The impact of the COVID-19 Pandemic on Higher Education-A Case of Success of ICT Educational Programs

The COVID-19 pandemic has had a big impact in all human being activities;education context was especially affected. A disrupted shift from face-to-face teaching-learning practices to learning activities and/or pedagogical activities supported by digital platforms or social networks was lived. Limitations in Internet access and mastering of technological media impacted the pedagogical, psychological, and affective side of the students. This paper presents a study on the changes caused by the COVID-19 pandemic in terms of school dropout;an analysis was carried out on the percentages of the indicator of non-enrollment of each one of the educational programs at a Mexican university. The results showed that educational programs with an ICT orientation beat this contingency in a better way. This encourages us to continue this research to investigate how new professionals are getting ready for the fashion of working from home. © 2022 IEEE.

The whole grain manifesto: From Green Revolution to Grain Evolution

Grains have historically represented a major component of human diets and were predominantly consumed in whole form until the first half of the 19th century, when a combination of technological innovations and market dynamics made refined grains, hitherto a premium product, affordable and available to the masses. Grains still account for more than half of the total caloric intake among vulnerable populations worldwide, and their dominant consumption in refined form turns a nutrient-dense, protective food into a nutrient-poor one contributing to growing rates of obesity and noncommunicable disease. Shifting a substantial portion of global grain consumption to whole grains is potentially one of the most significant and achievable improvements to diets and food systems worldwide. In countries with significant micronutrient deficiencies, a switch from refined to fortified whole grain foods can enable institutional channels such as school feeding programs to measurably improve diet quality in a budget-neutral way.

Incidencia, Características y Evolución de las Endocarditis Nosocomiales Durante la Pandemia COVID-19

Introducción: La pandemia COVID-19 ha podido tener influencia en la incidencia de endocarditis infecciosa nosocomial (EIN). Objetivos: Describir la incidencia, características y evolución de la EIN durante la pandemia COVID-19. Material y métodos: Estudio retrospectivo unicéntrico incluyendo las EIN definidas, según los criterios de Duke, desde marzo 2020 hasta marzo 2021. Se dividieron a los pacientes en ingreso por COVID-19 (grupo COVID) o por otros motivos (grupo no COVID). Se comparó la incidencia de EIN con el mismo periodo de 2019-2020. Resultados: Durante el periodo de estudio se diagnosticaron 22 EIN, 7 (31,8%) en COVID, 15 (68,2%) en no COVID. La incidencia fue 9,7 casos/10.000 ingresos (22/22.596). La incidencia en el mismo periodo 2019-2020 fue 4,6/10.000 (10/21.668), siendo la diferencia significativa (OR 1,91, IC95% 1,03-3,96, p = 0,038). Durante el periodo 2020-2021, la incidencia de EIN en COVID fue 24,6/10.000 (7/2.846) frente a 7,5/10.000 (15/19.750) en no COVID, siendo la diferencia significativa (OR 3,23 IC95% 1,32-7,95, p < 0,001). La mediana de edad fue 75 años (RIQ 68-80), siendo varones 68,2%. La mediana de Índice de Charlson fue 5 (RIQ 4-6). Un 36,4% presentaban válvula protésica, mientras un 22,7% valvulopatías significativa no protésica. Los pacientes COVID habían recibido más frecuentemente inmunosupresores (71,4% vs. 13,3%, p = 0,014), sin otras diferencias entre grupos. El foco primario fue considerado vascular en 86,4% (19/22;10 por vía periférica (VP), 5 por catéter venoso central (CVC), 4 no se pudo diferenciar origen entre VP o CVC). 3 pacientes presentaron foco no vascular (1 genitourinario, 2 gastrointestinal). No hubo diferencias entre grupos. Las manifestaciones fueron: fiebre 95,5%;insuficiencia cardiaca 68,2%;embolismos 45,5%;ictus 40,9%;insuficiencia renal 40,9%;bacteriemia persistente 38,1%;y shock séptico 14,3%. Los pacientes no COVID presentaron con más frecuencia clínica subaguda (0 vs. 46,7%, p = 0,042), sin otras diferencias estadísticamente significativas. La etiología fue: estafilococos coagulasa negativo 6 (27,3%);Enterococcus faecalis 6 (27,3%);Staphylococcus aureus 4 (18,2%);Candida albicans 3 (13,6%). En 3 casos no hubo aislamiento microbiológico (13.6%). No hubo diferencias entre grupos. La mortalidad a 30 días fue 45,5%, siendo la EIN o sus complicaciones la causa en todos los casos salvo 1 (no COVID). No hubo diferencias de mortalidad entre grupos (28,6% vs. 53,3%, p = 0,381). Conclusiones: La incidencia de EIN ha aumentado durante la pandemia, especialmente en pacientes ingresados por COVID-19. El foco primario de las EIN fue predominantemente vascular. Afectaron frecuentemente a pacientes con comorbilidad y patología valvular previa. Las manifestaciones, etiología y evolución fueron similares en COVID y no COVID, destacando una elevada frecuencia de eventos embólicos, especialmente ictus. Las EIN asocian elevada morbimortalidad y es importante extremar las medidas de prevención.

Measuring College Students' Experiences with Virtual Education During the Pandemic by COVID-19

Due to the COVID-19 pandemic, young university students had to adjust to the emergency remote education provided by the online education modality. To know about the impact of this situation, the objective of this work was to validate the Scale of Experiences of University Students in Virtual Education (EEEV). A total of 2841 Chilean university students participated, with a mean age of 23.42 years (SD=7.72), of which 20% were engineering students. The EEEV arose from the adaptation of the questionnaire of expectations towards virtual education in university students during the COVID-19 pandemic, composed of six dimensions (Relationship with peers, Online learning, Online teaching, Self-efficacy for online learning, Online evaluation, and Comparison with face-to-face education). The psychometric properties of the EEEV version were verified. Validity estimations were performed using confirmatory factor analysis, finding a good fit, and maintaining the original version's factors. As for the dimensions, the internal consistency coefficient for the total scale was adequate. Therefore, it is concluded that the EEEV is a valid and reliable scale for measuring the experiences of university students in the context of emergency remote education.

Educational inclusion during the Post-COVID school from the perspective of Therapeutic Pedagogy tea- chers

Schools in the post-COVID era have adopted a series of hygienic-sanitary and organizational measures which have limited the inclusive practices that had been carried out in schools during the last years. The aim of this research is to find out and analyze the school experiences of students with special needs during the academic year 2020/21, in terms of inclusion, and based on the testimonies of the teachers involved. Methodologically, we proposed a qualitative research, in which we conducted virtual semi-structured interviews and focus groups, and in which 37 special education teachers participated from the autonomous community of Andalucia. From the final analysis, situations of school exclusion emerge, as a consequence, on the one hand, of spatial separations within schools (bubble groups) and, on the other hand, due to the lack of resources for the attention of students enrolled in regular classrooms and special education classrooms that have limited their social, emotional and learning experiences. These situations show that talking about diversity in school has not changed significantly, and it is still synonymous with school exclusion.

Farmworkers and COVID-19: prevention and working conditions in Sonora, Mexico

Objective: To analyze the relationship between socio-labor conditions and health care in the face of COVID-19 among the farmworkers in two municipalities of Sonora, Mexico. Method:. Through semistructured interviews and field observations, the care practices and health provisions implemented by the agricultural work centers were analyzed. Twenty-two interviews were conducted, 18 in the municipality of Hermosillo and 4 in San Miguel de Horcasitas. Results: Agricultural activities in Mexico did not cease and farmworkers continued their work in a diverse context of prevention measures. We found a disparity between the different productive units, which carried out protocols oriented to the care of the harvest to the detriment of human health. The means of agricultural transport lacked sufficient attention in terms of contagion prevention. The practice of payments in the localities without a sanitary protocol was evident. Conclusion: The intervention of the health authorities is necessary to homogenize the prevention protocols in the face of COVID-19. Socio-labor conditions are an obstacle to pandemic mitigation.

Educational inclusion during the Post-COVID school from the perspective of Therapeutic Pedagogy teachers

Schools in the post-COVID era have adopted a series of hygienic-sanitary and organizational measures which have limited the inclusive practices that had been carried out in schools during the last years. The aim of this research is to find out and analyze the school experiences of students with special needs during the academic year 2020/21, in terms of inclusion, and based on the testimonies of the teachers involved. Methodologically, we proposed a qualitative research, in which we conducted virtual semi-structured interviews and focus groups, and in which 37 special education teachers participated from the autonomous community of Andalucía. From the final analysis, situations of school exclusion emerge, as a consequence, on the one hand, of spatial separations within schools (bubble groups) and, on the other hand, due to the lack of resources for the attention of students enrolled in regular classrooms and special education classrooms that have limited their social, emotional and learning experiences. These situations show that talking about diversity in school has not changed significantly, and it is still synonymous with school exclusion. © 2022 Elsevier Doyma. All rights reserved.

Positive environmental impact of remote teleconsultation in urology during the COVID-19 pandemic in a highly populated area

Introduction & Objectives: Greenhouse gas (GHG) emissions are a serious environmental issue. The healthcare sector is an important emitter of GHGs. Our aim was to assess the environmental cost of teleconsultations in urology compared to face-to-face consultations. Materials & Methods: Prospective study of all patients who had a remote teleconsultation over a 2-week period during COVID-19 pandemic. Main outcome was the reduction in CO2e emissions related to teleconsultation compared to face-to-face consultation and was calculated as: total teleconsultation CO2e emissions – total face-to-face consultation CO2e emissions. Secondary outcome measures were the reduction in travel distance and travel time related to teleconsultation. Results: Eighty patients were included. Face-to-face consultations would have resulted in 6699 km (4162 miles) of travel (83.7 km (52 miles) per patient). Cars were the usual means of transport. CO2e avoided due to lack of travel was calculated at 1.1 tonnes. Teleconsultation was responsible for 1.1 kg CO2e while face-to-face consultation emitted 0.5 kg of CO2e. Overall, the total reduction in GHGs with teleconsultation was 1141 kg CO2e, representing a 99% decrease in emissions. Total savings on transport were 974 € (fuel 645 €, tolls 283 €, metro tickets 46 €) and savings on travel time were 112 h (1.4 h/patient). Conclusions: Teleconsultation reduces the environmental impact of face-to-face consultations. The use of teleconsultation in our urology departments resulted in the avoidance of more than 6000 km of travel, equivalent to a reduction of 1.1 tonnes of CO2e. Teleconsultation should be considered for specific indications as the healthcare system attempts to become greener.

Assessment of physicians’ satisfaction with a virtual tumour board in a French academic centre during the COVID-19 pandemic

Introduction & Objectives: During the COVID-19 pandemic, physicians were instructed to avoid face-to-face meetings. Virtual Tumour Boards (vTBs) were therefore established. Our objective was to assess physicians’ satisfaction with vTB use during the crisis. Materials & Methods: Twenty-eight physicians in onco-urology involved in a vTB in a single department in Paris, France, were asked to answer an online survey between March 17th and April 28th, 2020. A validated scale employed for teleconsultations was adapted to assess physician satisfaction with the vTB (e.g. Telehealth Usability Questionnaire - TUQ) including additional criteria such as ergonomic, learnability and satisfaction items. A satisfying experience was defined as TUQ score >85. Participants were stratified into two groups, senior and junior, to assess any differences in opinion. Results: A total of 23/28 physicians (82.1%) responded to the questionnaire (median age: 36-years [IQR: 32-40], male: female ratio 2.8, 11 senior physicians (47.8%)). Overall, 164 medical cases were discussed, representing a 23.4% decrease when compared to the similar period in 2019 (n=214). Median TUQ score was 100 [IQR: 92-109] and 22 participants (95.7%) reported a satisfying experience with no significant difference between senior and junior physicians. Limitations include the small sample size, monocentric design, use of a modified telehealth questionnaire in order to fit the vTB, and potential bias inherent in self-reporting. Conclusions: The vTB was a rapid and effective way to deal with onco-urology cases. vTB adherence was high and we believe that this way of working will continue beyond the current crisis.

[Headache associated with the use of personal protective equipment during the COVID-19 pandemic: a practical way to improve this condition]. / Cefalea asociada con el uso de equipo de protección personal durante la pandemia de la COVID-19: una forma práctica de mejorar esta condición.

TITLE: Cefalea asociada con el uso de equipo de protección personal durante la pandemia de la COVID-19: una forma práctica de mejorar esta condición.

P.0876 Perceived stress during COVID-19 confinement in elderly participants with mild cognitive impairment or mild dementia: a cross-sectional study

Introduction: Covid-19 disease forced the Spanish government to declare a national state of alarm implementing restrictive measures such as lockdown, social distancing and stay at home measures. These measures can be related to negative consequences on mental health and stress increase in elderly people with mild cognitive impairment or mild dementia. Objectives: The aim of this study was to explore the impact of this strict confinement and to analyze factors associated with perceived stress on community-dwelling older adults with mild cognitive impairment or mild dementia during the start of the COVID-19 pandemic. Methods: This study was conducted in Málaga a Spanish region of Andalucía. In total 143 elderly participants (>55 years old) with mild cognitive impairment or mild dementia, from the SMART 4 MD (n=69) and TV-AssistDem (n=74) randomized clinical trial (RCT), were interviewed by telephone between May 11 and June 25 2020. Participants were contacted by telephone by 5 health professionals (two Neuropsychologists, a Clinical Psychologist, a Psychologist and a Psychiatric and Mental Health Clinical Nurse Specialist). Researchers had previously established relationships with participants during both RCTs. The mean time from the start of the lockdown and home-confinement measures to the interview was 70.93 days (SD=12.36, Range: 52-102). Perceived stress was assessed with the Perceived Stress Scale (PSS-14). Depression (Geriatric Depression Scale), cognition (Mini-Mental State Examination-22), quality of life (Quality of Life-Alzheimer's Disease Scale), health status (EuroQoL-5D-3L) and other variables (specific structured questionary) were also measured. To analyze the factors associated with perceived stress linear regression models were used. R version 4.0.4 program was used for statistical analysis. Results: Of the respondents, 94/143 (65.7%) were women. The mean age was 74.12 years (SD 6.49), and 36/143 (25.2%) lived alone. 66/143 (46.48%) participants were worried and 33/143 (23.24%) were afraid at the time of the evaluation. Perceived stress was negatively associated with change in living arrangement (B=-4.89;p<0.05), feeling well (B=-7.88;p<0.001), feeling calm (B=-3.12;p<0.05), quality of life (B=-1.02;p<0.001) and health status (B=-0.20);p<0.001) and positively associated with feeling sad (B=7.32;p<0.001), feeling worried (B=6.45;p<0.001), feeling afraid (B=7.77;p<0.001), feeling anxious (B=10.44;p<0.001), feeling bored (B=6.77;p<0.001), sleep disturbances (B=5.49;p<0.01) and score of depression (B=1.83;p<0.001). Discussion: Surprisingly, the score of perceived stress was similar to other studies with comparable samples1,2. The strict confinement seems not to have affected this population significantly regarding perceived stress. Less perceived stress was associated with wellbeing and better quality of life. More perceived stress was associated with less mental health and sleep disturbances. A change in living arrangements was negatively correlated with perceived stress, probably due to the increase in family support. More studies are necessary to evaluate the long-term consequences of COVID-19 restricted measures in perceived stress and mental health in this vulnerable population. No conflict of interest

Echocardiographic markers of mortality at 60 days in patients with COVID-19 in the intensive care unit

Introduction: Coronavirus disease (COVID)-19 predominantly produces its effects through lung damage, but an important component of multi-organ dysfunction is cardiac involvement. We have few reports that inform about the behavior of echocardiographic images of patients with the most severe forms of the disease. Purpose: The present work aims to identify prognostic markers for 60-day mortality in patients hospitalized in intensive care based on echocardiographic findings. Methodology: A single-center retrospective cohort was conducted. Hospitalized patients were included in one of the nine intensive care units for COVID-19 confirmed by RT-PCR from May to October 2020. Patients with previous conditions that determined a limitation of the therapeutic effort, those who died before 24 hours and pregnant women were excluded. Portable echocardiograms were performed by two expert cardiologists following the recommendations for isolation and personal protection. The time to death was evaluated as outcome. A Cox proportional hazards model was constructed, HR and 95% confidence intervals with their p values. The study was approved by the institutional ethics committee. Results: Of 326 patients included, 153 patients had an echocardiogram. The mean age was 60.7 years, 47 (30.7%) were female and 67 (44.7%) had positive troponin. 91 patients (59.5%) not survive, the mean long of stay was 8.4 (SD: 4.2) days. 111 (72.5%) had shock, 128 (83.7%) severe ARDS (PaO2 / FiO2 <100 mmHg), 142 (92.8%) required invasive ventilatory support, and 86 (56.2%) acute kidney injury. 27 (17.6%) patients had acute pulmonary embolism, 16 (10.4%) acute myocardial infarction and 9 (5.9%) myocarditis. The mean right ventricular ejection fraction was 37%, TAPSE was decreased in 16 cases (10.4%). 41 cases (26.8%) had right diastolic dysfunction. 34/48 (71%) cases had pulmonary hypertension. The average LVEF was 59.3% and 74 (48.4%) had some left ventricular diastolic dysfunction. 12 (7.8%) had left ventricular segmental wall motion abnormality and 16 (10.4%) had pericardial effusion. Univariate analysis identified TAPSE, PSAP, acute cor pulmonale and right ventricular dilatation as variables related to the outcome of mortality. The multivariate Cox model (Table 2) documented that acute cor pulmonale with a HR of 12.8 (95% CI 3.51 - 46.63, p<0.001) and right ventricular dilation with a HR of 4, 87 (95% CI 1.36-17.46, P 0.016) were associated with mortality. Conclusions: In patients hospitalized in the intensive care unit for COVID- 19, acute cor pulmonale and right ventricular dilatation behaved as independent predictors of in-hospital death. (Figure Presented).

High sensitivity troponin as a 60-day mortality marker in patients with COVID-19 in intensive care at a Latin American hospital

Introduction: Coronavirus disease (COVID) - 19 presents with periodic outbreaks with a large number of critical cases that overwhelm the health system. One of the objectives of screening and management is to have markers that can efficiently stratify the individual risk of experiencing adverse results. High-sensitivity troponin has been proposed as one of the possible prognostic markers. Purpose: To evaluate the prevalence of troponin elevation and its performance for predicting 60-days mortality in patients in ICU due to COVID - 19 in a Latin American population. Methodology: A single-center retrospective cohort study was carried out in which patients in ICU for COVID-19 confirmed by RT-PC between May and December 2020 were included. Patients with previous conditions that determined a limitation of therapeutic effort and pregnant women were excluded. The outcome was 60-days mortality. Kaplan Meier survival curves were constructed, a ROC curve was generated for the prediction of death according to troponin levels by calculating the area under the curve. Finally, a Cox proportional hazards model was generated. Results: 296 patients were included, 110 (37.2%) female, the mean age was 60 (SD 14) years and the duration of symptoms before admission to the ICU was 8.4 (SD 4.2) days. 81.4% of the patients had at least one comorbidity, 117 (39.5%) had hypertension, 65 (21.9%) had diabetes, and 63 (21.3%) had chronic lung disease. Mortality occurred in 151 cases (51%), 225 (76%) presented shock, 242 (81.8%) severe ARDS (PaO2 / FiO2 <100 mmHg), 232 (78.4%) required invasive ventilatory support, and 153 (5.7%) developed acute kidney injury. The APACHE II average was 13.1 and SOFA 4.8. Troponin was positive in 118 (39.9%) patients, 29.6% of the survivors and 49.7% in non survivors. The AUC was 0.65 (95% CI 0.59-0.71) for predicting mortality (Figure 1). The Kaplan Meier curves are shown in Figure 2 with a p less than 0.001 by achieving the test. In the bivariate analysis, troponin obtained a HR of 1.94 and p<0.001, but in the multivariate model it was 1.39 (95% CI of 0.21-1.56) and p of 0.12. Conclusions: High sensitivity troponin was found to be elevated in patients hospitalized for COVID-19 in the intensive care unit who died, with regular discrimination (AUC: 0.65), even though the univariate analysis by the Cox and Kaplan Meier methods showed association with 60-days mortality, this was not maintained in the multivariate model. (Figure Presented).

Positive environmental impact of remote teleconsultation in urology during the COVID-19 pandemic in a highly populated area.

INTRODUCTION: Greenhouse gas (GHG) emissions are a serious environmental issue. The healthcare sector is an important emitter of GHGs. Our aim was to assess the environmental cost of teleconsultations in urology compared to face-to-face consultations. MATERIALS AND METHODS: Prospective study of all patients who had a remote teleconsultation over a 2-week period during COVID-19 pandemic. Main outcome was the reduction in CO2e emissions related to teleconsultation compared to face-to-face consultation and was calculated as: total teleconsultation CO2e emissions-total face-to-face consultation CO2e emissions. Secondary outcome measures were the reduction in travel distance and travel time related to teleconsultation. RESULTS: Eighty patients were included. Face-to-face consultations would have resulted in 6699km (4162 miles) of travel (83.7km (52 miles) per patient). Cars were the usual means of transport. CO2e avoided due to lack of travel was calculated at 1.1 tonnes. Teleconsultation was responsible for 1.1kg CO2e while face-to-face consultation emitted 0.5kg of CO2e. Overall, the total reduction in GHGs with teleconsultation was 1141kg CO2e, representing a 99% decrease in emissions. Total savings on transport were 974 € and savings on travel time were 112h (1.4h/patient). CONCLUSIONS: Teleconsultation reduces the environmental impact of face-to-face consultations. The use of teleconsultation in our urology departments resulted in the avoidance of more than 6000km of travel, equivalent to a reduction of 1.1 tonnes of CO2e. Teleconsultation should be considered for specific indications as the healthcare system attempts to become greener. LEVEL OF EVIDENCE: 3.

Safety and tolerability of cladribine in multiple sclerosis-clinical experience of two tertiary centers

Background: Cladribine is a selective and oral immunological reconstitution treatment, approved in Europe in 2017 and in Portugal in 2018 for very active multiple sclerosis (MS) with relapses. Its safety and efficacy profile were assessed in phase III CLARITY (2005-2009) trial. Post-commercialization studies in real life conditions, are essential to confirm this profile. Objectives: To assess the safety and tolerability of cladribine in MS patients a real-world clinical setting, during treatment follow-up. Methods: Observational, multicentric, prospective study. Consecutive MS patients treated with cladribine were included in two tertiary hospitals in Lisbon and followed during treatment. Demographic and clinical aspects, EDSS, previous disease-modifying drugs (DMD) and annual relapse rate (ARR) were recorded, as well as laboratory, imaging monitoring and adverse reactions during treatment. Results: Eighty-five included patients, 54 (63.5%) female, mean age 42±12 years old, mean disease duration 9±7 years. Seventyseven (90.6%) had relapsing-remitting MS, and the remaining had secondary progressive MS. Median pre-treatment EDSS was 2,0 (1,5-4,0). Most (65.9%) patients had been submitted to more than one DMD before, 43 (51.2%) with first-line therapies and 9 (10.7%) were naïve. Cladribine was started in 57 (68.7%) patients due to inefficacy of previous drug. Mean follow-up time was 13±6 months, and 54 (63.5%) completed first year of treatment. Second year of treatment was delayed in some patients due to global COVID-19 pandemic. Most frequent adverse reactions were lymphocytopenia (43,5%), infections (20,8%) and fatigue (18,1%). After two months of first dose, CD19+ lymphocyte count showed greater reduction compared with CD4+ and CD8+. There were no grade 4 lymphocytopenia cases registered. Four (5.5%) serious adverse reactions were recorded. There were no cases of cladribine withdrawal because of adverse reactions. Conclusions: This cohort has similar characteristics to the CLARITY trial study population. Registered adverse reactions were comparable to previously described, showing higher incidence of fatigue and lower incidence of infections. This study confirms the short-term tolerability and safety profile of cladribine in real life scenarios.

Effectiveness of cladribine in multiple sclerosis-clinical experience of two tertiary centers

Background: Cladribine is a selective and oral immunological reconstitution treatment, approved in Europe in 2017 and in Portugal in 2018 for very active multiple sclerosis (MS) with relapses. Its safety and efficacy profile were assessed in phase III CLARITY (2005-2009) trial. Post-commercialization studies in real life conditions, are essential to confirm this profile. Objectives: To assess the efectiveness of cladribine in multiple sclerosis patients a real-world clinical setting, during treatment follow-up. Methods: Observational, multicentric, prospective study. Consecutive MS patients treated with cladribine were included in two tertiary hospitals in Lisbon and followed during treatment. Demographic and clinical aspects, EDSS, previous disease-modifying drugs (DMD) and annual relapse rate (ARR) were recorded, as well as laboratory and imaging monitoring during treatment Results: Eighty-five included patients, 54 (63.5%) female, mean age 42±12 years old, mean disease duration 9±7 years. Seventyseven (90.6%) had relapsing-remitting MS, and the remaining had secondary progressive MS. Median pre-treatment EDSS was 2,0 (1,5-4,0), and 40 (47.1%) patients had at least one relapse in previous year. Most (65.9%) patients had been submitted to more than one DMD before, 43 (51.2%) with first-line therapies and 9 (10.7%) were naïve. Cladribine was started in 57 (68.7%) patients due to inefficacy of previous drug. Mean follow-up time was 13±6 months, and 54 (63.5%) completed first year of treatment. Second year of treatment was delayed in some patients due to global COVID-19 pandemic. Fifteen relapses were registered in 12 patients. Five (5.9%) stopped treatment because of disease activity in the first year. After 12 months of follow-up (n=54), no difference was found between previous and 12-month EDSS medians (2 (IQR 1,5-4,0) vs 2 (IQR 1,25-4) p=0.606). Mean 12-month ARR (0,1±0,4) was significantly inferior to previous year ARR (0,6±1,0), p<0.001. Conclusions: At pivot trial, the efficacy of cladribine was proved after two annual treatment cycles. In this population, short follow-up period is a limitation, but after mean follow-up of one year, clinical estabilization was found in MS patients treated with cladribine.

Cutaneous susceptibility to SARS-CoV-2 infection according to the expression of viral entry factors in the skin

Introduction: Reports of dermatological manifestations in patients with COVID-19 suggest a possible cutaneous tropism of SARS-CoV-2;however, the capacity of this virus to infect the skin is unknown.