Managing Safety and Security in the Smart City: Covid-19, Emergencies and Smart Surveillance

The chapter examines the role and potential inherent in surveillance systems in smart cities today. The Covid-19 pandemic and the resultant restrictions to mobility, on the one hand, and the need for strengthened enforcement measures highlighted the already existing weaknesses and contingencies besetting surveillance in smart cities. The chapter makes a case that the adoption of smart city surveillance and infrastructure management systems may contribute to the improvement of safety and security in the smart city as well as to an overall enhancement of the smart city's resilience. The discussion in this chapter focuses on the complex processes of data acquisition, data sharing, and data utilization to explain in which ways they all add to smart surveillance systems that-while aware of individual freedoms and privacy issues-contribute to the process of making a smart city resilient. To showcase the applicability of these findings, a wireless mesh network (WMN) surveillance system is presented. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Organizational Management of Primary Care in the Regional Health System in Puno, Peru

Objective To analyze the organizational management of primary health care (APS, by its initials in Spanish) during the COVID-19 pandemic in the Puno regional health system. Methods The methodological design adopted is phenomenology within the framework of the qualitative research paradigm. A theoretical sampling was carried out in addition to the intentional and convenience sampling, identifying actors with decision-making capacity in the health services management process at the different levels of care: director of the Health Regional Directorate (DIRESA, by its initials in Spanish), executive directors of the 11 health networks, two hospital directors, and two heads of health centers. The qualitative data collection has been based on semi-structured interviews, focus groups, and documentary reviews, the results of which were analyzed and inter-preted based on the human talent management approach, the theory of organizational behavior, and the APS paradigm. Results Organizational management of APS in Puno involves addressing six emerging analysis subcategories: unfavorable organizational culture and climate;centralization and prioritization of curative and recuperative medicine;organizational anarchy in the regional health system (poor rectory);institutional and organizational instability;politici-zation of the health system, and deficiencies in the training of health professionals. Conclusions An adequate human talent management of people in health will contribute significantly to the renewed organizational management of the regional and national health system based on a unified and complementary model between APS and curative and recuperative medicine. © 2022, Universidad Nacional de Colombia. All rights reserved.

Six consecutive cases of primary intracranial sarcoma in children in two private institutions from Lima during COVID-19 pandemic.

Objective: The article describes the clinical and neuroimaging characteristics of six children with the diagnosis of brain tumor attended in two private institutions from Lima, during the COVID-19 pandemic. Material(s) and Method(s): Descriptive study of cases of brain tumor in patients aged 18 and younger, followed at two private institutions in in Lima, from March 2020 to December 2021. Result(s): Six consecutive cases of intracranial tumors were detected during a large part of the COVID-19 pandemic's first year (October 2020 to March 2021), all of them with diagnosis of primary intracranial sarcoma. Before the pandemic, the last primary intracranial sarcoma in children, operated in the mentioned institutions, occurred in June 2018 and was the only case that year. Conclusion(s): During the COVID-19 pandemic, an unusual frequency of primary intracranial sarcoma in children was found in two private institutions from Lima.Copyright © 2023 Authors. All rights reserved.

First isolation and characterization of the prototype strain of the SARSCoV-2 virus at the beginning of the COVID-19 pandemic in Peru

Introduction: Currently, isolated from SARS-CoV-2 virus exceed 600 million cases in the world. Objective(s): Isolation and characterization of the SARS-CoV-2 virus causing COVID-19 at the beginning of the pandemic in Peru. Method(s): Twenty nasal and pharyngeal swab samples were isolated from SARS-CoV-2 using two cell lines, Vero ATCC CCL-81 and Vero E-6;virus identification was performed by RT-PCR and the onset of cytopathic effect (CPE) was evaluated by indirect immunofluorescence and subsequent identification by genomic sequencing. One of the most widely circulating isolates were selected and named the prototype strain (PE/B.1.1/28549/2020). Then 10 successive passages were performed on Vero ATCC CCL-81 cells to assess mutation dynamics. Result(s): Results detected 11 virus isolates by cytopathic effect, and subsequently confirmed by RT-PCR and indirect immunofluorescence. Of these, six were sequenced and identified as the lineages B.1, B.1.1, B.1.1.1, and B.1.205 according to the Pango lineage nomenclature. The prototype strain corresponded to lineage B.1.1. The analysis of the strains from the successive passages showed mutations mainly at in the spike (S) protein of the virus without variation in the identity of the lineage. Conclusion(s): Four lineages were isolated in the Vero ATCC CCL-81 cell line. Subcultures in the same cell line showed mutations in the spike protein indicating greater adaptability to the host cell and variation in pathogenicity in vitro, a behavior that allows it to have more survival success.Copyright © 2023 Anales de la Facultad de Medicina. All rights reserved.

Reaction of the Colombian Health System to the Covid-19 pandemic: A rapid assessment using epidemiological indicators

This article describes some of the actions taken by the Colombian health system in order to improve the response capacity to the COVID-19 (SARS-CoV-2) pandemic and correct some of the structural failures of the system that threatened the effectiveness of the response. The evolution of some epidemiological markers of the impact of the pandemic is also presented, between March 2020 and September 2021, which can help to unders-tand whether the measures taken could mitigate the impact of the pandemic or not. Among the actions that could most influence the epidemiological outcomes (cases and deaths) of the pandemic, we can highlight the increase in the number of Intensive Care Unit beds (from 5 000 to 11 000 approximately) and the steps taken to acquire vaccines in a highly competitive international market which preferred to provide vaccines first to industrialized countries than to less developed ones. Despite these efforts, the draconian isolation measures, and the suspension of many economic activities, during the study period, Colombia was one of the 15 countries with the highest mortality in the world and more than 60% of the population became infected after the first wave of the pandemic. This suggests a low effectiveness of the efforts made to strengthen the health system. © 2022, Universidad Nacional de Colombia. All rights reserved.

COVID-19 Pandemic: attitudes-facilities as a mediator between self-care and mental wellness among medical science interns

Objective To determine in health sciences interns if self-care is a factor whose direct effect on mental wellness is mediated by attitudes and facilities during internship, during the second wave of the COVID-19 pandemic. Method Cross-sectional, multivariate correlational research. 174 interns participated during the COVID-19 pandemic, selected by convenience sampling;three self-report scales were applied. Results Among the health sciences interns, being a woman, having a family member at home infected with COVID-19, and having an unfavorable general health status perception are risk factors that are likely to have a negative state of mental wellness (1.9>OR<3.9);while self-care together with attitudes and facilities during the internship are protective factors to counteract the existence of a negative state of mental wellness (OR<1;p<0.05). The structural regression model shows that self-care variables such as attitudes adopted, and facilities experienced by students in the internship have direct effects on mental wellness;likewise, attitudes and facilities play a mediating role between self-care and mental wellness (CFI=0.96;TLI=0.95;RMSEA and SRMR<0.08). The model as a whole explains 50.7% of the variability of mental wellness. Conclusion Self-care is a factor whose direct effect on mental wellness is mediated by attitudes and facilities in internship during the second wave of the COVID-19 pandemic in 2021. © 2022, Universidad Nacional de Colombia. All rights reserved.

Usefulness of C-reactive protein to determine the severity of SARS-CoV-2 infection in Peru.

Background: Recently, many biomarkers have been studied to determine severe cases of COVID-19. C-reactive protein (CRP) has shown high sensitivity in identifying patients with severe disease and utility comparable to computed tomography. Aim(s): To determine the usefulness of CRP to predict the severity of SARS-CoV-2 infection in patients hospitalized at the Naval Medical Center of Peru during the period January-September in the year 2021. Method(s): A quantita-tive, observational, analytical, retrospective, and diagnostic test type design was used. A sample size of 503 patients was calculated, which were divided into two groups according to their severity. Result(s): An optimal cut-off point of 10.92 mg/L for CRP levels was determined for the diagnosis of severe COVID-19. An area under the curve (AUC) of 0.762 was calculated and sensitivity, specificity, positive and negative predictive values and diagnostic accuracy values of 78.88%, 66.4%;41.42%;87.01%;and 67.27%;respectively. Fagan's normogram showed a post-test probability of 41%. In the adjusted model, CRP (aOR = 4.853;95% CI 2.987-7.886;p = 0.001), ferritin (aOR = 1.001;95% CI: 1.001-1.002;p = 0.001) and hypothyroidism (adjusted OR = 4899;95% CI: 1272-18872;p = 0.021) showed significance. Conclusion(s): The present study showed an association between CRP and the severity of SARS-CoV-2 infection in an adjusted model, showing its potential utility and contributing to determine the cut-off point of CRP in the Peruvian population and its international comparison.Copyright © 2023, Sociedad Chilena de Infectologia. All rights reserved.

Barriers and facilitators of HPV vaccination in sub-saharan Africa: a systematic review.

BACKGROUND: Human Papilloma Virus (HPV) is the most common sexually transmitted infection worldwide. Globally, both men and women have a 50% risk of being infected at least once in their life. HPV prevalence is among the highest in sub-Saharan Africa (SSA), at an average of 24%. HPV causes different types of cancers, including cervical cancer (CC), which is the leading cause of cancer deaths among women in SSA. HPV-vaccination has been proven to be effective in reducing HPV induced cancers. SSA countries are delayed in reaching the WHO's target of fully vaccinating 90% of girls within the age of 15 by 2030. Our systematic review aims to identify barriers and facilitators of HPV-vaccination in SSA to inform national implementation strategies in the region. METHODS: This is a mixed method systematic review based on the PRISMA statement and The Joanna Briggs Institute Reviewers' Manual. Search strategies were adapted to each selected database: PubMed/MEDLINE, Livivo, Google Scholar, Science Direct, and African Journals Online for papers published in English, Italian, German, French and Spanish between 1 December 2011 and 31 December 2021. Zotero and Rayyan were the software used for data management. The appraisal was conducted by three independent reviewers. RESULTS: A total of 20 articles were selected for appraisal from an initial 536 articles. Barriers included: limited health system capacities, socio-economic status, stigma, fear and costs of vaccines, negative experience with vaccinations, COVID-19 pandemic, lack of correct information, health education (HE) and consent. Additionally, we found that boys are scarcely considered for HPV-vaccination by parents and stakeholders. Facilitators included: information and knowledge, policy implementation, positive experience with vaccinations, HE, stakeholders' engagement, women's empowerment, community engagement, seasonality, and target-oriented vaccination campaigns. CONCLUSIONS: This review synthesizes barriers and facilitators of HPV-vaccinations in SSA. Addressing these can contribute to the implementation of more effective HPV immunization programs targeted at eliminating CC in line with the WHO 90/70/90 strategy. REGISTRATION AND FUNDING: Protocol ID: CRD42022338609 registered in the International Prospective Register of Systematic Reviews (PROSPERO). Partial funds: German Centre for Infection research (DZIF) project NAMASTE: 8,008,803,819.

Physical activity level and factors associated with perceived stress among Peruvian university professors during the COVID-19 pandemic.

Introduction: The COVID-19 pandemic led to the transition to remote work, triggering variations in stress and physical activity (PA), associated with context-specific instability. Objective: To identify the association between perceived stress (PS) and the level of physical activity (PA) and explore its relationship with the sociodemographic, family, work and individual characteristics of professors working remotely during the COVID-19 pandemic. Material and methods: Cross-sectional analytical study based on a virtual survey of professors. PS was assessed using the Perceived Stress Scale (PSS-14), and PA using an International Physical Activity Questionnaire. The prevalence of high PS and the association with PA were estimated using a Poisson regression analysis with robust variance that estimated crude prevalence ratios (cPR) and adjusted prevalence ratios (aPR) with a 95% confidence interval (CI). Five models were developed to assess associations of PS and PA with sociodemographic, family, work, and individual variables. Results: The information of 191 professors was analyzed; 39.27% were women, aged 52 (41-60). The prevalence of high stress was 47.12%. The age and being head of household did not show significant individual associations with PS. However, the regression analysis assessing the association of PS and other factors showed that compared to the moderate PA group, a statistically significant association was found between stress and high PA (aPR = 0.19; 0.06-0.59), low PA (aPR = 1.43; 1.02-2.01), mainly influenced by age, being head of household and sleep quality. Conclusion: Stress was associated with PA level, family and individual factors. These findings allow identifying characteristics, such as being head of household, age and quality of sleep among teachers, as being associated with a higher probability of having high stress. Subsequent studies should consider the role of individuals and working conditions as part of occupational health surveillance, given the presence of hybrid education in the education sector.

Pharmacovigilance of the effects associated with vaccination against SARS-CoV-2 in the health personnel of a hospital for the exclusive care of patients with COVID-19

The Pablo Arturo Suárez Hospital, located in Quito, the capital of Ecuador, became an exclusive care hospital for COVID-19 patients in March 2020. It was one of the first centers to immunize its staff with a single type of vaccine, that of Pfizer-BioNTech. A pharmacovigilance study was conducted on 1304 health workers from this center who were immunized between January and March 2021. The vaccinated had an average age of 38.7 years, and the female sex predominated (63%). 81 (6%) immunized reported adverse effects, and their mean age was 38.8 years;women (69%) predominated, similar to the total population. Three hundred five adverse effects related to vaccines were reported;of them, only 1 (0.3%) was severe and required hospitalization, and the rest (23%) were non-serious. The most reported effects were headache, malaise, and pain at the injection site. The results show a parallel with what has been said worldwide on the safety of vaccines against COVID-19 in general and Pfizer-BioNTech in particular. The relevance of our work lies in the fact that it is one of the first reports of the reactogenicity of this vaccine in a high-altitude city at the beginning of the pandemic, in a court of health personnel directly dedicated to the care of this type of patient. Copyright: © 2022 by the authors.

Sleep quality among teachers of an educational institution during the COVID-19 health emergency, Peru, 2021.

Objective: The COVID-19 pandemic affected the quality of life of the population worldwide. The countries took several protective measures to avoid contagion, including social isolation, teleworking and distance education. As schools closed, teachers took over primarily online teaching. The study main objective was to determine the sleep quality among teachers of a public educational institution in the district of Mancora, Peru, during the COVID-19 pandemic social isolation. Material(s) and Method(s): An observational, cross-sectional and prospective study. The Pittsburgh Sleep Quality Index was used to assess 59 preschool, primary and secondary school teachers who taught through distance education from March to December 2021. Result(s): The average age was 44.3 +/- 8.89 years. Women accounted for 64.4 %, specialist teachers-i.e., those who have expertise in a particular field-55.9 %, secondary school teachers 55.9 %, primary school teachers 30.5 % and preschool teachers 13.6 %. The affected sleep quality parameters were the following: 69.5 % had poor sleep quality, 67.8 % inadequate sleep latency, 61 % sleep duration of less than five hours, 27.1 % habitual sleep efficiency of less than 65 % and 49.2 % sleep disturbances. Moreover, 50.8 % reported using a sleeping medication more than once a week and 39 % severe daytime dysfunction. There was an association between sleep quality and the components subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency and daytime dysfunction. Nonetheless, there was no association with sex, educational level and teaching specialty. Conclusion(s): Teachers of an educational institution in Mancora had a high prevalence of poor sleep quality and the most affected components were sleep latency, daytime dysfunction and sleep disturbances.Copyright © La revista. Publicado por la Universidad de San Martin de Porres, Peru.

Prevalence and risk factors associated with SARS-CoV-2 infection among workers of Instituto Nacional de Salud del Nino, Peru, April 2020 to March 2021.

Objective: To determine the prevalence and risk factors associated with SARS-CoV-2 infection among workers of Instituto Nacional de Salud del Nino (INSN) from April 2020 to March 2021. Material(s) and Method(s): A non-experimental, descriptive, cross-sectional study. The sample consisted of 608 workers who tested positive for COVID-19 using a rapid antigen test. The COVID-19 clinical-epidemiological research sheets prepared by the Ministry of Health of Peru and self-administered by the workers were reviewed. The INSN Department of Epidemiology staff verified the completion of the sheets. The data was entered into a database, which was used for the respective statistical analysis. The study was approved by the INSN Institutional Research Ethics Committee (registration code: PI-17/21). Result(s): COVID-19 prevalence among INSN workers was 7.24 % from April 2020 to March 2021. Out of the workers with COVID-19, 71.4 % were women;83.4 % were in the 30 to 59 age range with an average age of 44.71 years;65.6 % were healthcare workers, most of whom were nursing technicians;and 56.9 % experienced symptoms, mainly fever/chills (12.2 %), cough (8.9 %), malaise (7.7 %), sore throat (6.7 %), stuffy nose (2.5 %) and headache (1.3 %). Most workers lived in Lima Centro districts (33.2 %). A significant association between sex, age groups, worker type and worker profile was found. Conclusion(s): COVID-19 prevalence among INSN workers was 7.24 %;the most frequent characteristics, which showed significant differences with the rest of the factors, were being a woman, healthcare worker and nursing technician. A total of 56.9 % of the workers experienced symptoms, only 20.9 % developed clinical signs and 10.9 % had comorbidities.Copyright © La revista. Publicado por la Universidad de San Martin de Porres, Peru.

Main changes in the model of diagnosis-related groups in 2021.

The authors explain the main changes in the Russian model of diagnosis-related groups used for medical care payment from the funds of compulsory health insurance in 2021 compared to 2020. New diagnosis-related groups for payment for treatment of patients with malignancies of lymphoid and hematopoietic tissues, treatment and follow-up of patients with new coronavirus in-fection, rehabilitation after COVID-19 and cancer, surgical treatment of large and giant hernias with mesh implants are described. The authors discuss expanding the list of classification criteria for diagnosis-related groups, updating of approaches to cost weight coefficients for calculation of cost of antineoplastic treatment.Copyright © 2021, Media Sphera Publishing Group. All rights reserved.

Cardiovascular risk among patients recovered from COVID-19 in the short and medium term: what does the current evidence conclude?.

Cardiovascular risk and diseases among patients recovered from COVID-19 is a recent field of study in the world medical literature and is also of vital importance because a large number of patients develop complications once the acute phase of the disease is over. The broad spectrum of myocardial injury in cardiovascular diseases can range from the asymptomatic elevation of cardiac troponin levels to the development of fulminant myocarditis and/or circulatory shock, which can leave significant sequelae. Despite the fact that there is no clear strategy to treat cardiac events that occur during COVID-19 infection and taking into account that treatment is mainly aimed at relieving patients' symptoms as they arise, the objective of this work was to find out and collect current evidence on this subject, so that readers can be offered a reference guide in Spanish that contributes to the development of their health profession. The methodology used was a literature search in databases including Medline, Scopus and ScienceDirect within a time window between 2019 and 2022. The main results revealed that the molecular and pathophysiological mechanisms involved in post-COVID-19 syndrome include the renin-angiotensin-aldosterone system since SARS-CoV-2 tropism is linked to angiotensin-converting enzyme 2. This causes an alteration of the neurohumoral response of the cardiovascular, renal and digestive systems, generating deficits in the signaling pathways and causing direct damage to the heart, lungs and other organs. Post-COVID-19 syndrome, in general, is defined as the occurrence or persistence of symptoms three or four weeks after the acute phase of the disease. This could then be considered as a time window of risk and strict follow-up to assess in a personalized way the risk among the different groups of patients, especially those with a past history of cardiovascular disease. The main results revealed disorders such as heart failure, arrhythmias, pericarditis and myocarditis, which require early detection and occur days or even weeks after the acute phase of COVID-19.Copyright © La revista. Publicado por la Universidad de San Martin de Porres, Peru.

Prevalence of dry socket associated with urgent dental extractions due to pain performed at an emergency service in the Buenos Aires Metropolitan Area during the mandatory preventive social isolation for the COVID-19 pandemic in Argentina

Objective: To evaluate the prevalence of dry socket as a postoperative complication in cases where there was intense local pain in the preoperative state, during the preventive mandatory social isolation (PMSI) for the COVID-19 pandemic in Argentina. Method(s): This was a descriptive study, which included 1209 walk-in patients at the emergency and orientational service at Buenos Aires University School of Dentistry during the PMSI from March 20 to June 20, 2020, with indication for dental extraction as well as intense acute pain at the surgical site. The presence of dry socket was exploratoryly associated with the variables age, sex, smoking and chronic medication use. Result(s): 1209 patients were operated, resulting in a total 1372 dental extractions. Average patient age was 41 years. The prevalence found in this study was 1.06%. Conclusion(s): The prevalence of dry socket was 1%, not being higher than other experiences where pain was not considered a condition prior to extraction.Copyright © 2023 Duke University Press. All Rights Reserved.

Pulmonary parenchymal involvement secondary to subcutaneous injection of silicone gels: a case report.

Pulmonary parenchymal involvement secondary to the subcutaneous injection of silicone gels is an unusual condition which occurs more frequently in women aged between 22 and 55 years. Although different theories have been put forward about its etiology, it is unknown and the condition may cause local and systemic complications and even have a fatal outcome. Few cases have been reported in South America and there is no report of this unique entity in Peru. We present the case of a previously healthy 28-year-old male transgender patient who, after an illegal subcutaneous injection of silicone gels in the gluteal region given by a non-healthcare professional, showed progressive respiratory distress and stabbing chest pain of approximately 7 out of 10 on the pain scale within the first 24 hours. Upon admission to the emergency room, respiratory failure was objectively evidenced since the patient had an oxygen saturation of 72 % at a FiO2 of 21 %, as well as pulmonary parenchymal involvement both in the CT scan and chest X-ray with signs highly suggestive of this pathology. Using a SARS-CoV-2 RNA real-time RT-PCR test performed on a respiratory specimen, COVID pneumonia, immunodeficiency disorders and pulmonary embolism were ruled out. Since there is no standard treatment, the patient was given relevant support measures such as the administration of supplemental oxygen at a low flow rate by binasal cannula, intravenous systemic corticosteroids and antibiotic therapy, thus achieving good progress with resolution of the initial clinical presentation. Then, after 10 days of intrahospital treatment, the patient was discharged.Copyright © La revista. Publicado por la Universidad de San Martin de Porres, Peru.

Organizational climate among healthcare personnel and satisfaction of users assisted by the Mobile Emergency Care Service (SAMU) in the context of COVID-19, Piura, 2021.

Objective: To determine the relationship between the organizational climate among healthcare personnel and the satisfaction of users assisted by the Mobile Emergency Care Service (SAMU) in the context of COVID-19, Piura. Material(s) and Method(s): A Likert-scale survey was administered to 80 healthcare workers to assess the organizational climate and 110 SAMU users to assess their satisfaction level and whether they met the selection criteria. The survey had one section addressed to SAMU workers and another one to SAMU users. Result(s): Out of all healthcare personnel, 51.3 % were men with an average age of 32.65 +/- 6.8 % years, and there were more registered nurses (32.50 %) than doctors (31.30 %). Out of all users, 54.5 % were men with an average age of 58.78 +/- 20.97 years, 57.3 % had no comorbidities and 84.5 % used the service once. The organizational climate and its dimensions showed healthy outcomes (96.58 +/- 3.21). Most SAMU users (51.60 %) were satisfied (57/110) while 38.20 % (42/110) were moderately satisfied and 10.20 % (11/110) showed dissatisfaction. The main hypothesis concerning the relationship between the organizational climate and the satisfaction of SAMU users (p < 0.005) was confirmed. Moreover, there was a relationship between the five dimensions and the satisfaction of users. Conclusion(s): There is a relationship between the organizational climate among SAMU healthcare workers and the satisfaction of SAMU users in Piura. The organizational climate and its dimensions, compared to the instrument developed by MINSA, showed healthy outcomes. Most patients were satisfied with the care received and the most frequent comorbidities were hypertension and type 2 diabetes mellitus.Copyright © La revista. Publicado por la Universidad de San Martin de Porres, Peru.

Characteristics and frequency of tuberculosis before and during the COVID-19 pandemic among adults treated in a primary healthcare center in Lima, Peru, 2019-2020.

Objective: To determine the characteristics and frequency of patients aged over 18 years with tuberculosis (TB) before (2019) and during (2020) the COVID-19 pandemic in a healthcare center (CS) in Lima, Peru. Material(s) and Method(s): A descriptive retrospective study that included medical records of 100 patients aged > 18 years enrolled in the TB program at CS Los Libertadores (SMP-Lima, Peru) from 2019 to 2020. Sociodemographic (sex, origin, age), clinical (admission/discharge status, body mass index, comorbidities, TB infection site, type of resistance, treatment regimen) and laboratory (smear microscopy, culture, drug susceptibility testing) variables were analyzed. Patients who did not have all the variables were excluded. An Excel database was prepared and a descriptive statistical analysis of the qualitative variables, expressed in frequencies, and quantitative variables, expressed in measures of central tendency (mean) and standard deviation, was performed using IBM SPSS Statistics. TB prevalence per year was determined, according to the population assigned to the healthcare center. Said information was obtained through the Tuberculosis Management Information System (SIGTB). Result(s): TB prevalence was 0.0015 % (49 patients) in 2019 and 0.075 % (51 patients) in 2020. In both years, the male sex and the age group between 18 and 29 years prevailed, and the most common site of infection were the lungs. In 2020, an increase in HIV comorbidity and mortality rate (0.074) was observed, as well as more positive smear microscopy cases. Conclusion(s): TB prevalence was higher in 2020, the first year of the COVID-19 pandemic, due to a reduced approach to TB programs as a result of the situation imposed by the pandemic. In addition, TB mortality rates raised in the same year, probably due to an increase in treatment dropouts or HIV and diabetes comorbidity rates.Copyright © La revista. Publicado por la Universidad de San Martin de Porres, Peru.

Discontinuation of Antihypertensive Drug Use Compared to Continuation in COVID-19 Patients: A Systematic Review with Meta-analysis and Trial Sequential Analysis.

INTRODUCTION: COVID-19 related mortality is about 2%, and it increases with comorbidities, like hypertension. Regarding management, there is debatable evidence about the benefits of continuation vs. discontinuation of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEI/ARB). AIM: We performed a systematic review to assess the effects and safety of in-hospital discontinuation compared to continuation of ACEI/ARB in COVID-19 patients. METHODS: We systematically searched on PubMed, Scopus, and EMBASE from inception to June 19, 2021. We included observational studies and trials that compared the effects and safety of continuing ACEI/ARB compared to discontinuing it in COVID-19 patients. Effects sizes for dichotomous variables were expressed as risk ratios (RR) and 95% confidence intervals. For continuous variables, effects were expressed as mean difference (MD). We used random effect models with the inverse variance method. We assessed certainty of evidence using the GRADE approach. RESULTS: We included three open-label randomized controlled trials and five cohort studies. We found that the continuation group had lower risk of death compared with the discontinuation group only in the cohort group (RR: 0.46, 95% CI: 0.24-0.90), but not in the RCT group (RR: 1.22, 95% CI: 0.75-2.00). The ICU admission rate was significantly lower in the continuation group (RR: 0.46, 95% CI: 0.31-0.68) in the cohort group, but not in RCT group (RR: 1.03, 95% CI: 0.67-1.59). We did not find significant differences between groups regarding hospitalization length, hypotension, AKI needing renal replacement therapy, mechanical ventilation, new or worsening heart failure, myocarditis, renal replacement therapy, arrhythmias, thromboembolic events and SOFA AUC. The GRADE approach revealed that the certainty ranged from moderate to high level. CONCLUSIONS: There is no significant difference in mortality and other outcomes between continuation and discontinuation groups.

Quality of Physical Activity Participation Among Adults with Disabilities Through Pandemic Restriction.

Background. Physical activity (PA) is essential for maintaining well-being in adults with disabilities. This population experienced reduced PA during the COVID-19 pandemic; yet, the impact on quality of PA participation remains unclear. Purpose. This secondary analysis explored how pandemic restrictions impacted six experiential dimensions of quality of PA participation among adults with disabilities. Methods. An exploratory sequential mixed-methods design, including semi-structured interviews (n = 10) and self-reported surveys (n = 61), was conducted in May-2020 and February-2021. Quality of PA participation was measured using the Measure of Experiential Aspects of Participation (MeEAP). Participants included community-dwelling adults over 19 years of age (mean 59.2 ± 14.0 years) living with stroke, spinal cord injury, or other physical disabilities. Findings. Directed content analysis identified three themes related to adjusting PA participation for restrictions, motivation barriers, and valuing social support. These themes highlighted five factors, such as resilience, as potential quantitative predictors of quality of PA participation. While paired correlations with MeEAP scores were observed, these factors were not statistically predictive in multiple regression analysis (adjusted R2 = -0.14, F(10,50) = 0.92, p = .53). Implications. The interplay between Meaning, Autonomy, Engagement, and Belongingness dimensions of quality of PA participation was complex, with an emphasized role for mental health, in adults with disabilities.