Simulation Model of the Effect of the COVID-19 Biosecurity Protocol in the Queues for the Return to Face-to-Face Classes.

This article presents a simulation model of the effect of the COVID-19 Biosafety protocol in the Queues for the return to face-to-face classes as a basis for the return of educational activities. The restrictive measures to face the COVID-19 pandemic, greatly affected the normality of the development of activities carried out in higher education, constituting a great challenge since the measures and conditions of return and access to institutions are different from what was previously carried out before the pandemic. The objective of this article is to carry out a simulation of queues through SIMIO (Logistics process simulation software), where the number of students expected per day and the average entry times are taken into account to adjust them to an exponential distribution, from this information loaded into the simulation it is They will determine if the times increase or decrease taking into account the theory of queues and conditions presented in the study such as the probability distribution of the times of each of the processes involved in the process of accessing the University facilities.

Patient characterization and adverse health care-related events in SARS-CoV-2 infected patients who died in a tertiary hospital.

OBJECTIVE: To characterize health care-related adverse events in patients with SARS-CoV-2 infection who died in a tertiary hospital. METHODS: This is a retrospective, observational study, that included patients who died at HUGTiP hospital between 16 March and 10 April 2020. Data was extracted from the electronic medical record. RESULTS: The median age of the 164 SARS-CoV-2 infected patients who died in the center in the study period was 77.5 years and >90% of patients had ≥1 comorbidity. Forty point two percent of patients had at least ≥1 health care-related adverse event. Twenty three point eight of patients had an adverse drug reaction, the leading cause of adverse events in patients who died. Of patients who died in intensive care units, the frequency of problems related to mechanical ventilation was 8.8%. CONCLUSIONS: Although the case fatality rate associated with the adverse events detected was very low, close monitoring of potential health care-related adverse events, especially drug reactions, as the therapeutic management of the disease remains unclear.

OBJETIVO: Caracterizar los eventos adversos relacionados con la asistencia sanitaria en pacientes infectados por SARS-CoV-2 fallecidos en un hospital de tercer nivel. MÉTODOS: Estudio observacional retrospectivo en el que se incluyeron los pacientes fallecidos en el centro entre el 16 de marzo y el 10 de abril de 2020. La información fue extraída desde la historia clínica electrónica. RESULTADOS: La mediana de edad de los 164 pacientes analizados fue de 77,5 años. Más de 9 de cada 10 pacientes fallecidos presentaban al menos una comorbilidad. El 40,2% de los pacientes presentó al menos un evento adverso (EA) asociado a la atención sanitaria. Un 23,8% de los pacientes presentó alguna reacción adversa a medicamentos, constituyendo la primera causa de EA entre los pacientes fallecidos. Entre los pacientes que fallecieron en unidades de cuidados intensivos, los problemas relacionados con la ventilación mecánica han aparecido con una frecuencia del 8,8%. CONCLUSIONES: A pesar de que la letalidad asociada a los EA detectados fue muy reducida, es fundamental establecer una vigilancia estrecha de los posibles EA asociados a la asistencia sanitaria, especialmente los farmacológicos, dado que se trata de una enfermedad con un manejo terapéutico incierto.

Cytokine release syndrome in infection due to COVID-19 and administration of tocilizumab as therapeutic option.

The novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), causing of coronavirus disease 2019 (COVID-19), is resulting in a worldwide pandemic and has affected more than 200 countries, leading in more than 10 million cases with 508,000 confirmed deaths. The disease spectrum is wide from mild symptoms to severe pneumonia, and some critical conditions be able to produce life-threatening complications, particularly in patients with cytokine release syndrome. This is characterized by dyspnea, hypoxemia and bilateral lung infiltrates on chest radiographic imaging, in case of disease progression invasive mechanical ventilation is needed. The clinical presentation includes hypotension, fever, septic shock with vasopressor therapy, endothelial injury, disseminated intravascular coagulation and multi-organic failure. The most relevant paraclinical parameters associated to cytokine release syndrome are cytopenias, elevated levels of inflammatory cytokines, transaminasemia, coagulation abnormalities and increment in C-reactive protein values. Tocilizumab is a humanized monoclonal antibody against the interleukin-6 receptor (IL-6r), it has been successful administrated in cytokine release syndrome. We propose the blockage with tocilizumab in patients who fulfilled the clinical criteria of cytokine release syndrome based on the literature review as a therapeutic target for COVID-19 infection. (English) [ FROM AUTHOR] La pandemia derivada por el nuevo síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2), agente causal de la enfermedad por coronavirus 2019 (COVID-19), ha afectado a más de 200 países, ocasionando cerca de 10 millones de casos confirmados y 508,000 muertes. El espectro de la enfermedad varía desde casos leves de neumonía hasta el estado crítico que puede poner en peligro la vida, en especial en los pacientes que manifiestan el síndrome de liberación de citocinas. Éste se caracteriza por disnea, hipoxemia e infiltrados bilaterales en la radiografía de tórax que en ocasiones requiere ventilación mecánica;en términos clínicos, los pacientes con síndrome de liberación de citocinas pueden cursar con hipotensión, fiebre elevada, estado de choque con requerimiento de vasopresor, daño vascular, coagulación intravascular diseminada e insuficiencia orgánica múltiple. Entre los parámetros de laboratorio que destacan en los pacientes con síndrome de liberación de citocinas están las citopenias, elevación de citocinas, incremento en las enzimas hepáticas, alteración en los parámetros de coagulación y aumento en la proteína C reactiva. Tocilizumab es un anticuerpo monoclonal humanizado recombinante antagonista del receptor de IL-6 que se ha prescrito en forma exitosa en pacientes con este síndrome. El enfoque orientado hacia el bloqueo de citocinas para contrarrestar la hiperinflamación observada en COVID-19 representa una oportunidad terapéutica. En esta revisión se proponen algunos criterios para la administración de tocilizumab en pacientes con infección por SARS-CoV-2 y síndrome de liberación de citocinas. (Spanish) [ FROM AUTHOR] Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico 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.)

Factors Associated With Hospitalization or Intensive Care Admission in Children With COVID-19 in Latin America.

Background: Limited data is available from low-middle and upper-middle income countries of the factors associated with hospitalization or admission to pediatric intensive care unit (PICU) for children with COVID-19. Objective: To describe the factors associated with hospitalization or PICU admission of children with COVID-19 in Latin America. Method: Multicenter, analytical, retrospective study of children reported from 10 different Latin American countries to the Latin-American Society of Pediatric Infectious Diseases (SLIPE-COVID) research network from June 1, 2020, and February 28, 2021. Outpatient or hospitalized children <18 years of age with COVID-19 confirmed by polymerase chain reaction or antigen detection from the nasopharynx were included. Children with multisystem inflammatory syndrome in children (MIS-C) were excluded. Associations were assessed using univariate and multivariable logistic regression models. Results: A total of 1063 children with COVID-19 were included; 500 (47%) hospitalized, with 419 (84%) to the pediatric wards and 81 (16%) to the ICU. In multivariable analyses, age <1 year (Odds Ratio [OR] 1.78; 95% CI 1.08-2.94), native race (OR 5.40; 95% CI 2.13-13.69) and having a co-morbid condition (OR 5.3; 95% CI 3.10-9.15), were associated with hospitalization. Children with metabolic or endocrine disorders (OR 4.22; 95% CI 1.76-10.11), immune deficiency (1.91; 95% CI 1.05-3.49), preterm birth (OR 2.52; 95% CI 1.41-4.49), anemia at presentation (OR 2.34; 95% CI 1.28-4.27), radiological peribronchial wall thickening (OR 2.59; 95% CI 1.15-5.84) and hypoxia, altered mental status, seizures, or shock were more likely to require PICU admission. The presence of pharyngitis (OR 0.34; 95% CI 0.25-0.48); myalgia (OR 0.47; 95% CI 0.28-0.79) or diarrhea (OR 0.38; 95% CI 0.21-0.67) were inversely associated with hospital admission. Conclusions: In this data analysis reported to the SLIPE research network in Latin America, infants, social inequalities, comorbidities, anemia, bronchial wall thickening and specific clinical findings on presentation were associated with higher rates of hospitalization or PICU admission. This evidence provides data for prioritization prevention and treatment strategies for children suffering from COVID-19.

Evaluation of a support system for health professionals confined by COVID-19.

OBJECTIVE: To evaluate the implementation of a telephone system in a department of Primary Care in Barcelona, Spain, supporting health professionals confined by COVID-19. METHODS: We conducted an observational, descriptive, cross-sectional study with confined professionals, between March 11 and May 31, 2020. We emailed a questionnaire with 18 closed-ended questions and one open-ended question and performed a descriptive analysis of the closed-ended answers and an analysis of the thematic content of the open-ended question. RESULTS: Thirty-nine hundred and ninety-eight professionals evaluated the system overall with a score of 6.54 on a scale of 1 to 10. The evaluation of the format of calls made in the support system had higher scores, while the psychological support unit and the coordination of the different groups had lower scores. The content analysis of the open-ended question provides explanatory arguments for the quantitative results. CONCLUSIONS: The study allowed a valid and reliable evaluation of the implementation of a support system for confined professionals, in addition to recognizing areas for improvement.

The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis.

BACKGROUND: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity. METHODS: We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes. MAIN OUTCOME MEASURES: Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions. RESULTS: Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32-3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11-2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43-8.94, p <  0.001) was also observed in positive mothers. CONCLUSION: This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.

Optic neuritis following SARS-CoV-2 infection.

The most common neurologic symptoms in COVID-19 are headache, anosmia, and dysgeusia. Optic neuritis is an unusual manifestation of SARS-CoV-2 infection. We report a case of a patient who initially consulted for vision loss in the absence of respiratory symptoms. She was diagnosed with optic neuritis following SARS-CoV-2 infection. Delay in diagnosis of neuro-ophthalmic manifestations of COVID-19 may lead to irreversible optic atrophy. A mechanism in which viral antigens would induce an immune response against self-proteins, or direct SARS Cov-2 infection of the central nervous system, may be involved in optic nerve injury.

Obstetric Outcomes of SARS-CoV-2 Infection in Asymptomatic Pregnant Women.

Around two percent of asymptomatic women in labor test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Spain. Families and care providers face childbirth with uncertainty. We determined if SARS-CoV-2 infection at delivery among asymptomatic mothers had different obstetric outcomes compared to negative patients. This was a multicenter prospective study based on universal antenatal screening for SARS-CoV-2 infection. A total of 42 hospitals tested women admitted for delivery using polymerase chain reaction, from March to May 2020. We included positive mothers and a sample of negative mothers asymptomatic throughout the antenatal period, with 6-week postpartum follow-up. Association between SARS-CoV-2 and obstetric outcomes was evaluated by multivariate logistic regression analyses. In total, 174 asymptomatic SARS-CoV-2 positive pregnancies were compared with 430 asymptomatic negative pregnancies. No differences were observed between both groups in key maternal and neonatal outcomes at delivery and follow-up, with the exception of prelabor rupture of membranes at term (adjusted odds ratio 1.88, 95% confidence interval 1.13-3.11; p = 0.015). Asymptomatic SARS-CoV-2 positive mothers have higher odds of prelabor rupture of membranes at term, without an increase in perinatal complications, compared to negative mothers. Pregnant women testing positive for SARS-CoV-2 at admission for delivery should be reassured by their healthcare workers in the absence of symptoms.

[Patient characterization and adverse health care-related events in SARS-CoV-2 infected patients who died in a tertiary hospital]. / Caracterización y eventos adversos relacionados con la asistencia sanitaria en pacientes infectados por el SARS-CoV-2 fallecidos en un hospital de tercer nivel.

OBJECTIVE: To characterize health care-related adverse events in patients with SARS-CoV-2 infection who died in a tertiary hospital. METHODS: This is a retrospective, observational study, that included patients who died at HUGTiP hospital between 16 March and 10 April 2020. Data was extracted from the electronic medical record. RESULTS: The median age of the 164 SARS-CoV-2 infected patients who died in the center in the study period was 77.5 years and> 90% of patients had ≥ 1 comorbidity. Forty point two percent of patients had at least ≥ 1 health care-related adverse event. Twenty three point eight of patients had an adverse drug reaction, the leading cause of adverse events in patients who died. Of patients who died in intensive care units, the frequency of problems related to mechanical ventilation was 8.8%. CONCLUSIONS: Although the case fatality rate associated with the adverse events detected was very low, close monitoring of potential health care-related adverse events, especially drug reactions, as the therapeutic management of the disease remains unclear.