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BackgroundThe COVID-19 pandemic triggered serious challenges in the treatment of chronic diseases due to the lack of access to medical attention. Patients with rheumatic diseases (RD) must have adequate treatment compliance in order to reach and maintain remission or low activity of their diseases. Treatment suspension because of non-medical reasons might lead to disease activation and organ damage.ObjectivesIdentify the frequency of biologic treatment (bDMARD) suspension in patients with RD during the COVID-19 pandemic and determine the associated factors for suspension.MethodsIn this study we included all patients registered in the Mexican Biologics Adverse Events Registry (BIOBADAMEX), that started bDMARD before March 2019 and suspended treatment during the COVID-19 pandemic. We used descriptive statistic to analyze baseline characteristics and main treatment suspension causes. We used Chi[2] and Kruskal Wallis tests to analyze differences between groups.ResultsA total of 832 patients patients registered in BIOBADAMEX were included in this study, 143 (17%) suspended bDMARD during the COVID-19 pandemic. The main causes of suspension were inefficacy in 54 (38%) patients, followed by other motives in 49 (34%) patients from which 7 (5%) was loss of medical coverage. Adverse events and loss of patients to follow up were the motive in 16 (11%) and 15 (11%) patients respectively.When we compared the group that suspended bDMARD with the non-suspenders (Table 1), we found statistical differences in patient gender, with 125 (87%) female patients that suspended bDMARD, with a median age of 52 (42-60) years, and a treatment duration of 3.8 years.ConclusionIn our study we found that 17% of patients with RD suspended bDMARD treatment during the COVID-19 pandemic and that non-medical motives such as lack of patients follow up and loss of medical coverage due to unemployment were important motives. These results are related to the effect of the pandemic on other chronic diseases.Table 1.Patients baseline characteristicsPatients that did not suspended bDMARD during pandemic (n = 689)Patients that suspended bDMARD during pandemic (n = 143)pFemale gender, n(%)549 (79.7)125 (87.4)0.02Age, median (IQR)55 (45 – 63)52 (42 – 60)0.04Body mass index, median (IQR)26.4 (23 – 30.4)27.23 (24.2 – 30.46)0.13Social security, n(%)589 (85.5)128 (89.5)0.2Diagnosis0.7- Rheumatoid arthritis444 (64.4)97 (67.8)- Juvenil idiopathic athritis29 (4.2)2 (1.4)- Ankyosing sponylitis93 (13.5)19 (13.3)- Psoriasic arthritis43 (6.2)6 (4.2)- Systemic lupus erithematosus32 (4.6)9 (6.3)- Others48 (6.9)10 (6.9)Disease duration, median (IQR)11 (7 – 19.5)12 (6 - 18)0.95Comorbidities, n(%)305 (44.3)73 (51)0.08Previos biologic, n(%)249 (36.1)60 (42)0.1Treatment at pandemic iniciation, n(%)0.8 - Etanercept a34 (4.9)5 (3.5)- Infliximab a24 (3.5)5 (3.5)- Adalimumab130 (18.9)22 (15.4)- Rituximab a61 (8.9)25 (17.5)- Abatacept76 (11)20 (14)- Tocilizumab82 (11.9)18 (12.6)- Certolizumab92 (13.4)28 (19.6)- Rituximab b7 (1)0- Golimumab36 (5.2)5 (3.5)- Tofacitinib14 (2)1 (0.7)- Infliximab b4 (0.5)2 (1.4)- Etanercept b31 (4.5)6 (4.2)- Baricitinib12 (1.7)1 (0.7)- Belimumab5 (0.7)1 (0.7)- Secukinumb8 (1.2)3 (2.1)Steroids use, n(%):254 (36.9)57 (39.9)0.2Steroids dose (mg), median (IQR)6 (5 – 10)6 (5 – 10)0.47DMARD use, n(%):538 (78.1)118 (82.5)0.1Treatment duration, median (IQR)5.06 (4.04 – 5.78)3.82 (3.35 – 4.95)0.001Suspension motive, n(%)NA- Inefficacy-54 (37.8)- Adverse event-16 (11.2)- Pregnancy-2 (1.4)- Loss of patient-15 (10.5)- Remission-7 (4.9)- Others-49 (34.2)Adverse events, n(%):102 (14.8)24 (16.8)0.3- Severe, n(%)13 (1.9)5 (3.5)0.4a original, b biosimilarREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsVijaya Rivera Teran: None declared, Daniel Xavier Xibille Friedmann: None declared, David Vega-Morales: None declared, Sandra Sicsik: None declared, Angel Castillo Ortiz: None declared, Fedra Irazoque-Palazuelos: None declared, Dafhne Miranda: None declared, Iris Jazmin Colunga-Pedraza: None declared, Julio Cesar Casasola: None declared, Omar Elo Muñoz-Monroy: None declared, Sandra Carrilo: None declared, Angélica Peña: None declared, Sergio Duran Barragan: None declared, Luis Francisco Valdés Corona: None declared, Estefanía Torres Valdéz: None declared, Azucena Ramos: None declared, Aleni Paz: None declared, ERICK ADRIAN ZAMORA-TEHOZOL: None declared, Deshire Alpizar-Rodriguez Employee of: Scientific Advisor in GSK México.
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PURPOSE: To evaluate the presence of SARS-COV-2 specific IgA and IgG antibodies in tears of unvaccinated and anti-COVID-19 vaccinated subjects with previous history of SARS-COV-2 infection. To compare results in tears with those in saliva and serum and correlate with clinical data and vaccination regimens. METHODS: Cross-sectional study including subjects with a previous history of SARS-CoV-2 infection, both unvaccinated and vaccinated against COVID-19. Three samples were collected: tears, saliva and serum. IgA and IgG antibodies against S-1 protein of SARS-CoV-2 were analyzed with a semi-quantitative ELISA. RESULTS: 30 subjects, mean age 36.4⯱â¯10, males 13/30 (43.3%) with history of mild SARS-CoV-2 infection were included. 13/30 (43.3%) subjects had received a 2-dose regimen and 13/30 (43.3%) a 3-dose regimen of anti-COVID-19 vaccine, 4/30 (13.3%) subjects were unvaccinated. All the participants with full anti-COVID-19 vaccination (2-or 3-doses) presented detectable anti-S1 specific IgA in all three biofluids, tears, saliva and serum. Among unvaccinated subjects, specific IgA was detected in 3/4 subjects in tears and saliva, whereas IgG was not detected. Considering IgA and IgG antibodies titers, no differences were observed between the 2- and 3-dose vaccination regimen. CONCLUSIONS: SARS-CoV-2-specific IgA and IgG antibodies were detected in tears after mild COVID-19, highlighting the role of the ocular surface as a first line of defense against infection. Most naturally infected unvaccinated individuals exhibit long-term specific IgA in tears and saliva. Hybrid immunization (natural infection plus vaccination) appears to enhance mucosal and systemic IgG responses. However, no differences were observed between the 2- and 3-dose vaccination schedule.
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COVID-19 , Male , Humans , Adult , Middle Aged , Cross-Sectional Studies , SARS-CoV-2 , Eye , Antibodies, Viral , Immunoglobulin G , Immunoglobulin AABSTRACT
Purpose: To evaluate the presence of SARS-CoV-2 specific IgA and IgG antibodies in tears of unvaccinated and anti-COVID-19 vaccinated subjects with previous history of SARS-CoV-2 infection. To compare results in tears with those in saliva and serum and correlate with clinical data and vaccination regimens. Methods: Cross-sectional study including subjects with a previous history of SARS-CoV-2 infection, both unvaccinated and vaccinated against COVID-19. Three samples were collected: tears, saliva and serum. IgA and IgG antibodies against S-1 protein of SARS-CoV-2 were analyzed with a semi-quantitative ELISA. Results: Thirty subjects, mean age 36.4 ± 10, males 13/30 (43.3%) with history of mild SARS-CoV-2 infection were included. 13/30 (43.3%) subjects had received a 2-dose regimen and 13/30 (43.3%) a 3-dose regimen of anti-COVID-19 vaccine, 4/30 (13.3%) subjects were unvaccinated. All the participants with full anti-COVID-19 vaccination (2-or 3-doses) presented detectable anti-S1 specific IgA in all 3 biofluids, tears, saliva and serum. Among unvaccinated subjects, specific IgA was detected in 3/4 subjects in tears and saliva, whereas IgG was not detected. Considering IgA and IgG antibodies titers, no differences were observed between the 2- and 3-dose vaccination regimen. Conclusions: SARS-CoV-2-specific IgA and IgG antibodies were detected in tears after mild COVID-19, highlighting the role of the ocular surface as a first line of defense against infection. Most naturally infected unvaccinated individuals exhibit long-term specific IgA in tears and saliva. Hybrid immunization (natural infection plus vaccination) appears to enhance mucosal and systemic IgG responses. However, no differences were observed between the 2- and 3-dose vaccination schedule.
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Purpose: This paper examines whether following a health crisis the use of health and safety protocols and hotel brand awareness influences hotel perceived value and intention to visit. Design/methodology/approach: Using an experimental design, the study evaluates the effectiveness of the use of health and safety protocols and the moderating effect of brand awareness on perceived value and intention to visit. Findings: The results show that the hotels using health and safety protocols (compared to those that do not use them) will achieve a higher perceived value and intention to visit. In addition, the awareness of brand does not moderate the effect of the health and safety protocols on perceived value and intention to visit. Practical implications: This research identifies mechanisms for future consideration by hotel companies to promote the recovery of their activity after a health crisis. Specifically, using health and safety protocols will result in the market evaluating the brand more highly and produce a greater intention to visit. At the same time, the research indicates that regardless of whether the brand is well-known or not, the use of a health and safety protocol is advantageous. Originality/value: This study offers new insights that can be useful for developing a resilient hotel sector in the face of future health crises. Specifically, the results show progress in understanding the effects that the use of health and safety protocols and brand awareness have on key consumer variables for the recovery of the sector in a post-pandemic context. © 2023, Emerald Publishing Limited.
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This paper examines whether, following a prolonged health crisis, the offer of a tourist destination coupled with the use of health and safety protocols at the destination, influences brand equity and intention to visit. Specifically, it (a) examines whether the indoor/outdoor activity offers influence brand equity and intention to visit, (b) demonstrates whether health and safety protocols influence brand equity and intention to visit, and (c) tests whether there is a moderating effect by the use of health and safety protocols in destinations specializing in indoor, rather than outdoor, activities. The study is based on an experimental design in which the type of offer (out/indoor activities) and the use of anti-covid protocols versus their non-use were manipulated. © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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The tourism industry has dynamized the economy of the countries by offering places, as well as related tourism experiences, products, and services. In the context of the COVID-19 pandemic, some of these tourist destinations were affected by subjective perceptions of users on social networks, within stands out Twitter. To achieve an objective perception from user comments posted on Twitter in front of a tourist destination, we propose a PANAS-tDL (Positive and Negative Affect Schedule - Deep Learning) model which integrates into a single structure a neural model inspired by a Stacked neural deep learning model (SDL), as well as the PANAS-t methodology. For this process, a database of comments was available for four destinations (Colombia, Italy, Spain, USA), and its tourist's products and services, before and in the context of COVID-19 pandemic throughout the year 2020. The proposed model made it possible to generate objective perceptions of the tourist destinations and their products and services using an automatic classification of comments in each category defined by the PANAS-t methodology (11-sentiments). The results show how users' perceptions were towards the negative sentiment zone defined by this methodology, according to the evolution of the COVID-19 pandemic worldwide throughout the year 2020. The proposed model also integrated an automatic process of normalisation, lemmatisation and tokenisation (Natural language process - NLP) for the objective characterization of perceptions, and due to its capacity for adaption and learning, it can be extended for the evaluation of new tourist destinations, products or services using comments from different social networks. Copyright © 2021 by Author/s and Licensed by Veritas Publications Ltd., UK.
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INTRODUCTION: The COVID-19 pandemic has disrupted many aspects of clinical practice in oncology, particularly regarding early cancer diagnosis, sparking public health concerns that possible delays could increase the proportion of patients diagnosed at advanced stages. In 2009, a cancer fast-track program (CFP) was implemented at the Clinico-Malvarrosa Health Department in Valencia, Spain with the aim of shortening waiting times between suspected cancer symptoms, diagnosis and therapy initiation. OBJECTIVES: The study aimed to explore the effects of the COVID-19 pandemic on our cancer diagnosis fast-track program. METHODS: The program workflow (patients included and time periods) was analysed from the beginning of the state of alarm on March 16th, 2020 until March 15th, 2021. Data was compared with data from the same period of time from the year before (2019). RESULTS: During the pandemic year, 975 suspected cancer cases were submitted to the CFP. The number of submissions only decreased during times of highest COVID-19 incidence and stricter lockdown, and overall, referrals were slightly higher than in the previous 2 years. Cancer diagnosis was confirmed in 197 (24.1%) cases, among which 33% were urological, 23% breast, 16% gastrointestinal and 9% lung cancer. The median time from referral to specialist appointment was 13 days and diagnosis was reached at a median of 18 days. In confirmed cancer cases, treatment was started at around 30 days from time of diagnosis. In total, 61% of cancer disease was detected at early stage, 20% at locally advanced stage, and 19% at advanced stage, displaying time frames and case proportions similar to pre-pandemic years. CONCLUSIONS: Our program has been able to maintain normal flow and efficacy despite the challenges of the current pandemic, and has proven a reliable tool to help primary care physicians referring suspected cancer patients.
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COVID-19 , Lung Neoplasms , Humans , COVID-19/epidemiology , Pandemics , Communicable Disease Control , Referral and Consultation , Lung Neoplasms/diagnosisABSTRACT
Scholarship drawing from a wide array of perspectives including field theoretical and functional differentiation approaches has shed increasing light on the sectoral dimensions of world politics. In contrast to dominant approaches emphasizing hierarchy and power in relations between global fields, this article offers a novel interpretive framework for understanding how diverse fields, systems, or sectors may interact and facilitate change in world politics beyond the operation of established hierarchies and power dynamics. Taking forward the previously underutilized concept of symbolically generalized media of communication, this article elucidates two processes of international political change by which different fields, systems, or sectors may transform world politics. The first process, lateral retreat, is illustrated with reference to the case study of the Protestant Reformation, in which internal changes in the religious field facilitated the development of an increasingly autonomous political domain. The second process, lateral penetration, is illustrated with reference to the international political response to the climate change and Covid-19 crises, in which the scientific sector contributed toward transformed political priorities and associated hierarchies, at least in the short term. These diverse cases are used to indicate the broad potential scope of application of the concept of symbolically generalized media of communication to enrich relational theorizing in the study of international relations, and to improve understanding of diverse dynamics of international political change missed in traditional power- (and anarchy-) centric accounts.
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Background: The COVID-19 pandemic has had a great impact and high cost on the education of physicians that has not been determined in the long term. Objective: To determine the impact of COVID-19 on undergraduate interns and how it affected their academic training. Material and methods: Mixed study. Qualifications of the bimonthly departmental exam from 2018 to 2020 of the FACMED-UNAM internal doctors were reviewed, the focus group technique was used to investigate their experience and repercussions during the pandemic. Results: The grade point average for 18-19 was 70.76+/- 10.12. In 2020 76.19+/-10.66 (p = 0.000). In the CDMX 2018-2019 an average 70,405+/-10,156 against 71.97+/- 10.28 of foreign headquarters (p > 0.05). In 2020, the capital's headquarters an average of 77.02+/-10.31 against 73.86+/-11.296 in the interior (p = 0.000). When comparing the bimonthly ratings, there were no significant differences in 2018 and 2019;However, in 2020 there is an increase from 69.40 +/-9.538 to 79.39 +/-10.709. Conclusions: The ratings for 2020 had better results in relation to 2018 and 2019, they were higher in capital cities in relation to foreign ones. The retrospective perception of the inmates was that they had more time to study thematic contents and less pressure in the care work;They stated that they would have preferred to stay in their rotations, with the necessary protective equipment to avoid getting infected.
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AIMS: Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors. METHODS: 8996 healthcare workers evaluated on 5 May-7 September 2020 (baseline) were invited to a second web-based survey (October-December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview. RESULTS: 4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar. CONCLUSIONS: Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565.
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COVID-19 , Depressive Disorder, Major , COVID-19/epidemiology , Depressive Disorder, Major/epidemiology , Health Personnel , Humans , Longitudinal Studies , PandemicsABSTRACT
Before the pandemic, the United Nations Sustainable Development Goals included cutting learning poverty in half by 2030. The COVID-19 pandemic has had severe negative impact on education throughout the world and set back progress toward this goal. Science, Technology, Engineering and Mathematics (STEM) education include laboratory experiences. Engineering and Technology program Accreditation Agencies deem labs critical to an engineer's education and require it in the criteria for international accreditation. While converting traditional instruction to virtual instruction posed a challenge to all, developing countries faced higher constraints of limited bandwidth, connectivity, and household access to technology. Once the access problems are resolved, universities still have the challenge of providing inclusive access to online laboratory experiments, particularly for engineering students. This paper presents current solutions for online Engineering laboratories and proposes an online lab management system and a federated lab model appropriate for developing countries that the Latin American and Caribbean Consortium of Engineering Institutions (LACCEI) is currently developing and piloting. © 2021 IEEE.
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Healthcare workers (HCW) are at high risk for suicide, yet little is known about the onset of suicidal thoughts and behaviors (STB) in this important segment of the population in conjunction with the COVID-19 pandemic. We conducted a multicenter, prospective cohort study of Spanish HCW active during the COVID-9 pandemic. A total of n = 4809 HCW participated at baseline (May-September 2020; i.e., just after the first wave of the pandemic) and at a four-month follow-up assessment (October-December 2020) using web-based surveys. Logistic regression assessed the individual- and population-level associations of separate proximal (pandemic) risk factors with four-month STB incidence (i.e., 30-day STB among HCW negative for 30-day STB at baseline), each time adjusting for distal (pre-pandemic) factors. STB incidence was estimated at 4.2% (SE = 0.5; n = 1 suicide attempt). Adjusted for distal factors, proximal risk factors most strongly associated with STB incidence were various sources of interpersonal stress (scaled 0-4; odds ratio [OR] range = 1.23-1.57) followed by personal health-related stress and stress related to the health of loved ones (scaled 0-4; OR range 1.30-1.32), and the perceived lack of healthcare center preparedness (scaled 0-4; OR = 1.34). Population-attributable risk proportions for these proximal risk factors were in the range 45.3-57.6%. Other significant risk factors were financial stressors (OR range 1.26-1.81), isolation/quarantine due to COVID-19 (OR = 1.53) and having changed to a specific COVID-19 related work location (OR = 1.72). Among other interventions, our findings call for healthcare systems to implement adequate conflict communication and resolution strategies and to improve family-work balance embedded in organizational justice strategies.
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COVID-19 , COVID-19/epidemiology , Health Personnel , Humans , Incidence , Organizational Culture , Pandemics , Prospective Studies , Social Justice , Spain/epidemiology , Suicidal IdeationABSTRACT
The rapid spread of the SARS-CoV-2 virus has highlighted many social interaction problems that favor the spread of disease, particularly airborne spread, which can be addressed by adjusting existing systems. Of particular interest are places where large numbers of people interact, as they become a focus for the spread of these diseases. This paper proposes and evaluates an autonomous identification scheme for certain surfaces considered high risk due to their continuous handling. These high-contact surfaces can be identified by an autonomous system to apply specific cleaning tasks to them. We evaluate three convolutional models from a proprietary dataset with a total of 2000 images ranging from wall switches to water dispensers. The objective is to identify the ideal architecture for the system. The ResNet (Residual Neural Network), DenseNet (Dense Convolutional Network), and NASNet (Neural Architecture Search Network) models were selected due to their high performance reported in the literature. The models are evaluated with specialized metrics in non-binary classification problems, and the best scheme is selected for prototype development. © 2021 Institute of Physics Publishing. All rights reserved.
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Pandemic by COVID-19 has impacted the life of each and every person in one way or another. And such impacts are going to endure long enough after this pandemic period of time. This is why to reconstruct the experiences of the process while it is taking place becomes a task not only interesting but necessary. Following this reasoning the present article elaborates on the perceptions, attitudes and practices that Cuban individuals have developed regarding COVID-19, and about the measures the government has implemented towards its control between April and September 2020. For that purpose, it was applied a quantitative method by surveys combining open questions during a first stage of the research and closed questions during a second. There were surveyed 516 subjects through different virtual platforms. Main results go around four categories such as perceptions about the decease itself, about the measures of the government, the ways of coping and acting toward the situation and the challenges perceived by the population.
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Background : Association between some analytical parameters and clinical evolution of patients infected by SARS-COV-2 is a controversial issue. Aims : Review the relationship between laboratory parameters and severity and/or lethality of the COVID-19. Methods : Observational, cross-sectional and retrospective study. Data obtained from electronic health record of patients over 18 years of age admitted in our hospital, between March and May 2020 with suspected SARS-COV-2 infection. After descriptive statistical study, we did an inferential analysis using Mann-Whitney U test for independent samples, in order to verify association between the results of analytical parameters and the clinical severity (defined by hospitalization in conventional ward vs. intensive care units (ICU)) and/or lethality (alive vs. death at the end of the study). Results : 668 patients were included, 345 men (52%) and 323 women (48%), with a median age of 70 years. 80% of patients had previous comorbidities, 10% were admitted to the ICU, and 17% died.Differences were found in hematimetric parameter between the different groups: leukocytes (10 3 /μl): 8.3 in ICU patients vs. 6.5 in those admitted to the ward;platelet count (10 3 /μl) of 182l in death patients vs. 223 in survivors;hemostasis parameters: D-dimer (DD) (μg/L) of 1379 and 1236 in deceased and admitted to the ICU respectively, compared to 734 and 786 in survivors and not admitted to ICU;and biochemical figures (increase in C-reactive protein (CRP), lactate dehydrogenase (LDH) or cardiac enzymes, the latter, especially, in patients who were deceased, with a median ultrasensitive troponin I (ng/L) of 34.75 vs. 7.1 in survivors. The differences were statistically significant ( P value <0.01). Conclusions : Correlation exist between severity of infection and the increase in leukocytes, neutrophils, DD, CRP and LDH, and lymphopenia, in our sample. Decrease in the platelet count and the increase in cardiac enzymes were associated with an increased risk of mortality.
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Background : A first publication by Tang et in March 2020 reported a high incidence of Disseminated Intravascular Coagulation (DIC) in patients who died from SARS-COV-2 (COVID-19) infection. Since then, some studies have questioned this high incidence. Aims : To investigate the incidence of DIC in patients with confirmed diagnosis of severe COVID-19, who required admission to the ICU. Methods : Observational, descriptive, and retrospective study that includes patients older than 18 years with severe COVID-19 infection admitted to the ICU of the “Miguel Servet” University Hospital, between March to November 2020. All clinical and laboratory parameters, as well as the clinical conduct, were requested and carried out according to the usual clinical practice. Results : We included 130 patients 60% men, median age of 67 years (24-79), mortality of 40.8%, 9 cases (6.9%) of established DIC were documented, with impact in survival (Figure 1). Conclusions : Mortality in our series is similar to that reported (40%), the incidence in our series is higher than a recently published metaanalysis (6.9 VS 3%). The low incidence of DIC is interesting, because the high frequency of coagulopathy and elevation of D-dimer in the published series so, this raises the question, if there really is a classic DIC in patients with COVID-19. In our series, none of the patients with DIC presented hypofibrinogenemia. These findings support the theory that coagulopathy in COVID-19 patients is different from classic DIC and requires different management and classification.
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Purpose This study aims to determine whether the consumer's information literacy self-efficacy plays a role in their intention to resume their consumption of tourist services - specifically, hotel accommodation - in the context of the "new normal" brought about by the COVID-19 pandemic. Design/methodology/approach A quantitative empirical study is performed on hotel accommodation consumers and a structural equation modeling analysis is used to verify the proposed relationships. Findings The findings reveal that the tourist's information literacy self-efficacy - their ability to find the information they need, use it efficiently and discount fake news - positively influences their perception of hotel safety;and perceived hotel safety increases tourist intention to return to consuming hotel services. Practical implications The results show how the consumer's intention to return to using hotel services can be enhanced because of their management of information, especially in a crisis context. Hotel firms must position the provision of safety information at the heart of their marketing and communications strategies, and adapt this information to the different processing capabilities of consumers. Social implications This study provides valuable insights into the hotel industry - a major contributor to gross domestic product and employment worldwide that is being particularly hard-hit by the COVID-19 crisis. Originality/value This study represents an advance in the literature as it demonstrates - as a novelty - the vital role of consumer information literacy self-efficacy in encouraging people to begin visiting hotels again in the "new normal."
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TOPIC: Signs and Symptoms of Chest Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cardiorespiratory disorders usually present with acute respiratory distress;likewise, ureteral rupture usually presents as an acute abdomen [1]. We report a case of ureteral rupture presenting with acute respiratory distress leading to a delayed diagnosis. CASE PRESENTATION: An 82 y/o M with a history of congestive heart failure (CHF), chronic obstructive pulmonary disease, chronic renal failure and recently diagnosed COVID -19 pneumonia, was admitted for progressive dyspnea and abdominal discomfort for 2 days. Arterial blood gas showed hypercapnic hypoxic respiratory failure. Chest computed tomographic (CT) scan without contrast showed moderate right-sided pleural effusion but pulmonary embolism (PE) could not be ruled out. He also had a left leg deep venous thrombosis with worsening renal function and B-type natriuretic peptide (BNP) of 139pg/ml.His symptoms were thought to be due to acute decompensated CHF, COVID-19 pneumonia and possible PE. He failed to improve with intravenous furosemide, bilevel positive airway pressure ventilation and empiric anticoagulation. Due to worsening renal function and abdominal pain, an abdominal CT was done which showed right ureteral rupture with retroperitoneal collection and multiple non-obstructing renal calculi. The patient had placement of a double J stent with prompt resolution of respiratory distress. DISCUSSION: There are very few case reports of ureteral rupture occurring spontaneously and causing marked dyspnea. Respiratory distress may occur if the extravasated urine leads to an urinothorax or abdominal compartment syndrome [1]. Suspicion of non-cardiorespiratory causes of acute dyspnea in patients with underlying congestive heart failure includes respiratory distress disproportionate to the size of pleural effusion, unilateral effusions or effusions of markedly disparate size, absence of pulmonary vascular congestion and cardiomegaly, worsening renal function, ascites, urinary retention or anuria, abdominal pain, failure of the effusion to respond to management of heart failure, fever or pleuritic chest pain, and low or near-normal natriuretic peptides [2,3].When there are concerns for non-cardiorespiratory causes of respiratory distress, the diagnosis can be made with thoracentesis and imaging such as abdominal ultrasound, or CT [2]. CONCLUSIONS: This case illustrates a rare presentation of ureteral rupture causing respiratory distress and the key points that should elicit high clinical suspicion for non-cardiorespiratory causes of acute respiratory distress. When these findings are present, appropriate investigations and urgent intervention may be life-saving. REFERENCE #1: Choi SK, Lee S, Kim S, et al. A rare case of upper ureter rupture: ureteral perforation caused by urinary retention. Korean J Urol. 2012;53(2):131-133. doi:10.4111/kju.2012.53.2.131 REFERENCE #2: Leonidas Laskaridis, Spyridon Kampantais, Chrysovalantis Toutziaris, Basileios Chachopoulos, Ioannis Perdikis, Anastasios Tahmatzopoulos, Georgios Dimitriadis, "Urinothorax—An Underdiagnosed Cause of Acute Dyspnea: Report of a Bilateral and of an Ipsilateral Urinothorax Case", Case Reports in Emergency Medicine, vol. 2012, Article ID 395653, 3 pages, 2012. https://doi.org/10.1155/2012/395653 REFERENCE #3: Porcel JM. Pleural effusions from congestive heart failure. Semin Respir Crit Care Med. 2010 Dec;31(6):689-97. DOI: 10.1055/s-0030-1269828. Epub 2011 Jan 6. PMID: 21213200. DISCLOSURES: No relevant relationships by sharmela Brijmohan, source=Web Response No relevant relationships by Angelica Medina-Pena, source=Web Response No relevant relationships by Noura Semreen, source=Web Response
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TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Coronavirus Disease 2019 (COVID-19) has affected over 140 million with over 3 million deaths worldwide. As the virus continues, we face a new challenge;to discern between post COVID syndromes or COVID reinfection. We present a case with this medical dilemma. CASE PRESENTATION: 64 y/o F with Diabetes, Hypertension & history of asymptomatic COVID infection eight weeks prior to presentation with follow-up negative testing, presented with fever & SOB. She initially developed progressive dyspnea on exertion for which bronchodilators were initiated as an outpatient. She then presented to our hospital with fevers & progressive SOB. Her initial workup revealed normal blood work & inflammatory markers, however her COVID RNA test was positive with seronegative COVID antibodies. Imaging revealed increased bilateral ground-glass opacities & inter-septal thickening when compared to imaging one month prior. Her positive COVID tests were attributed to viral shedding & COVID therapy was not initiated. On hospital day 6 she began to decompensate requiring rapid escalation of oxygen supplementation to high flow nasal cannula. At this time high dose steroids were initiated as post COVID syndrome was thought to be the disease pathology. On hospital day 12 retesting revealed seroconversion of COVID antibodies. Her hospital course was complicated by severe hypoxia requiring prolonged steroid taper & oxygen supplementation. She was ultimately discharged on home oxygen with outpatient management. DISCUSSION: Complications of COVID-19 disease include reinfection & post-COVID syndrome. Reinfection was considered in this patient due to repeated negative tests & an asymptomatic period. This remains a rare phenomenon. There are only 5 reported known cases thus far. It was ruled out according to WHO guidelines, since there were <90 days between her 1st & 2nd positive tests. There was no genomic sequencing of both samples to confirm different genetic lineages. Her course was attributed to prolonged shedding of virus which can occur >3 months after infection & despite neutralizing antibodies. We believe she developed severe ARDS due to COVID pneumonitis with possible progression to ILD. Typical disease course is still unclear. There is increasing evidence of fibrotic-like changes in the lung in high rate of patients for up to 6 months. Reversibility of these findings is unknown. Post-mortem evaluation of lung tissue reveals diffuse alveolar damage from chronic inflammation. Obesity, ARDS, prolonged hospitalization & NIMV are reported risk factors. CONCLUSIONS: This case shows the importance of considering COVID reinfection in patients with atypical presentation. It is imperative that we differentiate between viral shedding & reinfection in patients with post-acute COVID symptoms. Both presentations may be similar, therefore it is pivotal that we continue to investigate these two-potentially fatal COVID related processes. REFERENCE #1: Pan American Health Organization / World Health Organization. Interim guidelines for detecting cases of reinfection by SARS-CoV-2. 29 October 2020, Washington, D.C.: PAHO/WHO;2020 REFERENCE #2: Qian Li, Xiao-Shuang Zheng, Xu-Rui Shen, Hao-Rui Si, Xi Wang, Qi Wang, Bei Li, Wei Zhang, Yan Zhu, Ren-Di Jiang, Kai Zhao, Hui Wang, Zheng-Li Shi, HuiLan Zhang, Rong-Hui Du & Peng Zhou (2020): Prolonged shedding of severe acute respiratory syndrome coronavirus 2 in patients with COVID-19, Emerging Microbes & Infections, DOI: 10.1080/22221751.2020.1852058 REFERENCE #3: Han X, Fan Y, Alwalid O, et al. Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. Radiology. 2021;299(1):E177-E186. doi:10.1148/radiol.2021203153 DISCLOSURES: No relevant relationships by Angelica Medina-Pena, source=Web Response No relevant relationships by Anna-Belle Robertson, source=Web Response No relevant relationships by Noura Semreen, source=Web Response no disclosure on file for David Shiu;No relevant relationships by Ro-Kaye Simmonds, source=Web Re ponse No relevant relationships by Jodi-Ann Smith, source=Web Response
ABSTRACT
Background: The COVID-19 pandemic has disrupted many aspects of clinical practice in oncology, particularly in making timely cancer diagnosis. Our public health system has been concerned about potential delays leading to a higher proportion of patients with advanced stages. Our cancer diagnosis fast-track program (CFP) in the Clinic-Malvarrosa Health department in Valencia (Spain) is connecting primary care (PC) with different specialists to speed cancer diagnosis and treatment upon well founded suspicion. A 10-year evaluation of our CFP has recently been published. The aim of this analysis was to investigate the impact of the COVID-19 pandemic on the CFP. Methods: We analysed the programme flow during the state of emergency starting on March 16, 2020 for one year. Results: During that year, 975 suspected cancer cases were submitted to the CFP. The submissions only decreased during the times of highest COVID-19 incidence and stricter lockdown (March, April and October 2020). However, referrals were slightly higher than in the two previous years (average 877). Of those 975 patients, 817 were seen by the corresponding specialist. A cancer diagnosis was confirmed in 197 (24.1%) with 33% urological, 23% breast, 16% gastrointestinal and 9% lung cancer. Median time from referral to the specialist visit was 13 (interquartile range, 8 to 22 days) days and a diagnosis was reached in a median of 18 days (interquartile range, 10 to 30 days). In cancer patients, treatment was started in around 30 days (interquartile range, 13.5 to 51 days) from the time of diagnosis. Sixty-one percent of cancers were found in an early stage, 20% in a locally advanced stage, and 19% in an advanced stage. These intervals and proportions were similar to the previous years. Conclusions: Our programme has proven to be a reliable tool to help PC physicians referring patients with cancer suspicion cancer, maintaining its normal flow and efficacy despite the current pandemic. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.