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Background: COVID-19 in pregnancy can increase the risk of complications due to the cardiorespiratory and immunological changes typical of pregnancy. Objective: To report the epidemiological characterization of COVID-19 in Mexican pregnant women. Material and methods: Cohort study on pregnant women with a positive COVID-19 test, which were followed until delivery and one month later. Results: 758 pregnant women were included in the analysis. Mothers' mean age was 28.8 +/- 6.1 years;the majority were workers 497 (65.6%) and with an urban origin (482, 63.6%);the most common blood group was O with 458 (63.0%);478 (63.0%) were nulliparous women and more than 25% had some comorbidities;the average gestation weeks at infection were 34.4 +/- 5.1 weeks;only 170 pregnant women (22.4%) received vaccination;the most frequent vaccine was BioNTech Pfizer (96, 60%);there were no serious adverse events attributed to vaccination. The mean gestational age at delivery was 35.4 +/- 5.2 weeks;85% of pregnancies were cesarean section;the most frequent complication was prematurity (406, 53.5%), followed by preeclampsia (199, 26.2%);there were 5 cases of maternal death and 39 cases of perinatal death. Conclusions: COVID-19 in pregnancy increases the risk of preterm birth, preeclampsia, and maternal death. Vaccination against COVID-19 in this series showed no risk for pregnant women and their newborns. Copyright © 2023 Revista Medica del Instituto Mexicano del Seguro Social.
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The current context of a pandemic associated with a new remote educational modality has generated various effects on the world population. University students, and specifically postgraduate students, face various challenges to adapt to this new reality, which could generate certain levels of academic stress. This research of mixed nature sought, first, to determine the main frequencies of the dimensions of academic stress in 67 students of the master's degree in Education of a private university of Lima for which the Inventory of Academic Stress SISCO SV adapted to this context was applied. Secondly, it aimed to propose and evaluate strategies aimed at improving the psychological well-being of these students based on a focus group made to the students. In the initial findings, certain stressors perceived by the students were identified, such as the overload of tasks and works, the manner of evaluation of the teachers, and the perception about the limited time to do the works. In addition, among the most recurrent symptoms, are chronic fatigue, drowsiness or increased need for sleep, restlessness, and anxiety. From the application of strategies of an emotional and academic nature, there was an improvement in the perception declared by the students, which favored their psychological well-being. © 2022 IEEE.
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Since March 2020 when the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic was widespread in the U.S., masks became a primary form of protection for healthcare workers when caring for patients. While wearing masks was not a new phenomenon in the health field, there is little known on how the use of them affects the patient-provider relationship. This study explored the experience of wearing masks on the patient-provider relationship in the hospital. This qualitative study involved interviews with both providers and patients at an academic hospital in the Midwest. At the time of this study, in July 2021, hospital policy required all healthcare providers and staff to wear surgical masks with patients, but patients were not required to wear masks while in their rooms. Interviews were audio-recorded and transcribed;they were coded using MAXQDA. Nine patients and nine providers took part in interviews. There were 4 women and 5 men in each group. The primary benefit of mask-wearing identified by both groups was safety and protection from disease. Connection with patients was a major theme as well. Providers adapted to try to improve connection in four primary ways: showing the patient their face, speaking loudly and clearly, spending additional time with patients, and being more expressive. It was also reassuring that safety was one of the main themes and encouraging that masks were not a substantial barrier to communication with patients. © The Author(s), 2022.
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Participatory design and interdisciplinarity are essential aspects when designing for children with accentuated needs;however, they have been even more relevant during the pandemic. COVID-19 has established structural and social changes in our society (telework, online education, globalization of work schedules, etc.) which have made family conciliation a great difficulty for families with children with accentuated needs, given their low self-autonomy. This situation has reinforced the importance of the interconnected needs and skills of the different agents (parents, children, therapists, teachers, etc.) that are involved in their lives, which, therefore, should be considered when working on the self-autonomy of these children. This work explores how these interconnected experiences should be reflected in product design and the relevance of having participatory design and interdisciplinarity at the core of the process, to create meaningful products that improve the independence of these children. This work is developed by conducting bibliographic research, surveys, and interviews with family members and professionals. It explores the perspectives of different agents on what the pandemic implied and the importance of translating them into design methods. The results showed that the needs of parents, professionals, and children differ from each other;thus, to create products that help these children be more independent, the combination of experiences of the different agents should serve as the basis for the product design. It is a first step toward participatory design and interdisciplinary methods focused on interconnected needs, experiences, and culture to design socially sustainable products. © Common Ground Research Networks, Raquel Cañete, María Estela Peralta, All Rights Reserved.
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Background: In coronavirus disease 2019 (COVID-19) the need for intervention increases with disease severity and a risk prediction model that incorporates biomarkers would be beneficial for identifying patients for treatment escalation. Aim(s): To investigate biomarkers changes associated with disease severity and outcomes (mortality, thrombosis). Method(s): COVID-19 patients were sampled between April 15 and May 31 2020. Disease severity was assessed by World Health Organization (WHO) ordinal scale. 132 systemic biomarkers were investigated by routine and multiplex assays and statistical analysis performed to characterise the biomarker profile of COVID-19 patients associated with disease severity, duration, survival and thrombosis. Result(s): The study enrolled 150 COVID-19 positive adults and 16 healthy volunteers. The average age was 64 years, 59% were male, 85% had co-morbidities, 33% had a thrombotic event, and 13% died. A cross comparative analysis of biomarkers identified 13 biomarkers common to severity, mortality and thrombosis with significant correlation;including endothelial dysfunction (VWF, tPA, TFPI), hypercatabolism (low albumin, Hb, FXIII) and inflammatory response (IL-8, Osteopontin). Similarly, 14 biomarkers associated with severity and mortality included pro-inflammatory cytokines and their receptors (sTNFRII, STNFRI, sIL2a, IL6, MIP1a), neutrophils (elevated WBC, Neutrophils, TIMP1) and tissue remodelling (SCGF, EG3A). Nine biomarkers common across severity and thrombosis were angiogenesis (VEGF, LYVE1, Follistatin), acute phase response (SAP, AGP) and clot formation (Fibrinogen and PAPs). Conclusion(s): The biomarker profile associated with poorer outcomes indicates an inflammatory response, endothelial cell disruption, hypercoagulability and hypercatabolism. This study has identified several biomarkers that may be useful indicators of disease severity and progression. Further work is needed to determine how these may be used to direct clinical management. (Figure Presented).
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Background: The severe clinical conditions and fatal outcomes resulting from SARS-CoV- 2 infection have been associated with increased inflammatory and hypercoagulability processes, where an interplay between different comorbidities and genetic factors would be directly involved in the poor prognosis. Aim(s): To study the association of different genetic variants, clinical variables and biological markers involved in inflammation and coagulation with the survival outcome of COVID-19. Method(s): 204 unvaccinated COVID-19 confirmed patients were grouped and compared according to their survival outcome. Inflammatory and hemostatic variables measured upon hospital admission, different clinical variables and the genotypic distributions of the genetic variants Factor II20210A (II20210A), Factor V Leiden (FVL), Fibrinogen Gamma 10034C>T (FGG10034C/T), Factor XI7872C>T (FXI7872C/T) and rs11385942 were compared between patients that either died (n = 63) or survived (n = 141). Differences between continuous variables were analyzed by either a t-test or a U-Mann Whitney test and differences in genotypic distributions were studied by a Chi-square test. Cut off values were set for continuous variables significantly associated with a fatal outcome and their Odds Ratios (OR) of association were calculated through univariate logistic regression. Result(s): The group of patients who died were significantly older, had a higher BMI index and presented with a lower platelet count, lower lymphocytes levels, higher levels of leukocytes and neutrophils, a higher neutrophils/lymphocytes ratio and higher levels of D-dimer, Ferritin and LDH than survivors. No differences were observed in the genotypic distributions of the genetic variants studied between both groups. Conclusion(s): In agreement with previous studies, age, obesity, and the levels of different hematological and plasmatic markers upon hospital admission would be useful predictors of a fatal outcome in COVID-19 patients. Despite the typical exacerbation of inflammation/ coagulation in severe COVID-19, no association was found between the carriage of any of the proinflammatory/prothrombotic genetic variants studied and a higher risk of dying. (Table Presented).
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Introduction: Within the framework of the pandemic provoked by the COVID-19, every teacher took the challenge to rebrand quickly and start working differently by designing and learning evaluative activities to face this E-Learning environment in which most students and teachers all around the world have been immersed for so long. Objective: To establish the impact of the methodological change within the traditional and virtual classroom in academics of Universidad Nacional of Costa Rica -Campus Liberia. Method: A total of 85 professors of the different majors have participated in this study and under a non-probabilistic sampling. A structured and closed questionnaire containing few questions was sent by e-mail utilizing the mail institutional platform and cellphones by the common digital platform WhatsApp. Results: The improvement of the pedagogic practice has a closed relationship with the good access to technologies and internet connection, which has been considered a clear limitation for academics to communicate with students in an easy, better and effective way. Discussion: The academy needs to have the clarity in relation to the conditions that students face daily in order to study utilizing distant education spaces which in many of the cases do not have access to the technological tools and connectivity, most of that due to their bad social and economic conditions.
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COVID-19 has posed new physical and mental challenges for the population worldwide, establishing social and structural changes in the labor market that could be maintained and implemented permanently. This new reality will require new strategies to improve family and work conciliation, which is especially challenging for families with children suffering from psychological pathologies such as autism spectrum disorder (ASD). These changes have led to more frequent and intense behavioral problems, causing stress, anxiety, and confusion for these children and their families. Thus, the need to have tools that help parents reconcile work with the care of these children, who have low autonomy, is reinforced. This work develops a method for the design of assistive technology and smart products to support children with ASD in following a routine and managing tasks autonomously. In this way, the article analyzes the design problem including the needs and preferences of children with ASD and their parents during confinement in terms of dependence and adaptability;develops a design method for interactive and smart products focused on children with ASD in confinement situations;and validates this method in a case study, in which a robot is developed that makes it easier for children with ASD to follow a routine.
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The pandemic situation generated by COVID-19, chaotized the socio-educational processes of universities around the world. In the same way, these conditions influenced the socio-psychological manifestations of all the students of the Law career of the Universidad Regional AutOnoma de los Andes, in its headquarters in Puyo, Ecuador. These manifestations were studied from two perspectives, from the conceptual platform required and addressed in the research on resilience, and the virtuality of professional training identified in both synchronous and asynchronous activities. The action-research directed the study through qualitative methods and with the support of documentary-bibliographic inquiry as a container of the initial research principles. The existing relationship between the appreciations of the training from virtuality, the physical and socio-psychological conditions, and the influence of this on the resilient states were identified. All the above promoted recommendations of didactic actions to face the individual differences in the resilient processes faced by the students, from the position of guide and promoter of the teachers.
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Background: Increasing evidence suggests that endothelial activation and dysfunction contribute to COVID-19 pathogenesis by altering vessel integrity, promoting pro-coagulative and inflammatory state. Aims: 1. Investigate changes in coagulation, inflammation and endothelium associated with the progression and severity of COVID-19, as well as their correlation to survival and/or occurrence of venous thromboembolic events (VTE). 2. Explore potential new biomarkers to predict COVID-19 severity. Methods: Samples were collected from COVID-19 patients after appropriate consent. Disease severity was assessed with WHO ordinal scale on day of sampling. In addition to routine haematology, biochemistry and coagulation analysis, additional analysis spanning coagulation, endothelium, platelet, inflammatory biomarkers by conventional assays and multiplex immuno-assays were undertaken. Results: Participants included 151 COVID-19 patients aged 18 years and greater, 16 healthy volunteers and 9 non-COVID-19 ICUcontrols. COVID-19 patients were categorised in 7 groups based on severity and time from symptom onset and the data also provides mortality and VTE rates (Table 1). The biomarker profile of hospitalised COVID-19 patients demonstrated an increase in plasma levels of cytokines, inflammatory, soluble endothelial cell markers and markers of coagulation activation when compared to the ambulatory group (Figure 1). Significantly higher levels of inflammatory markers (CRP, WBC, fibrinogen, serum amyloid P, alpha 1 acid glycoprotein) were observed in patients with VTE and in the non-survivors group. Interestingly, the same trend was seen for coagulation (FVIII, VWF) and fibrinolysis markers (D-dimer, TFPI, t-PA) with higher levels in the VTE and non-survivors group. In addition, higher plasma levels of endothelial markers (ICAM-1, angiopoietin, TIE-2, LYVE-1, syndecan) were observed in severe COVID-19 when compared to non-COVID-19 ICU-controls. (Figure Presented) Conclusions: Our study provides evidence of a strong, global inflammatory response in COVID-19 patients. The elevation of circulating markers suggests significant endothelial cell activation/dysfunction and a possible cause for the pro-coagulant phenotype observed in these patients.
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FLT180a is an investigational gene therapy medicinal product candidate intended for treating HB patients. It includes a novel synthetic capsid, AAVS3, with a higher liver transduction efficiency than wild type AAV, and a codon optimised F9 gene with a gain of function mutation. To assess the safety and efficacy of a single systemic adminis-tration of FLT180a in adult patients with HB. Phase 1/2, multi- centre, ongoing, open- label and long- term follow- up study assessing FLT180a dose levels in an escalating/descending adaptive design, to identify a dose that consistently normalises FIX activity (50- 150%). Participants have severe or moderately severe HB and are negative for neutralis-ing AAVS3 antibodies. Pre- emptive immunosuppression is given to mitigate vector related transaminitis and associated reduction in FIX expression. Ten patients with severe HB have been treated across 4 dose levels, with week 3 FIX activity levels ranging between 24 and 168%. The first two patients, receiving the 4.5e11vg/Kg dose, have stable, therapeutic, FIX activity levels through week 104. No patient has had a bleeding episode requiring FIX concentrates. The most common drug related serious adverse event was transient transaminitis (in four patients) requiring supplemental immunosup-pression. FIX activity levels above 150% have been observed, which were individually assessed for risk of thrombosis, and one patient is being treated with DOACs. Refinement of the immunosuppression regimen for the latest three patients (9.75e11 vg/kg dose) prevented transaminitis during the critical phase (4- 16 weeks). FLT180a achieves clinically meaningful, dura-ble FIX activity levels in patients with HB, associated with in-dependence from FIX replacement therapy and zero treated bleeds. Transient transaminitis was largely averted by prophy-lactic immunosuppression. A dose between 7.5 to 9.75e11vg/Kg can potentially create sustained, normal FIX activity levels in patients with severe HB.