ABSTRACT
Introduction: During the COVID-19 pandemic, the number of patients who required admission to the intensive care unit (ICU) and prolonged intubation (ETI) or a tracheotomy (TT) due to severe ARDS has increased. Causes of persistent dyspnea after severe COVID-19 pneumonia include diffuse lung disease and pulmonary embolism. However, other causes of persistent dyspnea need to be ruled out in COVID-19 ICU-survivors, including iatrogenic tracheal stenosis (TS). Iatrogenic TS account for 50% of the 15-20 patients evaluated every year in the laryngotracheal multidisciplinary team (MDT) of our center. The management of these patients requires an individualized and multidisciplinary assessment, including Interventional Pulmonologists, Thoracic Surgeons and Otolaryngologists. The objective of this study was to describe the cases of iatrogenic TS after severe pneumonia due to COVID-19. Material(s) and Method(s): A descriptive study of the cases of iatrogenic TS in COVID-19 ICU-survivors evaluated at our center's MDT, from the end of the first wave to present. Result(s): A total of 10 patients were included, 70% were women, with a median age of 60 years [53.5-64.5]. The median ICU stay was 58.5 days [34-91]. All patients were intubated and 9 of them (90%) required TT, in 2 cases due to extubation failure. Symptoms at diagnosis included dyspnea in 3 (30%), stridor in 6 (60%) and 1 (10%) was asymptomatic. TS location was glottic in 2 (20%) and tracheal in 8 (80%). The main cause of TS was ring fracture secondary to TT (40%). Conclusion(s): Iatrogenic TS is a rare cause of dyspnea in COVID-19 ICU-survivors, but it must be considered in these patients given the high number of patients who required prolonged ETI or TT during the COVID-19 pandemic.
ABSTRACT
From the first months of 2020 we were surprised when the SARS-COV2 showed up. Its impact was global and affected different areas of social, cultural and economic daily life. In education area, especially at the teaching-learning processes, most of the people changed substantially owed their dynamics. At the University of Colima, Mexico, regular classes were suspended from March18, and after that, a brief period of adjustments was stablished for all of the involved people as an alternative way to continue with the scheduled. That way, teachers and pupils, they both were virtually resumed through “technological mediation classes”. For teachers and students it was a big challenge, the curricular contents were reorganized into an academic continuity program, which was designed taking care of the materials and technological tools. This alternative and emergent way for taking and teaching classes was fully incorporated into the school dynamics. This unprecedented situation made visible a basic problem: the differential vulnerabilities of teachers and students who did not have the basic skills and adequate technological equipment at their homes. From a phenomenological theory and methodology approach, the aim of this paper is to reflect on the specific vulnerabilities that are visible in students when starting another home studying semester through technological mediation. This allowed the unveiling of two scenarios: an adverse one full of emotional, educational and economic challenges that young university students (Bachelors) have had to overcome, and the second one encouraging scenario, anchored to positive expectations associated with a new learning with the aim of getting ahead of the pandemic by COVID-19 and return to the classroom again. © 2021 by the Author(s).
ABSTRACT
The new Coronavirus pandemic is a spatial phenomenon directly related to the flow of people in the territory and, therefore, large cities were the initial epicenter of the current health crisis. However, the circulation of the virus in small towns became an important focus of public managers attention due to the lack of hospital infrastructure. In this research, we analyzed the interiorization process of Covid-19 in Ceara. The accomplishment of the work took place from the literature review, statistical analysis and construction of thematic maps. The imbalance of the Ceara urban network and socio-spatial inequalities in access to health services constitute a barrier to actions to deal with the pandemic. Covid-19 exacerbated the need to strengthen local health and social protection networks for the most economically vulnerable population.