The Impact of Public Health, Socioeconomic, and Environmental Factors on SARS-CoV-2 Infection and Mortality Rates in Peru: Exploring the Role of Obesity

Introduction: Although several factors contributed to the rates of infection and mortality of the SARS-CoV-2 pandemic, obesity seemed to have played a larger role than most within the first several months of the pandemic. In addition, both preexisting health conditions and poor environmental condi-tions seemed to have added to higher levels of infection and mortality in several regions of the country. This study aimed to explore the impact of public health, socio-economic and environmental factors on the rate of infection and mortality of SARS-CoV-2 on gender and age groups in Peru.Methods: We explored the relationships, using Pearson's correlation and stepwise linear regression, between the in-fection and mortality cases per 100,000 individuals with pub-lic health data (obesity prevalence, total number of health in-frastructure, hypertension prevalence, active smokers, tuberculosis cases freely available from the Ministry of Health of Peru), socio-economic data (health needs not met, child-hood malnutrition, access to potable water, access to chlori-nated water system from National Institute of Statistics and Informatics of Peru) and environmental data (NO2 concen-tration from the Sentinel-2 satellite) in Peru. We used con-firmed cases from the 26 department level jurisdictions from 2020, before known variants were registered within the country and focused on gender and age groups, as well as case-fatality rate.Results: Multiple linear regression models indicate obe-sity, air quality, access to chlorinated water system, and prevalence of smoking are influential factors in the distribu-tion of infection and mortality for middle-age and elderly fe-male and male groups, but prevalence of TB and health needs not met were more important for children and young adults in Peru. Case-fatality rate was weakly associated with NO2 concentration.Conclusions: Obesity, exposure to poor air quality, and so-cio-economic conditions are significant factors in the morality of individuals above the age of 40 for both men and women, while other health factors appear to be more important to those younger than 40. The combination of these factors played a significant role during the first wave of SARS-CoV-2 infection in Peru in 2020.

[Early use of tocilizumab in hospitalized patients with severe and critical COVID-19 in the Province of Buenos Aires: a multicentric study]

INTRODUCTION: Tocilizumab (TCZ), an IL-6 receptor antagonist monoclonal antibody is warranted in severe and critically-ill COVID-19 patients. The objective was to evaluate 28-day mortality of patients with severe or critical COVID-19 treated with early vs delayed TCZ. METHODS: Multicenter, retrospective cohort study including patients >18 years hospitalized between 7/1/2021-8/1/2022 with confirmed COVID-19, with 5, 6 and 7 points of WHO Ordinal Initial Severity Scale [SS]. Early or late administration was considered if TCZ was administered before or after 48 hours from admission. Outcomes were 28-day mortality and change of SS. Factors related to 28-day mortality were evaluated with Cox regression. RESULTS: 266 patients were included, 159(60%) male;aged 58(+/- 15);frequent comorbidities were hypertension (42%), obesity (37%) and diabetes (27%). Seventy patients had a SS = 5 (Supplemental O2), 143 had SS = 6 (NIV/ HFNC), and 53 had SS = 7 (IMV). 28-day mortality was 42%(112/266);predictors were age, obesity, higher SS, days between hospitalization and TCZ administration, and fewer days between symptoms onset and TCZ. Mortality of SS 5, 6 and 7 was 26%, 39% and 72% respectively. Compared with baseline SS points, 76% and 62% of patients remained stable or improved on days 3 and 7 since TCZ administration. 28-day mortality was lower when TCZ was administered before 48 hours (39% vs 57%;p = 0.02;HR = 0.63;[0.41-0.99, p = 0.05]). DISCUSSION: This study supports the early use of TCZ in patients with severe or critical COVID-19.

Predictive indexes in prolonged weaning of mechanical ventilation due to tracheostomy in patients with COVID19 pneumonia

Introduction: In the pandemic, porlonged weaning(PW) of mechanical ventilation (wMV) of COVID patients in the intermediate respiratory care unit IRCU was performed. It was necessary to use predictive indexes for(wMV), which do not generate aerosolization of viral particles. Objetive: To develop a oredictive indexes for wMV and tracheostomy decannulation (TCHd) for COVID-19 pneumonia in IRCU. Method(s): The sample consists of 76 serial cases to the IRCU, in 2020 and 2021. Indexes were developed with an oxygenation variable (PaO2/FiO2) or (SatO2/FiO2), respiratory rate (RR) and corrected (C) in based alveolar ventilation (PCO2), the following indexes were developed as predictors of wMV;ventilation-oxygenation index IVOX= (PaFi/RR), IVOX corrected for PCO2 is IVOX-C=(IVOX x Oco2) and with SaFi the SIVOX-C= [(SaFi/RR) x PCO2]. The StatPlus 7.3 program forWindows was used of the Mann-Whitney U (M-WU) comparing their mean values, using binary logistic regression (BLR) and area under curve AUC ROC to compare their predictability. Result(s): Mean age 58,9 +/-14,4;male 53,7% and the stay in the IRCU was 16,7+/- 11 days, mortality of 28,3%(22);received MV (71,0%) 54. wMV was(70,4%)38 and TCHd was (67,3)35. The mean differrences in disconnected and non-diconnected from MV analyzed by M-WU are significante. An BLR model was built to analyze the predictive behavior ofIVOX, IVOX-C and SIVOX-C for wMV. It was observed that the three indexes are predictive, but IVOX-C and SIVOX-C have the highest predictive weight. In turn the AUC ROC was significance. Conclusion(s): The construction of a predictive indexes of wMV and TCHd in this sample the patients who reached the objective.

Evaluación de riesgos y mejora de la seguridad biológica y radiológica en la toma de radiografía torácica a pacientes con COVID-19.

INTRODUCTION: Health workers are at high risk of becoming infected with COVID-19. The objective of the study was to evaluate the risks and improve the biological and radiological safety measures for taking chest X-rays in patients with COVID-19 in a Social Security hospital in Utcubamba (Peru). MATERIAL AND METHODS: Quasi-experimental intervention study type before and after without a control group, carried out between May and September 2020. A process map and an analysis of failure modes and effects (FMEA) of radiological care were prepared. The gravity (G), occurrence (O), and detectability (D) values ??were found and the risk priority number (RPN) was calculated for each failure mode (FM). FM with RPN ≥ 100 and G ≥ 7 were prioritized. Improvement actions were implemented based on the recommendations of recognized institutions and the O and D values ??were re-evaluated. RESULTS: The process map consisted of 6 threads and 30 steps. 54 FM were identified, 37 of whom had RPN ≥ 100 and 48 had G ≥ 7. Most of the errors occurred during the examination 50% (27). After entering the recommendations, 23 FM had RPN ≥ 100. CONCLUSIONS: Although none of the measures applied through the FMEA made the failure mode impossible, they made it more detectable and less frequent and reduced the RPN for each failure mode; however, a periodic update of the process is necessary.

Where did the input crisis originate and what to do to mitigate its impact? [Spanish]

This article examines the increase in prices of farm inputs (herbicides, insecticides, fungicides and fertilizers) in 2021 and the reasons for the increase, including the rise in energy costs, the disruption caused by outbreaks of new variants of COVID-19, and the increase in international freight prices. It is concluded that there are definitely external factors, beyond local control, that are drastically affecting the prices of farm inputs, a situation that directly harms the Colombian agri-food market by significantly increasing production costs due to the high dependence on imported products and raw materials necessary in the national agrochemical and fertilizer industry. There is a need to implement technologies and cultivation practices that lead to the reduction and/or rationalization in the use of inputs, seeking to reduce production costs and increase yields.

Validation of the Fear of COVID-19 Scale in a sample of university students

Introduction: The fear of COVID-19 has spread worldwide, affecting all communities, including university students. It is required to have tools to measure this fear. Objective: To validate the translate Spanish version of the FCV-19S questionnaire (Fear of COVID-19 Scale). Methodology: A cross-sectional online-questionnaire-based study was conducted among Peruvian university students during the first outbreak by COVID-19. Undergraduate students with a native Spanish language, with internet access, were voluntarily included, and subjects with language comprehension problems were excluded. The translation of the questionnaire was carried out under a standardized protocol and an observational evaluation was applied to assess the validity and reliability of FCV-S19 with α-Cronbach, Pearson's correlation, and factor analysis. Results: Two-hundred eight university students with an average age of 25.9 ± 5.9 (IC95 %: 25.1 a 26.7) years were surveyed, where more than half were women (58.7 %) and approximately 57 % lived with their parents. The Cronbach alpha was ≥ 0.8 among the domains, giving a good internal consistency of the questionnaire (Cronbach alpha = 0.832). The validity of the instrument between the 7 items and the 5 categories showed an adequate correlation (p< 0.5), the Bartlett (p= 0,0001) and the Kaiser-Meyer Olkin (0,818) tests defined by factor analysis a dimension that explained 52.3 % of the total variance. Conclusions: The translation into Spanish of the FCV-19S questionnaire has optimal validity and reliability, being able to measure fear of COVID-19 in a sample of university students from Peru. © 2022, Editorial Ciencias Medicas. All rights reserved.

Optimizing Vaccine Allocation Strategies in Pandemic Outbreaks: An Optimal Control Approach

Since early 2020, the world has been dealing with a raging pandemic outbreak: COVID-19. A year later, vaccines have become accessible, but in limited quantities, so that governments needed to devise a strategy to decide which part of the population to prioritize when assigning the available doses, and how to manage the interval between doses for multi-dose vaccines. In this paper, we present an optimization framework to address the dynamic double-dose vaccine allocation problem whereby the available vaccine doses must be administered to different age-groups to minimize specific societal objectives. In particular, we first identify an age-dependent Susceptible-Exposed-Infected-Recovered (SEIR) epidemic model including an extension capturing partially and fully vaccinated people, whereby we account for age-dependent immunity and infectiousness levels together with disease severity. Second, we leverage our model to frame the dynamic age-dependent vaccine allocation problem for different societal objectives, such as the minimization of infections or fatalities, and solve it with nonlinear programming techniques. Finally, we carry out a numerical case study with real-world data from The Netherlands. Our results show how different societal objectives can significantly alter the optimal vaccine allocation strategy. For instance, we find that minimizing the overall number of infections results in delaying second doses, whilst to minimize fatalities it is important to fully vaccinate the elderly first. © 2022 EUCA.

What is the perception of medical students about eLearning during the COVID-19 pandemic? A multicenter study in Peru

Introduction: As face-to-face medical education was restricted during the pandemic;digital tools have been deployed to continue education showing a good educational impact in most countries. However, the perception of medical students in Peru on eLearning has not yet been investigated. This study assessed the perception of 440 medical students from two national universities in Peru on the characteristics and limitations of eLearning during 2021. Materials and methods: We conducted a cross-sectional study using the self-administered survey Encuesta Virtual en Tiempos de COVID-19 (EVI-CV19) on students between the second and sixth medical year of the Universidad Nacional Mayor de San Marcos (UNMSM) and the Universidad Nacional San Luis Gonzaga (UNSLG, n=325). Results: The majority of students were under 30 years of age (93.9% vs. 97.2%, p=0.084), and female (67% vs. 64%, p=0.107). Of the total, 63.9% and 81.5% UNMSM and UNSLG students considered the virtual platform effective in favouring feedback with recorded lectures (85.2% vs. 85.5%) and the organization of documents (61.7% vs. 80.9%), respectively (p>0.05). Seventy per cent and 46.8% of UNMSM and UNSLG students perceived that teachers were not trained (p=0.063), and 26.1% and 17.2% of students perceived that the virtual modality affected their academic performance a lot, respectively (p=0.003). About 38% of students from both universities perceived the virtual platforms as very secure. We found differences between UNMSM and UNSLG students on whether the virtual exams were fair (28.7% vs. 52.3%, p<0.001). Conclusions: This study reported a favorable perception of medical eLearning with clear differences in the limitations of the virtual environment.

ACUTE RENAL FAILURE IN COVID-19: AETIOLOGY AND RENAL EVOLUTION. AKI-COVID REGISTRY OF THE SPANISH SOCIETY OF NEPHROLOGY

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).

Persistent COVID-19 and chronic pain. Are we prepared?: Presentation of three clinical cases and review of the literature

Long COVID is a term that describes a group of multiorganic symptoms that affect patients who have suffered from COVID-19 and who remain symptomatic for a sustained period of time after the acute phase of the disease. Amongst those symptoms, pain is one of the most frequently reported, shaping into different specific syndromes such as persistent thoracic pain, generalized pain, arthralgia, myalgia and cephalalgia. Multiple mechanisms can explain the onset and perpetuation of chronic pain in these patients. It is known that SARS-CoV-2 is a neurotropic virus that can alter the somatosensory nervous system and which can also cause an intense autoimmune response with effects on multiple organs and systems. We present three clinical cases of long COVID where pain was the main symptom altogether with anxiety, depression, insomnia, catastrophic thoughts related to pain, cognitive impairment and post-traumatic stress disorder. These all show the existing complexity in the management of this new-found entity. Given the extensive number of SARS-CoV-2 infections reported globally, chronic pain in relation to long COVID can become a public health issue. Therefore, it is necessary to make it visible and to establish strategies to prevent it and confront it.

COVID-19 persistente y dolor crónico. ¿Estamos preparados? Presentación de tres casos clínicos y revisión de la literatura

Long COVID is a term that describes a group of multiorganic symptoms that affect patients who have suffered from COVID-19 and who remain symptomatic for a sustained period of time after the acute phase of the disease. Amongst those symptoms, pain is one of the most frequently reported, shaping into different specific syndromes such as persistent thoracic pain, generalized pain, arthralgia, myalgia and cephalalgia. Multiple mechanisms can explain the onset and perpetuation of chronic pain in these patients. It is known that SARS-CoV-2 is a neurotropic virus that can alter the somatosensory nervous system and which can also cause an intense autoimmune response with effects on multiple organs and systems. We present three clinical cases of long COVID where pain was the main symptom altogether with anxiety, depression, insomnia, catastrophic thoughts related to pain, cognitive impairment and post-traumatic stress disorder. These all show the existing complexity in the management of this new-found entity. Given the extensive number of SARS-CoV-2 infections reported globally, chronic pain in relation to long COVID can become a public health issue. Therefore, it is necessary to make it visible and to establish strategies to prevent it and confront it. © 2021 Publicaciones Permanyer. All rights reserved.

Inferential Statistical Analysis in E-Learning University Education in Latin America in Times of COVID-19

Since the appearance of COVID-19, the teaching-learning processes in higher education have changed. This article shows a focus on university education and e-learning, performing a statistical analysis on university students in Ecuador, obtaining significant evidence that the use of ICTs improves academic performance in the subject of statistics. In the first case, two third semester courses are taken, the experimental group is made up of 23 students, to which e-learning is applied and an application developed in Scilab that shows the resolution process for descriptive and inferential statistics;while the control group is made up of 14 students, in which only e-learning and traditional teaching are used. In the second case, 2 courses are taken, the first is formed by 14 students and the second by 22 students, using e-learning and traditional teaching. First, the Shapiro Test is used to determine if the population has a normal distribution, then the Student’s T test is applied in the hypothesis test of difference of means to determine if academic performance is improved with the use of ICTs. Finally, for α= 0.05, it is verified that the developed application improves academic performance. Another important finding is that only using traditional teaching with e-learning does not significantly change academic performance. © 2022, Springer Nature Switzerland AG.

Implementation of Tax Incentives to Avoid Unemployment Caused by the Economic Situation due to the COVID-19 Health Emergency in Mexico

Since the end of March 2020 millions, as the COVID-19 pandemic emerged as a health emergency, working people had to stay at home, telework or had to face consequences of the crisis such as low wages or layoffs.i In Mexico unemployment became a major problem for the economy. Although the country took measures to contain the imp act of the pandemic on the labor market, these have not been sufficient;the development and implementation of activities that create incentive or promotions are indispensable components of the recovery or sustainability of industries in times of crisisii. According to Article 25 of the Political Constitution of Mexicoiii, the State is responsible for guiding national development and ensure that it is comprehensive and sustainable;the State shall, according to the Constitutional provision, ensure the stability of public finances and the financial system to help generate favorable conditions for economic growth and employmentiv. I shall argue however that the fiscal policies implemented to contribute as determining factors in the sector of growing unemployment due to the COVID-19 pandemic have not been adequate even though the optimal measures were being taken under a more socialist system of governance in place during the two years. © AesthetixMS 2021

Early toxicity with stereotactic body radiation therapy for prostate cancer

Purpose or Objective: Stereotactic body radiotherapy (SBRT) has proven to be a new option for localized prostate cancer. SBRT specific indications has been transformed due to SARS-2-COVID19 scenario. This communication shows our data about acute toxicity in patients treated with SBRT during the last sixteen months. Materials and Methods: This retrospective and observational study was performed on prostate cancer patients admitted into our radiotherapy department for SBRT between October 2019 until January 2021. SBRT treatment at our institution has been standardized as an IGRT technique using VMAT radiation therapy due to deliver total doses of 36.25 or 40 Gy in 5 fractions. The following variables were recorded: age, past medical history, previous treatment with anticoagulant or antiplatelet drugs, Performance Status (PS), ACE-27 score, IPSS score, Gleason score, Prostate Volume, Tumor Stage, PSA levels, Risk group following NCCN, Hormonotherapy, Radiation Area, RT Doses as well as different toxicity types depending on Genitourinary (GU) or Gastrointestinal (GI) location. Toxicity review was recorded (after RT, six month and 12 months) according to Common Terminology Criteria for Adverse Events (CTCAE). For the descriptive analysis, analytical variables were represented using absolute and relative frequencies. All statistical analysis were conducted using software from SPSS (version 25.0, Chicago, IL). The hypothesis of our study is SBRT technique will reduce radiotherapy sessions with a low rate of toxicity. Results: A total of 47 patients were included, with a median age of 71 years, performance status 0-1, including high risk prostate cancer (25 patients with Gleason score 6, 17 with score 7, 4 with score 8 and 1 with score 9), all of them without seminal vesicles affected. Related to NCCN risk group, 57.4 % of the patient had very low risk, low risk and favorable intermediate risk and 42.6% were unfavorable intermediate, high and very high risk. Androgen deprivation was associated in 40.4% of the cases with a median of treatment in six months (RI:6-24). Image Guided Radiotherapy was performed by matching of fiducial markers on kvCBCT images that were acquired prior to treatment, for positioning, and during treatment, for intrafraction movement control in 74.5% of the patients. The remaining 25.5% were treated by means of a gating system guided by continuous transperineal ultrasound scanning (Clarity ®system). Acute toxicity grade 1 and 2 after RT was greater at GU (51.1%/21,3%) than GI (12.8%/4.3%) location. During subsequent follow-up no patient developed acute GU or GI toxicity greater than or equal to grade 2. At 6 and 12 months evaluation GU toxicity was greater than GI, 31.7% Vs. 17.1% and 12%Vs.4%, respectively. Conclusion: Evaluation of toxicity during the early phase SBRT has proven to be a well tolerated treatment for prostate cancer in our series.

Teaching history in times of pandemic: A case study in a Chilean school

The carried out research aims to identify and understand the main advantages and challenges for history and social sciences teaching in the context of the COVID-19 pandemic. Furthermore, this study recognizes the work spaces that allow teachers to develop historical empathy and the teaching of participatory citizenship through this new school context. This is done through a case study of a group of teachers who belong to an educational centre in the Metropolitan Region of Chile;we have been able to collect the perceptions, emotions, feelings and views of history and social sciences teachers on how they develop their educational practice in a setting of pandemic. The methodology followed is of qualitative nature under a case study design. The results stand out concerning the interrelation that is generated. On the one hand, it interrelates in the complexity that teaching during the pandemic implies with the context of inequalities that the school faces highlighting the efforts of educational innovation to generate significant learning for and the students. Amongst the main conclusions there are the efforts made by teachers to generate educational innovation in the complex context of the pandemic, where the school and all the social problems that arise are inserted. Teachers have found the spaces and raised new perspectives of teaching that promote historical empathy and education for citizenship in students. ,,. © 2021 Univ Nacional de Educacion a Distancia (UNED). All rights reserved.

Low Incidence and Mortality by SARS-CoV-2 Infection Among Healthcare Workers in a Health National Center in Mexico: Successful Establishment of an Occupational Medicine Program

Background: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Healthcare workers (HCWs) constitute a population which is significantly affected by SARS-CoV-2 infection worldwide. In Mexico, the Instituto Nacional de Enfermedades Respiratorias (INER) is the principal national reference of respiratory diseases. Aim: To evaluate the efficiency of the INER-POL-TRAB-COVID19 program to mitigate the SARS-CoV-2 infection risk among the INER-healthcare workers (INER-HCW). Methods: Currently, the INER has 250 beds and 200 respiratory ventilators to support COVID-19 patients in critical condition. On March 1st, 2020, the INER-POL-TRAB-COVID19 program was launched to mitigate the SARS-CoV-2 infection risk among the INER-HCW. Findings: From March 1st to October 1st, 2020, 71.5% of INER-HCWs were tested for SARS-CoV-2 infection, and 77% of them were frontline workers. Among the tested INER-HCWs, 10.4% were positive for SARS-CoV-2 infection. Nonetheless, nosocomial infection represented only 3.8% of the cases and the mortality was null. Fifty-three of INER-HCWs positive to SARS-CoV-2 had a negative test 42-56 days post-diagnosis and were returned to service. Finally, although a change in the PPE implemented on May 11th, 2020, the incidence of SARS-CoV-2 infection was not affected. Conclusion: INER has a lower incidence of HCWs infected with SARS-CoV-2 as compared to the mean of the national report. The implementation of the INER-POL-TRAB-COVID19 program is efficient to decrease the risk of infection among the HCWs. Our findings suggest that the implementation of a similar program at a national level can be helpful to provide a safe environment to HCWs and to prevent the collapse of health institutions.

Convalescent plasma therapy in COVID-19 patients, in the province of Buenos Aire

This is a preliminary, multicenter, retrospective cohort study, including 272 consecutive patients with COVID-19 admitted to hospitals in Buenos Aires Province, between May 15th and July 1st, 2020, included in an expanded access program to convalescent plasma. Our objectives were to analyze mortality and its independent risk factors, and to assess the occurrence of a favorable evolution, defined as hospital discharge, or stay at the ward, or transfer from ICU to ward. Patients were stratified int o 4 subgroups: admission to the ward with pneumo nia and/or oxygen requirement (WARD;n=100);ICU admission (ICU;n=87);ICU admission with requirement of mechanical ventilation (ICU-MV;n=56), and ICU-MV plus septic shock (ICU-MV-SS;N=29). Mortality at 28 days was 26.1% for the entire group, 14.0% for WARD group, 18.4% for ICU, 44.6% for ICU-MV, and 55.2% for ICU-MV-SS. Mean survival time (days) was 25.6+or-0.6 (WARD);25.3+or-0.7 (ICU);20.8+or-1.2 (ICU-MV) and 18.2 +or- 1.8 (ICU-MV-SS). Independent predictors of mortality were MV, septic shock and weight. A favorable evolution occurred in 81.4% of WARD patients;in 70.9% of ICU;in 39.6% of ICU-MV and in 27.6% of ICU-MV-SS patients. Severity of illness on admission, age, weight and heart rate were independently associated with evolution. No major adverse effects were recorded. The lack of a control group precluded the estimation of efficacy. However, our 26% mortality rate was higher than that of the treatment arm of clinical trials comparing plasma with usual treatment, which might be ascribed to higher proportion of patients with MV and septic shock in our cohort.