Reducing the risk of indoor transmission of SARS-CoV-2 using UV-C disinfection

In this work, SARS-CoV-2 infectivity after UV-C exposure of porous and non-porous surfaces was assessed under controlled environment conditions. The irradiance of a setup of UV-C lamps, placed indoors was studied in detail as a function of the geometry and the distance to the surface. In the presence of living beings, the external UV-C lamps are turned off, and the UV-C lamps mounted inside the disinfection chamber are kept active, allowing a continuous air disinfection and a decreased risk of indoor transmission. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

COVID-19: prevention, diagnosis and treatment. Recommendations of a multidisciplinary group.

BACKGROUND: SARS-CoV-2 infection, which causes COVID-19, has impacted the entire world due to its extensive and rapid spread. In the last two years, more than 412 million cases have been confirmed, with more than 5.8 million deaths, as of February 14, 2022. OBJECTIVE(S): Integrate a series of recommendations based on the best level of evidence in prevention, diagnosis and treatment of SARS-CoV-2 infection, including its new variants. METHODOLOGY: Review of different international guidelines and recent articles published in peer-reviewed journals. Issue recommendations based on the level of evidence and degree of confirmation established by the guidelines of the National Institute for Health and Care Excellence (NICE). The authors analyzed the selected articles and, based on their experience, summarized the most relevant to meet the objectives of these recommendations. RESULT(S): 200 articles were found, of which only 124 were selected that met the requirements to identify the level of evidence and degree of recommendation. CONCLUSION(S): Prevention through vaccination continues to be the best tool to establish protection mechanisms against the virus and substantially reduce hospitalizations and associated mortality. Although homologous vaccination is still the accepted reference pattern, the efficacy of heterologous schemes to avoid hospitalization and mortality must be considered. Monoclonal experiments, such as sotrovimab, have activity against the Omicron variant and the AZD7442 molecule that have shown high efficacy in preventing symptomatic COVID-19 in pre- and post-exposure conditions.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.

Anxiety and depression among medical students during COVID-19 pandemic

Background: Medical students are especially prone to anxiety and depression. Aim: To characterize the presence of anxiety and depression and their association with gender and academic year among medical students. Material and Methods: Standardized electronic surveys about anxiety and depression symptoms were sent to 498 medical students with a response rate of 78%. Results: We analyzed 359 surveys. A mean of 11.4 points out of 27 was observed in the depression symptoms scale. Also, 23 and 10% of respondents had moderately severe or symptoms of depression, respectively. A mean of 8.9 out of 21 points in the anxiety symptoms scale was observed. Moderate or severe anxiety symptoms were present in 26 and 15% of respondents, respectively. Women and preclinical students had higher depression and anxiety scores. Conclusions: A high presence of anxiety and depression symptoms was characterized among medical students during the pandemic. Preclinical students and women had higher scores in both scales.

Causes of academic dropout in higher education in Andalusia and proposals for its prevention at university: A systematic review

Introduction: One of the main problems facing the university system is the high student dropout rate due to a number of variables, accentuated by the COVID-19 pandemic. This is a problem not only in Spanish universities but is prevalent worldwide. It is therefore important to understand and analyze the underlying reasons for dropout so that it can be addressed and mechanisms implemented to limit dropout in higher education to the greatest extent possible. Method: A systematic review was carried out summarizing the results of studies and reports on university dropout in Spain and specifically in the universities of the Autonomous Community of Andalusia. The review was conducted in accordance with the PRISMA statement by searching the scientific databases Scopus and Web of Science, limiting the search to articles published between 2010 and 2022. Results: The main publications in both Spain and the Autonomous Community of Andalusia were identified. The review included the main causes of university dropout indicated in each of the selected studies and the proposals to reduce it, including educational policies, the rise of distance education, academic failure in basic educational stages, and social, personal, psychological, and economic variables. Conclusion: There is a lack of research on university dropout, with only 25% of Spanish universities having carried out research on this subject in the last 12 years. The studies analyzed conclude that the most frequent causes of university dropout are associated with low academic performance, poor social support in the new academic environment, low socio-economic status, pessimism, and lack of motivation, together with other less significant factors such as poor relationships with teachers, lack of vocation, work incompatibility, and previous academic performance. Further research on the causes of university dropout and its prevention is needed both before university entrance, by providing meaningful information to secondary school students, and during the university stay, through institutional and teaching policies that improve family support and social roots, produce positive academic experiences, favor associationism, and encourage activities that improve planning and time management, together with cognitive learning strategies, motivational strategies and the use of advanced learning materials [such as Information and Communication Technology (ICT) tools]. Copyright © 2023 de la Cruz-Campos, Victoria-Maldonado, Martínez-Domingo and Campos-Soto.

Adversities imposed by COVID-19 on family farming: case studies in the municipalities of Santa Maria and Sao Joao do Polesine/RS

Family farming is present in 70% of Brazilian rural properties. However, despite the representativeness, historically this category is not a priority in the State's actions, assuring to grow and establish itself on the margins of business agriculture, and it is only because of the accentuated rural exodus effect that public policies for maintaining the population in the field are created, such as the National Rural Financing Program, PRONAF. Furthermore, a process of questioning about the health effects caused by the intensive use of pesticides in food production begins, and organic/healthy family agriculture gets visibility and space in the market, especially in open markets. Thus, the present paper ought to check which are the impacts of the Covid-19 pandemic in this sector since the commercialization units started to operate in reduced periods and with less public. The paper aims to present the main adversities generated by the Pandemic for family farming, in the municipalities of Santa Maria/RS and Sao Joao do Polesine/RS, as well as the strategies used by the farmers. Therefore, three case studies are presented, which were studied, methodologically, from fieldwork in loco and online questionnaires. The found results are positive and demonstrate that despite the difficulties, farmers adapt themselves inserting new marketing strategies and access to customers.

Sense of Belonging and Student Commitment in the Context of Higher Distance Learning with Virtual Mediation

Both technological advances and the context of the pandemic have positioned virtual mediation as a strong alternative for the transit and projection of higher education institutions and their adaptability to new demands, contexts, and changes.The implementation of remote virtual mediation as a consequence of the Covid-19 pandemic has impacted the sense of belonging and student commitment in higher education with face-to-face modality. However, the question arises as to how the behavior of these variables is consolidated in higher education institutions in which remote virtual mediation has always been their methodological hallmark. Seeking to establish the profile of the students of the National Open and Distance University (UNAD) in these contexts and to analyze the interaction of the variables of student commitment and sense of belonging, in this order of ideas and in a random manner, the investigators took a sample of 312 students from the aforementioned university. In this way, the study was developed from a positivist paradigm, with a descriptive-inferential level of depth, with a prospective, cross-sectional and non-experimental record. In addition, the authors used 2 instruments for data collection.The first one was focused on the measurement of the degree and the orientation of the student commitment, while the second one identified determinant factors in the sense of belonging. Finally, the investigators concluded that there is a tangible difference between the profile of the distance education student and that of face-to-face education. Likewise, it is recommended to delve into research focused on the processes of a sense of belonging and student commitment, even more so in distance Higher Education, which has not been sufficiently explored.

Randomized, Controlled Phase 3 Study of anti-C5a Vilobelimab's Effect on Mortality in Critically Ill COVID-19 Patients: A Therapy for Viral Pneumonia

Background. SARS-CoV-2 induces endothelial damage and activates the complement system. In severe COVID-19 patients, complement split factor C5a is highly elevated leading to inflammation that contributes to multiorgan failure. The anti-C5a monoclonal antibody, Vilobelimab (Vilo), which preserves the membrane attack complex (MAC), was investigated in an adaptively designed, randomized doubleblind, placebo (P)-controlled Phase 3 international multicenter study for survival in critically ill COVID-19 patients (pts). Methods. COVID-19 pneumonia pts (N=368;Vilo n=177, P n=191), mechanically ventilated within 48 hrs before treatment, received up to 6, 800 mg infusions of Vilo or P on top of standard of care. The primary and main secondary endpoints were 28-day (d) and 60-d all-cause mortality. Results. Pts enrolled in the study were on corticosteroids (97%) and anticoagulants (98%) as standard of care. A smaller proportion (20%) were either continuing or had taken immunomodulators such as tocilizumab and baricitinib prior to receiving Vilo. The 28-d all-cause mortality was 31.7% with Vilo vs 41.6% with P (Kaplan-Meier estimates;Cox regression site-stratified, HR 0.73;95% CI:0.50-1.06;P=0.094), representing a 23.8% relative mortality reduction. In predefined primary outcome analysis without site stratification, however, Vilo significantly reduced mortality at 28 (HR 0.67;95% CI:0.48-0.96;P=0.027) and 60 days (HR 0.67;95% CI:0.48-0.92;P=0.016). Vilo also significantly reduced 28-d mortality in more severe pts with baseline WHO ordinal scale score of 7 (n=237, HR 0.62;95% CI:0.40-0.95;P=0.028), severe ARDS/PaO2/FiO2 <= 100 mmHg (n=98, HR 0.55;95% CI:0.30-0.98;P=0.044) and eGFR < 60 mL/min/1.73m2 (n=108, HR 0.55;95% CI:0.31-0.96;P=0.036). Treatment-emergent AEs were 90.9% Vilo vs 91.0% P. Infections were comparable: Vilo 62.9%, P 59.3%. Infection incidence per 100 Pt days were equal. No meningococcal infections were reported. Serious AEs were 58.9% Vilo, 63.5% P. Conclusion. Vilo significantly reduced mortality at 28 and 60 days in critically ill COVID-19 pts with no increase in infections suggesting the importance of targeting C5a while preserving MAC. Vilo targets inflammation which may represent an approach to treat sepsis and ARDS caused by other respiratory viruses. (Figure Presented).

Outpatient Treatment With the SARS-CoV-2-Neutralizing Antibody Combination AZD7442 (Tixagevimab/Cilgavimab) for Preventing COVID-19 Hospitalizations in the Phase 3 TACKLE Trial

Background. Outpatient treatment with SARS-CoV-2-neutralizing antibody combination AZD7442 (tixagevimab/cilgavimab) in adults with mild to moderate COVID-19 significantly reduced progression to severe disease or death through Day 29 and was well-tolerated in the Phase 3 TACKLE study primary analysis (NCT04723394). AZD7442 administered earlier in the disease course leads to more favorable outcomes and has the potential to prevent COVID-19 hospitalizations and reduce hospital burden. We report key secondary efficacy results with longerterm safety data from TACKLE over 6 months. Methods. In TACKLE, non-hospitalized adults with mild to moderate COVID-19 were randomized 1:1 and dosed <=7 days from symptom onset with a single 600-mg AZD7442 dose (2 consecutive intramuscular injections, 300 mg of each antibody;n=452) or placebo (n=451). The key secondary endpoint was death from any cause or hospitalization for COVID-19 complications or sequelae through Day 169, analyzed using a Cochran-Mantel-Haenszel test stratified by time from symptom onset and risk of severe COVID-19 progression. Results. Death from any cause or hospitalization for COVID-19 complications or sequalae occurred in 20 (5.0%) versus 40 (9.8%) participants receiving AZD7442 versus placebo, respectively, translating to a relative risk reduction (RRR) of 49.1% (95% confidence interval [CI] 14.5-69.7) versus placebo (P=0.009). A sensitivity analysis excluding participants who were unblinded prior to Day 169 for consideration of vaccination yielded a similar RRR of 50.7% (95% CI 17.5-70.5;P=0.006). For baseline seronegative participants, an RRR of 58.6% (95% CI 27.6-76.4;P=0.001) was observed. The median (range) safety follow-up was 170 (1-330) days with AZD7442 and 170 (1-326) days with placebo. Adverse events occurred in 38.5% of AZD7442 participants and 43.5% of placebo participants, and were mostly mild to moderate. Conclusion. A single 600-mg AZD7442 dose demonstrated statistically significant protection against death from any cause or hospitalization for COVID-19 through 6 months, and was well-tolerated. These data provide further support of AZD7442 in the COVID-19 outpatient treatment setting, with potential to reduce hospital burden.

Impact of the SARS-CoV-2-Neutralizing Antibody Combination AZD7442 (Tixagevimab/Cilgavimab) on the Severity and Progression of COVID-19 Symptoms in the Phase 3 TACKLE Trial

Background. Outpatient treatment with SARS-CoV-2-neutralizing antibody combination AZD7442 (tixagevimab/cilgavimab) in adults with mild to moderate COVID-19 significantly reduced progression to severe disease or death through Day 29 and was well-tolerated in the Phase 3 TACKLE study (NCT04723394). We report a post hoc analysis of the impact of AZD7442 in reducing self-reported COVID-19 symptom severity and time to symptom resolution through Day 29 in TACKLE. Methods. In TACKLE, non-hospitalized adults with mild to moderate COVID-19 were randomized 1:1 and dosed <=7 days from symptom onset with a single 600mg AZD7442 dose (2 consecutive intramuscular (IM) injections, 300 mg of each antibody;n=452) or placebo (n=451). Symptom occurrence and severity were self reported daily by participants through study Day 29. Participants rated each symptom as not experienced, mild, moderate, severe, or emergency room (ER) or hospital visit. Symptom progression was compared between AZD7442 and placebo using a stratified Cochran-Mantel-Haenszel test. Change from baseline in symptom severity was compared using a mixed model for repeated measures. Time to symptom resolution was compared using Kaplan-Meier and Cox proportional hazards methods. Missing symptom data for those who were hospitalized or died were imputed as either failures or as severity scores of ER or hospital visit. Results. Progression of >=1 symptoms to a worse severity score occurred in 170 (55.7%) AZD7442- versus 204 (63.4%) placebo-treated participants, translating to a nominally significant relative risk reduction of 12.5% (95% confidence interval 0.5- 23.0;P=0.041). Over 29 days, the overall mean improvement from baseline in severity of body aches, chills, cough, diarrhea, fatigue, headache, muscle aches, nausea, and runny nose was significantly greater with AZD7442 versus placebo (Figure). The greatest improvements were observed with cough, fatigue, and muscle aches. Significant differences were observed for most symptoms within 1 and 2 weeks post AZD7442 dosing. Figure. Forest plot for LS difference in severity of COVID-19 symptoms between AZD7442 and placebo through Day 29 CI, confidence interval;LS, least squares. The overall P value is calculated using a mixed model for repeated measures, including terms for symptom severity baseline value, time from symptom onset (<=5 vs >5 days), risk of progression to severe COVID-19 (high vs low), treatment, visit, and treatment by visit interaction. Conclusion. For the treatmentofmildtomoderateCOVID-19,a single IM600-mg AZD7442 dose was associated with reductions in progression of COVID-19 symptom severity and may hasten symptom improvement through Day 29.

Sustained Alleviation and Resolution of Targeted COVID-19 Symptoms with Nirmatrelvir/Ritonavir versus Placebo

Background. Nirmatrelvir with ritonavir (nirmatrelvir/r) is an oral antiviral COVID-19 treatment. We report its efficacy to shorten time to sustained alleviation and resolution of COVID-19 signs/symptoms in nonhospitalized adults with COVID-19 at high risk of severe disease as of primary completion data cut (11 Dec 2021). Methods. In this phase 2/3 double-blind study, eligible adults with confirmed SARS-CoV-2 and <= 5 days (d) of symptoms were randomized 1:1 to nirmatrelvir/r 300 mg/100 mg or placebo (PBO) every 12 hrs for 5 d. Pts logged presence and severity (on 3- or 4-point scales) of prespecified COVID-19 signs/symptoms daily Day 1 (predose) through 28. Times to sustained alleviation and resolution of all targeted signs/ symptoms were assessed, summarized with Kaplan-Meier curves, and compared by treatment by log-rank test. Individual signs/symptoms were compared with descriptive analyses. Results. From Jul-Dec 2021, 2246 pts enrolled;2085 pts (nirmatrelvir/r, n=1039;PBO, n=1046) met criteria for the mITT1 population (<= 5 d of symptom onset, did not/not expected to receive an mAb). More pts achieved sustained alleviation or sustained resolution with nirmatrelvir/r. Shorter median times to sustained alleviation/ resolution were observed with nirmatrelvir/r (13/16 d) vs PBO (15/19 d;Fig 1 & 2). Also, a shorter median time to sustained alleviation was seen in pts treated <= 3 d of symptoms with nirmatrelvir/r (12 d) vs PBO (15 d). The most common symptoms were cough, muscle/body aches, and headache in both groups. The median time to sustained alleviation of cough and headache was 2 d less with nirmatrelvir/r vs PBO. The median time to sustained resolution of muscle aches and shortness of breath was 3 d and 4 d less with nirmatrelvir/r. The proportion of pts with severe signs/symptoms in the nirmatrelvir/r vs PBO group was significantly higher at baseline, but significantly lower after treatment, showing nirmatrelvir/r significantly reduced symptom severity through Day 28 (Fig 3). Pts who were seronegative vs seropositive or had high vs low viral load at baseline achieved faster times to sustained alleviation with nirmatrelvir/r vs PBO. Conclusion. Nirmatrelvir/r treatment reduced duration and severity of COVID-19 symptoms vs PBO in pts at high risk of progressing to severe disease. NCT04960202.

Effect of Nirmatrelvir/Ritonavir versus Placebo on COVID-19-Related Hospitalizations and Other Medical Visits

Background. Nirmatrelvir coadministered with ritonavir (nirmatrelvir/r) is a COVID-19 treatment. This study evaluated nirmatrelvir/r in nonhospitalized, symptomatic adults with COVID-19 at high risk of progressing to severe disease. We report secondary efficacy endpoints associated with COVID-19-related medical visits, including hospitalization details and oxygen support, as of the primary completion data cutoff (Dec 11, 2021). Methods. In this phase 2/3 double-blind, interventional study, adults with confirmed SARS-CoV-2 and symptom onset <= 5 days (d) were randomized 1:1 to receive nirmatrelvir/r 300 mg/100 mg or placebo (PBO) orally every 12 hours for 5 d. COVID-19-related medical visits were collected through Day 28. Oxygen support for COVID-19 and details of COVID-19-related hospitalization, including duration, intensive care unit (ICU) status, and mechanical ventilation, were assessed. Results. Of the 2246 patients (pts) enrolled globally from Jul to Dec2021, 2085 (nirmatrelvir/r, n=1039;PBO, n=1046) started treatment and met criteria for the modified intent-to-treat population (mITT1;<= 5 d of symptom onset, did not/not expected to receive a mAb). Fewer overall COVID-19-related medical visits were reported with nirmatrelvir/r vs PBO (Table 1). In addition to fewer hospitalizations being reported with nirmatrelvir/r (n=8 [0.8%]) vs PBO (n=65 [6.2%]), pts receiving nirmatrelvir/ r had fewer hospitalized d (Table 2), with mean durations of 9.6 (range, 5.0, 16.0) d with nirmatrelvir/r and 11.2 (range, 2.0, 57.0) d with PBO in hospitalized pts. No pts in the nirmatrelvir/r group and 9 pts (0.9%) in PBO group were admitted to the ICU. No pts in the nirmatrelvir/r group received mechanical ventilation vs 3 pts in the PBO group. Fewer other COVID-19-related nonhospital medical visits were reported with nirmatrelvir/r vs PBO (Table 3). In the full analysis set, fewer pts required oxygen therapy for COVID-19 with nirmatrelvir/r (n=9/1120 [0.8%]) vs PBO (n=54/1126 [4.8%]). Conclusion. High-risk adults with symptomatic COVID-19 treated with nirmatrelvir/ r within 5 d of symptom onset had fewer COVID-19-related medical visits and reduced healthcare utilization (no ICU visits, no mechanical ventilation, fewer days in hospital) vs pts receiving PBO. (Table Presented).

WAITING ROOM PROJECT: IMPROVING HEALTHCARE of SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS

Background: Systemic lupus erythematosus (SLE) prognosis is determined by a wide range of factors, such as the severity of the disease manifestations, the psychosocial aspects of patients, the proper management of comorbidities, adoption of a healthy lifestyle and adherence to treatment. Studies on chronic diseases highlight the value of patient education to foster treatment adherence and improve prognosis. Objectives: To promote health education to SLE patients and their families providing accessible and comprehensive Scientific information, in order to improve adherence to treatment and the patient's prognosis. Methods: The Waiting Room Project is linked to the Extension Health Care Program for SLE patients and their families of Universidade Federal de Minas Gerais, Brazil, since 2011. A total of 700 patients under SLE treatment at the Rheumatology Unit of the University Hospital are involved. Medical students and rheumatology fellows, altogether, developed high-quality informative texts, with clear content and layman language appropriate for the patient, under the supervision of the rheumatology professors. The texts are illustrated by the team of the Communication Department of the Medical School and medical students, and are printed in a leafet format. The material is handed out to the patients, while they wait for their medical appointment, by the students and the care team. The content of the leafets is discussed, making sure that all the concerns and doubts are properly addressed Results: The Waiting Room Project has produced 17 leafets, addressing different aspects of SLE, comorbidities, and treatment. The texts approach the traditional cardiovascular risk factors (Smoking, Arterial Hypertension, Diabetes, Obesity, Physical Activity), and some medical conditions related to general health and SLE treatment (Sun Protection, Healthy Food, Oral Care, Vaccination, Pregnancy, Osteoporosis). In 2020 and 2021, two leafets about Covid-19 were produced in order to clarify important aspects of this disease, its impact on lupus patients and to solve questions about SLE medications: one regarding the association between Lupus and Covid-19 and another about the treatment of lupus and Covid-19. Other four leafets were produced concerning SLE treatment, including Adherence to Treatment, the use of Antimalarials, Corticos-teroids, and Immunosuppressants. Information about the drugs, general importance on lupus treatment, recommendations and possible adverse events were described. Futhermore, additional content is currently in production with themes such as Intravenous Corticosteroid and Cyclophosphamide, Human Papilloma-virus Infection, Malignant Neoplasm, and specifc cancers frequently affecting women, such as Colorectal Cancer, Cervical Cancer, and Breast Cancer. The leafets are also available online on the Medical School website in Portuguese and in English (medicina.ufmg.br/alo/material-didatico/), on the Minas Gerais Rheumatology Society website (reumatologia.org.br/orientacoes-ao-paciente/), and on the Instagram page @lupusufmg Conclusion: The leafets have been an important source of information and health education for SLE patients and their families, improving student/physician-patient communication. Despite the adversities caused by the coronavirus pandemic, the Waiting Room Project has kept its purpose to make each patient with SLE an agent of their healthcare. Improving the patients' access to evidence-based information must be a goal of healthcare professionals that treat patients with SLE.

SHARED GENETIC MECHANISMS AMONG STROKE POST-COVID-19 CASES AND ISCHEMIC STROKE SUBTYPES

Background and aims: SARS-CoV2 infection may increase stroke risk. The biological mechanisms underlying ischemic stroke occurrence during COVID-19 remains unclear. Methods: A Genome-Wide Association Study (GWAS) from MEGASTROKE was used to generate Polygenic risk scores (PRSs) across four p-value thresholds (p=0.05-p=5e-8) using PRSice-2. For all ischemic stroke (AIS) we used 34217 cases and 406111 controls, large-artery atherosclerosis (LAA) 4373 cases 297290 controls, cardioembolic (CE) 7193 cases 355468 controls and small-vessel occlusion (SVO) 5386 cases 343560 controls. For undetermined stroke etiology (UND) 984 cases and 5590 controls from a Spanish stroke cohort were used. PRSs were tested in 54 patients with an ischemic stroke that occurred after COVID-19 hospitalization (<8 days)(IS-COV). IS-COV cases were genotyped with Axiom Spain Biobank Array (11 UND, 6 CE, 6 LAA, 5 SVO, 2 infrequent cause and 24 unknown etiology). 726 population controls were also genotyped. Results: We found significant associations of IS-COV with PRSAIS (threshold= 5e-5, p= 0.04;R2= 0.01, number of SNPs= 60), PRSCE (threshold= 5e-8, p= 0.02, R2= 0.01, SNPs= 4;threshold= 0.05, p= 5.9e-4, R2= 0.03, SNPs=19308), PRSLAA (threshold= 5e-5, p= 6.5e-3, R2= 0.02, SNPs= 81;threshold= 1e-4, p= 0.02, R2= 0.01, SNPs= 146;threshold= 0.05, p =1.3e-3, R2= 0.03, SNPs= 20722) and PRSUND (threshold= 1e-4, p= 0.04, R2= 0.01, SNPs=10;threshold= 0.05, p =1.5e-6, R2= 0.06, SNPs= 3416). We did not find any association between PRSSVO and IS-COV. Conclusions: CE, LAA and UND shared genetic mechanisms with ischemic stroke cases due to COVID-19. We found no association between SVO and IS-COV.

[Clinical characteristics related to mortality by COVID-19 in intensive care]

BACKGROUND: The COVID-19 pandemic caused hospital reconversion throughout Mexico and it was scarce information about its development in second-level intensive care units (ICU). OBJECTIVE: To determine the clinical characteristics related to COVID-19 mortality in a second-level ICU. MATERIAL AND METHODS: Observational, cohort, retrospective, and analytical study. Demographic variables, medical history, as well as clinical, ventilatory and laboratory characteristics, and complications of patients admitted to ICU from March to November 2020 due to acute respiratory failure were recorded. Patients were divided into two groups: improvement or death. Lost data were imputed by normal multivariated regression. Descriptive statistics and inferencial analysis were made to determine the risk of significant variables against the death outcome with Cox regression. RESULTS: 60% of patients were male. In-hospital mortality was 55%. An older age (44.4 ± 12.1 vs. 50.7 ± 12.1, p = 0.01), higher APACHE II score (8 (10-13) vs. 15 (11-21), p < 0.001), larger onset-symptom time to ICU (10.1 ± 4.0 vs. 12.0 ± 5.3 days, p = 0.049) and a lower oxygen saturation (78.2 ± 16.%5 vs. 71.1 ± 17.9%, p = 0.017) were significantly asociated characteristics to mortality. Average of stay at ICU was 8 days. CONCLUSIONS: A higher age, more days from beginning of symptoms to hospital admission, and lower oxygenation at admission were pre-admission determining factors for risk of death, while cardiovascular, renal complications and hyperglycemia were the in-hospital determinants.

Challenge Based Learning: A Fast Track To Introduce Engineering Students To Data Science

This article describes a data science challenge-based learning experience introduced to non-IT second-year engineering students. The methodology proposed in this article was successful in the short introductory course. The students presented well-considered, practical solutions to two challenges of a different nature derived from excellent, quality data processing. The students used free-access databases from Airbnb and Johns Hopkins University to tackle both challenges. Although the students' data analysis methods corresponded more to data analytics, the two student teams incorporated Machine Learning techniques and exceeded our initial expectations. The selection of the programming environment for this experience was a crucial issue addressed in this article. To illustrate the students' work in the course using this methodology, we present a selection of their results, including a new index to measure the degree of herd immunity in a country, relating this index with the possible appearance of a new strain of COVID-19.

Spatial analysis and distribution of the potential for sustainability in the post-pandemic of COVID-19 in the municipalities of Rio Grande do Sul

The pandemic caused by the coronavirus triggered the possibility of the crisis in several segments, especially with the adoption of social isolation, the main action for the control of the infectious disease, therefore, the present study is justified by the concern in relation to the trends of sustainable development in the post-pandemic of COVID-19, in the state of Rio Grande do Sul. Measuring the degree of sustainability of the municipalities follows the thesis that the greater the degree of sustainability of the municipalities, the less the impact of the pandemic, and the greater the resources to restore balance. The objective of the research is to analyze the spatial distribution of the potential for sustainability in the post-pandemic of COVID-19, in the municipalities of Rio Grande do Sul, in order to generate a risk map with less and greater potential for sustainability in the post-pandemic. This study was carried out by means of an ecological analysis and application of the Barometer of sustainability, later the distribution and spatial analysis was carried out by means of the Moran Index. The spatial analysis, performed by calculating the Moran Index, showed significant spatial independence for confirmed cases (I = 0.058;p = 0.024) and deaths (I = 0.032;p = 0.039), and a significant, albeit weak, correlation. for the incidence coefficient (I = 0.234;p = 0.001) of COVID-19. Spatiality does not explain the distribution of cases and deaths. However, when taking into account the population size of the municipalities, in relation to the number of cases, expressed by the incidence coefficient, the spatial aggregation gains merit. The potential for sustainability was estimated and the risk map of the potential for sustainability was generated, in the post-pandemic of COVID-19, for the municipalities of Rio Grande do Sul. © 2021, Universidade Federal de Pernambuco. All rights reserved.

Multidrug resistant Gram-negative bacilli infection in critically ill patients with Coronavirus disease 2019

Purpose Rapid spread of multidrug resistant Gram-negative bacilli (MDR-GNB) infection in Coronavirus disease (COVID-19) critically ill patients was observed even in those without underlying diseases and in all age groups. We conducted a prospective cohort study to assess the risk factors for acquisition of MDR-GNB infection in COVID-19 patients and its impact on patients´ outcome. Methods & Materials We included 43 consecutive patients with COVID-19 from a total of 8874 patients with COVID-19 admitted into the ICU of Aleman Hospital, Argentina, from May 1st 2020 to June 30th 2021. Followed up until death or 30 days after hospital discharge. We divided them into 4 groups: colonized with MDR-GNB (G1), colonized with MDR-GNB and infected with non-carbapenem resistant bacteria (G2), colonized and infected with MDR-GNB (G3), and infected with MDR-GNB without previous colonization (G4). Microbiological sampling was performed according to patient's conditions or epidemiological surveillance. Outcomes considered were length of hospital stay (LOS), mortality and readmission rate. Results Seven, five, six and twenty five patients were distributed respectively in G1, G2, G3 and G4. Male/female ratio was 2:1 with a median age of 68 years (IQR 62–75). Chronic pulmonary disease (18.6%) was the main comorbidity. Mean LOS was 40.16 days (P=0.79). Prolonged biomedical devices used were observed in 93% of patients (P=0.33). Ventilator associated pneumonia (n:15/36) and catheter-related bloodstream infection (n:16/36) were the most frequent infections (P=0.29, P=0.69). The most common carbapenem-resistant pathogens were Klebsiella pneumoniae (n: 38/60) and Pseudomonas aeruginosa (n:8/60). All patients were exposed to antibiotics before MDR-GNB was diagnosed. The first isolation of MDR-GNB was on average 14 days after hospital admission (P=0,84). Time between MDR-GNB colonization and infection was twice as much between G2 and G3 (8.4 Vs. 4 days, P=0.83). We observed no difference in all-cause mortality rate and readmission rate between the groups (P=0.75, P=0.97). Conclusion Prolonged ICU hospitalizations in addition to use of invasive devices and antibiotics exposure correlate with a higher risk of developing MDR-GNB colonization and infection in COVID-19 critically ill patients.