Invasive disease caused by Haemophilus influenzae: report of 14 cases one year after the start of the COVID-19 pandemic

Haemophilus influenzae (Hi) causes invasive disease (IE). Capsulated strains are distinguished, such as serotype b (Hib), and non-typeable strains (HNT). One year after the COVID-19 pandemic was declared, we observed an increase in cases.The clinical-epidemiological characteristics of children with IE due to Hi admitted to the hospital (July 2021-July 2022) are described. There were 14 cases;12 previously healthy. Isolates: Hib (n = 6), Hi serotype a (n = 2), HNT (n = 5), 1 was not typed. Median age: 8.5 months (IQR 4-21). Manifestations: meningitis (n = 5), pneumonia (n = 6), cellulitis (n = 2), arthritis (n = 1). Nine had incomplete vaccination for Hib.We observed a 2.5-fold increase in EI per Hi compared to previous years. These data suggest a resurgence of Hib due to the fall in vaccination coverage and because other Hib non-b strains are on the rise.

Palliative Care in a Pandemic: A Multicenter Cohort of Critically Ill Patients with Coronavirus Disease 2019.

Background: Trends in mortality, palliative care, and end-of-life care among critically ill patients with coronavirus disease 2019 (COVID-19) remain underreported. We hypothesized that use of palliative care and end-of-life care would increase over time, because improved understanding of the disease course and prognosis would potentially lead to more frequent use of these services. Patients and Methods: Adult patients with severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2) during pandemic wave one (W1: March 2020 to September 2020) or wave two (W2: October 2020 to June 2021) admitted to an intensive care unit (ICU) in one of six northeastern U.S. hospitals were identified and clinical characteristics obtained. Vaccination data were unavailable. Outcomes of interest included mortality, palliative care consultation, and any end-of-life care (including hospice and comfort care). Results: There were 1,904 critically ill patients with COVID-19: 817 (42.9%) in W1 and 1,087 (57.1%) in W2. Patients received mechanical ventilation more often during W1 than W2 (52.9% vs. 46.3%; p = 0.004), with no difference in ICU or hospital length of stay between waves. Mortality between W1 and W2 was similar (31.2% vs. 30.9%; p = 0.888). There was no difference in use of palliative care or any end-of-life care between waves. Patients who died during W2 versus W1 were more likely to have received both mechanical ventilation (77.1% vs. 67.1%; p = 0.007) and palliative care services (52.1% vs. 41.2%; p = 0.009). However, logistic regression adjusted for demographics, baseline comorbid disease, and clinical characteristics showed no difference in mortality (odds ratio [OR], 1.15; 95% confidence interval [CI], 0.89-1.48), palliative care (OR, 1.08; 95% CI, 0.84-1.40), or any end-of-life care (OR, 1.05; 95% CI, 0.82-1.34) in W2 versus W1. Conclusions: Mortality among critically ill patients with COVID-19 has remained constant across two pandemic waves with no change in use of palliative or end-of-life care.

External Validation of the 4C Mortality Score and the qSOFA for Different Variants of Concerns of SARS-CoV-2 Using Data of the NAPKON Cross-Sectoral Cohort Platform (SUEP)

Background. Numerous predictive clinical scores with varying discriminatory performance have been developed in the context of the current coronavirus disease 2019 (COVID-19) pandemic. To support clinical application, we test the transferability of the frequently applied 4C mortality score (4C score) to the German prospective Cross-Sectoral Platform (SUEP) of the National Pandemic Cohort Network (NAPKON) compared to the non COVID-19 specific quick sequential organ failure assessment score (qSOFA). Our project aims to externally validate these two scores, stratified for the most prevalent variants of concerns (VOCs) of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) in Germany. Methods. A total of 685 adults with polymerase chain reaction (PCR)-detected SARS-CoV-2 infection were included from NAPKON-SUEP. Patients were recruited from 11/2020 to 03/2022 at 34 university and non-university hospitals across Germany. Missing values were complemented using multiple imputation. Predictive performance for in-hospital mortality at day of baseline visit was determined by area under the curve (AUC) with 95%-confidence interval (CI) stratified by VOCs of SARS-CoV-2 (alpha, delta, omicron) (Figure 1). Figure 1: Study flow chart with inclusion criteria and methodological workflow. Results. Preliminary results suggest a high predictive performance of the 4C score for in-hospital mortality (Table 1). This applies for the overall cohort (AUC 0.813 (95%CI 0.738-0.888)) as well as the VOC-strata (alpha: AUC 0.859 (95%CI 0.748-0.970);delta: AUC 0.769 (95%CI 0.657-0.882);omicron: AUC 0.866 (95%CI 0.724-1.000)). The overall mortality rates across the defined 4C score risk groups are 0.3% (low), 3.2% (intermediate), 11.6% (high), and 49.5% (very high). The 4C score performs significantly better than the qSOFA (Chi2-test: p=0.001) and the qSOFA does not seem to be a suitable tool in this context. Table 1: Discriminatory performance of the 4C Mortality Score and the qSOFA score within the validation cohort NAPKON-SUEP stratified by the Variant of Concerns of SARS-CoV- 2. Conclusion. Despite its development in the early phase of the pandemic and improved treatment, external validation of the 4C score in NAPKON-SUEP indicates a high predictive performance for in-hospital mortality across all VOCs. However, since the qSOFA was not specifically designed for this predictive issue, it shows low discriminatory performance, as in other validation studies. Any interpretations regarding the omicron stratum are limited due to the sample size.

Experiencia Da Utilizacao Do Anticorpo Monoclonal Jovi-1 Em Laboratorio De Citometria De Fluxo

Objetivos: As neoplasias Linfoproliferativas (NLP) T sao um grupo heterogeneo de doencas oncohematologicas cujo diagnostico e desafiador devido ao amplo espectro de achados clinicos, morfologicos e histologicos que frequentemente se sobrepoem aos encontrados em condicoes reacionais. A determinacao de clonalidade e necessaria e pode ser realizada por deteccao dos rearranjos de genes do TCR por PCR ou NGS. No entanto, tais tecnicas apresentam alto custo e tempo prolongado para resultado. A imunofenotipagem por citometria de fluxo (CMF) e utilizada rotineiramente para diagnostico das NLP. O TCR e composto por cadeias alfa e beta com dois dominios constante da cadeia beta, TRBC 1 e TRBC2 que sao mutuamente exclusivos. O anticorpo JOVI-1 apresenta alta especificidade contra o TRBC1. Celulas normais ou reacionais demonstram um misto de positividade e negatividade para TRBC1, ou seja, um perfil policlonal, enquanto celulas T monoclonais demonstram expressao restrita de algum TRBC. A inclusao do anticorpo JOVI-1 nos paineis de CMF e, portanto, atrativa para determinacao da clonalidade das NLP-T. O objetivo desse trabalho e avaliar e reportar a inclusao do JOVI-1 nos paineis de CMF em casos suspeitos de NLP-T. Materiais e Metodos: Avaliacao de perfil de expressao de TCR Beta 1 atraves da inclusao com anticorpo JOVI-1 aos paineis utilizados em pesquisa de NLP-T. O JOVI-1 foi tambem utilizado na avaliacao de Leucemias Agudas T (LLA) de forma a ser um grupo controle para o ensaio, uma vez que linfoblastos imaturos nao apresentam expressao de TCR. Resultados: O JOVI-1 foi realizada em 18 casos suspeitos de NLP. 6 amostras de medula ossea e 12 de sangue periferico. A idade mediana dos suspeitos foi de 50,5 anos (1-71 anos) e a proporcao de individuos do genero masculino para o feminino foi de 2,4:1,0. 10 casos (55%) demonstraram perfil policlonal sendo que em 3 desses casos confirmaram-se infeccoes virais (1 por Covid-19 e 2 por Citomegalovirus) e 7 tiveram outros diagnosticos que nao NLP. Ja em 45% dos casos observou-se perfil monoclonal: 4 diagnosticos de Leucemia de Grandes Linfocitos Granulares T, 2 diagnosticos de Linfoma/Leucemia de Celulas T do Adulto, 1 diagnostico de Sindrome de Sezary e 1 caso de Linfoma T gama-delta. Foram avaliados 6 casos de LLA T, no qual apenas um foi positivo para o marcador e tratava-se de LLA T madura. Discussao e Conclusao: Nesse trabalho demonstramos que a adicao do JOVI-1 ao painel habitual de diagnostico torna a CMF uma boa ferramenta diagnostica para NLP-T cronicas obtendo estudo de clonalidade de forma relativamente simples e rapida, similar ao que acontece nas NLP de linhagem B ha decadas. Copyright © 2022

Safety and Pharmacokinetic Profile of an Immunobiological Drug (anti SARS-Cov-2) in the Treatment of CoViD-19

Introduction: Equine hyperimmune serum (F(ab')2 fragments) has been widely used in Argentina in the last 100 years with satisfactory results and an acceptable safety profile in the treatment of accidents with poisonous animals such as snakes (bothrops, chrotalus, elapids) and arthropods (Loxosceles, Latrodectus, Phoneutria and Tityus). These antisera were developed by the National Institute for the production of Biologicals (ANLIS-Malbran) and distributed free of charge in public hospitals in the country. Objective(s): The aims of this study (NCT04913779) is to analyze the efficacy and safety of a passive immunotherapy strategy using hyperimmune equine serum known as Anti-SARS-CoV-2 elaborated by the National Institute for the Production of Biologicals (ANLISMalbran) as an addition to the standard therapeutic approach for hospitalized patients with COVID-19, in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Method(s): A randomized, double-blind controlled clinical study is carried out in 200 patients with COVID-19 requiring oxygen therapy in which the safety and efficacy of early use (72 hours from the onset of symptoms) of the research product is evaluated. The present work corresponds to a preliminary result of the safety and pharmacokinetic analysis in the first 20 patients included. Result(s): 20 initial patients (1:1 treatment: control ratio) were studied. The post-administration follow-up time was 28 days. The pharmacokinetic analysis shows that the research product presents an extracellular volume of distribution, with a median half-life of distribution was 6.3h (10-90% percentiles: 3.4-8.1 h) and half-life of elimination, 121h (10th-90th percentiles: 83-171 h). Neutralizing activity in plasma was correlated with drug concentration. Daily controls were carried out including physical examination, questioning in relation to symptoms presented, and blood extraction for routine laboratory control. No patient reported symptoms consistent with adverse reactions. Although some patients presented mild laboratory alterations (hepatogram, urea, creatinine), in all cases they were alterations that existed prior to the administration of the research product and that improved after treatment. Conclusion(s): Despite the small number of patients studied initially, and the possible masking of an adverse event due to the underlying disease (COVID-19), no significant adverse reactions were evidenced during treatment with the research product. There were no serious reactions and the pharmacokinetic characteristics appear to show a long-acting profile correlated with neutralizing activity in vitro.

Safety and Pharmacokinetic Profile of an Immunobiological Drug (anti SARS-Cov-2) in the Treatment of CoViD-19: An International Journal of Medical Toxicology and Drug Experience

Introduction: Equine hyperimmune serum (F(ab')2 fragments) has been widely used in Argentina in the last 100 years with satisfactory results and an acceptable safety profile in the treatment of accidents with poisonous animals such as snakes (bothrops, chrotalus, elapids) and arthropods (Loxosceles, Latrodectus, Phoneutria and Tityus). These antisera were developed by the National Institute for the production of Biologicals (ANLIS-Malbraín) and distributed free of charge in public hospitals in the country. Objective: The aims of this study (NCT04913779) is to analyze the efficacy and safety of a passive immunotherapy strategy using hyperimmune equine serum known as Anti-SARS-CoV-2 elaborated by the National Institute for the Production of Biologicals (ANLIS-Malbraín) as an addition to the standard therapeutic approach for hospitalized patients with COVID-19, in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: A randomized, double-blind controlled clinical study is carried out in 200 patients with COVID-19 requiring oxygen therapy in which the safety and efficacy of early use (72 hours from the onset of symptoms) of the research product is evaluated. The present work corresponds to a preliminary result of the safety and pharmacokinetic analysis in the first 20 patients included. Results: 20 initial patients (1:1 treatment: control ratio) were studied. The post-administration follow-up time was 28 days. The pharmacokinetic analysis shows that the research product presents an extracellular volume of distribution, with a median half-life of distribution was 6.3h (10-90% percentiles: 3.4-8.1 h) and half-life of elimination, 121h (10th-90th percentiles: 83-171 h). Neutralizing activity in plasma was correlated with drug concentration. Daily controls were carried out including physical examination, questioning in relation to symptoms presented, and blood extraction for routine laboratory control. No patient reported symptoms consistent with adverse reactions. Although some patients presented mild laboratory alterations (hepatogram, urea, creatinine), in all cases they were alterations that existed prior to the administration of the research product and that improved after treatment. Conclusion: Despite the small number of patients studied initially, and the possible masking of an adverse event due to the underlying disease (COVID-19), no significant adverse reactions were evidenced during treatment with the research product. There were no serious reactions and the pharmacokinetic characteristics appear to show a long-acting profile correlated with neutralizing activity in vitro.

PEDIATRIC INFLAMMATORY MULTISYSTEM SYNDROME TEMPORALLY-ASSOCIATED with SARS-COV-2-A PORTUGUESE SINGLE CENTRE CASE SERIES

Background: Across the globe, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 appears to affect paediatric population in a milder and non-threatening way, when compared to adults. However, since April 2020 case reports of previously healthy children presenting with unremitting fever, biologic infammatory syndrome and cardiac dysfunction have been emerging. This syndrome, which has been termed Pediatric Infammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 infection (PIMS-TS), represents a rare complication of COVID-19 in children1. Objectives: To describe the clinical, laboratory and imaging characteristics, course, management and outcomes of hospitalized children diagnosed with PIMS-TS in a Portuguese tertiary care hospital. Methods: A retrospective study including children (< 18 years) that attended our hospital from April 2020 to December 2021 was performed. All the children included fulflled the case defnition of PIMS-TS published by the Centre for Disease Control and Prevention. Sociodemographic and clinical data, laboratory markers and imaging fndings were collected. Results: A total of 19 children met the criteria for PIMS-TS, 68% male with a mean age at diagnosis of 8 years old (IQR 5.8-15). They were all caucasian, except for a mixed-race patient, and all previously healthy, except one patient who was obese. Twelve had recent infection by SARS-CoV-2 detected by reverse transcriptase (RT) PCR and 18 had positive IgG serology. All had fever at diagnosis, with a median duration of 6 days (IQR 5-6) and 89.5% had mucocutaneous, gastrointestinal and hematological attainment, respectively. Other affected systems were respiratory (73.7%), cardiovascular (63%), lymphoid organs (52.6%), musculoskeletal (47%), genito-urinary (31.6%) and neurological (26.3%). Laboratory fndings can be found in Table 1. Thirty-six percent were admitted in intensive care unit for a median duration of 8 days (IQR 4-9). 42.1% needed respiratory support, 87.5% with supplemental oxygen therapy, 62.5% with mechanical ventilation and 12.5% with non-invasive ventilation. All patients received intravenous (IV) immunoglobulin, 52.6% IV cor-ticosteroid (CS) pulses and 78.9% IV and oral CS. Other treatments included acetylsalicylic acid (n=18), heparin (n=8) and antibiotic therapy (n=19)-Table 3. Seventeen fully recovered and 2 had sequalae: one of them with coronary artery aneurysms and other exertional dyspnea. Conclusion: In this case series, there was a broad spectrum of clinical symptoms and disease severity, ranging from fever and systemic infammation to critical care admission with myocardial injury, shock, and development of coronary artery aneurysms. Despite short-term morbidity, there were no mortality cases, with most of them recovering without sequelae. All physicians providing clinical care to children should consider this rare but severe delayed syndrome in paediatric population.

COVID-19 Outbreak - New York City, February 29-June 1, 2020.

New York City (NYC) was an epicenter of the coronavirus disease 2019 (COVID-19) outbreak in the United States during spring 2020 (1). During March-May 2020, approximately 203,000 laboratory-confirmed COVID-19 cases were reported to the NYC Department of Health and Mental Hygiene (DOHMH). To obtain more complete data, DOHMH used supplementary information sources and relied on direct data importation and matching of patient identifiers for data on hospitalization status, the occurrence of death, race/ethnicity, and presence of underlying medical conditions. The highest rates of cases, hospitalizations, and deaths were concentrated in communities of color, high-poverty areas, and among persons aged ≥75 years or with underlying conditions. The crude fatality rate was 9.2% overall and 32.1% among hospitalized patients. Using these data to prevent additional infections among NYC residents during subsequent waves of the pandemic, particularly among those at highest risk for hospitalization and death, is critical. Mitigating COVID-19 transmission among vulnerable groups at high risk for hospitalization and death is an urgent priority. Similar to NYC, other jurisdictions might find the use of supplementary information sources valuable in their efforts to prevent COVID-19 infections.

Characterization of the Nasopharyngeal Microbiota of COVID-19 Patients According to Disease Severity

Purpose Increasing evidence indicates a possible relationship between the pathogenesis of COVID-19 and the nasopharyngeal microbiota. This study aimed to compare the nasopharyngeal microbiota of COVID-19 patients with different disease severity. Methods & Materials A comparative study was performed on patients classified into four groups according to their disease severity. A total of 26 patients were recruited for each of the following study groups. Group 1 (G1): patients with a confirmatory diagnosis of SARS-CoV-2 and hospitalized in the ICU. Group 2 (G2): patients with a confirmatory diagnosis of SARS-CoV-2 and hospitalized in regular hospitalization wards. Group 3 (G3): patients with a confirmatory diagnosis of SARS-CoV-2 who were not hospitalized and had mild or no symptoms. Group 4 (G4): healthy patients with a negative result for SARS-CoV-2. The diagnosis of SARS-CoV-2 was performed by reverse-transcriptase polymerase chain reaction (RT-PCR). The nasopharyngeal microbiota was characterized using polymerase chain reaction (PCR) targeting 13 representative bacteria genus. Results The detection of some bacteria genus was significantly more frequent in the hospitalized groups compared to healthy subjects. This is the case of Lactobacillus with 96.15% in G1, 96.15% in G2, 23.08% in G3 and 15.38% in G4. Similarly, Prevotella presented 96.15% in G1, 80.77 in G2, 0.00% in G3 and 19.23% in G4. Veilonella, Bacteroidetes and Firmicutes presented a similar prevalence. On the other hand, the detection of Eubacterium was more frequent among asymptomatic and healthy subjects, with 3.85% in G1, 19.23% in G2, 50.00% in G3 and 30.77% in G4. The relative abundance of the bacteria was evaluated and Lactobacillus and Veilonella were predominant in both of the hospitalized groups (G1 and G2). On the other hand, Actinobacteria and Eubacterium were predominant in the asymptomatic and healthy groups (G3 and G4) Conclusion In conclusion a unique nasopharyngeal microbiota profile was found in COVID-19 patients with different disease severity. Lactobacillus, Prevotella, Veilonella, Bacteroidetes and Firmicutes were the predominant bacteria genus in critical and hospitalized patients. While. Eubacterium and Actinobacteria were predominant in the groups of asymptomatic and healthy subjects. Further longitudinal studies are required to determine the prognostic role of the nasopharyngeal microbiota.

Phalangeal microgeodic syndrome - a rare vascular acrosyndrome in childhood

Introduction: Phalangeal microgeodic syndrome (PMS) is a rare disease of unknown etiology, which affects fingers and/or toes of children. Objectives: N/A Methods: N/AResults: Case Presentation The authors describe the case of a 9-year-old girl, who presented to the Pediatric Rheumatology outpatient clinic in November 2020 with painful swelling and cyanosis of all fingers for 3 weeks which had not improved with oral ibuprofen. She had no history of previous COVID-19 and, besides mild IgA vasculitis in 2015, was otherwise healthy. On physical examination, painful spindle-shaped swelling with functional limitation and cyanosis of fingers, associated with chilblain-like lesions were observed. She was started on pentoxifylline 400 + 200 mg/day and, later, nifedipine 0.5 mg/kg/day, and advised to avoid exposure to cold. Five months later she had marked improvement of pain and swelling, maintaining mild cyanosis. Laboratory workup revealed normal complete blood count, normal erythrocyte sedimentation and C-reactive protein, normal biochemical liver and renal parameters. Immunology tests showed normal IgG, IgA and IgM, positive antinuclear antibodies 1/100 and negative antidsDNA, ANCA, ACPA, rheumatoid factor, anti-ENA, anticentromere and antiphospholipd antibodies. Hand radiographs showed multiple small, round radiolucent images at the edge of the metaphysis of several phalanges. Hand MRI showed bone marrow edema in middle and distal phalanges of all fingers, and distal part of proximal phalanges (more diffuse and prominent in the second and fifth, bilaterally);there were no relevant changes in joints or tendons. These findings are compatible with PMS. Conclusion: This is a rare disease that should be included in the differential diagnosis of patients presenting with vascular acrosyndromes complaints. It can be misinterpreted as an infectious or post-infectious (namely COVID-19-related), inflammatory, or even malignant condition. It usually has a benign course and resolves with conservative treatment. Pediatric rheumatologists should be aware of this entity, as a timely and precise diagnosis prevents further investigations and complications.

Pediatric inflammatory multisystem syndrome temporallyassociated with SARS-COV-2 - a Portuguese single centre case series

Introduction: Across the globe, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 appears to affect paediatric population in a milder and nonthreatening way. However, since April 2020 case reports of previously healthy children presenting with unremitting fever, biologic inflammatory syndrome and cardiac dysfunction have been emerging. This syndrome, termed Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 infection (PIMSTS), represents a rare complication of COVID-19 in children. Objectives: The aim of this study is to describe the clinical and laboratory characteristics, course, management and outcomes of hospitalized children diagnosed with PIMS-TS in a Portuguese tertiary care hospital. Methods: A retrospective study including children that attended our hospital from April 2020 to April 2021 was performed. All the children fulfilled the case definition of PIMS-TS published by the Centers for Disease Control and Prevention. Data were collected. Statistical analysis was performed using SPSS 26.0. Results: A total of 19 children met the criteria for PIMS-TS, 68% male with a mean age at diagnosis of 8 years old (IQR 5.8-15). They were all caucasian, except for a mixed-race patient, and all previously healthy, except one patient who was obese. Twelve had recent infection by SARS-CoV-2 detected by reverse transcriptase (RT) PCR and 18 had positive IgG serology. One patient had negative RT-PCR and serology, but a positive contact history. All had fever at diagnosis, with a median duration of 6 days (IQR 5-6). 89.5% had mucocutaneous, gastrointestinal and haematological attainment, respectively. Other affected systems were respiratory (73.7%), cardiovascular (63%), lymphoid organs (52.6%), musculoskeletal (47%), genito-urinary (31.6%) and neurological (26.3%). Laboratory findings can be found in table 1. 36.8% were admitted in intensive care unit for a median duration of 8 days (IQR 4-9). 42.1% needed respiratory support, 87.5% with supplemental oxygen therapy, 62.5% with mechanical ventilation and 12.5% with non-invasive ventilation. All patients received intravenous (IV) immunoglobulin, 52.6% IV corticosteroid (CS) pulses and 78.9% IV and oral CS. Other treatments included acetylsalicylic acid (n=18), heparin (n=8) and antibiotic therapy (n=19). Seventeen fully recovered and 2 had sequelae: coronary artery aneurysms (n=1) and other exertional dyspnea (n=1). Conclusion: In this case series there was a wide spectrum of presenting signs and symptoms and disease severity, ranging from fever and systemic inflammation to critical care admission with myocardial injury, shock, and development of coronary artery aneurysms. Despite short-term morbidity, there were no mortality cases, with most of them recovering without sequelae. All physicians providing clinical care to children should consider this rare but severe delayed syndrome in paediatric population.

Trust building for integrative trade negotiations: Challenges posed by covid-19

This paper discusses and examines trust building in the remote-digital negotiations. More specifically, the paper focuses on international trade negotiations aimed at being integrative, and how the Covid-19 pandemic affected the way they have been conducted over the years, mainly relying in face-to-face meetings. Information exchange and knowledge sharing is essential part of negotiations, occurring in interactive processes between actors involved. Trust is a prerequisite for effective information exchange and knowledge sharing and creation. Trust creates openness, willingness to collaborate, and freedom to be productive, and is a foundation for integrative negotiations. Trust manifests in different ways, affecting time, intensity, process, and results of the overall negotiation process. Remote working and remote-digital meetings have become prevalent these days, especially due to the disruption caused by Covid-19. Remote communication necessarily carries inescapable restrictions compared to face-to-face encountering and discussion. Therefore, the technology mediated (TM) remote context highlights the meaning of trust, as interaction and collaboration emerge more restricted than in face-to-face contacts. This paper builds on previous research on integrative negotiations, role of trust, and meetings. By analysing and discussing the academic literature, the purpose of the paper is to provide theoretical views and insights for further research, and practical implications for negotiators and professionals in general. The exploratory research questions are: i) what challenges did the Covid-19 pandemic pose to international trade negotiations? ii) how do virtual-TM meetings may affect trust building for integrative negotiations? iii) how does country culture and technology mediate the impact of virtual meetings in trade negotiations? By responding to these research questions, the paper focuses on intangible factors that may contribute to trust building or trust destroying in virtual meetings and how they may affect information exchange, knowledge sharing and knowledge dynamics leading to successful integrative negotiations. © The Authors, 2021. All Rights Reserved.

Systematic screening for a proximal DVT in COVID-19 hospitalized patients: Results of a comparative study.

INTRODUCTION: The COVID-19 pandemic is associated with a high incidence of venous thromboembolism questioning the utility of a systematic screening for deep venous thrombosis (DVT) in hospitalised patients. METHODS: In this prospective bicentric controlled study, 4-point ultrasound using a pocket device was used to screen for DVT, in patients with SARS-CoV-2 infection and controls admitted for acute medical illness not related to COVID-19 hospitalised in general ward, in order to assess the utility of a routine screening and to estimate the prevalence of VTE among those patients. RESULTS: Between April and May 2020, 135 patients were screened, 69 in the COVID+ group and 66 in the control one. There was no significant difference in the rate of proximal DVT between the two groups (2.2% vs. 1.5%; P=0.52), despite the high rate of PE diagnosed among COVID-19 infected patients (10.1% vs. 1.5%, P=0.063). No isolated DVT was detected, 37.5% of PE was associated with DVT. Mortality (7.2% vs. 1.5%) was not different (P=0.21) between COVID-19 patients and controls. CONCLUSION: The systematic screening for proximal DVT was not found to be relevant among COVID-19 patients hospitalized in general ward despite the increase of VTE among this population. Further studies are needed to confirm the hypothesis of a local pulmonary thrombosis which may lead to new therapeutic targets.

Nutritional recommendations for healthcare and essential personnel exposed to COVID-19 in Latin America

These recommendations are based on current scientific evidence obtained through meta-analysis and systematic reviews on nutrition and the prevention of respiratory infections related to SARS-CoV, MERS-CoV or influenza, similar in structure to SARS-CoV-2. They are aimed at primary health care personnel and to those who provide essential services to the community and are, consequently, at high risk of COVID-19 infection. These individuals wear personal protective equipment, work long shifts, sometimes under extreme conditions, which can lead to insufficient rest, high stress levels, depression, poor nutrition and dehydration. Together, these factors have a negative impact on the immune system and could result in an increased risk of infection. An adequate intake of micronutrients and other bioactive compounds is essential for optimal immune performance. There is moderate evidence supporting supplementation, individually, with vitamin C (2 000 mg), vitamin D (1 000-2 000 IU) and zinc (=40 mg) for the prevention of respiratory infections in adults. Insufficient evidence was found to support supplementation with vitamin A, niacin, folic acid, B12, omega 3, probiotics and polyphenols;however, the consumption of foods rich in these nutrients is recommended to support immune function. It is recommended that workers follow the recommendation of consuming 400 g/day of fruits and vegetables, remain hydrated and limit caffeine. There is no scientific evidence supporting the consumption of alkaline foods to prevent infections. The aforementioned recommendations are particularly relevant during the pandemic.

Micronutrient recommendations for vulnerable groups in context of undernutrition, during the COVID-19 pandemic in Latin America

The COVID-19 crisis (SARS-CoV-2) might transform into a food catastrophe in Latin America and would increase the number of people suffering from hunger from 135 to 265 million, particularly in Venezuela, Guatemala, Honduras, Haiti and El Salvador, already facing economic and health crises. This manuscript presents the position of a group of Latin American experts in nutrition for establishing the recommendations for consumption and/or supplementation with vitamin A, C, D, zinc, iron, folates and multiple micronutrients, in undernutrition contexts, for vulnerable population of pregnant and lactating women, children under 5 years and the elderly. The recommendations seek to decrease the potential impact that COVID-19 will have on nutritional status during the pandemic. The position arises from the discussion of the experts based on the review of current scientific evidence for these vulnerable groups. It aims to reach stakeholders, public policy makers, health personnel and civil society organizations. Only after breastfeeding and a sufficient diet in terms of quantity and quality, a supplementation with the micronutrients mentioned above can help prevent and treat viral diseases, strengthen the immune system and even reduce complications. Breastfeeding with respiratory hygiene measures, the provision of multiple micronutrients powders for children from 6 moths to 5 years of age and the supply of iron and folates or multiple micronutrients tablets for pregnant women are proven and effective strategies that must continue to be implemented during COVID-19 pandemic. For older adults, supplementation with vitamin C, D and zinc might be indicated.