MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN ACROSS 16 LATIN AMERICAN COUNTRIES: A MULTICENTER STUDY FROM THE REKAMLATINA NETWORK

BackgroundMultisystem Inflammatory Syndrome in Children (MIS-C) is one of the most feared complications following SARS-CoV2 infection in children and adolescents. Few multinational multicenter studies from Latin America have been published.ObjectivesTo describe the clinical presentation, management, and outcomes of MIS-C in Latin America.MethodsObservational, prospective and retrospective, multicenter study to gather information from 84 participating centers across 16 Latin American countries, between August January 1, 2020 and June 30, 2022.ResultsOf the 1,239 reported cases of MIS-C, 84.2% were previously healthy. The most frequent clinical manifestation in our studied population was abdominal pain (N=804, 64.9%), followed by conjunctival injection (N=784, 63.3%). The median days of fever at the time of hospital admission was 5 and a significant number of subjects required admission to an intensive care unit (N=589, 47.8%). A total of 538 (47.2%) patients had an abnormal initial echocardiogram. Most of the subjects (N= 1,096, 88.7%) were treated with intravenous immunoglobulin (IVIG), while 76.7% (N= 947) were treated with steroids, of which 10.6% (N= 100) did not receive IVIG. The death rate attributed to MIS-C was 4.88%, with a rate of 3.39% for those initially diagnosed with MIS-C and 8.85% for those whose admission diagnosis was not MIS-C (P= 0.00001).ConclusionOne of the most significant findings from our study was the death rate, especially in those not initially diagnosed with MIS-C, in whom it was higher. This highlights the importance of increasing awareness and making an earlier diagnosis of MIS-C in Latin America.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Pbmc Immunophenotyping and Plasma Inflammatory Profile of Children with Long Covid

Background: Long COVID can be developed by individuals after an infection with SARS-CoV-2 as described by the WHO. Although this condition is more commonly described in adults, it can occur in children and adolescents with a wide range of estimated prevalence of 1-25%. Little is known about the role of the immune system in long COVID. However, one of the main hypotheses about the underlying mechanism in long COVID is that there is an immune and inflammatory dysregulation that persists after the acute infection. The objective of this study is to compare immune cells populations, and inflammatory biomarkers in paediatric populations with and without long COVID. Method(s): We analyzed 55 blood samples from the pediaCOVID cohort (Hospital Germans Trias i Pujol), which includes more than 130 children diagnosed with long COVID and 23 controls. We measured different immune cell populations using spectral cytometry with a panel of 37 cellular markers, and 42 inflammatory markers using Luminex or ELISA. EdgeR was used for statistical analysis of the spectral data;p-values of inflammatory markers were calculated using the likelihood ratio test and they were corrected for multiple comparisons. Result(s): The study cohort had a median age of 14.3 (IQR, 12.5-15.2) and 69.1% female. Patients had at least 3 symptoms associated with long COVID (median [IQR];10 [7-16]). The most common symptom was asthenia/fatigue (98.2%). Compared to the control cohort, children with long COVID had increased numbers of CD4+CD8+ T cells, IgA+CD21+CD27+ memory B cells, and IgA+CD21-CD27- memory B cells, while CD4+ TEMRA cells (CD45RA+, CCR7-), intermediate monocytes (CD14+, CD16+) and classical monocytes (CD14+, CD16-) were decreased (all p< 0.05;q=n.s.). None of the 42 inflammatory biomarkers showed significant differences between children with and without long COVID. Conclusion(s): The results of this study suggest that specific populations of peripheral blood immune cells might be involved in the mechanisms underlying prolonged COVID in children and adolescents. The increase in both IgA+CD21-CD27- and IgA+CD21+CD27+ memory B cells could be associated with the persistence of viral antigen in the gut and/or gut dysbiosis. Moreover, the decrease in CD4+ TEMRA cells could be related to autoantibodies against G-protein coupled receptors (GPCRs), since this cell population can express GPR56, and autoantibodies against GPCRs were previously reported to be elevated in adults with long COVID.

Psychological care service for children and adolescents convalescing from COVID-19 in Villa Clara

Background: children and adolescents constitute a sensitive population to the psychological impacts of the COVID-19 pandemic. Recognizing it implies the need for evaluation, monitoring and intervention, especially when it comes to infants who have suffered from the disease and require comprehensive pediatric care. Objective: to implement a psychological care service for children and adolescents convalescent from COVID-19.Methods: a participatory action research design was applied from a constructive-interpretive qualitative approach. It is made up of three lines of action: psychological evaluation, psychotherapeutic intervention and social support. Its design and implementation followed stages and was carried out collaboratively. The participants involved established symmetrical relationships and followed a cyclical process of planning-acting-observing-reflecting;basic procedure to attend and improve the practice.Results: the results were obtained regarding the evaluation and the actions of psychological intervention. Regarding the evaluation, clinical-psychological alterations with affectation of the psychic functions and needs for the preservation of health in the personal and family spheres stand out. Regarding the psychological intervention, all the beneficiaries received psychological counseling actions and those diagnosed with a psychiatric condition received psychotherapeutic actions. All families received social support. Conclusions: The psychological symptoms intensity reduction or remission was verified, elaboration of grief in the loss, adaptation of coping or behavior modification, strengthening of the social support networks' capacity, expansion of family knowledge, and creation of information channels between the family and the school.

Identification of effective ventilation strategies to reduce the risk of COVID-19 infections inside buildings, using the INDALO (R) digital multizone model

Faced with epidemic risks, ensuring an exchange of air and sufficient direction of airflow is essential to reduce the air-borne transmission of infectious agents in buildings. In this study, we strove to identify effective ventilation strategies to reduce the risk of infection by COVID-19 inside buildings. To do so, we developed a multi-route transmission model of SARS-CoV-2 (INDALO (R)-COVID) which estimates a risk of infection.This study enabled us to quantify the impact of two preventive measures (installation of a mobile air purifier and increase in the renewal of air by the air purification unit) on the risk of COVID-19 infection in a nursing home. In the configuration used in this study, the use of an air purifier in the rooms of residents with COVID-19 appears to be the most effective measure to reduce the viral load potentially transported to other areas of the building, and thus to reduce the risk of COVID-19 infection among all residents.The digital model developed is a versatile and ready-to-use solution, which can compare preventive measures and design/renovation choices for different types of buildings and uses.

Ordering countries when managing COVID-19

Here we assess countries' management of the coronavirus 2019 (COVID-19) pandemic using the reliability measure P(X ≤ Y). In this management, all kind of strategies as interventions deployed by governments as well individuals' initiatives to prevent, mitigate, and reduce the contagion of this disease are taken into account. Also, typical customs practiced locally and influencing contagion are included. Regarding a number of countries and rates associated to deaths and incidence, orderings of countries about such management are established, by using the measure of reliability indicated above. In this way, countries are distinguished from each other depending on how they managed this pandemic. This kind of analysis may be extended to the management of other diseases. Copyright © 2023 Cadena and Méndez.

Drug utilization in patients with SARS-CoV-2 in an intensive care unit

Context: Prescription indication studies allow identifying the problems that arise during the use of the drug. Aims: To evaluate the treatments used in patients diagnosed with SARS-CoV-2 infection hospitalized in critical care service, through a prescription indication study.Methods: A longitudinal observational study of medication use of the indication-prescription type with elements of the therapeutic scheme and practical consequences was carried out. The sample was characterized from the sociodemographic, clinical, and pharmacotherapeutic points of view. The prescription was evaluated through the indicators: indication, therapeutic scheme, treatment individualization, and drug combinations. The detected adverse reactions were classified according to their causality by the Naranjo Algorithm, their severity, their clinical significance, and according to their mechanism by Rawlins and Thompson.Results: In the sample (n = 77), the male gender predominated (79%) between 27-59 years old (64%), alcohol consumer (62%), hypertensive (33%) with long hospital stay (51%). A total of 417 medications were analyzed, being antibiotics (50.6%) the most prescribed. 73.4% of the therapeutic schemes were correct;however, 26.6% had problems with the therapeutic schemes due to incorrect doses, intervals, duration of treatment, and risky interactions. According to Rawlins and Thompson, two probable adverse reactions were detected, mild, non-serious, and type A and B.Conclusions: The results obtained will allow the pharmaceutical professional to create risk matrices that guarantee a timely intervention in the health team to contribute to the rational and safe use of medicines in patients infected with SARS-CoV-2.

Higher Education Student Complaint Behavior in a Complex Service Ecosystem: A Value Co-creation Perspective

During the global covid-19 pandemic, most of higher education institutions (heis) were forced to migrate to an e-learning methodology in order to continue their academic activities. At the same time, the student complaint behavior (scb) increased due to new experiences of dissatisfaction or non-satisfaction. In this context, and seeking to ensure student satisfaction, heis have managed this behavior in the same form that companies do with their customers. Therefore, we present a critical analysis on the generic and standardized approach in the literature and practice to understanding and managing scb in the same way as customer complaint behavior (ccb) is man-aged. A review of the literature on the theories and studies related to scb and ccb and the student/ customer treatment debate are presented, highlighting the complexity of higher education (he) service, which is considered a pillar of development due to its social value. The authors argue the suitable application of the Service-Dominant Logic (sdl), specifically its value co-creation premise, as well as the principles of the Service Ecosystem theory to differentiate scb from ccb. This may allow heis to continue to ensure student satisfaction through the management of their complaints without compromising educational quality and service sustainability. The reflection hereby presented is limited to the Latin America region educational contexts and their structures. © 2023, Universidad Nacional de Colombia. All rights reserved.

Optimal thromboprophylaxis and anticoagulant strategies in patients with COVID-19 pneumonia. The PROTHROMCOVID Trial

Introduction: Hospitalized patients with COVID-19 are at increased risk of venous and arterial thrombosis, ARDS, and death. The optimal dosage of thromboprophylaxis in patients is unknown. Objective: To evaluate the efficacy and safety of tinzaparin in prophylactic, intermediate and therapeutic doses in non-critical patients admitted for COVID-19 pneumonia.Design, Setting, and Participants: The PROTHROMCOVID multicenter randomized clinical trial enrolled noncritical hospitalized adult patients with COVID-19 pneumonia from February 1, 2021, to September 30, 2021, at 18 centers in Spain. Methods: Patients were randomized to prophylactic tinzaparin 4500IU or intermediate dose 100IU/kg or therapeutic tinzaparin 175IU/kg during hospitalization, followed by 7 days of prophylactic tinzaparin at discharge. The patients were stratified at the time of randomization according to age, sex and the presence or absence of hypertension.The primary efficacy outcome was a composite endpoint of symptomatic systemic thrombotic events, need for invasive or non invasive mechanical ventilation or not, including high-flow nasal cannula oxygen, or death within 30 days. The main safety outcome was major bleeding at 30 days. Data were collected and adjudicated locally by non-blinded investigators through imaging, laboratory, and health record data. Results: Of 311 patients randomized, 300 were included in the analysis (mean [SD]age, 56.7 [14.6] years;men, 182 [60.7%];women, 118 [39.3%]). 106 patients (35.33%) were assigned to the prophylaxis group, 91 patients (30.33%) were allocated to the intermediate dose group and 103 patients (34.33%) were randomized to the anticoagulant dose group. The composite endpoint thrombotic event, need for invasive (IMV) or noninvasive mechanical ventilation (NIV) or HFT via nasal cannula or death at 30 days from randomization occurred in 58 patients (19.3%) of the whole population, 19 patients (17.09%) in prophylactic group, 20 (21.98%) in intermediate group and 19 (18.45%) in therapeutic group (P=0.72). No major bleeding were reported in the trial and non-major bleeding occurred in 5 patients (4.71%) in prophilactic, in 3 patients (3.2%) in intermediate arm and in 3 patients (2.9%) in therapeutic, without significant differences in each group (P=0.31). Conclusions: In non-critically ill patients with COVID 19, intermediate or full-dose of tinzaparin do not appear to offer benefit over standard prophylactic doses IU in the likelihood of thrombotic event, non-invasive ventilation or high-flow oxygen, or death. Funding Acknowledgement: Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Leo Pharma

Drug utilization in patients with SARS-CoV-2 in an intensive care unit

Context: Prescription indication studies allow identifying the problems that arise during the use of the drug. Aim(s): To evaluate the treatments used in patients diagnosed with SARS-CoV-2 infection hospitalized in critical care service, through a prescription indication study. Method(s): A longitudinal observational study of medication use of the indication-prescription type with elements of the therapeutic scheme and practical consequences was carried out. The sample was characterized from the sociodemographic, clinical, and pharmacotherapeutic points of view. The prescription was evaluated through the indicators: indication, therapeutic scheme, treatment individualization, and drug combinations. The detected adverse reactions were classified according to their causality by the Naranjo Algorithm, their severity, their clinical significance, and according to their mechanism by Rawlins and Thompson. Result(s): In the sample (n = 77), the male gender predominated (79%) between 27-59 years old (64%), alcohol consumer (62%), hypertensive (33%) with long hospital stay (51%). A total of 417 medications were analyzed, being antibiotics (50.6%) the most prescribed. 73.4% of the therapeutic schemes were correct;however, 26.6% had problems with the therapeutic schemes due to incorrect doses, intervals, duration of treatment, and risky interactions. According to Rawlins and Thompson, two probable adverse reactions were detected, mild, non-serious, and type A and B. Conclusion(s): The results obtained will allow the pharmaceutical professional to create risk matrices that guarantee a timely intervention in the health team to contribute to the rational and safe use of medicines in patients infected with SARS-CoV-2. Copyright 2022 Journal of Pharmacy & Pharmacognosy Research

Network for the continuous monitorization of environmental quality in educational buildings

In this article we present a measurement network designed to improve air quality and energy efficiency in educational centers. We have made prototypes with carbon dioxide, temperature, humidity and light sensors with network connection for remote storage and processing of data, as well as autonomous prototypes. The design and construction of the equipment has been accelerated by taking advantage of previous experiences and has been carried out by the electronics teachers and students of the IES Escolas Proval de Nigran (Spain) within the framework of an Innovation Project granted by the Xunta de Galicia. The IES Val Miñor of Nigran also participates in the project in the development and interpretation of data, and the company Hermes Smart Control acts as a technology transfer center and has made a commercial product. The project has already been extended to other educational centers, taking measurements that demonstrate its usefulness for the application of ventilation regulations during the COVID-19 pandemic and are planned future uses such as automatic ventilation control or the improvement of energy efficiency in the educational buildings. © 2022 IEEE.

The role of school counselors in times of COVID-19

There is a growing need in schools for counsellors with an increasingly wide range of competences, amongst which socio-emotional competencies occupy a preferential place. Undoubtedly these competences have an enormous potential for dealing with various, unforeseen educational situations, especially in times of Covid-19. As a result of this, a study was undertaken with a quantitative methodological design (Likert-type rating scale) with the aim of specifically finding out the evaluations of secondary school counsellors within the Autonomous Community of Galicia on the socio-emotional competences and thus contribute to the effectiveness of their educational work particularly in the complex scenarios like the ones we are live in. This study offers valuable information that may likely be implemented, including the fostering of the most relevant social-emotional competences. © 2021 University of Granada. All rights reserved.

Efficacy of Transcutaneous Posterior Tibial Nerve Stimulation in Functional Constipation (preprint)

Introduction and Aims: Most children with functional constipation (FC) improve with conventional treatments. However, a proportion of children have poor treatment outcomes. Management of intractable FC may include botulinum toxin injections, transanal irrigation, antegrade enemas, colonic resections, and in some cases sacral nerve stimulation (SNS). SNS is surgically placed, not readily available and expensive. Posterior tibial nerve stimulation (PTNS) allows transmission of electronic impulses and retrograde stimulation to the sacral nerve plexus in a portable, simple and non-invasive fashion. Objectives: To assess the efficacy and safety of transcutaneous PTNS for the treatment of FC in children.Materials and Methods: Single-center, prospective interventional study. Children 4-14 years with Rome IV diagnosis of FC received ten daily PTNS (30 min/day) sessions. Electrodes placed over skin of ankle. Strength of stimulus was below pain threshold. Outcomes were assessed during treatment and 7 days after. Results: twenty-three subjects enrolled. Two children excluded (acute gastroenteritis, COVID-19 contact). 20 completed the study (4- 14 years), (8,4+/-3,2years, 71.4 % female). We found significant improvement in the consistency of Bowel Movements (BM) (p=0.005), Fecal Incontinence (FI) (p=0.005), Abdominal pain presence (p= <0.001) and intensity (p=0.005), and a significant for improvement in blood in stools (p=0.037). There was 86.3% improvement in abdominal pain. 96.7% reported treatment satisfaction. Only one child required rescue therapy. Conclusion: We found significant improvement in stool consistency, FI, abdominal pain and hematochezia. This suggests that transcutaneous PTNS could be a promising noninvasive treatment for FC in children. Large studies are needed.

POST-PANDEMIC RE-ADAPTATION AND THE USE OF ICTS: PERCEPTIONS OF STUDENTS FROM GUAYAQUIL UNIVERSITY

The COVID-19 pandemic has generated uncertainty in the university community and an enormous challenge for managing the processes, particularly the educational continuity, during the post-pandemic stage until the total reopening of the university institutions, with the consequent restructuring of the teaching and learning processes, taking advantage of the lessons learned during the crisis. This scientific article analyzes the perceptions of the students of the Information Technology and Telecommunications and Networking Engineering degree courses of the Faculty of Mathematical and Physical Sciences at the University of Guayaquil, on the potentialities of Information and Communication Technologies for their re-adaptation to university scenarios with higher levels of academic presence in post-pandemic contexts. In general, students consider the possibility offered by these technological resources to facilitate the transition from the distance mode to the blended mode without limiting the fulfilment of curricular objectives to be very high, which denotes the students’ preference for hybrid models that harmoniously combine the face-to-face and the virtual instead of the exclusive predominance of only one of these two forms of teaching interaction. © 2022, University of Cienfuegos, Carlos Rafael Rodriguez. All rights reserved.

THE CRISIS AND SPATIALITY OF CARE IN A PANDEMIC: Housing and Neighborhoods in Santiago de Chile

The material conditions of the city offer evidence of socio-territorial segregation. When sanitary measures to control the spread of COVID-19 were applied, those conditions made the extent of segregation in Santiago evident. Thus, the city, neighborhood, and housing scales open possible points of analysis to better understand the care crisis at the territorial level, where segregation and mutual support have been its main characteristics. © 2021, Pontificia Universidad Catolica de Chile 1. All rights reserved.

Dexamethasone and Remdesivir for the Mitigation of COVID-19 Symptoms in Pregnant Patients

OBJECTIVE: To report a series that involves the use of dexamethasone and remdesivir to mitigate the effects of COVID-19 in pregnancy. STUDY DESIGN: Patients in our series had moderate to severe disease and met the criteria for hospitalization. All patients had oxygen saturation <95% and chest CT changes compatible with COVID-19. All patients were treated with remdesivir and dexamethasone after extensive counseling and informed consent by the patient. All patients were also treated with low-molecular-weight heparin, and patients with suspected bacterial pneumonia were treated with ceftriaxone. Our objective was to mitigate the effect of COVID-19 and avoid further decompensation of the maternal-fetal unit. RESULTS: On average, participants were 27.2 years old, the gestational age was 31.0 weeks, gravidity was 3, and BMI was 31.73. None of the patients had a history of diabetes, chronic hypertension, pulmonary disease, or other comorbidities. The average total hospital stay was 7.2 days (range, 6–10 days). CONCLUSION: Nine pregnant patients hospitalized with moderate to severe COVID-19 were treated with dexamethasone and remdesivir, the use of which has yet to be established in pregnancy. All patients recovered and none displayed any lasting adverse effects from this treatment. None of the patients required anything other than supplemental oxygen at the beginning of their treatment. Patients with suspected bacterial pneumonia were treated with ceftriaxone and showed a good response. There were no cases of coagulopathy or other complications. (J Reprod Med 2021;66:321–326). © 2021, Journal of Reproductive Medicine, Inc.. All rights reserved.

CRISIS AND SPACE OF CARE IN PANDEMIA: housing and neighbourhood in Santiago de Chile

The material conditions of the city offer evidence of socio-territorial segregation. When sanitary measures were applied to control the spread of COVID-19, these conditions made the extent of segregation in Santiago. Thus, the city, neighborhood and housing scales offer inputs to understand the care crisis at a territorial level, where segregation and mutual support have been its main characteristics.

Effects Of Percutaneous Tibial Nerve Stimulation In Children With Funtional Constipation

Introduction: Management of intractable Functional Constipation (FC) can include antegrade enemas, transanal irrigation and in some cases sacral nerve stimulation (SNS). SNS is expensive, invasive and not available in all centers. Although the mechanism of action of SNS in the treatment of FC is unclear, one of its effects is through direct modulation of nerve activity. Percutaneous tibial nerve stimulation (PTNS) allows transmission of electronic impulses and retrograde stimulation to the sacral nerve plexus in a simple and non-invasive fashion. Methods: Single-center, prospective interventional study. Children between the ages of 4-14 with Rome IV diagnosis of FC. Exclusion criteria: Neurological problems or organic causes of fecal or urinary incontinence. Over a 2-week period, children received 10 daily sessions of PTNS (30 min/day) during weekdays. Electrodes were placed over the skin of the ankle posteriorly. Placement of electrodes on the anatomic route of the posterior tibial nerve was confirmed through visualization of rhythmic flexion of toes during initial stimulation. Strength of the stimulus was below pain threshold. Children recorded characteristics of bowel movements (BMs) daily during the intervention and the following 7 days. Consistency was assessed through Bristol scale and quality of life (QOL) via PedsQL GI questionnaire. Results: 23 children were enrolled. One child was excluded for acute gastroenteritis (on the 7th session of PTNS) and one child for COVID-19 exposure. 20 patients completed the study (4-14 years) (8,4+/-3,2years, 71.4 % female) day 1 (n=21) to day 17(n=20). By the end of the trial, there was a significant improvement in consistency of BMs, fecal incontinence (FI) (no episodes of FI), presence and intensity of abdominal pain and a trend for improvement in blood in the stools (no children had blood in the stools) (Table 1). In PedsQL GI questionnaire, there was a 91.3% improvement of incomplete BM and 86.3% improvement in abdominal pain. Only one child required rescue therapy (no BM for 3 days). This child was the only treatment failure. Two children reported leg cramps that resolved by changing the side of PTNS application. At 7 days follow-up, there was persistently significant improvement in presence and intensity of abdominal pain and no children had FI or blood in the stools. Conclusion We found an improvement in stool consistency, FI, blood in stools and QOL at the end of the trial with sustained benefits in abdominal pain, blood in stools and FI at follow-up. The study suggests that PTNS may be a promising noninvasive treatment for FC in children. Larger studies with long-term follow-up should confirm our findings. Controlled randomized clinical trials with various protocols are recommended. (Table Presented)

Subsistence Hunting During the COVID-19 Pandemic: The Case of the White-Tailed Deer (Odocoileus virginianus) in Rural Communities of Calakmul, Campeche, Mexico

Subsistence hunting for obtaining wild meat is a common practice in rural neotropical communities. Like other peasant practices disrupted by the COVID-19 pandemic, subsistence hunting could exacerbate pressure on wild mammals whose greater size contributes to feeding the hunter and his family. Thus, in the context of the pandemic, we assessed the subsistence hunting of the white-tailed deer (Odocoileus virginianus), one of the main traditional game species in the Calakmul region, Campeche, Mexico, and compared this activity with its pre-pandemic levels of such vertebrate species. Based on ethnographic information and hunting records from three rural communities, we found that in one trimester (July-September 2020) of the rainy season, a total of 26 white-tailed deer (923 kg of game biomass) were obtained by local peasant-hunters carrying out hunting mostly alone. Most peasant-hunters interviewed (36 of 51) stated that they hunted daily, and only a few hunted once a week or once a month (8 and 3%, respectively). This hunting activity and modalities were carried out at night (68%) versus day, stalking (21%) and opportunist (11%) near their community. The game biomass and hunting frequency in the studied communities were twice as high during the pandemic, compared to similar pre-pandemic periods in the region. Our survey highlights the need to expand monitoring and evaluation (during and after the pandemic) of subsistence hunting on key species, such as white-tailed deer, in order to ensure conservation and sustainable use of wildlife in this important Mesoamerican region.