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Innovation is becoming a fundamental part of many sectors and environments, including universities, not only regarding their research but also how education is approached. In this line, one of the ways to achieve these objectives is based on a collaboration between society, which presents a need to be solved, and the University. This society-university integration is achievable via the Service-Learning methodology (SLM), which has always been based on establishing strong links between the educational world and society. This paper presents a SLM-based project linked to technological development for the health sector during the SARS-CoV-2 pandemic. Specifically, undergraduate chemistry students, and Ph.D. students led by professors have presented part of their technological developments to people in society who are at risk of exclusion to help them understand aspects of infection as well as diagnosis of diseases. In short, the objective is to transfer in an enjoyable fashion, a set of technological developments and knowledge that can help society understand aspects related to the COVID-19 pandemic.
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The aim of this article is to systematically analyze the available literature on the efficacy and validity of artificial intelligence (AI) applied to medical imaging techniques in the triage of patients with suspected or confirmed coronavirus disease 2019 (COVID-19) in Emergency Departments (EDs). A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Medline, Web of Science, and Scopus were searched to identify observational studies evaluating the efficacy of AI methods in the diagnosis and prognosis of COVID-19 using medical imaging. The main characteristics of the selected studies were extracted by two independent researchers and were formally assessed in terms of methodological quality using the Newcastle-Ottawa scale. A total of 11 studies, including 14,499 patients, met inclusion criteria. The quality of the studies was medium to high. Overall, the diagnostic yield of the AI techniques compared to a gold standard was high, with sensitivity and specificity values ranging from 79% to 98% and from 70% to 93%, respectively. The methodological approaches and imaging datasets were highly heterogeneous among studies. In conclusion, AI methods significantly boost the diagnostic yield of medical imaging in the triage of COVID-19 patients in the ED. However, there are significant limitations that should be overcome in future studies, particularly regarding the heterogeneity and limited amount of available data to train AI models. Copyright © 2022 The Author(s). Published by MRE Press.
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The COVID-19 pandemic has affected trauma practices all over the world. Despite the increasing number of studies focused on the epidemiology of vertebral fractures (VFs) in COVID-19 patients, the impact of the pandemic on the incidence of trauma pathologies at the emergency department (ED) remains unclear. In Spain, very few studies have explored how the pandemic has affected the care of patients with osteoporotic vertebral fracture (OVF) in the ED and on their follow-up. The aim of this work is to evaluate the impact on the demand for care and diagnosis of VF during the COVID-19 pandemic, as well as the repercussions on patient follow-up. A longitudinal retrospective observational study was designed comparing two cohorts (pre-COVID and COVID) of patients for whom an emergency computed tomography scan was requested due to suspected vertebral fracture. Information was gathered on patient demographics, number and type of OVFs, time of day at which the diagnosis was made, follow-up, and treatment received. Comparative analyses were performed between both patient groups, with stratification by time intervals according to the pandemic waves in the COVID cohort. A total of 581 eligible patients were included in the study. The analyzed cohorts included 288 patients (145 and 143 in the pre-COVID and COVID cohorts, respectively), with a mean age of 73.4 ± 13.8 years and 205 (71.4%) women. No significant differences were observed on most measured variables. In the COVID cohort, the group of patients who received follow up care had a significantly lower mean age than the group that did not receive follow up care (70.2 ± 12.7 vs 76.2 ± 14.1 years, respectively, p = 0.008). In conclusion, the COVID-19 pandemic has had little impact on the diagnosis and management of patients with OVF in our hospital. This could be explained by the specific characteristics of OVFs and the type of patients it affects. Our study has some limitations, mainly derived from its retrospective and single-center nature with a short follow-up interval.
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Background: Factors associated with the development of chronic heart failure (CHF) in systemic lupus erythematosus (SLE) have received little attention. On the other hand, recent data from the use of hydroxychloroquine in the treatment of SARS-CoV-2 infection during the COVID19 pandemic have cast some doubts on its cardiological safety. Objectives: To identify factors associated to CHF in SLE. Methods: Retrospective cross-sectional study, including all patients with SLE (≥4 ACR-1997 criteria) recruited in RELESSER registry. The objectives and methodology of the registry have been described previously (1). CHF was defined according to the Charlson index item. Patients with CHF before diagnosis of SLE were excluded. Cumulative damage was measured with the SLICC/ ACR index, excluding cardiovascular (CV) items (mSDI). Multivariate analysis exploring factors associated with CHF was carried out. Results: 117 patients (3% of the entire cohort) with SLE and CHF and 3,506 controls with SLE without CHF were included. 90% were women. Disease duration: mean (SD), 120.2 (87.7) months. CHF appeared after a median (P25-P75) of 9.40 (4.2-18.3) years from SLE diagnosis. Patients with CHF were older (59.8 ± 18.2 vs. 46.2 ± 4.3). In the bivariate analysis, the association of CHF with greater severity [Katz severity index: median (IQR): 4 (3-5) vs. 2 (1-3)], damage [mSDI: 3 (2-4) vs 0 (0-1)], comorbidity [modified Charlson-excluding CV items: 4 (3-6) vs 1(1-3)] and both CV (37.5% vs 6.7%) and overall mortality (43.2% vs 4.7%) (p<0.0001 for all comparisons). Also, CHF patients were more refractory to SLE treatments (33.3% vs 24%, p=0.0377) and were more frequently hospitalised due SLE [median 3 (1-5) vs 1(0-2), p<0.0001]. The results of the multivariable model are depicted in table 1. Conclusion: -CHF is a rather late complication of SLE. -Patients with SLE and CHF have more severe SLE, with greater refractoriness to SLE treatments and higher overall mortality. -Treatment with antimalarials, as routinely used in SLE patients, is not only safe to heart, but even appears to have a cardioprotective effect. (Table Presented).
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Background: Patients (pts) with rheumatoid arthritis (RA) have an increased susceptibility to seasonal influenza and its complications.1 In light of the COVID-19 pandemic, there is a need to better understand acute respiratory viral RNA infections, such as influenza, in pts with RA. Objectives: To present a comprehensive summary of data on influenza adverse events (AEs) occurring in the tofacitinib RA clinical programme. Methods: Influenza AEs were evaluated in pts with RA from 21 Phase (P)1-3b/4 trials and two open-label, long-term extension (LTE) studies from 2005-2019. These were analysed as two cohorts: P2-3b/4 cohort (pts who received tofacitinib 5 or 10 mg twice daily [BID] as monotherapy or with conventional synthetic [cs]DMARDs, adalimumab, methotrexate or placebo, in P2-3b/4 controlled studies) and Overall cohort (pts who received ≥1 tofacitinib dose, as monotherapy or with csDMARDs, in P1-3b/4 and LTE studies;data were summarised by average tofacitinib dose [average tofacitinib 5 or 10 mg BID based on average total daily dose of <15 or ≥15 mg, respectively]). Incidence rates (IRs;unique pts with events/100 pt-years of exposure;censored at day of first event or up to last dose +28 days) were evaluated for influenza AEs, influenza complication AEs, influenza-like illness (all composites of several MedDRA preferred/verbatim terms) and overall influenza AEs (composite of all preferred/verbatim terms included under influenza AEs, influenza complication AEs and influenza-like illness). In the Overall cohort, the incidence of serious non-influenza AEs within 28 days of the start of an overall influenza AE and time taken to resolution of overall influenza AEs by action taken were summarised descriptively. Results: In total, 7964 pts were included;517 (6.5%) pts reported overall influenza AEs, three of which occurred outside the risk period. In the P2-3b/4 cohort (N=6690), IRs for influenza AEs, influenza-like illness and overall influenza AEs generally appeared similar across treatment arms (Figure 1a). In the Overall cohort, IRs for influenza AEs and influenza-like illness were similar between tofacitinib doses (Figure 1b), and IRs for overall influenza AEs were similar between tofacitinib doses and pt age groups (Figure 1c). No influenza complication AEs (eg pneumonia/encephalitis influenzal) were reported in either cohort. Among pts with overall influenza AEs, nine (1.7%) had serious overall influenza AEs (average tofacitinib 5 mg BID, n=6;average tofacitinib 10 mg BID, n=3). Of these pts, eight (1.5%) were hospitalised (average tofacitinib 5 mg BID, n=6;average tofacitinib 10 mg BID, n=2) and two (0.4%) died (average tofacitinib 5 mg BID, n=1;average tofacitinib 10 mg BID, n=1). Both deaths occurred in pts with H1N1 Influenza A. Twelve (2.3%) pts had a serious non-influenza AE within 28 days of the start of the overall influenza AE (average tofacitinib 5 mg BID, n=6;average tofacitinib 10 mg BID, n=6). The most common serious non-influenza AEs (one event each in average tofacitinib 5 and 10 mg BID groups) were acute respiratory distress syndrome and pneumonia. In most pts with overall influenza AEs, no change to tofacitinib treatment was made (70.2%, n=363) or treatment was stopped temporarily (28.2%, n=146) for a mean duration of 11.0 days. The mean number of days to resolution of overall influenza AEs was numerically similar, ranging from 10.4-11.8 days across tofacitinib doses, irrespective of these actions. Conclusion: This post hoc analysis of influenza AEs across the tofacitinib RA clinical programme, over 14-15 influenza seasons, showed generally similar rates between treatment groups, and between tofacitinib doses and pt age groups. Limitations include varying exposure across treatment arms in the P2-3b/4 cohort. Most influenza AEs were non-serious (98.3%), and were not associated with changes to tofacitinib treatment.
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Background: Patient reported outcomes measures (PROMs) represent a tool to objectively assess the health of cancer patients. PROMs may complement oncological evaluations by adding patients' perspectives on their care priorities. Aim: to address more accurately the management of tumor related symptoms or drug related toxicities to bring he therapies more accurately to bring patients the best quality of life diarrhea, dyspnea, vomiting and nausea. These symptoms were graded according to their severity using the Common Toxicity Criteria v5.0. Results: 49 patients admitted to Medical Oncology Hospitalization were included from July of 2020 to January 2021, 80% in advanced disease. Median age 63yo, 32% above 70 yo. Baseline data showed that 27% patients (19% stage IV) had fever at admission, decreasing at 48h to 4%. Patients who had vomiting at admission were 33% (28% stage IV) median grade 2 becoming 20% and grade 1 at 48h. Nausea was present in 49% patients (35% stage IV) at the time of admission with a median grade 1.5, and it decreased to 16% at 48h with a median grade 2. Diarrhea was reported in 12% patients (6% stage IV) median grade 2 at baseline and it was reduced to 10% median grade 1 at 48h. The median severity of diarrhea at admission was 2 and only 1 at 48h. At admission, 33% (all stage IV) of patients presented dyspnea with a median grade 3, while at 48h it was present in 26% of patients and reduced to median grade 2. Conclusions: By systematically measuring symptoms, patients achieved better control of diarrhea, dyspnea, vomiting and nausea after admission. It should be noted that nausea was the variable that decreased the most at 48h, followed by fever, vomiting, dyspnea and diarrhea. All patients with stage IV disease had dyspnea and most of them had nausea and vomiting. These results reflect that these symptoms are more usual in patients with advanced disease compared to those with localized disease. PROMS also help us educate patients by teaching them how to manage treatments, thus improving therapeutic adherence.
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Introduction Covid-19 is a recent outbreak of pneumonia caused by severe respiratory syndrome coronavirus (SARS-CoV2). It affects mainly the lungs causing pneumonia and complications like acute respiratory distress syndrome. Computed tomography (CT) plays a key role in diagnosis, the most common findings are bilateral, peripheral and basal ground-glass opacities. Pneumothorax secondary to SARS-CoV2 infection is rare and seems to develop later in the course of the disease, its mechanism is not completely understood. There are several reports about Covid-19 and pneumothorax, but few descriptions associated with pulmonary cysts. We describe seven cases of pneumothorax in patients with Covid-19, some of them with pulmonary cysts. Case descriptions We found a series of seven patients with Covid-19 pneumonia with pneumothorax, some as the initial presentation and some developing after the course of the disease, two to three weeks after initial symptoms. Patients were male, most of them in their fifties, two were former smokers and two had COPD. Only one patient had mechanical ventilation, two of them had pulmonary cysts in the CT scan which were not documented before. A Multifocal upper lobe consolidations. B. 29 days later. Left upper-lobe subpleural cystic lesions, ground-glass opacities, right pneumothorax. Discussion The course of Covid-19 depends on the damage caused by the virus and the host's immune response. CT scan is of great value in diagnosis and monitoring of progression and complications. The most common patterns are ground-glass opacification (88%), peripheral distribution (76%), bilateral (87.5%) and multilobe involvement (78.8%). Pneumothorax or cysts in Covid-19 have been described in few case reports. Pneumothorax seems to occur after two weeks of symptom onset, predominantly in male patients. Liu et al. described a series of two men with pneumothorax and peripheral pulmonary cysts after 26 and 40 days of symptom onset;cysts decreased in number and size in subsequent images. Other reports have described cysts or bullae. Pneumothorax seems to develop later in the course of the disease and they are most likely related to the reparation process. Mechanical ventilation with positive pressure is not associated with all cases. The pathogenesis of pulmonary cysts formation in Covid-19 is not well understood. Proposed mechanisms of cystic lung disease include necrosis due to ischemia, remodeling of interstitial matrix, and bronchial obstruction with distal overinflation phenomenon. Information regarding mechanism of pneumothorax in patients with lung infection secondary to Covid-19 is not yet completely understood, but cysts formation may play a role.
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Background: SARS-CoV-2 virus has spread worldwide causing a crisis in healthcare systems. We aimed to describe the clinical characteristics and to explore risk factors of death, critical care admission and use of invasive mechanical ventilation in hospitalized patients with SARS-CoV-2 pneumonia in Bogota, Colombia. Methods: We conducted a cross-sectional study of adult patients with laboratory-confirmed SARS-CoV-2 pneumonia. Demographic, clinical, and treatment data were extracted from electronic records. Univariate and multivariable methods were performed to investigate the relationship between each variable and clinical outcome at 28 days of follow-up. Results: Between March 20 and June 30, 2020, 377 adults (56.8% male) were included in the study, of whom 85 (22.6%) died. Non-survivors were older on average than survivors (mean age, 56.7 years [SD 15.8] vs. 70.1 years [SD 13.9]) and more likely male (28 [32.9%] vs. 57 [67.1%]). Most patients had at least one underlying disease (333 [88.3%]), including arterial hypertension (149 [39.5%]), overweight (145 [38.5%]), obesity (114 [30.2%]) and diabetes mellitus (82 [21.8%]). Frequency of critical care admission (158 [41.9%]) and invasive mechanical ventilation (123 [32.6%]) was high. Age over 65 years (OR 9.26, 95% CI 3.29-26.01;p=0.00), ICU admission (OR 12.37, 95% CI 6.08-25.18;p=0.00), and arterial pH higher than 7.47 (OR 0.25, 95% CI 0.08-0.74;p=0.01) were independently associated with in-hospital mortality. Model based on clinical characteristics on admission yielded an area under the receiver operating characteristic curve of 0.869. Discussion and Conclusions: To december 2020, this single-center study is the first report of hospitalized adult patients with SARS-CoV-2 pneumonia in Andean subregion. In this study of in-hospital patients with SARS-CoV-2 pneumonia frequency of death was similar to what has been reported. ICU admission and use of invasive mechanical ventilation was high and most patients had a mild pneumonia at admission, according to CURB-65 and qSOFA scores. Most of our patients had at least one comorbidity. The prevalence of obesity was considerably higher than the overall prevalence in Colombian adults. Further studies may help to understand the impact of high-altitude on Covid-19 outcomes given Bogota is situated at an altitude of 2,640 mamsl . Figure. Receiver ROC curves for (a) the model of age, ICU admission and arterial pH as a predictor of in-hospital mortality (area under the curve 0.869), and (b) the model of age, male sex, peripheral oxygen saturation and white blood cell count as a predictor of invasive mechanical ventilation due to SARS-CoV-2 pneumonia (AUC 0.761).
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Introduction: A characteristic of patients with acute respiratory distress syndrome associated to COVID-19, particularly the most severely affected, is the presence of refractory hypoxemia, which may require adjuvant therapy alongside artificial mechanical ventilation, including prone positioning of the patient. Objective: Present the available evidence about the changes undergone by the respiratory system with the implementation of prone positioning in patients with invasive ventilation support due to acute respiratory distress associated to COVID-19, as well as its impact on mortality. Methods: An observational retrospective bibliographic review about the topic was conducted from February to July 2020, initially with the search engine Google Scholar, and then in the bibliographic databases CUMED, LILACS, SciELO, PubMed/Medline, EBSCO, Cochrane Library and Web of Science. The search was based on key terms such as "prone position", "acute respiratory distress syndrome", "mechanical ventilation", obtained from the Health Sciences Descriptors (DeCS). Selection criteria included papers written in English or Spanish, of a foreign or national origin, about the topic suggested by the search terms used, published in the present century, preferably in the last five years. Conclusions: Current guidelines recommend early use of invasive mechanical ventilation in prone position for patients with COVID-19-induced moderate-severe acute respiratory distress syndrome for 12-16 hours daily to improve oxygenation and pulmonary recruitment, and reduce mortality. © 2021, Editorial Ciencias Medicas. All rights reserved.
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Spanish Values represent an essential content of moral principles, and are manifested in the modes of action of people in social practice. Is very importan determine the values that need to be strengthened in students from various health careers for the task of facing COVID-19. A descriptive cross-sectional study was carried out with the total number of students from the careers: Medicine, Imaging, Occupational Therapy, Nursing, Neurophysiology, inserted in the research activity. Offices No. 4 and No. 21 Polyclinic: Salvador Allende. Boyeros Municipality. The questionnaire was used as an instrument for data collection, which provided the necessary information on which values need to be strengthened in the students during the actual participation in the assigned mission. Despite the different profiles of health careers, all the students, from their own experience, agreed to during the actual participation in the assigned mission.
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The COVID pandemic has made telematic consultations a basic tool in daily practice. AIMS: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients. The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. METHODS: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. RESULTS: Phone call to 5,619 patients were made with a lack of response of 19%. The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department. Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement. Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. CONCLUSIONS: The cases of 74% of the patients who answered the phone call were resolved virtually. Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests. Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most.
Subject(s)
COVID-19 , Orthopedic Procedures , Orthopedics/methods , Remote Consultation/organization & administration , Traumatology/methods , Humans , Laparoscopy , SpainABSTRACT
TITLE: SARS-CoV-2, nuevo agente causal del síndrome de Guillain-Barré.