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COVID-19 causes acute respiratory failure syndrome (SIRA), leading patients to require intubation in the intensive care unit (ICU). A common complication of this ventilatory support is dysphagia, which has a prevalence of up to 30%.This work aims to describe rehabilitation methods in patients with coronavirus infection based on levels of evidence according to the GRADE System, so a systematic review of the literature was carried out. The selected articles were divided into the following subtopics: diagnosis of dysphagia and rehabilitation in COVID patients. The gold standard for the diagnosis of dysphagia is the videofluoroscopic swallowing study (VFS). Fiberoptic Evaluation of Swallowing Assessment (FEES) has high sensitivity and specificity, although they have the disjunction of an aerosol-generating procedure (AGP);however, in a pandemic situation, the study of choice in the literature is VF. Once the diagnosis is made, it is necessary to initiate rehabilitation as soon as possible, even from hospitalization in patients who have hemodynamic stability to prevent long-term effects and promote normal swallowing even before discharge. In patients with COVID-19 infection dysphagia, the risk-benefit of assessment tools and therapy used for diagnosis should be decided to help to maintain social distancing. It becomes imperative to carry out clinical studies with high levels of evidence that allow us to generate Clinical Practice Guides for the benefit of our patients.Copyright © 2021 Sociedad Medica del Hospital General de Mexico. Published by Permanyer.
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INTRODUCTION AND AIM: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged, causing the current pandemic of acute respiratory disease known as COVID-19. Liver injury due to COVID-19 is defined as any liver injury occurring during the course of the disease and treatment of patients with COVID-19, with or without liver disease. The incidence of elevated liver transaminases, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), ranges from 2.5 to 76.3%. The aim of the present study was to describe the hepatic biochemical abnormalities, after a SARS-CoV-2-positive polymerase chain reaction (PCR) test, and the mortality rate in critically ill patients. MATERIALS AND METHODS: A retrospective study was conducted that included 70 patients seen at a private hospital in Mexico City, within the time frame of February-December 2021. Median patient age was 44.5 years (range: 37-57.2) and 43 (61.4%) of the patients were men. Liver function tests were performed on the patients at hospital admission. RESULTS: Gamma glutamyl transferase (GGT) levels were elevated (pâ¯=â¯0.032), as were those of AST (pâ¯=â¯0.011) and ALT (pâ¯=â¯0.021). The patients were stratified into age groups: 18-35, 36-50, and > 50 years of age. The 18 to 35-year-olds had the highest liver enzyme levels and transaminase levels were higher, the younger the patient. Due to the low mortality rate (one patient whose death did not coincide with a hepatic cause), the multivariate analysis showed an R2 association of 0.689, explained by AST, GGT, and C-reactive protein levels. CONCLUSIONS: Despite the increase in transaminases in our study population during the course of COVID-19, there was no increase in mortality. Nevertheless, hospitalized patient progression should be continuously followed.
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Graphical Introduction and aim Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged, causing the current pandemic of acute respiratory disease known as COVID-19. Liver injury due to COVID-19 is defined as any liver injury occurring during the course of the disease and treatment of patients with COVID-19, with or without liver disease. The incidence of elevated liver transaminases, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), ranges from 2.5 to 76.3%. The aim of the present study was to describe the hepatic biochemical abnormalities, after a SARS-CoV-2-positive polymerase chain reaction (PCR) test, and the mortality rate in critically ill patients. Materials and methods A retrospective study was conducted that included 70 patients seen at a private hospital in Mexico City, within the time frame of February-December 2021. Median patient age was 44.5 years (range: 37-57.2) and 43 (61.4%) of the patients were men. Liver function tests were performed on the patients at hospital admission. Results Gamma glutamyl transferase (GGT) levels were elevated (p = 0.032), as were those of AST (p = 0.011) and ALT (p = 0.021). The patients were stratified into age groups: 18-35, 36-50, and > 50 years of age. The 18 to 35-year-olds had the highest liver enzyme levels and transaminase levels were higher, the younger the patient. Due to the low mortality rate (one patient whose death did not coincide with a hepatic cause), the multivariate analysis showed an R2 association of 0.689, explained by AST, GGT, and C-reactive protein levels. Conclusions Despite the increase in transaminases in our study population during the course of COVID-19, there was no increase in mortality. Nevertheless, hospitalized patient progression should be continuously followed.
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Introducción y objetivo: La pandemia por coronavirus de 2019 (COVID-19), puede causar El síndrome respiratorio agudo grave (SARS-CoV-2) emergió, causando la pandemia actual de enfermedad respiratoria aguda llamada COVID-19. La lesión hepática por COVID-19 se define como cualquier daño hepático que ocurra durante el curso de la enfermedad y el tratamiento de pacientes con COVID-19, con o sin enfermedad hepática. La incidencia de transaminasas hepáticas elevadas, ALT (alanina aminotransferasa) y AST (aspartato aminotransferasa), va de 2.5% a 76.3%. El objetivo del estudio fue describir las anormalidades bioquímicas hepáticas posterior a la prueba reacción en cadena de la polimerasa (PCR) positiva para SARS-CoV-2 y mortalidad en el paciente crítico. Material y métodos: Es un estudio retrospectivo, se incluyeron 70 pacientes, la mediana de edad 44.5 (rango 37-57.2), siendo del sexo masculino 43 (61.4%), de un hospital privado de la Ciudad de México, se midieron al ingreso hospitalario las pruebas de función hepática. Período de febrero-diciembre 2021. Resultados: Encontrando elevación de gamma-glutamil transferasa (GGT) p 0.032, aspartato aminotransferasa (AST) p 0.011, alanina-aminotransferasa (ALT) p 0.021, los pacientes se estratificaron en grupo de edad, 18-35, 36-50 y > 50 años. La mayor elevación fue de 18-35 años, entre más joven mayor elevación de transaminasas, debido a la baja mortalidad, 1 paciente, que no coincide con causa hepática, el análisis multivariado explicó una asociación R2.689 p 0.001, explicado por AST, GGT y proteína C reactiva. Conclusiones: A pesar del incremento de transaminasas durante la infección por COVID 19, en nuestra población no aumentó la mortalidad, si bien, debe darse seguimiento continuo durante la evolución hospitalaria.
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INTRODUCTION AND AIM: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged, causing the current pandemic of acute respiratory disease known as COVID-19. Liver injury due to COVID-19 is defined as any liver injury occurring during the course of the disease and treatment of patients with COVID-19, with or without liver disease. The incidence of elevated liver transaminases, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), ranges from 2.5 to 76.3%. The aim of the present study was to describe the hepatic biochemical abnormalities, after a SARS-CoV-2-positive polymerase chain reaction (PCR) test, and the mortality rate in critically ill patients. MATERIALS AND METHODS: A retrospective study was conducted that included 70 patients seen at a private hospital in Mexico City, within the time frame of February-December 2021. Median patient age was 44.5 years (range: 37-57.2) and 43 (61.4%) of the patients were men. Liver function tests were performed on the patients at hospital admission. RESULTS: Gamma glutamyl transferase (GGT) levels were elevated (p = 0.032), as were those of AST (p = 0.011) and ALT (p = 0.021). The patients were stratified into age groups: 18-35, 36-50, and > 50 years of age. The 18 to 35-year-olds had the highest liver enzyme levels and transaminase levels were higher, the younger the patient. Due to the low mortality rate (one patient whose death did not coincide with a hepatic cause), the multivariate analysis showed an R2 association of 0.689, explained by AST, GGT, and C-reactive protein levels. CONCLUSIONS: Despite the increase in transaminases in our study population during the course of COVID-19, there was no increase in mortality. Nevertheless, hospitalized patient progression should be continuously followed.
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The objective of the research work was to expose how the legal research process after the covid-19 pandemic has impacted on the solution of social problems and to determine a mechanism for the satisfaction of the actors of the legal research process at the Universidad de los Andes. Therefore, it is proposed to characterize the impact through a bibliographic search in databases of interest and subsequently determine the level of satisfaction of students, professors and certified researchers within the university with the existing legal research system through the application of the IADOV technique. A higher overall satisfaction index was obtained in the sampled analysis groups. It was observed that the group of professors obtained a higher overall satisfaction index than the rest of the two groups. The most important elements for each of the groups were es-tablished, as well as those that enhance and limit the research system. It is recommended to review and analyze the limiting elements detected in order to include them in a continuous improvement plan. © 2022, University of Cienfuegos, Carlos Rafael Rodriguez. All rights reserved.
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The assessment and training of respiratory muscles are two essential tasks for indirect screening of status and improvement of lung function, respectively, especially in times of COVID-19. To perform both tasks, we have designed an innovative handheld mouth pressure biofeedback system for assessment and personalized game-based training of respiratory muscle strength. Thirty recovered COVID-19 patients were involved in an across-ages pilot study to evaluate their respiratory muscle strength and the system’s usability, and eight of the thirty patients were involved in a home inspiratory training program of 3 weeks to assess its effectiveness. Results revealed that participants rated the system’s overall usability as excellent (91.3 ± 6.4) and consistently performed respiratory cycles along with the game-based training program in terms of mouth pressure. Furthermore, patients involved in the home training program showed a 40% increase in their Maximal Inspiratory Pressure (Pimax). These results indicate that the proposed system stands for a proper healthcare solution for the initial diagnosis of respiratory muscle dysfunction or disease and for guiding the correct performance of tailored and consecutive threshold load breathing cycles playfully and engagingly. Furthermore, it stands for an attractive and personalized biofeedback solution to promote adherence to at-home therapy. Finally, it can be used to investigate new and effective training protocols that improve respiratory muscle performance. [ FROM AUTHOR]
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Results from internal assessments show that passing rates in introductory courses as well as retention rates of first-year students in the College of Engineering and Computer Science at The University of Texas Rio Grande Valley, a predominantly Hispanic Serving Institution (HSI), significantly dropped with the advent of COVID-19. Such results and trends provide an overall perspective on the academic preparation of incoming students. There is a high concern that the necessary skill set (e.g., adaptability, persistence, and performance) of the new cohort, who are primarily underrepresented Hispanics from underserved and challenged communities from the Rio Grande Valley, is not optimal for the rigor of engineering education. To this end, an onboarding bootcamp for incoming and transfer students was created to bridge the transition from secondary education to higher education by priming students to overcome academic deficiencies, develop a critical skills portfolio, learn problem-solving techniques, build a sustainable community of mentoring support with faculty and students, and provide a template to sustain academic and professional success during their undergraduate education. This research-to-practice paper presents the bootcamps' design process steps: curricular analysis, identification of areas of opportunities, skills inventory, and blueprinting process, as well as its initial implementation in the mechanical engineering program. In this regard, the bootcamp was organized over a week span with hands-on engineering activities, faculty and student talks, and engineering lab tours;and was based on a design thinking approach. Daily activities were structured based on challenge-based instruction, innovation, design, and mentoring, and focused primarily on promoting critical thinking, being assertive in the face of adversity, making informed decisions, and prioritizing tasks. Results indicate that the bootcamp increased student confidence and established a valuable network system amongst other findings. Future work will focus on expanding the bootcamp to include students from other engineering and computer science departments and to offer the template to institutions with similar academic challenges. © American Society for Engineering Education, 2022
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IoT has become an essential resource in health applications, mainly for the monitoring of chronic diseases with integration with wearable devices, which helps to analyze symptoms in a non-invasive way, becoming a highly qualified resource for the health care of the patient. Novel Covid-19 disease emerged from China in December 2019 and became a problem of global concern the following year. Elderly and people with comorbidities are the most affected, causing a critical health condition or even death. Therefore, remote monitoring is necessary in patients with Covid-19 to avoid health complications caused by irregular conditions such as silent hypoxia. This paper proposes an efficient, low-cost, and rapidly assembled wearable IoT device model, focused on monitoring the health of the Covid-19 patients, including oxygen saturation and body temperature measurements with the aim of notifying patients and medical experts of health status during disease. Implementation is based on Espressif’s ESP32 SoC (System on a Chip) using its connectivity resources for Wi-Fi communication toward IoT platform in order to deploy physiological measurements in mobile devices and alert in case of critical values. The results of the prototype implementation are compared to commercial medical devices to demonstrate the functionality and efficiency of the wearable IoT device model. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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The objective of this study is to assess the transformations of pedagogical practice derived from COVID-19 pandemic confinement. The study is qualitative and the narrative method and the technique applied is a semistructured interview. The results indicate that teacher training, classroom practices assessment, and teacherstudent relationships are the areas in which the most significant changes occur. The changes implemented to continue training of students are oriented to follow policy. However, there is no critical nor reflective stance about the modifications. It is concluded that pedagogical practice is transformed by social isolation and by closure of educational institutions since it was designed for face-to-face teaching and learning and not for online education. © 2022
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Background. COVID-19 has become a worldwide pandemic that brought changes in sociological, economic and health perspectives. The impact of the pandemic on health maintenance is not yet understood, but aspects of the lockdown are being assessed for their impact on society. Diabetes and HIV are diseases that require frequent follow-up to achieve outcomes. Changes to routines during the lockdown, such as physical activity, eating habits, and psychological burden, may result in complications for this patient population. Methods. This is a multi-center, retrospective cohort study performed between October 2019 to October 2020 at two medical centers in Brooklyn, NY. All adult patients with diagnoses of diabetes and HIV were screened for inclusion. Exclusion criteria included pregnancy and long-term steroid use. Electronic medical records were reviewed to obtain demographic, laboratory data, and appointment retention data. The primary endpoint was the mean change in HbA1c (A1c) values before and after the pandemic. Endpoints were evaluated using paired T-tests and Wilcoxon Sign-Rank tests, where appropriate, and a repeated measures logistic regression model was used to analyze appointment retention rates. Results. Baseline characteristics are summarized in Table 1. No significance was observed between baseline A1c values and those taken either up to 3 months (p= 0.862) or up to 6 months (p= 0.977) after the start of the pandemic, as shown in Table 2. Similarly, no difference was observed in HIV surrogate markers. A1c significantly decreased from between the 3-month and 6-month study dates, after the start of the pandemic (p= 0.022). Table 3 shows patients were more likely to fulfill a scheduled appointment during the pandemic with an odds ratio of 1.455 (95% CI, 1.119-1.891). Conclusion. No significance was found in surrogate markers for health maintenance before and after the pandemic. Patients were more likely to keep an appointment after the start of the pandemic and A1c values significantly declined from 3 months to 6 months into the pandemic. Although COVID-19 did not appear to change overall health maintenance of T2DM within our population, our results imply that pandemic measures, such as telehealth appointments, positively affected appointment adherence, which is key to success in this population.
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Introduction: COVID-19 related restrictions necessitated a rapid transition to telemedicine (TM) ambulatory services for pediatric heart failure (HF) and heart transplant (HT) patients. The impact on patient related outcomes remains unknown. We report the feasibility of incorporating TM in routine ambulatory care delivery to pediatric HF and HT patients at a large academic center during the COVID era (04/2020-04/2021). Methods and Results: A total of 650 HF patients, median age 10 (0-25) years and 200 HT recipients, median age 10 (0-22) years were followed at our center during the COVID era. A centerspecific, risk stratified model based on patient characteristics (Table 1) and local COVID restrictions were used to determine patient eligibility for TM only, TM + in-person (IP) or IP care only. There were 2 unexpected deaths in the HT and 0 deaths in the HF patients during the COVID era compared to 1 death in HT and 0 deaths in HF patients in the pre-COVID era (01/2019-12/2019). Both deaths in the COVID era were due to non-cardiac causes and neither patient utilized the TM platform for care. There was a significant decrease in emergency room use and unplanned hospital admissions during the COVID-19 era compared to pre-COVID era (Table 2, Fig 1). Conclusions: TM can safely be incorporated in routine ambulatory care delivery for appropriately selected pediatric patients with HF and HT.
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Seasonal behaviour is an attribute of many viral diseases. Like other ‘winter’ RNA viruses, infections caused by the causative agent of COVID-19, SARS-CoV-2, appear to exhibit significant seasonal changes. Here we discuss the seasonal behaviour of COVID-19, emerging viral phenotypes, viral evolution, and how the mutational landscape of the virus affects the seasonal attributes of the disease. We propose that the multiple seasonal drivers behind infectious disease spread (and the spread of COVID-19 specifically) are in ‘trade-off’ relationships and can be better described within a framework of a ‘triangle of viral persistence’ modulated by the environment, physiology, and behaviour. This ‘trade-off’ exists as one trait cannot increase without a decrease in another. We also propose that molecular components of the virus can act as sensors of environment and physiology, and could represent molecular culprits of seasonality. We searched for flexible protein structures capable of being modulated by the environment and identified a galectin-like fold within the N-terminal domain of the spike protein of SARS-CoV-2 as a potential candidate. Tracking the prevalence of mutations in this structure resulted in the identification of a hemisphere-dependent seasonal pattern driven by mutational bursts. We propose that the galectin-like structure is a frequent target of mutations because it helps the virus evade or modulate the physiological responses of the host to further its spread and survival. The flexible regions of the N-terminal domain should now become a focus for mitigation through vaccines and therapeutics and for prediction and informed public health decision making.
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INTRODUCTION AND OBJECTIVE: Conserving hospital resources during the COVID-19 pandemic has involved restricting nonessential care, especially when hospital capacity, staff and protective equipment was limited. Triage was required to assess severity of illness and need for intervention, particularly affecting the volume of elective procedures to treat BPH. We examined trends in BPH procedures in the office and hospital during surges in the pandemic. METHODS: We compiled monthly volumes for BPH procedures using CPT codes from March 2020 to January 2021 by full time faculty at a single 2541 bed hospital system. Prostatic transurethral resection, laser vaporization, laser enucleation, aquablation, and robotic assisted simple prostatectomy were performed in the hospital and categorized together as “BPH surgery.” In-office prostatic urethral lift (PUL) and convective water vapor energy (WAVE) were categorized as “MIST.” Percent change in case volume was calculated based on the previous 12-month average. Ureteroscopy and stent cases (“URS/ stent”) were used as a control as they were more likely to be urgent. “Surges” during the pandemic were defined by county-specific metrics including hospitalization and COVID-19 positivity rates. RESULTS: During the pandemic, there was a modest decrease in BPH procedures with 582 cases, compared to 665 cases in the prior year. During the surges in 3/2020-4/2020, 7/2020, and 1/2021, the BPH surgery volume changed by -82.1%, -16.5%, and -47.5%, respectively. The MIST volume changed by -83.7%, =30.2%, and -7.7%, respectively. URS/stent cases decreased to a lesser degree than BPH procedures during the pandemic. CONCLUSIONS: During the COVID-19 pandemic, there was a slight decrease in the ability to perform surgery for BPH relative to stone cases. The trend was an adaptive response with pause in BPH surgeries during surges and an ensuing rebound. Office-based MIST procedures PUL and WAVE have been less affected compared to BPH surgeries in the hospital setting, likely resulting in conservation of hospital resources during surges.