Student-teacher out-of-class communication on engineering courses during the COVID-19 pandemic: from face-to-face to videocalls

Out-of-class communication between teachers and students is essential throughout university engineering courses for in-depth explanations of the concepts covered in class. This study evaluates this aspect throughout the COVID-19 pandemic. Thus, a survey that addressed this issue was administered to students at the beginning (March 2020) and at the end (May 2020) of the COVID-19 lockdown in Spain, and at the end of each semester of the 2020/21 and 2021/22 academic years. The results were analyzed with statistical, qualitative, and mixed methods. E-mail usage was widely observed at the beginning of the pandemic, while the use of online videoconferencing tools progressed during that time, thanks to their temporal and spatial flexibility, and the direct and personal nature of student-teacher contact through those channels. Its success was linked to the prior training of teachers in the use of videoconferencing, the establishment of fixed schedules for the meetings, and the use of digital whiteboards that instantaneously display writing when discussing problems. According to the opinions of students, videocalls could be used for questions on theoretical and easy practical aspects despite the resumption of out-of-class face-to-face meetings. Videoconferencing tools for educational communication between engineering students and teachers seem to be here to stay. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Basic monitoring mechanical ventilation in patients with COVID-19, rethinking what we know

During the COVID-19 pandemic, 15% of hospitalized patients have required mechanical ventilation and because the reorganization of health services at COVID-19 centers, a large percentage of health personnel have assumed new functions in the care of the critical patient;situation that makes evident the need to analyze the different techniques, maneuvers and calculations for an adequate assessment and decision-making. A bibliographic review of the topic was made searching for references in Elsevier, Pubmed, SciELO, Medline, Nature, New England Journal of Medicine using the words mechanical ventilation, COVID-19, acute respiratory distress syndrome, lung protection strategy, airway pressures, pulmonary mechanics, published from 2010 to 201 9 in English and Spanish. During the COVID-1 9 pandemic, mechanical ventilation has been a fundamental procedure in the management of severe acute respiratory distress syndrome, becoming indispensable that health personnel who work in COVID-1 9 areas know and understand the different techniques, maneuvers and calculations used to determine the state of the respiratory system in the ventilated patient and apply treatments accordingly.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.

Association between pulmonary extravascular water, dead space, and clinical outcome in intubated patients with COVID ARDS

Introduction: The aim of this study was to determine whether there is an association between extravascular lung water index (EVLWi) and physiological respiratory dead space (VDphys/VT) and to determine if these factors are associated with the possibility to being discharged alive on day 28. Method(s): We analyzed a prospective cohort of patients with COVID ARDS supported with invasive mechanical ventilation (IMV) admitted in our ICU who were monitored with volumetric capnography and transpulmonary thermodilution (TPTD). First day TDTP and VDphys/VT were considered. Bohr-Enghoff formula was used to obtain VDphys/ VT. This protocol was approved by the local IRB and informed consent was waived. Result(s): 31 patients with matched TPTD and VDphys/VT during the first 24 h were analyzed in who EVLWi correlated with VDphys/VT (r = 0.599 p = 0.002), however, EVLWi did not associated with PaFi. Patients with EVLWi > 10 ml/kg had higher APACHE II and VDphys/VT. These patients had a lower cumulative incidence to be discharged alive on day 28 with aHR 7.3 [1.4-39.1] p = 0.02 (adjusted by APACHE II and VDphys/VT, Fig. 1A). Remarkably, patients with EVLWi > 10 ml/ kg + VDphys/VT > 57% had worse outcome compared to those who had EVLWi > 10 ml/kg + VDphys/VT < 57% (25% vs 75%, p = 0.032, Fig. 1B). Conclusion(s): In patients with COVID ARDS supported with IMV, VDphys/VT give prognostic data additional to EVLWi.

Relationship between acne and the use of mask in doctors during the COVID-19 pandemic.

OBJECTIVE: To identify the characteristics of the use of masks and features of acne lesions and acne-like eruptions, among doctors involved in various clinical settings. MATERIALS AND METHODS: An observational, prospective, cross-sectional study was conducted from June to September 2020. The main tool of the study was a form designed with the Google forms platform, which has 17 items. RESULT(S): The responses of 150 participants from Mexico and Latin America were analyzed: 84 participants (56%) were female. The most frequent academic degree among the participants was Doctor of Medicine. The mask with the highest frequency of use was the N95 mask in 98 participants (65.3%);84% of the participants presented typical acne lesions, nodules were the most frequent lesions, only 24 patients did not present characteristic lesions. The topographic region where these lesions most frequently occurred was the chin region. CONCLUSION(S): The importance of the presence of acne and acne-like lesions in medical doctors who use personal protective equipment during their working hours is demonstrated, in order to issue future recommendations related to skin care during the SARS-CoV-2 pandemic.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.

Unleashing the potential of online learning in Spain: An econometric analysis

Online learning and training continue gaining momentum worldwide resulting in the reduction of the traditional form of face-to-face education with its temporal and spatial limitations. Online education improves access to education and training, as witnessed during the Covid-19 pandemic. This article focuses on online education adoption in Spain. A representative survey on ICT use in households conducted annually by the Spanish National Institute of Statistics is used to construct a panel database for the years 2008–2020. The first objective is to provide an econometric model for adopting online education using this panel data. Next is to measure the effects of relevant observable individual socioeconomic variables on adoption. A Heckman selection model allows for estimating the impact of gender, age, education, digital skills, habitat, and income. The article also measures the effects of Covid-19 in 2020 on different population groups. The drivers and impediments have the expected signs and plausible sizes. The paper concludes with policy recommendations and suggestions for further research. © 2023 Elsevier Ltd

Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?

OBJECTIVE: To describe the sequelae one month after hospital discharge in patients who required admission to Intensive Care for severe COVID 19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. DESIGN: Cohort, prospective and observational study. SETTING: Post-intensive care multidisciplinary program. PATIENTS OR PARTICIPANTS: Patients who survived admission to the intensive care unit (ICU) for severe COVID 19 pneumonia from April 2020 to October 2021. INTERVENTIONS: Inclusion in the post-ICU multidisciplinary program. MAIN VARIABLES OF INTEREST: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. RESULTS: 104 patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs 10.4% ONAF); brachial plexopathy (10.7% IMV vs 0% ONAF); decrease in grip strength: right hand 20.67kg (±8.27) in VMI vs 31.8kg (±11.59) in ONAF and left hand 19.39kg (±8.45) in VMI vs 30.26kg (±12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. CONCLUSIONS: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

Revising the Curriculum of Governance Teaching Post COVID-19

Governance has become a common part of teaching curriculums for most business schools, public administration schools and other related faculties. This paper questions the content of governance curriculums taught before COVID-19 pandemic in 5 European countries and provides a comparative assessment. Research findings indicate that apart from teaching general governance courses, governance is most often taught as specific for certain organizational or industrial context. This is followed with governance from perspective of leadership and change management, but also governance within business administration discipline of strategy. However, the intensity of governance as a topic within curriculums differs significantly. Only limited number of curriculums include resilience topics which have proven their importance during COVID-19 pandemic. Findings of this paper can be used to develop unitary and internationalized curriculums on governance studies at European universities in a post COVID-19 world. © 2022, Bucharest University of Economic Studies. All rights reserved.

Motivational Factors for Undergraduate Students During COVID-19 Remote Learning

Pedagogical practices use support of empirical research conducted on students learning in-person, but traditional methods of teaching might not work in times of rapid changes. Globally, courses have switched to online/remote learning and the transition has created challenges to student achievement. The unexpected public safety hazards shifted research focus on the impact of remote learning during COVID-19. Previous interventions including positive reinforcement, negative punishment, perceived control, optimism, and factors of self-determination as single constructs have been used to increase student motivation and engagement. The literature reviewed provides an overview of the impact of previous motivation interventions and the theories used to examine students' motivation. Future implications to design courses incorporating these key five focuses are ideal for student achievement in remote learning. © The Author(s) 2023.

AFFECTIVE CHANGES IN CHILDREN AND ADOLESCENTS: BEFORE AND DURING PREVENTIVE LOCKDOWN BY COVID-19

Objective: To analyze affective changes in children and adolescents between 8 and 16 years of age, before and during COVID-19 lockdown. Materials and Methods: Observational, cross-sectional study with repeated evoked measurement. Under non-probabilistic sampling, 87 voluntary school children and adolescents were surveyed online using the positive/negative affect questionnaire for children, with the addition of sociodemographic questions. Descriptive/associative analysis was performed to determine the behavior of child and adolescent affectivity before and after lockdown. Results: A significant decrease in positive affect during lockdown was observed (Z =-3.073;p=.002), as well as a significant increase in the probability that the previous affective state, positive (OR: 32.1: 95% CI 8.1-127.2) or negative (OR: 10.8: 95% CI 3.9-29.4), would increase the deterioration of present affectivity. Finally, there were no significant changes in negative affectivity before and during lockdown. Conclusions: During lockdown, a deterioration in the perception of emotional well-being associated with a decrease in positive affect was observed, with previous affectivity being a risk factor for the deterioration of well-being perceived by children and adolescents. It is necessary to strengthen the coping capacity of children so that positive affect becomes a protective factor in the face of new catastrophes. © 2022, Universidad de Concepcion. All rights reserved.

Antimicrobial photodynamic therapy and the advances impacted by the association with nanoparticles

Microbial resistance to antibiotics, antifungals, and virucides is one of today's most significant public health problems. Antimicrobial Photodynamic Therapy (aPDT) is a prominent therapeutic strategy for infection control that does not cause microbial resistance to treatment. Its microbial eradication potential is significantly increased when aPDT is associated with nanotechnology. aPDT causes cell death due to photophysical and photochemical events derived from the interaction between a photosensitive agent (PS), a light at an appropriate wavelength, and the oxygen in the medium. Its main product, reactive oxygen species (ROS), leads to the death of microorganisms in and around the irradiated PS. However, the low water solubility, instability, and low microbial internalization of PSs with high quantum yield diminish the effectiveness of the aPDT. Nanoparticles emerge to overcome these limitations. They have been shown to increase the photodynamic activity of PSs and potentially target their delivery to infected sites, increasing the selectivity of the therapy. This review addresses the main constraints of bacteria, fungi, and viruses to the effectiveness of aPDT and discusses how nanotechnology can overcome these difficulties. Current studies that used polymeric, lipid, and metallic nanoparticles associated with aPDT were raised, and the significant advances impacted by them were critically discussed. Among the microorganisms eliminated by nanoparticles-associated aPDT, Methicillin-Resistant Staphylococcus aureus (MRSA) bacteria in planktonic culture and the form of biofilms, and fungi such as Candida albicans, stand out. The nanoparticle-associated aPDT increases the chances of success of oral cavity treatments, such as those that affect the root canal, and cutaneous, such as dermatophytosis. The use of aPDT against viruses such as HSV-1 and HIV, including Sars-CoV-2, has also shown promising results. The selectivity and effectiveness of aPDT are strictly related to the characteristics of the PS-loaded nanoparticle. It is essential to know the microorganism and the place it is installed to select the nanocarrier properly. © 2023 Elsevier B.V.

[Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?] / Valoración multidisciplinar de las secuelas al mes del alta hospitalaria por neumonía grave COVID-19, ¿existen diferencias en función de la terapia respiratoria empleada durante su ingreso en Cuidados Intensivos?

Objective: To describe the sequelae one month after hospital discharge in patients who required admission to intensive care for severe COVID-19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. Design: Cohort, prospective and observational study. Setting: Post-intensive care multidisciplinary program. Patients or participants: Patients who survived admission to the intensive care unit (ICU) for severe COVID-19 pneumonia from April 2020 to October 2021. Interventions: Inclusion in the post-ICU multidisciplinary program. Main variables of interest: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. Results: One hundred and four patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs. 10.4% ONAF); brachial plexopathy (10.7% IMV vs. 0% ONAF); decrease in grip strength: right hand 20.67 kg (± 8.27) in VMI vs. 31.8 kg (± 11.59) in ONAF and left hand 19.39 kg (± 8.45) in VMI vs. 30.26 kg (± 12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs. 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. Conclusions: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

Impact of the COVID-19 pandemic on the diagnosis and treatment of onco-hematologic patients: a discussion paper.

We do not know the precise figure for solid organ tumors diagnosed each year in Spain and it is therefore difficult to calculate whether there has been a decrease in cancer diagnoses as a consequence of the pandemic. Some indirect data suggest that the pandemic has worsened the stage at which some non-hematological neoplasms are diagnosed. Despite the lack of robust evidence, oncology patients seem more likely to have a poor outcome when they contract COVID-19. The antibody response to infection in cancer patients will be fundamentally conditioned by the type of neoplasia present, the treatment received and the time of its administration. In patients with hematological malignancies, the incidence of infection is probably similar or lower than in the general population, due to the better protective measures adopted by the patients and their environment. The severity and mortality of COVID-19 in patients with hematologic malignancies is clearly higher than the general population. Since the immune response to vaccination in hematologic patients is generally worse than in comparable populations, alternative methods of prevention must be established in these patients, as well as actions for earlier diagnosis and treatment. Campaigns for the early diagnosis of malignant neoplasms must be urgently resumed, post-COVID manifestations should be monitored, collaboration with patient associations is indisputable and it is urgent to draw the right conclusions to improve our preparedness to fight against possible future catastrophes.

Evolution and Trends in E-Learning Approaches to STEM, Engineering Education and Corporate Learning: A Bibliometric Analysis to 2021

Since the emergence of "computer-based learning", education has changed forever. This is true not only in academia but also in the engineering industry, as it has changed the way companies train engineers and technicians. Companies generally refer to these technologies as "computer-assisted learning". Academic institutions have applied these new learning approaches to complement traditional classroom presentations. When the Internet became available to individuals, some authors used the term "web-based learning"while others used the term "internet-based learning". Over time, the phrase "e-learning"became a general expression for learning approaches that were different from classroom presentations, which could be synchronous or asynchronous. The terms "online"or "virtual"learning also emerged, but the term "e-learning"predominated, and has now extended to academia and the corporate world. New variants of this concept have been developed, such as "mobile learning"and the combination of a presentation modality with electronic learning has resulted in the development of "blended learning". Since 2020, increasing numbers of publications have been produced in the areas of electronic and blended learning driven by the COVID pandemic and its consequences for education around the world, including engineering. Although publications in the field of engineering education are still led by the USA, we find that STEM publications are led by China. © 2022 IEEE.

Analysis of the Capabilities for Research, Development, and Innovation in Telecommunications Engineering Careears

International organizations notes that the main weakness for innovation in Latin American countries is that their national research organizations only evaluate and stimulate pure academic personnel by publications and citations, forgetting those who work in industry, losing a vast potential in each country. Higher education institutions must increase the development and innovation if they want to contribute to the third mission, which means the economic development of a country, in addition to the traditional advanced education and research, to adapt to new realities for the knowledge-based economies. Commercial war, SARS COV-2, and energy crisis drive policymakers and university managers to rethink and redesign institutions. This work offers an approach to measure the research, development, and innovation capabilities of three telecommunications engineering careers in three Latin American universities in Mexico and Ecuador looking for to increasing capabilities when doing collaboration. Results confirm that the knowledge contribution in engineering is proportional to the number of supported engineering careers, even mapped to national and international rankings. Also is confirmed that research is related to the academic production, but development and innovation are more related to an effective relation to industry. © 2022 IEEE.

Impact of the COVID-19 Pandemic First Wave on Clostridioides difficile Infection

Background. Clostridioides difficile infection (CDI) is the leading cause of nosocomial diarrhea and a costly burden on the healthcare system. The COVID-19 pandemic brought enhanced infection control measures that could hypothetically decrease CDI transmission. Nonetheless, diarrhea secondary to COVID-19 and increased usage of broad-spectrum antibiotics could potentially increase testing for or frequency of CDI. We aimed to assess variations in CDI testing and frequency during the first surge of the COVID-19 pandemic in a tertiary community medical center in the Southern United States. Methods. Records from adult patients were retrospectively reviewed at Princeton Baptist Medical Center, Birmingham, AL. Three groups spanning equal time periods were created based on the CDC COVID-19 rate curves for Alabama: PPG (pre-pandemic, 03/01/2020 to 05/31/2020), PG (pandemic, 06/01/2020 to 08/ 31/2020), and SCG (seasonal control, 06/01/2019 to 08/31/2019). We included patients >= 18 years old and excluded readmissions and follow-up visits. We determined the frequency, testing rates, and positivity rates for CDI in each group to assess their differences. Also, we measured the rate of coinfection between C. difficile and SARS-CoV-2. CDI cases were defined as positive toxin enzyme-linked immunosorbent assay (EIA) and glutamate dehydrogenase (GDH), or positivity of either in addition to positive nucleic acid amplification test (NAAT). Differences in frequencies and rates across groups were compared with Fisher exact test. Results. Overall, 7,252 hospitalized patients and 29,671 outpatients were included (Figure 1). No outpatient CDI cases were detected. Outpatient testing rates were: PPG 3 (0.05%), PG 4 (0.05%), and SCG 9 (0.06%). Among inpatients, 3,912 (53.9%) were female with a mean +/- SD age of 61.2 +/- 17.5 years. Overall, CDI frequency, testing rates, and positivity rates did not vary significantly among all groups (Table 1). Among those tested, the only case of C.difficile/SARS-CoV-2 coinfection corresponded to PPG. Conclusion. There were no statistically significant differences in CDI frequency, or positivity rate between the pre-pandemic, pandemic, and seasonal control groups for inpatients. No CDI cases were detected in outpatients. This is likely due to a low testing rate in our population.

Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care? Valoración multidisciplinar de las secuelas al mes del alta hospitalaria por neumonía grave COVID-19, ¿existen diferencias en función de la terapia respiratoria empleada durante su ingreso en Cuidados Intensivos?

Graphical Objective To describe the sequelae one month after hospital discharge in patients who required admission to Intensive Care for severe COVID 19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. Design Cohort, prospective and observational study. Setting Post-intensive care multidisciplinary program. Patients or participants Patients who survived admission to the intensive care unit (ICU) for severe COVID 19 pneumonia from April 2020 to October 2021. Interventions Inclusion in the post-ICU multidisciplinary program. Main variables of interest Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. Results 104 patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs 10.4% ONAF);brachial plexopathy (10.7% IMV vs 0% ONAF);decrease in grip strength: right hand 20.67 kg (+/- 8.27) in VMI vs 31.8 kg (+/- 11.59) in ONAF and left hand 19.39 kg (+/- 8.45) in VMI vs 30.26 kg (+/- 12.74) in ONAF;and limited muscle balance in the lower limbs (28.6% VMI vs 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. Conclusions The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

Reflections on the COVID-19, a look from the social marketing

Introduction: We are currently experiencing an extremely complex situation worldwide, due to the covid-19 pandemic caused by the SARS-CoV-2 virus, and the use of social marketing in health management has been indispensable as a tool, since it enables changes in the behavior and conduct of individuals or groups in a political, social and economic environment. Development: Marketing in its social approach is a discipline that has multiple applications in health activities, however, through health promotion it acts as a transversal component and is a tool to prevent, promote and improve the quality of life of individuals through social action. During the covid-19 pandemic it has been necessary to implement strategies for behavioral change in users, as well as in health institutions and its evaluation has achieved a positive positioning of ideas and practices among the population. Conclusions: the use of social marketing during this pandemic has been a powerful tool that has helped to control the pandemic through prevention and control, and it is essential that all health professions have the knowledge of social marketing to solve current problems that every day faces public health worldwide.

Use of Kidneys from Hepatitis C Nat Positive Donors for Uninfected Recipients: Early Results from a Rural Appalachian Kidney Transplant Program

Purpose: Increasing mismatch between kidneys available for transplant and the number of patients on the transplant wait list has led to research into novel sources of organs. One such source is kidneys from hepatitis C NAT positive deceased donors. This was previously deemed unforbidden territory due to the risk of disease transmission;however, with the development of direct-acting antiviral agents for effective treatment of Hepatitis C, this organ pool is now usable. Method(s): A retrospective analysis of outcomes of Hepatitis C NAT positive kidney transplants into Hepatitis C seronegative recipients was conducted at newly opened Appalachian transplant center. Due to insurance constraints, the criteria to initiate hepatitis C therapy was seroconversion to positive Hepatitis C PCR. Outcomes examined include median creatinine, glomerular filtration rate (GFR), liver function tests, recipient Hepatitis C seroconversion, concomitant Ebstein Barr virus (EBV), Cytomegalovirus (CMV) or polyoma hominis (BK) activation, morbidities and mortality. Result(s): Six transplants (of 15 total kidney transplants) from Hepatitis C NAT positive donors were performed in the first year of establishment. Male to female ratio was 2:1 and median patient age was 55.7 years (Range 42-73 years). Median follow-up was 10 months (Range 2-12 months). Diabetes and hypertensive nephrosclerosis were the most common causes of end stage renal disease at 40%. The average time on dialysis was 2.9 years (Range 1-6 years), the most common type being hemodialysis (67%) followed by peritoneal dialysis (33%). Average time on transplant waitlist was 5.57 months (Range 1.2-13.2 months). All patients seroconverted but with treatment, by 24 weeks all patients maintained undetectable viral loads. Patient survival rate was 83% with a death censored graft survival rate of 100%. One patient died due to respiratory failure from COVID-19 infection. Median creatinine and GFr were 1.96 mg/dL (Range 1.8 - 2.6 mg/dL) and 41.3 (Range 35.3 - 50) respectively. One case each of acute antibody and T cell mediated rejection was seen (6.7%), which were treated successfully. CMV, BK and EBV virus reactivation were seen in one patient each (6.7%). The most common complication was COVID-19 infection (50%) followed by neutropenia (33%). Conclusion(s): With the development of direct-acting antiviral agents offering complete cure of Hepatitis C, kidneys from Hepatitis C positive donors can be used for transplantation with excellent outcomes.

Successful Implementation of a Rural Appalachian Kidney Transplant Program, One Year Outcomes

Purpose: Kidney transplantation has become the optimal treatment for end stage renal disease (ESRD), allowing dialysis free survival. Despite widespread availability of transplant programs;rural patients have limited access to transplantation due to several barriers including increased travel time and financial burden. We report outcomes after establishment of a kidney transplant program serving rural West Virginia. Method(s): A retrospective review of the first 15 kidney transplants performed at a newly established Appalachian transplant program was conducted. Primary outcomes measured were graft survival and function. Other outcomes included graft rejection, patient survival and complications. Data related to patient demographics, etiology of ESRD, type of renal replacement therapy, time on transplant waitlist and average travel to transplant center were also collected. Result(s): The first 15 kidneys transplanted had an overall death censored graft survival rate of 100%. Median patient age was 53 (Range 31- 73 years) and a median follow-up of 6 months (Range 1-13 months). The average time on dialysis for this cohort was 4 years (n=13, Range 1-6 years) and average time on waitlist was 4.06 months (Range 0.4-13.2 months). The most common type of dialysis was hemodialysis (77%) followed by peritoneal dialysis (15%). Two patients were predialysis. Diabetes with hypertension (20%), IgA nephropathy (13%) and diabetes without hypertension (13%) were the most common causes of ESRD. Median graft creatinine was 1.51 mg/dL (Range 1.26 - 1.83 mg/dL) with a glomerular filtration rate (GFR) at 51.38 (Range 41.86-70) at one year. One patient developed acute antibody mediated rejection and one developed borderline T cell mediated rejection (13.3%), which were successfully treated with steroids, plasmapheresis and immune globulin therapy. Two patients died (13.3 %);one from acute respiratory failure following coronavirus (COVID-19) infection and one from cardiac arrest secondary to myocarditis (possible COVID-19). Patients experienced COVID-19 infection at a rate of 13.3 %. The average distance patients had to travel was 94 miles (Range 12 - 164 miles) with a travel time of 1 hour and 52 minutes on average (Range 20 minutes - 2.5 hours) to reach the transplant center. Conclusion(s): We report comparable outcomes from our new rural transplant program despite several barriers to delivery of quality care to our population.