Machine Learning Applied to COVID-19: A Review of the Initial Pandemic Period

Diagnostic and decision-making processes in the 2019 Coronavirus treatment have combined new standards using patient chest images, clinical and laboratory data. This work presents a systematic review aimed at studying the Artificial Intelligence (AI) approaches to the patients' diagnosis or evolution with Coronavirus 2019. Five electronic databases were searched, from December 2019 to October 2020, considering the beginning of the pandemic when there was no vaccine influencing the exploration of Artificial Intelligence-based techniques. The first search collected 839 papers. Next, the s were reviewed, and 138 remained after the inclusion/exclusion criteria was performed. After thorough reading and review by a second group of reviewers, 64 met the study objectives. These papers were carefully analyzed to identify the AI techniques used to interpret the images, clinical and laboratory data, considering a distribution regarding two variables: (i) diagnosis or outcome and (ii) the type of data: clinical, laboratory, or imaging (chest computed tomography, chest X-ray, or ultrasound). The data type most used was chest CT scans, followed by chest X-ray. The chest CT scan was the only data type that was used for diagnosis, outcome, or both. A few works combine Clinical and Laboratory data, and the most used laboratory tests were C-reactive protein. AI techniques have been increasingly explored in medical image annotation to overcome the need for specialized manual work. In this context, 25 machine learning (ML) techniques with a highest frequency of usage were identified, ranging from the most classic ones, such as Logistic Regression, to the most current ones, such as those that explore Deep Learning. Most imaging works explored convolutional neural networks (CNN), such as VGG and Resnet. Then transfer learning which stands out among the techniques related to deep learning has the second highest frequency of use. In general, classification tasks adopted two or three datasets. COVID-19 related data is present in all papers, while pneumonia is the most common non-COVID-19 class among them.

Challenges and Results of Haploidentical Stem Cell Transplantation for Adult Patients in Cuba

The Hermanos Ameijeiras Hospital (HAH) in Havana is the only center performing allogeneic hematopoietic stem cell transplantation (HSCT) in adult patients in Cuba. Because transplants from unrelated donors are not possible due to political restrictions and economic embargo, in 2016 HAH and University of Illinois at Chicago (UIC) started a collaboration to support the training of a physician, annual educational programs and exchange of guidelines and protocols to perform haploidentical transplants. The first haploidentical transplant was performed at HAH in 2016. Because of limited resources, disease risk stratification is based on morphologic assessment, as cytogenetic is tested on an irregular basis. Peripheral blood stem cells (PBSC) were infused based on total nucleated cell count (TNC) due to lack of reagents for flow cytometry. Posttransplant chimerism and CMV monitoring cannot be performed. Transplant activity was stopped in 2020 due to high expenses allocated for COVID19 pandemic in Cuba. From 2016 to 2020, 16 haploidentical HSCT in 15 patients (9 males/ 6 females) were completed at HAH. The median age of patients was 34 years (range:21-54). Diagnoses included: acute leukemia, n=12, myelodysplastic syndrome, n=1, Hodgkin disease, n=1, and severe aplastic anemia, n=1. At the time of transplant, 11 patients were in morphologic remission and 5 had active disease. Conditioning regimens utilized were myeloablative (Flu/Bu) in 10 cases and at reduced intensity (Flu/Cy/ TBI200 +/- ATG) in 6 cases, and GVHD prophylaxis was standard PTCy on D3 and 4, CsA and mycophenolate. The donors were mother (n=10), father (n=1), child (1), or sibling (n=3) and the median age was 48 years (range: 26-68). All patients received fresh stem cells from PBSC(n=13) or bone marrow (n=3). Median cell dose infused was 5.5x108 TNC/kg (range: 2.2-8). All patients but 1 engrafted and median time to neutrophil and platelet engraftment was 17 days (range:12-28) and 16 days (range:11-30), respectively. Acute graft-versus-host disease (GVHD) grade 2-3 occurred in 50% of patients and chronic GVHD in 2 out of 8 that were evaluable. Day 100 and 2-year overall survival rates were 73% and 40%, respectively. With a medium follow-up of 18.8 months (range: 0.3-64), 5 of 15 patients (30%) are alive and complete remission. Causes of death in the remaining 10 patients included relapse of original disease, n= 4;bacterial infection, n=2;brain hemorrhage, n=1;VOD, n=1;graft failure, n=1;and multi-organ failure, n=1. Despite significant difficulties, HAH implemented a haploidentical transplant program for adult patients in Cuba. Among future steps, improving access to molecular testing and using younger donors will be pursued to improve on the results. The partnership between HAH and UIC has been instrumental in building clinical and research capacity and continues to support HAH in its mission to provide care to patients in Cuba.(Figure Presented)Copyright © 2023 American Society for Transplantation and Cellular Therapy

The importance of the human factor in organizational change in banking. Evolution and systematics between two crises

Objective: This study aims to highlight the evolution operated in the three banks of systemic size in Spain, in the 11-year period observed and which is framed between two major crises, the first known in Spain as the "brick crisis", and the second derived from the COVID-19 pandemic. It specializes in the treatment and management of human resources, as the engine of organizational change in the financial sector aimed not only at reducing costs, but also at the digital business revolution. Thus, it is intended to demonstrate the importance of the human factor in the organizational change of banking. Methodology: An economic-financial analysis methodology of data and ratios contained in balance sheets and annual reports has been used, which cover the information provided to shareholders and stakeholders. Results: The evolutionary design of banking in terms of its parameters follows a line already drawn, assuming each of the two crises we encounter an acceleration of processes. Limitations: A greater number of banking entities would have made it possible to generalize what was indicated in the study. Practical implications: Facilitate the understanding of a certain line of action common to all financial entities, in the relationship between human resources and economic results.

Delayed type hypersensitivity (DTH) cutaneous test as a first step to investigate long term immune response to Covid-19 vaccines

Background: As we progress with mass vaccination against SARs-CoV- 2, there are key questions about immunogenicity of Covid vaccines that still are not answered. One of the reasons for this is the lack of suitable cellular immune methods that are easy to perform in large amount of vaccinated individuals. Conventional methods of measuring cellular and humoral immunity are complex and expensive in a pandemic situation. Here we present data about in vivo Delayed Type Hypersensitivity (DTH) results on the long-term follow-up of vaccinated immunocompetent health care workers showing that DTH is a suitable and affordable method to understand immunigenicity elicited by Covid-vaccines. This tool could be used to modify vaccine administration to optimize responses obtained in the vaccinated individuals. Method(s): Forty healthy healthcare workers accepted to participate during the vaccination schedule with a mRNA vaccine against SARS-CoV- 2. We measure the DTH cutaneous response after intradermal test of protein S of SARS-CoV- 2 at day 35 and day 200. At the same time, we perform specific anti-RBD IgG using a classic ELISA before vaccination and on days 35 and 200. Result(s): All forty individuals had a positive DTH skin response al day 35, whereas thirty-nine participants had a positive skin test at day 200 (Figure 1). Moreover, although all 40 individuals showed a humoral response of specific IgG against spike protein at day 35 considered positive, most of them have significant lower levels at day 200. Conclusion(s): DTH responsiveness has been shown to be an ideal and easy method to predict cellular immunity response to mRNA vaccines 200 days after starting immunization schaedule with mRNA vaccine for Covid-19. (Figure Presented).

A Development Framework for a Health Monitoring Application in the Power App Platform

Globally, COVID-19 pandemic has influenced and changed norms and common health cultures. Different countries have implemented risk management and dealt with the condition based on the applicability of the international measures and some uniquely to their situations. As technology has become a key tool in daily lives and smart phones and connectivity has become a common necessity for most of the world's population, these can be used to help face the pandemic and the new normal it brings. Using one of the widely used software platforms, the research intends to design a framework for a health monitoring application for private institutions. © 2022 IEEE.

Severe allergy to polyethylene glycol: The importance of allergy work-up testing with PEG 1500 extract in the scope of SARS-CoV- 2 vaccination

Background: Polyethylene glycol (PEG) is being used for the first time as an excipient in mRNA vaccines against SARS-CoV- 2 containing PEG 2000, highlighting it as a potential cause of anaphylaxis. We aim to report clinical cases of severe allergy to PEG and furthermore to assess the usefulness of skin tests (ST) performed with the commercial extract PEG 1500 for the allergy work-up of patients with suspected allergy to SARS-CoV- 2 vaccines. Method(s): We evaluated 126 patients with moderate to high risk of allergy to SARS-CoV- 2 vaccination referred to our Allergy Department from March to December 2021. ST were performed with extract PEG 1500 (Roxall), using the following methodology: prick tests with 0.1%, 1% and 10% concentrations, with readings at 30 minutes (according to manufacturer's instructions);if negative, intradermal tests (IDT) were performed with the 1/10 dilution (0.01%), except in cases of anaphylaxis, where dilutions 1/1000 and 1/100 were used (adapted from previous publication using PEG 20000). Immediate IDT readings were made at 30 minutes and delayed readings at 24 hours. The same protocol was applied to 5 healthy controls who received PEGylated vaccines. Result(s): We present 6 cases of severe PEG allergy: one near-fatal anaphylaxis after glucocorticoid injection containing PEG 3350 and five systemic allergic reactions after mRNA vaccine containing PEG 2000 (Pfizer-BioNTech or Moderna). All patients had positive immediate IDT using PEG 1500 allowing the diagnosis and the selection of vaccine without PEG. All of them were negative to polysorbate 80. One patient developed anaphylaxis following IDT 0.01%. In the remaining 120 patients, the ST using PEG 1500 were negative in immediate and delayed reading of IDT. Seven patients were positive to polysorbate 80. All healthy controls had negative ST using PEG 1500. Conclusion(s): To our knowledge this is the first case series describing the allergy work-up testing with commercial extract PEG 1500 in the scope of SARS-CoV- 2 vaccination. ST using extract PEG 1500 revealed to be a useful tool for the diagnosis of PEG allergy, since it allowed confirming six cases of severe PEG allergy, contraindicating the further administration of PEGylated vaccines. It also allowed allergy exclusion in one hundred cases that took afterwards SARS-CoV- 2 vaccines containing PEG 2000. Moreover, healthy controls had negative IDT demonstrating the reliability of the proposed procedure. Investigation should only be conducted in a specialized drug allergy centre.

Race and teaching evaluations: evidence from the covid-19 pandemic

While faculty of colour tend to receive lower course evaluations, it is unclear whether the lack of face-to-face interaction during the COVID-19 pandemic affected them differently. We examine this question using course-level data from a large US university. Estimates from our difference-in-differences models show that non-white faculty suffered a larger decline in ratings compared to their white peers, with the effect persisting even after controlling for English as the faculty's second language. These findings contribute in furthering the discussion on how universities value course evaluations to measure teaching effectiveness and allocate faculty resources. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Polythylene glycol severe allergy and SARS-CoV-2 vaccines: usefulness of testing with PEG 1500 extract.

Summary: Background. Polyethylene glycol (PEG) is being used for first time as an excipient for mRNA anti-SARS-CoV-2 vaccines containing-PEG2000, highlighting it as a potential cause of anaphylaxis. Objective. To assess the usefulness of skin tests using PEG1500 extract in patients with suspected allergy to SARS-CoV-2 vaccines. Methods. We evaluated 126 patients with moderate-high risk of allergy to SARS-CoV-2 vaccines referred to our department from March-December 2021. Skin tests were performed with PEG1500 extract (Roxall), using a stepwise approach, with readings at 30 minutes: prick tests with 0.1%, 1% and 10% concentrations; if negative, intradermal tests with 0.0001%, 0.001% and 0.01% concentrations. The same protocol was applied to 5 healthy controls. Results. Six patients had positive immediate intradermal tests with PEG1500, all with severe PEG allergy: one with a near-fatal anaphylaxis after glucocorticoid injection containing-PEG3350 and five with systemic allergic reactions after mRNA vaccines containing-PEG2000 (Pfizer-BioNTech or Moderna). One patient developed anaphylaxis during intradermal test. These six patients were negative to polysorbate 80. The remaining 120 patients had negative tests to PEG1500; seven had positive tests to polysorbate 80. All controls had negative tests. Conclusions. To our knowledge this is the first study describing the allergy work-up testing with PEG1500 commercial extract in the scope of SARS-CoV-2 vaccination. The algorithm designed for skin tests revealed to be a useful tool. Severe PEG allergy was diagnosed in 5% of patients, contraindicating PEG-containing vaccines. PEG allergy was excluded in one hundred patients that afterwards took SARS-CoV-2 vaccines containing-PEG2000. Investigation should be conducted in specialized drug allergy centres.

Multisystem Inflammatory Syndrome in Children associated with COVID-19: A comparison study between cohorts from different geographic locations

Introduction. We aim to evaluate the sociodemographic and clinical differences between hospitalized children with multisystem inflammatory syndrome in children (MIS-C) in the United States vs. Colombia. Materials and methods. Multicenter prospective observational study of children diagnosed with MIS-C' according to the US CDC definition were enrolled between 03Mar2020-06Apr2022 at one US site (Connecticut Children's Medical Center [CT cohort]) and two Colombian sites (Clinica Imbanaco [CI] and Hospital Universitario del Valle [HUV] in Cali [CI/HUV cohort]). Data was collected in a standardized' online case-collection form developed in REDCap. Cohorts were compared using Fisher's Exact test or Mann-Whitney U test as appropriate. Results. Sixty-four MIS-C cases were included' 40 in CT and 24 in CI/HUV. Median age was 8.6 years (IQR 5,3-13,0)' 53% were male' and almost one-third had a co-morbid condition. A higher median BMI and obesity prevalence were reported in the CT cohort. Overall' most children presented with fever' mucocutaneous findings' or gastrointestinal symptoms. 13% had systolic hypotension. More children in the CI/HUV cohort presented with upper respiratory symptoms compared to the CT cohort (88% vs 28%) while fewer presented with systemic symptoms (50% vs 85%). Laboratory and radiologic findings were similar across both cohorts. Children in the CT cohort received steroids' combined IVIg/steroids' and antibiotics more frequently. Outcomes were similar across both cohorts' except for a longer hospital stay in the CI/HUV cohort. Conclusions. Despite different interventions in comparable cohorts' outcomes were similar. Data from larger studies are needed to evaluate whether these differences are intrinsic to individual conditions or different treatment protocols.

A Programmatic Approach to Improve Efficiency in Lung Cancer Screening

Introduction: Largely as a result of the COVID pandemic, our lung cancer screening (LCS) program was underperforming entering 2021. The program serves a majority minority, socio-economically disadvantaged community. Loss of personnel and reallocated resources, allied to pandemic focus, led to decreased referrals and excessive time from referral to low dose computed tomography (LDCT) appointments. Here we describe our programmatic approach to improve LCS metrics. Methods: LCS transitioned from a Department of Radiology program into a Cancer Center-administered collaborative effort under surgical oncology and radiology leadership. Outreach efforts were reinitiated. To facilitate referrals from our primary care network, the cancer service line created a practical guide, “6 Steps to Lung Cancer Screening”, directly linked to an e-referral mechanism in our EMR. Monthly review and quality assurance meetings were held with a multidisciplinary team, specifically focused on program volume and on addressing delays to LDCT appointments. An additional Nurse Practitioner was brought in to enhance the existing LCS Nurse Navigator and Cancer Center staff were utilized to contact and schedule patients and to perform data compilation and analysis. Results: In 2020, LCS referrals had decreased 13% from 2019. In Q1/2021, the median monthly number of LCS referrals was 132 which increased steadily by quarter to 218 in Q4/2021 (p=0.16, Figure 1A). In January 2021, the average time from LCS referral to LDCT appointment was 101 days. Despite the increasing number of referrals through 2021, we were able to decrease the time to appointment from a median of 86 days in Q1/2021 to a median of 29 days in Q4/2021 (p=0.02, Figure 1B). By December 2021, the average time from LCS referral to LDCT appointment was just 18 days. Our LCS referral population was predominantly non-white (76%). Among them, 7.4% of patients with LDCT scans were found to have Lung RADS 3 or 4 nodules. All of these patients were referred to a newly created high-risk lung nodule clinic for management and follow up. Conclusions: We employed a multidisciplinary team approach to improve inefficiencies in our LCS program. The resources, support, and leadership of the health care system’s Cancer Center were crucial to this multi-pronged initiative. The decreased time from LCS referral to LDCT facilitates our ability to handle the anticipated growth in referral volume. This has been shown to enhance engagement with LCS and to improved annual screening compliance, translating to earlier detection of lung cancer and to improved patient outcomes. [Formula presented] Keywords: Lung cancer screening, Adherence, Disparity

Design, production and characterization of antiviral proteins targeting SARS-CoV-2

The virus responsible for the current COVID -19 pandemic is SARS-CoV-2, which has caused >400 million infections and >5 million deaths (as of February 2022). Despite vaccination efforts, there is still an urgent need to develop strategies to control infection and treat patients. One of the proteins bound to the viral membrane is the spike (S) protein, which consists of two subunits: S1, which contains a receptor-binding domain (RBD) responsible for binding to the host cell receptor, and S2, which facilitates membrane fusion between the viral and host cell membranes, previously published in: Jackson CB et al. (2018) Nat Rev Mol Cell Biol 23, 3-20. Thus, this protein is primarily responsible for the ability of the virus to enter host cells, making it one of the most promising therapeutic targets of coronavirus, previously published in: Cao L et al. (2020) Science 6515, 426- 431. The aim of this work was to design and produce antiviral proteins that could prevent the interaction between the two proteins and thus block infection by binding to the RBD region and blocking its interaction with the host receptor, angiotensin converting enzyme-2 (ACE2) protein. First, several antiviral proteins were computationally designed using the Rosetta program based on the interactions between ACE2 and the RBD. Next, six molecular dynamics simulations (MD) of 1 ls of three candidates were performed to test their interaction with the RBD. This was followed by experimental validation after expression and purification of the three candidates. The secondary structure and thermostability of these proteins were tested by far-UV circular dichroism spectropolarimetry. Surface plasmon resonance was used to evaluate the affinity of each candidate for RBD. Neutralization assays were performed to investigate the neutralization ability of the proteins. The experimental results show that one of the developed proteins is a promising therapeutic approach that will be further improved in the future.

COVID-19 epidemic in Spain in the first wave: Estimation of the epidemic curve inferred from seroprevalence data and simulation of scenarios based on SEIR model

The COVID-19 pandemic represents one of the most severe challenges in the recent history of public health. The aim of this study is to estimate the transmission rate parameter (beta) and to predict the epidemic progression in Spain. We integrated data from Our World in Data. Our model considered a mean time from infection to death to be 24 days and the results of the seroprevalence survey in Spain. We calculated beta using a SEIR model estimated by least squares. We also used a SEIR model to evaluate four scenarios: 1) model 1: no containment measures, 2) model 2: containment measures from the beginning of the epidemic, 3) model 3: mild measures since the 20th day, 4) model 4: strict containment measures since the 20th day. The estimated beta parameter was 1.087. We calculated 41,210,330 infected people and 725,302 deaths in model 1;165,036 infected people and 2,905 deaths in model 2;4,640,400 infected people and 81,671 deaths in model 3;and, 62.012 infected people and 1,091 deaths in model 4. Peak of the epidemic varied from 69th day in model 1 to 216th day in model 4. Containment measures prevented a scenario with a significant increase in deaths and infected people. Our findings showed that, by stricter interventions such as quarantine and isolation could lead to reduce the potential peak number of COVID-19 cases and delay the time of peak infection.

TELEMEDICIN A TOOL FOR THE TREATMENT OF NEW ONSET TYPE 1 DIABETES IN PEDIATRICS: TWO YEAR FOLLOW-UP IN ARGENTINE PATAGONIA

Background and Aims: Background: The care of pediatric patients with new-onset type 1 diabetes in remote areas of Patagonia presents multiple challenges. The current pandemic has presented additional difficulties. We describe the follow-up through telemedicine by an interdisciplinary team of pediatric patients living in rural areas after two years from the start of the SARS COV2 pandemic. Aims: Report on the follow-up of 20 new-onset type 1 diabetes cases in children. The cases were diagnosed in different areas of Patagonia Argentina located more than 200 km from the referral center and were treated through a mixed method : face-to-face and virtual. Methods: Telemedicine was used from the first day to contact the specialist. The management included diabetes education for the patient and family. The patients used multiple daily insulin injections and used software to generate ambulatory glucose profiles. Subsequently, the follow-up was carried out in a mixed modality. Results: The patients achieved adequate glycemic control and reached the diabetes education goals;the management of the cases did not require transfers to the referral center during the first year. Conclusions: These cases show the usefulness of telemedicine to guarantee accessibility to the health systems when the patient's attendance at the referral centers it's not possible. Telemedicine can be used to achieve glycemic control of the patient, for diabetes education in a safe, efficient way and with the satisfaction of the users.The mixed method allows to strengthen the relationship between the team and the patient and the meeting of families in educational workshops.

The COVID - 19 pandemic's impact on the behavioral trends in the use of printed book or e-book: a case study in Portugal and Brazil

In a time of serious health crisis worldwide, this study is the extension of a case study already started (in February and March 2020) about the issue, reading behaviors, and preferences between the use of books and e-books. The COVID-19 pandemic came to impose social distancing in the world, closing universities, schools, and other services. The implementation of Internet services has presented itself as a valid response to the change that has so brutally arisen. Naturally, everyone had to adapt to it. In this context, the question about the preferences in using books or e-books is now even more relevant. This paper analyses the impact of COVID-19 in the behavioral trends in the use of scientific information from printed books and e-books in Portugal and Brazil. To this end, a survey was conducted on a user sample from various Portuguese and Brazilian higher education schools and public libraries. The first part focused on the characterization of the respondents, which includes data on gender and qualifications attended. In the second part, we obtained viewpoints about the advantages and disadvantages of each medium, frequency of use, choice of medium according to the purpose of reading, and devices used. The results let us examine the factors that influence and change the behaviors of users concerning their choice. Research such as this is beneficial to support the decision not only in selecting the information resources to be bought or pondering user preferences, but also to define strategies for advocating the use of various media that, rather than competitors, should be complimentary.

Factors associated with the use of emergency services by the Spanish population in 2017

Background: In modern health systems, emergency services (ES) constitute one of the cornerstones of health care, and they have an essential role in the conception of current health services. The objective of this work was to analyze the effect of sociodemographic characteristics and clinical factors in the use of ES.

Minimizing the Effect of Covid-19 Pandemic as One of the Supply Chain Disruption in a Timber Trade Sector

This paper aims to minimize the effect of COVID-19 pandemic as one of the supply chain disruption in timber trade sector. In order to investigate how COVID-19 created problem, how the pandemic disrupted the operations, and how the company minimized the problem, survey questionnaire was distributed online. The questionnaire was distributed to 20 respondents from timber trade sector, from where 20 responses were gathered. The timber trade sector suffered greatly during the pandemic as there are many new implemented policies and regulations about how the timber sector will trade to the people. In addition to this, the timber sector have experienced rapid change due to the effect of supply chain disruption and companies especially small companies had a hard time in adapting. However, the pandemic shouldn’t be a barrier in having a successful trade, the use of technology should be utilized by creating online strategy in timber trading as the solution to the effect of the pandemic as one of the supply chain disruptions and also keep the sustainability of supply chain to timber sector. The timber trade sector must have digital transformation in order to compete properly, this strategy will change offline store to online purchases for the safety and convenience of both the public and the company. The use of digital transformation will greatly help in the situation the timber trade is facing. Digital transformation is not just about the use of technology, it also about how businesses can compete more because it can minimize cost in many ways. © IEOM Society International.

Characterization of tofacitinib use as COVID-19 therapy

Objective: The main purpose of this study is to characterize and compare the population that received tofacitinib with those that were not treated with the drug for COVID-19 at the Clínica Unión Médica del Norte, in 2020. Methods: An observational, retrospective, cross-sectional, exploratory, and secondary source study was conducted. A comparison was made between clinical and sociodemographic characteristics, laboratory results and their treatment option. Results: Five hundred and seven patients admitted to the COVID-19 unit of the Clínica Unión Médica del Norte were included. It was determined that lower death rates were registered in the group that received tofacitinib (6.45%) compared to the group that did not use the drug. Likewise, those receiving this therapy required less mechanical ventilation, however, a higher proportion of these patients were admitted to the Intensive Care Unit. In addition, a greater reduction in glycaemia was identified in the patients receiving tofacitinib, but they had higher levels of ferritin and D-dimer. Conclusions: Tofacitinib may be beneficial in terms of mortality rates and reduction in the use of mechanical ventilation. Furthermore, it is promising with respect to positive patient progression. However, our research is not conclusive. Future confirmatory research is needed on the efficacy of tofacitinib therapy for COVID-19 patients.