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    Home-based and remote exercise testing in chronic respiratory disease MESHD, during the COVID-19 pandemic and beyond: a rapid review

    Authors: Anne E Holland; Carla Malaguti; Mariana Hoffman; Aroub Lahham; Angela T Burge; Leona Dowman; Anthony K May; Janet Bondarenko; Marnie Graco; Gabriella Tikellis; Joanna Y.T. Lee; Narelle S Cox

    doi:10.1101/2020.07.15.20154930 Date: 2020-07-16 Source: medRxiv

    Objectives: To identify exercise tests that are suitable for home-based or remote administration in people with chronic lung disease HP lung disease MESHD. Methods: Rapid review of studies that reported home-based or remote administration of an exercise test in people with chronic lung disease HP lung disease MESHD, and studies reporting their clinimetric properties. Results: 84 studies were included. Tests used at home were the 6-minute walk test (6MWT, 2 studies), sit-to-stand tests (STS, 5 studies), Timed Up and Go (TUG, 4 studies) and step tests (2 studies). Exercise tests administered remotely were the 6MWT (2 studies) and step test (1 study). Compared to centre-based testing the 6MWT distance was similar when performed outdoors but shorter when performed at home (2 studies). The STS, TUG and step tests were feasible, reliable (intra-class correlation coefficients >0.80), valid (concurrent and known groups validity) and moderately responsive to pulmonary rehabilitation (medium effect sizes). These tests elicited less desaturation than the 6MWT, and validated methods to prescribe exercise were not reported. Discussion: The STS, step and TUG tests can be performed at home, but do not accurately document desaturation with walking or allow exercise prescription. Patients at risk of desaturation should be prioritised for centre-based exercise testing when this is available.

    Machine learning prediction for mortality of patients diagnosed with COVID-19: a nationwide Korean cohort study

    Authors: Chansik An; Hyunsun Lim; Dong-Wook Kim; Jung Hyun Chang; Yoon Jung Choi; Seong Woo Kim

    doi:10.21203/rs.3.rs-36458/v1 Date: 2020-06-19 Source: ResearchSquare

    The rapid spread of COVID-19 is likely to result in the shortage of medical resources, which necessitates accurate prognosis prediction to triage patients effectively. This study used the nationwide cohort of South Korea to develop a machine learning model to predict prognosis based on sociodemographic and medical information. Of 10,237 COVID-19 patients, 228 (2.2%) died, 7,772 (75.9%) recovered, and 2,237 (21.9%) were still in isolation or being treated at the last follow-up (April 16, 2020). The Cox proportional hazards regression analysis revealed that age TRANS > 70, male TRANS sex, moderate or severe disability, the presence of symptoms, nursing home residence, and comorbidities of diabetes mellitus MESHD diabetes mellitus HP (DM), chronic lung disease HP lung disease MESHD, or asthma MESHD asthma HP were significantly associated with increased risk of mortality (p ≤ 0.047). For machine learning, the least absolute shrinkage and selection operator (LASSO), linear support vector machine (SVM), SVM with radial basis function kernel, random forest (RF), and k-nearest neighbors were tested. In prediction of mortality, LASSO and linear SVM demonstrated high sensitivities SERO (90.3% [95% confidence interval: 83.3, 97.3]and 92.0% [85.9, 98.1], respectively) and specificities (91.4% [90.3, 92.5] and 91.8%, [90.7, 92.9], respectively) while maintaining high specificities >90%. The most significant predictors for LASSO included old age TRANS and preexisting DM or cancer; for RF they were old age TRANS, infection MESHD route (at large clusters or from personal contact with an infected individual), and underlying hypertension MESHD hypertension HP. The proposed prediction model may be helpful for the quick triage of patients without having to wait for the results of additional tests such as laboratory or radiologic studies, during a pandemic when limited medical resources have to be wisely allocated without hesitation.

    Age TRANS-dependent assessment of genes involved in cellular senescence, telomere and mitochondrial pathways in human lung tissue of smokers, COPD and IPF: Associations with SARS-CoV-2 COVID-19 ACE2-TMPRSS2-Furin-DPP4 axis

    Authors: Krishna P Maremanda; Isaac Kirubakaran Sundar; Dongmei Li; Irfan Rahman

    doi:10.1101/2020.06.14.20129957 Date: 2020-06-16 Source: medRxiv

    Aging is one of the key contributing factors for chronic obstructive pulmonary diseases MESHD chronic obstructive pulmonary diseases HP (COPD) and other chronic inflammatory lung diseases MESHD. Cigarette smoke is a major etiological risk factor that has been shown to alter cellular processes involving mitochondrial function, cellular senescence and telomeric length. Here we determined how aging contribute to the alteration in the gene expression of above mentioned cellular processes that play an important role in the progression of COPD and IPF. We hypothesized that aging may differentially alter the expression of mitochondrial, cellular senescence and telomere genes in smokers and patients with COPD and IPF compared to non-smokers. Total RNA from human lung tissues from non-smokers, smokers, and patients with COPD and IPF were processed and analyzed based on their ages TRANS (younger: <55 yrs and older: >55 yrs). NanoString nCounter panel was used to analyze the gene expression profiles using a custom designed codeset containing 112 genes including 6 housekeeping controls (mitochondrial biogenesis and function, cellular senescence, telomere replication and maintenance). mRNA counts were normalized, log2 transformed for differential expression analysis using linear models in the limma package (R/Bioconductor). Data from non-smokers, smokers and patients with COPD and IPF were analyzed based on the age groups TRANS (pairwise comparisons between younger vs. older groups). Several genes were differentially expressed in younger and older smokers, and patients with COPD and IPF compared to non-smokers which were part of the mitochondrial biogenesis/function (HSPD1, FEN1, COX18, COX10, UCP2 & 3), cellular senescence (PCNA, PTEN, KLOTHO, CDKN1C, TNKS2, NFATC1 & 2, GADD45A) and telomere replication/maintenance (PARP1, SIRT6, NBN, TERT, RAD17, SLX4, HAT1) target genes. Interestingly, NOX4 and TNKS2 were increased in the young IPF as compared to the young COPD patients. Genes in the mitochondrial dynamics and other quality control mechanisms like FIS1 and RHOT2 were decreased in young IPF compared to their age TRANS matched COPD subjects. ERCC1 (Excision Repair Cross-Complementation Group 1) and GADD45B were higher in young COPD as compared to IPF. Aging plays an important role in various infectious diseases MESHD. Elderly TRANS patients with chronic lung disease HP lung disease MESHD and smokers were found to have high incidence and mortality rates in the current pandemic of SARS-CoV-2 infection MESHD. Immunoblot analysis in the lung homogenates of smokers, COPD and IPF subjects revealed increased protein abundance of important proteases and spike proteins like TMPRSS2, furin and DPP4 in association with a slight increase in SARS-CoV-2 receptor ACE2 levels. This may further strengthen the observation that smokers, COPD and IPF subjects are more prone to COVID-19 infection MESHD. Overall, these findings suggest that altered transcription of target genes that regulate mitochondrial function, cellular senescence, and telomere attrition add to the pathobiology of lung aging in COPD and IPF and other smoking-related chronic lung disease HP lung disease MESHD in associated with alterations in SARS-CoV-2 ACE2-TMPRSS2-Furin-DPP4 axis for COVID-19 infection MESHD.

    Inhaled corticosteroids downregulate the SARS-CoV-2 receptor ACE2 in COPD through suppression of type I interferon

    Authors: Lydia J Finney; Nicholas Glanville; Hugo Farne; Julia Aniscenko; Peter Fenwick; Samuel Kemp; Maria-Belen Trujillo-Torralbo; Maria Calderazzo; Jadwiga A Wedzicha; Patrick Mallia; Nathan W Bartlett; Sebastian L Johnston; Aran Singanayagam

    doi:10.1101/2020.06.13.149039 Date: 2020-06-13 Source: bioRxiv

    Coronavirus disease MESHD 2019 (COVID-19) caused by SARS-CoV-2 is a new rapidly spreading infectious disease MESHD. Early reports of hospitalised COVID-19 cases have shown relatively low frequency of chronic lung diseases HP lung diseases MESHD such as chronic obstructive pulmonary disease MESHD chronic obstructive pulmonary disease HP (COPD) but increased risk of adverse outcome. The mechanisms of altered susceptibility to viral acquisition and/or severe disease MESHD in at-risk groups are poorly understood. Inhaled corticosteroids (ICS) are widely used in the treatment of COPD but the extent to which these therapies protect or expose patients with a COPD to risk of increased COVID-19 severity is unknown. Here, using a combination of human and animal in vitro and in vivo disease MESHD models, we show that ICS administration attenuates pulmonary expression of the SARS-CoV-2 viral entry receptor angiotensin-converting enzyme (ACE)-2. This effect was mechanistically driven by suppression of type I interferon as exogenous interferon-{beta} reversed ACE2 downregulation by ICS. Mice deficient in the type I interferon-/{beta} receptor (Ifnar1-/-) also had reduced expression of ACE2. Collectively, these data suggest that use of ICS therapies in COPD reduces expression of the SARS-CoV-2 entry receptor ACE2 and this effect may thus contribute to altered susceptibility to COVID-19 in patients with COPD.

    Age TRANS-dependent assessment of genes involved in cellular senescence, telomere and mitochondrial pathways in human lung tissue of smokers, COPD and IPF: Associations with SARS-CoV-2 COVID-19 ACE2-TMPRSS2-Furin-DPP4 axis

    Authors: Krishna P. Maremanda; Isaac K. Sundar; Dongmei Li; Irfan Rahman

    doi:10.21203/rs.3.rs-35347/v1 Date: 2020-06-12 Source: ResearchSquare

    Aging is one of the key contributing factors for chronic obstructive pulmonary diseases MESHD chronic obstructive pulmonary diseases HP (COPD) and other chronic inflammatory lung diseases MESHD. Cigarette smoke is a major etiological risk factor that has been shown to alter cellular processes involving mitochondrial function, cellular senescence and telomeric length. Here we determined how aging contribute to the alteration in the gene expression of above mentioned cellular processes that play an important role in the progression of COPD and IPF. We hypothesized that aging may differentially alter the expression of mitochondrial, cellular senescence and telomere genes in smokers and patients with COPD and IPF compared to non-smokers. Total RNA from human lung tissues from non-smokers, smokers, and patients with COPD and IPF were processed and analyzed based on their ages TRANS (younger: <55 yrs and older: >55 yrs). NanoString nCounter panel was used to analyze the gene expression profiles using a custom designed codeset containing 112 genes including 6 housekeeping controls (mitochondrial biogenesis and function, cellular senescence, telomere replication and maintenance). mRNA counts were normalized, log2 transformed for differential expression analysis using linear models in the limma package (R/Bioconductor). Data from non-smokers, smokers and patients with COPD and IPF were analyzed based on the age groups TRANS (pairwise comparisons between younger vs. older groups). Several genes were differentially expressed in younger and older smokers, and patients with COPD and IPF compared to non-smokers which were part of the mitochondrial biogenesis/function (HSPD1, FEN1, COX18, COX10, UCP2 & 3), cellular senescence (PCNA, PTEN, KLOTHO, CDKN1C, TNKS2, NFATC1 & 2, GADD45A) and telomere replication/maintenance (PARP1, SIRT6, NBN, TERT, RAD17, SLX4, HAT1) target genes. Interestingly, NOX4 and TNKS2 were increased in the young IPF as compared to the young COPD patients. Genes in the mitochondrial dynamics and other quality control mechanisms like FIS1 and RHOT2 were decreased in young IPF compared to their age TRANS matched COPD subjects. ERCC1 (Excision Repair Cross-Complementation Group 1) and GADD45B were higher in young COPD as compared to IPF. Aging plays an important role in various infectious diseases MESHD. Elderly TRANS patients with chronic lung disease HP lung disease MESHD and smokers were found to have high incidence and mortality rates in the current pandemic of SARS-CoV-2 infection MESHD. Immunoblot analysis in the lung homogenates of smokers, COPD and IPF subjects revealed increased protein abundance of important proteases and spike proteins like TMPRSS2, furin and DPP4 in association with a slight increase in SARS-CoV-2 receptor ACE2 levels. This may further strengthen the observation that smokers, COPD and IPF subjects are more prone to COVID-19 infection MESHD. Overall, these findings suggest that altered transcription of target genes that regulate mitochondrial function, cellular senescence, and telomere attrition add to the pathobiology of lung aging in COPD and IPF and other smoking-related chronic lung disease HP lung disease MESHD in associated with alterations in SARS-CoV-2 ACE2-TMPRSS2-Furin-DPP4 axis for COVID-19 infection MESHD.

    Prevalence SERO and mortality of Lung Comorbidities Among Patients with COVID-19: A systematic review and meta-analysis

    Authors: Mohammed G Alkhathami; Shailesh Advani; Adil A Abalkhail; Fahad M Alkhathami; Mohammed K AlShehri; Ebtisam Albeashy; Jihad A Al Salamah

    doi:10.1101/2020.06.01.20119271 Date: 2020-06-03 Source: medRxiv

    Abstract Background COVID-19 infections MESHD are seen across all age groups TRANS but they have shown to have a predisposition for the elderly TRANS and those with underlying comorbidities. Patients with severe COVID-19 infections MESHD and comorbidities are more prone to respiratory distress HP syndrome MESHD (ARDS), mechanical ventilator use and ultimately succumb to these complications. Little evidence exists of the prevalence SERO of underlying lung comorbidities among COVID-19 patients and associated mortality. Methods We performed a systematic review of the literature including PubMed (Medline), Embase (Ovid), Google Scholar and Cochrane Library. The last date for our search was 29th April 2020. We included all original research articles on COVID-19 and calculated prevalence SERO of chronic lung disease HP lung disease MESHD patients among COVID-19 patients using random effects model. Further we assessed for mortality rates among COVID-19 patients associated with these lung comorbidities. Results The authors identified 29 articles that reported prevalence SERO of chronic lung conditions among COVID-19 patients. Among those, 26 were from China and 3 from the United States. The pooled prevalence SERO of lung comorbidities including Asthma MESHD Asthma HP, COPD, and lung cancer was 3% (95% CI=0-14%), 2.2% (95% CI=0.02-0.03%) and 2.1% (95% CI=0.00-0.21%) respectively. Mortality rates associated with these comorbidities was 30% (41/137) for COPD and 19% (7/37) for lung cancer respectively. No mortality rates were reported for patients with asthma MESHD asthma HP. Conclusion This study offers latest evidence of prevalence SERO of chronic lung conditions among patients with COVID-19. Asthma MESHD Asthma HP, followed by COPD and lung cancer, was the most common lung comorbidity associated with COVID-19, while the higher mortality rate was found in COPD. Future studies are needed to assess other lung comorbidities and associated mortality among patients diagnosed with COVID-19.

    Lack of Benefit in COVID-19 Patients Treated with Hydroxychloroquine or Chloroquine: A Systematic Review and Meta-Analysis

    Authors: Liang Chen; Shuoyan An; Guangyu Yao; Jiasheng Xiong; Haiyan Xiong; Ping Zhao; Lufang Jiang; Wei Hua; Chenglong Xiong; Firat Duru; Qingwu Jiang

    doi:10.21203/rs.3.rs-33047/v2 Date: 2020-06-02 Source: ResearchSquare

    Background: Hydroxychloroquine (HCQ) and chloroquine (CQ) have been widely used for the treatment of the coronavirus disease MESHD 2019 (COVID-19), despite limited clinical evidence and controversial early reports. The aim of this report was to provide a systematic review of the literature and meta-analysis on the use of HCQ/CQ with respect to safety and clinical efficacy of these medications. Methods: We performed a systematic search of the medical databases and included studies if they focused on patients with COVID-19 who received HCQ or CQ alone, or in combination with other treatments, and were compared with a control group. We analyzed two important clinical objectives; viral clearance rate by reverse transcription-polymerase chain reaction (RT-PCR) negativity and all-cause mortality.Results: A total of 14 studies were included in the quantitative synthesis. The use of HCQ/CQ was associated with higher viral clearance rate compared with control group (OR: 3.12, 95% CI: 2.17-4.49 p<0.0001). In the sensitivity SERO analysis, the effect on viral clearance disappeared (OR 1.44, 95% CI: 0.87-2.37, p=0.155). The use of HCQ/CQ was associated with a higher risk of mortality (OR 1.26, 95% CI: 1.05-1.51, p<0.0001). Due to huge heterogeneity between the studies (I2 = 86%, p < 0.01), we performed a meta regression analysis. Both treatment within 24 hours (p=0.047) and comorbidities [ hypertension MESHD hypertension HP (p=0.025), diabetes (p=0.049) and chronic lung disease HP lung disease MESHD (p=0.0064)] contributed to the heterogeneity. HCQ/CQ daily dose (p=0.61) and age TRANS (p=0.62) had no impact on effect size. Higher rate of comorbidities led to a higher risk of mortality by using HCQ/CQ. Overall, the use of HCQ/CQ resulted in longer QTc intervals.Conclusions: Our meta-analysis did not reveal a clinical benefit of HCQ/CQ on in-hospital outcomes for patients with COVID-19. The use of HCQ/CQ did not result in rapid viral clearance on RT-PCR. Moreover, our results showed that higher rate of comorbidities led to a higher risk of mortality by using HCQ/CQ.

    CONUT score is associated with mortality in patients with COVID-19: a retrospective study in Wuhan

    Authors: Ruoran Wang; Min He; Jirong Yue; Lang Bai; Dan Liu; Zhixin Huang; Ting Zhu; Yan Kang

    doi:10.21203/rs.3.rs-32889/v1 Date: 2020-06-01 Source: ResearchSquare

    Background The coronavirus disease MESHD 2019 (COVID-19) pneumonia MESHD pneumonia HP, outbreak in Wuhan, China, has led to a global pandemic. The high mortality of COVID-19 patients makes it significant to evaluate possible disease progression MESHD. This study was designed to explore the prognostic value of Controlling Nutritional Status (CONUT) score in patients with COVID-19.Methods Patients diagnosed with COVID-19 of a single center in Wuhan, China from January 2020 to February 2020 were enrolled in this study. Logistic regression analysis was performed to find independent risk factor of mortality. Receiver operating characteristics (ROC) curve was drawn to evaluate the prognostic value of CONUT score.Results Among 442 included patients, there were 79 non-survivors with mortality of 17.9%. Compared with survivors, the median age TRANS (p < 0.001) and male TRANS ratio (p = 0.042) were higher in non-survivors. Non-survivors had higher incidence of comorbidities including hypertension MESHD hypertension HP (p < 0.001), chronic lung disease HP lung disease MESHD (p = 0.001) and cardiovascular disease MESHD (p = 0.005). Complications such as respiratory failure HP(p < 0.001), acute kidney injury MESHD acute kidney injury HP (AKI) (p < 0.001) occurred more frequently in non-survivors. Multivariate logistic regression analysis showed that CONUT (p = 0.002), lactate dehydrogenase (LDH) (p < 0.001), C-reactive protein (CRP) (p = 0.020) were risk factor of mortality in COVID-19 patients. Area under the ROC curve (AUC) of CONUT and Nutrition risk screening 2002 (NRS2002) score were 0.813 and 0.795, respectively. Comprised of CONUT, LDH, CRP, the constructed prognostic model had higher AUC of 0.923 (Z = 3.5210, p < 0.001).Conclusion CONUT is an independent risk factor of mortality in COVID-19 patients. Evaluating CONUT is beneficial for clinicians to predict the progression of COVID-19 patients and strengthen monitoring and management to improve prognosis.

    Interim Analysis of Risk Factors for Severe Outcomes among a Cohort of Hospitalized Adults TRANS Identified through the U.S. Coronavirus Disease MESHD 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET)

    Authors: Lindsay Kim; Shikha Garg; Alissa O'Halloran; Michael Whitaker; Huong Pham; Evan J. Anderson; Isaac Armistead; Nancy M. Bennett; Laurie Billing; Kathryn Como-Sabetti; Mary Hill; Sue Kim; Maya L. Monroe; Alison Muse; Arthur Reingold; William Schaffner; Melissa Sutton; H. Keipp Talbot; Salina M. Torres; Kimberly Yousey-Hindes; Rachel A Holstein; Charisse Cummings; Lynette Brammer; Aron Hall; Alicia Fry; Gayle E. Langley

    doi:10.1101/2020.05.18.20103390 Date: 2020-05-22 Source: medRxiv

    Background: As of May 15, 2020, the United States has reported the greatest number of coronavirus disease MESHD 2019 (COVID-19) cases and deaths MESHD globally. Objective: To describe risk factors for severe outcomes among adults TRANS hospitalized with COVID-19. Design: Cohort study of patients identified through the Coronavirus Disease MESHD 2019-Associated Hospitalization Surveillance Network. Setting: 154 acute care hospitals in 74 counties in 13 states. Patients: 2491 patients hospitalized with laboratory-confirmed COVID-19 during March 1-May 2, 2020. Measurements: Age TRANS, sex, race/ethnicity, and underlying medical conditions. Results: Ninety-two percent of patients had at least 1 underlying condition; 32% required intensive care unit (ICU) admission; 19% invasive mechanical ventilation; 15% vasopressors; and 17% died during hospitalization. Independent factors associated with ICU admission included ages TRANS 50-64, 65-74, 75-84 and 85+ years versus 18-39 years (adjusted risk ratio (aRR) 1.53, 1.65, 1.84 and 1.43, respectively); male TRANS sex (aRR 1.34); obesity MESHD obesity HP (aRR 1.31); immunosuppression (aRR 1.29); and diabetes (aRR 1.13). Independent factors associated with in-hospital mortality included ages TRANS 50-64, 65-74, 75-84 and 85+ years versus 18-39 years (aRR 3.11, 5.77, 7.67 and 10.98, respectively); male TRANS sex (aRR 1.30); immunosuppression (aRR 1.39); renal disease MESHD (aRR 1.33); chronic lung disease HP lung disease MESHD (aRR 1.31); cardiovascular disease MESHD (aRR 1.28); neurologic disorders (aRR 1.25); and diabetes (aRR 1.19). Race/ethnicity was not associated with either ICU admission or death MESHD. Limitation: Data were limited to patients who were discharged or died in-hospital and had complete chart abstractions; patients who were still hospitalized or did not have accessible medical records were excluded. Conclusion: In-hospital mortality for COVID-19 increased markedly with increasing age TRANS. These data help to characterize persons at highest risk for severe COVID-19-associated outcomes and define target groups for prevention and treatment strategies.

    COVID-19 pandemic and bariatric surgery in Argentina

    Authors: Axel Beskow; Pedro Martinez Duartez; Estuardo Beheren; Felipe Fiolo; Cardoso Ramos Almino

    doi:10.21203/rs.3.rs-29759/v1 Date: 2020-05-19 Source: ResearchSquare

    Background: The SARS-CoV2 virus pandemic pandemic has been characterized for its rapid global dispersion. Obesity MESHD Obesity HP is an independent risk factor for the most severe cases of COVID -19. The impact in Argentina differs from others since it was able to anticipate public health interventions in order to flatten the contagion curve. Early quarantine achieved better control of the pandemic and, following the recommendations of scientific societies in countries with higher affectation, elective bariatric surgeries (BS) and in-person consults were suspended. Objective: Bariatric surgeons were surveyed to assess the impact of the pandemic and the measures undertaken on the practice of BS in Argentina.Method: Between April 17 and 21, 2020, an online survey in Google forms was disseminated to bariatric surgeons residing in Argentina. It consists of 40 specific and non-specific questions regarding BS practice and COVID pandemic. Consent to participate was obtained from surgeons by completing the survey.Results: 83 surgeons averaging 47.17 years of age TRANS responded the survey. Together they performed 10515 BS in 2019. More than 65% stated that more than 50% of their income derives from this activity, and more than 40% depend on more than 75% of it. The average hospital stay was 1.6 days and 85% reported using Intensive Care Unit (ICU) in less than 1% of their patients. According to the scores of hospital affectation issued by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), 54% reported being in Phase I and 34% had not yet been affected by the pandemic. All, except one, suspended the elective BS 7.7 days on average before the appearance of the first local case. 95.7% offer virtual consults, but 48% obtain no retribution for them. 26% would consider performing BS without a previous endoscopic evaluation.90% of the surgeons surveyed (75) continue performing other types of surgeries via laparoscopy. In case of operating a patient without suspected SARS-CoV-2 virus infection MESHD, 80% would use N95 masks and 56.6% would use face protection shields; two thirds would use smoke filters for the pneumoperitoneum MESHD and only 10.8% would continue with the usual protection measures. To restart the elective activity, 56.6% proposed that the hospital should be in phase 0 or I, that the patient should meet certain characteristics for their selection and that the scientific society must recommend the way to restart of the activity.Patient selection criteria with greater consensus were testing to rule out asymptomatic TRANS COVID-positive patients, epidemiology, absence of chronic lung disease HP lung disease MESHD, age TRANS under 60, and immunological integrity. 19.2% regard sleeve gastrectomy as the ideal BS during the pandemic, and 88% of the surgeons would not change their chosen BS technique based on infection MESHD infection risk TRANS infection risk TRANS risk. Conclusion: Elective BS is currently suspended in Argentina, although epidemiologically the conditions in the country are not unfavorable. Economic impact for those involved is significant. Short-term vision is pessimistic, but recommendations originating from the scientific societies that nucleate them are expected in order to guide health authorities towards appropriate regulations suitable for the local practice. 

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