Attitudes, Practices and Knowledge of Honduran Physicians in the Prescription of Antibiotics in Covid-19

Intro: Antimicrobial resistance has been considered a global health problem, being one of the 10 most important public health problems worldwide. During the COVID-19 pandemic, a large number of antibiotics were used without any control, both on an outpatient basis and in hospitalization, which can have serious consequences. Method(s): Prior informed consent, a cross-sectional descriptive study was conducted with a sample of 322 physicians. A survey was carried out in Google forms, and it was shared by telephone messages and social networks. Finding(s): 322 physicians, 60.9% women and 39.1% men, mean age 33.4 years, 85.9% general practitioners, 11.5% specialist physicians. 47.2% work in private institutions, 36% in public centers. Antibiotic policies in institutions: 50.3% do not have regulations for the use of antibiotics in COVID-19, only 29.5% work with policies to control the use of antibiotics and control measures against antibiotic resistance, 73.9% lack a committee for infection control and prevention of antibiotic resistance. Use of antibiotics: only 20.8% never used antibiotics in COVID-19, 45.6% used antibiotics in severe COVID-19, 40.4% hospitalized patients, and 33.5% outpatients. The most used antibiotics were azithromycin (67.1%), levofloxacin (53.4%), ceftriaxone (53.4%), and amoxicillin plus clavulanic acid (34.8%). 43.2% consider that using antibiotics can reduce mortality in moderate and severe COVID-19, 50.3% believe antibiotics should be suspended if there is clinical improvement, 96.3% believe there is an increase in self-medication of antibiotics, 59.8% consider that they used antibiotics inconrrectly at some point, 58.1% consider antibiotic resistance to be a problem in their workplace. 86.3% currently make less use of antibiotics in patients with COVID-19. Conclusion(s): In Honduras, there are deficiencies in policies for the use of antibiotics and control of antimicrobial resistance. Most doctors consider that they have used antibiotics incorrectly, including antibiotics that can generate resistance.Copyright © 2023

High-Dose vs. Low-Dose Dexamethasone in Patients With COVID-19: A Cohort Study in Rural Central America.

To compare the clinical outcomes of a low dose dexamethasone strategy vs. a high-dose dexamethasone strategy in hypoxemic COVID-19 patients. A retrospective observational study comparing low-dose (8 mg) and high-dose dexamethasone (24 mg) of COVID-19 patients admitted from September 1, 2020 to October 31, 2020 in a hospital in Honduras. We included 81 patients with confirmed COVID-19 who required oxygen therapy. The mean age was similar between groups (57.49 vs. 56.95 years). There were more male patients in the group of 24 mg ( p = 0.01). Besides, patients on the 24 mg dose had more prevalence of hypertension ( p = 0.052). More patients in the 24 mg group had a higher rate of invasive mechanical ventilation (15.00% vs. 2.56%, p = 0.058). When evaluating the association between the high dose group and outcomes, we find no significant association with mortality, nosocomial infections, high flow mask, invasive mechanical ventilation, or the need for vasopressors. We find no significant differences in the Kaplan-Meier analysis regarding the survival (log-rank p -value = 0.315). We did not find significant differences between the use of 24 mg and 8 mg of dexamethasone in hypoxemic COVID-19 patients.

Community response to COVID-19: The case of rental housing cooperatives in Melbourne, Australia and Choluteca, Honduras.

COVID-19 and its restrictions have had widely documented negative impacts for private and social rental sectors, internationally. Limited evidence exists about how the pandemic effects were experienced in alternative forms of renting such as housing cooperatives. Rental cooperatives, recognised for their principles of democratic control, education and training and concern for community, may offer different outcomes for members than more individually-oriented rental forms. This paper seeks to explore whether and how COVID-19 was responded to within cooperative rental housing models, and if the pandemic posed a challenge to cooperative principles. Using a social practices approach, the analysis first identifies cooperative members' formal and informal responses to COVID-19, and second explores the meaning of such activities in the pandemic context in Australia and Honduras cooperatives. The continuity of usual housing cooperative practices and pandemic measures were analysed via in-depth interviews with 15 residents. Findings indicate that cooperative responses acted to reduce negative impacts of the pandemic or to find effective solutions. Rental housing cooperative residents' lived experiences during the COVID-19 pandemic, invite us to reflect on the role of housing cooperatives in the housing sector, the importance of collaborative housing models and the relevance of housing-based community resilience.

Impact of fluvoxamine on outpatient treatment of COVID-19 in Honduras in a prospective observational real-world study.

Background: The COVID-19 pandemic has impacted millions of lives globally. While COVID-19 did not discriminate against developed or developing nations, it has been a significant challenge for third world countries like Honduras to have widespread availability of advanced therapies. The concept of early treatment was almost unheard of when early outpatient treatments utilizing repurposed drugs in Latin American countries began showing promising results. One such drug is fluvoxamine, which has shown tremendous potential in two major studies. As a direct result, fluvoxamine was added to the standard of care in a major medical center outpatient COVID-19 clinic. Methods: This is a prospective observational study performed at the Hospital Centro Médico Sampedrano (CEMESA) in San Pedro Sula, Cortes, Honduras in the COVID-19 outpatient clinic. All patients were at least 15 years of age who had presented with mild or moderate signs and symptoms of COVID-19, and who also had a documented positive SARS-CoV-2 antigen or Reverse Transcription Polymerase Chain Reaction (RT-PCR) were included in the study. These patients then were all prescribed fluvoxamine. The cohort of patients who decided to take fluvoxamine were compared for primary endpoints of mortality and hospitalization risk to the cohort who did not take fluvoxamine. Patients were then monitored for 30 days with the first follow up at 7 days and the second follow up at 10-14 days of symptom onset. Categorical variables were compared by Pearson Chi-square test. The Relative risk was calculated using regression models. Continuous variables were compared by t-test and Wilcoxon rank-sum tests. Results: Out of total 657 COVID-19 cases, 594 patients took fluvoxamine and 63 did not take fluvoxamine. A total of five patients (0.76 percent) died, with only one death occurring in the fluvoxamine group. Patients who received fluvoxamine had a significantly lower relative risk of mortality (RR 0.06, p 0.011, 95% CI 0.007-0.516). There was a lower relative risk of hospitalization in the patients who in the fluvoxamine group. (-10 vs. 30 hospitalizations, RR 0.49, p = 0.035, 95% CI 0.26-0.95). There was 73 percent reduction in relative risk of requiring oxygen in the fluvoxamine group (RR 0.27, p < 0.001, 95% CI 0.14-0.54 Mean lymphocytes count on the first follow-up visit was significantly higher in the fluvoxamine group (1.72 vs. 1.38, Δ 0.33, p 0.007, CI 0.09-0.58). Conclusion: The results of our study suggest that fluvoxamine lowers the relative risk of death, hospitalization, and oxygen requirement in COVID 19 patients.

Social, environmental, and COVID-19 pandemic-related effects on women's food security and health in Honduras.

The COVID-19 pandemic has disproportionally affected women in Honduras in terms of loss of employment and income opportunities, access to healthcare services, and increased poverty and food insecurity. The pre-pandemic gender inequalities in Honduras have resulted in harsher conditions for women since the onset of the pandemic. Early reports indicate that women have lost employment and incomes and have been burdened by other effects of the pandemic, such as more household work, childcare activities, and home schooling. Marginal groups such as indigenous women face greater challenges because of the structural and systemic inequalities which have existed for a long time. The impact of the COVID-19 pandemic has also differed across geographic areas and between rural and urban settings. In addition to the pandemic, the economic outlook for women in Honduras has worsened since the impact of Hurricanes Eta and Iota in November 2020, which displaced over a million people. The agricultural sector was devastated, and infrastructure was severely damaged. The recovery efforts have been slow because of the COVID-19 pandemic. This paper explores the root causes of gender inequalities and how it affects women's food security and health.

Field Evaluation of a Hemozoin-Based Malaria Diagnostic Device in Puerto Lempira, Honduras.

The diagnosis of malaria in Honduras is based mainly on microscopic observation of the parasite in thick smears or the detection of parasite antigens through rapid diagnostic tests when microscopy is not available. The specific treatment of the disease depends exclusively on the positive result of one of these tests. Given the low sensitivity of conventional methods, new diagnostic approaches are needed. This study evaluates the in-field performance of a device (Gazelle™) based on the detection of hemozoin. This was a double-blind study evaluating symptomatic individuals with suspected malaria in the department of Gracias a Dios, Honduras, using blood samples collected from 2021 to 2022. The diagnostic performance of Gazelle™ was compared with microscopy and nested 18ssr PCR as references. The sensitivity and specificity of Gazelle™ were 59.7% and 98.6%, respectively, while microscopy had a sensitivity of 64.9% and a specificity of 100%. The kappa index between microscopy and Gazelle™ was 0.9216 using microscopy as a reference. Both methods show similar effectiveness and predictive values. No statistical differences were observed between the results of the Gazelle™ compared to light microscopy (p = 0.6831). The turnaround time was shorter for Gazelle™ than for microscopy, but the cost per sample was slightly higher for Gazelle™. Gazelle™ showed more false-negative cases when infections were caused by Plasmodium falciparum compared to P. vivax. Conclusions: The sensitivity and specificity of Gazelle™ are comparable to microscopy. The simplicity and ease of use of the Gazelle™, the ability to run on batteries, and the immediacy of its results make it a valuable tool for malaria detection in the field. However, further development is required to differentiate Plasmodium species, especially in those regions requiring differentiated treatment.