The Impact of the COVID-19 Pandemic on Surgical Services in Brazil's Healthcare System: A Retrospective Cross-Sectional Study.

Background The coronavirus disease 2019 (COVID-19) pandemic provoked disruptions in healthcare delivery, leading to the cancellation and postponement of various health services, including surgery. Numerous countries closed their borders and established laws mandating the use of face masks and social distancing and enforced lockdowns, and various activities were constrained. Brazil, the largest and most populous country in Latin America, also experienced a rapid and sustained surge in infections and deaths. Brazil was the most severely impacted nation in Latin America. The impact of the pandemic on surgical services in Brazil has not been adequately studied since most studies only cover the early phases of the pandemic. Thus, this study aimed to assess the impact of the COVID-19 pandemic on surgical services throughout the entire period. Methods A retrospective cross-sectional design was used to examine surgical cases from 2019 to 2022 and compared the following indicators: (1) number of hospital admissions, (2) length of hospital stay (LOS) (in days), and (3) volume of urgent and elective procedures. Data was divided into four time periods, pre-pandemic (March-December 2019), pandemic (March-December 2020), recovery (March-December 2021), and post-pandemic (March-December 2022), and was analyzed for the number of admissions and LOS based on surgical procedures performed by stratifying according to region, sex, age, and type of surgery (urgent versus elective). Results The number of admissions for surgical procedures ranged between 859,646 and 4,015,624 for 2019, 686,616 and 3,419,234 for 2020, 787,791 and 3,829,019 for 2021, and 760,512 and 3,857,817 for 2022 for the category of region; 4,260,900 and 5,991,775 for 2019, 3,594,117 and 4,984,710 for 2020, 4,182,640 and 5,590,808 for 2021, and 4,077,651 and 5,561,928 for 2022 for the category of sex; and 2,170,288 and 3,186,117 for 2019, 1,516,830 and 2,825,189 for 2020, 1,748,202 and 3,030,272 for 2021, and 1,900,023 and 2,859,179 for 2022 for the category of age. The variable age showed a comparable trend, albeit with an expressive decline for surgeries in the age range of 0-19 years. The LOS (in days) for surgical procedures ranged between 110,157 and 910,846 for 2019, 58,562 and 897,734 for 2020, 67,926 and 904,137 for 2021, and 100,467 and 823,545 for 2022. Thoracic surgery indicated no statistically significant difference in the number of admissions and LOS. Elective surgeries had a decline in the number of admissions and LOS, a 13% and 9.3% decline between 2019 and 2020, respectively. Urgent surgeries experienced a slight decrease in admissions and LOS, with a decline of 2.4% and 2.8% between 2019 and 2020, respectively. Conclusions Population characteristics, such as age, sex, and region, showed decreased hospital admissions during the pandemic, followed by a recovery toward pre-pandemic levels afterward. The number of surgical admissions and the length of hospital stays decreased during the pandemic but gradually returned to pre-pandemic levels in the recovery and post-pandemic phases. Notably, thoracic surgery remained statistically consistent across all periods, indicating its emergency nature compared to other surgeries. Thus, we conclude that the pandemic had minimal impact on thoracic surgery cases, contributing to a stable trend.

Interdisciplinary approaches to the teaching of forensic science in the Forensic Science Undergraduate Program of the National Autonomous University of Mexico, before and after COVID-19.

In 2013, the Forensic Science Undergraduate Program (FSUP) at the National Autonomous University of Mexico was created in response to an alarming criminal situation in Mexico, as well as to the radical reform of its criminal justice system. Its mission is to educate and train ethical, critical, and humanistic forensic scientists capable of conducting inquiries that meet scientific quality standards and assist the justice system in firmly linking legal rulings to the available evidence. At the time, it was the first such program in the country, and the contributions that interdisciplinary forensic scientists could make to criminal investigations were largely unknown among forensic and legal practitioners. During its existence, providing an interdisciplinary, competence-based education to students has been one of the main challenges. To overcome it, teaching and assessment approaches-centered on the achievement of specifically forensic competencies as learning outcomes and the integration of forensic disciplines towards the resolution of simulated cases-have been devised to help develop the professional skill set expected of graduates. The COVID-19 pandemic led to adapting these approaches to distance or hybrid modes of learning, increasing their versatility and enriching the pedagogic repertoire of the FSUP. Currently, the main impact of the program lies in the successful incorporation of some of its graduates to agencies belonging to or related to the criminal justice system, such as the National Prosecutor's Office, the Commission for Truth and Justice for the Ayotzinapa Case, and the National Commission for the Search of Missing and Disappeared Persons, among others.

Diagnostic performance of the RSNA-proposed classification for COVID-19 pneumonia versus pre-pandemic controls.

OBJECTIVE: To evaluate the diagnostic accuracy of the Radiological Society of North America (RSNA) classification system for coronavirus disease 2019 (COVID-19) pneumonia compared to pre-pandemic chest computed tomography (CT) scan images to mitigate the risk of bias regarding the reference standard. MATERIALS AND METHODS: This was a retrospective, cross-sectional, diagnostic test accuracy study. Chest CT scans, carried out from May 1 to June 30, 2020, and from May 1 to July 17, 2017, were consecutively selected for the COVID-19 (positive reverse transcription-polymerase chain reaction [RT-PCR] for severe acute respiratory syndrome coronavirus 2 result) and control (pre-pandemic) groups, respectively. Four expert thoracic radiologists blindly interpreted each CT scan image. Sensitivity and specificity were calculated. RESULTS: A total of 160 chest CT scan images were included: 79 in the COVID-19 group (56 [43.5-67] years old, 41 men) and 81 in the control group (62 [52-72] years old, 44 men). Typically, an estimated specificity of 98.5% (95% confidence interval [CI] 98.1%-98.4%) was obtained. For the indeterminate classification as a diagnostic threshold, an estimated sensitivity of 88.3% (95% CI 84.7%-91.7%) and a specificity of 79.0% (95% CI 74.5%-83.4%), with an area under the curve of 0.865 (95% CI 0.838-0.895), were obtained. CONCLUSION: The RSNA classification system shows strong diagnostic accuracy for COVID-19 pneumonia, even against pre-pandemic controls. It can be an important aid in clinical decision-making, especially when a typical or indeterminate pattern is found, possibly advising retesting following an initial negative RT-PCR result and streamlining early management and isolation.

Diagnostic performance of the RSNA-proposed classification for COVID-19 pneumonia versus pre-pandemic controls

Abstract Objective To evaluate the diagnostic accuracy of the Radiological Society of North America (RSNA) classification system for coronavirus disease 2019 (COVID-19) pneumonia compared to pre-pandemic chest computed tomography (CT) scan images to mitigate the risk of bias regarding the reference standard. Materials and methods This was a retrospective, cross-sectional, diagnostic test accuracy study. Chest CT scans, carried out from May 1 to June 30, 2020, and from May 1 to July 17, 2017, were consecutively selected for the COVID-19 (positive reverse transcription-polymerase chain reaction [RT-PCR] for severe acute respiratory syndrome coronavirus 2 result) and control (pre-pandemic) groups, respectively. Four expert thoracic radiologists blindly interpreted each CT scan image. Sensitivity and specificity were calculated. Results A total of 160 chest CT scan images were included: 79 in the COVID-19 group (56 [43.5-67] years old, 41 men) and 81 in the control group (62 [52-72] years old, 44 men). Typically, an estimated specificity of 98.5% (95% confidence interval [CI] 98.1%-98.4%) was obtained. For the indeterminate classification as a diagnostic threshold, an estimated sensitivity of 88.3% (95% CI 84.7%-91.7%) and a specificity of 79.0% (95% CI 74.5%-83.4%), with an area under the curve of 0.865 (95% CI 0.838-0.895), were obtained. Conclusion The RSNA classification system shows strong diagnostic accuracy for COVID-19 pneumonia, even against pre-pandemic controls. It can be an important aid in clinical decision-making, especially when a typical or indeterminate pattern is found, possibly advising retesting following an initial negative RT-PCR result and streamlining early management and isolation.