ECMO in acute fulminant myocarditis in pediatrics

Objectives: To describe our experience in ECMO for acute myocarditis Methods: Descriptive, retrospective study (2018-2022) of a cohort of 8 patients < 16 years with acute myocarditis who were assisted on ECMO. Result(s): 8 patients were collected, (6 females), with a mean age 7;8 years [range 0;1-13;8]. In 7/8, the reason for cannulation was hemodynamic instability refractory to medical treatment, with a mean inotropic score of 70 [range 10-122]. Sixty-two percent presented cardiorespiratory arrest prior to cannulation and 2 of them needed ECRP. The mean precannulation troponin level was 1498 ng/ml [range 89-6212]. Primary transport was performed in 4 patients. ECMO was peripheral veno-arterial in 100%, jugulo-carotid in 2/8 and femoro-femoral in 6/8. All patients underwent atrioseptostomy. They received treatment with levosimendan, immunoglobulins, corticoids and carnitine. In 4 acute infectious etiology was confirmed (parvovirus, influenza and SARSCoV2), another one was due to PIMS-TS and in 3 no etiology was found. Six patients underwent myocardial biopsy and 5 of them showed inflammatory infiltrates. The mean time on ECMO was 8 days [range 3-14], 2 of them requiring 2 ECMO courses. The mean length of PICU stay was 21 days [range 10-50]. Two were transferred to a heart transplant center. The main complications were arterial hypertension (88%), bleeding (63%), neurological (50%), arrhythmias (38%), coagulopathy (38%) and infectious (38%). One patient required renal replacement therapy. 1 patient died, 2 had moderate neurological sequels. Conclusion(s): ECMO is a therapeutic option in patients with fulminant myocarditis refractory to medical treatment and may help improve their prognosis.

ECMO for the immunocompromised pediatric patient: Our experience

Objectives: To present a series of immunosuppressed patients (oncohematological disease, congenital immunosuppression, hematopoietic stem cell (HSCT), and solid organ transplant) assisted on ECMO. Method(s): Descriptive, retrospective study (2011-2020) of a cohort of 9 immunosuppressed patients, supported on ECMO. Medical records were reviewed and demographic, clinical, and analytical variables were collected. Result(s): In our series of 9 patients, 5 were male, the median age was 8 years [RIC 3-11 years]. Considering the underlying disease, 6 were oncologic, 1 liver transplant and 2 with congenital immunodeficiency after HSCT. 4 were under active chemotherapy (median 6 days after the last cycle [RIC 5-188]). 6 were admitted due to acute respiratory failure, 3 due to hemodynamic instability (3/9), (one septic shock). The median PEEP was 12 [RIC 9-15] and FiO2 100% (81-100%). 78% (6) required vasoactive drugs (median inotropic score 35 [RIC 0-75]. 40%. 5 had severe neutropenia and/or plateletopenia in the 24 hours prior to ECMO, and alterations in acid-base balance (median pH 7. 1 [RIC 6.9-7.15]. 5 were on multiorgan failure. TPrimary ECMO transport was performed in 4 patients (44%). Cannulation was peripheral in 80% (57% cervical, 43% femoral) and central in 20%;70% VA-ECMO. Median time of assistance was 15 days [RIC 3.5-31.5] in cardiac ECMO (4), and 29 days [RIC 13.5-42] and in pulmonary ECMO (n=5). The median total time of admission was 45 days [RIC 27-59]. 9 had an infection, 2 COVID after HSCT, and 8 bleeding complications, but only one required surgical revision. Renal replacement therapy was used in 5 (median 9 days [RIC 5-34.5]). Other therapies used were polymyxin hemadsorption(2), intratracheal surfactant(2), plasma exchange(1), infusion of mesenchymal cells(1) and specific memory T lymphocytes(2). 4 patients died, 5 survived decannulation, 2 died later, with an overall survival rate to hospital discharge of 33% (3/9). Conclusion(s): Despite having a worse prognosis, ECMO can increase survival in immunosuppressed patients, in situations that are challenging and require a multidisciplinary approach.

Social Connection in Older Age

While social isolation and loneliness affect individuals of all ages and backgrounds, older adults can be affected disproportionately, and are much more likely to suffer from health complications and related healthcare expenses. The COVID-19 pandemic has highlighted and heightened the severity of social isolation and loneliness, especially for people aging at home, in long-term care facilities, and in nursing homes. This article explores meaningful interventions for older adults, including some that look outside the traditional healthcare sector and in the technology, housing, transportation, and nutrition fields. Copyright 2022 American Society on Aging;all rights reserved.

[Impact of days elapsed from the onset of symptoms to hospitalization in COVID-19 in-hospital mortality: Time matters]. / Impacto de los días transcurridos desde el inicio de los síntomas hasta la hospitalización en la mortalidad hospitalaria por COVID-19: el tiempo importa.

Background: COVID-19 shows different clinical and pathophysiological stages over time. Theeffect of days elapsed from the onset of symptoms (DEOS) to hospitalization on COVID-19prognostic factors remains uncertain. We analyzed the impact on mortality of DEOS to hospital-ization and how other independent prognostic factors perform when taking this time elapsedinto account. Methods: This retrospective, nationwide cohort study, included patients with confirmed COVID-19 from February 20th and May 6th, 2020. The data was collected in a standardized online datacapture registry. Univariate and multivariate COX-regression were performed in the generalcohort and the final multivariate model was subjected to a sensitivity analysis in an earlypresenting (EP; < 5 DEOS) and late presenting (LP; ≥5 DEOS) group. Results: 7915 COVID-19 patients were included in the analysis, 2324 in the EP and 5591 in theLP group. DEOS to hospitalization was an independent prognostic factor of in-hospital mortalityin the multivariate Cox regression model along with other 9 variables. Each DEOS incrementaccounted for a 4.3% mortality risk reduction (HR 0.957; 95% CI 0.93---0.98). Regarding variationsin other mortality predictors in the sensitivity analysis, the Charlson Comorbidity Index onlyremained significant in the EP group while D-dimer only remained significant in the LP group. Conclusion: When caring for COVID-19 patients, DEOS to hospitalization should be consideredas their need for early hospitalization confers a higher risk of mortality. Different prognosticfactors vary over time and should be studied within a fixed timeframe of the disease.

Quality of life of coffee growers in the high mountains of Veracruz, Mexico

Introduction. The High Mountain Region (RHM) is the most productive and socioeconomic region for the coffee cultivation in the state of Veracruz, Mexico, and one of the most representative of the sector at the national level. Objective. To determine the quality of life (QL) from the objective and subjective point of view of the small coffee producers (SP) in RHM, Mexico. Materials and methods. One hundred and fifty semi-structured interviews were applied to producers in eleven municipalities located in: Comapa, Coscomatepec, Huatusco, Ixhuatlan del cafe, Sochiapa, Tenampa, Tomatlan, Totutla, Tlaltetela, Tlacotepec, and Zentla, during 2020. Descriptive statistics and trend measurements were obtained. Results. At objective level the QL was found to be low, but at the farmers' subjective level, it was determined to be acceptable. In the objective assessment, it was identified that the SP have minimal education (primary), the income is not adequate (they require activities outside the farm with an average net annual income of US $ 416 to US $ 1115), the cost of health has increased (due to the COVID-19 pandemic), and proper nutrition is lacking (19 to 25 meals per month). In the subjective assessment there is insecurity and distrust with the government authorities, however, the producers have adapted to living in adverse socioeconomic contexts, since they value community life, intra-family relationships and their environment (coffee growing), which could be influenced by their own worldview. Conclusion. With or without knowledge of the concept of quality, producers have developed a learned or acquired capacity, both individually and collectively to adapt to the environment. Objectively, the quality of life is considered low, however, the interviewees had a perception of satisfaction both individually and collectively.

Impacto de los días transcurridos desde el inicio de los síntomas hasta la hospitalización en la mortalidad hospitalaria por COVID-19: el tiempo importa Impact of days elapsed from the onset of symptoms to hospitalization in COVID-19 in-hospital mortality: Time matters

Antecedentes La COVID-19 muestra diferentes fases clínicas y fisiopatológicas a lo largo del tiempo. El efecto de los días transcurridos desde el comienzo de los síntomas (DTCS) hasta la hospitalización sobre los factores pronósticos de la COVID-19 sigue siendo incierto. Analizamos el impacto en la mortalidad de los DTCS hasta la hospitalización y cómo se comportan otros factores pronósticos independientes al tener en cuenta dicho tiempo transcurrido. Métodos En este estudio de cohortes nacional retrospectivo se incluyó a pacientes con COVID-19 confirmada entre el 20 de febrero y el 6 de mayo de 2020. Los datos se recopilaron en un registro normalizado de captura de datos en línea. Se realizó una regresión de Cox uni y multifactorial en la cohorte general y el modelo multifactorial final se sometió a un análisis de sensibilidad en un grupo de presentación precoz (PP) < 5 DTCS y otro de presentación tardía (PT) ≥ 5 DTCS). Resultados En el análisis se incluyó a 7.915 pacientes con COVID-19, 2.324 en el grupo de PP y 5.591 en el de PT. Los DTCS hasta la hospitalización fueron un factor pronóstico independiente de mortalidad intrahospitalaria en el modelo de regresión de Cox multifactorial junto con otras nueve variables. Cada incremento en un DTCS supuso una reducción del riesgo de mortalidad del 4,3% (RRI = 0,957;IC 95%, 0,93-0,98). En cuanto a las variaciones de otros factores predictivos de la mortalidad en el análisis de sensibilidad, únicamente el índice de comorbilidad de Charlson siguió siendo significativo en el grupo de PP, mientras que únicamente el dímero D lo siguió siendo en el grupo de PT. Conclusiones Al atender a pacientes con COVID-19 hay que tener en cuenta los DTCS hasta la hospitalización porque la necesidad de hospitalización precoz confiere un mayor riesgo de mortalidad. Los diferentes factores pronósticos varían con el tiempo y deberían estudiarse dentro de un marco temporal fijo de la enfermedad.

Effect of the COVID-19 pandemic on the mental health, daily and occupational activities among health professionals in Colombia: A cross-sectional study

Background: The COVID-19 pandemic has placed an unprecedented physical and mental burden on healthcare workers who are frequently at high risk of infection, particularly in low-income countries. Particularly, allergists who are frequently exposed to the airway and respiratory diseases. This study aimed to assess the prevalence and associated factors of anxiety, depression, and stress, as well as changes in daily and occupational activities among healthcare professionals due to the COVID-19 pandemic in Colombia. Method(s): An observational, cross-sectional study was conducted between February and June 2021. The survey incorporated validated mental health tools such as the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Perceived Stress Scale-10. Multivariable ordinal logistic regression analysis was performed to determine the factors associated with severe mental health outcomes. Result(s): Among 1345 healthcare workers the prevalence of anxiety, depression, and stress were 75.61%, 59.18%, and 53.09%, respectively. Anxiety (OR:1.44;95%CI:1.16-1.8), depression (OR:1.74;95%CI:1.27-2.37), and stress (OR:1.51;95%CI:1.18-1.94) were more frequent in women, and individuals who expressed fear of a negative outcome (death, sequelae) (OR:2.25;95%CI:1.60-3.25), (OR:1.49;95%CI:1.03-2.16) and (OR:2.36;95%CI:1.69-3.29) respectively. Allergists were morelikely to report symptoms of anxiety (76.47%), depression(43.14%), and stress (49.02%). Age was negatively associated with anxiety (OR:0.98;95%CI:0.98-0.99), stress (OR:0.98;95%CI:0.97-0.99), and depression (OR:0.97;95% CI:0.96-0.98). Reduction in consultations and surgeries (OR:1.01;95%CI:1.0-1.01) was positively associated with anxiety. Due to the pandemic, most specialists expected to incorporate drastic long-term (>1 year) changes in their clinical setting and daily activities. Conclusion(s): The prevalence of anxiety, depression, and stress is higher among Colombian healthcare workers compared to previous reports. Further research regarding these psychological outcomes is needed to achieve early mental health intervention strategies.

Criminal law, ageism and dependency. Are the events that occurred in nursing homes during the COVID-19 pandemic punishable?

The present work aims to provide the necessary theoretical support to determine whether it is possible to subsume some of the events that occurred in nursing homes during the first wave of the COVID-19 pandemic under the criminal types of reckless homicide and refusal to provide health care. This will be done through an analysis of the data that today can be considered less controversial and taking into account the few pronouncements made in this regard by the court decisions that have been issued so far on said events. Naturally, the objective is not to advocate for the initiation of prospective proceedings but, rather, to elucidate whether there is sufficient evidence to defend the posture that some of those events may have been criminal in nature. © 2022 Authors. All rights reserved.

Building the new client experience in a post COVID world

This article offers some advice on how veterinary practices can effectively use mobile apps and digital technology to improve the client experience.

Drug use in pandemic times: reflections on mental health impacts

A new type of coronavirus, causing an infectious disease called COVID-19, with a high rate of transmissibility has spread around the world. The population was told to stay in their homes, in social isolation, so as not to act as vectors of virus transmission to more vulnerable individuals. The pandemic of the new coronavirus has brought social, economic, and psychological effects all over the world. Although these are necessary measures, the impacts of social isolation on the mental health of the population must be taken into consideration. This study aims to reflect on the effects of quarantine and the increase of addictive behaviors in this period of pandemic, bringing the implications of these for the mental and physical health of the population. This is a narrative review of articles, reports and book chapters published since the beginning of the pandemic, the main databases being Medline, Scielo and Scopus Elsevier. The findings point out that quarantine, has negatively impacted both the mental and physical health of the population, triggering psychological symptoms, such as anxiety, depression and addictive behavior, in addition, can arouse feelings such as sadness and anger, and may be punctual or extend after the end of isolation. However, there are strategies that, when adopted together, can minimize the psychological effects of isolation and make this moment less unhealthy. In this sense, this study highlights the importance of offering interdisciplinary treatments and effective public health strategies in public health systems, so that they can meet the needs of the population by providing comprehensive care and treatment, and by considering short, medium, and long-term actions to prevent addictive behaviors.

Wine, Tourism and COVID-19: The Impact of COVID-19 on the Wine Routes of Spain

Several studies have addressed the role played by the Spanish Wine Routes in boosting the competitiveness of a territory, increasing wine production, improving the quality of life of citizens and respecting the environment. However, to our knowledge, the impact of COVID-19 on these wine routes has not been addressed in the academic literature. In order to overcome this research gap, this paper aims to analyse the impact of the pathogen on the supply and demand of tourist activities by analysing the evolution of the institution members of the Spanish wine routes and the economic impact of the 32 routes that make up this tourist product. © PASOS. Revista de Turismo y Patrimonio Cultural.

Prone positioning in COVID-19 patients with acute respiratory distress syndrome and invasive mechanical ventilation Decúbito prono en pacientes COVID-19 con síndrome de distrés respiratorio agudo y ventilación mecánica invasiva

Objective To identify adverse events related to prone positioning in COVID-19 patients with severe disease and acute respiratory distress syndrome, to analyze the risk factors associated with the development of anterior pressure ulcers, to determine whether the recommendation of prone positioning is associated with improved clinical outcomes. Methods Retrospective study performed in 63 consecutive patients with COVID-19 pneumonia admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning between March and April 2020. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. Results A total of 139 proning cycles were performed. The mean number of cycles were 2 [1–3] and the mean duration per cycle was of 22 h [15–24]. The prevalence of adverse events this population was 84.9 %, being the physiologic ones (i.e., hypo/hypertension) the most prevalent. 29 out of 63 patients (46%) developed prone-related pressure ulcers. The risk factors for prone-related pressure ulcers were older age, hypertension, levels of pre-albumin <21 mg/dl, the number of proning cycles and severe disease. We observed a significant increase in the PaO2/FiO2 at different time points during the prone positioning, and a significant decrease after it. Conclusions There is a high incidence of adverse events due to PD, with the physiological type being the most frequent. The identification of the main risk factors for the development of prone-related pressure ulcers will help to prevent the occurrence of these lesions during the prone positioning. Prone positioning offered an improvement in the oxygenation in these patients.

Healthcare Built Environment and Telemedicine Practice for Social and Environmental Sustainability

The practice of telemedicine started at the beginning of the 20th century but has never been widely implemented, even though it is significantly sustainable compared to traveling to healthcare However, the ongoing COVID-19 pandemic pushed organisations and patients to accept this technology. During the pandemic, telemedicine consultations took place in ad hoc environments without much preparation and planning. As a result, there is a knowledge gap in the field between telemedicine's clinical care services and healthcare built environment, in terms of design. This research focused on addressing the quality of service and experience of telemedicine in primary healthcare settings and how this could be influenced by the digital infrastructure. Our aim was to understand the correlations between telemedicine and healthcare built environment and whether the latter could have a significant impact on telemedicine practice. The methodology included interviews with professionals involved in healthcare planning, architecture and ethnography, and end user research involving telemedicine sessions. The interviews highlighted that professionals involved in the design of healthcare environments demonstrated limited consideration of telemedicine environments. Yet, the ethnographic, end-user research identified areas where the telemedicine environment could affect user experience and should be taken into consideration in the design of such spaces. © 2023 by the authors.

Impact of days elapsed from the onset of symptoms to hospitalization in COVID-19 in-hospital mortality: time matters.

BACKGROUND: COVID-19 shows different clinical and pathophysiological stages over time. The effect of days elapsed from the onset of symptoms (DEOS) to hospitalization on COVID-19 prognostic factors remains uncertain. We analyzed the impact on mortality of DEOS to hospitalization and how other independent prognostic factors perform when taking this time elapsed into account. METHODS: This retrospective, nationwide cohort study, included patients with confirmed COVID-19 from February 20th and May 6th, 2020. The data was collected in a standardized online data capture registry. Univariate and multivariate COX-regression were performed in the general cohort and the final multivariate model was subjected to a sensitivity analysis in an early presenting (EP; <5 DEOS) and late presenting (LP; ≥5 DEOS) group. RESULTS: 7915 COVID-19 patients were included in the analysis, 2324 in the EP and 5591 in the LP group. DEOS to hospitalization was an independent prognostic factor of in-hospital mortality in the multivariate Cox regression model along with other 9 variables. Each DEOS increment accounted for a 4.3% mortality risk reduction (HR 0.957; 95% CI 0.93-0.98). Regarding variations in other mortality predictors in the sensitivity analysis, the Charlson Comorbidity Index only remained significant in the EP group while D-dimer only remained significant in the LP group. CONCLUSION: When caring for COVID-19 patients, DEOS to hospitalization should be considered as their need for early hospitalization confers a higher risk of mortality. Different prognostic factors vary over time and should be studied within a fixed timeframe of the disease.

Prone positioning in COVID-19 patients with acute respiratory distress syndrome and invasive mechanical ventilation.

OBJECTIVE: To identify adverse events related to prone positioning in COVID-19 patients with severe disease and acute respiratory distress syndrome, to analyze the risk factors associated with the development of anterior pressure ulcers, to determine whether the recommendation of prone positioning is associated with improved clinical outcomes. METHODS: Retrospective study performed in 63 consecutive patients with COVID-19 pneumonia admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning between March and April 2020. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. RESULTS: A total of 139 proning cycles were performed. The mean number of cycles were 2 [1-3] and the mean duration per cycle was of 22h [15-24]. The prevalence of adverse events this population was 84.9 %, being the physiologic ones (i.e., hypo/hypertension) the most prevalent. 29 out of 63 patients (46%) developed prone-related pressure ulcers. The risk factors for prone-related pressure ulcers were older age, hypertension, levels of pre-albumin <21mg/dl, the number of proning cycles and severe disease. We observed a significant increase in the PaO2/FiO2 at different time points during the prone positioning, and a significant decrease after it. CONCLUSIONS: There is a high incidence of adverse events due to PD, with the physiological type being the most frequent. The identification of the main risk factors for the development of prone-related pressure ulcers will help to prevent the occurrence of these lesions during the prone positioning. Prone positioning offered an improvement in the oxygenation in these patients.

Wine tourism in Spain: The economic impact derived from visits to wineries and museums on wine routes

Wine and tourism represent a perfect symbiosis, as they offer a different experience to tourists and also promote the economic, social, and environmental development of wine regions. In Spain, wine tourism is an increasingly important research field and several studies have been conducted on the role of wine routes in boosting the competitiveness of a territory, increasing wine production, improving the quality of life of citizens, and respecting the environment. However, to the best of our knowledge, the economic impact generated by these routes in Spain has not been addressed in the academic literature. To overcome this research gap, this paper aims to analyze the supply and demand of tourism activities by examining the evolution of the institutions involved in the Spanish wine routes, on the one hand, and the economic impact of these routes, on the other. The results show a sharp drop in the supply of institutions and the demand for tourist routes in 2020 as a result of COVID-19, with a decrease of 2.58% in the total number of institutions adhered to the wine routes, a decrease of 73.53% in the total number of visitors to the different Wine Routes of Spain and a decrease of 74.7% in the economic impact compared to the previous year. Likewise, the research shows the existence of differences between the Wine Routes of Spain in terms of the number of visitors and their economic impact, which could serve as a guide for managers to make investments through acquisitions and/or their own investments in wineries located on the routes with the greatest economic impact.

A comprehensive call center supporting safe, efficient operations during a pandemic

Research has shown that a comprehensive call center can support a safe, efficient, and quality experience for patients and their families. When a patient receives a cancer diagnosis, the stakes are already high. Add a pandemic to an immunocompromised patient population and fear escalates. In order to accommodate the ever-changing information and ease patients' anxieties surrounding their cancer diagnoses, it is necessary that an institution be available 24/7 to inform, help navigate systems, and manage symptoms because the emergency room, and many times the clinics, have too many inherent risks. MD Anderson expanded the hours of operation for askMDAnderson, a comprehensive call center staffed by operators, health information specialists, registered nurses, and advance practice providers, to cater to all the needs, and to support safe and efficient operations during the pandemic. This highly skilled team serves as a critical information link to patients and their loved ones for all transitions in care needs, such as guidance on food delivery, parking, medication renewals and side effect management. The askMDAnderson staff educates our stakeholders about MD Anderson services, programs, treatments and clinical trials during and after the pandemic until we return to the "new normal." Our employees are available for all levels of "hand holding” and provide a constant flow of timely, factual information. In this case study, you will learn how MD Anderson expanded this newly evolving system and how our team's efforts led to a safer, more efficient, less expensive, and more satisfying care experiences for patients and their families. © The Author(s), 2020.

Our Experience Establishing Food Insecurity Screening in the Pediatric Endocrinology Clinic During the Beginning of the COVID-19 Pandemic

Objectives In 2019, food insecurity was estimated to affect approximately one fifth of the Pittsburgh population. Food insecurity may be linked to other barriers affecting the care of children with chronic health conditions including endocrinopathies. We established a systematic, sustainable method of screening to determine the prevalence of food insecurity in our practice. Methods For 12 months, beginning in May 2020, a written version of the validated questionnaire, The Hunger Vital SignTM (Hager et al), was administered during the patient triage process. The results were documented in the EMR. Patients and families with positive screens met with a social worker and received information about local resources. Screening rates and the frequency of positive screens for food insecurity were reviewed weekly. Results The screening rate was 26% in the first month after implementation;screening increased to 80% by the third month of the project, as the clinic visits transitioned from telemedicine to face-toface (Figure 1). The prevalence of food insecurity in our patient population in this year was 3.5%, which was lower than the reported prevalence in the city of 19.4% in 2018 (Feeding America, 2018) and the projected prevalence for the city, 15.4%, for 2020. Forty-one percent of the patients with food insecurity were attending diabetes clinic and 59% were attending endocrinology clinic. Sixteen percent of the families with food insecurity also reported issues with paying rent/utilities and 14% identified transportation as a barrier to attending medical appointments. Thirteen percent identified negative financial repercussions of COVID-19 such as job loss or reduction of work hours. Approximately 8% identified the patient's medical diagnosis and related dietary requirements as factors contributing to food insecurity. Conclusions Ascertaining food insecurity in our clinic provided a valuable tool to identify and address socioeconomic determinants influencing health. Families appreciated the printed materials and verbal education regarding available local resources. This screening method was sustainable, has been incorporated into EMR, and will continue to support our patients' families. Future studies will increase understanding how food insecurity impacts management of chronic pediatric endocrine conditions.

Interleukin-6 versus ferritin and D-Dimer in the cytokine release syndrome in critically ill Covid-19 patients

Introduction: The lack of a clear definition of cytokine release syndrome (CRS) allowed this study to analyze the utility of interleukin-6 (IL-6), ferritin, and D-dimer (DD) with other variables and their clinical evolution. Methods: A prospective, observational, and analytical study was conducted from October 2020 to July 2021 in 125 patients in the intensive care unit (ICU) of Hospital Obrero Nro. 2 of the Caja Nacional de Salud in Cochabamba, Bolivia. The three markers and other exams were requested to determine correlations, survival, and relationship with CRS. Results: The mean ferritin was 1193.7±814.8 ng/ml, D-dimer 1427±1005 ng/ml, and IL-6 58.5±34.1 pg/mL. No statistical association was found between these markers, but a Spearman's Rho of 0.5 between ferritin and DD (p<0.05) was found in patients who died. In addition, there were associations between male gender and ferritin, DD and dyspnea, and IL-6 and tracheostomy. Survival was 9 days 95% CI (8.02-9.98) with similar values of DD and ferritin for both normal and elevated levels. The values of the area under the curve (AUC) did not show prediction of mortality, but a rate of 70%. Survival was better in those who did not suffer from acute respiratory distress syndrome (ARDS), with eight days (p=0.011). Conclusions: It is not possible to relate CRS to IL-6, DD, and ferritin, or to define it with fever, leukocytosis, renal failure, tracheostomy, due to the heterogeneous values of IL-6 in relation to COVID-19 and other inflammatory pathologies. The position of a hypoinflammatory disease rather than a hypercytokinemia remains in doubt. © 2022 The authors.

Mobile Robots for COVID-19 Pandemic: A State of the Art

This paper aims to show how technology and automation have supported the fight against the covid-19 pandemic and how have contributed to assistance and personal interaction, the state of the art and some of the models that are being used in common applications that have a risk of contact or transmission are presented. Finally, the use of technology in the health area in El Salvador is discussed. © 2022 IEEE.