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Background: Intravenous (IV) tocilizumab has been used to stop the inflammatory phase of SARS-CoV-2 infection. To preserve the largest number of IV units for this use, the Spanish Agency for Medicines and Health Products (AEMPS) carried out a controlled supply of it and recommended the change to a subcutaneous presentation (SC) of tocilizumab or sarilumab in all those patients in IV tocilizumab treatment for rheumatologic indications. The objective of this study was to evaluate the change from IV tocilizumab to SC presentation due to its controlled supply during the COVID-19 pandemic. Methods: Retrospective observational study of adult patients (>18 years old) under treatment with IV tocilizumab follow-up by the Rheumatology Service of the Hospital 12 de Octubre. The follow-up period was 3 months (March 2020-June 2020) and 39 patients were included in the study. Variables related to the patients and their treatment were collected. A descriptive analysis of the data was carried out. Results: In 69.23% (n=27) of the patients, treatment was changed to SC tocilizumab (n=23) or sarilumab (n=4). 44% of patients (n=12) switched back to their original IV tocilizumab treatment. The reasons for stopping treatment with SC tocilizumab were: drug intolerance (n=4), disease worsening (n=4), and patient preference (n=1). Regarding sarilumab, the reasons were drug intolerance (n=2) and patient preference (n=1). Conclusions: Almost half of the patients had to return to the original treatment. The main reason was intolerance to the new treatment, followed by ineffectiveness and patient preferences.
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This paper addresses the close relationship between the social sciences and the health sciences. From a general point of view, both disciplines seem to have followed a parallel path and without points of intersection;However, the COVID-19 pandemic has demonstrated the close relationship that science has to explain and confront the complex and multidimensional reality that is, at the same time, eco-biopsychosocial. This reality requires having researchers, professionals and theorists who see the need to interpret the world within complexity, from multidisciplinary approaches, which makes it possible to verify the particularities of each community. Therefore, an effort is necessary to reinterpret the training of health and social science professionals, carrying out joint work, leading to success in working with the communities. © 2022, Universidad del Zulia. All rights reserved.
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Universities in difficult times of pandemic, face great challenges in the continuity of the training of professionals and the development of research and innovation, to respond to the demands of society, in conditions of social isolation, according to the particularities of the context, in the present and with a future still uncertain. An important role in this direction is played by the cooperative relations between them and the academic and scientific community in general, for the search for alternatives and solutions, this raises the need to deepen the study and debate in this regard. The purpose of this work is to contribute to the strengthening of the internationalization of Higher Education in current conditions and is supported by an analytical methodology with an exploratory approach, based on documentary research and the development of integrated practices, based on actions and relationships between the "Carlos Rafael Rodriguez" University of Cienfuegos, Cuba and the Metropolitan University of Ecuador. The study considers three theoretical-practical nuclei of great value, which are: The humanistic vision and the research process in current conditions, the innovation of academic processes and the role of academic and scientific networks in the current and future scenario. The results of the actions developed between both universities are shown, supported by the exchange of good practices and learning.
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OBJECTIVE: Intravenous (IV) tocilizumab has been used to stop the inflammatory phase of SARS-CoV-2 infection. To preserve the largest number of IV units for this use, the Spanish Agency for Medicines and Health Products (AEMPS) carried out a controlled supply of it and recommended the change to a subcutaneous presentation (SC) of tocilizumab or sarilumab in all those patients in IV tocilizumab treatment for rheumatologic indications. The objective of this study was to evaluate the change from IV tocilizumab to SC presentation due to its controlled supply during the COVID-19 pandemic. METHODS: Retrospective observational study of adult patients (>18 years old) under treatment with IV tocilizumab follow-up by the Rheumatology Service of the Hospital 12 de Octubre. The follow-up period was 3 months (March 2020-June 2020) and 39 patients were included in the study. Variables related to the patients and their treatment were collected. A descriptive analysis of the data was carried out. RESULTS: In 69.23% (n=27) of the patients, treatment was changed to SC tocilizumab (n=23) or sarilumab (n=4). 44% of patients (n=12) switched back to their original IV tocilizumab treatment. The reasons for stopping treatment with SC tocilizumab were: drug intolerance (n=4), disease worsening (n=4), and patient preference (n=1). Regarding sarilumab, the reasons were drug intolerance (n=2) and patient preference (n=1). CONCLUSIONS: Almost half of the patients had to return to the original treatment. The main reason was intolerance to the new treatment, followed by ineffectiveness and patient preferences.
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In December 2019, a pandemic began in Wuhan, China, whose global impact has yet to be determined. It is an infectious process that mainly affects the respiratory tract. Two transmission routes, fomites and drops, were proposed in the first instance. The evolution of the disease has revealed the role of aerosols in its spread, thus discovering new measures to prevent the spread of the virus. Unlike other respiratory infections, patients with asthma have not seen their disease worsened, and the possible protective effect of inhaled corticosteroids has been evaluated in some studies. After analyzing the risk factors associated with this disease, environmental contamination is once again in the spotlight as in previous outbreaks caused by SARS-CoV-1. Some authors relate the levels of contamination and the increase in morbidity and mortality due to COVID-19, although they acknowledge that other types of studies are needed to demonstrate causality since there are multiple confounding factors involved. The measures of social distancing, use of masks, individual protection equipment, disinfection of surfaces … have been effective in protecting against the virus. The significant reduction in travel and industrial activity during the pandemic has demonstrated the influence of human beings on air quality and leads us to reflect on the need to continue implementing measures to improve the environment. © 2021, Spanish Association of Primary Care Pediatrics. All rights reserved.
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Introduction: Comorbidities have been related to highrisk of contracting COVID-19, and of having poor evolution and mortality.
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Background: The use of corticosteroids, specifically dexamethasone has been associated to low mortality in COVID-19 patients. We present here the mortality related to the use of corticosteroids in the first two months of the SARS-CoV-2 outbreak in México City. Methods: We conducted a case series of patients with the diagnosis of pneumonia due to SARS-CoV-2 virus admitted to a tertiary care center in Mexico City, between March 14th and May 14th, 2020. Data collected included demographic information, comorbidities, treatment and outcomes including mortality. Results: We included 109 patients with diagnosis of COVID-19 associated pneumonia with computed tomography;76(69.7%) were male and 33(30.3%) female with a median age of 52 yo (24-85) and 51 yo (25-81), respectively. Most common comorbidities were overweight (48.6%), obesity (35.8%), hypertension (23.8%), and diabetes (18.3%). Thirty-eight patients received corticosteroids (Methylprednisolone 30, Hydrocortisone 6 and dexamethasone and prednisone in on case). Mortality in those that used corticosteroids was 21% (8/38) and 5.6% for those that did not received (4/71), p=0.014. Forty cases needed mechanical ventilation from the beginning, and 24 of those received corticosteroids with a mortality of 29% (7/24), while the mortality was 18.7% (3/16) in those with no steroid use, p=0.45. Conclusion: Mortality in our small cohort with predominantly use of methylprednisolone is not lower in those using steroids. In fact, mortality was significantly higher in those that received corticosteroids, while this significance was not maintained in those that needed immediate mechanical ventilation. Use of corticosteroids for COVID-19 patients with pneumonia, should be further investigated.
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Background: As of today, more than 8 million people have been infected and around 440,000 of them have lost their lives due to complications of SARS-CoV-2 infection. The first confirmed case of COVID-19 in Mexico was on February 28, 2020, and currently, there are more than 150,300 confirmed cases and more than 17,500 deaths have been reported, this work presents the characteristics of the first cases on a tertiary care center with special focus on common comorbidities in Mexicans. Methods: We conducted a case series of patients with the diagnosis of pneumonia due to SARS-CoV-2 virus admitted to a tertiary care center in Mexico City, between March 14th and May 4th, 2020. Data collected included demographic information, comorbidities, clinical presentation, and outcomes. Regarding clinical outcomes, we measured the need of admission to Intensive Care Unit (ICU), mortality during hospitalization, discharge, and patients that remained hospitalized. Results: 85 patients were included, median age 53.5 years;69.4% were male. Most common clinical manifestations at admission were fever (61, 71.8%), cough (29, 34.1%), headache (25, 29.4%) and dyspnea (22, 25.9%). Most common comorbidities were overweight (44/82, 53.6%), obesity (25/82, 30.5%), hypertension (18, 21.2%), and diabetes (17, 20%). 31 of 85 (36.5%) patients were diagnosed with critical disease, whereas 54 of 85 (63.5%) were classified as non-critical. In the 31 critically ill patients, the length of invasive mechanical ventilation was 13 days [range {2-45}];5 patients (16.1%) required tracheostomy. The mean of mechanical ventilation prior to tracheostomy was 19.8 days [range {14-25}]. In all patients, the total length of hospitalization was 12.1 days [range {2-52}], 14.8 days [range {3-52}] in ICU patients, and 6.7 days [range {2-30}] in floor unit patients. No readmissions were documented. Global mortality was 4.7% (9.6% in ICU, 1.8% in floor unit). Of the 4 deceased patients, 3 presented comorbidities (75%), while 1 was previously healthy, documenting massive pulmonary embolism as the cause of sudden death. Conclusion: This study shows that the clinical characteristics in this initial cohort are not different that described elsewhere. Mortality is low but it is mainly related to prevalent comorbidities in the Mexican population.
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Background: The clinical presentation of SARS-CoV-2 disease ranges from asymptomatic respiratory infection to acute respiratory distress syndrome. Risk factors upon hospital admission associated with the need for invasive mechanical ventilation are not well documented. Methods: 185 hospitalized patients with confirmed COVID-19 were enrolled in this study, and they were classified as patients who required invasive mechanical ventilation and patients who did not require it. Comorbidities such as diabetes, high blood pressure, obesity, chronic lung disease and immunodeficiency were recorded. Laboratory studies were requested upon admission such as C-reactive protein, leukocyte and lymphocyte levels, D-dimer, troponin, serum ferritin and procalcitonin. Results: Of the patients who entered the study, 65 patients (35%) required invasive mechanical ventilation (IMV), while 120 (65%) did not require advanced airway management. Of the patients with invasive mechanical ventilation, age > 65 years, male sex, obesity (BMI > 30) and high blood pressure were the most frequent characteristics, presenting the latter two in 26% and 27% respectively. Regarding laboratory studies, the parameters most associated with the requirement for mechanical ventilation were a D-dimer (> 1000) and troponin (> 1), with 26% and 18%, respectively. Conclusion: This study showed the high proportion of obesity, hypertension and advanced age among patients who required invasive mechanical ventilation associated with SARS-CoV2 infection. The presence of elevated D-dimer and troponin on admission are associated with more severe presentations and a requirement for invasive mechanical ventilation.
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The public health crisis caused by the current COVID-19 pandemic ('the COVID-19 crisis') forces the European Union and the Member States to face an unprecedented challenge which has put at risk not only their health care systems, the normal development of administrative action or its economic stability, but also the set of values and way of life that make up the concept of European citizenship. In this context, the technological development resulting from the profound processes of digitization and datification of society that we are witnessing in recent years, is presented as a definite alternative to inform citizens and assist relevant public authorities in their efforts to contain the spread of the virus. In addition, they can be a valuable tool to reverse the isolation based on data models strategies that point to the potential effects of relaxing social distancing measures. However, the implementation of some of these measures raises questions from the point of view of several fundamental rights and freedoms guaranteed in the legal system, especially the right to privacy and the right to protection of personal data. The purpose of this study is to clarify, on the basis of the law, the main questions surrounding the use of technology in times of disaster, helping to clarify the difficult balance between technological development and the guarantee of citizen's fundamental rights, paying particular attention to the protection of personal data. © 2020, Iustel. All rights reserved.