CRIRES+on sky at the ESO Very Large Telescope: Observing the Universe at infrared wavelengths and high spectral resolution

The CRyogenic InfraRed Echelle Spectrograph (CRIRES) Upgrade project CRIRES+ extended the capabilities of CRIRES. It transformed this VLT instrument into a cross-dispersed spectrograph to increase the wavelength range that is covered simultaneously by up to a factor of ten. In addition, a new detector focal plane array of three Hawaii 2RG detectors with a 5.3 μm cutoff wavelength replaced the existing detectors. Amongst many other improvements, a new spectropolarimetric unit was added and the calibration system has been enhanced. The instrument was installed at the VLT on Unit Telescope 3 at the beginning of 2020 and successfully commissioned and verified for science operations during 2021, partly remotely from Europe due to the COVID-19 pandemic. The instrument was subsequently offered to the community from October 2021 onwards. This article describes the performance and capabilities of the upgraded instrument and presents on sky results. © 2023 The Author(s).

Trend on erectile rehabilitation after radical prostatectomy: Results of an international survey among urologists

Introduction & Objectives: In the last two decades, several therapeutic schemes have been proposed for erectile rehabilitation (ER) after radical prostatectomy (RP), but none has been standardized or validated due to the lack of high-level evidence in the Literature. We performed an international Survey focused on the current worldwide approach to ER, highlighting the contact and divergent aspects. Materials & Methods: We purposed an online Survey between July and December 2020 using email lists and Twitter, aiming to evaluate the ER protocols after RP performed by urologists and andrologists in daily practice. The following sections were investigated: 1) Demographics;2) Number and type of RP performed;3) Type and schedule, timing and duration of ER erectile programs;4) Standard treatment protocol. The specialists were contacted with the support of Confederación Americana de Urología (CAU), Urological SOcial MEdia (UroSoMe) Working Group, Functional Urology- Techno Urology- Research (FUTURe) Group and by a dedicated uro-andrologists spaces on Twitter platform of iTRUE Group. Results: The Survey was completed by 518 responders from 52 worldwide countries. The main criteria to candidate patients for ER were nerve sparing surgery (72.8%), lack of significant comorbidities (66.4%), patient’s request (55.4%), valid pre-operative EF (55%), age (48.1%), and partner’s willing (19.1%). Surgical techniques reported were: 38.9% open RP, 22.9% video laparoscopic RP, 38.2% robot- assisted RP. There were no significant differences (p>0.05) among the main surgical techniques and the time of EF recovery beginning, protocol and duration. The use of specific ER protocols was reported by 61.4%. The beginning of ER was reported by 33% of responders at catheter removal, after one month from surgery by 22%, and before RP by 15%. PDE5i were more frequently used as first line treatment (99.4%). Tadalafil 20 mg was the most prescribed in monotherapy, prescribed daily (48.2%) or 2-3 times/week (46%). PGE1 intra-cavernosal injection (67.9%) was the second more common prescription in monotherapy, followed by the association of PDE5i and vacuum device (29.6%). A minority of specialists 44/518 (8.5%) recommended low intensity shock wave therapy, while 63/518 (12.2%) proposed this in association to other therapies. The duration of ER was: in 16.2% <6 months, in 39% between 6 and 11 months;in 31.9% between 12 and 18 months;in 9.2% between 19-24 months, and in 3.7% >24 months. In case of first-line failure, the majority of the responders shifted to another treatment after at least 3 months (71%). During COVID-19 outbreak, the 37.4% of responders did not perform EF recovery consultations, while 26.8% had normal consultations, and 35.7% used telemedicine. Conclusions: This Survey showed an inhomogeneous approach to ER, reflecting the lack of high-level evidence on this topic. A worldwide accepted guideline on ER is therefore needed.

Gastric Remnant Cancer: Complete Pathological Response - Case report

Background: Remnant gastric cancer (RGC) refers to carcinoma of the residual stomach occurring after gastrectomy. With an incidence of 1-7%, it is believed to have a different disease mechanism and a poorer prognosis than primary gastric cancer (PGC). However, due tu its rarity, the standard treatment for RGC remains undefined. Therefore, the multidisciplinary/tailored approach becomes crucial for the treatment of these patients. Materials and Methods: We present the case of a 64 years old male patient with family history of GC (father) and personal history of distal gastrectomy for peptic disease with Billroth-II reconstruction in 1979, orchiectomy for pT1 seminoma in 2017, and COPD. During follow-up for his seminoma the patient was diagnosed with clinical stage III intestinal type G1 gastric adenocarcinoma. The case was presented to our multidisciplinary team meeting (MDTm) and neoadjuvant treatment (FLOTx4) was started. In november 2019 an exploratory laparotomy was performed finding a RGC of the lesser curvature infiltrating the pancreas, the surgical team decided not to perform resection. The case was again presented in our MDTm and FLOT Protocol was completed (x4 cicles). CT scan showed good response and new laparotomy was planned. However, due to SARS-CoV2 outbreak the patient could not be operated on and was presented again to MDTm, deciding to proceed with chemoradiotherapy (50Gy + Taxol + CBP for 6 weeks). After the outbreak a new laparotomy was performed and a subtotal (95%) gastrectomy + Roux-n-Y reconstruction was performed. Results: After a period of 2 weeks in ICU due to aspiration pneumonia the patient recovered well and was discharged 23 days after surgery. Pathological report showed complete pathological response (grade 0) ypT0ypN0. The patient is currently well and will under surveillance. Conclusions: Although not as frequent as PGC, RGC is a disease with poor prognosis due to its diagnosis at advanced stages and the lack of standard treatment in current guidelines for both systemic and surgical treatment. In this setting, the role of MDTs and tailored treatments can contribute to both short- and long-term oncological outcomes and patient’s quality of life. In this case, FLOT followed by chemoradiotherapy (50Gy + Taxol + Carboplatinum) for 6 weeks, followed by subtotal gastrectomy allowed us to achieve a complete pathological response. Eventhough these results need further research, this could be a good treatment option in selected patients.

TIVURON PROJECT: AN INTERNATIONAL MULTICENTER PROSPECTIVE COHORT STUDY EVALUATING THE GASTROINTESTINAL SYMPTOMS AND COMPLICATIONS OF COVID-19 IN HOSPITALIZED PATIENTS

Background/Aims: Digestive symptoms are common in patients with COVID-19. Neverthe-less, the evidence available so far is based on retrospective and observational studies. This prospective multicenter cohort study aimed to describe the frequency, intensity, evolution, and impact of digestive symptoms and complications, during hospitalization and after dis-charge, of patients with COVID-19. Methods: Patients hospitalized due to COVID-19 (posi-tive PCR for SARS-CoV-2) from May to August 2020, were prospectively recruited in 31 centers. Follow-up included the period between admission and 15 days after discharge. Results: 829 patients (mean age 56.7±17.9 years;42% of females) were enrolled in this study. Of these, 7.2% were active smokers and the mean BMI was 29.1±5.7. Proton pump inhibitors were used by 21.5% (n=178). The most prevalent symptoms on admission were diarrhea (39.4%), nausea (27.4%), and abdominal pain (20.7%). Anorexia, a non-specific symptom, was present in 49.8% of hospitalized patients. At discharge and 15 days after discharge, most symptoms resolved, returning to the baseline prevalence of patients (<5%). Digestive complications during admission were infrequent, except for liver injury defined as hypertransaminasemia which was present in 267 patients (32.3%). The mean length of hospital stay was 8 days (5-12) and 13.6% needed ICU admission. Death happened in 5.2%of patients. On multivariate analysis, diarrhea on admission was associated with a shorter hospital stay (<10 days) ORa 0.508 (0.350-0.739) p=0.000. During hospitalization, diarrhea, constipation, and abdominal bloating were associated with shorter hospital stay ORa 0.531 (0.298-0.946) p=0.032, ORa 0.384 (0.167-0.885) p=0.025, ORa 0.163 (0.057-0.466) p= 0.00, respectively.Odynophagia and dysphagia during hospitalization were associated with a higher need for ICU admission, ORa 6.518 (2.255-18.835) p=0.001 and ORa 4.035 (1.453-11.204) p=0.007, respectively. Liver injury during hospitalization was associated with a higher hospital stay (>10 days) ORa 1.442 (1.019-2.041) p=0.039. In the linear regression analysis, the set of GI symptoms and complications, along with age, comorbidity, and respiratory symptoms, were able to predict 43% (R2 0.43) of the observed variability in the speed of ICU admission;in this case, digestive symptoms slowed it down (more days until ICU admission). Conclusions: Gastrointestinal manifestations of COVID-19 are common in hospitalized patients, while complications are infrequent. Gastrointestinal symptoms seemed to predict a shorter hospital stay and slower speed of ICU admission. These tend to resolve to their baseline prevalence 15 days after discharge, while elevated transaminases were associated with a longer hospital stay. Odynophagia and dysphagia during hospitaliza-tion were associated with an increased need for ICU admission.

P.0564 Active suicidal ideation one year after the beginning of COVID-19 pandemic in a large spanish sample: risk and protective factors

Introduction: The influence of coronavirus disease 2019 (COVID-19) pandemic over mental health and suicidal behavior has been described worldwide [1,2]. Active suicidal ideation (ASI) and its associated risk and protective factors after one year of COVID-19 pandemic need to be measured and described in order to easy design effective mental health strategies. Objectives: To assess the prevalence of active suicidal ideation in a sample of the general Spanish population after one year of COVID-19 pandemic and to characterize factors associated with active suicidal ideation. Methods: Cross-sectional study based on an anonymous self-report online survey consisting of sociodemographic and clinical questions. The survey was conducted between March 16 and 31, 2021. It was completed by 5,646 participants, aged 18 and over, from all over Spanish territory. The Spanish versions of Depression, Anxiety and Stress Scale (DASS-21), the Dep5 and Anx5, and the Paykel Suicidal Ideation Scale (PSS) were used to assess psychological impact and suicidal ideation. The sample was divided into two different groups based on PSS responses: “active suicidal ideation” (ASI) (positive answer to questions 3 and/or 4) and "no active suicidal ideation" (NASI) (negative answer to questions 3 and 4). Logistic regression models (forward stepwise selection) were estimated to determine the independent factors associated with having ASI. Cohen's d equivalence for Odds Ratios (OR) has been included. Due to multiple comparisons and to avoid inflation in Type I error, the level of statistical significance was set at α ≤ 0.001 (two-tailed). Results: The total sample included 5,654 respondents [mean age (SD) = 39.65 (12.65);females: n = 4,575 (80.9%)]. From the total sample, 415 participants (7.3%: IC 95% [6.7-8.0]) presented ASI during the last month. A logistic regression model, including all significant variables from bivariate analyses, was run to assess variables associated with ASI. Risk factors for ASI were: income reduction > 50% [OR (IC 95) = 1.994 (1.317-3.020), p = 0.001], history of past or current mental disorder [OR (IC 95%) = 1.469 (1.067-2.023), p = 0.018;OR (IC 95%) = 3.161 (2.468-4.048), p < 0.001, respectively], insomnia [OR (IC 95%) = 1.850 (1.404-2.437), p < 0.001] and personal history of suicide attempt [OR (IC 95) = 3.779 (2.681-5.327), p < 0.001]. Protective factors against ASI were: older age [OR (IC 95%) = 0.968 (0.958-0.978), p < 0.001), living with one or more than one other person [OR (IC 95%) = 0.537 (0.385-0.747), p < 0.001;OR (IC 95%) = 0.634 (0.466-0.863), p = 0.004, respectively] and neutral or sleep satisfaction [OR (IC 95%) = 0.672 (0.510-0.886), p = 0.005;OR (IC 95%) = 0.472 (0.349-0.638), p < 0.001, respectively]. Conclusion: The estimated prevalence of ASI in this large sample of Spanish general population was significantly high. In addition, significant income reduction, history of past or current mental disorder, insomnia or history of suicide attempt have been described as risk factors associated with ASI, whereas older age, neutral or sleep satisfaction act as protective factors. The results from this study provide useful information which may help to identify vulnerable population characteristics. No conflict of interest

P.0647 Psychological impact in patients with common mental disorders after six months of COVID-19 outbreak

Introduction: Studies focused on the impact of the COVID-19 pandemic in patients with psychiatric disorders have reported a deterioration of their mental health due to this situation [1]. A study focused on the early COVID-19 pandemic consequences on mental health found that participants reporting a current mental disorder were experiencing the greatest psychological impact, followed by those reporting a past mental disorder [2]. We hypothesize that having suffered or suffering from a depressive or anxiety disorder at that time can lead to maladaptive responses during the pandemic and social restrictions. Aims of the study: To describe the psychological impact among patients with a current or past diagnosis of Common Mental Disorders (CMD;anxiety and depressive disorders) after six months of the beginning of the COVID-19 pandemic. 1. To explore risk and protective factors associated with a Severe Psychological Impact (SPI). Methods: Cross-sectional survey. A self-reported online test was completed by the participants during the pandemic from October 14th to November 8th, 2020, from all over the Spanish territory. From the sample (N=5900), 1122 (19.02%) reported suffering from CMD in the past or at the moment the study was conducted (mean age±SD=46.01 ±14.12 years) The Spanish version of the Depression, Anxiety and Stress Scale (DASS-21) was used to evaluate the maladaptive psychological responses. Psychological impact in CMD was classified according to the number of maladaptive responses in the DASS-21 scale, considering: mild (1 response), moderate (2 responses) and severe (3 responses). Statistical analyses: Chi-square, t-student test (IBM SPSS version 24 was used for data analyses). The p-value was set at <0.05. Results: Women represented 70.1% of the sample. Approximately half of the participants were married or were living with a cohabiting partner (55.8%). Most of the responders had completed university studies (69.6%). From the sample, 1240 participants (21%) had a somatic disease (12% hypertension and 10.8% chronic respiratory disease). 16.1% increased their alcohol consumption and 14.1% increased their tobacco consumption. CMD reported the highest psychological impact on Depressive DASS-21 subscale (59.5% χ²=206.6, p<0.001), followed by Stress subscale (38.6, χ²= 482.2, p<0.001) and Anxiety subscale (31.3, χ²= 204.7, p<0.001). According to copying strategies, a high percentage of patients with CMD reported being able to enjoy leisure time (88.1%). Reading or listening to music were the most frequent activities (87.8%). 20.7% of the sample showed a SPI. Considering the statistically significant variables, a logistic regression analysis was obtained. On the one hand, older age (B=-0.03, OR=0.972, p<0.001), male sex (B=-0.6, OR=0.55, p=0.008), university studies (B=-0.43, OR=0.652, p=0.008) and being able to enjoy leisure time (B=-1.1, OR=0.341, p<0.001) were protective factors of SPI. On the other hand, having a somatic illness (B=0.59, OR=1.797, p<0.001) and the increase in tobacco use (B=0.58, OR=1.778, p=0.005) were factors associated with SPI. Conclusions: This study illustrates the psychological impact in CMD after half-year of the COVID-19 outbreak. Being young, a woman, suffering from somatic illness, and not having a university education are risk factors for SPI. However, being able to enjoy leisure time is the main protective factor against a SPI in CMD. No conflict of interest

Immunonological biomarkers of fatal coronavirus disease 2019 (covid-19): A study of 513 patients including hematological cases

Background: Knowledge on the immunopathobiology of COVID-19 is rapidly increasing but most studies analyzed relatively small series of patients and immune features predictive of fatal outcome are unavailable for routine stratification. Furthermore, an increased risk of death in patients with hematological cancer infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been identified, but it remains unknown if this is related to possible immunosuppression caused by cancer itself and cytotoxic treatment. Aims: Characterize the immune response to SARS-CoV-2 in a large cohort of patients to identify high-risk immune biomarkers and evaluate the association between COVID-19 severity and immunosuppression in patients with hematological cancer. Methods: Multidimensional flow cytometry was used to conduct holistic and unbiased analyses of17 immune cell types on 780 peripheral blood samples obtained from 513 COVID-19 patients, 24 cases with non-SARS-CoV-2 infection and 36 age-matched healthy adults.167 COVID-19 patients had 207 longitudinal samples collected over time. RNA sequencing on FACSorted cells and high-resolution flow cytometry were used to perform a deeper characterization of various myeloid and lymphoid subsets in14 COVID-19 patients and4 healthy adults. Results: Immune profiles of COVID-19 patients were generally similar to those of age-matched patients with non-SARS-CoV-2 infection, but significantly different from those of age-matched healthy adults. When compared to the later, COVID-19 patients showed increased percentages of neutrophils, CD4+CD56+ T-cells, and plasmablasts, whereas levels of basophils, eosinophils, and non-classical monocytes, as well as double-negative, CD8loCD56-, CD8-/loCD56+ and CD8hiCD56- T-cells, and B-cells were decreased. Both transcriptional and immunophenotypic data in myeloid and lymphoid subsets suggested an association between COVID-19 severity and neutrophil activation, as well as significantly reduced levels of specific adaptive immune cell types. Unsupervised clustering analysis of 513 patients revealed three immunotypes in response to SARS-CoV-2 infection. One of them, present in14% of patients (n=74), was characterized by significantly lower percentages of all immune cell types except neutrophils and plasmablasts, and was significantly associated with more severe disease. Of note, 50% of COVID-19 patients with blood cancer displayed this immunotype. Accordingly, hematological patients showed a significantly higher frequency of admission into intensive care units (50% vs 5%, P<.001) and death (30% vs4%, P<.001) than patients without tumor did. On multivariate analysis incorporating age and comorbidities, the frequency of B-cells and non-classical monocytes were independent prognostic factors for overall survival. Indeed, <1% B-cells in peripheral blood was most strongly associated with risk of death. Among patients with immune monitoring during follow-up, significant changes in the relative distribution of eight immune cell types, including basophils, CD8loCD56- T-cells, and B-cells, were observed from the first to last peripheral blood sample between patients who survived or died. Summary/Conclusion: Our results accelerate our understanding of the immunopathobiology of COVID-19 and unveil an association between altered immune profiles in patients with hematological cancer and their poorer outcome. Reduced percentages of B-cells and non-classical monocytes are high-risk immune biomarkers that could be readily implemented in routine practice for risk-stratification of COVID-19.

COVID-19 psychological impact in patients with depressive disorder: Differences based on their age

IntroductionCOVID-19 pandemic and lockdown have provoked a considerable psychological impact in Spain. Some studies have reported greater psychological impact in the younger population. To date, no previous study has focused on depressive disorder (DD) patients based on their age.ObjectivesTo describe the psychological impact on DD according to age.MethodsCross-sectional study of an online survey available from 19 to 26 March 2020. Out of a total of 21207 respondents, 608 (2.9%) reported suffering from DD (mean age ±SD = 41.2 years±14.07 [18-82], 80.6% women). The subsample (608) was divided according to age, “youngsters” <45 (57.4%)/ “elders” ≥45. DASS-21 and IES scales were employed. Statistical analyses: Chi-square, t-Student test.ResultsBoth groups did not differ (p>0.05) in sex, having COVID-19 symptoms, having family/friends infected, or income changes. While youngsters were single more frequently (68.8% vs 14.3%, χ² = 179.7, p<0.001), elders had somatic illness more frequently (64.8% vs 39.7% χ² =30.401, p<0.001). Youngsters obtained higher scores in depression (4.69 vs 4.1, T=5.413, p<0.001), anxiety (2.86 vs 1.97, T=5.249, p<0.001) and stress (4.48 vs 3.17, T=6.355, p<0.001) DASS-21 subscales, as in intrusive (3.42 vs 3.05, T=1.984, p=0.048) and avoidant (4.64 vs 4.11, T=3.056, p=0.002) IES scores.ConclusionsDespite the group of elders with depression being more vulnerable to severe COVID-19 disease and presenting more frequently somatic comorbidities, younger depressive patients suffered more from depressive, anxiety, stress and avoidant symptoms and intrusive thoughts, in line with previous reports in the general population.DisclosureNo significant relationships.

P.859COVID-19 lockdown in people with severe mental disorders in Spain: do they have a specific psychological reaction?

Introduction: After the outbreak of a new coronavirus subtype SARS-CoV-2 in China in late 2019, a global pandemic developed, generating a health, economic, and social emergency [1]. In Spain, the COVID-19 pandemic crisis forced the government to declare a state of emergency on 14 March 2020 and to implement unprecedented lockdown restriction. In this context, patients with severe mental disorders (SMD) may be particularly exposed to stress and social distancing measures [2, 3] and thus disproportionately vulnerable to public health interventions to fight the COVID-19 [4]. However, the early psychological impact of the pandemic and the lockdown in this population is still mostly unknown. Aims of the study: Here, we aim to compare the early psychological impact (depression, anxiety, and stress responses, intrusive and avoidant thoughts, and coping strategies) in a sample of people with SMD compared with two control groups: other mental disorders (OMD) and healthy controls (HC). Methods: An anonymous online questionnaire using a snowball sampling method was conducted from March 19-26, 2020 and included sociodemographic and clinical data along with the Spanish versions of the Depression, Anxiety, and Stress Scale (DASS-21) and the Impact of Event Scale (IES). A total of 21,279 people living in Spain answered the questionnaire, and 125 people with SMD were included in the analysis. Subjects in each of the two control groups (OMD, n = 250;HC, n = 250) were matched (ratio 1:2) for sex and age (± 1 year) with the SMD group. We performed descriptive and bivariate analyses and multinomial and linear regression models. Results: People with SMD [mean age = 43.25 years (SD = 14.41);61.6% females] had statistically significantly higher scores on anxiety, stress, and depression subscales of the DASS-21 compared with the HC group, but lower scores than OMD in all domains (p < 0.05). Most people with SMD (87.2%) were able to enjoy free time, although control groups had higher percentages. After controlling for confounding factors, anxiety was the only significant psychological domain with lower scores in HC than people with SMD (OR = 0.721;95% CI: 0.579 - 0.898). In the SMD group, the multiple linear regression model (R2 = 0.580, F = 41.027, p < 0.001) found that higher anxiety was associated with being single (ẞ = 0.144, t = 2.291, p = 0.024), having COVID-19 symptoms (ẞ = 0.146, t = 2.395, p = 0.018), and a higher score on the stress subscale (ẞ = 0.538, t = 7.635, p < 0.001);whereas being able to enjoy free time was a protective factor (ẞ = -0.244, t = -3.692, p < 0.001). Conclusions: Our results showed that patients with SMD reacted to the pandemic and the lockdown restrictions with higher anxiety levels than the general public, suggesting that this domain could be a criterion for early intervention strategies and closer follow-up. No conflict of interest

P.690 Post-traumatic stress symptoms during the COVID-19 in different regions of Spain

Background: COVID-19 is the pandemic most affected since the 1918 influenza. In order to control its effects, the governments of different countries, including Spain, adopted exceptional measures such as lockdown and the suspension of non-essential economic activity. Studies carried out in China, where the population was also confined, have found an increase in the prevalence of post-traumatic stress symptom among the most affected regions compared to other less affected [1] Aim: To describe the presence of post-traumatic symptom among a large sample from the general population in the different regions of Spain after two weeks from the declaration of the state of alarm in Spain. Methods. The data was obtained through an online questionnaire two weeks after the declaration of the state of alarm in Spain (performed between 19 and 26 March, 2020) addressed to general population over eighteen years old [2]. It was spread using an online “snowball” method. Assessment sociodemographic, clinical variables and psychometric scales. Post-traumatic stress symptoms were measured by the Stressful Impact Scale (EIE), which consists of 15 items, divided into two subscales related to symtoms of intrusion and avoidance. The SPSS v24.0 program was used in the statistical analysis. Results: The sample consists of 21,153 individuals [30.3% men] with an average age of 39.75 ± 14.04 (18 to 100 years). A) Intrusive response: regions with the highest prevalence of intrusive response are Castilla La Mancha (31.2%), Andalusia (30.7%) and Extremadura (26.2%);regions with the lowest prevalence of intrusive response are Aragon (18.9%), Navarra (16.0%) and La Rioja (21.4%). B)Avoidance response: regions with the highest prevalence of avoidance response are Andalusia (55.7%), Extremadura (53.7%) and Castilla La Mancha (51.3%);regions with the lowest prevalence of avoidance response are Galicia (39%), Aragon (37.6%) and Navarra (32.7%). In Madrid, the prevalence of avoidant and intrusive symptoms was 43.1% and 26.0%, respectively. Conclussions: Avoidance symptoms were more frequent than intrusion symptoms in all regions. Andalusia, Extremadura and Castilla La Mancha are the regions with the highest prevalence of post-traumatic stress symptoms, both intrusive and avoidant. In addition, Aragon and Navarra presented low post-traumatic symptoms prevalence. The situation in the Community of Madrid is particularly garish. Despite being the region most affected by the COVID-19 pandemic in Spain, the prevalence of post-traumatic stress symptoms, both intrusive and avoidant, is close to average. The representativeness of the regions in the sample is a limitation of our study. However, the Madrid region is well represented in terms of the percentage share of the total sample. The results obtained do not seem consistent with the epidemiological situation of these regions at that time. It neither are according to the findings of other studies, so it would be necessary to investigate the existence of other factors that contribute to explaining these results. No conflict of interest

P.661 Psychological impact of the COVID-19 outbreak and lockdown in Spanish sample with anxiety disorder: differences according to sex

Introduction: We have experienced the effects of an unprecedented pandemic due to the new coronavirus SARS-CoV-2. This is the causative agent of COVID-19. There are precedents for the imposition of lockdown in previous outbreaks that caused a great psychological impact. Specifically, an increase in the mean post-traumatic stress scores, high depressive symptoms and an increase in completed suicides was reported [1,2]. The severity of the impact on mental health is greater in vulnerable people such as those with a psychiatric history [3,4]. Aims: This study aims 1) to assess the psychological impact on a large sample of participants with an anxiety disorder during the onset of the pandemic and lockdown in Spain;2) to Explore differences in the magnitude of the psychological impact of the people with an anxiety disorder according to the sex. Methods: Secondary analyses of a descriptive and comparative cross-sectional study of the data provided by the participants in an anonymous online survey conducted between March 19 and 26. The ad hoc questionnaire included sociodemographic, clinical data and variables related to COVID-19 as well as questions on coping strategies, and the Spanish versions of the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale (IES). From the entire sample of 21207 participants, we analyzed 1617 (7.6%) people with an anxiety disorder at that time [mean age = 35.6 (SD = 12.47);women = 1347 (83.3%)]. For the statistical analysis, the sample was divided into two groups according to sex. We used a chi-square test and Student's t test to detect differences among groups. Next, we analyzed the associations between sex and scores on psychometric scales using logistic regression to control for potential confounding factors. Results: Of the individuals with an anxiety disorder, 55.7% were single, 10.2% lived alone and only 2.4% live with family members infected by SARS-CoV-2. 72.8% do not have children in charge, and 89.1% do not have elderly people dependent on them. Comparing the psychological impact between groups, we observed that it is greater in women. We found statistically significant differences in every DASS-21 subscale: depression (4.35 ± 1.19 vs 4.10 ± 1.28;T= -3.076, p<0.002), anxiety (3.20 ± 2.14 vs 2.41 ± 2.03;T= -5.625, p< 0.001) and stress (4.60 ± 2.15 vs 3.86 ± 2.49;T= -4.540, p< 0.001);and in intrusive (3.63 ± 2.07 vs 2.83 ± 2.09;T= -5.751, p< 0.001) and avoidance subscales of IES (4.72 ± 1.89 vs 3.80 ± 2.06;T= -6.850, p< 0.001). Multivariate analysis revealed a statistically significant association of intrusive thoughts (OR 1.12;IC 95%:1.05-1.21, p=0.001), avoidant thoughts (OR 1.19;IC 95%:1.01-1.29, p<0.001) and age (OR 0.99;IC 95%:0.98-0.99, p=0.004) with being female. Conclusions: Our data indicated that the COVID-19 outbreak and lockdown harmed the mental health of people with mental disorders such as anxiety disorders. After considering confounding variables, we observed that women with an anxiety disorder suffer greater negative repercussions such as intrusive and avoidant thoughts compared to men. No conflict of interest

Innate immunity during SARS-CoV-2: evasion strategies and activation trigger hypoxia and vascular damage.

Innate immune sensing of viral molecular patterns is essential for development of antiviral responses. Like many viruses, SARS-CoV-2 has evolved strategies to circumvent innate immune detection, including low cytosine-phosphate-guanosine (CpG) levels in the genome, glycosylation to shield essential elements including the receptor-binding domain, RNA shielding and generation of viral proteins that actively impede anti-viral interferon responses. Together these strategies allow widespread infection and increased viral load. Despite the efforts of immune subversion, SARS-CoV-2 infection activates innate immune pathways inducing a robust type I/III interferon response, production of proinflammatory cytokines and recruitment of neutrophils and myeloid cells. This may induce hyperinflammation or, alternatively, effectively recruit adaptive immune responses that help clear the infection and prevent reinfection. The dysregulation of the renin-angiotensin system due to down-regulation of angiotensin-converting enzyme 2, the receptor for SARS-CoV-2, together with the activation of type I/III interferon response, and inflammasome response converge to promote free radical production and oxidative stress. This exacerbates tissue damage in the respiratory system, but also leads to widespread activation of coagulation pathways leading to thrombosis. Here, we review the current knowledge of the role of the innate immune response following SARS-CoV-2 infection, much of which is based on the knowledge from SARS-CoV and other coronaviruses. Understanding how the virus subverts the initial immune response and how an aberrant innate immune response contributes to the respiratory and vascular damage in COVID-19 may help to explain factors that contribute to the variety of clinical manifestations and outcome of SARS-CoV-2 infection.