Urban resilience: discourse and institutionalisation of a concept

The impact of the covid-19 pandemic has made the concept of "urban resilience" even more relevant as one of the keys to the future of our urban areas. Given that they were already evident, the measures to be adopted to contain the pandemic have clarified the limited capacity of our cities to respond to specific and/or structural problems. This article has made it possible to analyse and make visible the different approaches, dimensions, and fields to resilience in the international, European and national reference framework documents that provide guidelines for future urban intervention in our cities.

Identification of Predictive Markers of Response to Immunomodulators in the Treatment of COVID-19 Patients.

BACKGROUND: Proper identification of patients at risk of developing serious disease in the context of SARS-CoV-2 infection, as well as the initiation of early treatment, is one of the fundamental elements for successful management of COVID-19. The main objective of this study was to evaluate the usefulness of serum biomarkers (neutrophils, lymphocytes, C-reactive protein, lactate dehydrogenase, D-dimer, ferritin, and interleukin-6) to predict the early response to immunosuppressant therapy in COVID-19 patients. METHODS: This is a case-control study nested in a retrospective cohort, which included hospitalized patients with interstitial pneumonia and with elevation of some proinflammatory parameters. Each of the individuals who died during the 28-day follow-up was defined as a case. For each case, 4 controls were selected, matched by age, gender, and comorbidities. RESULTS: The initial cohort included 856 patients. The incidence of therapeutic failure in the cohort was 14%, thus we identified a total of 120 cases. After the application of a Cox regression model, high serum concentrations of LDH (> 451 IU/L), ferritin (> 1,014 ng/mL) and D-Dimer (> 1,300 ng/mL) were identified as predictors of poor response to treatment. Highly-specific cut-off points could not be established for any of these biomarkers. CONCLUSIONS: Some inflammatory biomarkers, such as LDH, ferritin, and D-dimer, may be helpful in identifying patients for whom an early immunomodulatory therapeutic intervention should be considered in the treatment of COVID-19 patients with pneumonia.

Biomarker's usefulness to predict the efficacy of IL6 inhibitors and corticosteroids in the treatment of COVID19

Objective: Proper identification of patients at risk of developing serious disease in the context of SARS-CoV-2 infection, as well as the initiation of early treatment, is essential for COVID19 successful management. The main objective of this study was to evaluate the usefulness of serum biomarkers (i.e., neutrophils, lymphocytes, Creactive protein, lactate dehydrogenase, D-dimer, ferritin and interleukin-6) to predict the early response to immunosuppressant therapy in COVID19 patients. Material and/or methods: This is a case-control study nested in a retrospective cohort, which included hospitalized patients with COVID19 pneumonia and presented elevation of some pro-inflammatory parameters. Each of the individuals who died during the 28-day follow-up was defined as a case. For each case, four controls were selected, matched by age, sex and comorbidities. Results: Overall, 856 patients were included in the initial cohort. The incidence of therapeutic failure in the cohort was 14%, thus a total of 119 cases were identified. After applying a Cox regression model, high serum concentrations of LDH (>451 IU/L), ferritin (>1014 ng/mL) and D-Dimer (>1300 ng/mL) were identified as predictors of poor response to treatment. High-specific cut-off points could not be established for any of these biomarkers. Conclusions: Some inflammatory biomarkers, such as LDH, ferritin and D-dimer, may be helpful in identifying patients for whom an early immunomodulatory therapeutic intervention should be considered in the treatment of COVID19 patients with pneumonia.

The influence of the COVID19 pandemic in the patterns of acute poisoning presenting to an emergency department in Spain

Objective: COVID-19 has left no healthcare system untouched. Adjustments to accommodate COVID-19 pandemic needs resulted in widespread deferment of non-COVID19 scheduled healthcare activities, added to a general patient's reluctance to visit healthcare settings. This study is aimed to analyse retrospectively demographic and clinical characteristics of patients with acute poisoning attended at the Emergency Department (ED) in three different pandemic periods of time. Material and/or methods: We carried out an observational and retrospective study in which we included all the patients who visited the Emergency Department at Hospital Son Espases due to acute poisoning during three different periods of time from June to July in 2019 (pre pandemic), same period in 2020 (right after the strict confinement in Spain) and in 2021 (post-pandemic). This study was approved by the Research Ethics Committee of the Balearic Islands. Results: All cases of acute poisoning were included (n = 1182). Patients with acute poisoning presenting to the ED decreased significantly during the pandemic (2019: 1.9%, 2020: 1.5%;p < 0.01). The ratio male/female and the mean age of the patients increased during the pandemic (2 vs. 1.4, p = 0.02, and 31.4 vs. 41.3 years, p < 0.001, respectively). The roll of poisoning in suicide attempts increased substantially during the pandemic (2019: 8.71%, 2020: 21%;p < 0.01), mostly driven by the increase in poisoning due to commercially available drugs (2019: 14.20%;2020: 28.76%, p < 0.01), while recreational drug poisoning decreased (2019: 76.1%, 2020: 62%;p < 0.01), while in 2021, figures tended to return to prior patterns. Conclusions: This study found significant changes in some clinical patterns in patients attending the ED due to acute poisoning in the context of COVID19, in line with the already described impact of the pandemic in other areas of the healthcare system.

Pre- and post-COVID-19 pandemic: acute poisoning among patients in an Emergency Department

Objective: The COVID-19 pandemic has affected daily life in unprecedented ways. Many studies have found dramatic changes in individuals' physical activity, sleep and mental health [1]. This study aimed to analyze retrospectively demographic and clinical characteristics of patients with acute poisoning presenting to the Emergency Department (ED) [2] in three different periods of time (June-July): pre-pandemic (2019), after strict confinement of the Spanish population (2020) and post-pandemic (2021) [3]. Methods: All cases of poisoning in the study periods were reviewed. Demographic variables and the type of intoxication were studied. A comparison was made between the three periods. Results: All cases of acute poisoning were included (n=1182, 528 in June-July 2019;299 in June-July 2020, 355 in June-July 2021). Patients with acute poisoning presenting to the ED decreased during the pandemic (2019: 1.9%, 2020: 1.5%;p<0.01). The ratio male/female increased during the pandemic (2 versus 1.4, p=0,02). The mean age of the patients increased during the pandemic (2019: 31.4, 2020: 41.3, p<0,001), this tendency was maintained in 2021 (38.3). Poisoning in suicide attempts increased during the pandemic (2019: 8.71%, 2020: 21%;p<0.01), as well as poisoning due to commercialized drugs (2019: 14.20%;2020: 28.76%, p<0.01), while recreational drug poisoning decreased (2019: 76.1%, 2020: 62%;p<0.01), in 2021 these increased again (69%, p 0.07). Conclusion: This study has found significant changes in some clinical patterns in patients attending the ED due to acute poisoning in the context of COVID-19, in line with the already described psychological impact of the pandemic.

A curious method to commit suicide

Objective: The COVID-19 pandemic has generated an increase in anxiety-depressive disorders throughout society, with an evident impact on children and adolescents, further precipitated by limitations in social activities during confinement. The increase in home isolation with abuse of new technologies, often far from parental control, involves risky situations such as the case we present. Case report: A 19-year-old man diagnosed with major depressive disorder, with psychiatric admissions since July 2019 for overdose with suicidal intent was home treated with methylphenidate 40mg, mirtazapine 15mg and vortioxetine 10mg. In August, the patient was searching for information on the Internet about euthanasia and suicide without pain in different pages and Internet forums. He bought two products online (by Amazon) that seemed effective for this purpose: a kilogram packet of sodium nitrate and a bottle of antifreeze. Finally, he decided on the first option due to the risk of suffering after ingesting antifreeze. On August 26 (4:00 pm), he ate a tablespoon (80 mg) of sodium nitrate. He developed dyspnea and feeling overwhelmed so he decided to informed his family of what he had done and an ambulance was called. He was transferred to hospital and given oxygen. At 7:00 pm in the emergency department he was noted to have a greyish coloration (“hot dead” appearance) with poor respiratory mechanics, tachycardic, tachypneic, with signs of peri-arrest: blood pressure 96/50mmHg, heart rate 145 bpm, respiratory rate 30/min, oxygen saturations 70%. He also had uncoordinated movements, and could not obey orders. The patient was sedated for intubation and mechanical ventilation. An arterial blood gas analysis performed after intubation showed: pH 7.35, pO2 165mmHg, pCO2 24mmHg, base excess -10.4, bicarbonate 14.5 mEq/L, potassium 3.1 mmol/L, methemoglobin 83%, carboxyhemoglobin 1.4%, lactate 13.3mmol/L. Methylene blue 1% (75mg intravenously) and activated charcoal by nasogastric tube were administered (after intubation). Later, he was admitted to the intensive care unit (9:20 pm). Physicians from this unit decided to administrate hydroxocobalamin (5 g intravenously at 00.39 am). The patient was extubated and discharged from the intensive care unit 36 hours after his admission to the department of Internal Medicine, without clinical complications;later he was transferred to Psychiatry Department. Conclusion: The toxic mechanism of sodium nitrate is related to the generation of methemoglobin. This patient survived a potentially lethal methemoglobin level following intentional ingestion of sodium nitrate with prompt administration of an antidote.

ORAL SALIVA SWAB RT-PCR AS A FIT-FOR-PURPOSE DIAGNOSTIC TEST for COVID-19 in CHILDREN

Background: Testing using nasopharyngeal swabs (NPS) samples is the cornerstone for the control of the COVID-19 pandemic, but the procedure is uncomfortable and generates anxiety, especially in children. We aimed to evaluate the adequacy of oral saliva swab analysis using RT-PCR comparing to NPS by RT-PCR and Antigen Rapid Test (AgRT) on NPS in children. Methods: Cross-sectional multicenter diagnostic study nested in a prospective, observational cohort (EPICO-AEP) carried out between February and March 2021 at 10 hospitals in Spain. Participants were children 0 to 18 years old with symptoms compatible with SARS-CoV-2 infection of ≤5 days of duration attending at emergency departments. Three samples were collected, two NPS (for AgRT and for RT-PCR) and one oral saliva swab for RT-PCR. In patients with discordant results, new NPS was collected for viral culture and original samples were tested for viral RNA subgenomic (sgRNA) study. Results: 1174 children were included in the analysis, aged 3.8 years (IQR, 1.7-9.0), 647/1174 (55.1%) were male and 760/1174 (64.7%) presented fever 1 day before emergency department admission (IQR 1.0-2.0). Overall, 73/1174 (6.2%) patients tested positive in at least one of the techniques. Sensitivity for RT-PCR in oral saliva swab was 72.1% (95%CI, 59.7-81.9) and specificity 99.6% (95%CI, 99.0-99.9);AgRT in NPS was 61.8% (95%CI, 49.1-73.0) and 99.9% (95%CI, 99.4-100). Kappa index for RT-PCR oral saliva swab was 0.80 (95%CI, 0.72-0.88), and for AgRT was 0.74 (95%CI, 0.65-0.84) vs RT-PCR in NPS. A Bayesian model was used to estimate the accuracy assuming that RT-PCR in NPS is not a perfect gold standard. In this model, sensitivity for RT-PCR oral saliva swab was 84.8% (95%Cr 71.5-93.6), and for AgRT, it was 72.5% (95%Cr, 58.8-83.6). Specificity for RT-PCR oral saliva swab was 99.7% (95%Cr, 99.2-99.9), and for AgRT it was 99.9% (95% Cr, 99.6-100). The Cts were higher in oral saliva swabs compared with NPS;being Ct (NPS)=0.5 x (Ct saliva) + 4.5 (p=0.027). Overall, 4 (10.8%) patients with discordant results had a positive culture. In 3 of the 4 patients, the discordance consisted of positive result on oral saliva swab and nasopharyngeal swabs RT-PCR but negative by antigen rapid diagnostic test. No patient had (+) culture, (+)NP, (-)oral swab. Conclusion: RT-PCR on oral saliva swab is an accurate option for SARS-CoV-2 testing in children. A friendlier technique for younger patients, who must be tested very frequently, may help to increase the number of patients tested.

[Acute poisoning among patients attended to in an emergency department: From the pre-pandemic period to the new normality]. / Intoxicaciones agudas atendidas en un servicio de urgencias. De la prepandemia a la nueva normalidad.

Background: The COVID-19 pandemic has caused global changes that affect the daily life of the world's population, with a direct impact on individuals' physical and mental health as well as on their social and recreational habits. Methods: This study aimed to retrospectively analyze the demographic and clinical characteristics of patients attended to for acute poisoning in a hospital emergency department (ED) at three different periods of time: pre-pandemic (2019), after strict lockdown of the population in Spain (2020), and post-pandemic (2021). We analyzed 2 months (June and July) in each period. Results: A total of 1,182 cases of acute poisoning were included. Compared to the pre-pandemic period, during lockdown, the number of patients with acute poisoning decreased (2019: 1.9% vs. 2020: 1.5%; p<.01); the ratio of men to women increased (2.0 vs. 1.4; p=.02); and the mean age of patients increased (2019: 31.4 vs. 2020: 41.3; p<.001), a trend which continued in 2021 (38.3). Poisoning with suicidal intention also increased during the pandemic (2019: 8.71% vs. 2020: 21.0%; p<.01) whereas poisonings with a recreational intention declined (2019: 76.1% vs. 2020: 62.0%; p<.01) with a non-significant increase in 2021 (69.0%, p=.07). Conclusion: The COVID-19 pandemic generated clinical and epidemiological changes in the acute poisonings attended to in a hospital emergency department during the various phases of the pandemic.

Diagnostic accuracy of sars-cov-2 antigen rapid test compared to real time pcr in ped

Background: The accuracy of rapid antigen tests (RAT) SARS-CoV-2 for in children is unknown. Our aim was to determine the diagnostic accuracy and concordance of the RAT PanBioTM (Abbott) compared to RT-PCR in nasopharyngeal smear (NPS) samples, in symptomatic pediatric population. Methods: This is a descriptive, retrospective, multicentre clinical study nested in a prospective, observational, multicenter cohort study. We included pediatric patients aged 0 to 16 years with symptoms consistent with COVID-19 of ≤5 days of evolution, attended in the Emergency Departments of the seven centers involved. A total of two consecutive NPS were obtained from each patient: one was employed to perform the RAT and the other to perform RT-PCR. Sample size for a non-inferiority study was calculated considering 80% power, for a 5% prevalence and a 90% sensitivity, using RT-PCR as the gold standard reference. A confusion matrix was displayed. Non-inferiority of sensitivity and specificity between diagnostic tests was assessed using the McNemar's test. The agreement between the two methods was calculated using Cohen's kappa index. Results: A total of 1620 patients were tested in 7 hospitals. The overall sensitivity for RAT PanBioTM was 45.4% (95%CI, 34.1-57.2), and specificity was 99.8% (95%CI, 99.4-99.9) (Figure 1). The positive predictive value (PPV) for this 4.8% prevalence was 92.5% (95%CI, 78.6-97.4). The negative predictive value was 97.3 % (95%CI, 96.8-97.8). Positive likelihood ratio (PLR) was high - 233.8 (IC 95%, 73.5-743.3), and negative likelihood ratio (NLR) was low - 0.54 (95%CI, 0.44-0.67). Conclusion: Compared to RT-PCR, the sensitivity of the RAT PanBioTM was low in children with <5 days of symptoms of COVID-19. The specificity and PLR were good, and the NLR and concordance with RT-PCR were only moderate. These results suggest that the test is very good when the result is positive, and that the test has only a limited value when the result is negative. In relation with screening and public health policy, these results should be interpreted considering also rapidness, availability and false positives ratio compared to RT-PCR or other tests.