Virtual education in university teaching. Application of the TPACK model in quantitative subjects

Purpose: To analyse the impact of the compulsory adaptation of teaching brought about by Covid-19 in quantitative subjects, taking into account the technological, pedagogical and content-related aspects of the TPACK model.Design/methodology: A structured questionnaire with differentiated blocks with closed and open-ended questions is applied. The data collected from 215 students are analysed descriptively and inferentially using Student's t-test. Sentiment analysis is carried out on the text collected from the survey's open-ended questions.Findings: By applying e-learning under the TPACK model, lessons are redesigned in a way that encourages participation and follow-up. From the results of the survey carried out with students with a face-to-face profile, the positive assessment of the method and the tools used stand out.Practical implications: The use of technological tools and, above all, how they are introduced in the classroom improves student acceptance, thereby reducing the probability of students dropping out, especially among those with a strong face-to-face profile. Originality/value: This evidence-based research offers to address the shortage of conceptual models suitable for teacher training, not only in technology and its use but also in how to apply it effectively, including the knowledge, skills and abilities needed to implement it.

GLUCOCORTICOIDS, RITUXIMAB and the PRESENCE of INTERSTITIAL LUNG DISEASE ARE ASSOCIATED with POOR OUTCOMES of the SARS-COV-2 INFECTION in PATIENTS with RHEUMATOID ARTHRITIS: DATA from the NATIONAL REGISTRY SAR-COVID

Background: High disease activity, treatment with glucocorticoids (GC) and rituximab (RTX), have been related to worse outcomes of COVID-19. Objectives: To assess the clinical characteristics and severity of the SARS-CoV-2 infection in patients with rheumatoid arthritis (RA) included in the SAR-COVID registry and to identify factors associated with poor outcomes. Methods: SAR-COVID is a national, longitudinal and observational registry. Patients of ≥18 years old, with diagnosis of RA (ACR-EULAR criteria 2010) who had confrmed SARS-CoV-2 infection (RT-PCR or positive serology) were included between 13-8-20 and 31-7-21. Sociodemographic and clinical data, comorbidities, disease activity and treatment at the moment of the SARS-CoV-2 infection were collected. Additionally, infection symptoms, complications, medical interventions and treatments for COVID-19 were registered. Infection severity was assessed using the WHO-ordinal scale (WHO-OS)1. A cut-off value of ≥5 identifed patients with severe COVID-19 and those who died. Statistical analysis: Descriptive statistics. Chi2 or Fischer test, Student T test or Mann-Whitney and Kruskal Wallis or ANOVA, as appropriate. Multiple logistic regression model. Results: A total of 801 patients were included, with a mean age of 53.1 ± 12.9 years, most of them were female (84.5%) and the median (m) disease duration was 8 years (IQR 4-14). One third were in remission and 46.4% had comor-bidities, being the most frequent, hypertension (26.9 %), dyslipidemia (13.5 %), obesity (13.4 %) and diabetes (8.9%). Moreover, 3.2% had interstitial lung disease (ILD) associated with RA. At SARS-CoV-2 diagnosis, 42.5% were receiving glucocorticoids (GC), 73.9% conventional (c) disease modifying antirheumatic drugs (DMARD), 24% biologic (b) DMARD and 9.1% targeted synthetic (ts) DMARD. Among bDMARD, the most frequently used were TNF inhibitors (17%), followed by abatacept (2.8%), IL-6 inhibitors (2.4%) and rituximab (RTX) (2.1%). During the SARS-CoV-2 infection, 95.8% had symptoms, 27% required hospital-ization, 7.9% presented complications and 4.4% died due to COVID-19. Severe disease and death (WHO-OS≥5) was present in 7.5% of the patients. They were older (62.9±12.5 vs 52.2±12.7, p<0.001), and they had more frequently ILD (18.5% vs 2%, p<0.001), comorbidities (82.5% vs 43.7%, p<0.001), ≥2 comor-bidities (60.3% vs 25.8%, p<0.001), treatment with GC (61% vs 40.7%, p=0.04) and RTX (8.3% vs 1.6%, p=0.007). Conversely, the use of cDMARD and TNF inhibitors was more frequent in patients with WHO-OS<5, nevertheless this difference was not signifcant. Disease activity was comparable between groups. In multivariable analysis, older age, the presence of diabetes, ILD, the use of GC and RTX were signifcantly associated with WHO-OS≥5 (Figure 1). Furthermore, older age (65.7±10.8 vs 52.4±12.8, p<0.001), the presence of comor-bidities (87.9% vs 44.7%, p<0.001), chronic obstructive pulmonary disease (21.9% vs 5.2%, p=0.002), diabetes (30.3% vs 7.9%, p<0.001), hypertension (57.6% vs 25.6%, p<0.001), cardiovascular disease (15.6% vs 3.2%, p=0.005), cancer (9.1% vs 1.3%, p=0.001), ILD (23.3% vs 2.4%, p<0.001) and the use of GC (61.8% vs 41.4%, p=0.02) were associated with mortality. Older age [OR 1.1 IC95% 1.06-1.13] and the use of GC 5-10 mg/day [OR 4.6 IC95% 1.8-11.6] remained signifcantly associated with death due to COVID-19. Conclusion: Treatment with RTX and GC, as well as older age, the presence of diabetes and ILD were associated with poor COVID-19 outcomes in this national cohort of patients with RA. Older patients and those taking GC had a higher mortality rate.

PREVALENCE of LONG COVID in RHEUMATIC DISEASE PATIENTS: ANALYSIS of SAR COVID REGISTRY

Background: Persistent symptoms after acute COVID have been described previously. Main symptoms reported are fatigue, arthralgias, myalgias and mental sickness. Defnition and methods vary widely.1 Objectives: To asses prevalence and related factors to long COVID in a retrospective cohort of patients with rheumatic diseases from Argentina. Methods: A total of 1915 patients were registered from August 18th, 2020 to July 29th, 2021. Patients > 18 years old, with rheumatic disease and confrmed infection by SARS-CoV-2 (antigen or RT-PCR) were included. Those dead, with unknown outcome, wrong date or missing data were excluded. Demographic data, comorbidities, rheumatic disease, and characteristics of SARS-CoV-2 infection were recorded. Long COVID was defned according to NICE guidelines (persistent symptoms for more than 4 weeks, without alternative diagnosis). Long COVID symptoms were defned by rheumatologist. Severity of infection was clas-sifed according to WHO ordinal scale. We used descriptive statistics, univariate model (Student's test, chi square test, ANOVA) and multivariate logistic regression analysis. Results: 230 (12%) had long COVID. Median age was 51 (IQR 40-61]) years, 82% were females, 51% were not caucasian. Median of education was 13.3 years (IQR 12-16), 79 % had private health insurance and 55 % were employed. Nearly half (n=762, 46%) had comorbidities, the most prevalent was hypertension (n=396, 24%). The most frequent rheumatic diseases were rheumatoid arthritis (n=719, 42%) and systemic lupus ery-thematosus (n=280, 16 %). Most were in low activity/remission (79%), used Conventional DMARD (n=773 patients, 45%) and steroids (n=588, 34%) at low dose (n=415, 71%). Main laboratory findings were abnormal D-di-mer (n=94, 28%) and leukopenia (n=93, 26%). Most patients had a WHO ordinal scale < 5 (n=1472, 86%). Median of hospitalization at intensive care unit (ICU) was 8 days [IQR 5, 13]. Treatment for SARS-CoV-2 infection (steroids, anticoagulation, azithromycin, convalescent plasma) was used in 461 (27%) patients. Most of long COVID (n= 152, 69%) reported 1 symptom, the most frequent was fatigue (n= 55, 22%). Figure 1. Univariate analysis is presented in Table 1. In multivariate logistic regression analysis non-caucasian ethnicity OR 1.44 (1.07-1.95), years of education OR 1.05 (1-1.09), treatment with cyclophosphamide OR 11.35 (1.56-112.97), symptoms of COVID-19 OR 13.26 (2.75-242.08), severity scale WHO ≥ 5 OR 2.46 (1.68-3.57), and ICU hospitalization days OR 1.09 (1.05-1.14) were factors associated to long COVID. Conclusion: Prevalence of long COVID was 12%. Non-caucasian ethnicity, higher education, treatment with cyclophosphamide, symptoms of COVID-19, severe disease and ICU hospitalization days were related to long COVID.

Inflammatory bowel disease (IBD) and immunosuppression do not worsen the prognosis of COVID-19. Results from the eneida project of Geteccu

Introduction: The exhaustive registry of COVID-19 cases in patients with IBD is a unique opportunity to learn how to deal with this infection, especially in reference to the management of immunosuppressive treatment, isolation measures or if the disease is more severe in IBD patients due to immunosuppression. Aims & Methods: Aims: The aims of this study were to know the incidence and characteristics of COVID-19 in the ENEIDA cohort during the first wave of the pandemic;the outcomes among those under immunosuppressants/ biologics for IBD;the risk factors for contracting the infection and poor outcomes;and the impact of the infection after three-month followup. Methods: Prospective observational cohort study of all IBD patients with COVID-19 included in the ENEIDA registry (with 60.512 patients in that period) between March and July 2020, with at least 3 months of follow-up. Any patient with a confirmed (by PCR or SARS-CoV-2 serology) or probable (suggestive clinical picture) infection was considered as a case. Results: A total of 482 patients with COVID-19 from 63 centres were included: 247 Crohn's disease, 221 ulcerative colitis and 14 unclassified colitis;median age 52 years (IQR: 42-61), 48% women and 44% 1 comorbidity. Diagnosis was made by PCR: 62% and serology: 35%. The most frequent symptoms: fever (69%), followed by cough (63%) and asthenia (38%). During lockdown 78% followed strict isolation. 35% required hospital admission (ICU: 2.7%) and 12% fulfilled criteria for SIRS upon admission. 18 patients died from COVID-19 (mortality:3.7%). 12% stop IBD medication during COVID-19. At 3 months, taken into account all included cases, 76% were in remission of IBD. Age 50 years (OR 2.09;95% CI:1.27-3.4;p=0.004), 1 comorbidities (OR 2.28;95% CI:1.4-3.6;p=0.001), and systemic steroids <3 months before infection (OR 1.3;95%CI:1-1.6;p= 0.003), were risk factors for hospitalisation due to COVID-19. A Charlson score 2 (OR 5.4;95%CI:1.5-20.1;p=0.01) was associated with ICU admission. Age 60 years (OR 7.1;95%CI:1.8-27.4;p=0.004) and having 2 comorbidities (OR 3.9;95% CI:1.3-11.6;p=0.01) were risk factors for COVID- 19 related death. Conclusion: IBD does not seem to worsen the prognosis of COVID-19, even when immunosuppressants and biological drugs are used. Age and comorbidity are the most important prognostic factors for more severe COVID-19 in IBD patients.

Comorbidities and epidemiological risk factor but not immunosuppressive therapies increase the risk of COVID-19 in inflammatory bowel disease (IBD): An ENEIDA-based, casecontrol study

Introduction: The information regarding IBD patients with COVID-19 suggests that the factors related to bad outcome are older age and comorbidity whereas immunosuppressants do not have a significant impact worsening the disease evolution. Aims & Methods: Aims: To assess if there are differences in epidemiological, demographical, and clinical characteristics between infected and non-infected IBD patients. Methods: Case-control study in IBD patients with COVID-19 (cases) compared to IBD without COVID-19 (controls) in the period March-July/2020 within the ENEIDA registry (promoted by GETECCU and with more than 60.000 IBD patients included). Cases were matched 1:2 by age (±5y), type of disease (CD/UC), gender, and centre. All controls were selected from only one investigator blind to other clinical characteristics of the patients to avoid selection bias. Results: 482 cases and 964 controls from 63 Spanish centres were included. No differences were found within the basal characteristics including CD location, CD behaviour, extraintestinal manifestations, family history of IBD or smoking habits. Cases had ≥ 1 comorbidities (cases:43%vs. controls: 35%, p=0.01) and occupational risk (cases:27% vs. controls:10.6%, p<0.0001) in a higher proportion. Strict lock-down was the only measure demonstrating protection against COVID-19 (cases:49% vs. controls:70%, p<0.0001). There were no differences in the use of systemic steroids (p=0.19), immunosuppressants (p=0.39) or biologics (p=0.28) between cases and controls. Cases were more often treated with aminosalycilates (42% vs.34%, p=0.003). Having ≥ 1 comorbidities (OR:1.6, 95%CI: 1.2-2.1), occupational risk (OR:1.95, 95%CI:1.39-2.7) and the use of aminosalycilates (OR:1.4, 95%CI: 1-1.8) were risk factors for COVID-19. On the other hand, strict lockdown was a protective factor (OR:0.38, CI:0.29-0.49). Conclusion: Comorbidities and epidemiological risk factors are the most relevant aspects for the risk of COVID-19 in IBD patients. This risk of COVID- 19 seems to be increased by aminosalycilates but not by immunosuppressants or biologics. The attitude regarding treating IBD patients with aminosalicylates during COVID-19 pandemic deserves a deeper analysis. (Table Presented).

Benefit of treatment with tocilizumab in hemophagocytic lymphystiocytosis secondary to visceral leishmaniasis infection

Background: Visceral Leishmaniasis (VL) is a zoonotic infection produced by the Leishmania spp parasite transmitted through the bite of the Phlebotomus or Lutzomya mosquito. It is more frequent in endemic areas and a common, although underdiagnosed, cause of secondary hemophagocytic lymphohistiocytosis (HHL), consisting of a dysregulation of T lymphocytes and NK cells and uncontrolled macrophage activation. The generated cytokines storm (IFN-gamma, IL-1, 6, 10, 12, and 18) and uncontrolled hemophagocytosis result in a life-threatening hyperinflammatory state. The clinical-analytical manifestations between HLH and VL may overlap, making diagnosis difficult. Amphotericin B is the treatment of choice, together with corticosteroids and immunoglobulins in case of LHHs and no response to initial treatment. Aims: To express the importance of controlling the cytokine storm in Hemophagocytic Lymphohistiocytosis to avoid the development of the hyperinflammation state. Methods: Description of clinical case and sample of response to treatment with Tocilizumab. The follow-up was carried out until January 31, 2021. Results: A 51-year-old man with a personal history of psoriasis arthritis treated with Adalimumab and Methotrexate and cutaneous leishmaniasis on the pinna in February 2019, untreated. Consultation in the Emergency Service for a 2-week fever and general malaise, presenting progressive pancytopenia without remarkable findings in the peripheral blood smear. Viral serologies and PCR for SARS-CoV2 were negative;antigenuria for Leishmania was positive. Abdominal CT showed mild hepatomegaly and splenomegaly of 19 cm. Treatment is started with Liposomal Amphotericin B. The subsequent analytical study showed CRP 77.4 mg/L, IL-6 19.2 pg/mL, Ferritin> 4,500 ng/mL, triglycerides 217 mg/dL, AST/ALT 221/135 U/L and CD25s> 7500 U/mL. A bone marrow aspirate was performed which, together with a positive Leishmania PCR in peripheral blood and bone marrow and HScore with a probability of 94% HLH-2004 score with 6/8 items completed, LHHs to LV were diagnosed, adding Dexamethasone according to the HLH- 2004 protocol and Gammaglobulin. Despite the instaured measures, pancytopenia, fever> 38oC, liver involvement and hyperinflammatory status with IL-6 87.5 pg/mL persisted, deciding to administer a single dose of Tocilizumab 8 mg/Kg. The fever disappeared and the laboratory abnormalities were normalized in 1.5 months. Dexamethasone decrease was performed according to protocol. Currently Adalimumab has been restarted and continues with monthly doses of Amphotericin B. Summary/Conclusion: There is little scientific evidence about the targeted management of the cytokine storm generated in LHHs. Blocking the action of IL-6 with Tocilizumab at standard doses allowed adequate management of the pro-inflammatory state and the infection, without side effects and with good tolerance. Experience with Tocilizumab in LV LHHs is extremely limited. Understanding the pathophysiology of this entity and its similarity to other states of hyperactivation and immune dysregulation will allow better therapeutic regimens to be established. There is little scientific evidence about the targeted management of the cytokine storm generated in LHHs. Blocking the action of IL-6 with Tocilizumab at standard doses allowed adequate management of the pro-inflammatory state and the infection, without side effects. Experience with Tocilizumab in LV LHHs is extremely limited. Understanding the pathophysiology of this entity and its similarity to other states of hyperactivation and immune dysregulation will allow to establish better therapeutic regimens.

MONEO: A phase II study of avelumab (Av) plus FLOT in the peri-operative treatment for patients (pts) with resectable gastric or gastroesophageal junction cancer (GC)

Background: GC represents a worldwide problem;radical surgery remaining the gold standard of curative treatment. In the West, even with peri-operative chemotherapy, 5-year survival rate is approximately 40%. GC is a heterogeneous disease, well characterized by different molecular classifications, all having in common the role of the immune system and a T-cell inflamed phenotype across all subtypes. The anti-PD-L1 Av antibody has demonstrated efficacy in GC with response rates of around 10% in the refractory setting. The addition of other immune checkpoint inhibitors to chemotherapy have demonstrated efficacy in the metastatic setting. The combination of Av to perioperative chemotherapy may increase pathological responses by a synergistic effect, and then improving the survival (OS). Methods: The MONEO is an open-label, non-randomized, multicentric, phase II study that explores the combination of Av plus peri-operative FLOT (docetaxel, oxaliplatin, fluorouracil/leucovorin) in resectable GC pts. EudraCT 2019-000782-21;ClinicalTrials NCT03979131. Main inclusion criteria require pts with histologically proven GC, stage Ib (T1N1 only) - IIIC (7th AJCC Ed), available paraffin block from diagnosis and surgery, evaluable disease (RECIST 1.1) amenable to radical surgery. Significant comorbidities and active autoimmune diseases are excluded. Treatment consists of surgery with 4 peri-operatory cycles of FLOT + Av, followed by Av up to one year. The primary objective is the pathological complete response (pCR) rate, compared to historical data. Secondary objectives include OS, disease-free survival, R0 resection rate, tolerability and biomarker analysis. Key point is the comprehensive biomarker analysis from tissue and blood samples (pathological immune response, TCR clonality, immune contexture characterization, immunodynamic monitoring). Statistics for an estimated 33% pCR (historical 16%), 82% power, 0.1 one-side type I error. 37 pts will be recruited from 10 Spanish centers. The sponsor is Vall d'Hebron Institute of Oncology (VHIO), principal investigators Dr. Melero and Dr. Alsina. In compliance with the Helsinki Declaration. At a data cut-off day of 5 of February 2021, 38 patients have been enrolled, 27 of them have had the surgery. Although the difficulties during the COVID19 pandemia, only two patients had been withdrawn from the study.

Expectations and attitudes towards the COVID-19 of nursing students at a peruvian public university

Quantitative, descriptive, cross-sectional study, whose objective was to describe the expectations and attitudes towards COVID-19, of the nursing students of the Toribio Rodriguez de Mendoza University (UNTRM) Amazonas - Peru. The instrument was applied virtually to 182 students, using descriptive statistics and binary logistic regression. Results: If they became ill, only 29.1% would be cared for in a hospital;94.0% would apply the vaccine. 78.0% feel psychologically prepared to perfonn in the profession and 90.1% are willing to care for patients, despite not having good working conditions. Regarding expectations, 56.6% consider that this virus is here to stay;89.6% would work in the healthcare area, although 20.9% consider that their expectations regarding the post-COVID-19 period are uncertain, insecure, and discouraging;the probability of a good job expectation is approximately 4 times more, so 98.9% want to continue studying Nursing.

Evaluation of two rapid ultrafiltration-based methods for SARS-CoV-2 concentration from wastewater.

Quantitative measurements of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in raw wastewater have been implemented worldwide since the beginning of the pandemic. Recent efforts are being made to evaluate different viral concentration methodologies to overcome supplier shortages during lockdowns. A set of 22-wastewater samples seeded with murine hepatitis virus (MHV), a member of the Coronaviridae family, and the bacteriophage MS2, were used to characterize and compare two ultrafiltration-based methods: a centrifugal ultrafiltration device (Centricon® Plus-70) and the automated concentrating pipette CP-Select™. Based on the recovery efficiencies, significant differences were observed for MHV, with Centricon® Plus-70 (24%) being the most efficient method. Nevertheless, concentrations of naturally occurring SARS-CoV-2, Human adenoviruses and JC polyomaviruses in these samples did not result in significant differences between methods suggesting that testing naturally occurring viruses may complement the evaluation of viral concentration methodologies. Based on the virus adsorption to solids and the necessity of a pre-centrifugation step to remove larger particles and avoid clogging when using ultrafiltration methods, we assessed the percentage of viruses not quantified after ultrafiltration. Around 23% of the detected SARS-CoV-2 would be discarded during the debris removal step. The CP-Select™ provided the highest concentration factor (up to 333×) and the lowest LoD (6.19 × 103 GC/l) for MHV and proved to be fast, automatic, highly reproducible and suitable to work under BSL-2 measures.

The International Day of Light in Spain: A three years perspective

In this article we report on the activities in Spain related to the celebration of the International Day of Light (IDL). The Spanish Committee for the IDL was constituted in 2017, as a continuation of the previous Committee for the International Year of Light (2015). This Committee involves different academic, scientific and industrial partners in Spain related to light science and light technologies, and develops actions to promote and disseminate the IDL activities. After the success of the 2018 and 2019 editions, the 2020 IDL celebration has been totally affected by the Covid-19 pandemic, and most of the programmed events were cancelled. Nevertheless, some on-line activities were developed. The aim of this work is to review the IDL impact in Spain in these last three years. © 2020 SPIE.