COVID-19 and its consequences on the physical, psychological and social health of obstetricians

Introduction: The COVID-19 pandemic has had effects on the health of health workers, including obstetricians, but the consequences in this occupational group are unknown. Objective: Determine the consequences of COVID-19 on the physical, psychological and social health of obstetricians in Peru. Methods: Observational, descriptive, cross-sectional study, carried out on 511 attending obstetricians, in the first line of care. An online questionnaire, previously validated and reliable, was applied to measure the variables: general characteristics and exposure to COVID-19, physical health, psychological health, and social health. Data were analyzed using descriptive statistics. Results: 468 (91.6%) obstetricians are women, 287 (56.2%) aged 40-59 years, 213 (41.7%) married, 292 (57.1%) working at the first level of care;216 (42.3%) were infected with COVID-19, 165 (32.3%) had headache, 127 (24.9%) sore throat and 121 (23.7%) fatigue;167 (77.3%) required outpatient treatment and 3 (1.3%) intensive care. Obesity reported by 102 (20.0%) obstetricians was the main comorbidity, followed by hypertension with 38 (7.4%) and diabetes with 14 (2.7%);263 (51.5%) reported depressive symptoms and 464 (90.8%) stress;238 (46.6%) felt discrimination and 118 (23.1%) carried the workload of the home alone. Conclusions: The physical, psychological and social health of obstetricians is affected by the pandemic;generates disorders of overweight/obesity, depression, stress;as well as discrimination and work overload at home. © 2023, Editorial Ciencias Medicas. All rights reserved.

Non-invasive mechanical ventilation in patients admitted to a provisional center for moderate COVID-19 patients

Introduction:Non-invasive mechanical ventilation is a ventilatory alternative for COVID-19 cases. Background:To describe the characteristics and evolution of non-invasive mechanical ventilation (NIMV) in patients discharged from Provisional Center for moderate COVID-19 patients in Figali, Panama. Methods:A descriptive, retrospective, longitudinal stu was carried out in all adult patients discharged from June to July 2021 and who received non-invasive mechanical ventilation. A questionnaire was used using the digital individual medical record as primary source. Descriptive statistics techniques were used. Results:35.9% of the patients (78/217) who were admitted required non-invasive mechanical ventilation on the ninth day of symptoms and the second day after admission. 62.8% (49/78) were obese and 29.5% (23/78) hypertensive. The respiratory rate 30 and the decrease in the PaO2/FiO2 ratio decided the begining of non-invasive mechanical ventilation in 56.4% (78/217) of those admitted. 62.8% (49/78) had moderate-severe acute respiratory distress syndrome, and the severity was related to ventilation failure out of the total number of ventilated patients. Ventilation was successful in 65.4% (51/78). PaO2/FiO2 <150 (62.9%), respiratory rate 30 (55.6%) and physical exhaustion (51.85%) decided ventilation failure. Conclusions:Non-invasive mechanical ventilation is an effective procedure in COVID-19 patients and moderate or severe respiratory distress;although its success is related to the less severe forms. Low PaO2/FiO2, together with symptoms, were key indicators to assess the begining, success or failure of NIMV;not so the values of PaO2, PaCO2 and SpO2.

SPANISH NATIONAL REGISTRY OF BELIMUMAB IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

BackgroundBelimumab (BLM) is a monoclonal antibody that inhibits B-lymphocyte stimulating factor (BlyS) approved as a specific treatment for systemic lupus erythematosus (SLE) in 2011. We present the experience with BLM in a Spanish cohort with more than 460 patients.ObjectivesTo describe demographic characteristics, efficacy and safety of BLM in patients with SLE in Spanish population since its approval.MethodsDescriptive, retrospective, multicenter study in patients diagnosed with SLE according to EULAR/ACR 2019, SLICC and/or ACR 1997 diagnostic criteria. Data regarding SLE patients treated with BLM were collected from medical records (2011-2022). Demographic features, efficacy, laboratory variables, SLEDAI, renal involvement, steroid dose, administration routes and safety were assessed. To see whether a trend in BLM prescription had changed or not over time, two periods of time were analyzed: 2011-2016 (period1) and 2017-2022 (period2).ResultsBaseline characteristics of patients are summarized in Table 1.A total of 462 patients (36 hospitals) were included, 50.9% were on intravenous (IV), 34% on subcutaneous (SC) and 15.1% switched from IV to SC route. The median number of pre-BLM csDMARD use was 2.0 (2.0-3.0), being hydroxychloroquine (HCQ) the most frequently used (94.5%). Fifty-two patients were treated with IV cyclophosphamide with a median of 6 bolus received. At the time of BLM start, 443 patients were on prednisone with a median dose of 6.2 mg (5.0-10.0). Significant decreases in prednisone dose, SLEDAI and anti-DNA antibodies were observed from baseline until the last visit, whereas complement C3 and C4 values raised (Figure 1). A total of 118 patients (27.4%) had renal involvement with a median proteinuria of 1.0 g/day (0.5-2.4). Renal biopsy was done in 102 out of 118 patients, being class IV (33%), class III (21%) and class V (16%) the most frequently reported. After BLM, 73.3% of these patients improved (median proteinuria of 0.2 g/day (0.1-0.7).In period1, 100 patients started BLM compared to 362 in period2. The median time from SLE diagnosis to BLM begin was 7.1 (4.0-13.7) and 6.2 (2.1 -14.4) years in period1 and period2, respectively (p=0.454). We found a trend to use more csDMARD before BLM treatment in period1: 2.5 (2-3) vs. 2 (2-3) (p=0.088).A total of 143 (30.5%) patients discontinued treatment mostly due to inefficacy (55.9%) and infections (11.9%). In fact, 116 patients developed infections, mostly mild;2 patients died, 16 had COVID-19 and 4 patients developed tumors requiring discontinuation of the drug.ConclusionIn our cohort of SLE patients in a real-world setting, BLM has been effective, safe and seems to be a good choice to treat renal involvement.References[1]Navarra SV, Guzmán RM, Gallacher AE, et al. Lancet. 2011;377(9767):721-31.[2]Stohl W, Hiepe;rt al. Arthritis Rheum. 2012;64(7):2328-37.[3]Furie R, Rovin BH, Houssiau F, et al. N Engl J Med. 2020;383(12):1117-1128.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

JOB SATISFACTION OF PUBLIC WORKERS IN NORTHERN PERU DURING THE COVID-19 PANDEMIC

Objective: The objective of the study was to determine the job satisfaction of public workers in the provincial municipalities of the Tumbes region (Peru). Method: The method used was a descriptive, non-experimental cross-sectional design. The sample consisted of 319 male and female workers from the 3 provincial municipalities. A sociodemographic questionnaire and the Job Satisfaction Questionnaire were used as data collection instruments. Results: The results showed that only 10% of the participants had high job satisfaction. Within the dimensions, the majority showed low satisfaction (67%) with the remuneration received. No significant differences were found between men and women with respect to job satisfaction, and those with permanent employment status had lower levels than those who work on a temporary basis. Conclusions: It is concluded that most of the personnel working in the provincial municipalities of the Tumbes region have low levels of job satisfaction, so it is important to develop programs aimed at strengthening the bond and favorable attitude of workers with the institution where they work. © 2023 The Authors.

Long COVID / COVID prolongado

Existen múltiples reportes de manifestaciones persistentes en pacientes que cursaron infecciones por SARS-CoV-2, independiente de su gravedad, configurando el síndrome de COVID-19 prolongado. No existe una definición consensuada de este síndrome, cuya patogenia pareciera ser multifactorial. Considerando las más de 500 millones de infecciones en todo el mundo, este síndrome pudiese incidir en una insospechada y prolongada carga sobre los sistemas sanitarios. Reportes recientes han asociado a la vacunación con esquema primario completo como una asociación protectora para el desarrollo de COVID-19 prolongado, transformándose en otro beneficio poblacional asociado a las vacunas.(AU)

There are multiple reports of persistent manifestations in patients who had SARS-CoV-2 infections, regardless of their severity, configuring the prolonged COVID-19 syndrome. There is no agreed definition of this syndrome whose pathogenesis seems to be multifactorial. Considering the more than 500 million infections worldwide, this syndrome could have an unsuspected and prolonged burden on health systems . Recent reports have associated vaccination with a complete primary schedule as a protective association with the development of prolonged COVID-19, becoming another population benefit associated with vaccines.(AU)

COVID-19 exposure setting, social and gender determinants in a Mediterranean region

BACKGROUND: Knowledge of social and gender determinants, which influence the places where people are exposed to COVID-19, may be relevant in the development of preventive and control strategies. The aim of this paper was to determine the context in which COVID-19 cases were infected (household, work/labor, health, social-health, and social-leisure settings) according to country of origin, occupational social class and gender, which is essential in order to designing public health strategies. METHODS: A cross-sectional study of an epidemiological registry of 56,628 COVID-19 incident cases was made, whose exposure/ contagion setting was studied according to the previous variables from June 15 to December 23, 2020, in the Region of Murcia (Spain). An exact Fisher test was used to study the distribution of COVID-19 cases based on the above variables. RESULTS: The cumulative incidence was higher in people from Africa (5,133.5 cases/100,000 inhabitants) and Latin America (11,351.1) than in non-immigrants (3,145.7). It was also higher in women (3,885.6) than in men (3,572.6). It is noteworthy, that 53.3% of the cases with employment were workers in industry or construction, artisans, agricultural workers, or elementary occupations. In contrast, during the second semester of 2020, 41.3% of the employed population in the Region of Murcia performed such jobs. The household was the main exposure setting (56.5% of cases with a known setting), followed by social-leisure (20.7%) and work/labor (18.2%). The labor settings were more important in immigrants from Africa (28.4%) and Latin America (35.7%) than in non-immigrants (12%), inversely to social-leisure settings. Labor context was more important in women (19.6%) than in men (16.5%) and in manual workers (44.1%) than in non-manual workers (26.6%). CONCLUSIONS: The context in which COVID-19 cases were infected is different according to social inequalities related to country of origin, gender and occupational social class.

Mental health consequences of isolation of patients with COVID-19

BACKGROUND: The COVID-19 pandemic has had a negative effect on the mental health on the population. It is unknown if the different types of patient isolation affect them equally. The objective of the study was to determine if the effect on the psychological discomfort caused by the isolation of the population with COVID-19 in a hotel supervised by health professionals was different compared with those who were isolated at home. METHODS: Patients diagnosed with COVID-19 during the first pandemic wave in Barcelona, consecutively selected from the Primary Care lists. A telephone survey was carried out to collect information about mental health in patients who were isolated in a hotel compared to those isolated at their homes. Descriptive statistics were performed and the study variables were analyzed using mean and standard deviation, count (percentage), Chi-square test, and Student's t-test. Logistic regression models were carried out selecting frustration and anger/irritability as response variables. RESULTS: Of the 89 patients included, 45 (50.6%) were isolated at their homes and 44 (49.4%) at the hotel. Frustration was identified in 48.3% and irritability in 29.2% of the most patients. Most of those who presented frustration were between 45 and 65 years old, while 50% of those who felt irritability were younger. Multivariate models confirmed that patients isolated at home showed a higher risk of frustration (Odds ratio 4,12;95% Confidence interval 1,60-11,49) and irritability (Odds ratio 3,81;95% Confidence interval 1,32-12,10), respectively. CONCLUSIONS: Patients isolated at home show a higher risk of presenting feelings of frustration and irritability than isolated patients in supervised hotels.

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

Covid-19 pandemic impact in pediatricians: stress factors and their consequences

Previous studies have demonstrated that the COVID-19 pandemic has had negative psychological consequences on healthcare professionals, however, specific data on pediatricians are scarce. Ob-jective: To evaluate anxiety among pediatricians after the first COVID-19 wave as well as to identify possible related risk factors. Material and Method: A cross-sectional multicentric survey study was designed and sent to Spanish pediatricians through the Asociacion Espanola de Pediatria's e-mail lists. Demographic, socio-familial, occupational, emotional self-perception, psychosomatic symptoms, smoking, alcohol, and psychotropic drugs use data were collected. The State-Trait Anxiety Scale (STAI) was included, and its association with qualitative and quantitative variables of the sample was studied. Results: 440 surveys were registered. 42.2% of the participants expressed moderate-intense anxiety symptomatology according to the Anxiety-State scale and 26.9% on the Anxiety-Trait scale. Isolation at home was associated with a higher score on both scales. A change in the work situation of the cohabitant resulted in a higher score on the Anxiety-State scale. 41.1% of the respondents clas-sified the psychological impact suffered as mild, 50% as moderate, and 8.9% as severe. Up to 71.8% of the participants manifested some psychosomatic symptoms, with a linear association between the concurrence of symptoms and higher scores on the two scales. Conclusions: After the first pandemic wave, pediatricians have suffered anxiety, causing physical and emotional discomfort. Personal sit-uations were the main source of concern. Likewise, the presence of several somatic symptoms was associated with higher levels of anxiety.

Effectiveness and Safety of Nirmatrelvir/ Ritonavir in Real Life Setting

Background and Importance On March 28th 2022, nirmatrelvir/ ritonavir was marketed in Spain. The Spanish Agency for Medicines and Medical Devices (AEMPS) established criteria to prioritise its administration in patients at high risk of progression to severe COVID. Data regarding the effectiveness and safety of nirmatrelvir in preventing severe coronavirus disease outcomes are limited. Aim and Objectives To assess the effectiveness and safety of nirmatrelvir/ritonavir in patients at high risk for severe COVID-19. Material and Methods Prospective descriptive study from April to August 2022 of patients treated with nirmatrelvir/ritonavir. Sociodemographic variables, vaccination status, hospital admission, high risk factors for progression and concomitant treatment were recorded. Readmissions were recorded within 30 days of the end of antiviral treatment. Results 53 patients were included with a mean age of 64 years, 51% women and 49% men. 57% were vaccinated with 3 doses, 17% with 2 doses, 9% with 4 doses, 6% with 1 dose and 11% were not vaccinated. 34% (18/53) were hospitalised at the time of initiation of treatment. The most prevalent high-risk criteria were: 24% active treatment with myelotoxic chemotherapy, 21% treatment in the previous 6 months with anti-CD20 drugs, 14% over 80 years vaccinated with some risk factor for progression, 7% patients with onco-haematological treatment and 7% in treatment in the previous 3 months with inhibitors of the proteinkinase. 3 treatments were performed off-label for persistent covid. The mean number of days from the onset of symptoms to the start of treatment was 1.6 days. 23% of patients required dose adjustment due to renal impairment. 53% required adjustment of chronic treatment for interactions, mainly with metamizole, statins, fentanyl and diazepam. 2 patients received remdesivir and sotrovimab, 2 remdesivir and another two sotrovimab. 4 (7%) patients were readmitted within 30 days after the end of treatment with nirmatrelvir ritonavir, 1 of them with persistent covid. One patient stopped treatment for hives. Conclusion and Relevance Nirmatrelvir ritonavir has been shown to be a safe and effective drug in high-risk patients of progression to severe covid.

Ensayo clínico aleatorizado en pacientes COVID- 19 sobre el efecto de la fisioterapia precoz en su acondicionamiento físico

Introduction: The WHO recommends early rehabilitation and mobilization interventions in patients hospitalized for COVID-19. The benefits of early physiotherapy, during the hospital stay, have not been proven in clinical trials. Objective: To evaluate the effects of early physiotherapy and health education in hospitalized COVID-19 patients, in relation to the symptoms described in previous studies, analyzing differences between groups regarding their physical conditioning, need for oxygen therapy and hospital stay. Methodology: Randomized clinical trial with two arms, developed in hospitalization and intermediate respiratory care units, with COVID-19 patients. Sixty-four patients included in the experimental group (implementation of an early physiotherapy program after 48–72 h of admission) and 62 patients in the control group (usual treatment of the center). Sociodemographic and clinical variables: mMRC, oxygen therapy, MRC-SS, 30 s-STST, FPM, Tinetti, FRAIL Scale and PCFS. They were evaluated on admission, discharge and two months after discharge. Results: The experimental patients had fewer days of admission and conventional oxygen therapy. At discharge, they present a lower risk of falling (72.9% vs. 95.8%) and less weakness in MRC-SS (2.1% vs. 14.6%). At two months they had less frailty (5.0% vs. 14.5%), greater hand grip strength, less dyspnea, better results in 30s-STST and fewer post-COVID limitations (86.5% vs. 96.4%). Conclusión: The intervention of early physiotherapy in COVID-19 patients and the health education received, prevents muscle weakness during admission, improves physical conditioning at discharge and two months later, and reduces the days of hospital stay. ClinicalTrials.gov (NCT05032885). © 2023 Asociación Española de Fisioterapeutas

Mild sensory symptoms during SARS-CoV-2 infection among healthcare professionals⋆ Estudio de clínica sensitiva leve durante la infección por SARS-CoV-2 en población sanitaria

Introduction It is not yet possible to estimate the proportion of patients with COVID-19 who present distinguishable classical neurological symptoms and syndromes. The objective of this study is to estimate the incidence of sensory symptoms (hypoaesthesia, paraesthesia, and hyperalgesia) in physicians who have presented the disease at Hospital Universitario Fundación Alcorcón (HUFA) in Madrid;to establish the relationship between sensory symptoms and the presence of other signs of infection;and to study their association with the severity of COVID-19. Methods We conducted a descriptive, cross-sectional, retrospective, observational study. HUFA physicians who presented SARS-CoV-2 infection between 1 March and 25 July 2020 were included in the study. A voluntary, anonymous survey was distributed via corporate email. Sociodemographic and clinical characteristics were collected from professionals with PCR- or serology-confirmed COVID-19. Results The survey was sent to 801 physicians and we received 89 responses. The mean age of respondents was 38.28 years. A total of 17.98% presented sensory symptoms. A significant relationship was found between the presence of paraesthesia and cough, fever, myalgia, asthaenia, and dyspnoea. A significant relationship was also found between paraesthesia and the need for treatment and admission due to COVID-19. Sensory symptoms were present from the fifth day of illness in 87.4% of cases. Conclusions SARS-CoV-2 infection can be associated with sensory symptoms, mostly in severe cases. Sensory symptoms often appear after a time interval, and may be caused by a parainfectious syndrome with an autoimmunity background.

Academic Directors Facing Internet Addictions, Learning and Health Promotion

The result that is presented is expressed from a bibliographic review of works published during the last two years 2020-2022 and, through which it was possible to verify the relationships that are established between the work of the Academic Directors, before the latent challenge and visible that is the crossroads of Internet addictions, by university students, increased in the stage already overcome of social isolation imposed by Covid 19 but, with emphasis on the achievement of learning at this high educational level, its risks and consequent decreases in the attacks that occur as a result of procrastination. All associated with the addictive phenomenon, in a projection of health promotion that the current, humanistic, modern and developing university should not give up in any way, being precisely in this direction an unavoidable pillar of social development, which lies precisely in the high professional qualification. of the new generations committed to a prosperous and sustainable social change. © 2023 Varela et al.

Epidemiology of bacterial co-infections and risk factors in COVID-19-hospitalized patients in Spain: a nationwide study.

BACKGROUND: We performed a nationwide population-based retrospective study to describe the epidemiology of bacterial co-infections in coronavirus disease 2019 (COVID-19)-hospitalized patients in Spain in 2020. We also analyzed the risk factors for co-infection, the etiology and the impact in the outcome. METHODS: Data were obtained from records in the Minimum Basic Data Set (MBDS) of the National Surveillance System for Hospital Data in Spain, provided by the Ministry of Health and annually published with 2 years lag. COVID-19 circulated in two waves in 2020: from its introduction to 31st June and from 1st July to 31st December. The risk of developing a healthcare-associated bacterial co-infection and the risk for in-hospital and intensive care unit (ICU) mortality in co-infected patients was assessed using an adjusted logistic regression model. RESULTS: The incidence of bacterial co-infection in COVID-19 hospitalized patients was 2.3%. The main risk factors associated with bacterial co-infection were organ failure, obesity and male sex. Co-infection was associated with worse outcomes including higher in-hospital, in-ICU mortality and higher length of stay. Gram-negative bacteria caused most infections. Causative agents were similar between waves, although higher co-infections with Pseudomonas spp. were detected in the first wave and with Haemophilus influenzae and Streptococcus pneumoniae in the second. CONCLUSIONS: Co-infections are not as common as those found in other viral respiratory infections; therefore, antibiotics should be used carefully. Screening for actual co-infection to prescribe antibiotic therapy when required should be performed.

Mild sensory symptoms during SARS-CoV-2 infection among healthcare professionals.

INTRODUCTION: It is not yet possible to estimate the proportion of patients with COVID-19 who present distinguishable classical neurological symptoms and syndromes. The objective of this study is to estimate the incidence of sensory symptoms (hypoaesthesia, paraesthesia, and hyperalgesia) in physicians who have presented the disease at Hospital Universitario Fundación Alcorcón (HUFA) in Madrid; to establish the relationship between sensory symptoms and the presence of other signs of infection; and to study their association with the severity of COVID-19. METHODS: We conducted a descriptive, cross-sectional, retrospective, observational study. HUFA physicians who presented SARS-CoV-2 infection between 1 March and 25 July 2020 were included in the study. A voluntary, anonymous survey was distributed via corporate email. Sociodemographic and clinical characteristics were collected from professionals with PCR- or serology-confirmed COVID-19. RESULTS: The survey was sent to 801 physicians and we received 89 responses. The mean age of respondents was 38.28 years. A total of 17.98% presented sensory symptoms. A significant relationship was found between the presence of paraesthesia and cough, fever, myalgia, asthaenia, and dyspnoea. A significant relationship was also found between paraesthesia and the need for treatment and admission due to COVID-19. Sensory symptoms were present from the fifth day of illness in 87.4% of cases. CONCLUSIONS: SARS-CoV-2 infection can be associated with sensory symptoms, mostly in severe cases. Sensory symptoms often appear after a time interval, and may be caused by a parainfectious syndrome with an autoimmunity background.

Lyrics Training: An E-learning Approach to Improve Listening Skills

Due to the COVID-19 pandemic, educational agents have been forced to apply strategies and methodologies and use new technological tools that allow them to continue with the teaching–learning processes. Because of this, the present research implements an innovative methodology to analyze the contribution of the Lyrics Training method in the development of listening skills for English language improvement. The experiment was carried out with high school seniors from an academic unit in the city of Ambato. A sample of 62 students was divided into two groups, an experimental group and a control group, each of 31 learners. When comparing both groups through a t-student test for independent samples, the results showed a p-value lower than 0.05 and a Cohen's d coefficient higher than 0.8, establishing that the teaching process through the Lyrics Training methodology is efficient. Finally, to verify if the Lyrics Training method is suitable for the selected experimental group, the usability scale (SUS) was applied, in which an average acceptance of more than 70 points was obtained, indicating that, in general terms, the Lyrics Training method through a web page is efficient for teaching the English language. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Liver Injury after Covid-19 Vaccination Compared to Post-Influenza Vaccines: Retrospective Cohort Study

Introduction and Objectives: Cases suggestive of immune-mediated acute hepatitis following SARS-CoV-2 vaccination have been reported. The risk of liver injury after Covid-19 vaccination is unknown. This study aimed to estimate the cumulative incidence of liver injury within 90 days after the Covid-19 vaccine, defined as the occurrence of AST and/or ALT increases at least two times the limit of normal or ALP increases at least x 2. To compare with an active comparator group (influenza vaccine). Material(s) and Method(s): Retrospective cohort study. We analyze a consecutive sample of adult patients vaccinated with Covid-19 vaccines (Sputnik, AstraZeneca/Oxford, Covishield, or Sinopharm) between January 1 and May 30, 2021, and a historical control group vaccinated with influenza between March 1 and July 30, 2019. Qualifying labs were collected as part of routine clinical care or the development of symptoms. Result(s): From a total of 29,918 subjects who received the Covid-19 vaccine in 2021 and 24,753 who received the Influenza vaccine in 2019, 130 and 148 patients, respectively, were excluded because of previously altered liver function tests or known hepatic disease. Both groups were comparable in age (73 years old (IQR 65-80), p=0.125) and gender (67% were females). In the Influenza group were more dysmetabolic and immunosuppressed patients. A total of 269 and 273 patients, respectively, presented altered liver function tests within 90 days post-vaccination. The cumulative incidence of liver injury was 4.6 per 1,000 (95% CI 3.9-5.5) for Covid-19 and 5.1 per 1,000 (95%CI 4.3-6.1) for Influenza (p=0.453). Although, two patients from the COVID group had a more severe injury, with hyperbilirubinemia, development of autoantibodies and requirement of steroids for disease control. Conclusion(s): The occurrence of events was similar in subjects vaccinated with Covid-19 compared to the control group. Acute hepatitis characteristics arising after the COVID-19 vaccine needs to be further clarified.Copyright © 2023

Clinical, Histological and Serological Features of Autoimmune-Like Acute Liver Injury after Sars-Cov-2 Vaccination

Introduction and Objectives: Acute autoimmune-like liver injury has been increasingly reported after vaccination against SARS-CoV-2. Pathogenesis, steroid requirement and long-term prognosis are unknown. This study aimed to evaluate clinical, serological and histological features, response to treatment and prognosis in patients with post-vaccination acute hepatitis. Material(s) and Method(s): We included patients without known pre-existing liver diseases with transaminase levels >= 2.5 upper limits of normal within 90 days after the SARS-CoV-2 vaccine with an available liver biopsy. Clinical data and outcomes after a six months follow-up were collected. Result(s): 17 patients were included,12 females, median age 60 (51,5/66) exposed to vectorial (Sputnik V n=7, AstraZeneca n=6), inactivated (Sinopharm n=3) or ARNm Vaccines (Moderna=1). In 8 patients, liver injury developed after the first dose and in 7 after the second dose and in 2 after the third dose. The median time to the development of injury was 33(23,50/53,50) days. Eight patients had a history of extrahepatic autoimmune disease and five patients had metabolic syndrome and used statins. Immune serology showed anti-antinuclear antibody in 10 (58,8%), anti-smooth muscle antibody in 5(29,4%). 14/17 patients presented with elevated IgG levels. Liver histology showed lobular hepatitis in 13/17, portal hepatitis in 17/17 with plasmocytic lymphocytic infiltrate and 4/17 had eosinophils, 6/17 with severe interface hepatitis, and one patient had fibrosis Ishak stage >=3. 12/17 (70,5%) were treated with steroids. Transaminases improved in 17 cases and normalized in 6/12 by month 6. Only 1/17 developed liver function deterioration, yet no patient required liver transplantation. Most patients tolerated the tapering of steroids and in 6 azathioprine was started before month 3. Conclusion(s): Long-term follow-up might help to differentiate between induced classical autoimmune hepatitis, autoinflammatory self-limited events, or drug-induced liver injury in these patients.Copyright © 2023

The Evolution of Ecuador's Foreign Policy in the 21st Century: Analysis from the Theory of Peripheral Realism

This article analyses the evolution of Ecuador's foreign policy during the governments of Rafael Correa, Lenín Moreno and Guillermo Lasso in the framework of the theoretical postulates of peripheral realism, which argues that small and medium-sized states should develop a policy of collaboration with major powers and reduce their opposition to those events that directly affect the interests of their nationals. To this end, key moments in each of the abovementioned governments are analysed, including the closure of the Manta Base, the relationship with the IMF, the handover of Julian Assange and the purchase of vaccines against Covid-19. The article concludes by showing how the three presidents developed strategies that did not maximise Ecuador's interests, as they alternated policies where confrontation with the great powers was generalized with policies that prioritised rapprochement with them at the expense of national interests. © UNISCI, 2023.