Atividade F?sica e bem-estar mental durante o distanciamento social da pandemia de COVID-19

Objective: This research sought to understand how social distancing during the COVID-19 pandemic impacted physical activity levels and mental well-being. Methods: The study included 511 people from 19 Uruguayan states who participated in the study, 69.1% of whom were female and aged between 18 and 24 (43.4%). Participants answered an online questionnaire containing questions about fatigue, PA level before and after the pandemic onset, Warwick-Edinburgh Mental Well-Being Scale, time spent in front of screens and number of people they kept in touch with. The information was kept anonymous and confidential, with no questions that could identify the participants. The survey was conducted during the period of social distancing, remaining available for one month and 12 days. Results: The results showed an increase in physical inactivity and a negative impact on the mental well-being of those who became inactive during the distancing period. Conclusion: In sum, distancing measures caused harm to the physical and mental health of the population, requiring the implementation of measures to encourage PA practice so that people can re-equip and enhance their integral health care.

"A Switch Went off in my Whole Body": Lived Experiences of Fatigue and Post-Exertional Malaise in Long Covid

The growing HCI agenda on health has focused on different chronic conditions but less so on Long Covid, despite its severe impact on the quality of life. We report findings from 2 workshops with 13 people living with Long Covid, indicating the challenges of making sense of their physical, cognitive, and emotional symptoms, and of monitoring the triggers of post-exertional malaise. While most participants engage in pacing activities for the self-management of fatigue, only a few are aware of the importance of planning all their daily activities and routines in order to avoid post-exertional malaise. We conclude with design implications to support lightweight tracking and sensemaking of fatigue symptoms, novel data analytics for monitoring the triggers of post-exertional malaise and the worsening of symptoms, and support for self-management in order to prevent post-exertional malaise. © 2023 Owner/Author.

FORMAÇÃO VIRTUAL EM PROGRAMAS UNIVERSITÁRIOS PARA ADULTOS E IDOSOS: LIÇÕES DA PANDEMIA

PALAVRAS-CHAVE: COVID-19, Programas Universitarios para Adultos e Idosos, eLearning, aprendizagem continua The surprising announcement of an unknown pandemic caused by a coronavirus in the early 2020s confronted the world's education systems with a major challenge. The aim of this article is to highlight the relevance of virtual training in this type of context through the specific example of the University of Burgos and to highlight the much-needed role of the University in the development of lifelong learning for all citizens regardless of their age or place of residence. COVID-19, University Programmes for Older Adults, eLearning, lifelong learning 1INTRODUÇAO O desafio mais significativo enfrentado pelos sistemas educativos mundiais no século XXI foi desencadeado no inicio de 2020, quando uma nova pandemia, causada por um coronavirus, espalhou-se. Dito isto, ao nos concentrarmos na educaçao universitária dos adultos e idosos, nao podemos deixar de nos perguntar se as extraordinárias mudanças provocadas pela integraçao da aprendizagem virtual continuarlo no futuro.

[Early use of tocilizumab in hospitalized patients with severe and critical COVID-19 in the Province of Buenos Aires: a multicentric study]

INTRODUCTION: Tocilizumab (TCZ), an IL-6 receptor antagonist monoclonal antibody is warranted in severe and critically-ill COVID-19 patients. The objective was to evaluate 28-day mortality of patients with severe or critical COVID-19 treated with early vs delayed TCZ. METHODS: Multicenter, retrospective cohort study including patients >18 years hospitalized between 7/1/2021-8/1/2022 with confirmed COVID-19, with 5, 6 and 7 points of WHO Ordinal Initial Severity Scale [SS]. Early or late administration was considered if TCZ was administered before or after 48 hours from admission. Outcomes were 28-day mortality and change of SS. Factors related to 28-day mortality were evaluated with Cox regression. RESULTS: 266 patients were included, 159(60%) male;aged 58(+/- 15);frequent comorbidities were hypertension (42%), obesity (37%) and diabetes (27%). Seventy patients had a SS = 5 (Supplemental O2), 143 had SS = 6 (NIV/ HFNC), and 53 had SS = 7 (IMV). 28-day mortality was 42%(112/266);predictors were age, obesity, higher SS, days between hospitalization and TCZ administration, and fewer days between symptoms onset and TCZ. Mortality of SS 5, 6 and 7 was 26%, 39% and 72% respectively. Compared with baseline SS points, 76% and 62% of patients remained stable or improved on days 3 and 7 since TCZ administration. 28-day mortality was lower when TCZ was administered before 48 hours (39% vs 57%;p = 0.02;HR = 0.63;[0.41-0.99, p = 0.05]). DISCUSSION: This study supports the early use of TCZ in patients with severe or critical COVID-19.

Adaptation of a mobile app for early anxiety and depression intervention in university students in Chile: Participatory study

The high prevalence of mental health problems among university students poses a challenge when developing effective interventions, with digital technologies emerging as a potential resource to address this problem. The inclusion of student input in the design and development of such interventions is critical to improving their impact. This study contributed to the initial phase of a research project that aims to adapt and evaluate the feasibility and acceptability of an early intervention for anxiety and depression based on digital technologies for university students. Three participatory workshops were conducted with 13 university students in Chile to inquire about the features and content that a mental health mobile app should include to meet their needs and preferences. The workshop transcripts were analysed using inductive thematic analysis. The results of this study highlight the value of modifications such as the personalisation of some features of the app. The students recommended incorporating topics related to university life and the possibility of contacting a mental health professional, as well as the inclusion of peer interaction or other forms of support.Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

Lyrics Training: An E-learning Approach to Improve Listening Skills

Due to the COVID-19 pandemic, educational agents have been forced to apply strategies and methodologies and use new technological tools that allow them to continue with the teaching–learning processes. Because of this, the present research implements an innovative methodology to analyze the contribution of the Lyrics Training method in the development of listening skills for English language improvement. The experiment was carried out with high school seniors from an academic unit in the city of Ambato. A sample of 62 students was divided into two groups, an experimental group and a control group, each of 31 learners. When comparing both groups through a t-student test for independent samples, the results showed a p-value lower than 0.05 and a Cohen's d coefficient higher than 0.8, establishing that the teaching process through the Lyrics Training methodology is efficient. Finally, to verify if the Lyrics Training method is suitable for the selected experimental group, the usability scale (SUS) was applied, in which an average acceptance of more than 70 points was obtained, indicating that, in general terms, the Lyrics Training method through a web page is efficient for teaching the English language. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

The assessment of lifestyle changes during the COVID-19 pandemic using a multidimensional scale

Introduction: Healthy lifestyles are relevant to several diseases and to maintain individuals' mental health. Exposure to epidemics and confinement have been consistently associated with psychological consequences, but changes on lifestyle behaviours remain under-researched. Materials and Methods: An online survey was conducted among the general population living in Spain during the COVID-19 home-isolation. In addition to demographic and clinical data, participants self-reported changes in seven lifestyle domains. The Short Multidimensional Inventory Lifestyle Evaluation was developed specifically to evaluate changes during the confinement (SMILE-C). Results: A total of 1254 individuals completed the survey over the first week of data collection. The internal consistency of the SMILE-C to assess lifestyles during confinement was shown (Cronbach's Alpha = 0.747). Most participants reported substantial changes on outdoor time (93.6%) and physical activity (70.2%). Moreover, about one third of subjects reported significant changes on stress management, social support, and restorative sleep. Several demographic and clinical factors were associated to lifestyle scores. In the multivariate model, those independently associated with a healthier lifestyle included substantial changes on stress management (p < 0.001), social support (p = 0.001) and outdoor time (p < 0.001), amongst others. In contrast, being an essential worker (p = 0.001), worse self-rated health (p < 0.001), a positive screening for depression/anxiety (p < 0.001), and substantial changes on diet/nutrition (p < 0.001) and sleep (p < 0.001) were all associated with poorer lifestyles. Conclusions: In this study, sizable proportions of participants reported meaningful changes in lifestyle behaviours during the COVID-19 pandemic in Spain. Moreover, the SMILE-C was sensitive to detect these changes and presented good initial psychometric properties. Further follow-up studies should collect relevant data to promote healthy lifestyles in pandemic times.

Analysis of Risk Factors for a Low Immune Response to Messenger RNA COVID-19 Vaccine in Kidney Transplant Recipients and Differences Between Second and Third Dose.

BACKGROUND: The efficacy of the response to SARS-CoV-2 vaccination in kidney transplant recipients is low. The aim of our study was to evaluate the risk factors correlated with the low antibody response and whether there was an improvement between the second and the third dose. METHODS: A prospective study was conducted on 176 kidney transplant recipients who received the second and the third dose of the anti-SARS-CoV-2 mRNA Comirnaty vaccine. We evaluated the seroconversion process after administration of the second and the third dose and assessed a possible correlation with age, time between transplant and vaccination, and type of immunosuppressive therapy. RESULTS: A total of 98 of the 176 patients (55.7%) responded positively after the inoculation of the second dose and according to the multivariable logistic regression analysis the lack of seroconversion was independently associated with patient age ≥60 (P = .025; odds ratio [OR], 2.094), time since transplant of 1 to 3 months (P = .032; OR, 2.118), and triple therapy (P = .044; OR, 2.327). After the vaccine third dose, the seroconversion increased to 62.5%, and it was negatively influenced by calcineurin inhibitor use (12/21, 57.1% vs 71/78, 91.0%, P = .0006) and triple therapy (13/21, 61.9% vs 72/78, 92.3%, P = .0014). The median of antispike antibody response significantly increased from 18.5 IU/mL after the second dose to 316.9 IU after the third dose (P < .0001). CONCLUSIONS: We demonstrated a correlation between older age and shorter distance from the transplant and triple immunosuppressive therapy with the lack of seroconversion. We noticed a significant improvement in antibody response by a third dose of messenger RNA vaccine.

Vascular Access Devices (Vad) and Covid+19 Patiens Not Admitted in the Icu

The study of COVID-19 patient's management with vascular access has been very low but a consensus has been reached to improve care in this type of patient. The importance of care, the proper choice of the vascular access device (DAV), the reduction of adverse effects and the minimization of contagion risks by health personnel are a new axis of study. AIM Highlight the work of the Vascular Access Unit from Arnau de Vilanova Hospital with Covid 19 patients who didn't require admission to the Intensive care Unit. Methodology: Observational, descriptive and retrospective study by auditing the digitized medical records of 52 patients with medical discharged from the Arnau de Vilanova hospital from March 2019 to December 2021. Result(s): The 90% of DAVs were removal at the end of the therapy. In the 100% of the cases the first change dressing was 7 days later the insertion due to the use of cyanoacrylate use at the exit site. The average use was 16 days. 5 devices were remove for malfunction, 12 for exitus and 35 were removed for end of treatment. The average number of days from the time the patient is admitted until the day insertion is requested is 5 days. Conclusion(s): The existence of a UAV has meant an increase in patient safety and has allowed to be carried out the therapy for COVID 19 patients who were not included in the ICU The UAV has been able to insert the DAVs at bedside, improving the safety profile of the personnel. The use of new materials such as cyanoacrylate has reduced the workload and the risk of occupational exposure, while also reducing costs.

Vascular Accesses Used in the Administration of Antineoplasic Therapy in an Oncological Day Hospital

Introduction: Antineoplasic chemotherapy in intravenous infusion is one of the most common therapeutic modalities in cancer patients. The vast majority of antineoplasic drugs have an Osmolarity >900 mOsm/l, so its administration must be done through central venous routes. However, the channelling of central routes is limited to patients with difficulty in peripheral venous approach or long-term treatments. Objective(s): Describe the vascular accesses used at the University Hospital of La Ribera for the administration of antineoplastic drugs, assess the adequacy of the same and determine if the type of vascular access used varied during the COVID-19 pandemic. Methodology: A quantitative, observational and analytical cross-sectional study of the vascular accesses used in the administration of antineoplasic therapy in cancer day hospital was carried out. Data collection was carried out through direct observation and consultation of the medical history. The pre-pandemic period was executed from 20 to 21/1/2020(n=125), the pandemic sample from 8 to 12/2/21(n=121). Result(s): Although 70% of the drugs administered had the capacity for tissue aggression, the peripheral venous route was established in 69.9% of cases, the forearm being the most frequent anatomical location (n=102) and the peripheral venous catheter the most commonly used device (n=172). The expected duration of treatment was medium-term in 74.8% of patients. The use of central venous routes during the pandemic increased by 30.7%,(p=0.017), being the subcutaneous venous reservoir the one with the highest representation(RVSC 75.5 %, IPCC 24.5 %). Conclusion(s): Short peripheral venous catheter was the most used device in the administration of chemotherapy in oncology HDD of the UHLR, even administering drugs with high tissue aggression and establishing a medium duration of treatment, being this an area of improvement in the care of cancer patients. During the pandemic, the use of central routes increased in the administration of antineoplasic treatment on an outpatient basis.

Vascular Access and Covid-19 Pandemic in a Quality Program for Intravenous Therapy in Spain (Incativ)

Introduction: INCATIV is a research program carried out by nurses on 34 hospitals of the Region of Valencia (Spain). This program measures vascular access quality on patients of these hospitals via cross-sections. The objective of the study is to evaluate the influence of COVID-19 pandemic in the registers of the vascular accesses' quality program. Method(s): Quantitative observational, analytical, and retrospective study of two cross-sections. First cross-section was developed before pandemic (C10: 02-2020) and second cross-section during pandemic (C11: 05-2020). Data was obtained from INCATIV's platform. Result(s): Among 34 participant hospitals in INCATIV Program, there was a 100% of participation at C10, collecting 7647 registers of all hospital units included at the program. 4820 vascular accesses were evaluated. Only a 1.22% of them presented signs of phlebitis. 92% of the vascular accesses had the right dressing. At C11, there was a 50% of participation. 3234 registers were collected. Phlebitis rate remains at 1.15%. The use of correct dressing reached at 92% too. Discussion and conclusion: Data indicate a strong decrease in the number of participating hospitals as on the number of registers of this quality program focused on intravenous therapy, confirming the existence of changes in the trend of the registers, in the absence or presence of pandemic moments. On the other hand, it is observed that there are no statistically significant differences related to the quality of the vascular accesses, showing that two main indicators measured, included at INCATIV bundle, such as type of dressing and signs of phlebitis, remain constant despite being measured at two different pandemic moments. Further studies are necessary about how vascular accesses nursing care has changed only in COVID-19 patients.

Immunogenicity of the vaccine against Sars-Cov-2 in cancer patients under active treatment

Background: Coranavirus disease 2019 (COVID-19) has affected more than 220 millon people worldwide. The establishment of safe and effective vaccine coverage is crucial in these patients. We aim to investigate the safety, adverse effects and immune response (cellular and humoral) in cancer patients under active treatment and risk criteria. Methods: 56 samples from cancer patients under active treatment for cancer were collected before and after vaccination Demographic, clinical and biochemical data were collected and a post-vaccination symptomatology questionnaire was performed. For the determination of anti-SARS-Cov-2 antibodies (Immunoglobulin G and immunoglobulin M) we used the ELISA technique (LIASON SARS-CoV-2 S1/S2 IgG test and LIASON SARS-CoV-2 IgM test, DiaSorin, Saluggia, Italy). A study of the lymphocyte population was performed by flow cytometry. Results: We enrolled 52 patients with cancer who received mRNA vaccines (mRNA-1273 and BNT162b2), 2 patients with AZD1222vaccine and 2 with Ad26.COV2.S vaccine. All patients were SARS-COV-2 naive as determined by a negative anti-SARS-COVID-2 IgG test baseline. The median follow-up time was 50 days after receip of a second vaccine dosis. All subject received anti- cancer therapy. The most common anti-cancer treatment received by this cohort of patients was cytotoxic chemoterapy (44.6%), immunotherapy (25%), and monoclonal antibody therapy (14.3%). Overall, a high rate of seroconvertion(anti-IgG) (94,5%) was observed in our cohort, 1 patients with chemotherapy (1,8%) and 2 patients with immunotherapy (3,6%) were negatives. No significant differences in antibody titer were observed according to therapy. Thirty percent presented an antibody titer lower than 1000 U/ml, 27 (48%) patients developed an anti-SARS-CoV2 titer between 1000-4000 U/ml, and only 9 (16%) subjects presented a titer higher than 4000 U/ml. Studies of the lymphocyte profile of vaccinated patients showed no significant changes in the subtypes, except for peripheral memory CD3+ CD8+ lymphocytes which were significantly increased (p = 0.0001) after the second dose of anti-SARS-CoV-2 vaccine. Interestingly, cell apoptosis was significantly reduced in almost all T lymphocyte subtypes studied in vaccinated patients. Finally, analysis of blood cells showed a statistically significant increase (p = 0.0402) of eosinophils in vaccinated patients compared to baseline data. Conclusions: A personalized approach to vaccination can be proposed to cancer patients, especially depending on the type of tumor and the specific oncological treatments received. We are currently recruiting patients (n = 150) who have received the third dose of vaccine and plan to follow up at 6 months for humoral and cellular immune response. Final results will be reported at the ASCO meeting.

Acute Neurological Inflammatory Diseases in Colombia: A Multi-center Observational Study from Zika outbreak to SARS-CoV-2 pandemic

Objective: To evaluate clinical, laboratory, and epidemiological features of acute neuroinflammatory disorders (ANIDs) that followed the 2016 Zika epidemic in Colombia. Background: The outbreak of Zika virus infection in Colombia in 2015-2016, produced an increased incidence of Guillain-Barré Syndrome (GBS) and other ANID cases. The Neuroviruses Emerging in the Americas Study (NEAS) network was established in 2016 as a multicenter-based observatory of ANIDs to investigate the role of emerging pathogens in neuroinflammatory diseases. Design/Methods: NEAS serves as a multi-center study based on 13 hospitals in 7 cities in Colombia which study all newly diagnosed patients who fulfill established criteria for GBS, encephalitis, myelitis, meningoencephalitis, or cranial nerve disorders as part of an observational cohort. We analyzed the clinical and epidemiological features of all cases evaluated between January 2016 and September 2021. Results: An observational cohort of 825 patients with ANIDs were recruited during the study period. 58.8% of cases were male with a median age of 43 (IQR 25-58) years. The most frequent ANIDs were GBS (46.1%) and facial nerve palsy (28.7%). The diagnosis of encephalitis (9.5%), myelitis (6.5%), and optic neuritis (5.9%) were less frequent. Patients with GBS were predominantly male (70.6%) and had a median age of 49 (IQR 32-60) years. Interestingly, there was an increase incidence of GBS in 2019. Conclusions: The outbreak of Zika in Colombia produced a marked increase in the incidence of GBS in 2016. Although cases of GBS and other ANIDs continued to emerge after the incidence of Zika infection decreased in July 2016, the recent SARS-CoV-2 pandemic has not produced any significant increase in the incidence of GBS in Colombia.

NEUTRALIZING ANTIBODY RESPONSE and TRANSPLACENTAL TRANSFER in COVID-19 in PREGNANCY

Background: There are limited data on how COVID-19 disease severity and vaccination throughout different trimesters in pregnancy impact maternal neutralizing antibody responses and transplacental transfer to the neonate at birth. Further characterization of the antibody response of in utero SARS-CoV-2 may inform vaccination schedules in pregnancy in order to optimize maternal and neonatal protection. Methods: The COVID-19 Outcomes in Mother-Infant Pairs (COMP) study is a longitudinal cohort of mother-infant dyads diagnosed with PCR-confirmed SARS-CoV-2 at any point during pregnancy. Maternal and cord sera from delivery, as well as infant sera collected at 24 hours of life, were analyzed by enzyme-linked immunosorbent assay (ELISA) for IgA, IgG, and IgM targeting receptor binding domain (RBD) of the SARS-CoV-2 spike protein. Neutralizing antibody (NAb) activity against the original L strain was evaluated in a subset of unvaccinated mother-infant dyads with evidence of IgG transfer or history of severe/critical COVID-19 in pregnancy. Results: Among 115 pregnant women, the NIH COVID-19 severity of illness categories were: 12% asymptomatic, 70% mild/moderate, 11% severe/critical disease, and 7% vaccinated prior to delivery following recovery. Fifty percent of the cohort was diagnosed in the 3rd trimester, and the median diagnosis date to delivery was 61.5 days (IQR 27.75-122.25). The majority (74%) of the cohort produced all three anti-SARS-CoV-2 isotypes, although 5% had no detectable antibody class. Transplacental transfer ratios increased with increasing duration between onset of infection and delivery (Figure 1, r2=0.17). Infant IgG levels (ng/mL) were the highest among neonates born to vaccinated mothers (Figure 1), and maternal IgG levels increased with disease severity, although vaccination elicited a comparable maternal antibody response to severe/critical disease (Figure 1). Among 50 maternal specimens, 80% demonstrated in vitro neutralization activity, and 52% of 33 neonatal specimens had NAb. Conclusion: While transplacental transfer of IgG was high with natural infection and correlates with increasing duration between onset of infection and delivery, only half of analyzed neonatal specimens demonstrated in vitro neutralization activity. Further research is needed to characterize the functionality and kinetics of both maternal and neonatal antibody responses elicited by in utero SARS-CoV-2 natural infection compared with COVID-19 vaccination.

Getting the Country Back to Work, Safely: A Digital Solution

This article explains how businesses can use a widely available, low-cost technology to protect their employees from Covid-19 as they return to work. The proposed approach encompasses the need for better management of processes that can limit infection spread, including management of employee movements, physical distancing, segmentation of personnel into groups, and coordination of sanitization activities. © 2020 ACM.

POS-531 MONOCLONAL GAMMOPATHY PRESENTING AS ACUTE PSEUDOHYPERPHOSPHATEMIA IN A MAINTENANCE HEMODIALYSIS PATIENT: A RARE PRESENTATION

Introduction: Phosphorus is an essential component of many macromolecules found in bone, lipid membranes, and DNA. It circulates in serum as phosphate. Phosphate level is mainly determined by kidney function. Other factors such as 1, 25 vitamin D3, thyroid hormone and low phosphorous intake can increase renal absorption of phosphate. Hyperphosphatemia presents when serum phosphate is above 4.5 mg/dl (1.45 mmol/L). The phosphate target for hemodialysis (HD) patients is 5.5 mg/dl (1.77 mmol/L) or less. Serum phosphate is commonly measured through the colorimetric method and can also be measured isotopically. Depending on the method used to measure the serum phosphate, many factors have been reported to produce falsely elevated levels. Methods: 52-year-old female with past medical history of end stage renal disease on HD, heart failure with severely reduced ejection fraction secondary to ischemic cardiomyopathy status post left ventricular assist device (LVAD), type 2 diabetes, hypertension, upper gastrointestinal bleeding, anemia, was admitted at a rehabilitation center after a hospital stay due to COVID-19 infection and E. faecium bacteremia secondary to a drive-line infection of the LVAD which was treated with daptomycin. On admission, the patient was found to have a phosphorus level of 6.3 mg/dl, PTH 265 pg/mL, corrected calcium 10 mg/dl, and hemoglobin 9.1 g/dL. Results: Patient was started on oral Sevelamer tablets 800 mg every 8 hours and underwent regular full HD sessions. However, the hyperphosphatemia persisted. Sevelamer was increased to 1600 mg every 8 hours, and she was maintained on a strict low phosphorous renal diet. Four days later while on the new regimen, the phosphorous increased to 12.2 mg/dl. She remained asymptomatic. Hemolysis and hyperbilirubinemia were excluded. A serum protein electrophoresis revealed a monoclonal spike in the gamma region with gamma % of 38.5 (normal range 11-20), gamma globulin 3.0 g/dL (normal range 0.6 – 1.6 g/dL), and quantification of the abnormal protein of 0.41 g/dL (5.3% total). Serum immunofixation showed a probable IgG Lambda monoclonal band. A serum free light chain assay demonstrated a Kappa light chain free serum of 548.9 mg/L (normal range 3.3 – 19.4 mg/L) and Lambda light chain free serum 549.7 mg/L (normal range 5.7 – 26.3 mg/L). Patient was diagnosed with a monoclonal gammopathy, and the elevated phosphorus deemed to be pseudohyperphosphatemia secondary to paraproteinemia. Conclusions: Colorimetric assay with phosphomolybdate ultraviolet (UV) is commonly used for measurement of serum phosphate. The ammonium molybdate reacts with the phosphate to form a cloudy complex, UV absorbance is measured at a specific wavelength. Several factors have been reported to cause falsely high phosphate such as hyperlipidemia, hyperbilirubinemia, hemolysis, liposomal amphotericin B, recombinant tissue plasminogen activator, heparin sulfate, and gammopathies. The paraproteinemia present in monoclonal gammopathies creates a cloudier sample which increases the absorbance of UV light leading to spurious elevation of serum phosphate. Although hyperphosphatemia is a common finding in dialysis patients, the presence of persisting or worsening hyperphosphatemia in a compliant patient taking phosphorous binders and adhering to a low phosphorus diet should raise concern for pseudohyperphosphatemia. No conflict of interest

Hemoperfusion with the Cytosorb device in a patient with severe COVID-19

The COVID-19 disease is an infectious disease caused by the SARS-CoV 2 virus whose clinical presentation is very heterogeneous: it can range from asymptomatic people to critically ill patients, with cytokine storm, acute respiratory distress, organ dysfunction and even death. Current therapies for its treatment are aimed at reducing the impact of the inflammatory cascade, and within these we find hemoadsorption technologies such as the CytoSorb membrane. Next, we present a 31-year-old male patient, who consulted due to severe symptoms of COVID-19 and showed an evident clinical and biochemical improvement after using the CytoSorb device. This is the only documented patient in Colombia who has undergone haemoperfusion therapy with this device in conjunction with prolonged intermittent renal replacement therapy and favorable clinical outcomes have been recorded. © 2021, Asociacion Colombiana de Nefrologia e Hipertension Arterial. All rights reserved.

High-flow nasal therapy in severe respiratory failure due to SARS-CoV-2

The use of high-flow nasal therapy (HFNT) in patients with severe acute respiratory failure (SARF) due to COVID-19 pneu-monia (NCOVID-19) is debated. Given the lack of beds in Intensive Care Units in the Public Health System of the Province of Neuquén, their use was implemented in general wards. This restrospective multicenter study was carried out to describe the experience of using HNFT in patients with SARF due to NCOVID-19. The primary outcome was the frequency of successful weaning from HFNT and in-hospital mortality (IHM). Two hundred ninety-nine patients were analyzed;120 (40.1%) were successfully withdrawn from HFNT. This failed in 59.8% (179), 44.1% (132) required invasive mechanical ventilation (IMV), and 15.7% (47) was not candidates for intubation. A ROX index ≥ 5 at 6 h after initiation was associated with the success of HFNT (OR 0.26 [IC 95% 0.15-0.46] p<0.0001). The general IHM was 48.5% (145/299), 70.4% (93/132) in patients with IMV, 4.2% (5/120) died after successful weaning from HFNT and 100% (47/47) in the group not candidates for intubation. Patients with TNAFO had a statistically significant decrease in MIH and days of hospitalization. TNAFO in general wards achieved a decrease in the use of IMV, with a reduction in mortality and days of stay in hospitalized for NCOVID-19 with SARF.

Impact of sars-cov-2 infection in waiting list for liver transplantation: A cohort study on clinical outcomes

Purpose: Infections in cirrhotic patients are associated with an increased risk of liverrelated complications (LRC) and mortality. Limited data regarding the prevalence of Coronavirus disease (COVID-19) in cirrhotic patients' awaiting liver transplantation (LT) are available. The aim of this study was to evaluate the prevalence of Sars-cov2 in a cohort of cirrhotic patients and its impact on LRC rate and on LT. Methods: We retrospectively included 187 waitlist patients for LT from 24-January-2020 (2020-cohort) and 123 patients from 24-January-2019 (2019-cohort). All 2020-cohort patients were screened for COVID-19 symptoms with a survey. COVID-19 infection was defined by a positive PCR assay for SARS-CoV-2 on nasopharyngeal swab or the positivity for specific antibodies or typical lung lesions on CT scan. We also assessed the indirect impact of Sars-Cov2 infection on LRC and LT rate, estimated by competitive risk survival analyses in 2020-cohort vs. 2019-cohort (Fine and Gray method). Results: In 2020-cohort, 72.7% (n=136) of patients were male with mean age of 55.5±12, 47.2% (n=85) patients have alcohol and/or NASH related cirrhosis, with a median MELD score of 14.1±7.4. 45.5% (n=71), 38.5% (n=60) and 14.8% (n=23) of patients were A, B and C for Child-Pugh-score, respectively. 172 patients responded to survey and 22% (n= 38) had symptoms. 20/38 patients were tested for Sars-Cov2 and 4 patients were positive. 3/4 patients with COVID-19 disease needed hospitalization and 1 intensive care support. No death was reported and 1 patient was LT. The 2020-cohort and 2019-cohort were comparable for sex (p=0,6), age (p=0.7), comorbidities (p=0.2) and Child-Pugh-score (p=0.2). The cumulative incidence of LRC was not significantly higher in the 2020-cohort vs. 2019-cohort (SHR 0.65, 95% CI 0.36-1.15, p=0.138). The cumulative incidence of LT was significantly lower in the 2020-cohort than in the 2019-cohort (SHR0.21, 95% CI 0.13-0.33, p<0.001). Conclusions: Our study reported a low prevalence rate of Sars-Cov2 infection in a cohort of cirrhotic patients waiting for LT. No Sars-Cov2 infection direct or indirect impact on mortality and LRC rate was reported. However, a significant shortage of LT was found in 2020 cohort.