Allergological study in patients referred for adverse reactions to the SARS CoV2 vaccine: Our experience

Background: Adverse reaction's reported after COVID 19 vaccination had a negative impact on public opinion. These adverse reactions may be or may be not be mediated by hypersensibility reactions. The proper assesment and the manegament of adverse reactions are crucial in order to offer a safer inmunitation and also to reduce the misinformation and the growing rejection to COVID 19 vaccination. Objective(s): To describe clinical characteristics and the allergological study done in different patients who had an adverse event right after COVID 19 vaccine administration Method: Descriptive study in patients who have experienced an adverse event after one single dose of the SARS CoV2's vaccine. Sex, age, atopy, drug allergies, anaphylaxis reaction (according to EEACI), syntoms, timing, vaccine and dose are described on this study. Skin test were done in every patient (Prick-Test and intradermo reaction) with ARN vaccine samples (Pfizer and Moderna), Adenovirus vaccine extract (Astrazeneca) and a battery of excipients (Polietilenglicol, Polisorbato80 and Trometamol). Result(s): The study included 44 patients with an average of 48,76 +/- 12,23 years, (93% women-29% atopic). 29% of the patients reported to be allergic to other drugs (AINES especially). The most frequent reaction according to EEACI anaphilaxy's classification was Grade 1 with a 61%. Grade 2: 18%, Grade 3: 21%. Urticaria and/or angioedema were the most frequent syntoms (60%) followed by disnea (20%) and being late syntoms (50%) the most usual ones. Pfizer was the most implicated vaccine (64%) with the first dose (84%). Skin tests with Polietilenglicol, Trometamol and Polisorbato80 at different concentrations were negative in all patients but two, one positive to Polisorbato80 0.004mg/ml with a previous sensitization to Prontosan (contains Polisorbato) and another one positive to Trometamol 0.1mg/ml. Conclusion(s): Allergists play a main role to offer the maximum befenits to their patients and to improve the vaccine's safety. Skin tests were the most efective tool to diagnose hypersensibility reactions. The 93,17% of the patients with a negative test result tolerated the second dose. The others did not get the second dose due to their own will. Avoiding the COVID 19 vaccine was recommended in those patients with a hypersensibility to the vaccine components diagnose.

Resilient clean cooking: Maintaining household clean cooking in Ecuador during the COVID-19 pandemic

Decades of government subsidies for LPG and electricity have facilitated near-universal clean cooking access and use in Ecuador, placing the nation ahead of most other peer low- and middle-income countries. The widespread socio-economic impacts of the COVID-19 pandemic has threatened the resilience of clean cooking systems globally, including by altering households' ability to purchase clean fuels and policymakers' considerations about continuing subsidy programs. As such, assessing the resilience of clean cooking in Ecuador during the pandemic can offer important lessons for the international community, especially other countries looking to ensure resilient transitions to clean cooking. We study household energy use patterns using interviews, newspaper reports, government data on household electricity and LPG consumption, and household surveys [N = 200 across two rounds]. The LPG and electricity distribution systems experienced occasional disruptions to cylinder refill delivery and meter reading processes, respectively, which were associated with pandemic-related mobility restrictions. However, for the most part, supply and distribution activities by private and public companies continued without fundamental change. Survey participants reported increases in unemployment and reductions in household income as well as increased use of polluting biomass as a secondary fuel. Ecuador's LPG and electricity distribution systems were resilient throughout the pandemic, with only minimal interruption of the widespread provision of low-cost clean cooking fuels. Our findings inform the global audience concerned about the resilience of clean household energy use on the potential for clean fuel subsidies to facilitate continued clean cooking even during the COVID-19 pandemic.

Determinants of job satisfaction in a health facility during the state of health emergency, Peru

In this research, the determining factors of job satisfaction in a health facility during the state of health emergency in Peru were examined. Surveys were conducted with 244 collaborators from the different areas of the health facility. The study was carried out under the quantitative approach and ex post facto design. The data collection technique was the survey, which was applied in August 2020, when Covid 19 cases were on the rise. Hierarchical stepwise regression was applied to test the hypothesis, where two models were determined to explain job satisfaction. The first model explains that job satisfaction depends on burnout in 20.4%, with a power of 0.996;while the second model explains job satisfaction due to burnout and motivation in 28.7%, with a power of 0.99. Therefore, the research confirmed that the determinants of job satisfaction are burnout and motivation according to the collaborators of the health establishment during the state of health emergency.

Echocardiographic markers of mortality at 60 days in patients with COVID-19 in the intensive care unit

Introduction: Coronavirus disease (COVID)-19 predominantly produces its effects through lung damage, but an important component of multi-organ dysfunction is cardiac involvement. We have few reports that inform about the behavior of echocardiographic images of patients with the most severe forms of the disease. Purpose: The present work aims to identify prognostic markers for 60-day mortality in patients hospitalized in intensive care based on echocardiographic findings. Methodology: A single-center retrospective cohort was conducted. Hospitalized patients were included in one of the nine intensive care units for COVID-19 confirmed by RT-PCR from May to October 2020. Patients with previous conditions that determined a limitation of the therapeutic effort, those who died before 24 hours and pregnant women were excluded. Portable echocardiograms were performed by two expert cardiologists following the recommendations for isolation and personal protection. The time to death was evaluated as outcome. A Cox proportional hazards model was constructed, HR and 95% confidence intervals with their p values. The study was approved by the institutional ethics committee. Results: Of 326 patients included, 153 patients had an echocardiogram. The mean age was 60.7 years, 47 (30.7%) were female and 67 (44.7%) had positive troponin. 91 patients (59.5%) not survive, the mean long of stay was 8.4 (SD: 4.2) days. 111 (72.5%) had shock, 128 (83.7%) severe ARDS (PaO2 / FiO2 <100 mmHg), 142 (92.8%) required invasive ventilatory support, and 86 (56.2%) acute kidney injury. 27 (17.6%) patients had acute pulmonary embolism, 16 (10.4%) acute myocardial infarction and 9 (5.9%) myocarditis. The mean right ventricular ejection fraction was 37%, TAPSE was decreased in 16 cases (10.4%). 41 cases (26.8%) had right diastolic dysfunction. 34/48 (71%) cases had pulmonary hypertension. The average LVEF was 59.3% and 74 (48.4%) had some left ventricular diastolic dysfunction. 12 (7.8%) had left ventricular segmental wall motion abnormality and 16 (10.4%) had pericardial effusion. Univariate analysis identified TAPSE, PSAP, acute cor pulmonale and right ventricular dilatation as variables related to the outcome of mortality. The multivariate Cox model (Table 2) documented that acute cor pulmonale with a HR of 12.8 (95% CI 3.51 - 46.63, p<0.001) and right ventricular dilation with a HR of 4, 87 (95% CI 1.36-17.46, P 0.016) were associated with mortality. Conclusions: In patients hospitalized in the intensive care unit for COVID- 19, acute cor pulmonale and right ventricular dilatation behaved as independent predictors of in-hospital death. (Figure Presented).

Acute lymphoblastic leukemia and SARSCOV- 2, response to treatment and spontaneous remissions. Experience of two covid-19 hospitals in Mexico City

Background: From the end of December 2019, the new beta coronavirus named COVID-19 has significantly affected the greater number of countries in the world. The major part of the recommendations for the treatment of ALL in the era of COVID-19 includes delaying as long as possible chemotherapy, except in cases of high risk of complications or disease progression. In Mexico, the number of cases of leukemia has diminished due to hospital conversion such as limited access to treatments. The object of this study was to describe the cases with de novo acute lymphoblastic leukemia in two institutions assigned as COVID-19 hospitals in Mexico City Aims: Describe patients' clinical and prognostic behavior with ALL and COVID-19 infection at diagnosis as at any stage of treatment. Methods: A prospective, observational study in patients de novo diagnosed with ALL according to the WHO criteria, cared for in the Hematology Department of the Hospital Regional de Alta Especialidad de Ixtapaluca and the Hospital General de México. The clinical records of the patients diagnosed with ALL from April to December 2020 were included;they received treatment based on intermediate intensity program (CALGB-10403) or high-intensity program (Hyper-CVAD), maintaining the majority of patients as outpatients. ALL the confirmed COVID-19 cases with ALL were compared with non-cancer COVID- 19 cases to describe the difference. Support treatment for COVID-19 was based on local considerations. This research was registered on the ClinicalTrials platform (NCT04745416). Results: Thirty patients were studied (April to December 2020);one case was excluded from the analysis (spontaneous remission). Of the 29 cases, 6 (20.7%) were COVID-19 confirmed cases, four at diagnosis and two during the induction period.There were no differences in gender, age (24 vs. 30 years, p=0.261), or mean leukocyte count at diagnosis (156.3 vs. 116.5 x109/L, p=0.564, 95%CI). BCR-ABL was detected in one case with COVID-19;two cases with COVID-19 showed AF4-MLL and ELN-MLL. According to risk, 66.7% (n=4) of the cases with COVID-19 were considered high risk. The treatment for COVID-19 was high-flow oxygen, azithromycin, anticoagulation. Upon analyzing the response to induction, the group negative to COVID-19 showed a higher proportion of response than the cases with a background of COVID-19 (78.3% vs. 66.7%), but without statistical significance (p=0.628). The group with COVID-19 showed a higher proportion of leukemia refractory to induction (33% vs. 17.4%), requiring a second treatment program. There were no deaths in the COVID-19 arm. Comparing the survival with non-cancer COVID-19 patients, the mortality was 51.7% for individuals without leukemia and 16.7% (n=1) for leukemia COVID-19 cases. Two female patients showed ALL patients' morphological remission: (19 years and 38 years of age). Both debuted with fever as the main manifestation, cytopenias (patient 1: WBC 0.5 x 109/L, platelets 13 x109/L;patient 2: 0.7 x109/L, platelets 123 x109/L) without cytogenetic abnormalities. From day 10 of hospital stay, they showed improvement in leukocyte and platelet counts, reaching the normal range by day 21, requiring evaluation of extended bone marrow, which showed an absence of blasts. Patient 1 had a negative finding after beginning an induction program, and patient two is still without treatment. Summary/Conclusion: The prognosis of individuals with COVID-19- ALL is better due to the null development of cytokine storm;similar to other tumors, spontaneous remission can be seen, especially in young individuals, and decreased tumor burden.

Effect of rivaroxaban (10mg) versus observation on the risk of thrombosis at discharge in individuals with covid-19

Background: Coagulopathy associated with COVID-19 is one of the main complications, especially in individuals with risk factors. Simultaneously, the use of low molecular weight heparin is the recommended strategy in hospitalized individuals, but the usefulness of other strategies such as DOACs in outpatients is still unknown. Aims: Describe the benefit of the use of rivaroxaban at discharge on the risk of thrombosis in patients discharged from COVID-19.Identify the behavior of Dimero-D at discharge and its modification with anticoagulant therapy. Methods: Randomized 1: 1 study (Rivaroxaban 10mg for 14 days versus observation) at discharge in individuals with COVID-19 who have not required mechanical ventilation. D-dimer was evaluated at 14 and 30 days after discharge in conjunction with a CT angiography at four weeks after hospital discharge. The protocol was developed in the Hospital Regional de Alta Especialidad de Ixtapaluca, authorized by the ethics committee with registration number NR-19-2020. The study is identified in ClinicalTrials.gov with the following registry NCT04508439 Results: Forty individuals were evaluated (20 in each arm) with follow- up greater than 100 days. Gender distribution was equitable in each arm, with a mean age of 50 years (21 to 74 years), 40% (n = 16) were older than 55 years, 27.5% (n = 11) had hypertension and 20% (n = 8) had diabetes. The mean length of hospital stay was 10.5 days (6 to 23 days) treated with oxygen and low molecular weight heparin. At discharge, treatment was started with rivaroxaban 10mg x 14d vs. observation;in the rivaroxaban group, four events were identified (3 hemorrhages / 1 thrombosis), this difference being significant (Log Rank 0.016). Only one thrombosis event (pulmonary embolism) was identified in the rivaroxaban group at eight treatment days. Compared to the diagnosis, DD levels were lower at both 14 and 30 days (p = 0.000, 95% CI, 440.8-1164.9) without finding a difference in those treated with rivaroxaban or observation (p = 0.721, 95% CI, -68.48 to 241.18). Summary/Conclusion: The use of DOACs at discharge does not benefit from an increased risk of hemorrhagic events;the anticoagulant strategy should be individualized, focused only on those patients at very high risk of thrombosis.

Policies and strategies implemented in Paraguay to control the COVID-19 Pandemic

Introduction: The purpose of this article is to contribute to the discussion on the repercussions and disruptive effects of the COVID-19 pandemic on the region’s health systems based on the description of the epidemiological scenario, and the policies and strategies implemented in Paraguay. Methodology: This is a case study, a cross-sectional descriptive type. The description was operationalized based on the following dimensions of analysis: crisis management model, governance, leadership, media, technological solutions for surveillance, clinical and healthcare management, care for health personnel, socio-sanitary repercussions, complemented with the rapid review of original articles, official documents, administrative and epidemiologicaldata, and gray literature obtained from websites of national and international steering organizations. Structured matrices were used to organize the relevant information. Results: Health policies were articulated with social policies and solidarity initiatives, immediate suppression measures, and reconfiguration of emergency care and specialized level. The cumulative incidence rate in Paraguay has reached 17 cases per 100 000 inhabitants, with a high proportion of asymptomatic or oligosymptomatic patients. The protagonism of multiple health, economic, scientific, and mass media actors was decisive in activating intersectoral responses, with the predominance of the National Health Authority’s steering roles. Conclusion: Ethical and political dilemmas demand a broad debate and analysis, due to their impact and socio-health, political, and economic consequences. They also constitute opportunities to redesign strategies and measures to contain them in the short, medium, and long term. © 2020 Academia Nacional de Medicina. All rights reserved.