Perspectives of health practitioners on the challenges to accessing sexual and reproductive health care services for Venezuelan migrant women during the COVID-19 pandemic in Quito, Ecuador.

Objectives: To describe the perspectives of health practitioners on the barriers, gaps, and opportunities that Venezuelan migrant women experienced to accessing sexual and reproductive health (SRH) services during the COVID-19 pandemic and how SRH services were affected in Quito, Ecuador. Methods: Health practitioners involved in SRH services at nine public health care facilities in three zones of Quito were surveyed. The Minimum Initial Service Package readiness assessment tool survey, available from the Inter-Agency Working Group on Reproductive Health in Crisis, was adapted for use and data collection in Ecuador. Results: Of 297 respondents, 227 were included in the analysis. Only 16% of the health practitioners agreed that discrimination against migrant Venezuelans women occurred in the health care system. Of those, only 2.3% described specific conditions associated with discrimination, including requiring identification documents (7.5%) and lack of empathy or responsiveness (6.6%). Most (65.2%) respondents reported that the COVID-19 pandemic affected the use of SRH services by women in the general population and by Venezuelan migrant women more so (56.3%) because of more limited access to SRH services, poverty, and vulnerability. There were no differences between perceptions by levels of health care facility, except with regard to the lack of supplies, awareness of discrimination, and the belief that Venezuelan migrant women were affected more negatively than the local population. Conclusion: The perception among health practitioners in Quito was that discrimination occurred infrequently during the COVID-19 pandemic despite affecting the health care system. However, some level of discrimination toward migrant Venezuelan migrant women seeking SRH services was acknowledged and may be underrepresented.

Severe Sars-COV-2 Infection in Patients with Chronic Kidney Disease and Lung Disease. Outcomes and Referral for Palliative Care in a Tertiary Center in SÃo Paulo, Brazil

BACKGROUND AND AIMS Coronavirus disease 2019 (COVID-19) is mainly an infectious disease of the respiratory system transmitted through air droplets, and pulmonary symptoms constitute the main presentations of this disease [1]. The first cases of the disease were identified in Wuhan, China, which occurred in early December 2019. Initially, it was called pneumonia of unknown origin, severe acute (SARS-CoV-2) [2]. In addition to being a target of the virus, the kidney also seems to have a substantial influence on the outcomes of the disease [3]. Underlying kidney disease is an emerging risk factor for more severe coronavirus disease 2019 (COVID-19) illness [4]. Identifying patients who require a palliative care approach is challenging for family physicians, even though several identification tools have been developed for this purpose. The Supportive and Palliative Care Indicators Tool (SPICT™) aims at facilitating this identification [5]. The aim of this study is to compare the outcomes presented between patients with nephropathy and lung disease in the first wave of COVID-19 assisted by a reference center in Brazil. METHOD This study is a data analysis from patients assisted by a reference center in São Paulo, Brazil, which includes 2013 patients from March to July of 2020. This period consists on the first wave of COVID-19 infection in this country. In addition, a literature review was conducted, papers were selected searching PubMed/Medline, SciELO and LILACS databases using the terms (COVID-19) AND (nephropathy) AND (pneumopathy) AND (outcomes) in January 2022. There were no language or publication date restrictions. Also, we used the (SPICT™ to classify the patients for treatment with palliative care. RESULTS Among 2013 patients included in our study, 223 had nephropathy, 127 males and 96 females. As for pulmonary disease, there were 155 patients, 93 males and 62 females. Furthermore, among pneumopathy patients, 65% were >60 years old, and, among renal patients, 47% approximately were >60 years old. In addition, the mean age of the renal patients’ group was lower than the group of patients with lung disease. The outcomes in the nephropathy group consisted in 109 discharges and 114 deaths. In the group of pulmonary patients, 90 were discharged and 59 died;the other patients were transferred to specialized services. Renal patients presented worse outcomes than pulmonary patients, even though COVID-19 mainly affects the lung, our patients had substantial impact of its infection. Despite the fact that SPICTTM identified 41 renal patients eligible for palliative care, only 31 were referred to this service at the hospital where the study was conducted. When compared with the total population of this study, the renal patient's group was the third with the highest number of hospitalizations due to COVID-19. CONCLUSION Renal patients had a worse prognosis when compared with patients with lung disease and the total population. The outcomes could have been different if all renal patients had been referred and treated with palliative care.

Immune Response in Severe and Non-Severe Coronavirus Disease 2019 (COVID-19) Infection: A Mechanistic Landscape.

The mechanisms underlying the immune remodeling and severity response in coronavirus disease 2019 (COVID-19) are yet to be fully elucidated. Our comprehensive integrative analyses of single-cell RNA sequencing (scRNAseq) data from four published studies, in patients with mild/moderate and severe infections, indicate a robust expansion and mobilization of the innate immune response and highlight mechanisms by which low-density neutrophils and megakaryocytes play a crucial role in the cross talk between lymphoid and myeloid lineages. We also document a marked reduction of several lymphoid cell types, particularly natural killer cells, mucosal-associated invariant T (MAIT) cells, and gamma-delta T (γδT) cells, and a robust expansion and extensive heterogeneity within plasmablasts, especially in severe COVID-19 patients. We confirm the changes in cellular abundances for certain immune cell types within a new patient cohort. While the cellular heterogeneity in COVID-19 extends across cells in both lineages, we consistently observe certain subsets respond more potently to interferon type I (IFN-I) and display increased cellular abundances across the spectrum of severity, as compared with healthy subjects. However, we identify these expanded subsets to have a more muted response to IFN-I within severe disease compared to non-severe disease. Our analyses further highlight an increased aggregation potential of the myeloid subsets, particularly monocytes, in COVID-19. Finally, we provide detailed mechanistic insights into the interaction between lymphoid and myeloid lineages, which contributes to the multisystemic phenotype of COVID-19, distinguishing severe from non-severe responses.

An Effective Model for Establishing a Collaborative for the Treatment of COVID-19 in the Rio Grande Valley.

The DHR Health Institute for Research and Development spearheaded a region-wide initiative to establish a Rio Grande Valley (RGV) Collaborative for early diagnosis, prevention, and treatment of COVID-19. The Collaborative was established on March 23, 2020, to conserve resources and provide the best clinical care in the face of an imminent regional health crisis in an underserved community, predominantly of Hispanic heritage with some of the highest rates of chronic diseases in the United States. The use of plasma obtained from convalesced SARS-CoV-2-infected donors was approved by the FDA and the RGV Collaborative took this as its initial challenge. To date, over 2,200 patients with severe and life-threatening COVID-19 have successfully received transfusion of convalescent plasma in various health care facilities in the RGV. The RGV Collaborative is a unique model for creating an effective public health strategy for the delivery of quality clinical care, especially in underserved communities.

Immune Assessment of BNT162b2 m-RNA-Spike Based Vaccine Response in Adults.

Vaccine efficacy is based on clinical data. Currently, the assessment of immune response after SARS-CoV-2 vaccination is scarce. A total of 52 healthcare workers were immunized with the same lot of BNT162b2 vaccine. The immunological response against the vaccine was tested using a T-specific assay based on the expression of CD25 and CD134 after stimulation with anti-N, -S, and -M specific peptides of SARS-CoV-2. Moreover, IgG anti-S2 and -RBD antibodies were detected using ELISA. Furthermore, the cell subsets involved in the response to the vaccine were measured in peripheral blood by flow cytometry. Humoral-specific responses against the vaccine were detected in 94% and 100% after the first and second doses, respectively. Therefore, anti-S T-specific responses were observed in 57% and 90% of the subjects after the first and second doses of the vaccine, respectively. Thirty days after the second dose, significant increases in T helper 1 memory cells (p < 0.001), peripheral memory T follicular helper (pTFH) cells (p < 0.032), and switched memory (p = 0.005) were observed. This study describes the specific humoral and cellular immune responses after vaccination with the new mRNA-based BNT162b2 vaccine. A mobilization of TFH into the circulation occurs, reflecting a specific activation of the immune system.

Physicians' and Nurses' Knowledge in Palliative Care: Multidimensional Regression Models.

The increase in life expectancy has led to a growth in the number of people in need of palliative care. Health professionals must possess appropriate knowledge and skills. This study aimed to assess knowledge in palliative care through the Palliative Care Knowledge Test Spanish Version (PCKT-SV)®. A cross-sectional analytical study was conducted in 40 primary care health services. A total of 600 PCKT-SV questionnaires were distributed among health professionals; 561 of them (226 nurses and 335 physicians) were properly filled up. Sociodemographic information, education, and work experience were also recorded. A total of 34.41% of the nurses and 67.40% of the physicians showed good or excellent knowledge of palliative care. Physicians' scores for pain, dyspnea, and psychiatric disorders were higher than those of the nurses. Nurses scored significantly better in philosophy. Professionals with continuous training in palliative care showed a higher level of knowledge. Age and work experience of physicians and undergraduate training in nurses had significant weight in knowledge. Developing continuous training and enhancing undergraduate training in palliative care will lead to improved patient care at the end of life.

TRASTORNOS DE LAS EMOCIONES A CONSECUENCIA DEL COVID-19 Y EL CONFINAMIENTO EN UNIVERSITARIOS DE LAS DIFERENTES ESCUELAS DE LA UNIVERSIDAD NACIONAL HERMILIO VALDIZÁN. PERÚ.

The Covid-19 pandemic has transformed the way we live, and after mandatory confinement, the way we interact with people will also change drastically. And without going through the traumatic experience of hospitalization, society as a whole will suffer post-traumatic stress, due to home isolation. In many cases, the disease has directly impacted close people, which will translate into a higher prevalence of mental health-related problems. In this sense, no one doubts the psychological and social footprint that the pandemic will leave on the majority of the population. The work carried out has the objective of identifying the disorders of the emotions as a result of the covid-19 and the confinement in university students of the National University Hermilio Valdizán. The type and level of research was descriptive, exploratory, explanatory, applicative, analytical, prospective and cross-sectional, with a sample of 100 university students from the different academic professional schools of the university. For data collection, the questionnaire was used and the virtual survey was used as a technique. The main results show that university students present emotional disorders such as: sleep problems (85%) and feelings of depression and hopelessness (83%). It is concluded that as a result of confinement, university students present psychological problems of anxiety and depression (46%), 22% present depression and stress, while 17% of university students present post-traumatic stress as a result of COVID-19 and confinement.

La pandemia por el Covid-19 ha transformado la manera en la que vivimos, y tras el confinamiento obligatorio, la forma en la que nos relacionamos con las personas cambiará también de manera drástica. Y sin llegar a vivir la experiencia traumática de una hospitalización, la sociedad en su conjunto sufrirá estrés postraumático, debido al aislamiento domiciliario. En muchos casos, la enfermedad ha impactado de forma directa a personas cercanas, lo que se traducirá en una prevalencia mayor de los problemas relacionados con la salud mental. En este sentido, nadie duda de la huella psicológica y social que la pandemia dejará en la mayoría de la población. El trabajo realizado tiene el objetivo de identificar los trastornos de las emociones a consecuencia del covid-19 y el confinamiento en universitarios de la Universidad Nacional Hermilio Valdizán. El tipo y nivel de investigación fue descriptivo, exploratorio, explicativo, aplicativo, analítico, prospectivo y transversal, con una muestra de 100 universitarios de las diferentes escuelas académico profesionales de la universidad. Para la recopilación de datos se utilizó el cuestionario y se hizo uso de la encuesta virtual como técnica. Los principales resultados demuestran que los universitarios, presentan trastornos emocionales como: problemas de sueño (85%) y sentimientos depresivos y de desesperanza (83%). Se concluye que a consecuencia del confinamiento los universitarios presentan problemas psicológicos de ansiedad y depresión (46%), el 22% presenta depresión y estrés, mientras que un 17% de universitarios presenta estrés post traumático a consecuencia del covid-19 y el confinamiento.

Validation of a Quick Flow Cytometry-Based Assay for Acute Infection Based on CD64 and CD169 Expression. New Tools for Early Diagnosis in COVID-19 Pandemic.

Objectives: Several parameters aid in deciphering between viral and bacterial infections; however, new tools should be investigated in order to reduce the time to results and proceed with an early target-therapy. Validation of a biomarker study, including CD64 and CD169 expression, was conducted. Material and Methods: Patients with active SARS-CoV-2 infection (ACov-2), bacterial infection (ABI), healthy controls, and antiretroviral-controlled chronic HIV infection were assessed. Whole blood was stained and, after lysing no-wash protocol, acquired by flow cytometry. The median fluorescence intensity (MFI) of CD64 and CD169 was measured in granulocytes, monocytes, and lymphocytes. The CD64 MFI ratio granulocytes to lymphocytes (CD64N) and CD169 MFI ratio monocytes to lymphocytes (CD169Mo) were evaluated as biomarkers of acute bacterial and viral infection, respectively. Results: A CD64N ratio higher than 3.3 identified patients with ABI with 83.3 and 85.9% sensitivity and specificity, with an area under the curve (AUC) of 83.5%. In contrast, other analytic or hematological parameters used in the clinic had lower AUC compared with the CD64N ratio. Moreover, a CD169Mo ratio higher than 3.3 was able to identify ACov-2 with 91.7 and 89.8 sensitivity and specificity, with the highest AUC (92.0%). Conclusion: This work confirms the previous data of CD64N and CD169Mo ratios in an independent cohort, including controlled chronic viral HIV infection patients as biomarkers of acute bacterial and viral infections, respectively. Such an approach would benefit from quick pathogen identification for a direct-therapy with a clear application in different Health Care Units, especially during this COVID pandemic.

Usefulness of a Telemedicine Tool TELEA in the Management of the COVID-19 Pandemic.

Background: The usefulness of telemedicine in the management of the coronavirus disease 2019 (COVID-19) pandemic has not been evaluated. Methods: We conducted a descriptive study of the process of recruitment and follow-up of patients using a telemedicine tool (TELEA) in the management of patients at risk, in a rural environment with a dispersed population in Lugo in north western Spain. Results: A large number of patients diagnosed with COVID-19 infection (N = 545) were evaluated. Of this group, 275 had comorbidities and were enrolled in the program, with a mean age of 57.6 ± 16.3 years, 43.1% male. The risk factors were hypertension (38%), diabetes (16%), asthma (9.5%), heart disease (8.8%), and immunosuppression (5.1%). Patients were followed through the platform with daily control of symptoms and vital signs. Only 8% were admitted to the hospital, 5.1% on a scheduled basis and 2.9% through the emergency room. Conclusion: The telemedicine tool TELEA is useful for the management of high-risk patients with COVID-19.