EPICORE: AN INNOVATIVE GLOBAL DISEASE SURVEILLANCE TOOL FOR HUMAN, ANIMAL, AND ENVIRONMENTAL PUBLIC HEALTH EVENTS

EpiCore was launched in 2013 and is a tool designed to supplement traditional infectious disease surveillance efforts by bringing together human, animal, and environmental experts on a digital platform to provide field-based verification efforts of global public health events1,2. Public health professionals from organizations around the globe, including Ending Pandemics, HealthMap, Geosentinel, MSF-OCBA, ProMED, and EDIS-RSOE, are trained as Moderators and are able to send Requests for Information (RFIs). Moderators utilize nontraditional resources, such as social media and news articles, to identify potential health events. Through EpiCore, moderators send out a RFI to EpiCore members located in a geographic area where a new or known health event is occurring. Health experts who receive the RFI may anonymously respond with information about the health event. A moderator reviews the responses and determines whether the information verifies a new event or updates a known ongoing event. Verified and updated events are summarized and published on the EpiCore public dashboard and shared with WHO EIOS. The study period was January 2020 - July 2022. In the study period, 231 RFIs were sent requesting signals about potential health events;111 of those RFIs received responses with information that allowed moderators to confirm or negate a suspected event, or update a known ongoing event. 82% of those RFIs were responded to within 24 hours. EpiCore is a resource for public health professionals and organizations to supplement traditional infectious disease surveillance efforts. For example, information collected through EpiCore was used to provide timely details on the emerging COVID-19 outbreak in Wuhan, China in January 2020. Additionally, responses to RFIs supported surveillance efforts of the 2022 global monkeypox outbreak. Future efforts include outreach and engagement with existing and new members to expand EpiCore's member base in countries with few to no members. [ FROM AUTHOR] Copyright of International Journal of Infectious Diseases is the property of Elsevier B.V. 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.)

Towards an E-Psychology Solution to Support, Intervene and Educate the Control of Emotions in Infants

Anxiety and depression in infants are a problem that is increasing, this being a consequence of the global pandemic caused by COVID-19. The current panorama indicates that infants are possible victims of suffering from these moods at very early ages and in the worst case, it becomes the leading cause of child suicide. For this reason, it is very important to seek resources and means to mitigate the situation. The current project consisted of making a web application for the control of emotions in primary school children through modules made up of theoretical sessions that cover the management of emotions, thoughts, assertiveness, frustration, breathing, and muscle relaxation. Each module in turn has an intervention session, which consists of situations that are presented to the infants with the aim of analyzing the psychological impact that the theoretical sessions had, with the main purpose of improving or intervening the control of their emotions. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Sirs and Septic Shock Alert Evaluation

INTRODUCTION: Prompt recognition of sepsis is imperative for timely treatment and has led to the creation of the CERNER St. Johns Sepsis (SJS) Surveillance Agent Algorithm. Patient specific values are analyzed to determine if criteria for a Systemic Inflammatory Response Syndrome (SIRS) or Septic Shock Alert is met. The SJS Surveillance Agent Algorithm has a positive predictive value of 64%. The study site modified the alert criteria in the acute care areas and the emergency department to reduce alert fatigue. The purpose of this evaluation was to assess whether the modified alert criteria accurately identifies patients with possible sepsis. METHOD(S): This is a single center, retrospective, cohort evaluation. A Cerner Sepsis Audit report of all SIRS and Septic Shock Alert patients admitted between July 1 and July 14, 2021 was used for analysis. Patients were screened at random and included once per admission, first occurrence only. Patients were excluded if they had a presumed or confirmed COVID-19 diagnosis during admission. The proportion of SIRS and Septic Shock Alerts that correlate to a sepsis diagnosis and the proportion of patients with a discharge diagnosis code of sepsis where no alert was generated were analyzed using descriptive statistics. RESULT(S): A total of 147 patients were screened for inclusion with 121 patients included in the final analysis. There were 105 patients who triggered a SIRS or Septic Shock Alert and 16 patients coded for sepsis with no alert generated. The modified SJS criteria resulted in a positive predictive value of 60% (63 sepsis diagnosis vs. 42 noninfectious diagnosis). A majority of alerts were generated by SIRS criteria versus Septic Shock criteria. The most common non-infectious diagnoses in patients who alerted without sepsis were hemorrhage, hypovolemia, and trauma. CONCLUSION(S): Modification of the SJS algorithm occurred in an effort to decrease alert fatigue and was found to be comparable in positive predictive value to the unmodified algorithm.

Telemedicine and its impact on rural health care in times of COVID-19: a systematic review

The COVID-19 pandemic highlighted the importance and utility of telemedicine in providing a way to connect patients and healthcare professionals when an in-person consultation is not possible in rural areas. A systematic review of Telemedicine and its impact on rural healthcare in times of COVID-19 was carried out from 2016 to 2021. The search strategy identified 1480 papers from digital libraries such as Google Scholar, ACM Digital Library, ProQuest, ARDI, Taylor & Francis Online, Wiley Online Libray and Microsoft Academic. Then 71 papers were considered based on exclusion criteria. The results of the systematic review have focused on recent studies of Telemedicine where it highlights the importance in the care of patients in rural areas also provides statistical graphs of the extracted studies to compare by relevance to their settings and situations.

JEJUNAL PERFORATION SECONDARY TO KICK DURING KICK-BOXING PRACTICE: LAPAROSCOPIC MANAGEMENT

Small bowel injury in a sports setting is a rare occurrence with a paucity of reported cases. A 30-year old male patient consulted for generalized abdominal pain subsequent to secondary blunt abdominal trauma during kick-boxing practice. A computed tomography scan of the abdomen and pelvis revealed a moderate amount of free fluid in both the parietocolic space and the rectovesical pouch, with perihepatic pneumoperitoneum. Emergency laparoscopy was indicated and a closure of small bowel defect was performed. Diagnosis of small bowel injuries is difficult, resulting in delayed treatment and increased mortality and morbidity.

Impact of one year of pandemic on Spanish Intensive Care Units.

OBJECTIVE: To measure the impact of the pandemic in Spanish ICUs. METHODS: On-line survey, conducted in April 2021, among SEMICYUC members. Participants were asked about number of patients admitted, increase in the number of beds and staff, structures created in the hospital and self-assessment of the work performed. RESULTS: We received 246 answers from 157 hospitals. 67.7% of the ICUs were expanded during the pandemic, overall increase in beds of 58.6%. The ICU medical staff increased by 6.1% and there has been a nursing shortage in 93.7% of units. Patients exceeded 200% the pre-pandemic ICU capacity. In 88% of the hospitals the collaboration of other specialists was necessary. The predominant collaboration model consisted of the intensive care medicine specialist being responsible for triage and coordinating patient management. Despite that 53.2% centres offered training for critical care, a deterioration in the quality of care was perceived. 84.2% hospitals drew up a Contingency Plan and in 77.8% of the hospitals a multidisciplinary committee was set up to agree on decision-making. Self-evaluation of the work performed was outstanding and 91.9% felt proud of what they had achieved, however, up to 15% considered leaving their job. CONCLUSIONS: The Spanish ICUs assumed an unprecedented increase in the number of patients. They achieved it without hardly increasing their staff and, while intensive care medicine training was carried out for other specialists who collaborated. The degree of job satisfaction was consistent with pre-pandemic levels.

Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study.

OBJECTIVE: The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators. DESIGN: Prospective descriptive multicenter cohort study. SETTING: 26 Intensive care units (ICU) from Andalusian region in Spain. PATIENTS OR PARTICIPANTS: Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30. INTERVENTIONS: None. VARIABLES: Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied. RESULTS: 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission <6.5%, and thrombocytopenia whereas the use of lopinavir/ritonavir was a protective factor. CONCLUSION: Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor.

Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study Factores predictivos de la mortalidad a las seis semanas en pacientes críticos con SARS-CoV-2: estudio multicéntrico prospectivo

Objective The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators. Design Prospective descriptive multicenter cohort study. Setting 26 Intensive care units (ICU) from Andalusian region in Spain. Patients or participants Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30. Interventions None. Variables Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied. Results 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%;14 days mortality: 81/422 (19.2%);28 days mortality: 121/422 (28.7%);6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470 U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72 h post-ICU admission <6.5%, and thrombocytopenia whereas the use of lopinavir/ritonavir was a protective factor. Conclusion Age, APACHE II, SOFA > value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor.

Real-world Evaluation of SARS-CoV-2 Monoclonal Antibodies in Solid Organ Transplant Recipients

Background. Patients with COVID-19 infection at highest risk for poor outcomes include immunocompromised patients, such as solid organ transplant (SOT) recipients. Monoclonal antibody (mAb) infusions were developed to promote passive immunity. Analysis of the first 200 patients who received SARS-CoV-2 mAb at our hospital showed a 27 % absolute reduction in hospitalization and emergency department (ED) visits. Understanding the role of SARS-CoV-2 mAb therapy in management of the SOT population is likely to inform decision making for these patients. Methods. We conducted a retrospective chart review of SOT patients diagnosed with COVID-19 who received mAb therapy between 11/18/20 and 04/26/21. Patients were excluded if they were < 18 years of age or if they weighed < 40 kg. We compared those patients who were hospitalized or visited the ED within 29 days of mAb therapy to those who recovered without further visits to our hospital. Results. A total of 50 SOT patients receiving mAb therapy were included in this analysis. Bamlanivimab was given to 33 patients, while 9 patients received bamlanivimab/ etesevimab and 8 patients received casirivimab/imdevimab. Twelve (24 %) patients were hospitalized or visited the ED within 29 days of mAb therapy;38 patients did not. These 2 groups did not significantly differ by age, gender, body mass index, time from SOT, or other risk factors for severe COVID-19 illness per FDA Emergency Use Authorization guidance. Both groups were primarily made up of kidney transplant recipients (66.7 % and 68.4 %, respectively). Significantly more patients in the hospitalization/ ED group were receiving antimetabolites as part of their immunosuppression (IS) regimen prior to COVID-19 diagnosis (100 % vs 68.4 %, p = 0.047). Patients in the hospitalization/ED group received mAbs within a median of 6 days (IQR 3.8) of symptom onset compared to 4 days (IQR 4) (p = 0.006). Conclusion. SOT recipients were more likely to be hospitalized or visit the ED due to COVID-19 after mAb if they were receiving antimetabolite IS or received mAb later after symptom onset. These data stress the importance of early mAb administration in all SOT patients, particularly in those on antimetabolite therapy.

Generalized anxiety disorder in the health workers of Salud Chacao

Few are the studies and epidemiological data published and updated in Venezuela, regarding generalized anxiety disorder in health workers, whose worldwide prevalence is 30 % to 50 %, with a recent increase due to the COVID-19 pandemic. The objective of this study is to determine the prevalence of generalized anxiety disorder in the health workers of the ambulatory healthcare centers of Salud Chacao, during June- August 2021. The authors carried out a descriptive, cross-sectional, quantitative, and population study, with a sample of 110 health workers, including specialist medical doctors, general physicians, and nurses. The female sex was predominant, and the mean age was of 36.75 ± 12.307 years. 50 % (n = 55) of said sample presented mild anxiety, especially specialist medical doctors (61.8 %;n = 34);44 % (n = 48) referred moderate to severe anxiety, mainly nurses (43.7 %;n = 21);and the remaining 6 % (n = 7) presented mild to moderate anxiety, especially general physicians (85.7 %;n = 6). The prevalence of stress was 67.9 % (n = 75). This study determined that there is a high and statistically significant prevalence of generalized anxiety disorder in the health workers of Salud Chacao, which can be extrapolated to the rest of said workers, both nationally and internationally. © 2021 Academia Nacional de Medicina. All rights reserved.

Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units☆ Recomendaciones para el manejo de los pacientes críticos con COVID-19 en las Unidades de Cuidados Intensivos

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

Attitudes compatible with the preservation of the affective state in young people with COVID-19

The predisposition determines the attitudes that people have to face the circumstances;in this research, a comprehensive approach is made to the attitudes of young people infected by COVID-19 to preserve their affective states;during and after the infection, there is an alteration of the experiences with the family members of the home, with the couple and with the family that is living in another place, which confronts the young person to resolve this situation. To carry out the research, we worked with four male and four female participants and three doctors who treated COVID-19, who with their testimonies, helped to understand the subject better. The semi-structured in-depth interview was used, and software and discourse content analysis were used for processing. The results show attitudes of resignation to the acceptance of death, compliance with the measures of social isolation, rationalization of death as a good act use of biosafety equipment, show feelings of helplessness in the face of calamity. Intake of infusions and preventive medications;in couple relationships, they show an attitude of trust;communication is carried out by telephone. Young people have savings for emergencies, in cases of death, they perform religious rituals, among their priorities is their family;household members have returned to work;in cases where deaths have been registered. There was emotional and economic dependence on the deceased;they receive emotional support from significant others, and there is economic and moral solidarity.

CLINICAL PSYCHOLOGY DURING THE COVID-19 PANDEMIC: EXPERIENCES FROM SIX FRONTLINE HOSPITALS IN MEXICO

Around the world, the COVID-19 pandemic has generated clinical challenges for health personnel in general, and particularly hospital personnel. In Mexico, the clinical psychologists who are part of the local hospital systems have adapted professional practices to provide mental health care in COVID-19 frontline hospitals. This text describes the actions, lessons, and challenges arising from treating patients, families, and health workers in six COVID-19 hospitals in Mexico. It highlights the main problems identified, strategies to address them, and the barriers encountered during this pandemic. Finally, this paper may be useful for planning clinical psychological activities within COVID-19 hospitals in locations where new waves of contagion appear.

Spanish Oncology Nursing Society efforts during COVID-19 pandemic

Background: During the first wave of the SARS-CoV-2 Coronavirus pandemic in Spain, the care of cancer patients was altered in all aspects and in all phases of the cancer patients’ paths, especially in determined areas of population. Given the seriousness of the situation, specific actions were implemented from Spanish Society of Oncology Nursing on behalf of oncology nurses in Spain, with the aim of (a)minimizing the risk of contracting the coronavirus disease and (b) continuing to guarantee the best assistance as possible. Methods: Working and coordination meetings were established, and we planned different strategies and lines of action. This planning was carried out in an open and permanent way to be able to introduce changes and improvements with capacity to adapt in the face of uncertainty. We evolved all the team work into an uninterrupted chain of communication leading to the board, as well as the continuity of the work within the scientific society was ensured. Results: All the proposed actions were implemented successfully, through emails, with dissemination both through social networks and newsletters. a) Safe circuits were established for the care of cancer patients at the hospitals, limited number of companions, antigenic testing from early April. A telephone follow-up was implemented for both outpatient visits and information. b) Training actions: webinars on the correct use of a mask. Protective measures, hand washing. From the very beginning, early march 2020, we strongly recommended all cancer patients to wear a mask, c) Publications: Recommendations on infection and Positioning against health strategies in collaboration with other scientific and patient societies for adult and pediatric patients, and their families. Conclusions: It was possible to continue with adequate care and several actions to improve care have been promoted, although the greatest impact has been detected in new diagnoses (1 in 5 cancer patients have not been diagnosed or have been diagnosed late). The impact of the first wave has been controlled and mitigated, however, persistently, we will have a delay in the implementation of treatments. We estimate that a large part of the delays in the first diagnosis or in the implementation of treatments may be due to the pandemic situation. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Nutritional status in locally advanced or metastatic solid cancer patients in Spain: The NutriOncoSearch (NOS) study

Background: Malnutrition is a common issue in oncology patients, and negatively affects patients' evolution and their quality of life, increasing the incidence of infection, hospital stay, and mortality. New approaches to targeted therapy and immunotherapy represent the future in the field of oncology, making it essential to understand its effect on patients. Study endpoints were (a). To describe the percentage of nutritional counseling or nutritional support among those diagnosed as malnourished or at risk. And (b) to categorize the percentage and descriptive characteristics of cancer patients with mild, moderate, or severe malnutrition in Spain and descriptive characteristics of patients with malnutrition according to sociodemographic and clinical characteristics. Methods: From a total of 585 patients from 10 hospitals, two groups were established, group A, N: 408, patients undergoing immunotherapy, group B with patients with inmuno plus chemotherapy and/or radiotherapy (N: 204). The objective of this observational study was to determine the prevalence (or risk) of malnutrition in the Spanish population of outpatients receiving immunotherapy. To do this, it was proposed to explore the nutritional status of these patients using Nutritional risk (NutriScore), Nutritional Global Subjective Assessment, ECOG PS;type of cancer and nutritional treatment: chemo, type of chemo, and COVID-19 diagnosis. Results: In group A (Immuno only) 28.3% of the patients were at risk of malnutrition, compared to 58.5% in group B (combined Immuno plus Chem&RT) with a statistically significant difference (p<0.0001);27.4% were on nutritional therapy, 97 (42.9%) of patients who obtained a score ≥of 5 (at risk), and 63 (17.5%) %) of patients who obtained a score <5 (out of risk) in NutriScore (p<0.0001). Dietary advice was the most common type of nutritional therapy, present in 123 (76.9%) patients of 160 with nutritional therapy, followed by oral supplements (69 (43.1%)) and enteral nutrition (11 (6.9%)). Conclusions: Nutritional diagnosis is key in cancer patients. It allows determining the needs of the patient in each of the phases of the patient's evolution, improving the quality of life through different interventions, especially dietary education. Clinical trial identification: NCT04168814. Legal entity responsible for the study: Spanish Society of Oncology Nursing. Funding: Baxter Healthcare Corporation. Disclosure: All authors have declared no conflicts of interest.

[Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units]. / Recomendaciones para el manejo de los pacientes críticos con COVID-19 en las Unidades de Cuidados Intensivos.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.