Alcohol risk consumption during the COVID-19 pandemic quarantine time in Paraguay, 2020: a virtual survey

Introduction: The impact of the outbreak of pandemic proportions of COVID-19 has initiated several health and social measures worldwide. Thus, there is growing concern about the consequences of preventive social confinement associated with the pandemic due to the potential increase in the consumption of alcohol and other harmful substances. Between 2010-2014, in Paraguay approximately 5% of deaths over 15 years of age are attributable to alcohol consumption and are associated with external cause injuries, cancers, liver disease, cardiovascular diseases, addictions and domestic violence. Early detection and treatment are recommended intervention strategies to prevent these consequences. Objective: To determine the demographic characteristics of alcohol risk consumption during the covid-19 pandemic quarantine period. Methods: Analytical cross-sectional, exploratory observational study. It consisted of 16,538 virtual surveys carried out on persons of legal age throughout the national territory between June and September 2020. A total of 219 respondents were excluded for not meeting the inclusion criteria or for incorrectly filled out data. Risk consumption was determined using a test that rated consumption by scores. More than 5 points for men, more than 4 for women. Results: 12224 adult participants (18-65 years old) with a mean age of 31.9 years (±9.2), were part of the analysis, with a predominance of male participation 64.5% (n=10531). The 74.9% (n=12224) came from the Metropolitan Axis. According to gender, the OR was 1.15 CI95 (1.08-1.23), pv=0.001. When comparing educational level, high school complete/incomplete, the OR was 1.56 CI95 (1.19-2.06), pv=0.001. And when comparing by axes of residence, the OR was 0.83 CI95 (0.77-0.89), pv=0.001. Discussion: It was observed that, during the quarantine period, alcohol consumption increased as the educational level of the population increased. Males presented a higher risk consumption than males. Knowing this behavior would help to propose actions to help prevent alcohol consumption in the most atrisk group. © 2022, Faculty of Medical Sciences, Santa Rosa del Aguaray Branch, National University of Asuncion. All rights reserved.

Feelings about School in Gifted and Non-Gifted Children: What Are the Effects of a Fine Art Program in Primary School?

There is a consensus about the benefits of an artistic activity on health and well-being. In France, a gifted child is considered a special needs student for whom enrichment is advocated. Therefore, this study examines the extent to which a whole-class art enrichment program delivered to both gifted and non-gifted children benefits both student populations with respect to their school well-being. The art program was implemented in classrooms over the course of an entire school year (during the COVID-19 pandemic). The self-report French version of the Feelings About School scale (i.e., FAS) was completed in three steps (i.e., before, mid-program, and after) by a sample of gifted and non-gifted children benefiting from the program. The FAS scores of those students were also compared at the end of the school year with those of students who did not participate in the art program. Despite the pandemic context that requires caution in drawing definite conclusions, this study supports that (i) the fine arts practice is a lever of development, (ii) the sanitary situation was detrimental for elementary school students, and (iii) better adaptive capacities were exhibited by gifted children in this context. © 2023 by the authors.

Virtual reality technology as an educational tool in the context of the COVID 19 pandemic: A systematic review

After the COVID 19 pandemic, universities were forced to interrupt face-to-face training and face the immediacy of a virtual learning environment. Almost two years after this event, it is urgent to rethink the training space and have a hybrid learning in which education makes both face-to-face and virtual training more flexible. Based on this premise, the objective of the article is to provide information on the contributions of scientific research on the use of virtual reality technology in the educational field from 2020 to 2022. This research is a review article. systematic, it is of a qualitative approach, basic-descriptive type. 15 articles have been selected for analysis from the Scopus database. For inclusion and exclusion criteria and search terms, based on the PRISMA protocol, are presented. © 2022, Associacao Iberica de Sistemas e Tecnologias de Informacao. All rights reserved.

Airway Management During Mechanical Ventilation: COVID-19

The disease caused by the new SARS-CoV-2 can elicit a violent, dysregulated host immune response that can lead to severe results in most of these older patients as ARDS, multiple-organ failure, and death. Acute respiratory distress syndrome (ARDS) is defined as hypoxemia secondary to a rapid onset of non-cardiogenic pulmonary edema. The airway management in a patient with COVID-19 should be carried out considering several aspects. Once it is decided to intubate the patient, use a rapid induction sequence. When signs of respiratory distress are associated with severe hypoxemia, patients should be managed as soon as possible according to the pulmonary phenotypes;however, management of mechanical ventilation must be personalized;if possible, use low tidal volume with 6 mL/kg of predicted body weight. There is no consensus regarding the best PEEP value;several guidelines recommended keeping Pplat 30 cmH2O in patients with ARDS. There are no available studies that describe the clinical evolution of COVID-19 patients ventilated in the prone position;intermittent doses of neuromuscular blocking agents to facilitate lung-protective ventilation, and tracheostomy, remain necessary in some patients with COVID-19. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Collapsing glomerulonephritis in a COVID-19 patient. Case report

Acute renal injury due to collapsing glomerulonephritis is associated with high morbidity and mortality, requiring chronic dialysis, COVID-19 is one of its causes. A 17-year-old male patient presented with a four-month history of edema, foamy urine and reduction in the urine flow;anasarca was observed at physical examination. Laboratory values showed creatinine 4,2 mg/dl;albumin 1,9 gr/dl;cholesterol and triglycerides were high;proteinuria 6,7 gr/24h: leucocyturia and hematuria with negative urine culture. Serologies for HIV, syphilis and hepatitis were negative. Studies for systemic lupus were negative. An antigenic test for SARS-CoV-2 was positive as well as an IgG. Renal Biopsy showed Focal and Segmental Glomerulosclerosis, Collapsing variant. He received corticosteroids and cyclosporine. Creatinine improved;proteinuria remained >3 gr/24 hours.Copyright © Universidad Peruana Cayetano Heredia, Facultad de Medicina Alberto Hurtado. All Rights Reserved.

Mechanical Ventilation in Sepsis

Sepsis can cause lung injury. Prior to the COVID-19 pandemic, sepsis was the main cause of acute respiratory distress syndrome (ARDS), associated with approximately >50% of cases. Mechanical ventilation (MV) may amplify the lung-specific inflammatory response in preinjured lungs by elevating cytokine release and augmenting damage to the alveolar integrity;in addition, sepsis per se constitutes a risk factor for mechanical ventilator-induced lung injury. Inadequate ventilator setting can contribute to increased infection-induced organ failure and uncontrolled systemic inflammatory response. Objectives of invasive MV are to maintain adequate gas exchange: maintain oxygenation goals and adequate ventilation. Regarding ventilatory modes, it has been proposed that volume control-continuous mandatory ventilation may be more protective than pressure control-continuous mandatory ventilation. It may be reasonable to maintain a target arterial partial pressure of oxygen of 60–80mm Hg (Young et al. 2022) or a saturation of peripheral oxygen of 92%–96% for most patients. Sepsis-induced diaphragmatic dysfunction is a major risk factor of weaning failure during MV. Diaphragmatic ultrasound had been a useful tool for predicting successful liberation from MV. Another important aspect of ventilation is the type of sedation to use. © 2023 Elsevier Inc. All rights reserved.

Evaluation of Nirmatrelvir/Ritonavir Use and Effectiveness

Background and Importance Nirmatrelvir/ritonavir (PAXLOVID) is a recently approved drug to prevent progression in high-risk COVID-19-infected patients. Aim and Objectives To evaluate prescribing and dispensing of PAXLOVID and the proportion of patients with hospitalisation or death from any cause at 28 day. Material and Methods Descriptive, retrospective, observational study carried out between May and August 2022 in a secondlevel hospital. All patients with PAXLOVID prescription were selected. Sources of information were: electronic medical records and the prescription programme. The Variables analysed were: sex, age, risk factors, indications, interactions, dispensation (yes/no) and final treatment received. Risk factors were evaluated with our country's drug regulatory agency (DRA) recommendations to assesed the indication. Efficacy was assessed by the proportion of patients admitted to hospital and 28-day mortality. Results PAXLOVID was prescribed to 34 patients, 14 (41.2%) were women. The median age was 76.3 years old [RIQ 25.4]. Main indications for PAXLOVID were: to be undergoing treatment with myelotoxic chemotherapy (32.3%), corticosteroids or other immunosuppressants (29.4%);being over 80 years of age and presenting specific Risk factors (14.7%) and primary immunodeficiency (5.8%). 21 patients (61.8%) had some relevant interaction with their usual medication. The most frequent interactions were with statins (23.5%), analgesics (20.6%), oral anticoagulants (12%), antiarrhythmics (8.8%), antiplatelet drugs (5.8%), antidepressants (5.8%) and antidiarrhoeals (5.8%). After Validation by the Pharmacy Service, 11 patients (32.4%) did not receive PAXLOVID, 5 because they did not meet DRA criteria, 2 because their glomerular filtration rate was less than 30 ml/min and 4 because they had incompatible interactions. 4 patients finally received 3 days-remdesivir. Among patients who received PAXLOVID, 82.26% received full doses, with 4 patients (11.76%) requiring adjustment for renal impairment. 3 patients (13%) were hospitalised in the first month, none died. Conclusion and Relevance The main indications for which PAXLOVID was prescribed were patients undergoing chemotherapy and/or immunosuppressive treatments. Interactions with PAXLOVID were frequent and in some cases limited treatment. Validation by Pharmacy Service prevented a considerable number of patients from receiving PAXLOVID when it was no-indicated or when they had insurmountable interactions, also allowed patients to receive the dose adjusted for renal impairment. PAXLOVID was effective in avoiding hospital admission and mortality in the majority of patients.

Assessing Indoor Air Quality and Ventilation to Limit Aerosol Dispersion—Literature Review

The COVID-19 pandemic highlighted the importance of indoor air quality (IAQ) and ventilation, which researchers have been warning about for years. During the pandemic, researchers studied several indicators using different approaches to assess IAQ and diverse ventilation systems in indoor spaces. To provide an overview of these indicators and approaches in the case of airborne transmission through aerosols, we conducted a literature review, which covered studies both from before and during the COVID-19 pandemic. We searched online databases for six concepts: aerosol dispersion, ventilation, air quality, schools or offices, indicators, and assessment approaches. The indicators found in the literature can be divided into three categories: dose-, building-, and occupant-related indicators. These indicators can be measured in real physical spaces, in a controlled laboratory, or modeled and analyzed using numerical approaches. Rather than organizing this paper according to these approaches, the assessment methods used are grouped according to the following themes they cover: aerosol dispersion, ventilation, infection risk, design parameters, and human behavior. The first finding of the review is that dose-related indicators are the predominant indicators used in the selected studies, whereas building- and occupant-related indicators are only used in specific studies. Moreover, for a better understanding of airborne transmission, there is a need for a more holistic definition of IAQ indicators. The second finding is that although different design assessment tools and setups are presented in the literature, an optimization tool for a room's design parameters seems to be missing. Finally, to efficiently limit aerosol dispersion in indoor spaces, better coordination between different fields is needed. © 2023 by the authors.

[Efficacy of tele-rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review].

The COVID-19 pandemic has required the use of new technologies to carry out rehabilitation sessions for COP D remotely. The aim of this systematic review was to analyse the available evidence on the efficacy of telerehabilitation in COPD patients. PubMed, WOS, PEDro and Cochrane databases were consulted. The systematic review included nine clinical trials, 55.5% of which display good methodological quality. The most commonly used rehabilitation methods were applications or software for real-time video-calls, visualisation of exercises and recording progress. TR was as effective as outpatient pulmonary rehabilitation, with greater benefits in functional capacity, self-efficacy, mental health, exacerbations and emergency care visits, offering a cost-effective option with high patient satisfaction. The small number of studies and the variety of rehabilitation methods examined limit the value of the evidence obtained.

Acute Coronary Syndrome during the Era of Covid-19: Perspective and Implications Using Google Trends

Background Acute coronary syndrome (ACS) hospital admissions decreased during the start of the COVID-19 outbreak. There is limited information on how Google searches related to patients behavior during this time. Methods We examined de-identified data from 2019 through 2020 regarding monthly: 1) admissions for ACS from the Veterans Affairs Healthcare System;2) out of hospital cardiac arrest (OHCA) from NEMSIS public dataset;and 3) Google searches for "chest pain", "coronavirus", "chest pressure", and "hospital safe" from Google Trends. We analyzed the trends for ACS admissions, OHCA, and Google searches. Results During the early months of the first COVID-19 outbreak: 1)Veterans Affairs data showed a significant reduction in ACS admissions at a national and regional (Florida) level (Figure 1);2) NEMSIS database showed a marked increase in OHCA at a national level;and 3) Google Trends showed a significant increase in the before mentioned Google searches at a national and regional level. Conclusion ACS hospital admissions decreased during the beginning of the pandemic likely due to delayed healthcare utilization secondary to patients fear of acquiring COVID-19 infection. Concordantly, Google searches for hospital safety and ACS symptoms increased along with OHCA events during this time. Our results suggest that Google Trends may be a useful tool to predict patients behavior and increase preparedness for future events, however, statistical strategies to establish association are needed. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Relationship between Krebs Von Den Lungen-6 (Kl-6) Levels and the Severity of Patients of a Post-Covid Multidisciplinary Unit

Aim: The aim of this study was to determine severity in patients who have had SARS-CoV2 pneumonia. Method(s): A cohort of 802 patients from our post-COVID multidisciplinary unit treated at least 30 days after being discharged from hospital was analyzed. Patients were divided into three groups: group 1 (admission to the Intensive Care Unit or Intermediate Respiratory Care Unit), group 2 (admission to conventional hospitalization), and group 3 (outpatient management without hospitalization). Symptoms, quality of life, daily physical activity, emotional state, biomarkers of systemic inflammation and KL-6 levels were evaluated. Result(s): A total of 802 patients with a median (interquartile range) age 59 (48-70 years) at diagnosis were reviewed, of whom 439 (54.8%) were women. Dyspnea was reported by 351 (66.%) patients and 142 (36.4%) had a grade more than 2 on the mMRC scale. Likewise, 106 (20.1%) presented dry cough and 233 (44.5%) asthenia. There were significant differences between groups 2 and 3 in: dyspnea (p=0.04), myalgia (p=0.04) and asthenia (p=0.01). Group 1 had a higher score in the TTO and VAS rates of the EuroQuoL scale compared to group 2. Finally, the KL6 levels in groups 1, 2 and 3 were: 381.50 (304 - 511.75) U/ml, 372 (249 - 483) U/ml and 298 (231.5 - 398) U/ml, respectively. Statistically significant differences were observed between the 3 groups (p=0.001) and in the post-hoc analysis, lower levels of KL-6 were observed in group 3 compared to the other two groups. Conclusion(s): There is evidence to affirm that KL6 levels in post-COVID patients are related to the severity of the acute episode.

Evolution of asthmatic patients at 6 and 12 months after acute COVID-19 recovery

Nowadays, beyond the acute phase of COVID-19, there is a growing interest in the clinical manifestations that appear after the recovery of this phase, giving the potential repercussions that this could have in the recovered population. Asthma is a prevalent disease, and it is possible that its pathogenic basis could affect the postCOVID-19 course. Objective(s): evaluate the evolution of asthmatic patients at 6 and 12 months after the recovery of COVID-19. Method(s): Data was collected through manual revision of electronic clinical histories. There were included as demographic features the age and sex, and comorbidities such as smoking habit, COPD, obesity (BMI > 30 Kg/m2), obstructive sleep apnea, gastroesophagic reflux, rinosinusitis, nasal poliposis, anxiety and depression. Patients were classified according to whether they had T2 asthma or not. There were considered previous pneumonia, need of conventional hospitalization or ICU. Symptoms (chest pain, cough, sputum production and dyspnoea) and the development of further complications were also recorded. Result(s): After analyzing the variables at 6 months after recovery, we found statistical significance in the presence of chest pain in patients with previous COVID-19 pneumonia (p=0.009). In the same period, lower eosinophil blood levels were found in patients that had dyspnoea (p=0.043). Additionally, there was a significant association between smoking habit and pulmonary embolism at 12 months after recovery (p=0.025). Conclusion(s): Developing COVID-19 associated pneumonia in asthmatic patients is related to the presence of chest pain at 6 months after recovery. Also, the smoking habit seems to be associated with thromboembolic disease in postCOVD-19 period.

Sudden Sensorineural Hearing Loss and COVID-19. Systematic Review

Introduction: Cases of sudden deafness, tinnitus and vestibular neuritis related to SARS-CoV-2 infection have increased. Objective: Systematic review of published cases of sudden hearing loss in the context of SARS-CoV-2 infection and discuss the potential association of infection as a possible etiological agent. Material and method: We conducted a systematic search of PubMed, EMBASE, Cochrane Library and Scielo, without language restriction, including all articles published from March 2020 to 31 January 2022. Results: A total of 16 articles met the inclusion criteria, obtaining 30 patients with sudden deafness and COVID-19. 53% were women and 47% men with a mean age of 46.75 years. 4 patients had cardiovascular risk factors, one asthma, another rheumatoid arthritis and 10 had no history. 25 had unilat-eral deafness and in 5 cases it was bilateral. All degrees of hearing loss were found, from mild to cophosis. Tinnitus was the most associated symptom in half of the patients, accompanied by vertigo in 10%. 14 patients required ICU admission, 9 received no treatment for infection, one patient received hydroxychloroquine, 2 favipavir and enoxaparin and 2 azithromycin and prednisone. The cochlear implant was the treatment of hearing loss in 2 cases, one was treated with hydroxychloroquine and 23 with intravenous and/or oral and/ or intratympanic corticosteroids. Conclusions: Sudden hearing loss is a symptom recently associated with SARS-CoV-2 infection and of uncertain prevalence. The presence of hearing loss should be considered as part of the clinical evaluation of these patients to ensure early diagnosis and treatment.

Virtual university teaching of audiovisual communication during the COVID-19 pandemic: challenges and lessons

The main objective of this research study is to identify the challenges faced by audiovisual communication university professors during their adaptation to virtual teaching during the COVID-19 pandemic. The present study also exposes lessons learned, within the analyzed educational framework, during this public health crisis. For this purpose, two different questionnaires are applied. The first is sent to professors at four Faculties of Communication located in Spain, Ecuador, and Colombia. The second questionnaire is sent to the deans of the four institutions under study. The results show that one of the main difficulties encountered by professors is related to a lack of competence in the use of new technologies. It is concluded that compulsory virtual teaching was conducted in the institutions examined thanks to the fact that they have implemented powerful administrative mechanisms and technological tools that allowed countering issues caused by the COVID-19 pandemic. © 2022, Formacion Universitaria. All Rights Reserved.

Bundled Antimicrobial Stewardship Intervention Reduces Inpatient Third Generation Cephalosporin Use without Restriction

Background. The use of third generation cephalosporins (3GC) has been linked to collateral damage such as increased risk of infection with C. difficile, ESBL-producing organisms, VRE, and MRSA. Reduction in use of 3GC has been shown to reduce prevalence of these infections, particularly with C. difficile and ESBLs. An increase in 3GC use was observed at our facility in 2019 and 2020, likely due to targeted fluoroquinolone reduction initiatives in 2019 and COVID-19 surges in 2020. A multifaceted intervention targeting 3GC reduction without restriction was implemented starting in December 2020. Figure 1 Monthly third generation cephalosporin use (Days of Therapy per 1000 patient days) from January 2019 to December 2021. Methods. We conducted a retrospective quasi-experimental study evaluating the impact of a combination of interventions intended to reduce 3GC use. The intervention included modification of local clinical guidelines for urinary tract infection (UTI) and community acquired pneumonia (CAP), provider education, and daily review of active 3GC orders in 2021. Local guideline changes include preferred use of ampicillin/sulbactam and amoxicillin/clavulanate for CAP and cefazolin and cephalexin for UTI over 3GCs. Use of first generation cephalosporins for UTI was supported by local antibiogram susceptibilities for common UTI pathogens. Days of therapy (DOT) per 1000 patient days were collected monthly and yearly for ceftriaxone, ceftazidime, cefpodoxime, and cefdinir for pre-intervention (January 2019 to December 2019 and January to December 2020) and post-intervention (January 2021 to December 2021) periods. Results. 3GC use significantly decreased from 89.52 DOT per 1000 patient days in 2020 to 53.06 in 2021, a 40.73% reduction. To account for increases in antibiotic use during COVID-19 surges in 2020 as a potential confounding variable, 2019 3GC use was also compared to 2021 use. A 31.40% decrease was seen, with 77.35 DOT per 1000 patient days in 2019. This effect was sustained through COVID-19 surges in January and August 2021 (Figure 1). Conclusion. A combination of interventions without restriction of 3GC was successful in reducing inpatient use of this class of antibiotics, including through two COVID-19 surges in 2021. Further study is required to determine impact on clinical outcomes, such as C. difficile and antimicrobial resistance rates.

Main substance of consumption of patients in followup in the Hospital consultation. Have there been changes in the current pandemic context? And what about women?

Introduction: Gender is a factor influencing characteristics of substance use disorders. The Covid-19 pandemic has had a great impact in all areas of society, meaning a context of exceptionality in this population. Usually the male population represents a greater number of patients in general samples, so the descriptive characteristics of a global sample may not be representative in the case of women. Objective(s): - Identify if there are changes in the main substance of psychoactive substance use during the Covid-19 pandemic. - Identify possible divergences in characteristics of the general sample with respect to the sample made up of women. Method(s): It will be used data collected in the database of patients in follow-up with the addiction consultation service in two periods of 6 months, one prior to the pandemic situation due to Covid-19 and another corresponding to same period in 2020. A descriptive analysis is carried out by applying chi-square statistic, performing the analysis by subgroups according to gender. Result(s): 84.8% of total sample are men. Results show that there are no statistically significant differences between periods in main substance of consumption. Despite this, differential trends can be observed in the sample that correspond to women with respect to the global sample and that of men. Conclusion(s): Taking into account the low number of women that make up the sample, the fact that differential trends are observed could indicate possible differences, which in case of increasing the sample size could acquire statistical significance and that this it would be specific to women subgroup.

Distinctive features of First Episode of Psychosis during the Covid-19 pandemic

Introduction: COVID19 has brought several psychosocial stressors that are having an impact on global mental health. The impact of the pandemic on the incidence of First Episode of Psychosis (FEP) is not clear. Objective(s): To describe the clinical and sociodemographic characteristics of FEP patients diagnosed since the onset of theCOVID19 pandemic and compare them with the equivalent period of the previous year. Method(s): We included all FEP patients attended at Parc de Salut Mar (Barcelona, Spain) from March 14, 2020 (when the state of emergency in Spain began) to December 31, 2020 with the same period of 2019. We assessed sociodemographic variables, duration of untreated psychosis (DUP), cannabis and alcohol use, psychiatric diagnosis, and psychiatric symptom scales. We performed a univariate analysis between the groups using U-Mann Whitney for continuous variables and Chi-Square for qualitative variables. Result(s): A total of 20 FEP patients were diagnosed in each period. No differences were found in sociodemographic variables, scales scores or DUP. During COVID19 period there was a smaller proportion of cannabis users (60% vs 90%;p=0.028) and a tendency of lower weekly consumption (14.44 vs 16.42;p=0.096). There were more cases of BPD (25% vs 5%;p=0.077) and less of affective psychosis (0% vs 25%;0.017). Conclusion(s): During the COVID-19 pandemic we did not find an increase of FEP or more severe clinical presentations. However, we identified differences in the type of FEP that could be related to the psychosocial stressors of this time.

Acute Confusional Syndrome and Covid-19 disease. Clinical and Sociodemographic differences with other comorbid diseases

Introduction: Coronavirus Disease 19 (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020. Since the outbreak, neuropsychiatric presentations such as delirium have been developing. Objective(s): Our aim is to describe sociodemographic and clinical differences between inpatients cursing with Acute Confusional Syndrome (ACS) with and without COVID-19 pneumonia. Method(s): This is an observational-descriptive study. All patients attended by the liaison psychiatry service of Hospital del Mar, between February and April 2020, with ACS diagnosis were included. The sample was divided in 2 groups (with and without COVID-19 pneumonia). Sociodemographic and clinical variables including sex, age, previous somatic or psychiatric history, ACS risk factors, ACS subtype and pharmacological treatment were compared. Chi-square and U Mann Whitney tests were used. Result(s): The total sample was 62 patients. 43.5% were women with a mean age of 71,7 (SD 11,3). Covid pneumonia group included 26 patients. There was a higher percentage of Hypoxemia in Covid pneumonia patients (p<0,001). There were significant differences between Covid pneumonia group and ACS in relation to: a previous diagnosis of IschemicHeart Disease (p=0,007), Heart Failure (p=0,029) and Nephropathy (p=0,022). Dexmedetomidine (p=0,001) was highly used for ACS treatment in Covid pneumonia patients. Conclusion(s): In this sample, patients with ACS and Covid pneumonia had a bigger rate of hypoxemia and previous history of Ischemic Heart Disease, Heart Failure and Nephropathy compared to the rest of ACS patients. Dexmedetomidine was more commonly used for the treatment of ACS in Covid pneumonia group. More studies would be necessary to assess the significance.

COVID-19 and Health Sciences Libraries of public hospitals in Spain

The COVID-19 Pandemic has ostensibly affected the workability of libraries in all sectors, including health service libraries. The aim of this study is to analize the impact of this situation with a descriptive cross-sectional study carried out in specialized libraries of health sciences within public hospitals in Spain. Methodology: This study was carried out via an email questionnaire from june to november of 2020, comprising 35 items and it gathered data in reference to personnel, services and collections before and during phase 0 of the alarm state. Results: 137 libraries were identified and 100 were analyzed. During the phase 0 of the alarm state 72% remained closed and 76% of the staff combined working in person with working from home. The greatest demand was for research papers/documentation and bibliography searches, no change was experienced with regard to collections. More than half who have participated in collaborative work groups value it as very useful. According to the authors, while this situation has revealed that the librarians have had a great capacity to readapt, they conclude that it has also directly affected libraries with their temporary reconversion or in some cases their total closure. © 2022 CSIC. Este es un artículo de acceso abierto distribuido bajo los términos de la licencia de uso y distribución Creative Commons Reconocimiento 4.0 Internacional (CC BY 4.0).

Breakthrough COVID-19 infection after vaccination in people with multiple sclerosis on disease modifying therapies in Latin America: data from RELACOEM registry

Introduction: In this study we aimed to monitor the risk of breakthrough COVID-19 infection in pwMS on different Disease Modifying Therapies (DMT) included in RELACOEM, a LATAM registry of MS and NMOSD patients infected with and vaccinated against COVID-19. Method(s): retrospective cohort study conducted between May 2021 and December 2021. The primary outcome was the appearance of infection during the follow-up time (at least three months after complete vaccination (second dose)). Specific information was requested (vaccine received, dose, date, symptoms, COVID- 19 infection, need for hospitalization, ventilatory assistance, treatment, and evolution). The primary objective of the analysis was to compare the incidence of breakthrough SARS-CoV-2 infections among the vaccinated pwMS in each DMT group. These conditions entail a PCR-confirmed test, and a time lag of at least 14 days from a full vaccination cycle (after the second vaccination dose). Cumulative incidence was reported by Kaplan Meier survival curves as well as incidence density. Result(s): A total of 857 pwMS patients from eight countries in LATAM were included. Mean age was 44.3 +/-12 years. The most frequent treatment used was fingolimod in 171 (19.9%). Most frequent first and second dose received was Astra-Zeneca (33%). During follow-up, a total of 28 COVID-19 cases were observed for a total exposure time of 150.965 days. The overall cumulative incidence was 3.2% (SE 0.22%) with an overall incidence density (ID) of 1.8 x 10.000 patients/day (95%CI 0.2-3.2). Compared to other DMTs, the incidence rate of breakthrough infections was significantly higher on ocrelizumab (6.02 (95%CI=5.65-7.16, RR=5.17 95%CI 3.27-7.12) and rituximab (6.94 (95%CI=6.15-9.12, RR= 5.93 95%CI 3.55-7.32) compared with other DMTs. No significant differences in the risk of breakthrough were observed for vaccine subtypes. Conclusion(s): An increased risk of breakthrough COVID-19 infections was observed in patients treated with ocrelizumab and rituximab.