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SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection is a respiratory infection initially identified in Wuhan, China, in December 2019. Some of the patients have been found to show no signs of respiratory distress;however, when oxygen saturation levels are measured, they are abnormally lower than expected in relation to their clinical condition. This is why we collected a series of cases from patients diagnosed with COVID-19 (Coronavirus disease 2019) who underwent a 2-min walking test during the initial evaluation in the emergency department. A drop in oxygen saturation below 90% was considered a positive result. Eighty-five percent of patients with a positive walking test required in-hospital management and 70% required oxygen supplementation during hospitalization. This clinical tool could help determine which of these patients might require in-hospital care due to occult hypoxemia, considering the current epidemiological situation and high bed occupancy rates. © 2022 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo
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Background: SARS-CoV-2, the novel coronavirus identified for the first time in December 2019 in the city of Wuhan, China was identified for the first time in the Colombian territory on March 6, 2020. By November 2020, it had affected more than 47 million people and caused more than a million deaths worldwide. It has been observed that comorbidities such as diabetes can be associated with more severe forms of the disease and higher mortality rates. Hyperglycaemic crisis, referring to diabetic ketoacidosis and hyperosmolar nonketotic state can be precipitated by COVID-19. The following describes the cases of 15 patients who were admitted for COVID-19 and also had a hyperglycaemic crisis in a hospital in Medellín, Colombia. © 2021
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SESSION TITLE: Pulmonary Manifestations of Infections SESSION TYPE: Case Reports PRESENTED ON: 10/17/2022 03:15 pm - 04:15 pm INTRODUCTION: Diffuse alveolar hemorrhage (DAH) due to an undiagnosed autoimmune condition is rare and can be life-threatening. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been described as a viable rescue therapy in severe cases, providing time to establish a diagnosis and begin remission induction therapy (1). We report a patient who presented during the Omicron surge with hypoxemic respiratory failure due to pulmonary hemorrhage ultimately diagnosed with antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) who was supported with VV-ECMO without systemic anticoagulation. CASE PRESENTATION: A 46-year-old woman presented with subacute fatigue and two days of cough and brown sputum. She was found to have normocytic anemia (hemoglobin 3.5 g/dL), renal failure (serum creatinine 17.4 µmol/L), and bilateral pulmonary infiltrates on chest roentgenogram. Though vaccinated, nasal molecular testing detected SARS-CoV-2. She was intubated for progressive hypoxic respiratory failure and bronchoalveolar lavage fluid was consistent with DAH. She received empiric antibiotics, remdesivir, and pulse dose intravenous methylprednisolone as well as continuous renal replacement therapy and plasma exchange. Due to refractory hypoxemia she was cannulated for VV-ECMO. Systemic anticoagulation was deferred due to concerns that it may exacerbate her underlying pathology and due to a small subcortical bleed seen on computed tomography of the head. Perinuclear ANCA (titer >1:1280) was confirmed by immunofluorescence analysis with elevated myeloperoxidase serologies and cyclophosphamide was initiated. Glomeruli with cellular crescent formation consistent with AAV was later identified on renal biopsy. Her course was complicated by recurrent DAH while tapering steroids and an iliac vein thrombus, extracted during decannulation. Her respiratory failure resolved and she was discharged to rehab. DISCUSSION: Traditionally, VV-ECMO obligates systemic anticoagulation to prevent circuit thrombosis, however this may be viewed as a barrier to its use in patients with prohibitive bleeding risk and may contribute to the therapy's overall morbidity. Some institutions have begun to demonstrate the safety of ECMO with low- or prophylactic doses of anticoagulation (2), but this practice remains controversial. Detection of SARS-CoV-2 posed diagnostic and management challenges and its significance to this case remains uncertain. There are many past examples of infectious triggers for both DAH and AAV, and there is emerging evidence for an association between SARS-CoV-2 and ANCA (3). Concerns regarding the risk of B-cell depletion influenced the selection of remission induction therapy. CONCLUSIONS: In the case described, a patient with severe DAH was successfully supported with VV-ECMO. Withholding systemic anticoagulation did not prevent recurrent bleeding and may have contributed to a deep vein thrombosis. Reference #1: Arnold S, Deja M, Nitschke M, Bohnet S, Wallis S, Humrich JY, Riemekasten G, Steinhoff J, Lamprecht P. Extracorporeal membrane oxygenation in ANCA-associated vasculitis. Autoimmun Rev. 2021 Jan;20(1):102702. doi: 10.1016/j.autrev.2020.102702. Epub 2020 Nov 11. PMID: 33188916. Reference #2: Kurihara C, Walter JM, Karim A, et al. Feasibility of Venovenous Extracorporeal Membrane Oxygenation Without Systemic Anticoagulation. Ann Thorac Surg. 2020;110(4):1209-1215. doi:10.1016/j.athoracsur.2020.02.011 Reference #3: Kadkhoda, K., Laurita, K. Antineutrophil cytoplasmic antibodies and their association with clinical outcomes in hospitalized COVID-19 patients. Cell Death Discov. 7, 277 (2021). DISCLOSURES: No relevant relationships by Nathaniel Nelson No relevant relationships by Radu Postelnicu no disclosure on file for Antonio Velez;
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Collaboration is one required skill for the future workforce that requires constant practice and evaluation. However, students often lack formative feedback and support for their collaboration skills during their formal learning. Current technologies for emergent learning due to COVID-19 could make visible digital traces of collaboration to support timely feedback. This work aims to automatically detect the group work environment using speech data captured during group activities. Grounded in literature and students’ perspectives, this work defines and implements three indicators for detecting the work environment namely noise, silence and speech time. Three experts rated two hundred thirty-two video instances lasting 30-secs each to get a group work environment score. We report the results of two machine learning models for detecting the group work environment and briefly reflect on these results. © 2022, Springer Nature Switzerland AG.
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INTRODUCTION: the impact of maternal SARS-CoV2 infection and its risk of vertical transmission is still not well known. Recommendations from scientific societies seek to provide safety for newborns without compromising the benefits of early contact. The aim of the study is to describe characteristics and evolution of newborns born to mothers with SARS-CoV2 infection, as well as the implemented measures following recommendations from the Sociedad Espanola de Neonatologia. METHODS: observational, prospective and single-center cohort study. A specific circuit was designed for mothers with SARS-CoV2 infection and their newborns. Epidemiological and clinical data were collected. PCR were performed in newborns at delivery and at 14 days of age. RESULTS: 73 mothers and 75 newborns were included in the study. 95.9% of maternal infections were diagnosed during the third trimester of pregnancy, 43.8% were asymptomatic. Median gestational age was 38 weeks (IQR:37-40), 25.9% of newborns required admission to Neonatology. Skin-to-skin mother care was performed in 68% of newborns, 80% received exclusive maternal or donated breast milk during hospital stay. No positive PCR results were observed in newborns at delivery, one case of positive PCR was observed in an asymptomatic neonate at 14 days of age. CONCLUSIONS: Risk of SARS-CoV2 transmission is low when complying to the recommendations issued by Sociedad Espanola de Neonatologia, allowing rooming-in and promoting breastfeeding.
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Objective: We aimed to realize a verification of the performance of the rapid serological tests used in Risaralda department. Methods: Analytical, cross-sectional study. Serum samples from health workers in Pereira city, who had a clinical and epidemiological suspicion for SARS-CoV-2 were included. The processing and validation of the tests was carried out at Universidad Tecnológica de Pereira. Sensitivity and specificity of rapid IgM / IgG serological tests were calculated using RT-PCR as the gold standard test. Results: 144 samples of health professionals were included. Rapid serological tests useful to identify or rule out the presence of IgM and IgG antibodies, especially in symptomatic patients, in whom the onset of symptoms is longer than 11 days. Discussion: The use of rapid tests is increasing, not only due to the speed of their results, but also due to the low associated costs and the need to identify non-susceptible patients, who must prioritize their return to work activities in the community as part of the economic reactivation of Colombia. It is necessary to confirm the adequate performance of the test to increase the probability of an adequate classification before proceeding with the routine use of this test. © 2021 Asociacion Colombiana de Infectologia. All rights reserved.