Lung scintigraphy with SPECT/CT in the assessment of post COVID-19 respiratory complications

Aim/Introduction: The evolution of the COVID-19 pandemic has led to the appearance of a spectrum of pulmonary parenchymal and vascular pathology related to the disease, including the development of fibrosis and chronic thromboembolic disease. The aim of this study is to assess the utility of lung scintigraphy with SPECT/CT in the respiratory complications in post-COVID patients. Material(s) and Method(s): Retrospective-prospective study that included 55 consecutive patients aged 27 to 84 years (55+/-11 y.o., 31 women) from April/2020 to January/2022, from two nuclear medicine centers in Uruguay and one in Argentina. Patients presented with dyspnea (n=52), chest pain (n=1), right heart failure (n=1) or O2 desaturation (n=1). Lung scintigraphy with 99mTc-MAA included planar images and SPECT/CT of the chest. Twenty-three patients underwent ventilation scintigraphy with 99mTc-DTPA. All the patients had a negative RT-PCR test for SARS CoV-2. Result(s): Most common risk factors included age > 55 years in 29 patients, diabetes in 10, obesity in 18 and hypertension in 30. Nine patients had asthma or COPD. Thirty-eight patients required hospitalization (8 in moderate care, 23 in ICU). All patients required O2 and received thromboprophylaxis during the illness. Only 4 patients had D-dimers, elevated in all of them. Six patients had Doppler ultrasound, negative in all of them. Seven patients had previous CT angiography, positive in 2. SPECT/CT was positive for pulmonary embolism (PE) in 10 patients (18%). Nine of them had ventilation studies. All presented typical segmental and/or subsegmental V/Q mismatches predominantly in the upper lobes and middle lobe. Thirteen patients (24%) presented matched defects, 11 of them with structural alterations on CT. CT abnormalities consisted of a reticular pattern with ground glass areas, consolidation foci and bilateral bronchiectasis. Two patients presented pleural effusion and 1 pericardial effusion. 3 patients with mismatched defects associated CT alterations. In clinical follow-up, all patients positive for PE were anticoagulated and improved after treatment. None of the patients presented PE during the acute phase of the disease. Conclusion(s): SPECT/CT lung scintigraphy is a useful tool to identify PE in patients with post-COVID syndrome. Beyond its advantages in the detection of small-vessel defects and the evaluation of chronic PE compared to CT angiography, the hybrid technique can demonstrate persistent pulmonary alterations that may explain the symptoms, separating the hemodynamic sequelae of deconditioning from limitations related to respiratory dysfunction in a new clinical situation that has the potential to become a public health problem.

Ecoguided ablation with foam: an alternative to the treatment of venous insufficiency in time of pandemic

BACKGROUND: Venous insufficiency has well-defined symptoms with repercussions at the socioeconomic level. The covid pandemic decreed in March 2020 the confinement of the population, leading society to a sedentary lifestyle and weight gain, with aggravation of venous symptoms. Objective(s): To treat patients who did not respond to medical treatment in times of covid, with echo-guided foam ablation of the lesser saphenous vein. METHOD(S): It is an observational, prospective and intervention study. Patients were studied from June to September 2020. Inclusion criteria: all patients who presented symptoms and who presented reflux in the small saphenous vein during the venous Doppler study, greater than 0.5 s and a diameter greater than 4 mm and less than 7 mm. Exclusion criteria: patients who refused to participate in the study, presence of insufficiency of the great saphenous vein with transfer of reflux to the system of the small saphenous vein and those who had an ABI<0.8. RESULT(S): Four hundred patients were studied, 74% were women, with an average age of 57.6. The insufficiency of the lesser saphenous vein was found in 122 (29%), 68% were female;14.7% of the patients did not respond to treatment, and ultrasound-guided sclerosis was performed with foam. At seven days control, 83.3% of patients had the lesser saphenous vein occluded;at fourteen days, 93% of patients had the vein occluded;and 73.3% had the vein with total occlusion at one-year ultrasound control. CONCLUSION(S): Athermal ablation has been found to be a good method for treating small saphenous vein insufficiency, it can be performed in the office without complications. Copyright © 2022 EDIZIONI MINERVA MEDICA.

Case-Based Learning and Flipped Classroom for Teaching Administrative Processes

In times of confinement due to the COVID-19 pandemic, it was necessary for teachers and students to change the way they teach and learn;in that sense, this research work presents an experience of the application of Case-Based Learning and the Flipped Classroom. The work was applied with 26 students from the Professional School of Political Science and Governance of UNAMBA. The applied methodology was as follow: first, videos of 5 case studies were delivered to the students before the class session;second, in the class session each case was presented and analyzed;and third, the students created a video summary of the case to socialize with the other classmates. Subsequently, a 16-question satisfaction questionnaire was applied with 3 related factors: benefits of the Flipped Learning, use of videos, and collaboration and communication. Finally, the results show that 96.1% achieved positive evaluations in which the participants show their satisfaction with this applied strategy.

Considerations for Radiation Safety Professionals to Prepare and Respond to the Next Pandemic.

ABSTRACT: The Health Physics Society's stated mission is "excellence in the science and practice of radiation safety." Why, then, should we discuss disease outbreaks, epidemics, and pandemics with radiation safety professionals? The answer is simple: all workers are impacted by infectious diseases-and, as safety professionals, we will inevitably be called upon to prepare for and respond to these events. The COVID-19 pandemic has disrupted every facet of life, including home, school, work, and leisure. Moreover, virtually all radiation safety professionals have been impacted by the pandemic either personally, academically, or professionally. Even if radiation safety professionals were not involved directly with COVID-19 response, they were impacted by school closures, remote schooling and work, testing regimes, temperature screenings, vaccination programs, and so forth. However, many radiation safety professionals have been intimately involved in COVID-19 response through activities such as the deployment of personal protective equipment, directional airflow verification for isolation areas, disinfection and decontamination efforts, the design and layout of testing and vaccine centers, and in many other ways. Yet, it is likely that many radiation safety professionals have not received formal training in epidemiology, disease control, or other related topics, and thus may not be attuned to the key aspects to consider when the next pandemic emerges-and it will.

Predominance of cheapfakes in social networks Technical complexity and textual functions of disinformation checked in Argentina during 2020

Research on disinformation concentrates a growing interest in the design of deepfakes and the possible political, economic and social implications of their viral dissemination on social networks. However, as much or more worrying are the cheapfakes: the hoaxes created by the users themselves through the native features of their mobile devices, the rude manipulation of pre-existing files or the simple addition of text that alters the original meaning of the shared messages. The objective of this research is to analyze the degree of technological complexity of the disinformation that circulated in Argentina during 2020 throughout social networks, as well as the role that the text played in its creation. For this, a content analysis is applied to a corpus made up of the 201 denials referring to the disinformative material that was released during that year by the fact-checking platform Chequeado, the only one accredited by the International Fact-Checking Network in the country. With the results we propose a curve of technical complexity of disinformation that shows the absolute predominance of hoaxes associated with very low, low or medium digital skills. This proves that cheapfakes are much more popular on social media than those desinformative content created professionally or through artificial intelligence. In addition, it is found that falsehoods are essentially created through captions or the insertion of text in the images, whose main function is to disinform about events or specific facts through the dissemination of wrong data or the omission of other true ones.

Scare to destabilise: disinformation about COVID-19 in Argentina and Spain

Disinformation about the COVID-19 pandemic has reached such a magnitude that the situation has been described as infodemic. The aim of this research is to analyze the intentions of such disinformation on social networks and its relationship with the sources, topics, main actors, and emotional appeals of the hoaxes. To this end, we conducted a content analysis on the 548 pandemic-related disinformation published between 1January 2020 and 30 June 2021 by the fact-checking media platforms Chequeado, in Argentina, and Newtral, in Spain. The results show that disinformation about COVID-19 has similar characteristics in both countries, except in sources' case, which is consistent with the transnational nature of the infodemic. The hoaxes seek, above all, to destabilise;negationism is the most frequent issue;the most common protagonists are health institutions and professionals, and negative emotional appeals prevail, especially anger, used with polarizing objectives, and fear, whose incorporation pursues destabilising and chaos-fuelling purposes. The appeal to positive emotions is reserved, for fake content with reputational or informative objectives. Furthermore, a statistical correlation is observed between the inferred intention of disinformation and the rest of the variables. The findings of this study lead to the conclusion that the infodemic had the same transnational character as the pandemic, which would suggest that disinformation on a global agenda item uses shared parameters for its propagation in different scenarios.

The impact of COVID-19 upon student radiographers and clinical training in Latin America.

INTRODUCTION: This study aimed to identify the impact of the COVID-19 pandemic upon radiography education across Latin American countries. METHODS: A survey containing 20 questions was circulated to radiography students, across 13 universities in 11 countries of Latin America using Google Forms. The survey contained open and closed questions. Answers were analysed with descriptive statistics and the methodology of interpretative phenomenological analysis for the open answers. RESULTS: Of the 1310 responses only 23.9% (n = 313) of students reported attending clinical placements and from this cohort only 8.9% (n = 28) became infected with COVID-19. In response to how the pandemic had impacted upon the students' academic progression, the most common topic in the open answers was "Concerns about the lack of clinical training", mentioned by 629 students. Students in middle and later years of their radiography education expressed the greatest concern about future clinical placements. Almost all radiography students (95.2%/n = 1247) indicated that their main concerns regarding COVID-19 infection while undertaking clinical placements was in relation to the risk of infecting their families as most students stated they cohabited with relatives (86.6%/n = 1134). CONCLUSION: Compared to European findings co-habitation trends increased anxiety related to infection and impacted their mental health. Students expressed concern about the quality of education they were receiving during the pandemic and access to resources to facilitate on-line learning was inadequate. Socio-economic and internet connectivity factors specific to Latin America were identified and these issues need to be addressed if on-line education is required in the future. IMPLICATIONS FOR PRACTICE: The COVID-19 pandemic has impacted Latin America and this study identifies the implications for radiography students related to their clinical and academic training and highlights factors which require consideration to support radiography students as the pandemic continues.

Takotsubo cardiomyopathy due to hemophagocytic lymphohistocytosis secondary to COVID-19 pneumonia

Case Report Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal disease characterized by excessive immune response and cytopenia. Severe COVID-19 infection induces a life-threatening inflammatory syndrome associated with intense cytokine release that similar to HLH. We present a patient who developed takotsubo cardiomyopathy due to HLH. Case 24-year olrd man with a past medical history of obesity was admitted at the medical intensive care unit (MICU) due to acute respiratory distress syndrome secondary to COVID- 19 pneumonia. During the MICU stay, the patient required a high dose of vasopressors and ventilatory support. For Covid management, the patient received tocilizumab, high dose steroids (20 mg daily of dexamethasone), and empiric antibiotic coverage with vancomycin and cefepime. On day six of MICU admission, the patient developed hypertriglyceridemia (TGL) that was initially thought to be secondary to propofol, but after discontinuing propofol the patient continued to have increasing TGL levels. On day 8 of MICU admission, the suspicion of HLH increased, HSscore was calculated, and the patient had a 70-80% probability of having HLH (181 points: Temperature of 103 °F, ferritin 2580 ng/ml, TGL:771 mg/dl, Fibrinogen 220 mg/dl, AST:116 u/L). On day 10 of MICU admission, troponins increased from 7.5 to 2,966 ng/L, telemetry showed diffuse ST elevations, but ECG did not show any ischemic changes. At that time, his clinical parameters included HR: 96 bpm, BP: 92/42 mmHg, O2 Sat:93% on mechanical ventilation with pressure support FIO2: 100%, Hb: 11.6 g/dl, WBC:10.36 k/dl, Plt: 210 k/dl. Acute stress cardiomyopathy secondary to HLH was suspected. Transthoracic echocardiogram demonstrated preserved ejection fraction and inferoapical akinesia consistan as takotsubo cardiomyopathy. On day 11 of MICU admission, the patient had a cardiac arrest and after 30 minutes of cardiopulmonary resuscitation no return of spontaneous circulation was achieved. Discussion HLH induces a cytokine cascade that causes an excessive inflammatory response and multi-organ dysfunction that can be secondary to infections such as Covid-19. Takotsubo cardiomyopathy also known as stress cardiomyopathy, is a reversible dysfunction characterized by acute hypokinesia/ akinesia of the apical and middle segments of the left ventricle that extends beyond a unique coronary territory. We conclude that the trigger for takotsubo cardiomyopathy in this case was related to excess catecholamine release secondary to HLH.

Thrombus or vegetation? The importance of following the duke criteria for infective endocarditis before proceeding with advanced cardiac imaging

Case Report We present a case of a middle-age male who based on the Duke criteria (DC), we were able to rule out infective endocarditis (IE) before proceeding with advanced imaging. Case We present a case of a 51-year-old man with past medical history of heroin and cocaine use disorder, that was admitted to the intensive care unit (ICU) becouse COVID-19 pneumonia. On day 1 of admission, transthoracic echocardiogram (TTE) showed moderate tricuspid regurgitation. In the ICU, blood cultures (BC) were positive for Staphylococcus coagulase-negative species, patient received a course of vancomycin for 7 days. On day 17, the patient had repeat TTE, which showed new nodular thickening of the tricuspid valve associated with tricuspid regurgitation. BC were sent that same day, and they grew out Staphylococcus coagulase-negative species. At that time, it was not clear if new tricuspid valve findings were secondary to vegetation or a thrombus. The DC for infective endocarditis was applied to determine whether the findings on the TTE were due to IE. Major criteria include positive blood cultures and findings of vascular vegetation on echocardiography. After analyzing the BC and meeting with the microbiology personnel, it was found that the Staphylococcus coagulase-negative species found were different from each other. However, there was a possible vegetation present, shown on echocardiography. The patient had predisposing heart condition of tricuspid regurgitation and a history of IV drug abuse. Fever was absent. As for vascular phenomena, the patient did not have skin changes and no pulmonary embolism was found following chest CT protocol. As for immunologic phenomena, the patient did not have Roth spots or glomerulonephritis. Lastly, for microbiological evidence, the patient's blood cultures were possibly positive due to contamination. Based on the DC the patient had a possible diagnosis of IC but it was rejected because a patient had a firm alternative diagnosis, mainly a ventricular thrombus. The patient received anticoagulation treatment for thrombus, and he was discharged on his 24th day of hospitalization without complications. Discussion The diagnosis of IE remains difficult due to low specificity of the laboratory and imaging tests. Our patient had all the risk factors to believe it was endocarditis instead of a thrombus. Based on the DC, endocarditis was ruled out and the patient responded well to anticoagulation. More studies are needed to clarify the utility of the DC as a method to differentiate IE from thrombus before proceeding with advanced imaging.

Cough and Dyspnea in 2021: A Case of Asthma, COVID-19, or.?

Background: COVID-19 has changed the perspective through which medical staff look at dyspnea and hypoxemia cases. Epidemiological links are frequently missing, and clinical and imagological findings are often unspecific, overlapping substantially with other respiratory infections. Case summary: We report the case of an 11-year-old girl with a known history of asthma who had recently moved from Guinea-Bissau with her mother. Although the mother reported being Ag HBs positive, no serologic studies had ever been performed on the child. The patient was admitted to the Emergency Room after 4 days of cough and the feeling of thoracic oppression, without fever. No contact with suspected or confirmed individuals infected with SARS-CoV-2 or other respiratory viruses was reported. She presented with peripheral oxygen saturation of 90%, costal retractions and a prolonged expiratory phase. After an unsuccessful course of bronchodilators and prednisolone, she was admitted to the Pediatric Intermediate Care Unit because of a sustained need for oxygen therapy. Polymerase chain reaction analysis for SARS CoV-2 came back negative. A chest radiograph displayed a bilateral reticular infiltrate, and therapy with azithromycin was started. Due to a deterioration of the dyspnea, a chest tomography was eventually performed, revealing an exuberant and bilateral ground glass-like densification suggestive of alveolar injury. Echocardiogram and e electrocardiogram were both normal. After a positive serologic result for HIV, the patient was transferred to a Level III hospital, and Pneumocystis jirovecii was identified in bronchoalveolar lavage. T cell count was 12/mm3. Highly active antiretroviral therapy and cotrimoxazole were started, prompting clinical and analytical recovery. Discussion: Pneumocystis jirovecii can cause fatal pneumonia in immunocompromised children. Even though an asthma exacerbation and atypical bacterial or viral infections, namely COVID-19, present as more usual causes of dyspnea, a low suspicion index is warranted in children coming from HIV-endemic countries, particularly those who are unresponsive to conventional bronchodilator and antibiotic therapy.

Dynamics of insecurity and violence during the pandemic in Colombia

The purpose of the following article is to present the main dynamics of criminal activities and violence produced by the armed conflict in Colombia during the pandemic caused by COVID-19. After a review of the most relevant literature produced in 2020, this study presents trends in criminal violence, lato sensu, and those associated with the internal armed conflict. The situation of paralysis that the confinement produced has not translated into a mitigation of the phenomenon of violence. Thus, the massacres and murders of social leaders, activists, human rights defenders or ex-guerrillas of the FARC-EP has remained constant if not increasing during this time. This must also be related to a context of difficulty added to a Peace Agreement signed with the FARC-EP in November 2016. This must also be related to a context of added difficulty to a Peace Agreement signed with the FARC-EP in November 2016, which, in addition to governmental resistance and non-compliance, is overcome by an increasingly intense violence, which hinders the prospects of a peace-building scenario in the country.

Thymic Epithelial Tumors: The Importance of Invasive Investigation to Adequate Diagnosis

Introduction: Thymic epithelial tumors (TET) are the most common neoplasms of the anterior mediastinum. The incidence of this disease is extremely low, and there is little data on the Brazilian context. This study aims to describe the experience from PUCRS's Sao Lucas Hospital Thoracic Surgery team on mediastinal tumor resections (MTR) during the investigation of TET. Methods: The Thoracic Surgery team from PUCRS's Sao Lucas Hospital maintains a prospective database with the Brazilian Thoracic Surgery Society. Data from patients who underwent investigation for TET within 2016 and 2020 were collected from medical records in March 2021. Descriptive analyses were performed on this data. We used the classification proposed by the World Health Organization (2004) to classify all cases found. Results: There were 90 MTR performed on a total of 87 patients between 2016 and 2020. Of these, 56 (64.36%) were female, and the average age was 54.28. Among performed MTR, 11 (12.22%) were due to TET, being 10 (11.11%) by thymoma and 1 (1.11%) by thymic carcinoma. From the 10 cases of thymoma, 7 (70%) were female, and the only patient diagnosed with thymic carcinoma was male. Of the 11 patients diagnosed with TET, the average age was 56. According to the TET classification used, 1 (9.09%) was type A, 5 (45.45%) was AB, 1 (9.09%) was B2, 1 (9.09%) was B3, 1 (9.09%) was C (thymic carcinoma was classified as type C), 1 (9.09%) classified as types B1 and B2, and another (9.09%) as types AB and B3. Among 10 cases of thymoma, 2 (20%) had myasthenia gravis (MG). Immediate postoperative mortality was zero. During yearly follow-up, only 1 (9.09%) patient had a recurrence of disease, and 1 (9.09%) died. It is important to highlight that from all 90 MTR performed, 80 (88.88%) occurred between 2016 to 2019 (18 in 2016, 16 in 2017, 21 in 2018, 25 in 2019), resulting in an average of 20 RTM per year. However, in 2020, only 10 (11.11%) RTM were performed, showing a significant reduction during the first year of the COVID-19 pandemic in Brazil. Conclusion: Our data converge to what is shown in the literature since a small portion of patients who underwent MTR had a thymoma diagnosis and only one had a diagnosis of thymic carcinoma. The most frequent type was AB. Studies demonstrate that 30-65% of patients with thymoma also have MG. On the other hand, our sample shows 20%. It is essential to emphasize the reduction in the number of procedures during the Sars-CoV-2 pandemic in 2020. Keywords: thymic carcinoma, thymoma, thoracic malignancies

GRUPO ABO E A SUSCETIBILIDADE A INFECÇÃO POR SARS-COV-2: UMA REVISÃO DE LITERATURA

Objetivo: O presente estudo buscou analisar a suscetibilidade pela infecção por SARS-CoV-2 entre a tipagem sanguínea com base em estudos publicados. Introdução: O SARS-CoV-2 é um vírus pertencente à família dos Coronaviridae, tendo o RNA como seu material genético, que leva ao desenvolvimento da doença COVID-19. O novo coronavírus foi detectado pela primeira vez em dezembro de 2019 na cidade de Wuhan, China, tornando-se uma pandemia acometendo até agosto de 2020, 215 países. Neste sentido, a busca por entender os mecanismos e/ou suscetibilidade frente a infecção por este vírus, se tornou prioridade entre os pesquisadores do mundo, sugerindo então uma correlação entre o sistema ABO frente a infecção por SARS-CoV-2. Metodologia: Foi realizada uma revisão da literatura com base em artigos indexados nas plataformas: Pubmed e medRxiv, no ano de 2020. Ao final da aplicação dos critérios de exclusão para seleção dos artigos, foram selecionados 17 estudos. Resultados e discussões: Mesmo com a escassez de estudos, o que é justificável por se tratar de um novo vírus, as pesquisas apontam que o tipo A é o mais susceptível e o grupo O menos susceptível, todavia, a gravidade quanto ao risco de óbito está associado ao tipo AB. Até o presente momento não se sabe ao certo o porquê o SARS-CoV-2 é menos susceptível ao grupo O. Hipotetiza-se que o anti-A desse grupo é capaz de interferir na ligação entre a proteína Spike com o receptor da enzima conversora angiotensina 2 (ACE2), mecanismo este visto na infecção por SARS-CoV-1. Outro fato que pode ser considerado é em relação a neutralização que os anticorpos anti-A e/ou anti-B podem exercer em infecções virais semelhantemente visto nas infecções por HIV, que poderia neutralizar também o SARS-CoV-2. Conclusão: Em suma, nota-se que o tipo sanguíneo O apresenta uma menor suscetibilidade diante a infecção pelo novo coronavírus, porém, não há nenhum estudo que elucide de qual forma o SARS-CoV-2 se porta diante o grupo ABO, fazendo então a necessidade de pesquisas para esclarecer este processo.

Risk perception and the impact of the sars-cov-2 (Corona virus) pandemic on rheumatic diseases in Mexico

Objectives: To describe risk perception and its relationship with sources of information consulted, actions, and the impact of the pandemic on the physical and mental health as well as social aspects of a group of patients from the rheumatology consultation. Methods: A survey was conducted from August 10 to November 29, 2020 in rheumatic diseases (RD) patients who returned to an outpatient clinic in Mexico following the Stay at home program implemented from March 23 to July 31. An online questionnaire was administered on mobile devices. Measurements: Assessment of the patient's health status by rheumatologist (visual analog scale ranging 0-10) and some sections of the UNIV-COVID-19 questionnaire. A descriptive analysis was performed. Measures of central tendency and dispersion for continuous variables and frequency measures for categorical variables. Normality was checked with the Shapiro-Wilk test. Inferential statistical tests were performed to determine differences between the COVID-19 + vs -groups with Chi-square and Student's t test for nominal and continuous sociodemographic variables, respectively. Logistic regressions were performed. Results: A total of 471 patients with RD were included, 84.5% women, aged 46.9 (SD 14.5) years old;rheumatoid arthritis (RA) was the most prevalent diagnosis 42.4%. 4.8%had SARS-CoV-2 infection, 21.74% required hospitalization. Treatment modification was reported in 36.1% (66.6% discontinued);health condition worsened in 39.1% of the patients. 52.1% of the patients who made modifications in their treatment had COVID-19 and 39.1% of those who had COVID-19 reported that their health condition worsened. The perception of risk was 85.9% (very serious/serious). The preventive action carried out was home isolation 44.3%. Television was consulted 88.7%and alert 74.5%the most prevalent feeling, while 7% said they felt discriminated. The logistic regression analysis revealed that having SpA, taking leflunomide, feeling discriminated, and greater perception of risk were associated with having COVID-19. The bimodal results for each variable are presented to indicate the change on action taken per group. Conclusion: The risk perception in RD patients was very high. 5% had COVID-19. The impact on disease activity, physical/mental health was greater in patients with COVID-19. Discrimination of RD and COVID-19 patients is an important phenomenon.

Mortality of COVID-19 in patients with rheumatic diseases: Comparison to the general population in méxico

Background: COVID-19 outcomes in Mexican patients with rheumatic diseases (RDs) in comparison to general population patients are unknown. Objectives: To compare mortality and hospitalization of COVID-19 patients with RDs and those without. Methods: We included for this study all the Mexican patients with RDs and COVID-19 registered from April 17th to October 30th, 2020 in the COVID-19 Global Rheumatology Alliance registry. We compare clinical and demographic characteristics of patients with RDs and COVID-19 to patients with COVID-19 that were selected randomly from the Mexican Epidemiology database (1:3). A logistic regression analysis was performed to adjust for confusion variables. Results: We included 322 patients with COVID-19 and RDs and 969 controls without RDs. Table 1 shows the demographic characteristics and comorbidities of both groups. Bivariate analysis showed that patients with RDs had higher mortality, were older, and were more frequently hospitalized. Comorbidities, such as diabetes, hypertension, cardiovascular and renal diseases were also more frequent in patients with RDs. In the multivariate analysis, having a RD was no longer associated with mortality (Figure 1). Conclusion: Patients with RDs had higher comorbidities, hospitalizations, and mortality than the general population in the bivariate analysis. However, adjusted multivariate analysis showed that the odds for mortality were not increased because of having a RD. These findings suggest that the increased mortality of Mexican patients with RDs may be explained by the higher frequency of comorbidities in this population.

Factors associated with mortality in patients with rheumatic diseases and COVID-19 in Mexico

Background: As of the 25th of January 2021, more than 150 thousand deaths as consequence of COVID-19 have been reported in Mexico [1]. Advanced age, male gender and comorbidities have been described as risk factors for severe disease and mortality in general population [2]. COVID-19 mortality in Mexican patients with rheumatic and musculoskeletal diseases (RMDs) is unknown. Objectives: To describe characteristics of Mexican patients with RMDs and COVID-19, and to analyse factors associated with mortality. Methods: The Global Rheumatology Alliance COVID-19 (GRA) physician reported registry, is an international effort to collect information on COVID19 in adult patients with RMDs. GRA is an observational registry. The first patient from Mexico was registered on April 17, 2020. All Mexican patients registered in GRA until October 30, 2020 were included in this analysis. The association of mortality with demographic and clinical variables was estimated using logistic regression analysis. Results: A total of 323 patients were registered, with a median age of 52 (IQR 41-61) years old, 166 (51.4%) patients lived in Mexico City. The most frequent RMDs were rheumatoid arthritis, 149 (46.1%) and systemic lupus erythematosus, 24 (19.8%). Over a third of patients with RMDs and COVID-19 (119 (36.8%)) were hospitalized, and 43 (13.3%) died. Table 1 shows clinical and demographic characteristics. In the univariable analysis, the absence of comorbidities was a protective factor, OR 0.3 (95% CI 0.1-0.6). Factors associated with mortality at COVID-19 diagnosis were age over 65 years old, having type 2 diabetes, chronic renal insufficiency, treatment at COVID-19 diagnosis with corticosteroids or with CD20 inhibitors. In the multivariable adjusted analysis, these factors remained independently associated with mortality. No associations with other treatments or comorbidities at COVID-19 diagnosis were found. Conclusion: Mexican patients with RMDs and COVID-19 in the GRA physician reported registry had a mortality of 13.3%. Factors associated with mortality were those described in the general population, such as older age and being on corticosteroids and CD20 inhibitors treatment at COVID-19 diagnosis.

Formation of oxidized gases and secondary organic aerosol from a commercial oxidant-generating electronic air cleaner

The COVID-19 pandemic increased the demand for indoor air cleaners. While some commercial electronic air cleaners can be effective in reducing primary pollutants and inactivating bioaerosol, studies on the formation of secondary products from oxidation chemistry during their use are limited. Here, we measured oxygenated volatile organic compounds (OVOCs) and the chemical composition of particles generated from a hydroxyl radical generator in an office. During operation, enhancements in OVOCs, especially low-molecular-weight organic acids, were detected. Rapid increases in particle number and mass concentrations were observed, corresponding to the formation of highly oxidized secondary organic aerosol (SOA) (O:C ∼1.3), with an enhanced signal at m/z 44 (CO2+) in the organic mass spectra. These results suggest that organic acids generated during VOC oxidation contributed to particle nucleation and SOA formation. Nitrate, sulfate, and chloride also increased during the oxidation without a corresponding increase in ammonium, suggesting organic nitrate, organic sulfate, and organic chloride formation. As secondary species are reported to have detrimental health effects, further studies should not be limited to the inactivation of bioaerosol or reduction of particular VOCs, but should also evaluate potential OVOCs and SOA formation from electronic air cleaners in different indoor environments. © 2021 American Chemical Society.