Influence of diabetes mellitus on the prognosis of patients hospitalised for COVID-19

Background: Various studies have established a relationship between coronavirus infection (COVID-19) and diabetes mellitus (DM) as a factor of poor prognosis. Purpose(s): To determine the influence of DM on the evolution of patients hospitalised by COVID-19. Method(s): Retrospective observational study. All hospitalised patients with COVID-19 infection treated with Lopinavir/Ritonavir and Hydroxychloroquine during March and April 2020 were included. Two cohorts were performed: patients with DM and patients without DM. Patients who were not discharged or exited until April 30th 2020, were excluded. The treatment guidelines used were: Lopinavir/Ritonavir 200/50 every 12 hours mg for 14 days and Hydroxychloroquine 400 mg every 12 hours on the first day, followed by 200 mg every 12 hours during four days. Data were obtained through the Athos-Prisma inpatient prescription programme and review of medical records at Diraya. The chi-square test of comparison between data series of the two patient subgroups was performed. Result(s): Fifty-six (56) patients, 40 men and 16 women were included. The cohort of patients with DM (n=15) presented a mean of 66.7 years (53.8-79.6) vs 65.8 years (52.4-75.7) in the cohort of patients without DM (n=41). Mortality in the group with DM was 46.6% vs. 29.2% in the group without DM. After performing the chi-square test, a p>0.05 was obtained, so the differences between the two subgroups were not statistically significant. Conclusion(s): Our results do not associate DM with a poor prognostic factor in COVID-19 infection, although they are conditioned to the small sample size available. New studies with a larger number of patients will be necessary.

Challenging picturebooks and domestic geographies: A multimodal learning path to discuss the consequences of the COVID-19 lockdowns in the classroom

The COVID-19 pandemic has brought new ways of facing the world and its multiple realities. Picturebooks, as a crossover genre, help in the process of understanding new contexts while offering literature as therapy. The new challenges of the 21st century require the implementation of methodologies that focus both on words and on other modes of representation to construct knowledge, and to this end, literacy education through challenging picturebooks involves paying attention to the diverse pedagogical demands of a global, aesthetic, and multimodal world. This chapter supports the notion of visual literacy as a multidimensional concept and proposes the approach to different picturebooks dealing with neighbours and neighbourhoods through the pedagogy of the multiliteracies, in order to enhance the transformation of the self and the global and local understanding of the current world. A learning path for teachers is designed according to the four knowledge processes: experiencing, conceptualizing, analyzing, and applying. © 2023 by IGI Global. All rights reserved.

Impact of extracurricular factors on the academic performance of university students during the COVID-19 pandemic

This article aims to study the incidence of extracurricular factors relating to (a) personal work situation and place of residence;(b) family finances;and (c) access to the virtual environment on the academic results of university students during the COVID-19 pandemic. Regression models were used to determine the impact of the different factors on academic performance in a sample of 138 students of the Primary Education Teaching Degree at a Spanish Public University. The results show that students who devote themselves wholly to studying without having to work obtain better academic results than those who have to combine study and work. Furthermore, internet access affects academic results, with students having ADSL and Wi-Fi via smartphones reporting the highest grades.

Periodontitis and COVID-19: Biological Mechanisms and Meta-analyses of Epidemiological Evidence.

Since the beginning of 2020, the entire global health care system has been severely challenged by the outbreak of coronavirus 2019 disease (COVID-19). Robust evidence has demonstrated a more severe course of COVID-19 in the presence of several comorbidities, such as cardiovascular diseases, diabetes mellitus, and obesity. Here, we critically appraise the recent research discoveries linking periodontitis to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to severe COVID-19, with a special focus on the associated biological mechanisms and the available epidemiological evidence. SARS-CoV-2 main receptors and coreceptors (ACE2, TMPRSS2, furin, CD147) are overexpressed in periodontal tissues of periodontitis patients, with inflammation, periodontal pathogens, and damage-induced pyroptosis triggering a positive feedback loop. However, meta-analyses of epidemiological studies only indicated a nonstatistically significant tendency for an increased risk of SARS-CoV-2 infection in subjects with periodontitis (odds ratio [OR] = 1.69; 95% CI, 0.91-3.13, P = 0.09). Furthermore, periodontitis may worsen clinical COVID-19 courses through multiple direct and indirect pathways, including damage to lower airways due to aspiration of periodontal pathogens, exacerbation of the cytokine storm via the low-grade chronic systemic inflammation, and SARS-CoV-2 dissemination through the ulcerated gingival epithelium with consequent induced pulmonary vessels vasculopathy. Indeed, meta-analyses of epidemiological studies indicated that periodontitis subjects are more likely to experience a more severe course of COVID-19. Specifically, periodontitis was associated with a 4-fold increased odds of hospitalization (OR = 4.72; 95% CI, 1.11-20.03, P = 0.04), 6-fold of requiring assisted ventilation (OR = 6.24; 95% CI, 2.78-14.02, P = 0.00), and more than 7-fold of death due to COVID-19 complications (OR = 7.51; 95% CI, 2.16-26.10, P = 0.00). The breakthrough analyzed here emphasizes the relevance of the mouth-systemic connection as a target to mitigate the current COVID-19 emergency and the future predicted coronavirus pandemics.

Has COVID affected the treatment of oncology patients?: a descriptive study of treatments from 2019 to 2021

Background and importanceThe COVID-19 pandemic has had a significant impact on cancer diagnosis and treatment worldwide.Aim and objectivesTo describe patients in oncology treatments comparing 2019, 2020, and 2021 to September 2021.Material and methodsA descriptive study was conducted in a tertiary hospital from January 2019 to September 2021. Inclusion criteria were patients undergoing parenteral and oral oncology treatment. Variables were: gender, age, diagnosis, patients with oral and parenteral oncology treatments dispensed by the Pharmacy Service. Data were collected from the electronic medical record (FarmaTools).ResultsDuring the study period, 1010 patients were treated with parenteral and 402 with oral antineoplastics. The average age was 67±23.7 years (51.6% male). In the group of parenteral treatments the main diagnoses in 2019 were: vesical carcinoma (VC) (14%), metastasic non-small cell lung cancer (mNSCLC) non-squamous (NS) noALK noEGFR (7.1%) and metastatic KRAS and NRAS mutated colorectal cancer (mCC) (6%);in 2020 were VC (13%), mNSCLC NS noALK noEGFR (6.2%) and adjuvance in breast cancer (mBC) noHER2 and positive hormonal receptor (+HR) (5.6%);and in 2021 (to September) VC (9%), metastasic NSCLC NS noALK noEGFR (5,9%) and KRAS and NRAS mutated mCC (5.9%). In treatment with oral antineoplasics in 2019: adjuvance CC (27.6%), mBC noHER2 +HR (20%) and metastasic castration-resistant prostate cancer (mCRPC) (10.5%);in 2020 mBC noHER2 +HR (20%), adjuvance CC (12.5%) and mCRPC (10.5%);and in 2021 mBC noHER2 +HR (21%), adjuvance CC (11.8%) and mCRPC (7.8%). 364 patients were treated by an intravenous route in 2021, 356 in 2020 and 290 in 2021. 105 patients were treated by oral treatment in 2019, 144 in 2020 and 153 in 2021. Patients treated in metastasic stages were 241 in 2019, 254 in 2020 and 234 in 2021.Conclusion and relevanceIn 2020, there was a decrease in patients treated with KRAS and NRAS mutated mCC and an increase in adjuvance BC. Regarding oral treatment, patients on adjuvant treatment with colorectal cancer decreased in 2020. The increase in the number of patients on oral treatments from 2019 to 2021 is notable, and the important role that telemedicine has had from 2020 and the home delivery of medication by pharmacy services, thus reducing hospital visits. Further studies are needed to confirm this.References and/or acknowledgementsConflict of interestNo conflict of interest

The Department of Psychiatry and Mental Health of the Military Hospital «Gómez Ulla» during the SARS-CoV-2 pandemic

SUMMARY In this work the structural and logistical measures are exposed, as well as the planned clinical practice, to be able to respond to the pandemic caused by the virus SARS-CoV-2 in the Department of Psychiatry and Mental Health of the Central Defense Hospital «Gómez Ulla». The planning of the care function was divided into five groups: psychiatric patients admitted to the Brief Hospitalization Unit;patients with psychiatric pathology admitted to other different Psychiatric Services;outpatients treated in Outpatient Consultations;the relatives of the patients admitted by COVID-19;the health personnel of the Central Defense Hospital «Gómez Ulla». Based on the needs of these care groups, comprehensive care planning was carried out. During the period March 14 to May 30, 13% of the staff presented moderate-severe symptoms of COVID-19;19% of the psychiatric patients admitted to the hospitalization unit were COVID19 positive, none of whom died. 74% of the inter-consultations carried out were on patients admitted for COVID-19 who presented mostly confusional symptoms of varying intensity or psychosis secondary to the use of drugs in the active treatment of COVID-19. 4.185 calls were made to family members, of which 14% (n = 575) were at the request of the family members themselves. More than 220 video calls were made and 100% of the external consultations were kept online.

Late Breaking Abstract - Effect of a conservative approach to the start of mechanical ventilation on ventilator-free days in coronavirus disease 2019 (COVID-19) pneumonia after adjustment by inverse probability of treatment weighting

Introduction: High flow nasal cannula (HFNC) decreases the need for intubation in patients with acute respiratory failure (ARF). However, delaying intubation has been linked to worse patients' outcome in the acute respiratory distress syndrome (ARDS). Methods: Prospectively once-daily collected database including patients admitted to 30 Spanish ICUs. On May 13th, we identified 390 patients where outcome data was complete. Patients were divided into 2 groups: 1) 272 subjects who received mechanical ventilation (MV) at admission or early after ICU admission (before day 2 considering admission as day 0), and 2) 118 patients who did not receive MV in this time period. The probability of not being ventilated was estimated by means of multivariate logistic regression including age, sex, number of comorbidities, respiratory and non-respiratory SOFA score, minimal systolic blood pressure on days 1 and 2, maximal heart rate on days 1 and 2, respiratory rate and hospital (divided in 4 groups based on the number of cases). Treatment weighting was defined as the inverse of the probability for group 2 and as the inverse of 1 minus the probability for group 1, as described elsewhere. Ventilator-free days (VFD) at 28 days were compared between groups. Follow-up was continued until ICU discharge, death or 28 days after ICU admission. Death was computed as 0 VFDs. Results: VFD was 4.8 days longer in those not receiving early MV (95% CI 2.2 to 7.4). Conclusion: After adjusting for confounding, avoiding early MV increased VFD by 4.8 days in this group of COVID-19 patients.

Contingency Plan for the Intensive Care Services for the COVID-19 pandemic. / Plan de contingencia para los servicios de medicina intensiva frente a la pandemia COVID-19.

In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC, have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies.

Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: A prospective, cohort, multicentre study. / Características, evolución clínica y factores asociados a la mortalidad en UCI de los pacientes críticos infectados por SARS-CoV-2 en España: estudio prospectivo, de cohorte y multicéntrico.

BACKGROUND: The clinical course of COVID-19 critically ill patients, during their admission in the intensive care unit (UCI), including medical and infectious complications and support therapies, as well as their association with in-ICU mortality has not been fully reported. OBJECTIVE: This study aimed to describe clinical characteristics and clinical course of ICU COVID-19 patients, and to determine risk factors for ICU mortality of COVID-19 patients. METHODS: Prospective, multicentre, cohort study that enrolled critically ill COVID-19 patients admitted into 30 ICUs from Spain and Andorra. Consecutive patients from March 12th to May 26th, 2020 were enrolled if they had died or were discharged from ICU during the study period. Demographics, symptoms, vital signs, laboratory markers, supportive therapies, pharmacological treatments, medical and infectious complications were reported and compared between deceased and discharged patients. RESULTS: A total of 663 patients were included. Overall ICU mortality was 31% (203 patients). At ICU admission non-survivors were more hypoxemic [SpO2 with non-rebreather mask, 90 (IQR 83 to 93) vs. 91 (IQR 87 to 94); P<.001] and with higher sequential organ failure assessment score [SOFA, 7 (IQR 5 to 9) vs. 4 (IQR 3 to 7); P<.001]. Complications were more frequent in non-survivors: acute respiratory distress syndrome (ARDS) (95% vs. 89%; P=.009), acute kidney injury (AKI) (58% vs. 24%; P<10-16), shock (42% vs. 14%; P<10-13), and arrhythmias (24% vs. 11%; P<10-4). Respiratory super-infection, bloodstream infection and septic shock were higher in non-survivors (33% vs. 25%; P=.03, 33% vs. 23%; P=.01 and 15% vs. 3%, P=10-7), respectively. The multivariable regression model showed that age was associated with mortality, with every year increasing risk-of-death by 1% (95%CI: 1 to 10, P=.014). Each 5-point increase in APACHE II independently predicted mortality [OR: 1.508 (1.081, 2.104), P=.015]. Patients with AKI [OR: 2.468 (1.628, 3.741), P<10-4)], cardiac arrest [OR: 11.099 (3.389, 36.353), P=.0001], and septic shock [OR: 3.224 (1.486, 6.994), P=.002] had an increased risk-of-death. CONCLUSIONS: Older COVID-19 patients with higher APACHE II scores on admission, those who developed AKI grades ii or iii and/or septic shock during ICU stay had an increased risk-of-death. ICU mortality was 31%.

[Contingency plan for the intensive care services for the COVID-19 pandemic]. / Plan de contingencia para los servicios de medicina intensiva frente a la pandemia COVID-19.

In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies.

[Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19)]. / Recomendaciones de «hacer¼ y «no hacer¼ en el tratamiento de los pacientes críticos ante la pandemia por coronavirus causante de COVID-19 de los Grupos de Trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC).

On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.

Increased in-hospital mortality from COVID-19 in patients with schizophrenia.

BACKGROUND: There is limited information describing the presenting characteristics and outcomes of patients with schizophrenia (SCZ) requiring hospitalization for coronavirus disease 2019 (COVID-19). AIMS: We aimed to compare the clinical characteristics and outcomes of COVID-19 SCZ patients with those of non-SCZ patients. METHOD: This was a case-control study of COVID-19 patients admitted to 4 AP-HM/AMU acute care hospitals in Marseille, southern France. COVID-19 infection was confirmed by a positive result on polymerase chain reaction testing of a nasopharyngeal sample and/or on chest computed scan among patients requiring hospital admission. The primary outcome was in-hospital mortality. The secondary outcome was intensive care unit (ICU) admission. RESULTS: A total of 1092 patients were included. The overall in-hospital mortality rate was 9.0%. The SCZ patients had an increased mortality compared to the non-SCZ patients (26.7% vs. 8.7%, P=0.039), which was confirmed by the multivariable analysis after adjustment for age, sex, smoking status, obesity and comorbidity (adjusted odds ratio 4.36 [95% CI: 1.09-17.44]; P=0.038). In contrast, the SCZ patients were not more frequently admitted to the ICU than the non-SCZ patients. Importantly, the SCZ patients were mostly institutionalized (63.6%, 100% of those who died), and they were more likely to have cancers and respiratory comorbidities. CONCLUSIONS: This study suggests that SCZ is not overrepresented among COVID-19 hospitalized patients, but SCZ is associated with excess COVID-19 mortality, confirming the existence of health disparities described in other somatic diseases.

Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19)

On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic. Resumen El 11 de marzo de 2020 el director general de la Organización Mundial de la Salud (OMS) declaró la enfermedad causada por el SARS-CoV-2 (COVID-19) como una pandemia. La propagación y evolución de la pandemia está poniendo a prueba los sistemas sanitarios de decenas de países y ha dado lugar a una miríada de artículos de opinión, planes de contingencia, series de casos e incipientes ensayos. Abarcar toda esta literatura es complejo. De forma breve y sintética, en la línea de las anteriores recomendaciones de los Grupos de Trabajo, la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) ha elaborado esta serie de recomendaciones básicas para la asistencia a pacientes en el contexto de la pandemia.