ABSTRACT
BACKGROUND: In a decade, we faced two pandemic viruses, influenza A H1N1pdm09 and SARS CoV-2, whose most serious manifestation is pneumonia. AIM: To compare the clinical, epidemiological and management aspects of pneumonias caused by each pandemic virus in adults requiring hospitalization. MATERIAL AND METHODS: Comparative, observational study carried out at a regional Chilean hospital, including 75 patients with influenza A H1N1pdm09 prospectively studied in 2009 and 142 patients with SARS-CoV-2 studied in 2020. RESULTS: Patients with SARS-CoV-2 pneumonia were older (56 and 39.7 years respectively, p < 0.01) and had significantly more comorbidities. Cough, fever and myalgias were more frequent in influenza. Dyspnea was more frequent in COVID-19. Patients with COVID-19 had more extensive lung involvement and a longer hospitalization (13.6 and 8.6 days respectively, p = 0.01). There was no difference on ICU admission requirements and mortality attributable to pneumonia. Patients with influenza had greater APACHE scores and a higher frequency of a PaO2/FiO2 ratio ≤ 200. During COVID-19pandemic chest sean replaced x-ray examination. Also high-flow nasal cannulas and awake prone position ventilation were added as treatments. CONCLUSIONS: COVID-19 patients were older, had fewer classic flu symptoms but more dyspnea and longer hospitalization periods than patients with influenza.
Subject(s)
COVID-19 , Influenza, Human , Pneumonia, Viral , Adult , COVID-19/epidemiology , Dyspnea , Hospitalization , Humans , Influenza, Human/diagnosis , Influenza, Human/epidemiology , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , SARS-CoV-2ABSTRACT
Introducción: Desde que se declaró la alerta sanitaria el 13 de marzo del 2020, todos nuestros protocolos de actuación se han visto modificados, dando prioridad al diagnóstico y tratamiento de aquellos pacientes infectados con SARS-CoV-2;lo cual creemos ha tenido un impacto negativo en el diagnóstico y tratamiento de otras patologías infecciosas, incluida la endocarditis Infecciosa (EI). Objetivos: Evaluar el impacto de la pandemia por SARS-CoV-2 en diagnóstico y tratamiento de la endocarditis infecciosa en un hospital terciario. Material y métodos: Estudio observacional retrospectivo de una base de datos obtenidos prospectivamente. La comparación entre periodos (2019 vs. 2020) se realizo utilizando un análisis de t de Fisher para las variables cualitativas y una prueba t para muestras independientes para las variables cuantitativas. Resultados: Al comparar los periodos de estudio (tabla), hemos encontrado una reducción del 62,5% en el número de casos diagnosticados con EI durante la pandemia (48 casos en 2019 vs. 18 casos en 2020). La mayoría de los casos (55,5%) de los casos diagnosticados durante la pandemia fueron mujeres, con un significativamente menor índice de Charlson ajustado por edad (5,69 vs. 4,38 p = 0,002). Cuatro de los casos de EI durante el 2020 tuvieron una coinfección por SARS-CoV-2;dos de los cuales fueron de adquisición nosocomial. Dentro de los efectos de la pandemia en el diagnóstico de la endocarditis hemos encontrado un aumento significativo en la media de días desde el primer contacto médico hasta el ingreso hospitalario de 18,7 días en 2019 a 35,3 días en 2020;al igual que en la adquisición nosocomial (18,7 vs. 37,3% p = 0,17) y el número de casos de endocarditis infecciosa por S. aureus resistente a meticilina (4,2% vs. 16,6 p = 0,095). El tiempo desde el diagnóstico hasta la cirugía también se vio significativamente aumentado de 36,8 días en 2019 a 69,8 días en 2020 (p = 0,015). [Formula presented] Conclusiones: La pandemia por SARS-CoV-2 ha tenido un impacto negativo tanto en el diagnóstico como en el tratamiento de la endocarditis infecciosa, retrasando tanto el ingreso hospitalario como el tiempo hasta la cirugía. Aunque ninguno de estos efectos ha tenido un impacto en la mortalidad de nuestros pacientes, quizás es un buen momento para reflexionar como deberemos modificar nuestros protocolos de actuación en los próximos años.
ABSTRACT
The use of water is a very important economic and environmental factor in all industrial sectors since the improvement in its use offers an optimization of this resource. The waste of water usually causes damages firstly to the environment by the supply sources, then to the industries by its high demand and to the hydrosanitary sources that the houses have. The valves have some control that allows a more comfortable use of this resource in sinks that provides some savings. Currently, there are valves that usually replace the traditional ones due to their automatic and/or mechanical operation, which allows for innovation and savings of this resource. In this sense, this research is oriented to the design of a mechanical pedal valve that allows a more comfortable and controlled control, thus granting the operator control in an immediate way, without wasting the fluid in the middle of the washing and avoiding a manual contact that in a certain way dissipates the risk of contagion of diseases such as Covid-19 by direct manipulation. An analytical methodology supported by computer aided drafting programs such as Ansys Fluent and SolidWorks was used. Finally, it was determined that, for the dynamic and static studies, the designed valve complies with the Colombian technical standard and the static design factors. © 2021 Institute of Physics Publishing. All rights reserved.
ABSTRACT
Background: Knowledge on the immunopathobiology of COVID-19 is rapidly increasing but most studies analyzed relatively small series of patients and immune features predictive of fatal outcome are unavailable for routine stratification. Furthermore, an increased risk of death in patients with hematological cancer infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been identified, but it remains unknown if this is related to possible immunosuppression caused by cancer itself and cytotoxic treatment. Aims: Characterize the immune response to SARS-CoV-2 in a large cohort of patients to identify high-risk immune biomarkers and evaluate the association between COVID-19 severity and immunosuppression in patients with hematological cancer. Methods: Multidimensional flow cytometry was used to conduct holistic and unbiased analyses of17 immune cell types on 780 peripheral blood samples obtained from 513 COVID-19 patients, 24 cases with non-SARS-CoV-2 infection and 36 age-matched healthy adults.167 COVID-19 patients had 207 longitudinal samples collected over time. RNA sequencing on FACSorted cells and high-resolution flow cytometry were used to perform a deeper characterization of various myeloid and lymphoid subsets in14 COVID-19 patients and4 healthy adults. Results: Immune profiles of COVID-19 patients were generally similar to those of age-matched patients with non-SARS-CoV-2 infection, but significantly different from those of age-matched healthy adults. When compared to the later, COVID-19 patients showed increased percentages of neutrophils, CD4+CD56+ T-cells, and plasmablasts, whereas levels of basophils, eosinophils, and non-classical monocytes, as well as double-negative, CD8loCD56-, CD8-/loCD56+ and CD8hiCD56- T-cells, and B-cells were decreased. Both transcriptional and immunophenotypic data in myeloid and lymphoid subsets suggested an association between COVID-19 severity and neutrophil activation, as well as significantly reduced levels of specific adaptive immune cell types. Unsupervised clustering analysis of 513 patients revealed three immunotypes in response to SARS-CoV-2 infection. One of them, present in14% of patients (n=74), was characterized by significantly lower percentages of all immune cell types except neutrophils and plasmablasts, and was significantly associated with more severe disease. Of note, 50% of COVID-19 patients with blood cancer displayed this immunotype. Accordingly, hematological patients showed a significantly higher frequency of admission into intensive care units (50% vs 5%, P<.001) and death (30% vs4%, P<.001) than patients without tumor did. On multivariate analysis incorporating age and comorbidities, the frequency of B-cells and non-classical monocytes were independent prognostic factors for overall survival. Indeed, <1% B-cells in peripheral blood was most strongly associated with risk of death. Among patients with immune monitoring during follow-up, significant changes in the relative distribution of eight immune cell types, including basophils, CD8loCD56- T-cells, and B-cells, were observed from the first to last peripheral blood sample between patients who survived or died. Summary/Conclusion: Our results accelerate our understanding of the immunopathobiology of COVID-19 and unveil an association between altered immune profiles in patients with hematological cancer and their poorer outcome. Reduced percentages of B-cells and non-classical monocytes are high-risk immune biomarkers that could be readily implemented in routine practice for risk-stratification of COVID-19.