ABSTRACT
BACKGROUND AND AIMS: The Coronavirus Disease 2019 (COVID-19) pandemic has greatly impacted the world health system, affecting almost 20 million people with a high fatality rate, mainly patients with comorbidities including patients with chronic kidney disease (CKD) in all its stages and renal replacement therapy. The aim of the present study was to evaluate the biochemical characteristics of the patients who urgent-start hemodialysis during the pandemic and additionally to evaluate their survival. METHOD: Patients urgent-start hemodialysis were taken during the months of August to November 2020, the admission laboratory data was recorded, including the test to determine SarsCov-2, and Kaplan-Meier survival analysis was applied taking in it counts variables such as sex, professional who placed the vascular access, COVID-19 test result and evaluation by nephrology in the pre-dialysis clinic. RESULTS: 92 patients were including in the analysis, 65% male, the nephrologist placed the vascular access in 54% of the patients, 71% had a negative result in the COVID-19 test and 55% had no evaluation in the pre-dialysis clinic. Among the biochemical results was found BUN 95.3mg/dl (SD 38.1), sCr 10.3mg/dl (SD 6.3), Na 130.6mg/dl (SD 7.5), K 5mmol/L (SD 1.1), Ca 7.8mg/dl (SD 1), P 6.5mg/dl (SD 3.3), uric acid 8.3mg/dl (SD 10) and PTH 279pg/ml (SD 267). As prognostic markers of infection by COVID-19, the following results were foundWC 12.3k/UL (SD 9.3), hemoglobin 9.35g/dl (SD 2.5), hematocrit 28.7% (SD 9.4), platelets 291mcL (SD 137), sedimentation 75mm/hr. (SD 37), CRP 81.8mg/L (SD 113.8), interleukin-6 232-6pg/ml (SD 838.8), ferritin 1074.3mg/ml (SD 825.3), D dimer 4.3mcg/dl (SD 11.2), lactate dehydrogenase 322U/L (SD 255) and procalcitonin 6.5ng/ml (SD 16.8). When evaluating survival with the Kaplan-Meier analysis, no statistically significant difference was found when analyzing the variable presence of COVID-19 infection (Figure 2-p: 0.89), sex (Figure 3-p: 0.54), professional who placed vascular access (Figure 4-p: 0.1), and the pre-dialysis evaluation (Figure 5-p: 0.33), having a survival in general of 77% at 3 months (Figure 1). CONCLUSION: The present study found a 77% survival rate in patients with urgentstart hemodialysis. There are no other documented data in Guatemala, which is why it provides guidelines for future studies in the country. Among the variables taken, no one was found that would determine a better survival, including SarsCov-2 infection. It will be necessary to carry out more studies with greater follow-up, more patients and more centers to carry out a better analysis.
ABSTRACT
Introduction: From 2017 to 2020, strategic actions for obesity prevention have been developed at community level such as: assessment of nutritional status and level of food and nutritional insecurity. These strategies have been modified based on the new challenges that have emerged mainly derived from emergencies that have occurred in the last two years, such as the eruption of Volcan de Fuego and the current COVID 19 pandemic. The prevention of obesity represents an important challenge for the country, institutions, families and individuals due to the risk of associated comorbidities and treatment costs. Objectives: Describe nutritional status and food insecurity level to guide obesity strategies and programs in rural communities in Guatemala. Methods: The data obtained from the field work carried out by students and professors in communities of the departments of Chimaltenango, Escuintla, Sacatepéquez and Guatemala was analyzed. Anthropometric indicators BMI /age and Height/age for children under 5 and BMI for adults were used to determine nutritional status and ELCSA scale was applied to assess the level of nutritional food insecurity (INSAN). Results: In 2017, 360 children under 5 in the community of San José El Yalú were diagnosed with 32% stunting, 16% overweight and 80% of households in food insecurity level. In 2019, the nutritional status of 370 scholars in the same community was evaluated, a 51% stunting, 25% overweight, 5% obesity and 95% of homes in food insecurity level were identified showing that stunting and food insecurity worsen in school children and their families, therefore it is necessary to strengthen early interventions in the course of life in these groups. In 2020, the evaluation was carried out on 470 scholars of Jocotenango, Sacatepequez identifying 40% stunting, 25% overweight and 9% obesity, very similar to the groups evaluated in prior years in other communities. Based on these results, audiovisual educational material and interventions were designed focused on scholars which included school gardens, cookbooks, infographics on processed and ultra-processed foods, a tool to assess emotional hunger, education on breastfeeding and a handbook of nutrition education for teachers. Conclusions: Stunting along with overweight and obesity are increasing in children and require continuous assessment and interventions adapted to the socioeconomic and cultural community context. The undergraduate Nutrition program of Universidad Mariano Galvez of Guatemala contributes with basic data to institutions and decision makers at community level for the design of prevention strategies. The systematization of nutritional interventions at community level makes it possible to influence behavior change, mainly if it includes risk assessment and the education and communication component.
ABSTRACT
Introduction: As part of the undergraduate Nutrition program of Mariano Galvez University of Guatemala, the professional practice at community level is developed in the last year for a period of four months. In 2020 this was oriented towards the search for interventions for the promotion of health and prevention of malnutrition in the framework of COVID 19 pandemic, considering that the presence of malnutrition both due to excess and deficiency as well as presenting chronic non-communicable diseases and obesity increase the risks of a patient infected by SARS-CoV-2 in addition to the post-pandemic effects on nutritional food security in communities. Objectives: Identification of strategies and interventions for health promotion and prevention of malnutrition and Non Communicable Disease in the context of the COVID 19 pandemic. Methods: A review of scientific literature and health and nutrition data from Guatemala was carried out to analyze the information published about the nutritional and food situation in the framework of the COVID 19 pandemic, which included technical documents and protocols from CEPAL, INCAP, CieNut, FAO, WHO, Spanish Academy of Nutrition and Dietetics and OXFAM. With the analyzed information and data, proposals were prepared and strategies designed to promote nutritional food security and healthy eating habits and hygiene and sanitation, as well as prevention of malnutrition, with emphasis on the maternal and infant group and other vulnerable groups at rural and urban areas as part of the Nutrition professional practice in Guatemala, Amatitlan and Chimaltenango during the months of March to June 2020. Results: With the analyzed information, intervention proposals and instruments were developed oriented to food and nutritional consequences after the COVID 19 pandemic, as well as education and communication materials for the promotion of healthy lifestyles and the prevention of malnutrition and NCD, including breastfeeding as one of the most important protective factors during the first 2 years of life. Among the proposals are a manual for home gardens for post-COVID 19 food production, a project for the prevention of acute respiratory infections (ARIs), a proposal for the evaluation of monetary transfers from the government during COVID emergency, a proposal for the collection of food (REKKO-lecta), response plan to mitigate Food and Nutritional Insecurity, project for post-COVID 19 consumption assessment, proposal to evaluate the use of donated food as part of a food assistance programs. Conclusions: Nutrition schools have a great opportunity to identify and support local and institutional actions for the prevention and promotion of health, nutrition and food and nutritional security (SAN) at community level for the prevention of malnutrition and NCD in the framework of the COVID 19 pandemic through the different supervised practice programs.