The impact of the COVID-19 pandemic on people living with HIV: a cross-sectional study in Caracas, Venezuela.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has disrupted multiple health services, including human immunodeficiency virus (HIV) testing, care, and treatment services, jeopardizing the achievement of the Joint United Nations Programme on HIV/AIDS 90-90-90 global target. While there are limited studies assessing the impact of the COVID-19 pandemic on people living with HIV (PLHIV) in Latin America, there are none, to our knowledge, in Venezuela. This study aims to assess the impact of the COVID-19 pandemic among PLHIV seen at the outpatient clinic of a reference hospital in Venezuela. METHODS: We conducted a cross-sectional study among PLHIV aged 18 years and over seen at the Infectious Diseases Department of the University Hospital of Caracas, Venezuela between March 2021 and February 2022. RESULTS: A total of 238 PLHIV were included in the study. The median age was 43 (IQR 31-55) years, and the majority were male (68.9%). Most patients (88.2%, n = 210) came for routine check-ups, while 28 (11.3%) were newly diagnosed. The majority of patients (96.1%) were on antiretroviral therapy (ART), but only 67.8% had a viral load test, with almost all (95.6%) being undetectable. Among those who attended regular appointments, 11.9% reported missing at least one medical consultation, and 3.3% reported an interruption in their ART refill. More than half of the patients (55.5%) had received at least one dose of the COVID-19 vaccine, while the rest expressed hesitancy to get vaccinated. Most patients with COVID-19 vaccine hesitancy were male (65.1%), younger than 44 years (57.5%), employed (47.2%), and had been diagnosed with HIV for less than one year (33%). However, no statistically significant differences were found between vaccinated patients and those with COVID-19 vaccine hesitancy. Older age was a risk factor for missing consultations, while not having an alcoholic habit was identified as a protective factor against missing consultations. CONCLUSION: This study found that the COVID-19 pandemic had a limited impact on adherence to medical consultations and interruptions in ART among PLHIV seen at the University Hospital of Caracas, Venezuela.

Remitting neuropsychiatric symptoms in COVID-19 patients: Viral cause or drug effect?

Numerous reports of neuropsychiatric symptoms highlighted the pathologic potential of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its relationship the onset and/or exacerbation of mental disease. However, coronavirus disease 2019 (COVID-19) treatments, themselves, must be considered as potential catalysts for new-onset neuropsychiatric symptoms in COVID-19 patients. To date, immediate and long-term neuropsychiatric complications following SARS-CoV-2 infection are currently unknown. Here we report on five patients with SARS-CoV-2 infection with possible associated neuropsychiatric involvement, following them clinically until resolution of their symptoms. We will also discuss the contributory roles of chloroquine and dexamethasone in these neuropsychiatric presentations.

First wave of COVID-19 in Venezuela: Epidemiological, clinical, and paraclinical characteristics of first cases.

The coronavirus disease 2019 (COVID-19) pandemic has particularly affected countries with weakened health services in Latin America, where proper patient management could be a critical step to address the epidemic. In this study, we aimed to characterize and identify which epidemiological, clinical, and paraclinical risk factors defined COVID-19 infection from the first confirmed cases through the first epidemic wave in Venezuela. A retrospective analysis of consecutive suspected cases of COVID-19 admitted to a sentinel hospital was carried out, including 576 patient cases subsequently confirmed for severe acute respiratory syndrome coronavirus 2 infection. Of these, 162 (28.1%) patients met the definition criteria for severe/critical disease, and 414 (71.2%) were classified as mild/moderate disease. The mean age was 47 (SD 16) years, the majority of which were men (59.5%), and the most frequent comorbidity was arterial hypertension (23.3%). The most common symptoms included fever (88.7%), headache (65.6%), and dry cough (63.9%). Severe/critical disease affected mostly older males with low schooling (p < 0.001). Similarly, higher levels of glycemia, urea, aminotransferases, total bilirubin, lactate dehydrogenase, and erythrocyte sedimentation rate were observed in severe/critical disease patients compared to those with mild/moderate disease. Overall mortality was 7.6% (44/576), with 41.7% (28/68) dying in hospital. We identified risk factors related to COVID-19 infection, which could help healthcare providers take appropriate measures and prevent severe clinical outcomes. Our results suggest that the mortality registered by this disease in Venezuela during the first epidemic wave was underestimated. An increase in fatalities is expected to occur in the coming months unless measures that are more effective are implemented to mitigate the epidemic while the vaccination process is ongoing.

Amoebic liver abscess in a COVID-19 patient: a case report.

BACKGROUND: Amoebiasis is a parasitic disease caused by Entamoeba histolytica, which affects people living in low- and middle-income countries and has intestinal and extraintestinal manifestations. To date, knowledge on coronavirus disease 2019 (COVID-19) coinfection with enteric parasites is limited, and E. histolytica coinfection has not been previously described. Here we present the case of a patient with COVID-19 who, during hospitalisation, presented a clinical picture consistent with an amoebic liver abscess (ALA). CASE PRESENTATION: A 54-year-old man, admitted as a suspected case of COVID-19, presented to our hospital with dyspnoea, malaise, fever and hypoxaemia. A nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction. After 7 days, he developed diarrhoea, choluria and dysentery. An abdominal ultrasound showed a lesion compatible with a liver abscess; stool examination revealed E. histolytica trophozoites, and additional serology for E. histolytica was positive. After 12 days of treatment with metronidazole, ceftazidime and nitazoxanide, the patient reported acute abdominal pain, and an ultrasound examination revealed free liquid in the abdominal cavity. An emergency exploratory laparotomy was performed, finding 3000 mL of a thick fluid described as "anchovy paste". Computed tomography scan revealed a second abscess. He ended up receiving 21 days of antibiotic treatment and was discharged with satisfactory improvement. CONCLUSION: Here we present, to the best of our knowledge, the first report of ALA and COVID-19 co-presenting. Based on their pathophysiological similarities, coinfection with SARS-CoV-2 and E. histolytica could change the patient's clinical course; however, larger studies are needed to fully understand the interaction between these pathogens.

Knowledge, attitudes, and practices related to COVID-19 among patients at Hospital Universitario de Caracas triage tent: A cross-sectional study. / Conocimientos, actitudes y prácticas relacionadas con COVID-19 en pacientes de la carpa de triaje del Hospital Universitario de Caracas: un estudio transversal

INTRODUCTION: The studies on knowledge, attitudes, and practices (KAP) regarding COVID-19 help to identify erroneous concepts and inadequate practices related to the disease. This baseline information is essential to design effective strategies and improve adherence to prevention measures. OBJECTIVE: To identify the COVID-19-related KAP in Venezuelan patients screened at the Hospital Universitario de Caracas triage tent. MATERIALS AND METHODS: We conducted a cross-sectional study among 215 patients between April 25th and May 25th, 2020, with in-person interviews using a KAP survey. RESULTS: Most surveyed patients (53.5%) were asymptomatic. Most of them, both from the symptomatic and the asymptomatic groups, had adequate knowledge about the symptoms and transmission of the disease and the majority said they were practicing quarantine, frequent handwashing, and the use of face masks in public areas. However, the daily replacement of cloth face masks was more frequent in the asymptomatic group whereas replacement every three days was more frequent in the symptomatic group. Finally, more than half of the participants admitted having been in crowded places, a common practice among the symptomatic compared to the asymptomatic patients. CONCLUSIONS: This is the first KAP study in Venezuela about COVID-19. Knowledge and practices among Venezuelans could be improved by strengthening education and training programs. This information from the early phase of the pandemic in Venezuela may contribute to the design of COVID-19 promotion and prevention strategies.

Introducción: Los estudios sobre conocimientos, actitudes y prácticas (CAP) sobre COVID-19 ayudan a identificar conceptos erróneos y prácticas inadecuadas relacionadas con la enfermedad. Esta información de referencia es fundamental para diseñar estrategias efectivas y mejorar la adherencia a las medidas de prevención. Objetivo: Identificar la CAP relacionada con COVID-19 en pacientes venezolanos cribados en la carpa de triaje del Hospital Universitario de Caracas. Materiales y métodos: Realizamos un estudio transversal entre 215 pacientes entre el 25 de abril y el 25 de mayo de 2020, con entrevistas en persona utilizando una encuesta KAP. Resultados: La mayoría de los pacientes encuestados (53,5%) se encontraban asintomáticos. La mayoría de ellos, tanto del grupo sintomático como asintomático, tenían un conocimiento adecuado sobre los síntomas y la transmisión de la enfermedad y la mayoría dijo que practicaban la cuarentena, el lavado frecuente de manos y el uso de mascarillas en las áreas públicas. Sin embargo, el reemplazo diario de mascarillas de tela fue más frecuente en el grupo asintomático, mientras que el reemplazo cada tres días fue más frecuente en el grupo sintomático. Finalmente, más de la mitad de los participantes admitieron haber estado en lugares concurridos, una práctica común entre los sintomáticos en comparación con los asintomáticos. Conclusiones: Este es el primer estudio CAP en Venezuela sobre COVID-19. El conocimiento y las prácticas entre los venezolanos podrían mejorarse fortaleciendo los programas de educación y capacitación. Esta información de la fase inicial de la pandemia en Venezuela puede contribuir al diseño de estrategias de promoción y prevención del COVID-19.

Knowledge, attitudes, and practices related to COVID-19 among patients at Hospital Universitario de Caracas triage tent: A cross-sectional study / Conocimientos, actitudes y prácticas relacionadas con la Covid-19 en pacientes atendidos en la carpa de triaje del Hospital Universitario de Caracas: un estudio transversal

Abstract | Introduction: The studies on knowledge, attitudes, and practices (KAP) regarding COVID-19 help to identify erroneous concepts and inadequate practices related to the disease. This baseline information is essential to design effective strategies and improve adherence to prevention measures. Objective: To identify the COVID-19-related KAP in Venezuelan patients screened at the Hospital Universitario de Caracas triage tent. Materials and methods: We conducted a cross-sectional study among 215 patients between April 25th and May 25th, 2020, with in-person interviews using a KAP survey. Results: Most surveyed patients (53.5%) were asymptomatic. Most of them, both from the symptomatic and the asymptomatic groups, had adequate knowledge about the symptoms and transmission of the disease and the majority said they were practicing quarantine, frequent handwashing, and the use of face masks in public areas. However, the daily replacement of cloth face masks was more frequent in the asymptomatic group whereas replacement every three days was more frequent in the symptomatic group. Finally, more than half of the participants admitted having been in crowded places, a common practice among the symptomatic compared to the asymptomatic patients. Conclusions: This is the first KAP study in Venezuela about COVID-19. Knowledge and practices among Venezuelans could be improved by strengthening education and training programs. This information from the early phase of the pandemic in Venezuela may contribute to the design of COVID-19 promotion and prevention strategies.

Resumen | Introducción. Los estudios de conocimientos, actitudes y prácticas (CAP) relacionados con la Covid-19 permiten establecer los conceptos erróneos y las prácticas inadecuadas en torno a esta enfermedad, información fundamental para diseñar estrategias eficaces y mejorar el cumplimiento de las medidas de prevención. Objetivo. Establecer los conocimientos, actitudes y prácticas relacionadas con la Covid-19 en pacientes venezolanos cribados en la carpa de triaje del Hospital Universitario de Caracas. Materiales y métodos. Se hizo un estudio transversal en 215 pacientes entre el 25 de abril y el 25 de mayo de 2020, mediante entrevistas personales y utilizando una encuesta sobre conocimientos, actitudes y prácticas. Resultados. La mayoría (53,5 %) de los pacientes encuestados se encontraba asintomática; los encuestados tenían un conocimiento adecuado sobre los síntomas y la transmisión de la enfermedad, sin distinción entre sintomáticos y asintomáticos. La mayoría de ellos indicó estar respetando las prácticas de cuarentena, lavado de manos frecuente y uso de tapabocas en público; sin embargo, el reemplazo diario de los tapabocas de tela fue más frecuente en el grupo de los asintomáticos, en tanto que el reemplazo cada tres días fue más común entre los sintomáticos. Por último, más de la mitad de los participantes admitió haber estado en lugares concurridos, siendo esta práctica más frecuente entre los sintomáticos que entre los asintomáticos. Conclusiones. Este es el primer estudio de conocimientos, actitudes y prácticas sobre la Covid-19 en Venezuela. El conocimiento y las prácticas de los venezolanos podrían mejorar mediante el fortalecimiento de los programas de educación y capacitación. Esta información, obtenida durante la fase inicial de la pandemia en Venezuela, podría contribuir al diseño de estrategias de promoción y prevención de la Covid-19.

Knowledge, Attitudes, and Practices Regarding COVID-19 Among Healthcare Workers in Venezuela: An Online Cross-Sectional Survey.

Background: The deterioration of Venezuela's health system in recent years undoubtedly contributes to an increased impact of the COVID-19 pandemic. Understanding healthcare workers' (HCWs) knowledge, attitudes, and practices (KAPs) toward COVID-19 in the early stages of the pandemic could inform their medical training and improve their preparedness. Methods: A online national cross-sectional survey was conducted between May 26th and May 30th, 2020, to assess KAPs among HCWs in Venezuela. Results: A total of 1,441 HCWs from all 24 regions of the country responded to the survey. The mean age of the HCWs was 44 (SD [standard deviation] 14) years; most were women (66.4%). Most HCWs were specialized doctors (48%), followed by nurses (13%) and resident doctors (12.3%). The majority of HCWs had good knowledge (76.3%), obtained information mainly from scientific literature (85.4%); had negative attitudes (53.6%), felt uncomfortable with their work during the current pandemic (59.8%); and reported appropriate practices (76.9%). However, participation in COVID-19 related training was absent in more than half of the HCWs. Positive attitudes were significantly more frequent in frontline workers than in non-frontline workers (p = 0.001). Bioanalysts, students, and doctors were more likely to have good knowledge; participating in training was a predictor for positive attitudes and older age was an appropriate practice predictor. Conclusions: HCWs, knowledge in Venezuela could be improved by strengthening education and training programs. Strategies should focus on reducing fear and improving attitudes toward the care of COVID-19 patients, as well as the promotion of preventive practices.