The Pandemic in Latin America and the challenges of Human Rights

The purpose of the present study is to know the impacts of Covid19 on the structures of governmental institutions in Latin America and the effects on Human Rights in terms of health and education, for example. For the analysis, we consider some elements such as the functioning of political parties, the arbitrariness of power, fiscal transparency and public spending, allowing us to take a picture of the reality to be studied regarding the quality of democracy in these countries, and also considering the cooperation efforts, in the normative and institutional scopes inside and out. As we seek to relate Human Rights and Democracy, we focus on the ethical dimension of the new challenges facing Latin America. The exposition, sometimes detailed, of situations that illustrate the malfunctioning of institutions came from observation and review of a diverse literature, and from different perspectives specifically in the scope of International Relations. © 2022, UNIV CARLOSIII MADRID. All rights reserved.

Effect of Wearing a Face Mask on Vocal Self-Perception during a Pandemic

Objective. To analyze the vocal self-perception of individuals who wore face masks for essential activities and those who wore them for professional and essential activities during the coronavirus disease pandemic.Materials and Methods. This was an observational, descriptive, cross-sectional study. The study included 468 individuals who were stratified into two groups: the Working Group, comprising individuals who wore face masks for professional and essential activities during the pandemic;and the Essential Activities Group, with indi-viduals who wore face masks only for essential activities during the pandemic. The outcome measures tested were self-perception of vocal fatigue, vocal tract discomfort, vocal effort, speech intelligibility, auditory feedback, and coordination between speech and breathing. Descriptive and inferential statistics were performed. Results. Face masks increased the perception of vocal effort, difficulty in speech intelligibility, auditory feed-back, and difficulty in coordinating speech and breathing, irrespective of usage. Individuals who wore face masks for professional and essential activities had a greater perception of symptoms of vocal fatigue and discomfort, vocal effort, difficulties in speech intelligibility, and in coordinating speech and breathing.Conclusion. Use of face masks increases the perception of vocal symptoms and discomfort, especially in indi-viduals who wore it for professional and essential activities.

Progression Free Survival (PFS) Analysis of Daratumumab (Dara), Cyclophosphamide, Thalidomide and Dexamethasone: A Quadruplet Intensified Treatment for Transplant Eligible Newly Diagnosed Multiple Myeloma (TE NDMM) Patients

Background: Newly drugs access for MM treatment still a challenge in some countries. One of the most available inductions for TE NDMM patients (pts) worldwide is cyclophosphamide (C), thalidomide (T) and dexamethasone (d)-(CTd). Dara the first anti- CD38, had been combined with VCd, VTd and VRd and markedly increased the depth and duration of the response. We hypothesized that Dara and CTd combination could be safe and allow deeper activity as an alternative protocol. Aims: The aims of this analysis were to evaluate Progression Free Survival (PFS) of Dara-CTd treatment and minimal residual disease (MRD) after one year of Dara maintenance. Primary endpoint of the study was to evaluate the VGPR after two consolidation cycles post-autologous stem cell transplantation (ASCT). Methods: This is a phase II, open-label single-center clinical trial. The main inclusion criteria were: TE NDMM, creatinine clearance > 30 ml/min, normal cardiac, renal and liver function and the Easter Cooperative Oncology Group (ECOG) performance status = 0 - 2. The protocol was Dara-CTd for up to four 28-day induction cycles: C-500mg oral (PO) on days 1,8 and 15, T at 100-200mg PO on days 1 to 28, (d) at 40mg PO on days 1,8,15 and 22 and Dara at 16mg/Kg/dose intravenous (IV) on days 1,8,15 and 22 during cycles 1 - 2 and every other week in cycles 3 - 4, followed by ASCT. All pts received up to four 28-day consolidation cycles that was started at D+30 after ASCT: Dara at 16mg/Kg and (d) at 40mg every other week, associated with T at 100mg PO on days 1 - 28. Dara at 16mg/Kg was used monthly as maintenance until progression or limiting toxicity. G-CSF was used for stem cell (SC) mobilization and plerixafor had been allowed whenever the pts need. The MRD was evaluated by next-generation flow (NGF) based and PET-CT was performed when the patient obtained NGF negativity or finished consolidation. PFS outcome was estimated using Kaplan-Meier method. All pts received antiviral, anti-pneumocystis and anti-thrombotic prophylaxis. Data cut-off was June 15, 2021. Results: The first pts was enrolled in November 2018. A total of 24 pts were included, the median age being 60 (range 37- 67 years), 23 (92%) were non-white, 5 (21%) had an R-ISS = 1, 12 (54%) had an R-ISS = 2 and 4 (16%), an R-ISS = 3. Six (25%) pts had high-risk chromosomal abnormalities [del17p, t(4;14) or t(14;16)]. To date, all pts have completed induction, 20 have received transplant and 17 have completed D+90 post-transplant assessment. No SC mobilization failure was observed, and six (30%) pts needed plerixafor use. By ITT analysis after a median follow up of 20 months the PFS at 12 and 18 months was 86%. No PFS difference was observed between different subgroups. Regarding response rates, after the end of induction (cycle 4), 19 (90%) of the pts obtained > PR and 8 (38%) obtained >VGPR, including three MRD negativity by NGF. 17 pts have completed two consolidation cycles after transplant and 94% obtained > VGPR as best response, 13 (76%) obtained MRD negativity by NGF and 10 (58%) had negative PET-CT. Seven (41%) pts had both flow and PET-CT negativity. Six pts completed one year of maintenance and five of them (83%) still MRD negativity by NGF. Four pts died from infection, two of them related with covid infection (one before transplant and one during maintenance). Another case post-transplant, considered not related to the investigational agent and one after consolidation, related to the investigational agent. Two pts have discontinued treatment due to progression - 1 before ASCT e 1 during maintenance. The most common adverse events (AEs) grades 3 and 4 were neutropenia (n = 12), infusion reaction (n = 7), neuropathy (n = 6), lymphopenia (n = 4), infection (n = 3), hypertension (n = 1) and rash (n = 1). Summary/Conclusion: The Daratumumab - CTd protocol is an active regimen capable of producing deep and sustainable responses and improve the PFS of NDMM TE pts with a favorable safety profile. Clinical trial information: NCT03792620. Disclosures: De Queiroz Crusoe: Janssen: Research Fund ng. Hungria: Sanofi: Honoraria, Other: Support for attending meetings/travel;Takeda: Honoraria;Abbvie: Honoraria;Amgen, BMS, Celgene, Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending meetings/travel.

COVID-19 mortality in an area of northeast Brazil: epidemiological characteristics and prospective spatiotemporal modelling.

This study aimed to analyse the spatial-temporal distribution of COVID-19 mortality in Sergipe, Northeast, Brazil. It was an ecological study utilising spatiotemporal analysis techniques that included all deaths confirmed by COVID-19 in Sergipe, from 2 April to 14 June 2020. Mortality rates were calculated per 100 000 inhabitants and the temporal trends were analysed using a segmented log-linear model. For spatial analysis, the Kernel estimator was used and the crude mortality rates were smoothed by the empirical Bayesian method. The space-time prospective scan statistics applied the Poisson's probability distribution model. There were 391 COVID-19 registered deaths, with the majority among ⩾60 years old (62%) and males (53%). The most prevalent comorbidities were hypertension (40%), diabetes (31%) and cardiovascular disease (15%). An increasing mortality trend across the state was observed, with a higher increase in the countryside. An active spatiotemporal cluster of mortality comprising the metropolitan area and neighbouring cities was identified. The trend of COVID-19 mortality in Sergipe was increasing and the spatial distribution of deaths was heterogeneous with progression towards the countryside. Therefore, the use of spatial analysis techniques may contribute to surveillance and control of COVID-19 pandemic.

Risk clusters of COVID-19 transmission in northeastern Brazil: prospective space-time modelling.

This study aimed to analyse the trend and spatial-temporal clusters of risk of transmission of COVID-19 in northeastern Brazil. We conducted an ecological study using spatial and temporal trend analysis. All confirmed cases of COVID-19 in the Northeast region of Brazil were included, from 7 March to 22 May 2020. We used the segmented log-linear regression model to assess time trends, and the local empirical Bayesian estimator, the global and local Moran indexes for spatial analysis. The prospective space-time scan statistic was performed using the Poisson probability distribution model. There were 113 951 confirmed cases of COVID-19. The average incidence rate was 199.73 cases/100 000 inhabitants. We observed an increasing trend in the incidence rate in all states. Spatial autocorrelation was reported in metropolitan areas, and 178 municipalities were considered a priority, especially in the states of Ceará and Maranhão. We identified 11 spatiotemporal clusters of COVID-19 cases; the primary cluster included 70 municipalities from Ceará state. COVID-19 epidemic is increasing rapidly throughout the Northeast region of Brazil, with dispersion towards countryside. It was identified high risk clusters for COVID-19, especially in the coastal side.

Transcranial direct current stimulation as a strategy to manage COVID-19 pain and fatigue

The novel coronavirus disease (COVID-19) has infected millions of people worldwide and generated many sequels in the survivors, such as muscular pain and fatigue. These symptoms have been treated through pharmacological approaches;however, infected people keep presenting physical limitations. Besides, the COVID-19 damage to the central nervous system has also been related to the presence of some physical impairment, so strategies that focus on diverse brain areas should be encouraged. Transcranial Direct Current Stimulation (tDCS) is a non-pharmacological tool that could be associated with pharmacological treatments to improve the central nervous system function and decrease the exacerbation of the immune system response. tDCS targeting pain and fatigue-related areas could provide an increase in neuroplasticity and enhancements in physical functions. Moreover, it can be used in infirmaries and clinical centers to treat COVID-19 patients.

Adaptive modes of adult men during COVID-19: qualitative analysis under Roy's model

Objective. This study aims to understand how adult men adapt to the COVID-19 pandemic. Methods. Qualitative study involving 45 adult men residing in Brazil in 2020. Data were obtained from a Web Survey and treated using Reflective Thematic Analysis and interpreted in the light of Callista Roy's Adaptation Model. Results. The COVID-19 pandemic mobilized in men the ways of adaptation that are configured in: mobilization of the physiological-physical and regulatory dimension: adjustments in the sleep pattern, dietary pattern, and maintenance of physical activity;group self-concept identity: managing emotions;role function: self-knowledge and self-care;interdependence: adjustments in the marital relationship, family ties and paternity, investment in training and studies and control of excessive consumption of content on cell phones. Conclusion. The perception of the own vulnerability favored the entry of men into ways of adaptation in search of balance during the pandemic, motivating them to move through practices of taking care of themselves and taking care of others. Markers of psycho-emotional distress alert to adherence to new modes of care capable of promoting healthy transitions in the face of disruptions and uncertainties generated by the pandemic. This evidence can support the establishment of goals for nursing care aimed at men.