Impact of the COVID-19 Pandemic on Antimicrobial Stewardship, Infection Prevention & Control, and Clinical Microbiology Practices in Argentina, Brazil, and Chile

Background. During the coronavirus disease 2019 (COVID-19) pandemic, healthcare facilities (HCFs) were overwhelmed with increasing patient volumes and limited resources. Reports of disruptions in routine practices at HCFs have emerged. We evaluated changes in policies, practices, and programs for antimicrobial stewardship (AMS), infection prevention and control (IPC), and clinical microbiology across six HCF in South America following the onset of the COVID-19 pandemic. Methods. We conducted a survey in 6 HCFs in Argentina, Brazil, and Chile;2 HCFs in each country. Data on 5 components (facility characteristics, antibiotic procurement and distribution, AMS activities, IPC activities, and clinical microbiology) were collected from designated specialists within each HCF from March 2018 - February 2021. We compared observations within these 5 components pre-pandemic (March 2018 - February 2020) to during pandemic (March 2020 - February 2021.) Results. During the pandemic, the number of ICU beds increased across all the 6 HCFs by 57-633%, and the number of ventilators increased by 15-317% in 5 out of the 6 HCFs. Healthcare personnel shortages were observed in all 6 HCFs, notably common for nurses and laboratory personnel (Table 1). Extended use of N95 respirators was reported across all 6 HCFs with 2 doing extended use of gowns and medical masks. The only PPE reused was N95 respirators in 2 HCFs. Difficulties in cohorting patients with multi-drug resistance organism (MDRO) was reported by one of the HCFs. Three HCFs reported shortages in drugs with coverage for MRSA, gramnegative bacteria, and fungal pathogens despite no reports of interruption in AMS activities in these HCFs. Two hospitals reported delays on microbiology results. Facility characteristics and reported changes during COVID-19 pandemic (March 2020-February 2021) Conclusion. The COVID-19 pandemic led to substantial increases in ICU beds, number of ventilators, and extended use of PPE suggesting increases in admission of severe patients and suboptimal IPC practices in HCFs in South America. It is unclear if shortages in agents commonly used to treat MDRO was related to overuse or access difficulties. Additional evaluation is needed to determine the impact of these findings on antimicrobial resistance and antimicrobial use.

TRAINING AND DEVELOPMENT OF MANAGEMENT SKILLS PROGRAMS TO IMPROVE THE ORGANIZATIONAL COMMITMENT OF CIVIL SERVANTS IN A PERUVIAN MUNICIPALITY IN TIMES OF COVID-19

During the COVID-19 pandemic, organizational commitment in the public sector of Peru decreased due to teleworking and fear of contagion. The objective was to demonstrate the influence of the application of the RELO Management Skills Program in improving the organizational commitment of the servers of the Provincial Municipality of Huancayo in times of COVID-19. The applied research of quasi-experimental design, had as a sample 150 public servants, 75 in the control group and 75 in the experimental group;The RELO Management Skills Program was developed and validated for the study, the Organizational Commitment Scale of Meyer and Allen was applied in the pretest and posttest. The experimental group reached the mean of 58.08 in the pretest and 65.25 in the posttest;the control group reached the mean of 61.77 in the pretest and 61.87 in the posttest, showing progress in the experimental group. In contrasting hypotheses, the Wilcoxon test determined P-value = 0.000, showing significant influence.

Peruvian plants of traditional use as potential sources of molecules with activity against COVID-19

Introduction: The current situation of COVID-19 is a big issue for the human population. At present, no healing drug is available in the market. Researchers are doing their best to produce drugs to fight the disease. Various efforts are being considered based on different directions of scientific knowledge and technologies for the treatment of the disease. Unfortunately, none of these drugs works absolutely against the pandemic. Therefore, bioactive molecules from plants, animals and microorganisms could be a better option to treat COVID-19. Objective: Review the literature about species of the flora of Peru used for the treatment of respiratory diseases and highlight the plants with potential in the production of secondary metabolites and plant lectins as an alternative against COVID-19. Methods: A review was conducted of scientific articles related to the use of traditional medicine in Peru, China, and India for the treatment of respiratory diseases, as well as information about plant lectins and secondary metabolites potentially useful against COVID-19. Results: A long list is presented of genera and species of the flora of Peru with great potential against COVID-19. Most of these species belong to the Asteraceae, Loranthaceae, Piperaceae, Viscaceae and Zingiberaceae families. Numerous species are endemic to Peru. Conclusions: The flora of Peru has more than 22 000 plant species. Many of these species are traditionally used in the treatment of respiratory diseases and are potentially useful for the treatment of COVID-19. © 2021, Editorial Ciencias Medicas. All rights reserved.

Prevalence and persistence of covid-19 antibodies in New York City hemodialysis clinic

BACKGROUND AND AIMS: Dialysis patients are at higher risk for severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. Longevity of antibody response to SARS-CoV-2 infection remains unclear. It is reported that maintenance hemodialysis (MHD) patients can mount an antibody response that is similar in intensity and timing to the non-dialysis population. We aim to investigate the prevalence and persistence of antibodies in hemodialysis patients. METHOD: We measured IgG and IgM antibodies in MHD patients as part of a quality improvement project. Four New York City dialysis clinics participated in this study. Strict policy of RT-PCR testing was implemented in clinics for patients with signs and symptoms of Coronavirus Disease 2019 (COVID-19). Initial antibody testing was done on June 10 and July 13, 2020 (phase 1) and retesting was done for previously positive patients between December 9 and 17, 2020 (phase 2). Upon obtaining verbal consent, 3.5 ml of pre-dialysis blood samples were taken via vascular access. SARS-CoV-2 antibodies were determined using the emergency use authorized Diazyme DZ-Lite SARS-CoV-2 IgM / IgG CLIA assays with 100% sensitivity and 98% specificity. Detection of formed immune-complexes is achieved with N-(4-amino-butyl)-N-ethylisoluminol;the luminescence signal is reported as units per ml (AU/ml), values ≥ 1.00 AU/ml are considered as 'reactive' and < 1.00 AU/ml as 'non-reactive.' RESULTS: A total of 429 MHD patients were studied in phase 1. Antibodies were present in 130 (30.3%) and only 55 patients with Covid-19 diagnosis confirmed by RTPCR test were reactive for IgG antibodies. The time to antibody testing was 73 days (median 77;range 30-111) days. In the phase 2 antibody testing, IgG antibodies were only detected in 47 patients (85.5%) 242 days (median 245, range 204 to 268) after clinical diagnosis of Covid-19. Between the two phases of antibody testing, the luminescence signal declined by 40.9 AU/mL (95% confidence interval 31.5 to 50.3) from 54.1±45.3 to 13.2±20.9 AU/mL (P<0.0001 by paired t-test;Figure 1). In univariate logistic regression, a higher number of days between clinical diagnosis of COVID-19 and the second antibody measurement was associated with a lower seropositivity rate (odds ratio 0.929, 95% confidence interval 0.864 to 0.998, P=0.044). Antibody persistence was not associated with age, gender, race, and ethnicity. CONCLUSION: We observed that about 6 out of 7 MHD patients maintain SARSCoV-2 antibodies over 6-9 months but there is a significant decline of IgG level. The time between clinical diagnosis and IgG testing was associated with IgG decline. Follow up study to understand antibody dynamics in MHD population is a crucial step once vaccines become available.

Is Uro-oncological Surgery Safe During the COVID-19 Pandemic? Comparative Morbidity and Mortality in Patients Undergoing Surgery 2019-2020.

INTRODUCTION: The SARS-CoV-2 infection has resulted in an unprecedented pandemic. Patients undergoing surgery are a group at risk of exposure. Also, patients with ongoing infection undergoing surgery may be more susceptible to developing complications. There is no significant data on surgical safety in the pandemic period. MATERIAL AND METHODS: Observational study based in a prospective database of urological oncological surgery. Data were obtained during the 2020 mandatory confinement period compared to the same period in 2019. The records were reviewed 45 days post-surgery. The objective was to compare surgical morbidity and mortality during the pandemic versus an average year in urological cancer surgery. RESULTS: During confinement period (2020), 85 patients underwent uro-oncology surgery, while in 2019, during the same period, 165. The Clavien-Dindo morbidity ≥3 in 2020 was 2.3% (n=2), and in 2019, it reached 6% (n=10). In 2020, 9 patients were readmitted (10.5%). One patient (1.1%) was re-interfered, with a perioperative mortality of 1.1%. In 2019, 21 patients (12.7%) were readmitted. Seventeen patients (10.3%) were re-interfered, with a perioperative mortality of 1.8%. The median number of days hospitalized was 2 (IQR=2) in 2020 and 3 (IQR=3) in 2019. No significant differences were found in population or morbimortality, except for reoperation in a normal year. CONCLUSION: Postoperative morbidity and mortality reported are lower than those shown in the literature concerning COVID-19 and similar to that historically reported by our centers. This study suggests that it is safe to operate patients with urological cancer following the appropriate protocols during a pandemic.

Anti-inflammatory therapies for SARS-CoV-2 infection from a hematological perspective

The pathophysiology of the inflammatory profile induced by SARS-COV2 infection has similarities with conditions of immune system activation with cytokine release such as hemophagocytic syndrome and some cases of acute graftversus- host disease. There are encouraging results of clinical studies, performed with increasingly better methodological quality, supporting the use of targeted and specific anti-inflammatory therapy in selected groups of patients with COVID-19 with severe inflammation. In this review we describe the inflammatory pathophysiology of the disease and the recent findings about its treatment.

COVID-19 and family care. programm "mecuida"

The COVID-19 outbreak has forced schools and day care centres to close their doors. In response, many parents are now juggling housework and paid work with a sudden increase in child care responsibilities. The Royal Decree Law 8/2020 have recognized a series of rights to favor the work-life balance of workers employed by third parties who accredit duties of care to dependent persons due to exceptional circumstances related to the prevention of the extension of COVID-19, specifically recognizing the right to agree to the adaptation of working hours and, subsidiarily, to be in a reduction of their working hours. © 2020 Ibero-American Law Institute. All rights reserved.

How to face a massive respiratory epidemic, from the organizational point of view and a contingency plan?

The epidemics are not a «globalization» product, this exists since the humanity begun, it´s not necessary to close borders neither trade between countries, in the past did not exist highways, railway, tall ships or aircraft and the epidemics already existed, the history show and demonstrate us that the real protection is the interchange of confident information and the teamwork, we should work like global unity. In the global universe the information grow up exponentially daily, so we have to be careful with all the data that come to us. If we understand that an epidemic’s antidote is the cooperation and unity, we should have the capacity to organize a solid teamwork based on a situational diagnose. Our purpose in this paper is to share our experience in organizational logistics and give its true value to health personnel.

Traqueostomy in COVID-19 patients: Current recomendations

The new coronavirus (SARS-CoV-2), which causes COVID-19 disease, is a high mortality pandemic illness. One of the most important factors is its high rate of transmissibility by respiratory droplets, aerosols and fomites. The reigning trend of this disease is progressively increasing infected patients in our country, therefore, more patients in intensive care units (ICU) with invasive mechanical ventilation (IMV). Tracheostomy (TQT) is used in critical patients to facilitate long-term IMV and ventilation weaning. An early TQT, defined as performed in the first 7 days after orotracheal intubation (IOT) is associated with a reduction IMV duration, mortality rate and length of stay in ICU. TQT is a surgical procedure which generates a huge amount of aerosols that need special measures to perform in COVID-19 patients. It is necessary to use appropriate personal protection elements (PPE) according to the intervention, limiting the spread of SARS-CoV-2 in health workers. It is for this reason that this article proposes to use the acronym C-O-RO-NA to remember fundamental elements and steps when performing this technique in order to minimize health workers infection.