ABSTRACT
Background: The use of uncooked cornstarch every four hours remains the most efficient treatment to prevent recurrent hypoglycemia in individuals with glycogen storage diseases (GSD). However, children must wake up overnight for therapy, and delayed administration of cornstarch can be associated with hypoglycemia, seizures, neurologic injury, and death. Since the introduction of extended-release, waxy maize cornstarch (ER-CS) Glycosade as a medical food, patients and families have benefited from ER-CS by avoiding the overnight dose while maintaining metabolic control. It is recommended that individuals with GSD transitioning to ER-CS be admitted to the hospital for two nights for initial evaluation of the ER-CS dose. This recommendation was made to minimize the risk of hypoglycemia. During this hospitalization, it is recommended glucose levels be measured hourly. The ER-CS package insert states that outpatient transition may be considered if the patient has history of adherence to recommendations, good metabolic control, and the calculated dose falls within the recommended range. Detailed guidance of home transition was not provided. During the COVID-19 pandemic, our clinic developed an outpatient protocol for ER-CS transition. The goal of this protocol was to prevent unnecessary hospitalizations while safely transitioning individuals with GSD to ER-CS. Method(s): We identified patients followed in the Metabolic Genetics Clinic at Texas Children's Hospital with liver GSD who require overnight uncooked cornstarch, have a history of adherence to recommendations, and good metabolic control. Each had a working glucometer, test strips for three nights of hourly blood glucose tests, emergency rescue glucose products, and a personalized hypoglycemia action plan. The trial took place over three nights. During the first 24 h of the trial, the patient followed their previous uncooked cornstarch regimen and feeding schedule with pre-prandial glucose measures. If euglycemia was documented, ER-CS was subsequently used on nights #2 and #3. Patients were monitored with hourly blood glucose measurements and hourly ketones in GSD III or IX. ER-CS doses were calculated following the standard insert packet recommendations. If hypoglycemia was detected on either night, the dose of ER-CS was increased prior to continuing the trial. Families communicated the results of nightly blood glucose logs with the metabolic dietician on the subsequent mornings. Result(s): Three patients with GSD III and one patient with GSD Ia attempted the home ER-CS trial. All patients passed the trial. All glucose levels and ketone levels were obtained as directed. One patient had a documented blood glucose level of 69 at hour eight on the third night of the trial. The dose of ER-CS was subsequently increased. The trial was extended to a fourth night and euglycemia was maintained. No further side effects were reported in the other patients. Conclusion(s): We report successful outpatient ER-CS transitions of multiple patients with GSDs. No adverse events or significant hypoglycemic episodes were recorded during at-home trials. Thus, in patients with GSDs who are compliant with medical recommendations and under good metabolic control, at-home transition to ER-CS can be done safely and effectively without need for hospitalization.Copyright © 2023
ABSTRACT
Prior to the pandemic, agri-tourism was on its rise in the Philippines. It is known as a fusion of Agriculture and tourism, linked to other sectors, including hospitality and transportation. However, travel bans and other restrictions amid the COVID-19 pandemic have adversely affected tourism. This study aimed to describe the pandemic effects on agri-tourism enterprises in the province of La Union, Philippines, and their adaptation strategies. A survey of 16 enterprises was conducted in May 2021. Descriptive and content analysis was employed to analyze the data and information gathered. The pandemic was found to have significantly affected the enterprises' marketing function, resulting in financial losses and adjustments to their business models. Their adaptation strategies were categorized as either survival or sustaining. Survival strategies were the farms' initial coping mechanisms like shifting to a new market, lowered prices, and switching to online marketing. On the other hand, sustaining strategies were also known as long-term solutions like diversification and expansion. The enterprises that adopted both strategies had wider offerings and possessed more than one accreditation. It is recommended that agri-tourism enterprises continue strategizing as the pandemic remains a threat. They should consider employing sustaining strategies for post-pandemic.
ABSTRACT
Introduction: In December 2019, the first group of patients with symptoms of atypical pneumonia was discovered in Wuhan, China. On January 7, 2020, the etiologic agent was identified;it was a new betacoronavirus, genetically similar to SARS-CoV-1, consisting of a simple RNA strand, an enveloped virus of 50-200nm in diameter, which was called SARS-CoV-2. Soon after, the disease was named COVID-19. On January 30, WHO declared a Public Health Emergency of International Importance due to the spread of the coronavirus. Tests for serological detection of IgM and IgG antibodies are those that provide an estimate of the immune response to SARS-CoV-2, highlighting the Rapid Diagnostic Tests (RDT), simple and accessible with a result within 5-30 minutes, based on sensitization of antigens/antibodies conjugated to colloidal gold capturing specific proteins present in the infected serum, plasma or blood. Objective: This work aims to show the analysis carried out with RDT for COVID-19 diagnosis in compliance with the current legislation from 02.04 to 18.08.2020. Method: In March of 2020, 25 serum/plasma samples were donated, without any identification. These samples were the remaining samples of tests performed on individuals with a confirmed diagnosis of SARS-CoV-2 infection by the RT-PCR technique from health services (National Institute of Infectious Diseases Evandro Chagas - INI and State Institute of the Brain Paulo Niemeyer - IEC) located in the metropolitan region of the state of Rio de Janeiro. The samples obtained in order to become a serological panel were stored at -20 degrees C until the moment of use. Simultaneously, a panel of samples with confirmed reactivity for IgM and IgG antibodies from COVID-19 was being made, throughout the pandemic and the samples used were evaluated against three Rapid Tests, of different antigenic compositions or different brands;two ELISA tests for IgM and IgG;two chemiluminescence tests and when applicable, a molecular test. In order to assess the specificity of the products sent, surplus donation plasma samples were selected, known to be negative for HIV, HTLV, hepatitis b and c, chagas and syphilis, collected between 2013 and 2014, in the southern regions of the country, period in which SARS-CoV-2 was nonexistent in the world. In addition to True Positive (VP) and True Negative (VN) samples, interfering serum or plasma samples with reactivity for HIV, HCV, HTLV, HBsAg, chagas disease, syphilis and dengue were also included in the evaluation. Results: Out of 178 TR lots, 74.1%, 132 lots were from China and 25.9%, 46 TR lots were from Brazil;Germany;South Korea;Canada;USA;Singapore;Ireland and Switzerland. The analytical result showed that 57.0%, 101 TR lots obtained a Satisfactory result and 43%, 77 lots had Unsatisfactory results, when compared to the Sensitivity and Specificity values declared by the manufacturer, in the Instructions for Use. Conclusions: The results obtained show the need for constant monitoring of TRs for COVID-19 with the primary purpose of guaranteeing the quality of products sold in the country, one of the National Health Surveillance System pillars of action.