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Objectives: Patients with systemic lupus erythematosus (SLE) present greater severity of SARS-CoV-2 infection compared to the general population, particularly those with glomerulonephritis and who are treated with glucocorticoids. Likewise, high disease activity and some immunosuppressants have been associated with worse outcomes. The aim of this study was to describe the characteristics of SARS-CoV-2 infection in patients with SLE in Argentina from the SAR-COVID registry and to establish factors associated with a worse outcome. Method(s): Observational study. Patients diagnosed with SLE with confirmed SARS-CoV-2 infection (RT-PCR and/or positive serology) from the SAR-COVID registry were included. Data were collected from August 2020 to March 2022. The outcome of the infection was measured using the World Health Organization-ordinal scale (WHO-OS). Severe COVID-19 was defined as an WHO-OS value >=5. Descriptive analysis, Student's t , Mann Whitney U, ANOVA, Chi2 and Fisher's tests. Multivariable logistic regression. Result(s): A total of 399 patients were included, 93%female, with a mean age of 40.9 years (SD 12.2), 39.6% had at least one comorbidity. At the time of infection, 54.9% were receiving glucocorticoids, 30.8% immunosuppressants, and 3.3% biological agents. SARS-CoV-2 infection was mild in most cases, while 4.6% had a severe course and/or died. The latter had comorbidities, used glucocorticoids, and had antiphospholipid syndrome (APS) more frequently and higher disease activity at the time of infection. In the multivariate analysis, high blood pressure (OR 5.1, 95% CI 1.8-15.0), the diagnosis of APS (4.7, 95% CI 1.2-15.8), and the use of glucocorticoids (10 mg/day or more: OR 5.5, 95% CI 1.6-20.5) were associated with severe hospitalization and/or death from COVID-19 (WHO-EO >= 5). Conclusion(s): In this cohort of SLE patients with confirmed SARS-CoV-2 infection, most had a symptomatic course, 22.1% were hospitalized, and 5% required mechanical ventilation. Mortality was close to 3%. The diagnosis of APS, having high blood pressure, and the use of glucocorticoids were significantly associated with severe COVID-19.
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Objetive: This study aims to determine the prevalence of mental disorders in the Peruvian population attended via telephone calls in the "Te cuido Peru" program in the context of the COV-ID-19 pandemic. Methodology: Descriptive and cross-sectional study, 2,375 people with a diagnosis of COVID-19 attended via telephone call in this program participated. Result(s): The results indicate that 82.1% of the sample attended presented some type of mental disorder. The most prevalent disorders were anxiety (34.15%), depression (25.22%), acute stress (13.81%), panic disorder (3.24%), adjustment disorder (2.44%), eating disorders (1.64%), obsessive compulsive disorder (0.8%) and other mental disorders (0.8%). Conclusion(s): These findings suggest the need to establish promotion, prevention, and psy-chotherapeutic treatment actions to provide better psychological tools to the affected and at-risk population, to enable them to manage and strengthen their coping and adaptation capacity in the face of the COVID-19 pandemic. Copyright © 2021, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.
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Background: High disease activity, treatment with glucocorticoids (GC) and rituximab (RTX), have been related to worse outcomes of COVID-19. Objectives: To assess the clinical characteristics and severity of the SARS-CoV-2 infection in patients with rheumatoid arthritis (RA) included in the SAR-COVID registry and to identify factors associated with poor outcomes. Methods: SAR-COVID is a national, longitudinal and observational registry. Patients of ≥18 years old, with diagnosis of RA (ACR-EULAR criteria 2010) who had confrmed SARS-CoV-2 infection (RT-PCR or positive serology) were included between 13-8-20 and 31-7-21. Sociodemographic and clinical data, comorbidities, disease activity and treatment at the moment of the SARS-CoV-2 infection were collected. Additionally, infection symptoms, complications, medical interventions and treatments for COVID-19 were registered. Infection severity was assessed using the WHO-ordinal scale (WHO-OS)1. A cut-off value of ≥5 identifed patients with severe COVID-19 and those who died. Statistical analysis: Descriptive statistics. Chi2 or Fischer test, Student T test or Mann-Whitney and Kruskal Wallis or ANOVA, as appropriate. Multiple logistic regression model. Results: A total of 801 patients were included, with a mean age of 53.1 ± 12.9 years, most of them were female (84.5%) and the median (m) disease duration was 8 years (IQR 4-14). One third were in remission and 46.4% had comor-bidities, being the most frequent, hypertension (26.9 %), dyslipidemia (13.5 %), obesity (13.4 %) and diabetes (8.9%). Moreover, 3.2% had interstitial lung disease (ILD) associated with RA. At SARS-CoV-2 diagnosis, 42.5% were receiving glucocorticoids (GC), 73.9% conventional (c) disease modifying antirheumatic drugs (DMARD), 24% biologic (b) DMARD and 9.1% targeted synthetic (ts) DMARD. Among bDMARD, the most frequently used were TNF inhibitors (17%), followed by abatacept (2.8%), IL-6 inhibitors (2.4%) and rituximab (RTX) (2.1%). During the SARS-CoV-2 infection, 95.8% had symptoms, 27% required hospital-ization, 7.9% presented complications and 4.4% died due to COVID-19. Severe disease and death (WHO-OS≥5) was present in 7.5% of the patients. They were older (62.9±12.5 vs 52.2±12.7, p<0.001), and they had more frequently ILD (18.5% vs 2%, p<0.001), comorbidities (82.5% vs 43.7%, p<0.001), ≥2 comor-bidities (60.3% vs 25.8%, p<0.001), treatment with GC (61% vs 40.7%, p=0.04) and RTX (8.3% vs 1.6%, p=0.007). Conversely, the use of cDMARD and TNF inhibitors was more frequent in patients with WHO-OS<5, nevertheless this difference was not signifcant. Disease activity was comparable between groups. In multivariable analysis, older age, the presence of diabetes, ILD, the use of GC and RTX were signifcantly associated with WHO-OS≥5 (Figure 1). Furthermore, older age (65.7±10.8 vs 52.4±12.8, p<0.001), the presence of comor-bidities (87.9% vs 44.7%, p<0.001), chronic obstructive pulmonary disease (21.9% vs 5.2%, p=0.002), diabetes (30.3% vs 7.9%, p<0.001), hypertension (57.6% vs 25.6%, p<0.001), cardiovascular disease (15.6% vs 3.2%, p=0.005), cancer (9.1% vs 1.3%, p=0.001), ILD (23.3% vs 2.4%, p<0.001) and the use of GC (61.8% vs 41.4%, p=0.02) were associated with mortality. Older age [OR 1.1 IC95% 1.06-1.13] and the use of GC 5-10 mg/day [OR 4.6 IC95% 1.8-11.6] remained signifcantly associated with death due to COVID-19. Conclusion: Treatment with RTX and GC, as well as older age, the presence of diabetes and ILD were associated with poor COVID-19 outcomes in this national cohort of patients with RA. Older patients and those taking GC had a higher mortality rate.
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Background: Persistent symptoms after acute COVID have been described previously. Main symptoms reported are fatigue, arthralgias, myalgias and mental sickness. Defnition and methods vary widely.1 Objectives: To asses prevalence and related factors to long COVID in a retrospective cohort of patients with rheumatic diseases from Argentina. Methods: A total of 1915 patients were registered from August 18th, 2020 to July 29th, 2021. Patients > 18 years old, with rheumatic disease and confrmed infection by SARS-CoV-2 (antigen or RT-PCR) were included. Those dead, with unknown outcome, wrong date or missing data were excluded. Demographic data, comorbidities, rheumatic disease, and characteristics of SARS-CoV-2 infection were recorded. Long COVID was defned according to NICE guidelines (persistent symptoms for more than 4 weeks, without alternative diagnosis). Long COVID symptoms were defned by rheumatologist. Severity of infection was clas-sifed according to WHO ordinal scale. We used descriptive statistics, univariate model (Student's test, chi square test, ANOVA) and multivariate logistic regression analysis. Results: 230 (12%) had long COVID. Median age was 51 (IQR 40-61]) years, 82% were females, 51% were not caucasian. Median of education was 13.3 years (IQR 12-16), 79 % had private health insurance and 55 % were employed. Nearly half (n=762, 46%) had comorbidities, the most prevalent was hypertension (n=396, 24%). The most frequent rheumatic diseases were rheumatoid arthritis (n=719, 42%) and systemic lupus ery-thematosus (n=280, 16 %). Most were in low activity/remission (79%), used Conventional DMARD (n=773 patients, 45%) and steroids (n=588, 34%) at low dose (n=415, 71%). Main laboratory findings were abnormal D-di-mer (n=94, 28%) and leukopenia (n=93, 26%). Most patients had a WHO ordinal scale < 5 (n=1472, 86%). Median of hospitalization at intensive care unit (ICU) was 8 days [IQR 5, 13]. Treatment for SARS-CoV-2 infection (steroids, anticoagulation, azithromycin, convalescent plasma) was used in 461 (27%) patients. Most of long COVID (n= 152, 69%) reported 1 symptom, the most frequent was fatigue (n= 55, 22%). Figure 1. Univariate analysis is presented in Table 1. In multivariate logistic regression analysis non-caucasian ethnicity OR 1.44 (1.07-1.95), years of education OR 1.05 (1-1.09), treatment with cyclophosphamide OR 11.35 (1.56-112.97), symptoms of COVID-19 OR 13.26 (2.75-242.08), severity scale WHO ≥ 5 OR 2.46 (1.68-3.57), and ICU hospitalization days OR 1.09 (1.05-1.14) were factors associated to long COVID. Conclusion: Prevalence of long COVID was 12%. Non-caucasian ethnicity, higher education, treatment with cyclophosphamide, symptoms of COVID-19, severe disease and ICU hospitalization days were related to long COVID.
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At present it is going through a global pandemic that forced the human being to adopt different ways of relating and doing their daily tasks, for that reason we wanted to make a comparison of the depressive symptoms of caregivers, the perception of the function family and internalized and externalized problems in children aged two to five years, in three groups interviewed at three times: 1) before quarantine by COVID-19 in Colombia, 2) during the first three weeks of quarantine and 3 ) from the fourth to the sixth week of quarantine. The questionnaires used measured: sociodemographic characteristics, the perception of the impact of COVID-19 on the lives of individuals, the perception of family-function, depressive symptoms of caregivers, and the behavior and emotional state of children. Aggressive behavior (Mean = 8,79;p = 0,000), anxiety (3,85;p = 0,025) and attention problems (2,53;p = 0,023) were found to be higher in the third group studied. The perception of family function was more positive in the third group (Average: 14,06;p = 0,006). The findings indicate that home confinement is an unprecedented measure that can have a negative impact on preschool childre.
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In recent years, there have been significant changes in weather patterns, mainly caused by sharp increases in temperature, increases in carbon dioxide, and fluctuations in precipitation levels, negatively impacting agricultural production. Agricultural systems are characterized by being vulnerable to the variation of biophysical and socioeconomic factors involved in the development of agricultural activities. Agent-based models (ABMs) enable the study, analysis, and management of ecosystems through their ability to represent networks and their spatial nature. In this research, an ABM is developed to evaluate the behavior and determine the vulnerability in the sugarcane agricultural system;allowing the capitalization of knowledge through characteristics such as social ability and autonomy of the modeled agents through fuzzy logic and system dynamics. The methodology used includes information networks for a dynamic assessment of agricultural risk modeled by time series, system dynamics, uncertain parameters, and experience;which are developed in three stages: vulnerability indicators, crop vulnerability, and total system vulnerability. The development of ABM, a greater impact on the environmental contingency is noted due to the increase in greenhouse gas emissions and the exponential increase in extreme meteorological phenomena threatening the cultivation of sugarcane, making the agricultural sector more vulnerable and reducing the yield of the harvest.
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The pandemic of SARS-CoV-2 infection, which causes COVID-19, has deeply affected health systems and has had a significant impact on families, communities and nations. A comprehensive response strategy requires in addition to epidemiological, scientific and technical considerations, for human suffering associated with disease, vulnerability and death not to be forgotten. Palliative care for people with suspicion or diagnosis of COVID-19 with serious evolution and their families should also be a key pad of organized actions that helps alleviate suffering and improve quality of life by controlling symptoms, addressing psychological, social and spiritual needs, support for advanced care and its goals, end-of-life care, as well as support in complex decision-making and ethical problems, among others. Recommendations are provided for offering palliative care in the COVID-19 pandemic context.
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Background: Patients undergoing hematopoietic stem cell transplantation (HSCT) are at greater risk of intensive care unit admission, need for mechanical ventilation, or death compared to immunocompetent patients. eHealth is one of the multidisciplinary components that can have the greatest impact on quality of life, accessibility, and quality of service due to its potential to improve efficiency and productivity in health service system processes.The objective of this study is to determine the scientific evidence on eHealth strategies, the level of implementation and their role in HSCT. Methods: The search strategy used was: (Hematopoietic Stem Cell Transplantation OR Stem Cell Transplantation, Hematopoietic OR Transplantation, Hematopoietic Stem Cell) AND (Telemedicine OR Mobile Health OR mHealth OR Telehealth OR eHealth OR Health, Mobile). In the bibliographic search, 98 articles were obtained from PubMED and Scopus sources. By means of evaluating pairs a first selection was made by title and abstract, in the discrepancies consensus was sought by means of discussion between pairs. Of the articles chosen for full reading, those that reported results of eHealth-based interventions were included. Articles not performing a transplant and eHealth application were excluded. Results: A total of 46 articles were selected for full reading and 26 were finally included in this review. We identified that the majority of the studies were conducted in the USA (n = 10), the publication concentrates mostly on the year 2020, and a first study in 2007. The purpose of the interventions included the follow-up and management of risk factors related to cardiovascular disease, accompaniment for symptom detection and improvement of the quality of life of patients, remote monitoring of patients with telemetry, and training of patients (eLearning). The objectives of these interventions included: medication adherence, physical activity monitoring, infection prevention, patient participation in content creation, symptom tracking and management, follow-up with self-reporting of data, mainly in patients with complications associated with post-HSCT treatment, and pain management in adults. The population involved in the interventions included: patients with allogeneic and autologous transplants, adolescents, caregivers, parents of transplanted children, among others. It should be noted that the projects where patient follow-up was sought managed to improve the patient's quality of life. Remote monitoring with adequate teaching is useful for the rapid detection of complications and in adolescents it can take advantage due to their affinity with mobiles, it also had an impact for patients who lived far from the transplant centers by reducing complications and cost. The most frequent type of intervention was the use of mobile applications for data collection, monitoring and monitoring of symptoms. The interventions with the greatest impact on patients were applications due to their accessibility, feasibility, benefits, and acceptance by patients. Conclusions: The scientific evidence on eHealth for HSCT shows products such as applications, mobile health and telemedicine, with the greatest publication of works in the last year. A multidisciplinary commitment is necessary in planning for development, costs, times and execution of projects with information technology, as well as the need for a focus on User Experience, important and necesary after the experience of COVID-19.
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With the rise of information technology and digitization, education has been faced with the need to adopt new learning models using technology to create innovative educational methodologies. In addition, due to pandemic restrictions and in order to help contain the spread of the virus (COVID-19), all educational institutions have been forced to switch immediately to online education. The application of augmented reality (AR) in education provides important benefits, such as increased engagement and interactivity, and can help to minimize the negative effects of the disruption of face-to-face education. Therefore, this paper focuses on describing the effect of an augmented reality mobile application (NetAR) that was developed for engineering students as a complement to traditional education. To achieve this objective, an experimental group and a control group were established to work with the application for three weeks for three hours a day. Moreover, there are a number of usability issues with AR that may impact learning effectiveness and motivation. Therefore, the usability of the application was evaluated with the IBM Computer System Usability Questionnaire (CSUQ) tool. The usability results show that users are satisfied with NetAR, and the statistical data from the control group indicate that the application positively affects learning.