ABSTRACT
ECMO offering is limited to advanced HIV/AIDS patients. The Covid-19 pandemic exposed primary care shortage with resurgence of STDs, including HIV. At the same time, immunocompromised hosts with COVID-19 infection carried worse outcomes. We report a case of successful use of VV-ECMO in a newly diagnosed HIV/AIDS patient with severe ARDS as bridge to respiratory and immunologic recovery A 36-year-old white male diagnosed with moderate COVID-19 pneumonia in early August 2022, treated with steroids and remdesivir, found with HIV/AIDS stage 3 (CD4 of 28/5%) and high viral load (7 million cop/mL). Respiratory status declined to require invasive mechanical ventilation (MV) and unsuccessful trial of proning. Due to persistent hypoxemia, VV- ECMO was initiated in late August 2022. HIV antiretroviral therapy (ARV) was bictegravir/emtricitabine/tenofovir, then Dolutegravir + emtricitabine/tenofovir to enable nasogastric administration. Empirically treated with Bactrim and continued steroids for PJP, confirmed positive by PCR, in addition to high CMV titers in blood (129.000 IU/mL) and BAL (42.000 IU/mL), suggestive of CMV pneumonitis co-infection treated with Ganciclovir IV. Tracheostomy was performed on day 15. ECMO run faced formidable challenges including circuit insufficiency in the settings of possible Immune Reconstitution Inflammatory Syndrome with elevated cardiac output, managed with addition of right jugular vein return cannula;RV failure secondary to Pulmonary HTN, supported with inotropes and inhaled pulmonary vasodilators;uncertain ECMO pharmacodynamics for ARV and high sedative demands;thrombocytopenia (HIV and iatrogenic) deriving in spontaneous small subdural hematoma with no sequela. After 7 weeks of ECMO therapy, MV via tracheostomy was transitioned to High Flow Nasal Cannula while improving ECMO settings towards circuit weaning, HIV and CMV had virtually suppressed (252 cop/mL and 751 IU/mL, respectively), and CD4 increased to 122/18% COVID-19 pandemic propelled the use of ECMO therapy for severe ARDS and spotlighted healthcare access disparities with resurgence of vulnerable populations such the advanced HIV/AIDS patients. High-volume ECMO centers are acquiring expertise to enable survival of complex patients historically deprived of high-end therapies [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
The digitalisation process in which Spanish society has been immersed over the past few years has been accelerated by the COVID-19 pandemic and the subsequent lockdown situation. This has affected social services in two ways. First, it has shown that user needs can be dealt with effectively through digital interventions. Second, it has highlighted the fact that the digital represents an environment in its own right in which both social inclusion and social exclusion processes can be generated. This chapter presents some of the main results of the digital transformation process in Spain from the perspective of social welfare and social inclusion. In particular, it focuses on the consolidation of digital social work and the digital transformation of social services. The chapter concludes by presenting best practices for designing digital social intervention strategies aimed at reducing inequality and increasing social welfare in digital societies. © 2023 selection and editorial matter, Antonio López Peláez, Sang-Mok Suh and Sergei Zelenev;individual chapters, the contributors.
ABSTRACT
Chapter 2 takes readers on a journey through world regions during the first six months of the pandemic, a period shaped by vastly different approaches between and within countries ranging from denial, mitigation to suppression. Some countries had to deal with major weather events and other disasters while also managing the health emergency. The ideologies of governments came to the fore influencing whether health or economies were prioritised, the science was accepted, and whether approaches were informed by individualism or collective responsibility. The first six months of the pandemic highlighted vast inequalities and established the global conditions for the emergence of new variants. © 2022 selection and editorial matter, Patricia Fronek and Karen Smith Rotabi-Casares;individual chapters, the contributors.
ABSTRACT
The COVID-19 pandemic has sped up the pace of the digital transition process in which we have been immersed. In a context of generalized lock-down, our organizations have been forced to go digital and many of the activities social workers perform must now be done remotely. As a result, e-social work, or digital social work, has gone from being an emerging specialization to a critical specialty across organizations and activities. In this article, we examine some basic scientific and methodological foundations to develop a science of social work from the perspective of critical realism, with special attention to digitalization. Establishing the scientific foundations of digital social work is a preliminary step for its development as a field of specialization. © 2021, Western Michigan University. All rights reserved.