Reactivation of BCG vaccination scars after mRNA -SARS- CoV2 -vaccine and SARS-CoV2 infection: Two case reports

Case report Purpose: To report two cases of reactivation of BCG vaccination scars, the first after mRNA -SARS- CoV2 -vaccine and the second after SARS-CoV2 infection. Case 1: A 33 year-old woman, a nursing assistant, was referred with erythema and swelling of her BCG vaccination scar 24 hours after receiving her second dose of the BNT162b2 mRNA vaccine (Pfizer-BioNTech) and, 10 months later, after receiving her third dose with the mRNA-1273 (Moderna) vaccine. Case 2: A 60 year-old woman, a medical doctor, was referred with erythema and swelling of her two BCG vaccination scars (one administered at birth and the second one at the age of 10), 12 days after testing positive for SARS-CoV2 associated with homolateral supraclavicular and axillary adenopathy's . In both cases, total IgE values and D-dimer were normal and symptoms resolved spontaneously within 7 days, without further treatment. Discussion(s): Bacillus Calmette-Guerin (BCG) local scar inflammatory reactions have been described with Kawasaki disease in children, with other viral infections such as measles and human herpesvirus type 6 (HHV6) infection and following influenza vaccination. The relationship between the BCG vaccine and SARS-CoV2 remains unclear. Even in mid-2020 and during the first years of the pandemic, it was proposed that the BCG vaccine could be protective against SARS-CoV2 infection. Several studies were launched to evaluate this hypothesis, with no conclusive results in this regard. Along the last two years, some cases of reactivation of BCG vaccination scars have been reported after vaccination with mRNA -SARS- CoV2 -vaccines. To our knowledge, this is the first reported case of reactivation of BCG vaccination scars after SARS-CoV2 infection. Conclusion(s): We report the first case of BCG vaccine scar inflammation as a local reaction following SARS-CoV2 infection. The reactivation of BCG vaccine scar after receiving mRNA vaccines and after SARS-CoV2 infection might have been caused by an immunological reaction due to a cross reactivity phenomenon between BCG and SARS-CoV2. The immunological and clinical implication of this reaction needs to be further studied. Clinicians need to be aware of this local reaction to SARS-CoV2 vaccines and infection. (Figure Presented).

Impact of the COVID-19 pandemic on the use of contraceptive methods, Chile

Introduction: Daily life was affected during the COVID-19 pandemic, so there were difficulties in getting inputs (merchandise, job, services, etc.), and obtaining contraceptives were specifically affected. Aim: describe the impact of the pandemic as regards the use of methods of contraception in women aged 18-23 living in Viña del Mar. Methods: This study is cross-sectional, continuous quantitative, a non-probabilistic sampling denominated "snowball”. Women living in Viña del Mar City were surveyed, and the sample size amounts to 90 persons, with a cohort point ranging from 18 to 23 years. Results: 85 % of surveyed women are students. The more frequently used methods of contraception are the pill and the external condom. During the pandemic (2020, 2021, 2022), 12,87 % of them left their method of contraception, whereas 17,76 % changed it. Conclusion: The pandemic is a determining factor in adherence to methods of contraception. Even though the results we obtained in this study are positive as compared to other pieces of research, it must be considered that interrupting them entails a violation of sexual and reproductive rights, which must be guaranteed despite being in a crisis. © Este es un artículo en acceso abierto.

Analysis of the first 106 telemedicine consultations in a vascular surgery service

Background: Telemedicine became a relevant means to provide healthcare without face-to-face medical evaluation during the COVID-19 pandemic. Aim(s): To describe the effectiveness of telemedicine in vascular surgery. Material(s) and Method(s): Review of medical records of all vascular surgery consultations carried out in a clinical hospital between April and October 2020. The main outcome measured was the resolution of the reason for consultation. Secondary outcomes were the need to request laboratory tests or imaging, the need to evaluate the patient in person, and the need for referral to hospitalization or emergency service. Result(s): One hundred-six new consultations and their follow-up (remotely or in person) were analyzed. A definitive diagnosis could be reached in 74% of consultations, treatment could be instituted or modified in 69% of them, and the reason for consultation could be resolved in 74% of cases. Laboratory and imaging tests were requested in 36 and 63% of consultations, respectively. Four percent of patients were referred to the emergency department or hospitalization. Conclusion(s): In the vast majority of consultations, it was possible to achieve a definitive diagnosis, prescribe a treatment and resolve the reason for consultation without the need for a face-to-face medical evaluation. Copyright © 2022 Sociedad Medica de Santiago. All rights reserved.

Assessment of the patient safety culture in the ICU of a second level hospital at the end of the third COVID-19 wave Valoración de la cultura de seguridad del paciente en la UCI de un hospital de segundo nivel al finalizar la tercera oleada de COVID-19

Introduction Current healthcare settings and ICUs especially are complex, highly technical, and multidisciplinary, with interactions between healthcare professionals and users, in which there may be errors at different levels. Our objective was to assess the perception of patient safety in our unit at the end of the third wave of the COVID pandemic, with the intention of conducting subsequent improvement actions. Methods Observational, cross-sectional, and descriptive study. The perception of Safety Culture was estimated using the HSOPS questionnaire translated into Spanish. Some questions were posed in a positive sense, and others in a negative sense. The response was also rated as positive, negative, or neutral. Our findings were compared visually, not mathematically, with those found in the previous national study «Analysis of the culture on patient safety in the hospital setting of the Spanish National Health System» published in 2009. A subgroup analysis was performed according to professional group and seniority as a health worker. The Student's t, χ? and ANOVA tests were used. Results Sixty-two professionals responded to the questionnaire, 73.90% of the total. The median time working in ICU 2 years (interquartile range 2-4.5 years). The rating for the degree of safety was 8.06 (SD 1.16). The majority (91.20%) had not reported any adverse event in the last year. A total of 30.90% had recently received patient safety training. The dimensions considered as weaknesses were 9 («Staffing», with 27.57% of positive responses) and 10 (“Support of the hospital management in safety”, with 17.64% of positive responses). The dimensions considered as strengths were 3 («Expectation of actions by management / supervision of the service») with 85.29% of positive responses, and 5 («Teamwork») with 95.58% of positive responses. The Cronbach's alpha index values suggest that the questionnaire has adequate internal consistency. In general, our data are more positive than those collected in the 2011 national survey, although the 2 dimensions considered weaknesses were already considered such in the previous work. Conclusions The perception of patient safety in the ICU of our hospital after the end of the third wave of the COVID pandemic is adequate, with a more positive rating than that of the national study on safety culture at the hospital level carried out in 2009. The constant quest for patient safety should prioritize activity in the 2 dimensions considered weaknesses: staffing, and support from hospital management in everything related to patient safety.

Assessment of the patient safety culture in the ICU of a second level hospital at the end of the third COVID-19 wave.

INTRODUCTION: Current healthcare settings and ICUs especially are complex, highly technical, and multidisciplinary, with interactions between healthcare professionals and users, in which there may be errors at different levels. Our objective was to assess the perception of patient safety in our unit at the end of the third wave of the COVID pandemic, with the intention of conducting subsequent improvement actions. METHODS: Observational, cross-sectional, and descriptive study. The perception of Safety Culture was estimated using the HSOPS questionnaire translated into Spanish. Some questions were posed in a positive sense, and others in a negative sense. The response was also rated as positive, negative, or neutral. Our findings were compared visually, not mathematically, with those found in the previous national study «Analysis of the culture on patient safety in the hospital setting of the Spanish National Health System¼ published in 2009. A subgroup analysis was performed according to professional group and seniority as a health worker. The Student's t, χ2 and ANOVA tests were used. RESULTS: Sixty-two professionals responded to the questionnaire, 73.90% of the total. The median time working in ICU 2 years (interquartile range 2-4.5 years). The rating for the degree of safety was 8.06 (SD 1.16). The majority (91.20%) had not reported any adverse event in the last year. A total of 30.90% had recently received patient safety training. The dimensions considered as weaknesses were 9 ("Staffing", with 27.57% of positive responses) and 10 ("Support of the hospital management in safety", with 17.64% of positive responses). The dimensions considered as strengths were 3 ("Expectation of actions by management/supervision of the service") with 85.29% of positive responses, and 5 ("Teamwork") with 95.58% of positive responses. The Cronbach's alpha index values suggest that the questionnaire has adequate internal consistency. In general, our data are more positive than those collected in the 2011 national survey, although the 2 dimensions considered weaknesses were already considered such in the previous work. CONCLUSIONS: The perception of patient safety in the ICU of our hospital after the end of the third wave of the COVID pandemic is adequate, with a more positive rating than that of the national study on safety culture at the hospital level carried out in 2009. The constant quest for patient safety should prioritize activity in the 2 dimensions considered weaknesses: staffing, and support from hospital management in everything related to patient safety.

[Assessment of the patient safety culture in the ICU of a second level hospital at the end of the third COVID-19 wave]. / Valoración de la cultura de seguridad del paciente en la UCI de un hospital de segundo nivel al finalizar la tercera oleada de COVID-19.

Introduction: Current healthcare settings and ICUs especially are complex, highly technical, and multidisciplinary, with interactions between healthcare professionals and users, in which there may be errors at different levels. Our objective was to assess the perception of patient safety in our unit at the end of the third wave of the COVID pandemic, with the intention of conducting subsequent improvement actions. Methods: Observational, cross-sectional, and descriptive study. The perception of Safety Culture was estimated using the HSOPS questionnaire translated into Spanish. Some questions were posed in a positive sense, and others in a negative sense. The response was also rated as positive, negative, or neutral. Our findings were compared visually, not mathematically, with those found in the previous national study «Analysis of the culture on patient safety in the hospital setting of the Spanish National Health System¼ published in 2009. A subgroup analysis was performed according to professional group and seniority as a health worker. The Student's t, χ? and ANOVA tests were used. Results: Sixty-two professionals responded to the questionnaire, 73.90% of the total. The median time working in ICU 2 years (interquartile range 2-4.5 years). The rating for the degree of safety was 8.06 (SD 1.16). The majority (91.20%) had not reported any adverse event in the last year. A total of 30.90% had recently received patient safety training. The dimensions considered as weaknesses were 9 («Staffing¼, with 27.57% of positive responses) and 10 ("Support of the hospital management in safety", with 17.64% of positive responses). The dimensions considered as strengths were 3 («Expectation of actions by management / supervision of the service¼) with 85.29% of positive responses, and 5 («Teamwork¼) with 95.58% of positive responses. The Cronbach's alpha index values suggest that the questionnaire has adequate internal consistency. In general, our data are more positive than those collected in the 2011 national survey, although the 2 dimensions considered weaknesses were already considered such in the previous work. Conclusions: The perception of patient safety in the ICU of our hospital after the end of the third wave of the COVID pandemic is adequate, with a more positive rating than that of the national study on safety culture at the hospital level carried out in 2009. The constant quest for patient safety should prioritize activity in the 2 dimensions considered weaknesses: staffing, and support from hospital management in everything related to patient safety.

Physical education in the COVID-19 era: remote classes in graduation during the pandemic

This research aimed to analyze the impact of remote activities on the Physical Education courses at the University of the Region of Joinville/SC - Univille, during the pandemic period. The method adopted for the investigation was descriptive and transversal. A total of 110 students participated in the study, all of them from the Physical Education undergraduate courses at Univille. As a research instrument a questionnaire was used, organized in the Google Forms.. platform, composed of 12 affirmative questions, in the Likert Scale model for measuring the answers. The questions were organized into three categories: Learning, Professional Path and Intrinsic Recognition. The data after being collected were organized for statistical treatment in the SPSS.. 16.0 program. After determining the normality of the data distribution, using the Kolmogorov-Smirnov test, Pearson's correlation test was applied and p-values<0.05 were considered significant. When performing the statistical analysis in each category, the results revealed five significant moderate linear associations. One in the "Learning" domain (p-value<0.002), two in the "Professional Path" (p-value<0.0003 and p-value<0.003), and two in the "Intrinsic Recognition" (p-value<0.005 and p-value<0.002). For the analysis between categories, seven moderate correlations were found. Two in the "Learning and Professional Path" component (p-value<0.004 and p-value<0.002), three in the "Learning and Intrinsic Recognition" (p-value<0.005, p-value<0.004 and p-value<0.001), and two in the "Professional Path and Intrinsic Recognition" with the same value (p-value<0.003). Given the evidence found, it was possible to verify through the predominance of significant linear associations, that remote activities hindered the teaching-learning process for students of Physical Education courses, during the pandemic.

The relevance of compounding factors and the risk of anaphylaxis in 63 patients allergic to alpha-gal

Background: Compounding factors have been frequently described as helpers in food allergic reactions, not only favouring but also intensifying them. However, in alpha-gal syndrome, cofactors haven been controversial or not clearly identified. Objective: Analyze the data in 63 alpha-gal allergic patients studied in the last 8 years in Araba University Hospital (HUA;Vitoria-Gasteiz;Basque Country, north of Spain), in order to clarify the envolvement of compounding factors, their relevance, and the risk of anaphylaxis. Method: We report 10 women and 53 men (range, 9-86 years) including 2 children and 1 teenager, diagnosed of alpha-gal allergy by skin tests to mammalian meat extracts and to cetuximab;specific IgE to mammalian meats, alpha-gal and Activation Basophil Test (BAT) in 26 cases. The number of patients which presented severe allergic reactions and the implication of possible cofactors involved in severe and non-severe allergic reactions are collected. Results: In 46 % of the patients (29/63), compounding factors were reported. Compounding factors were: NSAIDs, exercise, alcohol, emotional stress, intense hot weather, infections, Angiotensin Converting Enzyme (ACE) Inhibitors and Proton Pump Inhibitors (PPIs). NSAIDs were the most reported (8/29), followed by exercise (7/29);alcohol (6/29);infections (3/29): 1 SARS-CoV- 2 virus infection, 1 Varicela virus and 1 bacterial infection. ACE Inhibitors (2/29);PPIs (1/29);intense hot weather (1/29) and emotional stress (1/29). Severe allergic reactions were presented in 44% (28/63) of total cases. Cofactors were involved in 12/28 severe patients (43%). Cofactors were presented in 3/5 anaphylactic shocks (2 alcohol, one of them associated with a bacterial infection, 1 emotional stress) and in 9/23 anaphylaxis (4 exercise, 3 NSAIDs, 1 PPIs, 1 alcohol). 35 cases were non-severe reactions. Cofactors were involved in 29% of non-severe reactions. In 3/35, various compounding factors were involved (9%). Case number (no) 1: exercise and NSAID (diclofenac);no 2: exercise and ACE inhibitor;no 3: exercise, NSAID and intense hot weather. Conclusion: We present 63 allergic alpha gal patients registered in the last 8 years in which, 1. Almost half of the patients, present severe allergic reactions. 2. Compounding factors are presented in 44% of the allergic reactions. 3. In severe cases, compounding factors are involved in 43% of the patients versus in 29% non-severe reactions.

Valoración de la cultura de seguridad del paciente en la UCI de un hospital de segundo nivel al finalizar la tercera oleada de COVID-19 Assessment of the patient safety culture in the ICU of a second level hospital at the end of the third COVID-19 wave

Introducción El ambiente sanitario actual y, especialmente, las UCI, sen un medio complejo, altamente tecnificado y multidisciplinar, con interacciones entre los profesionales sanitarios y los usuarios, en los que puede haber errores a distinto nivel. Nuestro objetivo fue valorar la percepción de seguridad del paciente en nuestra unidad al terminar la tercera ola de la pandemia de COVID-19, con la intención de llevar a cabo acciones de mejora posteriores. Métodos Estudio observacional, transversal y descriptivo. La percepción sobre la cultura de seguridad se estimó mediante el cuestionario HSOPS traducido al castellano. Algunas preguntas se plantearon en sentido positivo y otras en sentido negativo. También se calificó la respuesta como positiva, negativa o neutra. Se compararon visualmente, no de forma matemática, nuestros hallazgos con los encontrados en el estudio nacional previo «Análisis de la cultura sobre seguridad del paciente en el ámbito hospitalario del Sistema Nacional de Salud español» publicado en 2009. Se realizó un análisis de subgrupos en función del grupo profesional y de la antigüedad como sanitario. Se emplearon las pruebas t de Student, χ? y ANOVA. Resultados Respondieron al cuestionario 62 profesionales, el 73,90% del total. La mediana del tiempo de trabajo en UCI fue 2 años (rango intercuartil 2-4,5 años). La calificación del grado de seguridad fue 8,06 (DE 1,16). La mayoría (91,20%) no había notificado ningún evento adverso en el último año. Un 30,90% había recibido formación en seguridad de paciente recientemente. Las dimensiones consideradas como debilidad fueron la 9 («Dotación del personal», con 27,57% de respuestas positivas) y la 10 («Apoyo de la gerencia del hospital en la seguridad», con 17,64% de respuestas positivas). Las dimensiones consideradas como fortalezas fueron 3 («Expectativa de acciones por parte de dirección o supervisión del servicio») con un 85,29% de respuestas positivas y 5 («Trabajo en equipo») con el 95,58% de respuestas positivas. Los valores del índice α de Cronbach indican una consistencia interna adecuada del cuestionario. En general, nuestros datos son más positivos que los recogidos en la encuesta nacional de 2011, aunque las 2 dimensiones consideradas debilidades ya lo eran en el trabajo previo. Conclusiones La percepción de seguridad del paciente en la UCI de nuestro hospital tras finalizar la tercera oleada de la pandemia de COVID-19 era adecuada, con estimaciones más positivas que las del estudio nacional sobre cultura de seguridad hospitalaria realizado en 2009. La búsqueda constante de la seguridad del paciente debería priorizar su actividad en las 2 dimensiones consideradas debilidades: la Dotación de personal y el Apoyo de la gerencia del hospital en todo lo relacionado con la seguridad del paciente.

Descriptive observational study of rheumatic patients receiving rituximab during one year of covid19 pandemic

Objectives: To describe the rate of COVID19 infection in rheumatic patients receiving rituximab (RTX) and the prognosis of these patients. Methods: Descriptive study of patients from our Rheumatology service who received RTX for any rheumatic disease during 2020, it was retrospectively analyzed the presence of confirmed COVID19 infection, as well as its demographic and clinical variables, through digital medical records. Results: During 2020, 20 patients (7 vasculitis, 4 AR, 4 IIM, 3 MCTD, 1 SLE and 1 pSS) received RTX (12 women (60%) and 8 men (40%);mean age 51.05 years). The mean time since the first dose of RTX was 58.6 months with a mean cumulative dose per patient of 5936 mg and the last dose of 666 mg. Nasopharyngeal PCR test was performed on 13 patients, of which 8 were positive (6 after COVID19 symptoms and 2 after COVID19 + contact) and 5 negative (3 after COVID19 + contact and 2 due to hospital admission). Comparing the 8 patients who had COVID19 infection versus the 12 who did not, there were no differences regarding age, sex, mean time of exposure to RTX, mean accumulated dose of the drug or last dose. There were no differences between patients infected or not by COVID19 with respect to those considered as risk factors for complicating this infection, nor with respect to DMARDs associated with RTX (Table 1). 7 (87.5%) of the 8 patients with COVID19 infection developed bilateral pneumonia and required admission for a mean time of first hospitalization of 36 days. The pharmacological treatment they received is shown in Table 2. The mean COVID19 infection severity index in our patients was 5.25, according the WHO classification (1). Nasopharyngeal PCR became negative in a mean of 47 days, and no SARS-CoV-2 IgG has developed to date. Three patients required NIV and two were admitted in ICU. After hospital discharge, 3 patients were readmitted several times due to clinical worsening, with a new nasopharyngeal PCR test positive and the need for hospital retreatment. One patient died due to an intestinal perforation. Conclusion: A high percentage (40%) of our patients who received RTX for 1 year had SARS CoV-2 infection. They did not present any known risk factors for complication from this infection;despite this, the COVID-19 severity was high in the majority, requiring prolonged hospitalization and even the need for readmission. The PCR test became negative very late and no patient developed IgG SARS CoV-2.