COVID-19, Health Habits, and Addictive Behaviors in the General Population

The lockdown due to the coronavirus disease 2019 (COVID-19) pandemic had a significant impact on daily routines and habits. New lifestyle behaviors contributed to the onset and course of mental diseases, including addictive problems. The objective of this work was to describe changes in health status during lockdown in the general population, including potentially addictive behaviors, and explore possible contributing factors. The analyzed data comprised a population-based sample of 240 individuals (73.3% women, mean age 43.8 years old). Assessments included sociodemographics and self-reports for health state and addictive behaviors. The risk of perceived worsening physical and psychological state was 21.7% and 20.0%, respectively, after the lockdown. The risk of requiring a new treatment for physical and psychological illnesses was 10.4% and 4.2%, respectively, while 2.5% of the participants started using illegal drugs and 9% initiated video game use. Finally, the statistical predictors of health worsening during the lockdown were the presence of anxiety symptoms, being unmarried, having low education levels, experiencing fears related to COVID-19 infection, and having family conflicts. This research identified vulnerability factors contributing to changes in physic and mental health, as well as those associated with addictive behaviors during lockdown. These results should be considered in further stressful situations to design personalized preventive and therapeutic plans. © Author(s).

ISOLATION OF PAN-SARBECOVIRUS mABs THAT NEUTRALIZE SARS-CoV-1 AND SARS-CoV-2 VARIANTS

Background: The continued emergence of severe acute respiratory syndrome coronaviruses (SARS-CoVs) and recent explosion of the SARS-CoV-2 pandemic highlights the need for broad and potent antibody recognition and understanding the contexts in which they may develop. Antibodies with cross reactivity across SARS lineages may be of particular value in preparing for future outbreaks of new sarbecoviruses. Method(s): We isolated monoclonal antibodies (mAbs) from an individual 60-days post-vaccination, 30-days post Delta-infection. Reconstructed antibodies were screened for binding to a panel of prefusion-stabilized Spike trimers from SARS-CoV-2 and other beta-coronaviruses using enzyme-linked immunosorbent assay (ELISA). Neutralization potency and breadth was assessed using a spike-pseudotyped lentivirus neutralization assay. Additionally, epitope and escape mutant profiling was conducted by deep mutational scanning (DMS) to identify mutations that affect antibody binding. Lastly, binding breadth was further evaluated using a yeast display library of RBDs from SARS-CoV-2 variants and related sarbecoviruses. Result(s): We identified several SARS-CoV-2-specific mAbs that neutralized SARS-CoV-2 variants of concern (VOCs) and SARS-CoV-1. Notably, two of these mAbs (C68.61 and C68.185) neutralized SARS-CoV-1 with an IC50 = 307 and 139 ng/mL (respectively) that is similar to or better than the potency of S309 (IC50 = 206 ng/mL) and CR3022 (IC50 = 981 ng/mL), which are mAbs isolated from individuals with SARS-CoV-1 infections. C68.61 also neutralized all Omicron VOCs tested and retained neutralization activity against currently circulating variants BQ1.1 (IC50=790 ng/ml) and XBB (IC50=590 ng/ml). Key C68.61 mAbescape mutations identified by DMS in the Omicron BA.2 background yeast display library included sites K462, E465, R466, and I468, which are conserved sites across all VOCs and SARS-CoV-1. The isolated mAbs displayed crossreactive binding to RBDs from diverse SARS-CoV-1-related CoVs and African and European sarbecovirus isolates as well as SARS-CoV-2 VOCs. Conclusion(s): Here we describe mAbs from a SARS-CoV-2-infected individual that bound and neutralized both SARS-CoV-2 and SARS-CoV-1, including one that showed breadth across recent VOCs. Given their breadth, these SARS-CoV-2 cross-reactive mAbs may be robust to viral escape and thus could contribute to therapeutic efforts. In addition, these mAbs displayed broad cross-reactive activity across sarbecoviruses and may be beneficial against future spillover events.

Machine learning uncovers blood test patterns subphenotypes at hospital admission discerning increased 30-day ICU mortality rates in COVID-19 elderly patients

Introduction: Since March 2020, a number of SARS-CoV-2 patients have frequently required intensive care unit (ICU) admission, associated with moderate survival outcomes and an increasing economic burden. Elderly patients are among the most numerous, due to previous comorbidities and complications they develop during hospitalization [1]. For this reason, a reliable early risk stratification tool could help estimate an early prognosis and allow for an appropriate resources allocation in favour of the most vulnerable and critically ill patients. Method(s): This retrospective study includes data from two Spanish hospitals, HU12O (Madrid) and HCUV (Valencia), from 193 patients aged > 64 with COVID-19 between February and November 2020 who were admitted to the ICU. Variables include demographics, full-blood-count (FBC) tests and clinical outcomes. Machine learning applied a non-linear dimensionality reduction by t-distributed stochastic neighbor embedding (t-SNE) [2];then hierarchical clustering on the t-SNE output was performed. The number of clinically relevant subphenotypes was chosen by combining silhouette and elbow coefficients, and validated through exploratory analysis. Result(s): We identified five subphenotypes with heterogeneous interclustering age and FBC patterns (Fig. 1). Cluster 1 was the 'healthiest' phenotype, with 2% 30-day mortality and characterized by moderate leukocytes and eosinophils. Cluster 5, the severe phenotype, showed 44% 30-day mortality and was characterized by the highest leukocyte, neutrophil and platelet count and minimal monocytes and lymphocyte count. Clusters 2-4 displayed intermediate mortality rates (20-28%). Conclusion(s): The findings of this preliminary report of Eld-ICUCOV19 patients suggest the patient's FBC and age can display discriminative patterns associated with disparate 30-day ICU mortality rates.

BROAD ANTIBODIES TO FUNCTIONALLY CONSTRAINED REGIONS OF SARS-CoV-2 SPIKE

Background: While remarkable and rapid progress was made in fighting the SARS-CoV-2 pandemic with vaccines and therapeutic antibodies, these approaches were quickly compromised by viral evolution. Therapeutic monoclonal antibodies (mAbs) that were once authorized for clinical use, which all target the receptor binding domain (RBD), are no longer effective against current variants of concern (VOCs) due to mutations in this region of Spike. Thus, to achieve durable protection against SARS-CoV-2, novel mAbs need to show breadth and potency across VOCs and target epitopes that are more constrained. Method(s): mAbs from an individual who had a breakthrough Delta VOC infection after vaccination were isolated from Spike-specific memory B cells. mAbs were assessed for binding affinity and neutralization potency using Spike-pseudotyped lentivirus (PSV) and live SARS-CoV-2 virus neutralization assays. Epitopes were mapped using deep mutational sequencing (DMS) and structural-based methods. Result(s): Three novel mAbs (C68.3, C68.13, C68.59) demonstrated binding breadth to Spikes from various VOCs including Omicron VOCs despite that C68 had not yet been exposed to Omicron. These mAbs potently neutralized the Wuhan-Hu-1 vaccine and Delta strains (IC50 = 9-61ng/mL), and early Omicron strains BA.1, BA.2, BA.5 (IC50 = 12-149 ng/mL). C68.3 and C68.59 retained potency against recent VOCs BQ.1.1 and XBB (IC50 = 121-122 ng/mL and 56-82 ng/mL, respectively) in the PSV assay. Similar neutralization activity was observed in the live virus assay. The potency of these mAbs was greater against Omicron VOCs than all but one of the mAbs previously authorized for treatment and they showed greater breadth. The mAbs target distinct epitopes on the Spike glycoprotein, two in the RBD (C68.3, C68.13) and one in an invariant region downstream of RBD in subdomain 1 (SD1) (C68.59). Structural analysis of C68.59 Fab binding to Spike trimer revealed significant allosteric changes to regions of Spike outside of the epitope in the S2 unit. Finally, DMS escape pathways showed these mAbs target regions highly conserved across VOCs that are also functionally constrained, suggesting escape could incur a fitness cost. Conclusion(s): Overall, these mAbs are novel in their breadth across VOCs and include a potent mAb targeting a rare epitope outside of the RBD in SD1. These mAbs focus on diverse, functionally constrained regions in Spike making them candidates for development as combination therapeutics with good durability against future VOCs.

Covid-19 Vaccine Protection against Mortality in Patients with Oxygen: A Multicontinental Study

INTRODUCTION: The COVID-19 vaccines have effectiveness above 90% for avoiding hospitalization. However, 5% of vaccinated patients require hospitalization with a mortality ratio between 15% to 24%, similar to the one reported for unvaccinated hospitalized patients. These vaccinated patients belong to the most sensitive groups with a high comorbidity burden. The similarity in the mortality ratio between vaccinated and unvaccinated patients has been used to make claims against the vaccine's efficacy. A thoughtful analysis, taking into account the comorbidities of each group, on how vaccination protects patients with moderate or severe illness, is missing. METHOD(S): We perform a multi-continental retrospective cohort study in 111 hospitals in Spain and 37 in Argentina. We included hospitalized patients who received oxygen therapy older than 18 years with COVID-19. To assess the relation between COVID-19 vaccine status and death, we performed a logistic regression adjusting by confounders. Also, as a sensitivity analysis, we perform a propensityscore matching. Additionally, we studied the Population Attributable Risk (PAR). RESULT(S): Between January 2020 and May 2022, we included 21,479 patients, 717 (3 3%) were vaccinated. Hospitalized vaccinated patients with oxygen therapy had a higher proportion of comorbidities. The overall mortality in vaccinated patients was 20 9%, and 19 5% in unvaccinated patients. The crude Odds Ratio was 1 07 (IC95% 0 89-1 29;p=0 41), while the adjusted was 0 73 (IC95% 0 56-0 95;p=0 02) in the complete case analysis (6,352 patients) and 0 77 (CI 95% 0 54-0 97;p=0 02) in the complete dataset after multiple imputations. These observations were robust to the sensitivity analysis. The adjusted PAR reduction was 4 3% (95%CI 1%-5%). Therefore, as the death proportion in unvaccinated patients was 19 6% (95%CI 19%-20 1%), if they were vaccinated the expected death proportion would have been 15 3% (95%CI 12 9%-18%;p< 0 01). CONCLUSION(S): Even with the high protection of the COVID-19 vaccine, patients with a high burden of comorbidities will be hospitalized in future pandemic waves. In this study, we observed that the COVID-19 vaccines significantly reduce the probability of death even when lung inflammation has already been initiated, with moderate or severe COVID-19 disease.

Considering equity in priority setting using transmission models: Recommendations and data needs.

OBJECTIVES: Disease transmission models are used in impact assessment and economic evaluations of infectious disease prevention and treatment strategies, prominently so in the COVID-19 response. These models rarely consider dimensions of equity relating to the differential health burden between individuals and groups. We describe concepts and approaches which are useful when considering equity in the priority setting process, and outline the technical choices concerning model structure, outputs, and data requirements needed to use transmission models in analyses of health equity. METHODS: We reviewed the literature on equity concepts and approaches to their application in economic evaluation and undertook a technical consultation on how equity can be incorporated in priority setting for infectious disease control. The technical consultation brought together health economists with an interest in equity-informative economic evaluation, ethicists specialising in public health, mathematical modellers from various disease backgrounds, and representatives of global health funding and technical assistance organisations, to formulate key areas of consensus and recommendations. RESULTS: We provide a series of recommendations for applying the Reference Case for Economic Evaluation in Global Health to infectious disease interventions, comprising guidance on 1) the specification of equity concepts; 2) choice of evaluation framework; 3) model structure; and 4) data needs. We present available conceptual and analytical choices, for example how correlation between different equity- and disease-relevant strata should be considered dependent on available data, and outline how assumptions and data limitations can be reported transparently by noting key factors for consideration. CONCLUSIONS: Current developments in economic evaluations in global health provide a wide range of methodologies to incorporate equity into economic evaluations. Those employing infectious disease models need to use these frameworks more in priority setting to accurately represent health inequities. We provide guidance on the technical approaches to support this goal and ultimately, to achieve more equitable health policies.

Impact on the incidence of gastrointestinal perforation during the COVID-19 pandemic in the Costa del Sol healthcare system area.

INTRODUCTION AND AIMS: Gastrointestinal perforation is a surgical emergency that is associated with a high mortality rate and requires special care. During the pandemic, there has been competition with COVID-19 patients for health resources, especially ICU bed availability. The primary aim of our study was to compare the incidence of gastrointestinal perforation during the COVID-19 pandemic, with cases registered before the pandemic. MATERIALS AND METHODS: A retrospective, observational, single center, cohort study was conducted that included patients that underwent emergency surgery for gastrointestinal perforation in the periods during the pandemic (6 months) and before the pandemic (12 months). Sociodemographic characteristics, comorbidities, duration of hospital and ICU stay, status at discharge, and perforation site were compared. RESULTS: The study included 67 subjects (33 in the pre-pandemic period and 34 in the pandemic period). There were no significant differences regarding sex, age, or comorbidity. The perforation rate per emergency intervention was 4-times higher during the pandemic. There was an increase in the number of patients that were foreigners (4 [11%]) and nonresidents (6 [17%]). ICU admissions decreased (6 [19%]) but ICU stay increased to 137 h. Hospital stay increased by 5 days and delay in care increased 4.5 h. The number of deaths was higher (from 5 [15.2%] to 10 [29.4%]). Four patients with perforations were positive for COVID-19, were admitted to the ICU, and died. CONCLUSIONS: During the COVID-19 pandemic there was an increase in the incidence of gastrointestinal perforations at our healthcare system area; symptoms were more advanced, and mortality was higher.

Impact on the incidence of gastrointestinal perforation during the COVID-19 pandemic in the Costa del Sol healthcare system area Impacto en la incidencia de perforación gastrointestinal durante la pandemia de COVID-19 en el área sanitaria Costa del Sol

Introduction and aims Gastrointestinal perforation is a surgical emergency that is associated with a high mortality rate and requires special care. During the pandemic, there has been competition with COVID-19 patients for health resources, especially ICU bed availability. The primary aim of our study was to compare the incidence of gastrointestinal perforation during the COVID-19 pandemic, with cases registered before the pandemic. Materials and methods A retrospective, observational, single center, cohort study was conducted that included patients that underwent emergency surgery for gastrointestinal perforation in the periods during the pandemic (6 months) and before the pandemic (12 months). Sociodemographic characteristics, comorbidities, duration of hospital and ICU stay, status at discharge, and perforation site were compared. Results The study included 67 subjects (33 in the pre-pandemic period and 34 in the pandemic period). There were no significant differences regarding sex, age, or comorbidity. The perforation rate per emergency intervention was 4-times higher during the pandemic. There was an increase in the number of patients that were foreigners (4 [11%]) and nonresidents (6 [17%]). ICU admissions decreased (6 [19%]) but ICU stay increased to 137 h. Hospital stay increased by 5 days and delay in care increased 4.5 h. The number of deaths was higher (from 5 [15.2%] to 10 [29.4%]). Four patients with perforations were positive for COVID-19, were admitted to the ICU, and died. Conclusions During the COVID-19 pandemic there was an increase in the incidence of gastrointestinal perforations at our healthcare system area;symptoms were more advanced, and mortality was higher.

CAPSULE ENDOSCOPY FINDINGS in PATIENTS with SEVERE SARS-CoV-2 INFECTION: PILOT STUDY

Background: Although SARS-CoV-2 has mainly respiratory manifestations, gastrointestinal symptoms are observed in 30% of cases. The ACE-2 receptor used by SARS-CoV-2 to infect cells is highly expressed in the brush border of enterocytes. However, studying the small intestine in live patients is a challenge in the field of clinical research. A minimally invasive alternative for studying the small intestine is the use of capsule endoscopy, which could be useful in the context of COVID-19. Here, we describe endoscopic changes in the mucosa of the small intestine secondary to severe SARS-CoV-2 infection in hospitalized patients. Methods: We performed a prospective observational study in hospitalized patients with a severe COVID-19 according to NIH guidelines. Participants with a positive COVID-19 PCR from nasopharyngeal swab, hemodynamically stable, able to swallow, and without additional respiratory co-infections, were enrolled between January 27th and May 17th, 2021 at the largest tertiary COVID-19 referral center in Mexico City. Demographic and clinical characteristics were collected for each participant from clinical files. A PillCam capsule from Medtronic® was used for Capsule Endoscopy (CE). Each capsule study was reviewed separately by two trained endoscopists. Detection of SARS-CoV-2 RNA in stool samples was performed according to CDC guidelines for all participants. Results: Twenty volunteers were enrolled in the study. Diarrhea was the most common gastrointestinal symptom (78%). CE study was normal in 6 participants, while the rest showed at least one intestinal finding. The most frequent finding was shortening or atrophy of villi and hyperemia (45%);followed by red spots (40%), and ulcers (15%). Two participants with shortening or atrophy of villi also presented denuded mucosa. CE findings were observed mainly in duodenum and jejunum. Participants showing changes in villi also presented positive SARS-CoV-2 RNA in stool. Conclusion: We observed that macroscopic changes in the small intestine mucosa, specifically in villi, occurred frequently in severe COVID-19 patients. These changes were accompanied by the presence of SARS-CoV-2 RNA in stool. We proposed the term COVID-19 Enteropathy to encompass these findings. Further studies are warranted to establish mechanisms of SARS-CoV-2-associated gastrointestinal disease.

Impacto en la incidencia de perforación gastrointestinal durante la pandemia de COVID-19 en el área sanitaria Costa del Sol Impact on the incidence of gastrointestinal perforation during the COVID-19 pandemic in the Costa del Sol healthcare system area

Introducción y objetivos: La perforación gastrointestinal es una emergencia quirúrgica asociada a una alta mortalidad que precisa cuidados avanzados. Durante la pandemia ha competido con los pacientes de COVID-19 por los recursos sanitarios, especialmente por la disponibilidad de camas en UCI. El objetivo principal del estudio fue comparar la incidencia de perforación gastrointestinal durante la pandemia por COVID-19 con los casos registrados en prepandemia. Material y métodos: Estudio retrospectivo observacional de cohortes unicéntrico que incluyó a los pacientes intervenidos de urgencia por perforación gastrointestinal en periodos de pandemia (6 meses) y prepandemia (12 meses). Se compararon características sociodemográficas, comorbilidad, tiempos de ingreso hospitalario y en UCI, situación al alta y localización de la perforación. Resultados: Se incluyeron 67 sujetos (33 en prepandemia y 34 en pandemia). No hubo diferencias significativas respecto al sexo, edad, o comorbilidad. La razón de tasas de perforación por intervenciones urgentes fue 4 veces mayor durante la pandemia. Aumentaron el número de extranjeros;4 (11%) y no residentes;6 (17%). Los ingresos en UCI disminuyeron;6 (19%), aunque su estancia se prolongó 137 horas. La estancia hospitalaria aumentó 5 días y la demora en la atención 4,5 horas. Aumentaron las perforaciones de intestino grueso;3 (8%). La mortalidad fue mayor;10 (29,4%) frente a 5 (15,2%). Hubo 4 pacientes perforados COVID-19 positivos, todos ellos fueron a UCI y fallecieron. Conclusiones: Durante la pandemia por COVID-19 hubo un aumento de la incidencia de perforaciones gastrointestinales en nuestra área de atención, con cuadros más evolucionados y mayor mortalidad.

[Impact on the incidence of gastrointestinal perforation during the COVID-19 pandemic in the Costa del Sol healthcare system area]. / Impacto en la incidencia de perforación gastrointestinal durante la pandemia de COVID-19 en el área sanitaria Costa del Sol.

INTRODUCTION AND AIMS: Gastrointestinal perforation is a surgical emergency that is associated with a high mortality rate and requires special care. During the pandemic, there has been competition with COVID-19 patients for health resources, especially ICU bed availability. The primary aim of our study was to compare the incidence of gastrointestinal perforation during the COVID-19 pandemic, with cases registered before the pandemic. MATERIALS AND METHODS: A retrospective, observational, single center, cohort study was conducted that included patients that underwent emergency surgery for gastrointestinal perforation in the periods during the pandemic (6 months) and before the pandemic (12 months). Sociodemographic characteristics, comorbidities, duration of hospital and ICU stay, status at discharge, and perforation site were compared. RESULTS: The study included 67 subjects (33 in the pre-pandemic period and 34 in the pandemic period). There were no significant differences regarding sex, age, or comorbidity. The perforation rate per emergency intervention was 4-times higher during the pandemic. There was an increase in the number of patients that were foreigners (4 [11%]) and nonresidents (6, [17%]). ICU admissions decreased (6 [19%]) but ICU stay increased to 137 h. Hospital stay increased by 5 days and delay in care increased 4.5 h. The number of deaths was higher (from 5 [15.2%] to 10 [29.4%]). Four patients with perforations were positive for COVID-19, were admitted to the ICU, and died. CONCLUSIONS: During the COVID-19 pandemic there was an increase in the incidence of gastrointestinal perforations at our healthcare system area; symptoms were more advanced, and mortality was higher.

Referral Criteria for Asthma: An Updated Consensus

Asthma is one of the most prevalent chronic diseases in Spain. In 2019, the Spanish Society of Allergology and Clinical Immunology (SEAIC), the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of General and Family Physicians (SEMG) and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) drafted a document laying down the criteria for referral and action guidelines in the diagnosis, control and monitoring of the asthmatic patient to facilitate ongoing care and improved attention in every setting. The new circumstances derived from the Covid-19 pandemic have demanded that some of the recommendations of the previous edition be updated and adapted to the new healthcare situation. © 2021 Sociedad Española de Neumología y Cirugía Torácica (SEPAR)

Adapting evaluation method of skills acquisition in basic cardiopulmonary resuscitation among year 5 and year 6 primary school pupils during the COVID-19 lockdown: a pilot study.

OBJECTIVE: This longitudinal descriptive study aimed to evaluate cognitive skills acquisition in basic Cardiopulmonary Resuscitation (bCPR) among a group of Year 5 and Year 6 primary school pupils. The study made use of online tools due to the impossibility of conventional methods during the COVID-19 lockdown. MATERIALS AND METHODS: Pupils received formal training in bCPR. Training was imparted uniformly by a teacher at the school (qualified in Basic Life Support -BLS- and Advanced Life Support -ALS- training by the CPR National Plan). The skills acquired (those proposed as essential for bCPR training by the European Resuscitation Council) were evaluated fifteen weeks later. Skills acquisition was evaluated by means of an online questionnaire developed specifically for the study. RESULTS: In all the cognitive skills included in bCPR training, the acquisition level achieved was over 65%. Acquisition of knowledge of the anatomical areas at which cardiac massage must be applied and the means of emergency systems activation was high, while 25.5% of pupils knew the order in which maneuvers should be performed. Pupils' self-confidence and self-perception of their capacity to act when faced with a real CPR situation increased significantly. CONCLUSIONS: Primary school pupils learned all the cognitive skills involved in bCPR, showing high levels of skills acquisition and positive self-perception of their capacity to apply them.

Medicines use: Better data, better decisions, better health systems, and better outcomes

Background: Better data on medicines use can inform better decisions, better health systems, and better patient outcomes. More African studies of medicines use are emerging, especially those using routinely-collected data. Such work is even more pressing given the growing burden of non-communicable diseases (NCD) - where medicines are often the mainstay of treatment - and additional challenges in financing sustainable health systems for universal health coverage and the ongoing COVID-19 pandemic. Objective: To describe how medicines use studies can strengthen health systems (focus on Ghana). Methods: We identified sources of data: national health insurance systems (public and private);district level health information systems (DHIMS2);health service and hospital data;together with commercial local, regional, and global data. Data users need to be mindful of appropriate data governance and privacy of patient's records. Results and Conclusions: 1. Rational use of medicines: adherence with standard treatment guidelines, treatment pathways, potential cost savings, pharmacovigilance 2. Health Technology Assessment: key inputs for cost-effectiveness and budget impact analysis of medicines for inclusion within a benefits package. 3. Patterns of disease: explore prevalence and incidence of disease (especially NCDs) plus comorbidities using medicines use as a proxy for diseases, particularly in the absence of other high-quality epidemiological data. 4. Health Policy + Monitoring and Evaluation: developing essential medicines lists and treatment guidelines;key indicators in M&E of health systems. 5. Building research capacity: promoting researchers in pharmacoepidemiology using identified and accessible data sources. Initial steps in Africa can develop with continued training and support.

Mental Health Status of Healthcare Workers During the COVID-19 Outbreak An International Study

Background: The COVID-19 pandemic is a massive health crisis that has exerted enormous physical and psychological pressure. Mental healthcare for healthcare workers (HCWs) should receive serious consideration. This study served to determine the mental-health outcomes of 1,556 HCWs from 45 countries who participated in the COVID-19 IMPACT project, and to examine the predictors of the outcomes during the first pandemic wave. Methods: Outcomes assessed were self-reported perceived stress, depression symptom, and sleep changes. The predictors examined included sociodemographic factors and perceived social support. Results: The results demonstrated that half of the HCWs had moderate levels of perceived stress and symptoms of depression. Half of the HCWs (n = 800, 51.4%) had similar sleeping patterns since the pandemic started, and one in four slept more or slept less. HCWs reported less perceived stress and depression symptoms and higher levels of perceived social support than the general population who participated in the same project. Predictors associated with higher perceived stress and symptoms of depression among HCWs included female sex, not having children, living with parents, lower educational level, and lower social support. Discussion: The need for establishing ways to mitigate mental-health risks and adjusting psychological interventions and support for HCWs seems to be significant as the pandemic continues.

Sleep quality during the coronavirus pandemic in a brazilian family-based cohort

Introduction: Early in the COVID-19 pandemic, Brazil adopted measures to minimize the spread of the virus, including quarantine orders where people only left home for essential business. This practice could negatively impact sleep by reducing exposure to daylight and physical activity. We examined subjective sleep quality in Baependi, a small rural town in Brazil during the COVID-19 quarantine order. Methods: This sample is from the Baependi Heart Study, a familybased cohort of adults. Participants (n=800, 71% women, mean age 51.6±15.6 years) completed the Pittsburgh Sleep Quality Index (PSQI) early in the COVID pandemic (April-May, 2020). They were also asked about their compliance to the quarantine order (yes/no). We compared sleep between quarantined (QT) and not-quarantined individuals (NQT). Longitudinal data was obtained from a subsample of 417 individuals who also completed a pre-COVID PSQI between January, 2010 and September, 2014. Results: Individuals compliant with the quarantine had worse sleep quality than non-quarantined individuals [QT PSQI= 6.1 (±3.9), NQT PSQI= 5.0 (±3.5), p<0.01]. Stratified analysis showed that differences in PSQI scores between QT and NQT was greater for women [QT = 6.4 (±4), NQT = 5.2 (±3.7), p<0.01] and older people [QT = 6.6 (±0.1), NQT = 5.5 (±3.3), p=0.02]. Associations were attenuated after adjusting for age and gender. PSQI components demonstrated a higher sleep latency for the QT group in the full sample (p=0.02), women (p<0.01) and young (<50 years, p=0.03). Sleep duration was shorter in the QT young subsample (p=0.03). QT women also reported lower sleep efficiency (p=0.01) and greater use of sleep medication than NQT women (p<0.01). In the longitudinal subsample, PSQI scores were significantly higher during COVID than pre-pandemic [COVID= 5.7 (±3.8), pre-COVID= 5 (±3.3), p<0.01]. The significant change in PSQI was only observed in the QT participants [COVID= 5.9 (±3.7), pre-COVID= 5.2 (±3.4), p<0.01] and not NQT [COVID= 5 (±3.7), pre- COVID= 4.5 (±3), p=0.12. Conclusion: Individuals who quarantined during COVID-19 had worse sleep quality than individuals who did not quarantine. Longitudinal comparison demonstrated that participants who quarantined had worse sleep quality during COVID compared to before to the pandemic.

COVID-19: Hematological and laboratory findings in patients from a private hospital in Caracas, Venezuela. Correlation with mortality

The first cases of COVID-19 in Venezuela occurred in mid-March 2020. The number of cases remained relatively low until May when it began to increase, reaching its maximum in August 2020. The purpose of this work is to present the clinical, hematological, and laboratory studies carried out on 139 patients hospitalized at the El Ávila Clinic, a private hospital in Caracas, between June 30 and September 15, 2020. The 139 patients (98 males, 41 females) had an average age of 62.7 years (range 31 to 91);55 (39.8 %) patients presented worsening of their disease, for which they were transferred to the intensive care unit, where 41 (74.54 %) died. Most of these patients had comorbidities such as obesity, diabetes, and high blood pressure. Hematological and laboratory studies on admission are similar to those reported in similar studies in different parts of the world. © 2021 Academia Nacional de Medicina. All rights reserved.

[Pulse oximetry: Role in the COVID-19 patient at home]. / Pulsioximetría: papel en el paciente COVID-19 domiciliario.

COVID-19 behaves like a heterogeneous disease. Some patients may develop dyspnea-free hypoxemia during its evolution (silent hypoxemia). Pulse oximetry plays a crucial role in detecting hypoxemia in these patients, especially when they remain at home. Patients with SpO2 levels ≤ 92% or desaturations ≥ 3% after exercise test require hospital admission. Progressive saturation declines reaching SpO2 levels < 96% require strict clinical assessment (radiological study, blood test) for which it will be sent to a health center.