COVID-19 and Dermal Fillers: Should We Really Be Concerned? / COVID y rellenos faciales ¿realmente debemos preocuparnos?

SARS-CoV-2 has caused millions of infections and deaths worldwide and case numbers continue to rise. Besides the effect of the virus on key organs - leading to respiratory illness, anosmia, diarrhea, and fever and other complications - delayed inflammatory reactions to hyaluronic acid dermal fillers, mainly in the face, have also been reported to occur after confirmed SARS-CoV-2 infections and in vaccinated individuals. While delayed inflammatory reactions tend to be self-limiting, they should be diagnosed and treated with corticosteroids, hyaluronidase, and/or antibiotics when necessary. The inflammation is generally not severe, yet these complications are classified as serious adverse events by the US Food and Drug Administration. They appear to be delayed type IV hypersensitivity reactions triggered by the immune system in the presence of SARS-CoV-2 or other viruses, such as those causing influenza, although the underlying mechanisms have not been fully elucidated. Because the longevity of dermal fillers is increasing, while the pandemic continues to evolve and new vaccines are under development, the long-term effects on hyaluronic acid fillers and other bioimplant materials should be studied. Physicians must also be encouraged to report these reactions, however mild, to ensure accurate records.

Organization of the fight against COVID-19 in a hospital institution. Cienfuegos Province, 2020-2021

Background: epidemics of unknown emerging diseases test not only the technical and human capacity of health professionals, but also of all those who make up the scientific community in society.Objective: to describe the organization of health care services in the fight against COVID-19 at the Heroes de Paya Giron Specialized Outpatient Center, in Cienfuegos.Methods: a research was carried out on health systems and services that describe the stages of hospital reconversion for the care of suspected and confirmed patients, the number of admitted patients, the extension to a nearby school center and the maintenance of other vital services. Human resources and availability of beds for patient care were also taken into account. The After Action Review method was applied to study lessons learned. The information was obtained from interviews with ten key informants and from the statistics and human resources departments' reports.Results: the organization of medical care during the year 2020 was related to the evolution of the pandemic in the province. 569 adults and 91 pediatric patients were admitted. On January the 5th, 2021, the second stage of confronting the disease began and the mission of the center was transformed towards the care of positive cases of COVID-19, the number of intensive care beds was increased, a sign of the progressive worsening of patients especially from the end of June, July and August 2021.Conclusions: it can be affirmed that there is a center in the Cienfuegos Province with the capacity to rearrange itself in less than 24 hours to take care of patients with emerging infectious diseases. This shows the need to increase the training of Graduates in Intensive Nursing, as well as to create an Organization and Procedures Manual in each service, adjusted to the care protocols and asepsis, antisepsis and biosafety measures.

[Expert opinion on strategies to improve vaccination coverage against seasonal influenza]. / Documento de opinión de expertos para la mejora de la cobertura vacunal frente a la gripe estacional.

Seasonal flu continues to be a major public health concern, and the influenza vaccine remains the most effective preventive measure. In Spain, vaccination coverage data from previous seasons show vaccination rates well below official targets; however, these figures improved significantly after the COVID-19 pandemic. Given the importance of achieving and maintaining high vaccination rates in order to avoid the clinical and economic impact of influenza, our multidisciplinary group of experts on vaccines analyzed the impact of low vaccination rates in Spain and drafted a series of measures to boost influenza vaccination coverage, particularly among priority groups.

COVID-19 and resource families: an examination of ongoing impact and disparities

Resource parents (n = 527) in Los Angeles County were surveyed about their experiences with COVID-19, comparing the beginning of "Safer-at-Home” to over a year later. The findings reveal increased infection rates, maintained or increased reports of adverse impact and coping challenges, decreased reports of positive impact, and increased access to resources across time points. Compared to White resource parents, Black and Latinx resource parents reported both more adverse and more positive impact and less access to resources. Further, single caregiver households reported more financial worries, and foster parents and kinship caregivers reported more coping challenges than foster-adoptive parents. © 2023 Taylor & Francis Group, LLC.

Impact of the COVID-19 pandemic on the mental health of the general population and health care workers.

The Health Sciences Foundation has assembled a multidisciplinary group around a series of questions about the impact of the COVID-19 pandemic on the mental health of the general population and specific groups within that population, particularly healthcare workers. In the general population, the most prevalent mental disorders have been anxiety, sleep disorders and affective disorders, primarily depression. There has been a considerable increase in suicidal behavior, especially in young women and men over 70 years of age. There has been an increase in alcohol abuse and nicotine, cannabis and cocaine use. In contrast, the use of synthetic stimulants during periods of confinement has decreased. With regard to non-substance addictions, gambling was very limited, pornography consumption increased significantly and there was an increase in compulsive shopping and the use of video games. Particularly vulnerable groups include adolescents and patients with autism spectrum disorders. Healthcare workers suffered an increase in depression, anxiety and post-traumatic stress, especially those who were exposed during the early stages of the pandemic. Female sex, being a nurse, proximity to patients with COVID-19, working in a rural environment and having previous psychiatric or organic illnesses were some of the most frequently repeated factors in various studies in this population group. The media have shown a good degree of knowledge about these problems and have dealt with them frequently and from the point of view of ethics, crisis situations, such as the one experienced, have triggered not only physical but also moral claudications.

Telemedicine Associated with Integrated Decentralized Testing and Onsite Treatment for Hepatitis C Infection at Drug Addiction Centres Is Effective: A Randomized Clinical Trial

Background: The role of telemedicine seems to be important in the management of hepatitis C virus (HCV) infected patients. Many studies have been conducted in prisons, drug addiction centres and more recently general population because of the COVID pandemic. However, evidence of effectiveness evaluated by randomized clinical trials is scarce but relevant to firmly promote telemedicine at drug addiction centres to achieve WHO 2030 elimination goals. Method(s): From Jul/2019 to Dec/2020, a total of 120 patients who attended one drug addiction centre were randomized (NCT04035980) into two groups: telemedicine strategy (including dry blood spot HCV RNA testing, HCV specialist videoconferencing with the patient, and onsite treatment and FIB-4 score calculation if RNA was positive) vs. conventional care strategy (included dry blood spot testing and referral to reference centre with the specialist if RNA was positive). Clinical variables were collected to assess the characteristics of patients in both strategies. Sustained virological response was assessed as a primary outcome. Additionally, among a patient subset, we administered a modified 10-item telemedicine satisfaction questionnaire. Result(s): We included 120 subjects (age 42.4+/-11.1, 85% male) with characteristics shown in the table. The number of included patients during the COVID pandemic (n=41) was similar in the telemedicine group and conventional group (31.7% vs 36.7%). Overall, 13 (10.8%) patients tested positive for RNA, 10 (9 in pre-pandemic time) in the telemedicine group vs. 3 (1 in pre-pandemic time) in the conventional group (p=0,050). All but one of the patients in the telemedicine group initiated treatment with direct-acting antivirals, whereas only one patient (33.3%) in the conventional group that was rescued with telemedicine after not showing up to the appointment with the specialist. Sustained virological response was documented in 90.9% of the patients. Patients who attended by telemedicine scored high on the satisfaction questionnaire. Conclusion(s): Our results showed telemedicine and onsite treatment delivery at drug addiction centres as the integrative model of care of choice to eliminate HCV from persons with substance use disorders. (Figure Presented).

Timing analysis of the sanitization process due to the COVID-19 pandemic in an elementary school using simulation

The recent pandemic caused by the COVID-19 virus, forced all educational institutions in the Mexican national territory to close their doors to face-to-face classes during the month of March 2020. It was many months later, when the Ministry of Public Education announced the return to hybrid classes for the 2021-2022 school year. This represented a challenge for schools in this national territory, particularly those from primary level since all institutions must have had biosafety and disinfection protocols in order to receive all their students and safeguard their safety. For this reason, a primary school was chosen for this study and a discrete event simulation was performed;the main objective of the simulation was to analyze the time invested in the different sanitizing stations, as well as the establishment of new stations to choose the best option that can lead to a timely disinfection process that accommodates the total number of students without affecting the planned day-to-day academic activities. © 2022 The Authors.

COVID-19 and Dermal Fillers: Should We Really Be Concerned? COVID y rellenos faciales ¿realmente debemos preocuparnos?

SARS-CoV-2 has caused millions of infections and deaths worldwide and case numbers continue to rise. Besides the effect of the virus on key organs – leading to respiratory illness, anosmia, diarrhea, and fever and other complications – delayed inflammatory reactions to hyaluronic acid dermal fillers, mainly in the face, have also been reported to occur after confirmed SARS-CoV-2 infections and in vaccinated individuals. While delayed inflammatory reactions tend to be self-limiting, they should be diagnosed and treated with corticosteroids, hyaluronidase, and/or antibiotics when necessary. The inflammation is generally not severe, yet these complications are classified as serious adverse events by the US Food and Drug Administration. They appear to be delayed type IV hypersensitivity reactions triggered by the immune system in the presence of SARS-CoV-2 or other viruses, such as those causing influenza, although the underlying mechanisms have not been fully elucidated. Because the longevity of dermal fillers is increasing, while the pandemic continues to evolve and new vaccines are under development, the long-term effects on hyaluronic acid fillers and other bioimplant materials should be studied. Physicians must also be encouraged to report these reactions, however mild, to ensure accurate records.

Epidemiology Of Herpes Zoster Ophthalmicus in context of the SARS-CoV2 (COVID) pandemic

Purpose : The incidence of herpes zoster ophthalmicus (HZO) may be increasing, however the impact of the SARS-CoV2 pandemic (COVID) on HZO epidemiology is unclear. This study seeks to determine the variation in the incidence of HZO over the past 6 years with a special focus on its correlation with overall systemic herpes zoster (SHZ) incidence and HZO monthly and seasonal changes before and after the onset of COVID. Methods : This is a hospital-based epidemiology study of patients attending Duke University Hospital System (DUHS) between 01/2016 and 10/2021 via Duke Enterprise Data Unified Content Explorer (DEDUCE) data with corresponding ICD codes for HZO and SHZ diagnosis. The analysis calculated monthly incidence of novel consults of HZO and SHZ with emphasis on demographics, seasonal variation, and the changes in rates with the COVID pandemic (estimated to impact DUHS population starting in 03/2020). Results : 24896 patients presented with SHZ at DUHS in the study period, of whom 2921 (11.7%) suffered from HZO. The mean age at the incident episode of HZO was 62.8±15.6 years. Most patients were white (78%), female (63.5%), above 50 years old (79.5%) and non-smokers (61.5%). Over the study period SHZ experienced an overall decline in its incidence, however HZO incident cases have been slightly increasing with a mean of 37/month in 2016, 47/month in 2019, and 50/month in 2021. The ratio of monthly incidence HZO/SHZ demonstrates a steady increase from an annual 9% in 2016 to 13.4% in 2019 and 15.5% in 2021. Interestingly, HZO annual peak incidence steadily emerged in the months of November and February throughout all the years. Since COVID onset, the mean monthly incidence of SHZ decreased significantly (373.1 +/- 35 vs 312.1 ± 28, p<0.0001). However, the mean monthly incidence of HZO exhibited a statistically significant increase (39.5 ± 10 vs 46.7 ± 16;p=0.025). Likewise, the trendlines of HZO/SHZ exhibited a significant increase since COVID (10.6% ± 4.6 to 15.1% ± 2.7;p<0.0001). Conclusions : These study findings point that HZO incidence may be increasing, despite an overall lower SHZ incidence, which may suggest a distinct mechanism for HZO appearance despite vaccination efforts. A specific seasonal variation with winter peaks was observed, which should guide physicians towards early recognition of HZO. COVID, directly or indirectly, may have accelerated the already increasing HZO incidence.

[[Translated article]]COVID-19 and Dermal Fillers: Should We Really Be Concerned?

SARS-CoV-2 has caused millions of infections and deaths worldwide and case numbers continue to rise. Besides the effect of the virus on key organs - leading to respiratory illness, anosmia, diarrhea, and fever and other complications - delayed inflammatory reactions to hyaluronic acid dermal fillers, mainly in the face, have also been reported to occur after confirmed SARS-CoV-2 infections and in vaccinated individuals. While delayed inflammatory reactions tend to be self-limiting, they should be diagnosed and treated with corticosteroids, hyaluronidase, and/or antibiotics when necessary. The inflammation is generally not severe, yet these complications are classified as serious adverse events by the US Food and Drug Administration. They appear to be delayed type IV hypersensitivity reactions triggered by the immune system in the presence of SARS-CoV-2 or other viruses, such as those causing influenza, although the underlying mechanisms have not been fully elucidated. Because the longevity of dermal fillers is increasing, while the pandemic continues to evolve and new vaccines are under development, the long-term effects on hyaluronic acid fillers and other bioimplant materials should be studied. Physicians must also be encouraged to report these reactions, however mild, to ensure accurate records.

A randomized multicentre clinical trial to evaluate the efficacy of melatonin in the prophylaxis of SARS-COV-2 infection in high-risk contacts (MECOVID trial): Preliminary data

Objective: To evaluate the efficacy of melatonin as a prophylactic treatment on prevention of symptomatic SARSCoV- 2 infection among healthcare workers at high risk of SARS-CoV-2 exposure. Material and/or methods: In April 2020 we designed a two-arm parallel randomized double-blind controlled trial. Healthcare workers fulfilling inclusion criteria were recruited in five hospitals in Spain and were randomized 1:1 to receive melatonin 2 mg administered orally for 12 weeks or placebo. Study visits: Screening (D1), Week 4, 8 and 12. A follow-up phone call was performed 4 weeks after the last intake of the study drug. The main outcome was the number of SARS-CoV-2 symptomatic infections (COVID-19) confirmed by polymerase chain reaction (PCR) or serologic test or according to each centre diagnosis protocol. During the study, participants should daily enter in an online application data concerning treatment administration, adverse events, food intake, exercise, sleeping hours and other data related to the effects of melatonin. Also, participants were asked to fulfil the Pittsburgh Sleep Quality Index (PSQI) at screening and at the 12 week visit. Results: A total of 344 volunteers were screened, mean age was 40.1 (10.8) years and most of them were females (80.8%). Three hundred fourteen were randomized (151 placebo;163 melatonin) and 308 received the study treatment (148 placebo;160 melatonin). We detected 13 SARS-CoV-2 symptomatic infections during the follow-up, 2.6% in the placebo arm (n = 4/151) and 5.5% in the melatonin arm (n = 9/163) (p = 0.2). A total of 124 participants had at least one adverse event. A total of 304 adverse events were detected. No severe adverse events related to treatment were reported. Conclusions: We cannot confirm our hypothesis that administration of melatonin prevents the development of SARS-CoV-2 infection in high-risk contacts (hospital staff). Other safety and efficacy data, PSQI data and data obtained from the online application fulfilled by the participants will be soon analysed.

Associations of the COVID-19 pandemic with social well-being indicators in Mexico.

BACKGROUND: Public health measures for COVID-19 containment have implied economic and social life disruptions, which have been particularly deleterious in low- and middle-income countries (LMIC) due to high rates of informal employment, overcrowding, and barriers to accessing health services, amongst others social determinants. Mexico, a LMIC, is a country with a high COVID-19 mortality in which there has been a very limited governmental response to help mitigate such COVID-related disruptions. This study analyzes the association of the first wave of the COVID-19 crisis in Mexico with four well-being indicators: income, employment, anxiety, and food security. METHODS: It uses pooled cross-sectional data (n = 5453) of five monthly nationally representative surveys collected between April and August 2020. Probit models are estimated to assess the association of the pandemic with job loss and anxiety; a multinomial logistic regression is estimated for food security, and an ordinary least squares regression assesses the association between the pandemic and changes in household's income. RESULTS: Females were significantly associated with worse outcomes for the 4 well-being measures with an average reduction of 2.3% in household income compared to pre-COVID-19 levels, an increased probability (6.4 pp) of being in a household that had lost jobs, decreased probability of food security (6.9 pp), and an increased risk of anxiety symptoms (8.5 pp). In addition, those with lower SES and household with children also reported worse outcomes for employment, income and food security. The month variable was also statistically significant in these models suggesting that as more months of the pandemic elapsed the effects persisted. CONCLUSION: The currents study documents how the COVID-19 pandemic is associated with different well-being indicators in a LMIC. It suggests the urgent need to take actions to support vulnerable groups, particularly women, households with children and those in the lowest SES. If policy actions are not taken, the pandemic will increase social and gender disparities, and will jeopardize childhood development.

TELEWORKING A NEW REALITY IN THE SPANISH PUBLIC ADMINISTRATION. DEVELOPMENT OF A MUNICIPAL PROJECT OFFICE IN DISTANCE MODE

The health crisis caused by COVID-19 has forced Public Administrations to take a giant step in electronic administration and teleworking. This step, which would have taken years to be implemented due to the rigid structures of the Spanish Administration, had to be implemented in two weeks with a new working system. Having overcome the provisional situation, it is necessary to carry out an implementation of e-administration and teleworking thoughtfully and not unexpectedly. The Project Management Offices have a scarce implantation in the public administrations in Spain. This paper analyses the different types of methodologies for the development and implementation of a PMO in a Spanish City Council, for its technical unit of projects, in order to improve the quality of the projects and the results of the public service provided for the development of municipal works. The result of the analysis will be used for the design of a municipal PMO model focused on the quality of the projects, the quality of the public service, and on the fact that, in the PMO of the future, as long as it is not an activity in which presence is essential, the work will be virtual. © 2021 by the authors

Suicide-related thoughts and behavior and suicide death trends during the COVID-19 in the general population of Catalonia, Spain.

The COVID-19 pandemic is expected to increase suicidal behavior. However, data available to date are inconsistent. This study examines suicidal thoughts and behaviors and suicide trends in 2020 relative to 2019 as an approximation to the impact of the pandemic on suicidal behavior and death in the general population of Catalonia, Spain. Data on suicide-related thoughts and behaviors (STBs) and suicidal mortality were obtained from the Catalonia Suicide Risk Code (CSRC) register and the regional police, respectively. We compared the monthly crude incidence of STBs and suicide mortality rates of 2020 with those of 2019. Joinpoint regression analysis was used to assess changes in trends over time during the studied period. In 2020, 4,263 consultations for STBs and 555 suicide deaths were registered in Catalonia (approx. 7.5 million inhabitants). Compared to 2019, in 2020 STBs rates decreased an average of 6.3% (incidence rate ratio, IRR=0.94, 95% CI 0,90-0,98) and overall suicide death rates increased 1.2% (IRR=1.01, 95% CI 0.90-1.13). Joinpoint regression results showed a substantial decrease in STBs rates with a monthly percent change (MPC) of -22.1 (95% CI: -41.1, 2.9) from January-April 2020, followed by a similar increase from April-July 2020 (MPC=24.7, 95% CI: -5.9, 65.2). The most restrictive measures implemented in response to the COVID-19 pandemic reduced consultations for STBs, suggesting that the "stay at home" message may have discouraged people from contacting mental health services. STBs and mortality should continue to be monitored in 2021 and beyond to understand better the mid-to-long term impact of COVID-19 on suicide trends.

Semi-autonomous Mobile Robot for Environmental Surfaces Disinfections Against SARS-CoV-2

In recent years, semi-autonomous and teleoperated mobile robots have been designed and implemented to perform various disinfection tasks in different environments. Since the end of 2019 new mobile robots have been created or modified to contribute to the needs of disinfection tasks caused by the COVID-19 pandemic. Most of these mobile platforms currently in use are based on disinfection by means of either UVC rays or approved chemical products. In this paper, the description of a new disinfection robot against SARS-CoV-2 is presented, with the idea of making a new contribution to this cause. This is a semi-autonomous mobile robot that carries a fogging system whose nozzle is guided by means of a small two-degree-of-freedom robotic arm designed and implemented for this purpose. In addition, this disinfection mobile robot can also be tele operated. The robot has an on-board computer for high-level control and microcontroller boards for low-level control. It also has an on-board sensory system consisting of depth and tracking cameras. Communication with the remote operator is done via the Internet by implementing a Wi-Fi module in the robot. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Puerto Rico Health System Resilience After Hurricane Maria: Implications for Disaster Preparedness in the COVID-19 Era

Background: Every year, Puerto Rico faces a hurricane season fraught with potentially catastrophic structural, emotional and health consequences. In 2017, Puerto Rico was hit by Hurricane Maria, the largest natural disaster to ever affect the island. Several studies have estimated the excess morbidity and mortality following Hurricane Maria in Puerto Rico, yet no study has comprehensively examined the underlying health system weaknesses contributing to the deleterious health outcomes. Methods: A qualitative case study was conducted to assess the ability of the UPR health system to provide patient care in response to Hurricane Maria. An established five key resilience framework and inductive analysis was used to identify factors that affected health system resilience. Thirteen Emergency Medicine Physicians, Family Medicine Physicians, and Hospital Administrators in a University of Puerto Rico (UPR) Community Hospital were interviewed as part of our study. Results: Of the five key resiliency components, three domains were notably weak with respect to UPR's resiliency. Prior to the Hurricane, key personnel at the UPR hospital were unaware of the limited capacity of back-up generators at hospitals and were ill-prepared to transfer ICU patients to appropriate hospitals. Post Hurricane, the hospital faced self-regulation challenges when triaging the provision of Hurricane-related emergency services with delivering core health services, in particular for patients with chronic conditions. Finally, during and after the Hurricane, integration of patient care coordination between the UPR hospital ambulances, neighboring hospitals, and national and state government was suboptimal. The two remaining resiliency factors, addressing diverse needs and system adaptiveness in a time of crisis, were seen as strengths. Conclusions: Hurricane Maria exposed weaknesses in the Puerto Rican health system, notably the lack of awareness about the limited capacity of backup generators, poor patient care coordination, and interruption of medical care for patients with chronic conditions. As in other countries, the current COVID epidemic is taxing the capacity of the Puerto Rico health system, which could increase the likelihood of another health system collapse should another hurricane hit the island. Therefore, a resilience framework is a useful tool to help health systems identify areas of improvement in preparation for possible natural disasters.