Fulminant myocarditis following SARS-CoV-2 mRNA vaccination rescued with venoarterial ECMO: A report of two cases

Objectives: Cases of fulminant myocarditis after mRNA COVID-19 vaccination have been reported. The most severe may need venoarterial extracorporeal membrane oxygenation (V-A ECMO) support. Here we report two cases successfully rescued with V-A ECMO. Method(s): We included all the cases supported with V-A ECMO for refractory cardiogenic shock due to myocarditis secondary to a mRNA SARS-COV2 vaccine in the high-volume adult ECMO Program in Vall Hebron University Hospital since January 2020. Result(s): We identified two cases (table). One of them was admitted for out-of-hospital cardiac arrest. In both, a peripheral V-A ECMO was implanted in the cath lab. An intra-aortic balloon pump was needed in one case for left ventricle unloading. Support could be successfully withdrawn in a mean of five days. No major bleeding or thrombosis complications occurred. Definite microscopic diagnosis could be reached in one case (Image, 3). Treatment was the same, using 1000mg of methylprednisolone/day for 3 days. A cardiac magnetic resonance 10 days after admission showed a significant improvement in systolic function and diffuse oedema and subepicardial contrast intake in different segments (Image, 1-2). Both patients were discharged fully recovered. Conclusion(s): V-A ECMO should be established in cases of COVID-19 vaccine-associated myocarditis with refractory cardiogenic shock during the acute phase. (Table Presented).

Mainstreaming disaster risk management technical and vocational education and training (DRM-TVET) program in higher education institutions: flexible ladderized capacity building model amid COVID-19

Disasters are increasingly becoming more destructive in their impacts. Lives have been lost and properties damaged due to the lack of institutional and personnel coping and adaptive capacities. Several policies in the Philippines have noted the importance of capacity development in implementing Disaster Risk Management (DRM). To meet the above necessity, in 2017, Philippine School of Business Administration (PSBA), Manila, one of the higher education institutions pioneered a specialization of DRM in its existing Master in Business Administration program. However, meeting the demand for Disaster Risk Management Technical and Vocational Education and Training (DRM-TVET) through Formal Degree Program (FDP) and keeping FDP sustainable is still facing a number of challenges. The main drivers of these challenges include but are not limited to the following: time constraint on the part of participants to complete 2–4 years' FDP;lack of institutions offering DRM-TVET programs;and unavailability of a Learning Management System. The main objective of this research is to develop an Alpha-Flexible Ladderized Capacity Building Model (A-FLCBM) amid COVID-19. Further, the study should also provide logical flow and recommendations to operationalize the remaining activities of the Conceptual Framework in developing the Beta (B)-FLCBM amidst COVID-19. In this regard, the researchers collected pertinent data through a substantive, thorough, sophisticated literature review and examined the available mandates on existing Flexible ladderized models. Further, a Conceptual Framework (CF) is also developed and partially operationalized. The output allowed researchers to develop A- FLCBM amidst COVID-19 using the PSBA curriculum as a pilot case. However, the framework activities, i.e., dry run, Technical Education and Skills Development Authority (TESDA) registration for National Certification (NC), development of B-FLCBM, and the empirical assessment of DRM-TVET and FDP sustainability will be covered in future studies. The A-FLCBM comprises of interrelated activities including mode of learning and well-designed DRM NC short courses, workshops, and trainings for the trainers. The Model is aligned with the Executive Order 358, promulgated in 2004. Further, the Ladderized Education (LE) system introduced through Commission on Higher Education Memorandum Order No. 43, 2008 Series, was also considered for wider-scale and accelerated implementation of LE nationwide and globally. The implementation of B-FLCBM will provide a unique opportunity to develop the skills required to be a professional in the DRM and business continuity field, improving the quality of life and raising awareness on the importance of preventing and mitigating disasters and reducing the loss incurred by countries in terms of lives, property, and economy. © 2023 Elsevier Inc. All rights reserved.

[Factors associated with the risk of hospitalization and death related to SARS-CoV-2 infection.]

OBJECTIVE: COVID-19 has tried out global health causing high mortality. There are some risk factors that associate greater severity and mortality from COVID-19;but their individual impact is unknown yet. There are also no fixed criteria for hospital admission. For this reason, this study aimed to analyze the factors associated with the severity of COVID-19 and create predictive models for the risk of hospitalization and death due to COVID-19. METHODS: A descriptive retrospective cohort study was made in Talavera de la Reina (Toledo, Spain). Data were collected through computerized records of Primary Care, Emergencies and Hospitalization. The sample consisted of 275 patients over eighteen years old diagnosed with COVID-19 in a centralized laboratory from March 1st to May 31st, 2020. Analysis was carried on using SPSS, creating two predictive models for the risk of hospitalization and death using linear regression. RESULTS: The probability of hospitalization increased independently with polypharmacy (OR 1.086;CI95% 1.009-1.169), the Charlson index (OR 1.613;CI95% 1.158-2.247), the history of acute myocardial infarction (AMI) (OR 4.358;95% CI 1.114-17.051) and the presence of COVID symptoms (OR 7.001;95% CI 2.805-17.475). The probability of death was independently associated with age, increasing 8.1% (OD 1.081;95% CI 1.054- 1.110) for each year of the patient. CONCLUSIONS: Comorbidity, polypharmacy, history of AMI and the presence of COVID-19 symptoms predict the risk of hospitalization. The age of individuals predicts the risk of death. Detecting patients at high risk of hospitalization and death allows us to define the target population and define measures to implement.

ECMO in acute fulminant myocarditis in pediatrics

Objectives: To describe our experience in ECMO for acute myocarditis Methods: Descriptive, retrospective study (2018-2022) of a cohort of 8 patients < 16 years with acute myocarditis who were assisted on ECMO. Result(s): 8 patients were collected, (6 females), with a mean age 7;8 years [range 0;1-13;8]. In 7/8, the reason for cannulation was hemodynamic instability refractory to medical treatment, with a mean inotropic score of 70 [range 10-122]. Sixty-two percent presented cardiorespiratory arrest prior to cannulation and 2 of them needed ECRP. The mean precannulation troponin level was 1498 ng/ml [range 89-6212]. Primary transport was performed in 4 patients. ECMO was peripheral veno-arterial in 100%, jugulo-carotid in 2/8 and femoro-femoral in 6/8. All patients underwent atrioseptostomy. They received treatment with levosimendan, immunoglobulins, corticoids and carnitine. In 4 acute infectious etiology was confirmed (parvovirus, influenza and SARSCoV2), another one was due to PIMS-TS and in 3 no etiology was found. Six patients underwent myocardial biopsy and 5 of them showed inflammatory infiltrates. The mean time on ECMO was 8 days [range 3-14], 2 of them requiring 2 ECMO courses. The mean length of PICU stay was 21 days [range 10-50]. Two were transferred to a heart transplant center. The main complications were arterial hypertension (88%), bleeding (63%), neurological (50%), arrhythmias (38%), coagulopathy (38%) and infectious (38%). One patient required renal replacement therapy. 1 patient died, 2 had moderate neurological sequels. Conclusion(s): ECMO is a therapeutic option in patients with fulminant myocarditis refractory to medical treatment and may help improve their prognosis.

ECMO for the immunocompromised pediatric patient: Our experience

Objectives: To present a series of immunosuppressed patients (oncohematological disease, congenital immunosuppression, hematopoietic stem cell (HSCT), and solid organ transplant) assisted on ECMO. Method(s): Descriptive, retrospective study (2011-2020) of a cohort of 9 immunosuppressed patients, supported on ECMO. Medical records were reviewed and demographic, clinical, and analytical variables were collected. Result(s): In our series of 9 patients, 5 were male, the median age was 8 years [RIC 3-11 years]. Considering the underlying disease, 6 were oncologic, 1 liver transplant and 2 with congenital immunodeficiency after HSCT. 4 were under active chemotherapy (median 6 days after the last cycle [RIC 5-188]). 6 were admitted due to acute respiratory failure, 3 due to hemodynamic instability (3/9), (one septic shock). The median PEEP was 12 [RIC 9-15] and FiO2 100% (81-100%). 78% (6) required vasoactive drugs (median inotropic score 35 [RIC 0-75]. 40%. 5 had severe neutropenia and/or plateletopenia in the 24 hours prior to ECMO, and alterations in acid-base balance (median pH 7. 1 [RIC 6.9-7.15]. 5 were on multiorgan failure. TPrimary ECMO transport was performed in 4 patients (44%). Cannulation was peripheral in 80% (57% cervical, 43% femoral) and central in 20%;70% VA-ECMO. Median time of assistance was 15 days [RIC 3.5-31.5] in cardiac ECMO (4), and 29 days [RIC 13.5-42] and in pulmonary ECMO (n=5). The median total time of admission was 45 days [RIC 27-59]. 9 had an infection, 2 COVID after HSCT, and 8 bleeding complications, but only one required surgical revision. Renal replacement therapy was used in 5 (median 9 days [RIC 5-34.5]). Other therapies used were polymyxin hemadsorption(2), intratracheal surfactant(2), plasma exchange(1), infusion of mesenchymal cells(1) and specific memory T lymphocytes(2). 4 patients died, 5 survived decannulation, 2 died later, with an overall survival rate to hospital discharge of 33% (3/9). Conclusion(s): Despite having a worse prognosis, ECMO can increase survival in immunosuppressed patients, in situations that are challenging and require a multidisciplinary approach.

Analytical Framework for Emergency Remote Education in Universities During Lockdown

This paper presents a framework based on three dimensions (material, educational, and psychoemotional) to explore the characteristics, processes, and outcomes of emergency remote education introduced by in-person universities during the COVID-19 pandemic. With this aim, two ad hoc questionnaires were designed and administered in April-May to a sample of 220 teachers and 548 students in a Spanish university. The most significant findings show digital inequality between students in terms of technological equipment and the quality of connectivity. Remote education was designed as a way to transfer the in-person teaching model to a virtual environment. Both teachers and students experienced an overload of work, which may help to explain the high levels of stress experienced by both groups. The research concludes with proposals to improve the quality and effectiveness of distance learning in any future crises.

Generic Competences in Higher Education After Covid-19 Pandemic

This paper aims to analyse whether acquisition of students' generic competences has been influenced by Covid-19 pandemic in an online higher education environment. In order to analyse these effects we present an empirical study to know the influence of Covid-19 pandemic in generic competences of business and economics students. A quantitative analysis is conducted in a sample of 221 students from the online bachelor's degree programme on Business and Economics at the Universitat Oberta de Catalunya. The analyses show that the achievement of most part of competences has been affected by the pandemic, but in different levels. Moreover, the analyses also show which competences are affected in higher levels and which one in lower levels. Moreover the study analyses the possible differences depending on whether the students were at the beginning of the studies or at the end. The key finding is the effect of Covid-19 pandemic on generic competences, which creates an opportunity to undertake actions to address the lowest achieved and to generate strategies in order to adapt to this new situation. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Neoadyuvant Treatment in the Covid Era

Since Coronavirus Disease 2019 (COVID-19) was declared pandemic in March 2020, there have been 545.226.550 cases up to 4 July 2022 (1). Several studies concluded that patients (pts) with cancer are at increased risk of COVID-19 infection, morbidity and mortality. Those undergoing neoadyuvant treatment are at particularly risk of disease progression if chemotherapy or surgery are delayed. Also, is known that a higher NLR (neutrophil to limphocyte ratio) is related to worse outcomes (3). Our hospital is located at the Northwest of Spain and in the last months we noticed a never seen number of infections in cancer population. The aim of this study is to evaluate the severity of COVID19 and its impact on chemotherapy and surgery delay in pts undergoing neoadjuvant chemotherapy breast cancer. METHOD(S): We conducted a ambispective, unicenter, observational study of breast cancer pts, treated with neoadjuvant chemotherapy, between March 2020 and May 2022 at University Hospital A Coruna (Spain). We analyzed type of infection, need of hospitalization, chemotherapy and surgical delay, and its association with tumor type;BRCA germline mutation;clinical stage;treatment;vaccination status;and neutrophils, lymphocytes, and NLR before COVID-19 disease. RESULT(S): During the study period, from 1 March 2020 to 31 May 2022, 183 pts underwent neoadjuvant chemotherapy. A total of 23 (12.5%) pts experienced COVID-19 infection, of which 21 were diagnosed between January and May 2022. The median age was 47,91 years [range 33 - 69 years]. Luminal B HER 2 negative comprised the most common molecular subtype (40.9%), followed by Triple Negative (36.4%), Luminal B HER 2 positive (13.6%), and HER 2 enriched (9.1%). Germline mutations in BRCA account for 13.6% pts. At diagnosis, 4.5%, 72.7%, and 22.7% had stages I, II, and III respectively. Chemotherapy treatments included: paclitaxel followed by AdryamicineCyclophosphamide (AC) (45.4%);carboplatin - paclitaxel - trastuzumab - pertuzumab (18,2%);carboplatin - paclitaxel followed by AC (18,2%);KEYNOTE-756: pembrolizumab/placebo - paclitaxel followed by AC (13.7%);and paclitaxel - trastuzumab - pertuzumab followed by myocet - cyclophosphamide - trastuzumab - pertuzumab (4.5%). The association of G-CSF ocurred in 9 pts (40.9%). 22 pts were fully vaccinated, 8 pts (36.4%) with two doses and 13 pts (59.1%) with three doses. 77.3% pts experienced mild respiratory symptoms with 9.1% hospitalizations. The median duration of delays was 15 days for chemotherapy and 29,58 days for surgery. NLR percentil 25 was associated with COVID-19 type of infection. For those pts with a lower rate, infection was asymptomatic and for those with a higher rate symptoms were moderate (X2= 5,119, p = 0,024). CONCLUSION(S): COVID-19 disease become a high prevalent infection in pts undergoing neoadjuvant breast cancer chemotherapy. Most pts are fully vaccinated and experienced an indolent infection. NLR is an easily measurable and cost-effective parameter that could be useful as a prognostic marker of severity in COVID-19. We will continue to follow-up these pts to see the impact of chemotherapy or surgery delay in pathological complete response and disease-free survival until the congress in December 2022.

Pandemic experimentalism: decentering studio art education in an ongoing global emergency

After eighteen months of online art education during the COVID-19 pandemic, the authors consider Form and Time, a required first-year studio art course at OCAD University in Toronto, as a case study within global practices of reconfiguration and experimentalism in art and design pedagogy during the crisis. Form and Time was scheduled to launch as a required first-year course on campus at OCADU in Fall 2020, but quarantine prompted the pivot to fully remote. Critiques of the traditional art school's situated format were launched before COVID-19 by anti-ableist, Indige-nous and feminist scholars, addressing access barriers and stressing resilience in the face of crisis and oppression. The pandemic disrupted the centrality of in-person studios and critique methods in post-secondary art education;this accelerated and took unexpected turns during the online pedagogical experiments of the early pandemic. In this context, Form and Time foreshadows new modes of art school studio delivery, decentering and critically intersecting with studio precedents suddenly disrupted by remote learning during COVID-19. Form and Time's weekly asynchronous video lectures and online meetings probed themes of Space, Form and Time. Students posted weekly studio experiments on discussion boards, using materials close at hand. As with other art and design courses, everyday objects and materials provided a platform for discussing material conditions and encounters during the pandemic. Students depicted their unique surroundings using strategies of observation and wal-king. They accessed faculty-made online micro-workshops recorded by the various course instructors on home studio material techniques. These comprise a growing online archive shared by faculty teaching the multi-section course. Looking forward, we anticipate further crises. Greater interplay between online, blended and hands-on art studio education will prioritize flexibility that can better adapt to life pressures and emergencies, opening access for a diverse range of learners in decentered locations. © 2023, Judith Doyle, Simone Jones, Elizabeth Lopez.

Study of the adaptability to change and proactive behavior of students in a university context in face of the COVID-19 health emergency

The objective of this study is to analyze the variables of adaptability to change and organizational behavior of the students of the Tecnologico Nacional de Mexico Campus Coatzacoalcos, in the state of Veracruz-Mexico. The research has a qualitative and quantitative approach, it is a cross-sectional study with a single cut in time, developed in the period corresponding to the month of November 2021 and June of this year. The method used is hypothetical-deductive. A non -probabilistic sampling was determined with the convenience technique, obtaining the participation of 513 students from the different careers offered at the institution. A measurement instrument was applied that analyzes the perception of the eight dimensions to be studied: need for change, leadership and management, attitude to change, communication, adaptation to change, proactive behavior oriented towards the organization, proactive behavior oriented towards others and behavior proactive proactive towards oneself. Through a parametric test, Kolmogorov-Smirnov hypothesis testing and Whitney's Mann's U, male and female students adapt to change in the institution and that males are more likely to have change-oriented behavior that the women.

Collateral consequence of COVID pandemic: Increased incidence of cat scratch disease

Background. Cat scratch disease (CSD) is a zoonosis caused primarily by Bartonella henselae. The aim of our study was to determine the incidence CSD before the preventive and obligatory social isolation/distancing that was indicated in Argentina as a consequence of the SARS-CoV-2 pandemic on March 19, 2020 ('first period') and to compare it with the incidence since then to present ('second period'). Methods. Retrospective analysis of patients with CSD admitted to the Infectious Diseases outpatient office at Ricardo Gutierrez Children's Hospital (a tertiary care center) from March 2012 to March 2022. Charts were reviewed for demographic and epidemiological data, duration of symptoms, clinical manifestations and systemic compromise. Results. Two hundred twenty-nine patients were observed during the study period. The median delay between symptoms onset and medical consultation was 15 days (IQR 9-30d), without statistically significant differences between periods The median age at presentation was 101.67 months (range 11.3 to 211.87 months) Age and gender were similar between periods. The average number of cases per month was 1.63 (158 in 97 months) versus 3.23 (71 cases in 22 months) in the first and second periods, respectively, with an increasing incidence of 98%. The frequency of systemic compromise was higher in the second period: 47.89% versus 32.28% (p= 0.01). The months with the highest incidence were February to July. Conclusion. A significant increase of CSD were observed during the COVID pandemic probably related to a closer children's contact with pets due to the strict quarantine that health authorities implemented. Moreover, an unexpected finding was a higher proportion of patients with systemic CSD during the pandemic period.

About Some Spanish graphic novels in times of COVID-19 pandemic: Cathartic panels for the end of the world

The purpose of this chapter is to attend to comics produced during COVID-19 pandemic, especially those referring to the hardest moments of confinement and which may allow to observe the use of comics as a tool to analyze reality, both from a psychological point of view and from a sociopolitical one. Being such a recent phenomenon, corpus selection is introduced as temporary since new items continue to emerge, and furthermore, it is still early to assess its significance. As a pragmatic criterion, two vectors will be used: on the one hand, focus will be stressed on works belonging to the Spanish comics market in order to portray a particular cultural environment;on the other hand, four items will be selected to establish a coherent story which may adapt the stages of the hero's journey into a new paradigm (1. Fear, 2. Anger, 3. Humor, and 4. Healing). © 2023 by IGI Global. All rights reserved.

Ingestion of Alcohol-Based Hand Sanitizer: A case report

Introduction: Alcohol-based hand sanitizers containing ethanol or is opropanol are being used in order to prevent person-to-person transmission during the COVID-19. Early signs and symptoms of this ingestion include nausea, vomiting, headache, abdominal pain, blurred vision, loss of coordination, and decreased level of consciousness. After hand sanitizer ingestion we have to suspect about methanol poisoning, monitoring the start of anion-gap metabolic acidosis, seizures, and blindness is essential. Treatment includes supportive care, acidosis correction, and the administration of an alcohol dehydrogenase inhibitor. In servere cases hemodialysis may be required. Objective(s): To present a case of an 29-year-old woman who was taken to the emergency department after voluntary ingestion of alcohol-based hand sanitizer in a suicide attempt. To describe the most common side effects of hand sanitizer ingestion and the literature review. Method(s): Clinical case presentation and literature review of similar cases. Result(s): A 29-year-old woman, with diagnosis of borderline personality disorder and previous suicide attempts was taken to the emergency department after 3 hours of voluntary ingestion of an unknown quantity of alcohol-based hand sanitizer. Initial laboratory findings showed laboratory a blood methanol concentration of 66 mg/dL, with an anion gap of 30 mEq/L, arterial blood pH of 7.2, serum bicarbonate concentration of 12 mEq/L. Patient complained of abdominal pain and nervoussness. Conclusion(s): Most common signs and symptoms of alcohol-based hand sanitizer ingestion include nausea, vomiting, headache, abdominal pain, blurred vision, loss of coordination, and decreased level of consciousness. Treatment includes supportive care, acidosis correction, the administration of an alcohol dehydrogenase inhibitor and sometimes may be required.

Credit Risk Models in the Mexican Context Using Machine Learning

The Default Rate is related to the period of the economic cycle in which they are observed, during expansion periods of the economy the default rate tends to be lower. But in contraction periods, the default rate tends to increase and this could be a risk for the stability of a country’s economy. Therefore, it is important to monitor the perspective of the economy in case it is expected to decrease or have abrupt movements. This work aims to identify the economic variables that determine the default rate of the Mexican Financial System and to find a machine learning model that forecasts the default rate. For this, we aggregate a dataset based on three official Mexican sources that compile data from 2013 to 2022, including the COVID-19 pandemic time frame. Then, we propose the analysis using two machine learning models. After the analysis, the results confirm that the artificial neural networks model shows better predictive power for the default rate values. We also implement an easy to use web application to estimate the default rate based on three simple variables. We anticipate this work might help on estimating the default rate and might impact on the strategic policies in the Mexican economy. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Generic competences and learning results during the COVID-19 pandemic: a comparative study

The paper has a dual aim: first, to study the effect the COVID-19 pandemic has had on the development of students' generic competences and learning outcomes;and second, to analyse the observed differences between these two elements depending on whether the students' teaching-learning environment of origin was face-to-face or online. To analyse the effect the pandemic has had, data were collected on the students enrolled in two universities with different methodologies, one face-to-face and one online. A descriptive analysis and comparison of means were carried out using questionnaires designed to collect information on students' perception of the effect of the pandemic on their generic competences and learning results, depending on the environment of origin. The results confirm that the pandemic has affected the development of students' generic competences, despite students themselves considering that they have met their learning objectives. Furthermore, the teaching-learning environment of origin influences both variables, with differences observed between face-to-face and online university students.

Health prevention from the Public Space Design. The URB_HealthS project as a knowledge transfer experience

Urban planning has formed a binomial with health since its origins as a discipline. The demands derived from the welfare society, environmental sustainability and the health circumstances of COVID-19 testify to the need to update this relationship. The aim of the URB_HealthS project is to study the ways of endorsing health in the contemporary city through the urban design of public space. A knowledge transfer model between the academy and the local society in the field of urban health and public space has been defined, whose theoretical structure and implementation in three European localities is presented.

Advantages and limitations of the ROX index

Dear editor We have read with interest the study by Vega et al1 published in the latest issue of the journal, where the authors propose the ROX index as a predictor of failure of high-flow nasal cannula (HFNC) therapy in patients with pneumonia due to SARS-CoV-2, and we would like to share some considerations on the advantages and disadvantages of using this index.