An effective COVID-19 response in South America: the Uruguayan Conundrum

BackgroundSouth America has become the new epicenter of the COVID-19 pandemic with more than 1.1M reported cases and >50,000 deaths (June 2020). Conversely, Uruguay stands out as an outlier managing this health crisis with remarkable success. MethodsWe developed a molecular diagnostic test to detect SARS-CoV-2. This methodology was transferred to research institutes, public hospitals and academic laboratories all around the country, creating a "COVID-19 diagnostic lab network". Uruguay also implemented active epidemiological surveillance following the "Test, Trace and Isolate" (TETRIS) strategy coupled to real-time genomic epidemiology. ResultsThree months after the first cases were detected, the number of positive individuals reached 826 (23 deaths, 112 active cases and 691 recovered). The Uruguayan strategy was based in a close synergy established between the national health authorities and the scientific community. In turn, academia rapidly responded to develop national RT-qPCR tests. Consequently, Uruguay was able to perform [~]1,000 molecular tests per day in a matter of weeks. The "COVID-19 diagnostic lab network" performed more than 54% of the molecular tests in the country. This, together with real- time genomics, were instrumental to implement the TETRIS strategy, helping to contain domestic transmission of the main outbreaks registered so far. ConclusionsUruguay has successfully navigated the first trimester of the COVID-19 health crisis in South America. A rapid response by the scientific community to increase testing capacity, together with national health authorities seeking out the support from the academia were fundamental to successfully contain, until now, the COVID-19 outbreak in the country.

Auditory verbal skills training is a new approach in adult cochlear implant rehabilitation.

INTRODUCTION: Outcome after cochlear implantation in adults varies and is affected by many factors. One factor is auditory training after implantation. No national guidelines for adult auditory training currently exist in Denmark. An auditory verbal skills training (AVST) rehabilitation programme was developed and applied at the East Danish Cochlear Implant (CI) Centre (Rigshospitalet, Gentofte Unit). The AVST intervention was inspired by the auditory verbal therapy practice and targeted the paediatric population and their families. The objectives were to document the outcome for first-time adult CI users, to apply and explore the effects of the AVST and to examine CI users' possibly extended need for technical follow-up. METHODS: A prospective comparative study design was used. Ten CI users participated in AVST with a relative. Seven CI users were included in a control group. The outcome measures of speech understanding and quality of life (QoL) were recorded pre-implant and post-implant. RESULTS: All participants showed improved speech understanding and a higher QoL post-implant. The within-group analyses showed significant improvements in outcome over time. However, no differences were seen in the between-group analyses post-implant. The CI users in the intervention group received more CI fine-tuning. CONCLUSIONS: The AVST was successfully implemented at the CI Centre. Improvements in speech understanding and QoL were seen in both groups over time, but no differences were seen between the groups. The CI users in the intervention group received more fine-tuning of their processor. FUNDING: Oticon Medical A/S supported the study financially. TRIAL REGISTRATION: Not relevant as the study applied a prospective method study design.

Efficacy and safety of a fixed-dose combination of D-norpseudoephedrine, triiodothyronine, atropine, aloin, and diazepam in obese patients
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OBJECTIVE: A fixed-dose combination (FDC) of D-norpseudoephedrine, tri-iodothyronine, atropine, aloin, and diazepam is used in Mexico for the short-term treatment of obesity; however, its efficacy and safety have been scarcely studied. The aim of this study was to analyze the efficacy and safety of this FDC in Mexican adult overweight and obese patients by a prospective, uncontrolled, multicenter, phase IV open-label study. MATERIALS AND METHODS: 3,290 patients with a body mass index (BMI) ˃ 27 kg/m2 were included in the current study. Primary outcome was the absolute body weight loss, whilst secondary outcomes were the improvement of anthropometric and cardiometabolic parameters as well as the description of adverse events. RESULTS: The FDC decreased the body weight and BMI by -9.0 ± 5.6 kg and -3.4 ± 2.2 kg/m2, respectively, at 6 months. In addition, 43.3% and 14.3% of subjects achieved at least 5% or 10% weight loss at 6 months, respectively. The FDC also significantly improved waist circumference, hip circumference, body fat, visceral fat, systolic blood pressure, diastolic blood pressure, diabetes risk, and mortality risk, at 3 and 6 months. Moreover, the FDC seems to have better results in the following order: obese grade 3 ≈ obese grade 2 ˃ obese grade 1 ˃ overweight patients. Mild mouth dryness, anxiety, and headache were the main reported adverse events. CONCLUSION: Data suggest that the FDC is effective and well tolerated for the short-term therapy of overweight and obesity in Mexican patients.
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Six-month efficacy and safety of amfepramone in obese Mexican patients: a double-blinded, randomized, controlled trial.

Amfepramone, also known as diethylpropion, is an anorectic drug used for the short-term treatment of obesity; however, its efficacy and safety during periods greater than 3 months has been scarcely studied. To evaluate the 6-month efficacy and safety of amfepramone treatment in obese adult Mexican patients resistant to diet and exercise, a double-blinded, randomized, and placebo-controlled clinical trial study was designed on 156 volunteers with a body mass index (BMI) greater than 30 kg/m2 and less than 45 kg/m2. Patients were randomized to receive a 75 mg tablet of amfepramone or placebo daily for 6 months. Primary outcome was the absolute body weight loss, whereas secondary outcomes were the percentage of patients who achieved at least 5% or 10% weight loss, as well as the improvement of anthropometric and metabolic parameters. Amfepramone treatment produced a superior efficacy to decrease body weight than placebo at 3 months (-4.9±0.25 kg vs. -0.7±0.32 kg) and 6 months (-7.7±0.52 kg vs. -1.1±0.7 kg). In addition, 64 and 34 patients achieved at least 5% or 10% weight loss, respectively, with amfepramone at 6 months, compared with 8 and 0 patients on placebo. Amfepramone also significantly improved BMI and waist circumference, but it only showed a favorable tendency in the waist-hip index (WHI), glucose, total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL), triglycerides, heart rate, systolic blood pressure, and diastolic blood pressure at 3 and 6 months. Amfepramone produced only mild adverse events, and they were presented in a greater number than placebo only at 3 months, dry mouth being the the main adverse event. Data suggest that amfepramone is effective and well tolerated in obese Mexican patients during a 6-month regimen.

[Parents' perceptions of their deaf children's speech, language and social outcome after cochlear implantation]. / Foraeldrevurdering af talesprog og generel trivsel hos børn med cochleaimplantat.

INTRODUCTION: Our goal was to present results related to the speech and language skills and social well-being of 62 deaf children with cochlear implant performed at the East Danish CI Center, Gentofte County Hospital. We performed an outcome study based on parents' reports and background information. MATERIALS AND METHODS: In all, we studied 62 hard-of-hearing/deaf children operated on, switched on and fine-tuned from 1993 to 2003 in the East Danish CI center, Gentofte County Hospital. RESULTS: The following parameters were found to have a significant correlation with the children's speech and language outcome: the period of time the CI had been used, educational level, parents' mode of communication. A significant correlation was also found between educational placement and communication mode at home. Sixty of the 61 children were reported to have a satisfactory or very satisfactory level of social well-being. CONCLUSION: The children's level of social well-being is satisfactory. The period of time the CI has been used, educational placement, and the parents' mode of communication are important factors in each child's speech and linguistic development.