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Introduction: COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020 due to its complexity and rapid global expansion. Sandino municipality presented its first positive case on October 6, 2020. Objective(s): To characterize the clinical-epidemiological behavior of COVID-19 in Sandino municipality, in 2020. Method(s): A descriptive and cross-sectional research was conducted from March 11 to December 31, 2020. With the information obtained from clinical-epidemiological records, virological results, home and work screening, care for acute respiratory infections in clinics and polyclinics, and the daily reports of the Municipal Health Directorate, a statistical analysis was carried out whose information was inserted in an Excel database. Result(s): The incidence rate was 528.23 per 100 000 population;no deaths. Most of the cases occurred in the city of Sandino. There was a higher frequency of patients in the ages from 41 and 60, and the male sex;while 55.73 % were asymptomatic at diagnosis. The most common symptoms were cough, fever and nasal congestion. Between one and 13 cases per day were diagnosed during the 63 days that there was positivity. Family transmission was 68.23 % and occupational transmission was 50.52 % of cases. Conclusion(s): COVID-19 had a high incidence in Sandino municipality, and this predominated in places with higher population density with intense family and work transmission in a short period of time;also, in the male sex, the age group in working ages, and in the asymptomatic patients.Copyright © 2023, Editorial Ciencias Medicas. All rights reserved.
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The global COVID pandemic has evidenced how essential territories are in general, and mobility in particular, dealing with the current crisis. In Chile, we have observed how multiple scales and diverse territorial relations and dimensions have had a crucial role in the spread of the virus. Current mobilities, or, more precisely, the ban on movement, unveiled the multiple inequalities faced by urban dwellers;while some were able to stay at home and manage distance working, many others had to continue moving around. The latter also live in conditions that make it impossible for them to do so, either because of their income-generating activities, overcrowded living conditions or remote distances to reach infrastructures and services, among others. Amid these conditions, many of the difficulties faced during months of confinement relate with unavoidable caring responsibilities. In the Chilean context of inadequate protection provided by authorities, urban dwellers had to undertake caring responsibilities both at the individual and community levels as weeks and months went by. Under lockdown, work and health issues became intertwined with domestic chores including caring activities of relatives, friends, and neighbours. The measures taken by government authorities were insufficient to actually take care of citizens, and generated an increase in illness numbers, hunger, decrease in income, and overall malaise, which led to the emergence of neighbourhood and community support groups to take care of the uncared-for population. This chapter tries to document how these care actions emerge as a possibility for rethinking our cities for the future and discusses how we can transit from cities focused on efficiency and productivity to cities that take care of its reproduction. Recognising territories as relational and valuing the multiple knowledges present in these relations highlights the importance of care not just as private matters to be solved individually, generally by women, but instead, as a collective concern linked by mobility practices. © 2023 selection and editorial matter, Maria Alice de Faria Nogueira;individual chapters, the contributors.
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Evusheld®, anticuerpos monoclonales cilgavimab y tixagevimab, están indicados para los pacientes con condiciones de riesgo que cursan con inmunosupresión e inadecuada respuesta a la vacunación o contraindicación de la misma, presentando alto riesgo de la enfermedad grave por SARS-CoV-2. Describir las características de los pacientes con serología negativa tras la vacunación completa según la estrategia de vacunación frente a la COVID-19 en España, es una condición necesaria para recibir Evusheld®. Métodos: Estudio descriptivo de pacientes mayores de 17 años con serología negativa antiproteína S, extraída entre el 31/03/2022 y el 10/06/2022, tras la administración de la tercera o la cuarta dosis de vacuna frente a la COVID-19 en un hospital de tercer nivel. Las variables cuantitativas se evaluaron mediante media ± desviación estándar y las cualitativas mediante porcentajes. Se utilizó el estadístico de la U de Mann Whitney. Resultados: De las 3.103 serologías realizadas, 155 fueron negativas (5,0%). El 47,7% (74) fueron mujeres, y un 52,3% (81) hombres. La edad media fue de 62,7 ± 11,8 años, 65,3 ± 10,3 en los hombres y 60,9 ± 13,1 en las mujeres (p = 0,114). El 32,9% de los pacientes que no respondieron a la vacunación eran pacientes tratados con inmunosupresores o inmunomoduladores biológicos y el 51,6% (80) eran pacientes trasplantados, siendo 72 (46,5%) receptores de trasplante de órgano sólido (TOS) y un 5,2% (8) de trasplante autólogo de progenitores hematopoyéticos. De los receptores de TOS, un 20,2% (34) eran renales y un 12,5% (21) pulmonares. Conclusiones: Los pacientes que no respondieron adecuadamente a la vacunación frente a la COVID-19 fueron, en su mayoría, receptores de TOS o tratados con inmunosupresores o inmunomoduladores biológicos, siendo por tanto candidatos potenciales para recibir Evusheld®.
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Las nuevas vacunas de ARN mensajero (ARNm) desarrolladas durante la pandemia causada por el SARS-CoV-2 han demostrado una gran efectividad. Sin embargo, existen pocos estudios de evaluación de la respuesta posvacunal en los pacientes vulnerables (trasplantados, VIH, uso de inmunosupresores, etc.). El objetivo del estudio es evaluar la respuesta de las vacunas de ARNm frente a SARS-CoV-2 en los pacientes inmunodeprimidos. Métodos: Análisis descriptivo exploratorio empleando datos de la historia clínica electrónica y de un registro de vacunación autonómico. Se incluyeron pacientes del grupo 7 (estrategia de vacunación de la COVID-19 del Ministerio de Sanidad) con serología posvacunal tras una cuarta dosis de vacuna de ARNm frente a SARS-CoV-2. Se evaluó la respuesta por sexo, grupo de riesgo y edad (distribución de grupos de edad 0-44, 45-54, 55-64, 65-74, 75-84, ≥ 85). Resultados: Se vacunaron 3.104 pacientes pertenecientes al grupo 7, de los cuales se realizaron serología 2.800 (90,2%). En los pacientes con prueba, 2.623 resultaron positivos (93,7%), 157 negativos (5,6%) y 20 indeterminados (0,7%). No se encontraron diferencias significativas en la proporción de serologías negativas por sexo (5,4% en las mujeres frente a 5,7% en los hombres;p = 0,890) a nivel general, ni tras la estratificación por grupos de edad. La proporción de serologías negativas aumentó con la edad: 0-44 (2,5%), 45-54 (4,7%), 55-64 (4,6%), 65-74 (8,1%), 75-84 (9,2%) y > 85 (9,7%) (p < 0,001). Por grupo de riesgo, fue mayor en receptores de órgano sólido (9,5%), trasplante de progenitores hematopoyéticos (6,7%) e inmunodeficiencias primarias (6,4%), siendo menor en las enfermedades oncohematológicas (5,2%), uso de inmunosupresores (3,9%), cáncer de órgano sólido (3,7%) y tratamiento sustitutivo renal (1,9%).Unlabelled ImageUnlabelled Image Conclusiones: La edad avanzada se relacionó con una peor respuesta vacunal a la vacuna de ARNm frente a SARS-CoV-2. Se observaron diferencias en la respuesta vacunal en función de la causa de inmunosupresión.
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Purpose: Liver transplant recipients have a high risk of developing postoperative pulmonary complications. Pulmonary function tests (PFTs) are expensive and often incapable of predicting patients at risk or improving patient outcomes, thus a single-center implemented specific criteria to determine when a PFT is administered for the evaluation of patients for liver transplantation. The protocol recommends a PFT for patients with a history of chronic lung disease, recurrent pneumonia prior to transplant, symptomatic COVID-19 requiring hospitalization, tobacco abuse, alpha-1 antitrypsin positivity, or oxygen dependency. Method(s): We conducted a retrospective cohort study of consecutive adult patients (age greater than 18 years) who underwent deceased donor liver transplantation from January 1, 2020, to June 30, 2021. We analyzed results from pre-protocol (PRE) and post-protocol (POST) implementation. Result(s): There were a total of 215 patients in the study, 186 PRE and 29 POST protocol implementation. In the PRE group, 168 (90%) patients received PFTs compared to 12 (41%) in the POST group, p<0.001). There was no difference between the PRE and POST groups based on age in years (56 vs 55, p=0.713), male gender (65% vs 662%, p=0.83), White race (80% vs 86%, p=0.15), BMI (34 vs 28, p=0.107), or cold ischemic time in hours (5.7 vs 6, p=0.252). There was no difference in FVC (3.3 vs 3.0, p=0.84), FEV1 (2.6 vs 2.2, p=0.87), FEV1/FVC% (76.9 vs 74.4, p=0.47) and DLCO (16.4 vs 13.8, p=0.11). The postoperative variables were the same for both groups with time to extubation hours (25 vs 31, p=0.26), ICU length of stay days (8 vs 10, p=0.12), and transplant admission length of stay days (14.4 vs 17.4, p=0.36). Lastly, there was no difference between PRE and POST graft survival (p=0.69) or patient survival (p=0.08). Conclusion(s): This study demonstrates the successful implementation of a PFT protocol with a cost savings of roughly $38,000 in just three months with no impact on patient outcomes. Further research is indicated for broad-scale implementation.
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Background: The COVID-19 pandemic remains a large contributor to the global burden of disease. SARS-CoV-2 RNAemia detection has been connected to higher mortality, but consistent data of solid organ transplant (SOT) recipients have not been analyzed. Aim: To determine and quantify RNAemia at hospital admission and its impact on robust unfavorable clinical outcomes. Methods: From January 6, 2020 to August 13, 2021, we followed a multicenter cohort of 408 immunocompetent and 47 SOT patients hospitalized with COVID-19. Outcome variables were 30-day allcause mortality and invasive mechanical ventilation. Multivariate Cox regression analyses were performed and a propensity score (PS) was calculated. Results: SARS-CoV-2 RNAemia was demonstrated in 104 (22.9%) patients. Those with RNAemia were more frequently transplanted and presented a higher proportion of severe symptoms and signs. Mortality was 29.8% (31/104) and 3.4% (12/351) in RNAemic and non-RNAemic patients (p <0.001). The multivariate analysis adjusted by PS selected CURB-65≥2 (HR, 3.61;95% CI, 1.18-11.01;p = 0.02) and RNAemia (HR, 7.46;95% CI, 2.41-25.38;p = 0.001) as independent predictors of death. In the PS matching, SOT patients showed higher prevalence of RNAemia (57.6% vs. 13.6%) and mortality (HR, 4.56;95% CI, 1.47-7.13;p = 0.01). Conclusions: Positive RNAemia is an independent predictor of unfavorable outcome in immunocompetent and SOT. High viral load was linked to worse prognosis in a univariate analysis. Our findings help elucidate the pathogenesis of SARS-CoV-2 and provide insights for the better management of patients.
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The objective of the book’s chapter was to compare the physical activity evaluated through metabolic equivalents in athletic trainers during the SARS-CoV-2 lockdown. Thirty-seven athletic trainers took part in the study, in order to determine the physical activity and calculate the energy expenditure, the International Physical Activity Questionnaire (IPAQ) was used, the evaluation was virtually before and during the SARS-CoV-2 lockdown. The Student's t-test for independent sampling was used to calculate the equality of variance resulting in non-significant values in the total physical activity in MET-minutes of sports coaches before than during the SARS-CoV-2 lockdown (p =.232), with a percentage difference of 15.1?%. The level of financial activity in athletic trainers remains with no changes than those others professionals within the public health, who help to increase the active lifestyle of a society. © 2022 by Nova Science Publishers, Inc.
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Background: The risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is higher than individuals from the general population due to chronic infammation. Current CV risk screening and management strategies underestimate the actual CV risk in RA. Thus, an adequate CV risk stratifcation has special relevance in RA to identify patients at risk of CV disease. Objectives: To assess the incidence of cardiovascular events in a RA cohort after a 2 years follow-up. Methods: A cohort study was performed in which inclusion criteria were adult RA patients and matched adults in terms of age, sex and CV risk factors (controls). Population over 75 years old, patients with established CV disease and/or stage III chronic kidney disease were excluded. Controls with other infam-matory diseases, pregnant women or any malignancy were also excluded. This study was performed from July-2019 to January-2022. CV risk assessment included risk factors collection and US evaluation consisted in detection of plaques and measurement of the intima-media thickness in both right and left carotid. Results: Overall, a total of 200 cases and 111 healthy controls were enrolled in the study. Demographical and clinical variables were comparable between cases and controls and are shown in Table 1. US study revealed a higher IMT in both right and left carotid arteries with greater presence of plaques in patients than in controls (CI 95% [1.542;3.436], p<0.001). Plaques were found in both carotid arteries in the 32% of cases and 9.91% of controls. The longer duration of RA was related to a higher presence of carotid plaques (95% [1.015;1.056], p<0.001). Eight patients (4%) presented a cardiovascular event, and one of them died (0.5%). The events consisted in 2 angina pectoris, 3 transient ischemic attack, 1 acute myocardial infarction, 1 lacunar stroke and 1 cardiac arrest. Six out those 8 patients demonstrated bilateral plaque presence at baseline. Two patient caused loss of follow up due to death related to Covid-19. Not a single cardiovascular event was reported in the control group. Conclusion: Our results shows that cardiovascular events are increased in RA patients and US study may be useful in predicting an event.
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Background: Recent published data have emerged some concerns about safety of Janus kinase (JAK) inhibitors and FDA have established prescribing restrictions. Objectives: The aim of this study was to analyze the safety profile of current approved JAK inhibitors in Europe with data from a Real World cohort. Methods: A single center observational study was performed including patients who had initiated treatment with Tofacitinib, Baricitinib or Upadacitinib from September, 2017 to January, 2022. Demographic, clinical, laboratory and safety variables were collected from baseline and at months 1, 3, 6 and every six months. Safety data was collected including any adverse event (AE) due to any cause. An AE was considered serious if it was life-threatening or result in hospitaliza-tion, disability or in death. All AE and SAE were expressed adjusted by exposure (E/100 PY). Results: A total of 194 patients were included whom baseline demographic and disease characteristics are exposed in Table 1. Drug exposure was 265.5 patient-years. Overall, 214 AE were detected being mild upper tract respiratory infection the most frequently registered (15.82 E/100PY) followed by Urinary tract Infection accounting 7.16 E/100PY. 10 Serious Infections were detected in 10 patients of which 5 were pneumonia (1.88 E/100PY), 1 cellulitis (0.38 E/100PY) and 2 COVID-19 (0.76 E/100PY). 12 herpetic infection were detected in 9 patients (4.52 E/100PY) of which 7 were caused by herpes zoster (2.64 E/100PY) and 5 by herpes simplex (1.88 E/100PY) 3 cases were mono-metameric and 4 multi-metameric. Moreover, 2 patient developed postherpetic neuralgia. A patient with RA developed Miliary Tuberculosis (0.38 E/100PY) with a negative IGRA test prior to the JAKi. A patient with RA suffered a Myocardial Infarction (0.38 E/100PY). 7 RA patients developed malignancy (2.64 E/100PY), one with oral squamous cell carcinoma, two Bowen carcinoma, one breast cancer, 2 basal cell carcinoma and a colorectal metastatic cancer. Not a single case of thromboembolic event nor Hepatitis B Virus reactivation were registered. 2 patients died, one with cancer and the other suffered a severe COVID-19 (unvaccinated). Conclusion: In this updated analysis of 194 patients treated with JAKi, the three approved JAKi showed a safety profile consistent with data from RCT. The patients under JAK therapy should be carefully evaluated on their follow-up.
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Background: During the frst months of the Sars-CoV-2 pandemic, antimalarial drugs were the central axis of the treatment of patients with acute respiratory infection. After that, several studies reported a risk of prolongation of corrected QT interval (QTc) at the electrocardiogram (ECG). Historically, these drugs, have been the common denominator in the treatment of patients with Systemic Lupus Erythematosus (SLE). Objectives: To analyze the possible relationship between the use of antima-larial drugs ant the electrocardiographic alterations in patients diagnosed with SLE. Methods: Cross-sectional study in patients diagnosed with SLE (SLICC 2012). In all of them, we performed a 12-lead ECG at rest. We measured the QT interval: manually and automatically, ant its correction was made according to the Hodge formule (QTc). Results: 91 patients diagnosed with SLE were included in the study. Of the total of patients included in the study, 64 were in current treatment with an antimalar-ial drug, with a mean of 9.09 (5.73) years of treatment, and a mean cumulative dosage of 813.16 (436.12) gr. Of the patients on current treatment with antimalarial drugs, 4.69% had a prolonged QTc, compared to 3.7% of the patients without current treatment with these drugs. We analyzed the possible relationship between the QTc interval, the current treatment with antimalarial drugs, and the cumulated dosage of this medication. We corrected the lineal regression models by the years of disease evolution, the presence or absence of known heart disease, the women gender, and other treatments such as antiarrhythmics or beta-blockers. We found a statistically signifcant association between taking antimalarial drugs and the elongated QTc interval (p= 0,001). Nevertheless, in the multivariate analysis, we did not found a signifcant relationship between the ECG alterations and the treatment with antimalarial drugs. Conclusion: In our study, we did not observe a direct relationship between the intake of antimalarial drugs and the alteration of the corrected QT interval.
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Background: The need to avoid the transmission of COVID19 infection has forced to promote teleconsultations for rheumatic diseases follow-up. However, remote monitoring for rheumatic diseases which require clinical examination, as rheumatoid arthritis (RA), may affect to the evaluation of clinical activity, including the biological therapies follow-up. Due to that, count on tools as Patient Reported Outcomes (PROs) could help the remote monitoring of patients when it is not advisable their physical presence in health centers, being a great help in RA control. Objectives: We aim to assess the association among the tiredness, disability and pain perception with the clinical activity in RA patients. Methods: We performed a prospective observational study of three months of follow-up in RA patients (ACR/EULAR 2010) who are newly on biological or anti-JAK therapy. A basal visit and 1, 3 months follow-up visits were conducted. We analyzed changes during follow-up in the PROs parameters reported by patients through FACIT-fatigue and HAQ questionnaires, as well as pain VAS (0-10). Moreover we measured clinical activity through Das28, Das28-CRP, SDAI and CDAI index. Results: We included 60 patients (83.3% female), with a mean age of 55 (13) and mean disease evolution of 13 (11) years. At the basal visit, 55% of them exhibited increased levels of CRP and the 48.3% of ESR, showing moderate or high clinical activity the 83.3% of the total patients. 39 patients started anti-JAK therapy and 21 with TNF-α inhibitors. The 33.34% of patients were under monotherapy, and the 46.67% previously have been treated with biological therapy. The 77.36% of the total number of patients was on the biological therapy at 6 months of follow-up, while the 22.64% discontinued at 6 months of follow-up (9 due to inefficacy and 3 due to adverse effects). 48 patients continued the treatment in the 6 months after, and 12 patients discontinued due to ineffectiveness or drug intolerance. Clinical activity, fatigue, disability and pain perception are shown in Table 1. Using a mixed linear regression model the association among the fatigue, disability and pain perception with clinical activity was conducted, corrected by age, smoking habits, time of disease evolution, BMI, previous biological/anti-JAK therapy administration and current dose of steroids. We observed a signifcant association among clinical activity and fatigue (P<0.001), disability (P<0.001) and pain perception (P<0.001). The statistical analyses showed a signifcant association where a high fatigue is increased in cases with high pain perception (P>0.001) and high number of swollen joints (P=0.002), but not in high levels of CRP and ESR. Fatigue was higher in those cases whom discontinued treatment (P=0.044) regardless of which therapy was chosen. No effect of age, time of disease evolution, steroid dose, BMI or previous therapy and smoking habits in the PROs values was observed. Conclusion: PROs would be helpful in the disease control in those cases where a remote monitoring is needed, since HAQ or FACIT-FATIGUE index showed a signif-cant association with clinical activity index in RA. Because of its ease for shipping and handling by the health professional, PROs could be a useful tool in the disease control. Its implementation in the remote monitoring of RA patient, as has been the case of Covid19 pandemic, results in an improvement of the clinic evaluation of RA patient, due to required information to clinical management is reported, avoiding presence consultation in those situations when it is required.
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Emotions are increasingly present in political communication;therefore, it is important to master certain non-verbal behaviors so that the desired message could be perceived in the right way. This article performs a comparative analysis of the emotions displayed by the Prime Ministers and Presidents of Germany, Canada, Italy, the United States, Spain, France and the United Kingdom during the communication of the extraordinary measures adopted to contain the COVID-19 pandemic. To carry out this study, the Releyeble software was used, a tool that allows to extract the dominant facial emotional features of any person who is within the field of vision in fractions of one second. With the obtained records, a quantitative content analysis was performed, measuring the frequency of gesticulation displayed by each leader during their interventions. Similarly, we developed a thematic analysis of the leaders’ speeches to observe the consonance between the verbal and non-verbal language. The results show different emotional models in the studied leaders. Similarly, they present how politicians display a variety of emotions throughout their interventions such as anger, surprise or disgust. In the analysis of the speeches, the research identified different narrative styles as well as common resources to seek cohesion and citizen awareness. © 2022, Arco Libros S.L.. All rights reserved.
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The Coronavirus Disease 2019 (COVID-19) epidemic is an unprecedented global health crisis and the effects may be related to environmental and socio-economic factors. In São Paulo, Brazil, the first death occurred in March 2020 and since then the numbers have grown to 175 new deaths per day in April 2021, positioning the city as the epicenter of the number of cases and deaths in Brazil. São Paulo is one of the largest cities in the world with more than 12 million inhabitants, a fleet of about 8 million vehicles and frequent pollutant concentrations above recommended values. Social inequalities are evident in the municipality, similarly to other cities in the world. This paper focuses on transportation activities related to air pollution and associated with cardiovascular and respiratory diseases especially on people who developed comorbidities during their whole life. This study relates travel trip data to air quality analysis and expanded to COVID-19 disease. This work studied the relationship of deaths in São Paulo due to COVID-19 with demographic density, with family income, with the use of public transport and with atmospheric pollution for the period between March 17th, 2020 and April 29th, 2021. The main results showed that generally passenger kilometers traveled, commuting times and air quality related diseases increase with residential distance from the city center, and thus, with decreasing residential density. PM2.5 concentrations are positively correlated with COVID-19 deaths, regions with high urban densities have higher numbers of deaths and long-distance frequent trips can contribute to spread of the disease.
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Background: Some in vitro, animal, and epidemiological data suggest that tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) might be an efficacious treatment for COVID-19 Methods: In a multicenter open-label, pragmatic, randomized trial in 25 hospitals in Spain we included participants with symptomatic SARS-CoV-2 detected by PCR or antigenic test, with a creatinine clearance > 60 mL/min, > 60 years or younger if they had at least 2 comorbidities (hypertension, obesity, diabetes, cirrhosis, chronic neurologic disease, active cancer, heart failure, coronary heart disease or COPD). Participants were randomized to receive or not TDF/FTC. Randomization was stratified by age group, symptoms duration (< or ≥ 5 days) and health care setting (hospitalized, long-term care facility, ambulatory). Primary outcome was 28 days mortality. Secondary outcomes were disease progression (increased O2 requirements, need for mechanical ventilation or increase in medical therapy: steroid dose, need for tocilizumab). At any moment during the trial participants with room air O2 saturation < 95% and ≥ 1 increased inflammatory biomarker could be randomized to dexamethasone (D) or dexamethasone plus baricitinib (DB) Results: 355 participants included (TDF/FTC n=177, no TDF/FTC n=178), median age 67 years (IQR 62-73), male (64.5%), median days of symptoms 8 (IQR 5-10), 29% with < 5 days of symptoms, 96.9% hospitalized, 35.5% with 1 and 36.6 % with ≥ 2 comorbidities (62.8% hypertension, 9.3% diabetes, 1.7% obesity), median room air SaO2 95% (IQR 94-96), 63% receiving O2 and 11.8% Remdesivir. 74% of participants were simultaneously randomized to D or DB. There were not statistically significant differences in endpoints in participants not treated vs.treated with TDF/FTC: mortality 2.2%/4.0%, disease progression 23.6%/22.0%, deferred randomization to D or DB 6.7%/6.2%, mechanical ventilation (invasive or noninvasive) 22.5%/20.3%, days since randomization until discharge (median [IQR]) 7 [5,14]/6 [4,12], discharge before 28 days 91.9%/89.7%. By Cox regression Hazard Ratio (95% CI) of 28-day mortality was 1.96 (0.55-7.01) for participants treated with TDF/FTC. Serious adverse events occurred in 6.18%/5.65% of participants not treated/treated with TDF/FTC. Adverse events leading to TDF/FTC discontinuation occurred in 2.26%. Conclusion: In this clinical trial of high-risk patients with COVID-19 TDF/FTC did not improve disease outcomes. Overall mortality was unexpectedly low.
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Background: Transmission of SARS-CoV-2 is highly heterogeneous, with a small fraction of infected individuals (often referred to as "superspreaders") contributing a disproportionate share of forward transmission. Numerous behavioral and environmental explanations have been offered to explain transmission heterogeneity, but the extent to which the underlying features of the infection process within individual hosts contribute towards the superspreading phenomenon remains unclear. In addition, it is not clear how vaccination would impact on the viral infection dynamics and thus the infectiousness of individuals. Addressing these gaps in knowledge will inform the design of more targeted and effective strategies for controlling community spread. Methods: In a study on UIUC campus (UIUC SHIELD), the dynamics of infectious virus and viral RNA shedding were captured through daily longitudinal sampling of 72 individuals for up to 14 days (60 unvaccinated and 12 vaccinated). We fitted mechanistic models to both viral loads and cell culture positivity data, and directly estimated viral reproduction and clearance rates, and overall infectiousness for each individual. Results: Integrating mathematical models with viral load and cell culture positivity data, we show a substantial level of heterogeneity in infectiousness of individual. In unvaccinated individuals, peak viral loads and clearance kinetics of B.1.1.7 and non-variant of concern viruses were indistinguishable. In vaccinated individuals, the viral dynamics do not follow typical patterns of acute infection dynamics and we estimate that these individuals are much less infectious than unvaccinated individuals. Conclusion: Our work provides a high-resolution portrait of SARS-CoV-2 infection dynamics. Significant person-to-person variation in infectious virus shedding suggests that individual-level heterogeneity in viral dynamics contributes to superspreading. Vaccinated individuals are less infectious than unvaccinated individuals overall.
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Background: Trials on convalescent plasma (CP) for hospitalized patients with COVID-19 have not demonstrated clear benefits. However, data on outpatients with early symptoms are limited. We studied if treatment with CP reduces disease burden of outpatients treated in the first 7 days of symptoms. Methods: Two double blind randomized trials (NCT04621123, NCT04589949) were merged. Pooling of data started when <20% of their predefined sample size had been recruited. A Bayesian adaptive individual patient data meta-analysis was implemented. Analyses were done with Bayesian proportional odds and logistic models, where odds ratios(OR)<1.0 indicate a favorable outcome for CP. A DSMB monitored the accumulating data for efficacy. Patients aged ≥50, diagnosed with COVID-19 and symptomatic for ≤7days were eligible for participation. The intervention was one unit (200-300mL) of CP with a predefined minimum level of antibodies. The two primary endpoints were (a) a 5-point disease severity scale (fully recovered by day 7 or not, hospital or ICU admission and death) and (b) a composite of hospitalization or death. Secondary endpoints were efficacy in patients with ≤5days of symptoms and time to full symptom resolution. Results: Of 797 patients included, 390 received CP and 392 placebo. They had a median age of 58, 1 comorbidity, symptoms for 5 days and 93% tested negative for SARS-CoV-2 S-protein IgG antibodies. 74 patients were hospitalized, 6 required mechanical ventilation and 3 died. The OR of CP for an improved disease severity scale was 0.936 (credible interval (CI) 0.667-1.311). The OR for hospitalization or death was 0.919 (CI 0.592-1.416). The effect of CP on hospital admission or death was largest in patients with ≤5days of symptoms (OR 0.658, 95% CI 0.394-1.085). CP did not decrease the time to full symptom resolution (p=0.62). Conclusion: Treatment with CP of outpatients in the first 7 days of symptoms did not improve outcome of COVID-19. The possible beneficial effect in patients with ≤5days of symptoms requires further study.
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Neonatal asphyxia and its complications remain a serious problem at birth;the knowledge and skills of those who apply the Neonatal Resuscitation Program have an impact on the morbidity and mortality of the newborn. Recently, the International Liaison Committee on Resuscitation (ILCOR) has published new recommendations on neonatal resuscitation to improve outcomes in newborns, as well as methodology for provider education. It also contains a section on care during the COVID-19 pandemic. This article presents a summary of the most important changes in the book Neonatal Resuscitation, eighth edition, published in 2021 by the American Heart Association and the American Academy of Pediatrics. © 2021 Sociedad Mexicana de Pediatria. All rights reserved.
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The health crisis resulting from the pandemic (COVID-19) led to a hasty adaptation of the university towards teaching methodologies based on online experiences. As a result, teaching and assessment methods were adapted according to different formulas. Teaching in Architecture, where drawing is a fundamental tool in communication, required a particular adaptation given the specificity of the competences and learning outcomes in this type of teaching. The aim of this communication is to analyse the students’ academic results after the pandemic period (academic years 2019/20 and 2020/21) with online and blended learning teaching and assessment respectively, and to contrast them with those of previous academic years, developed with traditional face-to-face teaching and assessment methodologies. The focus is on the basic courses of the Area of Architectural Graphic Expression of the Bachelor Degree in Fundamentals of Architecture at the School of Architecture and Building of the Technical University of Cartagena. The conclusions address statistical data relating to the student performance rate and provide an overview of the effect that virtual teaching and assessment have had on academic results. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.