[Quality of life of health personnel during the COVID-19 pandemic: exploratory reviewQualidade de vida do pessoal de saúde durante a pandemia de COVID-19: revisão exploratória]. / Calidad de vida del personal de salud durante la pandemia de COVID-19: revisión exploratoria.

Objective: Describe the quality of life of health personnel, the work environment, and interactions between employees and their work environment during the pandemic. Methods: A scoping review was conducted. The electronic databases PubMed, Cumulative Index of Nursing and Allied Literature Complete, and Google Scholar were used, as well as the repositories of the World Health Organization and the Centers for Disease Control and Prevention. Primary, secondary, and grey literature studies published between December 2019 and March 2021 in Spanish, English, and Portuguese were included. Methodological quality was assessed using the Authority, Accuracy, Coverage, Objectivity, Date and Importance (AACODS) checklist; a tool for the measurement of multiple systematic reviews (AMSTAR); and the Critical Appraisal Checklist for Text and Opinion Papers. A thematic analysis was carried out based on the quality-of-life and well-being model. Results: Of a total of 208 articles, 11 were included. The quality of life of health personnel during the COVID-19 pandemic was affected by the characteristics of health personnel, the work environment, and interactions between employees and their work environment. Problems related to psychosocial and occupational factors were observed. Discussion: The quality of life of health personnel was characterized by stigmatization, stress, anxiety, and fatigue. Organizational management and the implementation of psychological interventions appear to affect interactions between employees and their work environment, and improve their quality of life.

Objetivo: Descrever a qualidade de vida do pessoal de saúde, o ambiente de trabalho e a interação entre o funcionário e o ambiente de trabalho durante a pandemia. Métodos: Foi realizada uma revisão exploratória. Foram utilizadas as bases de dados eletrônicas PubMed, Cumulative Index of Nursing and Allied Literature Complete, Google Scholar e os repositórios da Organização Mundial da Saúde e dos Centros de Controle e Prevenção de Doenças. Foram incluídos estudos primários, secundários e da literatura cinzenta, publicados entre dezembro de 2019 e março de 2021, em espanhol, inglês e português. A qualidade metodológica foi avaliada pelas checklists AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance), AMSTAR (A measurement tool to assess systematic reviews) e Critical Appraisal Checklist for Text and Opinion Papers. Foi realizada uma análise temática com base no modelo de qualidade de vida e bem-estar. Resultados: De um total de 208 artigos, 11 foram incluídos. A qualidade de vida do pessoal de saúde durante a pandemia de COVID-19 foi influenciada pelas características do pessoal de saúde, do ambiente de trabalho e da interação entre o funcionário e o ambiente de trabalho. Constataram-se deficiências relacionadas a fatores psicossociais e ocupacionais. Discussão: A qualidade do pessoal de saúde foi caracterizada por estigma, estresse, ansiedade e fadiga. A gestão organizacional e a aplicação de intervenções psicológicas evidenciam um efeito na interação entre o funcionário e o ambiente de trabalho, e influenciam sua qualidade de vida.

[Factors associated with an unfavorable evolution in patients diagnosed with COVID-19 and followed up in primary care in 2020]. / Factores asociados con una evolución desfavorable en pacientes diagnosticados de COVID-19 y seguidos en atención primaria en 2020.

AIM: To know the factors associated with an unfavorable evolution (UE) of patients diagnosed with COVID-19 with total or partial follow-up in primary care. DESIGN: A case series. SETTING: Urban health center. PARTICIPANTS: By systematic sampling, patients ≥18 years, diagnosed with COVID-19, with analytical confirmation, in 2020 and followed up by their family doctors, were selected. MAIN MEASUREMENTS: Dependent variable: hospital admission or death due to COVID-19. INDEPENDENT VARIABLES: age, sex, medical background, clinical data and treatments related to the disease. Statistical analysis, with SPSS 25.0: descriptive analysis, comparison of proportions (chi square) and medians (Mann-Whitney U). The analysis is completed with logistic regression. RESULTS: 610 patients were included in the study. The median age was 49 years (interquartile range: 35-61); 51.8% were women; 14.9% presented UE (95% CI: 12.0-17.8). The sociodemographic variables or the variables related to medical background that showed an independent association with UE were age (OR: 1.066; 95% CI: 1.038-1.095), sex (OR for men: 3.277; 95% CI: 1.304-8.235) and being a smoker or former smoker (OR: 2.565; 95% CI: 1.135-5.800). Regarding the clinical variables of the disease, an association was found for altered consciousness (OR: 62.829; 95% CI: 9.177-430.149), dyspnea (OR: 14.339; 95% CI: 6.046-34.009), expectoration (OR: 4.764; 95% CI: 1.858-12.213)) and asthenia (OR: 3.993; 95% CI: 1.705-9.351). CONCLUSIONS: 14.9% of the patients diagnosed with COVID-19 presented an UE. Older age, male sex and being a smoker or former smoker increased the probability of it. Altered consciousness, dyspnea, expectoration, and asthenia were the clinical data that best predicted UE.

[Characteristics and evolution of COVID-19 in an urban Health Center at the pandemic beginning']. / Características y evolución de los pacientes COVID-19 en un centro de salud urbano al inicio de la pandemia.

OBJETIVE: To evaluate SAR-COV-2 pacients' features. To analyse de diferences between those who required hospital care and those who didn't. DESIGN: Observational, descriptive and retrospective study. SETTING: Twomedical practices of an urban health center in Salamanca (Spain). PARTICIPANTS: ≥18 years diagnosed with SAR-CoV-2 between March 11th and April 20th. MAIN MEASUREMENTS: clinical-epidemiological chatacteristics, diagnosis, treatment and outcome at the end of study RESULTS: 122 patients (63.9% female), 19.7% social and health care workers y 4.9% from nursing homes. Predominant age group: 46-60 years. 67.2% without comorbility. Predomint symptoms: low-grade fever (73.5%), cough (65.2%) y fever (43%). Average age of the patients requiring hospital care was higher: 59.85 (DE16.22) versus 50.78 (DE17.88) P=.013. 63.6% of all the patients monitored by Primary Health Care and 14.1% of patients that required assistance did not present dyspnea P=.001. Only 2.5% of the hospital-assisted patients, compared to 61.5% of Primary Health Care, were not tested P=.0001. 26 patients were attendedn at an emergency room: 11(9%) stayed and 2 (1.6%) passed away. No antibiotic or inhaler treatment for 52.5% and 70.5% respectively. The most used antipyretic treatment was paracetamol (78.7%). CONCLUSIONS: Prevalence in females, comorbility-free patients and in age range: 46-60 years. Complementary and confirmatory test were performed mainly in hospital care. Predominance of mild symptoms and favourable evolution. Highliting the role played by Primary Health Care in detection, early intervention and monitoring of severe cases.

Changes in Neonatal Intensive Care Unit statistics during the COVID-19 pandemic.

BACKGROUND: With the identification of COVID-19 disease in China, a pandemic began that affected health-care systems. The Neonatal Intensive Care Unit (NICU) of the Hospital de Ginecobstetricia del Centro Médico Nacional de Occidente experienced an increase in patient flow as part of the COVID-19 strategy of the Instituto Mexicano del Seguro Social (IMSS). This study aimed to analyze the impact of the COVID-19 pandemic on neonatal care and mortality indicators in our unit. METHODS: We conducted a retrospective study to compare the number of hospital births, pre-term newborns (PTNB), NICU admissions, and deaths. Changes in frequencies between 2019 and 2021 were analyzed using Poisson distribution. Changes in PTNB births, proportion of admissions, and deaths/NICU discharges were analyzed by z-test for two proportions. RESULTS: Between 2019 and 2021, the number of births increased by more than 2-fold. NICU admissions increased from 770 in 2019 to 1045 in 2021 (p < 0.01). The ratio of deaths/discharge from the service was 16.9% in 2019 and 13.1% in 2021 (p = 0.02). CONCLUSIONS: Mortality indicators in the NICU decreased from 2019 to 2021, even with the increase in the number of patients admitted during the COVID-19 pandemic.

INTRODUCCIÓN: Con la identificación de la enfermedad por COVID-19 en China, inició una pandemia que afectó a los sistemas de salud. La Unidad de Cuidados Intensivos Neonatales (UCIN) del Hospital de Ginecobstetricia del Centro Médico Nacional de Occidente del Instituto Mexicano del Seguro Social (IMSS) vio incrementado su flujo de pacientes como parte de la Estrategia COVID-19 del IMSS. El objetivo fue analizar el impacto de la pandemia COVID-19 en los indicadores de atención y mortalidad neonatal en nuestra unidad. MÉTODOS: Se realizó un estudio retrospectivo para comparar el número de nacimientos en el hospital, nacimientos de recién nacidos prematuros (RNPT), ingresos a UCIN y defunciones. Se analizaron los cambios en frecuencias entre los años 2019 a 2021 mediante la distribución de Poisson. Los cambios en nacimientos de RNPT, proporción de ingresos y defunciones/egreso en UCIN se analizaron mediante prueba Z para dos proporciones. RESULTADOS: Entre los años 2019 a 2021, el número de nacimientos incrementó más de 2 veces. Los ingresos a UCIN aumentaron de 770 en 2019, a 1045 en 2021 (p < 0.01). La proporción de defunciones/egreso del servicio fue de 16.9% en 2019, y 13.1% en 2021 (p = 0.02). CONCLUSIONES: Los indicadores de mortalidad en la UCIN disminuyeron de 2019 a 2021, aun con el incremento en el número de pacientes atendidos durante la pandemia COVID-19.

Factors associated with the intensity of anxiety and depression symptoms in health workers of two centres of reference for COVID 19 patient care in Antioquia, Colombia - A latent class analysis.

OBJECTIVE: To classify the staff of two reference institutions for COVID-19 care in Antioquia according to the intensity of anxiety and depression symptoms, and to determine the factors associated with these classes. METHODS: Cross-sectional study in which the GAD-7, PHQ-9, fear of COVID-19, and the Copenhagen Burnout scale were used. Latent class analysis was performed to identify the classes, and the factors associated with these were determined using multinomial logistic regression. RESULTS: 486 people participated. The three-class model had the best fit: class I with low scores on the scales; class II with mild degrees of anxiety and depression, and intermediate levels of fear of COVID-19 and perceived stress; and class III with moderate and severe degrees of anxiety, depression, and perceived stress. The factors associated with belonging to class III were age (OR = 0.94; 95%CI, 0.91-0.96), change of residence to avoid exposing relatives (OR = 4.01; 95%CI, 1.99-8.09), and a history of depressive disorder (OR = 3.10; 95%CI, 1.27-7.56), and anxiety (OR = 5.5; 95%CI, 2.36-12.90). Factors associated with class II were age (OR = 0.97; 95%CI, 0.95-0.99), history of depressive disorder (OR = 3.41; 95%CI, 1.60-7.25), living with someone at risk of death from COVID-19 (OR = 1.86; 95%CI, 1.19-2.91), family member being healthcare staff (OR = 1.58; 95%CI, 1.01-2.47), and change of residence to avoid exposing relatives (OR = 1.99; 95%CI, 1.11-3.59). CONCLUSIONS: Three classes of participants were obtained, two of them with anxiety and depression symptoms. Younger age and a history of mental disorder were factors associated with the two classes of symptomatic patients; other factors may be causes or consequences of the symptoms.

Analysis of perceptions and emotional repercussions in Twitter users in Colombia during the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic has negatively impacted mental health. Up to a quarter of the population has reported mental health disorders. This has been studied mainly from a nosological perspective, according to diagnostic criteria. Nevertheless, we did not find studies that have explored the daily expressions of the population. Our objective was to evaluate the perceptions of the COVID-19 pandemic and its repercussions on the emotional well-being of the Colombian population. METHODS: We performed a Twitter metrics and trend analysis. Initially, in the trend analysis, we calculated the average duration in hours of the 20 most popular trending topics of the day in Colombia and we grouped them into trends related to COVID-19 and unrelated trends. Subsequently, we identified dates of events associated with the pandemic relevant to the country, and they were related to the behaviour of the trends studied. Additionally, we did an exploratory analysis of these, selected the tweets with the greatest reach and categorised them in an inductive way to analyse them qualitatively. RESULTS: Issues not related to COVID-19 were more far-reaching than those related to coronavirus. However, a rise in these issues was seen on some dates consistent with important events in Colombia. We found expressions of approval and disapproval, solidarity and accusation. Inductively, we identified categories of informative tweets, humour, fear, stigma and discrimination, politics and entities, citizen complaints, and self-care and optimism. CONCLUSIONS: The impact of the COVID-19 pandemic generates different reactions in the population, which increasingly have more tools to express themselves and know the opinions of others. Social networks play a fundamental role in the communication of the population, so this content could serve as a public health surveillance tool and a useful and accessible means of communication in the management of health crises.

[Mortality associated with myocardial damage by troponin I in patients with COVID 19]. / Mortalidad asociada a daño miocárdico mediante troponina I en pacientes con COVID-19.

Background: Coronavirus disease 2019 (COVID-19) can cause cardiac injury, probably associated with myocarditis and ischemia induced by the infection. Myocardial damage leads to the liberation of proinflammatory cytokines and to the activation of autoimmune adaptive mechanisms through molecular limitation. Objective: To assess mortality associated with myocardial damage in hospitalized patients with COVID-19 confirmed by troponin I measurement. Material and methods: Case-control study nested in a cohort of patients of a third-level hospital. Descriptive statistics were used to characterize the population. Qualitative variables were expressed as proportions and ranges, quantitative variables as means and standard deviation. Fisher's exact test was used to compare mortality between patients with and without myocardial damage. A p value < 0.05 was considered significant. Results: From June 2020 to August 2020, 28 patients who met the selection criteria were enrolled, out of which 15 had no myocardial damage and 13 had myocardial damage assessed by serum troponin measurement. A strong association was found between mortality and the presence of myocardial damage, since mortality was 20% (3/15) among patients without myocardial damage and 92.3% (12/13) among those with myocardial damage (Fisher's exact test, p < 0.005). Conclusion: Mortality in patients with COVID-19 is associated with myocardial damage assessed by troponin I measurement.

Introducción: la enfermedad por coronavirus del 2019 (COVID-19) puede causar lesión cardiaca, probablemente asociada con miocarditis e isquemias inducidas por la infección. El daño miocárdico conduce a la liberación de citocinas proinflamatorias y a la activación de mecanismos adaptativos de tipo autoinmune por medio de la limitación molecular. Objetivo: evaluar la mortalidad asociada a daño miocárdico en pacientes hospitalizados con COVID-19 confirmado mediante la medición de troponina I. Material y métodos: estudio de casos y controles anidado en una cohorte de los pacientes de un hospital de tercer nivel. Se utilizó estadística descriptiva para caracterizar a la población. Las variables cualitativas se expresaron como proporciones y rangos, las cuantitativas como medias y desviación estándar. Para comparar la mortalidad entre pacientes con y sin daño miocárdico se utilizó la prueba exacta de Fisher. Valores de p < 0.05 fueron significativos. Resultados: de junio del 2020 a agosto del 2020 se enrolaron 28 pacientes que cumplieron los criterios de selección, de los cuales 15 no tuvieron daño miocárdico y 13 tuvieron daño miocárdico evaluado con la medición de troponina sérica. Se encontró fuerte asociación entre la mortalidad y la presencia de daño miocárdico, ya que se registró mortalidad del 20% (3/15) entre los pacientes sin daño miocárdico y de 92.3% (12/13) entre los que tuvieron daño miocárdico (prueba exacta de Fisher: p < 0.005). Conclusiones: la mortalidad en pacientes con COVID-19 se asocia a daño miocárdico evaluado a través de la medición de troponina I.

Repercussions of COVID-19 on psychiatric inpatient care in Latin America and the Caribbean.

OBJETIVE: To characterise the impact of the COVID-19 pandemic on psychiatric hospitalisations in the Latin American and Caribbean (LAC) region. METHODS: Descriptive study. 85 semi-structured interviews were conducted with health workers involved with psychiatric hospitalisations in general hospitals (GHs) and specialised psychiatric hospitals (SHs) from 18 LAC countries. The interviews were done between 8 May and 30 June 2020. The data were analysed quantitatively and qualitatively. RESULTS: An initial decrease in the demand for hospitalisation is reported, attributed to the population's fear of approaching health services as well as restrictions on mobility. Stricter criteria for hospitalisation were reported with a double focus on the acute within the acute. The length of hospitalisations were mixed, with both increases and decreases in GHs and SHs. The therapeutic offer was drastically reduced, and interaction between hospitalised people and their support networks was restricted. CONCLUSIONS: In the COVID-19 context, hospitalisation seems to be not the last but the only alternative for psychiatric treatment. The decrease in the number of beds in SHs could be a positive aspect for the reform of psychiatric care, but it is questioned since this reduction also occurs in GHs.

[Clinical features of pericarditis in patients with SARS-CoV-2]. / Características clínicas de la pericarditis en pacientes con SARS-CoV-2.

Background: COVID-19 disease (coronavirus disease 2019) has multiple potentially fatal cardiovascular complications and pericarditis is one of them; however, if prompt treatment is given, fatal events associated to this complication decrease. Its frequency and presentation characteristics are unknown, which is why its early diagnosis is important. Objective: To know the frequency of pericarditis secondary to COVID-19 and its presentation characteristics. Material and methods: Cross-sectional study in patients with a diagnosis of pericarditis after COVID-19 disease (with a positive test). Symptoms, age, sex, comorbidities, and electrocardiogram (ECG) and transthoracic echocardiogram (TTE) results were obtained. Results: A total of 3364 patients positive for COVID-19 were registered, out of which 10 met criteria for pericarditis, which represented a frequency of 0.30%. The average age of the sample was 46.1 years and 60% predominated in the male gender with a 1.5:1 ratio. The most frequent clinical characteristics were the presence of retrosternal pain (90%), absence of comorbidity (50%), and absence of electrocardiographic changes (40%). Conclusions: Pericarditis has a low frequency in patients with COVID-19. The predominant clinical presentation is chest pain. Almost half will not have electrocardiographic changes, and half will not have comorbidities.

Introducción: la enfermedad COVID-19 (coronavirus disease 2019) tiene múltiples complicaciones cardiovasculares potencialmente mortales y la pericarditis es una de ellas; sin embargo, si se da un tratamiento oportuno disminuyen sus eventos fatales. Se desconoce su frecuencia y características de presentación, por lo que es importante su diagnóstico temprano. Objetivo: conocer la frecuencia de pericarditis secundaria a COVID-19 y sus características de presentación. Material y métodos: estudio transversal en pacientes con diagnóstico de pericarditis posterior a la enfermedad COVID-19 (con prueba positiva). Se obtuvo la sintomatología, edad, sexo, comorbilidades y resultados de electrocardiograma (ECG) y ecocardiograma transtorácico (ETT). Resultados: se registraron 3364 pacientes positivos a COVID-19, de los cuales 10 cumplieron con criterios para pericarditis, lo que representó una frecuencia del 0.30%. La edad promedio de la muestra fue de 46.1 años y predominó en el género masculino (60%) con una relación 1.5:1. Las características clínicas más frecuentes fueron la presencia de dolor retroesternal (90 %), ausencia de comorbilidad (50 %) y ausencia de cambios electrocardiográficos (40%). Conclusiones: la pericarditis tiene una frecuencia baja en pacientes con COVID-19. La presentación clínica predominante es el dolor retroesternal. Casi la mitad no tendrá cambios electrocardiográficos y la mitad no tendrá comorbilidades.

[Adverse effect incidence of Pfizer/BioNTech COVID-19 vaccine: Retrospective cohort study]. / Incidencia de efectos adversos de la vacuna contra COVID-19 Pfizer/BioNTech: estudio de cohorte retrospectivo.

Background: Coronavirus SARS-CoV-2 has been the cause of multiple hospitalizations due to respiratory distress, pneumonia, multi-organic failure and death in all the world. The BioNTech/Pfizer lab was the first to get the approval from the Food and Drug Administration (FDA) for vaccine application, beginning with health workers. However, there are a few studies about adverse effects after applying the COVID-19 vaccine. Objective: To assess the presence and time of onset of adverse effects produced by the COVID-19 vaccine. Material and methods: A retrospective cohort study was carried out, including medical residents from the Hospital de Especialidades No. 1 (Specialties Hospital No. 1) from the Bajío National Medical Center, who received two doses of Pfizer-BioNTech vaccine and decided to participate voluntarily. We obtained the information by a self-assessment tool sent via email. All adverse effects were collected emphasizing those described in the literature. Results: A total of 101 medical residents were included. It was observed that 55.54% presented adverse effects after the first dose, which appeared in the first 24 hours after the vaccine was administered. After the second dose, 54.5% presented symptomatology, 41.6% during first 24 hours after the vaccine was administered. Conclusions: It was observed symptomatology after applying the complete series (two doses) of BioNTech/Pfizer; however, there were mild and of short duration.

Introducción: el coronavirus SARS-CoV-2 ha sido causa de múltiples hospitalizaciones por distrés respiratorio, neumonía, falla multiorgánica y fallecimientos en todo el mundo. El laboratorio de BioNTech/Pfizer fue el primero en conseguir aprobación por la Food and Drug Administration (FDA) para la aplicación a gran escala de su prototipo de vacuna, comenzando la aplicación en el sector salud. Sin embargo, existen pocos estudios sobre los efectos adversos tras la aplicación de dicha vacuna. Objetivo: evaluar la presencia y el tiempo de inicio de efectos adversos producidos por la vacuna contra COVID-19. Material y métodos: se realizó un estudio de cohorte retrospectivo, se incluyeron médicos residentes adscritos al Hospital de Especialidades No. 1 del Centro Médico Nacional del Bajío, quienes recibieron dos dosis de la vacuna BioNTech/Pfizer y que decidieron participar voluntariamente. Se recabó la información mediante un instrumento de evaluación autoaplicable vía electrónica. Se recolectaron todos los eventos adversos y se hizo énfasis en los descritos en la literatura. Resultados: se incluyeron un total de 101 médicos residentes. Se observó que el 55.4% presentó efectos secundarios después de la primera dosis, mismos que aparecieron en las primeras 24 horas tras la aplicación. Posterior a la aplicación de la segunda dosis, el 54.5% presentó sintomatología, el 41.6% en las primeras 24 horas posterior a la aplicación. Conclusiones: se observó la aparición de sintomatología posterior a la aplicación del esquema de vacunación con BioNTech/Pfizer; sin embargo, se trató de síntomas leves de corta duración.

[Cognitive alterations in patients recovered from COVID-19 treated in Cardiopulmonary Rehabilitation]. / Alteraciones cognitivas en pacientes recuperados de COVID-19 atendidos en Rehabilitación Cardiopulmonar.

Background: COVID-19 is associated with multiple complications, in addition to those produced at the pulmonary level. Post-COVID-19 cognitive deficits have been detected in the cognitive domain of attention and executive functions, even 4 months after COVID-19. Objective: to determine the frequency of cognitive alterations in patients recovered from COVID-19. Material and methods: A cross-sectional, descriptive and analytical study was carried out. Records of patients in care after infection by SARS-CoV-2 were integrated, the Neuropsi test was applied. Descriptive statistics and association tests were used through the Chi square test, taking p < 0.05 as significant. Results: Data from 44 files were integrated. The median age, I place them in the sixth decade of life. There was a predominance of men (63.6%). The most frequent comorbidities were systemic arterial hypertension (50%) and diabetes mellitus (40.9%). Most of the patients were managed only at home (61.4%) with a moderate-severe COVID-19 picture (68.2%). The most affected dimensions of the Neuropsi test were attention and concentration (47.7%, mild alteration) and short-term memory (77.3%, mild alteration). Conclusions: Cognitive impairment in patients recovered from COVID-19 assessed through the Neuropsi test presented mild alterations in attention and concentration, as well as in short-term memory. These could affect functionality, quality of life and ability to perform work.

Introducción: la COVID-19 está asociada a múltiples complicaciones, además de las producidas a nivel pulmonar. Se han detectado déficits cognitivos post COVID-19 en el dominio cognitivo de atención y funciones ejecutivas, incluso 4 meses después del COVID-19. Objetivo: determinar la frecuencia de alteraciones cognitivas en pacientes recuperados de COVID-19. Material y métodos: se realizó un estudio transversal, descriptivo y analítico. Se integraron expedientes de pacientes en atención posterior a infección por SARS-CoV-2, se aplicó la prueba Neuropsi. Se utilizó estadística descriptiva y pruebas de asociación a través de la prueba Chi cuadrada, tomando como significativo p < 0.05. Resultados: se integraron datos de 44 expedientes. La mediana de la edad los ubicó en la sexta década de la vida. Hubo predominio de pacientes hombres (63.6%). Las comorbilidades más frecuentes fueron: hipertensión arterial sistémica (50%) y diabetes mellitus (40.9%). La mayoría de los pacientes fueron manejados solamente en domicilio (61.4%) con un cuadro de COVID-19 moderado-severo (68.2%). Las dimensiones más afectadas de la prueba de Neuropsi fueron la atención y concentración (47.7%, alteración leve) y memoria a corto plazo (77.3%, alteración leve). Conclusiones: el deterioro cognitivo en pacientes recuperados de COVID-19 valorado a través de la prueba Neuropsi presentó alteraciones leves en la atención y concentración, así como en la memoria a corto plazo. Estas podrian afectar la funcionalidad, calidad de vida y capacidad de desempeño laboral.

Burden of COVID-19 in Córdoba, A Department of Colombia: Results of Disability-Adjusted Life-Years: Carga de COVID-19 en Córdoba, un Departamento de Colombia: Resultados de los Años de Vida Ajustados por Discapacidad.

OBJECTIVES: This study aimed to estimate the burden of acute COVID-19 in Córdoba, one of the most affected departments (states) in Colombia, through the estimation of disability-adjusted life-years (DALYs). METHODS: DALYs were estimated based on the number of cases of severe acute respiratory syndrome coronavirus 2 infection cases reported by official Colombian sources. A transition probability matrix among severity states was calculated using data obtained from a retrospective cohort that included 1736 COVID-19 confirmed subjects living in Córdoba. RESULTS: Córdoba had 120.23 deaths per 100 000 habitants during the study period (March 2020 to April 2021). Estimated total DALYs were 49 243 (2692 DALYs per 100 000 inhabitants), mostly attributed to fatal cases (99.7%). On average, 25 years of life were lost because of death by this infection. A relevant proportion of years of life lost because of COVID-19 (46.6%) was attributable to people < 60 years old and was greater in men. People ≥ 60 years old showed greater risk of progression to critical state than people between the age of 35 and 60 years (hazard ratio 2.5; 95% confidence interval 2.5-12.5) and younger than 35 years (9.1; 95% confidence interval 4.0-20.6). CONCLUSION: In Córdoba, premature mortality because of COVID-19 was substantially represented by people < 60 years old and was greater in males. Our data may be representative of Latin American populations with great infection spread during the first year of the pandemic and contribute to novel methodological aspects and parameter estimations that may be useful to measure COVID-19 burden in other countries of the region.

Effect of immunonutrition on serum levels of C-reactive protein and lymphocytes in patients with COVID-19: a randomized, controlled, double-blind clinical trial.

INTRODUCTION: Introduction: patients with COVID-19 undergo changes in leukocyte count, respiratory disorders, and an increase in inflammatory substances. To improve the inflammatory condition, some nutrients can be used, including arginine, omega-3 fatty acids and nucleotides. This study aims to evaluate how oral immunonutrient supplements affects serum C-reactive protein (CRP) levels and lymphocyte count in patients with COVID-19. Methods: in this double-blind clinical trial, we randomized 43 adult patients with COVID-19 to receive a standard high-protein normocaloric supplement (control) or an immunonutrient-enriched supplement (experiment) for 7 days. The primary outcome was to evaluate changes in total lymphocyte count and serum level of CRP. The assessment of risk and nutritional status of these patients was also performed. Results: forty-three patients with mean age of 41.5 (± 1.8) years were followed up, 39.5 % of them women. The mean body mass index was 27.6 (± 0.8) kg/m² and 58.1 % had low nutritional risk. In the experiment group, there was a CRP reduction of 23.6 (± 7.5) mg/L, while in the control branch the decrease was 14.8 (± 12.1) mg/L (p = 0.002). There was an increase in lymphocytes in the experiment group (+367.5 ± 401.8 cells/mm³) and a reduction in the control group (-282.8 ± 327.8 cells/mm³), although there was no statistical significance (p = 0.369). Relative risk (RR) of treatment in reducing CRP by 30 % or more was 4.45 (p < 0.001; 95 % CI, 1.79-11.07). RR in increasing lymphocyte count by 30 % or more was 1.28 (p = 0.327; 95 % CI, 0.67-2.45). Conclusion: we conclude that immunonutrient supplements seem to reduce CRP levels more than standard high-protein normocaloric supplements.

INTRODUCCIÓN: Introducción: los pacientes con COVID-19 sufren cambios en el recuento de leucocitos, trastornos respiratorios y aumento de sustancias inflamatorias. Para mejorar la condición inflamatoria se pueden usar algunos nutrientes, como la arginina, los ácidos grasos omega-3 y los nucleótidos. Este estudio tiene como objetivo evaluar cómo los suplementos de inmunonutrientes orales afectan a los niveles séricos de proteína C-reactiva (PCR) y al recuento de linfocitos en pacientes con COVID-19. Métodos: en este ensayo clínico doble ciego, aleatorizamos a 43 pacientes adultos con COVID-19 para recibir un suplemento normocalórico estándar alto en proteínas (control) o un suplemento enriquecido con inmunonutrientes (experimento) durante 7 días. El resultado primario fue evaluar los cambios en el recuento total de linfocitos y el nivel sérico de PCR. También se realizó la evaluación del riesgo y el estado nutricional de estos pacientes. Resultados: cuarenta y tres pacientes con edad media de 41,5 (± 1,8) años fueron seguidos, el 39,5 % de ellos mujeres. El índice de masa corporal medio fue de 27,6 (± 0,8) kg/m² y el 58,1 % tenían bajo riesgo nutricional. En el grupo experimental hubo una reducción de la PCR de 23,6 (± 7,5) mg/L, mientras que en la rama de control la disminución fue de 14,8 (± 12,1) mg/L (p = 0,002). Hubo un aumento de linfocitos en el grupo experimental (+367,5 ± 401,8 células/mm³) y una reducción en el grupo de control (-282,8 ± 327,8 células/mm³), aunque no hubo significación estadística (p = 0,369). El riesgo relativo (RR) del tratamiento para reducir la PCR en un 30 % o más fue de 4,45 (p < 0,001; IC 95 %: 1,79-11,07). El RR en el aumento del recuento de linfocitos en un 30 % o más fue de 1,28 (p = 0,327; IC 95 %: 0,67-2,45). Conclusión: se concluye que los suplementos de inmunonutrientes parecen reducir los niveles de PCR más que los suplementos normocalóricos estándar altos en proteína.

Beau's line in COVID-19 after a long ICU stay.

Introduction: The 2019 coronavirus disease pandemic (COVID-19) overloads hospitalizations in intensive care units (ICUs) around the world and its severe form is a complex disease that is still being understood. Due to the lack of direct evidence in patients with SARS-CoV-2 infection, guidelines for nutritional management have been based on evidence from critically ill patients in general. Thus, it is known that intense metabolic stress and malnutrition precede the appearance of Beau's lines. This is the case report of a 58-year-old man with the severe form of COVID-19 hospitalized for 33 days in the ICU and who presented the Beau´s lines after 4 months of discharge, even with the infusion of nutritional therapy following the current recommendations for the critical period of the disease.

Introducción: La pandemia de la enfermedad por coronavirus de 2019 (COVID-19) sobrecarga las hospitalizaciones en unidades de cuidados intensivos (UCI) en todo el mundo y su forma grave es una enfermedad compleja que aún se está comprendiendo. Debido a la falta de evidencia directa en pacientes con infección por SARS-CoV-2, las pautas para el manejo nutricional se han basado en la evidencia de pacientes críticos en general. Así, se sabe que el estrés metabólico intenso y la desnutrición preceden a la aparición de las líneas de Beau. Este es el caso clínico de un hombre de 58 años con la forma grave de COVID-19 hospitalizado durante 33 días en la UCI y que presentó las líneas de Beau después de 4 meses del alta, incluso con la infusión de terapia nutricional prescrita en consecuencia a las recomendaciones actuales para el periodo crítico de la enfermedad.

[Nutritional risk and clinical outcomes in patients diagnosed with COVID-19 in a high-complexity hospital network]. / Riesgo nutricional y desenlaces clínicos en pacientes con diagnóstico de COVID-19 en una red hospitalaria de alta complejidad.

INTRODUCTION: Introduction: the identification of nutritional risk at hospital admission is important to establish timely interventions in the COVID-19 patient care cycle, due to a high risk of it being associated with complications. Objective: to determine the association between the level of nutritional risk upon admission and in-hospital mortality at 28 days in patients diagnosed with COVID-19 treated between March and October 2020 in two hospital institutions in Colombia. Methods: a retrospective, observational study. Hospitalized patients with a diagnosis of COVID-19 were included and assessed by the Nutrition Service using the nutritional risk identification in emergencies scale, adapted from the NRS 2002 scale. In-hospital mortality at 28 days was analyzed as the primary endpoint, and hospital stay, admission to Intensive Care Unit (ICU), and requirement for mechanical ventilation as secondary endpoints. Results: a total of 1230 patients were included, with a mean age of 65.43 ± 15.90 years, mainly men (57.1 %, n = 702). A high nutritional risk (≥ 2 points) was identified in 74.3 % (n = 914). Patients with a high nutritional risk had a greater probability of in-hospital death at 28 days (HRadj: 1.64; 95 % CI: 1.11-2.44), and a greater risk of requiring mechanical ventilation (OR = 1.78; 95 % CI: 1.11-2.86) or ICU admission (OR = 1.478; 95 % CI: 1.05-2.09), as well as hospital stay longer than 7 days (OR = 1.91; 95 % CI: 1.47-2.48). Conclusions: patients with a diagnosis of COVID-19 at high nutritional risk had a significantly higher in-hospital mortality at 28 days and a higher probability of requiring mechanical ventilation, ICU admission, and prolonged hospital stay.

INTRODUCCIÓN: Introducción: la identificación del riesgo nutricional al ingreso hospitalario es importante para establecer intervenciones oportunas en el ciclo de atención del paciente con COVID-19, debido al alto riesgo de asociarse a complicaciones. Objetivo: determinar la asociación entre el nivel de riesgo nutricional al ingreso y la mortalidad intrahospitalaria a 28 días en pacientes con diagnóstico de COVID-19 atendidos entre marzo y octubre de 2020 en una red de dos instituciones hospitalarias de Colombia. Metodología: estudio observacional retrospectivo. Se incluyeron pacientes hospitalizados con diagnóstico de COVID-19 y valorados por el Servicio de Nutrición con la escala de identificación de riesgo nutricional en emergencias, adaptada de la escala NRS 2002. Se analizó como resultado principal la mortalidad intrahospitalaria a 28 días y como secundarios, la estancia hospitalaria, el ingreso a la Unidad de Cuidados Intensivos (UCI) y el requerimiento de ventilación mecánica. Resultados: se incluyeron 1230 pacientes, con edad promedio de 65,43 ± 15,90 años, principalmente hombres (57,1 %, n = 702). Se identificó un alto riesgo nutricional (≥ 2 puntos) en el 74,3 % (n = 914). Se evidenció que los pacientes con alto riesgo nutricional tenían una mayor probabilidad de muerte intrahospitalaria a 28 días (HR: 1,64; IC 95 %: 1,11-2,44) y un mayor riesgo de requerir ventilación mecánica (OR = 1,78; IC 95 %: 1,11-2,86), de ingreso en la UCI (OR = 1,478; IC 95 %: 1,05-2,09) y de estancia hospitalaria superior a 7 días (OR = 1,91; IC 95 %: 1,47-2,48). Conclusiones: los pacientes con diagnóstico de COVID-19 y riesgo nutricional alto presentaron una mortalidad intrahospitalaria a 28 días significativamente mayor y una mayor probabilidad de requerir ventilación mecánica y atención en la UCI, así como estancias hospitalarias prolongadas.

Pneumomediastinum and air leaks secondary to COVID-19: Expectant vs. invasive management of a rare complication.

Several alterations that, due to their pathophysiology, are collectively classified as "air leaks", have been rare complications of COVID-19 pneumonia. In the context of infection by SARS-CoV-2, the debate arises as to whether these are classified as spontaneous or secondary, since the multiple mechanisms of pulmonary structural damage that COVID-19 entails condition lung fragility in a patient in short time. For the above, we presents the case of a 36-year-old female patient with COVID-19 complicated with pneumomediastinum and subcutaneous emphysema in order to illustrate and discuss these complications.

Diversas alteraciones que, por su fisiopatología, son clasificadas en conjunto como «fugas de aire¼, han sido complicaciones raras de la neumonía por COVID-19. Respecto a la infección por SARS-CoV-2, se plantea el debate de si estas se clasifican como espontáneas o secundarias, ya que los múltiples mecanismos de daño estructural pulmonar que conlleva la COVID-19 condicionan fragilidad pulmonar en corto lapso. Por lo anterior, se expone el caso de una paciente de 36 años con COVID-19 complicada con neumomediastino y enfisema subcutáneo con el objetivo de ilustrar y discutir dichas complicaciones.

Consensus of the Liaison-Psychiatry Committee of the Colombian Psychiatric Association on the diagnosis and treatment of delirium in the context of the COVID-19 pandemic.

The pandemic caused by the new coronavirus named SARS-CoV-2 poses unprecedented challenges in the health care. Among them is the increase in cases of delirium. The severe SARS-CoV-2 disease, COVID-19, has common vulnerabilities with delirium and produces alterations in organs such as the lungs or the brain, among others, which have the potential to trigger the mental disorder. In fact, delirium may be the first manifestation of the infection, before fever, general malaise, cough or respiratory disturbances. It is widely supported that delirium increases the morbidity and mortality in those who suffer from it during hospitalization, so it should be actively sought to carry out the relevant interventions. In the absence of evidence on the approach to delirium in the context of COVID-19, this consensus was developed on three fundamental aspects: diagnosis, non-pharmacological treatment and pharmacological treatment, in patients admitted to the general hospital. The document contains recommendations on the systematic use of diagnostic tools, when to hospitalize the patient with delirium, the application of non-pharmacological actions within the restrictions imposed by COVID-19, and the use of antipsychotics, taking into account the most relevant side effects and pharmacological interactions.

Late bilateral vocal cord palsy following endotracheal intubation due to COVID-19 pneumonia.

Vocal cord paralysis is a rare but severe complication after orotracheal intubation. The most common cause is traumatic, due to compression of the recurrent laryngeal nerve between the orotracheal tube cuff and the thyroid cartilage. Other possible causes are direct damage to the vocal cords during intubation, dislocation of the arytenoid cartilages, or infections, especially viral infections. It is usually due to a recurrent laryngeal nerve neuropraxia, and the course is benign in most patients. We present the case of a man who developed late bilateral vocal cord paralysis after pneumonia complicated with respiratory distress due to SARS-CoV-2 that required orotracheal intubation for 11 days. He presented symptoms of dyspnea 20 days after discharge from hospital with subsequent development of stridor, requiring a tracheostomy. Due to the temporal evolution, a possible contribution of the SARS-CoV-2 infection to the picture is pointed out.

[Experiences and impact on the quality of life of people with long COVID]. / Vivencias e impacto en la calidad de vida de personas con COVID persistente.

OBJECTIVE: To explore the experiences of people with persistent COVID in the Basque Country more than a year after the start of the pandemic, in order to understand the health and social impact it has, as well as to detect possible areas for improvement in the care that these people receive in order to develop health programms to support their recovery. METHOD: Qualitative phenomenological study. In-depth interviews will be carried out as a data collection technique until saturation of the discourse. Patients of legal age who present persistent COVID symptomatology with an evolution time of more than 12 weeks were included. Contact with the patients was made through the Basque Long COVID Collective. The interviews were carried out and recorded through the ZOOM application. After the literal transcription of the interviews, the thematic analysis will be carried out, identifying the first units of meaning and assigning codes that will later be grouped into the different categories. RESULTS: 20 patients participated. A total of three main categories emerged from the analysis of the discourses: 1) affecting/impacting patients' quality of life; 2) identifying improvements in healthcare; and 3) comforting aspects. CONCLUSIONS: This study shows the significant impact on the quality of life suffered by these people. It is necessary to design health policies that favour a personalised, comprehensive and multidisciplinary approach to these patients.

The value of human resources: Experience of critical care nurses during the COVID-19 epidemic.

The COVID-19 pandemic has caused an unprecedented health crisis. Pressure on the National Health System has created unique demand particularly in certain services and care units like the critical care units. OBJECTIVE: To learn about the experience of nurses in caring for people with coronavirus in critical care units. METHOD: A qualitative phenomenological study that constitutes the second phase of a mixed methodology project. We conducted interviews with 17 nurses caring for patients affected by COVID-19 in critical care units. The interviews were audio-recorded, transcribed, and analysed using thematic discourse analysis. RESULTS: This article shows the findings around the theme "the value of human resources" which is nuanced through sub-themes "it's not the beds, it's the expert staff", "shouldering the patient's burden", and suffering because "they have not cared well". DISCUSSION: Expert nurses have emerged as leading professionals in the care of the critical patient during the COVID-19 pandemic. This leadership is executed from a profile framed in an inclusive philosophy where wisdom, agility and intuition are the key elements underpinning problem identification and solving in a creative way, while adapting to the needs of the patient and healthcare team as they emerge. CONCLUSIONS: Expert nurses have played an advanced role in the management of care and human resources by exercising effective leadership in the clinical setting. Care has been hampered due to the crisis, which causes nurses moral distress because they have been unable to meet standards of quality and excellence in care.