Mechanical Ventilation in COVID

From the start of the pandemic, amid the frequency of cases with COVID-19 associated respiratory failure, mechanical ventilation has been the object of controversy. Reports associating its use with higher mortality, likely reflecting the severity of an unknown illness devastating the entire world, as well as the turmoil caused by the lack of sufficient equipment to supply the increasing demands in our hospitals, both were points of attention for media and public in general. However, from the clinical perspective, the need to apply different methods or to deviate from stablished guidelines to be able to adequately support these patients, was soon noticed. Multiple publications were guiding clinicians in the obscured territory of the unknown disease and to its variable impact on the respiratory system. This chapter aims to summarize the knowledge acquired throughout the pandemic, describing some of the elements of COVID-19 respiratory failure as well as its management with mechanical ventilation. The chapter recovers some of the increasing information appearing almost daily in the literature. We recognize that given the changing nature of the disease and the progressive knowledge of the same, some of the concepts covered in this chapter might be subject of some review or modification at the moment of the publication. We, the authors, have attempted to summarize the existing evidence and to maintain a basic conceptual approach to the management of COVID-19 respiratory failure. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

[Factors associated with mortality due to SARS-CoV-2 in the population over 75 years of age in the Community of Madrid]. / Factores asociados con la mortalidad por SARS-CoV-2 en la población mayor de 75 años de la Comunidad de Madrid.

Objective: Various studies have identified factors associated with risk of mortality in patients with SARS-CoV-2 infection. However, their sample size has often been limited and their results partially contradictory. This study evaluated factors associated with COVID-19 mortality in the population of Madrid over 75 years of age, in infected patients, and in hospitalized patients up to January 2021. Patients and methods: This population-based cohort study analyzed all residents of the Community of Madrid born before January 1, 1945 who were alive as of December 31, 2019. Demographic and clinical data were obtained from primary care electronic medical records (PC-Madrid), data on hospital admissions from the Conjunto Mínimo Básico de Datos (CMBD, Minimum Data Set), and data on mortality from the Índice Nacional de Defunciones (INDEF, National Death Index). Data on SARS-CoV-2 infection, hospitalization, and death were collected from March 1, 2020 to January 31, 2021. Results: A total of 587,603 subjects were included in the cohort. Of them, 41,603 (7.1%) had confirmed SARS-CoV-2 infection, of which 22,362 (53.7% of the infected individuals) were hospitalized and 11,251 (27%) died. Male sex and age were the factors most closely associated with mortality, though many comorbidities also had an influence. The associations were stronger in the analysis of the total population than in the analysis of infected or hospitalized patients. Mortality among hospitalized patients was lower during the second wave (33.4%) than during the first wave (41.2%) of the pandemic. Conclusion: Age, sex, and numerous comorbidities are associated with risk of death due to COVID-19. Mortality in hospitalized patients declined notably after the first wave of the pandemic.

The Effect of Resilience on Entrepreneurial Intention in Higher Education Students in a Post-Covid Stage 19

The situation resulting from the COVID-19 pandemic has affected several areas: economic, social, relational, and, of course, education. This article aims to determine the impact on education, transposed to Resilience and entrepreneurial intention. A quantitative study was carried out, and 550 undergraduate university students were surveyed by random probability sampling, and the data were analyzed by factor analysis for the reduction of dimensions, and subsequently, linear and correlational regressions were applied. We found that there is a positive impact between Resilience and the entrepreneurial intention of university students, and it was also demonstrated that the greater the Resilience, the greater the perceived control of the entrepreneurial intention. Both attitude and subjective norm showed the highest positive relationships. The present work provides essential findings on the effect of Resilience on students and supports the importance of including entrepreneurship in education as a post-pandemic triggering factor. Furthermore, it opens future lines of research related to the inclusion of entrepreneurship in university students and the specific social impacts that may affect entrepreneurial intention. © 2022, North American Business Press. All rights reserved.

Analysis of COVID-19 Impact on Public Transport Usage based on Smart Card Data-A Regional Case Study in Australia

The outbreak of COVID-19 has made a profound impact on mobility, especially for public transport users. Extensive research has been conducted on the change of travel patterns in major cities where public transport systems have been well developed and heavily used. However, in small cities, the public transport network is relatively sparse, especially in suburban areas, which makes the corresponding travel patterns differ from those in major cities. Therefore, proper investigation of the public transport usage in such small cities is still needed, especially under the COVID-19 impact. This paper aims to reveal the change of public transport users' travel patterns based on a comparative study of public transport usage Pre-COVID and during the COVID-19 period. The Illawarra, a coastal region close to Sydney in Australia is used as a case study. Smart card data is used to reveal relevant changes in both intraregion (in the Illawarra) and inter-region (between the Illawarra and Sydney) travels in consideration of heterogeneous user groups. The results show a significant decrease (around 47%) in public transport ridership by both train and bus. However, compared to intra-region ridership, the inter-region trips by train drop much more (around 62%). Moreover, heterogeneous age group passengers show different changes after the COVID-19 outbreak. The research findings are expected to provide valuable suggestions for policy making and public transport service adjustment when a similar crisis occurs again. © 2022 IEEE.

[Pre-clinical validation of a turbine-based ventilator for invasive ventilation-The ACUTE-19 ventilator]. / Validación preclínica de un respirador de turbina para la ventilación invasiva: el respirador ACUTE-19.

Background: The severe acute respiratory syndrome-coronavirus 2 pandemic pressure on healthcare systems can exhaust ventilator resources, especially where resources are restricted. Our objective was a rapid preclinical evaluation of a newly developed turbine-based ventilator, named the ACUTE-19, for invasive ventilation. Methods: Validation consisted of (a) testing tidal volume delivery in 11 simulated models, with various resistances and compliances; (b) comparison with a commercial ventilator (VIVO-50) adapting the United Kingdom Medicines and Healthcare products Regulatory Agency-recommendations for rapidly manufactured ventilators; and (c) in vivo testing in a sheep before and after inducing acute respiratory distress syndrome by saline lavage. Results: Differences in tidal volume in the simulated models were marginally different (largest difference 33 ml [95% CI 31 to 36]; P < .001). Plateau pressure was not different (-0.3 cmH2O [95% CI -0.9 to 0.3]; P = .409), and positive end-expiratory pressure was marginally different (0.3 cmH2O [95% CI 0.2 to 0.3]; P < .001) between the ACUTE-19 and the commercial ventilator. Bland-Altman analyses showed good agreement (mean bias -0.29 [limits of agreement 0.82 to -1.42], and mean bias 0.56 [limits of agreement 1.94 to -0.81], at a plateau pressure of 15 and 30 cmH2O, respectively). The ACUTE-19 achieved optimal oxygenation and ventilation before and after acute respiratory distress syndrome induction. Conclusions: The ACUTE-19 performed accurately in simulated and animal models yielding a comparable performance with a VIVO-50 commercial device. The ACUTE-19 can provide the basis for the development of a future affordable commercial ventilator.

Factors associated with mortality due to SARS-CoV-2 in the population over 75 years of age in the Community of Madrid.

OBJECTIVE: Various studies have identified factors associated with risk of mortality in patients with SARS-CoV-2 infection. However, their sample size has often been limited and their results partially contradictory. This study evaluated factors associated with COVID-19 mortality in the population of Madrid over 75 years of age, in infected patients, and in hospitalized patients up to January 2021. PATIENTS AND METHODS: This population-based cohort study analyzed all residents of the Community of Madrid born before January 1, 1945 who were alive as of December 31, 2019. Demographic and clinical data were obtained from primary care electronic medical records (PC-Madrid), data on hospital admissions from the Conjunto Mínimo Básico de Datos (CMBD, Minimum Data Set), and data on mortality from the Índice Nacional de Defunciones (INDEF, National Death Index). Data on SARS-CoV-2 infection, hospitalization, and death were collected from March 1, 2020 to January 31, 2021. RESULTS: A total of 587,603 subjects were included in the cohort. Of them, 41,603 (7.1%) had confirmed SARS-CoV-2 infection, of which 22,362 (53.7% of the infected individuals) were hospitalized and 11,251 (27%) died. Male sex and age were the factors most closely associated with mortality, though many comorbidities also had an influence. The associations were stronger in the analysis of the total population than in the analysis of infected or hospitalized patients. Mortality among hospitalized patients was lower during the second wave (33.4%) than during the first wave (41.2%) of the pandemic. CONCLUSION: Age, sex, and numerous comorbidities are associated with risk of death due to COVID-19. Mortality in hospitalized patients declined notably after the first wave of the pandemic.

Validación preclínica de un respirador de turbina para la ventilación invasiva: el respirador ACUTE-19 Pre-clinical validation of a turbine-based ventilator for invasive ventilation–The ACUTE-19 ventilator

Graphical Antecedentes La pandemia producida por el síndrome respiratorio agudo severo por coronavirus 2 puede agotar los recursos sanitarios, especialmente de respiradores, en situaciones de escasez de recursos sanitarios. Nuestro objetivo fue realizar una evaluación preclínica rápida de un prototipo de respirador de turbina para la ventilación invasiva denominado ACUTE-19. Métodos La validación consistió en: a) evaluación de la administración de un volumen corriente en 11 modelos pulmonares simulados, con diversas resistencias y compliancias;b) comparación con un ventilador comercial (VIVO-50) adaptando las recomendaciones de la Agencia Reguladora de Medicamentos y Productos Sanitarios del Reino Unido para ventiladores de fabricación rápida, y c) realización de pruebas in vivo en una oveja antes y después de inducir el síndrome de distrés respiratorio agudo mediante lavado salino. Resultados Las diferencias de volumen corriente en los modelos simulados fueron mínimamente diferentes (la mayor diferencia fue de 33 ml [IC 95%: 31 a 36];p < 0,001). La presión de meseta no fue diferente (−0,3 cmH2O [IC 95%: −0,9 a 0,3];p = 0,409), y la presión positiva al final de la espiración fue levemente diferente (0,3 cmH2O [IC 95%: 0,2 a 0,3];p < 0,001) comparando el ACUTE-19 y el ventilador comercial. El análisis de Bland-Altman mostró una buena concordancia (sesgo medio −0,29 [límites de concordancia 0,82 a −1,42], y sesgo medio 0,56 [límites de concordancia 1,94 a −0,81], a una presión de meseta de 15 y 30 cmH2O, respectivamente). El ACUTE-19 consiguió una oxigenación y ventilación óptimas antes y después de la inducción del síndrome de distrés respiratorio agudo en el modelo animal. Conclusiones El ACUTE-19 se comportó con precisión en los modelos simulados y animales, con un rendimiento comparable al del dispositivo comercial VIVO-50. El ACUTE-19 puede servir de base para el desarrollo de un futuro ventilador comercial asequible.

Pre-clinical validation of a turbine-based ventilator for invasive ventilation-The ACUTE-19 ventilator.

BACKGROUND: The Severe Acute Respiratory Syndrome (SARS)-Coronavirus 2 (CoV-2) pandemic pressure on healthcare systems can exhaust ventilator resources, especially where resources are restricted. Our objective was a rapid preclinical evaluation of a newly developed turbine-based ventilator, named the ACUTE-19, for invasive ventilation. METHODS: Validation consisted of (a) testing tidal volume (V_T) delivery in 11 simulated models, with various resistances and compliances; (b) comparison with a commercial ventilator (VIVO-50) adapting the United Kingdom Medicines and Healthcare products Regulatory Agency-recommendations for rapidly manufactured ventilators; and (c) in vivo testing in a sheep before and after inducing acute respiratory distress syndrome (ARDS) by saline lavage. RESULTS: Differences in V_T in the simulated models were marginally different (largest difference 33ml [95%-confidence interval (CI) 31-36]; P<.001ml). Plateau pressure (P_plat) was not different (-0.3cmH₂O [95%-CI -0.9 to 0.3]; P=.409), and positive end-expiratory pressure (PEEP) was marginally different (0.3 cmH₂O [95%-CI 0.2 to 0.3]; P<.001) between the ACUTE-19 and the commercial ventilator. Bland-Altman analyses showed good agreement (mean bias, -0.29, [limits of agreement, 0.82 to -1.42], and mean bias 0.56 [limits of agreement, 1.94 to -0.81], at a P_plat of 15 and 30cmH₂O, respectively). The ACUTE-19 achieved optimal oxygenation and ventilation before and after ARDS induction. CONCLUSIONS: The ACUTE-19 performed accurately in simulated and animal models yielding a comparable performance with a VIVO-50 commercial device. The acute 19 can provide the basis for the development of a future affordable commercial ventilator.

Tissue-specific evidence for SARS-CoV-2 within intraocular tissues

Purpose : To systematically investigate ocular changes in autopsied eyes from fatal cases of Coronavirus disease 2019 (COVID-19) and to investigate the localization of severe acute respiratory syndrome coronavirus (SARS-CoV-2) within ocular structures. Methods : Macroscopic and microscopic histopathological evaluation was performed and the localization of SARS-CoV-2 RNA within ocular tissues investigated using an in situ hybridization (ISH) technique in 13 eyes. Contralateral eyes were freshly dissected, and droplet digital polymerase chain reaction (ddPCR) assay was performed on ocular fluids and tissues to quantify SARS-CoV-2 RNA. Results : A total of 21 fatal COVID-19 cases were included (mean age, 60.2 years [range, 27- 91 years];23.8% female). Histopathological abnormalities include vascular changes (61.9%), cytoid bodies (52.4%), and retinal edema (23.8%) with minimal inflammation (0.09%) were observed. Non-CMV viral inclusions were identified in one eye. No CMV positivity was detected. Of the 21 contralateral eyes tested by ddPCR, 14 tested positive for SARS-CoV-2. Using ddPCR and ISH, SARS-CoV-2 localization was observed in the following ocular tissues and fluid: cornea (27.3%), aqueous (26.3%), lens (54.5%), vitreous (15.0%), retina (22.2%), choroid/sclera (47.4%), and optic nerve (50.0%). The choroid/sclera, optic nerve and lens were the most frequent ocular structures found to be ddPCR positive. Evidence of replication was detected in four cases. Conclusions : Our results suggest that SARS-CoV-2 localizes to intraocular tissues. However, histological changes observed are likely a secondary hemodynamic change rather than primary effect of the virus.

Factors associated with mortality due to SARS-CoV-2 in the population over 75 years of age in the Community of Madrid Factores asociados con la mortalidad por SARS-CoV-2 en la población mayor de 75 años de la Comunidad de Madrid

Objective Various studies have identified factors associated with risk of mortality in patients with SARS-CoV-2 infection. However, their sample size has often been limited and their results partially contradictory. This study evaluated factors associated with COVID-19 mortality in the population of Madrid over 75 years of age, in infected patients, and in hospitalized patients up to January 2021. Patients and Methods This population-based cohort study analyzed all residents of the Community of Madrid born before January 1, 1945 who were alive as of December 31, 2019. Demographic and clinical data were obtained from primary care electronic medical records (PC-Madrid), data on hospital admissions from the Conjunto Mínimo Básico de Datos (CMBD, Minimum Data Set), and data on mortality from the Índice Nacional de Defunciones (INDEF, National Death Index). Data on SARS-CoV-2 infection, hospitalization, and death were collected from March 1, 2020 to January 31, 2021. Results A total of 587,603 subjects were included in the cohort. Of them, 41,603 (7.1%) had confirmed SARS-CoV-2 infection, of which 22,362 (53.7% of the infected individuals) were hospitalized and 11,251 (27%) died. Male sex and age were the factors most closely associated with mortality, though many comorbidities also had an influence. The associations were stronger in the analysis of the total population than in the analysis of infected or hospitalized patients. Mortality among hospitalized patients was lower during the second wave (33.4%) than during the first wave (41.2%) of the pandemic. Conclusion Age, sex, and numerous comorbidities are associated with risk of death due to COVID-19. Mortality in hospitalized patients declined notably after the first wave of the pandemic.

Evaluation of the Performance of an Immersive System for Tele-education

Tele-education was already a solution for people who cannot attend lessons in person (such as inaccessibility in rural areas or illness issues). However, COVID has revealed problems in tele-education with current technology, causing adolescents and children to slow down their learning curves and experience problems of social distancing with their classmates. This paper presents a user study to validate an immersive communication system for tele-education purposes. This system streams in real time a class using 360-degree cameras, allowing remote students to explore the whole scene and improving the feeling of being in the classroom with their colleagues. Additionally, the prototype provides notifications to the remote students about events (such as a changes in the teacher's presentation or classmates raising their hands) that occur outside their viewport to indicate in which direction they should move their heads to visualize them. To validate the system and investigate its possible added value, socioemotional factors such as presence, perceived quality, usability, and usefulness of the notifications were evaluated through a user test using questionnaires. The obtained results show that using immersive tele-education systems can improve the presence, as well as the benefits of the notifications on the experience of the remote students. © 2022 ACM.

Descriptive analysis of menstrual alterations reported to the Spanish pharmacovigilance system (SEFV as acronym of its name in Spanish) after vaccination against COVID-19

Objective: • To describe the most reported menstrual alterations to the SEFV in relation to vaccination against COVID-19. • To stratify cases by age, type of vaccine and reporter. • To collect the latencies of adverse events. Material and/or methods: Review of the notifications uploaded to the FEDRA database with the following search criteria: the suspected drug is a vaccine against COVID-19, the adverse drug reaction (ADR) is part of the Meddra HLGT “alterations of menstrual flow” and the upload date is between the date of authorisation of the first vaccine (22/12/20) and the cut-off date established by protocol (3/11/2021). Also, those cases corresponding to Canary Islands have been selected for a detailed analysis. Results: There are 2275 notifications in Spain that meet the search criteria. The SEFV is the source of 98% of the notifications, being the pharmaceutical industry the source of the 2% left. In Canary Islands, there have been 80 notifications that meet the criteria. Of these, 87.5% come from female users (patients). The average age is 36 years. The most reported menstrual disorders were “intermenstrual bleeding,” “menstrual disorder” and “irregular menstruation.” The latencies described have a mean of 12.5 days with a median of 6 days and a mode of 3 days, appearing after the first dose in most cases. Conclusions: Most of the reports are from female users. Coding is complex due to the difficulty of the terms, which complicates data analysis. Reported reactions are diverse, being the most frequent terms non-specific. Menstrual disturbances interfere with daily life, are underreported and under-diagnosed.

Impact of layered non-pharmacological interventions on COVID-19 transmission dynamics in Yucatan, Mexico.

Background: The pandemic propagation of SARS-CoV-2 led to the adoption of a myriad of non-pharmacological interventions (NPIs, e.g., social distancing, mobility restrictions, gathering restrictions) in the Americas. Using national epidemiological data, here we report the impact of the layered adoption of multiple NPIs aimed at curving SARS-CoV-2 transmission in Yucatan State, Mexico. Methods: Data from suspected and laboratory confirmed COVID-19 cases during 2020 were analyzed by age groups and sex, clinical signs, and symptoms as well as outcome. The impact of NPIs was quantified using time-varying reproduction numbers (R t) estimated as a time-series and by sectors of the city. Findings: A total of 69,602 suspected cases were reported, 39.3% were laboratory-confirmed. Men were hospitalized (60.2%), more severely ill (3% vs 1.9%) and more likely to die (62%) than women. Early in the outbreak, all sectors in Merida had R t estimates above unity. Once all NPÍs were in place, R t values were dramatically reduced below one, and in the last interval transmission estimates of R t remained below one in all sectors. Interpretation: In the absence of a COVID-19 vaccination program, the combination and wide adherence of NPÍs led to a low and stable trend in SARS-CoV-2 transmission that did not overwhelm the health sector. Our study reflects that a controlled and planned ease of restrictions to balance health, social and economic recovery resulted in a single wave of transmission that prolonged at low and stable levels. Funding: GVP received funding from Emory University via the MP3 Initiative.

[Body image adaptation in health personnel during COVID-19]

BACKGROUND: Everything that has contact with the body is also integrated as part of the individual's body image;Personal Protective Equipment (PPE) could be integrated into body image. OBJECTIVE: To describe the characteristics of the drawing of the human figure as a projective tool of body image in health personnel. MATERIAL AND METHODS: A retrospective longitudinal descriptive study was carried out, which consisted of the compilation and analysis of the drawing tests of the human figure performed on health personnel in the contingency of COVID-19. A descriptive analysis of the qualitative variables and an inferential analysis with McNemar's test were carried out to compare proportions between groups. RESULTS: 147 drawings in the previous context and their respective drawings in context during the contingency were included. When comparing both groups, in the pandemic context an increase in distortions or omissions was observed (p = 0.013), mainly located in the hands and arms (p < 0.001). Also, traces suggestive of isolation (p = 0.039), drawings with poor definition of the eyes (p = 0.69), inclusion of PPE (p < 0.001), and omission of the nose (p = 0.011) and mouth (p < 0.001) were observed). CONCLUSIONS: The increase in distortions or omissions may be related to reconstructing the social part. Six months after the start of the contingency, 40% of the health personnel had already incorporated the PPE into their projective drawing of body image.

COVID-19 in Hidalgo, Mexico. A study of territorial inequalities

Introduction: The ongoing global pandemic due to the COVID-19 virus has had varying impacts on the quality of life in different regions. This article aims to identify areas of high social vulnerability in the municipalities in Hidalgo with information gathered in 2015. Methodology: The social vulnerability index was calculated by using the principal component analysis technique along with geographic information systems to evaluate its relationship with COVID-19 fatality ratio. Variables were constructed based on information taken from the 2015 Intercensal Survey for municipalities. Results: Two regions, one in the northeast and the other in the southwest of the state of Hidalgo, showed a strong relationship between social vulnerability and the fatality ratio. Conclusions: The variables that best explain social vulnerability in the Municipalities in Hidalgo are those that contemplate population characteristics. The findings could be used in planning social actions so that they not only focus on health care services in order to reduce the impacts of the current pandemic and reduce mortality due to COVID-19 in the most vulnerable sectors in Municipalities in Hidalgo. © 2022 Instituto de Geografia. All rights reserved.

Kidney infarction in patient with covid-19: Clinical case

Description: A 50-year-old male who was admitted to intensive care with a Coronavirus-19 diagnosis for strict handling requiring oxygen therapy. He presented distention and abdominal pain, for which an abdomen-pelvic tomography was requested, reporting lack of filling in the right renal artery and renal infarcts requiring angioplasty and double antiplatelet therapy. The evolution was favorable, and the patient was discharged. Currently, a renal Doppler reports adequate vascularization. The patient presents proper renal function. Clinical Significance: The coronavirus disease is a contagious and life- threatening infection caused by the severe acute respiratory syndrome coronavirus 2. It can lead patients to arterial and venous thrombosis. However, acute renal artery occlusion is considered a rare disease. Clinical Implications: Prompt diagnosis and treatment are important to prevent permanent kidney damage or permanent loss of kidney function. Conclusion: The underlying etiology of renal infarcts remains largely unknown at present, but it may include direct viral cytopathic effects on endothelial cells. Most patients are managed conservatively. Some cases undergo angioplasty successfully. The patient in this case received earlier treatment with doses of anticoagulant enoxaparin, and his glomerular filtration remained stable, although complementary treat- ment was required. © 2022 Sociedad Mexicana de Urologia. Colegio de Profesionistas A.C.. All rights reserved.

EL BURNOUT ACADÉMICO Y LA INTENCIÓN DE ABANDONO DE LOS ESTUDIOS UNIVERSITARIOS EN TIEMPOS DE COVID-19

The crisis caused by the COVID-19 pandemic has profoundly affected the educational system, due to the interruption of academic normality and the transition to virtual learning. The changes derived from this situation represent a risk for students' educational trajectories and their enrollment in school. In relation to this problem, the objective of this study is to analyze the effect of academic burnout on the intent to leave school, among a sample of 475 university students of differing classifications. The results show a positive correlation between burnout and the intent to leave school. The data should serve to implement preventive programs to reduce the effects of stress, facilitate adapting to the new reality, and prevent the problem of dropping out. © 2021 Consejo Mexicano de Investigacion Educativa. All rights reserved.

Dietary patterns of adolescent students during the COVID-19 pandemic lockdown.

This study aimed to analyze the dietary patterns of adolescent students during the COVID-19 pandemic lockdown. To achieve the research´s aim 127 adolescent students, 60 men (18.88±4.18 years) and 67 women (17.61±7.43 years) completed an online questionnaire that analyzed variables regarding their nutritional profile. Adolescent students presented a dietary pattern during the COVID-19 pandemic lockdown characterized by different associations of food consumption, On one hand, the consumption of healthier foods such as meat, fish, vegetables, legumes, rice, or pasta, and on the other hand non-healthier foods as food, alcohol, or pastries. Further investigations are needed to implement multidisciplinary interventions to develop healthier habits in schools and to encourage the adoption of healthy diets among adolescents.