Acute Necrotizing Encephalopathy Post SARS-CoV-2 Infection in an Adult Patient: Case Report.

To show the MRI findings in a rare case of acute necrotizing encephalopathy following SARS-CoV-2 infection in an adult patient. Acute necrotizing encephalopathy is a rare condition characterized by the presence of symmetrical multifocal lesions with predominantly thalamic involvement, as well as the brainstem and cerebellum. We describe the case of a 26-year-old male with a medical history of medulloblastoma that was disease-free after treatment and who tested positive in a PCR for SARS-CoV-2 in cerebrospinal fluid. Upon evaluation at the emergency department one week later, the patient was found to be awake, oriented, and focused and could maintain attention for periods of time. Mixed dysarthria persisted, characterized by being flaccid and hypokinetic. On magnetic resonance imaging, there were multiple hemorrhagic lesions with surrounding edema in the right thalamus with an extension to the posterior arm of the internal capsule, a smaller one in the left thalamus, and another expanded to the ipsilateral peduncle. Acute necrotizing encephalopathy presents a great clinical and diagnostic challenge, close clinical and radiological follow-up is essential, and magnetic susceptibility sequences (T2 or SWI) should be included in the diagnosis protocol.

Genetic Ancestry, Race, and Severity of Acutely Decompensated Cirrhosis in Latin America.

BACKGROUND & AIMS: Genetic ancestry or racial differences in health outcomes exist in diseases associated with systemic inflammation (eg, COVID-19). This study aimed to investigate the association of genetic ancestry and race with acute-on-chronic liver failure (ACLF), which is characterized by acute systemic inflammation, multi-organ failure, and high risk of short-term death. METHODS: This prospective cohort study analyzed a comprehensive set of data, including genetic ancestry and race among several others, in 1274 patients with acutely decompensated cirrhosis who were nonelectively admitted to 44 hospitals from 7 Latin American countries. RESULTS: Three hundred ninety-five patients (31.0%) had ACLF of any grade at enrollment. Patients with ACLF had a higher median percentage of Native American genetic ancestry and lower median percentage of European ancestry than patients without ACLF (22.6% vs 12.9% and 53.4% vs 59.6%, respectively). The median percentage of African genetic ancestry was low among patients with ACLF and among those without ACLF. In terms of race, a higher percentage of patients with ACLF than patients without ACLF were Native American and a lower percentage of patients with ACLF than patients without ACLF were European American or African American. In multivariable analyses that adjusted for differences in sociodemographic and clinical characteristics, the odds ratio for ACLF at enrollment was 1.08 (95% CI, 1.03-1.13) with Native American genetic ancestry and 2.57 (95% CI, 1.84-3.58) for Native American race vs European American race CONCLUSIONS: In a large cohort of Latin American patients with acutely decompensated cirrhosis, increasing percentages of Native American ancestry and Native American race were factors independently associated with ACLF at enrollment.

Retinal vein occlusion in the general population after COVID-19 vaccination and infection.

INTRODUCTION: Retinal vein occlusion (RVO) is mostly a consequence of vascular risk factors (VRF). COVID-19 vaccines have been related to vascular and thrombotic events (VTE). OBJECTIVE: To assess the RVO incidence in the general population in our health area and the possible relation with COVID-19 infection and vaccination. METHODS: Demographic features, classic VRF, thrombophilia data, COVID-19 status, and Framingham risk score were collected prospectively. RESULTS: 472 consecutive patients studied over 13 years with RVO were included (Valdecilla Cohort). Classic VRFs were present in 90%, antiphospholipid syndrome in 12.3%, and genetic thrombophilia in 13.5%. Ninety-one percent of RVO patients were vaccinated and 6.8% suffered COVID-19 infection. In the cohort, no patient had a new RVO after vaccination or infection. In the general population, 20 subjects had RVO after receiving the vaccine (0.006%). Overall, 8 cases occurred in the first-month post-vaccination and 12 after 30 days. In the early and late groups, there are 3 and 4 patients respectively, with a low-intermediate risk Framingham score. Twenty-nine patients in the cohort suffered SARS-CoV-2 infection, twenty-seven of them had RVO before infection. Two patients with low-risk Framingham scores had RVO after infection, one of them early (<1 month). CONCLUSIONS: Vaccination and COVID-19 might be involved in the development of RVO in some cases, mainly in patients without VRF, thrombophilia, or chronic inflammatory conditions and with a lower Framingham score, especially in the first month after vaccination or infection.

Serum Calcitonin Gene-Related Peptide α and ß Levels are Increased in COVID-19 Inpatients.

BACKGROUND: Vasoactive peptides play an important role in a wide range of physiological and pathological conditions. Due to its known functions, the calcitonin gene-related peptide (CGRP) has been suggested as a possible modulator of the hyperimmune response in COVID-19 and thus, blocking its action may lessen the pulmonary effects of COVID-19. AIM OF THE STUDY: To compare the circulating levels of CGRPα and CGRPß in healthy controls compared to hospitalized COVID-19 patients. The study also analyzed how different comorbidities and treatments may affect these concentrations in cases of COVID-19 infection with pulmonary involvement METHODS: Serum samples were collected from the antecubital vein of 51 control subjects (mean age = 55 ± 14 years; range = 26-77; 56.9% female) and 52 patients hospitalized with COVID-19 infection (mean age = 55 ± 13; range = 23-77; 55.8% female) from December 2020 to May 2021. Enzyme-linked immunosorbent assays (ELISAs) were used for CGRPα (Abbexa, UK) and CGRPß (CUSABIO, China) measurements. Comorbidities, symptoms, and treatments of infection were listed. RESULTS: The results showed that the serum levels of both isoforms of CGRP were significantly higher in patients with COVID-19 (α: 57.9 ± 35.8 pg/mL; ß: 6.1 ± 2.6 pg/mL) compared to controls (α: 41.8 ± 25.4 pg/mL; ß: 4.5 ± 2.4 pg/mL) (p <0.01). Also, the presence of arterial hypertension (HT), obesity, or corticosteroid treatment significantly alter the serum concentration of CGRPα in the subgroups compared to controls. CONCLUSION: The elevated serum CGRP levels found in our COVID-19 group compared to controls may suggest that CGRP plays a role in the pathophysiology of the disease, more specifically, in the cytokine storm and in the pulmonary involvement. Future studies should focus on the source of this CGRP elevation.

Multifocal glioblastoma and hormone replacement therapy in a transgender female.

Background: Glioblastoma multiforme represents approximately 60% of all brain tumors in adults. This malignancy shows a high level of biological and genetic heterogeneity associated with exceptional aggressiveness, leading to poor patient survival. One of the less common presentations is the appearance of primary multifocal lesions, which are linked with a worse prognosis. Among the multiple triggering factors in glioma progression, the administration of sex steroids and their analogs has been studied, but their role remains unclear to date. Case Description: A 43-year-old transgender woman who has a personal pathological history of receiving intramuscular (IM) hormone treatment for 27 years based on algestone/estradiol 150 mg/10 mg/mL. Three months ago, the patient suddenly experienced hemiplegia and hemiparesis in her right lower extremity, followed by a myoclonic focal epileptic seizure, vertigo, and a right frontal headache with a visual analog scale of 10/10. Magnetic resonance imaging images revealed an intra-axial mass with poorly defined, heterogeneous borders, and thick borders with perilesional edema in the left parietal lobe, as well as a rounded hypodense image with well-defined walls in the right internal capsule. The tumor was resected, and samples were sent to the pathology department, which confirmed the diagnosis of wild-type glioblastoma. Conclusion: This report identifies prolonged use of steroid-based hormone replacement therapy as the only predisposing factor in the oncogenesis of multifocal glioblastoma. It is an example that highlights the importance for physicians not to consider pathologies related to the human immunodeficiency virus rather than neoplasms in transgender patients in view of progressive neurological deterioration.

Severe acute hepatitis of unknown origin.

At the beginning of 2022, in the United Kingdom, and later in several European countries, a group of pediatric patients who developed acute hepatitis of so far unknown origin was reported. Clinical data include nausea, vomiting, jaundice, and liver failure; some patients require liver transplantation. The affected population is younger than 10 years of age. The probable etiological agent is adenovirus genotype F41, and toxic factors have been ruled out, as well as a relationship with COVID-19. There are several theories to explain this phenomenon, which are being investigated.

A inicios de 2022, en Reino Unido, y posteriormente en varios países europeos, se informó sobre un grupo de pacientes pediátricos que desarrollaron hepatitis aguda de origen desconocido hasta ahora. Los datos clínicos consisten en náusea, vómito, ictericia y falla hepática; algunos pacientes necesitan trasplante hepático. La población afectada es menor a los 10 años. El agente etiológico probable es el adenovirus genotipo F41 y se han descartado factores tóxicos, así como la relación con COVID-19. Existen varias teorías para explicar este fenómeno, las cuales se están investigando.

Severe acute hepatitis of unknown origin / Hepatitis aguda grave de origen desconocido

Resumen A inicios de 2022, en Reino Unido, y posteriormente en varios países europeos, se informó sobre un grupo de pacientes pediátricos que desarrollaron hepatitis aguda de origen desconocido hasta ahora. Los datos clínicos consisten en náusea, vómito, ictericia y falla hepática; algunos pacientes necesitan trasplante hepático. La población afectada es menor a los 10 años. El agente etiológico probable es el adenovirus genotipo F41 y se han descartado factores tóxicos, así como la relación con COVID-19. Existen varias teorías para explicar este fenómeno, las cuales se están investigando.

Abstract At the beginning of 2022, in the United Kingdom, and later in several European countries, a group of pediatric patients who developed acute hepatitis of so far unknown origin was reported. Clinical data include nausea, vomiting, jaundice, and liver failure; some patients require liver transplantation. The affected population is younger than 10 years of age. The probable etiological agent is adenovirus genotype F41, and toxic factors have been ruled out, as well as a relationship with COVID-19. There are several theories to explain this phenomenon, which are being investigated.

Plataforma de colaboración digital aplicada a la gestión universitaria

La pandemia Covid-19 se convirtió en un gran desafío para mantener las prácticas en los laboratorios desde la distancia, con un servicio educativo de calidad mediante la interacción con las plataformas virtuales. El objetivo de este estudio fue analizar la experiencia del uso de la plataforma digital para los docentes de la Fundación Universitaria Cafam en el área de Ingeniería, en Colombia. Se hizo el estudio bajo el enfoque cualitativo, con la metodología del análisis hermenéutico y las técnicas de observación, revisión bibliográfica, entrevistas semiestructuradas dentro del entorno universitario. Resultados dan cuenta de la optimización de un sistema de gestión universitaria digitalizado y el empleo de plataformas de colaboración como Share Point, garantizan el acceso y facilitan la permanencia exitosa de los estudiantes en el sistema educativo universitario, además de contribuir con la formación de profesionales altamente calificados, en entornos caracterizados por tecnología innovadora. Se concluye que el empleo de las herramientas tecnológicas colaborativas como el Share Point, son pertinentes y relevantes para la optimización de la gestión universitaria, desde la formalización en el uso de la estructura, como la garantía de la atención integral a los estudiantes que hacen frente a los retos pos pandémicos.Alternate :The Covid-19 pandemic has become a great challenge to maintain practices in laboratories from a distance, with a quality educational service through interaction with virtual platforms. The objective of this study was to analyze the experience of using the digital platform for teachers of the Cafam University Foundation (Unicafam) in the area of Engineering, in Colombia. The study was carried out under the qualitative approach, with the methodology of hermeneutic analysis and observation techniques, bibliographic review, semi-structured interviews within the university environment. Results show the optimization of a digitized university management system and the use of collaboration platforms such as Share Point, guarantee access and facilitate the successful permanence of students in the university educational system, in addition to contributing to the training of highly qualified professionals. qualified, in environments characterized by innovative technology. It is concluded that the use of collaborative technological tools such as Share Point, are pertinent and relevant for the optimization of university management, from the formalization in the use of the structure, as the guarantee of comprehensive care for students who face to post-pandemic challenges.

Severe acute hepatitis of unknown origin / Hepatitis aguda grave de origen desconocido

Resumen A inicios de 2022, en Reino Unido, y posteriormente en varios países europeos, se informó sobre un grupo de pacientes pediátricos que desarrollaron hepatitis aguda de origen desconocido hasta ahora. Los datos clínicos consisten en náusea, vómito, ictericia y falla hepática; algunos pacientes necesitan trasplante hepático. La población afectada es menor a los 10 años. El agente etiológico probable es el adenovirus genotipo F41 y se han descartado factores tóxicos, así como la relación con COVID-19. Existen varias teorías para explicar este fenómeno, las cuales se están investigando.

Abstract At the beginning of 2022, in the United Kingdom, and later in several European countries, a group of pediatric patients who developed acute hepatitis of so far unknown origin was reported. Clinical data include nausea, vomiting, jaundice, and liver failure; some patients require liver transplantation. The affected population is younger than 10 years of age. The probable etiological agent is adenovirus genotype F41, and toxic factors have been ruled out, as well as a relationship with COVID-19. There are several theories to explain this phenomenon, which are being investigated.

One-year cardiovascular outcomes after coronavirus disease 2019: The cardiovascular COVID-19 registry.

BACKGROUND: The long-term cardiovascular (CV) outcomes of COVID-19 have not been fully explored. METHODS: This was an international, multicenter, retrospective cohort study conducted between February and December 2020. Consecutive patients ≥18 years who underwent a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV2 were included. Patients were classified into two cohorts depending on the nasopharyngeal swab result and clinical status: confirmed COVID-19 (positive RT-PCR) and control (without suggestive symptoms and negative RT-PCR). Data were obtained from electronic records, and clinical follow-up was performed at 1-year. The primary outcome was CV death at 1-year. Secondary outcomes included arterial thrombotic events (ATE), venous thromboembolism (VTE), and serious cardiac arrhythmias. An independent clinical event committee adjudicated events. A Cox proportional hazards model adjusted for all baseline characteristics was used for comparing outcomes between groups. A prespecified landmark analysis was performed to assess events during the post-acute phase (31-365 days). RESULTS: A total of 4,427 patients were included: 3,578 (80.8%) in the COVID-19 and 849 (19.2%) control cohorts. At one year, there were no significant differences in the primary endpoint of CV death between the COVID-19 and control cohorts (1.4% vs. 0.8%; HRadj 1.28 [0.56-2.91]; p = 0.555), but there was a higher risk of all-cause death (17.8% vs. 4.0%; HRadj 2.82 [1.99-4.0]; p = 0.001). COVID-19 cohort had higher rates of ATE (2.5% vs. 0.8%, HRadj 2.26 [1.02-4.99]; p = 0.044), VTE (3.7% vs. 0.4%, HRadj 9.33 [2.93-29.70]; p = 0.001), and serious cardiac arrhythmias (2.5% vs. 0.6%, HRadj 3.37 [1.35-8.46]; p = 0.010). During the post-acute phase, there were no significant differences in CV death (0.6% vs. 0.7%; HRadj 0.67 [0.25-1.80]; p = 0.425), but there was a higher risk of deep vein thrombosis (0.6% vs. 0.0%; p = 0.028). Re-hospitalization rate was lower in the COVID-19 cohort compared to the control cohort (13.9% vs. 20.6%; p = 0.001). CONCLUSIONS: At 1-year, patients with COVID-19 experienced an increased risk of all-cause death and adverse CV events, including ATE, VTE, and serious cardiac arrhythmias, but not CV death. STUDY REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT04359927.

Tracking the clonal dynamics of SARS-CoV-2-specific T cells in children and adults with mild/asymptomatic COVID-19.

Children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) develop less severe coronavirus disease 2019 (COVID-19) than adults. The mechanisms for the age-specific differences and the implications for infection-induced immunity are beginning to be uncovered. We show by longitudinal multimodal analysis that SARS-CoV-2 leaves a small footprint in the circulating T cell compartment in children with mild/asymptomatic COVID-19 compared to adult household contacts with the same disease severity who had more evidence of systemic T cell interferon activation, cytotoxicity and exhaustion. Children harbored diverse polyclonal SARS-CoV-2-specific naïve T cells whereas adults harbored clonally expanded SARS-CoV-2-specific memory T cells. A novel population of naïve interferon-activated T cells is expanded in acute COVID-19 and is recruited into the memory compartment during convalescence in adults but not children. This was associated with the development of robust CD4+ memory T cell responses in adults but not children. These data suggest that rapid clearance of SARS-CoV-2 in children may compromise their cellular immunity and ability to resist reinfection.

Data-driven assisted model specification for complex choice experiments data: Association rules learning and random forests for Participatory Value Evaluation experiments

We propose three procedures based on association rules (AR) learning and random forests (RF) to support the specification of a portfolio choice model applied in data from complex choice experiment data, specifically a Participatory Value Evaluation (PVE) choice experiment. In a PVE choice experiment, respondents choose a combination of alternatives, subject to a resource constraint. We combine a methodological-iterative (MI) procedure with AR learning and RF models to support the specification of parameters of a portfolio choice model. Additionally, we use RF model predictions to contrast the validity of the behavioural assumptions of different specifications of the portfolio choice model. We use data of a PVE choice experiment conducted to elicit the preferences of Dutch citizens for lifting COVID-19 measures. Our results show model fit and interpretation improvements in the portfolio choice model, compared with conventional model specifications. Additionally, we provide guidelines on the use of outcomes from AR learning and RF models from a choice modelling perspective.

Comparación y migración de la actividad física durante el confinamiento por covid-19 en Latinoamérica (Comparison and migrations of physical activity during covid-19 confinement in Latin American)

Purpose: The study aims to characterize the practice and migration of physical activity in active people during the COVID-19 pandemic. Design: Cross-sectional observational study of a Latin American survey. Setting: An online survey in Google Forms format was applied between June and July 2020 through social networks. The survey consisted of general characteristics, characteristics of confinement, and characteristics related to physical activity. Subjects: 2134 people participated (33.6% male, the mean age was 30.7 ± 9.2 years), 95.2% with higher education, 74% were normal weight, 60.8% in voluntary lockdown, and 39.2% mandatory lockdown. Results: Pre-pandemic men did 217.92 min/week, and women 199.78 min/week;post-pandemic men declined to 168.34 min/week, and women to 176.70 min/week. Men pre-pandemic, had a higher proportion of compliance the WHO recommendation (77.3% vs 64.9% p =0.001). Regarding, physical activity migrations, men decreased in outside activities, team sports and increase in home physical activity, in women decreased in outside activities, team sports and an increased in fitness classes, yoga and home physical activity. Finally, when associating compliance with physical activity during confinement, it is associated with being a woman and with long weeks of confinement. Conclusion: The physically active people, despite the confinements, remain like this in the four countries evaluated;only changes are observed in the type of physical activity and the frequency of weekly sessions, not affecting their physical condition levels according to self-report. Alternate :Objetivo: Caracterizar la práctica y migración de actividad física (AF) en personas activas durante la pandemia de COVID-19. Diseño: Estudio observacional transversal de una encuesta latinoamericana. Escenario: Se aplicó una encuesta online en formato Google Forms entre junio a agosto de 2020 a través de las redes sociales. La encuesta consistió en características generales, del encierro y relacionadas con la AF. Sujetos: Participaron 2134 personas (33,6% hombres), edad media 30,7 ±9,2 años), 95,2% con educación superior, 74% normopeso, 60,8% confinamiento voluntario y 39,2% obligatorio. Resultados: Pre-pandemia hombres realizaban 217,92, y las mujeres 199,78 min/semana, post-pandemia los hombres bajaron a 168.34 y las mujeres a 176.70 min/semana. Los hombres pre pandemia tuvieron una mayor proporción de cumplimiento de la recomendación OMS (77,3% vs 69,4%, p = 0,001). Con respecto a las migraciones del tipo de AF en hombres se observó una reducción de actividades al aire libre, deportes de equipos y aumento de AF el hogar, en mujeres se observa una disminución de actividades al aire libre y deportes en equipos y un aumento en la práctica de clases de fitness, yoga y AF en el hogar. Finalmente, al asociar el cumplimiento de la AF durante el confinamiento esta se asocia a ser mujer y a mayores semanas de confinamiento. Conclusión: Las personas físicamente activas, durante el confinamiento, disminuyeron los minutos de AF, migran a actividades dentro del hogar, mientras que el cumplimiento de la AF se asocia con ser mujer y mayor número de semanas de cuarentena.Alternate :Objetivo: O estudo tem como objetivo caracterizar a prática e migração de atividade física em pessoas ativas durante a pandemia de COVID-19. Desenho: Estudo observacional transversal de uma pesquisa latino-americana. Cenário: Foi aplicado um questionário online no formato Google Forms entre junho e julho de 2020 por meio das redes sociais. A pesquisa consistiu em características gerais, características do confinamento e características relacionadas à atividade física. Sujeitos: participaram 2.134 pessoas (33,6% do sexo masculino, a média de idade foi de 30,7 ± 9,2 anos), 95,2% com ensino superior, 74% com peso normal, 60,8% em confinamento voluntário e 39,2% em confinamento obrigatório. Resultados: Homens pré-pandemia fizeram 217,92 min/semana e mulheres 199,78 min/semana;os homens pós-pandemia diminuíram para 168,34 m n/semana e as mulheres para 176,70 min/semana. Homens pré-pandemia, apresentaram maior proporção de cumprimento da recomendação da OMS (77,3% vs 64,9% p=0,001). Em relação às migrações de atividade física, os homens diminuíram nas atividades externas, esportes coletivos e aumentaram na atividade física domiciliar, nas mulheres diminuiu nas atividades externas, esportes coletivos e aumento nas aulas de ginástica, ioga e atividade física domiciliar. Por fim, ao associar a adesão à atividade física durante o confinamento, associa-se a ser mulher e a longas semanas de confinamento. Conclusão: As pessoas fisicamente ativas, apesar dos confinamentos, permanecem assim nos quatro países avaliados;observam-se apenas alterações no tipo de atividade física e na frequência das sessões semanais, não afetando seus níveis de condição física de acordo com o autorrelato.

Stepping into the shoes of the policy maker: Results of a Participatory Value Evaluation for the Dutch long term COVID-19 strategy.

BACKGROUND: The COVID-19 outbreak early 2020 was followed by an unprecedented package of measures. The relative calmness of the pandemic early 2022 provides a momentum to prepare for various scenarios. OBJECTIVES: As acceptance of COVID-19 measures is key for public support we investigated citizens' preferences towards imposing measures in four scenarios: 1) spring/summer scenario with few hospitalizations; 2) autumn/winter scenario with many hospitalizations; 3) a new contagious variant, the impact on hospitalizations is unclear; 4) a new contagious variant, hospitalizations will substantially increase. METHODS: Study 1 comprised a Participatory Value Evaluation (PVE) in which 2011 respondents advised their government on which measures to impose in the four scenarios. Respondents received information regarding the impact of each measure on the risk that the health system would be overloaded. To triangulate the results, 2958 respondents in Study 2 evaluated the acceptability of the measures in each scenario. RESULTS: Measures were ranked similarly by respondents in Study 1 and 2: 1) the majority of respondents thought that hygiene measures should be upheld, even in the spring/summer; 2) the majority supported booster vaccination, working from home, encouraging self-testing, and mandatory face masks from scenario 2 onwards; 3) even in scenario 4, lockdown measures were not supported by the majority. Young respondents were willing to accept more risks for the health system than older respondents. CONCLUSION: The results suggest that policies that focus on prevention (through advising low-impact hygiene measures) and early response to moderate threats (by scaling up to moderately restrictive measures and boostering) can count on substantial support. There is low support for lockdown measures even under high-risk conditions, which further emphasizes the importance of prevention and a timely response to new threats. Our results imply that young citizens' concerns, in particular, should be addressed when restrictive COVID-19 measures are to be implemented.