Subacute thyroiditis and thyrotoxicosis after SARS-CoV-2 vaccine: report of 2 cases / Tiroiditis subaguda y tirotoxicosis posterior a vacuna contra SARS-CoV-2: reporte de 2 casos

La enfermedad por coronavirus SARS-CoV-2 que surgió en el año 2019 (COVID-19), ha obligado al rápido desarrollo de vacunas para prevenir su propagación e intentar controlar la pandemia. Dentro de las vacunas desarrolladas, las primeras en ser aprobadas con una tecnología nueva en el campo de la vacunación, fueron las vacunas basadas en ARNm (ácido ribonucleico mensajero), que lograron tasas de efectividad cercanas al 95 % para la prevención de la enfermedad COVID-19 grave. Los eventos adversos comunes son reacciones locales leves, pero ha habido varios informes de pacientes que desarrollaron tiroiditis subaguda y disfunción tiroidea después de recibir la vacuna contra SARS-CoV-2. Este artículo presenta dos casos de tiroiditis subaguda poco después de recibir la vacuna contra COVID-19

The SARS-CoV-2 coronavirus disease which emerged in 2019 (COVID-19), has forced the rapid development of vaccines to prevent the spread of infection and attempt to control the pandemic. Among the vaccines developed, one of the first to be approved with a new technology in the field of vaccination, was the mRNA (messenger ribonucleic acid) vaccine, with rates of effectiveness close to 95% for the prevention of severe COVID-19 disease. Common adverse events are mild local reactions, but there have been some reports of patients developing sub-acute thyroiditis and thyroid dysfunction after receiving the SARS-CoV-2 vaccine. This article presents two case reports of subacute thyroiditis shortly after receiving the COVID-19 vaccine

Adaptogens on Depression-Related Outcomes: A Systematic Integrative Review and Rationale of Synergism with Physical Activity.

Depression is considered the most important disorder affecting mental health. The aim of this systematic integrative review was: (i) to describe the effects of supplementation with adaptogens on variables related to depression in adults; and (ii) to discuss the potential combination with physical exercise to aid planning and commissioning future clinical research. An integrative review was developed complementing the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PROSPERO registration: CRD42021249682). A total of 41 articles met the inclusion criteria. With a Price index of 46.4%, we found that: (i) Hypericum perforatum (St. John's Wort) is the most studied and supported adaptogen (17/41 [41.46%], three systematic reviews with meta-analysis) followed by Crocus sativus L. or saffron (6/41 [14.63%], three systematic reviews with meta-analysis and two systematic reviews); (ii) it is possible that the significantly better performance of adaptogens over placebo is due to the reduction of allostatic load via the action of secondary metabolites on BDNF regulation; and, (iii) the number of studies reporting physical activity levels is limited or null for those that combine an exercise program with the consumption of adaptogens. Aware of the need for a multidisciplinary approach for depression treatment, this systematic integrative review provides an up-to-date view for supporting the use of St. John's Wort and saffron as non-pharmacological strategies while also help commissioning future research on the efficacy of other adaptogens. It also contributes to the design of future clinical research studies that evaluate the consumption of herbal extracts plus physical exercise, mainly resistance training, as a potentially safe and powerful strategy to treat depression.

Long COVID-19: The Need for an Interdisciplinary Approach.

Long coronavirus disease 2019 (COVID-19) is characterized by persistent COVID-19 symptoms that last for at least 2 months. In the elderly population, apart from the typical symptoms (fatigue, cough, or dyspnea), unspecific symptoms coexist (functional deterioration, cognitive impairment, or delirium) that can mitigate the prevalence of this syndrome in this age group. Its main consequence is the functional decline, leading to sarcopenia, frailty, and disability, in addition to the nutritional and cognitive disorders. Thus, a multicomponent and individualized program (exercise, diet, cognitive stimulation) should be designed for older people with persistent COVID, where new technologies could be useful.

Corporate Social Responsibility during COVID-19 Pandemic

The health, economic, and social consequences of the SARS-CoV-2 virus have highlighted the need for collaboration among all agents to face a scenario that we have not before seen. The aims of this paper are to analyze the involvement that large Spanish companies have shown during the toughest moments of the epidemic and to determine the objectives these companies have pursued with them. The results show that several firms have shown a great commitment with society, developing actions that alleviate the consequences of the COVID-19 like others have developed several strategies with different objectives. More concretely, three clusters of responsibility have been identified: (i) protecting only the interests of shareholders and investors;(ii) favoring the wellbeing of the Spanish society in general and vulnerable groups in particular;and (iii) combining the previous altruistic actions with commercial interests.

Biotechnological Approach to Increase Oxyresveratrol Production in Mulberry In Vitro Plants under Elicitation.

Morus alba L. is used for a range of therapeutic purposes in Asian traditional medicine, and its extracts are reported to be effective against lipidemia, diabetes, and obesity, as well as being hepatoprotective and tyrosinase-inhibitory. They are also included in cosmetic products as anti-aging and skin-whitening agents. Stilbenes, the major bioactive compounds found in M. alba, have received renewed attention recently because of their putative activity against COVID-19. In this study M. alba plants were established in vitro, and the effect of elicitation on plant growth and stilbene accumulation, specifically oxyresveratrol and trans-resveratrol, was investigated. Different concentrations of the elicitors including methyl jasmonate and cyclodextrins were applied, and stilbene levels were determined in leaves, roots, and the culture medium. Elicitation of the M. alba plants with 5 mM cyclodextrins, alone or in combination with 10 µM methyl jasmonate, significantly increased the total phenolic content in the culture medium and leaves after 7 days of treatment. The higher total phenolic content in the roots of control plants and those treated only with methyl jasmonate indicated that cyclodextrins promoted metabolite release to the culture medium. Notably, the cyclodextrin-treated plants with the highest levels of oxy- and trans-resveratrol also had the highest total phenolic content and antioxidant capacity. These results indicate that elicited M. alba in vitro plants constitute a promising alternative source of bioactive stilbenes to supply pharmaceutical and cosmeceutical industries.

Family and School Relationship during COVID-19 Pandemic: A Systematic Review.

Education systems worldwide have been affected by a sudden interruption in classroom learning because the coronavirus pandemic forced both the closure of all schools in March 2020 and the beginning of distance learning from home, thus compelling families, schools, and students to work together in a more coordinated fashion. The present systematic review was carried out following PRISMA guidelines. The main objective was to present critical information on the relationship between the family and the school in the face of the imposed distance learning scenario caused by COVID-19. A total of 25 articles dealing with the relationships established during the pandemic of any of the three agents involved (family, students, and school) were analysed. The results showed that the relationships between the three groups involved must be improved to some extent to meet the needs that have arisen as a result of distance learning. In conclusion, the educational scenario during the pandemic has been one of the most significant challenges experienced in the recent history of education.

[Prognostic impact of prior cardiopathy in patients hospitalized with COVID-19 pneumonia]. / Repercusión pronóstica de cardiopatía previa en pacientes hospitalizados con neumonía por COVID-19.

Objective: From the onset of COVID-19 pandemic, the presence of previous cardiopathy was thought to be related with a worse prognosis of the disease. We aimed to analyse that theoretical adverse impact in a large cohort of patients. Method: We selected 1065 patients admitted for SARS-CoV-2 pneumonia between March and June 2020, divided in three groups according to (1) absence of cardiopathy, (2) presence of valvular heart disease or ischemic heart disease, or (3) presence of heart failure. We analysed the differences between groups regarding the need for admission in intensive care unit for mechanical ventilation or mortality during admission, or mortality during admission or in the next 6 months. Results: The factors that were associated with a worse prognosis both in acute phase and in the next 6 months were age, male gender, obesity and oncologic disease. The presence of previous cardiopathy did not have an adverse prognostic impact neither initially nor in the short term, in our study. Conclusions: We did not obtain significative association of the presence of cardiopathy with a worse medical evolution, neither in acute phase nor in the short term, of patients admitted for SARS-CoV-2 pneumonia.

Objetivo: Desde el inicio de la pandemia por enfermedad por coronavirus 2019 (COVID-19) se relacionó la presencia de cardiopatía previa con un peor pronóstico de la enfermedad. Nuestro objetivo fue analizar esa posible repercusión desfavorable en una cohorte amplia de pacientes. Método: Se incluyeron 1,065 pacientes ingresados con neumonía por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) entre marzo y junio de 2020, divididos en tres grupos, según no tuvieran cardiopatía previa (grupo 1), presentaran cardiopatía valvular o isquémica (grupo 2) o tuvieran insuficiencia cardiaca (grupo 3). Se analizaron las diferencias entre los grupos en cuanto a necesidad de ingreso en unidad de cuidados intensivos para ventilación mecánica o mortalidad durante el ingreso, o mortalidad durante el ingreso o a los seis meses. Resultados: Los factores que se asociaron con un peor pronóstico inicial y a los seis meses fueron la edad, el sexo masculino, la obesidad y la presencia de patología oncológica, sin que la presencia de cardiopatía supusiera una influencia pronóstica negativa inicial ni a corto plazo en nuestro trabajo. Conclusiones: No obtuvimos asociación significativa de la presencia de cardiopatía por si sola con una peor evolución en fase aguda ni a corto plazo de pacientes ingresados con neumonía por SARS-CoV-2.

Long COVID-19: The Need for an Interdisciplinary Approach

Synopsis Long COVID-19 is characterized by persistent COVID-19 symptomatology that lasts for, at least, two months. In old population, apart from the typical symptoms (fatigue, cough, or dyspnea), coexist unspecific symptoms (functional deterioration, cognitive impairment, or delirium) that could apparently mitigate the prevalence of this syndrome in this age group. Its main consequence is the functional decline, leading to a development of sarcopenia, frailty, and disability, without forgetting the nutritional and cognitive disorders. Thus, a multicomponent and individualized program (exercise, diet, cognitive stimulation) should be designed for older people suffering from persistent COVID, where new technologies could be useful.

COVID-19-associated pulmonary aspergillosis (CAPA): Risk factors and development of a predictive score for critically ill COVID-19 patients.

BACKGROUND: COVID-19-associated pulmonary aspergillosis (CAPA) is a major complication of critically ill COVID-19 patients, with a high mortality rate and potentially preventable. Thus, identifying patients at high risk of CAPA would be of great interest. We intended to develop a clinical prediction score capable of stratifying patients according to the risk for CAPA at ICU admission. METHODS: Single centre retrospective case-control study. A case was defined as a patient diagnosed with CAPA according to 2020 ECMM/ISHAM consensus criteria. 2 controls were selected for each case among critically ill COVID-19 patients. RESULTS: 28 CAPA patients and 56-matched controls were included. Factors associated with CAPA included old age (68 years vs. 62, p = .033), active smoking (17.9% vs. 1.8%, p = .014), chronic respiratory diseases (48.1% vs. 26.3%, p = .043), chronic renal failure (25.0% vs. 3.6%, p = .005), chronic corticosteroid treatment (28.6% vs. 1.8%, p < .001), tocilizumab therapy (92.9% vs. 66.1%, p = .008) and high APACHE II at ICU admission (median 13 vs. 10 points, p = .026). A score was created including these variables, which showed an area under the receiver operator curve of 0.854 (95% CI 0.77-0.92). A punctuation below 6 had a negative predictive value of 99.6%. A punctuation of 10 or higher had a positive predictive value of 27.9%. CONCLUSION: We present a clinical prediction score that allowed to stratify critically ill COVID-19 patients according to the risk for developing CAPA. This CAPA score would allow to target preventive measures. Further evaluation of the score, as well as the utility of these targeted preventive measures, is needed.

Association of COVID-19-Associated Pulmonary Aspergillosis with Cytomegalovirus Replication: A Case-Control Study.

Introduction: Cytomegalovirus (CMV) infection is a well-known factor associated with invasive aspergillosis in immunocompromised hosts. However, its association with COVID-19-associated pulmonary aspergillosis (CAPA) has not been described. We aimed to examine the possible link between CMV replication and CAPA occurrence. Methods: A single-center, retrospective case-control study was conducted. A case was defined as a patient diagnosed with CAPA according to 2020 ECMM/ISHAM consensus criteria. Two controls were selected for each case among critically ill COVID-19 patients. Results: In total, 24 CAPA cases were included, comprising 14 possible CAPA and 10 probable CAPA. Additionally, 48 matched controls were selected. CMV replication was detected more frequently in CAPA than in controls (75.0% vs. 35.4%, p = 0.002). Probable CMV end-organ disease was more prevalent in CAPA (20.8% vs. 4.2%, p = 0.037). After adjusting for possible confounding factors, CMV replication persisted strongly associated with CAPA (OR 8.28 95% CI 1.90-36.13, p = 0.005). Among 11 CAPA cases with CMV PCR available prior to CAPA, in 9 (81.8%) cases, CMV replication was observed prior to CAPA diagnosis. Conclusions: Among critically ill COVID-19 patients, CMV replication was associated with CAPA and could potentially be considered a harbinger of CAPA. Further studies are needed to confirm this association.

Circular Economy Projects and Firm Disclosures in an Encouraging Institutional Environment

This paper analyses the strategies implemented by listed Spanish companies that are leaders in their industrial environments to inform shareholders and the public about their circular economy projects. It uses content and textual approaches through the factorial correspondence analysis of all the information about the circular economy presented on corporate websites. The analysis of the 17,510 resulting terms suggests that companies prioritise discourses about a sustainable future, their commitment to the proper use of resources and the reduction or elimination of greenhouse gases. The sectors most sensitive to institutional pressures, such as oil and energy companies, are more active in disclosing the problems and desired solutions of their projects.

Impact of COVID-19 Lockdown in Eating Disorders: A Multicentre Collaborative International Study.

BACKGROUND: The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. AIMS: (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. METHODS: The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). RESULTS: Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. CONCLUSIONS: The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients.

Efficiency in the governance of the Covid-19 pandemic: political and territorial factors.

BACKGROUND: The pandemic generated by Covid-19 has changed the way of life of citizens around the world in a short time, affecting all areas of society directly or indirectly, which is facing a global health crisis with different national responses implemented by governments. Several months into the pandemic, the first after-effects of Covid-19 are beginning to be felt by citizens, who are questioning the management carried out so far. In order to improve the performance of governmental decisions to reduce the impact of the pandemic during the coming months, we calculated the levels of efficiency in the management of health resources. In addition, we identify some country characteristics that may condition efficient management. RESULTS: We obtained significant differences according to the geographical location of the country, with European and American countries being less efficient than Asian and African countries. Likewise, we can affirm that greater freedom of expression, a higher median age and an unstable economy and labor market reduce efficiency. However, female leadership of the government and greater compliance with the rule of law offer more efficient management, as do countries that derive more revenues from tourism. CONCLUSIONS: These results provide an opportunity for political leaders to reflect on their management during these months of the pandemic in order to identify mistakes and improve the implementation of effective measures. It has been shown that using more resources does not mean managing better; therefore, policymakers need to pay special attention to the use of resources, taking into account the budgetary constraints of the public sector.

The Commitment of Spanish Local Governments to Sustainable Development Goal 11 from a Multivariate Perspective

The commitment of governments to sustainable development was materialised in the Millennium Development Goals (MDGs) and later in the Sustainable Development Goals (SDGs), the latter being a more ambitious project that positions local governments as the main agents for its implementation. With the aim of improving the sustainability of cities, this research analyses the commitment of Spanish local governments to the SDG-11, indicating possible improvements with the aim of complying with Agenda 2030. We use the X-STATIS study technique with graphic representations. The results indicate a positive trend towards achieving SDG-11, in which progressive governments are concerned with issues of inclusive and sustainable urbanisation as a result of increased citizen participation, and conservative governments focus on slum upgrading and safety in inclusive and accessible public spaces. In addition, the ideological coincidence between different administrative levels is an impetus to the fulfilment of SDG-11.

Corporate Social Responsibility in the COVID-19 Pandemic Period: A Traditional Way to Address New Social Issues

The COVID-19 pandemic has had serious health, social and economic consequences. In this difficult context, companies are called upon to implement corporate social responsibility (CSR) activities to support society and the weakest individuals. This study examines how Spanish companies have supported society and vulnerable individuals through partnerships with non-governmental organizations (NGOs). In this regard, a multiple case study analysis based on 14 companies listed on the Madrid Stock Exchange that have created collaborations with different NGOs was conducted. The results show that these partnerships are mainly aimed at providing food, health, social and technological support to society and vulnerable individuals. To the best of our knowledge, this is the first study that examines the support provided by companies to society during the COVID-19 pandemic in the European context.

Different Leaders in a COVID-19 Scenario: CEO Altruism and Generous Discourse

Academic literature has begun to be interested in the informational gaps between what companies say and do in relation to their financial performance and their commitment to society and the environment, identifying the use of self-protection and self-enhancement strategies before their interest groups. In this research, based on a statistical analysis of textual data and a correspondence analysis, the sentiment of the discourse that Spanish CEOs have held with their stakeholders regarding the operational and strategic decisions they made in the face of COVID-19 is analysed. The evidence shows that managers who promptly reported negative news regarding divestments, cutting expenses and destroying jobs, used the epidemic as justification. The leaders who combined these decisions with responsible actions—focused on the ethical and commercial sustainable dimensions—adopted an approach with a different degree of self-enhancement to value their responsible decisions. In contrast, optimistic CEOs, altruistically committed to society, opted for more personal, emotional, dynamic and constant channels and procedures, avoiding selfish attributions for their actions.

[Blue Lungs in Covid-19 Patients: A Step beyond the Diagnosis of Pulmonary Thromboembolism using MDCT with Iodine Mapping]. / Pulmones azules en pacientes COVID-19: un paso más allá del diagnóstico de tromboembolismo pulmonar mediante TCMD con mapa de yodo.

OBJECTIVE: To evaluate the diagnostic capacity of pulmonary angiography with multidetector computed tomography (MDCT) and iodine mapping in the diagnosis of pulmonary thromboembolism (PTE) in patients with Covid-19 disease. METHODS: Retrospective observational study of 81 consecutive patients admitted with Covid-19 respiratory infection who underwent MDCT for clinical suspicion of PTE (sudden dyspnea, chest pain, hemoptysis, severe respiratory failure (SRF) not corrected with high O2 flow) and/or raised D-dimer. RESULTS: Of the 81 patients studied [64 (79.01%) men], acute PTE was identified in 22 (27.16%), bilaterally in 13 (59.09%), and 13 (59,09%) showed areas of hypoperfusion. Of the 59 (72.83%) patients without PTE, hypoperfusion was observed in 41 (69.49%) (attributable in one case to pulmonary emphysema). In 18 (22.2%) of the total number of patients, neither PTE nor hypoperfusion were seen. A crazy paving pattern is a risk factor for developing PTE (OR 1.94; 95% CI 0.28-13.57), as are consolidations (OR 1.44; 95% CI 0.24-8.48) and septal thickening/bronchiectasis (OR 1.47; 95% CI 0.12-17.81).Patients with O2-refractory SRF showed a 6.36-fold higher risk for hypoperfusion on the iodine map. CONCLUSION: By adding the functional image to the anatomical image, pulmonary angiography with MDCT and iodine mapping can demonstrate not only PTE in main, lobar and segmental arteries, but also the presence of hypoperfusion in distal vessels. This makes it a highly useful tool for the accurate diagnosis and therapeutic orientation of patients with Covid-19 lung involvement.

Gestión enfermera durante la COVID-19: oportunidades y retos futuros

La pandemia COVID-19 ha representado un reto hasta ahora desconocido para nuestro sistema sanitario. Una parte significativa de la gestión de la crisis y adaptación durante este periodo ha correspondido a los mandos de enfermería. Este artículo muestra las dificultades y los éxitos de esta gestión, así como las oportunidades futuras que estos cambios pueden suponer para la profesión enfermera. Se realizó una encuesta telemática de 17 preguntas a las responsables de gestionar la adaptación de los servicios hospitalarios a la pandemia COVID-19, mediante la reestructuración de diferentes áreas: la comunicación interna con participación en la toma de decisiones, la formación para la seguridad de los pacientes, la dotación de materiales, la dotación y rotación de los profesionales y la actualización de los protocolos. Mediante el análisis de una encuesta realizada por responsables de enfermería de diversos hospitales públicos y mutuas laborales situados en Cataluña, hemos podido identificar las principales dificultades surgidas y las decisiones tomadas en un tiempo record para poder adaptar nuestros hospitales a la pandemia, preservando la seguridad del personal y dar una respuesta profesional y humana a nuestros pacientes. La crisis sanitaria vivida representa un incentivo para consolidar logros y proponer cambios que afiancen los aciertos, realizar autocrítica de los errores y devolver así a la sociedad, mediante cambios estructurales, aquello que hayamos aprendido. Defender este cambio supone impulsar perspectivas valientes en la redefinición de las enfermeras del futuro The COVID-19 pandemic has represented a hitherto unknown challenge for our healthcare system. A significant part of management and adaptation during this period has been the responsibility of middle management nursing staff. This article shows the difficulties and successes of this management, in addition to the future opportunities that these changes, if they are known how to take advantage of, may represent for the nursing profession. An online survey was carried out with 17 questions to those responsible for managing the adaptation of various hospital services to the COVID-19 pandemic, through the internal communication redesign, the participation in the decision making process, the education for the patient's safety and the management of personnel, systems and materials. Through the analysis of a survey carried out by nursing managers from various public hospitals and labour mutual societies located in Catalonia, we have been able to identify the main difficulties encountered and the decisions taken in record time to be able to adapt our hospitals to the pandemic, preserving the safety of the staff and give a professional and humane response to our patients. The lived health crisis represents an incentive to consolidate achievements and propose changes that strengthen the successes, carry out self-criticism of mistakes and thus return to society, through structural changes, what we have learned. Defending this paradigm shift means promoting courageous perspectives in redefining the nurses of the future