Secondary respiratory early and late infections in mechanically ventilated patients with COVID-19.

BACKGROUND: Patients with COVID-19 receiving mechanical ventilation may become aggravated with a secondary respiratory infection. The aim of this study was to describe secondary respiratory infections, their predictive factors, and outcomes in patients with COVID-19 requiring mechanical ventilation. METHODS: A cohort study was carried out in a single tertiary hospital in Santiago, Chile, from 1st June to 31st July 2020. All patients with COVID-19 admitted to the intensive care unit that required mechanical ventilation were included. RESULTS: A total of 175 patients were enrolled, of which 71 (40.6%) developed at least one secondary respiratory infection during follow-up. Early and late secondary infections were diagnosed in 1.7% and 31.4% respectively. Within late secondary infections, 88% were bacterial, 10% were fungal, and 2% were of viral origin. One-third of isolated bacteria were multidrug-resistant. Bivariate analysis showed that the history of corticosteroids used before admission and the use of dexamethasone during hospitalization were associated with a higher risk of secondary infections (p = 0.041 and p = 0.019 respectively). Multivariate analysis showed that for each additional day of mechanical ventilation, the risk of secondary infection increases 1.1 times (adOR = 1.07; 95% CI 1.02-1.13, p = 0.008) CONCLUSIONS: Patients with COVID-19 admitted to the intensive care unit and requiring mechanical ventilation had a high rate of secondary infections during their hospital stay. The number of days on MV was a risk factor for acquiring secondary respiratory infections.

Climate-resilient and regenerative futures for Latin America and the Caribbean

Few events have had an impact as the global crisis caused by COVID-19. However, prior to the pandemic, Latin American and Caribbean (LAC) countries already had severe problems in terms of inequality, environmental degradation, and dysfunctional political systems. Added to this are the growing challenges that climate change poses for this highly vulnerable region. This historic turning point represents a new call to consider future studies to re-imagine and reinvent alternative futures for the LAC region. For this paper, we conducted an in-depth qualitative futures study to identify how Latin American and Caribbean countries could build long-term resilience, focusing on adaptability to climate change risks, considering existing sustainable development challenges and the detrimental effects of the COVID-19 pandemic on the economic, environmental, and social aspects. This study's findings provide recommendations for policymakers and decision-makers to achieve sustainable futures for LAC. Finally, it reflects on the value of collective action for a future-proof region.

Aprendizaje Por Proyectos Para El Razonamiento Fisioterapéutico Sobre El Dolor Espinal Durante La Cuarentena Por COVID 19

Resumen INTRODUCCIÓN: El COVID-19 trajo consigo el aislamiento físico afectando el desarrollo habitual de las actividades académicas. La carrera de fisioterapia adquirió un reto mayor, pues sus contenidos requieren un alto componente práctico de intercorporalidad. Siendo el objetivo del presente artículo, describir la experiencia pedagógica alrededor del aprendizaje por proyectos para el razonamiento clínico sobre el dolor espinal durante la cuarentena en estudiantes de fisioterapia de la Universidad de La Sabana. MÉTODOS: Se creó un proyecto conforme a las demandas en salud de las personas que realizan teletrabajo o estudio virtual, por el riesgo de padecer cérvico-dorso-lumbalgia asociado al puesto de trabajo y a los hábitos posturales. El proyecto tuvo 3 fases, una diagnóstica, una de elaboración de material, y una de divulgación. RESULTADOS: Frente a la cuarentena por COVID-19 los estudiantes de fisioterapia debieron adaptarse a diferentes retos para alcanzar un aprendizaje significativo desde la virtualidad;permitiendo el desarrollo de habilidades para el razonamiento clínico, basándose en la metodología del aprendizaje por proyectos mediante la conformación de equipos de trabajo que emplearan las TIC para la creación de material de divulgación relacionado al dolor espinal. CONCLUSIÓN: El aprendizaje por proyectos mediado por las TIC para el razonamiento clínico del dolor espinal en estudiantes de fisioterapia resultó una experiencia positiva para el desarrollo de los contenidos académicos y adquisición de competencias de aprendizaje. INTRODUCTION: The COVID-19 brought physical isolation affecting the usual development of academic activities. The physiotherapy career took on a greater challenge, as many of its contents require a practical component of intercorporality. Thus, the objective of this article is to describe the pedagogical experience around project-based learning for clinical reasoning about spinal pain during quarantine in physiotherapy students from University of La Sabana. METHODS: A Project was created in according to the health demands of people performing telework or virtual study, because of the risk of cervical-back-low back pain associated with the workplace and postural habits. The Project had 3 phases, a diagnosis, the second to develop educational material, a final of disclosure. RESULTS: Faced with the COVID-19 quarantine, physiotherapy students had to adapt to different challenges in order to achieve meaningful learning from virtuality;this allowed the development of skills for clinical reasoning, based on the methodology of project-based learning through the formation of work teams that used ICTs to create dissemination materials related to spinal pain. CONCLUSION: Project-based learning mediated by ICTs for the clinical reasoning of spinal pain in physical therapy students resulted as a positive experience for development of academic content to acquire learning competencies.

A pilot trial of human amniotic fluid for the treatment of COVID-19.

OBJECTIVE: Vertical transmission from SARS CoV-2-infected women is uncommon and coronavirus has not been detected in amniotic fluid. Human amniotic products have a broad immune-mediating profile. Observing that many COVID-19 patients have a profound inflammatory response to the virus, we sought to determine the influence of human amniotic fluid (hAF) on hospitalized patients with COVID-19. RESULTS: A 10-patient case series was IRB-approved to study the impact of hAF on hospitalized patients with documented COVID-19. Nine of the 10 patients survived to discharge, with one patient succumbing to the disease when enrolled on maximal ventilatory support and severe hypoxia. The study design was altered by the IRB such that the last 6 patients received higher dose of intravenous hAF. In this latter group, patients that had observed reductions in C-reactive protein were associated with improved clinical outcomes. No hAF-related adverse events were noted. Acknowledging some of the inherent limitations of this case series, these results inform and catalyze a larger scaled randomized prospective trial to further investigate hAF as a therapy for COVID-19. Trial Registration ClinicalTrials.gov: NCT04319731; March 23, 2020.