ABSTRACT
Background. Simulators in laryngology are an essential part of training. They provide an avenue for medical students and resident trainees to practice valuable psychomotor skills outside the realm of an actual patient encounter - thereby decreasing the risk of possible patient morbidity. Herein we present three locally manufactured simulation devices that can be used to train residents in laryngology procedures. Objective. To present three simulation platform devices (Laser Box, Flexible Endoscopy Simulation, Thiel Cadaver Chair) and their applications in simulation-based learning Methods. The Laser Box, Flexible Endoscopy Simulation, and Thiel Cadaver Chair were manufactured by outside parties designated as 'Laser Machinists'. Results. Ten (10) units of the Laser Box, two (2) units of the Thiel Cadaver Chair, and two (2) units of the Flexible Endoscopy Simulation were constructed. They were used in a laryngology postgraduate course in our institution to teach the participants on endoscopies and laser phonosurgery. Conclusion. Simulation for otolaryngologic procedures should be an essential part of training. The learning curve for procedures such as laryngoscopy and laser phonosurgery can be addressed with the production of simulation platforms. Most institutions in the Philippines still adopt the "see one, do one, teach one" approach, which lacks standardization and puts patients at risk. Various task trainers for laser phonosurgery and flexible endoscopy have been reported in the literature, but there seems to be no published data on the use of a cadaver chair for simulation. In the COVID-19 era, aside from being excellent teaching tools, simulation platforms derive their importance in helping train residents, educate medical students, and review consultants - maximizing skill development - and thereby decreasing repeated attempts, and indirectly, exposure to the SARS-CoV-2. Future validation studies are required for the models, with the eventual long-term goals to further standardize training, increase patient safety and incorporate a simulation-based curriculum for the specialty locally. © 2022 University of the Philippines Manila. All rights reserved.
ABSTRACT
Objective. To determine the diagnostic accuracy of self-collected snorted and spit saliva in detecting COVID-19 using RT-PCR (ssRT-PCR) and lateral flow antigen test (ssLFA) versus nasopharyngeal swab RT-PCR (npRT-PCR). Methods. One hundred ninety-seven symptomatic subjects for COVID-19 testing in a tertiary hospital underwent snort-spit saliva self-collection for RT-PCR and antigen testing and nasopharyngeal swab for RT-PCR as reference. Positivity rates, agreement, sensitivity, specificity, and likelihood ratios were estimated. Results. Estimated prevalence of COVID-19 using npRT-PCR was 9% (exact 95% CI of 5.5% - 14.1%). A higher positivity rate of 13% in the ssRT-PCR assay suggested possible higher viral RNA in the snort-spit samples. There was 92.9% agreement between ssRT-PCR and npRT-PCR (exact 95% CI of 88.4% to 96.1%;Cohen’s Kappa of 0.6435). If npRT-PCR will be assumed as reference standard, the estimated Sensitivity was 83.3% (exact 95% CI of 60.8% to 94.2%), Specificity 93.9% (exact 95% CI of 89.3% to 96.5%), Positive predictive value of 57.7% (exact 95% CI of 38.9% to 74.5%), Negative predictive value of 98.2% (exact 95% CI of 95% to 99.4%), positive likelihood ratio of 3.65 (95% CI of 7.37 to 24.9), negative likelihood ratio of 0.178 (95% CI of 0.063 to 0.499). There was 84.84% agreement (95% exact CI of 79.1% to 89.5%;Cohen’s Kappa of 0.2356) between ssLFAvs npRT-PCR, sensitivity of 38.9% (exact 95% CI of 20.3% to 61.4%), specificity of 89.4% (exact 95% CI of 84.1% to 93.1%), PPV of 26.9% (95% CI of 13.7% to 46.1%), NPV of 93.6% (exact 95% CI of 88.8% to 96.4%), LR+ of 3.67 (95% CI of 1.79 - 7.51), LR – of 0.68 (95% CI of 0.47 - 0.99). Conclusion. Our data showed that snort-spit saliva RT-PCR testing had acceptable diagnostic performance characteristics and can potentially be used as an alternative to the standard nasopharyngeal/oropharyngeal swab RT-PCR test for COVID-19 in certain situations. However, our data also showed that snort-spit saliva antigen testing using lateral flow assay did not offer acceptable performance. © 2021 University of the Philippines Manila. All rights reserved.
ABSTRACT
Background and objectives There is limited information on outcome, complications and treatments of critically ill COVID-19 patients requiring admission to an intensive care unit (ICU). The aim of this study is to describe the clinical ICU course, treatments used, complications and outcomes, of critically ill COVID-19 patients admitted in seven ICU in Galicia region during the 2020 March–April pandemic peak. Methods Between March 21 and April 19, 2020, we evaluated critically ill COVID-19 patients admitted to the ICU of Anesthesia of seven hospitals in Galicia, northwestern Spain. Outcome, complications, and treatments were monitored until May 6, 2020, the final date of follow-up. Results A total of 97 critically ill COVID-19 patients were included. During ICU stay, mechanical ventilation became necessary in 80 (82.5%) patients, and tracheostomy in 22 (22.7%) patients. Prone position was used frequently in both intubated (67.5%) and awake (27.8%) patients. Medications consisted of antivirals agents (92.7%), corticosteroids (93.8%), tocilizumab (57.7%), and intermediate or high doses of anticoagulants (83.5%). The most frequent complications were ICU-acquired infection (52.6%), thrombosis events (16.5%), and reintubation (9.3%). After a median follow-up of 42 (34–45) days, 15 patients (15.5%) deceased, 73 patients (75.2%) had been discharged from ICU, and nine patients (9.3%) were still in the ICU. Conclusions A high proportion of our critically ill COVID-19 patients required mechanical ventilation, prone positioning, antiviral medication, corticosteroids, and anticoagulants. ICU complications were frequent, mainly infections and thrombotic events. We had a relatively low mortality of 15,5%. Resumen Antecedentes y objetivos Existe poca información sobre la evolución, complicaciones y los tratamientos recibidos por los pacientes críticos con COVID-19 que requieren ingreso en una unidad de cuidados intensivos (UCI). El objetivo de este estudio es describir la evolución clínica, los tratamientos utilizados, las complicaciones y resultados de pacientes críticos COVID-19 ingresados en siete UCI de Anestesiología en la Región de Galicia durante el pico de la pandemia en marzo-abril 2020. Métodos Entre el 21 de marzo y el 19 de abril de 2020 evaluamos todos los pacientes críticos COVID-19 ingresados en las UCI de Anestesiología de siete hospitales en Galicia, en el Noroeste de España. Los resultados, complicaciones y los tratamientos administrados se registraron hasta el 6 de Mayo de 2020, fecha final del seguimiento. Resultados Un total de 97 pacientes críticos COVID-19 fueron incluidos. Durante su estancia en UCI, 80 pacientes (82,5%) necesitaron ventilación mecánica, y 22 pacientes (22,7%) traqueotomía. El decúbito prono se usó frecuentemente en pacientes intubados (67,5%) y despiertos (27,8%). Las medicaciones usadas fueron antivirales (92,7%), corticoides (93,8%), tocilizumab (57,7%), y dosis intermedias y altas de anticoagulantes (83,5%). Las complicaciones más frecuentes fueron infecciones adquiridas en UCI (52,6%), eventos trombóticos (16,5%), y reintubationes (9,3%). Tras un seguimiento medio de 42 (34–45) días, 15 pacientes fallecieron (15,5%), 73 pacientes (75,2%) habían sido dados de alta de UCI y nueve pacientes (9,3%) permanecían todavía en la unidad. Conclusiones Un alto porcentaje de nuestros pacientes críticos COVID-19 requirieron ventilación mecánica, posición prona, medicaciones antivirales, corticoides y anticoagulantes. Las complicaciones en UCI fueron frecuentes, principalmente infecciones y eventos trombóticos. Tuvimos una mortalidad relativamente baja del 15,5%.
ABSTRACT
BACKGROUND AND OBJECTIVES: There are limited information on outcome, complications and treatments of critically ill COVID-19 patients requiring admission to an intensive care unit (ICU). The aim of this study is to describe the clinical ICU course, treatments used, complications and outcomes, of critically ill COVID-19 patients admitted in seven ICU in Galicia region during the 2020 March-April pandemic peak. METHODS: Between March 21 and April 19, 2020, we evaluated critically ill COVID-19 patients admitted to the ICU of Anesthesia of seven hospitals in Galicia, northwestern Spain. Outcome, complications, and treatments were monitored until May 6, 2020, the final date of follow-up. RESULTS: A total of 97 critically ill COVID-19 patients were included. During ICU stay, mechanical ventilation became necessary in 80 (82.5%) patients, and tracheostomy in 22 (22.7%) patients. Prone position was used frequently in both intubated (67.5%) and awake (27.8%) patients. Medications consisted of antivirals agents (92.7%), corticosteroids (93.8%), tocilizumab (57.7%), and intermediate or high doses of anticoagulants (83.5%). The most frequent complications were ICU-acquired infection (52.6%), thrombosis events (16.5%), and reintubation (9.3%). After a median follow-up of 42 (34-45) days, 15 patients (15.5%) deceased, 73 patients (75.2%) had been discharged from ICU, and nine patients (9.3%) were still in the ICU. CONCLUSIONS: A high proportion of our critically ill COVID-19 patients required mechanical ventilation, prone positioning, antiviral medication, corticosteroids, and anticoagulants. ICU complications were frequent, mainly infections and thrombotic events. We had a relatively low mortality of 15,5%.