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The COVID-19 pandemic has required the use of new technologies to carry out rehabilitation sessions for COP D remotely. The aim of this systematic review was to analyse the available evidence on the efficacy of telerehabilitation in COPD patients. PubMed, WOS, PEDro and Cochrane databases were consulted. The systematic review included nine clinical trials, 55.5% of which display good methodological quality. The most commonly used rehabilitation methods were applications or software for real-time video-calls, visualisation of exercises and recording progress. TR was as effective as outpatient pulmonary rehabilitation, with greater benefits in functional capacity, self-efficacy, mental health, exacerbations and emergency care visits, offering a cost-effective option with high patient satisfaction. The small number of studies and the variety of rehabilitation methods examined limit the value of the evidence obtained.
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COVID-19 , Pulmonary Disease, Chronic Obstructive , Telerehabilitation , Humans , Pandemics , Pulmonary Disease, Chronic Obstructive/rehabilitation , Quality of LifeABSTRACT
In December 2019, a new Coronavirus called Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), appeared in China, spreading rapidly around the globe and becoming a pandemic. SARS-CoV-2 is the cause of a serious life-threatening disease known as COVID-19. The risk of SARS-CoV-2 infection in patients with preexisting systemic autoimmune diseases (AID) appears to be slightly higher than in the general population, but the clinical course does not appear to be different. However, we must bear in mind that the use of corticosteroids, immunomodulatory drugs, and biological therapy in patients with AID can modulate the risk of hospitalization and death. The alterations in the innate and adaptive immune response found in patients with cytokine storm due to COVID-19 are the reasons for the high morbidity and mortality. Thus, clinicians should early identify the symptoms and closely monitor patients with risk factors for developing these complications and the interactions with other systems such as the immune-neuro-endocrine system. © 2023 Elsevier Inc. All rights reserved.
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The term "cytokine storm” was first proposed in 1993 by Ferrara et al. In 1991, Chatenaud described a systemic clinical picture called "Cytokine Release Syndrome” very similar to "Cytokine Storm Syndrome” so these terms can be used synonymously. During the COVID-19 pandemic, high-risk individuals (>65 years, with comorbidities) may develop cytokine storms as a consequence of multiorgan involvement seen during the acute and post-COVID-19 phases. On the other hand, the term immune neuroendocrine system was first proposed by Besedovsky H et al. Evidences obtained during COVID-19 infection demonstrated that SARS-CoV-2 infections can affect the immune neuroendocrine system, both in its invasion stage of different organs and tissues and in the recovery stage. This damage is caused by viral infection and/or cytokine storm. This chapter analyzes the devastating effect of SARS-CoV-2 infection and the cytokine storm on the immune neuroendocrine system. These evidences may lead to new therapeutic proposals. © 2023 Elsevier Inc. All rights reserved.
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Objective: To evaluate the consumption of sugar-sweetened beverages (SSB) during confinement due to the Covid-19 pandemic and its relationship with sociodemographic and dietary factors. Material and Methods: Multicenter study. Citizens residing in 12 countries were invited to participate (Argentina, Chile, Colombia, Costa Rica, Ecuador, Spain, Guatemala, Mexico, Peru, Paraguay, Panama, and Uruguay) to whom an online survey on food consumption and sociodemographic indicators was applied. Results: 10,573 questionnaires were analyzed. Regarding the consumption of sugar-sweetened beverages, 78.0% of women had low consumption versus 69.2% of men. Frequency of SSB consumption was similar according to age group. For education, 13.4% of people with a university-level education reported excessive consumption versus 23.1% of people with a primary or basic education level (p<0.001). The frequency of SSB consumption was similar by urban versus rural residence. According to self-report, 19.0% of weight gain was due to excessive consumption of SSB compared to 10.4% of those who lost weight (p<0.001). Similar figures were found in self-reported portion size change, 19.3% who increased their portion consumed SSB in excess versus 10.0% who decreased portion size. Finally, in a re-gression model: being a man, being between 40 and 59 years old, primary academic level, weight gain, and presenting changes in diet, increased the probability of having a high level of SSB consumption. Conclusion: The consumption of SSB, in general, is low but excessively relevant in some groups of the study variables, in addition, there is a relationship between the consumption of SSB and the variables studied.
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The objective was to determine the impact of socio-emotional and pedagogical factors on the academic performance of students from the UNAM professional school of Management and Social Development during the COVID 19 pandemic, based on neural networks and stepwise regression. From the 38 indicators of socio-emotional and pedagogical factors applied to 236 students, the stepwise regression model identified 7 significant indicators (pedagogical and personal problems) that impact on academic performance, the neural network model determined the importance of indicators that influence academic performance. academic performance, considering the personal problems first, followed by pedagogical and family ones. The mean square error for the stepwise regression model is 7.25 and the coefficient of determination was 0.221, for the neural network model the mean square error was 6.78, while the coefficient of determination was 0.256. According to the results of both methodologies, the students of the professional school of Management and Social Development showed pedagogical and personal problems in their academic performance during the COVID 19 pandemic. © 2021 Latin American and Caribbean Consortium of Engineering Institutions. All rights reserved.
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Controversies still exist regarding the humoral response to the virus SARS-CoV-2 in convalescent patients and seroconversion in patients with autoimmune diseases. There are few reports on the clinical and evolution of COVID-19 in the latter group. The objective was to examine the clinical and evolutionary characteristics associated with COVID-19 and the percentage of seroconversion in people with rheumatic diseases. Fifty-three patients were included, mainly with rheumatoid arthritis and lupus. The majority were female and average age 48 ± 14 years. Symptoms: fever (56%), anosmia (35.8%), dyspnea (34%), headache (30.2%) and cough (30.2%). Duration of infection 12 ± 7 days. Almost half of the patients were hospitalized (23, 43.4%), 5 in critical care units (9.4%) and 3 died (5.6%). The prevalence of steroid use was 56.6% (30), with an average dose of 8 mg/d, and 17 (32%) used immunosuppressive biopharmaceuticals. There was a correlation between age and the need for hospitalization with a risk of 9.4% per year. There were no differences with other variables. The presence in serum of IgG immunoglobulin against SARS-CoV-2 protein S was determined in 23/53 patients (43.4%), with detectable levels in 15 (62.2%), and in the 23 without autoimmune connective tissue diseases who suffered from COVID-19, 12 had detectable antibodies. Death in this group of rheumatic diseases was low, similar to the general population. More than half had specific antibodies against the virus regardless of the medication used.
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Objectives: To determine the risk factors, impact and outcomes of COVID-19 in autoimmune / inflammatory diseases (AID). Methods: Case (patients with AID) and controls (patients without AID) study. Both groups with SARS-CoV-2 by PCR. Clinical, biochemical, treatment and outcome characteristics were determined. Spearman correlation, X2 and multivariate analysis were performed. Results: AID, 90 (49.49 ± 14.2 years) vs controls, 90 (52.58 ± 13.5 years). AID: systemic lupus erythematosus (SLE) (n = 20, 22.2%), systemic sclerosis (n = 16, 17.8%), rheumatoid arthritis (n = 14, 15.6%), primary antiphospholipid syndrome (n = 12, 13.3%), autoimmune encephalitis (AIE) (n = 6, 6.7%), granulomatosis with polyangiitis (GPA) (n = 5, 5.6%) and multiple sclerosis (n = 3, 3.3%) were the most frequent. Treatment: anticoagulant 73.3%, glucocorticoid 53.3% and antimalarials 35.6%. The AID patients had less invasive mechanical ventilation (IMV) (p = 0.004), lower death (p = 0.006) and lower discharge with O2 (p = 0.001) (Table 1). AID: creatinine correlate positively with days with IMV (rho = 539, p 0.024). In AID, AIE and O2 saturation ≤ 88% provided risk for IMV (OR 88.42, CI 3.9-196.7, p = 0.005 and OR 10.05, CI 1.2-83.7, p = 0.033, respectively) while antimalarials were protective for IMV (OR 0.08, CI 0.0-0.9, p = 0.042). Regarding death in AID, oxygen saturation ≤ 88% and CO-RADS ≥4 were risk factors (OR 5.12, CI 1.5-16.4, p = 0.006 and OR 8.84, CI 1.2-64.0, p = 0.031, respectively) and anticoagulant use was protective (OR 0.26, CI 0.0-0.8, p = 0.019) (Table 2). Conclusion: Our study suggests that patients with AID have a better outcome than the control group. Multiple factors are involved in this outcome such as surveillance, chronic use of antimalarials, steroid and anticoagulation.We propose that at the molecular level high levels of IFN may be a protective factor for complications from SARS-CoV-2 infection. New longitudinal and molecular level studies in patients with mild/moderate, severe and critical COVID-19 will be necessary to know the impact of COVID-19 in AID.
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Objectives: The aim was to determine the clinical evolution and the prognosis of COVID-19 in a cohort of patients with systemic sclerosis (SSc). Methods: During the pandemic we had continuous contact by digital media with a cohort of 197 patients with SSc. If they presented a condition that met the suspicious definition of COVID-19 disease, the polymerase chain reaction test for SARS-CoV-2 was performed and their evolution was followed every 24 hours until they were asymptomatic, or death occurred. Patients with COVID-19 were treated on a regular basis by the outpatient or in-hospital without interfering with their treatment. Results: Thirteen patients, 57 years of age (range 50 to 77), 9 diffuse cutaneous (dcSSc) and 4 limited cutaneous (lcSSc) become ill with COVID-19 during 9 months of follow-up. Immunosuppressors drugs used at the time of illness were: 6 mycophenolate mofetil, 2 methotrexate, 4 low-dose of prednisone. Seven patients had interstitial lung disease (ILD). Main symptoms were chest pain, cough, dyspnea, dysgeusia and anosmia, 1 had mild symptoms without pneumonia, 11 had mild pneumonia and received outpatient treatment, 1 only one had severe pneumonia requiring hospital management. One used supplemental oxygen as part of her treatment for lung fibrosis but additionally 4 used it during her illness. Only one (7.7%) had severe pneumonia was hospitalized and died at 77 years of age. Three patients discontinued their immunosuppressants during the pandemic and among them was the patient who died. Image 1 Conclusion: COVID-19 disease in patients with SSc can be overcome in most cases, even when they have ILD and were using immunosuppressants at the time of contagion with the SARS-CoV-2 virus. The low aggressiveness of atypical pneumonia in these patients may be due to the existence of protective mechanisms that participate in the pathogenesis of SSc.
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Mortality levels due to Covid-19 have increased significantly during the last half of 2020 in practically all regions of the world. The work presented aims to analyze the spatiotemporal evolution of the standardized case fatality rate among patients with Covid-19 and its relationship with diabetes in northeastern Mexico for a nine-month period between April 2020 and January 2021. This is a longitudinal cohort study, based on the estimation of six competing Bayesian models that capture the spatio-temporal dependence using a poisson counting process with excess of zeros (zero-inflated poisson). The results show the presence of a positive correlation between the number of patients diagnosed with diabetes and the increase in the Covid-19 case-fatality rate in the period analyzed. Covid-19 case-fatality was heterogeneously distributed in space-time, being concentrated in 4 of the 132 municipalities of the region.
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BACKGROUND: Immune cell counts in blood in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection may be useful prognostic biomarkers of disease severity, mortality, and response to treatment. OBJECTIVES: To analyze sub-populations of lymphocytes at hospital admission in survivors and deceased from severe pneumonia due to coronavirus disease-2019 (COVID-19). METHODS: We conducted a cross-sectional study of healthcare workers confirmed with SARS-CoV-2 in convalescents (control group) and healthy controls (HC) diagnosed with severe COVID-19. Serum samples were taken at hospital admission and after recovery. Serum samples ≥ 25 days after onset of symptoms were analyzed for lymphocyte subpopulations through flow cytometry. Descriptive statistics, Kruskall-Wallis test, receiver operating characteristic curve, calculation of sensitivity, specificity, predictive values, and Kaplan-Meier analysis were performed. RESULTS: We included 337 patients: 120 HC, 127 convalescents, and 90 severe COVID-19 disease patients (50 survivors, 40 deceased). For T cells, total lymphocytes ≥ 800/μL, CD3+ ≥ 400/μL, CD4+ ≥ 180/μL, CD8+ ≥ 150/μL, B cells CD19+ ≥ 80/μL, and NK ≥ 34/μL subsets were associated with survival in severe COVID-19 disease patients. All subtypes of lymphocytes had higher concentrations in survivors than deceased, but similar between HC and convalescents. Leukocytes ≥ 10.150/μL or neutrophils ≥ 10,000/μL were associated with increased mortality. The neutrophil-to-lymphocyte ratio (NLR) ≥ 8.5 increased the probability of death in severe COVID-19 (odds ratio 11.68). CONCLUSIONS: Total lymphocytes;NLR;and levels of CD3+, CD4+, CD8+, and NK cells are useful as biomarkers of survival or mortality in severe COVID-19 disease and commonly reach normal levels in convalescents.
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This is a prospective three-and-a-half-month follow-up work of two groups of 65 Patients of different sex and age, who received Major Autohemoterapy ( AHTMy) applications at different times during the Pandemic and exposed to it and another unknown group that never received this application. The differences found are statistically significant so it is qualitatively presumed that this application was a co-aid in the face of cases that exposed to the virus did not develop disease.
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The work seeks to model the distribution of cumulative incidence rate of COVID-19 in municipalities of Mexico through the adjustment of three generalized linear models (in competition) with spatial and temporal effects and Poisson link function. Data of confirmed cases of COVID-19, reported by Health Secretary of Mexico, from February to July 2020, were used. In order to reduce the computational costs associated with the estimation of multiple parameters with large amounts of data, we chose the Integrated Nested Laplace Approximation implemented in R language (R-INLA). The models were evaluated through the Akaike (AIC) criterion, and the best was the Non-parametric Model of Space-Time Interaction. The results confirm the presence of significant levels of heterogeneity in the spatial-temporal distribution of COVID-19 incidence's rates among municipalities of Mexico.