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One of the effects of the COVID-19 pandemic is the adaptation of most of the activities remotely or virtually, in the case of medical appointments, in the different specialties other than emergencies produced by COVID-19. Most of them continued in the format through online appointments. One of the important processes in medical evaluations is related to the so-called specialist boards, where special cases are evaluated, for which several physicians must be connected online, in addition to being able to make reports jointly. In this paper we develop a methodology to perform medical meetings of specialists, using a platform dedicated to the use in video games, through the DISCORD tool interconnectivity from various devices is performed, the results demonstrate the interactivity and applicability of the methodology, so it can be applied in different processes where interconnectivity between different devices and the concurrence of several users is required. We present a methodology to configure virtual appointment rooms, the results allow us to verify that the methodology can be replicated and scaled according to the needs. © 2022 ACM.
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The effects of the COVID-19 pandemic have led to certain patterns in the different actions people take. One of the areas in which this pandemic has impacted most strongly is related to educational activities and children were the most affected. They went from studying in their schools where they have all the conditions, to a physical space at home. This strong change in the environment added to the high levels of contagion, have caused students to present certain manifestations such as the level of stress which can be manifested by many factors such as the main vital signs such as oxygen saturation and heart rate. In this paper we present a methodology to perform these measurements in order to evaluate these measurements when students are attending classes from home. © 2022 ACM.
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NON-TECHNICAL SUMMARY The significant outlays by countries in the Global South to recover from the Covid-19 crisis could have been an opportunity to build back better, advancing both a green recovery and addressing pressing social problems, thus advancing sustainability. To examine if this was the case, in this paper we analyze the expected impacts of recovery initiatives in five Latin American countries. Our results show that these programs do not support the possibility of building back better, weakly impacting twelve dimensions related to sustainability. We also propose a methodology to improve how sustainability concerns can be included in future choice of projects. TECHNICAL SUMMARY It has been argued that the significant outlays by governments across the world required to recover from the Covid-19 crisis can be an opportunity to build back better, i.e. advance towards greener societies. In the Global South, which suffered acute social, economic and environmental problems prior to this health crisis, recovery initiatives would be best suited to focus on sustainable economic recovery which — along with the environmental concerns of a green recovery — could address pressing local problems. To this end, we analyzed the expected impacts of recovery initiatives in five Latin American countries on each of 71 sustainability criteria. These criteria are based on the UN sustainable development goals and other relevant literature related to sustainable development. This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work. Using principal component analysis, criteria are grouped into twelve dimensions. Our results show that recovery programs examined do not take advantage of the possibility of building back better, and many relevant dimensions related to a sustainable recovery are only weakly considered. Our methodology provides a step forward towards supporting governments in their efforts to identify better policies and investment projects and consequently put together packages of initiatives that advance on sustainability, green recovery, or other long-term goals they may have. SOCIAL MEDIA SUMMARY Methodology to analyze covid-19 recovery packages shows small impact on sustainability in 5 Latin American countries. © 2023 Cambridge University Press. All rights reserved.
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Introduction: COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020 due to its complexity and rapid global expansion. Sandino municipality presented its first positive case on October 6, 2020. Objective(s): To characterize the clinical-epidemiological behavior of COVID-19 in Sandino municipality, in 2020. Method(s): A descriptive and cross-sectional research was conducted from March 11 to December 31, 2020. With the information obtained from clinical-epidemiological records, virological results, home and work screening, care for acute respiratory infections in clinics and polyclinics, and the daily reports of the Municipal Health Directorate, a statistical analysis was carried out whose information was inserted in an Excel database. Result(s): The incidence rate was 528.23 per 100 000 population;no deaths. Most of the cases occurred in the city of Sandino. There was a higher frequency of patients in the ages from 41 and 60, and the male sex;while 55.73 % were asymptomatic at diagnosis. The most common symptoms were cough, fever and nasal congestion. Between one and 13 cases per day were diagnosed during the 63 days that there was positivity. Family transmission was 68.23 % and occupational transmission was 50.52 % of cases. Conclusion(s): COVID-19 had a high incidence in Sandino municipality, and this predominated in places with higher population density with intense family and work transmission in a short period of time;also, in the male sex, the age group in working ages, and in the asymptomatic patients.Copyright © 2023, Editorial Ciencias Medicas. All rights reserved.
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The emergence of the novel coronavirus SARS-CoV-2 has significantly impacted the world's population, disrupting healthcare systems around the globe and leading to human and material losses. While different vaccines have been approved in record time, there continues to be a high number of daily new cases, and patients face a wide range of presentations of the disease, from asymptomatic to potentially fatal. Therefore, the search for therapeutic agents that can aid in the management and control of the disease has become one of the main goals for researchers and clinicians. As an inflammatory disease, targets for the treatment of COVID-19 have largely involved the immune system. Inflammation has also been associated with mental health disorders, and studies have shown the potential involvement of inflammatory pathways in the pathophysiology of depression. As a consequence, the hypothesis of using antidepressants and other psychotropics for the treatment of COVID-19 has emerged. In this review, we aim to summarize the molecular pathways that could be involved as well as the emergent evidence that has been reported by studies performed since the appearance of SARS-CoV-2 in 2019. While it has been observed that there are potential therapeutic pathways for the use of antidepressants in the treatment of COVID-19, additional studies are needed to evaluate the feasibility, safety, and efficacy of psychotropics in this disease.Copyright © 2023 Bentham Science Publishers.
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This article assesses the role played by the information design of the interactive visualization of the press in the spread of the COVID 19 pandemic, taking as a case study the newspaper The New York Times, a world reference in scientific journalism that has played a fundamental role as an informant on this health crisis. To do this, a content analysis method was integrated into different interactive journalistic visualizations (N=103) that the newspaper published from December 2019 (beginning of the pandemic) to December 2020 (beginning of the first acquisitions of vaccines), and were coded to determine, identify and examine detailed patterns in three axes of study: I) the informative approach;2) visual and multimedia resources;and 3) type of interaction. The results indicate that the design of interactive press information in the dissemination of the COVID 19 pandemic focuses mainly on data journalism through visualizations with non-figurative and hybrid graphical interfaces with access to geo-located databases that offer the possibility of exploring the visualization of data in an innovative way and in real time on the total number of contagion cases per day (hospitalized, percentage of bed occupancy and number of beds available in hospitals), cases per capita and deaths from coronavirus by state and counties in the United States, as well as other countries. These practices are associated with interoperability activities and globally linked data, which provide the opportunity to generate greater knowledge about the behavior of this pandemic in the world and allow more effective management of risks to human health. © 2022 Universidad Diego Portales. All rights reserved.
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Objective: To describe pediatric dentists' perceptions regarding dental biosafety in times of COVID-19 in Lima, 2020. Material(s) and Method(s): A qualitative, phenomenological and content-analysis study. In-depth semi-structured interviews were conducted with 18 pediatric dentists through the Zoom videoconferencing platform, following the guidelines described in a guide and after obtaining the pertinent virtual informed consent. ATLAS.ti software version 8.4 was used for data analysis, where all the verbatim files of each interview were uploaded. Result(s): Pediatric dentists perceived themselves to be professionally empowered with knowledge about biosafety measures. Moreover, they highlighted the mastery of various techniques such as mouthwash, use of personal protective equipment, control of aerosols, social distancing between patients and disinfection of environments, which are essential for patient safety. They also reported that biosafety regulations are somewhat confusing, unclear, and lack a pediatric approach. Conclusion(s): Pediatric dentists are strategic human resources for healthcare because they gained biosafety knowledge as part of their professional education and received training on new biosafety regulations in the context of the COVID-19 pandemic. It is important to standardize the criteria and approaches in the model of care for pediatric dentistry and guarantee the conditions for the sustainability of this professional practice. Copyright © La revista.
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Background. Since the beginning of the pandemic and its passage through the different affected continents, there have been differences in the presentation depending in part on the characteristics of each population, so it is important to know how it behaves in the local population. Methods. Clinical-epidemiological study in adults hospitalized for suspected COVID-19 at the General Hospital 71 of the City of Veracruz, Mexico, from April to December 2020. Demographic and clinical characteristics are studied, as well as a comparative and stratified analysis was performed by intubation and death. Results. 1212 patients are included, 53% are men, average age 49 years. 20.5% reported sudden onset of symptoms;the most frequent: fever (79.8%), headache (75.2%), cough (71%), myalgia (62%), arthralgia (58%) and dyspnea (46.3%). Comorbidities were reported in 54.7%, the most frequent: Hypertension (29.2%), Diabetes (29.1%) and obesity (13.9%). Regarding the outcomes, 120 (9.9%) required intubation and 300 (25%) died. Men requiring intubation were significantly older than women [62.5 vs 37.5%;p = 0.027]. The mean age of the intubated patients was higher compared to that of the non-intubated [60.5 vs 44.8 years;p = 0.001]. The male gender had a risk association for intubation. The group aged 60 years or older compared to those aged 59 years or younger had a higher risk of intubation. Clinical variables that had a risk association with intubation were: dyspnea, chest pain and prostration. Among comorbidities, hypertension and diabetes had a risk association with intubation. Female gender and headache had a protective association for intubation. In addition, odynophagia, rhinorrhea, and abdominal pain showed a protective association for intubation. There was no difference in terms of gender by death. The mean age of the patients who died was significantly older [64.5 vs 43.8 years;p = 0.001]. The clinical variables that had a risk association with death were: dyspnea, chest pain, polypnea, cyanosis and prostration. The protective variables were: rhinorrhea, odynophagia, headache and conjunctivitis Conclusion. By studying a population affected by COVID, its own characteristics and inherent risks can be known to help take local diagnosis and treatment strategies that ensure a better outcome for those affected.
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Background. Baricitinib is a treatment authorized by the FDA for the treatment of moderate to severe COVID-19, despite this there are few approved drugs;polymerized type I collagen (PTIC) is a drug that has been used in Mexico with great potential for treating moderate to severe cases of COVID-19. Methods. Comparative, descriptive and retrospective analysis of two populations of adult patients affected by COVID-19 confirmed by antigen test or RT-PCR as well as CO-RADS 6 CT, who consented to be treated between 2020 and 2021, a population using oral baricitinib at a dose of 4mg/day/14 days and another using polymerized type I collagen intramuscularly at a dose of 1.5ml every 12 hours for 3 days, followed by 1.5ml every 24 hours for 4 days;The most affected age and gender, comorbidities and laboratory abnormalities are analyzed, as well as improvement in inflammatory and oxygenation indices measured by pulse oximetry and SAFI (SpO2/FiO2), finally the outcome of the patients and the presence of adverse events. Results. 80 patients for each group, the most affected gender was male;the average age in the PTIC group was 51 years and in the baricitinib group it was 56 years;the main comorbidities were obesity, diabetes and hypertension in both groups;the decrease in acute phase reactants such as CRP, D-dimer and ferritin was greater in the PTIC group compared to the baricitinib group, the latter drug requiring a regimen of more days to achieve the objectives of the first drug (PTIC 7 days and baricitinib 14 days);Similarly, in oxygenation measured, the PTIC group reached goals in less time compared to the baricitinib group, which required twice as many days of treatment to achieve adequate oxygenation;Regarding the outcomes, there was a higher mortality in the baricitinib group compared to the PTIC group (6.25% vs 3.75%). Regarding adverse events reported for the PTIC group, they were minor and related to the intramuscular administration of the drug in 7 patients, while in the baricitinib group, 5 patients were reported with added bacterial pneumonia. Conclusion. Polymerized type I collagen has anti-inflammatory and immunomodulatory potential similar to baricitinib in cases of moderate to severe COVID-19, even reaching treatment goals in less time both in inflammatory indices and in oxygenation indices.
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Background: Numerous studies have suggested a possible role for acute kidney injury (AKI) biomarkers in predicting renal recovery after kidney replacement therapy (KRT) with poor performance. In this study, we investigated urinary SerpinA3 (USerA3) as a biomarker to predict renal recovery (RR) after AKI in critically ill COVID-19 patients with invasive mechanical ventilation (IMV). Method(s): Prospective cohort study of patients with critical COVID-19 in ICU with IMV and who required KRT, admitted to our Institute in Mexico City (Mar 2020 -Feb 2022). Patients with CKD stages 4 or 5 and kidney transplant were excluded. SerpinA3, KIM-1, NGAL and HSP-72 were measured in urine on day 0 (start of KRT) and days 1, 3, 7 and 14. We performed log10 transformation only for urinary USerA3 and, subsequently performed repeated sample ANOVA for each one of the biomarkers. Result(s): Sixty patients were included, 52% died before discharge, 38% had complete RR after 90 days and 10% partial RR. Characteristics at baseline for KRT are shown in Table 1. No differences or trends were found in KIM-1 (p=0.380), NGAL (p=0.956), or HSP-72 (p=0.899). In Figure 1 appears USerA3 behavior along the study, showing a clear tendency to be different among the groups. We can observe that the patients who died presented lower amount of USerA3 compared to those who survived. On the other hand, patients with partial RR exhibited USerA3 excretion with a tendency to be lower than those with complete RR, especially in measurements 4 and 5 (day 7 and day 14, respectively). Conclusion(s): In this study, we observed that USerA3 seems to be a predictor of RR and survival, which probably reflects a greater renal functional reserve.
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A case report of COVID-19 infection in a patient presenting with upper and lower gastrointestinal and respiratory symptoms, ending in respiratory failure and the need for invasive mechanical ventilation, presenting with improvement in his respiratory and gastrointestinal symptoms, but with limitations for extubation due to altered state of consciousness despite weaning from analgesia for more than 72 hours, in whom elevated levels of ammonia were found without signs of liver failure. Diarrhoea and liver involvement are frequent manifestations in patients with COVID-19, which can possibly lead to a decrease in carnitine levels and secondary hyperammonaemia, becoming a challenge for clinicians. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo
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The confinement due to the COVID-19 pandemic had a devastating impact on different areas of social, emotional, economic and school life, among others, and university education was no exception, at that time the so-called emergency remote education emerged. Learning styles were adapted and changes in emotions were present according to the students' experiences. Three questionnaires were applied to 303 medicine students: #EstamosConectados, CESEA and AMAI, to identify availability of digital tools and devices, connectivity, learning styles, emotions, and socioeconomic level. According to data obtained, 45% had a computer, 55% had inadequate connectivity and the theoretical-operative learning style predominated with 25.4%. In relation to emotions, 62.7% felt accompanied, 60% experienced anxiety and stress. Finally, the majority socioeconomic level with 63.7% corresponded to level B of the AMAI scale. The results obtained suggested that a flexible educational model is required, which transforms, encompasses and guarantees inclusive quality teaching, adaptable to an equitable hybrid model, in addition to constant communication between peers and teachers through educational platforms, with free access to the Internet;as well as offering the necessary emotional accompaniment for students.
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Introduction: Durvalumab received EMA approval as consolidation therapy (CT) for unresectable stage III NSCLC with PD-L1 ≥1% and who did not have progression after CRT. Our objective was to analyze in real clinical practice the effectiveness of durvalumab and explore the clinical factors that may be associated with the benefit from CT. Methods: Retrospective study was made at Hospital of Leon (Spain), including 37 patients with locally advanced NSCLC treated with durvalumab after CRT treatment between March 2018 and october 2021 (40.5% patients were included in the durvalumab early access program). The neutrophil-to-lymphocyte ratio (NLR) could identified after CRT as a factor that may be benefit from durvalumab. Results: Median age was 67 years (range 46-82 years). 40.5% of patients were ≥70 years old. 78.4% were male and 51.4% smokers. 54% had non-squamous histology. PD-L1 expression was <1% in 5% and not available in 8% patients. 2.7% ROS1 rearrangements, 5.4% KRAS mutations and not available in 43.2% patients. Stage IIIA, IIIB, IIIC disease were 24.3%, 54.1% and 21.6%, respectively. Median time from end of CRT to onset durvalumab was 44 days (range 13-120 days). Overall median CT duration was 214.8 days (range 69-399 days) with a median of 14 infusions (range 6-27 infusions). With a median follow up of 19.7 months (range 1.4-34.9 months);67.6% had stopped CT: 37.8% due to completing treatment, 16.2% disease progression, 10.8% adverse event and 2.7% due to COVID19 infection. Median real-world progression-free survival (rwPFS) was 17 months (95% CI, 11-23). Median real-world overall survival (rwOS) was 29.9 months (95% CI, 23.3-36.6). %rwOS at 6, 18 and 24 months were 100%, 86.9% and 74.5%, respectively. For patients with post-CRT NLR not exceeding the cohort median value of 6, receipt of durvalumab was associated with an improvement in rwOS (median not reached vs 25.7 months;p=0.025). 56.8% patients had any grade of radiation pneumonitis (median time from CRT start: 119 days [range 36-241 days]). Of these, 19% patients developed worsening of radiation pneumonitis with durvalumab. 54,1% developed immune-mediated toxicity, mostly G1-2 (85.1%). Conclusions: Our results demonstrate the effectiveness of durvalumab consolidation in this patients population in a real-life setting. We identified low NLR after CRT as a potentially predictive factor for the benefit of CT in locally advanced NSCLC. Keywords: DURVALUMAB, PACIFIC, REAL WORLD DATA
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Objective: Since the beginning of the 2019 global pandemic of Coronavirus Disease, using invasive mechanical ventilation as support therapy has been a critical treatment of acute respiratory failure. In the context of a collapsed health system, having an early extubation predictor becomes a useful way of supporting clinical management, by enabling to anticipate the availability of mechanical ventilators. Hence, we assessed the relationship between the progression of lactate dehydrogenase and early extubation in patients with COVID-19. Design: A retrospective study. Setting: A single private hospital in Chile. Patients: Adults aged 18 or older diagnosed with COVID-19 pneumonia and requiring mechanical ventilation, having been admitted to an ICU during the study period. Interventions: None. Measurements and Main Results: Fifty two individuals, 73% males, were included with a median age of 47.1 years old and a median body mass index of 29. Individuals extubated within the first 5 days of mechanical ventilation, early extubation group, amounted to 34.6%. The average decrease in serum lactate dehydrogenase levels was 27.5 UI/L per day (p < 0.01) in the early extubation group compared to 14.7 UI/L per day (p < 0.01) in the late extubation group (individuals extubated after day 5). During the first 48 hours, the average daily decrease was 56.7 UI/L in the early extubation group compared to 13.2 UI/L per day in late extubation group (p < 0.01). Conclusions: Serum lactate dehydrogenase daily level decrease during the first days of mechanical ventilation is associated with earlier patient extubation. © 2022 Sociedad de Anestesiologia de Chile. All rights reserved.