Aumento de mortalidad materna y de prematuridad durante pandemia de COVID-19 en Chile Increase in maternal mortality and prematurity during the COVID-19 pandemic in Chile

Introducción En Chile los casos reportados de COVID-19 a nivel nacional al tercer año de pandemia (3 de noviembre del 2022) son de 4.769.638 y 61.725 fallecidos (1,3%), con el 93% de la población con esquema completo de vacunación (17.686.528). Objetivo El objetivo de este estudio es una comunicación breve sobre el impacto de la pandemia de SARS-CoV-2 en la mortalidad materna, perinatal y prematuridad en Chile. Método Se utilizó la base de datos nacional del Departamento de Informática del Ministerio de Salud de Chile (DEIS), y la información reportada desde sitio web oficial de OMS. Se incluyeron todos los nacidos, muertes generales y fetales desde enero 1990 a septiembre del 2022. Se realiza una comparación entre los indicadores básicos maternos y perinatales de los últimos 30 años y los de los años de la pandemia. Resultados Desde marzo 2020 a septiembre 2022, fallecieron más de 61.000 personas en Chile con diagnóstico asociado al COVID-19, el 17% de la mortalidad general para el período (364.000 fallecidos). Se observó una aceleración en la tendencia histórica hacia la disminución de la razón nacimientos/defunciones generales de 1,9 pre-pandemia a 1,4 al tercer año de pandemia. La razón de mortalidad materna en el año 2020 fue de 28,1 × 100.000 nacidos vivos y aumentó en comparación al año 2019 pre-pandemia (19,1) o a la línea simple de tendencia histórica proyectada para el 2020 (18) en un 56%. La prematuridad bajo 37 semanas de gestación, se incrementó de 8,5% (2019) a 9,5% para los años 2021 y 2022. La mortalidad neonatal de los primeros 28 días se mantuvo estable en 9 × 1.000 nacidos vivos durante los 3 años de pandemia y la mortalidad fetal (>21 semanas) tuvo un leve incremento a 4,7 × 1.000 nacidos vivos (año 2020) en relación a 3,4 del año 2019. Conclusiones En Chile ocurrió un aumento de aproximadamente un 56% de la mortalidad materna el primer año de pandemia de SARS-CoV-2, el segundo año se observa un aumento significativo de la prematuridad tardía y un leve incremento de la mortalidad fetal. Estos hallazgos han sido reportados en las revisiones y últimas actualizaciones del año 2022.

COVID-19 Impacts on Online and In-Store Shopping Behaviors: Why they Happened and Whether they Will Last Post Pandemic

Throughout the COVID-19 pandemic, people's online and in-store shopping behaviors changed significantly. As the pandemic subsides, key questions are why those changes happened, whether they are expected to stay, and, if so, to what extent. We answered those questions by analyzing a quasi-longitudinal survey dataset of the Puget Sound residents (Washington, U.S.). We deployed structural equation modeling (SEM) to build separate models for food, grocery, and other items shopping to explore the factors affecting such changes. The results revealed that people's online and in-store shopping frequencies during the pandemic were affected by their perceived health risk, attitudes toward shopping, and pre-pandemic shopping frequencies. Similarly, it was shown that how frequently people expect to shop post pandemic is influenced by their attitudes toward shopping, changes during the pandemic, and their pre-pandemic frequencies. We also classified respondents into five groups, based on their current and expected future shopping behavior changes, and performed a descriptive analysis. The five groups—Increasers, Decreasers, Steady Users, Returnees, and Future Changers—exhibited different trends across online and in-store activities for shopping different goods. The analysis results showed that, while 25% of the respondents increased their online shopping, only 8% to 13% decreased their in-store activities, implying that online shopping did not completely substitute in-store shopping. Moreover, we found that online shopping is a substitution for in-store shopping for groceries, while it complements in-store shopping for food and other items. Additionally, more than 75% of new online shoppers expect to keep purchasing online, while 63%–85% of in-store Decreasers plan to return to their pre-pandemic frequencies.

Severe Hyponatremia in the Setting of COVID-19-Associated Syndrome of Inappropriate Antidiuretic Hormone: A Case Report.

The COVID-19 pandemic has resulted in significant worldwide morbidity and mortality. One of the less studied clinical manifestations is Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) associated with COVID-19 pneumonia. We present a single case of COVID-19 pneumonia-associated SIADH in a 71-year-old male with a history of alcohol use disorder. This case highlights the importance of full diagnostic workup of the underlying cause of hyponatremia to avoid significant morbidity.

Non-Melanoma Skin Cancer: A Genetic Update and Future Perspectives.

Skin cancer is one of the main types of cancer worldwide, and non-melanoma skin cancer (NMSC) is the most frequent within this group. Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common types. Multifactorial features are well-known for cancer development, and new hallmarks are gaining relevance. Genetics and epigenetic regulation play an essential role in cancer susceptibility and progression, as well as the variety of cells and molecules that interact in the tumor microenvironment. In this review, we provide an update on the genetic features of NMSC, candidate genes, and new therapies, considering diverse perspectives of skin carcinogenesis. The global health situation and the pandemic have been challenging for health care systems, especially in the diagnosis and treatment of patients with cancer. We provide innovative approaches to overcome the difficulties in the current clinical dynamics.

Chronic rhinosinusitis is associated with increased risk of COVID-19 hospitalization.

OBJECTIVE: The rationale of the study was to examine the association between chronic rhinosinusitis (CRS) and COVID-19 hospitalization. STUDY DESIGN: Retrospective cohort study. SETTING: Cleveland Clinic hospital inpatient and outpatient. METHODS: A retrospective chart review of patients that were tested for COVID-19 at Cleveland Clinic. The study took place between March 8, 2020 and May 15, 2020. RESULTS: From a total of 23,282 Patients that underwent SARS-CoV-2 testing, 996 COVID-19 negative and 998 COVID-19 positive patients were included in the analysis. COVID-19 positive patients with chronic rhinosinusitis (CRS) were at higher risk for hospitalization compared to patients without CRS (39.2% vs 25.7%, p = 0.0486). There was no significant difference between the two groups in relation to ICU admission, mechanical ventilation, and death, After adjustment for covariates, our multivariate analysis showed that patients with chronic rhinosinusitis (CRS) were approximately 3.46 (OR = 3.19, 95% CI (1.12-10.68)) times more likely to be hospitalized compared to patients that have no CRS. CONCLUSION: Our results demonstrated that patients with chronic rhinosinusitis are associated with higher risk of COVID-19 hospitalization, albeit no increased risk of mortality.

More Evidence of the Link of Interleukin-6 and Interleukin-10 with Critical COVID-19: A Report in Mexican Patients.

BACKGROUND: According to the World Health Organization, Mexico presents one of the highest mortality rates due to coronavirus disease 2019 (COVID-19). The "cytokine storm" phenomenon has been proposed as a pathological hallmark of severe COVID-19. OBJECTIVE: To determine the association of serum cytokine levels with COVID-19 severity. METHODS: We studied the cytokines IL-2, IL-4, IL-6, IL-10, TNF-α, and the IFN-γ serum levels through flow cytometry in 56 COVID-19 patients (24 critical and 32 non-critical) from Northwest Mexico. RESULTS: We observed a significant increase in the IL-6 and the IL-10 levels in the sera of critical patients. These cytokines were also associated with mechanical ventilation necessity and death, IL-6 showing AUC values above 0.7 for both variables; and correlated with Na+, creatinine, and platelet levels. On the other hand, no association was found between IL-2, IL-4, TNF-α, and IFN-γ with tested variables. CONCLUSION: Our results corroborate previous observations regarding IL-6 and IL-10 involvement in the severity of COVID-19.

Shoulder Pain in COVID-19 Survivors Following Mechanical Ventilation.

COVID-19 has caused a certain proportion of patients to be hospitalized in intensive care units (ICU) and may cause musculoskeletal and neurological deficits following intubation and mechanical ventilation. The aim of this study was to quantify and describe the presence of shoulder pain in patients released from hospitals after suffering COVID-19. Patients with positive Apley tests were sent to a physiatrist for a clinical evaluation, ultrasound and electromyography (EMG). This evaluation was completed with a pain scale, joint range and shoulder muscle strength evaluations. Of the one-hundred-sixteen patients, seventy eight entered the respiratory rehabilitation program. Twenty patients were sent to the multidisciplinary shoulder team for positive Apley scratch tests. Of these twenty patients, one had only an EMG, ten had only ultrasounds, seven had an EMG and ultrasound and two did not need complementary tests. The twenty patients were sent to the physical therapist, with all presenting pain and diminished joint range and muscle strength in the affected shoulder. In this context, shoulder pain could be associated with the prone position in the ICU. We suggest time control and position change for patients on mechanical ventilation in a prone position with COVID-19.

Fetal Bladder Rupture as a Complication of Adjunctive Therapy in Severe Maternal SARS-CoV-2 Pneumonia.

INTRODUCTION: A case of spontaneous fetal bladder rupture occurring in a woman with SARS-CoV-2 pneumonia receiving invasive ventilatory support is reported. CASE: A 33-year-old woman was admitted at 30.6 weeks' gestation with the diagnosis of severe pneumonia due to COVID-19. The patient required invasive mechanical ventilation on day 2. Propofol, fentanyl, midazolam, and dexmedetomidine were administered for sedation, pain relief, and to improve patient-ventilator interaction. A bedside ultrasound on day 3 revealed fetal megacystis. Follow-up scan two days later showed urinary ascites and a collapsed bladder. The diagnosis of fetal bladder rupture was confirmed postpartum. Bladder repair was performed on day 5, with an uneventful recovery. DISCUSSION: Transplacental transfer of opioids during invasive ventilatory support in pregnancy may cause acute fetal bladder atony leading to severe urine retention and, potentially, bladder rupture. This can be a serious complication of adjunctive therapy in women with severe SARS-CoV-2 pneumonia.

Maternal and perinatal outcomes in pregnant women with confirmed severe and mild COVID-19 at one large maternity hospital in Chile.

OBJECTIVE AND METHODS: We conducted a prospective observational cohort study in 458 pregnant and puerperal women, with confirmed COVID-19 at Hospital San Jose, Santiago, Chile, to determine the impact of COVID-19 on pregnancy and confirm safety and feasibility of a management protocol based on clinical presentation of the disease. RESULTS: 25.5% (117/458) of women were severe and 74.4% (341/458) mild presentation. Three percent (9/341) of mild presentations required a subsequent hospitalization. Overall, 26/458 women (5.6%) were admitted to ICU, and 13/458 (2.8%) required mechanical ventilation. One maternal death occurred at 49-days postpartum. Severe presentation, infection above 24 weeks, and comorbidities were associated with an adverse maternal outcome. Of total deliveries, 16.5% (36/217) were <37 weeks. Perinatal mortality was 6/226 (2.7%), mostly due to the fetal component. CONCLUSIONS: A quarter of the women had severe COVID-19 that, combined with occurrence of disease in the second half of pregnancy, resulted in substantial maternal compromise. Perinatal morbidity and mortality in women with severe disease were high and warrant consideration. Outpatient management was safe for mild cases.

Aplicaciones móviles: incorporación en procesos de enseñanza en tiempos de covid-19

A partir de la pandemia declarada por la Organización Mundial de la Salud en marzo del 2020 a raíz del virus COVID-19, las aplicaciones móviles que permiten la comunicación a distancia, como Whatsapp, han visto disparado su uso alrededor del mundo. Alrededor del noventa por ciento de las aulas del mundo cerraron sus puertas, obligando a utilizar plataformas de enseñanza a distancia para llevar a cabo el proceso educativo. El objetivo de este trabajo es reflexionar sobre el uso de las aplicaciones de mensajería instantánea para el desarrollo del proceso educativo en medio de la pandemia. La investigación corresponde a una revisión teórica documental y/o bibliográfica. Los resultados arrojaron que estas plataformas permiten la virtualización de la enseñanza, la separación del proceso educativo de un espacio arraigado, así como el uso de nuevas formas de lenguaje, vinculado a la cultura tecnológica de los dispositivos móviles. Se concluye que la utilización de aplicaciones tecnológicas como el WhatsApp en el proceso de aprendizaje ofrece diversas ventajas, pero al mismo tiempo, evidencian profundas brechas tecnológicas, tanto en el acceso a la tecnología como en los conocimientos para su uso.Alternate abstract:Since the pandemic declared by the World Health Organization in March 2020 as a result of the COVID-19 virus, applications that allows remote communication, such as WhatsApp, have risen their use around the world. Around ninety percent of the world's classrooms closed their doors, forcing the use of distance learning strategies to carry out the educational process. The objective of this work is to reflect on the use of instant messaging applications for the development of the educational process in the midst of the pandemic. The research corresponds to a theoretical documentary and / or bibliographic review. The results showed that these platforms allow the mobility of teaching, the separation of the educational process from an entrenched space, as well as the use of new forms of language linked to the technological culture of mobile devices. It is concluded that the use of technological applications such as WhatsApp in the learning process offers several advantages, but at the same time, they show deep technological gaps, both in access to technology and in the knowledge for its use.

Proposed method to measure the economic impact of SARS-COV-2

The SARS-CoV-2 pandemic has led to the Second Global Crisis, the magnitude and duration of which is expected to be more intense than the First Global Crisis of 2008 caused by the bankruptcy of Lehman Brothers. This paper proposes a procedure to calculate the economic impact of SARS-CoV-2, taking into account the number of deaths by gender by age bracket (40-49, 50-59 and 60-64 years) and the updated value of income per capita moderated by the average of each age bracket. As a result, the social and economic impact of the virus is reflected on.Alternate abstract: La pandemia del SARS-CoV-2 ha llevado hacia una Segunda Crisis Global, cuya magnitud y duración es previsible que sea más intensa que la Primera Crisis Global de 2008 originada por la quiebra de Lehman Brothers. En este trabajo se propone un procedimiento para calcular el impacto económico del SARS-CoV-2, teniendo en cuenta el número de fallecidos por género por tramos de edad (40-49, 50-59 y 60-64 años) y el valor actualizado de la renta per cápita moderada por la media de cada tramo de edad. Como resultado se reflexiona sobre el impacto social y económico del virus.Alternate abstract: A pandemia de SARS-CoV-2 levou à Segunda Crise Global, cuja magnitude e duração devem ser mais intensas que a Primeira Crise Global de 2008, causada pela falência do Lehman Brothers. Este artigo propõe um procedimento para calcular o impacto econômico do SARS-CoV-2, levando em consideração o número de mortes por gênero, por faixa etária (40-49, 50-59 e 60-64 anos) e o valor atualizado de renda per capita moderada pela média de cada faixa etária. Como resultado, o impacto social e econômico do vírus é refletido.