Prevalence and diagnostic significance of novel 12-lead ECG patterns following COVID-19 infection in elite soccer players

Background: Identification of athletes with cardiac inflammation following COVID-19 can prevent exercise fatalities. The efficacy of pre and post COVID-19 infection electrocardiograms (ECGs) for detecting athletes with myopericarditis has never been reported. We aimed to assess the prevalence and diagnostic significance of novel 12-lead ECG patterns following COVID-19 infection in elite soccer players. Method(s): We conducted a multicentre study over a 2-year period involving 5 centres and 34 clubs and compared pre COVID and post COVID ECG changes in 455 consecutive athletes. ECGs were reported in accordance with the International recommendations for ECG interpretation in athletes. The following patterns were considered abnormal if they were not detected on the pre COVID-19 infection ECG: (a) biphasic T-waves;(b) reduction in T-wave amplitude by 50% in contiguous leads;(c) ST-segment depression;(d) J-point and ST-segment elevation >0.2 mV in the precordial leads and >0.1 mV in the limb leads;(e) tall T-waves >=1.0 mV (f) low QRS-amplitude in >3 limb leads and (g) complete right bundle branch block. Athletes exhibiting novel ECG changes underwent cardiovascular magnetic resonance (CMR) scans. One club mandated CMR scans for all 28 (6%) athletes, despite the absence of cardiac symptoms or ECG changes. Result(s): Athletes were aged 22+/-5 years (89% male and 57% white). 65 (14%) athletes reported cardiac symptoms. The mean duration of illness was 3+/-4 days. The post COVID ECG was performed 14+/-16 days following a positive PCR. 440 (97%) athletes had an unchanged post COVID- 19 ECG. Of these, 3 (0.6%) had cardiac symptoms and CMRs resulted in a diagnosis of pericarditis. 15 (3%) athletes demonstrated novel ECG changes following COVID-19 infection. Among athletes who demonstrated novel ECG changes, 10 (67%) reported cardiac symptoms. 13 (87%) athletes with novel ECG changes were diagnosed with inflammatory cardiac sequelae;pericarditis (n=6), healed myocarditis (n=3), definitive myocarditis (n=2), and possible/probable myocarditis (n=2). The overall prevalence of inflammatory cardiac sequelae based on novel ECG changes was 2.8%. None of the 28 (6%) athletes, who underwent a CMR, in the absence of cardiac symptoms or novel ECG changes revealed any abnormalities. Athletes revealing novel ECG changes, had a higher prevalence of cardiac symptoms (67% v 12% p<0.0001) and longer symptom duration (8+/-8 days v 2+/-4 days;p<0.0001) compared with athletes without novel ECG changes. Among athletes without cardiac symptoms, the additional yield of novel ECG changes to detect cardiac inflammation was 20% (n=3). Conclusion(s): 3% of elite soccer players demonstrated novel ECG changes post COVID-19 infection, of which almost 90% were diagnosed with cardiac inflammation during subsequent investigation. Most athletes with novel ECG changes exhibited cardiac symptoms. Novel ECGs changes contributed to a diagnosis of cardiac inflammation in 20% of athletes without cardiac symptoms.

Patient Experience With Anti-Vascular Endothelial Growth Factor (VEGF) Therapy in Neovascular Age-Related Macular Degeneration (nAMD) and Diabetic Macular Edema (DME): A Multinational Survey

Objectives: Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is efficacious for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). However, the frequent treatment and monitoring required for optimal real-world outcomes can be burdensome to patients and can impact adherence to treatment. This study aimed to understand patient treatment experience with anti-VEGF standard of care. Method(s): A cross-sectional survey was employed comprising de novo questions, patient-reported outcome (PRO) measures and medical chart extraction. Adult patients with nAMD or DME treated with intravitreal anti-VEGF injections for >=12 months were recruited via 38 clinical sites (6 Canada, 6 France, 4 Italy, 7 Spain, 6 United Kingdom, 9 United States). Result(s): Surveys were completed by 391 patients with nAMD and 183 patients with DME. PRO scores indicated that patients across both conditions had relatively high vision-related functioning and were generally satisfied with their current treatment. Mean number of anti-VEGF injections over 12 months across countries ranged from 6.3-9.7 for nAMD and 4.3-8.0 for DME. Nineteen patients with nAMD (19/391;5%) and 27 patients with DME (27/183;15%) missed >=1 injection or examination visit in the past 12 months. Reported barriers were mainly related to treatment (eg, pain and discomfort during/after anti-VEGF injection), clinic (eg, not having someone to accompany them to appointments) and, to a lesser extent, the COVID-19 pandemic. After treatment, the majority recovered in <=1 day;however, 24% (139/574) needed >1 day to recover. Impairment in daily activities due to treatment was reported by 45% (258/574) of patients. Among working patients 62% (41/66) reported productivity impairment from absenteeism. Conclusion(s): Patients reported impairment of daily activities, burden and barriers related to intravitreal anti-VEGF therapy, despite high adherence and treatment satisfaction levels. More durable therapy options, requiring less frequent treatments may be able to reduce treatment-related burden and barriers. Copyright © 2022

COVID-19 and EU-China relations

This chapter analyses the impact of COVID-19 on EU–China relations and explores its implications for the Belt and Road Initiative. COVID-19 has accelerated some of the contradictory dynamics that have characterized EU–China relations in the last few years. China has proven to be a necessary partner and crucial provider of medical supplies, but it has also deployed a more assertive, and at times aggressive, public diplomacy which has reinforced advocates of moderating dependency from China inside the EU. The pandemic has fostered EU calls for a more balanced relationship based on reciprocity and a level playing field and locked pending negotiations in a stalemate. It is also likely to impact the debates on supply chain diversification, monitoring of Chinese FDI, and restrictions on Chinese 5G providers. In this context, Chinese attempts to revitalize the Health Silk Road have been unsuccessful, and China has turned to a more conservative strategy to preserve the BRI’s (limited) advances in the EU. © 2022 selection and editorial matter, Vassilis Ntousas and Stephen Minas;individual chapters, the contributors.

Multi-Camera Workflow Applied to a Cultural Heritage Building: Alhambra’s Torre de la Cautiva from the Inside

It is increasingly necessary to generate accessible and navigable digital representations of historical or heritage buildings. This article explains the workflow that was applied to create such a digital component for one of the least accessible areas of the Alhambra palace in Granada, the so-called Torre de la Cautiva (Tower of the Captive). The main goal of this process was to create affordable, photorealistic 3D models that contribute to the dissemination of cultural heritage, the decision making for its conservation and restoration, and public engagement and entertainment. With enough preparation, the time spent gathering data following a Structure from Motion (SfM) approach can be significantly reduced by using a multi-camera (low cost DSLR) photogrammetric strategy. Without the possibility of artificial lighting, it was essential to use RAW images and calibrate the color in the scene for material and texture characterization. Through processing, the amount of data was reduced by optimizing the model’s topology. Thus, a photorealistic result was obtained that could be managed and visualized in immersive Visual Reality (VR) environments, simulating different historical periods and environmental and lighting conditions. The potential of this method allows, with slight modifications, the creation of HBIMs and the adaptation to VR systems development, whose current visualization quality is below the resolution of actionable models in rendering engines.

The Impact of COVID-19 on Student Experiences and Expectations: Evidence from a Survey

In order to understand the impact of the COVID-19 pandemic on higher education, we surveyed approximately 1,500 students at one of the largest public institutions in the United States using an instrument designed to recover the causal impact of the pandemic on students' current and expected outcomes. Results show large negative effects across many dimensions. Due to COVID-19: 13% of students have delayed graduation, 40% lost a job, internship, or a job offer, and 29% expect to earn less at age 35. Moreover, these effects have been highly heterogeneous. One quarter of students increased their study time by more than 4 hours per week due to COVID-19, while another quarter decreased their study time by more than 5 hours per week. This heterogeneity often followed existing socioeconomic divides;lower-income students are 55% more likely to have delayed graduation due to COVID-19 than their higher-income peers. Finally, we show that the economic and health related shocks induced by COVID-19 vary systematically by socioeconomic factors and constitute key mediators in explaining the large (and heterogeneous) effects of the pandemic.

Estimating Students' Valuation for College Experiences

The college experience involves much more than credit hours and degrees. Students likely derive utility from in-person instruction and on-campus social activities. Quantitative measures of the value of these individual components have been hard to come by. Leveraging the COVID-19 shock, we elicit students’ intended likelihood of enrolling in higher education under different costs and possible states of the world. These states, which would have been unimaginable in the absence of the pandemic, vary in terms of class formats and restrictions to campus social life. We show how such data can be used to recover college student’s willingness-to-pay (WTP) for college-related activities in the absence of COVID-19, without parametric assumptions on the underlying heterogeneity in WTP. We find that the WTP for in-person instruction (relative to a remote format) represents around 4.2% of the average annual net cost of attending university, while the WTP for on-campus social activities is 8.1% of the average annual net costs. We also find large heterogeneity in WTP, which varies systematically across socioeconomic groups. Our analysis shows that economically-disadvantaged students derive substantially lower value from university social life, but this is primarily due to time and resource constraints.

Evaluation of stress, burnout and hair cortisol levels in health workers at a University Hospital during COVID-19 pandemic.

In the critical context of COVID-19 pandemic, healthcare workers are on the front line, participating directly in the care, diagnosis, and treatment of patients with COVID-19. This exposes them to a higher risk of developing chronic stress, psychological distress, and any other mental health symptoms. OBJECTIVE: to evaluate stress and burnout in a health workers population and, in addition, to measure hair cortisol concentration as a current biomarker of stress. MATERIALS AND METHODS: 234 health workers from Hospital de Clínicas "José de San Martín", Buenos Aires University, were included in this study. In this population hair samples were obtained from the posterior vertex as close to the scalp as possible and the individuals completed the following surveys: perceived stress, social support, burnout scale, life event scale, and sociodemographic data. Hair cortisol was measured by an automated chemiluminescent method. The studied population was divided into three groups considering those individuals below the healthy reference sample range (< 40 pg/mg hair), within the healthy reference range (40-128 pg/mg hair) and above the reference range (> 128 pg/mg hair). This study used a transversal and observational design. RESULTS: Our results show that 40% of the studied population presented hair cortisol values outside of the healthy reference range. In the whole studied population, a direct correlation was found between hair cortisol concentration and perceived stress as well as between hair cortisol concentration and the emotional exhaustion component of burnout (r = 0.142, p = 0.030; r = 0.143, p = 0.029, respectively). 12% of the studied population showed Burnout (52% doctors and residents, 19% nurses, 19% administrative personnel). Higher values in hair cortisol levels were found in the group with burnout versus individuals without burnout (p = 0.034). Finally, a mediation analysis was performed, finding that depersonalization is a mediating variable in the relationship between self-perceived stress and hair cortisol level (F = 4.86, p = 0.0086; indirect effect IC: 0.0987-1.8840). CONCLUSION: This is the first study in which a stress biomarker such as hair cortisol is evaluated in this population and in this context. Healthcare workers are subjected to increased levels of stress and burnout. High depersonalization, emotional exhaustion, and decreased personal sense of accomplishment characterize this population. It is the responsibility of the health authorities to implement strategies to manage this psychological emergency.

Parallel/Distributed Generative Adversarial Neural Networks for Data Augmentation of COVID-19 Training Images

This article presents an approach using parallel/distributed generative adversarial networks for image data augmentation, applied to generate COVID-19 training samples for computational intelligence methods. This is a relevant problem nowadays, considering the recent COVID-19 pandemic. Computational intelligence and learning methods are useful tools to assist physicians in the process of diagnosing diseases and acquire valuable medical knowledge. A specific generative adversarial network approach trained using a co-evolutionary algorithm is implemented, including a three-level parallel approach combining distributed memory and fine-grained parallelization using CPU and GPU. The experimental evaluation of the proposed method was performed on the high performance computing infrastructure provided by National Supercomputing Center, Uruguay. The main experimental results indicate that the proposed model is able to generate accurate images and the 3 × 3 version of the distributed GAN has better robustness properties of its training process, allowing to generate better and more diverse images. © 2021, Springer Nature Switzerland AG.

Activity and short-term outcomes of kidney transplantation during the COVID-19 pandemic

Introduction During the COVID-19 pandemic, the national transplant activity has been reduced due to the overload of the health system and concern for patient safety in this situation. The aim of our work is to expose the activity of kidney transplantation in Cantabria during the state of alarm, as well as to assess the safety of the transplantation program. Material and methods Retrospective study of kidney transplants performed in our Center from the beginning of the state of alarm until the beginning of the lockdown easing in Cantabria. Descriptive analysis of the demographic data of recipients and their donors, intraoperative data and postoperative outcomes. Comparative analysis with the data of the same period in 2017–2019, by means of the X2 for categorical variables, Student’s T and Mann-Whitney U tests in case of quantitative variables of normal and non-normal distribution, respectively. Results Fifteen kidney transplants were performed in the period described. Delayed renal function (DRF) was seen in 7.5% of patients, and 26.6% showed data of acute rejection;no patient presented COVID-19 disease. Comparative analysis showed a remarkable increase in the number of transplants in comparison with previous periods (15 vs 5.6), at the expense of donors from outside Cantabria (93.3%). We found no statistically significant differences in terms of cold ischemia time (p 0.77), DRF (p 0.73), need for dialysis (p 0.54), or appearance of post-surgical complications (p 0.61). Conclusions The evolution of the pandemic in our region, and the adoption of strict protective measures has allowed the early and safe resumption of the renal transplantation program, increasing the number of transplants performed compared to previous years and maintaining comparable early post-operative results. Resumen Introducción Durante la pandemia COVID-19, la actividad nacional de trasplante se ha visto reducida por la sobrecarga del sistema sanitario, y la preocupación por la seguridad de los pacientes en esta situación. El objetivo de nuestro trabajo es exponer la actividad de trasplante renal en Cantabria durante el estado de Alarma, así como valorar la seguridad del programa de trasplante. Material y métodos Estudio retrospectivo de los trasplantes renales realizados en nuestro Centro desde el inicio del estado de Alarma hasta el inicio del desconfinamiento en Cantabria. Análisis descriptivo de los datos demográficos de receptores y sus donantes, datos intraoperatorios y resultados postoperatorios. Análisis comparativo con los datos del mismo periodo de 2017–2019, mediante los estadísticos X2 para variables categóricas, T-Student y U de Mann-Whitney en caso de variables cuantitativas de distribución normal y no normal, respectivamente. Resultados Se realizaron 15 trasplantes renales en el periodo descrito. 7,5% de pacientes presentaron función renal retrasada (FRR), 26,6% mostró datos de rechazo agudo;ningún paciente presentó enfermedad por COVID-19. En el análisis comparativo, llamativo aumento del número de trasplantes frente a periodos anteriores (15 vs 5,6), a expensas de donantes de fuera de Cantabria (93,3%). No encontramos diferencias estadísticamente significativas en cuanto a tiempo de isquemia fría (p 0,77), FRR (p 0,73), necesidad de diálisis (p 0,54), o aparición de complicaciones postquirúrgicas (p 0,61). Conclusiones La evolución de la pandemia en nuestra región y la adopción de medidas de protección rigurosas ha permitido reiniciar el programa de trasplante renal de una forma temprana y segura, aumentando el número de trasplantes realizados frente a años anteriores y manteniendo unos resultados postoperatorios tempranos comparables.

Activity and short-term outcomes of kidney transplantation during the COVID-19 pandemic. / Actividad y resultados a corto plazo del trasplante renal durante la pandemia COVID-19.

INTRODUCTION: During the COVID-19 pandemic, the national transplant activity has been reduced due to the overload of the health system and concern for patient safety in this situation. The aim of our work is to expose the activity of kidney transplantation in Cantabria during the state of alarm, as well as to assess the safety of the transplantation program. MATERIAL AND METHODS: Retrospective study of kidney transplants performed in our Center from the beginning of the state of alarm until the beginning of the lockdown easing in Cantabria. Descriptive analysis of the demographic data of recipients and their donors, intraoperative data and postoperative outcomes. Comparative analysis with the data of the same period in 2017-2019, by means of the χ2 for categorical variables, Student's T and Mann-Whitney U tests in case of quantitative variables of normal and non-normal distribution, respectively. RESULTS: Fifteen kidney transplants were performed in the period described. Delayed renal function (DRF) was seen in 7.5% of patients, and 26.6% showed data of acute rejection; no patient presented COVID-19 disease. Comparative analysis showed a remarkable increase in the number of transplants in comparison with previous periods (15 vs 5.6), at the expense of donors from outside Cantabria (93.3%). We found no statistically significant differences in terms of cold ischemia time (p=0.77), DRF (p=0.73), need for dialysis (p=0.54), or appearance of post-surgical complications (p=0.61). CONCLUSIONS: The evolution of the pandemic in our region, and the adoption of strict protective measures has allowed the early and safe resumption of the renal transplantation program, increasing the number of transplants performed compared to previous years and maintaining comparable early post-operative results.

Telemedicine and smart working: Spanish adaptation of the European Association of Urology recommendations. / Telemedicina y trabajo inteligente: adaptación al español de las recomendaciones de la Asociación Europea de Urología.

INTRODUCTION: Telemedicine provides remote clinical support through technology tools. It can facilitate medical care delivery while reducing unnecessary office visits. The COVID-19 outbreak has caused an abrupt change in our daily urological practice, where teleconsultations play a crucial role. OBJECTIVE: To provide practical recommendations for the effective use of technological tools in telemedicine. MATERIALS AND METHODS: A literature search was conducted on Medline until April 2020. We selected the most relevant articles related to «telemedicine¼ and «smart working¼ that could provide valuable information. RESULTS: Telemedicine refers to the use of electronic information and telecommunication tools to provide remote clinical health care support. Smart working is a working approach that uses new or existing technologies to improve performance. Telemedicine is becoming a useful and fundamental tool during the COVID-19 pandemic and will be even more in the future. It is time for us to officially give telemedicine the place it deserves in clinical practice, and it is our responsibility to adapt and familiarize with all the tools and possible strategies for its optimal implementation. We must guarantee that the quality of care received by patients and perceived by them and their families is of the highest standard. CONCLUSIONS: Telemedicine facilitates remote specialized urological clinical support and solves problems caused by limited patient mobility or transfer, reduces unnecessary visits to clinics and is useful to reduce the risk of COVID-19 viral transmission.

The impact of COVID-19 on student experiences and expectations: Evidence from a survey.

In order to understand the impact of the COVID-19 pandemic on higher education, we surveyed approximately 1500 students at one of the largest public institutions in the United States using an instrument designed to recover the causal impact of the pandemic on students' current and expected outcomes. Results show large negative effects across many dimensions. Due to COVID-19: 13% of students have delayed graduation, 40% have lost a job, internship, or job offer, and 29% expect to earn less at age 35. Moreover, these effects have been highly heterogeneous. One quarter of students increased their study time by more than 4 hours per week due to COVID-19, while another quarter decreased their study time by more than 5 hours per week. This heterogeneity often followed existing socioeconomic divides. Lower-income students are 55% more likely than their higher-income peers to have delayed graduation due to COVID-19. Finally, we show that the economic and health related shocks induced by COVID-19 vary systematically by socioeconomic factors and constitute key mediators in explaining the large (and heterogeneous) effects of the pandemic.