Experience achieved after implementation of the Veno-Venous ExtraCorporeal Membrane Oxygenation(ECMO) retrieval program in the region of Madrid (Spain). Hospital Universitario 12 de Octubre

Objectives: The objetive of this study is to describe the cases trasferred to an ECMO referral;s centre (Hospital Universitario 12 de Octubre, Madrid (Spain)), to investigate characteristics before ECMO and while the patient was on ECMO, to analyse the presence or not of complications secondary to transfer and cannulation and finally to analyse the ICU outcome. Method(s): This is a Prospective study done from November 1st, 2020 to December 31st, 2022. The cases were accepted either for emergency ECMO cannulation in the hospital of origin and retrieval or for conventional transfer. We analysed basic decriptive variables such as male proportion, age, IMC and etiology of ARDS and variables before ECMO such as prone position, duration of non-invasive ventilation, invasive ventilation and ICU leght of stay before ECMO. We recorded ELSO, SOFA and APACHE Severity Scores. We also analysed several variables on ECMO: if prone position on ECMO was done, median days of ECMO and succesfull weaning from ECMO. We also recorded whether there were complications or not in the transfer and cannulation. Finally ICU survival was examined. Result(s): 31 cases were accepted. 22 (71 %) were male. 29 cases were accepted for emergency ECMO cannulation. Median age was 47 years and IMC 31.1. The etiology of SDRA was COVID 19 infection in 23 cases (74% cases). Lenght of non invasive and invasive ventilation before ECMO were 4 days and 3 days respectively and lenght of ICU admission before ECMO was 2 days. Prone position was 1 day and 2 prone sessions were done before ECMO. Severity scores: APACHE 10 , SOFA 4 , ELSO 3 . On ECMO Prone position was done on 15 cases(48.4%) . Median days on ECMO were 13.5 days. Succesfull weaning from ECMO were achieved on 20 cases(61%), 2 cases remain on ECMO. No complications were seen on transfer or cannulation. ICU Survivors were 16(51.6%). Conclusion(s): After 2 years of experience on ECMO retrieval in the region of Madrid ECMO availability was achieved. Our results are similar than ELSO mortality.

Successful Inter-Professional Team (IPT) collaboration in the care of peripartum women with COVID-19 on Extracorporeal Membrane Oxygenation (ECMO)

Objectives: To describe the IPT collaborative approach for peripartum women with COVID-19 on ECMO and report the intervention outcomes. Method(s): A retrospective electronic health record review was performed from January 2020 through January 2022. All peripartum women on ECMO with COVID19 admitted to the cardiothoracic intensive care unit (CTICU) were included. The IPT came together to coordinate peripartum care and delivery. An algorithm was created to outline the roles and workflow in the care of these patients. The outcomes evaluated included delivery method, timing, and location, maternal survival at discharge, maternal ICU length of stay (LOS), and neonatal survival Results: Thirteen Peropartum women were placed on ECMO (5 antepartum and 8 postpartum, ages 27-42). None had been vaccinated against COVID-19. All received femoral vessel cannulation (11 venovenous and 2 venoarterial). Four patients underwent Caesareansection delivery while on ECMO. Maternal survival to hospital discharge was 84.6%. All neonates survived with COVID-19 negative status. Conclusion(s): The collaborative IPT approach with a structured algorithm facilitated survival outcomes. This report adds to the limited literature on peripartum. ECMO and provides insights to consider in planning for the care of these patients.

Comparative study of the limitations produced to freedom of movement in the European Union during the coronavirus crisis

This article seeks to define the exceptionality in the fulfillment of rights and free-doms of European citizens related to the free movement of people. The situation arising from the COVID-19 pandemic made the members of the European Union and the Schengen Area decide to impose movement restriction measures for citizens and residents in them. These ones, understandable at first due to the uncertainty of a new a new disease, endangered the European system of free movement itself, as well as the relevance of the systems of restriction of this right linked to European citizenship. © GKA Ediciones, authors.

"They Protect us as if they were our Mom" Masking Attitudes from Freelist Survey Data and Qualitative Interviews in San Diego School Communities.

BACKGROUND: Despite being disproportionately impacted by COVID-19 due to a lack of structural support, marginalized communities have been largely ignored in the politically polarized debate over school masking. In response to this, we sought to explore masking attitudes by centering the voices of parents and children at historically marginalized, predominantly Hispanic schools in southern California. METHODS: We conducted a mixed-methods study with parents and children attending 26 low-income predominantly Hispanic-serving elementary schools. A random sample of parents was asked to provide a freelist of words they associate with masking. A subset of parents with children aged 4-6 was recruited from these surveys to participate in parent-child interviews (PCI). We calculated Smith's salience index for all unique items, stratifying by language (English/Spanish). Item salience guided PCI thematic analysis for additional context and meaning. RESULTS: 648 participants provided 1118 unique freelist items in English and Spanish. 19 parent-child pairs were interviewed, 11 in Spanish and 8 in English. The most salient words were "safety"(0.37), "protection"(0.12), "prevention"(0.05), "health"(0.04), "good"(0.03), "can't breathe"(0.03), "necessary"(0.02), "care"(0.02), "precaution"(0.02), and "unnecessary"(0.02). Spanish speakers had a more favorable view of masking than English speakers, particularly regarding "protection" (0.20 vs 0.08) and "prevention" (0.10 vs 0.02). DISCUSSION: Masking is an affordable individual-level risk mitigation that protects the communities that have inequitably shouldered the burdens of the COVID-19 pandemic. We recommend that policymakers prioritize the views of those most impacted when deciding on risk mitigation policies like school masking.

New Challenges in the Development of Research Skills in Medicine Schools

To be a researcher and to have a scientific way of thinking is a kind of behavior and a way to perform that should be created since undergraduate cour-ses. It should accompany our future physicians all their career long. Crises periods like the one of the present Covid-19 pandemic make us re-think on the need of this way of thinking and the importance of the investigation process. The formation of investigation skills in Cienfuegos Medicine program is insufficient according to the behavior patterns that are declared in the professional profile. To contribute to solve this problem a didactic strategy was designed to develop research skills in medicine students. Theoretical and empirical methods were used with this purpose. This strategy was considered appropriate for this context and contributes to the development of research skills since it considers as its axis in the main cycles of the Medicine program. Mainly, the discipline of General Medicine was chosen for being the principal one in the curriculum.

Poor glycemic control: a public health challenge prepandemic and pandemic

Objective. To compare glycemic control in patients with type 2 diabetes mellitus who attended primary healthcare units in Mexico City, prepandemic and during the COVID-19 pandemic. Materials and methods. Records of 23 912 diabetes patients were analyzed;78.7% were from the prepandemic group (2016 to 2020) and 21.3% from the pandemic group (March 2020 to July 2021). Central tendency and dispersion measures were calculated, Student's t-test and multiple logistic regression model were performed. Results. Patients with diabetes were mainly women (66.6 and 62.6%) with an average age of 59 and 58 years, respectively. Glycosylated hemoglobin (HbA1) levels were 7.7 in the prepandemic group and (8.0) in the pandemic group. The variables associated with poor glycemic control included period, HbA1 level, overweight, obesity, history of parents with diabetes, number of medications and type of insulin. Conclusions. Most patients with diabetes continued to have poor glycemic control in both groups. Patients in the pandemic group had poor glycemic control compared to the prepandemic group.After medical intervention, patients improved their glycemic control in both groups © 2023,Salud Publica de Mexico. All Rights Reserved.

Competitive cause of death in elderly breast cancer survivors

Background: Breats cancer is a major health problem in elderly ( >= 70 years) women. Increase incidence with age and the progressive increase in life expectancy mean that the numbers in elderly breast cancer diagnosis are increasing. These patients do not always receive the proper treatment and despite this the survival of this population is not always depends on cancer, there are other competing causes of death typical of the aging population. Method(s): A retrospective observational analysis of women >= age 70 diagnosed with breast carcinoma in HUPHM between 2014 and 2020 was made. Clinical, pathological data and stages at diagnosis were analyzed. We checked our patients with the national death center (official national registry) thus obtaining an exact date of death and the cause of death. Data updated in January 2023 , ensuring a minimum follow-up of 24 months. We excluded deaths from Covid or of unknown cause to avoid bias. Result(s): A total of 421 patients were analyzed, mean age of 78.6 years and median follow-up of 48 months. 28% of patients had died at the time of analysis, 11% due to cancer and 17% from other causes. If we analyze the population deceased by cancer, no deaths are detected in patients diagnosed with carcinoma in situ (4% of the population), in stage I (30% of the population) the cumulative incidence of cancer death at 5 years is 3%, 7% In stage II (30% of the population), 15% in stage III (16%) and 70% in stage IV (12%). Death by other causes are more frequent in early breast cancer, the cumulative incidence at 5 years are 10% in stage I, 22% in stage II, 44% in satge III and just 10% in stage IV. The most frequent causes of death in this population were caridovascular events and infections. There are no differences in 5-year mortality according to histological subtypes 20%, 12%, 25% and 12% for triple negative, Rh+/HER2-, RH+/her2+ and RH-/HER2+ respectively. Conclusion(s): Although elderly patients do not receive optical treatments, mortality from cancer in early stages is incidental at 5 years, a different scenario is seen in metastatic disease in which the patient's prognosis depends mainly on the oncological disease, Therefore, an effort should be made in the treatment of these patients with metastatic breast cancer since adequate treatments can have a clearly positive impact on the survival of patients. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.Copyright © 2023

Metabolomics: From Scientific Research to the Clinical Diagnosis

Metabolomics supports uncovering relevant pathophysiological mechanisms and identifying biomarkers of risk and progression in diseases. Furthermore, metabolomics has allowed the characterization of the proteins and metabolites of COVID-19, neurodegenerative processes, gestational diabetes mellitus, cancer breast, process of kidney transplantation, and Parkinson diagnosis, among other diseases (Table 7.1). Metabolomics employs noninvasive human biological samples such as serum, breath, and urine to screen and identify novel biomarkers. The combination of NMR, LC/MS, and CG/MS is desirable to detect, identify, and quantify hundreds of thousands of metabolites, useful in biomarker discovery toward clinical applications. The generation of biological information has led to the creation of databases such as BioBankWarden, which can be used to store and retrieve specific information from different clinical fields linked to biomaterials collected from patients. The use of metabolomics allows greater precision in the diagnosis and follow-up of the treatment of any disease. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Cost and performance analysis of efficiency, efficacy, and effectiveness of viral RNA isolation with commercial kits and Heat Shock as an alternative method to detect SARS-CoV-2 by RT-PCR

In late 2019 a new virus reported in Wuhan, China, identified as SARS-CoV-2, rapidly challenging the healthcare system worldwide. The need for rapid, timely and accurate detection was critical to the prevention of community outbreaks of the virus. However, the high global demand for reagents during the years 2020 and 2021 generated a bottleneck in kits used for detection, significantly affecting developing countries and lagging their ability to diagnose and control the virus in the population. The difficulty in importing reagents, high costs and limited public access to the SARS-CoV-2 detection test led to the search for alternative methods. In this framework, different commercial nucleic acid extraction methodologies were evaluated and compared against heat shock as an alternative method for SARS-CoV-2 detection by RT-PCR to determine the diagnostic yield and its possible low cost compared to other methodologies. Nasopharyngeal samples were used where the diagnostic efficiency of the alternative method was 70 to 73%. The evaluation of the discriminatory efficacy of the technique took the sensitivity and specificity to establish its cut-off point, being 0.73 to 0.817, which allows discrimination between COVID-19 positives and negatives;as for the diagnostic effectiveness expressed as, the proportion of subjects correctly classified is between 80 and 84%. On the other hand, in terms of the costs necessary to carry out the detection, the alternative method is more economical and accessible compared to the commercial methods available in this comparison and evaluation, being possible its implementation in developing countries with high infection rates, allowing access to the diagnostic test with a reliable and low-cost method. © 2022 by the authors.

Neurological manifestations in patients with COVID-19

Introduction: COVID-19 pandemic represents a challenge for healthcare systems, due to the impact on different systems, such as respiratory, cardiovascular and nervous systems. Background: to describe the neurological manifestations in patients with COVID-19. Methods: a search for information was carried out in the PubMed/Medline, SciELO, EBSCO, Lilacs and Scopus databases. A search strategy was applied by combining terms and using Boolean operators. Thirty references were chosen. Results: olfactory nerves and invasion of peripheral nerve terminals are suggested as routes of entry;the presence of severe neural symptoms associated with lesions of other organs and cytokine storm is also described. Headache was the most common neurological manifestation in patients with COVID-19, and rhabdomyolysis, acute hemorrhagic necrotizing encephalopathy, Guillain Barre syndrome, meningitis and encephalitis are rare neurological entities. In Guillain Barre syndrome, the literature suggests both a post infectious and para-infectious pattern. Conclusions: COVID-19 is associated with different neurological manifestations, including headache, dizziness, vertigo, vomiting, and alterations of consciousness, stroke and others not so frequent. These symptoms as a whole should be evaluated by healthcare personnel, with a view to their rapid detection and management, in order to guarantee the disappearance of sequelae that reduce the quality of life of patients, as well as to reduce the associated mortality records.

Impact of COVID-19 Lockdown on cardiometabolic risk scales in Adults: A before and after Pandemic Lockdown Longitudinal Study

Introduction: In December 2019 the first cases of SARS-CoV-2 virus infection were detected, with the months it became pandemic and forced most countries to establish a state of lockdown. The aim of this study is to evaluate the influence of unhealthy lifestyles during lockdown on different cardiometabolic parameters. Methods: A prospective study was performed in 6.236 workers in a Spanish population between March 2019 and March 2021. Different cardiometabolic parameters were determined before and after pandemic lockdown. Results: An increase in all the parameters analyzed in the post-lockdown period compared to the pre-lockdown period was observed. Conclusions. Lockdown has had a negative impact on cardiometabolic parameters in both sexes.

The COVID-19 and the Schengen Area.Towards a new model of European interdependence

This research starts from the situation generated by the pandemic in 2022 in the Schengen area. Paradoxically, a few days before the 25th anniversary of the establishment of the Schengen area, the World Health Organization (WHO) declared the outbreak of Coronavirus, a global pandemic which forced the closure of most European borders. What seemed to be a guaranteed right, freedom of movement, was suspended in order to control the pandemic. The decisions taken by states unilaterally generated complex derivations in the framework of complex interdependence within which the European Union operates. National measures, far from guaranteeing the four fundamental freedoms, highlighted the discrepancies and lack of integration in this area.The temporary restrictions on free movement indirectly signified the proclamation that public health and those freedoms cannot coexist in critical situations, eliminating any pretense of EU leadership.Transnational relations, which on the one hand led to the increasing interconnectedness of societies, on the other hand also resulted in the restriction of states' foreign policy spaces for action. This has led to the emergence of international governance, a model that has a strong influence on the development and functioning of the EU. Most EU Member States reacted quickly to the risk of the exponential spread of the coronavirus and adopted stringent preventive measures that culminated in unprecedented restrictions on the free movement of persons within the EU, with important consequences for the functioning of the internal market.The narrative of Europe as a market power emerges as an alternative. The normative approach to European identity assumes that the very nature of the EU as a market predisposes it to use its economic capabilities as a foreign policy tool. Thus, an approach that emphasizes this fact will be analytically more appropriate than an approach based on the normative identity of the Union. This points to the gestation of a new form of global governance and the design of new mechanisms for cooperation between states in the framework of interdependence and could be seen as a starting point for the debate on whether interfering in the internal market with restrictions and prohibitions on mobility was a reasonable alternative for member states to take, considering other competing interests. That is, whether the situation generated by the pandemic justified the degree of interference with free movement within the EU.The European system of governance, the most developed in contemporary international relations, showed many weaknesses and even a regression during the pandemic;that is, to a pre-eminently intergovernmental process, led by the most powerful EU countries. The EU's international cooperation systems, mechanisms and instruments must lay the foundations for a new agenda adapted to the reality of a post-Covid multipolar and interdependent world. This article is organized in three parts. The first part focuses on situating the concept of interdependence in both traditional and contemporary International Relations. This interdependence is generated for different reasons, each of which specifically defines the model to be followed by states in their transnational relations. The progressive redistribution of global power towards multipolarity and the deepening of interdependence between states have given rise to a transition towards interpolarity in which cooperation/integration, multilateralism and the role of the great powers or polarity occupy a prominent place. This is due to the increase in the number, quality and nature of the different interconnections that, at the international level, take place between different types of actors.Once the concept of interdependence has been placed in a global framework, the impact of this phenomenon on the Schengen area will be studied as an element common to all Member States, but for which different solutions were offered. The temporary suspension of the Schengen area affected the four fundamental freedoms and, although some were affected more than others, there is no doubt about its impact on European systems. This impact, far from being gauged by the European Union as an organization, was managed unilaterally by the states that persisted in their isolationist attitude, reinforcing the scarce integration that the Schengen area has always experienced but which was necessary in this context. The difference in scope and rigidity of national travel restrictions and bans resulted in a spectrum of diverse and sometimes inconsistent restrictions across the Union. As an example, most entry bans to national territories contained exceptions for domestic nationals and residents: some provided exceptions for nationals, residents, and persons confirmed negative for Covid-19, whereas others offered exceptions to nationals, residents, and persons entering the national territory for valid reasons.The second part of our research focuses on a qualitative analysis of the restrictions in the Schengen area and whether the interdependence experienced in this area and its lack of integration favour or harm the EU's behaviour on the international stage. Member States justified all travel restrictions -including entry and exit bans to and from national territories- on public health grounds. In this sense, the removal of multilevel governance elements in different EU policy areas elevated issues originally from the European framework to the international level without considering their long-term impact. Thus, some EU covid-19 measures, such as the severe restrictions on free movement that affected refugee and asylum rights during the pandemic showed that the terms of solidarity underpinning the framework for the implementation of refugee and asylum rights in the EU, which does not go beyond the national level, are not commensurate with the real need for concrete solutions in this area. The human rights implications of all these border closures are alarming and put at serious risk vulnerable populations that should be protected by these national and international legal obligations.With regards to the internal aspect, the Schengen area is a space where interdependence between states is clearly visible in such obvious and important areas as global trade in goods and services, capital transfers, and information connectivity, thanks to the Internet and social networks. For example, we see that during the Covid-19 pandemic, there was a direct link between, for example, the suspension of the Schengen area, the health systems of the Member States, and the health systems of the EU Member States.

Immunopathology of SARS-CoV-2 virus infection

Introduction: the daily increase in cases and deaths, the economic losses in the millions suffered by affected nations and the consequent strain on the human resources involved in reversing this situation have made the COVID-19 pandemic an unprecedented international challenge. Background: to describe the orchestrated immune response following SARS-CoV-2 infection. Methods: an up-to-date bibliometric study was conducted on the type of articles stated in the objective, using a total of 30 bibliographies. Documentary review and analysis-synthesis methods were used to prepare the final report. Resources available on the Infomed network were used to select the information, specifically: PubMed and SciELO, through the databases: Medline, Search Premier and Scopus. Development: the core elements in the immunopathology of COVID-19 involve innate immunity, with the sustained increase of pro-inflammatory interleukins associated with failures in the interferon system, which can trigger a potentially fatal cytokine storm. In terms of elements linked to adaptive immunity, there is evidence of marked lymphopenia which, depending on the degree, may indicate the severity of the disease. Conclusions: understanding the orchestrated immune response following SARS-CoV-2 infection and its temporal sequence allows us to choose timely and effective therapies, specifically when selecting anti-inflammatory drugs and the time of their application, as it is difficult to determine when they will be clearly beneficial, that they do not impair the response and that it is not too late, given the irreversibility of the process.

Dermatological manifestations associated with the severity of COVID-19 infection: A retrospective cross-sectional observational study in 144 patients

Introduction: COVID-19 infection is a disease caused by the type 2 coronavirus that causes severe acute respiratory syndrome (SARS-CoV-2) that affects the respiratory mucosa and all those organs that present the type 2 angiotensin receptor (ACE2), within them the skin. Several authors have mentioned the importance of reporting and carrying out databases on skin lesions caused by this virus, since it is related to the detection, severity and prognosis of the systemic condition. Material(s) and Method(s): A retrospective cross-sectional observational study was carried out on the cases of patients who presented dermatological manifestations due to COVID-19, registered in the physical database of the National Specialized Hospital of Villa Nueva, Guatemala, from January 1st to December 31, 2021. Result(s): A total of 144 patients presented dermatological manifestations due to COVID-19, which were: acral lesions (42%), rash (21%), subcutaneous emphysema (12%), oral mucosal lesions (7%), necrosis (6%), erythema multiforme (5%), telogen effluvium (2%), vesicular lesions (2%), urticaria (1%), pityriasis rosea Gibert (1%) and livedo-type lesion (1%). A statistically significant association (p = 0,00) was found in patients who presented dermatological manifestations with vasculonecrotic damage as they were more likely to suffer from severe to critical disease (OR 2,91;95% CI 1063-3083). Conclusion(s): Early identification of cutaneous semiology is essential for timely management of complications associated with COVID-19 disease.Copyright © 2022 Elsevier Espana, S.L.U.

Acute exantematic pustulosis generalized by meropenem, differential diagnosis with COVID

Case report We present the case of a 63-year- old man with two consecutive admissions, due to COVID19 infection and subsequent bacterial superinfection. Three days after the second admission (04/28), and 43 days from the beginning of the infection an assessment by dermatology and allergology is then requested. The patient had generalized erythematous maculopapular rash in the trunk, back, groin and limbs. On the left side and back, pustular lesions not focused on follicles were also added, with a fever of 37.7degreeC. There were no oral and genital lesions. No psoriasis. The drugs used during the present and previous admissions were reviewed. Previous admission (04/04-22/ 20): Linezolid, ciprofloxacin, meropenem 04/13-22, piperacillin/tazobactam, hydroxychloroquine, azithromycin, ceftriaxone. Upon discharge amoxicillin/acid clavulanic. Present admission (04/25) Cutaneous reaction 04/28. 04/25: meropenem, paracetamol, enoxaparin, insulin, omeprazole, venlafaxine. 04/26: Darbepoetin, furosemide, mycophenolate in single dose. 04/27: Linezolid, macrogol, Clopidogrel, Magnesium, Calcitriol. Medical records: DM type 2, liver transplantation due to HCV cirrhosis, HCV recurrence, uninodular hepatocarcinoma, advanced CKD, secondary hyperparathyroidism, multiple neurological antecedents. We performed a detailed study. We hypothesized with a pharmagological/ drug reaction with several drugs possibly involved and our main suspicion was an allergic reaction to beta-lactams. Biopsy: Subcorneal pustules, basal spongiosis and presence in the superficial dermis of edema and an inflammatory infiltrate with abundant neutrophils. No fungi. Findings compatible with clinical diagnosis of generalized acute exanthematic pustulosis (PEGA). Immunohistochemical study Covid19. (Jimenez Diaz Foundation) Finely granular positivity in endothelium and more coarse in sweaty epithelium. Neutrophilic superficial inflammatory component with presumably spure staining. ACe-2 (positive external control) is not detected. The patient presents a EuroSCAR score of 9, sum of the clinic and the pathological anatomy, and therefore defined diagnosis. Clinical diagnosis: PEGA secondary to meropenem. Conclusion(s): We present the case of a PEGA by meropenem, not very often described in the literature. We highlight the importance of differential diagnosis with viral infections. Skin tests, especially epicutaneous tests, are key to the diagnosis. (Figure Presented).

Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?

OBJECTIVE: To describe the sequelae one month after hospital discharge in patients who required admission to Intensive Care for severe COVID 19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. DESIGN: Cohort, prospective and observational study. SETTING: Post-intensive care multidisciplinary program. PATIENTS OR PARTICIPANTS: Patients who survived admission to the intensive care unit (ICU) for severe COVID 19 pneumonia from April 2020 to October 2021. INTERVENTIONS: Inclusion in the post-ICU multidisciplinary program. MAIN VARIABLES OF INTEREST: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. RESULTS: 104 patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs 10.4% ONAF); brachial plexopathy (10.7% IMV vs 0% ONAF); decrease in grip strength: right hand 20.67kg (±8.27) in VMI vs 31.8kg (±11.59) in ONAF and left hand 19.39kg (±8.45) in VMI vs 30.26kg (±12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. CONCLUSIONS: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

Assessment of learning in online academic programs from the digital transformation impelled by Covid-19

The objective of the study is to determine the stages of the evaluation of learning in online academic programs as a result of the digital transformation impelled by the Covid-19 pandemic in higher education. It is based on the digital transformation adopted in higher education since the Covid-19 pandemic, which accelerated the renewal of existing curricular programs and teaching-learning processes with a fragmented evaluation process. Through an explanatory research - purposeful and qualitative approach, the variables and metric indicators of pertinence, relevance and frequency of production of literature associated with the theme are studied to process the data. Likewise, a questionnaire was designed for the pilot study, selecting 25 teachers as sample units from two accredited private higher education institutions in Colombia located in Santiago de Cali and Barranquilla. The findings determined a 0.946 margin of reliability of the instrument for its application in the second phase and a matrix of indicators and the system of relations on the components and stages of the evaluation system were generated. The systematized practice of the stages is proposed as a conclusive basis for the definition of metrics that determine the incidence on the application of the evaluation of learning from academic programs mediated by digital technologies © 2023, Revista de Ciencias Sociales.All Rights Reserved.

Evolution of the cassava (Manihot esculenta, Euphorbiaceae) in vitro germplasm bank of the Facultad de Ciencias Agrarias de la Universidad Nacional del Nordeste (FCA-UNNE) and the Instituto de Botánica del Nordeste (IBONE, CONICET-UNNE) in pre-pandemic and COVID-19 pandemic times

The normal management of plant germplasm conservation laboratories involves carrying out numerous and diverse activities, which were affected by the coronavirus pandemic (COVID-19). The objective of this publication was to review the evolution of the cassava in vitro germplasm bank at the FCA-UNNE and IBONE (CONICET-UNNE) and to tell about usual management practices and the procedures to preserve living plant material and the personnel's life involved in pre-pandemic and COVID-19 pandemic times. Teachers, researchers, undergraduate and graduate students carried out, for almost 40 years, the in vitro conservation of 56 cassava cultivars from different countries. Before March 2020, the bank management consisted mainly in scientific-technological activities for the conservation of the material and the search for parameters to establish an order of subcultures. Having decreed Social, Preventive and Compulsory Isolation in Argentina, conservation activities continued applying the usual practices by following political-institutional sanitary measures. To face the new sanitary scenarios, methodologies must be adjusted so that they are effective at maintaining viability of the plant material and at prolonging conservation time. © 2022 Instituto de Botanica del Nordeste. All rights reserved.

The Evolution of Ecuador's Foreign Policy in the 21st Century: Analysis from the Theory of Peripheral Realism

This article analyses the evolution of Ecuador's foreign policy during the governments of Rafael Correa, Lenín Moreno and Guillermo Lasso in the framework of the theoretical postulates of peripheral realism, which argues that small and medium-sized states should develop a policy of collaboration with major powers and reduce their opposition to those events that directly affect the interests of their nationals. To this end, key moments in each of the abovementioned governments are analysed, including the closure of the Manta Base, the relationship with the IMF, the handover of Julian Assange and the purchase of vaccines against Covid-19. The article concludes by showing how the three presidents developed strategies that did not maximise Ecuador's interests, as they alternated policies where confrontation with the great powers was generalized with policies that prioritised rapprochement with them at the expense of national interests. © UNISCI, 2023.