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2.
Sn Computer Science ; 4(1):14, 2023.
Article in English | MEDLINE | ID: covidwho-2175612

ABSTRACT

Scientific advances, especially in the healthcare domain, can be accelerated by making data available for analysis. However, in traditional data analysis systems, data need to be moved to a central processing unit that performs analyses, which may be undesirable, e.g. due to privacy regulations in case these data contain personal information. This paper discusses the Personal Health Train (PHT) approach in which data processing is brought to the (personal health) data rather than the other way around, allowing (private) data accessed to be controlled, and to observe ethical and legal concerns. This paper introduces the PHT architecture and discusses the data staging solution that allows processing to be delegated to components spawned in a private cloud environment in case the (health) organisation hosting the data has limited resources to execute the required processing. This paper shows the feasibility and suitability of the solution with a relatively simple, yet representative, case study of data analysis of Covid-19 infections, which is performed by components that are created on demand and run in the Amazon Web Services platform. This paper also shows that the performance of our solution is acceptable, and that our solution is scalable. This paper demonstrates that the PHT approach enables data analysis with controlled access, preserving privacy and complying with regulations such as GDPR, while the solution is deployed in a private cloud environment.

3.
Transplant Proc ; 2022 Oct 24.
Article in English | MEDLINE | ID: covidwho-2184112

ABSTRACT

BACKGROUND: The efficacy of the response to SARS-CoV-2 vaccination in kidney transplant recipients is low. The aim of our study was to evaluate the risk factors correlated with the low antibody response and whether there was an improvement between the second and the third dose. METHODS: A prospective study was conducted on 176 kidney transplant recipients who received the second and the third dose of the anti-SARS-CoV-2 mRNA Comirnaty vaccine. We evaluated the seroconversion process after administration of the second and the third dose and assessed a possible correlation with age, time between transplant and vaccination, and type of immunosuppressive therapy. RESULTS: A total of 98 of the 176 patients (55.7%) responded positively after the inoculation of the second dose and according to the multivariable logistic regression analysis the lack of seroconversion was independently associated with patient age ≥60 (P = .025; odds ratio [OR], 2.094), time since transplant of 1 to 3 months (P = .032; OR, 2.118), and triple therapy (P = .044; OR, 2.327). After the vaccine third dose, the seroconversion increased to 62.5%, and it was negatively influenced by calcineurin inhibitor use (12/21, 57.1% vs 71/78, 91.0%, P = .0006) and triple therapy (13/21, 61.9% vs 72/78, 92.3%, P = .0014). The median of antispike antibody response significantly increased from 18.5 IU/mL after the second dose to 316.9 IU after the third dose (P < .0001). CONCLUSIONS: We demonstrated a correlation between older age and shorter distance from the transplant and triple immunosuppressive therapy with the lack of seroconversion. We noticed a significant improvement in antibody response by a third dose of messenger RNA vaccine.

4.
Journal of Vascular Access ; 23(1 Supplement):21-22, 2022.
Article in English | EMBASE | ID: covidwho-2115308

ABSTRACT

The study of COVID-19 patient's management with vascular access has been very low but a consensus has been reached to improve care in this type of patient. The importance of care, the proper choice of the vascular access device (DAV), the reduction of adverse effects and the minimization of contagion risks by health personnel are a new axis of study. AIM Highlight the work of the Vascular Access Unit from Arnau de Vilanova Hospital with Covid 19 patients who didn't require admission to the Intensive care Unit. Methodology: Observational, descriptive and retrospective study by auditing the digitized medical records of 52 patients with medical discharged from the Arnau de Vilanova hospital from March 2019 to December 2021. Result(s): The 90% of DAVs were removal at the end of the therapy. In the 100% of the cases the first change dressing was 7 days later the insertion due to the use of cyanoacrylate use at the exit site. The average use was 16 days. 5 devices were remove for malfunction, 12 for exitus and 35 were removed for end of treatment. The average number of days from the time the patient is admitted until the day insertion is requested is 5 days. Conclusion(s): The existence of a UAV has meant an increase in patient safety and has allowed to be carried out the therapy for COVID 19 patients who were not included in the ICU The UAV has been able to insert the DAVs at bedside, improving the safety profile of the personnel. The use of new materials such as cyanoacrylate has reduced the workload and the risk of occupational exposure, while also reducing costs.

5.
Journal of Vascular Access ; 23(1 Supplement):20-21, 2022.
Article in English | EMBASE | ID: covidwho-2114410

ABSTRACT

Introduction: Antineoplasic chemotherapy in intravenous infusion is one of the most common therapeutic modalities in cancer patients. The vast majority of antineoplasic drugs have an Osmolarity >900 mOsm/l, so its administration must be done through central venous routes. However, the channelling of central routes is limited to patients with difficulty in peripheral venous approach or long-term treatments. Objective(s): Describe the vascular accesses used at the University Hospital of La Ribera for the administration of antineoplastic drugs, assess the adequacy of the same and determine if the type of vascular access used varied during the COVID-19 pandemic. Methodology: A quantitative, observational and analytical cross-sectional study of the vascular accesses used in the administration of antineoplasic therapy in cancer day hospital was carried out. Data collection was carried out through direct observation and consultation of the medical history. The pre-pandemic period was executed from 20 to 21/1/2020(n=125), the pandemic sample from 8 to 12/2/21(n=121). Result(s): Although 70% of the drugs administered had the capacity for tissue aggression, the peripheral venous route was established in 69.9% of cases, the forearm being the most frequent anatomical location (n=102) and the peripheral venous catheter the most commonly used device (n=172). The expected duration of treatment was medium-term in 74.8% of patients. The use of central venous routes during the pandemic increased by 30.7%,(p=0.017), being the subcutaneous venous reservoir the one with the highest representation(RVSC 75.5 %, IPCC 24.5 %). Conclusion(s): Short peripheral venous catheter was the most used device in the administration of chemotherapy in oncology HDD of the UHLR, even administering drugs with high tissue aggression and establishing a medium duration of treatment, being this an area of improvement in the care of cancer patients. During the pandemic, the use of central routes increased in the administration of antineoplasic treatment on an outpatient basis.

6.
Journal of Vascular Access ; 23(1 Supplement):31-32, 2022.
Article in English | EMBASE | ID: covidwho-2114397

ABSTRACT

Introduction: INCATIV is a research program carried out by nurses on 34 hospitals of the Region of Valencia (Spain). This program measures vascular access quality on patients of these hospitals via cross-sections. The objective of the study is to evaluate the influence of COVID-19 pandemic in the registers of the vascular accesses' quality program. Method(s): Quantitative observational, analytical, and retrospective study of two cross-sections. First cross-section was developed before pandemic (C10: 02-2020) and second cross-section during pandemic (C11: 05-2020). Data was obtained from INCATIV's platform. Result(s): Among 34 participant hospitals in INCATIV Program, there was a 100% of participation at C10, collecting 7647 registers of all hospital units included at the program. 4820 vascular accesses were evaluated. Only a 1.22% of them presented signs of phlebitis. 92% of the vascular accesses had the right dressing. At C11, there was a 50% of participation. 3234 registers were collected. Phlebitis rate remains at 1.15%. The use of correct dressing reached at 92% too. Discussion and conclusion: Data indicate a strong decrease in the number of participating hospitals as on the number of registers of this quality program focused on intravenous therapy, confirming the existence of changes in the trend of the registers, in the absence or presence of pandemic moments. On the other hand, it is observed that there are no statistically significant differences related to the quality of the vascular accesses, showing that two main indicators measured, included at INCATIV bundle, such as type of dressing and signs of phlebitis, remain constant despite being measured at two different pandemic moments. Further studies are necessary about how vascular accesses nursing care has changed only in COVID-19 patients.

8.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2005688

ABSTRACT

Background: Coranavirus disease 2019 (COVID-19) has affected more than 220 millon people worldwide. The establishment of safe and effective vaccine coverage is crucial in these patients. We aim to investigate the safety, adverse effects and immune response (cellular and humoral) in cancer patients under active treatment and risk criteria. Methods: 56 samples from cancer patients under active treatment for cancer were collected before and after vaccination Demographic, clinical and biochemical data were collected and a post-vaccination symptomatology questionnaire was performed. For the determination of anti-SARS-Cov-2 antibodies (Immunoglobulin G and immunoglobulin M) we used the ELISA technique (LIASON SARS-CoV-2 S1/S2 IgG test and LIASON SARS-CoV-2 IgM test, DiaSorin, Saluggia, Italy). A study of the lymphocyte population was performed by flow cytometry. Results: We enrolled 52 patients with cancer who received mRNA vaccines (mRNA-1273 and BNT162b2), 2 patients with AZD1222vaccine and 2 with Ad26.COV2.S vaccine. All patients were SARS-COV-2 naive as determined by a negative anti-SARS-COVID-2 IgG test baseline. The median follow-up time was 50 days after receip of a second vaccine dosis. All subject received anti- cancer therapy. The most common anti-cancer treatment received by this cohort of patients was cytotoxic chemoterapy (44.6%), immunotherapy (25%), and monoclonal antibody therapy (14.3%). Overall, a high rate of seroconvertion(anti-IgG) (94,5%) was observed in our cohort, 1 patients with chemotherapy (1,8%) and 2 patients with immunotherapy (3,6%) were negatives. No significant differences in antibody titer were observed according to therapy. Thirty percent presented an antibody titer lower than 1000 U/ml, 27 (48%) patients developed an anti-SARS-CoV2 titer between 1000-4000 U/ml, and only 9 (16%) subjects presented a titer higher than 4000 U/ml. Studies of the lymphocyte profile of vaccinated patients showed no significant changes in the subtypes, except for peripheral memory CD3+ CD8+ lymphocytes which were significantly increased (p = 0.0001) after the second dose of anti-SARS-CoV-2 vaccine. Interestingly, cell apoptosis was significantly reduced in almost all T lymphocyte subtypes studied in vaccinated patients. Finally, analysis of blood cells showed a statistically significant increase (p = 0.0402) of eosinophils in vaccinated patients compared to baseline data. Conclusions: A personalized approach to vaccination can be proposed to cancer patients, especially depending on the type of tumor and the specific oncological treatments received. We are currently recruiting patients (n = 150) who have received the third dose of vaccine and plan to follow up at 6 months for humoral and cellular immune response. Final results will be reported at the ASCO meeting.

9.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925439

ABSTRACT

Objective: To evaluate clinical, laboratory, and epidemiological features of acute neuroinflammatory disorders (ANIDs) that followed the 2016 Zika epidemic in Colombia. Background: The outbreak of Zika virus infection in Colombia in 2015-2016, produced an increased incidence of Guillain-Barré Syndrome (GBS) and other ANID cases. The Neuroviruses Emerging in the Americas Study (NEAS) network was established in 2016 as a multicenter-based observatory of ANIDs to investigate the role of emerging pathogens in neuroinflammatory diseases. Design/Methods: NEAS serves as a multi-center study based on 13 hospitals in 7 cities in Colombia which study all newly diagnosed patients who fulfill established criteria for GBS, encephalitis, myelitis, meningoencephalitis, or cranial nerve disorders as part of an observational cohort. We analyzed the clinical and epidemiological features of all cases evaluated between January 2016 and September 2021. Results: An observational cohort of 825 patients with ANIDs were recruited during the study period. 58.8% of cases were male with a median age of 43 (IQR 25-58) years. The most frequent ANIDs were GBS (46.1%) and facial nerve palsy (28.7%). The diagnosis of encephalitis (9.5%), myelitis (6.5%), and optic neuritis (5.9%) were less frequent. Patients with GBS were predominantly male (70.6%) and had a median age of 49 (IQR 32-60) years. Interestingly, there was an increase incidence of GBS in 2019. Conclusions: The outbreak of Zika in Colombia produced a marked increase in the incidence of GBS in 2016. Although cases of GBS and other ANIDs continued to emerge after the incidence of Zika infection decreased in July 2016, the recent SARS-CoV-2 pandemic has not produced any significant increase in the incidence of GBS in Colombia.

10.
Bipolar Disorders ; 24:23-23, 2022.
Article in English | Web of Science | ID: covidwho-1925123
11.
Topics in Antiviral Medicine ; 30(1 SUPPL):266-267, 2022.
Article in English | EMBASE | ID: covidwho-1880059

ABSTRACT

Background: There are limited data on how COVID-19 disease severity and vaccination throughout different trimesters in pregnancy impact maternal neutralizing antibody responses and transplacental transfer to the neonate at birth. Further characterization of the antibody response of in utero SARS-CoV-2 may inform vaccination schedules in pregnancy in order to optimize maternal and neonatal protection. Methods: The COVID-19 Outcomes in Mother-Infant Pairs (COMP) study is a longitudinal cohort of mother-infant dyads diagnosed with PCR-confirmed SARS-CoV-2 at any point during pregnancy. Maternal and cord sera from delivery, as well as infant sera collected at 24 hours of life, were analyzed by enzyme-linked immunosorbent assay (ELISA) for IgA, IgG, and IgM targeting receptor binding domain (RBD) of the SARS-CoV-2 spike protein. Neutralizing antibody (NAb) activity against the original L strain was evaluated in a subset of unvaccinated mother-infant dyads with evidence of IgG transfer or history of severe/critical COVID-19 in pregnancy. Results: Among 115 pregnant women, the NIH COVID-19 severity of illness categories were: 12% asymptomatic, 70% mild/moderate, 11% severe/critical disease, and 7% vaccinated prior to delivery following recovery. Fifty percent of the cohort was diagnosed in the 3rd trimester, and the median diagnosis date to delivery was 61.5 days (IQR 27.75-122.25). The majority (74%) of the cohort produced all three anti-SARS-CoV-2 isotypes, although 5% had no detectable antibody class. Transplacental transfer ratios increased with increasing duration between onset of infection and delivery (Figure 1, r2=0.17). Infant IgG levels (ng/mL) were the highest among neonates born to vaccinated mothers (Figure 1), and maternal IgG levels increased with disease severity, although vaccination elicited a comparable maternal antibody response to severe/critical disease (Figure 1). Among 50 maternal specimens, 80% demonstrated in vitro neutralization activity, and 52% of 33 neonatal specimens had NAb. Conclusion: While transplacental transfer of IgG was high with natural infection and correlates with increasing duration between onset of infection and delivery, only half of analyzed neonatal specimens demonstrated in vitro neutralization activity. Further research is needed to characterize the functionality and kinetics of both maternal and neonatal antibody responses elicited by in utero SARS-CoV-2 natural infection compared with COVID-19 vaccination.

12.
Medicina ; 82(1):47-54, 2022.
Article in Spanish | GIM | ID: covidwho-1864015

ABSTRACT

The use of high-flow nasal therapy (HFNT) in patients with severe acute respiratory failure (SARF) due to COVID-19 pneu monia (NCOVID-19) is debated. Given the lack of beds in Intensive Care Units in the Public Health System of the Province of Neuquen, their use was implemented in general wards. This restrospective multicenter study was carried out to describe the experience of using HNFT in patients with SARF due to NCOVID-19. The primary outcome was the frequency of successful weaning from HFNT and in-hospital mortality (IHM). Two hundred ninety-nine patients were analyzed;120 (40.1%) were successfully withdrawn from HFNT. This failed in 59.8% (179), 44.1% (132) required invasive mechanical ventilation (IMV), and 15.7% (47) was not candidates for intubation. A ROX index 5 at 6 h after initiation was associated with the success of HFNT (OR 0.26 [IC 95% 0.15-0.46] p<0.0001). The general IHM was 48.5% (145/299), 70.4% (93/132) in patients with IMV, 4.2% (5/120) died after successful weaning from HFNT and 100% (47/47) in the group not candidates for intubation. Patients with TNAFO had a statistically significant decrease in MIH and days of hospitalization. TNAFO in general wards achieved a decrease in the use of IMV, with a reduction in mortality and days of stay in hospitalized for NCOVID-19 with SARF.

13.
Digital Government: Research and Practice ; 1(4), 2020.
Article in English | Scopus | ID: covidwho-1774991

ABSTRACT

This article explains how businesses can use a widely available, low-cost technology to protect their employees from Covid-19 as they return to work. The proposed approach encompasses the need for better management of processes that can limit infection spread, including management of employee movements, physical distancing, segmentation of personnel into groups, and coordination of sanitization activities. © 2020 ACM.

14.
Kidney International Reports ; 7(2):S230-S231, 2022.
Article in English | EMBASE | ID: covidwho-1703781

ABSTRACT

Introduction: Phosphorus is an essential component of many macromolecules found in bone, lipid membranes, and DNA. It circulates in serum as phosphate. Phosphate level is mainly determined by kidney function. Other factors such as 1, 25 vitamin D3, thyroid hormone and low phosphorous intake can increase renal absorption of phosphate. Hyperphosphatemia presents when serum phosphate is above 4.5 mg/dl (1.45 mmol/L). The phosphate target for hemodialysis (HD) patients is 5.5 mg/dl (1.77 mmol/L) or less. Serum phosphate is commonly measured through the colorimetric method and can also be measured isotopically. Depending on the method used to measure the serum phosphate, many factors have been reported to produce falsely elevated levels. Methods: 52-year-old female with past medical history of end stage renal disease on HD, heart failure with severely reduced ejection fraction secondary to ischemic cardiomyopathy status post left ventricular assist device (LVAD), type 2 diabetes, hypertension, upper gastrointestinal bleeding, anemia, was admitted at a rehabilitation center after a hospital stay due to COVID-19 infection and E. faecium bacteremia secondary to a drive-line infection of the LVAD which was treated with daptomycin. On admission, the patient was found to have a phosphorus level of 6.3 mg/dl, PTH 265 pg/mL, corrected calcium 10 mg/dl, and hemoglobin 9.1 g/dL. Results: Patient was started on oral Sevelamer tablets 800 mg every 8 hours and underwent regular full HD sessions. However, the hyperphosphatemia persisted. Sevelamer was increased to 1600 mg every 8 hours, and she was maintained on a strict low phosphorous renal diet. Four days later while on the new regimen, the phosphorous increased to 12.2 mg/dl. She remained asymptomatic. Hemolysis and hyperbilirubinemia were excluded. A serum protein electrophoresis revealed a monoclonal spike in the gamma region with gamma % of 38.5 (normal range 11-20), gamma globulin 3.0 g/dL (normal range 0.6 – 1.6 g/dL), and quantification of the abnormal protein of 0.41 g/dL (5.3% total). Serum immunofixation showed a probable IgG Lambda monoclonal band. A serum free light chain assay demonstrated a Kappa light chain free serum of 548.9 mg/L (normal range 3.3 – 19.4 mg/L) and Lambda light chain free serum 549.7 mg/L (normal range 5.7 – 26.3 mg/L). Patient was diagnosed with a monoclonal gammopathy, and the elevated phosphorus deemed to be pseudohyperphosphatemia secondary to paraproteinemia. Conclusions: Colorimetric assay with phosphomolybdate ultraviolet (UV) is commonly used for measurement of serum phosphate. The ammonium molybdate reacts with the phosphate to form a cloudy complex, UV absorbance is measured at a specific wavelength. Several factors have been reported to cause falsely high phosphate such as hyperlipidemia, hyperbilirubinemia, hemolysis, liposomal amphotericin B, recombinant tissue plasminogen activator, heparin sulfate, and gammopathies. The paraproteinemia present in monoclonal gammopathies creates a cloudier sample which increases the absorbance of UV light leading to spurious elevation of serum phosphate. Although hyperphosphatemia is a common finding in dialysis patients, the presence of persisting or worsening hyperphosphatemia in a compliant patient taking phosphorous binders and adhering to a low phosphorus diet should raise concern for pseudohyperphosphatemia. No conflict of interest

15.
Revista Colombiana de Nefrologia ; 8(1), 2021.
Article in Spanish | Scopus | ID: covidwho-1687733

ABSTRACT

The COVID-19 disease is an infectious disease caused by the SARS-CoV 2 virus whose clinical presentation is very heterogeneous: it can range from asymptomatic people to critically ill patients, with cytokine storm, acute respiratory distress, organ dysfunction and even death. Current therapies for its treatment are aimed at reducing the impact of the inflammatory cascade, and within these we find hemoadsorption technologies such as the CytoSorb membrane. Next, we present a 31-year-old male patient, who consulted due to severe symptoms of COVID-19 and showed an evident clinical and biochemical improvement after using the CytoSorb device. This is the only documented patient in Colombia who has undergone haemoperfusion therapy with this device in conjunction with prolonged intermittent renal replacement therapy and favorable clinical outcomes have been recorded. © 2021, Asociacion Colombiana de Nefrologia e Hipertension Arterial. All rights reserved.

16.
Medicina (Argentina) ; 82(1):47-54, 2022.
Article in Spanish | EMBASE | ID: covidwho-1647588

ABSTRACT

The use of high-flow nasal therapy (HFNT) in patients with severe acute respiratory failure (SARF) due to COVID-19 pneu-monia (NCOVID-19) is debated. Given the lack of beds in Intensive Care Units in the Public Health System of the Province of Neuquén, their use was implemented in general wards. This restrospective multicenter study was carried out to describe the experience of using HNFT in patients with SARF due to NCOVID-19. The primary outcome was the frequency of successful weaning from HFNT and in-hospital mortality (IHM). Two hundred ninety-nine patients were analyzed;120 (40.1%) were successfully withdrawn from HFNT. This failed in 59.8% (179), 44.1% (132) required invasive mechanical ventilation (IMV), and 15.7% (47) was not candidates for intubation. A ROX index ≥ 5 at 6 h after initiation was associated with the success of HFNT (OR 0.26 [IC 95% 0.15-0.46] p<0.0001). The general IHM was 48.5% (145/299), 70.4% (93/132) in patients with IMV, 4.2% (5/120) died after successful weaning from HFNT and 100% (47/47) in the group not candidates for intubation. Patients with TNAFO had a statistically significant decrease in MIH and days of hospitalization. TNAFO in general wards achieved a decrease in the use of IMV, with a reduction in mortality and days of stay in hospitalized for NCOVID-19 with SARF.

17.
American Journal of Transplantation ; 21(SUPPL 4):623, 2021.
Article in English | EMBASE | ID: covidwho-1494560

ABSTRACT

Purpose: Infections in cirrhotic patients are associated with an increased risk of liverrelated complications (LRC) and mortality. Limited data regarding the prevalence of Coronavirus disease (COVID-19) in cirrhotic patients' awaiting liver transplantation (LT) are available. The aim of this study was to evaluate the prevalence of Sars-cov2 in a cohort of cirrhotic patients and its impact on LRC rate and on LT. Methods: We retrospectively included 187 waitlist patients for LT from 24-January-2020 (2020-cohort) and 123 patients from 24-January-2019 (2019-cohort). All 2020-cohort patients were screened for COVID-19 symptoms with a survey. COVID-19 infection was defined by a positive PCR assay for SARS-CoV-2 on nasopharyngeal swab or the positivity for specific antibodies or typical lung lesions on CT scan. We also assessed the indirect impact of Sars-Cov2 infection on LRC and LT rate, estimated by competitive risk survival analyses in 2020-cohort vs. 2019-cohort (Fine and Gray method). Results: In 2020-cohort, 72.7% (n=136) of patients were male with mean age of 55.5±12, 47.2% (n=85) patients have alcohol and/or NASH related cirrhosis, with a median MELD score of 14.1±7.4. 45.5% (n=71), 38.5% (n=60) and 14.8% (n=23) of patients were A, B and C for Child-Pugh-score, respectively. 172 patients responded to survey and 22% (n= 38) had symptoms. 20/38 patients were tested for Sars-Cov2 and 4 patients were positive. 3/4 patients with COVID-19 disease needed hospitalization and 1 intensive care support. No death was reported and 1 patient was LT. The 2020-cohort and 2019-cohort were comparable for sex (p=0,6), age (p=0.7), comorbidities (p=0.2) and Child-Pugh-score (p=0.2). The cumulative incidence of LRC was not significantly higher in the 2020-cohort vs. 2019-cohort (SHR 0.65, 95% CI 0.36-1.15, p=0.138). The cumulative incidence of LT was significantly lower in the 2020-cohort than in the 2019-cohort (SHR0.21, 95% CI 0.13-0.33, p<0.001). Conclusions: Our study reported a low prevalence rate of Sars-Cov2 infection in a cohort of cirrhotic patients waiting for LT. No Sars-Cov2 infection direct or indirect impact on mortality and LRC rate was reported. However, a significant shortage of LT was found in 2020 cohort.

18.
Journal of the American Society of Nephrology ; 32:306, 2021.
Article in English | EMBASE | ID: covidwho-1489868

ABSTRACT

Introduction: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome first reported in 1996 which describes the presence of a wide range of neurological symptoms, and posterior brain white matter edema on imaging studies which may be reversible. The clinical presentation is characterized by headache, altered consciousness, visual disturbances and seizures;hypertension is frequent, although not invariable. Case Description: A 37-year-old male with past medical history of hypertension and end stage kidney disease on hemodialysis who presented with shortness of breath, occipital headache, and bilateral acute vision loss. On admission, he was afebrile with a blood pressure of 274/147 mmHg, RR of 16, HR 98 bpm and oxygen saturation of 89% on room air. Due to acute vision loss, a stroke alert was initiated. A head CT scan showed subcortical hypodensities in the bilateral occipital lobes consistent with PRES. He was started on Nicardipine drip in the ICU with subsequent decrease in blood pressure to 166/105 mmHg. His vision restored fully without further episodes of vision loss. Patient was found to be positive for COVID-19 and did not receive treatment for it as his shortness of breath and hypoxia resolved. The patient received maintenance hemodialysis, Nicardipine drip was weaned, and he was transitioned to oral blood pressure medications. Discussion: The relationship between kidney disease and PRES is not fully understood. Reported cases of PRES have been linked with hypertension, autoimmune disease, and immunosuppressive states, common diseases in ESKD. The pathophysiology of PRES appears to be related to cerebral blood flow dysregulation and endothelial cell dysfunction. The proinflammatory response in COVID-19 produces dysfunction and death of endothelial cells which may increase vascular permeability, promoting the cerebral edema seen in PRES. The estimated prevalence of PRES in COVID-19 patients is between 1-4%. Reports of PRES in ESKD are rare. PRES may not be readily recognized given the heterogeneity of presentation. Therefore, high index of suspicion is needed in the ESKD population.

19.
Palliative Medicine ; 35(1 SUPPL):201, 2021.
Article in English | EMBASE | ID: covidwho-1477133

ABSTRACT

Background: Due to COVID-19, team has piloted new service of volunteers supporting patients/relatives isolated home using telephone and videocalls, with global good response to this initiative. The literature review shows no robust studies associating palliative care (PC) volunteering with new technologies (NT). Aims: The main goal is implementing and evaluating volunteer training programme in the use of NT (specifically smartphones and tablets) to support patients facing life-threatening illness and relatives. Specific objectives are: 1. Explore need and usefulness of NT from point of view of patients/relatives, volunteers and health care professionals (HCP) in PC and describe technological profile. 2. Design techvolunteer curriculum and implement techvolunteer training programme. 3. Implement techvolunteer programme within PC home care service and Inpatient unit and assess impact on care provided. Methods: Pilot study: 20 volunteers and 70 patients/relatives. Mix-methods design allows combining quantitative measures of implementation with in-depth qualitative data to provide detailed understanding intervention functioning on small scale. Pragmatic cluster randomized clinical trial to test efficacy (unit of randomization is the volunteer and unit of analysis is patient/relative). Before-after design to test effectiveness (volunteers and HCP satisfaction with intervention and its implementation). Cost-utility study. Interviews (individuals and groupal) with HPC, volunteers and key informants of patients/relatives to test the beginning need and usefulness of NT, and during implementation process to test changes and experiences. Intention to treat analysis. Conclusion: This study will bring real evidence toward NT integration as useful tool not only to facilitate communication between volunteers and patients/relatives, but also to turn NT into instruments support daily living and enhance care, when in the hands of trained tech-volunteers.

20.
International Conference on Communication and Applied Technologies, ICOMTA 2021 ; 259 SIST:515-523, 2022.
Article in English | Scopus | ID: covidwho-1473975

ABSTRACT

Background: On March 11, 2020, the World Health Organisation (WHO) declared the SARS-CoV-2 virus a pandemic. Spain and Italy decreed a state of emergency, implementing an enforced confinement of citizens. The United States and the United Kingdom took similar steps. Method: This article quantitatively investigates the evolution of the most searched terms on Google and YouTube on ‘quarantine’. Google Trends data on the word ‘quarantine’ was used in the four countries with the highest number of total deaths from Covid-19 disease at the end of May 2020: United States (85,906), United Kingdom United (33,614), Italy (31,368) and Spain (27,459) from February to June 2020. Results: Linear regression analysis show a positive correlation between searches for the word “quarantine” in Italy in relation to those in the United States (R2 = 0.96) and Spain (R2 = 0.96), being able to generate predictive models for the future. Comparison of the data for Italy with the UK is less statistically relevant (R2 = 0.78). Conclusions: There is an increase in the searches for ‘quarantine’ in Google and YouTube up to June 2020. The citizens of these countries first searched for this concept on Google and later on YouTube. There is a statistical correlation between Google searches in Italy compared separately to the United States and Spain. The quarantine data of interest in Italy generate a prediction pattern in the United States and Spain. However, this phenomenon does not happen between Italy and the UK due to the lack of statistical correlation. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

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