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Background: Short-term cardiopulmonary extracorporeal life supports (ECLS) are invasive devices whose use has increased exponentially during the COVID-19 pandemic. Major bleeding is a main cause of morbi-mortality in ECLS patients and acquired von Willebrand disease (aVWD) could justify this complication. Aim(s): We aim at investigating the primary hemostasis alterations profile in ECLS patients, and to propose a potential treatment if bleeding. Method(s): Patients in ECLS at our center since June 2021 were included (n = 25). Primary hemostasis was evaluated by: Von Willebrand Factor antigen (VWF:Ag) and activity (VWF:GPIbM) measurement (immunoturbidimetry), VWF multimeric analysis (agarose-gels and immunoblotting), platelet function analysis (PFA-200), and platelet activation (CD62P and CD63 expression by flow cytometry). Studies were performed 24 h after implant, each 7 days, and in the first week after ECLS extraction. T-TAS was used for hemostasis analysis in samples from bleeding patients, before and after in vitro addition of purified VWF. This study was approved by the Hospital Clinic's Ethics Committee (HCB/2021/0200). Result(s): After 24 h of ECLS implant, increased VWF:Ag levels and prolonged PFA occlusion times. In 60% of patients, altered VWF:GPIbM/VWF:Ag ratio ( < 0.7) and loss of VWF high molecular weight multimers (HMWM) were observed. CD62P expression was slightly higher in ECLS patients platelets than in controls (MFI+/-SD of 4.34 +/- 2.2 vs. 3.27 +/- 0.6, respectively;p = 0.3). Early after ECLS extraction, there was normalization of the VWF multimeric profile and PFA values. Interestingly, in samples from bleeding patients, addition of purified VWF reduced significantly the T-TAS occlusion times (776 s+/-207 s vs. 1161 s+/-251 s, Mean+/-SD, post vs. pre, respectively;p = 0.033). Conclusion(s): ECLS caused primary hemostasis alterations, leading to aVWD and platelet activation, solved early after support removal. Hemostatic efficiency in ECLS bleeding patients, with lack of HMWM, was corrected in vitro by providing functional purified VWF. (Figure Presented).
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SESSION TITLE: What Lessons Will We Take From the Pandemic? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Inhaled pulmonary vasodilators such as epoprostenol (IE) and nitric oxide have been used to treat refractory hypoxemia due to COVID-19 by improving ventilation-perfusion mismatch. One undesirable consequence of this therapy is increased left atrial pressures and risk of pulmonary edema due to systemic vasodilation. The concomitant use of diuretics could mitigate this side effect thereby optimizing IE’s therapeutic impact. The aim of this study was to assess improvement in oxygenation in spontaneously breathing and mechanically ventilated patients with COVID-19 who received IE alone and those who received both IE and loop diuretic (LD) within 24 hours of each other. METHODS: This is a retrospective case control study approved by the local IRB. Improvement in oxygenation was defined as an improvement in the PaO2/FiO2 (PF) ratio by at least 10% within the 24 hours following therapy. SpO2/FiO2 (SF) ratio was used as a surrogate in cases where arterial blood gas trend was not available. Data was analyzed using SPSS version 26 and chi-square analysis was used to compare the 2 groups. RESULTS: A total of 80 patients with COVID-19, confirmed through RT-PCR, received IE from October 2020 to February 2022. Patients were stratified into 2 groups: combination therapy with IE and LD (IE-LD;n = 34;42.5%) vs IE alone (n = 46;57.5%). Improvement in oxygenation was seen in 82.4% IE-LD patients, which was a statistically significant difference compared to19.6% IE patients (z = 5.568, p <.00001). Hospital length-of-stay was comparable (19.6 days in IE-LD, 25.0 days in IE;p = 0.13) but there was a trend towards decreased in-hospital mortality (64.7% in IE-LD, 82.6% in IE only). The eventual need for mechanical ventilation in spontaneously breathing patients (52.9% in IE-LD, 56.3% in IE;p = 0.85) and mean ventilator days in intubated patients (14.3 days in IE-LD, 16.6 days in IE;p = 0.61) were not statistically different between the 2 groups. CONCLUSIONS: IE is a valuable rescue therapy in cases of refractory hypoxemia due to Covid-19 as previous studies have shown that approximately half of all patients will show improvement in oxygenation. In our study, 43 out of 80 patients had an increase in PF or SF ratio of at least 10% and the majority of these received combination therapy rather than IE alone, suggesting that LD is an effective adjunct to IE. CLINICAL IMPLICATIONS: The role of inhaled pulmonary vasodilators in management of Covid-19 is well-documented as they have been shown to delay intubation in spontaneously breathing Covid-19 patients. Despite the small sample size and retrospective design, our study reports that using LD to minimize inadvertent effects of pulmonary edema when administering IE, can further improve oxygenation in this population. Thus, more studies investigating this combination therapy are warranted. DISCLOSURES: No relevant relationships by Kristine Bessette No relevant relationships by Raj Parikh No relevant relationships by Michael Perkins No relevant relationships by Mari-Elena Pino No relevant relationships by Saimir Sharofi
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The COVID-19 pandemic has represented a hazardous situation for individuals with Autism Spectrum Disorder (ASD) and their families. The difficulties, following the COVID-19-derived lockdown, have involved working from home or loss of employment, and the demands of looking after their children without the daily support of specialists. The aim of this study was to evaluate the adaptive behaviour of young adult participants with ASD after the enforcement of lockdown measures in March 2020 in a specialised centre in central Italy, by administering the Italian form of the Vineland Adaptive Behaviour Scales Second Edition (VABS-II), at baseline as well as 6 months and 1 year after the lockdown. Participants with ASD who were not able to access their normal, in-person care - they were only followed at a distance (i.e. telehealth) - declined dramatically in their adaptive behaviour during the first months after the lockdown for some VABS-II dimensions such as the socialisation and daily living domains. The effects of the lockdown on adaptive behaviour remained after 1 year. Our results emphasise the need for immediate, continuous and personal support for people with ASD during and after the restrictions caused by the COVID-19 pandemic, in order to ensure at least partial recovery of adaptive functioning.
Subject(s)
Autism Spectrum Disorder , Autistic Disorder , COVID-19 , Child , Young Adult , Humans , Autism Spectrum Disorder/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Longitudinal Studies , Pandemics/prevention & control , Communicable Disease Control , Italy/epidemiologyABSTRACT
Background: In December 2020, Sputnik V was incorporated to the National COVID-19 Immunization Plan in Argentina. Studies had shown 98% of antibody response rate. To date, data on immunogenicity and antibody persistence in Argentina are scarce.The objective was to assess humoral immune response after two doses of Sputnik V in Health Care Workers (HCWs) at the Ricardo Gutierrez Children's Hospital (RGCH). Methods: A prospective, cohort study in HCWs immunized with two doses of Sputnik V between February and March 2021. The following variables were assessed: age, gender, risk factors for severe COVID-19 or mortality, immunosuppressive therapy and history of SARS-CoV-2. Blood samples were drawn on the day of the first dose, 28 days and 180 days after the second. Anti-Spike IgG was measured using an ELISA assay. Differences in immune response were evaluated according to study variables. Comparison analyses between groups with or without history of infection were performed, with T-test and ANOVA or Mann-Whitney tests. For each subject, we compared baseline values with 28 days and 180 days after the second vaccine.STATA version 14 and R Sofware were used for data analyses. Results: We included 528 individuals, mean age 41.5 years, 82.9% female, 14.4% (76/528) reported previous SARS-CoV-2 infection.All subjects developed antibodies post-vaccination. At day 28, concentrations were significantly higher in previously infected than naïve subjects (p < 0.001) with no differences according to age, gender and comorbidities.At day 180, 17% (95% CI 13.17-21.53) of naïve subjects were negative. Antibody concentrations decreased significantly in all subjects except in those who reported SARS-CoV-2 infection after vaccination (n = 31). This last group had significantly higher antibody concentrations. Conclusion: This study assessed immune response to a new COVID-19 vaccine in real life in a cohort of subjects. Antibody concentrations varied according to history of SARS-COV-2 infection and decreased over time.
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Background: Systemic and local inflammation following SARS-CoV-2 infection has been widely described and predictive of disease severity and death. However, the exact immune mediators driving inflammation contributing to SARS-CoV-2 host defense vs. those driving immune-mediated pathology in humans have not been fully elucidated. Deficiencies in type-I interferon (IFN-I) responses, including inborn errors to genes in the IFN-I pathway, neutralizing auto-antibodies against all subtypes of IFN-I, or the lack of production of IFN-I, are associated with severe COVID-19 in otherwise healthy individuals. Conversely, sustained IFN-I responses have been shown to contribute to severe COVID-19 by exacerbating inflammation, and prolonged IFN-I signaling has been shown to interfere with lung repair following viral infection and to increase susceptibility to bacterial infections. Thus, it is critical to understand the roles of IFN-I signaling in COVID-19 to design therapeutic strategies. Methods: Here, we modulated IFN-I signaling in rhesus macaques (Macaca mulatta;RMs) from day-1 through day 2 post SARS-CoV-2 infection (dpi) using an IFN-I antagonist (IFNant). Eighteen RMs (9 control and 9 IFNant treated) were infected with SARS-CoV-2 on day 0, with 6 RMs sacrificed at 2, 4, and 7dpi. Nasal and throat swabs were collected for viral load;blood and bronchoalveolar lavage fluid (BAL) for flow cytometry and RNAseq. Results: IFNant treatment prior to infection resulted in a highly significant and consistent reduction in SARS-CoV-2 viral load in the lower airways (>3-log difference;2dpi BAL) and upper airways (nasal and throat swabs). Treatment with IFNant initiated also potently reduced: (i) soluble markers of inflammation in BAL, (ii) expansion of inflammatory monocytes (CD14+CD16+), and (iii) pathogenesis in the lung. Furthermore, Siglec-1 expression, which has been shown to enhance SARS-CoV-2 infection, was rapidly downregulated in the lung and in monocytes of IFNant-treated RMs. Remarkably, RNAseq analysis showed a robust reduction in pathways associated with inflammation and decreased levels of interferon-stimulated genes post-infection in treated RMs. Thus, IFNant treatment prior to infection resulted in limited viral replication, inflammation, and pathogenesis in SARS-CoV-2-infected RMs. Conclusion: These data indicate a vital, early role of IFN-I in regulating COVID-19 progression and emphasize the importance of understanding IFN-I pathways in COVID-19 for the development of targeted therapeutic strategies.
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The need to reduce expenses in touristic services and the lack of an explicit method in the consulted literature of the integration of lean thinking as a facilitating element in organizational change management is what gave origin to this investigation. It's goal is to develop a model of organizational change management with lean thinking in touristic services that will contribute to increase customer value. Starting from a revision of the literature on organizational change management and lean thinking, both philosophies' main components were analyzed;their similarities identified and mathematical methods were applied to relate them. The contributions of this article are centered on the assumed definition of organizational change management with lean thinking and the graphic representation of the model of organizational change management with lean thinking in touristic services. A model to be considered to manage the change COVID-19 will impose on tourism. © 2019 Universidad Nacional Autónoma de México.
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ᴥ SUMMARY. This study aimed at pilot-testing a new screening tool for assessing risk perception of and hesitancy about anti-COVID-19 in patients diagnosed with cancer. We recruited consecutive cancer patients (n = 356) who were either in treatment or follow-up. All the participants completed several measures of risk perception, confidence in safeguards, treatment adherence, and psychosocial distress. Scree plot and parallel analysis suggest a unifactorial structure (explained variance = 47.816%). The total scale was found a reliable 7-item measure (Cronbach’s a = .806;McDonald’s Ω= .810). Correlations and comparisons to other measures confirmed concurrent and predictive validity. The new measure reports a moderate correlation (r = .410;p<.001) with treatment non-adherence, whereas the correlation with distress was not significant. In conclusion, the new measure seems to be a reliable and valid tool for assessing risk anti-COVID-19 vaccine hesitancy in patients diagnosed with cancer. Further research is needed to confirm the unifactorial structure or better understand the underlying psychological mechanisms of vaccine hesitancy. © 2021, Giunti Psychometrics. All rights reserved.
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The purpose of this work is to analyze the current state of water resources, a year having elapsed since the state of emergency generated by the COVID 19 pandemic was decreed, developing the following aspects, water resources before the pandemic, measures implemented during the pandemic, methodology for assessing environmental impacts and impacts of the measures implemented during the pandemic on water resources. The methodology set out by Conesa (1997) was taken as a basis, from which five criteria were selected, specifically, nature, intensity, extension, moment and synergy, and these were applied to the five most restrictive measures implemented during the COVID 19 pandemic, obtaining as results that the measure with the highest score is the temporary closure of borders with 100 and the measure with the lowest score is wearing a mask with 38.75. While the total score is 356.25, which translates into a moderate impact on water resources.
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The purpose of this scientific note is to discuss the impact of the COVID 19 pandemic on environmental conditions, expressed in terms of how the strategic measures implemented by the state, specifically mandatory social isolation, have affected aspects, such as water from rivers, atmospheric conditions, plant species, animal species and waste generation. This analysis allows us to conclude that the confinement measures have favored the decrease in pollution levels, evidenced by the greater presence of fish in rivers, clarity of the atmosphere, greenery and regeneration of plant species, and an increase in the volume of non-reusable waste.
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The impact of an educational guidance program through social networks on three dimensions related to the COVID- 19 pandemic was evaluated, in subjects living in the urban area of the province of Chachapoyas, Peru, during the period September-December 2020. The program consisted of in the dissemination through social networks of up-todate scientific information on the etiology, prevention and therapy of the disease, and the transfer of mental techniques to protect emotional health, through accessible and enjoyable communication strategies. The dimensions studied were level of knowledge about the pandemic, care and preventive measures, and the management of emotional health, using a 12-item Likert-type instrument that was applied before and after the execution of the program. The scores achieved by each of the dimensions were compared, those observed between the dimensions, and the uniformity of the opinions of the subjects in each dimension was also measured both before and after. An increase in the score was found in each of the dimensions after the application of the program, being statistically significant for the management of emotional health. Significant differences were observed in the scores between the three dimensions both before and after, with greater force in that of care and preventive measures. The program also produced uniformity in the opinions of the subjects on each of the dimensions. These results suggest that the transfer of knowledge and healthy methods through social networks to teach people to take care of COVID-19 is a viable and potentially sustainable strategy.
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Background: Healthcare authorities at National and Regional level have prioritized vaccinations for cancer patients. Patients with cancer are among the very high-risk groups for adverse outcomes including hospitalization and/or death from COVID-19. The Medical Oncology Unit in Florence encourage vaccination for all patients with cancer being actively treated, regardless of treatment type, performance status, or life expectancy. A COVID-19 vaccination campaign, with the support of the Health Departments, was launched on April 02. The Pfizer BNT162b2 mRNA or the Moderna mRNA-1273 vaccines, based on availability, were used. Data regarding the safety of the mRNA vaccines in patients with cancer were collected. Material (patients) and methods: Between April 02 and May 07, vaccination was offered to patients actively undergoing cancer treatment. Side effects were monitored via detailed telephone questionnaires. Results: 913 patients were offered the vaccine. 22 (2%) refused the vaccination, mostly due to fear of side-effects, 73 (8%) patients did not answer the call, while 181 (20%) patients were had already been vaccinated. 637 patients received the first vaccination dose, of whom 601 (94%) received the second dose. The second dose was omitted if the patient contracted SARS-CoV-2 infection between three and six months before the first dose. The most common side-effects after the first dose were local, with 126 (24%) of 523 evaluable patients reporting pain at the site of injection. Systemic side-effects included fatigue (34 [6%]), headache (18 [3%]), muscle pain (14 [2%]), fever (17 [3%] and chills (3 [1%]). Two of 523 patients were admitted to hospital for acute allergic reactions. Three patients died after the first dose due to disease progression and two patients refused the second dose. More systemic side-effects were observed after the second dose of vaccine. Pain at the injection site was reported in 18 [3%] of the 502 evaluable patient, whereas the most common systemic side effects were muscle pain (39 [34%]), fatigue (19 [34%]), headache (31 [16%]), fever (102 [10%]), chills (17 [10%]). None of the reported side-effects required admission to hospital or any other special intervention. Two patients developed asymptomatic SARS-CoV-2 infection after the first and the second dose of vaccine, respectively. Conclusions: The reassuring safety signal regarding the mRNA COVID-19 vaccines in patients with cancer support call for vaccination of cancer patients.
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Controversies still exist regarding the humoral response to the virus SARS-CoV-2 in convalescent patients and seroconversion in patients with autoimmune diseases. There are few reports on the clinical and evolution of COVID-19 in the latter group. The objective was to examine the clinical and evolutionary characteristics associated with COVID-19 and the percentage of seroconversion in people with rheumatic diseases. Fifty-three patients were included, mainly with rheumatoid arthritis and lupus. The majority were female and average age 48 ± 14 years. Symptoms: fever (56%), anosmia (35.8%), dyspnea (34%), headache (30.2%) and cough (30.2%). Duration of infection 12 ± 7 days. Almost half of the patients were hospitalized (23, 43.4%), 5 in critical care units (9.4%) and 3 died (5.6%). The prevalence of steroid use was 56.6% (30), with an average dose of 8 mg/d, and 17 (32%) used immunosuppressive biopharmaceuticals. There was a correlation between age and the need for hospitalization with a risk of 9.4% per year. There were no differences with other variables. The presence in serum of IgG immunoglobulin against SARS-CoV-2 protein S was determined in 23/53 patients (43.4%), with detectable levels in 15 (62.2%), and in the 23 without autoimmune connective tissue diseases who suffered from COVID-19, 12 had detectable antibodies. Death in this group of rheumatic diseases was low, similar to the general population. More than half had specific antibodies against the virus regardless of the medication used.
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Coronavirus pandemic has increased the necessity for tourism destinations to develop strategies to position a positive image that reactivate tourism demand. The purpose of this paper is to evaluate the influence of tourism destination image on consumer behaviour during post Covid-19 stage. A structural equation model was developed to validate research hypotheses. Using a structured questionnaire applied to 150 consumers of Holguin tourism destination, it was evaluated the influence of image formation agents on tourism destination image. Furthermore, it was evaluated how image influence consumer behaviour, using a 7-point Likert scale. Results showed there is a positive influence from the content generated on official tourism providers social media profiles and mass-media on Holguin tourism destination image, especially on items related to security and sanitary protocols. It was demonstrated the moderator role of image on travel and recommendation intention by consumers.
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Background: Endothelial dysfunction is crucial in moderate to severe SARS-CoV-2 infection. Preeclampsia is an endothelial pregnancyrelated syndrome that shares some clinical and analytical features with COVID19. COVID19 signs in pregnant women might be misdiagnosed as preeclampsia leading to an iatrogenic preterm delivery. Aims: To address whether endothelial damage, microvascular thrombosis and dysregulated immune response exhibit different patterns in preeclampsia and COVID19 in pregnancy. Methods: Plasma samples were obtained from pregnant women with COVID19 pneumonia classified into moderate ( n = 10) or severe disease ( n = 9). Endothelial damage and immune response markers were assessed, including VCAM-1, TNF-receptor I (TNFRI), angiotensin II (ANGII), heparan sulfate (HS), PAI-1, dsDNA for neutrophil extracellular traps (NETs), C5b9, thrombomodulin (TM) and ADAMTS-13 activity. Results were compared to those in SARS-CoV-2 negative including healthy pregnant women as controls (C, n = 10), and patients with preeclampsia (PE, n = 13). Results: All endotheliopathy markers were significantly increased in severe COVID19 and PE patients compared to healthy pregnants ( p <0,05, Table 1), except TM and ADAMTS-13 activity. Patients with moderate COVID19 presented a biomarker profile similar to the observed in control patients. Severe COVID19 and PE profiles were distinctive among them regarding four markers: VCAM-1, TNFRI and ANGII, clearly higher in PE, and HS, significantly lower in PE. The principal component analysis (PCA) in Figure 1, demonstrated the separation between severe COVID19 and PE from moderate COVID19 or uncomplicated pregnancies. The first and second components explained 29.1% and 18.4% of the variance between groups. (Figure Presented) Conclusions: Severe COVID19 exhibits signs of endothelial damage and immune dysregulation and some of them are shared with preeclampsia. However, there are specific markers with the potential to discriminate between both conditions. Investigation in this direction could help to develop new strategies for the prevention and treatment of both entities. Grants: Fundació Clínic (HCB/2020/0401), JazzPharmaceuticals (IST-16-10355), Fundació La Marató de TV3 (202026-10).
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Background: Facing a severe life-threatening disease has physical and emotional consequences for patients. Aim: To evaluate the physical and emotional sequelae in patients who survived COVID-19 pneumonia. Material and Methods: This cross-sectional study collected data from post-COVID-19 pneumonia patients admitted to an outpatient follow-up program in a public hospital in Chile. One month after hospital discharge, the evaluation of physical capacity was carried out through the 1-minute sit-to-stand test (1STST). In addition, the Clinical Frailty Scale (CFS) and the Hospital Anxiety and Depression scale were applied Results: We included 70 patients aged 63 +or- 13 years (54% women). Eighty-five percent of the patients were able to execute the 1STST with an average of 20.6 +or- 4.8 repetitions. Forty-eight percent of the patients had a performance below the 2.5th percentile according to the reference values and 28% of patients had exertional desaturation. The CFS classified as mildly vulnerable or with some degree of frailty to 33% of patients. Twenty-five percent of the patients presented symptoms of depression and 33% of anxiety. Conclusions: Patients who survived COVID-19 have a decrease in physical capacity and a significant proportion of depression and anxiety one month after hospital discharge.