Risk of Aki in Covid-19 Patients: Clinical Course and Outcomes

Introduction: Acute kidney injury (AKI) occurs in 0.5 to 25% of hospitalized COVID-19 patients. Clinical severity and renal involvement are due to inflammation, immune and endothelial dysfunction. On the other hand, risk factors such as age, comorbidities, mechanical ventilation requirement, hypovolemia and MAP <65 mm Hg are associated with AKI development. This study aim to evaluate the development of AKI and determine the relationship between serum creatinine and inflammatory. Method(s): A single center, retrospective study involving 166 patients under the diagnosis of moderate to severe COVID-19 infection in Hospital General Regional 110 Oblatos, Guadalajara, Mexico. A consecutive sample was approached. AKI was determined and classify when changes in serum creatinine met KDIGO definition. Demographics, clinical and biochemical data, risk factors for AKI and RRT prescription were assessed and reported during diagnosis and discharge. Outcome measures were renal recovery, mortality and causes of death. Differences were compared using 2-sample t test for continuous variables and chi-square for categorical variables. Relationship between creatinine changes and inflammation markers were assessed using Pearson correlation coefficients. All statistical tests were performed using SPSS 28.0 and a P < 0.05 level of significance. Result(s): Mean age 59 +/- 18.38 years. 60 cases (36%) were diagnose as AKI. 41% were in stage 1, whereas 35% and 24% made up stage 2 and 3, respectively. Changes in serum creatinine (SCr) correlated with gender (r=0.155, p 0.48), changes in hemoglobin (r= -0.384, p < 0.01), neutrophil/ lymphocyte ratio (NLR) (r= 0.229;p 0.003), serum phosphate (r= 0.555, p < 0.01), serum calcium (r= -0.210, p < 0.011), serum potassium (r= 0.555, p < 0.01), serum magnesium (r= 0.212, p < 0.012), D-dimer (r= 0.246, p 0.02) and (r= -0.322, p < 0.01). After adjusting model for cofounders, hospitalization length and age (OR: 3.03, CI 0.39, 11.56, p=0.033) trend to be a significant data, other cofounders in relation to the presence of AKI o changes in SCr were no significant with other potential outcomes. [Formula presented] Conclusion(s): The present study highlighted that the presence of AKI is associated the increased of inflammation, but the current evidence limits the outcomes in already none predictive factors. Further studies are needed to establish early strategies aimed to prevent AKI and its evolution in COVID-19 patients and pandemics ahead. No conflict of interestCopyright © 2023

Improving Semi-supervised Deep Learning by using Automatic Thresholding to Deal with Out of Distribution Data for COVID-19 Detection using Chest X-ray Images

Semi-supervised learning (SSL) leverages both labeled and unlabeled data for training models when the labeled data is limited and the unlabeled data is vast. Frequently, the unlabeled data is more widely available than the labeled data, hence this data is used to improve the level of generalization of a model when the labeled data is scarce. However, in real-world settings unlabeled data might depict a different distribution than the labeled dataset distribution. This is known as distribution mismatch. Such problem generally occurs when the source of unlabeled data is different from the labeled data. For instance, in the medical imaging domain, when training a COVID-19 detector using chest X-ray images, different unlabeled datasets sampled from different hospitals might be used. In this work, we propose an automatic thresholding method to filter out-of-distribution data in the unlabeled dataset. We use the Mahalanobis distance between the labeled and unlabeled datasets using the feature space built by a pre-trained Image-net Feature Extractor (FE) to score each unlabeled observation. We test two simple automatic thresholding methods in the context of training a COVID-19 detector using chest X-ray images. The tested methods provide an automatic manner to define what unlabeled data to preserve when training a semi-supervised deep learning architecture. © 2022 IEEE.

Mental health and associated factors among undergraduate students during Covid-19 pandemic in Chile

Introduction: Very few studies have explored mental health among undergraduate students in Chile, especially during the Covid-19 pandemic. International studies have estimated the prevalence of depression at around 28%. Objective(s): i) To determine the prevalence of mental health problems among undergraduate students at a private university in Chile;ii) to explore the associated factors in the context of the Covid-19 pandemic. Method(s): This was a cross-sectional study, approved by the Ethical Committee of the Universidad de los Andes, Santiago Chile (CEC201984). Undergraduate students completed an online survey between August and September 2020. Mental health was assessed using The Depression, Anxiety and Stress Scale-21;suicidality, using the Columbia Suicide Severity Rating Scale;insomnia using the Insomnia Severity Index;and several individual, family, and university factors. Variables regarding the Covid-19 were also assessed, such as personal and family history of covid-19 contagion and death of family members due to Covid-19. A multivariate logistic analysis was performed. Result(s): 5,037 students responded to the survey. 70.4% were female, mean age, 21 years. 37.1% had depression;38%, anxiety;54.6%, stress;32.6%, insomnia;and 20.5%, suicidal ideation (last month). The most important risk factors were non-medical use of benzodiazepine and fear of contracting Covid-19;the most relevant protective factors were high family functionality and a high sense of university belonging. Conclusion(s): This is one of the first studies that has evaluated mental health among undergraduate students in the context of the Covid-19 pandemic in Chile. The findings showed concerning levels of mental health problems.

Students' Perception about the Use of an Educational Web Application During the COVID-19 Pandemic

SARS-CoV-2 virus has caused universities to update their courses in the distance modality. The general aim of this mixed research was to build and analyse the use of a web application for the educational process about the t-test considering data science. In particular, the professor of the Teaching of Mathematics II course needed to update the school activities because of the new educational demands caused by the COVID-19 pandemic. To facilitate the educational process of math, this teacher decided to build a web application that presents the formulas and calculation of the mean, standard deviation and statistical error to understand the use of the t-test. This technological tool allows the personalisation of learning through the simulation of data. The participants were 42 students from a Mexican university. The results of machine learning indicated that the contents of the web application positively influenced the assimilation of knowledge, satisfaction during the learning process, development of mathematical skills and learning in the distance modality. The decision tree technique allows the construction of four (4) predictive models about the use of the web application for the educational process about the t-test. Finally, educators have the opportunity to improve the teaching-learning conditions during the SARS-CoV-2 virus through the design and construction of web applications. © 2022, Commonwealth of Learning. All rights reserved.

Basal characteristics of the prospective spanish immunotherapy registry of cardiovascular toxicity: SIR-CVT

Background: The immune checkpoint inhibitors (ICI) have improved the prognosis of many cancers in the last years but concerning cardiovascular toxicity (CVtox) have been reported. Nowadays, specific surveillance protocols are lacking, and early diagnosis of toxicity may be challenging. Purpose: To characterize the cardiovascular (CV) effects of immunotherapy and to seek for the mechanisms of CVtox of ICI in a protocolize surveillance program of cardio-oncology. Methods: A multicentre national registry was developed by a research consortium of scientific societies of Cardiology and Oncology (SEC and SEOM) and the cardiovascular research centre (CNIC) in Spain (Figure 1). A total of 18 hospitals participate in recruiting since Q4 2021. A follow-up protocol was stablished with clinical, electrocardiographic (EKG), echocardiography, cardiac magnetic resonance (CMR) and laboratory assessment, including cardiac biomarkers, inflammatory panel and the expression of miR-721, a specific myocarditis biomarker. Toxicity management is performed at each institution following international guidelines. Results: 53 patients were currently included. Median age was 68 [59, 75] years-old, 79% were male. 83% had at least 1 CV-risk factor (75% smoking history, 20% diabetes mellitus, 50% hyperlipemia, 57% hypertension, 19% chronic kidney injury) and up to34% had previous CV disease. 93% had at least one dose of COVID19 vaccine. Dyspnoea was referred by 23% of patients, 28% have abnormal EKG findings and one-third (33%) abnormal cardiac biomarkers (median Troponin I-hs 5.30 [2.60, 11.00];NT-proBNP 199 [68, 736]). Mean LVEF (60% [56.15, 66.78]) and GLS (−18 [−19.75, −16]) were within the normal range but 26% showed LGE at baseline. Cancer characteristics are summarized in Table 1. Conclusion: Real-world SIR-CVT patients show a high CV risk profile and frequent pre-existing CV diseases before ICI treatment. The prospective follow-up of this cohort will help to develop personalized surveillance protocols according to baseline CVtox risk and to define different grades of cardiotoxicity. Funding Acknowledgement: Type of funding sources: None.Figure 1Table 1

Digital skills and sociodemographic variables in university teachers in the Peruvian Amazon during the COVID-19 pandemic

The objective of this research was to analyze the sociodemo-graphic variables associated with the digital skills of university teachers in the Peruvian Amazon during the COVID-19 pandemic. The approach was quantitative, the design was non-experimental and the type was cross-sectional comparative descriptive. The sample consisted of 167 teachers from 3 universities to whom the Digital Teaching Competence Questionnaire was applied, an instrument with adequate metric properties (validity based on content and reliability). According to the results, the digital skills of 55.7% of university teachers are developed, 40.7% are partially developed and 3.6% are poorly developed. Similarly, it was determined that some sociodemographic variables such as age group and area of knowledge were significantly associated with the level of development of digital skills (p<0.05). It was concluded that university teachers were characterized by having digital skills developed in the post-pandemic context, which were more favorable in younger teachers and whose area of knowledge was Engineering and Architecture. Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.

Multiscale Fractal Shape Cues Support Hierarchical Maturation Of Podocytes Via Curvature induced Extracellular Matrix Patterning

Purpose/Objectives: Nature efficiently self-organizes cells and tissues into complex fractal forms. Whether fractal patterning contributes functionally to maturation, and how cells sense and interpret such shape cues, is not well understood. Methodology: Using kidney podocytes as a model system, bioinspired templating of glomerular histology was leveraged to design controlled fractal 21/2 -D surfaces for cell culture. Results: Microcurvature was associated with charge density gradients in space, found to direct extracellular matrix protein organization resulting in hierarchical assembly of cell structures and fractally-branching podocyte morphology in vitro, that was delineated clearly in vitro with a novel highresolution fluorescent assaying technique. Shape stimulation was uniquely associated with development of mature-like foot processes and organized ECM. In applications of drug testing, coronavirus infection, and a cells-as-sensors approach to patient serum diagnostics, fractally stimulated cells were more responsive than flat cultures. Conclusion/Significance: Fractal frameworks may thus provide a functional role in podocyte maturation and could serve to advance other bioengineered systems.

Net treatment benefit of OSE2101 in HLA-A2+ non-small cell lung cancer (NSCLC) patients after failure to immune checkpoint inhibitors (IO) in phase III Atalante-1 randomized trial

Background: OSE2101 (Tedopi) is an anticancer vaccine that increased overall survival (OS) (HR 0.59, p=0.017) versus Standard of Care Chemotherapy in the population of interest (PoI N=118) of patients with IO secondary resistance after sequential CT-IO (ESMO 2021 #47LBA). The Net Treatment Benefit (NTB) is an original method combining efficacy and safety endpoints to test the overall improvement in health outcome between 2 treatments (Buyse M. Stat Med 2010). NTB was assessed in the overall population (N=219) from whom OS improvement of OSE2101 (HR 0.86, p=0.35) was lower than in PoI. Methods: NTB was tested by comparing prioritized outcomes using Generalized Paired Wise Comparisons (GPC). The prioritized outcomes were OS, then time to worsening ECOG (threshold=2 months) followed by severe adverse events, progression free survival (shorter vs. longer than 2 months) and Quality of Life (threshold=5 points on Global Health Status of EORTC-QLQC30). Analysis was stratified using the 3 strata of the study (histology, best response to 1rst line, line of prior IO) and enrollment time (before vs during COVID-19). Sensitivity analyses used no stratification, different thresholds of clinical relevance and PoI. Results: In the primary analysis (1088 pairs), NTB was 19% and reached statistical significance in favor of OSE2101 (p=0.035). In unstratified analysis (11120 pairs), NTB was 11% (p=0.188). In the PoI (388 pairs), NTB was 22% (p stratified=0.074) and 28% (p=0.014) in unstratified analysis (3040 pairs). Although the primary analysis was statistically positive, results were not consistent in some sensitivity analyses due to the limited sample size and the impact of stratification factors. Conclusions: An overall improvement in health outcome was observed with OSE2101 in the overall population of advanced NSCLC after IO failure with a NTB of 19% over SoC. In PoI with IO secondary resistance after CT-IO, the NTB was 22%. Post-hoc analyses are ongoing intended to explain the variability of NTB and will be detailed. Clinical trial identification: EudraCT: 2015-003183-36;NCT02654587. Editorial acknowledgement: We thank Pierre Attali (Medical Expert, MD) for his support in the writing of the . Legal entity responsible for the study: Ose Immunotherapeutics. Funding: Ose Immunotherapeutics. Disclosure: M.E. Buyse: Financial Interests, Personal, Officer, Chief Scientific Officer: IDDI;Financial Interests, Personal, Invited Speaker, Board Member: CluePoints;Financial Interests, Personal, Stocks/Shares: IDDI, CluePoints. F. Montestruc: Financial Interests, Personal, Member of the Board of Directors, CEO of the Company: eXYSTAT SAS;Financial Interests, Institutional, Other, Statistician Consultant: AbbVie, Biocodex, Geneuro, Gensight, Guerbet, Imcheck, Ose Immunotherapeutics, Pfizer, Takeda;Non-Financial Interests, Personal, Other, Statistician Consultant and Training: Institut Pasteur. J. Chiem: Financial Interests, Personal, Full or part-time Employment: IDDI. V. Deltuvaite-Thomas: Financial Interests, Personal, Full or part-time Employment: IDDI. S. Salvaggio: Financial Interests, Personal, Full or part-time Employment, Working as a statistician: International Drug Development Institute. M.R. Garcia Campelo: Financial Interests, Personal, Advisory Role: Roche/Genentech, MSD Oncology, AstraZeneca, Bristol-Myers Squibb, Pfizer, Novartis, Takeda, Boehringer Ingelheim, Janssen Oncology;Financial Interests, Personal, Speaker’s Bureau: Roche, AstraZeneca, Bristol-Myers Squibb, Pfizer, Novartis, Takeda, Boehringer Ingelheim, MSD Oncology, Sanofi/Aventis, Janssen Oncology, Amgen;Financial Interests, Personal, Other, Travel, Accommodations, Expenses: Roche/Genentech, MSD Oncology, Pfizer. F. Cappuzzo: Financial Interests, Personal, Invited Speaker: Roche, AstraZeneca, BMS, Pfizer, Takeda, Lilly, Bayer, Amgen, Sanofi, PharmaMar, Mirati, Novocure, OSE, and MSD;Financial Interests, Personal, Advisory Board: Roche, AstraZeneca, BMS, Pfizer, Takeda, Lilly, Bayer, Amgen, Sanofi, Mirati, PharmaMar, Novocure, OSE, Galecto and MS . S. Viteri Ramirez: Financial Interests, Personal, Advisory Board: Merck Healthcare KGAA Germany, Bristol Myers Squibb S.A. U, Puma Biotechnology;Financial Interests, Personal, Invited Speaker: Takeda Farmaceutica España SA, MSD de España SA, AstraZeneca Farmaceutica Spain, Roche Farma SA;Financial Interests, Personal, Expert Testimony: Reddy Pharma Iberia SAU. W. Schuette: Financial Interests, Personal, Other, Honoraria: Roche, MSD, Novartis;Financial Interests, Personal, Advisory Role: Roche, MSD, Novartis. A. Zer: Financial Interests, Personal, Invited Speaker: Roche, BMS, MSD, Takeda, Pfizer, Novartis;Financial Interests, Personal, Advisory Board: AstraZeneca, Steba, Oncohost;Financial Interests, Personal, Stocks/Shares: Nixio;Financial Interests, Institutional, Research Grant: BMS. S. Comis: Financial Interests, Personal, Full or part-time Employment: Ose Immunotherapeutics. B. Vasseur: Financial Interests, Personal, Full or part-time Employment: Ose Immunotherapeutics;Financial Interests, Personal, Other, Actions: Ose Immunotherapeutics. R. Dziadziuszko: Financial Interests, Personal, Advisory Board: Roche, AstraZeneca, Seattle Genetics, Pfizer, Takeda, Regeneron, MSD, Bristol Myers-Squibb, PharmaMar, Bayer;Financial Interests, Personal, Invited Speaker: Boehringer Ingelheim, Foundation Medicine;Financial Interests, Personal, Expert Testimony: Novartis;Financial Interests, Personal and Institutional, Invited Speaker: Roche, AstraZeneca, MSD, Amgen, Celon Pharma, Pfizer, Novartis, Brsitol Myers-Squibb, Eli Lilly, Loxo;Financial Interests, Invited Speaker: BeiGene, Ardigen, Ose Immunotherapeutics;Financial Interests, Personal and Institutional, Other, Subinvestigator and ad hoc Consultant: PDC* line Pharma;Non-Financial Interests, Institutional, Product Samples: Novartis, Pfizer, AstraZeneca, Roche;Other, Travel: Roche, Bristol Myers-Squibb, AstraZeneca. G. Giaccone: Financial Interests, Personal, Advisory Board: Novartis;Financial Interests, Institutional, Research Grant: Karyopharm. B. Besse: Financial Interests, Institutional, Funding: 4D Pharma, AbbVie, Amgen, Aptitude Health, AstraZeneca, BeiGene, Blueprint Medicines, Boehringer Ingelheim, Celgene, Cergentis, Cristal Therapeutics, Daiichi Sankyo, Eli Lilly, GSK, Janssen, Onxeo, Ose Immunotherapeutics, Pfizer, Roche-Genentech, Sanofi, Takeda, Tolero Pharmaceuticals;Financial Interests, Institutional, Research Grant: Chugai Pharmaceutical, EISAI, Genzyme Corporation, Inivata, Ipsen, Turning Point Therapeutics. E. Felip: Financial Interests, Personal, Advisory Board: Amgen, AstraZeneca, Bayer, BeiGene, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Glaxo Smith Kline, Janssen, Medical Trends, Merck Sharp & Dohme, Pfizer, Puma, Sanofi, Takeda, Merck Serono, Peptomyc, Regeneron, Syneos Health, F. Hoffmann-La Roche;Financial Interests, Personal, Invited Speaker: AstraZeneca, Bristol Myers Squibb, Eli Lilly, Medscape, Merck Sharp & Dome, Peervoice, Pfizer, Springer, Touch Medical, Amgen, F. Hoffmann-La Roche, Janssen, Medical Trends, Merck Serono;Financial Interests, Personal, Invited Speaker, Independent member: Grifols;Financial Interests, Institutional, Invited Speaker, Clinical Trial: F. Hoffmann-La Roche Ltd, Merck Sharp & Dohme Corp, AstraZeneca AB, Daiichi Sankyo Inc, Exelixis Inc, Merck KGAA, Janssen Cilag International NV, GlaxoSmithKline Research & Development Limited, AbbVie Deutschland GmbH & Co KG, Novartis Farmaceutica SA, Bayer Consumer Care AG, Takeda Pharmaceuticals International, Boehringer Ingelheim International GmbH, Pfizer S.L.U., Amgen Inc, Bristol-Myers Squibb International Corporation (BMS), Mirati Therapeutics Inc;Non-Financial Interests, Leadership Role, President Elect (2021-2023): SEOM (Sociedad Espanola de Oncologia Medica);Non-Financial Interests, Member, Member of ESMO Nominating Committee and Compliance Committee: ESMO;Non-Financial Interests, Leadership Role, Member of Board of Directors and the Executive Committee (2017-Sept 2021): IASLC (International Association for the Study of Lung Cancer);Non-Fina cial Interests, Member of Scientific Committee: ETOP (European Thoracic Oncology Platform). All other authors have declared no conflicts of interest.

Asociación entre alteraciones en el sueño y problemas de salud mental en los estudiantes de Medicina durante la pandemia de la COVID-19

Introduction: Medical students are a population vulnerable to poor sleep quality and sleep deprivation;these problems were accentuated during the COVID-19 pandemic. The objective was to evaluate the association between sleep disturbances and the presence of depression and anxiety in medical students during the pandemic. Materials and methods: Cross-sectional, analytical study in medical students of a private university in Peru. Data were collected from May 22 to June 14, 2020, after 3 months of mandatory social isolation. The Patient Health Questionnaire (PHQ-9;≥ 10), the Generalized Anxiety Disorder (GAD-7;≥ 10) scale and the Insomnia Severity Index (ISI;≥ 8) were used to assess depression, anxiety and insomnia, respectively. Poisson regressions with robust variance were used to calculate prevalence ratios. Results: The prevalence of depression, anxiety and insomnia was 28.5%, 29.5% and 60.1% respectively. It was found that those who had short sleep (RPa: 1.40, CI: 1.05-1.87, p: 0.024), who slept after 2:00 hours (RPa: 2.24, CI: 1.31-3.83, p: 0.003) and who presented insomnia (RPa: 7.12, CI: 3.70-13.73, p: < 0.001) had a higher prevalence of anxiety. Likewise, those who slept after 2:00 hours (RPa: 2.13, CI: 1.24-3.64, p: 0.006) and those who presented insomnia (RP: 8.82, CI: 4.17-18.68, p: < 0.001) had a higher prevalence of depression. Conclusions: Short sleep, bedtime and insomnia are factors associated with the prevalence of depression and anxiety. © 2022 The Authors

Ibero-American consensus on learning outcomes for the acquisition of competencies by medical students through clinical simulation

OBJECTIVE: Our aim was to reach expert consensus on specific learning outcomes (LOs) that can be achieved through clinical simulation aimed at developing the cornpetencies that medical students need to be able to successfully manage patients and assume general clinical responsibilities. MATERIALS AND METHODS: The six-member scientific committee peer-reviewed Spanish reference documentation (in line with the Bologna Process) on required competencies in medical undergraduate students to select an initial set of 16 competencies that could feasibly be developed through simulation and a corresponding set of 75 LOs. Snowball sampling was used to identify candidates for an international panel of simulation experts. Applying a set of pre-defined criteria. 19 panelists from seven Spanish-speaking regions were recruited to participate in a modified two-round Delphi procedure based on electronic questionnaires and aimed at reaching formal consensus on appropriate LOs for simulated medical training. RESULTS: Final agreement between the panelists was high: no mean score fell below 7.26 of a maximum of 9, and all 75 LOs were agreed on. 74 in the first round and only one requiring the second round. The 16 LOs with mean scores in the top 25th percentile were selected as a set of core LOs to attain via simulation. CONCLUSIONS: This Ibero-American consensus on observable and measurable LOs. reflecting competencies that can feasibly be developed via clinical simulation. is a framework that aims at helping medical schools' plans and delivering specific kinds of undergraduate medical training through simulation. It is also proposed in a set of core LOs as a starting point for less experienced schools to design a simulated training program.

[Post-COVID-19 severe cholangiopathy: report of 6 cases]

Coronavirus disease 2019 (COVID-19) is a predominantly respiratory tract infection with the capacity to affect other organs. Liver chemistry abnormalities are a frequent manifestation of COVID-19 but are usually transient. We describe the clinical course and most relevant findings of 6 patients who developed a cholangiopathy after severe COVID-19. The mean age of the patients, 4 men and 2 women, was 56 years and the mean time from COVID-19 diagnosis to diagnosis of cholangiopathy was 138 days. The features most important were the increase of alkaline phosphatase and destructuring and beading of the intrahepatic bile duct in magnetic resonance imaging. Cholangiopathy after severe COVID-19 constitutes a novel entity with unique features and potential for progressive biliary injury and secondary biliary cirrhosis. Further studies are required to understand this disease.

STROKE AFTER COVID-19 ERA: IS THERE A “STROKE WAVE” RESULTING FROM THE PANDEMIC?

Background and aims: The pandemic caused by SARS-COV2 is responsible for a considerable impact on stroke care. During this time many other non-COVID diseases have been neglected. Primary health care centers collapsed in some regions and the control and monitoring of vascular risk factors has been difficult. On the other hand, it is also known that covid infection leads to a certain prothrombotic state that could result in subsequent strokes. Our objective is to evaluate the effect of the SARS-CoV-2 pandemic on stroke unit admission rates. Methods: Temporal admission rates in the stroke unit of a regional hospital were analyzed from 2019, 2020 and 2021. The type of stroke, baseline characteristics and treatments received were recorded. Results: Stroke unit admission rates were similar between 2019 and 2020: 397 and 408 patients respectively. However, in 2021 the number of stroke admission, Ischemic or hemorrhagic, has incremented by more than 30% (p-value 0,005), with 589 attended patients. Hemorrhagic stroke rates were 15.62%, 10.70% and 16.98% in the three years respectively. Conclusions: During the first year of SARS-CoV-2 pandemic the use of health services for neurological emergencies was reduced, included the number of admissions at the stroke unit. However, we are experiencing a significant increase in the number of strokes, which now far exceeds prepandemic levels. It remains to be determined whether the cause of this huge increase in stroke cases is related to suboptimal vascular risks factor control, to COVID-related factors or to optimal population response following stroke campaigns in the region.

People don't give up on pandemic: social protest during lockdown in Cali

This article studies the modalities of social protests that Calelio citizens deployed during the implementation of restrictive measurements of confinement to combat Covid 19 from 17 March to 31 August 2020. The article focuses on describing four aspects of the social protests. First, it describes the collective actors involved in the protest. Second, it analyzes the repertoire of collective actions that calefio citizens developed during the restrictive measurements. Third, it identifies the geographic distributions of the protests;and fourth, its rhythms.

Medical training and death: a descriptive study on the emotional impact in palliative care

Introduction: The social service in palliative care aims for doctors in the last stage of training in the Bachelor of Medical Surgeon to integrate a vision of care towards people who face diseases that limit or threaten their lives. Coping with death represents emotional and existential challenges, however, improve training in palliative care can promote self-competence in working with death. Aim: This study aim to evaluate the self-competence to work with death in undergrate doctors, before and after performing social service in a palliative care unit, as well as depressive symptoms and anxiety symptoms. Method: The emotional and existential dimension of selfcompetence in death work was evaluated in 25 undergrate doctors from two generations of the Rotary social service in Palliative Care of the UNAM Faculty of Medicine, before starting the social service and at the end of it. The spanish versio of Self-competence in Death Work Scale (SC-DWS), the Beck Depression Inventory (IDB) and the Beck Anxiety Inventory (IAB) were used in this study. Descriptive statistics and Student’s t test for related samples were used. Results: In the participants of the 2019 generation, a statistically significant increase was observed in the total score of the SC-DWS, in its existencial and emotional subscales and in depressive symptoms. In the participants of the 2020 generation, a decrease was observed in the total score of the SC-DWS and in the existencial and emotional subscales. Conclusion: This study provides evidence of the relevance of training in palliative care in undergraduate doctors to increase self-competence in death work, especially in highly stressful contexts due to its relationship with death processes such as the COVID-19 pandemic. © 2022, Universidad Nacional Autonoma de Mexico. All rights reserved.

AGRICULTURAL GENETIC RESOURCES AS A SOURCE OF RESILIENCE IN THE FACE OF THE COVID-19 PANDEMIC IN MEXICO †

Background: The COVID-19 pandemic evidenced the fragility of the agri-food sector by affecting the food supply chains which directly depend on the health of its main actors. In this context, countries need to rethink the agricultural production models, considering environmental and human health as priorities to achieve food safety. Aim: Systematically review the state of the art regarding the role of agricultural genetic resources as a source of resilience in the face of events such as the present pandemic as a point of reflection for the identification of opportunities for the restructuring of regional agriculture sensitive to nutrition for health. Methodology: Exhaustive search and analysis of documentary information regarding the effects of COVID-19 on the agri-food sector and the role of agricultural genetic resources in the current pandemic were conducted. Then, through an analysis of the occurrence and association of the main terms addressed in the literature considered, the thematic axes were drawn to address the central discussion of the systematic review. Results: Terms co-occurrence analysis corroborated the relevance and pertinence of the topic addressed. Additionally, the importance of the conservation of agricultural genetic resources and implementation of sustainable agriculture models, as a source of resilience to pandemics, was visualized. The discussion addressed the impact of the pandemic on the Mexican agri-food sector and the restructuring of post-COVID-19 agriculture through the nation and nutrition-sensitive agriculture for health approaches. Implications: The exhaustive analysis of the relationship COVID-19-agricultural genetic resources-health in Mexico highlights the need for the generation of agricultural policies and the increase in multidisciplinary research that favors biodiversity as a source of sustainability, productivity, and health for agroecosystems and the welfare of humanity. Conclusions: A fatalistic scenario for humanity seems to be dissipating in the face of the possibilities of rethinking the economic, social, and agricultural systems from the approaches of the nation and nutrition-sensitive agriculture for health, where, through the responsible use of agricultural resources it is possible to rebuild an agri-food production system with a tendency to resilience to events such as the current pandemic caused by the COVID-19 disease. © 2022 Universidad Autonoma de Yucatan. All rights reserved.

SUCCESSFUL USE OF EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) IN MORBIDLY OBESE PATIENTS

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: In 2020, ELSO published guidelines to assist providers with patient selection for ECMO in COVID ARDS. A BMI > 40 was listed as a relative contraindication for ECMO support without any supporting data in this specific patient population. Two major reports on ECMO patients from France and the ELSO database that included a total of 1118 patients with COVID ARDS, all with BMIs of <37, revealed mortality rates that ranged from 31%-37%. As a result of these publications and the ELSO guidelines mentioned above, multiple centers are using obesity as an exclusion factor for cannulation in COVID-19 patients. Our center in Central Florida used a modified patient eligibility criterion which allowed for patients with BMI >40 to be ECMO candidates. We aim to demonstrate the outcomes and feasibility of using ECMO in ARDS patients with extreme obesity METHODS: Data was collected from the ELSO database outlining outcomes of patients cannulated at Advent Health-Orlando for ECMO due to COVID ARDS between March 2020 – April 2021. The data included only patients with a BMI > 40. Data collected included age, length of stay, survival, discharge disposition, and expiration RESULTS: We have cannulated a total of 33 morbidly obese patients (BMI >40). 19/33 (57%) have survived and transitioned to either home, long-term acute care facility, rehab, or original referring hospital. 11/33 (33%) expired while on ECMO, 1/33 (3%) expired post-ECMO, resulting in an overall mortality of (12/33) 36%. The average LOS for all patients was 39.9 days. The survival group had an average LOS of 46.1 days. The average age for our cohort was 41 years CONCLUSIONS: It is our experience at Advent Health Orlando, that providing ECMO support to patients with BMI >40 has similar outcomes to patients who are not morbidly obese, our 59% survival rate compares to 60% in the ELSO historical database. Our 36% mortality rate compared to a range of 31-37% reported in the recent literature for COVID ARDS. Based on our results, we suggest that BMI > 40 be removed as a relative contraindication to ECMO. We also urge other centers to re-consider denying morbidly obese patients ECMO support based on the assumption that they may have a worse outcome than the rest of the population CLINICAL IMPLICATIONS: Based on our data, we demonstrate patients with COVID-19 ARDS with BMI > 40 benefited from ECMO support. In order to effectively ventilate morbidly obese patients, higher plateau pressures are required and may result in barotrauma and hemodynamic compromise. Supporting obese patients with ECMO to maintain protective lung settings can ultimately lead to better long-term outcomes. More data is needed to fully assess the survivability and overall quality of life in morbidly obese patients who are placed on ECMO, however, while this information is collected, we hope that the medical community will start offering the same opportunities to all patients regardless of weight DISCLOSURES: No relevant relationships by Nicholas Cavarocchi, source=Web Response No relevant relationships by Sergio Ramirez, source=Web Response No relevant relationships by Mai Vo, source=Web Response

Changes in the ambulatory care of prostate cancer patients during the SARS-CoV-2 pandemic. Literature review and contribution of our group in telematic care.

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has brought about changes in the management of urology patients, especially those with prostate cancer. The aim of this work is to show the changes in the ambulatory care practices by individualized telematic care for each patient profile. MATERIALS AND METHODS: Articles published from March 2020 to January 2021 were reviewed. We selected those that provided the highest levels of evidence regarding risk in different aspects: screening, diagnosis, treatment and follow-up of prostate cancer. RESULTS: We developed a classification system based on priorities, at different stages of the disease (screening, diagnosis, treatment and follow-up) to which the type of care given, in-person or telephone visits, was adapted. We established 4 options, as follows: in priority A or low, care will be given by telephone in all cases; in priority B or intermediate, if patients are considered subsidiary of an in-person visit after telephone consultation, they will be scheduled within 3 months; in priority C or high, patients will be seen in person within a margin from 1 to 3 months and in priority D or very high, patients must always be seen in person within a margin of up to 48 h and considered very preferential. CONCLUSIONS: Telematic care in prostate cancer offers an opportunity to develop new performance and follow-up protocols, which should be thoroughly analyzed in future studies, in order to create a safe environment and guarantee oncologic outcomes for patients.

First COVID-19 pandemic wave in Peru: Purchase of staple products, knowledge, infodemic and associated factors

At the beginning of the pandemic, an excessive purchase of some products was observed, but this has not been evaluated if it is related to mental health. Therefore, the objective was to determine the factors associated with the purchase of basic necessities in the Peruvian population at the beginning of the first wave of the COVID-19 pandemic. An analytical cross-sectional study was carried out, based on a secondary data analysis. Information from 3379 Peruvians from all regions was used, they were asked about the purchases they made, crossing these with the results of the "KNOW-P-COVID-19", "F-COVID-19" and "MED-COVID-19" scales;obtaining descriptive and analytical results. The most purchased products were disinfectant (43.9%), followed by soap (43.6%) and alcohol (40.8%). In the multivariate analysis, the purchase of disinfectants (p=0.009), soap (p<0.001) and alcohol (p=0.002) was found to be associated with sex;the purchase of personal protective equipment (p=0.027), antibacterial gel (p=0.010) and face masks (p=0.015) was associated with age;to the fatalism score the purchase of food (p=0.005), personal protective equipment (p<0.001), soap (p=0.014), alcohol (p=0.043) and face masks (p<0.001);to the score of fears and concern conveyed by the media the purchase of personal protective equipment (p=0.007), soap (p<0.001) and face masks (p=0.005) and to the score of knowledge of the disease the purchase of soap (p<0.001), antibacterial gel (p=0.011) and toilet paper (p=0.009). Significant associations were found with the purchase of supplies (p<0.011). © 2021 Instituto de Altos Estudios de Salud Publica. All rights reserved.

Recommendations for the diagnosis and management of persons with suspected vaccine-induced immune thrombotic thrombocytopenia (VITT)

In recent months, rare cases of thrombosis at unusual sites associated with thrombocytopenia, occurring within a typical risk window (i.e., 4-28 days) after receiving SARS CoV2 vaccines, have been reported. Healthcare professionals should be prepared to detect these cases on time. The Expert Panel of the Knowledge Management and Transfer Network conducted a free search of the related literature. With the available information and the clinical expertise of the working group, we formulated, reviewed, and endorsed recommendations for the timely suspicion, diagnosis (case definitions, the use of initial laboratory and imaging tests, specific tests), and management of these thrombotic conditions. This document is considered a living document that will be updated as new evidence emerges, and recommendations may change over time.