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BACKGROUND: Barotrauma is a lesion generated for changes in the pressure and/or volume within a specific anatomic way;pneumo-mediastinum and pneumothorax are clear samples of this effect, frequently related to infectious symptoms. CLINICAL CASES: Two clinical cases are presented, 34 and 44 years old, that had pneumonia due to COVID-19, with subsequent exacerbation of the symptoms caused by barotrauma. Patients were evaluated at emergency unit of the Hospital Angeles Pedregal, Mexico City;their clinical presentation was similar and was unleashed by repeated cough in the context of pneumonia due to SARS-CoV-2. CONCLUSION(S): Now there is more experience on the complications associated during COVID-19, although more cases must be study to know their prognostic meaning and, in case it becomes a progression marker of the illness, to establish specific measures and therapeutic recommendations. The presentation of pneumonia stands out despite the vaccination, having to get the general population make consciousness of continuing with measures of respiratory isolation.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.
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Introduction: Peritonitis associated with peritoneal dialysis (PD) has complications such as transfer from PD to HD and increased morbidity and mortality. In our environment, there is little information regarding survival in this population. Method(s): Retrospective cohort, 147 PD patients, 18 years, with PD catheter removal between 2018-2021. Clinical, biochemical and technique-related variables were measured. Patients who died of cancer and other unrelated causes were excluded. Descriptive statistics, Kaplan-Mayer analysis and Cox regression analysis were used Results: Age 42 +- 17 years, 65% men, 65% unknown cause of CKD. The time between peritonitis diagnosis and catheter removal was 37 (25-61) days. Nine patients (6%) returned to PD, the rest (94%) remained on HD due to unfit abdomen (55%), patient decision (9%), unknown (17%), others (19%). Mortality was 31% and the causes of death were: sepsis (33%), COVID-19 (29%), pneumonia (19%), pulmonary edema (5%), hyperkalemia (5%), CVD (5%), others (4%). Survival after the refractory peritonitis event was 25 (95% CI 22-28) months. Survival at 3, 12, 24, and 36 months was 87%, 71%, 61%, and 35%. In the bivariate analysis, age, DM, time on dialysis, and serum albumin were associated with a higher risk of death. However, in the multivariate analysis, only time on dialysis was significant (OR 1.014, 95% CI 1.002-1.027). [Formula presented] Conclusion(s): Mortality was 31% and the most frequent cause of death was sepsis. Patient survival was 25 (95% CI 22-28) months. Time on dialysis was associated with a higher probability of death. It is necessary to compare these results with a group of patients who do not present failure of the technique. No conflict of interestCopyright © 2023
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Background: Kidney damage in COVID-19 patients has been of special concern. Kidney function after COVID-19 has not been comprehensively studied, and there is scarce information comparing kidney function among patients with or without AKI during hospital admission. Method(s): Retrospective cohort study in a secondary level center in Guadalajara, Mexico. Patients who were admitted due to COVID-19 from April-December 2020 and who survived at discharge and who had at least one follow-up visit in the outpatient clinic 6 months after initial symptoms were included. Information was obtained from outpatient electronic medical files. Result(s): From a total of 1085 patients, 733 survived at discharge. 113 had AKI during admission and only 33 (29.2%) had any kind of outpatient follow-up. Their mean age was 60.6 years, 63.6% were men, 48.4% had DM and 66.6% had HTN. Mean baseline SCr was 0.82 mg/dL with a mean eGFR of 90.82 ml/min. On follow-up mean stable SCr increased to 1.49 mg/dL, with a mean eGFR of 65.71 ml/min, a mean decrease of 25.11 ml/min. 15 patients (45.45%) developed CKD and 1 patient (3.03%) started RRT. Mean follow-up time was 451 days. 34 patients with no AKI during admission had a follow-up visit;mean age was 58.1 years, 58.8% were men, 47.1% had DM and 70.6% had HTN. Mean baseline SCr was 0.78 mg/dL and mean eGFR was 92.33 ml/min. On follow-up mean stable SCr increased to 0.86 mg/dL, with a mean eGFR of 86.64 ml/min, a mean decrease of 5.69 ml/min. 1 patient (2.94%) developed CKD and none required to start RRT. Mean follow-up time was 468 days. Conclusion(s): AKI during COVID-19 was associated to a significant decrease in eGFR on follow-up. Those with COVID19 without AKI during admission also had a small decrease in eGFR on follow-u. Timely and more intense follow-up strategies after COVID19 and AKI are needed.
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With the Covid-19 pandemic outbreak, the demand for high-quality, low-cost, and safe use equipment for disinfecting hospitals, offices, schools, restaurants, supermarkets, etc., is growing. Although for years it has been known that the ozone produced by the UV-C technology irradiation is highly germicidal, its commercial use for enclosed spaces disinfection as a source of bacteria and viruses' infections is recent. Motivated by the above, this article introduces a low-cost ozone and UV-C light-emission portable device to satisfy the growing demand for disinfection of enclosed and unoccupied spaces. gLAMP, the proposal of this work, offers users a safe-to-use disinfection process by incorporating a pair of sensors into the design to measure air quality, keep users out of the risk area and streamline the ozone diffusion and ventilation processes in the area to be disinfected. As well as a mobile application to control and monitor the equipment and disinfection service remotely. Preliminary tests were carried out to verify the functionality of gLAMP and its potential commercial impact. © 2022 ACM.
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Introduction: In the context of the pandemic generated by SARS-CoV-2, clinical teaching has undergone important changes, from the cancellation of learning activities and reduction of rotations in the services, to the implementation of measures that allow students to continue learning. Objective: To gain knowledge on the perception of patients, evaluators and first-year resident physicians in the specialty of family medicine, when performing a Web-ECOE. Methods: Qualitative analysis. Population: four standardized patients, four trained evaluators and 20 resident physicians from 10 academic sites. Results: Patients expressed that this modality of medical care is adequate and the feedback experience was positive, the evaluators commented that it’s an area of opportunity for them and the residents, and that medical care could be granted under this online concept, the residents perceived this strategy as adequate for their assesment, however, they agree on the limitation of the physical examination. © 2022, Universidad Nacional Autonoma de Mexico. All rights reserved.
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The first wave of the COVID-19 crisis dramatically affected the global population. Madrid was one of the most severely affected regions in Spain. For public health reasons, family visits to hospitalized patients were restricted, preventing relatives from accompanying them. This article details the descriptive study that we carried out on the emotional support program offered to relatives of patients admitted during the first wave at Hospital Puerta de Hierro. A total of 456 relatives (mostly female, usually spouses or sons or daughters of patients) were contacted. Relatives of ICU patients and female relatives required broader levels of support. Increasing the perception of care through an emotional support program can be important for family members. Nevertheless, we consider additional studies to be necessary to explore the specific psychological benefits that these interventions provide.
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Background: Pts with malignancies are at risk for developing severe complications of COVID19 with high mortality rate. We retrospectively analyzed COVID-19 related outcomes for hospitalized pts with SMs. Methods: We collected data on hospitalized pts with SMs and COVID-19 from 3/1/20 to Jan 1/1/21. Diagnosis COVID-19 was confirmed by RT-PCR of nasopharyngeal swabs. We assessed the association between the 30-day mortality and potential prognostic variables such as tumor types, cancer status, timing of treatment, types of anticancer therapy using logistic regression analyses. Results: A total of 246 hospitalized pts with SMs had COVID-19. Median age was 70 years, 87 (35%) were ≥75 years, 151 (61%) were female. The most common SMs were breast (56 [23%]), non-small cell lung (44 [18%]) and colon (31 [13%]). 154 (63%) pts were on active anticancer therapies. Of those 88 (35.5%) received treatment within 2 weeks, 16 (16.5%) within 4-12 weeks, 99 (39.9%) >3 months prior to COVID-19 diagnosis. 101 (65%) pts received cytotoxic chemotherapies, 26 (16.8%) received immune check point inhibitors (ICIs), 17 (11%) received targeted agents such as anti-EGFR therapy and 11 (7.1%) received monoclonal antibodies. Overall 30-day mortality was 42%, however, all pts with melanoma (7/7) died. The 30-day mortalities for pts who received anticancer treatments within 4 weeks, 4-12 weeks and >12 weeks of COVID-19 diagnosis were 47%, 50%, and 37%. For pts who never received treatment, 30-day mortality was 31%. For pts were in remission, stable disease and progressive disease, the 30-day mortalities were 32%, 35% and 62%. The 30-day mortalities for pts who received cytotoxic therapy, monoclonal antibodies, targeted therapies and ICIs, were 38%, 46%, 41% and 69%. Logistic regression analysis showed that pts who were >80 years of age (OR 3.6, 95% CI 1.6-8.1), had progressive disease (OR 3.4, 95% CI 1.8-6.5) or treated with ICIs (OR 3.6, 95% CI 1.5-8.7) were associated with higher 30-day mortality. Conclusions: COVID-19 associated 30-day mortality is high for hospitalized pts with SMs. Early surveillance of clinical deterioration could be helpful for hospitalized SMs pts with risk factors identified here. Further studies are needed to discern the observed association between ICIs use and worse COVID-19 outcome. (Table Presented).
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Background: Coronavirus Disease 2019 (COVID-19) is a new disease of pandemic proportions. Currently, there are no reports about kidney involvement and the association with mortality in Mexico. Our aim was to describe the characteristics in our population, clinical and renal outcomes. Methods: Prospective, descriptive, single-center study in patients diagnosed with COVID-19 (positive RT-PCR tests), admitted to our hospital from April 2020 to date. Results: 48 patients (60.41% men) with an average age of 54.33 years were included. 23 (47.9%) had a previous diagnosis of HTN and DM, 11 (22.9%) had obesity, 5 (10.4%) had neurological diseases, 4 (6.3%) had heart disease, 3 (6.3%) had malignancies and 1 (2.1%) had liver disease. 9 (18.8%) patients with a history of smoking. At admission, the mean oxygen saturation was 85.76%. The main reason for consultation was dyspnea in 35 patients (72.9%). Regarding symptoms, 81.3% (39) had dyspnea, 87.5% (42) fever, 54.2% (26) headache, 72.9% (35) cough and, to a lesser extent, odynophagia, myalgia and malaise in 33.3% (16), 45.8% (22) and 41.7% (20) respectively. The mean creatinine, urea and bicarbonate was 1.34 mg/dl, 56.69 mg/dl, and 18.49 mmol/l respectively. 25% of the patients required ICU admission and 27.1% mechanical ventilation. During the study period, 19 patients (39.6%) developed AKI, 20.8% classified as KDIGO stage 1 and 18.8% as stage 3. At the end of this study, 56.3% (27) had a complete recovery, 35.4% (16) died and 8.3% (5) are still admitted. Regarding the patients that had an AKI, 6 (31.57%) had a complete recovery, 3 (15.7%) required intermittent HD but eventually died, for a total of 13 death patients (68.4%). There was a statistically significant difference in mortality between patients with AKI vs patients with normal kidney function (p=0.002), with a RR of 3.47. Conclusions: This study showed a higher prevalence of AKI in the Mexican population compared to reports from other countries, with a significantly higher risk for death. Special attention should be paid to this outcome and as nephrologists, we must take an active role in the care of these patients.
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Background: Coronavirus disease 2019 (COVID-19) is a new disease of pandemic proportions. There are only a few reports about urinary abnormalities in this disease, and to our knowledge there are no reports about the usefulness of urinary sediment on prognosis. Our aim was to describe the urinary abnormalities in COVID-19 and to assess the utility of urinary sediment on prognosis in COVID-19. Methods: Prospective, single-center study, in patients diagnosed with COVID-19 (with a positive RT-PCR test), who were admitted in our hospital, from April 2020 to date, and whose urine sample could be obtained at admission to the isolation wing. Results: 22 patients were included;17 (77.3%) had proteinuria, 12 (54.5%) had microscopic hematuria, and 9 (40.9%) had leukocyturia. Granular casts (with a Chawla cast scoring index greater than 3) were present in 8 (36.4%) patients. Of the 8 patients with granular cast, 6 developed an AKI (75%), 2 required Hemodialysis (25%) and 3 died (37.5%). Of the 14 patients whose urinary sediment was classified as bland, 5 developed an AKI (35.7%), none of them required hemodialysis, and 2 subsequently died (14.2%). There was a statistically significant difference between a bland urinary sediment and a sediment showing granular casts for the need of hemodialysis or death (p=0.02), with a positive LR of 3.5. Conclusions: The urinary sediment is a cheap, available tool for the prognosis of need for hemodialysis or death in patients diagnosed with COVID-19, and should be taken into consideration in the assessment of these patients by the Nephrology department.