The Psychological and Wellbeing Impacts of Quarantine on Frontline Workers during COVID-19 and Beyond.

OBJECTIVE: The current study investigated the experiences, wellbeing impacts, and coping strategies of frontline workers who participated in "Hotels for Heroes", an Australian voluntary hotel quarantine program during the COVID-19 pandemic. The program was open to those who were COVID-19 positive or exposed to COVID-19 as part of their profession. METHODS: Frontline workers who had stayed in voluntary quarantine between April 2020 and March 2021 were invited to participate in a voluntary, anonymous, cross-sectional online survey including both quantitative and qualitative responses. Complete responses were collected from 106 participants, which included data on sociodemographic and occupational characteristics, experiences of the Hotels for Heroes program, and validated mental health measures. RESULTS: Mental health problems were prevalent amongst frontline workers (e.g., moderate anxiety symptoms, severe depression symptoms, and greater than usual impact of fatigue). For some, quarantine appeared to be helpful for anxiety and burnout, but quarantine also appeared to impact anxiety, depression, and PTSD negatively, and longer stays in quarantine were associated with significantly higher coronavirus anxiety and fatigue impacts. The most widely received support in quarantine was from designated program staff; however, this was reportedly accessed by less than half of the participants. CONCLUSIONS: The current study points to specific aspects of mental health care that can be applied to participants of similar voluntary quarantine programs in the future. It seems necessary to screen for psychological needs at various stages of quarantine, and to allocate appropriate care and improve its accessibility, as many participants did not utilise the routine support offered. Support should especially target disease-related anxiety, symptoms of depression and trauma, and the impacts of fatigue. Future research is needed to clarify specific phases of need throughout quarantine programs, and the barriers for participants receiving mental health supports in these contexts.

Long-Term Hydroxychloroquine and Its Association with Covid-19 Infection, a Cohort Study from a South American Hospital

Objectives: We aimed at examining whether patients with rheumatological conditions receiving chronic hydroxychloroquine therapy are at a lower risk of developing SARS-CoV-2 infection than those not receiving hydroxychloroquine. Method(s): This historical cohort study included information of all patients aged 18 years or older with rheumatoid arthritis, systemic lupus erythematosus, or associated rheumatological conditions (based on International Classification of Diseases, 10th edition, diagnostic codes). A propensity score was calculated for each patient, and each patientwho was receiving hydroxychloroquine was matched to two patients who were not receiving hydroxychloroquine (controls). The primary endpoint was the proportion of patients with PCR-confirmed SARS-CoV-2 infection among those receiving chronic hydroxychloroquine versus the propensity-matched patients not receiving chronic hydroxychloroquine in 2021. Result(s): 322 patients receiving hydroxychloroquine and 645 patients not receiving hydroxychloroquine were included in the primary analysis. The incidence of active SARS-CoV-2 infections during the study period did not differ between patients receiving hydroxychloroquine and patients not receiving hydroxychloroquine ( [0 3%] vs 78 [0 4%] of 21406;odds ratio 0 79, 95% CI 0 52-1 20, p = 0 27). There were no significant differences in secondary outcomes between the two groups of patients who developed active SARS-CoV-2 infection. For all patients in the study, overall mortality was lower in the hydroxychloroquine group than in the group of patients who did not receive hydroxychloroquine (odds ratio hydroxychloroquine was not associated with the development of active SARS-CoV-2 infection (odds ratio 0 79, 95% CI 0 51-1 42) Conclusion(s): Hydroxychloroquine was not associated with a protective effect against SARS-CoV-2 infection in a large group of patients with rheumatological conditions.

Impact of COVID-19 pandemic in solid organ transplant in Bogota, Colombia

Introduction: During the COVID-19 pandemic the number of solid organ transplants (SOT) lessened globally due probably to decreased donation and detour of resources to other prioritized activities [1, 2]. The aim of this paper is to analyze the SOT behavior during the COVID- 19 pandemic in this city. Method(s): An exploratory analysis was performed on the data of the Statistics on donation and transplant of organs and tissues in Bogota from 2018 until the third trimester of 2022 [3]. Result(s): 416 SOT from 365 organ donors were performed in Bogota during 2018. The first COVID-19 case in Colombia was documented in March 2020. During the following two years there was a decline in the number of performed SOT and total organ donors, as shown in Table 1. During 2020 there was a drastic reduction on the total SOT, compared with 2018. During 2021 there was a slight recovery in the total SOT, and in the first three trimesters of 2022 there was a drastic increase in the total SOT with 380 procedures performed and 380 organ donors. There was a steeper reduction in the number of heart and lung transplants during 2020 and 2021. The SOT waiting lists remained stable from 2018 to 2022, with 1804 patients in 2021, up to 1950 patients in 2022. Conclusion(s): The reduction in SOT might be due to COVID-19 in donors, reduced incidence of brain death and lessened capability to preserve viable organ donors. The SOT waiting list didn't increase possibly caused by high mortality due to end-stage organ failure. The SOT increase during 2021 coincides with a decrease in COVID-19 lethality in Bogota. This decline in SOT was observed globally during 2020, whilst the rapid recovery in SOT and availability of organ donors during 2022 is a phenomenon that has not been described yet to our knowledge.

Geodemographic factors associated with COVID-19 mortality in indigenous population in Colombia

Introduction: Since 2019 there have been over 80,000 confirmed COVID-19 cases in the indigenous ethnic groups in Colombia. Age, sex, and region of residency might be factors that contribute to COVID-19 mortality in these ethnic populations. The objective of this research is to describe COVID-19 whether these are associated with COVID-19 mortality in this population. According to the 2018 national population census, there are 1.905.617 persons who identified themselves as indigenous, 50.1% of whom are women, younger than 64 years old and live in rural areas [1]. Method(s): This is a retrospective cohort study, using data collected through the national retrospective cohort of confirmed COVID-19 cases. The study population were the confirmed COVID-19 cases in the indigenous population in Colombia since 03/2019 until 10/2022. A Cox Regression Model was used to estimate the HR by age, sex, and geographical location. Result(s): There were 83,436 confirmed COVID-19 cases in the indigenous population in this period. The association between age and COVID-19 mortality shows that older individuals and males have higher mortality risk. The geographical location was explored as a risk factor for COVID-19 mortality. Results are shown in Table 1. Most of the regions have HR very close to 1.0, and none reached statistical significance. Conclusion(s): Age and sex remain significant factors associated with COVID-19 mortality, as they are in other population studies [2]. The region of residency is not a factor significantly associated with COVID-19 mortality in this study, as this characteristic does not seem to reflect socioeconomic inequalities that have been proven to impact COVID-19 mortality in Colombia [2].

The Challenge of Introducing Informatics Topics From an Early Age in Peru During the Pandemic

Contribution: Adaptation and application of a methodology to introduce Informatics from an early age to students living in disadvantaged areas in Peru and analysis of its effects. Background: On the on hand, during the COVID-19 pandemic, students living in disadvantaged areas in Peru were confined to their home under the supervision of their family and without access to computers. On the other hand, the multistage sequencing knowledge transmission methodology (L2T2L), first proposed in JolasMATIKA (Basque Country), to introduce Informatics topics using CS Unplugged from university to school had shown to be effective. Research Question: Does the introduction from an early age into Informatics affect the appreciation of students living in disadvantaged areas about what Informatics is and their attitude toward it? Is the methodology used appropriate for times of pandemic? Methodology: A pilot project based on the L2T2L methodology was introduced at the Public School of the Religious Association Br. Thomas Helm S.M. (Peru) for primary and secondary education during the 2020/2021 pandemic academic year. University engineering students from the UTEC University were in charge of initiating the transmission of Informatics concepts to teachers of secondary and primary education who transmitted the knowledge to their respective students, using mobile phones. Surveys were used to gather data at the beginning and the end of the experience. Findings: A methodology adequate for introducing Informatics from an early age and for reducing the digital divide between technologically advanced communities and more disadvantaged communities. Students and family unit members changed their opinion about Informatics. IEEE

The Effect of Translator Use on Length of Hospital Stay

INTRODUCTION: An impacted population of the COVID-19 pandemic is those with limited English proficiency (LEP). Due to visitor restrictions, caregivers were unable to facilitate communication with hospital staff, and those with LEP were more susceptible to poor communication with their healthcare providers. METHOD(S): Data was ed from the BIDMC site of the SCCM VIRUS Discovery Database, a de-identified, HIPAA-compliant database containing clinical information for COVID-19 patients admitted to BIDMC. Patients were placed into two groups, either requiring translator services for any language or not. Statistical analyses were performed in R Version 3.0 to calculate test statistics such as ANOVA and Chi-Square p-values. The primary outcome assessed length of stay (LOS). Secondary outcomes included complications, discharge status of alive or deceased, discharge location of either home or another care facility, and number of symptomatic days before hospital admission. The association between non-White, non-Hispanic demographics and need for translation services was also examined. RESULT(S): 1522 patients were included with 91 excluded due to unknown use of translator services. The relationship between the requirement of an interpreter and LOS, complications, and symptomatic days was not statistically significant. However, statistically significant findings include patients who required translational services were more likely discharged alive (OR 1.53, 95% CI 1.07-2.24), and discharged to their homes (OR 1.42, 95% CI 1.07-1.91). Use of translator services was strongly associated with minority status (OR 5.20, 95% CI 3.81-7.21). A limitation of this dataset is that deceased status is only recorded if the patient dies during the index visit, potentially missing those who expire from COVID-related complications post-discharge. CONCLUSION(S): The requirement of a translator was not correlated with longer hospital stays, more complications, or days symptomatic prior to admission in comparison to the patients' English-speaking counterparts. However, the use of a translator was positively correlated with survival, discharge home, and minority status. The increased odds of discharge home could be due to the cultural values of minorities providing care in a familial setting.

Covid-19 Icu Admission Disparities among Hispanics and African Americans in Boston

INTRODUCTION: Racism has been identified as a driver of health disparities. The COVID pandemic has widened the gap between Whites and racial minorities, resulting in an even greater burden of disease and poorer health outcomes. The Boston area has a greater wealth disparity between these groups compared to the national average. We hypothesize that African American and Hispanic groups in the Boston Area have carried a greater burden of severe disease compared to Whites. METHOD(S): This cross-sectional study included 1,272 single-event adults admitted to Beth Israel Deaconess Medical Center (Boston, MA) due to COVID from March 2020 to April 2022. Patients were grouped by demographics captured in the medical records. Three groups were determined to have the appropriate sample sizes for analysis: Hispanics of any race, African American Non-Hispanics, and White Non-Hispanics. The primary outcome assessed was ICU admission rates;secondary analyses included length of hospitalized and ICU stay and comorbidity rates. Statistical analyses were performed in R Version 3.0. RESULT(S): Out of our sample, 31% were African American (AA), 20% Hispanic, and 49% White. Compared to Whites, ICU admission rates for AA patients were higher than for Hispanics, with an odds ratio (OR) of 1.45 (95% CI, [1.11,1.91]) and 1.21 [1.27, 1.64], respectively. When adjusting for sex, age, and comorbidities, the same pattern was observed: ICU admission rates for AAs were positively associated for both males (1.64, [1.11,2.43] and females (1.19, [1.04,1.36]), but only for Hispanic females (1.44, [1.05,1.97]). AAs and Hispanics had a significantly higher OR of having 3+ comorbidities (1.3, [1.13,1.72] and 1.47 [1.12, 1.96]). CONCLUSION(S): Ethnic minority groups have suffered a disproportionately greater burden of disease related to COVID. Our study shows that ICU admission was positively associated with AA and Hispanic race, opposite to what had been previously shown in some publications. Our findings could help reorient public health measures to improve health outcomes in these populations.

Incidence and role of nosocomial coinfections in patients with COVID-19 admitted to a hospital in latin america, July 2020 follow-up January 2021

Introduction: The role ofcoinfections in patients with COVID-19 has been dismissed, and their role in their prognosis and outcomes is unknown. Materials and Methods: Retrospective study of 306 adults infected by SARS-CoV-2 by antigenic or molecular test. The main objective was to evaluate the role of nosocomial coinfections in patients with COVID-19, follow-up from July 2020 to January 2021. Results: There was a higher frequency of the male gender 78 % in relation to the female 22 %, the accumulated mortalities in the presence of infection nosocomial for those under 60 were 5 (14.7 %), between 60 and 70 (28.57 %) and those over 70 years old 73 (59.8 %), showing that in those over 70 years old it doubles those between 60 and 70 and triples those under 60 years of age, all analyzes showing statistical significance, p<0.005. Discussion: The present study showed an adequate correlation between the presence of nosocomial infection and higher mortality in those who presented it, especially those older than 70 years. Conclusions: Coinfection at the time of diagnosis of COVID-19 is relatively frequent. The implicit mortality that nosocomial infections have in the COVID-19 patient makes it necessary to review care protocols and carry out epidemiological and hospital surveillance activities in these patients. Such findings could be essential to define the role of empirical antimicrobial therapy or prevention strategies. Administration at the time of suspicion of a co-infection, always in an individualized manner and based on the profiles of each health institution. © 2022 Academia Nacional de Medicina. All rights reserved.

Evaluation and follow-up in functionality in patients with Pediatric Multisystem Inflammatory Syndrome associated with COVID-19 (MIS-C)

In June 2020 appeared the first cases of Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 in Chile. Possible sequelae associated with this condition are still unknown. Objective(s): To describe the functional status of children with MIS-C admitted to a high complexity Hospital. Patients and Method: Descriptive, prospective study. Sample of 28 patients. The functional status was evaluated during Hospitalization, and in the first and fourth months after discharge with the Functional Status Scale (FSS), Pediatric Evaluation of Disability Inventory (PEDI-CAT), 6-minute walk test (6MWT), PImax and PEmax, and dynamometry. Post-Traumatic Stress Disorder was screened with the Child PTSD Symptom Scale (CPSS). Result(s): Mean age 63.6 months. Sixteen were women and 60.7% presented no comorbidities. Half of the cases presented with Shock. Mean hospitalization was 9 days. Twenty-two patients were admitted to the ICU;54% required me-chanical ventilation and/or vasoactive drugs, and 82% had cardiac repercussions. During hospitalization, 82.3% presented some physical alteration, 29.1% of them were confirmed ICU-acquired weakness (ICU-AW), and 16.6% were suspected cases. Thirteen patients presented emotional symptoms, 39.2% had post-ICU syndrome. Most of the patients (58.8%) had an unfavorable Functional Situation and recovered 4 months post-discharge. All patients reversed echocardiographic abnormalities in the first month and regained muscle strength in the fourth month. 38.5% of subjects reported suboptimal values in the 6MWT and 66.6% presented alteration in the post-traumatic stress screening. Conclusion(s): Most of the patients presented functional compromise with favorable recovery despite the severity of the symptoms and possible secondary complications after ICU. Copyright © 2022, Sociedad Chilena de Pediatria. All rights reserved.

Sars-Cov2 and Liver Damage in Pediatric Population

The Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV2) initially was perceived as a lower respiratory tract infection. However, with time coronavirus disease (COVID-19) presented with a wide variability of symptoms, including gastrointestinal and hepatic. This because the viral tropism to the angiotensin-converting enzyme 2 (ACE2) receptor found in liver and bile-duct epithelial cells. The ACE2 expression is mainly in cholangiocytes (60% of cells), minimally expressed in hepatocytes (3% of cells) and absent in Kupffer cells. Hepatic involvement can be evidenced with elevation of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH), these alterations have been evidenced in up to 43% of patients. The aim of this study is to evaluate liver damage in pediatric patients with COVID-19. Material(s) and Method(s): A retrospective cohort was carried out between March 2020 to October 2021 at the Instituto Nacional de Pediatria in Mexico City. We include all patients between 0 to 18 years with positive COVID-19 PCR test or antigen rapid test. Result(s): We had a total population of 161 subjects of which 83 had liver function tests (inflammation, excretion, or synthesis) during SARS-CoV2 infection;82 had ALT value. Mean age was 5.3 years and 56% were men (n: 47). Fifty-four patients (65%) had previous comorbidity, with oncological diseases being the most frequent (33%). Of the 54 patients with previous comorbidity, 3 had liver disease (Graft-versus-host disease, nonalcoholic fatty liver disease and autoimmune hepatitis). Regarding treatment, 32 patients did not require oxygen support, 32 patients had non-invasive devices and 19 patients required mechanical ventilation. Fifty-four percent (n = 45) were using steroid management. In relation to the outcome of the patients, 11 die and the rest were discharged. Liver function tests were submitted 2 days after admission, 51 patients (62%) presented elevation of ALT (according to age and sex). Second liver function tests were taken around day 23 53 patients. Table 1 shows the average of each of the parameters. It has been documented that severe COVID-19 is associated with higher levels of inflammatory mediators like C-reactive protein (CRP) and ferritin. Therefore, levels of this inflammatory mediators were evaluated, the average of this parameters was 1601 ng/mL and 8.19 mg/L respectively in the first test. Analysis: We evaluated the difference that existed in liver function tests by comparing the first and second determination. Regarding AST, INR and PT, a significant difference was found (p = <0.05) with improvement compared to baseline. While the ALT did not show a significant difference, there was an improvement compared to baseline. Secondary to the association described between elevation of inflammatory mediators and severity of the disease, a Pearson Correlation test was performed between liver inflammatory tests and ferritin/prealbumin. A significant correlation was obtained when comparing ALT with ferritin (r = 0.301, p = 0.033) and AST with ferritin (r = 0.311, p= 0.028), which demonstrate a weak correlation probably associated with the amount of population. The correlation between ALT/AST and prealbumin was carried out without being significant. In search of associated factors, it was found that the alteration of liver function tests is a risk factor for needing support with supplemental oxygen with an Odds Ratio of 2.007 (CI: 0.77-5.31). From 19 patients who required mechanical ventilation, 73.7% had altered liver function tests. Conclusion(s): SARS-CoV2 is a virus that has been shown to have liver involvement which can be demonstrated with elevation of liver function test. In our series, 62% had elevated ALT, being the most sensitive parameter of liver inflammation. With respect to factors associated with liver impairment, we found that higher ferritin levels are associated with greater liver involvement, as well as that having hepatic impairment is a risk factor for the use of supplemental oxygen. Therefore, it is important to consider in patients with COVID-19 liver function tests and thus make a timely detection of alterations at this level. Studies with more population are required to have external validity.

Transmission of COVID-19 in the Abreus Municipality, between weeks 29 and 41 of the year 2021

Background: The 21st century has been characterized from the beginning by a health problem that has affected the world and Cuba, ranging from an increase in microbial resistance to the appearance of new infectious diseases, such as COVID-19. Objective: To describe the transmission of COVID-19 in the Abreus municipality, Cienfuegos province, between weeks 29 and 41 of the year 2021. Methods: An observational, descriptive, retrospective cross-sectional study was carried out from week 29-41. The universe consisted of 3,421 patients diagnosed with COVID-19, confirmed by a real-time polymerase chain reaction (RT-PCR) diagnostic test. Results: A high magnitude of transmission was observed with 3,421 cases, 122 on average in week 33. Trend of increased case reporting and transmission speed from statistical week 29 to 35 (385 to 3,421 cases). The maximum peak was observed at statistical week 33, with a decrease from that week;In addition, there was a dispersion in all the popular councils, with a greater concentration in the Abreus (1035) and Horquita (725) popular councils. Viral circulation was above 20% in all weeks and the highest occurred in statistical week 37. Conclusions: COVID-19 in the Abreus municipality had a great impact in the period studied. Useful information was provided for decision-making during the development of the disease and a basis for the evolutionary understanding of future analogous events.

The art in medicine. Jobs with electrical risk and pandemic

This article presents a reflection about the risk by exposure to electricity for workers who work at height. This collective of workers-who are considered essential and whose activity requires a specific set of physical skills and adequacies-are now exposed to the added risks of the COVID-19 pandemic. The consequences of work related accidents or injuries also implicate their families, and this is reflected in Francisca Lita's painting, which opens a door towards present and future hope, showing her belief that the COVID-19 virus will eventually be controlled.

COVID-19 anxiety, psychological well-being and preventive behaviors during the COVID-19 pandemic in Latin America and the Caribbean: relationships and explanatory model

This study assesses the relationship between COVID-19 anxiety and subjective well-being in terms of the mediating role of COVID-19 preventive behaviors. Additionally, the contribution of sociodemographic factors (sex and age) and risk perception on COVID-19 anxiety and its potential measurement invariance was tested in 5655 participants from 12 countries in Latin America and the Caribbean. A mixture of both latent and observable variables were analyzed using a system of structural equations. The Coronavirus Anxiety Scale (CAS), Preventive COVID-19 Infection Behaviors Scale (PCIBS) and single-item measures were used to assess the perceived probability of death, perceived severity and concern about transmitting COVID-19. The results indicated that there is a significant and relevant direct effect of COVID-19 anxiety on participants' well-being. Furthermore, COVID-19 anxiety significantly predicted both preventive behavior (beta = .29, p < .01) and well-being (beta = -.32, p < .01). The effects of COVID anxiety and preventive behavior explained 9.8% of the variance in well-being (R-square = .098);whereas, 8.4% of the variance in preventive behavior was associated with COVID anxiety (R-square = .084). Likewise, perceived likelihood of death from COVID, perceived severity of COVID, and concerns about COVID transmission were positively related to anxiety. Age was negatively related to anxiety, with men being less anxious than women. The results are invariant by country, i.e., the broad relationships found in the combined sample are also present in each individual country. The findings indicate that, although the exact relationships between variables may vary between countries, there are enough similarities to provide useful information about the impact of the COVID-19 pandemic in each of the countries included in the study.

In-hospital hyperglycemia but not diabetes mellitus alone is associated with increased in-hospital mortality in community-acquired pneumonia (CAP): a systematic review and meta-analysis of observational studies prior to COVID-19.

The objective of this review was to quantify the association between diabetes, hyperglycemia, and outcomes in patients hospitalized for community-acquired pneumonia (CAP) prior to the COVID-19 pandemic by conducting a systematic review and meta-analysis. Two investigators independently screened records identified in the PubMed (MEDLINE), EMBASE, CINAHL, and Web of Science databases. Cohort and case-control studies quantitatively evaluating associations between diabetes and in-hospital hyperglycemia with outcomes in adults admitted to hospital with CAP were included. Quality was assessed using the Newcastle-Ottawa Quality Assessment Scale, effect size using random-effects models, and heterogeneity using I2 statistics. Thirty-eight studies met the inclusion criteria. Hyperglycemia was associated with in-hospital mortality (adjusted OR 1.28, 95% CI 1.09 to 1.50) and intensive care unit (ICU) admission (crude OR 1.82, 95% CI 1.17 to 2.84). There was no association between diabetes status and in-hospital mortality (adjusted OR 1.04, 95% CI 0.72 to 1.51), 30-day mortality (adjusted OR 1.13, 95% CI 0.77 to 1.67), or ICU admission (crude OR 1.91, 95% CI 0.74 to 4.95). Diabetes was associated with increased mortality in all studies reporting >90-day postdischarge mortality and with longer length of stay only for studies reporting crude (OR 1.50, 95% CI 1.11 to 2.01) results. In adults hospitalized with CAP, in-hospital hyperglycemia but not diabetes alone is associated with increased in-hospital mortality and ICU admission. Diabetes status is associated with increased >90-day postdischarge mortality. Implications for management are that in-hospital hyperglycemia carries a greater risk for in-hospital morbidity and mortality than diabetes alone in patients admitted with non-COVID-19 CAP. Evaluation of strategies enabling timely and effective management of in-hospital hyperglycemia in CAP is warranted.