[Development of the INSABI educational strategy: a lesson learned from the COVID-19 epidemic]

The Institute for Health for Well-being (INSABI according to its initials in Spanish), in collaboration with the National Institute of Medical Sciences and Nutrition Salvador Zubiran (INCMNSZ), instituted the Continuous Training on clinical management "Mexico against COVID-19" in 2020, with the purpose of training the frontline health personnel in the care for patients with COVID-19 in the context of hospital reconversion through the COVIDUTI platform. Virtual conferences were held for medical personnel from all over the country with the possibility of interacting with various specialists. In 2020, 215 sessions were held and 158 in 2021. That year educational content was expanded and included topics for other health categories, such as nursing and social work. In October 2021, it was established the Health Educational System for Well-being (SIESABI), with the aim of promoting continuous and permanent education for health workers. It currently offers face-to-face and virtual courses, permanent seminars, and telementoring, with the possibility of providing academic follow-up to its subscribers and linking priority courses that are on other platforms. The educational platform is an opportunity to unify the efforts of the health system in Mexico in the continuous and permanent education of professionals who care for people without social security and thereby contribute to the implementation of a model of care based on primary health care (PHC). Copyright © 2023 Revista Medica del Instituto Mexicano del Seguro Social.

CLINICAL OUTCOMES BY SARS-CoV-2 VARIANT AT A SINGLE ACADEMIC MEDICAL CENTER

Background: SARS-CoV-2 continues to change over time due to genetic mutations and viral recombination.1 Given the changing landscape of COVID-19 variants and availability of COVID-19 vaccinations, disease severity during acute infection has also been variable. However, most research related to COVID-19 to date has not focused on evaluating differences in outcomes by the dominant variant and the impact it might have on post-acute sequalae of COVID-19 (PASC). Method(s): We developed a data mart of electronic health record data pertaining to COVID-19 in a single North American metropolitan health system (RUSH University Medical Center). Patients were selected for analysis if they had at least one documented infection of COVID-19. Date ranges were established per dominant variant, and the date of diagnosis was matched to variant. Variants were determined by the most prominent variant of concern (VOC) circulating in the city of Chicago. Variants were categorized by the following by date ranges: Wildtype+D614G (3/7/20-3/20/21), Alpha (3/21/21-6/19/21), Delta (6/20/21-12/11/21), Omicron BA.1 (12/12/21-3/19/22), Omicron BA.2 (3/20/22- 6/18/22), and Omicron BA.4/BA.5 (6/19/22-present (9/30/22). Subsequent clinical outcomes were examined, including hospitalization, intensive care unit admission, or death. We characterized our sample by conducting descriptive statistics including frequency and percent of outcome by variant. Result(s): 44,499 patients were included in this analysis with 30.23% requiring hospitalization, 4.25% being admitted to intensive care unit (ICU), and 2.35% resulting in death. The greatest percentage of hospitalizations occurred with the Alpha variant at 41.88% (N=928), and the greatest percentage of ICU admissions (6.43%) and death (3.15%) occurred with the Delta variant. The latest Omicron variant (Wave 6) showed an increase in hospitalizations (35.18%), as compared to early Omicron waves (Wave 4 and 5) but maintained similar ICU rates. Death rates continued to decline during the Omicron waves (Table 1). Conclusion(s): Although Alpha and Delta variants seem to have more severe outcomes compared to other variants, it is important to note that COVID-19 prevention, treatment access, and management continues to change, potentially influencing how outcomes may differ over time. Future work should determine factors to adjust for when examining variant-level differences.

Implementation of the teleconsultation service with an emphasis on gastroenterology in the San Pablo Clinic Network (Peru) during the COVID-19 pandemic

Objective: To describe the assistance provided by the teleconsultation service in the San Pablo Clinic Network (RCSP) during the COVID-19 pandemic, with an emphasis on the specialty of gastroenterology. The study: Descriptive study. Data from the Electronic Medical Records System and the RCSP administrative system were reviewed. Results: The RCSP includes 8 locations (5 in Lima). Between April 2020 and December 2021, 1,156,253 visits were made (6.6% of these by teleconsultation). The specialties with the most teleconsultations were internal medicine and endocrinology, and the specialties with the most face-to-face consultations were gynecology-obstetrics and traumatology. Gastroenterology was the ninth most frequent specialty in teleconsultation and the fifth in face-to-face consultation. The most frequent diagnoses of this specialty, both for face-to-face consultation and teleconsultation, were dyspepsia and gastroesophageal reflux disease Conclusion: The implementation of the teleconsultation service in the RCSP is reported. In addition, lessons learned in this process are provided.

Clinical phenotypes of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19

The multisystem inflammatory syndrome in children associated with COVID-19 (MIS-C) is infre-quent but potentially lethal. There are few reports of this disease and its phenotypes in Latin America. Objective: To describe the characteristics of the clinical phenotypes of MIS-C in hospitalized patients in Lima, Peru. Patients and Method: A descriptive and retrospective study in patients under 14 years old with a diagnosis of MIS-C at the Hospital Nacional Edgardo Rebagliati Martins (Lima, Peru), from April 2020 to August 2021. Clinical-demographic and microbiological variables were recorded. According to these, patients with MIS-C were classified into the shock phenotype, Kawasaki disease (KD) without shock, and the fever and inflammation phenotype, analyzing their clinical outcomes. Results: 58 patients were analyzed. 32 (55.2%) presented the shock phenotype, 15 (25.8%) Kawasaki disease (KD) phenotype without shock, and 11 (19%) fever and inflammation phenotype. In the shock phenotype, 17 had KD. The mean age was 7 +/- 3.5 years and 67.2% were males. Gastrointes-tinal and mucocutaneous manifestations predominated in all phenotypes. The mortality was 3.5%. The frequency of coronary aneurysms was 10.2%. Most patients received immunomodulatory and antiplatelet treatment. Patients with shock phenotype showed greater involvement in inflammatory markers, hematological dysfunction, and myocardial injury, with a higher frequency of respiratory failure and invasive mechanical ventilation. Conclusions: In our case series, patients with shock phenotype were the most frequent and had worse clinical outcomes. Active surveillance of clinical phenotypes is needed to make an early diagnosis and management to improve the prognosis in these patients.

Depression and spousal violence in Peruvians pregnant during the COVID-19 pandemic

Introduction: The restrictive measures chosen to reduce COVID-19 infection could maintain and even increase high levels of depression and violence, putting at risk both the fetus and the mother. Objective: To identify the prevalence and factors associated with depression in pregnant Peruvians during the COVID-19 pandemic. The study: Observational-analytical study, with 267 pregnant women in their third trimester of pregnancy. Conducted during the month of January 2021, applying the Edinburgh Scale and the Spanish version of the Index of Spouse Abuse-19 (ISA-19). Findings: 62.17% of pregnant women presented depression and 17.6% spousal violence during pregnancy. Spousal violence, the history of at least one lost pregnancy and planned pregnancy, were associated with depression. Conclusions: Spousal violence increases the prevalence of depression during pregnancy as opposed to a planned pregnancy or the history of at least one lost pregnancy.

Errors Detected in the Telepharmacy Procedure

Background and Importance After the rise of telemedicine with the COVID-19 pandemic, a telepharmacy consultation has been implemented in our hospital in the pharmacy outpatient area, sending medicines to community pharmacies within a population area of 600,000 inhabitants. Aim and Objectives The purpose of this study is to analyse the medication errors (ME) that have occurred during a specific period of time, throughout the process of medication delivery. The aim is finding causes and possible improvements. Material and Methods We carried out a retrospective descriptive study. The errors that occurred between January 2021 and August 2022 (20 months) in the telepharmacy process were analysed, taking into account everything from the preparation in the hospital pharmacy to the collection of the medication by the patient in the community pharmacy. The MEs were collected in a local database. We described date, personal data of the patient, codes assigned to the single shipping route and destination community pharmacy, type of error and step in which the ME was detected. Results In the period studied, a total of 69 MEs were recorded. We break them down into the following types: 20 cases with a quantitative lack of medication (28.99%), 19 cases in which a different medication was sent (27.54%), 15 with another patient's medication (21.74%), 10 with medicine with wrong dose (14.49%), 2 cases in which the medicine was not sent (2.90%) and another 2 in which the medicine was sent badly packaged (2.90%), 1 case in which the one in which the misidentified medicine was sent (1.45%) and 1 case in which a larger quantity was sent (1.45%). 48 MEs were detected by the patient (69.56%), 15 were detected in the community pharmacy (21.74%), 4 were detected in the hospital pharmacy (5.80%) and 2 cases were detected during the transportation of the medication (2.90%). None of the errors detected had consequences for the patient to our knowledge. Conclusion and Relevance Among the MEs detected, the most common were those related to a quantity defect or lack of a medication and those in which a different medication was sent. In general, they are errors that could be avoided by automating processes that are currently carried out manually.

Inequalities in connectivity and academic performance during non-face-to-face teaching due to the Covid-19 Pandemic

The outbreak of the COVID-19 virus has turned our world upside down. Universities were not the exception. Most administrators struggle to redesign higher education for a postCOVID world university. During the pandemic, however, many of the face-face courses turned to virtual, giving rise to or incrementing inequalities among students due to lack of equipment and network connectivity could affect their academic performance. This paper brings together evidence from various data sources and the most recent studies to describe what we know so far about the impacts of the COVID-19 crisis on inequalities across several key domain factors, including the availability of equipment and connectivity could affect their academic performance. The paper explores the effect of connectivity on the academic performance of our chemical and engineering students based on (i) the location of the home, (ii) the equipment, (iii) the type of connectivity, (iv) the number of people with those in which the equipment is shared and (v) online attendance at classes, finding that the ones with the greatest impact are the lack of synchronous attendance at class, the equipment, and internet connectivity. © 2022 IEEE.

Clinical phenotypes of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19

The multisystem inflammatory syndrome in children associated with COVID-19 (MIS-C) is infre-quent but potentially lethal. There are few reports of this disease and its phenotypes in Latin America. Objective(s): To describe the characteristics of the clinical phenotypes of MIS-C in hospitalized patients in Lima, Peru. Patients and Method: A descriptive and retrospective study in patients under 14 years old with a diagnosis of MIS-C at the Hospital Nacional Edgardo Rebagliati Martins (Lima, Peru), from April 2020 to August 2021. Clinical-demographic and microbiological variables were recorded. According to these, patients with MIS-C were classified into the shock phenotype, Kawasaki disease (KD) without shock, and the fever and inflammation phenotype, analyzing their clinical outcomes. Result(s): 58 patients were analyzed. 32 (55.2%) presented the shock phenotype, 15 (25.8%) Kawasaki disease (KD) phenotype without shock, and 11 (19%) fever and inflammation phenotype. In the shock phenotype, 17 had KD. The mean age was 7 +/- 3.5 years and 67.2% were males. Gastrointes-tinal and mucocutaneous manifestations predominated in all phenotypes. The mortality was 3.5%. The frequency of coronary aneurysms was 10.2%. Most patients received immunomodulatory and antiplatelet treatment. Patients with shock phenotype showed greater involvement in inflammatory markers, hematological dysfunction, and myocardial injury, with a higher frequency of respiratory failure and invasive mechanical ventilation. Conclusion(s): In our case series, patients with shock phenotype were the most frequent and had worse clinical outcomes. Active surveillance of clinical phenotypes is needed to make an early diagnosis and management to improve the prognosis in these patients. Copyright © 2022, Sociedad Chilena de Pediatria. All rights reserved.

Mortality and Clinical Characteristics of Multisystemic Inflammatory Syndrome in Children (Mis-C) Associated with Covid-19 in Critically Ill Patients in a Middleincome Country: Observational Multicenter Study

BACKGROUND AND AIM: The clinical presentation and severity of (MIS-C) presents a very low mortality in high-income countries. This research describes clinical characteristics of MIS-C in critically ill children in middleincome countries and factors associated with mortality and critical outcomes. METHOD(S): Observational cohort study in 14 (PICUs) in Colombia between April 2020 -January 2021. Patient age from one month to18 years, that met WHO requirements for MIS-C. RESULT(S): There were 78 children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old. 35 % of patients (29/78) were obese or overweight. 100 % had fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87% (68/78) shock or systolic myocardial dysfunction (78 %), 35% (27/78) coronary aneurysms, and pericardial effusion in 36 %.There was a higher mortality rate compared to high in-come countries (9 % vs. 1.8 %;p=0.001). When assessing the group of patients who died, ferritin levels was above 500 ngr/mL (100 % vs. 45 %;p=0.012), as well as more cardiovascular complications (100 % vs. 54 %;p = 0.019). CONCLUSION(S): MIS-C in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics, similar to high-income countries. Inflammatory response and cardiovascular involvement added to the difficulties in accessing the healthcare system in limited resources countries, could explain the greater mortality seen. Prospective studies are needed to compare the differences found in MIS-C outcomes between countries with different income.

Eliciting Complex Thinking Through Open Educational Resource Projects

Since the COVID-19 pandemic, the use of Open Educational Resources (OERs) has increased due to its advantages for academic activities and educational quality. Hence, Higher Education Institutions (HEIs) have sought to develop strategies to promote curricular and extracurricular activities that favor developing disciplinary and transversal competencies such as complex thinking and its meta-competencies: critical, systemic, scientific, and innovative thinking, oriented to favor problem-solving among students and the academic community. The main objective of this study was to analyze how using OERs in virtual education can promote the development of complex thinking as a transversal competency in higher education. We analyzed the content of 65 educational projects in a webinar aimed at promoting the adoption of OERs in the professional practice of the educational community. Each project had to comply with specific requirements, from the project's identification and description to measuring and evaluating the results and its impact and added value. Once all the projects were reviewed, the responses were classified into defined categories for better presentation;the sub-competency of complex thinking promoted by each project element was identified qualitatively. The results highlight how an OER can, through concrete activities, elicit complex thinking and its sub-competencies in higher education. The present study adds new evidence to the literature regarding boosting OERs as a tool to develop competencies aligned with UNESCO recommendations and contribute to fulfilling the Sustainable Development Goals in education. © 2022, Association for Social Studies Educa. All rights reserved.

Breakthrough COVID-19 infection after vaccination in people with multiple sclerosis on disease modifying therapies in Latin America: data from RELACOEM registry

Introduction: In this study we aimed to monitor the risk of breakthrough COVID-19 infection in pwMS on different Disease Modifying Therapies (DMT) included in RELACOEM, a LATAM registry of MS and NMOSD patients infected with and vaccinated against COVID-19. Method(s): retrospective cohort study conducted between May 2021 and December 2021. The primary outcome was the appearance of infection during the follow-up time (at least three months after complete vaccination (second dose)). Specific information was requested (vaccine received, dose, date, symptoms, COVID- 19 infection, need for hospitalization, ventilatory assistance, treatment, and evolution). The primary objective of the analysis was to compare the incidence of breakthrough SARS-CoV-2 infections among the vaccinated pwMS in each DMT group. These conditions entail a PCR-confirmed test, and a time lag of at least 14 days from a full vaccination cycle (after the second vaccination dose). Cumulative incidence was reported by Kaplan Meier survival curves as well as incidence density. Result(s): A total of 857 pwMS patients from eight countries in LATAM were included. Mean age was 44.3 +/-12 years. The most frequent treatment used was fingolimod in 171 (19.9%). Most frequent first and second dose received was Astra-Zeneca (33%). During follow-up, a total of 28 COVID-19 cases were observed for a total exposure time of 150.965 days. The overall cumulative incidence was 3.2% (SE 0.22%) with an overall incidence density (ID) of 1.8 x 10.000 patients/day (95%CI 0.2-3.2). Compared to other DMTs, the incidence rate of breakthrough infections was significantly higher on ocrelizumab (6.02 (95%CI=5.65-7.16, RR=5.17 95%CI 3.27-7.12) and rituximab (6.94 (95%CI=6.15-9.12, RR= 5.93 95%CI 3.55-7.32) compared with other DMTs. No significant differences in the risk of breakthrough were observed for vaccine subtypes. Conclusion(s): An increased risk of breakthrough COVID-19 infections was observed in patients treated with ocrelizumab and rituximab.

Breakthrough COVID-19 infection after vaccination in patients with NMOSD in Latin America: data from RELACOEM registry

Objective: The objective of the study was to evaluate the incidence of COVID-19 infections after vaccination in NMOSD patients included in RELACOEM, a LATAM registry of MS and NMOSD patients infected and vaccinated for COVID-19. Method(s): Retrospective cohort study developed between May 2021 to December 2021. The primary outcome was the appearance of infection during the follow up time (at least three months after complete vaccination (second dose)). Data was collected through the contact between the treating physician and the patient. Specific information was requested (vaccine received, dose, date, symptoms, COVID-19 infection, need for hospitalization, ventilatory assistance, treatment, and evolution). The primary objective of the analysis was to compare the incidence of breakthrough SARS-CoV-2 19 infections among the vaccinated pwMS in each DMT group. These conditions entail a PCR-confirmed test, and a time lag of at least 14 days from a full vaccination cycle (after the second vaccination dose). Cumulative incidence was reported by Kaplan Meier survival curves as well as incidence density. Result(s): A total of 49 NMOSD patients from eight countries in LATAM were included. Mean age was 43.8 +/-13 years. The most frequent treatment use was rituximab in 29 (59.2%). The mean follow up after the second dose was 149 +/- 32 days. Most frequent first and second dose received was Pfizer (28.6%), followed by Sinopharm (24.5%). During follow up a total of 2 COVID-19 cases were observed for a total exposure time of 8627 days. Cumulative incidence was 4.1% (SE 0.87%) with an overall incidence density of 2.31 x 10.000 patients/day (95%CI 1.13-3.71). Both cases occurred in patients under rituximab (2/29, exposure time 4208, IR 4.7 x 10,000 patients/day 95%CI 3.5-5.1). No hospitalizations were reported for both cases. Conclusion(s): We observed an ID of COVID-19 infection after vaccination of 2.31 x 10.000 patients/day in NMOSD patients.

Recommendations for the use of oxygen and its basic and advanced supply devices: Rationality and safety in times of SARS-CoV-2 pandemic in Colombia

In the midst the COVID-19 pandemic, and given the imminence of oxygen shortages in Colombia, the Knowledge Management and Transfer Network, made up of 19 scientific societies, health institutions, and universities, generates an update to the document led by the Colombian Association of Critical Medicine and includes new evidence-informed guidelines for the rational management of oxygen therapy, as well as basic and advanced devices for oxygen therapy. The recommendations refer to five topics: goal-oriented rational use of oxygen, standardization of follow-up and dose adjustment, effective use of oxygen therapy devices, rational use of invasive mechanical ventilation, and rational use of extracorporeal oxygenation membrane therapy. When exercising their judgment, it is expected that professionals and care teams will take into account these guidelines to make rational and safe use of oxygen therapy and its basic and advanced devices, together with the individual needs and preferences of the people who are under their care. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

Optimization Model Applied to the Distribution of Covid-19 Vaccines in Lima and Callao

Currently, Peru has started a vaccination plan to face the crisis generated by Covid-19;however, it has not been the most efficient. The current study seeks to reduce vaccine distribution times and costs in Lima and Callao by applying a mathematical optimization model. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Evaluation of Variables to Determine Cycling Routes in Lima-Perú

The demand for transport without agglomerations in many cities has increased lately to avoid infections of COVID19. Therefore, this research is focused on a mathematical model for a cycling network minimizing the distances of cycle paths and maximizing the factors that are more important for citizens of Lima using linear programming and analytics. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Dynamics of Covid-19 infection, using Delay Differential Equations

Due to the current Covid-19 pandemic, the scientific community has needed to generate increasingly fine and realistic models to predict the behavior of the virus over the weeks, so that local authorities can make decisions to slow the spread of the virus. The differential equations of delay will be used to capture the incubation cycles of the virus and susceptibility, adjusting the model to the reality of the city of Milagro in Ecuador. These equations are solved using the differential transformation method, a non-traditional numerical method, that takes advantage of its linear properties to find the solution through a Taylor series. Finally you will find the susceptible curve, infected and immunized over time will be found. © 2022 Latin American and Caribbean Consortium of Engineering Institutions. All rights reserved.

COVID-19 VACCINATIONS AMONG VETERANS WITH MENTAL ILLNESS

BACKGROUND: Patients with mental illness have high COVID-19 infection rates and mortality. Equitable vaccination strategies have prioritized outreach for high-risk medical conditions, racial/ethnic groups, and social groups (e.g., experiencing homelessness). Despite calls to ensure adequate access for persons with mental illness, COVID-19 vaccination disparities have not been systematically evaluated in this population. A recent study demonstrated that Veteran's Administration (VA) systems can deliver equitable vaccine access for traditionally marginalized racial/ethnic groups.We sought to evaluate whether there are disparities in COVID-19 vaccination rates for veterans with mental illness. METHODS: We conducted a retrospective cohort study among Veterans assigned to primary care at the VA Puget Sound with >1 visit recorded in the past two years. We used logistic regression to determine the association between diagnosis of serious mental illness (SMI) (bipolar disorder or schizophrenia), post-traumatic stress disorder (PTSD), depression or anxiety, and substance use disorder (SUD) and COVID-19 vaccination using three separate models. Covariates were age, sex, race/ethnicity, marital status, Gagne comorbidity score, socioeconomic status index, rurality based on home address, homelessness, number of primary care and mental health visits in the past 12 months, and percentage without a high school degree. RESULTS: We identified 103,025 veterans with no mental health diagnoses, 1,467 with SMI, 15,329 with PTSD, depression or anxiety, and 5,110 with SUD. Those with mental health diagnoses were younger, had higher Gagne scores, higher primary care and mental health utilization, were more likely to experience homelessness, and to live in urban settings. In adjusted analysis the odds ratio of vaccine receipt was higher in all three groups compared to those without mental health diagnoses: 1.58 (95% CI 1.38, 1.82) for SMI, 1.26 (1.2, 1.32) for PTSD/Depression/Anxiety, and 1.24 (1.15, 1.34) for SUD. CONCLUSIONS: After adjusting for clinical and sociodemographic covariates, we found that diagnoses of SMI, SUD, PTSD, depression or anxiety were associated with a slightly higher predicted probability of vaccination compared to no mental health diagnoses among Veterans receiving primary care within the VA. No other published analysis reports vaccination rates in persons with mental health conditions, so we are unable to assess whether this is a trend nationally or specific to the VA system, where vaccination efforts were conducted using a clear equity framework, strong data sources, and heavy outreach campaigns. Study limitations include unclear generalizability to other geographic areas, and exclusion of veterans with mental health diagnoses not enrolled in primary care, due to lack of adequate clinical covariate information. Nevertheless, our results provide initial evidence that disparities in COVID-19 vaccination rates for persons with mental illness can be prevented.