COVID-19 Waves and Politics in Costa Rica

In 2018, the government that came to power in Costa Rica quickly began to promote socially regressive policies, which directly favored the oligarchic groups, at the expense of the working classes and the middle sectors. The COVID-19 pandemic, instead of stopping this process, accentuated it. After a very moderate first wave of infections (March-May 2020), the disease spread steadily during a second wave (June 2020-February 2021). A third wave (so far May-June 2021) has brought the public health system to the brink of collapse. With the social protests neutralized by health measures to contain COVID-19, authorities took advantage of this situation to promote new reforms that deteriorate labor rights, reduce wages and deepen inequalities. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Acute respiratory distress syndrome due to COVID-19. Clinical and prognostic features from a medical Critical Care Unit in Valencia, Spain Síndrome de dificultad respiratoria aguda asociado a la COVID-19. Características clínicas y de pronóstico en una unidad de cuidados intensivos de Valencia, España

Objective Information from critically ill coronavirus disease 2019 (COVID-19) patients is limited and in many cases coming from health systems approaches different from the national public systems existing in most countries in Europe. Besides, patient follow-up remains incomplete in many publications. Our aim is to characterize acute respiratory distress syndrome (ARDS) patients admitted to a medical critical care unit (MCCU) in a referral hospital in Spain. Design Retrospective case series of consecutive ARDS COVID-19 patients admitted and treated in our MCCU. Setting 36-bed MCCU in referral tertiary hospital. Patients and participants SARS-CoV-2 infection confirmed by real-time reverse transcriptase–polymerase chain reaction (RT-PCR) assay of nasal/pharyngeal swabs. Interventions None Main variables of interest Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Results Forty-four ARDS COVID-19 patients were included in the study. Median age was 61.50 (53.25 – 67) years and most of the patients were male (72.7%). Hypertension and dyslipidemia were the most frequent co-morbidities (52.3 and 36.4% respectively). Steroids (1mg/Kg/day) and tocilizumab were administered in almost all patients (95.5%). 77.3% of the patients needed invasive mechanical ventilation for a median of 16 days [11-28]. Prone position ventilation was performed in 33 patients (97%) for a median of 3 sessions [2-5] per patient. Nosocomial infection was diagnosed in 13 patients (29.5%). Tracheostomy was performed in ten patients (29.4%). At study closing all patients had been discharged from the CCU and only two (4.5%) remained in hospital ward. MCCU length of stay was 18 days [10-27]. Mortality at study closing was 20.5% (n 9);26.5% among ventilated patients. Conclusions The seven-week period in which our MCCU was exclusively dedicated to COVID-19 patients has been challenging. Despite the severity of the patients and the high need for invasive mechanical ventilation, mortality was 20.5%.

Reactive psychoses in the context of the COVID-19 pandemic: Clinical perspectives from a case series

Introduction: The world is currently undergoing an extremely stressful scenario due to the COVID-19 pandemic. This unexpected and dramatic situation could increase the incidence of mental health problems, among them, psychotic disorders. The aim of this paper was to describe a case series of brief reactive psychosis due to the psychological distress from the current coronavirus pandemic. Materials and methods: We report on a case series including all the patients with reactive psychoses in the context of the COVID-19 crisis who were admitted to the Virgen del Rocío and Virgen Macarena University Hospitals (Seville, Spain) during the first two weeks of compulsory nationwide quarantine. Results: In that short period, four patients met the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for a brief reactive psychotic disorder. All of the episodes were directly triggered by stress derived from the COVID-19 pandemic and half of the patients presented severe suicidal behavior at admission. Conclusions: We may now be witnessing an increasing number of brief reactive psychotic disorders as a result of the COVID-19 pandemic. This type of psychosis has a high risk of suicidal behavior and, although short-lived, has a high rate of psychotic recurrence and low diagnostic stability over time. Therefore, we advocate close monitoring in both the acute phase and long-term follow-up of these patients.

An Exploration of Student-Tutor Interactions in Computing

As enrollments in computing courses have surged, the ratio of students to faculty has risen at many institutions. Along with many other large undergraduate programs, our institution has adapted to this challenge by hiring increasing numbers of undergraduate tutors to help students. In early computing courses, their role at our institution is primarily to help students with their programming assignments. Despite our institution offering a training course for tutors, we are concerned about the quality and nature of these student-tutor interactions. As instruction moved online due to COVID-19, this provided the unique opportunity to record all student-tutor interactions (among consenting participants) for research. In order to gain an understanding of the behaviors common in these interactions, we conducted an initial qualitative analysis using open coding followed by a quantitative analysis on those codes. Overall, we found that students are not generally receiving the instruction we might hope or expect from these sessions. Notably, tutors often simply give students the solution to the problem in their code without teaching them about the process of finding and correcting their own errors. These findings highlight the importance of tutoring sessions for learning in introductory courses and motivate remediation to make these sessions more productive. © 2022 Owner/Author.

Treatment of ACL injury in a professional soccer player during COVID-19 lockdown

Anterior Cruciate Ligament (ACL) injuries stand out as the most severe in sports such as soccer. This study presents the rehabilitation process of a professional soccer player who suffered a total ACL tear. It details the treatment performed after the surgical intervention and all the adaptations that had to be applied in the rehabilitation process due to the lockdown period established at the beginning of the COVID-19 pandemic. During the period comprised between weeks 9 and 21 post-surgery, the rehabilitation treatment was carried out virtually, adapting the actions, work environment and equipment used. Despite the limitations it entailed, the virtual format and the adaptations in the treatment allowed the rehabilitation process to continue, fulfilling all the pre-established objectives and deadlines with a consequent satisfactory and safe return to competitive sport. After carrying out a bibliographic research, no clinical cases have been found regarding the adaptation of the rehabilitation process of an ACL reconstruction in a professional soccer player during the COVID-19 lockdown.

PROJETO SENTINELA COVID-19: ESTUDO DE VIABILIDADE DA DETECÇÃO VIRAL EM ASSINTOMÁTICOS UTILIZANDO O TESTE POINT OF CARE PARA DETECÇÃO DO ANTÍGENO DO SARS-COV-2 E RESULTADOS EM MEIO À EXPANSÃO DA VARIANTE DELTA NO BRASIL

A OMS estabelece como métricas para avaliação da transmissão comunitária da COVID-19 a ocorrência de casos novos, mortes, internações e positividade da testagem sentinela. A testagem sentinela por razões econômicas e logísticas não ocorreu no Brasil e sempre atuamos sob indicadores já ocorridos. Considerando a relevância da transmissão assintomática, sobretudo com a expansão da vacina, e a necessidade de aprimorar a vigilância sobre a circulação viral implementamos um projeto sentinela na cidade de Cubatão na região da Baixada Santista em São Paulo. Realizamos semanalmente, aos sábados, dois testes para cada 1000 habitantes em todas as regiões do município, incluindo as mais socialmente desafiadoras, respeitando as bases e divisões dos setores censitários do IBGE. Aplicamos o TCLE e coletamos um questionário em meio digital com dados demográficos, clínicos e epidemiológicos. Entre 31/07 e 25/09/21 foram realizados 2185 testes (Panbio-AbbottR). Foram identificados 6 casos positivos no período (0,3%). A mediana de idade dos testadas foi de 49 anos, sendo 51,8% do sexo feminino. Em média, ao longo do período de testagem, 51,1% da amostra avaliada havia tomado 2 doses de vacinas dentro do prazo e foi possível avaliar a evolução da cobertura vacinal no período. Na última data de inquérito no período (25/09/2021), 75,59% da amostra estava plenamente vacinada e quase a totalidade com uma dose ao menos. Os resultados de baixa positividade alinham-se com a redução na demanda por consultas em PA por COVID (menos 70%), por internações (menos 97%) e por vagas em UTI (menos 98%) comparando-se os meses entre março (pico) e agosto de 2021. Alinham-se ainda à redução de positividade do RT-PCR entre sintomáticos de 88% para o mesmo período (de 43,6 para 4,9%). Entre 30/08 e 08/09/21 100% das variantes isoladas no município são delta e nenhum dos pacientes teve evolução desfavorável com necessidade de internação. O uso da testagem sentinela mostrou-se uma ferramenta útil no processo da gestão dos leitos e decisões estratégicas da secretaria de saúde, teve excelente aceitação e performance sem nenhuma perda, foi sensível e esteve em linha com os dados compilados pela gestão. Seu uso deve ser realizado como ferramenta útil no monitoramento precoce e antes que desfechos clínicos mais severos estejam concretizados. Por fim, está evidente a performance da vacina como ferramenta essencial na proteção contra formas graves da COVID e na contenção da expansão da variante delta.

Clinical characteristics and in-hospital outcomes of patients coinfected with Chagas disease and SARS-CoV-2

Background: Underlying comorbidities have been widely associated with a worse prognosis for COVID-19 patients, since viral infections could act as triggers for worsening of chronic diseases. Although Chagas disease (CD) is endemic in Latin America, it has been recognized that the disease is now a worldwide concern. Information on the interplay between COVID-19 and CDis lacking. Purpose: To assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Methods: Patients with COVID-19 diagnosis were selected from the Brazilian COVID-19 Registry, a prospective multicenter cohort, from March to September, 2020. CD diagnosis was based on hospital record at the time of admission. Study data were collected by trained hospital staff using Research Electronic Data Capture (REDCap) tools. Genetic matching for sex, age, hypertension, DM and hospital was performed in a 4:1 ratio. Results: Of the 7,018 patients who had confirmed infection with SARSCoV- 2 in the registry, 31 patients with CD and 124 matched controls were included. Overall, the median age was 72 (64.-80) years-old and 44.5% were male. At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p<0.05 for both). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). Seventy-two (46.5%) patients required admission to the intensive care unit. In-hospital management, outcomes and complications were similar between the groups (Table 1). Conclusions: In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation. (Figure Presented).

Impact of the COVID-19 pandemic on tuberculosis management in Spain.

BACKGROUND: The impact of COVID-19 on the diagnosis and management of tuberculosis (TB) patients is unknown. METHODS: Participating centres completed a structured web-based survey regarding changes to TB patient management during the COVID-19 pandemic. The study also included data from participating centres on patients aged ≥18 diagnosed with TB in 2 periods: March 15 to June 30, 2020 and March 15 to June 30, 2019. Clinical variables and information about patient household contacts were retrospectively collected. RESULTS: A total of 7 (70%) TB units reported changes in their usual TB team operations. Across both periods of study, 169 patients were diagnosed with active TB (90 in 2019, 79 in 2020). Patients diagnosed in 2020 showed more frequent bilateral lesions in chest X-ray than patients diagnosed in 2019 (P = 0.004). There was a higher percentage of latent TB infection and active TB among children in households of patients diagnosed in 2020, compared with 2019 (P = 0.001). CONCLUSIONS: The COVID-19 pandemic has caused substantial changes in TB care. TB patients diagnosed during the COVID-19 pandemic showed more extended pulmonary forms. The increase in latent TB infection and active TB in children of patient households could reflect increased household transmission due to anti-COVID-19 measures.

Acute respiratory distress syndrome due to COVID-19. Clinical and prognostic features from a medical Critical Care Unit in Valencia, Spain.

OBJECTIVE: Information from critically ill coronavirus disease 2019 (COVID-19) patients is limited and in many cases coming from health systems approaches different from the national public systems existing in most countries in Europe. Besides, patient follow-up remains incomplete in many publications. Our aim is to characterize acute respiratory distress syndrome (ARDS) patients admitted to a medical critical care unit (MCCU) in a referral hospital in Spain. DESIGN: Retrospective case series of consecutive ARDS COVID-19 patients admitted and treated in our MCCU. SETTING: 36-bed MCCU in referral tertiary hospital. PATIENTS AND PARTICIPANTS: SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal/pharyngeal swabs. INTERVENTIONS: None MAIN VARIABLES OF INTEREST: Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. RESULTS: Forty-four ARDS COVID-19 patients were included in the study. Median age was 61.50 (53.25 - 67) years and most of the patients were male (72.7%). Hypertension and dyslipidemia were the most frequent co-morbidities (52.3 and 36.4% respectively). Steroids (1mg/Kg/day) and tocilizumab were administered in almost all patients (95.5%). 77.3% of the patients needed invasive mechanical ventilation for a median of 16 days [11-28]. Prone position ventilation was performed in 33 patients (97%) for a median of 3 sessions [2-5] per patient. Nosocomial infection was diagnosed in 13 patients (29.5%). Tracheostomy was performed in ten patients (29.4%). At study closing all patients had been discharged from the CCU and only two (4.5%) remained in hospital ward. MCCU length of stay was 18 days [10-27]. Mortality at study closing was 20.5% (n 9); 26.5% among ventilated patients. CONCLUSIONS: The seven-week period in which our MCCU was exclusively dedicated to COVID-19 patients has been challenging. Despite the severity of the patients and the high need for invasive mechanical ventilation, mortality was 20.5%.