Estrategia de intervención con el candidato vacunal Abdala en trabajadores de la Salud

El proceso de vacunación contra la COVID-19 en Cuba está sustentado en fundamentos epistemológicos de la Medicina y las Ciencias biomédicas que permitieron la ejecución de los ensayos clínicos con vacunas de producción nacional, así como el desarrollo de otros candidatos vacunales durante el periodo de emergencia epidemiológica. El objetivo de este artículo es fundamentar los conocimientos en relación a la estrategia de intervención con el candidato vacunal Abdala en trabajadores de la Salud en Santiago de Cuba. Mediante una revisión bibliográfica realizada desde el 1ro. de marzo hasta el 31 de mayo de 2021, se analizaron artículos científicos, datos publicados por la Organización Mundial de la Salud, y libros de textos, todo lo cual facilitó la recuperación y valoración de la información sistematizada. La estrategia de intervención con el candidato vacunal Abdala en trabajadores de la salud en Santiago de Cuba demandó una gestión transdisciplinaria, intersectorial y participativa. La aplicación de los procedimientos del método clínico-epidemiológico reveló la necesidad de amplificar una cultura de inmunización con sustentos epistemológicos mediante la sistematización del proceso asistencial.

The vaccination process against COVID-19 in Cuba is based on epistemological foundations of Medicine and Biomedical Sciences that allowed the execution of clinical trials with nationally produced vaccines, as well as the development of other vaccine candidates during the epidemiological emergency period. The objective of this article is to base the knowledge in relation to the intervention strategy with the vaccine candidate Abdala in Health workers in Santiago de Cuba. Through a bibliographical review carried out from the 1st. From March to May 31st, 2021, scientific articles, data published by the World Health Organization, and textbooks were analyzed, all of which facilitated the recovery and evaluation of systematized information. The intervention strategy with the vaccine candidate Abdala in health workers in Santiago de Cuba demanded a transdisciplinary, intersectoral and participatory management. The application of the procedures of the clinical-epidemiological method revealed the need to amplify an immunization culture with epistemological supports through the systematization of the care process.

Local ocular surface findings in COVID-19 patients without ocular symptoms / Achados locais de superfície ocular em pacientes com COVID-19 sem sintomas oculares

ABSTRACT Purpose: To investigate subjective ocular symptoms and objectively measure tear secretion in patients with a confirmed diagnosis of coronavirus disease-2019 (COVID-19). Methods: In this prospective cross-sectional study, 24 patients who had survived COVID-19 infection and 27 healthy controls were enrolled. Conjunctival impression cytology, the Schirmer test, tear-film break-up time, corneal staining scores were applied to all the participants. Results: No significant difference was noted with regard to the gender and mean age between the two groups (p=0.484 and p=0.599, respectively). The conjunctival impression cytology analysis revealed that the density of the goblet cells was decreased, while the counts of lymphocytes and neutrophils were increased in the COVID-19 group patients when compared with ethe control group patients. When the Nelson classification was applied to the conjunctival impression cytology samples, 25% of the COVID-19 group patients and 14.8% of the control group patients exhibited changes consistent with ≥grade 2. The mean tear-film break-up time, Schirmer test, and corneal staining score results were determined to differ between the COVID-19 and control groups (p=0.02, p<0.001, and p=0.003, respectively). Conclusions: The present study revealed the pathological conjunctival alterations of patients with a confirmed diagnosis of COVID-19, indicating the possibility of the occurrence of pathological ocular surface alterations to even at the end of COVID-19 infection, without the occurrence of any significant clinical ocular manifestations.

RESUMO Objetivo: Investigar sintomas oculares subjetivos e medir a secreção lacrimal objetivamente em pacientes com diagnóstico confirmado da doença coronavírus 2019 (COVID-19). Métodos: Vinte e quatro pacientes que sobreviveram à infecção pela COVID-19 e 27 controles saudáveis foram incluídos neste estudo transversal prospectivo. Citologia de impressão da conjuntiva, teste de Schirmer, tempo de separação do filme lacrimal, pontuações de coloração da córnea foram aplicados a todos os participantes. Resultados: Concluiu-se que não houve diferença significativa em relação ao gênero e idade média entre os dois grupos (p=0,484 e p=0,599, respectivamente). A análise dos resultados da citologia de impressão da conjuntiva revelou que a densidade das células do cálice diminuiu, enquanto os linfócitos e neutrófilos aumentaram nos pacientes do grupo COVID-19 quando comparados com os do grupo controle. Quando a classificação de Nelson foi aplicada às amostras de citologia de impressão da conjuntiva, determinou-se que 25% dos pacientes do grupo COVID-19 e 14,8% dos pacientes do grupo controle apresentaram alterações consistentes com grau 2 ou superior. O tempo médio de separação do filme lacrimal, teste de Schirmer e os resultados das pontuações de coloração da córnea foram determinados, diferindo entre o grupo COVID-19 e o grupo controle (p=0,02, p<0,001, and p=0,003, respectivamente). Conclusões: As análises realizadas neste estudo revelaram as alterações conjuntivais patológicas de pacientes com diagnóstico confirmado de COVID-19 e mostraram que é possível que alterações patológicas da superfície ocular ocorram mesmo no final da infecção pela COVID-19, sem a ocorrência de manifestações oculares clínicas significativas.

Clinical characteristics of patients infected with 2019 novel coronavirus Omicron variant in Zhuhai City / 中华传染病杂志

Objective:To explore the clinical characteristics of patients infected with 2019 novel coronavirus (2019-nCoV) Omicron variant in Zhuhai City.Methods:A retrospective study was conducted to compare the clinical characteristics of patients infected with 2019-nCoV Omicron variant (Omicron variant group, 39 cases) from January 13 to January 25, 2022, and those infected with 2019-nCoV non-Omicron variant (non-Omicron variant group, 98 cases) from January 17 to February 17, 2020, in the Fifth Affiliated Hospital of Sun Yat-sen University. Statistic methods were used by Mann-Whitney U test, chi-square test and Fisher exact probability test. Results:Among adults, the age of 21 patients in Omicron variant group was younger than that of 93 patients in non-Omicron variant group (34.0(26.0, 40.5) years vs 50.0(36.0, 62.0) years, Z=-3.81, P<0.001). Patients with underlying diseases in Omicron variant group were fewer than those in non-Omicron variant group (4.8%(1/21) vs 31.2%(29/93), χ2=6.17, P=0.013). The clinical classification of the Omicron variant group was mainly mild (71.4%(15/21)) or common type (28.6%(6/21)), while the non-Omicron variant group was dominated with common type (57.0%(53/93)) and severe type (23.7%(22/93)), and the clinical classification of the two groups had statistically difference ( χ2=31.79, P<0.001). The time of positive nucleic acid in Omicron variant group was longer than that in non-Omicron variant group (14.0(10.5, 16.5) d vs 8.5(4.0, 12.0) d, Z=-3.56, P<0.001). The proportion of pneumonia in Omicron variant group was less than that in non-Omicron variant group (28.6%(6/21) vs 86.0%(80/93), χ2=30.52, P<0.001). Differences were all statistically significant. There was no significant difference of the clinical characteristics in pediatric patients, but the proportion of children infected with 2019-nCoV Omicron variant was significantly higher than that infected with 2019-nCoV non-Omicron variant (46.2%(18/39) vs 5.1%(5/98), χ2=33.65, P<0.001). Conclusions:Adults infected with 2019-nCoV Omicron variant in Zhuhai City present with milder clinical symptoms, less proportion of pneumonia, but the time of positive nucleic acid is longer. The clinical characteristics of children infected with 2019-nCoV Omicron variant are not specific, while the proportion of children infected with 2019-nCoV Omicron variant is significantly higher.

Síntomas afectivos en profesionales que laboran en la atención a casos positivos de COVID-19 / Affective symptoms in professionals who work in the positive COVID-19 cases care

RESUMEN Fundamento La COVID-19 implica retos específicos para los trabajadores de la salud, los cuales representan una mayor carga de estrés. Ello confiere interés y relevancia al estudio de la esfera afectiva en este sector, protagonista en la atención a pacientes positivos de COVID-19. Objetivo caracterizar síntomas afectivos en profesionales que laboran en la atención a casos positivos de COVID-19. Métodos se realizó un estudio descriptivo transversal, en profesionales de la salud que laboran en la atención a pacientes positivos a la COVID-19; enmarcado entre los meses de abril y julio del 2020, en el hospital Manuel Fajardo Rivero de Santa Clara. La población de estudio fueron 82 trabajadores (enfermeros y tecnólogos de la Salud). Las variables estudiadas fueron sexo, categoría profesional y rango de severidad de los síntomas afectivos (depresión y ansiedad). Resultados la totalidad de los profesionales presentó algún grado de ansiedad, con predominio de la forma moderada (64,6 %). El 63,4 % no manifestó depresión, sin embargo, el 43,47 % de los que tuvieron este síntoma fueron mujeres, y el 52,63 % enfermeros de profesión. La ansiedad en forma moderada afectó al 72,22 % de los hombres, 58,69 % de las mujeres, y el 68,42 % de los enfermeros. Conclusión Entre los síntomas afectivos en profesionales que laboran en la atención de casos positivos a la COVID 19 se observó un predominio de la ansiedad. Este estudio explora aspectos de la salud mental que avizoran sobre la importancia de intervenciones futuras.

ABSTRACT Background COVID-19 involves specific challenges for healthcare workers, which represent a greater burden of stress. This confers interest and relevance to the study of the affective sphere in this sector, a protagonist in the positive COVID-19 patient's care. Objective to characterize affective symptoms in professionals who work in the positive COVID-19 cases care. Methods a cross-sectional descriptive study was carried out in health professionals who work in the positive COVID-19 patient's care; between April and July 2020, at the Manuel Fajardo Rivero hospital in Santa Clara. 82 workers (nurses and health technologists) were the study population. The variables studied were sex, professional category and range of severity of affective symptoms (depression and anxiety). Results all the professionals presented some degree of anxiety, with a predominance of the moderate form (64.6%). The 63.4% did not show depression, however, 43.47% of those who had this symptom were women, and 52.63% were professional nurses. Anxiety moderately affected 72.22% of men, 58.69% of women, and 68.42% of nurses. Conclusion Among the affective symptoms in professionals who work in the positive COVID 19 cases care, a predominance of anxiety was observed. This study explores aspects of mental health that foresee the importance of future interventions.

Población vulnerable a la COVID-19 según prevalencia de enfermedades no transmisibles en Cienfuegos / Vulnerable population to COVID-19 according to the prevalence of non-communicable diseases in Cienfuegos

RESUMEN Fundamento La identificación de los espacios de altas concentraciones de personas con factores de riesgo ante la COVID-19, como lo son las enfermedades no transmisibles, permite una toma de decisiones más certera en la labor de hacer frente a la propagación del virus y salvaguardar vidas humanas. Objetivo analizar la distribución de la población vulnerable a la COVID-19 según la prevalencia de enfermedades no transmisibles. Métodos: estudio descriptivo, transversal, de carácter geográfico-epidemiológico, en la provincia de Cienfuegos. Se aplicó la ponderación de mapas temáticos de distribución de pacientes con prevalencia de enfermedades no transmisibles, en grupos de edades de 25 a 59 y 60 años y más, mediante técnicas de evaluación multicriterio en los sistemas de información geográfica. Se elaboraron mapas síntesis con la estratificación de las áreas de salud en cincos grados de vulnerabilidad poblacional a la COVID-19. Resultados: las áreas de salud más vulnerables fueron: la "Cecilio Ruiz de Zárate", del municipio de Cienfuegos en el grupo de 25 a 59 años, y esta propia área y la "Aracelio Rodríguez Iglesias", de Cumanayagua, en el de 60 años y más. Conclusión: las áreas de salud más vulnerables fueron identificadas en los municipios cienfuegueros de mayor importancia económica; sobre todo en la ciudad de Cienfuegos, en la parte más antigua, más densamente poblada y de mayor número de servicios, todo lo cual supone un riesgo extra, ya que en los espacios que con más facilidad se propaga el virus SARS-CoV-2, reside un mayor número de personas vulnerables a la COVID-19.

ABSTRACT Background The identification of spaces with high concentrations of people with risk factors for COVID-19, such as non-communicable diseases, allows more accurate decision-making in the work of facing the spread of the virus and safeguarding human lives. Objective to analyze the vulnerable population distribution to COVID-19 according to the prevalence of non-communicable diseases. Methods: descriptive, cross-sectional study, of a geographic-epidemiological nature, in the Cienfuegos province. The weighting of thematic maps of distribution of patients with prevalence of noncommunicable diseases was applied, in age groups from 25 to 59 and 60 years and over, using multi-criteria evaluation techniques in geographic information systems. Synthesis maps were prepared with the stratification of health areas in five degrees of population vulnerability to COVID-19. Results the most vulnerable health areas were: "Cecilio Ruiz de Zárate", from the Cienfuegos municipality in the aged group 25 to 59, and "Aracelio Rodríguez Iglesias", from Cumanayagua, in the 60 years of age and more. Conclusion the most vulnerable health areas were identified in the Cienfuegos municipalities of greater economic importance; especially in the Cienfuegos city, in the oldest part, more densely populated and with the greatest number of services, all of which implies an extra risk, since the SARS-CoV-2 virus spreads easily, live a greater number of vulnerable people to COVID-19.

O processo de tomada de decisão médica em tempos de pandemia por coronavírus / The medical decision-making process in the time of the coronavirus pandemic

RESUMO A pandemia causada pelo novo coronavírus tem provocado mudanças significativas no processo de tomada de decisão médica diante do paciente grave. Repentinamente, aumentaram as admissões em unidades de tratamento intensivo, porém, muitos desses casos não apresentam quadros relacionados à infecção viral, mas à exacerbação de doenças preexistentes. Nesse contexto, precisamos evitar que o processo decisório intuitivo e a insegurança nos levem a exaurir a disponibilidade de leitos críticos, antes do momento em que eles sejam realmente necessários, mesmo reconhecendo a importância do método decisório rápido em situações emergências. Uma das melhores formas de atingir esse propósito talvez seja por meio da prática da metacognição e da estruturação de formas de feedback regulares aos profissionais envolvidos em processos decisórios inerentemente rápidos.

ABSTRACT The disease pandemic caused by the novel coronavirus has triggered significant changes in the medical decision-making process relating to critically ill patients. Admissions to intensive care units have suddenly increased, but many of these patients do not present with clinical manifestations related to the viral infection but rather exacerbation of preexisting diseases. In this context, we must prevent intuitive decision-making and insecurity from leading us to exhaust the available critical-care beds before they are truly necessary, while still recognizing the importance of rapid decision-making in emergency situations. One of the best ways to achieve this goal may be by practicing metacognition and establishing ways for regular feedback to be provided to professionals engaged in inherently rapid decision-making processes.

Características clínico-epidemiológicas en pacientes con diagnóstico covid-19. Red de salud Virú, marzo - mayo 2020 / Clinical-epidemiological characteristics in patients with covid-19 diagnosis. Virú health network, march - may 2020

Objetivo. Describir las características clínico-epidemiológicas en pacientes con diagnóstico confirmado COVID-19 de la Red de Salud Virú marzo a mayo 2020. Material y Métodos: Estudio de enfoque cuantitativo y diseño observacional descriptiva con datos secundarios. La población conformada por pacientes diagnosticados positivos a COVID-19 con pruebas moleculares y serológicas. Se aplicó la técnica de la documentación. El instrumento establecido, basado en la ficha de investigación clínico epidemiológica COVID-19 usada durante la consulta clínica. Se identificó variables sociodemográficas, antecedentes y manifestaciones clínicas. Se procesó la data mediante tablas dinámicas en Excel y software SPSS 26.0. Resultados: Se halló un 67,7% de casos COVID-19 en la Red de Salud Virú en las etapas de vida adulto y adulto mayor. Predominio de pacientes de sexo masculino (57,4 %) frente al sexo femenino (42,6 %). El distrito de Virú presentó 52,9 % de los casos confirmados de pacientes con COVID-19. Los síntomas fueron: Tos (48,7%), malestar general (48,2%), dolor de garganta (39,1%) y fiebre/escalofrío (37,5 %), congestión nasal (22,0 %), cefalea (21,3%) dificultad respiratoria (17,1 %), dolor muscular (12,2 %) y dolor de pecho (8,4%). Otros síntomas en menor proporción, náuseas/vómitos (5,6%), diarrea (5,2 %), dolor abdominal y de articulaciones (1,9%). Las comorbilidades predominantes son: diabetes (3,7%), enfermedad cardiovascular (3,5%), embarazo(1,9%) enfermedad pulmonar crónica (0,5%), enfermedad hepática y cáncer con (0,2%) respectivamente. Conclusiones: Dentro de las características clínico-epidemiológicas tenemos que el sexo más frecuente fue varones, siendo la tos el síntoma principal y la diabetes mellitus la comorbilidad más frecuente.

Objetive. To describe the clinical-epidemiological characteristics in patients with a confirmed diagnosis of COVID-19 from the Viru Health Network from March to May2020. Material and Methods: Study with a quantitative approach and descriptive observational design with secondary data. The population made up of patients diagnosed positive for COVID-19 with molecular and serological tests. The documentation technique was applied. The established instrument, based on the COVID-19 clinical epidemiological investigation card used during the clinical consultation. Sociodemographic variables, antecedents and clinical manifestations were identified. The data was processed using dynamic tables in Excel and SPSS 26.0 software. Results: 67.7% of COVID-19 cases were found in the Virú Health Network in the adult and elderly life stages. Prevalence of male patients (57.4%) compared to female (42.6%). The Virú district presented 52.9% of the confirmed cases of patients with COVID-19. The symptoms were: cough (48.7%), general malaise (48.2%), sore throat (39.1%) and fever / chills (37.5%), nasal congestion (22.0%), headache (21.3%) respiratory distress (17.1%) ), muscle pain (12.2%) and chest pain (8.4%). Other symptoms to a lesser extent, nausea / vomiting (5.6%), diarrhea (5.2%), abdominal and joint pain(1.9%).The predominant comorbidities are: diabetes(3.7%),cardiovascular disease (3.5%), pregnancy (1.9%), chronic lung disease (0.5%), liver disease and cancer (0.2%) respectively. Conclusions: Within the clinical-epidemiological characteristics, we have that the most frequent sex was male, being cough the main symptom and diabetes mellitus the most frequent comorbidity.

Ensino na pandemia: decisões do Instituto Federal de Roraima para o Curso Técnico em Enfermagem / Teaching in the pandemic: decisions of the Federal Institute of Roraima for the Technical Course in Nursing / Enseñanza en la pandemia: decisiones del Instituto Federal de Roraima para el Curso Técnico en Enfermería

Objetivo: analisar as tomadas de decisão do Instituto Federal de Roraima, durante o primeiro semestre de 2020, frente à pandemia da COVID-19 e possíveis impactos no ensino do conteúdo pertinente ao Curso Técnico em Enfermagem. Método: pesquisa qualitativa, executada com auxílio do software MAXQDA, que analisou documentos normativos expedidos pela instituição de ensino e que lançou mão da análise de Bardin para categorização das chaves de significado. Resultados: As portarias trazem fortes componentes administrativos pautados na lei que rege o serviço público federal, bem como faz-se presente o aspecto humanista. Conclusão: as ações emergenciais foram pensadas e desenvolvidas para oferecer a continuidade de um ensino forte, consistente e seguro, em meio à pandemia da COVID-19.

Objective: to analyze the decision-making of the Federal Institute of Roraima, during the first semester of 2020, in face of the pandemic of COVID-19 and possible impacts on the teaching of the content pertinent to the Technical Course in Nursing. Method: qualitative research, performed with the aid of the MAXQDA software, which analyzed normative documents issued by the educational institution and which used Bardin's analysis to categorize the keys of meaning. Results: The ordinances have strong administrative components based on the law that governs the federal public service, as well as the humanist aspect. Conclusion: the emergency actions were thought and developed to offer the continuity of a strong, consistent and safe teaching, in the midst of the COVID-19 pandemic.

Objetivo: analizar la toma de decisiones del Instituto Federal de Roraima, durante el primer semestre de 2020, ante la pandemia de COVID-19 y los posibles impactos en la enseñanza del contenido pertinente al Curso Técnico en Enfermería. Método: investigación cualitativa, realizada con la ayuda del software MAXQDA, que analizó documentos normativos emitidos por la institución educativa y que utilizó el análisis de Bardin para clasificar las claves del significado. Resultados: las ordenanzas tienen fuertes componentes administrativos basados en la ley que rige el servicio público federal, así como en el aspecto humanista. Conclusión: las acciones de emergencia fueron pensadas y desarrolladas para ofrecer la continuidad de una enseñanza fuerte, consistente y segura, en medio de la pandemia de COVID-19.