Acute pulmonary embolism in times of SARS-CoV-2: Diagnostic and therapeutic management / Tromboembolismo pulmonar agudo en tiempos de SARS-CoV-2: diagnóstico y tratamiento

There is a clear association between novel coronavirus 2 infection and the diagnosis of venous thromboembolic disease, as a cosequence of the development of a systemic inflammatory response syndrome due to the activation of the coagulation cascade. It occurs in 90% of patients with severe forms of the infection, evidencing the presence of pulmonary endovascular micro and macro thrombosis. This suggests a possible clinical benefit of thromboprophylaxis according to the patient's clinical risk. The suspicion of venous thromboembolic disease in the context of this pandemic represents a diagnostic challenge due to the co-existence of similarities between both conditions in several different aspects. It should be noted that the diagnosis of acute pulmonary embolism does not exclude the possibility of simultaneous viral infection. The evaluation of patients with suspected acute pulmonary embolism in the context of the pandemic should be optimized in order to implement a rapid diagnosis and treatment to reduce the associated morbidity and mortality. This will help reducing infectious risk for health-care professionals and other patients.

Existe una clara relación entre la infección por el nuevo coronavirus 2 y el diagnóstico de enfermedad tromboembólica venosa, como consecuencia del desarrollo de un síndrome de respuesta inflamatoria sistémica debido a la activación de la cascada de la coagulación. Se presenta en el 90% de los pacientes con formas graves de la infección, lo que revela la presencia de microtrombosis y macrotrombosis intravascular pulmonar. Esto sugiere un posible beneficio clínico de la aplicación de una tromboprofilaxis adecuada al riesgo clínico de cada paciente. Asimismo, la sospecha de enfermedad tromboembólica venosa en el contexto de esta pandemia representa un reto diagnóstico debido a la existencia de similitudes entre ambas alteraciones en varios aspectos. Debe tenerse en cuenta que el diagnóstico de tromboembolismo pulmonar agudo no excluye la posibilidad de infección viral. La valoración de pacientes con sospecha de tromboembolismo pulmonar agudo en el contexto de la pandemia debe ser eficaz para establecer un diagnóstico y tratamiento con rapidez, a fin de reducir la morbilidad y mortalidad adjuntas, sin que ello eleve el riesgo de infección para los profesionales de la salud y otros pacientes.

Aggression, Micro-aggression, and Abuse Against Health Care Providers During the COVID-19 Pandemic. A Latin American Survey.

The COVID-19 pandemic has had tremendous consequences globally. Notably, increasing complaints of verbal and physical violence against health care providers have been reported. A cross-sectional electronic survey was conducted between January 11 and February 28, 2022 to delineate the violent behavior against front-line health professionals in Latin America. A total of 3544 participants from 19 countries were included. There were 58.5% women, 70.8% were physicians, 16% were nurses, and 13.2% were other health team members. About 54.8% reported acts of abuse: 95.6% verbal abuse, 11.1% physical abuse, and 19.9% other types. Nearly half of those who reported abuse experienced psychosomatic symptoms after the event, 56.2% considered changing their care tasks, and 33.6% considered quitting their profession. In a logistic regression model, nurses (odds ratio (OR) 1.90, P < 0.001), doctors (OR 2.11, P < 0.001), and administrative staff (OR 3.53, P = 0.005) experienced more abuse than other health workers. Women more frequently reported abuse (OR 1.56, P < 0.001), as well as those who worked directly with COVID-19 patients (OR 3.66, P < 0.001). A lower probability of abuse was observed at older ages (OR 0.95, P < 0.001). There has been a high prevalence of abuse against health personnel in Latin America during the COVID-19 pandemic. Those caring for COVID-19 patients, younger staff, and women were found to be at elevated risk. It is imperative to develop strategies to mitigate these acts and their repercussions on the patient-provider relationship and outcomes.

Ambulatory Patients with Cardiometabolic Disease and Without Evidence of COVID-19 During the Pandemic. The CorCOVID LATAM Study.

Background: SARS-CoV-2 pandemic has modified the cardiovascular care of ambulatory patients. The aim of this survey was to study changes in lifestyle habits, treatment adherence, and mental health status in patients with cardiometabolic disease, but no clinical evidence of COVID-19. Methods: A cross-sectional survey was conducted in ambulatory patients with cardiometabolic disease using paper/digital surveys. Variables investigated included socioeconomic status, physical activity, diet, tobacco use, alcohol intake, treatment discontinuation, and psychological symptoms. Results: A total of 4,216 patients (50.9% males, mean age 60.3 ± 15.3 years old) from 13 Spanish-speaking Latin American countries were enrolled. Among the study population, 46.4% of patients did not have contact with a healthcare provider, 31.5% reported access barriers to treatments and 17% discontinued some medication. Multivariate analysis showed that non-adherence to treatment was more prevalent in the secondary prevention group: peripheral vascular disease (OR 1.55, CI 1.08-2.24; p = 0.018), heart failure (OR 1.36, CI 1.05-1.75; p = 0.017), and coronary artery disease (OR 1.29 CI 1.04-1.60; p = 0.018). No physical activity was reported by 38% of patients. Only 15% of patients met minimum recommendations of physical activity (more than 150 minutes/week) and vegetable and fruit intake. Low/very low income (45.5%) was associated with a lower level of physical activity (p < 0.0001), less fruit and vegetables intake (p < 0.0001), more tobacco use (p < 0.001) and perception of depression (p < 0.001). Low educational level was also associated with the perception of depression (OR 1.46, CI 1.26-1.70; p < 0.01). Conclusions: Patients with cardiometabolic disease but without clinical evidence of COVID-19 showed significant medication non-adherence, especially in secondary prevention patients. Deterioration in lifestyle habits and appearance of depressive symptoms during the pandemic were frequent and related to socioeconomic status.

Impact of the Pandemic on NonInfected Cardiometabolic Patients: A Survey in Countries of Latin America-Rationale and Design of the CorCOVID LATAM Study.

BACKGROUND: The first case of coronavirus 2019 (COVID-19) in Latin America was detected on February 26th, 2020, in Brazil. Later, in June, the World Health Organization announced that the focus of the outbreak had shifted to Latin America, where countries already had poor control of indicators of noncommunicable diseases (NCDs). Concerns about coronavirus infection led to a reduced number of visits and hospitalizations in patients with NCDs, such as cardiovascular disease, diabetes, and cancer. There is a need to determine the impact of the COVID-19 pandemic on patients who have cardiometabolic diseases but do not have clinical evidence of COVID-19 infection. METHODS: The CorCOVID LATAM is a cross-sectional survey of ambulatory cardiometabolic patients with no history or evidence of COVID-19 infection. The study will be conducted by the Interamerican Society of Cardiology. An online survey composed of 38 questions using Google Forms will be distributed to patients of 13 Latin American Spanish-speaking countries from June 15th to July 15th, 2020. Data will be analyzed by country and regions. Seven clusters of questions will be analyzed: demographics, socioeconomic and educational level, cardiometabolic profile, lifestyle and habits, body-weight perception, medical follow-up and treatments, and psychological symptoms. RESULTS: Final results will be available upon completion of the study. CONCLUSIONS: The present study will provide answers regarding the impact of the COVID-19 pandemic on noninfected cardiometabolic patients. Data on this topic are scarce, as it is an unprecedented threat, without short-term solutions.

CONTEXTE: Le premier cas de maladie à coronavirus 2019 (COVID-19) en Amérique latine a été détecté le 26 février 2020 au Brésil. En juin, l'Organisation mondiale de la Santé a annoncé que le foyer de l'épidémie s'était déplacé en Amérique latine, où le suivi des indicateurs relatifs aux maladies non transmissibles est déjà déficient. Les préoccupations relatives à l'infection par le coronavirus ont entraîné une diminution du nombre de consultations et d'hospitalisations des patients atteints d'une maladie non transmissible, comme une ma-ladie cardiovasculaire, le diabète ou un cancer. Il est donc nécessaire d'évaluer l'incidence de la pandémie de COVID-19 chez les patients atteints d'une maladie cardiométabolique ne présentant aucun signe clinique d'une infection au virus de la COVID-19. MÉTHODOLOGIE: L'étude CorCOVID LATAM est une enquête transversale menée auprès des patients ambulatoires atteints d'une maladie cardiométabolique n'ayant pas d'antécédents d'infection au virus de la COVID-19 et ne présentant aucun signe d'une telle infection. L'étude est réalisée par la Société interaméricaine de cardiologie. Du 15 juin au 15 juillet 2020, on a demandé aux patients de 13 pays hispanophones d'Amérique latine de répondre à un questionnaire en ligne de 38 questions dans Google Forms. Les données seront analysées par pays et par région. Les réponses aux questions seront examinées selon sept grands thèmes : caractéristiques démographiques, caractéristiques socioéconomiques et niveau de scolarité, profil cardiométabolique, mode de vie et habitudes, perception quant au poids corporel, suivi et traitements médicaux et symptômes psychologiques. RÉSULTATS: Les résultats seront publiés à la fin de l'étude. CONCLUSIONS: L'étude fournira des renseignements sur l'incidence de la pandémie de COVID-19 chez les patients atteints d'une maladie cardiométabolique non infectés. Les données sur cette question sont rares, puisqu'il s'agit d'une menace sans précédent, à laquelle il n'existe de surcroît pas de solution à court terme.

Cambios Degenerativos y Evaluación Funcional de Fracturas Intraarticulares de Tobillo en Pacientes Pediatricos

Introducción Las fracturas de tobillo representan el 12% de las fracturas en la edad pediátrica. Planteamos la hipótesis que los pacientes con fracturas intraarticulares de tobillo tendrán un excelente resultado funcional y no presentarán cambios degenerativos articulares a los 6 meses post cirugía. El objetivo del estudio es realizar un analisis del resultado funcional, así como la presencia de cambios radiologicos degenerativos precoces en el seguimiento de pacientes con fracturas intra-articulares de tobillo tratadas en nuestro centro. Materiales y Métodos Estudio de Cohorte retrospectivo, se recolectaron datos de pacientes con fracturas intra-articulares de tobillo entre 2012 y 2016. Se clasificaron y evaluaron mediante score AOFAS y radiografías para clasificar según Van Dijk. Resultados La diferencia promedio de edad entre las fracturas triplanares y tillaux es de 17 meses (p: 0.038). La media de Score AOFAS fue de 85,2%. El 88.8% refiere dolor en relación a actividades cotidianas, a pesar de tener excelentes o buenos resultados funcionales. No hay correlación significativa entre los resultados de AOFAS en pacientes con fracturas transicionales y no transicionales., 43,4% presentaron estadio 0, 43,4% estadio I y 13% estadio II de Van Dijk. Ningún caso presento estadio III. Discusión En base a los hallazgos de este estudio, y al contrario de lo hipotetizado, la mayoría de los pacientes tienen un buen resultado funcional tras el manejo de las fracturas intraarticulares de tobillo y no excelente como se pensaba. Existe un grupo de pacientes que mostró cambios degenerativos precoces demostrables por radiografía. Background Ankle fractures represent 12% of fractures in pediatric age. We hypothesized that patients with intra-articular ankle fractures will have an excellent functional result and will not present degenerative joint changes 6 months after surgery. The objective of the study is to carry out an analysis of the functional result, as well as the presence of early degenerative radiological changes in the follow-up of patients with intra-articular ankle fractures treated in our center. Methods Retrospective cohort study, data were collected from patients with intra-articular ankle fractures between 2012 and 2016. They were classified and evaluated using AOFAS score and radiographs to classify according to Van Dijk. Results The average age difference between triplanar and tillaux fractures is 17 months (p: 0.038). The mean AOFAS Score was 85.2%. 88.8% reported pain in relation to daily activities, despite having excellent or good functional results. There is no significant correlation between the AOFAS results in patients with transitional and non-transitional fractures. 43.4% had stage 0, 43.4% stage I, and 13% stage II Van Dijk. No case presented stage III. Discussion Based on the findings of this study, and contrary to the hypothesized, most patients have a good functional result after the management of intra-articular ankle fractures and not excellent as previously thought. There is a group of patients who showed early degenerative changes demonstrable by radiography.