Angiotensin and pain

The role of the renin-angiotensin system in human pain is a complicated and controversial field, partly due to the complexities of the system itself, but also because of the diverse ways in which pain functions. Here, we focus on what is known about the angiotensins in pathological pain and describe the ongoing attempts to identify candidate modulators of clinical significance. Systemic angiotensin agonists and antagonists have effects in a number of neuropathic ailments, including some of the most medically intractable conditions, such as endocrine disorders, cancer, myopathies, and viral infections (such as COVID-19), apart from direct damage to the nervous system. These arise due to multiple physiological processes involving both neural and nonneural pathways that could be overcome with future research. In summary, it is clear that the angiotensins acting through their different receptors exercise both algesic and analgesic effects, but less clear how this diversity of responses arises. © 2023 Elsevier Inc. All rights reserved.

Respiratory Outcomes in COVID-19 patients 3-6 months after admission to Public Health Hospital Maciel. Montevideo, Uruguay. A Follow up Cohort Study

To date, millions of people worldwide have recovered from COVID19, but concern remains on long-term impairment. We aimed to determine 3-6 months respiratory outcomes in a Latin American Public Health Hospital. Method(s): COVID-19 patients referred (April-June 2021,gamma variant breakdown) were enrolled, recalling epidemiology, demographic, comorbidities, laboratory, radiology, treatment and outcomes, performing spirometry, lung volumes, diffusing capacity (DLCO), walking test (6MWT);values< 80% of predicted were considered abnormal. Logistic regression analysis were performed to evaluate covariates associated with DLCO abnormality. Result(s): 56 patients followed 6 months make up the cohort. 56,9 +/- 13,0 years, 58,9% female,46,4% ever smokers, 42,9% obesity (BMI >30), 37,5% hypertension, 23,2% diabetes, 16,1% heart disease, 16,1% asthma. 64% dyspnea (MRC>1), 50% fatigue, sit to stand Sp02% 94,7 +/- 3,9. Lymphocites103 /muL 413,3 +/- 625,7,D-dimer ng/ml 3050,9 +/-7226,1,ferritin ng/ml 641,8 +/- 1173,4, 21.4% radiology abnormality, 35.7% admitted to ICU, days stay 17,1 +/- 10,5. 3 vs 6 months: TLC 5,3 +/- 1,9 vs 5,16 +/- 2,3 p=0.05;FVC 3,10 +/- 0,9 vs 3,16 +/- 1,0 p=0.04;DLCO:17,2 +/- 6,0 vs 17,8 +/- 6,2 7 p=0.006;Sp02% in 6MWT 90,1 +/- 98,2 vs 91,1 +/- 3,6 p=0.05. 6 months: dyspnea 28.6%, fatigue 26.8%, abnormality in: FVC 12,5%,FEV1 16,1%,DLCO 58,9%,distance 6MW 28,6%. Abnormal DLCO correlations: age > 65 p=0.02,smoking p=0.04,heart disease p=0.04,dyspnea MRC>1 p=0.002, persistent fatigue p=0.05. Conclusion(s): At 6 months some COVID-19 patients maintain symptoms and impaired DLCO and are the main target for further follow up and intervention.

Perception of affectation attributed to the COVID-19 pandemic in Colombian parents

Objetive. To describe the perceptions associated with the impact of the COVID-19 pandemic on coexistence, living conditions and possible parental burnout with parents living in the Colombian territory. Methodology. A sociodemographic record was applied, an Ad Hoc instrument to establish how the pandemic affected coexistence and the obtaining of resources, and the Latin American version of the 'Parental Burnout Assessment' was applied with a convenience sample of 390 parents. Results. Personal, economic, family relationships, parental burnout and mental health deterioration were evidenced in a significant proportion of participants. Conclusion. Coping with situations derived from COVID-19, added to the associated confinement, led to a significant deterioration in the living conditions of Colombian parents, which should be taken into account for the development of programs aimed at the preventive and therapeutic approach of the identified variables.

Family education in the sports initiation of chess from a scientific and innovative perspective

The article aims to expose ways of family education aimed at preparing families of Chess practitioners in the initiation phase. It is derived from an ongoing investigation, the results of which contribute to a line of work of the Study Group of School Sports Initiation, of the Faculty of Physical Culture, of the University of Sancti Spiritus "Jose Marti", focused on the search for knowledge theoretical and practical contributions that help to support, from a more scientific and innovative perspective, the role of the family in sports initiation in the spiritual context. The routes are presented in different modalities: workshops, activities, consultancies, recommendations, among others. The research methodology used is based on the dialectical approach, which allows the combination of theoretical methods (analysis-synthesis, historical-logical, induction-deduction), empirical (observation, interview, document analysis, self-assessment scale, analysis group, methodological triangulation) and mathematical-statistical (percentage calculation and descriptive statistics). The situation caused by COVID-19, prevents the experimentation phase of this proposal in the planned stage, but at the moment it is applied in the Sports Complex "Eumelia Abreu Carvajal" of the municipality of Fomento. Preliminary results reveal a very positive assessment of families on the pathways of family education, taking into account the three dimensions that are taken into consideration to assess the level of preparation: acquired knowledge, increased motivation and improved attitudes towards this practice sport in the initiation stage.

Low Socio-economic Status and Customer Churn Respect to Home Internet Service in the Intra-city Context

Home Internet is important and even more so since the beginning of the COVID-19 pandemic. Internet enables communication with co-workers, family, basic services providers, etc. Customer churn means that a costumer has left their service provider for some reason. Scientific literature addresses customer churn in various business areas from different perspectives, however, it focuses very little on the socio-economic factor as a possible cause for the customer churn from residential Internet service. The objective is to determine if the socio-economic factor influences the customer churn from the residential Internet service in the intra-city context. The percentage of customer churn associated with the economic factor is important (38%). This case study is focused to the phenomenon of customer churn due to economic reasons affects low-income areas of the city. This study reaffirms that it is necessary to study the barriers for Internet adoption in different contexts and socio-economic groups. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

SARS-CoV-2 transmission dynamics in the urban-rural interface.

OBJECTIVES: As the world responds to the coronavirus outbreak, the role of public health in ensuring equitable health care that considers the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dynamics in rural communities is still a challenge. The same suppression and mitigation measures have been implemented homogeneously, ignoring the differences between urban and rural areas. We propose an epidemiological model and simulate the dynamics of SARS-CoV-2 in urban and rural areas considering the interaction between these regions. STUDY DESIGN: This was a population modeling study. METHODS: A compartmental epidemiological model was formulated to simulate the transmission of SARS-CoV-2 in urban and rural areas. We use the model to investigate the impact of control strategies focused on the urban-rural interface to contain the epidemic size of SARS-CoV-2 in rural areas. RESULTS: Considering five different levels for the exposition rate in urban areas and keeping intrarural and urban-rural exposition rates fixed, the preventive measures reduce the size and delay the peak for the urban infectives. The response of infected individuals and cumulative deaths in rural areas upon changes in the urban dynamics was small but not negligible. On the other hand, preventive measures focused on the urban-rural interface impact the number of infected individuals and deaths in rural areas. CONCLUSIONS: The maintenance of SARS-CoV-2 in rural areas depends on the interaction of individuals at the urban-rural interface. Thus, restrictive measures established by the governments would not be required within rural areas. We highlight the importance of focused preventive measures on the urban-rural interface to reduce the exposure and avoid the transmission of SARS-CoV-2 to rural communities.

Mental well-being among patients with congenital heart disease and heart failure during the COVID-19 pandemic

Patients with congenital heart disease (CHD) show increasing survival. We evaluated the influence of COVID-19 confinement on the mental well-being of patients with CHD. Descriptive, cross-sectional, observational epidemiological study in a cohort of 242 patients with CHD over 14 years old recruited consecutively from a single adolescent and adult CHD outpatient unit. Patients were sent an online questionnaire to determine clinical, demographic and the 12-element general health questionnaire (GHQ-12) data during the COVID-19 quarantine. 242 out of 407 (59%) patients with CHD, to whom the questionnaire was sent, responded to the survey. 98 (42%) patients were between 14 and 24 years old and 133 (58%) were over 25 years old. Of the total, 119 (51%) were male. 123 (51%), 88 (36%) and 31 (13%) patients with CHD had mild, moderate, and severe anatomical complexity respectively. 11 (4.5%) out of 242 patients with CC presented heart failure (HF) symptoms, requiring 18% of them admission to the hospital emergency department during the pandemic (P=0.002). In relation to the GHQ-12 questionnaire, patients with CHD and HF enjoyed less their daily activities (81% vs. 51%, P=0.043) and had less self-confidence (46% vs. 18%, P=0.041) than those without HF symptoms. In conclusion, patients with CHD and HF, during the COVID-19 quarantine, presented a lower capacity to enjoy daily activities and self-confidence than CHD without HF symptoms.

Covid-19 quarantine and depression in patients with congenital heart disease

COVID-19 outbreak has brought tremendous psychological pressure to the general population, especially to those with associated cardiovascular disease. An online Patient Health Questionnaire (PHQ-9) survey on consecutive congenital heart disease (CHD) patients, was carried out to determine depression during the Spanish coronavirus disease (COVID-19) quarantine. Two-hundred forty-two out of 407 (59%) CHD patients answered the survey, 123 (51%) had mild defects, 88 (36%) moderate and 31 (13%) great defects, most of them between 18 and 24 years old and 51% were male. Patients were dichotomized to no or mild (PHQ-9 < 10) and moderate to severe (≥ 10) depressive symptoms. Thirty-four (14%) patients showed a PHQ-9 ≥ 10 and 10 of them (29%) were under anxiolytic or antidepressant treatment during the quarantine. During the study period, 9 (4%) patients had COVID-19 symptoms. Patients with a NYHA above 2 (P=0.025), living in houses without garden or balcony (P=0.014), needing psychological/psychiatric evaluation/medication in the previous 12 months or being under anxiolytic/antidepres-sant treatment during the confinement had, significantly, a PHQ-9 score ≥ 10 (P < 0.001). Being under anxiolytic/ antidepressant treatment during the coronavirus pandemic [OR 3.92 (95% CI 1.05-14.66), P=0.043] and having previous psychological/psychiatric evaluation in the previous 12 months to the quarantine [OR 3.82 (95% CI 1.16-12.54), P=0.027] were the only variables that reached statistical significance, in the multivariable analysis, as predictors of a pathological PHQ-9 questionnaire (score ≥ 10). In conclusion depression was frequent during the COVID-19 quarantine among CHD patients, with only a third of them being under anxiolytic or antidepressant treat-ment. Needing psychological/psychiatric evaluation/treatment during the previous 12 months to the lockdown was a predictive factor for an abnormal PHQ-9 score.

Smart school routing problem for the new normality

The Smart Mobility Plan in Monterrey’s metropolitan area seeks to generate mobility strategies for the city that are sustainable and make dynamic use of data (with the support of ICTs). This initiative aims to improve the mobility in the region's universities and their surrounding zones as pilot tests and then scale them to larger city districts or to other schools around the world. As part of the university mobility plans, universities such as Universidad de Monterrey (UDEM), offers dedicated transportation services to its community (i.e. students and employees). However, recent studies show a low utilization of this service. This problem gets worse by the drastic social behavior changes caused by the COVID19 pandemic and the decreased service capacity in response to the healthy distance constraints, on the eve of back to school under the new normality. The methodology followed in this work is Intervention Scientific Research, according to its Classic classification, implementing the Hypothetic-Deductive Method. This project uses UDEM university as a case study to develop a comprehensive mobility proposal for school routes within the new normality’s operational conditions, such as potential demand increase, capacity decrease, demand patterns change, and real-time demand information. © IEOM Society International.

Burnout, workload, and organizational climate in mexican workers in the context of COVID-19

The COVID-19 pandemic has brought changes in the working conditions of workers, these effects are appreciated from the income to their health, considering this situation;the purpose of this research was to investigate the effect of teamwork and workloads on burnout in workers under the context of the SARS-CoV-2 virus pandemic. Data were collected through an instrument in a sample of 350 workers from eight medium-sized companies established in the metropolitan area of Mexico City. The hypotheses were tested through a structural equation model using the AMOS 20 software. The results indicate that, under the circumstances of a pandemic, the organizational climate and workloads have interrelated behaviors;However, these variables are negatively related to burnout, this means that the variations that may suffer as a result of the pandemic do not have significant effects on worker burnout;therefore, burnout will have its origin in other circumstantial factors. © 2020, Universidad del Zulia. All rights reserved.

Lung ultrasound in critical care. clinical application

Lung ultrasound has had a great development in the critical patient management in the last decade. it is a safe, non-invasive and radiation-free tool that allows examining the patient at the bedside without the need for transfer. The last characteristic is particularly beneficial in patients with hypoxemia, hemody-namic instability and with high-risk of nosocomial contamination, as currently occurs in the pandemic caused by the outbreak of the new coronavirus 2019 disease (COviD-19). Lung ultrasound can be used to assess lung aeration in the patient under mechanical ventilation, evaluating the response to different strategies, personalizing lung recruitment maneuvers, and guiding the weaning process. This review describes the basic principles of lung ultrasound to obtain the images and interpret them. Lung ultrasound provides anesthesiologists, intensivists and respiratory therapists a safe and reliable tool for the diagnosis and follow-up of the main pulmonary diseases in the critical ill patient. © 2020 Sociedad de Anestesiologia de Chile. All rights reserved.

COVID-19 and its impact on the control of Aedes (Stegomyia) aegypti mosquito and the epidemiological surveillance of arbovirus infections

Countries of Latin America are dealing with a simultaneous COVID-19 and vector borne disease (VBDs, Dengue, Zika and Chikungunya) outbreaks. In Mexico, certain activities to control Aedes aegypti mosquito (the main VBDs vector) comprise community participation through the interaction between householders and vector control personnel. Preventive measures against COVID-19 include social distancing and stay-at-home strategy, to obey these policies, and reduce the risk of infection, the National Center for Preventive Programs and Disease Control of Mexico (CENAPRECE) has adapted the vector control approaches in the country. In this paper we mention routine prevention and control activities to control mosquitoes and show the adapted measures. Because, a number of symptoms of the COVID-19 and dengue fever overlap with each other, we also discuss the relevance of accurate disease surveillance and medic's training and supervision.

Colombian consensus for the prevention, diagnosis and treatment of thrombotic conditions in adults with COVID-19: applying GRADE Evidence to Decision (EtD) Frameworks

Introduction: recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. Objective: to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: a rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection;b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.

Impact of the COVID-19 pandemic on the Colombian population according to mitigation measures Preliminary data from epidemiological models for the period March 18 to April 18, 2020

Introduction First case of COVID-19 in Colombia was diagnosed on March 6th. Two weeks later, cases have rapidly increased, leading the government to establish some mitigation measures. Objectives The first objective is to estimate and model the number of cases, use of hospital resources and mortality by using different R0 scenarios in a 1-month scenario (from March 18 to April 18, 2020), based on the different isolation measures applied. This work also aims to model, without establishing a time horizon, the same outcomes given the assumption that eventually 70% of the population will be infected. Materials and Methods Data on the number of confirmed cases in the country as of March 18, 2020 (n=93) were taken as the basis for the achievement of the first objective. An initial transmission rate of R0= 2.5 and a factor of 27 for undetected infections per each confirmed case were taken as assumptions for the model. The proportion of patients who may need intensive care or other in-hospital care was based on data from the Imperial College of London. On the other hand, an age-specific mortality rate provided by the Instituto Superiore di Sanità in Italy was used for the second objective. Results Based on the 93 cases reported as of March 18, if no mitigation measures were applied, by April 18, the country would have 613 037 cases. Mitigation measures that reduce R0 by 10% generate a 50% reduction in the number of cases. However, despite halving the number of cases, there would still be a shortfall in the number of beds required and only one in two patients would have access to this resource. Conclusion This model found that the mitigation measures implemented to date by the Colombian government and analyzed in this article are based on sufficient evidence and will help to slow the spread of SARS-CoV-2 in Colombia. Although a time horizon of one month was used for this model, it is plausible to believe that, if the current measures are sustained, the mitigation effect will also be sustained over time. © 2020, Universidad Nacional de Colombia. All rights reserved.