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Background and Importance On March 28th 2022, nirmatrelvir/ ritonavir was marketed in Spain. The Spanish Agency for Medicines and Medical Devices (AEMPS) established criteria to prioritise its administration in patients at high risk of progression to severe COVID. Data regarding the effectiveness and safety of nirmatrelvir in preventing severe coronavirus disease outcomes are limited. Aim and Objectives To assess the effectiveness and safety of nirmatrelvir/ritonavir in patients at high risk for severe COVID-19. Material and Methods Prospective descriptive study from April to August 2022 of patients treated with nirmatrelvir/ritonavir. Sociodemographic variables, vaccination status, hospital admission, high risk factors for progression and concomitant treatment were recorded. Readmissions were recorded within 30 days of the end of antiviral treatment. Results 53 patients were included with a mean age of 64 years, 51% women and 49% men. 57% were vaccinated with 3 doses, 17% with 2 doses, 9% with 4 doses, 6% with 1 dose and 11% were not vaccinated. 34% (18/53) were hospitalised at the time of initiation of treatment. The most prevalent high-risk criteria were: 24% active treatment with myelotoxic chemotherapy, 21% treatment in the previous 6 months with anti-CD20 drugs, 14% over 80 years vaccinated with some risk factor for progression, 7% patients with onco-haematological treatment and 7% in treatment in the previous 3 months with inhibitors of the proteinkinase. 3 treatments were performed off-label for persistent covid. The mean number of days from the onset of symptoms to the start of treatment was 1.6 days. 23% of patients required dose adjustment due to renal impairment. 53% required adjustment of chronic treatment for interactions, mainly with metamizole, statins, fentanyl and diazepam. 2 patients received remdesivir and sotrovimab, 2 remdesivir and another two sotrovimab. 4 (7%) patients were readmitted within 30 days after the end of treatment with nirmatrelvir ritonavir, 1 of them with persistent covid. One patient stopped treatment for hives. Conclusion and Relevance Nirmatrelvir ritonavir has been shown to be a safe and effective drug in high-risk patients of progression to severe covid.
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The objective of this study was to evaluate emotional intelligence and life satisfaction in 69 Social Education students. The results showed higher scores in the variables of emotional intelligence and life satisfaction in the posttest evaluation when comparing the values of the medians (Mdn pre vs Mdn post), with lower academic performance (Mdnpost=8.00 < Mdnpre=6.90). In relation to gender in the pretest measure, rank differences were obtained only in the factor evaluating one's own emotions, with the effect size Hedges'g equal to.5996. The practical consequences will allow us to reflect on the effects caused by the pandemic in the university context. © GKA Ediciones, authors.
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Education and information dissemination are fundamental to safety and security risk management and mitigation. A web-based examination system called OPCW eQChemSS was developed to assess individuals on their knowledge in chemical safety and security. This can be used as an evaluation tool for chemical safety and security courses, workshops, and seminars. A database of questions was included in this web-based software, which was divided into three categories. Category A is general chemistry level safety, Category B is chemical safety related to organic and inorganic compounds, and Category C is on chemical safety and security and the Chemical Weapons Convention (CWC). The system was designed to automatically check the examination and instantly provide the result of the test in terms of percentage correct answers. A feedback mechanism from the examinees was also included to assess the effectiveness of this e-learning educational material. The importance of e-learning materials in this time of COVID-19 pandemic cannot be more emphasized. The need for readily accessible e-sources that will aid in virtual learning for various topics will be significant even in the coming new normal of hybrid or flexible learning where both online and face-to-face learning may be implemented. © 2022 Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.
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Risk theorists have frequently discussed the discursive construction of risk perception. In particular, the effect of media consumption on increasing the subjective perception of risk has been highlighted. Not much is known about how government communication affects citizens' impressions and attitudes in this area, something that this research seeks to address. During the sixth wave of Covid-19, triggered by the emergence of the Omicron variant, government discourse shifted from initial concern to what has become known as the "influenzaisation” paradigm, an attempt to normalise the disease. Based on the results of a survey carried out in January 2022 amongst 664 citizens of the Community of Madrid, we sought to demonstrate, using binary logistic regression (BLR) models, to what extent the degree to which the citizens of Madrid internalised the government's thesis of "influenzaisation” was related to a lower perception of risk. Similarly, the aim is to show whether agreement with the "influenzaisation” thesis also favoured positions that were less inclined to restrictions, so that government communication succeeded in reducing the social demand for measures. Finally, the study evaluates the predictive character of ideology on levels of risk perception and attitudes towards restrictive mea-sures. The findings indicate that acceptance of the "influenzaisation” story led to a lower perception of risk and, as a con-sequence, reduced support for restrictive measures among those most exposed to this thesis. The discursive articulation of risk in government communication becomes a central element of crisis management and the strategic formulation of "risk de-escalation” or "post-risk” messages. © 2022, El Profesional de la Informacion. All rights reserved.
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BACKGROUND AND OBJECTIVES: Despite the increasing evidence supporting the importance of airborne transmission in SARS-CoV-2 infection, it has not been considered relevant in the vast majority of reported nosocomial outbreaks of COVID-19. The aim of this study is to describe a nosocomial outbreak of SARS-CoV-2 infection whose features suggest that aerosol transmission had an important role. METHODS: This is a descriptive analysis of a nosocomial outbreak of SARS-CoV-2 infection in an internal medicine ward that occurred in December 2020. All cases were confirmed by a positive PCR test for SARS-CoV-2. RESULTS: From December 5 to December 17, 21 patients and 44 healthcare workers (HCWs) developed a nosocomial SARS-CoV-2 infection. Fifty-one of the 65 cases (78.5%) were diagnosed between December 6 and 9. The attack rate in patients was 80.8%. Among HCWs, the attack rate was higher in those who had worked at least one full working day in the ward (56.3%) than in those who had occasionally been in the ward (25.8%; pâ¯=â¯0.005). Three days before the first positive case was detected, two extractor fans were found to be defective, affecting the ventilation of three rooms. Sixteen cases were asymptomatic, 48 cases had non-severe symptoms, and 2 cases required admission to the intensive care unit. All patients eventually recovered. CONCLUSION: The high attack rate, the explosive nature of the outbreak, and the coincidence in time with the breakdown in air extractors in some rooms of the ward suggest that airborne transmission played a key role in the development of the outbreak.
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From the onset, it was clear that the impact of the global economic and social crisis caused by the COVID-19 pandemic was unlikely to affect all children equally. Thus, it was necessary to ascertain the impact of COVID-19 on child poverty as the events unfolded. Many of the indirect effects of the pandemic - disruptions to health services, delayed vaccination programmes, widespread school closures, and increases in food insecurity - have significant impacts on the realisation of children's rights and, consequently, were expected to increase material deprivations across different dimensions. The question was by how much? In this article we explain the modelling and methodological approach to project or nowcast the answer to that question. The method is dynamic as it was revised as additional information emerged during 2020 and 2021. © 2022 - The authors.
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On January 30, 2020, the World Health Organization (WHO) declared SARS-CoV-2 infection an international public health emergency. The autopsy, considered the best method of studying the patient and the disease, corroborates that patients can die from the direct action of the virus (who died from COVID-19), while others positive for SARS-CoV-2 did not show morphological lung changes attributed to the action of the virus. It is proposed to establish the morphological diagnostic criteria in the context of the SARS-CoV-2 and COVID-19 epidemic in the deceased in Cuba based on the systematic study of autopsies. The morphological patterns that are established in the lungs of patients who died under the effect of COVID-19 have been identified. The pulmonary edema of permeability with the widening of the pulmonary septum, the deposit of the disorganized hyaline membrane inside the alveoli, the detachment of epithelial cells (pneumocytes and bronchial and bronchiolar cells), followed by epithelial hyperplasia with sometimes the presence of metaplastic changes and atypia, and finally, fibrosis. When autopsies are performed, it is possible to locate each disease in its place, in chronopathogram, which allows death certificates repair to be carried out to assess the place that COVID-19 has occupied as a cause of death in the population studied. In the opinion of the group, identifying morphological alterations is essential to prepare the chronopathogram of the deceased and the adequate clinical-pathological evaluation of the patient. © 2022, Editorial Ciencias Medicas. All rights reserved.
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Introduction: A case of a patient who died from COVID-19 is presented, which the authors consider to be the prototype of most of those who died from this condition, which was performed at autopsy. Objective: Disseminate the experiences in the study of the autopsy of this type of patients and contribute to its application in clinical and scientific practice. Clinical case: A 78-year-old male patient is presented, with arterial hypertension, diabetes mellitus and obesity, who began with cough, fever, runny nose, who was admitted with a diagnosis of COVID-19, progressed to severity and died 10 days later. of his admittance. The fundamental elements of the clinical history, the diagnoses of causes of death pre-mortem and post-mortem are presented. Autopsy diagnoses and quality assessment results of clinical cause of death diagnoses are specified. Conclusions: The experiences of the study of this autopsy as a prototype, reaffirm the damage caused by SARS-CoV-2 and contribute to the knowledge of this field. © 2022, Editorial Ciencias Medicas. All rights reserved.
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Funding Acknowledgements Type of funding sources: None. Introduction Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, affecting 1-2% of the population, and several types have been described, each one with different prevalence. Partial raphae have also been described and much rarer congenital affectations of aortic valve also exist (unicuspid, quadricuspid), with its own classification. Although echocardiogram is usually enough for diagnosis, sometimes other exams are needed to assess the anatomy of the valve. In these cases, due to lack of radiation, Magnetic Resonance (MRI) can be performed. Methods We reviewed cases from a single general cardiology clinic in which MRI was needed for asses aortic valve anatomy during a period of 9 non-consecutive (due to Covid-19 pandemic) months, Characteristics of the patients, as well as valvular and aortic characteristics, were reported. Results There 8 doubtful cases. 5 men. Mean Age 60 years old (range 21-77, 6 patients 58 or more). 6 cases were non-tricuspid aortic valve: 5 bicuspid, 1 quadricuspid. Except in rare anatomies (bicuspid with 2 cusps type lateral and quadricuspid), with age 21 and 38 respectively (both men), the mean age was 70, ranging from 58 to 77, with 3 cases (50%) women. Except 2 cases, MRI was performed after the first visit, without follow-up time. Taking into account all patients, mean time from first visit to perform MRI was 1,12 years (maximum 6 years in the quadricuspid case). 6 cases had valvular functional anomalies greater than mild (3 women). 5 cases presented aortic dilatation (3 men), 1 man without valvular functional anomalies, 1 woman with tricuspid aortic valve. BAV with 2 cusps type lateral and quadricuspid cases had no aortic dilatation. There were no extracardiac findings in the exams. Figure shows characteristics of patients. Figure 2 shows images from exams (in the superior left and inferior right part of the image are shown BAV with 2 cusps and quadricuspid valve repectively, in diastole and systole). Conclusions Clinicians usually think BAV is a problem of young people, but can be even diagnosed in the eighth decade of life. In these cases, senile changes with valvular degeneration make diagnosis more challenging with doubtful cases. Rare anatomies may be also challenging. MRI seems useful to assess doubtful cases. Although usually performed in the first visit, in some cases it can take years before MRI is performed. In older cases, there may be no sex predominance for BAV. Table: Characteristics of patients Figure. Images from exams
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Purpose: The purpose of this paper is to reflect on how climate change risk reporting might evolve in various world regions in the post COVID-19 pandemic era. Design/methodology/approach: Using a multiple-case study approach and adopting an institutional theory lens, we assess whether the pandemic is likely to strengthen or weaken institutional pressures for climate change risk disclosures and predict how climate-related risk reporting will evolve post-pandemic. Findings: The authors find that climate change risk reporting is likely to evolve differently according to geographical location. The authors predict that disclosure levels will increase in regions with ambitious climate policy and where economic stimulus packages support sustainable economic recovery. Where there has been a weakening of environmental commitments and economic stimulus packages support resource intensive business, climate change risk reporting will stagnate or even decline. The authors discuss the scenarios for climate change risk reporting expected to play out in different parts of the world. Originality/value: The authors contribute to the nascent literature on climate change risk disclosure and identify future directions in the wake of the COVID-19 pandemic. © 2022, Emerald Publishing Limited.
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The home confinement that was imposed to reduce and control the spread of COVID-19 pandemic led educational systems to implement changes in many school activities. Teachers moved to remote teaching and relied on digital apps to present and discuss learning activities with their students. Likewise, they looked for new routes and means to follow up and assess the students' achievement and problem-solving competencies. What is important in structuring an online teaching environment to foster students' learning of mathematics? To address this question, we present and discuss essentials of a conceptual framework to structure online learning environments. It includes three intertwined elements: a problem-solving approach for learners to learn mathematics, the students' use of digital affordances to represent, explore, and solve problems, and an online students' learning support. To this end, the use of a digital wall emerges as a reflective tool for students to organise, structure, and monitor their own learning experiences and problem-solving approaches.
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Background and objectives Despite the increasing evidence supporting the importance of airborne transmission in SARS-CoV-2 infection, it has not been considered relevant in the vast majority of reported nosocomial outbreaks of COVID-19. The aim of this study is to describe a nosocomial outbreak of SARS-CoV-2 infection whose features suggest that aerosol transmission had an important role. Methods This is a descriptive analysis of a nosocomial outbreak of SARS-CoV-2 infection in an internal medicine ward that occurred in December 2020. All cases were confirmed by a positive PCR test for SARS-CoV-2. Results From December 5 to December 17, 21 patients and 44 healthcare workers (HCWs) developed a nosocomial SARS-CoV-2 infection. Fifty-one of the 65 cases (78.5%) were diagnosed between December 6 and 9. The attack rate in patients was 80.8%. Among HCWs, the attack rate was higher in those who had worked at least one full working day in the ward (56.3%) than in those who had occasionally been in the ward (25.8%;p = 0.005). Three days before the first positive case was detected, two extractor fans were found to be defective, affecting the ventilation of three rooms. Sixteen cases were asymptomatic, 48 cases had non-severe symptoms, and 2 cases required admission to the intensive care unit. All patients eventually recovered. Conclusion The high attack rate, the explosive nature of the outbreak, and the coincidence in time with the breakdown in air extractors in some rooms of the ward suggest that airborne transmission played a key role in the development of the outbreak.
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Background: The pandemic propagation of SARS-CoV-2 led to the adoption of a myriad of non-pharmacological interventions (NPIs, e.g., social distancing, mobility restrictions, gathering restrictions) in the Americas. Using national epidemiological data, here we report the impact of the layered adoption of multiple NPIs aimed at curving SARS-CoV-2 transmission in Yucatan State, Mexico. Methods: Data from suspected and laboratory confirmed COVID-19 cases during 2020 were analyzed by age groups and sex, clinical signs, and symptoms as well as outcome. The impact of NPIs was quantified using time-varying reproduction numbers (R t) estimated as a time-series and by sectors of the city. Findings: A total of 69,602 suspected cases were reported, 39.3% were laboratory-confirmed. Men were hospitalized (60.2%), more severely ill (3% vs 1.9%) and more likely to die (62%) than women. Early in the outbreak, all sectors in Merida had R t estimates above unity. Once all NPÍs were in place, R t values were dramatically reduced below one, and in the last interval transmission estimates of R t remained below one in all sectors. Interpretation: In the absence of a COVID-19 vaccination program, the combination and wide adherence of NPÍs led to a low and stable trend in SARS-CoV-2 transmission that did not overwhelm the health sector. Our study reflects that a controlled and planned ease of restrictions to balance health, social and economic recovery resulted in a single wave of transmission that prolonged at low and stable levels. Funding: GVP received funding from Emory University via the MP3 Initiative.
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Background: Children with cancer are at risk of severe COVID-19 infections. Unique from adults, children are susceptible to Multisystem Inflammatory Syndrome in Children (MIS-C). Between 0.01% and 0.06% of children infected with COVID-19 develop MIS-C. However, little is known about MIS-C in children with cancer. Objectives: Among children with cancer and COVID-19, evaluate the rate of MIS-C along with the clinical and sociodemographic characteristics and clinical course of those who develop MIS-C. Design/Method: The Pediatric Oncology COVID-19 Case Report (POCC) collects de-identified clinical and sociodemographic data on children with cancer infected with COVID-19 from >100 US institutions. This analysis examines children with cancer (<21y at COVID-19 infection) who developed MIS-C. The following are described: MIS-C prevalence;clinical characteristics (cancer diagnosis, blood or marrow transplantation [BMT] status, disease status [new diagnosis vs. relapsed/refractory], time from last chemotherapy), and sociodemographic characteristics (age, sex, race/ethnicity, insurance);clinical course of COVID-19 (symptoms, level of support, changes in cancer therapy). Results: Among 1,279 children with cancer and COVID-19, 23 (1.8%) developed MIS-C at a median age of 12 (interquartile range [IQR] 4-17), among whom 12 (52%) were Hispanic and 15 (65%) publicly insured. Nineteen (83%) had hematologic malignancies and 3 (13%) had received a BMT. At the time of infection, children had received chemotherapy a median of 14d (IQR: 4-52) prior, and 7 (31%) patients had an ANC <500. The most common symptoms were: systemic symptoms (n = 18, 78%), respiratory (n = 13, 57%) and gastrointestinal (n = 10, 44%). Eighteen (78%) children were admitted to the hospital, 13 (57%) to the intensive care unit (ICU). Five (22%) required mechanical ventilation, 3 (13%) hemodialysis, and one (4%) extracorporeal membrane oxygenation (ECMO). Fourteen (61%) had their cancer-directed therapy changed. Seven (30%) children with MIS-C died;COVID-19 contributed to the death in five children while two died because of their cancer. Conclusion: Children with cancer and COVID-19 can develop MIS-C, potentially at higher rates than in the general pediatric population. Additionally, the majority of children with MIS-C and COVID-19 have severe disease as indicated by a high hospitalization rate, and many of these patients require ICU admission and unfortunately die related to complications. More than half also have their cancer therapy changed, which has unknown implications on their long-term cancer outcomes. Pediatric oncologists can consider these risks as they evaluate children with cancer and COVID-19 and as they advise families regarding their risks of COVID-19 and the benefits of vaccination.
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The main objective of this research study is to conduct a comparative analysis of positive mental health between men and women university students isolated due to COVID-19. Positive mental health is reviewed theoretically, including its associated measurement factors. Basic concepts of discriminant analysis are examined. Discriminant analysis is applied to assess significant differences between 337 men and women university students by using the Lluch’s Positive Mental Health scale, which measures the following factors: pro-social attitude, autonomy, self-control, personal satisfaction, problem solving, and interpersonal relationships. The results show that pro-social attitude, self-control, and problem-solving are significant factors for positive mental health of male and female university students. In conclusion, these findings can be used to prioritize intervention factors in programs or processes to improve psychosocial conditions of a given population in educational contexts. © 2022