Impact of the COVID-19 pandemic on the treatment of head and neck cancer in Brazil

Introduction: To restrict the spread of COVID-19 infection, billions of people around the world have been quarantined or in social isolation. As a result of these health public measures, only essential services were maintained. Outpatient consultations and non-urgent surgeries were suspended to reduce hospitalizations and the risk of contagion. This context resulted in a delay in the diagnosis of several diseases, including head and neck cancer (HNC). Objective(s): To assess the impact of the COVID-19 pandemic on the treatment of HNC, comparing the number of surgery and radiotherapy, and chemotherapy procedures carried out during the pre-pandemic and pandemic periods in Brazil. Material(s) and Method(s): We compared the mean number of HNC surgeries and the number of radiotherapy and chemotherapy procedures carried out during the pre-pandemic (from March to July 2015-2019) and pandemic period (from March to July 2020) in the five geographic regions of Brazil. Result(s): Between 2015 and 2019, the mean number of surgeries for HNC was 5410. In 2020, during the same period, there were 3522 surgeries, representing a 35% decrease during the pandemic period. The greatest decrease was observed in the Northern region (60.7%). The number of radiotherapy and chemotherapy procedures increased by 50,8% in the pandemic period, with a higher prevalence in the Northeast (75.1%). Conclusion(s): During the peak of the COVID-19 pandemic, the data demonstrate a likely change in the HNC treatment protocol in Brazil.

Methodology for Virtual Education of Clinical Engineering through the Implementation of Digital Tools for Simulated Scenarios and International Collaboration

The Covid-19 global pandemic has represented a challenge for education, which had to migrate to virtual environments. Universities adopted different teaching methods to keep contributing to the growth of the professionals in various fields. In this context, the Biomedical Engineering program of the Pontificia Universidad Catolica del Peru and the Universidad Peruana Cayetano Heredia had to change or adapt the methodology of the courses included in its curriculum in order to reach the learning objectives. This paper presents a methodology for an innovative approach of simulated scenarios using digital tools for the virtual teaching of Clinical Engineering. The learning results achieved in two semesters of implementation of the methodology, during 2020 and 2021, were measured by means of a survey applied to the students at the end of the course. Obtaining achievement results above 76 % and improvement opportunities that would be useful for the next version of this course and for the replication of the methodology in other universities. © 2023 IEEE.

Patterns of Progression and Treatment Discontinuation in a Real Life Latin American Prospective Cohort Study of Intermediate-Advanced Hepatocellular Carcinoma: Second Interim Analysis

Introduction and Objectives: Previously published regional real-world results of overall survival (OS) in Barcelona Clinic Liver Cancer (BCLC) B and C patients demanded a prospective cohort study nested in a systematic and continuous medical educational networking group. This study aimed to describe and evaluate the treatment decisions in patients with hepatocellular carcinoma (HCC) within BCLC B and C stages. Material(s) and Method(s): A multicenter prospective cohort study, conducted in different Latin American centers from Argentina, Brazil and Colombia, started on 15th May 2018 (delayed recruitment during COVID locked-down period). Patients within BCLC B or C stages were included. Survival, tumor progression and patterns of treatment suspension were evaluated. Result(s): At this second interim analysis (projected final analysis March 2023), 390 HCC BCLC-B or C patients were included (n=15 excluded);mean age 65 years, 75.6% males and 89.5% cirrhotic. Median OS since HCC diagnosis was 27.2 months. Among BCLC-B patients, the most frequent therapy was transarterial chemoembolization (TACE, 42.3%);51.8% using drug-eluting beads and 47.4% conventional TACE;with a median OS since 1st TACE of 41.9 months. Similar radiological responses after 1st TACE were observed between both modalities. Overall, 48.2% of the cohort received systemic therapy for HCC (n=188), 23.7% still on BCLC-B stage. The most frequent systemic treatments were Sorafenib (74.5%), atezolizumab bevacizumab (17.5%), and lenvatinib (12.2%), with a median OS since systemic therapy of 15.7 months. Lenvatinib or atezolizumab bevacizumab was used as the second line following sorafenib in 5 and 3 patients, respectively. The most common causes of systemic treatment discontinuation were tumor progression and liver function deterioration (15% to 36.4%). Patterns of tumor progression were not specifically associated with prognosis or treatment discontinuation. Conclusion(s): Liver function deterioration occurs in a third of patients following systemic therapies. The complexity of treatment decisions underly the need for a multidisciplinary team and the role of hepatologists.Copyright © 2023

Job satisfaction of health personnel during the health emergencies in Latin America

Covid-19 put the healthcare system to the test worldwide and showed the relevance of health personnel, but also the weaknesses of the system to support their performance. In Latin America, the situation was chaotic for both the user and the health personnel. The latter were subjected to endless and stressful working hours with limited resources in most cases, which influenced their level of job satisfaction. Therefore, the research aimed to explain job satisfaction among health personnel in Peru, Bolivia and Brazil during the pandemic, considering motivation, working conditions and burnout as determinants. A quantitative, nonexperimental, cross-sectional and ex post facto approach was applied. The results showed the correlation between the determinants and job satisfaction. In the case of Brazil and Peru, the level of satisfaction tends to be higher, which is explained by positive working conditions, motivation and burnout, while in the case of Bolivia, job satisfaction is the lowest but also responds to negative values in the determinants. Additionally, it was found that there are other variables that could influence the level of job satisfaction © 2023, Revista de Ciencias Sociales.All Rights Reserved.

What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care

Objective: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. Methods: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. Results: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39;p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136;p = 0.6), antibiotic therapy (57% versus 64%;p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%;p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5];p = 0.002) and presented a higher use of vasopressors (47% versus 36%;p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%;p < 0.001) at admission, prone positioning (45% versus 36%;p = 0.04), and hydroxychloroquine (59% versus 10%;p < 0.001) and lopinavir/ ritonavir (41% versus 10%;p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%;p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. Conclusion: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave. © 2023 Associacao de Medicina Intensiva Brasileira - AMIB. All rights reserved.

Validation of the Prediction of Effectiveness of Statistical Time Series Models Using an Artificial Neural Network Model

The objective of this project was to predict the number of cases of infections and deaths from covid-19 through the application of artificial intelligence techniques in order to validate the effectiveness of a statistical model and counteract congestion in the health area within the territory. Ecuadorian, the rapid spread that caused serious consequences in the health systems and the virus triggered a global health crisis, the drastic impact on people's lives caused the application of Artificial Neural Networks-RNA techniques to obtain rapid diagnoses and effective. Historical data from the Ecuadorian state about the infections and deaths recorded per day were taken, the data was processed using the time series statistical method technique and later in the RNA models for the generation of the prediction and validation of the statistical method, the results obtained from each of the neural networks provided a feasible forecast that was close to the real values. The main conclusions show that the techniques applied in this project are efficient when predicting the number of cases of infection and death from covid-19 based on historical data and that the use of neural networks is very useful for solving various predictive problems. © 2022 Latin American and Caribbean Consortium of Engineering Institutions. All rights reserved.

Obtaining Geothermal Energy (green energy), an environmentally friendly and self-sustainable energy source. A literature review for the feasibility of implementation in Ecuador

Geothermal energy is a clean and sustainable energy source that should be introduced gradually as an eco-friendly alternative in Ecuadorian society in order to reduce pollution rates and the ecological footprint caused in the Ecuadorian territory and globally is an energy source that has been growing steadily in recent years, however, the recent energy crisis caused by the COVID 19 pandemic that hit every corner of the planet and the collateral effects of the armed conflict in Europe has substantially reduced its use, returning to the use of fossil fuels for momentary sustainability. This research article is developed with the purpose of analyzing the feasibility of implementing geothermal energy as a source of energy that is capable of supplying the energy consumption needs in communities far from the main cities in the province of Chimborazo, In addition to considering the advantages and disadvantages that are presented in the process of implementation of thermodynamic systems that are capable of supplying the energy consumption of the area, focusing mainly on the energy transformation to obtain electricity capable of feeding the household power grid that has a low energy demand according to its population density. Using a descriptive methodology and non-experimental design, among the results obtained it can be seen that in the province of Chimborazo, despite having several sources that if exploited could supply not only the surrounding communities, its scope could be extended to entire cantons if applied, however, the limitation is the economic investment and the almost null knowledge of the sectional authorities in the implementation of policies for the exploitation of clean and eco-friendly energies.Copyright © 2023, Anka Publishers. All rights reserved.

Detection of Covid-19 Through the Analysis of Radiographic Images of the Chest using Convolutional Neural Networks

There are different ways to detect Covid-19, which have emerged so far giving an effective response in detecting the disease, the PCR test is a reliable diagnostic method, which requires a well-equipped laboratory to obtain results, which can take hours or days. Another detection technique for this disease is by analyzing the chest image;This technique is used as a diagnostic tool in emergency areas in health centers, because it can reveal characteristics related to lung involvement. For this reason, it is important to develop an automatic detection system, as an alternative diagnosis option for Covid-19. Deep Learning techniques can help detect the SARS-CoV-2 virus by analyzing chest radiographic images. Thanks to the high availability of the datasets available, and using convolutional neural networks, the analysis is carried out by classifying images. In this research, two CNN models were created whose outputs are normal or covid19, the same ones that were trained with two datasets from public research repositories. The performance of the models trained in Pytorch were compared with the models trained in Keras under similar conditions of parameters and hyperparameters, obtaining a higher performance with Pytorch however since the two types of models have learned adequately with an accuracy that is above the 90% recommended the use of both models. © 2022 Latin American and Caribbean Consortium of Engineering Institutions. All rights reserved.

Digital planning in the treatment of juvenile maxillary psamomatoid ossifying fibroma Presentation of a case

Ossifying fibromas are benign fibro-osseous neoplasms that affect the craniofacial and mandibular skeleton. Juvenile psamomatoid ossifying fibroma is a rare variant of ossifying fibroma, which can be locally aggressive, and with a high recurrence rate. We present the clinical case of a 15-year-old patient with a morbid history of hypothyroidism and hyperparathyroidism, who consulted for increased volume and displacement of teeth in the right maxilla. The histopathological result was consistent with juvenile psamomatoid ossifying fibroma. Owing to the hospital situation during the COVID-19 the treatment consisted of hemimaxillectomy with iliac crest autograft using digital planning. © 2022 SECOM CyC.

Secondary bacterial infection in hospitalized COVID-19 patients. Experience in Colombia, South America

Background. Secondary infections are common among severe COVID-19 patients, increasing complications and mortality risk. These infections are not well characterized in Latin America and the Caribbean. Methods. A cross-sectional observational study of adult patients with COVID-19 admitted to the hospital Fundacion Valle del Lili in Cali-Colombia from March 2020 to March 2021. Demographic data, clinical characteristics, laboratory parameters, and clinical outcomes were collected. We describe secondary infection, antibiotic therapy, and antibiotic resistance profiles. Secondary infection was defined if the diagnosis occurred >=48 hours after hospital admission for COVID-19. Results. A total of 2138 patients with COVID-19 were analyzed;350 (16.3%) presented secondary infection. 60% were male;the median age was 65 years [IQR: 55-72]. Glucocorticoid therapy was indicated in 335 patients (96.3%). 281 received high doses and 54 low doses. Bacterial infections were the most common, affecting 81.3 % of patients, followed by fungal (14.4%) and viral (4.3%) infections. Most bacterial isolates were orotracheal secretion, blood, urine, and bronchoalveolar lavage fluid culture. The three most frequently identified bacteria were Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa. Most of the initial isolates were not antibiotic-resistant (75-89.7%). Empiric antibiotic therapy was indicated in 346 patients (98.9%), 268 received carbapenems (76.6%), 267 Vancomycin (76.3%), and 233 cefepime (66.6%). Of the 350 patients, 327 (93.4%) required management in the intensive care unit, and overall mortality was 35.4% (124/350). Conclusion. Our results showed a lower frequency of secondary infection than previous reports;However, a high frequency of broad-spectrum antibiotics usage was found despite a high prevalence of non-resistant bacteria. Further studies are needed to establish the best approach for antibiotics therapy.

Molecular diagnosis of SARS-CoV-2 at LIORAD-AICA+ laboratories, a one-year work experience

Introduction: The increase in the number of cases of COVID-19 in Cuba demanded of new capacities for the molecular diagnosis of the infection. A Laboratory of Molecular Biology for the molecular diagnosis of this disease was installed at the Base Business Unit LIORAD-AICA+ Laboratories in Havana.

Molecular diagnosis of SARS-CoV-2 at LIORAD-AICA+ laboratories, a one-year work experience

Introduction: The increase in the number of cases of COVID-19 in Cuba demanded of new capacities for the molecular diagnosis of the infection. A Laboratory of Molecular Biology for the molecular diagnosis of this disease was installed at the Base Business Unit LIORAD-AICA+ Laboratories in Havana. Objective(s): To analyze a one-year work experience in the molecular diagnosis of COVID-19 at the Laboratory of Molecular Biology, LIORAD-AICA+. Method(s): To begin with the molecular diagnosis of SARS-CoV-2 at LIORAD-AICA+, a group of actions were carried out aimed at evaluating the risks, establishing the working areas and flow, and training the work team. Personnel were trained, and procedures and guidelines were drawn up and modified. Result(s): Risk assessment allowed identifying several risks associated with the diagnostic activity, and measures were established to mitigate them. The laboratory personnel received 23 training sessions;and eight procedures and guidelines, and two registers were drawn up. The laboratory processed a total of 125 154 samples in a year. Conclusion(s): During the work year, the accurate diagnosis of the disease was conducted at the Laboratory of Molecular Biology, LIORAD-AICA+. This evidences the importance of personnel training and the compliance with good practices and biosafety measures when working with potentially infectious samples. Copyright © 2022, Editorial Ciencias Medicas. All rights reserved.

[Impact of COVID-19 pandemic confinement on musculoskeletal pain and quality of life]

INTRODUCTION: in March 2020, lockdown was established in Spain because of the COVID-19 pandemic. The aim of this study is to assess its impact on pain and quality of life in patients with musculoskeletal pain. MATERIAL AND METHODS: prospective study including 490 individuals grouped in: 140 people without pain, 140 people with musculoskeletal pain but without any related pathology diagnosed, 140 patients diagnosed for a musculoskeletal condition and 70 patients in surgical waiting list (SWL) for a musculoskeletal condition. Data regarding pain, physical activity and quality of life (EuroQol-5D) was collected at the beginning of lockdown and one year after (March 2021). RESULTS: mean age was 53 ± 17.5 years old (18-88) and 51.3% were women. Patients in SWL referred significantly more pain than the rest of groups (p < 0.001), with a score in the visual analogue scale of 6.3 ± 1.9. Groups 3 and 4 suffered a significant increase of their pain from 2020 to 2021 (p < 0.001), while decreasing in group 2 (p < 0.001). Analgesics intake grew from 2020 to 2021 (39.9% versus 44.3%, p = 0.007). 70.2% experienced a worsening of at least one dimension of EuroQol-5D over last year, with patients in SWL being the most affected (p < 0.001). CONCLUSION: lockdown has caused in patients with musculoskeletal conditions a greater aggravation of pain and deterioration of quality of life than in the general population, especially in patients in SWL, translating in an increase in analgesics intake.

Application of Machine Learning for the Prediction of Covid19 through Classification Techniques and Supervised Learning

In January 2020, in the city of Wuhan in China, a highly dangerous disease for humans appeared, cataloged as COVID-19 and caused by a virus called SARS-CoV-2;This disease spread from Asia to Europe and then spread throughout the American continent, causing a pandemic that to this day continues to cause irreparable damage. Currently the virus has mutated, and its variants continue to congest health systems in all parts of the world. The spread of the virus has generated information that is available on public research-oriented portals, and that is available for scientists and researchers to have the necessary information so that they can develop strategies to face and stop the disease. Using machine learning techniques, a prediction model has been created, which by applying supervised learning performs an analysis of historical data and has learned to identify patterns, managing to identify the disease. © 2022 Latin American and Caribbean Consortium of Engineering Institutions. All rights reserved.

Strategy for the reactivation of tourism in Mexico;Evidence of the use of saliva pools for the detection of COVID-19 in a tourist resort

The COVID-19 pandemic has caused a decrease in tourism activity. This has caused huge losses to the tourism industry, so different approaches have been devised for economic reactivation. This article aims to provide a novel strategy for mass molecular monitoring of clinically healthy individuals, and also including potentially asymptomatic carriers of SARS-CoV-2, who traveled to a tourist resort The monitoring consisted of collecting individual saliva samples (n=120) and conforming groups of 10 samples, thus setting 12 individual pools, which were analyzed by qRT-PCR. Obtained data showed that all the samples analyzed were negative, thus confirming that no individuals were infected with SARS-CoV-2 before and during the travel. The proposed molecular protocol allowed the analysis of massive saliva samples and detect individual infected persons (negative or positive). protocol for evaluate massive event, thus promoting the economic activation of the tourism industry.

Radiotherapy for Painful Bone Metastases: Analyzing Our Practice

Background/aims: Palliation of painful bone metastases encompasses a significant portion of radiation treatments. The COVID-19 pandemic has led us to consider shorter courses and hypofractionation. The purpose of this study is to analyze our practice: efficacy of single-fraction vs standard multifraction radiotherapy for alleviation of pain in patients with bone metastases. Methods: 178 patients who receive radiation treatment for painful bone metastases from March 2020 to March 2021 were reviewed. We analyze rate of re-irradiation and how the treatment line has been modified throughout the 1 year of the pandemic. Results: Median age was 68 years (range 36-93), 67% males, 33% females. Main primary tumors were 40% lung, 13% prostate and 32% breast. . Advanced disease was detected in 11% as debut. Treatment provided was: Only 8 patients required reirradiation, 75% of them had received single fraction. Currently, 62% died. Conclusions: Painful bone metastases is not an oncologic emergency but requires Radiotherapy for symptom management. Radiotherapy has improved quality of life in patients with advanced disease in the midst of the COVID-19 pandemic, when short radiation therapy cycles prevailed over the long ones. Almost single-fraction has shown to be an effective treatment option for patients with painful bone metastases, conventional multifraction should be considered for patients expected to have relatively long survival. (Table Presented).

Our Experience in Palliative Radiotherapy During the COVID-19 Pandemic

Background/aims: Radiotherapy is an effective palliative treatment for metastatic disease. The current COVID-19 pandemic has led us to consider shorter courses, new guidelines and prioritize cases clinically urgent. The purpose of this study is to analyze our practice in palliative treatment, new potential strategies and hypofractionation. Methods: 252 patients who receive palliative radiation treatment from March 2020 to March 2021 were reviewed. We analyze how the treatment line has been modified throughout the 1 year of the pandemic and other items related to the different therapeutic options as mortality, reirradiation, primary localization and intention. Results: Median age was 68 years (range 33-95y), 66% males, 34% females. Main primary tumors were 30% lung, 12% prostate and 10% breast. 65% patients had painful bone metastases, 15% brain metastases, 14% cord compression, 4% bleeding and 2% superior vena cava obstruction. Advanced disease was detected in 12% as debut. Half of patients were treated in the two first months of the pandemic than later. Treatment provided was: 8 patients required reirradiation. Currently, 66% died. Conclusions: Radiotherapy plays a critical role improving quality of life in patients with advanced disease, even in the midst of the COVID-19 pandemic. During the first months of confinement, short radiation therapy cycles prevailed over the long ones, as the normal schemes of fractionation coinciding with a greater number of sessions gained importance as time went on. (Table Presented).

Palliative Radiation Therapy for Painful Bone Metastasis in Times of COVID-19

Background/aims: Radiation therapy is critical for the treatment of painful bone metastases, providing an improvement in the quality of life of cancer patient. During the coronavirus disease 2019 (COVID-19) pandemic period, radiation oncologists have adapted to the situation, modifying the fractionations to shorter schedules, to prevent the risk of infection in palliative patient. Methods: Patients who receive antialgic palliative radiotherapy for painful bone metastases from March 2020 to March 2021 were reviewed. In this review we analyze the evolution of treatment schedules in related to the pandemic, as well as other data of interest related to the treatment. Results: 178patients were analyzed, with an average age of 68years (36-93years). 67.42% patients were males and 32.58% females. Most frequently primary tumors were 38%lung, 21%prostate and 18%breast. Pain bone metastasis were diagnosed as a debut symptom in 19 patients (10.67%). 7 patients(3.93%) required reirradiation. 110 patients(68%) died. Treatment schedules were: 99 patients (55.62%) received 5 fractions of 4Gy, 43 (24.16%) single fraction of 8Gy, 21 (11.80%) 10 fractions of 3Gy. Months with the highest incidence by COVID-19 were used shortest divisions and single session treatments. Conclusions: Cancer pain is one of the main reasons for radiotherapy treatment. During the pandemic, patients have been diagnosed in more advanced stages, in many cases as metastatic disease. Therefore, the need for treatment has increased. The option of shorter schedules is beneficial for the patient, since by reducing visits to the hospital the risk of infection decreases, without worsening the effectiveness of the treatment. (Table Presented).