BIOLOGIC TREATMENT SUSPENSION AND ASSOCIATED FACTORS IN PATIENTS WITH RHEUMATIC DISEASES DURING THE COVID-19 PANDEMIC: DATA FROM MEXICAN ADVERSE REGISTRY (BIOBADAMEX)

BackgroundThe COVID-19 pandemic triggered serious challenges in the treatment of chronic diseases due to the lack of access to medical attention. Patients with rheumatic diseases (RD) must have adequate treatment compliance in order to reach and maintain remission or low activity of their diseases. Treatment suspension because of non-medical reasons might lead to disease activation and organ damage.ObjectivesIdentify the frequency of biologic treatment (bDMARD) suspension in patients with RD during the COVID-19 pandemic and determine the associated factors for suspension.MethodsIn this study we included all patients registered in the Mexican Biologics Adverse Events Registry (BIOBADAMEX), that started bDMARD before March 2019 and suspended treatment during the COVID-19 pandemic. We used descriptive statistic to analyze baseline characteristics and main treatment suspension causes. We used Chi[2] and Kruskal Wallis tests to analyze differences between groups.ResultsA total of 832 patients patients registered in BIOBADAMEX were included in this study, 143 (17%) suspended bDMARD during the COVID-19 pandemic. The main causes of suspension were inefficacy in 54 (38%) patients, followed by other motives in 49 (34%) patients from which 7 (5%) was loss of medical coverage. Adverse events and loss of patients to follow up were the motive in 16 (11%) and 15 (11%) patients respectively.When we compared the group that suspended bDMARD with the non-suspenders (Table 1), we found statistical differences in patient gender, with 125 (87%) female patients that suspended bDMARD, with a median age of 52 (42-60) years, and a treatment duration of 3.8 years.ConclusionIn our study we found that 17% of patients with RD suspended bDMARD treatment during the COVID-19 pandemic and that non-medical motives such as lack of patients follow up and loss of medical coverage due to unemployment were important motives. These results are related to the effect of the pandemic on other chronic diseases.Table 1.Patients baseline characteristicsPatients that did not suspended bDMARD during pandemic (n = 689)Patients that suspended bDMARD during pandemic (n = 143)pFemale gender, n(%)549 (79.7)125 (87.4)0.02Age, median (IQR)55 (45 – 63)52 (42 – 60)0.04Body mass index, median (IQR)26.4 (23 – 30.4)27.23 (24.2 – 30.46)0.13Social security, n(%)589 (85.5)128 (89.5)0.2Diagnosis0.7- Rheumatoid arthritis444 (64.4)97 (67.8)- Juvenil idiopathic athritis29 (4.2)2 (1.4)- Ankyosing sponylitis93 (13.5)19 (13.3)- Psoriasic arthritis43 (6.2)6 (4.2)- Systemic lupus erithematosus32 (4.6)9 (6.3)- Others48 (6.9)10 (6.9)Disease duration, median (IQR)11 (7 – 19.5)12 (6 - 18)0.95Comorbidities, n(%)305 (44.3)73 (51)0.08Previos biologic, n(%)249 (36.1)60 (42)0.1Treatment at pandemic iniciation, n(%)0.8 - Etanercept a34 (4.9)5 (3.5)- Infliximab a24 (3.5)5 (3.5)- Adalimumab130 (18.9)22 (15.4)- Rituximab a61 (8.9)25 (17.5)- Abatacept76 (11)20 (14)- Tocilizumab82 (11.9)18 (12.6)- Certolizumab92 (13.4)28 (19.6)- Rituximab b7 (1)0- Golimumab36 (5.2)5 (3.5)- Tofacitinib14 (2)1 (0.7)- Infliximab b4 (0.5)2 (1.4)- Etanercept b31 (4.5)6 (4.2)- Baricitinib12 (1.7)1 (0.7)- Belimumab5 (0.7)1 (0.7)- Secukinumb8 (1.2)3 (2.1)Steroids use, n(%):254 (36.9)57 (39.9)0.2Steroids dose (mg), median (IQR)6 (5 – 10)6 (5 – 10)0.47DMARD use, n(%):538 (78.1)118 (82.5)0.1Treatment duration, median (IQR)5.06 (4.04 – 5.78)3.82 (3.35 – 4.95)0.001Suspension motive, n(%)NA- Inefficacy-54 (37.8)- Adverse event-16 (11.2)- Pregnancy-2 (1.4)- Loss of patient-15 (10.5)- Remission-7 (4.9)- Others-49 (34.2)Adverse events, n(%):102 (14.8)24 (16.8)0.3- Severe, n(%)13 (1.9)5 (3.5)0.4a original, b biosimilarREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsVijaya Rivera Teran: None declared, Daniel Xavier Xibille Friedmann: None declared, David Vega-Morales: None declared, Sandra Sicsik: None declared, Angel Castillo Ortiz: None declared, Fedra Irazoque-Palazuelos: None declared, Dafhne Miranda: None declared, Iris Jazmin Colunga-Pedraza: None declared, Julio Cesar Casasola: None declared, Omar Elo Muñoz-Monroy: None declared, Sandra Carrilo: None declared, Angélica Peña: None declared, Sergio Duran Barragan: None declared, Luis Francisco Valdés Corona: None declared, Estefanía Torres Valdéz: None declared, Azucena Ramos: None declared, Aleni Paz: None declared, ERICK ADRIAN ZAMORA-TEHOZOL: None declared, Deshire Alpizar-Rodriguez Employee of: Scientific Advisor in GSK México.

Mapping the Suitability of Existing and Probable Isolation Facilities

This study aimed to map the accessibility of the existing isolation facilities in Cabagan, Isabela, and propose probable locations suitable for establishing isolation facilities using the Geographic Information System (GIS). Digital datasets of the current isolation facilities were used in the study, along with factors such as land uses, hazards, landfills, and road networks that should be taken into consideration when choosing potential locations for isolation facilities. These factors follow the guidelines set by the Department of Health (DOH). The processing and generation of layers related to the criteria were done using GIS techniques, specifically overlay analysis tools. In order to project an appropriate map of potential isolation facilities in Cabagan, Isabela, the layers were combined and overlaid. The existing isolation facilities are accessible to Milagros Albano District Hospital (MADH) since all of them are adjacent to national or barangay roads. More than half, or 65.38%, of the isolation facilities, belong to areas with low to moderate susceptibility to flooding, and 26.92% are in areas with high susceptibility to flooding. Furthermore, all isolation facilities are open to the public, with 53.85% of existing isolation facilities in residential areas, 7.69% in commercial areas, and 38.46% in agricultural areas. The suitability map of proposed isolation facilities was successfully generated, showing that 100% of the proposed isolation facilities are accessible from any road network in the municipality with low and moderate susceptibility to flooding and low susceptibility to landslides. © 2022 IEEE.

Musculoskeletal Ailments and Working Conditions in Teachers Who Telework: A Case Study from a Private Institution in the City of Guayaquil

Education has suffered changes during the outbreak of the novel Coronavirus COVID-19 forcing our teachers to implement new strategies to teach online. With this new working format, we must consider that one of the most common health problems affecting our teleworkers are musculoskeletal ailments. These types of alterations constitute the pathology that generates a large number of cases of disability. The objective of this research was to determine the prevalence of musculoskeletal ailments through the use of the ERGOPAR questionnaire, the working conditions through the use of the PVD (DSE) questionnaire in teachers that perform online teaching. It's a descriptive study with a transversal approach performed with 104 teachers from an education institution in the city of Guayaquil-Ecuador in the year 2021. ERGOPAR and PVD (DSE) questionnaires were applied. The prevalence was high, finding discomfort, pain, or both in "neck, shoulders, and thoracic back pain” 77.77% in males and 81.82% in females;discomfort or pain in the "lumbar zone” 70.37% in males and 79.22% in females. It's demonstrated that there is no predisposition to a higher affection on a particular sex. Characteristically, the exposure to DSE causes discomfort due to the reflection from the screen affecting 51.85% of males and 66.23% of females. This research contributes significantly to ergonomics, it could demonstrate a negative relationship in the health of teachers linking musculoskeletal ailments and the characteristics of online teaching. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Cytokine storm and stem cell activation in unveiling potential targets for diagnosis and therapy

Cytokine storms illustrate a robust, uncontrolled immune response that can severely disrupt the physiology of a person infected with a virus such as COVID-19. Cytokine storms during the most severe of COVID-19 infections are believed to be one of the major contributing factors to mortality and severe pathologic outcomes of the disease. Dysregulated levels of cytokines during a cytokine storm contribute to changes in different components of the local microenvironments including the stem cell components. Here, we review the pathophysiology of cytokine storms looking at different aspects of viral-induced cytokine release. In particular, we note the changes in the stem cell compartments that occur as well as therapeutic targets relying on targeting stem cells. © 2022 Elsevier Inc. All rights reserved.

Features and evolution of patients with COVID-19 who required mechanical ventilation

Background: The overall mortality of patients with COVID-19 admitted to intensive care units is approximately 40%. Aim: To describe the characteristics of a cohort of patients with COVID-19 who required invasive mechanical ventilation due to severe hypoxemic acute respiratory failure at a general hospital in Santiago, Chile. Material and Methods: Review of medical records and follow up for 28 days of patients with COVID-19 confirmed by polymerase chain reaction who required invasive mechanical ventilation and who were admitted to the intensive care unit from March 24 to June 7, 2020. Results: Data from 152 patients aged 58 (interquartile range (IQR) 47-65 years (66% men) was analyzed. As of July 5, 36 (24%) had died, 75 (49%) were discharged, 10 (7%) were still on invasive mechanical ventilation, 11 (7%) remained with tracheostomy but without invasive mechanical ventilation, and 20 (13%) were hospitalized in a basic unit. The median time on invasive mechanical ventilation among extubated patients was 14 days (IQR 10-21) and 121 (80%) were in the prone position. Patients who died were older, had a higher frequency of diabetes mellitus and a higher driving pressure at 7 days than those discharged alive from the intensive care unit. Conclusions: In this study mortality was lower than that reported in the first international studies, probably due to the selection of younger patients and greater knowledge of the disease.

PRONE POSITIONING IN AXILLARY INTRA-AORTIC BALLOON PUMP COUNTERPULSATION: FIRSTIN-HUMAN CASE REPORT

Background: Acute respiratory distress syndrome (ARDS) is characterized by hypoxemia and non-hydrostatic pulmonary edema. While ARDS is associated with a high mortality rate, its conjunction with cardiogenic shock (CS) can lead to devastating outcomes. ARDS is managed via lung protective ventilation with low tidal volumes and positive end expiratory pressures. Prone positioning has emerged as a supplementary strategy with beneficial effects on gas exchange, respiratory mechanics, and hemodynamics. Our case underlines the feasibility of intra-aortic balloon pump counterpulsation (IABP) with concurrent prone positioning in a patient with ARDS and CS. Case: 71-year-old male with history of coronary artery disease, hypertension, hyperlipidemia, and chronic kidney disease, presented to the emergency department with new onset chest pain. EKG showed ST-segment elevations in leads V1-V2 consistent with acute anterior wall myocardial infarction. Patient underwent percutaneous coronary intervention to the left anterior descending artery.Due to worsening hemodynamics and CS, it was decided to place a left axillary IABP. Hospital course was further complicated by acute pulmonary edema and ARDS requiring emergent intubation and mechanical ventilation. Patient was also started on renal replacement therapy given progression of renal failure. Decision-making: Given the onset of ARDS, the patient was placed in prone position for 12-16 hours/day for 5 days. There was no special technique required during proning, other than additional staff to ensure IABP stability. Gradual improvement in hemodynamics was attained, including an increase in cardiac index from 2.1 to 3.4, and a decrease in pulmonary vascular congestion. Conclusion: With the emergence of COVID-19 pandemic, the incidence of ARDS has increased significantly, with simultaneous occurrence of CS in some of these patients. Prone positioning has become one of the main therapeutic modalities in the management of ARDS. Our case highlights the feasibility of axillary IABP while implementing prone positioning in patients with concomitant ARDS and CS.

Bayesian surface regression versus spatial spectral nonparametric curve regression

COVID-19 incidence is analyzed at the provinces of the Spanish Communities in the Iberian Peninsula during the period February–October, 2020. Two infinite-dimensional regression approaches, surface regression and spatial curve regression, are proposed. In the first one, Bayesian maximum a posteriori (MAP) estimation is adopted in the approximation of the pure point spectrum of the temporal regression residual autocorrelation operator. Thus, an alternative to the moment-based estimation methodology developed in Ruiz-Medina, Miranda and Espejo (2019) is derived. Additionally, spatial curve regression is considered. A nonparametric estimator of the spectral density operator, based on the spatial periodogram operator, is computed to approximate the spatial correlation between curves. Dimension reduction is achieved by projection onto the empirical eigenvectors of the long-run spatial covariance operator. Cross-validation procedures are implemented to test the performance of the two functional regression approaches. © 2022 Elsevier B.V.

GLOBAL KNOWLEDGE? COOPERATION AND CONFLICT IN THE POST-HEGEMONIC ERA: FACING THE PANDEMIC CRISIS

In recent decades, we have witnessed the consolidation of the knowledge society, based on a process of globalization, which promotes the consolidation of the knowledge economy as an emerging paradigm, as well as promoting new dynamics of scientific cooperation, especially from the European Union to the rest of the world. Agreements, summits, and a network of science diplomacy have been set up reflecting the impact of knowledge on new development models. From this process, conceived as a catalyst for value chains based on knowledge intensity, it is possible to glimpse new power conflicts related to other recent conflicts for economic and political hegemony on a global scale. This study aims to analyze countries' behavior vis-à-vis the global threat of the COVID 19 pandemic, based on the correlation between their ability to face it and their levels of knowledge-based development as a differentiating element in terms of vulnerability. The results show a process where scientific cooperation has given way to a field of geopolitical competition between the actors of the international system, affecting their levels of vulnerability to global threats. © The author(s) 2021.

Local public health professionals contribution to infodemic management

The digital age we currently live in is characterized by an overwhelming production of information by multiple users. This is particularly relevant in public health areas, where inaccurate information can be a threat to populations' wellbeing. The internet became a field where anyone can produce non validated health information and spread rumors that can drive vaccine hesitancy, non compliance with public health measures and use of ineffective treatments, among other consequences highlighted by the COVID-19 pandemic. Public health professionals must be aware of such relevant concepts, the cognitive theories that support them and the strategies that can be used to monitor, identify, prevent and tackle the spread of health misinformation. However, such an approach should involve not only public health professionals but also journalists, data scientists, social marketeers and behavioural change experts involved in different organizations. Infodemic management is a recent area of research and practice that requires a comprehensive, multidisciplinary capacity building approach focusing behavioural change theories, digital technologies and social media, and community engagement strategies among others. This presentation will provide a brief introduction on main infodemic concepts and cognitive theories, show how infodemic management can overlap common epidemic management and highlight monitoring and social listening strategies and relevant interventions to prevent and tackle misinformation.

Characteristics, Comorbidities, and Data Gaps for Coronavirus Disease Deaths, Tennessee, USA.

As of March 2021, coronavirus disease (COVID-19) had led to >500,000 deaths in the United States, and the state of Tennessee had the fifth highest number of cases per capita. We reviewed the Tennessee Department of Health COVID-19 surveillance and chart-abstraction data during March 15‒August 15, 2020. Patients who died from COVID-19 were more likely to be older, male, and Black and to have underlying conditions (hereafter comorbidities) than case-patients who survived. We found 30.4% of surviving case-patients and 20.3% of deceased patients had no comorbidity information recorded. Chart-abstraction captured a higher proportion of deceased case-patients with >1 comorbidity (96.3%) compared with standard surveillance deaths (79.0%). Chart-abstraction detected higher rates of each comorbidity except for diabetes, which had similar rates among standard surveillance and chart-abstraction. Investing in public health data collection infrastructure will be beneficial for the COVID-19 pandemic and future disease outbreaks.

Children's behavioral problems, screen time, and sleep problems' association with negative and positive parenting strategies during the COVID-19 outbreak in Brazil.

Families' health, safety, and economic stability were jeopardized during the pandemic. Parental stress is a risk factor for hostile and less supportive parenting. Parenting styles are a set of attitudes, feelings and behaviors related to parenting that modulate the child's psychosocial functioning and might impact on the adaptability to a stressful time. OBJECTIVE: To investigate the group differences among children raised by negative and positive parenting families during COVID-19 pandemic. METHODS: We have done an online survey with 329 parents. Parents answer about parenting strategies and styles, children's behavior, Covid related questions, socio-economic information, sleep and gaming disorders. RESULTS: Parents' frequent use of negative strategies were a risk factor to have a negative outcome related to mental health, games, sleep, and children behavior. DISCUSSION: Parenting strategies are some targets pointed in this study for intervention. Parents' styles and strategies training to better manage children might be even more important to avoid negative consequences for children in stressful times.

Extracellular Vesicles as a Means of Viral Immune Evasion, CNS Invasion, and Glia-Induced Neurodegeneration.

Extracellular vesicles (EVs) are small, membrane-bound vesicles released by cells as a means of intercellular communication. EVs transfer proteins, nucleic acids, and other biologically relevant molecules from one cell to another. In the context of viral infections, EVs can also contain viruses, viral proteins, and viral nucleic acids. While there is some evidence that the inclusion of viral components within EVs may be part of the host defense, much of the research in this field supports a pro-viral role for EVs. Packaging of viruses within EVs has repeatedly been shown to protect viruses from antibody neutralization while also allowing for their integration into cells otherwise impervious to the virus. EVs also bidirectionally cross the blood-brain barrier (BBB), providing a potential route for peripheral viruses to enter the brain while exiting EVs may serve as valuable biomarkers of neurological disease burden. Within the brain, EVs can alter glial activity, increase neuroinflammation, and induce neurotoxicity. The purpose of this mini-review is to summarize research related to viral manipulation of EV-mediated intercellular communication and how such manipulation may lead to infection of the central nervous system, chronic neuroinflammation, and neurodegeneration.

Brief symptom inventory: Reporting brazilian populational parameters during covid-19 pandemics

Background: The Brief Symptoms Inventory is a valid and reliable instrument, and one of the most often used tools to assess mental health. Despite its translation to Brazilian Portuguese, there are no normative parameters for interpretation of its scores. Objective: This study provides a normative parameter for interpretation of the performance of a large sample of adults by using a version of BSI adapted to Brazilian Portuguese. Method: We assessed 2127 adults (57% female) from all of the Brazilian regions. Normative data and Internal consistencies and performance data were calculated for the general score index and the nine factors. Results: The associations between gender and BSI scores present a significant effect size. Therefore, we provided a percentile rank parameter for the different BSI subscores, considering the whole sample and gender division. Internal consistency varies from omega equal .87 – .98 and alpha equal .86-.98, which suggests that both GSI and the nine factors have excellent reliability. Discussion: Our results support the use of the Brazilian adaptation of BSI in different regions of the country to measure mental health and its specific factors. During the pandemic of COVID-19, the establishment of normative parameters is of utmost relevance. The stability of the parameters reported here should be addressed in future studies. © 2021, UNIV SAOPAULO. All rights reserved.

Transition from VV to VA or hybrid ECMO: An ELSO Overview

Objective: The use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) has increased significantly in the last years, and in particular in the recent pandemic COVID-19, representing a valuable therapy to treat severe respiratory failure. However, few patients remain hypoxemic and become hemodynamically instable during V-V ECMO support requiring a change in ECMO configuration. Methods: The Extracorporeal Life Support Organization Registry was reviewed for all cases of adult ARDS in patients undergoing ECMO requiring a change in configuration during the support run. (2017 to 2019). All main aspects, if available, characterizing the patients undergoing ECMO support modifications were collected and analyzed in terms of incidence, causes, patterns, complications and outcomes. Results: Of 9936 V-V ECMO runs, there were 354 ECMO that requiring a in changing configurations (3,5%). Over the study period the proportion of ECMO changing configuration was 1,3% (136) for VA, 1,6% (166) for V-VA and 0,8(85%) for Other configurations with an increasing in configuration changing during the years. The mortality rate in the shifting population was 55%. The new configurations were associated with major bleeding, stroke and renal failure was similar. Main determinants of poor outcome were the severity of the underlying illness, the delay in recognizing evolution of the disease, the complications associated with the conversion itself, and the more complex management of the hybrid setting. Conclusions: Our review of ARDS patients showed the variation in configuration VA ECMO or Hybrid ECMO was not associated with worse survival but with a high rates of complications rates compared with VV ECMO. These data suggest that in very selected patients it may reasonable to initially instituted VV ECMO support, reserving VA or Hybrid ECMO forms for conversion for refractory cardiopulmonary failure and cardiogenic shock that represent the major reasons of VV ECMO failure.