Design of an Automatic System for the Control and Monitoring of Symptoms of Covid-19 through IoT Technology

The specific symptomatology of Covid-19 reveals discomfort with mild or moderate intensity depending on the body of each person. This article develops the design of an automatic device that encompasses an intelligent control and monitoring system for symptoms of covid-19, which allows determining and identifying an estimate of suspected cases of people who enter the Continental University-Peru, through a reading of patterns. The device was made covering three systems (mechanical, mechatronic and control), the integration of systems allowed an efficient design, dimensioned calculations in the mechanical, electrical, and electronic, and its integration of hardware-software for the graphical interface. The system presented allows real-Time monitoring of parameters captured by sensors with IOT technology, which has made it possible to deepen and estimate suspected cases of covid by comparing measured values with the ranges of values established by the American Medical Association. © 2022 IEEE.

Impact of the first lockdown related to the COVID-19 pandemic on ophthalmic emergencies in a French University Hospital.

INTRODUCTION: At the beginning of the COVID-19 pandemic, the French government implemented its first national lockdown between March and May 2020 in order to limit the dissemination of the virus. This historic measure affected patients' daily lives and transportation, resulting in changes in the delivery of medical care, particularly emergency care. This study aimed to assess the impact of this restriction policy on the number and severity of ophthalmic emergencies seen in an ophthalmology emergency department. METHODS: This retrospective study conducted at the regional university Hospital of Tours included all patients presenting to the ophthalmology emergency department over four periods: lockdown (03/16/2020 to 05/10/2020), post-lockdown (05/11/2020 to 06/12/2020) and the two corresponding periods in 2019. The following data were recorded: sex, age, time of visit, reason for visit, diagnosis, severity of emergency graded on the BaSe SCOrE, time from first symptoms until visit, existence of a work-related injury, and referral source (ophthalmologist or other). RESULTS: A total of 1186 and 1905 patients were respectively included during the 2020 lockdown period and the corresponding period in 2019. The study populations for the 2019 and 2020 post-lockdown periods consisted of 1242 and 1086 patients respectively. During the lockdown, the number of consultations decreased significantly (-37.7%), affecting mild and severe emergencies similarly. During the post-lockdown period, the number of emergencies gradually increased but did not reach the level of the corresponding period in 2019 (-12.6%). CONCLUSION: The first French lockdown resulted in a significant decrease in ophthalmic emergency visits, similar for all levels of severity. All age groups were impacted similarly, without the expected exaggerated decrease for patients over 50 years of age, who are considered to be at greater risk for developing a severe form of COVID-19. The post-lockdown period showed a gradual increase in ophthalmic emergency visits, although these remained fewer than the previous year.

Audit of prostanoid use in severe Raynaud'sand adherence to treatment of digital ulcers inpatients with SSc NHSE pathway: Commissioningpolicy cost analysis and alternative therapeuticpathway proposed

Background/AimsSevere Raynaud's phenomenon (RP) can lead to digital ulcers (DU), ischaemia, infection and gangrene. In 2015, NHS England published a commissioning policy enabling the use of bosentan fordigital ulceration in SSc in patients refractory to intravenous 6-8weekly prostanoid in combination with sildenafil following standardtherapy (including calcium channel blockers (CCB), ACE inhibitors, losartan and fluoxetine). Bosentan is licensed to prevent newDUs in SSc. Specialist MDT ratification and Blueteq registration isrequired. RCTs showed bosentan reduced the formation of newDU by 30-50% in at risk individuals. It is a well-tolerated drug. It isnow off-patent so its cost has reduced from £22, 000 to £650 peryear.AimTo audit current departmental practice in patients receiving prostanoid(epoprostenol) for severe RP from any cause and check adherence tothe patient pathway for treatment escalation prior to prostanoidtherapy. To determine approximate costs of alternative therapeuticapproaches. MethodsWe retrospectively audited patients attending our day unit forepoprostenol infusions over a 12-month period between 2018 and2019. Using our centre's admissions database and electronic patientrecords, we identified which oral medications patients were currentlyco-prescribed or had previously trialled. Using pharmacy data andtariff costings, we calculated the cost of epoprostenol infusions andoral medications with blood monitoring.ResultsBetween 2018 and 2019, 73 patients attended for epoprostenolinfusions: 31 SSc, 25 RP, 17 other diagnoses (mixed/undifferentiatedCTD, SLE, vasculitis). The mean number of epoprostenol infusions perpatient per year was 5.92 days (range 1-25). The percentage ofpatients who had first been trialled on the following medicationsinclude: CCB 77.4%, ACEi/ARB 41.1%, fluoxetine 9.59%, sildenafil87.1% and tadalafil 25.8%. In the SSc group 22.6% had also trialledbosentan. Only 2 SSc patients (6.45%) had trialled all of the drugs onthe pathway prior to prostanoid reflecting the relative lack of efficacy ofsome first line therapies. The departmental tariff per prostanoidinfusion is £450, resulting in an estimated average annual cost of£2700 per patient. The annual cost of supplying bosentan 125mg twicedaily plus blood monitoring for the first year is approximately £1350.ConclusionEpoprostenol is used in our unit for patients with severe RP from arange of conditions. Sildenafil and CCB have been trialled in themajority of our patients prior to escalation. Only a minority of patientshave received bosentan according to current guidelines and licensing.Given the reduction in cost, combined with the importance of avoidinghospital admissions with COVID-19, we would suggest that bosentancould be used earlier in the treatment pathway for a broader range ofindications. NHSE is revising the SSc commissioning policy.

Implementation of a protection protocol against covid-19 in a big endoscopy unit. Assessment of its efficacy

Aims To assess the efficacy of a protocol based on two different levels of protective equipment (PE) to avoid Covid 19(C19) infections in the endoscopy unit. Methods To resume our endoscopic activity after the first wave of C19 infection, a protection protocol depending on C19reverse transcription polymerase chain reaction (PCR) test result and clinical triage before endoscopy was established. Twoprotection levels were defined: Low (negative PCR and triage), requiring basic protection (hat, gloves, permeable coat, surgical mask in lower and fpp2 in upper endoscopy);and high (positive PCR or symptoms), requiring advanced protection(hat, ocular protection, fpp2 mask, gloves and waterpro of coat). Non urgent endoscopies where cancelled if PCR waspositive. A prospective research evaluating the efficacy of this protocol was completed from april 27th to june 24th. Patientswhere contacted 2 weeks later to exclude a possible C19 infection. Results 2304 patients, 46.1 % women, were included with mean age of 59.88 ±15,547. 987 gastroscopies, 1084colonoscopies, 113 ERCP, 101 ecoendoscopies, 9 enteroscopies and 173 rectosigmoidoscopies were performed. PreviousPCR was made to 2302 patients and was positive in 10 (7 endoscopies were cancelled). We classiffied 2291 (99.7 %)patients as low risk and 13 as high. The PE used by the endoscopist was considered appropriate in 42.2 %, excessive in 41 % and insufficient in 16.7 % according to the protection protocol. This was influenced by the endoscopist (p < 0,01) and thetype of endoscopy: in 43.1 % of the colonoscopies the PE was excessive (p < 0,001). None of the endoscopists were infectedby C19 during the research period. We contacted 1744 patients (75.9 %) with no suspicion of C19 in any. Conclusions A protocol based on two protection levels according to the risk of patients to be infected and the type ofendoscopic procedure, seems to be useful to avoid C19 infections in the endoscopy unit.

Community Risk Factors in the COVID-19 Incidence and Mortality in Catalonia (Spain). A Population-Based Study

The heterogenous distribution of both COVID-19 incidence and mortality in Catalonia (Spain) during the firsts moths of the pandemic suggests that differences in baseline risk factors across regions might play a relevant role in modulating the outcome of the pandemic. This paper investigates the associations between both COVID-19 incidence and mortality and air pollutant concentration levels, and screens the potential effect of the type of agri-food industry and the overall land use and cover (LULC) at area level. We used a main model with demographic, socioeconomic and comorbidity covariates highlighted in previous research as important predictors. This allowed us to take a glimpse of the independent effect of the explanatory variables when controlled for the main model covariates. Our findings are aligned with previous research showing that the baseline features of the regions in terms of general health status, pollutant concentration levels (here NO₂ and PM₁₀), type of agri-food industry, and type of land use and land cover have modulated the impact of COVID-19 at a regional scale. This study is among the first to explore the associations between COVID-19 and the type of agri-food industry and LULC data using a population-based approach. The results of this paper might serve as the basis to develop new research hypotheses using a more comprehensive approach, highlighting the inequalities of regions in terms of risk factors and their response to COVID-19, as well as fostering public policies towards more resilient and safer environments.