How were modified the human anatomy study habits during and after confinement by the COVID-19 pandemic? / ¿Cómo se modificaron los hábitos de estudio en anatomía humana durante y después del confinamiento por la pandemia del COVID-19?

SUMMARY: During 2020 and 2021 the anatomy subject was developed by online classes. In 2022, face-to-face teaching activities were resumed. The objective was to compare the autonomous study habits of two student generations that coursed the Human Anatomy subject in online and face-to-face mode. Two groups of students were asked to fill-out an online questionnaire. Online Generation (OL) (n=185) and Face-to-face Generation (FF) (n=154). The difference between both groups was the learning activities. OL received only online classes, and FF received theoretical classes and laboratory activities in face-to-face sessions. The most of OL subjects had greater clarity about the contents (71.9 %) and the depth (50.8 %) that they should study them, in contrast with FF (58.4 %, p = 0.0124 and 24.7 %, p < 0.0001 respectively). In OL, 47 % spent more than 4 hours weekly studying human anatomy, whereas in FF 68.2 % (p<0.0001). In both groups, the most important resource was the Video Recorded Classes (90.8 % in OL, and 83.1 % in FF). For OL, the three priority resources were exclusively electronic: 1) Video Recorded Classes, 2) Apps on smartphone or tablets, and 3) Apps on laptop or computer. FF generation prioritized: 1) Video Recorded Classes, 2) Anatomy Atlas, and 3) Class Slides. During the COVID-19 pandemic, the students that received only online classes were able to plain their study time in a better way than whose were in face-to-face classes. However, they spent less time to study the topics. In addition, it was possible to determine that students prefer digital resources (video classes recorded and apps in smartphone or computer) over traditional resources such as textbook and anatomy atlas. It proposes to consider these results in the Human Anatomy subjects design, in virtual or face-to-face mode.

Durante 2020 y 2021, la asignatura de anatomía fue desarrollada exclusivamente en modalidad online. En 2022 se retomaron las clases presenciales. El objetivo de este estudio fue comparar los hábitos de estudio autónomo de dos generaciones de estudiantes de anatomía. Dos grupos de estudiantes completaron un cuestionario online: Generación Online (OL) (n=185) y Generación Presencial (FF) (n=154). La principal diferencia entre ellos fue que OL recibió clases exclusivamente en modalidad online y FF exclusivamente presencial. La mayoría de los sujetos de OL tuvieron mayor claridad acerca de los contenidos (71,9 %) y la profundidad con que debían estudiarlos (50,8 %) en contraste con FF (58,4 %, p = 0,0124 and 24,7 %, p < 0,0001, respectivamente). En OL, el 47 % empleó más de 4 horas semanales de estudio, mientras en FF fue el 68,2 % (p<0.0001). En ambos grupos, el recurso más importante empleado fue la clase grabada (90,8 % en OL y 83,1 % en FF). Para OL la prioridad en el uso de los recursos de estudio fueron 1) Videoclase grabada, 2) Aplicación en teléfono o tablet y 3) Aplicación en computador. Para FF el orden de prioridad fue 1) Videoclase grabada, 2) Atlas de Anatomía y 3) Diapositivas de clases. Durante la pandemia de COVID-19, los estudiantes que recibieron exclusivamente clases online planearon su tiempo de estudio de mejor manera que quienes tuvieron clases presenciales y emplearon menos tiempo de estudio. Además, fue posible determinar que los estudiantes prefieren recursos de información digital (Videoclase Grabada y aplicaciones para teléfono celular o computador) por sobre los recursos tradicionales tales como texto y atlas de anatomía. Se propone considerar estos resultados en el diseño de los programas de asignatura de Anatomía Humana, a impartir en modalidad online o presencial.

How were modified the human anatomy study habits during and after confinement by the COVID-19 pandemic? / ¿Cómo se modificaron los hábitos de estudio en anatomía humana durante y después del confinamiento por la pandemia del COVID-19?

SUMMARY: During 2020 and 2021 the anatomy subject was developed by online classes. In 2022, face-to-face teaching activities were resumed. The objective was to compare the autonomous study habits of two student generations that coursed the Human Anatomy subject in online and face-to-face mode. Two groups of students were asked to fill-out an online questionnaire. Online Generation (OL) (n=185) and Face-to-face Generation (FF) (n=154). The difference between both groups was the learning activities. OL received only online classes, and FF received theoretical classes and laboratory activities in face-to-face sessions. The most of OL subjects had greater clarity about the contents (71.9 %) and the depth (50.8 %) that they should study them, in contrast with FF (58.4 %, p = 0.0124 and 24.7 %, p < 0.0001 respectively). In OL, 47 % spent more than 4 hours weekly studying human anatomy, whereas in FF 68.2 % (p<0.0001). In both groups, the most important resource was the Video Recorded Classes (90.8 % in OL, and 83.1 % in FF). For OL, the three priority resources were exclusively electronic: 1) Video Recorded Classes, 2) Apps on smartphone or tablets, and 3) Apps on laptop or computer. FF generation prioritized: 1) Video Recorded Classes, 2) Anatomy Atlas, and 3) Class Slides. During the COVID-19 pandemic, the students that received only online classes were able to plain their study time in a better way than whose were in face-to-face classes. However, they spent less time to study the topics. In addition, it was possible to determine that students prefer digital resources (video classes recorded and apps in smartphone or computer) over traditional resources such as textbook and anatomy atlas. It proposes to consider these results in the Human Anatomy subjects design, in virtual or face-to-face mode.

Durante 2020 y 2021, la asignatura de anatomía fue desarrollada exclusivamente en modalidad online. En 2022 se retomaron las clases presenciales. El objetivo de este estudio fue comparar los hábitos de estudio autónomo de dos generaciones de estudiantes de anatomía. Dos grupos de estudiantes completaron un cuestionario online: Generación Online (OL) (n=185) y Generación Presencial (FF) (n=154). La principal diferencia entre ellos fue que OL recibió clases exclusivamente en modalidad online y FF exclusivamente presencial. La mayoría de los sujetos de OL tuvieron mayor claridad acerca de los contenidos (71,9 %) y la profundidad con que debían estudiarlos (50,8 %) en contraste con FF (58,4 %, p = 0,0124 and 24,7 %, p < 0,0001, respectivamente). En OL, el 47 % empleó más de 4 horas semanales de estudio, mientras en FF fue el 68,2 % (p<0.0001). En ambos grupos, el recurso más importante empleado fue la clase grabada (90,8 % en OL y 83,1 % en FF). Para OL la prioridad en el uso de los recursos de estudio fueron 1) Videoclase grabada, 2) Aplicación en teléfono o tablet y 3) Aplicación en computador. Para FF el orden de prioridad fue 1) Videoclase grabada, 2) Atlas de Anatomía y 3) Diapositivas de clases. Durante la pandemia de COVID-19, los estudiantes que recibieron exclusivamente clases online planearon su tiempo de estudio de mejor manera que quienes tuvieron clases presenciales y emplearon menos tiempo de estudio. Además, fue posible determinar que los estudiantes prefieren recursos de información digital (Videoclase Grabada y aplicaciones para teléfono celular o computador) por sobre los recursos tradicionales tales como texto y atlas de anatomía. Se propone considerar estos resultados en el diseño de los programas de asignatura de Anatomía Humana, a impartir en modalidad online o presencial.

Anxiety, depression, and academic stress among medical students during the COVID-19 pandemic.

Background: The social distancing policies implemented by the health authorities during the COVID-19 pandemic in Mexico and elsewhere led to major changes in teaching strategies for college undergraduates. So far, there is limited data regarding the impact of the lockdown on the academic stress and mental health of these students. Objective: To assess the occurrence of academic difficulties, anxiety, depression, and academic stressors resulting in somatization with subsequent coping strategies linked to the pandemic. Materials and methods: A cross-sectional study was conducted with 728 medical students (years 1-5). A purposely designed questionnaire to assess academic difficulties associated with the pandemic was administered electronically. The validated Goldberg anxiety and depression scale was also used, as well as the SISCO-II inventory on academic stress. Results: Screening for anxiety and depression led to a prevalence of 67.9 and 81.3%, respectively. Most relevant stressors, reported always or nearly always, included professors' evaluations (63.9%), and reading overload of academic papers (50.6%). Factorial analyses showed that women were more prone to stress than men (p < 0.001). Somatization symptomatology included drowsiness or increased need of sleep, anxiety, anguish, desperation, chronic fatigue, and sleep disorders. Common coping strategies included practicing a hobby, done always or nearly always by 65% of students with high stress, and 34% of those with low stress (p < 0.001). Conclusion: There was a relevant impact of the mandatory lockdown during COVID-19 pandemic on the mental health of medical students reflected in the high prevalence rates of anxiety, depression, and stressors in the studied population pointing to the need for designing and implementing preventive strategies to deal with the effects of lockdowns.

Minimizing the epidemic final size while containing the infected peak prevalence in SIR systems.

Mathematical models are critical to understand the spread of pathogens in a population and evaluate the effectiveness of non-pharmaceutical interventions (NPIs). A plethora of optimal strategies has been recently developed to minimize either the infected peak prevalence ( I P P ) or the epidemic final size ( E F S ). While most of them optimize a simple cost function along a fixed finite-time horizon, no consensus has been reached about how to simultaneously handle the I P P and the E F S , while minimizing the intervention's side effects. In this work, based on a new characterization of the dynamical behaviour of SIR-type models under control actions (including the stability of equilibrium sets in terms of herd immunity), we study how to minimize the E F S while keeping the I P P controlled at any time. A procedure is proposed to tailor NPIs by separating transient from stationary control objectives: the potential benefits of the strategy are illustrated by a detailed analysis and simulation results related to the COVID-19 pandemic.

Development of an Auxiliary Platform (Mentali) for the Primary Screening of Anxiety and Depression in Young Adults.

The current COVID-19 pandemic has completely changed people's daily routines. This has had a big impact on mental health. In Mexico, medical school authorities are interested in understanding the mental health status of the student population to be able to provide support to students who may need help from a mental health specialist. The aim of this study was to develop a platform comprised of a mobile and web application called Mentali, to be used as an auxiliary tool for the detection of conditions such as anxiety and depression, as well as variations in mood, by analysis of the results of validated inventories. Following the Scrum software development methodology, Python, Dart and PHP programming languages were used for development of the application. This platform was used prospectively with 155 first year students taking part in the human medicine program. After 22 weeks, Mentali enabled the identification of 40 users with positive primary screening for anxiety and/or depression (45% for anxiety, 32.5% for both anxiety and depression, and 22.5% for altered mood). These students were contacted and referred to a psychologist; however, only 26 (65%) accepted psychological support. For all of these students a mental health disorder was confirmed. The results support the use of Mentali for the primary screening of anxiety and depression in young adults, including medical students.

Medical decision support system using weakly-labeled lung CT scans

Purpose Determination and development of an effective set of models leveraging Artificial Intelligence techniques to generate a system able to support clinical practitioners working with COVID-19 patients. It involves a pipeline including classification, lung and lesion segmentation, as well as lesion quantification of axial lung CT studies. Approach A deep neural network architecture based on DenseNet is introduced for the classification of weakly-labeled, variable-sized (and possibly sparse) axial lung CT scans. The models are trained and tested on aggregated, publicly available data sets with over 10 categories. To further assess the models, a data set was collected from multiple medical institutions in Colombia, which includes healthy, COVID-19 and patients with other diseases. It is composed of 1,322 CT studies from a diverse set of CT machines and institutions that make over 550,000 slices. Each CT study was labeled based on a clinical test, and no per-slice annotation took place. This enabled a classification into Normal vs. Abnormal patients, and for those that were considered abnormal, an extra classification step into Abnormal (other diseases) vs. COVID-19. Additionally, the pipeline features a methodology to segment and quantify lesions of COVID-19 patients on the complete CT study, enabling easier localization and progress tracking. Moreover, multiple ablation studies were performed to appropriately assess the elements composing the classification pipeline. Results The best performing lung CT study classification models achieved 0.83 accuracy, 0.79 sensitivity, 0.87 specificity, 0.82 F1 score and 0.85 precision for the Normal vs. Abnormal task. For the Abnormal vs COVID-19 task, the model obtained 0.86 accuracy, 0.81 sensitivity, 0.91 specificity, 0.84 F1 score and 0.88 precision. The ablation studies showed that using the complete CT study in the pipeline resulted in greater classification performance, restating that relevant COVID-19 patterns cannot be ignored towards the top and bottom of the lung volume. Discussion The lung CT classification architecture introduced has shown that it can handle weakly-labeled, variable-sized and possibly sparse axial lung studies, reducing the need for expert annotations at a per-slice level. Conclusions This work presents a working methodology that can guide the development of decision support systems for clinical reasoning in future interventionist or prospective studies.

Usefulness of a Mobile Application (Mentali) for Anxiety and Depression Screening in Medical Students and Description of the Associated Triggering Factors.

The impact of the COVID-19 health crisis on the mental health of the population requires the implementation of new primary screening strategies of mental health disorders to intervene in a timelier manner, and technology may provide solutions. We aimed to evaluate the usefulness of the mobile app Mentali (version 1.1.2; creators: Jorge Alfonso Solís Galván Sodel Vázquez Reyes, Margarita de la Luz Martínez Fierro, Perla Velasco Elizondo, Idalia Garza Veloz, Alejandro Mauricio González and Claudia Caldera Villalobos, Zacatecas, México) as a primary screening tool for anxiety and depression disorders in medical students and to assess the triggering risk factors. This was a descriptive and longitudinal study and included 155 Mexican medical students. Participants interacted with Mentali for 6 months. The mobile app integrated the Beck anxiety and depression inventories together with a mood module. At the end of the interaction, the students received psychological and psychiatric interventions to confirm their primary diagnoses. Symptoms of moderate/severe anxiety and depression were present in 62.6% and 54.6% of the studied population. When corroborating the diagnoses, Mentali obtained a sensitivity of 100%, 95%, and 43% to classify a mental health disorder, anxiety, and depression, respectively. The most important triggers found were as follows: belonging to a dysfunctional family, being introverted, and having suffered from bullying. The proportion of users with excellent/good mood decreased from 78.7% to 34.4% at the end of the semester, and the proportion of users who claimed to have bad/very bad mood increased from 7.4% to 34.4% at the end of the semester (p < 0.05). Mentali was useful for identifying users with anxiety and/or depression, and as an auxiliary tool to coordinate the provision of specialized interventions, allowing us to increase the proportion of patients who needed psychological care and received it by 30%. The efficacy of Mentali in identifying activities through time with an impact on the mood and mental health of the users was confirmed. Our results support the use of Mentali for the primary screening of mental health disorders in young adults, including medical students.

On stability of nonzero set-point for nonlinear impulsive control systems

The interest in non-linear impulsive systems (NIS) has been growing due to their impact on application problems such as disease treatments (diabetes, HIV, influenza, COVID-19, among many others), where the control action (drug administration) is given by short-duration pulses followed by time periods of null values. Within this framework, the concept of equilibrium needs to be extended (redefined) to allow the system to keep orbiting (between two consecutive pulses) in some state-space sets out of the origin, according to the usual objectives of most real applications. Although such sets can be characterized by means of a discrete-time system obtained by sampling the NIS at the impulsive times, no agreement has been reached on their asymptotic stability (AS) under optimizing control strategies. This paper studies the asymptotic stability of control equilibrium orbits for NIS, based on the underlying discrete-time system, in order to establish the conditions under which the AS for the latter leads to the AS for the former. Furthermore, based on the latter AS characterization, an impulsive Model Predictive Control (i-MPC) that feasibly stabilizes the non-linear impulsive system is presented. The biomedical problems of intravenous bolus administration of Lithium and antiretrovirals administration for HIV treatments are considered as simulation examples to demonstrate the controller performance

Mental Health Changes in Older Adults in Response to the COVID-19 Pandemic: A Longitudinal Study in Mexico.

This study examined changes in some aspects of mental health, as well as worries and behaviors related to the COVID-19 pandemic in a sample of older adults, during three different moments of the first year of the pandemic in Mexico. The sample consisted of 2,307 older adults (38% men and 62% women). The results indicated that older adults presented less concern about the COVID-19 pandemic, as well as less adherence to preventing procedures in the first wave, compared to subsequent evaluations. In addition, greater depressive symptoms, anxiety and stress were found in older adults in the last wave; however, the proportion of older adults identified with high scores in these variables was lower than that reported in national data.

Integrating heterogeneous data to facilitate COVID-19 drug repurposing.

In the COVID-19 pandemic, drug repositioning has presented itself as an alternative to the time-consuming process of generating new drugs. This review describes a drug repurposing process that is based on a new data-driven approach: we put forward five information paths that associate COVID-19-related genes and COVID-19 symptoms with drugs that directly target these gene products, that target the symptoms or that treat diseases that are symptomatically or genetically similar to COVID-19. The intersection of the five information paths results in a list of 13 drugs that we suggest as potential candidates against COVID-19. In addition, we have found information in published studies and in clinical trials that support the therapeutic potential of the drugs in our final list.

Efficacy and safety of intramuscular administration of allogeneic adipose tissue derived and expanded mesenchymal stromal cells in diabetic patients with critical limb ischemia with no possibility of revascularization: study protocol for a randomized controlled double-blind phase II clinical trial (The NOMA Trial).

BACKGROUND: Chronic lower limb ischemia develops earlier and more frequently in patients with type 2 diabetes mellitus. Diabetes remains the main cause of lower-extremity non-traumatic amputations. Current medical treatment, based on antiplatelet therapy and statins, has demonstrated deficient improvement of the disease. In recent years, research has shown that it is possible to improve tissue perfusion through therapeutic angiogenesis. Both in animal models and humans, it has been shown that cell therapy can induce therapeutic angiogenesis, making mesenchymal stromal cell-based therapy one of the most promising therapeutic alternatives. The aim of this study is to evaluate the feasibility, safety, and efficacy of cell therapy based on mesenchymal stromal cells derived from adipose tissue intramuscular administration to patients with type 2 diabetes mellitus with critical limb ischemia and without possibility of revascularization. METHODS: A multicenter, randomized double-blind, placebo-controlled trial has been designed. Ninety eligible patients will be randomly assigned at a ratio 1:1:1 to one of the following: control group (n = 30), low-cell dose treatment group (n = 30), and high-cell dose treatment group (n = 30). Treatment will be administered in a single-dose way and patients will be followed for 12 months. Primary outcome (safety) will be evaluated by measuring the rate of adverse events within the study period. Secondary outcomes (efficacy) will be measured by assessing clinical, analytical, and imaging-test parameters. Tertiary outcome (quality of life) will be evaluated with SF-12 and VascuQol-6 scales. DISCUSSION: Chronic lower limb ischemia has limited therapeutic options and constitutes a public health problem in both developed and underdeveloped countries. Given that the current treatment is not established in daily clinical practice, it is essential to provide evidence-based data that allow taking a step forward in its clinical development. Also, the multidisciplinary coordination exercise needed to develop this clinical trial protocol will undoubtfully be useful to conduct academic clinical trials in the field of cell therapy in the near future. TRIAL REGISTRATION: ClinicalTrials.gov NCT04466007 . Registered on January 07, 2020. All items from the World Health Organization Trial Registration Data Set are included within the body of the protocol.

Direct RT-PCR amplification of SARS-CoV-2 from clinical samples using a concentrated viral lysis-amplification buffer prepared with IGEPAL-630.

The pandemic of 2019 caused by the novel coronavirus (SARS-CoV-2) is still rapidly spreading worldwide. Nucleic acid amplification serves as the gold standard method for confirmation of COVID-19 infection. However, challenges faced for diagnostic laboratories from undeveloped countries includes shortage of kits and supplies to purify viral RNA. Therefore, it is urgent to validate alternative nucleic acid isolation methods for SARS-CoV-2. Our results demonstrate that a concentrated viral lysis amplification buffer (vLAB) prepared with the nonionic detergent IGEPAL enables qualitative detection of SARS-CoV-2 by direct Reverse Transcriptase-Polymerase Chain Reaction (dRT-PCR). Furthermore, vLAB was effective in inactivating SARS-CoV-2. Since this method is inexpensive and no RNA purification equipment or additional cDNA synthesis is required, this dRT-PCR with vLAB should be considered as an alternative method for qualitative detection of SARS-CoV-2.

Isothermal recombinase polymerase amplification-lateral flow detection of SARS-CoV-2, the etiological agent of COVID-19.

The rapid detection of novel pathogens including SARS-CoV-2 necessitates the development of easy-to-use diagnostic tests that can be readily adapted and utilized in both clinical laboratories and field settings. Delay in diagnosis has facilitated the rapid spread of this novel virus throughout the world resulting in global mortality that will surpass 2.5 million people. Development of point-of-care diagnostic assays that can be performed in rural or decentralized health care centers to expand testing capacity is needed. We developed a qualitative test based on recombinase-polymerase-amplification coupled with lateral flow reading (RPA-LF) for rapid detection of SARS-CoV-2. The RPA-LF detected SARS-CoV-2 with a limit of detection of 35.4 viral cDNA nucleocapsid (N) gene copies/µL. Additionally, the RPA-LF was able to detect 0.25-2.5 copies/µL of SARS-CoV-2 N gene containing plasmid. We evaluated 37 nasopharyngeal samples using CDC's N3, N1 and N2 RT-real-time PCR assays for SARS-CoV-2 as reference test. We found a 100 % concordance between RPA-LF and RT-qPCR reference test as determined by 18/18 positive and 19/19 negative samples. All positive samples had Ct values between 19-37 by RT-qPCR. The RPA-LF primers and probe did not cross react with other relevant betacoronaviruses such as SARS and MERS. This is the first isothermal amplification test paired with lateral flow developed for qualitative detection of COVID-19 allowing rapid viral detection and with prospective applicability in resource limited and decentralized laboratories.

Dynamical characterization of antiviral effects in COVID-19.

Mathematical models describing SARS-CoV-2 dynamics and the corresponding immune responses in patients with COVID-19 can be critical to evaluate possible clinical outcomes of antiviral treatments. In this work, based on the concept of virus spreadability in the host, antiviral effectiveness thresholds are determined to establish whether or not a treatment will be able to clear the infection. In addition, the virus dynamic in the host - including the time-to-peak and the final monotonically decreasing behavior - is characterized as a function of the time to treatment initiation. Simulation results, based on nine patient data, show the potential clinical benefits of a treatment classification according to patient critical parameters. This study is aimed at paving the way for the different antivirals being developed to tackle SARS-CoV-2.

Distress, Depression, Anxiety, and Concerns and Behaviors Related to COVID-19 during the First Two Months of the Pandemic: A Longitudinal Study in Adult MEXICANS.

We examined longitudinal differences in the severity of distress, depression, anxiety, and concerns and behaviors related to COVID-19 during the first two months of this pandemic, correlations between these variables, and interactions of distress with significant sociodemographics across waves. A longitudinal online survey was conducted in the State of Mexico, from 8 April to 27 May, 2020, in a sample of men and women between 18 and 60 years old, using: Impact of Event Scale-6, Patient Health Questionnaire-9, General Anxiety Disoder-7, and a questionnaire of concerns and behaviors related to COVID-19. Six hundred seventy participants were analyzed. Only a mild difference in distress was observed between the two waves and mild correlations of this variable with contagion in oneself and in a relative. Having a high-risk medical condition proved a considerable effect on distress within both waves. Perception of usefulness of preventive measures, concerns of contagion in a relative, and financial and security situations scored high within our questionnaire but did not change in the follow-up. We hypothesize that habituation to distressful events in the Mexican population (emergent resilience) might explain the absence of meaningful differences. Our research adds to the monitoring of mental health in Mexicans during the COVID-19 pandemic; its findings can serve to perform comparisons in other studies and for further meta-analyses.

Diabetes mellitus and COVID-19: pathophysiology and treatment proposal for glycemic control at the time of the pandemic / Diabetes mellitus y COVID-19: fisiopatología y propuesta de tratamiento para el control glucémico en el tiempo de la pandemia

RESUMEN El coronavirus 2 del síndrome respiratorio agudo grave es el tercer betacoronavirus desde el año 2003 capaz de ocasionar una infección del tracto respiratorio inferior, llevando, en casos críticos, al síndrome de dificultad respiratoria aguda y la muerte. La edad avanzada, la hipertensión arterial y la diabetes mellitus son, entre otros, tres factores determinantes en los peores desenlaces clínicos. Múltiples mecanismos pueden explicar la mayor susceptibilidad de las personas diabéticas a las infecciones respiratorias. La hiperglucemia crónica altera tanto a la inmunidad humoral como al celular. Esta enfermedad predispone a la sobreexpresión de la proteína de la membrana celular que sirve como receptora del virus y a una respuesta inflamatoria exacerbada, aumentando el riesgo de una descompensación y de la aparición de crisis hiperglicémicas. Ante la ausencia de un tratamiento efectivo o de una vacuna, todos los esfuerzos deben hacerse para procurar un buen control metabólico de los pacientes con diabetes mellitus con y sin COVID-19. Por lo anterior, se plantean en este artículo de reflexión, diferentes propuestas para el tratamiento de la diabetes mellitus en la unidad de cuidados intensivos, sin descartar la forma ambulatoria, en donde la telemedicina y otras tecnologías permitirán acortar la distancia y mantener las medidas de aislamiento preventivo.

SUMMARY Severe acute respiratory syndrome coronavirus 2 is the third beta-coronavirus since 2003 capable of causing lower respiratory tract infection, leading to severe cases of acute respiratory distress syndrome and death. Advanced age, high blood pressure and diabetes mellitus are three predictors of worse clinical outcomes. Multiple mechanisms could explain the greater susceptibility of diabetic people to respiratory infections. Chronic hyperglycemia alters both humoral and cellular immunity. This disease predisposes to virus receptor overexpression and an exaggerated inflammatory response, increasing the risk of decompensation and hyperglycemic crises. In the absence of an effective vaccine or treatment for the virus, this vicious circle should be stopped with an emphasis on controlling glucose. This paper presents different proposals for the treatment of diabetes mellitus both on an outpatient basis where telemedicine and other technologies will make it possible to continue adequate ambulatory care to maintain preventive isolation measures up to care in the intensive care unit.

Psychological impact of sociodemographic factors and medical conditions in older adults during the COVID-19 pandemic in Mexico / Impacto psicológico de factores sociodemográficos y condiciones médicas en adultos mayores durante la pandemia de COVID-19 en México

Abstract Introduction Older adults are not only at a higher medical risk during the COVID-19 pandemic, but they may also be a group particularly vulnerable to mental health diminishing. Objective To analyze the effect of some sociodemographic factors (sex and age) and medical conditions (diabetes and hypertension) on mental health and concerns about COVID-19 in a sample of older adults. Method A non-probabilistic sample of 2,992 older adults (37.7% men and 62.3% women) was selected, with an average age of 70.45 years (SD = 7.31). Participants were given the Impact of Event Scale-6 (IES-6), the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), a questionnaire of concerns about COVID-19, and a sociodemographic questionnaire. Participants' answers were captured via Google Forms. Results The results showed that women had greater concerns about COVID-19 than men. The findings in general showed significant effects, with women showing higher scores in depressive symptoms, anxiety, and greater stress generated in addition by the impact of the event. Differences concerning event-related stress and depression were found in relation to subgroups by age. Discussion and conclusion These finding could serve for the planning and development of strategies that provide attention to the mental health of this population group.

Resumen Introducción Los adultos mayores no sólo presentan un mayor riesgo médico durante la pandemia de COVID-19, sino que también pueden ser particularmente vulnerables a la disminución de la salud mental. Objetivo Analizar el efecto de algunos factores sociodemográficos (sexo y edad) y condiciones médicas (diabetes e hipertensión) sobre la salud mental y las preocupaciones sobre COVID-19 en una muestra de adultos mayores. Método Se seleccionó una muestra no probabilística de 2,992 adultos mayores (37.7% hombres y 62.3% mujeres), con una edad promedio de 70.45 años (DE = 7.31). Los participantes recibieron la Estala de Impacto de Evento-6, el Cuestionario de Salud del Paciente-9, el Trastorno de Ansiedad Generalizada-7, un cuestionario de preocupaciones sobre COVID-19 y un cuestionario sociodemográfico. Resultados Las mujeres presentaron mayores preocupaciones por COVID-19 que los hombres. Las respuestas de los participantes se capturaron en Google Forms. Resultados En general, los hallazgos mostraron efectos significativos, siendo las mujeres quienes presentaron puntuaciones más altas en síntomas depresivos y ansiedad, así como mayor estrés asociado a evento. Además, se encontraron efectos diferenciados por subgrupos de edad en relación con estrés asociado a evento y síntomas depresivos. Discusión y conclusión Estos hallazgos pudieran ser útiles para planificar y desarrollar estrategias que brinden atención a la salud mental de este grupo de población.

COVID-19 in Pediatrics: clinical and epidemiological aspects, immunopathogenesis, diagnostic and treatment

RESUMEN Introducción: La Organización Mundial de la Salud declaró desde el 11 de marzo de 2020 la infección por el coronavirus denominado SARS-CoV-2, como una pandemia, existente desde finales de 2019 en la provincia china de Wuhan. La enfermedad producida por este coronavirus se denomina COVID-19, entidad que ha mostrado una baja morbilidad y mortalidad en pediatría. Objetivo: Examinar factores epidemiológicos, sintomatología, diagnóstico y tratamiento de la enfermedad en la edad pediátrica. Métodos: Se revisó la literatura utilizando la base de datos PubMed para identificar artículos publicados hasta el 30 de abril 2020, informes, series de casos y datos de laboratorio. Resultados: La edad de presentación con mayor frecuencia ocurrió en los pacientes mayores de 5 años con 2,5 % de casos graves, acompañados de fiebre, tos, congestión nasal, disnea, vómitos y diarreas como síntomas más frecuentes. Los datos de laboratorio indican una media de conteo leucocitario entre 6,1 y 6,8 × 105, linfopenia con rango entre 2,5 y 40 %, y aumento de las enzimas alaniltranferasa y creatininfosfoquinasa, además del marcador antiinflamatorio proteína C reactiva, este último con concentraciones entre el 17 y 62,5 %. La transmisión vertical no ha sido verificada. El tratamiento utilizado con mayor frecuencia es Lopinavir/ ritonavir e interferón. La radiografía de tórax fue normal entre el 20 y el 66 %. No se registran fallecidos en las seis series revisadas. Consideraciones finales: La infección por SARS-CoV-2 en pediatría evoluciona con un pronóstico favorable, pero se necesitan más investigaciones para un mejor conocimiento de la entidad. ABSTRACT Introduction: The World Health Organization declared as a pandemic the infection by the coronavirus called SARS-CoV-2 on March 11th, 2020 that emerged in the last days of 2019 in the Chinese province of Wuhan. The disease produced by this coronavirus it is called COVID-19 and it is an entity that has shown low morbidity and mortality in pediatric patients. Objective: To examine epidemiological factors, symptomatology, diagnostic and treatment of the disease in pediatric ages. Methods: It was reviewed literature using PubMed database to identify articles published until April 30th, 2020, and also reports, series of cases and laboratory data. Results: The most frequent onset age was in patients older that 5 years, having 2,5% of seriously ill patients with fever, cough, nasal congestion, dyspnoea, vomiting and diarrhea as the most frequent symptoms. Laboratory data indicated a mean of leukocyte count between 6,1 and 6,8 x 105, lymphopenia with a range between 2,5 and 40%, and an increase of alaniltranferase and creatininfosfoquinase enzymes, in addition to the C reactive protein anti-inflammatory marker with concentrations between 17 and 62,5%. Vertical transmission has not been verified. The most frequently used treatment is Lopinavir/ ritonavir and interferon. Chest X-ray was normal in the 20 to 66 % of the cases. No deaths were recorded in the six series of cases reviewed. Final considerations: The infection by SARS-CoV-2 in pediatric ages evolves with a favorable prognosis but more researches on the topic are needed for a best knowledge of this entity.

Characterization of SARS-CoV-2 dynamics in the host.

While many epidemiological models were proposed to understand and handle COVID-19 pandemic, too little has been invested to understand human viral replication and the potential use of novel antivirals to tackle the infection. In this work, using a control theoretical approach, validated mathematical models of SARS-CoV-2 in humans are characterized. A complete analysis of the main dynamic characteristic is developed based on the reproduction number. The equilibrium regions of the system are fully characterized, and the stability of such regions is formally established. Mathematical analysis highlights critical conditions to decrease monotonically SARS-CoV-2 in the host, as such conditions are relevant to tailor future antiviral treatments. Simulation results show the aforementioned system characterization.

Surgical Tracheostomies in COVID-19 Patients: Indications, Technique, and Results in a Second-Level Spanish Hospital.

OBJECTIVE: The main purpose of this work is to describe the sociodemographic and clinical characteristics of intensive care unit (ICU) patients in a second-level hospital in Madrid, Spain, focusing in those who underwent surgical tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic. The surgical technique and associated complications are also detailed. STUDY DESIGN: Observational and historical cohort. SETTING: Single center. METHODS: Eighty-three intubated COVID-19 patients were analyzed. Thirty bedside surgical tracheostomies had been performed following our safety protocol. RESULTS: Data from 83 patients admitted to the ICU in Infanta Leonor University Hospital were collected; 74.7% were male. The average age was 59.7 years. The main comorbidities found were hypertension in 51.8%, diabetes mellitus in 25.3%, asthma in 7.2%, and chronic obstructive pulmonary disease in 3.6%. A surgical tracheostomy was carried out in 36.1% of patients who needed a prolonged intubation. The most frequent complication of the surgical procedure, bleeding, occurred in 30%, but the majority were mild and ceased with compression only. The most relevant complication was local infection, which occurred in 26.7% of patients. There were statistically significant differences in the time from the beginning of mechanical ventilation until weaning between tracheostomized and nontracheostomized patients. The mortality rate of patients who underwent tracheostomy was 56.7%. Despite severe acute respiratory syndrome coronavirus 2 being highly contagious and tracheostomy being considered a high-risk procedure, our rate of infected ear, nose, and throat specialists was only 11.8%. CONCLUSION: In our experience, bedside surgical tracheostomy is a safe procedure in COVID-19 patients when safety protocols are followed.