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A multidisciplinary team of physicians, physicists, and optical engineers conceived, deployed, and scaled up an operational, financial, and educational solution to address the limited supply of a critical component of safety during the Covid-19 pandemic at 21 hospitals in low- and middle-income countries.
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Leadership and political communication in moments of crisis require an efficient strategy that guides the citizens on how to act correctly. Nowadays, most leaders use digital social networks as political instruments. President Lopez Obrador is one of the politicians with the most followers (almost nine million) on the digital social network Twitter. The sanitary crisis due to Covid-19 keeps producing repercussions for what has studied the communication of the Mexican president. The objective of this paper is to analyze the leadership and political communication in the Mexican president's tweets in 2020, the first year of the Covid-19 pandemic. The communication constructs of communication, populism, charism, and strategic behavior were used to determine his political communication and leadership style. 631 tweets were analyzed by way of a qualitative methodology and a content analysis where 104 were concerning Covid-19. The results show that president Lopez Obrador mainly uses an informative-communication style about his management with populist features. The paper concluded that the Mexican president didn't use Ratter as an informative strategy for the health emergency which is the opposite of effective leadership and political communication during the crisis, either as a correct political instrument. In addition, adapting his style to the circumstances may be recommended.
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Background: Coagulopathy associated with COVID-19 is one of the main complications, especially in individuals with risk factors. Simultaneously, the use of low molecular weight heparin is the recommended strategy in hospitalized individuals, but the usefulness of other strategies such as DOACs in outpatients is still unknown. Aims: Describe the benefit of the use of rivaroxaban at discharge on the risk of thrombosis in patients discharged from COVID-19.Identify the behavior of Dimero-D at discharge and its modification with anticoagulant therapy. Methods: Randomized 1: 1 study (Rivaroxaban 10mg for 14 days versus observation) at discharge in individuals with COVID-19 who have not required mechanical ventilation. D-dimer was evaluated at 14 and 30 days after discharge in conjunction with a CT angiography at four weeks after hospital discharge. The protocol was developed in the Hospital Regional de Alta Especialidad de Ixtapaluca, authorized by the ethics committee with registration number NR-19-2020. The study is identified in ClinicalTrials.gov with the following registry NCT04508439 Results: Forty individuals were evaluated (20 in each arm) with follow- up greater than 100 days. Gender distribution was equitable in each arm, with a mean age of 50 years (21 to 74 years), 40% (n = 16) were older than 55 years, 27.5% (n = 11) had hypertension and 20% (n = 8) had diabetes. The mean length of hospital stay was 10.5 days (6 to 23 days) treated with oxygen and low molecular weight heparin. At discharge, treatment was started with rivaroxaban 10mg x 14d vs. observation;in the rivaroxaban group, four events were identified (3 hemorrhages / 1 thrombosis), this difference being significant (Log Rank 0.016). Only one thrombosis event (pulmonary embolism) was identified in the rivaroxaban group at eight treatment days. Compared to the diagnosis, DD levels were lower at both 14 and 30 days (p = 0.000, 95% CI, 440.8-1164.9) without finding a difference in those treated with rivaroxaban or observation (p = 0.721, 95% CI, -68.48 to 241.18). Summary/Conclusion: The use of DOACs at discharge does not benefit from an increased risk of hemorrhagic events;the anticoagulant strategy should be individualized, focused only on those patients at very high risk of thrombosis.
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Introduction. Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive disease that significantly reduces patients' quality of life and survival.1 In our country there are no statistics of this disease, only isolated cases. The ability to diagnose it has dramatically improved since the 2019 Multisociety Consensus for Multimodality Imaging.2,3 The study aimed to know patients' demographic and imaging characteristics in suspected ATTR-CA and the prevalence of positive cases in a reference Cardiology Center using 99mTc-pyrophosphate scintigraphy (99mTc-PYP). Methods. Prospective, observational study approved by Institutional committees. We studied with 99mTc-PYP patients from November 2019 to December 2020 sent to the Nuclear Cardiology Department with clinical suspicion of ATTR-CA and negative light chain quantification. We included parameters as red flags, ECHO suggestive findings (septal thickness >12 mm, diastolic dysfunction), and MRI suggestive findings. ATTR-CA was diagnosed by clinical suspicious, positive scintigraphy, and negative serum studies. 99mTc-PYP were acquired according to current recommendations. Frequency distribution of categorical variables were reported as frequencies and percentages;continuous variables are presented in mean. Mann-Whitney U tests were conducted for continuous variables, while Fisher's exact test was performed for categorical variables. Results. Due to the Covid-19 pandemic, our Cardiology Hospital reconverted to covid attention;we studied a reduced number, and they were mainly inpatients: total 35 (28-inpatients, 7-outpatients). 21 (60%) were male, 14 (40%) were female, average age was 56.5 yo. 31%- heart failure diagnosis, 6%-history of carpal tunnel syndrome and 3%-spinal stenosis. ECHO: 26% had suggestive imaging, 43% with diastolic dysfunction, and 37% had a septal thickness >12mm. MRI: 42.9% had suggestive CA findings. No significant differences were found in the characteristics of suspicion between positive and negative patients. Regarding of the 35 patients scintigraphy, 7 (20%) were positives, establishing ATTR-CA diagnosis, 28 (80%) were negatives. The positivity probability was significant by H/Cl ratio, Perugini score, and SPECT findings (p 0.001). Until this protocol started and we share it among hospital physicians, we had never been asked to acquired this type of scintigraphy. Our study shows that if we purposely search for the disease, it can be found. The sample is small due to the limitations we had in the face of the pandemic;however, the study findings are significant for ATTR-CA diagnosis. It is striking that the ECHO and MRI suggestive findings were not statistically significant for the diagnosis. Conclusions. We present the initial experience of the first study of cardiac amyloidosis in our country, to show the disease's presence and that the diagnosis can be made effectively, quickly, economically, and non-invasively by nuclear medicine scintigraphy. (Table Presented).
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OBJECTIVE: To demonstrate that delayed cord clamping (DCC) is safe in mothers with confirmed SARS-CoV-2 infection. DESIGN, SETTING AND PARTICIPANTS: Prospective observational study involving epidemiological information from 403 pregnant women with SARS-CoV-2 between 1 March and 31 May 2020. Data were collected from 70 centres that participate in the Spanish Registry of COVID-19. METHODS: Patients' information was collected from their medical chart. MAIN OUTCOMES AND MEASURES: The rate of perinatal transmission of SARS-CoV-2 and development of the infection in neonates within 14 days postpartum. RESULTS: The early cord clamping (ECC) group consisted of 231 infants (57.3%) and the DCC group consisted of 172 infants (42.7%). Five positive newborns (1.7% of total tests performed) were identified with the nasopharyngeal PCR tests performed in the first 12 hours postpartum, two from the ECC group (1.7%) and three from the DCC group (3.6%). No significant differences between groups were found regarding neonatal tests for SARS-CoV-2. No confirmed cases of vertical transmission were detected. The percentage of mothers who made skin-to-skin contact within the first 24 hours after delivery was significantly higher in the DCC group (84.3% versus 45.9%). Breastfeeding in the immediate postpartum period was also significantly higher in the DCC group (77.3% versus 50.2%). CONCLUSIONS: The results of our study show no differences in perinatal outcomes when performing ECC or DCC, and skin-to-skin contact, or breastfeeding. TWEETABLE ABSTRACT: This study demonstrates that delayed cord clamping is safe in mothers with confirmed SARS-CoV-2 infection.