Hospital-based proton therapy implementation during the COVID pandemic: early clinical and research experience in a European academic institution.

INTRODUCTION: A rapid deploy of unexpected early impact of the COVID pandemic in Spain was described in 2020. Oncology practice was revised to facilitate decision-making regarding multimodal therapy for prevalent cancer types amenable to multidisciplinary treatment in which the radiotherapy component searched more efficient options in the setting of the COVID-19 pandemic, minimizing the risks to patients whilst aiming to guarantee cancer outcomes. METHODS: A novel Proton Beam Therapy (PBT), Unit activity was analyzed in the period of March 2020 to March 2021. Institutional urgent, strict and mandatory clinical care standards for early diagnosis and treatment of COVID-19 infection were stablished in the hospital following national health-authorities' recommendations. The temporary trends of patients care and research projects proposals were registered. RESULTS: 3 out of 14 members of the professional staff involved in the PBR intra-hospital process had a positive test for COVID infection. Also, 4 out of 100 patients had positive tests before initiating PBT, and 7 out of 100 developed positive tests along the weekly mandatory special checkup performed during PBT to all patients. An update of clinical performance at the PBT Unit at CUN Madrid in the initial 500 patients treated with PBT in the period from March 2020 to November 2022 registers a distribution of 131 (26%) pediatric patients, 63 (12%) head and neck cancer and central nervous system neoplasms and 123 (24%) re-irradiation indications. In November 2022, the activity reached a plateau in terms of patients under treatment and the impact of COVID pandemic became sporadic and controlled by minor medical actions. At present, the clinical data are consistent with an academic practice prospectively (NCT05151952). Research projects and scientific production was adapted to the pandemic evolution and its influence upon professional time availability. Seven research projects based in public funding were activated in this period and preliminary data on molecular imaging guided proton therapy in brain tumors and post-irradiation patterns of blood biomarkers are reported. CONCLUSIONS: Hospital-based PBT in European academic institutions was impacted by COVID-19 pandemic, although clinical and research activities were developed and sustained. In the post-pandemic era, the benefits of online learning will shape the future of proton therapy education.

COVID-19 cases, hospitalizations, outpatients, and deaths in Mexico by ethnicity and state-level income.

INTRODUCTION: Mexico is one of the countries that is most affected by mortality due to COVID-19. Once infected, the indigenous population living in the lower-income states had worse outcomes. Our objectives were to analyze outcomes by ethnic group, and determine the association between state-level income and the incidence, hospitalizations, outpatients, and death rates per 100,000 population. METHODOLOGY: We analyzed 1,037,567 confirmed COVID-positive cases from February 29 to November 13, 2020 recorded in the Mexican COVID-19 cases database. Sociodemographic characteristics, comorbidities, and outcomes were analyzed. Data was allocated according to the state where the patients were treated. Statistical association between age-adjusted incidence and death rates with state-level GDP per capita (as a measure of income), were ascertained using Spearman correlations. Kruskal-Wallis tests examine the association of cumulative incidence, hospitalizations, outpatients, and death rates, with income quartiles. When significant, a follow-up analysis (Mann-Whitney) was conducted. RESULTS: Respective cumulative incidence rates and death rates were: 900.3 (non-indigenous) and 94.4 (indigenous), and 87.1 (non-indigenous) and 13.9 (indigenous). Spearman correlation coefficients of income with age-standardized incidence and death rates were 0.657 and 0.607 (p < 0.001 for both). Kruskal-Wallis H-Values indicate significant median differences by income in total population rates: cumulative incidence 13.47 (p < 0.01), hospitalizations 11.67 (p < 0.01), outpatients 12.86 (p < 0.01), and deaths 8.92 (p < 0.05). CONCLUSIONS: Cumulative incidence, hospitalizations, outpatients, and mortality rates presented a reversed socioeconomic status health gradient in Mexico. Less adverse outcomes were observed in the lowest-income states compared to higher-income states.

[University emergency departments in the corona pandemic-Results from the ReCovER registry]. / Universitäre Notaufnahmen in der Coronapandemie ­ Ergebnisse des ReCovER-Registers.

BACKGROUND: The current COVID-19 pandemic, despite the availability of rapid tests and the start of the vaccination campaign, continues to pose major challenges to emergency departments (ED). Structured collection of demographic, clinical, as well as treatment-related data provides the basis for establishing evidence-based processes and treatment concepts. AIM OF THE WORK: To present the systematic collection of clinical parameters in patients with suspected COVID-19 in the Registry for COVID-19 in the Emergency Room (ReCovER) and descriptive presentation of the first 1000 patients. MATERIALS AND METHODS: Data from patients with suspected COVID-19, regardless of evidence of SARS-CoV­2 infection, are continuously entered into a web-based, anonymized registry in ED at six university hospitals. RESULTS: Between 19 May 2020 and 13 January 2021, 1000 patients were entered into the registry, of whom 594 patients (59.4%) were in the SARS-CoV­2 positive group (PG) and 406 patients (40.6%) were in the negative group (NG). Patients of the PG had significantly fewer pre-existing conditions and a significantly longer latency between symptom onset and presentation to the ED (median 5 vs. 3 days), were more likely to suffer from cough, myalgia, fatigue, and loss of smell/taste and had significantly higher oxygen requirements than NG patients. The rate of severe disease progression was significantly higher in the PG, and persistent symptoms were more common after discharge (11.1 vs. 4.6%). CONCLUSIONS: The multicenter collection of comprehensive clinical data on COVID-19 suspected cases in the ED allows analysis of aspects specific to the situation in Germany in particular. This is essential for a targeted review and adaptation of internationally published strategies.

Health crisis and quarantine measures in Peru: Effects on livelihoods of coffee and potato farmers

This study contrasts the short-term effects of the quarantine measures implemented to contain the COVID-19 disease on the production and commercialization strategies of potato and coffee producers in Peru. Potato farmers appeared more impacted by the shock due to disruptions in the commercialization channels, leading to lower sales volumes and prices. In the near future, both potato and coffee farmers risk severe capital losses that are likely to affect the next agricultural season. Changes in household consumption patterns and intentions to introduce new crops to improve food security were reported, along with some concerns about long-term effects on the health and nutritional status of the households.