Incorporation of 5 methylcytidine alleviates innate immune response to self-amplifying RNA vaccine (preprint)

In order to improve vaccine effectiveness and safety profile of existing synthetic RNA-based vaccines, we have developed a self-amplifying RNA (saRNA)-based vaccine expressing membrane-anchored receptor binding domain (RBD) of SARS-CoV-2 S protein (S-RBD) and have demonstrated that a minimal dose of this saRNA vaccine elicits robust immune responses. Results from a recent clinical trial with 5-methylcytidine (5mC) incorporating saRNA vaccine demonstrated reduced vaccine-induced adverse effects while maintaining robust humoral responses. In this study, we investigate the mechanisms accounting for induction of efficient innate and adaptive immune responses and attenuated adverse effects induced by the 5mC-incorporated saRNA. We show that the 5mC-incorporating saRNA platform leads to prolonged and robust expression of antigen, while induction of type-I interferon (IFN-I), a key driver of reactogenicity, is attenuated in peripheral blood mononuclear cells (PBMCs), but not in macrophages and dendritic cells. Interestingly, we find that the major cellular source of IFN-I production in PBMCs is plasmacytoid dendritic cells (pDCs), which is attenuated upon 5mC incorporation in saRNA. In addition, we demonstrate that monocytes also play an important role in amplifying proinflammatory responses. Furthermore, we show that the detection of saRNA is mediated by a host cytosolic RNA sensor, RIG-I. Importantly, 5mC-incorporating saRNA vaccine candidate produced robust IgG responses against S-RBD upon injection in mice, thus providing strong support for the potential clinical use of 5mC-incorporating saRNA vaccines.

Peruvian Children's Access to Oral Health Information during the COVID- 19 Pandemic.

Aim: The aim of this study was to determine the impact of COVID-19 pandemic on access to oral health information of Peruvian children. Materials and Methods: The Demographic and Family Health Survey generates annually a national database of Peruvian children between 0 and 11 years old, which is collected through direct interviews applied in the homes of residents of the country. A cross-sectional study was applied with this information collected during 2019 and 2020, with a final sample of 39 124 subjects, 15 974 from the year 2019 (62.03%) and 7088 from the year 2020 (55.54%). The dependent variable was access to oral health information and the independent variable was year; in addition, there were considered sociodemographic and geographical covariates. Finally, there were executed descriptive, bivariate, and multivariate analyses. Results: Access to oral health information was 59.85% (n = 23 062). For the bivariate analysis, the dependent variable showed association with year, natural region, sex, altitude, health insurance coverage, area, place of residence and wealth index. During multivariate analysis, year manifested a negative association with access to oral health information (aPR: 0.89; 95%CI: 0.85-0.92; P < 0.001), adjusted for co-variables that previously manifested association. Conclusion: Access to oral health information for Peruvian children had a negative impact during 2020, in which COVID-19 pandemic occurred.

Inborn errors of OAS-RNase L in SARS-CoV-2-related multisystem inflammatory syndrome in children.

Multisystem inflammatory syndrome in children (MIS-C) is a rare and severe condition that follows benign COVID-19. We report autosomal recessive deficiencies of OAS1, OAS2, or RNASEL in five unrelated children with MIS-C. The cytosolic double-stranded RNA (dsRNA)-sensing OAS1 and OAS2 generate 2'-5'-linked oligoadenylates (2-5A) that activate the single-stranded RNA-degrading ribonuclease L (RNase L). Monocytic cell lines and primary myeloid cells with OAS1, OAS2, or RNase L deficiencies produce excessive amounts of inflammatory cytokines upon dsRNA or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) stimulation. Exogenous 2-5A suppresses cytokine production in OAS1-deficient but not RNase L-deficient cells. Cytokine production in RNase L-deficient cells is impaired by MDA5 or RIG-I deficiency and abolished by mitochondrial antiviral-signaling protein (MAVS) deficiency. Recessive OAS-RNase L deficiencies in these patients unleash the production of SARS-CoV-2-triggered, MAVS-mediated inflammatory cytokines by mononuclear phagocytes, thereby underlying MIS-C.

Comparison of Outcomes of Covid-19 Between Fully Vaccinated and Unvaccinated Kidney Transplant Recipients and According to the Type of M-RNA Vaccine

Purpose: The evidence regarding the clinical effectiveness of COVID-19 vaccination in kidney transplant (KT) recipients is limited so far. Our purpose is to analyze the characteristics and outcomes of a large series of KT with COVID-19 breakthrough infection and compare them with unvaccinated patients. As a secondary objective, we analyzed the evolution according to the type of mRNA vaccine administered. Method(s): From April to October 2021, KT recipients with COVID-19, included in the COVID-19 registry of the Spanish Society of Nephrology, were analyzed. Data regarding vaccination status and type of vaccine were collected and outcomes of unvaccinated or partially vaccinated patients were compared with fully vaccinated patients. Result(s): Clinical picture was similar and survival analysis showed no differences between groups: 21.7% of fully vaccinated patients and 20.8% of unvaccinated or partially vaccinated died (p=.776). In multivariable analysis age and pneumonia were independent risk factors for death, while vaccination status was not related to mortality. These results remained similar when we excluded patients with partial vaccination as well as when we analyzed exclusively hospitalized patients. Patients vaccinated with mRNA-1273 (Moderna) (n=213) showed a significantly lower mortality than those who received BNT162b2 (Pfizer-BioNTech) vaccine (n=121) (16.4% vs. 28.8%, p=.002) (HR: 0.52, CI 95% 0.31-0.85, p=.010). Conclusion(s): COVID-19 severity in KT patients has remained high and has not improved despite receiving 2 doses of an mRNA vaccine, but the mRNA-1273 vaccine shows higher clinical effectiveness than BNT162b2 in KT recipients with breakthrough infection, so it could be considered as the first option in these patients.

The role of B cells in COVID-19 infection and vaccination.

B cells secrete antibodies and mediate the humoral immune response, making them extremely important in protective immunity against SARS-CoV-2, which caused the coronavirus disease 2019 (COVID-19) pandemic. In this review, we summarize the positive function and pathological response of B cells in SARS-CoV-2 infection and re-infection. Then, we structure the immunity responses that B cells mediated in peripheral tissues. Furthermore, we discuss the role of B cells during vaccination including the effectiveness of antibodies and memory B cells, viral evolution mechanisms, and future vaccine development. This review might help medical workers and researchers to have a better understanding of the interaction between B cells and SARS-CoV-2 and broaden their vision for future investigations.

Impact of Social Support on Perceived Stress in Latin American and Caribbean Dental Students and Dental Practitioners during Mandatory Social Isolation within the Coronavirus Pandemic in 2020.

OBJECTIVE: To determine the impact of social support on perceived stress in Latin American and Caribbean dental students and dental practitioners during mandatory social isolation within the coronavirus (COVID-19) pandemic in 2020. METHODS: A cross-sectional study was conducted with a sample of 1812 dental students and dental practitioners from 21 Latin American and Caribbean countries. Perceived stress was assessed using the perceived stress scale (PSS-14), and the influence of social support was addressed using the Duke-UNC-11. Additionally, sociodemographic variables, knowledge of and preventive behaviour against COVID-19 and health status were considered. A descriptive, bivariate and multivariate analysis was performed through multiple linear regression. RESULTS: In the multivariate analysis, model 4 presented R2% = 21.20 (P < 0.001), a constant of 40.049; within the model, the social support variable had a non-standardised regression coefficient (b) of -4,527 (95% CI - 5.646 to -3,408; P < 0.001), the self-perceived level of concern regarding COVID-19 was b = 1.838 (95% confidence interval [CI] 0.887 to 2.790; P < 0.001), the self-perceived health status was b = -2.191(95% CI -2.944 to -1.437; P < 0.001), the number of days in compulsory isolation was b = -0.965 (95% CI -1.908 to -0.022; P = 0.045), while the level of confinement was b = 0.923 (95%CI: 0.106-1.740; P = 0.027), age was b = -1.743 (95% CI -2.625 to -0.860; P < 0.001), sex was b = 1.324 (95% CI 0.311 to 2.337; P = 0.011) and the economic income level was b = -1.539 (95% CI -2.434 to -0.644; P = 0.001). CONCLUSION: An association was determined between perceived stress and social support, as well as the variables of concern about the disease, self-perceived health status, number of days and level of confinement, age, sex and economic income level, based on the experience of dental practitioners and dental students in mandatory isolation.

Nursing care of patients with multiple sclerosis during the COVID-19 pandemic

Introduction: At the beginning of the SARS-CoV-2 pandemic, health centres were places where there was a high risk of infection, and during the period of lockdown face-to-face health care was substantially reduced, forcing rapid changes in the care of multiple sclerosis patients by the specialised nursing staff in the units and monographic consultations of this disease. Development: The experience of the nursing staff of multiple sclerosis units and monographic consultations, in 8 Spanish hospitals, is collected from the beginning of the pandemic and in later stages, and the adaptations that they made to continue caring for patients are specifically described. The scientific literature about how the SARS-CoV-2 has affected patients with multiple sclerosis is also reviewed, as well as the experiences of other multiple sclerosis teams in health centres in other countries. Conclusions: During the lockdown and in later stages, new forms and previously little used forms of care were applied to multiple sclerosis patients. The nursing staff kept contact with them by telephone and online, provided them with information about safety and behaviour in relation to COVID-19. Face-to-face visits, treatments and distribution of medication were adapted. Information was provided about how patients could receive psychosocial support and about how they could maintain their quality of life.

General Labor Well-Being in Latin American Dentists during the COVID-19 Pandemic.

This study aimed to determine the general labor well-being of Latin American dentists according to sociodemographic characteristics during the COVID-19 pandemic. A cross-sectional study was conducted in a final sample of 2214 participants from 11 countries. A validated online questionnaire on general work well-being was used (data collection period from 1 June to 10 July 2021), containing two dimensions: psychosocial well-being and collateral effects. The sociodemographic characteristics of the dentists and their perception of the economic impact of the pandemic were also recorded. A multivariate linear regression analysis was performed (hierarchical regression model) to evaluate the joint effect of the explanatory variables on labor well-being and the changes in the variance between each model. A score of psychosocial well-being of 233.6 + 40.2 and collateral effects of 45 + 20.1 was found. Psychosocial well-being was associated with sex, country of origin, academic training achieved, type of dental activity, and perceived impact during the pandemic (p < 0.05). Somatization was frequently manifested through back pain (88.2%) and muscular tensions (87.2%). Women, those who worked 41 or more hours and had between 1 to 15 years of professional experience presented a greater collateral effect (p < 0.001). The impact of the COVID-19 pandemic a year and a half after it began on the labor well-being of Latin American dentists was evidenced with important interactions with social characteristics.

Impact of the COVID-19 pandemic on the timing of dental care in elderly peruvians.

In Peru, there is low dental service use among older adults, in addition to a social gradient for use. Furthermore, the COVID-19 pandemic triggered complex scenarios characterized by inadequate access to health services, with greater impact on vulnerable population groups such as the elderly. The aim of this study was to determine the impact of the COVID-19 pandemic on the time since last dental care visit among elderly Peruvians. It was a cross-sectional study conducted on a population of 5247 respondents in 2019, and 5066 respondents in 2020. The study considered the answers of people who responded to the question on the last time they had received dental care, extracting a total 4045 subjects for 2019 and 3943 for 2020. The dependent variable was time since last dental care measured in years, while the variables on health, geographic and sociodemographic characteristics were grouped within three dimensions. A descriptive bivariate and multivariateanalysiswasapplied by means of multiple linear regression to analyze the behavior of the variables. Time since the last dental care visit was 7.93 years (SD=8.03) in 2019 and 7.94 years (SD=7.28) in 2020. A hierarchical multiple linear regression analysis was performed, where no variable in the 2019 model was significant; while for 2020, health, geographic, and sociodemographic characteristics variables were significant. In the analysis where the 'year' variable becomes independent, only model 4, which considers all variables, was valid (p=0.018). The variables 'area of residence' and 'wealth index' were also significant. To conclude, the 2020 pandemic year for COVID-19 had no impact on the time since last dental care visit among elderly Peruvians, though factors such as area of residence and wealth index were found to be associated with the time since last dental care visit.

En Perú, los adultos mayores presentan un bajo uso de los servicios odontológicos, además de percibirse una gradiente social para su utilización. Adicionalmente, la pandemia por COVID-19 desencadenó escenarios complejos, caracterizados por un inadecuado acceso a los servicios de salud, que afectó con mayor énfasis a grupos poblacionales vulnerables, como las personas en edades extremas. El objetivo de este estudio fue determinar el impacto de la pandemia por COVID-19 en el tiempo de atención odontológica en adultos mayores peruanos. Estudio transversal con población de 5247 encuestados para el 2019 y 5066 para el 2020. Se consideraron los registros de quienes respondieron a la pregunta sobre el tiempo desde su última atención odontológica, extrayéndose del 2019 un total de 4045 y para 2020, 3943 sujetos. La variable dependiente consistió en el tiempo desde la última atención odontológica medido en años; mientras que dentro de tres dimensiones,seagruparon a lasvariables sobre características de salud, geográficas y sociodemográficas. Se aplicó un análisis descriptivo, bivariado y multivariado, donde el tiempo desde la última atención odontológica en el año 2019 fue de 7.93 años (DE=8.03) y en el 2020 fue de 7.94 años (DE=7.28). Se realizó un análisis de regresión lineal múltiple jerárquica, donde ninguna variable del modelo 2019 fue significativa; mientras que para 2020, las variables características de salud, geográficas y sociodemográficas si lo fueron. Al análisis, donde el año pasa a ser independiente, sólo el modelo 4, que considera todas las variables fue válido (p=0.018); asimismo, el área de residencia e índice de riqueza presentaron significancia estadística. Para concluir, en el año 2020 la pandemia por COVID-19 no impactó en el tiempo de atención odontológica en adultos mayores peruanos, sin embargo, factores como área de residencia e índice de riqueza si presentaron asociación con el tiempo desdelaúltimaatención.

General Labor Well-Being in Latin American Dentists during the COVID-19 Pandemic

This study aimed to determine the general labor well-being of Latin American dentists according to sociodemographic characteristics during the COVID-19 pandemic. A cross-sectional study was conducted in a final sample of 2214 participants from 11 countries. A validated online questionnaire on general work well-being was used (data collection period from 1 June to 10 July 2021), containing two dimensions: psychosocial well-being and collateral effects. The sociodemographic characteristics of the dentists and their perception of the economic impact of the pandemic were also recorded. A multivariate linear regression analysis was performed (hierarchical regression model) to evaluate the joint effect of the explanatory variables on labor well-being and the changes in the variance between each model. A score of psychosocial well-being of 233.6 + 40.2 and collateral effects of 45 + 20.1 was found. Psychosocial well-being was associated with sex, country of origin, academic training achieved, type of dental activity, and perceived impact during the pandemic (p < 0.05). Somatization was frequently manifested through back pain (88.2%) and muscular tensions (87.2%). Women, those who worked 41 or more hours and had between 1 to 15 years of professional experience presented a greater collateral effect (p < 0.001). The impact of the COVID-19 pandemic a year and a half after it began on the labor well-being of Latin American dentists was evidenced with important interactions with social characteristics.

Impact of mandatory social isolation measures due to the COVID-19 pandemic on the subjective well-being of Latin American and Caribbean dentists.

BACKGROUND: With the spread of the COVID-19 virus, containment measures such as home confinement were implemented, generating stress, anxiety, depression and aggravation of pre-existing diseases in the population, including dentists, who have also been affected due to the risk involved in practicing their profession. Objective: To determine the impact of mandatory social isolation measures on the subjective well-being of Latin American and Caribbean dentists during the community quarantine due to the COVID-19 pandemic in 2020. MATERIAL AND METHODS: A Cross-sectional study in a sample of 1195 dentists from 21 countries in Latin America and the Caribbean. The main outcome was Subjective Well-Being, evaluated through the World Health Organization Well-Being Index (WHO-5). In addition, sociodemographic characteristics, variables related to the community quarantine due to the COVID-19 pandemic and health variables were considered. A descriptive, bivariate and multivariate (multiple linear regression) analysis was performed to observe the behavior of the variables. RESULTS: A multiple linear regression analysis was performed, where all the variables included within dimensions, were distributed in a single model, observing an R2% of 9.000 (p<0.001), where the R2% change was significant (p<0.001) and a constant of 44.190; likewise, within this model, the variable follow-up of preventive measures against COVID-19 reported an unstandardized regression coefficient (b) of 2. 316 (95%CI:1.133-3.499;p<0.001), the self-perceived level of concern against COVID-19 obtained a (b) of -5.470 (95%CI:-7.509--3.430; p<0.001), the biological sex variable manifested a (b) of -5.417 (95%CI: - 1.157-1.910; p<0.001); finally, the level of economic income during compulsory social isolation presented a (b)=5.354 (CI95%:3.461- 7.247; p<0.001). CONCLUSIONS: An association was found between subjective well-being and variables related to the social impact of the COVID-19 pandemic, such as following preventive measures, concern about the pandemic and economic factors (decrease in income level), in addition to biologic sex. Follow-up strategies are required for these dental professionals, considering that social isolation measures have continued in many of the countries. Key words:Quarantine, Coronavirus infections, WHO-5, Cross-sectional studies, Latin America, Caribbean Region.

The Effect of Periodontal Treatment on Clinical and Biological Indicators, Quality of Life, and Oral Health in Rheumatoid Arthritis Patients: A Quasi-Experimental Study.

Non-surgical periodontal therapy (NSPT) has been shown to have systemic effects. It has been suggested that, similar to rheumatoid arthritis (RA), periodontitis (PD) has an impact on general health, in terms of psychological, physical, and social aspects. This study determines the effect of periodontal treatment in RA activity, health-related quality of life, and oral health self-perception before and after periodontal treatment in RA patients. A quasi-experimental, prospective, non-randomized study was conducted, and 52 patients were included in the study. Periodontal parameters and the instruments disease activity score-28 (DAS-28), SF-36, and OHIP-14 were measured at baseline and at 3 months after NSPT. All differences were statistically assessed. The study protocol was registered in Clinical Trials (NCT04658615). No statistically significant differences were found in the scores of DAS-28 before and after the intervention in the group with PD and reduced periodontium. When the effect of periodontal treatment was analyzed in the group of 29 patients who were followed up, it was found that there were statistically significant differences before and after in variables such as psychological distress, emotional role, and mental health, which indicates an improvement in the scores of these variables. NSPT influenced the health-related quality of life measured with SF-36 and OHIP-14 in patients with RA. In conclusion, NSPT has an effect on self-reported quality of life and health indicators more than the RA activity as measured with DAS-28. However, the clinical effect of periodontal treatment in RA patients provides important data to support periodontal care in patients.

Study of the impact of the COVID-19 pandemic in the Pediatric Emergencies of a tertiary hospital

Objectives. In recent years, hospital emergency departments have experienced a progressive increase in the demand for care, at the expense of trivial pathology. This trend changes from 14 March 2020, when the state of alarm was declared due to the COVID-19 pandemic, which led to the compulsory confinement of the population. The main objective of this study was to determine the impact that this state of alarm has had on the volume of paediatric emergencies in a third level hospital. Material and methods. A retrospective study of cohorts was carried out and included those under 14 years of age who demanded care during the months of the state of alarm and during the same months in the previous year. Different epidemiological and clinical data have been analysed. Results. 3,371 patients attended our Emergency Department in 2019, and 650 in 2020, with a similar average patient age. The most frequent diagnostic groups at discharge in both time periods were infectious and digestive diseases. In terms of hospital admissions, 7.12% required admission in 2019 and 13.69% in 2020. Regarding the department in charge of the patient during admission, in 2020 27.72% of patients were admitted by Paediatric Surgery. Conclusions. The activity in the paediatric emergency departments of our hospital varied considerably during the state of alarm. There has been a considerable decrease in the number of patients who have requested assistance due to the perceived risk of contagion by the population. In addition, we have perceived a relative increase in hospital admissions and, specifically, in urgent surgical pathology compared to the previous year.

Predictors of severe COVID-19 in kidney transplant recipients in the first and second waves: Analysis of the spanish registry

Purpose: To better know the impact and characteristics of Covid-19 in renal patients, the Spanish Society of Nephrology set up a voluntary registry in March, 2020 Methods: Retrospective observational study of KT recipients included in the Spanish Covid-19 Registry (1st March to 14th November, 2020). We applied Cox multivariate analysis to identify risk factors for mortality and Kaplan-Meier and log rank survival analysis. Results: 1080 KT with Covid-19 were registered, having 937 (86.1%) their outcome reported (cure or death). Most were men (63.2%), mean age 60 years infected a median of 72 months postransplantation. Death occurred in 204 patients. Multivariate analysis found age, neumonia and KT within the last 6 months before Covid-19 were risk factors for mortality and gastrointestinal symptoms were protective. Survival analysis showed significant increasing mortality risk in four subgroups: age<65 years&postransplant time> 6mo (n=526), age<65×<6mo (n=49), age>65× >6mo (n=325) and age>65×<6mo (n=31)($$graphic). Of 1080 cases, 605 correspond to the first wave (1stW until June2020) and 475 to the second wave (2ndW). In the 2ndW, KT were younger (56.4 vs 61.1yr;p=.000), 15.8% were asymptomatic (p=.000) and presented less pneumonia (50.3% vs. 78%;p=.000). Fever, lymphopenia and respiratory symptoms were less frequent but gastrointestinal symptoms similar (30.9% vs. 34.2%;p=.256). Treatment has changed, with more use of remdesivir (p=.000) and steroids (p=.018), no use of ritonavir/lopinavir, hidroxycloroquine andazitromycin (p=.000), and no treatment in (37.1% vs 6.3% in 1stW, p=.000). Hospitalization decreased (89.2% vs. 63.2%;p=.000) but more KT were admitted to critical care units (14.5% vs 20%;p=.058). We found lower mortality (overall 26.4% vs 14.8%;p=.000, hospitalized 29% vs 23%;p=.088). Multivariate analysis of the 2ndW shows again that age, pneumonia and recent transplant (< 6 months) are mortality risk factors. Conclusions: Over a thousand KT have suffered Covid-19 in Spain with a high mortality rate in the first and second waves, mainly related with age, pneumonia and recent transplantation. The interaction between age and time after transplant has to be considered when selecting recipients in the Covid-19 pandemic.

SARS-CoV-2 infection causes immunodeficiency in recovered patients by downregulating CD19 expression in B cells via enhancing B-cell metabolism.

The SARS-CoV-2 infection causes severe immune disruption. However, it is unclear if disrupted immune regulation still exists and pertains in recovered COVID-19 patients. In our study, we have characterized the immune phenotype of B cells from 15 recovered COVID-19 patients, and found that healthy controls and recovered patients had similar B-cell populations before and after BCR stimulation, but the frequencies of PBC in patients were significantly increased when compared to healthy controls before stimulation. However, the percentage of unswitched memory B cells was decreased in recovered patients but not changed in healthy controls upon BCR stimulation. Interestingly, we found that CD19 expression was significantly reduced in almost all the B-cell subsets in recovered patients. Moreover, the BCR signaling and early B-cell response were disrupted upon BCR stimulation. Mechanistically, we found that the reduced CD19 expression was caused by the dysregulation of cell metabolism. In conclusion, we found that SARS-CoV-2 infection causes immunodeficiency in recovered patients by downregulating CD19 expression in B cells via enhancing B-cell metabolism, which may provide a new intervention target to cure COVID-19.

A Qualitative Study of the Health Perceptions in the Venezuelan Immigrant Population in Medellín (Colombia) and Its Conditioning Factors.

This study explored the general and oral health perceptions in the Venezuelan immigrant population in Medellín (Colombia) and its conditioning factors. A qualitative study involving Venezuelan immigrants ≥18 years with a minimum stay of six months in Colombia was conducted. Dentists, dental students, and other health professionals also participated. Semi-structured interviews (n = 17), focus groups (n = 2), and key informants' interviews (n = 4) were utilized. The interviews and focus groups were recorded and transcribed for later narrative content analysis. A high degree of vulnerability of participants was found due to the precarious living conditions from the premigratory moment and the lack of job placement possibilities at the time of settling in Colombia, where the migratory status played a fundamental role. Among the perceived needs, the mitigation of noncommunicable diseases stood out. Poor mental health symptoms (depression and anxiety) were perceived, and oral health was not a priority. Barriers to accessing health and dental care were found. The migrant condition was found to be a determinant that affected physical, mental, and oral health and the provision of health care. This situation is of interest to the construction of public health policies that guarantee access to fundamental rights.

The 1,000th Transplant for Multiple Sclerosis and Other Autoimmune Disorders at the HSCT-México Program: A Myriad of Experiences and Knowledge.

After gaining experience conducting both auto and allografts in persons with hematological diseases in the HSCT programs in Puebla and Monterrey, México, this study outlines subsequent program autografting patients with autoimmune conditions. The first transplant in multiple sclerosis was conducted in Puebla on July 5, 2006. From 2015 we increased activity autografting persons with autoimmune conditions in the two campuses of the HSCT-México program: Puebla and Monterrey. By December 6, 2020, patient number 1,000 in the program was autografted. In our experience, a significant reduction in the expanded disability status scale score was achieved in all of the three phenotypes of the disease (from a median of 5.1 to 4.5 points), whereas the response rate (defined as a decrease of at least 0.5 of EDSS score regardless of baseline EDSS, or unchanged EDSS) was 83, 78, and 73% after 12 months in the relapsing-remitting, primary-progressive and secondary-progressive forms of multiple sclerosis, respectively. In addition to analyzing the viability, safety, and efficacy of our method, this study contributes new knowledge to the field of both stem cell transplantation and multiple sclerosis.

Ventilation and air-conditioning systems in dental clinics and COVID-19: How much do we know?

BACKGROUND: This study evaluated the association between knowledge and management of ventilation and air-conditioning systems (VAC) to avoid the spread of the SARS-CoV-2 virus in health facilities by dentists and demographic variables. MATERIAL AND METHODS: A cross-sectional digital media survey was administered to dentists as part of global research. The core questionnaire was used including four additional questions on VAC (Q1: knowledge, Q2: work settings, Q3: temperature, and Q4: maintenance). A descriptive analysis was conducted for sociodemographic and VAC variables, and bivariate analysis was carried out using different tests. RESULTS: 5370 dentists answered the survey (median age of 45 years; 72.22% women). About half of the respondents said that they knew about the guidelines issued for the management of air conditioners (AC) during the pandemic, and 16.77% have made modifications to their VAC systems during this period. The most frequent AC temperature range used in the dentists' offices during the pandemic was 18°C to 20°C. As age increased, self-reported knowledge about VAC guidelines expanded. Remote and rural regions were perceived to have less knowledge of the guidelines. CONCLUSIONS: Although perceptions of knowledge about VAC systems during the COVID-19 pandemic was high, the temperature in dental offices was colder than that recommended. Greater disclosure of VAC management practices and adherence to VAC management guidelines are required. Key words:Air conditioning, dentistry, coronavirus.

Perceived Stress in Dentists and Dental Students of Latin America and the Caribbean during the Mandatory Social Isolation Measures for the COVID-19 Pandemic: A Cross-Sectional Study.

This study aims to determine the impact of the COVID-19 pandemic, specifically considering the mandatory social isolation measures implemented, on the perceived stress of a sample of dentists and dental students from Latin America and the Caribbean, as well as the associated sociodemographic and pandemic-related variables. A cross-sectional survey was conducted with a sample of 2036 dentists and dental students (1433 women). For the main outcome, the 14-item Perceived Stress Scale (PSS-14) was used. The survey also questioned sociodemographic aspects, questions on the COVID-19 pandemic, health variables, and habits. Descriptive, bivariate, and multivariate analyses (linear regression) were applied to observe the factors associated with perceived stress. The PSS-14 mean score was 24.76 (±11.76). Hierarchical regression models showed significant variables associated with the PSS-14 scores: income level during mandatory social isolation, having older adults under care during mandatory social isolation, self-perceived level of concern regarding COVID-19, self-perceived health, Coffee consumption during mandatory social isolation. In general terms, the pandemic has influenced the personal, social, labor, and everyday life of dental staff and affected the mental health of this population specifically when perceived stress is considered. Public policies, strategies, and mental health surveillance systems are required for this population.