Effects of the pandemic on tourism and the Chilean economy, a look from multivariate techniques

The impact of the Covid-19 pandemic has brought dire consequences. The paralysis of a large part of the tourism sector since April 2020 has strongly affected the economy and employment worldwide, leaving without a livelihood a number of people who live and depend on the tourism company. In this context, the present research aims to analyze the effect of the pandemic on tourism in Chile. It is methodologically based on two aspects, first, on the documentary review of different sources that critically analyze the consequences of this health crisis on the economy and tourism, and secondly, on the data processing carried out through the application of the HJ Biplot Multivariate Cubes Model. As the main results of this research, it is evident that the pandemic has caused a decrease in employment and sales in Accommodation Services and Food Services, as well as the arrivals of passengers at Tourist Activity Establishments. It is projected that this study could be a contribution in the construction of public policies that support the reactivation of the national and world economy through tourism. © 2023, Universidade de Aveiro. All rights reserved.

An Unusual Case of Cardiogenic Shock in a Cardio-Oncologic Patient

Background Graft versus host disease (GVHD) most often occurs 100-365 days after hematopoietic stem cell transplant (HSCT). Manifestations most often are dermatologic, hepatic or pulmonic, and are rarely cardiac. We present a unique case of GVHD inducing cardiogenic shock necessitating advanced heart failure therapies. Case This is a 34 year-old male with a history of acute lymphoblastic leukemia who completed chemoradiation and HSCT from an HLA perfect sibling in 1992. In May 2020, he presented with dyspnea for 6 weeks. An echocardiogram at that time showed an EF of 10% and severe biventricular dilatation. He was originally hospitalized at an outside institution for hypoxia where a left heart catheterization showed normal coronaries and goal directed therapy was initiated. After 2 negative COVID tests, he was discharged with a LifeVest. One month later, despite medication compliance, he returned in cardiogenic shock after his LifeVest was activated for ventricular tachycardia (VT). Decision-making He was started on inotropic therapy and an intra-aortic balloon pump (IABP) was placed 1:1 prior to transfer to our tertiary center. After support was started, a right heart catheterization showed a right atrial pressure of 13 mmHg, a wedge of 17, and a cardiac index of 2.6. His course was complicated by VT storm. Differentials for his non-ischemic cardiomyopathy (NICMO) included myocarditis (viral vs. giant cell) with a possible component of chemotherapy/radiation induced NICMO. Immediate AHFT work-up was started. He was unable to be weaned off his IABP or inotropic support. The decision was made to pursue emergent left ventricular assist device placement (LVAD) and achieve a definitive diagnosis with a core biopsy. Pathology resulted with myocyte hypertrophy, chronic inflammation with eosinophils concerning for chronic GVHD. Conclusion There have only been a handful of case reports describing cardiac manifestations of GVHD, and none with NICMO and cardiogenic shock requiring an LVAD. Despite this, suspicion should remain present for GVHD in HSCT patients regardless of time frame from oncologic therapies or specificity of HLA match when presenting in cardiogenic shock.Copyright © 2023 American College of Cardiology Foundation

Effect of N-acetyl cysteine in a patient cohort with severe or very severe COVID-19 pneumonia

Introduction: COVID-19, as of 9 June 2020, had been responsible for 404,396 deaths worldwide. Throughout the pandemic, IRCU and ICU directly cared for patients with severe or very severe respiratory failure due to COVID19 pneumonia. Objective(s): To determine if N-acetyl-cysteine (NAC) could be associated with lower mortality risk. Methodology: 1141 patients from March to May 2020 admitted to the ICU and IRCU of the Fundacion Jimenez Diaz were analysed. Patients with <3 days of hospital admission and those with CURB-65 equal to or <0 were excluded. A multivariate regression logistics models have been used to respond to our hypothesis and investigate the relationship between each variable and the mortality. Result(s): Of all patients analyzed, 44% received treatment with NAC associated with other drugs according to established protocols. Of these, 55% were male, most non-smokers with a mean age of 74.43 years. In table 2 we describe statistically significant predictive parameters associated with a decreased risk of mortality in severe or very severe patients with an area AUC of 0.80 Conclusion(s): Adjuvant treatment with NAC in severe or very severe COVID-19 pneumonia is associated with a significantly lower risk of mortality by 30% in elderly patients, principally males, and with associated co-morbidities.

Analysis of Survival in Patients with End-End Chronic Kidney Disease Switching from Peritoneal Dialysis to Hemodialysis Due to Refractory Peritonitis

Introduction: Peritonitis associated with peritoneal dialysis (PD) has complications such as transfer from PD to HD and increased morbidity and mortality. In our environment, there is little information regarding survival in this population. Method(s): Retrospective cohort, 147 PD patients, 18 years, with PD catheter removal between 2018-2021. Clinical, biochemical and technique-related variables were measured. Patients who died of cancer and other unrelated causes were excluded. Descriptive statistics, Kaplan-Mayer analysis and Cox regression analysis were used Results: Age 42 +- 17 years, 65% men, 65% unknown cause of CKD. The time between peritonitis diagnosis and catheter removal was 37 (25-61) days. Nine patients (6%) returned to PD, the rest (94%) remained on HD due to unfit abdomen (55%), patient decision (9%), unknown (17%), others (19%). Mortality was 31% and the causes of death were: sepsis (33%), COVID-19 (29%), pneumonia (19%), pulmonary edema (5%), hyperkalemia (5%), CVD (5%), others (4%). Survival after the refractory peritonitis event was 25 (95% CI 22-28) months. Survival at 3, 12, 24, and 36 months was 87%, 71%, 61%, and 35%. In the bivariate analysis, age, DM, time on dialysis, and serum albumin were associated with a higher risk of death. However, in the multivariate analysis, only time on dialysis was significant (OR 1.014, 95% CI 1.002-1.027). [Formula presented] Conclusion(s): Mortality was 31% and the most frequent cause of death was sepsis. Patient survival was 25 (95% CI 22-28) months. Time on dialysis was associated with a higher probability of death. It is necessary to compare these results with a group of patients who do not present failure of the technique. No conflict of interestCopyright © 2023

SARS-CoV-2 seroprevalence in workers from a Colombian University Hospital.

BACKGROUND: Antibody (Ab) tests for SARS-CoV-2 virus allows for the estimation of incidence, level of exposure and duration of immunity acquired by a previous infection. In health workers, the hospital setting might convey a greater risk of infection. AIMS: To describe the frequency of immunoglobulin G (IgG) Abs (IgG-Abs) to the SARS-CoV-2 virus among workers at a third-level university hospital in Colombia. METHODS: In this cross-sectional study, we included medical and non-medical personnel with at least one real-time polymerase chain reaction (RT-PCR)/antigen test between March 2020 and March 2021. In April 2021, an IgG-Ab test against SARS-CoV-2 was conducted for all participants and replicated 2 weeks later in a random sample (10%). The frequency of IgG-Abs is presented based on status (positive/negative) and time elapsed since RT-PCR/antigen test (<3 months, 3-6 months, >6 months). RESULTS: We included 1021 workers (80% women, median age 34 years (interquartile range 28-42), 73% medical personnel, 23% with previous positive RT-PCR/antigen). The overall seroprevalence was 35% (95% CI 31.6-37.4, 35% in medical and 33% in non-medical personnel). For those with a previous positive RT-PCR/antigen test, the seroprevalence was 90% (<3 months), 82% (3-6 months) and 48% (>6 months). In participants with a previous negative RT-PCR/antigen test, the seroprevalence was 17% (<3 months), 21% (3-6 months) and 29% (>6 months). CONCLUSIONS: High IgG-Ab positivity was found in hospital personnel, regardless of work activities. The prevalence of detectable Abs differed by previous RT-PCR/antigen status and time elapsed since the diagnostic test.

Patients Admitted to Pediatric Intensive Care with Sars-Cov2: Results from a Nationwide Multicentre Study

BACKGROUND AND AIM: Admission to PICU due to SARS-CoV2 infection in children is unfrequent. However there are few pediatric patients who may require intensive care management. The aim of our study was to describe characteristics and evolution of those patients admitted to Spanish PICUs due to SARS-CoV2 infection. METHOD(S): A multicentre nationwide prospective registry involving all Spanish PICUs was carried out between 1st of march 2020 and 30 November 2021. RESULT(S): During the study period 299 patients where admitted to the participating units. Median age was 8.9 years (IQR 4.4 -12.2). 208 patients (69,6%) where diagnosed of Multisystem Inflamatory Syndrome associated to SARS-CoV2 (MIS-C). 225 patients (75.3%) where previously healthy. Main reason for admission was shock (which was present in 55.9% of patients). Respiratory difficulty was present only in 40.8% of patients. 50.5% of patients required vasoactive drugs, which was more frequent among those presenting with MIS-C (66.5% vs 20.9%, p<0.001). Only 17.4% of patients required mechanical ventilation, which was less frequent in patients with MIS-C (11.1% vs 34.1% p<0.001). 9 patients (3%) included in the registry died. Death was more frequent among patients with previous diseases (9.6% vs 0.9%, p<0.001) and less frequent in those admitted due to MIS-C (0.5% vs 9.3%, p<0.001). CONCLUSION(S): MIS-C was the most frequent cause of admission to PICU in Spain related to SARS-CoV2 infection. Most patients were admitted presenting shock and required vasoactive drugs, but only a few mechanical ventilation. Mortality rate was low. Prognosis was more favourable in those admitted due to MIS-C.

Physical and emotional sequelae after hospitalization for COVID-19

Background: Facing a severe life-threatening disease has physical and emotional consequences for patients. Aim: To evaluate the physical and emotional sequelae in patients who survived COVID-19 pneumonia. Material and Methods: This cross-sectional study collected data from post-COVID-19 pneumonia patients admitted to an outpatient follow-up program in a public hospital in Chile. One month after hospital discharge, the evaluation of physical capacity was carried out through the 1-minute sit-to-stand test (1STST). In addition, the Clinical Frailty Scale (CFS) and the Hospital Anxiety and Depression scale were applied Results: We included 70 patients aged 63 +or- 13 years (54% women). Eighty-five percent of the patients were able to execute the 1STST with an average of 20.6 +or- 4.8 repetitions. Forty-eight percent of the patients had a performance below the 2.5th percentile according to the reference values and 28% of patients had exertional desaturation. The CFS classified as mildly vulnerable or with some degree of frailty to 33% of patients. Twenty-five percent of the patients presented symptoms of depression and 33% of anxiety. Conclusions: Patients who survived COVID-19 have a decrease in physical capacity and a significant proportion of depression and anxiety one month after hospital discharge.

Recommendations for the teams that manage school canteens in the public health emergency of COVID-19 in Argentina

The impact of the pandemic caused by COVID-19 may deepen the situations of malnutrition, where it will be necessary to adapt food programs to this new context. The objective of this work was to present the methodology and the main results of the process of formulating a federal guide based on scientific evidence and adapted to the reality of the child and adolescent population that attend school canteens in the 24 jurisdictions of Argentina. It was observed that the modalities for the implementation of SC during the pandemic were: food modules (the most frequent);food modules delivered at school with regular SC support and, food and/or snacks delivered daily. There was little evidence at the global and regional level on specific recommendations applied to the implementation of SC, although recommendations on hygiene and food handling were found. Based on a participatory process among key actors, specific recommendations were obtained according to the dimensions of food and nutrition security (FNS). It is concluded that it is necessary to increase participatory experiences in the design of recommendations based on evidence, adapted to the territory and that assume a comprehensive approach from the dimensions of FNS. Arch Latinoam Nutr 2020;70(3): 215-234. © 2020 Archivos Latinoamericanos Nutricion. All rights reserved.

Kidney and clinical outcomes of COVID-19 in The Mexican population

Background: Coronavirus Disease 2019 (COVID-19) is a new disease of pandemic proportions. Currently, there are no reports about kidney involvement and the association with mortality in Mexico. Our aim was to describe the characteristics in our population, clinical and renal outcomes. Methods: Prospective, descriptive, single-center study in patients diagnosed with COVID-19 (positive RT-PCR tests), admitted to our hospital from April 2020 to date. Results: 48 patients (60.41% men) with an average age of 54.33 years were included. 23 (47.9%) had a previous diagnosis of HTN and DM, 11 (22.9%) had obesity, 5 (10.4%) had neurological diseases, 4 (6.3%) had heart disease, 3 (6.3%) had malignancies and 1 (2.1%) had liver disease. 9 (18.8%) patients with a history of smoking. At admission, the mean oxygen saturation was 85.76%. The main reason for consultation was dyspnea in 35 patients (72.9%). Regarding symptoms, 81.3% (39) had dyspnea, 87.5% (42) fever, 54.2% (26) headache, 72.9% (35) cough and, to a lesser extent, odynophagia, myalgia and malaise in 33.3% (16), 45.8% (22) and 41.7% (20) respectively. The mean creatinine, urea and bicarbonate was 1.34 mg/dl, 56.69 mg/dl, and 18.49 mmol/l respectively. 25% of the patients required ICU admission and 27.1% mechanical ventilation. During the study period, 19 patients (39.6%) developed AKI, 20.8% classified as KDIGO stage 1 and 18.8% as stage 3. At the end of this study, 56.3% (27) had a complete recovery, 35.4% (16) died and 8.3% (5) are still admitted. Regarding the patients that had an AKI, 6 (31.57%) had a complete recovery, 3 (15.7%) required intermittent HD but eventually died, for a total of 13 death patients (68.4%). There was a statistically significant difference in mortality between patients with AKI vs patients with normal kidney function (p=0.002), with a RR of 3.47. Conclusions: This study showed a higher prevalence of AKI in the Mexican population compared to reports from other countries, with a significantly higher risk for death. Special attention should be paid to this outcome and as nephrologists, we must take an active role in the care of these patients.

Urinary abnormalities and urinary sediment findings in COVID-19 patients

Background: Coronavirus disease 2019 (COVID-19) is a new disease of pandemic proportions. There are only a few reports about urinary abnormalities in this disease, and to our knowledge there are no reports about the usefulness of urinary sediment on prognosis. Our aim was to describe the urinary abnormalities in COVID-19 and to assess the utility of urinary sediment on prognosis in COVID-19. Methods: Prospective, single-center study, in patients diagnosed with COVID-19 (with a positive RT-PCR test), who were admitted in our hospital, from April 2020 to date, and whose urine sample could be obtained at admission to the isolation wing. Results: 22 patients were included;17 (77.3%) had proteinuria, 12 (54.5%) had microscopic hematuria, and 9 (40.9%) had leukocyturia. Granular casts (with a Chawla cast scoring index greater than 3) were present in 8 (36.4%) patients. Of the 8 patients with granular cast, 6 developed an AKI (75%), 2 required Hemodialysis (25%) and 3 died (37.5%). Of the 14 patients whose urinary sediment was classified as bland, 5 developed an AKI (35.7%), none of them required hemodialysis, and 2 subsequently died (14.2%). There was a statistically significant difference between a bland urinary sediment and a sediment showing granular casts for the need of hemodialysis or death (p=0.02), with a positive LR of 3.5. Conclusions: The urinary sediment is a cheap, available tool for the prognosis of need for hemodialysis or death in patients diagnosed with COVID-19, and should be taken into consideration in the assessment of these patients by the Nephrology department.