High efficacy of activated carbon fabric filters and masks developed to prevent the inhalation of microorganisms and particles associated with respiratory tract infections

As a major international public health emergency, COVID-19 has posed many challenges for healthcare professionals who have been heavily exposed to contamination. This article describes the development of a high-filtration capacity mask consisting of filter-element layers interspersed with super-activated carbon fiber fabric, non-woven polypropylene for dental–medical–hospital use and antiviral polyamide with nanostructured SiO2 thin film coating. The study found 98.18% particle filtration efficiency and determined 2.11 mmH2O/cm2 differential pressure, while fluid repellency complied with Brazilian standard NBR ABNT 15052:2004. © The Author(s) 2022.

Prolonged Versus Standard Prone Position in Covid-19 Ventilated Patients: A Quasi-Experimental Study

INTRODUCTION: Acute respiratory distress syndrome (ARDS) related to COVID-19 increased the number of patients requiring prone position ventilation (PPV). The ProSEVA PPV strategy of daily reproning is resource intensive because each complete PPV cycle takes half an hour of work from 4 experienced operators. Therefore the Standard PPV was extended until 24 to 48 hours. In 2021 Douglas et al. propose the Prolonged PPV strategy for COVID-19 ARDS, returning to the supine position only when the patient has stable gas exchange (Fio2< 60% with PEEP< 10cmH2O). This strategy was secure, but they did not compare the clinical outcomes of the Prolonged against the Standard PPV. In this study, we compare the number of PPV cycles and pressure wounds (PWs) in COVID-19 patients with Standard PPV vs. Prolonged PPV. METHOD(S): Quasi-experimental before-and-after study. We included ventilated patients with PPV indication (criteria from the ProSEVA Trial). Between October 1, 2020, to April 30, 2021, patients with indication of PPV received the standard PPV (24 to 48 hs), and patients hospitalized between May 1, 2021, to October 1, 2021, were treated with the Prolonged PPV. For the primary outcome (number of PPV cycles), we compare the proportion of patients with more than 2 PPV cycles in each group. As a sensitivity analysis, we performed a Fine and Gray regression adjusting by confounders, considering death as a competing event, two PPV cycles as the event, and censoring patients with one PPV cycle at ICU discharge. RESULT(S): We included 64 patients in the Standard PPV group and 16 in the Prolonged PPV group. No differences were observed in the number of PPV cycles between groups (patients with more than one cycle: 42.2% [n=27] vs. 62.5% [n=10];p=0.18). These observations were robust to the sensitivity analysis (the adjusted sHR to have two PPV cycles for the Prolonged PPV group was 1.31 [CI95% 0.63-2.71;p=0.46]). Patients in Prolonged PPV had 2.96 (IQR1.98-3.42) days in PPV vs. 1.98 (IQR1.38-2.94) in the Standard PPV (p=0.03). Chest and abdominal PWs were more frequently in the Prolonged PPV group (chest wounds: 5 patients [31.5%] vs 5 [7.8%];p=0.024 - abdominal: 3 [18.8%] vs 2 [3.12%];p=0.02). CONCLUSION(S): The Prolonged PPV increases the time in PPV and the PPV-associated PWs but does not reduce the total PPV cycles.

Discrimination and Calibration of Predictive Scores of Mortality in Ecmo for Patients with Covid-19

INTRODUCTION: The criteria for the COVID-19 patients' selection that benefit most from ECMO therapy are yet to be defined. In this study, we evaluate the predictive performance of the ECMO mortality predictive models in patients with COVID-19. METHOD(S): A retrospective study was performed in two high-complexity hospitals between March 18, 2020, and December 31, 2021. We included patients over 18 years old with COVID-19 infection confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) who received V-V ECMO due to COVID-19-related ARDS. We evaluated the predictive performance (discrimination, calibration, and accuracy) of death prediction of the following predictive models: i) Prediction of Death due to Severe ARDS in V-V ECMO score (PRESERVE);ii) The Respiratory Extracorporeal Membrane Oxygenation Survival Score (RESP) score;iii) Prediction of Survival on ECMO Therapy- Score (PRESET) score, to predict death. Also, we perform a cost-benefit analysis using the health-related quality of life reported by the CESAR TRIAL and the US life expectancy. Besides, we add the mortality predicted probability calculated with the best predictive model to the cost-benefit analysis. Therefore, the cost/QALY formula was: cost/QALY = cost / age-specific life expectancy*health utilitiesz.ast;survival probability. RESULT(S): We included 38 adult patients who received ECMO due to COVID-19. The PRESET score had the highest discrimination (AUROCs 0.81 [CI95% 0.67-0.94]) and the best calibration (Hosmer-Lemeshow test, p=0.6). The optimal threshold for this score was 7 (sensitivity 67%, specificity 89%, accuracy 78%). The cost per QALY in the USA, adjusted to life expectancy, was higher than UDS 100,000 in patients older than 45 years with a PRESET>10. CONCLUSION(S): The PRESET score had the highest predictive performance and could help in the patient's selection that benefits most from this resource-demanding and highly invasive therapy. Also, the addition of the costbenefit analysis output can help decide which patient to place on ECMO therapy, especially in low-resource settings.

Multicenter validation of Early Warning Scores for detection of clinical deterioration in COVID-19 hospitalized patients.

OBJECTIVE: Investigate the predictive value of NEWS2, NEWS-C, and COVID-19 Severity Index for predicting intensive care unit (ICU) transfer in the next 24h. DESIGN: Retrospective multicenter study. SETTING: Two third-level hospitals in Argentina. PATIENTS: All adult patients with confirmed COVID-19, admitted on general wards, excluding patients with non-intubated orders. INTERVENTIONS: Patients were divided between those who were admitted to ICU and non-admitted. We calculated the three scores for each day of hospitalization. VARIABLES: We evaluate the calibration and discrimination of the three scores for the outcome ICU admission within 24, 48h, and at hospital admission. RESULTS: We evaluate 13,768 days of hospitalizations on general medical wards of 1318 patients. Among these, 126 (9.5%) were transferred to ICU. The AUROC of NEWS2 was 0.73 (95%CI 0.68-0.78) 24h before ICU admission, and 0.52 (95%CI 0.47-0.57) at hospital admission. The AUROC of NEWS-C was 0.73 (95%CI 0.68-0.78) and 0.52 (95%CI 0.47-0.57) respectively, and the AUROC of COVID-19 Severity Index was 0.80 (95%CI 0.77-0.84) and 0.61 (95%CI 0.58-0.66) respectively. COVID-19 Severity Index presented better calibration than NEWS2 and NEWS-C. CONCLUSION: COVID-19 Severity index has better calibration and discrimination than NEWS2 and NEWS-C to predict ICU transfer during hospitalization.

Multicenter validation of Early Warning Scores for detection of clinical deterioration in COVID-19 hospitalized patients Validación multicéntrica de Sistemas de Alerta Temprana para la detección precoz de deterioro clínico en pacientes hospitalizados por COVID-19

Objective Investigate the predictive value of NEWS2, NEWS-C, and COVID-19 Severity Index for predicting intensive care unit (ICU) transfer in the next 24 h. Design Retrospective multicenter study. Setting Two third-level hospitals in Argentina. Patients All adult patients with confirmed COVID-19, admitted on general wards, excluding patients with non-intubated orders. Interventions Patients were divided between those who were admitted to ICU and non-admitted. We calculated the three scores for each day of hospitalization. Variables We evaluate the calibration and discrimination of the three scores for the outcome ICU admission within 24, 48 h, and at hospital admission. Results We evaluate 13,768 days of hospitalizations on general medical wards of 1318 patients. Among these, 126 (9.5%) were transferred to ICU. The AUROC of NEWS2 was 0.73 (95%CI 0.68–0.78) 24 h before ICU admission, and 0.52 (95%CI 0.47–0.57) at hospital admission. The AUROC of NEWS-C was 0.73 (95%CI 0.68–0.78) and 0.52 (95%CI 0.47–0.57) respectively, and the AUROC of COVID-19 Severity Index was 0.80 (95%CI 0.77–0.84) and 0.61 (95%CI 0.58–0.66) respectively. COVID-19 Severity Index presented better calibration than NEWS2 and NEWS-C. Conclusion COVID-19 Severity index has better calibration and discrimination than NEWS2 and NEWS-C to predict ICU transfer during hospitalization.

Biotechnological therapies and biosimilars for COVID-19: scarcities, poor regulation, and pharmaceutical black market: a case analysis in Ecuador

At the beginning of the COVID-19 pandemic, Ecuador was unprepared for the overwhelming number of COVID-19 cases. As the general population started to see the effects of the pandemic, unproven treatments and medications were sought by the population to try to ameliorate the impact of the pandemic. The growing demand for therapies that were unavailable, as well as the rise in misinformation, created the perfect scenario for the misuse of medicines and enabled the appearance of a rampant black market of unregistered biological products. In this manuscript, we describe the Ecuadorian experience in relation to the off-label use of biological and biosimilar products during the COVID-19 pandemic, the role of the pharmaceutical black market, and the lack of national regulations to avoid dangerous practices. To the best of our knowledge this is the first report that has aimed to describe the unapproved and even illegal sale and use of biologicals, biosimilars and related products, with or without approved therapeutic indications in the treatment of COVID-19.

Predicting mortality in critically ill patients with COVID-19 in the ICU from a secondary-level hospital in Ecuador

Since its molecular isolation on January 7, 2020, the new SARS-CoV-2 coronavirus has spread rapidly, affecting regions such as Latin America. Ecuador received the worst outbreak globally if we count excess mortality per capita. This study describes the clinical, epidemiological and therapeutic characteristics of 89 patients admitted to an intensive care unit (ICU) in a second-level hospital in Quito, Ecuador. Methods: We conducted a retrospective cohort study. We collected data from health records of adult patients with severe COVID-19 admitted to an ICU in Quito, Ecuador, during the first five months of the SARSCoV-2 outbreak. We used the Chi-square test or Fisher's exact statistics to analyze risk and associations between survivors and non-survivors. We used ROC curve analysis to predict mortality and determine cut-off points for mechanical, analytical, and cytometric ventilation parameters. We used the Wald test to evaluate the categorical predictors of the model at the multivariate level during the regression analysis. Results: 89 patients were recruited. The mean age of the patients was 54.72 years. Men represented 68.54% (n=61) and women 31.46% (n=28). Significant differences in mortality were observed (men 40.98% vs. women 17.76%). LDH and IL-6 at 24 hours after hospital admission were higher among non-survivors than survivors. Persistent hypercapnia (PaCO2 >45 mmHg), a PaFiO2 ratio of less than 140 mmHg, and positive end-expiratory pressure (PEEP) titration >9 mmHg were also associated with increased mortality. Conclusions: Elevated levels of LDH at 24 hours, IL-6 at 24 hours, lymphocyte and platelet count at 48 hours, neutrophil count at 48 hours and NLR are factors associated with higher motility, higher risk of failed extubation and reintubation in patients with acute respiratory distress syndrome due to COVID-19. © 2022 by the authors.

DevOpsBL: DevOps-based learning on information systems higher education

Information System (IS) higher education has faced challenges to keep the students' academic performance and motivation to learn, especially during the pandemic period of COVID-19. Within this context, previous studies based on student-centric approaches, such as agile project-based learning, shown benefits to students, such as an increase in motivation. Mainly grounded by didactic translation theory, in this paper we termed and propose the DevOps-based Learning (DevOpsBL). We adopted the design science methodology, and its research question is: Does DevOpsBL contributes to IS students' performance and motivation to learn when compared to both professor-centric approach? We collected historical data from 158 students of DevOpsBL modules (2019 - 2020) and compared them with the previous 1331 students' non-DevOpsBL modules (2015 - 2018). As result, we found that DevOpsBL students' academic performance increased by circa 4.3%. This research is relevant to IS courses that plan to adopt didactic translation teaching methods such as DevOpsBL. © AMCIS 2021.

Transient lupus anticoagulant presence in COVID-19 pneumonia, a probably epiphenomenon

Background : High prevalence of Lupus anticoagulant (LA) has been reported in COVID-19 infection. Aims : To determine the presence and the evolution of LA in COVID-19 pneumonia en the first 10 days at Intensive Care Unit (UCI). Methods : Prospective observational cohort study: Consecutive adult COVID-19 patients admitted to ICU. Exclusion criteria: age > 80 years, anticoagulation, tocilizumab, convalescent plasma transfusion, thrombophilia, pregnancy and cancer.Blood samples on day 1, 5 and 10 from UCI admission. Studies: PT, APTT, silica clotting time [HemosILSCT, Instrumentation laboratory(IL)], diluted Russell viper venom time HemosILDRVVT(IL) and STADRVVT(STAGO Diagnostic). Screening. Mixing with normal pooled plasma (NP) and confirmatory tests should be above their cur off points to be consider LA+. Biomarkers: D Dimer(DD), Reactive Protein C high sentitivity(cRP-H), Ferritina, LDH and interleukin 6(IL 6). Results : Patients included: 23, age 57 y (IQR52-71), 70% male, 15 required mechanical ventilation(MV).Twelve(52.1%) had LA+ by HemosILDRVVT in at least one time point, 3 in 3, 1 in 2(T5,10) and 8 in one(7/8 T1, 1/8 T5);4/5 patients with hospital discharge before T10 presented LA+ only at T1. LA prevalence was lower with STADRVVT(Table 1). SCT was negative in all samples. CRP-H, IL6 and Ferritin were higher in LA+, particularly at T5 and T10(Table 2). We cannot exclude CRP interference in DRVVT many samples had CRP > 126 (maximum concentration tested in vitro on NP). Patients received prophylactic enoxaparin, samples were taken at through, antiXa = 0.08 (0.04-0.12)U/mL, ruling out interference. LA+ was not associated with death ( n = 4) or VM requirement. Only one LA-patient developed pulmonary thromboembolism after leaving ICU. Conclusions : LA presence was demonstrated in this cohort of COVID-19 Pneumonia patients. Its presence was transient during the short period evaluated, LA was diagnosed through DRVVT with differences between regents. LA presence was associated with inflammatory biomarkers but not with MV requirement or death. These results confirm that LA is probably an epiphenomena.

Hypercoagulable rotational thromboelastometry naheptem profile is related to mechanical ventilation requirementamong critically ill COVID-19 patients

Background : Hypercoagulability and pulmonary microvascular thrombosis has been related to COVID-19 hypoxemia. Rotational thromboelastometry (RT) could identify the procoagulant state. Aims : -To evaluate maximum clot firmness(MCF) and other RT parameters among COVID-19 patients in intensive care unit(ICU) compared to healthy controls(HC) -To compare them according to mechanical ventilation (MV) requirement Methods : Prospective observational cohort study (August-November 2020). ICU cohort: All adult patients admitted due to COVID-19. HC cohort: healthy volunteers. Coagulation profile was evaluated by RT NaHEPTEM assay in ROTEM Delta at day 1 (T1), 5 (T5) and 10 (T10) from ICU admission. D-Dimer and Fibrinogen were also evaluated. Results : Twenty three COVID-19 patients (under prophylactic dose enoxaparin) and 19 HC were included. MCF was statistically higher in ICU patients vs HC at admission (T1) and further increasing at T5. (Table 1) Distribution of NaHEPTEM parameters, DD and Fibrinogen in samples from ICU patients under MV or not are shown in Figure 1. ICU patients under MV compared to non-MV presented higher levels of fibrinogen from T1 to T10, DD and MCF at T5,and shorter clotting formation time (CFT), higher maximum velocity (MaxV) and 5 min Amplitude (A5) at T1. Maximum Lysis (ML) was significantly lower at T5 and T10 compared to T1, P = 0.003 and P = 0.008, respectively, but not associated with MV. (TABLE1). COVID-19 patients discharged from hospital before T10 ( n = 5) presented at T5 significant lower values of DD, Fibrinogen and RT MaxV compared to patients with longer UCI stay. Conclusions : NaHEPTEM assay could detect hypercoagulability among COVID-19 critically ill patients. Velocity parameters(CFT, MaxV) and A5 seem to be further altered in patients that required MV at early stages after ICU admission, probably reflecting increased thrombin generation. MCF and DD were higher at T5 post ICU admission in patients under MV. ML decreased along to study period without association to MV and no difference to HC. Further studies are needed to evaluate its clinical usefulness.

Neurological complications of COVID-19 (SARS-CoV-2) literature review

Since the diagnosis of the first person infected with SARS-Cov-2, it has quickly spread throughout the world causing a pandemic and putting healthcare systems on maximal alert. Currently, evidence indicates that SARS-Cov-2 infection is not a disease limited to the respiratory system but it can also affect the central nervous system, causing anosmia, headache, seizures, stroke and altered mental status. For this reason, it is important to be aware of the neurological complications associated SARS-CoV-2 infection. © 2020 Fundacion para la difusion neurologica en Ecuador - FUNDINE. All rights reserved.

Covid-19: Pandemic in ecuador: A health disparities perspective

The global COVID-19 pandemic initiated in Ecuador with the patient zero in February 2020 and since more than 40,000 persons have been tested positive to the virus, lea-ving some 3,500 deceased, while approximately about 10,500 persons above annual average numbers died within March to May. A strict lockdown was applied by mid-March, which resulted to a severe economic crisis in the country. Although during the lockdown occurred a notable decrease in the number of new cases, the spread of the infection was already massive, untechnical, political and economic decisions will cer-tainly lead to continuous wave of infections for months. Objective Our study postulates, that persons who are most likely to be infected during such secondary wave will be people who have already health issues to which we count besides the known ones, especially those who are already suffer by the distribution of volcanic ashes, as such pyroclastic material is known to affect lunges and thyroids. Methods A descriptive ecological study of information related to COVID-19 infection at a national level using official data from the Minister of Public Health and volcanic ash fall by geographical area in Ecuador. Results The mortality rate per canton indicated that those with lower attack rates are the ones with highest mortality rate. For instance, Portovelo (21.3/100,000), Pla-yas (18.4/100,000), Santa Rosa (15.8/100,000), Suscal (15.3/100,000) and Penipe (14.3/100,000) reported the highest mortality rate per 100,000 people. The main distribution of such volcanic material is within the central to northern area of the Highlands and Inter-Andean Valley of Ecuador, due to the analysis of some 7394 satellite images of the last 21 years. Conclusions We conclude that areas with high vulnerabilities are also most suscepti-ble to develop COVID-19. Such areas with their respective populations will be affected above average and shall be protected in particular within the presently starting during possible second wave of infection. © 2020, Universidad Nacional de Colombia. All rights reserved.