How the COVID-19 pandemic affects the moral reasoning of pediatric residents and the general population.

BACKGROUND: Kohlberg's theory of moral development asserts that people progress through different stages of moral reasoning as their cognitive abilities and social interactions mature. Individuals at the lowest stage of moral reasoning (preconventional stage) judge moral issues based on self-interest, those with a medium stage (conventional stage) judge them based on compliance with rules and norms, and those at the highest stage (postconventional stage) judge moral issues based on universal principles and shared ideals. Upon attaining adulthood, it can be considered that there is stability in the stage of individuals' moral development; however, the effect of a global population crisis such as the one experienced in March 2020, when the World Health Organization (WHO) declared the COVID-19 pandemic, is unknown. The purpose of this study was to evaluate the changes in the moral reasoning of pediatric residents before and after one year of the COVID-19 pandemic and compare them with a general population group. METHODS: This is a naturalistic quasi-experimental study conducted with two groups, one comprised 47 pediatric residents of a tertiary hospital converted into a COVID hospital during the pandemic and another group comprised 47 beneficiaries of a family clinic who were not health workers. The defining issues test (DIT) was applied to the 94 participants during March 2020, before the pandemic initiated in Mexico, and later during March 2021. To assess intragroup changes, the McNemar-Bowker and Wilcoxon tests were used. RESULTS: Pediatric residents showed higher baseline stages of moral reasoning: 53% in the postconventional group compared to the general population group (7%). In the preconventional group, 23% were residents and 64% belonged to the general population. In the second measurement, one year after the start of the pandemic, the group of residents had a significant decrease of 13 points in the P index, unlike the general population group in which a decrease of 3 points was observed. This decrease however, did not equalize baseline stages. Pediatric residents remained 10 points higher than the general population group. Moral reasoning stages were associated with age and educational stage. CONCLUSIONS: After a year of the COVID-19 pandemic, we found a decrease in the stage of moral reasoning development in pediatric residents of a hospital converted for the care of patients with COVID-19, while it remained stable in the general population group. Physicians showed higher stages of moral reasoning at baseline than the general population.

SARS-CoV-2 and methemoglobinemia in the neonatal period. Case report

INTRODUCCTION: Methemoglobinemia (MetaHb) is a condition where the erythrocyte is unable to release oxygen into tissues causing tissue hypoxia and metabolic acidosis with high lactate. In adult patients with SARS-CoV2 infection, some cases of coexistence of MetaHb and refractory hypoxemia have been reported;although there are no reports of this association in the neonatal stage. CLINICAL CASES: We show two cases of premature newborns with SARS-CoV-2 infection who had multisystemic deterioration and MetaHb in the second to the thrid week of life, without microbiological isolation, or temperary relationship with known MetaHb triggers, normal G6PD levels, and partial response to exchange transfusion or infusion of methylene blue. CONCLUSION: The relationship between MetaHb and SARS-CoV-2 infection is still unknown, but its pro-inflammatory activity has recently been documented, which can increase cytokine storm and worsen the evolution and prognosis of the patient with moderate to severe infection. Further studies of these associations are therefore necessary to enable timely interventions. © 2023 Instituto Nacional de Pediatria. All rights reserved.

COVID-19 and the Impact on Sports Betting Markets and Sports Bettors' Mental Health

This chapter investigates the impact of COVID-19 on sport betting markets and the mental health of those involved in sports betting. Given the wider discussion about the impact of the pandemic on mental health and the negative consequences of lockdowns and social distancing on people's mental well-being, the chapter focuses on a complex but critical issue for the global sporting community. The chapter also scrutinises the available sports betting data from the start of the pandemic and looks at the impact on bookmaker revenue. © 2023 selection and editorial matter, Stephen Frawley and Nico Schulenkorf;individual chapters, the contributors.

Assessing Wellbeing and Soft Skills of Software Developers and Students in the Context of Working from Home during the COVID-19 era

Derived from COVID-19 pandemic remote work is now a trend, involving new skills and variations on developers' wellbeing. Current students are going to live this new era in the labor market;it is needed to know if they are getting ready for this scenario. This paper presents an exploratory study based on a survey to assess how developers in industry and students in the academy experienced their wellbeing expressed in emotions during the pandemic, as well as how they practiced the soft skills involved in software development. The results of developers are considered as basis to assess how students are prepared for this context. The descriptive study has shown that developers experienced more positive emotions, while students had a mix of positive and negative emotions. In terms of soft skills, developers and students showed closer levels of practice, however students should reinforce some skills. © 2022 IEEE.

How COVID-19 Pandemic affects Software Developers' Wellbeing, and the Necessity to strengthen Soft Skills

: The coronavirus COVID-19 swept the world in early 2020, working from home was a necessity. In the software industry, thousands of software developers began working from home, many did so on short notice, under difficult and stressful conditions. The emotions of developers can be affected by this situation. On the other hand, some well-known soft skills have been emphasized as required for working remotely. Software engineering research lacks theory and methodologies for addressing human aspects in software development. In this paper we present an exploratory study with a survey applied to practitioners in the west border area of Mexico-USA. It is focused on the developers' wellbeing during pandemic, expressed as emotions, and the perceptions of the level in which soft skills are practiced/required in the working from home mode. The results show that high percent expressed to experience positive emotions, however, a portion of respondents expressed to feel negative emotions. In general terms, 91.0% of respondents expressed to be satisfied working from home, but some conditions should be improved. In the case of soft skills, some of them are revealed as practiced in high level in working from home, but still there is not consensus. © 2022, Pleiades Publishing, Ltd.

Pyridostigmine reduces mortality of patients with severe SARS-CoV-2 infection: A phase 2/3 randomized controlled trial.

BACKGROUND: Respiratory failure in severe coronavirus disease 2019 (COVID-19) is associated with a severe inflammatory response. Acetylcholine (ACh) reduces systemic inflammation in experimental bacterial and viral infections. Pyridostigmine increases the half-life of endogenous ACh, potentially reducing systemic inflammation. We aimed to determine if pyridostigmine decreases a composite outcome of invasive mechanical ventilation (IMV) and death in adult patients with severe COVID-19. METHODS: We performed a double-blinded, placebo-controlled, phase 2/3 randomized controlled trial of oral pyridostigmine (60 mg/day) or placebo as add-on therapy in adult patients admitted due to confirmed severe COVID-19 not requiring IMV at enrollment. The primary outcome was a composite of IMV or death by day 28. Secondary outcomes included reduction of inflammatory markers and circulating cytokines, and 90-day mortality. Adverse events (AEs) related to study treatment were documented and described. RESULTS: We recruited 188 participants (94 per group); 112 (59.6%) were men; the median (IQR) age was 52 (44-64) years. The study was terminated early due to a significant reduction in the primary outcome in the treatment arm and increased difficulty with recruitment. The primary outcome occurred in 22 (23.4%) participants in the placebo group vs. 11 (11.7%) in the pyridostigmine group (hazard ratio, 0.47, 95% confidence interval 0.24-0.9; P = 0.03). This effect was driven by a reduction in mortality (19 vs. 8 deaths, respectively). CONCLUSION: Our data indicate that adding pyridostigmine to standard care reduces mortality among patients hospitalized for severe COVID-19.

Preterm pregnant woman with COVID-19 associated with aggravated pre-eclampsia

Introduction: Coronavirus disease 2019 (COVID-19) is an acute respiratory infection caused by SARS-CoV-2, which can potentially cause severe acute respiratory syndrome and cause the death of the patient. Objective: To present a patient with COVID-19 associated with aggravated preeclampsia, in a preterm pregnant woman. Clinical case: A 25-year-old patient with a gestation of 35.2 weeks, a history of apparent health that was received since her arrival at the intensive care unit, referred for being positive for COVID-19, with respiratory symptoms of an associated lung disease, as high blood pressure figures, without other symptoms. Through physical examination and complementary humoral studies, an aggravated preeclampsia and oligohydramnios were diagnosed due to rupture of the ovular membranes. She was treated and compensated;Induction was started and during the procedure a risk of loss of fetal well-being was diagnosed, so it was decided to perform an urgent cesarean section. A healthy newborn was received. The patient did not present post-surgical complications and was treated according to current standards for cases of severe mother with COVID-19;she had a favorable evolution. Conclusions: The early diagnosis and treatment of a pregnant woman with COVID-19 and associated preeclampsia allows a satisfactory evolution of the mother-fetus binomial. © 2022, Editorial Ciencias Medicas. All rights reserved.

ACUTE RENAL FAILURE IN COVID-19 PATIENTS IN A LATIN AMERICAN HEALTH INSTITUTION

BACKGROUND AND AIMS: Acute renal failure in hospitalized patients for COVID- 19 occurs in 3%-28% and is a poor prognostic factor. The mechanisms of renal involvement are not completely clarified. However, it has been evaluated that the presentation of renal failure increases adverse outcomes. METHOD: Prospective observational study of all the cases that were admitted for COVID-19 between January and December 2021. Clinical and analytical data of kidney complications in patients with COVID-19 were collected. RESULTS: A total of 306 patients with a mean age of 70.2 years, 75.1% men and with previous chronic kidney disease in 29.7% were analyzed. A total of 50.8% had severe pneumonia or acute respiratory distress syndrome and 22.9% required admission to the ICU. Proteinuria was registered in 77.6% and hematuria in 67.6%. A total of 20.9% of the patients required renal replacement therapy. Renal failure was of prerenal etiology in 59.2%, acute tubular necrosis in the context of sepsis in 23.5%, glomerular in 8.1% and due to tubular toxicity in 9.2%. The median stay was 15 days, and 31.7% died. Patients who developed kidney failure during admission had higher C-reactive protein, LDH, and D-dimer values, more severe lung involvement, more need for ICU admission, and greater need for renal replacement therapy. CONCLUSION: Hypovolemia and dehydration are common causes of acute kidney injury in COVID-19 patients. Those who develop renal complications have a worse pulmonary, renal and systemic prognosis profile. We point out that monitoring an individualized management of blood volume can be decisive in preventing worse outcomes.

The impact of COVID-19 upon student radiographers and clinical training in Latin America.

INTRODUCTION: This study aimed to identify the impact of the COVID-19 pandemic upon radiography education across Latin American countries. METHODS: A survey containing 20 questions was circulated to radiography students, across 13 universities in 11 countries of Latin America using Google Forms. The survey contained open and closed questions. Answers were analysed with descriptive statistics and the methodology of interpretative phenomenological analysis for the open answers. RESULTS: Of the 1310 responses only 23.9% (n = 313) of students reported attending clinical placements and from this cohort only 8.9% (n = 28) became infected with COVID-19. In response to how the pandemic had impacted upon the students' academic progression, the most common topic in the open answers was "Concerns about the lack of clinical training", mentioned by 629 students. Students in middle and later years of their radiography education expressed the greatest concern about future clinical placements. Almost all radiography students (95.2%/n = 1247) indicated that their main concerns regarding COVID-19 infection while undertaking clinical placements was in relation to the risk of infecting their families as most students stated they cohabited with relatives (86.6%/n = 1134). CONCLUSION: Compared to European findings co-habitation trends increased anxiety related to infection and impacted their mental health. Students expressed concern about the quality of education they were receiving during the pandemic and access to resources to facilitate on-line learning was inadequate. Socio-economic and internet connectivity factors specific to Latin America were identified and these issues need to be addressed if on-line education is required in the future. IMPLICATIONS FOR PRACTICE: The COVID-19 pandemic has impacted Latin America and this study identifies the implications for radiography students related to their clinical and academic training and highlights factors which require consideration to support radiography students as the pandemic continues.

A mediasport typology for transformative relationships: enlargement, enhancement, connection and engagement beyond COVID-19. (Special Issue: Sport and COVID-19: impact and challenges for the future: volume 2.)

Research question: The business of sport has been radically challenged by the COVID-19 pandemic, impelling a rapid reassessment of practices to survive the disruption. One stakeholder comprehensively impacted has been the media, whose investments in augmenting sport's commercial appeal have been immense. The media will need to rethink their strategies to adequately leverage their connections to sport products. Similarly, sport properties and content providers will need to reconsider their mediated offerings and how fan relationships can be sustained. In response, this article outlines a pathway to superior fan activation and engagement, noting the accelerated transformation of sport arising in consequence of the pandemic.

PREPARE-IBD: Physician responses to disease flares and patient adaptation in relation to events in inflammatory bowel disease during the COVID-19 pandemic: A multicentre cohort analysis

Background: The COVID-19 pandemic continues to pose complex problems across Europe and the world, with rising numbers of infections and the ongoing need for drastic public health interventions. This is difficult for patients with immune-mediated disorders like Inflammatory Bowel Disease (IBD), where immunosuppressive medications may affect susceptibility to serious infection. It was particularly challenging for physicians and patients during the first wave of the pandemic, when it was unclear whether anti-inflammatory flare treatment should be adapted to reduce infection risk, whilst trying to ensure symptomatic control and avoid admission to overwhelmed hospitals. Despite the development of various IBD / COVID-19 databases, the treatment adaptations and outcomes of patients experiencing IBD flares during the COVID-19 pandemic remain undefined. We aimed to compare IBD management and outcomes between pandemic and prepandemic cohorts. Methods: An observational cohort study was performed, comprising patients who contacted IBD teams for a symptom flare between March - June, 2020 in, 60 National Health Service trusts in the United Kingdom. Data were compared to a pre-pandemic cohort after propensity- matching for age and disease severity. Statistical analyses were performed using R (version, 4.1.0, Vienna, Austria). Results: In total, 3728 patients in the pandemic (n=1864) and pre-pandemic (n=1864) cohorts were included. The principal findings were reduced systemic corticosteroid prescription during the pandemic in both Crohn's disease (prednisolone: pandemic, 199/752, 26.5% vs, 263/708, 37.1%;p<0.001) and ulcerative colitis (UC) (prednisolone: pandemic, 372/1112, 33.5% vs, 470/1156, 40.7%, p<0.001), with increases in poorly bioavailable oral corticosteroids in Crohn's (pandemic, 117/752, 15.6% vs, 48/708, 6.8%;p<0.001) and UC (pandemic, 131/1112, 11.8% vs, 60/1156, 5.2%;p<0.001). Ustekinumab (Crohn's and UC) and vedolizumab (UC) treatment also significantly increased during the pandemic. Three-month steroid-free remission was similar in both Crohn's (pandemic, 175/616, 28.4% vs, 195/608, 32.1%;p=0.17) and UC (pandemic, 312/858, 36.4% vs, 404/1006, 40.2%;p=0.095). The, 65 patients experiencing a flare and COVID-19 were more likely to have moderate-to-severely active disease at three months compared to those with a flare alone. Conclusion: Despite several treatment adaptations during the pandemic, steroid-free outcomes were comparable to pre-pandemic levels, though patients with a flare and COVID-19 experienced worse outcomes. These findings have implications for IBD management during future waves or pandemics.

Pregnancy and COVID-19. Considerations in the practice of Hematology

Coronavirus disease 2019 (COVID-19) in a vulnerable population, such as the pregnant woman, fetus, and newborn, requires an establishment of effective and safe strategies focused on the safety of the mother-child binomial. The objective of this report is to present the results of the review of secondary information sources (meta-analysis and systematic review), of the state of the art in the advancement of knowledge of the disease due to COVID-19 during pregnancy. Different reports have insisted that maternal mortality from COVID-19 is low. However, the maternal mortality ratio (MMR) increased from 30.9 to 45.5 deaths per 100,000 births, that is, it showed an increase of 36.32% compared to the same week of 2019. Due to its unprecedented condition and the particular behavior of the COVID-19 disease during the perinatal period, the generation of new data, its integration into accessible information and its epidemiological clinical analysis will inevitably provide new evidence that must be integrated into clinical management and practice. But the issue is not limited to COVID-19, the increase in MMR is 24% for maternal obstetric hemorrhage, 20% for hypertensive disease, and 28.5% for puerperal sepsis. There is no characteristic hematological behavior and the appearance of thrombotic or hemorrhagic complications in the patient with COVID-19, without clinical characteristics similar to those seen in her non-pregnant peers. The global increase in all causes of maternal mortality are not exclusive to COVID-19, which exposes the deficiencies of the health system in terms of primary health care, prenatal surveillance, family planning, among other programs;additional to the impact of COVID-19. The redesign of public policies in terms of primary health care for the entire population is an urgent need, particularly for pregnant women.

How COVID-19 Pandemic affects Software Developers' Wellbeing: An Exploratory Study in the West Border Area of Mexico-USA

The coronavirus COVID-19 swept the world in early 2020, working from home was a necessity. In the software industry, thousands of software developers began working from home, many did so on short notice, under difficult and stressful conditions. The emotions of developers can be affected by this situation. Software engineering research lacks theory and methodologies for addressing human aspects in software development. In this paper we present an exploratory study with a survey applied to practitioners in the west border area of Mexico-USA. This study is focused on the developers' wellbeing during pandemic, expressed as emotions. The results show that high percent expressed to experience positive emotions such as optimism, serenity, happiness, acceptance, trust, and interest;however, even when negative emotions are not experienced in a significant level, a portion of respondents expressed to feel them. 91.0% expressed to be satisfied working from home, however, some conditions should be improved. © 2021 IEEE.

POS-854 NEGATIVE ALACTIC VALUE IS REVERSED BY HEMOPERFUSION IN SEPTIC PATIENTS

Introduction: Gattinoni et al. have recently introduced a new internal milieu parameter: the “alactic base excess” (ABE). This variable is obtained by applying the following equation: ABE mmol/L = standard base excess (SBE) mmol/L + lactate mmol/L, being standard base excess mmol/L = [bicarbonate mmol/L - 24.8 mmol/L] + 16.2 mmol/L x (pH - 7.4). In a clinical setting, a negative ABE value is directly related to fix acid retention, and is associated with higher mortality in septic patients. Hemoperfusion (HPF) is an extracorporeal technique which involves the passage of blood (or plasma) through an adsorption cartridge, where solutes are removed by direct binding to the sorbent material. Then, we decided to evaluate if HPF could modify negative ABE value in sepsis. Methods: Basal values of ABE, SBE and lactate (mean, SD) were obtained. The difference between these parameters values before and after 4 HPF (HA330) sessions (delta value) was evaluated. Student and Wilcoxon tests were applied for data analyses Results: From 32 patients (age: 57±13, male 69%) suffering from respiratory insufficiency secondary to COVID-19 (RIC) who were treated with HPF (HA330) in the critical care unit of Clinica de la Mujer, Bogotá (Colombia), 6 presented metabolic acidosis (pH:7.37±0.1, pCO2: 36±14 mmHg, bicarbonate:20.5±3 mmol/L) with negative ABE value (-2.7±1) composed by negative SBE (- 4.7±1) and high lactate serum value (2±0.7 mmol/L). Delta ABE, SBE and lactate were: 7.7 (p:0.005), 6.1 (p:0.003) and 1.6 (p:NS), respectively. Thus, negative ABE was significantly reversed by HPF, due to SBE positivization without significant change in lactate. Conclusions: Negative alactic parameter was significantly reversed by HPF in septic patients. No conflict of interest

Inter-observer variability with five computed tomography severity scales for COVID-19 pneumonia assessment

Introduction: By the end 2019 there was an outbreak of pneumonia caused by a new corona virus, a disease that was called COVID-19. Computed tomography has played an important role in the diagnosis of COVID-19 patients. Objective: To demonstrate inter-observer variability with five scales proposed for measuring the extent of COVID-19 pneumonia on tomography. Methods: 35 initial chest computed tomography scans of patients who attended respiratory triage for suspected COVID-19 pneumonia were analyzed. Three radiologists classified the tomographic images according to the severity scales proposed by Yang (1), Yuan (2), Chun (3), Wang (4) and INER-Chung-Pan (5). The percentage of agreement between the evaluators for each scale was calculated using the infra-class correlation index. Results: In most patients were five pulmonary lobes compromised (77.1 % of the patients). Scales 1, 2, 4 and 5 showed an infra-class correlation > 0.91 (p < 0.0001), with agreement thus being almost perfect. Conclusions: Scale 4 (proposed by Wang) showed the best inter-observer agreement, with a coefficient of 0.964 (p = 0.001).