Lean Healthcare: A Critical Analysis

The current pandemic situation caused by COVID-19, also known as coronavirus, has put the health sector in the spotlight. It has led to the emergence of new plans and strategies that can help society control and stop the spread of COVID-19. These strategies include the Strategic Preparedness and Response Plan, led by the World Health Organization (WHO), which highlights and outlines the public health measures that countries should adopt to prepare for and respond effectively to the spread of the coronavirus. The pandemic is much more than a health crisis. It requires a response, matching the main problems detected in health and emergency centers. Some of them are quick and exponential spread of the disease, a spike in the number of COVID-19 cases, the successive waves, an increase in the number of patients, and insufficient response healthcare capacity. These problems become more important when there is also an economic downturn, which has made it impossible to expand budgeted public spending on healthcare. For this reason, research for alternative methods that can improve the quality of healthcare management, but without generating increases in budgetary costs, is timely. Implementing Lean Methodology in healthcare can enhance the quality of service, process improvement, and improve patient satisfaction. This chapter analyzes the application of lean manufacturing in the healthcare sector: from specific departments of a hospital (emergency, surgery, etc. to the healthcare management of a region. It identifies also the most commonly used lean tools and their benefits in order to achieve sustainable competitive advantages.

Sliding into Your Dms in 1, 2, 3: Instagram-Dating Practices of Filipino Professionals in a Relationship Amidst the Covid-19 Pandemic

This study explores self-reported narratives of Filipino professionals in a relationship (FPR) in terms of their online-dating practices. It examines how romantic alternatives are experienced and expressed through Instagram (IG) My Stories during the quarantine period brought about by the COVID-19 pandemic. Specifically, the present study aims to investigate the reasons and dynamics of IG-dating practices as well as how social media usage impacts romantic alternatives. The study hopes to fill the knowledge gap on the role IG dating plays in the various stages of online-dating practices during the quarantine period. The researchers analysed responses from two semi-structured interviews, six narratives or written responses, and follow-up email interviews with all eight FPR involved in this study. Findings indicate that compared to previous findings, the FPR did not regard being in IG as an important marker of their romantic and emotional relationships as it is merely their coping and surviving mechanism against boredom at the time of quarantining and their way of escaping and diverting their worries about the pandemic;hence, ending a relationship can take place at any stage in the form of "ghosting". Furthermore, IG's main activities such as posting, reacting, replying/ commenting, and chatting can initiate and maintain these romantic alternatives, and the primary motivation of the FPR to engage in IG dating concerns face-/self -presentation and negotiation. Finally, the term "quaranfling" is proposed to describe a phenomenon pertaining to a no-strings-attached flirting during quarantine, which is basically a casual romantic relationship. The current study may be a precursor to further investigations on quaranfling and whether online platforms (e.g., social media and dating apps) can be attributed to the growing number of relationship dilemmas (e.g., cheating and breakups) among modern-day couples not only in the Philippines but also in Asia Pacific.

Lean Healthcare: A Critical Analysis

The current pandemic situation caused by COVID-19, also known as coronavirus, has put the health sector in the spotlight. It has led to the emergence of new plans and strategies that can help society control and stop the spread of COVID-19. These strategies include the Strategic Preparedness and Response Plan, led by the World Health Organization (WHO), which highlights and outlines the public health measures that countries should adopt to prepare for and respond effectively to the spread of the coronavirus. The pandemic is much more than a health crisis. It requires a response, matching the main problems detected in health and emergency centers. Some of them are quick and exponential spread of the disease, a spike in the number of COVID-19 cases, the successive waves, an increase in the number of patients, and insufficient response healthcare capacity. These problems become more important when there is also an economic downturn, which has made it impossible to expand budgeted public spending on healthcare. For this reason, research for alternative methods that can improve the quality of healthcare management, but without generating increases in budgetary costs, is timely. Implementing Lean Methodology in healthcare can enhance the quality of service, process improvement, and improve patient satisfaction. This chapter analyzes the application of lean manufacturing in the healthcare sector: from specific departments of a hospital (emergency, surgery, etc. to the healthcare management of a region. It identifies also the most commonly used lean tools and their benefits in order to achieve sustainable competitive advantages. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Introducing Ethics by Design in Engineering Education: Designing COVID-19 Tracing Apps

Including ethical concepts and considerations in engineering education has attracted significant interest in recent years, mainly due to the impact of some AI applications in different areas of our life. The use of case studies in teaching ethics is a well-known and useful approach. The debate related with a given case study helps students think about the implications, motivations and foreseeable impact of the technologies. This fact is in contrast with the common easy-thinking that technologies are neutral and that an engineer should not bother about ethics and does not have any responsibility at all. While many basic technologies may be considered neutral, more developed and complex systems are not so neutral;they have a motivation and some foreseeable impact and consequences. Thence, the main message is that engineers have a responsibility when developing these systems. This paper presents a case study used in a course for Ph.D. students in a Technical University to introduce the concept of ethics by design and to stress the idea of responsible conduct in engineering. The case under study is the design and development of tracing applications for fighting against the Covid-19 pandemic in 2020. The analysis of the case requires to understand the basic technologies proposed, the different alternatives considered at that time, the basic facts related with the contagion chain and the main factors to be addressed, the consideration of the balance between public health rights and individual privacy rights, and the social aspects related with the acceptability by citizens. © 2022 SEFI 2022 - 50th Annual Conference of the European Society for Engineering Education, Proceedings. All rights reserved.

[Peripheral stimulation of the trigeminal nerve by nasopharyngeal swabbing as a possible trigger of migraine attacks]. / Estimulación periférica del nervio trigémino mediante frotis nasofaríngeo como posible desencadenante de migraña.

INTRODUCTION: The role of the central and peripheral nervous system in the generation of migraine is not well understood. Our aim was to determine whether peripheral trigeminal nerve stimuli, such as nasopharyngeal swabs, could trigger migraine attacks. SUBJECTS AND METHODS: A survey was sent to 658 doctors, nurses and medical students, asking about the presence of headache suggestive of migraine after carrying out a SARS-CoV-2 swab test, their previous history of migraine, and demographic and headache-related characteristics. Those who tested positive or had associated clinical signs and symptoms of COVID were excluded. RESULTS: A total of 377 people were recruited, 309 of whom were included in the sample. Forty-seven (15.2%) reported headache suggestive of migraine after the swab test and 42 (89.4%) of them had a previous history of migraine. The risk of developing migraine was higher in the subgroup of patients with a history of headache suggestive of migraine - odds ratio: 22.6 (95% confidence interval: 8.597-59.397); p < 0.001. No differences were found between the main characteristics of attacks suggestive of migraine before and after the swab test, except for a lower percentage of associated aura afterwards (42.8% vs. 26.1%; p = 0.016). Individuals with previous attacks suggestive of migraine with a frequency of more than two episodes per month had a higher risk of developing a headache suggestive of migraine after the test - odds ratio = 2.353 (95% confidence interval: 1.077-5.145); p = 0.03. CONCLUSIONS: Nasopharyngeal swabbing may trigger migraine attacks, with a greater likelihood in individuals with a higher frequency of previous migraines. This would confirm the idea that peripheral stimuli on the trigeminal nerve can trigger migraine attacks in individuals with migraine, according to their degree of trigeminovascular sensitisation.

TITLE: Estimulación periférica del nervio trigémino mediante frotis nasofaríngeo como posible desencadenante de migraña.Introducción. La implicación del sistema nervioso central y periférico en la generación de la migraña no se conoce bien. Nuestro objetivo fue determinar si estímulos periféricos sobre el nervio trigémino, como el frotis nasofaríngeo, podrían desencadenar ataques de migraña. Sujetos y métodos. Se envió una encuesta a 658 médicos, enfermeras y estudiantes de medicina, preguntando por la presencia de cefalea sugestiva de migraña tras la realización de un frotis para la determinación del SARS-CoV-2, su historia previa de migraña, y sobre características demográficas y relacionadas con la cefalea. Los que tenían resultado positivo o que asociaban sintomatología de COVID fueron excluidos. Resultados. Se reclutó a 377 personas y se incluyó a 309. Cuarenta y siete (15,2%) refirieron cefalea sugestiva de migraña tras la realización del frotis, de las cuales 42 (89,4%) tenían historia previa de migraña. El riesgo de desarrollarla fue mayor en el subgrupo de pacientes con cefalea sugestiva de migraña previa ­razón de probabilidad: 22,6 (intervalo de confianza al 95%: 8,597-59,397); p < 0,001­. No hubo diferencias entre las características principales de los ataques sugestivos de migraña previos y los desencadenados tras la prueba, excepto un porcentaje menor de aura asociada tras el frotis (42,8% frente a 26,1%; p = 0,016). Los individuos con ataques sugestivos de migraña previos con frecuencia superior a dos episodios mensuales presentaron mayor riesgo de desarrollar una cefalea sugestiva de migraña tras el test ­razón de probabilidad = 2,353 (intervalo de confianza al 95%: 1,077-5,145); p = 0,03­. Conclusiones. El frotis nasofaríngeo podría desencadenar ataques de migraña, más probablemente en individuos con mayor frecuencia de migrañas previas. Esto confirmaría que estímulos periféricos sobre el nervio trigémino pueden desencadenar ataques de migraña en individuos con migraña, de acuerdo con su grado de sensibilización trigeminovascular.

Staggered loans: A flexible modality of long-term financing for SMEs in global health emergencies

Context: The context of this paper is the unprecedented global situation which has been and is still experiencing all countries all over the world, due to the pandemic caused by Covid-19 and its variants. Apart from the important problem of health population, all countries are facing a sharp reduction in their main economic indicators: stock indices, GDP (Gross Domestic Product), rates of employment, closing down of businesses, etc. Results: In this paper, we have presented and mathematically analyzed the so-called staggered loans as a useful tool for SMEs to be applied after times of crisis. Moreover, their pros and cons, and the advantages for lenders and borrowers have been highlighted. Specifically, this kind of loan can help solve the problem of the scarce offer of credit due to monetary politics currently addressed to reduce inflation. Policy implications: Taking into account that this economic situation cannot continue for longtime, many countries are thinking about the next stages of the way-out from the crisis in all sectors of affected economies. Purpose: In this research, we seek to provide some information on the characteristics of the so-called staggered loans and the repayment system applied by some microfinance institutions in Latin America. This can help SMEs to obtain the liquidity necessary to reopen and develop their activity. Methods: Methodologically, we have presented risk-based measures able to guarantee the profitability of lenders and control the solvency of lenders and borrowers.

Unraveling the role of calcitonin gene-related peptide b in gastrointestinal disorders: Implications for migraine

Introduction: Calcitonin gene-related peptide (CGRP) a is well-known to be implicated in migraine pathophysiology. Its b isoform, released mainly in the enteric nervous system, has not been as extensively studied. Previous research prompt CGRP has a role in gastrointestinal motility, as well as immune and intestinal blood flow regulation. It is postulated to help peptic ulcer healing, and immune cell migration and regulation in acute gastrointestinal infections. In COVID-19 between 2% and 50% of patients develop diarrhea, and its prevalence increases with the severity of the disease. The pathophysiology of the diarrhea in this infection is not completely clear but CGRP has been proposed to play a role in different aspects of the symptomatology. Inflammatory bowel disease (IBD), known to be associated with migraine, is a chronic gastrointestinal autoimmune disease. Neuropeptides like CGRP might play a role in the complex pathophysiology of the disease, but this has not been well established yet. On the other hand, the most frequent adverse event of new monoclonal antibodies against CGRP for migraine is constipation, which points out that the blockage may affect CGRPbeta release. Objective(s): To assess the role of CGRPbeta in two gastrointestinal disorders: COVID-19 with acute diarrhea;and IBD. Method(s): CGRPbeta were measured by ELISA (CUSABIO, China) in early morning serum samples in patients with IBD at diagnosis, as well as in COVID-19 inpatients experiencing diarrhea. We compared each group with a cohort of healthy controls matched by age and sex. Image: Results: Twenty-six COVID-19 inpatients with diarrhea were included (mean age=62+/-16 years, range 31-91 years;69.2% females) who were matched with 30 healthy controls (mean age=61+/-15 years, range 29-89 years, 66.6% women). Fifty-nine patients with early IBD (mean age 48.9+/-16.4 years, range 21-79 years;62,7% females were matched with 59 healthy controls (mean age 49.0+/-14.9 years, range 23-77 years;62,7% females). While CGRPbeta levels were significantly elevated in COVID-19 patients (6,3+/-2.6 pg/mL) vs controls (4.2+/-2.4 pg/mL) (+26.2%;p<0.01), CGRPbeta levels in patients with IBD were significantly decreased (3.1+/-1.8 pg/mL) as compared to controls (4.8+/-2.6 pg/mL) (-35.4%, p<0.001). Conclusion(s): CGRPbeta seems to exert different actions depending on the underlying conditions. While its increase with diarrhea in COVID-19 patients fits very well with the known acute effects of increase gastrointestinal motility in CGRP infusion in volunteers, the decrease in CGRPbeta levels in IBD confirm a protective role of this peptide in the homeostasis of the intestinal mucosa. These findings may help to explain the role of CGRPbeta in digestive manifestations of migraine and in the constipation seen in migraine patients on CGRP antibodies as well.

Comparison of Outcomes of Covid-19 Between Fully Vaccinated and Unvaccinated Kidney Transplant Recipients and According to the Type of M-RNA Vaccine

Purpose: The evidence regarding the clinical effectiveness of COVID-19 vaccination in kidney transplant (KT) recipients is limited so far. Our purpose is to analyze the characteristics and outcomes of a large series of KT with COVID-19 breakthrough infection and compare them with unvaccinated patients. As a secondary objective, we analyzed the evolution according to the type of mRNA vaccine administered. Method(s): From April to October 2021, KT recipients with COVID-19, included in the COVID-19 registry of the Spanish Society of Nephrology, were analyzed. Data regarding vaccination status and type of vaccine were collected and outcomes of unvaccinated or partially vaccinated patients were compared with fully vaccinated patients. Result(s): Clinical picture was similar and survival analysis showed no differences between groups: 21.7% of fully vaccinated patients and 20.8% of unvaccinated or partially vaccinated died (p=.776). In multivariable analysis age and pneumonia were independent risk factors for death, while vaccination status was not related to mortality. These results remained similar when we excluded patients with partial vaccination as well as when we analyzed exclusively hospitalized patients. Patients vaccinated with mRNA-1273 (Moderna) (n=213) showed a significantly lower mortality than those who received BNT162b2 (Pfizer-BioNTech) vaccine (n=121) (16.4% vs. 28.8%, p=.002) (HR: 0.52, CI 95% 0.31-0.85, p=.010). Conclusion(s): COVID-19 severity in KT patients has remained high and has not improved despite receiving 2 doses of an mRNA vaccine, but the mRNA-1273 vaccine shows higher clinical effectiveness than BNT162b2 in KT recipients with breakthrough infection, so it could be considered as the first option in these patients.

COVID-19 and the role of medical professional societies

Responding to the coronavirus disease 2019 pandemic has helped craft a global medical community of medical professional society members and nonmembers alike in ways previously unanticipated. The public-facing elements of medical professional societies include their websites, official organs, and educational elements that have been liberated using a Free Open-Access Medical education approach. Work products including guidelines, blogs, and social media offerings have helped clinicians to prepare for pandemic care or refine existing practices to support outcome excellence. Often, that guidance has flowed from collaborations between medical professional organizations, some of which are novel and might not have occurred outside of a dire global need. Leaders of such organizations have been catapulted into the spotlight by the universal need for information and guidance—including that of one’s home government—and appeared quite regularly in print and digital media as well as live radio broadcasts. Finally, the need to pursue remote medical professional organization work as well as education has developed member and nonmember facilities with a host of digital platforms. Such skill sets have also helped to maintain communication between clinicians and patient's remote family members to support patient- and family-centered care while maintaining shared decision making. The flexibility and innovation that characterize medical professional organizations have been highlighted by the realities of providing pandemic care. © 2022 Elsevier Inc. All rights reserved.

COVID-19 INFECTION AFTER KIDNEY TRANSPLANTATION IN SPAIN: COMPARABLE IMPACT THROUGHOUT SIX EPIDEMIC WAVES

BACKGROUND AND AIMS: The successive COVID-19 epidemic waves have significantly influenced kidney transplantation (KT) programs. Contact protection together with vaccination are the principal protective tools for KT recipients. We reviewed the impact of COVID-19 infection in KT recipients throughout the different epidemic waves. METHOD: Of 900 active KT recipients in our program, 160 (17.8%) have suffered COVID-19 infection during the six epidemic waves: first (March-August 2020), second (September-December2020), third (January-March 2021), fourth (April-May 2021), fifth (June-September 2021) and sixth (October-December 2021, preliminary data). We compared the clinical evolution and the impact of vaccination. RESULTS: Infected KT recipients were younger in the third and fourth waves (P < 0.001). We observed a higher percentage of pneumonia and hospital admission in the first and fifth waves (P = 0.045, P = 0.016) (Table 1), without differences in ICU admission, and with the disappearance of asymptomatic cases after the third wave. The highest mortality was observed in KT recipients >65 years old infected within the first 6 months after KT (P = 0.006) and overall mortality was higher in the first wave (P = 0.033). Mortality in hospitalized KT recipients and those admitted in the ICU were similar along the 5 waves, without clear impact of vaccination (P = 0.251). On the 5 January 2022, we have already accumulated an incidence of COVID in KT of 3.1% (sixth wave, 77% with booster vaccination), similar to the first wave (3.8%), with 12.5% mortality, similar to second, third and fifth waves, in patients with outcome (53.3%). CONCLUSION: The incidence of COVID-19 in KT recipients has been high in all the waves of the pandemic in Spain. Global mortality has diminished after the first wave, and the time until outcome has increased. The highest mortality occurs in the subgroup of old KT recipients early after KT. Vaccination has not significantly reduced the mortality in KT with Covid who require hospital or ICU admission. (Table Presented).

Glossophobia in postgraduate degrees. Online public speaking in times of Covid-19

This study focuses on the fear of public speaking, or glossophobia, among postgraduate students in Spain. The main objective is to evaluate the levels of glossophobia in this group, with special attention paid to online public speaking. COVID-19 has forced the online performance of multiple academic activities, including the defence of Master's Theses (MT). A mixed research method (qualitative-quantitative) has been employed by means of a survey (500 responses) of the student body conducted at the time of presentation of their MT (June-July 2020). Fifteen experts had previously validated the questionnaire. The resulting Cronbach's coefficient alpha, which measures its reliability, was 0.82. The main result is that the vast majority of the group is aware of their oratorical weakness. Almost all show interest in improving this competence and consider that presenting the MT has been the greatest speaking challenge in their lives. Among the main conclusions, the need to introduce specific training in public speaking in the students' curriculum stands out. It should be included in the curriculum of postgraduate programs, regardless of their specialty, with particular emphasis on online interactions. Glossophobia has been shown to be transversal and affects all types of students. The proposal made herein is currently non-existent in Spain.

A uniquely violent year: The impact of social and political events on 2020 urban injury patterns

INTRODUCTION/HYPOTHESIS: 2020 was marked by social and political events that substantially disrupted healthcare. The COVID-19 pandemic, lockdown, public health measures, as well as civic and political unrest over racial tensions during an election year could plausibly impact injury care. We hypothesized that increased injuries related to high-risk activities during 2020 was temporally related to sociopolitical unrest and pandemic public health measures. METHODS: Retrospective data from two Level 1 urban, adult trauma centers in different US states (City A population:1.6M, City B:0.21M) were assessed (1/1/2020- 12/31/2020). Calendar months were divided into quartiles and compared to analogous quartiles in years 2016 -2019. Variables studied (demographics, injury mechanisms and outcomes) were compared between years, and across 2020 quartiles, against a backdrop of key sociopolitical events. RESULTS: More patients presented for injury in 2020 (A: n=1057, B: n= 1053) than in prior years (p< 0.05). Compared to 2016-2019, 2020, patients were more often black (A:63.1% vs. 69.8% p< 0.001;B:31.0% vs. 34.3%, p=0.02). Institution A patients were more likely to be male (p=0.002) & younger (p< 0.001) in 2020 vs. 2016-2019. Both institutions noted a steep rise in gunshot wound (GSW) and motor vehicle collision (MVC) injuries following state lockdowns (Fig A, B) with a persistent rise in GSWs until late fall (Fig C). CONCLUSIONS: 2020 was a unique year of sociopolitical unrest interwoven with a pandemic. Most affected populations were young, black males in two different urban centers and primarily involved GSWs and MVCs. Future disaster response planning should consider the drivers of these trends to mitigate their impact, especially in vulnerable populations.

Caseload and cardiopulmonary arrest management by an out-of-hospital emergency service during the COVID-19 pandemic

Objective. To describe the effect of the coronavirus disease 2019 (COVID-19) pandemic on the initiation of cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiopulmonary arrest. To compare the cardiopulmonary arrest caseload during the pandemic to the caseloads in other periods. Methods. Observational, prospective study based on the registry of out-of-hospital cardiopulmonary arrest emergencies the SUMMA112 ambulance service responded to between March 1 and April 30, 2020, in the Spanish autonomous community of Madrid. The registry is a Utstein-style database. The period of March April 2019 was the control period for direct comparison with the 2020 study period and with the January February periods of 2019 and 2020. Results. The responders undertook advanced CPR in 146 of the 313 cardiopulmonary arrest cases registered during March-April, 2020. Of the 87 patients with COVID-19 positive tests, 33 reached the hospital alive. Advanced CPR was not applied in 167 cases;the most frequent reason was prolonged circulatory collapse. Most cases (92.7%) occurred in the home. The emergency dispatchers received more calls in March and April of 2020, but they sent out a similar number of ambulances. Conclusions. Mortality was higher in cases of cardiopulmonary arrest during the COVID-19 pandemic. The percentage of cases with no application of advanced CPR rose;the main reason was the amount of time between collapse and first response. Even though the number of emergency calls increased significantly, the SUMMA112 service did not dispatch more ambulances.

Serological response to SARS-CoV-2 vaccination in multiple sclerosis patient in a real-life experience

Introduction: Vaccination against COVID-19 has been widely recommended for patients with multiple sclerosis (MS), although the effect of different disease-modifying treatments (DMTs) on said immunization is not well known. Some studies begin to point out a relationship between DMTs of greater efficacy with a lower rate of seroprotection. Objectives: To assess serological response to SARS-CoV-2 vaccination in MS patients receiving disease-modifying treatments (DMTs) in a real-life setting. Methods: Anti-spike protein-based serology was measured in 191 patients with MS and 6 patients with neuromyelitis optica spectrum disorder (NMOSD). Patients were either untreated or under treatment with different DMTs. A group of healthy subjects similarly vaccinated served as control. The percent of subjects that developed protective antibodies, the antibody-titer, and lymphocyte counts were evaluated. Results: Patients and controls were vaccinated with different available vaccines: BNT162b2 (68.6%), mRNA-1273 (5.4%), ChAdOx1-S (20.7%) and Ad26COVS1 (4.3%). Protective serological response was observed in 100% of controls, NMOSD, untreated (n=19), Interferon-beta (n=17), Glatiramer-acetate (n=15), Cladribine (n=11), Dimethyl-fumarate (n=15), Teriflunomide (n=29) and Natalizumab (n=25) patients. 100% was also observed in Alemtuzumab (n=11) patients but none received treatment dose in last year. Serological response was observed in 42%, 44% and 0% of Fingolimod (n=12), Ocrelizumab (n=26) and Rituximab (n=6) patients respectively. Time from the last dosing was related to serological response in anti-CD-20 therapies;age, disease duration, disease phenotype, vaccine used, or lymphocyte counts did not affect humoral response to COVID-19 vaccination. Conclusions: Anti-CD20 therapies and Fingolimod seem to condition a lower humoral response to vaccines against SARS-CoV-2. Vaccination prior initiation of these DMTs medication administration would be recommendable whenever possible.

Predictors of severe COVID-19 in kidney transplant recipients in the first and second waves: Analysis of the spanish registry

Purpose: To better know the impact and characteristics of Covid-19 in renal patients, the Spanish Society of Nephrology set up a voluntary registry in March, 2020 Methods: Retrospective observational study of KT recipients included in the Spanish Covid-19 Registry (1st March to 14th November, 2020). We applied Cox multivariate analysis to identify risk factors for mortality and Kaplan-Meier and log rank survival analysis. Results: 1080 KT with Covid-19 were registered, having 937 (86.1%) their outcome reported (cure or death). Most were men (63.2%), mean age 60 years infected a median of 72 months postransplantation. Death occurred in 204 patients. Multivariate analysis found age, neumonia and KT within the last 6 months before Covid-19 were risk factors for mortality and gastrointestinal symptoms were protective. Survival analysis showed significant increasing mortality risk in four subgroups: age<65 years&postransplant time> 6mo (n=526), age<65×<6mo (n=49), age>65× >6mo (n=325) and age>65×<6mo (n=31)($$graphic). Of 1080 cases, 605 correspond to the first wave (1stW until June2020) and 475 to the second wave (2ndW). In the 2ndW, KT were younger (56.4 vs 61.1yr;p=.000), 15.8% were asymptomatic (p=.000) and presented less pneumonia (50.3% vs. 78%;p=.000). Fever, lymphopenia and respiratory symptoms were less frequent but gastrointestinal symptoms similar (30.9% vs. 34.2%;p=.256). Treatment has changed, with more use of remdesivir (p=.000) and steroids (p=.018), no use of ritonavir/lopinavir, hidroxycloroquine andazitromycin (p=.000), and no treatment in (37.1% vs 6.3% in 1stW, p=.000). Hospitalization decreased (89.2% vs. 63.2%;p=.000) but more KT were admitted to critical care units (14.5% vs 20%;p=.058). We found lower mortality (overall 26.4% vs 14.8%;p=.000, hospitalized 29% vs 23%;p=.088). Multivariate analysis of the 2ndW shows again that age, pneumonia and recent transplant (< 6 months) are mortality risk factors. Conclusions: Over a thousand KT have suffered Covid-19 in Spain with a high mortality rate in the first and second waves, mainly related with age, pneumonia and recent transplantation. The interaction between age and time after transplant has to be considered when selecting recipients in the Covid-19 pandemic.

Male sex is associated with in-hospital death in non-dialysis CKD patients with COVID-19

BACKGROUND AND AIMS: Coronavirus disease (COVID-19), caused by Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) can lead to significant organ injury. CKD has been associated with increased mortality in previous epidemics, and male sex has been correlated with worse outcomes during COVID-19 in the general population. Our aim was to describe the differential effect of sex as a risk factor for in-hospital mortality among non-dialysis CKD subjects. METHOD: Multicenter, observational cohort study including 136 adult patients with CKD and 136 age- and sex-matched controls who required admission for COVID-19 in three academic hospitals in Spain. Viral infection was confirmed by real-time RTqPCR and/or serologic testing in all cases. Disease severity on admission was classified according to the WHO-China Joint Mission Report on COVID-19. The presence of CKD was defined as sustained eGFR <60 and >15 ml/min/1.73m2 within the 6 months prior to COVID-19 hospitalization. Demographic and clinical data were gathered from medical records. Outcomes were recorded during the following 28 days after admission. We applied Cox proportional hazards models, adjusted for age, sex, hypertension, diabetes and severe or critical disease at presentation. RESULTS: Due to the matched design, no differences were found regarding age and sex between cohorts. CKD patients suffered more frequently from hypertension and diabetes and presented higher 28-day mortality after hospital admission due to COVID-19 compared with age- and sex-matched controls (40.4 vs. 24.3%;P=0.004). In adjusted Cox regression analysis among CKD patients, only age (HR: 1.087, 95% CI: 1.047-1.128) and male sex (HR: 1.883, 95% CI: 1.045-3.391) were independent predictors of 28-day mortality. Comparatively, among patients without CKD, only age acted as an independent predictor for 28-day mortality (HR: 1.082, 95% CI: 1.033- 1.133). None of the variables included in adjusted regression was able to predict ICU admission in any of the cohorts. CONCLUSION: Male sex is associated with increased mortality, but not with ICU admission, after hospitalization due to COVID-19 among non-dialysis CKD patients. That effect was not observed among hospitalized controls without CKD.

1st Post-European Headache Federation Meeting: a review of the latest developments presented at the 2020 European Headache Federation Congress. / I Reunión Post-European Headache Federation: revisión de las novedades presentadas en el Congreso de la European Headache Federation de 2020.

INTRODUCTION: After the European Headache Federation (EHF) Congress, renowned Spanish neurologists specialised in migraine presented the most significant latest developments in research in this field at the Post-EHF Meeting. DEVELOPMENT: The main data presented concerning the treatment of chronic and episodic migraine were addressed, with attention paid more specifically to those related to preventive treatments and real-life experience in the management of the disease. An important review was carried out of the new therapeutic targets and the possibilities they offer in terms of understanding the pathophysiology of migraine and its treatment. An update was also presented of the latest developments in the treatment of migraine with fremanezumab, a monoclonal antibody recently authorised by the European Medicines Agency. Participants were also given an update on the latest developments in basic research on the pathology, as well as an overview of the symptoms of migraine and COVID-19. Finally, the repercussions of migraine in terms of its burden on the care and economic resources of the health system were addressed, along with its impact on society. CONCLUSIONS: The meeting summarised the content presented at the 14th EHF Congress, which took place in late June/early July 2020.

TITLE: I Reunión Post-European Headache Federation: revisión de las novedades presentadas en el Congreso de la European Headache Federation de 2020.Introducción. Tras la celebración del congreso de la European Headache Federation (EHF), reconocidos neurólogos españoles expertos en el tratamiento de la migraña expusieron en la Reunión Post-EHF las principales novedades presentadas en el congreso y relacionadas con ese ámbito. Desarrollo. Se abordan los principales datos presentados relacionados con el tratamiento de la migraña crónica y episódica; concretamente, los relacionados con los tratamientos preventivos y la experiencia en vida real en el manejo de la enfermedad. Se hizo una importante revisión de las nuevas dianas terapéuticas y las posibilidades que ofrecen en cuanto al conocimiento de la fisiopatología de la migraña y su tratamiento. Asimismo, se hizo una actualización de las novedades presentadas en el tratamiento de la migraña con fremanezumab, anticuerpo monoclonal recientemente autorizado por la Agencia Europea de Medicamentos. Se hizo una actualización de las novedades en investigación básica en la patología, así como una relación de los síntomas de migraña y COVID-19. Finalmente, se abordaron las implicaciones de la migraña en la carga sanitaria asistencial y económica, y su impacto en la sociedad. Conclusiones. En la reunión se hizo un resumen del contenido presentado en el 14 Congreso de la EHF, que tuvo lugar a finales de junio y principios de julio de 2020.

Supression of ACE2 function and antiviral immune response by SARS-CoV-2 infection

Background: SARS-CoV-2 receptor angiontensin-conveting-enzyme 2 (ACE2) is also a protective factor that contributes to reduce inflammation and fibrosis in tissues. An active form of ACE2 can be released from the cell surface by host proteases ADAM17 and TMPRSS2, being the latter also necessary for viral entry. Due to its properties, the administration of soluble recombinant ACE2 has been proposed as a SARS-CoV-2 treatment. Here, we assess the role of ACE2 activity and antiviral immune response at the site of infection in nasopharyngeal swabs of SARS-CoV-2 patients, to unravel its effect on inflammation cascade and infection outcome. Methods: Soluble enzymatic activity of ACE2 was measured in nasopharyngeal swabs at the time of PCR positivity (mean time from symptom=4d) and 3 days after in a cohort of mild SARS-CoV-2 patients (n=40, mean age=42y) and in uninfected controls. Gene expression profiles of ACE2, its proteases, ADAM17 and TMPRRS2, and interferon-stimulated genes (ISGs), DDX58, CXCL10 and IL-6 were also evaluated by RT-qPCR. Results: Both ACE2 activity and mRNA expression decreased significantly during infection course in paired samples of SARS-CoV-2 infected subjects (p=0.048 and p<0.001, respectively), although differences between infected and uninfected subjects were only seen at mRNA level (p<0.001) Importantly, both ACE2 activity and mRNA expression showed a positive correlation with viral load (rho=0.352, p-value=0.0259), suggesting that viral infection is influencing ACE2 function. Similarly, infection downregulates TMPRSS2 expression (pvalue< 0.01), but not ADAM17, further indicating the viral-induced regulation of host receptors. In contrast to ACE2 data, a clear induction of IFN stimulated genes, CXCL10, IL-6 and DDX58 (RIG-I), is observed upon infection (p-value<0.05 in all cases), demonstrating that SARS-CoV-2 induces an antiviral response and suggesting that ACE2 is not an ISG. This increased expression of ISGs is directly linked to viral load (rho=0.6177, p-value<0.0001;rho=0.4026, p-value=0.0110;rho=0.3024, p-value=0.0613, respectively) but it is rapidly reversed during infection course. Conclusion: Overall, our results demonstrate the existence of mechanisms by which SARS-CoV-2 suppress ACE2 expression and function, intracellular viral detection and subsequent ISG induction, offering new insights into ACE2 dynamics and inflammatory response in the human upper respiratory tract that may contribute to understand the early antiviral host response to SARS-CoV-2 infection.