ABSTRACT
The Internet and social networks are considered as important sources of information for rural producers, regarding property management and agricultural activities. The objective of this work was to understand the influence of social networks on actors of the honey production chain, in Para state, regarding the changes of the production practices and the effect of the coronavirus pandemics on this process. This is an explanatory case study with qualitative approach carried out through semistructured interviews with beekeepers/ honey producers, and apicultural technicians, in Para state. The indication of WhatsApp as the most relevant social network for the beekeeping activity in this Brazilian state- for information exchange, remote technical assistance, broadcasting, and adoption of new technologies of production and marketing -, as well as the expansion of this relevance during the coronavirus pandemics, are the main contributions of this research that also can help to a more efficient planning of communication strategies for the technology transfer and innovation processes in the rural environment.
ABSTRACT
Introduction: The 2020 pandemic caused by the SARS-CoV-2 virus has led to a reduction in health care globally outside the scope of patients with COVID-19. Colorectal cancer (CRC) screening has been seriously affected worldwide and non-urgent colonoscopies have been postponed. It is expected that CRC patients will be affected by the pandemic. Aims & Methods: This study aims to evaluate the impact of the COVID-19 pandemic in the diagnosis and characteristics of colorectal cancer patients. Seven hospitals with a reference population of approximately 1,329,391 inhabitants participated in the study. The number of CRC cases and their clinical characteristics diagnosed in Aragón (Spain) in two periods, pre-pandemic (1 March 2019-14 March 2020) and pandemic (15 March 2020-28 February 2021) periods, were studied. Results: A total of 1,385 cancers were diagnosed, 868 (62.7%) in the prepandemic period (24,860 colonoscopies) and 517 (37.3%) in the pandemic period (17,337 colonoscopies), which represents 351 (40.4%) fewer tumours of the expected incidence of CRC. The mean age of patients was 71.6±12.0 years and 911 (65.8%) were males. There were no significant differences regarding sex between both periods (p=0.102), but in the pandemic period the mean age at diagnosis was significantly higher (72.4±12.0 years vs 71.1±12.1 years in the pre-pandemic period;p=0.023). Fewer CRCs were identified by screening in the pandemic period (182 (21.0%) pre-pandemic vs 22 (4.3%) pandemic;p<0.001) and obviously more CRC were diagnosed due to symptoms in the pandemic period (599 (69.0%) pre-pandemic vs 420 (81.2%) pandemic;p<0.001). CRC identified by surveillance in high-risk individuals did not show differences between both periods (39 (4.5%) pre-pandemic vs 28 (5.4%) pandemic;p=0.404). CRC patients with a serious complication (perforation, abscess, obstruction, or bleeding requiring admission) at diagnosis were significantly more frequent during the pandemic period compared to the pre-pandemic period, 76 (14.7%) and 92 (10.6%) respectively (p=0.027). Advanced stage of CRC (stages III and IV) was not different between both periods (400 (46.1%) prepandemic vs 259 (50.1%) pandemic;p=0.149), although there was a clear trend towards a higher percentage of stage IV tumours in the pandemic period (138 (15.9%) pre-pandemic vs 103 (19.9%) pandemic;p=0.057). The delay of CRC diagnosis, considered as the difference in days from the date of the colonoscopy request to the date of its performance, was shorter in the pandemic period (median 27.0 days (IQR 7.0-56.8) pre-pandemic vs 19.0 (IQR 5.0-46.0) pandemic;p=0.013). Conclusion: Compared to the pre-pandemic period, the COVID pandemic has reduced the number of CRC diagnosed by 40.4% in a year time. Patients diagnosed of CRC were older, had more frequently symptoms, a greater number of complications, and a trend to present more advanced stages of the disease. This study reflects, at least in part, the short-term consequences of the suspension of CRC screening in our region.
ABSTRACT
OBJECTIVE: In some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management around the world; therefore, clinical strategies to avoid ICU admission are needed. We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients. METHODS: A retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first. RESULTS: A total of 77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P=0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In the multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0.1, P=0.0001) of ICU admission or death. CONCLUSIONS: Tocilizumab in early stages of the inflammatory flare could reduce an important number of ICU admissions and mechanical ventilation. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports. This is a non-randomized study and the results should be interpreted with caution.