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The pandemic caused by the SARS-CoV-2 coronavirus has been especially detrimental to patients with end-stage renal disease. History with other vaccines suggests that patients with renal disease may not respond adequately to the SARS-CoV-2 vaccine. The aim of this study is to evaluate the immunity to SARS-CoV-2 mRNA vaccines in renal patients. Post SARS-CoV-2 vaccination first, and after the booster dose, antibodies and cellular immunity were studied in patients on hemodialysis (N = 20), peritoneal dialysis (N = 10) and renal transplantation (N = 10). After the two doses of vaccine, there was an effective immunity in dialysis patients, with 100% seroconversion and 87% detection of cellular immunity (85% in hemodialysis and 90% in peritoneal dialysis). In contrast, in renal transplant recipients there was only 50% seroconversion and cellular immunity was detected in 30% of patients. After the booster dose, all dialysis patients achieved a cellular and antibody immunity, whereas in transplant patients, despite improvement, 20% did not produce antibodies and in 37.5% cellular immunity could not be detected. The mRNA vaccine plus booster performs excellently in dialysis patients, whereas in kidney transplant recipients, despite the booster, complete immunization is not achieved.Copyright © 2022
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In the context of the 80th anniversary of the Instituto Mexicano del Seguro Social (IMSS), there are several health problems and challenges to be faced in relation to user population, which currently represents 42% of Mexico's population. Among these issues, once five waves of COVID-19 infections have passed and mortality rates have decreased, mental and behavioral disorders stand out as a re-emerging and priority problem. In response to this, in 2022 the Mental Health Comprehensive Program (MHCP, 2021-2024) materialized, which represents, for the first time, the opportunity to provide health services that address mental disorders and addictions of user's population IMSS, under the Primary Health Care model. That is, prioritizing health promotion, risk factors prevention, screening, timely diagnosis, and not just hospitalization and drug supply. Among the MHCP strategies, which motivated the writing of this document, we highlight the availability of reliable data, through the census of mental and behavioral disorders, related to important characteristics in terms of population, state, hospital, prevalence of disorders, in order to act accordingly through the infrastructure and human resources available at the IMSS, with emphasis on the first level of care. Copyright © 2023 Revista Medica del Instituto Mexicano del Seguro Social.
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Nowadays, mental health has acquired greater relevance and attention as a consequence mainly of the COVID-19 pandemic, to which is attributed a negative impact on the development of life, work and social coexistence of people, along with the magnitude derived from non-communicable diseases. This is why the Instituto Mexicano del Seguro Social (IMSS, Mexican Institute for Social Security) developed the Mental Health Comprehensive Program 2021-2024, whose main purpose was to establish strategies and lines of action for the prevention, early detection and timely management regarding mental health and addictions. Based on this, different actions have been carried out, for example, the identification of the material and human resources available at IMSS to meet the mental health issue;the training of healthcare professionals at the three levels of care;the integration of a census that has reported a prevalence of anxiety and depressive episodes in the users of 39.9 and 3%, respectively, as well as the evaluation of instruments for screening mental disorders. Therefore, this document describes what has been done in the IMSS in relation to the user's mental health in the context of the COVID-19 pandemic.
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The pandemic caused by the SARS-CoV-2 coronavirus has been especially detrimental to patients with end-stage renal disease. History with other vaccines suggests that patients with renal disease may not respond adequately to the SARS-CoV-2 vaccine. The aim of this study is to evaluate the immunity to SARS-CoV-2 mRNA vaccines in renal patients. Post SARS-CoV-2 vaccination first, and after the booster dose, antibodies and cellular immunity were studied in patients on hemodialysis (N=20), peritoneal dialysis (N=10) and renal transplantation (N=10). After the two doses of vaccine, there was an effective immunity in dialysis patients, with 100% seroconversion and 87% detection of cellular immunity (85% in hemodialysis and 90% in peritoneal dialysis). In contrast, in renal transplant recipients there was only 50% seroconversion and cellular immunity was detected in 30% of patients. After the booster dose, all dialysis patients achieved a cellular and antibody immunity, whereas in transplant patients, despite improvement, 20% did not produce antibodies and in 37.5% cellular immunity could not be detected. The mRNA vaccine plus booster performs excellently in dialysis patients, whereas in kidney transplant recipients, despite the booster, complete immunization is not achieved.
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Aim: COVID-19 is mostly well known because of its respiratory pathology, nevertheless several ischemic complications have been reported during the pandemia. The aim of this report is to present 9 cases of acute intestinal ischemia in patients with concomitant SARS-COV- 2 bilateral pneumonia. Method(s): We present a case series collected from a retrospective database, that includes 9 patients with intestinal ischemia and bilateral COVID 19 pneumonia diagnosed during the years 2020 and 2022 at the "Hospital Universitario Nuestra Senora de Candelaria." Results: Of the 9 patients, 6 were men with a mean age of 63 years, 5 of them unvaccinated and 2 with partial dose. All presented with bilateral covid pneumonia requiring admission and intubation at the intensive care unit. During admission, after a hemodynamic worsening with increasing lactate, acute intestinal ischemia was diagnosed on a CT scan (7 non occlusive and 2 occlusive ischemia of the SMA). 7 of them underwent damage control surgery of whom only 2 survived. The remaining 3, died hours after diagnosis, not undergoing surgical treatment due to poor short-term prognosis. Conclusion(s): The severe inflammatory response along with a hypercoagulable state secondary to COVID 19 is responsible for many severe ischemic diseases such as intestinal ischemia. These can go unnoticed in intubated critically ill patients, or with concomitant respiratory disease due to the absence of obvious clinical manifestations. Given its high mortality, it is essential to take this differential diagnosis into account, to obtain an early diagnosis and treatment.
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Aim: The COVID-19 pandemic has drastically impacted the surgical world. Proctology has been severely affected by the reorganisation of healthcare systems over the last year. We present the COVID-19 infection screening protocol that we have carried out in our Major Ambulatory Surgery (MAS) unit for proctological procedures. Method(s): Analysis of the cases operated between April-20 and February-21 in the MAS unit following the protocol established for screening against COVID-19 for both, patients and staff, system alerts and solutions to outbreaks. Screening of patients is carried out by PCR test 48h prior to the intervention, outside the unit and extracted by trained staff. If positive, the intervention is postponed for 40-60 days or until a negative PCR is obtained. Screening of all staff is carried out weekly with a PCR test and 24-48 hours before any professional enters in the unit. If a positive case is detected, it is isolated for a week until negative PCR is obtained and all contagions are tested on days 0, 4 and 8. If an outbreak of less than 3 professionals is detected, they are isolated and follow-up continues. In case of 4 or more, activity in the unit is stopped until PCR is negative. Result(s): 2068 procedures were performed in the MAS unit of which 202 were proctological interventions: 38.6% perianal fistulas, 20.8% haemorrhoids, 12.9% anal dysplasia, 9.4% fissures and 18.32% other pathologies. 48 positive cases of patients were detected and the intervention was postponed without prejudice to the patients. Five alerts were detected in the staff screening, with a maximum of 3 professionals infected in one outbreak. The affected cases were removed from the unit until a negative PCR test was obtained. At no time did the MAS unit have to be closed due to infection. Conclusion(s): Our COVID-19 screening for patients and professionals has been effective and has allowed us to continue our healthcare practice during the pandemic, without the need to close the unit due to outbreaks.
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Background. A large number of viral infections are characterized by the presence of cutaneous manifestations. Multiple dermatological manifestations have been observed in patients with COVID-19. Dermatological lesions in patients infected by SARS-CoV-2 such as livedo reticularis, rash and vascular lesions may represent manifestations of secondary phenomena such as paraviral rashes or by participation of the innate or adaptive immune system that cause vasodilation, vascular leakage or procoagulant effects Methods. Descriptive and observational study, adult patients with COVID-19 pneumonia were selected, confirmed by RT-PCR and chest CT. General symptoms, hematic cytometry results, pneumonia severity, prognosis as well as dermatological manifestations are characterized. Results. 100 patients were entered into the study, with an average age of 49.4 years, 54% male. The general symptoms with the highest incidence were: fever, cough and dyspnea characteristic of SARS-CoV-2 infection, followed by chest pain, headache, anosmia and dysgeusia. The main alteration of the hemogram was lymphopenia, no leukopenia or plaquetopenia was demonstrated. 54% of those affected had mild pneumonia, the rest severe pneumonia. 75% progressed towards improvement and 25% died. Among the dermatological manifestations identified, all occurred in cases with severe pneumonia, the one with the highest incidence was the morbilliform viral exanthema in 18%, the presence of diffuse partial alopecia in 7% as well as manifestations of lividity and maceration in 1%. Regarding alopecia, in 6% it was reversible androgenetic alopecia, having manifested during the acute stage of pneumonia (all men), in 1% it presented alopecia areata (male) that has been persistent beyond the acute phase and in frank recovery Demographic and clinical variables Conclusion. The incidence of dermatological manifestations is low in this study population, the most frequent being the morbilliform viral exanthema expected in a virus, however they present manifestations of low incidence such as reversible androgenetic alopecia associated with severity of the disease, a finding that has been documented recently as a manifestation associated with COVID-19.
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Background. Patients affected by COVID-19 pneumonia who present severe symptoms with manifest hypoxemia and cytokine storm have a high mortality rate, which is why therapies focused on reducing inflammation and improving lung function have been used, one of them being jakinibs through of the blocking of the JAK tracks. Methods. Patients who presented data of severe pneumonia due to COVID-19 with data of severe hypoxemia and cytokine storm were selected, from June to August 2020, to whom the SaO2/FiO2 ratio is measured at the beginning, intermediate and end of treatment, as well as D dimer and serum ferritin. Comorbidity and drugs taken previously are analyzed. The patients being cared for at home. Results. We included data from 30 patients, 8 (27%) women and 22 (73%) men, with a median age of 58.5 (46.5 - 68.0) years. 23 patients (77%) had comorbidities, the most frequent being arterial hypertension (43%), followed by obesity (30%), type 2 diabetes mellitus (27%), among others. In the laboratory, the medians of D-Dimer 982 ng/ mL, Ferritin 1,375 ng/mL and C-Reactive Protein 10.0 mg/dL. Regarding the use of previous medications, we found that 29 (97%) patients had treatment with some medication, the most frequent: azithromycin (77%), ivermectin (53%) and dexamethasone (47%). The median number of medications received was 3. The initial pulse oximetry (SaO2) measurement with room air had a median of 80.5% and the median SaO2/FiO2 (SAFI) was 134;Regarding the type of SIRA, 90% had moderate SIRA and 10% had severe SIRA. The median day of evolution on which baricitinib was started was 10 days, all received 4 mg/day, and the median days of treatment with baricitinib was 14.0 days. At follow-up, SaO2 at 7 days had a median of 93.0% and the median SAFI at 7 days was 310.0;the median SaO2 at 14 days was 95.0% and the median SAFI at 14 days was 452.0. In comparative analysis, baseline SaO2/SAFI was significantly lower compared to 7 and 14 days (p = 0.001 for both comparisons). The outcomes, 27 (90%) patients improved and there were 3 (10%) who died. Conclusion. Baricitinib therapy in these patients with severe COVID-19 pneumonia who present with severe hypoxemia and cytokine storm presented good results by improving clinical status and pulmonary failure, with patients being cared for at home and avoiding mechanical ventilation.
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Artificial Intelligence (AI) and robotics are two realities that are here to stay and whose involvement in our society covers a multitude of very diverse areas. The fact that we are dealing with a technology capable of emulating human attitudes, such as learning or adaptation, makes AI, and specifically robots equipped with it, unpredictable machines. Furthermore, the potential interaction between machines and vulnerable subjects, such as consumers or patients, is a compounding factor, which implies even greater risk. This is precisely why it is necessary to analyse the legal and ethical consequences of the use of intelligent robots in our society.
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Introduction: Few studies have examined the effects of COVID-19 on the mental health of patients with inflammatory bowel disease (IBD), who are already at higher risk of depression, anxiety and stress than the general population. Aims & Methods: This cross-sectional study was conducted to assess the psychosocial impact of COVID-19 on patients with IBD in Spain during lockdown and the first wave of the pandemic. A self-report questionnaire that integrated the Spanish version of the Depression, Anxiety and Stress Scale-21 items (DASS-21) and the Perceived Stress Questionnaire (PSS) was designed to gather sociodemographic data and information related to the effects of COVID-19 on the lives of IBD patients. Twelve IBD units invited their patients to answer the anonymous online survey via email or by using a QR code displayed at the unit. A link to the survey was also published on the GETECCU (Spanish IBD group) website and social media account. The survey was conducted between the 1st July and the 25th August 2020. Results: Of the 693 survey participants with IBD, 67% were female, mean age 43 (12y SD). 61% had ulcerative colitis, 36% Crohn's disease 3% indeterminate colitis. Only 15 participants were diagnosed with COVID-19: 3 of them required hospital admission and none required ICU admission. Physical activity levels and sleep habits were adversely affected for 79% and 67% of respondents, respectively. In addition, 39% reported a decrease in income due to the pandemic. 95% report having complied with IBD treatment during the COVID-19 pandemic, despite over 50% of them feeling that they were more at risk of infection due to their medication. DASS-21 scores indicate that during the lockdown the estimated prevalence of depression was 10.5% [95% CI 8.2-13%], anxiety 20% [95% CI -17- 23%] and stress 18% [95% CI 8.2-13%]. Conclusion: In the short-term, lockdown during the COVID-19 pandemic has had a considerable impact on the mental health of IBD patients in Spain. Further follow-up studies should be carried out to determine the real long-term impact.
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This paper presents a novel platform for electrical circuits applied for educational purposes based on an Arduino and Matlab-Simulink. The platform components are given by hardware setup and software setup that integrated the platform are described. Performance of the platform is assessed by means of real-Time experiments using ArduinoIO package for first order and second order electrical circuits. The platform is easy to implement and to interface with any computer and can be carried home by students, opening new possibilities for practical assignments in electrical circuits, dynamic of systems and control courses. We include experiments and studied topics during various practices which the platform was demonstrated during the SARS CoV-2 pandemic. © 2003-2012 IEEE.
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Background and aims: Recent studies and observations have shown various thrombotic and thromboembolic complications from COVID-19 infection. Multiple mechanisms of hypercoagulability have been proposed: direct endothelial injury and invasion, increased circulating pro-thrombotic factors (including factor VII, fibrinogen), multiple coagulation abnormalities referred to as COVID- 19 associated coagulopathy (CAC), and others. Updated guidelines recommend high intensity DVT prophylaxis in patients with COVID-19. Previous reports have outlined multiple cases of large vessel strokes associated with COVID-19. In some cases, stroke was the presenting symptoms of COVID-19 infection. Younger patients with few or no stroke risk factors generally have better outcomes. Methods: We observed three cases of large vessel occlusion (LVO) strokes in elderly patients with symptomatic COVID-19 pneumonia and respiratory failure. Stroke diagnosis was made by clinical examination and neuroimaging including computed topography (CT) and CT angiography (Figure 1 and 2). Patient characteristics, including past medical history and stroke risk factors, are detailed in Table 1. These patients remained critically ill throughout their hospitalizations. Results: In this case series, all three patients died irrespective of aggressive therapies ranging from intravenous thrombolysis, mechanical thrombectomy (MT), and full dose anticoagulation. Conclusion: COVID-19 associated hypercoagulability increases the risk of LVO strokes, and is associated with poor outcomes in older aged, high risk patients with underlying medical comorbidities and stroke risk factors. Patients with severe infection may benefit from high intensity venous thromboembolism prophylaxis or even therapeutic dose anticoagulation, which may also lower risk of ischemic LVO strokes. (Figure Presented).
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This article analyzes the use of force in Colombian penitentiaries. It studies the current situation in penitentiaries and the particular effect of the Covid-19 pandemic, which triggered mutinies in some prisons. As a consequence of these mutinies, the government had to declare a state of emergency for the prison system. Our findings let us argue that the rationality of the punishment and the use of force against inmates is appropriate de jure but not de facto. For example, deaths and injuries suffered by inmates at the La Modelo (Jail in Bogota), during the mutiny on March 21st, 2020, affected the legitimacy of the authorities' actions. Instead of maintaining order in the penitentiary, the result was a massacre.