ABSTRACT
The current international pandemic situation caused by the COVID-19 outbreak has disrupted economic activity and development worldwide. However, digital enabled activities have proven a relative stronger resilience, and, worldwide, most economic sectors have shifted to digital platforms to continue operating. In this context, the drafting of digital economy regulations has become a relevant policy issue for governments across the Asia Pacific region. Nevertheless, the absence of multilateral regulations in this area has become an obstacle for achieving common regulatory frameworks to deal with digital economy issues, for which regional and bilateral agreements have begun to draft regulations. The proliferation of digital economy provisions in preferential agreements may lead to the so called "spaghetti bowl”. From here, the objective of this paper is to contribute to the governance of digital economy among APEC economies, through the characterization of free trade agreements signed between APEC and Latin American economies. This selection was made due to the diversity of agreements that can be found within this subregion. In this context, the Digital Economy Partnership Agreement (DEPA), led by Chile, New Zealand, and Singapore has become a reference point that could serve as a steppingstone towards common regulatory frameworks in this matter. The paper concludes that DEPA may be used as a benchmark for the development of regulations that will help boost cross border e-commerce in APEC economies for a post pandemic sustainable recovery. © 2022, University of Passo Fundo. All rights reserved.
ABSTRACT
A new pandemic was recently declared by the World Health Organisation due to the SARS-CoV-2 virus. This virus is characterised by being highly transmissible, lethal, and affecting all age groups. This declaration led to the activation, in all countries, of emergency mechanisms to deal with this public health crisis that has exposed the weaknesses of the health systems and the deficit of beds in adult intensive care (UCIA) and paediatric intensive care units (PICU). Colombia has a reduced number of PICU beds compared to other low- and middle-income countries. For this reason, we must optimise resources, anticipate severe cases, and understand the behaviour of the disease caused by the SARS-CoV-2 virus (called COVID-19) in paediatrics, especially in severe forms of presentation in children. The severity and degree of involvement by the virus in all countries has been very similar, with a greater severity and frequency of infection in the adult population, particularly in people over 60 years of age, and with comorbidities (obesity, hypertension, diabetes, among others). However, severe cases requiring advanced interventions in intensive care have also been reported in the paediatric population, including a form of presentation with a large inflammatory response in children, called multi-systemic inflammatory syndrome (MIS-C). The Colombian Association of Critical Medicine and Intensive Care (AMCI) convened a multidisciplinary team of experts in paediatric critical medicine to establish a consensus statement of good clinical practice for the care of children with severe COVID-19 requiring care in intermediate care or paediatric intensive care. The objective of this consensus statement is to facilitate and standardise decision making in the most relevant aspects of care and to carry out a comprehensive approach to the paediatric patient based on the best available evidence and the opinion of experts in paediatric intensive care with at least 10 years of work experience in the area. Additionally, it was sought to involve those Paediatric Intensivists who have to directly care for children with COVID-19, and belong to reference or university hospitals and have a proven track record in research and teaching in paediatric critical care. This consensus statement will seek to update, as often as necessary, according to the change in the best available evidence, which will enable physicians who care for critical children with COVID-19 to provide comprehensive and adequate care according to the best available literature. © 2020 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo
ABSTRACT
AIMS & OBJECTIVES: To develop a comprehensive description of multisystem inflammatory syndrome temporally associated with SARS -Cov-2 (PIMS-TS) by conducting a case series quantitative systematic review. METHODS: PIMS-TS studies were identified by searching Pub Med and Embase from May 1st to July 1st 2020.We extracted data on demographics, clinical presentation,laboratory, imaging studies, treatment and PICU outcomes. RESULTS: 11 studies were identified including 468 cases.The avergage age was 9.2 years (95% CI 8.5-9.9y) and 54%(95% CI 48-61) were males.SARS -CoV-2 RT-PCR was positive in 38%(95% CI 52-63) and serology in 68%(95%CI 50-84).All patients were febrile at presentation and gastrointestinal symptoms were reported in 85%(95%CI 74-94),shock in 76 %(95%CI 55-93) and rash in 58%((95%CI 52-63). 26% (95%CI 13-40) of cases fulfilled the AHA Kawasaki criteria.Laboratory markers of inflammation and cardiac injury (C reactive protein,procalcitonin, ferritin,D dimer,NTproBNP) were consistently elevated. Left ventricular dysfunction was found in 72%(95% CI52-89).Overall,82%(95% CI 68-93%) of patients required ICU,62% vasoactive drugs and 59%(95%CI 40-77) respiratory support. 25 patients were placed on ECMO. Intravenous immunoglobulin was used in 79%(95%CI 66-90) followed by steroids in 47%(95%34-59).ICU mean length of stay was 6 days (95% CI 4-7 d) .7 deaths ocurred,5 of them during ECMO run. CONCLUSIONS: PIMS TS is a rare and heterogeneous disease.PICU admission was frequent and mortality was low. This quantitative pooled data could help clinicians to improve diagnosis and prompt treatment of this new condition.