The Effect Of Covid-19 Infection On Sirolimus Metabolism In Heart Transplant

Introduction: Limited knowledge exists regarding the effect of Covid-19 on heart transplant recipients. Monitoring immunosuppressant levels is an important management strategy concerning the risk of graft rejection. Furthermore, how Covid-19 and its treatment affect sirolimus metabolism in solid organ transplants is not well understood. Here, we present a case of a heart transplant recipient with elevated sirolimus levels following Covid-19 infection. The elevated sirolimus levels occurred after previously being therapeutic on a steady dose and persisted despite significant dose reductions and no other known drug-drug interactions. Case Presentation: The patient is a 58-year-old male with a history of ischemic cardiomyopathy;status post orthotopic heart transplantation on 8/17/2009. The postoperative course was complicated by atrial tachycardia without rejection status post-ablation in 8/2020 and end-stage renal disease on hemodialysis. In January of 2022, the patient was instructed to present to the ER after missing dialysis due to Covid-like symptoms including generalized weakness, nausea, and shortness of breath. Covid-19 PCR returned positive. Before infection, the patient had been maintained on a steady dose of sirolimus 0.5 mg daily for 5 months with associated trough levels between the goal range of 4-8 ng/mL. At the time of infection, the patient's sirolimus was held due to elevated trough levels, and he was subsequently maintained on a dose of 0.5 mg every other day for the next few days. Seeing no improvement, the dose was then decreased to 0.25 mg every other day for the remainder of his admission. He expired on 2/09/2022 from Covid-19. Figure 1 shows the sirolimus trough:dose ratio before and after diagnosis of Covid-19. Discussion(s): To our knowledge, this is the first case presented of a heart transplant recipient with altered sirolimus metabolism status post Covid-19 infection without apparent drug-drug interactions. This may suggest a relationship between SARS-COV-2 viremia with sirolimus metabolism.Copyright © 2022

Teaching Microextraction Techniques During COVID-19 Pandemic through Remote Lab Strategy

Since the appearance of the COVID-19 pandemic and its subsequent stage, the changes produced in the chemistry teaching process have allowed educators to use a wide range of strategies, methodologies, and tools to promote student learning. To carry out laboratory practices, some strategies reported include the use of simulators and educational software, as well as the development of remote lab activities. In recent years, the teaching of microextraction techniques and the greening of the sample treatment process represent an important topic in instrumental analytical chemistry courses, incorporating green chemistry topics in the curricula. In this context, a hands-on activity through a kit of materials, equipment, and reagents delivered to students for teaching microextraction techniques during the pandemic's learning conditions is presented. The activity was designed to extract a food coloring dye applying four microextraction techniques, including solid-phase extraction (SPE), solid-phase microextraction (SPME), in-tube solid-phase microextraction (IT-SPME), and micro polymeric magnetized bar adsorptive extraction (μ-PMBAE). Finally, for quantitative analysis, a colorimetry and absorbance-based experiment through image acquisitions and RGB analysis was used. The experiments were applied as extracurricular activities, and students' feedback was fruitful due to the enthusiasm that it produced in them to carry out laboratory tasks after so much time of confinement. Among the successful points of the activity, it is possible to mention the ease of carrying out the experiments from home and the application of green sample treatment techniques that minimize the use of materials and reagents. © 2023 American Chemical Society and Division of Chemical Education, Inc.

Management of COVID-19 very Elderly Patients in Nursing Homes and Long-Term Care Facilities: Description of a New Model and Experience in a Medicalized Nursing Home

Introduction: COVID-19 has been a challenge for healthcare, mainly in elderly patients in Nursing Homes (NHs) and Long-Term Care Facilities (LTCFs). We present a pioneering novel experience in addressing healthcare of elderly patients with COVID-19 in these facilities by a re-conversion of a NH in a medicalized NH. Method(s): All patients admitted to the center were included, recording clinical and epidemiological variables. We conducted a descriptive analysis and a multivariate analysis to identify variables linked to mortality and persistence of positive PCR test. Result(s): 84 patients were included (40% men), women presented more symptomatology. We found a positive correlation between the duration of symptoms and the days required to obtain a negative PCR test (r=0.512, P<0.001). We also found an independent and significant association between as-thenia (OR=2.58;IC95% 1.22-5.46) and mutism (OR=5.21;IC95% 1.58-17.15) and a longer time to achieve a negative PCR test. All patients, except contraindication, were treated with hydrox-ychloroquine and azithromycin, which was the recommended treatment during the period of the study. The early start of corticoid treatment (within the first 72 hours since the start of symptoms) was linked to a lower mortality in patients with moderate-severe symptoms. Mortality was lower than expected (which was higher than 20% in that period and group of age), reaching 14%, the main factors linked to mortality were the presence of mutism (OR=19;IC95% 3.4-108;P=0.001) and dyspnea (OR=12;IC95% 1.3-111;P=0.029). Conclusion(s): An alternative system was presented for the care of these patients through the recon-version of a basic NH in a medicalized one, which showed a significant reduction in the expected mortality.Copyright © 2021 Bentham Science Publishers.

Propofol and COVID-19 infusion syndrome. Case report

The severe form of SARS-CoV-2 pneumonia (COVID-19) occurs in most cases with acute respiratory distress syndrome (ARDS), requiring the use of sedation during mechanical ventilation, with propofol being the most widely used for its pharmacokinetics and pharmacodynamics. Propofol is a widely used anesthetic in intensive care units (ICU). Its use can cause an infrequent but extremely serious adverse effect, known as propofol infusion syndrome (PRIS), which is closely associated with the speed of infusion coupled with risk factors specific to the patient, the clinical features of PRIS are hemodynamic instability, lactic acidosis and with progression to multi-organ dysfunction. We present a case of SIP in a patient with acute respiratory distress syndrome (ARDS) secondary to SARS-CoV-2 who develops this complication associated with sedation, discusses clinical pathophysiology and considerations that should be taken into account when using it in continuous infusion. © 2023, Colegio Mexicano de Anestesiologia A.C.. All rights reserved.

Factors impacting HPV vaccine initiation among English and Spanish speaking parents of Latino adolescents

Background: Human Papillomavirus (HPV)-associated cancers disproportionately impact Latinos. While data for English-speaking (ES) and Spanish-speaking (SS) Latinos is usually aggregated, differences in acculturation, sociodemographic characteristics, and health behaviors make it important to understand the factors impacting HPV vaccination among these groups separately. This understanding is crucial to improving HPV vaccination disparities as COVID-19 vaccinations have exacerbated issues of vaccine hesitancy and medical mistrust. Method(s): Self-administered online surveys examining HPV vaccine hesitancy in an urban, diverse community with low HPV vaccine uptake were completed by parents of adolescents (N=357) in English or Spanish. Bivariate logistic regression analyses were conducted to understand if medical mistrust, vaccine hesitancy, HPV knowledge, healthcare utilization and sociodemographic factors impact adolescent HPV vaccine uptake among ES and SS parents of Latino adolescents ages 12-17. Factors significant at p<.01 in the bivariate analyses were included in multivariable logistic regression models for each group. Result(s): 136 parents of adolescents aged 12-17 identified as Latino;56% completed the survey in English and 44% in Spanish. Bivariate analyses found significant associations between decreased HPV vaccine uptake and male parent/caregiver sex, higher HPV vaccine hesitancy, higher HPV knowledge, male adolescent sex, not receiving the flu vaccine and not receiving a provider recommendation to vaccinate against HPV among ES parents. In SS parents, parents aged 41-50 (compared to <40) and higher medical mistrust were associated with higher HPV vaccination;while male adolescent gender, not receiving TDAP immunization, and not receiving a provider recommendation to vaccinate against HPV were associated with lower HPV vaccine uptake. Multivariable regression models found that adolescents of ES parents were less likely to have initiated the HPV vaccine series if the parent/caregiver was male (OR=0.07, 95% CI:0.03,1.28), had higher HPV knowledge (OR=0.53, 95% CI:0.29,0.96), and did not receive a provider recommendation to vaccinate against HPV (OR=0.12, 95% CI:0.003,0.55). SS parents with higher medical mistrust (OR=7.27, 95% CI:1.14,46.41) and those aged 41-50 compared to parents younger than 40 (OR=18.19, 95% CI:0.28,407.78) were more likely to have adolescents who initiated the HPV vaccine series, while those without a provider recommendation to vaccinate had lower odds of HPV vaccine uptake (OR=0.004, 95% CI:<0.01,0.11). Discussion(s): Aligned with the literature, provider recommendation to vaccinate against HPV significantly impacted vaccination behavior among ES and SS parents. Interventions should focus on improving provider recommendations and communications with Latino parents of adolescents. More research should explore the surprising associations between higher medical mistrust and higher odds of HPV vaccination among SS parents, and more HPV knowledge and lower odds of HPV vaccination among ES parents.

Propofol and COVID-19 infusion syndrome. Case report

The severe form of SARS-CoV-2 pneumonia (COVID-19) occurs in most cases with acute respiratory distress syndrome (ARDS), requiring the use of sedation during mechanical ventilation, with propofol being the most widely used for its pharmacokinetics and pharmacodynamics. Propofol is a widely used anesthetic in intensive care units (ICU). Its use can cause an infrequent but extremely serious adverse effect, known as propofol infusion syndrome (PRIS), which is closely associated with the speed of infusion coupled with risk factors specific to the patient, the clinical features of PRIS are hemodynamic instability, lactic acidosis and with progression to multi-organ dysfunction. We present a case of SIP in a patient with acute respiratory distress syndrome (ARDS) secondary to SARS-CoV-2 who develops this complication associated with sedation, discusses clinical pathophysiology and considerations that should be taken into account when using it in continuous infusion. Copyright © 2023, Colegio Mexicano de Anestesiologia A.C.. All rights reserved.

An Observational Study on the Humoral and Cellular Immune Response to SARS-CoV-2 mRNA Vaccination in Multiple Sclerosis and Other Autoimmune Neurological Disorders Treated With Anti-CD20 Therapies

Objective To assess adaptive immunity to SARS-CoV-2 in anti-CD20 treated individuals with mRNA vaccination. Background Anti-CD20 therapies attenuate humoral responses to vaccines. However, their effect on T cell responses is less clear. We examined B and T cell responses following COVID-19 vaccination in patients receiving anti-CD20 therapy for multiple sclerosis (MS) and other autoimmune inflammatory neurologic diseases (AINDs, e.g., autoimmune encephalitis, stiff person syndrome, etc.). Design/Methods MS and AIND patients on anti-CD20 therapies were prospectively enrolled for longitudinal analysis of antibody and T cell responses after a 3rd COVID-19 vaccination. Serum antibodies against the receptorbinding domain of the S1 spike protein (RBD-S1 IgG), neutralizing antibodies, and SARS-CoV-2 CD8 T cell responses, using activationinduced markers (AIM) and INF-gamma release assays (EUROIMMUN, Germany), were measured at various time points including prevaccination, post initial vaccination series, and 4 and 12 weeks after 3rd dose. Results Thirty-four MS and AIND participants are enrolled. Results for these patients (mean age 52 years-old, 79% female, 21 Pfizer, 13 Moderna) demonstrated attenuated RBD IgG antibody responses. However, a robust CD8 T cell response was observed, following a two-dose series, compared to non-immunosuppressed, age-matched vaccinated controls or unvaccinated with severe SARS-CoV-2 infection (p = 0.01). T cell response was sustained long-term (>12 weeks post 3rd dose) in all 11 anti-CD20 patients analyzed thus far. Collections are completed for all participants at 12 weeks and analysis to be completed by 05/15/22. Further analysis includes correlation of the INF- gamma release assay compared to RBD-CD8 T cell response detected by AIM assay. Conclusions Results suggest that patients treated with anti-CD20 therapy generate a robust CD8 T cell response to SARS-CoV-2 mRNA after three doses but remain with attenuated humoral immune responses. Our observational study will provide important data to guide vaccine management in patients on or anticipating anti-CD20 therapy.

Medical training in orotracheal intubation with acrylic box in pediatric SARS-CoV-2 patients decreases exposure time

Introduction: in the SARS-CoV-2 pandemic, the modification of the intubation technique using the aerosol box, in order to reduce exposure to aerosols generates anxiety in Health Workers (HCWs), by increasing the degree of difficulty and time of endotracheal intubation (IT). Simulated intubation environments allow to measured IT and also increase intubation ability and decrease IT. Objective(s): to measure IT pre (without box without training-SS-, with box without training-CS-, with box with training-CC-) and post educational maneuver. Material(s) and Method(s): retrospective, comparative, before and after;with physicians trained in a simulated environment. Result(s): n = 82, age 29 years (27 to 31 years), clinicians 69.5%, residents 82.9%. IT: SS 35 s (27-47.25 s), CS 39.5 s (28-56.5 s) and CC 22 seconds (17.5-30 s), p = 0.0001. Higher IT of clinical vs surgical physicians SS 39 s (30-52 s) versus 32 s (24-34 s), p = 0.004;CS 42 s (33-59 s) versus 28 s (21-43 s), p = 0.016;CC 25 s (20-35 s) versus 19 s (16-21 s) p = 0.018. Higher TI novice vs experienced SS 68 s (39-135 s) versus 34 s (27-46 s), p = 0.058;CS 144 s (84-210 s) versus 38 (28-54 s), p = 0.001, CC 46 s (30-55 s) versus 22 s (17-30 s), p = 0.030. Using the device without training increased IT, but post-training IT decreased in all groups-16 s (-26 to-7 s), which was more noticeable among novices-98 s (-163 to-45.5 s) and the clinical group-18.5 s (-32 to-7 s). Conclusion(s): the use of devices with training can be efficient in terms of IT, regardless the degree of experience and type of medical specialty. Copyright © 2022, Instituto Nacional de Enfermedades Respiratorias. All rights reserved.

Characterization of the dietary profile of the old adults in Ibero-american during of pandemic by COVID 19

Objective: To characterize the food profile of the Older People of Ibero-America in times of the COVID 19 pandemic. Material and methods: Multicenter study in 12 Ibero-American countries, an online survey was applied that included sociodemographic questions and a Food Intake questionnaire that included the frequency of consumption for vegetables, sugary drinks, legumes, dairy products and portion of food. Results: The sample was made up of 624 participants, 72.1% (n= 450) of women. 54.7% of women do not consume sugary drinks, while in men 54% consume at least one glass a day (p=0.012). 35.6% of men consumed >= 3 legumes per week versus 23% of women (p=0.020). 37.3% of women consume >= 2 daily servings of dairy products, in men only 28.1% (p= 0.030). Women have a higher consumption of vegetables (44.7%, n= 201) compared to men (28.7%), (p=0.001). 17.4% of the total sample increased the size of the food portion, being higher in women (p=0.005). Conclusion: Women have healthier eating habits than men based on fruits, vegetables, on the other hand, the variation in size increases, especially in women.

Dietary Patterns and Dietary Recommendations Achievement From Latin American College Students During the COVID-19 Pandemic Lockdown

This study aimed to compare the diet quality of different dietary patterns among college students from Latin American countries, including vegetarians, vegans, and omnivores during the COVID-19 pandemic. A cross-sectional, observational, multicenter study was conducted including a non- probabilistic sample of university students from 10 countries. University students were invited to participate in the study through social network platforms. Participants were self-reported to have followed a specific dietary pattern;either the Prudent diet, Western diet, Ovo-dairy-vegetarian diet, Fish-vegetarian diet, Strict vegetarian diet (vegan) or other. The last three patterns (vegetarians and vegans) were grouped as following a plant-based diet. A self-assessment survey was used to evaluate healthy eating habits using a questionnaire with values between 1 (do not consume) and 5 (consume) for a total of 9–45 points (higher values represent better eating habits). Unhealthy habits were assessed with nine questions. A total of 4,809 students filled out the questionnaire, and the majority of them were females (73.7%). A high percentage have been in lockdown for more than 5 months and were in lockdown when the survey was released. 74.3% were self-reported to follow a prudent diet, while 11.4% reported following a western dietary pattern and 8.8% a plant-based diet. When compliance with healthy and unhealthy dietary habits was analyzed, although all groups had low compliance, the plant-based diet group (56.09 ± 6.11) performed better than the Western diet group (48.03 ± 5.99). The total diet quality score was significantly higher for plant-based diet followers, who also tended to better achieve the recommendations than omnivorous students, especially the ones following a western diet. These results present evidence that young adults such as college-aged students have unhealthy dietary habits. However, the ones who follow a plant-based diet such as vegetarians and vegans exhibit better scores and healthier dietary conducts. Copyright © 2022 Murillo, Gómez, Durán-Agüero, Parra-Soto, Araneda, Morales, Ríos-Castillo, Carpio-Arias, Cavagnari, Nava-González, Bejarano-Roncancio, Núñez-Martínez, Cordón-Arrivillaga, Meza-Miranda, Mauricio-Alza and Landaeta-Díaz.

Perceptions and experiences of an older adult during and after the diagnosis of COVID-19

Introduction: The COVID-19 pandemic has brought unprecedented challenges and a disproportionate threat to older adults, having an impact on their biopsychosocial and spiritual sphere. Objective: To explore the perceptions and experiences of an older adult during and after diagnosis of COVID-19. Methods: Single case study, with Merleau-Ponty's phenomenological approach. An in-depth interview was applied, which began with a generative question and five open-ended questions to deepen the phenomenon of perceptions and experiences of suffering from COVID-19. Colaizzi's phenomenological analysis technique was used for data analysis and interpretation. Results: The informant was an older adult of 66 years of age, who has been living with type 2 diabetes for 22 years, which made him vulnerable to the contagion of COVID-19. From the life experience, 4 categories and 8 subcategories were identified, where the impact of COVID-19 on corporeality, subjective expressiveness of the body in the face of the disease, the body in the interaction with others, awareness of support from a superior being and humanized attention in the lived world were addressed. Conclusion: The disease caused psychological, physical, social and spiritual changes since the appearance of signs and symptoms. Among them the feeling of fear, sadness, loneliness, deterioration of social and family function due to social isolation. Among the coping mechanisms of the disease is the family and God. © 2022, Editorial Ciencias Medicas. All rights reserved.

An Observational Study on the Humoral and Cellular Immune Response to SARS-CoV-2 mRNA Vaccination in Multiple Sclerosis and Other Autoimmune Neurological Disorders treated with Anti-CD20 Therapies

Objective: To assess adaptive immunity to SARS-CoV-2 in anti-CD20 treated individuals with mRNA vaccination as it relates to spike binding IgG, neutralizing antibody titers, and T cell response. Background: Anti-CD20 therapies attenuate humoral responses to vaccines. Their effect on T cell responses is unclear. We examined B and T cell responses with COVID-19 vaccination in patients receiving anti-CD20 therapy for multiple sclerosis (MS) and other autoimmune inflammatory neurologic diseases (AINDs). Design/Methods: Patients on anti-CD20 therapies were prospectively enrolled for longitudinal analysis of antibody and T cell responses before and after COVID-19 vaccination. Serum antibodies against the receptor-binding domain of the S1 spike protein (RBD-S1 IgG), neutralizing antibodies, and SARS-CoV-2 CD4 and CD8 T cell levels responses using activation-induced markers and INF-gamma release assay were measured at various time points including pre-vaccination, less than 12 weeks and greater than 12 weeks post initial vaccination series, and 4 and 12 weeks after 3rd “booster” vaccination. Results: Twenty-five MS and AIND participants are enrolled as of 10/11/21 with projected enrollment complete by December 2021 (50-60 total). Preliminary results for 17 of these patients (mean age 44 years-old, 83% female, 16 Pfizer, 1 Moderna) demonstrated attenuated RBD IgG antibody responses. However, CD8 T cell response is robust compared to non-immunosuppressed, age-matched controls (n=22) less than 12 weeks after two dose series (p value = 0.0069) and sustained long-term (>12 weeks) in all eight anti-CD20 patients tested thus far. Additional analysis will include comparison between pre and post 3rd vaccination at 4- and 12-week timepoints. Conclusions: Early results suggest that patients treated with anti-CD20 therapy generate a robust CD8 T cell response to SARS-CoV-2 mRNA post initial series of vaccination but remain with attenuated humoral immune responses. Our observational study will provide important data to guide vaccine management in patients on or anticipating anti-CD20 therapy.

LOSS of TOLERANCE and ANERGY in HUMAN PERIPHERAL B CELLS during SARS-CoV-2 INFECTION

Background: Severe infection with SARS-CoV-2 induces systemic autoreactive antibodies with specificity to Type I IFN, phospholipids, nuclear or tissue specific targets. The wide breadth of targets suggests a system-wide defect in B cell tolerance during viral infection and that the source of autoreactive antibodies is likely a heterogenous subset of B cells. BND cells are mature naïve B cells that do not express IgM but do express IgD and are enriched in autoreactive specificities. BND cells are held in an anergic state in healthy humans as a mechanism of peripheral tolerance, although in vitro evidence suggests anergy can be broken with strong inflammation. We hypothesized that robust inflammation associated with viral infection from SARS-CoV2 may relax peripheral tolerance and promote breakage of BND cell anergy. Methods: Plasma and PBMCs were collected from healthy controls (N=10), subjects immunized with Pfizer BNT162b2-mRNA/Moderna mRNA-1273 (N=10), subjects with mild (N=11) or severe SARS-CoV-2 infection (N=14). BND cells were examined ex vivo for markers of activation by flow cytometry. Phosphorylation of signaling proteins downstream of the BCR were measured in vitro with or without BCR crosslinking. Inflammatory cytokines were measured in plasma by multiplex. For statistical analysis, unpaired t test between populations or paired t test between unstimulated and BCR stimulated conditions were performed. Results: BND cells from severe SARS-CoV-2 infection have lower expression of CD21, associated with loss of anergy, higher expression of activation markers CD68 and CD86 with lower expression of inhibitory receptors CD22 and CD72 when compared to BND cells from other subjects, suggesting a phenotypical breach of anergy. Upon BCR crosslinking, BND cells have higher levels of downstream signaling components of the BCR (pPLCγ2, pBlnk, and pSyk) when compared to healthy controls and immunized subjects, suggesting a functional breach in anergy with infection. Examination of plasma from severe SARS-CoV-2 infection showed higher levels of inflammatory cytokines (IFNγ, TNFα, IL-6 and CRP) where TNFα and CRP correlated with enhanced BCR signaling in BND cells. Conclusion: We demonstrate that SARS-CoV-2 viral infection relaxes peripheral tolerance of BND cells, likely through strong systemic inflammation produced during infection. These autoreactive cells overcome anergy and become activated with increased BCR signaling. Thus BND cells could be a source of autoreactive antibodies during viral infection.

Sugar-sweetened beverage consumption during the covid-19 pandemic in twelve ibero-american countries: A cross-sectional study

Objective: To evaluate the consumption of sugar-sweetened beverages (SSB) during confinement due to the Covid-19 pandemic and its relationship with sociodemographic and dietary factors. Material and Methods: Multicenter study. Citizens residing in 12 countries were invited to participate (Argentina, Chile, Colombia, Costa Rica, Ecuador, Spain, Guatemala, Mexico, Peru, Paraguay, Panama, and Uruguay) to whom an online survey on food consumption and sociodemographic indicators was applied. Results: 10,573 questionnaires were analyzed. Regarding the consumption of sugar-sweetened beverages, 78.0% of women had low consumption versus 69.2% of men. Frequency of SSB consumption was similar according to age group. For education, 13.4% of people with a university-level education reported excessive consumption versus 23.1% of people with a primary or basic education level (p<0.001). The frequency of SSB consumption was similar by urban versus rural residence. According to self-report, 19.0% of weight gain was due to excessive consumption of SSB compared to 10.4% of those who lost weight (p<0.001). Similar figures were found in self-reported portion size change, 19.3% who increased their portion consumed SSB in excess versus 10.0% who decreased portion size. Finally, in a re-gression model: being a man, being between 40 and 59 years old, primary academic level, weight gain, and presenting changes in diet, increased the probability of having a high level of SSB consumption. Conclusion: The consumption of SSB, in general, is low but excessively relevant in some groups of the study variables, in addition, there is a relationship between the consumption of SSB and the variables studied.

Effect COVID-19 pandemic in an emergency department in Argentina

The objective of this study was to reveal how the COVID-19 pandemic process affected the number of visits to an emergency department of a highly complex hospital located in the Ciudad Autonoma de Buenos Aires, to explore the characteristics and reasons for consultation. The monthly number of visits between January 2019 and December 2020 was analyzed. The data showed a strong decrease in the number of visits (176 370 in 2019 and 95 421 in 2020), with an abrupt drop after the lockdown disposal (In aprilshowed the maximum reduction: 77.1%), and the different stages are reflected in the evolution (a consequence of quarantine), yielding a global annual reduction of 45.9%. The number of patients admitted by ambulances increased (5.1% in 2019 to 10.4% in 2020;p < 0.05), and consequently, the number of patients in the more complex sector (area B 2019: 5.3%, 2020: 11.5%;p < 0.01), as well as unscheduled hospitalizations from 6.8% (95% CI 6.7-6.9) to 12.1% in 2020 (95%CI11.8-12.3), p < 0.01. The five most frequent reasons for consultation in 2020 were: fever (5.1%), odynophagia (4.7%), abdominal pain (2.6%), cough (1.8%) and headache (1.8%), probably all related to COVID-19. In conclusion, the number of emergency department visits decreased by half compared to the previous year.

[Coinfections by SARS-CoV-2 and other respiratory viruses and their clinical outcome]

Background: SARS-CoV-2 is a coronavirus described for the first time in China, in December 2019. This virus can cause a disease with a very variable spectrum that ranges from asymptomatic cases to deaths. The most severe cases are normally associated with comorbidities and with the age of the patient. However, there are patients who are not part of these risk groups and develop severe cases. Objetive: To determine the association between coinfections by SARS-CoV-2 and other respiratory viruses and their clincal outcome. Material and methods: RT-qPCR was performed to determine the presence of 16 respiratory viruses in 103 confirmed COVID-19 cases. Demographic and comorbid data were collected, and statistical analyzes were performed to determine associations with severity. Results: Of the 103 analyzed cases, 14 (13.6%) presented a coinfection, of these, 92% did not require hospitalization, even in those cases in which the patient presented advanced age and some comorbidities. Conclusions: These results suggest that coinfection of SARS-CoV-2 and other respiratory viruses is not related to a more severe form of COVID-19 and, in some cases, depending on the virus involved, it could even lead to a better prognosis. These findings lay the foundations for the development of new studies that could determine the biological mechanism of this phenomenon.

THE BLACK SWAN OF COVID-19 AND THE FIGURE OF THE CONTROLLER IN BUSINESS MANAGEMENT

The COVID-19 significantly transforms universal life, particularly in the business environment, forcing systematic transformations to face uncertainties and the competitive environment. Objective: The aim of this study was to identify the profile of the Controller in business management. Methods: A descriptive, retrospective, observational and cross-sectional perceptual research was carried out. The documentary review technique was used, and the Category Matrix was designed as a data collection instrument. Results: It was evidenced that COVID-19 causes the labor market to go through a difficult moment, characterized by uncertainty and deep business transformations, in which the Controller is the most relevant figure. It was found that the Controller's tasks include the analysis and interpretation of financial statements;analytical breakdowns of information;budget design;systematic reporting to management;coordination of internal audits;with a leading role in strategy and the Balanced Scorecard. A profile for this position was evidenced characterized by: male between 30 and 50 years old, mainly within the industrial sector, who dedicates most of his time to the organization's operations, data extraction and analysis, with analytical and visionary capacity, together with general knowledge of the organization. Conclusions: It was concluded that the Controller with his proactivity links his protagonism as a strategist with business operational management, being a key professional in management control, fundamentally in periods of crisis such as the one caused by the COVID-19 black swan.

RELATION OF THE COVID-19 COUNTRY RISK INDEX TO THE ACTUAL IMPACT OF THE PANDEMIC

COVID-19 spread rapidly and put all nations at risk. The objective of the study was to demonstrate whether there is a relationship between INFORM's COVID-19 Risk Index by country and the actual impact of the pandemic. It was a relational, analytical, observational, cross-sectional, and retrospective study, developed in 184 countries. Spearman's correlation coefficient was used to test the hypothesis related to the proposed objective. The highest risk was concentrated in Africa and the countries with more deaths per million inhabitants were European. It was concluded that there is a correlation between the INFORM COVID-19 Risk Index by country and COVID-19 deaths per million inhabitants, with a negative value (-0.540).