Undergraduates' Critical Thinking Skills Development Through the Use of Short Animated Videos during the COVID-19 pandemic

Critical thinking skills are undoubtedly the 21st-century skills that people use in their daily lives. In this context, this action research had as its main objective to evaluate the contribution of the use of short animated videos to improve higher-order thinking skills (analyze, create and evaluate) of first-year undergraduate students, both in oral production tasks as well as in written tasks in English, during the COVID-19 pandemic. Furthermore, it explored students' perceptions in relation to their improvement in their own critical thinking skills. The data obtained were analyzed using descriptive statistics, specifically, measures of central tendency. Additionally, the non-parametric Wilcoxon test was used in the measurements that were made in the writing ability to verify if the change observed in the participants' development of critical thinking skill was statistically significant. The results obtained revealed that after the intervention, an improvement was observed in the development of the undergraduates' critical thinking skills (analysis, evaluation, creation) in both language skills (writing and speaking). In a more exhaustive statistical analysis through the non-parametric Wilcoxon test applied to the writing tests' measurements, an increase among undergraduates' critical thinking skills was observed. The results of the tasks developed correlated positively with the students' perceptions, which was collected through a Likert scale. In conclusion, the study showed that the use of short, animated videos effectively helped first-year undergraduate students improve their higher-order critical thinking skills, during the COVID-19 crisis.

[Bibliometric analysis of scientific publications on COVID-19 elaborated by staff of the Instituto Mexicano del Seguro Social]

BACKGROUND: Since the beginning of the pandemic, new knowledge about COVID-19 obtained by research has been disseminated in medical and scientific journals, but the large number of publications that have been generated in such a short time has been impressive. OBJECTIVE: To perform a bibliometric analysis of the published articles in medical-scientific journals carried-out by the Mexican Social Security Institute (IMSS) personnel on COVID-19. MATERIAL AND METHODS: Systematic review of the literature, identifying the publications included in the PubMed and EMBASE databases, up to September 2022. Articles on COVID-19 were included, in which at least one author had IMSS affiliation;there was no restriction on the type of publication, so original articles, review articles, clinical case reports, etc. were included. The analysis was descriptive. RESULTS: 588 abstracts were obtained, of which 533 full length articles met the selection criteria. Most were research articles (48%), followed by review articles. Mainly clinical or epidemiological aspects were addressed. They were published in 232 different journals, with a predominance of foreign journals (91.8%). Around half of the publications were carried out by IMSS personnel together with authors from other institutions, national or foreign. CONCLUSIONS: The scientific contributions prepared by IMSS personnel have contributed to understanding clinical, epidemiological and basic aspects of COVID-19, which has had an impact on improving the quality of care for its beneficiaries.

Exploring the Affordances of Immersive Visualization Spaces: A Use Case About COVID-19

This paper presents an immersive visualization of a taxonomy containing the most relevant words to describe the COVID-19 pandemic. In a hyper-informed world, people could feel frustrated when looking for news about a sensitive topic. Counterbalancing information overload involves offering reliable information to learn about a topic of interest in an engaging way. Our solution contributes to this end by providing a COVID taxonomy and an immersive visualization. To build the taxonomy, we involved an epidemiologist identifying the most meaningful words to describe the disease. The result is a hierarchical structure with sixty terms grouped into twelve categories representing symptoms, prevention measures, and treatments. The second contribution is a visualization designed to take advantage of the affordances of immersive spaces to improve the interaction with the information. The users can explore the taxonomy by interacting with terms and categories represented as connected spheres in a virtual world. To assess the experience, we involved 32 participants in a user engagement evaluation. The results show that the immersive space is an innovative and didactic way to understand a topic of interest. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Life experiences of people with Covid-19 during the quarantine period

Main objective: to understand the life experiences of people diagnosed with Covid-19 during the quarantine period in Santiago de Chile city. Design: a descriptive phenomenological qualitative study with an exploratory approach. Methodology: Participants aged between 18 and 65 years, with previous Covid-19 infection and positive PCR. Purposive sampling with 11 informants was used. The information was collected through in-depth online interviews, recorded, and manually transcribed. Data were analyzed using Colaizzi’s seven-step method. Main results: intense emotions, support from family and neighbors, stigma and self-care were the four categories that emerged from the analysis. Main conclusion: people with Covid-19 had a high risk for emotional and social problems. However, the pandemic also had a positive effect on family relationships, meaning of life, self-control, and self-care. © 2022, Fundacion Index. All rights reserved.

Mental health of doctors and nurses in health crisis situations

Introduction: The COVID-19 pandemic has generated many repercussions in the mental health of the population, especially in those working in the front line of care. Objective: To characterize front-line health care personnel according to the level of depression, anxiety, and stress in the context of the COVID-19 pandemic. Methods: Observational, descriptive, cross-sectional study. Health professionals involved in the first-line care of COVID-19 patients in critical areas were surveyed between October and December 2020. The Depression Anxiety and Stress Scale was used to measure the dependent variables;in addition, epidemiological variables were collected: sex, age and type of profession. A descriptive analysis of the data was performed using frequency/percentage tables and cross tables. Results: Of the 86 physicians and nurses surveyed, 36.05 % presented depression, predominantly at the moderate level, 55.81 % presented anxiety, predominantly at the mild level, and 53.49 % presented stress, predominantly at the mild level. Higher levels of depression (71 %), anxiety (75 %) and stress were found in female personnel (73.91 %), in the 41-60 age group higher levels of stress (64.52 %), anxiety (64.58 %) and stress (30.43 %) were found, and in the professional group of nurses higher levels of depression (67.71 %), anxiety (72.92 %) and stress (67.39 %) were found. Conclusion: Of the 3 psychopathological disorders studied in the health professionals, the one with the highest percentage is anxiety, followed by stress and depression. Female participants, the 41-60 years age group, and nurses have higher levels of depression, anxiety and stress. © 2022, Editorial Ciencias Medicas. All rights reserved.

Crowdsourcing during COVID-19: Case studies in health and education

Crowdsourcing is a means by which public interest is sought and leveraged to achieve specific goals, and this fascinating study highlights how the model has been used to challenge the effects of the COVID-19 pandemic. The book investigates what factors have encouraged the use of crowdsourcing during the pandemic, as well as those issues which have restricted its use. It is illustrated with four detailed case studies, covering the fields of education and health, demonstrating how crowdsourcing as a means of crisis management has, ultimately, been used to influence and develop public policy. A timely analysis of this emerging concept, the book will appeal to researchers and practitioners across health and social care, public policy and management, and the voluntary sector more generally. © 2022 Carmen Bueno Muñoz, Luis R. Murillo Zamorano, and José ángel López Sánchez. All rights reserved.

Gamification and artificial intelligence during COVID-19: Case studies in health and education

The health emergency caused by COVID- 19 has been a global challenge. During this period, it was necessary to quickly develop solutions that were able to cope with the pandemic and help mitigate the effects that the new coronavirus was causing in many sectors. This book analyzes how gamification and artificial intelligence (AI) have been used during the COVID- 19 pandemic in two areas that have been particularly affected: health care and education. To this end, a review of the main applications of gamification and AI during this period is made. We also analyze four cases framed in health care and education in which both resources, gamification and AI, are combined and their usefulness in the context characterized by COVID- 19 is analyzed. Finally, some of the ethical issues surrounding gamification and AI in this scenario are examined. © Peter Lang GmbH Internationaler Verlag der Wissenschaften Berlin 2022. All rights reserved.

Virtually Commedia: An interactive online theatre programme for LGBTQ+ youth

Many individuals experienced increased isolation and loneliness due to COVID-19 pandemic restrictions on social activities, yet the impacts of this isolation can be more pronounced for vulnerable populations such as LGBTQ+ youth. In order to offer a destigmatized space for LGBTQ+ youth to connect during the pandemic, facilitators at the University of Florida modified an LGBTQ+ youth theatre programme (Theatre Connect) to be delivered via an online platform. In the spring of 2021, facilitators developed an eight-week Commedia dell’Arte curriculum that was delivered over Zoom to nine youth. Although modified to fit the needs of the group, the programme provided the opportunity for urban and rural youth to connect with one another and develop theatre skills in a safe environment.These field notes describe curriculum development as well as challenges, successes and feedback. Due to the success of this programme, Theatre Connect will maintain online programming in future seasons. © 2022 The Authors.

Controlled supply of tocilizumab during the COVID-19 pandemic and its influence on the treatment of rheumatological patients

Background: Intravenous (IV) tocilizumab has been used to stop the inflammatory phase of SARS-CoV-2 infection. To preserve the largest number of IV units for this use, the Spanish Agency for Medicines and Health Products (AEMPS) carried out a controlled supply of it and recommended the change to a subcutaneous presentation (SC) of tocilizumab or sarilumab in all those patients in IV tocilizumab treatment for rheumatologic indications. The objective of this study was to evaluate the change from IV tocilizumab to SC presentation due to its controlled supply during the COVID-19 pandemic. Methods: Retrospective observational study of adult patients (>18 years old) under treatment with IV tocilizumab follow-up by the Rheumatology Service of the Hospital 12 de Octubre. The follow-up period was 3 months (March 2020-June 2020) and 39 patients were included in the study. Variables related to the patients and their treatment were collected. A descriptive analysis of the data was carried out. Results: In 69.23% (n=27) of the patients, treatment was changed to SC tocilizumab (n=23) or sarilumab (n=4). 44% of patients (n=12) switched back to their original IV tocilizumab treatment. The reasons for stopping treatment with SC tocilizumab were: drug intolerance (n=4), disease worsening (n=4), and patient preference (n=1). Regarding sarilumab, the reasons were drug intolerance (n=2) and patient preference (n=1). Conclusions: Almost half of the patients had to return to the original treatment. The main reason was intolerance to the new treatment, followed by ineffectiveness and patient preferences.

Impact of Level of Knowledge, Attitude, Practice, Perceived Barriers and Risk Perception on COVID-19 and Infection Control on Residency Training among Physical Medicine and Rehabilitation Trainees in the Philippines

Introduction. In compliance with the COVID-19 infection control guidelines outlined by the Center for Disease Control and the World Health Organization, non-urgent and non-essential services have been postponed in most healthcare institutions in the Philippines, including medical training institutions wherein responses and strategies for the residency program vary. These changes may impact the trainees’ knowledge, skills, and attitudes on their training. Specifically, most services were halted indefinitely in Physical Medicine and Rehabilitation (PM&R). Some resident trainees were deployed to treat COVID-19 patients not as PM&R residents but as generalists to augment the number of medical front-liners. Objective. To determine the PM&R residents’ COVID-19 risk preparedness in terms of relevant knowledge, attitudes, practice, and perceived barriers, and to describe the impact of COVID-19 on residency training. Methods. In this descriptive cross-sectional survey, the population consisted of a sample of PM&R residents from the six training institutions in the Philippines. A 15-20-minute web-based assessment tool was used to gather the following: participant characteristics;level of awareness and knowledge of residents towards COVID-19;risk preparedness through risk perception, knowledge, and attitudes regarding COVID-19;and impact of COVID-19 on residency training. Results. A total of 62 PM&R residents participated in the study. The majority were female and aged at least 30 years. The respondents had the following mean scores: 12.84 out of 14 for knowledge (interpreted as good), 9.16 out of 35 for attitude (interpreted as positive), and 5.65 out of 6 for practiced adherence to COVID-19 and infection control measures in their respective institutions (interpreted as good). The most commonly cited barriers to COVID-19 infection control included overcrowding in the emergency room (95%), lack of knowledge about the mode of transmission of the disease (92%), and limitation of infection control resources (92%). The majority reported that the main impact of the pandemic on PM&R residency training included the lack of clinical exposure to cases and procedures. Conclusion. The study provided local baseline data on the PM&R residents’ level of COVID-19 risk preparedness and the perceived impact of the pandemic on their training. The study results may help the faculty plan for program improvement measures amid the changing COVID-19 landscape. © 2022 University of the Philippines Manila. All rights reserved.

Continuing Care through Telerehabilitation for Patients in a COVID-19 Referral Center in the Philippines: A Case Series

In April 2020, the Department of Rehabilitation Medicine (DRM) of the University of the Philippines - Philippine General Hospital (UP-PGH) transitioned to a telerehabilitation program called ITAWAG, an acronym for Introducing Telerehab As a Way to Access General rehabilitation medicine services. This was in response to the designation of UP-PGH as a COVID-19 referral center and the abrupt closure of all its in-patient and out-patient rehabilitation services. Eleven previous in-patients and out-patients with musculoskeletal and neurologic impairments continued their rehabilitation programs remotely, either through a phone call or video call. Their clinical outcomes and the implementation of the ITAWAG program were monitored to determine the effectiveness of an offsite continuing care program. Using the Clinical Global Impressions-Severity (CGI-S) scale, eight patients had a reduction in the severity of their illness, while the remaining three clients had no change. Feedback surveys showed that most clients and caregivers (68%) and health providers (77%) were satisfied with the program's implementation and its outcome. A frequent complaint was the poor phone reception and internet connection. As threats of a COVID-19 outbreak continue, telerehabilitation gives patients a safe, affordable, and convenient alternative for follow-up and continuity of care in medical rehabilitation. Integrating the ITAWAG program into the initial facility-based rehabilitation management can enhance its value in optimizing functional gains and resolving its shortcomings. © 2022 University of the Philippines Manila. All rights reserved.

Fear, Anxiety, and Depression among Employees of the Department of Rehabilitation Medicine-Philippine General Hospital amidst Changes from the COVID-19 Pandemic: A Cross-sectional Study

Objective. This study described levels of fear, anxiety, depression, and contributing factors among health providers and administrative staff of the Department of Rehabilitation Medicine, Philippine General Hospital (PGH-DRM) during the COVID-19 pandemic. Methods. The cross-sectional study was conducted from August to November 2020. We recruited 71 participants who were working in the premises of the hospital and those who were working from home by purposive sampling. The fear numerical rating scale and Hospital Anxiety and Depression Scale were used to determine the presence of fear, anxiety, and depression. The 36-Item Short Form Survey (SF-36) was used to determine the baseline level of physical and mental wellness among participants. Results. Seventy-three percent of the full-time, permanent employees of the PGH-DRM unit joined the study. Majority of the respondents were health providers (86%) but only one hospital staff had high-risk contact with patients with COVID-19. Most participants (63%) did a combination of on-site work and home-based work and three (4%) worked entirely from home. Moderate to severe levels of fear was reported by 54% of the participants. Fear levels were highest among those who worked on-site. Anxiety was borderline in 32%, and abnormal in 30%, while depression was borderline in 21%, and abnormally high in 34% of the participating employees. Feelings of anxiety were higher among those who worked on-site and who worked both on-site and from home, while depression was highest among those who worked from home. The SF-36 Physical Health Summary score (x̄ = 72.49) was higher than the Mental Health Summary score (x̄ = 55.45). Employees who worked from home had the highest SF-36 summary scores for both mental and physical health. Conclusion. The employees of the DRM had low-risk contact work assignments when the PGH transitioned to a tertiary level COVID-19 referral hospital. Half of the employees experienced fear, anxiety, and depression and had low SF-36 summary scores in mental health. Further studies are needed to determine the key factors that affect their mental health and well-being during the pandemic. A relevant mental health and wellness program is strongly recommended. © 2022 University of the Philippines Manila. All rights reserved.

Readiness and Acceptance of Philippine General Hospital Medical Staff for Telemedicine as Alternative Method of Patient Consultation during the COVID-19 Pandemic and Post-enhanced Community Quarantine Period

Introduction. The coronavirus disease 2019 (COVID-19) pandemic prompted a shift from standard in-person consultation to non-patient contact methods such as telemedicine. To our knowledge, there was no published a priori evaluation of the telemedicine readiness and acceptance among the medical staff of the Philippine General Hospital (PGH) before implementing the institution’s telemedicine program. The lack of this vital pre-implementation step is understandable given the unprecedented crisis. However, if telemedicine programs will continue in the post-quarantine period, it is crucial to determine the facilitators and barriers to the use of telemedicine. Objective. This study determined the level of readiness and acceptance for telemedicine as an alternative method for patient consultation during the COVID-19 pandemic and post-enhanced community quarantine period among PGH medical staff (consultants, residents, fellows). Methods. The cross-sectional study was conducted from October 2020 to July 2021. Medical staff from the 16 clinical departments of the PGH were selected by systematic random sampling. Inclusion criteria included appointment as medical staff in PGH or University of the Philippines College of Medicine (UPCM), voluntary informed consent, internet access, and technical capacity to access e-mail and SurveyMonkey™. The online survey consisted of two questionnaires. It collected data on the demographic profile and outcomes of interest (e.g., telemedicine readiness and acceptance). Technological readiness was determined through the 16-item modified version of Technological Readiness Index (TRI) version 2.0, while telemedicine acceptance was determined through the modified version of the 19-item Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Descriptive and analytical statistics were performed at a 95% confidence interval. Results. The study had an 87% response rate with 205 respondents, 62% of whom were physicians in training (resident physicians and fellows). The respondents had a median age of 33 years and were mostly males. Only 19% had telemedicine experience before the pandemic. The majority (51%) learned telemedicine on their own. The most common devices used for telemedicine were mobile or smartphones (53%) and laptops (38%). The primary source of internet for telemedicine was mobile broadband (e.g., cellular data) (40%). The majority practiced telemedicine at their home or residence (51%), followed closely by the hospital or clinic (47%). The mean score of the respondents on TRI was 3.56 (very good technological readiness), and 4.00 (very good telemedicine acceptance) on UTAUT (behavioral intention to use the system). Performance expectancy (p = 0.02), effort expectancy (p = 0.03), and self-efficacy (p = 0.02) were significantly directly related to telemedicine adoption, while anxiety (p = 0.03) was significantly inversely related. Conclusion. The PGH medical staff were found to have very good telemedicine readiness and acceptance. This suggests a willingness to use telemedicine during the pandemic. Further studies on the organization and technical support system of the telemedicine program in the PGH are strongly recommended. The quality and efficiency of the program will strongly influence the continued use of telemedicine by the medical staff even after the pandemic. © 2022 University of the Philippines Manila. All rights reserved.

Impaired antibody response after mRNA COVID-19 vaccination in patients with chronic lymphocytic leukemia

Introduction: Patients with hematological malignancies have a higher susceptibility to develop severe COVID-19 and their humoral response to vaccination is usually impaired due to the immunosuppression caused by treatments or the disease itself. A recent prospective study that analyzed the humoral response to the BNT162b messenger RNA (mRNA) COVID-19 vaccine in patients with CLL showed an antibody response rate of 39.5%, significantly lower than that of sex- and agematched healthy controls. Patients with active disease or under treatment, especially with targeted agents were the ones with the worst humoral response (Herinashu et al., 2021). More data are needed to validate these results and enhance protective strategies in those patients. In this study, we aimed to assess the humoral response following vaccination with the mRNA SARS-CoV-2 vaccine in a cohort of CLL patients from routine clinical practice and compared it with patients with other hematological neoplasms. Methods: Twenty-two CLL patients underwent blood sampling 2-4 weeks after the second dose of BNT162b2 (Pfizer- BioNTech) or mRNA-1273 (Moderna) vaccine. A control group was composed of 65 patients with other hematological cancers that also received mRNA vaccines. IgG antibodies against SARS-CoV-2 Spike antigen were measured using electrochemiluminescent assay (ADVIA Centaur XPT, Siemens), and responses reported as index inferior or superior to 1 (range 0.50-150.00), being index <1.00 informed as no reactive and index >1.00 as reactive. Statistical analyses were performed using SPSS, version 22.0 (IBM SPSS Statistics, IBM Corporation). Results: CLL patient's characteristics are shown in Table 1. Antibody-response to the vaccine was only obtained in 54.5% of the patients with CLL (12/22) and was significantly lower than that observed in the control group, in which 77.8% of the patients with other malignancies seroconverted (p=0.03), Figure 1. The other malignancies group was composed of multiple myeloma (N=21);indolent non-Hodgkin lymphoma (NHL) (N=12), Hodgkin lymphoma (N=5);acute myeloblastic leukemia (N=1);myeloproliferative neoplasms (N=12);myelodysplastic syndromes (N=7) and aggressive NHL (N=7). Antibody titers in patients with CLL showed a trend to be lower than the control group [median 3.16 (0-150) vs. 52.95 (0-150), p=0.133]. Focusing on CLL patients, antibody response rate was higher when disease was not active (75 vs. 43%, p=0.1) and in treatment-naïve patients (66.7 vs. 52.6%, p=0.6). Moreover, we observed similar responses in patients who obtained clinical remission after treatment (56.6 vs. 50%, p=0.8%). In patients under treatment with targeted drugs (Bruton's tyrosine kinase inhibitors (BTKi) or venetoclax based regimens) at the time of vaccination, antibody response rates were significantly lower (33 vs. 80%, p=0.03). Specifically, 40% of patients under BTKi showed a serologic response, and only 25% of patients under venetoclax-based regimens. Of note, at the moment of the study, the disease was controlled in all patients under continuous treatment. Conclusions: Antibody-mediated response to mRNA COVID-19 vaccines in CLL patients is significantly impaired in comparison to other onco-hematological diseases. Our series confirms better response rates when the disease is controlled and in treatment-naïve patients, showing slightly better responses than published to date (54.5 vs. 39.5%), which reinforces the need to vaccine CLL patients as some of them will benefit. Special concern must be taken to patients treated with targeted drugs, who show very low humoral responses. Therefore, in this vulnerable population, preventive measures, such as masks wearing, social distancing, and co-habitants vaccination should be reinforced.

COVID-19 and risk assessment room for public health in four Colombian cross-border territories

Introduction: Public health risk management in Colombia is led by the National Institute of Health. In the face of the COVID-19 emergency, response actions were carried out through the implementation of Risk Analysis Rooms, strengthening surveillance at points of entry into the country. Objective: To carry out an analysis of the implementation and maintenance phases of the COVID-19 Risk Analysis Rooms in four border departments of Colombia. Materials and methods: A qualitative study was carried of Risk Analysis Rooms in public health for COVID-19. The documentation and data generated in the period from March to June 2020 in Amazonas, Vichada, Guainia and Putumayo were reviewed. Semi-structured interviews were conducted with key actors. The analysis was performed with the NVivo plus version 11 application, in three cycles: open coding;identification of emerging categories and modeling by analyzing the identified strengths and weaknesses. Results: The components of the incident command structure and the relationships between the public health areas were identified. Strengths were found in the integration of the areas;management of information in real time, border surveillance and strengthening of immediate response teams. The weaknesses identified were established in the planning, community surveillance and risk communication processes. Conclusions: The Risk Analysis Rooms constitute a joint effort of the national and local level where the articulated participation of the actors is promoted to analyze information and optimize the organized response during the COVID-19 pandemic.

High-flow nasal therapy in severe respiratory failure due to SARS-CoV-2

The use of high-flow nasal therapy (HFNT) in patients with severe acute respiratory failure (SARF) due to COVID-19 pneu-monia (NCOVID-19) is debated. Given the lack of beds in Intensive Care Units in the Public Health System of the Province of Neuquén, their use was implemented in general wards. This restrospective multicenter study was carried out to describe the experience of using HNFT in patients with SARF due to NCOVID-19. The primary outcome was the frequency of successful weaning from HFNT and in-hospital mortality (IHM). Two hundred ninety-nine patients were analyzed;120 (40.1%) were successfully withdrawn from HFNT. This failed in 59.8% (179), 44.1% (132) required invasive mechanical ventilation (IMV), and 15.7% (47) was not candidates for intubation. A ROX index ≥ 5 at 6 h after initiation was associated with the success of HFNT (OR 0.26 [IC 95% 0.15-0.46] p<0.0001). The general IHM was 48.5% (145/299), 70.4% (93/132) in patients with IMV, 4.2% (5/120) died after successful weaning from HFNT and 100% (47/47) in the group not candidates for intubation. Patients with TNAFO had a statistically significant decrease in MIH and days of hospitalization. TNAFO in general wards achieved a decrease in the use of IMV, with a reduction in mortality and days of stay in hospitalized for NCOVID-19 with SARF.

Molecular tests for the diagnosis of COVID-19: South America's response

Currently, worldwide, the reverse transcriptase-polymerase chain reaction (RT-PCR) is used as a high-precision technique in detecting and amplifying specific sections of the genetic structure. In this sense, it is considered a molecular diagnostic test in the detection of SARS-CoV-2. A review of the literature was carried out on articles published in the last 5 years (2015-2020). The following databases were consulted: PUBMED (Medline), PUBMED CENTRAL, and SCIELO. Articles in Spanish and English were retrieved, according to MESH terminology: SARS-CoV-2, RT-PCR, COVID-19. RT-PCR tests that use nasal and pharyngeal swab samples are considered the standard gold test in suspected cases of COVID-19. Through the South American review of molecular tests, RT-PCR turned out to be the test of choice in the countries of South America during the period less than 7 days of infection, highlighting the in-house production in scale by Uruguay and the Loop-mediated isothermal amplification test (RT-LAMP) adapted in Peru as a rapid diagnostic alternative with principles similar to RT-PCR, only for health facilities with less equipment, infrastructure, and trained personnel. The availability of molecular diagnostic tests is also crucial for isolating positive cases and monitoring the epidemiological chain of transmission. © 2021 Revista Bionatura. All rights reserved.

[Controlled supply of tocilizumab during the COVID-19 pandemic and its influence on the treatment of rheumatological patients.]

OBJECTIVE: Intravenous (IV) tocilizumab has been used to stop the inflammatory phase of SARS-CoV-2 infection. To preserve the largest number of IV units for this use, the Spanish Agency for Medicines and Health Products (AEMPS) carried out a controlled supply of it and recommended the change to a subcutaneous presentation (SC) of tocilizumab or sarilumab in all those patients in IV tocilizumab treatment for rheumatologic indications. The objective of this study was to evaluate the change from IV tocilizumab to SC presentation due to its controlled supply during the COVID-19 pandemic. METHODS: Retrospective observational study of adult patients (>18 years old) under treatment with IV tocilizumab follow-up by the Rheumatology Service of the Hospital 12 de Octubre. The follow-up period was 3 months (March 2020-June 2020) and 39 patients were included in the study. Variables related to the patients and their treatment were collected. A descriptive analysis of the data was carried out. RESULTS: In 69.23% (n=27) of the patients, treatment was changed to SC tocilizumab (n=23) or sarilumab (n=4). 44% of patients (n=12) switched back to their original IV tocilizumab treatment. The reasons for stopping treatment with SC tocilizumab were: drug intolerance (n=4), disease worsening (n=4), and patient preference (n=1). Regarding sarilumab, the reasons were drug intolerance (n=2) and patient preference (n=1). CONCLUSIONS: Almost half of the patients had to return to the original treatment. The main reason was intolerance to the new treatment, followed by ineffectiveness and patient preferences.

Recruitment of specific monocyte and dc subsets to the lung during severe COVID-19

Background: SARS-CoV-2 is responsible for the development of COVID-19 in infected individuals, who can exhibit mild to severe symptoms including acute respiratory distress syndrome (ARDS). Critical patients developing ARDS are characterized by exacerbated inflammation and dysregulated adaptive immune responses. However, the differential association of specific myeloid subsets of dendritic cells (DC) and monocytes (Mo) to the induction of ARDS in these critical COVID-19 patients is poorly understood. Methods: A total of 64 COVID-19 patients qPCR positive for SARS-CoV were included in the study. Patients were stratified into 3 subgroups attending to non-severe (G1), severe (G2) and critical (G3) severity based on changes in respiratory frequency (RF), partial pressure arterial oxygen and fraction of inspired oxygen ratio (PaO2/FiO2) and respiratory failure values. PBMC were obtained from blood samples collected from all COVID-19 patient subgroups and with paired cell infiltrates from bronchial aspirates in the case of critical G3 patients requiring respiratory support. PBMC samples from n=22 non-COVID individuals were also included for comparison purposes. Expression of markers defining different DC and Mo subsets and their level of activation were analyzed by multicolor flow cytometry. Results: CD141+ conventional and CD123hi plasmacytoid DCs were similarly depleted from blood in COVID19 patients (p<0.0001;p<0.0001) from all severity subgroups but were absent in the lung infiltrates from critical individuals. In contrast, CD1c+ DC, inflammatory transitional and non-classical Mo were dramatically depleted from the blood and preferentially enriched in lung infiltrates in patients with critical G3 COVID-19 individuals (p<0.01;p<0.001;p<0.001). Remarkably, proportions of transitional Mo in the blood were increased in G1 COVID19 patients exhibiting non-severe progression. Importantly, myeloid subsets infiltrating the lung of critical G3 COVID19 patients were characterized by increased expression of the activation marker CD40. Moreover, activated CD38+ CXCR5+ and CD38+ CXCR5-CD8+ T cells were enriched in the lungs from critical COVID-19 patients (p<0.001;p<0.05). Finally, higher levels of CD40 on transitional Mo were positively associated with proportions of CD38+ CXCR5-CD8+ T cells in the lung. Conclusion: The study identified the recruitment of specific myeloid subsets from the blood to the lung in critical COVID-19 patient that could be targeted by future therapies.