Effectiveness and Adherence to Closed Face Shields in the Prevention of COVID-19 Transmission: A Non-inferiority Randomized Controlled Trial in a Middle-Income Setting (COVPROSHIELD)

BACKGROUND: The use of respiratory devices can mitigate the spread of diseases such as COVID-19 in community settings. We aimed to determine the effectiveness of closed face shields with surgical face masks to prevent SARS-CoV-2 transmission in working adults during the COVID-19 pandemic in Bogotá, Colombia. METHODS: An open-label non-inferiority randomized controlled trial that randomly assigned participants to one of two groups: the intervention group was instructed to wear closed face shields with surgical face masks, and the active control group was instructed to wear only surgical face masks. The primary outcome was a positive reverse transcription polymerase chain reaction test, IgG/IgM antibody test for SARS-CoV-2 detection, or both during and at the end of the follow-up period of 21 days. The non-inferiority limit was established at - 5%. RESULTS: A total of 316 participants were randomized, 160 participants were assigned to the intervention group and 156 to the active control group. In total, 141 (88.1%) participants in the intervention group and 142 (91.0%) in the active control group completed the follow-up. PRIMARY OUTCOME: a positive SARS-CoV-2 test result was identified in one (0.71%) participant in the intervention group and three (2.1%) in the active control group. In the intention-to-treat analysis, the absolute risk difference was - 1.40% (95% CI [- 4.14%, 1.33%]), and in the per-protocol analysis, the risk difference was - 1.40% (95% CI [- 4.20, 1.40]), indicating non-inferiority of the closed face shield plus face mask (did not cross the non-inferiority limit). CONCLUSIONS: The use of closed face shields and surgical face masks was non-inferior to the surgical face mask alone in the prevention of SARS-CoV-2 infection in highly exposed groups. Settings with highly active viral transmission and conditions such as poor ventilation, crowding, and high mobility due to occupation may benefit from the combined use of masks and closed face shields to mitigate SARS-CoV-2 transmission. TRIAL REGISTRATION: ClinicalTrials.gov NCT04647305 . Registered on November 30, 2020

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

A systematic review and meta-analysis of the efficacy and safety of tapentadol immediate release compared to oxycodone immediate release in the management of postoperative acute pain in orthopedic surgery

El papel del tratamiento con analgésicos opioides en el período posoperatorio temprano sigue siendo controvertido. El uso de nuevos medicamentos como tapentadol, comúnmente utilizado en el dolor neuropático crónico, sugiere su utilidad en el manejo del dolor posoperatorio después de procedimientos quirúrgicos ortopédicos para enfermedades con dolor neuropático crónico. Se realizó una revisión sistemática y un metanálisis para sintetizar la evidencia existente sobre el uso de tapentadol en este contexto. Se accedió a las bases de datos PubMed-MEDLINE, EMBASE, OVID, Web of Science y LILACS. La eficacia y seguridad del uso de tapentadol fueron los resultados evaluados. La calidad de la evidencia se evaluó siguiendo las indicaciones del Manual Cochrane para revisiones sistemáticas y el enfoque GRADE. Se incluyeron cinco ensayos clínicos aleatorios. Se incluyó un total de 2520 pacientes en el análisis agrupado.The role of opioid analgesic management in the early postoperative period remains controversial. The use of new medications such as tapentadol, used commonly in chronic neuropathic pain, suggests its utility in the management of postoperative pain after orthopedic surgical procedures for diseases with chronic neuropathic pain. A systematic review and meta-analysis was conducted to synthesize the existing evidence regarding the use of tapentadol in this context. PubMed-MEDLINE, EMBASE, OVID, Web of Science and LILACS databases were accessed. Efficacy and safety of the use tapentadol were the outcomes evaluated. Quality of the evidence was assessed following the indications of the Cochrane Manual for systematic reviews and the GRADE Approach. Five randomized clinical trials were included. A total of 2520 patients were included in the pooled analysis.Magíster en EpidemiologíaMaestrí

Caracterización de los resultados adversos maternos y neonatales luego de operación cesárea en la E.S.E. Clínica de Maternidad Rafael Calvo

Revista Ciencias Biomédicas Vol.6, Núm.2 (2015) Pag 241 - 250Introducción: la Organización Mundial de la Salud (OMS) recomienda que la incidencia de cesárea no supere el 15%; sin embargo, su uso se ha incrementado en las dos últimas décadas, lo cual implica un problema de salud pública. Objetivo: caracterizar los resultados adversos maternos y neonatales de la cesárea en la Clínica Maternidad Rafael Calvo (CMRC) de Cartagena Colombia. Materiales y métodos: estudio descriptivo de corte transversal, donde se caracterizaron los resultados adversos maternos y neonatales posteriores a cesárea. Resultados: se realizaron 1.804 cesáreas (46.5%) y 2.073 partos vaginales (53.5%). Las indicaciones más frecuentes para cesárea fueron cesárea anterior (35.5%), desproporción céfalo pélvica (30.6%) y oligoamnios (10.8%). Los resultados adversos maternos más frecuentes fueron hemorragia que requirió transfusión (9.17%), hematoma en la herida quirúrgica (3.28%) e ingreso a UCI (1.5%). Los resultados neonatales adversos más frecuentes fueron APGAR<7 a los 5´ (4.3%)El control prenatal (CNP) fue factor protector para hemorragia uterina que requirió transfusión (OR crudo 0.54, IC 0.38 – 0.76, OR ajustado 0.53 IC 0.38 – 0.76), hemorragia uterina que requirió histerectomía (OR crudo 0.20, IC 0.01 - 0.72, OR ajustado 0.11, IC 0.11 – 0.72), shock obstétrico (OR crudo 0.06, IC 0.00 – 0.55, OR ajustado, 0.04, IC 0.04 – 0.38) y destino (alojamiento conjunto) (OR ajustado 0.66 IC 0.49 – 0.90), APGAR <7 a 1’ (OR ajustado 0.78, IC, 0.44 – 0.72), APGAR <7 a los 5’(OR ajustado 0.48, IC 0.28 – 0.82) y la presencia de síndrome de distrés respiratorio (OR crudo 0.28, IC, 0.15 – 0.51; OR ajustado 0.53, IC 0.28 – 0.98) Conclusiones: la proporción de cesáreas que se realizan en la CMRC (46,5%) es superior al 15% recomendado por la OMS. La operación cesárea conlleva al aumento de morbilidad materno- fetal. El CNP se comportó como factor protector frente a la aparición de resultados adversos maternos y neonatales

La transformación social : El gran reto de las organizaciones cívicas comunitarias

Tesis (Trabajadora Social) -- Universidad de Cartagena. Facultad de Ciencias Sociales y Educación. Programa de Trabajo Social, 1999Rescatar y fortalecer los espacios de participación social que tienen los ciudadanos, específicamente del corregimiento de Bayunca (Radio donde se delimita nuestra acción), facilitando la expresión del sentir y pensar de estos ciudadanos

Guías de laboratorio de histología práctica: Aplicación de un modelo constructivista

Este instrumento de aprendizaje denominado “Guías de laboratorio de histología práctica. Aprendizaje de un modelo constructivista” consta de dos módulos: El primer módulo, denominado “Guía del estudiante”, consiste en capítulos que describen cuales son las características microscópicas de los sistemas que conforman el cuerpo humano, visto a través de un microscopio. Muestra una explicación sencilla y de fácil lectura que permite al estudiante que se enfrenta por primera vez a una lámina histológica, familiarizarse con los términos histológicos y distinguir las estructuras básicas en los cortes histológicos. El segundo módulo denominado “Guía del docente” consiste en diferentes prácticas de laboratorio, cada una de las cuales está dividida en una o más sesiones de trabajo en las cuales se detallan los pasos a seguir para que el docente realice el montaje de una práctica y posterior a su realización sea capaz de evaluar el desempeño de sus estudiantes de una manera objetiva

Metered-dose inhalers versus nebulization for the delivery of albuterol for acute exacerbations of wheezing or asthma in children: a systematic review with meta-analysis

Objectives The benefits of metered‐dose inhalers with a spacer (MDI+S) have increasingly been recognized as an alternative method of albuterol administration for treating pediatric asthma exacerbations. The aim of this systematic review was to compare the response to albuterol delivered through nebulization (NEB) with albuterol delivered through MDI+S in pediatric patients with asthma exacerbations. Methods We conducted an electronic search in MEDLINE/PubMed, EMBASE, Ovid, and ClinicalTrials. To be included in the review, a study had to a randomized clinical trial comparing albuterol delivered via NEB versus MDI+S; and had to report the rate of hospital admission (primary outcome), or any of the following secondary outcomes: oxygen arterial saturation, heart rate (HR), respiratory rate (RR), the pulmonary index score (PIS), adverse effects, and need for additional treatment. Results Fifteen studies (n = 2057) met inclusion criteria. No significant differences were found between the two albuterol delivery methods in terms of hospital admission (relative risk, 0.89; 95% confidence interval [CI], 0.55–1.46; I2 = 32%; p = .65). There was a significant reduction in the PIS score (mean difference [MD], −0.63; 95% CI, −0.91 to −0.35; I2 = 0%; p < .00001), and a significantly smaller increase in HR (better; MD −6.47; 95% CI, −11.69 to −1.25; I2 = 0%; p = .02) when albuterol was delivered through MDI+S than when it was delivered through NEB. Conclusions This review, an update of a previously‐published meta‐analysis, showed a significant reduction in the PIS and a significantly smaller increase in HR when albuterol was delivered through MDI+S than when it was delivered through NEB

Risk factors for SARS-CoV-2 transmission in close contacts of adults at high risk of infection due to occupation: results from the contact tracing strategy of the CoVIDA epidemiological surveillance study in Bogotá, Colombia, in 2020–2021

Objectives To estimate the risk factors for SARS-CoV-2 transmission in close contacts of adults at high risk of infection due to occupation, participants of the CoVIDA study, in Bogotá D.C., Colombia.Setting The CoVIDA study was the largest COVID-19 intensified sentinel epidemiological surveillance study in Colombia thus far, performing over 60 000 RT-PCR tests for SARS-CoV-2 infection. The study implemented a contact tracing strategy (via telephone call) to support traditional surveillance actions performed by the local health authority.Participants Close contacts of participants from the CoVIDA study.Primary and secondary outcome measures SARS-CoV-2 testing results were obtained (RT-PCR with CoVIDA or self-reported results). The secondary attack rate (SAR) was calculated using contacts and primary cases features.Results The CoVIDA study performed 1257 contact tracing procedures on primary cases. A total of 5551 close contacts were identified and 1050 secondary cases (21.1%) were found. The highest SAR was found in close contacts: (1) who were spouses (SAR=32.7%; 95% CI 29.1% to 36.4%), (2) of informally employed or unemployed primary cases (SAR=29.1%; 95% CI 25.5% to 32.8%), (3) of symptomatic primary cases (SAR of 25.9%; 95% CI 24.0% to 27.9%) and (4) living in households with more than three people (SAR=22.2%; 95% CI 20.7% to 23.8%). The spouses (OR 3.85; 95% CI 2.60 to 5.70), relatives (OR 1.89; 95% CI 1.33 to 2.70) and close contacts of a symptomatic primary case (OR 1.48; 95% CI 1.24 to 1.77) had an increased risk of being secondary cases compared with non-relatives and close contacts of an asymptomatic index case, respectively.Conclusions Contact tracing strategies must focus on households with socioeconomic vulnerabilities to guarantee isolation and testing to stop the spread of the disease