Analysis of paxlovid® for the treatment of COVID-19 in Aragón, Spain

Background and ImportancePaxlovid® is indicated for the treatment of COVID-19 in adults who do not require supplemental oxygen and who are at increased risk for progressing to severe COVID-19. The Spanish Drug Agency published prioritisation criteria for it access. Paxlovid® has significant drug interactions, mainly due to ritonavir. Hospital pharmacists must validate the prescription, carrying out a thorough review of the patient‘s medical history to check its suitability, as well as the concomitant medication to avoid interactions.Aim and ObjectivesAnalyse the use of Paxlovid® in Huesca and Sector-1 of Zaragoza (Aragon, Spain) in early months post-authorisation.Material and MethodsAll Paxlovid's prescriptions from April to September 2022 were reviewed. The following variables were collected: gender, age, vaccination schedule, prioritised high-risk criteria and renal function. All concomitant medication was reviewed for drug interactions using a protocol created by Coordination Unit for the Rational Drug Use of Aragon. The observations made to the prescribing physician by the hospital pharmacist were recorded.Results40 requests were received. 5 were prescription errors. 29 (82.9%) were accepted and 6 (17.1%) rejected. Median age (years, interquartile-range q1-q3) was 52.2 (45.6–65.3), 57.1% were male. Vaccination status was complete primary vaccination with booster-dose (62.8%) followed by complete vaccination (25.7%) and incomplete vaccination (11.5%). As high-risk criteria prioritised, 91.4% belonged to group composed by immunocompromised persons. 91.4% had renal function >60ml/min. Only in 3 cases (8.6%) the prescribing physician indicated the patient had potential drug interactions.All patients had concomitant medication, median of 8 drugs (4–10). 60% had any potential interaction, with serious drug interactions in 42.9% of them. Drugs with potential serious interactions were statins (5/11);benzodiazepines (2/11) and antithrombotic agents (2/11).44.8% prescriptions were accepted with recommendations to modify or temporary stop some of the patient‘s usual treatment. 80% of the rejected cases were due to serious drug interactions.Conclusion and RelevanceIn the use of Paxlovid®, the role of hospital pharmacists was crucial, as drug interactions were detected in 60% of patients and were serious in 42.9% of them, leading to recommendations for adjustments in patients‘ drug therapy in almost half of the cases, with potentially serious drug interactions being the main reason to not dispense Paxlovid®.References and/or AcknowledgementsConflict of InterestNo conflict of interest

Severe SARS-CoV-2 pneumonia and pneumomediastinum and/or pneumothorax: a prospective observational study in an intermediate respiratory care unit

Introduction: The occurrence of pneumomediastinum (PNMMD) or pneumothorax (PNMTX) was evaluated in patients with severe SARS-CoV-2 pneumonia. Method(s): This is a prospective observational descriptive study that was carried out on patients admitted to the IRCU of a COVID-19 monographic hospital in Madrid from 14/01/2021 to 27/09/2021. All of them had a diagnosis of severe SARS-CoV-2 pneumonia and required NIRS (HFNC, CPAP, BPAP). The incidences of PNMMD and PNMTX, total and according to NIRS, and their impact on the probability of IMV and death were studied. Result(s): (tables 1 and 2) 4.3% (56/1306) developed PNMMD or PNMTX, 3.8% (50) PNMMD, 1.6% (21) PNMTX, and 1.1% (15) PNMMD+PNMTX. 16.1% of patients with PNMMD or PNMTX had HFNC alone (vs 41.7% without PNMMD or PNMTX;p<0.001) and 83.9% CPAP (vs 57.5%;p<0.001). There was a probability of needing IMV of 64.3% among patients with PNMMD or PNMTX (vs 21.0%;p<0.001), and a mortality of 33.9% (vs 10.5%;p<0.001). Conclusion(s): In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia who required NIRS, incidences of 3.8% for PNMMD and 1.6% for PNMTX were observed. LDH was a risk factor for developing PNMMD or PNMTX (median 438 vs 395;p=0.013), and PNMMD (median 438 vs 395;p=0.014). The majority of patients with PNMMD or PNMTX had CPAP as the NIRS device, much more frequently than patients without PNMTX or PNMMD. However, the pressures used in CPAP were even lower in patients with PNMMD or PNMTX (median 8 vs 10;p=0.031). The probabilities of IMV and mortality among patients with PNMMD or PNMTX were 64.3% and 33.9%, respectively, higher than in patients without PNMMD or PNMTX, 21.0% and 10.5%.

Clinical Findings and Outcomes from 1306 Patients with Covid-19 Pneumonia in an Intermediate Respiratory Care Unit: A Prospective, Observational Study

Background: An intermediate respiratory care unit (IRCU) may be a valuable tool for optimizing patient care, allowing to implement standardized algorithm management to decrease clinical failure and mortality. We aimed to describe the practice of noninvasive respiratory strategies (NRS) in a novel facility fully dedicated to COVID-19 and to establish outcomes of these patients Methods: Prospective, observational study performed at one hospital in Spain. We included consecutive patients admitted to IRCU due to COVID-19 requiring NRS between December 2020 and September 2021. Data collected included mode and usage of NRS, endotracheal intubation and mortality to day 30. A multivariable Cox proportional hazards method was used to assess risk factors associated with clinical failure and mortality Findings: 1306 patients with COVID-19 were included. Of them, 64.6% were men and mean age was 54.7 years. During IRCU stay, 345 patients presented a clinical failure, (89.6% intubated;14.5% died). Cox model showed a higher clinical failure in IRCU when time between symptoms onset and hospitalization < 10 days (HR 1.59;95% CI 1.24-2.03;p<0.001) and PaO2/FiO2 <100 (HR 1.59;95% CI 1.27-1.98;p<0.001). Conversely, these variables were not associated with an increased mortality to day 30 Interpretation: IRCU may be a useful option for the multidisciplinary management of COVID-19 patients requiring NRS;thus, reducing ICU overcharge. Men gender, gas-exchange and blood chemistry at admission are associated with worse clinical outcomes, while older age, gas-exchange and blood chemistry are associated with 30-day mortality.

Usefulness of the early combination of non-invasive respiratory therapies in patients with COVID-19

Aim: To determine the effect of the early combination of high flow nasal cannula (HFNC) plus continuous positive airway pressure (CPAP) regarding endotracheal intubation (ETI) and 30-day mortality in patients with SARS-CoV-2 pneumonia. Method(s): Observational study of patients admitted to the intermediate respiratory care unit (IRCU) who received HFNC+CPAP. Two groups were formed according to the time of starting the combined therapy: Early HFNC+CPAP (first 24 h - EHC) and Late HFNC+CPAP (after 24 h - LHC). A multivariate analysis was performed to establish the strength of the association with ETI and 30-day mortality. Result(s): 780 patients were included (502 male, mean age 56.5 +/- 12.9 years). Table 1 shows the baseline characteristics. 273 patients were subjected to ETI, 32.9% in the EHC group vs 38.9% in the LHC group (p 0.05). 30day mortality was 8.2% in the EHC vs 15.5% LHC (p 0.02). Table 2 shows the multivariate analysis. Conclusion(s): The combination of HFNC+CPAP, especially in the first 24 hours after IRCU admission, is a useful tool in the management of SARS-CoV-2 pneumonia.

ADHD in a patient with eating disorder. Case report

Introduction: 15-year-old female referred to outpatient unit after COVID lockdown for binge eating and purging with depressive symptoms and anxiety. Objective(s): To show the importance of a correct diagnosis in an impulsive patient with eating disorder Methods: case report and literature review Results: The patient presents emotional instability with interpersonal difficulties with high fear of rejection. She suffered from fear of gaining weight and desires to lose weight with rejection of her body image. Fluoxetine and lorazepam are started together with low doses of olanzapine. During the follow up she presented a worsening of mood, onset of self-injuries and an episode of suicidal attempt. A biographical examination was performed, expressing a feeling of academic failure with difficulty concentrating and performing simple tasks. As a child she is described as impulsive, with frequent arguments with classmates. CPT III was performed with a high probability of ADHD. Treatment was started with lisdexamfetamine up to 50 mg with good tolerance. From the beginning of the treatment the patient expressed a feeling of improvement in the control of emotions as well as in the management of her impulsivity. There was an improvement in her academic performance with a decrease in self-injury episodes. The patient was able to express improvement in the sense of incapacity she felt. Conclusion(s): This case shows how marked emotional dysregulation and impulsive symptoms improves after diagnosis and subsequent treatment of ADHD, also improving eating symptoms. ADHD is present in eating disorders, especially in those with impulse dyscontrol such as binge eating disorder or bulimia nervosa.

Sensitivity of the Panbio COVID-19 rapid antigen detection test in primary care

Introduction and objectives: primary care paediatricians need reliable rapid diagnostic techniques (RDTs) to prevent the spread of coronavirus disease 19 (COVID-19) through early and effective screening while awaiting a vaccine. The objective of this study was to evaluate the sensitivity (Sen) of the Abbott laboratory SARS-CoV-2 Panbio antigen test, newly introduced in primary care, in both adults and children (symptomatic and asymptomatic contacts) in comparison to the polymerase chain reaction (PCR) test. Sample and methods: the study included 591 patients (222 aged less than 14 years) from 7 primary care centres;of who 249 were symptomatic and 342 asymptomatic contacts. We calculated the Sen and specificity (Spe) with their 95% confidence intervals (CIs). We assessed the independence of the two results with the McNemar test. Results: the Sen of the test within 5 days from onset was 81% in adults (95% CI, 66.16-96.34) and 80% in children (95% CI: 34.94-100). In contacts, we assessed the Sen within 5 days, in adults (68%;95% CI: 51.13-86.37), in 5 to 9 days (85%) and in children (66%;95% CI: 30.31-100). The most frequent source of exposure were household contacts (52% of the cases). The Spe was 100% in every case. Conclusions: the Panbio SARS-CoV-2 rapid antigen test can be useful for diagnosis in adults and children within 5 days of onset, and from days 5 to 9 in contacts of confirmed COVID 19 cases. Further studies are required for adequate interpretation of the latter result. © 2022, Spanish Association of Primary Care Pediatrics. All rights reserved.

Reticencias vacunales COVID-19

Introducción y objetivos Las reticencias vacunales frente a COVID-19 en España han ido evolucionando de un 32 a un 10%, causando que España sea uno de los países con mayores tasas de vacunación sin ser obligatoria. De febrero a mayo del 2022 se observó un levantamiento de restricciones y uso de medidas no farmacológicas, dejándose de exigir también el certificado digital, no obstante, una parte de la población continuó iniciando la vacunación frente al COVID-19. El objetivo es evaluar las causas que conducen a la vacunación en las personas vacunadas de forma tardía. Métodos El presente es un estudio cualitativo, descriptivo y prospectivo, con entrevistas telefónicas individuales a personas vacunadas frente a COVID-19 de forma tardía, entre febrero y mayo del 2022. El cuestionario se realizó telefónicamente, se efectuaron 2 llamadas por identificador y se utilizaron preguntas cerradas, obteniendo información de datos sociodemográficos, así como relacionados con la COVID-19 y su vacunación. Resultados La población vacunada de primera dosis durante el período de estudio fue de 1.768, contactando con 801, accediendo a contestar la encuesta 338 personas. Las variables sociodemográficas de la población encuestada se encuentran recogidos en la tabla, los resultados de los motivos de no vacunación en la tabla 2 y los motivos que conducen a la vacunación en la tabla 3.Unlabelled ImageUnlabelled ImageUnlabelled Image Conclusiones Una prioridad de la Estrategia Nacional de Vacunación frente a COVID-19 es iniciar la vacunación en las personas no vacunadas. Para las campañas hacia este colectivo es necesario diseñar estudios específicos para conocer a las personas reticentes frente a esta vacunación. Uno de los motivos que han fomentado la vacunación es considerar «ya» segura la vacuna, siendo fundamental reforzar los mensajes de seguridad. Además, viajar es un motivo reiterado para la vacunación, siendo importante no olvidar la posibilidad de exigir la vacunación para alguna actividad.

Could lockdown increase the incidence of eating disorders?

Introduction Spanish Governmen declared state of emergency in March 2020 to prevent coronavirus COVID-19 from spreading. During September and October 2020, at Child and Adolescent Psychiatry Unit we have attended patients who presented altered eating behaviors whose onset was during lockdown. We report a series of seven cases of adolescent girls between the ages of 11 and 16, who had no previous history of mental illness. During lockdown, they have presented restriction of food and increased physical exercise, with weight loss. Some of these patients have also presented food binges and purging behaviors. Objectives Review the impact of lockdown on eating behavior, specially on weight loss. Methods Literature review of scientific papers searching in Pubmed. Results There are articles that study the variations in eating habits and exercise ocurred during confinement. Most focus on two trends: on the one hand, increased intake and the tendency to a more sedentary life;on the other hand, the worsening of people with a previous diagnosis of eating disorder. However, there is a third trend for which there are few studies: the new appearance of restrictive eating behaviors, together with increased physical exercise, bingeing and purging. This is the case of the patients we present. These studies describe as a possible cause of these alterations that confinement is a novel situation, which generates stress, social isolation, boredom, anxiety and a feeling of loneliness, which can influence self-concept and eating behaviors. Conclusions Lockdown has favored a change in eating habits and exercise. More studies are needed on new-onset eating disorders.

Descriptive study on psychological first aid for COVID-19 patients’ relatives

Introduction The presence of psychological impact on relatives of patients admitted for Covid-19 has been described. The effectiveness of psychological first aid in critical situations has also been described. The first psychological aid describes a human response supporting another person who is suffering. This intervention is indicated for those affected by a traumatic event. Objectives To present a theoretical review about psychological first aid and to describe data about it on relatives of patients admitted for Covid-19. Methods Literature review about psychological first aid and data description of telephone intervention carried out by mental health professionals on family members of patients admitted for Covid-19. Results From an initial pool of 77 Covid-19 patients, 50 were selected as telephone contact with relatives was possible. Mean age was 68.9 years, 13 were female and 37 male. 90% were admitted in internal medicine department and 10% in intensive care unit. First telephone intervention in all cases was to introduce the psychiatrist in charge of the follow-up and provide contact number of psychiatry department. In 13 relatives` support, emotional ventilation and active listening was provided and 2 of them also received therapeutic guidelines. Further phone contact was required in 12 relatives. In follow-up phone calls, all relatives received therapeutic guidelines and 3 was referred to our outpatient clinic. Conclusions Family members of patients admitted for covid-19 may present emotional symptoms, many of them normal reactions in context of a crisis situation. A large percentage do not require a structured psychotherapeutic intervention but can benefit from a first psychological help. Disclosure No significant relationships.

Translating in turbulent times: Impact of the COVID-19 pandemic crisis on the language service industry in Colombia and Spain - Perspectives to become sustainable

The language service industry was deeply impacted by the COVID-19 pandemic. The turbulent times faced because of COVID-19 changed the way LSPs made decisions and delivered services to their customers. LSPs had to react by adapting themselves to the unexpected new market game. This study scrutinizes what the COVID-19 meant for the LSPs based in Colombia and Spain, and how they were tackled from those two different markets. Colombia, a developing country with an industry almost exclusively made up of independent freelance translators and interpreters, faced the crisis both distressingly and smartly. Spain, a developed country with a stronger language industry, coped with the COVID-19-induced economic calamity in a quite analogous fashion. In both cases, uncertainty led LSPs to make decisions, clarify their visions, and make a clear commitment to becoming sustainable in the global market. An in-depth analysis of how those two industries behaved might be useful to draw important conclusions on how a crisis can become an opportunity if properly managed. © 2022, IGI Global.

[Quantitative analysis of COVID-19 and its psychological and educational impacts on university and secondary students in Córdoba, Spain]. / Análisis cuantitativo del COVID-19 y sus impactos psicológicos y educativos en estudiantes universitarios y de secundaria en Córdoba, España.

INTRODUCCION: The COVID-19 pandemic that began in Wuhan, China, at the end of 2019, and which today threatens all the inhabitants of the planet, is currently the priority research topic. In this context, this article focuses on how this health problem directly affects the psychological and educational status of 344 university and high school students in Córdoba, Spain. MATERIAL AND METHODS: For the analysis, the structural equation model (SEM) has been used, through the quantification of a set of relationships between one or more independent variables, trying to condense the pandemic scenario and its health, psychological and educational implications. RESULTS: The first latent variable "Health" is causal of the latent variable "Psychology", and, of the endogenous variables, "social relations effects", "sadness effects" and "sexuality effects", which confirms that the COVID-19 seriously affected the psychological behavior of university and high school students in Córdoba.

Passive Method for Wax Casting in the Production of the Fuel Grain for in-space Hybrid Rocket

The Space Enabled Research Group at MIT is conducting a multiyear research effort to better understand the technical and logistical challenges posed by the implementation of a wax-based hybrid chemical in-space propulsion system. Paraffin and beeswax are being considered as candidate fuels. The overarching effort includes imagery analysis conducted on paraffin and beeswax centrifugal casting tests conducted onboard progressively higher-fidelity experimental platforms within transparent hardware which aids in optical investigations. Such platforms include a laboratory optical table experiment, as well as a vacuum chamber test, a parabolic trajectory microgravity aircraft (three flights to date), the Blue Origin New Shepard suborbital launch vehicle (three experiments onboard and scheduled for mid to late 2022), and potentially the Destiny laboratory module of the International Space Station. Each of these platforms allows for testing in a new environment or increasingly longer-duration microgravity. The main focus of this paper is in regards to a Suborbital flight experiment. This experimental setup had multiple limiting factors such a size, 10 cm x 10 cm x 20 cm and power of approximately 5 W. This lead to trying a new approach to the spin casting approach used previously by the team, as the method of forming the fuel grain annulus. This new approach was passive, meaning it did not require any additional power other than to melt the wax, and relied heavily on the surface tension properties of the containment chamber. The surface tension of the end caps was modified by using an oleophobic substance to repel the wax. Unfortunately, due to the Covid-19 pandemic, delays on flight caused results to not be ready before the date of publication of this paper. © 2022, American Institute of Aeronautics and Astronautics Inc, AIAA. All rights reserved.

Medicalization of nursing facilities as a real alternative to hospitalization during the COVID-19 pandemic

Background: Nursing homes are high-risk environments for the transmission of the SARS-CoV-2 coronavirus, as they are a closed environment, with patients who present atypical manifestations of the disease, high risk of unfavorable evolution, and staff who frequently present a high mobility in relation to their jobs. On the other hand, in a pandemic situation, numerous hospitals have suffered periods of great healthcare pressure. The objective of this work was to present an experience of medicalization of a residence where almost 50% of the residents contracted the disease.

Prevalence of depression among medical students during the COVID-19 pandemic. A systematic review and meta-analysis

Background: Medical students frequently have depressive symptoms. Thus, the psychological impact of COVID-19 on them should be high. Aim: To conduct a systematic review and meta-analysis on the prevalence of depression in medical students during the COVID-19 pandemic. Material and Methods: MEDLINE via PubMed, Embase and Web of Science were searched for studies reporting the prevalence of depression in medical students, published from December 1, 2019 to December 27, 2020. Results: Eleven studies were included, most of them from Asia. The estimated overall prevalence of depression in medical students was 31% (95% CI: 23%-40%), with lower prevalence rates reported in studies from Asia in general, and China in particular. Conclusions: Our findings indicate that the proportion of medical students with depression during the pandemic was high, and comparable with that reported in other university students.

Volatile compounds from Phyla scaberrima (Juss. ex Pers.) Moldenke and Dysphania ambrosioides (L.) Mosyakin & Clemants as possible SARS-CoV-2 protease inhibitors: Identification and in-silico study

Context: COVID-19 is a pandemic that has affected the entire population, characterized by multisystemic involvement. With around 130 million cases of infection and more than 2.5 million deaths globally. However, the development of a low-efficacy treatment has led to the study of natural products as possible therapeutic alternatives against SARS-CoV-2. Aims: To identify volatile compounds present in two plants in the Colombian Pacific and carry out in-silico studies to search for promising inhibitory molecules against SARS-CoV-2 proteases. Methods: This research carried out the identification of metabolites of two plants identified in the Colombian Pacific, called P. scaberrima (Juss. ex Pers.) Moldenke y D. ambrosioides (L.) Mosyakin & Clemants. Ethanolic extracts were obtained by rotary-evaporation and determinated by GC-MS. Subsequently, in-silico studies were carried out by molecular docking against Mpro and PLpro using Autodock-vina 1.1. Also, a prediction of ADMET properties using SwissADME and GUSAR-Online server was performed. Results: Thus, 15 volatile compounds with similarities greater than 85% were identified from both extracts, mostly sesquiterpenic and monoterpenic compounds. The compounds that showed the highest affinity against Mpro were α-amorphene and phytol for PLpro. Likewise, these were contrasted with co-crystallized molecules such as boceprevir and VIR2-251 as control structures. Finally, the predictions of ADMET properties showed values consistent with the literature. Conclusions: Therefore, the follow-up of in-silico studies with these plants from Colombian pacific are considered as possible tools in the search for active molecules against proteases linked to virus.

Dentistry in the COVID-19 environment. adaptation of the dental health units in Madrid's public primary health centres

The COVID-19 respiratory manifestations go from mild symptoms similar to those of a common cold to severe pneumonia with respiratory distress syndrome, septic shock and multiorgan failure. The disease is caused by the SARS-CoV-2 virus, whose transmission mechanism most relevant to dentistry is through respiratory droplets and possibly also aerosols, as well as direct contact with mucous membranes of the nose, mouth or eye via contaminated hands or objects. The professionals of the dental health units have a high risk exposure since they work at short distances (less than 1 m from the head of the patient) in the oral cavity, where a maximal expression of possible cell receptors for the virus has been reported. Also, most procedures in the dental cabinet imply aerosol generation. Cross-infection is possible during dental care, not only with diagnosed COVID-19-positive patients but also with patients who remain undetected due to asymptomatic or presymptomatic disease. For all these reasons, dental care in the primary health setting has had to change in order to adapt to the pandemic. The changes affect both the appointment scheduling and the care itself and imply the establishment of general and specific barrier protections as well as measures related to ventilation, cleaning, disinfection and sterilization, reinforced with additional infection prevention and control measures. This article summarizes.

Descriptive Study of an Emotional Support Program for Relatives of Patients Hospitalized with COVID-19 in the Puerta de Hierro Hospital in Madrid

The first wave of the COVID-19 crisis dramatically affected the global population. Madrid was one of the most severely affected regions in Spain. For public health reasons, family visits to hospitalized patients were restricted, preventing relatives from accompanying them. This article details the descriptive study that we carried out on the emotional support program offered to relatives of patients admitted during the first wave at Hospital Puerta de Hierro. A total of 456 relatives (mostly female, usually spouses or sons or daughters of patients) were contacted. Relatives of ICU patients and female relatives required broader levels of support. Increasing the perception of care through an emotional support program can be important for family members. Nevertheless, we consider additional studies to be necessary to explore the specific psychological benefits that these interventions provide.