Identification of clinical and demographic variables associated with severe Covid-19 in subjects with rheumatic disease in a third-level hospital in Mexico City

Dear editor: Subjects with rheumatic diseases are a group with risk for clinical complications by Covid-19.1 Some demographic and clinical variables have been identified as risk factors for severe Covid-19 in infected people, but is not clear whether these predictors might further increase risk in patients with rheumatic diseases.2 In this retrospective study based on a systematic sampling from May 2020 to July 2021, we assessed severity-associated risk generated by Covid-19 between a group of patients with rheumatic diseases (54.5%, n=36, RDs group) and another group without immunological deterioration (45.4%, n=30, NRs patients) (Protocol Register Number 09-CEI-005-20201111). Clinical and demographic data from sixty-six patients with Covid-19 confirmed by PCR testing and computed tomography for lung lesions were collected (table I). Severity in patients were classified based on oxygen requirement levels since non-severe condition (PaO2 /FiO2 >95%) or any other condition according with the World Health Organization criteria.3 Results showed that 11.1% of RDs patients required mechanical ventilation, 47.2% required any oxygen supplement and 41.7% were classified as non-severe Covid-19 while all non-rheumatic cohort required any minor oxygen support. Analysis by logistic regression models identified that the risk for clinical complications such as acute respiratory distress syndrome (ARDS) were associated with the presence of diabetes mellitus type-2 (DMT-2) (OR: 5.61 [1.7747,17.7367], p-value<0.05). Particularly, in RDs group the risk for severe Covid-19 were associated with the presence of DMT-2 (OR: 21.00 [1.7343,254.274], p<0.05), which was nine times higher than in NRs group. Our data are similar with reports in where presence of comorbidities are associated with hospitalization due to severe Covid-19.4 Moreover, clinical parameters were associated to severe Covid-19 in RDs group including creatinine >1.5 mg/ dL (OR: 1.6875 [0.3043,9.3584], p<0.05);alanine aminotransferase enzyme ≥40 U/L (OR: 9.000 [1.1257,71.9578], p<0.05), lymphocytes counts <1000 per mL (OR: 13.50 [1.3793,1315789], p<0.05) and hemoglobin <10 g/dL (OR: 18.75 [1.5434,227.7808], p<0.05). These increases in risk could be explained by immunological disfunction own of each rheumatic disease or by genetic variants of the adaptive and innate immune system.5 In this study, we concluded that individuals with rheumatic disease have an increased risk for very severe Covid-19 and non-rheumatic predictors may affect them even more than general population. © 2023,Salud Publica de Mexico. All rights reserved.

Clinical identification and severity in patients with COVID-19

The clinical evaluation of the patient with COVID-19 allows better care, application of safety criteria and preventive measures. The disease progresses from mild to severe and critical. In this work, is evaluated in patients with COVID-19 clinical format to identify moderate to severe stages of the disease. Following a cohort of male and female patients over 18 years of age admitted to the Infectology Service of the General Hospital of Mexico. Each patient is studied using the"COVID-19 Infectology"clinical format and in the first 24 hours of admission, a real-time RT-PCR molecular test is performed for SARS-CoV-2 infection. 65 patients classified as severe COVID-19 were studied, the RT-PCR was positive in 60 patients and negative in 5, clinical data did not differ from the positive ones and the 5 negative were considered false negative cases of the molecular test. There were no differences between positives and negatives with Fisher's test, and no difference in age, comorbidities, or prognostic evaluation with Student's t test. The conclusion is that the clinical format"COVID-19 Infectology"allows to recognize the cases and identify those that are in a severe evolution.Copyright /© 2021 Sociedad Medica del Hospital General de Mexico. Published by Permanyer.

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

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

[Analysis of the evolution of patients attended in Spanish emergency departments during the first wave of the pandemic].

BACKGROUND: To describe the number of visits (total and per COVID-19) attended by the Spanish hospital emergency departments (EDs) during the first wave of the pandemic (March-April 2020) compared to the same period in 2019, and to calculate the quantitative changes in healthcare activity and investigate the possible influence of hospital size and COVID-19 seroprevalence. METHOD: Cross-sectional study that analyzes the number of visits to Spanish public EDs, reported through a survey of ED chiefs during the study periods. Changes in healthcare activity were described in each autonomous community and com-pared according to hospital size and the provincial impact of the pandemic. RESULTS: A total of 187 (66?%) of the 283 Spanish EDs participated in the study. The total number of patients attended de-creased to 49.2?% (

A Usability-focused Method to Design a Cybersecurity MOOC for Children

Teaching cybersecurity to children is not a trivial task due to the complexity of explaining online-threat-related topics such as sexting or cyberbullying. Moreover, most of the courses designed to raise awareness in these controversial subjects has been mainly produced in English. However, during the Covid-19 pandemic, getting access to Spanish-based training for protecting children online became a priority for parents in countries such as Ecuador, which was not prepared to have children studying at home whilst being exposed to such threats. In this paper, we show that it is feasible to design a virtual course (MOOC) to teach cybersecurity to Spanish-speaking children with acceptable usability levels and minor usability issues. Our proposed methodology combines ADDIE, DPIPE and UDL for developing the course, and uses both SUS and Nielsen as methods to assess the MOOC from an usability point of view. For enhancing user engagement, our course uses novel 3D anthropomorphic characters and storyboards to aid the learning process. Regarding usability results, our proposed MOOC has very high and acceptable scores, with around 86/100 using the SUS scale, and less than 3 in the Nielsen score. © 2022 IEEE.

Education outside the classroom: Hybrid teaching-learning methods

Digitalization in education, accelerated by the recent COVID-19 confinement, shows that a high proportion of learning is outside the classroom and that a post-pandemic return to a previous state in the teaching-learning process is not possible. Thus, being the objective to document how the advance of educational technology changed teaching, it is proposed: (i) to take the construct of educational modalities by curriculum to a hybrid teaching-learning process: with digital mediation and teacher mediation;(ii) and for this, the participants will have to assume responsibilities in the conduction of the new educational reality. © GKA Ediciones, authors.

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

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

Successful Treatment With Eculizumab in Patients With Severe ANCA Vasculitis

Background: Severe presentation of ANCA vasculitis is a life-threatening disease despite aggressive immunodepression therapy. Complement hyperactivation is involved in pathogenesis;thus, the effect of the C5 inhibitor (eculizumab) used in severe forms of ANCA vasculitis may be a treatment option. Method(s): This is a retrospective study. Nine patients were included. Period of study: from May 2017 to May 2022. All patients received at least 3 drugs (steroids, rituximab and mycophenolate or cyclophosphamide) before eculizumab. Eculizumab was indicated as an off-label indication due to lack of improvement or clinical worsening. Result(s): Mean (SD) age: 62 (15) years. Female: 4. Three patients showed serum antiproteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA) and 5 (myeloperoxidase: MPO-ANCA) and one was ANCA-negative. Six patients had an estimated glomerular filtration rate (eGFR) < 10 ml/min/1.73 m2 at presentation. Five patients had pulmonary involvement. The mean (min-max) time of follow-up after the onset of eculizumab was 27 (1-60) months. One patient ANCA-negative microscopic polyangiitis with diffuse alveolar hemorrhage needed orotracheal intubation and had a satisfactory evolution after eculizumab;however, 20 days after, the patient developed a COVID-19 infection and died. One patient who needed urgent dialysis at presentation did not recover renal function and showed a complement factor H mutation. The evolution of the other 7 patients was as follows: the median (p25-p75) eGFR increased from baseline to the end of the follow-up: 9.1(4.8-21.7)ml/min/1.73m2 to 31(13-45)ml/min/1.73m2, respectively (P=0.018) and the mild proteinuria disappeared in all patients. Alveolar hemorrhage improved in all patients within seven days after the first eculizumab administration. The median (p25-p75) doses of eculizumab administered were 1800(1800-3600) mg. One patient required eculizumab for two different periods. Conclusion(s): One patient died due to a COVID-19 infection, and one remained in chronic renal replacement therapy. Alveolar hemorrhage was well controlled in all patients. The eGFR increased significantly in 7/9 patients, and in 4/6 patients, dialysis could be withdrawn. In severe ANCA vasculitis, eculizumab should be considered for improving outcomes.

INDUCTION IMMUNOSUPPRESSION AND OUTCOME IN EARLY KIDNEY TRANSPLANT RECIPIENTS WITH COVID-19

BACKGROUND AND AIMS: COVID-19 in kidney transplants has a high risk of complications and mortality, especially in older recipients diagnosed during the early period after transplantation. Management of immunosuppression has been challenging during the pandemic. We investigated the impact of induction immunosuppression, either basiliximab or thymoglobulin, on the clinical evolution of kidney transplants developing COVID-19 during the early period after transplantation. METHOD: Kidney transplant recipients with <6 months with a functioning graft diagnosed of COVID-19 from the initial pandemic outbreak (March 2020) until 31 July 2021 from different Spanish centres participating in a nationwide registry. RESULTS: A total of 127 patients from 17 Spanish centres developed COVID-19 during the first 6 months after transplantation, 73 (57.5%) received basiliximab and 54 (42.5%) thymoglobulin. Demographics were not different between groups, but patients receiving thymoglobulin were more sensitized (cPRA of 32.7% ± 40.8% versus 5.6% ± 18.5%) and more frequently re-transplanted (30% versus 4%). Recipients older than 65 years treated with thymoglobulin showed the highest rate of acute respiratory distress syndrome [64.7% versus 37.1% for older recipients receiving thymoglobulin and basiliximab (P < .05), and 23.7% and 18.9% for young recipients receiving basiliximab and thymoglobulin (P > .05)] and the poorest survival [mortality rate of 64.7% and 42.9% for older recipients treated with thymoglobulin and basiliximab, respectively (P < .05), and 8.1% and 10.5% for young recipients treated with thymoglobulin and basiliximab (P > .05)]. Older recipients treated with thymoglobulin showed the poorest survival in the Cox's regression model adjusted for comorbidities. CONCLUSION: Thymoglobulin should be used with caution in older recipients during the present pandemic era.

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

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

Making it Work in the Virtual Capstone Climate and Beyond: Project-based Perspectives Across a Variety of Programs and Universities

With all the changes in the educational landscape due to COVID-19, capstone design courses have been uniquely affected. With several transitions to virtual course delivery and/or hybrid models of learning, capstone faculty are now challenged with helping students meet project objectives and deliverables, fostering student team cohesion, and managing sponsor expectations in virtual settings, all while fulfilling the course learning outcomes. While there have been countless programs, communities, and support systems implemented to guide the transition to online teaching, initially there was very little available to systematically understand and support the capstone and PBL community. The objectives of this work are twofold. The first aim is to outline the challenges faced by capstone faculty due to transitions to primarily remote capstone offerings, particularly within the areas of managing sponsorship, completing projects, and producing the associated final project deliverables. The second objective is to open a dialogue to chronicle concerns, gather input, and share best practices across the broader capstone community. The overarching goal is to help overcome -and even rise to- these challenges. This research was conducted by capstone faculty at four different universities. The first phase of this initiative involved research to identify the issues and practices in the existing literature, especially relevant to virtual capstone offerings. The second phase of this research involved a survey of capstone faculty on this topic to reinforce and/or supplement the literature findings as the virtual circumstances evolved. To understand the acute challenges, the survey noted above was conducted with the broader capstone community to include a diversity of faculty associated with capstone at a variety of institutions. This included capstone directors, coordinators, instructors, and advisors. The third phase gathered information through a panel organized and conducted by the authors at the most recent ASEE conference while dealing with societal and academic COVID-19 restrictions. The ASEE panel served as a platform to bring together the capstone community for ongoing dialogue, supplying additional solution recommendations. Results from this research coupled with literature findings indicated the commonality of challenges faced by capstone programs regardless of timing, engineering major, program profile, or type of institution. Among the survey results were the following: (1) Due to COVID-19 conditions, 44% of the respondents reported complete cancellation of this event while 56% reported conducting some form of virtual exposition. The work represented in this paper supports an intention to be agile enough to adapt to any situation along this continuum - and likewise be posed to adjust when our capstone programs must react to emerging circumstances in the future. © American Society for Engineering Education, 2021

The resetting of a local health system: an opportunity for health promotion

Background The COVID-19 pandemics brings a window of opportunity for the 2021-2025 Health Plan of Catalonia to better address the social determinants of health. Different public organisms are leading the Health Promotion (HP) agenda without a real integration of the approach. An interdisciplinary group of health professionals working on HP carried out a qualitative study to assess barriers, facilitators and recommendations of health professionals and public policy managers for applying HP. Methods Six focus groups with 52 purposively selected professionals of different health disciplines and three in-depth interviews with public policy managers were conducted between March 2017-February 2020 until saturation was reached. An external expert on Sociology conducted all interviews and codification was done by three researchers from the group. Literature review helped to complete triangulation. Results The salutogenic approach was mostly unknown. The health system was not set with a people-centred perspective and HP not integrated within health services. Different public organisms competed for leadership and resources in HP. There was limited expenditure for the primary health care services working on HP. Coordination across healthcare services levels and sectors was scarce. Roles and responsibilities related to HP were not defined. Health professionals were not aware of evidence-based approaches. Some interdepartmental public health plans were already designed but not fully deployed, mainly due to lack of funding and disaggregated mechanisms of governance and financing. Initiatives such as the Municipal Health Committees or social prescription were positively perceived. Conclusions The Catalan Public Health Agency and health providers should work aligned. Financing and reallocation of resources for Public Health and HP should be enhanced. Health should be a core value in educational plans. Local and regional stakeholders should have a higher role in resetting health services. Key messages Governance for Health in All Policies needs intersectoral partnerships. The health system should be rebuilt to properly address the social determinants of health in the post-COVID era.

Increased severity in SARS-CoV-2 infection of minorities in Spain.

OBJECTIVE: With the global spread of COVID-19, studies in the US and UK have shown that certain communities have been strongly impacted by COVID-19 in terms of incidence and mortality. The objective of the study was to determine social determinants of health among COVID-19 patients hospitalized in the two major cities of Spain. METHODS: A multicenter retrospective case series study was performed collecting administrative databases of all COVID-19 patients ≥18 years belonging to two centers in Madrid and two in Barcelona (Spain) collecting data from 1st March to 15th April 2020. Variables obtained age, gender, birthplace and residence ZIP code. From ZIP code we obtained per capita income of the area. Predictors of the outcomes were explored through generalized linear mixed-effects models, using center as random effect. RESULTS: There were 5,235 patients included in the analysis. After multivariable analysis adjusted by age, sex, per capita income, population density, hospital experience, center and hospital saturation, patients born in Latin American countries were found to have an increase in ICU admission rates (OR 1.56 [1.13-2.15], p<0.01) but no differences were found in the same model regarding mortality (OR 1.35 [0.95-1.92], p=0.09). CONCLUSIONS: COVID-19 severity varies widely, not only depending on biological but also socio-economic factors. With the emerging evidence that this subset of population is at higher risk of poorer outcomes, targeted public health strategies and studies are needed.

ENCOVUR-2 study: Analysis of the protocols of action, management and availability of intensive care resources for patients with severe COVID-19 attended in spanish Emergency Departments during the first peak of the pandemic.

OBJECTIVE: During the first wave of the COVID-19 pandemic, the availability of a critical care bed was insufficient. The aim of this work was to evaluate the presence of protocols, management in the emergency department (ED) and the availability of intensive care unit (ICU) beds for severe COVID-19 patients attended in Spanish hospital EDs during the first peak of the 2020 pandemic. METHODS: Questionnaire collecting data regarding ED care in March-April 2020 aimed at all Spanish public health care EDs. The respondents were the Chiefs of EDs. The variables of interest were: 1) Presence and of compliance with ED protocols for decision making and adequacy of therapeutic effort;2) management of COVID-19 patients with non-invasive mechanical ventilation (NIMV) or high flow nasal cannula (HFNC) in the ED;and 3) ICU bed accessibility for ED patients. The results were compared based on the characteristics of the hospital, impact of the pandemic and autonomous community. A descriptive and inferential analysis of the variables studied was performed using the chi-square test and analysis of variance. RESULTS: A total of 246 questionnaires (89%) were received. Protocols were available in 136 EDs (57.1%). Globally, the protocol was applied in >95% of the EDs, although this was less frequent (76%) in EDs with high impact of the pandemic. 53% of the EDs managed patients with severe COVID-19 with NIMV/HFNC in the ED itself, and 19.4% suffered from lack of ICU beds. The lack of ICU beds for severe COVID-19 patients in the ED significantly differed among periods, and more marked in hospitals with ICU and with high pandemic impact. CONCLUSIONS: It is needed to generalize the implementation of protocols in EDs for the management of severe COVID-19 patients and improve the capacity of the ICUs to homogeneously adjust to the needs.

Multiagent System for Home Appliances on Internet of Things (MAS-HAIoT)

Currently, there are various smart devices for homes, which have different functions that support domestic tasks such as keeping the pantry always full, accessing recipes, and creating shopping list. These devices have a high cost, for this reason, it arises in creating a low-cost smart device, which contains the options described above. In addition to having a module called “nutrition”, with which you can keep a record of meal plans and a diet provided by a nutritionist at a cost minor, for this, a mobile application was created called: Mobile application for smart appliances (MoASa) given the current situation due to the COVID-19 pandemic. It has resulted in many people taking shelter in their homes and taking care measures such as avoiding going out to non-essential situations, this pretends to be a support to carry out grocery shopping and avoid going out as little as possible. The analysis and design of the device contain several agents, this article described the nutrition agent, the food ontology, its semantic network, hardware, and software for communication with multiple applications that support the user. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Ehealth As A Tool in Hematopoietic Stem Cell Transplantation: A Narrative Review

Background: Patients undergoing hematopoietic stem cell transplantation (HSCT) are at greater risk of intensive care unit admission, need for mechanical ventilation, or death compared to immunocompetent patients. eHealth is one of the multidisciplinary components that can have the greatest impact on quality of life, accessibility, and quality of service due to its potential to improve efficiency and productivity in health service system processes.The objective of this study is to determine the scientific evidence on eHealth strategies, the level of implementation and their role in HSCT. Methods: The search strategy used was: (Hematopoietic Stem Cell Transplantation OR Stem Cell Transplantation, Hematopoietic OR Transplantation, Hematopoietic Stem Cell) AND (Telemedicine OR Mobile Health OR mHealth OR Telehealth OR eHealth OR Health, Mobile). In the bibliographic search, 98 articles were obtained from PubMED and Scopus sources. By means of evaluating pairs a first selection was made by title and abstract, in the discrepancies consensus was sought by means of discussion between pairs. Of the articles chosen for full reading, those that reported results of eHealth-based interventions were included. Articles not performing a transplant and eHealth application were excluded. Results: A total of 46 articles were selected for full reading and 26 were finally included in this review. We identified that the majority of the studies were conducted in the USA (n = 10), the publication concentrates mostly on the year 2020, and a first study in 2007. The purpose of the interventions included the follow-up and management of risk factors related to cardiovascular disease, accompaniment for symptom detection and improvement of the quality of life of patients, remote monitoring of patients with telemetry, and training of patients (eLearning). The objectives of these interventions included: medication adherence, physical activity monitoring, infection prevention, patient participation in content creation, symptom tracking and management, follow-up with self-reporting of data, mainly in patients with complications associated with post-HSCT treatment, and pain management in adults. The population involved in the interventions included: patients with allogeneic and autologous transplants, adolescents, caregivers, parents of transplanted children, among others. It should be noted that the projects where patient follow-up was sought managed to improve the patient's quality of life. Remote monitoring with adequate teaching is useful for the rapid detection of complications and in adolescents it can take advantage due to their affinity with mobiles, it also had an impact for patients who lived far from the transplant centers by reducing complications and cost. The most frequent type of intervention was the use of mobile applications for data collection, monitoring and monitoring of symptoms. The interventions with the greatest impact on patients were applications due to their accessibility, feasibility, benefits, and acceptance by patients. Conclusions: The scientific evidence on eHealth for HSCT shows products such as applications, mobile health and telemedicine, with the greatest publication of works in the last year. A multidisciplinary commitment is necessary in planning for development, costs, times and execution of projects with information technology, as well as the need for a focus on User Experience, important and necesary after the experience of COVID-19.

Promoting physical activity in patients with cardiovascular disease during the covid-19 confinement

At present, sedentary behavior and physical inactivity have been identified as some of the most important risk factors for the development of cardiovascular disease (CVD). Their prevalence has grown in recent years, mainly due to their increase in the sedentary time, with reduced participation in active transport and prolonged leisure time unrelated to physical activity (PA). Despite the wide knowl-edge on the pleiotropic benefits of PA, the degree of adher-ence to these healthier lifestyles is notoriously low in the general population. During the current pandemic of coro-navirus disease 2019 (COVID-19), various high-risk popu-lations have been recognized, such as elderly people and patients with cancer, cardiometabolic, respiratory or other chronic disorders. Although various management plans have been designed for the pandemic, their impact on this situa-tion on cardiovascular health has been overlooked. Although the quarantine measures have been effective in controlling the propagation of COVID-19, they may have significant col-lateral aspects in other areas, especially in patients with high cardiovascular risk. In this scenario, maintaining adequate PA levels has become a veritable challenge of adaptability for both, patients and medical personnel. It is essential that both parts work in ensemble to design effective strategies for each particular case, aiming to grant the protective effects of PA during this emergency period.