Automated ventilator prototype for COVID-19 patient treatment: the design and development of the electronic system

The coronavirus disease 2019 (COVID-19) pandemic has created an urgent global demand for ventilators, respirators and various resuscitation devices. Various research and development organizations, private companies and individual engineers have collaborated and carried out the development of low-cost ventilation prototypes. In turn, doctors and nurses are collapsed due to the exponential increase in COVID-19 cases. This scenario worsens more when the tasks are manual in nature. The article`s objective to describe the electronic system designed, developed and implemented in a functional prototype of an automatic ventilator in order to be evaluated by a team of health professionals to be later used in cases of health emergencies. This system automates the manual ventilation task aided by a few medical resources in a scenario of scarce resources and is a temporary solution when a respirator is not available. © 2023, Institute of Advanced Engineering and Science. All rights reserved.

Inductive open data study on teleworking dissatisfaction in Spain during the Covid-19 pandemic

Purpose: The research paper aims to study dissatisfaction of teleworking employees in Spain during the Covid-19 health pandemic in order to propose three models: sociodemographic profile of the teleworking dissatisfied employee;advantages and disadvantages for the teleworking dissatisfied employee and advantages for the teleworking dissatisfied employee. Design/methodology/approach: This study uses official open data obtained from the Spanish National Statistical Institute (INE, 2022) through Decision Trees statistical multivariable models implementing Classification and Regression Trees and Recursive Partitioning and Regression Trees techniques to determine the variables that can influence the satisfaction or dissatisfaction of the subjects. Findings: This investigation offers three models with two sociodemographic profiles of dissatisfied teleworking employee, who is a high/middle-level manager/employee around 45 years old, and she/he lives with the partner. Regarding the most important advantage of teleworking, employees consider "use/saving of time” and as disadvantage "worse organization and coordination of work”. Originality/value: This research provides empirical evidence with inductive reasoning on understanding the challenges of teleworking dissatisfied employees in Spain not only in turbulent times but also in "normalcy” to improve overall teleworker well-being and accomplish company's and organization's long-term objectives for better productivity and effectivity. The study has high practical value due to the integral approach incorporating dissatisfaction as a driver that can trigger negative behaviours towards the organizations and that is seldom addressed in the literature. Additionally, this paper could provide some new ideas for accomplishing "Spain Digital 2025” and "Europe's Digital Decade: 2030” plans on institutional level. © 2023, Emerald Publishing Limited.

Perspectives and parameters for the use of digital banking

For fear of Covid-19 infection, the population opted for the use of technological means to make payments by electronic means deciding to use other means of payment (credit or debit card) to perform any type of banking service, hence the banks offer cards with different benefits, the objective is to measure the perspectives and parameters requested by users to obtain a credit or debit card, with a descriptive, quantitative, cross-sectional, correlational and predictive study, with a sample of 1646 surveys conducted online and anonymously, using the measurement instrument with questions about digital banking (pre and post pandemic) whose parameters are digital banking services and motivational factors for its use. The results show that users are increasingly interested in adopting digital band services in a meaningful way. In conclusion the measurement instrument is suitable for application, parameters such as cellular service (App) and account status information are priority for the population. © 2022 IEEE.

Cell-free plasma next-generation sequencing assists in the evaluation of invasive mold infection in patients with COVID-19: a case series

Background. Distinguishing COVID-19 Associated Pulmonary Aspergillosis (CAPA) and invasive mold infections (IMIs) from other causes of secondary pneumonia in COVID-19 can be challenging. 1,3-beta-D-Glucan and galactomannan are commonly utilized biomarkers for the workup of IMIs but are limited by a lack of specificity and sensitivity respectively. Cell-free plasma next-generation sequencing (cfNGS) is a promising non-invasive approach that can provide direct detection of pathogens in patient's serum. This study explored its potential role in the evaluation of secondary pneumonia in patients with COVID-19. Methods. We performed a retrospective single-center observational study from March 2020 to December 2021 at Virginia Commonwealth University Medical Center, a 811-bed tertiary care center, to evaluate patients with laboratory confirmed SARS-CoV-2 virus infection who underwent cfNGS for the evaluation of CAPA. CfNGS (Karius, Inc., Redwood City, CA) was performed at the discretion of the clinical provider and we evaluated the test indication, patient history, clinical impact, correlation with serum biomarkers, and 30 day all-cause mortality. Results. Thirteen patients were evaluated and none had Aspergillus species detected. One patient had Pneumocystis jirovecii on cfNGS. There was a 76.9% (10/13) concordance rate with patients' serum fungal biomarkers. CfNGS also detected concomitant organisms in 53.8% (7/13) of our cohort. These data assisted in changes of clinical management for 84.6% (11/13) of patients and lead to the change in antifungal usage in 69.2% (9/13). Conclusion. In this study, both negative and positive cfNGS test results assisted in important clinical decision making. cfNGS may have a role in the evaluation of CAPA or other IMIs in patients with COVID-19.

Learning strategies in e-learning formative processes in mathematical contents during the Covid-19 era

The aim of this study was to find out the learning strategies of university students in the on-line training of mathematical content so that the training content is assimilated, and active meaningful and motivating learning is promoted. A descriptive, correlational and predictive research method was used to study these strategies. The sample included 1,017 university students in Peru. Data collection was carried out using the LimSt instrument. The results show that the evaluation of the LimSt dimensions is medium-high. When determining the relationship between the analysis of the particularities of mathematics as a subject and the e-learning method, it is observed that there is a significant relationship with respect to gender and the branch of education. In addition, gender, age and branch of education provide a predictive model that mainly focuses on the learner's effort in relation to the e-learning pedagogical method. It is concluded that the e-learning pedagogical method applied for the training of Peruvian students for subjects related to the field of mathematics is positively evaluated. © 2022 WIETE

Biochemical parameters and blood count of patients with moderate and severe COVID-19 in intensive care at a basic hospital in Ecuador

COVID-19 infection occurs mainly in mild and severe forms, the latter requiring hospitalization and respiratory support due to complications such as severe acute respiratory syndrome (SARS), the clinical course of which has been widely described;however, the alteration of laboratory profiles has not been precisely established. A retrospective study was carried out to determine biochemical parameters and blood counts in 32 patients with moderate and severe COVID-19, confined at the "Raul Maldonado Mejia" Basic Hospital in Cayambe, Ecuador, and to evaluate their usefulness as indicators of severity. Medical records were reviewed., obtaining clinical, biochemical and hematometric data. A higher proportion of moderate and severe COVID cases was observed in men, and the severe form in both genders, with an average age between 45-73 years. The most frequent comorbidities were: arterial hypertension (HTA), type 2 diabetes mellitus (DM2), congestive heart failure (CHF) and obesity. The biochemical and blood count parameters with the worst prognosis for severity were: elevation of lactate dehydrogenase (LDH) activity, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP) levels, prothrombin time (PT) prolonged, total leukocyte count, ne index utrophil/lymphocyte (INL) and decreased lymphocytes. Biochemical parameters (LDH, CRP, ALT, AST), coagulation (PT) and blood counts (leukocyte count, lymphocytes and INL) can be useful indicators of severity in patients with COVID-19, allowing early identification of patients with moderate disease and avoid the development of the most severe form of the disease and its complications.

Utilization and Discard of Organs from Covid -19 Infected Donors: A Us National Registry Analysis

Purpose: Expansion of the donor pool remains a major unmet need for solid organ transplants (SOT). Early data suggests that at least some severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID) nucleic acid test positive (NAT+) organs could be transplanted safely although there is substantial controversy about this topic. Method(s): A retrospective analysis of the national United States Organ Procurement and Transplantation Network database was performed, demonstrating initial experience with COVID NAT+ deceased donor organs with a focus on kidney transplants, from August 8, 2020, to Sep 29, 2021. Result(s): During this time period, 17,143 COVID NAT negative (NAT-) deceased donors and 150 COVID NAT+ deceased donors were assessed for organ donation (Figure 1) (Table 1). When compared to COVID NAT- donors, there was a higher (p<0.001 for all) non-recovery rate for COVID NAT+ hearts (35% vs 87%), lungs (71% vs 99%), livers (24% vs 53%), and pancreas (89% vs 98 %). Of a total of 385 recovered organs from 150 COVID NAT+ donors, 276 (72%) organs were transplanted into 262 recipients. Majority of donors had a COVID NAT+ <=7 days prior to procurement (94;62.7%). While only a minority of pancreases, hearts, lungs, and livers were procured, almost all were transplanted post-procurement. In contrast, there was a high discard rate for kidneys post-procurement (102/295;34.6%) with the most common reason (~70%) for discards being 'exhaustion of the wait list'. Presumably superior quality COVID NAT+ kidneys were discarded compared with COVID NAT- kidneys (mean KDPI: 67% vs 76%;p=0.04). Limited outcome data was available with a median post-transplant follow-up of 75 days (range: 23-243 days). Three kidney allograft losses (2 due to allograft thrombosis) and five deaths (2 kidneys, 3 livers) were reported, of which, one was due to respiratory failure and one due to sepsis. Conclusion(s): These data provide early reassuring evidence on the utilization of non-lung COVID NAT+ organs. However, a substantially lower procurement rate for non-kidney transplantable organs and a high discard rate for kidneys were noted. (Table Presented).

Iron oxide and iron oxyhydroxide nanoparticles impair SARS-CoV-2 infection of cultured cells.

BACKGROUND: Coronaviruses usually cause mild respiratory disease in humans but as seen recently, some human coronaviruses can cause more severe diseases, such as the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the global spread of which has resulted in the ongoing coronavirus pandemic. RESULTS: In this study we analyzed the potential of using iron oxide nanoparticles (IONPs) coated with biocompatible molecules like dimercaptosuccinic acid (DMSA), 3-aminopropyl triethoxysilane (APS) or carboxydextran (FeraSpin™ R), as well as iron oxyhydroxide nanoparticles (IOHNPs) coated with sucrose (Venofer®), or iron salts (ferric ammonium citrate -FAC), to treat and/or prevent SARS-CoV-2 infection. At non-cytotoxic doses, IONPs and IOHNPs impaired virus replication and transcription, and the production of infectious viruses in vitro, either when the cells were treated prior to or after infection, although with different efficiencies. Moreover, our data suggest that SARS-CoV-2 infection affects the expression of genes involved in cellular iron metabolism. Furthermore, the treatment of cells with IONPs and IOHNPs affects oxidative stress and iron metabolism to different extents, likely influencing virus replication and production. Interestingly, some of the nanoparticles used in this work have already been approved for their use in humans as anti-anemic treatments, such as the IOHNP Venofer®, and as contrast agents for magnetic resonance imaging in small animals like mice, such as the FeraSpin™ R IONP. CONCLUSIONS: Therefore, our results suggest that IONPs and IOHNPs may be repurposed to be used as prophylactic or therapeutic treatments in order to combat SARS-CoV-2 infection.

Prevalence and correlation of IgG in patients infected by SARS-COV2 attended at Hospital Dr. Santiago Ramón y Cajal, ISSSTE in Durango

introduction. In the immune system there are two types of responses: rapid and unspecified innate immune response, and one adaptive response, slower but capable of creating memory. objective. To identify the prevalence of the igg in sars-cov-2 infected patients at issste Hospital in Durango. material and methods. Descriptive, observational, cross-sectional study;igg concentration was measured in 33 sars-cov-2 infected patients, the chemiluminescence method was used in the Architect i 2000 sr®;a concentration ≥1.4 was considered positive, it was expressed in conventional units. The spss v24, descriptive statistics, ji2 of Bartlett, t of student, “r” of Pearson with ic95% and p<0.05 were used as a reference point. The information obtained was kept anonymous. results. An media of 42.7 years was obtained, out of which the 60.6% were male, the media igg concentration was 3.8 conventional units, symptoms persisted 9.5 days, and between the beginning of the symptoms and sampling, 104.2 days elapsed;the 87.8% of the patients had symptoms and 86.2% of them igg was detected. There was a positive correlation between igg concentration and duration of symptoms, this being significant. conclusions. igg concentrations will depend on how many days the symptoms last, there were patients that despite presenting symptoms, igg was no longer detected for 104 days, this also happened with patients classified as asymptomatic.

A randomized multicentre clinical trial to evaluate the efficacy of melatonin in the prophylaxis of SARS-COV-2 infection in high-risk contacts (MECOVID trial): Preliminary data

Objective: To evaluate the efficacy of melatonin as a prophylactic treatment on prevention of symptomatic SARSCoV- 2 infection among healthcare workers at high risk of SARS-CoV-2 exposure. Material and/or methods: In April 2020 we designed a two-arm parallel randomized double-blind controlled trial. Healthcare workers fulfilling inclusion criteria were recruited in five hospitals in Spain and were randomized 1:1 to receive melatonin 2 mg administered orally for 12 weeks or placebo. Study visits: Screening (D1), Week 4, 8 and 12. A follow-up phone call was performed 4 weeks after the last intake of the study drug. The main outcome was the number of SARS-CoV-2 symptomatic infections (COVID-19) confirmed by polymerase chain reaction (PCR) or serologic test or according to each centre diagnosis protocol. During the study, participants should daily enter in an online application data concerning treatment administration, adverse events, food intake, exercise, sleeping hours and other data related to the effects of melatonin. Also, participants were asked to fulfil the Pittsburgh Sleep Quality Index (PSQI) at screening and at the 12 week visit. Results: A total of 344 volunteers were screened, mean age was 40.1 (10.8) years and most of them were females (80.8%). Three hundred fourteen were randomized (151 placebo;163 melatonin) and 308 received the study treatment (148 placebo;160 melatonin). We detected 13 SARS-CoV-2 symptomatic infections during the follow-up, 2.6% in the placebo arm (n = 4/151) and 5.5% in the melatonin arm (n = 9/163) (p = 0.2). A total of 124 participants had at least one adverse event. A total of 304 adverse events were detected. No severe adverse events related to treatment were reported. Conclusions: We cannot confirm our hypothesis that administration of melatonin prevents the development of SARS-CoV-2 infection in high-risk contacts (hospital staff). Other safety and efficacy data, PSQI data and data obtained from the online application fulfilled by the participants will be soon analysed.

Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe Covid-19 Pneumonia

Background-aim: Critically ill patients with COVID-19 pneumonia suffered both high thrombotic and bleeding risk. The effect of SARS-CoV-2 on coagulation and fibrinolysis is not well known. Methods: Retrospective cohort study including 84 patients, during 16 months, divided into two groups: patients with severe SARS-Cov-2 pneumonia (group 1, N=42) and patients with severe non-COVID-19 pneumonia (group 2, N=42). We evaluated coagulation standard parameters (hemoglobin, platelet count and conventional laboratory coagulation tests) in group 1 vs group 2 and coagulation standard parameters on day of admission (T0) and 10 (T10) days after admission to ICU and coagulation function using rotational thromboelastometry (ROTEM) in patients with severe SARS-Cov-2 pneumonia. Results: 84 patients were enrolled into the study. Similar results in conventional laboratory coagulation tests were detected in group 1 and group 2: prothrombin time (15.14s vs 14.76s, p=0.212), international normalized ratio (1.21 vs 1.19, p=0.112), activated partial thromboplastin time (32.17s vs 25.52s, p=0.06), fibrinogen level (6.15 mg/dl vs 3.39 mg/dl, p=0.208), hemoglobin (11.81 g/dl vs 11.20 g/dl, p=0.139) and platelet count (208.98x103/ul vs 288.74 x103/ul, p=0.123). However, a statistically significant difference was observed in the D-dimer count (2442.11 ng/ml vs 370 ng/ml, p=0.03). In addition, statistically significant increase in D-dimer count during Intensive Care Unit (ICU) stay (T0=2442.11 ng/ml vs T10=8564.39 ng/ml, p=0.000) in group 1 were detected. Finally, blood thromboelastometry profiles were consistent with hypercoagulability characterized by higher clot strength (MCF or maximum clot firmness close to upper limit in FIBTEM test, MCF median value= 25.9 mm). Clotting time presented normal results in INTEM (163.41 s) and EXTEM (68.74 s). No sign of secondary hyperfibrinolysis were found during the study period. In six patients a deep vein thrombosis and in six patients a thromboembolic event. Eighteen patients (43%) died during hospitalization due to coagulopathy produced by SARS-Cov-2 pneumonia. Conclusions: The results observed in our study support hypercoagulability in a severe inflammatory state, rather than a Consumption Coagulopathy (DIC) state. More studies are needed to better understanding of coagulopathy produced in patients with severe COVID-19 pneumonia.

Flu and pertussis vaccination during pregnancy in Geneva during the COVID-19 pandemic: A multicentric, prospective, survey-based study.

OBJECTIVE: To determine pertussis and influenza vaccination coverage during pregnancy among women delivering in all the maternities of Geneva (Switzerland), during the COVID-19 pandemic. METHODS: All women delivering in all the maternity centres of the canton of Geneva from 1st November 2020 to 30th November 2020 (beginning of the flu vaccination season) and from 8th March 2021 to 7th April 2021 (end of the flu vaccination season) had their records checked upon admission to the labour ward regarding pertussis and influenza vaccination during pregnancy. Reasons for non-vaccination were recorded. Univariate and multivariate analyses were done to identify predictors of vaccine uptake. RESULTS: 951 women delivered in Geneva during the two study periods, of which 950 were included in the study. 86.2% were vaccinated against pertussis, with no significant difference between the study periods (87.5% vs 85% at the beginning and end of the flu vaccination season respectively). 49.8% were vaccinated against influenza, with no significant difference between the study periods (48.8% vs 50.7% beginning and end of the flu vaccination season respectively). The influenza vaccine was 5 times more likely not to be proposed (8.9% vs. 1.7%) and 3 times more likely to be refused (26.6% vs. 8%) than the pertussis vaccine. Main reason for refusal was a lack of maternal desire for both vaccines, but not vaccine fear. Maternal parity ≥ 1 was significantly associated with pertussis vaccine uptake at univariate analysis. Women were significantly more likely to accept the influenza vaccine if they had a university degree or if they did not deliver in a midwife-only run delivery unit in both univariate and multivariate analysis. CONCLUSIONS: In Geneva, most gynaecologists offer pertussis immunization during antenatal care and uptake is high, but more efforts must be done to increase influenza vaccination coverage. Education level impacts maternal flu vaccination uptake, but other social disparities did not.

Circularity effect in the viability of bio-based industrial symbiosis: tackling extraordinary events in value chains. (Special Issue: Green, circular and bioeconomy practices and strategies.)

The complexity of predicting the impact of extraordinary events in the bio-based industrial symbiosis (BBIS) emerges as the main challenge addressed in this study. Complex systems theory, value chain dynamics, and the geographic economy constitute the best available frameworks to shed light on the aim of identifying the relationship between circular economy (CE) and viable value chains in BBIS. The Bazancourt-Pomacle biorefinery was selected as the case study to be analyzed at the mesoscale via System dynamics modelling. A scenario-based approach was adopted to identify the most required conditions to implement circularity in the sugar-beet value chain in BBIS. Three scenarios have been proposed up to 2027, the baseline scenario, the second scenario that considers the non-viable value chain scenario due to climate change effects, and the third showing an outstanding implementation of CE strategies (risk mitigation;production changeover, re-design of products and by-products, capacity buffers, and responsiveness) applied to face COVID19 outbreak is the most circular among the three. Finally, the third scenario also ensures the viability of the sugar beet value chain when facing the COVID19 outbreak by triggering leagility (leanness + agility), resilience, and survivability making the shift from bioethanol to alcohol production possible and therefore maintaining the value chain functionality.

Autopsy and medical death certificates in deaths related to COVID-19

Introduction: The COVID-19 pandemic has been the largest in the current century and the reason for numerous scientific works. In Cuba, the Temporary Group of Pathological Anatomy has been established to study the autopsies of those who died from COVID-19 (more than 400). The medical death certificates, documents of inestimable value, in Cuba are repaired according to the results of the autopsies, to raise their quality. Objectives: To evaluate the results of autopsies with COVID-19 diagnoses, compared to medical death certificates. Methods: The diagnoses of causes of death of 65 autopsies of the year 2020 were evaluated with their medical death certificates. The diagnoses were processed in the Automated System for the Registration and Control of Pathology. Direct causes of death, basic causes of death, intermediate causes of death, and contributing causes of death were analyzed. The total agreement of both diagnoses was defined, partial agreement, diagnostic mismatch or discrepancy, and insufficient data. Results: Diagnostic discrepancies of basic and direct cause of death are 46.2 % and 60.0 % of all cases and 19.4 % and 64.5 % when COVID-19 was basic cause of death. The high figures for diagnostic discrepancies correspond to those reported in previous studies, both in clinical diagnoses and in medical death certificates. Conclusions: There are high numbers of diagnostic discrepancies compared with the results of autopsies with COVID-19 diagnoses, compared to medical death certificates. © 2021, Editorial Ciencias Medicas. All rights reserved.

[Heterotopic ossification in SARS-CoV-2: Scintigraphic and radiological images]. / Osificación heterotópica en paciente con SARS-CoV-2: imágenes gammagráficas y radiológicas.

Patients with severe COVID-19 can develop painful range-of-motion restrictions of large joints due to heterotopic ossification. We present the case of a patient who developed hip pain after prolonged admission for severe COVID-19 pneumonia. Conventional radiography, computed tomography and bone scan showed extensive heterotopic ossification in the hips. It is probable that both local and systemic factors contribute to the development of heterotopic ossifications and it is necessary to rule out this entity when these patients reported joint pain. Early diagnosis is important to provide non-pharmacological interventions such as mild passive mobilization and anti-inflammatory medication and in refractory cases surgical resection of the ectopic bone is consider.