An occurrence of immune-mediated necrotizing myopathy following treatment of polymyositis in a Filipino female: A case report

Background: Necrotizing myopathy has been previously described but was not included in the Peter and Bohan criteria until 2004, when immune-mediated necrotizing myopathy (IMNM) was distinguished from polymyositis (PM) based on immunologic and histopathologic differences. IMNM is currently a well-recognized autoimmune myopathy and represents up to 20% of these cases. Case: A 60-year- old female with biopsy-proven PM achieved sustained clinical remission with Rituximab. Her co-morbid conditions include hypertension, diabetes mellitus, and dyslipidemia. The patient noted a recurrence of gradual progressive, proximal muscle weakness and easy fatigability after receiving her first mRNA Covid-19 vaccine. Four months after onset of symptoms, CK Total was 9600 U/L. Rituximab was administered and muscle weakness and total CK levels (1247 U/L) improved within 10 days. She was prescribed rosuvastatin and fenofibrate for dyslipidemia within 7 days of completing the rituximab course. Two weeks later, proximal muscle weakness recurred. She became wheelchair-bound and experienced dysphonia. MMT score was 2/5 in proximal muscles and total CK total increased to 19,935 U/L. The patient received Methylprednisolone 500 mg IV once a day for 3 days. She had a good response with resolution of dysphonia and improvement of MMT to 4/5 on shoulder abduction and hip flexion on the 6th hospital day. She was discharged on oral methylprednisolone at 1 mg/kg/day. Muscle biopsy was consistent with an immune-mediated necrotizing myopathy, revealing necrotic fibers, intracellular macrophages, fatty infiltrates, irregular staining patterns on NADH stain with no evidence of endomysial inflammation, perifascicular atrophy, ragged red fibers, or rimmed vacuoles. Antibodiy against 3-hydoxy- 3- methylglutarylcoenzymeA reductase (HMGCR) result is pending but the other myositis-specific antibodies are negative.(including anti-SRP). Conclusion(s): IMNM is an autoimmune myopathy associated with anti-HMGCR and anti-SRP antibodies that clinically present similarly to polymyositis. The temporal occurrence of worsening muscle weakness with initiation of statin therapy make statin toxic myopathy or immune mediated necrotizing myopathy as diagnostic considerations. This case emphasizes the need to re-evaluate the etiology of new onset muscle weakness in patients with idiopathic inflammatory myopathy and highlights the role of myositis-specific antibodies and muscle biopsy in confirming the diagnosis.

Autoimmune syndrome induced by adjuvants (asia) in a 71-year- old filipino female after an inactivated virus vaccine: A case report

Background: Autoimmune Syndrome Induced by Adjuvants, or ASIA, suggests certain environmental exposures, including vaccination can cause hyperstimulation of the innate and adaptive immune system leading to production of autoantibodies in a genetically predisposed individual. A diagnosis of exclusion, proposed diagnostic criteria suggested ASIA if specified major and minor criteria are fulfilled. Suspicion for ASIA was raised in our patient due to identified exposure accompanied by typical manifestations not explained by another cause. Case: A 71-year- old Filipino female with controlled hypertension and diabetes, came in due to progressive right eye pain, supraorbital headache, ptosis and limitation of extra-ocular movements for 3 weeks. No blurring of vision, color vision changes, or visual field cuts. She didn't have other systemic features but received 2 doses of inactivated COVID-19 vaccine 1 month (1st) and 1 day (2nd) prior to the symptom onset. The left eye was unremarkable. ESR was elevated (109) with normal CRP. ANA was 1:80 with a speckled pattern. The complements were normal and lupus confirmatory panel was negative. CSF studies showed slightly elevated protein and glucose with no pleiocytosis, IgG level was normal with negative oligoclonal panel and cultures. EMG-NCV showed acute partial incomplete bilateral facial neuropathy. Cranial MRI/MRA showed chronic lacunar infarct in the right corona radiata. The MRI of the orbits showed right optic nerve enhancement with hyperintense nerve sheath compatible with optic neuritis. She underwent pulse IV steroid therapy (Methylprednisolone 1 g) for 3 days and was maintained on oral steroid 1 mg/kg/day. There was minimal improvement of symptoms for which she received intravenous immunoglobulin for 5 days. Her symptoms gradually improved upon discharge. Conclusion(s): Identification of the possible autoimmunity from adjuvants is not to discourage vaccination but rather raise awareness of the need for further studies to screen who might be at risk and to prepare or even develop alternatives, such as vaccines with a different type of adjuvant.

Patient perceptions and satisfaction of telemedicine use in rheumatology during the covid-19 pandemic: A single-center, descriptive study in the Philippines

Background: Telemedicine became the emergent means of providing and continuing medical care due to the COVID 19 pandemic. This study aims to evaluate the knowledge, perception, and satisfaction with the use of telemedicine among patients with rheumatic diseases. An understanding of our patients' experiences can be utilized to provide access to care, improve gaps in delivery of care, and improve healthcare disparities. Method(s): Filipino patients with rheumatic disease who had telehealth visits between June 2020 and August 2021 in St Luke's Medical Center Outpatient Department participated in an online survey. Information on demographics, diagnosis, knowledge and experience on telemedicine, and perspectives on benefits and limitations of telemedicine were collected. Result(s): There were 70 respondents: 52.9% with SLE, 25.7% with RA, 10% with osteoarthritis, 5.7% with psoriatic arthritis, 2.9% with scleroderma. Results showed that 64.3% are familiar with the use of video conference platforms. Facebook messenger was the most used (85.7%). Half of respondents have used telemedicine on their own, while 33% required assistance. The remaining respondents have not used telemedicine due to lack of experience or awareness on how to proceed with consults. The reasons for using telemedicine were restrictions of the pandemic (82.9%), limited access to clinics (31.4%), and disability (1.4%). Most remain satisfied with telemedicine (75.7%), 50% of patients stated that telemedicine was comparable to an in-clinic visit, and 85.7% (N = 60) would recommend its use. Conclusion(s): Filipinos with rheumatic disease are knowledgeable on online platforms and telemedicine, however, it is important to note the digital divide. Patients need assistance and improved awareness on accessing remote care. Providing continuity of healthcare can lead to less complications and better outcomes despite pandemic restrictions. There is an overall favorable satisfaction for care. Half the respondents remain satisfied with telemedicine. Rheumatologists need further studies on benefits and outcomes on providing remote healthcare.

BILATERAL PNEUMOTHORAX, PNEUMOMEDIASTINUM, AND SUBCUTANEOUS EMPHYSEMA: A CASE OF A RARE SYNCHRONOUS TRIAD IN ASTHMA EXACERBATION

SESSION TITLE: Obstructive Lung Disease Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Individual cases of pneumothorax, pneumomediastinum and subcutaneous emphysema have been reported in asthma attacks, but rarely coincide. Pathophysiology is secondary to obstruction in the minor airways leading to air-trapping and barotrauma of distal airways with subsequent alveolar rupture. This case illustrates a case of asthma exacerbation with a synchronous triad of rare complications. CASE PRESENTATION: 65-year-old female with a history of breast cancer, asthma and hypertension presented with shortness of breath, wheezing, and productive cough since four days ago. Vital signs were remarkable for tachypnea and saturation of 91%. Physical examination revealed respiratory distress, and auscultation disclosed diffuse inspiratory and expiratory wheezing. Limited bedside ultrasound showed B-lines compatible for pulmonary edema. Arterial blood gases were compatible with respiratory acidosis and hypoxemia. Laboratories showed leukocytosis, hypotonic hyponatremia, normal brain natriuretic peptide, and negative COVID-19 PCR test. Chest Xray (CXR) demonstrated changes concerning for pneumonia with superimposed pleural effusion. The patient was admitted with the impression of asthma exacerbation versus community acquired pneumonia. Initially, the patient was placed in bi-level positive airway pressure to aid in respiratory discomfort, broad spectrum antibiotic regimen, and diuresis therapy. On follow up, she was found hypoxic with periorbital edema, dyspnea, and subcutaneous emphysema in neck, upper extremities, and thorax for which emergent intubation was performed. CXR and Thoracic CT confirmed pneumomediastinum, large right sided pneumothorax and a moderate left sided pneumothorax requiring tube thoracostomy. At the Intensive Care Unit, treatment included combination therapies with levalbuterol, ipratropium, terbutaline, theophylline, budesonide, IV steroids and magnesium without appropriate response. Mechanical ventilator was set to protective lung parameters to avoid worsening barotrauma. Subsequently, she was paralyzed for 48 hours to aid in synchrony and allow adequate pulmonary gas exchange. Nonetheless, severe bronchoconstriction was persistent along with depressed neurological status. Two months later, the patient passed away. DISCUSSION: We believe our patient developed barotrauma secondary to a cough attack combined with positive airway pressure. Similarities in presentation such as dyspnea, tachycardia, and hypoxia may prove difficult in differentiation. Although each of these pathologies separately can generally be self-limiting depending on size and hemodynamic compromise, the combination can be mortal and clinical suspicion is important in fast diagnosis and treatment. CONCLUSIONS: Our case demonstrates the importance of suspicion of barotrauma in patients with asthma attacks not responding adequately to therapy or developing worsening hypoxia which can be detrimental. Reference #1: Franco, A. I., Arponen, S., Hermoso, F., & García, M. J. (2019). Subcutaneous emphysema, pneumothorax and pneumomediastinum as a complication of an asthma attack. The Indian journal of radiology & imaging, 29(1), 77–80. https://doi.org/10.4103/ijri.IJRI_340_18 Reference #2: Zeynep Karakaya, Şerafettin Demir, Sönmez Serkan Sagay, Olcay Karakaya, Serife Özdinç, "Bilateral Spontaneous Pneumothorax, Pneumomediastinum, and Subcutaneous Emphysema: Rare and Fatal Complications of Asthma", Case Reports in Emergency Medicine, vol. 2012, Article ID 242579, 3 pages, 2012.https://doi.org/10.1155/2012/242579 Reference #3: Subcutaneous Emphysema in Acute Asthma: A Cause for Concern? Patrick D Mitchell, Thomas J King, Donal B O'Shea Respiratory Care Aug 2015, 60 (8) e141-e143;DOI: 10.4187/respcare.03750 DISCLOSURES: No relevant relationships by Juan Adams-Chahin No relevant relationships by Gretchen Marrero No relevant relationships by natalia Mestres No relevant relationships by Are is Morales Malavé No relevant relationships by Carlos Sifre No relevant relationships by Paloma Velasco No relevant relationships by Mark Vergara-Gomez

ERN-EUROBLOODNET EUROPEAN REGISTRY OF PATIENTS AFFECTED BY RED BLOOD CELL DISORDERS AND COVID-19

Background: Patients with red blood cell disorders (RBCD), are likely to be at increased risk of complications from SARS-Co-2 (Coid-19), but eidence in this population is scarce due to its low frequency and heterogeneous distribution. Aims: ERN-EuroBloodNet, the European Reference Network in rare hematological disorders, established a European registry to determine the impact of COVID-19 on RBCD patients and identify risk factors predicting seere outcomes. Methods: The ERN-EuroBloodNet registry was established in March 2020 by VHIR based on Redcap software in accordance with the Regulation (EU) 2016/679 on personal data. The local Research Ethics Committee confirmed that the exceptional case of the pandemic justifies the waier of informed consent. Eligible patients had confirmed RBCD and COVID-19. Data collected included demographics, diagnosis, comorbidities, treatments, and COVID-19 symptoms and management. For analysis of COVID-19 seerity, two groups were established 1) Mild: asymptomatic or mild symptoms without clinical pneumonia and 2) Seere: pneumonia requiring oxygen/respiratory support and/or admission to intensie care unit. Continuous ariables were compared using the Wilcoxon rank-sum test or Kruskall Wallis test, while categorical ariables were analyzed using the Chi-square test or Fisher's Exact test. Releant factors influencing disease or seerity were examined by the logistic regression adjusted for age. Results: As of February 25, 2022, 42 medical centers from 10 EU countries had registered 428 patients: 212 Sickle cell disease (SCD), 186 Thalassemia major and intermedia (THAL). The mean age of SCD was lower (22y) than of THAL (39.4y). Splenectomy and comorbidities were higher in THAL (51.4% and 61,3%) than in SCD (16,3% and 46,8%) (p<0.001, p=0.004). Age and BMI correlated with COVID-19 seerity, as described in the general population (p=0.003, p<0.001). Fig 1 shows age distribution and COVID-19 seerity by disease seerity groups. The mean age for seere COVID-19 was lower in patients with seere SCD (SS/SB0 s SC/SB+: 23y s 67.5y) and THAL (major s intermedia: 43.5 s 51.3y) (p<0.001). Potential risk factors such as eleated ferritin, current chelation or history of splenectomy did not confer additional risk for deeloping seere COVID-19 in any patient group. Only diabetes as a comorbidity correlated with seerity grade in SCD (p=0.01) and hypertension in THAL (p=0.009). While seere COVID-19 infection in SCD was associated with both ACS (p<0.001) and kidney failure requiring treatment (p<0.001), this was not predicted by a history of preious ACS or kidney disease in steady state. Oerall, 14,6% RBC patients needed oxygen/respiratory support, 4% were admitted to ICU with an oerall mortality rate of 1%, much lower than reported in other similar cohorts. Hospital Son Espases, Palma de Mallorca, Spain;54 Clinical Pharmacology Serice, Hospital Uniersitari Vall d'Hebron, Barcelona, Spain;55 Vall d'Hebron Institut de Recerca, Barcelona, Spain;56 Diision of Hematology and Oncology, Department of Internal Medicine, American Uniersity of Beirut Medical Center, Beirut, Lebanon;57 UOC Pediatric Hematology Oncology, Uniersity of Padoa, Padoa, Italy;58 Department of Haematology, Oxford Uniersity Hospitals NHS Foundation Trust, Oxford, United Kingdom;59 Translational Research in Child and Adolescent Cancer, Vall d'Hebron Institut de Recerca, Barcelona, Spain Background: Patients with red blood cell disorders (RBCD), are likely to be at increased risk of complications from SARS-Co-2 (Coid-19), but eidence in this population is scarce due to its low frequency and heterogeneous distribution. Aims: ERN-EuroBloodNet, the European Reference Network in rare hematological disorders, established a European registry to determine the impact of COVID-19 on RBCD patients and identify risk factors predicting seere outcomes. Methods: The ERN-EuroBloodNet registry was established in March 2020 by VHIR based on Redcap software in accordance with the Regulation (EU) 2016/679 on personal data. The local Research Ethics Committee confirm d that the exceptional case of the pandemic justifies the waier of informed consent. Eligible patients had confirmed RBCD and COVID-19. Data collected included demographics, diagnosis, comorbidities, treatments, and COVID-19 symptoms and management. For analysis of COVID-19 seerity, two groups were established 1) Mild: asymptomatic or mild symptoms without clinical pneumonia and 2) Seere: pneumonia requiring oxygen/respiratory support and/or admission to intensie care unit. Continuous ariables were compared using the Wilcoxon rank-sum test or Kruskall Wallis test, while categorical ariables were analyzed using the Chi-square test or Fisher's Exact test. Releant factors influencing disease or seerity were examined by the logistic regression adjusted for age. Results: As of February 25, 2022, 42 medical centers from 10 EU countries had registered 428 patients: 212 Sickle cell disease (SCD), 186 Thalassemia major and intermedia (THAL). The mean age of SCD was lower (22y) than of THAL (39.4y). Splenectomy and comorbidities were higher in THAL (51.4% and 61,3%) than in SCD (16,3% and 46,8%) (p<0.001, p=0.004). Age and BMI correlated with COVID-19 seerity, as described in the general population (p=0.003, p<0.001). Fig 1 shows age distribution and COVID-19 seerity by disease seerity groups. The mean age for seere COVID-19 was lower in patients with seere SCD (SS/SB0 s SC/SB+: 23y s 67.5y) and THAL (major s intermedia: 43.5 s 51.3y) (p<0.001). Potential risk factors such as eleated ferritin, current chelation or history of splenectomy did not confer additional risk for deeloping seere COVID-19 in any patient group. Only diabetes as a comorbidity correlated with seerity grade in SCD (p=0.01) and hypertension in THAL (p=0.009). While seere COVID-19 infection in SCD was associated with both ACS (p<0.001) and kidney failure requiring treatment (p<0.001), this was not predicted by a history of preious ACS or kidney disease in steady state. Oerall, 14,6% RBC patients needed oxygen/respiratory support, 4% were admitted to ICU with an oerall mortality rate of 1%, much lower than reported in other similar cohorts. Summary/Conclusion: Results obtained so far show that seere COVID-19 occurs at younger ages in more aggressie forms of SCD and THAL. Current preentie approaches focus on age oer disease seerity. Our data highlights the risk of seere COVID-19 infection in some young patients, particularly those with SS/SB0 SCD, suggesting that immunization should be considered in this pediatric group as well. Results between similar sized cohorts of RBCD patients ary between each other and those presented here, highlighting the importance of collecting all of these small cohorts together to ensure adequate statistical power so that definitie risk factors can be reliably identified and used to guide management of patients with these rare disorders in the light of the ongoing pandemic. (Figure Presented).

ERN-EuroBloodNet European Registry of Patients Affected by Red Blood Cell Disorders and COVID-19

[Formula presented] PV, NR and MMP contributed equally Introduction Patients with red blood cell disorders (RBCD), chronic life threating multisystemic disorders in their severe forms, are likely to be at increased risk of complications from SARS-Cov-2 (Covid-19), but evidence in this population is scarce due to its low frequency and heterogeneous distribution. ERN-EuroBloodNet, the European Reference Network in rare hematological disorders, established a European registry to determine the impact of COVID-19 on RBCD patients and identify risk factors predicting severe outcomes. Methods The ERN-EuroBloodNet registry was established in March 2020 by Vall d'Hebron Research Institute based on REDcap software in accordance with the Regulation (EU) 2016/679 on personal data. The local Research Ethics Committee confirmed that the exceptional case of the pandemic justifies the waiver of informed consent. The ERN-EuroBloodNet registry on RBCD and COVID-19 is endorsed by the European Hematology Association (EHA). Eligible patients had confirmed RBCD and COVID-19. Data collected included demographics, diagnosis, comorbidities, treatments, and COVID-19 (severity grade, clinical manifestations, acute events, treatments, hospitalization, intensive care unit, death). For analysis of COVID-19 severity, two groups were established 1) Mild: asymptomatic or mild symptoms without clinical pneumonia and 2) Severe: pneumonia requiring oxygen/respiratory support and/or admission to intensive care unit. Continuous variables were compared using the Wilcoxon rank-sum test or Kruskall Wallis test, while categorical variables were analyzed using the Chi-square test or Fisher's Exact test. Relevant factors influencing disease or severity were examined by the logistic regression adjusted for age. Results As of June 2021, 42 medical centers from 10 EU countries had registered 373 patients: 191 Sickle cell disease (SCD), 156 Thalassemia major and intermedia (THAL) and 26 other RBCD. 84% of the SCD patients were reported by Spain, Belgium, Italy and The Netherlands and 92% of the THAL patients by Italy and Greece. The mean age of SCD was lower (22.5y) than of THAL (39.6y) with pediatric population accounting for 50.5% in SCD and 9% in THAL (p <0.001). Splenectomy and comorbidities were higher in THAL (51.3% and 65.8%) than in SCD (16% and 48.1%) (p<0.001, p=0.002). Age and BMI correlated with COVID-19 severity, as described in the general population (p=0.002, p<0.001). Fig 1 shows age distribution and COVID-19 severity by disease severity groups. The mean age for severe COVID-19 was lower in patients with severe SCD (SS/SB0 vs SC/SB+: 23.3y vs 67.5y) and THAL (major vs intermedia: 43.5 vs 51.3y) (p<0.001). Potential risk factors such as elevated ferritin, current chelation or history of splenectomy did not confer additional risk for developing severe COVID-19 in any patient group. Only diabetes as a comorbidity correlated with severity grade in SCD (p=0.011) and hypertension in THAL (p=0.014). While severe COVID-19 infection in SCD was associated with both ACS (p<0.001) and kidney failure requiring treatment (p=0.001), this was not predicted by a history of previous ACS or kidney disease in steady state. Overall, 14.8% RBC patients needed oxygen/respiratory support, 4.4% were admitted to ICU with an overall mortality rate of 0.8% (no deaths were registered in pediatric age), much lower than reported in other similar cohorts. Discussion Results obtained so far show that severe COVID-19 occurs at younger ages in more aggressive forms of SCD and THAL. Current preventive approaches (shielding, vaccinations) focus on age over disease severity. Our data highlights the risk of severe COVID-19 infection in some young patients, particularly those with SS/SB0 SCD, suggesting that immunization should be considered in this pediatric group as well. Results between similar sized cohorts of RBCD patients vary between each other and those presented here, highlighting the importance of collecting all of these small cohorts together to ensure adequate statistical p wer so that definitive risk factors (eg. age, genotype, comorbidities) can be reliably identified and used to guide management of patients with these rare disorders in the light of the ongoing pandemic. [Formula presented] Disclosures: Longo: Bristol Myers Squibb: Honoraria;BlueBird Bio: Honoraria. Bardón-Cancho: Novartis Oncology Spain: Research Funding. Flevari: PROTAGONIST COMPANY: Research Funding;ADDMEDICA: Consultancy, Research Funding;BMS: Research Funding;IMARA COMPANY: Research Funding;NOVARTIS COMPANY: Research Funding. Voskaridou: BMS: Consultancy, Research Funding;IMARA: Research Funding;NOVARTIS: Research Funding;ADDMEDICA: Consultancy, Research Funding;GENESIS: Consultancy, Research Funding;PROTAGONIST: Research Funding. Biemond: GBT: Honoraria, Research Funding, Speakers Bureau;Novartis: Honoraria, Research Funding, Speakers Bureau;Novo Nordisk: Honoraria;Celgene: Honoraria;Sanquin: Research Funding. Nur: Celgene: Speakers Bureau;Roche: Speakers Bureau;Novartis: Research Funding, Speakers Bureau. Beneitez-Pastor: Agios: Honoraria;Alexion: Honoraria;Novartis: Honoraria;Forma Therapeutics: Honoraria. Pepe: Chiesi Farmaceutici S.p.A: Other: no profit support;Bayer S.p.A.: Other: no profit support. de Montalembert: Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees;Addmedica: Membership on an entity's Board of Directors or advisory committees;BlueBirdBio: Membership on an entity's Board of Directors or advisory committees;Vertex: Membership on an entity's Board of Directors or advisory committees. Glenthøj: Agios: Consultancy;Novo Nordisk: Honoraria;Novartis: Consultancy;Alexion: Research Funding;Bluebird Bio: Consultancy;Bristol Myers Squibb: Consultancy;Saniona: Research Funding;Sanofi: Research Funding. Benghiat: Novartis: Consultancy;BMS: Consultancy. Labarque: Novartis: Consultancy;Bayer: Consultancy;Sobi: Consultancy;NovoNordisk: Consultancy;Octapharma: Consultancy. Diamantidis: Genesis Pharma: Honoraria;Uni-Pharma: Honoraria;Bristol Myers Squibb: Consultancy;IONIS Pharmaceuticals: Research Funding;NOVARTIS, Genesis Pharma SA: Research Funding. Kerkhoffs: Sanofi: Research Funding;Terumo BCT: Research Funding. Iolascon: Celgene: Other: Advisory Board;Bluebird Bio: Other: Advisory Board. Taher: Vifor Pharma: Consultancy, Research Funding;Agios Pharmaceuticals: Consultancy;Ionis Pharmaceuticals: Consultancy, Research Funding;Bristol Myers Squibb: Consultancy, Research Funding;Novartis: Consultancy, Research Funding. Colombatti: Novartis: Membership on an entity's Board of Directors or advisory committees;Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding;Novonordisk: Membership on an entity's Board of Directors or advisory committees;Forma Therapeutics: Membership on an entity's Board of Directors or advisory committees;Addmedica: Membership on an entity's Board of Directors or advisory committees;BlueBirdBio: Research Funding. Mañú Pereira: Novartis: Research Funding;Agios Pharmaceuticals: Research Funding.

Results of the COVID-19 survey on students, teachers and users of the ADEMA University School

Introduction: SARS-Cov-2 is the coronavirus responsible for the pandemic that has ravaged the world since the end of 2019, having its origin in Wuhan. The clinical picture includes a multitude of symptoms although the most frequent are fever, dry cough and shortness of breath, and has as main complications pneumonia, acute respiratory syndrome or sepsis. Material and methods: A survey was made of 1296 users (teachers, students and patients of the dental clinic) of the ADEMA University School who were asked about symptoms compatible with COVID in the previous two weeks, about situations of risk of contagion and about knowledge of the protocol drawn up by the educational center. Results: More than 99% of respondents had not had symptoms compatible with SARS-CoV-2 infection in the two weeks prior to completing the survey. A similar percentage have complied with the rules established by the health authorities regarding the use of masks and have not been in contact or living with persons suspected or diagnosed with COVID. Less than 1% are awaiting diagnostic test results and 40.9% of respondents confirm that they have read the protocol developed by ADEMA for the pandemic. Conclusions: The number of ADEMA University School users who have presented symptoms or have been exposed to risk situations is very low, less than 1%, while the percentage of those who confirm having read the protocols elaborated for this pandemic is very low, barely 40%.

The collective disorientation of the covid-19 crisis

One of the chief features of this global crisis is that we find ourselves in a shifting landscape. The resulting disorientation extends beyond health research and into many domains of our individual and collective lives. We suffer from political disorientation (the need for a radical shift in economic thinking), from social disorientation (the rearrangement of social dynamics based on distancing measures), and from temporal disorientation (the warping of our sense of time during lockdown), to name but a few. This generalised state of disorientation has substantial effects on wellbeing and decision making. In this paper, we review the multiple dimensions of disorientation of the COVID-19 crisis and use state-of-the art research on disorientation to gain insight into the social, psychological and political dynamics of the current pandemic. Just like standard, spatial cases of disorientation, the non-spatial forms of disorientation prevalent in the current crisis consist in the mismatch between our frames of reference and our immediate experience, and they result in anxiety, helplessness and isolation, but also in the possibility of re-orienting. The current crisis provides a unique environment in which to study non-spatial forms of disorientation. In turn, existing knowledge about spatial disorientation can shed light on the shifting landscape of the COVID-19 pandemic. © Bristol University Press 2021.

Prevalence of COVID-19 in oral health professionals of the Balearic Islands in the period of confinement and start of the deescalated

The aim of the present study is to perform an anonymous, quantitative and descriptive analysis about the prevalence of COVID-19 infections in oral care professionals in the Autonomous Community of the Balearic Islands, during the confinement of the copulation and the beginning of the deescalated. For this, an online self-filling survey was used. It was sento to the oral care professionals working in the Balearic Islands. Dentists and stomatologists (DS), superior technicians in oral hygiene (OH) and superior techniclans in dental prosthesis (DP). The oral care professionals received and answered the survey in the period between June 1st and 30th 2020, using a form served through the Google Forms Gsutt application. 148 professionals responded to the survey, of which 4% reported a positive serology to COVID-19. All positive professionals were from Mallorca and from urban (83,3%) and semi-urban areas (16,6%). Significantly more OH (76%) and DP (88%) did not undergone the COVID test in comparison with DS (49%, p = 0.0008). There was no statistically significant difference between the different professionals regarding the fear of contracting the virus. There was also no statistically significant diference between the type of mask (p=0.6166) used by the professionals. With the results of the present study was possible to find a prevalence of 4% of COVID-19 infection among the oral care professionals of the Balearic Islands who answered the survey.

Survey on the situation of professionals of oral health in the Balearic Islands against COVID-19 in time of confinement population and start of de-escalation

Introduction: The ADEMA-UIB University School of Dentistry, faced with the situation caused by COVID-19, has carried out a survey for dentists and stomatologists, superior technicians in oral hygiene and superior technicians in dental prosthesis of the Balearic Islands, in order to know various important aspects of their work and personal situation in relation to COVID-19, as well as the measures adopted and the functionality of the Dental Clinics and the Dental Prosthesis Laboratories, during the confinement of the population and the start of de-escalation. The aim of the study is to know the changes produced in the oral care of the population during this stage of the pandemic. Material and method: We carried out an online self-filling survey, with free access to the 1,482 professionals involved in oral care of the population of the Balearic Islands. The data has been collected between days 1 and 30 of June 2020, through a form served through the Google Forms Gsuit application. This study is quantitative, descriptive and anonymous. Results: The responses received by the 148 professionals who filled in the form, already reported specific percentage trends. After comparing their sociodemographic aspects, individual protection equipment, infections and operations of dental clinics and prosthetic laboratories, significant differences between them were observed. Conclusions: The surveyed population presented a greater exposure to the risk of contracting the viral infection than in the general population. Around 30% of those surveyed have maintained their usual activity and around 15% have declared that they have closed their center. Furthermore, the most frequent masks used by them were surgical masks and FFP2, although among the higher technicians in dental prosthesis the use of surgical masks was more frequent. Discussion: In reference to the data observed in the surveys carried out at a national level, it is worth highlighting some differences between the results from the Balearic Islands surveys and the national ones. While the Balearic Islands had a percentage of 83% in relation to the participation of the urban environment, the national surveys reported a percentage of 58%. Moreover, the use of waterproof suits resulted in 78,7% in the Balearic Islands compared to 15% at a national level and around 11,5% of the participants had difficulties to obtain PPEs in the Islands compared to 80% at a national level. Finally, the number of tests for the diagnosis of COVID-19 which have been carried out on the surveyed professionals reached 43.9% in the Balearic Islands compared to just 1% of professionals nationwide, which justifies the underdiagnoses of COVID-19 among the country.

An innovative, reusable and sustainable face-seal device to improve protection efficacy of surgical masks against COVID-19

The outbreak of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic has had a direct impact on the global health system, causing an alarming shortage of Personal Protective Equipment (PPE). Recent studies have shown that a significant number of healthcare professionals have been contaminated by the COVID-19 at their workplace due to the lack of appropriate PPE. Consequently, the PEE requirements have changed, making the use of filtering face-piece respirators (FFR) N95 and NK95 (FFP2 or FFP3, respectively) mandatory in place of the surgical masks previously used by healthcare professionals. Applying individualized face-seal devices in surgical masks, such as a thermoplastic resin ring, may significantly avoid inhalation of unfiltered air. Besides reducing leakage around the mask, which could convert surgical masks into PPE dual masks due to the high percentage of face-seal, it would allow a bidirectional protection for both healthcare professionals and patients, thus becoming a medical device. The polylactic acid (corn starch) thermoplastic resin ring is the device proposed here to be used in order to decrease leakage of potentially contaminated air. The use of poly lactic acid is of particular interest due to the fact that is a material appropriate for sanitary use, reusable and biodegradable. Therefore, healthcare professionals and organizations can maintain clinical activity in a cost-efficient manner whilst improving clinical safety.