Neumonía por Aspergillus en paciente pos-COVID-19 / Aspergillus Pneumonia in pos-COVID-19 patient

Introducción: La enfermedad por el nuevo coronavirus SARS-CoV-2 (COVID-19) se extendió rápidamente por todo el mundo y generó un gran desafío. La aparición de coinfecciones se encuentra entre las complicaciones más graves que pueden desarrollar los enfermos. La aspergilosis pulmonar se ha identificado como una complicación de la neumonía por la COVID-19 en los pacientes ventilados en las unidades de cuidados intensivos. Objetivo: Presentar un caso clínico poco común de aspergilosis pulmonar. Caso clínico: Se presenta el caso de una paciente con historia reciente de la COVID-19, con un cuadro clínico enteral dado por diarreas, vómitos e insuficiencia respiratoria en el que concomitan la evolución de un cáncer de colon y neumonía asociada a la ventilación provocada por Aspergillus niger. Conclusiones: La aspergilosis pulmonar asociada a la COVID-19 es una complicación que debe considerarse y buscarse en pacientes con historia reciente de esta enfermedad(AU)

Introduction: The new SARS-CoV-2 coronavirus disease (COVID-19) spread rapidly throughout the world, which created a great challenge. The appearance of coinfections is among the most serious complications that these patients can develop. Pulmonary aspergillosis has been identified as a complication of COVID-19 pneumonia among ventilated patients in intensive care. Objective: To present an unusual clinical case of pulmonary aspergillosis. Clinical case: It is presented the case of a patient with a recent history of COVID-19, with an enteral clinical picture of diarrhea and vomiting plus respiratory failure, in which the evolution of colon cancer and ventilator-associated pneumonia caused by Aspergillus niger are concomitant. Conclusions: Pulmonary aspergillosis associated with COVID-19 is a complication that should be considered and sought in patients with a recent history of this disease(AU)

COVID-19 nas prisões: validação de um inquérito de conhecimento, atitude e prática / COVID-19 en las cárceles: validación de un estudio de conocimiento, actitud y práctica / COVID-19 in prisons: validity of a knowledge, attitude and practice survey

Resumo Objetivo Validar um inquérito de conhecimento, atitude e prática sobre medidas preventivas da COVID-19 para os funcionários do sistema penitenciário, fundamentado na teoria ambientalista. Métodos Estudo metodológico desenvolvido em quatro etapas: estabelecimento da estrutura conceitual, elaboração do instrumento, validação do conteúdo por juízes e avaliação da aparência pelo público-alvo. O conteúdo de cada item foi validado quanto a objetividade, clareza e relevância. A aparência do inquérito foi avaliada quanto ao objetivo, a organização, ao estilo da escrita e a motivação. Utilizou-se o coeficiente de validação de conteúdo para avaliar a concordância entre os juízes e entre o público-alvo. Os dados foram analisados por meio de distribuições brutas, percentuais, medidas de posição e de dispersão. O índice alfa de Cronbach foi utilizado para analisar a consistência das avaliações dos juízes e do público-alvo. Resultados Quanto ao conteúdo e a aparência, os requisitos avaliados obtiveram concordância superior a 0,9. Na avaliação da consistência, obteve-se índice alfa de Cronbach > 0,9 e > 0,7, quanto ao conteúdo e à aparência, respectivamente, indicando que juízes e público-alvo tenderam a fazer avaliações similares. Conclusão O inquérito apresentou validade de conteúdo e aparência para a coleta de dados referentes a conhecimento, atitude e prática sobre prevenção da COVID-19, para os funcionários do sistema penitenciário, indicando que poderá contribuir para o planejamento e a avaliação de ações de educação em saúde.

Resumen Objetivo Validar un estudio de conocimiento, actitud y práctica sobre medidas preventivas de COVID-19 para los empleados del sistema penitenciario, fundamentado en la teoría ambientalista. Métodos Estudio metodológico llevado a cabo en cuatro etapas: establecimiento de la estructura conceptual, elaboración del instrumento, validación del contenido por jueces y evaluación de la apariencia por el público destinatario. Se validó el contenido de cada ítem respecto a la objetividad, claridad y relevancia. Se evaluó la apariencia del estudio respecto al objetivo, la organización, el estilo de escritura y la motivación. Se utilizó el coeficiente de validez de contenido para evaluar la concordancia entre los jueces y entre el público destinatario. Los datos se analizaron mediante distribuciones brutas, porcentajes, medidas de posición y de dispersión. Se utilizó el índice alfa de Cronbach para analizar la consistencia de las evaluaciones de los jueces y del público destinatario. Resultados Respecto al contenido y a la apariencia, los requisitos evaluados obtuvieron concordancia superior a 0,9. En la evaluación de la consistencia, se obtuvo un índice alfa de Cronbach > 0,9 respecto al contenido y > 0,7 respecto a la apariencia, lo que indica la tendencia de los jueces y del público destinatario a realizar evaluaciones similares. Conclusión El estudio presentó validez de contenido y apariencia para la recopilación de datos referentes a conocimiento, actitud y práctica sobre prevención de COVID-19 para empleados del sistema penitenciario, lo que indica que podrá contribuir a la planificación y evaluación de acciones de educación para la salud.

Abstract Objective To validate a knowledge, attitude and practice survey on preventive measures against COVID-19 for penitentiary system staff based on environmental theory. Methods This is a methodological study developed in four stages: conceptual structure establishment; instrument elaboration; content validity by judges; and appearance assessment by the target audience. The content of each item was validated for objectivity, clarity and relevance. Survey appearance was assessed regarding objective, organization, writing style and motivation. Content validity coefficient was used to assess agreement among judges and the target audience. Data were analyzed using gross distributions, percentages, position and dispersion measures. Cronbach's alpha index was used to analyze the consistency of judges' and target audience's assessments. Results Regarding content and appearance, the assessed requirements achieved agreement greater than 0.9. In consistency assessment, a Cronbach's alpha index > 0.9 and > 0.7 was obtained for content and appearance, respectively, indicating that judges and target audiences tended to make similar assessments. Conclusion The survey presented content and appearance validity for collecting data regarding knowledge, attitude and practice regarding COVID-19 prevention for penitentiary system staff, indicating that it could contribute to health education action planning and assessment.

Atención a la paciente obstétrica en el contexto de la pandemia de COVID-19 / Obstetric patient care in the context of COVID-19 pandemic

La infección causada por el SARS-CoV-2, tuvo una repercusión negativa en la evolución clínica de un número importante de gestantes y puérperas en todo el mundo. Este trabajo tiene como objetivo, exponer los principales resultados de la organización del proceso de atención a la paciente obstétrica en el contexto de la pandemia por la COVID-19. Está basado en la organización y elementos fundamentales seguidos con las pacientes que ingresaron, por afecciones relacionadas con el aborto, embarazo o puerperio, con sospecha de COVID-19 o con RT-PCR para SARS-CoV-2 positivo, en el año 2020, y las positivas al SARS-CoV-2 en 2021, de las provincias La Habana, Mayabeque y Artemisa, que fueron atendidas en el Hospital Militar Central Dr. Luis Díaz Soto. Se tuvo en cuenta el total de casos ingresados, pacientes confirmadas, ingresos en unidad de cuidados intensivos obstétricos, en servicio de vigilancia intensiva obstétrica, y la evolución clínica Con la organización de la atención médica a las pacientes obstétricas con la COVID-19, se logró el cumplimiento de los protocolos establecidos y la integración multidisciplinaria en el seguimiento de los casos, lo cual contribuyó a la evolución favorable de la mayoría de las pacientes(AU)

The infection caused by SARS-CoV-2 had a negative impact on the clinical evolution of a significant number of pregnant and puerperal women worldwide. The aim of this work is to present the main results of the organization of the obstetric patient care process in the context of the COVID-19 pandemic. It is based on the organization and fundamental elements followed with the patients who were admitted, for conditions related to abortion, pregnancy or puerperium, with suspicion of COVID-19 or with positive RT-PCR for SARS-CoV-2, in the year 2020, and those positive to SARS-CoV-2 in 2021, from Havana, Mayabeque and Artemisa provinces, who were attended at the Central Military Hospital Dr. Luis Díaz Soto. The total number of cases admitted, confirmed patients, admissions to the obstetric intensive care unit, obstetric intensive surveillance service, and clinical evolution were taken into account. With the organization of medical care for obstetric patients with COVID-19, compliance with established protocols and multidisciplinary integration in the follow-up of cases was achieved, which contributed to the favorable evolution of most patients(AU)

Impacto psicológico de la pandemia de la COVID-19 en personal sanitario / Psychological impact of the COVID-19 pandemic on health professionals

Introducción: La rápida propagación de la COVID-19 a escala mundial ocasionó el colapso de los sistemas sanitarios, lo cual contribuyó a que el personal sanitario incrementara el agotamiento sufrido, tanto físico como mental. Objetivo: Determinar el impacto psicológico de la pandemia de la COVID-19 en el personal sanitario. Métodos: Estudio multicéntrico transversal, en 145 sujetos que se desempeñaron como personal sanitario en el periodo de enero a diciembre de 2021. La información se recopiló a través de un formulario online, precisando edad, sexo, antecedentes patológicos personales, institución, categoría laboral, acceso diario a información sobre la COVID-19, asistencia directa a pacientes infectados y muerte de personas cercanas. Se aplicó el Cuestionario de Salud General. Se utilizó la prueba de U de Mann-Whitney para buscar diferencias en la puntuación general reportada. Resultados: Presentaron un impacto psicológico alto el 62,1 por ciento de los encuestados; el 70,0 por ciento eran médicos y enfermeras; el 62,2 por ciento accedía más de 2 h al día a información sobre la COVID; el 64,4 por ciento participó directamente en la atención a pacientes infectados y el 35,6 por ciento había perdido a personas cercanas por la pandemia. Ser mujer (p= 0,008), acceder a información sobre la COVID-19 más de 2 h al día (p= 0,026), asistir directamente a pacientes infectados (p= 0,033) y la muerte de personas cercanas (p= 0,018) tuvo diferencias estadísticamente significativas en el impacto psicológico. Conclusiones: La pandemia de la COVID-19 se asocia a un impacto psicológico alto en el personal sanitario(AU)

Introduction: The fast spread of COVID-19 around the world caused health systems collapse, which contributed to increase fatigue suffered by health workers, physical as well as mental. Objective: To determine psychological impact of COVID-19 pandemic on health professionals. Methods: A multicenter cross-sectional study was carried out in 145 subjects who worked as health professionals from January to December 2021. This information was collected in an online form. Age, sex, medical record, institution, work category, daily access to COVID-19 information, direct assistance to infected patients and close people death was considered parameters in the applied form. Mann-Whitney U test was applied to find differences in the overall reported score. Results: 62.1 percent of health workers presented a High Psychological Impact, 70.0 percent were medical and nursing staff; 62.2 percent accessed to information about COVID-19 for more than 2 hours daily, 64.4 percent assisted infected patients directly, and 35.6 percent experienced close people death due to the pandemic. Being a woman (p= 0,008), accessing information about COVID-19 for more than 2 hours daily (p= 0,026), directly assisting infected patients (p= 0,033), and the death of close people (p= 0,018) had statistically significant differences in psychological impact. Conclusions: The COVID-19 pandemic is associated with a high psychological impact in health workers(AU)

Adicción a los teléfonos inteligentes en adolescentes tras la pandemia por la COVID-19 / Smartphone addiction in adolescents after the COVID-19 pandemic

Introducción: La pandemia por la COVID-19 trajo consigo cambios en el comportamiento humano y afecciones psíquicas que afectan la salud mental. Objetivo: Estimar la adicción a los teléfonos inteligentes en adolescentes mujeres tras la pandemia por la COVID-19. Métodos: Estudio transversal realizado en noviembre y diciembre del 2022, en una institución educativa pública de Ica, Perú. Participaron 581 adolescentes que respondieron a un cuestionario con variables generales y la Escala de Adicción a los Teléfonos Inteligentes. Se aplicó un análisis estadístico descriptivo y multivariado mediante modelos lineales generalizados de la familia Poisson para evaluar la asociación entre las variables. Resultados: De las participantes, el 21,7 por ciento reveló adicción a los teléfonos inteligentes y el 48,7 por ciento se encuentra en riesgo alto de dependencia. Los conflictos familiares en el hogar (razón de prevalencia ajustada - RPa= 1,41; intervalo de confianza -IC 95 por ciento: 1,00-1,99) y los sentimientos de vergüenza (RPa= 1,44; IC 95 por ciento: 1,01-2,03), se asociaron a mayor adicción a los teléfonos inteligentes. No obstante, el sentimiento de tristeza, ansiedad o depresión y el hecho de sentirse rechazado por la sociedad presentaron asociación, no ajustada. Conclusiones: La adición a los teléfonos inteligentes y el riesgo de padecer este trastorno es alto en las adolescentes; existen variables generales susceptibles de ser modificadas que podrían mermar dicha afección comportamental inducida o potenciada por la pandemia de la COVID-19(AU)

Introduction: The COVID-19 pandemic brought with it changes in human behavior and psychic conditions that affect mental health. Objective: Estimate smartphone addiction in female adolescents after COVID-19 pandemic. Methods: Cross-sectional study, conducted during November to December 2022, in a public educational institution in Ica, Peru. A total of 581 adolescents participated and answered a questionnaire with general variables and the Smartphone Addiction Scale. A descriptive and multivariate statistical analysis was applied using Poisson family generalized linear models to evaluate the association between variables. Results: Of the participants, 21.7 percent revealed addiction to smartphones and 48.7 percent were at high risk of dependence on these devices. Family conflicts at home (adjusted prevalence ratio-RPa = 1.41; 95 percent confidence interval-CI: 1.00-1.99) and feelings of shame (RPa = 1.44; 95 percent CI: 1.01-2.03), were associated with higher smartphone addiction. However, feelings of sadness, anxiety or depression and feeling rejected by society showed an unadjusted association. Conclusions: Smartphone addiction and risk for this disorder is high in adolescent girls; there are general variables amenable to modification that could diminish such a behavioral condition induced or potentiated by the COVID-19 pandemic(AU)

Percepción de los universitarios sobre las repercusiones académicas originadas por la pandemia de COVID-19 / University Students' Perceptions of the Academic Impact of the COVID-19 Pandemic

Introducción: Durante la pandemia de la COVID-19, la educación superior ha enfrentado la transición a la educación no presencial, con importante repercusión tanto en el rendimiento académico como en otros aspectos de la vida de los estudiantes. Objetivo: Aportar validez a la escala ACAD-COVID-19 y evaluar la percepción de los universitarios limeños acerca de las repercusiones académicas originadas por la pandemia de la COVID-19. Métodos: El estudio fue de diseño descriptivo y transversal, durante el año 2021. Se obtuvo una muestra conformada por 608 estudiantes del primer año académico de diferentes carreras, de 5 universidades de Lima. Se aplicó la escala ACAD-COVID-19 de 8 ítems y alternativas en escala Likert. Se realizaron análisis descriptivos y factoriales, utilizando SPSS versión 26.0. Resultados: Se evidenció que el instrumento es confiable. Se determinaron 3 factores, que pueden asociarse a las dimensiones académica, económica y el temor propio hacia enfermedad o muerte generada por la COVID-19. El 61,3 por ciento de los estudiantes limeños manifiestan indiferencia respecto a la percepción sobre el impacto académico generado por el coronavirus, con un promedio general de los ítems de 3,21. La mayor media fue de la pregunta 5 (3,47). Conclusiones: Se aportó validez a la escala ACAD-COVID-19 con su aplicación a la población universitaria limeña en un período de cuarentena durante el 2021. Los estudiantes, en general, manifestaron indiferencia en su percepción sobre el impacto académico generado por el coronavirus, aunque dentro de las repercusiones percibidas, predomina el miedo a enfermar al volver a las clases presenciales(AU)

Introduction: During the COVID-19 pandemic, higher education has faced the transition to distance learning, with important repercussions on academic performance as well as on other aspects of students' lives. Objective: To provide validity to the ACAD-COVID-19 scale and to evaluate the perception of university students in Lima about the academic repercussions caused by the COVID-19 pandemic. Methods: The study was of descriptive and cross-sectional design, during the year 2021. A sample of 608 students in their first academic year of different careers from 5 universities in Lima was obtained. The ACAD-COVID-19 scale of 8 items and Likert scale alternatives was applied. Descriptive and factorial analyses were performed using SPSS version 26.0. Results: The instrument was found to be reliable. Three factors were determined, which can be associated with the academic, economic and fear of illness or death generated by the COVID-19. 61.3 percent of the students from Lima expressed indifference with respect to the perception of the academic impact generated by the coronavirus, with an overall average of 3.21 for the items. The highest mean was for question 5 (3.47). Conclusions: Validity was provided to the ACAD-COVID-19 scale with its application to the Lima university population in a quarantine period during 2021. Students, in general, expressed indifference in their perception of the academic impact generated by the coronavirus, although among the perceived repercussions, the fear of getting sick when returning to classes was predominant(AU)

La niebla mental, una manifestación neurocognitiva del síndrome post-COVID-19 / Brain fog, a neurocognitive manifestation of the post-COVID-19 syndrome

Introducción: La COVID-19, infección causada por el SARS-CoV-2, ocasiona daños a diferentes órganos y sistemas, como el sistema nervioso central. Entre las alteraciones neurológicas se describe la niebla mental como manifestación neurocognitiva frecuente en el síndrome post-COVID-19, con un impacto negativo en la calidad de vida de los pacientes. Se revisaron 104 artículos publicados desde junio 2020 a octubre del 2022, en las bases de datos Pubmed, Medline, Lilacs y Cumed. Objetivo: Actualizar conocimientos sobre las manifestaciones neurocognitivas de niebla mental en el síndrome post-COVID-19. Desarrollo: Se describen alteraciones neurocognitivas de niebla mental, trastornos de atención, concentración y memoria, asociados a otros síntomas neurológicos, como cefalea, insomnio, anosmia, ageusia, ansiedad, depresión, y otros síntomas persistentes, que caracterizan al síndrome post-COVID-19. Se hace referencia a elementos de la etiopatogenia, resaltando la respuesta inmune sistémica exagerada, generada por la liberación de citoquinas, aspectos a tener presentes para la conducta diagnóstica y terapéutica de los pacientes post-COVID-19. Conclusiones: Los síntomas neurocognitivos de niebla mental, constituyen las alteraciones neurológicas frecuentes del síndrome post-COVID-19, son variados, con combinación de diferentes síntomas en cada enfermo, más frecuentes en mujeres y en pacientes que presentaron enfermedad grave(AU)

Introduction: COVID-19, infection caused by SARS-CoV-2, causes damage to different organs and systems, such as the central nervous system. Among the neurological alterations, brain fog is described as a frequent neurocognitive manifestation in post-COVID-19 syndrome, with a negative impact on patients' quality of life; 104 articles published were reviewed from June 2020 to October 2022, in Pubmed, Medline, Lilacs and Cumed databases. Objective: To update knowledge on the neurocognitive manifestations of brain fog in post-COVID-19 syndrome. Development: Neurocognitive alterations of mental fog, attention, concentration and memory disorders, associated with other neurological symptoms, such as headache, insomnia, anosmia, ageusia, anxiety, depression, and other persistent symptoms, which characterize post-COVID-19 syndrome, are described. Reference is made to elements of the etiopathogenesis, highlighting the exaggerated systemic immune response, generated by the release of cytokines, aspects to keep in mind for the diagnostic and therapeutic conduct of post-COVID-19 patients. Conclusions: The neurocognitive symptoms of brain fog are frequent neurological alterations of post-COVID-19 syndrome, they are varied, with a combination of different symptoms in each patient, more frequent in women and in patients who presented severe disease(AU)

Impacto de la COVID-19 en la superación profesional en el Centro de Posgrado "Hermanos Ameijeiras" / Impact of COVID-19 on Professional Development at Centro de Posgrado Hermanos Ameijeiras

La COVID 19 ha impactado en todos los ámbitos de la vida social y cultural. Es significativa la influencia deletérea que ha ejercido sobre todos los niveles educacionales, en particular en la educación superior. En el caso específico de la actividad de superación profesional en el Centro de Posgrado Hermanos Ameijeiras, los efectos negativos han resultado evidentes. No obstante, la situación generada constituyó, al mismo tiempo, una oportunidad para el desarrollo y la consolidación de la docencia a distancia como una modalidad que permitió mantener la vitalidad de la enseñanza y de la preparación metodológica de los profesores, en correspondencia con la necesidad de garantizar la continuidad de estudios en situaciones de contingencia, por lo que el objetivo de este artículo fue exponer los efectos de la contingencia epidemiológica causada por la COVID-19 sobre la actividad de superación profesional en el Centro de Posgrado Hermanos Ameijeiras(AU)

COVID 19 has had an impact on all areas of social and cultural life. The deleterious influence that it has exerted on all educational levels, particularly in higher education, is significant. In the specific case of professional development activities at Centro de Posgrado Hermanos Ameijeiras, the negative effects have been evident. However, the situation generated was, at the same time, an opportunity for the development and consolidation of distance teaching as a modality that allowed maintaining the vitality of teaching and the methodological preparation of professors, in correspondence with the need to guarantee the continuity of studies in contingency situations; therefore, the objective of this article was to expose the effects of the epidemiological contingency caused by COVID-19 on the activity of professional development at Centro de Posgrado Hermanos Ameijeiras(AU)

First management of percutaneous dilatational tracheostomy in severe acute respiratory syndrome coronavirus 2 akin to the vital head and neck region and thyroid gland bed: trust, but be careful whom (you trust)?

OBJECTIVE: The objective of this study was to compare the clinical outcomes of percutaneous dilatational tracheostomy in COVID-19 and non-COVID-19 patients. METHODS: A total of 48 patients who underwent percutaneous dilatational tracheostomy, with 24 COVID-19 patients (Group C) and 24 non-COVID-19 patients (Group N), were included in the study. Patients' demographic features including age and gender, time to intubation, duration of intubation, Acute Physiology and Chronic Health Evaluation scores, comorbidities, duration of opening tracheostomy, complications, duration of mechanical ventilation, length of stay in the intensive care units, and mortality were recorded and compared between the groups. RESULTS: There was no statistically significant difference between the groups regarding age and gender (p=0.558 and p=0.110, respectively). Time to intubation was significantly more prolonged, and intubation follow-up duration was significantly shorter in Group C compared to Group N (p=0.034 and p=0.002, respectively). The Acute Physiology and Chronic Health Evaluation score was statistically significantly higher in Group N compared with Group C (p=0.012). The most common comorbidity was hypertension in 29 (60.4%) patients, followed by cerebrovascular disease in 19 (39.6%) patients. There was no statistically significant difference between the groups regarding mortality (p=0.212). CONCLUSION: This study suggests that percutaneous dilatational tracheostomy can be performed safely in COVID-19 and non-COVID-19 patients. However, COVID-19 patients may have a longer time to intubation and shorter intubation follow-up duration than non-COVID-19 patients. The study also found a higher incidence of complications in COVID-19 patients undergoing percutaneous dilatational tracheostomy. These results emphasize the importance of careful patient selection, meticulous technique, and close postoperative monitoring in patients undergoing percutaneous dilatational tracheostomy, particularly in those with COVID-19.

Bariatric Surgery Before and After the SARS-CoV-2 Pandemic: a Comparative Study of Cases Before the Onset of the Pandemic in a High-Volume Academic Center.

INTRODUCTION: At the beginning of the pandemic, studies showed a higher risk of severe surgical complications and mortality among patients with perioperative SARS-CoV-2 infection, which led to the suspension of elective surgery. Confinement and lockdown measures were shown to be associated with weight gain and less access to medical and surgical care in patients with obesity, with negative health consequences. To evaluate the safety of bariatric surgery during the pandemic, we compared 30-day complications between patients who underwent bariatric surgery immediately before with those who underwent bariatric surgery during the opening phase of the pandemic. METHODS: Observational analytical study of a non-concurrent cohort of patients who underwent bariatric surgery in 2 periods: pre-pandemic March 1 to December 31, 2019, and pandemic March 1 to December 31, 2020. Surgical complications were defined using the Clavien-Dindo classification. RESULTS: Pre-pandemic and pandemic groups included 256 and 202 patients who underwent primary bariatric surgery, respectively. The mean age was 37.6 + 10.3 years. The overall complication rate during the first 30 days of discharge was 7.42%. No differences between groups were observed in severe complications (pre-pandemic 1.56% vs. pandemic 1.98%, p: 0.58). No mortality was reported. Overall 30-day readmission was 3.28% with no differences between groups. CONCLUSION: The findings of this study did not find a difference in the rate of severe complications, nor also we report severe COVID-19 complications in this high-risk population. During the pandemic, with appropriately implemented protocol, the resumption of bariatric surgery is possible with no increased risk for patients.

Salud mental de los docentes de educación básica durante el retorno a la educación presencial / Mental health of basic education teachers during the return to face-to-face education

Introducción: El retorno a la presencialidad luego de la emergencia sanitaria por la COVID-19 está provocando mucha preocupación en el ámbito laboral a los docentes, por ello, es necesario evaluar su salud mental. Objetivo: Describir la presencia de depresión, ansiedad y estrés de los docentes de educación básica al retorno a la educación presencial. Método: Estudio observacional, descriptivo, de corte transversal. La muestra estuvo conformada por 233 docentes a quienes se les aplicó la Escala de Depresión, Ansiedad y Estrés (DASS-21). Se utilizó la aplicación de mensajería Whatsapp para invitar a los docentes a participar. Se aplicaron métodos estadísticos descriptivos para categorizar las variables según los puntos de corte (leve, moderado y alto) y se utilizó la prueba no paramétrica ji cuadrado con el propósito de determinar si se asociaban con las variables sociodemográficas y laborales propuestas. Resultados: El 56,2 por ciento del total de docentes tenían niveles leves de depresión, el 45,1 por ciento tenían niveles moderados de ansiedad y el 42,9 por ciento también tenían niveles moderados de estrés. Asimismo, se determinó que el sexo se asociaba de manera significativa a las variables de estudio (p< 0,05). Conclusiones: Los docentes de educación básica presentan niveles leves de depresión y niveles moderados de ansiedad y estrés al retorno a la presencialidad. Por otro lado, las mujeres son las que presentan más síntomas de depresión, ansiedad y estrés que los hombres (AU)

Introduction: The return to face-to-face attendance after the health emergency caused by COVID-19 is causing a lot of concern in the workplace for teachers, therefore, it is necessary to evaluate their mental health. Objective: To describe the levels of depression, anxiety and stress of basic education teachers upon return to face-to-face education. Method: Observational, descriptive, cross-sectional study. The sample consisted of 233 teachers who were administered the Depression, Anxiety, and Stress Scale (DASS-21). The messaging application Whatsapp was used to invite teachers to participate. Descriptive statistical methods were applied to categorize the variables according to cutoff points (mild, moderate, and high), and the non-parametric Chi-square test was used to determine if they were associated with the proposed sociodemographic and work-related variables. Results: 56.2 percent of all teachers had mild levels of depression, 45.1 percent had moderate levels of anxiety and 42.9 percent also had moderate levels of stress. Likewise, it was determined that gender was significantly associated with the study variables (p< 0.05). Conclusions: Basic education teachers experience mild levels of depression and moderate levels of anxiety and stress upon returning to in-person instruction. On the other hand, women show more symptoms of depression, anxiety, and stress than men(AU)

Linfocitopenia como biomarcador de gravedad en pacientes pediátricos con la COVID-19 / Lymphocytopenia as a biomarker of severity in pediatric patients with COVID-19

Introducción: La COVID-19 en edades pediátricas presenta características singulares; un pequeño número de pacientes pediátricos desarrollan un estado clínico grave. Objetivos: Evaluar si la linfocitopenia es un predictor de gravedad en pacientes pediátricos con la COVID-19. Métodos: Se estudiaron en 706 pacientes, las variables edad, sexo, antecedentes patológicos personales de enfermedades crónicas de la infancia (asma bronquial, diabetes mellitus), comorbilidades, estado clínico, valores de linfocitos, conteo absoluto de linfocitos (≤ 1 x 109/L = linfocitopenia). De acuerdo con el estado clínico los pacientes se agruparon en 5 grupos, de asintomáticos a críticos. Se determinó la correlación entre el estado clínico y el conteo absoluto de linfocitos; de este se determinó su capacidad discriminativa para estimar el pronóstico. Resultados: La media de la edad fue 8,6 años; el 6,2 por ciento de los pacientes evolucionó al estado grave o crítico; 74,6 por ciento tuvo valores normales de linfocitos, el 16,14 por ciento altos y el 9,2 por ciento bajos. Linfocitopenia presentó el 4,2 por ciento; se correlacionó significativamente con estado grave, área bajo la curva de 0,711 (IC 95 por ciento: 0,595-0,827); 46 por ciento de sensibilidad y 98 por ciento de especificidad. Conclusiones: La linfocitopenia es un biomarcador que puede estimar el pronóstico en pacientes pediátricos con la COVID-19 que desarrollan un estado clínico grave (AU)

Introduction: COVID-19 in pediatric ages presents unique features; a small number of pediatric patients develop severe clinical status. Objectives: To evaluate whether lymphocytopenia is a predictor of severity in pediatric patients with COVID-19. Methods: In 706 patients were studied the variables age, sex, personal pathological history of childhood chronic diseases (bronchial asthma, diabetes mellitus), comorbidities, clinical status, lymphocyte values, absolute lymphocyte count (≤ 1 x 109/L = lymphocytopenia). According to clinical status patients were grouped into 5 groups, from asymptomatic to critical. The correlation between clinical status and absolute lymphocyte count was determined; its discriminative capacity to estimate prognosis was determined. Results: The mean age was 8.6 years; 6.2 percent of patients progressed to severe or critical condition; 74.6 percent had normal lymphocyte values, 16.14 percent high and 9.2 percent low. Lymphocytopenia presented 4.2 percent; it was significantly correlated with severe condition, area under the curve of 0.711 (95 percent CI: 0.595-0.827); 46 percent sensitivity and 98 percent specificity. Conclusions: Lymphocytopenia is a biomarker that can estimate prognosis in pediatric patients with COVID-19 who develop severe clinical status (AU)

Long-term antibody titers variation in unvaccinated patients receiving convalescent plasma or placebo for severe SARS-CoV-2 pulmonary infection.

BACKGROUND: Convalescent plasma (CP) became a prominent treatment in the early stages of the SARS-CoV-2 pandemic. In Argentina, a randomized clinical trial was executed to compare the use of CP in inpatients with severe COVID-19 pneumonia versus placebo. No differences in clinical outcomes or overall mortality between groups were observed. We conducted a cohort study in outpatients enrolled in the trial to describe long-term antibody titer variations between CP and placebo recipients. METHODS: Patients' total SARS-CoV-2 IgG antibodies against spike protein were collected 3, 6 and 12 months after hospital discharge from August 2020 to December 2021. In addition, reinfections, deaths and vaccination status were retrieved. Statistical analysis was performed using antibody geometric mean titers (GMT). All estimations were made considering the date of the trial infusion (placebo or CP) as time 0. RESULTS: From the 93 patients included in the follow-up, 64 had received CP and 29 placebo. We excluded all 12-month measurements because they were collected after the patients' vaccination date. At 90 days post-infusion, patients had an antibody GMT of 8.1 (IQR 7.4-8.1) in the CP group and 8.8 (IQR 8.1-9.1) in the placebo group. At 180 days, both groups had a GMT of 8.1 (IQR 7.4-8.1). No statistical differences in GMT were found between CP and placebo groups at 90 days (p = 0.12) and 180 days (p = 0.25). No patients registered a new COVID-19 infection; one died in the CP group from an ischemic stroke. CONCLUSIONS: No differences were observed in long-term antibody titers in unvaccinated patients that received CP or placebo after severe COVID-19 pneumonia.

Remote monitoring as a surveillance method in patients on automated peritoneal dialysis for preventing complications and COVID-19 contagion.

BACKGROUND: Due to the health emergency of COVID-19, telemedicine has become more relevant. Remote monitoring conspicuous as a valuable tool for the clinical follow-up of kidney patients, in this case, who are treated with automated peritoneal dialysis. This study aims to describe the use of remote monitoring as a surveillance method in a cohort of patients on automated peritoneal dialysis prevent complications and COVID-19 contagion. METHODS: Study of a cohort of patients who initially participated in a randomized block clinical trial in which the use of Automated Peritoneal Dialysis with Remote Monitoring (APD-RM) was compared with conventional treatment. A descriptive analysis was performed of the rates of infection by COVID-19, the time of incidence until this, mortality, and rates of transfer to hemodialysis. In addition, survival was measured by survival curves. RESULTS: Of the 509 patients, 19 were positive for COVID-19 (incidence rate of 7.0 episodes/100 patient-year), and only six patients recovered from the infection; the death rate was 2.6 % compared to all-cause death of 9.8 %. The most affected group of patients were those over 50 years old, with 71.4 % mortality, in contrast to younger patients infected, with a mortality of 60 %. During the follow-up period, 21 patients were transferred to HD: six due to peritonitis, five due to UF failure, seven due to catheter dysfunction, one due to uremic syndrome, one due to COVID-19, and one by surgical intervention. CONCLUSION: APD-RM patients have a significant advantage over other dialysis therapies because the use of telemedicine not only provides continuity in the patient's clinical treatment but also favors the prevention of COVID-19 infection, the management and prevention of complications inherent to therapy and the preservation of the life of Peritoneal Dialysis patients.

Use of convalescent plasma to treat COVID-19: case studies.

There have been several efforts to minimize the effects caused by the COVID-19 virus around the world. Vaccines were developed in record time and alternative therapies were studied and applied in several countries, such as the use of plasma from recovered patients. Identifying, systematically evaluating and summarizing the best available scientific evidence on the efficacy and safety of using plasma from recovered COVID-19 patients remains the objective of this study. The studies carried out showed that the application of convalescent plasma contributes to the reduction of mortality, viral load and length of hospital stay. However, the effectiveness of the therapy still raises doubts due to the number of patients evaluated in clinical studies, in addition to its high cost and limitations in terms of availability and implementation, with the drug being authorized only for hospital use.

Reduced Mortality among COVID-19 ICU Patients after Treatment with HemoClear Convalescent Plasma in Suriname.

Convalescent plasma is a promising therapy for coronavirus disease 2019 (COVID-19), but its efficacy in intensive care unit (ICU) patients in low- and middle-income country settings such as Suriname is unknown. Bedside plasma separation using the HemoClear device made convalescent plasma therapy accessible as a treatment option in Suriname. Two hundred patients with severe SARS-CoV-2 infection requiring intensive care were recruited. Fifty eight patients (29%) received COVID-19 convalescent plasma (CCP) treatment in addition to standard of care (SOC). The CCP treatment and SOC groups were matched by age, sex, and disease severity scores. Mortality in the CCP treatment group was significantly lower than that in the SOC group (21% versus 39%; Fisher's exact test P = 0.0133). Multivariate analysis using ICU days showed that CCP treatment reduced mortality (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.18 to 0.66; P = 0.001), while complication of acute renal failure (creatinine levels, >110 mol/L; HR, 4.45; 95% CI, 2.54 to 7.80; P < 0.0001) was independently associated with death. Decrease in chest X-ray score in the CCP treatment group (median -3 points, interquartile range [IQR] -4 to -1) was significantly greater than that in the SOC group (median -1 point, IQR -3 to 1, Mann-Whitney test P = 0.0004). Improvement in the PaO2/FiO2 ratio was also significantly greater in the CCP treatment group (median 83, IQR 8 to 140) than in the SOC group (median 35, IQR -3 to 92, Mann-Whitney P = 0.0234). Further research is needed for HemoClear-produced CCP as a therapy for SARS-CoV-2 infection together with adequately powered, randomized controlled trials. IMPORTANCE This study compares mortality and other endpoints between intensive care unit COVID-19 patients treated with convalescent plasma plus standard of care (CCP), and a control group of patients hospitalized in the same medical ICU facility treated with standard of care alone (SOC) in a low- and middle-income country (LMIC) setting using bedside donor whole blood separation by gravity (HemoClear) to produce the CCP. It demonstrates a significant 65% survival improvement in HemoClear-produced CCP recipients (HR, 0.35; 95% CI, 0.19 to 0.66; P = 0.001). Although this is an exploratory study, it clearly shows the benefit of using the HemoClear-produced CCP in ICU patients in the Suriname LMIC setting. Additional studies could further substantiate our findings and their applicability for both LMICs and high-income countries and the use of CCP as a prepared readiness method to combat new viral pandemics.

Vaccination and mortality from COVID-19: a comparative study between hemodialysis, peritoneal dialysis, and non-dialysis adult population in Panama.

PURPOSE: Dialysis patients have a different response than the non-dialysis population to infection with COVID-19. This study evaluates the prevalence of infection and lethality in patients receiving hemodialysis or peritoneal dialysis in Panama, compared to non-dialysis adult population, and reports of adverse events of vaccination. METHODS: This is a prospective, multi-center cohort study of spatients aged 18 years or older and receiving in-center hemodialysis or ambulatory peritoneal dialysis in 13 centers in Panama from March 2021 to 2022. For comparison with general population, the study used an extended period of two years. RESULTS: A total of 1531 patients receiving dialysis treatment accepted to participate. PD patients represented an 18% of study patients. Lethality was higher in peritoneal dialysis patients with COVID-19 infection than in hemodialysis in the study group (p 0.02). Total deaths in dialysis patients for 2020 were 156 patients, before vaccination; 79 in 2021; and 25 for the first trimester of 2022. Lethality for the period of 2020-2022 was 9.3% for dialysis patients and 0.2% for non-dialysis population. There was no difference in symptoms in first dose, but with second dose, hemodialysis patients reported fewer symptoms than peritoneal dialysis patients (p < 0.0001). CONCLUSION: Ninety one percent of people in the country received BNT162b2 Pfizer BionTech vaccine. Lethality decreased from 30 to 5% once vaccination was available. There were no severe adverse effects and symptoms reported were less frequent than in general population, probably due to low reactogenicity in dialysis patients, or better tolerance to pain.

Lung Transplantation for COVID-19 Pulmonary Sequelae.

BACKGROUND: The role of lung transplantation for coronavirus disease 2019 (COVID-19)-related lung failure is evolving as the pandemic persists. METHODS: From January 2021 to April 2022, 20 patients (median age 62 y; range 31-77) underwent lung transplantation for COVID-related lung failure at our institution. We reviewed their clinical and intraoperative characteristics and early outcomes including postoperative complications. RESULTS: Eleven patients (55%) had chronic lung disease when they contracted COVID-19. All 20 patients required hospitalization for antivirus treatment. Median lung allocation score was 74.7 (33.1-94.0). Thirteen patients (65%) underwent single-lung transplants, and 7 patients (35%) underwent double-lung transplants. Concomitant coronary artery bypass graft surgery was performed in 2 (10%) patients because of severe coronary artery disease. Postoperatively, venovenous extracorporeal membrane oxygenation was needed in 3 patients (15%) because of severe primary graft dysfunction; all were eventually weaned. Ten patients (50%) experienced deep venous thrombosis, and 1 eventually developed a major pulmonary embolus. The median intensive care unit stay and hospital stays were 6.5 d (3-44) and 18 d (7-77), respectively. During a median follow-up of 201 d (47-418), we experienced 1 late mortality due to COVID-19-related myocarditis. Among the 13 patients with single-lung transplant, 5 demonstrated improvement in their native lungs. CONCLUSIONS: Lung transplantation yielded favorable early outcomes in a heterogeneous patient cohort that included older patients, obese patients, and patients with coronary artery disease or preexisting chronic lung disease. Our data also shed light on the transforming role of lung transplantation for the pulmonary sequelae of a complex multisystem COVID-19 disorder.

Manifestaciones psicopatológicas en una adolescente debido al impacto de la COVID-19 / Psycho-Pathological Manifestations In An Adolescent Due to The Impact of COVID-19

Introducción: La adolescencia es una de las etapas más trascendentales de la vida; en ella el cerebro experimenta una serie de cambios y conexiones que suponen un antes y un después para la persona. Cada adolescente vive esta experiencia de una manera diferente. Muchos estudios muestran las devastadoras consecuencias que ha dejado el confinamiento generado por la pandemia de COVID-19 en este segmento poblacional y la importancia de aplicar un tratamiento adecuado. Objetivo: Identificar las manifestaciones psicopatológicas frente al impacto de la COVID-19. Presentación del caso: Adolescente femenina, de 13 años, de procedencia urbana, con antecedentes de salud mental previa, que convive con ambos padres y una hermana menor, en un ambiente familiar armónico. Acudió al cuerpo de guardia en compañía de su madre, por presentar manifestaciones depresivas y ansiosas dadas por miedo a contagiarse, a la muerte, a estar sola, a la oscuridad, a perder a sus familiares, deambulaba de un lado a otro sin ningún propósito y se negaba a ingerir alimentos. Todo comenzó al inicio de la pandemia por la COVID-19. Se decidió su ingreso en la sala de psiquiatría del Hospital Pediátrico Docente Sur Dr. Antonio María Béguez César Santiago de Cuba en abril de 2020. Conclusiones: La intervención psicoterapéutica y el tratamiento psicofarmacológico, resultaron efectivos para disminuir la ansiedad, el miedo a la muerte, la fobia y los elementos obsesivos, la depresión y el insomnio, generados por el confinamiento debido a la pandemia por COVID-19 (AU)

Introduction: Adolescence is one of the most transcendental stages of life. In it the brain undergoes a series of changes and connections that represent a before and after for the person. Every teenager lives this experience in a different way. Many studies show the devastating consequences left by the confinement generated by the COVID-19 pandemic in this population segment, and the importance of applying adequate treatment. Objective: To identify the psycho-pathological manifestations against the impact of COVID-19. Case presentation: Female adolescent, 13 years old, of urban origin, with a previous mental health history, who lives with both parents and a younger sister, in a harmonious family environment. She went to the emergency service in the company of her mother, after presenting depressive and anxious manifestations given by fears of being infected, of death, of being alone, of darkness, of losing her relatives; she wandered back and forth without any purpose and refused to eat food. It all started at the beginning of the COVID-19 pandemic. It was decided to admit her to the psychiatric service of Dr. Antonio María Béguez César South Teaching Pediatric Hospital, in Santiago de Cuba province in April 2020. Conclusions: Psychotherapeutic intervention and psycho-pharmacological treatment were effective in reducing anxiety, fear of death, phobia and obsessive elements, and depression and insomnia generated by the confinement due to the COVID-19 pandemic(AU)

Accidente cerebrovascular por COVID-19 en una lactante de 6 meses / Stroke due to COVID-19 in a Six-month-old infant

Introducción: En de la población adulta predomina la enfermedad pulmonar, pero el coronavirus infantil grave parece más tipificado por una respuesta inflamatoria inmunomediada, con o sin síndrome inflamatorio multisistémico asociado. Objetivo: Examinar un paciente pediátrico con accidente cerebrovascular, como consecuencia de la enfermedad producida por el coronavirus tipo 2. Presentación del caso: Lactante femenina de 6 meses, que se presentó a emergencia con historia de fiebre de 39 oC, sin predominio de horario, de 10 días de evolución que no cedió con antipiréticos tipo acetaminofén, y dificultad respiratoria en los 3 días previos a su presentación en emergencia del hospital. Antecedentes familiares patológicos positivos, por la enfermedad del coronavirus en su padre. En la radiografía de tórax se observó infiltrado alveolar derecho y se ingresó con diagnóstico de neumonía por síndrome respiratorio agudo grave por coronavirus tipo 2. La tomografía de cráneo registró foco isquémico frontal parasagital derecho y parietal izquierdo; posteriormente se confirmó con resonancia magnética, en cuyo informe se definió la presencia de infartos en fase aguda a nivel frontal derecho y parietal izquierdo. Conclusiones: Se expuso una manifestación infrecuente en población pediátrica asociada a la enfermedad por coronavirus. La tasa de eventos tromboembólicos en el curso de las infecciones virales no es baja, y por coronavirus no es la excepción. Se requieren mayores estudios y pruebas para determinar el papel del síndrome respiratorio agudo severo por coronavirus tipo 2 en el accidente cerebrovascular pediátrico(AU)

Introduction: Pulmonary disease predominates in the adult population, but severe infantile coronavirus appears more typified by an immune-mediated inflammatory response, with or without associated multisystem inflammatory syndrome. Objective: To examine a pediatric patient with stroke resulting from coronavirus type 2 disease. Case presentation: 6-month-old female infant presenting to emergency with history of fever of 39 ℃ with no hourly predominance, of 10 days of evolution that did not subside with acetaminophen-type antipyretics and respiratory distress in the three days prior to presentation to hospital emergency. Positive family history of coronavirus disease in his father. Chest X-ray showed right alveolar infiltrate and she was admitted with a diagnosis of severe acute respiratory syndrome pneumonia due to coronavirus type 2. The cranial tomography recorded a right frontal parasagittal and left parietal ischemic focus, later confirmed by magnetic resonance imaging whose report defined the presence of acute phase infarcts at the right frontal and left parietal levels. Conclusions: An infrequent manifestation in pediatric population associated with coronavirus disease is exposed. The rate of thromboembolic events in the course of viral infections is not low and coronavirus is no exception. Further studies and evidence are required to determine the role of severe acute respiratory syndrome due to coronavirus type 2 in pediatric stroke(AU)