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Background: Telemedicine became a relevant means to provide healthcare without face-to-face medical evaluation during the COVID-19 pandemic. Aim(s): To describe the effectiveness of telemedicine in vascular surgery. Material(s) and Method(s): Review of medical records of all vascular surgery consultations carried out in a clinical hospital between April and October 2020. The main outcome measured was the resolution of the reason for consultation. Secondary outcomes were the need to request laboratory tests or imaging, the need to evaluate the patient in person, and the need for referral to hospitalization or emergency service. Result(s): One hundred-six new consultations and their follow-up (remotely or in person) were analyzed. A definitive diagnosis could be reached in 74% of consultations, treatment could be instituted or modified in 69% of them, and the reason for consultation could be resolved in 74% of cases. Laboratory and imaging tests were requested in 36 and 63% of consultations, respectively. Four percent of patients were referred to the emergency department or hospitalization. Conclusion(s): In the vast majority of consultations, it was possible to achieve a definitive diagnosis, prescribe a treatment and resolve the reason for consultation without the need for a face-to-face medical evaluation. Copyright © 2022 Sociedad Medica de Santiago. All rights reserved.
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This study aims to verify whether managers in the agricultural, transport and storage, and tourism and food sectors of Colombia follow a hierarchy of preferences or Pecking Order when defining the capital structure of their companies. Based on Bloomberg and EMIS, the financial statements of 1,548 firms from 2017 to 2020 were used to build three panel data analysis models with fixed effects, one per sector. The findings show a negative relationship between profitability and retained earnings with level of indebtedness in the agricultural and tourism and food sectors. They also indicate that the level of indebtedness of the tourism and food sector increased with the economic crisis generated by COVID-19, while it decreased in the agricultural sector. The conclusions suggest that in these two sectors there is a hierarchy of preferences, but not so in the transport and storage sector, where only a negative relationship with profitability is observed.
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Background. New York City emerged as the Epicenter for Covid-19 due to novel Coronavirus SARS-CoV-2 soon after it was declared a Global Pandemic in early 2020 by the WHO. Covid-19 presents with a wide spectrum of illness from asymptomatic to severe respiratory failure, shock, multiorgan failure and death. Although the overall fatality rate is low, there is significant mortality among hospitalized patients. There is limited information exploring the impact of Covid-19 in community hospital settings in ethnically diverse populations. We aimed to identify risk factors for Covid-19 mortality in our institution. Methods. We conducted a retrospective cohort study of hospitalized in our institution for Covid 19 from March 1st to June 21st 2020. It comprised of 425 discharged patients and 245 expired patients. Information was extracted from our EMR which included demographics, presenting symptoms, and laboratory data. We propensity matched 245 expired patients with a concurrent cohort of discharged patients. Statistically significant covariates were applied in matching, which included age, gender, race, body mass index (BMI), diabetes mellitus, and hypertension. The admission clinical attributes and laboratory parameters and outcomes were analyzed. Results. The mean age of the matched cohort was 66.9 years. Expired patients had a higher incidence of dyspnea (P < 0.001) and headache (0.031). In addition, expired patients had elevated CRP- hs (mg/dl) ≥ 123 (< .0001), SGOT or AST (IU/L) ≥ 54 (p < 0.001), SGPT or ALT (IU/L) ≥ 41 (p < 0.001), and creatinine (mg/dl) ≥ 1.135 (0.001), lower WBC counts (k/ul) ≥ 8.42 (0.009). Furthermore, on multivariate logistic regression, dyspnea (OR = 2.56, P < 0.001), creatinine ≥ 1.135 (OR = 1.79, P = 0.007), LDH(U/L) > 465 (OR = 2.18, P = 0.001), systolic blood pressure < 90 mm Hg (OR = 4.28, p = .02), respiratory rate > 24 (OR = 2.88, p = .001), absolute lymphocyte percent (≤ 12%) (OR = 1.68, p = .001) and procalcitonin (ng/ml) ≥ 0.305 (OR = 1.71, P = .027) predicted in- hospital mortality in all matched patients. Conclusion. Our case series provides admission clinical characteristics and laboratory parameters that predict in- hospital mortality in propensity Covid 19 matched patients with a large Hispanic population. These risk factors will require further validation.
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Latin America has been severely affected by the COVID-19 pandemic. The COVID-19 burden in rural settings in Latin America is unclear. We performed a cross-sectional, population-based, random-selection SARS-CoV-2 serologic study during March 2021 in the rural population of San Martin region, northern Peru. In total, 563 persons from 288 houses across 10 provinces were enrolled, reaching 0.2% of the total rural population of San Martin. Screening for SARS-CoV-2 IgG antibodies was done using a chemiluminescence immunoassay (CLIA), and reactive sera were confirmed using a SARS-CoV-2 surrogate virus neutralization test (sVNT). Validation of the testing algorithm using prepandemic sera from two regions of Peru showed false-positive results in the CLIA (23/84 sera;27%) but not in the sVNT, highlighting the pitfalls of SARS-CoV-2 antibody testing in tropical regions and the high specificity of the two-step algorithm used in this study. An overall 59.0% seroprevalence (95% confidence interval [CI], 55 to 63%) corroborated intense SARS-CoV-2 spread in San Martin. Seroprevalence rates between the 10 provinces varied from 41.3 to 74.0% (95% CI, 30 to 84%). Higher seroprevalence was not associated with population size, population density, surface area, mean altitude, or poverty index in Spearman correlations. Seroprevalence and reported incidence diverged substantially between provinces, suggesting regional biases of COVID-19 surveillance data. Potentially, limited health care access due to environmental, economic, and cultural factors might lead to undetected infections in rural populations. Additionally, test avoidance to evade mandatory quarantine might affect rural regions more than urban regions. Serologic diagnostics should be pursued in resource-limited settings to inform country-level surveillance and vaccination strategies and to support control measures for COVID-19. IMPORTANCE Latin America is a global hot spot of the COVID-19 pandemic. Serologic studies in Latin America have been mostly performed in urban settings. Rural populations comprise 20% of the total Latin American population. Nevertheless, information on COVID-19 spread in rural settings is scarce. Using a representative population-based seroprevalence study, we detected a high seroprevalence in rural populations in San Martin, northern Peru, in 2021, reaching 41 to 74%. However, seroprevalence and reported incidence diverged substantially between regions, potentially due to limited health care access or test avoidance due to mandatory quarantine. Our results suggest that rural populations are highly affected by SARS-CoV-2 even though they are sociodemographically distinct from urban populations and that highly specific serological diagnostics should be performed in resource-limited settings to support public health strategies of COVID-19 control.
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Background: The pathobiology of in situ pulmonary thrombosis in acute respiratory distress syndrome (ARDS) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is incompletely characterized. In human pulmonary artery endothelial cells (HPAECs), hypoxia upregulates expression of a pro-thrombotic NEDD9 peptide (N9 ) on the extracellular plasma membrane surface. We hypothesized that increased pulmonary endothelial N9 is a novel feature of the SARS-CoV-2 pathophenotype. Methods: Paraffin-embedded autopsy lung specimens were acquired from patients with ARDS due to SARS-CoV-2 infection (n=13), ARDS of other causes (n=10), and non-disease controls (n=5). Immunofluorescence characterized expression of N9 , fibrin, and TCF12, a putative binding target of SARS-CoV-2 and known transcriptional regulator of NEDD9. We performed RNA-Seq on mRNA isolated from control HPAECs treated with normoxia or hypoxia (0.2% O2 ) for 24 hr. Immunoprecipitation-liquid chromatography-mass spectrometry (IP-LC-MS) profiled protein-protein interactions involving N9 relevant to thrombus stabilization. Results: Compared to non-SARS-CoV-2-ARDS lungs, pulmonary endothelial N9 expression and N9-fibrin colocalization was increased by 174% (P<0.002) and 212% (P<0.001) in SARS-CoV-2-ARDS, respectively. Compared to normoxia, hypoxia increased TCF12 mRNA quantity significantly in HPAECs in vitro [+1.19-fold, P=0.001;false discovery rate (FDR)=0.005]. Pulmonary endothelial nuclear TCF12 expression was also increased by 370% in SARS-CoV-2-ARDS vs. controls. In HPAEC plasma membranes, IP-LC-MS identified a novel protein-protein interaction between NEDD9 and the β3 subunit of the αvβ3 integrin, which regulates fibrin anchoring to endothelial cells. Conclusions: Compared to non-SARS-CoV-2-ARDS, SARS-CoV-2-ARDS is associated with increased pulmonary endothelial N9 expression and N9-fibrin colocalization in microthrombi in situ. Increased hypoxia signaling or SARS-CoV-2-mediated regulation of TCF12 are potential mechanisms by which to explain these findings. Identifying N9 in the pulmonary microthrombi of SARS-CoV-2 lungs may have important pathobiological and, potentially, therapeutic implications for ARDS patients.
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Objectives: Ecuador has been affected by the COVID-19 pandemic since March 2020. The impact of the infection in rheumatic patients is still being examined. The purpose of the study was to describe the clinical demographics and impact of COVID19 in of Ecuadorian patients with rheumatic conditions. Methods: Rheumatologists practicing in Ecuador reported the data from June 2020 to February 2021, demographic data, clinical status, rheumatic treatment and COVID-19 directed therapy was retrieved. Data were analyzed in SPSS v22. Results: A total of 114 patients with COVID-19 and primary diagnosis of rheumatic disorders were registered, 78% female and 22% male with a mean age of 50.5 ± 16.6 [23-83].Most patients were considered as Mestizo/mixed race 88% [100]. Primary diagnosis included rheumatoid arthritis 42%, osteoarthritis 19%, systemic lupus erythematous 15%, fibromyalgia 8%, ankylosing spondylitis 4%, other seronegative disorders 3%, gout 3%, Sjögren syndrome 2%, polymyalgia rheumatica 2%, dermatomyositis and psoriatic arthritis 1%. Medications for rheumatic disorders included methotrexate 33%, glucocorticoids 40%, hydroxychloroquine 20%, biologics 8%, anti-TNF 9%, tofacitinib 2%, among others. 83%of the sample were in remission or controlled disease before getting infected by COVID-19. COVID-19 symptoms included fever 74%, chills 28%, cough 55%, sore throat 46%,myalgia 47%, anosmia 41%, headache 39%, arthralgia 38%, fatigue 35%, dyspnea 6%, nausea and vomiting 8%, diarrhea 35%, abdominal pain 10%, ageusia 31%, skin lesions 5%. 92%spent the clinical course at home and 9% hospitalized with a mean of days of stay of 18.7 ± 5.4 [4-60]. 45% of the patients required treatment adjustments for the rheumatic conditions. 82% have a resolved clinical course of the infection. 40% of the patients with controlled/remission RA experienced a flare after COVID-19 infection and SLE patients flared in 19%. 3% of the patients died from COVID-19 infection. Conclusion: This is the first study of rheumatic patients with history of COVID-19 infection in Ecuador. The majority (86%) of the patients were in remission before the infection. COVID-19 triggered flares in 40% of RA patients and on 19%of SLE patients with well controlled disease before viral infection. It is still unknown the long-term effects of COVID-19 in rheumatic patients;however, it is evident that it has a negative impact on disease activity.