IMPLICATIONS OF POTENTIAL NEW REGULATORY MEASURES TO ADDRESS AVIATION EMISSIONS

This work is an analysis of the implications of the potential new regulatory policies being recently proposed in the European Union, in particular the mandatory blending of SAF (on top of the already existing CORSIA or ETS), to address aviation emissions from a technical, operational and economic perspective. As a continuation of previous work from the Department of Aerospace Systems, Air Transport and Airports from the ETSIAE (Universidad Politécnica de Madrid), the air traffic structure of the European Union in 2019 has been analysed based on publicly available data from EUROCONTROL and EUROSTAT. The output has been used as the reference scenario for the implementation of the mandatory blending of SAF, expected to take over at the beginning of 2025, since it is expected that by then, air traffic will reach the pre-COVID levels. The results show that all the policy options considered so far have uneven impact among the different stakeholders and that before deciding going forward with any of the presented options, extra work needs to be done to overcome the different challenges that would potentially arise. © 2022 ICAS. All Rights Reserved.

EFFECT OF THE COVID-19 PANDEMIC ON METABOLIC CONTROL IN INSULIN PUMP USERS IN A DIABETES CENTER IN COLOMBIA

Background and Aims: The COVID-19 pandemic has led to changes in the management of insulin pump patients, requiring the use of telemedicine as a follow-up strategy. This study aimed to describe the metabolic control before and during the pandemic following the implementation of a teleconsultation program. Methods: Observational study of a cohort of insulin pump users at the Diabetes Center, Fundación Santa Fe de Bogotá from January 2020 to July 2021. Changes in HbA1c, time in range, episodes of hypoglycemia in both, pre-pandemic ( January to April 2020). and the pandemic (April to July 2021) period were evaluated. Results: During the study period, 44 patients were included, 22 males (50%), with a mean age of 41 years and time of diabetes 20.9 years. Micro-infusion systems incluided paradigm754 (11%), veo640 (72%), and veo670 (15%). No significant changes in metabolic control or time in the range were observed in the patients under follow-up (Table 1). Table 1 Conclusions: The implementation of a telemedicine program for follow-up of patients on insulin pumps provided maintenance of metabolic control.

IMPACT OF COVID-19 LOCKDOWN ON GLYCEMIC CONTROL IN PATIENTS WITH TYPE 1 DIABETES. WHAT HAS HAPPENED 1 YEAR AFTER LOCKDOWN?

Background and Aims: People with type 1 diabetes (PWT1D) using flash glucose monitoring (FGM) showed no deleterious effect or even an improvement on glycemic control during COVID-19 lockdown. The aim is to assess the impact on glycemic control after 8 weeks and one year after lockdown. Methods: Observational retrospective study in PWT1D using FreeStyle Libre®. Glucometric data from the 2 weeks before lockdown start (PRE) were compared with data of the last 14 days after 8 weeks of consecutive lockdown (POST), and last 14 days one year after lockdown (1 YEAR POST). Results: Data from 287 patients were analyzed (median age 45,5±12,6 years, 50,2% male (n = 144), median diabetes duration 20,5±12,1 years). Median lockdown time was 53,9±4,4 days. Conclusions: PWT1D using FGM monitoring during COVID- 19 pandemic in our clinic showed an improvement in glycemic metrics which was sustained 1 year after lockdown.

Home making without a home: dwelling practices and routines among people experiencing homelessness

The article presents the discussion on exhortation from governments in the attempt for reducing the contagion of Covid-19. Topics include raising questions about the ways where people experiencing homelessness dwelling in places having no shelter, no house, and no home to stay in;and experiencing homelessness and rooflessness, as well as vulnerable migrants and refugees, lone adults, couples and families.

Predictor factors of severe forms of COVID-19 requiring hospitalisation in patients with diabetes mellitus

Aims: To identify possible risk factors of hospitalisation in patients with diabetes (DM) and 2019 novel coronavirus disease (COVID-19), to establish the prevalence of DM among infected patients and that of DM in patients requiring hospitalisation. Research design and methods: Between March-May 2020, 1202 consecutive subjects in the healthcare area of Santiago de Compostela and Barbanza (Galicia, Spain) were diagnosed with COVID- 19, among whom 136 patients with DM were identified. Demographic data, DM characteristics and complications during hospitalisation were collected and analysed. Results: The prevalence of DM among COVID-19 infected subjects was 11.3%. This ascended to 21.7% in inpatients, while only 8.1% of outpatients had DM (p<0.0001). Higher levels of glycated haemoglobin significantly increased the risk of hospitalisation (OR: 1.57;95% CI: 1.03-2.41, p=0.037), with small differences making the difference between inpatients and outpatients (7.3 +/- 1.3% vs 6.8 +/- 0.9% [56 +/- 14 vs 51 +/- 10 mmol/mol], respectively, p=0.009). Obesity (BMI = 30 kg/m2) was the only comorbidity associated to hospitalization (OR: 2.94;95% CI: 1.17-7.30, p=0.021). There were no differences in the type and duration of DM, the type of glucose-lowering drugs, or in the presence of micro/macrovascular complications. Conclusion: DM does not increase the risk of suffering from COVID-19, but it can worsen the outcome, raising the hospitalisation rate. Thus, obesity and worse chronic glycaemic control, even with small variations, are independent and determining factors for severe forms which require hospitalisation.

NECROTIZING PNEUMONIA AND MASSIVE AIR LEAK IN A PATIENT WITH COVID-19

TOPIC: Cardiothoracic Surgery TYPE: Global Case Reports INTRODUCTION: To observe the pathological characteristics and the clinical significance of COVID 19 infected pneumonia causing degeneration and necrosis of parenchymal cells, thrombus in small and medium vessels. Pulmonary pathological changes of fatal COVID-19 are diffuse alveolar damage that is presents in the acute exudative stage and the organic proliferative stage. There is alveolar cavity formation, fibrinous exudate, fibroblastic proliferation in alveolar septum, and alveolar epithelial cell injuries. A large number of neutrophils and monocytes infiltration is present in most cases and bacteria and fungi are detected in some cases, suggesting a serious combination to generate lung necrosis and huge air leak. CASE PRESENTATION: The case of a 50 years old female with severe COVID 19 pneumonia, requiring admission to the ICU during her hospitalization present bilateral pneumothorax that was solved with bilateral chest tube, one week later present persistent right pneumothorax and a continuous air leak that prevented ventilation, surgical intervention was decided as a result of the ventilatory, hemodynamic deterioration and state of sepsis finding in the right lower lung focal hemorrhage, organization of exudates in various cavities in the lung, and pulmonary fibrosis generating degeneration and necrosis of parenchymal cells, formation of thrombus in small vessels, and pathological changes of chronic diseases were observed with fibrous tissue, firm adhesions DISCUSSION: Infectious disease by COVID 19 pneumonia can generate cavitary lung process, necrotizing pneumonia, lung abscess and septic pulmonary embolism. Being able to aggregate infections that include cavitating fungal and superinfection of preexisting spaces. Accompanied by infarction from thromboembolic disease. In these cases, we found an extensive lung necrosis with a grade 4 air leak, accompanied by intraparenchymal purulent fibrin, infected cavities with fluid and bronchial necrosis as well as blood vessel thrombosis CONCLUSIONS: The management of this pathology include treatment as any lung necrosis with major resection and reinforcement of the bronchial stump with the considerations of the aerosol that are generated by bronchial necrosis and parenchyma, the initial approach includes immediate obturation of the bronchus and subsequently continue with vascular dissection. Which indicates that COVID pneumonia can present in a short time all the changes of acute and chronic disease. Generally, an acute or subacute process suggests bacterial and fungal causes of pulmonary abscesses, necrotizing pneumonias, and septic emboli. And a chronic process suggests mycobacterial, fungal, viral, or parasitic infections;malignancy or autoimmune disorders REFERENCE #1: Anaesthesia. 2020 Nov;75(11):1509-1516. doi: 10.1111/anae.15112. Epub 2020 Jun 2. Management of the airway and lung isolation for thoracic surgery during the COVID-19 pandemic: Recommendations for clinical practice endorsed by the Association for Cardiothoracic Anaesthesia and Critical Care and the Society for Cardiothoracic Surgery in Great Britain and IrelandM Thornton 1, D Reid 1, B Shelley 2 3, M Steven 1 REFERENCE #2: Anaesthesia. 2020 Nov;75(11):1509-1516. doi: 10.1111/anae.15112. Epub 2020 Jun 2.Management of the airway and lung isolation for thoracic surgery during the COVID-19 pandemic: Recommendations for clinical practice endorsed by the Association for Cardiothoracic Anaesthesia and Critical Care and the Society for Cardiothoracic Surgery in Great Britain and IrelandM Thornton 1, D Reid 1, B Shelley 2 3, M Steven 1 REFERENCE #3: Am Fam Physician. 1991 Nov;44(5):1719-21.Necrotizing aspiration pneumoniaD Disler 1, S A Deluca DISCLOSURES: No relevant relationships by Gabriela Alejandra Buerba Romero Valdes, source=Web Response No relevant relationships by Gabriela Del Angel Millán, source=Web Response No relevant relationships by EMMANUEL PEÑA GOMEZ PORTUGAL, source=Web Response No relevant relationships by ALMA SOLANO NIETO, source= eb Response

COVID-19 and HELLP Syndrome, uncertain diagnosis: Case report

BACKGROUND: It is possible that the hyperinflammatory state in pregnant patients with COVID-19 is associated with hypoxic lesions in the placenta, which induce a clinical and biochemical picture similar to that of preeclampsia and HELLP syndrome. CLINICAL CASE: 40-year-old patient, with a history of primary infertility, with 33.1 weeks of pregnancy achieved by in vitro fertilization and embryo transfer. She was admitted to the emergency department due to hypertensive crisis accompanied by respiratory distress, hemolysis, hyperbilirubinemia and increased lactate dehydrogenase, elevated liver enzymes, thrombocytopenia and proteinuria. It was decided to terminate the pregnancy due to a suspected diagnosis of HELLP syndrome and probable acute pulmonary edema secondary to preeclampsia, with severity criteria. During the immediate postpartum period, chest CT scan showed pulmonary changes due to SARS-CoV-2 pneumonia, CORADS classification 5. During her stay in intensive care, she experienced clinical and biochemical improvement and was discharged on the sixth day after hospitalization. CONCLUSION: In this case we found similarity of the clinical picture and biochemical alterations of SARS-CoV-2 with preeclampsia and HELLP syndrome. To avoid in treatment and complications associated with late diagnosis it is important to establish the differential diagnosis.

Medical and Legal Aspects of the Practice of Teledermatology in Spain. / Aspectos medicolegales de la práctica de la teledermatología en España.

Teledermatology is now fully incorporated into our clinical practice. However, after reviewing current legislation on the ethical aspects of teledermatology (data confidentiality, quality of care, patient autonomy, and privacy) as well as insurance and professional responsibility, we observed that a specific regulatory framework is still lacking and related legal aspects are still at a preliminary stage of development. Safeguarding confidentiality and patient autonomy and ensuring secure storage and transfer of data are essential aspects of telemedicine. One of the main topics of debate has been the responsibilities of the physicians involved in the process, with the concept of designating a single responsible clinician emerging as a determining factor in the allocation of responsibility in this setting. A specific legal and regulatory framework must be put in place to ensure the safe practice of teledermatology for medical professionals and their patients.

Medical and Legal Aspects of the Practice of Teledermatology in Spain

Teledermatology is now fully incorporated into our clinical practice. However, after reviewing current legislation on the ethical aspects of teledermatology (data confidentiality, quality of care, patient autonomy, and privacy) as well as insurance and professional responsibility, we observed that a specific regulatory framework is still lacking and related legal aspects are still at a preliminary stage of development. Safeguarding confidentiality and patient autonomy and ensuring secure storage and transfer of data are essential aspects of telemedicine. One of the main topics of debate has been the responsibilities of the physicians involved in the process, with the concept of designating a single responsible clinician emerging as a determining factor in the allocation of responsibility in this setting. A specific legal and regulatory framework must be put in place to ensure the safe practice of teledermatology for medical professionals and their patients. Resumen El ejercicio de la teledermatología ya se encuentra plenamente incorporado a nuestra práctica clínica. Sin embargo, tras revisar aspectos legislativos y éticos sobre confidencialidad, calidad asistencial, autonomía del paciente, privacidad, responsabilidad profesional y seguros en relación con la teledermatología constatamos que aún carece de regulación específica, estando los aspectos legales de la misma poco desarrollados. Garantizar la confidencialidad, la autonomía del paciente y la seguridad en el almacenamiento y envío de los datos son cuestiones imprescindibles para su práctica. La responsabilidad de los facultativos que intervienen en el proceso es uno de los principales motivos de controversia, siendo la figura del médico responsable determinante para decidir sobre la atribución de la misma. Es necesario el desarrollo de una regulación concreta para ejercer la teledermatología de forma segura para los profesionales y los pacientes.

Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: A prospective, cohort, multicentre study. / Características, evolución clínica y factores asociados a la mortalidad en UCI de los pacientes críticos infectados por SARS-CoV-2 en España: estudio prospectivo, de cohorte y multicéntrico.

BACKGROUND: The clinical course of COVID-19 critically ill patients, during their admission in the intensive care unit (UCI), including medical and infectious complications and support therapies, as well as their association with in-ICU mortality has not been fully reported. OBJECTIVE: This study aimed to describe clinical characteristics and clinical course of ICU COVID-19 patients, and to determine risk factors for ICU mortality of COVID-19 patients. METHODS: Prospective, multicentre, cohort study that enrolled critically ill COVID-19 patients admitted into 30 ICUs from Spain and Andorra. Consecutive patients from March 12th to May 26th, 2020 were enrolled if they had died or were discharged from ICU during the study period. Demographics, symptoms, vital signs, laboratory markers, supportive therapies, pharmacological treatments, medical and infectious complications were reported and compared between deceased and discharged patients. RESULTS: A total of 663 patients were included. Overall ICU mortality was 31% (203 patients). At ICU admission non-survivors were more hypoxemic [SpO2 with non-rebreather mask, 90 (IQR 83 to 93) vs. 91 (IQR 87 to 94); P<.001] and with higher sequential organ failure assessment score [SOFA, 7 (IQR 5 to 9) vs. 4 (IQR 3 to 7); P<.001]. Complications were more frequent in non-survivors: acute respiratory distress syndrome (ARDS) (95% vs. 89%; P=.009), acute kidney injury (AKI) (58% vs. 24%; P<10-16), shock (42% vs. 14%; P<10-13), and arrhythmias (24% vs. 11%; P<10-4). Respiratory super-infection, bloodstream infection and septic shock were higher in non-survivors (33% vs. 25%; P=.03, 33% vs. 23%; P=.01 and 15% vs. 3%, P=10-7), respectively. The multivariable regression model showed that age was associated with mortality, with every year increasing risk-of-death by 1% (95%CI: 1 to 10, P=.014). Each 5-point increase in APACHE II independently predicted mortality [OR: 1.508 (1.081, 2.104), P=.015]. Patients with AKI [OR: 2.468 (1.628, 3.741), P<10-4)], cardiac arrest [OR: 11.099 (3.389, 36.353), P=.0001], and septic shock [OR: 3.224 (1.486, 6.994), P=.002] had an increased risk-of-death. CONCLUSIONS: Older COVID-19 patients with higher APACHE II scores on admission, those who developed AKI grades ii or iii and/or septic shock during ICU stay had an increased risk-of-death. ICU mortality was 31%.

Towards a malaria-free world: Utopia or reality

Malaria is a disease caused by a parasite that is transmitted to humans through the bite of the female Anophele mosquito. Reporting the WHO in 2019, 229 million cases and 409,000 deaths from the disease in 87 countries of the world, There are six species of this parasite: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale wallickeri, Plasmodium ovale curtisi, Plasmodium malariae and Plasmodium knowlesi. The species P. falciparum is the cause of greatest morbidity, with a rate between 10 and 50% of mortality from complicated malaria. About 108 countries have declared malaria as an endemic disease, and the disease can occur at any time of the year. However, in the case of Latin America today there is a stagnation of the disease, with fewer than 100 indigenous cases reported in countries between 2000 and 2019, with some exceptions. This situation of vulnerability of countries such as Brazil, Colombia, the Peru-Ecuador border, Venezuela, increases in the face of the active presence of the pandemic product of the Covid-19 coupled with economic restrictions, increased mining activity, or public policies that put at risk the sustainability of the disease control programme. By 2021, WHO confirms that there are 87 countries with malaria worldwide, of which 24 had interrupted their indigenous transmission for 3 years. Reality that consolidates the proposal after the experience acquired, that whatever the epidemiological situation of entry, The work towards the eradication of malaria must be understood and addressed as a continuous process where the States themselves must from their own reality and strategies articulate with the Global Technical Strategic Plan Against Malaria 2016-2030 proposed by the WHO. © 2021 Instituto de Altos Estudios de Salud Publica. All rights reserved.