PURPOSE The COVID-19 pandemic is a colossal challenge for global health; nonetheless, specific subgroups face considerably higher risks for infection and mortality. Among patients with malignant diseases, those with hematologic neoplasms are at a higher risk for poor outcomes. The objective of this study was to register treatment modifications associated with the COVID-19 pandemic and their short-term consequences in Latin America. METHODS Multicenter, prospective, observational, cohort study including patients older than 14 years from 14 centers in four countries (Mexico, Peru, Guatemala, and Panama) who had a confirmed diagnosis of acute leukemia, and who were undergoing active treatment since the first COVID-19 case in each country until the cutoff on July 15, 2020. RESULTS We recruited 635 patients. Treatment modifications because of the COVID-19 pandemic were reported in 40.8% of cases. The main reason for such modifications was logistic issues (55.0%) and the most frequent modification was chemotherapy delay (42.0%). A total of 13.1% patients developed COVID-19 disease, with a mortality of 37.7%. Several factors were identified as independently associated with mortality, including a diagnosis of acute myeloid leukemia (odds ratio 2.38 [95% CI, 1.47 to 3.84]; P < .001), while the use of telemedicine was identified as a protective factor (odds ratio 0.36 [95% CI, 0.18 to 0.82]; P = .014). CONCLUSION These results highlight the collateral damage of COVID-19 in oncology patients.

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Background Clostridium difficile infection (CDI) is a nosocomial condition prevalent in patients with hematological disorders. We aimed to identify the risk factors associated with the development of CDI and assess the mortality rate at 15 and 30 days among hematologic patients admitted to a tertiary care center. Methods We conducted a retrospective case-control study from January 2010 to December 2015. Forty-two patients with hematologic malignancy and CDI, and 84 with hematologic disease and without history of CDI were included in the case and control groups, respectively. Results Univariate analysis revealed that episodes of febrile eutropenia [odds ratio (OR), 5.5; 95% confidence interval (CI), 2.3–12.9; P <0.001], admission to intensive care unit (OR, 3.8; 95% CI, 1.4–10.2; P =0.009), gastrointestinal surgery (OR, 1.2; 95% CI, 1.1–1.4; P <0.001), use of therapeutic (OR, 6.4; 95% CI, 2.5–15.9; P <0.001) and prophylactic antibiotics (OR, 4.2; 95% CI, 1.6–10.7; P =0.003) in the last 3 months, and >1 hospitalization (OR, 5.6; 95% CI, 2.5–12.6; P <0.001) were significant risk factors. Multivariate analysis showed that use of therapeutic antibiotics in the last 3 months (OR, 6.3; 95% CI, 2.1–18.8; P =0.001) and >1 hospitalization (OR, 4.3; 95% CI, 1.7–11.0; P =0.002) were independent risk factors. Three (7.1%) and 6 (14.2%) case patients died at 15 and 30 days, respectively. Conclusion The risk factors for developing CDI were exposure to therapeutic antibiotics and previous hospitalization. Hematological patients who developed CDI had higher early mortality rates, suggesting that new approaches for prevention and treatment are needed.

El uso de terapias antitrombóticas y de antiinflamatorios no esteroideos ha aumentando progresivamente, lo cual incrementa el riesgo de hemorragia. Entre las causas y sitios de hemorragia asociada a estas terapias están aquellos que suceden alrededor de un procedimiento invasivo como la endoscopia. En los pacientes que reciben terapia antitrombótica y que serán sometidos a algún procedimiento endoscópico se debe equilibrar el riesgo de hemorragia frente al riesgo trombótico, para minimizar el tiempo en que el paciente estará sin la debida protección antiplaquetaria o anticoagulante. El manejo de la terapia antitrombótica durante una endoscopia se ha hecho más complejo debido al desarrollo de anticoagulantes de acción directa. Aunque existen guías y revisiones internacionales sobre el manejo de estos fármacos en relación con procedimientos endoscópicos, el idioma de publicación, y la disponibilidad y accesibilidad de medicamentos limitan el acceso a ellas, así como su aplicabilidad ad integrum; esto justifica su revisión y adaptación a México. La Asociación Mexicana de Endoscopia Gastrointestinal convocó a un grupo de gastroenterólogos, cardiólogos, hematólogos y endoscopistas para revisar y evaluar de manera crítica la evidencia científica para proponer estrategias de manejo de la terapia antitrombótica antes, durante y después de algún procedimiento endoscópico. El objetivo es sugerir alternativas de acuerdo con la disponibilidad de recursos humanos y tecnológicos en nuestro país basadas en la evidencia científica disponible en la actualidad.