RETENTION IN CARE AMONG PERUVIAN MSM AND TGW IN A REAL-WORLD HIV PrEP PROGRAM

Background: Tenofovir-based daily oral HIV pre-exposure prophylaxis (HIV PrEP) is a highly efficacious HIV prevention modality, but sustained use over time is needed for continued protection among individuals at high risk for HIV exposure. Suboptimal adherence and retention in care threaten to diminish the impact of HIV PrEP on reducing HIV burden. PrEP PERU is an ongoing, multi-site, prospective cohort study evaluating HIV PrEP implementation among adult men who have sex with men (MSM) and transgender women (TGW) accessing care at non-government health centers in Peru. We sought to evaluate HIV PrEP adherence and retention in care among PrEP PERU participants prior to the onset of COVID-19 service disruptions. Method(s): We analyzed baseline and follow-up data from the PrEP PERU study through 3/15/2020, the first day of Peru's COVID-19 lockdown. MSM and TGW >=18 years of age with at least one HIV risk factor were eligible for enrollment. After the first follow-up visit at 4 weeks, TDF/FTC refills and clinic visits occur quarterly, at the discretion of the prescribing clinician. The medication is provided free of charge, but participants pay for laboratory testing plus a small service fee for clinic visits. Data is collected at baseline and quarterly follow-up visits on sexual risk behaviors and HIV PrEP use. We used bivariate analysis to evaluate the association between baseline factors and 6-month HIV PrEP retention in care. As a proxy for adherence, pharmacy dispensation records were used to calculate the proportion of days covered (PDC) by TDF/FTC. Result(s): Overall, 351 participants started TDF/FTC at four study sites in Lima from 1/23/2017 to 3/15/2020. Of this analysis population, 94% were cisgender men, 10% identified as bisexual, and median age was 31 (interquartile range [IQR], 27 - 38). Among those with at least 6 months of observation time (n=302), 91% attended >=1 follow-up visit and 77% attended >=2 follow-up visits during the 6 months after enrollment. The proportion with favorable adherence (PDC >=0.8) was 85%. There were 6 confirmed HIV seroconversions in the analysis period (1.2 per 100 person-years). Conclusion(s): In this analysis of HIV PrEP outcomes among MSM and TGW prior to COVID-19 pandemic disruptions in Peru, over 3/4 of the population remained in care and had favorable measures of adherence during the first 6 months after.

Acute respiratory distress syndrome due to COVID-19. Clinical and prognostic features from a medical Critical Care Unit in Valencia, Spain Síndrome de dificultad respiratoria aguda asociado a la COVID-19. Características clínicas y de pronóstico en una unidad de cuidados intensivos de Valencia, España

Objective Information from critically ill coronavirus disease 2019 (COVID-19) patients is limited and in many cases coming from health systems approaches different from the national public systems existing in most countries in Europe. Besides, patient follow-up remains incomplete in many publications. Our aim is to characterize acute respiratory distress syndrome (ARDS) patients admitted to a medical critical care unit (MCCU) in a referral hospital in Spain. Design Retrospective case series of consecutive ARDS COVID-19 patients admitted and treated in our MCCU. Setting 36-bed MCCU in referral tertiary hospital. Patients and participants SARS-CoV-2 infection confirmed by real-time reverse transcriptase–polymerase chain reaction (RT-PCR) assay of nasal/pharyngeal swabs. Interventions None Main variables of interest Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Results Forty-four ARDS COVID-19 patients were included in the study. Median age was 61.50 (53.25 – 67) years and most of the patients were male (72.7%). Hypertension and dyslipidemia were the most frequent co-morbidities (52.3 and 36.4% respectively). Steroids (1mg/Kg/day) and tocilizumab were administered in almost all patients (95.5%). 77.3% of the patients needed invasive mechanical ventilation for a median of 16 days [11-28]. Prone position ventilation was performed in 33 patients (97%) for a median of 3 sessions [2-5] per patient. Nosocomial infection was diagnosed in 13 patients (29.5%). Tracheostomy was performed in ten patients (29.4%). At study closing all patients had been discharged from the CCU and only two (4.5%) remained in hospital ward. MCCU length of stay was 18 days [10-27]. Mortality at study closing was 20.5% (n 9);26.5% among ventilated patients. Conclusions The seven-week period in which our MCCU was exclusively dedicated to COVID-19 patients has been challenging. Despite the severity of the patients and the high need for invasive mechanical ventilation, mortality was 20.5%.

Predictive models of intensive care unit admission in patients with covid-19: systematic review

Background: It is essential to identify the epidemiological and clinical characteristics of patients infected with COVID-19 associated with disease progression leading to ICU admission. The objective was to systematically review the models or scores for predicting admission to the intensive care unit (ICU) available to date for patients with COVID-19. Methods: The study is a systematic review. PubMed, Scopus, Web of Science, Ovid-Medline, and Embase were searched until July 13, 2022. We included studies that have developed and validated a model or scoring system to predict ICU admission in patients with COVID-19. The primary outcome was ICU admission. Risk of bias assessment was performed using the PROBAST tool which is based on four domains: participants, predictors, outcome and analysis. Results: Two studies were included for data extraction and critical appraisal. Predictive models of ICU admission and performance were obtained as primary outcomes. Common predictors for both models were associated with pulmonary compromise (respiratory rate or pulmonary ventilation) and systemic inflammation (C-reactive protein). Conclusions: It is feasible to determine predictor variables for ICU admission in patients hospitalized for COVID-19. However, the studies do not determine a clearly defined score and present a high risk of bias, so it is not feasible to recommend the application of any of these models in clinical practice. © 2022 Publicado por Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo.

Hypnosis applied to the fear of COVID-19 in a cancer caregiver

Objective: Treatment of fear of contagion during the COVID-19 pandemic and the adaptation to the oncological disease through a multicomponent program that includes clinical hypnosis, in the main caregiver. Method(s): An intervention using clinical hypnosis to manage the fear of contagion during the process of caring for an oncological patient. Result(s): There is a reduction in anxiety symptoms, in relation to the fear of contagion, which allows the patient to address different situations without applying avoidant coping, using fear as a protection strategy against COVID-19. Insomnia problems were improved, reducing problems with conciliation insomnia, improving self-esteem and reinforcing self-concept. Conclusion(s): Hypnosis is revealed as a useful, fast and effective technique that allows to adequately manage anxiety symptoms within a multicomponent program. Copyright © 2022, Universidad Compultense Madrid. All rights reserved.

HCV screening in a tertiary french hospital: just do it !

Background and aims: Universal screening appears to be the most cost-effective strategy to reach the HCV elimination planned byWHO for 2030. All HCV patients have currently access to treatment. In France HCV screening is based on identification of Risk Factor. The aim of the present studywas to test universal screening strategy in all hospitalized patients. Method: From November 2019 to November 2021, we conduct a prospective, longitudinal monocentric study screening all consent patients for HCV regardless identification of Risk Factor. All HCV Ab positive was followed by HCV RNA screening. All replicating patients were proposed to be treated according to the other pathologies for which the patients were hospitalized. The study was authorized by CPP Toulouse. Because of occurrence COVID 19 pandemics, conducting this studywe identify several limitations leading to the prolongation of inclusion time and to develop adaptive measures such as oral consent. Results: As of September 30, 2021 results are shown in this figure: (Figure Presented) HCV Ab + patients seemed older;however this difference is not statistically different. Large part of patients (2/3) were unware of the HCV status. 49 (39.5%) patients come from surgical departments, 38 (30.5%) from the medical department and 37 (30%) are followed in gastroenterology office. All HCV RNA+ patients have been evaluated for treatment. 8 are eradicated, 2 DAA therapy are still on going,1patient refuse treatment (89 years old), 5 patients suffer from HCC and treatmentwas delayed, 2 patients died during palliative management Conclusion: HCVAb prevalence recorded is significantly higher than that observed in the general population in France. However only 15.8% of hospitalized patients have been included. Motivation of all health care workers is essential. Final results of the study will be present at the meeting

Sex Differences in Nutritional Refeeding Treatment Among Adolescents and Young Adults Hospitalized for Eating Disorders

Purpose: Eating disorders in male populations are underrecognized and undertreated, leading to delays in identification, diagnosis, and treatment. Although male adolescents and young adults generally have greater energy requirements than females due to greater body weights, metabolic response, and exercise, current inpatient nutritional refeeding protocols support a single caloric prescription regardless of sex. The objective of this study was to determine sex differences in nutritional refeeding outcomes among adolescents and young adults hospitalized for eating disorders. Methods: We retrospectively reviewed electronic medical records of 601 patients aged 9-25 years admitted to a tertiary care center for medical and nutritional management, between May 2012 and August 2020. We collected demographic, clinical, and nutritional characteristics (including initial calorie prescription, discharge kilocalories [kcals], weight change, and length of stay) from the electronic medical record. Descriptive statistics, unadjusted, and adjusted linear regression models were used to assess the association between sex and nutritional outcomes, as well as length of stay. Results: A total of 588 adolescents and young adults met eligibility criteria, [16% male, mean (SD) age 15.96±2.75, 71.6% anorexia nervosa, admission percent median body mass index (%mBMI) 87.1±14.1]. In unadjusted comparisons, there were no significant sex differences in prescribed kilocalories (kcal) per day at admission (2013 vs. 1980 kcal, P=0.188);however, males had higher Estimated Energy Requirements (EER) (3694 vs. 2925 kcal, P<0.001). In linear regression models adjusting for potential confounders including age, race/ethnicity, and diagnosis, male sex was associated with higher prescribed kcals at discharge (B=855 kcal, p<0.001), greater weight change (B=0.50 kg, p=0.016), and longer length of stay (B=1.83 days, p=0.001) than females. Older age, lower admission weight, lower prescribed kcal at admission, higher EER, and lower heart rate at admission were factors associated with longer length of stay in linear regression models. In these adjusted models, every 1000 lower kcal prescribed at admission was associated with a 3.99 day longer length of stay while every 1000 greater kcal in the EER was associated with a 1.61 day longer length of stay. Conclusions: We report for the first time that males hospitalized for eating disorders require higher kcal/day at discharge than females despite clinical protocols that standardize the beginning kcal/day regardless of sex. This may lead to longer hospitalizations for male adolescents and young adults with eating disorders. These findings suggest that current refeeding approaches may be insufficient for male patients and support the development of individualized treatment protocols for males with eating disorders. Given the rise in hospitalizations for eating disorders during the COVID-19 pandemic, these findings can improve quality of care and healthcare efficiency among an underserved population in a post-pandemic world. Sources of Support: K08HL159350.

A Dynamic Social Vulnerability Index to COVID-19 in Mexico

Several months have passed since the appearance of COVID-19, populations that were the most vulnerable at the beginning might not be anymore, and vice-versa. Government interventions, people behaviours and vaccination policies, change the social vulnerability. Our work proposes a complementary framework to the classic vulnerability indexes which aggregate structural variables into composite indexes. We define a Dynamic Vulnerability Index as an evolving relation between structural indicators and mortality ratio, we construct this index using a data-driven approach that updates the mortality ratio and uses Partial Least Squares to find a weighting of the structural variables at each municipality. Our index is able to distinguish at any given time between zones that are potentially vulnerable but do not exhibit a high exposure, and zones that are not as vulnerable in terms of their structural variables but present higher levels of exposure. The southwest part of the country, comprising the states of Chiapas, Guerrero and Oaxaca, exhibits low Dynamic Vulnerability for most of the study period despite being one of the poorest regions in the country. This happens because most of the region is relatively isolated and doesn’t have a great influx of people that could carry the virus. On the contrary, the Central Region where the capital (Mexico City) is located and has been the epicenter of the pandemic in Mexico, has remained with a high vulnerability for the whole period, even if it is not particularly poor. Our index represents a complement to the static view of vulnerability in the context of an evolving pandemic. While static vulnerability highlights regions that could experience a strong impact, the dynamic vulnerability highlights regions where there is a strong relationship between the fixed structural conditions and the evolving epidemic. This complementary picture allows decision makers to take more focused actions. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Involving parents in the remote diagnosis of Autism during the COVID-19 pandemic: a case study

Objective To evaluate the feasibility of remotely providing a diagnosis of autism during the Coronavirus Disease pandemic of 2019. Methods A child psychiatrist guided the parents' Autism Diagnostic Observation Schedule (ADOS-2) administration to assess their child's developmental delay through a video conference. Trained clinicians (n = 10) rated the recorded procedure. Interrater reliability for each item was evaluated using the kappa statistic and percent agreement. Results The mean percent agreement across all items was 96%, range = 85.96-100%, and mean weighted kappa = .81, range = .44-1. Conclusions This study highlights the feasibility of providing early identification and continuous psychiatric care during a pandemic lockdown.

The management of research from the framework of bonding. Elaboration of the researcher's profile and their competences

This is a proposal on the competencies required in the researcher's profile, it derives from the new requirements of the research policies of the National Council of Science and Technology in Mexico, with the intention of guiding research towards projects with social impact and relevance, in accordance with the strategic national programs and to the new reality imposed by the COVID-19 pandemic. In this context, it is proposed to strengthen the competencies traditionally developed by the university researcher, but also to incorporate others, which for many researchers-especially those in theoretical disciplines-are new, such as: management competence, bonding competence and the search for funding. Thus, a new profile is proposed to adapt to a changing and uncertain reality. The methodology is based on the analysis of the evidence from various studies and on the adequacy of the new policies proposed in the Mexican context.

D-dimer as an ICU Admission Risk Predictor in COVID-19 Patients, A Prospective Study

Background. Since the onset of the 2019 coronavirus disease 2019 (COVID-19) pandemic, the rapid increase in community-acquired pneumonia (CAP) cases has led to an excessive rate of intensive care units (ICU) admissions, a rate varying between 5-18%, depending on the country. Consequently, the study of serum biomarkers, such as D-dimer, have been utilized to identify patient with severe disease. However, further data is needed to confirm the association between this serum concentration of D-dimer and the risk of ICU admission. Thus, the aim of this study was to determine if serum concentration of D-dimer predict the risk of ICU admission in patients with COVID-19 and CAP. Methods. A prospective observational study was carried out at the Clinica Universidad de La Sabana, Colombia. Patients older than 18 years old, hospitalized for COVID-19 or CAP were included. Then, patients were stratified into ICU and non-ICU patients. Plasma samples were collected within the first 24 hours of hospital admission to quantify D-dimer using the PATHFAST system. Concentrations were compared among groups and to assess the biomarker capacity to predict ICU admission risk, ROC curves were used. Finally, a DeLong test was applied to compare their differences. Results. A total of 240 patients diagnosed with lower respiratory tract infection were included in the study. 88 patients were COVID-19 negative (CAP) and 152 were positive. Plasma concentrations of D-dimer (μg/ml) were significantly higher in COVID-19 patients admitted to the ICU when compared with non-ICU COVID-19 admitted patients (Median [IQR];1.54 [0.9-3.25] Vs. 1.13 [0.69-1.69], p=0.005). The area under curve (AUC) ROC to predict ICU admission was 0.62 among COVID-19 patients. DeLong's test p value was 0.24. Serum D-dimer an ICU admission Conclusion. D-dimer seems to be a promising tool to identify COVID-19 patients with disease. However, this predicting capacity was not observed in CAP patients. Further studies are needed to identify the mechanisms underling the elevation of D-dimer in COVID-19 patients.

Presepsin as a Prognostic Biomarker for Mortality in COVID-19 Patients vs Community-Adquired Pneumonia (CAP) Patients

Background. Lower respiratory tract infections such as community-acquired pneumonia (CAP) and coronavirus disease 2019 (COVID-19) are the main current causes of mortality worldwide. Several scores and biomarkers have been proposed to identify patients at risk of dying, with unclear results. Presepsin is a glycoprotein expressed on the surface of the membrane of monocytes and macrophages and its utility has been proven in sepsis as a predictor of severity and treatment response. However, it is unknown the utility of this biomarker as a mortality predictor among COVID-19 and CAP patients. Thus, the aim of this study was to determine the utility of serum presepsin to identify patients at risk of dying due to COVID-19 and CAP. Methods. A prospective observational study was conducted at Clinica Universidad de La Sabana, Colombia. We included 240 patients who required hospital admission due to CAP or COVID-19. Plasma samples were collected within 24 hours of admission. The presepsin concentration was quantified using the PATHFAST system. Afterwards, a two-tailed test was used to compare mortality rates among patients and their presepsin plasma concentration. Lastly, the ROC was calculated to determine presepsin's sensibility as a mortality predictor. Results. A total of 88 patients with CAP and 152 patients with COVID-19 were included in the study. The median [with IQR] in Presepsin plasma concentration was higher in all patients who died (920 [573 - 2340] vs 573 [307,5 - 1052,5], p-value< 0.0001). Furthermore, comparing to the study group, the median concentration of presepsin was higher in patients deceased by COVID-19 than those who survived. (1358 [642,8 - 2976,8] vs 570 [333,2 - 1007,5], p-value< 0.0001). In addition, the area under the curve (AUC) ROC of presepsin to predict risk of mortality was 0.769. DeLong's test comparing ROC curves in COVID-19 and CAP patients had a p-value=0.073. Conclusion. Plasma concentrations of presepsin plasma were higher among COVID-19 patients who died. Moreover, serum concentration of presepsin were not useful to identify CAP patients at risk of dying. However, practical use of Presepsin as a prognostic biomarker of severity is yet to be assessed as further studies are needed.

High Levels of Serum Troponin i Indicate Higher Mortality Risk in Patients with COVID-19

Background. Up until this day, over 3.5 million fatalities related to coronavirus disease 2019 (COVID-19) have been registered worldwide by the World Health Organization. Healthcare professionals require prognostic tools for COVID-19 patients in order to guide treatment strategies. Elevated troponin levels, a biomarker of cardiac injury, have been detected among patients with COVID-19, hence associating it with cardiac injury. Although several studies have mentioned it, the role of troponin as a prognosis biomarker is unclear. Elevation in troponin levels has been observed in patients with community-acquired pneumonia (CAP). However, its association with mortality is scarcely mentioned in literature. Thus, we sought to determine the utility of serum troponin I levels as a mortality predictor for patients with COVID-19 and CAP. Methods. A prospective observational study was carried out at Clinica Universidad de La Sabana, Colombia, with patients hospitalized due to CAP and COVID-19. Troponin biomarker was quantified in serum samples using the PATHFAST system within the first 24 hours of hospital admission. Serum concentrations of troponin were compared among study groups. To assess the biomarkeŕs capacity to predict mortality, ROC curves were used, quantifying their differences through the DeLonǵs test. Results. A total of 88 patients with CAP and 152 with COVID-19 were included in the study. In all cohort the median [IQR] serum concentration of troponin (ng/ml) was higher in those who died (34.2, [9.74-384] vs 5.89, [2.44-27.9] p< 0.001). Furthermore, troponin was higher in deceased patients with COVID-19 vs those who survived (77.35 [11.9-346.5] vs. 4.88 [2.10-13.02], p< 0.001). However, there was no significant difference between CAP deceased and not deceased patients (18.1 [8.52-398] vs 15.7 [3.75-62.8], p=0.16). Although sample size might be a limitation when analyzing these results, the AUC ROC of troponin I to predict mortality was 0.799 for COVID-19 and 0.615 for CAP, the DeLongs test for compared ROC curves was a p= 0.0351. A. Serum troponin I and mortality due to lower respiratory tract infections B. Serum troponin I to predict mortality in patients with lower tract infections C. ROC curve for serum troponin I to predict risk of mortality Conclusion. Overall, troponin levels were higher among deceased patients. Our findings suggest that high troponin levels are a mortality predictor for patients with COVID-19.

High Serum Levels of Interleukin-10 as a Predictor Factor of In-Hospital Mortality in COVID-19 Patients

Background. Since the spread of SARS-CoV-2 worldwide, there has been the need for scores and biomarkers to identify patients at risk of died or requiring admission to the intensive care units (ICU) admission. Interleukin-10 (IL-10) is released as a response to the infection, stimulating inflammatory pathways in the acute phase response. Thus, previous studies have shown that high serum concentrations IL-10 can be identify patients with severe community acquired pneumonia (CAP). Nevertheless, there is a lack of information regarding the capacity of IL-10 to identify severe COVID-19. Thus, the aim of this study was to determine the capacity of IL-10 as a prediction factor for mortality in hospital admitted patients with COVID-19 compared with CAP patients. Methods. A prospective observational study was carried out at the Clinica Universidad de La Sabana, Colombia. Patients older than 18 years and old, hospitalized due to COVID 19 or CAP, were included. Patients were stratified into COVID-19 and non-COVID-19 patients. IL-10 levels were quantified in serum samples using the LUMINEX technology. Serum samples were collected within the first 24 hours of hospital admission. Afterward, concentrations of interleukinwere statistically compared among groups. ROC curves were calculated. Results. A total of 88 patients with CAP and 152 patients with COVID-19 were enrolled in the study. The median [with IQR] serum concentration of IL-10 were higher in those patients who died (81.1 [30.7-148.9] vs 18.8 [8.3-48.4] p-value < 0.0001). Then, comparing the study group, the median concentration of IL-10 levels among patients deceased by COVID-19 were higher than patients those who survived (85.1 [40-149.8] vs 32.4 [13.9-56.7] p-value < 0.001). In addition, IL-10 levels were higher in patients who survived COVID-19 compared with those who survived CAP (32.4 [13.9-56.7] vs 10.6 [4.9-18] p-value < 0.0001). The area under curve (AUC) ROC of IL-10 to predict mortality risk was 0.754 for all cohort. DeLonǵs test comparing ROC curves in COVID-19 and CAP patients had a p= 0.744. Conclusion. High serum levels of IL-10 are a good predictor of in-hospital mortality among COVID-19 patients. However, this risk association was not observed in CAP patients. Further studies are needed.

ADHERENCE AND SATISFACTION IN ONLINE VS. IN-PERSON GROUP PSYCHOTHERAPY IN TIMES OF COVID-19

In recent decades we are witnessing an important growth of clinical experiences based on the use of technology for the development of psychotherapy, we are in a period of research and theoretical development before the incorporation of an emerging resource and its integration into professional practice. Our work starts from a bibliographic search about online group psychotherapy through the most relevant publications to date, we made a synthesis of information about the advantages and disadvantages, results on its effectiveness. In addition, we provide a summary of our clinical experience in online group psychotherapy by video conference at the Day Hospital of the Psychiatry Service, analysing the results obtained on adherence to treatment and satisfaction of participants, in comparison with face-to-face group psychotherapy. In this study we compared the assistance in Day Hospital during the months of May and June 2019 (before the COVID-19 pandemic) in face-to-face group psychotherapy, with the assistance in online format in the same months in 2020. In this second group, we evaluated the subjective perception of satisfaction through an ad hoc questionnaire carried out by this group by merging previous questionnaires. We observe that attendance decreases significantly in the virtual group, not finding significant differences in the comparison of attendance by diagnostic group;that satisfaction with online psychotherapy is acceptable;and we observe the development of phenomena typical of group relationship in its virtual format.

Hcv screening in a tertiary french hospital: Health care professionals are the major impediment!

Background: France is currently on track to meet the Who hepatitis C virus elimination. Universal screening appears to be the most cost-effective strategy to reach this goal. Since May 2019, all HCV patients have access to treatment. Up to now, strategy of HCV screening is based on HAS Recommendations of March 2019 targeting patients with risk factors. The aim of the present study was to test universal screening strategy in all patients in our hospital. Methods: From November 2019 to November 2021 we conduct a monocentric, prospective, study (DEVICHO) to propose screening at entry for all hospitalized patients regardless identified risk factors. After informed consent, HCV Ab testing was done. As soon as HCV Ab was detected, HCV RNA was done and replicating patients were propose to be treated according to the other pathologies for which the patients was hospitalized. The study was authorized by CPP Toulouse and fees for all biological test was supported by ARS PACA. Results: Between November 2019 and March 2021, 26,679 patients were hospitalized. 2433 patients (9.1%) were included in the DEVICHO study. 58 patients (2.38% 95% CI: 1.78-2.99) had anti-HCV + Ab, of which 46 patients were unaware of their status and 12 patients (0.5%) had HCV + RNA. 10 patients were treated and cured of HCV, one patient died and one patient refused treatment. In the same period 3,605 patients (13.5%) were screened for hepatitis C based on risk factors. 97 patients (2.69% 95% CI: 2.16-3.21) had anti-HCV + antibodies. In total, during the study period, 6,038 patients (22.6%) were screened for hepatitis C and 155 patients (2.56%) had anti-HCV + antibodies. There was no significant difference in the prevalence of HCV between patients screened in the DEVICHO study and those screened for risk factors (p = 0.45). During the study, we noted many difficulties related to the heterogeneity of patient recruitment depending on the hospital services and the occurrence of the COVID-19 pandemic which slowed down inclusions, especially during periods of confinement.We have simplified the inclusion measures with oral consent based on showing movies , pictures, flyers and we tried to implement HCV screening in the entry checks of some department. Conclusion: The prevalence of HCV in hospitalized patients is higher than that observed in the general population in France. Universal screening of all hospitalized patients shows the same HCV prevalence as targeted screening based on risk factors identified according to HAS criteria. Our study also shows, through the low percentage of included patients , that caregivers are the main obstacle to screening for hepatitis.

Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU.

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.

Using gamification to develop shared understanding of the pandemic: COVID-19 in indigenous communities of Choco, Colombia

Effective communication with local communities is a critical factor in containing an outbreak. However, simply broadcasting "expert"knowledge carries a risk of being rejected, particularly in indigenous communities that traditionally rely on ancestral knowledge. This paper presents an investigation into developing a shared understanding of COVID-19 in indigenous communities of Choco, Colombia, that could help them develop effective mitigating practices, while being respectful of their believes. Unstructured interviews and observations were used to explore how indigenous communities perceive and respond to COVID-19. Based on these, a communicative strategy was developed using participatory design and gamification approach, that aimed at bridging their beliefs and traditional ancestral medicine with the official medical recommendations for prevention of the virus transmission. The findings revealed that the intervention became a trigger for mindful discussion within indigenous communities about the preventive measures from the virus, while gamification elements acted as an enabler of such discussion and created more trusting attitude towards the recommendations. Based on the initial findings, we discuss challenges of conducting indigenous research, including the role of trust between researchers and the communities, gamification as an enabler of shared knowing of a problem matter, and the importance of flexible participatory research methods whereby indigenous people are treated not as mere researched, but as full participants of the study. Copyright © 2021 for this paper by its authors.