Cobertura de vacunación contra COVID-19 e influenza en personal de salud y administrativo en Paraguay

Introducción: A nivel mundial, la cobertura de vacunación contra el COVID-19, así como contra la influenza es baja tanto en la población general como en los profesionales de la salud a pesar de que la vacuna es gratuita y obligatoria en el personal sanitario. Objetivo: Describir la cobertura de vacunación contra el COVID -19, y la influenza en personal de salud y administrativo de un hospital de referencia del Ministerio de Salud Pública y Bienestar Social en el periodo 2021-2022. Metodología: Estudio observacional descriptivo de corte trasverso. Se hizo la revisión de los registros del personal sanitario y administrativo del centro vacunatorio del Hospital Nacional de Itauguá de la campaña vacunal contra el COVID-19 y de anti-influenza en el periodo 2021- 2022. Resultados: De los 3.586 funcionarios, 999 (27,9 %) eran médicos, 1494 (41,7 %) personal de enfermería, 366 (10,2 %) otra categoría de personal sanitario, y 727 (20,3 %) personal administrativo. En forma global, el 86,5 % de los funcionarios recibió por lo menos las dos dosis que constituyen el esquema primario y el 73 % la dosis de refuerzo. El 2,1 % del personal no recibió ninguna dosis de vacuna anti covid-19, la cifra fue mayor en el personal administrativo (4,8 %). La cobertura de vacunación contra la influenza fue de 20 % en el 2021 y 25 % en el 2022. Discusión: Si bien cobertura de vacunación anti-COVID-19 fue comparable a otros países, la vacunación contra la influenza fue muy baja. Es urgente implementar estrategias dirigidas a aumentar la percepción de riesgo y aceptabilidad de las vacunas obligatorias para el personal sanitario.

Introduction: Worldwide, vaccination coverage against COVID-19, as well as against influenza, is low both in the general population and in health professionals, despite the fact that the vaccine is free and mandatory for health personnel. Objective: To describe the COVID -19 and influenza vaccination coverage in health and administrative personnel of a reference hospital of the Ministry of Public Health and Social Welfare in the period 2021-2022. Methods: Cross-sectional descriptive observational study. Charts of the health and administrative personnel of the vaccination center of the Itauguá National Hospital of the COVID-19 and influenza vaccination campaign in the period 2021-2022 were reviewed. Results: Of the 3,586 personnel, 999 (27.9%) were medical personnel, 1,494 (41.7%) nursing personnel, 366 (10.2%) other category of health personnel, and 727 (20.3%) administrative personnel. Overall, 86.5% of the employees received at least the two doses that constitute the primary schedule and 73% the booster dose; 2.1% of the staff did not receive any dose of the anti COVID-19 vaccine, which was higher in the administrative staff (4.8%). Influenza vaccination coverage was 20% in 2021 and 25% in 2022. Discussion: Even though the vaccination coverage of anti-COVID-19 was comparable to other countries, vaccination anti-influenza was very low. It is urgent to implement strategies aimed at increasing the perception of risk and acceptability of mandatory vaccines for health personnel.

Manifestaciones orales del COVID-19 en Paraguay: resultados de una encuesta en línea

Introducción: Estudios previos han reportado que pacientes infectados con el virus del COVID-19, podrían manifestar sintomatologías a nivel de la cavidad oral. Objetivo: Evaluar la frecuencia de manifestaciones orales asociadas a COVID-19 en un segmento de la población paraguaya y determinar cuáles son las más prevalentes. Metodología: Estudio descriptivo de corte transversal. Fue realizada una encuesta electrónica de enero a marzo del 2022. Los datos fueron presentados como frecuencias y porcentajes y analizados mediante la prueba de chi-cuadrado. El análisis estadístico se realizó con el software R versión 4.0.3. Resultados: La muestra estuvo compuesta por 478 personas. El 79,50 % correspondió al sexo femenino y el 45,19 % tenía entre 25 y 34 años. El 65,48 % informó haber experimentado al menos 1 síntoma o signo oral durante el curso de COVID-19. La pérdida de la sensación de sabores amargos, seguida de la alteración del sabor de los alimentos y la pérdida de la percepción dulce, fueron los síntomas más comunes. Se encontró una proporción significativamente mayor de manifestaciones orales en el rango de 18-24 años (χ²; p= 0,003). Entre las personas que desarrollaron COVID-19 de forma moderada a severa hubo mayor número de manifestaciones de síntomas orales (χ²; p= 0,044). Discusión: Se identificó una alta frecuencia de manifestaciones orales en pacientes con casos de moderados a severos de COVID-19, destacándose los trastornos del gusto como los más predominantes. Los individuos más jóvenes fueron los más afectados.

Introduction: Previous studies have reported that patients infected with the COVID-19 virus could manifest symptoms in the oral cavity. Objective: To evaluate the frequency of oral manifestations associated with COVID-19 in a segment of the Paraguayan population and determine the most prevalent ones. Methods: Descriptive cross-sectional study. An electronic survey was conducted from January to March 2022. The data were presented as frequencies and percentages and analyzed using the chi-square test. Statistical analysis was performed with R software version 4.0.3. Results: The sample consisted of 478 individuals. 79.50% were female, and 45.19% were between 25 and 34 years old. 65.48% reported having experienced at least 1 oral symptom or sign during the course of COVID-19. The loss of the sensation of bitter tastes, followed by the alteration of the taste of foods and the loss of sweetness perception, were the most common symptoms. A significantly higher proportion of oral manifestations was found in the 18-24 age range (χ²; p= 0.003). Among people who developed COVID-19 in a moderate to severe form, a greater number of oral symptom manifestations were observed (χ²; p= 0.044). Discussion: A high frequency of oral manifestations was identified in patients with moderate to severe cases of COVID-19, with taste disorders standing out as the most predominant. Younger individuals were the most affected.

Calidad de vida laboral del personal de Enfermería de un hospital regional de Paraguay durante la pandemia COVID-19 / Occupational quality of life of the nursing staff at a regional hospital in Paraguay during the covid-19 pandemic

Objetivo: determinar la calidad de vida laboral en tiempos de COVID-19 del personal de Enfermería del Hospital Regional de Coronel Oviedo (Paraguay) durante el año 2022. Método: se realizó un estudio descriptivo trasversal en el Hospital Regional de Coronel Oviedo, en Paraguay, en enfermeros y enfermeras con al menos un año de experiencia. Se utilizó el cuestionario de calidad de vida laboral adaptado de Cruz Luque, además de variables sociodemográficas y laborales. Para los análisis bivariados entre las dimensiones del cuestionario de calidad de vida con las variables sociodemográficas y laborales, se utilizó la prueba de Chi cuadrado de Pearson. Resultados: se incluyeron 170 profesionales, con un rango etario entre 24 y 43 años, con predominio del sexo femenino (84,7%), estado civil casado (50,5%), con alguna especialización en el área (48,2%), y trabajando principalmente en un solo lugar. El promedio de pacientes diarios fue de uno a cinco pacientes (54,7%), con turnos laborales de 12 horas (56,4%). La percepción global de la calidad de vida laboral se ubicó entre mala (48%) y regular (37%). Las dimensiones específicas mostraron que la percepción más baja se encontró en el soporte institucional (48,82%) e integración en el puesto de trabajo (52,35%). Se identificaron asociaciones estadísticamente significativas entre la percepción de la calidad laboral y datos demográficos y laborales como edad, género, nivel educativo, turno de trabajo, experiencia laboral, horas trabajadas semanalmente y número de empleos. Conclusión: la percepción de calidad laboral se encontró entre mala y regular, siendo las dimensiones de soporte institucional y seguridad laboral las principales áreas críticas.(AU)

Objective: to determine the occupational quality of life in times of COVID-19 of the Nursing Staff of the Hospital Regional de Coronel Oviedo (Paraguay) during 2022. Method: a cross-sectional descriptive study was conducted at the Hospital Regional de Coronel Oviedo, in Paraguay, including male and female nurses with at least one year of experience. The adapted Occupational Quality of Life Questionnaire by Cruz Luque was used, as well as sociodemographic and occupational variables. Pearson’s Square Chi Test was used for bivariate analysis between the quality of life questionnaire dimensions and the sociodemographic and occupational variables. Results: the study included 170 professionals, with a 24-to-43-year age range, with prevalence of female gender (84.7%), married civil status (50.5%), with some specialization in the area (48.2%), and mostly working in one single place. The average daily patients were from one to five (54.7%), with 12-hour work shifts (56.4%). The overall perception of their occupational quality of life was between bad (48%) and moderate (37%). Specific dimensions showed that the lowest perception was found in institutional support (48.82%) and integration in the workplace (52.35%). Statistically significant associations were identified between the perception of work quality and demographic and occupational data such as age, gender, educational level, work shift, work experience, hours worked per week and number of jobs. Conclusion: the perception of quality of work was between bad and moderate, and the main critical areas were the dimensions of institutional support and safety at work.(AU)

Clinical evolution and mortality of critically ill patients with SARS-CoV-2 pneumonia treated with remdesivir in an adult intensive care unit of Paraguay.

BACKGROUND: The health crisis due to Covid-19 led to the search for therapeutics that could improve the evolution of the disease. Remdesivir, an antiviral that interferes with viral replication, was one of the first to be used for the treatment of this pathology. OBJECTIVE: To determine clinical course and mortality of patients with severe SARS-CoV-2 pneumonia treated with remdesivir, in comparison of those who didn't receive the medication. PATIENTS AND METHODS: Retrospective cohort study, with medical records review of COVID-19 patients, between August 2020 and August 2021. The subjects were divided into two groups, those who received remdesivir before or after admission to intensive care and those who didn't. The primary outcome variable was mortality in intensive care. RESULTS: Of 214 subjects included, 109 (50,9%) received remdesivir. The median of days for the drug administration was 8 (2-20), IQR: 3. The bivariate analysis prove that the use of remdesivir was related with lower risk of develop Acute Respiratory Distress Syndrome (ARDS) (p = 0,019; OR: 0,521) and lower requirement of mechanical ventilation (p = 0,006; OR:0,450). Additionally, patients treated with remdesivir develop less kidney injury (p = 0,009; OR: 0,441). There was a total of 82 deaths, 29 (26,6%) in the remdesivir group and 53 (50,5%) in the control group [p < 0,001; OR: 0,356 (0,201-0,630)]. All the risk factors associated with mortality in the bivariate analysis were entered into the multivariate analysis by logistic regression, the use of remdesivir remained associated as an independent protective factor to mortality (p = 0.034; OR: 0.429). CONCLUSION: Critically ill patients with SARS-CoV-2 pneumonia treated with remdesivir had a lower risk of death and need for mechanical ventilation and develop less ARDS as compared to the control group. No differences were found in the presentation of adverse effects.

Mental Health News during the COVID-19 Pandemic: A 3-year analysis in Paraguay / Noticias sobre Salud Mental durante la pandemia de COVID-19: Un análisis de 3 años en Paraguay

Introduction. The connection between news sources and the connotation of mental health articles in Paraguay during the COVID-19 pandemic (2020-2023) significantly impacted public opinion about mental health. Objective.This study analyzednews onmental health in Paraguay in the context of the COVID-19 pandemic. Material and methods.A descriptive retrospective study of all news articles on mental health published in the three primary newspapers of the country between May 2020 and May 2023 was conducted. The keywords were depressive disorders, anxiety disorders, bipolar disorder, schizophrenia, and mental health issues. Results. A total of 534 newswereexamined, 39.5% published by La Nación newspaper, 33.1% in 2023, and in 88.4% the author's identity and gender were not specified. Of the writing characteristics, 99.8% were written in the third person, 62.7% had a human-interest context,48.5% had a neutral connotation, 65.7% focused on health and well-being,and 7.5% written by health experts. The year of publication wasstatistically associated to connotation (p=0.003) and context (p<0.001). Conclusion. The media has paid significant attention to mental health. Despite the objectivity provided by third-person narration, problems arise because of a lack of author identification. To encourage balanced and non-polarized reporting, it is crucial to incorporate expert voices and promote the framing of mental health stories as "human interest". Palabras clave: mental health; news; newspaper article; COVID-19; Paraguay

Introducción. La conexión entre las fuentes de noticias y la connotación de los artículos sobre salud mental en Paraguay durante la pandemia de COVID-19 (2020-2023) impactó significativamente en la opinión pública sobre la salud mental. Objetivo. Analizar las noticias sobre salud mental en Paraguay en el contexto de la pandemia COVID-19. Material y métodos. Se realizó un estudio descriptivo retrospectivo de todos los artículos periodísticos sobre salud mental publicados en los tres principales periódicos del país entre mayo de 2020 y mayo de 2023. Las palabras clave fueron trastornos depresivos, trastornos de ansiedad, trastorno bipolar, esquizofrenia y problemas de salud mental. Resultados. Se examinaron 534 artículos periodísticos, 39,5% publicados por el diario La Nación, 33,1% en 2023y en 88,4%no se especificó la identidad ni el género del autor. De las características de redacción, el 99,8% estaban escritos en tercera persona, 62,7% pertenecían a un contexto de interés humano,48,5% tenían una connotación neutra, 65,7% se centraban en la salud y el bienestar y el 7,5% escritos por expertos en salud. El año de publicación se asoció significativamente con la connotación (p=0,003) y con el contexto (p<0,001). Conclusión. Los medios de comunicación han prestado gran atención a la salud mental. A pesar de la objetividad que aporta la narración en tercera persona, surgen problemas por la falta de identificación del autor. Para fomentar una información equilibrada y no polarizada, es crucial incorporar voces expertas y promover el encuadre de las historias de salud mental como "interés humano". Key words: salud mental; noticias; artículo de periódico; COVID-19;Paraguay

Mortalidad intrahospitalaria de pacientes con COVID-19 complicados con neumonías bacterianas en asistencia respiratoria mecánica en Cuidados Intensivos de Adultos en un Hospital del Paraguay / In-hospital mortality of patients with COVID-19 complicated by bacterial pneumonia on mechanical ventilation in Adult Intensive Care in a Hospital in Paraguay

Introducción: los pacientes con COVID-19 ingresan en mayor proporción a asistencia respiratoria mecánica, aumentando: el riesgo de neumonía asociada a ventilador (NAV) las tasas de mortalidad, los días de permanencia en las unidades de terapia intensiva (UCI) y los costos sanitarios. Objetivo: determinar la Mortalidad intrahospitalaria de pacientes con COVID-19 complicados con neumonías bacterianas en asistencia respiratoria mecánica en Cuidados Intensivos de Adultos en un Hospital del Paraguay durante los años 2020 a 2021. Metodología: estudio analítico de tipo cohorte retrospectiva. Se registraron variables demográficas, comorbilidades, puntajes en scores de gravedad como el APACHE II al ingreso, la cifra más baja de oxigenación durante la internación expresado por la PaO2 / FIO2, días de ventilación, colocación en decúbito prono, traqueotomía, medidas terapéuticas farmacológicas y no farmacológicas, días de internación, así como las complicaciones y la mortalidad. Resultados: fueron incluidos 214 pacientes, 135 ingresaron a asistencia respiratoria mecánica (ARM) de los cuales 58 (42,9 %) desarrollaron NAV, con edad mediana de 52 años (40-60). Los microorganismos de NAV fueron cocos Gram negativos en 98,3 %, incluyendo Acinetobacter baumanii en 46,5 %, Klebsiella pneumoniae en 22,8 %, Pseudomona aeruginosa en 15,5 % y 5,2 % Stenotrophomona maltofilia. La mortalidad intrahospitalaria fue del 44,8 %. Los menores de 50 años tienen una sobrevida mayor que los mayores (34 días vs 22 días, con p de 0,026). Conclusión: la mortalidad intrahospitalaria fue del 44,8 %. La edad fue un factor de riesgo independiente para la mortalidad en pacientes con NAV, por lo que los profesionales de la salud deben estar atentos a la posibilidad de NAV en pacientes que requieren asistencia respiratoria mecánica, especialmente en pacientes mayores de 50 años.

Introduction: patients with COVID-19 are more likely to require mechanical ventilation, which increases the risk of ventilator-associated pneumonia (VAP), mortality rates, length of stay in intensive care units (ICUs), and healthcare costs. Objective: to determine the in-hospital mortality of patients with COVID-19 complicated by bacterial pneumonia on mechanical ventilation in Adult Intensive Care in a Hospital in Paraguay during the years 2020 to 2021. Methodology: this is a retrospective cohort analytical study. Demographic variables, comorbidities, severity scores such as APACHE II on admission, the worst oxygenation during hospitalization expressed by PaO2/FiO2, days of ventilation, prone position, tracheostomy, pharmacological and non-pharmacological therapeutic measures, days of hospitalization, as well as complications and mortality were recorded. Results: a total of 214 patients were included, 135 were admitted to mechanical ventilation (MRA), of which 58 (42.9%) developed VAP, with a median age of 52 years (40-60). VAP microorganisms were Gram-negative cocci in 98.3%, including Acinetobacter baumanii in 46.5%, Klebsiella pneumoniae in 22.8%, Pseudomona aeruginosa in 15.5%, and Stenotrophomona maltophilia in 5.2%. In-hospital mortality was 44.8%. Those under 50 years of age have a longer survival than those older (34 days vs. 22 days, with p of 0.026). Conclusion: the overall mortality rate was 44.8%. Age was an independent risk factor for mortality in patients with VAP, so healthcare professionals should be aware of the possibility of VAP in patients who require mechanical ventilation, especially in patients over 50 years of age.

Hope, resilience and subjective happiness among general population of Paraguay in the post COVID-19 pandemic.

BACKGROUND: Positive mental health includes not only the absence of mental disorders but also the presence of subjective well-being, good coping strategies for life stress, and strategies for adapting to community life. It is well known that the COVID-19 pandemic has challenged mental health in general population worldwide. However, research has not measured protective factors for mental health in the general population after the declared end of pandemic by the World Health Organization. METHODS: This observational, cross-sectional study surveyed 591 Paraguayan participants aged ⩾18 years, who were recruited through an online survey. Demographic characteristics, socioeconomic status were collected as well as mental health and validated tools for hope, resilience, subjective happiness were administered. RESULTS: Of the participants, 81.6% were women, 54% were married or in a relationship and 90.7% reported an university education. The main source of stress was economic issues (30.3%). A total of 22.7% had been previously diagnosed with a mental disorder, 22.2% had consulted a mental health professional and 10.8% had consumed prescription drugs. 42.6% reported flourishing, 36.2% reported moderate and 21.2% reported languishing mental health. CONCLUSIONS: This large survey has shown that most of participants reported a flourishing mental health with high ratings at hope, resilience, and subjective happiness scales. Also, the main sources of stress were economic issues, not consequently related to the pandemic. This may add evidences to the international debate on the long term effects of the global pandemic and probably suggests that recovery processes have been collectively adopted in Paraguay.

Depresión, Ansiedad y Estrés en Enfermería en el Hospital Psiquiátrico, a 18 Meses de la Pandemia en Paraguay, 2021

Introducción: Los profesionales de salud, especialmente los del área de enfermería, se encuentran en mayores posibilidades de desarrollar trastornos mentales, debido a la alta exposición a condiciones tensionantes propias del ambiente laboral, que afectan integralmente a la persona. Objetivo: Identificar los niveles de depresión, ansiedad y estrés en Enfermería en el Hospital Psiquiátrico, en el hospital psiquiátrico, a 18 meses de la pandemia en Paraguay, 2021. Materiales y métodos: Estudio transversal descriptivo, aplicado a 79 profesionales de enfermería del Hospital Psiquiátrico en noviembre de 2021, mediante un instrumento de auto-llenado con variables sociodemográficas, laborales y clínicas, seguido del Inventario DASS-21. Resultados: Edad promedio 40 años, 63% femenino, 53% estado civil solteros/as, 78% son de asistencia directa y 22% gerenciales, con antigüedad promedio 14 años, 71% con un vínculo laboral, 25% fue muy afectado por la cuarentena, 57% enfermo de COVID-19, 70% no tuvo fallecidos por COVID-19 en su entorno familiar. En relación con los niveles de condiciones emocionales encontrados según el DASS-21, 58% tuvo ansiedad, 53% depresión y 49% estrés. Conclusión: Los porcentajes obtenidos en los diferentes niveles en la investigación son elevados, y se relacionan con las diferentes investigaciones desarrolladas sobre el tema.

Introduction: Healthcare professionals, especially those in nursing, are at a higher risk of developing mental disorders due to their exposure to stressful conditions inherent in the work environment, which profoundly affect individuals. Objective: To identify the levels of depression, anxiety, and stress among nursing staff at the Psychiatric Hospital, 18 months into the pandemic in Paraguay, 2021. Materials and Methods: A descriptive cross-sectional study was conducted in November 2021, involving 79 nursing professionals at the Psychiatric Hospital. Participants completed a self-administered instrument comprising sociodemographic, occupational, and clinical variables, followed by the DASS-21 Inventory. Results: Average age 40 years, 63% female, 53% single marital status, 78% were direct assistance and 22% managerial, with average seniority of 14 years, 71% with one work relationship, 25% were very affected by quarantine, 57% ill with COVID-19, 70% had no deaths due to COVID-19 in their family environment. In relation to the levels of emotional conditions found according to the DASS-21, 58% had anxiety, 53% depression and 49% stress. Conclusion: The percentages obtained in the different levels in the investigation are high and are related to the different investigations developed on the subject.

Caracterización Epidemiológica del Virus de Inmunodeficiencia Adquirida en Itapúa, Paraguay 2017-2021

Introducción: Un mayor conocimiento y difusión acerca del comportamiento epidemiológico de la infección por VIH en el Departamento de Itapúa genera una evidencia significativa para la toma de decisiones a nivel regional. Objetivo: Caracterizar epidemiológicamente a pacientes con VIH que forman parte del PRONASIDA del Hospital Regional de Encarnación desde el año 2017 a 2021. Material y Métodos: Estudio transversal descriptivo en pacientes con VIH captados por el PRONASIDA del Hospital Regional de Encarnación, 7ª Región Sanitaria, durante los años 2017-2021 (n=375). Los datos se expresaron en medidas de tendencia central y dispersión, y tabla de proporciones. Resultados: El mayor número de casos (80) se evidenció en los años 2018 y 2019. El rango etario de 20-29 años reportó el mayor número de casos, 20% (75), con predominancia del sexo femenino 64% (229), el 47% (177) procedente de Encarnación. Se halló un 43% (106) de casos de sida con CD4 menor a 200 células/mL, la mediana de la carga viral fue de 96.030cél/mL con un rango intercuartílico de 401.884,5cél/mL. Conclusión: Se identificó la disminución de nuevos diagnósticos en el año 2020, lo cual guarda relación con las medidas sanitarias a causa de la pandemia por COVID-19. Las características analizadas mostraron predominancia del sexo femenino en grupos etarios en edad joven con procedencia de Encarnación. Se considera importante fortalecer el primer nivel de atención en Itapúa a fin de evidenciar las brechas con el objetivo de ampliar el acceso para captación de pacientes y asegurar un diagnóstico precoz.

Introduction: Increased knowledge and dissemination about the epidemiological behavior of HIV infection in the Department of Itapúa generates significant evidence for decision-making at the regional level. Objective: To describe the epidemiological characteristics of patients with HIV who are part of the PRONASIDA of the Regional Hospital of Encarnación from 2017 to 2021. Materials and Methods: Cross-sectional study conducted on HIV patients enrolled in the PRONASIDA program at the Regional Hospital of Encarnación, 7th Health Region, during the years 2017-2021 (n=375). Data were expressed in measures of central tendency and dispersion, and proportions table. Results: The highest number of cases (80) was observed in 2018 and 2019. The age range of 20-29 years reported the highest number of cases, 20% (75), predominantly among females 64% (229), with 47% (177) originating from Encarnación. Forty-three percent (106) of AIDS cases had CD4 counts lower than 200 cells/mL, with a median viral load of 96,030 cells/mL and an interquartile range of 401,884.5 cells/mL. Conclusion: A decrease in new diagnoses was identified in the year 2020, likely associated with health measures due to the COVID-19 pandemic. The analyzed characteristics showed a predominance of females in younger age groups originating from Encarnación. It is considered important to strengthen primary care in Itapúa to highlight gaps, aiming to broaden access for patient enrollment and ensure early diagnosis.

Perfil de transmisión del SARS-COV-2 en una región sanitaria del Paraguay

Introducción: La transmisión viral a menudo se propaga en grupos, donde las infecciones se pueden rastrear hasta un caso índice o una ubicación geográfica, para así poder tomar medidas de prevención al respecto. Entender el perfil de transmisión del SARS-CoV-2 es esencial para desarrollar estrategias efectivas de prevención y control de la enfermedad. Objetivo: Determinar el perfil de transmisión del Sars-Cov-2, a partir de clúster con casos índices identificados, en la V región sanitaria (Caaguazu) del Paraguay, entre julio y octubre del 2020. Metodología: Se realizó un estudio observacional, descriptivo, de corte transversal, con fichas de notificación de casos de COVID-19 y resultados laboratoriales de la RT_PCR en pacientes diagnosticados con COVID-19 en la V Región Sanitaria entrejulio y octubre del 2020. Resultados: Fueron identificadas 703 personas con Sars-Cov-2 positivo. El 55,49 % de las personas no reconoció algún nexo de contagio. Con respecto al tipo de evento donde ocurrían con mayor frecuencia los contagios, ocurrieron en Eventos Sociales en 58,14 % de los casos y en el Ambiente Familiar en el 33,89 %. La transmisión secundaria se observó en el 17,40 % de los casos. Fueron identificados 58 Clústers, con una mediana de tamaño de los mismos de 3 (RIQ 2-4), y 267 personas (37,98 %) asociadas a los mismos. Discusión: La mayoría de las personas no reconocieron su nexo de contagio, sin embargo, en los que, si conocieron, se puede observar que la participación en eventos sociales fue el principal nexo, por lo que es fundamental realizar este tipo de ejercicios para hacer el seguimiento oportuno de los casos.

Introduction: Viral transmission often spreads in clusters, where infections can be traced to an index case or a geographic location, in order to take preventive measures in this regard, understanding the transmission profile of SARS-CoV-2 is essential. to develop effective disease prevention and control strategies. Objective: to determine the transmission profile of Sars-Cov-2, from clusters with identified index cases, in the V health region (Caaguazú) of Paraguay, between July and October 2020. Methodology: We carried out an observational, descriptive, cross-sectional study, with notification sheets of COVID-19 cases and laboratory results of the RT_PCR in patients diagnosed with COVID-19 in the V Sanitary Region between July and October 2020. Results: We identified 703 people with positive Sars-Cov-2. 55.49% of people did not recognize any contagion link. Regarding the type of event where infections occurred most frequently, was in Social Events in 58.14% of the cases and the Family Environment in 33.89%, secondary transmission was observed in 17.40% of the cases. 58 Clusters were identified, with a median size of 3 (IQR 2-4), and 267 people (37.98%) associated with them. Discussion: Most of the people did not recognize their contagion link, however, in those who did know, the main link was because they participated in social events, so it is essential to carry out this type of exercise to do timely follow-up. of the cases.

Vacunación contra el SARS-CoV-2 en pacientes paraguayos con artritis reumatoide

Introducción: La vacunación en poblaciones expuestas a mayor riesgo de enfermedad grave y muerte consecuentes a la infección por SARS-CoV-2, ha generado un gran impacto en la salud pública mundial. Indudablemente, el beneficio ha sido evidenciado mayormente en personas con comorbilidades crónicas, donde la artritis reumatoide (AR) juega un rol importante. Objetivo: Analizar la vacunación contra Sars-CoV-2 en pacientes paraguayos con AR, durante la pandemia COVID-19. Métodos: Se realizó un estudio multicéntrico, en el que se analizó transversalmente a una cohorte de pacientes con AR, durante el periodo de octubre a diciembre del año 2022. Para el estudio se registraron variables clínico-epidemiológicas y relacionadas con la vacunación (i.e. acceso a la vacunación, tipo, número de dosis). Se realizó un análisis descriptivo de las variables con el software R-4.3.2. Resultados: Se incluyeron 568 pacientes, 84,1% eran mujeres, con un promedio de edad de 55,5±13,9 años. El 88,7% (504) pacientes, recibieron al menos una dosis de vacuna contra SARS-CoV-2. 85% (483) recibieron dos dosis, mientras que el 60,9% (344) pacientes recibieron el primer refuerzo, y 21,2% el segundo refuerzo. Conclusiones: En esta serie de pacientes paraguayos con AR el porcentaje de vacunación contra SARS-CoV-2 fue más elevado que el registrado en la población general del país. Esto podría estar relacionado con la prioridad de esta población para acceder a las vacunas y a la insistencia de sus médicos en completar el esquema de vacunación.

Introduction: Vaccination in populations exposed to increased risk of severe disease and death consequent to SARS-CoV-2 infection has generated a major impact on global Public Health. Certainly, the benefit has been evidenced mostly in people with chronic comorbidities, where rheumatoid arthritis (RA) plays an important role. Objective: To analyze vaccination against Sars-CoV-2 in paraguayan patients with rheumatoid arthritis (RA) during the COVID19 pandemic. Methods: A multicenter study was carried out, in which a cohort of patients with RA was analyzed cross-sectionally, during the period from October to December 2022. For the study, clinical-epidemiological and vaccination-related variables were recorded (i.e. access to vaccination, type, number of doses). A descriptive analysis of the variables was carried out with the R-4.3.2 software. Results: 568 patients were included, 84.1% were female, with an average age of 55.5±13.9 years. 88.7% (504) patients received at least one dose of SARS-CoV-2 vaccine, 85% (483) received two doses, while 60.9% (344) patients received the first booster, and 21.2% the second booster. Conclusions: In this series of Paraguayan patients with RA the percentage of vaccination against SARS-CoV-2 was higher than that registered in the general population of the country. This could be related to the priority of this population to access vaccines and the insistence of their physicians to complete the vaccination schedule.

Neutralizing antibodies from naturally infected individuals against SARS-CoV-2 Gamma and Delta variants in the Paraguayan population.

INTRODUCTION: Severe Acute Respiratory Syndrome-Coronavirus-2 Virus (SARS-CoV-2) is responsible for Coronavirus Disease 2019 (COVID-19). A substantial number of SARS-CoV-2 infection cases have been reported during the pandemic, and vaccination coverage in some regions, particularly in developing countries, remains very low. SARS-CoV-2 variants of concern (VOCs) have also emerged as some of the most pressing public health issues. In this scenario, it is crucial to know whether COVID-19 convalescent antibodies have cross-neutralizing action against VOCs to contribute to the analysis of the future progress of the pandemic. METHODOLOGY: The plasma of individuals infected with SARS-CoV-2 from June to November 2020 in Paraguay (before the first recorded infections associated with VOCs in the country) was selected. Anti-spike antibodies were determined in plasma samples (n = 626) obtained from this convalescent and unvaccinated group. Using a pseudotyped virus neutralization assay, we then investigated the neutralizing response against D614G variant and Gamma, and Delta VOCs. RESULTS: IgG antibodies against spike were detected in 85.6% of convalescent individuals. Samples from individuals previously infected by a non-VOC showed a 6.6- and 8.1-fold reduction in neutralizing capacity to the Gamma and Delta variants, respectively, when compared to the D614G variant. CONCLUSIONS: Our findings show that antibodies generated by non-VOC infection have reduced neutralizing capabilities against Gamma and Delta variants that appeared subsequently and might have implications for immunity strategies.

COVID-19 vaccine effectiveness against hospitalizations in Paraguay, May 2021-April 2022: A test-negative design.

BACKGROUND: Vaccine effectiveness (VE) estimates vary by population characteristics and circulating variants. North America and Europe have generated many COVID-19 VE estimates but relied heavily on mRNA vaccines. Fewer estimates are available for non-mRNA vaccines and from Latin America. We aimed to estimate the effectiveness of several COVID-19 vaccines in preventing SARS-CoV-2-associated severe acute respiratory infection (SARI) in Paraguay from May 2021 to April 2022. METHODS: Using sentinel surveillance data from four hospitals in Paraguay, we conducted a test-negative case-control study to estimate COVID-19 vaccine effectiveness against SARI by vaccine type/brand and period of SARS-CoV-2 variant predominance (Gamma, Delta, Omicron). We used multivariable logistic regression adjusting for month of symptom onset, age group, and presence of ≥1 comorbidity to estimate the odds of COVID-19 vaccination in SARS-CoV-2 test-positive SARI case-patients compared to SARS-CoV-2 test-negative SARI control-patients. RESULTS: Of 4,229 SARI patients, 2,381 (56%) were SARS-CoV-2-positive case-patients and 1,848 (44%) were SARS-CoV-2-negative control-patients. A greater proportion of case-patients (73%; 95% CI: 71-75) than of control-patients (40%; 95% CI: 38-42) were unvaccinated. During the Gamma variant-predominant period, VE estimates for partial vaccination with mRNA vaccines and Oxford/AstraZeneca Vaxzevria were 90.4% (95% CI: 66.4-97.6) and 52.2% (95% CI: 25.0-69.0), respectively. During the Delta variant-predominant period, VE estimates for complete vaccination with mRNA vaccines, Oxford/AstraZeneca Vaxzevria, or Gamaleya Sputnik V were 90.4% (95% CI: 74.3-97.3), 83.2% (95% CI: 67.8-91.9), and 82.9% (95% CI: 53.0-95.2), respectively. The effectiveness of all vaccines declined substantially during the Omicron variant-predominant period. CONCLUSIONS: This study contributes to our understanding of COVID-19 VE in Latin America and to global understanding of vaccines that have not been widely used in North America and Europe. VE estimates from Paraguay can parameterize models to estimate the impact of the national COVID-19 vaccination campaign in Paraguay and similar settings.

Percepción sobre la vacuna COVID-19 y su efecto en la cobertura de vacunación regular de pueblos indígenas del Departamento de Presidente Hayes, Paraguay

Introducción: Durante la pandemia por COVID-19, factores como cierre de fronteras, recepción tardía de vacunas, limitación de circulación de la población, reubicación de enfermeros/as de áreas de vacunación a áreas de atención de pacientes con COVID-19, sumado el miedo al contagio, afectaron las coberturas de vacunación en varios países. Objetivo: Describir la percepción sobre la vacuna COVID-19 y su efecto en la cobertura de vacunación regular de pueblos indígenas del departamento de Presidente Hayes, Paraguay. 2022. Metodología: Estudio observacional descriptivo, retrospectivo de diseño cuali-cuantitativo de corte transversal. Resultados: Las características de los pueblos indígenas revela que 110(26,44 %) se ubica entre 28 a 37 años, 276(66,35 %) del sexo femenino, 133(31,97 %) son de la etnia Angaité, 290(69,71 %) poseen estudios hasta el nivel primario y 178(42,79 %) de estado civil soltero. La percepción hacia la vacunación COVID-19 fue favorable en 201 sujetos (48 %) y muy desfavorable en 148 (36 %). Existen pueblos indígenas con gran influencia de creencias culturales y religiosas en relación con las vacunas. La vacunación regular se vio afectada. Discusión: Se observó que la pandemia del COVID-19 y la aparición de la vacuna desarrolló desconfianza no solo en la vacuna COVID-19 si no también en el resto de las vacunas en algunos de los pueblos estudiados.

Introduction: During the COVID-19 pandemic, factors such as border closures, late receipt of vaccines, limitation of population circulation, relocation of nurses from vaccination areas to areas of care for patients with COVID-19, added to the fear of contagion affected vaccination coverage in several countries. Objective: Describe the perception of the COVID-19 vaccine and its effect on the regular vaccination coverage of indigenous peoples in the department of Presidente Hayes, Paraguay 2022. Methods: Descriptive, retrospective, observational study with a qualitative-quantitative cross-sectional design. Results: The characteristics of the indigenous peoples reveals that 110 (26.44%) are between 28 and 37 years old, 276 (66.35%) are female, 133 (31.97%) are of the Angaité ethnic group, 290 (69.71%) have studies up to the primary level and 178 (42.79%) have single marital status. The perception towards the COVID-19 vaccination was favorable in 201 subjects (48%) and very unfavorable in 148 (36%). There are indigenous peoples with great influence of cultural and religious beliefs in relation to vaccines. Regular vaccination was affected. Discussion: It was observed that the COVID-19 pandemic and the appearance of the vaccine developed distrust not only in the COVID-19 vaccine but also in the rest of the vaccines in some of the towns studied.

Factores asociados a mortalidad en pacientes críticos con COVID-19 en un centro universitario de Paraguay

Introducción: La pandemia por COVID-19 es un problema de salud mundial. Habitualmente cursa con sintomatología leve y 5% de los afectados evoluciona a cuadros graves que requieren de cuidados intensivos. Objetivo: Determinar el perfil clínico, la mortalidad y factores asociados a la misma en pacientes con COVID-19 ingresados al Departamento de Cuidados Intensivos de Adultos, del Hospital de Clínicas de la Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Paraguay, entre agosto de 2020 a agosto de 2021. Pacientes y Método: Se realizó un estudio observacional analítico de corte transverso. Los datos se obtuvieron a partir de las historias clínicas de los pacientes. Resultados: Se incluyeron 214 pacientes críticos entre 21 y 85 años de edad (mediana 54 años), 57,9% del sexo masculino, 85% provenientes del Departamento Central y Asunción. La mortalidad global fue de 38,3%. Se asociaron significativamente con la mortalidad una edad ≥ 60 años, las comorbilidades (diabetes mellitus, cardiopatía, enfermedad renal crónica), los índices de gravedad (APACHE II, SOFA, inicial), procalcitonina elevada, utilización de vasopresor, asistencia respiratoria mecánica y utilización del decúbito prono; así como la presencia de SDRA y el requerimiento de depuración extrarenal. En el análisis multivariado (por regresión logística) los factores de riesgo de mortalidad independientes fueron: la edad mayor de 60 años, la utilización de noradrenalina y depuración extra-renal durante la hospitalización. Conclusión: Nuestra mortalidad es similar a la reportada internacionalmente. Los factores de riesgo de mortalidad identificados muestran una población con mayores posibilidades de un desenlace desfavorable.

Background: The COVID-19 pandemic is a world health issue. Generally, it is with mild and around 5% evolves to a severe disease that requires intensive care. Aim: To determine the clinical profile, mortality and associated factors in COVID-19 patients admitted at the Adult Intensive Care Department at the Hospital de Clinicas, between August 2020 and August 2021. Methods: Cross-section observational analytic study. Data was obtained from clinical charts. Results: 214 patients were included, with an average age of 54 years, 57.9% male. Overall mortality was 38.3%. Factors associated significantly with mortality were: ≥60 years of age, comorbidity (diabetes mellitus, heart disease, chronic renal disease), severity index (APACHE II, initial SOFA), high procalcitonin, use of vasopressor, mechanical respiratory assistance and prone decubitus; as well as the presence of acute respiratory distress syndrome and hemodialysis. Multi varied analysis identified as mortality risk factors: ≥60 years of age, noradrenaline use and hemodialysis. Conclusion: Mortality rate is similar to that reported worldwide. Mortality risk factors identified show a population with higher possibilities for unfavorable outcome.

The Experience of Testing for Coronavirus Disease (COVID-19) at a Single Diagnostic Center in Paraguay before the Introduction of Vaccination.

Soon after the declaration of the COVID-19 pandemic, the Institute for Health Sciences Research (IICS) of the National University of Asunción, Paraguay became a testing laboratory (COVID-Lab) for SARS-CoV-2. The COVID-Lab testing performance was assessed from 1 April 2020 to 12 May 2021. The effect of the pandemic on the IICS and how the COVID-Lab contributed to the academic and research activities of the institute were also assessed. IICS researchers and staff adjusted their work schedules to support the COVID-Lab. Of the 13,082 nasopharyngeal/oropharyngeal swabs processed, 2704 (20.7%) tested positive for SARS-CoV-2 by RT-PCR. Of the individuals testing positive, 55.4% were female and 48.3% were aged 21-40 years. Challenges faced by the COVID-Lab were unstable reagent access and insufficient staff; shifting obligations regarding research, academic instruction, and grantsmanship; and the continuous demands from the public for information on COVID-19. The IICS provided essential testing and reported on the progress of the pandemic. IICS researchers gained better laboratory equipment and expertise in molecular SARS-CoV-2 testing but struggled to manage their conflicting educational and additional research obligations during the pandemic, which affected their productivity. Therefore, policies protecting the time and resources of the faculty and staff engaged in pandemic-related work or research are necessary components of healthcare emergency preparedness.

Mortalidad en adultos con COVID-19: experiencia de la Unidad de Cuidados Intensivos de un Hospital de Tercer Nivel de Paraguay

Introducción: diversos factores pueden influir en la mortalidad de pacientes hospitalizados por COVID-19. Objetivo: determinar la mortalidad y los factores asociados a esta en adultos con COVID-19 hospitalizados en la unidad de cuidados intensivos de un Hospital de Tercer Nivel de Paraguay. Metodología: estudio observacional, descriptivo, de asociación cruzada, de corte transversal y temporalmente retrospectivo. Se incluyó historias clínicas de pacientes adultos, de ambos sexos, que tenían diagnóstico confirmado (por prueba de antígeno y/o PCR) de infección por SARS-CoV-2 y que estaban hospitalizados en la unidad de cuidados intensivos de un Hospital General de Tercer Nivel de Paraguay. Resultados: Se incluyeron 116 pacientes, de los cuales el 54 % correspondió al sexo masculino. La edad media fue de 57±12,9 años. El 51 % tenía hipertensión arterial y el 29 % diabetes mellitus. El requerimiento de ventilación mecánica se dio en un 85% de pacientes. El 75 % de los pacientes ventilados tuvo un desenlace fatal. Se encontró una asociación estadísticamente significativa entre la presencia de infecciones bacterianas y requerimiento de hemodiálisis y el desenlace fatal (p=0,0074 y p=0,00011, respectivamente). La media de las edades de los pacientes fallecidos fue de 59,5 años, mientras que el grupo de pacientes que recibieron el alta desde la unidad de cuidados intensivos arrojó una media de 54,2 años. La diferencia entre estas edades en relación con el óbito fue significativa, con una p<0,05. Discusión: La mortalidad general debido a COVID-19 fue de más de 6 por cada 10 pacientes, siendo más alta en aquellos pacientes con ventilación. Aquellos pacientes que presentaron sobreinfección bacteriana o requirieron de hemodiálisis durante el curso de la hospitalización presentaron un peor desenlace en comparación con los pacientes que no presentaron este tipo de complicaciones.

Introduction: Several factors may influence mortality in patients hospitalized with COVID-19. Objective: This research aimed to determine mortality and associated factors in adults with COVID-19 hospitalized in the intensive care unit of a Third Level Hospital in Paraguay. Methodology: Observational, descriptive of cross-association, cross-sectional, and retrospective study. We included medical records of adult patients, of both sexes, who had a confirmed diagnosis (by antigen and/or PCR test) of SARS-CoV-2 infection and who were hospitalized in the intensive care unit of a Third Level General Hospital in Paraguay. Results: We included 116 patients, 54% of whom were male. The mean age was 57 ± 12.9 years. Of participants, 51% had hypertension and 29% diabetes mellitus. Mechanical ventilation was required in 85% of the patients. Of ventilated patients, 75% had a fatal outcome. A statistically significant association was found between the presence of bacterial infections and hemodialysis requirement and fatal outcome (p=0.0074 and p=0.00011, respectively). The mean age of the deceased patients was 59.5 years, while the group of patients discharged from the intensive care unit had a mean age of 54.2 years. The difference between these ages in relation to death was significant, with a p<0.05. Discussion: Overall mortality due to COVID-19 was more than 6 per 10 patients, being higher in those patients with ventilation. Those patients who presented bacterial superinfection or required hemodialysis during hospitalization had a worse outcome compared to patients who did not present this type of complications.

"Pandemic Fatigue" in South America: A Multi-Center Report from Argentina, Bolivia, Paraguay, Peru, and Uruguay.

The COVID-19 pandemic has had a heavy impact on daily life, leading to physical and psychosocial consequences. Nowadays, clinicians and health researchers are particularly interested in describing and facing the long-term effects of COVID-19, also known as "long-COVID syndrome". Pandemic fatigue has been defined as a cluster of demotivation, tiredness, and psychological effects that emerge gradually over time after the infection or through the adoption of the recommended measures to combat it. In this study, we report the findings of a large survey conducted in South America involving 1448 participants (mean age: 33.9 ± 11.2 years old) from Argentina, Bolivia, Uruguay, Peru, and Paraguay. An online survey was launched through the common social media based on a specific assessment aimed to detect the prevalence of pandemic fatigue and associated factors. Socio-demographic characteristics, medical, and personal information were collected; the Pandemic Fatigue Scale (PFS) and the Coronavirus Anxiety Scale (CAS) were also administered. We found mid-levels of pandemic fatigue among respondents (21.7 ± 7.95 score at PFS) as well as significant anxiety related to the COVID-19 pandemic (1.56 ± 2.76 score at CAS). In addition, pandemic fatigue was significantly associated with the experience of the loss of a relative/friend due to COVID-19, anxiety related to the infection, and reliance on social media as a primary source of information on the pandemic. Vaccination significantly reduced the levels of fatigue among respondents. Our findings may add to the international debate regarding the long-term health consequences of the COVID-19 pandemic and strategies to manage them in the general population of South America.

Características epidemiológicas de la infección por SARS-CoV-2 en hogares de escolares de tres instituciones educativas en Asunción y departamento Central entre octubre a noviembre de 2021 / Epidemiological characteristics of SARS-CoV-2 infection in households of schoolchildren from three educational institutions in Asunción and the Central department between October and November 2021

Introducción. Caracterizar la epidemia del SARS-CoV-2 en la comunidad puede aportar datos útiles a las autoridades en la toma de decisiones sobre las instituciones educativas en Paraguay. Objetivo. Describir las características epidemiológicas de la infección por SARS-CoV-2 en los hogares de escolares de tres instituciones de Asunción y departamento Central. Materiales y Métodos. Estudio descriptivo transversal realizado entre el 25 de octubre al 5 de noviembre de 2021. Se aplicaron encuestas estructuradas a los padres o encargados de escolares mediante un cuestionario en formato del formulario de Google enviado a través del WhatsApp desde la Dirección de las instituciones educativas. El cuestionario incluía preguntas sobre el número integrantes del hogar, datos demográficos del encuestado, número de personas con co-morbilidad, personas con COVID-19, con necesidad de hospitalización, número de fallecidos y vacunados contra COVID-19. Resultado. Se obtuvieron datos de 780 hogares, 379 (48,6%) de San Lorenzo, 217 (27,8) de Limpio, 93 (11,9%) de Asunción y 91 de otras localidades de Central (11,7%), el 18,6 % (731/3920) de los integrantes del hogar tuvo COVID-19, de ellos 9,7% (71/731) fue hospitalizado. La mortalidad fue de 0,79% (31/3920) y la letalidad 4,2% (31/731). El 52,7% (2340/3920) ya fue vacunado contra COVID-19 y el 88,2% (2065/2340) de ellos con dosis completa. Conclusión. La prevalencia de COVID-19 estuvo dentro del rango esperado para las infecciones sintomáticas con un alto índice de transmisión intradomiciliaria. Tanto la tasa de mortalidad como letalidad fueron consistentes con los datos nacionales. Palabras Clave: COVID-19; instituciones académicas; Paraguay; características de estudios epidemiológicos

Introduction. Characterizing the SARS-CoV-2 epidemic in the community can provide useful data for the authorities in making decisions on the educational institutions in Paraguay. Objective.To describe the epidemiological characteristics of SARS-CoV-2 infection in the homes of schoolchildren from three institutions in Asunción and the Central Department. Materials and Methods. Cross-sectional descriptive study carried out between October 25 and November 5, 2021. Structured surveys were applied to parents or guardians of schoolchildren through a questionnaire in the format of the Google form sent through WhatsApp from the Directorate of the educational institutions. The questionnaire included questions about the number of household members, demographic data of the respondent, number of people with co-morbidity, people with COVID-19, need of hospitalization, number of death and vaccinated against COVID-19. Results.Data from 780 households were obtained, 379 (48.6%) from San Lorenzo, 217 (27.8) from Limpio, 93 (11.9%) from Asunción and 91 from other localities from Central (11.7%); 18.6% (731/3920) of household members had COVID-19, of them 9.7% (71/731) were hospitalized. Mortality rate was 0.79% (31/3920) and lethality 4.2% (31/731). 52.7% (2,340/3,920) were already vaccinated against COVID-19 and 88.2% (2,065/2,340) of them fully vaccinated. Conclusion.The prevalence of infection was within the expected range for symptomatic COVID-19 infections with a high rate of intradomiciliary transmission. Both the hospitalization and fatality rates were within the range for the country. Key words: COVID-19; schools; Paraguay; epidemiologic study characteristics