Chilean institutional policies and multi-level agents: Challenges from the COVID-19 pandemic and carbon footprint

Introduction: As a result of the increasing number of multilateral agreements that Chile has signed, different sectors of consumption have become sources of emissions. In this context attempts to implement guidelines to address this issue have been made. Nevertheless, international policies such as sustainable development goals (SDG) 11–12 often generate dissonance in national and local administrations and have been approached by different instruments to reduce the effects of emissions, mostly focused on the private industrial sector. Methods: This article focuses on four of the most polluted cities in south-central Chile (Coronel, Temuco, Valdivia, and Osorno). Key agents (ministries, regional government, municipalities, and civil society) from three levels of policy development were selected at three scales (national, regional, and local) and interviewed considering three thematic axes: knowledge of carbon footprint areas (housing, heating, food, mobility, and energy), institutional governance, and adaptive changes due to COVID-19. Results: The results show that in Chile, there is a multiscale climate governance led by the Ministry of the Environment (national level), followed by the regional and local levels. Citizens are then left with few capacities, which is negatively viewed. In relation to the carbon footprint and COVID-19, it can be observed that the topic of energy was more addressed at the national and regional levels. Food and energy, followed by heating and then mobility were addressed at the communal level and in civil society. Discussion: Decision-making strategies and policies were discussed in this paper. Copyright © 2023 Bergamini, Ojeda, Gutiérrez, Salazar and Curillán.

Artificial intelligence for the triage of COVID-19 patients at the emergency department: a systematic review

The aim of this article is to systematically analyze the available literature on the efficacy and validity of artificial intelligence (AI) applied to medical imaging techniques in the triage of patients with suspected or confirmed coronavirus disease 2019 (COVID-19) in Emergency Departments (EDs). A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Medline, Web of Science, and Scopus were searched to identify observational studies evaluating the efficacy of AI methods in the diagnosis and prognosis of COVID-19 using medical imaging. The main characteristics of the selected studies were extracted by two independent researchers and were formally assessed in terms of methodological quality using the Newcastle-Ottawa scale. A total of 11 studies, including 14,499 patients, met inclusion criteria. The quality of the studies was medium to high. Overall, the diagnostic yield of the AI techniques compared to a gold standard was high, with sensitivity and specificity values ranging from 79% to 98% and from 70% to 93%, respectively. The methodological approaches and imaging datasets were highly heterogeneous among studies. In conclusion, AI methods significantly boost the diagnostic yield of medical imaging in the triage of COVID-19 patients in the ED. However, there are significant limitations that should be overcome in future studies, particularly regarding the heterogeneity and limited amount of available data to train AI models. Copyright © 2022 The Author(s). Published by MRE Press.

COVID-19 in Business, Management, and Economics: Research Perspectives and Bibliometric Analysis

This document aims to analyze co-citations with computational tools to identify the research perspectives related to COVID-19 in the areas of business, management, and economy. In addition, a bibliometric analysis is carried out that includes annual productivity, the most relevant authors, countries and institutions, the most cited documents, collaboration networks, and co-authorship. Information obtained from the Web of Science database found 4,347 documents published between the years 2020 and 2021 that were scientifically mapped in this field. An analysis of the research perspectives was carried out. The perspectives were determined through an analysis of co-citations from the application of a clustering algorithm using Gephi. In addition, tools such as Bibliometrix and VOSviewer were used for the development of bibliometric analysis. Through open-access tools, five perspectives related to the impact of COVID-19 on business, management, and economics were found. The first analyzes the effects on financial markets;the second presents the effects on tourism and consumer behavior;the third indicates the socio-economic effects of applying policies;the fourth presents the environmental and public health impacts;and the fifth shows the impacts on gender. © 2022, ANPAD - Associacao Nacional de Pos-Graduacao e Pesquisa em Administracao. All rights reserved.

EVALUATION OF THE EFFECTIVENESS AND SAFETY OF SWITCHING FROM INTRAVENOUS TO SUBCUTANEOUS TOCILIZUMAB

Background and importance In the context of the COVID-19 pandemic, one of the strategies implemented to minimise patient visits to health centres was switching the administration of tocilizumab (TCZ) from intravenous (IV) to subcutaneous (SC). Aim and objectives To evaluate the effectiveness and safety of switching from IV to SC TCZ. Material and methods Retrospective observational study conducted in a tertiary hospital including patients receiving active treatment of IV TCZ during the period March-April 2020. Data were collected on the following variables: age, sex, pathology, switching to SC TCZ, switching back to IV administration, physician assessment or patient self-assessment, as well as adverse reactions. The follow-up period was 1 year. Results A total of 45 patients were included, with a median age of 54 (40-62) years. Women represented 85%. Patients included were diagnosed with rheumatoid arthritis (49%), juvenile idiopathic arthritis (18%), Graves disease (13%), lupus (2%), spondylarthritis (2%) and other diagnoses (16%). The prescribing physicians were rheumatologists (62%), internists (24%) and paediatricians (13%). Of 45 patients, 71% (n=32) switched to SC TCZ during the study period. 86% of rheumatology, 83% of paediatrics and 27% of internal medicine patients changed to SC TCZ. Aggravation after switching to SC TCZ was reported in 7/ 32 (22%) cases (5 with rheumatoid arthritis and 2 with juvenile idiopathic arthritis). All of these switched back to IV administration, plus 4 additional patients for undetermined reasons. Of those who switched back to IV administration due to clinical worsening, 4 reported improvement afterwards. Regarding safety, only 2 patients suffered adverse reactions after switching to SC (injection site reaction, palpitations, tremor and oedema). Neither of them switched back to IV administration. Conclusion and relevance One-fifth of the patients reported loss of effectiveness when changing from IV to SC form, and one-third switched back to IV administration. Regarding safety, the toxicity profile of both forms was similar to other studies. The effectiveness results observed are in contrast with the MUSASHI study, which did not report loss of efficacy after switching from IV to SC. However, effectiveness was not measured using the internationally validated ordinary objective scales (DAS28, CDAI), but physician subjective assessments or patient self-assessments, which represents a significative limitation for our study.

Clustering of COVID-19 Time Series Incidence Intensity in Andalusia, Spain

In this paper, an approach based on a time series clustering technique is presented by extracting relevant features from the original temporal data. A curve characterization is applied to the daily contagion rates of the 34 sanitary districts of Andalusia, Spain. By determining the maximum incidence instant and two inflection points for each wave, an outbreak curve can be described by six intensity features, defining its initial and final phases. These features are used to derive different groups using state-of-the-art clustering techniques. The experimentation carried out indicates that k= 3 is the optimum number of descriptive groups of intensities. According to the resulting clusters for each wave, the pandemic behavior in Andalusia can be visualised over time, showing the most affected districts in the pandemic period considered. Additionally, in order to perform a pandemic overview of the whole period, the approach is also applied to joint information of all the considered periods. © 2022, Springer Nature Switzerland AG.

Determinants of COVID-19 fatality among healthcare workers during the first and second waves in Peru

Introduction: Healthcare workers are at high risk of COVID-19, a fact that is especially important in Peru which has one of the highest COVID-19 case fatality rates. Objective: To identify and compare the determinants of COVID-19 case fatality among healthcare workers in Peru between the first and second waves of the pandemic. Material and Methods: Secondary analysis of data from the COVID-19 Health Sector Workers Situation Room which included 95,966 confirmed cases of COVID-19 until October 21, 2021. Case fatality rate was calculated;crude and adjusted odds ratios with 95 % confidence intervals were obtained by applying binary logistic regression. Results: The results show that 65,5 % of the workers were female, aged 41,2 (S.D.=11,1) years on average. Case fatality rate was higher in the second wave. Male sex (3,49 [95 %CI=3,09–3,95] in the first wave (2,1 % [95 %CI=2,0-2,2] vs. 2,6 % [95 %CI=2,5-2,8]), and 2,65 [95 %CI=2,32–3,02] in the second wave), ≥40 years ofage (9,97 [95 %CI=8,19–12,13] in the first wave, and 10,77 [95 %CI=8,56–13,54] in the second wave), and healthcare professionals (1,14 [95 %CI=1,01–1,28] in the first wave, and 1,59 [95 %CI=1,39–1,82] in the second wave) were determinants for COVID-19 case fatality in both waves. Conclusions: COVID-19 case fatality was higher in the second wave, and was associated with individual, geographic and occupational determinants in Peruvian healthcare workers.

Analysis of the effect of the covid-19 pandemic on maternal care at the Acobamba hospital - Huancavelica, Perú 2020

To determine the effect of the COVID-19 pandemic on maternal care in the Hospital of Acobamba - Huancavelica, 2020. Methodology: The research was observational, retrospective, and longitudinal with the population being consisted of 27 and 29 pregnant women, 53 and 60 deliveries, 27 and 29 postpartum women during the second trimester of the year 2019 and 2020, respectively. Results: Analysis with pandemic (2020) and without pandemic (2019), pregnant women attended 86.6% and 114.8%;pregnant women controlled (6APN) 62.1% and 88.9%;with full laboratory set 44.8% and 88.9%. During the pandemic, each pregnant woman received 1.8 visits and 3.9 telephone follow-ups, compared to 0.9 visits and no telephone follow-ups. During the pandemic, delivery care reached 236.7% since deliveries from other jurisdictions and by returning migrants were attended and there were 5% of home deliveries, while during the non-pandemic 86.8% and no home deliveries were attended. The first puerperal check-up reached 162.1%, 137.9% compared to 66.7% and 59.3%;visits to puerperal women reached 117.2% compared to 74.1% non-pandemic. The causes of the main emergencies were abortion (22.2%), hypertensive disease of pregnancy (15.3%), fetal distress (8.3%) and hemorrhage during pregnancy (8.3%). Conclusion: COVID-19 pandemic reduced APN, increased delivery and puerperium care, strengthened follow-up of pregnant and puerperal women, increased emergencies and reduced cases of postpartum hemorrhage. The health team responded to the situation with commitment and responsibility). © 2022 by the authors.

Social media: An essential capability for business effectiveness?

The issue of social media is rather new and unexplored in comprehending how this capability can improve effectiveness in emerging economies, in particular, that of the companies classified as micro, small and medium-sized (MSMEs). It is argued that some company and manager characteristics may affect the role of social media in business performance, therefore this research attempts to answer the following questions: Does the use of social media contribute to improving performance of MSMEs? How does the relationship behave according to the characteristics of the company and those of the manager? For this purpose, the resource-based view of the firm is used as a framework of the analysis, which was carried out with data collected before the COVID pandemic. To validate the proposed hypotheses, we used Structural Equation Model (SEM) with a sample of 229 Mexican enterprises. The main contribution of this study is twofold: providing empirical evidence on the existence of influence from social media capability to the business performance and effectiveness of MSMEs in a Latin American emergent economy, even before the imposition of radical constraints by the pandemic;and the key theoretical implication is a better understanding of the nature of this influence. © 2022 John Wiley & Sons Ltd.

Recommendations for the diagnosis and management of persons with suspected vaccine-induced immune thrombotic thrombocytopenia (VITT)

In recent months, rare cases of thrombosis at unusual sites associated with thrombocytopenia, occurring within a typical risk window (i.e., 4-28 days) after receiving SARS CoV2 vaccines, have been reported. Healthcare professionals should be prepared to detect these cases on time. The Expert Panel of the Knowledge Management and Transfer Network conducted a free search of the related literature. With the available information and the clinical expertise of the working group, we formulated, reviewed, and endorsed recommendations for the timely suspicion, diagnosis (case definitions, the use of initial laboratory and imaging tests, specific tests), and management of these thrombotic conditions. This document is considered a living document that will be updated as new evidence emerges, and recommendations may change over time.

Infection Risk in Lymphoproliferative Diseases (LPD) Treated with Targeted Drugs. Geltamo Real-Life Experience

Introduction:Recently there has been a renewal of therapeutic tools for the treatment of lymphoid neoplasms to increase the antitumor efficacy and reduce the toxicity generated by conventional chemotherapies, which adds to the intrinsic immunological dysfunction of the disease itself. To date, few data are published about infection risk of these new drugs, and the need for infectious prophylaxis is unknown. The aim of the study is to analyze the infectious complications in patients with LPD treated with monoclonal antibodies (obinutuzumab, ofatumumab, brentuximab, nivolumab and pembrolizumab), BTK inhibitors (ibrutinib, acalabrutinib) and PI3K inhibitors (idelalisib). Methods: Multicenter retrospective study in patients with LPD treated with targeted therapies (single agents or combination) in 18 Hematology centers in Spain, from the time of their commercial availability to March 2020. Patients in clinical trials were excluded as well as patients with active infections at the beginning of treatment. Results:During the study period, 380 patients were included.Baseline characteristics of the entire cohort are shown in Table 1.Median follow-up was 17.3 months (range 0-103), the longest follow-up corresponding to CLL patients (24 months, range 0-98) and the shortest to LBCL (5 months, range 0-25). Median exposure to target drugs was 8 months (range 0-72).Ibrutinib was administered to 219 patients(1 FL, 147 CLL, 27 MCL, 10 DLBCL, 1 TL and 32 WM, 1 HL),Brentuximab to 49(31 HL, 14 TL and 4 DLBCL) andIdelalisibto 35 patients (16 affected by chronic lymphocytic leukemia - CLL, 15 FL and 1 DLBCL, 1 WM, 1MCL, 1HL).Obinutuzumabcombinations were used in 10 (6 CLL, 3 FL, 1 MCL) and 5 HL patients (of which 4/5 underwent previous BMT) receivedNivolumab. A total number of 237 infectious events occurred in 148/380 patients (38.9%), 39% of which were grade 3 and 54/148 (36.4%) experienced 2 or more infective episodes: of those 54, 21 (38%) had underwent 3 or more lines of therapy and 28 (51%) had hypogammaglobulinemia. Hospitalization was required in 59.2% events. A bacterial cause of infection was reported in 40% of cases, and viral in 16%, including 11/237 (4,6%) SARS-CoV-2 infection. Invasive fungal infection (IFI) occurred in 3.3% (8/237). Noteworthy, no case of PJP was identified. Lung was the most frequent site of infection in 24% of cases (57/237) while the upper respiratory tract was involved in 17% of events (41/237). Urinary tract infections were diagnosed in 10% (24/237). Other sites involved were skin and soft tissue 7%, gastrointestinal tract 5,4%, bloodstream infections 3% and catheter related infections 2,5%. Considering drugs individually, 86 patients that receivedIbrutinib(39.2 %)experienced a total of 137 infectious episodes: 30% bacterial, 19% viral, 5% fungal and 45% clinical and image-based infections;the 17(34.6%of those who received Brentuximab, experienced a total of 16 infectious episodes: 56% bacterial, 37.5% viral infections and one catheter-related sepsis. Of those who receivedIdelalisib,18 (51.4%)experienced a total of 28 episodes: 42% bacterial, 14% viral and 7% fungal. Four patients treated withObinutuzumabcombinations (40%) experienced one infection during treatment (25% bacterial and 75% viral). Only one patient treated withNivolumabexperienced more than three infections, he was also under corticosteroid treatment. Focusing on IFI (Table 2): 7/8 infections were identified in CLL patients, 6 out 7 being on ibrutinib treatment and 1/7 on Idelalisib.Aspergilluswas the fungus most frequently isolated. The targeted drug was discontinued temporarily in 4 patients and indefinitely in 3. Twenty three (6%) patients died due to infection in our series. Conclusions: 1. We identified 38.7% infections in our LPD patients treated with targeted drugs, with a median drug-exposure time of 8 months (range 0-72), with a non-negligible incidence of bacterial infections. 2. The highest rates of infection were found in patients treated with with Idelalisib and Ibrutinib (51.4% and 39.2% respectively). 3. IFI (3.3%) occurr d with low frequency, mostly in CLL patients during ibrutinib treatment, leading to its temporal discontinuation in most of the cases. 4. No case of PJP was identified in our cohort. 5. An analysis to determine risk factors for infection and the optimal monitoring and prophylaxis for these patients is ongoing. [Formula presented] Disclosures: Hernandez-Rivas:Janssen:Membership on an entity's Board of Directors or advisory committees;Abbvie:Membership on an entity's Board of Directors or advisory committees;Roche:Membership on an entity's Board of Directors or advisory committees;AstraZeneca:Membership on an entity's Board of Directors or advisory committees;Gilead:Membership on an entity's Board of Directors or advisory committees;Celgene/BMS:Membership on an entity's Board of Directors or advisory committees;Rovi:Membership on an entity's Board of Directors or advisory committees.Lopez-Guillermo:novartis:Consultancy;celgene:Consultancy, Research Funding;roche:Consultancy, Research Funding;gilead:Consultancy, Research Funding.

Recommendations for the use of thromboprophylaxis in hospitalized patients with COVID-19 in Argentina

Although the incidence is uncertain, some case reports suggest that COVID 19 infection is associated with an increased risk of venous thromboembolism. We suggest starting prophylactic anticoagulant therapy for all patients hospitalized with a symptomatic infection with COVID-19, unless contraindicated, with enoxaparin 40 mg SC daily if creatinine clearance is greater than 30 ml/min.

Fake news about Covid-19: a comparative analysis of six Ibero-american countries

Introduction: Producers of misinformation and fake news find in fear, uncertainty in pandemic times, and virtual social networks facilitators for disseminating them, doing harder the task to detect them even for experts and laymen. Typologies designed to identify and classify hoaxes allow their analysis from theoretical perspectives such as echo chambers, filter bubbles, information manipulation, and cognitive dissonance. Method: A content analysis was developed with 371 fake news, previously verified by fact-checkers. After the intercoder test, it was proceeded to classify disinformation according to their type, intentionality, the main topic addressed, networks where they circulated, deception technique, country of origin, transnational character, among other variables. Results: The most common intent of fake news was ideological, associated with issues such as false announcements by governments, organizations, or public figures, as well as with false context elaboration technique. A quarter of the hoaxes analyzed were repeated in several countries, mainly promoting false cures with fabricated content as a deception technique. Discussion and Conclusions: Disinformation is a manipulation and filtering phenomenon based on ideological and emotional coincidence shared by those who circulate them. (Dis)information that converges with the users' interests, makes its dissemination indiscriminate, and facilitates its transnationality, with slight modifications, without affecting its acceptance and recirculation.

Pregnancy and novel coronavirus: worldwide reported experience / Embarazo y nuevo coronavirus: experiencia global reportada

INTRODUCCIÓN: La Organización Mundial de La Salud ha reportado recientemente que el nuevo foco de la pandemia global de la enfermedad Covid-19 es el continente americano. OBJETIVO: Realizar una revisión de la literatura sobre la experiencia internacional de la pandemia Covid 19 y embarazo. MÉTODO: Se realiza una búsqueda de la base de datos PubMed para las palabras clave Pregnancy / Pregnant / Novel Coronavirus / SARS-CoV-2 / Covid-19, desde el 1 de noviembre 2019 hasta el 21 de mayo 2020. RESULTADOS: Un total de 365 artículos fueron inicialmente seleccionados de acuerdo con la estrategia de búsqueda diseñada. El total de artículos revisados de acuerdo con los criterios fueron 42. Las series clínicas seleccionadas acumularon un total de 1098 embarazadas y enfermedad de Covid-19. Las co-morbilidades mas frecuentes fueron hipertensión arterial, diabetes mellitus, obesidad y asma. La mortalidad en relación con el total de pacientes fue de un 1,2 % y la transmisión al recién nacido de 1,7% (15 de 875). CONCLUSIÓN: La información obtenida permite inferir que la presentación clínica de la enfermedad es a lo menos equivalente a la de mujeres de la misma edad no embarazadas. Dada la severidad de la enfermedad por SARS-CoV-2 reportada, las lecciones aprendidas deben ser rápidamente asimiladas y utilizadas en el contexto de la situación nacional epidémica.

INTRODUCTION: The World Health Organization has recently reported that the new focus of the global pandemic of Covid-19 disease is the American continent. OBJECTIVE: To conduct a literature review on the international experience of the Covid 19 pandemic and pregnancy. METHOD: A PubMed database search is performed for the keywords Pregnancy / Pregnant / Novel Coronavirus / SARS-CoV-2 / Covid-19, from November 1, 2019 to May 21, 2020. RESULTS: A total of 365 articles were initially selected according to the designed search strategy. The total of articles reviewed according to the criteria was 42. The selected clinical series accumulated a total of 1098 pregnant women and Covid-19 disease. The most frequent comorbidities were hypertension, diabetes mellitus, obesity, and asthma. Mortality in relation to the total number of patients was 1.2% and transmission to the newborn was 1.7% (15 of 875). CONCLUSION: The information obtained allows us to infer that the clinical presentation of the disease is at least equivalent to that of non-pregnant women of the same age. Given the severity of the reported SARS-CoV-2 disease, the lessons learned must be quickly assimilated and used in the context of the national epidemic situation.

Management of patients with oral cancer during the covid-19 pandemic

Introduction: The influence of the COVID-19 pandemic on healthcare to the public is severe. There is a high viral load in the nasal and oral cavities of infected patients, especially endangering those specialties focused around this region. Within the field of action of oral and maxillofacial surgeons, the approach and management of oral cancer is one relevant area. The present review aims to collect and discuss aspects of the management of inpatients and outpatients with oral cancer during the COVID-19 pandemic. Corpus: The care of the patient affected with oral cancer is imperative. Following strict biosecurity protocols, procedures such as clinical examinations for cancer patients and biopsies can be performed. In the case of benign slowly growing tumors, deferral of surgery until the COVID-19 pandemic situation has settled is recommended. In the case of malignant tumors, surgery must be performed using appropriate biosecurity measures. Conclusion: The reduction of elective surgery is necessary;nevertheless, urgent oncologic and emergency surgery still has to be performed. Strategies must be developed to reduce the number of infections. The adequate approach of the COVID-19 challenge merits significant changes in the infrastructure of outpatient units, inpatient units, and operating rooms. © The authors, 2020.

Social cost of premature deaths due to COVID-19 in Peru

Background: The human cost of the COVID-19 pandemic is significant, but the true impact is still uncertain. OBJECTIVE: To determine the years of potential life lost and the social cost of death due to the COVID-19 disease in the Peruvian population. Material and Methods: An observational and descriptive study was carried out, through the secondary analysis of deaths due to COVID-19 in Peru between January 1, 2020, and July 31, 2021, reported by the Ministry of Health of Peru. Results: During 2020, 926,343.5 years of life were lost in Peru;however, between January 1 and July 31, 2021, 1,116,553.1 years had already been lost. From the start of the pandemic until July 31, 2021, the social cost of deaths due to COVID-19 has amounted to USD 18,807,942,464.6. Conclusion. The COVID-19 pandemic has caused a high loss of potential years of life and high social cost, mainly in urban territories with higher economic development. © 2022 Columbia Data Analytics. All rights reserved.