Hematoma of the rectus abdominis sheath in the course of COVID-19

Introduction: Spontaneous abdominal wall hematoma is a rare clinical entity in medical practice. In the context of COVID-19, intra-abdominal hematoma presented as a complication of the imposed therapy and was not taken into consideration when making the differential diagnosis of abdominal pain and arterial hypotension. Objective: To report the appearance of rectus abdominis sheath hematoma as a complication of the use of anticoagulants in the course of COVID-19 treatment. Clinical case: A 71-year-old patient with COVID-19 is presented who was receiving anticoagulant treatment and began with acute abdominal pain, with abdominal ultrasound that was inconclusive, laparotomy was performed and a large hematoma was found in the abdominal Retzius space. She evolved favourably and is discharged after 7 days. Conclusions: The trans-operative diagnosis together with the drainage of the hematoma and the opportune fluid therapy allowed a favourable evolution and the recovery of the patient. © 2023, Editorial Ciencias Medicas. All rights reserved.

[Castellon Field Hospital: comprehensive analysis of its use during the SARS-CoV-2 pandemic.]

OBJECTIVE: Field hospitals, also known as alternative care sites, have been an important healthcare reinforcement during the SARS-CoV-2 pandemic worldwide. In the Valencian Community, three of these hospitals were opened, one for each province. Our study aimed to make a comprehensive analysis of this resource in Castellon. METHODS: A retrospective observational study was carried out with an analytical and statistical component of 3 aspects: infrastructure, satisfaction and clinical data from COVID-positive hospitalized patients. The sources of information were primary, institutional for the infrastructure and personal for the satisfaction surveys and clinical data. RESULTS: A set of 6x3 metres polyvalent tents was chosen, which joined formed a single-floor area of about 3.500 m2. Although hospital opened for approximately a year and a half with multiple uses, most in relation to the COVID pandemic (vaccination center, emergency room observation, hospital assistance, warehouse...), reception of positive patients for the virus began during the third wave of the pandemic, remaining active for eleven days. A total of thirty-one patients with a mean age of 56 years were admitted. 41.9% did not have any comorbidity and 54.8% needed treatment with oxygen therapy. Furthermore, the length of stay was three days, finding a significant relationship between this one, the oxygen flow required during admission and the age. Satisfaction was measured by a survey of seventeen questions where an average satisfaction of 8.33/10. CONCLUSIONS: This is one of the few studies in the literature in which a field hospital is analyzed from such different points of view. After this analysis, it is concluded that it is an extraordinary and temporary resource whose use is useful without reflecting an increase of morbidity/mortality among our patients and with a very favorable subjective assessment.

[Castellón Field Hospital: comprehensive analysis of its use during the SARS-CoV-2 pandemic.]

OBJECTIVE: Field hospitals, also known as alternative care sites, have been an important healthcare reinforcement during the SARS-CoV-2 pandemic worldwide. In the Valencian Community, three of these hospitals were opened, one for each province. Our study aimed to make a comprehensive analysis of this resource in Castellon. METHODS: A retrospective observational study was carried out with an analytical and statistical component of 3 aspects: infrastructure, satisfaction and clinical data from COVID-positive hospitalized patients. The sources of information were primary, institutional for the infrastructure and personal for the satisfaction surveys and clinical data. RESULTS: A set of 6x3 metres polyvalent tents was chosen, which joined formed a single-floor area of about 3.500 m(2). Although hospital opened for approximately a year and a half with multiple uses, most in relation to the COVID pandemic (vaccination center, emergency room observation, hospital assistance, warehouse...), reception of positive patients for the virus began during the third wave of the pandemic, remaining active for eleven days. A total of thirty-one patients with a mean age of 56 years were admitted. 41.9% did not have any comorbidity and 54.8% needed treatment with oxygen therapy. Furthermore, the length of stay was three days, finding a significant relationship between this one, the oxygen flow required during admission and the age. Satisfaction was measured by a survey of seventeen questions where an average satisfaction of 8.33/10. CONCLUSIONS: This is one of the few studies in the literature in which a field hospital is analyzed from such different points of view. After this analysis, it is concluded that it is an extraordinary and temporary resource whose use is useful without reflecting an increase of morbidity/mortality among our patients and with a very favorable subjective assessment.

COVID-19 PANDEMIA: ECONOMIC IMPACT AND ANTICYCLICAL POLICIES. SIMULATIONS BASED ON A COMPUTABLE GENERAL EQUILIBRIUM MODEL OF ARGENTINA

A computable general equilibrium model of Argentina was adapted to analyze the impact of the Covid-19 pandemia on the economy and to assess the mitigating effects of anticyclical policies. The simulations are consistent with the observed performance of GDP, unemployment and social welfare. The anticyclical program is effective in reducing the short term adverse impact on several economic and social indicators, particularly, on social welfare. But over the medium and long term, smaller capital accumulation and sovereign indebtment imply lower growth and welfare. A sustainable fiscal policy –that stabilizes the debt-GDP ratio– allows the economy to, through higher investment and employment creation recover the base scenario levels (only) after 10 years. © 2023, Revista de Analisis Economico. All Rights Reserved.

Evolucion De La Epidemiologia De La Enfermedad Celiaca E Impacto De La Covid19. Resultados Preliminares Del Plan Nacional De Enfermedad Celiaca-Ciberehd

Introduccion: Se ha reportado que tanto la prevalencia como la incidencia de la enfermedad celiaca (EC) estan aumentando a nivel mundial. Este aumento podria ser atribuido a infecciones viricas como desencadenante de la EC, entre otros factores. La COVID-19 ha impactado de lleno en la realizacion del estudio de prevalencia del Plan Nacional de EC promovido por el CIBERHED. Se ha sugerido que SARS-CoV-2, que penetra por via digestiva, podria desencadenar brotes de EC. Objetivos: 1) Evaluar la prevalencia actual de EC en comparacion con la de la cohorte 2004-2009. 2) Evaluar el impacto de la COVID-19 en la prevalencia actual de EC. Metodos: Desde enero 2021 hasta la actualidad se han incluido 1886 individuos de entre 1 y 90 anos atendidos por cirugia menor en los 6 hospitales participantes (Hospitales Universitarios (HU) Mutua Terrassa- Sant Joan de Deu, HU Virgen del Rocio, HU Central de Asturias, HU Galdakao-Cruces y HU Fundacion Jimenez Diaz) (calculo muestral: 5.300). La inclusion se realiza ajustada por edad y sexo a la piramide poblacional. Se determinan Ac. antitransglutaminasa (tTGA) y en los casos positivos se confirma el diagnostico segun guias de consenso. Se reporta la prevalencia serologica (tTGA > 7 U/ml) mas los casos prevalentes previamente diagnosticados. La relacion entre COVID19, registrada mediante cuestionario, y los casos positivos (tTGA > 7 U/mL y tTGA zona gris 2-7 U/mL) se ha evaluado mediante prueba exacta de Fisher. Resultados: Se han detectado 11 sujetos con serologia positiva y 2 pacientes con diagnostico previo de EC;prevalencia 6,89 x 1.000, IC95% 3,68-11,76. En comparacion con la prevalencia de la cohorte (2004-2007), 5,67 x 1.000, no existen diferencias significativas. Se han detectado 3 casos con serologia tTGA positiva y COVID-19 sobre un total de 335 pacientes infectados y 8 casos con serologia tTGA positiva sin COVID-19 sobre un total de 1.547 individuos no infectados (p = 0,4247). Tampoco se ha encontrado relacion entre COVID-19 y valores de serologia en la zona gris. Conclusiones: No se detecta un incremento de la prevalencia de EC en las ultimas dos decadas en nuestro medio. La infeccion por COVID19 no ha tenido impacto en la aparicion de nuevos casos de la enfermedad.Copyright © 2023 Elsevier Espana, S.L.U. Todos los derechos reservados.

Educational Challenges and Motivational Orientations in College Students from the Health Sciences Department during the COVID-19 Pandemic

Online classes have become one of the main teaching methods in higher education during the pandemic, which has forced students to adapt themselves to keep their motivation in the face of different educational challenges that have not been fully resolved. The objective of the study was to describe the educational challenges and motivational orientations of college nursing students during the COVID-19 pandemic. Through a descriptive type design, the researchers applied a standardized questionnaire to 300 Mexican university students. As the main discoveries, it was found that students mostly face technological challenges, followed by socio -affective ones. However, the motivational orientation towards learning predominates among students, where the educational context is a determinant of the teaching-learning process. Hence, the authors concluded that motivation (learning orientation) favors learning and acts as an essential intermediary during online learning. Moreover, the transfer from face-to-face education to online teaching has complicated the processes of integration and adaptation for students. The former occurs while educational challenges have become more acute in a pandemic context, and where technological and socio-affective categories represent the elements students must face. Therefore, the researchers recommend a correlational study to provide a better understanding of the possible relationship between the two studied variables. In addition, in the future, different qualitative methods could be used to further explore the meaning of different motivational orientations in online educational environments under different conditions.

[Analysis of infectious diseases care in Spanish hospitals from 2016-2020, including the first year of the SARS-CoV-2 pandemic]. / Análisis de la atención a patologías infecciosas en los hospitales españoles en el periodo 2016-2020, incluyendo el primer año de pandemia por SARS-CoV-2.

Aims: This work aimed to review patients discharged from Spanish hospitals with a principal diagnosis of infection during a 5-year period, including the first year of the SARS-CoV-2 pandemic. Materials and method: This work analyzed the Basic Minimum Data Set (CMBD) of patients discharged during the 2016-2020 period from hospitals in the Spanish National Health Service in order to identify cases with a principal diagnosis of an infectious disease according to the ICD-10-S code. All patients older than 14 years of age admitted to a conventional ward or intensive care unit, excluding labor and delivery, were included in the analysis and were evaluated based on the discharging department. Results: Patients discharged with infectious diseases as the principal diagnosis have increased from 10% to 19% in recent years. A large part of the growth is due to the SARS-CoV-2 pandemic. Internal medicine departments cared for more than 50% of these patients, followed by pulmonology (9%) and surgery (5%). In 2020, 57% of patients with a principal diagnosis of infection were discharged by internists, who cared for 67% of patients with SARS CoV-2. Conclusions: At present, more than half of patients admitted with a principal diagnosis of infection are discharged from internal medicine departments. Given the growing complexity of infections, the authors advocate for an approach in which training allows for specialization, but within a generalist context, for the better management of these patients.

Echocardiographic phenotype and prognostic value of relative apical sparing of longitudinal strain pattern in severe aortic stenosis with and without cardiac amyloidosis. The AMYTAVI study

Introduction: It is estimated that 15% of patients with AS have concomitant cardiac amyloidosis (CA). Left ventricular (LV) longitudinal strain (LS) pattern with relative apical sparing (RELAPS>1), shown as bright red in the apical segments on the polar map, has been strongly associated with CA. Its presence and its significance in AS is yet to be determined. Purpose(s): To determine the prevalence of the RELAPS>1 pattern in patients with severe AS with and without concomitant CA, and to analyze the echocardiographic phenotype associated with this strain pattern and its prognostic value. Method(s): Patients with severe symptomatic AS undergoing TAVI were prospectively and consecutively included between Jan-19 and Dec-20. Pre-procedure, a complete echocardiogram was performed that included deformation parameters using Speckle-Tracking. Strain derived Indices accepted for CA screening were calculated: RELAPS: Relative apical LS (average apical LS/average basal+mid LS);SAB: (apical-septal/basal-septal LS);EFSR: (LVEF/GLS). After TAVI, a 99Tc-PYP scintigraphy and a proteinogram were performed to screen for CA. Result(s): 324 patients were included. The mean age was 81 yo, 52% women. Strain analysis could be performed in 243 patients due to acoustic window and covid19 pandemic restrictions. Among those, 111 (46%) presented relative apical sparing (RELAPS>1). There were no differences in clinical characteristics between patients with RELAPS <1 and >1: Similar age, sex, cardiovascular risk factors and funcional class, renal function or NT-proBNP. Among patients with RELAPS>1 there was more frecuently CA with uptake grade 2 and 3 on scintigraphy (15% vs. 4.5%, P=0.006) (Figure 1). RELAPS>1 group showed greater LV hypertrophic remodeling: Thicker myocardial wall with smaller ventricular cavity, especially concentric hypertrophy;LVEF and GLS was similar, however, MAPSE and myocardial contraction fraction (MCF) were worse in RELAPS >1 group, and EFSR was significantly higher (4.2 vs 3.9, p=0.002). RELAPS >1 group had smaller aortic valve area (AVA: 0.6 vs 0.7 cm2, p=0.045), but similar transvalvular gradients due to lower stroke volume. It had larger atria and less left atrial (LA) fractional emptying, as well as higher prevalence of atrial fibrillation (AF: 41% vs 27%, p=0.03). Right ventricle (RV) size were similar, however, RV function was worse in RELAPS >1 group (TAPSE: 19 vs 21 mm, p=0.003;free Wall LS: -24 vs -27%, p=0.008). There was no difference in all-cause mortality at 1 year of follow-up between groups (6.4% vs. 6.3%, p=1). Figure 2 represents the morphological characteristics according to the LS phenotype. Conclusion(s): In severe AS, RELAPS >1 is present in almost half of the patients. It is associated with worse cardiac remodeling, as well as higher prevalence of AF. However, it wasn't associated with higher mortality at 1 year. 1 in 7 patients with AS and RELAPS >1 have concomitant ATTR CA grade 2/3.

Clinical outcome of patients with severe malignant pericardial effusion due to neoplastic disease undergoing percutaneous balloon pericardiotomy during COVID-19 pandemic

Background: Neoplastic pericardial effusion (NPE) is a serious complication that occurs in the setting of advanced oncological disease and is associated with a high recurrence rate. Currently, pericardiocentesis (PCT) remains the first therapeutic option and the use of percutaneous balloon pericardiotomy (PBP) is limited to the treatment of recurrences. However, it is not known whether some aspects of the procedure during PBP lead to different outcomes in terms of survival and recurrence, and no such patients have been included in studies during COVID-19 pandemic. Purpose(s): The aim is to analyses the success, complications and recurrence rate (defined as recurrence of NPE requiring PCT, PBP or surgical pericardial window (SPW) of both procedures (BP) in order to establish the optimal entry treatment for these patients. Method(s): This research analyzed the clinical characteristics and prognostic factors of patients with severe pericardial effusion of neoplastic etiology who underwent PBP during the COVID-19 pandemic. A prospective study was conducted involving 23 patients admitted between January 2020 and January 2022 for severe NPE who underwent PCT or PBP as initial treatment of NPE. Result(s): We included 23 patients, 62.9% were male with a mean age of 51.2+/-14.9 years NPE was the first manifestation of the oncological process in 12 patients (52.1%) with lung cancer being the most frequently associated primary cancer (58.7%) followed by breast cancer in 12.7% of cases. A total of 26 procedures were performed, 10 PCT, 15 PBP, 1 SPW, with tumors cells identified in the pericardial fluid in 13.0% of cases. PCT was used as an entry point in 10 patients (43.5%), 6 patients were COVID-19 positive and PCT was performed as the first treatment. While PBP was chosen as the first therapeutic option in 13 patients (56.5%) (2 Re-PBP). The initial efficacy of the procedure was 93.1% and 92.2% respectively (p=0.88), with 1 complication occurring in the PBP group but not requiring scheduled SPW. In the former group, the percentage of recurrences was higher (34.7%;8 recurrences in 10 patients) compared to patients treated with upfront PBP (8.6%;2 recurrences in 13 patients), p=0.09. In addition, only one patient had to resort to surgery. When analyses according to the BP. used, the recurrence rate was 4.0 times higher for PCT (34.7 vs. 8.6% recurrences), although without reaching statistical significance (p=0.16). Conclusion(s): The PBP is a simple, safe and effective technique for the treatment of NPE during the COVID-19 pandemic, in our series it was associated with a lower recurrence rate. Therefore, it could replace PCT in these patients during the COVID-19 pandemic as optimal first line treatment, providing better quality of life and reducing the need for re-interventions. (Figure Presented).

Application of big data analytics in the COVID-19 pandemic: Selected problems

The coronavirus disease 2019 (COVID-19) pandemic enabled many governments around the globe to test and apply big data-based tracing technologies and various big data-driven tools to curb and monitor the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. The regular procedures of data and privacy protection were partially sacrificed to fight the pandemic. For the public health safety, all incidents of COVID-19 are considered of being hazardous, uncertain, and sudden. If a government can continuously and efficiently collect big data from various sources and apply suitable and efficient analytical methods, it might instantly respond to the public health threats by executing optimal decisions to slow the spread of the pandemic and for a fast return to normality. A specific framework is presented as a multidimensional recommendation for the efficient utilization of big data analytical technologies to control and prevent pandemics and epidemics. The recommendations and challenges with regard to employing big data for combatting COVID-19 are being discussed along with the background information. © 2023 Elsevier Inc. All rights reserved.

In-person versus virtual administration of the American College of Rheumatology gold standard cognitive battery in systemic lupus erythematosus: Are they interchangeable?

OBJECTIVE: During the COVID-19 pandemic, many research studies were adapted, including our longitudinal study examining cognitive impairment (CI) in systemic lupus erythematosus (SLE). Cognitive testing was switched from in-person to virtual. This analysis aimed to determine if the administration method (in-person vs. virtual) of the ACR-neuropsychological battery (ACR-NB) affected participant cognitive performance and classification. METHODS: Data from our multi-visit, SLE CI study included demographic, clinical, and psychiatric characteristics, and the modified ACR-NB. Three analyses were undertaken for cognitive performance: (1) all visits, (2) non-CI group visits only and (3) intra-individual comparisons. A retrospective preferences questionnaire was given to participants who completed the ACR-NB both in-person and virtually. RESULTS: We analysed 328 SLE participants who had 801 visits (696 in-person and 105 virtual). Demographic, clinical, and psychiatric characteristics were comparable except for ethnicity, anxiety and disease-related damage. Across all three comparisons, six tests were consistently statistically significantly different. CI classification changed in 11/71 (15%) participants. 45% of participants preferred the virtual administration method and 33% preferred in-person. CONCLUSIONS: Of the 19 tests in the ACR-NB, we identified one or more problems with eight (42%) tests when moving from in-person to virtual administration. As the use of virtual cognitive testing will likely increase, these issues need to be addressed - potentially by validating a virtual version of the ACR-NB. Until then, caution must be taken when directly comparing virtual to in-person test results. If future studies use a mixed administration approach, this should be accounted for during analysis.

Acute Coronary Syndrome during the Era of Covid-19: Perspective and Implications Using Google Trends

Background Acute coronary syndrome (ACS) hospital admissions decreased during the start of the COVID-19 outbreak. There is limited information on how Google searches related to patients behavior during this time. Methods We examined de-identified data from 2019 through 2020 regarding monthly: 1) admissions for ACS from the Veterans Affairs Healthcare System;2) out of hospital cardiac arrest (OHCA) from NEMSIS public dataset;and 3) Google searches for "chest pain", "coronavirus", "chest pressure", and "hospital safe" from Google Trends. We analyzed the trends for ACS admissions, OHCA, and Google searches. Results During the early months of the first COVID-19 outbreak: 1)Veterans Affairs data showed a significant reduction in ACS admissions at a national and regional (Florida) level (Figure 1);2) NEMSIS database showed a marked increase in OHCA at a national level;and 3) Google Trends showed a significant increase in the before mentioned Google searches at a national and regional level. Conclusion ACS hospital admissions decreased during the beginning of the pandemic likely due to delayed healthcare utilization secondary to patients fear of acquiring COVID-19 infection. Concordantly, Google searches for hospital safety and ACS symptoms increased along with OHCA events during this time. Our results suggest that Google Trends may be a useful tool to predict patients behavior and increase preparedness for future events, however, statistical strategies to establish association are needed. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

A space-time model for analyzing contagious people based on geolocation data using inverse graphs

Mobile devices provide us with an important source of data that capture spatial movements of individuals and allow us to derive general mobility patterns for a population over time. In this article, we present a mathematical foundation that allows us to harmonize mobile geolocation data using differential geometry and graph theory to identify spatial behavior patterns. In particular, we focus on models programmed using Computer Algebra Systems and based on a space-time model that allows for describing the patterns of contagion through spatial movement patterns. In addition, we show how the approach can be used to develop algorithms for finding ”patient zero” or, respectively, for identifying the selection of candidates that are most likely to be contagious. The approach can be applied by information systems to evaluate data on complex population movements, such as those captured by mobile geolocation data, in a way that analytically identifies, e.g., critical spatial areas, critical temporal segments, and potentially vulnerable individuals with respect to contact events. © 2023 the Author(s), licensee AIMS Press.

Three Mathematical Models for COVID-19 Prediction

The COVID-19 outbreak was a major event that greatly impacted the economy and the health systems around the world. Understanding the behavior of the virus and being able to perform long-term and short-term future predictions of the daily new cases is a working field for machine learning methods and mathematical models. This paper compares Verhulst's, Gompertz´s, and SIR models from the point of view of their efficiency to describe the behavior of COVID-19 in Spain. These mathematical models are used to predict the future of the pandemic by first solving the corresponding inverse problems to identify the model parameters in each wave separately, using as observed data the daily cases in the past. The posterior distributions of the model parameters are then inferred via the Metropolis–Hastings algorithm, comparing the robustness of each prediction model and making different representations to visualize the results obtained concerning the posterior distribution of the model parameters and their predictions. The knowledge acquired is used to perform predictions about the evolution of both the daily number of infected cases and the total number of cases during each wave. As a main conclusion, predictive models are incomplete without a corresponding uncertainty analysis of the corresponding inverse problem. The invariance of the output (posterior prediction) with respect to the forward predictive model that is used shows that the methodology shown in this paper can be used to adopt decisions in real practice (public health). © 2023 by the authors.

[Factors associated with the duration of SARS-CoV-2 infection in healthcare professionals at a second-level public hospital in the Community of Madrid (Spain) during the sixth wave.]

OBJECTIVE: The incidence of COVID-19 infections among health professionals during the sixth wave has suffered an exponential increase, mainly due to the rapid community transmission caused by the Omicron variant. The main objective of the study was to evaluate the time to negativization in COVID-positive health professionals during the sixth wave, according to the PDIA result;and secondarily, to evaluate the possible influence of other factors (previous infection, vaccination, sex, age, job position) on the time to get negative status. METHODS: A descriptive, longitudinal, observational and retrospective study was carried out at Infanta Sofia University Hospital (Madrid, Spain). Made from the registry of the Occupational Risk Prevention Service of suspected or confirmed cases of SARS-COV-2 infection in health professionals, during the period between November 1, 2021 and February 28, 2022. Bivariate comparisons were made using Mann Whitney, Kruskal Wallis or Chi-square test (or exact test) according to variables. Subsequently, logistic regression (explanatory model) was performed. RESULTS: The cumulative incidence of SARS-COV-2 infection in health professionals was 23.07%. The mean time to become negative was 9.94 days. Only the history of previous SARS-COV-2 infection had a statistically significant influence on the time to negativization of PDIA. The variables vaccination, sex and age had no effect on the time to negativization of PDIA. CONCLUSIONS: Professionals with a history of COVID-19 infection present lower times of negativization than those who had not have the disease. The results of our study confirm the immune escape of the vaccine against COVID-19, since more than 95% of those infected had received a complete vaccination schedule.

Vaccination and variants: A COVID-19 multi-strain model evolution for the Philippines

Coronavirus disease 2019 (COVID-19) management and response is a challenging task due to the uncertainty and complexity of the nature surrounding the virus. In particular, the emergence of new variants and the polarizing response from the populace complicate government efforts to control the pandemic. In this study, we developed a compartmental model that includes (1) a vaccinated compartment, (2) reinfection after a particular time, and (3) COVID-19 variants dominant in the Philippines. Furthermore, we incorporated stochastic terms to capture uncertainty brought about by the further evolution of the new variants and changing control measures via parametric perturbation. Results show the importance of booster shots that increase the vaccine-induced immunity duration. Without booster shots, simulations showed that the dominant strain would still cause significant infection until 31 December 2023. Moreover, our stochastic model output showed significant variability in this case, implying greater uncertainty with future predictions. All these adverse effects, fortunately, can be effectively countered by increasing the vaccine-induced immunity duration that can be done through booster shots. Copyright © 2023 Campos, Raza, Arcede, Martinez and Caga-anan.

Effects of early physical therapy in acute severe COVID-19 pneumonia

Introduction: Rehabilitation in subjects with severe coronavirus disease 2019 (COVID-19) pneumonia has been widely recommended. However, data regarding the starting time of rehabilitation, subjects and healthcare workers safety are limited. We aimed to assess the safety and characterize the effect of early and non-early physiotherapy on severe COVID-19 pneumonia subjects. Method(s): Retrospective cohort study including a consecutive sample of surviving subjects admitted to an acute care hospital due to severe COVID-19 pneumonia from March 13th to May 15th of 2020. Subjects were separated into three groups: non-physical therapy, early physiotherapy (onset <7 days of admission), and non-early physiotherapy. Subject and therapist safety, and length of hospital stay were the main evaluated outcomes. Result(s): A total of 159 subjects were included (72% male;median age 62 years). Rehabilitation was performed on 108 subjects (32 early and 76 non-early physiotherapy). The length of hospital stay was 19 (IQR 36.25) and 34 days (IQR 27.25) (p=0.001) for early and non-early physiotherapy groups, respectively. No physiotherapist was infected and no subject adverse effect was identified. Multivariate analysis of subjects receiving physiotherapy during admission identified obesity (Odds ratio [OR] 3.21;p-value 0.028), invasive mechanical ventilation (OR 6.25;p-value <0.001) and non-early physiotherapy (OR 3.54;p-value 0.017) as independent factors associated with a higher risk of prolonged hospital stay. Conclusion(s): Rehabilitation in acute severe COVID-19 pneumonia is safe for subjects and healthcare workers, and could reduce the length of hospitalization stay, especially in those that may start early.

Telemedicine home CPAP titration and follow-up in the COVID-19 scenario

Introduction: Continuous positive airway pressure (CPAP) titration was dramatically affected by the coronavirus disease 2019 pandemic due to increased biological risk. This study aims to compare successful CPAP adaptation and compliance with home telemedicine CPAP titration with the usual method based on face-to-face visits. Methodology: A prospective cohort using telemedicine home-CPAP titration and follow-up during the COVID-19 pandemic (TC) was compared with a retrospective cohort receiving face-to-face pre-pandemic home titration (RC). The TC included a subgroup with a smartphone application (APP). Successful CPAP adaptation and compliance at one month of follow-up were the main endpoints, while patient satisfaction and costs were secondary endpoints. Result(s): 210 consecutive patients were evaluated (80 RC, 130 TC). 36 patients used APP (TC-APP). CPAP titration was successful in 90% in RC vs 95% in TC (p-value 0.346) and 100% in TC-APP (p-value 0.222). No differences between groups were found at one month of compliance (4.79 h/d RC, 4.33 h/d TC, 4.59 h/d TC-APP). Patient satisfaction out of 10 was 7.69 (SD 2.05) in RC versus 9.02 (SD 0.64) in TC (p-value <0.001). 64% of the TC-APP subgroup reported that their telemedicine strategy influenced in an increase in CPAP use (p-value 0.011). CPAP adaptation with follow-up had an estimated direct staff cost per patient of 19.61 (SD 8.61) in TC-noAPP (TC no APP used) against 23.79 (SD 9.94) in TC-APP (p-value 0.048). Conclusion(s): Telemedicine in CPAP titration and early follow-up is equivalent to the usual care in terms of successfully adaption and compliance, while achieving a greater patient satisfaction.

Estudio de la incidencia de COVID-19 en España y su relación geográfica provincial Study of incidence of COVID-19 in Spain and its relationship to geographical province distribution

Introducción El objetivo de este trabajo fue conocer la incidencia de COVID-19 en España en relación con la geografía en provincias durante el conjunto de la pandemia. Método Análisis de conglomerados de la incidencia de COVID-19 en las provincias y ciudades españolas en las seis primeras olas de la pandemia. Resultados Todas las provincias de Canarias, Cataluña y Andalucía forman conglomerados sin presencia de ninguna otra provincia. Además, en la Comunidad Valenciana, Galicia, País Vasco y Aragón dos de las tres provincias (tres de cuatro en el caso de Galicia) estaban en el mismo conglomerado. Discusión La incidencia de COVID-19 en las seis primeras olas forma conglomerados que reproducen la división de España en comunidades autónomas. Aunque esto podría explicarse por una mayor movilidad dentro de una comunidad, no puede descartarse que esta distribución se deba a diferencias a la hora de cribar, diagnosticar, registrar o comunicar casos de COVID-19.