Comparison of Sedation and Analgesia Requirements in Patients With SARS-CoV-2 Versus Non-SARS-CoV-2 Acute Respiratory Distress Syndrome on Veno-Venous ECMO.

BACKGROUND: Increased analgosedation requirements have been described in patients with acute respiratory distress syndrome (ARDS) on extracorporeal membrane oxygenation (ECMO) support due to unique pharmacokinetic challenges. There is a paucity of data comparing sedation requirements in patients on ECMO for ARDS secondary to SARS-CoV-2 versus other etiologies of respiratory failure. OBJECTIVE: To compare sedation and analgesia requirements in adult patients with SARS-CoV-2 versus non-SARS-CoV-2 ARDS requiring veno-venous (VV) ECMO support. METHODS: We performed a retrospective cohort study of adult patients receiving sedation and analgesia on VV-ECMO support. Patients were excluded if cannulated at an outside hospital for greater than 24 hours, expired within 48 hours of ECMO cannulation, or received neuromuscular blocking agents for greater than 7 consecutive days following ECMO cannulation. RESULTS: We evaluated 108 patients on VV-ECMO support, including 44 with non-SARS-CoV-2 ARDS and 64 with SARS-CoV-2 ARDS. The median daily dexmedetomidine requirements were significantly higher in the SARS-CoV-2 cohort (16.7 vs 13.4 mcg/kg/day, P = 0.03), while the median propofol daily requirements were significantly higher in the non-SARS-CoV-2 cohort (40.3 vs 53.5 mg/kg/day, P < 0.01). There was no difference in daily requirements of opioids, benzodiazepines, and ketamine between groups. Use of adjunct agents to facilitate weaning was significantly higher in the SARS-CoV-2 cohort (78.1% vs 43.2%, P < 0.01). CONCLUSION AND RELEVANCE: Patients with ARDS on VV-ECMO support require multiple analgosedative agents with concomitant use of nonparenteral adjunct agents. Further studies are needed to evaluate optimal analgosedation strategies in patients on ECMO support.

Adherence to COVID-19 preventive behaviors in Colombian trans women

Introduction/Objective: To establish the level of adherence of a group of Colombian trans women to SARS-CoV-2 prevention measures. Method: Single-stage descriptive correlational cross-sectional design. An anonymous online questionnaire was administered to 100 Colombian trans women. The results were obtained using both frequentist and bayesian (a priori-a posteriori) statistical methods. Results: About three-quarters of the participating women reported a high level of adherence to preventive behaviors. Associated factors were feeling able to implement the preventive actions and believing in their effectiveness, to avoid infecting others, conflicts with others, and avoiding legal problems. Conclusions: Self-efficacy and rule-governed behaviors are related to adherence to prevention measures. Addressing adherence in times of COVID-19 implies comprehensively incorporating the magnitude of social inequities and injustices and the health responses to a situation that affects humanity in a diverse and differentiated manner. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Spanish) Introduccion/Objetivo: Establecer el nivel de adherencia de un grupo de mujeres trans colombianas a las medidas de prevencion ante el SARS-CoV-2. Metodo: Diseno transversal correlacional descriptivo de una sola etapa. Se administro un cuestionario en linea anonimo a 100 mujeres trans de Colombia. Los resultados fueron obtenidos utilizando metodos estadisticos tanto frecuentistas como bayesianos (a priori- a posteriori). Resultados: Cerca de las tres cuartas partes de las mujeres participantes reportaron un alto nivel de adherencia a las conductas preventivas. Los factores asociados fueron sentirse capaz de implementar las acciones de prevencion y creer en la eficacia de ellas, para evitar contagiar a otros, los conflictos con otras personas y problemas legales. Conclusiones: La autoeficacia y los comportamientos gobernados por reglas estan relacionados con la adherencia a las medidas de prevencion. Abordar la adherencia en tiempos de COVID-19 implica incorporar de manera integral la magnitud de las inequidades e injusticias sociales y las respuestas en salud ante una situacion que afecta a la humanidad de manera diversa y diferenciada. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Depressive symptomatology in adults during the COVID-19 pandemic.

Depression entails changes in the mental health of individuals worldwide. Episodes of depression lead to mood swings and changes in the motivational dimension. Our research focused on the prevalence of depression in the adult population and on how it affected the social and affective dimensions. Owing to the current pandemic, we deemed it necessary to explore how protective measures against COVID-19 infection, such as quarantines, could be related to mental health. Moreover, we found it important to determine the prevalence of depressive and anxious symptomatology in adults from the Valle del Cauca region in Colombia during the social isolation connected to COVID-19. Our study was descriptive, analytical and cross-sectional, and involved 1248 subjects. As tools, we used the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale. The data demonstrated that women were more likely to display symptoms of depression and that individuals aged between 24 and 29 were less likely to reveal symptoms of anxiety than those aged between 18 and 23. Moreover, childless or economically dependent individuals proved to be more likely to display symptoms of depression during the pandemic.

Sample pooling for SARS-CoV-2 RT-PCR screening.

OBJECTIVE: To evaluate the efficacy of sample pooling compared to the individual analysis for the diagnosis of coronavirus disease 2019 (COVID-19) by using different commercial platforms for nucleic acid extraction and amplification. METHODS: A total of 3519 nasopharyngeal samples received at nine Spanish clinical microbiology laboratories were processed individually and in pools (342 pools of ten samples and 11 pools of nine samples) according to the existing methodology in place at each centre. RESULTS: We found that 253 pools (2519 samples) were negative and 99 pools (990 samples) were positive; with 241 positive samples (6.85%), our pooling strategy would have saved 2167 PCR tests. For 29 pools (made out of 290 samples), we found discordant results when compared to their correspondent individual samples, as follows: in 22 of 29 pools (28 samples), minor discordances were found; for seven pools (7 samples), we found major discordances. Sensitivity, specificity and positive and negative predictive values for pooling were 97.10% (95% confidence interval (CI), 94.11-98.82), 100%, 100% and 99.79% (95% CI, 99.56-99.90) respectively; accuracy was 99.80% (95% CI, 99.59-99.92), and the kappa concordant coefficient was 0.984. The dilution of samples in our pooling strategy resulted in a median loss of 2.87 (95% CI, 2.46-3.28) cycle threshold (Ct) for E gene, 3.36 (95% CI, 2.89-3.85) Ct for the RdRP gene and 2.99 (95% CI, 2.56-3.43) Ct for the N gene. CONCLUSIONS: We found a high efficiency of pooling strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA testing across different RNA extraction and amplification platforms, with excellent performance in terms of sensitivity, specificity and positive and negative predictive values.