Behavior of COVID-19 virus in an intensive care unit

Introduction: The COVID-19 pandemic affected public health. Objective: To describe the behavior of COVID-19 virus in patients with a confirmed diagnosis in the ICU of the San Juan de Dios University Hospital in Armenia between April and June 2020. Materials and methods: Descriptive cross-sectional study. Variables are described in mean, standard deviation and confidence intervals. A comparative analysis is made by sex and outcome, analysis of variance and Chi square were performed and statistical difference was considered when the p value was less than 0.05. Results: Sixty patients were included, 38% female and 62% male, with a significant difference by gender (p value = .003). The average age was 57 ± 1 years. Symptoms were dyspnea in 98.3%, dyspnea and cough in 38%, dyspnea and fever in 32%, and dyspnea, cough and fever in 12%. The comorbidities were arterial hypertension 33%, diabetes mellitus 21% and obesity 25%. Dimer D (763 ng/ml), ferritin (1253 ng/ml) and LDH (426 U/l) were elevated. The oxygenation index was decreased (114 mm/Hg). Chest X-rays showed pneumonia in 78% and infiltrates in all four quadrants in 7%, and chest CT showed a ground glass image in 47% and multifocal pneumonia in 20%. The average stay in the ICU was 13.55 days, with a range between 0 and 41 days. Conclusions: The patients presented a moderate to severe oxygenation disorder, which is why they required mechanical ventilation and prone position and 45% died. © 2023

Behavior of COVID-19 virus in an intensive care unit

Introduction: The COVID-19 pandemic affected public health. Objective: To describe the behavior of COVID-19 virus in patients with a confirmed diagnosis in the ICU of the San Juan de Dios University Hospital in Armenia between April and June 2020. Materials and methods: Descriptive cross-sectional study. Variables are described in mean, standard deviation and confidence intervals. A comparative analysis is made by sex and outcome, analysis of variance and Chi square were performed and statistical difference was considered when the p value was less than 0.05. Results: Sixty patients were included, 38% female and 62% male, with a significant difference by gender (p value = .003). The average age was 57 ± 1 years. Symptoms were dyspnea in 98.3%, dyspnea and cough in 38%, dyspnea and fever in 32%, and dyspnea, cough and fever in 12%. The comorbidities were arterial hypertension 33%, diabetes mellitus 21% and obesity 25%. Dimer D (763 ng/ml), ferritin (1253 ng/ml) and LDH (426 U/l) were elevated. The oxygenation index was decreased (114 mm/Hg). Chest X-rays showed pneumonia in 78% and infiltrates in all four quadrants in 7%, and chest CT showed a ground glass image in 47% and multifocal pneumonia in 20%. The average stay in the ICU was 13.55 days, with a range between 0 and 41 days. Conclusions: The patients presented a moderate to severe oxygenation disorder, which is why they required mechanical ventilation and prone position and 45% died. © 2023

Adverse right ventricular remodeling in severe obstetric patients with COVID-19

Introduction: COVID-19 has led to an increased incidence of right ventricular remodeling in severe obstetric patients. Objective: To identify the diagnostic elements that influenced the occurrence of right ventricular remodeling in severe obstetric patients with COVID-19.Methods: A descriptive, cross-sectional, single-center study was performed in 53 severe obstetric patients with COVID-19.Results: The most significant average echocardiographic values were TAPSE (15.4mm), right ventricular end-diastolic diameter (31.3mm) and RV/LV ratio (0.75). An increase in troponins (39.5 ng/L), CPK (338.4 U/L) and CK-MB (51.3 U/L) was observed on admission to the intensive care units, and greater ventricular dilatation and dysfunction were observed in pregnant women with high dímero D (84.6% and 76.9% respectively). AHT (32.07%) was the predominant obstetric risk factor, while patients with bronchial asthma (77.7%) and obesity (69.2%) presented greater dilatation and ventricular dysfunction, respectively. LV ejection fraction constituted the only factor associated with patient survival (p = 0.01).Conclusions: In severe obstetric patients due to COVID-19 decreased TAPSE values and RV dilatation were the main echocardiographic features found. In addition, there was a considerable increase in troponin, CPK and CK-MB values. Greater right ventricular dilatation and dysfunction were recorded in asthmatic and obese women, respectively, with elevated D-dimer values. LV ejection fraction was the only independent factor related to survival in these patients. © 2022, Cuban Society of Cardiology, Cuban Institute of Cardiology and Cardiovascular Surgery. All rights reserved.

Impact of SARS-CoV-2 (COVID-19) on the mental health of healthcare professionals: a systematic review

Background: In times of this global pandemic situation, population's mental health is compromised, especially in those groups that are at the forefront of defense against the virus such as healthcare professionals. The objective of this study was to analyze the impact of the SARS-CoV-2 outbreak on healthcare professionals' mental health.

A multidimensional security approach to Colombia's biodefense against future pandemics

Before the COVID-19 outbreak, infectious diseases did not attract much political or social attention in Colombia. Now, it is clear that an infectious disease can levy an intolerable burden on society and the State. This article seeks to determine whether possible future pandemics can be considered a threat to Colombia's multidimensional security. Based on this research's first installment statements, this work begins by studying the main epidemiological outbreaks so far in the 21st century. Next, it analyzes the evolution of the current pandemic's threat and its social, economic, and geopolitical effects. Then, it reflects on whether this type of pandemic should be considered a threat to multidimensional security. Finally, it proposes some recommendations to the Colombian Government for anticipating and preparing the State's biodefense to face an impending pandemic. © 2021 Escuela Militar de Cadetes. All rights reserved.

Infection Risk in Lymphoproliferative Diseases (LPD) Treated with Targeted Drugs. Geltamo Real-Life Experience

Introduction:Recently there has been a renewal of therapeutic tools for the treatment of lymphoid neoplasms to increase the antitumor efficacy and reduce the toxicity generated by conventional chemotherapies, which adds to the intrinsic immunological dysfunction of the disease itself. To date, few data are published about infection risk of these new drugs, and the need for infectious prophylaxis is unknown. The aim of the study is to analyze the infectious complications in patients with LPD treated with monoclonal antibodies (obinutuzumab, ofatumumab, brentuximab, nivolumab and pembrolizumab), BTK inhibitors (ibrutinib, acalabrutinib) and PI3K inhibitors (idelalisib). Methods: Multicenter retrospective study in patients with LPD treated with targeted therapies (single agents or combination) in 18 Hematology centers in Spain, from the time of their commercial availability to March 2020. Patients in clinical trials were excluded as well as patients with active infections at the beginning of treatment. Results:During the study period, 380 patients were included.Baseline characteristics of the entire cohort are shown in Table 1.Median follow-up was 17.3 months (range 0-103), the longest follow-up corresponding to CLL patients (24 months, range 0-98) and the shortest to LBCL (5 months, range 0-25). Median exposure to target drugs was 8 months (range 0-72).Ibrutinib was administered to 219 patients(1 FL, 147 CLL, 27 MCL, 10 DLBCL, 1 TL and 32 WM, 1 HL),Brentuximab to 49(31 HL, 14 TL and 4 DLBCL) andIdelalisibto 35 patients (16 affected by chronic lymphocytic leukemia - CLL, 15 FL and 1 DLBCL, 1 WM, 1MCL, 1HL).Obinutuzumabcombinations were used in 10 (6 CLL, 3 FL, 1 MCL) and 5 HL patients (of which 4/5 underwent previous BMT) receivedNivolumab. A total number of 237 infectious events occurred in 148/380 patients (38.9%), 39% of which were grade 3 and 54/148 (36.4%) experienced 2 or more infective episodes: of those 54, 21 (38%) had underwent 3 or more lines of therapy and 28 (51%) had hypogammaglobulinemia. Hospitalization was required in 59.2% events. A bacterial cause of infection was reported in 40% of cases, and viral in 16%, including 11/237 (4,6%) SARS-CoV-2 infection. Invasive fungal infection (IFI) occurred in 3.3% (8/237). Noteworthy, no case of PJP was identified. Lung was the most frequent site of infection in 24% of cases (57/237) while the upper respiratory tract was involved in 17% of events (41/237). Urinary tract infections were diagnosed in 10% (24/237). Other sites involved were skin and soft tissue 7%, gastrointestinal tract 5,4%, bloodstream infections 3% and catheter related infections 2,5%. Considering drugs individually, 86 patients that receivedIbrutinib(39.2 %)experienced a total of 137 infectious episodes: 30% bacterial, 19% viral, 5% fungal and 45% clinical and image-based infections;the 17(34.6%of those who received Brentuximab, experienced a total of 16 infectious episodes: 56% bacterial, 37.5% viral infections and one catheter-related sepsis. Of those who receivedIdelalisib,18 (51.4%)experienced a total of 28 episodes: 42% bacterial, 14% viral and 7% fungal. Four patients treated withObinutuzumabcombinations (40%) experienced one infection during treatment (25% bacterial and 75% viral). Only one patient treated withNivolumabexperienced more than three infections, he was also under corticosteroid treatment. Focusing on IFI (Table 2): 7/8 infections were identified in CLL patients, 6 out 7 being on ibrutinib treatment and 1/7 on Idelalisib.Aspergilluswas the fungus most frequently isolated. The targeted drug was discontinued temporarily in 4 patients and indefinitely in 3. Twenty three (6%) patients died due to infection in our series. Conclusions: 1. We identified 38.7% infections in our LPD patients treated with targeted drugs, with a median drug-exposure time of 8 months (range 0-72), with a non-negligible incidence of bacterial infections. 2. The highest rates of infection were found in patients treated with with Idelalisib and Ibrutinib (51.4% and 39.2% respectively). 3. IFI (3.3%) occurr d with low frequency, mostly in CLL patients during ibrutinib treatment, leading to its temporal discontinuation in most of the cases. 4. No case of PJP was identified in our cohort. 5. An analysis to determine risk factors for infection and the optimal monitoring and prophylaxis for these patients is ongoing. [Formula presented] Disclosures: Hernandez-Rivas:Janssen:Membership on an entity's Board of Directors or advisory committees;Abbvie:Membership on an entity's Board of Directors or advisory committees;Roche:Membership on an entity's Board of Directors or advisory committees;AstraZeneca:Membership on an entity's Board of Directors or advisory committees;Gilead:Membership on an entity's Board of Directors or advisory committees;Celgene/BMS:Membership on an entity's Board of Directors or advisory committees;Rovi:Membership on an entity's Board of Directors or advisory committees.Lopez-Guillermo:novartis:Consultancy;celgene:Consultancy, Research Funding;roche:Consultancy, Research Funding;gilead:Consultancy, Research Funding.

COVID-19 impact on nurses in Spain: a considered opinion survey.

AIM: To survey nurses' opinions about their work conditions at the onset of the COVID-19 pandemic in Spain. BACKGROUND: For the Spanish General Council of Nursing (the Consejo General de Enfermería de España), it was essential to have information on nursing workforce conditions and nurses' preparedness to wear protective measures at the pandemic's onset. The coronavirus outbreak was believed to have started in China and rapidly spread as a global pandemic requiring policies and actions for planning emergency healthcare delivery. METHODS: A cross-sectional survey was conducted online. Data were collected during April 2020 and covered social demography, working conditions, training, availability of personal protective equipment, and nurses' health conditions, including the impact of COVID-19. FINDINGS: From all national territories in Spain, 11 560 registered nurses from different services completed the questionnaire. Findings indicated that the lack of personal protective equipment was a crucial issue, as well as service planning and organization, and 80.2% reported high or very high psychological impact of COVID-19. Alarmingly, 29.5% of the nurses reported COVID-19 symptoms. Of these 23.3% had been tested, and 30.2% were confirmed as being positive to the virus. The nurses deemed proper preparedness for emergencies and disasters as a significant concern. CONCLUSION: Nurses' responses showed evidence of health services deficiencies as a source of damage to their capacity to provide safe patient care and protect themselves and their families' health. The working conditions of the nurses are at critical levels and are unacceptable. The study results provide evidence regarding the necessity of suitable planning and actions being taken to enable safe patient care and safety for nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Our survey gathered nurses' views at the pandemic's onset. The evidence gathered is being used to advise policymakers and nursing organizations to take actions to control public health risks to populations. It is necessary that more investment in growing nursing workforce expertise and health infrastructure for pandemic and epidemic emergencies is provided.

Nutritional recommendations for healthcare and essential personnel exposed to COVID-19 in Latin America

These recommendations are based on current scientific evidence obtained through meta-analysis and systematic reviews on nutrition and the prevention of respiratory infections related to SARS-CoV, MERS-CoV or influenza, similar in structure to SARS-CoV-2. They are aimed at primary health care personnel and to those who provide essential services to the community and are, consequently, at high risk of COVID-19 infection. These individuals wear personal protective equipment, work long shifts, sometimes under extreme conditions, which can lead to insufficient rest, high stress levels, depression, poor nutrition and dehydration. Together, these factors have a negative impact on the immune system and could result in an increased risk of infection. An adequate intake of micronutrients and other bioactive compounds is essential for optimal immune performance. There is moderate evidence supporting supplementation, individually, with vitamin C (2 000 mg), vitamin D (1 000-2 000 IU) and zinc (=40 mg) for the prevention of respiratory infections in adults. Insufficient evidence was found to support supplementation with vitamin A, niacin, folic acid, B12, omega 3, probiotics and polyphenols;however, the consumption of foods rich in these nutrients is recommended to support immune function. It is recommended that workers follow the recommendation of consuming 400 g/day of fruits and vegetables, remain hydrated and limit caffeine. There is no scientific evidence supporting the consumption of alkaline foods to prevent infections. The aforementioned recommendations are particularly relevant during the pandemic.

Micronutrient recommendations for vulnerable groups in context of undernutrition, during the COVID-19 pandemic in Latin America

The COVID-19 crisis (SARS-CoV-2) might transform into a food catastrophe in Latin America and would increase the number of people suffering from hunger from 135 to 265 million, particularly in Venezuela, Guatemala, Honduras, Haiti and El Salvador, already facing economic and health crises. This manuscript presents the position of a group of Latin American experts in nutrition for establishing the recommendations for consumption and/or supplementation with vitamin A, C, D, zinc, iron, folates and multiple micronutrients, in undernutrition contexts, for vulnerable population of pregnant and lactating women, children under 5 years and the elderly. The recommendations seek to decrease the potential impact that COVID-19 will have on nutritional status during the pandemic. The position arises from the discussion of the experts based on the review of current scientific evidence for these vulnerable groups. It aims to reach stakeholders, public policy makers, health personnel and civil society organizations. Only after breastfeeding and a sufficient diet in terms of quantity and quality, a supplementation with the micronutrients mentioned above can help prevent and treat viral diseases, strengthen the immune system and even reduce complications. Breastfeeding with respiratory hygiene measures, the provision of multiple micronutrients powders for children from 6 moths to 5 years of age and the supply of iron and folates or multiple micronutrients tablets for pregnant women are proven and effective strategies that must continue to be implemented during COVID-19 pandemic. For older adults, supplementation with vitamin C, D and zinc might be indicated.

[Impact of SARS-CoV-2 (Covid-19) on the mental health of healthcare professionals: a systematic review.]

BACKGROUND: In times of this global pandemic situation, population's mental health is compromised, especially in those groups that are at the forefront of defence against the virus such as healthcare professionals. The objective of this study was to analyze the impact of the SARS-CoV-2 outbreak on healthcare professionals' mental health. METHODS: A systematic review was carried out following the PRISMA format in Pubmed, Scopus, Web of Science, CINAHL, PsycINFO and ScienceDirect electronic databases between January and May 2020. Methodological quality was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tools for non-randomized studies. RESULTS: A total of 13 studies were included in this review. Professionals' mental health and mental functions were compromised, being especially affected those professionals on the front line of battle against the virus. However, these stats were below the general population data. Although there is wide variability of results, medium-high levels of anxiety (26,5%-44,6%), depression (8,1%-25%), concern and insomnia are detected (23,6%-38%). Paradoxically, stress levels were below expectations (3,8%-68,3%). CONCLUSIONS: The mental well-being of health professionals working on the front line is compromised in times of pandemic by presenting medium-high levels of anxiety, depression, nervousness and insomnia, and, to a lesser extent, stress.