of dying (HR 2.1; 1.2-3.7 95%CI; p=0.0113). Conclusion Delirium was a prevalent condition in older people admitted with COVID-19 and pre-existing cognitive impairment was its main risk factor. Delirium was associated with higher in-hospital mortality. These results highlight the importance of early recognition of delirium especially when pre-morbid cognitive comorbidities are present.

The anticlotting and antithrombotic activities of heparin, heparan sulfate, low molecular weight heparins, heparin and heparin-like compounds from various sources used in clinical practice or under development are briefly reviewed. Heparin isolated from shrimp mimics the pharmacological activities of low molecular weight heparins. A heparan sulfate from Artemia franciscana and a dermatan sulfate from tuna fish show a potent heparin cofactor II activity. A heparan sulfate derived from bovine pancreas has a potent antithrombotic activity in an arterial and venous thrombosis model with a negligible activity upon the serine proteases of the coagulation cascade. It is suggested that the antithrombotic activity of heparin and other antithrombotic agents is due at least in part to their action on endothelial cells stimulating the synthesis of an antithrombotic heparan sulfate.

The year 2007 was marked by widespread adverse clinical responses to heparin use, leading to a global recall of potentially affected heparin batches in 2008. Several analytical methods have since been developed to detect impurities in heparin preparations; however, many are costly and dependent on instrumentation with only limited accessibility. A method based on a simple UV-scanning assay, combined with principal component analysis (PCA), was developed to detect impurities, such as glycosaminoglycans, other complex polysaccharides and aromatic compounds, in heparin preparations. Results were confirmed by NMR spectroscopy. This approach provides an additional, sensitive tool to determine heparin purity and safety, even when NMR spectroscopy failed, requiring only standard laboratory equipment and computing facilities.

Background & aims: To investigate the association of nutritional risk at admission with the length of hospital stay (LOS) and mortality in older patients with COVID-19. Methods: Retrospective monocentric study in an acute geriatric hospital. Data were collected after an extensive review of medical records and the nutritional risk was assessed according to the Nutritional Risk Screening (NRS). Univariate and multivariate (adjusted for age, sex and comorbidity burden) Cox proportional-hazard and linear regression models were used to investigate the association with the above-mentioned outcomes. Results: Of a total of 245 patients (86.1 ± 6.4 yrs), 50.6% had a severe nutritional risk with an NRS!5/7 at admission. Lower BMI, cognitive impairment and swallowing disorders were more prevalent in the patients with a higher NRS. A NRS!5 was not associated with mortality but prolonged by more than 3 days the LOS among the 173 survivors (b 3.69; 0.71e6.67 95% CI; p ¼ 0.016), with a discharge rate delayed by 1.8 times (HR 0.55; 0.37e0.83 95% CI; p ¼ 0.101). Conclusion: Among the survivors of COVID-19 in an acute geriatric hospital, a NRS !5 at admission was associated with a longer LOS, but not with mortality.