SPANISH NATIONAL REGISTRY OF BELIMUMAB IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

BackgroundBelimumab (BLM) is a monoclonal antibody that inhibits B-lymphocyte stimulating factor (BlyS) approved as a specific treatment for systemic lupus erythematosus (SLE) in 2011. We present the experience with BLM in a Spanish cohort with more than 460 patients.ObjectivesTo describe demographic characteristics, efficacy and safety of BLM in patients with SLE in Spanish population since its approval.MethodsDescriptive, retrospective, multicenter study in patients diagnosed with SLE according to EULAR/ACR 2019, SLICC and/or ACR 1997 diagnostic criteria. Data regarding SLE patients treated with BLM were collected from medical records (2011-2022). Demographic features, efficacy, laboratory variables, SLEDAI, renal involvement, steroid dose, administration routes and safety were assessed. To see whether a trend in BLM prescription had changed or not over time, two periods of time were analyzed: 2011-2016 (period1) and 2017-2022 (period2).ResultsBaseline characteristics of patients are summarized in Table 1.A total of 462 patients (36 hospitals) were included, 50.9% were on intravenous (IV), 34% on subcutaneous (SC) and 15.1% switched from IV to SC route. The median number of pre-BLM csDMARD use was 2.0 (2.0-3.0), being hydroxychloroquine (HCQ) the most frequently used (94.5%). Fifty-two patients were treated with IV cyclophosphamide with a median of 6 bolus received. At the time of BLM start, 443 patients were on prednisone with a median dose of 6.2 mg (5.0-10.0). Significant decreases in prednisone dose, SLEDAI and anti-DNA antibodies were observed from baseline until the last visit, whereas complement C3 and C4 values raised (Figure 1). A total of 118 patients (27.4%) had renal involvement with a median proteinuria of 1.0 g/day (0.5-2.4). Renal biopsy was done in 102 out of 118 patients, being class IV (33%), class III (21%) and class V (16%) the most frequently reported. After BLM, 73.3% of these patients improved (median proteinuria of 0.2 g/day (0.1-0.7).In period1, 100 patients started BLM compared to 362 in period2. The median time from SLE diagnosis to BLM begin was 7.1 (4.0-13.7) and 6.2 (2.1 -14.4) years in period1 and period2, respectively (p=0.454). We found a trend to use more csDMARD before BLM treatment in period1: 2.5 (2-3) vs. 2 (2-3) (p=0.088).A total of 143 (30.5%) patients discontinued treatment mostly due to inefficacy (55.9%) and infections (11.9%). In fact, 116 patients developed infections, mostly mild;2 patients died, 16 had COVID-19 and 4 patients developed tumors requiring discontinuation of the drug.ConclusionIn our cohort of SLE patients in a real-world setting, BLM has been effective, safe and seems to be a good choice to treat renal involvement.References[1]Navarra SV, Guzmán RM, Gallacher AE, et al. Lancet. 2011;377(9767):721-31.[2]Stohl W, Hiepe;rt al. Arthritis Rheum. 2012;64(7):2328-37.[3]Furie R, Rovin BH, Houssiau F, et al. N Engl J Med. 2020;383(12):1117-1128.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

KIR2DL2/C1: A potential predictive immunogenetic marker to COVID-19 severity in Spanish patients

COVID-19 has aspects on its pathogenesis that still need elucidating and an analysis of clinical and immunogenetic factors in each cohort of patients is paramount to understanding how genetic variability can explain the multiple clinical spectra seen in patients infected with SARS-CoV-2. The aim of this study was to correlate the KIR polymorphism/HLA class I ligand interactions from patients and healthy subjects with either the susceptibility or severity to COVID-19. Genotyping of HLA-A, -B, -C and KIR genes were carried out from 459 symptomatic as well as 667 non-infected Spanish Caucasian individuals using Lifecodes HLA-SSO and KIR-SSO kits (ImmucorTM, USA) and analyzed in the Luminex in this uni-centre case-control study performed at the University Hospital of Salamanca, Spain. Comparative KIR gene analysis showed that KIR2DS4 was significantly more representative in healthy versus infected individuals. When comparing subgroups of infected patients, KIR2DS3 had a higher frequency in those who progressed to a more severity disease and yet with higher mortality rate. Three functional combinations were significant on univariate analysis: KIR2DL2/C1, KIR2DS2/C1, and KIR2DS3/C1. However, in the multivariate analysis, only the KIR2DL2/C1 interaction remained significant (OR = 15.2 (95% CI 1.5-147), p = 0.0189). Compared with the solo-clinical characteristics predictive model, that included well-known comorbidity variables such as hypertension, age, sex, diabetes, C-reactive protein, dyslipidemia, smoking, ferritin, and fibrinogen, the clinical-and-KIR-based model showed a better ability to discriminate between severe and nonsevere patients with higher sensitivity and specificity. Our results support a fundamental role of KIR/ligand interaction in the clinical course of COVID-19. Since the KIR2DL2 gene has a high frequency in Spain (60%), the analysis of the KIR2DL2/C1 in symptomatic patients who require hospitalization could be helpful to better determine their prognosis.

Epidemiology of bacterial co-infections and risk factors in COVID-19-hospitalized patients in Spain: a nationwide study.

BACKGROUND: We performed a nationwide population-based retrospective study to describe the epidemiology of bacterial co-infections in coronavirus disease 2019 (COVID-19)-hospitalized patients in Spain in 2020. We also analyzed the risk factors for co-infection, the etiology and the impact in the outcome. METHODS: Data were obtained from records in the Minimum Basic Data Set (MBDS) of the National Surveillance System for Hospital Data in Spain, provided by the Ministry of Health and annually published with 2 years lag. COVID-19 circulated in two waves in 2020: from its introduction to 31st June and from 1st July to 31st December. The risk of developing a healthcare-associated bacterial co-infection and the risk for in-hospital and intensive care unit (ICU) mortality in co-infected patients was assessed using an adjusted logistic regression model. RESULTS: The incidence of bacterial co-infection in COVID-19 hospitalized patients was 2.3%. The main risk factors associated with bacterial co-infection were organ failure, obesity and male sex. Co-infection was associated with worse outcomes including higher in-hospital, in-ICU mortality and higher length of stay. Gram-negative bacteria caused most infections. Causative agents were similar between waves, although higher co-infections with Pseudomonas spp. were detected in the first wave and with Haemophilus influenzae and Streptococcus pneumoniae in the second. CONCLUSIONS: Co-infections are not as common as those found in other viral respiratory infections; therefore, antibiotics should be used carefully. Screening for actual co-infection to prescribe antibiotic therapy when required should be performed.

Radiological sequelae in patients with ARDS due to SARSCoV-2 pneumonia

Research Questions: To describe the prevalence of radiological sequelae, 1 year after admission, of patients with pneumonia and adult respiratory distress syndrome (ARDS) due to SARS-CoV-2 and avaluate their relationship with ventilatory support and/or corticosteroids (CC) Material(s) and Method(s): Observational study of patients with pneumonia and ARDS due to SARS-CoV-2 who required admission to the ICU/IRCU of Granollers Hospital between March and May 2020. We collect clinical and radiological data, the treatment received (ventilatory support and CC) and radiological features (thoracic CT) at 12 months Results: Of a total of 109 admitted patients, 23 died during hospital stay. 78 patients were followed up. 69% were men;mean age 61 (+/-11) years. 49% required invasive ventilation (IV), 27% non-invasive positive pressure support (NIV), and 24% high-flow nasal cannula oxygen therapy (HFNC). 66% received CC therapy Of the 71 patients who were followed up at year, 31% presented normal radiology, 7% ground glass opacities, 53.5% reticulum and 8.5% fibrosis. In relation to residual/fibrotic sequelae, a higher proportion was observed in >60 years (73.9% vs 40%;p=0.005) and in patients who required IV, compared to NIV and HFNC (73.5% vs 61.9 vs 37.5%;p=0.05), with no significant differences in the use of CC (72.1% vs 55.6%;p=0.156) In the multivariate analysis, age (>60 years) and invasive ventilation were associated with the presence of pulmonary sequelae (OR 3.92 [95% CI 1.31-11.75]) and (OR 3.85 [95% CI 1.01-14.64]) Conclusion(s): 8.5% of patients presented pulmonary fibrosi at 1 year. Age (>60) years and invasive ventilation were related to a higher frequency of pulmonary radiological sequelae, regardless of administration of CC.

Lung function at 12-18 months in patients with ARDS due to SARS-CoV-2 pneumonia

Research Questions: To describe lung function at 12-18 months in patients with pneumonia and adult respiratory distress syndrome (ARDS) due to SARS-CoV2 with radiological sequelae Material(s) and Method(s): Observational study of patients with pneumonia and ARDS due to SARS-CoV2 who required admission to the ICU/IRCU of Granollers Hospital between March and May 2020. We collected clinical, chest CT, spirometry and DLCO data. The dyspnoea is defined according to the modified Medical Research Council (mMRC) scale, an altered spirometry is considered when FVC and/or FEV1<80%, and the presence of a reticular patern/fibrosis is valued as radiological sequelae Results: Of a total of 109 admitted patients, 23 died during hospital stay. Of the survivors, 71 patients were followed up in outpatient clinics after 1 year. Of these, 44 presented radiological sequelae on chest CT at 1 year after discharge (6, pulmonary fibrosis). 70.5% were men, mean age of 63.8 (+/-9.08) years and 56.8% with smoking history At 1 year, 39% had MMRC dyspnoea grade 0, 43.9% grade 1, and 17.1% grade 2 or 3 32.5% had normal spirometry and DLCO>80%, 35% normal spirometry and DLCO<80%, and 17.5% altered spirometry and DLCO<80%. 42.5% had a DLCO between 60-79% and 10% between 40-59% We observed that 53.3% of patients with dyspnoea grade 0 and 54.2% of patients with dyspnoea grade >1 had DLCO<80% [p= 0'959] and that 75% of patients with fibrosis and 50% of patients with reticular pattern had DLCO<80% At 18 months, a drop in DLCO>15% was observed in 3/30 patients (10%) Conclusion(s): At 1 year, 32.5% of patients had normal Spirometry and DLCO>80%. No relationship was observed between degree of dyspnoea and DLCO. No significant drop in DLCO was regarded at 18 months .

Clinical impact of out-of-ICU non-invasive respiratory support in patients with COVID-19 related pneumonia

In response to the COVID-19 pandemic, health systems attempted to rapidly reorganise their healthcare including implementation of Respiratory Support Units (RSU). Aim(s): To describe the characteristics of the patients admitted to our RSU. Method(s): Observational study including patients admitted to the RSU with bilateral COVID-19 pneumonia from 03/15/2020 to 09/14/2021. Clinical characteristics, gasometrical data on admission, pharmacological treatments, respiratory support therapies, days of stay in the RSU, complications and mortality are described. Result(s): 176 patients (111 men) were included, mean age 64 years. Most frequent comorbidities: hypertension (93 patients), dyslipidaemia (70), obesity (49) and diabetes (45). On admission, the mean respiratory rate was 24 rpm, PaO2/FiO2 143 mmHg. Most used drugs: Enoxaparin > 40mg/day in 126 patients, Dexamethasone in 113, Tocilizumab in 102 and Remdesivir in 53. Parenteral nutrition was received by 26 patients. All patients received oxygen therapy, CPAP was applied to 86 patients and NIV to 55. Mean PEEP applied was 11 cm H2O. Twenty-three patients presented myopathy, 12 pulmonary thromboembolism, 8 haemorrhagic accidents, 3 pneumothorax, 3 venous thromboses, 3 infections due to multiresistant germs, and 2 confussional syndromes. Mean RSU stay was 12 days. Fitting patients required IOT and global mortality was 12%. Conclusion(s): 1. The RSU has allowed us to assume the great demand for care of seriously ill patients derived from the current COVID-19 pandemic. 2. Non-invasive ventilation techniques are a valid alternative for the treatment of hypoxemic respiratory failure refractory to conventional oxygen therapy in these patients.

Professional practice in times of pandemic covid-19: case cecar university corporation of the caribbean

The professional practice is the means that allows students to apply the knowledge learned during their training process and strengthen the competencies of knowing, knowing how to do and being/coexisting. The article synthesizes the characteristics and processes developed from the professional practice course at the Corporación Universitaria del Caribe in pandemic. Meanwhile, the practice process was adapted to the contingency by adopting new modalities of practice at institutional level (telepractice, work at home, advisor/tutor practice, research, entrepreneurship and telepsychology) to guarantee the students the pedagogical space that allowed them to put into practice their knowledge and disciplinary competences. © GKA Ediciones, authors.

Successful design and execution of two gastric cancer chemoprevention trials in Central America and Puerto Rico

Gastric adenocarcinoma (GAC) is the third leading global cause of cancer mortality and leading infection-associated cancer. The high incidence regions are Latin America, East Asia, and Eastern Europe. In the U.S., GAC represents a major cancer disparity, double the incidence rates in all nonwhite populations, the opposite of Barrett's Esophagus and EAC. Immigrants from high incidence regions maintain the risk profile of their nations of origin. In a paradigm shift, recent guidelines now recommend surveillance endoscopy (eg, 3 years) for patients with high-risk gastric premalignant conditions (GPMCs). Clinical trials of chemoprevention agents for patients with GPMCs are lacking. We conducted two independent, NCI DCP funded, phase II placebo-controlled chemoprevention trials in patients with GPMCs (intestinal metaplasia, atrophic gastritis). The oral agents were curcumin and eflornithine (DFMO). A highly bioavailable preparation of curcumin was used. The RCTs were conducted in Puerto Rico and rural Honduras, with important characteristics: (1) representative of Caribbean and Mesoamerican populations and linked to large U.S. immigrant populations;(2) high prevalence of H. pylori infection and GPMCs;(3) absence of turmeric and curcuminoids in the local diets;(4) proven bidirectional collaboration with academic institutions in the U.S. In the curcumin trial (NCT02782949) H. pylori negative patients were randomized to study drug or placebo for 6 months. In the eflornithine study (NCT02794428), H. pylori positive and negative subjects were randomized to study drug or placebo for 18 months, with endoscopy at baseline, and 6. 18, and 24 months. The primary outcomes were based upon changes in histologic parameters at 6 months. Principal study challenges included: (1) International and bilingual regulatory environment;(2) Strengthening of the research infrastructure, particularly in Central America;(3) Participant recruitment, eg, in the curcumin RCT in Honduras wherein only 10-15% are H. pylori negative;(4) The Covid-19 pandemic;(5) Natural disasters (3 hurricanes). In Conclusion(s): Eflornithine and curcumin RCTs have been successfully completed, despite important challenges in implementation and execution. No losses to follow-up were encountered related to the pandemic or natural disasters. The south-south partnership may provide a model for chemoprevention and translational studies in Latino populations with prevalent cancers such as GAC..

Effectiveness of SinergiAPS, an intervention based on Patient Feedback to Improve Patient Safety in Primary Care: a randomized clinical trial in Spain

Aims: To evaluate the effectiveness of SinergiAPS (a patient-centred audit and feedback intervention) in improving patient safety in primary healthcare (PHC) centres. Method(s): We conducted a cluster randomized controlled clinical trial in 59 PHC centres in Spain. We audited all the participant centres, assessing their level of patient safety based on the administration of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire to 75 patients/centre. Then, PHC centres were randomly allocated to receive the SinergiAPS intervention or usual care. Only the intervention centres were fed back with the audit results. They received: (1) a bespoke feedback report with quantitative (scale and item level scores) and qualitative (free text) results;(2) a set of educational materials (based on available evidence-based strategies for addressing patient safety problems);and (3) a structured template to record and monitor their safety improvement plans. The intervention was remotely delivered using a bespoke web tool. The primary outcome was patient safety culture among professionals (MOSPSC questionnaire). Secondary outcomes were patient-reported patient safety (mean scores of five PREOS-PC questionnaire scales), and rate of avoidable hospital admissions. After 12 months follow-up, we conducted 14 semi-structured qualitative interviews with PHC professionals to explore their perceptions of the intervention and to identify implementation barriers. Result(s): We successfully recruited 1053 professionals out of 1971 (53%) invited professionals (81% women;mean (SD) age 49 (10) years). The post-intervention followup rate was 75% (793/1053). No significant differences were observed at 12 months between groups in patient safety culture score (intervention: 3.60 [95%CI 3.55-3.64] vs. control: 3.64 [95%CI 3.60-3.68]), or in any of the secondary outcomes. The qualitative interviews revealed that the response to the COVID-19 pandemic (which in Spain started 6 weeks after starting to deliver feedback reports) severely limited the ability of PHC centres to use the intervention resources as planned. Despite its low ''reach'', the intervention presented high acceptability and perceived utility. Conclusion(s): In the context of a health emergency, SinergiAPS did not improve patient safety in Spanish PHC centres. Future studies are needed to evaluate its effectiveness in contexts more consistent with usual practice.

Bilateral covid pneumonia and intestinal ischemia, an analysis of our experience

Aim: COVID-19 is mostly well known because of its respiratory pathology, nevertheless several ischemic complications have been reported during the pandemia. The aim of this report is to present 9 cases of acute intestinal ischemia in patients with concomitant SARS-COV- 2 bilateral pneumonia. Method(s): We present a case series collected from a retrospective database, that includes 9 patients with intestinal ischemia and bilateral COVID 19 pneumonia diagnosed during the years 2020 and 2022 at the "Hospital Universitario Nuestra Senora de Candelaria." Results: Of the 9 patients, 6 were men with a mean age of 63 years, 5 of them unvaccinated and 2 with partial dose. All presented with bilateral covid pneumonia requiring admission and intubation at the intensive care unit. During admission, after a hemodynamic worsening with increasing lactate, acute intestinal ischemia was diagnosed on a CT scan (7 non occlusive and 2 occlusive ischemia of the SMA). 7 of them underwent damage control surgery of whom only 2 survived. The remaining 3, died hours after diagnosis, not undergoing surgical treatment due to poor short-term prognosis. Conclusion(s): The severe inflammatory response along with a hypercoagulable state secondary to COVID 19 is responsible for many severe ischemic diseases such as intestinal ischemia. These can go unnoticed in intubated critically ill patients, or with concomitant respiratory disease due to the absence of obvious clinical manifestations. Given its high mortality, it is essential to take this differential diagnosis into account, to obtain an early diagnosis and treatment.

Elevated clozapine levels in patients with COVID-19 infection

Introduction Clozapine is the most effective antipsychotic for treatment resistant schizophrenia. In patients treated with clozapine, COVID-19 infection may result in complications including an increased risk of pneumonia, clozapine toxicity, and disruption to clozapine treatment by COVID-19 induced lymphopenia. Objectives We report 5 cases of elevated clozapine levels occurring in patients with COVID-19 infection who had been previously managed for several years on stable doses. Methods Subjects: 48 admitted patients to a long-stay psychiatric unit. COVID-19 infection confirmed by positive nasopharyngeal swab for viral ribonucleic acid of SARS-CoV-2. Hematological controls between March and April 2020. Results 16 patients (33%) treated with clozapine.18 patients (37’5%) had COVID-19 infection, of which 5 (10’4%) were treated with clozapine. Results are presented in table 1. Increases in plasma clozapine levels were observed in all cases (49’38 to 307.5%). We don’t have the clozapine levels of a patient who presented a pneumonia requiring admission and treatment in the general hospital. Two cases of neutropenia were observed, of which one had to discontinue treatment with clozapine. In the other three patients the dose of clozapine was reduced and they did not present haematological or intoxication complications that required further adjustments. Conclusions Covid-19 infection is associated with increased serum clozapine levels by probably multifactorial mechanisms (systemic infection, reduced smoking). Importance of full clinical assessment of suspected COVID-19 infection in clozapine treated patients, including assessment clozapine level, and full blood count. The general recommendation is to reduce the dose of clozapine in this patients.

Who Benefits More of Durvalumab after Chemoradiotherapy (CRT) in Real-World Patients with Locally Advanced Non-Small-Cell Lung Cancer (NSCLC)?

Introduction: Durvalumab received EMA approval as consolidation therapy (CT) for unresectable stage III NSCLC with PD-L1 ≥1% and who did not have progression after CRT. Our objective was to analyze in real clinical practice the effectiveness of durvalumab and explore the clinical factors that may be associated with the benefit from CT. Methods: Retrospective study was made at Hospital of Leon (Spain), including 37 patients with locally advanced NSCLC treated with durvalumab after CRT treatment between March 2018 and october 2021 (40.5% patients were included in the durvalumab early access program). The neutrophil-to-lymphocyte ratio (NLR) could identified after CRT as a factor that may be benefit from durvalumab. Results: Median age was 67 years (range 46-82 years). 40.5% of patients were ≥70 years old. 78.4% were male and 51.4% smokers. 54% had non-squamous histology. PD-L1 expression was <1% in 5% and not available in 8% patients. 2.7% ROS1 rearrangements, 5.4% KRAS mutations and not available in 43.2% patients. Stage IIIA, IIIB, IIIC disease were 24.3%, 54.1% and 21.6%, respectively. Median time from end of CRT to onset durvalumab was 44 days (range 13-120 days). Overall median CT duration was 214.8 days (range 69-399 days) with a median of 14 infusions (range 6-27 infusions). With a median follow up of 19.7 months (range 1.4-34.9 months);67.6% had stopped CT: 37.8% due to completing treatment, 16.2% disease progression, 10.8% adverse event and 2.7% due to COVID19 infection. Median real-world progression-free survival (rwPFS) was 17 months (95% CI, 11-23). Median real-world overall survival (rwOS) was 29.9 months (95% CI, 23.3-36.6). %rwOS at 6, 18 and 24 months were 100%, 86.9% and 74.5%, respectively. For patients with post-CRT NLR not exceeding the cohort median value of 6, receipt of durvalumab was associated with an improvement in rwOS (median not reached vs 25.7 months;p=0.025). 56.8% patients had any grade of radiation pneumonitis (median time from CRT start: 119 days [range 36-241 days]). Of these, 19% patients developed worsening of radiation pneumonitis with durvalumab. 54,1% developed immune-mediated toxicity, mostly G1-2 (85.1%). Conclusions: Our results demonstrate the effectiveness of durvalumab consolidation in this patients population in a real-life setting. We identified low NLR after CRT as a potentially predictive factor for the benefit of CT in locally advanced NSCLC. Keywords: DURVALUMAB, PACIFIC, REAL WORLD DATA

Clinicopathological characteristics and prognosis in women with breast cancer affected by COVID 19

Background: there are few reported series n women with breast cancer (BC) and COVID-19, a better prognosis has been observed, with a lower rate of hospitalization and mortality than other neoplasms. Methods: We conducted a restrospective, non-experimental, observational, single center, study with a sample of 69 patients with BC who had presented COVID-19, in the period between March 2020 to August 2021. Clinicopathological characteristics of patients with BC were compared between severe and non-severe covid 19 groups, as well as hospitalized and non-hospitalized patients. An analysis of possible risk factors associated with severe disease and hospitalization was performed. Results: 69 cases were reported, median age 52y, mean BMI 25.2, ECOG 0-1: 97%. Smoking history in 24%, diabetes and hypertension were the most frequent comorbidities. The most frequent histology was ductal carcinoma in 80.6%, 73.8% showed ER + and 69.3% PR +, HER2 was overexpressed in 9.2%. The early stages predominated, I 22 (31.3%), II 25 (37.3%), III in 12 (17.9%) and IV in 6 (9%). The most frequents symptoms of COVID-19 were fatigue 70.1%, fever 65.7%, cough 59.7%, headache 56.7%, hyposmia 47.8%, dysgeusia 38.8%. A total of 53 (76.8%) mild cases, 14 (20.3) severe cases and 2 (2.9%) critical cases were registered. The 89.9% (62 patients) were treated as an outpatient basis, while 7 (10.1%) required hospitalization. Active treatment (< 45 days) at the time of COVID-19 was hormonal therapy 36 (50.7%), chemotherapy 11 (16.4%), anti-HER2 in 3 (4.5%), immunotherapy in 1.5%, targeted treatment in 4 (6.0%), surgery in 7 (10.4%) and radiotherapy in 1 (1.5%) patient. When comparing the severe and non-severe groups, as well as hospitalized versus nonhospitalized, we observed no difference between the clinicopathological characteristics. Then, we serch for possible risk factors, in wich, surgery in a period of less than 3 months increases the risk of severity OR 1,297 (95% CI 1,112-1,514), the risk of hospitalization increased in the triple negative subgroup OR 1,143 (95% CI, 1,035- 1,262), surgery less than 3 months OR 1,116 (1,014-1,229) and chemotherapy less than 45 days OR 1,217 (95% CI, 1,024-1,447). Conclusions: In patients with BC, the prevalence of severe or critical COVID-19 was 23% and the hospitalizacion rate 10%. No patient died from this infection. The clinical and pathological characteristics of BC do not appear to increase the risk of severe COVID-19 or the rate of hospitalization. Surgery performed in a period of less than 3 months is marginally associated with an increased risk of severe disease. Chemotherapy, targeted therapy, and immunotherapy do not modify the risk of severe disease;however, higher Ki 67, triple negative subgroup, surgery and chemotherapy showed a slight increase in risk of hospitalization.

Evaluation of changes in lymph node size and metabolism by PET CT in patients with cancer who have been immunized against COVID 19: A Mexican study

Background: The risk of developing COVID-19 in patients with cancer has increased, directly influenced by age and the magnitude of comorbidities. In this population, the estimated mortality is 10.9%. With this, the urgent need for patients with cancer to get vaccinated against SARS COV 2 has generated an international response. With the ongoing vaccination campaign, experts in nuclear medicine have observed an increment in lymph node uptake in PET CT with 18 FDG. Increased uptake in lymph nodes in patients with a neoplastic diagnosis on PET CT 18 FDG must be closely followed and well-studied to differentiate disease progression from an inflammatory, fleeting reaction. Methods: Amongst the inclusion criteria were patients over 18 years of age with solid tumors, including lymphomas, who were on active oncologic treatment with chemotherapy, immune therapy, radiotherapy or under surveillance between April 2021 and July 2021 who underwent a PET CT scan and had at least one dose of a COVID 19 vaccine, and a prior PET CT to the vaccine for comparison. Patients were excluded who showed evidence of progression or disease recurrence of the primary tumor. We evaluated lymph node size and metabolism measured by SUV max in the PET CT scan prior to being vaccinated and posterior to, as well as patients' clinical characteristics. Results: A total of 92 patients who met inclusion criteria were included in the study. Amongst those, 54.3% were women, the median age was 68 years (27 - 95 years), the most common neoplastic diagnoses were breast cancer (19.6%), gastrointestinal tumors (17.4%), urothelial tumors (9.8%), lymphomas (9.8%) and ovarian cancer (8.7%). 52.2% of patients were under surveillance and 47.8% were under active treatment. 79% of patients had at least 2 vaccine doses. 59% had received Pfizer vaccines and the measurable adenopathies were axillary in 32.7% and mediastinal in 27%. The medium size of the measured lymph nodes prior to receiving the vaccine was 2.86 mm with an SUV max of 1.24, while after vaccination were 6.01 and 2.27 respectively. A Kruskal Wallis test was conducted to compare median results according to histopathologic reports, with no statistical difference. A Mann Whitney U test was conducted to compare breast cancer to other cancer histologies, where a statistical difference was found for SUV max, p = 0.003 and size with p = 0.033. Conclusions: This work details significant differences between lymph node size and SUV max in oncologic patients pre and post vaccination for COVID 19, showing a statistical difference in patients with breast cancer. This increment in lymph node uptake in patients with a neoplastic diagnosis PET CT 18 FDG must be closely followed and well-studied to differentiate disease progression from an inflammatory reaction.

TOURISM AND COVID-19. SCIENTIFIC PRODUCTIVITY ANALYSIS IN SCOPUS

This paper analyzes the scientific production about tourism and Covid-19 on the Scopus database. The methodology is based on an exploratory-descriptive study with a hindsight design. The time frame studied was from 2019 to 2021. In a first instance, the methodological procedure included the definition of keywords for a generic search, followed by the standardization using the software EndNote X9 and last, the data analysis through Bibexcel, Microsoft Excel 2013, pAjEx, and Vosviewer. Four hundred eighty three papers were identified and most of them (72.26%) were academic articles. The scientific journals with the highest production are Tourism Geographies, Sustainability Switzerland y Current Issues in Tourism. By countries, institutions from USA, Uk and China lead the scientific production on this issue. The topics studied on the publications that were analysed show a similar evolution to the pandemic phases worldwide.

Delivery of antimicrobial stewardship competencies in UK pre-registration nurse education programmes: a national cross-sectional survey.

BACKGROUND: Registered nurses perform numerous functions critical to the success of antimicrobial stewardship, but only 63% of pre-registration nursing programmes include any teaching about stewardship. Updated nursing standards indicate that nurses require antimicrobial stewardship knowledge and skills. AIM: To explore the delivery of key antimicrobial stewardship competencies within updated pre-registration nursing programmes. METHODS: This study had a cross-sectional survey design. Data were collected between March and June 2021. FINDINGS: Lecturers from 35 UK universities responsible for teaching antimicrobial stewardship participated in this study. The provision of antimicrobial stewardship teaching and learning was inconsistent across programmes, with competencies in infection prevention and control, patient-centred care and interprofessional collaborative practice taking precedent over competencies pertaining to the use, management and monitoring of antimicrobials. Online learning and teaching surrounding hand hygiene, personal protective equipment and immunization theory was reported to have increased during the pandemic. Only a small number of respondents reported that students shared taught learning with other healthcare professional groups. CONCLUSION: There is a need to ensure consistency in antimicrobial stewardship across programmes, and greater knowledge pertaining to the use, management and monitoring of antimicrobials should be included. Programmes need to adopt teaching strategies and methods that allow nurses to develop interprofessional skills in order to practice collaboratively.