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Objectives: To estimate the reclassification of COVID-19 related ICD-10 codes from admission to discharge using Real-World Data (RWD) from the 2020 Mexican Ministry of Health (MoH) hospitals discharge dataset. Method(s): In this retrospective study, we analyzed all COVID-19 related discharges in the 2020 MoH open database, according to ten ICD-10 codes that the WHO associated with COVID-19. Reclassification was defined as those COVID-19 related cases who were discharged with a different ICD-10 code compared to their ICD-10 admission code. Result(s): From a total of 1,937,360 discharges reported in the MoH's 2020 database 63,740 (3.3%), mostly men (60.8%), with a median age of 56 years, were discharged with a COVID-19 related ICD-10 code and 12,945 of these were reclassified (20.3%). Although "2019-nCoV acute respiratory disease" (U071) had the greatest frequency of reclassified discharges (12,013, 22.3%), the "other coronavirus as the cause of diseases classified elsewhere" (B972) was associated with the greatest reclassification proportion (68, 74.7%) followed by "pneumonia case confirmed as due to COVID-19" (J128) (26.0%). Codes with lower percentages were "acute respiratory distress syndrome due to COVID-19" (J80X) and "acute respiratory failure due to COVID-19" (J960) with 6.3% and 3.8%, respectively. From 63,740 discharges, 50.7% were due to clinical improvement, followed by death (38.2%), transfer to another unit (5.2%) and voluntary discharge (3.3%). The J960 code had the highest mortality (67%) followed by codes J80X (59.7%) and U071 (35.5%). Conclusion(s): In our RWD analysis, we identified that 1 in 5 COVID-19 discharges were admitted with different diagnoses, highlighting the enormous challenges faced by the Mexican MoH during the global health crisis to establish an accurate COVID-19 diagnosis and coding. Given that this is the first reclassification analysis in Mexico, the conduction of future studies is essential to gain more insights on the consequences of reclassification at a health system level.Copyright © 2023
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Remote learning replaced for almost a year the traditional face-to-face education to maintain and ensure the continuity of the teaching-learning process during the Covid-19 pandemic. This article reports the results of an exploratory and descriptive-transversal study that exposes primary and secondary school students' perceptions about their experience with remote learning during 2020. Though the research study was also aimed at finding out potential teaching and learning issues inherent to remote education, we only focus on reporting the main findings on the determining factors that hindered or enhanced students' learning during their remote education experience. Data were collected through two different surveys addressed to 101 secondary and primary school students from Neiva and Pitalito, the two most populated towns in the state of Huila, Colombia. The findings showed that the Maria Fernanda Jaime-Osorio, Maria Alejandra Campos-Perdomo, Gilber Ignacio Rodriguez-Artunduaga students' learning was both positively and negatively influenced by several factors affecting interaction inside and outside of the classroom setting.
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BACKGROUND: In 2020, no consensus or guidance existed for managing COVID-19. Many PCP offices were forced to close. CANO kept clinics fully staffed and open, and published two articles on best practices for treating COVID-19 (5,6). CANO is a PCP network caring for underserved Medicare Advantage (MA). Growing from a single clinic (1) to ∼130 centers in < 6Y, CANO focused on 'treatable' gaps in: chronic disease management, HEDIS measures, and clinical inertia. CANO results have been extraordinary (2-6). Here we describe initiatives and strategies to navigate care delivery through the pandemic. METHODS: Tracking COVID-19 Cases-Bracing for Surges. A dedicated CANO COVID Task Force (CTF) collected data on 38,193 patients. Detection of 'surges' reliably predicted need to restock COVID-19 medicines, allocate staff, and communicate updates to staff and patients. The CTF collected data on COVID-19 infections, admissions, ER visits, patient deaths, etc. RESULTS: Staff Retention. The CTF performed much of COVID-related care and research, PCPs provided routine care with little interruption. Development of Published COVID-19 Treatment Algorithm. Data came directly from CANO EMR (5) and literature review (6). Application of the treatment algorithm led to a 60% lower outpatient COVID-19 mortality vs national average (P < .05) (7). At-Home COVID Care. Televisits;in home visits including testing, vaccination, treatment;home delivery of pulse oximeters, prescriptions and oxygen. Vaccination Program. A telephone campaign resulted in a vaccination rate of 83.8% vs. Florida average 74.9% as of Dec 31, 2021(7). Resumption of In-Person Clinic Visits. Dedicated Retention Team drove the return to in-clinic visits from 6% in April, 2020 to >90% by December, 2021. Impact of Real time monitoring. The collection and monitoring of data by the CTF through CANO's proprietary population health platform, Cano Panorama (R), facilated strategic planning and allocation of resources. Repurposing of staff. Associates were repurposed due to reduced in office visits to various teams. These teams included dedicated CTF call center, retention team, CANO at Home staff. CONCLUSIONS: Key Lessons for Dissemination: CANO platforms have served well during the crisis presented by the pandemic as in routine care. CANO has quickly put into systems and platforms that place highly effective and reproducible strategies to reduce the burden of COVID-19, improve disease course and survival, and, renormalize care.
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Background and importanceA reference panel of antimicrobial consumption indicators was published in 2019 by a committee from the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC).Aim and objectivesTo calculate 2020 hospital antimicrobial consumption indicators and carry out a comparative analysis of these consumption indicators with those observed in the previous 2 years.Material and methodsBased on the panel, 10 antimicrobial consumption indicators were selected. The unit of measurement for the consumption was the number of defined daily doses per 100 stays (DDD/100e).ResultsAntibacterials overall consumption (OC) 1.5% (86.5 to 85.2) decrease in 2019;and 4.7% increase in 2020 compared to 2019 (89.2).Antifungals OC 3% decrease in 2019 (7.05 to 6.84);26% increase in 2020 compared to 2019 (8.65).Carbapenems: in 2019, consumption decreased by 4.2% (10.17 to 9.74);in 2020 it increased by 2% compared to 2019 (9.94).Fluoroquinolones: maintained overall 37.4% decrease (13.01 in 2018, 10.83 in 2019 and 8.14 in 2020).Fosfomycin: maintained overall increase of 27.6% (0.49 in 2018, 0.65 in 2019 and 0.62 in 2020).Aminoglycosides: maintained overall decrease of 40.7% (3.27 in 2018, 2.32 in 2019 and 1.94 in 2020).Colistin: 12.8% decrease in 2019 (1.09 to 0.95), and an 8.4% increase in 2020 compared to 2019 (1.03).Anti-pseudomonal cephalosporins: maintained overall increase of 19% (2.11 in 2018, 2.47 in 2019 and 2.51 in 2020).Amoxicillin-clavulanate/piperacillin-tazobactam ratio: maintained decrease of 47% compared to 2018 (4.34 in 2018, 3.54 in 2019 and 2.26 in 2020).Fluconazole/equinocandins ratio: 24% rise in 2019 (4.14 to 5.45);in 2020 it decreased by 16% (4.57).Conclusion and relevanceDuring 2020, a change in trend has been perceived in a series of antimicrobial consumption indicators, with higher antibacterials and antifungals OC, carbapenems and colistin consumption, and a decreased fluconazole/equinocandins ratio. This change in trend could be related to the increase of multiresistant bacterial and fungal infections associated with COVID-19.The downward trend in the consumption of fluoroquinolones and aminoglycosides and the upward trend in anti-pseudomonal cephalosporins and fosfomycin was maintained. Interventions carried out through the antimicrobial stewardship programme aimed at optimising and/or de-escalating empirical antimicrobial treatment may be behind this trend.The amoxicillin-clavulanate/piperacillin-tazobactam ratio may have been influenced by frequent piperacillin-tazobactam stock-outs in the years studied.References and/or acknowledgements1. Gutiérrez-Urbón JM.Indicadores del uso hospitalario de antimicrobianos basados en el consumo. Farm Hosp 2019;43(3):94–100.Conflict of interestNo conflict of interest
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Background: Allergic reactions to vaccines are rare, occurring at 1 per 1'000.000 to 30 per 100.000;BNT162b2 vaccine excipients include polyethylene glycol/macrogol (PEG), rarely cause of allergy. Contact sensitivity to PEG is more frequent than anaphylaxis. CDC reported an estimated rate of 11.1 cases of anaphylaxis per million doses administered in patients with a history of allergies. Method: We prospectively assessed the early allergic reactions of Phase 0 COVID-19 vaccination plan in Guayaquil, Ecuador. Participants received two 30-μg doses, administered intramuscularly 21 days apart. Phase 0 included first line health care workers who were healthy or had stable chronic medical conditions. Participants were observed for 30 minutes after vaccination for any acute reactions;we used Brighton scale for anaphylaxis definition criteria. The primary endpoint was to measure any allergic reaction, anaphylaxis and use of medication within 14 days after the receipt of each dose of vaccine;day 1 referred to the vaccination day. Participants reported their symptoms on weekly telephonic follow-up made by the pollsters team. Results: 187 subjects were enrolled, the mean age was 41.11 ± 17.78, 61% were female and 27.3% patients presented with an allergic past history, 15% had allergic rhinitis (Table 1). Allergic symptom onset was 2.2 ± 3.63 minutes compared to 30 minutes of another study. We did not report any anaphylaxis case. On the first day, 5.35% presented an allergic reaction including generalized rash, injection site rash and petechiae. On second dose, 3.7% presented injection site rash, generalized pruritus and petechiae (Figure 1). Conclusion: Our study found a similar prevalence of allergic reaction according to previous reports. The majority of patients, 94.65%, did not report any allergic symptoms after BNT162b2, similar to previous studies (98%). Anaphylaxis with COVID-19 vaccination is extremely rare, we did not find any case similarly to other reports (0.027%). To our knowledge, this is the first study to report acute allergic reactions in South America. Further studies are needed in order to prove the allergic reactions differences with other populations. (Table Presented).
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The crisis in the education system generated by the appearance of covid-19 revealed the multiple gaps that exist due to the diversity of contexts to which students and teachers belong. This article reports on a case study which explored the challenges English teacher educators (tes) at a public university in Neiva, Colombia faced during the pandemic due to the imposition of emergency remote teaching (ert), the pedagogical strategies they used to respond to these challenges, and the ones that remain. To do this, data were collected from a questionnaire and a focus group with tes and pre-service teachers (psts) from the language teacher education program. The main findings show that the transition from classroom teaching to ert brought some challenges for tes and their trainees related to the social realities existing in the context of the latter. To respond to these challenges, tes had to adjust their teaching strategies and learn to use some technologies such as videoconferencing software and educational apps. Still some challenges remain for the future, such as enhancing pst's motivation, autonomy and classroom interaction. The study suggests the need to continue training language tes on the use of ert technologies and to find more and better ways to promote autonomous learning processes to adapt teaching practices to current times. © 2021 Universidad de Antioquia. All Rights Reserved.
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Introduction: Treatment-free remission (TFR) is an emerging treatment goal for chronic myeloid leukemia (CML) patients in deep molecular response (DMR). Current evidence shows that 40%-60% of patients relapse while in TFR;and nearly all regain response once tyrosine kinase inhibitors (TKIs) treatment are reinitiated. However a robust predictor of prolonged TFR has not been reported yet. Considering real-life setting, 2 key factors may affect TFR outcome if not properly done: Access to serial molecular monitoring at optimal timepoints and quality laboratory terms as accuracy, sensitivity and rapid results. This motivated the creation of the AST study in our region to guarantee adequate molecular monitoring for TFR in Argentina and characterize new prognostic biomarkers helpful to identify more accurately patients who will be able to sustain TFR. We aimed to assess the proportion of patients with sustained major molecular response (MMR) after TKIs discontinuation and define precise conditions for stopping treatment. Methods: This prospective, multicentre Argentina Stop Trial (AST) trial is recruiting chronic phase CML patients under TKI treatment for at least ≥ 4 years, in DMR (≥MR4.0) sustained for ≥ 2 years in standardized laboratory, confirmed typical BCR-ABL1 transcripts b3a2 and/or b2a2 and aged > 18 years. Molecular tests are centralized in 2 harmonized laboratories and performed monthly for the first 6 months, every 2 months until the first year, and every 3 months during the second year. If patients lost MMR, TKI was restarted immediately. Molecular relapse Free Survival was estimated by Kaplan-Meier method. Difference between survival variables was evaluated through log-rank test. Multivariate analysis was performed through Cox proportional hazards model. The cutoffs of the numerical variables were considered according to the log-rank test. Results: Between February 2019 and July 2020, we evaluated 50 CML patients of whom 46 were enrolled from 7 centers in Argentina and 4 were screening failures. Recruitment was interrupted due to COVID-19 pandemic. Patient median age was 57.5 years (range 24-85). Before discontinuation, TKI treatment was as follows: Imatinib 37/46 (80%), Nilotinib 5/46 (11%) and Dasatinib 4/46 (9%), 2G-TKI as 1st line, 11% of the patients received non-branded treatment. Sokal risk score showed to be low in 22 patients (48%), intermediate in 14 (30%) and high in 10 (22%). Median follow-up was 10 months (range 4-17) and the estimated molecular relapse-free survival was 80.2% (95%CI 69-93) at 6 months Fig 1. Longer DMR durations before discontinuation were associated with increased probability of maintaining response at 6 and 12 months: 83.2% for patients who had >54 months in DMR vs 70% with <54 months and 72% vs 23.3% respectively (p=0.0453) Fig 2. Cox multivariate analysis was performed including different variables as age at diagnosis, time in DMR, time in TKI previous to discontinuation and Sokal risk. The only significant variable associated to improved prognosis was time in DMR (HR 2.8 95%CI 1.002-8.07 p=0.0495). Our cohort had a long time on TKI treatment previous to discontinuation, median 10.5 years (4.16-17.5) probably considering it a favorable factor for the high TFR rates described at 6 months. Among the 46 patients included, 15 (33%) lost MMR, all restarted treatment with the same TKI used before discontinuation, 12/15 (80%) regained MMR with a median time of 3 months (range1-8) and 9/15(60%) obtained MR 4.0 with a median time of 3 months (range1-5). Conclusion: This is the first multicenter study of TKI discontinuation in CML patients in Argentina showing that TKI can be safely discontinued in those who achieve and maintain a DMR before discontinuation. We observed high rates of molecular relapse free survival, although longer follow-up is needed. We must continue with this approach for patients participating in TFR trials or TFR programs in order to decrease the risk of relapse and make this goal a fact in our region. This discontinuation study will allow in a near futu e significant saving of economic resources and might improve patients quality of life specially in those who are currently experiencing treatment adverse events. [Formula presented] Disclosures: Pavlovsky: Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;BMS: Speakers Bureau;Pfizer: Speakers Bureau;Pint Pharma: Speakers Bureau. Varela: Novartis: Consultancy, Speakers Bureau. Pavlovsky: Janssen: Membership on an entity's Board of Directors or advisory committees, Other: travel grants, Speakers Bureau;Abbvie: Membership on an entity's Board of Directors or advisory committees, Other: Travel grants, Speakers Bureau;Astra Zeneca: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Varifarma: Speakers Bureau. Moiraghi: BMS: Speakers Bureau;Novartis: Speakers Bureau.
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On December 30, 2019, the first reports of a group of patients with unknown etiology pneumonia appeared in Wuhan city, Hubei province, China. Taking into consideration the large amount of similar nucleotide sequences between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the past epidemic coronavirus, it will be appropriate to expect that such pathogens share the same cell line tropism and systemic pathology. Although several studies have, so far, identified the clinical characteristics of COVID-19 cases, there is very little knowledge on the extrapulmonary affection of SARS-CoV-2. In this review, we summarize reports of the main affected organs besides the pulmonary system such as the liver and kidneys, as well as the cardiovascular and nervous system. The mechanisms of lesion remain largely unclear. The approach of this investigation is to suggest multisystemic work-up in patients with SARS-CoV-2 infection, aside from its respiratory management.