The PHH-1V HIPRA vaccine: a new tool in the vaccination strategy against COVID-19.

OBJECTIVE: Vaccination against SARS-CoV-2 is essential to mitigate the personal, social and global impact of the coronavirus disease (COVID-19) as we move from a pandemic to an endemic phase. Vaccines are now required that offer broad, long-lasting immunological protection from infection in addition to protection from severe illness and hospitalisation. Here we present a review of the evidence base for a new COVID-19 vaccine, PHH-1V (Bimervax®; HIPRA HUMAN HEALTH S.L.U), and the results of an expert consensus. METHODS: The expert committee consisted of Spanish experts in medicine, family medicine, paediatrics, immunology, microbiology, nursing, and veterinary medicine. Consensus was achieved using a 4-phase process consisting of a face-to-face meeting during which the scientific evidence base was reviewed, an online questionnaire to elicit opinions on the value of PHH-1V, a second face-to-face update meeting to discuss the evolution of the epidemiological situation, vaccine programmes and the scientific evidence for PHH-1V and a final face-to-face meeting at which consensus was achieved. RESULTS: The experts agreed that PHH-1V constitutes a valuable novel vaccine for the development of vaccination programmes aimed towards protecting the population from SARS-CoV-2 infection and disease. Consensus was based on evidence of broad-spectrum efficacy against established and emerging SARS-CoV-2 variants, a potent immunological response, and a good safety profile. The physicochemical properties of the PHH-1V formulation facilitate handling and storage appropriate for global uptake. CONCLUSIONS: The physicochemical properties, formulation, immunogenicity and low reactogenic profile of PHH-1V confirm the appropriateness of this new COVID-19 vaccine.

Idiopathic inflammatory myopathies linked to vaccination against SARS-CoV-2: a systematic review.

The COVID-19 pandemic represents a global health problem, which has been mitigated by the opportune introduction of vaccination programs. Although we already know the benefit that vaccines provide, these are not exempt from adverse events which can be mild to deadly, such as idiopathic inflammatory myopathies, in which a temporal association has not been defined. It is for this reason that we carried out a systematic review of all reported cases of vaccination against COVID-19 and myositis. To identify previously reported cases of idiopathic inflammatory myopathies associated with vaccination against SARS-CoV-2 we registered this protocol on the website of PROSPERO with identification number CRD42022355551. Of the 63 publications identified in MEDLINE and 117 in Scopus, 21 studies were included, reporting 31 cases of patients with vaccination-associated myositis. Most of these cases were women (61.3%); mean age was 52.3 years (range 19-76 years) and mean time of symptom onset post-vaccination was 6.8 days. More than half of the cases were associated with Comirnaty, 11 cases (35.5%) were classified as dermatomyositis, and 9 (29%) as amyopathic dermatomyositis. In 6 (19.3%) patients another probable trigger was identified. Case reports of inflammatory myopathies associated with vaccination have heterogeneous presentations without any specific characteristics: as a consequence, it is not possible to ensure a temporal association between vaccination and the development of inflammatory myopathies. Large epidemiological studies are required to determine the existence of a causal association.

CoViD-19 During the First Pandemic Wave in Mexico Valle and Mexico City: A Spatial Analysis Approach in Small Areas

The first cases of the CoViD-19 disease in Mexico came from abroad in February 2020. Com-munitarian propagation accelerated the infection in the big metropolitan areas of Mexico, such as Valle de México Metropolitan Zone (VMMZ), were located the biggest people concentration in the country. In this study, we evaluate the spatial distribution of the positive cases and deaths in VMMZ at municipality level through a spatial econometric model that include socio demographic and eco-nomic variables, besides we explore the active cases in México City at neighborhood level. We found significant spatial effects, most notably in positive cases, that could help to explain the stage of the disease, in both municipality and neighborhood. The model shed light to observe how the CoViD-19 hits harder at the municipalities more densely populated and where the urbanization pro-cess was deeper, compared with those peripheral, nevertheless, worst living conditions also exhibit a positive relationship, in both positive cases and deaths. © 2023,Revista Portuguesa de Estudos Regionais. All Rights Reserved.

Impact of plasmapheresis on severe COVID-19.

The clinical course of COVID-19 may show severe presentation, potentially involving dynamic cytokine storms and T cell lymphopenia, which are leading causes of death in patients with SARS-CoV-2 infection. Plasma exchange therapy (PLEX) effectively removes pro-inflammatory factors, modulating and restoring innate and adaptive immune responses. This clinical trial aimed to evaluate the impact of PLEX on the survival of patients with severe SARS-CoV-2 and the effect on the cytokine release syndrome. Hospitalized patients diagnosed with SARS-CoV-2 infection and cytokine storm syndrome were selected to receive 2 sessions of PLEX or standard therapy. Primary outcome was all-cause 60-days mortality; secondary outcome was requirement of mechanical ventilation, SOFA, NEWs-2 scores modification, reduction of pro-inflammatory biomarkers and hospitalization time. Twenty patients received PLEX were compared against 40 patients receiving standard therapy. PLEX reduced 60-days mortality (50% vs 20%; OR 0.25, 95%CI 0.071-0.880; p = 0.029), and this effect was independent from demographic variables and drug therapies used. PLEX significantly decreased SOFA, NEWs-2, pro-inflammatory mediators and increased lymphocyte count, accompanied with a trend to reduce affected lung volume, without effect on SatO2/FiO2 indicator or mechanical ventilation requirement. PLEX therapy provided significant benefits of pro-inflammatory clearance and reduction of 60-days mortality in selected patients with COVID-19, without significant adverse events.

LIFE LESSONS: THE EXPERIENCES OF OLDER ADULTS LIVING IN PUERTO RICO DURING COVID-19

What life lessons emerge from a group of older Puerto Ricans concerning their experiences with COVID-19. We will review study participants' reports of how they spent their time during the pandemic, what they found most difficult to cope with, and life lessons they learned as a result. We will use Erickson's life course theory of psychosocial development to frame their responses to these questions, including the crises (and strengths) of generativity versus stagnation (care) and ego integrity versus despair (wisdom). We will report evidence of care and wisdom as core ego strengths resulting from their lived experience. We will also review how isolation, sense of community, and key mental and physical health factors seemed to influence how their responses suggest coping strengths. We will discuss our findings in the context of social and cultural norms of current cohorts of older Puerto Ricans, highlighting the salience of community and family relations. (150 words)

METHODOLOGICAL AND ETHICAL ISSUES OF RESEARCH WITH OLDER ADULTS IN PUERTO RICO DURING COVID-19

Engaging diverse groups of older adults is essential to addressing health disparities. In this presentation, we will describe how we used our research team's networks and knowledge of the target population to engage key stakeholders in our KAP project. We will address our partnerships with clergy, NGO staff and administrators, housing authorities, colleagues at Puerto Rican universities, and older adults who serve as informal community and institutional gatekeepers. We will discuss how these partnerships facilitated our ability to identify and access study sites and participants;conduct telephone and in-person interviews;ensure data quality through training and monitoring;and, assure safety through adherence to COVID-19 protocols. Finally, we will describe key cultural and ethical issues of conducting research with older adults through community partnerships during a pandemic. The presentation has implications for developing beneficial partnerships with local community leaders and enhancing the representation of diverse groups of older adults in research.

Prototype of a Pulse Oximeter Based on an Open-Source Platform with Wireless Design and Cloud Service

Telemonitoring has been useful during the COVID19 pandemic, to monitor patients avoiding risk of infection, and patients living in remote areas. Monitoring of SpO2 has been a fundamental parameter to preserve health and go to hospitals only in emergencies. This research develops a prototype of pulse oximetry for telemonitoring using an open-source platform and low-cost elements, the Atmega328 microcontroller and MAX30102 sensor to measure the reflection of light in the blood were used. Our device displays the SpO2 and HR on a screen and through an ESP8266 WiFi module sends the data automatically to a free cloud platform “ThingSpeak”, where it is stored, visualized, or can be exported for analysis in other software. A comparison with a commercial clinical grade device was performed and Bland-Altman charts and ICC to verify the concordance between both. The results are ICC of 0.97 and 0.73 corresponding ±2 BPM and ±3% SpO2 have been obtained. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Economic reactivation of the productive sector of Cañar, Ecuador: theoretical construct in the COVID-19 scenario

This article is a response to the need for economic reactivation because of the crisis resulting from the context of COVID-19. The purpose of the research was to elaborate a theoretical construct through the application of Confirmatory Factor Analysis that gathers observable variables around dimensions or factors. The study begins with a review of the literature that approximates the causal relationship of the phenomenon. The research has a quantitative approach with exploratory, descriptive and correlational designs. The following factors such as associativity, sustainable tourism, competitive advantage, market orientation, digital inclusion, agricultural innovation and knowledge transfer were found and they are linked with the economic reactivation. The Confirmatory Factorial Analysis was used in this study which helped to reduce from 117 to 47 items in the measurement instrument for the research of economic reactivation in the province of Cañar in Ecuador with factor loadings higher than 0.6. As a conclusion, it is said that it is possible to study the phenomenon with a validated questionnaire on the bivariate association of the researching variables. © 2022, Universidad del Zulia. All rights reserved.

Effectiveness of the contingency plan of the internal inflammatory disease unit before COVID-19 infection

Background: Decision making in hospitals, and especially in their own healthcare services, is hardly referenced in the literature. During the pandemic period, healthcare services have put in place contingency plans to minimize the consequences of the coronavirus on professionals and patients. However, the deployment of contingency plans and results are hardly shared, depriving other services of references to refute, compare or emulate the aforementioned plans. The objective of this work was the description of the implementation and evaluation of Contingency Plans in the Covid-19 pandemic in a unit of inflammatory bowel disease of a Digestive Service in the Sanitary Area of Pontevedra and O Salnes.

Manifestaciones sistémicas y extrapulmonares en la COVID-19 Systemic and extrapulmonary manifestations of COVID-19

Aunque la fiebre y los síntomas respiratorios son la principal expresión clínica de la enfermedad de la COVID-19, pueden aparecer importantes complicaciones extrapulmonares que afectan a la mayoría de los órganos y sistemas. La participación multisistémica puede atribuirse principalmente a la localización generalizada en todo el organismo de los receptores de la ECA2, que actúan como el principal punto de entrada del virus. Las manifestaciones sistémicas pueden aparecer, en ocasiones, antes que la sintomatología típica, aunque en general son tardías o representan secuelas de la enfermedad. Las complicaciones tromboembólicas son preocupantes por su frecuencia y gravedad, y traducen un estado procoagulante con múltiples manifestaciones clínicas posibles. Pueden aparecer complicaciones cardíacas, neurológicas, digestivas, renales, endocrinometabólicas, cutáneas y oculares. Se comentan las manifestaciones y los aspectos terapéuticos específicos sobre la enfermedad de la COVID-19 en la mujer embarazada, y sobre las implicaciones de la enfermedad en los niños. En todo paciente con sospecha clínica de COVID-19, se realizarán las pruebas correspondientes para confirmar el diagnóstico de la infección. Las pruebas diagnósticas específicas indicativas de afectación de los distintos órganos irán dirigidas en función de la sospecha clínica. La realización de estas pruebas podrá ser individualizada, teniendo en cuenta las medidas de aislamiento requeridas y la gravedad de cada caso. Asimismo, se administrará el tratamiento correspondiente, siguiendo criterios generalmente superponibles a los de la población general.

Neumonía vírica. Neumonía en la COVID-19 Viral pneumonia. COVID-19 pneumonia

Los virus están cobrando cada vez más importancia como agentes etiológicos de la neumonía, en base, principalmente, a la mejoría de las técnicas de diagnóstico, suponiendo actualmente aproximadamente un tercio de los casos de neumonía adquirida en la comunidad. Suelen ocurrir en la edad infantil y en pacientes de edad avanzada, causando desde casos leves a casos graves que precisan intubación y cuidados intensivos. Entre los principales agentes responsables están: rinovirus, virus influenza A o B, meta-pneumovirus, virus respiratorio sincitial, parainfluenzae, coronavirus o adenovirus. La infección producida por SARS-CoV-2, causante de la actual pandemia de COVID-19 de consecuencias devastadoras, es muestra de la vital importancia de la neumonía vírica y representa el objeto principal de la presente actualización. Usando la abundante información disponible, en continua evolución desde el inicio de la pandemia, en esta actualización se revisarán las principales características del virus, su fisiopatología y las manifestaciones clínicas, así como los principales métodos de diagnóstico y tratamiento.

Elevated Cytokine Levels in Plasma of Patients with SARS-CoV-2 Do Not Contribute to Pulmonary Microvascular Endothelial Permeability

The vascular endothelial injury occurs in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, but the mechanisms are poorly understood. We sought to determine the frequency and type of cytokine elevations and their relationship to endothelial injury induced by plasma from patients with SARS-CoV-2 versus controls. Plasma from eight consecutively enrolled patients hospitalized with acute SARS-CoV-2 infection was compared to controls. Endothelial cell (EC) barrier integrity was evaluated using ECIS (electric cell-substrate impedance sensing) on human lung microvascular EC. Plasma from all SARS-CoV-2 but none from controls decreased transendothelial resistance to a greater degree than that produced by tumor necrosis factor-alpha (TNF-alpha), the positive control for the assay. Thrombin, angiopoietin 2 (Ang2), and vascular endothelial growth factor (VEGF), complement factor C3a and C5a, and spike protein increased endothelial permeability, but to a lesser extent and a shorter duration when compared to SARS-CoV-2 plasma. Analysis of Ang2, VEGF, and 15 cytokines measured in plasma revealed striking patient-to-patient variability within the SARS-CoV-2 patients. Pretreatment with thrombin inhibitors, single, or combinations of neutralizing antibodies against cytokines, Ca3 and C5a receptor antagonists, or with ACE2 antibody failed to lessen the SARS-CoV-2 plasma-induced EC permeability. The EC barrier destructive effects of plasma from patients with SARS-CoV-2 were susceptible to heat inactivation. Plasma from patients hospitalized with acute SARS-CoV-2 infection uniformly disrupts lung microvascular integrity. No predicted single, or set of, cytokine(s) accounted for the enhanced vascular permeability, although the factor(s) were heat-labile. A still unidentified but potent circulating factor(s) appears to cause the EC disruption in SARS-CoV-2 infected patients. IMPORTANCE Lung vascular endothelial injury in SARS-CoV-2 patients is one of the most important causes of morbidity and mortality and has been linked to more severe complications including acute respiratory distress syndrome (ARDS) and subsequent death due to multiorgan failure. We have demonstrated that in eight consecutive patients with SARS-CoV-2, who were not selected for evidence of endothelial injury, the diluted plasma-induced intense lung microvascular damage, in vitro. Known endothelial barrier-disruptive agents and proposed mediators of increased endothelial permeability in SARS-CoV-2, induced changes in permeability that were smaller in magnitude and shorter in duration than plasma from patients with SARSCoV-2. The effect on endothelial cell permeability of plasma from patients with SARS-CoV-2 was heat-labile. The main plasma factor that causes the increased endothelial permeability remains to be identified. Our study provides a possible approach for future studies to understand the underlying mechanisms leading to vascular injury in SARS-CoV-2 infections.

PHYSICAL REHABILITATION AND COVID-19

Exercise therapy is an independent medical discipline that applies its means in the recovery of work capacity. In respiratory conditions, it constitutes an entity within the rehabilitation process, not proven, on patients with COVID-19. The objective of the study was to provide theoretical support on early physical function rehabilitation therapies in COVID-19. A review study was assumed, Databases were consulted: EMBASE Elsevier BV, HINARI, MedicLatina: EBSCO Group, MEDLINE, SciELO, SCOPUS, Journal Citation Reports and Science Citation Index Expanded. The descriptors used were [physical exercise-respiratory conditions], [respiratory physiotherapy], [Exercise therapy-COVID-19], [Physical rehabilitation-COVID-19 systematic reviews], [physical exercise PosCOVID-19 systematic review]. 248,000 articles were processed, 14 met the search and inclusion criteria for review and analysis. It was evidenced: few intervention, clinical and preclinical studies that confirm the relationship between physical rehabilitation and COVID-19. It was concluded that there are numerous studies that theoretically support the importance of physical exercise, as an element to take into account in the rehabilitation of conditions respiratory diseases, but there are not enough arguments to confirm its recovery effect in patients with COVID-19. © 2022, University of Cienfuegos, Carlos Rafael Rodriguez. All rights reserved.

RURAL-COVID-19 Trial: Retrospective Analysis of COVID-19 Coinfections in Hospitalized Urban and Rural Adults

Background. The impact of COVID-19 in rural communities has been well described. However, little is known regarding differences in coinfections among COVID-19 patients in rural vs. urban settings. Our primary objective is to evaluate community acquired coinfection (CACo) rates (< 72 hrs from admission) and healthcare-associated infection (HAI) rates ( > 72 hrs from admission) in these populations. Secondary objectives include use of empiric antibiotics, pathogen prevalence, and patient outcomes. Methods. Retrospective analysis of the first 255 adult patients admitted to a tertiary medical center with symptomatic COVID-19 and confirmed by PCR. Rural and urban categories were determined using patient address and county census data. Isolated pathogens were individually evaluated and considered coinfections if the patient met predetermined criteria. Predetermined Coinfection Criteria Results. The rates of CACo for rural (n = 90) and urban (n = 165) residents were 11.1% and 13.3%, respectively. Non-respiratory coinfections, such as bloodstream and urinary tract infections, were more common in urban residents;however, empiric antibiotics were started in 75.1% of all subjects. Methicillin susceptible staphylococcus aureus and Escherichia coli were the most common pathogens isolated on admission in both populations. HAI rates were 13.3% in the rural residents vs 13.9% in the urban residents with Methicillin resistant staphylococcus aureus as the most common respiratory pathogen, although Pseudomonas aeruginosa was the most prevalent overall pathogen. There was no significant difference in hospital length of stay or 30-day allcause mortality among both populations. Conclusion. There was no significant difference in the rate of CACo or HAI among rural or urban populations. Despite the high rate of antibiotic use to empirically cover community acquired respiratory infections at the start of the pandemic, only 1.9% of the subjects had a possible or proven respiratory coinfection on admission. Despite prior research showing worse outcomes for rural populations with COVID-19, our data demonstrates that coinfection rates and patient outcomes were similar among these populations when receiving medical care at an academic hospital.

Small Towns, Big Cities: Rural and Urban Disparities among Hospitalized Patients with COVID-19

Background. More than half of all hospitals in the U.S. are rural hospitals. Frequently understaffed and resource limited, community hospitals serve a population that tends to be older and have less access to care with increased poverty and medical co-morbidities. There is a lack of data surrounding the impact of COVID-19 among rural minority communities. This study seeks to determine rural and urban disparities among hospitalized individuals with COVID-19. Methods. This is a descriptive, retrospective analysis of the first 155 adult patients admitted to a tertiary hospital with a positive COVID-19 nasopharyngeal PCR test. Augusta University Medical Center serves the surrounding rural and urban counties of the Central Savannah River Area. Rural and urban categories were determined using patient address and county census data. Demographics, comorbidities, admission data and 30-day outcomes were evaluated. Results. Of the patients studied, 62 (40%) were from a rural county and 93 (60%) were from an urban county. No difference was found when comparing the number of comorbidities of rural vs urban individuals;however, African Americans had significantly more comorbidities compared to other races (p-value 0.02). In a three-way comparison, race was not found to be significantly different among admission levels of care. Rural patients were more likely to require an escalation in the level of care within 24 hours of admission (p-value 0.02). Of the patients that were discharged or expired at day 30, there were no differences in total hospital length of stay or ICU length of stay between the rural and urban populations. Conclusion. This study suggests that patients in rural communities may be more critically ill or are at a higher risk of early decompensation at time of hospitalization compared to patients from urban communities. Nevertheless, both populations had similar lengths of stay and outcomes. Considering this data is from an academic medical center with a large referral area and standardized inpatient COVID-19 management, these findings may prompt further investigations into other disparate outcomes.

DYNAMICS OF CRIMINAL EVENTS DURING THE COVID-19 PANDEMIC IN THE MUNICIPALITY SANTIAGO DE CUBA

The purpose of the article is to diagnose the behavior of criminal offenses held in Santiago de Cuba, during the period of application of measures in the phase of limited autochthonous transmission of COVID-19 pandemic, declared by the Cuban State. With the use of trends analysis methods, trend component of the temporal series according to Hodrick and Prescott and the analysis of documents, it was designed an exploratory-descriptive research, which led to explore, know, investigate, calculate, identify and predict the dynamics of criminal events judged in Santiago de Cuba's municipality during the COVID-19 pandemic. The results achieved are consistent with the identification of the most recurrent criminal facts and their random variability in the interrupted time series, motivated by an exceptional event, as well as their behavior pattern in those circumstances;and the capacity to promote and develop foundations of an adaptive right to exceptional events. It can be concluded that the dynamics of criminal acts carried out during an exceptional event (Pandemic COVID-19) in the municipality of Santiago de Cuba, during the analyzed period (1-03-2020 to 30-04-2020), did not behave like a typical high-profile employer with respect to certain criminal figures.

THE CONTRADICTIONS OF POST-MODERN TEMPORALITY IN THE LIGHT OF THE NEW CORONA VIRUS PANDEMIC

This article reflects on how much we live in a time of increasing complexity, which seemed to have already overcome all problems, given the security that confidence in scientific and technological processes seemed to have returned to us. But when these processes, as now happens in the Coronavirus pandemic, show their weakness, they reveal, as never before, their weaknesses. These are the weaknesses that result from depositing all the objective value in these processes, believing that in them was the capacity to redeem us from all our ills. Running after innovation and success at all costs, without ethics, without respect for nature and for others, without regard for the past and without anchoring the future in it, reduces the stability and structural security of the societies and individuals that compose them.