Multiple Mechanical Ventilation: historical review and cost analysis

In times of crisis in public health where the resources available in the hospital network are scarce and these must be used to the fullest, innovative ideas arise, which allow multiplying the use of existing resources, as artificial mechanical ventilators can be. These can be used in more than one patient, by attaching a device to distribute the mixture of air and oxygen from the ventilator being used simultaneously (multiple mechanical ventilation). This idea, although innovative, has generated controversy among the medical community, as many fear for the safety of their patients, because attaching such devices to the ventilator loses control over the mechanical ventilation variables of each patient and can only maintain general vigilance over the ventilator. These misgivings about the device have led several researchers to take on the task of verifying the reliability of this flow splitter connector. It is for this reason that this article presents a thorough review of the studies carried out on the subject and additionally shows an analysis of comparative costs between the acquisition of a mechanical ventilator and the flow division system.

MEDIIK: Design and Manufacturing of an Emergency Ventilator against COVID-19 Pandemic

Herein we describe the modular design and manufacturing of an emergency ventilator based on cyclical compression of a resuscitation bag to face the COVID-19 pandemic. This was done to mitigate the staggering conditions to supply these medical devices under challenging scenarios of need and logistics. The design is based on international standards and commissions for medical electrical equipment, particular requirements for basic safety, electromagnetic compatibility, and essential performance of critical care and emergency ventilators. The modular design is capable of providing four ventilation modes: volume/pressure mandatory ventilation and volume/pressure assisted ventilation. After testing with artificial lungs, calibration, and validation instruments it was found that the main ventilation parameters achieved are: maximum tidal volume of 700 mL, maximum pressure of 50 cmH2O, inspiration/expiration ratio up to 1:4 at 30 breaths per minute. The MEDIIK designation is derived from the mayan word ik' which means wind. © 2021 ACM.

COVID-19 and higher education: responding to local demands and the consolidation of e-internationalization in Latin American universities

Purpose This paper aims to provide insights into the internationalization strategic responses to the COVID-19 pandemic by higher education institutions (HEIs) in Latin America. Design/methodology/approach This study is based on information from eight leading Latin American private universities. The data were obtained from official sources such as institutional communications and university administrators. Findings The authors identify two main issues that HEIs should consider while responding to the pandemic. First, greater attention and resource allocation to the universities' main local stakeholders can affect traditional internationalization activities. Second, a focus on revitalizing foreign partnerships and strengthening "virtual internationalization" can help maintain and eventually increase international presence. Research limitations/implications While this study analyses how these Latin American HEIs responded during the initial stages of the COVID-19 outbreak, it is important to conduct follow-up studies to shed light on how HEIs are adapting to the COVID-19 crisis as it continues to unfold. Originality/value This study is based on unique information gathered from leading private, not-for-profit HEIs in Latin America, which, contrary to state-owned HEIs or other private institutions in developed economies, have exhibited different means and conditions to respond to the coronavirus outbreak. Finally, the authors contribute to the literature on the internationalization of HEIs by discussing the role of a significant disruptive event on the internationalization of higher education and, particularly, business schools.

Imagenological Evolution of Pulmonary Secuelae after SARS CoV2 Infection

INTRODUCTION: due to the fact that lung disease due to SARS COV 2 infection is of recent appearance and the lack of knowledge about its natural history, it is not clear the moment of adequate follow-up by diagnostic images, this being suggested after 3 months of the onset of the symptoms according to the evolution of the patient. We present the variation of image findings of a patient with severe COVID-19 pneumonia. DESCRIPTION:we present the case of a 56-year-old male patient who required initial hospitalization of 14 days because of symptoms secondary to multilobar severe pneumonia due to SARS-COV-2 infection with initial tomographic findings of classic pattern given by ground glass opacities of subpleural distribution predominantly in the lower lobes. The patient was discharged with low flow oxygen supplementation and attended the pulmonology consultation a month later reporting improvement in dyspnea with medical research council score grade 1 and complete withdrawal of oxygen support. A control chest computed tomography was taken 6 weeks since initial evaluation reporting subpleural bullae of recent appearance in the upper and lower right lobe with diameters of up to 80 mm. It was also described a small residual laminar pneumothorax adjacent to the lingula with pleural effusion with apparent septae. Given these findings, an intervention by thoracic surgery was requested who decided to schedule a surgical procedure and performed a new control image corresponding to 8 weeks from the initial one with findings of complete and spontaneous resolution of the pneumothorax as well as the pleural effusion although persistence of the bullas. It was decided there was not required further interventions and patient was discharged from follow-up.DISCUSSION: SARS-CoV2 infection manifests itself in different patterns of lung damage and can have long term pulmonary sequelae that are only identified with judicious and strict follow-up during the first months after infection. Nevertheless, the British Thoracic Society (BTS) has recommended the first image follow-up to be preformed after 3 months of the initial symptoms because of the high incidence of image alterations in that period of time and lesser probability of occult malignancy. This case described a rare presentation of lung damage with equally spontaneous resolution of the complications confirming the timeframe proposed by the BTS.

Histopathogical Lung Patterns of SARS CoV2 Infection

INTRODUCTION: residual lung injury in patients recovering from COVID-19 information is scarce. Herein, we present a previous confirmed SARS-CoV2 infection case series including five patients, who underwent either open or transbronchial lung biopsy due to no clinical improvement. DESCRIPTION: Case 1: a 73-year-old male patient initially asymptomatic, with positive RT-PCR after transurethral resection of the prostate. Consulted for dyspnea and room air desaturation after 24 days during postoperative. Chest computed tomography reported findings compatible with organizing pneumonia, then a transbronchial biopsy was performed confirming diagnosis. Case 2: a 48-year-old male patient with COVID-19 pneumonia who required 14 days hospitalization. He was readmitted after 25 days since initial symptoms due to dyspnea and room air desaturation with a chest CT that revealed findings suggestive of pulmonary fibrosis. Therefore, an open lung biopsy was performed with a probable usual interstitial pneumonia pattern report. Case 3: a 86-year-old male patient, with initial mild COVID-19 infection who later progressed to severe pneumonia requiring high levels of supplemental oxygen. At 18 days of admission, due to persistent clinical compromise, a chest CT was performed with findings of organizing pneumonia. Therefore, he was taken to transbronchial lung biopsy that revealed non-specific interstitial pneumonia in the fibrosing phase. Case 4: a 61-year-old male patient with HIV/AIDS infection presented acute respiratory distress syndrome due to severe COVID-19 pneumonia with inability to withdraw invasive mechanical ventilation after one month. An open lung biopsy was performed with histopathology diagnosis of diffuse alveolar damage in the proliferative phase.Case 5: 41-year-old male patient with severe COVID-19 pneumonia requiring invasive mechanical ventilation, with persistent use of high levels of supplemental oxygen after 30 days since symptomatic. The chest CT suggested pulmonary fibrosis;therefore, an open lung biopsy was performed and confirmed Non-Specific Interstitial Pneumonia. DISCUSSION: to date, reports of interstitial lung disease due to COVID-19 refer to imaging findings or post-mortem histopathological studies which have been relatively limited given the strict guidelines and restrictions for performing bronchoscopies and lung surgery during the pandemic. The foregoing highlights the importance of tissue analysis under rigorous safety protocols in order to provide an early detection of interstitial lung involvement secondary to SARS-CoV-2 infection and then evaluate a prolonged steroid treatment recommendation.

Crises conducting stakeholder salience: shifts in the evolution of private universities’ governance in Latin America

Purpose: This study aims to build on embedded approaches to stakeholder management and examines how organizational decision-makers consider social responsibility toward proximal stakeholders in crises that encompass an entire system of stakeholder relationships. Design/methodology/approach: Within a criterion-based sample of eight Latin American private universities, this paper develops in-depth exploratory case studies to examine the prioritization of stakeholders in higher education institutions’ decision-making during the outbreak of the COVID-19 crisis. Findings: Contrary to the notion that during crises organizations prioritize stakeholders that provide resources that are critical to survival, this study finds that in contextual crises stakeholder management is informed by social responsibility. In addition, the findings suggest that crises may be tipping points for changes toward mission-driven approaches to governance. Practical implications: Acknowledging the roles of social responsibility and proximity in stakeholder management during contextual crises allows for more informed governance of organizations that face disruptions in their system of stakeholder relations. Originality/value: This study contributes unique insights into the decision-maker’s prioritization of stakeholders during the COVID-19 crisis. The uncertainty associated with the emerging “new normal” allowed for an extreme test of socially embedded versus resource-oriented approaches to stakeholder management. © 2021, Emerald Publishing Limited.

Clinical characterization of obstetric patients with suspected covid-19

Introduction: The COVID-19 pandemic has caused more than 350,000 deaths worldwide. Objective: To clinically characterize obstetric patients with suspected COVID-19. Methods: A retrospective, descriptive, cross-sectional study was performed. All obstetric patients admitted to the Hospital Militar Central "Dr. Luis Díaz Soto" between March 12 and May 20, 2020. They were divided into two groups;Group I included those with negative RT-PCR for SARS-CoV-2 and group II with positive results. The variables analyzed were age, obstetric history, personal pathological history, epidemiological history, clinical picture, complications, admission to the intensive care unit and maternal mortality. Results: 60 obstetric patients were admitted and 6 (10%) were positive for SARS-CoV-2, from the provinces of Havana, Mayabeque and Artemisa. The average age was 25 years. 25.9% of group I and 66.6% of group II were in the 1st trimester of pregnancy. 38.8% and 16.6%, of group I and group II, respectively, presented comorbidity. 50% of the positives were asymptomatic. Leukopenia was observed in 10 (18.5%) cases in group I and in 5 (83.3%) in group II. Spontaneous abortion occurred in group II. There was no COVID-19 pneumonia, nor maternal death. Conclusions: COVID-19 occurred more frequently in pregnant women during the first trimester, the mild form of the disease prevailed, with no COVID-19 pneumonia or deaths from this disease. © 2020, Editorial Ciencias Medicas. All rights reserved.