Psychological effects of social distancing on medical students

Objective: To estimate the prevalence of anxiety and depression symptoms in students. Method: A cross-sectional, descriptive and observational study with a quantitative approach, carried out in a University Center by applying an online electronic form to 170 university students, using the Patient Health Questionnaire-9, an instrument that assesses depressive disorder, and the General Anxiety Disorder-7 scale, which assesses and monitors anxiety. Results: It was verified that 42.9% of the students had moderate anxiety and 37.0% of the participants had moderate depressive disorder. Medical students aged between 25 and 29 years old with no previous psychological disorder were the most susceptible to presenting greater signs of depression and anxiety during the pandemic, and the students reported that they would have liked to have received psychological support from the university during this period. Conclusions: Educational institutions need to provide multilateral support, including early mental health interventions, especially during pandemic times. © 2022,Journal of Mathematical Inequalities.All Rights Reserved.

Caring in times of pandemic: experience of a nursing assistant in Bogotá

Background: Health care in times of pandemic has required a great commitment of the members of health care teams, who have been affected by the many changes. Objective: To describe the experience of caring for a nursing assistant in Bogotá during the Covid-19 pandemic. Methods: Qualitative study, biographical account, an interview was conducted at a nursing assistant frontline care, and thematic analysis of information. Results: The central theme allows to approach the process of going through change, of which five sub-themes are developed that make visible the vulnerability of the participant in this situation and the urgent need for attention. Conclusions: Frontline care in times of pandemic has had many implications that go beyond the professional work and are reflected in the personal, family and social life. © 2021, Fundacion Index. All rights reserved.

Controlling potentially infectious fugitive bioaerosol emissions during nebulizer treatments

INTRODUCTION: Nebulizer treatments can create aerosolized spread of highly-contagious airborne viruses (eg, COVID-19). With increased risk of aerosolized spread within confined ambulance compartments, this study specifically evaluated a specially-designed nebulizer mask modified with expiratory-port filters and a sealing faceplate to minimize fugitive bio-aerosol emissions (FBAE). METHODS: As FBAE carrying contagious viruses typically range from 0.5 to 1.5 micron (μ), a 6-port (0.3-10μ) Kanomax 3889 particle measurement (PM) counter was placed 78 cm from each of 15 rotating adult volunteers (non-patients;beardless;7 women, 8 men;ages 18-59 yrs) sitting upright in one of 3 rotating fleet ambulances using the EMS agency's usual jet-nebulizers on day 1 with either a conventional mask (CM) or an aerosol-controlling mask (ACM). Each person returned on another day using the other mask as indicated. Ambient ambulance PMs (PMamb) were sampled before subjects entered. After re-closing the door and waiting 5 mins, a pre-nebulization PM (preNeb-PM) was made. Jet-nebulizers (using H2O solutions) were then applied (either by CM or ACM) for 5 min followed by post-neb PMs (Post1) and 2 successive PMs (Post2/Post 3), all 5 mins apart, with masks remaining in place. RESULTS: After “treatment”, mean 1μ CM PMs (Post1CM) were 152.2-fold larger (p=0.001) than mean 1μ ACM PMs (Post1ACM), remaining 49.6-fold (p=0.005) and 7.2-fold (p=0.006) larger at Post2 and Post3 readings. PMamb and preNeb-PM were all similar (NSD) for both ACM and CM across all PM sizes (0.5, 1.0, 3.0 μ) including 1μ ACM preNeb-PMs of 6,977/cf vs. 5.683/cf for CM preNeb-PMs (NSD). While mean 1μ Post1ACM readings decreased (-31.7%) from ACM pre-Neb-PM (6,977 to 4,662/cf;p=0.002), the 1μ Post1CM readings rose 14,500.1% (5,683 to 700,549.93/cf;p=0.002) with corresponding elevations for 0.5μ (p=0.001) and 3μ (p=0.002) particles using CM. Of additional note, ACMs were uniformly well-tolerated over the 15 mins being worn. CONCLUSION: Compared to conventional methods, a modified mask system designed specifically to limit aerosolization of inhaled solutions did provide profound control of fugitive aerosolized particle emissions during nebulizer applications. The findings indicate a much safer approach to treating COVID-19 patients and all others requiring nebulization.

To get vaccinated or not? Social psychological factors associated with vaccination intent for COVID-19

Pandemic control not only requires effective COVID-19 vaccines but also that they are accepted by at least 80% of the population. For this reason, understanding the social psychological variables associated with vaccination intent is essential to achieve herd immunity. Drawing on the theory of reasoned action, this study seeks to analyze vaccination intent using the beliefs about vaccine effectiveness, conspiracy theories, and injunctive norms as predictors. A non-probabilistic national online survey was conducted during December 2020. A sample of 1,033 people in Chile answered a questionnaire with the study variables. Using structural equation models, it was found that vaccination intent was explained in 62.1% by beliefs about vaccine effectiveness and injunctive norms, controlling for age, political orientation, socioeconomic status, educational level, and gender. Specifically, beliefs about vaccine effectiveness are based on people's experience with previous immunization processes, which predict vaccination intent. Regarding injunctive norms, they act by influencing and encouraging vaccination by seeking the approval of significant others. Contrary to expected, conspiracy beliefs were not directly associated with the intention to receive a COVID-19 vaccine but were highly related to lower beliefs about vaccine effectiveness. This study suggests that to enhance the vaccination intent, socio-psychological and structural variables need to be considered. © The Author(s) 2021.

Fear of covid-19 in Mexican women with autoimmune rheumatic diseases

Objectives: We aimed to describe the fear of COVID-19 scale in women with autoimmune rheumatic diseases (ARDs) from Mexico. Methods: A cross-sectional study was conducted from September to November 2020 at the Pregnancy and Rheumatic Diseases Clinic from the University Hospital Dr. JoseE. Gonzalez in Monterrey, Mexico. Women with ARDs were invited to participate. The Fear of COVID-19 scale (FCV-19S) was applied. The instrument consists of seven items, each with a five-point Likert scale of options. The maximum possible total is 35 points, with cutoff point score of 16.5. The validated Spanish FCV-19S version was used. Also, sociodemographic data were collected from the medical charts. Results: A total of 83 women were included: 46 were in childbearing age, 32 were postpartum women, 4 were pregnant and 1 was going through menopause. The most frequent diagnosis was rheumatoid arthritis in 41 (49.4%), followed by systemic lupus erythematosus 31 (37.3%), 8 (9.6%) with other diagnosis (Sjogren's syndrome 2, antiphospholipid syndrome 3, and dermatomyositis 2 and psoriatic arthritis 1 patient). The demographic variables are shown in Table 1. The mean level of fear was 18.09 points, which means the fear of COVID-19 screening was highly positive. Regarding the rheumatic diseases group, women in the category of Other diagnoses had a greater mean FCV-19S score (19.0), than patients with systemic lupus erythematosus (17.45) and rheumatoid arthritis (18.8). Also, in the reproductive status classification the postpartum women had the highest mean score (19.68). Only the group of Non diagnostic yet, had a score below the cutoff point. Conclusion: Postpartum women with ARDs had a higher FCV-19S score than women with a different reproductive status. Women with ARDs and especially postpartum women should receive psychological support and be screened for symptoms of depression and anxiety.

Safer Delivery of Aerosolized Medications When Dealing With COVID-19 and Other Contagious Airborne Viruses

Study Objective: Nebulizer treatments for ill patients with chronic lung disease, reactive airways and other respiratory emergencies have been implicated in aerosolized spread of highly contagious airborne viruses, including COVID-19. Considering the increased risk of aerosolized spread of viruses within confined ambulance compartments, this study specifically evaluated a specially designed nebulizer mask modified with expiratory-port filters and sealing faceplates to minimize bio-aerosol spread. Methods: Recognizing that fugitive aerosol emissions (such as those that would possibly carry COVID-19) typically range from 0.5 to1.5 micron (μ), a six-port (0.3–10μ) Kanomax 3889 R particle measurement (PM) counter was placed 78 cm from each of 15 rotating adult volunteers (non-patient, beardless) including 7 women and 8 men, ages 18-59 with a mean age of 39 years. The subjects were each sitting upright on a stretcher within a closed standard ambulance compartment. Assigned to one of three rotating fleet ambulances, subjects used the EMS agency’s usual jet-nebulizers with a conventional mask (CM) and then returned on another day to receive jet-nebulization with the aerosol-controlling mask (ACM) or vice versa (ACM first day, CM next day). After documenting baseline ambient PMs (PM amb) within the compartment, the Kanomax operator quickly brought in a subject, closed the door, and waited 5 minutes before making a pre-nebulization PM (preNeb-PM). Jet-nebulizers (using H 2 0 solutions) were then applied (either by CM or ACM as described) for 5 min with immediate post-nebulization measurements (Post1) and two successive measurements (Post2/Post 3), all five minutes apart. Results: Following the 5-min nebulization, mean CM PMs (Post1 cm) were 152.2-fold larger than mean ACM PMs (Post1 ACM) measurements (p=0.001) and respectively remained 49.6-fold (p=0.005) and 7.2-fold (p=0.006) larger at Post2 and Post3 readings. PM amb and preNeb-PM were all similar (NSD) for both ACM and CM approaches when examining all studied particle sizes (0.5, 1.0, and 3.0 μ) including 1μ preNeb-PMs, measuring 6,977 for ACM approaches and 5,683 for CM use, respectively (NSD). While mean Post1 ACM 1μ PMs decreased (-31.7%) from pre-Neb-PM readings (6,977 to 4,662;p=0.002), counterpart Post1 CM 1μ measurements rose 14,500.09% (from 5,683 to 709,549.93;p=0.002) with corresponding significant elevations for 0.5μ (p=0.001) and 3μ (p=0.002) particle sizes using conventional masks. Of additional note, though applied for just five minutes, ACMs were uniformly well tolerated. Conclusion: Compared to conventional methods, a modified mask system designed specifically to limit aerosolization of inhaled solutions did provide profound control of fugitive aerosolized particle emissions during nebulizer applications. The findings indicate a much safer approach to treating COVID-19 patients and all others requiring nebulization.

Experience with the use of siltuximab in patients with SARS-CoV-2 infection.

OBJECTIVE: The study aims to describe characteristics and clinical outcome of patients with SARS-CoV-2 infection that received siltuximab according to a protocol that aimed to early block the activity of IL-6 to avoid the progression of the inflammatory flare. METHODS: Retrospective review of the first 31 patients with SARS-CoV-2 treated with siltuximab, in Hospital Clinic of Barcelona or Hospital Universitario Salamanca, from March to April 2020 with positive polymerase-chain reaction (PCR) from a nasopharyngeal swab. RESULTS: The cohort included 31 cases that received siltuximab with a median (IQR) age of 62 (56-71) and 71% were males. The most frequent comorbidity was hypertension (48%). The median dose of siltuximab was 800 mg ranging between 785 and 900 mg. 7 patients received siltuximab as a salvage therapy after one dose of tocilizumab. At the end of the study, a total of 26 (83.9) patients had been discharged alive and the mortality rate was 16.1% but only 1 out of 24 that received siltuximab as a first line option (4%). CONCLUSIONS: Siltuximab is a well-tolerated alternative to tocilizumab when administered as a first line option in patients with COVID-19 pneumonia within the first 10 days from symptoms onset and high C-reactive protein.

Low-Intensity Pulmonary Rehabilitation Through Videoconference for Post-Acute COVID-19 Patients

RATIONALE: In mid-March 2020, all rehabilitation centers in Rio de Janeiro closed as a strategy to contain the progress of COVID-19. Patients who went through the acute phase of disease noticed the need for rehabilitation follow-up, at that time was impossible to perform presently. The objective of this study was to verify whether a pulmonary rehabilitation program through videoconference could improve patients' exercise capacity after the acute phase of COVID-19. METHOD: We prospectively evaluated 196 subjects during the post-acute phase of COVID-19, without requiring ICU admission and they were divided into two groups. The Control Group (CG) with 92 subjects receiving no non-drug intervention for six weeks, and the Intervention Group (IG) with 104 subjects that performed a low-intensity Pulmonary Rehabilitation Program (PRP) during 6 weeks, held at home, with a weekly session by videoconference. As all the protocol was performed trough videoconference, the exercise capacity was assessed through 30 seconds sit-to-stand test (STS), the fatigue sensation after the exercise using 10-points Borg Scale, and the Physical Activity in Daily Life (PADL) assessed using a cell phone application that measures moves you in steps/day. RESULTS: The IG after the six weeks of PRP, achieved a significant increase in the STS and PADL, and an important decrease in the sensation of fatigue after exercise (p <0.05). The control group does not present a significant improvement in AFVD and STS and does not show improvement in the fatigue sensation. CONCLUSION: Our findings reinforce the importance of evaluating and offering a low-intensity program for patients after the acute phase of COVID-19, that in this population presented improvement in exercise capacity, AFVD, and feeling of fatigue after 6 weeks, compared to subjects who did not perform a PRP and they did not achieve this improvement after that time.

Tocilizumab reduces the risk of ICU admission and mortality in patients with SARS-CoV-2 infection.

OBJECTIVE: In some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management around the world; therefore, clinical strategies to avoid ICU admission are needed. We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients. METHODS: A retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first. RESULTS: A total of 77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P=0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In the multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0.1, P=0.0001) of ICU admission or death. CONCLUSIONS: Tocilizumab in early stages of the inflammatory flare could reduce an important number of ICU admissions and mechanical ventilation. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports. This is a non-randomized study and the results should be interpreted with caution.

Pneunomia by sars cov-2 in five months old newborn

Introduction: Pneumonias adquired in the community have a high rate of morbility in pediatric ages, besides it is still the main infectious cause of death in developing countries. Pediatric cases recorded with COVID-19 are less frequent than in adults and with lighter features in general sense, specially in newborns. In Cuba more than 70% of pediatric patients possitive to COVID-19 have developed the disease as asymptomatics. Objective: To describe the characteristics of an asymptomatic pediatric patient with pneumonia caused by SARS-Cov-2. Case presentation: Five months old newborn admitted in hospital after a polimerase´s chain reaction test (PCR) possitive to the new coronavirus. At the admittion time as the patient was asymptomatic, it was diagnosed pneumonia by thorax X-ray. It was started a treatment according to the protocol with kaletra chloroquine and ceftriaxone, with evident improvement during the hospital stay. Conclusions: Pneumonia caused by SARS CoV-2 in pediatric ages normally evolves clinically asymptomatic and it is essencial to keep a high rate of suspicion towards this entity which in most of the cases its diagnosis is only by imaging studies. © 2020, Editorial Ciencias Medicas. All rights reserved.

Cutaneous manifestations in pediatric patients infected with sars-cov-2 coronavirus

Introduction: The new coronavirus called SARS-Cov-2 has caused a severe outbreak of the disease called COVID-19. This virus was identified for the first time in Wuhan, China on December,2019. There were recently described its cutaneous manifestations, with clinical similarities among children and adults. There were identified five cutaneous patterns: macular-papular rash, hives, acral lesions pernicious type, vesicular rash and livedo reticularis. Objective: To characterize pediatric patients with cutaneous manifestations during COVID19 disease. Cases presentation: There were studied 10 pediatric patients with COVID-19 admitted in ´´Comandante Manuel Piti Fajardo´´ Military Hospital of Villa Clara province. From the total of patients, eight presented eritemato-papular rash and two had urticariform rash. Urticariform lesions were present just in the girls, the eritomato-papulosa lesions presented similarly in both sexes with slight predominance in female adolescents. Both types of lesions appeared with predominance in the torso and accompanied of slight or absent pruritus. Just the urticariform lesions required medical treatment. Conclusions: The main clinical presentations in the pediatric population attended in the Military Hospital of Villa Clara province are the cutaneous manifestations. Eritematopapular lesions are the most frequent;they have late onset and favorable evolution with no need of treatment and with no other symptomatology. © 2020, Editorial Ciencias Medicas. All rights reserved.

Critical analysis on the use of cholecalciferol as a COVID-19 intervention: a narrative review

BACKGROUND: The World Health Organization has declared that a pandemic situation exists in relation to the disease caused by the new coronavirus, COVID-19. So far, the absence of a vaccine against the new coronavirus has led people worldwide to seek various therapeutic alternatives, including use of cholecalciferol. DESIGN AND SETTING: Narrative review developed by a research group at a public university in Recife (PE), Brazil. METHODS: We searched the literature on the use of cholecalciferol for prevention or treatment of COVID-19, using the MEDLINE and LILACS databases, with the keywords "vitamin D", "cholecalciferol", "SARS-CoV-2", "COVID-19" and "coronavirus", from January 1, 2020, to June 10, 2020. Narrative reviews, cohort studies and ecological studies were selected. RESULTS: We retrieved 32 references, of which 8 were considered eligible for intensive review and critical analysis. These comprised five narrative reviews, two observational studies and one protocol proposal. Most of the studies selected reported positive effects from use of vitamin D for prevention or treatment of COVID-19. However, there was little quantitative data to assess the real impact of using this vitamin as an intervention against this disease. CONCLUSIONS: Current studies on vitamin D used for purposes other than bone health promotion cannot be taken as support to justify its use in a disease as recent as COVID-19. Studies of greater robustness, with higher levels of clinical evidence, need to be conducted. Rational use of this vitamin needs to be ensured, thereby minimizing the impacts on the patient and the public healthcare system.

Paternal experiences of premature babies, music therapy and the kangaroo position: Content analysis

Objective: To understand the experiences and perceptions of fathers of premature babies regarding the realization of the kangaroo position with or without music. Method: Qualitative study with the Family-Centered Care theoretical framework. The sample consisted of parents aged between 19 and 39 years old, who had hospitalized premature newborns and who had the opportunity to perform a kangaroo position with or without music therapy. The collection took place from April to June 2020. The Content Analysis methodological framework was used. Results: The speeches allowed the identification of five categories: Feelings provided by the first kangaroo position;Skin-to-skin contact and the awakening of fatherhood;Re-signifying the kangaroo care method through music;Music and its meanings;Paternal feelings regarding music and COVID-19. Conclusion: Music therapy associated with the kangaroo position for the father was considered a moment which strengthened the father-child bond, as well as reducing sadness and anxiety. © 2021. Online Brazilian Journal of Nursing. All Rights Reserved.