Activated CD8 T-cell hepatitis in children: a single institution experience

Background: Pediatric acute liver failure is a rare and serious life-threatening situation, principally for the 30 to 50% of children in whom the etiology of their liver failure is unclear or indeterminate. Treating these patients is challenging, requiring constant assessment over time with regular evaluation for possible liver transplantation. Children with pediatric acute liver failure of undetermined etiology have lower spontaneous survival and higher rates of transplantation and death than other diagnostic groups. Emerging evidence suggests that a subgroup of patients with indeterminate pediatric acute liver failure have clinical, laboratory, and liver biopsy features of immune dysregulation with a dense infiltration of CD8 T cells. Method(s): In 2022, we received percutaneous liver biopsies from three children with acute hepatic dysfunction that showed an increased number of lymphocytes including CD8 T cells. For each case, routine H&E stains with levels, special stains and immunostains were performed. The first biopsy was from an 18-month-old male who presented with COVID infection, pancytopenia, elevated transaminases, and synthetic liver dysfunction (elevated INR). The second was from a 9-year-old female with a history of elevated liver enzymes with no clear cause. The third case was from a 2-year-old male with elevated liver enzymes, coagulopathy, and cholestasis. Result(s): The three cases showed similar histopathologic findings;an acute liver injury pattern with lobular architectural disarray, giant cell formation, reactive changes, single cell necrosis, cholestasis and marked mixed lymphocytic infiltrates. The infiltrates were predominantly composed of CD8-positive T-lymphocytes with scattered neutrophils, eosinophils and rare plasma cells. Portal areas were mildly expanded with mild bile ductular proliferation and mild to moderate lymphocytic infiltrates. Immunostains for CD8 demonstrated that the infiltrates were predominantly composed of CD8-positive T-lymphocytes. All three patients received steroids and responded to treatment evidenced by normalization of liver enzymes and function. Conclusion(s): Dense hepatic CD8 T-cell infiltration is a major finding inactivated CD8 T-cell hepatitis. However, the percentage distribution of lymphocyte subtypes in the setting of hepatitis is not well established, and CD8 T-cell infiltration has also been described in cases of drug-induced hypersensitivity reactions, viral hepatitis, hemophagocytic lymphohistiocytosis, and macrophage activation syndrome, as well as autoimmune hepatitis. Further investigation is needed to better understand the diagnostic criteria in this disease.

Systems applied to active methodologies as a teaching-learning strategy for engineering students

The impact of the Covid-19 pandemic has led to a "social distancing” in academic institutions of higher education and the need to implement contingency plans for the continuity of their activities, forcing teaching supported by tele-education;outlining new teaching strategies in engineering. The objective of the research was to make a bibliographic review analyzing the active methodologies in virtual teaching-learning environments used by teachers. Taking into account the importance in the training and perspectives of future engineers. The methodology was focused on a systematic review (SR), considering 105 articles published between the years 2015-2022 related to scientific literature articles with active methodologies in virtual environments identified in different databases. Concluding that it is necessary to adopt activities and strategies for the academic training of engineering students characterized in friendlier methodological proposals. © 2022, Associacao Iberica de Sistemas e Tecnologias de Informacao. All rights reserved.

Importance of the communication of university teachers in Peru, in virtual education: Systematic review

The article is framed in the category of systematic review, responds to the review, analysis, and bibliographic selection of existing articles of the last 10 years, linked to the importance of university teacher communication in virtual education. It aims to describe the importance of university teacher communication in the teaching-learning process within virtual educational practice. He belongs to the research line of pedagogical innovation, is descriptively and methodologically has followed the guidelines of the flow of systematic review of the scientific literature, making use of the prism method, review table of articles, table of s, statistical graphs of the reviewed scientific literature, analysis of the results, discussion, and conclusions of the reviewed literature.The results of the 23 selected articles make visible the position of different writers regarding the communication of the university professor, virtual education, the link between both criteria and certain characteristics;the literature reflects a lack of articles that delimit the impact of the communicative strategies used in the virtual education process. However, relevant information was found regarding the importance of communication and communication skills of teachers in their educational practice and in the process of training future professionals. Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.

University social responsibility and the formative process of students in Peru

The pandemic caused by Covid-19, led to a total dismantling of face-to-face classes in educational institutions, constituting a challenge for governments to implement means and instruments for virtual education. The objective was to show social responsibility in the training process of students at the Toribio Rodríguez de Mendoza University during Covid-19, its intervention is analyzed from its dimensions: teaching-learning, methodological strategies, management of virtual instruments. The type of study is quantitative and non-experimental design, transactional-descriptive, the sample was 109 teachers, an intentional non-probabilistic sampling was applied, a Likert-type scaling questionnaire was used. The results showed that teachers promote university social responsibility in students in times of pandemic, promoting the generation of new knowledge in their development in society. Concluding that teachers must promote innovative teaching strategies, the usual change caused by the pandemic and value the management of virtual instruments associated with collective practices of responsibility and social protection, promoting an inclusive and inclusive university. © 2022, Universidad del Zulia. All rights reserved.

IMPACT OF COVID-19 ON THE EDUCATIONAL PROCESS OF THE FEMALE ESMERALDAS SOCIAL REHABILITATION CENTER

Education is basic skill and profesional training in prisions. Play a very importatnt role in the reitegration of inmates since it constitutes a training opportunity for inmates, and potentially expands the possibilities of emplyment whith better remuneration. Education in confinement enviroments has particularities focused on achieving an impact in terms of personal fulfillment and growth. Since covid-19 pandemic, educational processes in the context of prisions have been significallity affected, with fundamental effects due to suspension of teaching activities due to movility restrictions to avoid contagions, lack of motivation to continue efficient projects, lack of focused staff and material resorces. A series of actions are propoused that cover the epidemiological, administrative, motivational and individual areas with the objetive of minimizing the effects on short term and facilitate the continuity of studies, inclusion and reitegration at the end of the sentence.

Ambulatory treatment with chloroquine in patients with suspicion of COVID-19 for the reduction of symptoms associated to the infection

OBJECTIVE: To establish whether there is clinical improvement with the administration of chloroquine as outpatient treatment in patients suspected of COVID-19 assessed by the reduction of clinical manifestations associated with viral infection. MATERIALS AND METHODS: An experimental study was made in patients suspected of COVID-19 who were attended in the respiratory emergency service of the Hospital Juárez de México from June 1st to July 30th, 2020, who received outpatient treatment with chloroquine. The patients were followed up by telephone to find out their health condition. RESULTS: Fifty patients were included, of which 36 were female. The mean age was 41.1 year;the most frequent symptoms were fever, cough and odynophagia;the most persistent symptom was cough (31 out of 50). Also, 24 patients were positive for SARS-CoV-2 and completed their treatment with chloroquine, with persistent descricough;diarrhea, dysgeusia, and symptoms such as nausea, hypogeusia and headache were documented. No patient required a second evaluation in the emergency room or hospital admissions. CONCLUSIONS: Clinical evidence suggests that chloroquine may be useful in reducing the symptoms associated with SARS-CoV-2 if it is administered in the first five days of the onset of the disease;controlled studies are required to confirm this possibility.

Design of inhibitory peptides of the interaction between the rbd domain of the s1 protein of sars-cov-2 and the angiotensin-converting enzyme 2 (Ace2) receptor

Background: The recent outbreak caused by SARS-CoV-2, known as COVID-19, has been cataloged as a global catastrophe due to the growing number of infected cases and deaths since November 2019;this infectious, contagious disease, to date, does not have a vaccine or specific treatment available, which is why the number of cases continues to increase. SARS-CoV-2 infects humans as a result of the interaction between the receptor-binding domain of the viral spike protein and the receptor of the angiotensin-converting enzyme-2 (rACE2), located predominantly in the alveolar cells. Objective: This study aims to identify inhibitory peptides of the protein-protein interaction between the receptor-binding-domain of the spike protein of SARS-CoV-2 and the angiotensin-converting enzyme-2 receptor through computational tools. Methods: Through the Research Collaboratory for Structural Bioinformatics protein database, crystals were selected and interaction models were carried out between the viral protein and the ACE2;thereafter, the study designed inhibitory peptides of the interaction through the Rosetta web server, validated their interaction through ClusPro and, finally, determined the theoretical physicochemical and cytotoxic properties. Results: A protein complex was generated and modeled through ClusPro;the balanced model was selected with the lowest binding energy. From the protein interactions of each of the crystals and from the model, eight peptides of 20 residues were obtained. The theoretical evaluation showed non-toxic peptides, six soluble in water, and two insoluble. Conclusion: We found eight peptides that interacted with the receptor-binding-domain of the spike protein of SARS-CoV-2, which could avoid contact with the cell receptor and generate interference in the infection process.

Should i bronch or should i go: The need for bronchoscopy in an immunosuppressed child with COVID-19

Introduction: Flexible bronchoscopy with bronchoalveolar lavage (FB+BAL) is routinely used for diagnostic evaluation in immunocompromised patients with pulmonary infiltrates. However, during the current COVID-19 pandemic, this procedure has usually been deferred in those with suspected or known diagnosis of COVID-19, given the risk of aerosolization and subsequent transmission of SARS-CoV-2 to healthcare personnel. We report the case of an immunosuppressed teenager with persistent fever and progressive respiratory symptoms after an initial diagnosis of COVID-19 in whom the need of FB+BAL represented a clinical dilemma. Description: A 14-year-old female on treatment for relapsed acute lymphoblastic leukemia was diagnosed with SARS-CoV-2 infection by polymerase chain reaction (PCR) in a nasal sample after having a positive household contact. Her symptoms were initially mild until she developed fever, cough, and dyspnea ∼2 weeks after diagnosis. Her laboratory evaluation was notable for lymphopenia and her chest CT revealed extensive lower lobe consolidations with scattered ground-glass opacities (Figure A), prompting hospitalization. Despite broad-spectrum antibiotics, her respiratory status worsened and she eventually required high-flow nasal cannula support. Pediatric pulmonology was consulted for consideration of FB+BAL to rule out opportunistic infections. Her repeat SARSCoV-2 PCR nasal test at that time, done ∼3 weeks after her initial diagnosis, was inconclusive. Because of this, as well as her tenuous respiratory status, it was decided not to proceed with FB+BAL. She then received steroids, remdesivir, and immunoglobulin, with gradual resolution of her hypoxemia. She was subsequently discharged home. Unfortunately, her fever and dyspnea returned ∼1 week after, prompting re-admission. Her repeat SARS-CoV-2 PCR nasal test was positive and her chest CT demonstrated shifting consolidative and ground-glass opacities, now more predominant in the upper and mid-lung fields (Figure B). We then proceeded with FB+BAL, which was unremarkable. Evaluations for a broad range of viral, bacterial, and fungal pathogens were negative, except for positive SARS-CoV-2 by PCR from BAL fluid. Her symptoms slowly improved with supportive treatment, so she was again discharged home. Her SARS-CoV-2 PCR nasal testing ∼2 months after initial diagnosis continued to be positive. Discussion: There is limited evidence regarding the safety and utility of FB+BAL in those with suspected or diagnosed COVID-19, particularly in the pediatric population. This case highlights an immunosuppressed child with prolonged viral shedding and emphasizes that in certain clinical situations FB+BAL may be required for further microbiologic data, especially when illness is protracted, the differential diagnosis is broad, and imaging findings are non-specific for COVID-19.

Sars-cov-2 infection and viral load are associated with the upper respiratory tract microbiome

RATIONALE: The upper respiratory tract (URT) is the portal of entry and an active site of replication of SARS-CoV-2 and thus of critical importance in the pathogenesis of COVID-19. However, little is known about the relationships between SARS-CoV-2 and the URT microbiome. To fill this gap in knowledge, we 1) compared the URT microbiome between SARS-CoV-2-infected and-uninfected adults, and 2) examined the association of SARS-CoV-2 viral load with the URT microbiome during COVID-19. Methods: We characterized the URT microbiome using 16S ribosomal RNA sequencing in 59 adults (38 with confirmed, symptomatic, mild-to-moderate COVID-19 and 21 asymptomatic, uninfected controls). In those with COVID-19, we measured SARS-CoV-2 viral load using qRT-PCR. We then examined the association of SARS-CoV-2 infection status and its viral load with the α-diversity i.e., richness ± evenness), β-diversity (i.e, overall structure), and abundance of bacterial taxa of the URT microbiome using common microbial ecology analyses. Our main models were all adjusted for age and sex. Results: The median (interquartile range) age was 30 (27-45) years and none of the participants had recently used antibiotics or intranasal steroids. The observed species -diversity index was higher in SARS-CoV-2-infected than in-uninfected adults (β=7.53, 95%CI=0.17-14.89, p=0.045). There were no differences in the Bray-Curtis β-diversity index between groups (permutational multivariate analysis of variance p>0.05). In DESeq2 testing, 21 amplicon sequence variants (ASVs) were differentially abundant between groups, with 13 being more abundant (including Brevundimonas, Corynebacterium, Granilucatella, Anaerococcus, and Peptoniphulus ASVs) and 8 being less abundant (including Corynebacterium-1, Prevotella, Staphylococcus, Anaerostipes, and Neisseria ASVs) in SARSCoV-2-infected vs.-uninfected adults (p<0.05 for all comparisons). In the adults with COVID-19, there were no associations of viral load with -or β-diversity indices of the URT microbiome (p>0.05 for all comparisons). However, 21 ASVs were differentially abundant between groups in DESeq2 analyses, with 9 being more abundant (including Neisseriacea, Anaerococcus, Peptoniphulus, Campylobacter, and Enterococcus ASVs) and 12 being less abundant (including Corynebacterium-1, Staphylococcus, Granilucatella, Neisseria, and Prevotella ASVs) in those with high viral load when compared to those with low viral load (p<0.05 for all comparisons) (Figure 1). Conclusions: Our findings suggest complex associations between SARS-CoV-2 and the URT microbiome in adults. Our study is a stepping stone in examining the role of the URT microbiome in SARS-CoV-2-related outcomes and in understanding the development of bacterial co-infections during COVID-19. We are now examining longitudinal associations of SARS-CoV-2 viral load with the URT microbiome over time.

Status of novel coronavirus disease and analysis of mortality in Mexico, until June 30th, 2020: an ecological study

Introduction. Mexico has high number of new cases of Coronavirus Infectious Disease-19 and high rates of diabetes, hypertension, obesity, smoking, that can increase the mortality. The aim was to analyze the evolution of the disease until June 30th, 2020;to know the Cause-Specific Mortality Rate by each state from Mexico and the effect of co-morbidities on mortality for Coronavirus Infectious Disease-19. Methods. An ecological study was designed with public data of National Epidemiological Surveillance System to compare the hospital infrastructure (beds) and Cause-Specific Mortality Rate in each state from Mexico and analyze the effect of co-morbidities in mortality by Coronavirus Infectious Disease.19. It was used t-Student test, Z for two proportions, P-values, and OR, CI95%, and logistic regression . Results. From 509,539 registries, 226,089 (44.37%) were confirmed cases and 27,769 deaths were reported (12.28%). The states with higher mortality were Morelos, Baja California, Chihuahua, Guerrero. There was a lineal relationship between number of beds and cause-specific mortality rate (P<,05). Diabetes, chronic obstructive pulmonary disease, immunosuppression, hypertension, cardiovascular disease, chronic kidney disease and obesity shown a stronger effect on mortality by coronavirus disease (OR higher than 2). Asthma shown a protective effect on mortality from coronavirus disease in Mexican population. Conclusion. The spread on coronavirus disease is active in Mexico. The comorbidities had a stronger effect on mortality of Coronavirus disease.

Status of novel coronavirus disease and analysis of mortality in Mexico, until June 30th, 2020: An ecological study

Mexico has high number of new cases of Coronavirus Infectious Disease-19 and high rates of diabetes, hypertension, obesity, smoking, that can increase the mortality. The aim was to analyze the evolution of the disease until June 30th, 2020;to know the Cause-Specific Mortality Rate by each state from Mexico and the effect of co-morbidities on mortality for Coronavirus Infectious Disease-19. Methods. An ecological study was designed with public data of National Epidemiological Surveillance System to compare the hospital infrastructure (beds) and Cause-Specific Mortality Rate in each state from Mexico and analyze the effect of co-morbidities in mortality by Coronavirus Infectious Disease.19. It was used t-Student test, Z for two proportions, P-values, and OR, CI95%, and logistic regression.Results. From 509,539 registries, 226,089 (44.37%) were confirmed cases and 27,769 deaths were reported (12.28%). The states with higher mortality were Morelos, Baja California, Chihuahua, Guerrero. There was a lineal relationship between number of beds and cause-specific mortality rate (P<,05). Diabetes, chronic obstructive pulmonary disease, immuno suppression, hypertension, cardiovascular disease, chronic kidney disease and obesity shown a stronger effect on mortality by coronavirus disease (OR higher than 2). Asthma shown a protective effect on mortality from coronavirus disease in Mexican population. Conclusion. The spread on coronavirus disease is active in Mexico. The comorbidities had a stronger effect on mortality of Coronavirus disease. © 2020 This is an Open Access article licensed under a Creative Commons license: Attribution 4.0 International (CC-BY). Published by Oriental Scientific Publishing Company.

Quito's coronavirus curfew: Escalating tropospheric ozone pollution

The effect of the curfew due to the pandemic of Covid-19 virus on the levels of air pollution in the historic center of Quito was evaluated with a focus on tropospheric ozone (O3). During the curfew period the daily O3 mean concentration increased by 96%, 109% and 95% in comparison to the concentrations for the same period in the years 2017, 2018 and 2019. This increase is mainly explained by considerable reduction in NOx emissions, thus there was little titration of ozone accumulated in the city environment due to its shallow boundary layer by NO, reaching its maximum concentration at midday. Among studied pollutants that influence O3 formation (CO, NO2, PM2.5) during the curfew the contaminant that showed the greatest reduction in the mean concentration compared to three previous years was NO2, followed by CO and PM2.5. The daily O3 8-hour mean concentrations during the curfew both on weekdays and weekends were lower than the limit values. These results are relevant for designing abatement policies of secondary pollutants such as O3 under strict measures of control of primary pollutant emissions. © The Authors, published by EDP Sciences, 2020.

Description of Confirmed Cases and Deaths from COVID-19 in Mexico, until May 6, 2020: An Ecological Study

A review is made of the confirmed cases of COVID-19 and deaths in Mexico as of May 6, 2020, from the public database of the General Directorate of Epidemiology and the National System of Epidemiological Surveillance of the Ministry of Health in Mexico. A descriptive ecological study of confirmed cases and deaths by COVID-19 is designed. 27,634 confirmed cases and 2,704 registered deaths were reviewed. Of the confirmed cases they predominated in men (58.48%) and their distribution by states of Mexico, being more frequent in Mexico City, State of Mexico, Baja California and Tabasco. Deaths are shown by day on which they occurred. It is concluded that the measures of social isolation and quarantine should be reinforced to decrease the number of confirmed cases and deaths related to COVID-19.

Evolution of COVID-19 Infection in Mexico Until April 16, 2020: A Descriptive Ecological Study

The aim was to describe the number of confirmed cases of COVID-19 in Mexico until April 16, 2020. The study design was an ecological descriptive study. The place and duration of study were registries of confirmed cases for COVID-19 in Mexican population during February and until April 16, 2020, 13:00 PM, from National System of Epidemiological Surveillance/ General Direction of Epidemiology/ Secretary of Health, Mexico. Material and methods: Accord to database of confirmed cases of COVID-19 by Secretary of Health in Mexico, it was collected data on age, gender, it was included 6,297 registries. Results: The first confirmed case in Mexico was February 20, 2020 and the frequency are arising at the end of February and throughout March. The early confirmed cases were imported cases for travel to USA, Italy, Germany, Spain, France and Singapore. No one travelled to China. Now, there are a lot of confirmed cases infected for contact with a case. Conclusion: The frequency of confirmed cases of COVID-19 are higher and the health authorities in Mexico are waiting that the peak of the epidemiological curve is in early May.

SARS-CoV-2 infection and coronavirus disease (COVID-19) clinical data: A review of the literature

The aim was to describe the clinical data from patients with confirmed cases of COVID-19 and clinical data of patients with pneumonia by the same virus. It was selected articles on clinical data from patients with COVID-19 and pneumonia by SARS-CoV-2 in pubmed, embase and google schoolar. It was described the clinical data of patients with COVID-19 from 3 studies with 1,078 patients. The main clinical data for COVID-19 were cough 60.4%, fever 40.9%, and production of sputum 26.0%. For pneumonia by SARS-CoV-2, was described clinical data from 495 patients from 5 studies, were fever 77.4%, cough 68.9%, and myoarthralgia 49.9%. In children with COVID-19 was reported cough 48.5%, pharyngeal erythema 46,2%, and fever 41.5%. To use only clinical data to submit patients to RT-PCR test is not good, because many infected patients have not clinical data (asymptomatic carriers) or they did not reported the main clinical data as fever, cough or myoarthralgia.