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Introduction and Objectives: Cases suggestive of immune-mediated acute hepatitis following SARS-CoV-2 vaccination have been reported. The risk of liver injury after Covid-19 vaccination is unknown. This study aimed to estimate the cumulative incidence of liver injury within 90 days after the Covid-19 vaccine, defined as the occurrence of AST and/or ALT increases at least two times the limit of normal or ALP increases at least x 2. To compare with an active comparator group (influenza vaccine). Material(s) and Method(s): Retrospective cohort study. We analyze a consecutive sample of adult patients vaccinated with Covid-19 vaccines (Sputnik, AstraZeneca/Oxford, Covishield, or Sinopharm) between January 1 and May 30, 2021, and a historical control group vaccinated with influenza between March 1 and July 30, 2019. Qualifying labs were collected as part of routine clinical care or the development of symptoms. Result(s): From a total of 29,918 subjects who received the Covid-19 vaccine in 2021 and 24,753 who received the Influenza vaccine in 2019, 130 and 148 patients, respectively, were excluded because of previously altered liver function tests or known hepatic disease. Both groups were comparable in age (73 years old (IQR 65-80), p=0.125) and gender (67% were females). In the Influenza group were more dysmetabolic and immunosuppressed patients. A total of 269 and 273 patients, respectively, presented altered liver function tests within 90 days post-vaccination. The cumulative incidence of liver injury was 4.6 per 1,000 (95% CI 3.9-5.5) for Covid-19 and 5.1 per 1,000 (95%CI 4.3-6.1) for Influenza (p=0.453). Although, two patients from the COVID group had a more severe injury, with hyperbilirubinemia, development of autoantibodies and requirement of steroids for disease control. Conclusion(s): The occurrence of events was similar in subjects vaccinated with Covid-19 compared to the control group. Acute hepatitis characteristics arising after the COVID-19 vaccine needs to be further clarified.Copyright © 2023
ABSTRACT
Introduction and Objectives: Acute autoimmune-like liver injury has been increasingly reported after vaccination against SARS-CoV-2. Pathogenesis, steroid requirement and long-term prognosis are unknown. This study aimed to evaluate clinical, serological and histological features, response to treatment and prognosis in patients with post-vaccination acute hepatitis. Material(s) and Method(s): We included patients without known pre-existing liver diseases with transaminase levels >= 2.5 upper limits of normal within 90 days after the SARS-CoV-2 vaccine with an available liver biopsy. Clinical data and outcomes after a six months follow-up were collected. Result(s): 17 patients were included,12 females, median age 60 (51,5/66) exposed to vectorial (Sputnik V n=7, AstraZeneca n=6), inactivated (Sinopharm n=3) or ARNm Vaccines (Moderna=1). In 8 patients, liver injury developed after the first dose and in 7 after the second dose and in 2 after the third dose. The median time to the development of injury was 33(23,50/53,50) days. Eight patients had a history of extrahepatic autoimmune disease and five patients had metabolic syndrome and used statins. Immune serology showed anti-antinuclear antibody in 10 (58,8%), anti-smooth muscle antibody in 5(29,4%). 14/17 patients presented with elevated IgG levels. Liver histology showed lobular hepatitis in 13/17, portal hepatitis in 17/17 with plasmocytic lymphocytic infiltrate and 4/17 had eosinophils, 6/17 with severe interface hepatitis, and one patient had fibrosis Ishak stage >=3. 12/17 (70,5%) were treated with steroids. Transaminases improved in 17 cases and normalized in 6/12 by month 6. Only 1/17 developed liver function deterioration, yet no patient required liver transplantation. Most patients tolerated the tapering of steroids and in 6 azathioprine was started before month 3. Conclusion(s): Long-term follow-up might help to differentiate between induced classical autoimmune hepatitis, autoinflammatory self-limited events, or drug-induced liver injury in these patients.Copyright © 2023
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This article analyses the evolution of Ecuador's foreign policy during the governments of Rafael Correa, Lenín Moreno and Guillermo Lasso in the framework of the theoretical postulates of peripheral realism, which argues that small and medium-sized states should develop a policy of collaboration with major powers and reduce their opposition to those events that directly affect the interests of their nationals. To this end, key moments in each of the abovementioned governments are analysed, including the closure of the Manta Base, the relationship with the IMF, the handover of Julian Assange and the purchase of vaccines against Covid-19. The article concludes by showing how the three presidents developed strategies that did not maximise Ecuador's interests, as they alternated policies where confrontation with the great powers was generalized with policies that prioritised rapprochement with them at the expense of national interests. © UNISCI, 2023.
ABSTRACT
Background/Introduction: COVID-19 PANDEMIA has significant cardiovascular implications. Patients with acute or latent infection may present with myocardial injury, endothelial dysfunction and thrombotic complications. Health systems in many places have been overwhelmed and prevention has been pushed aside in favor of urgent care. In many cases, the usual activity of heart rehabilitation programmes is affected. Some programmes have stopped, some have managed to perfom e-rehailitation. Our programme stopped during confinement and restarted on face-to-face mode in June 2020 with adjustments (reduction of capacity, reduction of sessions, hygienic measures) Purpose: Our objective is to analyze the main characterisitcs and main results of the patients included on heart rehabilitation programmes inmediately before and inmediately after the beginning of COVID-19 pandemia and check if the changes made to the programme affected the results of the patients Methods: Retrospective descriptive cohort of consecutive patients admitted to cardiac rehabilitation in the second half of 2019 compared with patients who started inmediately after the pandemia beginning in our city (second half of 2020), The selection criteria are: 1) patients who have started rehabilitation within the established periods. 2) complete cardiac rehabilitation programme. Baseline, ergometric and echocardiographic characteristic are analyzed. Results: 131 patients werw included, 59 in second half 2019 group (2019 group) and 72 in the second half 2020 group (2020 group). The mean age of the 2020 group was lower, without reaching statistical significance (65 +/-13 vs 62 +/-10 p=ns). In the “2019 group” 52(88%) males were included vs 58 males (81%) included in the “2020 group”. The initial burden of cardiovascular risk factors (hypertension, diabetes, dyslipemia, smoking habit) was similar ( see Table 1). The main reason for inclusion in cardiac rehabilitation programme was ischemic heart disease in both groups (49 (83%) VS 57 (79%), p= ns), and the number of vessel affected was similar ( see Table 1). Patients with ventricular ejection fraction less than 50% were similar, too. Initial functional capacity (initial METS) and final functional capacity ( final METS) showed no differences, neither mean BMI. The initial and final lab test parameters analyzed here (LDL-choleterol and HDL-cholesterol) showed no differences between the 2 groups. Conclusion(s): Our group opted to maintain a face-to-face cardiac rehabilitation programme with adaptations (reduction of capacity, reduction of sessions, hygienic measures among others. Despite this adaptation, the baseline characteristics of the patients included, the reason for inclusion on the programme and the main results showed no differences between both groups. (Figure Presented).
ABSTRACT
Introduction: Public health risk management in Colombia is led by the National Institute of Health. In the face of the COVID-19 emergency, response actions were carried out through the implementation of Risk Analysis Rooms, strengthening surveillance at points of entry into the country. Objective: To carry out an analysis of the implementation and maintenance phases of the COVID-19 Risk Analysis Rooms in four border departments of Colombia. Materials and methods: A qualitative study was carried of Risk Analysis Rooms in public health for COVID-19. The documentation and data generated in the period from March to June 2020 in Amazonas, Vichada, Guainia and Putumayo were reviewed. Semi-structured interviews were conducted with key actors. The analysis was performed with the NVivo plus version 11 application, in three cycles: open coding;identification of emerging categories and modeling by analyzing the identified strengths and weaknesses. Results: The components of the incident command structure and the relationships between the public health areas were identified. Strengths were found in the integration of the areas;management of information in real time, border surveillance and strengthening of immediate response teams. The weaknesses identified were established in the planning, community surveillance and risk communication processes. Conclusions: The Risk Analysis Rooms constitute a joint effort of the national and local level where the articulated participation of the actors is promoted to analyze information and optimize the organized response during the COVID-19 pandemic.
ABSTRACT
The Tourist Governance (GT) is considered a practice of decentralization of the public management, promoting the democratic participation of different actors, both in the management as in the execution of tasks, and its relevance occurs in the global context as national. Coupled to this, the pandemic context caused by the COVID-19 remodeled all the spheres of the society, moreover, the tourism. Global impacts, in this sector, will lose more than 75 million jobs and a damage of 2,1 trillions of dollars according to the World Travel Tourism Council (2020) affecting so many public aspects as social. In this regard, this article aims to analyze the conjecture of the GTs in Brazil in the context of the COVID-19. The used methodology had an investigatory descriptive qualitative character approach, with linked techniques of collection and analysis of the netnography. The results set forth that despite the pandemic context of the COVID-19 to be damaging to the tourist sector, the ecological improvement is indisputable, this factor very much discussed in the Brazilian GTs, mainly linked to the mass tourism or over tourism, which must be rethought. Besides this, the national GTs was consolidated as an effective tool of the competitive increase, mainly in the increase of value of the local tourism, current and future tendency in this segment.
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A 43-year-old woman with a recent diagnosis of Graves-Basedow disease was admitted to the emergency room due to soft tissue infection, thiamazole agranulocytosis, and severe hyperthyroidism. The patient required definitive treatment for hyperthyroidism, but given the context of the SARS-COV-2 pandemic, radioactive iodine was not available, so she prepared for total thyroidectomy. A rapid and effective preoperative preparation was required, so it was decided to compensate her hyperthyroidism with lugol, lithium carbonate, dexamethasone and finally plasmapheresis before surgery. Thyroid hormone levels normalized in a short time, and the thyroidectomy was performed. The case is presented because of the anecdotal and because knowledge of management in scenarios, such as this pandemic, where there is no access to 131I.