How the COVID-19 pandemic affects the moral reasoning of pediatric residents and the general population.

BACKGROUND: Kohlberg's theory of moral development asserts that people progress through different stages of moral reasoning as their cognitive abilities and social interactions mature. Individuals at the lowest stage of moral reasoning (preconventional stage) judge moral issues based on self-interest, those with a medium stage (conventional stage) judge them based on compliance with rules and norms, and those at the highest stage (postconventional stage) judge moral issues based on universal principles and shared ideals. Upon attaining adulthood, it can be considered that there is stability in the stage of individuals' moral development; however, the effect of a global population crisis such as the one experienced in March 2020, when the World Health Organization (WHO) declared the COVID-19 pandemic, is unknown. The purpose of this study was to evaluate the changes in the moral reasoning of pediatric residents before and after one year of the COVID-19 pandemic and compare them with a general population group. METHODS: This is a naturalistic quasi-experimental study conducted with two groups, one comprised 47 pediatric residents of a tertiary hospital converted into a COVID hospital during the pandemic and another group comprised 47 beneficiaries of a family clinic who were not health workers. The defining issues test (DIT) was applied to the 94 participants during March 2020, before the pandemic initiated in Mexico, and later during March 2021. To assess intragroup changes, the McNemar-Bowker and Wilcoxon tests were used. RESULTS: Pediatric residents showed higher baseline stages of moral reasoning: 53% in the postconventional group compared to the general population group (7%). In the preconventional group, 23% were residents and 64% belonged to the general population. In the second measurement, one year after the start of the pandemic, the group of residents had a significant decrease of 13 points in the P index, unlike the general population group in which a decrease of 3 points was observed. This decrease however, did not equalize baseline stages. Pediatric residents remained 10 points higher than the general population group. Moral reasoning stages were associated with age and educational stage. CONCLUSIONS: After a year of the COVID-19 pandemic, we found a decrease in the stage of moral reasoning development in pediatric residents of a hospital converted for the care of patients with COVID-19, while it remained stable in the general population group. Physicians showed higher stages of moral reasoning at baseline than the general population.

Extracorporeal Membrane Oxygenation Utilization in Pregnant and Post-Partum Patients During the Covid-19 Pandemic

The use of veno-venous extracorporporeal membrane oxygenation (ECMO) support quickly became instrumental in treating a wide-range of patients demographics, including peripartum, that became critically ill with COVID pneumonia. Despite the surge in VV ECMO support throughout the pandemic data remains limited on safety and efficacy as a treatment modality in peripartum patients. A systematic review of all peripartum patients that were placed on VV ECMO support for COVID-19 pneumonia at a single institution from March 2020 to April 2022. Patient demographics, peripartum status, length of ECMO run, survival to discharge rates and associated complications with ECMO support were extracted through EMR and analyzed. Ten patients in the peripartum phase were included in the study. Mean age 35(±5.8) with mean body mass index 37.2(±11.4). Prior to ECMO insertion eight patients had infant delivery with a mean gestational age of 29.6(±3.2) weeks. Two patients were placed on ECMO at 19 and 28 weeks gestational age. Pre-ECMO patient presentation;All patients were on mechanical ventilation at 100% FiO2 , 5 had neuromuscular blockade infusions, 7 required inhaled nitric oxide, and the mean PaO2/FiO2 ratio was 86.7(95% CI 73.9-99.5). Mean predicted mortality scores at ECMO insertion were RESP 3.8(95% CI 2.8-4.8) and Murray 3.72(95% CI 3.6-3.8) respectively. Overall maternal and infant survival to discharge was 100%. Mean VA ECMO run was 18.5 days (±10.3) with mean hospital length of stay of 28.2 days (±11.5). Based on our findings, the use of VV ECMO support within this previously understudied patient population has proven to be a safe and an effective intervention. We should encourage clinicians to consider using VV ECMO in any peripartum patients who develop refractory ARDS in order to increase chance at survival. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Interstitial changes after severe SARS-CoV-2 Infection

Introduction and aim: COVID19 pandemic caused by SARS-CoV-2 is associated with high morbidity and mortality rate worldwide,producing inflammation that can lead to persistent parenchymal lesions. The aim was to analyse the medium-long term evolution of patients with severe COVID19. Method(s): Follow-up of a cohort of 97 COVID19 patients admitted to intensive care unit from March 2020 to June 2021,requiring invasive/non-invasive mechanical ventilation (IMV/NIMV) and/or high-flow nasal cannula (HFNC). They were clinically evaluated in the Interstitial Diseases consult at 4-6 weeks after discharge with spirometry (SP),CO diffusion capacity (DLCO) and thoracic ultrasound (TU);those suggestive of mild interstitial changes (IC) were evaluated at 3 months and moderate-severe ones at 6 months with HRCT,SP and DLCO. Result(s): Mean age was 61+/-15 years (61% male) and hospital stay was 26+/-17 days.93% used HFNC,57% NIMV and 31% IMV. At 4-6 week after discharge assessment showed 45% dyspnea and 33% crackles. SP was normal in 63%,with mild DLCO disorders in 36% and 77% pathological TU. The most frequent abnormality on HRCT was ground glass. After clinical-functional and ultrasound-radiological evaluation at 4-6 weeks after COVID19,37% of cases were discharged,another 2% at 3 months,22% at 6 months and 7% at 12 months. The remaining 32% are still being followed up for persistent IC(6 receiving home oxygen therapy,6 treated with steroids and 4 with antifibrotic). Conclusion(s): Most patients with severe COVID19 infection have after discharge IC with mild clinical-functional impact at 4-6 weeks,although one third have persistent changes after 12 months. Medium to long-term follow-up of postCOVID19 patients is necessary to identify those with permanent abnormalities.

Improving Veno-Veno Extracorporeal Membrane Oxygenation (VV ECMO) Survival to Discharge by Implementing a Goal-Oriented Expected Progression Patient Management Guideline

Management of VV ECMO has substantially evolved over the past two decades. Plenty literature has been published regarding indications, management, and outcomes, however limited evidence of standardized goal-oriented management practices exists. The VV ECMO Expected Progression guideline, approved on March 1, 2021 by the institution's ECMO Steering Committee, consists of five goal-oriented phases with suggestive interventions. Patient characteristics and outcomes were collected retrospectively and compared between July 2019 to Feb 2021 ("pre-implementation group") and March 2021 to April 2022 ("post implementation group"). Chi Square tests were performed to analyze the primary outcomes. Patient characteristics and outcomes are shown in table 1. Out of 125 adult patients, 78 followed the VV ECMO expected progression guideline. There was no significant difference in patient age, sex, and body mas index between both groups. COVID ARDS was the primary ECMO indicator for both cohorts at 96% (75/78) and 68% (32/47) respectively. Pre-ECMO presentation characteristics were evenly distributed between both groups. ECMO duration, ICU length of stay (LOS), and hospital LOS were significantly longer in the post implementation group (p=<0.01). ICU survival and hospital discharge outcome measures demonstrated a statistically significant improvement of 23.3% (p=<0.01) in the post implementation group. The VV ECMO Expected Progression goal-oriented guideline demonstrated to be a useful tool that resulted in streamlined care and improved survival to discharge. Of note, the post implementation group did report an increased in ECMO run time, ICU and hospital LOS. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Clinical epidemiological characterization of patients affected by COVID-19 in a General Hospital of Veracruz, Mexico

Background. Since the beginning of the pandemic and its passage through the different affected continents, there have been differences in the presentation depending in part on the characteristics of each population, so it is important to know how it behaves in the local population. Methods. Clinical-epidemiological study in adults hospitalized for suspected COVID-19 at the General Hospital 71 of the City of Veracruz, Mexico, from April to December 2020. Demographic and clinical characteristics are studied, as well as a comparative and stratified analysis was performed by intubation and death. Results. 1212 patients are included, 53% are men, average age 49 years. 20.5% reported sudden onset of symptoms;the most frequent: fever (79.8%), headache (75.2%), cough (71%), myalgia (62%), arthralgia (58%) and dyspnea (46.3%). Comorbidities were reported in 54.7%, the most frequent: Hypertension (29.2%), Diabetes (29.1%) and obesity (13.9%). Regarding the outcomes, 120 (9.9%) required intubation and 300 (25%) died. Men requiring intubation were significantly older than women [62.5 vs 37.5%;p = 0.027]. The mean age of the intubated patients was higher compared to that of the non-intubated [60.5 vs 44.8 years;p = 0.001]. The male gender had a risk association for intubation. The group aged 60 years or older compared to those aged 59 years or younger had a higher risk of intubation. Clinical variables that had a risk association with intubation were: dyspnea, chest pain and prostration. Among comorbidities, hypertension and diabetes had a risk association with intubation. Female gender and headache had a protective association for intubation. In addition, odynophagia, rhinorrhea, and abdominal pain showed a protective association for intubation. There was no difference in terms of gender by death. The mean age of the patients who died was significantly older [64.5 vs 43.8 years;p = 0.001]. The clinical variables that had a risk association with death were: dyspnea, chest pain, polypnea, cyanosis and prostration. The protective variables were: rhinorrhea, odynophagia, headache and conjunctivitis Conclusion. By studying a population affected by COVID, its own characteristics and inherent risks can be known to help take local diagnosis and treatment strategies that ensure a better outcome for those affected.

Comparative analysis between Polymerized Type I Collagen and Baricitinib as potential treatment for COVID-19

Background. Baricitinib is a treatment authorized by the FDA for the treatment of moderate to severe COVID-19, despite this there are few approved drugs;polymerized type I collagen (PTIC) is a drug that has been used in Mexico with great potential for treating moderate to severe cases of COVID-19. Methods. Comparative, descriptive and retrospective analysis of two populations of adult patients affected by COVID-19 confirmed by antigen test or RT-PCR as well as CO-RADS 6 CT, who consented to be treated between 2020 and 2021, a population using oral baricitinib at a dose of 4mg/day/14 days and another using polymerized type I collagen intramuscularly at a dose of 1.5ml every 12 hours for 3 days, followed by 1.5ml every 24 hours for 4 days;The most affected age and gender, comorbidities and laboratory abnormalities are analyzed, as well as improvement in inflammatory and oxygenation indices measured by pulse oximetry and SAFI (SpO2/FiO2), finally the outcome of the patients and the presence of adverse events. Results. 80 patients for each group, the most affected gender was male;the average age in the PTIC group was 51 years and in the baricitinib group it was 56 years;the main comorbidities were obesity, diabetes and hypertension in both groups;the decrease in acute phase reactants such as CRP, D-dimer and ferritin was greater in the PTIC group compared to the baricitinib group, the latter drug requiring a regimen of more days to achieve the objectives of the first drug (PTIC 7 days and baricitinib 14 days);Similarly, in oxygenation measured, the PTIC group reached goals in less time compared to the baricitinib group, which required twice as many days of treatment to achieve adequate oxygenation;Regarding the outcomes, there was a higher mortality in the baricitinib group compared to the PTIC group (6.25% vs 3.75%). Regarding adverse events reported for the PTIC group, they were minor and related to the intramuscular administration of the drug in 7 patients, while in the baricitinib group, 5 patients were reported with added bacterial pneumonia. Conclusion. Polymerized type I collagen has anti-inflammatory and immunomodulatory potential similar to baricitinib in cases of moderate to severe COVID-19, even reaching treatment goals in less time both in inflammatory indices and in oxygenation indices.

[Association of SARS-CoV-2 infection and administration of COVID-19 vaccines with alterations in the menstrual cycle. Literature review]. / Asociación de la infección por SARS-CoV-2 y la administración de las vacunas contra la COVID-19 con alteraciones en el ciclo menstrual. Revisión de la literatura.

A number of factors can affect a woman's menstrual cycle, including diseases or drugs, such as COVID-19 disease and vaccinations. The aim of this review is to explore the studies published to date that have studied the presence of alterations that may be related to COVID-19 or vaccination against the SARS-CoV-2 virus.We conducted a review in the PubMed database, selecting 10 articles in which the menstrual cycle of adult women of childbearing age was studied, 3 of them in which the participants had been diagnosed with COVID-19 and 7 in which the participants had been vaccinated against the SARS-CoV-2 virus.Regarding COVID-19-related disturbances, 16%-47.2% of the participants presented a prolongation of their cycle, which was more frequent in those who reported more COVID-19 symptoms, and which normalised after 1-2 cycles.Regarding the alterations described after SARS-CoV-2 vaccination, 45%-78% of participants reported menstrual cycle alterations, with disparate results for the different parameters analysed, except that the alterations resolved in about 2 months.Both COVID-19 disease and vaccination appear to be associated with the occurrence of menstrual disturbances, which are limited in time and not severe. However, studies are scarce to date, and it is important to continue to develop studies that provide scientific evidence.

Alternative Workflow for SARS-CoV-2 Testing Using a Heat Lysis Protocol for Respiratory Specimens

Background. The SARS-CoV-2 pandemic has demonstrated the need for streamlined workflows in high-throughput testing. In extraction-based testing, limited extraction reagents and required proprietary instrumentation may pose a bottleneck for labs. As a solution, ChromaCode developed a Direct Extraction protocol for the HDPCR™ SARS-CoV-2 Assay, distributed in accordance with the guidance on Policy for Coronavirus Disease-2019 Tests During the Public Health Emergency, Section IV.C., which allows for the processing of specimens without an extraction system. In lieu of an extraction system, the Direct Extraction protocol uses a thermal cycler to lyse and inactivate specimens which are directly added to the Polymerase Chain Reaction (PCR). Methods. The Limit of Detection (LoD), Clinical Performance, and effect of Interfering Substances was determined for the Direct Extraction protocol. The LoD was established on 6 PCR platforms with dilutions of inactivated SARS-CoV-2 virus spiked into residual, negative nasopharyngeal swab (NPS) matrix. Clinical performance was assessed with 48 positive and 50 negative frozen retrospective samples using the Direct Extraction protocol compared to an external Emergency Use Authorized (EUA) comparator assays (cobas® Liat® SARS-CoV-2 & Influenza A/B assay and the Hologic Panther Fusion® SARS-CoV-2 Assay respectively) on three PCR platforms. The Direct Extraction protocol was evaluated for performance in the presence of 13 potentially interfering substances that can be present in a respiratory specimen. Results. The LoD of the Direct Extraction protocol ranges from 1000 - 3000 genomic equivalents (GE)/mL. The clinical performance of the assay was 95.8% positive agreement (95% CI of 84.6% - 99.3%) and 100% negative agreement (95% CI of 90.9% - 100% or 91.1% - 100%) across all three PCR platforms tested. The viral target was detected at 3X LoD for all interferents tested. Conclusion. The Direct Extraction protocol of ChromaCode's SARS-CoV-2 Assay is a sensitive test that eliminates the need for sample extraction and performs very well against traditional extraction-based workflows. The inclusion of this protocol can reduce costs, reliance on extraction systems, and time associated with extraction-based protocols.

RESILIENCE, WELL-BEING AND POST-TRAUMATIC STRESS IN THE LOCKDOWN AND PANDEMIC OF COVID-19

The COVID-19 pandemic and social distancing measures have had a negative impact on mental health. The main objective is to study the role of resilience as a protective factor, against the impact of the pandemic and the confinement ofCOVID-19. The sample consisted of 179 participants with a mean age of 40.85 years (SD = 13.7). The analyzes indicate that resilience is highly predictive of psychological well-being and mood and is a protective factor against post-traumatic stress. Also for the ease of carrying the pandemic, which may be mediated by other factors. The effects of the pandemic and confinement appear to have significantly increased post-traumatic stress symptoms. Women have more post-traumatic stress and less psychological well-being. The age group most affected is that of young people (18-25 years).

Psychosocial and mental health during the COVID-19 lockdown: A rapid qualitative study in migrant shelters at the Mexico-United States border

Introduction. Migrants could be at increased risk of the psychosocial and mental health consequences of the COVID-19 pandemic. Research is needed to assess their needs and the most useful interventions in this regard. Objective. To describe the mental health consequences of the pandemic and lockdown measures among migrants living in shelters in Tijuana, Mexico, during the COVID-19 pandemic, barriers to mental healthcare during this period, and the key elements of psychosocial support provided by civil society organizations (CSOs), as described by shelters' staff. Method. In April-May 2020, we conducted a rapid qualitative study through interviews with persons providing services at eight migrant shelters, complementing the information with data from an ongoing ethnographic project. We situated the results within the levels of the United Nations' Inter-Agency Standing Committee (IASC) pyramid of psychosocial and mental health support. Results. In addition to fear of contagion and economic insecurity, migrants experienced emotional distress associated with hardening migration policies, and the difficulties of having to find shelter in place in non -private spaces. Some CSOs continued or adapted previous psychosocial support activities, helping migrants navigate these issues, but other activities stopped amidst physical distancing measures and because of limited resources. Migrants themselves implemented some group activities. There was a surge of civil society initiatives of online support, but some shelters laeked the technological and other resources to benefit from them. Discussion and conclusion. Migrants require a tailor made response to their mental health needs in the COVID-19 pandemic, such as the one provided by CSOs.

Oral anticoagulation with rivaroxaban as thromboprophylaxis in patients recovered from COVID-19 pneumonia inveracruz, mexico

Background : Patients affected by COVID-19 are at risk of various venous and arterial thrombotic events, as well as embolic risks, the risk can vary from 17% to 78% according to the different published series. therefore, thromboprophylaxis must be imperative. Aims : To assess the use of rivaroxaban as thromboprophylaxis in recovered COVID-19 patients who are at thrombotic risk Methods : Descriptive and analytical study in patients who presented pneumonia due to COVID-19 in April and May 2020, who received LMWH during their hospital stay and at discharge with rivaroxaban 10 mg/day for 2 months. D-dimer was measured at the beginning of the study and 1 month after discharge. Thrombotic or hemorrhagic episodes are controlled after 1 and 2 months of treatment (June -July 2020). Results : 50 patients, women 40% and men 60%, with a median age of 42.9 years. 64% had mild pneumonia and 36% had severe pneumonia, mean initial D-dimer 556.5 ng/ml, 56% had D-dimer ≥ 500 ng/ ml at the time of hospital admission. Baseline D-dimer values were significantly higher in severe pneumonia. In the follow-up at one and two months, we found that D-dimer values were significantly higher among patients with severe pneumonia and also, in this group of patients, the percentage of patients with D-dimer levels ≥ 500 ng/mL in the first month of follow-up, was significantly higher in the group of patients who were hospitalized for severe pneumonia. During the first month of follow-up, there was a thrombotic event and a hemorrhagic event in the group of patients with severe pneumonia;By the second month of follow-up, there was a hemorrhagic event in the group with mild pneumonia, but this difference in frequencies was not statistically significant. TABLE 1 Variables stratified by type of pneumonia Conclusions : The incidence of thrombotic and hemorrhagic events was low, so the thromboprophylaxis scheme used in patients with recovered pneumonia due to COVID-19 is recommended. Rivaroxaban is safe to use like thromboprophylaxis.

POSTING OF WORKERS AND THE REVISION OF THE EUROPEAN LEGAL FRAMEWORK: SOCIAL DUMPING AND UNFAIR COMPETITION TO AN END?

The posting of workers in the European Union (EU) has gained significant prominence in the last decade, due to the exponential growth of transnational provision of services following the financial crisis in 2008;the proliferation of letterbox companies in countries with comparatively low labour costs;the existence and increase in cases of fraud, discrimination and abuse;and, in particular, because in 2014 and 2018 there were legal reforms to combat legal uncertainty, social dumping and unfair competition at the European level. Although this sui generis form of international labour mobility is currently overshadowed by the situation caused by Covid-19, the legal debate as a result of the new provisions regulating the posting of workers will re-emerge because, whilst some of the inadequacies and weaknesses in Directive 96/71 have been amended, others have been left out and will undoubtedly be the subject of new disputes. This paper is dedicated to those, and to the analysis of cases 620/18 and 626/18 already settled by the CJEU, with the intention of contributing to a better interpretation of this phenomenon whose importance is indisputable, even more so in the current context of hypermobility in the internal market for services.

Performance Portability of Molecular Docking Miniapp On Leadership Computing Platforms

Rapidly changing computer architectures, such as those found at high-performance computing (HPC) facilities, present the need for mini-applications (miniapps) that capture essential algorithms used in large applications to test program performance and portability, aiding transitions to new systems. The COVID-19 pandemic has fueled a flurry of activity in computational drug discovery, including the use of supercomputers and GPU acceleration for massive virtual screens for therapeutics. Recent work targeting COVID-19 at the Oak Ridge Leadership Computing Facility (OLCF) used the GPU-accelerated program AutoDock-GPU to screen billions of compounds on the Summit supercomputer. In this paper we present the development of a new miniapp, miniAutoDock-GPU, that can be used to evaluate the performance and portability of GPU-accelerated prote-inligand docking programs on different computer architectures. These tests are especially relevant as facilities transition from petascale systems and prepare for upcoming exascale systems that will use a variety of GPU vendors. The key calculations, namely, the Lamarckian genetic algorithm combined with a local search using a Solis-Wets based random optimization algorithm, are implemented. We developed versions of the miniapp using several different programming models for GPU acceleration, including a version using the CUDA runtime API for NVIDIA GPUs, and the Kokkos middle-ware API which is facilitated by C++ template libraries. A third version, currently in progress, uses the HIP programming model. These efforts will help facilitate the transition to exascale systems for this important emerging HPC application, as well as its use on a wide range of heterogeneous platforms.

IoMT: Rinku's Clinical Kit Applied to Collect Information Related to COVID-19 Through Medical Sensors

COVID-19 healthcare professionals recommend the general population staying at home and remote contacting the authorities, e.g. via SMS messages, if they show symptoms like cough, body pain, fever, and breathing difficulties. Although this approach considers the patient self-report, it is not supported by physiological data, i.e. medical personnel does not have a remote mechanism to validate such symptoms. This paper proposes a system, called Rinku, to address the abovementioned scenario. Rinku integrates an electronic system (ClinicalKit) comprising biomedical sensors for body temperature, pulse rate, and oxygen saturation, as well as a digital platform for storing and displaying the collected data. Rinku system aims to provide health professionals with relevant information to remotely validate COVID-19 symptoms. Rinku can handle simultaneous information from multiple patients and provide valuable data related to the severity of the reported symptoms, which in turn could help healthcare professionals to make management decisions to optimize their clinical resources. In this paper, the functionality of the ClinicalKit, communication between the IoT architecture and the cloud, and the monitoring of physiological parameters were tested. The results showed that the enclosure design is convenient, IoT architecture is functional and the tracking of temperature, heart rate, and blood oxygen levels from subjects is promising. We consider that the Rinku system has the potential to provide an accurate forecast regarding the demand for clinical resources and take prompt actions related to this pandemic.

Mexico with high prevalence of chronic-degenerative diseases and risk factors that favor the development of COVID-19

Introduction: The COVID-19 disease caused by the SARS-CoV-2 virus has infected almost 75 million people worldwide and causing more than 1,680,000 deaths in 191 countries (December 2020). In Mexico with more than 1,300,000 cases and 115,000 deaths from COVID-19, adequate measures must be taken to prevent contagions and major complications, they are essential for the health system in Mexico. Objective: Identify risk factors that may be characteristic of Mexico and contribute to a higher risk before COVID-19. Generate awareness and understanding of these risk factors as a Public Health problem. Materials and methods: A review of articles indexed in PubMed and Redalyc was carried out between the months (December 2019 - July 2020), using the keywords "COVID-19, ACE2, Risk factor, Chronic-degenerative diseases, Mexico, Obesity, Overweight", in the 39 articles were reviewed with two or more keywords as inclusion criteria, as well as 4 specific reports of the prevalence of chronic degenerative diseases and risk factors from Mexico (ENSANUT 2012, 2016, 2018 and OECD-Health at a Glance 2019). Results: Chronic-degenerative diseases could favor the expression of angiotensin converting enzyme 2 (ACE2), therefore, increased ACE2 expression increases the risk of COVID-19 in this type of patient in Mexico. Conclusions: The increase in ACE2 in the cell membrane is favored by the development of diseases such as diabetes, hypertension, risk factors (overweight, obesity, smoking), as well as the use of anti-hypertensive drugs. It is necessary for the health system in Mexico to develop preventive measures in various areas, with the aim of reducing this type of diseases and risk factors to prevent the development of COVID-19.

Frontline doctors infected with COVID-19 during a hospital outbreak in Veracruz, Mexico

Background: The current Covid-19 pandemic has affected health workers, some estimates mention more than 90,000 affected, even with deaths throughout the world. Methods: Descriptive, analytical and cross-sectional study. The cases of front-line doctors infected with Covid-19 during a hospitalary outbreak, in the General Hospital 71 “Lic. Benito Coquet Lagunes” of Veracruz, dependent on the Mexican Institute of Social Security, from April 1 to May 31, 2020. Results: Seven doctors were entered into the study, with an average age of 42.4 years, all of them male. The affectation by service was: Internal medicine 5 of 17 doctors (29.4%), Emergencies 1 of 15 doctors (6.6%) and Intensive care 1 of 6 doctors (16.6%) infected by Covid-19. Laboratory studies were only performed in 5 cases, the presence of leukopenia in 1 case (20%), leukocytosis in 2 cases (40%), lymphopenia in 4 cases (80%) stand out. Impaired fasting glucose was reported in all cases. There was no alteration in kidney function;in liver function, transaminemia was reported in 80%. Regarding the acute phase reactants, the intake of these was very inconsistent since it was not uniform in all cases, but the most representative was elevated ESR in 4 of 4 cases (100%), positive PCR in 3 of 4 cases (75%), procalcitonin negative in 3 of 3 cases (100%), elevated DHL in 2 of 5 cases (40%), elevated D-dimer in 1 of 3 cases (33.3%), elevated ferritinemia in 1 of 2 cases (50 %). The rest of the characteristics in the table and graphs. Conclusion: The present cohort of doctors affected by Covid during a hospital outbreak shows that there are several factors to take into account, on the one hand, factors specific to the population (obesity, diabetes, hypertension), as well as the institutions that are in charge of medical personnel. they must identify the risk factors mentioned, influence them and protect said population that is vulnerable per se to a pandemic;Another constantly identified factor is occupational exposure to the pathogen without sufficient and adequate personal protective equipment. (Table Presented).

Neutrophil-lymphocyte index, platelet-lymphocyte index and systemic inflammation-immunity index in patients with COVID-19 pneumonia in Veracruz, Mexico

Background: Different indices have been devised that attempt to correlate the severity of the symptoms and predict mortality mainly in septic states and inflammation, with important results that validate their usefulness. In the present pandemic, to date, no indices have been used in severe cases of Covid- 19 that can predict the outcome. Result of the measurement of demographic and clinical variables Methods: It includes a cohort of patients with pneumonia confirmed by Sars Cov 2 PCR-RT, treated at the Veracruz Norte branch of the Instituto Mexicano del Seguro Social from April to May 2020, analyzing the neutrophil-lymphocyte, platelet-lymphocyte and immunity-systemic inflammation indices. Results: We included 100 patients, 54 (54%) women and 46 (46%) men, with a mean age of 49.4 ± 19.3 years. The mean of leukocytes was 10,103.0 ± 4,289.0 cel / mm3, neutrophils 8,509.3 ± 4,216.0 cel / mm3 and lymphocytes of 1,112.7 ± 585.4 cel / mm3;Regarding the hematological indices used to measure severity, we found that the mean of the INL was 10.7 ± 10.9, that of the IPL was 290.1 ± 229.2 and that of the IIIS was 2.6 ± 3.4 x 109. Regarding the type of pneumonia, 54 (54%) had mild pneumonia and 46 (46%) had severe pneumonia. Regarding hospital outcomes, 75 (75%) of the patients were discharged due to clinical improvement and 25 (25%) of the patients died during the hospital stay. The mean age was significantly higher in the group of patients who died during the hospital stay (45.9 ± 18.6 VS 60.0 ± 17.5 years, p = 0.001), the proportion of women who died was higher and tended to be statistically significant. The mean INL was 20.4 ± 16.9 in patients who died VS 7.5 ± 4.9 in patients who improved (p = 0.001). The mean IPL was 417.1 ± 379.7 in patients who died VS 247.7 ± 127.4 in patients who had improvement;p = 0.038. Finally, the mean IIIS was significantly higher in patients who died VS patients who had clinical improvement (4.8 ± 6.1 VS 1.9 ± 1.2;p = 0.030, respectively). In the correlation analysis, high and significant r were found in the three indices. Conclusion: Neutrophil-lymphocyte, platelet-lymphocyte and systemic immunity- inflammation indices in patients with Covid-19 pneumonia can be used as predictors of severity and predict hospital outcome.

Extracorporeal Membrane Oxygenation Dependent COVID19 Hospital Transfers

The World Health Organization has recorded over 8 Million cases of COVID19 as of October 2020. Despite receiving appropriate lung protective ventilation and medical treatment, some of these patients develop refractory hypoxemia and acute respiratory distress syndrome. Extracorporeal membrane oxygenation has been recognized as a lifesaving therapy for patients with ARDS secondary to COVID19. There are few centers in the United States equipped with the necessary staff and the experience to take care of such critically ill patients. Some patients are too ill to be transferred with conventional mechanical ventilation, and they require interhospital transport while on ECMO. We have developed a highly specialized ECMO Deployment Team dedicated to the cannulation and transport of COVID19 patients while on venous-venous (VV) ECMO or venous-arterial (VA) ECMO. We use routine bedside ECMO cannulation via bilateral femoral vessels configuration at the outside hospital. The patient is stabilized and transported by air or ground to one of our affiliated hospitals.Here we present a series of five patients who were cannulated by our team at an outside institution and transported while on ECMO support to one of our three system hospitals. Patient ages ranged between 49-64 years old. Four patients required VV ECMO for severe hypoxemia secondary to COVID19 ARDS. One patient required VA ECMO due to viral myocarditis secondary to COVID19. Time on ECMO ranged from 9-33 days. Three of the five patients recovered successfully and were discharged home, rehab or LTAC. One patient is still currently on ECMO and one patient is deceased. There were no reported or documented transmission of COVID19 to the members of the ECMO deployment team. The potential for survival of the critically ill due to COVID19 often demands a higher level of care. However, stable transport to an appropriate institution presents a limiting factor. Our method of a dedicated ECMO Deployment Team appears to provide favorable outcome for these patients. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)