Social Rights and the European Monetary Union

This thought-provoking book examines the state of the European Monetary Union (EMU) and its shortcomings in terms of social rights protection in the context of the COVID-19 pandemic and the aftermath of the Euro crisis. Providing a critical analysis of the basic tenets of European economic governance, it highlights current challenges for a Social Europe and proposes new avenues for tackling these issues. Focusing on the existing mechanisms of social rights protection in the EU, chapters explore the imbalance between economic and social goals within the EMU, discussing how to strengthen the building blocks of Social Europe in order to address this. The book also investigates the challenges for the adjudication of social rights before European and domestic courts, and considers alternative models of judicial review that offer better protection in the context of crisis. Scholars and students of EU law, constitutional law, and public international law will find this book a crucial read, in particular those with an interest in law and economics. It will also be useful for EU law practitioners working in social rights. © The Editors and Contributors Severally 2022. All rights reserved.

SARS-CoV-2 infection and solid organ transplantation.

Transplantation has become a valid therapeutic option for an increasing number of patients with end-stage organ disease. The emergence of SARS-CoV-2 coronavirus infection and associated disease (COVID-19) has alarmed the transplant community, since recommendations for adequate follow-up of organ transplant recipients during the acute phase of a pandemic are limited. Furthermore, treatment options against COVID-19 disease and adequate adjustment of immunosuppression in at risk patients remain a concern. This review summarizes current knowledge on the incidence and clinical course of SARS-CoV-2 infection in patients with solid organ transplantation. It also discusses therapeutic strategies and provides general recommendations on how to proceed with transplantation programs in a time when health care resources may become scarce.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.

Objective structured clinical examination (OSCE) during the COVID-19 pandemic

Introduction: Objective Structured Clinical Examination (OSCE) allows simulation of the interaction between the pharmacist (or the pharmacy student) and the patient in a community pharmacy or at a hospital setting. Hence, OSCE is nowadays considered the gold-standard for competency-based assessments in clinical disciplines such as Pharmacy. As a result of the pandemic situation, conventional face to face OSCE presents with challenges related to health and safety. Accordingly, alternative clinical competence assessments with similar objectives and standards for pharmacy students were designed. Method(s): OSCE was conducted during the academic year 2020-21 for fifth-year students after the completion of six months of practical rotations. Students completed an exam with five stations consisting of two face-to-face stations with simulated standardised patients and three online stations developed through the online learning platform Blackboard, each one with a duration of five minutes. The stations tested student knowledge, patient counselling and communication and acquisition of technical and/or clinical skills. Result(s): A total of 49 fifth-year students and ten examiners were involved in this OSCE hybrid format. The analysis of results showed that the best average grade was obtained at live stations. Comparing the results with previous conventional OSCEs (before pandemic) shows higher average grades for the hybrid OSCE celebrated in 2020-21. Amongst the participants in the hybrid OSCE, 33% of them preferred the online stations. Conclusion(s): During the COVID-19 pandemic, online stations have been implemented in OSCE as an opportunity to assess clinical skills in pharmacy students. The online version was effective for evaluating knowledge. However, there were limitations in the assessment of some specific skills such as communication.

Knowledge and dietary habits about omega 3 and 6 in university students from Ecuador and Peru, during COVID-19

Introduction: Confinement has adverse psycho-social as well as dietary repercussions. During the pandemic there was a higher consumption of processed and canned foods, in-creasing the consumption of omega 6 (co-6) and probably de-creasing the consumption of omega 3 (co-3).Objective: To determine the relationship between knowl-edge and dietary habits about omega 3 and 6 in university students from Ecuador and Peru during COVID-19.Methods: Descriptive, cross-sectional study, carried out in 134 Ecuadorian and 215 Peruvian students. Data were obtained from a virtual questionnaire with questions on knowledge and dietary habits about ca-3 and ca-6. Spearman's Rho, Mann Whitney U and Kruskall Wallis statistical tests were performed.Results: A correlation coefficient of knowledge and eating habits on ca-3 and ca-6, Rho=0.146 (p=0.092) and Rho=0.081 (p=0.235) was obtained for the samples from Ecuador and Peru, respectively. In Ecuadorian students, there were differences in the levels of knowledge about ca-3 and ca -6, both in males and females (p=0.007). In both countries there are different levels of knowledge in the different spe-cialties of the study (p=0.004).Conclusion: There is no correlation between knowledge and eating habits about ca-3 and ca-6 in university students of Health Sciences in both countries. Students from Ecuador present insufficient knowledge and inadequate dietary habits about ca-3 and ca-6, more than Peru.

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.

Who Benefits More of Durvalumab after Chemoradiotherapy (CRT) in Real-World Patients with Locally Advanced Non-Small-Cell Lung Cancer (NSCLC)?

Introduction: Durvalumab received EMA approval as consolidation therapy (CT) for unresectable stage III NSCLC with PD-L1 ≥1% and who did not have progression after CRT. Our objective was to analyze in real clinical practice the effectiveness of durvalumab and explore the clinical factors that may be associated with the benefit from CT. Methods: Retrospective study was made at Hospital of Leon (Spain), including 37 patients with locally advanced NSCLC treated with durvalumab after CRT treatment between March 2018 and october 2021 (40.5% patients were included in the durvalumab early access program). The neutrophil-to-lymphocyte ratio (NLR) could identified after CRT as a factor that may be benefit from durvalumab. Results: Median age was 67 years (range 46-82 years). 40.5% of patients were ≥70 years old. 78.4% were male and 51.4% smokers. 54% had non-squamous histology. PD-L1 expression was <1% in 5% and not available in 8% patients. 2.7% ROS1 rearrangements, 5.4% KRAS mutations and not available in 43.2% patients. Stage IIIA, IIIB, IIIC disease were 24.3%, 54.1% and 21.6%, respectively. Median time from end of CRT to onset durvalumab was 44 days (range 13-120 days). Overall median CT duration was 214.8 days (range 69-399 days) with a median of 14 infusions (range 6-27 infusions). With a median follow up of 19.7 months (range 1.4-34.9 months);67.6% had stopped CT: 37.8% due to completing treatment, 16.2% disease progression, 10.8% adverse event and 2.7% due to COVID19 infection. Median real-world progression-free survival (rwPFS) was 17 months (95% CI, 11-23). Median real-world overall survival (rwOS) was 29.9 months (95% CI, 23.3-36.6). %rwOS at 6, 18 and 24 months were 100%, 86.9% and 74.5%, respectively. For patients with post-CRT NLR not exceeding the cohort median value of 6, receipt of durvalumab was associated with an improvement in rwOS (median not reached vs 25.7 months;p=0.025). 56.8% patients had any grade of radiation pneumonitis (median time from CRT start: 119 days [range 36-241 days]). Of these, 19% patients developed worsening of radiation pneumonitis with durvalumab. 54,1% developed immune-mediated toxicity, mostly G1-2 (85.1%). Conclusions: Our results demonstrate the effectiveness of durvalumab consolidation in this patients population in a real-life setting. We identified low NLR after CRT as a potentially predictive factor for the benefit of CT in locally advanced NSCLC. Keywords: DURVALUMAB, PACIFIC, REAL WORLD DATA

USEFULNESS of AN ELECTRONIC CONSULTATION SYSTEM between PRIMARY CARE HEALTH CENTERS and RHEUMATOLOGY DEPARTMENT of A TERTIARY HOSPITAL

Background: The EPISER study is the frst Spanish epidemiological study that has confrmed the great burden of rheumatic diseases in the general population: they consume a large quantity of health resources (doctor visits, medical products) and imply a high social impact in terms of work absenteeism. Rheumatic diseases represent almost 30% of Primary Care medical consultations in Spain1,2. Electronic consultation could be an alternative response to the increase of this demand, both to make an early diagnosis and derivation and to improve communication with Primary Care physicians3,4. Objectives: To analyze the demand of Primary Care and its resolution through the electronic consultation system of the Rheumatology Department of a tertiary hospital. Methods: Retrospective descriptive study of the data collected in the request and information system (Sistema de Peticiones Electrónicas, SIPE) that supports electronic consultation between primary care physicians of the health area and the Rheumatology Department of a tertiary hospital, between July 2020 and May 2021.The following variables were collected: age, sex, reason for consultation, response time in days and destination (primary care/outpatient follow-up). Descriptive statistics were used to present the results. Results: The last 500 consecutive electronic consultations registered in the system, referring to 496 patients, were collected. Mean age was 59.5±17.7 years;74.2% women. Mean response time was 2 days, median response time 1 day and range 0-45. The reasons for consultation (see Graph 1) were: osteoporosis assessment 55 (11%), treatment adjustment 50 (10%), appointment request 49 (9.8%), loss to follow-up 43 (8.6%), local-regional pathology assessment 39 (7.8%), infltration request 28 (5, 6%), suspected rheumatoid arthritis 19 (3.8%), fare 18 (3.6%), suspected polymyalgia rheumatica or giant cell arteri-tis 16 (3.2%), COVID vaccine consultation 14 (2.8%), Raynaud's phenomenon 13 (2.6%), monoarthritis assessment 12 (2.4%), assessment of polyarthritis 11 (2.2%), adverse effects of treatment 11 (2.2%), suspected spondyloarthritis 11 (2.2%), suspected psoriatic arthritis 8 (1, 6%), generalized pain 7 (1.4%), suspected Sjögren's syndrome 5 (1%), suspected systemic lupus erythematosus 1 (0.2%), suspected other systemic autoimmune diseases 9 (1.8%), others 81 (16.2%). Fifty-seven and four % (287) of the patients required an appointment at the Rheumatology outpatient clinic and in 42.6% of the patients (213) the electronic consultation was successful, so it was not necessary to refer the patient to the hospital. Conclusion: Forty-two and six percent of the queries were resolved thanks to the electronic consultation system in an average of two days, otherwise that patients would have been referred to specialized care. The main reasons for consultation were osteoporosis assessment and clarifcation of doubts about the treatment of patients who were already being followed up by the Rheumatology Department.

The environment and influence on adolescence: Family, friends, school, university and the media

If there is a stage in life where the environment is decisive, this is undoubtedly adolescence. During childhood, the link with the reference person is created, laying the foundations of personality, and incorporating the tools to function afterwards. When adolescence arrives, the necessary “distance” from the family takes place, and the opinion and acceptance within the friend group becomes important. The adolescent’s self-perception and the way he/she relates with others will largely depend on these relationships. For adolescents and young people, school and university are the institutions where the knowledge taught is valued above other areas (such as family, networks or the Internet). Education equates all students, providing them with the training to later face the job market. Currently, we are facing the generation of digital media, who were born immersed in information and communication technologies (ICTs). Accessibility to a multitude of content, immediacy, relationships through networks, online games, etc, pose risks and opportunities. This article analyzes how the environment conditions the experience of the adolescent. Mention is made of the influence that the current pandemic situation due to SARS-CoV-2 is having.

El entorno y la influencia en la adolescencia: familia, amigos, escuela, universidad y medios de comunicación

If there is a stage in life where the environment is decisive, this is undoubtedly adolescence. During childhood, the link with the reference person is created, laying the foundations of personality, and incorporating the tools to function afterwards. When adolescence arrives, the necessary “distance” from the family takes place, and the opinion and acceptance within the friend group becomes important. The adolescent’s self-perception and the way he/she relates with others will largely depend on these relationships. For adolescents and young people, school and university are the institutions where the knowledge taught is valued above other areas (such as family, networks or the Internet). Education equates all students, providing them with the training to later face the job market. Currently, we are facing the generation of digital media, who were born immersed in information and communication technologies (ICTs). Accessibility to a multitude of content, immediacy, relationships through networks, online games, etc, pose risks and opportunities. This article analyzes how the environment conditions the experience of the adolescent. Mention is made of the influence that the current pandemic situation due to SARS-CoV-2 is having. © 2022, Ediciones Ergon SA. All rights reserved.

Partial breast irradiation with IORT using Xoft®. Experience at Catalan Institute of Oncology

Purpose or Objective external beam whole breast irradiation (WBI) for low-risk early-stage breast cancer patients after breast conserving surgery. We present the experience at our center treating patients with PBI using an IORT technic with Xoft® Axxent® Electronic Brachytherapy (eBx®) System®. Materials and Methods Between April 2019 and August 2021, 44 patients diagnosed with low-risk early-stage breast cancer who met international criteria for PBI, received IORT in a single fraction of 20 Gy to the tumor bed after lumpectomy. Toxicities and follow up were prospectively registered. Results 3 of the 44 initial patients were discarded for IORT due to non-compliance with the minimum safety distance (<1 cm) between the applicator and the skin. Of the remaining patients, 32/41 patients (78%) received a PBI, while 9/41 (22%) required adjuvant WBI due to adverse prognostic factors identified on the definitive biopsy. The most frequent risk factor was close resection margins (<2mm), present in 8/9 patients (88,8%). Two patients additionally presented sentinel node involvement and in 1 case no axillary sample was obtained. The most used IORT applicator was the 3-4 cm balloon, with most likely filling volumes between 30cc and 40 cc. For all treatments, the mean filling volume of the applicator was 45 cc and there were no complications during the irradiation procedure. Surgical bed seroma was the most common acute effect, observed in 29/41 patients (70,7%), although only 8/29 (27,5%) required drainage. We observed wound dehiscence in 7/41 cases (17%), inflammatory complications requiring antibiotics in 9/41 cases (19,5%), and 4/41 cases of hematoma (9,7%). Regarding late toxicity, at the time of the analysis it was only assessable for 37 patients. We observed low rates of local grade I fibrosis (21,6%) and only 1 case of tumor bed G2 fibrosis. Hyperpigmentation G1 was observed in 8,1% of patients and 10,8% presented occasional mild local discomfort. With median follow-up of 17.14 months (range 4-29 months), no relapses were observed, but 1 patient died from covid-19 pneumonia. Conclusion Intra operative PBI with Xoft® Axxent® Electronic Brachytherapy (eBx®) System® is a feasible approach to treat low-risk early-stage breast cancer patients. Our preliminary results show that it presents advantages over conventional WBI allowing for less toxic and shortened treatment courses while maintaining good local tumor control.

TREATMENTS for MIS-C in CHILDREN-DISCHARGE, FEVER and SECOND-LINE THERAPIES

Background: We aimed to analyse the effects of steroids, intravenous immunoglobulin (IVIG), and their combination on the probability of discharge over time, probability of switching to second-line treatment over time, and persistent fever after 2 days of treatment. Methods: We did a retrospective study to investigate the effect of treatments (IVIG plus steroids, steroids alone or IVIG alone) of children with MIS-C in a nationwide study, from 1 March to 1 June 2021. We used a Markovian multi-state model with the clock-forward approach and unidirectional arrows to build a multi-state model. Three transitions were defined: initiation of treatment to hospital discharge (t1), initiation of treatment to second-line therapy (t2), and second-line therapy to hospital discharge (t3). A treatment was considered as second-line if initiated >2 days after the first therapy. We estimated the time-to-event probability using a Cox model weighted by the propensity score to balance the baseline characteristics. Results: 30/132 (22.7%) patients were initially treated with steroids alone, 29/132 (21.9%) with IVIG alone, and 73/132 (55%) with IVIG plus steroids. The probability of early discharge was higher with IVIG than with IVIG plus steroids (hazard ratio [HR] 1.65, 95% CI 1.11-2.45, p=0.013), but with a higher probability of needing second-line therapy versus IVIG plus steroids (HR 3.05, 95% CI 1.12-8.25, p=0.028). Patients on steroids had a lower probability of persistent fever after 2 days of treatment (odds ratio [OR] 0.55, 95% CI, 0.28-1.05, p=0.081) versus patients on IVIG plus steroids, and those on the combination had with a lower probability versus IVIG alone (OR 0.21, 95% CI, 0.09-0.46, p=0.0001). We also directly compared the IVig-and steroid-alone treatments. The probability of early discharge of the patients on steroids and on IVig were not different (HR 0·58, 95% CI 0·27-1·24, p=0·166). The probability of transition second-line therapy was also similar (HR 0·71, 95% CI 0·29-1·74, p=0·456). IVIG had a 4-fold higher probability of persistent fever after treatment initiation than steroids (OR 4·23 95% CI 1·43-13·5, p=0·011). Conclusion: IVIG seemed to increase the probability of discharge over time but increased the probability of needing second-line treatment over time. Steroids seemed to reduce persistent fever after 2 days of treatment, and combination therapy reduced the need for escalating treatment.

SARS-CoV-2 infection and solid organ transplantation

Transplantation has become a valid therapeutic option for an increasing number of patients with end-stage organ disease. The emergence of SARS-CoV-2 coronavirus infection and associated disease (COVID-19) has alarmed the transplant community, since recommendations for adequate follow-up of organ transplant recipients during the acute phase of a pandemic are limited. Furthermore, treatment options against COVID-19 disease and adequate adjustment of immunosuppression in at risk patients remain a concern. This review summarizes current knowledge on the incidence and clinical course of SARS-CoV-2 infection in patients with solid organ transplantation. It also discusses therapeutic strategies and provides general recommendations on how to proceed with transplantation programs in a time when health care resources may become scarce.

Socially Distanced: Have user evaluation methods for Immersive Technologies changed during the COVID-19 pandemic?

Since the emergence of COVID-19 in late 2019, there has been a significant disturbance in human-to-human interaction that has changed the way we conduct user studies in the field of Human-Computer Interaction (HCI), especially for extended (augmented, mixed, and virtual) reality (XR). To uncover how XR research has adapted throughout the pandemic, this paper presents a review of user study methodology adaptations from a corpus of 951 papers. This corpus of papers covers CORE 2021 A* published conference submissions, from Q2 2020 through to Q1 2021 (IEEE ISMAR, ACM CHI, IEEE VR). The review highlights how methodologies were changed and reported;sparking discussions surrounding how methods should be conveyed and to what extent research should be contextualised, by drawing on external topical factors such as COVID-19, to maximise usefulness and perspective for future studies. We provide a set of initial guidelines based on our findings, posing key considerations for researchers when reporting on user studies during uncertain and unprecedented times.

25 Seroprevalence and clinical characteristics of SARS-CoV-2 infection in children and adolescents with cystic fibrosis

Background: Coronavirus disease of 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first detected in the United States in January 2020. Although pediatric cases represent a small proportion of total infections in the United States (11.8%), the majority of hospitalized children have underlying medical conditions, with chronic lung disease being most common. To date, only 1 study has described the clinical manifestations of COVID-19 specifically in children with CF [1]. Our study aims to define the rates of symptomatic and asymptomatic infection in people with CF (PwCF) followed at a large pediatric CF center and to assess demographic and clinical characteristics associated with infection. Methods: All children with CF followed at Seattle Children's Hospital CF Center were eligible to enroll between July 20, 2020 and February 28, 2021. Participants or parents completed an intake survey, including demographic data, COVID-19 exposures, and information about viral/respiratory illnesses after February 1, 2020. SARS-CoV-2 serostatus was determined with a commercial assay for nucleocapsid IgG. Participants or parents were sent weekly questionnaires electronically asking about exposures to and symptoms of COVID-19 for the 12-month study enrollment period. Follow-up serology testing occurs at 6- and 12-months post-enrollment. Results: Of 125 participants, 8 had positive SARS-CoV-2 antibodies (6.4%). Five were positive on enrollment, and 3 additional PwCF were positive at 6month follow-up with testing of 38 participants to date. Among all participants, the average age at enrollment was 11.5 years (range 0-20), 49% were female, and 92% were pancreatic insufficient. Ninety percent of participants had 1 or 2 copies of Phe508del CFTR mutation. The median baselineFEV1ppwas 104%(IQR98-115, N=98). Amongthe8positivecases, 4 endorsed mild upper respiratory infection (URI) symptoms prior to testing, and the remainder were asymptomatic. While only 10% of all participants identify as Hispanic, among PwCF who were seropositive, 50% (4/8) identify as Hispanic (P = 0.002). Among positive participants, 2 have hadrepeatsero logytesting, and bothcontinueto have positive SARS-CoV-2 serologies 18-25 weeks later. Conclusion: Our data suggest that a majority of PwCF have mild to no symptoms of COVID-19 when infected. PwCF who identify as Hispanic appear to be disproportionately affected, consistent with data describing racial and ethnic disparities among patients with COVID-19 in general. Initial 6-month follow-up testing suggests antibody durability but will require further investigation.

Factors associated with severe SARS-CoV-2 infection in patients with inflammatory rheumatic diseases in Madrid: Results from reuma-covid sorcom registry

Background: Patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 may be at risk to develop a severe course of COVID-19 due to the immune dysregulation or the influence of immunomodulating drugs on the course of the infection. For a better understanding of SARS-CoV-2 infections in patients with IRD and due to the high incidence of COVID-19 in Madrid from the beginning of this pandemic infection in Spain, the Society of Rheumatology from Madrid (SORCOM) established a registry (REUMA-COVID SORCOM) shortly after the beginning of the pandemic in Spain. Objectives: To determine factors associated with severity of infection with SARS-CoV-2 in patients with inflammatory rheumatic diseases in Madrid Methods: The REUMA-COVID SORCOM registry is a multicenter, retrospective, observational cohort study conducted in Madrid, a SORCOM initiative. All rheumatology departments from Madrid were invited to participate. The study includes patients with IRD presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020, and November 10, 2020. We consider severe infection death or need of hospitalization. Inclusion criteria was having an IRD and at least 1 of the following 4 criteria: (1) a biologically confirmed COVID-19 diagnosis based on a positive result of a SARS-CoV-2 polymerase chain reaction (PCR) test on a nasopharyngeal swab;(2) Detection of IgM or IgG anti SARSCoV2 in a symptomatic or asymptomatic patients (3)typical thoracic computed tomography (CT) abnormalities (ground-glass opacities) in epidemic areas;(4) COVID19-typical symptoms in an epidemic zone of COVID-19. Results: As of November 10, 2020, 417 patients with IRD were included in the REUMA-COVID SORCOM registry. 5 patients were discharged for incomplete data. Of 412 patients (mean age 57 years, 87.4% Caucasian race, 66.3% female) 174 need hospitalization (42.2%) and 33 patients died (18.4% mortality in hospitalized patients). 82.3% had comorbidities. 234 (56.8%) patients were classified as inflammatory arthropathy, 133 (32.3%) had connective tissue diseases (CTD). 41.1% of the patients had a large history of IRD (≥ 10 years). 10.4% of patients had previously pulmonary involvement. The study includes 143 patients taking Methotrexate, 89 patients taking anti-TNFα therapy and 27 Rituximab. In the univariant analysis, no differences were seen in the severity of COVID-19 infection in patients taking methotrexate. 63% of the all patients taking Rituximab included in the registry need hospitalization and 22% of them died. Hypertension, COPD or cardiovascular disease was associated with hospitalization. Independent factors associated with COVID-19 hospitalization in the multivariate analysis was: age (≥62 years), male sex, IMC ≥30, previous cardiovascular comorbidities and the IRD disease duration (≥ 10 years). Independent factors associated with COVID-19 related death was: age (≥ 62 years), having a CTD diagnose, pulmonary involvement before infection and chronical GC treatment. Conclusion: Patients with IRD represent a population of particular interest in the pandemic context because the baseline immunological alteration and the treated with immunosuppressants agents they receive, comorbidities and the well-known risk of severe infection. Older age, male sex, cardiovascular comorbidities were factors associated with high risk of hospitalization in IRD patients. CTD diseases, previously pulmonary involvement and chronical GC treatment with more than 10mg/day were associated with high risk of death. Neither anti TNF-α treatment nor Methotrexate were risk factor for hospitalization or death COVID-19 related in IRD patients.

Conclusion: Towards a post-pandemic, (post)human world

The conclusion of this volume considers the way that the coronavirus (COVID-19) pandemic has accelerated some of the effects of the fourth industrial revolution and boosted (bio)technological innovation. The digital world has expanded in a permanent manner, with an impressive leap in digital activity in all aspects of life, but the fears of digital surveillance and dehumanization have also increased. Lockdown has brought an unprecedented decrease in carbon dioxide emissions and forced us to face the reality of the Anthropocene and the dangers of our intervention in nature. Literary fiction can continue to be a useful tool to understand this emerging post-pandemic, (post)human world. © 2021 Taylor & Francis.

Clinical syndromes caused by covid-19 and a bayesian model to predict severity

Background: This study aimed to identify the different syndromes presented in hospitalized children with SARS-CoV-2, to analyze if the clinical features and biomarkers confer different risk depending on the syndromes, and to create a predictive model to anticipate the probability of the need for critical care Methods: We conducted a multicenter, prospective study of children aged 0 to 18 years old with SARS-CoV-2 infection in 52 Spanish hospitals. The primary outcome was the need for critical care: defined as the combined outcome of admission into a PICU, and/or need for respiratory support beyond nasal prongs. To understand the probability of needing critical care according to the diagnostic group and for each risk factor, a Bayesian multivariable model was applied. To build a predictive model of critical care, a naïve Bayes algorithm was implemented in a web app. Results: 292 children were hospitalized from March 12th, 2020 to July 1st, 2020;Of them, 214 (73.3%) were considered to have relevant COVID-19 (r-COVID-19). Among patients with r-COVID-19, 24.2% needed critical care. Out of 214 patients, 22.4% were admitted into a pediatric intensive care unit, 41.6% required respiratory support, and 38.8% presented complications (mostly cardiological). Four patients (1.8%) died, all of them had severe comorbidities. We identified 11 primaries diagnoses and grouped them into 4 large syndromes of decreasing severity: MIS-C (17.3%), bronchopulmonary (51.4%), gastrointestinal (11.6%), and mild syndrome with complications (19.6%). In the predictive model, the predictors with higher relative importance were high C-reactive protein, anemia, lymphopenia, platelets <220 000/mm3, type of syndrome, high creatinine, and days of fever. The different risk factors increase the risk differently depending on the patient's syndrome: the more severe the syndrome, the more risk the factor confers. We developed an online risk prediction tool to quantify the risk of critical disease (https://rserver.h12o. es/pediatria/EPICOAPP/, username: user, password:0000) Conclusion: We described the spectrum of r-COVID-19 in hospitalized children, consisting of 4 large syndromes of decreasing severity: MIS-C, bronchopulmonary syndrome, gastrointestinal syndrome, and a mild syndrome with complications. The risk factors increase the risk differently depending on the syndrome. A Bayesian model was implemented in an online app to anticipate the individual risk of critical care.