Immune Responses to Mrna Vaccines against Sars-Cov2 in Patients with Immune-Mediated Inflammatory Rheumatic Diseases

Background/Aims Patients with immune-mediated rheumatic diseases (IMRD) are commonly treated with immunosuppressors and are prone to infections. Recently introduced mRNA SARS-Cov2 vaccines have demonstrated extraordinary efficacy across all ages. Immunosuppressed patients were excluded from phase III trials with SARS-We aim to fully characterize B and T cell immune responses elicited by mRNA SARS-Cov2 vaccines in patients with rheumatic diseases under immunotherapies, and to identify which drugs reduce vaccine's immunogenicity. Methods Humoral, CD4 and CD8 immune responses were investigated in 147 SARS-Cov2-naive patients with selected rheumatic diseases under immunosuppression after a two-dose regimen of SARS-Cov2 mRNA vaccine. Responses were compared with age, gender, and diseasematched IMRD patients not receiving immunosuppressors and with healthy controls Results IMRD patients showed decreased seroconversion rates (63% vs 100%, p=0.04) and cellular immune responses (59% vs 100%, p=0.007). Patients on methotrexate achieved seroconversion in 62% of cases and cellular responses in 80% of cases. Abatacept deeply affected humoral and cellular responses. Rituximab (31% responders) and belimumab (50% responders) showed severely impaired humoral responses but cellular responses were often preserved. Antibody titers were reduced with mycophenolate and azathioprine but preserved with leflunomide. Conclusion IMRD patients exhibit impaired SARS-CoV-2 vaccine-immunogenicity, variably reduced with immunosuppressors. Among commonly used therapies, abatacept and B-cell depleting therapies show the most deleterious effects, while anticytokines preserved immunogenicity. The effects of cumulative methotrexate and glucocorticoid doses on immunogenicity should be considered. Humoral and cellular responses are weakly correlated, but CD4 and CD8 tightly correlate. Seroconversion alone might not reflect the vaccine's immunogenicity.

Educational Data Mining: Sentiment analysis in a university domain during the pandemic

The new normality caused by the COVID 19 health emergency forced governments to adopt mandatory isolation rules, the measures modified social interaction in almost all scenarios. In the educational field, educational establishments in general closed their facilities and adopted technological tools to replace the physical classroom, thus inaugurating a period of emergency remote education (Hodges et al., 2020) (Portillo, S., Castellanos, L., Reynoso, O., & Gavotto, O., 2020) (Castaneda and Vargas, 2021). The present investigation analyzes the student perception about the implementation of emergency remote education in the Social Communication Career of the Central University of Ecuador in the academic period 2020 -2020, for which an opinion poll was applied to students. The qualitative instrument collected the opinion, and the corpus was processed in a Python bookstore. In general, a positive assessment of the new educational reality was evidenced, the use of platforms and social networks was highlighted, as well as innovative educational practices in: master classes, experimentation, tutorials and evaluations;Among the negative aspects, the low teacher/student interaction, the lack of didactics in digital environments, and the deepening of the technological gap were questioned.

Lifestyle modifications of Chilean adolescents during the first COVID-19 confinement

Background: Confinement is an effective measure to control COVID-19, but it can have repercussions on lifestyle-related behaviors, especially among adolescents. Poor quality diet and low physical activity could trigger weight gain and the appearance of chronic non-communicable diseases at an early age. Aim: To study the changes in eating and physical activity patterns before and during the first COVID-19 confinement in Chilean adolescents. Material and Methods: Chilean adolescents aged between 10 and 19 years were invited to answer an online survey with 47 questions about dietary habits and physical activity. Results: The survey was answered by 420 participants and only four adolescents declined to answer it. Changes in eating patterns were evidenced, such as an increase in lunch consumption from 54.1 to 83%, and a decrease in the consumption of both healthy and unhealthy foods. Also, significant changes were observed in physical activity patterns, and an increase in the time spent sitting, from 4.7 to 5.8 hours during confinement. Conclusions: The first confinement for COVID-19 modified eating and physical activity patterns in Chilean adolescents towards unhealthy habits, which if maintained, could negatively affect their health and quality of life.

Factors Associated with Mortality in Patients with COVID-19 from a Hospital in Northern Peru

We aimed to identify the factors associated with mortality in patients with COVID-19 from the hospitalization service of the Cayetano Heredia Hospital, Piura, Peru, from May to June 2020. A prospective study was conducted in hospitalized patients with a confirmed diagnosis of COVID-19 through serological and/or molecular reactive testing. The dependent variable was death due to COVID-19, and the independent variables were the epidemiological, clinical and laboratory characteristics of the patient. The chi-square test and the non-parametric Mann–Whitney U test were used, with a significance level of 5%. Of 301 patients with COVID-19, the majority of them were male (66.1%), and the mean age was 58.63 years. Of the patients analyzed, 41.3% of them died, 40.2% of them were obese and 59.8% of them had hepatic steatosis. The three most frequent signs/symptoms were dyspnea (90.03%), fatigue (90.03%) and a cough (84.72%). Being an older adult (p = 0.011), being hospitalized in the ICU (p = 0.001), overweight (p = 0.016), obese (p = 0.021) and having compromised consciousness (p = 0.039) and thrombocytopenia (p = 0.024) were associated with mortality due to COVID-19. Overall, the mortality rate due to COVID-19 was 41.3%. Having an older age, being hospitalized in the ICU, overweight, obese and having compromised consciousness and thrombocytopenia were positively associated with mortality in patients with COVID-19. These findings highlight the need to establish an adequate system of surveillance and epidemiological education in hospitals and communities in the event of new outbreaks, especially in rural and northern Peru. © 2023 by the authors.

Convergence between technology and education for sustainable development in Latin America

The use of new technologies in education (computers and other devices) is a key factor that allows cost reduction, since physical material is no longer necessary and everything can be done through a program or app, making it easier for students and teachers to search and deliver quality information quickly and efficiently in real time. The objective of the work is to emphasize the strength of technology in higher education to favor integration, the modest but encouraging opportunities and results that have been achieved, as an ecumenical and dynamic factor in the integration process. The methodology is qualitative in approach, since a documentary analysis is developed through the collection of material, books and articles that allow us to reflect on the possibility of carrying out more in-depth studies on the convergence between education and technologies. The results reflect a technological evolution of Education 4.0 and the concepts that support higher education in the digital era, the pedagogical and academic trends that support it, and its impact on the virtualization of higher education. In the conclusions we perceive the new trends in digital education, the pandemic by covid-19 accelerated changes in study methods with the obligation of virtual study through similarities that describe the convergences and divergences between educational conceptions and technologies. © 2022 IEEE.

Clinical Characteristics and Outcomes of Adults with Covid-19 Admitted to a Pediatric Intensive Care Unit. A Challenge for Pediatric Intensivists

BACKGROUND AND AIM: The conversion of pediatric intensive care unit to adult intensive care unit (PICU-AICU) has occurred all over the world during the COVID-19 pandemic. The reports of the results and outcomes are limited. METHOD(S): Retrospective observational study of adults admitted to PICU-AICU for COVID-19 from May 11, to July 26, 2020. RESULT(S): Ninety-three patients over 18 years with suspected or confirmed COVID-19 were admitted to the PICU-AICU. The median age was 60.3 (SD 13.9) years and 59 (63.4%) patients were male. Eighty-two (88.1%) patients had at least 1 medical comorbidity. The median APACHE II score was 9.4 points (SD 5.6). Fifty-one (54.8%) patients were invasively ventilated, for a median of 13.7 days (DS 17.9). Inotropic support was used in 45 (48%) patients. Thirty-three (35.5%) patients presented acute kidney failure (AKI) and 14 (15.1%) patients received continuous renal replacement therapy. Twenty-nine (31.2%) patients had health-care associated infections. Median stay was 10.8 days (DS 11.8). A total of 25 (26.9%) patients died. Ten (40%) of the 25 patients who died had established limitation of therapeutic effort. CONCLUSION(S): The mortality rate of critically ill patients with COVID-19 is high. Older patients (>70 years), those who require invasive mechanical ventilation and who develop AKI are at increased risk of death. Although this is not a comparative study, our mortality rate and complications seem to be similar to those reported in adult case series.

Immune Responses to Mrna Vaccines against Sars-Cov-2 in Patients with Immune-Mediated Inflammatory Rheumatic Diseases

Aims To fully characterise B-cell and T-cell immune responses elicited by mRNA SARS-CoV-2 vaccines in patients with rheumatic diseases under immunotherapies, and to identify which drugs reduce vaccine's immunogenicity. Methods Humoral, CD4 and CD8 immune responses were investigated in 100 naive patients with SARS-CoV-2 with selected rheumatic diseases under immunosuppression after a two-dose regimen of SARS-CoV-2 mRNA vaccine. Responses were compared with age, gender and disease-matched patients with IMRD not receiving immunosuppressors and with healthy controls. Results Patients with IMRD showed decreased seroconversion rates (80% vs 100%, p=0.03) and cellular immune responses (75% vs 100%, p=0.02). Patients on methotrexate achieved seroconversion in 62% of cases and cellular responses in 80% of cases. Abatacept decreased humoral and cellular responses. Rituximab (31% responders) and belimumab (50% responders) showed impaired humoral responses, but cellular responses were often preserved. Antibody titres were reduced with mycophenolate and azathioprine but preserved with leflunomide and anticytokines. Conclusions Patients with IMRD exhibit impaired SARS-CoV-2 vaccine immunogenicity, variably reduced with immunosuppressors. Among commonly used therapies, abatacept and Bcell depleting therapies show deleterious effects, while anticytokines preserved immunogenicity. The effects of cumulative methotrexate and glucocorticoid doses on immunogenicity should be considered. Humoral and cellular responses are weakly correlated, but CD4 and CD8 tightly correlate. Seroconversion alone might not reflect the vaccine's immunogenicity.

INVASIVE PULMONARY FUSARIOSIS WITH SUPERIMPOSED HISTOPLASMOSIS IN AN IMMUNOCOMPETENT HOST

SESSION TITLE: Complicated Chest Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Fusarium species (FS) are large filamentous fungi widely distributed in soil and plants that are well-known to cause human infections ranging from superficial to disseminated predominantly depending on the host's immune system. Histoplasma capsulatum (HC), on the other hand, is a dimorphic fungus found in soil contaminated with bird or bat droppings, such as caves, where most infections are asymptomatic or self-limited. We present a case of an immunocompetent patient who developed long-term pulmonary sequelae after a co-infection pneumonia with FS and HC. CASE PRESENTATION: 47-year-old man, non-smoker with history of Myasthenia Gravis presents to the emergency department with worsening shortness of breath and sporadic episodes of fever over the course of 3 weeks. The patient claimed to have gone cave-exploring and worked as an air-condition technician. During the previous three years, he reports progressive dyspnea on exertion, fatigue, and a constant dry cough that required multiple hospitalizations which was treated as Myasthenic Crisis. Clinical exam was remarkable for diffuse rales on bilateral lungs with a resting hypoxia of 82-84%. Laboratories showed elevated inflammatory markers with no leukocytosis or neutropenia. Chest-x-ray revealed increased pulmonary markings and chest CT demonstrated diffuse bilateral ground-glass opacities with septal thickening and innumerable millimetric pulmonary nodules of unclear distribution. Extensive infectious, immunologic, and rheumatologic workup were negative. He underwent a bronchoscopy with broncho-alveolar lavage (BAL) which showed FS and HC on cytology. Therefore, intravenous liposomal Amphotericin B was given for 2 weeks followed by a long-course of oral Voriconazole resulting in marked improvement of symptoms, yet he remained with limited physical activity due to exertional hypoxia of less than 80%. Pulmonary function tests revealed mixed obstructive-restrictive disease. DISCUSSION: To our knowledge, this case represents a novel and rare presentation of invasive pulmonary fusariosis with superimposed histoplasmosis in an immunocompetent host. Our patient had environmental exposure for years with subsequent chronic and progressive respiratory symptoms, however, with no evidence of immunosuppression. Imaging findings were non-specific which difficulted the diagnosis. Nonetheless, the patient was given directed antifungal therapy as a result of the BAL's histopathologic findings with improvement of symptoms. CONCLUSIONS: Regardless of the immunologic status, invasive fungal pneumonia should be considered in patients with prolonged environmental exposure and non-specific chest imaging abnormalities. Reference #1: Chae, S. Y., Park, H. M., Oh, T. H., Lee, J. E., Lee, H., Jeong, W. G., & Kim, Y.-H. (2020). Fusarium species causing invasive fungal pneumonia in an immunocompetent patient: a case report. Journal of International Medical Research. https://doi.org/10.1177/0300060520976475. Retrieved March 18, 2022. Reference #2: Kauffman, C. A. (2022). Diagnosis and treatment of pulmonary histoplasmosis. In Bogorodskaya, M. (Ed.), UpToDate. Retrieved March 18, 2022, from https://www.uptodate.com/contents/diagnosis-and-treatment-of-pulmonary-histoplasmosis. Reference #3: Poignon, C., Blaize, M., Vezinet, C., Lampros, A., Monsel, A., & Fekkar, A. (2020). Invasive pulmonary fusariosis in an immunocompetent critically ill patient with severe COVID-19. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 26(11), 1582–1584. https://doi.org/10.1016/j.cmi.2020.06.026. Retrieved March 18, 2022. DISCLOSURES: No relevant relationships by Juan Adams-Chahin No relevant relationships by Jorge Barletta Farias No relevant relationships by Gabriel Galindez De Jesus No relevant relationships by Camille Gonzalez Morales No relevant relationships by manuel hernandez No rele ant relationships by Enrique Leal No relevant relationships by Arelis Morales Malavé No relevant relationships by Ruth Santos Rodriguez

Face-Mask Associated Dry Eye (F-MADE) Symptoms and Ocular Surface Alterations

Purpose : Since the onset of the coronavirus disease 19 (COVID-19) pandemic, people's lives have adapted, with the use of face masks becoming a part of our daily routine. Despite being a useful device to prevent disease contagion, a marked increase in dry eye and stye symptoms has been detected. We aimed to perform an observational correlation analysis between face-mask use and to report both objective and subjective ocular surface measurements performed on a multi-purpose advanced corneal topographer and a high-definition camera. Methods : This study included 25 healthy subjects without any ocular diseases, ages ranging from 19 to 68 years. We measured tear meniscus height, Non-Invasive Tear Breakup Time (NIBUT), overall redness score, and tear film lipid layer characterization using Keratograph 5M (Oculus, Wetzlar, Germany), as well as Ocular Surface Disease Index (OSDI) scores for dry eye symptomatic assessments. Patients were asked the number of hours of mask-use at the moment of enrollment, the average hours of mask use daily, and the type of face mask used. We assessed for differences between OSDI scores and gender and type of mask used, as well as correlation coefficients for all subjective and objective measurements. Results : The mean age of the subjects was 42.44±14.49 years. OSDI scores had no significant differences according to gender (p = 0.1664) or type of mask used (p = 0.0791). Correlation between hours of mask use at the time of testing and ocular surface modifications were minimal. Hours of mask-use at the time of the test and OSDI scores were moderately correlated (r= 0.5047, p=0.01). No correlation was found between the average hours of mask use and any ocular surface measurements or OSDI scores. Conclusions : The use of face masks increased subjectively dry eye symptoms. Nevertheless, ocular surface objective measurements remain unchanged by maskwearing.

Mobile App to Make Better the Obesity Prevention Process in Adolescents

Currently the whole world is going through an epidemiological crisis due to Covid-19, a virus which has a greater impact on people who are overweight or obese. Obesity represents a risk factor for serious illness and death from COVID-19. There is an enzyme that converts angiotesin-2, which is an enzyme that SARS-CoV-2 uses for entry at the cellular level, it is found in higher amounts in people with obesity. Among the group of people who can suffer from obesity are adolescents, who do not always maintain healthy eating habits or perform physical activities. In this research, a mobile application is presented to control and monitor the patient's body mass index according to their weight and height, making it known if they have obesity or any variant. In addition, it allows the patient to know the appropriate portions of daily food and to keep an own control of their physical activities and a history of their meals. That is why the objective of this research is to determine the impact that a mobile application can have on the obesity prevention process in adolescents. This study was carried out in Lima in 56 adolescents from 10 to 19 years old, in which 44.6% managed to improve their condition and 26.7% managed to stay in a normal condition.

Quality mobile applications aimed at fostering healthy habits in children and young people. Current outlook in Spain

Mobile applications which incorporate health-related contents are technological tools that have become more widely spread in recent years, especially due to the global coronavirus pandemic. In Spain, many apps have already been subjected to quality and reliability regulation through accreditation initiatives. In addition, it has been proven that gamification in this sort of technology is effective in generating healthy behaviors in the young population. This research focuses on knowing how many of these apps have a quality certification in our country and promote healthy habits in children and young people. An exhaustive review has been carried out of governmental and non-governmental health websites, specifically those which recognize different quality seals, badges or labels as accrediting initiatives in the field of health. As for the results, in spite of the importance for their health and well-being, there are few certified mobile applications that integrate gamified elements and are intended to educate children and adolescents about the importance of a healthy lifestyle in comparison to the number of apps available for adults.

Extracorporeal membrane oxigenation in COVID-19 patients: Results of the ECMO-COVID Registry of the Spanish Society of Cardiovascular and Endovascular Surgery

Background and aim: COVID-19 patients with severe heart or respiratory failure are potential candidates for extracorporeal membrane oxygenation (ECMO). Indications and management of these patients are unclear. Our aim is to describe the results of a prospective registry of COVID-19 patients treated with ECMO. Methods: An anonymous prospective registry of COVID-19 patients treated with veno-arterial (V-A) or veno-venous (V-V) ECMO was created on march 2020. Clinical, analytical and respiratory preimplantation variables, implantation data and post-implantation course data were recorded. The primary endpoint was all cause in-hospital mortality. Secondary events were functional recovery and the combined endpoint of mortality and functional recovery in patients followed at least 3 months after discharge. Results: Three hundred and sixty-six patients from 25 hospitals were analyzed, 347 V-V ECMO and 18 V-A ECMO patients (mean age 52.7 and 49.5 years respectively). Patients with V-V ECMO were more obese, had less frequently organ damage other than respiratory failure and needed less inotropic support;Thirty three percent of V-A ECMO and 34.9% of V-A ECMO were discharged (P = NS). Hospital mortality was non-significantly different, 56.2% versus 50.9% respectively, mainly during ECMO therapy and mostly due to multiorgan failure. Other 51 patients (14%) remained admitted. Mean follow-up was 196 ± 101.7 days (95%CI: 170.8-221.6). After logistic regression, body weight (OR 0.967, 95%CI: 0.95-0.99, P = 0.004) and ECMO implantation in the own centre (OR 0.48, 95%CI: 0.27-0.88, P = 0.018) were protective for hospital mortality. Age (OR 1.063, 95%CI: 1.005-1.12, P = 0.032), arterial hypertension (3.593, 95%CI: 1.06-12.19, P = 0.04) and global (2.44, 95%CI: 0.27-0.88, P = 0.019), digestive (OR 4,23, 95%CI: 1.27-14.07, P = 0.019) and neurological (OR 4.66, 95%CI: 1.39-15.62, P = 0.013) complications during ECMO therapy were independent predictors of primary endpoint occurrence. Only the post-discharge day at follow-up was independent predictor of both secondary endpoints occurrence. Conclusions: Hospital survival of severely ill COVID-19 patients treated with ECMO is near 50%. Age, arterial hypertension and ECMO complications are predictors of hospital mortality, and body weight and implantation in the own centre are protective. Functional recovery is only predicted by the follow-up time after discharge. A more homogeneous management of these patients is warranted for clinical results and future research optimization. © 2022 Sociedad Española de Cirugía Cardiovascular y Endovascular

VIRTUAL LEARNING ENVIRONMENTS: VARIABLES THAT AFFECT THE PEDAGOGICAL PRACTICES OF ELEMENTARY SCHOOL TEACHERS IN THE CHILEAN CONTEXT

The spread of the COVID-19 virus brought diverse consequences of a social, political, economic and cultural nature. Faced with the emergency, the governments of different countries, including Chile, were forced to close schools and transport educational processes to virtual learning environments. This article summarizes the qualitative research based on semi-structured interviews with six teachers, with the objective of knowing, analyzing and understanding teaching and evaluation practices, inquiring into the factors that directly or indirectly affect them. The results showed that personal characteristics, knowledge, conceptions and perceptions about different educational dimensions directly influence the practices and platforms used in distance learning. In parallel, the context of the students and the policies of each school, appear as factors that intervene in pedagogical practices in virtual environments.

Implications of the pandemic in radiotherapy for breast cancer. Hypofractionated radiation therapy

The current pandemic due to the new coronavirus (SARS-CoV-2) has put health systems around the world to the test, in a way so urgent that had not been seen in several years. The implications in health care not only affect patients with COVID-19, but they are transversal to all pathologies. Specifically in breast cancer, hypofractionated radiotherapy schemes constitute a valid and safe alternative that helps reduce the exposure of patients to the new virus, the congestion of health institutions and the costs of specialized cancer treatments. In this article, we conducted a review of the most relevant literature on shortened radiotherapy regimens in breast cancer: hypofractionation and extreme hypofractionation, and their equivalence with fractionation. In the end, the recommendations of different scientific societies and international experts are highlighted, to consider hypofractionated radiotherapy schemes, regarding the global health contingency. © 2021

Implications of the pandemic in radiotherapy for breast cancer. Radiation therapy omission

The current pandemic due to the new Coronavirus (SARS-CoV-2) requires the health systems to rapidly adopt measures aimed at mitigating the crisis, which implies redistributing economic and social resources and the workforce, so that those sectors of the population most affected can be cared for in an optimal and timely manner. In patients with low-risk invasive breast cancer and low-risk ductal carcinoma in situ, postoperative radiation therapy does not offer any benefit in overall survival, making the idea of omitting this oncological resource attractive. In this second article, we conducted a review of the literature on the criteria for omitting adjuvant radiotherapy in patients with low-risk breast neoplasms. In addition, the recommendations issued during the current contingency made by some international scientific societies are summarized, and certain reasons why physicians refuse to change clinical behaviors that offer limited advantages are analyzed, many times outweighed by the associated risks and adverse effects. © 2021

Sustainable business models to create sustainable competitive advantages: strategic approach to overcoming COVID-19 crisis and improve financial performance

Purpose The purpose of this study is to evaluate whether the implementation of sustainable business models contributes to improving a firm's performance during a global crisis, such as the one caused by COVID-19. Based on the triple bottom line theory, the paper explores the relation between the creation of value through solid corporate social responsibility (CSR) strategies, United Nations (UN) Global Compact's (GC) business model proposals and Global Reporting Initiative's (GRI) reporting scheme. Design/methodology/approach The present paper studies companies within the European Union, focusing specifically on the long-term impact of using the world's most widely used standards for sustainability reporting - the GRI's standards and/or the UNGC management models, as well as on the firm's performance based on the financial results during COVID-19 crisis. To achieve this goal, the study analyses the share price of firms publicly listed in the FTSEMIB (benchmark index of Italy's largest trading platform) out of those companies that are implementing the UN and GRI's tools. Findings Findings show how a commitment to sustainable business models and long-term CSR strategies can contribute to firm's ability to overcome periods of economic crisis. Furthermore, implementing GRI standards and UNGC guidelines within the business model seems to have a positive impact in overcoming a hard context such as COVID-19. In addition, it contributes to a better understanding of stakeholders' needs, consumer profiling and value creation. Originality/value This study evaluates firms' business models, considering the effects of decisions made in the context of COVID-19. The role of UNGC and GRI is evaluated in terms of their contribution to firms' financial performance and corporate reputation during a context of hardship. Consequently, this study contributes to academia and practice, adding value in areas related to strategic planning and business model design.