ABSTRACT
Coronavirus disease (COVID-19) and confinement have affected access to the health system and have impacted people's mental health, particularly families of children with autism spectrum di-sorder (ASD). Objective: To investigate the perceptions of parents of children with ASD regarding benefits, positive changes, and difficulties in behavioral management at home during the first con-finement due to COVID-19 in Chile. Subjects and Methods: We performed an exploratory cross-sectional qualitative study including 118 parents of individuals with ASD aged between 2 and 15 years. An online questionnaire, prepared by a multidisciplinary committee of national experts using Delphi methodology was applied, which contains four open-ended questions related to children's behavior (difficulties, improvements, benefits, and professional support required) during the pan-demic. Results: Parents perceived that confinement increased emotional stress for adults and chil-dren, which could exacerbate behavioral problems. The interviewees perceived improvements in child social-affective, individual autonomy, and communication skills. The family and resilience aspects, such as time-sharing that emerged during the pandemic to support children's needs, were appreciated. Parents also reported the need for professional support in behavioral and emotional management during confinement. Conclusion: Caregivers value the integration of the family into therapies during confinement. It is necessary to complement these results with additional studies exploring different life contexts of families with children with ASD in Chile and the impacts of long-term confinement.
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Background: Supervised exercise programs (SEP) have demonstrated an improvement in quality of life (QoL), cardiovascular health, treatment tolerance and disease outcomes in early breast cancer patients. In metastatic breast cancer (MBC), previous data suggest SEP are safe but no impact on QoL and a low adherence to programs were shown. These studies included a heterogenous population in terms of type of treatments received, numbers of previous lines or comorbidities. From our perspective, MBC profile that could benefit most from SEP needs to be explored. Thus, we conducted a pilot study to assess adherence, safety and impact on QoL of a combined SEP and nutritional program (NP) in a selected population of MBC of patients treated with cyclin-dependent kinase 4/6 inhibitors (iCDK 4/6). Method(s): This is a prospective, single center, single arm pilot study. SEP consisted in a 12-week intervention with twice a week in-person resistance exercise session. Patients also completed weekly aerobic exercise goals in self-managed sessions monitored with activity trackers. SEP was conducted by registered Physical Activity and Sports Science instructors that followed American College of Sports Medicine guidelines. In addition, participants had an initial nutritional assessment and personalized counselling by a qualified nutritionist. Adherence to treatment, biological variables and QoL assessments (FACIT-Fatigue and QLQ-C30 questionnaires) were collected at baseline (B) and week-12 (w12). Primary endpoint was global adherence (>=70% of attended sessions relative to scheduled sessions). Secondary endpoints included safety, changes in biological variables and QoL. Paired samples t-tests (Wilcoxon) were used to assess biological changes and QoL. Result(s): Patients (n=26) were recruited from October 2020 to November 2021. Median age was 47,5 years (45-55);84,6% of patients were ECOG 0. 42,3% of patients were receiving Abemaciclib;34,6% Ribociclib and 23,1% Palbociclib in first (73,1%) or second (26,9%) line treatment. Patients had bone (69,2%);visceral metastasis (57,7%) or both (30,8%). 2 patients did not start the intervention and additional 7 patients discontinued the program prematurely, the majority of them due to COVID-related concerns. Considering all patients who at least attended one session, global adherence was 66% (39-77,5%) and 45,8% of patients achieved an adherence of >= 70%. Patients reported an improvement in QoL [B global QLQ-C30 66,6 (50-75), w12 75 (66,6-83,3);p 0,0121] and fatigue [B FACIT-Fatigue 37 (30-44), w12 42 (38-48);p 0,0017]. Sit-to-stand repetitions in 30-second period also improved [(B 15 (12-17), 19 (15-23);p 0,0002]. Same benefits were seen in patients with adherence >= 70%. No statistically significant changes were seen in body fat or muscular composition and handgrip scores. Importantly, no safety issues related to study intervention were reported. Conclusion(s): Even though the study was conducted during COVID-19 pandemic, global adherence was 66%. For the first time in MBC, SEP and NP combined program demonstrated to be safe and improved QoL in patients with first or second line MBC treated with iCDK4/6. Further research is needed to identify strategies that improve QoL in MBC.
ABSTRACT
Coronavirus disease (COVID-19) and confinement have affected access to the health system and have impacted people's mental health, particularly families of children with autism spectrum disorder (ASD). Objective(s): To investigate the perceptions of parents of children with ASD regarding benefits, positive changes, and difficulties in behavioral management at home during the first confinement due to COVID-19 in Chile. Subjects and Methods: We performed an exploratory cross-sectional qualitative study including 118 parents of individuals with ASD aged between 2 and 15 years. An online questionnaire, prepared by a multidisciplinary committee of national experts using Delphi methodology was applied, which contains four open-ended questions related to children's behavior (difficulties, improvements, benefits, and professional support required) during the pan-demic. Result(s): Parents perceived that confinement increased emotional stress for adults and chil-dren, which could exacerbate behavioral problems. The interviewees perceived improvements in child social-affective, individual autonomy, and communication skills. The family and resilience aspects, such as time-sharing that emerged during the pandemic to support children's needs, were appreciated. Parents also reported the need for professional support in behavioral and emotional management during confinement. Conclusion(s): Caregivers value the integration of the family into therapies during confinement. It is necessary to complement these results with additional studies exploring different life contexts of families with children with ASD in Chile and the impacts of long-term confinement. Copyright © 2022, Sociedad Chilena de Pediatria. All rights reserved.
ABSTRACT
This research analyzes the conceptions expressed by teachers about the advantages and limitations of teaching history and social sciences in the context of a pandemic. In addition, it contrasts the content of the narratives of history and social science teachers about the teaching of historical empathy, citizenship and democratic participation pandemic times. The type of study is framed in the qualitative paradigm and follows the methodological strategies of a case study in a school in the Metropolitan Region in Chile. We were able to collect the conceptions of the team of teachers belonging to the Department of History of this educational center, which serves students with socio-economic difficulties and within a context of social vulnerability. The results show that the context of the pandemic exacerbated the needs and difficulties of the students and their families by highlighting the problems of connectivity to virtual classes, the lack of motivation and the absence of a future perspective. However, this healthcare context has allowed participating teachers to incorporate historical empathy and themes such as the teaching of democratic citizenship and student participation as an alternative to a new educational scenario.
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Background/Aims: Digestive symptoms are common in patients with COVID-19. Neverthe-less, the evidence available so far is based on retrospective and observational studies. This prospective multicenter cohort study aimed to describe the frequency, intensity, evolution, and impact of digestive symptoms and complications, during hospitalization and after dis-charge, of patients with COVID-19. Methods: Patients hospitalized due to COVID-19 (posi-tive PCR for SARS-CoV-2) from May to August 2020, were prospectively recruited in 31 centers. Follow-up included the period between admission and 15 days after discharge. Results: 829 patients (mean age 56.7±17.9 years;42% of females) were enrolled in this study. Of these, 7.2% were active smokers and the mean BMI was 29.1±5.7. Proton pump inhibitors were used by 21.5% (n=178). The most prevalent symptoms on admission were diarrhea (39.4%), nausea (27.4%), and abdominal pain (20.7%). Anorexia, a non-specific symptom, was present in 49.8% of hospitalized patients. At discharge and 15 days after discharge, most symptoms resolved, returning to the baseline prevalence of patients (<5%). Digestive complications during admission were infrequent, except for liver injury defined as hypertransaminasemia which was present in 267 patients (32.3%). The mean length of hospital stay was 8 days (5-12) and 13.6% needed ICU admission. Death happened in 5.2%of patients. On multivariate analysis, diarrhea on admission was associated with a shorter hospital stay (<10 days) ORa 0.508 (0.350-0.739) p=0.000. During hospitalization, diarrhea, constipation, and abdominal bloating were associated with shorter hospital stay ORa 0.531 (0.298-0.946) p=0.032, ORa 0.384 (0.167-0.885) p=0.025, ORa 0.163 (0.057-0.466) p= 0.00, respectively.Odynophagia and dysphagia during hospitalization were associated with a higher need for ICU admission, ORa 6.518 (2.255-18.835) p=0.001 and ORa 4.035 (1.453-11.204) p=0.007, respectively. Liver injury during hospitalization was associated with a higher hospital stay (>10 days) ORa 1.442 (1.019-2.041) p=0.039. In the linear regression analysis, the set of GI symptoms and complications, along with age, comorbidity, and respiratory symptoms, were able to predict 43% (R2 0.43) of the observed variability in the speed of ICU admission;in this case, digestive symptoms slowed it down (more days until ICU admission). Conclusions: Gastrointestinal manifestations of COVID-19 are common in hospitalized patients, while complications are infrequent. Gastrointestinal symptoms seemed to predict a shorter hospital stay and slower speed of ICU admission. These tend to resolve to their baseline prevalence 15 days after discharge, while elevated transaminases were associated with a longer hospital stay. Odynophagia and dysphagia during hospitaliza-tion were associated with an increased need for ICU admission.
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Introduction: The global spread of the SARS-CoV-2 virus has resulted in a worldwide pandemic with important socio-health repercussions. Current clinical experience and several published retrospective studies suggest that digestive symptoms are common in infected patients. [1][2] The aim of this study was to evaluate the frequency of gastrointestinal (GI) symptoms and complications in patients with COVID-19 disease managed on an outpatient basis. Aims & Methods: International, multicenter, prospective cohort study was conducted in 18 centers from Latin America, Asia, Africa and Europe. Subjects ≥18 years old, with COVID-19 disease, managed on an outpatient basis were included. Followed up period was 6 months. Baseline characteristics, comorbidities, GI symptoms or complications, hospital admission, ICU admission and mortality data were collected. A descriptive analysis of the study results was performed. A multivariate analysis was carried out, evaluating the association of GI symptoms and complications with age, baseline characteristics, comorbidity and COVID-19 treatments received. The adjusted Odd Ratio (ORa) was calculated assuming a significance level of p <0.05. Results: The preliminary analysis included a total of 436 patients. The median age was 35 years, interquartile range (IQR) 27-48 years. Two hundred and ten patients (48.2%) were male. The median of age-adjusted Charlson Comorbidity Index was 0 (IQR 0-1). The most frequent GI symptoms were anorexia 216 (49.5%), diarrhea 207 (47.5%), nausea 134 (30.7%), abdominal pain 122 (28%) and abdominal distension 121 (27.8%). At 4-week follow- up, symptoms resolved in most cases. Multivariate analysis showed that nausea was associated with Ivermectin treatment ORa 3.24 (95% CI 1.11-9.43) p= 0.030;abdominal pain was associated with Hydroxychloroquine treatment ORa 5.27 (95% CI 1.52-18.19) p= 0.009;diarrhea was associated with age ORa 0.966 (95% CI 0.93-0.99), p= 0.020 and Hydroxychloroquine treatment ORa 6.9 (95% CI 1.55-30.79), p= 0. 011;abdominal distension was associated with body mass index ORa 1.147 (95% CI 1.05-1.24), p< 0.001 and Hydroxychloroquine treatment ORa 7.6 (95% CI 2.00-29.51), p= 0.003. Digestive complications were infrequent (1 gastritis, 2 duodenitis, 1 jejunal ulcer, 3 hypertransaminasemia, 1 enteritis, 1 colitis). Twenty-three patients (5.3%) required hospital admission, of whom 4 (0.9%) required ICU admission and 2 (0.5%) died. Conclusion: Anorexia, diarrhea, nausea, abdominal pain and abdominal bloating were common symptoms in patients with COVID-19 disease managed on an outpatient basis. GI complications were infrequent in patients with COVID-19 who do not require hospitalization. Treatment with Hydroxychloroquine and Ivermectin was associated with more GI symptoms in COVID-19 outpatients.
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Background: SARS-CoV-2 infection (COVID-19 disease) can frequently affect the liver The most common manifestation is an asymptomatic, modest elevation of alanine aminotransferase and aspartate aminotransferase Initial histopathological reports of autopsies have described steatosis, mild lobular and portal activity, lymphocytic endotheliitis, and necrosis However, there is no consensus about the main histopathological findings in COVID-19. Aim: To characterize the pathological findings in liver injury due to SARS-CoV-2, from autopsies and biopsies of COVID-19 patients Methods: We conducted a systematic review with meta-analysis registered on PROSPERO (CRD42020192813), following PRISMA guidelines Eligible trials had to include patients of any age, diagnosed with COVID-19 based on a molecular diagnostic technique for SARS-CoV-2 We included liver histopathological reports from deceased COVID-19 patients who subsequently were studied with autopsy or liver biopsies Case reports and clinical series with less than 10 patients were excluded for meta-analysis Proportions were pooled using random-effects models We used Q statistic and I2 to quantify heterogeneity Level of evidence was evaluated using GRADE framework Results: We identified 18 studies from 7 countries;all were case reports and case series from autopsies All the patients were over 15 years old and 67 2% were males We performed a meta-analysis of 5 studies including 116 patients Pooled prevalence estimates of liver histopathological findings were hepatic steatosis 55.1% (95%CI: 46 2-63 8%), congestion of hepatic sinuses 34 7% (95%CI: 7 9-68 4%), vascular thrombosis 29 4% (95%CI: 0.4-87.2%), fibrosis 20.5% (95%CI: 0.6-57.9%), Kupffer cell proliferation or hyperplasia 13 5% (95%CI: 0 6-54 3%), portal inflammation 13.2% (95%CI: 0.1-48.8%), and lobular inflammation 11.6% (95% CI: 0.3-35.7%). We also identified the presence of venous outflow obstruction, phlebosclerosis of the portal vein, herniated portal vein, periportal abnormal vessels, hemophagocytosis, and necrosis Conclusion: In this systematic review and meta-analysis of autopsies from patients with COVID-19, we found a high prevalence of hepatic steatosis and the presence of vascular thrombosis as major histological liver features Other frequent histological features included portal and lobular inflammation and Kupffer cell hyperplasia Further studies are needed to establish the mechanism and implications of these findings.