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Introduction and Objectives: SARS-CoV-2 active infection diagnosis is currently performed through RT-qPCR. Despite the fact that PCR-based assays can provide results relatively fast, these techniques require capable professionals, specific equipment and adequate infrastructure. In order to facilitate COVID-19 diagnosis in remote areas, an alternative to RT-qPCR would be loop-mediated isothermal (RT-LAMP) amplification. SARS-CoV-2 variant genotyping through high-throughput sequencing (HTS) allows SARS-CoV-2 genomic surveillance, especially for patients with a higher vulnerability. This study aimed to optimize RT-LAMP and HTS methods for SARS-CoV-2 RNA detection and genotyping, respectively, in respiratory samples from patients with liver disease. Material(s) and Method(s): A total of 142 respiratory secretions were obtained from individuals with SARS-CoV-2 RNA detectable by RT-qPCR (N1 Ct <= 30), divided into groups with (n=18) or without (n=124) liver disease. The study also enrolled 55 individuals who had SARS-CoV-2 RNA undetectable at RT-qPCR. For RT-LAMP methodology, primers were used for ORF1 gene amplification. As for HTS genotyping, the steps of cDNA synthesis, complete SARS-CoV-2 genome PCR amplification, preparation of genomic libraries and sequencing in MinION device were performed for 26 swab samples. Result(s): Samples with viral RNA detectable by RT-qPCR had a mean Ct value of 24.3 +/- 3.75. Referring to RT-LAMP, it was observed a sensitivity of 71.1% (101/142). When considering RT-qPCR mean Ct value, RT-LAMP sensitivity was 88.9% (16/18), associated with a mean Ct of 23.3 +/- 3.5 for patients with COVID and hepatitis. A specificity of 100% (55/55) was observed since all negative swabs tested by RT-qPCR were negative at RT-LAMP. Through sequencing by MinION, SARS-CoV-2 lineages gamma (7/26;27%), zeta (1/26;3.9%), delta (6/26;23%) and omicron (12/26;46.1%) were genotyped and detected by RT-LAMP. Conclusion(s): RT-LAMP demonstrated high sensitivity for molecular detection of SARS-CoV-2 RNA for patients with high viral load. Besides, RT-LAMP was capable of detecting all SARS-CoV-2 lineages genotyped by MinION in both groups.Copyright © 2023
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We examine how individual characteristics of employees such as digital self-efficacy, workforce agility, innovativeness, and commitment to change influence technological readiness in different stages of a crisis, i.e., before a crisis and during a crisis. We carried out a fuzzy set qualitative comparative analysis (fsQCA) on data from 2892 employees representing companies across several sectors and countries. Our results show that specific characteristics of employees can be beneficial for reaching technological readiness in organisations before a crisis and during a crisis. Our results, e.g., show that digital self-efficacy has a differential impact on technological readiness prior to a crisis and during a crisis while workforce agility is essential for both phases.
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Background: C auris is an emerging often multidrug resistant pathogen capable of causing severe morbidity and mortality. C auris has been increasingly isolated from patients in skilled nursing facilities and hospitals, and has been associated with facility outbreaks. A resilient pathogen, C. auris survives harsh disinfectants, desiccation and readily colonizes the environment posing an especially great risk to immunocompromised patients with large open wounds and long lengths of stay. Methods: From 7/1/21 - 8/30/21 we noted a cluster of 4 patients with C auris in clinical cultures from the Burn ICU (BICU). A multidisciplinary team involving infection prevention, nursing/medical directors, health and safety, engineering, environmental services, and hospital leadership investigated the cluster as a potential outbreak. Mitigation measures involved a multi-modal response of C auris admission screening, weekly point prevalence testing of all BICU patients, environmental surface cultures, enhanced room cleaning, staff education, hand hygiene and personal protective equipment usage audits. Results: 11 cases of C auris were identified on our BICU from 7/1/21 - 2/28/22. 5 (45.5%) cases from clinical isolates, 1 (9.1%) from a BICU point prevalence screen on 12/15/21, 5 (45.5%) as a part of weekly point prevalence screens started on 1/1/22. 6 (54.5%) patients were admitted for burn related injuries, 2 (18.2%) for Steven Johnson Syndrome, 2 (18.2%) for necrotizing wounds, and 1 (9.1%) for COVID-19 pneumonia. Cases occurred in 6/10 rooms in the Burn ICU. One (9.1%) patient expired during this outbreak (not deemed to be from C auris infection). Conclusion: Resilient infections like C auris pose a risk of nosocomial transmission and potential high morbidity and mortality to burn patients with impaired immune defense and large open wounds. A multidisciplinary team using targeted interventions including screening, education, enhanced cleaning eradicated the outbreak in our BICU. As of 5/1/22, we went 13 + weeks without identifying a new case. The last patient with C auris was discharged 3/16/22. To prevent future outbreaks, we created a standardized response plan and instituted a universal screening protocol for C auris targeting all patient admissions from skilled nursing facilities and admissions to all ICUs. Disclosures: Jorge Paiva Parada, MD MPH, Shionogi: Honoraria.
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In this paper the general objective was determine the situation of Argentine universities: Problems, COVID-19, ICT & efforts. Methodology, in this research, 36 documents have been selected, carried out in the period 2016 - 2021;including: scientific articles, review articles and information from websites of recognized organizations. The keywords used in the searches were: Argentine universities, COVID-19 and ICT. Results, Argentine universities have many difficulties, like other Latin American universities. The pandemic has reduced access to economic resources. However, Argentine universities are making many efforts to fulfill their social role. Conclusions, the oldest university in Argentina is the National University of Cordoba, founded in 1613. Higher education in Argentina is primarily public, where direct entry is offered to students. The professional careers preferred by Argentine students are engineering, law and administration. There are also very internationally recognized private universities. Many universities are struggling to quickly set up their virtual platforms, before classes start. The difficult economic situation that the country is going through for several years, the health emergency and social isolation due to the pandemic, have paralyzed public and private university activity. It is important and urgent that Argentine universities strengthen the adoption of ICT and also promote innovation.
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Prone position (PP) allows recruitment of alveolar units by increasing functional residual capacity (FRC), decreasing strain and lung stress, and improving cardiopulmonary interaction. Patients admitted to the intensive care unit (ICU) for coronavirus disease 2019 (COVID-19) often require intravenous administration of various medications and vasopressors, as well as life-saving protective mechanical ventilation. The pandemic caused by COVID-19 has led to widespread use of PP in all ICUs, which has posed new challenges. Given the risk of respiratory deterioration in the supine position, placement of vascular access (VA) in PP is an option to be explored. We present a case report to describe the technique of vascular access placement in PP, as well as the feasibility and safety of its placement. © 2022 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo
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5% of patients with severe acute respiratory syndrome (SARS-CoV-2) by coronavirus 2 disease (COVID-19) develop acute respiratory distress syndrome (ARDS) resulting in a high mortality rate. A 36-year-old male patient with a history of renal transplant from a related living donor presented with fever of 39oC, asthenia, adynamia, myalgias and arthralgias. Polymerase chain reaction (PCR) for (COVID-19) was performed, as well as computerized axial tomography (CAT) of the thorax with a finding of CO-RADS 5, he developed greater respiratory insufficiency requiring invasive mechanical ventilation, cultures were obtained with the result of quantitative PCR/DNAc cytomegalovirus (CMV): 554 copies/mL, valganciclovir 900 mg was started, with the patient presenting adequate evolution until mechanical ventilation was withdrawn. Co-infection by CMV and SARS-CoV-2 at pulmonary level should be clinically suspected in the context of pneumonia in the immucompromised patient, favoring the correct and timely treatment that allows complete recovery of the patient.
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The use of technological means in the process of neuropsychological assessment has been proposed as a technique with promising results in the field of detection of neurocognitive disorders for community-dwelling older adults. Especially during the pandemic period due to COVID-19, telemedicine assumed to be vital in the field of early diagnosis of cognitive disorders and highlighted the clinical utility of remote methods of neuropsychological assessmentby video-conference. This descriptive study presents the development of a remote neuropsychological assessment protocol by selecting appropriate validated tests as part of a more comprehensive evaluation for older adults dwelling in the community. We recruited participants from the Athens Alzheimer's Association center in collaboration with the Hellenic Neuropsychological Society, in Athens, Greece, regarding the period between April 2020 and October 2021. 90 individuals, tested for the first time, were categorized into three groups according to their diagnosis which included: (a) Mild Cognitive Impairment (MCI), (b) Alzheimer's disease, (c) cognitively healthy older adults. The presented protocol outlines the main considerations of a framework about remote neuropsychological assessment, which can maximize the effectiveness of interventions and continuity regarding the care of older adults. The recommendations outlined in the presented protocol highlight strengths and limitations that should be taken into account in remote control procedures. Although the protocol was created in response to pandemic restrictions, tele-neuropsychology shows promise as a way to improve access opportunity to neurodiagnostic services for rural aging and underserved populations, which lack specialized healthcare services. Further application to different populations will add validity to the presented descriptive protocol.
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Introduction: COVID-19, rocked the world in December 2019. Since its inception, it has been observed that older patients are prone to develop severe forms of the disease. Objective: To determine the role of age as a variable associated with severity in COVID-19 patients. Methods: A retrospective cohort analytical study was conducted in 150 patients diagnosed with COVID-19, during March to June 2020. The severity was analyzed according to age groups, and a simple binary logistic regression model was used. Clinical and laboratory variables at hospital admission were summarized for the comparison of two age groups from the optimal cut-off point for age using the ROC curve. The free software R version 4.0.2 (22-06-2020) was used for processing. Results: The age of the patients had a wide range, with disease severity predominating in the older age groups. The optimal cut-off point calculated was 71.5. Was observed that from 70 years of age onwards patients had greater comorbidity and altered laboratory tests. Likewise, a greater number of symptoms, hospital stay, and number of deaths. Conclusions: Age is a risk factor associated with severity in patients with COVID-19, which increases significantly after 70 years of age, where a series of factors coexist which, together with advanced age, play an important role in the prognosis. © 2022, Editorial Ciencias Medicas. All rights reserved.
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This COVID-19 pandemic is impacting the world in health and economic terms since 2020 with more than 200 million confirmed infected people and more than 4 million deaths across 190 countries. Treatment used against COVID-19 disease has initially been based on the combination of several medicaments, such as hydroxychloroquine/chloroquine, azithromycin and kaletra, each of which can individually delay the ventricular depolarization and repolarization processes through morphological changes in the patient's electrocardiogram. These changes can produce serious arrhythmias that lead to the sudden death of the patient.This paper presents an interpretable fuzzy rule-based system for fatal ventricular arrhythmia risk level estimation due to COVID-19 treatment, whose decisions are made on the basis of the evolution of electrocardiogram morphology and certain patient's clinical information. For the risk level estimation, the proposed fuzzy rule-based system considers three different risk levels (High, Moderate and Low) which are indicated by means of three different colors (Red, Orange and Green). Decisions made by the fuzzy rule-based system present a reliable behavior in comparison with cardiologist's decision. To be precise, the obtained accuracy, when comparing both decisions, reaches the 96.43%, which, joint to the high measured interpretability of the decision making system, result in a powerful tool in order to avoid death in patients, even in health centers without specialized clinical staff, and to reduce the stress in medical centers by reducing reaction times in critical patient situations. © 2021 IEEE.