[Psychological Impact of COVID-19 on Health Workers During the Second Year of the Pandemic in Latin America: Cross-Sectional Survey Study]. / Impacto psicológico del COVID-19 en los trabajadores sanitarios durante el segundo año de pandemia en Latinoamérica: estudio de encuesta transversal.

Introduction: The coronavirus pandemic continues to affect the mental health of healthcare personnel in Latin America (LA). Objective: To estimate the prevalence of psychological disturbances and associated risk factors for mental health in healthcare personnel in LA during the second year of the COVID-19 pandemic. Method: This multicenter cross-sectional study included a total sample of 5437 healthcare professionals from Argentina, Bolivia, Chile, Colombia, Ecuador, and Peru. The PHQ-9, GAD-7, and a brief demographic questionnaire were used. The prevalence of anxiety and depression was estimated based on the cut-off points of the instruments. Two multivariate logistic regressions were performed. Results: A population burden of anxiety (40.1%) and depression (62.2%) was found in healthcare personnel in LA. Among professionals in Argentina (OR = 1.374; P<.001), those working in state hospitals (OR = 1.536; P<.003), frontline healthcare workers for COVID patients (OR = 1.848; P<.001), general practitioners (OR = 1.335; P<.001), and specialists (OR = 1.298; P<.001), a higher risk of experiencing mental disorders was observed. Among women, younger personnel, and administrative staff, a higher probability of experiencing anxiety and depression was identified. Conclusions: The burden of mental disorders on healthcare personnel in Latin America is alarming. Psychological support services are necessary, aimed at providing measures for professionals to develop healthy coping mechanisms that mitigate the impact of the pandemic on their well-being and facilitate post-crisis adjustment.

Impacto psicológico del Covid-19 en los trabajadores sanitarios durante el segundo año de pandemia en Latinoamérica: Estudio de encuesta transversal Psychological Impact of Covid-19 on Health Workers during the Second Year of the Pandemic in Latin America: Cross-Sectional Survey Study

La pandemia del Coronavirus continúa afectando la salud mental del personal sanitario en Latinoamérica (LA). Objetivo. Estimar la prevalencia de las alteraciones psicológicas y los factores de riesgo asociados a la salud mental en el personal de salud de LA, durante el segundo año de pandemia del Covid-19. Método. Estudio transversal multicéntrico que incluyó una muestra total de 5437 profesionales de la salud de Argentina, Bolivia, Chile, Colombia, Ecuador y Perú. Se utilizó el PHQ-9, el GAD-7 junto a un cuestionario demográfico breve. Se estimó la prevalencia de ansiedad y depresión a partir de los puntos de corte de los instrumentos. Se realizaron 2 regresiones logísticas multivariantes. Resultados. Se encontró una carga poblacional de ansiedad (40,1%) y depresión (62,2%) en el personal sanitario de LA. En los profesionales de Argentina (OR=1,374;p<0,001), quienes trabajan en hospitales estatales (OR=1,536;p<0,003), de primera línea de atención de pacientes con Covid (OR=1,848;p<0,001), en los médicos generales (OR=1,335;p<0,001), especialistas (OR=1,298;p<0,001), se observó un mayor riesgo de sufrir trastornos mentales. A su vez, en las mujeres, el personal más joven y en los administrativos se identificó una mayor probabilidad para sufrir ansiedad y depresión. Conclusiones. La carga de trastornos mentales en el personal de salud de Latinoamérica es alarmante. Es necesario servicios de apoyo psicológico, orientados a proporcionar medidas para que los profesionales desarrollen mecanismos de afrontamiento saludables que mitiguen el impacto de la pandemia en su bienestar y faciliten el ajuste posterior a la crisis sanitaria.

Untitled (atomic) form 2

NOTA DE LA AUTORA: Todo el mundo sabe que las cosas tardan en llegar a California. Por eso, algunas veces, en vez de esperar a que algo llegue, aquí terminamos inventándonoslo. Un buen ejemplo de esto ocurrió en el mes de enero del 2020, cuando, ajena a la pandemia que asolaba Europa y Asia, yo comenzaba una residencia de poesía en el Arts Research Center de Berkeley con la promesa de diseñar una serie de poemas digitales interactivos con los que examinar la intersección entre el lenguaje corporativo y el corporal. Construidos a partir de plataformas conocidas, como las encuestas de Google Forms, Survey Monkey, Qualtrics o Zoom, estos poemas reutilizarían el tipo de lenguaje que asociamos con estas tecnologías de recolección de datos para tratar de domesticarlo y, a la par, interrumpir o alterar su proceso de recolección lo suficiente para volverlo inútil para esas mismas plataformas en las que se generaría. Mi intención era, por un lado, explorar la artificialidad de sus lenguajes y, por otro, apuntar a cómo estas plataformas construían y modificaban nuestra realidad física por medio de un proceso de exposición de las variadas infraestructuras digitales que intervienen cada vez que rellenamos una encuesta online o hacemos una videollamada. Sin embargo, aunque tarde, todo llega –incluso a California. Y unos meses después, la pandemia global de la COVID-19 tocó a nuestra puerta obligándonos a encerrarnos en casa para, simultáneamente, abrirle la ventana a una nueva red digital que nos conectaría con otras ventanas virtuales distribuidas por todo el planeta. El confinamiento digital al que, por otra parte, estábamos ya tan habituadas que nos era casi imperceptible, y la relación que nuestros cuerpos ahora mantenían con el lenguaje digital se volvieron, casi de la noche a la mañana, dolorosamente evidentes. Así, me di cuenta de que los poemas digitales en los que yo había estado trabajando para subvertir los objetivos utilitarios de estas tecnologías permitían, también casi instantáneamente, una renovada conciencia acerca de sus capacidades para coleccionar datos en el entorno doméstico y personal de nuestras cuarentenas: conectándonos a cambio de convertirnos en datos que contabilizar. "Untitled (atomic) form 2” es una expresión analógica de las mismas ideas. En vez de crear un poema digital interactivo, esta vez se trata de un poema visual escrito y dibujado a mano siguiendo las convenciones de una encuesta de Google. En vez de lanzarlo como una proyección hacia el futuro sobre la mediación digital en tecnologías de la comunicación, sirve como reflexión de la dimensión material de todo lo que está ya conectado, incluyendo actores humanos y no humanos. Inspirado en el nuevo materialismo cuántico de Karen Barad, que rechaza cualquier posibilidad de exterioridad del ser humano frente al mundo para situarnos siempre de manera relacional en un interior que lo (y nos) coconstituye, y la perspectiva fenomenológica de Sarah Ahmed que habla de la relatividad de toda observación, este poema examina los límites sensuales de la experiencia humana y su discurso al enfatizar los otros límites de la comunicación basada en interfaces (digitales o impresas). También habla de la llegada de la COVID-19 y de cómo yo me invento cosas y seres, pero este es otro tema. El resto de los poemas digitales e interactivos de Corporate Poetry están en http://www.alexsaum.com/corporate-poetry/. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Prevalencia y factores asociados con las quejas cognitivas subjetivas del personal sanitario latinoamericano durante la pandemia de COVID-19 Prevalence and factors associated with subjective cognitive complaints in Latin American health workers during the COVID-19 pandemic

Introducción y objetivos: Se ha observado un incremento de alteraciones emocionales y quejas sobre el rendimiento cognitivo en el personal sanitario latinoamericano durante la pandemia de SARS-CoV-2;lo cual puede afectar a las capacidades de atención y aumentar los niveles de estrés y burnout de estos profesionales. El objetivo es analizar las quejas cognitivas subjetivas (QCS) y los factores asociados en el personal sanitario durante la pandemia de COVID-19 en 5 países de América Latina. Métodos: Estudio transversal multicéntrico que incluyó a 3.738 profesionales de Colombia, Chile, Argentina, Ecuador, Bolivia y Perú. Se utilizó la Escala de Trastorno de Ansiedad Generalizada (GAD-7) y el Patient Health Questionnaire (PHQ-9) para valorar la depresión y el Mini-Z para evaluar el burnout. Para las QCS se usó un ítem sobre preocupaciones cognitivas en atención y memoria. Resultados: Se observó una prevalencia de queja cognitiva del 69,2%. Los factores asociados con un mayor riesgo de QCS fueron las puntuaciones en GAD-7, PHQ y Mini-Z, además de ser parte del personal de salud del Ecuador. Conclusiones: La prevalencia de QCS en el personal sanitario es alta y está modulada por estados emocionales y estrés.

Acute Thalamic Ischemic Stroke in an Older Patient Newly Vaccinated with COVID-19 Vaccine Based on Adenoviral Vectors.

Introduction: Recent reports have shown several cases of cerebrovascular events after vaccination against COVID-19. The effects have been described mainly in women within the first two weeks of receiving the vaccine. Clinical Case: We describe here the first Colombian case of a cerebrovascular event after vaccination against COVID-19 in a 67-year-old woman with a vascular history. Four days after application of the messenger ribonucleic acid (mRNA) vaccine, she exhibited deviation of the labial commissure, ipsilateral ptosis, and limitation of march with lateralization. The event was associated with a subacute ischemic event in the right thalamus in parasagittal situation, changes in chronic ischemic microangiopathy of small vessels, and vascular crossing in the right cerebellar angle, without other alternative causes. Conclusion: The development and rapid use of vaccines has allowed the hospitalization and mortality statistics associated with COVID-19 to be reduced, but at the same time, it has generated concern about the potential side effects, generating controversy among the general population, especially in individuals with cardiovascular diseases. In our case, we provided evidence for the discussion of potential cerebrovascular events related to the application of vaccines in older people with a history of cerebrovascular diseases. This was done in order to analyze and control in subsequent studies the modulation of medical history on the likely effects of vaccination. However, despite the unavoidable side effects, the benefits of vaccination are superior.

Acute and Post-Acute COVID-19 Severity and Mortality in Patients with Hematologic Malignancies: A Population-Based Registry Study

Introduction: The severity of acute clinical outcomes and mortality in hematologic malignancy (HM) patients infected by SARS-CoV-2 was exhaustively documented in the first weeks of the pandemic. A consistent increased mortality compared to non-cancer patients was observed across studies. In this study we aimed to estimate survival in COVID-19 HM patients by type of malignancy, to describe acute and post-acute clinical outcomes, and to compare outcomes in early and later pandemic periods. Methods: In this population-based registry study sponsored by the Madrid Society of Hematology (Asociación Madrileña de Hematología y Hemoterapia), we collected de-identified data on clinical characteristics, treatment and acute and post-acute outcomes in adult patients with hematologic malignancies and confirmed SARS-CoV-2 infection within the Madrid region of Spain. Our case series included all eligible patients admitted to 26 regional health service hospitals and 5 private healthcare centers between February 28, 2020 and February 18, 2021 with a coverage of 98% on a population of 6.6 million inhabitants. The study outcomes were all-cause mortality, severity of disease (WHO), oxygen support, ICU admission, and follow-up symptoms and signs and complications. Survival probabilities were estimated with the actuarial method and reported overall and stratified by type of malignancy and for two study periods (early cohort,-COVID-19 diagnosis from February 28 to 31 May, 2020, and later cohort, up to February 18, 2021). Results: Of the 1408 patients reported to the HEMATO-MADRID COVID-19 registry, 1166 were included in the present analyses;839 (72%) had a lymphoid malignancy, including 325 (28%) with non-Hodgkin lymphoma, 50 (4%) with Hodgkin lymphoma and 263 (23%) with multiple myeloma;and 327 (28%) had a myeloid malignancy, including 115 (10%) with myelodysplastic syndrome, 92 (8%) with acute myeloid leukemia (AML) and 87 (7%) with Philadelphia chromosome (Ph)-negative myeloproliferative neoplasms. Overall COVID-19 clinical severity was classified as critical in 19% of patients, severe in 36%, moderate in 22%, and mild in 22%;10% were admitted to an ICU;8% were on mechanical ventilation and 19% on noninvasive ventilation. Mild disease increased between early and later period from 15% to 38% of patients;severe disease decreased from 42% to 24%, p<0.001. COVID-19 treatment with steroids increased from 38% to 59%, p<0.001. At follow-up, 22% reported persistent symptoms related to COVID-19 at 2 months, 16% at 4 months and 14% at 6 months. 381 of 1166 (33%) patients died. Overall 30-day survival was 68%;2 and 3-month overall survival probabilities were 56% and 53%, respectively. Survival was more favorable for patients with myeloproliferative neoplasms (82%, 69% and 65% at 30-days, 2 and 3 months, respectively) than for those with lymphoid malignancies (68%, 56% and 54%) or myelodysplastic syndrome/acute myeloid leukemia (61%, 51%, 46%), p=001. 285 (37%) patients died in the early period vs 96 (24%) in the later, p<0.001, but median (interquartile range) follow-up time was much higher in the early vs later, 45 (20-116) days vs. 26 (11-86), respectively. Overall survival was not different between periods, p=0.5 (hazard ratio [95%C], 0.93 [0.73-1.17]). In the later cohort, 30 and 60-day survival probabilities were 71% and 56% vs. 67% and 56% in the early cohort Conclusions. A population-based registry in Spain provided strong evidence that although COVID-19 severity decreased over year 1 of the pandemic, mortality remained high, and survival was stable over time in the group of patients with hematological malignancy infected by SARS-Coc-2. A relevant proportion of the infected patients (1 in 6) referred persistent symptoms attributable to COVID-19. The improved clinical management of severe COVID-19 in non-cancer patients that followed the dissemination of evidence-based recommendations did not translate in more favorable survival in patients with hematological malignancies. Research is needed to address the specific characteristics nd improve the clinical management of this vulnerable population. Disclosures: Martinez-Lopez: Novartis: Consultancy, Speakers Bureau;BMS: Consultancy, Research Funding, Speakers Bureau;Janssen: Consultancy, Speakers Bureau;Incyte: Consultancy, Research Funding, Speakers Bureau;Roche: Consultancy, Research Funding, Speakers Bureau;Astellas: Research Funding, Speakers Bureau. Jiménez-Yuste: Pfizer: Consultancy, Honoraria, Research Funding;Grifols: Consultancy, Honoraria, Research Funding;CSL Behring: Consultancy, Honoraria, Research Funding;Sanofi: Consultancy, Honoraria, Research Funding;Bayer: Consultancy, Honoraria, Research Funding;NovoNordisk: Consultancy, Honoraria, Research Funding;BioMarin: Consultancy;Sobi: Consultancy, Honoraria, Research Funding;Octapharma: Consultancy, Honoraria, Research Funding;Takeda: Consultancy, Honoraria, Research Funding;F. Hoffmann-La Roche Ltd: Consultancy, Honoraria, Research Funding. Kwon: Gilead: Honoraria.

Clinical Heterogeneity in ME/CFS. A Way to Understand Long-COVID19 Fatigue.

The aim of present paper is to identify clinical phenotypes in a cohort of patients affected of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Ninety-one patients and 22 healthy controls were studied with the following questionnaires, in addition to medical history: visual analogical scale for fatigue and pain, DePaul questionnaire (post-exertional malaise, immune, neuroendocrine), Pittsburgh sleep quality index, COMPASS-31 (dysautonomia), Montreal cognitive assessment, Toulouse-Piéron test (attention), Hospital Anxiety and Depression test and Karnofsky scale. Co-morbidities and drugs-intake were also recorded. A hierarchical clustering with clinical results was performed. Final study group was made up of 84 patients, mean age 44.41 ± 9.37 years (66 female/18 male) and 22 controls, mean age 45 ± 13.15 years (14 female/8 male). Patients meet diagnostic criteria of Fukuda-1994 and Carruthers-2011. Clustering analysis identify five phenotypes. Two groups without fibromyalgia were differentiated by various levels of anxiety and depression (13 and 20 patients). The other three groups present fibromyalgia plus a patient without it, but with high scores in pain scale, they were segregated by prevalence of dysautonomia (17), neuroendocrine (15), and immunological affectation (19). Regarding gender, women showed higher scores than men in cognition, pain level and depressive syndrome. Mathematical tools are a suitable approach to objectify some elusive features in order to understand the syndrome. Clustering unveils phenotypes combining fibromyalgia with varying degrees of dysautonomia, neuroendocrine or immune features and absence of fibromyalgia with high or low levels of anxiety-depression. There is no a specific phenotype for women or men.

Early discharge and postpartum home visit during the COVID-19 pandemic at the HULP (Madrid).

OBJECTIVE: The COVID-19 pandemic caused that the Health Department of the Autonomous Region of Madrid redirected the Obstetrics, Gynecology and Neonatology emergency care. On March 24th 2020, the HULP launched a program of postpartum early discharge and home visit. The objective of this work was to detect if the care strategy "Voluntary early discharge and home visit by the midwife (2nd year EIR)" applied by the HULP during the COVID-19 pandemic had any adverse effect on the woman and/or the newborn. METHODS: Cross-sectional observational descriptive study using convenience sampling among women included in the early discharge-home visit program from March 24th to May 5th 2020. 222 medical records and telephone surveys to postpartum women who complied with the inclusion criteria were analyzed. The statistical analysis was performed using SAS 9.4. RESULTS: The average of inpatient time was 25 hours and 15 minutes. 8.6% of newborns were sent back to the HULP, and 2.2% were readmitted for hyperbilirubinemia. 2.3% of parents took their infants to the Emergency Care Unit, but only 0.46% needed readmission. 0.4% of postpartum women were readmitted. At the discharge, 84.2% of newborns exclusively breastfed. After one week of the birth, 73.4% of infants were exclusively breastfeeding, 18% were mixed breastfeeding, and 8.6% were bottle feeding. 89.6% of women believed early discharge was appropriate. Home visit was described as "very satisfactory" in 83.3% of cases, and the care provided, in 88.7% of cases. CONCLUSIONS: With the early discharge-home visit program, continuity of care is provided, health problems were detected and resolved and high maternal satisfaction levels were obtained.

Monitoring and telematic control of people with kidney transplant and suspected COVID-19 infection

Background: People with Kidney Transplantation require immunosuppressant treatments and this classifies them as a population at risk for virus and/or bacterial infections. The objective of the study was to describe the follow-up of transplanted people with suspected COVID19 infection. Methods: Descriptive, cross-sectional, observational study with prospective follow-up carried out between March and June 2020. Sociodemographic and clinical data were recorded for the assessment, control and follow-up of the cases. The results were expressed with means and standard deviation, median and interquartile range, or frequencies and percentages. The chi-square test was used to compare qualitative variables and the Student's T test to compare quantitative variables with normal distribution. If they did not follow a normal distribution, the Mann Whitney U test was used. The level of statistical significance was established at p<0.05. Results: A total of 56 patients were included, with a mean of 62.73 +/- 13.01 years and a median of 39.5 [7.5;93] months transplanted. 2.48 +/- 2.69 calls/patient were made during a period of 3.46 +/- 4.41 days. Virtual follow-up was performed with 100% (n=56) and 71.43% (n=40) required hospital admission at some point. 28.57% (n=16) of the people evaluated were managed at home. The PCR test was performed on 85.71% (n=48) of the study population, being positive in 48.21% (n=27). 29.62% (n=8) of the positive cases required invasive mechanical ventilation and 33.33% (n=9) died. The mortality rate in the study population is 4.17 times higher than that presented in the data from the registries in the general population. Conclusions: According to the mortality data, it is essential to maintain close contact with the main objective of referring the case to the hospital system at the slightest suspicion of complication. Remote monitoring is offered as a positive opportunity for the control of transplant recipients who require close monitoring by the nursing team.