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Conspiracy theories widely influence our social and political lives. A recent example is the broad impact such theories had on government's efforts to halt the spread of the COVID-19 pandemic. In that context, public's compliance and willingness to get vaccinated was found to be substantially and negatively affected by the belief in conspiracy theories, among various factors. In the present study, we tested whether some countries are more susceptible to conspiracy theories than others. We examined, for the first time, the idea that the degree of intensity of conflict predicts the degree of belief in COVID-19 conspiracy theories. A multilevel analysis across 66 countries (N = 46,450) demonstrated that people living in countries with higher conflict intensity tended to be more susceptible to COVID-19 conspiracy beliefs. These findings are the first large-scale comparative evidence of the profound psychological effects of conflicts on the involved societies. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement The belief in COVID-19 conspiracy theories has severe implications on public's health. Thus, it is important to better understand the reasons behind such beliefs. The present study provides new information which helps to better understand the contexts in which conspiracy belief thrive. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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Introduction: The Coronavirus disease (COVID-19) is more severe in patients with pre-existing comorbidities;therefore, dialysis patients fall into this category. Not to mention the risk among patients receiving in-center dialysis, since they are known to be at higher risk of contracting this disease. Information about the clinical characteristics among hemodialysis patients with COVID-19 in Latin America and low-and middle-income countries are limited. Considering the importance of this topic, the aim of this study was to describe the clinical characteristics along with the outcome of 70 hemodialysis patients hospitalized for COVID-19. Method(s): This is a retrospective study in chronic hemodialysis patients hospitalized with COVID-19. All patients diagnosed with COVID-19 from March 2020 to January 2022 are included. Result(s): The mean age of the patients was 58 (range 19-87), where 65.7% were male. The most prevalent comorbidities were hypertension (98.6%) and type 2 diabetes (54.3%). The most common presenting symptoms were dyspnea (71.4%), fever (68.6%) and cough (58.6%). In addition of abnormal pulmonary auscultation in most patients (78.6%). Lymphocytopenia and elevated inflammatory markers as procalcitonin, erythrocyte sedimentation rate (ESR), D-dimer and C-reactive protein (CRP) were the main prevalent lab findings. At admission 90.1% had ground- glass abnormalities in the CT findings, being CO-RADS 3 the most frequent category between these patients. The average hospital stay was 8.51+/- 6.39 days;35.7% of these patients were admitted to the ICU and only 4 (5.7%) required mechanical ventilation. Therapeutic management included statins and antithrombotic therapy for all the patients at prophylactic doses. Treatment options were remdesivir, corticosteroids, hydroxychloroquine, antibiotics, and other immunosuppressant drugs. A total of 8 (11.4%) patients died during hospitalization and 62 (88.6%) were discharged. Conclusion(s): Even though dialysis patients are at higher risk of death, especially in developing countries, our findings suggest that the mortality rate were lower in comparison with other studies in Latin America and similar to some developed countries. The use of statins and antithrombotic prophylaxis in all hospitalized patients seems to be associated with a lower risk of death in conjunction with other therapeutic regimens according to the guidelines. No significant adverse effects were observed with remdesivir in these patients, so we believe that its use is beneficial in conjunction with the use of statins and antithrombotic prophylaxis, based on the patient's requirements. No conflict of interestCopyright © 2023
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Introduction: The coronavirus disease 2019 (COVID-19) has caused tremendous impact globally due to the significant morbidity and mortality caused by this virus. It is currently known that the probability of becoming seriously ill from this disease is higher in older adults, in people with pre-existing comorbidities, and those with a suppressed immune state. Therefore, transplant patients are not the exception. Considering the importance of this topic and the scarce information on the outcome of this type of patients, especially in Latin America, this series of cases is focused on our experience with 10 kidney transplant patients hospitalized for COVID-19. Method(s): We retrospectively reviewed the medical records of kidney transplant patients hospitalized for SARS-CoV-2 (COVID-19) between April 2020 and May 2021. Result(s): The age range of the patients was 41 to 68 years, where 8 of these were men. The most common admission symptoms were fever (80%), dyspnea (70%), myalgia/arthralgia (50%), and headache (50%). The most prevalent laboratory findings were lymphocytopenia and increased inflammatory markers such as D-dimer, LDH, procalcitonin, erythrocyte sedimentation, and ferritin. General management included supportive treatment, statins, and antithrombotic therapy, while the specific treatment options were hydroxychloroquine, antivirals, corticosteroids, Intravenous Immunoglobulin, tofacitinib, and convalescent plasma. All the patients improved and were discharged. Two of them went to the ICU and only one required mechanical ventilation. The majority of the patients (70%) remained with their baseline immunosuppression without dose reduction or suspension. Conclusion(s): Kidney transplant recipients are more susceptible to infections, along with increased disease severity. At the same time their immunosuppressed state may reduce the inflammatory response following this type of infection. Decisions were based on stopping or attenuating the viral load and the systemic inflammation caused by this virus, but at the same time protecting against acute allograft rejection and the coinfection with other pathogens. Our findings suggest that the use of statins and antithrombotic prophylaxis in all hospitalized transplant patients may be beneficial to reduce the risk of mortality in patients with COVID-19 infection. Also, the maintenance of immunosuppressive therapy was not associated with worse outcomes. No conflict of interestCopyright © 2023
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Background: A continuing nationwide vaccination campaign began in the Dominican Republic on February 16, 2021 to prevent severe consequences of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Estimates of vaccine effectiveness under real-world conditions are needed to support policy decision making and inform further vaccine selection. Methods: We conducted a test-negative case-control study to assess the real-world effectiveness of nationwide coronavirus disease 2019 (COVID-19) vaccination program using an inactivated vaccine (CoronaVac) on preventing symptomatic SARS-CoV-2 infections and hospitalizations from August to November 2021 in the Dominican Republic. Participants were recruited from 10 hospitals in 5 provinces to estimate the effectiveness of full immunization (≥14 days after receipt of the second dose) and partial immunization (otherwise with at least 1 dose ≥14 days after receipt of the first dose). Results: Of 1078 adult participants seeking medical care for COVID-19-related symptoms, 395 (36.6%) had positive polymerase chain reaction (PCR) tests for SARS-CoV-2; 142 (13.2%) were hospitalized during 15 days of follow up, including 91 (23%) among 395 PCR-positive and 51 (7.5%) among 683 PCR-negative participants. Full vaccination was associated with 31% lower odds of symptomatic infection (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.52-0.93) and partial vaccination was associated with 49% lower odds (OR, 0.51; CI, 0.30-0.86). Among 395 PCR-positive participants, full vaccination reduced the odds of COVID-19-related hospitalization by 85% (OR, 0.15; 95% CI, 0.08-0.25) and partial vaccination reduced it by 75% (OR, 0.25; 95% CI, 0.08-0.80); full vaccination was associated with reduced use of assisted ventilation by 73% (OR, 0.27; 95% CI, 0.15-0.49). Conclusions: Given the ancestral and delta viral variants circulating during this study period, our results suggest that the inactivated COVID-19 vaccine offered moderate protection against symptomatic SARS-CoV-2 infections and high protection against COVID-19-related hospitalizations and assisted ventilation. This is reassuring given that, as of August 2022, an estimated 2.6 billion inactivated CoronaVac vaccine doses had been administered worldwide. This vaccine will become a basis for developing multivalent vaccine against the currently circulating omicron variant.
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To assess changes in SARS-CoV-2 spike binding antibody prevalence in the Dominican Republic and implications for immunologic protection against variants of concern, we prospectively enrolled 2,300 patients with undifferentiated febrile illnesses in a study during March 2021-August 2022. We tested serum samples for spike antibodies and tested nasopharyngeal samples for acute SARS-CoV-2 infection using a reverse transcription PCR nucleic acid amplification test. Geometric mean spike antibody titers increased from 6.6 (95% CI 5.1-8.7) binding antibody units (BAU)/mL during March-June 2021 to 1,332 (95% CI 1,055-1,682) BAU/mL during May-August 2022. Multivariable binomial odds ratios for acute infection were 0.55 (95% CI 0.40-0.74), 0.38 (95% CI 0.27-0.55), and 0.27 (95% CI 0.18-0.40) for the second, third, and fourth versus the first anti-spike quartile; findings were similar by viral strain. Combining serologic and virologic screening might enable monitoring of discrete population immunologic markers and their implications for emergent variant transmission.
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COVID-19 , SARS-CoV-2 , Humans , Dominican Republic/epidemiology , COVID-19/epidemiology , Antibodies, Viral , Fever , Spike Glycoprotein, Coronavirus/genetics , Antibodies, NeutralizingABSTRACT
Research on health security has focused on how many different political, economic, social, and health-related factors affect disease containment within states. However, largely missing from this scholarship is an examination of the role public health intelligence plays in limiting the spread of disease. Thus, this study focuses on the effect epidemiological intelligence fusion centers have on disease prevalence. We conduct a case study analysis of the Dominican Republic's use of epidemiological intelligence fusion centers during the COVID-19 pandemic and provide policy recommendations for other states to follow. © 2022 Informa UK Limited, trading as Taylor & Francis Group.
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As we work to educate our children in effective ways, supporting their efforts to make a positive difference reaps benefits for both students and society.
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BACKGROUND: Good governance and regulatory supervision are required to conduct research in an international public health emergency context and to ensure compliance with ethical standards. The "Strengthening research ethics governance and regulatory oversight in Central America and the Dominican Republic in response to the COVID-19 pandemic" study is a regional effort in which research ethics stakeholders participated in addressing research ethics governance and preparedness response challenges to the COVID-19 pandemic in Central America and the Dominican Republic. METHODS: A qualitative action research study was conducted following a participatory approach. Research ethics stakeholders in Central America and the Dominican Republic were mapped; a regional webinar and three virtual workshops were conducted discussing research ethics governance, ethics review and collaborative research practice during the pandemic. A roundtable session presented results and obtained feedback on a draft of a policy to strengthen regional research ethics governance. RESULTS: Countries across Central America and the Dominican Republic are at different stages in their development of research ethics systems. Countries with more established systems before COVID-19 were better organized and prepared to respond. This finding argues against improvisation and supports further work on strengthening governance of research ethics systems. Community engagement in research ethics public policy-making is practically absent in the region. Research and research ethics collaboration schemes are lacking amongst the countries; however, there are incipient initiatives in the region, such as the Central America and Caribbean Network of Research Ethics Committees. A policy brief with recommendations on how to advance towards strengthening the governance of research ethics systems was prepared and submitted to the Central American Integration System for analysis and possible approval. CONCLUSION: National research ethics systems in Central America and the Dominican Republic were unprepared to respond to the COVID-19 pandemic with respect to research oversight and effective collaboration. In most cases, national research ethics systems were found to be weak, and regional research collaboration was practically absent. To promote collaboration, a joint strategy needs to be developed with a regional vision towards sharing knowledge and best practices.
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COVID-19 , Pandemics , Humans , Dominican Republic , Central America , Ethics, ResearchABSTRACT
Background. The COVID-19 pandemic has caused an unprecedented global public health emergency. Vaccine uptake in low and middle income countries (LMICs) lags developing nations and immunity from vector-based vaccines commonly used in LMICs may be inferior to mRNA vaccines. Thus, defining clinical characteristics that can help identify and triage cases and allocate resources in LMICs of priority. Hyperglycemia has been associated with higher morbidity and mortality in numerous diseases and in critical illness. We seek to understand the relationship between COVID-19 and hyperglycemia. Methods. This is a single center retrospective review of cases with COVID-19 between January 2021 and June 2021. Adult patients >18 years of age were reviewed and those with a molecular-based laboratory confirmed SARS-CoV-2 infection were included in our study. Patients with known diabetes, elevated A1C or prior steroid use within 2 weeks of admission were excluded. Clinical characteristics, demographics, glucose levels, C-reactive protein (CRP) and ferritin were reviewed. Results. A total of 120 patients were reviewed, of which 60.8% were male. Hyperglycemia ( >140mg/dL) was present in 57.5%. Hyperglycemia was associated with elevation of inflammatory markers including CRP and Ferritin (p=0.12) (Table 1). Hyperglycemia was more common in patients requiring supplemental low flow oxygen (table 2) and was more common in patients who did not survive (Figure 1). The mortality rate was higher in the hyperglycemia group with 61.5%, a statistically significant finding. Association between hyperglycemia and inflammatory markers. Conclusion. Hyperglycemia on admission was an independent risk factor for disease progression and death. Inflammatory markers were also higher in patients with hyperglycemia. These patients had no prior steroid use or diabetes. Thus, it is possible that it reflects inflammation, stress, or endocrine end-organ damage due to SARS-CoV-2. If validated in larger studies, this simple test can help clinicians identify patients at risk of decompensation and allocate resources and therapeutics accordingly.
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Background. The COVID-19 pandemic has strained healthcare systems worldwide and is now a leading cause of death. Remdesivir is the first antiviral shown to decrease time to recovery in a randomized placebo-controlled trial. Other studies have conflicting results and the World Helath Organization does not recommend the routine use of Remdesivir in hospitalized patients. The herogeneity of these studies and their populations makes interpretation of the available data difficult, with standard of care in different countries as the main confounding factor. Thus, it is imperative for low and middle income countries to study the role of remdesivir within their healthcare systems. We seek to further understand the impact of COVID-19 in a cohort in the Dominican Republic. Methods. This is a retrospective review of patients admitted for COVID-19 to a tertiary center in the DR between August 2020 to March. 2021. Patients with clinical findings consistent with COVID-19 pneumonia and a positive molecular test for SARS-CoV-2 were included in the study. Results. A total of 59 cases were reviewed, of which 40 were treated with remdesivir and 19 with remdesivir plus tocilizumab. Patients were more commonly male (69.5%) and ages ranged from 71-80 years (34.5%), 61-70 (20.7%), 51-60 (20.7%), 41-50 (10%), >81 (8.6%) and 18-30 (1.7%). Hypertension was the most common comorbidity (Figure 1). The average length of stay was 16.5 days, and 2.1 days. Mechanical ventilation was needed in 33.9%. Tocilizumab was administered in 32%. Mortality for the cohort was 29% (Figure 2). Mortality in patients treated with remdesivir alone was 22%, compared to 6.8% in those receiving tocilizumab and remdesivir. Comorbidities Mortality by length of stay Conclusion. In our cohort, the use of remdesivir was associated with higher mortality than remdesivir in combination with tocilizumab. The mortality in our cohort was high (29%) compared to the 11.9% reported in in the placebo group of the ACTT-1 study. Furthermore, studies have consistently shown benefit earlier in the disease course and with lower oxygen needs. Our cohort had high rates of mechanical ventilation. Thus, the modest benefit seen in developed countries may be harder to show in resource limited settings and the number needed to treat is likely much higher. Remdesivir did not appear to have an impact in our cohort.
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Background. The COVID-19 pandemic has strained healthcare systems worldwide. The disease spectrum of COVID-19 is wide, ranging from asymptomatic to respiratory distress and critical illness. A wide range of associated symptoms have been described, including gastrointestinal manifestations. Defining clinical characteristics that can help identify and triage cases towards COVID-19 treatment pathways early in low-and-middle income countries is of priority. Methods. Single center retrospective review of cases admitted to a tertiary center with COVID-19 and gastrointestinal symptoms between March 2020 and November 2021. Inclusion criteria was defined as molecular diagnosis of SARS-CoV-2 with symptomatic gastrointestinal disease. Demographic and clinical characteristics were tabulated, and statistics of association and mortality were performed. Results. A total of 95 cases admitted with SARS-COV2 pneumonia met the inclusion criteria. Cases were predominantly male (65.3%). Age distribution was 48.4% >61 years, followed by 51-60 (17.9%), 31-40 (15.8%) and 41-50 years (13.7%). The gastrointestinalfindings associated with COVID-19 were transaminitis (48.4%), Nausea and diarrhea (29.5%), anorexia (28.4%) and abdominal pain (13.7%). Patients with abdominal pain had 46% with respiratory decompensation and 23% critical illness (Figure 1) compared to 39% and 17.9% in patients with diarrhea. Transaminitis was associated with highest association with progression to critical illness (30%) and death (55%). Respiratory decompensation, critical illness and death by gastrointestinalfindings Conclusion. Gastrointestinal symptoms in COVID-19 have a wide range of clinical presentation and can be associated with severity of illness and decompensation. Transaminitis had the highest association with severe disease and death. These associations, if confirmed in larger studies, can help guide triage and prognostication in resource limited settings. Further studies are needed to validate thesefindings.
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Background. COVID-19-associated Pulmonary Aspergillosis (CAPA) and Invasive Pulmonary Aspergillosis (IPA) represent a difficult diagnostic challenge to the clinician. Moreover, during the COVID-19 pandemic, as airway invasive procedures were limited due to fear of contamination, these diagnoses were even harder to make, as one of the most useful diagnosis tools, bronchoscopies, were postponed. The aim of this study was to describe the epidemiology and risks factors of Aspergillosis and CAPA in a Dominican tertiary health care facility during the COVID-19 pandemic. Methods. A retrospective, cross-sectional, case-series study was carried out were all patients during the COVID-19 pandemic from March 2020 - March 2022 in HGPS who had a galactomannan (GM) test were analyzed. Using E-records patients with positive galactomannan (GM) tests were identified, and the following variables were evaluated: demographics, laboratories, risk factors, comorbidities, CT scans and prognosis. Cases were classified as CAPA (Probable, possible or proven according to classification ECMM/ISHAM), or IPA. Results. Out of 77 patients who underwent a GM test, 10 had a positive result;40% of these were probable CAPA and 60% were IPA. 7 were co-infected with multidrug-resistant pathogens from which 71.4% died;overall median age was 56.9 years (minimum 29 - maximum 71), and only one patient was female. The overall mortality rate was 60% and 50% for the probable CAPA group. Most radiological findings from the probable CAPA group were classified as typical invasive pulmonary aspergillosis. Major documented risk factors and comorbidities were lymphopenia, prolonged steroids use, hypertension, diabetes mellitus and mechanical ventilation. Conclusion. An increase in both CAPA and IPA screening is needed in patients who present risk factors such as mechanical ventilation, prolonged use of steroids, or renal replacement therapy. Screening for GM in bronchoalveolar lavage, mycologic cultures and histopathologic tests, are needed for an improvement in the diagnostic classification as well as the clinical outcome of these patients.
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Background. The COVID-19 pandemic has spread globally and millions of infections have occurred. As cases mount, atypical manifestations of COVID-19 and post-infectious complications such as multisystem inflammatory syndrome in children (MIS-C) become more likely. MIS-C is a life threatening post-infectious complication of COVID-19. There is a paucity of data of MIS-C in the Dominican Republic (DR). We seek to understand the clinical manifestations of MISC-C in the DR. Methods. This is a retrospective review of cases admitted to a pediatric hospital in the Dominican Republic from March 2020 to December 2021. Patients with clinical findings and a diagnosis of MIS-C were included. Echocardiographic (Echo) and electrocardiographic (ECG) changes were reviewed. Results. A total of 16 patients were included in our study, of which 68.75 were male. Ages were 12.5% < 1 years old, 12.5% between 1-4, 62.5% 5-12 and 12.5% over 12. Fever and rash were the most common clinical findings (Figure 1), while 69% had a new abnormality on echo and 50% had new ECG abnormalities. Echocardiographic findings are listed in Figure 2. Clinical findings in patients admitted with MIS-C Echo findings ECG findings Conclusion. The clinical manifestation of MIS-C are primarily fever, conjunctivitis, rash and hypotension. Because these findings can be non-specific, a high level of suspicion is needed. With over two thirds of patients with MIS-C showing echocardiographic changes and more than 50% showing ECG changes, these two tests can add significant diagnostic value in the right clinical setting. Clinicians should consider early echocardiography and ECG in patients with possible or suspected MIS-C.
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Introduction: The Coronavirus disease (COVID-19) is more severe in patients with pre-existing comorbidities;therefore, dialysis patients fall into this category. Not to mention the risk among patients receiving in-center dialysis, since they are known to be at higher risk of contracting this disease. Information about the clinical characteristics among hemodialysis patients with COVID-19 in Latin America and low-and middle-income countries are limited. Considering the importance of this topic, the aim of this study was to describe the clinical characteristics along with the outcome of 70 hemodialysis patients hospitalized for COVID-19. Case Description: The mean age of the patients was 58 (range 19-87), where 65.7% were male. The most prevalent comorbidities were Hypertension (98.6%) and Type 2 Diabetes (54.3%). The most common presenting symptoms were dyspnea (71.4%), fever (68.6%) and cough (58.6%). In addition of abnormal pulmonary auscultation in most patients (78.6%). Lymphocytopenia and elevated inflammatory markers as Procalcitonin, ESR, D-dimer and CRP were the main prevalent lab findings. At admission 90.1% had ground-glass abnormalities in the CT findings, being CO-RADS 3 the most frequent category between these patients. The average hospital stay was 8.51+/- 6.39 days, 35.7% of these patients were admitted to ICU with a median of 5.00 (IQR: 2.5-11) days and only 4 (5.7%) required mechanical ventilation. Therapeutic management included statins and antithrombotic therapy for all the patients at prophylactic doses. Treatment options were Remdesivir, corticosteroids, hydroxychloroquine, antibiotics, and other immunosuppressant drugs. A total of 8 (11.4%) patients died during hospitalization and 62 (88.6%) were discharged. Discussion(s): Even though dialysis patients are at higher risk of death, especially in developing countries, our findings suggest that the mortality rate were lower in comparison with other studies in Latin America and similar to some developed countries. The use of statins and antithrombotic prophylaxis in all hospitalized patients seems to be associated with a lower risk of death in conjunction with other therapeutic regimens according to the guidelines. No major adverse consequences were observed with Remdesivir in these patients.
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SESSION TITLE: Occupational and Environmental Lung Disease Cases SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Chlorine gas is a pulmonary irritant with pungent odor that damages the respiratory tract. Chlorine gas exposure occurs in industrial or household exposures,Chlorine gas has two forms either a liquid or gas, toxicity of chlorine gas depends on the dose and duration of exposure. Chlorine gas used in manufacturing products like paper, insecticides, Chlorine is used to treat bottled and swiming pool water. CASE PRESENTATION: A 37 Y.O Male, no PMH presents with progressive dyspnea for three days worse with activity,decreases with rest, denied cough fever or chest pain he is vaccinated for COVID,no smoking history. The patient worked at a chlorine gas factory in the Dominican Republic for 15 years. Exam: Vitals: BP 124/72 mmHg. HR 100 BPM. RR 21 BPM. SpO2 84%. General: acute distress. Heart: normal S1, S2. RRR. Lung: wheeze bilaterally. Abdomen: Soft. Musculoskeletal: no pitting edema. he was placed on 6 LPM NC saturation improved to 90%. CBC and Chemistry were unremarkable, he was started on steroid, breathing treatment with antibiotics. ABG showed hypoxemia. he was placed on Venturi mask and his saturation improved to 95%.CTA was negative for PE. EKG, troponin were unremarkable. A proBNP normal. The antibiotics were discontinued because of a negative workup. A TTE study was normal. HRCT scan of the chest, showed atelectasis and infiltrates of lower lobes. No interstitial fibrosis.A PFT showed obstructive airway disease. He was discharged on oral and inhaled steroids.Hi new onset obstructive airway could be due to chlorine gas exposure. DISCUSSION: Chlorine gas causes cellular injury through oxidative damage but further damage results from activation and recruitment of inflammatory cells with subsequent release of oxidants and proteolytic enzymes. Humans can detect chlorine gas odor at a concentration between 0.1-0.3 ppm. At 1-3 ppm,it causes irritation of oral,eye mucosal membranes. At 30-40 ppm causes cough, chest pain, and SOB. At 40-60 ppm, toxic pneumonitis and pulmonary edema and can be fatal at 430 ppm concentration or higher within thirty minutes. Chronic exposure to chlorine gas lead to chest pain, cough, sore throat, hemoptysis, recurrent asthma. Physical exam findings include tachypnea cyanosis, wheezing, intercostal retractions, decreased breath sounds. Pulmonary function tests may reveal obstructive lung function disease. Chronic exposure to a low level was found to be associated with an increased risk of asthma in swimmers. CONCLUSIONS: Chlorine exposure results in direct chemical toxicity to the airways with acute airways obstruction or airways hyperreactivity, presentation varies from acute overwhelming intoxication with acute lung injury and or death, occupational exposure increase the likelihood of chronic bronchitis or isolated wheezing attacks. Treatment for chlorine exposure is largely supportive. Reference #1: 1- Center of disease control and prevention website/emergency preparedness and response/ https://emergency.cdc.gov/agent/chlorine/basics/facts.asp Reference #2: 2- C- Morim A, Guldner GT. Chlorine Gas Toxicity. [Updated 2021 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537213/. Reference #3: A- Gummin DD, Mowry JB, Beuhler MC, et al. 2020 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021;59(12):1282-1501. doi:10.1080/15563650.2021.1989785 DISCLOSURES: No relevant relationships by Abdallah Khashan No relevant relationships by Samer Talib no disclosure on file for Matthew Yotsuya;
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Rumors of a new respiratory disease began to reach northern Haiti through reports from relatives from the diaspora;the subject soon took over radio stations, virtual communication apps, and everyday conversations in rural neighborhoods and popular markets. The need for social distancing, however, was met with skepticism—not out of disbelief in its effectiveness, but out of resignation to a situation that did not seem new. In this article, I look at the history of past epidemics in Haiti and how these experiences shaped the way people reacted to the arrival of COVID-19 in the country. Through ethnographic data and recent conversations with Haitian friends, I argue that the general feeling of immobility caused by the pandemic intensified a political and existential situation defined as lòk. Nevertheless, it was through a popular epidemiology centered around the household (lakou) that people were able to cope with this new virus. While discussing creative forms of dealing with this sense of stagnation, I try to show that mobility is a form of vitality, creating and structuring life even in situations of radical uncertainty.
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This article presents the case of the Dominican Republic in relation to its emergency preparedness, environmental and social vulnerability framework, its response to the COVID-19 pandemic, including the policies implemented to manage it, and its prospects for the future. The Dominican Republic, being highly vulnerable to climate change and environmental risks, needs to be prepared for national emergencies, including the current pandemic. At the time of the pandemic, the country had a weak health system and weak public funding and, in this context, experienced a significant number of confirmed cases. The country’s trajectory in terms of the number of cases, mortality, and availability of beds and intensive care units for the disease is analyzed, and the experience is compared with other countries in the Americas. As of November 2021, the Dominican Republic has been able to respond adequately, maintaining one of the lowest case-fatality rates in the region and substantially controlling its number of cases in the last year, especially after the vaccination process was initiated. The control measures implemented in the country, consisting of restrictive and timely distancing policies, are noteworthy. Likewise, the country’s successful vaccination program is being followed up as part of these measures. Regardless of the good management of the pandemic by the Dominican Republic and the positive outlook for the future in economic and social areas, the need to improve the preparedness of the country’s health system, such as increasing public spending on health and investment in the first level of care, is emphasized. © 2022 Academia Nacional de Medicina. All rights reserved.
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Background and Aims: In Spain, HIV, HBV, and HCV prevalence are lower in females. A 2017–2018 Ministry of Health serosurvey in 7, 675 primary care patients found 0.35% and 0.08% chronic HCV infection in men and women. A previous opportunistic, population-based screening program in 11, 449 primary care patients seen in our health department found 0.18% and 0.06% HIV infection prevalence, 1.11% and 0.56% chronic HBV infection prevalence, and 0.73% and 0.25% chronic HCV infection prevalence in men and women from February to December 2019. We aimed to assess HIV, HBV, and HCV prevalence among women seeking care in our health department’s 5 Sexual and Reproductive Health Units (SRHU), in the Human Reproduction Unit (HRU), and the Obstetrics and Gynecology Service (OGS). Method: We implemented opportunistic HIV, HBV, and HCV screening from March to October 2021, despite challenges related to a fifth wave of the SARS-CoV-2 pandemic. We used existing infrastructure and staff, aided by electronic health record system modifications, to identify screening eligibility and request serologies. Patients were eligible for testing upon verbal consent if they were between 18 and 80, and had no record of testing in the previous year, and required blood tests in their current health care visit. Follow-up or discharge was given, regardless of test results. A case manager contacted positive patients to ensure and monitor linkage to specialist medical care. Herein we analyze data from patients aged 18 to 45 — the maximum age of patients seen in the HRU. Results: We screened 934 women, of whom 48.1% (449) in SRHUs, 26.0% (243) in the HRU, and 25.9% (242) in the OGS (26%). Regarding age and nationality,14.6.% (136)were aged 18 to 25, 45.5% (425)were 26 to 35, 39.9% (373) were 36 to 45, and 20.6% (192) were foreigners. We found 1 (0.1%) HIV antibody positive patient (a 45-year-old from the Dominican Republic), 1 (0.1%) HBV surface antigen positive patient (a 36-year-old from China), 1 (0.1%) HCV antibody positive patient, and no HCV RNA positive patients. Conclusion: HIV prevalence among Valencian women in reproductive and sexual health serviceswas similar to the general population in primary health care in the area. In contrast, chronic HBV infection prevalence was low, and chronic HCV infection was not found. Our data suggest that opportunistic HBV and HCV screening of women aged 18 to 45 out of populations at increased risk is an inefficient public health strategy in our area
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Background: The IDF Diabetes Atlas 2019 points out that SACA is the region with the highest percentage of health expenditures on diabetes, 19.4%. The total number of individuals with diabetes in the region is 31.6 million, which means a prevalence of 9.4%. Countries with the largest percentage of expenditures are Cuba (24.3%), Brazil (24.2%), and Costa Rica (21.3%), while the lowest estimates are for Argentina (5.0%) and Uruguay (6.1%). Aim: Identify if insulin, oral medicines, supplies (syringes, test strips, needles, etc.) and lab exams are fully provided (free of charge) in those countries and if there is an association between percentage of expenditures on diabetes and care provision. Method: A digital online survey with 12 multiple choice questions was shared by e-mail and WhatsApp with all IDF members organizations in the SACA region. It was open for answers between April 4th and May 5th, during the COVID-19 pandemic. The question of interest for this was specifically about access to medicines and lab exams. Mean diabetes-related expenditure (USD) per person with diabetes (20–79 years) was based on IDF Diabetes Atlas 2019 data. Wilcoxon signed-rank test was used to compare expenditures of countries providing free supplies with those without free medical supplies. Results: The questionnaire was answered by 16 of the 18 IDF SACA region countries. Colombia and El Salvador were the only countries with no response. Most of the countries reported free access to oral medicines (69%), insulins (63%), supplies (syringes, needles, test strips, etc. - 56%) and lab exams (63%). Honduras was the only country where free access started because of the COVID-19 pandemic. Associations between expenditures and provision of free oral medicines, insulins, medical supplies or exams were not statistically significant, i.e. free provision of any of the four items was not associated with higher expenditures. Discussion: Our study revealed that expenditure does not determine whether medicines, supplies and exams are provided for free or not. We hypothesize that countries spending less in providing these essential items for free are still spending similar amounts due to the high costs of treating diabetes chronic complications caused by lack of access to insulin, oral medicines, supplies and lab exams. At the same time that most of the SACA countries already count on full coverage of essential diabetes medicines and supplies, such as insulin, metformin, test strips, and exams, there are still 6 countries (Bolivia, Cuba, Dominican Republic, Ecuador, Peru and Puerto Rico) lacking coverage of 3 out of four or of all essential items. It is especially worrisome that 100 years after the discovery of insulin more than a third of the countries in SACA regions still do not count on full provision of this essential life-saving medicine.
ABSTRACT
In smaller nations, where evolving sociopolitical factors, cultural attitudes, and governmental responses may influence the biology of disease, epidemics have been largely understudied. The Dominican Republic possesses several factors relevant to the current COVID-19 pandemic: a warm climate, proximity to densely populated islands, a valuable tourist industry, remittances, a younger population, and strong social networks driven by physical affection. The country's suboptimal health-care system and strained finances will also be key determinants of the effects of the pandemic locally. Early in 2020, officials adopted a casual approach to COVID-19, which quickly turned into a structured effort of closing borders and implementing social distancing. Initial infections were attributed to affluent Dominicans returning from Europe;transmission quickly spread to low-income segments of the population, particularly towns with a high frequency of travel to the United States. Popular and religious beliefs have surfaced: a “pilgrim” carrying a wooden cross traversed the island, reaching the coast to deposit it so the island would be free of COVID-19;deaths due to clerén intoxication, a drink similar to moonshine believed to possess curative powers;and the Catholic Church's “aerial blessing” delivered via helicopter. Other metaphors emerged in common survival strategies: homemade masks and gloves sold in neighborhood colmados;cartoons and videos ridiculing commentators and scientists, notably divorced from reality;a town's curfew violator rushing home on a horse while being chased by cops on motorcycles, etcetera. The fate of the epidemic remains uncertain: limited testing, lack of compliance with isolation by the self-employed, suspected government corruption, and newly elected authorities create a complex scenario where Dominicans remain torn between reality and hope. Poetry and politics, and symbolism and representation, are counterparts on an island nation that has not looked inward during crises for some time. © 2021 Inderscience Enterprises Ltd.. All rights reserved.