Gabriel J. Tobón

IMPORTANCE: The effect of high-flow oxygen therapy vs conventional oxygen therapy has not been established in the setting of severe COVID-19. OBJECTIVE: To determine the effect of high-flow oxygen therapy through a nasal cannula compared with conventional oxygen therapy on need for endotracheal intubation and clinical recovery in severe COVID-19. DESIGN, SETTING, AND PARTICIPANTS: Randomized, open-label clinical trial conducted in emergency and intensive care units in 3 hospitals in Colombia. A total of 220 adults with respiratory distress and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen of less than 200 due to COVID-19 were randomized from August 2020 to January 2021, with last follow-up on February 10, 2021. INTERVENTIONS: Patients were randomly assigned to receive high-flow oxygen through a nasal cannula (n = 109) or conventional oxygen therapy (n = 111). MAIN OUTCOMES AND MEASURES: The co-primary outcomes were need for intubation and time to clinical recovery until day 28 as assessed by a 7-category ordinal scale (range, 1-7, with higher scores indicating a worse condition). Effects of treatments were calculated with a Cox proportional hazards model adjusted for hypoxemia severity, age, and comorbidities. RESULTS: Among 220 randomized patients, 199 were included in the analysis (median age, 60 years; n = 65 women [32.7%]). Intubation occurred in 34 (34.3%) randomized to high-flow oxygen therapy and in 51 (51.0%) randomized to conventional oxygen therapy (hazard ratio, 0.62; 95% CI, 0.39-0.96; P = .03). The median time to clinical recovery within 28 days was 11 (IQR, 9-14) days in patients randomized to high-flow oxygen therapy vs 14 (IQR, 11-19) days in those randomized to conventional oxygen therapy (hazard ratio, 1.39; 95% CI, 1.00-1.92; P = .047). Suspected bacterial pneumonia occurred in 13 patients (13.1%) randomized to high-flow oxygen and in 17 (17.0%) of those randomized to conventional oxygen therapy, while bacteremia was detected in 7 (7.1%) vs 11 (11.0%), respectively. CONCLUSIONS AND RELEVANCE: Among patients with severe COVID-19, use of high-flow oxygen through a nasal cannula significantly decreased need for mechanical ventilation support and time to clinical recovery compared with conventional low-flow oxygen therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04609462.

It has been stated repeatedly that active participation in rehabilitation programs increases the benefit and effectiveness of therapy. In developing robotic devices for stroke rehabilitation, the existing use of boring task interfaces produces a significant reduction in elderly patient motivation. To combine robot-aided therapy with appealing games, then, is not only a matter of creating entertainment, but a real necessity for motor recovery. Besides emphasizing a lack of attention to elderly patients in conceiving games for post-stroke rehabilitation, this paper launches a challenge to two fields with tremendous collaborative potential. As a precursor to this collaboration, the following research consolidates the gaming scenario criteria for both rehabilitation and elderly entertainment. Conclusions are then formed from the adaptability of existing games to identify the direction of future game development.

INTRODUCTION: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by organ damage, flare-remission pattern, and increased mortality when compared with the general population. SLE mortality depends on epidemiological, sociodemographic, genetic, and clinical factors. Mortality causes have been mainly grouped in disease activity, infections, and cardiovascular complications. Lupus nephritis and neuropsychiatric lupus are the main manifestations associated to mortality. Bacterial infection remains an important cause of death, and cardiovascular mortality is almost double when compared to age - and sex-matched comparisons. Characteristics such as time from onset to diagnosis > 1-year, renal involvement, high SLEDAI and severe organ involvement, may be predictors of mortality. Interventions including steroids, immunosuppressants, plasmapheresis, some biologics, and vaccination have shown efficacy in reducing mortality rates. Areas covered: In this narrative review the epidemiology, main causes of mortality, potential predictors, and interventions are described. Expert commentary: Despite early diagnosis and immunosuppressive treatment, SLE mortality remains high. African-American, Hispanic-American origin, low socioeconomic status and male sex are associated with increased mortality. Currently, there is no unique, precise prediction model for mortality; however, predictors for increased activity such as infections and cardiovascular events, lead to increased mortality. New prediction models may indicate early interventions in order to improve mortality rates.