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Introduction. The diagnosis and management of chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic was one of the biggest challenges facing healthcare systems globally, especially in low-income countries. Since basic health care for chronic diseases can overwhelm the capacity of conventional face-to-face healthcare services, there is growing interest in using information and communication technology and telemedicine to improve access to medical services that are often not consistently available in rural communities. In this context, telemedicine tools should be directed toward maintaining basic health services for patients with chronic conditions in rural and underserved hospitals. This study evaluated a telemedicine system in remote public hospitals in Paraguay to demonstrate how telemedicine improved access to tertiary level diagnostic services for patients with chronic conditions. Methods. This descriptive study evaluated the use of telemedicine for diagnosing patients in remote public hospitals to improve provision of basic health services to patients with chronic disease during the COVID-19 pandemic. The type and frequency of diagnostic studies performed were determined. Results. During the study 677,023 telediagnoses were performed in 67 hospitals. The 435,568 electrocardiograms performed in 61 hospitals indicated normal physiology (60.1%), unspecified arrhythmias (10.5%), and sinus bradycardia (8.4%). The 227,360 teletomography tests performed in 12 hospitals were undertaken on the head (52.4%) because of trauma (motorcycle accidents) and cerebrovascular diseases, chest (15.8 %), and other anatomical regions. The 14,076 electroencephalograms performed in 19 hospitals were undertaken for antecedents of seizure (53.3%), disease progression controls (14.0%), and headache (12.5%). Nineteen prenatal ultrasound scans were conducted. Conclusions. Although the results are promising for using telemedicine to bridge gaps and improve equity in the provision of basic health services for patients with chronic diseases in remote locations during the COVID-19 pandemic, a widespread use assessment should be undertaken before this tool is adopted.
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Introduction. The evolution of advances in informatics, technology in medicine, and artificial intelligence (AI) offers opportunities to enhance health care during the coronavirus disease 2019 (COVID- 19) pandemic. The challenge for biomedical engineers is to implement these developments in clinical practice to improve global health. Populations living in low-income countries do not have access to specialist care and quality diagnostic services for COVID-19. Therefore, an AI system based on a telemedicine platform for diagnosing COVID-19 could help mitigate the lack of highly trained radiologists at regional hospitals and serve as a triage system for rationalizing the use of reverse transcription polymerase chain reaction (RT-PCR) testing and other health resources in low-income countries. Thus, the utility of an AI system for diagnosing COVID- 19 in Paraguay was investigated. Methods. This is a descriptive multicenter observational feasibility study of an AI tool for the rapid detection of COVID-19 in chest computed tomography (CT) images of patients with respiratory difficulties who attended public hospitals across the country. Results. Between March 2020 and August 2021, 3,514 rapid diagnostic tests were carried out on patients with respiratory disorders to rule out COVID-19 in 14 hospitals nationwide. The average age of the patients was 48.6 years (52.8% were men);the most common age ranges were 27 to 59 years, followed by older than 60 years and 19 to 26 years. The most frequent findings on the CT images were severe pneumonia, bilateral pneumonia with pleural effusion, bilateral pulmonary emphysema, diffuse ground glass opacity, hemidiaphragmatic paresis, calcified granuloma in the lower right lobe, bilateral pleural effusion, sequelae of tuberculosis, bilateral emphysema, and fibrotic changes. Overall, there was 93 percent agreement and 7 percent discordance between the AI system and the RT-PCR test results. Compared with RT-PCR testing, the AI system had a sensitivity of 93 percent and a specificity of 80 percent. Conclusions. Paraguay has an AI-based telemedicine screening system for the rapid detection of COVID-19 that uses chest CT images of patients with respiratory conditions.
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Introdução/Objetivos: A hanseníase é uma doença infecciosa causada pelo Mycobacterium leprae. No Brasil, é um importante problema de saúde pública, sendo de notificação compulsória e investigação obrigatória. O objetivo deste trabalho é analisar os casos de hanseníase notificados e relacionar a prevalência com características sócio-econômicas. Metodologia: Dados referentes às notificações de hanseníase, publicados no SINAN-DATASUS (Doenças e Agravos de Notificação), entre 2015 a 2020, foram tabulados, analisados, e comparados com os publicados em trabalhos científicos relacionados ao tema. Resultados: Entre os anos de 2015 e 2020 foram notificados 195.429 casos de hanseníase no Brasil. As maiores notificações ocorreram em 2018 (20,45%). As regiões Nordeste (42,3%), Centro-Oeste (21,2%), e Norte (14,4%) se destacam. As maiores prevalências foram observadas nas regiões Centro-Oeste (52,3/100.000 hab) e Norte (41,8/100.000 hab), em 2018. A região Sul apresentou o menor número de notificações (3,24%), bem como, a menor prevalência (2,1/100.000 hab, em 2020). A análise da distribuição dos casos por ano demonstra uma importante queda em 2020. A região Norte, por exemplo, apresentou queda de 46% entre 2019 e 2020, passando de 38,1/100.000 hab para 20/100.000 hab. A pandemia de COVID-19, bem como, as medidas de isolamento implantadas para seu controle, podem ter refletido na menor busca por atendimentos em saúde. Análise de casos por sexo demostra predominância do sexo masculino em todos as regiões e anos analisados. A hanseníase é considerada uma doença negligenciada, sendo esse conceito atribuído às doenças de maior ocorrência em países em desenvolvimento. Condições de vida precárias, pobreza, baixa escolaridade e fome são fatores de risco. Além disso, diferentes trabalhos associam a endemicidade de hanseníase à migração populacional. A baixa renda per capita das regiões Norte e Nordeste, bem como, dados referentes à pobreza podem explicar a alta prevalência de hanseníase nessas regiões. Movimentos migratórios associados ao crescimento econômico, ocorrido em cidades da região Centro Oeste, nos últimos anos, também são responsáveis pela sua endemicidade. Conclusão: Podemos concluir que, embora o tratamento preconizado para hanseníase seja disponibilizado no SUS e, o mesmo seja eficaz, sua prevalência ainda não apresenta uma queda satisfatória. Regiões com baixa renda per capita e cidades que apresentaram alterações demográficas importantes, são endêmicas.
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Background COVID-19 pandemic presented as a challenge to breast cancer (BC) treatment, especially considering safety concerns and resource scarcity. Treatment choices have been taken mainly based on safety according to guidelines which aim hierarchically categorize the clinical benefits of any clinical decision. Considering the magnitude of benefit, neo/adjuvant breast cancer treatment is positioned at medium/high levels. Despite these recommendations, patients might be refusing chemotherapy (CT) or avoiding emergency care utilization due to concerns about COVID- 19 infection. There have been described factors related to the reduction of effectiveness of neo/adjuvant CT for breast cancer, like relative intensity dose (RDI) <85%, which could be used to a brief analysis of latter impact of modifications in clinical protocols. We aimed to analyze the impact of COVID-19 pandemic, to the date, in the neo/adjuvant breast cancer chemotherapy in a university hospital to support strategies to minimize unfavorable outcomes. Methods Medical records from 307 breast cancer patients who started neo/adjuvant chemotherapy from January 2018 to June 2020 at the Hospital das CKnicas de Ribeirao Preto, University of Sao Paulo (HCRP-USP) were retrospectively analyzed, with a total of 2,074 cycles. It was considered the period from June 2018 to June 2020 to analyze the total cycles prescribed/month. Clinical data, treatment information and outcomes were collected. Considering COVID-19 restraining policies in our region were initiated on March 23th 2020, we considered the pandemic period from April 2020 to June 2020, and compared to the period before pandemic (Jan/2018-Mar/2020). A RDI <85% was considered a factor related to worse efficacy of chemotherapy. For safety assessment, it was considered the demand for medical care at emergency unit. The study was approved by the local ethics committee (HCFMRPUSP- 33148920.5.0000.5440). Results During the period before pandemic, an average of 10% (±4%) of the patients who received CT, monthly, sought the emergency unit, while only 3% (±4%) sought during the pandemic (p=0.17). In our institution, the average number of neo/adjuvant CT initiated monthly during pandemic tended to be lower than before the pandemic (7.0 ± 2.0 vs. 10.6 ± 3.5;p=0.06), while the average cycles prescribed monthly showed a 14% reduction compared to the period before pandemic (68 ± 5 vs. 79 ± 13;p=0.02). The frequency of treatments with RDI <85% during the pandemic was lower than before pandemic (6% vs. 23%;n=275;p=0.03). Conclusions COVID-19 pandemic presented as a challenge for the treatment of BC patients, including lower acceptance of neo/adjuvant treatment and reduced search for emergency unit due to chemotherapy adverse effects, which could compromise the of the treatment goals. In our institution, we found 23% of patients treated with neo/adjuvant chemotherapy had not reached the expected RDI >85% before the pandemic, similar to the literature. Despite the lower rate of RDI <85% during pandemic (6%), this may be related to treatments that are still in progress, greater refusal of chemotherapy by patients with morbidities or advanced age, or even related to treatment modification aiming to minimize toxicities and avoid interruptions (ie. prescription of colony-stimulating factors). Further analysis may help to identify the factors related to these findings. Despite this, every effort must be made to achieve the maximum effectiveness of CT and to ensure safety during treatment. The impact of treatment modifications should be monitored to minimize unfavorable outcomes.
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The COVID-19 outbreak began at the end of 2019, the epidemic, with its epicenter in Wuhan, China, affected more than 56 million people around the world. From the beginning, it was observed that certain countries showed better responses in countering the disease, and some of them were headed by women, such as New Zealand, Norway, Denmark, Germany, among others. Thus, the article aims to compare prevention practices against COVID-19 in countries governed by women. The methodology is descriptive, and data were collected through documental research, the sample consists on the 30 countries with the highest Human Development Index (HDI) in the world, and Brazil, as one of the countries most affected by the disease. The results suggest that of the 31 countries in the sample, among the 10 with the lowest absolute numbers of COVID-19 cases, 5 of them are governed by women: New Zealand, Hong Kong, Greece, Estonia, and Iceland. Of the 10 countries with the lowest number of cases of COVID-19, 4 are led by women: Hong Kong, New Zealand, Greece, and Estonia. Hence, it is assumed that women world leaders seem to have done a better job at confronting COVID-19.
ABSTRACT
Background: Cancer treatment during COVID-19 pandemic have been mainly focused on safety, and prioritization has been done to guide hierarchically choices according to clinical benefits considering resource scarcity. Considering the magnitude of benefit, neo/adjuvant breast cancer treatment is positioned at medium/high levels. Despite these recommendations, patients might be refusing chemotherapy or avoiding emergency care utilization because of COVID-19 infection concerns. A better understanding of the impact of the pandemic on breast cancer chemotherapy prescription patterns and demand for emergency care can support strategies to minimize unfavorable outcomes. Methods: Medical records from 299 breast cancer patients who started neo/adjuvant chemotherapy from January/2018 at the Hospital das Clínicas de Ribeirão Preto – USP (HCRP-USP) were retrospectively analyzed, with a total of 2,003 cycles. Clinical data, treatment information and outcomes were collected;COVID-19 pandemic period (CPP) (Mar/2020-Apr/2020) was compared to pre-pandemic period (PPP) (Jan/2018-Feb/2020). Results: The mean number of neo/adjuvant chemotherapy cycles prescribed monthly and the mean number of treatments initiated monthly during CPP, respectively, 76 (± 9) and 10.5 (± 2.1) were similar to PPP, respectively, 77 (±12;p= 1) and 10.7 (±3.5;p=0.94). An average of 6.0% (± 1.6%) of the patients who received chemotherapy sought emergency care monthly during CPP compared to 10.9% (± 3.8%, p=0.07) before the pandemic. Conclusions: According to ESMO recommendation, neo/adjuvant breast cancer treatments have been prioritized considering its curative benefit. During COVID-19 pandemic there seems to be no compromising in patient acceptance or medical recommendations at our institution. On the other hand, there was a trend to decrease the attendance in the emergency units, what could compromise treatment safety. Telemedicine and continuous monitoring could minimize unfavorable outcomes. Further analyzes to correlate the impact of the pandemic on the safety and efficacy of the treatment in this population will be completed soon. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: F.F. Pimentel: Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Libbs Farmaceutica;Speaker Bureau/Expert testimony: AstraZeneca. All other authors have declared no conflicts of interest.