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Coronavirus 2, universally known as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), was identified only a year ago as the causative agent of a new acute respiratory disease: the "coronavirus disease 2019" (COVID-19). The pathognomonic symptoms of COVID-19 are cough, fever, and dyspnea. To date, only two studies have been published to assess whether there are differences between the respiratory microbiota of healthy people and those with COVID-19, and in both cases the sample size was small. This chapter details these two studies. In any case, COVID-19 contains numerous aspects that constitute clear targets for the application of probiotics: the presence of diarrhea and other digestive symptoms in a high percentage of cases;modulation of the immune and inflammatory response to the virus;and so on. © 2023 John Wiley and Sons Ltd. Published 2023 by John Wiley and Sons Ltd.
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When the World Turned Upside Down is a collection of 66 essays and opinion columns written between 2019 and 2022, a period of momentous-some unimaginable-developments in the United States and across the world. This book stands at the intersection of opinion journalism, history, and chronicling offering a dialogue between past and present (or present and past). They are, to use the often-quoted phrase, first drafts of history. Over the past five years, the world has witnessed several "unimaginables" about which the author felt compelled to write. Some of the book's essays identify, analyze, and connect parallels between the U.S. Antebellum and Civil War and the contemporary increasingly polarized context that reached an explosive peak during the 2020 elections and the violent attack on the U.S. Capitol on January 6, 2021. Shrouded in a cloud of unprecedented global pestilence, the world has witnessed dramatic political and geopolitical change, mostly for the worse: China, Russia, Hungary, Belarus, Myanmar, Cuba, even Puerto Rico. Essays in this book discuss these transformations from a historical perspective as well as mass popular resistance, in places like Cuba, where they seemed unimaginable. The book's final section, "Not Boring at All: Globalization and World Politics," explores the global ramifications of the COVID-19 pandemic, geopolitical rearrangements related to China's meteoric ascendance as a world power, Russia's militaristic expansionism, and related topics. "In When the World Turned Upside Down, Luis Martínez-Fernández demonstrates that he is not 'merely' an acclaimed historian, but an engaging, sharp-witted social commentator. This excellent collection of columns, written during and about what Martínez-Fernández rightly terms 'the unimaginable events of 2019-2022,' is dazzling for his easy, readable blend of history, sociology, popular culture, politics and more." -Jeff Robbins, Columnist, Boston Herald and Creators Syndicate "Martínez-Fernández's book reads like a series of missives from the front, capturing the drama of unfolding, often unpredictable, events. The author is a master story-weaver, drawing from the warp and weft of our national and global histories to reveal patterns in today's events." -Suzette Martinez Standring, Author of The Art of Column Writing "Professor Martínez-Fernández fuses the perspective of a historian with a journalist's eye on wide-ranging contemporary events. The result is an exhilarating read and a broader understanding of today's world." -George Breslauer, Professor and Executive Vice Chancellor and Provost Emeritus, UC Berkeley. © 2023 Peter Lang Publishing, Inc. All rights reserved.
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Progressive respiratory failure is the primary cause of death in the coronavirus disease 2019 (COVID-19) pandemic. It is the final outcome of the acute respiratory distress syndrome (ARDS), characterized by an initial exacerbated inflammatory response and ultimate tissue scarring. Energy balance may be crucial for the recovery of clinical COVID-19. Hence, we asked if two key pathways involved in energy generation, AMP-activated protein kinase (AMPK)/acetyl-CoA carboxylase (ACC) signaling and fatty acid oxidation (FAO) could be beneficial. We tested the drugs Metformin (AMPk activator) and Baicalin (Cpt1A activator) in different experimental models mimicking COVID-19 associated inflammation in lung and kidney. We also studied two different cohorts of COVID19 patients that had been previously treated with Metformin. These drugs ameliorated lung damage in an ARDS animal model, while activation of AMPK/ACC signaling increased mitochondrial function and decreased TGF-beta-induced fibrosis, apoptosis and inflammation markers in lung epithelial cells. Similar results were observed with two new indole derivatives IND6 and IND8 with AMPK activating capacity. Consistently, a reduced stay in the intensive care unit was observed in COVID-19 patients previously exposed to Metformin. Baicalin also reduced kidney fibrosis in two animal models of kidney injury, another key target of COVID-19, while in vitro both drugs improved mitochondrial function and prevented TGF-beta-induced renal epithelial cell dedifferentiation. Our results support that strategies based on energy supply may prove useful in the prevention of COVID-19-induced lung and renal damage.Copyright © 2023
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Objectives: to evaluate the impact of the COVID-19 on the hospital key performance indicators using the diagnosis-related groups (DRG). To compare the results of the Angiology and Vascular Surgery Department of the University Hospital of Cabuenes (HUCAB) with the database of the Ministry of Health. Material(s) and Method(s): hospital discharges from the Vascular Surgery Department of the HUCAB during the years 2019, 2020 and 2021. All patients refined (APR)-DRG system was extracted for discharge coding. The hospital key indicators studied were: number of discharges, mortality, mean stay (EM) and mean weight (PM) of the DRG. The overall results per year and according to the most prevalent DRGs were studied. The results obtained were compared with the annual data from the coding of the Minimum Basic Data Set (CMBD) of the Ministry of Health. The configured EM by adjusting the performance of the standard (EMAF) and by the casuistry (EMAC), the index of the adjusted EM (IEMA), the functional index (FI), casuistic index (CI) and the number of avoidable hospital stays were also analyzed. Result(s): number of discharges: it was 10 % inferior in 2020 compared to 2019. Discharges of the GRD 181 linked to admissions from the Emergency increased more than 50 % during 2020 and more than 100 % in 2021 compared to 2019. Mortality: there was no significant increase. EM: it decreased 20 % in 2020 and 18 % in 2021, compared to 2019. PM: it increased progressively to 7.7% on average in 2021. EMAF: it was superior to standard EM. The number of stays saved was higher than expected. Conclusion(s): the pandemic of COVID-19 influenced the hospital key performance indicators studied, reducing the number of discharges and ME and increasing the PM of the DRGs. The number of avoidable stays saved was greater than the standard.© Copyright 2023 SEACV.
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Introduction: In Spain, influenza vaccination is available in companies free of charge for their workers. Despite this, vaccination coverage against influenza is very low in these groups. Objective(s): The aim of this work is to know the reasons for acceptance of influenza vaccination in a working population. Method(s): During the 2021-2022 influenza vaccination campaign, we conducted a survey of two groups of workers at the automobile factories of RENAULT ESPANA S.A. in the cities of Valladolid and Palencia (Spain). The first group (NV) was formed by 304 (33.5%) workers who did not receive the influenza vaccine in the previous season. The second (V) was formed by 604 workers (66.5%) who had been vaccinated against influenza at least the previous season. In the NV group, they were asked the reasons why they did not get vaccinated the previous season and if they did so in 2021-2022. In group V, only the reasons for continuing to be vaccinated were asked. Result(s): In NV, the main reason for avoiding vaccination in the previous season was the lack of perception of the severity of the influenza infection (74.7%), and 31.6% and 29.0% of them decided to get vaccinated during the 2021-2022 season due to the fear of co-infection of SARS-CoV-2 and influenza and medical recommendations respectively. The 83.5% of group V responded that the reason for getting vaccinated in 2021-2022 was their adherence to vaccination. Conclusion(s): The results show that medical recommendation is the best tool to vaccinate workers against influenza and make them adhere to it. Also, the fear to co-infection of COVID-19 and flu was a frequent reason for getting vaccinated, above all in NV.Copyright © 2023
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Ventilation in confined spaces is essential to reduce the airborne transmission of viruses responsible for respiratory diseases such as COVID-19. Mechanical ventilation using purifiers is an interesting solution for elevator cabins to reduce the risk of infection and improve the air quality. In this work, the optimal position and blowing direction of these devices to maximize ventilation and minimize the residence time of the air inside two cabins (large and small) is studied. Special attention is devoted to idle periods when the cabin is not used by the passengers, in order to keep the cabin ambient safe and clean, avoiding that the trapped air in the cabin (after its use) could suppose a reservoir for contaminants. CFD numerical models of two typical cabin geometries, including the discretization of small slots and grilles for infiltration, have been developed. A full 3D URANS approach with a k-epsilon RNG turbulence model and a non-reactive scalar to compute the mean age of air (MAA) was employed. The CFD results have been also validated with experimental measurements from a home-made 1:4 small-scale mock-up. The optimal position of the purifier is on the larger sidewall of the cabins for a downward blowing direction (case 1 of the database). Flow rates in the range of 0.4–0.6 m3/min, depending on the size of the cabin, are sufficient to assure a correct ventilation. Upward blowing may be preferable only if interaction of the jet core with the ceiling or other flow deflecting elements are found. In general, the contribution of infiltrations (reaching values of up to 10%), and how these secondary flows interact with the main flow pattern driven by the purifier, is relevant and not considered previously in the literature. Though an optimal position can improve ventilation considerably, it has been proven that a good choice of the purification flow rate is more critical to ensure an adequate air renewal. © 2022 The Authors
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Mitochondria surrounding lipid droplets (Peri-Droplet Mitochondria;PDM) maintain a unique proteome which is not equilibrated with the rest of the mitochondrial population. We find that PDM remain stationary and elongated on lipid droplets, fuel lipid droplet expansion, and do not fuse with cytosolic mitochondria. Compared to cytosolic mitochondria, PDM have higher capacity to metabolize pyruvate but reduced capacity to oxidize fatty acids. We reveal for the first time the mechanism by which the elongated mitochondrial shape of PDM differentiate their fuel preference from that of cytosolic mitochondria. We find that mitochondrial elongation reduces fatty acid utilization by inhibiting CPT1 activity. On the other hand, we find that mitochondrial fragmentation, such as observed in NASH, increases mitochondrial lipid utilization and may act as a compensatory mechanism to reduce lipotoxicity. Indeed, inhibition of fission in a model of NASH exacerbated NASH phenotype. We developed a cell-based imaging for the quantification of mitochondria-lipid droplet association and identified a set of small molecules that detach mitochondria from lipid droplets (PDM-Detachers). New unpublished data demonstrate PDM detachers induce lipolysis and lipid droplet shrinkage. Using these tools we assessed the role of lipid droplets in SARS-CoV2 expansion. We find that proliferation of various coronaviruses can be strongly inhibited by PDM-detachers and enhanced by attaching mitochondria to lipid droplets. We demonstrate that PDM can be found in humans. We studied adipose tissue from pheochromocytoma patients, a model of white adipose browning characterized by enhanced capacity for energy expenditure. Remarkably, bioenergetic changes associated with browning were primarily localized to PDM. Similar changes were found in a mouse model of re-browning, where PDM increased in whitened brown adipose tissue upon reducing housing temperature. Copyright © 2022
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Aims: It is known that there is a bidirectional relationship between diabetes mellitus (DM) and coronavirus disease (COVID-19). It has been described that those patients infected with SARS-CoV-2 could develop severe metabolic decompensation of pre-existing or new-onset DM, although diabetogenic effect of SARS-CoV-2 has still not been well consolidated. In fact, the coexistence of SARS-CoV-2 infection and new-onset DM is an infrequent situation. Method(s): We describe the clinical and analytical characteristics of 19 patients admitted to a Spanish tertiary hospital - all 19 having COVID-19 infection and new-onset DM. Result(s): 12/19 patients (63.2%) were female;the mean age at diagnosis of DM was 54 (39-65) years. The most frequent ethnic group was Caucasian (n=9), followed by Latin-American (n=7);7/19 (36.8%) previously met criteria for prediabetes due to altered basal glycaemia or HbA1c. The mean BMI at diagnosis was 32.26kg/m2 (27.62-35.18kg/m2). Eighteen of 19 patients (94.7%) showed bilateral bronchopneumonia. The mean blood glucose of the first blood was 17.5mmol/L (11.1-21.1mmol/L), and the mean HbA1c was 88mmol/mol (60-115mmol/mol). C-peptide was requested in eight patients and it was within normal range in 87.5% (n=7) and below the inferior threshold in one case. Autoantibodies were requested in 26.3% (five patients), being negative in 4/5 (80%) and positive in 1/5 (20%). Regarding the type of diabetes diagnosed, 18 were type 2 DM and only one case was diagnosed with type 1 DM. Seventeen had simple hyperglycaemia and two suffered a diabetic ketoacidosis. The mean HbA1c at 8.0 months (5.0-12.0 months) follow-up was 42mmol/mol (40-49mmol/mol). Conclusion(s): The majority of those described had type 2 DM that appears to have been unmasked by the COVID-19 infection, since they had high HbA1c and several risk factors for diabetes development, such as obesity and prediabetes. Most of them had their pancreatic reserve preserved, and this may suggest insulin resistance as the aetiology rather than direct beta-cell damage. A good evolution of diabetes after hospital discharge was observed in the patients followed up at our centre. Copyright © 2022 John Wiley & Sons. Copyright © 2022 John Wiley & Sons, Ltd.
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Introduction: COVID-19 vaccines have been related to immune mediated adverse events and recently some case reports of AAV precipitated after either RNA or viral vector vaccines have been reported. Case Description: A 83 year old woman with past records of polymyalgia rheumatica (2017) treated with low dose prednisone, was admitted to our hospital because of malaise, hyporexia and weight loss in the context of urinary symptoms. These started since the second COVID-19 Pfizer- BioNTech vaccine dose administred 3 months ago. Initial blood test revealed anemia, acute kidney injury (serum creatinine 1.7mg/dl), leucocytosis and elevated CRP. Urinalysis showed microhematuria and mild proteinuria in the context of a positive urine culture. She had normal kidneys on ultrasonography. Diuretics and antibiotics were started, but few days after renal function continued worsening (sCr 4,3 mg/dl) with an active sediment. For this reason, immunology tests were ordered with positive high MPO-ANCA antibodies. Hence, a kidney biopsy was performed showing 11 normal glomeruli but severe arteritis in two small-middle sized arterioles with fibrinoid necrosis. Steroids and Rituximab were given as induction therapy with good renal response. Discussion(s): AAV after COVID-19 vaccine administration has been reported previously, and it could be related to its molecular mimicry and immune crossreaction. Most of them were typical forms of pauci-immune crescentic glomerulonephritis, but none with isolated vascular damage. Although cases reported appeared shorter time after vaccine administration, our patient was on low dose prednisone which may explain a subacute onset of the disease. Moreover, she clearly presented constitutional sypmtoms ever since the second vaccine dose was administred. Finally, although the efficacy and safety of the COVID-19 vaccines have been demonstrated, particular attention should be paid to patients with known or suspected autoimmune diseases.
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La vacunación frente a COVID-19 en gestantes ha demostrado ser segura y eficaz en cualquier trimestre del embarazo. A pesar de ello, a lo largo de la pandemia se han identificado mujeres reticentes a la vacunación. El objetivo es exponer la implementación y los resultados de una campaña de captación (catch-up) frente a COVID-19 en gestantes. Métodos: Se realizó la revisión de la vacunación frente a COVID-19 en las mujeres con episodios activos de gestación en OMI-AP entre el 01/01/2019 y el 10/09/2021. Las gestantes que no estaban correctamente vacunadas (ninguna dosis administrada o pauta incompleta) recibieron por correo postal una carta nominal firmada por el Servicio de Medicina Preventiva y Salud Pública (MPySP) y el Servicio de Ginecología y Obstetricia (GyO) en la que se informaba sobre su situación vacunal y la importancia de recibir las vacunas. Asimismo, se les facilitaba un teléfono de contacto para solicitar cita y un correo electrónico para solucionar dudas. Resultados: Se evaluaron 722 mujeres, de ellas, 645 (89,34%) estaban correctamente vacunadas mientras que 77 (10,66%) mostraban vacunación incorrecta. En estas 77 mujeres se encontró que 60 (77,92%) no habían recibido ninguna vacuna, 11 (14,29%) registraban pauta incompleta, 3 (3,89%) las había recibido en otra comunidad autónoma y 3 (3,89%) había cursado COVID-19 antes de la primera dosis considerándose pauta completa. Tras el envío de las cartas se consiguió que de las 60 mujeres que habían rechazado, 28 (46,67%) iniciaran pauta y de las 11 (14,29%) que solo habían recibido una primera dosis se logró que 9 (81,82%) la completasen. Por tanto, de las 71 mujeres candidatas a mejorar su estado vacunal se realizó catch-up en 37 (52,11%). Conclusiones: La presente campaña de catch-up ha sido efectiva. Estas estrategias deben considerarse para mejorar las coberturas de vacunación de este colectivo.
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A pesar de las campañas oficiales de vacunación dirigidas a la población por parte de las autoridades sanitarias, aún se identifican personas que no han recibido ninguna dosis de vacuna o que registran pauta incompleta. El objetivo del presente trabajo es exponer la campaña de captación (catch-up) frente a COVID-19 en pacientes hospitalizados. Métodos: Se revisaron los calendarios de vacunación COVID-19 de los pacientes que estaban hospitalizados entre el 08/11/2021 y el 27/06/2022 justo en el momento en que el paciente se encontraba en el centro asistencial. En aquellos que no presentaban registro de vacunación COVID-19 o que presentaban pauta incompleta se registraba en la hoja de evolución clínica ofreciendo la vacuna COVID-19 durante la estancia hospitalaria o su programación tras el alta. El facultativo y la enfermera le trasladaban esta información al paciente haciendo hincapié en esta medida preventiva. Si el paciente accedía a vacunarse, se contactaba con la Unidad de Vacunas para proceder a la vacunación. Resultados: Se evaluaron un total de 2.961 pacientes. De ellos, 2.700 (91,18%) estaban correctamente vacunados según las indicaciones de vacunación vigentes. De los 261 (8,81%) restantes, 174 (66,66%) estaban pendientes de alguna dosis mientras que 87 (33,33%) habían rechazado vacunación. Tras registrar y ofrecerles la vacunación de manera oportunista a propósito de su hospitalización se consiguió que 66 (37,93%) de los que registraban vacunación incompleta continuaran con la pauta antes del alta hospitalaria y que 16 (18,39%) de los que habían rechazado previamente la vacunación, iniciaran la pauta durante su ingreso. La estrategia consiguió el catch-up frente a COVID-19 en 82 (31,41%) pacientes. Conclusiones: La presente campaña de catch-up se considera efectiva. La vacunación oportunista durante la hospitalización debe tenerse en cuenta como una estrategia útil para la mejora de las coberturas de vacunación globales.
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Introduction: White piedra is a rare superficial mycosis caused by the genus Trichosporon. Its prevalence is higher among tropical climates and predominantly affects children and women. Less than 17 cases have been described in Mexico, none of them in the Northeast region. We present the first case reported in this zone. Case presentation: A 27-year-old otherwise healthy woman presented to our clinic with a 1-month history of asymptomatic pseudonits on her scalp hair. Physical evaluation revealed numerous small white concretions over the majority of the hair shafts. At trichoscopic inspection, multiple white-yellowish ovoid nodules were observed. Direct microscopic examination with 20% potassium hydroxide (KOH) and blue cotton showed nodules composed of arthroconidia and hyphae over the hair shaft. Additionally, fungal culture was positive for Trichosporon inkin, confirming the diagnosis of white piedra. Treatment was initiated with ketoconazole shampoo and systemic itraconazole with favorable response. Discussion(s): Since the first case description by Beigel in Germany, most white piedra cases have been reported in tropical and humid climates. This mycosis typically affects females and subjects under 15 years of age. Some risk factors include poor hygiene, excess humidity, diabetes, and long, curly hair. In our case, the patient had curly hair and she constantly tied her hair up wet as she worked as a full-time nurse in a COVID-19 reference center. In our country, 50% of previous reported cases are from nontropical regions. Although infrequent in cosmopolitan areas in Northeast Mexico, white piedra should be considered in the differential diagnosis of pseudonits. Copyright © 2022
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Background: Patients with rheumatic diseases (RD) have been excluded from SARS-CoV-2 vaccine trials. Though data appear to show safety and efficacy, mostly evidence remains in mRNA vaccines. However in our country, adenovirus and inactivated vaccines, as well as heterologous schemes are frequently used. Objectives: To describe clinical characteristics and outcomes of SARS-CoV-2 infection after vaccination in patients with RD from de the SAR-CoVAC registry and to compare them with patients who got infected before vaccination. Additionally, factors associated with COVID-19 unfavorable outcome were assessed. Methods: Adult patients with RD who have been vaccinated for SARS-CoV-2 were consecutively included between June 1st and December 21st, 2021. Con-frmed SARS-CoV-2 infection (RT-PCR o serology) was reported by the treated physician. Infection after an incomplete scheme was defned when the event was diagnosed at least 14 days after frst dose;and after a complete scheme when it occurred > 14 days after second dose. Homologous scheme is defned by two same doses of vaccine and heterologous by two different doses. Patients with previous SARS-CoV-2 infection were excluded. To compare SARS-CoV-2 infection characteristics in not vaccinated patients, subjects from the SAR-COVID registry, which includes patients with RD and SARS-CoV-2 infection, were matched 2:1 by gender, age and RD. WHO-Ordinal Scale ≥5 was used to defne unfavorable infection outcome. Descriptive statics, Chi2 test, Fischer test, T test and ANOVA were used. Results: A total of 1350 patients from the SAR COVAC registry were included, 67 (5%) presented SARS-CoV-2 infection after vaccination. The later were mostly (72%) females with a mean age of 57 (SD 15) years old. The most frequent RD were rheumatoid arthritis (41%), psoriatic arthritis (12%) and systemic lupus erythematosus (10%). At vaccination, most of them (75%) had low disease activity or remission, 19% were taking steroids, 39% methotrex-ate, 27% bDMARDs and 6% JAK inhibitors. A total of 11 (16%) patients had SARS-CoV-2 infection <14 days after the frst vaccine dose, 39 (58%) after an incomplete scheme and 17 (25 %) following a complete one. In the incomplete scheme group, 59% received Gam-COVID-Vac, 31% ChAdOx1 nCov-19 and 10% BBIBP-CorV;and in patients with complete scheme 47%, 24% and 29%, respectively. No event was reported after a complete heterologous scheme. No signifcant differences regarding sociodemoghraphic characteristics, RD, disease treatment, type of vaccine and regimen was found between in those with infection and those without it. After vaccination only 8 (12%) of the patients who got infected had an unfavorable course, 88% of them following an incomplete scheme (5 received Gam-COVID-Vac, 1 ChAdOx1 nCov-19 and 1 BBIBP-CorV) and one subject after a complete homologous Gam-COVID-Vac scheme. Having an unfavorable outcome of SARS-CoV-2 infection was associated to: male gender [63% vs 24%, p=0.036], older age [mean 70 years (SD 7) vs 55 years (SD 15), p=0.005], being Caucasian [100% vs 54%, p=0.018], higher education [mean 17 years (SD 4) vs 12 years (SD 4), p=0.010], the presence of comorbid-ities [100% vs 39%, p=0.001, having pulmonary disease [37% vs 5%, p=0.019], dyslipidemia [63% vs 17%, p=0.011] and arterial hypertension [63% vs 24%, p=0.036], RD, treatments, disease activity and types of vaccines received were comparable between groups. When comparing patients with and without vaccination prior SARS-CoV-2 infection, those who received at least one dose of vaccine had less frequently severe COVID-19 (12% vs 24%, p=0.067) and presented lower mortality due to COVID-19 (3% vs 6%, p=0.498). However these differences did not reach statistical signifcance. Conclusion: In the SAR-CoVAC registry 5% of the patients had SARS-CoV-2 infection after vaccination, most of them mild and 25% after a complete scheme. Any vaccine was associated with severe COVID-19. When comparing with non-vaccinated patients, those with at least one dose, had less frequently severe disease and died due COVID-19.
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Background: Currently there is little information on the efficacy and safety of SARS-CoV-2 vaccination in patients with immune-mediated diseases and/or under immunosuppressive treatment in our country, where different types of vaccines and mix regimens are used. For this reason, the Argentine Society of Rheumatology (SAR) with the Argentine Society of Psoriasis (SOARPSO) set out to develop a national register of patients with rheumatic and immune-mediated infammatory diseases (IMIDs) who have received a SARS-CoV-2 vaccine in order to assess their efficacy and safety in this population. Objectives: To assess SARS-CoV-2 vaccine efficacy and safety in patients with rheumatic and IMIDs. Methods: SAR-CoVAC is a national, multicenter and observational registry. Adult patients with a diagnosis of rheumatic or IMIDs who have been vaccinated for SARS-CoV-2 were consecutively included between June 1st and September 17th, 2021. Sociodemographic data, comorbidities, underlying rheumatic or IMIDs, treatments received and their modifcation prior to vaccination and history of SARS-CoV-2 infection were recorded. In addition, the date and place of vaccination, type of vaccine applied, scheme and indication will be registered. Finally, adverse events (AE), as well as SARS-CoV-2 infection after the application of the vaccine were documented Results: A total of 1234 patients were included, 79% were female, with a mean age of 57.8 (SD 14.1) years. The most frequent diseases were rheumatoid arthritis (41.2%), osteoarthritis (14.5%), psoriasis (12.7%) and spondy-loarthritis (12.3%). Most of them were in remission (28.5%) and low disease activity (41.4%). At the time of vaccination, 21% were receiving glucocorti-coid treatment, 35.7% methotrexate, 29.7% biological (b) Disease Modifying Anti-Rheumatic Drugs (DMARDs) and 5.4% JAK inhibitors. Before vaccine application 16.9% had had a SARS-CoV-2 infection. Regarding the frst dose of the vaccine, the most of the patients (51.1%) received Gam-COV-ID-Vac, followed by ChAdOx1 nCoV-19 (32.8%) and BBIBP-CorV (14.5%). In a lesser proportion, BNT162b2 (0.6%), Ad26.COV2.S (0.2%) and Coro-naVac (0.2%) vaccines were used. Almost half of them (48.8%) completed the scheme, 12.5% were mix regimenes, the most frequent being Gam-COVID-Vac/mRNA-1273. The median time between doses was 51days (IQR 53). More than a quarter (25.9%) of the patients reported at least one AE after the frst dose and 15.9% after the second. The fu-like syndrome and local hypersensitivity were the most frequent manifestations. There was one case of mild anaphylaxis. No patient was hospitalized. Altogether, the incidence of AE was 246.5 events/1000 doses. BBIBP-CorV presented signifcantly lower incidence of AE in comparison with the other types of vaccines. (118.5 events/1000 doses, p<0.002 in all cases) Regarding efficacy, 63 events of SARS-CoV-2 infection were reported after vaccination, 19% occurred before 14 days post-vaccination, 57.1% after the frst dose (>14 days) and 23.8% after the second. In most cases (85.9%) the infection was asymptomatic or had an outpatient course and 2 died due to COVID-19. Conclusion: In this national cohort of patients with rheumatic and IMIDs vaccinated for SARS-CoV-2, the most widely used vaccines were Gam-COVID-Vac and ChAdOx1 nCoV-19, approximately half completed the schedule and in most cases homologously. A quarter of the patients presented some AE, while 5.1% presented SARS-CoV-2 infection after vaccination, in most cases mild.
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Purpose: In recent years, consumers have been demanding for sustainable practices, even more so after COVID-19, so fashion companies need to intensify their commitment to corporate social responsibility (CSR) practices. However, although the sector is characterized by a strong brand–customer orientation and high online activity, little attention has been paid to the role of brand image and the management of social media (SM) strategies. The purpose of this study was to develop an integrative model that includes the drivers of CSR in fashion small- and medium-sized enterprises (SMEs) and their relationship with business performance. The researchers also analyzed the country and level of internationalization effects of these companies. Design/methodology/approach: With a sample of 212 fashion SMEs from Spain and the UK, two of the biggest European fashion producers and consumers, a variance-based structural equation modeling (partial least squares structural equation modeling) technique was carried out to test the model proposed. Findings: This study demonstrated that branding and SM strategies are drivers of CSR practices in fashion SMEs. It also confirmed the positive CSR–performance relationship, the moderating country effect and the mediating role of internationalization in this relationship. Originality/value: The study contributes to the literature on CSR drivers in SMEs and their relationship with performance by combining different perspectives. The results can be used to encourage fashion SMEs' commitment to environmental sustainability practices and internationalization, as this can contribute to improving their performance. © 2022, Emerald Publishing Limited.
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Purpose or Objective The surface-guided radiotherapy (SGRT) VisionRT® system uses a combination of real-time optical and laserbased imaging to accurately position patients receiving radiotherapy. The aim of this study is to analyse the implementation efficiency of SGRT in four Genesis Care radiotherapy centers in Spain and to collect the RTT impressions regarding this system. Materials and Methods The system was implemented at GenesisCare facilities in Madrid, Barcelona, Alicante, and Málaga starting on August 15, 2020. Prior to this implementation, the centers were trained in a training program consisting of: A) An online course;B) A didactic weekend course;and C) Go live supervision during the first treatments for three days. The course was delivered by an expert VisionRT® trainer and a qualified radiotherapy technician. After two months of implementation, we collected the diagnostic and staging information of patients treated with the VisionRT system between the go live and October 16,2020. To evaluate the efficacy, we considered a goal of patients with SGRT in the practice: > 75% High, 75%- 50%: moderate, < 50%: low. Tattoo base method set up was allow for head and neck immobilization, skin cancer or clinician discretion. A questionnaire was carried out to the RTT working in these centers. The questionnaire contained a 1-5 satisfaction scale asking about the SGRT system: 1. very poor;2. poor;3. fair;4. good;or 5. very good regarding six points. These were safety (patient ID recognition), set up (precision increase, time reduction), management (no covid contact), confidence (technique), improvement (daily practice), and patient satisfaction (RTT point of view). Results 93.4 % of the patients in these four centers were positioned under SGRT conditions, and 6.6 % were positioned with a tattoo-based method. OF the total of 295 patients with SGRT, 212 of them were positioned without tattoos. The evaluated patients have breast cancer (43.0%), prostate cancer (18.6%), metastatic cancer (8.1 %) or lung cancer (5.4%). 21 RTT responded to the questionnaire. Results are as follows: 1. Safety: 61.9% very good and 38.1% good;2. Set-up: 61.9% very good, 28.6% good, and 9.5% moderate;3. Accuracy increase: 42.8% very good, 19% good, 28.6% fair, 4.8% poo,r and 4.8% very poor;4. Management (contactless COVID): 47.6% very good, 14.3% good, 23.8% fair, and 14.3% poor;5. Confidence (real time): 9.6% very good, 47.6% good, 33.2% fair, and 9.6% poor;5. Improvement: 52.4% very good, 23.8% good, 23.8% fair;6. Patient satisfaction with tattoo less from the technician point of view: 90.4% very good, 4.8% good, and 4.8% moderate. Conclusion The implementation of SGRT was carried out with high efficiency considering that 93,4% of care were delivered with this technique. RTT consider this technique very good for safety, accuracy, confidence, and improvement in the daily practice.