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BACKGROUND: High flow oxygen therapy (HFO) is a widely used intervention for pulmonary complications. Amid the coronavirus infectious disease 2019 (COVID-19) pandemic, HFO became a popular alternative to conventional oxygen supplementation therapies. Risk stratification tools have been repurposed -and new ones developed- to estimate outcome risks among COVID-19 patients. This study aims to provide a simple risk stratification system to predict invasive mechanical ventilation (IMV) or death among COVID-19 inpatients on HFO. METHODS: Among 529 adult inpatients with COVID-19 pneumonia, we selected unadjusted clinical risk factors for developing the composite endpoint of IMV or death. The risk for the primary outcome by each category was estimated using a Cox proportional hazards model. Bootstrapping was used to validate the results. RESULTS: Age above 62, eGFR under 60 ml/min, room air SpO2 ≤89 % upon admission, history of hypertension, history of diabetes, and any comorbidity (cancer, cardiovascular disease, COPD/ asthma, hypothyroidism, or autoimmune disease) were considered for the score. Each of the six criteria scored 1 point. The score was further simplified into 4 categories: 1) 0 criteria, 2) 1 criterion, 3) 2-3 criteria, and 4) ≥4 criteria. Taking the first category as the reference, risk estimates for the primary endpoint were HR; 2.94 [1.67 - 5.26], 4.08 [2.63 - 7.05], and 6.63 [3.74 - 11.77], respectively. In ROC analysis, the AUC for the model was 0.72. CONCLUSIONS: Our score uses simple criteria to estimate the risk for IMV or death among COVID-19 inpatients with HFO. Higher category reflects consistent increases in risk for the endpoint.
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Background. Severe COVID-19 elicits a hyperimmune response frequently amenable by high-dose steroids, although treatment may increase the risk for opportunistic infections. Invasive pulmonary aspergillosis (IPA) is a known complication of COVID-19, termed COVID-19 associated pulmonary aspergillosis (CAPA).While steroid use is a known risk factor for CAPA, the role of cumulative steroid dose in the development of CAPA is unclear. This study evaluates the relationship between cumulative steroid dose in hospitalized individuals and the risk for CAPA. Methods. This retrospective cohort study includes 130 hospitalized patients with RT-PCR-confirmed COVID-19 pneumonia at a specialized center in north Mexico. Patients who developed CAPA were matched by age and gender to two patients who did not develop CAPA. CAPA was defined according to 2020 ECMM/ISHAM criteria. Patients with either possible, probable, or proven CAPA were considered positive cases. Steroid dose was converted to dexamethasone equivalents according to potency and duration. Cumulative dose was obtained in every patient from admission until discharge or diagnosis of CAPA. We assessed the risk of CAPA by the continuous cumulative steroid dose using a logistic regression model. Results. A total of 42 patients were diagnosed with possible, probable, or confirmed CAPA and were matched to 88 controls. Mean age was 61 +/- 14 years, 94 (72%) were male, 11 (12%) were smokers, and 55 (50%) were obese. Mean cumulative steroid dose was 66 +/- 75 in patients without CAPA vs 195 +/- 226 in patients with CAPA (P< 0.001) (Figure Panel A). The risk for CAPA was higher as the cumulative dose of steroids increased, in a near-linear relationship (OR 1.008;95% CI 1.003, 1.013, P< 0.001) (Figure Panel B). Conclusion. Patients who develop CAPA have a history of higher cumulative steroid dose during hospitalization. The risk for CAPA increases in a near-linear fashion as the cumulative steroid dose during hospitalization increases. While causality cannot be drawn by this study, caution while prescribing high-dose steroids is warranted among individuals hospitalized with COVID-19 pneumonia. Clinical suspicion of CAPA should increase in individuals with a high cumulative dose of steroids and clinical decline.
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Introduction: The COVID-19 pandemic is considered to be the greatest healthcare challenge that has occurred in the world. Prevention and treatment services for chronic noncommunicable diseases have been severely affected. Objective: To identify the impact of the COVID-19 pandemic on the admission and clinical evolution of patients with cardiovascular pathologies treated in the Coronary Intensive Care Unit of the "Enrique Cabrera Cossío" General Teaching Hospital. Methods: A cross-sectional observational study was carried out. The universe consisted of all patients included in the unit's database (1360);the sample consisted of 213 and 159 patients attended six months prior to the pandemic (September 1 to February 28) and six months after its onset (March 1 to August 31), respectively;regardless of diagnosis. The results of the two periods were compared in terms of the following variables: number of admissions, clinical-epidemiological characteristics, clinical diagnosis on admission, and diagnosis on admission of the deceased. Results: We found a decrease in the number of admissions during the pandemic period of more cases, in the age group between 60 and 79 years. Mortality increased by 40.3%. Admissions for acute myocardial infarction increased (48.8%) and decreased for heart failure (70%) after the onset of the pandemic (p < 0.05);deaths due to acute myocardial infarction doubled and those caused by heart failure were reduced to zero in this same period. Conclusions: The COVID-19 pandemic has had a significant impact on the admission and clinical evolution of patients with cardiovascular pathologies. © 2022, Cuban Society of Cardiology, Cuban Institute of Cardiology and Cardiovascular Surgery. All rights reserved.
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We present a classroom exercise carried out in the field of teacher training during the first period of blended teaching after the outbreak of the covid-19 pandemic in 2020. Students had to identify their emotions and find a metaphor for them through a pictorial work. After that, a virtual expression framework was created in which all the information is uploaded and compiled, linking the concept to the image, as a group therapy. The objective was to work on resilience as an emotional state allowing to face the well-being of the group. The results show four emotional categories present among the students, being predominant the evocative or nostalgic one. Impressionism, due to its characteristics, becomes the artistic style that mostly reflects the different students' feelings. This exercise has allowed to create a space for emotional expression of the group- which offers an extraordinary setting to foster resilient attitudes. © Arteterapia.All rights reserved.
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Introduction: The clinico-epidemiological characteristics in the diagnosis, evolution and treatment of patients with acute myocardial infarction in the COVID-19 era depend on several factors. Objectives: To determine the behavior of some clinico-epidemiological variables in the management of patients with acute myocardial infarction during de COVID-19 pandemic. Methods: An observational study was carried out in four secondary care hospitals in Cuba. The following variables were used: number of admission due to acute myocardial infarction, hospital mortality, delay longer than four hours from the beginning of the symptoms to the arrival to the first medical assistance, and thrombolysis percentage. Two groups were defined, those admitted from March 1st to September 30th, 2019 ( Group I) and those admitted in the same period, but from 2020 ( Group II). Comparisons between both groups were made using the chi square test. Results: There was a decrease of 53 admissions due to acute myocardial infarction in Las Tunas ( 112 vs. 159;p<0.05), with an increase in the number of admissions in the Hospital Enrique Cabrera in patients from Group II ( 98 vs. 68;p<0.05). The number of deaths and hospital mortality in Group II increased in all the centers in relation to Group I. In most of the hospitals there was an increase of the time elapsed from the beginning of the symptoms to the arrival to the first medical assistance. Thrombolysis percentage in Group II was higher than 50% in most of the centers. Conclusions: The characteristics of COVID-19 may modify the clinical and epidemiological aspects in the management of patients with acute myocardial infarction.
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This article discusses issues around the communication of preventive health messages related to COVID-19 to indigenous language-speaking communities in Ecuador, Peru and Bolivia. Official communication is primarily in Spanish, and the many translation initiatives that have arisen do not always succeed in getting the message across due to the lack of cultural interpretation that needs to accompany the linguistic message. This situation compounds the vulnerability of indigenous peoples in the face of the crisis. © 2020 The Authors. Bulletin of Latin American Research published by John Wiley & Sons Ltd on behalf of Society for Latin American Studies.