ABSTRACT
Between January 2019 and December 2022, a student (named L.A.) doing a BTS (a senior technologist's certificate) in Management was treated using a trimodal system of care by the BAPU of the Claude Bernard Center. How was this original system organized, and how did changes related to the lockdown of March-May 2020 allow for progress in the proposed treatment? The consulting psychologist, Ms. Beaudre ', received the initial request: L.A. had multiple difficulties (learning, language, social, psychic, somatic, etc.). Rapid guidance was recommended in an individual space dedicated to educational psychology, while continuing with consultations. In the educational psychology space, L.A. met with Mr. Sanchez and first explained to him her concerns about her difficulties with the French language, her rejection of her mother tongue and her accent. Her learning difficulties made her fear she would fail the BTS. L.A. had low self-esteem. At the start of the lockdown of March-May 2020, the educational psychological support was done at a distance (by telephone), and this did not help to reduce L.A.'s anxiety. Shortly before the start of the lockdown, L.A. had met with Ms. Dziwulski, psychologistpsychotherapist, as part of a therapeutic relaxation session. The question of the physical isolation was an overwhelming concern. The isolation imposed by COVID-19 posed a serious problem for the continued use of this trimodal system of care: how to continue working with L.A.? Within the parameters of this trimodal care, an attempt was made to adapt the follow-up for L.A. around the question of the verbal contact via telephone and the physical presence (distant or real), in a way which would allow this young woman to question/examine the orders given by her inner voice that she called her "policeman". The temporary suspension of in person contact, as well as work on her self-image and imagination, the exclusivity of her inner voice and then the application of the telephone voice/real physical presence at the BAPU leading to the questioning of the role of the body in her difficulties, allowed L.A to exist differently. The establishment of and the modifications made to this system of care ultimately functioned as a mediation, which provided L.A. the possibility of acquiring another voice, another space in which to think.
ABSTRACT
The multisystem inflammatory syndrome in children associated with COVID-19 (MIS-C) is infre-quent but potentially lethal. There are few reports of this disease and its phenotypes in Latin America. Objective: To describe the characteristics of the clinical phenotypes of MIS-C in hospitalized patients in Lima, Peru. Patients and Method: A descriptive and retrospective study in patients under 14 years old with a diagnosis of MIS-C at the Hospital Nacional Edgardo Rebagliati Martins (Lima, Peru), from April 2020 to August 2021. Clinical-demographic and microbiological variables were recorded. According to these, patients with MIS-C were classified into the shock phenotype, Kawasaki disease (KD) without shock, and the fever and inflammation phenotype, analyzing their clinical outcomes. Results: 58 patients were analyzed. 32 (55.2%) presented the shock phenotype, 15 (25.8%) Kawasaki disease (KD) phenotype without shock, and 11 (19%) fever and inflammation phenotype. In the shock phenotype, 17 had KD. The mean age was 7 +/- 3.5 years and 67.2% were males. Gastrointes-tinal and mucocutaneous manifestations predominated in all phenotypes. The mortality was 3.5%. The frequency of coronary aneurysms was 10.2%. Most patients received immunomodulatory and antiplatelet treatment. Patients with shock phenotype showed greater involvement in inflammatory markers, hematological dysfunction, and myocardial injury, with a higher frequency of respiratory failure and invasive mechanical ventilation. Conclusions: In our case series, patients with shock phenotype were the most frequent and had worse clinical outcomes. Active surveillance of clinical phenotypes is needed to make an early diagnosis and management to improve the prognosis in these patients.
ABSTRACT
The Addressing the new educational needs and requirements still remains a challenge. Moreover, due to the COVID-19 pandemic and the technological advancements, learning environments are being transformed. Metaverse is a computer-generated lifelike 3D virtual extension of the physical world as it immerses users, allows them to interact with others and with digital objects, and eliminates the constraints of distance and time differences. It is characterized by persistence, interactivity, and embodiment. The use of the metaverse in educational and training processes to create new learning environments that allow learners to function in a parallel, safe and personalized reality is gaining ground. The aim of this study is to analyze the existing research into the metaverse in the educational field. Hence, a systematic literature review has been carried out using the Web of Science (WoS) and Scopus databases. To provide more complete and constructive results, no year, educational level, or subject restrictions were set. As metaverse is a new topic and taking the inclusion and exclusion criteria into account, a total of 17 articles has been analyzed. Based on the findings, metaverse has the potential to enrich and transform education and lead to increased learning outcomes and enhanced students' engagement and motivation. Despite this fact, the use of metaverse in education is in its infancy, thus, more research and experiments should be carried out in all educational levels and populations to assess its impact and improve its effectiveness. Finally, the need for designing valid instruments to evaluate the educational experiences generated within the metaverse was evident. © 2023 Universidad de Murcia. All rights reserved.
ABSTRACT
The appearance of COVID-19 has been a problem for public health on a global scale, putting pressure on health care systems. The after-effects of this illness have highlighted the importance of rehabilitation in long COVID patients involv-ing different health professionals. The treatment of the respiratory after-effects of this disease in an outpatient setting is a specialized field. It is appropriate to offer a series of practical recommendations of cardio-respiratory rehabilitation that are helpful to the professionals involved in the after-effects when ending hospitalisation. This review of the literature includes ten key aspects of respiratory physiotherapy that range from assessment, parameters to monitor, signs of alarm and respiratory rehabilitation techniques and other exercises for this population.
Subject(s)
COVID-19 , COVID-19/complications , Humans , Outpatients , Physical Therapy Modalities , SARS-CoV-2 , Post-Acute COVID-19 SyndromeABSTRACT
Between January 2019 and December 2022, a student (named L.A.) doing a BTS (a senior technologist's certificate) in Management was treated using a trimodal system of care by the BAPU of the Claude Bernard Center. How was this original system organized, and how did changes related to the lockdown of March-May 2020 allow for progress in the proposed treatment? The consulting psychologist, Ms. Beaudre, received the initial request: L.A. had multiple difficulties (learning, language, social, psychic, somatic, etc.). Rapid guidance was recommended in an individual space dedicated to educational psychology, while continuing with consultations. In the educational psychology space, L.A. met with Mr. Sanchez and first explained to him her concerns about her difficulties with the French language, her rejection of her mother tongue and her accent. Her learning difficulties made her fear she would fail the BTS. L.A. had low self-esteem. At the start of the lockdown of March-May 2020, the educational psychological support was done at a distance (by telephone), and this did not help to reduce L.A.'s anxiety. Shortly before the start of the lockdown, L.A. had met with Ms. Dziwulski, psychologist-psychotherapist, as part of a therapeutic relaxation session. The question of the physical isolation was an overwhelming concern. The isolation imposed by COVID-19 posed a serious problem for the continued use of this trimodal system of care: how to continue working with L.A.? Within the parameters of this trimodal care, an attempt was made to adapt the follow-up for L.A. around the question of the verbal contact via telephone and the physical presence (distant or real), in a way which would allow this young woman to question/examine the orders given by her inner voice that she called her "policeman". The temporary suspension of in person contact, as well as work on her self-image and imagination, the exclusivity of her inner voice and then the application of the telephone voice/real physical presence at the BAPU leading to the questioning of the role of the body in her difficulties, allowed L.A to exist differently. The establishment of and the modifications made to this system of care ultimately functioned as a mediation, which provided L.A. the possibility of acquiring another voice, another space in which to think.Copyright © 2023
ABSTRACT
Background and Aims: AKI is a common complication in critically ill patients, during the COVID-19 pandemic, it has been presented directly associated with damage by the virus, due to the severity of the disease and secondary to treatment, that is, secondary to the Crosstalk of organs and the crosstalk of support equipment, such as the extracorporeal oxygenation membrane (ECMO), which has been used in patients with severe respiratory failure. According to the international bibliography, the incidence of AKI in ECMO ranges from 26 to 85% depending on the characteristics of the patient, the percentage that requires KRT is around 45% . Objective(s): Our hospital is a national reference center for ECMO support therapy as for lung transplantation, it is the only center that has an active program, so understanding the epidemiology of AKI associated with ECMO in our population is important, in addition to representing an part of the experience in Latin America. Method(s): Retrospective and Descriptive study. Were included all patients 18y or older connected to ECMO with diagnosis of severe pneumonia for COVID-19 from June 2020 to August 2021. Data was collected in excel and using the ECMO Team platform data that is shared in the ELSO. Descriptive data analysis was performed with SPSS V21 and excel. Result(s): 48 patients were connected to ECMO for COVID-19 severe pneumonia in our center, 39 men. Average Age 49 years (Min 21y, Max 68y), average weight 93 kg (Min 55kg, Max 125kg) 25 patients (52%) with AKI, 22 (45%) requires KRT, 100% CKRT. 10 patients (20%) have kidney recovery function, all them get out form ECMO. From all, 45% patients died, these 45% were still in ECMO. In most of the cases the AKI cause is multifactorial, but the most common cause identified was sepsis, the second nephrotoxicity (antibiotics like vancomycin and colistin) and third hemolysis (as ECMO membrane complication). About the indication of star KRT: 50% fluid overload, 30% acidosis and uremia, 20% anuria. 100% of patients were in ECMO-VV at time CKRT started, all were connected in parallel in ECMO in Post blood pump and return Pre blood pump, with no coagulation problems as long as they have the ECMO anticoagulation, 93% patients with heparin and 7% with argatroban for HIT suspicious. As data to highlight from our population there is the first bilateral lung transplant secondary to covid-19 in Latin America and the longest air transfer in ECMO in the world. Conclusion(s): In our center the AKI, KRT and mortality in patients with ECMO it is much like other centers reported. In COVID-19 there is not yet very clear evidence and more studies should be done. This is the first study in Mexico about ECMO, AKI and COVID- 19.
ABSTRACT
The multisystem inflammatory syndrome in children associated with COVID-19 (MIS-C) is infre-quent but potentially lethal. There are few reports of this disease and its phenotypes in Latin America. Objective(s): To describe the characteristics of the clinical phenotypes of MIS-C in hospitalized patients in Lima, Peru. Patients and Method: A descriptive and retrospective study in patients under 14 years old with a diagnosis of MIS-C at the Hospital Nacional Edgardo Rebagliati Martins (Lima, Peru), from April 2020 to August 2021. Clinical-demographic and microbiological variables were recorded. According to these, patients with MIS-C were classified into the shock phenotype, Kawasaki disease (KD) without shock, and the fever and inflammation phenotype, analyzing their clinical outcomes. Result(s): 58 patients were analyzed. 32 (55.2%) presented the shock phenotype, 15 (25.8%) Kawasaki disease (KD) phenotype without shock, and 11 (19%) fever and inflammation phenotype. In the shock phenotype, 17 had KD. The mean age was 7 +/- 3.5 years and 67.2% were males. Gastrointes-tinal and mucocutaneous manifestations predominated in all phenotypes. The mortality was 3.5%. The frequency of coronary aneurysms was 10.2%. Most patients received immunomodulatory and antiplatelet treatment. Patients with shock phenotype showed greater involvement in inflammatory markers, hematological dysfunction, and myocardial injury, with a higher frequency of respiratory failure and invasive mechanical ventilation. Conclusion(s): In our case series, patients with shock phenotype were the most frequent and had worse clinical outcomes. Active surveillance of clinical phenotypes is needed to make an early diagnosis and management to improve the prognosis in these patients. Copyright © 2022, Sociedad Chilena de Pediatria. All rights reserved.
ABSTRACT
Emergencies produce significant changes in people's habits and lifestyles. Further, it also impacts our clothing tastes and preferences because social interaction is reduced, and everyday activities are performed at home. Thus, this paper shows a psychographic analysis to determine the type, style, color, and other clothing characteristics users preferred across the pandemic. In addition, some considerations have been taken into account to understand the clothing characteristics users will look for in post-pandemic presential jobs. In this context, the first version of a smartphone app using augmented reality (AR) has been developed. Three-dimensional objects were designed using Blender, while the smartphone app was set up using Unity, accompanied by modules such as AR Foundation, ARCore XR Plugin, and DOTween. The application allows the overview of the selected three-dimensional garment and relevant information about its components. Statistical analysis shows a vital essential between the monthly income of the participants and their purchasing decision;likewise, between sex and upper garments usage. Experimental tests inside a retail store validate this proposal throughout a new sample of 44 people. Ultimately, they filled out a usability test (SUS) that confirmed the application acceptance with an 82.73%. Finally, they gave the corresponding feedback on their experience using the app. Consequently, relevant information that might be used in future research to understand the consumer needs in a matter of clothing emergencies or confinement is passing through has been exposed. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
Before the arrival of the pandemic due to SARS-CoV-2, the Infantery Museum Marine Park was among the most visited tourist sites in Coveñas, however, due to Colombian decree 457, the museum closed its doors to the visitors, thus avoiding the exposure of the national military heritages that are exposed in it, restricting one of the most important contributions to the educational context in the Caribbean Region. Therefore, the objective of the research is to design the model of a web prototype, using View 360 ° technology, for the remote exhibition of the facilities and heritage of the Infantery Museum Marine Park. The type of research is basic and applied, where a documentary analysis of the 360 ° view technology was carried out, identifying the technical and user requirements for the development of the prototype design, which will integrate 360 ° panoramic photographs and points of access, strengthening the exhibition of the heritages and there was a completely new way for the museum professionals to communicate the exhibits to the public. It is concluded that the proposed prototype meets the functional requirements necessary to solve the problem presented.
ABSTRACT
Background and aims: The pandemic caused by SARS-COV2 is responsible for a considerable impact on stroke care. During this time many other non-COVID diseases have been neglected. Primary health care centers collapsed in some regions and the control and monitoring of vascular risk factors has been difficult. On the other hand, it is also known that covid infection leads to a certain prothrombotic state that could result in subsequent strokes. Our objective is to evaluate the effect of the SARS-CoV-2 pandemic on stroke unit admission rates. Methods: Temporal admission rates in the stroke unit of a regional hospital were analyzed from 2019, 2020 and 2021. The type of stroke, baseline characteristics and treatments received were recorded. Results: Stroke unit admission rates were similar between 2019 and 2020: 397 and 408 patients respectively. However, in 2021 the number of stroke admission, Ischemic or hemorrhagic, has incremented by more than 30% (p-value 0,005), with 589 attended patients. Hemorrhagic stroke rates were 15.62%, 10.70% and 16.98% in the three years respectively. Conclusions: During the first year of SARS-CoV-2 pandemic the use of health services for neurological emergencies was reduced, included the number of admissions at the stroke unit. However, we are experiencing a significant increase in the number of strokes, which now far exceeds prepandemic levels. It remains to be determined whether the cause of this huge increase in stroke cases is related to suboptimal vascular risks factor control, to COVID-related factors or to optimal population response following stroke campaigns in the region.
ABSTRACT
Introduction: in a short period of time, the pandemic caused by COVID-19 has caused a global health problem of great magnitude. Therefore, it was necessary to enable new medical consultations to limit contact between sick and healthy patients.
ABSTRACT
Objective: The COVID-19 pandemic has brought major changes to the model of patient care in Rheumatology. Our aim was to compare the change in the care delivered in a rheumatology nursing consultation before and during the pandemic.& nbsp;Material and methods: Descriptive and observational study. Patient care was registered before and during the COVID-19 outbreak. The variables collected were age, sex, prevalent rheumatic disease, type of visit and reason for consultation.& nbsp;Results: 254 consecutive patients were included before the COVID-19 pandemic for 20 days and 251 patients during COVID-19 for 10 working days. The mean age was 61 years before and 57 during the pandemic. Of both groups, 74% were women. The most frequently attended pathologies before and during COVID-19 were rheumatoid arthritis and spondyloarthropathies. Scheduled face-to-face visits decreased during COVID-19 (46.5% versus 1.6%), with an increased number of phone scheduled visits (2.8% versus 52.2%) and spontaneous consultations either by phone or e-mail (28.3% versus 45%). The type of scheduled visits during COVID-19 were for stable diseases (20% versus 37%) and monitoring (12% versus 38%). The reason for spontaneous consultation increased during COVID-19 and were mainly doubts regarding prevention measures and treatment optimization (13.8% versus 31.1%).& nbsp;Conclusions: The first wave of COVID-19 brought to rheumatology nursing consultation a global increase in all activities in the number of visits per day, in the number of stable patient controls, in monitoring and answering patient concerns. (C)& nbsp;2021 Published by Elsevier Espa?a, S.L.U.
ABSTRACT
This chapter examines an innovative learning project in which undergraduate marketing students manage and generate content on an official Instagram profile. The project is designed to provide students with a more active role in the learning process through the application of new virtual technology tools. During the pandemic (course 2020-21), students shared their knowledge about marketing and related topics through storytelling, transmedia, gamification, and virtual/augmented reality via Instagram. The students' perception of the learning outcomes, and their satisfaction, were compared with those of students from three previous courses (2017-20). The findings revealed that students assessed the Instagram activity more highly in the context of the pandemic than in previous years. Interestingly, the students also reported better learning outcomes and improvement in their soft skills and consequently were highly satisfied with the project, which suggests the activity should continue in the future. © 2021 by IGI Global. All rights reserved.
ABSTRACT
OBJECTIVES: The maintenance of sinus rhythm by means of antiarrhythmic drugs and/or upstream therapy to counter cardiac remodeling is fundamental to the management of atrial fibrillation (AF). This study aimed to analyze this approach and its appropriateness in the setting of hospital emergency departments. MATERIAL AND METHODS: Secondary analysis of data from the multicenter observational cross-sectional HERMES-AF study carried out in 124 hospitals representative of the Spanish national health service in 2011. Included were consecutive patients with AF restored to sinus rhythm who were discharged home from emergency care. RESULTS: A total of 449 patients were included;204 (45.4%) were already on sinus rhythm maintenance therapy. Of ,the 245 remaining patients, 107 (43.67%) were prescribed maintenance treatment in the emergency department, as follows: 41, an antiarrhythmic drug;19, upstream therapy;and 49, both treatments. The selection of an antiarrhythmic drug did not follow guideline recommendations in 10 patients (11.8%). Antiarrhythmic drug prescription was associated with having had a prior episode of AF (odds ratio [OR], 2.024;95% CI, 1.196-3.424;P = .009);a heart rate of more than 110 beats/min (OR, 2.147;95% CI, 1.034-4.456, P = 0.40);and prescription of anticoagulation on discharge (OR, 1.862;95% CI, 1.094-3.170;P = .022). Upstream therapy prescription was associated only with a heart rate over 110 beats/min (OR, 2.187;95% CI, 1.005-4.757;P = .018). In total, 311 patients (69.23%) were discharged from the emergency department with sinus rhythm maintenance therapy: 87 with an antiarrhythmic drug, 117 with an upstream therapy, and 107 with both. CONCLUSION: Treatment to prevent the recurrence of AF is underprescribed in emergency departments. Increasing such prescription and ensuring the appropriateness of antiarrhythmic therapy prescribed are points emergency departments can improve in the interest of better sinus rhythm maintenance.
ABSTRACT
Introduction. With the national guidelines of the Sustainable Selective Test-Tracking-Isolation program (PRASS in spanish) and the districts strategy of Detect-Isolation-Report (DAR in spanish) from the Public Health Plan of Collective Interventions (PSPIC in spanish), during 2020 were implemented activities of active search for positive cases of SARS-CoV-2, in order to identify risk areas and implement mitigation and containment strategies for the COVID-19 pandemic in Bogota. The objective of this work is to describe the strategy of active case-finding for COVID-19 in Bogota city, 2020-2021. Materials y methods. Using descriptive statistics, we described the search sessions carried out in the city. Thus, the integrated health services subnets with their home environment public health teams, integrated by professionals and trained technicians, carried out swab sampling in the following clusters: Select groups with greater vulnerability or high exposure to the virus given their daily activities, or specific areas of the city with a high rate of virus transmissibility or apparently silent. Samples were sent to the district public health laboratory for processing using the Charite protocol RT-PCR, Berlin. They also carry out communication and education activities for health and notification of cases to the Public Health Surveillance System-SIVIGILA. Results. Between June 2020 and June 2021, were performed 9997 journeys of active search, where 1000.225 samples were taken along the 20 localities of Bogota city, with a higher concentration of samples in Ciudad Bolivar (11%), Kennedy (9%), Tunjuelito (7%), Suba (6%), Usme (6%), Puente Aranda (6%) and Bosa (6%). Acumulative positivity ratio of 20% was observed for the observed period, in the three moments with the highest frequency of positive cases for the SARS-CoV-2 virus in the city, positivity ratios of 14% were reached in the months of July and August 2020, 19% between December 2020 and January 2021 and 39% in the third peak of infections between May and June 2021, finding for the latter period time, days with positivity proportions that exceeded 45%. Conclusion. In the city, epidemiological surveillance actions are continued, such as Field Epidemiological Investigations (IEC in spanish), as well as the increasing of collective interventions in the different environments of daily life, wich are focused on the areas with the higher positivity, developing actions aimed at empowering the community in relation to care and biosecurity guidelines to reduce the COVID-19 contagion risk. © 2021 IEEE.
ABSTRACT
OBJECTIVES: The maintenance of sinus rhythm by means of antiarrhythmic drugs and/or upstream therapy to counter cardiac remodeling is fundamental to the management of atrial fibrillation (AF). This study aimed to analyze this approach and its appropriateness in the setting of hospital emergency departments. MATERIAL AND METHODS: Secondary analysis of data from the multicenter observational cross-sectional HERMES-AF study carried out in 124 hospitals representative of the Spanish national health service in 2011. Included were consecutive patients with AF restored to sinus rhythm who were discharged home from emergency care. RESULTS: A total of 449 patients were included;204 (45.4%) were already on sinus rhythm maintenance therapy. Of ,the 245 remaining patients, 107 (43.67%) were prescribed maintenance treatment in the emergency department, as follows: 41, an antiarrhythmic drug;19, upstream therapy;and 49, both treatments. The selection of an antiarrhythmic drug did not follow guideline recommendations in 10 patients (11.8%). Antiarrhythmic drug prescription was associated with having had a prior episode of AF (odds ratio [OR], 2.024;95% CI, 1.196-3.424;P = .009);a heart rate of more than 110 beats/min (OR, 2.147;95% CI, 1.034-4.456, P = 0.40);and prescription of anticoagulation on discharge (OR, 1.862;95% CI, 1.094-3.170;P = .022). Upstream therapy prescription was associated only with a heart rate over 110 beats/min (OR, 2.187;95% CI, 1.005-4.757;P = .018). In total, 311 patients (69.23%) were discharged from the emergency department with sinus rhythm maintenance therapy: 87 with an antiarrhythmic drug, 117 with an upstream therapy, and 107 with both. CONCLUSION: Treatment to prevent the recurrence of AF is underprescribed in emergency departments. Increasing such prescription and ensuring the appropriateness of antiarrhythmic therapy prescribed are points emergency departments can improve in the interest of better sinus rhythm maintenance.
ABSTRACT
OBJECTIVE: Rituximab-induced immunosuppression could be a risk factor for mortality from COVID-19. The aim of the study was to describe the prevalence of SARS-CoV-2 infection in patients who have received rituximab and its association with a persistent viral infection. METHODS: Retrospective observational study of patients who received rituximab in the 6 months before to the onset of the pandemic. We analyzed the presence of infection and associated them with demographic variables, pathological history related to an increased risk of developing severe COVID-19, the doses of rituximab received, the type of ventilatory support, thromboembolic events, and the treatment received. A descriptive analysis of all the variables was carried out and infected and uninfected patients were compared. RESULTS: We screened a total of 68 patients who had received rituximab (median cumulative dose: 4,161mg (2,611-8,187.5)). 54.4% men, mean age 60.8 years (15.7; 25-87)). C + was confirmed for 22 patients. Of these, 45.5% had high blood pressure, 36.4% Diabetes Mellitus, 31.8% smokers/ex-smoker, 22.7% lung disease, 13.6% heart disease and 4.5% obesity. There were no statistically significant differences between C+ and C-. Only 2 patients developed immunity. For 10 patients (45.5%) did not have a negative CRP until the end of the follow-up. There was no association with cumulative dose of rituximab. The mortality rate was 22.7% in the C+. CONCLUSIONS: We observe that the persistence of the infection leads to a worse evolution of COVID-19. The use of alternatives should be considered during the pandemic, because of patients with decreased B-cell function may have high risk of fatal progression from COVID-19.
Subject(s)
COVID-19 Drug Treatment , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , Rituximab/adverse effects , SARS-CoV-2ABSTRACT
Purpose Epidemiological surveillance of novel Coronavirus SARS CoV-2 in the Constitutional Province of Callao in Perú. Methods & Materials We used the data collection about the notifications of cases of COVID-19. The database was uploaded from the application of the national notification system (Notiweb). We analyzed the information from 13th March in 2020 to 27th June in 2021. Concerning deaths, the names and dates also corroborated by the death notification system (Sinadef). Results The first notified confirmed case in the region was a female patient on 13th March in 2020. We have 154 977 notifications cases as accumulated total;97 381 confirmed cases (with laboratory analyzes that confirm infection), 43 970 suspected cases (compatible symptoms of COVID-19), 12 646 discarded cases and 984 compatible cases (suspected case more epidemiological criteria or suspected case more radiological criteria). The districts with more cases are Callao and Ventanilla. The group of age more affected was an adult (30-59 years old) with 43 702 cases (54.60%). The primary care is provided by three “Redes de Salud”, the Red de Salud Ventanilla report 17 421 confirmed cases of COVID-19, Red de Bonilla 13 706 confirmed cases and Red de Salud BEPECA 10 786 confirmed cases. The hospitals, private clinics and others notification centres report the rest of the cases. From 9290 deaths as confirmed cases, the majority occur at the big hospitals;6948 deaths occur at Essalud Hospitals, 1175 deaths at National Hospitals, 977 deaths at the Navy Army hospital, 45 deaths at private clinics. The rest outside third-level establishments;92 deaths on their residence place, 45 on temporary isolation services, 06 on public roads and 02 on primary care's centres. Conclusion The province of Callao is a remarkable region in Peru because it has two points of entry to the country, the International Airport “Jorge Chavez” and the international seaport “Terminal Portuario del Callao”, and also have 01 prisons. The curve of the total number of reported cases of COVID-19 shows two waves;this second wave is currently decreasing, with 9290 deaths over 97 381 confirmed cases, we have a Lethality rate of 9.54%
ABSTRACT
Background: Since the Covid-19 pandemic started, it has been necessary to adapt our clinical practice to limit physical contact. We have established a virtual/presential rehabilitation program (VPR) in patients with EDSS ≤6.5. Methods: Our aim was to compare the effectiveness of the VPR with the previous face-to-face rehabilitation program (PR). Retrospective data were obtained from all patients with an EDSS≤6.5 who were admitted between September and December of 2019 and 2020. All patients were attended 3 times per week for 4 months. In the 2019 group the sessions were PR based, whereas in the 2020 group patients received a VPR, with one face-to-face session plus 2 virtual sessions. Outcomes (obtained pre and post rehabilitation programs) compared between VPR and PR groups were: 10MWT, Tinnetti Test (TT) and Berg Balance Scale (BBS). A minimally clinical significant difference was established for each test: 20% for 10MWT, 3 points for BBS and 1 point for TT. Results: One hundred and forty people were included in the groups VPR (n=80) / PR (N=60). For VPR and PR groups, mean age was 51.45y (SD10.71) / 54.65y (SD11.19) and mean EDSS 4.62 (SD1.45) / 4.64 (SD1.46). All clinical outcomes demonstrated statistically significant improvements pre-post intervention in both groups. Comparing VPR vs PR scores, test didn't show differences using a U of Mann-Whitney for independent samples: BBS 54.2%/44.1% (p =0.27);10MWT 36.7%/22.0% (p =0.13) and TT 40.7%/37.3% (p =0.72). Conclusions: No differences were observed in the effectiveness of VPR versus PR in any of the tests. The VPR program could be a useful tool for patients with an EDSS≤6.5, as the VPR provides a series of subjective benefits (ease of occupational and family life, reduction of fatigue caused by long journeys) while maintaining effectiveness. Further studies with improved designs are warranted to confirm these findings.