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.

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.

Immunological basis that supports the treatment of Multi-System Inflammatory Syndrome in Children (MIS-C/PIMS)

Pediatric inflammatory multisystemic syndrome temporarily associated with COVID-19 (MIS-C/PIMS) is a new post-infectious condition, secondary to SARS-CoV2 infection. It has been characterized by an inflammatory response with multisystem involvement, involving several mechanisms of immune damage such as an exaggerated increase in cytokines and epithelial damage. Immunomodulatory treatment is aimed at controlling the manifestations of hyperinflammation, to stabilize and prevent long-term sequelae. © 2023 Instituto Nacional de Pediatria. All rights reserved.

Isolating the Effect of Covid-19 Related Disruption on Hiv Diagnoses in the Us, 2020

Background: Diagnoses of HIV in the US decreased by 17% in 2020 due to COVID-related disruptions. The extent to which this decrease is attributable to changes in HIV testing versus HIV transmission is unclear. We seek to better understand this issue by analyzing the discrepancy in expected versus observed HIV diagnoses in 2020 among persons who acquired HIV between 2010-2019, as changes in diagnosis patterns in this cohort cannot be attributed to changes in transmission. Method(s): We developed three methods based on the CD4-depletion model to estimate excess missed diagnoses in 2020 among PWH infected from 2010-2019. We stratified the results by transmission group, sex assigned at birth, race/ ethnicity, and region to examine differences by group and confirm the reliability of our estimates. We performed similar analyses projecting new diagnoses in 2019 among PWH infected from 2010-2018 to evaluate the accuracy of our methods against surveillance data. Result(s): There were approximately 3100-3300 fewer diagnoses than expected in 2020 among persons who acquired HIV from 2010-2019. Females (at birth), heterosexuals, persons who inject drugs, and Hispanic/Latino PWH missed diagnoses at higher levels than the overall population. By transmission category, MSM accounted for the highest percentage (61%) of missed diagnoses. Validation and stratification analyses confirmed the accuracy and reliability of our estimates. Conclusion(s): PWH infected from 2010-2019 showed a significant drop in diagnosis rate during 2020, suggesting that changes in testing played a substantial role in the observed decrease in new HIV diagnoses. Levels of missed diagnoses differed substantially across population subgroups. These analyses may be used to inform future estimates of HIV transmission during the COVID-19 pandemic and prioritize populations with increased testing needs.

COVID-19: prevention, diagnosis and treatment. Recommendations of a multidisciplinary group.

BACKGROUND: SARS-CoV-2 infection, which causes COVID-19, has impacted the entire world due to its extensive and rapid spread. In the last two years, more than 412 million cases have been confirmed, with more than 5.8 million deaths, as of February 14, 2022. OBJECTIVE(S): Integrate a series of recommendations based on the best level of evidence in prevention, diagnosis and treatment of SARS-CoV-2 infection, including its new variants. METHODOLOGY: Review of different international guidelines and recent articles published in peer-reviewed journals. Issue recommendations based on the level of evidence and degree of confirmation established by the guidelines of the National Institute for Health and Care Excellence (NICE). The authors analyzed the selected articles and, based on their experience, summarized the most relevant to meet the objectives of these recommendations. RESULT(S): 200 articles were found, of which only 124 were selected that met the requirements to identify the level of evidence and degree of recommendation. CONCLUSION(S): Prevention through vaccination continues to be the best tool to establish protection mechanisms against the virus and substantially reduce hospitalizations and associated mortality. Although homologous vaccination is still the accepted reference pattern, the efficacy of heterologous schemes to avoid hospitalization and mortality must be considered. Monoclonal experiments, such as sotrovimab, have activity against the Omicron variant and the AZD7442 molecule that have shown high efficacy in preventing symptomatic COVID-19 in pre- and post-exposure conditions.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.

A Randomized Trial of Ivermectin 600 Mcg/Kg Vs Placebo in Mild/ Moderate Covid-19

Background: Whether ivermectin, with a maximum targeted dose of 600 mug/ kg, shortens symptom duration or prevents hospitalization among outpatients with mild to moderate coronavirus disease 2019 (COVID-19) remains unknown. Our objective was to evaluate the effectiveness of ivermectin, maximum targeted dose of 600 mug/kg, daily for 6 days compared with placebo for the treatment of early mild to moderate COVID-19. Method(s): ACTIV-6, an ongoing, decentralized, randomized, double-blind, placebo-controlled, platform trial, was designed to evaluate repurposed therapies in outpatients with mild to moderate COVID-19. A total of 1206 participants age >=30 years with confirmed COVID-19, experiencing >=2 symptoms of acute infection for <=7 days, were enrolled from February 16, 2022, through July 22, 2022, with follow-up data through November 10, 2022, at 93 sites in the US. Participants were randomized to receive ivermectin, with a maximum targeted dose of 600 mug/kg (n=602), daily vs placebo daily (n=604) for 6 days. The primary outcome was time to sustained recovery, defined as at least 3 consecutive days without symptoms. The 7 secondary outcomes included a composite of hospitalization, death, or urgent/emergent care utilization by day 28. Result(s): Among 1206 randomized participants who received study medication or placebo, median (interquartile range) age was 48 (38-58) years;713 (59%) were women;and 1008 (84%) reported >=2 SARS-CoV-2 vaccine doses. Median time to recovery was 11 (11-12) days in the ivermectin group and 11 (11-12) days in the placebo group. The hazard ratio (HR) (95% credible interval [CrI], posterior probability of benefit) for improvement in time to recovery was 1.02 (0.92-1.13;P[HR >1]=0.68). In those receiving ivermectin, 34 (5.7%) were hospitalized, died, or had urgent or emergency care visits compared with 36 (6.0%) receiving placebo (HR 1.0, 0.6-1.5;P[HR< 1]=0.53). In the ivermectin group, 1 participant died and 4 were hospitalized (0.8%);2 participants (0.3%) were hospitalized in the placebo group and there were no deaths. Adverse events were uncommon in both groups. Conclusion(s): Among outpatients with mild to moderate COVID-19, treatment with ivermectin, with a maximum targeted dose of 600 mug/kg daily for 6 days, compared with placebo did not improve time to recovery. These findings do not support the use of ivermectin in patients with mild to moderate COVID-19. Primary and secondary outcomes.

Discovery and development of lead compounds from natural sources using computational approaches

Natural products have a significant role in drug discovery. Their unique chemical structures have led to compounds in clinical use to treat different diseases. Also, natural products are significant sources of inspiration or starting points to develop new therapeutic agents. There are also unique natural products such as peptides and macrocycles that offer sources or starting points to address complex diseases. Computational approaches that used chemoinformatics and molecular modeling methods contribute to assisting and accelerating natural product-based drug discovery. Several research groups have recently used computational methodologies to organize data, interpret results, generate and test hypotheses, filter large chemical databases before the experimental screening, and design experiments. Herein, we discuss chemoinformatics and molecular modeling applications to uncover bioactive natural products. We also discuss in silico methods to optimize the biological activity and anticipate potential toxicity issues of natural products. As case studies, we discuss the role of natural products for COVID-19 drug discovery and their impact on the identification of compounds with activity against DNA methyltransferase, an epigenetic target with relevance in cancer and other diseases. © 2022 Elsevier Inc. All rights reserved.

Onco-Hematology Telepharmacy during the Covid-19 Pandemic: Experience of Two Years

Introduction: The COVID-19 pandemic forced the Hospital Pharmacy Service (HPS) to adapt the outpatient pharmaceutical care services to ensure continuity and prevent exposure of onco-haematology outpatients to the virus. This situation was used to optimize clinical outcomes, accessibility and security through the establishment of a telepharmacy program (TP). Two years later, we describe the experience and analyse the impact. Material(s) and Method(s): The HPS coordinated with the Oncology and Haematology Services a TP that included: - Adaptation of schedules to make appointments. - Database in Excel. - Organization with delivery company. - Acquisition of resources. - Implantation and extension to all candidate patients. - Analysis of results and quality control. TP was implemented on March 23, 2020 and continues today. The patients have an appointment for: first telematic consultation (start of treatment), successive consultation (continuation or switch) or successive home delivery. Results and discussion: 533 deliveries were performed to a total of 142 patients in 2 years, since the implementation of the TP: 408 deliveries to 136 patients during the first year and 125 to 51 during the second year. The maximum activity was in April 2020, which represented 43%. 120 visits to the HPS were avoided. Virtual pharmaceutical care was carried out for initiations or changes to 112 patients and 53 calls were answered by telephone consulting interactions, adverse effects, dosage or requesting deliveries. On the first 3 months, home deliveries did not suppose cost since Civil Protection carried them out voluntarily. After that, the rate was 14 euros/shipment, whichmeant a total of 3.400 euros in the studied period. Satisfaction surveys were conducted on 64 random patients: 97% rated the service received as excellent;the remaining 3% as good. The medication arrived in optimal conditions in 98% of shipments. In those cases that needed to contact the HPS, 91% always did;9% usually. Conclusion(s): 100% of patients would like to maintain this service in the future. However, in the last year, shipments have decreased by 70% compared to the previous year. TP has changed the practice of outpatient pharmacy and allows to adapt the pharmaceutical care during the COVID-19 pandemic.

AM3, a natural glycoconjugate, as adjuvant treatment for COVID-19 patients

We have been immersed in the COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for two years, and the availability of drugs for its treatment remains limited. Both in the general population and in patients, one of the most effective tools to prevent viral infections or limit their impact is strengthening the immune system. AM3, a polysaccharide/protein compound, has shown regulatory effects on the immune system. In this study, we have evaluated the potential effect of AM3/probiotic for the treatment of COVID-19 patients. We have included 83 patients with mild-moderate SARS-CoV-2 infection that were randomly assigned to receive either AM3/probiotic or placebo. All patients filled a 32-item questionnaire, which assesses symptom burden over a 2-week period. Blood samples were also obtained to investigate immune response by flow cytometry. The administration of AM3/probiotics decreased the number of symptoms and their intensities (Total score after 1 month: 11.0 (1.0-20.3) vs 24.0 (12.0-61.00)) in ambulatory patients with COVID-19, and the length of hospital stay in those that required hospitalization with respect to those receiving placebo (5.8+/-0.7 vs 6.4 +/-1.4 days). In general, the treatment with AM3/probiotic did not affect CD4+ T cells, including Th1, Th2, and Th17 cells. By contrast, central memory (CM) and effector memory (EM) CD8+ T lymphocytes showed a significant increment after the AM3/probiotic treatment that was not observed in patients receiving placebo. Conclusion(s): Our data suggest the beneficial use of AM3/probiotics supplementation in the treatment of patients with COVID-19. Further studies will confirm these findings and investigate the mechanisms.

Intermediate respirtory care unit patient flow analysis during the covid-19 pandemic

The IRCU of our hospital has increased its activity in the COVID-19 pandemic. The respiratory isolation condition has been an organizational challenge and has had a huge impact in the patient flow. Our IRCU has 3 subunits: nonCOVID (8 beds), COVID (up to 24 beds in open stay) and non-tested (8 beds). We have analysed the hospital activity register from November 2020 to April 2021, analysing the patient flow. For COVID IRCU admission criteria, a positive PCR with FiO2 > 0.50 with SatO2 <95%, RR > 25 and PaO2/FiO2 <250. We had 685 admissions: 52% in the COVID IRCU (average stay 6.82 days), 27.6% in the non-tested IRCU (AS 3.94 d) and 26.4% in the non-COVID IRCU (AS 6.32 d). A total of 43% admissions of the COVID-IRCU came from the Infectious Diseases Unit (IDU), 43.5% from the ED/other hospitals, and 1.12% from the ICU. Of the overall of COVID-IRCU, 29% required admission to the ICU and the mortality rate (MR) was 15.16%. A total of 40.7% admissions of non-COVID IRCU, ED 45.7%, and 13.6% the ICU. Of 6.4% patients required admission to the ICU (MR 6.4%). A total of 61.4% admissions of the non-tested IRCU, ED and 22.2% required admission to the ICU, with a 13.2% MR. The pandemic has highlighted the importance of the IRCU, reducing admissions and ICU stay. Our IRCU, maintains optimal respiratory isolation conditions in the non-tested IRCU, maintaining the normal activity in the non-COVID IRCU.

Autoimmune manifestations associated with coronavirus disease 2019.

Introduction: Coronavirus disease 2019 (COVID-19), caused by a new coronavirus. Severe acute respiratory syndrome coronavirus 2 is having a devastating impact throughout the world. Its pathophysiology is the result of direct cytopathic effects of SARS-CoV-2 on respiratory epithelium, endothelium, other organ-specific cell types and the subsequent induction of a pro-inflammatory cytokine storm and dysregulated adaptive immunity, causing severe tissue damage. Objective(s): To describe autoimmune characteristics present during SARS-Cov-2 infection. Method(s): A literature review on COVID-19 and autoimmune manifestations was carried out. The articles were selected from a search of the following websites: Pubmed, Medline, SciELO. An analysis and summary of the reviewed information was made. Analysis and synthesis of information: Viruses have been considered the main infectious agents that trigger autoimmune phenomena in genetically susceptible individuals. SARS-CoV-2 has already been linked to a long list of autoinflammatory and autoimmune conditions that can be induced by various mechanisms proposed to explain virus-induced autoimmunity. In this pathology, the most described, is molecular mimicry. COVID-19 shares similarities with autoimmune diseases in its clinical manifestations, pathophysiological mechanisms and therapeutic response, such powerful immune reactions participate in the pathogenesis of both entities. Conclusion(s): SARS-CoV-2 infection may represent the complex and interrelated link between infections and autoimmunity.Copyright © 2022, Editorial Ciencias Medicas. All rights reserved.

Side effects of the COVID-19 vaccines

The ability to eradicate deadly diseases and decrease the mortality of others makes vaccines one of the most important discoveries of the last century. Despite already having effective vaccines, scientific advances continue developing new antigens capable of producing more significant immune responses to achieve stronger immunity. © 2023 Elsevier Inc. All rights reserved.

Promotion of entrepreneurship through business incubators: Regional analysis in Spain

This study focuses on business incubators in Spain, which helps compare regions within Spain. This study has four goals: to shape taxonomy of the Spanish business incubator system, to compare between regions, to identify the factors affecting incubators' success, and to analyse during the COVID pandemic. Of the 478 business incubators registered in Spain, 89 were selected as the sample for study. Business incubators provide office space, equipment and mentoring services, as well as financial, legal and administrative support for entrepreneurs and start-up companies. Non-parametric statistical techniques are used to compare between regions, considering each regional business incubator as an ecosystem. The study focuses on six Spanish regions: Madrid, Catalonia, Castile-Leon, Aragon, Basque Country and Galicia. © 2023 Elsevier Inc.

An outbreak in a pandemic in healthcare workers

BACKGROUND: An outbreak is defined as an increase in epidemiologically-associated cases greater than expected, during the 2019 Coronavirus pandemic 10.1% of cases are reported in healthcare workers in Mexico, however the circulation of the new Omicron variant with greater transmissibility is a risk for the occurrence of outbreaks. OBJECTIVE: Describes an outbreak of SARS-CoV-2 infection in health personnel of a pediatric hospital during the pandemic. METHODS: An outbreak study is carried out in health personnel diagnosed with SARSCoV- 2 infection, in a tertiary pediatric hospital, from January 1, 2021 to January 30, 2022. The increase in laboratory confirmed cases in January, higher than cases reported in the previous period indicated an outbreak and the need to strengthen prevention measures in the population. RESULTS: An outbreak with 508 cases in health personnel in January 2022 was confirmed, identifying 27.5% as in-hospital. The circulation of a new variant with high transmissibility, together with the relaxation of prevention measures due to the state of vaccination and the perception of a lower risk from COVID 19, are factors for the presence of the outbreak. CONCLUSIONS: It is important to continuously strengthen prevention measures and make staff adopt them as a daily behavior to avoid outbreaks. © 2022 Instituto Nacional de Pediatria. All rights reserved.

Emotional states and habits in college students during the COVID-19 pandemic: a cross-sectional study

Introduction: The COVID-19 pandemic triggered severe consequences for the physical and emotional health of the general population. Objective: Describe the emotional profiles and the habits of physical activity, sleep, tobacco, and alcohol consumption in physiotherapy students, in the context of the COVID-19 pandemic. Method: We conducted a cross-sectional survey of university physiotherapy students through a Google forms. We used the PANAS scale to assess positive and nega-tive affect, the PSQI questionnaire to assess sleep quality, and the IPAQ-S questionnaire for physical activity. Results: We included 60 students between 17 and 22 years old, primarily female (71.7%). Most participants reported having a low consumption of alcohol (43.3%) and tobacco (96.7%). A higher proportion reported a high level of physical activity (53.3%) and considered it decreased after the COVID-19 pandemic (76.7%). Regarding sleep quality, most students reported poor sleep (66.7%). We identified one emotional profile "positive,” related to positive affect, and three profiles related to negative affects;"upset,” "anxious,” and "guilty.” Conclusions: Based on the description of the emotional response and the physical activity, sleep, alcohol, and tobacco consumption habits of the participants, it is sug-gested to establish psychological support programs, em-phasizing the management of the emotional resources that the students have to face stressful situations caused by the confinement during the COVID-19 pandemic. © 2023, Universidad Nacional Autonoma de Mexico. All rights reserved.

A disease is a war: Political war metaphors on COVID-19

Metaphor, as cognitive science has pointed out, is much more than just a rhetorical ornament. With it, a certain image of what is communicated is projected and shared. It also serves to structure thought, analyze society or generate certain expectations about reality. Hence, it has seemed to us that its research is necessary in the case of political speeches, since these are the basis of the agenda of daily social interests, from which a certain perspective of a situation is revealed. For this reason, this text aims to study the transmission of the pandemic in the speeches of Spanish politicians in the Congress of Deputies based on the state of alarm decreed by the Government. The analysis of the identifying metaphoric structures of the Covid-19 with a war conflict has been carried out. Its use has been quantified, and related to the speeches of each political leader. Finally, metaphors have been classified into semantic frames or networks that project a certain image of the disease, and also of the action taken by the Government. © 2022 Universita degli Studi di Milano. All rights reserved.

Una enfermedad es una guerra: las metáforas bélicas políticas sobre el COVID-19

Metaphor, as cognitive science has pointed out, is much more than just a rhetorical ornament. With it, a certain image of what is communicated is projected and shared. It also serves to structure thought, analyze society or generate certain expectations about reality. Hence, it has seemed to us that its research is necessary in the case of political speeches, since these are the basis of the agenda of daily social interests, from which a certain perspective of a situation is revealed. For this reason, this text aims to study the transmission of the pandemic in the speeches of Spanish politicians in the Congress of Deputies based on the state of alarm decreed by the Government. The analysis of the identifying metaphoric structures of the Covid-19 with a war conflict has been carried out. Its use has been quantified, and related to the speeches of each political leader. Finally, metaphors have been classified into semantic frames or networks that project a certain image of the disease, and also of the action taken by the Government. © 2022 Universita degli Studi di Milano. All rights reserved.

THE DICENDI POLYPHONY AS AN ARGUMENTATIVE MODE IN POLITICAL SPEECHES ABOUT COVID-19

Political discourse is considered the application of a professional use of the language whose main purpose is the adherence of the listeners. To achieve this, they put to work, among other resources, that of the polyphony "of saying”, with which one's own point of view is supported or the opposite is criticized. To see how it develops, this work is focused on the intervention made by the President of the Government in the Congress of Deputies to explain the declaration of the state of alarm during the Covid-19 pandemic. The analysis of the polyphonic structures used by him to explain, justify and legitimize the authorization of the royal decree of 03/14/20 has been carried out. This work shows how the president used reinforcing, legitimizing and courteous polyphonic uses in his intervention to manage to project unity and the need to make such a decision. © 2022 Universidad de Cadiz. All rights reserved.