A deep look into the storm: Israeli multi-center experience of coronavirus disease 2019 (COVID-19) in patients with autoimmune inflammatory rheumatic diseases before and after vaccinations.

Objective: We aimed to characterize the course of COVID-19 in autoimmune inflammatory rheumatic disease (AIIRD) patients in Israel, taking into consideration several remarkable aspects, including the outcomes of the different outbreaks, the effect of vaccination campaigns, and AIIRD activity post-recovery. Methods: We established a national registry of AIIRD patients diagnosed with COVID-19, including demographic data, AIIRD diagnosis, duration and systemic involvement, comorbidities, date of COVID-19 diagnosis, clinical course, and dates of vaccinations. COVID-19 was diagnosed by a positive SARS-CoV-2 polymerase chain reaction. Results: Israel experienced 4 outbreaks of COVID-19 until 30.11.2021. The first three outbreaks (1.3.2020 - 30.4.2021) comprised 298 AIIRD patients. 64.9% had a mild disease and 24.2% had a severe course; 161 (53.3%) patients were hospitalized, 27 (8.9%) died. The 4th outbreak (delta variant), starting 6 months after the beginning of the vaccination campaign comprised 110 patients. Despite similar demographic and clinical characteristics, a smaller proportion of AIIRD patients had negative outcomes as compared to the first 3 outbreaks, with regards to severity (16 patients,14.5%), hospitalization (29 patients, 26.4%) and death (7 patients, 6.4%). COVID-19 did not seem to influence the AIIRD activity 1-3 months post-recovery. Conclusions: COVID-19 is more severe and has an increased mortality in active AIIRD patients with systemic involvement, older age and comorbidities. Vaccination with 3 doses of the mRNA vaccine against SARS-CoV-2 protected from severe COVID-19, hospitalization and death during the 4th outbreak. The pattern of spread of COVID-19 in AIIRD patients was similar to the general population.

Features of Medical Care Providing to Patients with Digestive Diseases in the Krasnodar Region during the COVID-19 Pandemic

The aim of the study: optimization the medical care provision to patients with diseases of the digestive system (DD) in the Krasnodar Region during the COVID-19 pandemic. Material and methods. The analysis of the features of the DD course in the Krasnodar Region was carried out according to the data of form C 51 "Distribution of the dead by sex, age groups and causes of death” of the Territorial Federal State Statistics Service in the Krasnodar Region, as well as monitoring the quality of medical care for patients with DD for the period from 2019 to 2021 years. Results. During the COVID-19 pandemic, the routing of gastroenterological patients, dispensary observation and preventive measures have undergone some changes. In the structure of total mortality in the Krasnodar Region, mortality from DD was 21.6 % in 2020 and 4.0 % in 2021. The decrease in the growth of mortality rate, including from DD, in the second year of the pandemic is associated with the completed healthcare systems reformatting. The increase in hospital mortality in patients with gastric and duodenal ulcers, ulcerative colitis, and diverticular disease had a significant impact on mortality rates from DD. The decreasing number of hospitalizations was explained due to the conversion of a number of hospitals into hospitals for the treatment of patients with COVID-19. The hospitalization was mainly carried out for emergency indications and patients with a more severe course of the disease. The pandemic has increased the need for telemedicine: 378 tele-consultations on the gastroenterological profile was carried out in the Krasnodar Region in 2021. Conclusion. Healthcare system workload in the Krasnodar Region increased significantly during the coronavirus pandemic that required a number of structural adjustments. In recent times, the regional health care is returning to the planned mode of providing medical care. © 2022 Russian Journal of Gastroenterology, Hepatology, Coloproctology

Misinfo Reaction Frames: Reasoning about Readers' Reactions to News Headlines

Even to a simple and short news headline, readers react in a multitude of ways: cognitively (e.g. inferring the writer's intent), emotionally (e.g. feeling distrust), and behaviorally (e.g. sharing the news with their friends). Such reactions are instantaneous and yet complex, as they rely on factors that go beyond interpreting factual content of news. We propose Misinfo Reaction Frames (MRF), a pragmatic formalism for modeling how readers might react to a news headline. In contrast to categorical schema, our free-text dimensions provide a more nuanced way of understanding intent beyond being benign or malicious. We also introduce a Misinfo Reaction Frames corpus, a crowdsourced dataset of reactions to over 25k news headlines focusing on global crises: the Covid-19 pandemic, climate change, and cancer. Empirical results confirm that it is indeed possible for neural models to predict the prominent patterns of readers' reactions to previously unseen news headlines. Additionally, our user study shows that displaying machine-generated MRF implications alongside news headlines to readers can increase their trust in real news while decreasing their trust in misinformation. Our work demonstrates the feasibility and importance of pragmatic inferences on news headlines to help enhance AI-guided misinformation detection and mitigation.

Multidrug-Resistant Klebsiella pneumoniae in a Patient with SARS-Cov-2 Pneumonia in an Intensive Care Unit in Guayaquil, Ecuador: A Case Report.

BACKGROUND Multi-resistant microorganisms are a public health problem. Their incidence has risen due to COVID-19, indiscriminate antibiotics use, corticosteroid treatments, and higher admissions to intensive care units (ICUs) of patients requiring invasive mechanical ventilation. These are risk factors for bacterial over-infection. The present case study that is relevant because of the multiple isolated strains with a resistance pattern: Klebsiella pneumoniae carbapenemases (KPC), extended-spectrum beta lactamases (ESBL) and New Delhi metallo-ß-lactamase (NDM) in a patient without comorbidities. CASE REPORT A 53-year-old Ecuadorian man with no past medical history arrived at the Emergency Department (ED) with dyspnea, nasopharyngeal swab with a positive reverse transcription polymerase chain reaction (RT-PCR) test for SARS-CoV2, and a chest computed tomography (CT) scan showing bilateral ground-glass pulmonary infiltrates with 40% involvement. On day 10 in the ICU, the presence of Klebsiella pneumoniae KPC strain was reported in an axillary swab culture. Consequently, the antibiotic was rotated to vancomycin 1 g intravenously (i.v.) every 12 h and meropenem 1 g i.v. every 8 h. On day 15 in the ICU, a tracheal secretion culture was reported with the presence of Klebsiella pneumoniae ESBL and a blood culture with Klebsiella pneumoniae NDM. CONCLUSIONS The COVID-19 pandemic is a perfect scenario for superinfection with multi-resistant pathogens such as carbapenem-resistant Klebsiella pneumoniae (CRKP), due to the increase in patients admitted to ICUs requiring invasive mechanical ventilation, the use of corticosteroids, and empirical broad-spectrum antibiotic management based on guidelines. The emergence of combined multidrug-resistant strains is a challenge for laboratory detection and the selection of antimicrobial treatment.

Probing the Conformational States of Thimet Oligopeptidase in Solution.

Thimet oligopeptidase (TOP) is a metallopeptidase involved in the metabolism of oligopeptides inside and outside cells of various tissues. It has been proposed that substrate or inhibitor binding in the TOP active site induces a large hinge-bending movement leading to a closed structure, in which the bound ligand is enclosed. The main goal of the present work was to study this conformational change, and fluorescence techniques were used. Four active TOP mutants were created, each equipped with a single-Trp residue (fluorescence donor) and a p-nitro-phenylalanine (pNF) residue as fluorescence acceptor at opposite sides of the active site. pNF was biosynthetically incorporated with high efficiency using the amber codon suppression technology. Inhibitor binding induced shorter Donor-Acceptor (D-A) distances in all mutants, supporting the view that a hinge-like movement is operative in TOP. The activity of TOP is known to be dependent on the ionic strength of the assay buffer and D-A distances were measured at different ionic strengths. Interestingly, a correlation between the D-A distance and the catalytic activity of TOP was observed: the highest activities corresponded to the shortest D-A distances. In this study for the first time the hinge-bending motion of a metallopeptidase in solution could be studied, yielding insight about the position of the equilibrium between the open and closed conformation. This information will contribute to a more detailed understanding of the mode of action of these enzymes, including therapeutic targets like neurolysin and angiotensin-converting enzyme 2 (ACE2).

Abnormal Echocardiographic Findings in Hospitalized Patients with Covid-19: A Systematic Review and Meta-analysis. / Achados Ecocardiográficos Anormais em Pacientes Internados com Covid-19: Uma Revisão Sistemática e Metanálise.

BACKGROUND: Coronavirus disease 2019 (Covid-19) can lead to severe respiratory distress and acute cardiac injury, but it is unclear how often it can cause cardiac dysfunction. OBJECTIVE: In this systematic review, we aimed to summarize the main echocardiographic findings in patients with Covid-19. METHODS: We systematically searched in PUBMED, EMBASE, LILACS and Cochrane databases, in addition MedRxiv and Scielo preprints from inception to July 21st, 2021. Studies reporting echocardiographic data in patients with Covid-19 were included. Demographic characteristics, previous cardiovascular disease (CVD), and echocardiographic findings were extracted. We performed a meta-analysis of proportions to estimate the main echocardiographic findings. The level of significance was p < 0.05. RESULTS: From 11,233 studies, 38 fulfilled inclusion criteria and were included in the meta-analysis. The estimated proportions of left ventricular (LV) systolic dysfunction were 25% (95%CI: 19, 31; I293%), abnormal global longitudinal strain 34% (95% CI 23, 45; I290%), righ ventricular (RV) systolic dysfunction 17% (95%CI 13, 21; I290%), pericardial effusion 17% (95%CI: 9, 26; I297%), and pulmonary hypertension 23% (95%CI: 15, 33, I2 96%). LV systolic dysfunction was directly associated with study-specific prevalence of previous abnormal echocardiogram (p<0.001). The proportion of patients in mechanical ventilation, indicating severity of disease, did not explain the heterogeneity in the proportions of LV dysfunction (p=0.37). CONCLUSION: Among hospitalized patients with Covid-19, LV dysfunction has been reported in one quarter, with smaller proportions of right ventricular dysfunction, pericardial effusion and pulmonary hypertension. However, there was a higher proportion of LV dysfunction among studies reporting the presence of prior heart disease, which suggests that cardiac dysfunction was mostly pre-existing.

FUNDAMENTOS: A doença do coronavírus 2019 (Covid-19) pode levar à insuficiência respiratória grave e lesão cardíaca aguda, mas não está claro com que frequência ela pode causar disfunção cardíaca. OBJETIVOS: Nesta revisão sistemática, nosso objetivo foi resumir os principais achados ecocardiográficos em pacientes com Covid-19. MÉTODOS: Conduzimos uma busca sistemática nos bancos de dados PUBMED, EMBASE, LILACS e Cochrane, além de artigos não pulicados ( preprints ) no MedRxiv e Scielo desde o início até 21 de julho de 2021. Foram incluídos estudos que apresentaram dados ecocardiográficos de pacientes com Covid-19. Características demográficas, doença cardiovascular (DCV) prévia, e achados ecocardiográficos foram extraídos dos estudos. Realizamos uma metanálise de proporções para estimar os principais achados ecocardiográficos. O nível de significância foi p<0,05. RESULTADOS: Do total de 11 233 estudos, 38 preencheram os critérios de inclusão e foram incluídos na metanálise. A proporção estimada de disfunção sistólica do ventrículo esquerdo (VE) foi 25% (IC95%: 19, 31; I2 93%), strain longitudinal global anormal 34% (IC95% 23, 45; I2 90%), disfunção sistólica do ventrículo direito (VD) 17% (IC95% 13, 21; I2 90%), derrame pericárdico 17% (IC95%: 9, 26; I2 97%), e hipertensão pulmonar 23% (IC95%: 15, 33, I2 96%). Disfunção sistólica do VE foi diretamente associada com prevalência de ecocardiograma anormal prévio nos estudos (p<0,001). A proporção de pacientes em ventilação mecânica, indicando gravidade da doença, não explicou a heterogeneidade nas proporções de disfunção do VE (p=0,37). CONCLUSÃO: Entre os pacientes internados com Covid-19, a disfunção ventricular esquerda foi descrita em um quarto dos pacientes, com menores proporções de disfunção do ventrículo direito, derrame pericárdico e hipertensão pulmonar. No entanto, houve uma proporção mais alta de disfunção do VE nos estudos que relataram presença de doença cardíaca prévia, sugerindo que a disfunção cardíaca era predominantemente pré-existente.

The Spike Protein of SARS-CoV-2 Is Adapting Because of Selective Pressures.

The global scale of the COVID-19 pandemic has demonstrated the evolution of SARS-CoV-2 and the clues of adaptation. After two years and two months since the declaration of the pandemic, several variants have emerged and become fixed in the human population thanks to extrinsic selective pressures but also to the inherent mutational capacity of the virus. Here, we applied a neutral substitution evolution test to the spike (S) protein of Omicron's protein and compared it to the others' variant of concern (VOC) neutral evolution. We carried out comparisons among the interactions between the S proteins from the VOCs (Alpha, Beta, Gamma, Delta and Omicron) and the receptor ACE2. The shared amino acids among all the ACE2 binding S proteins remain constant, indicating that these amino acids are essential for the accurate binding to the receptor. The complexes of the RBD for every variant with the receptor were used to identify the amino acids involved in the protein-protein interaction (PPI). The RBD of Omicron establishes 82 contacts, compared to the 74 of the Wuhan original viral protein. Hence, the mean number of contacts per residue is higher, making the contact thermodynamically more stable. The RBDs of the VOCs are similar in sequence and structure; however, Omicron's RBD presents the largest deviation from the structure by 1.11 Å RMSD, caused by a set of mutations near the glycosylation N343. The chemical properties and structure near the glycosylation N343 of the Omicron S protein are different from the original protein, which provoke reduced recognition by the neutralizing antibodies. Our results hint that selective pressures are induced by mass vaccination throughout the world and by the persistence of recurrent infections in immunosuppressed individuals, who did not eliminate the infection and ended up facilitating the selection of viruses whose characteristics are different from the previous VOCs, less pathogenic but with higher transmissibility.

Evaluation of the Access Bio CareStart™ Rapid SARS-CoV-2 Antigen Test in Asymptomatic Individuals Tested at a Community Mass-testing Program in Western Massachusetts

Background. Point-of-care antigen-detecting rapid diagnostic tests (RDTs) to detect Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) represent a scalable tool for surveillance of active SARS-CoV-2 infections in the population. Data on the performance of these tests in real-world community settings will be paramount for their implementation to combat the COVID-19 pandemic. Methods. We evaluated the performance characteristics of the CareStartTM COVID-19 Antigen Test (CareStart) in a community testing site in Holyoke, Massachusetts. We compared CareStart to a SARS-CoV-2 reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) reference, both using anterior nasal swab samples. We calculated the sensitivity, specificity, and the expected positive and negative predictive values at different SARS-CoV-2 prevalence estimates. Results. We performed 666 total tests on 591 unique individuals. 573 (86%) were asymptomatic. There were 52 positive tests by RT-qPCR. The sensitivity of CareStart was 49.0% (95% Confidence Interval (CI): 34.8 - 63.4) and specificity was 99.5% (95% CI: 98.5 - 99.9). Among positive RT-qPCR tests, the median cycle threshold (Ct) was significantly lower in samples that tested positive on CareStart. Using a Ct less than or equal to 30 as a benchmark for positivity increased the sensitivity of the test to 64.9% (95% CI: 47.5 - 79.8). Performance characteristics of CareStart test results benchmarked against the RT-qPCR gold standard (excluding undetermined results). Examples of images of CareStart rapid test showing variable band intensities. N2 gene RT-qPCR Cycle threshold (Ct) values corresponding to positive and negative CareStart rapid antigen test results for all RT-qPCR positive samples (n=52). Conclusion. Our study shows that CareStart has a high specificity and moderate sensitivity. The utility of RDTs, such as CareStart, in mass implementation should prioritize use cases in which a higher specificity is more important, such as triage tests to rule-in active infections in community surveillance programs.

Social presence in times of covid-19 distance teaching

This paper presents a qualitative research study at an Austrian teacher training university. After having a look at the basic terms of Emergency Remote Teaching (ERT) and the concept of social presence, the study which was carried out from April to November 2020 is presented. Pre-service teachers were interviewed at two points of time (spring and fall 2020) about their experience with regards to switching all courses to Emergency Remote Teaching (which means changing from classroom teaching to online-teaching due to Covid-19 regulations). The interviews focused on the experience of social presence which means the perception of other people (university teachers and students) as individuals. The results show that students experienced changing to distance teaching as quite positive at the beginning. However, they suffered from lack of synchronous exchange. This is especially due to the fact that not all university teachers could cope with ERT and were not tangible for the students. Although the results are not representative, they give some interesting insight into the conditions under which online learning can be successful. © the authors, 2021. All Rights Reserved.

Biological markers and follow-up after discharge home of patients with COVID-19 pneumonia

Background and objective. We aimed to analyze the clinical course of patients discharged from our emergency departament (ED) with pneumonia symptoms compatible with a diagnosis of COVID-19. Methods. We followed 102 patients discharged home with a diagnosis of pneumonia compatible with COVID19 between March 12 and 21, 2020, in our hospital in the southern part of the autonomous community of Madrid. Descriptive statistics (medians and interquartile ranges or frequencies, as appropriate) were compiled for the main variables. Treatments and prognoses were compared with chi(2), Kruskal Wallis, or Mann Whitney tests. The data then underwent logistic regression analysis. Results. Most patients (accounting for 74.5% of the discharges) were treated with hydroxychloroquine alone. The readmission rate was 15.7%;the ED revisiting rate was 25.7%. Admission was associated with an elevated lactate dehydrogenase (LDH) level (P=.011), elevated creatine kinase (CK) (P=.004), and lymphopenia (P=.034). Hypertension and chronic obstructive pulmonary disease were also related to admission. lschemic heart disease was associated with longer duration of symptoms. Conclusions. Lymphopenia, and elevated LDH and CK levels predicted the need for hospital admission better than other traditional biological markers in patients with mild to moderate symptoms. Telephone follow-up proved useful for dealing with the overloading of health care services.

Social distancing and bacteraemia in the time of COVID-19.

BACKGROUND: Social distancing was the predominant strategy used to mitigate the spread of Coronavirus disease 2019 (COVID-19) at the start of the COVID-19 pandemic. AIMS: To study the impact of social distancing on the incidence of bacteraemia. The number of admitted patients with positive blood cultures in April-May 2020 in one tertiary medical centre was compared with the number during the same period in the previous 3 years (April-May 2017-2019). METHODS: Retrospective review of all positive blood cultures from January to July in the years 2017-2020. RESULTS: There were fewer cases of Streptococcus bacteraemia as well as coagulase-negative Staphylococcus bacteraemia and other possible contaminated blood cultures in April-May 2020. Compared with the previous 3 years, the incidence of Streptococcus pneumoniae bacteraemia among all bacteraemias was lower in April-May 2020 (5%) than in 2017-2019 (12.0%; 95% confidence interval 10.3-14.1%). In general, fewer cases of bacteraemia caused by oropharynx organisms were observed in April-May 2020; only 6 cases versus 31 (95% confidence interval 10-53) during the same period in 2017-2019. Only one case of S. pneumoniae bacteraemia was observed in April-May 2020 and its percentage among all bacteraemias was lower in April-May 2020 (0.4%) than during the same period in 2017-2019 (3.3%). CONCLUSION: The incidences of streptococcal bacteraemia and bacteraemia of organisms transmitted through respiratory secretions were lower when there were social distancing restrictions. Adopting measures of social distancing may decrease the morbidity from bacteraemia caused by oropharynx and respiratory bacteria.

Neutral evolution test of the spike protein of SARS-CoV-2 and its implications in the binding to ACE2.

As the SARS-CoV-2 has spread and the pandemic has dragged on, the virus continued to evolve rapidly resulting in the emergence of new highly transmissible variants that can be of public health concern. The evolutionary mechanisms that drove this rapid diversity are not well understood but neutral evolution should open the first insight. The neutral theory of evolution states that most mutations in the nucleic acid sequences are random and they can be fixed or disappear by purifying selection. Herein, we performed a neutrality test to better understand the selective pressures exerted over SARS-CoV-2 spike protein from homologue proteins of Betacoronavirus, as well as to the spikes from human clinical isolates of the virus. Specifically, Tyr and Asn have higher occurrence rates on the Receptor Binding Domain (RBD) and in the overall sequence of spike proteins of Betacoronavirus, whereas His and Arg have lower occurrence rates. The in vivo evolutionary phenomenon of SARS-CoV-2 shows that Glu, Lys, Phe, and Val have the highest probability of occurrence in the emergent viral particles. Amino acids that have higher occurrence than the expected by the neutral control, are favorable and are fixed in the sequence while the ones that have lower occurrence than expected, influence the stability and/or functionality of the protein. Our results show that most unique mutations either for SARS-CoV-2 or its variants of health concern are under selective pressures, which could be related either to the evasion of the immune system, increasing the virus' fitness or altering protein - protein interactions with host proteins. We explored the consequences of those selected mutations in the structure and protein - protein interaction with the receptor. Altogether all these forces have shaped the spike protein and the continually evolving variants.

Efficacy of Proxalutamide in Hospitalized COVID-19 Patients: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Design Clinical Trial (preprint)

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectivity is mediated by the androgen-promoted protease, transmembrane protease, serine 2 (TMPRSS2). Previously, we have shown that treatment with proxalutamide, a non-steroidal androgen receptor antagonist, accelerates viral clearance and clinical remission in outpatients with coronavirus disease 2019 (COVID-19) compared to placebo. The effects in hospitalized COVID-19 patients were unknown. Methods: Men and women hospitalized but not requiring mechanical ventilation were randomized (1:1 ratio) to receive 300 mg of proxalutamide per day or placebo for 14 days. The study was conducted at eight sites in the state of Amazonas, Brazil. The primary outcome measure was the clinical status (8-point ordinal scale) at 14-days post-randomization. The primary efficacy endpoint was the 14-day recovery ratio (alive hospital discharge [scores 1, 2]). Findings: A total of 645 patients were randomized (317 received proxalutamide, 328 placebo) and underwent intention-to-treat analysis. The 14-day median ordinal scale score in the proxalutamide group was 1 (interquartile range [IQR]=1-2) versus 7 (IQR=2-8) for placebo, P<0.001. The 14-day recovery rate was 81.4% for proxalutamide and 35.7% for placebo (recovery ratio, 2.28; 95% CI 1.95-2.66 [P<0.001]). The 28-day all-cause mortality rate was 11.0% for proxalutamide versus 49.4% for placebo (hazard ratio, 0.16; 95% CI 0.11-0.24). The median post-randomization time to recovery was 5 days (IQR=3-8) for proxalutamide versus 10 days (IQR=6-15) for placebo. Interpretation: Hospitalized COVID-19 patients not requiring mechanical ventilation receiving proxalutamide had a 128% higher recovery rate than those treated with placebo. All-cause mortality was reduced by 77.7% over 28 days. (ClinicalTrials.gov number, NCT04728802).

Multicenter assessment of capabilities, effectiveness and safety of single operatorperoral transpapillary cholangiopancreaticoscopy

Aims Assessment of the capabilities of the SpyGlass system in the diagnosis and treatment of diseases of the pancreato-biliary zone. Methods From 12.2017 to 12.2020 we performed 191 single operator cholangiopancreatoscopies (SOC) in 188 patients(m-83, f-108;ranged 25-89 years;average age 57.2±32 years) using SpyGlass (Boston Scientific) in 4 leading Russianhospitals. All patient and cholangiopancreatoscopy data were recorded in the national registry. There were 164cholangioscopies and 27 pancreatoscopies. The indications for cholangioscopy were: undifferentiated strictures (97/188-51.6 %), large stones (42/188-22.3 %), “difficult strictures”, when it was impossible guidewire installation with traditionalway (15/188-8 %), postoperative benign strictures with ligatures and clips (11/188-5.8 %);for pancreaticoscopy-undifferentiated pancreatic strictures (13/188-6.9 %), morphologic verification of IPMN (3/188-1.6 %), large virsungolites(8/188-4.2 %) and assessment of the spread of major papilla adenoma on pancreatic duct (2/188-1.1 %). Results The overall technical success of SOCs was 96.3 % (184/191). Intraductal biopsy was successful in 85/87-97.7 %cases. Cholangiocarcinoma was obtained in 52(61.2 %) cases, benign strictures-in others. Therapeutic interventions weresuccessful in 64/70-91.4 % cases (laser lithotripsy of bile duct stones-14/15, electrohydraulic lithotripsy of bile ductstones-14/15 and of pancreatic duct stones-4/7, guidewire placement under visual control and further stenting-22/22,removal of ligatures(7) and clips(4) of bile duct-11/11). We had 7(3.8 %) complications-acute pancreatitis(3),bleeding(1) and cholangitis(3). Lethal outcomes after retrograde interventions not directly related to the SOC itself occurredin 2(1.1 %) patients at 5(ongoing pancreatic necrosis) and 3 day(multiple organ failure associated with COVID-19) afterERCP. Conclusions The opportunity of widespread use of SOC system in daily work for direct endoscopic examination of ductalsystems and performing invasive interventions under direct visual control provides new opportunities for increasing thelevel of diagnosis and the effectiveness of therapeutic interventions up to 96.3 %, without increasing the number of side effects during retrograde interventions.

The mental health benefits of physical activity in older adults survive the COVID-19 pandemic

Objective: To determine the relationship between the amount and intensity of physical activity performed by older adults in North America (United States and Canada) and their depression and anxiety symptoms while currently under social distancing guidelines (SDG) for the COVID-19 pandemic. Design: Descriptive cross-sectional study. Setting: Online survey conducted between April 9 and April 30, 2020, during the COVD-19 pandemic. Participants: About 1,046 older adults over the age of 50 who live in North America. Measurements: Participants were asked about their basic demographic information, current health status, and the impact of the current SDG on their subjective state of mental health. Participants completed the Physical Activity Scale for the Elderly, to determine the amount and intensity of physical activity performed, as well as both the Geriatric Depression Scale and Geriatric Anxiety Scale, to ascertain the extent of their depression and anxiety-like symptoms. Results: Ninety-seven percent of participants indicated that they adhered to current SDG "Most of the time" or "Strictly." Participants who performed greater levels of physical activity experienced lower levels of depression-like symptoms when age, sex, and education were accounted for;however, no relationship between physical activity and anxiety-like symptoms was found. A hierarchical regression analysis that incorporated the intensity of physical activity performed (light, moderate, and vigorous) in the model indicated that greater light and strenuous activity, but not moderate, predicted lower depression-like symptoms. Conclusions: These results suggest that performing even light physical activity during the COVID-19 pandemic may help alleviate some of the negative mental health impacts that older adults may be experiencing while isolated and adhering to SDG during the COVID-19 pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Neutral evolution test of the spike protein of SARS-CoV-2 and its implications in the binding to ACE2 (preprint)

As the SARS-CoV-2 has spread and the pandemic has dragged on, the virus continued to evolve rapidly resulting in the emergence of new highly transmissible variants that can be of public health concern. The evolutionary mechanisms that drove this rapid diversity are not well understood but neutral evolution should open the first insight. The neutral theory of evolution states that most mutations in the nucleic acid sequences are random and they can be fixed or disappear by purifying selection. Herein, we performed a neutrality test to better understand the selective pressures exerted over SARS-CoV-2 Spike protein, as well as in four of the identified health concern variants. Lys and Thr have higher occurrence rate on the Receptor Binding Domain (RBD) than in the overall sequence whereas Cys, His, and importantly Arg have low occurrence rate both in the whole protein and the RBD. Amino acids that have lower occurrence than the expected neutral control influence in the stability and or functionality of the protein. Our results show that most unique mutations either for SARS-CoV-2 or the variants of health concern are under selective pressures, which could be related either to the evasion of the immune system, increasing the virus’ fitness or altering protein – protein interactions with host proteins. Altogether all these forces have shaped the Spike protein. Understanding the evolutionary forces that act upon Spike protein may help designing better treatments and vaccines that target variants of health concern.

Comparison of viral loads in individuals with or without symptoms at time of COVID-19 testing among 32,480 residents and staff of nursing homes and assisted living facilities in massachusetts

Background. Transmission of COVID-19 from people without symptoms confounds public health containment strategies. Comprehensive cross-sectional screening enables assessment of viral load independent of symptoms, informing transmission risks. We quantified SARS-CoV-2 burden by RT-qPCR from comprehensive screening of nursing homes and assisted living facilities in Massachusetts to inform our ability to detect SARS-CoV-2 in individuals with or without symptoms. Methods. From 4/9/20 to 6/9/20, we tested nasopharyngeal (NP) swabs from 32,480 unique individuals comprising staff and residents of the majority of nursing homes and assisted living facilities in Massachusetts. Symptomatology at the time of sampling and demographic information were provided by each facility. NP swabs were collected, RNA extracted, and SARS-CoV-2 testing performed by RT-qPCR. We compared cycle thresholds (Ct) with a standard curve to quantify viral loads. Results. The nursing home and assisted living facilities resident cohort (N = 16,966) was 65% female with mean age 82. The staff cohort (N = 15,514) was 76% female with mean age 45. In all, 2654 residents (15.5%) and 624 staff (4.1%) tested positive for SARS-CoV-2, including 12.7% of residents and 3.7% of staff without symptoms, compared to 53.1% of residents and 18.2% of staff with symptoms. The Ct distributions for viral probes were very similar between populations with and without symptoms (Fig 1), with a statistically but not meaningfully different mean (ΔCt 0.71 cycles, p = 0.006) and a similar range (12-38 cycles). This similarity persisted across all sub-categories examined (age, race, ethnicity, sex, resident/staff). Conclusion. In a large cohort of individuals screened for SARS-CoV-2 by RT-qPCR, we found strikingly similar viral load distributions in patients with or without symptoms at the time of testing. The size of the study population, including both staff and residents spanning a wide range of ages, provides a comprehensive cross-sectional point prevalence measurement of viral burden. Because the distributions of viral loads are very similar regardless of symptoms, existing testing modalities validated for detection of SARS-CoV-2 RNA in symptomatic patients should perform similarly well in individuals without symptoms at the time of testing. (Figure Presented).

Forward-focused coping predicts better mental health outcomes in mid- to late-life during the COVID-19 pandemic.

Objectives: Psychosocial stressors associated with the COVID-19 pandemic may increase the risk of depression and anxiety in the general population. Individuals approaching or within older adulthood may be especially vulnerable to these psychosocial stressors and their impact on mental health outcomes. Consequently, there is an urgent need to identify protective factors for older adults. The purpose of the present study was to determine the relative contribution of coping flexibility (CF) and two distinct coping strategies, forward-focused and trauma-focused, on negative affect in persons 50 years of age and older during the COVID-19 pandemic. Method: Data were collected using an online survey, including questions about demographic information, coping, depression, and anxiety. Participants aged 50 and over were included in our analyses of depression (N = 800) and anxiety (N = 638). Results: Both higher CF and higher forward-focused coping predicted lower depression and lower anxiety. In contrast, higher trauma-focused coping predicted slightly higher depressive symptoms but was not a significant predictor of anxiety. Conclusion: Our findings suggest that higher forward-focused coping may serve as a protective factor in older adults during the pandemic and, therefore, may be an effective treatment target for mental health interventions.

Suddenly eLearning: A qualitative study of university students during COVID-19

When an organization has to turn to eLearning practically overnight and without preparation as it was the case in spring 2020 due to COVID-19 regulations, there are many challenges to be overcome. This contribution is based on qualitative interviews with 34 students studying for becoming primary school teachers at KPH Vienna/Krems (Austria) in April and May 2020 using an online conferencing tool. Students were asked about their experience after six to seven weeks of eLearning, the challenges they had to face as well as what they missed most when learning online. Finally, they should also state if they could imagine keeping some elements of eLearning for the next terms as well. Results show that most lecturers used the already established learning management system moodle. Some students struggled with organizing their new university life in the beginning due to missing structuring elements. Also, group-work was perceived as rather difficult compared to the terms before. What students missed most were social contacts to fellow students but also to lecturers. Although there were quite some challenges to be overcome for students, most of them said that they were interested in keeping some elements of eLearning for the future - mostly to be more flexible, to save time and to engage more deeply with the subjects. The study thus shows that eLearning or blended learning might be an option even for a very traditional university like KPH Vienna/Krems. © 2020 Academic Conferences Limited. All rights reserved.