Design and construction of automated mechanical ventilation equipment

This document presents the requirements met for the design, construction and initial validation of a mechanical ventilation system to be used in patients with respiratory insufficiency, which in the initial context was due to the COVID-19 pandemics. The design required the use of computer aided drawing software (Computer Aided Design) CAD and the construction required the use of installed capabilities in mechanical, electropneumatic, electronic, biomedical and automation manufacturing of institutes and centers of the Universidad Don Bosco (El Salvador). The adjust-ment, configuration and programming tasks were in charge of research professors specialized in these dis-ciplines. The elements used for its construction were available in the Salvadoran market, considering the closure of borders as a government measure to face the expansion of the pandemics. After the design, manufacturing and commissioning stage, conditions of the supplied air were measured with the help of professionals dedicated to the maintenance of medical equipment and with the approval of internist doctors. The results achieved are those obtained with paramedical equipment and with first aid equipment, and consequently it has been foreseen that the equipment can be tested in a subsequent instance with the certified medical union. © 2022, Universidad Politecnica Salesiana. All rights reserved.

Extensive rhino-orbital-cerebral mucormycosis in kidney transplant recipient associated with COVID-19 infection: a case report

Rhino-orbital-cerebral mucormycosis is an invasive disease caused by fungi. Diabetes mellitus and solid organ transplantation are known risk factors, while it is increasingly recognized in patients with COVID-19 although the exact causal relationship is unknown. Early diagnosis and treatment with liposomal amphotericin B with surgical debridement carries a better outcome in these patients. We present a case of extensive rhino-orbital-cerebral mucormycosis involving the paranasal sinuses, left orbit, cavernous sinus, middle cranial fossa with abscess formation in the left middle cerebellar peduncle in a 46-year-old kidney transplant recipient with concomitant COVID-19 infection.

Pulmonary embolism on ventilation/perfusion scintigraphy during the COVID-19 pandemic

Aim/Introduction: In March 2020, the World Health Organization (WHO) declared the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a pandemic. One complication associated with COVID-19 disease is a thrombotic event, including pulmonary embolism. The most commonly used imaging modality in nuclear medicine for diagnosing pulmonary embolism is ventilation/perfusion singlephoton emission computed tomography (V/Q-SPECT), especially in patients who are contraindicated to iodinated contrast agents and are not suitable for computed tomographic pulmonary angiography (CTPA). However, the true impact of these increased thromboembolic events on pulmonary scintigraphy results has not yet been investigated. Therefore, we investigated the value of ventilation/perfusion scintigraphy for diagnosing pulmonary embolism during the COVID-19 pandemic. Material(s) and Method(s): We retrospectively reviewed medical records of patients examined with 81mKr or 133Xe ventilation/ 99mTc-MAA perfusion scintigraphy between January 2019 and May 2021. Patients only examined with perfusions scintigraphy were excluded. The lung scintigraphy findings before (January 01, 2019 to March 15, 2020) and during (March 16, 2020 to May 31, 2021) the pandemic were compared. The number of examinations performed in the two periods were compared using Poisson regression, whereas Pearson's chisquare test was used for severity parameters. Result(s): The study population contained 1.127 patients, 538 before and 589 during the COVID-19 pandemic. The mean age was 68 years (standard deviation 17, range 17-99 years). No difference in the prevalence of positive lung scintigraphy was found before [144 (27 %)] and during the pandemic [179 (29%)] (p=0.433). During the pandemic the percentage of patients exhibiting central or segmental pulmonary embolisms slightly increased [3 (0.6%) vs. 9 (1.5%) and 21 (3.9%) vs. 29 (4.9%)] compared to before, whereas. subsegmental pulmonary embolisms were equally frequent [120 (22%) vs. 132 (22%)] (overall p=0.345). The number of multiple (>4) emboli was increased [32 (5.9%) vs. 45 (7.6%), p=0.314]. Conclusion(s): During the COVID-19 pandemic, pulmonary ventilation/perfusion scintigraphy is also a reliable examination method for detecting pulmonary emboli. Although increased thromboembolic events were described with COVID-19 infections, no significant increase in the number or severity of detected pulmonary emboli could be observed in our population.

Risk perception of contracting COVID-19 among healthcare workers

Objectives: to evaluate the dimensional validity of the perception scale of the risk of contracting COVID-19 and its association with sociodemographic and occupational factors, as well as with sleep complaints, among healthcare workers. Methods: cross-sectional study, carried out between May and August 2020, involving healthcare workers from Rio de Janeiro, Brazil. They filled in an online questionnaire regarding their work activities, risk perception of contracting COVID-19, and health behavior. We used factor analysis and binomial and multinomial regression models, adjusted for confounders. Results: 2,996 workers participated. Factor analysis confirmed the scale unidimensionality. Greater chances of high-risk perception were reported by women;caretakers of children/ elderly;those with a work journey of more than 40h/week;workers from primary health care and emergency units, and from general and specialized hospitals. High risk perception was associated with altered sleep duration (OR = 2.39;95%CI = 1.95;2.94), use (OR = 2.08;95%CI = 1.67;2.58) and increased dose of sleep medications (OR = 1.91;95%CI = 1.47;2.48). Conclusion: risk perception was associated with women, caretakers of children/elderly, longer working hours, sleep complaints, and use of sleeping pills. Investigating factors associated with stressful events, such as the COVID-19 pandemic, can support actions planning aimed at preventing diseases among healthcare workers.

Development of Animation as a Medium for Public Health Education

One of the diseases still suffered by many Indonesian people, especially in the city of Depok, is respiratory disease. Currently, respiratory tract disease is a case with a high number of sufferers. An effort to handle these cases is to provide counseling and education for the community. This education aims to enable people to apply a healthy lifestyle independently and prevent various types of diseases. During the COVID-19 pandemic, this role was somewhat difficult to carry out due to limited movement and space. As a solution to this problem, the part of information technology is crucial. One is utilizing multimedia technology as a medium for health education for the community, namely animation. Animation can describe and visualize something so that information can be presented clearly and visually. This study aims to develop animation as a medium of health education for the community, especially in respiratory health. The animation video was generated using the MDLC (Multimedia Development Life Cycle) method. The resulting animated video can inform the public about health that focuses on the health of the respiratory system. 85 % of users stated that this animated video helps them to understand the material presented. © 2022 IEEE.

Comparison of Outcomes of Viral Respiratory Tract Infections in Children during Pre Covid and Covid Era

BACKGROUND AND AIM: During the COVID period, reduced exposure to common viral infections is suggested to produce an immune debt in children leading to severe infections with complications. We planned to compare the clinical outcomes of non-covid viral respiratory tract infections (RTI) in children between the pre-COVID and COVID era. METHOD(S): Data from medical records of children admitted with RTI in pre-COVID (2018 - 2019) & COVID era (2021) were analyzed. Patient demographics, virology profile & outcomes were compared. Primary objective was to compare the need for invasive ventilation between the two groups and the secondary objective was to compare the length of ICU stay. RESULT(S): Total number of children admitted with RTI needing oxygen during pre-COVID and COVID era were 140 & 70 respectively. Out of this, 116 and 49 were virology positive. RSV was the commonest virus in both groups. During the pre-COVID period,12 out of 116 children (10.3%) needed invasive ventilation and in the COVID era, 7 out of 49 (14%) were ventilated (Relative risk: 1.38, 95% CI: 0.57 - 3.2). 9 out of 116 children (7%) in the pre- COVID period & 10 out of 49 children (18%) in the COVID era needed prolonged ICU stay (more than 14 days) (Relative risk: 2.63, 95% CI: 1.13 - 6.07). CONCLUSION(S): Children with viral respiratory infection in the COVID era required prolonged ICU stay compared to children in the pre-COVID period.

'Build forward better' must include heavy investment in government capacities to engage with communities and civil society. (Special Issue: COVID-19 health system governance.)

Civil society and community groups are active players in the COVID-19 response, providing support, advice and information where government reach is poor. Yet most governments have not managed to bring civil society's perspectives, insights, and experiences into the COVID-19 response in a systematic way. If the world is to 'build forward better', more regular and systematised government-civil society engagement will need to underpin a shift towards more inclusive health governance. Doing so successfully will require heavy investments in capacity-building for government actors to value and feel comfortable managing and sustaining participatory spaces and in skills to bring forward the kind of governance needed to build resilience against the next pandemic.

Knowledge, attitude and practice toward the vaccination for COVID-19: a private practitioner-based survey in India

Objectives: The knowledge of health care workers regarding upcoming vaccine for COVID-19 is important for the vaccination process which is going to be conducted soon. The present study was conducted to evaluate the knowledge, attitude and practice (KAP) among Health Care Workers about upcoming Vaccine for COVID-19.

Continued Resident Depression, Anxiety and Stress Despite Declining Covid Numbers and Increasing Vaccination Rates

Study Objective: Resident wellness is a critical issue for residency programs and much discussion has determined that programs across all specialties have a responsibility to monitor their residents for signs of depression, anxiety, and stress. Despite its importance, programs have yet to determine a simple, objective way to measure these signs. We sought to establish an objective measure of emergency medicine (EM) resident wellness last year during the SARS- CoV- 2 pandemic, and then determine if wellness improved as the pandemic was waning. Methods: Using the Depression, Anxiety, and Stress Scales (DASS), all residents in a suburban EM residency in the state with the highest SARS- CoV- 2 deaths per capita were surveyed during the pandemic (“during”) and then again six months later in the spring, as the CDC began to recommend lifting restrictions (“after”). The DASS is a validated psychometric scale used across multiple industries and designed to measure the negative emotional states of depression, anxiety and stress. Survey results were anonymous. The percentage of residents with depression, anxiety and stress during and after the pandemic was measured, and differences with 95% confidence intervals (CI) were calculated. Results: Out of 27 residents, 26 (96%) completed the “during” survey and 23 (85%) completed the “after” survey. During the pandemic, 42% of residents were measured as having some degree of depression, ranging from mild to severe, compared to 33% noted on the “after” survey (Difference - 9%, CI: - 38, 20). Results showed that 31% of residents were measured as having some degree of anxiety during the pandemic, compared to 38% noted in the “after” survey (Difference 7%, CI: - 21, 36). 46% of residents were measured as having some degree of stress during the pandemic, compared to 48% noted in the “after” study (Difference 1%, CI: - 29, 32). There were no significant changes in the percentage of residents classified as having “severe” depression, anxiety or stress. Conclusion: Despite the waning pandemic and increased rates of vaccination, there was no significant improvement in the levels of depression, anxiety and stress as measured by the DASS among the residents. The reason for this is unclear but certainly requires more investigation.