Pharmacotherapy and clinical outcomes of hospitalized COVID-19 patients in Chile during the first wave of pandemic

Background: The largest growth in cases of COVID-19 worldwide during 2020 was in the Americas, and Chile was one of the most affected countries. Aim: To describe, characterize, and evaluate the use of drugs as treatment for COVID-19 in hospitalized patients in Chile during the first wave of the pandemic. Methods: We performed a multicenter, observational study that included 442 patients with confirmed SARS-CoV-2 infection admitted in Chilean hospitals between March 21 and September 22, 2020. The analysis included demographics, comorbidities, specific drug therapy, and outcomes over a 28-day follow-up period. Results: The median age of patients was 68 years (IQR 55-73), and 38.9% were women. The most common comorbidities were hypertension (57.7%) and diabetes (36.9%). Fifty-seven (12.9%) patients died. Hypertension (HR 2.99; CI 95% 1.43-6.26) and age ≥ 65 (2.14; CI 95% 1.10- 4.17) were the main predictors of mortality. Primary drugs were azithromycin (58.8%) and corticosteroids (51.1%). In this sample, azithromycin was a protective factor regarding mortality (HR 0.53; CI 95% 0.31-0.90), increasing clinical improvement and avoiding progression. Conclusions: The patterns of use of drugs to treat COVID-19 in Chile during the first wave of the pandemic were very dynamic and followed the international, evidence-based guidelines. The low mortality rate indicates that the clinical management of hospitalized patients was adequate.

Antecedentes: Durante 2020, el mayor incremento de casos de COVID-19 se observó en el continente americano, donde Chile fue uno de los países más afectados. Objetivos: Describir, caracterizar y evaluar el uso de fármacos indicados para tratar el COVID-19 en pacientes hospitalizados en Chile durante la primera ola de pandemia. Pacientes y Métodos: Un estudio multicéntrico observacional incorporó a 442 pacientes con infección confirmada por SARS- CoV-2 admitidos en hospitales chilenos entre el 21 de marzo y el 22 de septiembre de 2020. Se analizaron variables demográficas, comorbilidades, terapia farmacológica específica y desenlaces clínicos para un período de seguimiento de 28 días. Resultados: La mediana de la edad fue de 68 años (RIC 55-73), y un 38,9% fueron mujeres. Las comorbilidades más comunes fueron hipertensión (57,7%) y diabetes (36,9%). Cincuenta y siete (12,9%) de los pacientes murieron. Los principales predictores de mortalidad fueron la hipertensión (HR 2,99; IC 95% 1,43-6,26) y la edad ≥ 65 años (2,14; IC 95% 1,10- 4,17). Los fármacos más utilizados fueron azitromicina (58,8%) y corticosteroides (51,1%). En esta muestra, la azitromicina fue un factor de protección respecto a la mortalidad (HR 0,53; IC 95% 0,31-0,90), incrementando igualmente la mejoría y evitando la progresión. Conclusiones: Los patrones de uso de fármacos para tatar COVID-19 en Chile durante la primera ola de pandemia fueron muy dinámicos y siguieron las directrices internacionales basadas en la evidencia. La baja mortalidad sugiere que el manejo de los pacientes hospitalizados fue adecuado.

Pharmacotherapy and clinical outcomes of hospitalized COVID-19 patients in Chile during the first wave of pandemic.

BACKGROUND: The largest growth in cases of COVID-19 worldwide during 2020 was in the Americas, and Chile was one of the most affected countries. AIM: To describe, characterize, and evaluate the use of drugs as treatment for COVID-19 in hospitalized patients in Chile during the first wave of the pandemic. METHODS: We performed a multicenter, observational study that included 442 patients with confirmed SARS-CoV-2 infection admitted in Chilean hospitals between March 21 and September 22, 2020. The analysis included demographics, comorbidities, specific drug therapy, and outcomes over a 28-day follow-up period. RESULTS: The median age of patients was 68 years (IQR 55-73), and 38.9% were women. The most common comorbidities were hypertension (57.7%) and diabetes (36.9%). Fifty-seven (12.9%) patients died. Hypertension (HR 2.99; CI 95% 1.43-6.26) and age ≥ 65 (2.14; CI 95% 1.10- 4.17) were the main predictors of mortality. Primary drugs were azithromycin (58.8%) and corticosteroids (51.1%). In this sample, azithromycin was a protective factor regarding mortality (HR 0.53; CI 95% 0.31-0.90), increasing clinical improvement and avoiding progression. CONCLUSIONS: The patterns of use of drugs to treat COVID-19 in Chile during the first wave of the pandemic were very dynamic and followed the international, evidence-based guidelines. The low mortality rate indicates that the clinical management of hospitalized patients was adequate.

West Syndrome in Children With Congenital Zika Virus Infection.

Congenital Zika infection has been linked with a characteristic phenotype including neurologic sequelae. However, West syndrome has not been previously well described as a consequence. We aim to show this association through a retrospective descriptive study performed in Ecuador. Among 147 infants with congenital Zika infection, 7.5% suffered from West syndrome. Vigabatrin seems to be effective to control the spasms.

Long-Term Outcomes of Infants with Congenital Zika Virus Infection in Ecuador: A Retrospective Longitudinal Study.

BACKGROUND: Few congenital Zika syndrome (CZS) cases have been notified in Ecuador and, to our knowledge, there are no significant published studies dealing with their clinical evolution. We present a detailed clinical characterization of 21 children with congenital Zika virus (ZIKV) infection born in Ecuador who were followed up until September 2019. METHODS: We did a retrospective longitudinal study of children attended by the infectious disease specialists of Francisco Icaza Bustamante Children's Hospital (Guayaquil) due to congenital ZIKV infection suspicion. The inclusion criteria consisted of laboratory confirmed diagnosis of congenital ZIKV infection. RESULTS: Sixteen of these 21 cases of congenital ZIKV infection showed clinical, neuroimaging and laboratory findings strongly suggestive of CZS and 5 children showed laboratory findings compatible with congenital ZIKV infection without congenital manifestations associated to CZS. All children with CZS showed neurodevelopmental delay, spasticity and hyperreflexia during follow-up, whereas the majority of them (14/15) experienced recurrent epileptic seizures and dysphagia (12/13). Two CZS cases died during follow-up. Visual evoked potential and hearing screening with acoustically evoked auditory brainstem response were abnormal in 50% and 37.5% of CZS cases, respectively. Congenital ZIKV infection without findings consistent with CZS at birth was not clinically relevant at 23 months of age in the five cases of our cohort. CONCLUSIONS: Severe neurodevelopmental delay, severe microcephaly, epileptic seizures and dysphagia were present at 2 years of age in most CZS cases of our cohort.

[Neutropenia associated with the use of cefepime in pediatric patients with cystic fibrosis]. / Neutropenia asociada al uso de cefepime en pacientes pediátricos con fibrosis quística.

Pulmonary exacerbations of infectious cause are one of the major complications in patients with cystic fibrosis (CF). These are associated with a progressive increase in morbidity and mortality. The treatment depending on the isolated microorganism. The ß-lactam antibiotics are generally used which are not exempt from adverse reactions. Next, two report of neutropenia cases are described after prolonged use of cefepime in CF patients.

Neutropenia asociada al uso de cefepime en pacientes pediátricos con fibrosis quística / Neutropenia associated with the use of cefepime in pediatric patients with cystic fibrosis

Resumen Las exacerbaciones pulmonares de causa infecciosa son una de las mayores complicaciones en los pacientes con fibrosis quística (FQ). Estas se asocian a un progresivo aumento en la morbilidad y mortalidad. El tratamiento antimicrobiano se realiza dependiendo del microorganismo aislado. Con frecuencia se utilizan antimicrobianos β-lactámicos, los cuales no están exentos de reacciones adversas. A continuación, se describen dos casos de neutropenia tras el uso prolongado de cefepime en pacientes con FQ.

Pulmonary exacerbations of infectious cause are one of the major complications in patients with cystic fibrosis (CF). These are associated with a progressive increase in morbidity and mortality. The treatment depending on the isolated microorganism. The β-lactam antibiotics are generally used which are not exempt from adverse reactions. Next, two report of neutropenia cases are described after prolonged use of cefepime in CF patients.

Consenso de farmacia clínica intensiva a nivel nacional / Consensus about the duties of pharmacists in intensive care units in Chile

In 2015, the directors of the Clinical Pharmacists Division of the Chilean Society of Intensive Care Medicine (SOCHIMI) organized a collaborative work along the country to define the minimum activities and duties that a pharmacist should perform in an Intensive Care Unit in Chile, according to the Ministry of Health and SOCHIMI guidelines and recommendations. This document summarizes the agreements on three priority areas of pharmacists' duties in intensive care: a) pharmacotherapy follow-up; b) pharmacological surveillance and security management of medications, and c) data recording and documentation. The recommendations collect the experiences from Chilean pharmacists along the country and provide information and support for future consensus for other specialties.

[Consensus about the duties of pharmacists in intensive care units in Chile]. / Consenso de farmacia clínica intensiva a nivel nacional.

In 2015, the directors of the Clinical Pharmacists Division of the Chilean Society of Intensive Care Medicine (SOCHIMI) organized a collaborative work along the country to define the minimum activities and duties that a pharmacist should perform in an Intensive Care Unit in Chile, according to the Ministry of Health and SOCHIMI guidelines and recommendations. This document summarizes the agreements on three priority areas of pharmacists' duties in intensive care: a) pharmacotherapy follow-up; b) pharmacological surveillance and security management of medications, and c) data recording and documentation. The recommendations collect the experiences from Chilean pharmacists along the country and provide information and support for future consensus for other specialties.

The Intra-Americas Sea low-level jet: overview and future research.

A relevant climate feature of the Intra-Americas Sea (IAS) is the low-level jet (IALLJ) dominating the IAS circulation, both in summer and winter; and yet it is practically unknown with regard to its nature, structure, interactions with mid-latitude and tropical phenomena, and its role in regional weather and climate. This paper updates IALLJ current knowledge and its contribution to IAS circulation-precipitation patterns and presents recent findings about the IALLJ based on first in situ observations during Phase 3 of the Experimento Climático en las Albercas de Agua Cálida (ECAC), an international field campaign to study IALLJ dynamics during July 2001. Nonhydrostatic fifth-generation Pennsylvania State University National Center for Atmospheric Research Mesoscale Model (MM5) simulations were compared with observations and reanalysis. Large-scale circulation patterns of the IALLJ northern hemisphere summer and winter components suggest that trades, and so the IALLJ, are responding to land-ocean thermal contrasts during the summer season of each continent. The IALLJ is a natural component of the American monsoons as a result of the continent's approximate north-south land distribution. During warm (cold) El Niño-Southern Oscillation phases, winds associated with the IALLJ core (IALLJC) are stronger (weaker) than normal, so precipitation anomalies are positive (negative) in the western Caribbean near Central America and negative (positive) in the central IAS. During the ECAC Phase 3, strong surface winds associated with the IALLJ induced upwelling, cooling down the sea surface temperature by 1-2 degrees C. The atmospheric mixed layer height reached 1 km near the surface wind maximum below the IALLJC. Observations indicate that primary water vapor advection takes place in a shallow layer between the IALLJC and the ocean surface. Latent heat flux peaked below the IALLJC. Neither the reanalysis nor MM5 captured the observed thermodynamic and kinematic IALLJ structure. So far, IALLJ knowledge is based on either dynamically initialized data or simulations of global (regional) models, which implies that a more systematic and scientific approach is needed to improve it. The Intra-Americas Study of Climate Processes is a great regional opportunity to address trough field work, modeling, and process studies, many of the IALLJ unknown features.

Prevalencia de la angiostrongilosis abdominal y la distribución estacional de la precipitación / Prevalence of the abdominal angiostrongyliasis and the distribution seasonal of the precipitation

Se hace una breve descripción de la Angiostrongylosis Abdominal (AA), una enfermedad parasitaria caracterizada por una reacción inflamatoria granulomatosa con fuerte infiltración eosinofílica de la pared intestinal, especialmente en la región ileocecoapendicular. Se resumen aspectos de la enfermedad relacionados con su etiología, epidemiología, patología, manifestaciones clínicas, diagnóstico y tratamiento. Se presenta un estudio preliminar de la relación entre prevalencia de AA y el promedio y la distribución estacional de la precipitación en dos regiones de Costa Rica en el período1994 - 1996. A pesar de que el período analizado es relativamente corto y hay otros factores biológicos, ecológicos y humanos que afectan el comportamiento de AA, la distribución estacional de precipitación parece jugar un papel importante en su prevalencia; posiblemente, facilitando la necesaria y continua humedad para el desarrollo de los huéspedes intermediarios del parásito.