Effectiveness of a portfolio model on the performance of the virtual osce

We evaluated the effectiveness of the portfolio combined with the flipped class-room, team-based learning, and online videos on students' performance in a virtual OSCE and their perception of the attributes of the OSCE and videos. The integration of the virtual OSCE in a medicine program manages the need to be on campus in the context of COVID-19, requires minimal technological resources, fulfills the main objective of creating a format of acceptable, low cost, and low administrative burden, and can be implemented in a short period. © GKA Ediciones, authors.

[Antimicrobial stewardship program during the COVID-19 pandemic]

In spite of the low frequency of COVID-19 associated bacterial coinfections, the rate of empiric antibiotic use varies between 70% and 90%. The primary objective of this study was to evaluate the impact of an antimicrobial stewardship program (ASP) on COVID-19 patients. The study design was an interrupted time series, assessing prevalence of antibiotic use, adequacy of treatment and antimicrobial consumption in adult patients hospitalized with COVID before the COVID-ASP implementation in June 2020, and on three subsequent periods (P2 in August 2020, P3 in October 2020 and P4 in June 2021). One hundred and one patients were included. Moderate and severe disease was more frequent in P2, P3, and P4 periods (p < 0.001). After the implementation we observed a significant reduction on ATM use (61% vs. 41% vs. 31.1% vs. 8.1%, p < 0.001), and macrolid combination therapy (17.3% vs. 19.2% vs. 10.8% vs. 1.4%, p = 0.03), and an increase of adequate use (37.5% vs. 46.9% vs. 69.9% vs. 66.6%, p = 0.039). Antimicrobial consumption by period in days of therapy (DOT)/1000 patient-day was 347.9 vs. 272.8 vs. 134.29 vs. 43.6 (p <0.001). We did not find any difference in intensive care unit transfer or mortality. COVID-ASP implementation was an effective strategy to reduce antimicrobial consumption and optimize antibiotic indications without affecting morbidity or mortality.

Multicenter study of COVID-19 incidence and determinants in Argentinian physicians

Background: Information about COVID infection in physicians is limited. This knowledge would allow the implementation of actions to reduce its impact. The objective was determining the incidence of SARS-CoV-2 infection in physicians from health institutions in Argentina, its characteristics, and associated factors. Methods: We conducted a multicenter prospective/retrospective cohort study with nested case-control study. Physicians active at the beginning of the pandemic were included, those on leave due to risk factors were excluded. The incidence of confirmed cases was estimated. We conducted bivariate analyses with various factors and used those significant in a logistic regression. Results: Three hundred and forty three physicians with COVID-infection from 8 centers were included. The incidence of disease was 12.1% and that of global absenteeism related to COVID, 34.1%. Almost 70% of close contacts were work-related. In the multivariate analysis living in Autonomous City of Buenos Aires (CABA) (OR 0.19, p = 0.01), working in high-risk areas (OR 0.22, p = 0.01) and individual transportation (OR 0, 34, p = 0.03) reduced the risk of COVID. The odds of infection increased 5.6 times (p = 0.02) for each close contact isolation. Discussion: The number of close contact isolation increased considerably the risk of infection. Living in Buenos Aires City, individual transportation and working in high-risk areas reduced it. Given the high frequency of close contact in the workplace, we strongly recommend the reinforcement of prevention measures in rest areas and non-COVID-wards.

Controversies during the COVID-19 pandemic

The COVID-19 pandemic has had an impact on public health and the global economy. The objective of this document was to update, according to the available evidence, the management of some basic elements in the Infection Control Programs (PCI) and the daily care of patients. As a result: 1. The routine use of the N95 masks is not recommended for the care of suspected or confirmed COVID-19 patients. Available data indicates that SARS-CoV-2 has spread primarily like most other common respiratory viruses, through droplet and contact transmission. In certain situations, personto- person transmission is described through the airway, observed in poorly ventilated environments, and while the individual carried out actions of greater potential transmission 2. The limited reuse and decontamination methods of N95 masks are accepted under safe and effective prot ocols in the context of limited resources. 3. The isolation of patients with COVID-19 can be lifted under a strategy based on the clinic, individual risk factors and time of evolution of the disease. 4. PCR control is not required in confirmed cases to determine epidemiological discharge. 5. Current evidence shows that there is a possibility of reinfection although its diagnosis is difficult. 6. The measurement of antibodies has a specific role in prevalence studies, diagnosis of multisystemic inflammatory syndrome and a picture compatible with negative PCR after the 7th. day.

Pneunomia by sars cov-2 in five months old newborn

Introduction: Pneumonias adquired in the community have a high rate of morbility in pediatric ages, besides it is still the main infectious cause of death in developing countries. Pediatric cases recorded with COVID-19 are less frequent than in adults and with lighter features in general sense, specially in newborns. In Cuba more than 70% of pediatric patients possitive to COVID-19 have developed the disease as asymptomatics. Objective: To describe the characteristics of an asymptomatic pediatric patient with pneumonia caused by SARS-Cov-2. Case presentation: Five months old newborn admitted in hospital after a polimerase´s chain reaction test (PCR) possitive to the new coronavirus. At the admittion time as the patient was asymptomatic, it was diagnosed pneumonia by thorax X-ray. It was started a treatment according to the protocol with kaletra chloroquine and ceftriaxone, with evident improvement during the hospital stay. Conclusions: Pneumonia caused by SARS CoV-2 in pediatric ages normally evolves clinically asymptomatic and it is essencial to keep a high rate of suspicion towards this entity which in most of the cases its diagnosis is only by imaging studies. © 2020, Editorial Ciencias Medicas. All rights reserved.

Cutaneous manifestations in pediatric patients infected with sars-cov-2 coronavirus

Introduction: The new coronavirus called SARS-Cov-2 has caused a severe outbreak of the disease called COVID-19. This virus was identified for the first time in Wuhan, China on December,2019. There were recently described its cutaneous manifestations, with clinical similarities among children and adults. There were identified five cutaneous patterns: macular-papular rash, hives, acral lesions pernicious type, vesicular rash and livedo reticularis. Objective: To characterize pediatric patients with cutaneous manifestations during COVID19 disease. Cases presentation: There were studied 10 pediatric patients with COVID-19 admitted in ´´Comandante Manuel Piti Fajardo´´ Military Hospital of Villa Clara province. From the total of patients, eight presented eritemato-papular rash and two had urticariform rash. Urticariform lesions were present just in the girls, the eritomato-papulosa lesions presented similarly in both sexes with slight predominance in female adolescents. Both types of lesions appeared with predominance in the torso and accompanied of slight or absent pruritus. Just the urticariform lesions required medical treatment. Conclusions: The main clinical presentations in the pediatric population attended in the Military Hospital of Villa Clara province are the cutaneous manifestations. Eritematopapular lesions are the most frequent;they have late onset and favorable evolution with no need of treatment and with no other symptomatology. © 2020, Editorial Ciencias Medicas. All rights reserved.