Technological innovation, transfer and social use of knowledge through the implementation of a university radio in pandemic contexts

The social and disruptive phenomenon of the pandemic caused by COVID-19 generated countless ethical, theoretical, pedagogical, socio-anthropological and communicational reflections in the field of Higher Education, to the point of identifying and implementing resilient actions by educational institutions in order to cope with the transition process from face-to-face education to a digitalized virtual education model. The initiatives entailed research actions to couple technological innovations for the transfer and social use of knowledge through the creation of digital channels for continuing education, research and links with society. The State Polytechnic University of Carchi, in its desire to enhance its role with society in the border integration zone between Ecuador and Colombia and at the same time, accompany the teaching-learning process of its university community, implemented Radio UPEC Mindalae, a space for the management of the social value of knowledge through research and interdisciplinary work from the practice of an educommunicational language.

SARS-CoV2 infection in oncohematological patients admitted to a general hospital

Introduction: Oncohematological patients (OHP) with Covid19 (C19) can develop serious and lethal complications. It depends on underlying disease, chemotherapy (ChT) and immunosuppressor (IS) prescribed. Objectives: compare mortality (M) in OHP vs. hospitalized normal hosts (NH);analyze independent risk factors (IRFs) of M. Methods: 3/2020-5/2022;population: OHP with C19. Prospective, observational data collection. Clinical presentation: NIH scale;Active treatment (AT): IS or ChT;Complete C19 vaccination (CV). Statistics: ANOVA and Tukey's post hoc tests for comparison of groups. Multivariate test to analyze IRFs associated with M. Results: OHP: 62;MM: 19.3%;LLC: 21%;Lymphomas: 24.2%;ALL: 11.3%;AML: 9.7%;MDS: 14.5%. Age: 68 (17-88);Male sex: 77.4%;moderate CAP: 72.6%;Severe CAP: 27.4%;CV: 22.6%;neutropenia (NP): 22.6%;AT: 61.3%. MM was associated with higher M. OD: 5.3 (95% CI 1.1742 -24.1685). OH had higher M statistically significant difference (SSD)- vs. ICP (12/62): 19% vs. (118/1168): 10%;p: 0.02. Multivariate analysis adjusted for age and sex: MM (OR: 5.32, 95% CI: 1.1742-24.1685) and Severe CAP (OD: 11.23, 95% CI: 2.0636 - 61.1310) were IRFs associated with M. AT (OR: 3.2) and NP (OR: 4.18) had higher risk of M with nonSSD;CV (OR: 0.66 95% CI 0.1110-4.0235) had lower risk without SSD. Conclusions: MM and severe CAP were IRFs for M. CAP was associated with higher M in OHP than NH. CV could be a protective factor without SSD. The high M documented in OHP with C19 justifies implementation of early preventive measures and treatment in this population.

COVID-19 pneumonia: Relationship between initial chest X-rays and laboratory findings.

OBJECTIVE: To analyze the initial findings in chest X-rays of patients with RT-PCR positive for SARS-CoV-2, and to determine whether there is a relationship between the severity of these findings and the clinical and laboratory findings. MATERIALS AND METHODS: This retrospective study analyzed the relationship between initial chest X-rays and initial laboratory tests in symptomatic adults with nasopharyngeal RT-PCR results positive for SARS-CoV-2 seen at our center between February 29 and March 23, 2020. Among other radiologic findings, we analyzed ground-glass opacities, consolidations, linear opacities, and pleural effusion. We also used a scale of radiologic severity to assess the distribution and extent of these findings. Among initial laboratory findings, we analyzed leukocytes, lymphocytes, platelets, neutrophil-to-lymphocyte ratio, and C-reactive protein. RESULTS: Of 761 symptomatic patients, 639 (84%) required hospitalization and 122 were discharged to their homes. The need for admission increased with increasing scores on the scale of radiologic severity. The extent of initial lung involvement was significantly associated with the laboratory parameters analyzed (P<.05 for platelets, P<.01 for lymphocytes, and P<.001 for the remaining parameters), as well as with the time from the onset of symptoms (P<.001). CONCLUSION: It can be useful to use a scale of radiologic severity to classify chest X-ray findings in diagnosing patients with COVID-19, because the greater the radiologic severity, the greater the need for hospitalization and the greater the alteration in laboratory parameters.

COVID-19 in Chile: A health crisis amidst a political crisis amidst a social crisis

Once regarded as the poster child for democratic stability and sound policymaking in Latin America, in the last two decades Chile has experienced increasing levels of mistrust in political institutions and media elites, as well as disenfranchisement. In the wake of the mass protests of October 2019, the COVID-19 pandemic found the Chilean government at record levels of disapproval and with citizens skeptical of messages by authorities and legacy media. Based on data from an online survey and a narrative analysis of public discourse of key government interventions during the first six months of the pandemic, this chapter pays attention to individuals’ perceptions regarding the coronavirus crisis and offers a qualitative assessment of how the government’s handling was addressed in the public sphere. Findings show that Chileans have been skeptical of government measures and critical of officials’ handling of the situation, regardless of their support for the administration. With the news media struggling to hold authorities accountable, the resulting crisis has only deepened the political, economic, and social divisions within Chilean society. © 2022 selection and editorial matter, Peter Van Aelst and Jay G. Blumler.

Low-dose radiotherapy for treatment of Covid

Postmortem analysis in COVID-19 infected patients has shown diffuse alveolar damage with inflammatory infiltrate present. It has been suggested that COVID-19 can induce a cytokine release syndrome caused by a systemic inflammatory response. This pulmonary hyperinflammation would be associated with severe acute respiratory syndrome, which has been described as the main cause of COVID-19 mortality. Radiation therapy administered at low doses (LD-RT) has antiinflammatory properties such as lowering levels of proinflammatory cytokines, inhibiting endothelial-leukocyte interaction, and changing the polarization of macrophages. In addition, LD-RT was used for pneumonia in the first half of the 20th century with evidence suggesting potential efficacy. In this context, several institutions proposed trials to evaluate the safety and efficacy LDRT to treat COVID-19 pneumonia. We conducted a prospective phase I-II trial enrolling COVID-19 patients ≥ 50 years-old, with bilateral lung involvement at imaging study and oxygen requirement. Patients received 1 Gy to total lungs in a single fraction. Forty-one patients were included. Three patients died <72h after LD-RT and were excluded from the analysis. Primary outcome was radiological response assessed by severity and extension scores at days 0, +3 and +7. Lung extension score on CT improved significantly (p=0.02) on day +7, however severity score was stable or slightly decreased (p=0.1). Clinically, patients improved SatO2/ FiO2 index significantly on day +3 and +7 (p<0.01). Our results are in agreement with previous data published by Ameri et al. They analyzed 9 patients treated with 0.5 or 1 Gy and found a SatO2 improvement in 63.6% of the patients 24 hours after RT, no significant differences were found between both fractionations. Hess et al compared 10 patients treated with 1.5 Gy whole-lung LD-RT with 10 control patients blindly matched by age and comorbidity, and they concluded that patients treated with LD-RT showed a significant faster recovery to room air than controls (3 days vs 12 days respectively, p=0.05). Also, LD-RT cohort trended toward superior rates of improved radiographs (P=0.12), delirium (P <.01), rate of intubation (10% vs 40%) and median time to hospital discharge (12 days vs 20 days). At our cohort with a median follow up of 95 days, 25 (66%) patients were discharged with a similar time to that reported by Hess et al, and 13 (34%) died. Less promising results were found when LD-RT was explored in critically ill patients requiring mechanical ventilation. Papachristofilou et al, randomized 22 patients to either 1 Gy whole-lung RT or sham-RT. They hypothesized that LD-RT would increase ventilator-free days (VFDs) to 10 days. The study failed to improve VFDs compared to sham-RT. LD-RT neither improved PaO2/FiO2 or overall survival at 28 days at this severe ill cohort. Moreover, although the baseline characteristics were overall similar in both groups, there was a higher proportion of patients managed with endotracheal intubation and higher rate of comorbidities in the LD-RT group. At our cohort only 5 patients (13%) were at ICU, 3 died and 2 were discharged. Regarding toxicity, no grade 3 was found in the reported studies. However, in our cohort 9 patients (23.7%) experimented grade 3-4 lymphopenia, although 8 of them had lymphopenia before treatment. Preliminary results show that LD-RT is feasible and well-tolerated treatment, with potential clinical improvement. Prospective randomized trials are needed to define the real efficacy of LD-RT.

COVID-19 pneumonia: relationship between initial chest X-rays and laboratory findings⋆ Neumonía COVID-19: relación entre la radiografía de tórax inicial y los datos analíticos

Objective To analyze the initial findings in chest X-rays of patients with RT-PCR positive for SARS-CoV-2, and to determine whether there is a relationship between the severity of these findings and the clinical and laboratory findings. Materials and methods This retrospective study analyzed the relationship between initial chest X-rays and initial laboratory tests in symptomatic adults with nasopharyngeal RT-PCR results positive for SARS-CoV-2 seen at our center between February 29 and March 23, 2020. Among other radiologic findings, we analyzed ground-glass opacities, consolidations, linear opacities, and pleural effusion. We also used a scale of radiologic severity to assess the distribution and extent of these findings. Among initial laboratory findings, we analyzed leukocytes, lymphocytes, platelets, neutrophil-to-lymphocyte ratio, and C-reactive protein. Results Of 761 symptomatic patients, 639 (84%) required hospitalization and 122 were discharged to their homes. The need for admission increased with increasing scores on the scale of radiologic severity. The extent of initial lung involvement was significantly associated with the laboratory parameters analyzed (p < 0.05 for platelets, p < 0.01 for lymphocytes, and p < 0.001 for the remaining parameters), as well as with the time from the onset of symptoms (p < 0.001). Conclusion It can be useful to use a scale of radiologic severity to classify chest X-ray findings in diagnosing patients with COVID-19, because the greater the radiologic severity, the greater the need for hospitalization and the greater the alteration in laboratory parameters.

Low Dose Radiotherapy in the Management of COVID-19 Pneumonia (LOWRAD-Cov19)

Purpose/Objective(s): To evaluate the safety and efficacy of Low-Dose Radiation (LD-RT) to treat COVID-19 pneumonia. Materials/Methods: We conducted a prospective phase I-II trial enrolling patients ≥ 50 years-old, COVID-19 positive, with lung involvement at imaging study and oxygen requirement. Patients received 100 cGy to total lungs in a single fraction. Dose planning goals were PTV95 > 80% with Dmax < 115%. Primary outcome was radiological response assessed as severity and extension scores at days 0, +3 and +7. Secondary outcomes were toxicity (CTCAE v5.0), days of hospitalization, changes in inflammatory blood parameters (ferritin, lymphocytes, C-reactive protein, d-dimer and LDH) and SatO2/ FiO2 index (SAFI) at +3 and +7 (normal SAFI > 315, mild respiratory failure < 300, and severe < 200). Descriptive analyses were summarized as means with standard deviation (SD) and medians with interquartile ranges (IQR). A Wilcoxon sign rank test for paired data was used to assess the CT scores and Chi Square was used to assess for comparison of categorical variables. Results: Forty-one patients were included. Three patients died < 72h after LD-RT and were excluded from the analysis. Median age was 71 (IQR 60-84). Eighteen patients (47%) received previously any anti-COVID treatment (tocilizumab, lopinavir/ritonavir, remdesivir) and thirty-two patients (84%) received steroids (GC) during LD-RT. Extension score improved significantly (P = 0.02) on day +7;severity score was stable or slightly decreased (P = 0.1). Median SAFI on day 0 was 147 (IQR 118-264), 230 (IQR 120-343) on day +3 and 293 (IQR 121-353) on day +7 (P < 0.01). SAFI improvement was associated with overall survival (P = 0.01). Significant decrease was found in C-reactive protein on day +7 (P = 0.02) and in lymphocytes counts on day +3 and +7 (P = 0.02). Median time to receive RT from the date of admission was 19 days (ranging 2-87). Median number of days in hospital after RT was 11 (4-78) and overall was 37 days (range 11-155). With a median follow-up of 67 days after LD-RT, 24 (63%) patients were discharged, twelve (32%) died and two (5%) are still inpatients. Conclusion: Our preliminary results show that LD-RT was feasible and well-tolerated treatment, with potential clinical improvement. Randomized trials are needed to establish whether LD-RT improves severe pneumonia.

COVID-19 pneumonia: relationship between initial chest X-rays and laboratory findings. / Neumonía COVID-19: relación entre la radiografía de tórax inicial y los datos analíticos.

OBJECTIVE: To analyze the initial findings in chest X-rays of patients with RT-PCR positive for SARS-CoV-2, and to determine whether there is a relationship between the severity of these findings and the clinical and laboratory findings. MATERIALS AND METHODS: This retrospective study analyzed the relationship between initial chest X-rays and initial laboratory tests in symptomatic adults with nasopharyngeal RT-PCR results positive for SARS-CoV-2 seen at our center between February 29 and March 23, 2020. Among other radiologic findings, we analyzed ground-glass opacities, consolidations, linear opacities, and pleural effusion. We also used a scale of radiologic severity to assess the distribution and extent of these findings. Among initial laboratory findings, we analyzed leukocytes, lymphocytes, platelets, neutrophil-to-lymphocyte ratio, and C-reactive protein. RESULTS: Of 761 symptomatic patients, 639 (84%) required hospitalization and 122 were discharged to their homes. The need for admission increased with increasing scores on the scale of radiologic severity. The extent of initial lung involvement was significantly associated with the laboratory parameters analyzed (p<0.05 for platelets, p<0.01 for lymphocytes, and p<0.001 for the remaining parameters), as well as with the time from the onset of symptoms (p<0.001). CONCLUSION: It can be useful to use a scale of radiologic severity to classify chest X-ray findings in diagnosing patients with COVID-19, because the greater the radiologic severity, the greater the need for hospitalization and the greater the alteration in laboratory parameters.

Rhabdomyolysis and high catabolic state in patients with COVID-19 who develop dialysis-requiring AKI

Introduction: Covid-19-associated rhabdomyolysis has not been clearly established;therefore, clinicians might have low clinical suspicion for rhabdomyolysis Case Description: We are presenting five cases where Covid-19 patients became very catabolic and developed rhabdomyolysis associated with acute kidney injury (AKI). Symptoms were shortness of breath, fever, generalized malaise one week before the presentation. At the time of admission all patients had fever, tachycardia, tachypnea and were hypoxemic. One day later they were intubated for tachypnea and worsening oxygen saturation. They were admitted to the intensive care units and were treated with intravenous hydration. All the patients eventually required pressor support. AKI developed 10 days after onset of the symptoms and it was attributed to cytokine storm, ischemic acute tubular necrosis, and rhabdomyolysis. Intravenous furosemide was attempted with poor responses. Renal replacement therapy (RRT) was needed approximately three days after development of AKI. Continues renal replacement therapy (CRRT) was the modality used. After 3 days of interrupted therapy due to clotting, there was not improvement and overall high mortality. Discussion: Rhabdomyolysis has been associated with many infectious diseases, including viral infections. The direct viral invasion and circulating viral toxins may directly destroy muscle cell membranes leading to rhabdomyolysis. However theexcessive immune response and cytokine storms which often seen in COVID-19 can promote to high catabolic state and rhabdomyolysis and therefore it will contribute to rapid worsening on renal function. Early detection and promptly supportive treatment with RRT may help to improve the vital prognosis of COVID-19.

The use of ace inhibitors and ARBS in patients admitted for COVID-19

Background: Angiotensin converting enzyme (ACE 2) receptor has been implicated as an entry point for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) causing pandemic coronavirus disease 2019 (COVID-19). Experts have postulated the potential benefits of using ACEI/ARB to reduce the severity of acute lung injury and as the treatment of hypertension in COVID-19. However, there is limited data in showing the renal outcomes after the use of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in COVID-19 patients. Methods: This is a retrospective, single center study of 300 patients diagnosed with COVID-19 confirmed by real-time reverse transcription polymerase chain reaction. Four groups were divided based on ACEI/ARB exposure. Group 1 (n=51 patients;17%) were initiated on ACEIs/ARBs during hospitalization, group 2 (n=58 patients;19%) were on ACEIs/ARBS at home and discontinued, group 3 (n=76 patients;25%) were on ACES/ ARBS at home and continued during hospitalization and group 4 (n=116 patients;38%) were never treated with ACEIs/ARBS. The primary end points including the incidence of AKI using KDIGO definition, hyperkalemia, the necessity of dialysis and the secondary end points being the length of total hospital stays, the recovery rate, mortality rate were compared between group 1,2,3 with 4 using adjusted odd ratios (ORs). Results: In group 1, the use of ACEI/ARB has 4 times higher risk of developing AKI than the control group 4 (P= 0.001, 95% CI of 1.70-9.59). and is 4.6 times for stage 2 or above AKI (P= 0.001;95% CI of 1.8-11.5). OR for hyperkalemia is 5.7 (P= 0.001, 95% CI of 2.09-15.5) and for hemodialysis is 3.7 (P= 0.02, 95% CI of 1.2-11.2). Their mortality rate is increased 2.9 times (P=0.026, 95% CI of 1.23-7.44). In group 2, the incidence of AKI is 7.5 times higher (P= <0.001, 95% CI of 3.3-17) and 3.5 times (P=0.001, 95% CI of 1.6-7.7) for stage 2 above AKI. OR for the initiation of hemodialysis and the mortality rate are not statistically significant after adjusted with variables. In group 3, no statistically significant data were found. Conclusions: Our findings suggest that the initiation of ACEI/ARB in COVID 19 patients have increased risk of AKI, hyperkalemia, necessity of dialysis and mortality rate.

A Retrospective observational study comparing the frequency of CRRT clotting in COVID-19 Positive vs. Negative patients

Background: Coronavirus disease 2019 (COVID-19) emerged from China in late 2019 as a respiratory disease of unknown cause. A novel coronavirus 2019-CoV was implicated as the cause. A high proportion of patients goes into septic shock from COVID- 19infection and develop acute kidney injury (AKI) which often requiring continuous renal replacement therapy (CRRT). Clinical experience has suggested that these patients are hypercoagulable with studies showing increased rates of thrombosis. This complicates the administration of CRRT as this leads to more frequent clotting of the dialysis catheter and sequelae of blood loss, time off dialysis, and increased use of resources Methods: We retrospectively audited all patients admitted at our center from February to April 2020 who developed severe AKI requiring CRRT and compared the number of CRRT clotted in the first 7 days in COVID-19 negative (N = 49) and positive (N = 55) patients. Pediatric patients were excluded from this analysis. We also collected data on other variables which may influence rate frequency such as location of catheter, INR, and presence of systemic anticoagulation Results: We found that patients who tested positive for COVID-19 had a higher number of clotting events in the first 7 days of CRRT (3.51 vs 1.63, p < 0.00008). This population had higher incidence of AKI vs ESRD, number of pressor, and PEEP. Also, COVID 19 patients on anticoagulation has decreased clotting frequency compare to COVID 19 positive patients not on anticoagulation (2.7 vs 4.3, P <0.05) Conclusions: This data confirms our clinical experience that coagulopathy in COVID-19 positive patients lead to a greater incidence of CRRT clotting and the use of systemic anticoagulation was effective in reducing the number of clotting events.