[Impact of COVID-19 on a rare disease (uveal melanoma) in a national reference unit of intraocular tumors in Spain]. / Impacto del COVID-19 en una enfermedad rara (melanoma uveal) en una unidad de referencia nacional de tumores intraoculares en España.

Objective: To analyze the impact of the COVID-19 pandemic on the diagnosis and management of uveal melanoma (a tumor included in the Orphanet catalog of rare diseases) in a Spanish national reference unit for intraocular tumors during the first year of the pandemic. Material and methods: An observational retrospective study of patients with uveal melanoma in the National Reference Unit for Adult Intraocular Tumors of the Hospital Clínico Universitario de Valladolid (Spain) was performed, analyzing the pre- and post-COVID-19 periods: from March 15, 2019 to March 15, 2020 and from March 16, 2020 to March 16, 2021. Demographic data, diagnostic delay, tumor size, extraocular extension, treatment and evolution were collected. A multivariable logistic regression model was used to identify factors that were associated with the variable: enucleation. Results: Eighty-two patients with uveal melanoma were included, of which 42(51.21%) belonged to the pre-COVID-19 period and 40(40.78%) to the post-COVID-19 period. An increase in tumor size at diagnosis and in the number of enucleations was observed during the post-COVID-19 period (p < 0.05). Multivariable logistic regression demonstrated that both medium-large tumor size and patients diagnosed in the post-COVID-19 period were independently related to an increased risk of enucleation (OR 250, 95%CI, 27.69-2256.37; p < 0.01 and OR 10; 95% CI,1.10-90.25; p = 0.04, respectively). Conclusions: The increase in tumor size observed in uveal melanomas diagnosed during the first year of the COVID-19 pandemic may have favored the increase in the number of enucleations performed during that period.

Differential Analysis of Psychological Variables Related to the Commitment to Sport Practice in University Students During Confinement by COVID-19

Nowadays, psychological components have attained a very notable importance in the acquisition of healthy behaviours. Therefore, this study analyses the differences between psychological variables that are related to sports practice in university students during the confinement caused by COVID-19. The study had a sample of 1239 participants (765 males and 474 females), aged 16-45 years (M = 21.44, SD = 3.94). A questionnaire, which included the Behavioural Regulation in Sport Questionnaire (BRSQ), the Basic Psychological Needs in Exercise Scale;the Physical Activity Self-Efficacy Scale;and the Degree of Sport Commitment Scale, was used. The most relevant results show significant differences (p<0.01) in favour of the male gender in almost all psychological variables except demotivation. Likewise, with regard to controlled motivation and demotivation, significant differences were found between small and large localities, with higher values in the former (p<0.05 and <0.01). The results are discussed in order to determine the differences in terms of which psychological components would allow for interventions that might be more effective in achieving regular sport practice, commitment, and adherence through the use of strategies aimed at fostering autonomous motivation in university students and counteracting the effects of controlled motivation and demotivation.

Online medical consultations and Covid-19 Vaccines in allergic patients

Background: Anaphylaxis reports after Covid-19 vaccination caused concerns regarding adverse effects. Many allergic patients demanded assurances by their allergists. Online Medical Consultations (OMC) are a communication tool between Primary Care and Allergy Department in Navarre. We assessed the impact of allergists' advice regarding Covid-19 vaccination in allergic patients, defined by vaccination status after OMC, and compared reported allergy severity between vaccinated and non-vaccinated. Method(s): Retrospective review of Allergy OMC and vaccination records of patients attended between 2020th September and 2021th August. We screened Covid-19 related OMC and selected those related with possible contraindications/specific recommendations before vaccination (BV).We analysed demographics, vaccination status, allergic diseases (green: non-anaphylactic allergy;yellow: anaphylaxis/ severe drug allergy;red: severe allergy to Covid-19 vaccine or related drug/excipients;blue: non-immunologic symptoms) and OMC replies (contraindication or other recommendations) Results: We received 1438 OMC, 422 due to Covid-19 vaccine and analysed 302 (71.6%), concerning BV. Demographics: Age (median, P25-P75) 61 (46.7-72.25) years. Sex: Female 221 (73.2%);Male 81 (26.8%). Vaccination: 275 (91.1%) completed vaccination (CV) (2 doses), 11 (3.6%) received 1 (IC) and 16 patients (5.3%) none (NC). Specific preparations were contraindicated in 28 (9.4%) (Pfizer-Biontech : 17, Astra-Zeneca 3 and Moderna: 8 cases). Recommendations: 30-minute observation 18.2%;45-minute observation 14.6%;antihistamines 2.6%;time interval with other injectables 1%;alternative vaccine 2.3%;other modifications 1%;premedication and observation period (2.3%). Ten patients (3.3%) required another OMC after adverse events during vaccination. Allergy severity was different according to sex (Male: green 59.2%, yellow 38.2%, red 0%;blue 2.46%;Female: green: 60.2%, yellow 31.8%, red 9.9%, blue: 4.5% (p = 0.025)). Comparison of allergies between groups: CV (Green: 60.7%, yellow: 33.4%, red: 2.9%, blue: 1%);IC (Green: 27%;yellow: 63.6% red: 0%, blue: 9%);NC (Green: 68.75%, yellow: 12.5%, red: 0%, blue: 18.75% (p = 0.03)) Conclusion(s): Adherence to OMC recommendations has been excellent in these patients. Differences in the number of OMC according to sex appear related to previous allergy diagnosis. Observed differences in past allergic diseases according to vaccination status are not related to real contraindications.

KIR2DL2/C1: A potential predictive immunogenetic marker to COVID-19 severity in Spanish patients

COVID-19 has aspects on its pathogenesis that still need elucidating and an analysis of clinical and immunogenetic factors in each cohort of patients is paramount to understanding how genetic variability can explain the multiple clinical spectra seen in patients infected with SARS-CoV-2. The aim of this study was to correlate the KIR polymorphism/HLA class I ligand interactions from patients and healthy subjects with either the susceptibility or severity to COVID-19. Genotyping of HLA-A, -B, -C and KIR genes were carried out from 459 symptomatic as well as 667 non-infected Spanish Caucasian individuals using Lifecodes HLA-SSO and KIR-SSO kits (ImmucorTM, USA) and analyzed in the Luminex in this uni-centre case-control study performed at the University Hospital of Salamanca, Spain. Comparative KIR gene analysis showed that KIR2DS4 was significantly more representative in healthy versus infected individuals. When comparing subgroups of infected patients, KIR2DS3 had a higher frequency in those who progressed to a more severity disease and yet with higher mortality rate. Three functional combinations were significant on univariate analysis: KIR2DL2/C1, KIR2DS2/C1, and KIR2DS3/C1. However, in the multivariate analysis, only the KIR2DL2/C1 interaction remained significant (OR = 15.2 (95% CI 1.5-147), p = 0.0189). Compared with the solo-clinical characteristics predictive model, that included well-known comorbidity variables such as hypertension, age, sex, diabetes, C-reactive protein, dyslipidemia, smoking, ferritin, and fibrinogen, the clinical-and-KIR-based model showed a better ability to discriminate between severe and nonsevere patients with higher sensitivity and specificity. Our results support a fundamental role of KIR/ligand interaction in the clinical course of COVID-19. Since the KIR2DL2 gene has a high frequency in Spain (60%), the analysis of the KIR2DL2/C1 in symptomatic patients who require hospitalization could be helpful to better determine their prognosis.

Impact of COVID-19 on a rare disease (uveal melanoma) in a national reference unit of intraocular tumors in Spain.

OBJECTIVE: To analyse the impact of the COVID-19 pandemic on the diagnosis and management of uveal melanoma (a tumour included in the Orphanet catalogue of rare diseases) in a Spanish national reference unit for intraocular tumours during the first year of the pandemic. METHOD: An observational retrospective study of patients with uveal melanoma in the National Reference Unit for Adult Intraocular Tumors of the Hospital Clínico Universitario de Valladolid (Spain) was performed, analysing the pre- and post-COVID-19 periods: from March 15, 2019 to March 15, 2020 and from March 16, 2020 to March 16, 2021. Demographic data, diagnostic delay, tumour size, extraocular extension, treatment and evolution were collected. A multivariable logistic regression model was used to identify factors that were associated with the variable: enucleation. RESULTS: Eighty-two patients with uveal melanoma were included, of which 42 (51.21%) belonged to the pre-COVID-19 period and 40(40.78%) to the post-COVID-19 period. An increase in tumour size at diagnosis and in the number of enucleations was observed during the post-COVID-19 period (p < 0.05). Multivariable logistic regression demonstrated that both medium-large tumour size and patients diagnosed in the post-COVID-19 period were independently related to an increased risk of enucleation (OR 250, 95%CI, 27.69-2256.37; p < 0.01 and OR 10; 95%CI, 1.10-90.25; p = 0.04, respectively). CONCLUSIONS: The increase in tumour size observed in uveal melanomas diagnosed during the first year of the COVID-19 pandemic may have favored the increase in the number of enucleations performed during that period.

Psychological Profiles of Positive Mental Health of Women in Situation of Confinement Due to COVID-19

Background: The world health organization has indicated that the problem of COVID-19 and confinement generated strong psychological impacts on the world population. Much of the research has focused on studying mental health in different population groups, leaving aside a positive mental health perspective. Objective(s): The present research intended to establish positive mental health profiles in confined women due to COVID-19 during 2020. Method(s): The factors of personal satisfaction, prosocial attitude, self-control, autonomy, problem-solving, self-actualization, and interpersonal relationships were assessed through the application of Lluch's positive mental health scale, in a sample of 202 confined women in the Department of Sucre, Colombia, selected by non-probabilistic convenience sampling. In addition, cluster analysis models were applied to identify psychological profiles of positive mental health and characterize sociodemographic variables, the selected model was evaluated and validated using the statistical technique of discriminant analysis using Minitab 18 software. Results and Discussion: A positive mental health differentiation in women is shown from which four psychological profiles of positive mental health could be identified, with scores of 14.10 in profile 1, 11.41 in profile 2, 9.15 in profile 3, and 7.56 in profile 4. The positive mental health factors used showed an ability to discriminate in 92.6% of the cases in the profiles. Conclusion(s): The identified profiles are significant and important to characterize psychometric profiles of positive mental health of confined women, which are important results for their diagnosis and the development of public policies for their treatment.Copyright © 2023 Bentham Science Publishers.

Pulmonary telerehabilitation in patients with chronic respiratory diseases during the pandemic by COVID-19 in Argentina. A multicenter observational study

Introduction: To our knowledge, there are no published studies on the implementation and results of Pulmonary telerehabilitation (PTR) in Argentina. Our objective was to describe PTR strategies used during the COVID-19 pandemic, the results of the different PTR modalities and the patient satisfaction. Method(s): A prospective study was carried out between April and August 2020. Patients who switched to different PTR modalities participated: synchronous (SPTR) or asynchronous (APTR). The level of satisfaction, quality of life with the St. George's Respiratory Questionnaire (SGRQ) and anxiety and depression with the Hospital Anxiety and Depression Scale (HADS) at baseline, 6 and 12 weeks were evaluated. Result(s): 20 centers participated. 299 patients were included (55.9% female), with a median (P25-75) age of 68 (62- 72) years, 184/249 (73.9%) diagnosed with COPD, 37 (14.9%) interstitial lung diseases, 12 (4.8%) asthma and 16 (6.4%) other CRD. 110 (36.8%) patients underwent SPTR and 189 (63.2%) with APTR. No differences were observed in the SGRQ and HADS except in the activities subscale of the SGRQ that increased significantly (p<0.05) in both groups, the impact subscale and the total that increased significantly in the SPTR group at 12 weeks (p<0.01). Both groups reported being satisfied with the PTR, 5.9 (5.4-6.3) in SPTR and 5 (4.6-5.4) in APTR, being significantly higher in SPTR (p=0.004) Conclusion(s): We observed significant satisfaction with PRT during the pandemic. No improvements were seen in quality of life, anxiety, or depression.

Case-control study on the association between nosocomial bloodstream infections and glucocorticoids, tocilizumab, systemic antibiotics, mechanical ventilation and length of hospital stay in COVID-19 hospitalised patients

Background and ImportanceHospitalised patients with COVID-19 are often exposed to immunosuppressive and anti-inflammatory drugs in addition to systemic antibiotic treatments. Nosocomial bloodstream infections (nBSI) have been associated with the need for mechanical ventilation or venous catheter insertion. However, there is current controversy regarding the influence of immunosuppressive, anti-inflammatory and antimicrobial drugs on nBSI occurrence.Aim and ObjectivesAssess the association between glucocorticoids, tocilizumab, systemic antibiotics and nonpharmacologic health interventions and the occurrence of nBSI in hospitalised patients with COVID-19.Material and MethodsCase–control study including cases of nBSI episodes in adult inpatients with SARS-CoV-2 pneumonia over a one-year period and controls without nBSI. Sociodemographic and clinical data were collected during hospitalisation. Bivariable analysis was performed. Numerical variables were compared using the Student's t-test or the Mann-Whitney test and categorical variables using the χ2 or Fisher's exact test. Variables with a p-value<0.1 in bivariable analysis were included in a multivariable logistic regression model to assess the factors independently associated with nBSI occurrence (p-value<0.05).Results50 cases with COVID-19 and 50 controls were included. Mean age was 63.0 ± 12.4(66% men, 2.3 ± 2.1 mean Charlson index and comparable between groups). nBSI episodes showed significantly higher length of hospital stay(LOS) (OR 1.173, 95% CI: 1.144-1.257, p<0.001), surgeries (OR 10.80, 95% CI: 1.310-88.5, p=0.008), need for mechanical ventilation(OR 8.10, 95% CI: 3.31-19.8, p<0.001) antibiotic and glucocorticoids therapy days (OR 1.166, 95% CI: 1.112-1.122, p=0.017 and OR 3.20, 95% CI: 1.325-7.287, p=0.010, respectively), and tocilizumab use (OR 9.33, 95% CI: 1.115-77.125, p=0.017). Non-significant higher number of chronic renal failure cases were present among nBSI episodes (p=0.1). Multivariate regression analyses showed mechanical ventilation (aOR 4.892, 95% CI: 1.206-19.845, p=0.026) and LOS (aOR 1.231, 95% CI: 1.104-1.371, p<0.001) as independent risk factors for nBSI when corrected for the presence of surgeries, central venous catheter, tocilizumab, chronic renal failure and the days of antibiotic and glucocorticoid treatment.Conclusion and RelevanceThis study found nBSI independently associated with mechanical ventilation and LOS and did not find an association between nBSI and the pharmacological interventions assessed. However, given the bivariate association between these pharmacological interventions and nBSI, and previous inconclusive literature on the effects of these treatments on bacterial and fungal infections occurrence, further investigation with a larger sample is required.1ReferenceCodina-Jiménez C., et al. Risk factors for nosocomial bloodstream infections in COVID-19 affected patients: protocol for a case-control study. Eur J Hosp Pharm.2022Conflict of InterestNo conflict of interest

[Positivity of antigen test in healthcare workers in the first week after diagnosis of SARS-CoV-2 infection.]

OBJECTIVE: The Surveillance and Control Strategy against COVID-19 of the spanish Ministry of Health focuses, since December 2021, on actions aimed at vulnerable people and areas, including healthcare professionals. According to these protocols, a diagnostic test for acute infection (PDIA), with a negative result, is required prior to returning to work (at least five days after the start of clinical practice). The aim of the study was to analyze the proportion of positive antigen (Ag) test results in the first week of diagnosis among healthcare professionals in a university hospital belonging to the province of A Coruna (Spain). METHODS: We calculated the proportion of healthcare professionals who had symptoms on the 5th day after diagnosis of COVID-19 between January and March 2022, and the proportion of Ag tests performed after returning to work with positive results. These results were compared according to the month and 95% confidence intervals were calculated. RESULTS: 1,085 cases of COVID-19 were diagnosed among healthcare professionals. 18.62% (95%CI 16.34-21.63;n=202/1,085) were still symptomatic on the 5th day. 55.27% (95% CI 51.92-58.58;n=488/833) of the Ag tests performed after return to work were positive. The mean number of days to perform the Ag test after diagnosis was 6.76 days (SD 0.76). CONCLUSIONS: Our results show a high proportion of positive results one week after diagnosis of COVID-19 in asymptomatic patients. Taking into account that in the general population, discharge is based on clinical and temporal criteria, and assuming that not every positive test indicates infectivity, adopting a strategy similar to the rest of the population in healthcare workers would be considered plausible.

Condiciones de habitabilidad durante la pandemia por COVID-19: San Juan de Lurigancho, Lima-Perú

This article seeks to understand the relationship between the production of urban space and the conditions of habitability in the self-produced neighborhoods of Metropolitan Lima in 2020, during the COVID-19 pandemic. As a case study, we chose the district of San Juan de Lurigancho (SJL) and developed the research under a mixed methodological approach. First, we characterized the living conditions in the self-produced neighborhoods of two communes of the district in order to see their relationship with COVID-19 infection. Finally, qualitative tools were used to delve deeper into the habitability conditions based on the narratives of the leaders in self-produced neighborhoods. Among the findings, diverse habitability conditions were found in the neighborhoods of the studied communes, where the impact of the pandemic did not represent a direct relationship with the contagion. In addition, the agency of local actors in the process of self-production of urban space is highlighted, as well as to other dimensions such as food security and health. © 2022 Universidad Nacional de Colombia. All rights reserved.

Collaborative online international learning (COIL) programme: Your career opportunities worldwide - learning from the experience and personal view of professionals in the sector

Introduction Degrees in Pharmacy, Biotechnology and Nutrition & Dietetics courses offer a wide range of career opportunities, but many students are unaware of these and feel disorientated when deciding on their professional future. In a global context, employers demand qualities such as intercultural communication skills, team-working skills, networking abilities and international collaborative experience. The COVID-19 pandemic has limited access to global mobility. Collaborative Online International Learning (COIL) programmes enable students to gain an international experience without travelling abroad. In this COIL project, students from Torino, Coventry and CEU-San Pablo Universities worked collaboratively to research the worldwide professional opportunities related to their degrees Method: This COIL included: Introductory session with icebreaker and intercultural activities;Teams' online meetings, where professors from three Universities guided and supervised the students'' work;Interviews of the students' teams with two to three professionals of Pharmacy, Biotechnology or Nutrition & Dietetics;Conferences by relevant professionals;and International Congress where information gathered by the students through oral communication was prepared and presented. It also included plenary conferences and a workshop on LinkedIn Results: This COIL programme involved three Universities, 38 professors, 111 students and 76 professionals (from 11 countries working in 60 institutions). More than 400 people from 40 different countries and 60 Universities were registered at the Congress. 41 interviews with professionals, 12 conferences by 32 speakers and one International Congress were organised. More than 80% of the students agreed that the COIL allowed them to improve their soft and intercultural skills, made them more employable and increased their motivation to work abroad. 90% of the students considered this COIL to be useful for their professional future Conclusion(s): These excellent results highlight the benefit of COIL programmes for students and their careers. This led the authors in 2022 to organise a second edition of the COIL programme with a possible international visit included.

THE SARS-COV-2 MUTATION LANDSCAPE IS SHAPED by NICHE ENVIRONMENTAL FACTORS

Mutation landscapes and signatures have been thoroughly studied in a wide variety of species, including cancer and SARS-CoV-2. There is a good understanding of the mechanisms behind some pattern changes observed in different types of cancer. However, for SARS-CoV-2, knowledge about the processes behind the observed changes in the mutation landscape is limited. Fortunately, the massive amount of information available about this virus allows us to study modifications in their genomic sequences under different circumstances and correlate them with clinical data. Thus, it was described that different SARS-CoV-2 lineages favour infecting different tissues, with Omicron replicating in the upper respiratory tract (URT), compared to other lineages, which replicate in both URT and lower respiratory tracts (LRT). Here, we present results that link the viral replication niche to specific changes in mutational patterns and explain them by a particular mechanism. Surprisingly, those patterns look to be also modified with events occurring in the patient, such as vaccination. Hence, deductive reasoning allowed us to identify the steps of the coronavirus infection cycle in which those mutations initiate.

Mortality and Clinical Characteristics of Multisystemic Inflammatory Syndrome in Children (Mis-C) Associated with Covid-19 in Critically Ill Patients in a Middleincome Country: Observational Multicenter Study

BACKGROUND AND AIM: The clinical presentation and severity of (MIS-C) presents a very low mortality in high-income countries. This research describes clinical characteristics of MIS-C in critically ill children in middleincome countries and factors associated with mortality and critical outcomes. METHOD(S): Observational cohort study in 14 (PICUs) in Colombia between April 2020 -January 2021. Patient age from one month to18 years, that met WHO requirements for MIS-C. RESULT(S): There were 78 children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old. 35 % of patients (29/78) were obese or overweight. 100 % had fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87% (68/78) shock or systolic myocardial dysfunction (78 %), 35% (27/78) coronary aneurysms, and pericardial effusion in 36 %.There was a higher mortality rate compared to high in-come countries (9 % vs. 1.8 %;p=0.001). When assessing the group of patients who died, ferritin levels was above 500 ngr/mL (100 % vs. 45 %;p=0.012), as well as more cardiovascular complications (100 % vs. 54 %;p = 0.019). CONCLUSION(S): MIS-C in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics, similar to high-income countries. Inflammatory response and cardiovascular involvement added to the difficulties in accessing the healthcare system in limited resources countries, could explain the greater mortality seen. Prospective studies are needed to compare the differences found in MIS-C outcomes between countries with different income.

Preface

The introduction of this book comes at a time when three co-occurring crises are challenging the United States: The COVID-19 pandemic, economic recession, and the heightened struggle for racial justice. School social workers (SSWs) who faithfully serve schools, students, and families are bearing witness to the drastic economic, academic, social, emotional, and physical effects said crises are having. And the most vulnerable of these populations, the economically challenged and/or marginalized racial groups served by SSWs, are experiencing devastatingly negative effects that will cause issues for decades. SSWs are finding their way through these crises;engaging in telehealth technology to service children, youth, and families;continuing to provide services to students most in need;and joining forces with others to stand as allies and colleagues in the fight for social justice. This book, then, is emerging out of the difficulties our society is experiencing: All of the activities that go into preparing a book-communication, recruitment of authors, creation of chapters, editing, and submission-are being done virtually. This book is a product of our environment, an effort to help new SSWs find their way in a confusing and disempowering world. © Oxford University Press 2022. All rights reserved.

INTELLECTUAL CAPITAL MANAGEMENT IN TIMES OF TURBULENCE: AN ANALYSIS OF BANKING IN ECUADOR

The purpose of this research is to measure the management of intellectual capital and its components in Ecuadorian private banks for the period 2003-2021 under the VAICTM methodology. This is the first study conducted in Ecuador. The results in-dicate that intellectual capital contributes 98% of the value added, while physical capital contributes 2%, and it is concluded that the efficiency of human capital is more influential than that of physical capital. In addition, the coefficient of intellectual value added is analyzed in four periods: 2003-2007, 2008-2010, 2011-2019, 2020-2021 in order to identify those banks that perform better in times of crisis and recovery. Banks in the analyzed periods create value, however, VAIC is drastically redu-ced in times of pandemic caused by Covid 19. The implications of the study allow management to refocus its strategies to increase the efficiency of intellectual capital in the different stages of the economic cycle and the importance of improving the quality of intellectual capital as a strategic resource of modern society, which will improve the quality of financial products/ services, innovate through points and channels of attention and strengthen financial education. © 2022, University of Cienfuegos, Carlos Rafael Rodriguez. All rights reserved.

Anosmia and negative polymerase chain reaction tests

Introduction: The COVID-19 disease caused by SARS-CoV-2 became a pandemic as of March 2020. Among the clinical manifestations of the peripheral nervous system may appear anosmia and ageusia. Objective: Demonstrate the importance of clinical and epidemiological diagnosis in the certainty criterion of COVID-19. Case presentation: 17-year-old male adolescent with loss of smell and family history of COVID-19, so he was left alone at home due to the admission in hospital of his family;he had two negative polymerase chain reaction tests in the first instance, without clinical picture of the apparent disease, until approximately 10 days after the appearance of the symptoms of the family, which begins with total loss of smell;the same test is repeated, which is negative again and he is referred to consultation for the study of anosmia. He was attended in Pediatrics service, a complete study is indicated and the interconsultation with the specialist of otolaryngology is carried out. All the complementary laboratory, microbiology and imaging tests were negative, so it was decided, due to the suspicion of COVID-19 and the family history, to perform serology for antibodies against SARS-CoV-2, which resulted in positive IgG. Conclusion: The retrospective clinical and epidemiological diagnosis allowed the certainty criterion of COVID-19 disease. © 2021, Editorial Ciencias Medicas. All rights reserved.

Case Study - Understanding the Correlation Between the Components of an Emergency Resuscitator

Given the high spread of Covid-19, many hospitals suffered from a shortage of ventilators to treat patients. Consequently, emergency resuscitators (ER) became popular as a cheaper and easier to manufacture option that would satisfy the need for ventilators in hospitals. These devices are characterized by an automated mechanism that tightens a Bag valve mask (BVM), commonly known as a manual resuscitator. The ERs main components are the controller, sensors, the Human Machine Interface (HMI), and the motor. For the effective design of these devices, the team must understand the relationship between components. In the iterative process of designing, changing one part can easily affect the operation of other components. This is the most critical points of the case study presented since it is not feasible to replace a component without considering the requirements of the other parts that make up the final product. Using a resuscitator developed by a Puerto Rican company as an example, if changes were to be made, to keep the current sensors, a Programmable Logic Controller (PLC) should be used as a controller. Changing the PLC affects the sensors and limits the options of the HMIs since many of them are designed to work with the same brand. On the other hand, when selecting the motor, the communication method and compatibility with the controller must be considered. For these reasons, this paper presents a case study to share the compatibility issues that are faced when developing this type of device. © 2022 IISE Annual Conference and Expo 2022. All rights reserved.

LONGITUDINAL STUDY ASSESSING THE EFFECTS OF METHENAMINE HIPPURATE ON THE URINARY MICROBIOME OF POSTMENOPAUSALWOMEN WITH RECURRENT UTI

Introduction: Postmenopausal women with recurrent urinary tract infections (RUTI) are repeatedly exposed to antibiotics and therefore at risk for colonization by multi-drug resistant organisms. Methenamine hippurate (MH) is FDAapproved for the prevention of RUTI;however, the mechanism of action of MH or, more specifically, the role of MH in the alteration of the urobiome is not known. Since preliminary data has shown that MH may be effective against some bacteria (e.g., Escherichia coli), but not others (e.g., Enterococcus faecalis), we hypothesize that resident bladder microbiota will be altered by administration of MH. Objective: Our objective is to determine the longitudinal effect of MH on the urobiome of postmenopausal women with RUTI. Methods: A longitudinal study with a convenient sample of 10 postmenopausal women with a clinical history of RUTI was conducted (Figure 1). UDI6 questionnaires, voided urine, catheterized urine, and peri-urethral swabs were obtained at baseline and three months after daily MH use. Expanded quantitative urine culture (EQUC) was performed on these specimens. In addition, during the 3-month timeframe, four self-collection windows were completed (windows A-D): (A) prior to initiating MH (baseline urobiome), (B) one week after starting MH, (C) two weeks before the 3-month follow-up, and (D) one week before the 3-month follow-up. Voided urine and peri-urethral swabs were collected daily for one week during windows A-D to determine how the urobiome changed. Sequencing of samples from these collection windows is pending. Results: Ten participants enrolled;however, three participants were not able to complete the study due to allergic reaction, improper handling of samples, and COVID infection. Six participants have completed the study;microbiological studies for one participant are still in process. There were no episodes of acute cystitis for any participant during the length of the study. UDI6 results suggested a trend towards a decrease in frequency, leakage with urgency, and abdominal pain;however, none of these were statistically significant (Table 1). Of the six remaining participants, the average baseline urine pH was 5.8 ± 0.8. For the completed participants, an initial microbiological comparison of EQUC results at baseline and 3-month visits show differences in sample diversity. Specifically, the number of species detected (richness) in catheterized urine increased for all but one participant (Figures 2A and 2B) though there was little or no changes in overall diversity (Shannon Index, Figure 2B) or evenness (Pielou's Index, Figure 2C) for any sample type. Exposure to MH did not result in the loss of uropathogenic species present in catheterized urine at baseline;instead, additional uropathogenic and commensal microbiota were detected at the 3-month visit. Conclusions: UDI6 trended towards symptom improvement in frequency, urge incontinence, and pain, consistent with RUTI prevention and symptoms control. Microbiological results suggest that MH increases the richness of the bladder urobiome. This consistent trend suggests MH may reduce RUTI events by altering the urobiome community richness instead of eliminating uropathogenic microbiota from the bladder. Further studies are needed to understand the interaction between MH and a host that is susceptible to uropathogen overgrowth (Table Presented).

Impact of COVID-19 Pandemic on Mental Health and Quality of Healthcare: Findings From the Joslin COVID-19 Study

The COVID-19 pandemic limited health care access for individuals with multiple chronic medical conditions. Our aim was to evaluate the impact of COVID-19 on mental health and quality of health care in patients with chronic comorbidities such as DM, HTN and CKD. An online survey was sent to patients over the age of 18 years who have been seen at Joslin during the last 24 months. Surveys were sent to participants by Redcap or conducted through telephone. The survey consisted of 92 items that included COVID diagnosis, General Health, Home self-care, Vaccines, Exposure to COVID, Health- care access and delivery, Perceptions of healthcare quality during the COVID-19 Pandemic, Pregnancy, Mental well-being, Diet and lifestyle, and demographics. Anxiety and depression symptoms were assessed using the Patient Health Questionnaire-4 (PHQ-4). As of November 1, 2021, 1189 had completed the survey. The mean age of participants was 54.2 ± 17.3 years. Half were women, and 89.2% were White. One hundred-six reported to have had COVID-19 infection;94% had diabetes, 36% had HTN, and 8% had CKD. An income of < $50,000 was reported in 9% and 39% were college graduates. While half of the CKD participants felt COVID-19 made their quality of healthcare “worse or a lot worse”, 81% of the participants with CKD felt that their doctors were available to meet their healthcare needs. In addition, the majority of the CKD participants reported to have access to all of their medications during the pandemic. About 48% reported COVID-19 outbreak has negatively affected their mental health with 21% and 11% screened positive for anxiety and depression respectively. Results were similar in patients with CKD. Individuals with depression and anxiety were, more likely to be women and obese. Fifteen percent of the participants with depression and 10.6% with anxiety responded that COVID-19 made the quality of healthcare a lot worse compared to 3.6% in individuals with no depression and 3.3% with no anxiety respectively (p<0.001). The COVID-19 pandemic has made an impact on mental health and quality of healthcare in individuals with CKD.