Mastocytosis and COVID19 infection and vaccination: A pediatric series

Introduction: Mastocytosis encompasses a heterogeneous group of diseases characterized by an accumulation of clonal mast cells (MC) in the skin and/or internal organs, and symptoms of MC activation. This MC activation can be elucidated by several factors, including infections or vaccination. Objective(s): We present our experience with COVID infection and vaccination in a series of 133 patients with pediatric mastocytosis. Method(s): Between January 1998 and December 2022, 133 pediatric patients have been referred to our hospital owing to clinically suspected MC disorder, mainly with mastocytosis in the skin. The final diagnoses of mastocytosis were established by the presence of typical skin lesions together with an increase of MC numbers in a biopsy from lesional skin or activating KIT mutations in lesional skin tissue. Serum baseline tryptase and total immunoglobulin E levels were measured, and patients underwent a comprehensive allergy workup to confirm atopic status and history of anaphylaxis. Regarding vaccination, REMA's (Spanish Network on Mastocytosis) protocol was followed. Result(s): 13 patients with COVID infection were identified, of which 25 (56,8%) were female and 0% had symptoms of MC activation. All of them had an asymptomatic or mild course of COVID infection. None of the patients experimented MC activation symptoms during viral illness. Regarding COVID vaccination, all patients received premedication with antihistamine 60 minutes prior vaccination. No one experimented immediate reactions and only one patient (0,75%) referred worsening of MC activation symptoms (baseline pruritus, urtication and brain fog) only after the first doses, recovering without changes in his treatment (oral cromoglycate and antihistamine) in two months. Discussion(s): Although MC have been implicated in the pathogenesis of cytokine storm in COVID19, there is no clinical evidence of SARSCoV- 2-induced MC activation, perhaps related to the fact that bone marrow MC lack angiotensin-converting enzyme 2 receptors.

Bradyarrhythmias in patients with SARS- CoV- 2 infection: Report of two cases

Several cardiovascular diseases and arrhythmogenic events have been associated with COVID-19 due to SARS-COV-2 infection, a topic of current global interest. Bradyarrhythmias are less frequent than other types of arrhythmia. We present a patient at 27 weeks of pregnancy, who on the fourth day of infection presented asymptomatic transient sinus pauses that did not require treatment ( sinus bradycardia of 41 beats per minute, pauses of two seconds and junctional escape rhythm). She was diagnosed as possible atrial myopathy with third degree sinoatrial block, sinus arrest or atrial quiescence, primary sinoatrial node dysfunction due to myocarditis ( edema and inflammation of the conduction system). She continued under follow-up, since after the infection was overcome arrhythmical events may recur. The second patient, 39 years old, presented bradyarrhythmia on the ninth day of infection, transient absence of P waves and junctional atrioventricular and idioventricular escape rhythms, as well as atrioventricular dissociation. No specific treatment was required.

Presence of rare potential pathogenic variants in subjects under 60 years old with very severe or fatal COVID-19

Background/Objectives: Genetic variants affecting host defense against pathogens may help explain COVID-19 fatal outcomes. Our aim was to identify rare genetic variants related to COVID-19 severity in a selected group of patients under 60 years who required intubation or resulting in death. Method(s): Forty-four very severe COVID-19 patients were selected from the Spanish STOP-Coronavirus cohort, which comprises more than 3,500 COVID-19 patients. Genotype was performed by whole exome sequencing and variants were selected by using a gene panel of 867 candidate genes (immune response, primary immunodeficiencies or coagulation, among other). Variants were filtered, priorized and their potential pathogenicity was assessed following ACGM criteria. Result(s): We detected 44 different variants of interest, in 29 different patients (66%). Some of these variants were previously described as pathogenic (26%). Mostly, the candidate variants were located in genes related to immune response (38%), congenital disorders of glycosylation (14%) or damaged DNA binding genes (9%). A network analysis, showed three main components, consisting of 25 highly interconnected genes related to immune response and two additional networks enriched in carbohydrate metabolism and in DNA metabolism and repair processes. Conclusion(s): The variants identified affect different, but interrelated, functional pathways such as immune response and glycosylation. Further studies are needed for confirming the ultimate role of the new candidate genes described in the present study on COVID-19 severity.

Social presence, synchrony, and personalization: challenges of online education in the post-pandemic university

During the COVID-19 pandemic, there was a forced transition to the virtuality of face-to-face training proposals from universities. But what happened in those higher education careers that already had a distance modality? What lessons learned does the pandemic leave in the subjects that have already been developed online, mediated by digital technologies? In search of answers to these questions, a paradigmatic case study was completed: a distance career with a helping profile, accredited by a private Argentine university2. The research covered two phases: exploration and description, arriving at a categorization that dialogues with con-cepts of the theoretical framework. The data obtained reveals the installation of videoconference as a common practice in traditionally asynchronous spaces. The conclusions highlight the relationship of the categories: social presence and per-sonalization, with the situation of synchrony associated with presence. Everything seems to indicate that the return to normality does not constitute a return to the previous situation, but rather an opening to a transformative process that conso-lidates synchrony as a common practice in distance learning modality, and that causes -in terms of De Alba (2021)- a structural dislocation whose derivations must be mapped to broaden the understanding of the phenomenon.

The Pandemic as a Political Opportunity. Media Visibility and the Mobilization of Migrant Laborers in Spain

The fear of food shortages during the COVID-19 pandemic reinforced the image of the agricultural sector as an essential activity of European countries. The situation faced by the agricultural labor force in Europe (which mainly consists of migrant workers from countries in the Global South) became the subject of much political, media and academic debate. Research published in this context shows that the pandemic further exacerbated the precarious working and living conditions of these migrant day laborers. However, so far, the same attention has not been paid to how migrant agricultural workers took political advantage of the public attention afforded them by the COVID-19 crisis. As a case study we have taken four Spanish agro-exporting regions and in this paper we analyze the cycle of protests and mobilizations conducted by day laborers between June and December 2020. We demonstrate how workers and their support organizations were able to transform the strong public visibility they enjoyed during the pandemic (with both positive and negative images of migrant day laborers) into a political window of opportunity to claim rights and to protest against the structural precariousness of their sector.

Application of 'Design Thinking' in the Development of Virtual Platforms with Gamified Elements

This article presents the development of a virtual platform with the Design Thinking methodology and gamified elements, to strengthen the teaching-learning process in the teachers of the González Suárez Educational Unit. This research arises from the need of a virtual platform with gamified elements that are free, easy to use, interactive and motivational. In this study user stories with the agile POV format, test cases to verify the functionality and abuse cases for robustness and to prevent the vulnerability of the virtual platform are used, as well as a b-Learning approach for testing in the classroom. Obtaining in the end as significant results a high and satisfactory assessment of the use of the virtual platform. © 2022 IEEE.

Migratory Flows Between Colombia and Venezuela Since 1950: The Impact of the COVID-19 Pandemic

Migratory flows between Colombia and Venezuela have been continuous and bidirectional since 1950. Depending on the period under analysis, one can find migratory flows from Colombia to Venezuela, or vice versa. During the second half of the twentieth century, intense violence and lack of economic development caused a constant migratory flow from Colombia to Venezuela. Since the beginning of the twenty-first century, this situation began to be reversed. Initially, an incipient migration to Colombia of Venezuelans with resources and high professional training occurred between 2000 and 2014. Subsequently, a massive migration flow of Venezuelans with fewer resources and limited professional training took place between 2015 and 2019, and especially between 2017 and 2019. This has been described as the largest migration wave in the recent history of Latin America. The COVID-19 pandemic has abruptly halted this migration wave from March 2020 due to several socioeconomic and political factors that are analysed in the chapter. © Oxford University Press 2022.

Post-COVID-19 patients show vascular sequelae that last up to 6 months

Introduction: SARS-CoV-2 infection causes severe endothelial damage, an essential step for cardiovascular complications including coagulopathies and thromboembolisms. Endothelial progenitor cells (EPCs) could act as a biomarker of vascular damage but its role in SARS-CoV-2 is unknown. Objective(s): The study aims to quantify the number of EPCs at 3 and 6 months after SARS-CoV-2 infection and to assess whether the number of EPCs differs from COVID-19 patients who suffered an acute pulmonary embolism (PE) than those that did not. Moreover, it will be evaluated if this increase correlates with any of the clinical parameters studied. Material(s) and Method(s): A total of 22 patients were recruited in the study at different time points after overcoming COVID-19 (3 and 6 months) and 26 healthy controls. All subjects were matched for age, gender, BMI and clinical comorbidities. Of these 22 COVID-19 patients, 9 had suffered PE. EPCs were obtained from peripheral blood and cultured with specific medium and conditions. The appearance, number of colonies and days of appearance were quantified. Result(s): The results show an abnormal increase in the number of EPCs at 6 months compared to controls. There was no difference in EPCs production in post-COVID-19 patients who presented an acute PE compared to those that did not. Non-PE patients with higher levels of D dimer showed significant higher troponin levels at 6 months compared to PE patients. No correlation was found between troponin levels and the number or appearance of EPCs colonies or with any other clinical parameter studied. Conclusion(s): The results confirm the presence of vascular sequelae in post-COVID-19 patients that is maintained for up to 6 months.

Results of an Automatic Alert System from Microbiology to Link Diagnosis to Treatment in Patients with Chronic Hepatitis C

Introduction and Objectives: Strategies to simplify the care circuit for patients with the hepatitis C virus (HCV) are vital to achieving its eradication. To achieve this aim, we introduced an electronic system of HCV serology detection to link diagnosis with specialized assistance in order to minimize the loss of patients. Material(s) and Method(s): A retrospective single-center study of HCV patients developed by Microbiology Department from February 15th, 2020, to December 15th, 2021. In the event of a positive HCV antibody, the anti-HCV core was directly measured by the electronic system. If positive, an encrypted e-mail with the patient data was automatically sent to HCV specialized physicians, who, after evaluating the benefits of antiviral therapy in each patient, contacted them by phone for an appointment. In the first face-to-face consultation FibroScan, HCV genotype and viral load measurement were performed, and antiviral therapy was prescribed. Patient diagnosis origin and public health characteristics were recorded. We analyzed the association between antiviral therapy prescription and these variables. Statistical significance was set at p<0.005. Result(s): Of 171 patients identified, with a mean age of 59.6 +/- 15.9, 61.5 % of males and 81.2% of Spanish nationals. HCV origin from out-of-hospital settings predominated (50.9%, 87/171), particularly primary care (28.7%), penitentiary (11.6%) and addiction units (8.2%). In all, 43.3% (74/171) were aware of their diagnosis, but 64.9% (48/74) hadn't previously received antiviral therapy. Genotype 1 predominated. We recorded 19.4% (20/103) of patients F3 fibrosis and 27.2% (26/103) F4. Finally, 58.5% (100/171) attended a physician consultation. They were all treated with pangenotypic interferon-free therapy. A 100% rate of sustained viral response was achieved. The main reasons for not being treated were high comorbidity (43.7%,31/71), not located (23.9%, 17/71), patient refusal to treatment (23.9%,17/71) and death (8.5%,6/71). The sole association found between antiviral therapy and patient variables was that of comorbidities with being untreated (OR=7.14, p<0.001). Conclusion(s): Our alert system is simple and easily reproducible. It allows for minimizing the loss of HCV patients, even considering it was performed during the COVID-19 pandemic.Copyright © 2023

A virtual reality platform for training in the management of acute respiratory diseases

Introduction: During the COVID-19 pandemic, alternatives to face-to-face teaching were on the urge. What's more, in the context of the respiratory support of COVID patients, the training and capacitation of personnel capable of taking care of these patients was critical. Aims and objectives: Develop a Virtual Reality (VR) app for remote training of medical staff in the management of different acute respiratory diseases, including COVID-19. Method(s): Pulmonologists and software developers designed an app based on a virtual hospital using VR glasses. The teacher programs different clinical scenarios, where the student can converse with the patient and explore him, observing the respiratory mechanics and the skin coloration, auscultating different noises in various cardiac and pulmonary foci, edema in the lower extremities, etc. The student can request different tests (blood analysis, radiography, etc.) and prescribe treatment, including oxygen therapy and respiratory support. The clinical situation of the patient can change during the simulation. Result(s): Different acute respiratory diseases were successfully simulated, with a correct interaction between the student and the teacher. Conclusion(s): VR can be used as a tool for the remote training of medical staff, and provide high fidelity simulations for training in a wide variety of clinical situations.

Fatigue and functional capacity post COVID-19

Background: We explored if fatigue influenced the long-term functional capacity of patients post COVID-19. Method(s): People after COVID -19, grouped by treatment setting (home - H, hospital ward - HW or intensive care unit - ICU), were studied 12 months after discharge. Fatigue-Functional Chronic Illness Assessment Questionnaire Fatigue Subscale, FACIT-F and functional capacity-6min walk test, 6MWD and 1min sit-to-stand test, 1minSTS were assessed. Groups were compared with one-way ANOVA or Kruskal-Wallis H test. Spearman's rho and multiple regression analyses were performed between fatigue-functional tests. Result(s): 148 subjects (H, n=44;HW, n=60;ICU, n=44) participated. Fatigue was clinically relevant at 12 months although not significantly different among groups [H: 41(35-49);HW: 42(33-50);ICU;42(32-48) points;p=.979). Functional capacity was significantly higher in those treated at home (6MWD: H,626 114m, HW: 527 146m, ICU: 528 129m, p<.001;1minSTS: H,29 11reps, HW: 23 8reps, ICU: 24 8reps, p<.002). Fatigue was significantly correlated with functional tests within each group (FACIT-F-6MWD,.317<rho<=.550, p<.01;FACIT-F-1minSTS, .364<rho<=.485, p<.01). Each point of FACIT-F could change 6MWD by 5-6m and 1minSTS by. 3-.5reps, explaining between 12-33% of change in 6MWD and 17-22% of change in 1minSTS (Table 1). Conclusion(s): Fatigue seems to influence functional capacity of patients post COVID-19. Early management of this symptom seems important for their long-term management.

Reinforcement Learning Through Gamification and Open Online Resources in Elementary School

We are now in the post-confinement phase, a confinement decreed by the authorities in many countries due to COVID-19, which has led to the suspension of face-to-face teaching at all educational stages. Educational institutions and teachers have worked together to provide online teaching to enable students to achieve the required competencies at each educational level during the period of confinement. In this paper we show an online education proposal focused on preschool education that began to be developed in the period of confinement, for students between 3 and 5 years old. The adaptation and successful use of this proposal for the post-confinement period is presented, in which the return to face-to-face education has taken place. This proposal is a significant part of a curriculum design conceived as a game-based project in which the part related to computer games is presented here. It is important to note that this proposal focuses on generations that are already digital natives, so it is necessary to pay attention to both the content and the design of the proposed computer games, as well as to maintain the motivation of the students. The methodology presented allows for live resources that evolve along with the trainees. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Persistent Pneumonitis Post-COVID 19: description and risk factors

Background: Some patients present persistent ground glass opacities (GGO) and/or consolidations after an acute episode of SARS-CoV-2 pneumonia (COVID19). Risk factors for persistent pneumonitis (PPN) and potential response to corticosteroids remain unclear. Objective(s): To evaluate the clinical characteristics of patients with PPN, as well as to detect possible risk factors and the role of corticosteroids. Method(s): We conducted a prospective, controlled, multicenter analysis of patients hospitalized because of COVID19 with (n=152) or without (n=140) PPN. PPN was defined by the persistence of pulmonary opacities in a chest CT scan >14 days after admission. Characteristics of participants were obtained from their medical records. A CT score was used to quantify parenchymal abnormalities when PPN was suspected. Result(s): Compared to controls, patients with PPN were older and suffered more comorbidities, also D-dimer and Creactive protein levels were higher. The most frequent features observed in CT scans were GGO (97%), consolidation (95%), bronchial dilatation (93%) and reticular pattern (92%) with a CT score of 16.12+/-4.26. Multivariate logistic regression identified age and C-reactive protein levels on admission as independent risk factors for PPN. No significant differences were observed in thoracic CT scan one-month after discharge in patients treated with higher corticosteroids doses (>50 mg/day after discharge) compared to lower doses. Conclusion(s): Age and raised C-reactive protein levels on admission are significant risk factors of PPN after COVID19. Treatment with high doses of corticosteroids does not seem to add benefit.

Telemedicine home CPAP titration and follow-up in the COVID-19 scenario

Introduction: Continuous positive airway pressure (CPAP) titration was dramatically affected by the coronavirus disease 2019 pandemic due to increased biological risk. This study aims to compare successful CPAP adaptation and compliance with home telemedicine CPAP titration with the usual method based on face-to-face visits. Methodology: A prospective cohort using telemedicine home-CPAP titration and follow-up during the COVID-19 pandemic (TC) was compared with a retrospective cohort receiving face-to-face pre-pandemic home titration (RC). The TC included a subgroup with a smartphone application (APP). Successful CPAP adaptation and compliance at one month of follow-up were the main endpoints, while patient satisfaction and costs were secondary endpoints. Result(s): 210 consecutive patients were evaluated (80 RC, 130 TC). 36 patients used APP (TC-APP). CPAP titration was successful in 90% in RC vs 95% in TC (p-value 0.346) and 100% in TC-APP (p-value 0.222). No differences between groups were found at one month of compliance (4.79 h/d RC, 4.33 h/d TC, 4.59 h/d TC-APP). Patient satisfaction out of 10 was 7.69 (SD 2.05) in RC versus 9.02 (SD 0.64) in TC (p-value <0.001). 64% of the TC-APP subgroup reported that their telemedicine strategy influenced in an increase in CPAP use (p-value 0.011). CPAP adaptation with follow-up had an estimated direct staff cost per patient of 19.61 (SD 8.61) in TC-noAPP (TC no APP used) against 23.79 (SD 9.94) in TC-APP (p-value 0.048). Conclusion(s): Telemedicine in CPAP titration and early follow-up is equivalent to the usual care in terms of successfully adaption and compliance, while achieving a greater patient satisfaction.

THE RATE OF ADVERSE EVENTS AFTER COVID-19 VACCINATION IS SIMILAR IN PATIENTS WITH CELIAC DISEASE AND NON-CELIAC POPULATION: RESULTS OF A LARGE INTERNATIONAL CROSS-SECTIONAL STUDY

Background Patients with celiac disease (CeD) reported increased COVID-19 vaccine hesitancy due to a fear of adverse events (AEs). However, the risk of AEs post-COVID-19 vaccination in patients with CeD is unknown. Purpose To assess whether the rate of common side effects (SEs) and AEs due to COVID vaccines are higher in patients with CeD compared to a non-CeD population. Method We conducted a collaborative international cross-sectional study in 16 countries between April 2022 and July 2022. An online survey was distributed to patients with CeD through patients' local societies, and to non-CeD from the general population in each country through social media posts, word-of-mouth, and through academic institutions. We collected data on participant demographics, medical conditions, CeD diagnosis, GFD adherence, history of COVID-19 vaccinations (type and doses) and self-reported SEs and AEs post-COVID-19 vaccine. SEs included pain/swelling at the site, fatigue, fever, chills, nausea and/or headaches. AEs included thrombosis, myocarditis, anaphylactic reaction, and hospitalization related to the vaccine. Logistic regression models were used to assess predictors such as CeD diagnosis, age, gender, vaccine type and comorbidities on the likelihood of reporting SEs and AEs post-vaccine. Result(s) : A total of 17,795 participants completed the survey, 13,638 with CeD (median age of 45[27]) and 4,157 non-CeD controls (median age of 43[20]). There were no significant differences in sex between CeD and controls. Overall, CeD patients had similar odds of SEs compared with non-CeD individuals (aOR=1.02;95% CI=0.92-1.14). SEs were slightly increased only in the second dose of the vaccine in the CeD population compared to non-CeD individuals (aOR= 1.35;95% CI=1.19-1.53). The most common reported SEs in CeD and controls were pain/swelling at the injection site (29% vs 23 %, p< 0.0001) and fatigue (29% vs 24%, p<0.0001). The odds of SEs were higher with Moderna Spikevax, AstraZeneca/Oxford and Johnson and Johnson vaccines than after the Pfizer vaccine (p< 0.0001). The overall rate of AEs post-vaccine was similar between patients with CeD and non-CeD individuals (aOR= 1.29;95% CI= 0.89-1.87). Overall, female gender, older age, GFD adherence, respiratory conditions, obesity and receiving immunosuppressive medications increased the odds of SEs, while only age and a history of allergies increased the odds of AEs. Conclusion(s) In this large international study, patients with CeD reported similar rates of SEs and AEs post-COVID vaccine compared to non-CeD individuals. This information is highly relevant as it addresses the main concern leading to COVID-19 vaccine hesitancy in CeD patients. Disclosure of Interest None Declared

Impact of COVID-19 on key performance indicators: analysis of diagnosis related groups in a vascular surgery department.

Objectives: to evaluate the impact of the COVID-19 on the hospital key performance indicators using the diagnosis-related groups (DRG). To compare the results of the Angiology and Vascular Surgery Department of the University Hospital of Cabuenes (HUCAB) with the database of the Ministry of Health. Material(s) and Method(s): hospital discharges from the Vascular Surgery Department of the HUCAB during the years 2019, 2020 and 2021. All patients refined (APR)-DRG system was extracted for discharge coding. The hospital key indicators studied were: number of discharges, mortality, mean stay (EM) and mean weight (PM) of the DRG. The overall results per year and according to the most prevalent DRGs were studied. The results obtained were compared with the annual data from the coding of the Minimum Basic Data Set (CMBD) of the Ministry of Health. The configured EM by adjusting the performance of the standard (EMAF) and by the casuistry (EMAC), the index of the adjusted EM (IEMA), the functional index (FI), casuistic index (CI) and the number of avoidable hospital stays were also analyzed. Result(s): number of discharges: it was 10 % inferior in 2020 compared to 2019. Discharges of the GRD 181 linked to admissions from the Emergency increased more than 50 % during 2020 and more than 100 % in 2021 compared to 2019. Mortality: there was no significant increase. EM: it decreased 20 % in 2020 and 18 % in 2021, compared to 2019. PM: it increased progressively to 7.7% on average in 2021. EMAF: it was superior to standard EM. The number of stays saved was higher than expected. Conclusion(s): the pandemic of COVID-19 influenced the hospital key performance indicators studied, reducing the number of discharges and ME and increasing the PM of the DRGs. The number of avoidable stays saved was greater than the standard.© Copyright 2023 SEACV.

Socio-Emotional Experiences of University Students in the Face of Virtual Education Due to Covid-19

The article analyzes and compares the socio-emotional experience of university students from Mexico and Peru in the face of migration to remote emergency education due to Covid-19. This is an exploratory-descriptive-comparative quantitative study with two independent purposive samples. Based on the results, it is shown that socio-emotional affectations reflect and prolong the unequal social structures that condition the university community in Latin America. © 2022 Instituto de Estudios Sociales Contemporaneos IESCO. All rights reserved.

LEARNING STRATEGIES, AN ADDITIONAL PINCH TO LEARNING A Study of the use of learning strategies by high school students in Mexico

This research presents an analysis of the learning strategies employed by students during confinement due to Covid-19 in the year 2021. The study sample consisted of 200 students from the Licenciado Benito Juárez García high school of the morning shift of the Benemérita Universidad Autónoma de Puebla. A survey was applied to measure the degree of satisfaction in relation to their use and impact on the acquisition of knowledge, allowing them to be more self-taught. The results show that the hypothesis was partially fulfilled, since practice and organization are the learning strategies that most supported them in learning. © GKA Ediciones, authors. Creative Commons Reconocimiento-NoComercial-SinObraDerivada.

COVID-19: the impact of the cytokine storm on the immune-neuroendocrine system

The term "cytokine storm” was first proposed in 1993 by Ferrara et al. In 1991, Chatenaud described a systemic clinical picture called "Cytokine Release Syndrome” very similar to "Cytokine Storm Syndrome” so these terms can be used synonymously. During the COVID-19 pandemic, high-risk individuals (>65 years, with comorbidities) may develop cytokine storms as a consequence of multiorgan involvement seen during the acute and post-COVID-19 phases. On the other hand, the term immune neuroendocrine system was first proposed by Besedovsky H et al. Evidences obtained during COVID-19 infection demonstrated that SARS-CoV-2 infections can affect the immune neuroendocrine system, both in its invasion stage of different organs and tissues and in the recovery stage. This damage is caused by viral infection and/or cytokine storm. This chapter analyzes the devastating effect of SARS-CoV-2 infection and the cytokine storm on the immune neuroendocrine system. These evidences may lead to new therapeutic proposals. © 2023 Elsevier Inc. All rights reserved.