Sars-CoV-2 in critical immunocompromised patients. Evolution and prognosis

Introduction: In this study, we share the results of immunosuppressed patients who suffered from acute respiratory distress syndrome (ARDS) secondary to COVID-19 pneumonia managed in our ICU. Method(s): We tracked all patients admitted to ICU of a Tertiary Hospital diagnosed with severe SARS-COV2 pneumonia from March 1, 2020 to January 31, 2022. The definition of Immunocompromised patient is based on history of transplantation, active neoplasia, autoimmune diseases or HIV. Collected data includes: sex, age, type of immunosuppression, vaccination, mechanical ventilation, ECMO VV, incidence of superinfections and mortality. Result(s): From a cohort of 425 patients, 55 met the inclusion criteria. 33% were women and 67% male. The average age was 58 years for women and 62 years for men. Out of these patients, 27% had solid organ transplants. 40% suffered from neoplasic disease. 27% had autoimmune diseases and were under treatment with immunosuppressants. 3 had HIV. Only the 29% had received at least 1 dose of COVID 19 vaccine. 80% required orotracheal intubation. 3.64% (2) required Veno-Venous ECMO. 61% presented bacterial superinfection, with the most frequent germs being Pseudomonas aeruginosa and Enterococcus. 36% had viral superinfection, being cytomegalovirus the most frequent one. 32% had fungal superinfection, mainly by Aspergillus fumigatus. 27% did not suffer any superinfection. 40% of the total sample died. After logistic regression, in our model (AUC 83,4% (Se 57.1%, Sp 87.9%), we identified need of intubation as independent variable of mortality (OR 27,06 IC95% 1.76-415.55, p = 0.018). Conclusion(s): Immunocompromised patients with ARDS secondary to COVID-19 pneumonia present high mortality, with statistically significant difference when mechanical ventilation is needed. The most frequently isolated germs causing superinfection in this group of patients are bacterias. We believe that this group of patients require special care in our ICU units and an in-depth analysis and study to optimize their prognosis.

Impact of COVID-19 infection control and prevention measures on physical-sports activity among adolescents in a rural population

The aim of this study was to analyse the changes related to the practice of physical-sports activities (P-SA) in adolescents owing to COVID-19 infection control and prevention measures. A total of 259 students (mean age=13.98+or-1.61 years) from a high school gave information on their physical-sports habits during the first year of the pandemic. The results showed a clear association between P-SA prior to the establishment of the state of alarm with P-SA practised after, and during the new normality. Also, a sporting club's membership was positively related to P-SA. Logistic regression analyses indicated that the duration of official training was the factor that most explained P-SA levels after confinement and during the new normality. In relation to post-confinement P-SA, males were more likely to practise more P-SA than females, but during the new normality, this factor was no longer significant and living with a family member at risk and the practice of individual sports became more important. These findings show that membership of a sporting club and commitment to training mitigated the negative impact of these health measures. Guidelines to ensure the maintenance of P-SA in adolescents should be established if similar situations are repeated in the future.

Allergology assessment prior to administration of COVID-19 vaccine in patients with allergy history

Background: The diagnosis of drug allergy requires a previous medical history suggestive of a Drug Hypersensitivity Reaction (DHR). DHRs caused by vaccines are rare (< 1/100.000 doses) and are mainly due to excipients. At the beginning of the COVID-19 vaccination, occasional cases of severe reactions were reported in patients with allergy history. This warning led to an increased demand for allergy testing to evaluate pre-vaccination risk assessment, especially due to the refusal of allergic patients to receive the vaccine. Method(s): Twenty patients were evaluated between May to July 2021, referred for allergology study prior to receiving the vaccine against COVID-19. All patients tested had allergy history. Skin tests were performed with the available excipients of the COVID-19 vaccine: polyethylene glycol (PEG-1500, 10% prick ROXALL), polysorbate 80 (tween 80 prick 0.04 -ID 0.004 mg/ml), and trometamol (prick 1 -ID 0.1 mg/ml). A telephone follow-up was subsequently performed to assess tolerance to the vaccine. Result(s): The median age of the patients was 54.5 years and ninety percent were female. (Table 1) The most frequent allergy history was adverse drug reactions (ADRs) in 18 patients (90%), followed by bronchial asthma (35%), rhinitis (25%), food allergy (25%), and dermatitis (15%). 12 patients (60%) had multiple allergic diseases. The drugs implicated in these ADRs were beta-lactam antibiotics (40%), NSAIDs (20%), radiographic contrast media (15%), and vaccines (15%). Skin tests with the excipients studied were negative in all cases. Subsequently, the COVID-19 vaccine was administered in 16 patients (80%). Six patients (30%) reported side effects expected from the vaccine and no DHRs were described. Although vaccination was recommended to all patients after the study, 4 patients (20%) refused the administration. Conclusion(s): Patients with atopic history do not require an allergology study prior to the administration of the COVID-19 vaccine. Exceptionally, it may be necessary if the patient has a history of suspected DHRs to the excipients involved. The previous allergology assessment did not prevent refusal of vaccination in 20% of the patients. (Table Presented).

COVID-19 screening in asymptomatic patients scheduled for surgery. What is the role of rt-PCR in elective procedures during the pandemic?

Background: COVID-19 has changed medical practice nowadays. One of the biggest concerns has been establishing when invasive procedures such as surgery, GI endoscopy or bone marrow transplant are safe;and if it is necessary to consider screening for asymptomatic patients. Method(s): We identified asymptomatic patients that were scheduled for invasive procedures from May 2020 to April 2021 at Clinica de Marly. Patients were asked to fill a questionnaire about GI and upper respiratory symptoms and contact with possible/confirmed cases of COVID- 19 in the last 15 days. Patients taken to emergency procedures, who had symptoms or contact with probable/confirmed cases in the last 15 days were excluded. rt-PCR was performed to screen COVID-19. Result(s): A total of 1837 patients were included. 104 rt-PCRs tested positive for SARS-CoV-2, leading to a 5.66% of identified asymptomatic patients. Patients were followed-up on the 30th day after the procedure. 1733 negative patients responded to our follow-up, in which only 1 death and 2 complications were detected. 102 positive patients were followed-up and no complications or deaths were reported. Conclusion(s): We found the presence of 5.66% of asymptomatic patients with positive rt-PCR for COVID-19. Safe screening will decide if these invasive interventions can be postponed, or, if the benefit outweighs the risks.Copyright © 2022 Asociacion Colombiana de Infectologia. All rights reserved.

The Development of Health Tourism in Senegal's Coastal Region

In less developed countries (LDC), health tourism can be seen as a way of specializing in tourism. Covid19 makes even more imperative the need to promote health tourism and also to link it to a greater extent to wellness tourism, thus responding to the current market requirements. The main objective of this study is to assess whether the current tourism offer in Senegal (LDC) could allow health tourism to be implemented. An ad-hoc study has been performed in Senegal's Coastal Region, where interviews directed at the socioeconomic agents and structured questionnaires have been developed, collecting information from the two populations: one sample of 21 private clinics and another of 31 hotels. The data obtained were analyzed following a descriptive analysis. The results indicate that it is possible the developing of wellness tourism, but not medical tourism. Even in the case of a laborintensive product, offering health tourism as a new tourist product requires more modern and sophisticated technological equipment © 2023,African Journal of Hospitality, Tourism and Leisure. All Rights Reserved.

A Review of the Progress and Potential of Energy Generation from Renewable Sources in Latin America

Sustainable energy economics in Latin America has become relevant due to the region's dependence on the oil market and the disruption caused by the COVID-19 pandemic. A systematic review of the ten major economies in the region based on gross domestic product is conducted. We primarily analyze production performance of hydro, wind, and solar energies, in terms of total gigawatt hours produced, current participation levels in energy matrices, and total installed capacity. Current and future trends and legal frameworks for each technology and country are discussed. Our analyses indicate that Latin America and the Caribbean can potentially increase the usage of renewable energy sources given a plethora of natural resources, favorable geographical and climatic conditions, and existing large-scale hydro installations to counteract the inconsistency of wind and solar projects. Therefore, governments in the region must overhaul sustainable policies to increase awareness and reduce energy dependence on foreign powers. © 2023 The Author(s). Published by Cambridge University Press on behalf of the Latin American Studies Association.

Pulmonary telerehabilitation in patients with chronic respiratory diseases during the pandemic by COVID-19 in Argentina. A multicenter observational study

Introduction: To our knowledge, there are no published studies on the implementation and results of Pulmonary telerehabilitation (PTR) in Argentina. Our objective was to describe PTR strategies used during the COVID-19 pandemic, the results of the different PTR modalities and the patient satisfaction. Method(s): A prospective study was carried out between April and August 2020. Patients who switched to different PTR modalities participated: synchronous (SPTR) or asynchronous (APTR). The level of satisfaction, quality of life with the St. George's Respiratory Questionnaire (SGRQ) and anxiety and depression with the Hospital Anxiety and Depression Scale (HADS) at baseline, 6 and 12 weeks were evaluated. Result(s): 20 centers participated. 299 patients were included (55.9% female), with a median (P25-75) age of 68 (62- 72) years, 184/249 (73.9%) diagnosed with COPD, 37 (14.9%) interstitial lung diseases, 12 (4.8%) asthma and 16 (6.4%) other CRD. 110 (36.8%) patients underwent SPTR and 189 (63.2%) with APTR. No differences were observed in the SGRQ and HADS except in the activities subscale of the SGRQ that increased significantly (p<0.05) in both groups, the impact subscale and the total that increased significantly in the SPTR group at 12 weeks (p<0.01). Both groups reported being satisfied with the PTR, 5.9 (5.4-6.3) in SPTR and 5 (4.6-5.4) in APTR, being significantly higher in SPTR (p=0.004) Conclusion(s): We observed significant satisfaction with PRT during the pandemic. No improvements were seen in quality of life, anxiety, or depression.

An Analysis of the Scientific Production Related to Digital Educational Resources (DER) and Virtual Learning Objects (VLO) between 2000-2021

This article aims to characterize the scientific production of Digital Educational Resources (DER) and Virtual Learning Objects (VLO) published between 2000 and 2021 and indexed in the main collections of Web of Science, Scielo Citation Index, Scopus, and Dimensions. To achieve this, a two-phase quantitative methodology is used. In the first phase, a bibliometric analysis (n=649) is carried out to characterize the production and, in the second phase, a content analysis (n=171) is carried out of publications focused on the development of DER and VLO. Our results show that Colombia is the country with the highest production of DER and VLO, that the largest number of educational resources are aimed at higher education students and that few are inclusive in their characteristics. Finally, the production of scientific texts has been increasing and is positioned as a trend in the specialized databases included in this study, especially for the time frame of the Covid-19 pandemic. © 2023 Authors. All rights reserved.

Presidential policy narratives and the (mis)use of scientific expertise: Covid-19 policy responses in Brazil, Colombia, and Mexico

Political leaders rely on narratives to make sense of crises, but the extent to which such narratives are used to (de)mobilize scientific evidence in policy responses has not been fully explored. Based on the analysis of public messages and communications of the presidents of Brazil, Colombia, and Mexico, we discuss how they have narratively approached the Covid-19 crisis, particularly with respect to the degree of their reliance on scientific expertise. Building on debates on policy narratives, crisis management, and evidence-based policymaking, we argue that the narratives presidents devised had significant (and mostly negative) effects on the design of policy responses. Their narratives sidelined (Bolsonaro), leveraged (Duque), or limited (López-Obrador) the role of scientific expertise in policy responses. Thus, in contrast to previous literature, these narratives aligned more with the president's agendas and personal biases, than with the need to explain the crisis for their societies or to design appropriate policies. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Drug utilization in patients with SARS-CoV-2 in an intensive care unit

Context: Prescription indication studies allow identifying the problems that arise during the use of the drug. Aims: To evaluate the treatments used in patients diagnosed with SARS-CoV-2 infection hospitalized in critical care service, through a prescription indication study.Methods: A longitudinal observational study of medication use of the indication-prescription type with elements of the therapeutic scheme and practical consequences was carried out. The sample was characterized from the sociodemographic, clinical, and pharmacotherapeutic points of view. The prescription was evaluated through the indicators: indication, therapeutic scheme, treatment individualization, and drug combinations. The detected adverse reactions were classified according to their causality by the Naranjo Algorithm, their severity, their clinical significance, and according to their mechanism by Rawlins and Thompson.Results: In the sample (n = 77), the male gender predominated (79%) between 27-59 years old (64%), alcohol consumer (62%), hypertensive (33%) with long hospital stay (51%). A total of 417 medications were analyzed, being antibiotics (50.6%) the most prescribed. 73.4% of the therapeutic schemes were correct;however, 26.6% had problems with the therapeutic schemes due to incorrect doses, intervals, duration of treatment, and risky interactions. According to Rawlins and Thompson, two probable adverse reactions were detected, mild, non-serious, and type A and B.Conclusions: The results obtained will allow the pharmaceutical professional to create risk matrices that guarantee a timely intervention in the health team to contribute to the rational and safe use of medicines in patients infected with SARS-CoV-2.

Analysis of a technological environment designed during the pandemic to enhance self-regulated learning in pre-university education

In March 2020, confinement is decreed with the closure of all educational centers. This situation means that the centers have to devise methodologies to implement distance learning. This article focuses on Baccalaureate of a center in the Balearic Islands, which has 300 students and 20 teachers. This article shows the results of a study carried out, which focuses on identifying and performing a mixed analysis, through the intrinsic type case study methodology, the elements of self-regulation of learning favored by the environment enriched by technology, implementing during confinement, due to COVID. The results and the discussion of the same allow establishing the elements, tools and methodologies of the designed environment that have influenced the self-regulation of student learning: the role of the teacher, the attitude of the students and their expectations of self-efficacy, strategic planning and the tools that allow social interaction and reflection in common. These results have served to establish the guidelines of a methodology that allow these aspects to be favored once the confinement has ended. © GTE-Educational Technology Group, University of the Balearic Islands. All rights reserved.

[Survival and decannulation at 90 days after percutaneous dilation tracheostomy in the COVID-19 intensive care unit]

INTRODUCTION: Tracheostomy (TCT) is the most frequently performed surgical procedure among COVID-19 patients. In Argentina, survival and decannulation rates are unknown. The main objectives of this study were to evaluate mortality and decannulation rates after 90 days of the percutaneous TCT performance. Secondarily, airway injury rate, days on invasive mechanical ventilation (IMV) and days of hospitalization in the intensive care unit (ICU) were also evaluated.

From usage value to the symbolic value of objects: Masks in times of pandemic

Reconfiguring the dynamics of life became a necessary reality due to COVID-19;most of the population did not visualize what we face today. Breaking with existing paradigms around derived activities from forced confinement and the use of masks, has given relevance to the image as the basic language in the face of social distancing. The objective of this work is to interweave symbolic representations and the need for human beings to integrate themselves into a society, through the processes of meaning and symbolic elements, to weave cohesion or to unravel social relationships. © Global Knowledge Academics, authors. All rights reserved.

CO2 Levels in the Naso-Buccal Area Due to the Use of Different Face Masks in Different Ventilation Conditions

In this work, CO2 levels were estimated in the naso-buccal area due to the use of face masks. Tests were performed on a healthy volunteer subject sitting at rest and breathing regularly, who used five types of face masks in well-ventilated and poorly ventilated rooms. The ventilation conditions were determined by the natural ventilation of the room. Each of the tests lasted one hour. To estimate the CO2 level, a sensor based on the Non-dispersive Infrared (NDIR) principle was used. The results revealed that while wearing a face mask, the ventilation conditions affected the CO2 concentration levels in the naso-buccal area of the user, especially in those that offered a higher level of protection, and in those that best fit the face of the subject. A multiple comparison method (Tukey) revealed significant differences in the levels of CO2 between all the facemask tested (p < 0.0001). The CO2 levels were also compared with the exposure limits recommended by NIOSH, showing that the use of N95 for 1 h exceeded the recommended 5,000 ppm for an 8-h workday. None of the masks tested exceeded the NIOSH-recommended short-term limit in the first 15 min of use. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Inactivation of Zika virus with nucleic acids transport media, potentially applicable to clinical samples for the molecular diagnosis of SARS-CoV-2

Introduction: Collection media of clinical samples with the capacity to denature viruses reduce the risk of contagion during transportation and processing. Objective(s): To use the nucleic acids transport media (NATM) in nasopharyngeal swab samples collected for the diagnosis of SARS-CoV-2. Method(s): An experimental study was conducted to demonstrate the medium capacity to inactivate viral infectivity. Zika virus (ZIKV), of biosafety level 2, was used as an enveloped virus model. The clinical performance of the NATM for the diagnosis of SARS-CoV-2 was evaluated. A ZIKV strain propagated in the Vero cell line was used and, prior to cells infection, ZIKV was in contact at different intervals (2;15, and 30 min) with pure NATM;subsequently, serial dilutions (10-1-10-4) were performed. Viral inactivation was evaluated by RT-PCR in the supernatant and the collected cells when the propagation period was completed. CITOSWAB VTM was used as reference to estimate the clinical performance of the NATM in 30 nasopharyngeal swabs collected for the diagnosis of SARS-CoV-2 infection. Result(s): ZIKV remained infectious at inoculum dilutions of >= 10-2, regardless of contact time. Clinical specificity and sensitivity of the NATM for the diagnosis of SARS-CoV-2 were 100%, respectively. Conclusion(s): Results suggest that ZIKV positive clinical samples at dilutions <= 10-1 of the NATM can be safely handled, which could potentially be applied to the molecular diagnosis of SARS-CoV-2. Copyright © 2022, Editorial Ciencias Medicas. All rights reserved.

Polyphenolic-rich extracts from Ilex paraguariensis and Larrea divaricata leaves and their antioxidant and antiCOVID-19 potential

Yerba mate (Ilex paraguariensis A.St. Hil) and jarilla (Larrea divaricata Cav.) leaves are commonly used as tea infu-sions in some Latin American countries. This study was con-ducted to evaluate the antioxidant activity (FRAP, ABTS, and DPPH) and the inhibitory potential of yerba mate and jarilla extracts on the 3CL protease (Mpro) from coronavirus SARS-COV-2 by a molecular docking approach. The main bioactive compounds present in the plant extracts were identified by HPLC-MS. According to the results, the extracts of yerba mate and jarilla showed high antioxidant activity in DPPH (> 91 %), ABTS (> 90 %), and FRAP (> 47 mg TE/g) assays. Additionally, the phenolic compounds present in yerba mate, quercetin-3-O-rutinoside (rutin) (-9.60 kcal/mol) and 3,4-dicaffeoylqui-nic acid (-8.20 kcal/mol) were more effective on Mpro than the antiviral drugs remdesivir and ribavirin. The compounds rutin and 3,4-dicaffeoylquinic acid have a high affinity and interaction with one of the catalytic residues Cys145 of Mpro. The glycosylation of phenolic compounds affects biological activities: positively anti-COVID-19 and negatively antio-xidant. The results suggest that extracts of yerba mate and jarilla leaves could enhance the body's antioxidant defenses and can be used to improve health.