SARS-CoV-2 ANTIBODY RESPONSES POST-INFECTION IN PREGNANCY BY VACCINATION STATUS

Background: We evaluated SARS-CoV-2 antibody binding and neutralization responses at delivery among pregnant persons with prior SARS-CoV-2 infection by vaccine status. Method(s): We enrolled participants with evidence of prior SARS-CoV-2 infection detected in pregnancy (anti-nucleocapsid [anti-N] IgG+ on enrollment or prior RT-PCR+ or antigen+) and followed them through delivery. Maternal delivery and cord blood samples were tested for SARS-CoV-2 binding antibodies to spike (anti-S) (from vaccination and/or infection) and anti-N (from infection only) IgG by Abbott Architect followed by neutralizing antibodies (classified as neutralizing if serum dilution inhibited infection by 50% [ND50 heat] >=20 and R2 >=0.9) if sample volume allowed. Positive IgG thresholds were Abbott index >=1.4 for anti-N and >=50 AU/mL for anti-S. Chi-squared test was used to compare differences in proportions between groups. Wilcoxon rank sum test was used to compare medians. Result(s): Among 71 participants with delivery and cord samples, median age was 33 years (interquartile range [IQR] 30-35) and median gestational age was 31.7 weeks (IQR 18.0-37.9) at enrollment in pregnancy. By delivery, 17 (24%) participants were unvaccinated, 21 (30%) were partially vaccinated or had completed a primary series, and 33 (46%) were boosted. Median time from infection (RT-PCR+ or antigen+ result) to delivery was 16.7 weeks (IQR 9.7- 24.3). At delivery, 33 (46%) of maternal (median 3.2 index) and 37 (52%) of cord samples (median 3.1 index) were anti-N IgG+. Participants with >=1 vaccine were more likely to be anti-S IgG+ than those unvaccinated (100% vs. 82%, p< 0.01), have higher median anti-S IgG+ (25,000 vs 1,019 AU/ml, p< 0.01), and have neutralizing antibodies (100% vs. 81%, p< 0.01) with higher median log10 neutralization (1:4.00 vs 1:2.41, p< 0.01) at delivery. Similarly, cord blood from participants with >=1 vaccine was more likely to be anti-S IgG+ than those unvaccinated (100% vs. 82%, p< 0.01), have higher median anti-S IgG+ (25,000 vs 1,188 AU/ml, p< 0.01), and have neutralizing antibodies (100% vs. 75%, p< 0.01) with higher median log10 neutralization (1:4.00 vs 1:2.41, p< 0.01) at delivery. Conclusion(s): Among pregnant people with prior SARS-CoV-2 infection detected during pregnancy, maternal and cord blood antibody binding and neutralization responses were higher among those receiving SARS-CoV-2 vaccination prior to delivery. (Table Presented).

Longitudinal SARS-COV-2 anti-spike antibody response in pregnant people with natural infection and variable vaccine uptake

Background. Natural SARS-CoV-2 infection results in anti-nucleocapsid (N) and anti-spike (S) antibody (Ab) development. Anti-S Ab response (conferred by infection and/or vaccination) is more closely associated with protection. We evaluated anti-N/S Ab responses in vaccinated (> 1 dose) and unvaccinated pregnant people with prior SAR-CoV-2 infection. Methods. During January 2021-March 2022, we enrolled participants with SARS-CoV-2 infection identified in pregnancy (26 via anti-N IgG+;52 via prior RT-PCR+). Baseline, 1, 2, 3, 6, and 12 months, and delivery samples were tested for anti-N (index >= 1.4 positive) and anti-S (>= 50 AU/mL positive) IgG Ab by Abbott Architect. Kaplan-Meier methods were used to measure Ab response duration. Results. Among 78 participants, 62 (79%) enrolled in pregnancy (median 27 weeks gestation), and 16 (21%) at delivery/postpartum (median 2 weeks);34 (44%) had received >=1 vaccine prior to initial Ab testing. At baseline, 59 (75%) participants had concordant anti-N/S positive results (median anti-N index 3.58 [IQR 2.01-5.82], median anti-S 5529 AU/ml [IQR 687-25000]). Anti-S IgG was higher (25000 vs 774, p< 0.001) among participants receiving >=1 vaccine vs no vaccine, while anti-N IgG indices were similar. Among 59 participants with initial anti-N IgG+ results, median time to anti-N IgG negative results was 31 weeks after first RT-PCR+ (median 17 weeks after first anti-N IgG+ result). Only 1 (unvaccinated) participant had an anti-S IgG negative result by 22 weeks after first RT-PCR+ result. Among 30 participants with delivery samples (median 16 weeks after RT-PCR+, 12 weeks after baseline anti-N IgG+ samples), 15 (52%) remained anti-N IgG+;29 (97%) remained anti-S IgG+. Anti-S IgG was higher (25000 vs 826 AU/ml, p< 0.001) among participants receiving >= 1 vaccine vs. no vaccine prior to delivery. Conclusion. Among pregnant persons with prior SARS-CoV-2 infection, duration of anti-S IgG response was longer than anti-N IgG irrespective of vaccine status;vaccination during pregnancy was associated with higher anti-S levels at baseline and delivery. While anti-S IgG were detectable for >= 6 months, longer term follow-up is needed to assess durability of hybrid immunity vs. infection alone and has implications for maternal and infant protection.

Association between the Multidimensional Poverty Measure and COVID-19 mortality in Colombia : Paula Diaz

Background Different socioeconomic aspects have been related to mortality from COVID-19. For this reason, the objective of this study was to analyze the association between the Multidimensional Poverty Measure at the municipal level (MPM) and the clinical outcome of mortality in the resident population of Colombia with a diagnosis of COVID-19. Methods Observational, non-concurrent cohort study of confirmed cases of COVID-19 reported in Colombia by August 2021. The main outcome variable was mortality from COVID-19, and the main exposure variable was MPM. The covariates included in the analysis were patient's sex, age, and municipality of residence. Unadjusted and adjusted logistic models were used using balanced random samples of deaths and recovered patients, calculating odds ratios (OR) and 95% confidence interval ranges (CI). Results In total, 4,194,538 cases of COVID-19 were included in the analysis, of which approximately 3% died. According to the adjusted multivariate analysis, it was found that patients who live in municipalities with an MPM between 20 to 40%, 41 to 60%, 61 to 80% and more than 80% had an OR of 1.6 (95% CI 1.4 to 1.8), 1.6 (95% CI 1.3 to 1.9), 1.7 (95% CI 1.2 to 2.5), and 2.2 (95% CI 0.7 to 7.8), respectively, for mortality from COVID-19 compared with an MPM of less than 20%. When analyzing the data according to sex for the MPM from 20 to 40%, 41 to 60%, 61 to 80% and more than 80%, an OR for women of 1.7 (95% CI 1.5 to 2.0), 1.8 (95% CI % 1.5 to 2.1), 1.9 (95% CI 1.3 to 2.6) and 2.8 (CI 0.9 to 10.1) respectively. For men an OR of 1.5 (95% CI 1.3 to 1.7), 1.4 (95% CI 1.2 to 1.7), 1.6 (95% CI 1.1 to 2.3) and 1.9 (95% CI 0.6 to 6.0) respectively compared to a MPM less than 20%. Conclusions The risk of mortality from COVID-19 in Colombia is increased in populations with higher MPM. Social determinants of health have an important effect on the outcomes of COVID-19. Key messages Only a few studies exist in South America on social determinants in health and COVID-19. This study provides evidence to understand the impact of poverty measures on mortality in COVID-19 patients. Multidimensional poverty measure at the municipal level was associated with increased COVID-19 mortality in a large cohort of patients from the Colombian population.

LONGITUDINAL SARS-CoV-2 ANTIBODY RESPONSE in PREGNANCY and TRANSPLACENTAL TRANSFER

Background: Longitudinal assessment of SARS-CoV-2 antibody (Ab) response during pregnancy after infection and transplacental transfer may inform durability of maternally derived Ab for mothers and infants. Methods: Between October 2020-September 2021, pregnant people testing SARS-CoV-2 IgG positive by Abbott Architect chemiluminescent immunoassay (CMIA) for anti-nucleocapsid (N) antibody (semi-quantitative index ≥1.4 considered IgG+) during pregnancy or delivery in a seroprevalence study, or identified with RT-PCR+ results via medical records, were invited to enroll in a longitudinal evaluation of maternal Ab responses and transplacental transfer. Maternal blood collected at 1, 2, 3, and 6 months after enrollment and maternal and cord blood collected at delivery were tested with the same assay. Results: Among 40 participants testing IgG+ for anti-N, 31 (78%) had a prior RT-PCR+ result. Median age was 32 years (IQR 29-35);27 (68%) enrolled during pregnancy at median 18 weeks gestation (IQR 13-33), while 13 (33%) enrolled at delivery or early postpartum. Median Abbott index was 3.06 (IQR 1.96-5.74) at first IgG+ result obtained at a median of 9 weeks (IQR 4-16) after RT-PCR+ result, for those with a known RT-PCR. Among 23 participants with ≥2 samples, 50% had IgG results below positivity threshold at median 17 weeks (IQR 12-28) after first IgG+ result (Figure). Seventeen mother-infant pairs had delivery samples collected at median 66 days (IQR 60-71 days) from maternal RT-PCR+ result. Six (35%) maternal samples remained IgG+ (median Abbott index 2.97 [IQR 2.35-7.01]) at delivery (gestational age 30-40 weeks) with all 6 paired cord sera testing IgG+ (median Abbott index 4.30 [IQR 2.93-7.22]). Median placental transfer ratio of maternally derived IgG Abs based on a positive Abbott index was 1.13 (95%CI 0.98-1.30) among mothers with samples remaining IgG+ at delivery. Conclusion: Within 4 months after first IgG+ result primarily in second trimester, about half of pregnant persons had SARS-CoV-2 IgG anti-N Ab levels below the Abbott CMIA positive threshold. Among evaluable mother-infant pairs, two-thirds of mothers no longer tested anti-N IgG+ at delivery. Transplacental transfer of maternal antibodies was confirmed in all infants born to mothers with samples remaining IgG+ at delivery. Durability of maternal SARS-CoV-2 Ab response and transplacental transfer following infection has implications for maternal and neonatal susceptibility to SARS-CoV-2 infection.

CHALLENGES AND REFLECTIONS ON TEACHER TRAINING IN TIMES OF COVID-19: AN ANALYSIS FROM EDUCATIONAL PSYCHOLOGY

Objective: to analyze the pedagogical practice experiences of teachers in training during the COVID-19 contingency, making visible the challenges, conditions, and emerging reflections of the pedagogical practice in pandemic and social isolation and characterize the teaching-learning strategies that favor skills in teachers' professional practices consistent with the need for mental health care and maintenance of the quality of life of students. Materials and methods: this research was developed from the constructivist paradigm and through the methodology of systematization of experiences. The study sample consisted of 231 students from strata 1, 2, and 3, and 11 practice advisers from a professional teacher training program. Results: professional practices in teacher training are a crucial moment for the development and strengthening of competencies associated with teaching-learning from the discipline. Before 2020, most of the professional practices were developed in-person, a situation that changed in the health contingency of COVID-19, causing a demand for sudden adaptation on the part of trainers and teachers in training for the development of practices professionals in virtual environments. Conclusions: at the end of the study, the different emerging challenges are evidenced, such as a weak command of information and communication technologies, empathy as a cognitive-emotional teacher competence, the constant maintenance of student motivation and the application of curricular flexibility strategies. Likewise, prevention and support actions developed based on an adaptive educational environment are identified, which favors successful training in times of social distancing, quarantine and isolation.

Airway management of COVID-19 patients: A survey on the experience of 1125 physicians in Spain.

BACKGROUND: We explored the experience of clinicians from the Spanish Society of Anesthesiology (SEDAR) in airway management of COVID-19 patients. METHODS: An software-based survey including a 32-item questionnaire was conducted from April 18 to May 17, 2020. Participants who have been involved in tracheal intubations in patients with suspected or confirmed COVID-19 infection were included anonymously after obtaining their informed consent. The primary outcome was the preferred airway device for tracheal intubation. Secondary outcomes included the variations in clinical practice including the preferred video laryngoscope, plans for difficult airway management, and personal protective equipment. RESULTS: 1125 physicians completed the questionnaire with a response rate of 40,9%. Most participants worked in public hospitals and were anesthesiologists. The preferred device for intubation was the video laryngoscope (5.1/6), with the type of device in decreasing order as follows: Glidescope, C-MAC, Airtraq, McGrath and King Vision. The most frequently used device for intubation was the video laryngoscope (70,5%), using them in descending order as follow: the Airtraq, C-MAC, Glidescope, McGrath and King Vision. Discomfort of intubating wearing personal protective equipment and the frequency of breaching a security step was statistically significant, increasing the risk of cross infection between patients and healthcare workers. The opinion of senior doctors differed from younger physicians in the type of video-laryngoscope used, the number of experts involved in tracheal intubation and the reason that caused more stress during the airway management. CONCLUSIONS: Most physicians preferred using a video-laryngoscope with remote monitor and disposable Macintosh blade, using the Frova guide.

[Airway management of COVID-19 patients: a survey on the experience of 1125 physicians in Spain]. / Manejo de vía aérea en pacientes COVID-19: una encuesta sobre la experiencia de 1125 médicos en España.

BACKGROUND: We explored the experience of clinicians from the Spanish Society of Anesthesiology in airway management of COVID-19 patients. METHODS: An software-based survey including a 32-item questionnaire was conducted from April 18 to May 17, 2020. Participants who have been involved in tracheal intubations in patients with suspected or confirmed COVID-19 infection were included anonymously after obtaining their informed consent. The primary outcome was the preferred airway device for tracheal intubation. Secondary outcomes included the variations in clinical practice including the preferred video laryngoscope, plans for difficult airway management, and personal protective equipment. RESULTS: 1125 physicians completed the questionnaire with a response rate of 40,9%. Most participants worked in public hospitals and were anesthesiologists.The preferred device for intubation was the video laryngoscope (5.1/6), with the type of device in decreasing order as follows: Glidescope, C-MAC, Airtraq, McGrath and King Vision. The most frequently used device for intubation was the video laryngoscope (70,5%), using them in descending order as follow: the Airtraq, C-MAC, Glidescope, McGrath and King Vision.Discomfort of intubating wearing personal protective equipment and the frequency of breaching a security step was statistically significant, increasing the risk of cross infection between patients and physicians. The opinion of senior doctors differed from younger physicians in the type of video-laryngoscope used, the number of experts involved in tracheal intubation and the reason that caused more stress during the airway management. CONCLUSIONS: Most physicians preferred using a video-laryngoscope with remote monitor and disposable Macintosh blade, using the Frova guide.

An Efficient Mixture of Deep and Machine Learning Models for COVID-19 and Tuberculosis Detection Using X-Ray Images in Resource Limited Settings

Clinicians in the frontline need to assess quickly whether a patient with symptoms indeed has COVID-19 or not. The difficulty of this task is exacerbated in low resource settings that may not have access to biotechnology tests. Furthermore, Tuberculosis (TB) remains a major health problem in several low- and middle-income countries and its common symptoms include fever, cough and tiredness, similarly to COVID-19. In order to help in the detection of COVID-19, we propose the extraction of deep features (DF) from chest X-ray images, a technology available in most hospitals, and their subsequent classification using machine learning that do not require large computational resources. We compiled a five-class dataset of X-ray chest images including a balanced number of COVID-19, viral pneumonia, bacterial pneumonia, TB, and healthy cases. We compared the performance of proposed pipelines combining 14 individual pre-trained deep networks for DF extraction with machine learning classifiers. A novel pipeline consisting of ResNet-50 for DF computation and ensemble of subspace discriminant classifier was the best performer in the classification of the five classes, achieving a detection accuracy of 91.6 ± 0.57% (± Confidence Interval, CI) at 95% confidence level). Furthermore, the same pipeline achieved accuracies of 98.6 ± 0.34% (± CI) and 99.9% in three-class and two-class problems focused on distinguishing COVID-19, TB and healthy cases;and COVID-19 and healthy images;respectively. The pipeline was computationally efficient requiring just 0.19 s to extract DF per X-ray image and 2 min for training a classifier on a CPU machine. The results suggest the potential benefits of using our pipeline in the detection of COVID-19, particularly in resource-limited settings as it relies in accessible X-rays and limited computational resources. The final constructed dataset, named COVID-19 five-class dataset and codes, are available from https://drive.google.com/drive/folders/1toMymyHTy0DR_fyE7hjO3LSBGWtVoPNf?usp=sharing. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Students' Perception of Virtual Adaptations in Human Anatomy Courses by the SARS-CoV-2 Contingency

the COVID-19 pandemic modified the ways of teaching and learning, switching from face-to-face classes in classrooms and laboratories to non-synchronous or asynchronous non-face to face classes on virtual platforms. Human anatomy courses require internships to understand anatomical structures. Objective: it is intended to explore the perception of the students of Medicine, Nursing and Psychology about the methodologies, content and didactics of learning that were developed in three courses of human anatomy adapted to the pandemic. Methodology: cross-sectional observational study, using fifteen-question on an online survey, conducted at the end of semester 2020-I about perception;scope of expectations;instructions;learning activities;probability of recommending only virtual, combined or face-to-face courses and points for or against the virtual methodology used. The study in 157 students participated, this way: 56 % (88/157) medical anatomy course, 27 % (43/157) morphology course and 17 % (26/157) neuroanatomy course. Results: a variety of assessments were found for or against adaptations made for anatomical virtual education amid the contingency. However, points in favor of virtuality such as the possibility of recording and not physical displacement plus access to models of computer anatomy, fail to overcome the comprehension of a teacher and the enthusiasm that awakens the palpable.

[Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection]. / Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures. Resumen La alta incidencia de insuficiencia respiratoria aguda en el contexto de la pandemia por COVID-19 ha conllevado el uso de ventilación mecánica hasta en un 15%. Dado que la traqueotomía es un procedimiento quirúrgico frecuente, este documento de consenso, elaborado por tres Sociedades Científicas, la SEMICYUC, la SEDAR y la SEORL-CCC, tiene como objetivo ofrecer una revisión de las indicaciones y contraindicaciones de traqueotomía, ya sea por punción o abierta, esclarecer las posibles ventajas y exponer las condiciones ideales en que deben realizarse y los pasos que considerar en su ejecución. Se abordan situaciones regladas y urgentes, así como los cuidados posoperatorios.

Consensus Document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on Tracheotomy in Patients with COVID-19 Infection. / Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica, y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

Mental Health of People Under Isolation During the covid-19 Outbreak: An Exploratory Study

We conducted an exploratory study using a survey inquiring on seven topics on how people were reacting to the covid-19 pandemic of 2020 aiming to trace a map of symptoms and feelings related to mental health and isolation. 1785 people participated in the survey. Additionally, we applied two psychological scales to analyze depression and stress (prevalent in previous studies). We found that people in isolation during the pandemic presented symptoms related to dissociative disorders, negative affect, and anxiety syndrome. Also, depression and stress had a high prevalence compared to the average rates indicated by the World Health Organisation and the Colombian Ministry of Health. The results indicated an association between depression and stress and being previously diagnosed with a mental health problem, and job and financial situation. Our results highlight the need to design prevention and intervention programmes to reduce the negative consequences of isolation. © 2022 Universidad Nacional de Colombia. All rights reserved.