El objetivo de la presente investigación consiste en averiguar cuáles fueron los ajustes y cambios que las micro, pequeñas y medianas empresas (MIPyMES) familiares restauranteras de la ciudad de Tepic tuvieron que realizar para enfrentar los efectos provocados por la crisis de la Covid 19: ¿qué pasó con los esfuerzos de las familias que dependen económicamente de un establecimiento de alimentos y bebidas? ¿Qué tipo de apoyos, capacitación o seguimiento obtuvieron por parte del Estado? ¿Cómo ha cambiado la operación de los establecimientos que continuaron en funcionamiento? Esta investigación permite realizar una primera caracterización y acercarse a la realidad vivida por este sector en la ciudad de Tepic Nayarit durante la presente crisis. Para tales efectos se realizó una encuesta telefónica aleatoria irrestricta aplicada al 10% del tamaño de las muestras calculadas para el universo de las MIPyMES reportadas por el Directorio Estadístico Nacional de Unidades Económicas 2019 del INEGI. El muestreo se distribuyó como sigue: microempresas, 31 entrevistas; pequeñas empresas, 4 y en el caso de la empresa mediana registrada, una entrevista. Se aplicaron un total de 36 entrevistas. Entre los resultados más sobresalientes se encontró que 77% de los establecimientos encuestados siguen en funcionamiento y un 23% no; de este último dato, 12% cerraron en forma permanente y 88% de forma temporal. 89% de los encuestados conocieron de las medidas exigidas por la Secretaría de Salud para operar a través de noticieros y redes sociales, el 11% restante se enteró por medio de familiares y otros colegas restauranteros.
Purpose/Objective(s)
To evaluate the safety and efficacy of Low-Dose Radiation (LD-RT) to treat COVID-19 pneumonia.
Materials/Methods
We conducted a prospective phase I-II trial enrolling patients ≥ 50 years-old, COVID-19 positive, with lung involvement at imaging study and oxygen requirement. Patients received 100 cGy to total lungs in a single fraction. Dose planning goals were PTV95 > 80% with Dmax < 115%. Primary outcome was radiological response assessed as severity and extension scores at days 0, +3 and +7. Secondary outcomes were toxicity (CTCAE v5.0), days of hospitalization, changes in inflammatory blood parameters (ferritin, lymphocytes, C-reactive protein, d-dimer and LDH) and SatO2/ FiO2 index (SAFI) at +3 and +7 (normal SAFI > 315, mild respiratory failure < 300, and severe < 200). Descriptive analyses were summarized as means with standard deviation (SD) and medians with interquartile ranges (IQR). A Wilcoxon sign rank test for paired data was used to assess the CT scores and Chi Square was used to assess for comparison of categorical variables.
Results
Forty-one patients were included. Three patients died < 72h after LD-RT and were excluded from the analysis. Median age was 71 (IQR 60-84). Eighteen patients (47%) received previously any anti-COVID treatment (tocilizumab, lopinavir/ritonavir, remdesivir) and thirty-two patients (84%) received steroids (GC) during LD-RT. Extension score improved significantly (
P
= 0.02) on day +7; severity score was stable or slightly decreased (
P
= 0.1). Median SAFI on day 0 was 147 (IQR 118-264), 230 (IQR 120-343) on day +3 and 293 (IQR 121-353) on day +7 (
P
< 0.01). SAFI improvement was associated with overall survival (
P
= 0.01). Significant decrease was found in C-reactive protein on day +7 (
P
= 0.02) and in lymphocytes counts on day +3 and +7 (
P
= 0.02). Median time to receive RT from the date of admission was 19 days (ranging 2-87). Median number of days in hospital after RT was 11 (4-78) and overall was 37 days (range 11-155). With a median follow-up of 67 days after LD-RT, 24 (63%) patients were discharged, twelve (32%) died and two (5%) are still inpatients.
Conclusion
Our preliminary results show that LD-RT was feasible and well-tolerated treatment, with potential clinical improvement. Randomized trials are needed to establish whether LD-RT improves severe pneumonia.
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