ABSTRACT
Background: During the Covid-19 pandemic, in low- and middle-income countries, hospital resilience was critical to the success of the pandemic response. In North Africa and Middle East region, little attention was paid to hospital resilience strategies. Objective(s): To explore hospital organizational resilience strategies in a Moroccan hospital. Method(s): Single case study with mixed methods. Ten interviews were conducted with managers and frontline healthcare workers. The concept of hospital resilience was assessed using a questionnaire given to 50 managers and frontline health workers. Result(s): Hospital resilience strategies included developing crisis preparedness plans, hiring professionals, and organizing care quickly. The challenges were: shortage of medication and human resources, lack of personal protective equipment, insufficient bed capacity and emotional and psychological impact of overwork on frontline professionals. Level of Evidence: 5.Copyright © 2022 Elsevier Masson SAS
ABSTRACT
Background and Purpose: Balo's concentric sclerosis (BCS) is a rare inflammatory demyelinating disorder of the central nervous system (CNS) characterized pathologically and radiologically by concentric lamella of alternating demyelinated and partially myelin-preserved white matter. Whether BCS is a variant of multiple sclerosis (MS) or a distinct entity remains debatable. Here, we report an unusual case of MS complicated by Balo's lesions, post-Coronavirus disease 2019 (COVID-19), focusing on the evolution ofMRI findings. Methods: Single-case study. Results: The patient is a 42-year-old woman with relapsing-remitting MS diagnosed at age of 19 who was treated with teriflunomide for the past 5 years. She developed a febrile illness and arthralgia for a week;however, COVID-19 testing was deferred. Two weeks later, she presented with vertigo followed by profound right-hemiparesis, gait impairment, and encephalopathy. Cerebrospinal fluid analysis revealed a protein of 56 mg/dl, increased immunoglobulinG(IgG) index, and>l10 unique oligoclonal bands. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG was detected in serum, but viral ribonucleic acid was absent in the CSF. BrainMRI demonstrated, for the first time, several Balo-like and tumefactive lesions, with contrast enhancement and restricted diffusion. She received plasma exchange alternating with pulse steroids, yet was left with ataxic hemiparetic gait. She was later switched to an anti-CD20 monoclonal antibody therapy. Followup brain MRIs showed continuous regression of the tumefactive and Balo-like lesions. Conclusion: This case adds to the emerging spectrum of COVID-19- associated radiological findings regarding inflammatory demyelination in the CNS. It remains unknown whether potential neurotropism of SARS-CoV-2 or parainfectious mechanisms might have contributed to the fulminant disease in our patient.
ABSTRACT
In the aftermath of catastrophic events, problems always arise in the supply of goods in places affected by the emergency. During the early stages of the COVID-19 pandemic, the shortage of Personal Protective Equipment (PPE) created problems, especially in the healthcare sector, contributing to the uncontrolled spread of the virus. This paper presents a case in which the emergence of a voluntary local production and distribution network based on 3D printing technology played an important role in compensating for the lack of PPE. From the case analysed, we compare the core characteristics of the emergent virtual networks against the features of well-established supply chains models to systematize relevant differences and common traits. This research contributes to defining, developing, and scoping the concept of emergent supply chains and illustrates how such networks can constitute an essential first response to the lack of materials and goods in emergency contexts.
ABSTRACT
The proceedings contain 138 papers. The topics discussed include: ethics and future of human challenge trials with SARS-COV-2 to speed vaccine development;managing pragmatic clinical trials in the time of COVID-19;design, implementation, and analysis of N-of-1 clinical trials;design and implementation of a vaccine trial in a pandemic - mRNA-1273 phase 1 trial;different clinical trial analyses for different stakeholders;leveraging external evidence in clinical research using novel statistical methods;benefit-risk assessment in clinical trials with individual patient needs in mind;adaptive COVID-19 treatment trial data management: ensuring success in a constantly-evolving, high-demand pandemic environment;and sample size re-estimation: reflections on implementation and extensions to complex designs.