CUERPOS NEGADOS, DISCRIMINADOS E INVISIBILIZADOS: SER INMIGRANTE EN LA ESCUELA DURANTE LA PANDEMIA

El objetivo es analizar el impacto de la pandemia COVID-19 sobre la población inmigrante en edad escolar, a partir de una comprensión fenomenológica y crítica de las múltiples formas de discriminación, negación e invisibilización que se construyen sobre la corporeidad de los extranjeros en el contexto chileno. Para ello, se exponen diferentes antecedentes organizados en cuatro secciones. Los dos primeros apartados contienen los elementos centrales de la discusión, señalando aquellos aspectos y dinámicas de interacción que posibilitan la percepción del inmigrante como un 'otro inferior', a partir del racismo que ha desnudado y profundizado la pandemia. En la tercera y cuarta sección del manuscrito se plantea la necesidad de reflexionar desde el escenario que ofrece y amerita la situación pandémica actual, sobre la necesidad de avanzar hacia realidades educativas que se sustenten en la dignidad humana y la valoración recíproca de las diferencias.Alternate :The aim is to analyse the impact of the COVID-19 pandemic on the school-age immigrant population, based on a phenomenological and critical understanding of the multiple forms of discrimination, denial and invisibilisation that are built on the corporeality of foreigners in the Chilean context. To this end, different background information is presented, organised into four sections. The first two sections contain the central elements of the discussion, pointing out those aspects and dynamics of interaction that make possible the perception of the immigrant as an 'inferior other', based on the racism that has revealed and deepened the pandemic. In the third and fourth sections of the manuscript, the need to reflect from the scenario that the current pandemic situation offers and merits, about the need to move towards educational realities that are based on human dignity and the reciprocal valuation of differences.Alternate :O objetivo é analisar o impacto da pandemia COVID-19 sobre a populaçâo imigrante em idade escolar, a partir de uma compreensäo fenomenologica e crítica das múltiplas formas de discriminaçâo, negaçâo e invisibilizaçâo que se constroem sobre a corporeidade dos estrangeiros no contexto chileno. Para isso, säo expostos diferentes antecedentes organizados em quatro seçöes. Os dois primeiros números contem os elementos centrais da discussäo, destacando aqueles aspectos e dinâmicas de interaçâo que possibilitam a percepçâo do imigrante como um 'outro inferior', a partir do racismo que evidencia e aprofunda a pandemia. Na terceira e quarta seçâo do manuscrito se sugere a necessidade de refletir a partir do cenário que oferece e requer a atual situaçâo pandémica, sobre a necessidade de avançar para realidades educativas baseadas na dignidade humana e na valorizaçâo recíproca das diferenças.

INFLUENCIA DE LA HISTORIA DE TABAQUISMO EN LA EVOLUCIÓN DE LA HOSPITALIZACIÓN EN PACIENTES COVID-19 POSITIVOS: DATOS DEL REGISTRO SEMI-COVID-19 INFLUENCE OF SMOKING HISTORY ON THE EVOLUTION OF HOSPITALIZED IN COVID-19 POSITIVE PATIENTS: RESULTS FROM THE SEMI-COVID-19 REGISTRY

Introducción: El tabaquismo puede tener un papel importante en la infección por SARS-CoV-2 y en el curso de la enfermedad. Los estudios previos muestran resultados contradictorios o no concluyentes sobre la prevalencia de fumar y la severidad en la enfermedad por coronavirus (COVID-19). Material y métodos: Estudio de cohortes observacional, multicéntrico y retrospectivo de 14.260 pacientes que ingresaron por COVID-19 en hospitales españoles desde febrero a septiembre de 2020. Se registraron sus características clínicas y se clasificaron en el grupo con tabaquismo si tabaquismo activo o previo o en el grupo sin tabaquismo si nunca habían fumado. Se realizó un seguimiento hasta un mes después del alta. Se analizaron las diferencias entre grupos. La relación entre tabaquismo y mortalidad intrahospitalaria se valoró mediante una regresión logística multivariante y curvas de Kapplan Meier. Resultados: La mediana de edad fue 68,6 (55,8-79,1) años, con un 57,7% de varones. El grupo con tabaquismo presentó mayor edad (69,9 (59,6-78,0 años)), predominio masculino (80,3%) y mayor índice de Charlson (4 (2-6)). La evolución fue peor en estos pacientes, con una mayor tasa de ingreso en UCI (10,4 vs 8,1%), mayor mortalidad intrahospitalaria (22,5 vs 16,4%) y reingreso al mes (5,8 vs 4,0%) que el grupo sin tabaquismo. Tras el análisis multivariante, el tabaquismo permanecía asociado a estos eventos. Conclusiones: El tabaquismo de forma activa o pasada es un factor predictor independiente de mal pronóstico en los pacientes con COVID-19, estando asociada a mayor probabilidad de ingreso en UCI y a mayor mortalidad intrahospitalaria.

Modelos de riesgo para la predicción de mortalidad hospitalaria en ancianos con neumonía por COVID-19

Objective. To compare the prognostic value of 3 severity scales: the Pneumonia Severity Index (PSI), the CURB-65 pneumonia severity score, and the Severity Community-Acquired Pneumonia (SCAP) score. To build a new predictive model for in-hospital mortality in patients over the age of 75 years admitted with pneumonia due to the coronavirus disease 2019 (COVID-19). Methods. Retrospective study of patients older than 75 years admitted from the emergency department for COVID-19 pneumonia between March 12 and April 27, 2020. We recorded demographic (age, sex, living in a care facility or not), clinical (symptoms, comorbidities, Charlson Comorbidity Index [CCI]), and analytical (serum biochemistry, blood gases, blood count, and coagulation factors) variables. A risk model was constructed, and the ability of the 3 scales to predict all-cause in-hospital mortality was compared. Results. We included 186 patients with a median age of 85 years (interquartile range, 80-89 years);44.1% were men. Mortality was 47.3%. The areas under the receiver operating characteristic curves (AUCs) were as follows for each tool: PSI, 0.74 (95% CI, 0.64-0.82);CURB-65 score, 0.71 (95% CI, 0.62-0.79);and SCAP score, 0.72 (95% CI, 0.63-0.81). Risk factors included in the model were the presence or absence of symptoms (cough, dyspnea), the CCI, and analytical findings (aspartate aminotransferase, potassium, urea, and lactate dehydrogenase. The AUC for the model was 0.81 (95% CI, 0.73-0.88). Conclusions. This study shows that the predictive power of the PSI for mortality is moderate and perceptibly higher than the CURB-65 and SCAP scores. We propose a new predictive model for mortality that offers significantly better performance than any of the 3 scales compared. However, our model must undergo external validation. Objetivo. Los objetivos son comparar la utilidad pronóstica de tres escalas de gravedad (Pneumonia Severity Index: PSI;CURB-65 scale;Severity Community Acquired Pneumonia Score: SCAP) y diseñar un nuevo modelo predictivo de mortalidad hospitalaria en pacientes mayores de 75 años ingresados por neumonía por COVID-19. Método. Estudio retrospectivo de pacientes mayores de 75 años ingresados por neumonía por COVID-19 desde el servicio de urgencias entre el 12 de marzo y el 27 de abril de 2020. Se recogieron variables demográficas (edad, sexo, institucionalización), clínicas (síntomas, comorbilidades, índice de Charlson) y analíticas (bioquímica en suero, gasometría, hematimetría, hemostasia). Se derivó un modelo de riesgo y se compararon las escalas de gravedad PSI, CURB-65 y SCAP para predecir la mortalidad intrahospitalaria por cualquier causa. Resultados. Se incluyeron 186 pacientes, con una mediana de edad de 85 años (RIC 80-89), un 44,1% varones. La mortalidad fue del 47,3%. Las escalas PSI, CURB-65 y SCAP tuvieron un área bajo la curva (ABC) de 0,74 (IC 95% 0,64-0,82), 0,71 (IC 95% 0,62-0,79) y 0,72 (IC 95% 0,63-0,81), respectivamente. El modelo predictivo compuesto por la ausencia o presencia de síntomas (tos y disnea), comorbilidad (índice de Charlson) y datos analíticos (aspartato- aminotransferasa, potasio, urea y lactato-deshidrogenasa) tuvo un ABC de 0,81 (IC 95% 0,73-0,88). Conclusión. Este estudio muestra que la escala PSI tiene una capacidad predictiva de mortalidad moderada, notablemente mejor que las escalas CURB-65 y SCAP. Se propone un nuevo modelo predictivo de mortalidad que mejora significativamente el rendimiento de estas escalas, siendo necesario verificar su validez externa.

Initial experience in Mexico with convalescent plasma in COVID-19 patients with severe respiratory failure, a retrospective case series (preprint)

Introduction: Hospital mortality due to COVID-19 in Mexico is high (32%) and as of today, effective treatment options are limited. More effective treatments that shorten hospital stay and reduce mortality are needed. Initial reports for the use of convalescent plasma (CP) therapy for COVID-19 appear promising. We describe a case series of eight patients with impending respiratory failure, who underwent CP therapy. Methods: Six male and two female (ages 31 to 79) patients that were admitted to the intensive-care unit for severe COVID-19 were transfused with two doses of CP (250 mL per dose, anti-SARS-CoV-2 IgG titers > 1:100). Donors were six SARS-CoV-2 infected males who remained asymptomatic for > 7 days and were negative for two nasopharyngeal RT-PCR tests. Clinical characteristics, inflammatory and cellular injury markers, chest X-ray findings and viral loads were analyzed before and after CP administration. Viral load association to disease severity was further analyzed on a separate cohort of asymptomatic vs hospitalized patients with COVID-19. Results: Eight patients with respiratory failure were successfully discharged with a median length of stay of 22.5 (IQR 18.25-29.00). After CP therapy, we observed a reduction of C-reactive protein (CRP) (median, 22.80 mg/dL vs. 1.63 mg/dL), and of procalcitonin (median, 0.27 ng/mL vs. 0.13 ng/mL). High-Sensitivity Cardiac Troponin I (hs-cTnI), Brain Natriuretic Peptide (BNP) and Lactate Dehydrogenase (LDH) were lower, and a mild reduction of pulmonary infiltrates by chest X-ray was observed. Lastly, a reduction of viral load was after CP therapy was found. (log, median [IQR], 1.2 [0.70-2.20] vs. 0.25 [0.00-1.78]). We observed no adverse effects. Conclusions: CP could potentially be an effective therapeutic option for patients with severe COVID-19. Clinical benefit needs to be studied further through randomized controlled trials.

A cohort of patients with COVID-19 in a major teaching hospital in Europe (preprint)

BACKGROUND Since the confirmation of the first patient infected with SARS-CoV-2 in Spain in January 2020, the epidemic has grown rapidly, with the greatest impact on the Madrid region. This article describes the first 2226 consecutive adult patients with COVID-19 admitted to the La Paz University Hospital in Madrid. METHODS Our cohort included all consecutively admitted patients who were hospitalized and who had a final outcome (death or discharge) in a 1286-bed hospital of Madrid (Spain) from February 25th (first case admitted) to April 19th, 2020. Data was entered manually into an electronic case report form, which was monitored prior to the analysis. RESULTS We consecutively included 2226 adult patients admitted to the hospital who either died (460) or were discharged (1766). The patients median age was 61 years; 51.8% were women. The most common comorbidity was arterial hypertension (41.3%). The most common symptoms on admission were fever (71.2%). The median time from disease onset to hospital admission was 6 days. Overall mortality was 20.7% and was higher in men (26.6% vs 15.1%). Seventy-five patients with a final outcome were transferred to the ICU (3.4%). Most patients admitted to the ICU were men, and the median age was 64 years. Baseline laboratory values on admission were consistent with an impaired immune-inflammatory profile. CONCLUSIONS We provide a description of the first large cohort of hospitalized patients with COVID-19 in Europe. Advanced age, male gender, the presence of comorbidities and abnormal laboratory values were more common among the patients with fatal outcomes.

COVID-19 severe pneumonia in Mexico City - First experience in a Mexican hospital (preprint)

Background: Coronavirus Disease 2019 (Covid-19) pandemic since its first confirmed case, has changed the world. The need for accurate and truthful information is vital. Mexico and Latin America have been widely affected, so having local epidemiological data, will be of great clinical utility. Methods: A total of 33 hospitalized patients with Covid-19 pneumonia (either severe or critical) were identified from electronic health record in a third level care private hospital in Mexico City from March 13rd to April 13rd, 2020. We conducted a descriptive study of patients for characterization of the clinical, laboratory and radiologic findings, as well as complications. Results: The mean age was 60.6 (12.68) years and 23 (69.7%) were males. Twenty-three patients (69.6%) were overweight or obese. The median duration of symptoms before admission was 7 days. All the patients required mechanical invasive ventilation. The median duration of the mechanical ventilation was 12(2.6) days and all patients were extubated except one. All patients were started on antiviral treatment in the first 24 hours after admission once the diagnosis of Covid19 pneumonia was made. There was no difference between the treatment option and the length of stay. The extubation rate was higher (91.6%) than in other series, with no fatalities even though they were treated with different regimens. Conclusions: This one-centre experience describes the epidemiology, treatment and outcome of 33 patients with severe or critical COVID pneumonia admitted to the ICU. Most patients in our series were overweight or obese male, which we observed were of higher risk to present critical pneumonia, as well as high levels of Interleukin-6. The foregoing is relevant, due to the high incidence of these comorbidities in our country.