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Background and Importance On March 28th 2022, nirmatrelvir/ ritonavir was marketed in Spain. The Spanish Agency for Medicines and Medical Devices (AEMPS) established criteria to prioritise its administration in patients at high risk of progression to severe COVID. Data regarding the effectiveness and safety of nirmatrelvir in preventing severe coronavirus disease outcomes are limited. Aim and Objectives To assess the effectiveness and safety of nirmatrelvir/ritonavir in patients at high risk for severe COVID-19. Material and Methods Prospective descriptive study from April to August 2022 of patients treated with nirmatrelvir/ritonavir. Sociodemographic variables, vaccination status, hospital admission, high risk factors for progression and concomitant treatment were recorded. Readmissions were recorded within 30 days of the end of antiviral treatment. Results 53 patients were included with a mean age of 64 years, 51% women and 49% men. 57% were vaccinated with 3 doses, 17% with 2 doses, 9% with 4 doses, 6% with 1 dose and 11% were not vaccinated. 34% (18/53) were hospitalised at the time of initiation of treatment. The most prevalent high-risk criteria were: 24% active treatment with myelotoxic chemotherapy, 21% treatment in the previous 6 months with anti-CD20 drugs, 14% over 80 years vaccinated with some risk factor for progression, 7% patients with onco-haematological treatment and 7% in treatment in the previous 3 months with inhibitors of the proteinkinase. 3 treatments were performed off-label for persistent covid. The mean number of days from the onset of symptoms to the start of treatment was 1.6 days. 23% of patients required dose adjustment due to renal impairment. 53% required adjustment of chronic treatment for interactions, mainly with metamizole, statins, fentanyl and diazepam. 2 patients received remdesivir and sotrovimab, 2 remdesivir and another two sotrovimab. 4 (7%) patients were readmitted within 30 days after the end of treatment with nirmatrelvir ritonavir, 1 of them with persistent covid. One patient stopped treatment for hives. Conclusion and Relevance Nirmatrelvir ritonavir has been shown to be a safe and effective drug in high-risk patients of progression to severe covid.
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The necessary health measures proposed to mitigate the viral spread of SARS-CoV-2, such as physical distancing and quarantines, have had an impact not only on the mental health of the population but have also forced changes in the provision of psychological services. The present study aims to gather essential information on the concept, advantages, disadvantages, uses and recommendations of telepsychology in times of COVID-19. To this end, a systematic review of the scientific evidence available in the Scopus, PubMed and Web of Science databases was carried out. Among the results, accessibility, reduction of stigma and flexibility in its application are highlighted. Limitations such as insecurity of data privacy, access barriers and low clinical training in the competencies required for this format are also mentioned. On the other hand, favorable evidence was found for its use in the treatment of post-traumatic stress disorder, panic and agoraphobia, generalized anxiety, and trauma. It is concluded that psychotherapeutic intervention through telepsychology, in consideration of certain recommendations and critical suggestions, can offer satisfactory results for the patient and therapist and be suitable for various age ranges and disorders. © 2022, Sociedad Interamericana de Psicologia. All rights reserved.
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The COVID-19 pandemic caused a rapid expansion of telemedicine use in the outpatient setting. Although studies have proposed several workflows for implementing telemedicine visits, most have not considered integrating the traditional role of medical assistants and nurses in virtual office visits. We report the experience of implementing telemedicine visits in a large university-based primary care office in the United States during the pandemic, with particular emphasis on integrating “virtual rooming” into the telemedicine workflow. This chapter describes the implementation of a virtual rooming model, including a discussion on facilitators, challenges, and suggestions for best practices. We examine these issues from the point of view of primary care providers, medical assistants (MAs)/licensed vocational nurses (LVNs), and office administration staff. Since telemedicine is likely here to stay, there is a need to develop, refine, and test effective and efficient workflows to integrate these visits seamlessly into office workflows without compromising the quality of patient care. © 2022 Elsevier Inc. All rights reserved.
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Introduction. Solid organ transplant recipients were excluded from the pivotal clinical trials of COVID-19 vaccines. Therefore, the safety and efficacy data of the different types of available vaccines in this susceptible population is scarce. 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 was performed for OLT patients, and they were included in the regular schedule according to age and place of residency. Controls were otherwise healthy people, mainly family members of patients. All subjects completed the full vaccination schemes, and blood samples were taken after at least 15 days of the complete vaccine doses. The samples were analyzed according to the manufacturer instructions using Liaison XL platform from DiaSorin, LIAISON® SARS-CoV-2 S1/S2 IgG (DiaSorin S.p.A., Italy), and SARS-COV-2 IgG II Quant (COV-2 IgG II) (Abbott Diagnostics, IL, USA). Results. In all, 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 (31.6% had hypertension, 32.6% diabetes, 7% neoplasia, and 23% obesity). By vaccine brands, 50.3% received Pfizer-BioNTech, 13.9% received Oxford-AstraZeneca, 10.7% received Sinovac, 7.0% Cansino;16% Sputnik-V and 2.1% received Moderna. 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 Pfizer-BioNTech, 60% Oxford-AstraZeneca, 76.9% Sinovac, 55.6% Cansino, 68.2% Sputnik-V, and 100% with Moderna. In controls, only Cansino had a 75% humoral response;all other vaccines had a 100% response. In a multivariable model adjusted for relevant confounders, the antecedent of COVID-19 and Pfizer-BioNTech inoculation were associated positively with the serologic response, while the use of prednisone (compared with other immunosuppressants) interfere with this response. Conclusion. The serologic response to COVID-19 vaccines in OLT patients is lower than otherwise healthy controls. In these patients, the Pfizer-BioNTech vaccine was associated with a higher serologic response. Other variables significantly associated with the humoral response were the COVID-19 antecedent (positively) and prednisone exposure (negatively). At the moment, further analysis is necessary to determine whether this serological response is associated with SARS-COV2 infection or reinfection. (Figure Presented)
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Introduction: The recent COVID-19 pandemic has represented the use by health care professionals (HCP) of different personal protective equipment (PPE), resulting in the appearance of skin injuries associated with PPE (PPE-SI). Knowing the epidemiology, characteristics and factors related to the use of different types of PPE and the prevention and treatment of PPE-SI can be very useful to understand the scope of the problem and to define strategies for its prevention and treatment in possible future pandemics. Methods: To this end, the GNEAUPP proposed the performance of a cross-sectional study, in the geographical area of the Spanish state, by means of a self-administered survey using a Google forms questionnaire. The study universe was HCP, from any discipline and from any level of care or type of institution with patients who have been in contact with COVID-19 patients or COVID-19 suspects and have used PPE during the first wave of the COVID-19 pandemic in Spain. Main results: We obtained 2078 questionnaires, 75.5% from nurses, 10.79% from nurse aids, and 6.6% from physicians. Of these, 84.7% were women and 15.3% were men with an average age of 43.7 years. In 18.2% of the cases the institution of the professional had a protocol for the prevention of PPE-SI, in 10.2% the professional did not know if it existed or not and in the remaining 71.3% the institution did not have such a protocol. 29.9% of the professionals always used some prevention product and 25.3% sometimes. 52.4% of respondents reported having submitted at least one PPE-SI, of which 39% had submitted one, 35.8% two, 14.3% three, 2.2% four and 8.6% more than four. In relation to PPE-SI, 74.3% were defined as pressure injuries (PI), 11% were friction injuries (FI), 8.5% were combined or multicausal injuries (CMCI) and 6.1% were skin injuries associated with moisture (MASI). The mean duration of incident injuries was 11.6 days (9.7 days for PI, 10.2 days for FI, 19.9 days for CMCI and 19.4 days for MASI). More detailed Information is presented in the paper by type of device causing, typology and severity of injuries per device as well as preventive measures used.
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Introduction: The recent COVID-19 pandemic has represented the use by health care professionals (HCP) of different personal protective equipment (PPE), resulting in the appearance of skin injuries associated with PPE (PPE-SI). Knowing the epidemiology, characteristics and factors related to the use of different types of PPE and the prevention and treatment of PPE-SI can be very useful to understand the scope of the problem and to define strategies for its prevention and treatment in possible future pandemics. Methods: To this end, the GNEAUPP proposed the performance of a cross-sectional study, in the geographical area of the Spanish state, by means of a self-administered survey using a Google forms questionnaire. The study universe was HCP, from any discipline and from any level of care or type of institution with patients who have been in contact with COVID-19 patients or COVID-19 suspects and have used PPE during the first wave of the COVID-19 pandemic in Spain. Main results: We obtained 2078 questionnaires, 75.5% from nurses, 10.79% from nurse aids, and 6.6% from physicians. Of these, 84.7% were women and 15.3% were men with an average age of 43.7 years. In 18.2% of the cases the institution of the professional had a protocol for the prevention of PPE-SI, in 10.2% the professional did not know if it existed or not and in the remaining 71.3% the institution did not have such a protocol. 29.9% of the professionals always used some prevention product and 25.3% sometimes. 52.4% of respondents reported having submitted at least one PPE-SI, of which 39% had submitted one, 35.8% two, 14.3% three, 2.2% four and 8.6% more than four. In relation to PPE-SI, 74.3% were defined as pressure injuries (PI), 11% were friction injuries (FI), 8.5% were combined or multicausal injuries (CMCI) and 6.1% were skin injuries associated with moisture (MASI). The mean duration of incident injuries was 11.6 days (9.7 days for PI, 10.2 days for FI, 19.9 days for CMCI and 19.4 days for MASI). More detailed Information is presented in the paper by type of device causing, typology and severity of injuries per device as well as preventive measures used.
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Shortages of personal protective equipment (PPE) during the COVID-19 pandemic presents challenges within laboratory animal facilities. The FDA and CDC provided guidance on PPE conservation and surgical mask reuse, however little scientific guidance exists on appropriate methods for achieving safe reuse. Similarly, the AVMA advocated the critical role veterinarians play in PPE conservation and collaborations were encouraged to share best practices on reusing disposable masks and determining viability of cloth masks as an acceptable substitute. To address these concerns, we sought to identify if our current disposable surgical masks are usable after general wear and resterilization through a standard autoclave cycle. Additionally, we sought to determine if cloth masks are suitable as an alternative to surgical masks during aseptic procedures. All mask types showed an immediate reduction in oropharyngeal bacterial secretions of the wearer compared to no mask (surgical 0.4 +/- 0.36 SEM;P < 0.0001;autoclaved 0, +/- 0 SEM, P < 0.0001;cloth 0, +/- 0 SEM, P < 0.0001;no mask 7.2+/- 2.37 SEM). No significance was identified between mask type (P = 0.92). These results supported modifications to our standard operating procedures to allow cloth masks during aseptic procedures resulting in conservation of critical PPE while simultaneously maintaining standard of care.