Increased frequency of CD14+HLA-DR-/low cells in type 2 diabetes patients with poor glycemic control.

AIMS: Type 2 diabetes (T2DM) is associated with alterations of the immune response and T2DM patients have an increased risk for infections and certain sorts of cancers. Although CD14+HLA-DR-/low cells have emerged as important mediators of immunosuppression in several pathologies, including cancer and non-malignant diseases, the presence of these cells in T2DM is not fully characterized. METHODS: In this study, we evaluated the frequency of CD14+HLA-DR-/low cells in non-obese T2DM patients and their association with glycemic control. Peripheral blood mononuclear cells were isolated from healthy controls (HC, n = 24) and non-obese T2DM patients (n = 25), the population was evaluated by flow cytometry, and an analysis of correlation between cell frequencies and clinical variables was performed. RESULTS: CD14+HLA-DR-/low monocytes were expanded in patients with T2DM compared to HC regardless of weight. Among the subjects with T2DM, the frequency of CD14+HLA-DR-/low was higher in patients with poor glycemic control (HbA1c > 9%) compared to those with better glycemic control (HbA1c < 9%) and, positively correlated with the years since the diagnosis of T2DM, the age of the patients and the glycemic index. CONCLUSIONS: An increased frequency of CD14+HLA-DR-/low cells in the blood of T2DM patients was recorded. The influence of hyperglycemia seems to be independent of obesity, but related to glycemic control and age.

Edge Intelligence Against COVID-19: A Smart University Campus Case Study

The COVID-19 pandemic has impacted the lifestyle of people in every community and workplace, including universities. There, places like cafeterias where people are expected to not wear a mask for the majority of time, i.e., while eating or drinking, are potentially very risky. In such scenarios, the Internet of Things (IoT) technological stack and Edge Intelligence paradigm represent really useful solutions for the safe provision of essential services by predicting, monitoring, and contrasting potentially dangerous situations. Therefore, in this chapter, we present an example of cognitive building denominated as Smart Cafeteria: it is a highly sensor-and-actuator-augmented environment, aimed at monitoring the users' presence in order to detect those dangerous situations for COVID-19 virus spreading. Driven by the development guidelines of the ACOSO-Meth methodology, the Smart Cafeteria exploits a set of heterogeneous edge devices, IoT technologies, cloud services, and neural networks for acquiring, gathering, analyzing, and predicting temperature and humidity values, since the latest studies have recently suggested that cold, dry, unventilated air contributes to virus transmission, especially in the winter season. The Smart Cafeteria has been designed within the campus of the University of Calabria, in Italy, as the specific target, but it can be adapted to any popular building or workplace. The obtained prototype testifies the suitability of approaches based on the Edge Intelligence paradigm for the development of effective and cheap solutions aimed at safer living spaces, within and beyond emergency situations. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

SARS-CoV-2 Vaccines and motor symptoms in Parkinson disease (PD)

Objective: We aimed to assess whether SARS-CoV2 vaccines have any positive or negative impact on motor symptoms in PD patients. Background: Studies focusing on the relationship between SARSCoV- 2, COVID-19 and PD have provided conflicting results (1). Recently, few cases of severe dyskinesia after receiving BNT162b2 mRNA vaccine have been reported but there is no data about impact of vaccines on motor symptoms in larger series of PD patients (2). Methods: We reviewed the charts of the last two months of consecutive PD patients who were attended monthly by telemedicine during the pandemic and who had received one or two doses of any of the SARSCoV- 2 vaccines available in Peru (BNT162b2, Pfizer/BioNTech and BBIBP-CorV, Sinopharm). We specifically searched for any reported variation on motor symptoms including dyskinesia during a period of at least three days after any of each dose. Results: One hundred eighty-one PD patients met inclusion criteria. 107 males and 74 females were included. Mean age was 65 years old (range 31-99). 178 patients received two doses of SARSCoV2 vaccine (177 Pfizer/BioNTech and 1 Sinopharm respectively) and three patients received only one dose of Pfizer/BioNTech vaccine. Eleven patients (6%) had COVID19 infection during the pandemic. The effect of the infection on parkinsonian symptoms was not evaluated in this report. Only two patients (1.1%) reported some degree of exacerbation following one of the dose of the vaccine. First one presented with increased rigidity and gait impairment soon after the first dose and the second case presented with increased resting tremor that lasted for two weeks also after the first dose. In both cases exacerbation improved spontaneously. Conclusion: The approved mRNA-based vaccines and viral vector vaccines are not expected to interact with the neurodegenerative process nor modify motor symptoms in PD. SARS-CoV-2 vaccines are not known neither to interfere with the current therapies for PD. Some patients have developed exacerbation of motor symptoms or severe dyskinesia after vaccination and the reasons remain unclear but they might be explained by triggering a systemic inflammatory response, by stress or excessive anxiety or due to modification of habitual medication response. These very low incidence should not discourage patients to receive vaccines and we recommend COVID-19 vaccination with approved vaccines for persons with PD, unless there is a specific contraindication.

COVID-19 VACCINATION IMPROVED PSYCHOLOGICAL DISTRESS (ANXIETY AND DEPRESSION SCORES) IN CHRONIC KIDNEY DISEASE PATIENTS: A PROSPECTIVE STUDY

BACKGROUND AND AIMS: To our knowledge, the psychological impact of coronavirus disease (COVID-19) vaccination has not yet been evaluated for the general population nor for chronic kidney disease (CKD) patients. The purpose of the study is to analyse the impact of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on anxiety and depression scores in patients with different modalities of CKD. METHOD: A total of 117 renal patients (50 haemodialysis patients, 13 peritoneal dialysis patients, 32 kidney transplants and 22 advanced CKD patients at pre-dialysis care) were evaluated for depression, anxiety, health-related quality of life (HRQOL) and perceived fears and resources with standardized (The Hospital Anxiety and Depression Scale;HADS) and self-reported questionnaires. The measure points were before vaccination and 15 days after vaccination. RESULTS: The main finding of the study is that there is a decrease in the global mean of normal scores for anxiety and depression symptoms in CKD patients, postvaccination. We did not find statistically significant differences in depression or anxiety scores, nor HRQOL differences between the treatment groups. The three main fears reported by the participants at baseline were those of adverse effects, not getting the vaccine and lack of information. CONCLUSION: These findings highlight the potential interest of assessing psychological variables related to the impact of vaccination against SARS-CoV-2. New studies will be required to assess the impact of comprehensive vaccine coverage and its psychological impact.

DYNAMICS OF SARS-COV-2-SPIKE-REACTIVE ANTIBODY AND T-CELL RESPONSES IN CHRONIC KIDNEY DISEASE PATIENTS WITHIN 3 MONTHS AFTER COVID-19 FULL VACCINATION

BACKGROUND AND AIMS: Little is known regarding the dynamics of antibody and T-cell responses in chronic kidney disease (CKD) following COVID-19 vaccination. METHOD: Prospective observational cohort study including 144 participants on haemodialysis (HD) (n = 52), peritoneal dialysis (PD) (n = 14), kidney transplantation (KT) (n = 30) or advanced chronic kidney disease not on dialysis (ACKD), and healthy controls (n = 18). Anti-Spike(S) antibody and T-cell responses were assessed at 15 days (15D) and 3 months (3M) after vaccination. RESULTS: Anti-S antibodies at 15D and 3M were detectable in 95% (48/50)/98% (49/50) of HD patients, 93% (13/14)/100% of PD patients, 67% (17/26)/75% (21/28) of KT patients and 96% (25/26)/100% (24/24) of ACKD patients. Rates for healthy controls were 81% (13/16)/100% (17/17). Antibody levels decreased at 3M in HD (P = 0.04), PD (P = 0.008) and ACKD patients (P = 0.0009). In KT, patients levels increased (P = 0.04) between 15D and 3M, although they were low at both time points. Detectable T-cell responses notably increased at 3M in HD patients (P < 0.022). In PD, patients response increased by 15D (13/14;93%) and 3M (9/9;100%), while they were present in KT patients at 41% (12/27), 84% (22/26) and 96% (25/26) at baseline. Detectable T-cell responses in ACKD patients reached 80% (20/25) and 89% (17/19) at 15D and 3M, respectively. whereas in healthy controls it was 67% and 89% at 15D and 3M. CONCLUSION: Most HD, PD and ACKD patients develop SARS-CoV-2-S antibody responses comparable to that of healthy controls, in contrast to KT recipients. Antibody waning at 3M was faster in HD, PD, ACKD patients. No differences in SARS-CoV-2 T-cell immunity responses were noticed across study groups.

Creating ACTIVE Learning in an Online Environment

This evidence-based practice paper describes a method for evaluating video platforms for development of active videos for Generation-Z (Gen-Z). These students represent the majority of students in higher education courses today. They are digital natives who are efficient multi-taskers across multiple devices. Gen-Z's consistent exposure to multiple incoming channels presents new challenges and opportunities for course delivery. Gen-Z students crave various learning opportunities and often turn to outside video resources for education and entertainment. Flipped classrooms and asynchronous learning utilize recorded videos, which are often well-received by Gen-Z. However, previous studies have shown that passive learning videos with stagnant quizzes may not affect learning outcomes or change students' perception of learning [1]. Consequently, we conduct a systematic investigation of video platforms that enable active learning interventions with clickable content and exercises to provide real-time feedback to students during virtual video lectures. We investigate several platforms to measure their aptitude for offering active learning opportunities. We develop a preference matrix with four main criteria: cost, interactivity, learning management system (LMS) integration, and data analytics. We explore 53 highly ranked and popular video platforms and participate in interactive demos for the top 11 contenders. This paper highlights the pros/cons and capabilities of platforms instructors should consider when developing active learning video lectures as well as how instructors can incorporate these tools into their online video lecture development. This is not a marketing tool for a specific platform but instead a review for how to identify the appropriate tool for a specific instructor's needs. Online material development is more critical than ever as instructors at all levels of education are now creating online material due to the COVID-19 global pandemic. © American Society for Engineering Education, 2021

Aislamiento comunitario como estrategia para la mitigacion de un brote de COVID-19: el caso de Villa Azul

INTRODUCCION: frente a la identificacion de la ocurrencia de un brote de COVID-19 en el barrio Villa Azul (Buenos Aires, Argentina) y dadas las caracteristicas de vulnerabilidad del barrio que dificultarian cumplir con el aislamiento domiciliario y las medidas de prevencion, se implemento una estrategia de aislamiento comunitario como respuesta sanitaria al brote. OBJETIVO: describir la estrategia de aislamiento comunitario utilizada en el barrio Villa Azul para contener y mitigar un brote de COVID-19. METODOS: se identificaron los limites del barrio y se procedio al cierre del mismo con fuerzas de seguridad. Quedo permitida la circulacion interna asumiendo que todos los habitantes eran casos sospechosos de COVID-19 o bien eran contactos estrechos de algun caso. En los dias subsiguientes se continuo con la busqueda activa de casos sospechosos, se realizaron los hisopados en el barrio y se obtuvieron los resultados a las 24 horas. Todos los dias, luego de la recepcion de los casos se les informaba el resultado a los casos negativos y se iba a las casas de los casos positivos para notificarlos del resultado y sugerirles el aislamiento fuera del barrio para cortar la cadena de contagios. RESULTADOS: en el barrio Villa Azul entre el 22 de mayo y el 20 de junio, se registraron 731 casos sospechosos de los cuales 379 fueron casos confirmados de COVID-19 (tasa de positividad acumulada del 52,1%). La primera semana hubo entre 20 y 40 casos confirmados diarios con un indice de positividad entre el 66 y el 81% pero con el correr del tiempo como consecuencia de la estrategia descripta fueron bajando el numero de casos por dia y tambien la positividad. Se trasladaron 193 pacientes confirmados para aislarlos afuera del barrio. Fallecieron 3 personas (tasa de letalidad 0,8%). DISCUSION: la estrategia de aislamiento comunitario resulto efectiva para contener el brote de COVID-19 en el barrio Villa Azul.

Monitoring of COVID-19 patients by telemedicine with telemonitoring. / Telemedicina con telemonitorización en el seguimiento de pacientes con COVID-19.

AIM: To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. METHODS: A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least 11a day. RESULTS: 313 patients (52.4% female) with a total average age of 60.9 (DE 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions; 18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. CONCLUSIONS: Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way.

Has the COVID-19 pandemic impacted the practice of urology in Mexico?

Objective: To know the impact the COVID-19 pandemic has had on the practice of urology in Mexico. Materials and Methods: A survey was conducted on Mexican urologists, utilizing the SURVIO® mobile application, within the time frame of March 16-22, 2020. It consisted of 8 dichotomous, multiple-choice questions on the practice of urology and how it has been affected by the COVID-19 pandemic. Results: A total of 374 questionnaires were received, in which 66% of the respondents stated that the healthcare institution they worked in had already emitted a management protocol for patients with COVID-19, 80% stated that urology consultations had not been reprogrammed or cancelled at their work centers, and 42% did not know which surgeries would be deferred. In addition, digital applications were included among the tools that would be the most widely used for substituting face-to-face consultation. Limitation: The present work has the limitations inherent in a survey. Originality: The present original work describes how the COVID-19 pandemic has impacted the daily urology practice. Conclusions: The COVID-19 pandemic is a challenge for our entire healthcare system. The practice of urology is facing unprecedented changes right now and will continue to do so in the future.

Tracing of COVID-19 patients by telemedicine with telemonitoring

Aim To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. Methods A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least 11a day. Results 313 patients (52.4% female) with a total average age of 60.9 (DE 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions;18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. Conclusions Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way. Resumen Objetivo Evaluar si la telemedicina con telemonitorización es una herramienta clínicamente útil y segura para el seguimiento de pacientes con COVID-19. Métodos Estudio observacional prospectivo de los pacientes con diagnóstico de COVID-19 por PCR positiva y considerados de alto riesgo que se siguieron con telemedicina y telemonitorización en el Área Sanitaria de Lugo entre el 17 de marzo y el 17 de abril del 2020. Se incluyeron 2grupos de pacientes: seguimiento ambulatorio desde el inicio y tras el alta hospitalaria. Cada paciente remitió un cuestionario clínico al día con su temperatura y saturación de oxígeno 3 veces al día. El seguimiento fue proactivo, contactando con todos los pacientes al menos una vez al día. Resultados Se incluyó a 313 pacientes (52,4% mujeres) con edad media 60,9 (DE 15,9) años. Otros 2 pacientes rehusaron entrar en el programa. Desde el inicio, se siguió ambulatoriamente a 224 pacientes y a 89 pacientes tras su alta hospitalaria. Entre los primeros, 38 (16,90%) se remitieron a Urgencias en 43 ocasiones con 18 (8,03%) ingresos y 2 fallecidos. En los domicilios no hubo fallecimientos ni urgencias vitales. Incluyendo a los pacientes tras hospitalización, el seguimiento se realizó en 304 casos. Un paciente reingresó (0,32%) y otro abandonó (0,32%). El tiempo medio de seguimiento fue 11,64 (DE 3,58) días y en los 30 días del estudio 224 (73,68%) pacientes fueron dados de alta. Conclusiones Nuestros datos sugieren que la telemedicina con telemonitorización domiciliaria, utilizada de forma proactiva, permite un seguimiento clínicamente útil y seguro en pacientes con COVID-19 de alto riesgo.