Use of Monoclonal Antibodies for Treatment of Solid Organ Transplant Recipients with COVID-19: A Single Center Experience

Purpose: The risk of severe COVID-19 requiring hospitalization and death is higher in solid organ transplant recipients (SOTr). There remains limited data on the use of monoclonal antibodies and long-term outcomes in SOTr. Method(s): This is a retrospective study conducted at Jackson Health System-Miami Transplant Institute in SOTr with mild-moderate COVID-19, from November 2020 to October 2021. Bamlanivimab was used initially for outpatients with mild to moderate COVID-19 but switched to casirivimab/imdevimab on March 1, 2021, due to rising prevalence of SARS-CoV-2 variants in the Miami-Dade area. Outcomes assessed included emergency department visits, hospitalizations, allograft rejection, and death. Result(s): Ninety-two patients were treated, most commonly with casirivimab/imdevimab (74%). The median age was 51 (range, 18-81) years, with 61% male and 60% Hispanic ethnicity. Transplanted organs included 68 kidney (74%), 10 liver (10.8%), 10 heart (10.8%), and 7 lung (7.6 %). Forty-two (45.6%) had a vaccine breakthrough infection, of which 34 (80.9%) were during the delta variant predominance. The median time from positive SARS-CoV-2 test to administration of monoclonal antibody was 1 (range, 0 - 10) day. Anti-metabolite agents were decreased or held in 54.3% of cases. Median follow-up was 116 (range, 19 - 358) days. Five (5.8%) patients had an emergency department visit, 26 (28.2%) were hospitalized;of which 11 (42%) were due to worsening COVID-19 symptoms within 28-days of infusion. 63.6% (7/11) required supplemental oxygen, none required mechanical ventilation. The median hospital length of stay was 6 (range, 2-32) days and all patients were discharged alive. During follow-up, 6 (4 kidney, 2 heart;6.5%) developed biopsy proven rejection. No graft loss or death occurred in this cohort. Conclusion(s): Early use of monoclonal antibodies in SOTr is associated with favorable outcomes. Multi-center studies assessing use of monoclonal antibodies in breakthrough infections and association with allograft rejection are needed.

The millennial consumer's perception of digital messages from the banking sector during the pandemic

During the pandemic, brands have seen the need to create messages with greater authenticity in order to become closer and be more relevant to the consumer. Thus, advertisements on digital platforms during the COVID-19 crisis came to modify their essence and structure, telling stories that involved the subject more and making him the protagonist of the message. Some authors have catalogued this restructuring of the advertising discourse during the crisis as Advertcrisis: a creative line that uses the crisis itself to elaborate messages that promote products and services. There are several categories that have used this formula -such as the banking category-, which used the crisis as a creative line to develop its discourse. For this reason, many messages focused on highlighting concepts such as union, progress or improvement. The objective of this study was to analyze, through in-depth interviews, the perception of men and women about the digital messages that some brands of the banking category developed during the first months of the pandemic. It has been observed how the participants of this research have had a negative perception of these many of the virtual strategies, since these have only been limited to emit empty emotional messages, unrelated to the real problems they were going through. © 2022 IEEE Computer Society. All rights reserved.

Social Media as a Communication Channel During the Coronavirus Pandemic among the Faculty of Industrial Engineering at the Technological University of Panama, Main Campus, Year 2020

This research paper details communication between faculty of a higher education institution in Panama and its students after the arrival of the COVID-19 pandemic. The study is limited to the undergraduate student population on the main campus of the Faculty of Industrial Engineering of the Technological University of Panama (UTP). It pursues the following objectives: a) To know how undergraduate students obtain correct, truthful, and timely information from the Faculty, and b) distinguish the content relevant to their needs. To develop the research, we collected social media data metrics and held a focus group session. The research concluded that the students in the institution use the Instagram platform as their primary source of information from the faculty. Their priority is to seek clear, accurate, timely and immediate information about processes that they can conduct during the semester that helps them to fulfill the course objectives, avoiding any possible setbacks.

Dynamic alterations of immunophenotype, C reactive protein and interleukine-6 levels in peripheral blood of severe COVID-19 patients

Introduction. Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) causes a coronavirus disease 2019 (COVID-19) characterized by a "cytokine storm"-increased activity of immune cells with the elevated production of inflammatory cytokines leading to respiratory failure. Additionally, the course of pneumonia is characterized by an increased content of C reactive protein. Leukocytosis, leukopenia and lymphopenia are also commonly present in COVID-19 patients. Fine alterations of the immune cells subpopulations and cytokines level in COVID-19 patients are little known. This work aimed to determine the immunophenotype of peripheral blood cells subpopulations and to study the mentioned underlying changes in IL-6 and CRP levels in patients with COVID-19 pneumonia. Methods. Blood count with Erythrocyte Sedimentation Rate (ESR) was completed by routine blood assay. CRP and IL-6 levels were measured by ELISA. Immunophenotype of subpopulations of peripheral blood cells was acquired by multiparametric fluorescence flow cytometry. Results. Blood parameters comparison in 14 hospitalized severe COVID-19 patients showed that WBC count increased on day 7 and steadily decreased by day 28, while the percentage of neutrophils decreased gradually from the time of admission to full-recovery state. The percentage and count of lymphocytes regularly increased. The percentage of monocytes had a trend to rising but not statistically significant. The red blood cells count, ESR, and platelet count were not altered during COVID-19 progression. On initial admission, 35.7 % of COVID-19 patients had leucopenia, while 14.3 % of patients had leukocytosis on day 7. Lymphopenia occurred in 76.9 % of patients on day 0 and was not present on day 28. Changes in CRP levels were statistically significant over the duration of COVID-19 progression and recovery (p=0.003;n=15). The maximum CRP value was at day 0 but reached a normal range on day 28. The Il-6 level did not change significantly over 28 days of observation demonstrating a steady twice higher level in COVID-19 patients compared to healthy donors (p=0.934;n=8). The population of CD45+ cells was significantly lower in COVID-19 patients than in the healthy donors group (p=0.009;n=12). Despite it grew gradually from day 0 to 28, it did not reach the normal value at full-recovery state. The population of CD3+ cells was higher than the normal ranges at the first assessment, then dropped on day 7 but return to elevated levels on days 14 and 28 (p=0.008;n=12). Changes in the CD19+ cells count were significantly lower than those of the healthy volunteers during the period of observations (p=0.007;n=12). There were decreases in CD16+CD56+ cells counts over each time of assessment compared to healthy donors, but not statistically significant. Conclusion. The understanding of the dynamic changes of lymphocyte populations, cytokines production in COVID-19 patients will provide an in-depth knowledge of the COVID-19 pneumonia progression.

Detection of anxiety and depression through mental health screening questionnaires in cystic fibrosis patients and their families during the COVID-19 pandemic

Justification: CF patients and their caregivers have a high prevalence of depression (D) and anxiety (A) compared to the general population. Due to the strict confinement during the months of March to May, we evaluated the mental health (MH) of our patients and their caregivers. Also, we evaluated clinical and demographic variables to determine their influence (age, sex, screening diagnosis, F508del homozygous, FEV1, asthma, P. aeruginosa infection, pancreatic insufficiency, BMI, CFRD, modulator treatment, number of consultations, SARS-Cov-2 PCR number, psychiatric background, marital status, educational level and occupation). Methodology: Patients with CF over 12 years-old and caregivers of children with CF from 0 to 18 years-old performed an online MH screening using two validated questionnaires: PHQ9 and GAD7. Results: 96 people participated in the study: 7.3% (n7) adolescents, 19.8% (n19) adult patients, 43.7% (n42) mothers and 29.2% (n28) fathers of CF patients. Of them, 57.3% (n55) had pathological results in the D surveys and 50% (n48) in the A surveys. Women, among patients and caregivers, had higher scores than men (D: p 0.013;A: p 0.042). Furthermore, 44.8% (n43) had both disorders. The 76% (n33) of the children and adolescents had at least one parent with symptoms of D or A. There was no correlation between the score of the adolescents and their parents (D: p 0.66;A: p 1.00). Only asthma had a negative influence on MH in adult patients (D: p 0.016;A: p 0.018). No statistically significant differences were observed in other variables. [Table presented] Conclusions: During confinement, we found elevated D and A values in CF patients and their caregivers. The group with the highest prevalence was adult patients, followed by mothers of children with CF. The scores for A and D were higher in women, and adult CF patients with asthma. Adolescents did not have relevant alterations, regardless of their parents’ outcomes.

Discourse analysis of physicians on Twitter about the validity of possible treatments for COVID-19

Introduction: Twitter is a platform that prioritizes the immediacy of communication. However, tweets in scientific areas rarely reach a wide audience. Objective: To examine discursive strategies used by Peruvian doctors with an active Twitter account on the validity of possible treatments for COVID-19. Methodology: Critical discourse analysis, using Fairclough's three-dimensional model with the help of notions of ethos. Results: Two areas were found where the medical-scientific discursive ethos is expressed: the construction as individual specialists in health and the approach given to the aspects of the medical-scientific ethos (the method, the evidence and the pseudo-scientific). Conclusions: The language used in the tweets is impersonal and neutral. The positioning of individuals as health specialists is done through a thematic opinion. A discursive ethos that reinforces the existing pre-discursive ethos through discursive strategies such as denomination and intertextuality is the one to develop this positioning.

Covid-19 and latin american Dentistry for patients with special needs

The Latin American region has become the most affected in the world by the COVID-19 pandemic. And people with special needs, a population already vulnerable, are suffering a significant impact from the current crisis. Since these people cannot stop being protected and cared for, a group of professors from 10 Latin American countries met to analyze the situation of dentistry for patients with special needs in the region. In all countries, it was evidenced that confinement and movement restrictions are interrupting access to essential goods and services for them. In dentistry, the general provision is to postpone routine procedures, unless they are clinically urgent or emergency;adopt strict personal protection measures and avoid or minimize interventions that may produce aerosols. Remote dentistry care, teledentistry, is considered a fundamental tool at this time, since it allows evaluating the need for face-to-face care and offering support, information and security to patients and families. The pandemic has shown us all that drive Health Promotion is the true path, and that we should not wait for conditions that affect the quality of life to come up.

Neuroleptic malignant syndrome in a COVID-19 patient. (Special Issue: Immunopsychiatry of COVID-19 pandemic.)

This paper reports the first two cases of Coronavirus Disease 2019 (COVID-19) who were receiving intensive care including favipiravir, and were clinically diagnosed with neuroleptic malignant syndrome (NMS) to focus attention on NMS in COVID-19 management. Case 1: A 46-year-old-man with acute respiratory distress syndrome (ARDS) caused by COVID-19 infection was being administered favipiravir. Fentanyl, propofol, and rocuronium were also given. On day 3, midazolam administration was initiated for deep sedation. On day 5, his high body temperature increased to 41.2 degrees C, creatine kinase level elevated, and he developed tachycardia, tachypnea, altered consciousness, and diaphoresis. NMS was suspected, and supportive therapy was initiated. High-grade fever persisted for 4 days and subsided on day 9. Case 2: A 44-year-old-man with ARDS caused by COVID-19 infection was being treated with favipiravir. On day 5, risperidone was started for delirium. On day 7, his body temperature suddenly increased to 40.8 degrees C, his CK level elevated, and he developed tachycardia, tachypnea, altered consciousness, and diaphoresis. NMS diagnosis was confirmed, and both, favipiravir and risperidone were discontinued on day 8. On the same day, his CK levels decreased, and his body temperature normalized on day 9. Patients with COVID-19 infection frequently require deep sedation and develop delirium;therefore, more attention should be paid to the development of NMS in patients who are being administered such causative agents. The mechanism underlying the occurrence of NMS in COVID-19 patients treated with favipiravir remains unknown. Therefore, careful consideration of NMS development is necessary in the management of COVID-19 patients.