Sars-CoV-2 in the second half of pregnancy: Maternal and perinatal outcomes / Sars-CoV-2 in the second half of pregnancy: Maternal and perinatal outcomes / SARS-CoV-2 en la segunda mitad del embarazo: resultados materno - perinatales

RESUMEN Introducción . La pandemia por COVID-19 es una emergencia sanitaria y social mundial. El conocimiento sobre su efecto en las gestantes es todavía limitado. Objetivo . Describir los resultados materno-perinatales de COVID-19 según clasificación de severidad en mujeres hospitalizadas en la segunda mitad del embarazo. Métodos . Estudio observacional, descriptivo, retrospectivo, desde marzo hasta julio del 2020, en el Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú. Se incluyeron a todas las gestantes hospitalizadas con RT-PCR y/o prueba rápida positiva para SARS-CoV-2. Se excluyeron los embarazos menores a 20 semanas y las altas epidemiológicas. Las características maternas al ingreso y los resultados materno-perinatales fueron agrupados según la clasificación clínica de la enfermedad. Las variables cualitativas son presentadas en recuentos y porcentajes; y las cuantitativas, en medianas y rangos. Resultados . Se estudiaron 247 gestantes. La mayoría correspondía al tercer trimestre (76%). La presentación más frecuente de la virosis fue asintomática (83%) y los casos de neumonía severa fueron pocos (3,2%). La tasa de cesárea fue alta (60%), aunque los partos vaginales se duplicaron en el tiempo (0-24% a 44%). Los casos severos tuvieron mayor tasa de cesárea (100%) y parto prematuro iatrogénico (100%). No se reportaron muertes maternas. Se registraron 9 óbitos fetales y 5 neonatos positivos para SARS-CoV-2, ambos entre las asintomáticas y leves. Conclusiones . En nuestra institución, la posibilidad de cesárea y de parto prematuro iatrogénico fue mayor en los casos severos. La tasa de parto vaginal aumentó en los últimos meses. No se identificaron complicaciones perinatales relacionadas al COVID-19.

ABSTRACT Introduction: The COVID-19 pandemic is a global health and social emergency. Knowledge is still limited about its effect on pregnant women. Objective: To describe maternal-perinatal outcomes of COVID-19 according to severity classification in women hospitalized in the second half of pregnancy. Methods: Retrospective, descriptive, observational study from March to July 2020 at Edgardo Rebagliati Martins National Hospital. All hospitalized pregnant women with RT-PCR and/ or rapid positive test for SARS-CoV-2 were included. Pregnancies less than 20 weeks and epidemiological discharges were excluded. Maternal characteristics at admission and maternal-perinatal outcomes were grouped according to the clinical classification of the disease. The qualitative variables are presented in counts and percentages; and quantitative ones, in medians and ranges. Results: 247 pregnant women were studied. Most of them were in the third trimester (76%). The most frequent presentation of the disease was asymptomatic (83%), and cases of severe pneumonia were few (3.2%). The cesarean section rate was high (60%), although vaginal deliveries doubled over time (0-24 a 44%). Severe cases had a higher rate of cesarean section (100%) and iatrogenic preterm delivery (75%). No maternal deaths were reported. There were 9 stillbirths and 5 positive neonates for SARS-CoV-2, both among asymptomatic and mild patients. 9 stillbirths and 5 positive neonates for SARS-CoV-2, both among asymptomatic and mild cases. Conclusions: The possibility of cesarean section and iatrogenic preterm delivery is greater in severe cases. The vaginal delivery rate increased in recent months. No perinatal complications related to COVID-19 were identified.

The coronavirus conundrum, the pregnant woman, her child. Part 2 / La incógnita del coronavirus, la gestante, su niño - Continuación

Resumen Cuando apareció la enfermedad por el coronavirus SARS-CoV-2, no esperábamos su rápida expansión en el mundo y las graves consecuencias que traería. Se ha ido conociendo al virus morfológicamente y su accionar en el ambiente y en el organismo del ser humano, su mayor predisposición de enfermar a poblaciones vulnerables, como el adulto mayor, poblaciones con comorbilidad como obesidad, diabetes, hipertensión e inmunodepresión, predilección por el sexo masculino, mayor prevalencia en países con mayor pobreza, promiscuidad, zonas deprimidas económicamente, entre otros. Se ha tenido que improvisar y descartar diversos tratamientos en aquellos pacientes con enfermedad COVID-19 moderada y severa. Eventualmente se está disminuyendo la frecuencia de muertes con medidas de protección personal, distanciamiento social, cuarentena de emergencia, y combinación de medicamentos y administración de oxígeno. Pero aún no hay cura, y se está a la expectativa en la aparición de la vacuna. Con relación a la mujer, ella es comprometida en menor proporción y severidad por la enfermedad COVID-19, pero debe cumplir las medidas de prevención, especialmente si es frágil y tiene comorbilidades. Se ha postergado temporalmente su evaluación preventiva y las intervenciones quirúrgicas si no son de emergencia. En la gestante se está encontrando aumento de prematuridad, gestaciones frustras, lesiones placentarias y presencia del virus en anexos placentarios, con casos de morbilidad severa y muerte maternas. En este artículo se hace una puesta al día resumida sobre la situación de la enfermedad COVID-19 en el mundo y el Perú, enfatizando el cuidado de la mujer y de la gestante.

Abstract When COVID-19 appeared, we did not expect its rapid expansion throughout the world nor the serious consequences it would bring. We currently understand more about the virus' morphology and its activity in the environment and within the human body, as well as its greater predisposition to affect vulnerable populations, such as the elderly and persons with comorbidities like obesity, diabetes, hypertension and immunosuppression. This virus shows a predilection for men, and a higher prevalence in countries with greater poverty, promiscuity and economically depressed areas, among others. Various treatments have been tested and discarded in patients with moderate and severe disease. The frequency of deaths is decreasing due to personal protection measures, social distancing, emergency quarantine, and combination of medications and supplemental oxygen. However, there is still no cure, and we are waiting for the appearance of the vaccine. Women are less frequently and less severely affected; however, they should follow preventive measures, especially if frail with comorbidities. Preventive medical consultations and non-emergency surgical procedures have been temporarily postponed. Pregnant women are experiencing an increase in prematurity, fetal deaths, placental lesions and presence of the virus in placental adnexa, with cases of severe morbidity and maternal death. This article is an update on the situation of COVID-19 in the world and in Peru, emphasizing the care of women and pregnant women.

Structure of nursing social representations on death due to COVID-19 / Estrutura das representações sociais da enfermagem sobre a morte decorrente da COVID-19 / Estructura de las representaciones sociales de enfermería sobre la muerte por COVID-19

Introdução: Ainda que se saiba que a morte faz parte do ciclo da vida, diante de uma doença com muitos aspectos ainda desconhecidos como a COVID-19, torna-se importante compreender como os trabalhadores de enfermagem representam esse fenômeno, uma vez que são os únicos profissionais de saúde que continuam o cuidado ao indivíduo mesmo após a finitude da vida. Objetivo: analisar a estrutura das representações sociais sobre morte e morrer decorrentes de COVID-19 elaboradas por profissionais de enfermagem. Materiais e métodos: estudo qualitativo ancorado na vertente estrutural da Teoria das Representações Sociais com ênfase na Teoria do Núcleo Central, desenvolvido junto a 32 profissionais de enfermagem da cidade de Natal, estado do Rio Grande do Norte, Brasil. A coleta de dados foi realizada online mediante utilização da técnica de associação livre de palavras. Para a análise dos dados recorreu-se às análises prototípica e de similitude. Resultados: o provável núcleo central das representações foi constituído pelos termos tristeza e medo, e a composição do sistema periférico e da zona de contraste reforçam esse núcleo. Discussão: o núcleo central das representações dos profissionais de enfermagem sobre morte e morrer decorrentes de COVID-19 se constitui em um Themata polêmico de representação, e destaca os prejuízos à saúde psicossocial dos trabalhadores de enfermagem da linha de frente. Conclusões: perante às representações elaboradas sobre a morte e morrer decorrentes de COVID-19, é necessário o desenvolvimento de estratégias de enfrentamento que colaborem para a saúde psicossocial dos trabalhadores de enfermagem.

Introduction: Although it is known that death is part of the life cycle, in the face of a disease with many aspects still unknown, such as COVID-19, it is important to understand how nursing workers represent this phenomenon, since they are the only professionals that continue to care for the individual even after the end of life. Objective: to analyze the structure of social representations about death and dying due to COVID-19 elaborated by nursing professionals. Materials and methods: qualitative study anchored in the structural aspect of the Theory of Social Representations with emphasis on the Theory of the Central Nucleus, developed with 32 nursing professionals from the city of Natal, state of Rio Grande do Norte, Brazil. Data collection was performed online using the free word association technique. For data analysis, prototypical and similarity analyzes were used. Results: the probable central nucleus of the representations was constituted by the terms sadness and fear, and the composition of the peripheral system and the contrast zone reinforce this nucleus. Discussion: the core of nursing professionals' representations about death and dying from COVID-19 constitutes a controversial issueof representation and highlights the damage to the psychosocial health of frontline nursing workers. Conclusions: in view of the elaborated representations about death and dying resulting from COVID-19, it is necessary to develop coping strategies that contribute to the psychosocial health of nursing workers.

Introducción: Si bien se sabe que la muerte es parte del ciclo de vida, ante una enfermedad con muchos aspectos aún desconocidos, como lo es el COVID-19, es importante comprender cómo los trabajadores de enfermería representan este fenómeno, ya que son los únicos profesionales que continuan cuidando al individuo incluso después del final de la vida. Objetivo: analizar la estructura de las representaciones sociales sobre la muerte y el morir por COVID-19 elaboradas por profesionales de enfermería. Materiales y métodos: estudio cualitativo anclado en el aspecto estructural de la Teoría de las Representaciones Sociales con énfasis en la Teoría del Núcleo Central, desarrollado con 32 profesionales de enfermería de la ciudad de Natal, estado de Rio Grande do Norte, Brasil. La recolección de datos se realizó en línea utilizando la técnica de asociación libre de palabras. Para el análisis de los datos se utilizaron análisis prototípicos y de similitud. Resultados: el probable núcleo central de las representaciones estuvo constituido por los términos tristeza y miedo, y la composición del sistema periférico y la zona de contraste refuerzan este núcleo. Discusión: el núcleo de las representaciones de los profesionales de enfermería sobre la muerte y el morir por COVID-19 constituye un temade representación controvertido, y destaca el daño a la salud psicosocial de los trabajadores de enfermería de primera línea. Conclusiones: frente a las representaciones elaboradas sobre la muerte y el morir como consecuencia de la COVID-19, es necesario desarrollar estrategias de enfrentamiento que contribuyan a la salud psicosocial de los trabajadores de enfermería.

Increased risk of hospitalization and death in Mexican children and adolescents with COVID-19 and comorbidities.

BACKGROUND: Although COVID-19 (coronavirus disease 2019) in children is usually mild, they need hospitalization and intensive care in exceptional cases. Adverse outcomes have been observed mainly among children with comorbidities, justifying their vaccination. This study aimed to assess the risk of hospitalization and death in Mexican children and adolescents with COVID-19 and comorbidities. METHODS: A cross-sectional study was performed on 366,542 confirmed COVID-19 cases under 18 years, reported by the Mexican Ministry of Health up to July 9, 2022. Logistic regression models were performed. RESULTS: The mean age was 10.98 years, 50.6% were male, and 7.3% reported at least one comorbidity. The percentage of hospitalization and death in COVID-19 patients with and without comorbidities was 3.52%, and 0.20%, respectively; children with comorbidities presented a higher percentage of hospitalization (14.0%) and death (1.9%). The probability of hospitalization was 5.6 times greater in pediatric patients with COVID-19 and comorbidities, and the comorbidities that showed the greatest risk were immunosuppression (odds ratio (OR) 22.06), chronic kidney disease (CKD) (11.36), and cardiovascular diseases (5.66). The probability of death in patients with comorbidities was 11.01 times higher than in those without diseases, and the highest risk was observed in those with CKD (OR 12.57), cardiovascular diseases (6.87), and diabetes (5.83). CONCLUSIONS: Pediatric patients with comorbidities presented a higher risk of severe COVID-19. It is suggested that vaccination should be promoted with greater emphasis on pediatric patients with comorbidities.

INTRODUCCIÓN: Aunque COVID-19 (enfermedad por coronavirus 2019) en niños es usualmente leve, en casos excepcionales requieren hospitalización y cuidados intensivos. Los resultados adversos han sido observados principalmente en los niños con comorbilidades, justificando su vacunación. El objetivo de este estudio fue evaluar el riesgo de hospitalización y muerte en niños y adolescentes mexicanos con COVID-19 y comorbilidades. MÉTODOS: Estudio transversal en 366,542 casos de COVID-19 confirmados, menores de 18 años y reportados por la Secretaría de Salud de México, hasta el 9 de julio del 2022. Se ejecutaron modelos multivariados de regresión logística. RESULTADOS: El promedio de edad fue de 10.98 años, 50.6% de sexo masculino, y 7.3% reportaron al menos una comorbilidad. El porcentaje de hospitalización y muerte en pacientes con COVID-19 sin comorbilidades fue 3.52% y 0.20%, respectivamente; mientras que los pacientes con comorbilidades presentaron más elevados porcentajes de hospitalización (14.0%) y muerte (1.9%). La probabilidad de hospitalización fue 5.6 veces más en los pacientes con COVID-19 y comorbilidades, comparando con aquellos sin comorbilidades. Las comorbilidades que mostraron más riesgo fueron inmunosupresión (razón de momios (RM) 22.06), enfermedad renal crónica (ERC) (RM 11.36) y enfermedades cardiovasculares (RM 5.66). La probabilidad de muerte en los pacientes con comorbilidades fue 11.01 veces más que en aquellos sin enfermedades, y fue más elevado en aquellos con ERC (RM 12.57), enfermedades cardiovasculares (RM 6.87) y diabetes (RM 5.83). CONCLUSIONES: Los pacientes pediátricos con comorbilidades presentaron mayor riesgo de COVID-19 severo, por lo que se sugiere promover con mayor énfasis la vacunación en ellos.

Meanings of mourning for people who faced the death of a family member due to covid-19 / Significados do luto para pessoas que enfrentaram a morte de um familiar por covid-19 / Significados del luto para personas que enfrentaron la muerte de un familiar por covid-19

Objetivo: compreender os significados do luto para as pessoas que enfrentaram a morte de um familiar devido a COVID-19. Método: estudo qualitativo, do tipo ação-participante, fundamentado nos pressupostos de Paulo Freire. Participaram 16 familiares, residentes no litoral de Santa Catarina, Brasil. Realizou-se um Círculo de Cultura de modo virtual, seguindo as etapas do Itinerário Freireano. Resultados: os participantes significaram que a vivência do luto do familiar, devido a COVID-19, tirou-lhes a oportunidade de se despedir do ente querido. A pandemia também lhes tirou o emprego, as aulas presenciais dos filhos, encontros, casamentos, abraços e sorrisos. Mas também significaram que trouxe aprendizado, com fortalecimento da espiritualidade e família. Conclusão: o significado do luto permeou inúmeras perdas, restringindo a vivência das etapas do luto. Contudo, houve maior busca pela espiritualidade e religião, com valorização da família e da vida.

Objetivo: comprender los significados del luto para las personas que enfrentaron la muerte de un familiar debido a COVID-19. Método: estudio cualitativo, del tipo acción-participante, fundamentado en los presupuestos de Paulo Freire. Participaron 16 familiares, residentes en el litoral de Santa Catarina, Brasil. Se realizó un Círculo de Cultura de modo virtual, siguiendo las etapas del Itinerario Freireano. Resultados: los participantes significaron que la vivencia del luto del familiar, debido a COVID-19, les quitó la oportunidad de despedirse del ser querido. La pandemia también les quitó el empleo, las clases presenciales de los hijos, encuentros, matrimonios, abrazos y sonrisas. Pero también significaron que trajo aprendizaje, con fortalecimiento de la espiritualidad y familia. Conclusión: el significado del luto ha permeado numerosas pérdidas, restringiendo la vivencia de las etapas del luto. Sin embargo, hubo mayor búsqueda por la espiritualidad y religión, con valoración de la familia y de la vida.

Objective: to understand the meanings of mourning for people who faced the death of a family member due to COVID-19. Method: qualitative study, action-participant type, based on the assumptions of Paulo Freire. Participants were 16 family members living on the coast of Santa Catarina, Brazil. A Culture Circle was held in a virtual way, following the stages of the Freire's Itinerary. Results: the participants meant that the experience of mourning the family, due to COVID-19, took them the opportunity to say goodbye to their loved one. The pandemic also took away their jobs, their children's face-to-face classes, meetings, weddings, hugs and smiles. But it also meant that it brought learning, with strengthening of spirituality and family. Conclusion: the meaning of mourning permeated countless losses, restricting the experience of the stages of mourning. However, there was a greater search for spirituality and religion, with appreciation of family and life.

Obesity and the obesity paradox in patients with severe COVID-19.

OBJECTIVE: To test the presence of the obesity paradox in two cohorts of patients hospitalized for COVID-19. DESIGN: Two multicenter prospective cohorts. SETTING: Three fourth level institutions. PATIENTS: Adults hospitalized in the general ward for confirmed COVID-19 in the three institutions and those admitted to one of the 9 critical care units of one of the institutions. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Categorized weight and its relationship with admission to the ICU in hospitalized patients and death in the ICU. RESULT: Of 402 hospitalized patients, 30.1% were obese. Of these, 36.1% were admitted to the ICU vs. 27.1% of non-obese patients. Of the 302 ICU patients, 46.4% were obese. Of these, mortality was 45.0% vs. 52.5% for non-obese. The requirement to transfer hospitalized patients to the ICU admission get a HR of 1.47 (95%CI 0.87-2.51, p = 0.154) in the multivariate analysis. In intensive care patients, an HR of 0.99 (95%CI: 0.92-1.07, p = 0.806) was obtained to the association of obesity with mortality. CONCLUSIONS: The present study does not demonstrate an association between obesity and risk of inpatient transfer to intensive care or death of intensive care patients due to COVID-19 therefore, the presence of an obesity paradox is not confirmed.

Covid-19 Shock: Will We Have a Disorder of the Decade?

A new coronavirus spread rapidly around the world characterizing a pandemic. In times of coronavirus disease 2019 (Covid-19), associated with physical health problems, economic and social problems, there are psychological suffering and psychological disorders. In this context, this theoretical essay aims to present reflections on social isolation, fear of imminent death, and the possible increase in the incidence of anxiety disorders, such as post-traumatic stress disorder (PTSD) and other mental health sequelae resulting from Covid-19. We observed that the pandemic is an important predictor of symptoms of anxiety disorders, as well as initial empirical studies indicated a considerable increase in the number of people with mental disorders resulting from Covid-19. There is a demand for research that explores and presents empirical data regarding the effects of Covid-19 on the mental health of the population, as well as proposing promotion and prevention strategies.Alternate : Un nuevo coronavirus se extendió rápidamente por todo el mundo y caracterizó una epidemia de grandes proporciones. En tiempos de Covid-19, asociado a problemas de salud física, económicos y sociales, hay sufrimiento psicológico y trastornos psicológicos. En este contexto, este ensayo teórico tuvo como objetivo presentar reflexiones sobre el aislamiento social, el miedo a la muerte inminente y el posible aumento en la incidencia de trastornos de ansiedad, como el trastorno de estrés postraumático (Tept), y otras secuelas mentales derivadas del Covid-19. Se observó que el contexto pandémico tiene importantes predictores de síntomas de trastornos de ansiedad, así como estudios empíricos iniciales indicaron un aumento considerable en el número de personas con trastornos mentales asociados al Covid-19 y resultantes del mismo. Existe una demanda de investigación que explore y presente datos empíricos sobre los efectos del Covid-19 en la salud mental de la población, además de proponer estrategias de promoción y prevención.Alternate : Um novo coronavírus se propagou rapidamente por todo o mundo e caracterizou uma epidemia de grandes proporções. Em tempos de Covid-19, associados aos problemas de saúde física, de natureza econômica e social, encontram-se o sofrimento psíquico e os transtornos psicológicos. Nesse contexto, o presente ensaio teórico objetivou apresentar reflexões sobre o isolamento social, o medo da morte iminente e o possível aumento na incidência de transtornos de ansiedade, como o transtorno do estresse pós-traumático (Tept), e de outras sequelas mentais decorrentes da Covid-19. Observou-se que o contexto pandêmico apresenta importantes aspectos preditores de sintomas de transtornos ansiosos, assim como estudos empíricos iniciais indicaram um considerável aumento no número de pessoas com transtornos mentais associados à Covid-19 e decorrentes dela. Há uma demanda por pesquisas que explorem e apresentem dados empíricos a respeito dos efeitos da Covid-19 sobre a saúde mental da população, bem como que proponham estratégias de promoção e prevenção.

Maternal death due to COVID-19: a scoping review / Morte materna em decorrência da COVID-19: revisão de escopo / Muerte materna por COVID-19: revisión de alcance

OBJETIVO: mapear o cenário da morte materna em decorrência da infecção pelo vírus SARS-CoV-2 em gestantes e puérperas. MÉTODO: revisão de escopo conforme o Instituto Joanna Briggs realizada por meio de uma estratégia de pesquisa na literatura disponível nos bancos de dados SciELO, LILACS, PubMed, CINAHL, Web of Science e PUBCOVID19. A análise do material identificado deu-se por dois revisores independentes. Os dados foram extraídos por meio de um instrumento construído pelos autores, analisados, sumarizados e classificados como categorias conceituais. RESULTADOS: dos 231 estudos encontrados, 66 foram elegíveis e tiveram os resultados sumarizados em quatro categorias conceituais: Desfecho morte materna em decorrência da COVID-19; Desfecho morte materna nas pandemias por Coronavírus; Morte materna por grupo obstétrico; Infecção por SARS-CoV-2, morte materna, recursos de saúde e determinantes sociais. CONCLUSÃO: a atenção vigilante, o diagnóstico precoce e o acesso em tempo oportuno foram eventos necessários para evitar a morte materna em 2020.

OBJECTIVE: to map the scenario of maternal death due to infection by the SARS-CoV-2 virus in pregnant and puerperal women. METHOD: A scoping review according to the Joanna Briggs Institute and conducted by means of a research strategy in the literature available in the SciELO, LILACS, PubMed, CINAHL, Web of Science and PUBCOVID19 databases. The analysis of the material identified was carried out by two independent reviewers. The data were extracted using an instrument prepared by the authors, analyzed, summarized and classified as conceptual categories. RESULTS: of the 231 studies found, 66 were eligible and had their results summarized in four conceptual categories: Outcome of maternal death due to COVID-19; Outcome of maternal death in the coronavirus pandemics; Maternal death by obstetric group; SARS-CoV-2 infection, maternal death, health resources and social determinants. CONCLUSION: vigilant care, early diagnosis and timely access were necessary events to prevent maternal death in 2020.

OBJETIVO: mapear las muertes maternas por infección por el virus SARS-CoV-2 en gestantes y puérperas. MÉTODO: revisión de alcance según el Instituto Joanna Briggs realizada mediante una búsqueda en la literatura disponible en las bases de datos SciELO, LILACS, PubMed, CINAHL, Web of Science y PUBCOVID19. El análisis del material identificado fue realizado por dos revisores independientes. Los datos fueron extraídos utilizando un instrumento elaborado por los autores, analizados, resumidos y clasificados en categorías conceptuales. RESULTADOS: de los 231 estudios encontrados, 66 fueron elegibles y los resultados se resumieron en cuatro categorías conceptuales: Desenlace muerte materna por COVID-19; Desenlace muerte materna en pandemias de coronavirus; Muerte materna por grupo obstétrico; Infección por SARS-CoV-2, muerte materna, recursos sanitarios y determinantes sociales. CONCLUSIÓN: la atención de calidad, el diagnóstico precoz y el acceso oportuno fueron eventos necesarios para prevenir la muerte materna en 2020.

Network analysis of the Posttraumatic Growth Inventory (PTGI-X) in Peruvian adults with family members killed by COVID-19 as a function of sex

Posttraumatic growth network structures were evaluated in males and females who lost a family member to COVID-19 to determine network variations according to sex. Six hundred sixty-nine Peruvian adults (M = 25.41, SD = 1.82) were included using the Posttraumatic Growth Inventory-X (PTGI-X) self-report measure. Two Gaussian plot models of partial correlations were estimated through the qgraph statistical package. The most central network domain items were emotional expression, closeness to others, and greater understanding of life-death issues. The highest connections were reported for items on the measures of personal relationships, appreciation for life, and spiritual-existential change. Both network models were found to be invariant and showed no significant differences at the level of structure and connections, and a difference was reported at the score level on the existential-spiritual change subscale in women. (English) [ FROM AUTHOR]

Pandemic-induced deathscapes: end-of-life, funerary and bereavement challenges for British-Bangladeshi Muslims

Following the onset of the Covid-19 pandemic in the UK, end-of-life rituals and funerals across groups of all faiths and none took on a new character due to government-imposed measures to control disease transmission. This article aims to explore the challenges faced by British-Bangladeshi Muslims in relation to performing end-of-life, funeral, and mourning rituals during the first pandemic wave, underpinned by the perception of a ‘good death’. This group was among those disproportionately affected by Covid-19-related mortality and morbidity. Contextualising the study within a review of the literature on deathscapes and shifting policy responses to multicultural populations in the UK, and using an in-depth qualitative research approach, the article highlights the ways in which pre-existing challenges facing individuals seeking Islamic end-of-life, funeral and bereavement rituals have been exacerbated by Covid-19. The article offers new empirical and conceptual insights into the spatio-temporal dimension of end-of-life and funerary practices performed by British-Bangladeshi Muslims to achieve a good death and the changing nature of embodied and virtual deathscapes triggered by the pandemic. (English) [ FROM AUTHOR] Résumé À la suite de l’apparition de la pandémie de Covid-19 au Royaume-Uni, les rituels de fin de vie et de funérailles, pour quiconque appartenant ou non à une religion, ont pris un nouvel aspect à cause des mesures imposées par le gouvernement pour contrôler la transmission du virus. Cet article vise à étudier les problèmes que les musulmans bangladais britanniques ont rencontrés face à l’accomplissement de rituels de fin de vie, de funérailles et de deuil, tous reposant sur la perception d’une « bonne mort », pendant la première vague de pandémie. Leur groupe était parmi ceux les plus excessivement touchés par la mortalité et la morbidité liées à la pandémie de Covid-19. En conceptualisant cette étude dans une analyse des études sur les espaces de mort et l’évolution des réponses politiques face aux populations multiculturelles du Royaume-Uni, et en utilisant une approche de recherche qualitative approfondie, l’article souligne les différentes façons par lesquelles les obstacles habituels auxquels les personnes recherchant des rites musulmans de fin de vie, de funérailles et de deuil devaient déjà faire face ont été exacerbés par la pandémie. Il offre de nouvelles perspectives empiriques et conceptuelles sur la dimension spatio-temporelle des pratiques de fin de vie et de funérailles que perpétuent les musulmans bangladais britanniques pour réaliser une bonne fin et la nature changeante des espaces de mort concrets et virtuels déclenchés par la pandémie. (Spanish) [ FROM AUTHOR] Resumen Tras el inicio de la pandemia del Covid-19 en el Reino Unido, los rituales del fin de la vida y funerales en grupos de todas las religiones y ninguna adquirieron un nuevo carácter debido a las medidas impuestas por el gobierno para controlar la transmisión de enfermedades. Este artículo tiene como objetivo explorar los desafíos que enfrentan los musulmanes británico-bangladesíes en relación con la realización de rituales del fin de vida, funerales y duelo durante la primera ola pandémica, fundamentados por la percepción de una ‘buena muerte’. Este grupo ese encontró entre aquellos que fueron desproporcionadamente afectados por la mortalidad y la morbilidad relacionadas con el COVID-19. Contextualizando el estudio dentro de una revisión de la literatura sobre paisajes de muerte y cambiando las respuestas de política pública a las poblaciones multiculturales en el Reino Unido, y utilizando un enfoque de investigación cualitativa a profundidad, el artículo destaca las formas en que los desafíos preexistentes que enfrentan las personas que buscan rituales islámicos para el fin de la vida, funerales y el duelo se han visto exacerbados por el Covid-19. El artículo ofrece nuevos conocimientos empíricos y conceptuales sobre la dimensión espaciotemporal de las prácticas funerarias y del final de la vida realizadas por musulmanes británicos-bangladesíes para lograr una buena muerte y la naturaleza cambiante de los paisajes de muerte encarnados y virtuales desencadenados por la pandemia. (French) [ FROM AUTHOR] Copyright of Social & Cultural Geography is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Brain death due to neuroaspergillosis in a patient with COVID-19.

Co-infections between SARS-CoV-2 and other pathogens is an important consideration for the treatment of patients with COVID-19. Aspergillus infections are part of this consideration since they present high morbidity and mortality. We present the case of a patient with COVID-19 and Aspergillus Fumigatus coinfection that evolves with brain death due to multiple heterogeneous lesions in the brain, which after a post-mortem biopsy found pathological lesions compatible with Aspergillus.

Spanish implantable cardioverter-defibrillator registry. 18th official report of the Heart Rhythm Association of the Spanish Society of Cardiology (2021).

INTRODUCTION AND OBJECTIVES: This article presents the data corresponding to implantable cardioverter-defibrillator (ICD) implantations in Spain in 2021. METHODS: The data were drawn from implanting centers, which voluntarily completed a data collection sheet during the procedure. RESULTS: In 2021, 7496 implant data sheets were received, compared with 7743 reported by Eucomed (European Confederation of Medical Suppliers Associations), indicating that data were collected from 96.8% of the devices implanted in Spain. Data completion ranged from 99.9% for "name of implanting hospital" to 8.9% for "implanting hospital". In 2021, 199 hospitals participated in the registry, exceeding the figures of previous years, with around 170 participating hospitals. The total rate of registered implants was 158/million inhabitants (163 according to Eucomed), making 2021 the year with the highest activity. However, the registry continues to show significant differences among the various autonomous communities and the lowest implantation rate of all the European countries participating in Eucomed. CONCLUSIONS: The Spanish implantable cardioverter-defibrillator registry for 2021 recorded an increase in the number of ICD implantations, reflecting the recovery of hospital activity after the initial impact of the COVID-19 pandemic in 2020. Although the total number of implants has increased in Spain, figures are still much lower than the European Union average, with differences persisting among Spanish autonomous communities.

Registro español de desfibrilador automático implantable. XVIII informe oficial de la Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología (2021)

Resumen Introducción y objetivos Se presentan los datos correspondientes a los implantes de desfibrilador automático implantable (DAI) en España en el año 2021. Métodos Los datos provienen de los centros implantadores, que cumplimentaron voluntariamente una hoja de recogida de datos durante el implante. Resultados En 2021 se recibieron 7.496 formularios de implante, frente a los 7.743 comunicadas por Eucomed (European Confederation of Medical Suppliers Associations), lo que implica que se han recogido datos del 96,8% de los dispositivos implantados en España. El cumplimiento osciló entre el 99,9% en el campo «nombre del hospital implantador» y el 8,9% en la variable «hospital de referencia». En 2021, 199 hospitales han participado en el registro, lo cual supera las cifras de los años previos en que el número de participantes osciló alrededor de 170 hospitales. La tasa total de implantes registrados fue 158/millón de habitantes (163 según Eucomed), lo que la sitúa como el año con mayor actividad. Sin embargo, el registro sigue mostrando diferencias importantes entre las comunidades autónomas y la tasa de implante más baja de todos los países europeos participantes en Eucomed. Conclusiones El Registro español de desfibrilador automático implantable del año 2021 recoge un incremento en el número de implantes de DAI y refleja la recuperación de la actividad hospitalaria tras el impacto inicial de la pandemia por COVID-19 durante 2020. A pesar del incremento en el número total de implantes en España, este sigue siendo muy inferior a la media de la Unión Europea y persisten las diferencias entre las comunidades autónomas españolas. Introduction and objectives This article presents the data corresponding to implantable cardioverter-defibrillator (ICD) implantations in Spain in 2021. Methods The data were drawn from implanting centers, which voluntarily completed a data collection sheet during the procedure. Results In 2021, 7496 implant data sheets were received, compared with 7743 reported by Eucomed (European Confederation of Medical Suppliers Associations), indicating that data were collected from 96.8% of the devices implanted in Spain. Data completion ranged from 99.9% for “name of implanting hospital” to 8.9% for “implanting hospital”. In 2021, 199 hospitals participated in the registry, exceeding the figures of previous years, with around 170 participating hospitals. The total rate of registered implants was 158/million inhabitants (163 according to Eucomed), making 2021 the year with the highest activity. However, the registry continues to show significant differences among the various autonomous communities and the lowest implantation rate of all the European countries participating in Eucomed. Conclusions The Spanish implantable cardioverter-defibrillator registry for 2021 recorded an increase in the number of ICD implantations, reflecting the recovery of hospital activity after the initial impact of the COVID-19 pandemic in 2020. Although the total number of implants has increased in Spain, figures are still much lower than the European Union average, with differences persisting among Spanish autonomous communities.

[Factors associated with an unfavorable evolution in patients diagnosed with COVID-19 and followed up in primary care in 2020]. / Factores asociados con una evolución desfavorable en pacientes diagnosticados de COVID-19 y seguidos en atención primaria en 2020.

AIM: To know the factors associated with an unfavorable evolution (UE) of patients diagnosed with COVID-19 with total or partial follow-up in primary care. DESIGN: A case series. SETTING: Urban health center. PARTICIPANTS: By systematic sampling, patients ≥18 years, diagnosed with COVID-19, with analytical confirmation, in 2020 and followed up by their family doctors, were selected. MAIN MEASUREMENTS: Dependent variable: hospital admission or death due to COVID-19. INDEPENDENT VARIABLES: age, sex, medical background, clinical data and treatments related to the disease. Statistical analysis, with SPSS 25.0: descriptive analysis, comparison of proportions (chi square) and medians (Mann-Whitney U). The analysis is completed with logistic regression. RESULTS: 610 patients were included in the study. The median age was 49 years (interquartile range: 35-61); 51.8% were women; 14.9% presented UE (95% CI: 12.0-17.8). The sociodemographic variables or the variables related to medical background that showed an independent association with UE were age (OR: 1.066; 95% CI: 1.038-1.095), sex (OR for men: 3.277; 95% CI: 1.304-8.235) and being a smoker or former smoker (OR: 2.565; 95% CI: 1.135-5.800). Regarding the clinical variables of the disease, an association was found for altered consciousness (OR: 62.829; 95% CI: 9.177-430.149), dyspnea (OR: 14.339; 95% CI: 6.046-34.009), expectoration (OR: 4.764; 95% CI: 1.858-12.213)) and asthenia (OR: 3.993; 95% CI: 1.705-9.351). CONCLUSIONS: 14.9% of the patients diagnosed with COVID-19 presented an UE. Older age, male sex and being a smoker or former smoker increased the probability of it. Altered consciousness, dyspnea, expectoration, and asthenia were the clinical data that best predicted UE.

[Brain death due to neuroaspergillosis in a patient with COVID-19]. / Muerte cerebral debida a aspergilosis cerebral en un paciente de COVID-19.

Co-infections between SARS-CoV-2 and other pathogens is an important consideration for the treatment of patients with COVID-19. Aspergillus infections are part of this consideration since they present high morbidity and mortality. We present the case of a patient with COVID-19 and Aspergillus Fumigatus coinfection that evolves with brain death due to multiple heterogeneous lesions in the brain, which after a post-mortem biopsy found pathological lesions compatible with Aspergillus.

Profiles in COVID-19: peritraumatic stress symptoms and their relation with death anxiety, anxiety sensitivity, and emotion dysregulation.

Background: The COVID-19 pandemic might be experienced as an ongoing traumatic event and could result in peritraumatic stress symptoms. Evidence implies that individuals' levels of death anxiety, anxiety sensitivity, and difficulties in emotion regulation may contribute to their peritraumatic stress symptomatology in the aftermath of trauma exposure. Objective: The current study aimed to explore these hypotheses in the context of the COVID-19 pandemic. Method: An online survey was conducted among a convenience sample of 846 Israeli adults from April 2 to 19 April 2020. COVID-19-related stressors, death anxiety, anxiety sensitivity, difficulties in emotion regulation, and peritraumatic stress symptoms were assessed via self-report questionnaires. Results: Analyses indicated significant relations between death anxiety, anxiety sensitivity, and emotion regulation difficulties, on the one hand, and peritraumatic stress symptoms, on the other. Three distinct profiles were identified. Furthermore, profile type - namely having low, medium, and high levels of death anxiety, anxiety sensitivity, and emotion dysregulation - had a significant effect in explaining peritraumatic stress symptoms. Conclusions: Results suggest that during the pandemic, levels of death anxiety, anxiety sensitivity, and emotion dysregulation may explain heterogeneity in individuals' trauma-related symptomatology.

Antecedentes: La pandemia del COVID-19 podría ser experimentada como un evento traumático en curso y podría resultar en síntomas de estrés peritraumático. La evidencia implica que los niveles individuales de la ansiedad por la muerte, la sensibilidad de la ansiedad, y las dificultades en la regulación emocional podrían contribuir a su sintomatología del estrés peritraumático en las secuelas de la exposición al trauma.Objetivo: El presente estudio buscó explorar estas hipótesis en el contexto de la pandemia del COVID-19.Método: Se realizó una encuesta en línea en una muestra por conveniencia de 846 adultos israelíes desde el 2 al 19 de abril de 2020. Los estresores relacionados al COVID-19, la ansiedad por la muerte, la sensibilidad de ansiedad, las dificultades en la regulación emocional, y los síntomas de estrés peritraumático fueron evaluados por medio de cuestionarios de auto-reporte.Resultados: Los análisis indicaron relaciones significativas entre la ansiedad por la muerte, la sensibilidad de la ansiedad, y las dificultades de regulación emocional, por un lado, y los síntomas de estrés peritraumático, por el otro lado. Tres perfiles distintivos fueron identificados. Además, el tipo de perfil ­ específicamente tener niveles bajos, medios, y altos de ansiedad por la muerte, sensibilidad de la ansiedad, y desregulación emocional ­ tuvieron un efecto significativo en explicar los síntomas de estrés peritraumático.Conclusión: Los resultados sugieren que, durante la pandemia, los niveles de ansiedad por la muerte, sensibilidad de la ansiedad, y desregulación emocional podrían explicar la heterogeneidad en la sintomatología relacionada al trauma de los individuos.

Spanish Implantable Cardioverter-defibrillator Registry. 17th Official Report of the Heart Rhythm Association of the Spanish Society of Cardiology (2020).

INTRODUCTION AND OBJECTIVES: We present the data corresponding to implantable cardioverter-defibrillator (ICD) implants in Spain in 2020. METHODS: The data in this registry were drawn from implantation centers, which voluntarily completed a data collection sheet. RESULTS: In 2020, 7056 implant sheets were received compared with 7106 reported by Eucomed (European Confederation of Medical Suppliers Associations), indicating that data were collected from 99% of the devices implanted in Spain. Completion of the implant sheet ranged from 99.8% for the field "name of the implanting hospital" to 2.6% for the variable "referral hospital". A total of 173 hospitals performed ICD implants and participated in the registry, which is a similar figure to that in 2019 (n=172). The total rate of registered implants was 149/million inhabitants (150 according to Eucomed), revealing a slight reduction in implants in Spain in 2020 as a result of the impact of the COVID-19 pandemic. This reduction was uneven among the autonomous communities. CONCLUSIONS: The Spanish Implantable Cardioverter Defibrillator Registry for 2020 shows an improvement in the rate of implants reported and a reduction in the number of ICD implants, which likely reflects the decrease in hospital activity not related to the treatment of COVID-19 infection. Similar to previous years, the total number of implants in Spain is still much lower than the average for the European Union, with an increase in the differences between Spanish autonomous communities.

Intersections of personal vs. collective trauma during the COVID-19 pandemic: the hijacking of the human imagination.

This paper explores how the deadly shadow of COVID-19 passing over the Earth constitutes a collective trauma that frequently opens up or 'triggers' un-remembered personal trauma, and it provides clinical examples of these intersections. The paper further explores how the human imagination, which we normally utilize to make meaning out of traumatic experience, can be hijacked by fear - leading to avoidance of suffering and to illusory formulations and alternative realities such as conspiracy theories. Alternatively, the imagination can be employed in more realistic and creative ways - leading through conscious suffering to healing and wholeness. Which path the imagination takes is shown to depend on the capacity of individuals to feel the full reality of the human condition in general and the exquisite vulnerability of our existence as fragile human beings at this moment in history. Ernest Becker's analysis of our 'denial of death' and his urgency to embrace our common human vulnerability is explored in relation to Jung's early tendency to deny the body. The author proposes that the more creative uses of the imagination, connected to a more humble and realistic apprehension of our common destiny, may be seen in the 'Black Lives Matter' movement that swept the world in the aftermath of the COVID-19 outbreak.

Cet article explore comment l'ombre de mort de la COVID-19, passant sur la terre, constitue un traumatisme collectif qui souvent ouvre ou ravive un traumatisme personnel non-remémoré. L'article fournit des exemples cliniques de telles intersections. Il explore comment l'imagination humaine, que nous utilisons normalement pour donner du sens à nos expériences traumatiques, peut être détournée par la peur. Ceci mène à l'évitement de la souffrance et à des formulations illusoires ou réalités alternatives telles que les théories du complot. Mais l'imagination peut aussi être employée de manières plus réalistes et créatives, nous guidant à travers une souffrance consciente à la guérison et la complétude. Nous montrerons que le choix du chemin que l'imagination emploie dépend de la capacité des personnes à éprouver la pleine réalité de la condition humaine en général et la vulnérabilité magnifique de notre existence en tant qu'êtres humains fragiles à ce moment de l'histoire. L'analyse que fait Ernest Becker de notre 'déni de la mort' et son insistance à épouser notre vulnérabilité humaine commune est étudiée et mise en relation avec la tendance de Jung, au début de son œuvre, à renier le corps. L'auteur propose que les utilisations plus créatives de l'imagination, reliées à une appréhension plus humble et plus réaliste de notre destinée commune, peuvent se retrouver dans le mouvement Black Lives Matter, mouvement qui a balayé le monde à la suite de la flambée de COVID-19.

El presente trabajo explora como la sombra mortal del COVID-19 pasando sobre la tierra constituye un trauma colectivo que frecuentemente abre o 'activa' trauma personal no recordado. Se proveen ejemplos clínicos de estas intersecciones. El escrito además explora cómo la imaginación humana, la cual normalmente utilizamos para encontrar sentido a partir de experiencias traumáticas, puede ser apropiada por el miedo - conduciendo a la evitación del sufrimiento y a formulaciones ilusorias y realidades alternativas tales como las teorías conspirativas. Alternativamente, la imaginación puede ser empleada en modos más realistas y creativos - conduciendo a través del sufrimiento consciente a la sanación y a la integridad. Cual camino toma la imaginación, se muestra que depende de la capacidad de los individuos para sentir la realidad plena de la condición humana en general y la exquisita vulnerabilidad de nuestra existencia como frágiles seres humanos en este momento de la historia. El análisis de nuestra 'negación de la muerte' de Ernest Becker y su urgencia por acoger nuestra común vulnerabilidad humana es explorada con relación a la temprana tendencia en Jung de negar el cuerpo. El autor propone que los usos más creativos de la imaginación, conectados a una aprehensión más humilde y realista de nuestro destino común, puede ser vista en el movimiento Black Lives Matter que recorrió el mundo en las postrimerías del estallido del COVID-19.

[Deaths by COVID-19: Not all were registered and others should not be accounted for]. / Defunciones por COVID-19: no están todas las que son y no son todas las que están.

The death counts from COVID-19 have generated public controversy. The regional health councils' need for information regardind the cases, has generated a variety of formats and procedures, used to report this information. Consecuently, this data has not always been communicated in a comparable maner to the Ministry of Health. The compilation of mortality statistics is complex. Central and autonomous public administrations are involved, and not in the same way. The medical death certificate (DC) is the main source of information that allows to specify place of occurrence and causes of death. The on-line registration of the DC in the computerized civil registry and/or digital medical records, would allow to establish a statistical processing circuit, and to obtain a death count more quickly according to causes of death in the event of a health emergency. This requires a multi-level institutional agreement for a total telematics statistic process of death causes in Spain.

Clinical - Epidemiological Characteristics Of Patients Deceased By COVID-19 In A National Hospital In Lima, Peru / Características clínicoepidemiológicas de pacientes fallecidos por COVID-19 en un hospital nacional de Lima, Perú

Introducción: La pandemia debida a enfermedad por coronavirus 2019 (COVID-19) ha producido más de 70 mil muertes en el mundo. Objetivo: Describir las características de pacientes fallecidos por COVID-19 en un hospital terciario. Métodos: Estudio descriptivo realizado en el servicio de emergencia del hospital Rebagliati Lima-Perú, que incluye los pacientes fallecidos con resultado positivo a infección por SARS-CoV-2 mediante PCR-TR hasta el 4 de abril de 2020. Se revisó la historia clínica y registros hospitalarios buscando variables sociodemográficas, antecedentes, manifestaciones clínicas, radiológicas, tratamiento y evolución. Resultados: Se identificaron 14 casos, 78,6% de sexo masculino, edad promedio 73,4 años (rango 26 a 97). Adquirieron la infección en el exterior del país el 21,4% de casos. Se encontró factores de riesgo en 92,9% de pacientes (más frecuentes adulto mayor, hipertensión arterial y obesidad). Los síntomas más frecuentes fueron disnea, fiebre y tos, con tiempo de enfermedad 8 días (+/- 3,0); los signos polipnea y estertores respiratorios. Los hallazgos de laboratorio más frecuentes fueron proteína C reactiva elevada (promedio 22 mg/dL) e hipoxemia. La presentación radiológica predominante fue infiltrado pulmonar intersticial bilateral en vidrio esmerilado. Ingresaron a ventilación mecánica 78,6% (11 de 14 casos); recibió azitromicina 71,4%, hidroxicloroquina 64,3% y antibióticos de amplio espectro 57,1% de los casos; con estancia hospitalaria de 4,7 días (+/-2,4). Conclusión: Los fallecidos por COVID-19 presentaron neumonía grave bilateral, más frecuentes en varones, con factores de riesgo (adulto mayor, hipertensión arterial y obesidad), con alta necesidad de asistencia ventilatoria.

Introduction: The COVID-19 pandemic has caused more than 70 thousand deaths worldwide. Objective: To describe the characteristics of COVID-19 patients who died in a tertiary hospital. Methods: A descriptive study was carried out in the emergency service of the Hospital Rebagliati in Lima, Peru, which includes deceased patients with a positive result for SARS-CoV-2 infection diagnosed by PCR-TR until April 4, 2020. The medical history was reviewed. and hospital records looking for sociodemographic variables, clinical characteristics, radiological manifestations, treatment and evolution. Results: 14 cases were identified, 78.6% were male, average age 73.4 years (range 26 to 97). 21.4% of cases acquired the infection out of Peru. Risk factors were found in 92.9% of patients (more frequent elderly, hypertension and obesity). The most frequent symptoms were dyspnea, fever and cough, with illness time 8 days (+/- 3); signs of polypnea and respiratory rales. The most frequent laboratory findings were elevated C-reactive protein (average 22 mg / dL) and hypoxemia. The predominant radiological presentation was bilateral interstitial pulmonary infiltration in ground glass. 78.6% (11 of 14 cases) entered mechanical ventilation; 71.4% of the cases received azithromycin, 64.3% hydroxychloroquine and 57.1% broad-spectrum antibiotics; with a 4.7 day hospital stay (+/- 2.4). Conclusion: Those who died from COVID-19 presented bilateral severe pneumonia, more frequent in men, with risk factors (elderly, hypertension and obesity), with a high need for ventilatory assistance.