Skeletal muscle symptoms and their relationship with burnout syndrome in the work activities of administrative personnel of a university in Ecuador

Covid-19 pandemic changed the manner on how people work, forcing administrative staff of a public university to adopt biosecurity measures, modify job positions, increase working hours, which caused employees to be exposed to psychosocial and ergonomic risks, among others. For this reason, the aim of this research is to analyze musculoskeletal symptoms and their relationship with Burnout Syndrome in the administrative staff of the Technical University of Babahoyo during the year 2021. Research with a descriptive-correlational approach. The participant population was 119 people. The Nordic Kuorinka and Maslach Burnout Inventory questionnaires were used for the variable's musculoskeletal symptoms and Burnout Syndrome respectively. The results show that all the collaborators show musculoskeletal symptoms at different levels of affectation, the highest percentage being found in the back, then the neck, followed by the shoulder and in a lower proportion the hand-wrist and elbow-forearm segments. The prevailing level of Burnout Syndrome in the administrative personnel is low with 55, 5%, followed by a medium level of 34, 5%. To conclude, the investigation reveals that there is a correlation between the two variables;therefore, one of the causes of the prevalence of musculoskeletal symptoms in university workers is Burnout Syndrome, which can affect the health of collaborators over time. © 2022 Latin American and Caribbean Consortium of Engineering Institutions. All rights reserved.

ACUTE KIDNEY INJURY IN COVID-19 PATIENTS: MEDIUM-TERM EVOLUTION OF RENAL FUNCTION

BACKGROUND AND AIMS: Acute kidney injury (AKI) is a common complication among patients hospitalized with COVID-19. The incidence of AKI is estimated to be around 5%-80%, according to the series, but data on renal function evolution is limited. Our main objective was to describe the incidence of AKI in patients with SARS-CoV-2 infection;secondarily, we analysed the severity of AKI and medium-term renal function evolution in these patients. METHOD: A retrospective observational study that included patients hospitalized a single hospital, diagnosed with SARS-CoV-2 infection, who developed AKI (March- May 2020). We register clinical and demographic characteristics, creatinine upon admission and prior to discharge, as well as creatinine and CKD-EPI glomerular filtration rate (eGFR) after at least 3 months after discharge. CKD was defined according to KDIGO stages based on the eGFR (G3-G5). The KDIGO classification was used to define and classify AKI. Recovery of kidney function was defined as difference in at discharge or post-hospitalization creatinine < 0.3 mg/dL with respect basal creatinine. The clinical follow-up ranged from admission to death or end of study. RESULTS: Of 258 patients hospitalized with SARS-CoV-2 infection, AKI occurred in 73 (28.3%). 63% (n = 46) were men;the mean of age was 69 years (57-76). DRA severity: 35 (48%) KDIGO-1, 15 (21%) KDIGO-2 and 23 (31%) KDIGO-3. The mean stay was associated with the severity of AKI: 7 days (3-11) for KDIGO-1, 11 days for KDIGO-2 (5-22) and 12 days (8-35) for KDIGO-3 (P = .02). The stage of CKD established differences in the severity of AKI: 66.6% (n = 6) of the patients with CKD G4-G5 presented AKI-KDIGO 3 versus only 25.0% (n = 4) in the CKD-G3 patients (P = .02). Admission to the ICU was more frequent in KDIGO 2-3 versus KDIGO-1 [39% (n = 15) versus 9% (n = 3);P < .01]. Of the 48 patients discharged, 30 (62.5%) had recovered their baseline renal function upon discharge. Only 2 are still on RRT after 8 months (2.7% of all patients). Of the 25 patients died (34% of patients with AKI) with a median time of 3 days from DRA diagnosis (1-8). Renal function of 35 patients was monitored, which correspond to 19 (54%) KDIGO- 1, 8 (23%) KDIGO-2, 8 (23%) KDIGO-3 stages. In these patients, analytical control starting 3 months after hospitalization revealed FG 66 (SD 30;56-76) mL/min/1.73 m2. We have not found differences in renal function between pre- and posthospitalization in related test. A total of 77% (n = 37) of discharged patients recovered their baseline renal function in the post-hospitalization control. CONCLUSION: The incidence of AKI in the context of COVID-19 in our series was 28.3%, with an associated mortality of 34.2%. Most of the patients presented with AKI KDIGO 1 (47.9%). The severity of AKI is associated with a longer hospital stay, admission to the ICU and the requirement for RRT. The advanced stages of CKD preadmission showed more severity of AKI. The maintenance in TRS in our series has been 2.7%. Patients who were discharged for recovery/improvement of COVID-19 had normalized kidney function during subsequent follow-up, regardless of the severity of the AKI developed on admission for COVID-19. (Figure Presented).

How stable are visions for protected area management? Stakeholder perspectives before and during a pandemic

Envisioning processes enable protected area managers to chart a course for future management to reach desired goals, but unexpected changes that could affect future visions are not usually considered. The global COVID-19 pandemic provided an opportunity to explore changes in stakeholder visions, the values that underpin the visions, and their perceptions of landscape changes and the underlying drivers (e.g. climate change, mass tourism and demographic trends). Through a mixed-methods approach in this post-evaluation study, we gathered comparative data on these issues from stakeholders in the Sierra de Guadarrama National Park, Spain, between July 2019 (pre-pandemic) and October 2020 (mid-pandemic). Our qualitative analysis demonstrates that pre-pandemic, differences in visions for protected area management were largely spurred by different perceptions of drivers of change, rather than differences in values or perceived landscape changes, which were similar across different vision themes. One year later, in the midst of the COVID-19 pandemic, the majority of stakeholders reported that their values, visions and perceptions of drivers did not change despite this large-scale disturbance. Of the 20%–30% of stakeholders that did report changes, visions generally shifted towards greater prioritization of biodiversity and nature conservation as a result of heightened perceptions of the impacts of drivers of change associated with an increase in the numbers of park visitors. These drivers included mass tourism, mountain recreation, lack of environmental awareness, and change in values and traditions. Our findings reinforce the importance of adaptive and inclusive management of protected areas, including enhancing transparency and communications regarding factors driving change in the landscape, and integration of local and traditional knowledge and stakeholder perceptions of changes and drivers. Furthermore, management plans integrating stakeholder values have the potential to stay relevant even in the face of wildcard events such as a pandemic. To enhance the relevancy of visions and scenarios in conservation and land-use planning, scenario planning methodologies should more strongly consider different potential disturbances and how drivers of change in the near and far future can be affected by wildcard events such as a pandemic. A free Plain Language Summary can be found within the Supporting Information of this article. © 2021 The Authors. People and Nature published by John Wiley & Sons Ltd on behalf of British Ecological Society

Effect COVID-19 pandemic in an emergency department in Argentina

The objective of this study was to reveal how the COVID-19 pandemic process affected the number of visits to an emergency department of a highly complex hospital located in the Ciudad Autonoma de Buenos Aires, to explore the characteristics and reasons for consultation. The monthly number of visits between January 2019 and December 2020 was analyzed. The data showed a strong decrease in the number of visits (176 370 in 2019 and 95 421 in 2020), with an abrupt drop after the lockdown disposal (In aprilshowed the maximum reduction: 77.1%), and the different stages are reflected in the evolution (a consequence of quarantine), yielding a global annual reduction of 45.9%. The number of patients admitted by ambulances increased (5.1% in 2019 to 10.4% in 2020;p < 0.05), and consequently, the number of patients in the more complex sector (area B 2019: 5.3%, 2020: 11.5%;p < 0.01), as well as unscheduled hospitalizations from 6.8% (95% CI 6.7-6.9) to 12.1% in 2020 (95%CI11.8-12.3), p < 0.01. The five most frequent reasons for consultation in 2020 were: fever (5.1%), odynophagia (4.7%), abdominal pain (2.6%), cough (1.8%) and headache (1.8%), probably all related to COVID-19. In conclusion, the number of emergency department visits decreased by half compared to the previous year.

Incidence and evolution of SARS-CoV2 infection in patients with inflammatory bowel disease in Southern Spain (Andalusia)

Introduction: The respiratory infection caused by SARS-CoV2, known as COVID-19, has presented a fast worldwide expansion with significant sanitary repercussion as well as social and economic. Globally, patients with inflammatory bowel disease (IBD) have been considered as population at risk for viral infections. To date, the evidence has not proved an increased risk for COVID-19 in this group. Aims & Methods: Our aim was to describe the main characteristics of our IBD patients who suffered SARS-CoV2 infection and to analyze both the evolution of their IBD and the infection's evolution. An observational, longitudinal, ambispective and multicentric study was performed. Patients with IBD with positive SARS-CoV2 PCR were included. Demographic variables along with data regarding to the COVID-19 infection were collected. SPSS® software version 20.0 was used for the statistic analysis. Results: We included 97 patients, 51.5% men. Overall mean age 43 (16-73) years old. Active smokers 13.5%, hypertensive 15.5%, diabetics 7.2% and obese 6.2%. According to the IBD 39.2% suffered from ulcerative colitis (UC), 55.7% Crohn's disease (CD), 2.1% linfocitic colitis and 2.1% indeterminate colitis. Mean IBD duration was 10.3 (SD 8.3) years. Perianal disease was present in 16.5% and extraintestinal manifestations (EIMs) 26.8% (77% joint involvement). Upon the time of infection 28.4% had active IBD. Regarding treatment, 55.7% were on aminosalycilates (5ASA), 45.8% on immunosuppressants, 25% on steroids and 41.7% on biologics. The main symptoms of SARS-CoV2 infection were astenia (62%), cough (60%), fever (58%), headache (52%) and diarrhoea (45%). Hospital admission was required in 24.2% (61% suffering from severe respiratory disease) and ICU was required in 17.4% of them. There were no deaths. Compared to those who did not need hospital admission;the admitted patients were older (50 vs 40 years old, p=0.006), were more likely to be obese (20% vs 2.8%, p=0.017), to suffer from hypertension (39% vs 8.3%, p=0.0001), from heart failure (13% vs 0%, p=0.002), had more EIMs (43.5% vs 22.2%, p= 0.047), had a higher previous hospitalization within the last 3 months (43.3% vs 8.3%, p=0.002), were more on 5ASA (91.3% vs 45.8%, p=0.0001) and showed higher C-reactive protein levels (71 vs 13.7, p=0.017). Hospitalized patients were more likely to present diarrhoea (63.8% vs 36.2%, p=0.009), dyspnoea (65.2% vs 20.6%, p=0.0001), hypoxemia (39.1% vs 1.5%, p=0.0001), hyporexia (60.9% vs 19.1%, p=0.0001), abdominal pain (36.4% vs 14.5%, p=0.025) and fever (82.6% vs 50%, p=0.006). Related to need of ICU admission, EIMs (75% vs 25.3%, p=0.029) and previous admission within the last 3 months (50% vs 13.2%, p=0.042), were more frequent. Neither immunosuppressant treatment (45.8% vs 47.8%, p=0.87) nor biologic therapy (43.1% vs 34.8%, p=0.48) were related to the need for hospital admission. Conclusion: A quarter part of the patients with IBD and SARS-CoV2 infection needed hospitalisation. An older age, presence of comorbidities, hospital admission within the previous 3 months, treatment with 5ASA and EIMs were more frequent in those requiring admission. There was not identified any relation between active IBD or the use of immunosuppressants/ biologics and a worse evolution of the infection.

Influence of COVID-19 on inflammatory bowel disease patients and biological treatment

Introduction: Inflammatory bowel disease (IBD) patients undergoing treatment with drugs that act on the immune system present an increased risk of infections in general1. For this reason, we could consider that these patients may have an increased risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, however, it remains unclear2. We aimed to analyze the cumulative incidence, the severity of the SARS-COV2 infection and its influence on the natural history of IBD in patients under biological treatment, also evaluating the possible differences with another group without these treatments. Aims & Methods: Retrospective observational study about our IBD patients followed between March 2020 and January 2021 divided into two groups: patients on treatment with biological drugs (anti-TNF, vedolizumab, ustekinumab and tofacitinib) and patients without biological therapy as thiopurines or mesalamine (5-ASA). We evaluated: the cumulative incidence in 10 months for COVID-19 in the 2 cohorts;clinical variables considered risk factors for the infection (sex, age, hypertension, diabetes, dyslipidemia, cardiovascular disease, body mass index)3,4;the infection severity (visits to the emergency room, need for hospital admission, type of treatment received) and influence on the course of IBD (Harvey- Bradshaw index and Mayo partial in Crohn's disease and ulcerative colitis respectively, before and after COVID-19). Results: It collected 755 IBD patients treated in our centre. Of these, a total of 89 patients were infected by SARS-COV-2, 43 belonged to the biologics group and 46 were to 5-ASA and thiopurines group treatment. Only 3 patients out of 89 were being treated with corticosteroids. We verified the groups' comparability discarded the existence of statistical differences in age, sex distribution and the rest of the risk factor's. The cumulative incidence in 10 months was 10.85% in the biologics group and 12.81% in the group without biologics, with no incidence significant differences. In most cases, the infection was mild (94.4%) and the required treatment was symptomatic in 86.4% of the total, without significant differences between groups. Pneumonia was diagnosed in 5 patients, whose required hospital admission (3 belonged to the biological group and 2 to the other). Only 18 patients (20,2%) required one emergency room visit and the rest none. The maximum respiratory support required was FIO2 36%, no patient required admission to the intensive care unit and there were no deaths. Additionally, the course of IBD was not affected as a result of COVID-19, considering no significant differences were observed in clinical scores in each group before and after infection, even though 14 of the patients in the biological group discontinued these medications temporarily during infection (mean 2.87 weeks). None of the patients in the thiopurines and 5-ASA group discontinued the drug Conclusion: Our study suggests that IBD patients under biological treatment do not have an increased incidence of SARS-COV-2 infection and also do not have a higher risk of severe disease than IBD patients with other treatments (5-ASA or thiopurines).

Experience with tocilizumab in severe acute respiratory syndrome coronavirus 2 (Sarscov-2) infection

Background and importance Tocilizumab is an immunosuppressive agent which has demonstrated high efficacy in clinical trials for the treatment of coronavirus because its mechanism of action seems to inhibit the inflammatory cascade. Aim and objectives To evaluate the efficacy and safety of tocilizumab during the global pandemic. Material and methods A descriptive, observational, prospective study was conducted in patients receiving treatment with tocilizumab for SARS-CoV-2 during the pandemic in March 2020. Clinical data were collected: sex, age, medical history, diagnosis, hospitalisation days, patients admitted to the intensive care unit (ICU), patients who required mechanical ventilation, dose of tocilizumab, time from onset of symptoms to administration, concomitant drugs for SARS-CoV-2, final situation and adverse reactions. The data were obtained from the electronic medical records. All patients met the criteria established by the Spanish Agency of Medicines and Medical Devices (AEMPS): adequate biochemical parameters and absence of ongoing infections. Results 130 patients were included in the study, 8 patients met the criteria of AEMPS, 75% were men and mean age was 70 (57-83) years. Background: 50% had arterial hypertension, 37.5% heart disease, 25% diabetes, 25% chronic obstructive pulmonary disease and 12.5% active neoplasia. The diagnosis was severe pneumonia in all cases. The average duration of hospitalisation was 29 (4-73) days. 50% of patients were admitted to the ICU and required mechanical ventilation. In 75%, the dose was 600 mg and the rest required 400 mg, all single doses. The average time from symptom onset to drug administration was 15 (10-30) days. Concomitant drug therapy for SARSCoV-2: 100% hydroxychloroquine with azithromycin, 87.5% lopinavir/ritonavir, 37.5% methylprednisolone boluses, 25% oral methylprednisolone and 12.5% interferon-β-1b. 87.5% of patients were discharged. No adverse reactions were reported. Conclusion and relevance Treatment with tocilizumab could be considered a safe and effective option in patients with severe SARS-CoV-2 pneumonia. Further studies are necessary to confirm these preliminary results. Adjustment of the treatments to the criteria established by the regulatory agencies and the recording of health outcomes could contribute to more efficient therapies.

Telepharmacy during sars-cov-2

Background and importance With the arrival of the global SARS-CoV-2 pandemic, hospital pharmacy services (HPS) have had to adapt to emerging needs. One of these measures has been the sending of medicines to vulnerable patients who, due to their pathologies, are discouraged from attending the hospital. Aim and objectives To analyse shipments and to evaluate the degree of patient satisfaction. Material and methods A retrospective study of shipments made between March and June 2020 in the outpatient department (OPD) of a tertiary hospital was conducted. Data were collected from the Farmatools drug dispensing programme and the citation lists of Jara Asistencial. The selected patients were those who were cited at the OPD, who did not have a face-to-face appointment with the doctor and accepted the referral. To measure the degree of user satisfaction, anonymous telephone surveys were made and evaluated by assigning a score from 0 to 10. The questions included aspects related to the attention received, schedule, information on the medication and overall satisfaction. A free field for suggestions for improvement was also included. A satisfied patient was defined as one whose global score was higher than 9. Results Of all the patients cited between March and June 2020 (2178 patients) by the HPS, 1284 (60%) were candidates for referral. Of the selected patients, 53% were finally sent the medication. 54% were from towns near Badajoz and the rest were from the capital city. Mean age was 53.5 years and 51.5% were women. The pathologies with the highest percentage of referrals with respect to the total number of patients registered in the OPD were: 83% primary biliary cirrhosis (5/6), 76% primary hyperparathyroidism (25/33), 73% inhibitors of PCSK9 (24/33) and 72% idiopathic pulmonary fibrosis (18/25). A total of 128 (64%) surveys were completed out of the 200 calls made. The average value of the responses obtained was higher than 9. Regarding the suggestions section, all survey respondents except one agreed to resume the medication delivery service. Conclusion and relevance Telepharmacy was a useful tool for the provision of pharmaceutical care, with a high acceptance rate by patients. It would be necessary to evaluate the inclusion of this service within the HPS.

Validation of Remote Administration of Social Cognitive Assessments in Pregnant Women

Background: Social cognition, and its relation to social behaviors during pregnancy and postpartum, merits further investigation. Additionally, the Covid-19 pandemic has increased the need to administer assessments remotely. We aimed to validate remote administration of social cognition tasks (the Movie for the Assessment of Social Cognition (MASC) and the Reading of the Mind in the Eyes (RMET)) in pregnant women. Methods: We compared performance of 15 pregnant women (mean age=20.71,SD=6.17) on the MASC administered via zoom and RMET via an online survey platform with 17 non-pregnant women (mean age=38.52,SD=12.46), who completed them in-person prior to the pandemic. Participants also completed self-report assessments of social support (Interpersonal Support Evaluation List (ISEL);Social Network Index (SNI)). Results: Since there were significant age differences between groups, age was entered as a covariate. MASC scores did not differ between remote (mean=32.07,SD=4.88) and in-person (mean=33.19,SD=7.00) administration, F(1,33)=0.131,p=0.720). RMET accuracy also did not differ between remote (mean=24.53,SD=3.63) and in-person (mean=26.75,SD=7.09) administration, F(1,22)=0.901,p=0.353). RMET and MASC hypomentalizing errors were negatively correlated (r= -0.451, p=0.03) and there was a trend level correlation between the MASC and RMET (r=0.394, p=0.063). MASC accuracy correlated with ISEL total (r=0.415, p=0.05), and RMET with SNI diversity (r=0.547, p=0.02) and number (r=0.521, p=0.03) of people within one’s social network. Conclusions: Social cognition tasks correlated with self-reported social support, validating the use of these assessments in pregnant women. Results also support the validity of remote administration for social cognition measures, which allows for greater access to vulnerable populations, although pregnancy may have influenced performance. Supported By: Icahn School of Medicine at Mount Sinai Keywords: Social Cognition, Remote Assessment, Pregnancy