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To date, the severe acute respiratory syndrome coronavirus 2 that causes the disease Coronavirus 2019, has infected 601 million people, claiming the lives of 6.4 million people worldwide. Of the patients who survive, 60% suffer from inflammatory problems leading to post-acute sequelae of COVID-19 (PASC). Inflammation in these patients is marked by an increase in pro-inflammatory cytokines which ultimately damage the body's organs, contributing to PASC. Understanding the main mechanism by which this cytokine storm occurs is of utmost importance in order to develop therapeutic strategies for counteracting inflammation in people suffering from COVID-19 and PASC. This project seeks to find out if an innate anti-inflammatory mechanism, the cholinergic anti-inflammatory response (CAR), works properly in patients suffering from COVID-19 and PASC by interrogating its functioning in its cellular substrate, macrophages.We hypothesized that disruption of the CAR in primary human monocytederived macrophages (MDMs) exposed to the SARS-CoV-2 spike protein trimer contributes to the chronic inflammation/ cytokine storm exhibited in these patients. To this end, we exposed MDMs to the SARS-CoV-2 spike protein in order to assess levels of the anti-inflammatory alpha-7 nicotinic acetylcholine receptor (alpha7-nAChR) by means of confocal imaging. Our results demonstrate a statistically significant reduction (P <= 0.01) of alpha7-nAChR expression in MDMs, in a time-dependent manner, after the addition of SARS-CoV-2 spike protein concentrations (30 nM and 100 nM), at different time points. Interestingly, when the receptor employed by the virus to infect, Angiotensin-converting enzyme 2 (ACE-2), was blocked, we detected a significant reduction in the levels of alpha7- nAChRs (P <= 0.001). Collectively, our results support the hypothesis of this work given that the SARS-CoV-2 spike protein is capable of compromising the functioning of the CAR by reducing the levels of alpha7-nAChRs available in macrophages to suppress inflammation. These results could position the alpha7- nAChR as a key target for the development of novel anti-inflammatory therapeutic strategies to counteract the inflammatory problem found in patients suffering from COVID-19 and PASC. We would like to acknowledge Dr. Negin Martin & Dr. Jerrel Yakel, for providing the Purified Spike Protein expressed by SARS-CoV-2 and Pseudotyped Virions in this collaborative study. Also, these experiments are being supported by the University of Puerto Rico - Rio Piedras NIH-RISE program. RISE Grant Number: 5R25GM061151-20.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.
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The digital transformation has become the fundamental axis to seek leadership in the market, organizations innovate production processes, but also in the provision of services always seeking to generate positive experiences, faced with this reality, Higher Education Institutions (HEIs) are also included. Universities adapt their management processes, not only in education, but also in applying new communication channels in the provision of services to students, who seek to streamline the relationship with their institution, optimizing resources and response times. It is the responsibility of the directors of HEIs, through their strategies, to move towards a digital culture in which the entire educational community can interact, leaving aside traditional structures applied in management towards students and the general public. The digital transformation in educational organizations is possible and necessary to begin as soon as possible and it will be viable if the teams that have to implement it know in detail the vision and strategy of the university, they know clearly where they want to go and what they want attain [1]. The main objective of this research is to determine the process of digital transformation in which the Universidad Tecnica Particular de Loja (UTPL) is working, the changes obtained as a result of the adaptation of new attention and communication channels in the provision of academic-administrative services, mainly towards his students. The processed data correspond to the collection of information on the use of communication channels used by UTPL students and how the issue of the COVID 19 pandemic influenced the repowering of these relationship media, ratifying the student as the center of its operation.
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SESSION TITLE: Pathologies of the Post-COVID-19 World SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: COVID-19 Associated Pulmonary Aspergillosis (CAPA) is a subset of invasive pulmonary aspergillosis occurring in patients actively infected with or recovering from COVID-19. It has mostly been described in immunocompromised or severely ill patients requiring invasive mechanical ventilation[1-6]. The authors report a case of CAPA infection in an ambulatory and immunocompetent patient with prior lung resection. CASE PRESENTATION: A 20-year-old male presented to a Comprehensive Cancer Center for fever and hemoptysis. He carried a diagnosis of metastatic germ cell tumor to his lungs, status post left upper-lobe wedge resection. He had completed bleomycin, etoposide, and cisplatin (BEP) chemotherapy one year earlier. He was recently diagnosed with COVID-19 one month prior to admission and treated as an outpatient with monoclonal antibodies. He reported ongoing cough productive of clear sputum since his diagnosis, which had worsened over the previous two days and was now blood-tinged. He had been afebrile for weeks before noting new fevers over the same period. Physical examination was notable for fever to 38.6°C and lungs clear to auscultation. His labs were significant for a WBC of 14.5 K/mcl (82.5% neutrophils), Cr 2.1 mg/dL (baseline 1.5 mg/dL), and normal platelets and coagulation studies. Serum Aspergillus galactomannan was normal. Repeat SARS-CoV-2 PCR was negative. Chest x-ray was unchanged. V/Q scan showed no evidence of pulmonary embolism. Non-contrast CT chest performed on hospital day #4 revealed a partial opacification and increased wall thickness of patient's largest left upper lobe surgical cavitation (see Image 1). A bronchoscopy was performed day #6, with bronchoalveolar lavage (BAL) galactomannan >5.56 (normal <0.5)7;fungal culture was significant for septate hyphae. He was started on voriconazole with improvement in his symptoms and discharged day #9. DISCUSSION: Immunocompromised patients with prolonged neutropenia, solid-organ or stem cell transplants, and patients with advanced AIDS are at highest risk of contracting PA[8-9]. ARDS secondary to viral pneumonia is also a common precipitant in immunocompetent patients[1-6,10,11]. The exact mechanism of this association remains unknown, but it is postulated to occur due to multiple factors, including host immune dysregulation[1,2], widespread exposure to corticosteroids[1,2], concomitant lung disease[1], and viral-induced lymphopenia[2]. We report a case of an immunocompetent patient with prior lung resection recovering from COVID-19 who experienced a secondary worsening of symptoms ultimately found to have CAPA to further highlight the link between these conditions. CONCLUSIONS: While many of CAPA case reports describe patients with typical risk profiles for CAPA, this case suggests that clinicians should consider structural lung disease alone in an otherwise immunocompetent, ambulatory individual to be a potential risk factor. Reference #1: See Image 2 for full list of references. DISCLOSURES: No relevant relationships by Raphael Rabinowitz No relevant relationships by Matthew Velez
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This study investigated the public schoolteachers’ level of awareness of the Magna Carta for Public School Teachers (RA 4670). An online survey was administered to public schoolteachers from three congressional districts and data were treated using appropriate statistical tools. The results revealed the respondents’ high awareness on the observance of due process at each stage of any disciplinary procedure, gradual salary progression every 3 years and required information was given in case of transfer. However, they were less aware of the permanency status of non-eligible teachers after rendering 10 years of service with no probationary period for eligible teachers. Also, there was a significant difference between teachers from districts 2 and 3, with the latter having a higher level of awareness. Therefore, this study recommends intensified information dissemination of the Magna Carta for Teachers, and further study may examine the relationship between teachers’ experience and awareness level of the said law. © 2022 Birlesik Dunya Yenilik Arastirma ve Yayincilik Merkezi. All rights reserved.
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The digital transformation has become the fundamental axis to seek leadership in the market, organizations innovate production processes, but also in the provision of services always seeking to generate positive experiences, faced with this reality, Higher Education Institutions (HEIs) are also included. Universities adapt their management processes, not only in education, but also in applying new communication channels in the provision of services to students, who seek to streamline the relationship with their institution, optimizing resources and response times. It is the responsibility of the directors of HEIs, through their strategies, to move towards a digital culture in which the entire educational community can interact, leaving aside traditional structures applied in management towards students and the general public. The digital transformation in educational organizations is possible and necessary to begin as soon as possible and it will be viable if the teams that have to implement it know in detail the vision and strategy of the university, they know clearly where they want to go and what they want attain [1]. The main objective of this research is to determine the process of digital transformation in which the Universidad Técnica Particular de Loja (UTPL) is working, the changes obtained as a result of the adaptation of new attention and communication channels in the provision of academic-administrative services, mainly towards his students. The processed data correspond to the collection of information on the use of communication channels used by UTPL students and how the issue of the COVID 19 pandemic influenced the repowering of these relationship media, ratifying the student as the center of its operation. © 2022 IEEE Computer Society. All rights reserved.
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Introduction. Childhood obesity is a major worldwide public health problem. To face this epidemic, society requires strategies developed from the structures and possibilities of the community local context and from a holistic approach. Community participation in the development of strategies is necessary to promote a healthy lifestyle. Objective. Select child promoters through online tools during COVID-19 pandemic using a participatory approach. Methods.. Puppet theater was used as a tool to select health promoters using a Community Based Participatory Research (CBPR) methodology;five acts regarding the characteristics of a health promoter (Sympathy, Empathy, Solidarity, Responsibility) were presented to children from four elementary schools in Hermosillo, Sonora, Mexico. Due to the COVID-19 pandemic lock down and the work-at-home modality implemented since March 2020 in Mexico, the strategy was developed using on-line platforms. Results. Through the CBPR practice, the classmates of four schools selected 79 students whom they considered met the characteristics to be a health promoter and then carry out a health promotion program aimed at the entire school community in a later study phase. Conclusion: The election participation process was adequately developed through online communication and CBPR principles, using the puppet theater tool.
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Priority setting during public health emergencies presents an enormous challenge for federal and state decision makers in the U.S. Objectives We describe the degree to which U.S. priority setting adheres to established quality indicators and explore relationships between such indicators and states' demographic characteristics. Methods Data includes the U.S. COVID-19 preparedness and response plan of January 2021 and individual state plans. Purposive sampling of 22 states from multiple geographic regions considered total population,% rural residents, income per capita, health ranking, and political leanings. State plans were sought online and using multiple contacts with state health and emergency preparedness departments. We analyzed plans using a tool based on an established framework of quality indicators to evaluate priority setting, for example principles and criteria, stakeholder and public participation, publicity and accountability. Results The national plan included 7 of 20 quality parameters, including attention to at-risk populations, a comprehensive list of resources and interventions to which priority setting would apply, publicity, and the use of (and efforts to improve) evidence for priority setting decisions. The US plan describes the importance of 'engag[ing] the American people' and various stakeholders to inform the federal response. Enforcement, accountability, incentives, and assessment of impact were not identified in the plan. We obtained pandemic plans from 4 states and documents from 6 states that, while not explicitly labelled as pandemic plans, include priority setting. Analysis is in process;we expect to present results for 4-10 states. Discussion The US plan's consideration of various scarce resources, public engagement, and equity concerns recognizes the disproportionate impact of COVID-19 among racial and ethnic minorities and low-income communities. However, its lack of accountability and assessment of impact on outcomes may hinder achievement of goals. Difficulty finding and obtaining state plans suggests a lack of publicity and transparency.
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Background The importance of stakeholder involvement in priority setting has been recognized in theoretical and empirical literature;however, there is a paucity of evidence reporting on stakeholder involvement in planning the response to public health emergencies. The COVID-19 pandemic provides an opportunity to explore how stakeholders are involved, and which groups are most engaged in these processes. Methods This study is part of a global documentary analysis of COVID-19 national response plans. We assessed the degree to which pandemic plans from a sample of 86 countries adhered to twenty quality indicators of effective priority setting included in the Kapiriri & Martin's framework. One of these is stakeholder involvement, viewed to enhance the legitimacy and acceptability of policy decisions by incorporating the interests of affected parties, and to enhance fairness through the inclusion of a range of values. We extracted information about individuals and institutions involved in the development of the plans, and any explanation of their level of involvement or contribution. Results Overall, 68 countries reported stakeholder involvement in the development of COVID-19 response plans. Most of these plans were led by the ministries of health in each country. Eighteen plans briefly described the engagement of representatives from different health-related government organizations, forty-five countries mentioned the involvement of stakeholders from sectors other than health (e.g., transportation, finance, trading, international affairs);and seven countries reported detailed information about approaches used to involve stakeholders, as well as different stakeholder groups engaged from academia, medical organizations, religious institutions, or citizen groups. Discussion In all reviewed plans, stakeholders were dominated by national government and expert representatives from the health sector. Direct involvement of citizens, community or patient groups was recorded in only a few plans. This low level of public participation may be related to the urgency with which plans were developed.
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Background The COVID-19 pandemic has significantly disrupted health systems in the Eastern Mediterranean Region (WHO-EMRO), where over half of the countries are affected by armed conflict. Active humanitarian and refugee crises have led to mass population displacement and increased health system fragility. This has exacerbated pre-existing resource gaps and increased competition for meager resources. With large proportions of vulnerable populations - refugees, migrants, and internally displaced people (IDPs) - their explicit consideration in planning documents is critical if equitable priority setting is to be realized during the pandemic. We examine what and how priority setting (PS) was included in national COVID-19 pandemic plans within the region. Methods An analysis of COVID-19 pandemic response and preparedness planning documents from a sample of twelve purposively selected countries in WHO-EMRO. We assessed the degree to which documented PS processes adhere to twenty established quality indicators of effective PS from Kapiriri & Martin's framework. Results While all reviewed plans addressed some aspect of PS, none included all quality parameters. Yemen's plan included the most quality parameters (12), while Egypt's addressed the least (4). Publicity of priorities was common to all plans. The next mostly commonly identified parameter was use of evidence to guide planning and PS. When considering equity as a PS criterion, despite the high concentration of refugees, migrant, and IDPs in the region, only a quarter of the plans prioritized these populations. Discussion When setting priorities in health emergencies, context is paramount. In areas experiencing conflict and crisis, PS can be an undemocratic and challenging process. Health system fragmentation is key contributor to COVID-19 inequities experienced across the EMRO region. Limited prioritization of vulnerable groups like refugees, migrant, and IDPs in planning documents, will have long-term health implications and exacerbate the disproportionate burden of COVID illness and death for these groups.
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Objective: We aimed to assess whether SARS-CoV2 vaccines have any positive or negative impact on motor symptoms in PD patients. Background: Studies focusing on the relationship between SARSCoV- 2, COVID-19 and PD have provided conflicting results (1). Recently, few cases of severe dyskinesia after receiving BNT162b2 mRNA vaccine have been reported but there is no data about impact of vaccines on motor symptoms in larger series of PD patients (2). Methods: We reviewed the charts of the last two months of consecutive PD patients who were attended monthly by telemedicine during the pandemic and who had received one or two doses of any of the SARSCoV- 2 vaccines available in Peru (BNT162b2, Pfizer/BioNTech and BBIBP-CorV, Sinopharm). We specifically searched for any reported variation on motor symptoms including dyskinesia during a period of at least three days after any of each dose. Results: One hundred eighty-one PD patients met inclusion criteria. 107 males and 74 females were included. Mean age was 65 years old (range 31-99). 178 patients received two doses of SARSCoV2 vaccine (177 Pfizer/BioNTech and 1 Sinopharm respectively) and three patients received only one dose of Pfizer/BioNTech vaccine. Eleven patients (6%) had COVID19 infection during the pandemic. The effect of the infection on parkinsonian symptoms was not evaluated in this report. Only two patients (1.1%) reported some degree of exacerbation following one of the dose of the vaccine. First one presented with increased rigidity and gait impairment soon after the first dose and the second case presented with increased resting tremor that lasted for two weeks also after the first dose. In both cases exacerbation improved spontaneously. Conclusion: The approved mRNA-based vaccines and viral vector vaccines are not expected to interact with the neurodegenerative process nor modify motor symptoms in PD. SARS-CoV-2 vaccines are not known neither to interfere with the current therapies for PD. Some patients have developed exacerbation of motor symptoms or severe dyskinesia after vaccination and the reasons remain unclear but they might be explained by triggering a systemic inflammatory response, by stress or excessive anxiety or due to modification of habitual medication response. These very low incidence should not discourage patients to receive vaccines and we recommend COVID-19 vaccination with approved vaccines for persons with PD, unless there is a specific contraindication.
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Purpose of Study The majority of documented SARS-CoV2 infections in children have been mild illnesses. The highest frequency of infection is documented in children between the ages of 5 -17 years;with the incidence of SARS-CoV2 being the highest in adolescents aged 12-17 years. Severe respiratory complications and a multi-system inflammatory syndrome (MIS-C) have been documented in pediatrics. There is very limited information about pediatric hematology and oncology patients in the United States, actively undergoing therapy, and how SARS-CoV2 affects them. Louisiana was an early 'hotspot' for SARS-CoV2 with its first documented infection on March 9, 2020. We present our institutional experience with SARS-CoV2 and pediatric hematology-oncology patients. Methods Used A retrospective chart review was performed on all pediatric hematology-oncology patients who were actively being treated at Children's Hospital of New Orleans between March 9, 2020, through December 15, 2020. Any patient who had a positive SARS-CoV2 test was included in the chart review. Information including demographics, signs, and symptoms at the time of testing, hospitalization, medications, diagnosis, and treatment was obtained. The institutional review board at Louisiana State University Health Sciences Center and Children's Hospital of New Orleans approved this study. Summary of Results Between March 9, 2020 and December 15, 2020, 15,404 patients were tested for SARS-CoV2 at Children's Hospital of New Orleans;628 children tested positive. Ten of those children had a pediatric hematological or oncological diagnosis. The mean age of the pediatric hematology- oncology patients was 7.9 years, and 80% were female. Ten percent of the patients identified as Hispanic. Forty percent were African American. Of the 10, four children (40%) had a diagnosis of acute lymphoblastic leukemia, and all were actively undergoing chemotherapy. One of the ten total children had undergone a bone marrow transplant. Five (50%) were hospitalized;2 (20%) with severe infections requiring PICU admission and 3 (30%) patients were treated for MIS-C with SARS-CoV2 specific therapy including Remdesivir, steroids, and Tocilizumab. One of our patients died from SARSCoV2 related complications. Conclusions Pediatric hematology-oncology patients are a heterogeneous group of patients, and little was known about how SARS-CoV2 would affect these patients. Of the 15,404 patients tested for SARS-CoV2 at CHNOLA, there were 628 that tested positive between March 9, 2020, and December 15, 2020. 1.6% of those had an oncology or hematology diagnosis. Most of our pediatric hematology oncology patients did not require hospitalization and did not require treatment. There was one patient who died of SARS-CoV2 related complications.
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Introduction: Patients with coronavirus disease 2019 (COVID-19) have an increased risk for venous thromboembolic events. Thrombotic events contribute to the morbidity and mortality associated with COVID-19 infection, and have prompted investigation into strategies for mitigating thrombosis risk in patients hospitalized with COVID-19 infection. Our team reviewed the charts of patients hospitalized with COVID-19 pneumonia at a tertiary hospital in metropolitan Phoenix Arizona between 2020-2021, to assess frequency and efficacy of utilizing a VTE prophylaxis algorithm designed to prevent thrombosis in patients infected with COVID-19. Methods: A total of 846 patients were retrospectively evaluated to determine if they were treated with guideline-appropriate anticoagulation while hospitalized with COVID-19, as well as if they developed venous or arterial thrombotic events, or major or minor bleeds. 317 patients were excluded for taking therapeutic anticoagulation prior to admission, or for having a COVID-19 diagnosis >7 days after admission. Appropriate anticoagulation was determined by an institutionally designed COVID-19 thromboprophylaxis algorithm, based on platelet count, d-dimer, bleeding risk, and level of medical care required. Regimen options included: no anticoagulation, prophylactic enoxaparin (40 mg SQ daily) or heparin in the setting of kidney dysfunction, weight-based dosing of enoxaparin (40 mg SQ BID if BMI>40), intermediate intensity enoxaparin without thrombus (30 mg BID if BMI<40, or 40 mg BID if BMI>40), and therapeutic anticoagulation (for example enoxaparin 1 mg/kg BID) with thrombus. Demographics: Demographic data and clinical characteristics were collected for 529 patients. Average age was 59 years old, and the majority were men (58.4%). Most patients were White (58.3%), followed by Hispanic (17.8%), or Native American (15.7%). Fewer patients had a normal BMI (21.3%;BMI 18.5 - 24.9) compared to those who were overweight (31.2%;BMI 25-29.9) or obese (43.1% BMI > 30). Other comorbidities included Type 1 or Type 2 diabetes mellitus (N= 172, 32.5%), hypertension (N = 271, 51.2%), and hyperlipidemia (N = 176, 33.3%). Results: A total of 42 patients (8%), were diagnosed with a venous thrombosis during hospitalization. Patients admitted to the ICU were significantly more likely to have a thrombotic event of any type compared to non-ICU patients (21.6% to 5.7%;p < 0.001). Specifically, critically ill patients had higher incidences of deep vein thrombosis (9.5% to 0.7%), pulmonary emboli (8.1% to 4.8%), and superficial thrombi (2.7% to 0.2%). Only 1.1% of patients (6/529) experienced any bleeding, of which 3 were classified as a major bleed. Discussion: Among patients hospitalized at our institution with COVID-19, the majority were anticoagulated appropriately according to the COVID-19 thromboprophylaxis algorithm. Overall incidence of thrombosis in the study population was 8%. A significantly higher percent of critically ill patients had thrombi, supporting reports of correlation between severity of illness and thrombosis risk. The two regimens of anticoagulation least adhered to were weight-based and intermediate-based dosing, likely reflecting a departure from the hospital's thromboprophylaxis regimens prior to COVID-19 pandemic. Further studies are needed to characterize whether identifiable risk factors correlate with the incidence of thrombosis, and whether treatment with lower than recommended doses of anticoagulation, based on the COVID-19 thromboprophylaxis algorithm, were associated with thrombosis. Disclosures: No relevant conflicts of interest to declare.
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The social and economic effects of the COVID-19 pandemic and the measures to contain it in Latin America could lead to a series of long run consequences that could impact the region's achievement of the Sustainable Development Goals (SDG). This article is the result of the collaboration of environmental economists from eight of the region's countries and it discusses the possible pandemic effects on air pollution, deforestation, and other relevant environmental aspects related to the SDG. In addition to reviewing some of the initial effects of the sanitary crisis on the environment, we discuss its potential effects in terms of environmental regulations and public policy interventions. Finally, we discuss a new research agenda with topics derived from the pandemic as well as topics that have recently become more relevant because of it, including its impact on achieving the SDG.