ABSTRACT
Background: Most patients with heterozygous familial hypercholesterolemia (FH) do not achieve current LDL-C goals proposed by European guidelines with conventional lipid-lowering therapy (LLT). Chronic use of PCSK9 inhibitors (PCSK9i) have shown to reduce LDL-C levels up to 61% on top of statins. Persistence to chronic LLT is important to reduce the burden of atherosclerotic cardiovascular disease (ASCVD). Purpose(s): To analyze persistence and effectiveness of PCSK9i in clinical practice setting in FH patients from the SAFEHEART register with longterm follow-up. Method(s): SAFEHEART is an open, long-term prospective study of a cohort of subjects with molecular diagnosis of FH. Follow-up is carried out every year through a standardized phone-call to collect clinical conditions, persistence to medications, lipid profile, and cardiovascular events. This study analyses subjects >=18 years of age on stable LLT who have received PCSK9i. Result(s): 696 individuals (46% females), median age 56.4 years (IQR 49- 66) started with PCSK9i (49% alirocumab and 51% evolocumab). Out of them 38% had history of ASCVD, and 89% were on maximum LLT. Median LDL-C at the moment of starting PCSK9i was 145 mg/dL (IQR, 123- 177), representing a poor 2016 & 2019 ESC/EAS guidelines achievement (3% and 0.1% respectively). After a median follow-up of 3.7 years (IQR, 2.3-4.8), 669 patients (96%) remained on PCSK9i treatment during entire follow-up. Only 27 patients (4%) discontinued, 5 temporarily (0.7%) and 22 permanently (3.2%). Most common reasons for PCSK9i treatment interruption were medical decision (n=6), adverse event (AE) (n=5), patient decision not related with AE (n=5) and comorbidity (n=5). Median time to permanent discontinuation was 15 months (IQR, 4-33). Median LDL-C levels observed and % of LDL-C reduction obtained after 1 year of treatment and in the last follow-up visit were: 63 mg/dL (IQR, 43- 88), 61 mg/dL (IQR, 44-82), 57.6% (IQR, 39.5-69) and 58% (IQR, 44-68), respectively. 2016 ESC/EAS guidelines LDL-C goals was achieved by 70% of patients at year 1 and 77% in the last follow-up visit after the introduction of PCSK9i (p<0.001). 2019 ESC/EAS goals were achieved by 44.5% and 48% (p=0.1). Conclusion(s): Long-term persistence to PCSK9i treatment in FH patients is very high (96%) and reasons for discontinuation are diverse. This study shows that COVID-19 pandemic did not affected persistence to treatment. Effectiveness in LDL-C reduction and LDL-C goal achievement improved significantly with introduction of PCSK9i in clinical practice setting.
ABSTRACT
Educational institutions globally were forced to provide learning spaces in synchronous and asynchronous online mode from the first quarter of 2020, a product of the Covid-19 pandemic. During the third quarter of 2021, the National Autonomous University of Honduras (UNAH) launched a pilot program to return to face-to-face teaching. For this reason, the Department of Informatics of the Faculty of Administrative and Accounting Economic Sciences conducted a cross-sectional descriptive study to identify why the students considered it necessary to return to the face-to-face modality. As a result, the categories Type of content, Forms of communication, Educational environment and Educational performance were found. The findings leave open future research to investigate more about the teaching-learning methodologies with which students received classes before the pandemic and methodologies used during the pandemic, given that other research has shown that master classes traditional ones do not motivate students, they do not benefit communication between the actors of the educational process, but are enriched by remote communication tools and active teaching methodologies. © 2023, University of Cienfuegos, Carlos Rafael Rodriguez. All rights reserved.
ABSTRACT
Background/aims: Palliative care professionals (PCP) work in an environment of great emotional impact where patients and caregivers present high levels of emotional distress and suffering. Working in these units frequently involves high levels of emotional distress. The emergence of the COVID-19 pandemic has intensified this emotional distress. The aim of this work was to analyze the levels of emotional distress of palliative care health professionals during the second wave of the pandemic in Spain. Methods: A descriptive cross-sectional study of palliative care health professionals who responded to an online survey during the second COVID-19 pandemic in Spain (July 2020). 95 palliative care professionals (58 women and 37 men) with a mean age of 45.72 ± 11.71 years responded to an online survey voluntarily, after giving informed consent. In addition to sociodemographic variables, anxiety, depression, emotional distress, post-traumatic stress, and questions related to the COVID-19 situation and the institution were analyzed. The study was approved by the Ethics Committee of the Autonomous University of Barcelona. Results: 53.7% of the health professionals reported anxiety, 46.7% depression, 54.5% emotional distress, and 28% post-traumatic stress disorder (PTSD). A 26.5% of the professionals think that they require psychological help. 32.8% believe that they feel recognized by their institution, and 28.7% feel cared for by their institution. We observe that the professionals who feel recognized by their institutions experience less emotional distress (p<0.01) and believe they need less psychological support (p<0.05) than those who do not perceive it. Conclusions: A high emotional impact generated by the COVID-19 pandemic is observed in PC professionals. It would be necessary to provide psychological resources related to emotional regulation and coping strategies to deal with this situation of high emotional impact generated by the pandemic and promote their well-being and facilitate coping of future pandemics.
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BACKGROUND AND AIMS: Acute kidney injury (AKI) has been described as a frequent complication in patients with COVID-19. The incidence of AKI is estimated to be around 5%-80% depending on the series;however, data characterizing the type of AKI and the evolution of renal function parameters in the medium-long term are still limited. METHOD: Based on the initial AKI-COVID Registry, we developed an extended registry where we registered retrospectively new variables that included clinical and demographic characteristics, infection severity parameters and data related to AKI (ethology, KDIGO classification, need of renal replacement therapy, analytic values: baseline creatinine, maximum creatinine during admission, creatinine at discharge or death, creatinine at 1 month after hospitalization and urinary parameters). Recovery of kidney function was defined as difference in at discharge or posthospitalization creatinine < 0.3 mg/dL with respect basal creatinine. RESULTS: Our analysis included 196 patients: 74% male, mean age 66 + 13 years;65% hypertensive, 33% diabetic and 22% chronic kidney disease. According to the KDIGO classification: 66% AKI KDIGO3, 17% KDIGO2 and 15% KDIGO1. Creatinine values are summarized in Table 1. We found significant differences in the baseline/high creatinine differential;these differences were lost after hospitalization. The main types of AKI were prerenal (35%) and acute tubular necrosis secondary to sepsis (ATN) (53%). 89% of patients with ATN presented AKI KDIGO 3, compared with 57% in the prerenal group (P < .001). Patients with prerenal AKI had greater comorbidity. On the other hand, patients with ATN AKI developed more serious COVID-19 infection: higher percentage of severe pneumonia, admission to the intensive care unit and need for orotracheal intubation. The analytical parameters were more extreme in patients with ATN AKI, except for creatinine and urea upon admission, which were higher in the prerenal AKI group. A total of 89 patients died during the study;65% of ATN AKI patients versus 31% of prerenal-AKI patients (P < .001). The ATN was a mortality risk factor, whit a hazard ratio 2.74 [95% confidence interval (95% CI )1.29-5.7] (P = .008) compared with the prerenal AKI. CONCLUSION: AKI in hospitalized patients with COVID19 presented with two different clinical patterns. Prerenal AKI more frequently affected older, more comorbid patients, and with a mild COVID19 infection. The NTA AKI affected younger patients, with criteria of severity of infection and multiplying mortality almost three times. In analytical control 1-month post-hospitalization, most of the patients recovered their kidney function. Although the implications of AKI associated with COVID-19 in the development of chronic kidney disease are still unclear, our data suggest that most patients will recover kidney function in a medium term. (Table Presented).
ABSTRACT
The objective of this study is to make a quick assessment of the psychological resources and emotional distress of the general population locked down during the COVID-19 pandemic (in Catalonia, Spain), and to observe their evolution over the course of two waves during lockdown: at two weeks and at one month (April 1th to 3th and April 17th to 19th). The longitudinal study collected data from 29,231 participants aged 18 or older through an online platform who answered questions which evaluated: optimism, uncertainty, perceived competence, self-efficacy, emotional distress, current job situation, sadness and anger in conjunction with sociodemographic variables. The main results indicated that general beliefs about the future, uncertainty, and optimism, together with beliefs about one's own conduct, such as perceived competence when facing the situation or self-efficacy to maintain routines, could predict the emotional distress experienced by an individual. A clear gender pattern was found. Between the two waves, optimism, perceived competence to manage the situation and self-efficacy to maintain routines decrease, uncertainty grows, and emotional distress remains. Taking these results into account we can prevent possible emotional scars and offer coping strategies to overcome the pandemic and the future situations of confinement in a more efficient way.
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Peru seemed well placed to respond to the COVID-19 pandemic as a country that had achieved sustained economic growth and moved towards achieving universal health coverage. However, Peru has one of the highest rates of transmission and mortality worldwide. This article analyses what the pandemic has unveiled with regards to the health system, arguing that a focus on meeting global development targets, including by promoting public-private partnerships in health, has distracted attention from the underlying structural causes of inequalities and enabled the continuation of a highly fragmented system, with access determined by income, gender, ethnicity and geography.
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COVID-19 has become a global pandemic during 2020 due to its high contagiousness and the high mobility of the world's population today. In just one year, this virus has caused millions of infections and deaths worldwide. These numbers will continue to grow until the population becomes immune to the virus thanks to an effective vaccine. Until this is possible, the only viable strategy is to try to stop its expansion through preventive measures such as limiting mobility, the use of masks, etc. In order to support these measures, this article presents a service to provide safe navigation solutions to reduce the likelihood of infection by avoiding potential conflict areas in the city. To identify these hotspots, a strategy that combines a rule-based system and a common-sense knowledge base is proposed. Through this strategy, an occupation model and a danger model are inferred. This requires the prior capture of knowledge about the general functioning of the city, its inhabitants and the virus. The proposed service makes decisions from these two models. Finally, a validation process has been carried out through surveys to evaluate the proposed solution. Obtained results demonstrate the potential of the proposed solution as a tool to identify safe routes that allow citizens to move around the city with low exposure to COVID-19.
ABSTRACT
Peru seemed well placed to respond to the COVID-19 pandemic as a country that had achieved sustained economic growth and moved towards achieving universal health coverage. However, Peru has one of the highest rates of transmission and mortality worldwide. This article analyses what the pandemic has unveiled with regards to the health system, arguing that a focus on meeting global development targets, including by promoting public-private partnerships in health, has distracted attention from the underlying structural causes of inequalities and enabled the continuation of a highly fragmented system, with access determined by income, gender, ethnicity and geography. © 2020 Canadian Association for the Study of International Development (CASID).