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American Journal of Respiratory and Critical Care Medicine ; 203(9):1, 2021.
Article in English | Web of Science | ID: covidwho-1407117
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277604


RATIONALE: Coronavirus Disease 2019 (COVID-19) that has caused an ongoing pandemic, is diagnosed by realtime reverse transcriptase polymerase chain reaction (RT-PCR). Computed tomography (CT) scans have shown typical changes of the disease but there is limited data comparing CT scan findings with COVID-19 clinical severity and illness duration. The study aims to determine the common chest CT findings of COVID-19 pneumonia in association with clinical severity and duration of symptoms.METHODS: This is a single-center, retrospective study including all adult patients with COVID-19 pneumonia, admitted from March 2020 to August 2020, with baseline RT-PCR and chest CT scan. Demographic data and CT scan findings were tabulated and analyzed using STATA 13.1.RESULTS: In this study of 304 patients, majority were above 60 years old (49%), male(62%), non-smokers (72.6%) with associated hypertension(56%) and diabetes mellitus(34%). Most common symptoms were cough (82%), dyspnea (76%) and fever (69%). Predominant chest CT patterns of COVID-19 pneumonia were ground glass opacity (GGO) (65%) and consolidation (39%) in bilateral, peripheral, and lower lobe distribution. Moderate group had higher GGO (72%, p0.047), unilateral (10%,p0.001) and peripheral distribution (68%,p0.001). Severe to critical groups had higher consolidation, number of lobes (>4 lobes), and diffuse involvement. Subjects with less than 14 days of symptoms, had more GGO. Those with more than 4 days of symptoms, had CT findings that were bilateral, more than 4 lobes, and extending to middle and upper lobes.CONCLUSION: Chest CT patterns typical of COVID-19 pneumonia and their extent of involvement were associated with clinical severity and illness duration. A simple Chest CT scan would help support physicians' decision making and prognostication.

Critical Care Medicine ; 49(1 SUPPL 1):590, 2021.
Article in English | EMBASE | ID: covidwho-1194048


INTRODUCTION: Children in low-middle income countries are disproportionately affected by shock, resulting in high mortality. Simulation has been successfully used as an educational tool in some low-resource settings. The objective of this study was to develop and evaluate educational efficacy of a simulation-based pediatric shock curriculum for pediatric residents in Manila, Philippines. We hypothesized that there would be decreased time to administration of first fluid bolus on a simulated mannequin after participation in the curriculum. METHODS: Prospective pre/post cohort study assessing a skills-based shock curriculum consisting of a multiple choice pre/post-test and a videotaped simulation-based pre/posttest. Implemented at Philippine Children's Medical Center in March 2020. Performance in simulation shock scenario was assessed by standardized checklist. Outcome measures were compared pre- and post intervention. Interrater and intrarater reliability on checklist assessed. RESULTS: Due to the COVID-19 pandemic, resident enrollment in the study was stopped prematurely. A total of 24 residents were enrolled. 96% of participants were female. Individuals reported a mean of 4/5 confidence in English in the medical setting (SD .66 CI 95% 3.7-4.3). Confidence in identifying shock (3.8 -> 4.3 p <0.01), identifying malnutrition (3.2 -> 4.1 p <0.01), managing hypovolemic shock (3.6 -> 4.3 p <0.01), managing septic shock (3.3 -> 4.1 p <0.01) and placing an IO (2.8 -> 4.0 p <0.01) all increased. Mean written test score showed no significant improvement (9.4/10 to 9.8/10, p = 0.15) but this may have been related to high pre-intervention performance on knowledge based test. The time to initiation of fluids did not change (83 s -> 75 s p = 0.42), although all residents initiated fluids within five minutes both pre and post-intervention. The total score on the checklist improved (9.8 -> 14.7, p <0.01). CONCLUSIONS: There was no difference in time to initiation of fluids pre/post intervention. There was improvement in confidence with shock concepts. Overall score on the checklist improved, which may be the most accurate marker of knowledge acquisition in this scenario. Through international collaboration it is possible to establish a successful simulation-based education program for trainee.