Refractory hypercapnia in a patient with malignant obesity-hypoventilation syndrome and COVID-19. A case report and management proposal

Obesity-hypoventilation syndrome associated with COVID-19 rapidly leads to severe acute respiratory failure with the need for invasive mechanical ventilation, becoming a therapeutic challenge for intensive care personnel due to the absence of ventilatory strategies. The following is the case of a 51-year-old male patient with a history of Pickwickian syndrome who presented with severe SARS-CoV-2 pneumonia, which progressed early to severe acute respiratory distress syndrome requiring invasive mechanical ventilatory support with positive pressure, and the need for vasoactive support, also presenting with a malignant phenotype obesity-hypoventilation syndrome. Based on the above, we make a clinical management proposal based on the current scientific literature on obesity-hypoventilation syndrome and severe pneumonia secondary to SARS-CoV-2. Despite the high mortality related to COVID-19 and the difficulty presented during invasive mechanical ventilation, the patient's outcome was favourable. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

Stenotrophomonas maltophilia superinfection in critically ill COVID-19 patients. Analysis of a series of cases

In patients with SARS-CoV-2 pneumonia, the increase in secondary infection by nosocomial microorganisms has alerted the health system. This is due to the increase in hospital stay and the final fatal outcome in critically ill patients. The following series of cases was carried out to evaluate the isolation of Stenotrophomonas maltophilia in hospitalized patients with COVID-19 in bronchial secretion samples. Seven patients were found associated with an excessive prescription of antibiotics with low susceptibility to Stenotrophomonas maltophilia and the presence of secondary bacterial infection by this microorganism associated with the use of invasive mechanical ventilation. This creates a dilemma in the medical strategies and recommendations used in many institutions for patients with SARS-CoV-2 pneumonia in need of an intensive care unit. © 2021

Factors related to bacterial pneumonia in patients with COVID-19 in an intensive care unit in Barranquilla, Colombia

Objective: To determine the factors related to bacterial pneumonia in patients with COVID-19 in an intensive care unit in Barranquilla, Colombia. Design: Nested, single-center case-control study, conducted between March and August 2020. Patients: Patients over 18 years of age, a hospital stay greater than 72 h, with invasive mechanical ventilation support admitted to the intensive care unit. Interventions: None. Measurements: Clinical variables were grouped for both cases and controls. Means and standard deviation were calculated in quantitative variables and proportions in categorical variables. Fisher's exact test was used to evaluate the differences between proportions, and the Mann-Whitney U test was used for differences in means. Variables with statistically significant differences were run in an explanatory model based on binary logistic regression. Results: The frequency of bacterial pneumonia was 10.07%, finding a high consumption of empirical antibiotic therapy. A statistical association was found between the time of dexamethasone use (OR 1.520;95% CI 1.131-2.042) with the development of bacterial pneumonia. The rest of the variables were not statistically significant after adjusting the model with logistic regression. Conclusion: Low rates of bacterial pneumonia were found, with Klebsiella pneumoniae prevailing as the most frequent bacterium. Overuse of dexamethasone in intensive care unit COVID-19 patients could increase the risk of bacterial pneumonia. For this reason, it must be evaluated in greater depth to explain causality and effect. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

SARS-CoV-2 pneumonia associated with Pneumocystis jirovecii coinfection in immunocompromised patients: a case report and literature review

Pneumocystis jirovecii pneumonia is an opportunistic infection that commonly occurs in patients with severe acquired immunodeficiencies. During the current health contingency, the presence of infection and co-infection by P. jirovecii in critically ill patients is apparently increasing altogether with the risk of fatal outcomes. The following is the case of a man with severe SARS-CoV-2 pneumonia, HIV immunosuppression and P. jirovecii coinfection who developed acute respiratory distress syndrome requiring invasive mechanical positive pressure ventilatory support. Despite the in-hospital management received, antibiotic therapy, and ventilatory support, the patient presented hemodynamic deterioration with instability, dying on day 20 of hospitalization. Subsequently, a bibliographic review of the current literature is carried out, discussing aspects such as epidemiology, pathophysiology, timely diagnosis, and treatment between the relationship of P. jirovecii and SARS-CoV-2 in critically ill patients. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

Primary spontaneous pneumothorax not associated with invasive mechanical ventilation in patients with COVID-19 pneumonia. Presentation of 2 cases

As the current SARS-CoV-2 virus pandemic progresses, scientific evidence of complications in the evolution of the disease is increasing. Pneumothorax is a common complication of acute respiratory distress syndrome, which significantly increases the mortality of patients. However, in COVID-19 to date there are few articles that report this complication. Below are two cases of patients with pneumonia complicated by COVID-19 with primary spontaneous pneumothorax without prior hospitalization. The first patient, a 63-year-old woman with hypertension, hypothyroidism and tobacco addiction, developed pneumonia complicated by COVID-19 with pneumothorax, recovered progressively and was discharged 20 days after admission to the unit. The second patient, a 44-year-old man with obesity, developed pneumonia complicated by COVID-19 with pneumothorax, which during his stay progressed to septic shock and he died. Timely identification of possible complications due to COVID-19 is crucial for reducing mortality, and therefore they should be suspected in all types of patients with SARS-CoV-2 pneumonia on their first admission to health centres. © 2021

PANACEA cough sound-based diagnosis of COVID-19 for the DiCOVA 2021 Challenge

The COVID-19 pandemic has led to the saturation of public health services worldwide. In this scenario, the early diagnosis of SARS-Cov-2 infections can help to stop or slow the spread of the virus and to manage the demand upon health services. This is especially important when resources are also being stretched by heightened demand linked to other seasonal diseases, such as the flu. In this context, the organisers of the DiCOVA 2021 challenge have collected a database with the aim of diagnosing COVID-19 through the use of coughing audio samples. This work presents the details of the automatic system for COVID-19 detection from cough recordings presented by team PANACEA. This team consists of researchers from two European academic institutions and one company: EURECOM (France), University of Granada (Spain), and Biometric Vox S.L. (Spain). We developed several systems based on established signal processing and machine learning methods. Our best system employs a Teager energy operator cepstral coefficients (TECCs) based frontend and Light gradient boosting machine (LightGBM) backend. The AUC obtained by this system on the test set is 76.31% which corresponds to a 10% improvement over the official baseline.

EXPLORING AUDITORY ACOUSTIC FEATURES FOR THE DIAGNOSIS OF COVID-19

The current outbreak of a coronavirus, has quickly escalated to become a serious global problem that has now been declared a Public Health Emergency of International Concern by the World Health Organization. Infectious diseases know no borders, so when it comes to controlling outbreaks, timing is absolutely essential. It is so important to detect threats as early as possible, before they spread. After a first successful DiCOVA challenge, the organisers released second DiCOVA challenge with the aim of diagnosing COVID-19 through the use of breath, cough and speech audio samples. This work presents the details of the automatic system for COVID-19 detection using breath, cough and speech recordings. We developed different front-end auditory acoustic features along with a bidirectional Long Short-Term Memory (bi-LSTM) as classifier. The results are promising and have demonstrated the high complementary behaviour among the auditory acoustic features in the Breathing, Cough and Speech tracks giving an AUC of 86.60% on the test set. © 2022 IEEE

Telemedicine for Genetic Counseling in Huntington's Disease during the COVID-19 Pandemic

Objective: To evaluate the feasibility of using telemedicine for predictive genetic testing in Huntington's disease (HD). Background: While a specific protocol for genetic testing in HD exists, evidence regarding its applicability via telemedicine is lacking. The implementation of social distancing guidelines during the COVID-19 pandemic led us to utilize telehealth visits in our clinic for predictive testing. Methods: From May 2020 to Sep 2021, eligible patients seen at the UTHealth Houston, HDSA Center of Excellence multidisciplinary clinic were offered predictive genetic testing via telemedicine. The 2016 HDSA recommendations for predictive testing were adapted and implemented via telemedicine. Visits were conducted by a team consisting of a movement disorder specialist, genetic counselor, psychiatrist, neuropsychologist, and social worker utilizing institute-approved telemedicine platforms. Patient satisfaction and telehealth quality were assessed with Telehealth Usability Questionnaire (TUQ), which included the components of usefulness, ease of use, interface quality, interaction quality, reliability, and satisfaction [1]. Results: 50 individuals expressed interest in predictive testing via telemedicine. Of these, 11 did not continue after initial inquiry and three had already prior testing [Fig. 1]. Of the remaining 36 individuals (mean age: 37.17 ± 13.23 years), 21 completed the consent and sample collection with an in-person visit. For 15 elected to use telemedicine consent was obtained via telemedicine, and sample collection was coordinated remotely. 21 individuals had results disclosure via telemedicine, 13 of whom used telemedicine for both visits. Seven out of 21 completed the TUQ and rated the visit usability as 92.5% usefulness, 75.5% ease of use, 78.6% interface quality, 86.7% interaction quality, 64.1% reliability, and 89.3% satisfaction and future use. Conclusion: Delivering the predictive testing protocol via telemedicine depends on various patient and clinician-related factors including ease of use, comfort with the type of visit and technology used. In our experience, a majority of patients who underwent telemedicine for genetic counseling and result disclosure were satisfied and would use this service in the future. Despite the convenience and patient satisfaction, it is imperative that caution is applied prior to determining patient readiness and result disclosure given the sensitive nature of HD gene testing.

Family organization during confinement in Mexican families

Objective. To analyze domestic housework in Mexican families during Covid-19 confinement, specifically in cleaning, feeding, school work and leisure activities. Methodology. The approach was qualitative with a gender perspective from social constructionism. Three mothers participated to whom semi-structured interviews were applied. Results and conclusion. One of the findings was that in this period of confinement, mothers experienced overloading of caring activities in the family organization, which is assumed and justified by gender. However, they were involving their family in housework duties. It was concluded that deconstruction of gender stereotypes, that have been legitimized in family dynamics, is necessary and that extended family, among other people, are recognized as a support network from which women seek to build bonds of well-being.

Personalized education during a period of educational change and innovation. An illustrative example

This article examines and empirically illustrate the personalized education conceived as a sum of different strategies, actuations and resources to promotes learners' sense-making in the teaching and learning process. Six principles or elements involved in personalized education are suggested: starting from recognizing students' identities, fostering reflexive practices, facilitating the learner's agency, developing learning pathways, promoting the multiple linking-bridging, and implementing socio-educative supports and scaffolds. After describing those principles, the project “¡Cápsulas! Itinerarios de aprendizaje” allow us to illustrate the elements previously described. This project was designed and implemented during the third semester of the course 2019-2020, within confinement circumstances caused by Covid-19 pandemic. It is concluded by considering three challenges and opportunities of virtual education or remote teaching from the empirical example examined here. © 2020 Elsevier Doyma. All rights reserved.

A manifest in a time of pandemic: For a communitarian, sustainable, intergenerational and critical education

The emergency resulting from the coronavirus pandemic reminds us that, as human beings, we share a common challenge. Recently, it has been suggested that COVID-19 pandemic involve a “world perezhivanie”, a collective and traumatic “lived experience”, characterized by a profound crisis that affects not only our health, but also our economic, social, political and educational systems. In the light of this situation, we need to critically re-imagine education in 21st century. In this theoretical paper, we propose two principles designed to overcome three common biases in our understanding of learning and education. From these assumptions, we describe and illustrate the meaning and practice behind an inter-generational, personalized, shared, connected and sustainable education, based on a culture and praxis that is caring and involved, that allows us to consolidate processes of educational transformation and improvement. Copyright©: 2020 National Institute for Museums and Public Collections. Published by Index Copernicus Sp. z o.o. All rights reserved.