BACKGROUND: Coronavirus disease (COVID-19) is the pandemic caused by SARS-CoV-2 that has caused more than 2.2 million deaths worldwide. We summarize the reported pathologic findings on biopsy and autopsy in patients with severe/fatal COVID-19 and documented the presence and/or effect of SARS-CoV-2 in all organs. METHODS AND FINDINGS: A systematic search of the PubMed, Embase, MedRxiv, Lilacs and Epistemonikos databases from January to August 2020 for all case reports and case series that reported histopathologic findings of COVID-19 infection at autopsy or tissue biopsy was performed. 603 COVID-19 cases from 75 of 451 screened studies met inclusion criteria. The most common pathologic findings were lungs: diffuse alveolar damage (DAD) (92%) and superimposed acute bronchopneumonia (27%); liver: hepatitis (21%), heart: myocarditis (11.4%). Vasculitis was common only in skin biopsies (25%). Microthrombi were described in the placenta (57.9%), lung (38%), kidney (20%), Central Nervous System (CNS) (18%), and gastrointestinal (GI) tract (2%). Injury of endothelial cells was common in the lung (18%) and heart (4%). Hemodynamic changes such as necrosis due to hypoxia/hypoperfusion, edema and congestion were common in kidney (53%), liver (48%), CNS (31%) and GI tract (18%). SARS-CoV-2 viral particles were demonstrated within organ-specific cells in the trachea, lung, liver, large intestine, kidney, CNS either by electron microscopy, immunofluorescence, or immunohistochemistry. Additional tissues were positive by Polymerase Chain Reaction (PCR) tests only. The included studies were from numerous countries, some were not peer reviewed, and some studies were performed by subspecialists, resulting in variable and inconsistent reporting or over statement of the reported findings. CONCLUSIONS: The main pathologic findings of severe/fatal COVID-19 infection are DAD, changes related to coagulopathy and/or hemodynamic compromise. In addition, according to the observed organ damage myocarditis may be associated with sequelae.
Objectives: To identify COVID-19 actionable statements (e.g., recommendations) focused on specific disadvantaged populations in the living map of COVID-19 recommendations (eCOVIDRecMap) and describe how health equity was assessed in the development of the formal recommendations.Study design and methods: We employed the PROGRESS-Plus framework to identify statements focused on specific disadvantaged populations. We assessed health equity considerations in the Evidence to Decision frameworks (EtD) of formal recommendations for certainty of evidence and impact on health equity criteria according to the GRADE criteria.Results: We identified 16% (124/758) formal recommendations and 24% (186/819) Good Practice Statements (GPS) that were focused on specific disadvantaged populations. Formal recommendations (40%, 50/124) and GPS (25%, 47/186) most frequently focused on children. Seventy-six percent (94/124) of the recommendations were accompanied with EtDs. Over half (55%, 52/94) of those considered Indirectness of the evidence for disadvantaged populations. Considerations in impact on health equity criterion most frequently involved implementation of the recommendation for disadvantaged populations (17%, 16/94).Conclusions: Equity issues were rarely explicitly considered in the development COVID-19 formal recommendations focused on specific disadvantaged populations. Guidance is needed to support the consideration of health equity in guideline development during health emergencies.
Determine the frequency and preventability of adverse events (AEs) from available information sources in selected ambulatory care (AC) sites in Latin America (LA). Multinational observational cohort was conducted to determine the period prevalence (retrospective focus) and the cumulative incidence (prospective focus) of AEs. Outpatient clinics in Mexico, Peru, Brazil and Colombia. A random selection of 2080 patients. The existence of AE was decided based on trigger information provided by the patient and crossing the data with each patient's medical history. AE occurrences 6 months prior (prevalence) and 42 days after (incidence) the patient receiving AC were identified. AE type and preventability were also described. Two thousand eighty patients participated in the study. AEs prevalence was 5.2% (108/2080) [95% confidence interval (CI) 4.2–6.1%], and cumulative incidence was 2.4% (42/1757) (95% CI 1.7–3.1%). AEs considered preventable were 44% (55/108) of prevalence period, and 52.4% (22/42) of incidence period. Preventability was associated with patient socioeconomic status (OR 3.5, 95% CI 1.4–8.8), medication error (OR 0.1, 95% CI 0.0–0.4), diagnostic error (OR 0.1, 95% CI 0.0–0.8) and a minor impact on the patient (OR 0.2 95% CI 0.1–0.9). The frequency of AE in ambulatory settings in LA is in the high-frequency range of research focused on the prevalence of AEs. Fifty percent was preventable. This study provides an approach for assessing the frequency and preventability of AE in order to enhance patient safety in LA.
Objectives: To evaluate the association between Colombia's third wave when the Mu variant was predominant in Colombia and COVID-19 all-cause in-hospital mortality.Methods: In this retrospective cohort, we included hospitalized patients ≥18 years with SARS-CoV-2 infection between March 2020 to September 2021 in ten hospitals from three cities in Colombia. Description analysis, survival, and multivariate Cox regression analyses were performed to evaluate the association between the third epidemic wave and in-hospital mortality.Results: A total of 25,371 patients were included. The age-stratified time-to-mortality curves showed differences according to epidemic waves in patients ≥75 years (log-rank test p=0.012). In the multivariate Cox analysis, the third wave was not associated with increased mortality relative to the first wave (aHR 0.95; 95%CI 0.84-1.08), but there was an interaction between age ≥75 years and the third wave finding a lower HR for mortality (aHR 0.56, 95%CI 0.36-0.86).Conclusions: We did not find an increase in in-hospital mortality during the third epidemic wave in which the Mu variant was predominant in Colombia. The reduced hazard in mortality in patients ≥75 years hospitalized in the third wave could be explained by the high coverage of SARS-CoV-2 vaccination in this population and patients with underlying conditions.
This systematic literature review sought to identify methodologies and technical strategies emphasising healthcare services and outcomes when incorporating the concept of equity into Clinical Practice Guidelines (CPG). 940 references were identified, of which 20 fulfilling the inclusion criteria were selected. While no reports were found describing or evaluating an explicit methodology for incorporating considerations of equity into CPG, some studies revealed related strategies or processes, summarised as follows: 1. Target population involvement during all phases of designing, implementing and evaluating CPG; 2. "Cultural capacity" seen as being necessary in CPGs' "cultural translation" for interventions to have less disparity regarding their application and results; 3. Considering psycho-social factors which could affect implementing CPG, and; 4. Considering system inequities so that any health intervention would also confront risks and obstacles to health care due to socioeconomic status. It was concluded that CPGs could be a potential route for promoting more equitable healthcare effects by standardising health interventions if, by incorporating some of the processes described above, they actively seek to avoid unjust differences in access to and/or the quality of the interventions that they prescribe.
Abstract Background The monkeypox virus, part of the Orthopoxvirus genus, triggered a worldwide outbreak in 2022. While this outbreak had widespread effects, there's limited information on mpox's specific impact in Colombia, particularly in terms of how it is managed, its burden, and its epidemiology. This research seeks to examine the medical context, clinical variations, and health consequences in individuals diagnosed with mpox, especially those with HIV in Colombian health institutions Methods This retrospective study was conducted in health institutions in Colombia based on clinical records from Jan 2022 to Dec 2023. . Participants in the study were diagnosed through molecular methods and their clinical evolution was tracked through medical records. CD4 groups, BMI groups, viral suppression status, and HIV status were used to analyse the results. Results One thousand four hundred thirteen (1,413, 97.2% male) individuals, including 2.6% identified as healthcare workers were included in this study. Concomitant sexually transmitted diseases were common, affecting 30.1%, mainly syphilis (80%) and Neisseria gonorrhoeae (16.4%). 54% of the population (764/1413 individuals, 99.3% male) were persons living with HIV (PWH), and almost one-third (31%, n=284) of participants had concomitant sexually transmitted diseases and HIV PWH also had a higher proportion of gastrointestinal symptoms and genital symptoms. An important difference between HIV-positive and negative patients is that the former had a higher proportion of syphilis (p-value 0.5909) and other STIs (p-value 0.0026). Although PWH were younger (34.3±7.7 vs. 37.7±7.5), the difference in mean age was not statistically significant, although the differences in proportion were (15 to 44 years group, p-value 0.0097). Conclusion The evidence presented shows that half of the population were people living with HIV, and the presence of mpox was not statistically significant in people with unsuppressed viral load or with low CD4 levels. The evidence provided by this study, whose results were standardized by the CRFs, and emphasizes the importance of interdisciplinary attention for patients suffering from mpox. Special emphasis should be placed on individuals support and follow-up, focusing on detecting concomitant STIs. Disclosures All Authors: No reported disclosures
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