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The dynamics of SARS-CoV-2 transmission are influenced by a variety of factors, including social restrictions and the emergence of distinct variants. In this study, we delve into the origins and dissemination of the Alpha, Delta, and Omicron variants of concern in Galicia, northwest Spain. For this, we leveraged genomic data collected by the EPICOVIGAL Consortium and from the GISAID database, along with mobility information from other Spanish regions and foreign countries. Our analysis indicates that initial introductions during the Alpha phase were predominantly from other Spanish regions and France. However, as the pandemic progressed, introductions from Portugal and the USA became increasingly significant. Notably, Galicia's major coastal cities emerged as critical hubs for viral transmission, highlighting their role in sustaining and spreading the virus. This research emphasizes the critical role of regional connectivity in the spread of SARS-CoV-2 and offers essential insights for enhancing public health strategies and surveillance measures.
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To date, the impact of COVID-19 vaccination on formerly menstruating women remains unknown. For this reason, a retrospective observational cross-sectional study was conducted (N= 548) using an online survey. General characteristics, medical history, and adverse events following COVID-19 vaccination were recorded. In comparison with the first dose, significantly higher percentages of respondents experienced menstrual-related disturbances (dose 1: 38.5% vs. dose 2: 44.8%; McNemar=9.15; mid P-value=0.002), as well as the simultaneous occurrence of two or more of these symptoms (dose 1: 11.2% vs. dose 2: 15.3%; McNemar=13.53; mid P-value=0.044) after receiving the second one. Among them, those related with the length and flow stand out, being of long-term nature in about 17-20% of cases. Interindividual factors influencing this unexpected event after receiving the dose 1 may include weight (AOR 1.02, CI 95% 1.01–1.03, P<.001), perimenopause (AOR 2.28, CI 95% 1.37–3.77, P=.001), pre-existing diagnoses of non-autoimmune rheumatic/articular conditions (AOR 0.31, CI 95% 0.10–1.00, P=0.05), hormonal contraceptive use (AOR 0.25, CI 95% 0.07-0.82, P=0.02), suffering from other vaccine side effects − such as arm pain (AOR 0.61, CI 95% 0.39–0.95, P=0.03), headache (AOR 0.53, CI 95% 0.35 – 0.80, P=.003), swollen glands (AOR 0.29, CI 95% 0.15 – 0.60, P=.001) and nauseas (AOR 0.35, CI 95% 0.14 – 0.86, P=0.02) – and the number of previous pregnancies (AOR 2.70, CI 95% 1.54 – 4.76, P=.001). Formerly menstruating women may experience long-term menstrual-related disturbances following COVID-19 vaccination.
Subject(s)
Pain , Headache , Nausea , COVID-19 , Menstruation DisturbancesABSTRACT
After three years of the onset of the pandemic, there is scarce evidence about how COVID-19 disease affect the female reproductive system, and consequently, the menstrual cycle. Since the common causes of secondary amenorrhea are considered as exclusion criteria in the studies about menstrual changes following SARS-CoV-2 infection, the prevalence of this event and the influencing factors in formerly menstruating women remains unknown. A retrospective observational cross-sectional study was conducted on Spanish adult women (N= 17,512), using an online survey; a subpopulation of SARS-CoV-2-infected-formerly menstruating women was included in the present analysis (n= 72). Collected data included general characteristics, medical history, and specific information about COVID-19 disease. 38.9% of the respondents experienced menstrual-related disturbances after suffering from the COVID-19 disease, unexpected vaginal bleeding being the most common (20.8%). Other alterations related with the length – “shorter” by 12.5% − and the flow − “heavier than usual” 30.3% − of the menstrual bleeding were reported. The binary logistic regression showed that being a perimenopausal woman (AOR 4.608, CI 95%, 1.018 – 20.856, p = 0.047) and having heavy menstrual bleeding (AOR 4.857, CI 95%, 1.239 – 19.031, p=0.023) are influential factors. This evidence could help health professionals to provide scientifically up-to-date information to their patients, empowering them to actively manage their reproductive health, especially in those societies where menstrual health is still a taboo.
Subject(s)
Hemorrhage , Amenorrhea , Severe Acute Respiratory Syndrome , Uterine Hemorrhage , COVID-19 , Menstruation DisturbancesABSTRACT
Introduction The state of alarm was declared in Spain due to the COVID-19 epidemic on March 14, 2020, and established population confinement measures. The objective is to describe the process of lifting these mitigation measures. Methods The Plan for the Transition to a New Normality, approved on April 28, contained four sequential phases with progressive increase in socio-economic activities and population mobility. In parallel, a new strategy for early diagnosis, surveillance and control was implemented. A bilateral decision mechanism was established between the Spanish Government and the autonomous communities (AC), guided by a set of qualitative and quantitative indicators capturing the epidemiological situation and core capacities. The territorial units were established ad-hoc and could be from Basic Health Zones to entire AC. Results The process run from May 4 to June 21, 2020. AC implemented plans for reinforcement of core capacities. Incidence decreased from a median (50% of territories) of 7.4 per 100,000 in 7 days at the beginning to 2.5 at the end. Median PCR testing increased from 53% to 89% of suspected cases and PCR total capacity from 4.5 to 9.8 per 1000 inhabitants weekly;positivity rate decreased from 3.5% to 1.8%. Median proportion of cases with traced contacts increased from 82% to 100%. Conclusion Systematic data collection, analysis, and interterritorial dialogue allowed adequate process control. The epidemiological situation improved but, mostly, the process entailed a great reinforcement of core response capacities nation-wide, under common criteria. Maintaining and further reinforcing capacities remained crucial for responding to future waves.
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In January 2022, there was a global and rapid surge of the Omicron variant of SARS-CoV-2 related to more transmission. This coincided with an increase in the incidence in Asturias, a region where rapid diagnosis and containment measures had limited the circulation of variants. METHODS: From January to June 2022, 34,591 variants were determined by the SNP method. From them, 445 were characterized by the WGS method and classified following pangolin program and phylogenic analysis. RESULTS: The Omicron variant went from being detected in 2438 (78%) samples in the first week of January 2021 to 4074 (98%) in the third week, according to the SNP method. Using the WGS method, 159 BA.1 (35.7%), 256 BA.2 (57.6%), 1 BA.4 (0.2%) and 10 BA.5 (2.2%) Omicron variants were found. Phylogenetic analysis detected that three new sub-clades, BA.2,3.5, BA.2.56 and BF1, were circulating. CONCLUSIONS: The increase in the incidence of SARS-CoV2 caused the circulation of new emerging variants. Viral evolution calls for continuous genomic surveillance.
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Introduction: During the early phase of the coronavirus disease 2019 (COVID-19), remdesivir was only approved for hospitalized patients. Our institution developed hospital-based, outpatient infusion centers for selected hospitalized patients with COVID-19 who had clinical improvement to allow for early dismissal. The outcomes of patients who transitioned to complete remdesivir in the outpatient setting were examined. Methods: Retrospective study of all hospitalized adult patients with COVID-19 who received at least one dose of remdesivir from 11/6/2020 to 11/5/2021 at one of the Mayo Clinic hospitals. Results: Among 3,029 hospitalized patients who received treatment with remdesivir for COVID-19, the majority (89.5%) completed the recommended the five-day course. Among them, 2,169 (80%) completed treatment during hospitalization, while 542 (20.0%) patients were dismissed to complete remdesivir in outpatient infusion centers. Patients who completed the treatment in the outpatient setting had lower odds of death within 28 days (aOR 0.14, 95% CI 0.06-0.32, p<0.001). However, their rate of subsequent hospital encounters within 30 days was higher (aHR 1.88, 95% CI 1.27-2.79, p=0.002). Among patients treated with remdesivir only in the inpatient setting, the adjusted odds of death within 28 days were significantly higher among those who did not complete the 5-day course of remdesivir (aOR 2.07, 95% CI 1.45-2.95, p<0.001). Conclusions: This study describes the clinical outcomes of a strategy of transitioning remdesivir therapy from inpatient to outpatient among selected patients. Mortality was lower among patients who completed the 5-day course of remdesivir.
Subject(s)
COVID-19 , DeathABSTRACT
Background. We aimed to develop objective criteria for cognitive dysfunction associated with the post-COVID syndrome. Methods. Four hundred and four patients with post-COVID syndrome from two centers were evaluated with comprehensive neuropsychological batteries. The International Classification for Cognitive Disorders in Epilepsy (IC-CoDE) framework was adapted and implemented. A complementary data-driven approach based on unsupervised machine-learning clustering algorithms was also used to evaluate the optimal classification and cutoff points. Results. According to the developed criteria, 41.2% and 17.3% of the sample were classified as having at least one cognitive domain impaired using -1 and -1.5 standard deviations as cutoff points. Attention/processing speed was the most frequently impaired domain. There were no differences in base rates of cognitive impairment between the two centers. Clustering analysis revealed two clusters according to the severity of cognitive impairment, but there was no difference in cognitive profiles. Cognitive impairment was associated with younger age and lower education levels, but not hospitalization. Conclusions. We propose a harmonization of the criteria to define and classify cognitive impairment in the post-COVID syndrome. These criteria may be extrapolated to other neuropsychological batteries and settings, contributing to the diagnosis of cognitive deficits after COVID-19 and facilitating multicenter studies to guide biomarker investigation and therapies.
Subject(s)
COVID-19 , Cognition DisordersABSTRACT
The impact of COVID-19 pandemic on mental health of adolescents are emerging and require particular attention in settings where challenges like armed conflict, poverty and internal displacement have previously affected their mental wellbeing. This study aimed to determine the prevalence of mental health problems and symptoms of anxiety and depression, probable post-traumatic stress disorder, and resilience capacity in adolescents in a post-armed conflict area in Colombia during the COVID-19 pandemic. A cross-sectional study was conducted with 657 school attending adolescents aged 12 to 18 years old. Mental health information was obtained through screening scales for anxiety (GAD-7), depression (PHQ-8), probable post-traumatic stress disorder (PCL-5) and resilience capacity (CD-RISC-25). The prevalence observed for moderate to severe depression symptoms was 30.0% (CI95%=26.5–33.7) and for moderate to severe anxiety symptoms was 18.9% (CI95%=16.0-22.1). A prevalence of probable post-traumatic stress disorder (PTSD) of 22.3% (CI95%=18.1–27.2) was found. The CD-RISC-25 results for resilience had a median score of 54 [IQR:30]. Our results are in line with emerging evidence that suggests multiple domains of adolescents’ mental wellbeing were negatively impacted by the pandemic, and agree with other studies of regions affected by the armed conflict that show an increase in the prevalence of mental health disorders in young populations. In contrast, our data show lower resilience than other studies of adolescents. These findings call for multidisciplinary actions necessary to respond effectively to the impact of the pandemic on the mental health of adolescents, as well as to guarantee a successful educational recovery, being schools key places in which prompt intervention might reduce the burden of mental distress in adolescents.
Subject(s)
Anxiety Disorders , Depressive Disorder , Lymphedema , Stress Disorders, Post-Traumatic , COVID-19 , Stress Disorders, TraumaticABSTRACT
Objectives MEMOGAL study (NCT04319081) is aimed at evaluating changes in cognitive function in patients treated with PCSK9 inhibitors (PCSK9i). This is the first analysis: (1) discussion about the role of the Hospital Pharmacists during the pandemic, and also the assessment of the impact of COVID-19 in the lipid control;(2) descriptive analysis;(3) effectiveness in LDL cholesterol (LDL-c) reduction of alirocumab and evolocumab;(4) communicate PCSK9i safety. Material and methods It is a prospective Real-World Evidence analysis of patients that take PCSK9i for the first time in the usual clinical practice, and they are included after the first dispensation in the public pharmacy consultations of 12 Hospitals in Galicia from May 2020 to April 2021. Baseline values of LDL-c are the previous values before taking PCSK9 and the follow-up values are in 6 months time. Results 89 patients were included. 86.5% with cardiovascular disease and 53.9% with statin intolerances. 78.8% of the patients were treated with high intensity statins. Statins most used were rosuvastatin (34.1%) and atorvastatin (20.5%). Baseline value of LDL-c was 148 mg/dL and the follow-up value was 71 mg/dL. The baseline value of patients treated with alirocumab (N = 43) was 144 mg/dL and 73 mg/dL in the follow-up. With evolocumab (N = 46) was 151 mg/dL in basaline and 69 mg/dL in follow-up. The LDLc- reduction was 51.21% with evolocumab and 51.05% with alirocumab. 43.1% of the patients showed values >70 mg/dL in six month time;19.4% between 69 mg/dl and 55 mg/dL and 37.5% <55 mg/dL. 58.3% of the patients achieved a reduction >50% of LDL-c. The adverse events were: injection point reaction (N = 2), myalgias (N = 1), flu-like symptoms (N = 1) and neurocognitive worsening (N = 1). Conclusions (1) Despite the number of prescriptions was reduced because of the pandemic, the lipid control was not affected. (2) Half of the patients treated with PSCK9i is due to statins intolerance and the 86% is for secondary prevention. (2) The reduction results were similar to pivotal clinical trials. Despite this, 39% of the total of the patients and 60% of patients with dual teraphy did not reach the goal of ESC/EAS guidelines (< 55 mg/dL and/or reduction > 50%). There were not significant differences between evolocumab and alirocumab: 51.21% vs 51.05% (P = .972). (3) There were not any adverse events of special interest. The possible neurocognitive worsening will be studied as the primary endpoint once the MEMOGAL study has been completed.
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Objectives MEMOGAL study (NCT04319081) is aimed at evaluating changes in cognitive function in patients treated with PCSK9 inhibitors (PCSK9i). This is the first analysis: (1) discussion about the role of the Hospital Pharmacists during the pandemic, and also the assessment of the impact of COVID-19 in the lipid control;(2) descriptive analysis;(3) effectiveness in LDL cholesterol (LDL-c) reduction of alirocumab and evolocumab;(4) communicate PCSK9i safety. Material and methods It is a prospective Real-World Evidence analysis of patients that take PCSK9i for the first time in the usual clinical practice, and they are included after the first dispensation in the public pharmacy consultations of 12 Hospitals in Galicia from May 2020 to April 2021. Baseline values of LDL-c are the previous values before taking PCSK9 and the follow-up values are in 6 months time. Results 89 patients were included. 86.5% with cardiovascular disease and 53.9% with statin intolerances. 78.8% of the patients were treated with high intensity statins. Statins most used were rosuvastatin (34.1%) and atorvastatin (20.5%). Baseline value of LDL-c was 148 mg/dL and the follow-up value was 71 mg/dL. The baseline value of patients treated with alirocumab (N = 43) was 144 mg/dL and 73 mg/dL in the follow-up. With evolocumab (N = 46) was 151 mg/dL in basaline and 69 mg/dL in follow-up. The LDLc- reduction was 51.21% with evolocumab and 51.05% with alirocumab. 43.1% of the patients showed values >70 mg/dL in six month time;19.4% between 69 mg/dl and 55 mg/dL and 37.5% <55 mg/dL. 58.3% of the patients achieved a reduction >50% of LDL-c. The adverse events were: injection point reaction (N = 2), myalgias (N = 1), flu-like symptoms (N = 1) and neurocognitive worsening (N = 1). Conclusions (1) Despite the number of prescriptions was reduced because of the pandemic, the lipid control was not affected. (2) Half of the patients treated with PSCK9i is due to statins intolerance and the 86% is for secondary prevention. (2) The reduction results were similar to pivotal clinical trials. Despite this, 39% of the total of the patients and 60% of patients with dual teraphy did not reach the goal of ESC/EAS guidelines (< 55 mg/dL and/or reduction > 50%). There were not significant differences between evolocumab and alirocumab: 51.21% vs 51.05% (P = .972). (3) There were not any adverse events of special interest. The possible neurocognitive worsening will be studied as the primary endpoint once the MEMOGAL study has been completed. Resumen Objetivos El estudio MEMOGAL (NCT04319081) está dirigido a evaluar cambios en la función cognitiva en pacientes tratados con inhibidores de la PCSK9 (iPCSK9). Se realiza primer análisis: 1) discutir el papel de los farmacéuticos hospitalarios durante de la pandemia, así como evaluar el impacto de la misma en el control lipídico;2) análisis descriptivo;3) eficacia en reducción de colesterol-LDL (c-LDL) de alirocumab y v;y 4) reportar seguridad de los iPCSK9. Material y métodos Se trata de un análisis prospectivo en vida real de pacientes tratados por primera vez con iPCSK9 en la práctica clínica habitual e incluidos en su primera dispensación en las consultas de farmacia de 12 hospitales de Galicia desde mayo de 2020-abril de 2021. Los valores basales de c-LDL son los previos al inicio del tratamiento con iPCSK9 y como seguimiento los valores a los 6 meses. Resultados Se incluyeron 89 pacientes. El 86,5% con enfermedad cardiovascular y un 53,9% intolerancia a las estatinas. Un 78,8% de los pacientes fueron tratados con estatinas de alta intensidad. Las estatinas más usadas fueron rosuvastatina (34,1%) y atorvastatina (20,5%). El nivel basal de c-LDL fue 148 mg/dl y de 71 mg/dl al seguimiento. Los pacientes tratados con alirocumab (n = 43) presentaban valores basales de 144 mg/dl y de 73 mg/dl al seguimiento y con evolocumab (n = 46) de 151 mg/dl basal y 69 mg/dl al seguimiento. La reducción de c-LDL fue para evolocumab 51,21% y alirocumab 51,05%. El 43,1% presentaba a los 6 meses valores > 70 mg/dl, el 19,4% entre 55 y 69 mg/dl y el 37,5% < 55 mg/dl. Los pacientes que obtuvieron una reducción > 50% de c-LDL fueron el 58,3%. Los eventos adversos presentados fueron: reacción en el lugar de inyección (n = 2), mialgias (n = 1), síntomas pseudogripales (n = 1) y deterioro neurocognitivo (n = 1). Conclusiones 1) A pesar de haber disminuido el número de prescripciones de iPCSK9 durante la pandemia, el control lipídico de estos pacientes no se ha visto afectado;2) la mitad de los pacientes tratados con iPSCK9 se debe a intolerancia a estatinas y el 86% es en prevención secundaria;3) se presentaron valores de reducción similares a los ensayos clínicos pivotales. A pesar de esto, un 39% del total y un 60% en doble terapia no alcanzaron las recomendaciones de las guías ESC/EAS (< 55 mg/dl y/o reducción > 50%). No hubo diferencias significativas entre evolocumab y alirocumab: 51,21% vs. 51,05% (p = 0,972);y 4) no se observaron eventos de especial interés con el uso de estos fármacos. El posible deterioro cognitivo será analizado como variable principal una vez completado el estudio MEMOGAL.
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Background and aims To face the rapid spread of SARS-CoV2 coronavirus pandemic, home lockdown in Spain was decreed on 15th March 2020. The main objective of this study is to evaluate the impact of this constraint on glycemic control in children and adolescents with type 1 diabetes mellitus (T1D). Patients and methods Observational, retrospective study in children and adolescents with T1D users of interstitial glucose monitoring systems. The following information corresponding to the last 2 weeks of lockdown was collected for subsequent comparison with data of 2 weeks prior to quarantine: daily insulin needs, mean interstitial glucose, estimated HbA1c, coefficient of variation (CV), time in range (70-180 mg/dl), hypoglycemia (<70 and <54 mg/dl) and hyperglycemia (>180 and> 250 mg/dl), sensor use and number of blood glucose measurements. Data about meal routines, physical exercise, need for adjustments in therapy, acute complications and lockdown of caregivers were assessed via a survey. Results 80 patients were studied (mean age 12.61 ± 3.32 years, mean time of evolution of the disease 5.85 ± 3.92 years), 66.2% treated with an insulin pump, users of following glucose monitoring systems: Guardian 3 (65%), FreeStyle Libre (18.8%) and Dexcom G6 (16.2%). Time in range in the cohort increased significantly during confinement (72.1 ± 10.5 vs 74.8 ± 10.5%;p = 0.011) with lower time in hypoglycemia both <70 mg/dl (4.6 ± 3.2 vs 3.2 ± 2.7%;p < 0.001) and <54 mg/dl (1.2 ± 1.6 vs 0.7 ± 1.2%;p < 0,001) and hyperglycemia >250 mg/dl (4.6 ± 3.9 vs 3.7 ± 3.7%;p = 0.038). CV also decreased (35.8 ± 6.3 vs 33.1 ± 6.1%;p < 0.001). Patients treated with multiple doses of insulin and poorer baseline glycemic control experienced greatest improvement. Daily insulin requirements remained stable. Regular practice of physical exercise and caregivers’ confinement did not have a significant impact. Conclusions Glycemic control in children and adolescents with T1D improved during quarantine, particularly in those with worse baseline control.
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Introducción: el SARS-CoV-2 es un virus ARN de cadena simple que compromete diferentes órganos, incluyendo la piel. Los pacientes que cursan con este virus pueden presentar diferentes manifestaciones mucocutáneas. Objetivo: determinar la prevalencia de las lesiones mucocutáneas en pac ientes hospitalizados por infección SARS-CoV-2/COVID 19 en el Hospital San Vicente Fundación Rionegro entre abril y junio del 2021. Materiales y métodos: estudio descriptivo transversal en pacientes hospitalizados con diagnóstico de infección por COVID-19 confirmado por pruebas serológicas y con lesiones mucocutáneas. Resultados: de 600 pacientes hospitalizados por COVID-19, 16 presentaron lesiones mucocutáneas para una prevalencia del 2,6%, y entre estos, 13 requirieron manejo en unidad de cuidados intensivos por síndrome de dificultad respiratoria aguda severa o enfermedad severa (81,25%) asociado a marcadores de mal pronóstico elevados. Los más elevados fueron la PCR, LDH o la presencia de linfopenia. Las lesiones vasculares fueron las más frecuentes (42,9%), que se manifestaron como púrpuras, vasculitis, livedo racemosa, perniosis y pseudoperniosis. Las erupciones o exantemas fueron de tipo maculopapulares (28,6%), eritematosas (19%) y urti cariales (9,5%);además de úlceras en cavidad oral (8,8%) y vesículas (2,9%). El 75% de estos pacientes presentaron lesiones cutáneas en la fase activa de la enfermedad y el 25% en la fase resolutiva. Las morbilidades más frecuentes fueron hipertensión arterial (30%) y diabetes (20%). Seis pacientes fallecieron (37,5%). Conclusiones: las manifestaciones mucocutáneas asociadas al COVID-19, especialmente las de tipo vascular como las púrpuras, vasculitis y livedo racemosa, se asocian a formas graves de la enfermedad, especialmente en pacientes con ventilación mecánica asistida con un alto índice de mortalidad.Alternate :Introduction: SARS-CoV-2 is a single-stranded RNA virus that affects different organs, including the skin. Patients with this virus can present different mucocutaneous manifestations. Objective: to determine the prevalence of skin lesions in patients hospitalized for SARS-CoV-2 / COVID 19 infection at the Hospital San Vicente Fundación Rionegro between April and June 2021. Materials and methods: descriptive cross-sectional study in hospitalized patients with a diagnosis of infection by COVID-19 confirmed by serological tests and with mucocutaneous lesions. Results: of 600 patients hospitalized for COVID-19, 16 presented mucocutaneous lesions for a prevalence of 2,6 %, and among these, 13 required management in the intensive care unit due to severe acute respiratory distress syndrome or severe illness (81,25%) associated with elevated markers of poor prognosis. The most increased were PCR, LDH and/or lymphopenia. Vascular lesions were the most frequent (42,9%), manifested as purples, vasculitis, livedo racemosa, perniosis and pseudoperniosis. The eruptions or rashes were maculopapular (28.6%), erythematous (19%) and urticarial (9,5%), and ulcers in the oral cavity (8,8%) and vesicles (2,9%). 75% of these patients had skin lesions in the active phase of the disease and 25% in the resolution phase. The most frequent morbidity was arterial hypertension (30%) and diabetes (20%). six patients (37,5%) died. Conclusions: the mucocutaneous manifestations associated with COVID-19, especially those of a vascular type such as purples, vasculitis and livedo racemosa, are associated with severe forms of the disease, especially in patients with assisted mechanical ventilation with a high mortality rate.
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Background: While evaluating COVID-19 vaccine responses using a rapid neutralizing antibody (NAb) test, we observed that 25% of RNA vaccine recipients did not neutralize >50%. We termed this group “vaccine poor responders” (VPRs). The objective of this study was to determine if individuals who neutralized <50% would remain VPRs, or if a third dose would elicit high levels of NAbs. Methods: 269 healthy individuals ranging in age from 19 to 80 (Average age = 51; 165 females and 104 males) who received either BNT162b2 (Pfizer) or mRNA1273 (Moderna) vaccines were evaluated. NAb levels were measured: i) 2-4 weeks after a second vaccine dose, ii) 2-4 months after the second dose, iii) within 1-2 weeks prior to a third dose and iv) 2-4 weeks after a third RNA vaccine dose. Results: Analysis of vaccine recipients revealed that 25% did not neutralize above 50% (Median neutralization = 21%, titers <1:80) within a month after their second dose. Twenty-three of these VPRs obtained a third dose of either BNT162b2 or mRNA-1273 vaccine 1-8 months (average = 5 months) after their second dose. Within a month after their third dose, VPRs showed an average 20-fold increase in NAb levels (range: 46%-99%). Conclusions: The results suggest that VPRs are not permanently poor responders; they can generate high NAb levels with an additional vaccine dose. Although it is not known what levels of NAbs protect from infection or disease, those in high-risk professions may wish to keep peripheral NAb levels high, limiting infection, and potential transmission.
Subject(s)
COVID-19ABSTRACT
Introduction The COVID-19 pandemic has had a great impact on people's mental health. Patients with eating disorders (ED) are also highly sensitive to the pandemic situation due to their physical and mental health. The objective of this study is to evaluate the impact that the COVID-19 pandemic may have had on the reasons for the urgent care of patients with an eating disorder, comparing the reasons for care with those from a previous period. Method We compared the visits to the emergency room and their characteristics before and after the pandemic of patients with an eating disorder in the province of Lleida. Information regarding sociodemographic status, reason for consultation, diagnosis, characteristics of suicidal behaviour, and other data were obtained from the electronic medical records. Results Within the total emergency attendances, eating disorders increased from 1.7% in the pre-pandemic period to 3.1% during the pandemic (p = 0.030). Regarding the reason for consultation, a change in the pattern is observed, decreasing consultations for anxious decompensation (p < 0.001) and increasing suicidal behaviour (p = 0.016) and behavioural disorder (p = 0.022). Conclusions In our study we ascertained an increase in urgent care given to patients with an eating disorder during the two states of alarm, while consultations for anxiety symptoms decreased notably. However, care for suicidal behaviour increased, especially in women with comorbidity of personality disorders and who were unemployed.
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New trends in higher education, accentuated by the global COVID19 pandemic, visualize the need for more flexible virtual courses. The Faculty of Accounting and Finance of the University of Havana, analyzes new technological configurations that facilitate the personalization of the educational process. In this context, this work aims to design an adaptive hypermedia system prototype applied to the Management Accounting 1 course at the University of Havana to guarantee the delivery, distribution, and variety of learning content to students in a personalized way. An empirical research supported by an experimental method is presented, with a sample of 94 students, a Control Group made up of 41 students and an Experimental Group made up of 53 students; Descriptive statistics and the Pareto principle support the results. It is concluded that, 1. The personalization of the educational process through the application of adaptive techniques leads to academic success at an individual and group level, in this sense, the Experimental group only needed a final exam session compared to the three calls of the group of control; 2. Need to continue investigating new adaptation criteria, in this sense, the mean scores obtained by the Experimental group did not have a significant increase in relation to that of the Control group. This work also contributes to visualizing educational equity referring to the capacity of the educational system to offer special supports that guarantee that educational objectives are achieved in a broader dimension; innovation is related to technologies and new strategies to optimize online educational processes.
Subject(s)
COVID-19ABSTRACT
SARS-CoV-2 infection produces a response of the innate immune system causing oxidative stress and a strong inflammatory reaction termed ‘cytokine storm’ that is one of the leading causes of death. Paraoxonase-1 (PON1) protects against oxidative stress by hydrolyzing lipoperoxides. Alterations in PON1 activity have been associated with pro-inflammatory mediators such as the chemokine (C-C motif) ligand 2 (CCL2) and the glycoprotein galectin-3. We aimed to investigate the alterations in the circulating levels of PON1, CCL2 and galectin-3 in 126 patients with COVID-19 and their interactions with clinical variables and analytical parameters. A machine learning approach was used to identify predictive markers of the disease. For comparisons, we recruited 45 COVID-19 negative patients and 50 healthy individuals. Our approach identified a synergy between oxidative stress, inflammation and fibrogenesis in positive patients that is not observed in negative patients. PON1 activity was the parameter with the greatest power to discriminate between patients who were either positive or negative for COVID-19, while their levels of CCL2 and galectin-3 were similar. We suggest that the measurement of serum PON1 activity may be a useful marker for the diagnosis of COVID-19.
Subject(s)
COVID-19ABSTRACT
INTRODUCTION: Patients with cancer may be at increased risk of more severe COVID-19 disease; however, prognostic factors are not yet clearly identified. The GRAVID study aimed to describe clinical characteristics, outcomes, and predictors of poor outcome in patients with lung cancer and COVID-19. METHODS: Prospective observational study that included medical records of patients with lung cancer and PCR-confirmed COVID-19 diagnosis across 65 Spanish hospitals. The primary endpoint was all-cause mortality; secondary endpoints were hospitalization and admission to intensive care units (ICU). RESULTS: A total of 447 patients with a mean age of 67.1 ± 9.8 years were analysed. The majority were men (74.3 %) and current/former smokers (85.7 %). NSCLC was the most frequent type of cancer (84.5 %), mainly as adenocarcinoma (51.0 %), and stage III metastatic or unresectable disease (79.2 %). Nearly 60 % of patients were receiving anticancer treatment, mostly first-line chemotherapy. Overall, 350 (78.3 %) patients were hospitalized for a mean of 13.4 ± 11.4 days, 9 (2.0 %) were admitted to ICU and 146 (32.7 %) died. Advanced disease and the use of corticosteroids to treat COVID-19 during hospitalization were predictors of mortality. Hospitalized, non-end-of-life stage patients with lymphocytopenia and high LDH had an increased risk of death. Severity of COVID-19 correlated to higher mortality, ICU admission, and mechanical ventilation rates. CONCLUSIONS: Mortality rate was higher among patients treated with corticosteroids during hospitalization, while anticancer therapy was not associated with an increased risk of hospitalization or death. Tailored approaches are warranted to ensure effective cancer management while minimizing the risk of exposure to SARS-CoV-2.