Excreción de SARS-CoV-2 infeccioso en dos niños asintomáticos

Asymptomatic infections with SARS-CoV-2 are associated with viral transmission and have a key role in the propagation of the pandemic. Understanding viral shedding during asymptomatic infections is critical. Unfortunately, data on asymptomatic SARS-CoV-2 infection in children is extremely limited. To determine the presence of viral viable shedding, we prospectively followed two healthy children of a family where both parents developed mild COVID-19 (April 2021). SARS-CoV-2 detection was made by RT-PCR and virus isolation by cell culture from saliva samples. Positive samples were sequenced to identify variants of SARS-CoV-2. Serum samples were evaluated to determine the presence of antibodies using a single enzyme-linked immunosorbent assay (ELISA, COVIDAR IgG). Both children were SARS-CoV-2 positive and asymptomatic. In addition, the virus grew in cell culture from saliva samples. Furthermore, one child showed viable SARS-CoV-2 for at least 17 days after the onset symptoms from his father. The recommended isolation period for asymptomatic contacts during the acquisition of data had been established for 10 days;however, this child remained with viable virus beyond that period. The positive samples from both children were consistent with B.1.1.28.1 lineage (Gamma). In both asymptomatic children, anti-Spike IgG was detected. Asymptomatic children may represent a source of infection that should not be underestimated during this pandemic. Las infecciones asintomáticas por SARS-CoV-2 están asociadas a la transmisión viral y tienen un papel clave en la propagación de la pandemia. Comprender la excreción viral durante las infecciones asintomáticas es fundamental. Desafortunadamente, los datos sobre la infección asintomática por SARS-CoV-2 en niños son extremadamente limitados. Para determinar la presencia de excreción de virus viable, se siguió prospectivamente a dos niños sanos de una familia en la que ambos padres desarrollaron COVID-19 leve (abril 2021). La detección de SARS-CoV-2 se realizó por RT-PCR y el aislamiento del virus por cultivo celular a partir de muestras de saliva. Las muestras positivas se secuenciaron para identificar variantes de SARS-CoV-2. En las muestras de suero se determinó la presencia de anticuerpos utilizando un ensayo de ELISA (COVIDAR IgG). Ambos niños fueron positivos para SARS-CoV-2 y asintomáticos. Además, el virus creció en cultivos celulares a partir de muestras de saliva. Uno de los niños mantuvo SARS-CoV-2 viables durante al menos 17 días después de la aparición de los síntomas de su padre. El período de aislamiento recomendado para contactos asintomáticos durante la adquisición de datos se había establecido en 10 días, sin embargo, este niño permaneció con virus viable más allá de ese período. Las muestras positivas de estos niños correspondieron al linaje B.1.1.28.1 (Gamma). En ambos niños asintomáticos se detectó anticuerpos IgG anti-Spike. Concluimos que los niños asintomáticos pueden representar una fuente de infección que no debe subestimarse durante esta pandemia.

[Risk of thrombosis recurrence among patients with COVID-19- and surgery-associated venous thromboembolism]. / Riesgo de recurrencia de la trombosis en pacientes con tromboembolia venosa asociada a COVID-19 y a cirugía.

Introduction: Recent surgery is a well-known major transient risk factor for venous thromboembolism (VTE) due to the low risk of VTE recurrence after anticoagulation is discontinued. On the other hand, the risk of VTE recurrence among patients with COVID-19-associated VTE is unknown. This study aimed to compare the risk of VTE recurrence between patients with COVID-19- and surgery-associated VTE. Methods: A prospective observational single-center study was performed including consecutive patients diagnosed with VTE in a tertiary hospital from January 2020 to May 2022 and followed up for at least 90 days. Baseline characteristics, clinical presentation, and outcomes were assessed. The incidence of VTE recurrence, bleeding, and death was compared between both groups. Results: A total of 344 patients were included in the study: 111 patients with surgery-associated VTE and 233 patients with COVID-19-associated VTE. Patients with COVID-19-associated VTE were more frequently men (65.7% vs 48.6%, p = 0.003). VTE recurrence was 3% among COVID-19 patients and 5.4% among surgical patients, with no significant differences (p = 0.364). The incidence rate of recurrent VTE was 1.25 per 1000 person-months in COVID-19 patients and 2.29 person-months in surgical patients, without significant differences (p = 0.29). In the multivariate analysis, COVID-19 was associated with higher mortality (HR 2.34; 95% CI 1.19-4.58), but not with a higher risk of recurrence (HR 0.52; 95% CI 0.17-1.61). No differences were found in recurrence in the multivariate competing risk analysis (SHR 0.82; 95% CI 0.40 - 2.05). Conclusions: In patients with COVID-19 and surgery-associated VTE, the risk of recurrence was low, with no differences between both groups.

Implementation and evaluation of virtual teaching during covid-19 emergency

This article describes the emergency implementation, and evaluates migration results from in person to virtual teaching in a regional university center during Covid-19 emergency. Planned in advance online education experiences are significantly different from the courses offered online in response to a crisis, hence the relevance of assessing this emergency implementation of online education. Through a descriptive quantitative re-search, an assessment tool aimed for professors of courses taught during the first semester of 2021 was designed. The objective was to evaluate the implementation of emergency remote teaching from the perception of professors. Operational, instrumental and pedagogical strategies that were generated for the conti-nuity of teaching, and the teaching perspective on the change of modality, are covered in the article. Assessment results highlight the maintenance of the courses in real time, the preference of certain technological tools, the readjustments of the evaluation methods and the discovery of the possibilities offered by the new modality. Concerns focus on instru-mental aspects of access and management of technology and not of a pedagogical nature.

[Implementation of a Geriatric liason team in coordination with Primary Care attending 60 nursing homes in the northwest community healthcare network of the Community of Madrid]. / Implantación de un programa de Geriatría de enlace coordinado con Atención Primaria en 60 centros sociosanitarios del área asistencial noroeste de la Comunidad de Madrid.

OBJECTIVE: To describe interventions included in the implementation of a multidisciplinary Geriatrics Program that gives support to nursing homes, in coordination with Primary Care and Public Health, in collaboration with other hospital departments. METHODS: An observational descriptive study was conducted in an area that includes 60 nursing homes with nearly 4600 residents from June 1 st, 2020 to October 1 st, 2021. The program consists of different interventions including Telemedicine and support of a Geriatric Consultation Liaison Team. An estimation of avoided costs through these interventions was carried out. RESULTS: The activity recorded was 11502 telephone calls, 2247 e-mails, 313 visits to these centres in where 4085 patients underwent comprehensive geriatric assessment. During this period of time 442 patients received intravenous therapy in their nursing homes, including 7541 different types of medication which 5850 of them were antibiotics. According to the Diagnosis-related-Group (DRG) of the patients that received intravenous treatment in their nursing homes, was estimated a cost reduction of 1,500,00€ and a total of 2800 days of hospital stay avoided. In the group of 198 patients that received video consultation was estimated reduction of costs of 37,026€. A hospital multidisciplinary care team focused on the nursing home patients was created. CONCLUSIONS: This program improves continuity of nursing homes patients care and to enhance communication and coordination among Primary Care, Hospitals and Public Health services and secondarily, reducing hospital costs.

Common pots in Chile. Understanding a social phenomenon of organization to face hunger during the COVID-19 pandemic.

Background: The COVID-19 pandemic has led to a socioeconomic crisis, increasing food insecurity. Government measures have not been enough, and the community has organized itself to solve its food needs. In Chile, the "Ollas Comunes" (OC) have re-emerged: self-managed social organizations whose purpose is to feed community members in a situation of hunger. The study aims to describe the characteristic elements of the operation of the OC in Chile during the COVID-19 pandemic. Method(s): This is a cross-sectional and descriptive study, which uses quantitative and qualitative data. Through an online form, information was collected from 117 OC nationwide. Result(s): On average, nine people work in the OC, with different tasks. The OC operated mainly three days a week in community spaces and in the more vulnerable neighborhoods. The volunteers recognized that the OC arose from a community need that the government could not attend to;the OC promoted social participation and helped the vulnerable population. Conclusion(s): This research could help develop public policies that consider these community organizations and their role in food insecurity and take advantage of the community capacity.Copyright © 2022 Sociedad Espanola de Nutricion Comunitaria. All rights reserved.

Riesgo de recurrencia de la trombosis en pacientes con tromboembolia venosa asociada a COVID-19 y a cirugía Risk of thrombosis recurrence among patients with COVID-19- and surgery-associated venous thromboembolism

Introducción La cirugía reciente es un factor de riesgo transitorio mayor y conocido de tromboembolia venosa (TEV) debido al bajo riesgo de recurrencia de la TEV una vez suspendida la anticoagulación. Por otro lado, se desconoce el riesgo de recurrencia de la TEV en los pacientes con TEV asociada a COVID-19. El objetivo de este estudio consistió en comparar el riesgo de recurrencia de la TEV entre pacientes con TEV asociada a COVID-19 y a cirugía. Métodos Se realizó un estudio prospectivo, observacional y unicéntrico en el que participaron pacientes consecutivos diagnosticados de TEV en un hospital terciario entre enero de 2020 y mayo de 2022 y que fueron objeto de seguimiento durante un mínimo de 90 días. Se evaluaron las características iniciales, el cuadro clínico y los resultados clínicos. Se compararon las incidencias de recurrencia de la TEV, hemorragias y muertes entre ambos grupos. Resultados En el estudio se incluyó a un total de 344 pacientes: 111 con TEV asociada a cirugía y 233 con TEV asociada a COVID-19. Entre los pacientes con TEV asociada a COVID-19 hubo una mayor frecuencia de varones (65,7 vs. 48,6%, p = 0,003). La recurrencia de la TEV fue de 3% en los pacientes con COVID-19 y de 5,4% en los pacientes quirúrgicos, sin diferencias significativas (p = 0,364). La tasa de incidencia de TEV recurrente fue de 1,25 y 2,29 por 1.000 personas-meses en los pacientes con COVID-19 y quirúrgicos, respectivamente, sin diferencias significativas (p = 0,29). En el análisis multifactorial, la COVID-19 se asoció a una mayor mortalidad (HR = 2,34;IC 95%, 1,19-4,58), pero no a un mayor riesgo de recurrencia (HR = 0,52;IC 95%, 0,17-1,61). En el análisis multifactorial de riesgos competitivos no se observaron diferencias en cuanto a recurrencias (SHR = 0,82;IC 95%, 0,40-2,05). Conclusiones El riesgo de recurrencia fue bajo en los pacientes con TEV asociada a COVID-19 y a cirugía, sin diferencias entre ambos grupos.

Opportune warning of COVID-19 in a Mexican health care worker cohort: Discrete beta distribution entropy of smartwatch physiological records

We present a statistical study of heart rate, step cadence, and sleep stage registers of health care workers in the Hospital General de México "Dr. Eduardo Liceaga” (HGM), monitored continuously and non-invasively during the COVID-19 contingency from May to October 2020, using the Fitbit Charge 3® Smartwatch device. The HGM-COVID cohort consisted of 115 participants assigned to areas of COVID-19 exposure. We introduce a novel biomarker for an opportune signal for the likelihood of SARS-CoV-2 infection based on the Shannon Entropy of the Discrete Generalized Beta Distribution fit of rank ordered smartwatch registers. Our statistical test indicated infection for 94% of patients confirmed by positive polymer chain reaction (PCR+) test, 47% before the test, and 47% in coincidence. These results required innovative data preprocessing for the definition of a new biomarker index. The statistical method parameters are data-driven, confidence estimates were calibrated based on sensitivity tests using appropriately derived surrogate data as a benchmark. Our surrogate tests can also provide a benchmark for comparing results from other anomaly detection methods (ADMs). Biomarker comparison of the negative Immunoglobulin G Antibody (IgG-) subgroup with the PCR+ subgroup showed a statistically significant difference (p < 0.01, effect size = 1.44). The distribution of the uninfected population had a lower median and less dispersion than the PCR+ population. A retrospective study of our results confirmed that the biomarker index provides an early warning of the likelihood of COVID-19, even several days before the onset of symptoms or the PCR+ test request. The method can be calibrated for the analysis of different SARS-CoV-2 strains, the effect of vaccination, and previous infections. Furthermore, our biomarker screening could be implemented to provide general health profiles for other population sectors based on physiological signals from smartwatch wearable devices.

Academic Continuity Plan in Light of the COVID-19 Contingency: A comparative study between Mexico and Spain

Faced with the Covid-19 contingency, many public and private universities worldwide had to suspend all face-to-face activities and develop academic continuity plans with the objective of assuring the permanence of university formation. It is in this sense that this paper submits the results of a comparative study regarding the academic continuity plans developed by private institutions of higher learning originating from the Covid-19 pandemic. A qualitative design was used in a series of semi-structured online interviews of university professors from the University of Monterrey (Mexico) and the Francisco de Vitoria University (Spain). The analysis was carried out from a comparative point of view to determine convergences and divergences in four categories: access, availability, use and shaping of Information and Communication Technologies;academic activities;teaching-learning processes;face-to-face academic continuity. The results revealed that there are convergences in the four categories analyzed in both university contexts. It is evident that the academic continuity plans of the University of Monterrey and the Francisco de Vitoria universities share equivalent characteristics and strategies. Similarly, it is shown that both private universities developed actions within the administration departments in order to offer prompt and pertinent answers in coordination with other departments. Likewise, it became evident that both universities had continuous improvement projects prior to the contingency that allowed them an immediate response for the continuance of academic activities. Finally, this paper seeks to contribute to the literature on the effectiveness of private sector university academic continuity plans. © Univ Nacional de Educacion a Distancia (UNED). All Rights Reserved.

Prospective study of pulmonary embolism in patients with SARS CoV-2 pneumonia with high levels of D Dimer

Pulmonary embolism (PE) is common among hospitalized adults with SARS CoV-2 pneumonia. D-dimer (DD)>1 mug/mL has been found to be a severity risk factor. However, most of the studies are based on retrospective data and the real prevalence is unknown Objectives: To evaluate the prevalence of PE in patients with SARS CoV-2 pneumonia, regardless clinical suspicion. Demographic and laboratory data, comorbidities, and clinical outcomes were compared between patients with and without PE Methods: Single-center prospective study. All consecutive cases of SARS CoV-2 pneumonia with DD>1 mug/mL underwent computed tomography pulmonary angiography Results: 179 patients (64 (55-74 years), 65% male) were included. PE was diagnosed in 71 patients (39.7%), mostly with a peripheral location and low thrombotic load (Qanadli score 10%). We did not find disparity in PE prevalence between men and women, and between obese and not obese patients. There were no differences in the intensive care unit admission rate. Mortality rate was 8.5% in patients with PE vs. 3.7% in those without PE, but the differences were not significant. Patients with PE had more history of cardiovascular disease and required more fractional inspired oxygen. DD, platelet distribution width (PDW), neutrophil-lymphocyte ratio (NLR), DD-lactate dehydrogenase ratio (DD/LDH), and DD-ferritin ratio values were significantly higher among PE patients. ROC analysis showed that PDW and DD/LDH had the greatest area under the curve Conclusion(s): Patients with SARS CoV2 pneumonia and DD>1mug/mL presented a high prevalence of PE, regardless of clinical suspicion. PDW, NLR, DD/LDH and DD/Ferritin may help to identify patients with high risk of PE.

Severe SARS-CoV-2 pneumonia and pneumomediastinum and/or pneumothorax: a prospective observational study in an intermediate respiratory care unit

Introduction: The occurrence of pneumomediastinum (PNMMD) or pneumothorax (PNMTX) was evaluated in patients with severe SARS-CoV-2 pneumonia. Method(s): This is a prospective observational descriptive study that was carried out on patients admitted to the IRCU of a COVID-19 monographic hospital in Madrid from 14/01/2021 to 27/09/2021. All of them had a diagnosis of severe SARS-CoV-2 pneumonia and required NIRS (HFNC, CPAP, BPAP). The incidences of PNMMD and PNMTX, total and according to NIRS, and their impact on the probability of IMV and death were studied. Result(s): (tables 1 and 2) 4.3% (56/1306) developed PNMMD or PNMTX, 3.8% (50) PNMMD, 1.6% (21) PNMTX, and 1.1% (15) PNMMD+PNMTX. 16.1% of patients with PNMMD or PNMTX had HFNC alone (vs 41.7% without PNMMD or PNMTX;p<0.001) and 83.9% CPAP (vs 57.5%;p<0.001). There was a probability of needing IMV of 64.3% among patients with PNMMD or PNMTX (vs 21.0%;p<0.001), and a mortality of 33.9% (vs 10.5%;p<0.001). Conclusion(s): In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia who required NIRS, incidences of 3.8% for PNMMD and 1.6% for PNMTX were observed. LDH was a risk factor for developing PNMMD or PNMTX (median 438 vs 395;p=0.013), and PNMMD (median 438 vs 395;p=0.014). The majority of patients with PNMMD or PNMTX had CPAP as the NIRS device, much more frequently than patients without PNMTX or PNMMD. However, the pressures used in CPAP were even lower in patients with PNMMD or PNMTX (median 8 vs 10;p=0.031). The probabilities of IMV and mortality among patients with PNMMD or PNMTX were 64.3% and 33.9%, respectively, higher than in patients without PNMMD or PNMTX, 21.0% and 10.5%.

Programmatic impacts of utilizing various staffing options for COVID-19 contact tracers: recommendations and lessons learned

Background: The rapidly expanding COVID-19 pandemic created an immediate demand for the Department of Health in Hillsborough County (DOH-Hillsborough) Epidemiology Program to supplement its contact tracing workforce;and, because of the long duration of the response, a sustained workforce was needed. The DOH-Hillsborough Epidemiology Program's COVID-19 response, broadly referred to as "contact tracing", included case investigations, outbreaks, and identification and notifications to exposed individuals. To meet contact tracing staffing needs, several staffing options were utilized, including Core Epidemiology Staff, Reassigned DOH-Hillsborough staff (Reassigned Staff), Contracted staffing agency hires (Contract Staff), State of Florida hires (State Level Hires), County hires (DOH-Hillsborough Hires), and college and university faculty and students (University Partners). Purpose: To understand the differences in work output and efficiency across staffing groups (quantitative analysis) and to understand Core Epidemiology Staff recommendations when hiring temporary staff as contact tracers (qualitative analysis). Methods: A mixed-methods approached was used to assess each staffing group hired in Hillsborough County. Quantitative data was analyzed from 3/1/2020 through 1/31/2021, and included data from the state's personnel management system and the state's reportable disease database to represent work output. Qualitative interviews with DOH-Hillsborough Core Epidemiology Staff were conducted and analyzed to understand Core Epidemiology Staff recommendations when hiring surge staffing in the future. Results: During the evaluation period, 199 staff across the staffing groups worked a collective 132,252.50 hours. The number of hours worked per case and contact ranged from 10.16 in Core Epidemiology Staff to 0.67 in University Partners. During qualitative interviews with the Core Epidemiology Staff, five common themes emerged as ideal characteristics for temporary contact tracing staff. These included: communication skills, professionalism, public health knowledge, following official guidance, and flexibility. Two groups who emerged as the "best hires" for their seamless transition into their roles included University Partners and the State Level hires. Discussion: These mixed methods data can be used to develop best practices to inform future surge staffing needs.

Usefulness of the early combination of non-invasive respiratory therapies in patients with COVID-19

Aim: To determine the effect of the early combination of high flow nasal cannula (HFNC) plus continuous positive airway pressure (CPAP) regarding endotracheal intubation (ETI) and 30-day mortality in patients with SARS-CoV-2 pneumonia. Method(s): Observational study of patients admitted to the intermediate respiratory care unit (IRCU) who received HFNC+CPAP. Two groups were formed according to the time of starting the combined therapy: Early HFNC+CPAP (first 24 h - EHC) and Late HFNC+CPAP (after 24 h - LHC). A multivariate analysis was performed to establish the strength of the association with ETI and 30-day mortality. Result(s): 780 patients were included (502 male, mean age 56.5 +/- 12.9 years). Table 1 shows the baseline characteristics. 273 patients were subjected to ETI, 32.9% in the EHC group vs 38.9% in the LHC group (p 0.05). 30day mortality was 8.2% in the EHC vs 15.5% LHC (p 0.02). Table 2 shows the multivariate analysis. Conclusion(s): The combination of HFNC+CPAP, especially in the first 24 hours after IRCU admission, is a useful tool in the management of SARS-CoV-2 pneumonia.

Clinical characteristics and respiratory care of hospitalized patients according to vaccination status of COVID 19

Although protection of vaccines against COVID-19 has been reported, very little is known about the clinical characteristics of hospitalized vaccinated patients. Method(s): This single-center cohort study of 1888 COVID-19 patients hospitalized at the "Enfermera Isabel Zendal" Emergencies Hospital, Madrid (Spain) was performed between July and September, 2021. It compared the results of 1327 unvaccinated patients to 209 fully vaccinated and 352 partially vaccinated. Vaccines administered were: BNT162b2, ChAdOx1 nCoV-19, mRNA-1273, Ad26.COV2.S. Finding(s): Hospitalized patients' median age was 41 years (IQR 33.0-50.0) for the unvaccinated and 61.0 years (IQR 53.0-67.0) for the fully vaccinated ones. The main comorbidities were obesity, hypertension and diabetes mellitus. The fully vaccinated patients obtained higher C-reactive protein values (median 48.9 mg/l [IQR 21.7-102.9]) and significantly lower for ferritin (median 367.0 ng/ml [IQR 182.0-731.0]) and lactate dehydrogenase (median 269.0 units/l [IQR 218.5-330.5]) values. 266 unvaccinated patients required noninvasive respiratory care, as did 51 partially vaccinated and 30 fully vaccinated patients;78 of the unvaccinated patients also needed invasive respiratory care, as did 16 partially vaccinated and 11 fully vaccinated patients. The fully vaccinated patients were 84% less likely to be admitted to hospital, and protection for those aged <50 years. Interpretation(s): Once hospitalized, the vaccinated patients displayed more protection against requiring respiratory care than the unvaccinated ones, despite being older and having more comorbidities. No differences appeared for the four studied vaccine types.

Risk of thrombosis recurrence among patients with COVID-19- and surgery-associated venous thromboembolism Riesgo de recurrencia de trombosis entre pacientes con COVID-19 y tromboembolismo venoso asociado a cirugía

Introduction Recent surgery is a well-known major transient risk factor for venous thromboembolism (VTE) due to the low risk of VTE recurrence after anticoagulation is discontinued. On the other hand, the risk of VTE recurrence among patients with COVID-19-associated VTE is unknown. This study aimed to compare the risk of VTE recurrence between patients with COVID-19- and surgery-associated VTE. Methods A prospective observational single-center study was performed including consecutive patients diagnosed with VTE in a tertiary hospital from January 2020 to May 2022 and followed up for at least 90 days. Baseline characteristics, clinical presentation, and outcomes were assessed. The incidence of VTE recurrence, bleeding, and death was compared between both groups. Results A total of 344 patients were included in the study: 111 patients with surgery-associated VTE and 233 patients with COVID-19-associated VTE. Patients with COVID-19-associated VTE were more frequently men (65.7% vs 48.6%, p =  0.003). VTE recurrence was 3% among COVID-19 patients and 5.4% among surgical patients, with no significant differences (p =  0.364). The incidence rate of recurrent VTE was 1.25 per 1000 person-months in COVID-19 patients and 2.29 person-months in surgical patients, without significant differences (p =  0.29). In the multivariate analysis, COVID-19 was associated with higher mortality (HR 2.34;95% CI 1.19–4.58), but not with a higher risk of recurrence (HR 0.52;95% CI 0.17–1.61). No differences were found in recurrence in the multivariate competing risk analysis (SHR 0.82;95% CI 0.40–2.05). Conclusions In patients with COVID-19 and surgery-associated VTE, the risk of recurrence was low, with no differences between both groups.

Risk of thrombosis recurrence among patients with COVID-19 and surgery-associated venous thromboembolism.

INTRODUCTION: Recent surgery is a well-known major transient risk factor for venous thromboembolism (VTE) due to the low risk of VTE recurrence after anticoagulation is discontinued. On the other hand, the risk of VTE recurrence among patients with COVID-19-associated VTE is unknown. This study aimed to compare the risk of VTE recurrence between patients with COVID-19- and surgery-associated VTE. METHODS: A prospective observational single-center study was performed including consecutive patients diagnosed with VTE in a tertiary hospital from January 2020 to May 2022 and followed up for at least 90 days. Baseline characteristics, clinical presentation, and outcomes were assessed. The incidence of VTE recurrence, bleeding, and death was compared between both groups. RESULTS: A total of 344 patients were included in the study: 111 patients with surgery-associated VTE and 233 patients with COVID-19-associated VTE. Patients with COVID-19-associated VTE were more frequently men (65.7% vs 48.6%, p =  0.003). VTE recurrence was 3% among COVID-19 patients and 5.4% among surgical patients, with no significant differences (p =  0.364). The incidence rate of recurrent VTE was 1.25 per 1000 person-months in COVID-19 patients and 2.29 person-months in surgical patients, without significant differences (p =  0.29). In the multivariate analysis, COVID-19 was associated with higher mortality (HR 2.34; 95% CI 1.19-4.58), but not with a higher risk of recurrence (HR 0.52; 95% CI 0.17-1.61). No differences were found in recurrence in the multivariate competing risk analysis (SHR 0.82; 95% CI 0.40-2.05). CONCLUSIONS: In patients with COVID-19 and surgery-associated VTE, the risk of recurrence was low, with no differences between both groups.

New perspectives obtained during the COVID 19 pandemic: the importance of an adequate directed structured clinical interview prior to [18]FDG-PET/CT in cancer patients

Aim/Introduction: During the COVID 19 pandemic, mass vaccination campaign has played an important role, with a special importance in oncological and immunosuppressed patients, who form a large part of our [18F]FDG-PET/CT studies. Unexpected findings in the form of reactive lymphadenopathy were commonly detected in [18F]FDG-PET/CT studies. It is essential to recognize them and adapt their interpretation to the current epidemiological context. Material(s) and Method(s): Retrospective study of consecutive [18F] FDG-PET/CT studies performed at our center in 219 patients with oncological pathology from June 15 to September 20, 2021. A structured interview was conducted on all the patients who came to undergo [18F]FDG-PET/CT, in which they were asked about the type, date and arm of administration of the vaccine. The frequency of appearance of reactive lymphadenopathy, its relationship with the type of vaccine, sex, age and the importance of a detailed clinical interview prior to the isotope injection and/ or study interpretation were analyzed. Patients that presented ipsilateral axillary lymphadenopathies following vaccination and presented increased metabolic activity regardless of node size were considered positive, size and SUVmax were assessed. Result(s): From De 219 patients reviewed, 32% presented positive [18F]FDG-PET/CT axillary lymph nodes ipsilateral to the arm where the vaccine was inoculated. There was a relationship (p=0.01) between the mean size of the lymph nodes (11+/-9mm) and its mean metabolic activity (3.7+/-2.6 SUVmax). The appearance of lymphadenopathy was more frequent in women (40.5% vs 21% p<0.001), in younger patients (mean age 53+/-14 years vs 68.5+/-13 years p<0.001), in patients who had received the Moderna vaccine (58.5% p<0.001) and in which the time elapsed between vaccination and the performance of [18F]FDG-PET/CT was shorter. Conclusion(s): The appearance of post SARS-CoV2-vaccination reactive lymphadenopathies has been a frequent finding in [18F]FDG-PET/CT despite the main oncological indication of the study. Knowing the circumstances of these findings in oncological patients is important when interpreting them, so the use of a structured directed clinical interview has been very useful to help the physician understand and differentiate these findings.

Comparative study of SARS CoV-2 detection by RT-PCR in nasopharyngeal swab and saliva samples: a pilot study in Bolivia

Objectives: Nasopharyngeal swab sampling for the detection of SARS-CoV-2 is a standard method for the diagnosis of COVID-19, but its collection usually causes discomfort in the patient and exposes healthcare workers to a higher risk. Saliva seems to be a good alternative to nasopharyngeal swabs, as it is non-invasive, reduces the risk of contamination of healthcare workers, and allows self-collection. This study aims to compare the ability to detect SARS-CoV-2 by RT-PCR in the same patient using saliva and nasopharyngeal swab samples to analyze the concordance of the results obtained between the two samples. Methods: Thirty saliva and nasopharyngeal swab samples from patients with COVID-19 symptoms who were admitted to the emergency department of the Viedma Clinical Hospital were taken in parallel. Both samples were analyzed by RT-PCR for the detection of SARS-CoV-2. The concordance of results was calculated using the Cohen's Kappa coefficient. Results: Our results show that there is good concordance (Kappa index 0.730;95% CI: 0.486-0.974) between the two types of samples analyzed. Conclusions: Saliva seems to be a reliable and effective sample for the detection of SARS-CoV-2. © 2022 Gaceta Medica Boliviana. All rights reserved.

Enhanced recovery after radical cystectomy: Outcomes of implementation after 80 cases

Objectives: To evaluate the effect of implementing Enhanced Recovery After Surgery (ERAS) and compliance to protocol in patients undergoing radical cystectomy (RC) and urinary diversion during the COVID-19 pandemic. Method(s): Since February 2020, a 14-point multimodal ERAS protocol has been implemented for patients undergoing elective CR and urinary diversion at our institution. We retrospectively evaluated 80 patients who underwent CR between February 2020 and February 2022. The effects of ERAS implantation for CR during the COVID-19 pandemic were validated. Result(s): With a mean age of 68.5 years [CI: 66.4-70.7], 80 patients who underwent RC were included in the analysis, 69 men (86%) and 11 women (14%). Main indication for surgery was muscle-invasive bladder cancer and laparoscopic or robot-assisted RC was performed in most cases (86%). Regarding urinary diversion, in 66 patients (82.5%) an ileal conduit was done and an orthotopic neobladder in 14 cases (17.5%). The attached table shows the percentage of compliance with each parameter of the 14-point ERAS protocol. Most of the compliance rates are above 80%, except for early mobilization. Efficiency item assesses whether the expected days of hospital admission are met. In this way, the median length of hospital stay (LOS) was 5 days [IQR 2.5]. In terms of follow-up, the hospital readmission rate one month after surgery was 6%. Before the application of the ERAS program this rate was 9.1%, thus it represents a significant reduction (p<0.05). [Formula presented] Conclusion(s): Our initial experience with the implementation of a 14-point enhanced recovery protocol after RC has been satisfactory achieving a 85% compliance rate and promising results regarding reduction of LOS and hospital readmission. Further cases and analysis are required to draw definitive conclusions. Disclosure of Interest: None declared Copyright © 2022