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1.
Disaster Medicine & Public Health Preparedness ; : 1-8, 2022.
Article in English | MEDLINE | ID: covidwho-1829866

ABSTRACT

OBJECTIVE: The surge in critically ill patients has pressured hospitals to expand their intensive care unit capacities and critical care staff. This was difficult given the country's shortage of intensivists. This paper describes the implementation of a multidisciplinary central line placement team and its impact in reducing the vascular access workload of ICU physicians during the height of the COVID-19 pandemic. METHODS: Vascular surgeons, interventionalists, and anesthesiologists were redeployed to the ICU Access team to place central and arterial lines. Nurses with expertise in vascular access were recruited to the team to streamline consultation and assist with line placement. RESULTS: While 51 central and arterial lines were placed per 100 ICU patients in 2019, there were 87 central and arterial lines placed per 100 COVID-19 ICU patients in the sole month of April 2020. The ICU Access Team placed 107 of the 226 vascular access devices in April 2020, reducing the procedure-related workload of ICU treating teams by 46%. CONCLUSIONS: The ICU Access Team was able to complete a large proportion of vascular access insertions without reported complications. Given another mass casualty event, this ICU Access Team could be reassembled to rapidly meet the increased vascular access needs of patients.

2.
Medisur-Rev. Cienc. Med. Cienfuegos ; 20(1):10-17, 2022.
Article in Spanish | Web of Science | ID: covidwho-1790632

ABSTRACT

After having suffered an acute infectious disease, a group of people suffer from very varied clinical manifestations, which can be transitory or permanent. Such is the case of COVID-19, in which a multitude of general symptoms and organs and systems have been reported, in a not inconsiderable number of people who have previously been infected with the SARS-CoV-2 virus. The World Health Organization issued on October 6, 2021 an official clinical definition of post-COVID-19 disease, agreed after a global consultation and published with the purpose of facilitating the treatment of the sick. Regarding this definition, comments are made about its implications for patients, health services and society in general.

3.
Journal of Medical Devices-Transactions of the Asme ; 16(1):5, 2022.
Article in English | Web of Science | ID: covidwho-1779291

ABSTRACT

The coronavirus disease of 2019 (COVID-19) has altered medical practice around the globe and revealed critical deficiencies in hospital supply chains ranging from adequate personal protective equipment to life-sustaining ventilators for critically ill hospitalized patients. We developed the CRISIS ventilator, a gas-powered resuscitator that functions without electricity, and which can be manufactured using hobby-level three-dimensional (3D) printers and standard off-the-shelf equipment available at the local hardware store. CRISIS ventilators were printed and used to ventilate sedated female Yorkshire pigs over 24-h. Pulmonary and hemodynamic values were recorded throughout the 24-h run, and serial arterial blood samples were obtained to assess ventilation and oxygenation. Lung tissue was obtained from each pig to evaluate for signs of inflammatory stress. All five female Yorkshire pigs survived the 24-h study period without suffering from hypoxemia, hypercarbia, or severe hypotension requiring intervention. One animal required rescue at the beginning of the experiment with a traditional ventilator due to leakage around a defective tracheostomy balloon. The wet/dry ratio was 6.74 +/- 0.19 compared to historical controls of 7.1 +/- 4.2 (not significantly different). This proof-of-concept study demonstrates that our 3D-printed CRISIS ventilator can ventilate and oxygenate a porcine model over the course of 24-h with stable pulmonary and hemodynamic function with similar levels of ventilation-related inflammation when compared with a previous control porcine model. Our work suggests that virtual stockpiling with just-in-time 3D-printed equipment, like the CRISIS ventilator, can temporize shortages of critical infrastructure needed to sustain life for hospitalized patients.

4.
MEDLINE;
Preprint in English | MEDLINE | ID: ppcovidwho-328525

ABSTRACT

The underlying immunologic deficiencies enabling SARS-CoV-2 reinfections are currently unknown. Here we describe a renal-transplant recipient who developed recurrent, symptomatic SARS-CoV-2 infection 7 months after primary infection. To elucidate the immunological mechanisms responsible for reinfection, we performed longitudinal profiling of cellular and humoral responses during both primary and recurrent SARS-CoV-2 infection. We found that the patient responded to the primary infection with transient, poor-quality adaptive immune responses that was further compromised by intervening treatment for acute rejection of the renal allograft prior to reinfection. Importantly, we identified the development of neutralizing antibodies and humoral memory responses prior to SARS-CoV-2 reinfection. However, these neutralizing antibodies failed to confer protection against reinfection, suggesting that additional factors are required for efficient prevention of SARS-CoV-2 reinfection. Further, we found no evidence supporting viral evasion of primary adaptive immune responses, suggesting that susceptibility to reinfection may be determined by host factors rather than pathogen adaptation.

5.
MEDLINE;
Preprint in English | MEDLINE | ID: ppcovidwho-326635

ABSTRACT

Prior to the emergence of antigenically distinct SARS-CoV-2 variants, reinfections were reported infrequently - presumably due to the generation of durable and protective immune responses. However, case reports also suggested that rare, repeated infections may occur as soon as 48 days following initial disease onset. The underlying immunologic deficiencies enabling SARS-CoV-2 reinfections are currently unknown. Here we describe a renal transplant recipient who developed recurrent, symptomatic SARS-CoV-2 infection - confirmed by whole virus genome sequencing - 7 months after primary infection. To elucidate the immunological mechanisms responsible for SARS-CoV-2 reinfection, we performed longitudinal profiling of cellular and humoral responses during both primary and recurrent SARS-CoV-2 infection. We found that the patient responded to the primary infection with transient, poor-quality adaptive immune responses. The patient's immune system was further compromised by intervening treatment for acute rejection of the renal allograft prior to reinfection. Importantly, we also identified the development of neutralizing antibodies and the formation of humoral memory responses prior to SARS-CoV-2 reinfection. However, these neutralizing antibodies failed to confer protection against reinfection, suggesting that additional factors are required for efficient prevention of SARS-CoV-2 reinfection. Further, we found no evidence supporting viral evasion of primary adaptive immune responses, suggesting that susceptibility to reinfection may be determined by host factors rather than pathogen adaptation in this patient. In summary, our study suggests that a low neutralizing antibody presence alone is not sufficient to confer resistance against reinfection. Thus, patients with solid organ transplantation, or patients who are otherwise immunosuppressed, who recover from infection with SARS-CoV-2 may not develop sufficient protective immunity and are at risk of reinfection.

6.
MEDLINE;
Preprint in English | MEDLINE | ID: ppcovidwho-326567

ABSTRACT

Since its emergence and detection in Wuhan, China in late 2019, the novel coronavirus SARS-CoV-2 has spread to nearly every country around the world, resulting in hundreds of thousands of infections to date. The virus was first detected in the Pacific Northwest region of the United States in January, 2020, with subsequent COVID-19 outbreaks detected in all 50 states by early March. To uncover the sources of SARS-CoV-2 introductions and patterns of spread within the U.S., we sequenced nine viral genomes from early reported COVID-19 patients in Connecticut. Our phylogenetic analysis places the majority of these genomes with viruses sequenced from Washington state. By coupling our genomic data with domestic and international travel patterns, we show that early SARS-CoV-2 transmission in Connecticut was likely driven by domestic introductions. Moreover, the risk of domestic importation to Connecticut exceeded that of international importation by mid-March regardless of our estimated impacts of federal travel restrictions. This study provides evidence for widespread, sustained transmission of SARS-CoV-2 within the U.S. and highlights the critical need for local surveillance.

7.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-296567

ABSTRACT

The COVID-19 pandemic has revealed the importance of virus genome sequencing to guide public health interventions to control virus transmission and understand SARS-CoV-2 evolution. As of July 20th, 2021, >2 million SARS-CoV-2 genomes have been submitted to GISAID, 94% from high income and 6% from low and middle income countries. Here, we analyse the spatial and temporal heterogeneity in SARS-CoV-2 global genomic surveillance efforts. We report a comprehensive analysis of virus lineage diversity and genomic surveillance strategies adopted globally, and investigate their impact on the detection of known SARS-CoV-2 virus lineages and variants of concern. Our study provides a perspective on the global disparities surrounding SARS-CoV-2 genomic surveillance, their causes and consequences, and possible solutions to maximize the impact of pathogen genome sequencing for efforts on public health.

8.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):207, 2021.
Article in English | EMBASE | ID: covidwho-1570352

ABSTRACT

Background: According to current evidence, the lungs are the most affected organ in SARS-CoV-2 infection. Recent data shows impairment of carbon monoxide diffusing capacity, decreased total lung capacity, and restrictive ventilatory defect in COVID-19 adult patients. Data in children are lacking. Our goal was to characterize clinically and demographically the pediatric population with asthma that tested positive for SARS-CoV-2 in our hospital during 2020 and evaluate the pulmonary function after the infection. Method: Cross-sectional study performed in Hospital Dona Estefânia, from March 2nd to December 31st, 2020. All pediatric asthmatic patients (<18 years) who tested positive for SARS-CoV-2 (RT-PCR test) were included. Asthma diagnosis was based on a previous physician's diagnosis or parent-reported history. A convenience sample of the asthmatic patients performed spirometry and carbon monoxide diffusing capacity (DLCO). Results: We were able to identify 20 asthmatic patients [50% male;median age: 10.5 years old (P25- 75: 9- 14.5)]. Atopic comorbidities were present in 75% ( n = 15) (rhinitis the most frequent). According to GINA, 11 (55%) had mild and 9 (45%) moderate asthma. Five patients (25%) needed hospital admission because of COVID-19 infection, 3 had asthma exacerbation, and 3 had COVID-19 pneumonia. Nine of the 20 patients performed spirometry and DLCO after COVID-19 infection. Respiratory function was performed few months after the infection [median=3 months (P25- 75: 2- 6.5)]. In our sample, we found 2 patients with obstructive ventilation impairment and small airway dysfunction. We didn't find any statistically significant difference between de FVC, FEV1, FEV1/FVC ratio, FEF25- 75, and peak expiratory flow (PEF) before and after COVID-19 infection. There were 2 asthmatics with impaired DLCO (65.1% and 64.7%). Conclusion: Two patients showed obstructive ventilation, but it could be due to the variable airflow limitation of asthma, and 2 had DLCO impairment. We didn't find any statistically significant difference between respiratory function before and after COVID-19 infection. However, this is a small sample, and further evaluations with larger populations are needed.

10.
Revista Da Associacao Medica Brasileira ; 67(9):1268-1273, 2021.
Article in English | MEDLINE | ID: covidwho-1533477

ABSTRACT

OBJECTIVE: Psychological effects of the coronavirus disease 2019 (COVID-19) pandemic on pregnant women with diabetes and hypertension are not yet studied. Besides the pregnancy, these women have additional risk factors for severe acute respiratory syndrome due to COVID-19 and are considered a particularly vulnerable, unique population. We aimed to assess their mental health during this pandemic. METHODS: This is a cross-sectional study carried out at a Brazilian tertiary hospital. Women with pregnancies complicated by hypertension and/or diabetes were evaluated. The primary outcome was anxiety, and depressive symptoms evaluated with the State-Trait Anxiety Inventory and Patient Health Questionnaire. Perception of changing habits during quarantine was evaluated as a secondary outcome. RESULTS: Seventy-nine patients were included. The prevalence of State-Trait Anxiety Inventory >=40 was 79.7% and that of Patient Health Questionnaire >=10 was 59.2%. Lower social support was correlated with higher scores on both scales. Time spent with electronic devices was perceived as greater by 62% of the women. CONCLUSIONS: Pregnant women with diabetes and hypertension presented high levels of anxiety and depressive symptoms during the COVID-19 pandemic. Considering that these symptoms can affect both the mother's and offspring's health, it is necessary to implement tools to improve their mental health.

11.
Medisur-Revista De Ciencias Medicas De Cienfuegos ; 19(5):807-813, 2021.
Article in Spanish | Web of Science | ID: covidwho-1515868

ABSTRACT

Background: The COVID-19 pandemic is the defining health crisis of our time that has put health systems to the test around the world. Objective: to describe the clinical epidemiological characteristics of patients in isolation, during the first four months of 2021. Methods: observational, descriptive, cross-sectional study. The study universe consisted of 2 631 patients who were contacts and suspected of the disease admitted to two isolation centers at the University of Medical Sciences of Cienfuegos, from January to April 2021. The variables were analyzed: age, sex, occupation, municipality of residence, epidemiological antecedents, comorbidities and confirmation by the real-time polymerase chain test. An epidemiological survey and individual medical history were prepared during isolation. Results: 78.3% of the patients in isolation were contacts of confirmed cases, the patients of working age represented the highest percentage, with a predominance of the female sex. The municipality of Cienfuegos contributed the largest number of patients. 59.2% of these had at least one comorbidity, more than 50% were hypertensive. 8% of the suspects were positive for COVID-19. Conclusions: the isolation of contact and suspects as a measure to contain the pandemic represents an impact strategy. Knowing the characteristics of isolated patients serves as a baseline for the development of new health measures.

12.
Estudos Ibero-Americanos ; 47(2):20, 2021.
Article in Portuguese | Web of Science | ID: covidwho-1408915

ABSTRACT

This article explores the collection of the History in Quarantine Project. Practiced during the Covid-19 pandemic as part of the Public History repertoire, the experience disseminated online left a legacy of approximately 150 hours of recorded material made available on Facebook and Youtube. The content produced shows the potential of the project for historical research, in addition to the dialogue with socially alive issues. Based on this logic, we selected as analysis material the videos about the "Myths of the Dictatorship" in Brazil. The approach consisted of systematizing 20 "myths" discussed. In addition, we suggest a research agenda on the dictatorship raised by the discussions. The History in Quarantine Project is a laboratory for reflection on the possibilities and dilemmas of scientific dissemination and its connection with Public History.

13.
Finlay ; 11(3):4, 2021.
Article in Spanish | Web of Science | ID: covidwho-1357813
14.
Proceedings of the 2021 Design of Medical Devices Conference ; 2021.
Article in English | Web of Science | ID: covidwho-1323578

ABSTRACT

During the Coronavirus-19, or COVID-19, pandemic there was an early shortage of available ventilators. Domestic production was limited by dependence on overseas sources of raw materials despite partnering with automotive manufacturers. Our group has developed a 3D printed alternative called the CRISIS ventilator. Its design is similar to existing resuscitator devices on the market and uses a modified Pressure-Control ventilation. Here we compare the performance of the device on a simulated ARDS lung and handling of different clinical scenarios included tension pneumothorax and bronchospasm.

15.
Medisur-Revista De Ciencias Medicas De Cienfuegos ; 19(3):363-376, 2021.
Article in Spanish | Web of Science | ID: covidwho-1303010

ABSTRACT

Convalescence is the last stage of the "natural history of a disease" - if death does not occur - and it is often not given full attention, so it is not idle to review some of its basic concepts. One year after the onset of the unprecedented SARS-CoV-2 pandemic, the gaze has turned to this evolutionary stage of the patients and to the identification and monitoring of clinical manifestations and possible effect. With the purpose of deepening the importance of this stage in COVID-19 patients and specifying its main characteristics, this work was carried out to contribute to its better understanding with updated information and favor the results in its management. The concepts of clinical discharge and epidemiological discharge and the need to assess the previous diagnosis are addressed. It insists on the factors that can influence convalescence: the characteristics of each person (biological, psychological, social, cultural and spiritual);the "state of seriousness" that the patient had in the acute phase of the disease and whether there was a need for admission to intensive care;adverse effects of medications and other procedures carried out during care and comorbidities.

16.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-8853

ABSTRACT

The underlying immunologic deficiencies enabling SARS-CoV-2 reinfections are currently unknown. Here we describe a renal-transplant recipient who developed recurrent, symptomatic SARS-CoV-2 infection 7 months after primary infection. To elucidate the immunological mechanisms responsible for reinfection, we performed longitudinal profiling of cellular and humoral responses during both primary and recurrent SARS-CoV-2 infection. We found that the patient responded to the primary infection with transient, poor-quality adaptive immune responses that was further compromised by intervening treatment for acute rejection of the renal allograft prior to reinfection. Importantly, we identified the development of neutralizing antibodies and humoral memory responses prior to SARS-CoV-2 reinfection. However, these neutralizing antibodies failed to confer protection against reinfection, suggesting that additional factors are required for efficient prevention of SARS-CoV-2 reinfection. Further, we found no evidence supporting viral evasion of primary adaptive immune responses, suggesting that susceptibility to reinfection may be determined by host factors rather than pathogen adaptation.

17.
Investigacoes em Ensino de Ciencias ; 26(1):127-144, 2021.
Article in Portuguese | Scopus | ID: covidwho-1234977

ABSTRACT

In view of the current coronavirus pandemic scenario (Covid-19), researchers from the most varied segments of the sciences have been mobilized to understand the problem, outline strategies to combat and suppress contagion, as well as mitigate the consequences that, according to national and international experience, have dramatically affected the life of society. As teachers, future teachers and researchers in the field of science education, we feel mobilized to address the issue from the point of view of Socio-Scientific Issues (SSI). Thus, this article seeks to delineate the problem from the perspective of the SSI, defining the controversial aspects, and to indicate possibilities for its treatment in the school context, showing formative and methodological perspectives, understanding this as a political and ethical commitment. In times of crisis, it is essential to mobilize our knowledge in order to understand, analyze, criticize and overcome it. © 2021 Universidade Federal do Rio Grande do Sul, Instituto de Fisica. All rights reserved.

19.
European Journal of Hospital Pharmacy. Science and Practice ; 28(Suppl 1):A109, 2021.
Article in English | ProQuest Central | ID: covidwho-1136094

ABSTRACT

Background and importanceIn the context of the COVID-19 pandemic, many patients avoided moving from their homes, even to acquire essential drugs, such as antiretroviral therapy (ART). High adherence (more than 95%) is essential to acquire viral suppression and is associated with reduced mortality and morbidity. Furthermore, poor ART adherence is the first cause of therapeutic failure in HIV patients and HIV drug resistant strains.Aim and objectivesTo evaluate and characterise the effect of the COVID-19 pandemic on adherence to ART and identify the main factors that influenced adherence during the pandemic.Material and methodsA retrospective, transversal, comparative study was conducted over the first semester of 2019 and 2020. HIV patients receiving ART were included. Exclusion criteria were: deaths, initiated ART during or after the first semester in 2019 and transfer to another hospital. To measure adherence, dispensing records were analysed. Registered variables were sex, risk factors that could compromise adherence and pill numbers. Data were obtained from the electronic medical records. For the statistical analysis, the paired t test was used to determine if there were differences in patient adherence before and after the COVID-19 pandemic.Results100 patients were analysed during the study period, with an average age of 48.9±12.3 years and 61% were men. ART adherence was 67% in 2019 (67% male non-adherent) whereas in 2020 it was 43% (58% male non-adherent). Comparing both years, there was a decrease of 24% in the adherence rate, which was significant (p=0.006). The main reasons for this reduction were: rescheduling of doctor appointments or blood tests, mandatory confinement due to COVID-19 or fear of using the hospital facilities.Conclusion and relevanceThe study results suggested that the COVID-19 pandemic affected HIV patient adherence. All efforts made to ensure continuity of treatment (medication delivery in the community and hospital pharmacies, teleconsultation) were not enough. It is important that pharmacists continue to promote therapeutic adherence and education about COVID-19. The main limitation of the study was the reduced sample used. It is highly important to monitor patients with ART to ensure their adherence rate and to understand how and why the COVID-19 pandemic affected their treatment. Further research is needed to know the real impact of the COVID-19 pandemic on the health of HIV patients.References and/or acknowledgementsConflict of interestNo conflict of interest

20.
Medisur-Revista De Ciencias Medicas De Cienfuegos ; 18(5):1052-1056, 2020.
Article in Spanish | Web of Science | ID: covidwho-1037669

ABSTRACT

Background: The search for cases as a continuous process constitutes a fundamental premise of active screening. This is a fundamental pillar for containing contagion in times of pandemic, which is why it is of interest to analyze its development and impact on communities. Objective: to describe the experiences of the active screening of acute respiratory infections in the context of the COVID-19 pandemic. Methods: a descriptive study was carried out, which included the population corresponding to the Community Polyclinic Teaching Area 1 Jose Luis Chaviano (22 038 inhabitants), Cienfuegos province, during March and April 2020 (45 days). Results: a total of 19,103 people were surveyed, for 86.2% of the existing population in the area. 151 had respiratory symptoms (0.7%). According to the epidemiology associated with these infections, 33 people (21.8%) were detected. It was possible to confirm 100% of the cases detected in the active investigation, together with the controls of the basic health team of the Family Medical Office. Conclusion: active screening contributes favorably to early intervention against COVID-19.

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