Performance and Early Results from the Earth Surface Mineral Dust Source Investigation (EMIT) Imaging Spectroscopy Mission

The Earth Surface Mineral Dust Source Investigation (EMIT) acquires new observations of the Earth from a state-of-the-art, optically fast F/1.8 visible to short wavelength infrared imaging spectrometer with high signal-to-noise ratio and excellent spectroscopic uniformity. EMIT was launched to the International Space Station from Cape Canaveral, Florida, on July 14, 2022 local time. The EMIT instrument is the latest in a series of more than 30 imaging spectrometers and testbeds developed at the Jet Propulsion Laboratory, beginning with the Airborne Imaging Spectrometer that first flew in 1982. EMIT's science objectives use the spectral signatures of minerals observed across the Earth's arid and semi-arid lands containing dust sources to update the soil composition of advanced Earth System Models (ESMs) to better understand and reduce uncertainties in mineral dust aerosol radiative forcing at the local, regional, and global scale, now and in the future. EMIT has begun to collect and deliver high-quality mineral composition determinations for the arid land regions of our planet. Over 1 billion high-quality mineral determinations are expected over the course of the one-year nominal science mission. Currently, detailed knowledge of the composition of the Earth's mineral dust source regions is uncertain and traced to less than 5,000 surface sample mineralogical analyses. The development of the EMIT imaging spectrometer instrumentation was completed successfully, despite the severe impacts of the COVID-19 pandemic. The EMIT Science Data System is complete and running with the full set of algorithms required. These tested algorithms are open source and will be made available to the broader community. These include calibration to measured radiance, atmospheric correction to surface reflectance, mineral composition determination, aggregation to ESM resolution, and ESM runs to address the science objectives. In this paper, the instrument characteristics, ground calibration, in-orbit performance, and early science results are reported. © 2023 IEEE.

Impact of combined non-invasive support strategies use during acute respiratory failure due to COVID-19

Objectives: To evaluate the impact of combined non-invasive support strategies in critically ill COVID-19 patients [high-flow nasal cannula (HFNC), non-invasive ventilation (NIV) or both]. Method(s): Prospective observational multicenter study in 73 Spanish ICU with data obtained from the SEMICYUC registry. All confirmed COVID-19 patients admitted due to respiratory failure were included. They were classified according to the ventilatory strategy used on admission and subsequently according to success, failure, or strategy change. Demographic data, comorbidities, severity at admission, respiratory, biomarkers, failure, length of stay and mortality were evaluated. Result(s): We analyzed 3,889 patients, 33% receiving HFNC, and 11% NIV at ICU admission. NIV group compared to HFNC were more severely ill with more shock on admission. When NIV was received as a first-choice higher failure rates and mortality were shown vs HFNC (68% vs 61%, p=0.016 and 27% vs 20%, p=0.003). Among patients who initially received HFNC, 57% failed and 7.4% switched to NIV, with no change in mortality. Among patients who were switched to NIV, 66% failed presenting a higher mortality trend than the intubated patients after the HFNC starting (40% vs 30%, p=0.098). Among patients who initially received NIV, 60% failed and 20% switched to HFNC. Patients in whom NIV was switched to HFNC, had lower mortality than patients who initially failed (18% vs 40%, p<0.001). Among patients who were switched to HFNC, 43% failed, presenting the same mortality as the intubated patients after the NIV starting (38% vs 38%, p=0.934). Conclusion(s): Patients receiving NIV at admission have worse outcomes than those receiving HFNC. Changing the strategy in patients who received HFNC as a first choice without success can worsen the prognosis.

Sociodemographic Factors and Mental Health in Nursing Students in Times of COVID-19

Introduction: Mental health has been affected during the pandemic by COVID-19, also in nursing students a negative effect on their levels of depression and anxiety has been observed. Objective: To describe the relationship between sociodemographic factors and mental health of nursing students in times of COVID-19. Methods: Quantitative, descriptive, cross-sectional study, whose population was 577 nursing students of a private university in Trujillo, Peru, enrolled in the semester 2021-01. A sample of 328 students was taken by non-probabilistic convenience sampling. Data were collected using the questionnaires to evaluate anxiety symptoms (GAD-7) and depression (PHQ-9), these instruments were sent through a Google form. Data were processed and described in absolute frequencies and percentages;Pearson's Chi-square test was used for inferential analysis. Results: The sociodemographic factors show that 31.10% belonged to the first cycle, 95.70% were female, 31.40% were aged up to 18 years, 92.10% were single, 68.90% professed the Catholic religion and 85.40% indicated residing in the department of La Libertad. It was also found that 45.40% of the students had mild anxiety and 19.80% severe anxiety;in addition, 39.60% did not present depressive symptoms, 18.90% presented mild major depression and 2.10% severe major depression;only a significant statistical relationship was found between the gender factor and depressive symptoms (p < 0.05). Conclusions: No relationship was found between sociodemographic factors and anxiety symptoms. © 2022, Editorial Ciencias Medicas. All rights reserved.

Reduced Mortality among COVID-19 ICU Patients after Treatment with HemoClear Convalescent Plasma in Suriname.

Convalescent plasma is a promising therapy for coronavirus disease 2019 (COVID-19), but its efficacy in intensive care unit (ICU) patients in low- and middle-income country settings such as Suriname is unknown. Bedside plasma separation using the HemoClear device made convalescent plasma therapy accessible as a treatment option in Suriname. Two hundred patients with severe SARS-CoV-2 infection requiring intensive care were recruited. Fifty eight patients (29%) received COVID-19 convalescent plasma (CCP) treatment in addition to standard of care (SOC). The CCP treatment and SOC groups were matched by age, sex, and disease severity scores. Mortality in the CCP treatment group was significantly lower than that in the SOC group (21% versus 39%; Fisher's exact test P = 0.0133). Multivariate analysis using ICU days showed that CCP treatment reduced mortality (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.18 to 0.66; P = 0.001), while complication of acute renal failure (creatinine levels, >110 mol/L; HR, 4.45; 95% CI, 2.54 to 7.80; P < 0.0001) was independently associated with death. Decrease in chest X-ray score in the CCP treatment group (median -3 points, interquartile range [IQR] -4 to -1) was significantly greater than that in the SOC group (median -1 point, IQR -3 to 1, Mann-Whitney test P = 0.0004). Improvement in the PaO2/FiO2 ratio was also significantly greater in the CCP treatment group (median 83, IQR 8 to 140) than in the SOC group (median 35, IQR -3 to 92, Mann-Whitney P = 0.0234). Further research is needed for HemoClear-produced CCP as a therapy for SARS-CoV-2 infection together with adequately powered, randomized controlled trials. IMPORTANCE This study compares mortality and other endpoints between intensive care unit COVID-19 patients treated with convalescent plasma plus standard of care (CCP), and a control group of patients hospitalized in the same medical ICU facility treated with standard of care alone (SOC) in a low- and middle-income country (LMIC) setting using bedside donor whole blood separation by gravity (HemoClear) to produce the CCP. It demonstrates a significant 65% survival improvement in HemoClear-produced CCP recipients (HR, 0.35; 95% CI, 0.19 to 0.66; P = 0.001). Although this is an exploratory study, it clearly shows the benefit of using the HemoClear-produced CCP in ICU patients in the Suriname LMIC setting. Additional studies could further substantiate our findings and their applicability for both LMICs and high-income countries and the use of CCP as a prepared readiness method to combat new viral pandemics.

Performance of Saliva Compared to Nasopharyngeal Swab in Detection of SARS-CoV-2 at a Field Site in Rural Guatemala Using the Roche Cobas Liat Point-of-Care Assay

Background. Saliva samples are less invasive but not considered the gold standard for detecting SARS-CoV-2, and they are not validated for the Roche Cobas Liat platform. We aimed to evaluate the performance of a saliva sample compared to nasopharyngeal (NP) swab in the detection of SARS-CoV-2 on the Roche Cobas Liat platform at a research site in rural Guatemala. Methods. Adults in an existing cohort study with influenza-like illness (ILI) provided clinical data and underwent NP swab (Copan) collection by trained nurses. Swabs were immediately placed into universal transport media (UTM), stored at 2-8 degreeC for less than 30 minutes and then tested on the Cobas Liat platform for SARS-CoV-2. Consenting subjects who had not eaten or drank in the last 2 hours were asked to provide a 5-mL saliva sample directly into an RNAse free container. The saliva sample remained at 2-8 degreeC for 24 hours, then diluted 1:2 with 0.85% saline (to reduce viscosity) and run on the same assay. We used descriptive statistics to compare the performance of saliva to NP swabs. Results. Of the 28 subjects screened (1/10/22 - 4/26/22), 23 (82%) were consented and enrolled. The majority of subjects were male (78.3%) with a mean age of 31 years (range: 18-59 years). Of the 23 subjects enrolled, 14 (30.4%) reported fever and cough, 16 (34.8%) reported cough only, 14 (30.4%) reported fever only, and 2 (4.3%) reported cough and nasal congestion. The median symptom duration was 3.0 days (IQR: 1.5-5 days). Of the 23 subjects, 5 (23.7%) tested positive for SARS-CoV-2 in both sample types (NP swab and saliva);3 (13%) were discordant, including 1 (4.3%) saliva-positive only and 2 (8.7%) NP-positive only. Compared to NP swab, preliminary performance of saliva in detection of SARS-CoV-2 included a sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 71.4%, 93.7%, 87%, 83.3%, and 88.2%, respectively. The Fisher's exact test p-value (0.003) shows concordance between both tests. Conclusion. Our preliminary results show good precision between NP and saliva samples in detection of SARS-CoV-2 on the Roche Cobas Liat platform. Ongoing data collection will provide greater insight on the discordant results, but our findings support the continued use of saliva in the detection of SARS-CoV-2 in this population.

Tratamiento farmacológico de la COVID-19: revisión narrativa de los Grupos de Trabajo de Enfermedades Infecciosas y Sepsis (GTEIS) y del Grupo de Trabajo de Transfusiones Hemoderivados (GTTH) Pharmacological treatment of COVID-19: Narrative review of the Working Group in Infectious Diseases and Sepsis (GTEIS) and the Working Groups in Transfusions and Blood Products (GTTH)

La infección por el virus SARS-CoV-2, denominada COVID-19 (COronaVIrus Disease 19), fue detectada inicialmente en China en diciembre 2019, y posteriormente se ha diseminado rápidamente por todo el mundo, hasta el punto de que el 11 de marzo la Organización Mundial de la Salud declaró que el brote podría definirse como pandemia. La COVID-19 presenta un cuadro que oscila desde episodios leves seudogripales a otros graves e incluso potencialmente mortales debido, sobre todo, a insuficiencia respiratoria aguda. Es frecuente el ingreso de estos pacientes en nuestros servicios de Medicina Intensiva en relación con un síndrome de distrés respiratorio agudo. La falta de un tratamiento con evidencia científica ha llevado al empleo de diferentes pautas terapéuticas, en muchas ocasiones, con modificaciones rápidas de los protocolos. Recientes revisiones en revistas de prestigio han destacado la falta de terapias probadas y la necesidad de ensayo clínicos que permitan establecer pautas de tratamiento claras y objetivas. Este documento tiene por objeto ofrecer una actualización de la terapia que se está aplicando en la actualidad, y una ayuda en la asistencia diaria, sin pretender sustituir los protocolos adoptados en cada centro.

Nécrolyse épidermique après vaccination contre le COVID-19 : que savons-nous ?

Introduction: À ce jour, près de 2 milliards de doses vaccinales anti-COVID-19 ont été administrées. Divers effets indésirables dermatologiques ont été décrits (réactions locales au point d'injection, urticaire, éruptions morbilliformes, etc.). Douze cas de nécrolyse épidermique (NE, incluant les syndromes de Stevens–Johnson et de Lyell) ont été publiés. Notre objectif était d'analyser les cas de NE post-vaccin anti-COVID-19 notifiés en pharmacovigilance (PV) et de faire une revue de la littérature. Matériel et méthodes: Nous avons extrait de la base de données mondiale de PV (VigiBase), en requêtant avec le « Prefered terms » NE et les vaccins anti-COVID-19 comme médicaments « suspect », les cas de NE déclarés jusqu'au 03/03/2022. Nous avons analysé les caractéristiques de la NE, le déclarant, le délai d'apparition des symptômes, le type de vaccin et la dose (1re : D1, ou 2e : D2), la présence éventuelle d'un autre médicament suspect. Nous avons décrit plus précisément les cas rapportés dans la base de données de PV française et calculé le score ALDEN pour chaque molécule suspectée. Enfin, nous avons analysé les cas de la littérature en revoyant les photos et les données cliniques publiées. Résultats: Nous avons identifié dans VigiBase 240 cas de NE pour lesquels les vaccins anti-COVID-19 étaient considérés comme « suspects », dans 64 % des cas en provenance des États-Unis, et pour 60,5 % survenus chez des femmes, majoritairement entre 45–64 ans. Il s'agissait de syndrome de Stevens–Johnson (décollement < 10 %) dans 80 % des cas, 7 % sont décédés. Le vaccin le plus souvent suspect était à ARNm (82 %). Ces cas étaient difficiles à interpréter en raison d'un manque de données (biopsies, symptomatologie, nature du déclarant).La base française de PV comporte 8 cas de NE. Un cas survenu chez une patiente asiatique avec HLA favorisant était plutôt lié à la lamotrigine d'après le calcul du score ALDEN (6 pour lamotrigine et 2 pour le vaccin), 4 cas étaient probablement des erreurs diagnostiques ou non médicamenteux (1 érythème polymorphe, 1 NE post-mycoplasme, 1 éruption morbiliforme et 1 surdosage en méthotrexate) et pour 1 cas, les données descriptives étaient manquantes. Nous avons donc retenu 2 cas de NE potentiellement en lien avec le vaccin : un homme de 40 ans dont la NE a débuté dans les 24 heures suivant la D1 du vaccin Pfizer®, et un homme de 81 ans ayant débuté 3 jours après la D2 du vaccin Pfizer® une NE d'issue fatale.Après analyse critique des 12 cas de la littérature, nous n'en avons retenu que 3 correspondant sémiologiquement à une NE possiblement en lien avec le vaccin. Discussion: Notre étude de PV, conjuguée à l'analyse critique de la littérature, ne retient au total que 5 cas de NE possiblement induite par le vaccin anti-COVID-19, sans toutefois pouvoir affirmer le lien de causalité. La majorité des autres cas ne sont pas des NE ou ont d'autres médicaments suspects. Comme avec les autres vaccins, l'éventualité d'une NE post-vaccinale anti-COVID-19 semble donc exceptionnelle et ne remet pas en question le bénéfice attendu de cette vaccination au regard de la morbi-mortalité du SARS-CoV-2.

The role of the father in the care of the newborn in an intensive care unit during the covid-19 pandemic: a perspective from the new masculinities

Goal. To analyze the role of the father in the care of the newborn hospitalized in a neonatal intensive care unit. Methodology. This is a qualitative approach study. The selection of open sampling, convenience saturation, interviewing 10 parents where at the end 4 were analyzed where the interviews were conducted in the Neonatal Intensive Care Units (NICU). The data was analyzed using the Atlas Ti 8.0 program through categories and content analysis. Results. Parents need to face the stressful situation of having their child in an intensive care unit, train and learn about the baby's health condition, constantly carry out introjection and reflective self-analysis, delve into the spiritual component and also focus on the I work as financial manager. Conclusion. The father's skills in the care of the hospitalized newborn were identified, such as patience and passion to perform the role of father. It is evident that man has a fundamental role in the care of the newborn. Copyright © 2022, Universidad de Chile - Centro Interdisciplinario de Estudios en Bioetica. All rights reserved.

Breakthrough COVID-19 infection after vaccination in people with multiple sclerosis on disease modifying therapies in Latin America: data from RELACOEM registry

Introduction: In this study we aimed to monitor the risk of breakthrough COVID-19 infection in pwMS on different Disease Modifying Therapies (DMT) included in RELACOEM, a LATAM registry of MS and NMOSD patients infected with and vaccinated against COVID-19. Method(s): retrospective cohort study conducted between May 2021 and December 2021. The primary outcome was the appearance of infection during the follow-up time (at least three months after complete vaccination (second dose)). Specific information was requested (vaccine received, dose, date, symptoms, COVID- 19 infection, need for hospitalization, ventilatory assistance, treatment, and evolution). The primary objective of the analysis was to compare the incidence of breakthrough SARS-CoV-2 infections among the vaccinated pwMS in each DMT group. These conditions entail a PCR-confirmed test, and a time lag of at least 14 days from a full vaccination cycle (after the second vaccination dose). Cumulative incidence was reported by Kaplan Meier survival curves as well as incidence density. Result(s): A total of 857 pwMS patients from eight countries in LATAM were included. Mean age was 44.3 +/-12 years. The most frequent treatment used was fingolimod in 171 (19.9%). Most frequent first and second dose received was Astra-Zeneca (33%). During follow-up, a total of 28 COVID-19 cases were observed for a total exposure time of 150.965 days. The overall cumulative incidence was 3.2% (SE 0.22%) with an overall incidence density (ID) of 1.8 x 10.000 patients/day (95%CI 0.2-3.2). Compared to other DMTs, the incidence rate of breakthrough infections was significantly higher on ocrelizumab (6.02 (95%CI=5.65-7.16, RR=5.17 95%CI 3.27-7.12) and rituximab (6.94 (95%CI=6.15-9.12, RR= 5.93 95%CI 3.55-7.32) compared with other DMTs. No significant differences in the risk of breakthrough were observed for vaccine subtypes. Conclusion(s): An increased risk of breakthrough COVID-19 infections was observed in patients treated with ocrelizumab and rituximab.

Anti-CD20 therapies decrease humoral immune response to SARS-CoV-2 vaccine in a cohort of patients with multiple sclerosis

Background: B cells are responsible for the synthesis of antibodies in people who receive SARS-CoV-2 vaccines. In multiple sclerosis (MS), the seroconversion rate after SARS-CoV-2 vaccine may be influenced by disease-modifying therapies (DMTs) specially by anti-CD20 therapies. Objective(s): To investigate the seroprevalence and the quantity of SARS-CoV-2 antibodies in a cohort of patients with MS. Method(s): It is a retrospective study in which we included MS patients treated with DMTs who were vaccinated against SARSCoV- 2 between February 18 - August 4, 2021.A blood collection at 4 weeks after the second dose was planned. Statistical analysis was performed using SPSS version 24. Significant statistical differences between variables were determined using the U Mann Whitney and chi squared tests. Result(s): A total of 43 MS patients were included in the study, the age range was 23-68. Sixty-nine percent (31/43) of the patients demonstrated a humoral response. Stratified by DMT type, patients treated with interferon yielded 100% measurable antibodies;62% of the MS patients developed antibodies following vaccination with fingolimod. Finally, only 43% of MS patients with anti-CD20 therapies developed a humoral response (p=0.03). The mean of SARSCoV- 2 antibodies in MS patients with anti-CD20 therapies were lower in comparison with patients treated with interferons and fingolimod (61,9 UI/ml vs 546,5 Ul/ml vs 263,4 Ul/ml) p<0.001. Conclusion(s): MS patients are able to mount a humoral vaccine response to SARS-CoV-2, irrespective of the vaccine type administered;patients treated with fingolimod and anti-CD20 agents are least likely to mount such a response in comparison with MS patients treated with interferon.

Breakthrough COVID-19 infection after vaccination in patients with NMOSD in Latin America: data from RELACOEM registry

Objective: The objective of the study was to evaluate the incidence of COVID-19 infections after vaccination in NMOSD patients included in RELACOEM, a LATAM registry of MS and NMOSD patients infected and vaccinated for COVID-19. Method(s): Retrospective cohort study developed between May 2021 to December 2021. The primary outcome was the appearance of infection during the follow up time (at least three months after complete vaccination (second dose)). Data was collected through the contact between the treating physician and the patient. Specific information was requested (vaccine received, dose, date, symptoms, COVID-19 infection, need for hospitalization, ventilatory assistance, treatment, and evolution). The primary objective of the analysis was to compare the incidence of breakthrough SARS-CoV-2 19 infections among the vaccinated pwMS in each DMT group. These conditions entail a PCR-confirmed test, and a time lag of at least 14 days from a full vaccination cycle (after the second vaccination dose). Cumulative incidence was reported by Kaplan Meier survival curves as well as incidence density. Result(s): A total of 49 NMOSD patients from eight countries in LATAM were included. Mean age was 43.8 +/-13 years. The most frequent treatment use was rituximab in 29 (59.2%). The mean follow up after the second dose was 149 +/- 32 days. Most frequent first and second dose received was Pfizer (28.6%), followed by Sinopharm (24.5%). During follow up a total of 2 COVID-19 cases were observed for a total exposure time of 8627 days. Cumulative incidence was 4.1% (SE 0.87%) with an overall incidence density of 2.31 x 10.000 patients/day (95%CI 1.13-3.71). Both cases occurred in patients under rituximab (2/29, exposure time 4208, IR 4.7 x 10,000 patients/day 95%CI 3.5-5.1). No hospitalizations were reported for both cases. Conclusion(s): We observed an ID of COVID-19 infection after vaccination of 2.31 x 10.000 patients/day in NMOSD patients.

A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients.

OBJECTIVE: To determine if the use of corticosteroids was associated with Intensive Care Unit (ICU) mortality among whole population and pre-specified clinical phenotypes. DESIGN: A secondary analysis derived from multicenter, observational study. SETTING: Critical Care Units. PATIENTS: Adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain. INTERVENTIONS: Corticosteroids vs. no corticosteroids. MAIN VARIABLES OF INTEREST: Three phenotypes were derived by non-supervised clustering analysis from whole population and classified as (A: severe, B: critical and C: life-threatening). We performed a multivariate analysis after propensity optimal full matching (PS) for whole population and weighted Cox regression (HR) and Fine-Gray analysis (sHR) to assess the impact of corticosteroids on ICU mortality according to the whole population and distinctive patient clinical phenotypes. RESULTS: A total of 2017 patients were analyzed, 1171 (58%) with corticosteroids. After PS, corticosteroids were shown not to be associated with ICU mortality (OR: 1.0; 95% CI: 0.98-1.15). Corticosteroids were administered in 298/537 (55.5%) patients of "A" phenotype and their use was not associated with ICU mortality (HR=0.85 [0.55-1.33]). A total of 338/623 (54.2%) patients in "B" phenotype received corticosteroids. No effect of corticosteroids on ICU mortality was observed when HR was performed (0.72 [0.49-1.05]). Finally, 535/857 (62.4%) patients in "C" phenotype received corticosteroids. In this phenotype HR (0.75 [0.58-0.98]) and sHR (0.79 [0.63-0.98]) suggest a protective effect of corticosteroids on ICU mortality. CONCLUSION: Our finding warns against the widespread use of corticosteroids in all critically ill patients with COVID-19 at moderate dose. Only patients with the highest inflammatory levels could benefit from steroid treatment.

A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients Una consideración terapéutica diferencial para el uso de corticoesteroides en COVID-19 según los diferentes fenotipos clínicos establecidos en pacientes críticos

Objective To determine if the use of corticosteroids was associated with Intensive Care Unit (ICU) mortality among whole population and pre-specified clinical phenotypes. Design A secondary analysis derived from multicenter, observational study. Setting Critical Care Units. Patients Adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain. Interventions Corticosteroids vs. no corticosteroids. Main variables of interest Three phenotypes were derived by non-supervised clustering analysis from whole population and classified as (A: severe, B: critical and C: life-threatening). We performed a multivariate analysis after propensity optimal full matching (PS) for whole population and weighted Cox regression (HR) and Fine-Gray analysis (sHR) to assess the impact of corticosteroids on ICU mortality according to the whole population and distinctive patient clinical phenotypes. Results A total of 2017 patients were analyzed, 1171 (58%) with corticosteroids. After PS, corticosteroids were shown not to be associated with ICU mortality (OR: 1.0;95% CI: 0.98–1.15). Corticosteroids were administered in 298/537 (55.5%) patients of “A” phenotype and their use was not associated with ICU mortality (HR = 0.85 [0.55–1.33]). A total of 338/623 (54.2%) patients in “B” phenotype received corticosteroids. No effect of corticosteroids on ICU mortality was observed when HR was performed (0.72 [0.49–1.05]). Finally, 535/857 (62.4%) patients in “C” phenotype received corticosteroids. In this phenotype HR (0.75 [0.58–0.98]) and sHR (0.79 [0.63–0.98]) suggest a protective effect of corticosteroids on ICU mortality. Conclusion Our finding warns against the widespread use of corticosteroids in all critically ill patients with COVID-19 at moderate dose. Only patients with the highest inflammatory levels could benefit from steroid treatment.

Clinical outcomes in patients with severe respiratory failure due to novel coronavirus disease 2019 treated with non-invasive respiratory support: observational, prospective study

BACKGROUND: In the present study we aimed to analyze the response to non-invasive respiratory support in patients stratified with acute respiratory failure due to novel coronavirus disease. METHODS: A prospective, observational study was carried out in Hospital Universitario Rey Juan Carlos from February 1st to June 30th, 2020. The study was approved by the Ethics Committee of the Fundacion Jimenez Diaz. We included patients over 18 years of age with confirmed SARS-CoV-2 infection who required non-invasive respiratory support (N.=130). We classified patients included in the sample according to the three clinical scenarios established by the Spanish Respiratory Society. RESULTS: The mean age of the patients was 64.3 +/- 12.9 years;43.8% were older than 70, and the majority were male (N.=88;67.7%). Eighty percent of the study population (N.=104) presented comorbidities. The most used device was the continuous positive airway pressure (54.6%, N.=71). Non-invasive respiratory support-based treatment avoided Intensive Care Unit admission in 68% of the acute respiratory failure cases studied. Treatment-failure occurred in 43.8% of patients (37% clinical scenario 1, de-novo acute respiratory failure, P=0.04) and the overall rate of mortality was 36.2% (14.8% clinical scenario 1, P<0.00001). CONCLUSIONS: The used of non-invasive respiratory support was safe and clinically effective treatment (68% of ICU admissions prevented, lower rate of TF than that reported for other viral pneumonias, and a mortality rate of 14.8% within clinical scenario 1). Non-invasive respiratory support may be considered a first-line therapy for patients with severe COVID-19.

Impact of one year of pandemic on Spanish Intensive Care Units.

OBJECTIVE: To measure the impact of the pandemic in Spanish ICUs. METHODS: On-line survey, conducted in April 2021, among SEMICYUC members. Participants were asked about number of patients admitted, increase in the number of beds and staff, structures created in the hospital and self-assessment of the work performed. RESULTS: We received 246 answers from 157 hospitals. 67.7% of the ICUs were expanded during the pandemic, overall increase in beds of 58.6%. The ICU medical staff increased by 6.1% and there has been a nursing shortage in 93.7% of units. Patients exceeded 200% the pre-pandemic ICU capacity. In 88% of the hospitals the collaboration of other specialists was necessary. The predominant collaboration model consisted of the intensive care medicine specialist being responsible for triage and coordinating patient management. Despite that 53.2% centres offered training for critical care, a deterioration in the quality of care was perceived. 84.2% hospitals drew up a Contingency Plan and in 77.8% of the hospitals a multidisciplinary committee was set up to agree on decision-making. Self-evaluation of the work performed was outstanding and 91.9% felt proud of what they had achieved, however, up to 15% considered leaving their job. CONCLUSIONS: The Spanish ICUs assumed an unprecedented increase in the number of patients. They achieved it without hardly increasing their staff and, while intensive care medicine training was carried out for other specialists who collaborated. The degree of job satisfaction was consistent with pre-pandemic levels.

Most widely used digital platforms in the educational field during the pandemic (covid-19)

The world is immersed in a health crisis due to COVID-19, from one day to the next the educational community was forced to change the classrooms of our centers for the rooms of home, where the teaching process is maintained thanks to the Information and Communication Technologies (ICT) manifesting itself in its multiple forms. This crisis has caused a series of challenges in various areas, one of the most affected has been the educational field, moving the face-to-face modality by a virtual modality and digital educational platforms have occupied an important role in this new modality. The teaching-learning process mediated by new technologies have caused a series of changes both in teachers and students themselves, among these changes can be highlighted teacher training, the difference in access to new technologies by students. Sometimes causing a strong digital divide and the adaptation of both groups to the new scenario among others. It is currently difficult to imagine what will happen from this new reality, but what cannot be denied is the increasingly important role that ICT is playing in the education system.

Mental well-being among patients with congenital heart disease and heart failure during the COVID-19 pandemic

Patients with congenital heart disease (CHD) show increasing survival. We evaluated the influence of COVID-19 confinement on the mental well-being of patients with CHD. Descriptive, cross-sectional, observational epidemiological study in a cohort of 242 patients with CHD over 14 years old recruited consecutively from a single adolescent and adult CHD outpatient unit. Patients were sent an online questionnaire to determine clinical, demographic and the 12-element general health questionnaire (GHQ-12) data during the COVID-19 quarantine. 242 out of 407 (59%) patients with CHD, to whom the questionnaire was sent, responded to the survey. 98 (42%) patients were between 14 and 24 years old and 133 (58%) were over 25 years old. Of the total, 119 (51%) were male. 123 (51%), 88 (36%) and 31 (13%) patients with CHD had mild, moderate, and severe anatomical complexity respectively. 11 (4.5%) out of 242 patients with CC presented heart failure (HF) symptoms, requiring 18% of them admission to the hospital emergency department during the pandemic (P=0.002). In relation to the GHQ-12 questionnaire, patients with CHD and HF enjoyed less their daily activities (81% vs. 51%, P=0.043) and had less self-confidence (46% vs. 18%, P=0.041) than those without HF symptoms. In conclusion, patients with CHD and HF, during the COVID-19 quarantine, presented a lower capacity to enjoy daily activities and self-confidence than CHD without HF symptoms.