Clinical evolution of patients with AF and diabetes mellitus in the COVID-19 pandemic. REFADI Registry

Introduction and objectives: To analyze the evolution of patients with atrial fibrillation (AF) and diabetes in the mid-term follow-up during the COVID-19 pandemic and to describe its impact on this population. Method(s): Multicenter and prospective registry that included patients with AF and diabetes attended in cardiology clinics. A multivariate analysis was performed to determine the variables associated with the occurrence of clinical events and mortality. Recruitment was performed in February-December 2019. Result(s): The evolution of 633 patients, 96,2% of those included in the REFADI registry with a median follow-up of 835 days was analyzed (mean age 73.8 +/- 8.5 years, 54.3% male, CHA2DS2-VASc 4,34 +/- 1,4, HAS-BLED 2,47 +/- 0,96) were analyzed. The proportion of anticoagulated patients remained constant (95.6% vs 94.5%;P = .24). There was a decrease in the prescription of vitamin K antagonists (from 31.4% to 19.7%;P < .01), and an increase in the use of direct anticoagulants (from 62.0% to 70.3%;P < .01). During the follow-up there was an increase in the prescription of SGLT2 inhibitors (from 20.0% to 25.5%;P < .01) and GLP1 agonists (from 4.2% to 9.1%;P < .01). During this period, 17.2% of patients died, the majority from cardiovascular causes, 6.4% from COVID-19, 2.8% from stroke, and 1.8% from hemorrhage. Older age, lower ejection fraction, lower hemoglobin levels, and especially lower direct anticoagulants prescription were associated with mortality. Conclusion(s): Patients with AF and diabetes have a high thromboembolic risk and a high risk of developing complications, especially of cardiovascular origin.Copyright © 2023 Sociedad Espanola de Cardiologia

PLASMA LIPIDS AND AMINO ACIDS LINKED TO LOW SARS-CoV-2 SUSCEPTIBILITY

Background: The mechanisms driving SARS-CoV-2 susceptibility remain poorly understood, especially the factors determining why a subset of unvaccinated individuals remain uninfected despite high-risk exposures. Method(s): We studied an exceptional group of unvaccinated healthcare workers heavily exposed to SARS-CoV-2 ('nonsusceptible') from April to June 2020, who were compared against 'susceptible' individuals to SARS-CoV-2, including uninfected subjects who became infected during the follow-up, and hospitalized patients with different disease severity providing samples at early disease stages. We analyzed plasma samples using different mass spectrometry technique and obtained metabolites and lipids profiles. Result(s): We found that the metabolite profiles were predictive of the selected study groups and identified lipids profiles and metabolites linked to SARS-CoV-2 susceptibility and COVID-19 severity. More importantly, we showed that non-susceptible individuals exhibited unique metabolomics and lipidomic patterns characterized by upregulation of most lipids -especially ceramides and sphingomyelin-and amino acids related to tricarboxylic acid cycle and mitochondrial metabolism, which could be interpreted as markers of low susceptibility to SARS-CoV-2 infection. Lipids and metabolites pathways analysis revealed that metabolites related to energy production, mitochondrial and tissue dysfunction, and lipids involved in membrane structure and virus infectivity were key markers of SARS-CoV-2 susceptibility. Conclusion(s): Lipid and metabolic profiles differ in 'nonsusceptible' compared to individuals susceptible to SARS-CoV-2. Our study suggests that lipid profiles are relevant actors during SARS-CoV-2 pathogenesis and highlight certain lipids relevant to understand SARS-CoV-2 pathogenesis. (Figure Presented).

Kikuchi-Fujimoto disease type lymph node reaction with increased plasmacytoid dendritic cells may appear as a side effect following COVID-19 vaccination: Report of a case and literature review

Subsequent to mass vaccination programs against COVID-19, diverse side effects have been described, both at the injection site, such as pain, redness and swelling, and systemic effects such as fatigue, headache, muscle or joint pain. On rare occasions, a lymphadenopathic syndrome may develop, raising the clinical suspicion of a lymphoproliferative disorder. We present the case of a 30-year-old woman who developed self-limiting left axillary lymphadenopathy following COVID-19 vaccination. To date, only seven similar cases with a complete clinicopathological description have been published, and fourteen cases have been notified to the European adverse events databases (Eudravigilance) in relationship with vaccination against COVID-19. It is important to be aware of this potential complication when a lymphadenopathic syndrome develops following vaccination, to avoid unnecessary treatment.Copyright © 2023 Sociedad Espanola de Anatomia Patologica

Profile of COVID-19 in Brazil-risk factors and socioeconomic vulnerability associated with disease outcome: retrospective analysis of population-based registers.

OBJECTIVES: To classify the most up-to-date factors associated with COVID-19 disease outcomes in Brazil. DESIGN: Retrospective study. SETTING: Nationwide Brazilian COVID-19 healthcare registers. PARTICIPANTS: We used healthcare data of individuals diagnosed with mild/moderate (n=70 056 602) or severe (n=2801 380) COVID-19 disease in Brazil between 26 February 2020 and 15 November 2021. MAIN OUTCOME MEASURES: Risk of hospitalisation and mortality affected by demographic, clinical and socioeconomic variables were estimated. The impacts of socioeconomic inequalities on vaccination rates, cases and deaths were also evaluated. RESULTS: 15.6 million SARS-CoV-2 infection cases and 584 761 COVID-19-related deaths occurred in Brazil between 26 February 2020 and 15 November 2021. Overall, men presented a higher odds of death than women (OR=1.14, 95% CI 1.13 to 1.15), but postpartum patients admitted to hospital wards were at increased odds of dying (OR=1.23, 95% CI 1.13 to 1.34) compared with individuals without reported comorbidities. Death in younger age groups was notably higher in most deprived municipalities and also among individuals <40 years belonging to indigenous backgrounds compared with white patients, as shown by descriptive analysis. Ethnic/racial backgrounds exhibited a continuum of decreasing survival chances of mixed-race (OR=1.11, 95% CI 1.10 to 1.12), black (OR=1.34, 95% CI 1.32 to 1.36) and indigenous (OR=1.42, 95% CI 1.31 to 1.54) individuals, while those in most deprived municipalities also presented an increased odds of death (OR=1.38, 95% CI 1.36 to 1.40). Deprivation levels also affect the prompt referral of patients to adequate care. Our results show that the odds of death of individuals hospitalised for less than 4 days is more than double that of patients with close-to-average hospital stays (OR=2.07, 95% CI 2.05 to 2.10). Finally, negative vaccination status also increased the odds of dying from the disease (OR=1.29, 95% CI 1.28 to 1.31). CONCLUSIONS: The data provide evidence that the patterns of COVID-19 mortality in Brazil are influenced by both individual-level health and social risk factors, as well as municipality-level deprivation. In addition, these data suggest that there may be inequalities in the timely provision of appropriate healthcare that are related to municipality-level deprivation.

E-COMMERCE AND CONSUMER HABITS DURING THE COVID-19 PANDEMIC IN MEXICO

In 2020, the entire world had to abruptly adapt to a new re-ality: the health emergency caused by covid-19. Organizations had to re-arrange their marketing strategies based on the changes brought by this situation to market and consumer behavior. covid-19 forced social dis-tancing, thus leading to shifts in online consumption habits. This paper aims to present an overview of the significant changes in online commerce during the covid-19 pandemic in Mexico through a documentary, explor-atory, qualitative and cross-sectional research. Secondary data were col-lected with information from the National Survey on the Availability and Use of Information Technologies in Homes (endutih, in Spanish), conducted by the Mexican Internet Association, the Mexican Association of Online Sales (amvo, in Spanish), and the Global Consumer Perspectives Survey 2021 (PwC, 2021), among other sources. Results show that consumers and companies had to rapidly learn, adapt, and respond to new market require-ments, and that the onset of covid-19, variations in consumption habits, business digitization, and digital inclusion in Mexico favored e-commerce. © 2022, Universidad Nacional de Colombia. All rights reserved.

CONSUMER BEHAVIOR IN RESPONSE TO HEALTH CONTINGENCY BY COVID-19 IN MICHOACAN 2021: GENERATION X

This research is aimed at the study of Generation X consumer behavior during the health contingency caused by COVID-19, the objective of which is to identify the new consumer behaviors and trends that this generation has during the pandemic. Likewise, the research is made up of a theoretical section that helps to substantiate the central themes of the same, as well as a research section of the object of study whose methodology was carried out under a mixed exploratory and descriptive approach. Research was conducted through an online survey whose final scope was 224 observations in an established range of 41 to 61 years old. It was identified that members of Generation X as a result of the health contingency began to use digital platforms as a support tool, but this was not the only relevant change in their behavior since Generation X still prefers to make purchases in a traditional way.

Partial breast irradiation with IORT using Xoft®. Experience at Catalan Institute of Oncology

Purpose or Objective external beam whole breast irradiation (WBI) for low-risk early-stage breast cancer patients after breast conserving surgery. We present the experience at our center treating patients with PBI using an IORT technic with Xoft® Axxent® Electronic Brachytherapy (eBx®) System®. Materials and Methods Between April 2019 and August 2021, 44 patients diagnosed with low-risk early-stage breast cancer who met international criteria for PBI, received IORT in a single fraction of 20 Gy to the tumor bed after lumpectomy. Toxicities and follow up were prospectively registered. Results 3 of the 44 initial patients were discarded for IORT due to non-compliance with the minimum safety distance (<1 cm) between the applicator and the skin. Of the remaining patients, 32/41 patients (78%) received a PBI, while 9/41 (22%) required adjuvant WBI due to adverse prognostic factors identified on the definitive biopsy. The most frequent risk factor was close resection margins (<2mm), present in 8/9 patients (88,8%). Two patients additionally presented sentinel node involvement and in 1 case no axillary sample was obtained. The most used IORT applicator was the 3-4 cm balloon, with most likely filling volumes between 30cc and 40 cc. For all treatments, the mean filling volume of the applicator was 45 cc and there were no complications during the irradiation procedure. Surgical bed seroma was the most common acute effect, observed in 29/41 patients (70,7%), although only 8/29 (27,5%) required drainage. We observed wound dehiscence in 7/41 cases (17%), inflammatory complications requiring antibiotics in 9/41 cases (19,5%), and 4/41 cases of hematoma (9,7%). Regarding late toxicity, at the time of the analysis it was only assessable for 37 patients. We observed low rates of local grade I fibrosis (21,6%) and only 1 case of tumor bed G2 fibrosis. Hyperpigmentation G1 was observed in 8,1% of patients and 10,8% presented occasional mild local discomfort. With median follow-up of 17.14 months (range 4-29 months), no relapses were observed, but 1 patient died from covid-19 pneumonia. Conclusion Intra operative PBI with Xoft® Axxent® Electronic Brachytherapy (eBx®) System® is a feasible approach to treat low-risk early-stage breast cancer patients. Our preliminary results show that it presents advantages over conventional WBI allowing for less toxic and shortened treatment courses while maintaining good local tumor control.

Academic Tourism in Barcelona (Spain) in the COVID-19 Era

Academic stays at higher education institutions located outside students’ usual environment for less than a year have become increasingly popular. The research reported in this article aimed to examine the current situation of international academic tourism in the region of Barcelona (Spain). The main objectives were to profile academic tourists, to analyse the impact of the COVID-19 pandemic on inbound academic tourism flows, and to explore the outcomes of academic travel experiences. Following a mixed-methods approach, two focus groups and three in-depth interviews were conducted to collect data from both a supply and demand perspective, in addition to a survey designed for international students. A total of 132 questionnaires were analysed by means of descriptive statistics and through chi-square and ANOVA tests. Qualitative data was processed by means of categorisation and content analysis using QDA Miner. The main results indicate that academic tourism has positive sustainable impacts and is conducive to transformational experiences. Tourists’ profile has been identified and the effects of the pandemic have been pinpointed. Due to COVID-19, academic tourism flows experienced a serious decline and the satisfaction degree with the academic travel experience was lower. Nonetheless, most of the respondents would recommend Barcelona as an academic destination. © 2022 by the authors.

TENOFOVIR DISOPROXIL FUMARATE and SEVERITY of COVID-19 in PEOPLE with HIV INFECTION

Background: Effective, safe, and affordable antivirals are needed for COVID-19. Several lines of reseach suggest that tenofovir may be effective against COVID-19 but no large-scale human studies with appropriate adjustment for comorbidities have been conducted. We describe the incidence, clinical severity and mortality of laboratory-confirmed SARS-CoV-2 infection by antiretroviral therapy (ART) among HIV-positive individuals with virological control adjusting for key potential confounders including hypertension, diabetes, chronic renal disease, cardiovascular disease, and treatment with immunosuppressants or corticosteroids. Methods: We studied HIV-positive individuals on ART in 2020 at 69 HIV clinics in Spain from February 1 to December 31. These 69 clinics serve approximately 44% of all persons on ART with virological suppression in Spain. We collected data on sociodemographics, ART, CD4-cell count, HIV-RNA viral load, comorbidities and the following outcomes: laboratory-confirmed SARS-CoV-2 infection, COVID-19 hospitalization, intensive care unit (ICU) admission and death. We compared 48-week risks, relative risks, relative differences and 95% confidence intervals (CI) for individuals receiving tenofovir disoproxyl fumarate (TDF)/emtricitabine (FTC), tenofovir alafenamide (TAF)/FTC, abacavir (ABC)/lamivudine (3TC), and other regimes. All estimates were adjusted for clinical and sociodemographic characteristics via inverse probability weighting. Results: Of 51,558 eligible individuals, 39.6% were on TAF/FTC, 11.9% on TDF/FTC, 26.6% on ABC/3TC, 21.8% on other regimes. There were 2,402 documented SARS-CoV-2 infections (425 hospitalizations, 45 ICU admissions, 37 deaths). Compared with TAF/FTC, the estimated risk ratios (RR) (95% CI) of hospitalization were 0.66 (0.43, 0.91) for TDF/FTC and 1.29 (1.02, 1.58) for ABC/3TC, the RRs of ICU admission were 0.28 (0.11, 0.90) for TDF/FTC and 1.39 (0.70, 2.80) for ABC/3TC, and the RRs of death were 0.37 (0.23, 1.90) for TDF/FTC and 2.02 (0.88-6.12) for ABC/3TC. The corresponding RRs of hospitalization for TDF/FTC were 0.49 (0.24, 0.81) in individuals ≥50 years and 1.15 (0.59, 1.93) in younger individuals. Conclusion: Our findings suggest that, compared with other antiretrovirals, TDF/FTC lowers COVID-19 severity among HIV-positive individuals with virological control. This protective effect may be restricted to individuals aged 50 years and older. Confirmatory randomized trials of TDF/FTC for the prophylaxis and early treatment of COVID-19 are warranted.

Mortality from Congenital Zika Syndrome - Nationwide Cohort Study in Brazil.

BACKGROUND: Prenatal exposure to Zika virus has potential teratogenic effects, with a wide spectrum of clinical presentation referred to as congenital Zika syndrome. Data on survival among children with congenital Zika syndrome are limited. METHODS: In this population-based cohort study, we used linked, routinely collected data in Brazil, from January 2015 through December 2018, to estimate mortality among live-born children with congenital Zika syndrome as compared with those without the syndrome. Kaplan-Meier curves and survival models were assessed with adjustment for confounding and with stratification according to gestational age, birth weight, and status of being small for gestational age. RESULTS: A total of 11,481,215 live-born children were followed to 36 months of age. The mortality rate was 52.6 deaths (95% confidence interval [CI], 47.6 to 58.0) per 1000 person-years among live-born children with congenital Zika syndrome, as compared with 5.6 deaths (95% CI, 5.6 to 5.7) per 1000 person-years among those without the syndrome. The mortality rate ratio among live-born children with congenital Zika syndrome, as compared with those without the syndrome, was 11.3 (95% CI, 10.2 to 12.4). Among infants born before 32 weeks of gestation or with a birth weight of less than 1500 g, the risks of death were similar regardless of congenital Zika syndrome status. Among infants born at term, those with congenital Zika syndrome were 14.3 times (95% CI, 12.4 to 16.4) as likely to die as those without the syndrome (mortality rate, 38.4 vs. 2.7 deaths per 1000 person-years). Among infants with a birth weight of 2500 g or greater, those with congenital Zika syndrome were 12.9 times (95% CI, 10.9 to 15.3) as likely to die as those without the syndrome (mortality rate, 32.6 vs. 2.5 deaths per 1000 person-years). The burden of congenital anomalies, diseases of the nervous system, and infectious diseases as recorded causes of deaths was higher among live-born children with congenital Zika syndrome than among those without the syndrome. CONCLUSIONS: The risk of death was higher among live-born children with congenital Zika syndrome than among those without the syndrome and persisted throughout the first 3 years of life. (Funded by the Ministry of Health of Brazil and others.).

Brazilian COVID-19 data streaming (preprint)

We collected individualized (unidentifiable) and aggregated openly available data from various sources related to suspected/confirmed SARS-CoV-2 infections, vaccinations, non-pharmaceutical government interventions, human mobility, and levels of population inequality in Brazil. In addition, a data structure allowing real-time data collection, curation, integration, and extract-transform-load processes for different objectives was developed. The granularity of this dataset (state- and municipality-wide) enables its application to individualized and ecological epidemiological studies, statistical, mathematical, and computational modeling, data visualization as well as the scientific dissemination of information on the COVID-19 pandemic in Brazil.

Difference in academic-scientific productivity from a gender perspective after COVID-19 using a simulation model

This article aims to simulate academic-scientific productivity in terms of submitted and published articles, carry out research projects and editorial processes, from the gender perspective after COVID-19, for researchers in the 2020-2025 period. The research methodology was focused on System Dynamics as the main technique for modelling and simulation. The parameters used for the generic model were those provided by the Colombian Ministry of Science, Technology, and Innovation for a research group in the Social Sciences area. The dynamic hypotheses and the two simulated scenarios revealed gender differences and their intensification in the production of manuscripts, submitted articles for evaluation for publication purposes, and published articles over a 5-year horizon.

Emotional impact and resilience in adolescents in Spain and Ecuador during COVID-19: A cross-cultural study

The COVID-19 pandemic is im-pacting the emotional health of adolescents. Factors such as resilience can buffer this important impact on their well-being. Our aim was to study the association between anxious-depressive symptomatology and resilience in adolescents from Spain and Mexico, and to compare the differences between the two samples. A total of 476 adolescents (70.10 % female) aged 9-18 years (M = 15.62;SD = 1.22), equally distributed between the two countries, participated in the study. They were assessed using the Depression, Anxiety and Stress Scale and the Resilience Scale. We conduct-ed descriptive analyses, independent samples t-tests, effect size calculation and Pearson correlations. The results showed that the profile of adaptive adjustment to the pandemic was: being a male, not having experienced a stressful life event, not having previous physical or psychological health problems and residing in Spain. While the risk profile for the pandemic was: being a female, having a stressful life event, having some type of previous physical and psychological health problem, and residing in Ecuador. Our data point to the importance of detecting the specific needs of adolescents according to their socio-economic and cultural context in order to implement interventions to protect their mental health during the pandemic.

Explanatory Variables of Dropout in Colombian Public Education: Evolution Limited to Coronavirus Disease

Student dropout, defined as the temporary or definitive suspension of the exercise of the right to education, is attributable to multiple variables classified into individual, academic, institutional, and socioeconomic determinants which may be exacerbated in the context of the Coronavirus disease (COVID-19) pandemic. Consequently, this work aims to synthesize, from the available evidence, the behaviour and influence of the explanatory variables of school dropout in infant school, primary school and, high school in Colombia for the period 2014-2019 compared to the period 2020-2021 under the COVID-19 pandemic conditions. The research methodology consisted of a systematic review of 125 indexed articles for 2014-2019 and 32 reports related to dropout in Colombian Basic education for the 2020-2021 period. The systematic review of the 157 articles revealed that dropout was studied and explained in both time periods, mainly from the academic determinant whose most cited explanatory variables were: ‘teachers’, ‘curriculum’ and ‘methodologies used’. Moreover, it could be perceived that in the period 2014-2019, the socioeconomic variable was the second dropout determinant, considering ‘family income” as the most important indicator, while in 2020-2021 the “infrastructure” and the ‘political environment’ remained as the most dominant. Lastly, in 2020-2021, the variable ‘teachers’ was highly cited showing that their practice made students maintain their interest despite the physical distance. © 2022 The Author(s).

Rural Population and COVID-19: A Model for Assessing the Economic Effects of Drop-Out in Higher Education

Higher education is one of the ways to overcome social inequalities in rural areas in developing countries. This has led states to develop public policies aimed at access, retention and timely graduation of students in those sectors, yet the high drop-out rates among the rural student population, which were catalysed by COVID-19, prevent the intrinsic and extrinsic benefits of obtaining a higher education degree from materialising. Thus, the study of the phenomenon of dropout before and after the pandemic has not sufficiently addressed the economic issues raised by this phenomenon for the different actors at the educational level. The purpose of this paper is to model the economic effects of rural student dropout at the higher education level for students and families, Higher Education Institutions (HEIs) and the State, based on public policies for access to higher education, in the pandemic and post-pandemic scenario. In order to delimit the operationalisation of the proposed model, a set of undergraduate training programmes in Colombia was taken as a reference. System dynamics was used as the main modelling technique. The model was based on data from the 20 training programmes with the highest number of students enrolled in rural areas for the year 2019, by running three computational simulations. The results showed the description of the dynamic model and the financial effects of dropout for the actors of the educational level with the current policies of access to higher education, the scenario in which COVID-19 would not have occurred and the consolidation of the public policy of tuition fee exemption in public HEIs as a result of the pandemic. It was concluded that the model developed is very useful for the valuation of these economic effects and for decision-making on policies to be implemented, given that the costs of dropout are characterised by high costs for students and their families as well as for HEIs, and where it was determined that current policies are inefficient in preventing and mitigating dropout. Copyright © 2021 Guzmán Rincón, Barragán Moreno and Cala-Vitery.

Antiviral therapy and immunotherapy of COVID-19.

The pharmacological treatment of COVID-19 has evolved in the months since the description of the disease. Published observational studies and, above all, clinical trials have highlighted drugs that are useful as well as ruled out any benefit from other drugs used at the beginning of the pandemic. The pathogenesis of the disease has suggested that patients may benefit from the administration of both antivirals, mainly in the earliest stages, and anti-inflammatory/immunomodulatory medications in more advanced stages. We present a short review of the drugs used and under investigation for the treatment of COVID-19.