The impact of the COVID-19 pandemic on medical education: adaptability and remote learning experience of the Peruvian American Medical Society

The COVID-19 pandemic had a significant impact on medical care and medical education in Peru. In response, the Peruvian American Medical Society (PAMS), a charitable medical organization based in the USA, pursued its medical and educational missions in Peru by adopting virtual learning technology. We developed closer collaborative relationships with several medical schools and the Peruvian Association of Medical Schools (ASPEFAM) while offering a faculty panel of twenty-four members to provide lectures and multidisciplinary webinars in Spanish. We conducted 19 webinars including COVID -19 and non-COVID-19 related topics that over the last two years attracted 14,489 participants from 23 countries. They were the foundation for twenty publications in Peruvian medical journals. Our clinical investigations competition was positively received as was our pilot project on research mentorship. The COVID -19 pandemic had a positive effect on the educational mission of PAMS in Peru.

Transmission dynamics and associated mortality of nosocomial COVID-19 throughout 2021: a retrospective study at a large teaching hospital in London.

BACKGROUND: The impact of nosocomial SARS-CoV-2 infections has changed significantly since 2020. However, there is a lack of up-to-date evidence of the epidemiology of these infections which is essential in order to appropriately guide infection control policy. AIMS: To identify the secondary attack rate of SARS-CoV-2 infection and associated mortality across different variants of concern. METHODS: A single-centre retrospective study of all nosocomial SARS-CoV-2 exposure events was conducted between 31st December 2020 and 31st December 2021. A secondary attack rate was calculated for nosocomial acquisition of SARS-CoV-2 infection and time to positivity. Positive contacts were assessed for all-cause 30-day mortality. RESULTS: A total of 346 sequential index exposure events were examined, and 1378 susceptible contacts identified. Two hundred susceptible contacts developed SARS-CoV-2 infection (secondary attack rate of 15.5%). The majority of index cases (59%) did not result in any secondary SARS-CoV-2 infection. Where close contacts developed SARS-CoV-2 infection, 80% were detected within the first five days since last contact with the index case. The overall associated mortality among positive contacts across 2021 was 9%, with an estimated reduction of 68% when comparing periods of high Omicron versus Alpha transmission. CONCLUSION: Our findings describe that most SARS-CoV-2 infections are detected within five days of contact with an index case; we have also demonstrated a considerably lower mortality rate with the Omicron variant in comparison to previous variants. These findings have important implications for informing and supporting infection control protocols to allow movement through the hospital, and ensure patients access care safely.

Trends in the parents' intention to vaccinate their children against COVID-19: A comparative study in Peru

Background. Although COVID-19 vaccination has shown to be clearly beneficial in children and adolescents to reduce hospitalization and potentially transmission, there is still a lot of hesitation among parents due to concerns about vaccine safety and efficacy, especially in children under 12 years of age. Methods. We conducted a comparative study in Peru to evaluate the trends in parents' intention to vaccinate their children under 12 years of age against COVID-19, for which an online survey was administered. The survey was distributed through social networks (Facebook, Twitter, etc.), and was applied during two periods: 11/25/2021 to 12/06/2022 (Period 1) and 01/16/2022 to 01/24/2022 (Period 2). We also assessed the factors associated with the intention to vaccinate in each period through crude (cPR) and adjusted prevalence rates (aPR). Results. During period 1, there were 673 participants (69.7% women). In period 2, we had 1139 respondents (77.7% women). Regarding intention to vaccinate, 83.5% of parents intended to vaccinate their children under 12 years of age during period 1. This percentage was almost the same during period 2 (83.3%). During period 1, the factors associated with a decrease in this intention were to believe that the vaccine was not necessary (aPR 0.65;95% CI 0.44 - 0.94, p=0.022), that it would not protect (aPR: 0.14;95% CI 0.03 - 0.63, p=0.011), that it would not be safe (aPR: 0.80;95% CI 0.70 - 0.92, p=0.001), that it could cause long-termside effects (aPR: 0.92;95% CI 0.85 - 1.00, p=0.037), and to think it should not be mandatory (aPR: 0.89;95% CI 0.80-0.99, p=0.038). During period 2, besides the factors identified in period 1, not knowing about COVID-19 infection risk in children (aPR: 0.92;95% CI 0.85-1.00, p=0.042) was also associated with a decrease in the intention. Living on the highlands or jungle was associated with an increase in the intention in both periods. Conclusion. A high rate of intention to vaccinate children under 12 years of age was noted among parents in Peru, which was maintained until the end of January of 2022, right before COVID-19 vaccination started for this age group. There was a perception in some parents that the vaccine might not be necessary or safe, leading to a lower intention to vaccinate their children.

Synthetic Platforms for Characterizing and Targeting of SARS-CoV-2 Genome Capping Enzymes.

Essential viral enzymes have been successfully targeted to combat the diseases caused by emerging pathogenic RNA viruses (e.g., viral RNA-dependent RNA polymerase). Because of the conserved nature of such viral enzymes, therapeutics targeting these enzymes have the potential to be repurposed to combat emerging diseases, e.g., remdesivir, which was initially developed as a potential Ebola treatment, then was repurposed for COVID-19. Our efforts described in this study target another essential and highly conserved, but relatively less explored, step in RNA virus translation and replication, i.e., capping of the viral RNA genome. The viral genome cap structure disguises the genome of most RNA viruses to resemble the mRNA cap structure of their host and is essential for viral translation, propagation, and immune evasion. Here, we developed a synthetic, phenotypic yeast-based complementation platform (YeRC0M) for molecular characterization and targeting of SARS-CoV-2 genome-encoded RNA cap-0 (guanine-N7)-methyltransferase (N7-MTase) enzyme (nsp14). In YeRC0M, the lack of yeast mRNA capping N7-MTase in yeast, which is an essential gene in yeast, is complemented by the expression of functional viral N7-MTase or its variants. Using YeRC0M, we first identified important protein domains and amino acid residues that are essential for SARS-CoV-2 nsp14 N7-MTase activity. We also expanded YeRC0M to include key nsp14 variants observed in emerging variants of SARS-CoV-2 (e.g., delta variant of SARS-CoV-2 encodes nsp14 A394V and nsp14 P46L). We also combined YeRC0M with directed evolution to identify attenuation mutations in SARS-CoV-2 nsp14. Because of the high sequence similarity of nsp14 in emerging coronaviruses, these observations could have implications on live attenuated vaccine development strategies. These data taken together reveal key domains in SARS-CoV-2 nsp14 that can be targeted for therapeutic strategies. We also anticipate that these readily tractable phenotypic platforms can also be used for the identification of inhibitors of viral RNA capping enzymes as antivirals.

Corpus Callosum Lesion Associated With COVID-19-Psychosis

This case report presents a patient with acute onset psychosis in the setting of a COVID-19 infection. Magnetic resonance imaging of the brain was ordered to evaluate for organic etiologies which revealed cytotoxic lesions of the corpus callosum. These lesions can be associated with infectious diseases which cause inflammation. She was treated with an antipsychotic and later also with an antiepileptic. This case demonstrates that COVID-19 can affect multiple systems. Neuropsychiatric symptoms are possible and neuroimaging may be helpful, especially if symptoms are acute in onset. Copyright © 2022 Cliggott Publishing Co.. All rights reserved.

SHARE, TRUST, ORGANIZE, PARTNER, THE COVID-19 CALIFORNIA ALLIANCE (STOP COVID-19 CA): COMMUNITY ENGAGEMENT AS A DISTRIBUTIVE APPROACH TO ADDRESS THE COVID-19 PANDEMIC'S CRISES AND DISPARITIES AMONG CALIFORNIA'S MOST VULNERABLE-HOW WELL DID WE DO, AND WHERE TO GO NEXT?

BACKGROUND: California is the most populous state in the United States (US), with 40 million residents and a global economy that would be the 5th largest. California is also known for dramatic disparities in wealth and healthwith some of the richest and poorest communities in the world just a few miles apart. As such, the traumas of the Coronavirus-19 disease (COVID-19) pandemic have fallen starkly and unevenly across this state. An equitable and just pandemic response calls for a “distributive approach” to close the gaps on these disparate COVID-19 experiences. The National Institutes of Health (NIH) responded in such a way-with the Community Engagement Alliance (CEAL) as an NIH platform for real-time communityengaged COVID-19 strategies. The NIH CEAL asked for the development of state teams to engage communities, and California was one of the first states to answer this call. STOP COVID-19 CA was established in September 2021 to advance equity in COVID-19 research, clinical practice, and public health for California's most under-resourced racial/ethnic minority groups. This study evaluates the early impacts of the Alliance, from the perspective of its participating sites and partnered community-based organizations (CBOs). METHODS: 11 university sites (and their 68 affiliated CBOs) were sent a qualtrics survey in August 2021. We requested at least one academic/CBO response from each of the 11 sites. We conducted a mixed methods evaluation of the responses: analysis of monthly acitivity reports from sites (9/2020-8/ 2021) and summary of their perceptions regarding impact. RESULTS: We received responses from 17 academic investigators and 17 CBOs. In the aggregate, STOP COVID-19 CA partnerships reported >18,000 surveys and 40 focus groups and reached an estimated 25,000 vulnerable Californians in >500 COVID-19 town halls and vaccine events. In the survey, academic and CBOs emphasized that the Alliance expanded community networks and broadened access to culturally specific COVID-19 messaging and vaccine outreach strategies. They noted accelerated knowledge sharing by learning from the successes and challenges of other sites' COVID-19 initiatives. Academic partners described leveraging the STOP COVID-19 CA network as a platform to reach local, state, and federal policymakers. CBOs expressed concerns about bureaucracy delaying funding for timesensitive COVID-19 CBOs-driven initiatives. Both groups also highlighted the potential for the Sustainability of this Alliance and the need for flexible resources to address the health disparities, conditions, and social determinants of health that predispose their communities to high rates and poor outcomes from COVID-19. CONCLUSIONS: STOP COVID-19 CA represents a new and potentially sustainable community engagement model for addressing disparities in multiethnic/multicultural and geographically dispersed communities.

PREFERENCE FOR DIGITAL CBTI: CHANGES DUE TO THE COVID-19 PANDEMIC IN A RANDOMIZED CONTROLLED TRIAL OF CBTI FOR MIDDLE AGED AND OLDER ADULTS

Introduction: Digital CBTI programs are effective at treating symptoms of insomnia. They also have the potential to increase treatment reach, convenience, and affordability for patients, and to reduce long wait times for behavioral sleep medicine providers. The COVID-19 pandemic has instigated an increased reliance on the use of technology for many. Thus, this study evaluates middle aged and older adults before and during the COVID-19 pandemic to assess: (1) differences in treatment modality preference (digital vs. therapist-led CBTI) and (2) sleep-related predictors of treatment modality preference. Methods: Participants were older adults (N=229, 74% female, mean age=63.14) who were enrolled in the RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice (RESTING) study. At baseline, participants rated if they would prefer to access CBTI digitally or with a CBTI therapist, either in person or via telemedicine. After March 2020, in person was no longer listed as an option. Participants completed the Insomnia Severity Index (ISI) and a two-week sleep diary that allowed for an assessment of total sleep time (TST), sleep onset latency (SOL), and wake after sleep onset (WASO). Analyses compared responses to these items from participants completing assessments before March 2020 (Pre- Covid;n=74, 65% female, mean age=62.52) and after March 2020 (During-Covid;n=155, 78% female, mean age=63.44). Results: Pre-Covid, 26% of participants preferred digital treatment, 47% of participants preferred a therapist-led intervention, and 27% did not express a preference. During-Covid, 35% of participants preferred digital treatment, 32% of participants preferred a therapist-led intervention, and 32% did not express a preference. This difference was statistically significant (c2=4.24, p=0.04). Responses were not significantly different between the first six months and the most recent six months of the pandemic (p=0.60). None of the sleep measures (ISI, TST, SOL, WASO) were associated with treatment modality preference in the full sample, Pre-Covid, or During-Covid. Conclusion: The COVID-19 pandemic was associated with increased preference for digital CBTI among patients who are 50 and older, regardless of insomnia severity. Findings suggest that digital CBTI may be an acceptable treatment to many individuals with insomnia, thus increasing its dissemination potential.

Recipe4Health: Preliminary Analysis of an Integrative Approach to Address Social Isolation and Food Insecurity during COVID-19

Methods: This 16-week intervention conducted at community health centers combines integrative group medical visits with produce prescriptions. Participating patients are adults diagnosed with chronic conditions including diabetes, hypertension and depression. Virtual integrative group medical visits meet weekly in Spanish or English with health coach support between sessions. Participants also receive weekly doorstep delivery of fresh vegetables grown using regenerative agriculture. Ongoing mixed-methods data collection includes: 1) semi-structured interviews with program staff and patients, and 2) pre-and post-program patient surveys including the 8-Item UCLA Loneliness Scale and the 6-item USDA short form for household food insecurity. Preliminary quantitative analysis uses mixed-effects models to assess the effects of participation in the combined intervention (N=185). Qualitative analysis uses reflexive thematic analysis (N=35). Results: Qualitative interview data explored program implementation and stakeholders' experiences with Recipe4Health during COVID-19. Patients and staff reported that virtual group visits provided social connection and supported mental health. Weekly produce delivery increased food security and provided access to new and familiar foods. Preliminary quantitative analysis included 185 patients: 83% female;51% Latin, 27% Black;61% spoke English as primary language, 39% Spanish. Average loneliness scores decreased from 5.2 to 4.7 (p<.04), despite notable national inc1reases in isolation and loneliness during COVID-19. While food insecurity doubled nationwide, the proportion of study participants reporting food insecurity or marginal food security decreased from 79% to 54% (p<.01). Background: Food insecurity has been associated with social isolation;both have risen dramatically in the US during the COVID-19 pandemic. This project, Recipe4Health, is implementing and assessing the impact of integrative group medical visits and produce prescriptions for low-income adults with chronic conditions. Conclusion: Combining integrative group medical visits and produce prescriptions can improve key patient outcomes including loneliness and food security in a pandemic context.

Information asymmetry, an obstacle to government support in the time of COVID-19 in Mexico

The COVID-19 pandemic has paralyzed businesses, causing a global economic crisis. In this paper, the support that the Mexican government intends to give to companies that fell into crisis is analyzed. The problem lies in a lack of knowledge of these companies: those that were in crisis before the epidemic and those that went into crisis because of it. To avoid economic and social losses, an asymmetric game is presented, the results show a mechanism to incorporate signals and improve uncertainty. The analysis deduces a threshold that determines a percentage of companies to support, showing that it is optimal to support 46% of the approximately 4 million MSMEs that exist in Mexico. The scarce official information limits the results, in addition to the fact that the model only shows a resource allocation mechanism and not an equilibrium, since the company player only emits an exogenous signal.

The impact of COVID-19 on cancer care in the Latinx community in Northern California: A mixed method community-engaged research study

The COVID-19 pandemic has negatively impacted cancer care including delayed diagnosis, procedures, and patient fears of COVID-19 infection. However, less is known about the impact on specific populations, including Latinx adults, who have been disproportionately affected by COVID-19. Cancer is the leading cause of death among Latinx adults. Alarmingly, they have low participation rates in cancer prevention programs and face multiple barriers in accessing healthcare, even before the pandemic. Rigorous methods and community-engaged approaches are needed to uncover key barriers and facilitators to cancer care across the socio-ecological spectrum and to translate findings into culturally congruent educational strategies and dissemination efforts. The present mixed methods study entails a bi-directional partnership between the Stanford Medicine Office of Community Engagement and Latinas Contra Cancer, a community-based organization increasing equitable cancer care access for Latinxs. This study aims to determine barriers and facilitators of cancer screening, diagnostics, and treatment in the Latinx community as a result of COVID-19 using a community-based survey (n=500) in Northern California. To gain a deeper understanding of the lived experience of Latinxs obtaining cancer-related care during the pandemic, we will conduct focus groups (n=4) with study participants stratified by barriers and facilitators they endorse across the socio-ecological spectrum, as well as by key demographics (e.g., socioeconomic status, nativity, health literacy). Moreover, medical providers and community clinics will be interviewed (n=15) to understand their unique circumstances during this pandemic (e.g., changing healthcare system logistics, telehealth challenges). Data collection is ongoing and expected to be complete by the end of the summer. We will present descriptive data and statistical analysis (e.g., chi-square tests, logistic regressions) exploring associations key sociocultural and demographic participants characteristics and their endorsement of a variety of barriers and facilitators to care. We will also present key themes from the qualitative data to further contextualize survey findings and gain deeper meaning of the complexities of cancer related care during the pandemic. Study findings will allow us to understand the complexity of barriers and facilitators of cancer prevention and care for Latinxs adults, inform the development of health promotion resources, and guide policy and solutions to reduce excess cancer burden for Latinxs communities.

Liponucleotides Improve Gas Exchange in Dogs with Aspiration Pneumonia

RATIONALE. There is an urgent need for new drugs for both COVID-19 patients and those with other forms of the acute respiratory distress syndrome (ARDS). ARDS in influenza-infected mice is associated with reduced levels of liponucleotides (essential precursors for de novo phospholipid synthesis) in alveolar type II epithelial cells. We found previously that early or late post-infection treatment of influenza A virus-infected mice with the liponucleotide CDP-choline decreased hypoxemia, pulmonary edema, lung dysfunction, and inflammation without altering viral replication. Because it is a truism that mice with ARDS are far easier to cure than people, we wished to show that parenteral liponucleotide administration could likewise attenuate ARDS in a more clinically-relevant real-world situation. METHODS. Client-owned pet dogs admitted to the Small Animal ICU at The Ohio State University Veterinary Medical Center for aspiration pneumonia were enrolled in a randomized, double-blinded, placebo-controlled trial of treatment with vehicle (0.1 ml/kg sterile 0.9% saline, i.v.;n=8 dogs) or CDP-choline (5 mg/kg in 0.1 ml/kg 0.9% saline, i.v.;n=9 dogs) every 12 hours over the first 48 hours after admission. Dogs received standard of care supportive therapy and supplemental O2 (in an O2 tent or via nasal cannula) as deemed necessary by the attending clinician. Vital signs, blood pressure, and peripheral O2 saturations were recorded every 8 hours. Arterial blood gases were measured every 12 hours. Venous blood was collected on admission and at 48 hours for clinical chemistry and CBC/differential counts. Written consent was obtained from all owners, who received a $400 financial incentive (in the form of a contribution to hospital expenses) to participate. RESULTS. Dogs in the treatment arm were significantly younger, but there were no other significant differences between placebo- and CDP-choline-treated dogs on admission. All dogs exhibited tachycardia, tachypnea, hypertension, hypoxemia, hypocapnia, lymphopenia, and neutrophilia. Administration of CDP-choline resulted in rapid, progressive, and clinically significant increases in PaO2:FiO2 values and declines in alveolar-arterial (A-a) gradients that did not occur in placebo (saline)-treated animals. CDP-choline treatment also prevented platelet consumption over the first 48 hours after admission but had no detectable detrimental effects in sick dogs. CONCLUSIONS. CDP-choline acts rapidly to promote gas exchange in dogs with spontaneous aspiration pneumonia. Because CDP-choline has been shown to be very safe in human subjects, it should be considered as a potential adjunct therapy in ARDS and/or COVID-19 patients.

Hypofractionation and Stereotactic Body Radiation Therapy in Inoperable Locally Advanced Non-small Cell Lung Cancer

Background and Aim: Radiotherapy (RT) plays a key role in the control of locally advanced non-small cell lung cancer (LA-NSCLC). Throughout the years, different doses and fractionations of RT have been used in an attempt to optimize the results. Recently, special interest has been given to hypofractionation (hypoRT) and stereotactic body radiation therapy (SBRT). HypoRT is a relatively widespread treatment, although the accompanying level of evidence is limited. For its part, SBRT has been used specially to overdose specific areas of the disease as a boost after radiochemotherapy. In both cases, the study of how to integrate these RT tools with chemotherapy and immunotherapy is fundamental. In addition, the 2020 COVID-19 pandemic situation has sparked increased interest in hypofractionated treatments. In this review, we analyze the role of SBRT and hypoRT in the management of LA-NSCLC in accordance with current scientific evidence. Relevance for Patients: The objective of this article is to introduce professionals to the role that hypoRT and SBRT can play in the treatment of LA-NSCLC to offer the best treatment to their patients.