ACE2 expression in the brain during development and susceptibility to brain infection by SARS-COV-2.

The COVID-19 pandemic spread around the world due to the enormous transmission of the SARS-CoV-2 among humans. COVID-19 represents a threat to global public health. The entry of this virus into cells is greatly facilitated by the presence of angiotensin-converting enzyme 2 (ACE2) in the cell membrane. Today we do not have a precise understanding of how this receptor expresses in the brain during human development and, as a consequence, we do not know whether neural cells in the developing brain are susceptible to infection. We review the knowledge about ACE2 expression in the developing human brain, with special attention to the fetal stage. This stage corresponds to the period of the cerebral cortex formation. Therefore, SARS-CoV-2 infection during the fetal period may alter the normal development of the cerebral cortex. Although few cases have been published demonstrating vertical transmission of SARS-CoV-2 infection, the large number of infected young people may represent a problem which requires health surveillance, due to the possibility of cognitive alterations and abnormalities in the development of cortical circuits that may represent a predisposition to mental problems later in life.Copyright © 2023, Instituto de Investigaciones Medicas. All rights reserved.

INGRESO Y PERMANENCIA EN LA UNIVERSIDAD NACIONAL DEL LITORAL: ESTUDIO DE LAS PRÁCTICAS EDUCATIVAS

In this direction, it is interesting to be able to identify the educational practices that are carried out in our context to define guidelines that regulate academic activities. The objective pursued in this work is to document and describe university educational practices in scientific and technological careers during the virtualization process, as a consequence of the COVID-19 pandemic, in the area of General and Inorganic Chemistry for the follow-up of cohorts of the Faculty of Biochemistry and Cs. [...]a new stage is proposed, the hybrid education between presence and virtuality. Luego, se dio una socialización dentro del DQGI de diferentes estrategias y se desarrollaron materiales adaptados a la virtualización, apoyándose en el Entorno Virtual de la asignatura (https://evirtual.unl.edu.ar/course/view.php?id=3299), que pasó de ser un repositorio de archivos a una plataforma virtual de enseñanza y aprendizaje con múltiples recursos y materiales para el desarrollo de todas las actividades propuestas. * Teorías: Las clases de desarrollo teórico (de tipo expositivo) fueron presentadas a los estudiantes de manera asincrónica (Figura 1) a través de un link al canal de YouTube del Departamento (https://www.youtube.com/channel/UCe4hS RIn2t a w88yMtC2A).

The impact of COVID-19 pandemic on physical activity in persons with multiple sclerosis: an international RIMSSIG Mobility study

Introduction: Restrictions aiming to slow down the spread of COVID-19 had consequences on the amount and content of physical activity in persons with multiple sclerosis (PwMS). Objectives & Aims: To investigate the impact of the COVID-19 pandemic on physical activity in PwMS. Method(s): An online survey was distributed during May - July 2021 in 11 countries. The survey gathered various metrics of physical activity (e.g. type, intensity, use of technology) performed prior to (2019) and during the pandemic (2021). Factors associated with stopping physical activity were also investigated. Result(s): The survey was completed by 3725 PwMS. Prepandemic 83% of the respondents reported being physically active, whereas during the pandemic 75% reported being physically active. Concern of contracting COVID-19 and loss of support were highly predictive factors associated with stopping physical activity. The decrease in physical activity was significant for both moderate and high intensity physical activity (p<.0001). Prior to the pandemic, 66% of the respondents reported physical activity behaviour indicating that they met the physical activity guidelines, while during the pandemic the respondents meeting the physical activity guidelines was 50%. The proportion of respondents meeting the guidelines decreased with increasing disability (Pre/during-pandemic: mild: 64%/ 55%;moderate: 52%/ 43%;severe: 39%/ 30%). Walking was the most frequent activity pre-pandemic (27%) and during the pandemic (33%). Of the 25% respondents who were inactive during the pandemic, 31% reported no interest in changing their physical activity behaviours, and 44% expressed a preference for a face-to-face format to conduct physical activity after the pandemic. During the pandemic, the most used technology (24%) were wearables (e.g. smart watch). Conclusion(s): Physical activity was reduced in PwMS from before to during the pandemic. Concerns of contracting COVID-19 and a loss of support were highly associated with reduced physical activity. There is a need to support PwMS aiming to increase physical activity. Physical activity programmes which address walking (the most frequent), disability and the use of wearable technology may be preferable.

The impact of the COVID-19 pandemic on physiotherapy services for people with multiple sclerosis: a multicentre survey study of the RIMS network

Introduction: The COVID-19 pandemic has placed a strain on healthcare services worldwide with a highly heterogeneous impact. Therefore, the Special Interest Group for Mobility (SIG Mobility) of the European Network for Best Practice and Research in Multiple Sclerosis Rehabilitation (RIMS) decided to examine the impact of the COVID-19 outbreak on physiotherapy services in people with multiple sclerosis (pwMS). Objective(s): To describe the impact of the pandemic on physiotherapy practice from the perspective of physiotherapists (PTs) by investigating changes in rehabilitation methods, organizational framework, and technology usage. Method(s): An online survey was developed by RIMS SIG Mobility and distributed to PTs in 9 countries (Australia, Belgium, Czech Republic, Ireland, Israel, Italy, Norway, Spain, and Turkey) from December 2020 to July 2021. Result(s): 215 PTs participated in the study. The therapy most affected during the pandemic was aerobic training/conditioning exercises;33.5% reported that these activities were either reduced or unavailable. In contrast, 15% reported increased use of relaxation/ mind-body techniques and/or fatigue management programs. Frequency, total number, and duration of sessions decreased significantly during the pandemic compared to before the pandemic (p<0.001). Physiotherapy service delivery (accessibility) and effectiveness for pwMS were significantly decreased (p<0.001). There was a 10% decrease in the use of hands-on techniques and a 10% increase in the use of oral instructions when treating pwMS having moderate or severe disability during the pandemic compared to before. PTs increased use of telerehabilitation applications during the pandemic (p<0.001): app usage increased significantly from 37% to 56%, use of recorded videos from 38% to 55%, use of physiotherapy exercise websites from 33% to 52%, and use of exercise classes on TV from 7% to 20%. The top 4 challenges faced in telerehabilitation were limitations of assessment (54%), difficulties with equipment (43%), difficulties with understanding the patient's body language (35%), and not being able to use proprioceptive cues (35%). Conclusion(s): The COVID-19 pandemic has notably affected physiotherapy services for pwMS internationally in terms of content, frequency of use, format, accessibility, and effectiveness. The long-term consequences of these changes should be investigated.

Commercial Management Model for Brand Awareness in a SME Company of Footwear Sector Before the COVID-19 Context

The objective of the research was to design a commercial management model for the brand awareness of an SME company in the Footwear Sector, of the city of Trujillo- Peru in 2021 in the context of COVID-19. The work methodology according to the approach is mixed, applied, prospective. Information gathering techniques from documentary analysis, observation of processes, interviews with the general manager and sales manager. A reliable questionnaire (Cronbach's Alpha of 0.811) and validated by expert judgment was applied to 40 clients (convenience sampling). The study was developed in three phases: Phase 1 - Strategic Formulation and Planning, with the analysis of the organizational culture, internal and external analysis, commercial analysis, Phase 2 - Strategic design, with the approach of 7 objectives and 8 strategic initiatives and Phase 3 - Evaluation and strategic monitoring, with the design of the Balanced Scorecard with performance evaluation indicators. Finally, a total investment of S / 76,530 was determined with an annual cost of S / 71,020 in 4 years of the project duration with a positive NPV of S / 173,598.16, IRR of 87% higher than the rate used and a B / C ratio of 1.58, which demonstrates the economic impact and positive viability of the implementation of the designed model in the company under study. © 2021 Latin American and Caribbean Consortium of Engineering Institutions. All rights reserved.

EVALUATION of the EFFICACY and SAFETY of the SARS-COV-2 VACCINE in PATIENTS with CHRONIC INFLAMMATORY DISEASES TREATED with BIOLOGICAL THERAPY

Background: In the current situation of the SARS-CoV-2 pandemic, the Spanish Society of Rheumatology recommends vaccination of patients with chronic infammatory diseases (CID) under treatment with biological DMARDs (bDMARDs). However, the data regarding the generation of protective antibody titers after mRNA vaccines in patients with CID is limited. Objectives: To determine the seroconversion rate and safety after the SARS-CoV-2 vaccine in patients with CID under treatment with bDMARDs Methods: Cross-sectional observational study of 81 patients with CID from the HURS in Córdoba, who have received full vaccination for SARS-CoV-2 (without having previously suffered from COVID-19 disease) according to national guidelines. A determination of specifc IgG-type antibodies against the trimeric spike protein of SARS-CoV2 was performed on all of them. The chemilumines-cence technique with the kit was used in serum samples taken 4-5 weeks after administration of the second dose of the vaccine. Information about sociode-mographic characteristics, disease, type of bDMARDs, concomitant treatments and adverse effects after the second dose of the vaccine were collected in each patient. Results: 81 patients were included (mean age 59.5, 72.8% females). 50.6% of patients had RA, 17.3% SpA, 11% PsoA and 18.5% other CID. 23.5% were under treatment with Rituximab, 38.8% antiTNF, 13.6% Tocilizumab, 9.9% abatacept, 5% anti-JAK and 14.2% under other treatments. Anti-SARS-CoV-2 antibodies and neutralizing activity were detected in 80% of study participants. Rituximab treatment was signifcantly associated with negative seroconver-sion in comparison with patients under antiTNF treatment (OR 84.0 (95%CI 12.9-1709.2)). No interaction was found between the bDMARDs treatment and the type of vaccine with regard to the seroconversion, nor between bDMARDs and concomitant synthetic DMARD. When we evaluated IgG titers against the spike protein of SARS-CoV2, we found that patients under treatment with Rituximab showed the lowest titers levels in comparison with patients with other treatments (Figure 1, Table 1). In addition, patients who received AstraZeneca vaccine developed lower titers of antibodies in comparison with patients who received Pfzer (Table 1). Interestingly, among patients with antiTNF treatment, AstraZeneca was associated with lower IgG titers in comparison with Pfzer and Moderna [405.9 (553.0) vs. 1084.1 (791.2) vs. 1264.0 (1012.6), p=0.016, respectively]. No differences between vaccines were found in patients with the other type of bDMARDs. Only 18.9% presented mild adverse effects. No serious adverse effects were observed and no patient experienced a disease fare after vaccination. Conclusion: Our results show that SARS-CoV-2 mRNA vaccines produce sero-conversion in most patients with CID, except in the case of patients with rituxi-mab. No severe adverse effects or CID reactivation were found. Despite the small number of patients included, this study suggests the need for revaccination in the group of patients treated with rituximab or vaccinated with Astrazeneca.

SARS-CoV-2 seroprevalence among people living with HIV in Guinea-Bissau.

OBJECTIVES: In low-income countries with poor SARS-CoV-2 monitoring and high HIV burden, the prevalence of SARS-CoV-2 is scarcely studied in people living with HIV (PLWH). We set out to measure SARS-CoV-2 seroprevalence in this group. STUDY DESIGN: Serosurvey of SARS-CoV-2 in PLWH. METHODS: We measured IgG/IgM antibodies using point-of-care rapid tests in 294 PLWH with HIV-1, HIV-2 or HIV-1/2 dual infection at an HIV clinic in Guinea-Bissau between June 1, 2021, and October 1, 2021. RESULTS: Unvaccinated PLWH (n = 195), constituting 66% of the total study population, had a seroprevalence of SARS-CoV-2 antibodies of 27.7%. Of SARS-CoV-2 seropositive unvaccinated PLWH, 71.2% reported no symptoms of COVID-19 since the start of the epidemic up to the inclusion date. Among all participants, 90.1% reported never having been tested for SARS-CoV-2 by any test (n = 292). Six participants reported a household death, corresponding to a crude annual death rate of 3.3 per 1000 people. CONCLUSIONS: Despite a low number of officially registered cases of SARS-CoV-2 in Bissau, we found a high seroprevalence of SARS-CoV-2 of 27.7% in unvaccinated PLWH. Coupled with few ever tested for SARS-CoV-2, it indicates that official PCR testing likely underestimates prevalence and that SARS-CoV-2 monitoring is challenged for PLWH. The low number of symptoms from seropositives may stem from survival bias, some effect of herd immunity or, coupled with a low crude annual death rate, that disease symptomatology and severity could be lower than expected.

Validation de la traduction française du CQR-5 (Compliance Questionnaire for Rheumatology), auto-questionnaire d’adhésion thérapeutique spécifique aux patients atteints de rhumatismes inflammatoires chroniques

Introduction Afin d’évaluer l’adhésion des patients souffrant de rhumatismes inflammatoires chroniques (RIC) à leurs traitements, de nombreux auto-questionnaires existent dont celui dédié et validé par la British Society of Rheumatology, le Compliance Questionnaire for Rheumatology (CQR) à 19 questions. Dans un souci de facilité et de rapidité d’utilisation en pratique clinique, a été développée et validée une version à 5 items (CQR-5) permettant de définir soit un profil hautement adhérent soit faiblement adhérent. L’objectif de cette étude a été de traduire et valider la traduction française du CQR-5 en suivant les recommandations internationales [1]. Matériels et méthodes Une étude observationnelle et monocentrique a été menée chez des patients atteints de RIC ayant eu une consultation médicale en rhumatologie entre mai 2019 et avril 2020. Les patients inclus étaient traités par un biomédicament sous forme sous-cutanée depuis au moins 3 mois. Les patients ont été invités à compléter en ligne deux fois le questionnaire CQR-5 ainsi que le questionnaire Routine Assessment of Patient Index Data 3 (RAPID3) à sept jours d’intervalle pour s’assurer de la stabilité de la maladie. L’adhésion des patients a été aussi évaluée grâce au Medication Possession Ratio (MPR) sur une période de 6 mois (juillet 2020 à janvier 2021) par un appel au pharmacien d’officine déclaré préalablement par le patient. La validité du CQR-5 a été évaluée par le coefficient α de Cronbach, par la méthode du test-retest à 7jours et par la comparaison au MPR en utilisant le coefficient de corrélation de Mathews. Résultats Au total, 92 patients ont été inclus (moyenne d’âge : 47,5±13,6 ans et 56,5 % de femmes). Les patients étaient atteints de spondyloarthrite (75 %), de polyarthrite rhumatoïde (23,9 %) ou d’arthrite juvénile (1,1 %). Parmi les biomédicaments, les anticorps monoclonaux anti TNF-α étaient prescrits chez 78,3 % des patients. Selon le CQR-5 français, 81,5 % (n=75) des patients étaient hautement adhérents. Selon le MPR, 79 % des patients étaient hautement adhérents. Selon le MPR, la sensibilité et la spécificité du CQR-5 étaient respectivement de 85 % et 32 % (corrélation : 0,17). La consistance interne du CQR-5 français est fiable (α Cronbach : 0,74 ;IC95 % :0,66-0,83), a une seule dimension (les 5 items explorent bien un seul concept : l’adhésion) et est reproductible (Kappa : 0,82 (95 %CI 0,51-0,96)). Discussion La faible spécificité de la version française par rapport au MPR peut être expliquée par la période de recueil de données (la pandémie COVID19 ayant entraîné des suspensions de biomédicament) et par l’espacement médicalement autorisé des injections par les patients, ce qui a contribué à sous-estimer le MPR. Conclusion La traduction française du CQR-5 est un outil pratique, rapide et reproductible en pratique clinique comme outil d’évaluation de l’adhésion aux biomédicaments chez les patients atteints de RIC.

Management of tubal ectopic pregnancy with methotrexate in the setting of symptomatic Coronavirus disease 2019 (COVID-19): A case report.

Background: Coronavirus Disease 2019 (COVID-19) represents a complex therapeutic challenge. As the pandemic progresses, patients are presenting with ectopic pregnancies (EPs) and symptomatic COVID-19. Objective: We present the management of a patient with multiple medical comorbidities and tubal EP in the setting of severe symptomatic COVID-19 infection where all management options were precluded. Methods: Case report with literature review of management of tubal EP in the setting of severe symptomatic COVID-19 infection. Result: After careful consideration of options, the patient underwent successful medical management with methotrexate while receiving supportive care for COVID-19. Conclusions: Methotrexate proved to be the safest therapeutic option in this patient. Management of patients with severe COVID-19 and gynaecologic emergencies should be individualised and carefully reviewed with evolving knowledge of COVID-19.

Hospitalization and mortality from COVID-19 of patients with rheumatic inflammatory diseases in Andalusia.

OBJECTIVE: To describe whether rheumatic inflammatory diseases (RID) are associated with a higher risk of hospitalization and/or mortality from COVID-19 and identify the factors associated with hospitalization and mortality in RID and COVID-19 in different Hospitals in Andalusia. METHODS: Design: Multicentre observational case-COntrol study. PATIENTS: RID and COVID-19 from different centres in Andalusia. CONTROLS: patients without RIS matched by sex, age and CRP-COVID. Protocol A list of patients with PCR for COVID-19 was requested from the microbiology service from March 14 to April 14, 2020. The patients who had RID were identified and then consecutively a paired control for each case. Variables The main outcome variable was hospital admission and mortality from COVID-19. Statistical analysis Bivariate followed by binary logistic regression models (DV: mortality/hospital admission). RESULTS: One hundred and fifty-six patients were included, 78 with RID and COVID-19 and 78 without RID with COVID-19. The patients did not present characteristics of COVID-19 disease different from the general population, nor did they present higher hospital admission or mortality. The factor associated with mortality in patients with RID was advanced age (OR [95% CI], 1.1 [1.0-1.2]; P= .025), while the factors associated with hospitalization were advanced age (OR [95% CI], 1.1 [1.0-1.1]; P = .007) and hypertension (OR [95% CI], 3.9 [1.5-6.7]; P = .003). CONCLUSION: Mortality and hospital admission due to COVID-19 do not seem to increase in RID. Advanced age was associated with mortality in RID and, in addition, HTN was associated with hospital admission.

Registry of neurological manifestations due to coronavirus-19 (COVID-19)

COVID-19 disease has spread around the world since December 2019. Neurological symptoms are part of its clinical spectrum. Objective: To know the neurological manifestations in patients infected by COVID-19 in Argentina. Methods: Multicenter study conducted in adults, from May 2020 to January 2021, with confirmed COVID-19 and neurological symptoms. Demographic variables, existence of systemic or neurological comorbidities, the form of onset of the infection, alteration in complementary studies and the degree of severity of neurological symptoms were recorded. Results: 817 patients from all over the country were included, 52% male, mean age 38 years, most of them without comorbidities or previous neurological pathology. The first symptom of the infection was neurological in 56.2% of the cases, predominantly headache (69%), then anosmia/ageusia (66%). Myalgias (52%), allodynia/hyperalgesia (18%), and asthenia (6%) were also reported. 3.2% showed diffuse CNS involvement such as encephalopathy or seizures. 1.7% had cerebrovascular complications. Sleep disorders were observed in 3.2%. 6 patients were reported with Guillain Barré (GBS), peripheral neuropathy (3.4%), tongue paresthesia (0.6%), hearing loss (0.4%), plexopathy (0.3%). The severity of neurological symptoms was correlated with age and the existence of comorbidities. Conclusions: Our results, similar to those of other countries, show two types of neurological symptoms associated with COVID-19: some potentially disabling or fatal such as GBS or encephalitis, and others less devastating, but more frequent such as headache or anosmia that demand increasingly long-term care.

Hospitalization and Mortality from COVID-19 of Patients with Rheumatic Inflammatory Diseases in Andalusia. / Hospitalizaciones y mortalidad por COVID-19 en pacientes con enfermedades inflamatorias reumáticas en Andalucía.

OBJECTIVE: To describe whether rheumatic inflammatory diseases (RID) are associated with a higher risk of hospitalization and/or mortality from COVID-19 and identify the factors associated with hospitalization and mortality in RID and COVID-19 in different Hospitals in Andalusia. METHODS: Design: Multicentre observational case-control study. PATIENTS: RID and COVID-19 from different centres in Andalusia. CONTROLS: patients without RIS matched by sex, age and CRP-COVID. Protocol A list of patients with PCR for COVID-19 was requested from the microbiology service from March 14 to April 14, 2020. The patients who had RID were identified and then consecutively a paired control for each case. Variables The main outcome variable was hospital admission and mortality from COVID-19. Statistical analysis Bivariate followed by binary logistic regression models (DV: mortality/hospital admission). RESULTS: One hundred and fifty-six patients were included, 78 with RID and COVID-19 and 78 without RID with COVID-19. The patients did not present characteristics of COVID-19 disease different from the general population, nor did they present higher hospital admission or mortality. The factor associated with mortality in patients with RID was advanced age (OR [95% CI], 1.1 [1.0-1.2]; p = 0.025), while the factors associated with hospitalization were advanced age (OR [95% CI], 1.1 [1.0-1.1]; p = 0.007) and hypertension (OR [95% CI], 3.9 [1.5-6.7]; p = 0.003). CONCLUSION: Mortality and hospital admission due to COVID-19 do not seem to increase in RID. Advanced age was associated with mortality in RID and, in addition, HTN was associated with hospital admission.

Pregnancy outcomes among women with and without COVID-19 in a national level III hospital in Peru

Objective: To compare pregnancy outcomes among women with and without COVID-19 infection attended in a national level III hospital in Peru. Method: Observational, retrospective and comparative study. RT-PCR positive pregnant women participated in a 1:1 ratio with negative RT-PCR, and 1:2 with pregnant women of 2019. Maternal and perinatal information was collected. Fisher’s exact test was used with a significance level of 0.05 and prevalence ratios (PR) with their confidence interval of 95% (CI95%). Results: 51 pregnant women with positive RT-PCR, 51 with negative RT-PCR and 102 pregnant women in 2019 participated. RT-PCR test were associated to preterm delivery (p < 0.05). The PR for preterm delivery in women with positive RT-PCR compared to pregnant women in 2019 was 3.14 (CI95%: 1.29-7.64);and compared to women with negative RT-PCR was 4.0 (CI95%: 1.13-14.17). Conclusions: The study’s findings suggest the existence of an association between maternal COVID-19 and preterm birth. However, more studies are required to analyze the role of maternal factors. © 2021 Sociedad Chilena de Obstetricia y Ginecología.