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Introduction: Triggered by the recent revolution posed by the digital era, medical education has evolved enormously over the last decade. Much of this transformation was further accelerated by the COVID-19 pandemic. Video Abstracts are an innovative tool in science communication allowing a quick overview of a scientific paper. It can be used to build capacity by connecting patients and healthcare professionals to education and research, fostering critical thinking, and filling gaps in education. The Video Abstracts Series is an initiative that was envisioned by the ISN Education Working Group in association with the DOPPS collaboration and put into action by the ISN Education Social Media Team. Starting in Dec 2021, the International Society of Nephrology (ISN) Video Abstracts Series has integrated the ISN global education strategy. The videos are allowed a maximum length of 2:20 min to fit the Twitter limits. It constitutes a video narrative of a study's principal characteristics and findings. The project was fully developed based on voluntary work, from conception to video production. Method(s): This study aimed to assess quantitatively the impact of the ISN Video Abstracts Series initiative. From Dec 2021 to Sept 2022, video impressions, engagements, and video views from Twitter, Facebook, LinkedIn, Instagram, and the Academy were analyzed. Result(s): The ISN Video Abstracts Series highlighted studies published in the Kidney International Reports (KIR, n=12);Kidney International (KI, n=12);and the ISN-DOPPS initiative (n=1). In combination, the 25 Video Abstracts, resulted in 139,402 impressions;3,434 engagements;and 25,041 video views. Most of the interactions occurred on Twitter (79.8%). In this digital platform, on average videos had 5,300 impressions and 790 views. The videos redirected the user to the journal publication in 435 instances. The ISN Video Abstracts Series addressing the KIR publication "Nicotinamide Adenine Dinucleotide Biosynthetic Impairment and Urinary Metabolomic Alterations Observed in Hospitalized Adults With COVID19-Related AKI", had the most views (n=2,125). Conclusion(s): The future of continuing medical education relies on new strategies and media to build capacity and bridge the gaps. The ISN offers a wide variety of educational and interactive resources through Social Media and the ISN Academy, its official e-Learning portal. The Video Abstracts Series is an innovative, inclusive, and resourceful tool. It combines sharp and concise information with an entertaining format that captures and retains the user's attention, opening new perspectives in the ISN strategy to boost continuing medical education in nephrology globally. No conflict of interestCopyright © 2023
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Background: In April 2020, the emergence of Multi-system Inflammatory Syndrome in Children (MIS-C) was first recognized. Existing studies have been mostly descriptive of the clinical characteristics associated with MIS-C. Studies concerning how MIS-C patients present to the Emergency Department (ED) are scarce. There are also few studies describing the progression of the disease during hospitalization and outcomes and comparing those who have severe versus non severe MIS-C. Our study sought to confirm prior findings as well as investigate if abnormal laboratory values were associated with worse outcomes based on hospital placement (not requiring admission, admission to pediatric floor, and admission to pediatric intensive care unit [PICU]) as well outcomes at time of disposition. Methods: This was a retrospective case-control study at a tertiary care pediatric children's hospital in a metropolitan area. Medical records of patients diagnosed with MIS-C per the Center for Disease Control's (CDC) or World Health Organization (WHO) criteria from March 2020 to June 2020 were reviewed. Control cases were defined as patients who met criteria for diagnosis of MIS-C but were found to be negative on COVID polymerase chain reaction (PCR) testing. To assess the differences between MIS-C patients discharged home from the ED and those admitted to the PICU regarding obesity neutrophilia, lymphopenia and elevated troponins, a Pearson's Chi-square test was conducted. The total MISC population was studied to see if associated obesity, neutrophilia, lymphopenia or elevated troponins were associated with a worse outcome, a Fisher's Exact test was conducted. Results: There were no differences between those with MIS-C and controls in reference to age, gender and race. Comparing those who were admitted to the PICU versus that were discharged from the ED, or admitted to a non-PICU bed, we found a significant increase in neutrophilia and troponin I. A significant association with elevated troponin and obesity occurred when comparing the MIS-C group and controls. There was no association of obesity, neutrophilia, lymphopenia, and elevated troponin with poor outcome. Conclusion: Children with neutrophilia and increased troponin I were associated with more severe illness requiring PICU admission. Despite these findings, their outcomes were not affected. When controls were compared to those with MIS-C there was a significant increase in elevated troponin and obesity. With these findings, ER physicians can expect worse illness based on neutrophilia and increased troponin I helping one to decide if a child needs to be admitted to the PICU.
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Street-level bureaucrats are professionals whose main role consists in the implementation of public policies at a community level, guiding themselves through the use of autonomy and discretion. In this narrative review of literature 44 articles that had information about street-level bureaucracy regarding healthcare workers in the COVID-19 pandemic in specific countries (China, United States, Italy, Brazil, Mexico and Colombia) were selected from various databases and analyzed to explore how the implementation of health public policies during the current COVID-19 pandemic impacted and shaped the work of healthcare workers. Various ideas were extracted and analyzed using the street-level bureaucracy model as a reference point. We concluded that street-level bureaucrats have played a crucial role in this pandemic and that providing them with government support, clear public policies and enough resources is essential for them to correctly manage public health problems. Further research needs to be done regarding the consequences brought upon street-level bureaucrats by the pandemic and the impact that street-level bureaucrats have had in countries like Colombia.
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In March 2020, the higher-education community faced one of its largest disruptions to date with the COVID-19 pandemic forcing campuses to close their doors to thousands of students. The university-wide closures prompted a collaboration between researchers and college administrators to assess the impact of COVID-19 on First-Generation College Students (FGCS). The team surveyed 659 FGCS across five U.S. universities to assess the ways in which the pandemic exacerbated already existing inequalities students faced in their persistence to graduate from college. The team used the social cognitive career theory as a conceptual framework for analysis. Our findings revealed that when respondents compared their life before COVID-19 with their present state, FGCS were less likely to perceive they had enough money to return to college, felt overwhelmed and lonely by added stress, and were more likely to see an increase in family responsibilities.
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The pandemic caused by COVID-19 has grown exponentially from the first reports from China in December 2019 to November 2020. Cases have been reported in more than 180 countries, totaling more than 61.8 million cases of COVID-19 throughout the world and more than 1.4 million deaths. Health personnel, being exposed to the care of COVID-19 patients with high viral load, have the risk of developing infections associated with health care, their high morbidity and mortality being of multifactorial origin. Given that the term Biosafety and Occupational Biosafety has been used internationally, this term does not have wide acceptance in the scientific community, and the case of Mexico is not referred to and is not defined in the Mexican legal framework or current regulations. Far from being handled and understood as an isolated concept, this term should be referred to as a multiple concepts, being recommended in the workplace in Mexico not to use it, suggesting referring to the Safety and Health Regulations at Work, whose mandatory application will allow reducing healthcare-associated infections. © 2021 Occupational Health and Safety Society of Nepal. All rights reserved.
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On March 11, the WHO declared COVID-19 a pandemic and the world entered in a confinement that aggravated both, sanitary and socioeconomic conditions. In Africa, some countries have plans to contain epidemics, although their availability and resources are insufficient, therefore the response to this pandemic is a huge challenge for each government. In Angola, the first case was reported on March 21;consequently, under the decree of a sanitary emergency, containment measures were dictated with severe social control measures. Initially, diagnosis was only made by government facilities, with capacity to study 90 specimens daily, but later the private sector was included. Both, the public sector and private companies made arrangements to comply with the preventive measures ordered. Informal workers did not comply as much with these requirements. However, the set of actions implemented have led to the facts that until September 16, there were 3,569 cases registered with 139 deaths;of these, 92% were related to complications of previous pathologies. Lessons learned from recent pandemics highlight the need to strengthen national public health, to improve staff training, building adequate infrastructure, and encourage continuous surveillance to improve response times. Learned lessons?
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Background: The epidemiology, clinical presentation, management and outcomes of COVID-19 comes from early reports from China and Europe with AKI prevalence ranging widely from 0.5% to 29%. However, knowledge about this pandemic is still emerging. With the epicenter now in the western hemisphere, we aim to determine the behavior and possible differences in presentation of AKI in COVID-19 patients in Latin America. To our knowledge, this is the first of such study. Methods: Descriptive analysis extracted from an online survey carried out among nephrologists, renal pathologists and other health workers treating kidney diseases between May 20-27, 2020 from sixteen Spanish speaking Latin American countries divided into 6 categories. We present the results for the AKI category. Results: 430 responses were obtained of which 360 (84%) were considered for analysis. 86% of the participants were nephrologists. 35% of the respondents reported the prevalence of AKI to be <5%, while 32% estimated it at 6-10%. The majority of AKI in these patients was stage 3 according to 31% of the respondents. Roughly half of the nephrologists witnessed new onset proteinuria which was almost exclusively (96%) subnephrotic. The majority (64%) reported no hematuria. Half of the participants (50.2%) reported that renal replacement therapy (RRT) was never or rarely required. Intermittent hemodialysis was the main RRT used reported by 88% of those surveyed followed by continuous renal replacement therapy (33%), peritoneal dialysis (24%) and prolonged intermittent RRT (19%). The most common complications during RRT were hypotension (60.3%) and circuit clotting (36.6%). Over one third of the participants (35%) estimated the mortality of patients with AKI and COVID to be <20%. Conclusions: Our survey highlights potential differences in the presentation, management and outcomes of AKI in patients with COVID-19 in LA;among those, a lower prevalence, higher need for RRT and lower mortality. More studies are warranted to better understand AKI in hispanic COVID-19 patients as well as its distinct characteristics compared to the rest of the world.
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Background: The rapid spread of the COVID-19 pandemic into LA countries where health systems were already facing major limitations might further challenge their physician's emotional and mental wellbeing. We aimed to describe the perception of health workers managing kidney diseases in the context of the COVID-19 pandemic. Methods: Descriptive analysis extracted from an online survey carried out among nephrologists, renal pathologists, and other health workers treating kidney diseases between May 20-27, 2020 from sixteen Spanish speaking Latin American countries divided into 6 categories. We present the results for the mental health category. Results: 430 responses were obtained of which 360 (84%) were considered for analysis. The participants were mainly nephrologists 276 (86%), renal pathologists 13 (4%), and physicians in training 11 (3%). Ages ranged between 30-49 years old in 271 (75%), mostly working on tertiary centers 258 (71%). 329 (90%) participated in inpatient care. 277 (86%) considered that the COVID-19 pandemic has impacted their mental health. Prevailing symptoms were anxiety, insomnia, and depression, with 75.2%, 42.5%, and 18.2%, respectively. Physical or verbal violence from the community was reported by 18 (5%) of the participants because they were seen as a source of viral transmission. 179 (55%) considered personal protective equipment (PPE) was sufficiently provided and 275 (79%) had to invest up to 20% of their income to obtain PPE. In addition, 144 (44%) of the respondents reported a shortage of COVID-19 tests and only 99 (30%) felt their hospital was well equipped to care for COVID-19 patients. 126 (39%) of the health workers responded that they received adequate training, while 105 (32%) endorsed they did not feel prepared in the management of patients with COVID-19. Conclusions: This survey reveals the considerable impact that the COVID-19 pandemic is generating among physicians treating patients with kidney diseases in LA. Possible aggravating factors also found in our survey included lack of testing, PPE availability, and overall hospital preparedness.
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Background: A significant fraction of patients with COVID-19 display renal involvement (60%);however, the histological findings and pathology practice in Latin America (LA) have not been reported. The aim is to know how COVID-19 pandemic has affected the protocols for renal pathology and the main pathology findings in the kidney. Methods: An online survey with 75 questions in 6 sections, directed to pathologists, nephrologists and other specialists from 16 Spanish speaking LA countries treating COVID patients with kidney involvement. We are analyzing the impact of COVID-19 in renal pathology and pathology practice in LA. Results: From 430 responses, 360 (84%) were considered for analysis. Only13 participants from 16 countries were renal pathologists but the rest of responders also contributed with the pathology section. Only 10% is performing renal biopsies (RBx) of COVID-19 patients. Acute kidney injury (AKI) (85%) was the most frequent indication for RBx, hematuria-proteinuria (42%), nephrotic syndrome (28%) and subnephrotic proteinuria (21%). Combination of AKI and other syndrome was seen. Handling fresh tissue for immunofluorescence (IF) is a regular practice in the centers that perform IF (66%). No ultrastructural examination in 90% due to the lack of EM equipment. Postmortem studies only in 3% of the centers. Autopsy and biopsies shiwed thrombotic microangiopathy (TMA), with acute tubular injury (ATI). Pathology redeployment to clinical areas, ICU and inpatient care is seen in 12%. Only 70% of those received guidance or updating clinical courses. Conclusions: The survey has highlighted the deep shortage of renal pathologists and the lack of equipment (EM) compromising the best practice of renal pathology in LA. Protocols for tissue handling for COVID have not been established in any center, adding a burden to the practice. Most frequent indication for renal biopsy is AKI while the presence of TMA and ATI is found in autopsy and renal samples. Collapsing glomerulopathy (CG) has a high prevalence in hispanics and has been described in COVID patients, however CG was not seen. Outbreaks had forzed pathology redeployment to clinical care without proper preparation.
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Background: As COVID-19 spreads across the world, nephrologists are facing difficult decisions regarding the management of active glomerular diseases (GD). We aimed to report how COVID-19 pandemic may have changed the use of immunotherapies among nephrologists In Latin America (LA) for the treatment of glomerulopathies. Methods: Descriptive analysis extracted from an online survey carried out among nephrologists, renal pathologists and other health workers treating kidney diseases between May 20-27, 2020 from sixteen Spanish speaking LA countries divided into 6 categories. We present the results for the GD and immunosuppression category. Results: 430 responses were obtained of which 360 (84%) were considered for analysis. The participants were mainly nephrologists 276 (86%), renal pathologists 13 (4%) and physicians in training 11 (3%). 213 (59%) of the respondents treat patients with GD. For patients at risk but without COVID-19 infection, the induction immunosuppression for GD treatment was not changed by 54.1% of the respondents while 24.2% gave only a fraction of it and 21.7% deferred the induction treatment. For maintenance immunosuppression, the same regimen was maintained by 74.2% of the respondents, 24.3% decreased it and 1.5% suspended it completely. In case of relapse or flare, 53.6% used standard increase of immunosuppression, 39.7% increased it but at lower levels than usual and 6.7% continued the maintenance regimen. For patients already on immunosuppression diagnosed with COVID-19 infection, 42% would decrease immunosuppressive regimens for mild disease, 62.3% in case of moderate disease and 70.8% would consider completely discontinuing immunosuppression in case of severe disease. Conclusions: Over 40% of the respondents in LA are already prescribing lower than recommended doses of immunosuppression for induction, relapses or flares as a preventive strategy in the context of COVID-19 pandemic. How this change in practice would affect the renal outcomes remains to be seen. The experience in the treatment of GD in patients with concurrent COVID-19 infection remains limited.
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Background: Patients on dialysis belong to the high-risk group to develop severe COVID-19 infection due to their multiple comorbidities. International societies have issued recommendations for the control and prevention of SARS-CoV-2 infection at dialysis units but implementing them may not always be feasible as many healthcare systems in Latin America (LA) have limited resources. This study aims to reflect the experience of nephrologists in LA at taking care of these patients and if the recommendations were adopted in their practices. Methods: Descriptive analysis extracted from an online survey carried out among nephrologists, renal pathologists and other health workers treating kidney diseases between May 20-27, 2020 from sixteen Spanish speaking LA countries divided into 6 categories. We present the results for the ESRD category. Results: 430 responses were obtained, 360 were considered for analysis. 276 (86.5%) of the participants were nephrologists and 178 (64%) of them practiced in dialysis units. 163 (92.6%) already implemented strategies to control and prevent COVID-19 in their units. 125 (71%) received training on it and 128 (72.7%) reported personal protective equipment availability. The most common implemented strategies were: education sessions about COVID-19 for patients and caregivers (68.5%), designated isolation areas (77.8%) or shifts (68.75%) for patients with suspected or confirmed COVID-19 and a 7-feet separation between hemodialysis (HD) machines (61.9%). 49 (28%) of the nephrologists reported an outbreak among patients and 60 (34.2%) among medical staff. Patient absenteeism to their HD sessions due to fear of infection, a decrease in the frequency and a shortening of the time of the sessions was reported in 41.7%, 30.2% and 36%, respectively. 29 (16.5%) of the respondents considered that those practices were associated with patient mortality. Conclusions: Most dialysis units in LA are partially implementing the recommended strategies for control and prevention of COVID-19 but this seems to be insufficient since at least one third of them already faced outbreaks among patients and medical staff.
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Objective To determine the changes in the practice of physical activity during the COVID-19 pandemic in adult subjects. Methods Cross-sectional study in 812 adults from the Colombian Caribbean region. A survey was applied by telephone that measured age, sex, educational level and socioeconomic status;likewise, the Prochaska and Marcus Physical Activity Intention Questionnaire to measure stages of change towards physical activity was applied. The time spent sitting each day in front of screens such as television, computer, and cellphone was investigated. Measurements were made throughout the months of May to July 2020. A binary logistic regression was performed to determine the relationship between individual factors and the practice of physical activity during the pandemic. Results The proportion of people who are categorized in the first three stages of change increased from 65% in the measurement before the pandemic to 74,4% after 4 months of social isolation (p=0,0001). The average hours a day in front of the TV for the general population is 2,7±2 hours;3,8±2,8 hours in front of cellphones, and 2,4±2,7 hours in front of the computer. Women had a higher risk of not practicing physical activity [OR 1,9 (95% CI 1,4-2,7)], alongside people with a low educational level [OR 1,7 (95% CI 1,2-2,4)], and elderly people [OR 1,7 (95% CI 1,3-2,4)]. Conclusion The COVID-19 pandemic has increased physical inactivity and sedentary behaviors, which vary according to individual characteristics. © 2022, Universidad Nacional de Colombia. All rights reserved.