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BackgroundBelimumab (BLM) is a monoclonal antibody that inhibits B-lymphocyte stimulating factor (BlyS) approved as a specific treatment for systemic lupus erythematosus (SLE) in 2011. We present the experience with BLM in a Spanish cohort with more than 460 patients.ObjectivesTo describe demographic characteristics, efficacy and safety of BLM in patients with SLE in Spanish population since its approval.MethodsDescriptive, retrospective, multicenter study in patients diagnosed with SLE according to EULAR/ACR 2019, SLICC and/or ACR 1997 diagnostic criteria. Data regarding SLE patients treated with BLM were collected from medical records (2011-2022). Demographic features, efficacy, laboratory variables, SLEDAI, renal involvement, steroid dose, administration routes and safety were assessed. To see whether a trend in BLM prescription had changed or not over time, two periods of time were analyzed: 2011-2016 (period1) and 2017-2022 (period2).ResultsBaseline characteristics of patients are summarized in Table 1.A total of 462 patients (36 hospitals) were included, 50.9% were on intravenous (IV), 34% on subcutaneous (SC) and 15.1% switched from IV to SC route. The median number of pre-BLM csDMARD use was 2.0 (2.0-3.0), being hydroxychloroquine (HCQ) the most frequently used (94.5%). Fifty-two patients were treated with IV cyclophosphamide with a median of 6 bolus received. At the time of BLM start, 443 patients were on prednisone with a median dose of 6.2 mg (5.0-10.0). Significant decreases in prednisone dose, SLEDAI and anti-DNA antibodies were observed from baseline until the last visit, whereas complement C3 and C4 values raised (Figure 1). A total of 118 patients (27.4%) had renal involvement with a median proteinuria of 1.0 g/day (0.5-2.4). Renal biopsy was done in 102 out of 118 patients, being class IV (33%), class III (21%) and class V (16%) the most frequently reported. After BLM, 73.3% of these patients improved (median proteinuria of 0.2 g/day (0.1-0.7).In period1, 100 patients started BLM compared to 362 in period2. The median time from SLE diagnosis to BLM begin was 7.1 (4.0-13.7) and 6.2 (2.1 -14.4) years in period1 and period2, respectively (p=0.454). We found a trend to use more csDMARD before BLM treatment in period1: 2.5 (2-3) vs. 2 (2-3) (p=0.088).A total of 143 (30.5%) patients discontinued treatment mostly due to inefficacy (55.9%) and infections (11.9%). In fact, 116 patients developed infections, mostly mild;2 patients died, 16 had COVID-19 and 4 patients developed tumors requiring discontinuation of the drug.ConclusionIn our cohort of SLE patients in a real-world setting, BLM has been effective, safe and seems to be a good choice to treat renal involvement.References[1]Navarra SV, Guzmán RM, Gallacher AE, et al. Lancet. 2011;377(9767):721-31.[2]Stohl W, Hiepe;rt al. Arthritis Rheum. 2012;64(7):2328-37.[3]Furie R, Rovin BH, Houssiau F, et al. N Engl J Med. 2020;383(12):1117-1128.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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We present the results of the characterization of the pedagogical practices of a teacher in a rural public school in the context of confinement by Covid-19. In order to study a specific context, we developed a case study with a Colombian teacher who is responsible for two primary school grades. We inquired about the development of her practices of planning, implementation, and evaluation of teaching for the mathematics area, in three different moments of the confinement period. We conducted semi-structured interviews in which we addressed, for example, the design of activities sent to students and the development of interaction spaces. We also explored the evolution of the affective dimension in the students and the teacher. The results show problems and difficulties the teacher has faced, the solutions she has conceived and implemented, and the successes and failures she has perceived. We present evidence of how the boundaries of standardization of practices were broken when faced with an unanticipated state of confinement. The development of these practices, in a particular reality, has been impacted by difficulties of access to technology and communication resources. The teacher shows how, despite the restricted opportunities in rural areas due to the socioeconomic context of the families, her implementation of actions in addition to the guidelines provided by her institution has contributed to the learning processes and the motivation of her students. © 2023 Czech Ethnological Society. All rights reserved.
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IMMUNION (Improving IMMunisation cooperation in the European UNION) is a European project having the objective to support vaccine strategies. The project (active from April 2021 to March 2023) has contributed to improve knowledge on vaccines and vaccinations among health professionals and the information circulation in different target groups, through a multistakeholder collaboration including institutions, associations and media. The IMMUNION consortium has been focusing on activities of survey, professional training and communication, even with the aim to sustain visibility and role of the Coalition for Vaccination. In particular, ISS has coordinated the Work Package on finalising vaccine communication tools to increase vaccination compliance in target communities.
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The pandemic caused by the SARS-CoV-2 coronavirus has been especially detrimental to patients with end-stage renal disease. History with other vaccines suggests that patients with renal disease may not respond adequately to the SARS-CoV-2 vaccine. The aim of this study is to evaluate the immunity to SARS-CoV-2 mRNA vaccines in renal patients. Post SARS-CoV-2 vaccination first, and after the booster dose, antibodies and cellular immunity were studied in patients on hemodialysis (N = 20), peritoneal dialysis (N = 10) and renal transplantation (N = 10). After the two doses of vaccine, there was an effective immunity in dialysis patients, with 100% seroconversion and 87% detection of cellular immunity (85% in hemodialysis and 90% in peritoneal dialysis). In contrast, in renal transplant recipients there was only 50% seroconversion and cellular immunity was detected in 30% of patients. After the booster dose, all dialysis patients achieved a cellular and antibody immunity, whereas in transplant patients, despite improvement, 20% did not produce antibodies and in 37.5% cellular immunity could not be detected. The mRNA vaccine plus booster performs excellently in dialysis patients, whereas in kidney transplant recipients, despite the booster, complete immunization is not achieved.Copyright © 2022
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Arterial dissection is an uncommon complication of reversible cerebral vasocon-striction syndrome (RCVS). We describe the case of a 35-year-old woman with a migraine history who presented with recurrent thunderclap headache and focal neurological signs, including right hemiataxia. She had been diagnosed with COVID-19 disease two weeks earlier. Neuroimaging revealed multifocal stenosis of the posterior circulation arteries and dissection of the right superior cerebellar artery. She improved significantly throughout her one-week hospitalization and maintained only mild ataxia. The interplay between COVID-19 disease, RCVS, and arterial dissection requires further investigation.Copyright © Author(s) (or their employer(s)) and Sinapse 2022.
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The pandemic caused by the SARS-CoV-2 coronavirus has been especially detrimental to patients with end-stage renal disease. History with other vaccines suggests that patients with renal disease may not respond adequately to the SARS-CoV-2 vaccine. The aim of this study is to evaluate the immunity to SARS-CoV-2 mRNA vaccines in renal patients. Post SARS-CoV-2 vaccination first, and after the booster dose, antibodies and cellular immunity were studied in patients on hemodialysis (N=20), peritoneal dialysis (N=10) and renal transplantation (N=10). After the two doses of vaccine, there was an effective immunity in dialysis patients, with 100% seroconversion and 87% detection of cellular immunity (85% in hemodialysis and 90% in peritoneal dialysis). In contrast, in renal transplant recipients there was only 50% seroconversion and cellular immunity was detected in 30% of patients. After the booster dose, all dialysis patients achieved a cellular and antibody immunity, whereas in transplant patients, despite improvement, 20% did not produce antibodies and in 37.5% cellular immunity could not be detected. The mRNA vaccine plus booster performs excellently in dialysis patients, whereas in kidney transplant recipients, despite the booster, complete immunization is not achieved.
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Background: Short-term cardiopulmonary extracorporeal life supports (ECLS) are invasive devices whose use has increased exponentially during the COVID-19 pandemic. Major bleeding is a main cause of morbi-mortality in ECLS patients and acquired von Willebrand disease (aVWD) could justify this complication. Aim(s): We aim at investigating the primary hemostasis alterations profile in ECLS patients, and to propose a potential treatment if bleeding. Method(s): Patients in ECLS at our center since June 2021 were included (n = 25). Primary hemostasis was evaluated by: Von Willebrand Factor antigen (VWF:Ag) and activity (VWF:GPIbM) measurement (immunoturbidimetry), VWF multimeric analysis (agarose-gels and immunoblotting), platelet function analysis (PFA-200), and platelet activation (CD62P and CD63 expression by flow cytometry). Studies were performed 24 h after implant, each 7 days, and in the first week after ECLS extraction. T-TAS was used for hemostasis analysis in samples from bleeding patients, before and after in vitro addition of purified VWF. This study was approved by the Hospital Clinic's Ethics Committee (HCB/2021/0200). Result(s): After 24 h of ECLS implant, increased VWF:Ag levels and prolonged PFA occlusion times. In 60% of patients, altered VWF:GPIbM/VWF:Ag ratio ( < 0.7) and loss of VWF high molecular weight multimers (HMWM) were observed. CD62P expression was slightly higher in ECLS patients platelets than in controls (MFI+/-SD of 4.34 +/- 2.2 vs. 3.27 +/- 0.6, respectively;p = 0.3). Early after ECLS extraction, there was normalization of the VWF multimeric profile and PFA values. Interestingly, in samples from bleeding patients, addition of purified VWF reduced significantly the T-TAS occlusion times (776 s+/-207 s vs. 1161 s+/-251 s, Mean+/-SD, post vs. pre, respectively;p = 0.033). Conclusion(s): ECLS caused primary hemostasis alterations, leading to aVWD and platelet activation, solved early after support removal. Hemostatic efficiency in ECLS bleeding patients, with lack of HMWM, was corrected in vitro by providing functional purified VWF. (Figure Presented).
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Background: Lung diseases are common in Patients with End Stage Kidney Disease (ESKD) making the differential diagnosis with COVID-19 a challenge. This study describes pulmonary chest tomography (CT) findings in hospitalized ESKD on renal replacement therapy (RRT) patients with clinical suspicion of COVID-19 and compare image characteristics of positive versus negative cases. Method(s): ESKD individuals referred to Emergency Department older than 18 with clinical suspicion of COVID-19 were recruited. Epidemiological, baseline clinical information was extracted from electronic health records. Pulmonary CT was classified as typical, indeterminate, atypical or negative. We then compare CT findings of positive and negative COVID-19 patients. Result(s): We recruited 109 patients (62,3% COVID-19 positive) between March and December 2020. Mean age was 60 +/- 12.5 years-old, 43% were female and the most common etiology of ESKD was diabetes. Median time on dialysis was 36 months, Interquartile range=12-84. The most common pulmonary lesion on CT was ground glass opacities. Typical CT pattern was more common in COVID-19 patients (40(61%) vs 0(0%), p<0.001). Sensitivity was 60.61% (40/66) and specificity was 100% (40/40). Positive predictive value and negative predictive value were 100% and 62.3%, respectively. Atypical CT pattern was more frequent in COVID-19 negative patients (9(14%) vs 24(56%), p<0.001), while the indeterminate pattern was similar in both groups (13(20%) vs 6(14%), p=0.606), and the negative pattern was more common in COVID-19 negative patients (4(6%) vs 12(28%), p=0.002). Conclusion(s): In hospitalized patients with ESKD on RRT an atypical chest CT pattern cannot adequately rule out the diagnosis of COVID-19.
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Background The COVID-19 pandemic caused an overabundance of valid and invalid information rapidly spread via traditional media, by internet and digital communication. Health Literacy (HL), as the ability to access, understand, appraise, apply health information, is fundamental for finding, interpreting, correctly using COVID-19 information. Methods In 2021, in the framework of the participation to the WHO M-POHL (Measuring Population and Organizational Health Literacy) network, a survey was conducted in a representative sample of the Italian general population aged 18+ years (N = 3,500). The validated HL questionnaire included coronavirus-related HL (HL-COVID, 16-items), general HL, sociodemographic characteristics, risk factors, lifestyles sections. For the HL-items, a 4-point Likert scale was applied: very easy, easy, difficult, very difficult. HL-COVID levels were defined as Good: very easy+easy>81.3% (more than 12 of 16 answers);Sufficient: 50.0%<very easy+easy < =81.3% (9-12 of 16 answers);Limited: very easy+easy < =50.0% (fewer than 9 of 16 answers). Elderly were responders aged 65+ years, the remaining ones were defined as adults. Ordinal Logistic Regression analysis was performed to assess the association of HL-COVID with sociodemographic characteristics (sex, age-group, educational level, financial deprivation). Results Good HL-COVID prevalence was lower in elderly than in adults (44.8% vs. 51.0%, p-value=0.001);the opposite for both sufficient (22.8% vs. 19.9%) and limited (32.5% vs. 29.1%) levels, but not statistically significant. The odds of a low HL-COVID (sufficient/limited) increased by 31% in the elderly and by 50%, 92%, and almost triple in persons with a low, considerable, and severe financial deprivation level, respectively. Conclusions The COVID-19 pandemic highlighted the need to improve HL and to prepare the general population for future emergency and non-emergency situations, confirming that HL can be considered a social vaccine. Key messages Low coronavirus-related HL level is mostly associated to elderly and to increasing deprivation level. The COVID-19 pandemic confirmed that Health Literacy can be considered a social vaccine.
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Objective To evaluate the rate of thrombosis, bleeding and mortality comparing anticoagulant doses in critically ill COVID-19 patients. Design Retrospective observational and analytical cohort study. Setting COVID-19 patients admitted to the intensive care unit of a tertiary hospital between March and April 2020. Patients 201 critically ill COVID-19 patients were included. Patients were categorized into three groups according to the highest anticoagulant dose received during hospitalization: prophylactic, intermediate and therapeutic. Interventions The incidence of venous thromboembolism (VTE), bleeding and mortality was compared between groups. We performed two logistic multivariable regressions to test the association between VTE and bleeding and the anticoagulant regimen. Main variables of interest VTE, bleeding and mortality. Results 78 patients received prophylactic, 94 intermediate and 29 therapeutic doses. No differences in VTE and mortality were found, while bleeding events were more frequent in the therapeutic (31%) and intermediate (15%) dose group than in the prophylactic group (5%) (p < 0.001 and p < 0.05 respectively). The anticoagulant dose was the strongest determinant for bleeding (odds ratio 2.4, 95% confidence interval 1.26–4.58, p = 0.008) but had no impact on VTE. Conclusions Intermediate and therapeutic doses appear to have a higher risk of bleeding without a decrease of VTE events and mortality in critically ill COVID-19 patients.
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Objective To evaluate the rate of thrombosis, bleeding and mortality comparing anticoagulant doses in critically ill COVID-19 patients. Design Retrospective observational and analytical cohort study. Setting COVID-19 patients admitted to the intensive care unit of a tertiary hospital between March and April 2020. Patients 201 critically ill COVID-19 patients were included. Patients were categorized into three groups according to the highest anticoagulant dose received during hospitalization: prophylactic, intermediate and therapeutic. Interventions The incidence of venous thromboembolism (VTE), bleeding and mortality was compared between groups. We performed two logistic multivariable regressions to test the association between VTE and bleeding and the anticoagulant regimen. Main variables of interest VTE, bleeding and mortality. Results 78 patients received prophylactic, 94 intermediate and 29 therapeutic doses. No differences in VTE and mortality were found, while bleeding events were more frequent in the therapeutic (31%) and intermediate (15%) dose group than in the prophylactic group (5%) (p<0.001 and p<0.05 respectively). The anticoagulant dose was the strongest determinant for bleeding (odds ratio 2.4, 95% confidence interval 1.26–4.58, p=0.008) but had no impact on VTE. Conclusions Intermediate and therapeutic doses appear to have a higher risk of bleeding without a decrease of VTE events and mortality in critically ill COVID-19 patients. Resumen Objetivo Evaluar la incidencia de eventos trombóticos, sangrado y mortalidad comparando diferentes regímenes de anticoagulación en pacientes ingresados en unidades de Cuidados Intensivos (UCI) por COVID-19. Diseño Estudio de cohortes retrospectivo observacional y analítico. Ámbito Pacientes con COVID-19 ingresados en una UCI de un hospital terciario entre marzo y abril del 2020. Pacientes Se incluyó a un total de 201 pacientes de UCI ingresados por COVID-19. Los pacientes se categorizaron en 3 grupos en función de la dosis de anticoagulación más alta recibida durante el ingreso: profiláctica, intermedia y terapéutica. Intervenciones Se comparó la incidencia de eventos trombóticos, hemorragia y mortalidad entre los grupos. Se realizaron 2 regresiones logísticas multivariables para comprobar la asociación entre los eventos trombóticos y el sangrado con el régimen anticoagulante. Principales variables de interés Eventos trombóticos, sangrado y mortalidad. Resultados De los pacientes incluidos, 78 recibieron dosis profilácticas, 94 intermedias y 29 terapéuticas. No se encontraron diferencias en los eventos trombóticos y la mortalidad entre grupos, mientras que los sangrados fueron más frecuentes en el grupo de dosis terapéutica (31%) e intermedia (15%) que en el grupo de dosis profiláctica (5%) (p <0,001 y p <0,05, respectivamente). El régimen anticoagulante fue el mayor determinante de sangrado (odds ratio 2,4;, intervalo de confianza del 95%, 1,26-4,58;p=0,008) pero no tuvo ningún impacto en los eventos trombóticos. Conclusiones Las dosis intermedias y terapéuticas parecen tener un mayor riesgo de sangrado sin una disminución de los eventos trombóticos ni la mortalidad en pacientes de UCI con COVID-19.
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HEMOCOVID-19 is a multi-center trial aiming to assess the microvascular and endothelial health of severe COVID-19 patients in the intensive care using near-infrared spectroscopy. Here, we present the preliminary results, showing that peripheral microcirculatory alterations are associated with the severity of acute respiratory distress syndrome. © 2022 The Author(s).
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Background: The Covid-19 pandemic has meant a modifcation of the patterns of the doctor-patient relationship, favoring online visits and reducing face-to-face visits. Likewise, the implementation of Patient-Reported Outcomes (PROs) that do not require the intervention of the doctor in our clinical practice and that given their close relationship with the clinical activity of chronic infammatory joint diseases (CIJD) has favored an empowerment of patients and can allow the development of the online visit. Objectives: Know the use and acceptance of patients with CIJD: rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondyloarthropathies (SpA) of a non-face-to-face online visit, through a digital environment. Methods: Patients were included in a platform called Rheumanet for access by username and passwords (https://www.laconsultacercadetI.com/). At the time of inclusion, demographic variables were collected: date of birth, sex, level of education (primary education, secondary education, vocational training, further education and higher education), distance from the hospital to the patient's home, and clinical variables such as diagnosis: RA, PsA or SpA, as well as the duration of the disease. Prior to the appointment, patients were encouraged to complete a PRO survey to assess their clinical situation: Routine Assessment of Patient Index Data 3 (RAPID3) for RA, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for SpA and RAPID3 and/or BASDAI for the PsA. Both the RAPID3 and BASDAI were scored for the patient's knowledge and assigned to a color scale based on disease activity in green (remission or low activity), orange (moderate activity) or red (severe activity). Likewise, they were ordered to express through a free text what they would tell us as if they were in a face-to-face consultation. Complementary tests (analytical, radiological studies and others) are obtained simultaneously from the medical records and a joint assessment of the visit is carried out. Results: Between September 1, 2020 and January 31, 2022, a total of 248 patients (113 RA, 53 SpA and 82 PsA) were included in the platform. 172 (69.3%) patients used the digital platform and made at least one non-face-to-face visit during follow-up. The number of online visits made by each patient ranged from 1 to a maximum of 13 visits. 80 patients (70.7%) suffered from RA, 40 (75.4%) from SpA and 52 (63.4%) from PsA. The number of patients who made non-face-to-face visits was 38 (72.3%) for a disease duration of <5 years and 137 (64.5%) for >5 years. When the ages of the patients were analyzed, the number of patients who made visits was 75 (73.5%) between 18 and 30 years old, 50 (67.7%) between 30 and 50 and 47 (66.4 %) from 50 years. According to the degree of activity of the disease, 75 patients were in remission or low activity at some point during the visits, 63 patients with moderate activity and 34 with severe activity. The distribution according to level of education was: 11 (6.3%) primary education, 21 (12.2%) secondary education, 37 (21.5%) vocational training, 63 (36.6%) further education and 40 (23.2%)higher education. The number of online visits was higher in patients who lived at a distance of 50 km or more from the hospital, reaching 100% of the visits in this subgroup of patients. Conclusion: The online visit through a digital platform through PROs is well accepted by our population with CIJD, especially in the young population, with a higher cultural level and whose home is far from the hospital. The online visit was made by patients regardless of the severity of their disease activity. Speed and ease of use using PROs already known to the patient and clinician is an important consideration for rheumatolo-gists working in healthcare systems where patient contact time is limited. It would be interesting to obtain this information in non-pandemic situations such as COVID-19, which would make it possible to assess actual acceptance and its use in this type of patient in circumstances in which fear of contagion is not a variabl to consider.
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Objective: To understand what were the coping strategies adopted by Brazilian physiotherapists in the face of the pandemic over two periods (2020 and 2021), and to analyze the barriers and facilitators they identified. Method: This is a quantitative observational study in two sections (cross-sectional and longitudinal), carried out through an online questionnaire, in which 304 physical therapists participated in the research. The instruments applied were a sociodemographic and work form and the Brief COPE questionnaire. For statistics the following analyses were used: frequency, mean, median, interquartile range, and standard deviation;the Mann Whitney U test;the Kruskal-Wallis test;the Spearman's correlation test;and the Wilcoxon test. Barriers and facilitators were organized in the form of a word cloud (Word Cloud Art Creator). Results: The most frequently used coping strategies were acceptance, planning, and active coping in the two periods of analysis. Most participants pointed out that the fear of infecting their family or friends was the main barrier, and family support was the main facilitator. Conclusion: The results demonstrate that the family served as a facilitator for coping, but also as a barrier due to the concern of possible infection of family members. The coping strategies used by physical therapists were considered satisfactory and adaptive.
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Introducción La población anciana es la más amenazada por COVID-19, con mayores tasas de mortalidad. El objetivo de este trabajo es analizar la letalidad en una cohorte de pacientes de COVID-19 con demencia degenerativa. Métodos Hicimos un estudio descriptivo de casos-control de una muestra de pacientes diagnosticados con demencias neurodegenerativas primarias. Resultados De los 88 pacientes incluidos en el estudio, 24 pacientes con COVID-19 fallecieron: 10/23 (43,4%) eran pacientes con diagnóstico de demencia y 14/65 (21,5%) pacientes del grupo control, una diferencia estadísticamente significativa. Discusión La letalidad por COVID-19 entre los pacientes con demencia degenerativa primaria es significativamente mayor en comparación con otros pacientes con edades medias y comorbilidades similares, según nuestro estudio.
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The World Health Organization estimates that globally, even before the start of the SARS-CoV-2 pandemic, 1 in 3 women suffer some form of physical or sexual violence by a partner and/or stranger. The pandemic and social distancing and isolation measures have exposed women and children to further violence, mistreatment, abuse and even murder. Forms of psycho-physical stress have increased especially among women and children.
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The search for new treatments to contain the Covid-19 pandemic has highlighted the importance of nucleoside antivirals, such as Remdesivir, Tenofovir and Molnupiravir. Over the last two years, these molecules have been intensely investigated as promising alternatives against SARS-CoV-2 virus. Considering the increasingly demand for those substances, several research groups are intensely investigating synthetic developments in order to obtain these nucleoside derivatives and their intermediates in a fast, efficient and accessible manner. In this context, this review aims to in-depth present the recent advances concerning the preparation of Remdesivir, Tenofovir and Molnupiravir. Aspects involving differences in the starting materials and reagents, as well as the advantages and limitations of each protocol would be carefully disclosed. Moreover, the use of synthetic tools, such as flow chemistry, organocatalysis and biocatalysis, would also be detailed. Finally, this review also presents aspects involving the scale-up of these transformations, including discussions about stereo- and diastereoselectivity, as well as product isolation details. In summary, an overview of the existing synthetic strategies for these active pharmaceutical ingredients (APIs) are presented. © 2022 Sociedade Brasileira de Quimica. All rights reserved.