ABSTRACT
INTRODUCTION: high-oxygen nasal cannulas in patients with respiratory failure secondary to SARS-CoV-2 pneumonia have not been studied from a cost-effectiveness point of view. METHODS: Retrospective analysis of patients who had entered the COVID-area of an intensive medicine service in a third reference hospital, between March-December 2020. An effectiveness cost analysis was carried out comparing 2therapeutic decisions: the experimental strategy was defined as a mixed strategy consisting of the initial application of high flow nasal oxygen (HFNO) and application of VMI only to HFNO failures. The optimal rational decision was defined as maximizing expected profit, and economic efficiency was assessed by calculating the Incremental Cost-Effectiveness Ratio (ICER) for years of life gained. RESULTS: Of the 185 patients tested, 101 (55%) received invasive mechanical ventilation immediately and 84 (45%) were treated with HFNO at the outset. In the cost-effectiveness analysis, comparing both therapeutic strategies, the probability that the experimental strategy would be more effective was 0.974, reaching statistical significance: Difference in average proportions -0.113; 95% CI:-0.018 to -0.208. This corresponds to an NNT of 9 patients. The optimal decision was HFNO's strategy followed by VMI in HFNO failures. This option had an RCEI of 5582 euros per year of life gained. CONCLUSIONS: It is important to establish in the future reliable markers in the use of HFNO so that this therapy improves its cost-effective benefits.
ABSTRACT
Background: children and adolescents constitute a sensitive population to the psychological impacts of the COVID-19 pandemic. Recognizing it implies the need for evaluation, monitoring and intervention, especially when it comes to infants who have suffered from the disease and require comprehensive pediatric care. Objective: to implement a psychological care service for children and adolescents convalescent from COVID-19.Methods: a participatory action research design was applied from a constructive-interpretive qualitative approach. It is made up of three lines of action: psychological evaluation, psychotherapeutic intervention and social support. Its design and implementation followed stages and was carried out collaboratively. The participants involved established symmetrical relationships and followed a cyclical process of planning-acting-observing-reflecting;basic procedure to attend and improve the practice.Results: the results were obtained regarding the evaluation and the actions of psychological intervention. Regarding the evaluation, clinical-psychological alterations with affectation of the psychic functions and needs for the preservation of health in the personal and family spheres stand out. Regarding the psychological intervention, all the beneficiaries received psychological counseling actions and those diagnosed with a psychiatric condition received psychotherapeutic actions. All families received social support. Conclusions: The psychological symptoms intensity reduction or remission was verified, elaboration of grief in the loss, adaptation of coping or behavior modification, strengthening of the social support networks' capacity, expansion of family knowledge, and creation of information channels between the family and the school.
ABSTRACT
Background: COVID-19 has fundamentally changed all fields of health care. Intensive care nurses have been at the forefront of the pandemic facing the massive impact of the disease, both professionally and personally. This study investigated nurses' experiences of caring for isolated COVID-19 positive patients in the intensive care department during the first wave of the COVID-19 pandemic. The study investigated how isolation affected the nurses themselves, how they related with their patients, and how isolation affected patient care in general. Methods: The study was performed at a 20-bed university hospital intensive care department in Copenhagen, Denmark. COVID-19 positive patients were isolated or cohort isolated. A dedicated nurse cared for each isolated patient and wore full personal protective equipment. The study is based on in-depth phenomenological interviews with intensive care nurses conducted in summer 2020. The interviews were structured according to the principles of "Phenomenologically Grounded Qualitative Research.” The data included observations from within the isolated patient rooms. Findings: Six intensive care nurses participated in the study. The analysis documented following themes consistently reported by all nurses: (1) a general sense of uncanniness, (2) intense feelings of confinement and co-isolation, and (3) heightened senses of bodily objectification, including how nurses' experienced their patients and also themselves. Conclusion: This is the first Scandinavian phenomenological study to focus on mapping the experiences of intensive care nurses during the extreme circumstances of the first wave of the COVID-19 pandemic. Further studies may explore long-term effects, such as psychiatric morbidity or psychological functioning in these individuals. © The Intensive Care Society 2023.
ABSTRACT
Vaccines based on recombinant mRNA technology helped to control the pandemic caused by the severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2). Clinical trials for showed that these vaccines are safe and effective and promote a strong type 1 driven T cell response. Yet, several reports claimed that SARS-CoV-2 mRNA vaccination might favor the onset, worsening or the reactivation of autoimmune disorders like pemphigus and bullous pemphigoid. However, no study demonstrated a direct immunological link between mRNA vaccination and disease appearance/worsening. We aimed to analyze the immunological and clinical effects exerted by mRNA booster vaccinations for SARS-CoV-2 in a cohort of patients with pemphigus (n=9), bullous pemphigoid (n=4) and in healthy individuals (n=5). Patients and healthy individuals were monitored at baseline, and after two and four weeks of mRNA vaccination. We assessed the clinical disease status, antibodies against the SARS-CoV-2 spike protein, antibody levels for BP180/230, DSG1/3 and tetanustoxoid. We also determined the distribution of peripheral T helper / T follicular cell subsets, intracellular cytokine production of T cells and cytokine serum levels. Our results show that booster vaccination increased anti spike protein IgG, while tetanustoxoid igC and skin-specific autoantibody titers were not or minimally affected. We observed an increase in Th1/Th17.1 cells, together with an increase in the intracellular production of IFN-gamma, IL-4 and IL-21 in peripheral T cells of pemphigus patients. Importantly, clinical activity in both remittent patients and in patients with active disease remained stable. In summary, vaccination with mRNA vaccines induced a specific activation of the humoral system with production of protective antibodies against the Sars-CoV-2 spike protein without affecting autoimmune disease activity in patients with pemphigus and bullous pemphigoid.Copyright © 2023
ABSTRACT
Pulmonary embolism (PE) is common among hospitalized adults with SARS CoV-2 pneumonia. D-dimer (DD)>1 mug/mL has been found to be a severity risk factor. However, most of the studies are based on retrospective data and the real prevalence is unknown Objectives: To evaluate the prevalence of PE in patients with SARS CoV-2 pneumonia, regardless clinical suspicion. Demographic and laboratory data, comorbidities, and clinical outcomes were compared between patients with and without PE Methods: Single-center prospective study. All consecutive cases of SARS CoV-2 pneumonia with DD>1 mug/mL underwent computed tomography pulmonary angiography Results: 179 patients (64 (55-74 years), 65% male) were included. PE was diagnosed in 71 patients (39.7%), mostly with a peripheral location and low thrombotic load (Qanadli score 10%). We did not find disparity in PE prevalence between men and women, and between obese and not obese patients. There were no differences in the intensive care unit admission rate. Mortality rate was 8.5% in patients with PE vs. 3.7% in those without PE, but the differences were not significant. Patients with PE had more history of cardiovascular disease and required more fractional inspired oxygen. DD, platelet distribution width (PDW), neutrophil-lymphocyte ratio (NLR), DD-lactate dehydrogenase ratio (DD/LDH), and DD-ferritin ratio values were significantly higher among PE patients. ROC analysis showed that PDW and DD/LDH had the greatest area under the curve Conclusion(s): Patients with SARS CoV2 pneumonia and DD>1mug/mL presented a high prevalence of PE, regardless of clinical suspicion. PDW, NLR, DD/LDH and DD/Ferritin may help to identify patients with high risk of PE.
ABSTRACT
Aim: The aim of this study was to determine severity in patients who have had SARS-CoV2 pneumonia. Method(s): A cohort of 802 patients from our post-COVID multidisciplinary unit treated at least 30 days after being discharged from hospital was analyzed. Patients were divided into three groups: group 1 (admission to the Intensive Care Unit or Intermediate Respiratory Care Unit), group 2 (admission to conventional hospitalization), and group 3 (outpatient management without hospitalization). Symptoms, quality of life, daily physical activity, emotional state, biomarkers of systemic inflammation and KL-6 levels were evaluated. Result(s): A total of 802 patients with a median (interquartile range) age 59 (48-70 years) at diagnosis were reviewed, of whom 439 (54.8%) were women. Dyspnea was reported by 351 (66.%) patients and 142 (36.4%) had a grade more than 2 on the mMRC scale. Likewise, 106 (20.1%) presented dry cough and 233 (44.5%) asthenia. There were significant differences between groups 2 and 3 in: dyspnea (p=0.04), myalgia (p=0.04) and asthenia (p=0.01). Group 1 had a higher score in the TTO and VAS rates of the EuroQuoL scale compared to group 2. Finally, the KL6 levels in groups 1, 2 and 3 were: 381.50 (304 - 511.75) U/ml, 372 (249 - 483) U/ml and 298 (231.5 - 398) U/ml, respectively. Statistically significant differences were observed between the 3 groups (p=0.001) and in the post-hoc analysis, lower levels of KL-6 were observed in group 3 compared to the other two groups. Conclusion(s): There is evidence to affirm that KL6 levels in post-COVID patients are related to the severity of the acute episode.
ABSTRACT
Background and objective: Biologic therapies are known to reduce exacerbations and improve severe uncontrolled asthma management. The at-home administration of biologics has increased during the COVID-19 pandemic, but the characteristics of severe uncontrolled asthma patients who may benefit from at-home administration of biologic therapy have yet to be identified. Material(s) and Method(s): This project is based on the Delphi method, designed to reach an expert consensus through a multidisciplinary scientific committee addressing the following questions: clinical characteristics, treatment adherence, patient or caregiver administration ability, patient self-care, relationship with the healthcare professional, patient preference, and access to the hospital. Result(s): One hundred and thirty-one healthcare professionals (pulmonologists, allergists, nurses, and hospital pharmacists) completed two Delphi consensus questionnaires. Fourteen items were identified as priority characteristics, the first five being: 1. The patient follows the healthcare team's indications/recommendations to control their disease, 2. The patient is capable of detecting any deterioration in their disease and of identifying exacerbation triggers, 3. The patient receives biologic therapy and has stable disease with no vital risk, 4. The patient takes responsibility for their self-care, 5. The patient has occupational/educational obligations that prevent them from going to the hospital regularly. Conclusion(s): Disease stability and control plus the ability to identify exacerbation triggers are the most important characteristics when opting for at-home administration for a patient with severe uncontrolled asthma on biologic therapy. These recommendations could be applicable in clinical practice.Copyright © 2022
ABSTRACT
The suspension of face-to-face classes due to the Covid-19 pandemic may represent a before and after for education in ge-neral. Some authors have called distance classes "the great experiment” because nobody knew what would happen when the entire formal education system in the world had to resort to technology to avoid collapsing. This qualitative study presents the results of ten semi-structured interviews conducted with English teachers at the higher education level in the northeastern region of the state of Puebla in Mexico. The information collected was analyzed with the support of the Atlas Ti software for qualitative data. The objective of this study was to investigate the perceptions that English teachers have regarding their process of adapting to non-face-to-face classes during the Covid-19 pandemic. The teachers report that they experienced difficulties related to schedules, technological infrastructure and appropriate methodologies for online English classes and even physical discomfort. However, they consider that despite the difficulties, this situation has also represented growth for them as English teachers. © 2023, University of Cienfuegos, Carlos Rafael Rodriguez. All rights reserved.
ABSTRACT
INTRODUCTION: This study analyzed the impact of patients' age, sex, vaccination, immunosuppressive treatment, and previous comorbidities on the risk of developing persistent COVID-19 or SARS-CoV-2 virus reinfection. METHOD: Population-based observational retrospective study of a cohort of 110,726 patients aged 12 years or older, who were diagnosed with COVID-19 between June 1st, 2021 and February 28th, 2022 in the island of Gran Canaria. RESULTS: 340 patients suffered reinfection. The combination of advanced age, female sex and lack of complete or incomplete vaccination against COVID-19 was strongly predictive of reinfection (p<0.05). In the 188 patients who developed persistent COVID-19, the persistence of symptoms was more frequent in adult patients, women, and patients with a diagnosis of asthma. Complete vaccination was associated with a lower risk of reinfection ([OR] 0.05, 95%CI 0.04-0.07; p<0.05) and of developing persistent COVID-19 ([OR] 0.07, 95%CI 0.05-0.10; p<0.05). None of the patients with reinfection or persistent COVID-19 died during the period of the study. CONCLUSIONS: This study confirmed the link between age, sex, asthma and risk of persistent COVID-19. It was not possible to define the patient's comorbidities as a factor that influences the development of reinfection, but its association with age, sex, type of vaccine and hypertension was demonstrated. Higher vaccination coverage was associated with a lower risk of persistent COVID-19 or SARS-CoV-2 reinfection.
Subject(s)
Asthma , COVID-19 , Adult , Humans , Female , SARS-CoV-2 , COVID-19/epidemiology , Spain/epidemiology , Reinfection , Retrospective Studies , Asthma/epidemiologyABSTRACT
We report the results from a 12 month-long study of the organic compounds associated to PM2.5 samples collected around two petroleum refineries (4 samples/month/site) in two complex industrial zones reporting atmospheric pollution issues in the past (Estuary of Huelva and Bay of Algeciras, Spain). Sampling campaign was done from March 2020 when a Covid-19 lockdown was established at Spain to March 2021. Concentrations of fine particulate polycyclic aromatic hydrocarbons (PAHs) and anhydrosugars were separately measured using gas chromatography-mass spectrometry (GC-MS) and ion chromatography-amperometric detection (IC-PAD). The annual average abundances of PM2.5-bound benzo[a]pyrene (BaP) are 0.024 and 0.013 ng˖m−3 at La Rábida and Puente Mayorga monitoring stations, while both sites have annual average concentrations of levoglucosan in PM2.5 of 14.98 and 9.78 ng˖m−3, respectively. Seasonal variations are observed for concentrations of ƩPAHs and total anhydrosugars in both sampling sites. For PAHs, the highest concentrations averaging c. a. 0.400 (La Rábida) and 0.350 ng m−3 (Puente Mayorga) are reported in cold months during December 2020-Febraury 2021 (post-lockdown period), compared to the lowest levels averaging 0.111 and 0.211 ng˖m−3, respectively, in temperate months from mid-March 2020 to early June 2020 (0.284 and 0.321 ng m−3 on average annually), coinciding with the confinement and relaxation periods in Spain. Similarly, total anhydrosugars show the highest values of 81.80 ng˖m−3 (La Rábida) and 53.52 ng˖m−3 (Puente Mayorga) in winter and lowest values of 2.71 ng˖m−3 and 3.30 ng˖m−3 into the lockdown period (22.51 and 14.09 ng˖m−3 on average annually). Except phenanthrene, PAHs are present in PM2.5 principally as result of motor vehicle exhausts. Levoglucosan, a tracer for biomass burning, peaked in December 2020 and January 2021, during the high residential wood-burning season. In addition, multivariate analysis was used to assess the origin of organic components of PM2.5 samples. The two principal components are characterized by the grouping of heavy PAHs associated to vehicular traffic, and anhydrosugars indicating biomass burning emissions, respectively.
ABSTRACT
The example of Cuba in the aspect of prevention, organization of services, control and constant monitoring (with daily public information) of the evolution of the COVID-19 pandemic at the population level is described as outstanding during all the months of battle. Despite the efforts made by the Ministry of Public Health, and the dignified and heroic work of health professionals in coordination with other sectors, as has happened at different times in most countries of the world, in Cuba The most complex period in the fight against the pandemic was experienced in the months of July and August 2021, with a high incidence of the Delta variant, when, in a context marked by insufficient financing and the increase in the international market of the cost of supplies, the country felt the shortage of medicines and other materials necessary for patient care. Describing the experience of Primary Health Care doctors around the tense situation of those moments is the objective of this work.
ABSTRACT
Resumen Antecedentes y objetivo Es bien sabido que las terapias biológicas reducen las exacerbaciones y mejoran el tratamiento del asma grave no controlada. La administración domiciliaria de biológicos ha aumentado durante la pandemia de COVID-19, pero aún no se han identificado las características de los pacientes con asma grave no controlada que pueden beneficiarse de la administración domiciliaria de terapia biológica. Materiales y métodos Este proyecto se basa en la metodología Delphi, diseñada para alcanzar un consenso entre expertos a través de un comité científico multidisciplinar que aborda las siguientes cuestiones: características clínicas, adherencia al tratamiento, capacidad de administración del paciente o cuidador, autocuidado del paciente, relación con el profesional sanitario, preferencias del paciente y acceso al hospital. Resultados Ciento treinta y un profesionales sanitarios (neumólogos, alergólogos, enfermeros y farmacéuticos hospitalarios) cumplimentaron las dos rondas de consenso del cuestionario Delphi. Se identificaron 14 ítems como características prioritarias, siendo los cinco primeros: 1. El paciente sigue las indicaciones/recomendaciones del equipo sanitario para controlar su enfermedad. 2. El paciente es capaz de detectar cualquier deterioro de su enfermedad y de identificar los factores desencadenantes de las exacerbaciones. 3. El paciente recibe tratamiento biológico y tiene una enfermedad estable sin riesgo vital. 4. El paciente se responsabiliza de su autocuidado y 5. el paciente tiene obligaciones laborales/educativas que le impiden acudir al hospital con regularidad. Conclusiones La estabilidad y el control de la enfermedad junto a la capacidad de identificar los factores desencadenantes de las exacerbaciones son las características más importantes a la hora de optar por la administración domiciliaria en un paciente con asma grave no controlada en tratamiento biológico. Estas recomendaciones podrían ser aplicables a la práctica clínica. Background and objective Biologic therapies are known to reduce exacerbations and improve severe uncontrolled asthma management. The at-home administration of biologics has increased during the COVID-19 pandemic, but the characteristics of severe uncontrolled asthma patients who may benefit from at-home administration of biologic therapy have yet to be identified. Materials and methods This project is based on the Delphi method, designed to reach an expert consensus through a multidisciplinary scientific committee addressing the following questions: clinical characteristics, treatment adherence, patient or caregiver administration ability, patient self-care, relationship with the healthcare professional, patient preference, and access to the hospital. Results One hundred and thirty-one healthcare professionals (pulmonologists, allergists, nurses, and hospital pharmacists) completed two Delphi consensus questionnaires. Fourteen items were identified as priority characteristics, the first five being: 1. The patient follows the healthcare team's indications/recommendations to control their disease, 2. The patient is capable of detecting any deterioration in their disease and of identifying exacerbation triggers, 3. The patient receives biologic therapy and has stable disease with no vital risk, 4. The patient takes responsibility for their self-care, 5. The patient has occupational/educational obligations that prevent them from going to the hospital regularly. Conclusions Disease stability and control plus the ability to identify exacerbation triggers are the most important characteristics when opting for at-home administration for a patient with severe uncontrolled asthma on biologic therapy. These recommendations could be applicable in clinical practice.
ABSTRACT
Society is facing a global pandemic, causing millions of deaths and hundreds of millions of infections. The importance of vaccination to face COVID-19 is decisive in the fight against the virus. However, many people have decided not to get vaccinated, ruining public health policy. The objective of this article is to apply knowledge about behavioral economics in the explanation of the behavior of those who decide not to be vaccinated, as well as the use of decision architecture and nudges for the design of behavioral interventions. The methodology used was qualitative, supported by bibliographic search and content analysis, with theoretical methods such as historical-logical analysis and deductive and hypothetical analysis. Behavioral economics has been used to modify behaviors associated with chronic non communicable diseases, so it can provide a solution to increase the number of people who are inoculated against the virus. The perception of risk and uncertainty, the amount of information and social pressure are identified as factors that influence the decision, as well as various heuristics and cognitive biases. The design of behavioral interventions should employ nudges in the decision architecture, starting from the "simple, attractive, social and timely" methodology as an opportunity to increase the number of people who are vaccinated. Copyright © 2022, Editorial Ciencias Medicas. All rights reserved.
ABSTRACT
OBJECTIVE: To analyze the frequency of influenza and SARS-CoV-2 co-infections, as well as the differences in the course of disease (risk of mortality, hospital and intensive care admissions) in patients infected with the SARS-CoV-2 virus in relation to flu vaccination status in the 2021-2022 season. METHODS: Population-based observational retrospective study in a cohort of 19,850 patients diagnosed with COVID-19 between June 1, 2021 and February 28, 2022 on the island of Gran Canaria. RESULTS: A total of 1,789 patients (9%) diagnosed with COVID-19 had received flu vaccinations. 13,676 people (68.9%) had a full course of COVID-19 vaccinations. In the period between June 1, 2021 and February 28, 2022, 8 cases of flu and COVID-19 coinfection were recorded. Hypertension (18.5%), asthma (12.8%) and diabetes (7.2%) were the most frequent comorbidities. There were 147 deaths (0.7%). Older patients ([OR] 1.11 95% CI 1.09-1.13) and people with cancer ([OR] 4.21 95% CI 2.58-6.89) had a higher risk of dying from COVID-19 (p<0.05). Female sex was noted as a protective factor ([OR] 0.61 95% CI 0.40-0.92). CONCLUSIONS: Old age, male sex and cancer were independent prognostic factors for mortality. Three doses of SARS-CoV-2 vaccines and influenza vaccines were highly effective in preventing COVID-19-related deaths and hospital admissions. These findings suggest that flu vaccination can help control the pandemic.