C-reactive protein lymphocyte index in COVID-19: a little-explored tool

Background: COVID-19 develops severe inflammatory responses that can lead to death. It is essential in a pandemic to have accessible instruments to estimate the prognosis of the disease. The lymphocyte-to-C-reactive protein ratio (LCR) is a predictive biomarker studied in oncology, which could have some advantages in COVID-19 patients in the early stages of the disease. Our objective was to estimate the risk of LCR < 100 and mortality in hospitalized patients with COVID-19. Methods: hospitalized patients with COVID-19 seen between March to October 2020 were included. The patients were grouped according to LCR < 100 and LCR > 100. A Cox regression model was performed to estimate the association between LCR < 100 and mortality. Results: we included 730 patients with COVID-19. The mean age at diagnosis was 49.9 years (SD 16.8) and 401 (55%) were men. Cox regression model showed an association between LCR < 100 and mortality (HR 6.2;95% CI 1.6 to 23.5;p 0.008), adjusting by age. severe pneumonia, intensive care requirements, and comorbidities. Conclusion: LPCR < 100 in the initial assessment of hospitalized patients with COVID-19 suggests a higher risk of mortality.

Impact of Covid-19 in Patients with Multiple Myeloma Who Are Candidates for Autologous Hematopoietic Stem Cell Transplantation

Introduction: Recent studies have shown an increased risk of covid infections in patients with multiple myeloma (MM) compared to patients withoutMM, a reduction in the number of new diagnoses ofMMin 2020 compared to 2019 as well as a decrease in the survival of newly diagnoses patients. The general objective of this study was to analyze the possible impact of covid-19 pandemic in the treatment plan for patients withMM who are candidates for autologous hematopoietic stem cell transplantation (HSCT). Material(s) and Method(s): All patients with MM who received autologous HSCT in our hospital between March 2020 and October 2021 has been included in the study. This period coincides with the beginning of the confinement for covid-19 in our country and the date of which 88,4% of the population over 12 years of age had received the complete vaccination schedule at that time according to official data. Patient demographics, disease-related variables were obtained from the patient's medical record. On the other hand, treatment-related variables were collected from the eprescription program. Results and discussion: A total of 13 patients were undergoing induction treatment or underwent autologous HSCT during the study period, 62% were men. The median age of the patients was 55 years (30-69). Almost all patients (92,3%) were affected in some way the planned treatment. The reasons were the following: the induction treatment had to be prolonged in 5 patients (increase in the number of cycles due to the impossibility of performing the HSCT), in 4 patients the induction treatment had to be changed (bortezomib/lenalidomide/dexamethasone for bortezomib/ thalidomide/dexamethasone) due to the impossibility of performing apheresis as planned after the third cycle, 2 patients had delay in starting second-line treatment after disease relapse or in starting consolidation treatment and 1 patient suffered a delay in the diagnosis of relapse (delay in the planned CT scan confirming progression). Conclusion(s): Although we cannot yet know the impact on survival, the covid-19 pandemic has meant an alteration in the treatment plan of practically all myeloma patients who are candidates for HSCT and who were receiving anti-myeloma therapy in our hospital in the first 18 months after the declaration of the pandemic in our country.

ANALYSIS OF THE TRADE AGREEMENTS OF PERU ACCORDING TO THE GRAVITY MODEL

International trade is of great importance for both developed and emerging economies to recover in the shortest possible time from the health and economic crisis caused by the COVID-19 pandemic. The objective of this research is to carry out an analysis of Peru's trade agreements according to the gravity model. As a result, it was possible to determine that the countries with which Peru has a current commercial agreement, the commercial exchange is more favorable, with the current conditions, is China. It is considered that the trade liberalization policy is adequate, and giving support to exporting companies as the central axis of exports is opportune. Additionally, the results of the basic indicators of commercial position: Trade balances, exports and imports, in which China is the country that unquestionably occupies the first place during the last decade, the US state in second position, after having held the first place in the 1990s. © 2022, University of Cienfuegos, Carlos Rafael Rodriguez. All rights reserved.

Multisystemic inflammatory syndrome in an adult secondary to SARS-CoV-2 infection. A case report

Recent reports describe multisystemic inflammation syndrome in children after COVID-19 infection, who have presented features of Kawasaki disease. Few cases have been reported of this entity in adults, but it has been observed in patients after exposure to SARS-CoV-2. The following case describes a 27-year-old male patient, with a history of previous COVID 19 infection diagnosed with the COVID 19 RT-PCR test, who presented with diarrhoeal stools, nausea, vomiting, febrile process, haemodynamic instability, and respiratory failure. The physical examination revealed a conjunctival injection in both eyes and a rash in the upper limbs. Laboratory tests demonstrated an infectious and inflammatory process. Findings of an inflammatory disorder similar to Kawasaki disease, with previous exposure to SARS-CoV-2, and with good response to treatment with human immunoglobulin (IVIG), steroid, and tocilizumab. Reporting these clinical cases alerts the medical scientific community to always have clinical suspicion and apply the diagnostic criteria established by the CDC for adult patients, thus prompt treatment is established for these patients. To the best of our knowledge, we present the first case of multisystemic inflammatory syndrome in adults secondary to SARS-CoV-2 infection in El Salvador. © 2021 The Author(s)

[Lymphocyte-to-C-reactive protein ratio in COVID-19: an unexplored tool]

BACKGROUND: COVID-19 develops severe inflammatory responses that can lead to death. It is essential in a pandemic to have accessible instruments to estimate the prognosis of the disease. The lymphocyte-to-C-reactive protein ratio (LCR) is a predictive biomarker studied in oncology, which could have some advantages in COVID-19 patients in the early stages of the disease. Our objective was to estimate the risk of LCR < 100 and mortality in hospitalized patients with COVID-19. METHODS: hospitalized patients with COVID-19 seen between March to October 2020 were included. The patients were grouped according to LCR < 100 and LCR > 100. A Cox regression model was performed to estimate the association between LCR < 100 and mortality. RESULTS: we included 730 patients with COVID-19. The mean age at diagnosis was 49.9 years (SD 16.8) and 401 (55%) were men. Cox regression model showed an association between LCR <100 and mortality (HR 6.2;95% CI 1.6 to 23.5;p 0.008), adjusting by age. severe pneumonia, intensive care requirements, and comorbidities. CONCLUSION: LPCR <100 in the initial assessment of hospitalized patients with COVID-19 suggests a higher risk of mortality.

Antinuclear antibodies detected by Enzyme-Linked Immunosorbent Assay (ELISA) in severe COVID-19: clinical and laboratory associations.

OBJECTIVE: Antinuclear antibodies (ANA) are detected in approximately a quarter of COVID-19 patients when assessed by indirect immunofluorescence. Since there is no information, our study investigated the presence of ANA detected by Enzyme-Linked Immunosorbent Assay (ELISA) and its clinical and laboratory associations. PATIENTS AND METHODS: A longitudinal study was conducted on 92 patients with severe COVID-19, 20 patients with acute myocardial infarction, and 25 healthy subjects. Blood samples were obtained at hospital admission. Commercial ELISA was used to detect ANA, while flow cytometry was used to measure serum interferons. RESULTS: ANAs were positive in 8.6% of COVID-19 patients, 10% of myocardial infarction patients, and 4% in healthy individuals (p=0.676). COVID-19 patients with ANA+ had less ferritin, troponin, and neutrophils but more albumin and lymphocytes than ANA- patients. Serum levels of type I, II, and III interferons were similar between groups. At follow-up, all ANA+ patients survived, while mortality was significant in ANA- patients (0 vs. 36%; p=0.048). CONCLUSIONS: ANA detection is not increased in severe cases of COVID-19 when assessed by ELISA. However, its presence appears to be associated with a less aggressive disease phenotype, regardless of circulating levels of interferons.

Analysis of teachers' experiences with virtual learning spaces: the case of the International University of Ecuador UIDE

With the expansion of COVID-19, the Universidad Internacional del Ecuador UIDE, with other colleges around the world, faced forward to the virtual model education, trying with this to secure access to higher education from their students. The follow work analyses what were the university community teachers perceptions around this new model of education, starting with the first impressions and their development. Based on mixed methods of investigation, set about a first exploration in a quantitative vision and enriched with qualitative methods based on speech analysis, this for trying to understand the complexity of the subjects' participations in these spaces. The conclusions of this work are the dragged use of the platforms impact in a positive way in the perceptions of them, also, the needed of complementary this with other tolls and social networks, and, for least, the need to incorporate in the students and teachers' formation these specific capacities.

Sociodemographic differentials of COVID-19 in cuban youth

The demography's objects of study are the composition and dynamics of the population, as well as the social, environmental, and economic factors that determine it. This creates a specific context, which affects the configuration of the characteristics of the COVID-19 pandemic. The composition of the population is an important component for the analysis of the pandemic. Three of its elements are fundamental: the size of the population, density and urbanization;the distribution by sex and age;and, the patterns of co-residence and relationships between generations. This article addresses the distribution by sex and age and the behavior in the evolution of COVID-19 in Cuba, of the young population, particularly those between 15 and 29 years of age;in the period between March 11, 2020 (date of the first confirmed cases in the country) until June 2021.

Corona: A Side-Scrolling Video Game-Preliminary Study

As the international community goes digital due to the state of affairs, it may be deemed that gamification is on the rise. Moreover, the coronavirus disease 2019 pandemic has impacted children, alongside adults, and they are in isolation, yet child development continues. The authors acknowledged these, took the notion that gamification is advantageous into consideration, and developed a side-scroller that is entertaining yet informative about SARS-CoV-2 and viruses at large using object-oriented programming, a programming paradigm, and the Association for Computing Machinery Java Task Force graphics library. This paper underlined that there is an absence of precedence of a side-scroller that is developed using this graphics library, and, subsequent to the assessment of the authors, it concluded that such a graphics library may not be suited to video game development due to its limiting factors. This paper deemed that gamification stimulates learning, nonetheless.

Systemic Analysis of the Territorial and Urban Planning of Guayaquil

Urban planning in Latin America has historically affected rural areas, giving way to urban concentration in an uncontrolled way. The metropolis of Guayaquil registers the highest urban growth rate in Ecuador, occupying an urban area of 97.46%, where only 2.54% of the inhabitants are in rural areas. In this study, an analysis is made of the main problems detected in the urban planning of Guayaquil where social actors, endogenous resources, among other fundamental components for the development of local development programs, are identified, focused on the five rural parishes of Guayaquil canton. It is concluded that local development historically has not obeyed models or strategies conceived with the participation of the academy, although a group of researchers has shown special interest in recent years in bringing to society the scientific results obtained in the scientific field. The systemic analysis carried out in the planning of Guayaquil constitutes an opportunity to position the territory as an option for rural and community tourism, also considering the urban regulations regarding health that the COVID-19 pandemic has imposed. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Clinical characteristics of COVID-19 patients on venovenous extracorporeal membrane oxygenation who develop severe thrombocytopenia

Background: Thrombocytopenia (<150 x109/L) is often encountered during mechanical circulatory support. Coagulopathy in SARS-COV-2 illness (COVID-19) is increasingly recognized as a risk factor for more severe illness and higher mortality. Thrombocytopenia in COVID-19 patients requiring venovenous (VV) extracorporeal membrane oxygenation (ECMO) is challenging, and therefore identification of contributing factors may aid in management of these complex patients. Methods: A retrospective review was performed for consecutive adult patients on VV ECMO for COVID-19 respiratory failure at a single institution from March to July 2020. Patient data was obtained from our internal registry with IRB approval. Group comparisons of means were made using unadjusted t-tests and proportions were evaluated with a simple chi-square test. Results: The majority (85%) of COVID-19 patients on VV ECMO developed thrombocytopenia. Twelve of 27 patients (44%) exhibited larger drops in platelet counts following ECMO initiation (73% vs 52% fall to nadir) raising concern for heparin-induced thrombocytopenia (HIT). Nine of the 12 (75%) patients tested positive for anti-PF4 antibodies;however, none tested positive via serotonin release assay. Characteristics that affected the degree of platelet decline included the need for simultaneous continuous renal replacement therapy (CRRT) and treatment with an immunomodulating agent, convalescent plasma, or azithromycin. Discussion: Thrombocytopenia in COVID-19 patients on VV ECMO is likely multifactorial, but a more severe thrombocytopenia exists in a subset of patients. CRRT therapy and certain COVID-directed pharmacotherapy agents appear to be influential factors. Anti-PF4 antibody testing may be falsely positive and should be interpreted cautiously.