Management of Obstructive Jaundice in Patients with Periampullary Tumors in a Covid-19 Pandemic Situation

Introduction: The redistribution of hospital resources secondary to SARS-CoV-2(COVID19) produced a reduction and delay in surgical activity. Analysis of the management of obstructive jaundice (OI) in a reference centre during COVID19 in patients with potentially resectable periampullary tumours. Method(s): Observational study, limited to the year 2021, on the management of OI in periampullary pathology. Analysis of the different biliary drainage (BD) techniques (endoscopic/transhepatic) and the associated complications. The indication criteria for BD were: bilirubin levels >10 mg/dl, cholangitis or expectation of surgery >2 weeks from inclusion on the waiting list. Patients with criteria of unresectability or those with neoadjuvant indication were excluded from the study. Result(s): Thirty-five patients were analyzed, with an age range between 45-80 years, who were indicated to undergo a pancreaticoduodenectomy. 51% of these patients required preoperative DB. DB was performed endoscopically (ERCP) in 10 patients and by transparietohepatic approach (TPHD) in 8 patients. In endoscopic approach the majority of stents used were expandable coated metallic (eight patients). The most frequent complications associated with ERCP were cholangitis and acute cholecystitis. The most frequent complication associated with TPHD was cholangitis. Conclusion(s): Preoperative BD associates a greater number of perioperative complications. At present, there is consensus in avoiding preoperative DB, except in cases with cholangitis or hyperbilirubinemia. If DB is necessary, the endoscopic approach (ERCP) would be indicated. Coated Metal stents should be considered for patients with resectable pancreatic cancer, especially if surgery is not immediate.

PROFILE OF PRIORITY SETTING INCORPORATED TO COVID-19 RESPONSE PLANS IN 86 COUNTRIES IN THE WORLD

Background The COVID-19 pandemic has imposed a burden on all health systems budgets and pushed policymakers to rapidly set priorities for resource allocation. This study aimed to identify quality parameters of priority setting (PS) incorporated in a sample of the national response plans. Methods We reviewed a sample of COVID-19 national response plans from 86 countries across six regions of the WHO to assess the degree to which they included twenty quality indicators of effective PS. A quantitative descriptive analysis was used to explore the profile of PS according to independent variables. Results The countries sampled represent 40% of countries in AFRO, 54,5% of EMRO, 45% of EURO, 46% of PAHO, 64% of SEARO, and 41% of WPRO. They also represent 39% of all HICs in the world, 39% of Upper-Middle, 54% of Lower-Middle, and 48% of LICs. No pattern in attention to PS quality indicators emerged by WHO region or country income levels. As per the quality PS parameters, evidence of political will, stakeholder participation, use of scientific evidence/adoption of WHO recommendations were each found in over 80% of plans. Regarding the frequency of other parameters we found, description of a specific PS process (7%);explicit criteria for PS (36,5%);inclusion of publicity strategies (65%), mention of mechanisms for enforcing decisions, either for appealing decisions or implementing strategies to improve internal accountability and reduce corruption (20%);explicit reference to public values (15%);description of means for enhancing compliance with the decisions (5%). Conclusion We found some emphasis on PS according to contextual factors. For instance, LMICs receiving international donations presented more detailed descriptions of resources required, plans for allocating resources and improving internal accountability. HICs more likely described stakeholder participation, mechanisms for public communication, and explicit PS processes. However, no country included all twenty parameters of PS.

STRESS IN SYMPTOMATIC RESPIRATORY PATIENTS AND COVID-19 PANDEMIC. CENTRAL HOSPITAL OF MARACAY, VENEZUELA

The objective of the present study was to evaluate the pandemic stress of COVID-19 in patients admitted to the Respiratory Symptomatic Triage at the Hospital Central de Maracay during the month of August 2020. An investigation was carried out under a quantitative, non-experimental, descriptive and cross-sectional approach, with a field design. The population consisted of 100 patients who were referred from the emergency on the 7 / 1pm shift to the Triage of respiratory symptoms at the aforementioned Hospital, to whom a questionnaire structured in three parts was applied considering the diagnostic and statistical criteria of mental disorders. The results indicate that the factors significantly associated with the level of moderate stress in the Aragonese population in the COVID-19 pandemic were: fear, fear or panic of the modes of transmission and the prognosis of the disease represented by 77%, the excessive flow of information circulating in the different social networks with 63%, the situation prevailing in the communities reflecting 80%. The concern and fear that the community presents of being infected with the virus that can lead to death is notorious. It is concluded that the stress derived from the COVID-19 pandemic should be considered as a public health problem that affects the biopsychosocial well-being of the individual, family and community, so it is necessary to apply preventive measures that promote the mental health of the population.