Exploratory Factorial Model of Hydric Conservation in the COVID-19 era

Scenarios of scarcity, shortages, healthiness and scarcity are proposed to which HEIs would react, but with nuances according to the capacities of the areas of knowledge such as the case of health sciences and administrative economic sciences. [...]a Modeling is a mapping of the variables indicative of a behavior based on inclusion criteria such as the consensus of the literature regarding the SDG-6 and its observation in HEIs. [...]verifiability frameworks prevail in the biological and health sciences. [...]a comparison between different sources observing the same phenomenon generates the veracity of a data [9]. The IES only covers a few disciplines that respond to the development needs of the region, as well as the projected labor demand [10]. [...]the objective of this work is to contribute with empirical evidence to the SDG indicators: scarcity, drought, depletion, sanitation, purification, quality and floods [11].

Minimal Clinically Important Differences in Inspiratory Muscle Function Variables after a Respiratory Muscle Training Programme in Individuals with Long-Term Post-COVID-19 Symptoms.

OBJECTIVE: To establish the minimal clinically important difference (MCID) for inspiratory muscle strength (MIP) and endurance (IME) in individuals with long-term post-COVID-19 symptoms, as well as to ascertain which of the variables has a greater discriminatory capacity and to compare changes between individuals classified by the MCID. DESIGN: Secondary analysis of randomised controlled trial of data from 42 individuals who performed an 8-week intervention of respiratory muscle training programme. RESULTS: A change of at least 18 cmH2O and 22.1% of that predicted for MIP and 328.5s for IME represented the MCID. All variables showed acceptable discrimination between individuals who classified as "improved" and those classified as "stable/not improved" (area under the curve ≥0.73). MIP was the variable with the best discriminative ability when expressed as a percentage of prediction (Youden index, 0.67; sensitivity, 76.9%; specificity, 89.7%). Participants classified as "improved" had significantly greater improvements in quality of life and lung function compared with the participants classified as "stable/not improved". CONCLUSION: In individuals with long-term post-COVID-19 symptoms, the inspiratory muscle function variables had an acceptable discriminative ability to assess the efficacy of a respiratory muscle training programme. MIP was the variable with the best discriminative ability, showing better overall performance when expressed as a percentage of prediction.

Nationality as an Influential Variable with Regard to the Social Skills and Academic Success of Immigrant Students

This study aims to expand the existing scientific, theoretical and empirical knowledge about the influence of the variables age, gender, nationality and place of residence on the probability of developing social skills that generate social wellbeing, and, in addition, to identify the relationship between the most influential variable and the academic success of immigrant students. We hope that the educational community, in an intercultural context, can benefit from and apply this knowledge to assist immigrant students. In this study, a sample of n = 749 students aged between 12 and 18, of 41 different nationalities, is analyzed using the Social Skills Scale for Young Immigrants (SSSYI). Data analysis is performed with the SPSS and STATA statistical programs. Multiple linear regression (MLR) analyses verify that nationality is the most influential variable. In addition, when calculating the Pearson correlation, high and positive correlations are found between social skills, nationality and students’ grades, with which academic success was measured. In conclusion, we find that students who emigrated from the European continent present better social skills, better social wellbeing and greater academic success.

Changes in the management and clinical outcomes of critically ill patients without COVID-19 during the pandemic. / Modificações no manejo e desfechos clínicos de pacientes críticos sem COVID-19 durante a pandemia.

OBJECTIVE: To analyze whether changes in medical care due to the application of COVID-19 protocols affected clinical outcomes in patients without COVID-19 during the pandemic. METHODS: This was a retrospective, observational cohort study carried out in a thirty-eight-bed surgical and medical intensive care unit of a high complexity private hospital. Patients with respiratory failure admitted to the intensive care unit during March and April 2020 and the same months in 2019 were selected. We compared interventions and outcomes of patients without COVID-19 during the pandemic with patients admitted in 2019. The main variables analyzed were intensive care unit respiratory management, number of chest tomography scans and bronchoalveolar lavages, intensive care unit complications, and status at hospital discharge. RESULTS: In 2020, a significant reduction in the use of a high-flow nasal cannula was observed: 14 (42%) in 2019 compared to 1 (3%) in 2020. Additionally, in 2020, a significant increase was observed in the number of patients under mechanical ventilation admitted to the intensive care unit from the emergency department, 23 (69%) compared to 11 (31%) in 2019. Nevertheless, the number of patients with mechanical ventilation after 5 days of admission was similar in both years: 24 (69%) in 2019 and 26 (79%) in 2020. CONCLUSION: Intensive care unit protocols based on international recommendations for the COVID-19 pandemic have produced a change in non-COVID-19 patient management. We observed a reduction in the use of a high-flow nasal cannula and an increased number of tracheal intubations in the emergency department. However, no changes in the percentage of intubated patients in the intensive care unit, the number of mechanical ventilation days or the length of stay in intensive care unit.

OBJETIVO: Analisar se as modificações na atenção médica em razão da aplicação dos protocolos para COVID-19 afetaram os desfechos clínicos de pacientes sem a doença durante a pandemia. MÉTODOS: Este foi um estudo observacional de coorte retrospectiva conduzido em uma unidade de terapia intensiva clínica e cirúrgica com 38 leitos, localizada em hospital privado de alta complexidade na cidade de Buenos Aires, Argentina, e envolveu os pacientes com insuficiência respiratória admitidos à unidade de terapia intensiva no período compreendido entre março e abril de 2020 em comparação com o mesmo período no ano de 2019. Compararam-se as intervenções e os desfechos dos pacientes sem COVID-19 tratados durante a pandemia em 2020 e os pacientes admitidos em 2019. As principais variáveis avaliadas foram os cuidados respiratórios na unidade de terapia intensiva, o número de exames de tomografia computadorizada do tórax e lavados broncoalveolares, complicações na unidade de terapia intensiva e condições quando da alta hospitalar. RESULTADOS: Observou-se, em 2020, uma redução significante do uso de cânula nasal de alto fluxo: 14 (42%), em 2019, em comparação com 1 (3%), em 2020. Além disso, em 2020, observou-se aumento significante no número de pacientes sob ventilação mecânica admitidos à unidade de terapia intensiva a partir do pronto-socorro, de 23 (69%) em comparação com 11 (31%) em 2019. Contudo, o número de pacientes com ventilação mecânica 5 dias após a admissão foi semelhante em ambos os anos: 24 (69%), em 2019, e 26 (79%) em 2020. CONCLUSÃO: Os protocolos para unidades de terapia intensiva com base em recomendações internacionais para a pandemia de COVID-19 modificaram o manejo de pacientes sem COVID-19. Observamos redução do uso da cânula nasal de alto fluxo e aumento no número de intubações traqueais no pronto-socorro. Entretanto, não se identificaram alterações na percentagem de pacientes intubados na unidade de terapia intensiva, número de dias sob ventilação mecânica ou número de dias na unidade de terapia intensiva.

IMPACTO DEL COVID-19 EN LOS SERVICIOS DE CIRUGÍA CARDIOVASCULAR EN ESPAÑA: ANÁLISIS DE LOS GRUPOS RELACIONADOS CON EL DIAGNÓSTICO (ESTUDIO SECCE-COVID19 FASE 2)

Resumen Introducción y objetivos: La pandemia de COVID-19 causada por infección del virus SARS-CoV-2 ha saturado al sistema sanitario español, afectándose la atención de las enfermedades cardiovasculares. Queremos cuantificar el impacto de la pandemia en el número de las intervenciones quirúrgicas cardíacas analizando los grupos relacionados con el diagnóstico (GRD) más prevalentes de nuestra especialidad. Métodos: A instancias de la Sociedad Española de Cirugía Cardiovascular y Endovascular se solicitó a todos lo centros nacionales que quisieron participar, los datos de los códigos de GRD números 162 (cirugía sobre válvulas cardíacas con infarto o diagnóstico complejo), 163 (cirugía sobre válvulas cardíacas sin infarto o diagnóstico complejo), 165 (bypass coronario con infarto o diagnóstico complejo), 166 (bypass coronario sin infarto o diagnóstico complejo) y 167 (otros procedimientos cardiotorácicos o vasculares torácicos) entre el 1 de marzo de 2020 y el 30 de septiembre de 2020 (7 meses), y como período control las mismas fechas de 2019. Resultados: Se recibieron los datos de 24 Hospitales, 22 públicos y 2 privados. Existió un descenso global en el número de intervenciones del 30% (Rango -19% a -42%, p<0.001) de 4648 en 2019 a 3262 en 2020 (-1386 de diferencia), siendo +7% para el GRD 162 (p=0.500), -37% para el 163 (p=0.001), -9% para el 165 (p=0,304), -32% para el 166 (p=0.001), y -16% para el 167 (p=0.062). Conclusiones: existió un descenso global de cirugías estadísticamente significativo en 2020 del 30% respecto a 2019 entre el 1 de marzo y el 30 de septiembre. Introduction and objectives: The COVID-19 pandemic caused by the SARS-CoV-2 virus infection has saturated the Spanish health system, affecting the care of cardiovascular diseases. In this phase 2 of the SECCE-COVID19 study we want to quantify the impact of the pandemic on the number of cardiac surgeries by analyzing the most prevalent diagnostic-related groups (DRGs) in our specialty. Methods: At the request of the Spanish Society of Cardiovascular and Endovascular Surgery, all the centers in the national territory that wanted to participate were asked for the data of the DRG codes number 162 (surgery on heart valves with infarction or complex diagnosis), 163 (surgery on heart valves without infarction or complex diagnosis), 165 (coronary bypass with infarction or complex diagnosis), 166 (coronary bypass without infarction or complex diagnosis) and 167 (other cardiothoracic or thoracic vascular procedures) between March 1, 2020 and September 30, 2020 (7 months), and as a control period the same dates of the year 2019. Results: Data were received from 24 Hospital Centers, 22 public and 2 private. There was a global decrease in the number of interventions of 30% (Range -19% a -42%, p<0.001) from 4648 in 2019 to 3262 in 2020 (-1386 difference), being +7% for the GRD 162 (p=0.500), -37% for 163 (p=0.001), -9% for 165 (p=0,304), -32% for 166 (p=0.001) and -16% for 167(p=0.062). Conclusions: there was a statistical significant global decrease in surgeries in 2020 of 30% compared to 2019 between March 1 and September 30.

Tracheal aspirate with closed suction device: a modified technique developed during the COVID-19 pandemic

Resumen Antecedentes: Tanto la sobreinfección bacteriana como la neumonía asociada a la ventilación (NAV) son eventos frecuentes en los cuidados críticos. Durante la pandemia de COVID-19, las prácticas diagnósticas habituales, como el lavado broncoalveolar y el aspirado traqueal, están limitadas debido al alto riesgo de exposición que conllevan para el operador. Con el fin de poner el foco principal en la protección del personal sanitario, se desarrolla y utiliza una técnica de aspiración traqueal modificada (M-TA) para la adquisición de muestras microbiológicas del tracto respiratorio inferior con un dispositivo de aspiración cerrado. Métodos: Se realiza un estudio observacional retrospectivo para evaluar la eficacia de la M-TA. Resultados: Se analizaron un total de 33 muestras de M-TA. En el 66,6% de los casos, los resultados condujeron a un cambio en la toma de decisiones médicas. Se alcanzó una precisión del 100% en el diagnóstico de COVID-19 y una tasa de crecimiento bacteriano del 56% en las cultivas en las que se sospechó de VAP. Ningún personal sanitario desarrolló síntomas ni dio positivo a COVID-19 durante o después de la recogida de muestras. Conclusiones: La técnica de M-TA presentada podría considerarse como un procedimiento seguro y eficaz con bajo porcentaje de complicaciones. Background: Bacterial superinfection, as well as ventilation associated pneumonia (VAP), are both frequent events in critical care. During the COVID-19 pandemic, usual diagnostic practices such as bronchoalveolar lavage and tracheal aspirate are limited due to their associated high risk of exposure for the operator. In order to set primary focus on the protection of health care personnel, a modified tracheal aspiration (M-TA) technique was developed and used for acquiring microbiological samples from the lower respiratory tract using a closed suction device. Methods: Retrospective observational study was conducted to evaluate effectiveness of an M-TA. Results: A total of 33 M-TA samples were analysed. In 66.6% of the cases, results led to a change in medical decision making. A 100% accuracy was achieved regarding COVID-19 diagnosis, and a 56% bacterial growth-rate in cultures where VAP was suspected. No health care personnel developed symptoms or tested positive for COVID-19 during or after sample collection. Conclusion: The M-TA technique presented could be considered as a safe and effective procedure with low percentage of complications.

Detection of Sars-Cov-2 in the air of two hospitals in Hermosillo, Sonora, México, utilizing a low-cost environmental monitoring system.

OBJECTIVE: The best way of preventing the dispersion of an infectious disease is decreasing the transmissibility of the pathogen. To achieve such a goal, it is important to have epidemiological surveillance to retrieve data about its routes of transmission and dispersion. This study investigated the possibility of SARS-CoV-2 detection using filtration through 0.22 µm pores. METHODS: A filtration system with vacuum pump was used for sampling, and molecular analysis was performed by RT-PCR for detecting the COVID-19 virus. RESULTS: It was found that SARS-CoV-2 could be detected in particulate matter trapped on 0.22 µm filters 3 h after air sampling, and the only contaminated areas were those near patient zones. CONCLUSIONS: The results confirm the possibility of finding this virus in floating particulate matter in contaminated zones, with a simple and economic sampling method based on filtration technology through 0.22 µm pores and detection with molecular techniques (RT-PCR). The higher risk zones were those near patients with COVID-19.

Clinical characteristics of critically ill patients with COVID-19 (preprint)

ObjectiveDescribe the clinical and respiratory characteristics of critical patients with coronavirus disease 2019 (COVID-19). DesignObservational and retrospective study over 6 months. SettingIntensive care unit (ICU) of a high complexity hospital in Buenos Aires, Argentina. PatientsPatients older than 18 years with laboratory-confirmed COVID-19 by reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2 were included in the study. Variables of interestDemographic characteristics such as sex and age, comorbidities, laboratory results, imaging results, ventilatory mechanics data, complications, and mortality were recorded. ResultsA total of 168 critically ill patients with COVID-19 were included. 66% were men with a median age of 65 years (58-75. 79.7% had at least one comorbidity. The most frequent comorbidity was arterial hypertension, affecting 52.4% of the patients. 67.9 % required invasive mechanical ventilation (MV), and no patient was treated with non-invasive ventilation. Most of the patients in MV (73.7%) required neuromuscular blockade due to severe hypoxemia. 36% of patients were ventilated in the prone position. The length of stay in the ICU was 13 days (6-24) and the mortality in the ICU was 25%. ConclusionsIn this study of critical patients infected by SARS-CoV-2 in a high-complexity hospital, the majority were comorbid elderly men, a large percentage required invasive mechanical ventilation, and ICU mortality was 25%.

COVID-19 Severity Index: predictive score for hospitalized patients (preprint)

IntroductionPandemics pose a major challenge for public health preparedness, requiring a coordinated international response and the development of solid containment plans. An early and accurate identification of high-risk patients in the course of the actual COVID-19 pandemic is vital for planning and for making proper use of available resources. ObjectiveThe purpose of this study was to identify the key variables to create a predictive model that could be used effectively for triage. MethodsA narrative literature review of 651 articles was conducted to assess clinical, laboratory and imaging findings of COVID-19 confirmed cases. After screening, 10 articles met the inclusion criteria and a list of suggested variables was gathered. A modified Delphi process analysis was performed to consult experts in order to generate a final list of variables for the creation of the predictive model. ResultsThe modified Delphi process analysis identified 44 predictive variables that were used for building a severity prediction score, the COVID-19 Severity Index. ConclusionSpecifically designed for current COVID-19 pandemic, COVID-19 Severity Index could be used as a reliable tool for strategic planning, organization and administration of resources by easily identifying hospitalized patients with higher risk of transfer to Intensive Care Unit (ICU).

Survey on the situation of telepharmacy as applied to the outpatient care in hospital pharmacy departments in Spain during the COVID-19 pandemic.

OBJECTIVE: To analyze the status of the implementation and development of  telepharmacy as applied to the pharmaceutical care of outpatients treated at  hospital pharmacy services in Spain during the COVID-19 pandemic. METHOD: Six weeks after the beginning of the confinement period, an online 10- question survey was sent to all members of the Spanish Society of Hospital  Pharmacists. A single response per hospital was requested. The survey included  questions on the provision of remote pharmaceutical care prior to the onset of  the health crisis, patient selection criteria, procedures for home delivery of  medications and the means used to deliver them, the number of patients who  benefited from telepharmacy, and the number of referrals made. Finally,  respondents were asked whether a teleconsultation was carried out before  sending patients their medication and whether these deliveries were recorded. RESULTS: A total of 39.3% (n = 185) of all the hospitals in the National Health  System (covering all of Spain's autonomous regions) responded to the survey.  Before the beginning of the crisis, 83.2% (n = 154) of hospital pharmacy  services did not carry out remote pharmaceutical care activities that included  telepharmacy with remote delivery of medication. During the study period,  119,972 patients were treated, with 134,142 deliveries of medication being  completed. Most hospitals did not use patient selection criteria. A total of 30.2%  of hospitals selected patients based on their personal circumstances. Home  delivery and informed delivery (87%; 116,129 deliveries) was the option used in most cases. The means used to deliver the medication mainly included the use  of external courier services (47.0%; 87 hospitals) or the hospital's own transport services (38.4%; 71 hospitals). As many as 87.6% of hospitals carried out  teleconsultations prior to sending out medications and 59.6% recorded their  telepharmacy activities in the hospital pharmacy appointments record. CONCLUSIONS: The rate of implementation of telepharmacy in outpatient care in  Spain during the study period in the pandemic was high. This made it possible to guarantee the continuity of care for a large number of patients.

Objetivo: Analizar la situación de la implantación y desarrollo de la telefarmacia aplicada a la atención farmacéutica a pacientes externos de los servicios de  farmacia hospitalaria en España durante la pandemia por la COVID-19.Método: Se envió una encuesta online de 10 preguntas a todos los socios de la  Sociedad Española de Farmacia Hospitalaria a las seis semanas del inicio del  periodo de confinamiento por la pandemia. Se solicitó una única respuesta por  hospital. Se incluyeron preguntas sobre la realización de atención farmacéutica  no presencial con dispensación a distancia previa al inicio de la crisis sanitaria,  los criterios de selección de pacientes, los procedimientos de envío de  medicación y los medios utilizados, el número de pacientes que se han  beneficiado de la telefarmacia y el número de envíos realizados. Por último, se  identificó la realización o no de teleconsulta previa al envío de medicación y si la  actividad quedó registrada.Resultados: Un 39,3% (n = 185) del total de hospitales públicos del Sistema  Nacional de Salud pertenecientes a todas las comunidades autónomas  respondieron a la encuesta. El 83,2% (n = 154) de los servicios de farmacia  hospitalarios no realizaban actividades de atención farmacéutica no presencial  con telefarmacia que incluyeran envío de medicación antes del inicio de la crisis  sanitaria. En el periodo de estudio se atendieron 119.972 pacientes y se  realizaron 134.142 envíos de medicación. La mayoría de los hospitales no  utilizaron criterios de selección de pacientes. El 30,2% de los centros  seleccionaron en función de las circunstancias personales del paciente. La  dispensación domiciliaria y entrega informada (87%; 116.129 envíos) fue la  opción utilizada de forma mayoritaria para el envío. Los medios para hacer llegar la medicación fueron, principalmente, la mensajería externa (47%; 87 centros) o medios propios del hospital (38,4%; 71 centros). Un 87,6% de los hospitales realizaron teleconsulta previa al envío de medicación y el 59,6% registró la actividad de telefarmacia en la agenda de citación. Conclusiones: La implantación de la telefarmacia aplicada a la atención a  pacientes externos en España durante la pandemia ha sido elevada. Así se ha  podido garantizar la continuidad de los tratamientos de un elevado número de  pacientes.

Recomendaciones De La Sociedad Española De Cirugía Cardiovascular Y Endovascular Ante La Pandemia Covid-19

Resumen Ante el contexto sanitario de Pandemia por COVID-19, la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) asume la obligación de elaborar y transmitir una serie de Recomendaciones que permitan asegurar una adecuada cobertura sanitaria de la población, al mismo tiempo que se minimice la exposición y el riesgo de contagio tanto de pacientes como de profesionales. Para ello, y dentro del marco global que formulan las instrucciones del Ministerio de Sanidad, Consejería de Sanidad y Direcciones-Gerencia de cada uno de los centros sanitarios, debe organizarse un plan de contingencia de los distintos servicios de Cirugía Cardiovascular. Este plan de contingencia debe mantener el correcto funcionamiento de los servicios de Cirugía Cardiovascular, asegurando el adecuado cumplimiento de las siguientes dimensiones asistenciales: a) La correcta atención de los pacientes urgentes y emergentes. b) La elaboración de una lista de pacientes preferentes y criterios temporales de tratamiento. c) La demora justificada y segura de aquellos pacientes de tratamiento electivo cuya patología y situación clínica lo permitan. d) La aplicación concreta de los programas de ECMO en el contexto COVID-19. In the actual COVID-19 Pandemic, the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) assumes the obligation to elaborate special recommendations that ensure an adequate health care of population, while minimizing the exposure and the risk of contagion for both patients and professionals. For that reason, Cardiovascular Surgery Departments need to develop a functional plan of contingency within the global framework formulated by the instructions of the Ministry of Health and hospital authorities. The aim of this strategy is the proper functioning of Cardiovascular Surgery Departments: a) Correct care for urgent and emerging patients. b) The preparation of a list of preferred patients and temporary treatment criteria. c) The justified and safe delay of elective patients if their pathology and clinical situation allow it. d) The concrete application of ECMO programs in the COVID-19 context.