Gastrointestinal symptoms and disorders related to COVID-19. Lessons learned from gastroenterologists

COVID-19 is mainly a respiratory illness caused by the SARS-CoV-2 but can also lead to GI symptoms. The primary host receptor which mediates the mechanism as SARS-CoV-2 enters the cell is the ACE2 receptor. Therefore, GI symptoms can be common in COVID-19, and in some cases, they are the first manifestation even before fever and respiratory symptoms. In addition, the liver function tests alteration often is related to a worse prognosis. The exact incidence of GI symptoms is a matter of debate. Moreover, wide variation concerning GI symptoms frequency exists, but the predominant ones seem to be diarrhea, anorexia, nausea, vomiting, and abdominal pain or discomfort.This review summarizes the most relevant findings of COVID-19 on the digestive system, including the liver, biliary tract, pancreas, the most common GI symptoms, and the atypical clinical GI manifestations.Copyright © 2022 Sociedad Medica del Hospital General de Mexico. Published by Permanyer.

The utility of telemedicine in cystic fibrosis clinic visits

Background: Cystic fibrosis (CF) is a progressive, genetic, multisystem disease. Exacerbations lead to long hospital stays and significant morbidity and mortality. At the crux of pulmonary exacerbation prevention is serial monitoring of pulmonary function tests and frequent outpatient follow-up. Patients at the Helen Devos Children's Hospital CF clinic receive quarterly multidisciplinary care from a CF clinic, but this schedule was complicated by the COVID-19 pandemic because of concern of infection precipitating a pulmonary exacerbation. In lieu of in-person visits, telemedicinewas used to continue necessary monitoring. The purpose of this study was to assess the accessibility, efficacy, and comfort of telemedicine visits at the CF clinic from the patient and provider perspective. Method(s): CF clinic parents and providers completed an anonymous survey by mail or email over a 6-month period. Patient surveys used a 5-point Likert scale to assess responses in four categories-accessibility, functionality, safety, and overall satisfaction-and an open-ended question on patient opinions of their telemedicine experience. Descriptive statistics and comparative means were used to interpret the data. Result(s): Average patient agewas 9.7, average years since diagnosis was 9.5, 53% of patients were male, and average one-way distance traveled to the clinic was 70 minutes (range 15-240). Patients reported that they had few difficulties accessing in-person visits at the clinic. They also reported the telemedicine experience to be functional and easy to navigate. In terms of safety (perceived assessment of respiratory status, overall health, and patients concerns), patients reported feeling neutral to moderate. Patients reported being very comfortable with virtual visits and moderately likely to schedule telemedicine visits at the CF clinic in the future. There was no correlation between travel distance to the clinic and likeliness of scheduling virtual visits in the future, although older patients were more likely to schedule virtual visits in the future. A few factors could be in play here;patients reported in-person visits to be very accessible, reporting that they rarely missed scheduled visits. Some patients reported internet connection problems, which may be more prevalent in rural areas farther from the clinic. At the time of this survey, patients did not have in-home spirometry. Provider responses were overwhelmingly positive, with high opinions of effectiveness, safety, and overall satisfaction. Providers also reported a subjective decrease in no-show rates for virtual visits. Conclusion(s): Virtual visits were found to be functional and have no perceived negative effects on safety. Patients reported high levels of comfort with virtual visits, although they were only moderately likely to schedule virtual visits in the future. This data, in conjunction with the open-ended responses, can be used to improve the CF telemedicine experience;patients are currently offered virtual visits every 6 months.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Evolucion De La Epidemiologia De La Enfermedad Celiaca E Impacto De La Covid19. Resultados Preliminares Del Plan Nacional De Enfermedad Celiaca-Ciberehd

Introduccion: Se ha reportado que tanto la prevalencia como la incidencia de la enfermedad celiaca (EC) estan aumentando a nivel mundial. Este aumento podria ser atribuido a infecciones viricas como desencadenante de la EC, entre otros factores. La COVID-19 ha impactado de lleno en la realizacion del estudio de prevalencia del Plan Nacional de EC promovido por el CIBERHED. Se ha sugerido que SARS-CoV-2, que penetra por via digestiva, podria desencadenar brotes de EC. Objetivos: 1) Evaluar la prevalencia actual de EC en comparacion con la de la cohorte 2004-2009. 2) Evaluar el impacto de la COVID-19 en la prevalencia actual de EC. Metodos: Desde enero 2021 hasta la actualidad se han incluido 1886 individuos de entre 1 y 90 anos atendidos por cirugia menor en los 6 hospitales participantes (Hospitales Universitarios (HU) Mutua Terrassa- Sant Joan de Deu, HU Virgen del Rocio, HU Central de Asturias, HU Galdakao-Cruces y HU Fundacion Jimenez Diaz) (calculo muestral: 5.300). La inclusion se realiza ajustada por edad y sexo a la piramide poblacional. Se determinan Ac. antitransglutaminasa (tTGA) y en los casos positivos se confirma el diagnostico segun guias de consenso. Se reporta la prevalencia serologica (tTGA > 7 U/ml) mas los casos prevalentes previamente diagnosticados. La relacion entre COVID19, registrada mediante cuestionario, y los casos positivos (tTGA > 7 U/mL y tTGA zona gris 2-7 U/mL) se ha evaluado mediante prueba exacta de Fisher. Resultados: Se han detectado 11 sujetos con serologia positiva y 2 pacientes con diagnostico previo de EC;prevalencia 6,89 x 1.000, IC95% 3,68-11,76. En comparacion con la prevalencia de la cohorte (2004-2007), 5,67 x 1.000, no existen diferencias significativas. Se han detectado 3 casos con serologia tTGA positiva y COVID-19 sobre un total de 335 pacientes infectados y 8 casos con serologia tTGA positiva sin COVID-19 sobre un total de 1.547 individuos no infectados (p = 0,4247). Tampoco se ha encontrado relacion entre COVID-19 y valores de serologia en la zona gris. Conclusiones: No se detecta un incremento de la prevalencia de EC en las ultimas dos decadas en nuestro medio. La infeccion por COVID19 no ha tenido impacto en la aparicion de nuevos casos de la enfermedad.Copyright © 2023 Elsevier Espana, S.L.U. Todos los derechos reservados.

The responsible social economy and the Sustainable Development Goals in the face of the post-COVID-19 crisis: the voice of experts

The objective of the work is to know the contributions that the social economy and corporate social responsibility can make in the search for solutions to the current health and economic crisis, in order to avoid its most traumatic effects. To this end, we analyze the variations that can occur in three scenarios: in social and responsible organizations, in the changes of values in accordance with the Sustainable Development Goals (SDGs), and in the transformation towards new economic and business models. In this way, the existing favorable elements are reviewed, such as the role of companies against the effects of the pandemic, the important existing international consensus -the Ten Principles of the Global Compact and the 17 SDGs and the increased collective awareness of the importance of the public and the risks of the planet. The main contribution of the work is to propose possible strategies against the crisis, both at the macro and micro levels, on the basis that this unprecedented situation collects and stimulates pre-existing elements that now take on new dimensions. Methodologically, these proposals are generated in a debate where academic literature, examples of business actions, the results of surveys and in a outstanding way, the technique of documentary compilation and analysis of the discourse of experts in the field. Among the findings and conclusions, we should highlight the greater sensitivity towards the public and sustainability, as an element of development, and more receptivity towards a new business paradigm © 2023 CIRIEC-España

Technological heterogeneity and time-varying efficiency of sharing accommodation: Evidence from the Canary Islands

The production of services in the accommodation sharing industry is heterogeneous in the sense that listings with different strategic management could adopt distinct technologies. This paper analyses the time-varying efficiency of the peer-to-peer accommodation sector using the input distance stochastic frontier model with random coefficients to accommodate both multi-input and multi-output technology and the technological heterogeneity among listings. An empirical analysis is conducted based on data from Airbnb and HomeAway listings in the Canary Islands (Spain), before, during and after the COVID-19 lockdown (source: AirDNA), in the period January 2019-September 2020 (monthly data). The results show technological heterogeneity between listings and time-varying inefficiency which negatively depends on productivity. Moreover, multi-unit hosts are clearly more efficient than single-unit hosts. A mean efficiency of around 78% during the study period was estimated. © 2023 The Authors

Building urban resilience through infrastructure exaptation

This article moves forward with the development of a young research field, aiming to merge urban exaptation processes and the science behind resilience, while facing COVID-19 pandemic, here considered as a symptom of a broader environmental crisis. This involves the understanding of the meaning of the exaptation of urban infrastructures as defined by Stephen Jay Gould. It briefly elucidates resilience science and exaptation processes embedded in socio-ecological systems. Extracted from both fields of study, exaptation processes are placed in the context of the renewal cycle, utilizing a changing framework model, commonly employed in resilience science to picture dynamics of the complex adaptive systems. In such cases, urban systems are considered prime examples. The insights generated in this endeavor are discussed, dealing with some key exaptation aspects in relation to four key attributes of resilience, i.e., "change,” "diversity,” "self-organzation,” and "learning.” Taking Mexico as a case study, we selected 10 examples to illustrate and relate these to the infrastructure exaptation of building functions, such as theaters, convention centers, and/or racecourses into hospitals, as a strategy to cope with the COVID-19 outbreak. The article elaborates a taxonomy of building infrastructure that, given its design features, allowed to be used as hospitals to face the pandemic. As a conclusion, we postulate different ways in which resilience thinking could promote the development of a new line of research for addressing designs for resilient urban social-ecological systems facing external disturbances such as pandemics. © 2023 Elsevier Inc. All rights reserved.

Covid-19-associated diffuse posthypoxic leukoencephalopathy and microhemorrhages - A case report

Background: Delayed post-hypoxic leukoencephalopathy (DPHL) with associated microbleeds is a clinical entity presenting with cognitive impairment days or weeks after an episode of acute hypoxic brain injury. Case report: We describe a 68-year-old male with SARS-CoV2 infection who had cardiac arrest, required sedation and mechanical ventilation for 17 days, and after sedation was discontinued, he became unresponsive. Brain MRI showed diffuse confluent hyperintense signals in the subcortical white matter and multiple subcortical white matter microhemorrhages. EEG revealed diffuse attenuation of brain electrical activity with isolated polymorphic delta waves in the frontal region without epileptiform activity. Conclusion(s): Clinicians need to be aware that patients with Covid-19 can develop delayed post-hypoxic leukoencephalopathy.Copyright © 2022 The Authors

Digital Global Classroom, a Collaborative Online International Learning (COIL) Approach: An Innovative Pedagogical Strategy for Sustainable Competency Development and Dissemination of SDGs in Engineering Higher Education

One of the most popular strategies to develop skills such as collaborative work, critical thinking, and problem-solving is the application of Collaborative Online International Learning (COIL), in which Professors from at least two universities from different countries and cultures develop a period known as "Global Classroom” (GC) in which, through the Challenge-Based Learning (CBL) approach, they solve a real challenge, using digital communication tools. This study held four-week global courses between groups from the Tecnológico de Monterrey in Mexico and groups from the Corporación Universitaria Minuto de Dios in Colombia. The challenges were related to two fundamental issues in sustainability: 1) Management of natural resources and climate change and 2) Biomimetics. Students were able to solve the challenges, develop skills to communicate effectively through online interaction with people from different cultures and disciplines, and use technological tools that facilitate distance learning in multicultural virtual environments. Current teaching models involve active and experiential learning, developing soft and hard skills. The GC experience is a tool that allowed continuity in the preparation of students during the COVID-19 pandemic. The use of GC is available to those interested as a valuable tool to provide students with the opportunity to live sustainable international experiences and promote the Sustainable Development Goals (SDG). © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Education for Sustainability: Calculation of the Digital Carbon Footprint

The COVID-19 pandemic brought confinement that caused a drastic change throughout society. Mobility was reduced, education suffered a substantive change, distance learning, and digital skills were developed. Climate change and environmental pollution indicators indeed decreased. However, the quantification of the environmental footprint of the new form of remote work (digital carbon footprint) has not been considered in systematic studies. There are not many tools to calculate the corresponding emissions. The main objective of this educational research work was to determine the carbon footprint of digital activities in a company during the confinement caused by COVID-19 through a Challenge-Based Learning methodology. A one-semester academic program was designed to develop energy auditing skills for students of Sustainable Development Engineering. A company (training partner) was determined to validate the evaluation instruments. Techniques for data collection, questionnaires, and analysis of energy consumption data were designed. A helpful protocol was defined to determine the digital carbon footprint generated in the pilot company, allowing us to scale our research towards quantifying Greenhouse Gas emissions in Institutions or Companies of greater size. The soft and disciplinary graduation competencies of the students were solidly developed and evaluated through internal instruments and by the training partner standards. Finally, we propose mitigation measures aligned with the Sustainable Development Goals, in line with the new Green and Sustainable Digital Education trend. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Lessons from covid-19. Anticipatory breach as a feasible alternative to force majeure and hardship under Art. 79 CISG

Article 79 of the United Nations Convention on Contracts for the International Sale of Goods imposes very strict requirements for its application as a ground for exemption from liability. As an alternative to it and in line with modern relational contracts theories, this article proposes, in situations where there are circumstances that prevent a normal development of the contract, the use of the anticipatory breach mechanism contained in Articles 71 to 73 of the Convention, especially for contracts of a certain complexity and of medium and long term, such as supply contracts. © 2023, UNIV CARLOSIII MADRID. All rights reserved.

Guillain-Barre syndrome following SARS-CoV-2 vaccination: Is there a real association?

Background: Guillain-Barre Syndrome (GBS) is the most common cause of acute flaccid paralysis, with an incidence of 0.81-1.89 cases per 100,000. With the SARS-CoV-2 virus pandemic, major international vaccination campaigns continue to be carried out to minimize the total burden of the disease. This study aims to report a case series of consecutive GBS patients after SARS-CoV-2 vaccination during the massive campaign in Mexico in 2021. Method(s): A single-center, observational study of consecutive GBS subjects diagnosed by Asbury criteria from January 1 to August 31, 2021. Including GBS-related symptoms on or after six weeks of vaccination record, both first and second doses. Result(s): From a total of 53 GBS patients, eight had a history of SARS-CoV-2 vaccination, 87.5% male, the median vaccination-symptom onset and symptom-to-admission time were 15 (IQR 12.75-23.25), and 3.5 (IQR 1.5-8.25), all of them had GBS Disability Scale >=3 at admission. Acute inflammatory demyelinating polyneuropathy (AIDP) was the most common electrophysiological variant encountered in this population. All patients received treatment Intravenous Immunoglobulin (IVIG) or Plasma Exchange (PE), 62.5% recovered independent walk at three months follow up. Conclusion(s): The annual incidence of GBS cases associated with vaccination remains lower (0.81 - 1.89 cases / 100,000 persons) than non-vaccinated patients;this should encourage health authorities to continue promoting massive vaccination as benefits outweigh the risks.Copyright © 2021

Serum markers of endothelial dysfunction and invasive mechanical ventilation in COVID-19

Introduction: Sars-Cov-2 infection induces vascular endothelium damage at pulmonary and systemic level. Alterations on immunity response generate inappropriate endothelial activation through pro-inflammatory cytokines release, up-regulated expression of adhesion molecules, leukocyte migration, increased nitric oxide requirements and oxidative stress. Endothelial function is a key feature in the pathogenesis of COVID-19. Objective(s): To evaluate circulating markers associated with endothelial activation in hospitalized patients with COVID-19 and determine the difference between patients who required invasive mechanical ventilation (IMV) and those who did not. Method(s): Cross-sectional study. Subjects with a confirmed diagnosis of COVID-19 and >18 years old were included. Patients who did not require hospitalization were excluded. Serum markers of endothelial function were tested during hospitalization and protein adjustment was performed. Result(s): A total of 390 patients were studied, with an average age of 57+/-13 years old. Patients who required invasive mechanical ventilation had higher prevalence of diabetes (34.53% vs 11.54%;p=0.020), higher serum nitrite levels (0.028 mmol/L [0.094-0.647] vs 0.07 [0.03-0.24];p=0.003), nitrates (0.363mmol/L [0.100- 0.591] vs 0.130[0.003-0.374];p=0.004) and E-selectin (1.00 ng/mg [0.79-1.32] vs 0.84 [0.55-1.09];p=0.019) when compared to non-IMV patients. Higher levels of nitrites adjusted by proteins were associated with an increased risk for IMV (OR 5.59, CI 95 1.15-27.00, p=0.032). Conclusion(s): Patients with increased nitrites and E-selectin levels had worse endothelial dysfunction and a higher risk for IMV during hospitalization.

Entrepreneurial intention in the context of natural disasters and the COVID-19 pandemic in San Pedro Sula, Honduras

Northern Honduras experienced a high impact from hurricanes Eta and Iota during a peak of COVID-19 in 2020. Field surveys were conducted to assess the experiences and perceptions of the residents of the city of San Pedro Sula, as part of UNITEC's "Earth Observations Data Center" project. ArcGIS Survey and PowerBI were used to process and visualize responses from 1,428 respondents (see Cortés Data Hub). The main impacts were loss of employment, death of family members, migration, damage to homes and closure of businesses. 48% of those surveyed reported the intention of starting a business, especially related to the opening of various types of stores, the sale of supplies, technology and various types of services. 22% of those interviewed expressed their intention to emigrate. The supply of options for successful enterprises is an urgency on the part of the state and the private sector. Academic institutions must also innovate to respond to these population needs and mitigate the impact of natural and health events. © 2022 Latin American and Caribbean Consortium of Engineering Institutions. All rights reserved.

Capital flows to emerging economies and global risk aversion during the COVID-19 pandemic

This paper analyses recent changes in the relative importance of the determinants of capital flows to emerging market economies. For this purpose, we estimate vector autoregressive (VAR) models for the period 2009–2021. Based on these models, we estimate the effects on debt flows from shocks to their determinants. Then, we quantify the contribution of each of the variables included in the model to explain the evolution of these flows in each month of the sample through a historical decomposition analysis. The main results indicate that the contribution of global risk aversion to explain the evolution of debt flows increased during March 2020 compared to the past, although its relative importance has decreased since, particularly as central banks in systemically important economies restored liquidity and the performance of financial markets improved. © 2023 John Wiley & Sons Ltd.

Impact of endothelial function on the prognosis of COVID19 patients

Introduction: The pathophysiological mechanisms related to the severity of the clinical picture of Sars-Cov-2 infection remain questions that the medical community seeks to resolve and whose knowledge will allow the design of therapeutic strategies. Purpose(s): To evaluate the association between endothelial function and mortality in patients with COVID-19. Material(s) and Method(s): Prospective cohort study. Patients with confirmed diagnosis of COVID-19, who required hospitalization, oxygen saturation <60% and laboratory data of endothelial function markers were included;all those with incomplete data were excluded. Result(s): The age of the population was 57.06 +/- 13.405, 69% were intubated, those who died had poorer ventilatory parameters;peak pressure (30.06 +/- 6.13 vs 24.82 +/- 6.06, p<0.001), Fi02 (57.5 [40 - 80] vs 45 [40 -80], p <0.001) and PaO2/FiO2 calculation (127.84 +/- 50.08 vs 163.36 +/- 45.47, p<0.001). In addition, they had greater laboratory alterations: procalcitonin (0.49 [0.16 - 4] vs. 18 [0.07 - 0.52], p=0.03) and CRP (13.34[7.67 - 19.03] vs 6.69 [2.4 - 15 89], p=0.05), higher levels of clotting times, PT(14.8 [14 - 16.6] vs 14.4 [13.7 -15.6], p=0.5) and INR (1.04 [0.98 - 1.17] vs 1.01 [.95 - 1.1], p=0.05). In blood biometry, higher numbers of leukocytes of (11.3 [8.65 - 14.4] vs. 9.9 [6.7 - 13], p=0.041), neutrophils (8.8 [7.4 - 12.5] vs. 8.1 [4.74 - 11.1], p=0.01) and lower numbers of lymphocytes (. 7 [.40 - 1.1] vs 1.1 [.7 - 1.5], p<0.001) and with significant statistical trend, hemoglobin(11.26 +/- 2.55 vs 12.42 +/- 2.4, p=0.07) compared to surviving subjects. Conclusion(s): Hematological and liver alterations are markers of higher mortality in patients with COVID-19 as an expression of multiorgan disease.

Effect of physical conditioning evaluated in the 6-minute walk in subjects recovered from COVID-19

Introduction: Physical conditioning develops conditional and coordinative capacities to improve physical performance through exercise. The 6-minute walk test (PC6M) assesses in an integrated manner the response of the respiratory, cardiovascular, metabolic, musculoskeletal, and neurosensory systems to the stress imposed by exercise. Functional integration is analyzed by the maximum distance an individual can cover during six minutes of walking as fast as possible. Objective(s): To evaluate the effect of physical conditioning on the physical capacity of subjects recovered from COVID 19. Method(s): Clinical trial in subjects recovered from COVID-19 who required hospitalization during the acute phase, > 18 years were included. Subjects with musculoskeletal lesions were excluded. Physical capacity was assessed by PC6M. The intervention had a duration of 20 sessions of physical conditioning on cycle ergometer for arms and legs, treadmill and elliptical trainer. Result(s): Forty-two patients were evaluated, 56.41% of whom were men, with a mean age of 53.48 +/- 14.3 years. After 20 physical conditioning sessions, increase the physical capacity (434.58 +/- 89.10 vs. 546.63 +/- 101.34;p < 0.001), assessing dyspnea, fatigue, and saturation where no significant differences were found observed. Conclusion(s): An improvement in functional capacity was observed after 20 sessions.

Guidelines on epidemics in Mexico. Historical perspective.

A perspective of epidemics and pandemics in Mexico is offered, focusing on three time periods, namely, end of the 18th century, the 20th century, and the 21st century, in order to analyze how they were approached by health and government authorities, as well as the challenges they have represented. Historical documentary sources were consulted and, in current cases, participation in them was analyzed. Epidemiological and social historical methodologies were combined. The presence of epidemics in Mexico is a constant on its evolution, which highlights the need for the epidemiological surveillance system to be updated, the importance of being prepared to face an epidemic and to develop a contingency plan.Copyright © 2022 Academia Nacional de Medicina de Mexico, A.C. Publicado por Permanyer.