Echocardiographic findings in critically Ill patients with COVID-19 treated with and without extracorporeal membrane oxygenation

Objectives: There is a paucity of data on echocardiographic findings in patients with COVID-19 supported with Venovenous Extracorporeal Membrane Oxygenation (VV ECMO). This study aimed to compare baseline echocardiographic characteristics of mechanically ventilated patients for acute respiratory distress syndrome (ARDS) due to COVID-19 infection with and without VV ECMO support and to describe the incidence of new echocardiographic abnormalities in these patients. Method(s): Single-center, retrospective cohort study of patients admitted from March 2020 to June 2021 with COVID-19 infection, that required mechanical ventilation, and had an available echocardiogram within 72 hours of admission. Follow-up echocardiograms during ICU stay were reviewed. Result(s): A total of 242 patients were included in the study. One-hundred and forty-five (60%) patients were supported with VV ECMO. Median (IQR) PaO2/ FiO2 was 76 (65-95) and 98 (85-140) in the VV ECMO and non-ECMO patients, respectively (P = < 0.001). On the admission echocardiograms, the prevalence of left ventricular (LV) systolic dysfunction (10% vs 15%, P= 0.31) and right ventricular (RV) systolic dysfunction (38% vs. 27%, P = 0.27) was not significantly different in the ECMO and non-ECMO groups. However, there was a higher proportion of acute cor pulmonale (41% vs. 26 %, P = 0.02) in the ECMO group. During their ICU stay, echocardiographic RV systolic function worsened in 44 (36%) patients in the ECMO group compared with six (10%) patients in the non-ECMO group (P< 0.001). The overall odds ratio for death for patients with worsening RV systolic function was 1.8 (95% confidence interval 0.95-3.37). Conclusion(s): Echocardiographic findings suggested that the presence of RV systolic dysfunction in COVIDECMO patients was comparable to the non-ECMO group on admission. However, a higher percentage of patients on ECMO developed worsening RV systolic function during follow-up.

Of the Knowledge Valuation of University Students on the Right to the Health

In the current situation for the one that has trafficked the world in these derived last years of the world pandemic of the Covid-19, have wakened up even more the interest on the part of the scientific community the study of the right to the health for all the sectors of the world society and with more emphasis the Ecuadorian. In correspondence with these reflections, the present investigation had as objec-tive: to value the knowledge of the university students on the right on the right to the health. For the development of the investigation methods of dissimilar classifications like the theoretical, empiric and mathematical were presented statistical. He/she was carried out a traverse study of ex-ploratory type in university students of the right career of the Autonomous Regional University of the Andes of the Republic of Ecuador. The obtained results are viable, and they demonstrate to have validity and scientific accuracy.

Female sex workers and police violence during the Covid-19 health crisis in 2020-2021: results from the EPIC multi-country community-based research program in Argentina.

BACKGROUND: Female sex workers (FSW) have been disproportionately impacted by the Covid-19 crisis. Data show increases of police violence toward key populations (KP), likely a consequence of their role in enforcing health government measures. This study aimed to identify factors associated with police violence experienced by FSW during the Covid-19 crisis in Argentina. METHODS: EPIC is a multi-country, cross-sectional, community-based research program evaluating the impact of Covid-19 among KP. In Argentina, the study was conducted in collaboration with FSW community-based organizations (CBO). Participants completed an online survey (October 2020-April 2021). Police violence was measured as having experienced episodes of violence (physical, verbal, psychological or sexual) by security forces since the start of the health crisis. Factors associated with police violence were assessed in logistic regression models. RESULTS: Among 173 respondents, median age was 34 [IQR 27-42], 39.3% were transgender women (TW), 78.1% declared sex work as their only income and 71.7% mentioned their financial situation has deteriorated with the health crisis. Nearly half of FSW (44.5%) reported experiencing police violence within the first year of the Covid-19 pandemic, and among them, 76.6% declared more frequent violence episodes since the beginning of the health crisis. After adjustment for age, being a TW (aOR [95% CI] = 2.71 [1.21;6.05]), reporting non-injection drug use (2.92 [1.02;8.36]), having a considerably deteriorated financial situation (3.67 [1.47;9.21]), having had a consultation with a CBO worker for medical care/treatments (5.56 [2.15;14.37]) and declaring fear or experiences of discrimination by physicians/other health workers (2.97 [1.21;7.29]), since the beginning of the Covid-19 health crisis, were independently associated with police violence. CONCLUSIONS: FSW in Argentina have experienced an increase in police violence since the beginning of the health crisis. Belonging to multiple KP (FSW, TW, people who use drugs) increases the likelihood of experiencing police violence, highlighting the need of an intersectional approach to develop interventions to reduce stigma and violence against FSW. CBOs have provided essential support and services during the crisis to FSWs, and other KPs, who may have avoided traditional healthcare structures due to fear or experiences of discrimination.

Revealing the Impact of Extreme Events on Electricity Consumption in Brazil: A Data-Driven Counterfactual Approach

The electric grid is uniquely susceptible to extreme events through both power supply and consumption pathways. Extreme events - like heatwaves and droughts - are expected to increase in frequency and severity due to climate change and are already causing consequences on power system operations and stability. Additionally, non-climate related events like the COVID-19 pandemic have had dramatic impacts on energy consumption patterns globally. We apply modern machine learning methods to model electricity consumption in Brazil, one of the largest generators of hydropower, to better understand the consumption-side effects of extreme national and regional events. After training on 20 years of historical data, we verify an R2of 0.848 and a MAPE of 2.6% for our counterfactual model and use it to assess impacts of historical events on electricity consumption. We then discuss how this approach can be applied toward measuring energy system responsiveness and resiliency on present and future scenarios. © 2022 IEEE.

EXPERIENCE REPORT OF THE VIRTUAL HEALTH EXTENSION PROJECT PREVENTION INSIDE THE HOME: EMERGENCY AID

The State University of Tocantins (Unitins) developed the extension project with the name "Virtual health: prevention inside the home", where several activities were carried out completely online in order to provide information to the population in the areas of health, social and legal assistance related to the Covid-19 pandemic. This work seeks to report the experience about the podcast and also the booklet that dealt with the emergency aid brought by law 13,982, which was published on April 2, 2020. The podcast and booklet were made available on the Project's website, in order to bring information to the community on this aid whose main objective was to benefit the most needy people in this moment of public calamity.

The importance of monitoring wet age-related macular degeneration patients during Coronavirus disease 19 pandemic: A retrospective study of assessment of functional and structural outcomes.

OBJECTIVES: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are the gold standard treatment for wet age-related macular degeneration (wet AMD). Coronavirus disease 2019 (COVID-19) has led to the cancellation of many scheduled intravitreal anti-VEGF injection visits. We compared the functional and structural visual outcomes of wet AMD patients who did not adhere to their planned intervals (group 1) with those who did (group 2). METHODS: Wet AMD patients of Swiss Visio Montchoisi and RétinElysée were included. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) changes between their first visit after the end of the first national lockdown in Switzerland (27 April 2020, first post-lockdown visit) and their last visit before the beginning of the first national lockdown in Switzerland (13 March 2020, last pre-lockdown visit) were assessed. The BCVA outcome was defined as unfavorable when there was a loss of≥5 ETDRS letters in the first post-lockdown visit compared to the BCVA at last pre-lockdown visit. The OCT outcome was defined as unfavorable when there was an increase in at least one of the parameters, intraretinal fluid (IRF), subretinal fluid (SRF), or pigment epithelial detachment (PED), at the first post-lockdown visit compared to the last pre-lockdown visit. MAIN RESULTS: Group 1 (89 patients, 109 eyes) had a 13.41% greater rate of unfavorable BCVA outcomes and a 38.27% greater rate of unfavorable OCT outcomes than group 2 (96 patients, 122 eyes) (P=0.04, P<0.0001, respectively). Multivariate analysis showed that the more the patients deviated from their programmed injections and the higher the BCVA pre-lockdown, the higher the rate of unfavorable BCVA outcomes (P=0.03 and P=0.02, respectively). OCT outcomes were not a predictive factor for an unfavorable BCVA outcome. CONCLUSIONS: The cancellation of many intravitreal anti-VEGF injection appointments resulted in worse functional and structural outcomes in wet AMD patients. The COVID-19 pandemic led many patients to refrain from their routine intravitreal anti-VEGF injection appointments, allowing us to analyze the role of designated intervals in the treatment of wet AMD. During any future lockdown due to COVID-19 or similar circumstances, continuity of care for wet AMD patients should be maintained.

THE RIGHT OF NATURE THROUGH ANDEAN PHILOSOPHICAL PRINCIPLES IN HIGHER EDUCATION

The current externalities of order have reached the critical point of considering an environmental disaster possible and immediate inter-generational intervention is needed. That is why the study of the environmental issue has aroused the interest of the international community, from the point of view of all sciences, and with regard to the legal field, it is mainly through Environmental Law, a relatively new branch, on which is being built at the supranational level, the essential rules to exercise proper control. Due to the importance that falls on the education of law, the main objective of the work is to determine which is the teaching approach that adjusts with the highest level of precision for the treatment of this topic in post-Covid-19 higher education. For this investigation, we start from the conceptualization of the terms of interest for the investigation and the Andean principles that support the theory of the rights of nature and culminate in a second empirical phase where the TOPSIS and AHP methods are used to determine the main teaching approaches to apply in this case.

PO58 CURRENT AND FUTURE MANAGEMENT OF PATIENTS WITH ADVANCED HR+ HER2- ABC WITH PIK3CA MUTATIONS IN THE UK: THE PIK PATHWAY UK PROJECT

Background: This survey aimed to expand understanding of the current and future UK management of patients with HR+ HER2-advanced/metastatic BC with PIK3CA mutations. Methods: Surveys were completed at one-to-one meetings with UK oncologists involved in HR+ HER2- aBC management, either in person or by video conference between February and October 2020. Questions (multi-option and open questions and Likert scales) were designed to understand the unmet need for HR+ HER2- aBC patients, current and future PIK3CA testing and treatment sequencing (pre/post-introduction of PI3Ki) and perceptions around managing adverse events. Responses were entered into a digital survey platform. Results: 264 oncologists were contacted to participate in the survey. Unprecedented pressures on NHS clinicians due to the COVID-19 pandemic limited availability to participate in the survey. As such, 36 oncologists working at 31 geographically-dispersed UK hospitals completed interviews. For HR+ HER2- aBC, 92% oncologists agreed/strongly agreed that the PIK3CA mutation was prognostically significant and 92% agreed/strongly agreed that a PIK3CA mutation was predictive of a response with PI3Ki. 58% oncologists had previously tested for PIK3CA mutations and 33% had clinical experience with PI3Ki. 53% oncologists are currently testing for PIK3CA, 79% of which are testing in the research setting only. Of those currently testing for PIK3CA mutations, 21% test at diagnosis of metastatic disease and the remainder at first- or second-line disease progression. The median (IQR) percentage of patients estimated to have available archival tissue for PIK3CA testing was 80% (33%-95%) including metastatic tissue in 50% (28%-73%). OS followed by PFS and then HRQoL were the priority primary treatment goals. Efficacy was the most important factor driving a decision to use a particular treatment. In the setting of PI3Ki becoming routinely available, the majority of clinicians would use a PI3Ki + fulvestrant as next line therapy following progression on CDK4/6i + AI in patients with a PIK3CA mutation (89% for patients progressing with primary endocrine resistance and 97% for patients progressing with secondary endocrine resistance (ABC guidelines). The PI3Ki-related Grade 1/2 toxicities of most concern to oncologists were diarrhoea and hyperglycaemia (40% and 35% concerned/strongly concerned, respectively). The AE of most concern to patients was thought to be diarrhoea (49% rated diarrhoea as the most concerning AE, 92% placed diarrhoea in the top 3 most concerning AEs). Opinion was that introduction of PI3Ki into UK clinical practice would result in increased utilisation of endocrinology support, increased consultation, clinic and clinician admin time, and more clinical assessments. Conclusions: The survey provides contemporary insights into UK aBC treatment pathways, suggesting how PI3Ki may be integrated following progression on first line CDK4/6i, and the potential impact of the general introduction of PI3Ki.

Updated Analysis Confirms Sustained Poor Prognosis of COVID-19 in Patients with Lymphoma in Latin America: A Cohort of 160 Patients from Gell

Updated analysis confirms sustained poor prognosis of COVID-19 in patients with lymphoma in Latin America: A cohort of 160 patients from GELL. Introduction: Ongoing SARS-COV-2 pandemic has impacted the management of cancer patients worldwide. Several reports have demonstrated inferior outcomes of patients with hematological malignancies, including higher rates of intensive care unit admission, need for mechanical ventilation and death. The impact of COVID-19 is profound in resource-restricted countries, including Latin America. Most cohorts reported have not included patients from Latin America, and there is paucity of data of the outcome of cancer patients with COVID-19 in low- and middle-income countries. Grupo de Estudio De Linfoproliferativos En Latino-America (GELL )is a collaborative network of hematological centers in 13 countries in Latin America. We report updated outcomes of lymphoma patients diagnosed with COVID-19 in Latin America. Methods: We conducted a retrospective study including patients with a diagnosis of lymphoma and COVID-19 infection. Patients with chronic lymphocytic leukemia/small lymphocytic lymphoma were excluded from the analysis We defined active disease as follow: (1) patients with detectable disease either prior to initiating therapy or upon relapse, and/or (2) patients undergoing active cancer treatment. The primary outcome was overall survival at 100 days. Survival curves were estimated using the Kaplan Meier method. Uni and multivariable analysis were carried out with Cox model. Results: A total of 160 patients were available for analysis. Median age was 60 years old. Hypertension was the most common comorbidity (33%). Most patients had aggressive lymphomas (62%), including 43% of patients with diffuse large B-Cell lymphoma (DLBCL). Follicular lymphomas were observed in 13% of patients and Hodgkin lymphoma in 12.5% of patients. With a median follow-up of 37 days, the 100-day OS was 64% (95CI 56-74%, fig. 1). In univariate analysis, age (HR 1.03, p=0.0025), hypertension (HR 2.01, p=0.017), >1 number of prior lines (HR 2.78, p=0.011), patients currently on treatment (HR 1.83, p=0.043), ferritin >2000 ng/mL (HR 4.74 p=0.00047) were associated with inferior OS. In multivariate analysis, age (HR 1.03, p=0.0026) and patients currently on treatment (HR 1.82, p=0.04) had inferior OS. There was a trend towards inferior outcomes in patients receiving monoclonal antibodies in univariate analysis (HR 1.82, p=0.081) but not in multivariable analysis (HR=1.29, p=0.48). Use of steroids was not statistically related to mortality (HR 1.79, p=0.074). Finally, contrary to other cohorts, no improvement in OS was observed in patients diagnosed later on the pandemic (fig. 2). Conclusion: In this large cohort of Latin American patients with lymphoma malignancies, our updated analysis showed a maintained dismal prognosis with COVID-19 infection. With a median follow up of 37 days, the 100-day OS was 64%. Older age and ongoing active cancer treatment were significantly associated with mortality. The use of monoclonal antibodies and systemic corticosteroids were not statistically associated to poor survival. Current efforts are focused on improving immunization in the Latin American population. There is an unmet need for improving survival in patients with hematologic malignancies and COVID-19 infection. [Formula presented] Disclosures: Perini: Janssen: Honoraria, Speakers Bureau;Takeda: Honoraria, Speakers Bureau;Astra Zeneca: Honoraria, Speakers Bureau;MSD: Honoraria, Speakers Bureau. Otero: ASTRA ZENECA: Current Employment. Abello: Dr Reddy's: Research Funding;Amgen: Honoraria;Janssen: Honoraria. Castillo: Abbvie: Consultancy, Research Funding;BeiGene: Consultancy, Research Funding;Pharmacyclics: Consultancy, Research Funding;Janssen: Consultancy;Roche: Consultancy;TG Therapeutics: Research Funding.

Relationship marketing in customer loyalty of commercial galleries in times of covid-19

. The main objective of the study is to determine the level of dependence between relationship marketing and the level of customer loyalty to the brand. The study was conducted through a quantitative approach using the CAWI method. Relationships were determined by several factors. The loyalty factors are: Differentiation, Personalization, Satisfaction, Loyalty, usually. The relationship marketing indicators are: Trust, Commitment, Customer Satisfaction, Intention to renew the relationship. The survey results were processed using statistical methods. In particular, internal consistency checks performed on the questionnaire with questions to use Cronbach’s alpha. The use of such criteria allows to draw conclusions about the high level of consistency. The coefficient of determination was used for statistical verification of dependence. The results of the calculations confirmed a high level of dependence. Dependence was also confirmed by calculating p-values with a high level of probability. Conclusions were drawn according to the results of the empirical investigation. © 2021 The Author(s).

HIERARCHICAL ANALYSIS PROCESS FOR THE STUDY OF THE LABOR SITUATION OF ETHNIC PEOPLES

Traditionally, ethnic peoples have been marginalized in different areas of life, including work. These peoples, due to their economy, have been forced to migrate to cities and seek employment. Currently, the COVID-19 situation has imposed a significant social margin. The economy has been greatly affected in all social classes, especially in the poorest ones such as ethnic peoples. That is why it is necessary to study this phenomenon in this new Ecuadorian reality. Therefore, the objective of this work is established: to analyze this situation through the PESTEL technique and the Hierarchical Analysis Process in order to offer help to the government's decision making process. It is considered that if a hierarchy of the factors affecting this phenomenon is established, it will help to take strategic solutions based on the real needs of the population. By way of conclusion, the results of this analysis conducted and suggested strategies will be presented.

Domestic violence suffered by men who have sex with men during the first lockdown related to COVID-19 pandemic

Introduction - The containment measures taken in March 2020 to stop the spread of the Coronavirus strengthened social disparities in populations already vulnerable in terms of physical and mental health and living conditions. Thus, an increase in domestic violence has been observed affecting women and children but also lesbian, gay, bisexual (LGB) people. The objective of this article is to estimate the levels of domestic violence suffered by men who have sex with men (MSM) residing during the eight weeks of the first lockdown of 2020 in a housing with one of their family members, to describe their characteristics and the impacts on health. Methods - ERAS is an anonymous, self-administered online cross-sectional survey based on voluntary. The COVID-19 special edition was conducted from 30 June to 15 July 2020 from Sante publique France. A total of 8,345 MSM residing in France responded to the survey. Results - Among the 8,345 MSM respondents, 2,467 reported living in the same housing as a family member during the eight weeks of the first lockdown. Among the latter, 35.2% (868) reported experiencing domestic violence during this period, mostly psychological verbal violence. The victims of domestic violence were young and in a precarious socio-economic situation. In this context of lockdown, this unfavorable family environment had negative impacts on the mental health of the victims. Conclusion - An action plan was launched by the government to combat anti-LGBT violence, but in light of the successive measures taken to contain the epidemic, innovative initiatives must be implemented to give them all the support they need.

Transesophageal echocardiography guidance for bedside extracorporeal membrane oxygenation cannulation in COVID-19 patients

Objective: To describe the use and safety of transesophageal echocardiography guidance for bedside ECMO cannulation in a large academic center. Methods: In this retrospective cohort study, we studied all patients who underwent bedside (in the intensive care unit) venovenous ECMO (VV-ECMO) cannulation under TEE guidance between May 4 to November 4, 2020, in a tertiary care center. Patient characteristics, physiological, and ventilatory parameters, as well as echocardiographic findings, were recorded and analyzed. Results: During the study period, 35 patients were placed on VV-ECMO. Nineteen patients (54%) were cannulated under TEE guidance of which sixteen (84%) had a confirmed COVID SARS-COV-2 pneumonia;two patients (11%) had mild to moderate right ventricular systolic dysfunction, and one (5%) had biventricular dysfunction. Cannula position was adequate in 18 cases (95%). No significant complications, such as post-cannulation complications, nosocomial COVID transmission or TEE related complications, were reported during this study. Conclusions: We report the safe utilization of bedside TEE-guidance for VV-ECMO cannulation in patients with severe respiratory failure, including in COVID patients. No TEE related complications, nor nosocomial transmission occurred in our cohort. Besides one superficial vascular injury, we did not encounter significant ECMO related complications.

Incidence of HIV infection with daily or on-demand oral prep with TDF/FTC in france

Background: On-demand PrEP with TDF/FTC has been recommended as an alternative to daily PrEP for MSM by EACS, WHO and IAS-USA guidelines, but has not been endorsed yet by CDC due to limited real-world experience. Methods: The ANRS Prevenir study is an ongoing prospective cohort study enrolling individuals at high risk for HIV infection on PrEP. MSM could opt for either daily or on-demand PrEP with TDF/FTC. At baseline, month 1 and every 3 months thereafter, subjects were tested for HIV using a 4th generation combined ELISA assay and other STIs and creatinine plasma levels were monitored. At each visit participants provided information regarding sexual behaviour, dosing regimen and drug adherence. Our main objective was to assess the overall HIV incidence in the study and per dosing regimen, as well as incidence of bacterial STIs (including syphilis, gonorrhoea, chlamydia and Mycoplasma genitalium) and viral hepatitis. Safety and study retention were also assessed. This analysis uses data accumulated up to September 30, 2020. Results: From May 3rd 2017 to March 2nd 2019, 3067 subjects were enrolled across 22 sites in the Paris region, 44% being PrEP naive. Median age was 36 years (IQR: 29-43), 98.5% were MSM. At enrolment, PrEP was used daily and on demand by 50.5% and 49.5% of participants, respectively. Median number of partners in the last 3 months was 10 (5-20) and median number of condomless sex events in the prior 4 weeks was 2 (0-5). Median follow-up lasted 22 months and accumulated 5633 person-years (PY) with an overall HIV incidence in the cohort of 0.11 (95% CI: 0.04-0.23) per 100 PY. Six participants (3 daily, 3 on demand) acquired HIV-infection during the study period (P=0.99). Condom use at last sexual intercourse was 19.6%. Overall STIs incidence was 73 (95% CI: 70.7-75.5) per 100 PY which remained stable during follow-up except during the COVID-19 lockdown when it dropped to 32.4 per 100 PY (P<10-4). HCV incidence was 0.69 per 100 PY. Incidence of participants lost to follow-up was 10.3/100 PY and 19 subjects (0.6%) discontinued PrEP for drug-related adverse events (gastrointestinal: 12, e-GFR < 70 ml/mn: 4, other: 3). Conclusion: In this PrEP cohort, enrolling mainly MSM at high risk of HIVacquisition in Paris, HIV incidence was low whether participants used daily or on demand PrEP. There was a high incidence of bacterial STIs and HCV infection despite a drop in STIs incidence during the COVID-19 lockdown.

Identification of clusters in COVID-19 cases in the Santiago de Cuba province

Introduction: From the onset of COVID-19 epidemic, a multidisciplinary team is formed in Santiago de Cuba with the participation of several institutions and activated by the Provincial Defense Council. Integrated epidemiological analysis, government management and social response would be decisive in controlling the disease. Objectives: To identify possible groups of COVID-19 cases in the Santiago de Cuba province and to describe the transmission according to epidemiological variables.

Capitalism Has No Clothes: The Unexpected Shock of the Covid-19 Pandemic

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or COVID-19 has undeniably changed the world forever. Capitalism in the United States and Europe can no longer feel immune from the effects of epidemics that were at one point in time the concern of minor countries, such as the recent (2014-2016) Ebola epidemic in Western Africa. This article examines how COVID-19 not only showed that Capitalism has no clothes in its inability to respond effectively to this momentous event, but shows the burgeoning of the impact on its slow-motion decline. This is evident from the still-unresolved healthcare crisis in the United States, which allows runaway contagion, sickness, and death due to a careless governmental attitude that prioritizes capital over human lives;the economic impact, which sidelines millions of workers into unemployment, leaving them without a way to sustain themselves due to a miserly and short-sighted governmental response;and the political and social cost that is yet to be determined. Copyright © 2020 by Koninklijke Brill NV, Leiden.