Successful ECMO course in an Acquired Immune Deficiency Syndrome (AIDS) patient with ARDS complicated by pneumocystis jirovecii pneumonia and COVID-19: A unique case

Objectives: Reviewing current literature and case reports of patients placed on Venous-Venous ECMO support for HIV and AIDS, with confection with Pneumocystis pneumonia and covid-19 pneumonia. The use of extracorporeal membrane oxygenation (ECMO) in patients who have acute respiratory distress syndrome has been shown to have very good outcomes. However, there is limited data to support the initiation of ECMO in patients who have human immunodeficiency virus infection with or without acquired immune deficiency syndrome. Method(s): We present a unique and challenging case of a 30 year old male, with no known past medical history, unvaccinated against covid-19, who presented with one week of progressive shortness of breath. On admission he was found with moderate bilateral infiltrates and was diagnosed with covid-19 pneumonia. Despite appropriate medical therapy, patient developed worsening hypoxic respiratory failure. Found to have elevated (1- 3)-7beta;-d-glucan and tested positive for HIV. CD4 count 11, HIV viral load 70,000. The patient remained severely hypoxemic despite mechanical ventilation, sedation, paralytics and proning. Venous venous extracorporeal membrane oxygenation was initiated. Considering his non improvement with variety of antivirals and antibiotics and with elevated (1-3)-7beta;-d-glucan in the setting of AIDS he was treated for presumed Pneumocystis pneumonia. The patient tolerated proning while on VV ECMO and his course was complicated with bilateral pneumothorax necessitating chest tube placement. Result(s): The patient successfully completed 64 days on VV ECMO, where he was treated for PCP pneumonia, covid pneumonia, CMV viremia and tolerated initiation of anti-retroviral therapy. Patient was successfully decannulated, and ultimately discharged from the hospital. Conclusion(s): VV-ECMO can be a beneficial intervention with successful outcomes in severely immunocomprimised patients with AIDS. This case highlights the importance of minimizing sedation and early mobilization on ECMO support. (Figure Presented).

Declaration of Cuernavaca

The National Public Health Institutes (NPHI), members of the Latin American Regional Network of the International Association of National Institutes of Public Health, met face to face at the headquarters of the National Institute of Public Health of Mexico, in the City of Cuernavaca, from October 5 to 7, 2022, with the participation of the directors or their representatives of the NPHIs of Bolivia, Brazil, Colombia, Costa Rica, El Salvador, Mexico, Peru and Suriname and representatives of the South American Sub regional Program (SAM), and the Central American Sub regional Program (CAM) of the Pan American Health Organization (PAHO), the Organization of the Amazon Cooperation Treaty (OTCA), the Andean Health Agency/Hipolito Unanue Agreement (ORAS/CONHU) and the Central American Integration System (SICA/COMISCA), analyzing the role of the NPHI in combating health inequities;in confronting the global climate and environmental crisis;combating hunger, food insecurity and malnutrition;successes and challenges in responding to the Covid-19 pandemic;strengthening and continuous improvement of integrated disease surveillance and preparedness for health emergencies;as well as the various existing regional and sub-regional health cooperation programs, noticing that: 1. In the current scenario, the dominating development model is a generator of growing social inequalities, which determine serious inequities in the health conditions of our peoples. 2. Likewise, the current model of production and consumption, adopted at the global level, has increased hunger, food insecurity and malnutrition that possibly constitute nowadays the main health problem in our region. 3. The environmental crisis, which is also a product of the current global development model, has a significant impact on human and animal health and the interaction between both. 4. The NPHIs have played a role of major relevance in confronting the Covid-19 pandemic, not fully applying, however, their full potential for research and for proposing national plans for the disease control. 5. Health surveillance systems, in most of our countries, suffer from significant fragmentation between various sectors and within the health sector itself, implying, in any case, reactive actions that do not allow for anticipating the emergence of new pathologies or health emergencies. 6. The various regional and sub regional cooperation agencies and programs offer an enormous capacity for synergies and mutual cooperation.

Spatial life narratives in the Covid-19 context: reflections from the Ecuadorian rurality

This paper is the result of extensive work with an ethnographic scope, carried out during the context of the Covid-19 pandemic in the rural territory of El Valle, Cuenca (Ecuador). The objective of this research is to study the new social constructions of space and rural territory that have arisen during the lockup time from the everyday life spatial narratives of the population that mobilizes, uses, and configures El Valle. Conceptually, this research uses the lenses of social space theory and emotional geographies. The results suggest that due to the pandemic, the inhabitants were situated in a certain place, but community markets and health centers became mobile social spaces. Inhabitants of El Valle point out the importance of rural territories to keep sustainability in the city. Finally, the local people have maintained survival and solidarity strategies such as mobile minka, especially in spaces designated for them as of the community use.

Severe SARS-CoV-2 pneumonia and pneumomediastinum and/or pneumothorax: a prospective observational study in an intermediate respiratory care unit

Introduction: The occurrence of pneumomediastinum (PNMMD) or pneumothorax (PNMTX) was evaluated in patients with severe SARS-CoV-2 pneumonia. Method(s): This is a prospective observational descriptive study that was carried out on patients admitted to the IRCU of a COVID-19 monographic hospital in Madrid from 14/01/2021 to 27/09/2021. All of them had a diagnosis of severe SARS-CoV-2 pneumonia and required NIRS (HFNC, CPAP, BPAP). The incidences of PNMMD and PNMTX, total and according to NIRS, and their impact on the probability of IMV and death were studied. Result(s): (tables 1 and 2) 4.3% (56/1306) developed PNMMD or PNMTX, 3.8% (50) PNMMD, 1.6% (21) PNMTX, and 1.1% (15) PNMMD+PNMTX. 16.1% of patients with PNMMD or PNMTX had HFNC alone (vs 41.7% without PNMMD or PNMTX;p<0.001) and 83.9% CPAP (vs 57.5%;p<0.001). There was a probability of needing IMV of 64.3% among patients with PNMMD or PNMTX (vs 21.0%;p<0.001), and a mortality of 33.9% (vs 10.5%;p<0.001). Conclusion(s): In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia who required NIRS, incidences of 3.8% for PNMMD and 1.6% for PNMTX were observed. LDH was a risk factor for developing PNMMD or PNMTX (median 438 vs 395;p=0.013), and PNMMD (median 438 vs 395;p=0.014). The majority of patients with PNMMD or PNMTX had CPAP as the NIRS device, much more frequently than patients without PNMTX or PNMMD. However, the pressures used in CPAP were even lower in patients with PNMMD or PNMTX (median 8 vs 10;p=0.031). The probabilities of IMV and mortality among patients with PNMMD or PNMTX were 64.3% and 33.9%, respectively, higher than in patients without PNMMD or PNMTX, 21.0% and 10.5%.

Economic policies versus Covid-19 from the perspective of international law

The sanitary crisis has brought greater effect to the world economy than the Great Recession;Covid-19 disrupts all sectors of the world economy and all regions of the orb, restricts movement and promotes social distancing. As a result, global value chains are affected, causing global trade to fall by up to 32% or more by the end of 2020, and global economic contraction. This implies that different international organizations with experience in the development of economic policy, fiscal and monetary measurements have expressed a series of recommendations for the national governments in order to resist, in an immediate way, the negative effects derived for Covid-19. In this paper, it is presented the economic impact of the health crisis on the world, and the recommendations and/or guidelines of the international organizations to promote the rapid recovery of the world economy, in all areas, which point to what taxation should look like in relation to Covid-19. Finally, within the framework of what it has been possible to predict, the sanitary crisis brings to collation the strengthening of a new world arranging characterized by the harmonization of fiscal politics expressed by the global institutions. That is, a legal order nurtured by standards known as soft law and led by global organisms. © 2022 Authors. All rights reserved.

SWF 3.0: How sovereign wealth funds navigated COVID-19 and changed forever

Sovereign wealth funds (SWFs) have been significantly and uniquely affected by the COVID-19 pandemic. From March 2020 to December 2021, governments around the world withdrew over US$ 211 billion from their books and "invited” them to bailout different sectors and businesses, most notably, state-owned airlines. However, some SWFs were also able to pursue opportunities overseas, and most grew their assets under management tremendously due to the stock market rally that followed the market and oil bust of the beginning of 2020. However, state investors are not expecting markets to stay bullish forever, and have been building an adequate level of liquidity in their books and of resilience as an organization for the next market shock, which may as well come with ESG. One can argue that SWFs have indeed entered a new phase "SWF 3.0” characterized by increasing size, influence, maturity, and sophistication;by an interest in different asset classes, regions, and industries;and by a focus on sustainability, collaboration, and long-term survival. © 2023, Academy of International Business.

Clinical Findings and Outcomes from 1306 Patients with Covid-19 Pneumonia in an Intermediate Respiratory Care Unit: A Prospective, Observational Study

Background: An intermediate respiratory care unit (IRCU) may be a valuable tool for optimizing patient care, allowing to implement standardized algorithm management to decrease clinical failure and mortality. We aimed to describe the practice of noninvasive respiratory strategies (NRS) in a novel facility fully dedicated to COVID-19 and to establish outcomes of these patients Methods: Prospective, observational study performed at one hospital in Spain. We included consecutive patients admitted to IRCU due to COVID-19 requiring NRS between December 2020 and September 2021. Data collected included mode and usage of NRS, endotracheal intubation and mortality to day 30. A multivariable Cox proportional hazards method was used to assess risk factors associated with clinical failure and mortality Findings: 1306 patients with COVID-19 were included. Of them, 64.6% were men and mean age was 54.7 years. During IRCU stay, 345 patients presented a clinical failure, (89.6% intubated;14.5% died). Cox model showed a higher clinical failure in IRCU when time between symptoms onset and hospitalization < 10 days (HR 1.59;95% CI 1.24-2.03;p<0.001) and PaO2/FiO2 <100 (HR 1.59;95% CI 1.27-1.98;p<0.001). Conversely, these variables were not associated with an increased mortality to day 30 Interpretation: IRCU may be a useful option for the multidisciplinary management of COVID-19 patients requiring NRS;thus, reducing ICU overcharge. Men gender, gas-exchange and blood chemistry at admission are associated with worse clinical outcomes, while older age, gas-exchange and blood chemistry are associated with 30-day mortality.

Usefulness of the early combination of non-invasive respiratory therapies in patients with COVID-19

Aim: To determine the effect of the early combination of high flow nasal cannula (HFNC) plus continuous positive airway pressure (CPAP) regarding endotracheal intubation (ETI) and 30-day mortality in patients with SARS-CoV-2 pneumonia. Method(s): Observational study of patients admitted to the intermediate respiratory care unit (IRCU) who received HFNC+CPAP. Two groups were formed according to the time of starting the combined therapy: Early HFNC+CPAP (first 24 h - EHC) and Late HFNC+CPAP (after 24 h - LHC). A multivariate analysis was performed to establish the strength of the association with ETI and 30-day mortality. Result(s): 780 patients were included (502 male, mean age 56.5 +/- 12.9 years). Table 1 shows the baseline characteristics. 273 patients were subjected to ETI, 32.9% in the EHC group vs 38.9% in the LHC group (p 0.05). 30day mortality was 8.2% in the EHC vs 15.5% LHC (p 0.02). Table 2 shows the multivariate analysis. Conclusion(s): The combination of HFNC+CPAP, especially in the first 24 hours after IRCU admission, is a useful tool in the management of SARS-CoV-2 pneumonia.

THE IMPACT OF COVID-19 VENTILATION REQUIREMENTS ON THE TEMPERATURE AND AIR QUALITY IN UNIVERSITY CLASSROOMS

The current study analyzes educational buildings aiming to determine the long and short-term effects of the COVID-19 pandemic situation regarding the usage patterns and indoor environmental quality standards. Through monitoring campaigns in various classrooms, data has been gathered on temperature and indoor air quality which has made it possible to obtain a picture of the current situation in rooms with forced ventilation systems as well as in rooms where only natural ventilation is available. Results show that the CO2 concentration levels remain controlled regardless of the number of students in spaces equipped with mechanical ventilation;however, in classrooms where only natural ventilation is available, these values vary depending on the occupancy and, when attempting to maintain the recommended levels, indoor thermal conditions are greatly affected by the external weather. The factors with the greatest impact on comfort are airspeed and outside temperature, which in several cases have resulted in very low indoor temperatures that do not comply with the legally required limits. © 2022 by the authors. Licensee AEIPRO, Spain. This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/bync-nd/4.0/)

MOOCs for Teaching in Times of COVID-19

The COVID-19 disease, caused by the SARS-CoV-2 virus, strengthened professional training and certification processes and integrated industrial processes for professionals. As a viable solution for fortifying education in the COVID-19 era, it comprises the integration of Open Adult Learning Courses on the Internet and their integration with information stored on digital educational platforms. This work aims to establish, through the integration of Open Online Courses and digital platforms, a set of steps for improving the quality of online courses in the teaching-learning process. The Delphi with expert criterion method assesses the effectiveness of integrating open online courses and digital platforms for quality assurance. The time factor is critical for laying the groundwork for integrating Open Online Intensive Courses and digital learning platforms. It is concluded that without measuring results, the success of integrating open online courses and digital platforms for quality education cannot be measured. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

A Developing Crisis in Hunger: Food Insecurity within 3 Public Colleges before and during the COVID-19 Pandemic

During the COVID-19 pandemic, food insecurity increased across the United States, with college students being particularly vulnerable. This study surveyed 1989 undergraduates attending three public colleges before and during the first year of the pandemic. At all times, students' food insecurity was related to worse academic performance, greater housing insecurity, poorer psychological and physical health, and less access to healthcare. Compared to pre-pandemic students, during-pandemic students reported greater use of and fewer barriers to food programs, spending more on and and receiving more government aid for food, experiencing more academic difficulties due to food insecurity, having greater housing insecurity, and enduring less access to healthcare. © 2022 Taylor & Francis Group, LLC.

Exploratory factorial model of innovation in the Covid-19 era

The objective of the study was to explore the dimensions of innovation in a public university in central Mexico during anti-COVID-19 policies of distancing and confinement of people. A cross-sectional, exploratory, psychometric and correlational research was carried out with a sample of 186, considering their professional practices and social service in public health institutions. The results show a structure of efficiency, usefulness and use. In relation to the state of the art, the structure of acceptance of the technology is corroborated, although in the pandemic scenario the dissolution of the second and third factors is appreciated, as well as the prevalence of the third factor. Copyright © 2022, Anka Publishers. All rights reserved.

A cross sectional examination of sunburn incidence in the context of race/ethnicity and skin type

Sun exposure is physiologically necessary, yet excessive amounts can be detrimental to skin, causing photoaging, sunburn, and skin cancer. Sunburn, presenting as delayed onset erythema, has been partially characterized for Caucasians, however the impact of excessive sun exposure has been less studied across race/ethnicity and skin tones. Herein, we present findings from a survey conducted across the United States, where sunburns were examined in a racially and ethnically diverse sample of 3597 participants spanning the Fitzpatrick skin phototype (FSP) scale. Individuals reporting sunburn were probed on the signs, severity, pain level, and anatomical location of their most recent sunburn and on the associated type of activity. Over the 8-month evaluation period (January-August 2020), sunburns were self-reported at rates generally consistent with those reported annually pre-COVID, with 39% Caucasian, 20% Asian, 12% African American and 32% Latino respondents reporting at least one sunburn. While average sunburn incidence among African American is low, a closer look reveals that African Americans with lighter skin tones (FSPs I-II) report higher sunburn rates (25.5%, n = 12), thus highlighting that sunburn risk does not depend on race/ethnicity alone. Furthermore, African Americans and Hispanics self-reported a significantly higher percentage of severe sunburns compared with Caucasians (27%, 20% and 11%, respectively) and African Americans, unlike Caucasians, indicated “peeling” as the top sign of their sunburn. This work provides a better understanding of the sunburn experience across race/ethnicity and skin tones and is a step toward enabling more personalized sun safety awareness and education.

MOOCs for Teaching in Times of COVID-19

The COVID-19 disease, caused by the SARS-CoV-2 virus, strengthened professional training and certification processes and integrated industrial processes for professionals. As a viable solution for fortifying education in the COVID-19 era, it comprises the integration of Open Adult Learning Courses on the Internet and their integration with information stored on digital educational platforms. This work aims to establish, through the integration of Open Online Courses and digital platforms, a set of steps for improving the quality of online courses in the teaching-learning process. The Delphi with expert criterion method assesses the effectiveness of integrating open online courses and digital platforms for quality assurance. The time factor is critical for laying the groundwork for integrating Open Online Intensive Courses and digital learning platforms. It is concluded that without measuring results, the success of integrating open online courses and digital platforms for quality education cannot be measured. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Digital Skills and Teaching Performance of the National University of Education in Times of Covid 19

The purpose of this paper is to determine the relationship between digital skills and teaching performance at the National University of Education during the Covid 19 period. The research follows a quantitative methodology and uses a non-uniform design. Experimental, relevant and cross-sectional is a sample consisting of 252 students, who were surveyed. The Spearman correlation coefficient was used for hypothesis testing. The most important conclusion is that, based on the results, there was a significant relationship between digital skills and teaching performance of the National University of Education during the period COVID-19 with a correlation value rho =0.499.

PREDICTIVE SEVERITY FACTORS of COVID-19 in PATIENTS with RHEUMATIC IMMUNE MEDIATED DISEASES

Background: COVID-19 has become a common disease in patients with rheumatic immune-mediated diseases (R-IMID). A risk stratifcation of the patients at COVID-19 onset is important to predict possible unfavorable results. Objectives: To identify predictive severity factors in patients with COVID-19 with R-IMID. Methods: Cross-sectional study in a single University Hospital. We included all consecutive patients with a R-IMID and COVID-19 up to November 6th, 2020. Confrmed infection was defned if the patient had a positive nasopharyngeal swab for SARS-CoV-2. COVID-19 case severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) COVID-19 guidelines (1). We performed a multivariable analysis and calculated de odds ratio of critical COVID in patients with R-IMID, adjusting by age, sex and comorbidities. Results: We included 274 patients with R-IMID complicated with COVID-19. At COVID-19 onset, the main comorbidities, analytical values, underlying R-IMID and treatments received are shown in Table 1. According to COVID-19 severity, patients were mild (n=209;76.3%), moderate (n=35;12.8%), severe (n=9;3.3%) and critical (n=21;7.7%). The predictive variables at COVID-19 onset related statistically to critical COVID were older patients, hypertension, dyslipidemia, previous cardiovascular disease, cancer, chronic kidney disease, and chronic liver disease. The only underlying R-IMID and treatment was polymyalgia rheumatica and Rituximab, respectively. Regarding analytical values were higher values of C-reactive protein, LDH, platelets and lymphopenia (Figure 1). Conclusion: We identifed various factors associated with a worse prognosis of COVID-19 in patients with R-IMID. This can help to identify which patients can present a worse course of the disease at the moment of the diagnosis.

COVID 19 INFECTION in PATIENTS with RHEUMATIC IMMUNE-MEDIATED DISEASES in A SINGLE UNIVERSITY HOSPITAL. MATCHED CASE-CONTROL STUDY

Background: COVID19 may present different degrees of severity. It is generally thought that viral infections in patients with rheumatic infammatory diseases (R-IMID) or receiving immunosuppressive treatment tend to present more severe disease. However, data comparing the severity of the disease between R-IMID and the general population are scarce. Objectives: To assess the predisposing factors, clinical-analytical features and severity of COVID-19 infection in R-IMID compare to patients without R-IMID. Methods: Case-control study in a single University Hospital. We included all consecutive patients with a diagnosis of a R-IMID and a positive test for COVID-19 up to March 31st, 2021. A total of 274 controls were selected for each case, and matched by sex, age (± 5 years), and without previous diagnosis of R-IMID or use of immunosuppresive therapy. Confrmed infection was defned if the patient had a positive nasopharyngeal swab for SARS-CoV-2. COVID-19 case severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) COVID-19 guidelines (1). Mild/moderate COVID19 was compared with critical. Results: We included 274 patients (185 women/89 men), mean age 59.1 18 years. More frequent R-IMID were: Rheumatoid arthritis (RA) (n=87, 31.8%), Axial spondylarthritis/Psoriatic arthritis (SpA/PsA) (n=90, 32.8%), Polymyalgia Rheumatica (PMR) (n=22, 8%) and Systemic Lupus Erythematosus (SLE) (n=22, 8%) We also included 274 age and matched controls. Main characteristics of patients with R-IMID and controls are shown in Table 1. Concerning comorbidities, hypertension and dyslipidemia were more frequent in patients with R-IMID (p< 0.05). COVID-19 symptoms' distribution is shown in Figure 1. Cough and dyspnoea were more frequent and headache, odynophagia and diarrhea were less frequent in the R-IMID group. The only analytical difference was D-Dimer that was signifcantly higher in patients with R-IMID. Although most of the cases were mild, critical cases and deaths were more frequent in R-IMID (p <0.05). Conclusion: Most of the patients present a mild COVID-19. However, a more severe syndrome was observed in R-IMID.

The Effect of the Covid-19 Epidemic on the Self-perception of Training Needs in STEAM Lecturers

This work in progress research-to-practice paper presents the initial results of a study carried out at our university among lecturers, aimed at determining how the perception of training needs have changed due to the pandemic, and if this change can be used to increase enrollment in the university training program. Pedagogical training of university lecturers has usually been a self-training process guided by their own beliefs about what good teaching is, and the self-perception of one's own strengths and weaknesses with respect to teaching. The COVID-19 pandemic shook the world in many ways, but it also challenged lecturers about their own convictions regarding educational methodologies, evaluation and their own approach to teaching, so it is a great opportunity for change.

Impact of COVID-19 pandemic and total neoadjuvant therapy (TNT) implementation in pathological complete response (pCR) rates in patients (pts) with locally advanced rectal cancer (LARC)

Background: Strategies for locally advanced rectal cancer LARC usually consisted of neoadjuvant concomitant chemoradiotherapy (CRT) followed by adjuvant chemotherapy, or short-course radiotherapy (SCRT). TNT is a novel approach for LARC, with several randomized clinical trials exploring its role and paving the way for implementation in clinical practice. Nevertheless, the COVID-19 pandemic represented a challenge for a timely diagnosis, implementation and follow-up of new treatment strategies in these pts. Methods: Records of all the pts diagnosed with LARC and stage IV rectal cancer evaluated in the Oncology department of Vall d’Hebron Hospital between Jan 1st, 2017 and Dec 31th 2021 were included. The period 2017-19 was considered pre-pandemic (PP) and 2020-2021 during-pandemic (DP). Patients with LARC receiving neoadjuvant and/or adjuvant treatment were analyzed, including those treated with SCRT, CRT, and TNT. Data regarding demographics, diagnosis and staging, preoperative treatment received, surgical outcomes, including treatment response, and pathological stage were collected. Results: 390 patients were included (31.28% female, 68.71% Male, median age 69). LARC pts characteristics included 123 (31.54%) either cT4 or cN2, 59 low rectal cancers, 4 with signet ring cells. Neoadjuvant treatment was done in 160 pts (CRT) and 59 pts (TNT). pCR was achieved in 20% and 22% for CRT, and TNT respectively (p0.84). 32 pts received only SCRT with 6.25% pCR. An increased ratio of stage IV pts compared to LARC was evident during the pandemic (stage IV 26.38% 2017-2019, 37.14% 2020-2021, p=0.044). The proportion of high risk LARC increased during pandemic (34.89% PP vs 39.04% DP, p=0.041). No difference was found in terms of pCR amongst the PP and DP patients (25.3% vs 27%, p=0.83) nor different strategies (TNT: 26.47% PP and 26.6% PD, p=0.98 and CRT 23.89% PP and 27.27 % PD, p=0.82). Conclusions: Efficacy of LARC neoadjuvant treatment measured by pCR was maintained in pts before and during COVID-19 pandemic despite an increasing proportion of new LARC high-risk pts. Evaluation of TNT impact in LARC outcomes was challenging because of pandemic confounding role. Real-world data in a post-pandemic setting is essential to evaluate outcome trends in LARC pts;an increase in high-risk LARC and metastatic pts should be expected. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosures: A. García Álvarez: Speaker Bureau / Expert testimony: ANGELINI PHARMA ESPAÑA;Travel / Accommodation / Expenses: Pfizer, Ipsen, Eisai Europe. All other authors have declared no conflicts of interest.