Study on the acceptance of virtual reality as a complement to the study of human anatomy

Introduction Information and communication technologies have demonstrated their utility adapted to Health Sciences, particularly from an educational perspective. Virtual reality (VR) has become a tool that catalyzes the acquisition of clinical skills before contact with the patient, increasing safety, dexterity in procedures, and reducing the possibility of errors or complications. However, these tools could also offer new approaches for teaching basic subjects for undergraduates (Anatomy, Histology, etc.) and the use of tablets, and especially smartphones, could act as a complementary educational incentive. Methods Two hundred seventy-four students from different levels of the degree in Medicine, were invited to use a VR app on their phones with stereoscopic goggles. The users immerse themselves in the bioscopic anatomy, navigating through different anatomical structures. Results The questionnaire scores were, in general, above 4, reaffirming a positive opinion, except regarding the use of the tool for student exams. Conclusion Universities could increase formative delivery at a reduced cost, while ensuring training quality. The proposed concept of VR also helps to provide a useful learning environment in the COVID-19 scenario. Our results show that the introduction of immersive technology associated with VR and smartphones for medical students can be a welcome complementary or alternative educational tool. Resumen Introducción Las tecnologías de la información y la comunicación han demostrado su utilidad adaptada a las Ciencias de la Salud, particularmente desde una perspectiva educativa. La realidad virtual (RV) se ha convertido en una herramienta que cataliza la adquisición de habilidades clínicas antes del contacto con el paciente, aumentando la seguridad, la destreza en los procedimientos y reduciendo la posibilidad de errores o complicaciones. Sin embargo, estas herramientas también podrían ofrecer nuevos enfoques para la enseñanza de materias básicas para estudiantes universitarios (Anatomía, Histología, etc.) y el uso de tabletas, y especialmente teléfonos inteligentes, podría actuar como un incentivo educativo complementario. Métodos Doscientos setenta y cuatro estudiantes de diferentes niveles de la licenciatura en Medicina fueron invitados a usar una aplicación de realidad virtual en sus teléfonos con gafas estereoscópicas. Los usuarios se sumergen en la anatomía bioscópica, navegando a través de diferentes estructuras anatómicas. Resultados Las puntuaciones del cuestionario fueron, en general, superiores a 4, reafirmando una opinión positiva, excepto en lo que respecta al uso de la herramienta para los exámenes de los estudiantes. Conclusión Las universidades podrían aumentar la entrega formativa a un costo reducido, al tiempo que garantizan la calidad de la capacitación. El concepto propuesto de RV también ayuda a proporcionar un entorno de aprendizaje útil en el escenario COVID-19 Nuestros resultados muestran que la introducción de tecnología inmersiva asociada con la realidad virtual y los teléfonos inteligentes para estudiantes de medicina puede ser una herramienta educativa complementaria o alternativa bienvenida.

Study of perioperative outcomes of acute appendicitis during the COVID-19 pandemic: An analytical observational cohort study / Estudio de los desenlaces perioperatorios de la apendicitis aguda durante la pandemia por COVID-19: un estudio observacional analítico de cohorte

Introducción. La condición de pandemia por COVID-19 impactó a la sociedad y los sistemas de salud a nivel mundial. Las adaptaciones institucionales procuraron mantener la calidad de la atención a pesar de un contexto organizacional desfavorable. La apendicitis aguda requirió ser manejada en un nuevo escenario institucional. El objetivo de este estudio fue evaluar la efectividad del tratamiento quirúrgico de la apendicitis durante la pandemia. Métodos. Estudio observacional analítico, retrospectivo, en el que se incluyeron pacientes sometidos a apendicectomía, antes y durante la pandemia por COVID-19. Se evaluaron las complicaciones, infección del sitio operatorio, reingresos y estancia hospitalaria. Adicionalmente, se analizaron los desenlaces en los 3 picos epidemiológicos de la pandemia. Se efectuaron estadísticas descriptivas y analíticas entre los grupos a comparar. Resultados. Se incluyeron 1521 pacientes con apendicitis, 48,3 % operados antes y 51,7 % durante la pandemia. No hubo diferencias entre los grupos en complicaciones (p=0,352), infección del sitio operatorio (p=0,191), reingreso en los primeros 30 días (p=0,605) y estancia hospitalaria (p=0,514). El manejo de la apendicitis durante el tercer pico fue similar a las prácticas habituales. El tiempo de evolución fue mayor durante la pandemia (p=0,04) y los pacientes fueron llevados a cirugía más pronto que previo a la pandemia (p<0,001). Conclusiones. No se evidenció un incremento de complicaciones quirúrgicas, reingresos, estancia hospitalaria ni infección del sitio operatorio en los pacientes operados durante la pandemia. Hubo un efecto favorable para los pacientes como consecuencia de la adaptación institucional en la pandemia por COVID-19

Introduction. COVID-19 pandemic impacted society and health systems worldwide. The institutional adaptations sought to maintain the quality of care in an unfavorable organizational context. Acute appendicitis was required to be managed in a new institutional setting. The effectiveness of surgical treatment of appendicitis during the pandemic was evaluated. Methods. Retrospective analytical observational study, in patients with appendectomy, before and during COVID-19 pandemic. Complications, surgical site infections, readmissions, and hospital stay were evaluated. Additionally, the outcomes in the 3 epidemiological peaks of the pandemic were analyzed. Descriptive and analytical statistics were performed between the groups to be compared. Results. A total of 1521 patients with appendicitis were included, 48.3% before and 51.7% during the pandemic. There were no differences in complications (p=0.352), operative site infection (p=0.191), readmission at 30 days (p=0.605), and hospital stay (p=0.514) between the groups. Management of appendicitis during the 3rd peak was like usual practices. There was a long evolution time during the pandemic (p=0.04) and the patients were taken to surgery sooner than before the pandemic (p<0.001). Conclusions. There was no evidence of an increase in surgical complications, readmissions, hospital stay, and surgical site infections during patients who underwent surgery. There was a favorable effect for patients because of institutional adaptation in the COVID-19 pandemic

Chronic Comorbidities in Middle Aged Patients Contribute to Ineffective Emergency Hematopoiesis in Covid-19 Fatal Outcomes

Background and Aims . Mexico is among the countries with the highest estimated excess mortality rates due to the COVID–19 pandemic, with more than half of reported deaths occurring in adults younger than 65 years old. Although this behavior is presumably influenced by the young demographics and the high prevalence of metabolic diseases, the underlying mechanisms have not been determined. Methods . The age–stratified case fatality rate (CFR) was estimated in a prospective cohort with 245 hospitalized COVID–19 cases, followed through time, for the period October 2020–September 2021. Cellular and inflammatory parameters were exhaustively investigated in blood samples by laboratory test, multiparametric flow cytometry and multiplex immunoassays. Results . The CFR was 35.51%, with 55.2% of deaths recorded in middle–aged adults. On admission, hematological cell differentiation, physiological stress and inflammation parameters, showed distinctive profiles of potential prognostic value in patients under 65 at 7 d follow–up. Pre–existing metabolic conditions were identified as risk factors of poor outcomes. Chronic kidney disease (CKD), as single comorbidity or in combination with diabetes, had the highest risk for COVID–19 fatality. Of note, fatal outcomes in middle–aged patients were marked from admission by an inflammatory landscape and emergency myeloid hematopoiesis at the expense of functional lymphoid innate cells for antiviral immunosurveillance, including NK and dendritic cell subsets. Conclusions . Comorbidities increased the development of imbalanced myeloid phenotype, rendering middle–aged individuals unable to effectively control SARS–CoV–2. A predictive signature of high–risk outcomes at day 7 of disease evolution as a tool for their early stratification in vulnerable populations is proposed. Graphical abstract Image, graphical abstract

Chronic Comorbidities in Middle Aged Patients Contribute to Ineffective Emergency Hematopoiesis in Covid-19 Fatal Outcomes.

BACKGROUND AND AIMS: Mexico is among the countries with the highest estimated excess mortality rates due to the COVID-19 pandemic, with more than half of reported deaths occurring in adults younger than 65 years old. Although this behavior is presumably influenced by the young demographics and the high prevalence of metabolic diseases, the underlying mechanisms have not been determined. METHODS: The age-stratified case fatality rate (CFR) was estimated in a prospective cohort with 245 hospitalized COVID-19 cases, followed through time, for the period October 2020-September 2021. Cellular and inflammatory parameters were exhaustively investigated in blood samples by laboratory test, multiparametric flow cytometry and multiplex immunoassays. RESULTS: The CFR was 35.51%, with 55.2% of deaths recorded in middle-aged adults. On admission, hematological cell differentiation, physiological stress and inflammation parameters, showed distinctive profiles of potential prognostic value in patients under 65 at 7 days follow-up. Pre-existing metabolic conditions were identified as risk factors of poor outcomes. Chronic kidney disease (CKD), as single comorbidity or in combination with diabetes, had the highest risk for COVID-19 fatality. Of note, fatal outcomes in middle-aged patients were marked from admission by an inflammatory landscape and emergency myeloid hematopoiesis at the expense of functional lymphoid innate cells for antiviral immunosurveillance, including NK and dendritic cell subsets. CONCLUSIONS: Comorbidities increased the development of imbalanced myeloid phenotype, rendering middle-aged individuals unable to effectively control SARS-CoV-2. A predictive signature of high-risk outcomes at day 7 of disease evolution as a tool for their early stratification in vulnerable populations is proposed.

Invernadero automatizado, laboratorio multidisciplinario para el desarrollo de retos vivenciales

El desarrollo del proyecto se dio durante la pandemia por COVID-19, por lo que gran parte del trabajo fue realizado en formato virtual a distancia, teniendo como resultados un mayor desempeño académico en los estudiantes de mecatrónica que trabajaron en este ambiente, así como la adquisición de conocimientos sobre el desarrollo tecnológico en el área de biotecnología. In this project, a dynamic, multidisciplinary, and experiential learning environment was created, compatible with the "new normality" with the aim of developing transversal skills and improving academic performance in students of biotechnology and mechatronics engineering careers. The development of the project took place during the COVID-19 pandemic, for which a large part of the work was carried out in a virtual format, resulting in a higher academic performance in the mechatronics students who worked in this environment, as well as the acquisition of knowledge about technological development in the area of biotechnology. El proyecto se desarrolló con dos grupos de estudiantes trabajando de manera multidisciplinaria, el primer grupo lo conformaron alumnos de IMT y el segundo grupo alumnos de IBT.

Humoral response to different SARS-CoV-2 vaccines in orthotopic liver transplant recipients.

BACKGROUND: The safety and efficacy data of the different types of available vaccines is still needed. The goal of the present analysis was to evaluate the humoral response to the COVID-19 vaccines in orthotopic liver transplant (OLT) recipients. METHODS: Participants were included from February to September 2021. No prioritized vaccination roll call applied for OLT patients. Controls were otherwise healthy people. Blood samples were drawn after 15 days of the complete vaccine doses. The samples were analyzed according to the manufacturer's instructions using the Liaison XL platform from DiaSorin (DiaSorin S.p.A., Italy), and SARS-COV-2 IgG II Quant (Abbott Diagnostics, IL, USA). RESULTS: A total of 187 participants (133 OLT, 54 controls, median age: 60 years, 58.8% women) were included for the analysis; 74.3% had at least one comorbidity. The serologic response in OLT patients was lower than in controls (median 549 AU/mL vs. 3450 AU/mL, respectively; p = 0.001). A positive humoral response was found in 133 OLT individuals: 89.2% with BNT162b2 (Pfizer-BioNTech), 60% ChAdOx1 nCOV-19 (Oxford-AstraZeneca), 76.9% with CoronaVac (Sinovac, Life Sciences, China), 55.6% Ad5-nCov (Cansino, Biologics), 68.2% Gam-COVID-Vac (Sputnik V) and 100% with mRNA-1273. In controls the serological response was 100%, except for Cansino (75%). In a multivariable model, personal history of COVID-19 and BNT162b2 inoculation were associated with the serologic response, while the use of prednisone (vs. other immunosuppressants) reduced this response. CONCLUSION: The serologic response to COVID-19 vaccines in OLT patients is lower than in healthy controls. The BNT162b2 vaccine was associated with a higher serologic response.

Does COVID-19 infection increase the risk of pressure injury in critically ill patients?: A narrative review.

ABSTRACT: Patients with severe COVID-19 may have endothelial dysfunction and a hypercoagulable state that can cause skin damage. In the presence of external pressure on the tissues, the local inflammatory process regulated by inflammatory cytokines can increase and prolong itself, contributing to the formation of pressure injury (PI). PI is defined as localized damage to the skin or underlying tissues. It usually occurs as a result of intense and/or prolonged pressure in combination with shear. The aim of the study is to perform a narrative review on the physiological evidence of increased risk in the development of PI in critically ill patients with COVID-19.In patients with severe COVID-19 a pattern of tissue damage consistent with complement-mediated microvascular injury was found in the lungs and skin of critically ill COVID-19 patients, suggesting sustained systemic activation of complement pathways. Theoretically, the same thrombogenic vascular changes related to COVID-19 that occur in the skin also occur in the underlying tissues, making patients less tolerant to the harmful effects of pressure and shear. Unlike the syndromes typical of acute respiratory illnesses and other pathologies that commonly lead to intensive care unit admission, COVID-19 and systemic viral spread show that local and systemic factors overlap. This fact may be justified by current epidemiological data showing that the prevalence of PI among intensive care unit patients with COVID-19 was 3 times higher than in those without COVID-19. This narrative review presents physiological evidence to suggesting an increased risk of developing PI in critically ill patients with COVID-19.

NAFLD determined by Dallas Steatosis Index is associated with poor outcomes in COVID-19 pneumonia: a cohort study.

Coronavirus disease 2019 is a worldwide health challenge. Liver steatosis diagnosis based on imaging studies has been implicated in poor outcomes of COVID-19 pneumonia, but results are inconsistent. The Dallas Steatosis Index (DSI) is an available calculator developed to identify patients with non-alcoholic fatty liver disease (NAFLD). We hypothesized that it would be associated with in-hospital mortality, intensive care unit admission (ICU), and invasive mechanical ventilation (IMV). We conducted a retrospective cohort study on inpatients with confirmed COVID-19 pneumonia between February 26 and April 11, 2020. We computed the DSI on admission, and patients with high DSI were considered with NAFLD. We employed logistic regression to study the association between NAFLD, mortality, ICU admission, and IMV. We studied the association between liver steatosis on computed tomography (CT) and these outcomes, and also between Metabolic Associated Fatty Liver Disease (MAFLD) based on CT findings and risk factors and the outcomes. 470 patients were included; 359 had NAFLD according to the DSI. They had a higher frequency of type 2 diabetes (31% vs 14%, p < 0.001), obesity (58% vs 14%, p < 0.001), and arterial hypertension (34% vs 22%, p = 0.02). In univariable analysis, NAFLD was associated with mortality, ICU admission, and IMV. Liver steatosis by CT and MAFLD were not associated with any of these outcomes. In multivariable logistic regression, high DSI remained significantly associated with IMV and death. High DSI, which can be easily computed on admission, was associated with IMV and death, and its use to better stratify the prognosis of these patients should be explored. On the other hand, liver steatosis by CT and MAFLD were not associated with poor outcomes.

A Proposed Framework for Developing FMEA Method Using Pythagorean Fuzzy CODAS

The purpose of this research article is to develop a hybridization between the Failure Mode and Effect Analysis (FMEA) method and the Combinative Distance-Based Assessment (CODAS) method under Pythagorean Fuzzy environment. The traditional FMEA procedure is based on the multiplication between the parameters of severity, occurrence, and detectability where everyone has equal relative importance;therefore, different combinations of these parameters can generate the same result creating uncertainty in the analysis. In this mode, the hybridization proposed in this research deal with relative importance of each parameter;in the fact to have a more suitable combination which consider the level of knowledge of the experts in the assessment. Finally, a numerical case was carried out concerning the public transportation service to validate our proposal;the results show that 31 failure modes and potential risks can be evaluated using user perceptions, a dominant with high level of knowledge about the public transportation service and an apprentice or common user, as team of experts and exploiting the subjectivity of the information in a mathematical model. Also, we compare the results with a variation of the proposed model with the multi-criteria method multi-objective optimization method by relationship analysis (MOORA);it was observed that the convergence of the failure modes depends on the nature of the mathematical model even under the same conditions at the start.

Risk perception and knowledge of COVID-19 in patients with celiac disease.

BACKGROUND: We recently demonstrated that the odds of contracting coronavirus disease 2019 (COVID-19) in patients with celiac disease (CeD) is similar to that of the general population. However, how patients with CeD perceive their COVID-19 risk may differ from their actual risk. AIM: To investigate risk perceptions of contracting COVID-19 in patients with CeD and determine the factors that may influence their perception. METHODS: We distributed a survey throughout 10 countries between March and June 2020 and collected data on demographics, diet, COVID-19 testing, and risk perceptions of COVID-19 in patients with CeD. Participants were recruited through various celiac associations, clinic visits, and social media. Risk perception was assessed by asking individuals whether they believe patients with CeD are at an increased risk of contracting COVID-19 when compared to the general population. Logistic regression was used to determine the influencing factors associated with COVID-19 risk perception, such as age, sex, adherence to a gluten-free diet (GFD), and comorbidities such as cardiac conditions, respiratory conditions, and diabetes. Data was presented as adjusted odds ratios (aORs). RESULTS: A total of 10737 participants with CeD completed the survey. From them, 6019 (56.1%) patients with CeD perceived they were at a higher risk or were unsure if they were at a higher risk of contracting COVID-19 compared to the non-CeD population. A greater proportion of patients with CeD perceived an increased risk of contracting COVID-19 when compared to infections in general due to their CeD (56.1% vs 26.7%, P < 0.0001). Consequently, 34.8% reported taking extra COVID-19 precautions as a result of their CeD. Members of celiac associations were less likely to perceive an increased risk of COVID-19 when compared to non-members (49.5% vs 57.4%, P < 0.0001). Older age (aOR: 0.99; 95%CI: 0.99 to 0.99, P < 0.001), male sex (aOR: 0.84; 95%CI: 0.76 to 0.93, P = 0.001), and strict adherence to a GFD (aOR: 0.89; 95%CI: 0.82 to 0.96, P = 0.007) were associated with a lower perception of COVID-19 risk and the presence of comorbidities was associated with a higher perception of COVID-19 risk (aOR: 1.38; 95%CI: 1.22 to 1.54, P < 0.001). CONCLUSION: Overall, high levels of risk perceptions, such as those found in patients with CeD, may increase an individual's pandemic-related stress and contribute to negative mental health consequences. Therefore, it is encouraged that public health officials maintain consistent communication with the public and healthcare providers with the celiac community. Future studies specifically evaluating mental health in CeD could help determine the consequences of increased risk perceptions in this population.

Low Thoracic Skeletal Muscle Area Is Not Associated With Negative Outcomes in Patients With COVID-19.

OBJECTIVE: Sarcopenia has been related to negative outcomes in different clinical scenarios from critical illness to chronic conditions. The aim of this study was to verify whether there was an association between low skeletal muscle index and in-hospital mortality, intensive care unit admission, and invasive mechanical ventilation need in hospitalized patients with COVID-19. DESIGN: This was a retrospective cohort study of a referral center for COVID-19. We included all consecutive patients admitted to the hospital between February 26 and May 15, 2020, with a confirmed diagnosis of COVID-19. Skeletal muscle index was assessed from a transverse computed tomography image at the level of twelfth thoracic vertebra with National Institutes of Health ImageJ software, and statistical analysis was performed to find an association between skeletal muscle index and in-hospital mortality, need of invasive mechanical ventilation, and intensive care unit admission. RESULTS: We included 519 patients, the median age was 51 (42-61) yrs, and 115 patients (22%) had low skeletal muscle index. On multivariable analysis, skeletal muscle index was not associated with mortality, intensive care unit admission, or invasive mechanical ventilation need nor in a subanalysis of patients 65 yrs or older. CONCLUSIONS: Skeletal muscle index determined by computed tomography at the level of twelfth thoracic vertebra was not associated with negative outcomes in hospitalized patients with COVID-19.

[Sleep disorders as a result of the COVID-19 pandemic]. / Trastornos del sueño a consecuencia de la pandemia por COVID-19.

Respiratory complications from COVID-19 can lead to death. For this reason, public health measures to curb the spread of the disease such as quarantine and other confinement strategies have been proposed in several countries, resulting in mental health and sleep disorders. We carried out a narrative review to systematize the most significant findings regarding insomnia in hospitalized patients with COVID-19, and in healthy persons who have been under confinement as a preventive measure. COVID-19-related conditions have caused insomnia in patients, which can alter the immune system and have a negative effect on health. For healthy people in quarantine, lifestyle changes, fear of becoming infected, young age, female gender, history of mental illness and reduced ability to cope with stress appear to be risk factors for insomnia. As well as the implementation of epidemiological and preventive measures, sleep hygiene should be promoted as a comprehensive coping strategy against the COVID-19 pandemic.

Las complicaciones respiratorias por la COVID-19 pueden llevar a la muerte, por lo que, dentro de las políticas de protección para evitar los contagios masivos, se han sugerido estrategias de cuarentena y confinamiento en muchos países, que han originado alteraciones en la salud mental y el sueño. A través de la siguiente revisión narrativa se pretende sistematizar los hallazgos más significativos en cuanto a la presencia de insomnio en pacientes hospitalizados con COVID-19, y de personas sanas que han estado sometidas a confinamiento como medida preventiva. Las condiciones propias de la enfermedad han hecho que los pacientes desarrollen insomnio, lo que puede empeorar su estado de salud y alterar su sistema inmunológico. Para las personas sanas en cuarentena los cambios en el estilo de vida, el miedo a contraer la enfermedad, la edad joven, el sexo femenino, los antecedentes de enfermedades mentales y una menor capacidad de afrontamiento al estrés parecen ser factores de riesgo para el insomnio. Al igual que la implementación de medidas epidemiológicas de cuidado y prevención contra el COVID-19, se debe tener en consideración promover la higiene del sueño como una estrategia de afrontamiento integral contra esta pandemia.

COVID-19 and the Case for Medical Management and Primary Care.

Hospitals and health systems suffer an over-reliance on elective surgeries to remain profitable. As a result, systems report record losses, while demand for emergency room, hospital, and intensive care beds have surged. Studies have admitted that many surgeries are unnecessary, and physician leaders admit that profit plays a role in driving such needless cost and risk. Most diseases are better managed with medications and lifestyle changes. But it pays more to replace a knee than to prevent that replacement. We must bring surgical and medical value closer in-line. Communities of color are suffering disproportionately from coronavirus. The social determinants of health that lead to higher concentrations of hypertension and diabetes can be mitigated by investment in primary care. Such investment has been proven to decrease cost and increase quality of life. However, the United States spends 50% less on primary care, than other developed countries. While showing promise, telehealth is not a panacea. It relies on continued reimbursement parity, and there remains a digital divide. Any meaningful fix will draw the ire from those who profit from such a profligate system. If we want to improve quality, access and equity, while avoiding unnecessary hospitalizations, risky surgeries, and runaway costs, we must invest in primary care.