Mobilizing Social Media Data: Reflections of a Researcher Mediating between Data and Organization

This paper examines the practices involved in mobilizing social media data from their site of production to the institutional context of non-profit organizations. We report on nine months of fieldwork with a transnational and intergovernmental organization using social media data to understand the role of grassroots initiatives in Mexico, in the unique context of the COVID-19 pandemic. We show how different stakeholders negotiate the definition of problems to be addressed with social media data, the collective creation of ground-truth, and the limitations involved in the process of extracting value from data. The meanings of social media data are not defined in advance;instead, they are contingent on the practices and needs of the organization that seeks to extract insights from the analysis. We conclude with a list of reflections and questions for researchers who mediate in the mobilization of social media data into non-profit organizations to inform humanitarian action. © 2023 ACM.

AN INNOVATIVE METHOD TO DECREASE BURNOUT ON A MEDICAL ONCOLOGY UNIT THROUGH STAFF LEAD EBP INTERVENTIONS

Oncology Nursing Practice Oncology nurses are exposed to many stressors while caring for the complex needs of cancer patients, which leads to burnout. The nurses on an inpatient medical oncology unit at an NYC academic medical center expressed many feelings of burnout in the work environment post the height of the COVID-19 pandemic. Two years later, nurses are still expressing and experiencing burnout. The purpose was to decrease oncology nurses' perceptions of nursing burnout through evidenced-based interventions. A survey was used to assess the current level of nurse burnout and ask the nurses to rank different activities in order of importance to help with decreasing the perception of burnout among staff. From May to August 2022, interventions to decrease nurse burnout were implemented such as, uninterrupted breaks, staff recognition using e-cards, organized outdoor group activities, and information on wellbeing-coaches and counseling available to staff. Burnout was measured with a 1 item question on a 5-point Likert scale validated previously in nurses to measure burnout. Items 1-2 indicate no burnout and items 3-5 indicate some level of burnout from "burning out" to "burnout won't go away" to "completely burned out." The burnout level of nurses equals 2.93 in May 2022 (n=46). This is at the higher end of 2, closer to 3, where 3 means some level of burnout. Participants were asked to rank 13 activities related to resilience and decreasing burnout in order of importance. The staff rated 1st: uninterrupted break, 2nd: time to unplug, 3rd: taking a break outside, 4th: group outings/activities, 5th: meditation/mindfulness was tied with view of outside during break, and 6th: recognition. Post implementation, in July (n=37) the burnout level was 2.89 and in August (n=31) burnout level was 2.98. Helping nurses deal with nurse burnout is multifactorial. Although the interventions implemented did not decrease perceptions of nurse burnout, staff were empowered to help each other and increase unity among staff. The staff felt like it was in their control to act towards improving their work environment and an improvement in staff morale was palpable. Over the past 6 months of the burnout project, a new shared governance unit council emerged to help further the professional practice of staff, increase staff engagement, and increase oncology nursing educational opportunities.

ON THE MEXICAN HOUSEHOLDS' SAVINGS BEFORE AND DURING THE COVID-19 PANDEMIC

In this research paper we analyze the Mexican household saving rates before and during the COVID-19 pandemic. Our key research goal is to update the knowledge on this topic and quantify the effects of socioeconomic and sociodemographic covariates as household saving determinants. We apply a quantile regression model taking data from the 2018 and 2020 Encuesta Nacional de Ingresos y Gastos de los Hogares. Our results provide evidence about the heterogeneity of the effects of socioeconomic and sociodemographic household saving determinants, also about the dynamic change of effects associated with the determinants and the household saving rate, as a consequence of the economic crisis derived from COVID-19. © 2023 Universidad Nacional Autonoma de Mexico. All rights reserved.

SAFETY of SARS-COV-2 VACCINES in PATIENTS with RHEUMATIC DISEASES: DATA from the NATIONAL REGISTRY SAR-COVAC from ARGENTINA

Background: Patients with rheumatic diseases (RD) have been excluded from SARS-CoV-2 vaccine trials, though data appear to show safety and efficacy, mostly evidence remains in mRNA vaccines. In our country, adenovirus-vector, inactivated and heterologous scheme vaccines are frequently used. Objectives: To describe the safety of SARS-CoV-2 vaccines in patients with RD from the national registry SAR-CoVAC and to assess sociodemographic and clinical factors associated to AE and disease fares after vaccination. Methods: Adult patients with RD who have been vaccinated for SARS-CoV-2 from de Argentine Society of Rheumatology Vaccine Registry (SAR-CoVAC) were consecutively included between June 1st and December 21st, 2021, This is a national multicentric observational registry that includes patients that have received at least one dose of any SARS-CoV-2 available vaccines in Argentina. Data is voluntarily collected by the treating physician. Naranjo scale was use to assess the association between the AE and vaccination. Homologous and heterologous schedules were defned according to whether both vaccines received were the same or different, respectively. Descriptive statics, Chi2 test, Fischer test, T test, ANOVA and multivariate regression logistic model were used. Results: A total of 1679 patients, with 2795 SARS-CoV-2 vaccine doses were included. Vaccines more frequently used were: Gam-COVID-Vac (1227 doses, 44%), ChAdOx1 nCov-19 (872 doses, 31%), BBIBP-CorV (482 doses, 17%) and mRAN-1273 (172 doses, 6%). Altogether, 510 EA were experienced by 449 (27%) patients. Pseudo-fu syndrome was the most frequent (11%), followed by injection site reaction (7%). They were signifcantly more frequent after the frst dose in comparison to the second one (13% vs 7% and 9% vs 5%, respectively, p<0.001 in both cases). All were mild or moderate and no patient was hospitalized due to an AE. One case of moderate anaphylaxis was reported by a patient who received Gam-COVID-Vac. No cases of vaccine-induced thrombotic thrombocytopenia were observed. There were 25 disease fares reported, 17 (68%) cases of arthritis. Among patients with two doses, those with heterol-ogous schedule presented AE more frequent after the second dose (39% vs 17%).Total incidence of EA was 182.5 events/10 00 doses, it was signifcantly lower for BBIBP-CorV (105.9 events/1000 dosis, p<0.002 for all cases). The higher incidence of AE was observed for mRAN-1273 (261.6 events/1000 doses) and ChAdOx1 nCov-19 (232.8 events/1000 doses). Patients with AE were younger [mean 55 years (SD 14) vs 59 years (SD 14), p <0.010], not Caucasian ethnicity [48% vs 35%, p<0.001], had higher education level [mean 13.8 years (SD 4) vs 11.9 years (SD 5), p<0.001], were more frequently employed [54% vs 44%, p<0.001], lived mostly in urban area [99% vs 95% p <0.001, had more frequently dyslipidemia [38% vs 28% p 0.012], and less frequently arterial hypertension [49% vs 65%, p<0.001]. Systemic lupus erythematosus [11% vs 7%, p=0.039] and Sjögren syndrome [6% vs 1.8%, p<0.001] were more frequent among them, while non infammatory diseases were less prevalent [19% vs 31%, p<0.001]. They were taking steroids [24 vs 18%, p=0.007], antimalarials [17% vs 10%, p<0.001] and methotrexate [41% vs 31%, p <0.001] more frequently. In the multivariable analysis, mRAN-1273 and ChAdOx1 nCov-19 were associated with AE, while BBIBP-CorV with lower probability of having one. (Figure 1) Conclusion: The incidence of AE was 1825 events/1000 doses, were signif-cantly higher for mRAN-1273 and ChAdOx1 nCov-19 and lower for BBIBP-CorV. Most common AE was pseudo-fu syndrome. Female sex, being younger, higher education level, ChAdOx1 nCov-19 and mRAN-1273 vaccines, the use of meth-otrexate and antimalarials were related of EA in patients with RD.

Improving the Care of Newly Arrived Immigrant Patients in Two Primary Care Clinics

Purpose/Objectives: 1) To design and implement a clinical pathway that delineates evidence-based recommendations of screening for newly arrived immigrant children in an academic primary care setting. 2) To improve adherence to recommended biomedical and infectious screening by providers caring for newly arrived immigrant children. 3) To evaluate the effectiveness of the clinical pathway and adjunct tools to support uptake and adherence to the pathway with a goal of achieving 90% adherence to key indicators in 18 months. Design/Methods: A clinical pathway for primary care of newly arrived immigrant children was developed and implemented based on existing evidence from immigrant and refugee populations, delineating recommended psychosocial, developmental, biomedical, and infectious screenings by region of origin. Adjuncts to support uptake were implemented, including an EMR order-set and note template. Faculty and resident education to the pathway was conducted in person and with pre-recorded educational presentations. Indicators of adherence were defined as the percentage of patients who obtained the recommended screening tests according to their world region of origin. Results: A total of 301 newly arrived immigrant patients were seen at the clinics during our observation period (from Dec 2018-May 2021);190 (63%) were seen after the rollout of our main interventions in August 2019, and 70 (23%) were seen after the onset of the COVID-19 pandemic in March 2020. We observed an improvement in the % of patients who obtained lead level, Complete Blood Count (CBC) with differential, Strongyloides, and Tuberculosis screening on their first visit in the U.S. following the introduction of the clinical pathway and order-set (Images 1 and 2). There have been six consecutive points above the mean in the case of lead level and Tuberculosis screening. In the case of Strongyloides screening, a mean shift was observed months after the implementation of the pathway. On average, 74% of the ordered screening tests for these patients were entered using the order-set. The COVID-19 pandemic impacted the number of new patients in both clinics from April 2020-Sep 2020. Periodical reminders and continuous education to providers also have proved beneficial to our goals. Conclusion/Discussion: Implementation of a clinical pathway for the care of newly arrived immigrant children resulted in improvements in adherence to region-specific recommendations for biomedical and infectious screenings;specifically for lead, CBC with differential, Strongyloides, and Tuberculosis screening. Implementation of an order-set embedded in the electronic medical records system was a successful strategy to facilitate adherence. Drastic reductions in the number of new immigrant children seeking care during the initial months of the COVID-19 pandemic raised concerns about access barriers for this vulnerable population and required strategies to remind clinicians about the use of the pathway as numbers of new immigrant patients return to baseline.

Analysis of Particulate Matter Concentration Changes before, during, and Post COVID-19 Lockdown: A Case Study from Victoria, Mexico

The lockdown measures implemented due to the SARS-CoV-2 pandemic to reduce the epidemic curve, in most cases, have had a positive impact on air quality indices. Our study describes the changes in the concentration levels of PM2.5 and PM10 during the lockdown and post-lockdown in Victoria, Mexico, considering the following periods: before the lockdown (BL) from 16 February to 14 March, during the lockdown (DL) from 15 March to 2 May, and in the partial lockdown (PL) from 3 May to 6 June. When comparing the DL period of 2019 and 2020, we document a reduction in the average concentration of PM2.5 and PM10 of −55.56% and −55.17%, respectively. Moreover, we note a decrease of −53.57% for PM2.5 and −51.61% for PM10 in the PL period. When contrasting the average concentration between the DL periods of 2020 and 2021, an increase of 91.67% for PM2.5 and 100.00% for PM10 was identified. Furthermore, in the PL periods of 2020 and 2021, an increase of 38.46% and 31.33% was observed for PM2.5 and PM10, respectively. On the other hand, when comparing the concentrations of PM2.5 in the three periods of 2020, we found a decrease between BL and DL of −50.00%, between BL and PL a decrease of −45.83%, and an increase of 8.33% between DL and PL. In the case of PM10, a decrease of −48.00% between BL and DL, −40.00% between BL and PL, and an increase of 15.38% between the DL and PL periods were observed. In addition, we performed a non-parametric statistical analysis, where a significant statistical difference was found between the DL-2020 and DL-2019 pairs (x2 = 1.204) and between the DL-2021 and DL-2019 pairs (x2 = 0.372), with a p < 0.000 for PM2.5, and the contrast between pairs of PM10 (DL) showed a significant difference between all pairs with p < 0.01. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

Analysis of the use of fondaparinux in suspected heparin-induced thrombocytopenia

Background and importanceHeparin-induced thrombocytopenia (HIT) is a rare but serious complication caused by antibodies to the heparin/platelet factor 4 complex. It produces sudden thrombocytopenia (decrease of more than 50% of the platelet count) during the first days of treatment with thrombosis. Once the diagnosis is suspected/confirmed by antigenic methods, heparin should be discontinued and replaced with alternative anticoagulants. Fondaparinux is frequently used as ‘off label’.Aim and objectivesTo analyse the relationship between fondaparinux and platelet recovery when it is used in suspected HIT, as well as the correct diagnosis of this pathology coinciding with the COVID-19 pandemic, a disease that also frequently produces thrombocytopenia, in a tertiary hospital.Material and methodsCross-sectional descriptive observational study. All patients who started treatment with fondaparinux during 4 months were collected, coinciding with a high number of admissions due to COVID-19. The variables collected were: sex, age, platelet count at the start of heparin or derivatives, at the beginning and end of treatment with fondaparinux, days of treatment with heparin and fondaparinux, request for antigenic tests to confirm HIT, and diagnosis of COVID-19Results40 patients (31 men, 77.5%) were included. The mean age was 71.5 (32–98) years. The mean platelet count at baseline was 136*103/μL, when heparin was discontinued and fondaparinux was initiated it was 87*103/μL and when fondaparinux was discontinued 151*103/μL. The median number of days with heparin was 6 (0–58), with fondaparinux 6.5 (1–41). 57.5% (n=23) of the patients were diagnosed with COVID-19. Tests for diagnosis of HIT were requested in only 10% of cases (n=4), being confirmed in 1 patient.Conclusion and relevanceIn our case series, there was a high number of suspected HIT. Although after treatment with fondaparinux, the platelet count recovers, this is probably due in most cases to other reasons, such as COVID-19 infection, coinciding with the recovery of the problem that causes it rather than to treatment with fondaparinux. Following the low proportion of requests for antigenic tests to confirm HIT, we consider it vitally important to promote these tests, which would avoid overdiagnosis in most patients and stop the use of such a common and useful drug, heparin, when thrombocytopenia is not in fact due to this cause.References and/or acknowledgementsConflict of interestNo conflict of interest

Use of a Continuous Glucose Monitoring System in High Risk Hospitalized Non-critically ill Patients with Diabetes after Cardiac Surgery and during their Transition of Care from the Intensive Care Unit during Covid-19-A Pilot Study

Objective: Continuous glucose monitoring (CGM) has demonstrated benefits in managing inpatient diabetes. We initiated this prospective pilot study to determine the feasibility and accuracy of CGM in high-risk cardiac surgery patients with diabetes after their transition of care from the intensive care unit(ICU). Methods: Clarke Error Grid(CEG) analysis was used to compare CGM and point-of-care(POC) measurements. Mean absolute relative difference(MARD) of the paired measurements was calculated to assess the accuracy of the CGM for glucose measurements during the first 24 hours on CGM, the remainder of time on the CGM as well as for different chronic kidney disease(CKD) strata. Results: Overall MARD between POC and CGM measurements was 14.80%. MARD for patients without CKD IV and V with eGFR < 20 ml/min/1.73m2 was 12.13%. Overall, 97% of the CGM values were within the no-risk zone of the CEG analysis. For the first 24 hours, a sensitivity analysis of the overall MARD for all subjects and for those with eGFR > 20 ml/min/1.73m2 was 15.42% (+/- 14.44) and 12.80% (+/- 7.85) respectively. Beyond the first 24 hours, overall MARD for all subjects and for those with eGFR > 20 ml/min/1.73m2 was 14.54% (+/- 13.21) and 11.86% (+/- 7.64) respectively. Discussion/Conclusion: CGM has great promise to optimize inpatient diabetes management in the noncritical care setting and after the transition of care from the ICU with high clinical reliability, accuracy, and superior detection of hypoglycemia. More studies are needed to further assess CGM in patients with advanced CKD.

Lessons Learned in the Implementation of a Training Knowledge Management System for the SERVIR Network

The SERVIR program is a unique partnership between NASA, the U.S. Agency for International Development (USAID), focusing on building capacity to use Earth observations for addressing development challenges. In that context, between 2004 and 2020, the program delivered approximately 365 trainings to almost 10,000 professionals. More recently, between November 2020 and August 2021, the SERVIR network executed some 55 training events addressing SERVIR’s 4 priority thematic areas, and roughly a quarter of SERVIR trainings overall have focused on themes related to Ecological Forecasting. Due to the ongoing COVID-19 pandemic, almost four-fifths of recent training events have been virtual, with the remainder being in-person under limited circumstances. The large number of training events delivered represents both an opportunity and a challenge in terms of knowledge management. While the training materials developed can later be reused in other parts of the SERVIR network, prior to recently, the lack of a central repository for those materials has prevented wider dissemination and use. The recently developed Training Knowledge Management System (TKMS) is now becoming an integral part of the SERVIR Capacity Building Framework, supporting the exchange of resources and methods for conducting training activities across the network. This presentation focuses on the structure of this system, as well as on the anticipated benefits for the User Communities for Earth Observations of Terrestrial Systems.

Chronic lung disease following covid-19 in an infant

Case Report Chronic respiratory sequelae are well documented in adults after COVID-19 infection, however, in young children and infants, evidence is still evolving. Here we report an infant with significant chronic respiratory complications after COVID-19. Case Report A 10 month old female with no significant past medical history was admitted to the PICU secondary to hypoxemia, respiratory distress, and respiratory failure following COVID-19 infection in January 2021. She was also positive for Rhinovirus and Enterovirus. CXR displayed worsening bilateral alveolar infiltrates, and she developed subsequent pneumothorax requiring a chest tube. Apart from mechanical ventilation, she received supportive treatment and broad spectrum antibiotics. Cardiac echocardiogram revealed pulmonary hypertension, PFO, and PDA. Due to worsening respiratory status and hypoxemia, she received bronchodilators, inhaled nitric oxide, sildenafil, steroids, and magnesium. After 3 weeks, her respiratory status improved and she was discharged. The patient required another hospitalization in March and an ER visit in April for persistent cough and shortness of breath. After evaluation by pulmonology, she began inhaled steroids and airway clearance treatments including chest physical therapy, hypertonic saline, and bronchodilators. Further workup ruled out cystic fibrosis, primary ciliary dyskinesia, and immunodeficiency. Chest CT showed diffuse bilateral patchy airspace opacities representing atelectasis and scarring. Despite a short period of improvement, the patient was hospitalized for respiratory distress in June, where she was hypoxemic and diagnosed with pneumonia. She required repeated outpatient visits to the PCP for persistent respiratory symptoms. PDA closure was performed in September. The patient continues to have persistent respiratory symptoms addressed with outpatient respiratory treatment regimen. Conclusion As we have ruled out other underlying causes, the patient's chronic lung disease and persistent respiratory symptoms occurred most probable secondary to COVID-19. This case report highlights the importance of monitoring respiratory symptoms in pediatric patients with severe COVID-19 infection for early identification of chronic respiratory sequelae.

Assessment of developing Physiology II as a virtual subject in the specialty of Clinical Neurophysiology

Introduction: Teaching through virtual modality was adopted as a preventive measure against the COVID-19 spread. For Cuban medical education, it has implied a challenge regarding the reorganization of study programs. For this purpose, the subject Physiology II was redesigned and implemented in virtual modality, in order to guarantee continuity in the training of Clinical Neurophysiology residents. Objective: To assess the development of the subject Physiology II in its virtual modality from the perspective of the students of the Clinical Neurophysiology specialty. Methods: Exploratory, nonexperimental and cross-sectional study. Through a questionnaire made up of closed questions and one open question (positive and negative aspects), the development of the subject in virtual modality was assessed in relation to the variables subject syllabus, professors’ performance, platform scenario, and technological support. Results: The subject Physiology II in virtual modality had a high acceptance by the students. The aspects identified as positive were those related to individual time management, as well as the subject’s applicability and structure;while the negative ones were oriented towards internet connectivity problems and the study environment. Conclusions: The successful experiences obtained in the development of Physiology II as a virtual subject lay the foundations for using this type of design in the specialty of Clinical Neurophysiology and the possibility of extending it to other subjects of the study plan. © 2021, Editorial Ciencias Medicas. All rights reserved.

The work represented of rural and urban-marginated elementary teachers during confinement by COVID-19

The aim of this research was to analyze the representations of rural and urban-marginalized elementary school teachers about their work during the COVID-19 pandemic at the beginning of the 2020-2021. The theoretical framework that guides the study is the sociodiscursive interactionism applied to the conception of teaching work, particularly the dimensions of represented and prescribed work. Part of the method was to apply a questionnaire with open and multiple-choice items that was supplied to 24 teachers from two Mexican states: San Luis Potosi and Veracruz. The results exibit that distance learning increases educational backwardness or hinders learning. Furthermore, they allow to identify the difficulties foreseen for the new school year (Internet connection, explanation of content and communication with families) and recognize that WhatsApp became the main alternative for the development of synchronous classes, sending assignments and communication with students and their families

Increasing fecal immunochemical test return rates by patient reminders: A quality improvement study

Introduction: The incidence of colorectal cancer (CRC) in the United States is increasing, and it remains the second leading cause of cancer death in the United States for men and women combined. The American Cancer Society now recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high sensitivity stool-based test or structural (visual) examination, depending on patient preference and test availability. The primary objective of this quality improvement project was to determine if reminder methods, such as telephone or letter reminders, increased the return rate of fecal immunochemical tests (FIT) for colorectal cancer screening. Methods: At public outreach events and daily clinics in the West Texas Panhandle area, participants in the GET FIT program were provided with FIT kits after completing the education on colorectal cancer. Participants who fit the inclusion criteria and had received a FIT kit from the program were included. They were instructed on how to perform the test and mail it back. Participants that did not return the completed kits within two weeks were reminded either by 1) through a reminder letter or 2) by telephone every 2 weeks (+/- 3 days) for 60 days or 5 attempts to contact. We de-identified and analyzed the FIT kit return data from June-November 2019 before instituting these reminder methods. We then calculated the change in return rates from December 2019 to February 2020. Our goal was to increase the FIT return rates by 25% over the baseline return rate. Results: The pre-intervention return rate of kits for June-November 2019 was 67.58%, and the postintervention return rate for December 2019-February 2020 was 81.87%. This rate was equal to an approximately 21% increase in return rates. The average return rate of FIT kits overall was 72.34%. The average rate of returned new patient kits was 69%, and the average % of new patient return kits was 68.51%. We also noticed a significant increase in return of FIT tests after a community cancer screening in October 2019. Conclusion: Fecal immunohistochemical test (FIT) remains one of the primary options for colorectal cancer screening. Due to its lower cost and noninvasiveness, FIT was offered to patients at average risk.We did achieve a significant increase in return rates, although we did not meet our target goal for this project. Our project was limited to studying 3 months post-intervention due to the COVID pandemic and barrier in returning tests. (Table Presented).

Emotional distress in cancer patients during the first wave of the COVID-19 pandemic in Madrid

Background: The COVID-19 pandemic has emerged as the most important international health problem of the last decades. This study explores the psychopathological implications that Covid-19 has caused on cancer patients during the first wave of the pandemic in Spain. Methods: In this prospective study, we included cancer patients in active treatment from March to June 2020. A 24-question semi-structured questionnaire was designed to measure baseline demographic, clinical and Covid-19 exposure characteristics. Mental health was assessed using the validated Hospital Anxiety and Depression Scale. A descriptive and analytical univariate analysis of the variables studied was performed. Results have been compared with baseline emotional distress rates from historical cohorts in cancer patients. Results: 104 cancer patients were included;a 52.8% of emotional distress, 42.3% of anxiety and 58.6% of depression were detected. 51% of patients expressed higher concern about cancer diagnosis vs COVID-19 infection. Tumor type, stage, type of oncologic treatment or rescheduling of cancer therapy were not related with higher levels of psychological symptomatology. Patients with previous consumption of psychotropic drugs and those who adopted additional infection prevention measures because they considered themselves at risk of having a more aggressive COVID-19 disease had higher levels of emotional distress (p=0.008;p=0.003), anxiety (p=0.026;p=0.004) and depression (p=0.013;p=0.008). Emotional distress was higher in patients whose financial status had worsened (p=0.002). Anxiety rates were higher among patients who often used relaxing therapies (p=0.011) and those who were frequently exposed to media (p=0.05). Depression rates were higher among patients with lower educational level (p=0.032), in those whose economic situation had worsened (p=0.003), and those who relied on Religion or Faith (p=0.029). Conclusions: High rates of emotional distress have been detected during the first wave of the Covid-19 pandemic among cancer patients in active treatment, however, not higher than expected in this population. The cancer disease itself continues to be the main factor of concern for cancer patients, above and beyond the distress generated by Covid-19 pandemic. Legal entity responsible for the study: Hospital Universitario De La Princesa, Medical Oncology Department. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

A multicenter analysis of the outcome of cancer patients with neutropenia and COVID-19 infection optionally treated with granulocyte colony-stimulating factor (G-CSF)

Background: Infection by SARS-CoV-2 can turn into an acute respiratory infection. Approximately 15% of patients will develop a distress syndrome responsible in most cases of mortality. A host hyperinflammatory response induced by a cytokine storm, is the main cause of this severe complication. Chemotherapy myelosuppression is associated with higher risk of infections and mortality in cancer patients. There have been no previous reports about the clinical management of patients with neutropenia and concomitant COVID- 19. Herein, we present a multicenter experience in several hospitals during COVID-19 outbreak in neutropenic cancer patients infected by SARSCov- 2. Methods: Retrospective clinical data were collected from clinical reports. Protocol was approved by a Clinical Research Ethics Committee (HULP: PI-4194). Inclusion criteria were cancer patients with neutropenia (<1500 cells/mm3) and concomitant COVID-19 infection. Comorbidities, tumor type and stage, treatment, neutropenia severity, filgrastim (G-CSF), COVID-19 parameters and mortality were analyzed. Exploratory analysis included a description of all data collected and bivariate analyses among different pairs of variables, including their impact in mortality in this cohort. In addition, multivariable logistic regression was used to predict respiratory failure and death as a function of multiple variables. Results: Among 943 patients with cancer screened in 14 hospitals in Spain, eighty-three patients (8%) had a febrile neutropenia and COVID-19 infection. Lung (26%), breast (22%), colorectal (13%) and digestive noncolorectal (17%) cancers were the main locations and most patients had advanced disease (67%). Fifty-three (63%) of patients included died because respiratory failure. Neumonia was presented in 76% of patients, bilateral in 47% and 12% of all patients had thrombotic events. The median of neutrophils was 650cls/mm3 and 49% received GCSF with a median of days on treatment around 4,5 days. Among all variables related with mortality in neutropenic cancer patients with COVID-19 infection, we found that the number of days with GCSF showed a significant trend toward worse outcome and higher mortality. In particular, a logistic regression model was developed to predict respiratory failure, as a function of the number of days of G-CSF treatment. As adjusting covariates, sex, age, treatment purpose (palliative vs curative, to adjust for patient status), tumor type, and the lowest level of neutrophils in the patient (to adjust for neutropenic status) were used. A significant effect was obtained for the days of G-CSF treatment (OR = 1.4, 95% CI [1.03, 1.92], p-value = 0.01). Conclusions: Our findings suggest that a prolonged G-CSF treatment could be disadvantageous for these cancer patients with COVID-19, with a higher probability of worse outcome.

Pregnancy and novel coronavirus: worldwide reported experience / Embarazo y nuevo coronavirus: experiencia global reportada

INTRODUCCIÓN: La Organización Mundial de La Salud ha reportado recientemente que el nuevo foco de la pandemia global de la enfermedad Covid-19 es el continente americano. OBJETIVO: Realizar una revisión de la literatura sobre la experiencia internacional de la pandemia Covid 19 y embarazo. MÉTODO: Se realiza una búsqueda de la base de datos PubMed para las palabras clave Pregnancy / Pregnant / Novel Coronavirus / SARS-CoV-2 / Covid-19, desde el 1 de noviembre 2019 hasta el 21 de mayo 2020. RESULTADOS: Un total de 365 artículos fueron inicialmente seleccionados de acuerdo con la estrategia de búsqueda diseñada. El total de artículos revisados de acuerdo con los criterios fueron 42. Las series clínicas seleccionadas acumularon un total de 1098 embarazadas y enfermedad de Covid-19. Las co-morbilidades mas frecuentes fueron hipertensión arterial, diabetes mellitus, obesidad y asma. La mortalidad en relación con el total de pacientes fue de un 1,2 % y la transmisión al recién nacido de 1,7% (15 de 875). CONCLUSIÓN: La información obtenida permite inferir que la presentación clínica de la enfermedad es a lo menos equivalente a la de mujeres de la misma edad no embarazadas. Dada la severidad de la enfermedad por SARS-CoV-2 reportada, las lecciones aprendidas deben ser rápidamente asimiladas y utilizadas en el contexto de la situación nacional epidémica.

INTRODUCTION: The World Health Organization has recently reported that the new focus of the global pandemic of Covid-19 disease is the American continent. OBJECTIVE: To conduct a literature review on the international experience of the Covid 19 pandemic and pregnancy. METHOD: A PubMed database search is performed for the keywords Pregnancy / Pregnant / Novel Coronavirus / SARS-CoV-2 / Covid-19, from November 1, 2019 to May 21, 2020. RESULTS: A total of 365 articles were initially selected according to the designed search strategy. The total of articles reviewed according to the criteria was 42. The selected clinical series accumulated a total of 1098 pregnant women and Covid-19 disease. The most frequent comorbidities were hypertension, diabetes mellitus, obesity, and asthma. Mortality in relation to the total number of patients was 1.2% and transmission to the newborn was 1.7% (15 of 875). CONCLUSION: The information obtained allows us to infer that the clinical presentation of the disease is at least equivalent to that of non-pregnant women of the same age. Given the severity of the reported SARS-CoV-2 disease, the lessons learned must be quickly assimilated and used in the context of the national epidemic situation.

COVID-19 and pregnancy in Chile: preliminary report of the GESTACOVID multicenter study / COVID 19 y embarazo en Chile: Informe preliminar del estudio multicéntrico GESTACOVID

INTRODUCCIÓN: En Chile, los efectos maternos y perinatales de la pandemia por SARS-CoV-2 son aún desconocidos. GESTACOVID es un estudio multicéntrico que incluye embarazadas y puérperas hasta el día 42 con COVID-19. El objetivo de este estudio es presentar un informe preliminar, describiendo el impacto de la enfermedad en las embarazadas, factores de riesgo asociados y resultados perinatales. MÉTODOS: Estudio de cohorte descriptivo que incluye 661 pacientes enroladas entre el 7 de marzo y el 6 de julio de 2020, en 23 centros hospitalarios del país. Se analizaron variables demográficas, comorbilidades, características clínicas y del diagnóstico de COVID-19 y resultado materno y perinatal. RESULTADOS: Las pacientes hospitalizadas por COVID-19 tuvieron mayor prevalencia de hipertensión arterial crónica [10% vs 3%; OR=3,1 (1,5-6,79); p=0,003] y de diabetes tipo 1 y 2 [7% vs 2%; OR=3,2 (1,3-7,7); p=0,009] que las pacientes manejadas ambulatoriamente. Un IMC >40 kg/mt2 se asoció con un riesgo dos veces mayor de requerir manejo hospitalizado [OR=2,4 (1,2 - 4,6); p=0,009]. Aproximadamente la mitad de las pacientes (54%) tuvo un parto por cesárea, y un 8% de las interrupciones del embarazo fueron por COVID-19. Hasta la fecha de esta publicación, 38% de las pacientes continuaban embarazadas. Hubo 21 PCR positivas en 316 neonatos (6,6%), la mayoría (17/21) en pacientes diagnosticadas por cribado universal. CONCLUSIONES: Las embarazadas con COVID-19 y comorbilidades como diabetes, hipertensión crónica y obesidad mórbida deben ser manejadas atentamente y deberán ser objeto de mayor investigación. La tasa de transmisión vertical requiere una mayor evaluación para diferenciar el mecanismo y tipo de infección involucrada.

INTRODUCTION: In Chile, effects of the SARS-CoV-2 infection in pregnant women are unknown. GESTACOVID is a multicenter collaborative study including pregnant women and those in the postpartum period (until 42 days) who have had COVID-19. The purpose of this study is to report our preliminary results describing the clinical impact of COVID-19 in pregnant women, the associated risk factors and perinatal results. METHODS: Descriptive cohort study including 661 patients between April 7th and July 6th, 2020, in 23 hospitals. Demographical, comorbidities, clinical and diagnostic characteristics of COVID-19 disease and maternal and perinatal outcomes were analyzed. RESULTS: Pregnant women with COVID-19 admitted to the hospital were more likely to have chronic hypertension [10% vs 3%; OR=3.1 (1.5-6.79); p=0,003] and diabetes type 1 and 2 [7% vs 2%; OR=3.2 (1.3-7.7); p=0.009] than those with outpatient management. A body mass index of >40 kg/mt2 was associated with two-fold higher risk of hospitalization [OR=2.4 (1.2-4.6); p=0.009]. Almost half of patients (54%) were delivered by cesarean section, and 8% of the medically indicated deliveries were due to COVID-19. So far, 38% of the patients are still pregnant. Among 316 newborns, there were 21 positive PCR tests (6.6%), mostly from asymptomatic mothers undergoing universal screening. CONCLUSIONS: Pregnant women with COVID-19 and comorbidities such as diabetes, chronic hypertension and morbid obesity need a close follow up and should be a matter for further research. Vertical transmission of COVID-19 should be thoroughly studied to define the mechanisms and type of infection involved.