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.

Impact of SARS-CoV-2 on HLA serological phenotyping level in southern Portuguese solid organ donors

HLA molecules play a key role in transplant medicine and disease pathogenesis, being a useful tool in predicting disease progression and identifying potential solid organ donors (SOD). The Coronavirus disease 2019 (SARS-CoV-2) pandemic had a huge worldwide impact, which strongly affected the activity of different transplant programs. So far, it has been shown that HLA type may be a crucial differentiator between individuals who have varying occurrence, morbidity, and mortality response to SARS-CoV-2. In this work, we investigated if differences in the frequency of SOD HLA alleles, were impacted during SARS-CoV-2 pandemic. We performed a retrospective file audit of all HLA-typings done in 2 subsets of SOD pre-pandemic period (ppp) (n = 379) and pandemic period (pp) (n = 351), collected in equivalent timeframes. We discuss data for the major HLA-A, HLA-B, HLA-C, and HLA-DRB1 allele groups at serological phenotyping level. Overall, there was a 7% SOD decrease in the pp. Considering both periods, the most common allele groups were HLA-A2, HLA-B35, HLA-Cw7, HLA-DR7 and HLA-DQ2. For the ppp group, the most common alleles were HLA-A2, HLA-B35, HLA-Cw7, HLADR13 and HLA-DQ2, while in the pp group the most common alleles were HLA-A2, HLA-B44, HLA-Cw7, HLA-DR4 and HLA-DQ2. When comparing both populations at the serological phenotyping level an increased in relative frequency was found for 10, 12, 8, 8 and 2, and a decreased was found for 10, 24, 8, 6 and 5 for HLA-A, -B, -C, -DR and -DQ, respectively. The significant variation within the HLA frequencies between the different pre-pandemic and pandemic groups highlights the value of population-specific HLA-typing. Furthermore, the identification of different frequencies among both populations will impact in patients HLA compatibility with SOD thus impacting their transplantability.

DIABETESvid: Web survey methods for diabetes self-care and resilience in the COVID-19 pandemic in Brazil

Aim: To describe Brazilian web survey methods termed DIABETESvid by assessing the diabetic individuals' self-care practices and their resilience in the COVID-19 pandemic. Method(s): This is a cross-sectional study on data collected from web surveys in the period between 1st September and 19th October 2020, in which socio-demographic, clinical, self-care and resilience variables were investigated. A questionnaire was elaborated and implemented by using the Research Electronic Data Capture platform. Result(s): A total of 1,633 participants were eligible for this study, with a higher frequency of females, 46.5% being aged between 18 and 39 years old, 40.9% being diagnosed with diabetes within 1 to 10 years and all having high level of education. Most of the participants was living in south-eastern Brazil, self-reported type 1 diabetes mellitus and had access to the survey link on WhatsApp. In this 7-week study, it was evidenced that the survey response rate was higher in the first week (38.5%) and number of accesses were increased on Thursdays (20.2%) and in the night (40.2%). Conclusion(s): The method used here can be useful as a baseline for future web surveys involving diabetic individuals so that several analyses can be conducted in the clinical care and academic contexts.Copyright © 2021 The Authors

Where did Brazilians get their diabetes drugs during the COVID-19 pandemic? DIABETESvid results

Access to diabetes medications is critical to disease control. However, social distancing in the COVID-19 pandemic may have limited the provision of medicines and supplies. Thus, the objective of this study was to analyze the sources of obtaining diabetes drugs in the COVID-19 pandemic in Brazil. The data came from the DIABETESvid survey, and this analysis considered a convenience sample of 1608 participants who responded to the questionnaire published on social media of scientific societies related to diabetes. This is a cross-sectional study, conducted in the form of a web survey, from September 1 to October 19, 2020. The outcome analyzed was the sources for obtaining diabetes drugs categorized in pharmacies of the "Sistema Único de Saúde", pharmacies of the "Aqui tem Farmácia Popular” program, as well as private pharmacies and drugstores and other sources. Most participants self-reported a diagnosis of type 1 diabetes mellitus (49.8%), used insulin (61.9%), and had a private health plan (68.7%). Private pharmacies and drugstores and other sources were the main places where medicines for diabetes were supplied (47.5%). Participants residing in the Midwest region of the country had a lower frequency of supply in pharmacies in the "Aqui tem Farmácia Popular” program (0.57;95%CI 0.36-0.92). In the studied sample, there was a higher frequency of supply of diabetes drugs in private pharmacies and drugstores and other sources with a reduction in frequency in public pharmacies during the COVID-19 pandemic in Brazil. © 2022 Centro Universitario Sao Camilo. All rights reserved.

LDL-C control according to risk: Is there a gender paradox?

Background and Aims : Background Low density lipoprotein cholesterol (LDL-C) treatment goals used for cardiovascular disease (CVD) prevention. Sex differences in CVD have been reported and women are less likely to receive statin therapy for secondary prevention. Nevertheless, little is known about gender according to risk categories Aims To assess the degree of LDL-C control in men vs women by CV risk levels and to report possible associations with clinical characteristics and lipid lowering therapies (LLT) in Portugal Methods: A non-interventional, cross-sectional study of patients regularly consulted for primary/secondary CVD in Portugal (1 hospital, 14 primary care centres). Data spanned a 12-year period (01/2008-12/2020) with index date for patient identification the 31/12/2020. CVD risk assessment was done according to 2019 ESC/EAS guidelines for the management of dyslipidaemias. Result(s): In our cohort of 129 764 patients with an overall median age of 53 years, 56.9% were women. 38.9% of men and 28.9% of women were classified as high/very high risk. History of previous CV hospitalization was present in 7.3% males and 5.0% females (table 1). LDL-C targets were attained more commonly in men for high and very high risk levels, although prescription of any LLT was more frequent in women (table 2). We found similar pattern in the two years prior to the COVID-19 pandemic. [Formula presented] [Formula presented] Conclusion(s): Women fail to achieve their LDL-C goals compared to men, although they are more frequent under LLT and have lower CV risk. The reasons and clinical associations require further research. More intensive therapies should perhaps be considered in women. Copyright © 2022

Quality of life in dentistry students in the pandemic of COVID-19: a multicentric study

This study aimed to assess the quality of life (QOL) of dental students in the 2019 Coronavirus Disease pandemic (COVID-19). A cross-sectional study was carried out with undergraduate students in Dentistry from Higher Education Institutions (HEIs) in the state of Ceara, Brazil. Data collection took place in May 2020, online, using questionnaires with sociodemographic, course-related and behavioral variables, in addition to the World Health Organization Questionnaire for Quality of Life-bref (WHOQOL-bref). Multinomial logistic regression was performed. 864 students participated in this study. Variables such as higher income (p = 0.034), having religion (p = 0.010), having health insurance (p = 0.005), satisfaction with sleep quality (p < 0.001), absence of insomnia (p < 0.001) and practicing physical activity always (p < 0.001) were associated with greater satisfaction regarding QOL. The QoL of dental students was classified in the dissatisfaction category, being perhaps impacted by the pandemic of COVID-19. Variables that reflected a more economically favorable living condition were associated with satisfaction with the quality of life of this public in the COVID-19 pandemic.

Experience of Basic Life Support with Automated External Defibrillation Course in the first year of Medical School

Introduction: The annual incidence of out of hospital cardiac arrest in Europe is between 67 to 170 per 100,000 inhabitants1. Basic Life Support (BLS) with Automated External Defibrillation (AED) are techniques with undoubted benefit2. Still, the use of AEDs remains low in Europe (average 28%)1. Training in BLS with AED is mandatory for health care professionals. Within the scope of the curriculum reform of the Integrated Master of Medicine (IMM), an Introduction to Medicine unit was created, which includes a BLS with AED course.We assessed medical students rating of this course. Material and methods: Assessment of satisfaction of the certified Portuguese Resuscitation Council/European Resuscitation Council BLS and AED course3 to first year students of the IMM at Instituto de Ciências Biomédicas Abel Salazar. School of Medicine and Biomedical Sciences, Porto, Portugal, since 2018 to 2021. Twelve questions regarding four areas, BLS, AED, Recovery position (RP) and Foreign body airway obstruction (FBAO), were graded from 0 = none to 5 = maximum. Results: In total, 38 courses were held, attended by 719 students. The global assessment was maximum on most questions. This trend was most pronounced in issues relating to the BLS (mean of 96,6% for grade 5) and AED (mean of 96,5% for grade 5). The relevance of the content in the four different areas was also very high (range 96,2 to 99,3%). In contrast, the RP (mean of 92,9% for grade 5) and FBAO (mean of 90,4% for grade 5) training ratings were the lowest, yet still quite high. The training conditions, either by limitations imposed by COVID, or by the training models, may have contributed to the less favourable results. Conclusions: Training in BLS and AED is confirmed as a very relevant practice for 1st year medical students. Improvement in its practical implementation may promote greater satisfaction and learning.

The relationship between nutritional deficiencies and mental health

The objective of this mini review was to discuss the relationship between nutritional deficiencies and mental health, and to present a structure that helps to visualize these associations based on a literature review and the scenarios of the COVID-19 pandemic. The study was conducted to demonstrate the effect of the nutritional deficiencies on the occurrence and/or worsening of mental health problems, mainly related to the most drastic measures of social distance during the COVID-19 pandemic. Studies have already shown that a nutritionally unbalanced diet may be associated with greater chances of mental health problems. Insufficient levels of micronutrients can, by regulating the stress response, immune and oxidative systems, negatively affect brain functions and, consequently, cognitive functions and mental health of individuals. The current pandemic of COVID-19 reveals an increase in food and nutritional insecurity, and a worsening of this situation among already vulnerable populations. Micronutrient deficiencies may be exacerbated in a context of increased food insecurity and the COVID-19 pandemic, which may contribute to increased mental health problems.

Blockchain and the organization of refugee´s data in international law from the COVID-19 pandemic on

Objective: based on the use of the disruptive technology of blockchain as a way of identifying Syrian refugees in Jordan by the UN in 2017, in a pilot project of the World Food Program-WFP, in the context of the "technological turn of law" accelerated in the year 2020 with the Covid-19 virus pandemic, it is aimed to demonstrate the need for the discipline of this technology by international law, presenting advantages and disadvantages of its use, which should inevitably face ethical and legal implications, essentially for the guarantee of the dignity of the refugee's human person on his or her personality rights. Methodology: the predominance of the empirical methodology is justified by the possible expansion of the use of this technology for the purposes of registration for refugees around the world, requiring a dialectical-inductive approach of a qualitative nature. Results: as a result of the research, it is considered that there is a need for international regulation of the use of technology, respecting and fully protecting the human person, so that this technology is used as a plus, a form of extended protection, with no openings for threats or injuries to human rights, considering essentially the high degree of vulnerability in which the refugee finds himself, essentially in periods such as the occurrence of a pandemic. Contributions: as a contribution, we give a legal warning that this technology should be used as an instrument of extended protection, having as limits the human rights themselves, so that it is not distorted into an instrument of exacerbated and discriminatory control in the future, especially in exceptional situations, such as wars and pandemics. © 2021, Centro Universitario Curitiba - UNICURITIBA. All rights reserved.

Pandemic in the 21st Century: religious and scientific discourse in adventist journals

This article is the result of documentary research on primary sources undertaken in the April 2020 editions of the denominational periodicals Revista Adventista, Revista Vida e Saude and in the special edition of Revista Sinais dos Tempos. We accessed the editions using the descriptors coronavirus, covid-19 and pandemic, which had a total of one hundred and seven occurrences. The objective of the research is to present the scientific and religious discourses put into circulation in the journals, in order to indicate the relationship between science and religion. It is worth mentioning that the data resulting from it receive an analysis treatment in this text, with theoretical references Even-Zohar (2013), Martino (2003), Bardin (2011), Chartier (2003) with regard to editorial strategies and Barbour (2004) about the relationship between science and religion. The use that we make of the categories of Barbour (2004) occurs along the lines of topical appropriation (Catani;Catani;Pereira, 2001).

Characteristics and outcomes of COVID-19 patients admitted to a regional health system in the southeast

Background: COVID-19, first described in Wuhan, China, is now a global pandemic. We describe a cohort of patients (pts) admitted to our academic health system (HS) in the southeast, where demographics and comorbidities differ significantly from other regions in the U.S. Methods: This was a retrospective review of 161 consecutive pts admitted with COVID-19 from 3/12/20 to 6/1/20. We assessed demographics, comorbidities, presenting symptoms, treatments and outcomes and compared pts who died during hospitalization to those who survived to discharge (EpiInfo 7.2, Atlanta, GA). Results: Mean age was 60.5 years, 51.6% were female, 72% African American (AA) and 69.6% admitted from home. 54.5% had a BMI >30, 72% had HTN, 47.2% diabetes, and 33.6% COPD or asthma. The majority (68.8%) presented with fever (>38.0) and required supplemental oxygen within 8 hours of admission (63.4%). Cough (65.6%), dyspnea (57.5%), myalgias (30.6%) and diarrhea (23.8%) were also common. 40.4% received hydroxychloroquine, 23.6% steroids and 19.9% convalescent plasma. 42.9% required ICU care, 27.3% were intubated, and 19.3% died. Characteristics associated with death included older age, male sex, HTN, ESRD on HD, and cancer. Symptoms associated with death included absence of cough, absence of myalgias, previous admission for COVID- 19, tachypnea, need for supplemental oxygen, elevated BUN and creatinine, and elevated ferritin. Interventions associated with death included use of steroids, receipt of ICU care, intubation, delay to intubation, and use of vasopressors or inotropes. Complications associated with death included development of a new arrhythmia, bacteremia, pneumonia, ARDS, thrombosis, and new renal failure requiring HD (Table). Conclusion: COVID-19 pts admitted to our southeast U.S. HS had significant comorbidities, most commonly obesity, HTN, and diabetes. Additionally, AA comprised a disproportionate share (72%) of our cohort compared to the general population of our state (30%), those tested in our region (32.9%), and those found to be positive for COVID-19 (35.8%). In-hospital mortality was 19.3% and intubation, particularly if delayed, was associated with death as were several complications, most notably arrhythmia, ARDS, and renal failure with HD.