Reflections on Digital Physiotherapy

The COVID-19 pandemic has brought with it a new way of caring for patients by health professionals. In physiotherapy, implementing the digital component in the field of telehealth is seen as an effective care alternative that should be investigated and regulated in all population groups. Although its advantages are reported, it is still too early to know its full scope;therefore, it is convenient to expand its disciplinary construction with a view to improving professional practice.

Association between the Multidimensional Poverty Measure and COVID-19 mortality in Colombia : Paula Diaz

Background Different socioeconomic aspects have been related to mortality from COVID-19. For this reason, the objective of this study was to analyze the association between the Multidimensional Poverty Measure at the municipal level (MPM) and the clinical outcome of mortality in the resident population of Colombia with a diagnosis of COVID-19. Methods Observational, non-concurrent cohort study of confirmed cases of COVID-19 reported in Colombia by August 2021. The main outcome variable was mortality from COVID-19, and the main exposure variable was MPM. The covariates included in the analysis were patient's sex, age, and municipality of residence. Unadjusted and adjusted logistic models were used using balanced random samples of deaths and recovered patients, calculating odds ratios (OR) and 95% confidence interval ranges (CI). Results In total, 4,194,538 cases of COVID-19 were included in the analysis, of which approximately 3% died. According to the adjusted multivariate analysis, it was found that patients who live in municipalities with an MPM between 20 to 40%, 41 to 60%, 61 to 80% and more than 80% had an OR of 1.6 (95% CI 1.4 to 1.8), 1.6 (95% CI 1.3 to 1.9), 1.7 (95% CI 1.2 to 2.5), and 2.2 (95% CI 0.7 to 7.8), respectively, for mortality from COVID-19 compared with an MPM of less than 20%. When analyzing the data according to sex for the MPM from 20 to 40%, 41 to 60%, 61 to 80% and more than 80%, an OR for women of 1.7 (95% CI 1.5 to 2.0), 1.8 (95% CI % 1.5 to 2.1), 1.9 (95% CI 1.3 to 2.6) and 2.8 (CI 0.9 to 10.1) respectively. For men an OR of 1.5 (95% CI 1.3 to 1.7), 1.4 (95% CI 1.2 to 1.7), 1.6 (95% CI 1.1 to 2.3) and 1.9 (95% CI 0.6 to 6.0) respectively compared to a MPM less than 20%. Conclusions The risk of mortality from COVID-19 in Colombia is increased in populations with higher MPM. Social determinants of health have an important effect on the outcomes of COVID-19. Key messages Only a few studies exist in South America on social determinants in health and COVID-19. This study provides evidence to understand the impact of poverty measures on mortality in COVID-19 patients. Multidimensional poverty measure at the municipal level was associated with increased COVID-19 mortality in a large cohort of patients from the Colombian population.

PREDICTING FACTORS OF PROLONGED MECHANICAL VENTILATION AFTER ENDOVASCULAR TREATMENT IN LARGE VESSEL OCCLUSION STROKE

Background and aims: Intensive Care Units(ICUs) are a necessary resource for many patients with large vessel occlusion stroke(LVOS) after endovascular treatment(EVT). However, ICUs have a limited availability of beds and ventilators, situation that has been worsened by the current Covid-19 pandemic. We analyze predicting factors for prolonged mechanical ventilation(PMV) after EVT in patients with LVOS. Methods: Retrospective study of patients admitted to our stroke center from 2012-2019 for LVOS who were treated with EVT. We identified patients that required PMV(defined as >24h intubation with admission in ICU) after EVT, and evaluated the association with clinical and radiological factors on admission. Results: N=438. 236(53.9%) women. Mean age 69(DE 14.6). 411(93.8%) anterior circulation stroke, 27(6.2%) posterior. 82(19%) required general anesthesia and intraprocedural intubation, and 47 of them(10.7%) required PMV. Median length of stay(LOS) in ICU: 3 days(1-7). 12/47(25.5%) had prolonged LOS for another reason (6 neurological worsening, 4 hemodynamic instability, 1 respiratory infection, 1 no available beds at Stroke Unit). 19/47(44%) died and 22/47(52.4%) were functionally dependent at three months. Factors associated to a higher risk of PMV after EVT were: basilar occlusion (OR=12.3, IC95%[5.3-28.4],p<0,001);ASPECTS ≤7 (OR=3, IC95%[1.4-6.1],p=0,003) and NIHSS ≥18 (OR=2.8, IC95%[1.3- 5.8],p=0,006). Patients with PMV had a higher risk of mortality (OR=6.5, IC95%[3.3-12.8],p<0,001) and functional dependence (OR=5.1, IC95%[2.4-1],p<0,001) at three months. Conclusions: In our study, patients with basilar occlusion, high NIHSS and lower ASPECTS had higher probability of requiring PMV after EVT, which also led to worse outcome. These are aspects to consider in scenarios with limited availability of ICU beds.

COMPARACIÓN DE LA MOTIVACIÓN EN ALUMNOS(AS) UNIVERSITARIOS(AS) DE MODALIDAD VIRTUAL/VIRTUAL VERSUS PRESENCIAL/VIRTUAL DESDE EL MSLQ

The objective of this study was to identify and compare, using the Motivated Strategies for Learning Questionnaire (MSLQ), the motivation of university students who took virtual classes before and during the COVID-19 pandemic (virtual/virtual), and the motivation of university students who transitioned from face-to-face to virtual learning (face-to-face/virtual). The questionnaire was answered on the Internet by 191 respondents. The SPSS program was employed to analyze the internal consistency of the questionnaire's items, before contrasting the results of students in both learning environments. According to the results, the virtual/virtual group showed more independence by attaching greater value to homework and by having higher expectations for their learning and class performance, while the face-to-face/virtual group attached greater importance to extrinsic motivation and experienced higher levels of anxiety. © 2022 Consejo Mexicano de Investigacion Educativa. All rights reserved.

Women, Telework, and Care Strategies in the Pandemic Context of Chile

The COVID-19 pandemic has impacted the world population in different dimensions and has increased inequalities in different countries. In addition to the effects on the economy and health, transformations in daily life are observed, such as the massification of telework. This has implied the convergence of the domestic and working spaces, significantly affecting working mothers, who have increased their care workload, and impacting their daily routines and mental health. The main objective is to analyze the strategies developed by Chilean mothers, who telework from confinement measures, to deal with the conflict between care tasks and paid work. Through the analysis of eighteen semi-structured interviews, five types of strategies adopted by women in this context of double presence and unequal distribution of tasks were recognized: organizational in the absence of time control, multiplicity and simultaneity of tasks, school support and proximity, work against overload, resistance.

COVID-19 with and without pneumonia: clinical outcomes in the internal medicine ward

The clinical features of COVID-19 differ substantially upon the presence (or absence) of viral pneumonia. The aim of this article was to describe the clinical characteristics of COVID-19 patients admitted to the Internal Medicine ward, as divided into those with and without pneumonia. This single-center prospective cohort study was conducted in a tertiary teaching public hospital in Buenos Aires City named Hospital General de Agudos Carlos G. Durand. Baseline data collection was performed within 48 hours of admission and patients were followed until discharge or in-hospital death. Epidemiological, clinical, laboratory, and radiological characteristics together with treatment data were obtained from the medical records. Of the 417 included, 243 (58.3%) had pneumonia. Median age was 43 years (IQR:32-57) and 222 (53.2%) were female. The overall crude case-fatality rate was 3.8%. None of the COVID-19 patients without pneumonia developed critical disease, required invasive mechanical ventilation nor died during hospitalization. However, 7 (4%) developed severe disease during follow-up. Among patients with COVID-19 pneumonia, in-hospital mortality rate was 6.6%, severe disease developed in 81 (33.3%), critical disease in 23 (9.5%), and 22 (9.1%) were admitted to the intensive care unit. A largely good prognosis was observed among COVID-19 patients without pneumonia, still, even among this group, unfavorable clinical progression can develop and should be properly monitored. Critical illness among patients with COVID-19 pneumonia was frequent and observed rates from this cohort provide a sound characterization of COVID-19 clinical features in a major city from South America.

COVID-19 con y sin neumonía: resultados en la sala de medicina interna

The clinical features of COVID-19 differ substantially upon the presence (or absence) of viral pneumonia. The aim of this article was to describe the clinical characteristics of COVID-19 patients admitted to the Internal Medicine ward, as divided into those with and without pneumonia. This single-center prospective cohort study was conducted in a tertiary teaching public hospital in Buenos Aires City named Hospital General de Agudos Carlos G. Durand. Baseline data collection was performed within 48 hours of admission and patients were followed until discharge or in-hospital death. Epidemiological, clinical, laboratory, and radiological characteristics together with treatment data were obtained from the medical records. Of the 417 included, 243 (58.3%) had pneumonia. Median age was 43 years (IQR:32-57) and 222 (53.2%) were female. The overall crude case-fatality rate was 3.8%. None of the COVID-19 patients without pneumonia developed critical disease, required invasive mechanical ventilation nor died during hospitalization. However, 7 (4%) developed severe disease during follow-up. Among patients with COVID-19 pneumonia, in-hospital mortality rate was 6.6%, severe disease developed in 81 (33.3%), critical disease in 23 (9.5%), and 22 (9.1%) were admitted to the intensive care unit. A largely good prognosis was observed among COVID-19 patients without pneumonia, still, even among this group, unfavorable clinical progression can develop and should be properly monitored. Critical illness among patients with COVID-19 pneumonia was frequent and observed rates from this cohort provide a sound characterization of COVID-19 clinical features in a major city from South America. Las características clínicas del COVID-19 difieren sustancialmente según la presencia (o ausencia) de neumonía viral. El objetivo de este artículo fue describir las características clínicas de los pacientes con COVID-19 internados en el servicio de Clínica Médica, divididos en pacientes con y sin neumonía. Fue un estudio de cohorte prospectivo, con base en un único centro, realizado en un hospital público de la ciudad de Buenos Aires: Hospital General de Agudos Carlos G. Durand. La recolección basal de datos se realizó dentro de las 48 horas del ingreso y los pacientes fueron seguidos hasta el alta o la muerte hospitalaria. Las características epidemiológicas, clínicas, de laboratorio y radiológicas junto con los datos del tratamiento se obtuvieron de la historia clínica. De los 417 incluidos, 243 (58.3%) tenían neumonía. La mediana de edad fue de 43 años (RIC: 32-57) y 222 (53.2%) eran mujeres. La tasa global de letalidad fue del 3.8%. Ninguno de los pacientes con COVID-19 sin neumonía desarrolló enfermedad crítica, requirió ventilación mecánica invasiva ni falleció durante la hospitalización. Sin embargo, 7 (4%) desarrollaron enfermedad grave durante el seguimiento. Entre aquellos con neumonía COVID-19, la tasa de mortalidad hospitalaria fue del 6.6%, se desarrolló enfermedad grave en 81 (33.3%), enfermedad crítica en 23 (9.5%) y 22 (9.1%) fueron trasladados a la unidad de cuidados intensivos. Los pacientes con COVID-19 sin neumonía presentaron buen pronóstico;sin embargo, incluso en este grupo, se observaron algunos con progresión clínica desfavorable, por lo que se requirió seguimiento adecuado. En los pacientes con neumonía por COVID-19, el desarrollo de enfermedad crítica fue frecuente y las tasas observadas en esta cohorte proporcionan una caracterización sólida de las características clínicas de los pacientes con COVID-19 en una importante ciudad de América del Sur.

Experience with subcutaneous tocilizumab in neuromyelitis optica spectrum disorders during SARSCOV-2 pandemic

Background: Tocilizumab is a monoclonal antibody against IL-6 that has been used to treat Neuromyelitis Optica spectrum disorders (NMOSD), generally intravenous. The evidence about its subcutaneous formulation to treat these diseases is scarce, but its efficacy seems to be similar. During SARS-CoV-2 pandemic, decreasing hospital attendance became a priority. According to this, subcutaneous formulations may represent a good therapeutic option in this context. Objectives: We present 3 cases of NMSOD who initiated subcutaneous tocilizumab during SARS-CoV-2 pandemic, with very good tolerability in all the cases. Methods: Retrospective and observational study. We reviewed clinical charts, patients' outcomes and available bibliography. Results: Patient 1: 74 year-old male, diagnosed with Neuromyelitis Optica (NMO) in 2010. He was started on rituximab in 2012. In 2018, he suffered from two optic neuritis (despite the absence of CD19+ and CD27+ cells in peripheral blood). Because of that, in 2019, rituximab was switched to intravenous tocilizumab, with good response and tolerability. In April 2020, due to SARS-CoV-2 pandemic, it was switched to subcutaneous tocilizumab in order to avoid hospital attendance, with very good tolerability. Patient 2: 40 year-old female, diagnosed with NMOSD vs CRION (chronic relapsing inflammatory optic neuropathy). Positive anti-NMO antibodies and negative anti-MOG antibodies were found. She was started on rituximab in 2015. In December 2019, she suffered from an optic neuritis despite having no CD19+ cells in peripheral blood. Hence, rituximab was switched to intravenous tocilizumab without any incidence. In March 2020, she was started on subcutaneous tocilizumab once a week because of the pandemic, with very good tolerability. Patient 3: 28 year-old female, diagnosed with seropositive NMO in 2012, treated with rituximab since 2014, free of relapses since them. In May 2020, we decided to switch to tocilizumab (subcutaneous to decrease hospital visits due to SARS-CoV-2 pandemic) because of hypogammaglobulinemia and repeated respiratory tract infections. Conclusions: Tocilizumab may be an option to treat NMOSD patients. Subcutaneous form decreases hospital visits and, according to our experience, is very well tolerated. Therefore, we postulate it can be a good alternative in the current situation.

[Multiple cerebral haemorrhages secondary to disseminated intravascular coagulation in a patient with COVID-19]. / Hemorragias cerebrales múltiples secundarias a coagulación intravascular diseminada en un paciente con COVID-19.

TITLE: Hemorragias cerebrales múltiples secundarias a coagulación intravascular diseminada en un paciente con COVID-19.