Chronic insomnia in older adults produced by the COVID-19 pandemic

Introduction: The COVID-19 pandemic has rocked our society to its core. Insomnia is the most common sleep disorder in later life and impacts approximately 20%-50% of older adults >65 years, therefore, especially vulnerable to mental health problems, including fear, anxiety and depression. Objective(s): To analyse the changes in older patients with chronic insomnia produced by the covid-19 pandemic. Method(s): Consecutives individuals aged >=65 years of the sleep unit were included, 50 patients before a COVID-19 pandemic (BeCOVID) and 50 patients posterior a COVID-19 pandemic (POSTCOVID). Clinical history specific for sleep disorders;scores on sleep-questionnaires: Epworth Sleepiness Scale (ESS) >=8 sleepiness mild, moderate or severe;Insomnia Severity Index (ISI)>=15 clinical insomnia moderate or severe;psychological tests Beck depression inventory (BDI-II), no-mild <=19, moderate-severe (20-63);the state-trait anxiety inventory (STAI) considered positive above 50th percentile. Result(s): A total of 8 patients BeCOVID and 25 POSTCOVID with chronic insomnia, the most prevalent sleep disorders in older adults produced by COVID-19 (p = < 0,001), age (72.5 +/- 0.8 and 71 +/- 0.9) years old. Intake of benzodiazepine hypnotic drugs in (63/40%), nonbenzodiazepine hypnotic drugs (13/12%) and antidepressants (25/32%) of the patients. Chronic diseases (hypertension 75/76%;mellitus diabetes 38/18%, dyslipidaemia 56/25%;glaucoma 38/8%), psychiatric disease previous 0/8%. Other sleep disorders, obstructive sleep apnoea 63/72%, rest leg syndrome 32/25%, periodic leg movement (PLM) disorders 63/16%, REM sleep behaviours disorders 0/4% and circadian rhythms disorders 2/2%. When comparing polysomnography no significant difference were observed in sleep architecture parameters such as sleep latency, REM sleep latency, efficiency, total sleep time, proportion of sleep stages (N1, N2, N3 y REM), wake after sleep onset, arousals index, PLM index or apnoea-hypopnea index (AHI) or changes of phases number were observed. Sleeps questionnaires show moderate or severe clinical insomnia in 50/76%, depression mild 20/32%, moderate 20/16% severe 0/8%, anxiety state 60/40% and trait 60/64%. Conclusion(s): Immediate interventions are essential in order to enhance psychological resilience.COVID-19 pandemic was associated an increase of chronic insomnia and generalized anxiety disorder in older patients.

Assessing the COVID-19 Vaccination Process via Functional Data Analysis

This manuscript aims to assess the evolution of the COVID-19 vaccination process in some American and European countries via Functional Data Analysis (FDA). Specifically, Functional Principal Components Analysis and Functional Clustering were implemented in a data set consisting of four COVID-19-related variables such as total cases per million, total deaths per million, total tests per thousand, and people fully vaccinated per hundred to explain heterogeneity in the vaccination process. We found that FDA methods are suitable to describe our study problem as, for example, the first two functional principal component corresponding to each variable explains above 96% of the variance. FDA techniques allow us to conclude that vaccines avoid people’s deaths from COVID-19, but they do not stop the propagation of the virus. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Advances in the Constitutionalization of the Colombian Contentious-Administrative Procedure in Times of COVID-19

This article aims to show the progress in the constitutionalization of the contentious-administrative procedure, on the occasion of the reform of Law 1437 of 2011, which materialized with Law 2080 of January 2021, amid the COVID-19 pandemic. Progress was made through this reform in the realization of the constitutional principles of transparency, legal security, good faith, respect for due process, effective access to material justice, and immediacy and orality, which allow the Social State of law to be concretized. © 2022, Universidad Santo Tomas. All rights reserved.

AGRICULTURAL GENETIC RESOURCES AS A SOURCE OF RESILIENCE IN THE FACE OF THE COVID-19 PANDEMIC IN MEXICO †

Background: The COVID-19 pandemic evidenced the fragility of the agri-food sector by affecting the food supply chains which directly depend on the health of its main actors. In this context, countries need to rethink the agricultural production models, considering environmental and human health as priorities to achieve food safety. Aim: Systematically review the state of the art regarding the role of agricultural genetic resources as a source of resilience in the face of events such as the present pandemic as a point of reflection for the identification of opportunities for the restructuring of regional agriculture sensitive to nutrition for health. Methodology: Exhaustive search and analysis of documentary information regarding the effects of COVID-19 on the agri-food sector and the role of agricultural genetic resources in the current pandemic were conducted. Then, through an analysis of the occurrence and association of the main terms addressed in the literature considered, the thematic axes were drawn to address the central discussion of the systematic review. Results: Terms co-occurrence analysis corroborated the relevance and pertinence of the topic addressed. Additionally, the importance of the conservation of agricultural genetic resources and implementation of sustainable agriculture models, as a source of resilience to pandemics, was visualized. The discussion addressed the impact of the pandemic on the Mexican agri-food sector and the restructuring of post-COVID-19 agriculture through the nation and nutrition-sensitive agriculture for health approaches. Implications: The exhaustive analysis of the relationship COVID-19-agricultural genetic resources-health in Mexico highlights the need for the generation of agricultural policies and the increase in multidisciplinary research that favors biodiversity as a source of sustainability, productivity, and health for agroecosystems and the welfare of humanity. Conclusions: A fatalistic scenario for humanity seems to be dissipating in the face of the possibilities of rethinking the economic, social, and agricultural systems from the approaches of the nation and nutrition-sensitive agriculture for health, where, through the responsible use of agricultural resources it is possible to rebuild an agri-food production system with a tendency to resilience to events such as the current pandemic caused by the COVID-19 disease. © 2022 Universidad Autonoma de Yucatan. All rights reserved.

Low muscle mass in COVID-19 critically-ill patients: Prognostic significance and surrogate markers for assessment.

INTRODUCTION: Low muscle mass is a common condition in the critically ill population and is associated with adverse clinical outcomes. The primary aim of this study was to analyze the prognostic significance of low muscle mass using computed tomography (CT) scans in COVID-19 critically ill patients. A second objective was to determine the accuracy and agreement in low muscle mass identification using diverse markers compared to CT as the gold standard. METHODS: This was a prospective cohort study of COVID-19 critically ill patients. Skeletal muscle area at the third lumbar vertebra was measured. Clinical outcomes (intensive care unit [ICU] and hospital length of stay [LOS], tracheostomy, days on mechanical ventilation [MV], and in-hospital mortality) were assessed. Phase angle, estimated fat-free mass index, calf circumference, and mid-upper arm circumference were measured as surrogate markers of muscle mass. RESULTS: Eighty-six patients were included (mean age ± SD: 48.6 ± 12.9; 74% males). Patients with low muscle mass (48%) had a higher rate of tracheostomy (50 vs 20%, p = 0.01), prolonged ICU (adjusted HR 0.53, 95%CI 0.30-0.92, p = 0.024) and hospital LOS (adjusted HR 0.50, 95% CI 0.29-0.86, p = 0.014). Bedside markers of muscle mass showed poor to fair agreement and accuracy compared to CT-assessed low muscle mass. CONCLUSION: Low muscle mass at admission was associated with prolonged length of ICU and hospital stays. Further studies are needed to establish targeted nutritional interventions to halt and correct the catabolic impact of COVID-19 in critically ill patients, based on standardized and reliable measurements of body composition.

HP37: Critical illness polyneuropathy in COVID-19 patients: A case-control study

Introduction: The coronavirus SARS CoV-2 (COVID-19) could cause damage to neural tissue. This injury is responsible for neuromuscular disturbance after the onset of respiratory symptoms in these patients. Objective: is to analyze the characteristics of all patients diagnosed with critical illness polyneuropathy (CIP) reported from March 2020 to March 2021 in the Clinical Neurophysiology Department from La Princesa University Hospital. Methods: Patients were classified into two groups 17 patients admitted to the hospital with confirmed COVID-19 (Cases Group, CaG) and 12 patients without COVID-19 infection (Control Group, CoG). We performed both electroneurography and electromyography. Results: The distribution of the subtypes of the CIP was as follows: axonal motor polyneuropathy (24% in CaG vs 25% in CoG), axonal sensorimotor polyneuropathy (35% in CaG vs 58% in CoG), and mixed sensorimotor polyneuropathy (41% in CaG vs 16% in CoG). Needle EMG showed spontaneous activity in 100% in CaG vs 75% in CoG. The days of hospitalisation were 64.8 ± 7.9 in the CaG and 54.5 ± 9.9 in the CoG. Favourable evolution was observed in the 35% in CaG vs 42% in CoG, and unfavourable evolution was observed in the 41% in CaG vs 33% in CoG. Conclusion: We highlighted the nerves damaged in patients infected by COVID-19 and admitted to the Intensive Care Unit. Viral neuropathy is thought to be primarily axonal;however, we observe a high prevalence of demyelinating injuries in patients affected with this infection. Considering these results, we focus on the importance of early neurorehabilitation to improve nerve function. [ FROM AUTHOR] Copyright of Clinical Neurophysiology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units☆ Recomendaciones para el manejo de los pacientes críticos con COVID-19 en las Unidades de Cuidados Intensivos

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

Tomographic characteristics of lung lesions in hospitalized patients with COVID-19 and its prognostic value

The severity of lung involvement on chest tomography (CT) images in COVID-19 patients may have a prognostic value. This study assesses the type, severity and frequency of the different images of lung CT in hospitalized patients with COVID-19, and the differences in clinical characteristics and in-hospital outcomes, according to the CT severity score. This represents an observational study (retrospective cohort) of hospitalized patients with COVID-19. The ISARIC-WHO form was used to collect data. The type of lung lesions, affected lobes, and total CT severity score were determined at hospital admission. The first, second and third quartiles of the total CT score were calculated to divide the sample into four equal parts (Q1, Q2, Q3 and Q4). A total of 556 patients were included, 336 men (60.4%) and 220 women (39.6%), with a mean age of 61.9 +/- 15.8 years;and 532 of them had CT scan at admission. Patients in the more severe quartiles had more days of symptoms evolution (Q1 6.4 +/- 3.5, Q2 7.9 +/- 4.1, Q3 8.2 +/- 4.1, Q4 8.1 +/- 4.4), desaturation (Q1 95.3 +/- 3.7, Q2 94.4 +/- 3.1%, Q3 91.7 +/- 4.8%, Q4 86.5 +/- 9.1%), alterations of inflammatory markers, hospital stay (Q1 6.4 +/- 2.9, Q2 7.4 +/- 4.1, Q3 9.6 +/- 5.8, Q4 13.1 +/- 10.4 days), admission to ICU (Q1-2.5%, Q2-5.8%, Q3-12.5%, Q4-49.1%), mortality (Q1-3.8%, Q2-4.5%, Q3-9.4%, Q4-33.3%), mixed CT lesions (ground glass opacity-consolidation), linear opacities, crazy-paving pattern, reverse halo sign, and bronchiectasis. The total CT score significantly correlated with leukocyte, neutrophil and lymphocyte counts, and with other inflammatory markers. Semi-quantitative evaluation of pulmonary involvement in the initial chest CT can help to establish the severity of the case and predict relevant clinical outcomes in COVID-19 patients.

Antibiotic prescription in hospitalized patients with covid-19 in a private hospital in caracas: Retrospective study

Background: There is little information on the prevalence of bacterial coinfection and use of antibiotics in hospitalized CO-VID-19 patients. The present study assesses the frequency of in-hospital antibiotic prescription, the bacterial cultures im-plementation and the clinical characteristics of patients with COVID-19 according to the use of antibiotics. Methods: Ret-rospective, observational study of hospitalized patients with COVID-19. The ISARIC-WHO form was used for data col-lection. Results: 145 patients were included, 95 men and 50 women, with a mean age 63.8±16.0 years. 79/145 (54.5%) patients received antibiotics, 52/145 (35%) had samples for culture and 49/145 (33.8%) were blood cultures. Pathogenic bacteria were isolated only in 7% of the patients. The patients with antibiotics had worse oxygenation, chest tomography and inflammatory markers, more admission to ICU, deaths, and prolonged hospital stay. Conclusion: Our results do not support the initial widespread use of antibiotics in hospitalized COVID-19 patients without knowing the pathogen and its susceptibility.

Hospitalized patients with COVID-19: One-year pandemic report

Background: There is limited information about the variations of the clinical characteristics and outcomes in hospitalized patients with COVID-19 during the pandemic. No study has evaluated these changes in our region. Objective: To assess the clinical characteristics and outcomes of adult hospitalized patients with COVID-19 during the first year of the pandemic. Methods: This is a retrospective, observational study. Medical charts of hospitalized patients with COVID-19 at the Hospital Centro Médico de Caracas were reviewed to obtain information about their clinical characteristics. Results: A total of 454 patients were included, 278 men (61 %) and 176 women (39 %), with an average age of 61.97±15.95 years, previous duration of symptoms 7.38 ± 4.01 days, chest CT score 11.49±5.80, and hospital stay 8.30±5.11 days. 59.8 % of the patients had severe-critical disease, 40.2 % mild-moderate, 15.86 % were admitted to the ICU, 81.2 % were discharged and 9.5 % had died. The curve of hospitalized cases was bimodal, identifying two waves: The first between July-September 2020 (peak in August with 59 cases), the second larger and longer between December 2020 and April 2021 (peak in March 2021 with 140 cases). The length of hospital stay remained stable over one year, while mortality decreased progressively (highest value in August 2020, 26.4 % and the lowest in March 2021, 5.4 %). Conclusion: The results show the behavior of hospitalized patients with COVID-19 during a year of the pandemic in our population. It is reasonable that the decline in mortality rate is the result of changes in the age of patients, the disease severity, and provision of care during the pandemic. © 2021 Academia Nacional de Medicina. All rights reserved.

[Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units]. / Recomendaciones para el manejo de los pacientes críticos con COVID-19 en las Unidades de Cuidados Intensivos.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

Clinical characteristics of patients hospitalized with COVID-19 according to glycemia levels: Case series

Hyperglycemia, with or without diabetes, is associated with complications in hospitalized patients with COVID-19. There is no information regarding this problem in our region. This study was aimed to compare the characteristics and in-hospital clinical course of patients with a probable diagnosis of COVID-19, with and without hyperglycemia during the hospitalization. This is a retrospective, observational study of clinical records review of hospitalized patients with COVID-19. The ISARIC-WHO form was used for data collection. Hyperglycemia was defined as a fasting value >= 140 mg/dL according to standard glycaemia targets in hospitalized patients. A total of 148 patients were included, 97 (65.5%) men and 51 (34.5%) women, with a mean age of 64.1 +/- 16.1 years;of which 42/148 (28.4%) patients reported previous diabetes, 60/148 (40.5%) patients had hyperglycemia during the hospitalization and 32/60 (53.3%) of these cases did not report previous diabetes. The patients with hyperglycemia were older, received more frequently systemic corticosteroids (96.6 vs 82.6%;p=0.01), and antibiotics (68.3 vs 44.3%;p=0.01), had worse baseline oxygenation parameters (SpO(2) 88.1 +/- 1,1.7%;vs 92.8 +/- 5.5%;p=0.02, PaO2/FiO(2), 194.4 +/- 119.7 vs 270.9 +/- 118.3;p<0.001), higher total lung severity score in the chest CT (14.9 +/- 5.7 vs 11.1 +/- 6.3;p<0.001) and higher levels of baseline inflammatory markers (CRP 6.73 +/- 3.61 vs 5.08 +/- 4.21;p<0.01, LDH 342.9 +/- 118.4 vs 296.5 +/- 161.4;p=0.01 and Ferritin 687.7 +/- 373.2 vs 542.6 +/- 395.3;p=0.01). Mortality (34.5 vs 10.7%;p<0.001) and admission to ICU (43.3 vs 7.9%;p<0.001) were higher in patients with hyperglycemia. Hyperglycemia in hospitalized patients with COVID-19 is a marker of severe disease and poor prognosis.