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Introduction: Cancer patients have a high risk of severe COVID-19 and complications from it. Although the COVID-19 pandemic has led to an increase in the conduction of clinical trials (CTs), there is a scarcity of data on CT participation among cancer patients. We aimed to describe the level of participation in a COVID-19 CT, willingness to participate, as well as trust in sources of information for CTs among persons with and without a previous cancer diagnosis in Puerto Rico. Method(s): Data collected from November 2021 to March 2022 from two cross-sectional studies were merged and used for analysis. Informed consent, telephone, face-to-face, and online interviews were conducted among participants >=18 years old living in Puerto Rico (n=987). Descriptive statistics and bivariate analysis (Fisher's exact text and chi-squared test) was done to describe the outcomes of interest, overall and by cancer status. Result(s): Mean age of participants was 41+/-15.5 years. Most participants were women (71.3%), with an educational level greater than high school (89.5%) and with an annual family income below $20,000 (75.1%). Overall, 4.4% of participants (n=43) reported history of cancer diagnosis. Only 1.8% of the population reported to have participated in a COVID-19 CT to receive either a treatment or vaccine;stratifying by cancer, none of the cancer patients had participated in a COVID-19 CT, and only 1.9% of non-cancer patients participated. While 37.0% of the participants indicated being very willing to sign up for a CT assessing COVID-19 treatment, willingness was higher in cancer patients (55.8%) than among participants without cancer (36.1%). Regarding trust in sources of information for CTs, the level of trust ("a great deal/a fair amount") was higher for their physicians (87.6%), researchers (87.0%), the National Institute of Health (86.7%), their local clinics (82.9%), and a university hospital (82.7%), while it was lower for a pharmaceutical company (64.0%), and for friend, relative, or community leader (37.6%);no differences were observed by cancer status. Conclusion(s): While participation in COVID-19 CTs was extremely low in the study population, the willingness to participate was higher among cancer patients. Education on CTs and their availability are necessary to increase participation in this understudied group. Such efforts will enhance the representation of Hispanic and vulnerable populations, such as cancer patients, on COVID-19 CTs, and thus proper generalizability of study findings in the future.
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Objectives: At the beginning of the pandemic, it was believed that severe SARS-CoV2 infection would induce lifelong immunity and that reinfections would be unlikely. However, several cases of reinfection were documented in previously infected patient and the waning humoral immunity has raised significant concerns. Accordingly, long-term and durable vaccineinduce antibody protection against infection have also become a challenge, as several breakthroughs of COVID-19 have been identified in individuals partially or fully vaccinated. This study describes the incidence, the characteristics of severe COVID-19 infections requiring ECMO occurred after vaccination and the presence of side effects related to the vaccine. Method(s): EuroECMO COVID is a prospective, multicenter, observational study, developed by the EuroELSO, based on data from patients aged >=16 years who received ECMO support for refractory COVID-19 during the pandemic in 204 centers. The analysis investigates the survival of vaccinated patient, the associations between management-related variables, the incidence of vaccination during the different pandemic phases, the type of vaccines and the possible side effects. Result(s): Immunosuppressed patients are susceptible to reinfection even after being naturally infected or receiving a full vaccination. Ineffective antibody production, due to relatively ineffective vaccines, inadequate number of doses or the time after vaccination are involved in the pathogenesis of postvaccination infections. This population was found to have a partial immunity due to an inadequate number of doses and an overlapped time from vaccination and SARS-CoV2 incubation with PCR results after being vaccinated. Several manifestations of SARS-CoV2 infection are similar to vaccine-induce side effects and mild symptoms can be presented both as an adverse reaction after vaccination and a result of infection. In this subgroup no side effects were attributable to the vaccine. Conclusion(s): Vaccination does not entirely prevent SARS-CoV2 but will lead to less morbidity and mortality, as demonstrated by less need of ICU and ECMO care. In addition, the partial immunity for inadequate doses of vaccine or through the evolution of new variants demonstrated the importance of further analysis to differentiate the possible causes of waning humoral immunity.
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Background: Long-term consequences of COVID-19 infection are still partly known. According to some studies several patients may experience long term symptoms;however, predictors of long-term mayor adverse cardiovascular events among (MACE) patients with previous COVID-19 infection are . Aim of the study: To derive a simple clinical score for risk prediction of long-term MACE among patients with previous covid-19 infection. Method(s): 2575 consecutive patients were enrolled in a multicenter, international registry (HOPE-2) from February 2020 to April 2021, and followedup at long-term. A risk score was developed using a stepwise multivariable regression analysis. Result(s): Out of 2575 patients enrolled in the HOPE-2 registry, 1481 (58%) were male, with mean age of 60+/-16 years. At long-term follow-up overall rate of MACE was 7.9% (202 of 2545 pts, 3.3% death, 2.4% inflammatory myocardial disease, 1.3% arterial thrombosis, 0.7% venous thrombosis). After multivariable regression analysis, independent predictors of MACE were used to derive a simple prognostic score: The HOPE-2 prognostic score may be calculated by giving: 1/2 point for every 10 years of age, 2 points for previous cardiovascular disease, 1 point for increased troponin serum levels during hospitalization, 2.5 points for heart failure and 3 points for sepsis during hospitalization, -1.5 points for vaccination at followup. Score accuracy at receiver operating characteristic curve analysis was 0.81. Stratification into 3 risk groups (0-2, 3-5, and >5 points) classified into low, intermediate and high risk. The observed MACE rates were 0.5% for low-risk patients, 4% for intermediate-risk patients, and 19.5% for high-risk patients (log-Rank p<0.001, Figure 1). Conclusion(s): The HOPE-2 prognostic score may be useful for long-term risk stratification in patients with previous COVID-19 infection. High-risk patients may require a strict cardiological follow-up. (Figure Presented).
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Background: Hydroxychloroquine (HCQ) may be an effective, safe, and affordable treatment for Covid-19 that can be used in selected patients. However, more evidence on its association when it is used in different stages of the disease with clinical outcomes is required. This observational study investigates the association between treatment with HCQ and mortality in patients with Covid-19. Method(s): The data from 6217 patients who died or were discharged from 24 Spanish hospitals were analyzed. Propensity matching scores (PMS) were used. Result(s): 5094 patients received HCQ. Death was recorded for 17.5% of those who had HCQ and 34.1% of those who did not have it. Mortality was lower for those who had HCQ, OR=0.41 (95% CI=0.34-0.48). The PMS analysis also showed that mortality was lower for those receiving HCQ, OR=0.47 (95%CI=0.36-0.62). PMS analysis for categories revealed an association between HCQ and lowered mortality for patients over 65 years of age, with a past medical history of hypertension, for those who were diagnosed during admission with sepsis related organ failure or pneumonia, and for those with lymphocytopenia, raised troponin, LDH, ferritin and D-dimer. No increase in mortality associated with HCQ was observed in any category of any of the variables investigated. Conclusion(s): HCQ could be associated with lower mortality for older patients, those with more severe disease and raised inflammatory markers. Further RCTs, observational studies, and summaries of both types of evidence on this topic are necessary to select the precise profile of patients that may benefit from HCQ.Copyright © 2023 Bentham Science Publishers.
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Prior to the COVID-19 pandemic, Puerto Rico (PR) had one of the highest Human Papillomavirus (HPV) vaccine rates in the United States. Yet, widespread misleading information about the COVID19 vaccine might negatively impact HPV vaccine attitudes. This study aims to assess and compare HPV and COVID-19 vaccines attitudes toward school-entry policies among adults living in PR. A convenience sample of 222 adults (>=21 years old) living in PR were recruited through social media and completed an online survey from November 2021 to January 2022. Participants answered questions about HPV and COVID-19 vaccines knowledge (ranging from 0=none to 3=high knowledge), attitudes toward vaccination policies for school-entry, and perceptions of trusted and untrusted sources of information. Descriptive statistics were computed to identify the demographics characteristics of the participants. We also estimated the prevalence ratio (PRadjusted) using a logistic regression model to assess the magnitude of association between COVID-19 vaccination for the school-entry policy and HPV vaccination for school-entry policy agreement, adjusting for different confounders. The mean age of the study sample was 36.73 +/- 11.18 years. The majority of the sample were female (87%, n=194), with at least some college of education (92%;n=205) and employed (61%;n=165). One-fifth of the participants reported having children between ages 11 and 16 (n=46). Participants' perceived knowledge about the HPV vaccine was moderate (mean=1.72;SD=1.12), while for COVID-19 vaccine was moderately high (mean=2.47;SD=.68). The most trusted form of information for HPV and COVID-19 vaccines were health care providers (42% and 17%, respectively), the Centers for Disease Control and Prevention (35% and 55%, respectively), and the Department of Health (15% and 19%, respectively). The least trusted source of information included social media (40% and 39%, respectively), friends and family (23% n=47, and 17% n=33, respectively), and the Department of Health (15% n=30, and 18% n=36, respectively). More than half of the participants agreed that HPV (76% n=156) and COVID vaccines (69% n=136) should be required for school-entry. Agreement with COVID-19 vaccination for the school-entry policy was significantly associated with HPV vaccination for school-entry policy agreement (PRadjusted:1.96;95% CI:1.48-2.61) after controlling for age, sex, education, and having children between age 11 and 16. Findings suggest that adults living in PR have an overall positive attitude about mandatory HPV and COVID-19 vaccination school-entry policies, and these attitudes are interrelated. Yet, it is concerning that the Department of Health is identified as one of the least trusted sources of information, as it has a prominent role in implementing HPV and COVID-19 vaccine policies in PR. Further research should elucidate why the Department of Health is considered an untrusted source of information among adults living in PR and evaluate the implications of the COVID-19 pandemic on HPV vaccine attitudes and adherence rates.
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Background. Currently, therapeutic options for outpatients with COVID-19 are limited, in Mexico Polymerized Collagen type I (PCTI) has been tested as a useful option. Methods. Double-blind, randomised, placebo-controlled clinical trial of PTIC vs placebo. To evaluate the safety, efficacy and effect of the intramuscular administration of polymerized type I collagen (PTIC) on hyperinflammation, oxygen saturation and symptom improvement in adult outpatients with symptomatic COVID-19. Eighty-nine adult participants with a confirmed COVID-19 diagnosis and symptom onset within the 7 days preceding recruitment were included from August 31, 2020 to November 7, 2020 and followed for 12 weeks. Final date of follow-up was February 4, 2021. Patients were randomly assigned to receive either 1.5 ml of PTIC intramuscularly every 12 h for 3 days and then every 24 h for 4 days (n=45), or matching placebo (n=44). Results. Of 89 patients who were randomised, 87 (97.8%) were included in an intention-to-treat analysis;37 (41.6%) were male and mean age was 48.5+/-14.0 years. The IP-10 levels decreased 75% in the PTIC group and 40% in the placebo group vs baseline. The comparison between treatment vs placebo was also statistically significant (P=0.0047). The IL-8 (44%, P=0.045), M-CSF (25%, P=0.041) and IL-1Ra (36%, P=0.05) levels were also decreased in the PTIC group vs baseline. Mean oxygen saturation >=92% was achieved by 40/44 (90%), 41/42 (98%) and 40/40 (100%) of participants that received PTIC at 8, 15 and 97 days of follow-up vs 29/43 (67%), 31/39 (80%) and 33/37 (89%) of patients treated with placebo (P=0.001). The unadjusted accelerated failure time model showed that patients treated with PTIC achieved the primary outcome 2.70-fold faster (P< 0.0001) than placebo. In terms of risk, the group of patients treated with PTIC had a 63% lower risk of having a mean oxygen saturation < 92% vs placebo (P< 0.0001). Symptom duration in patients treated with PTIC was reduced by 6.1+/-3.2 days vs placebo. No differences in adverse effects were observed between the groups at 8, 15 and 97 days of follow-up. Conclusion. Treatment with PTIC down-regulated IP-10, IL-8, M-CSF and IL-Ra levels, which could explain the PTIC effect on the higher proportion of patients with mean SaO2 >=92% and a shorter duration of symptoms as compared with placebo. Serum cytokine and chemokine levels of SARS-CoV2-infected symptomatic outpatients at baseline and day 8 post-treatment with PTIC or placebo. Data are expressed as median with 95% confidence. (A) IP-10, IFN-gamma inducible protein-10;(B) IL-8, Interleukin-8;(C) M-CSF, Macrophage colony-stimulating factor;(D) IL-1Ra, IL-1 receptor antagonist;(E) TRAIL, TNF-related apoptosis inducing ligand;and (F) Forest plot (95% confidence intervals). (A) Probability of oxygen saturation 92% or greater while breathing ambient air. (B) Accelerated time failure model for oxygen saturation 92% or greater while breathing ambient air among polymerised type I collagen and placebo.
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Introduction: Paediatric and adult psychiatric emergency department (ED) visits decreased during the initial COVID-19 pandemic outbreak. Long-term consequences of the pandemic will include increases in mental healthcare needs especially among especially vulnerable groups such as children and adolescents. Objective(s): This study examined changes in the number of overall and diagnosis-specific mental healthEDvisitsamongpatients aged<18 years following onset of the COVID-19 pandemic inMadrid, Spain. Method(s): We used electronic health records to extract the monthly numbers of total and diagnosis-specific mental health ED visits among patients aged <18 years, between October 2018 and April 2021, to La Paz University Hospital. We conducted interrupted time-series analyses and compared trends before and after the day of the first ED COVID-19 case (1st March 2020). Result(s): In March 2020, there was a marked initial decrease of -12.8 (95%CI -21.9, -7.9) less monthly mental health ED visits. After April 2020, there was a subsequent increasing trend of 3.4 (95%CI 2.6, 4.2) additional monthly mental health ED visits. Conclusion(s): After onset of the COVID-19 pandemic, there was an increase in paediatric psychiatric ED visits, especially due to suicide-related reasons. These data reinforce the crucial role of the ED in the management of acute mental health problems among youth and highlight the need for renovated efforts to enhance access to care outside of and during acute crises during the pandemic and its aftermath.
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Background: Few centers around the globe have a lung transplant (LT) program in Mexico there is only one. The possible complications are associated tpre transplant time, surgical and the post-surgical recovery, common one is AKI (20 to 90%), 15% need KRT. The AKI will complicate the in hospital evolution, time in ICU, risk of infections, also increase mortality and possibility of no renal recovery (RR). Method(s): Is a Retrospective and Descriptive study. patients 18y who performed LT in Christus Muguerza from January 2017 to May 2022. Data was collected in excel and the analysis was performed in SPSS V21. The confidentiality agreement is accordance with Helsinki declaration. Result(s): 24 patients had LT, 62.5% men, average age is 54 y, average BMI 23kg/m2. Idiopathic pulmonary fibrosis the most common diagnosis (58.3%) follow by COVID-19 (16.6%), 15 receive bi-pulmonary transplant. Survival rate is 66%. 37.5% developed AKI with the need of KRT all CKRT as initial therapy. 7 patientes where discharge with a complete renal recovery after KRT. 32% patients were in ECMO and 75% from these need CKRT. Conclusion(s): The involvement of kidney function is essential for the decision to go forward to LT, some patients develop AKI before surgical time, these should be evaluated from the crosstalk organ view, remembering that a high possibility of RR exist if the lung recovery is successful. Our work demonstrate that nephrology intervention in a team work help patient to RR. (Table Presented).
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Background: Patients on hemodialysis are at high-risk for complications derived from coronavirus disease-19 (COVID-19). The present study aims to evaluate the impact of a booster vaccine dose and breakthrough SARS-CoV-2 infections on humoral immunity three months after the booster dose. Method(s): This is a multicentric and prospective study assessing anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6-and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed. Result(s): 711 patients (67% male, 67 [20-89] years) were included. Of them, 545 (77%) patients had received an early booster and 166 (23%) a late booster. At 6 months, 64 (9%) patients had negative humoral response (3% of early booster and 29% of late booster participants, p=0.001) and 58 (91%) of them had seroconverted at 9 months, when, 5/545 (0.9%) patients in the early booster cohort and 1/166 (0.6%) in the late booster cohort remained antibody negative (p=NS). During follow-up, 35 patients (5%) developed COVID-19. Antibody titers at 9 months were independently associated to lower time from booster (B -0.12, p=0.043), COVID-19 (B 2.29, p<0.001) and mRNA-1273 booster (B 1.17, p=0.001). Conclusion(s): In hemodialysis patients, higher rates of anti-Spike antibody development were associated to mRNA-1273 booster, lower time from booster and breakthrough SARS-CoV-2 infection.
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Background: Chronic Kidney disease (CKD) is the risk factor that most increases the risk of lethal COVID-19. However, the underlying molecular mechanisms are unclear. CKD patients have an increased risk of multiple infections due to CKD-associated nonspecific immunodeficiency. Whether specific defects are related to the defense against SARS-CoV-2 is unknown. SARS-CoV-2 and coronavirus-associated receptors and factors (SCARFs) regulate coronavirus cell entry and/or replication. We hypothesized that CKD may alter the expression of SCARF genes. Method(s): A literature search identified 32 SARF genes of which 21 were directly related to SARS-CoV-2 or SARS-CoV infection and assessed their expression in target tissues of COVID-19 (kidneys, lungs, aorta and heart) in experimental CKD in mice fed adenine and compared them with controls. Result(s): Out of 21 SCARF genes, 19 (90%) were differentially expressed in at least one organ in CKD. 15 genes had a differential expression that would be expected to favor SARS-CoV-2 infection and/or severity in at least one organ. Of these, 13 were differentially expressed in the kidney. Only 2 genes reported to protect from SARS-CoV-2, Ifitm3 encoding interferon induced transmembrane protein 3 (IFITM3) and Ly6e encoding lymphocyte antigen 6 family member 6 (LY6E), were downregulated in at least two non-kidney target organs (lung and heart), potentially predisposing to more severe lung/ cardiovascular involvement in COVID-19 (Fig). The largest change was observed for Ifitm3. Conclusion(s): CKD is associated with the differential expression of multiple SCARF genes in target organs of COVID-19. The decreased expression of Ifitm3 and Ly6e in heart and/or lung may contribute to increase the severity of COVID-19 in CKD. These data may allow the development of interventions that decrease the risk of severe COVID-19 in CKD patients.
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Background: COVID-19 is an infectious illness, featured by an increased risk of thromboembolism. However, no standard antithrombotic therapy is currently recommended for COVID-19 hospitalized patients. Aim of this study was to evaluate safety and efficacy of additional therapy with aspirin over prophylactic anticoagulation (PAC) in COVID-19 hospitalized patients and its impact on survival. Methods: 8168 patients hospitalized with COVID-19 were enrolled in a multicenter-international prospective registry (HOPE COVID-19). Clinical data and in-hospital complications, including mortality, were recorded. 344 patients with incomplete data were excluded. Study population included patients treated with PAC or with PAC and aspirin. A comparison of clinical outcomes between patients treated with PAC and PAC and aspirin was performed using an adjusted analysis with propensity score matching. Results: Of 7824 patients, 360 (4.6%) received PAC and aspirin and 2949 (37.6%) PAC. Propensity-score matching yielded 298 patients from each group. Mean age was 73±11 years, 67% were male, prevalence of hypertension and diabetes was 79 and 33% respectively and 7.5% underwent invasive ventilation.In the propensity score-matched population, cumulative incidence of in-hospital mortality was lower in patients treated with PAC and aspirin vs PAC (15% vs 21%, Log Rank p=0.01, Figure 1). At multivariable analysis in propensity matched population of COVID-19 patients, including age, sex, hypertension, diabetes, kidney failure and invasive ventilation, aspirin treatment was associated with lower risk of in-hospital mortality (HR 0.62, CI 95% 0.42–0.92, p=0.018). Conclusions: Additional therapy with aspirin over PAC in COVID-19 hospitalized patients was associated with lower mortality risk in a propensity score matched population. Funding Acknowledgement: Type of funding sources: None.Figure 1. Survival curves according to therapy
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The use of automatic systems for medical image classification has revolutionized the diagnosis of a high number of diseases. These alternatives, which are usually based on artificial intelligence (AI), provide a helpful tool for clinicians, eliminating the inter and intra-observer variability that the diagnostic process entails. Convolutional Neural Network (CNNs) have proved to be an excellent option for this purpose, demonstrating a large performance in a wide range of contexts. However, it is also extremely important to quantify the reliability of the model's predictions in order to guarantee the confidence in the classification. In this work, we propose a multi-level ensemble classification system based on a Bayesian Deep Learning approach in order to maximize performance while providing the uncertainty of each classification decision. This tool combines the information extracted from different architectures by weighting their results according to the uncertainty of their predictions. Performance is evaluated in a wide range of real scenarios: in the first one, the aim is to differentiate between different pulmonary pathologies: controls vs bacterial pneumonia vs viral pneumonia. A two-level decision tree is employed to divide the 3-class classification into two binary classifications, yielding an accuracy of 98.19%. In the second context, performance is assessed for the diagnosis of Parkinson's disease, leading to an accuracy of 95.31%. The reduced preprocessing needed for obtaining this high performance, in addition to the information provided about the reliability of the predictions evidence the applicability of the system to be used as an aid for clinicians.
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During the COVID-19 pandemic, elderly adults with type 2 diabetes mellitus (T2DM) have experienced difficulties to adhere to their therapy (TA), a situation which not only has had an impact on their glycemic control, but on their quality of life (QoL) as well. Telepsychology has proved to be an effective alternative to treat health-related complications in patients with this disease, however, results of same are unknown among the Latin American population. The aim of this study was determining the effect of Online Cognitive-Behavioral Therapy on TA, overall QoL and specific QoL in two elderly adults with T2DM. The case of a 62-year-old woman and a 60-year-old man who was offered an intervention consisting of nine sessions offered through a video conference platform is presented. The procedure included: psychoeducation, self-control training techniques, behavior reinforcement, feedback and problem solving. The Objective Clinical Change (OCC) evidences an increase in TA behaviors, such as use of medications, following a healthy diet (OCC≥ 0.20) and monitoring capillary blood glucose in the medium term (four months). Likewise, improve specific QoL for T2DM patients (OCC≤ -0.20). It is concluded that telepsychology is a low-cost, safe, feasible and effective type of therapy to increase and maintain TA behaviors, as well as to improve the QoL of patients suffering T2DM. Even though, more research is needed to increase the effectiveness of this therapy modality © 2022 AAC
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Objective: To characterize the food profile of the Older People of Ibero-America in times of the COVID 19 pandemic. Material and methods: Multicenter study in 12 Ibero-American countries, an online survey was applied that included sociodemographic questions and a Food Intake questionnaire that included the frequency of consumption for vegetables, sugary drinks, legumes, dairy products and portion of food. Results: The sample was made up of 624 participants, 72.1% (n= 450) of women. 54.7% of women do not consume sugary drinks, while in men 54% consume at least one glass a day (p=0.012). 35.6% of men consumed >= 3 legumes per week versus 23% of women (p=0.020). 37.3% of women consume >= 2 daily servings of dairy products, in men only 28.1% (p= 0.030). Women have a higher consumption of vegetables (44.7%, n= 201) compared to men (28.7%), (p=0.001). 17.4% of the total sample increased the size of the food portion, being higher in women (p=0.005). Conclusion: Women have healthier eating habits than men based on fruits, vegetables, on the other hand, the variation in size increases, especially in women.
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This research is an epidemiological analysis that seeks to apply the General Excess Mortality as indicator that complements the COVID-19 surveillance strategy during the first 15 months of the pandemic in Ecuador. The selection of data from the Ecuadorian Institute of Statistics and Censuses and Civil Registry allowed the identification of an excess of 163,595 absolute deaths, which represents 42.80% of the excess of national general mortality, with April being the most affected month with a 249%. of excess global mortality compared to the following months. Santa Elena and Guayas are the provinces with the highest excess mortality recorded historically with 935% followed by 674% respectively. There is a direct correlation between the estimate of excess mortality with the mortality rates by province. Administrative planning zone 9 was the one that registered the highest excess mortality with 100%. The pattern of influence of the COVID-19 pandemic on the population was different between geographic regions, with the Ecuadorian coast being the first to present excess general mortality, followed by the mountains and eastern regions.