Respiratory Outcomes in COVID-19 patients 3-6 months after admission to Public Health Hospital Maciel. Montevideo, Uruguay. A Follow up Cohort Study

To date, millions of people worldwide have recovered from COVID19, but concern remains on long-term impairment. We aimed to determine 3-6 months respiratory outcomes in a Latin American Public Health Hospital. Method(s): COVID-19 patients referred (April-June 2021,gamma variant breakdown) were enrolled, recalling epidemiology, demographic, comorbidities, laboratory, radiology, treatment and outcomes, performing spirometry, lung volumes, diffusing capacity (DLCO), walking test (6MWT);values< 80% of predicted were considered abnormal. Logistic regression analysis were performed to evaluate covariates associated with DLCO abnormality. Result(s): 56 patients followed 6 months make up the cohort. 56,9 +/- 13,0 years, 58,9% female,46,4% ever smokers, 42,9% obesity (BMI >30), 37,5% hypertension, 23,2% diabetes, 16,1% heart disease, 16,1% asthma. 64% dyspnea (MRC>1), 50% fatigue, sit to stand Sp02% 94,7 +/- 3,9. Lymphocites103 /muL 413,3 +/- 625,7,D-dimer ng/ml 3050,9 +/-7226,1,ferritin ng/ml 641,8 +/- 1173,4, 21.4% radiology abnormality, 35.7% admitted to ICU, days stay 17,1 +/- 10,5. 3 vs 6 months: TLC 5,3 +/- 1,9 vs 5,16 +/- 2,3 p=0.05;FVC 3,10 +/- 0,9 vs 3,16 +/- 1,0 p=0.04;DLCO:17,2 +/- 6,0 vs 17,8 +/- 6,2 7 p=0.006;Sp02% in 6MWT 90,1 +/- 98,2 vs 91,1 +/- 3,6 p=0.05. 6 months: dyspnea 28.6%, fatigue 26.8%, abnormality in: FVC 12,5%,FEV1 16,1%,DLCO 58,9%,distance 6MW 28,6%. Abnormal DLCO correlations: age > 65 p=0.02,smoking p=0.04,heart disease p=0.04,dyspnea MRC>1 p=0.002, persistent fatigue p=0.05. Conclusion(s): At 6 months some COVID-19 patients maintain symptoms and impaired DLCO and are the main target for further follow up and intervention.

Mexican women narratives facing Covid-19: Job insecurity and family overload

The Covid-19 pandemic in Mexico had significant consequences for the economy and social dynamics not only in health. Given the neoliberal policies, the impact was especially perceived in women. In general, home overload and precariousness in extradomestic work was reported. The objective of the study was to analyze the narratives about job insecurity and family burden by Covid-19 of women from three states of the Mexican Republic. In a study qualitative and exploratory study we analyzed the narratives of eight women with jobs outside the home located in the cities of Morelia, Tepic, and Mexicali. The findings, analyzed with a gender perspective, allow to visualize forms of subjection according to job insecurity with emphasis on the individual over the collective. Their stories show the overload within the domestic unit, work self-exploitation, and the consequences on the physical and mental health, as well as the necessary changes to adapt the digital gap that they had to respond to, they needed to turn to micro-entrepreneur to generate incomes. All of this implied family dynamic changes and their own personal resources. We discuss the need to replace the individual empowerment approach to a socio-community model, where unpaid work does not deepen gender gaps © 2023, Revista Colombiana de Sociologia.All Rights Reserved.

Impact of the Covid-19 Pandemic in the Diagnosis and Therapy of Single Hepatocellular Carcinoma Less Than 3 Cm in a Western Country

Introduction: The aim of a cancer screening program is to reduce cancerrelated mortality. For that reason patients with liver cirrhosis are enrolled into surveillance through biannual ultrasonography plus AFP to detect single hepatocellular carcinomas (HCC) less than 3 cm, best candidates to apply therapies with curative intent. This study evaluates the impact of the COVID-19 pandemic in the time between detection, diagnosis, and treatment in patients with uninodular HCC < = 3 cm. The secondary objective is to assess the number and sequence of tests needed to achieve the final diagnosis. Aims & Methods: Retrospective inclusion of consecutive patients with final diagnosis of single HCC <= 3 cmat ourcentre. Baseline clinical and analytical variables, date of detection, diagnosis, treatment / entry on the transplant waiting list and the sequence of tests performed (CT, MRI, biopsy) were recorded. Time to diagnosis (period from detection to diagnosis), time to treatment (from diagnosis to date of treatment/entry on the waiting list) and overall time (the sum of the above) were defined. The results were analyzed globally and divided into two periods: pre-COVID (Jan-15 to Feb-2020) and COVID (Mar-20 to the present). Result(s): From Jan 27th2015 to Dec 27th2021, 128 patients of 685 had a final diagnosis of single HCC <= 3 cm, 18% in the pre-COVID era and 22% in the COVID era. Baseline characteristics: median age 64 years old, 84% males, aetiology: alcohol 46%, hepatitis C 39%, fatty liver disease 5%. Child-Pugh class A 86%, BCLC-0 29%, BCLC-A 71%. Median size 20.5 mm, median AFP 5 ng/mL. Only 74% were diagnosed within the screening program. Thermal ablation was applied in 58 patients, liver transplantation in 29, surgical resection in 21 and intraarterial therapy in 16. Twelve patients were left in natural history. Diagnosis was reached by non-invasive criteria (imaging) in 112 patients and by biopsy in 16.The tests performed are shown in the TABLE 1. No statistically significant differences were found in the diagnostic capacity between multiphasic CT (67.6%) and dynamic MRI (73.3%), p-value 0.113. There were no differences in the diagnostic method (imaging versus biopsy) according to the size of the nodule (21.43 mm vs. 21.13 mm), p-value 0.199;nor in the number of studies performed according to the sequence (CT-MR-Biopsy vs MR-CT-Biopsy vs others), p-value 0.746. There were no significant differences neither in the proportion of tumors diagnosed between 10-20 mm and 21-30 mm on the pre-COVID vs COVID era, p-value 0.80, nor in the therapy applied (surgical versus loco-regional, p-value 0.639). Time to diagnosis, time to treatment, and overall time are shown in TABLE 2. Significant differences were found in the time to treatment between the pre-COVID and COVID eras:8 weeks vs 11 weeks, p-value 0.038. Conclusion(s): The COVID pandemic did not affected the proportion of single HCC <=3 cm diagnosed, but it increased the median time from diagnosis to treatment.

Assessment of Lockdown Effectiveness during COVID-19 Pandemic Using Air Pollution Data in Armenia in March-June 2019 and 2020: A Cross-Sectional Study

Various methods used by different countries' governments to control the spread of coronavirus disease 2019 (COVID-19), the cause of pandemic in 2020, affected air quality. The aim of this study was to evaluate the effects of lockdown in Armenia on the content of the main air pollutants-dust, SO2 and NO2. This was a cross-sectional study. We analyzed data on the concentrations of SO2, NO2 and dust from March to June, 2019 and the same period in 2020 as well as data on positive COVID-19 cases from Yerevan, Vanadzor and Hrazdan. In 2020, dust was found to be lower in Yerevan and in Hrazdan and higher in Vanadzor than in the same period in 2019. The same pattern was present for SO2 concentrations: in Yerevan and Hrazdan there was a decrease, and there was an increase in Vanadzor. The concentrations of NO2 increased in Yerevan and Hrazdan, with a slight decrease in Vanadzor. New cases of COVID-19 had a negative correlation with dust and a positive correlation with SO2. The strict quarantine measures were effective in containing the spread of COVID-19.

[Adherence to influenza vaccination campaign 2020/21 in the pandemic SARS-CoV-2. Context analysis in management changes: A pilot study]. / Adherencia a la campaña de vacunación de la gripe 2020/21 en el contexto de la pandemia de SARS-CoV-2. Análisis de los cambios en la gestión: un estudio piloto.

INTRODUCTION: Vaccination campaigns against influenza virus achieve coverages under recommended and desired values. In current context of SARS-CoV-2 pandemic it becomes more relevant. Our objective is to evaluate the impact on vaccination coverage of a set of implementation strategies carried out. MATERIAL AND METHODS: Vaccine implementation strategies were introduced in our basic health zone as active caption of patients and schedule extension. Then the vaccination coverage achieved in the current campaign was evaluated and compared with previous in the 8th week and at the end of the campaign. Besides, a transversal study through a survey was carried out to measure the impact of the applied strategies. RESULTS: In the 8th week of the campaign significant differences were detected in the increase of vaccination coverage compared with previous years. These results were confirmed at the end of the campaign, getting a significant difference (<.05) of vaccination coverage in all the studied centers, these data support the effectivity of the applied strategies. CONCLUSIONS: The vaccine implementation strategies applied have shown effectivity, achieving an increase of until 74% in the total administered doses compared to previous campaigns and even a 15% of vaccination coverage increased in the group of patients older than 64 years; even in a pandemic context and the increasing of anti-vaccine movements.

CONHECIMENTO E ATITUDES SOBRE A MEDICINA DE VIAGEM NO BRASIL

Introdução: A Medicina de Viagem existe há mais de 40 anos. A prática desta especialidade no Brasil começou em 1997 na cidade do Rio de Janeiro. No entanto, essa especialidade é praticamente desconhecida no Brasil, apesar do grande número de brasileiros que viajam anualmente dentro e fora do país. Métodos: Com o objetivo de determinar o conhecimento dos brasileiros sobre a existência da Medicina de Viagem e suas atitudes em relação a ela, realizamos uma enquete online com 10 questões, da qual participaram 3.237 brasileiros. Resultados: Apesar de mais de 95% dos participantes saberem que para viajar a determinados países precisam tomar certas vacinas, apenas 28% dos participantes já ouviu falar em Medicina de Viagem, dos quais 30% tinha realizado uma consulta com um especialista antes de viajar. Depois de conhecer a definição e os objetivos da especialidade, mais de 90% considerou importante realizar uma consulta pré-viagem. Conclusão: A falta de conhecimento é a principal barreira para o acesso dos brasileiros à consulta de Medicina de Viagem. É necessário divulgar a especialidade, utilizando evidências científicas e tendo como exemplo a difusão mundial da COVID-19 por meio dos viajantes, conscientizar a população sobre a importância da consulta pré e pós-viagem.

Knowledge and attitudes about travel medicine in Latin America in the context of COVID-19: a cross-sectional study

Introduction: Travel Medicine specialty has existed in Latin American for more than 25 years. The creation of the Latin American Society of Travel Medicine (SLAMVI) stimulated medical education in this discipline, through research and scientific publications. However, Travel Medicine is practically unknown to Latin Americans.

Barriers to immunization in the dominican republic and covid-19

In recent years, the Dominican Republic has experienced a significant reduction in vaccination coverage;cases of tetanus and diphtheria that have recently emerged are a result of this situation. In order to identify barriers to immunization and determine the impact of COVID-19 on vaccination adherence, 2,584 Dominicans completed an online survey on personal vaccination history and reasons for not getting vaccinated. In addition, they answered questions about the acceptance of the COVID-19 vaccine and the influence of the pandemic on their perception/ adherence to vaccination. Most of those surveyed were not vaccinated during the pandemic, the main reason being: “I had no vaccination scheduled for this year.” This indicates that even though the pandemic made it difficult to access vaccination services, this was not the main barrier to immunization in the Dominican Republic in 2020. Despite the fact that most of the participants are in favor of vaccination, of the vaccines included in our study, the only one that reached the goal of the Global Vaccine Action Plan of achieving 90% vaccination coverage by 2020 was measles, mumps and rubella in children. The main barrier to immunization is forgetting to get vaccinated. It is necessary to adopt an effective reminder system to increase adherence and improve immunization rates. © 2021, Finlay Ediciones. All rights reserved.

Innovation in the airway approach during the COVID-19 pandemic

Background: COVID-19 is predominantly transmitted by droplets, being the risk of infection greatly increased in aerosol-generating procedures, such as intubation, extubation and aspiration of the orotracheal tube. Given the high transmission of this disease, it led to a reorganization of hospital teams and dynamics, with the implementation of additional protection measures. Medical innovation has taken an interesting role in the development of materials that provide protection when approaching the airway. Case: Male patient, 69 years old COVID-19 patient admitted to the Intensive Care Unit (ICU), that complicated with cardiopulmonary arrest. Advanced life support maneuvers with orotracheal intubation was immediately implemented, with recovery. The airway approach was performed using videolaryngoscope and placement of a plastic clamp in the orotracheal tube, only unclamped after connection to the closed circuit of the ventilator. For all these procedures, the aerosol box available at the ICU was used. Summary: The aerossol box and orotracheal tube clamp provided professionals decreases the dispersion of droplets and aerosols, reducing the exposure and consequently the risk of contagion of health professionals. Nevertheless, training and preparation of the staff is necessary in order to enhance the benefits and reduce the difficulties associated with the lack of experience in their use.

Characteristics and outcome of adults with acute lymphoblastic leukemia and COVID 19 infection in the first vs. Second epidemic wave in Spain: A study from the Pethema and Geth groups

Background: SARS-CoV-2 infection has bimodal distribution in Europe with a 1st wave in March-June 2020 and a 2nd in September 2020-February 2021. In cancer patients (pts) the lethality of COVID- 19 infection was 25%>35% in the 1st wave. Comparison on impact of COVID-19 infection in the 1st vs. 2nd waves have not been performed in ALL. Aims: We compared the frequency, clinical characteristics and outcome of adults with ALL and COVID-19 infection in the 1st vs. 2nd waves in Spain. Methods: Between March 1, 2020-May 31, 2020, and between September 12, 2020- January 12, 2021 (date of vaccination onset in Spain), a registry from the PETHEMA (Programa Espa.ol de Tratamientos en Hematologia) and GETH (Grupo Espa.ol de Trasplante Hematopoyético y Terapia Celular) groups prospectively recruited adult ALL pts with COVID-19 infection confirmed by PCR. Demographic and clinical characteristics of ALL and COVID-19 infection, comorbidities, treatment and outcome were collected and compared in the two periods. In addition, prognostic factors for survival were analyzed. Results: Fifty-six patients were collected in 82 centers contacted, 4 of them being excluded (COVID infection >3 yr. after end of ALL therapy [n=3] and Burkitt lymphoma [n=1]). Twenty-eight pts were collected in the 1st wave and 24 in the 2nd. Median age was 46 (range 20-83), (34 pts [65%] >40 yr). Comorbidities were present in 18 pts (35%). ALL was of B-cell precursors in 38 pts (74%) (Ph+ in 8, 15%). Thirtyone pts (60%) were under frontline treatment, 16 (31%) in rescue, 1 (2%) palliative and 4 (7%) had recently finished the therapy. Eight pts had received allogeneic HSCT (5 of them at COVID-19 infection diagnosis), CAR T (n=1, 2 yr prior to COVID-19 infection) or received immunotherapy (inotuzumab, n=6, 2 at COVID-19 infection, and blinatumomab, n=1, prior to COVID-19 infection). Eleven pts were receiving immunosuppressive drugs at COVID infection (fludarabine in 6, among others). No significant differences were observed in ALL characteristics in the two COVID-19 waves, except for a significantly higher number of patients on first line therapy in the second wave, and a higher frequency of severe neutropenia and lymphocytopenia in the first wave. COVID19 therapy was different in the two periods, with significantly higher use of hydroxychloroquine, remdesivir and lopinavir-ritonavir in the first wave and corticosteroids in the second wave. No significant differences were observed in need of oxygen support (12 vs. 8 pts), ICU requirement (7 vs. 4 pts), days in ICU (medians 16 vs. 21) and time to COVID infection recovery (medians 17 vs. 13 days). Seventeen patients (33%) died (11 vs. 6), being death attributed to COVID infection in 15 (29%), without significant differences in the 100-day survival probabilities (Figure 1). By multivariable analysis only comorbidities at COVID-19 infection had a negative impact on survival (HR: 5.358 [95% CI: 1.875;15.313]). Summary/Conclusion: COVID-19 infection was frequent in ALL pts, especially in those with advanced age and under ALL frontline or rescue therapy. The frequency of severe COVID-19 infection and mortality were high, with negative impact of comorbidities on survival. No significant differences were observed in ALL characteristics, response to therapy and outcome in the two waves of COVID infection. The poor outcome of COVID infection makes vaccination a priority for ALL patients in this pandemic period. Supported in part by 2017 SGR288 (GRC) Generalitat de Catalunya and "la Caixa" Foundation.

The world of molecular biology

The World of Molecular Biology is a book which examines and explores the discoveries as well as the lives of twenty-five stellar scientists who have all contributed in different ways to the field that we know today as “molecular biology.” The book covers a vast timeline from the last century to present day advances and concerns such as viral replication and transmission. The book examines the foundational structures of the field as well as how many scientists and basic scientific knowledge have contributed to our current understanding. Beginning with DNA (as hereditary material) and evolving into recombinant DNA and replication and somatic DNA, the book covers the way in which scientists have examined and explored these realms and some of the resultant discoveries which have led to the Nobel Prize. Nobel prize winners are not born, but they are made from years of education, years of familial nurturance, years of mentoring by other scientists (either formally or informally) and of course by luck, chance, fate and surreptitious encounters. Some of our scientists have spent years studying the fruit fly (drosophila), fly genetics, mutations, replications, and of course, genes, gene replication, split genes and “jumping genes.” For those seeking an overview of the field of molecular biology this text will provide an overview of the lives of those who have delved most deeply into these issues and those whose discoveries have resulted in the Nobel Prize. The text is certainly relevant in today’s world as we encounter and challenge the dreaded ever-evolving virus known as Covid-19 which seems intent on replicating, changing, evolving and challenging mankind and our scientific community. © 2021 by Nova Science Publishers, Inc.

The effect of the COVID-19 lockdown on air quality in three Italian medium-sized cities

Despite the societal and economic impacts of the COVID-19 pandemic, the lockdown measures put in place by the Italian government provided an unprecedented opportunity to increase our knowledge of the effect transportation and industry-related emissions have on the air quality in our cities. This study assessed the effect of reduced emissions during the lockdown period, due to COVID-19, on air quality in three Italian cities, Florence, Pisa, and Lucca. For this study, we compared the concentration of particulate matter PM₁₀, PM_2.5, NO₂, and O₃ measured during the lockdown period, with values obtained in the same period of 2019. Our results show no evidence of a direct relationship between the lockdown measures implemented and PM reduction in urban centers, except in areas with heavy traffic. Consistent with recently published studies, we did, however, observe a significant decrease in NO₂ concentrations among all the air-monitoring stations for each city in this study. Finally, O₃ levels remained unchanged during the lockdown period. Of note, there were slight variations in the meteorological conditions for the same periods of different years. Our results suggest a need for further studies on the impact of vehicular traffic and industrial activities on PM air pollution, including adopting holistic source-control measures for improved air quality in urban environments.