[Stress, anxiety, and depression in health workers during the COVID-19 pandemic]

Background: Mental health is an integral part of health. Having some psychiatric condition without treatment predisposes to a poor quality of life. These alterations have been found with an incidence of up to 50% in the general population. There are very few studies in Mexico on these conditions in health workers during the COVID-19 pandemic. Objective: To determine the prevalence of stress, anxiety, and depression during the COVID-19 pandemic in health workers. Material and methods: A descriptive, cross-sectional observational study was conducted on health workers in a tertiary hospital, through the application of randomized and self-completed surveys, in search of levels of stress, anxiety, and depression during the COVID-19 pandemic. Results: 44.7% of those surveyed showed depression, 83.1% anxiety, and 66.3% stress. The main groups affected were female staff, singles, and medical residents. Those with type 2 diabetes mellitus had higher anxiety and depression. Conclusion: The prevalence of stress, anxiety, and depression in health workers is similar to that of the general population in our study. Depression was the alteration most found. The scrutiny of alterations in mental health in health workers is of the utmost importance, with greater emphasis in the context of the aforementioned pandemic.

Virtual labs for the study of enzymatic stirred tank bioreactors

Virtual laboratories have successfully proven to be very versatile and intuitive when simulating experiments in science, biotechnology, and engineering. These tools must complement the experiments carried out in real labs or pilot plants. This study describes the creation of a virtual laboratory through the Easy JavaScript Simulation platform. A web-based simulation of an enzymatic stirred-tank bioreactor has been built using a dynamic model. This simulation reproduces the behavior of a continuous bioreactor, including the deviations of ideal mixing conditions as by the use of an in tanks-in-series model for nonideal flow. This article describes the continuous dynamic model in a stirred tank bioreactor, as well as the operation of a tool capable of carrying out virtual practice with students. Practice scripts have been developed that should be used by students during the practical classes. This interactive tool is powerful and useful to develop many experiments by varying the different input parameters, saving time and resources. In addition, the tool allows following teaching sessions in specific situations such as the health situation derived from the pandemic caused by COVID-19.

Tomographic characteristics of lung lesions in hospitalized patients with COVID-19 and its prognostic value

The severity of lung involvement on chest tomography (CT) images in COVID-19 patients may have a prognostic value. This study assesses the type, severity and frequency of the different images of lung CT in hospitalized patients with COVID-19, and the differences in clinical characteristics and in-hospital outcomes, according to the CT severity score. This represents an observational study (retrospective cohort) of hospitalized patients with COVID-19. The ISARIC-WHO form was used to collect data. The type of lung lesions, affected lobes, and total CT severity score were determined at hospital admission. The first, second and third quartiles of the total CT score were calculated to divide the sample into four equal parts (Q1, Q2, Q3 and Q4). A total of 556 patients were included, 336 men (60.4%) and 220 women (39.6%), with a mean age of 61.9 +/- 15.8 years;and 532 of them had CT scan at admission. Patients in the more severe quartiles had more days of symptoms evolution (Q1 6.4 +/- 3.5, Q2 7.9 +/- 4.1, Q3 8.2 +/- 4.1, Q4 8.1 +/- 4.4), desaturation (Q1 95.3 +/- 3.7, Q2 94.4 +/- 3.1%, Q3 91.7 +/- 4.8%, Q4 86.5 +/- 9.1%), alterations of inflammatory markers, hospital stay (Q1 6.4 +/- 2.9, Q2 7.4 +/- 4.1, Q3 9.6 +/- 5.8, Q4 13.1 +/- 10.4 days), admission to ICU (Q1-2.5%, Q2-5.8%, Q3-12.5%, Q4-49.1%), mortality (Q1-3.8%, Q2-4.5%, Q3-9.4%, Q4-33.3%), mixed CT lesions (ground glass opacity-consolidation), linear opacities, crazy-paving pattern, reverse halo sign, and bronchiectasis. The total CT score significantly correlated with leukocyte, neutrophil and lymphocyte counts, and with other inflammatory markers. Semi-quantitative evaluation of pulmonary involvement in the initial chest CT can help to establish the severity of the case and predict relevant clinical outcomes in COVID-19 patients.

Hospitalized patients with COVID-19: One-year pandemic report

Background: There is limited information about the variations of the clinical characteristics and outcomes in hospitalized patients with COVID-19 during the pandemic. No study has evaluated these changes in our region. Objective: To assess the clinical characteristics and outcomes of adult hospitalized patients with COVID-19 during the first year of the pandemic. Methods: This is a retrospective, observational study. Medical charts of hospitalized patients with COVID-19 at the Hospital Centro Médico de Caracas were reviewed to obtain information about their clinical characteristics. Results: A total of 454 patients were included, 278 men (61 %) and 176 women (39 %), with an average age of 61.97±15.95 years, previous duration of symptoms 7.38 ± 4.01 days, chest CT score 11.49±5.80, and hospital stay 8.30±5.11 days. 59.8 % of the patients had severe-critical disease, 40.2 % mild-moderate, 15.86 % were admitted to the ICU, 81.2 % were discharged and 9.5 % had died. The curve of hospitalized cases was bimodal, identifying two waves: The first between July-September 2020 (peak in August with 59 cases), the second larger and longer between December 2020 and April 2021 (peak in March 2021 with 140 cases). The length of hospital stay remained stable over one year, while mortality decreased progressively (highest value in August 2020, 26.4 % and the lowest in March 2021, 5.4 %). Conclusion: The results show the behavior of hospitalized patients with COVID-19 during a year of the pandemic in our population. It is reasonable that the decline in mortality rate is the result of changes in the age of patients, the disease severity, and provision of care during the pandemic. © 2021 Academia Nacional de Medicina. All rights reserved.

COVID-CANCER HUIL - Registry of oncological patients with diagnosis of COVID-19 at Hospital Universitario Infanta Leonor in Madrid (Spain): One year of pandemic

Background: During the first year of the SARS-CoV-2 pandemic the management and treatment of COVID-19 have been improved. However, cancer patients continue to be one of the most affected. We evaluate the mortality rate due to COVID-19 and associated risk factors in the cancer population diagnosed in our center during the first year of pandemic. Methods: We retrospectively reviewed the medical records of 189 cancer patients who were diagnosed with COVID-19 between March 5, 2020 and February 28, 2021. Mortality rate nd associated risk factors were studied. Results: Mortality rate: 55/189 patients. Mean age: 72 years (34-95), 125/189 male patients. Predominant histologies: lung cancer (72/189), colorectal (31/189), breast (24/189). Predominant staging: metastatic disease (113/189). Predominant cancer treatment: chemotherapy (63/189);118/189 patients were receiving any type of oncological treatment with palliative intention. Mortality was associated with male gender (45/55 vs 10/55, p=0.004), presence of comorbidities (48/55 vs 7/55, p=0.01), lung cancer (28/72 deaths with this tumor vs 27/117 with the rest, p=0.02), palliative intention cancer treatment (41/55 vs 12/55, p=0.02), older median age (76 vs 71, p = 0.02), higher median CRP (p=115.6 mg/dl vs 46 mg/dl), lower median lymphocytes (600/mm3 vs 1000/mm3 p<0.001). No specific treatment against COVID-19 significantly decreased mortality. Neither IL-6 nor ferritin were prognostic biomarkers. In multivariate analysis, male gender (OR 2.58, 95% CI 1.1-5.9, p = 0.02), lung cancer (OR 2.0, CI 1.0-3.8, p = 0.03), cancer treatment with palliative intention (OR 2.4, CI 1.07-5.3, p = 0.03), higher median CRP (OR 1.0, CI 1.00-1.01, p <0.001), as well as low lymphocyte median (OR 0.5, CI 0.25-1.0, p = 0.56), continued to be evidenced as risk factors, regardless of comorbidities, staging, sex, and palliative intention cancer-specific treatment, among other variables. Conclusions: Men with lung cancer under cancer-specific treatment with palliative intention who present, at the diagnosis of SARS-CoV-2 infection with elevated CRP above 115 mg/dl and a decrease in lymphocytes below 600/mm3 have a higher risk of presenting fatal complications. Legal entity responsible for the study: Medical Oncology department, Hospital Universitario Infanta Leonor. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

First wave mortality data versus full pandemic period from the COVID-CANCER HUIL study

Background: Cancer patients are one of the most affected by the current pandemic caused by SARS-CoV-2. Social inequalities influence the incidence rate of this disease, as we have seen in the high incidence in our center. In our study, we asked whether the last covid-19 treatment advances, the capacity for restructuring the health centers and their non-saturation, influences the cancer patients outcomes. Methods: Retrospective review of 189 cancer patients diagnosed in our center with COVID-19 from March 5, 2020 to February 28, 2021. Study data was collected and managed using REDCap. We compared COVID-19 diagnoses in first-wave cancer patients versus the full pandemic period until data cut-off, as well as patient characteristics and mortality rates. Results: Mortality rate: 55/189 patients during the entire pandemic period vs 40/85 patients in the first wave (p = 0.03). Median age: 72 years (34-95) vs 76 (34-94), 125/189 men in all the period vs 50/85 (p = 0.2). Most frequent histologies: lung cancer (72/189 vs 22/85, p = 0.07), colorectal (31/189 vs 19/85, p = 0.23), breast (24/189 vs 10/85, p = 0.82). Staging: 113/189 metastatic disease at diagnosis of infection vs 32/85 in first wave (p <0.001). During the 2 subsequent waves in our center, where 104 more patients have been detected, mortality has dropped significantly: from the initial 47% to 14.4% in the rest of the period (40/85 vs 15/104, p <0.001), despite having more metastatic involvement in infected patients. Conclusions: In our center, one of the worst hit by the coronavirus crisis in Spain, with a supersaturation of almost 250% in the middle of the first wave, we have verified how the knowledge of the behavior of this disease, improvements in its treatment and a multidisciplinary management in Oncology ward have led to a significant decrease in mortality, going from almost 50% in the first wave to less than 15%, despite having suffered the disease during the two subsequent waves a greater number of patients with metastatic disease. Legal entity responsible for the study: Medical Oncology Department, Hospital Universitario Infanta Leonor. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Modeling the viral load expelled in saliva droplets carrying SARS-CoV-2

One of the most likely routes of transmission of COVID-19 is through the saliva droplets that are produced while speaking, coughing or sneezing by infected people. The expelled droplets, measuring between 0.4 and 450 μm, follow trajectories determined, mainly, by the gravitational, and air frictional forces. We solve numerically the equations of motion in which the linear and quadratic velocity terms in the drag force are considered. In order to model the virus load expelled during respiratory events, we assume log-log Gaussian distributions, with peaks around 10 μm, and analyze four size ranges: the aerosol (0.4–5 μm), the small (5.1–10 μm), the middle (10.1–100 μm), and big (100.1–450 μm) droplet size regimes. In the aerosol regime, the frictional forces quickly stop the droplets in their horizontal movement and they fall extremely slowly pulled down by the gravitational force. The residence time, in a calm environment, goes from 3.83 days to 33.3 min. More massive droplets take shorter times and hit the ground meters away from the source. By assuming a constant density of virions per milliliter, we estimate the expelled amount into the environment. The middle and small size droplets contain the highest amount but since the aerosol droplets remain in the air such a long time, they represent also a high risk for infection. We emphasize the importance of face protection to minimize COVID-19, transmission.

Adopting A New Hybrid Force Model: A Survey During Covid-19 In Indian Higher Education

This quantitative study proposes and validates the Hybrid force model by analysing the challenges and opportunities in online education during COVID-19 through an online survey from students and teachers of Indian higher education institutions. The proposed model considers the learner as a system of study and talks about the amalgamation of knowledge, human force (teacher) and technological force for better online learning opportunities and experience. The results show Google Meet, Zoom and Microsoft Team as the main online platforms for imparting the classes while almost 80% of the students prefer a non-traditional teaching method (online and hybrid). The results highlight that more than 88% of the students prefer to have a personal teaching assistant in their learning trajectory. © 2021, International Journal of Emerging Technologies in Learning. All Rights Reserved.

Clinical characteristics of patients hospitalized with COVID-19 according to glycemia levels: Case series

Hyperglycemia, with or without diabetes, is associated with complications in hospitalized patients with COVID-19. There is no information regarding this problem in our region. This study was aimed to compare the characteristics and in-hospital clinical course of patients with a probable diagnosis of COVID-19, with and without hyperglycemia during the hospitalization. This is a retrospective, observational study of clinical records review of hospitalized patients with COVID-19. The ISARIC-WHO form was used for data collection. Hyperglycemia was defined as a fasting value >= 140 mg/dL according to standard glycaemia targets in hospitalized patients. A total of 148 patients were included, 97 (65.5%) men and 51 (34.5%) women, with a mean age of 64.1 +/- 16.1 years;of which 42/148 (28.4%) patients reported previous diabetes, 60/148 (40.5%) patients had hyperglycemia during the hospitalization and 32/60 (53.3%) of these cases did not report previous diabetes. The patients with hyperglycemia were older, received more frequently systemic corticosteroids (96.6 vs 82.6%;p=0.01), and antibiotics (68.3 vs 44.3%;p=0.01), had worse baseline oxygenation parameters (SpO(2) 88.1 +/- 1,1.7%;vs 92.8 +/- 5.5%;p=0.02, PaO2/FiO(2), 194.4 +/- 119.7 vs 270.9 +/- 118.3;p<0.001), higher total lung severity score in the chest CT (14.9 +/- 5.7 vs 11.1 +/- 6.3;p<0.001) and higher levels of baseline inflammatory markers (CRP 6.73 +/- 3.61 vs 5.08 +/- 4.21;p<0.01, LDH 342.9 +/- 118.4 vs 296.5 +/- 161.4;p=0.01 and Ferritin 687.7 +/- 373.2 vs 542.6 +/- 395.3;p=0.01). Mortality (34.5 vs 10.7%;p<0.001) and admission to ICU (43.3 vs 7.9%;p<0.001) were higher in patients with hyperglycemia. Hyperglycemia in hospitalized patients with COVID-19 is a marker of severe disease and poor prognosis.

A multicenter analysis of the outcome of cancer patients with neutropenia and COVID-19 infection optionally treated with granulocyte colony-stimulating factor (G-CSF)

Background: Infection by SARS-CoV-2 can turn into an acute respiratory infection. Approximately 15% of patients will develop a distress syndrome responsible in most cases of mortality. A host hyperinflammatory response induced by a cytokine storm, is the main cause of this severe complication. Chemotherapy myelosuppression is associated with higher risk of infections and mortality in cancer patients. There have been no previous reports about the clinical management of patients with neutropenia and concomitant COVID- 19. Herein, we present a multicenter experience in several hospitals during COVID-19 outbreak in neutropenic cancer patients infected by SARSCov- 2. Methods: Retrospective clinical data were collected from clinical reports. Protocol was approved by a Clinical Research Ethics Committee (HULP: PI-4194). Inclusion criteria were cancer patients with neutropenia (<1500 cells/mm3) and concomitant COVID-19 infection. Comorbidities, tumor type and stage, treatment, neutropenia severity, filgrastim (G-CSF), COVID-19 parameters and mortality were analyzed. Exploratory analysis included a description of all data collected and bivariate analyses among different pairs of variables, including their impact in mortality in this cohort. In addition, multivariable logistic regression was used to predict respiratory failure and death as a function of multiple variables. Results: Among 943 patients with cancer screened in 14 hospitals in Spain, eighty-three patients (8%) had a febrile neutropenia and COVID-19 infection. Lung (26%), breast (22%), colorectal (13%) and digestive noncolorectal (17%) cancers were the main locations and most patients had advanced disease (67%). Fifty-three (63%) of patients included died because respiratory failure. Neumonia was presented in 76% of patients, bilateral in 47% and 12% of all patients had thrombotic events. The median of neutrophils was 650cls/mm3 and 49% received GCSF with a median of days on treatment around 4,5 days. Among all variables related with mortality in neutropenic cancer patients with COVID-19 infection, we found that the number of days with GCSF showed a significant trend toward worse outcome and higher mortality. In particular, a logistic regression model was developed to predict respiratory failure, as a function of the number of days of G-CSF treatment. As adjusting covariates, sex, age, treatment purpose (palliative vs curative, to adjust for patient status), tumor type, and the lowest level of neutrophils in the patient (to adjust for neutropenic status) were used. A significant effect was obtained for the days of G-CSF treatment (OR = 1.4, 95% CI [1.03, 1.92], p-value = 0.01). Conclusions: Our findings suggest that a prolonged G-CSF treatment could be disadvantageous for these cancer patients with COVID-19, with a higher probability of worse outcome.

Psychological responses to the COVID-19 pandemic quarantine in Colombian population

Introduction: The aim of this study was to analyze the perceived stress, coping strategies, emotional regulation, impact of the event, and psychological distress during quarantine due to COVID-19 pandemic in the Colombian population. Method: Non-probabilistic sample made up of 356 adults who answered an online questionnaire. Results: It was found medium and high scores in active coping strategies and emotional regulation, and low scores in stress, psychological distress and impact of quarantine. The 38.76 % presented scores that indicate risk of post-traumatic stress disorder. Women, people under 35 years of age, high school graduates, students, and living alone during the quarantine showed higher affectation. Statistically significant correlations of stress with all variables except with social support and cohabitants during quarantine were found. Finally, it was found a positive association of stress with venting, expressive suppression, the impact of quarantine, and psychological distress, and negative association with planning, acceptance, cognitive reappraisal, and age over 25 years. Conclusions: These results contribute to understanding responses to quarantine and to identify vulnerability factors to design prevention and intervention programs. © 2022 Fundación Universitaria Konrad Lorenz.

CHANGES IN CLINICAL CHARACTERISTICS AND OUTCOMES OF PATIENTS HOSPITALIZED WITH COVID-19 DURING TWO YEARS OF THE PANDEMIC: EXPERIENCE IN A VENEZUELAN HOSPITAL

Objectives. To determine changes in the clinical characteristics and in-hospital outcomes of patients hospitalized for COVID-19 in a private hospital in Caracas during two years of the pandemic. Materials and Methods. Retrospective, observational study of patients hospitalized for COVID-19. We evaluated the correspondence between waves of hospital admissions and circulating variants of SARS-CoV-2 in the general population of the Capital District and Miranda state. Results. A total of 1025 patients (569 men and 456 women) were included, with a mean age of 62.9 SD: 16.2 years. Four waves of hospital admissions were identified: first (March-No-vember 2020) 150/1025 (14.6%) cases;second (December 2020 to May 2021) 415/1025 (40.5%) cases;third (June-December 2021) 344/1025 (33.6%) cases;fourth (January-February 2022) 116/1025 (11.3%) cases. The mean age was higher in the fourth wave (first: 64.0±15.7, second: 61.4±15.8, third: 62.1±16.5, and fourth wave: 68.5±16.4), while the proportion of male patients (first: 66.7%, se-cond: 58.8%, third: 50.3%, and fourth wave: 44.8%), patients with severe-critical illness (first: 65.3%, second: 57%, third: 51.7%, and fourth wave: 44.8%), in-hospital stay (first: 9.1±6.0, second: 9.0±7.3, third: 8.8±7.7, and fourth wave: 6.9±5.0 days), ICU admissions (first: 23.3%, second: 15.7%, third: 14.0%, and fourth wave: 11.2%;p=0.027) and mortality (first: 21. 8%, second: 10.7%, third: 9.1%, and fourth wave: 7.1%;p<0.001) progressively decreased over time. Conclusions. The results show lower frequency of severe cases and improvement of in-hospital outcomes in two years of the pandemic. Changes in circulating variants, improvements in disease management and vaccination are likely to have influenced these results. © 2022, Instituto Nacional de Salud. All rights reserved.