Longitudinal Characterization of a Neutralizing and Total Antibody Response in Patients with Severe COVID-19 and Fatal Outcomes.

The host immune response to SARS-CoV-2 appears to play a critical role in disease pathogenesis and clinical manifestations in severe COVID-19 cases. Until now, the importance of developing a neutralizing antibody response in the acute phase and its relationship with progression to severe disease or fatal outcome among hospitalized patients remains unclear. In this study, we aim to characterize and compare longitudinally the primary humoral immune host response in the early stages of the disease, looking for an association between neutralization, antibody titers, infective viral lineage, and the clinical outcome in hospitalized and non-hospitalized patients. A total of 111 patients admitted at INER from November 2021 to June 2022 were included. We found that patients with negative or low neutralization showed a significant reduction in survival probability compared to patients with medium or high neutralization. We observed a significant decrease in the median of neutralization in patients infected with viral variants with changes in RBD of the spike protein. Our results suggest that developing an early and robust neutralizing response against SARS-CoV-2 may increase survival probability in critical patients.

Clinical and Virological Features of Patients Hospitalized with Different Types of COVID-19 Vaccination in Mexico City.

Coronavirus disease 2019 (COVID-19) vaccines effectively protect against severe disease and death. However, the impact of the vaccine used, viral variants, and host factors on disease severity remain poorly understood. This work aimed to compare COVID-19 clinical presentations and outcomes in vaccinated and unvaccinated patients in Mexico City. From March to September 2021, clinical, demographic characteristics, and viral variants were obtained from 1014 individuals with a documented SARS-CoV-2 infection. We compared unvaccinated, partially vaccinated, and fully vaccinated patients, stratifying by age groups. We also fitted multivariate statistical models to evaluate the impact of vaccination status, SARS-CoV-2 lineages, vaccine types, and clinical parameters. Most hospitalized patients were unvaccinated. In patients over 61 years old, mortality was significantly higher in unvaccinated compared to fully vaccinated individuals. In patients aged 31 to 60 years, vaccinated patients were more likely to be outpatients (46%) than unvaccinated individuals (6.1%). We found immune disease and age above 61 years old to be risk factors, while full vaccination was found to be the most protective factor against in-hospital death. This study suggests that vaccination is essential to reduce mortality in a comorbid population such as that of Mexico.

Hacia una transición energética justa e inclusiva: la contribución de la Economía Social a la conformación de las Comunidades Energéticas Europeas

Una vez más, el gran cierre llevado a cabo para mitigar los efectos del impacto de la covid-19 ha demostrado la profunda relación existente entre nuestro sistema socioeconómico y el modelo energético. El impacto que la pandemia ha creado en el ámbito energético parece haber reforzado la necesidad de transitar hacia un modelo más justo e inclusivo. En este contexto (Marzo de 2019, pre-covid), la Comisión Europea impulsa una transición energética en la que la ciudadanía está llamada a jugar un rol central para conseguir un sistema energético asequible, fiable y sostenible mediante el desarrollo de comunidades locales de energía. Estas iniciativas comunitarias destacan por sus modos de gobierno basados en la promoción del bien común y su pertenencia formal a la Economía Social. Tienen el potencial de conformar un modelo energético más resiliente a través de la relocalización de la generación de la energía, la reducción de su consumo o la ubicación de la ciudadanía en el centro a través de la socialización de los medios de producción. Utilizando una extensa revisión bibliográfica y el análisis de fuentes secundarias, el objetivo de esta investigación es proponer un marco conceptual convergente entre la Economía Social y el paradigma de lo Común, y aplicarlo a las Comunidades de Energía impulsadas por la Comisión Europea. Mediante el diálogo entre los principios normativos y aplicados del paradigma de lo Común y los de la Economía Social, se desarrollará un mapa de las esferas de lo Público, lo Privado, lo Social y lo Común que, a su vez, justificará posicionar a la Economía Social como la forma idónea de organizar iniciativas como las Comunidades de Energía Europeas.Alternate :Once again, the great shutdown carried out to mitigate the impact of covid-19 has demonstrated the profound relationship between our socioeconomic system and the energy model. The impact this pandemic situation has created in the field of energy has reinforced the necessity of a transition towards a fairer and more inclusive model. In this context (March 2019, pre-covid), the European Commission is fostering an energy transition in which citizens should play a key role in order to achieve an affordable, safe, and sustainable energy system through the development of local energy communities. These community initiatives have government modes based on the promotion of the common good and, at the same time, they belong formally to the Social Economy. They have the potential to shape a more resilient energy model through the relocation of energy generation, the reduction of its consumption or the location of the citizen in the center through the socialization of the means of production. Using a thorough bibliographic review and the analysis of secondary data, the objective of this research is to present a conceptual framework to merge Social Economy and the Commons paradigm and apply this framework to the local energy communities promoted by the European Commission. Through the dialogue between the normative and applied principles of the Commons paradigm and those of the Social Economy, this research will develop a map of different spheres: public, private, social, and common. This map will justify the adoption of Social Economy as the proper form of organizing initiatives such as the European Energy Communities.

Serology-based therapeutic strategy in SARS-CoV-2-infected patients.

SARS-CoV-2 infection can be a life-threatening disease. The optimal treatment of patients is not yet standardized. We use a serology-based therapeutic strategy based on the presence of antibodies against the SARS-CoV-2 virus, in which patients with positive serology receive aggressive anti-inflammatory treatment with high-dose dexamethasone and/or tocilizumab and patients with negative serology receive early convalescent plasma therapy. We also analyze the immunological impact of this therapy in the recovery of T cells, B cells and NK cells during hospitalization in a COVID-19 infectious ward. Our results suggest that aggressive therapy with early administration of convalescent plasma and high-dose dexamethasone may be of benefit in patients with SARS-CoV-2 infection and might avoid progression of lung damage or need of admission in intensive care. This strategy did not impair immune responses against SARS-CoV-2, as 93% of the patients generated antibodies against the virus. Independently of previous immunological status of the patients, serology-guided therapy might benefit even patients with a high CIRS-G score, immunosuppressed or medically debilitated individuals and elderly patients. T cell disturbances were most frequent in patients who required high-dose dexamethasone, and B cell depletion was most frequent in patients who received tocilizumab. Early passive immunotherapy with convalescent plasma does not affect lymphoid recovery.

Dysbiosis and structural disruption of the respiratory microbiota in COVID-19 patients with severe and fatal outcomes.

The COVID-19 outbreak has caused over three million deaths worldwide. Understanding the pathology of the disease and the factors that drive severe and fatal clinical outcomes is of special relevance. Studying the role of the respiratory microbiota in COVID-19 is especially important as the respiratory microbiota is known to interact with the host immune system, contributing to clinical outcomes in chronic and acute respiratory diseases. Here, we characterized the microbiota in the respiratory tract of patients with mild, severe, or fatal COVID-19, and compared it to healthy controls and patients with non-COVID-19-pneumonia. We comparatively studied the microbial composition, diversity, and microbiota structure between the study groups and correlated the results with clinical data. We found differences in the microbial composition for COVID-19 patients, healthy controls, and non-COVID-19 pneumonia controls. In particular, we detected a high number of potentially opportunistic pathogens associated with severe and fatal levels of the disease. Also, we found higher levels of dysbiosis in the respiratory microbiota of patients with COVID-19 compared to the healthy controls. In addition, we detected differences in diversity structure between the microbiota of patients with mild, severe, and fatal COVID-19, as well as the presence of specific bacteria that correlated with clinical variables associated with increased risk of mortality. In summary, our results demonstrate that increased dysbiosis of the respiratory tract microbiota in patients with COVID-19 along with a continuous loss of microbial complexity structure found in mild to fatal COVID-19 cases may potentially alter clinical outcomes in patients. Taken together, our findings identify the respiratory microbiota as a factor potentially associated with the severity of COVID-19.

Guillain Barre vs. Miastenia Gravis as an Atypical Presentation of SARS COV 2 By Molecular Mimic: Purpose of a Case

Additionally, it is known that the pathophysiological mechanism of the entry of the virus into the cell, through the viral protein Spike, not only occurs through the receptor for the angiotensinconverting enzyme-2, but also uses glycoproteins and gangliosides that contain sialic acid on cell surfaces. In the presentation of our case, we raised the SARS-CoV-2 infection as a possible triggering event of MG or GB in the patient, based on the theory of molecular mimicry as a possible cause of the condition, in light of this case in clinical practice, we reinforce the hypothesis of the association between Guillain-Barré/ Myasthenia Gravis syndrome and SARS-CoV-2 virus infection, as has already been documented by other authors. Case Report A 21-year-old woman from Talaigua Nuevo, Bolívar municipality, Republic of Colombia, who is admitted to the emergency service due to a sudden onset clinical picture of approximately 1 hour of evolution consisting of dysphagia, odynophagia, asthenia, episodes of dizziness, adynamia, accompanied by decreased muscle strength in upper limbs, also associated with loss of tongue sensitivity;Additionally, the patient states that the only symptom that he presented in the last days was an occasional dry cough with a predominance of the day. Hemodynamic instability, manifested by the appearance of sustained supraventricular tachycardia with deterioration So we proceed to perform orotracheal intubation and electrical cardioversion. pharmacological with satisfactory reversal and stabilization;Later, CPK, VDRL, HIV, Hepatitis B extension paraclinics, lumbar puncture with cytochemicals and culture of common germs of the cerebrospinal fluid and chest CT scan are requested.

Use of Virtual Reality for Pediatric Cardiac Critical Care Simulation.

Simulation is a key component of training in the pediatric cardiac intensive care unit (CICU), a complex environment that lends itself to virtual reality (VR)-based simulations. However, VR has not been previously described for this purpose. Two simulations were developed to test the use of VR in simulating pediatric CICU clinical scenarios, one simulating junctional ectopic tachycardia and low cardiac output syndrome, and the other simulating acute respiratory failure in a patient with suspected coronavirus disease 2019. Six attending pediatric cardiac critical care physicians were recruited to participate in the simulations as a pilot test of VR's feasibility for educational and practice improvement efforts in this highly specialized clinical environment. All participants successfully navigated the VR environment and met the critical endpoints of the two clinical scenarios. Qualitative feedback was overall positive with some specific critiques regarding limited realism in some mechanical aspects of the simulation. This is the first described use of VR in pediatric cardiac critical care simulation.

Multisystem Inflammatory Syndrome in Children: An International Survey.

OBJECTIVES: To describe presentation, hospital course, and predictors of bad outcome in multisystem inflammatory syndrome in children (MIS-C). METHODS: Retrospective data review of a case series of children meeting the published definition for MIS-C who were discharged or died between March 1, 2020, and June 15, 2020, from 33 participating European, Asian, and American hospitals. Data were collected through a Web-based survey and included clinical, laboratory, electrocardiographic, and echocardiographic findings and treatment management. RESULTS: We included 183 patients with MIS-C: male sex, 109 (59.6%); mean age 7.0 ± 4.7 years; Black race, 56 (30.6%); obesity, 48 (26.2%). Overall, 114 of 183 (62.3%) had evidence of severe acute respiratory syndrome coronavirus 2 infection. All presented with fever, 117 of 183 (63.9%) with gastrointestinal symptoms, and 79 of 183 (43.2%) with shock, which was associated with Black race, higher inflammation, and imaging abnormalities. Twenty-seven patients (14.7%) fulfilled criteria for Kawasaki disease. These patients were younger and had no shock and fewer gastrointestinal, cardiorespiratory, and neurologic symptoms. The remaining 77 patients (49.3%) had mainly fever and inflammation. Inotropic support, mechanical ventilation, and extracorporeal membrane oxygenation were indicated in 72 (39.3%), 43 (23.5%), and 4 (2.2%) patients, respectively. A shorter duration of symptoms before admission was found to be associated with poor patient outcome and for extracorporeal membrane oxygenation and/or death, with 72.3% (95% confidence interval: 0.56-0.90; P = .006) increased risk per day reduction and 63.3% (95% confidence interval: 0.47-0.82; P < .0001) increased risk per day reduction respectively. CONCLUSIONS: In this case series, children with MIS-C presented with a wide clinical spectrum, including Kawasaki disease-like, life-threatening shock and milder forms with mainly fever and inflammation. A shorter duration of symptoms before admission was associated with a worse outcome.