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Background. Classification of MIS-C, COVID-19, and other pediatric inflammatory conditions is challenged by phenotypic overlap and absence of diagnostic laboratory evidence. Due to public health need and based on limited data from early cases, CDC developed a necessarily broad MIS-C surveillance case definition in May 2020. Studies have since shown that some criteria do not distinguish between MIS-C and other conditions and may contribute to misclassification. To inform planned revision to the CDC definition, we evaluated the impact of narrowing these criteria on case inclusion in national MIS-C surveillance. Methods. Of state and local health-department reported cases meeting the current MIS-C case definition as of 04/14/2022, we describe the proportion that met revised criteria under consideration including fever duration, C-reactive protein (CRP) elevation using a defined cutoff, and organ involvement represented by specific criteria. We also evaluated cases identified using potential combinations of revised criteria. Results. Of 8,096 MIS-C cases fulfilling the original case definition, 6,332 (78%) had sufficient data for evaluation of criteria. Of these, 96% had fever for >=2 days and 94% had a CRP >= 3.0 mg/dL (Table 1). Cardiac involvement defined by key features of MIS-C was present in 84% of cases (62% if BNP/proBNP elevation was excluded);43% had shock. Dermatologic, gastrointestinal (GI) and hematologic involvement were present in 75%, 89% and 37% of cases, respectively. Neurologic (excluding headache), renal, and respiratory involvement were present in 16%, 20%, and 63% of cases, respectively. The number of cases with >= 2 of cardiac (without BNP/proBNP elevation), shock, dermatologic, GI, or hematologic involvement was 5,733 (91%). SARS-CoV-2 testing results are shown in Table 2. Conclusion. The CDC MIS-C case definition is intentionally broad. Using national surveillance data, we evaluated case inclusion under narrower criteria, prioritizing features of MIS-C that distinguish it from similar pediatric inflammatory conditions. A surveillance case definition may not capture all cases and is not intended to replace clinical judgment. We plan to assess additional criteria combinations, describe potentially excluded cases, and incorporate findings into a revised definition.
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Background. CDC began collecting COVID-19 vaccination status of persons with MIS-C as part of national surveillance inMay, 2021. We describe and compare MIS-C in fully vaccinated persons withMIS-C in persons with partial or no vaccination reported. Methods. We identified COVID-19 vaccine age-eligible persons meeting the CDC MIS-C case definition reported by health departments as of March 28, 2022 and divided theminto 3 groups for this analysis: 1) fully vaccinated (receipt of a 2-dosemRNAprimary vaccine series with MIS-C onset >=28 days after vaccine dose 2 to account for the delay between infection and MIS-C), 2) partially vaccinated (MIS-C onset after dose 1 or < 28 days from dose 2 or receipt of Janssen [Johnson & Johnson] vaccine and 3) no vaccination reported. We compared characteristics between the groups. Results. Of 7,880 MIS-C cases reported, 1,085 were vaccine eligible: 45 were fully vaccinated, 64 partially vaccinated, and 976 had no vaccine reported. Demographic characteristics were similar, although the Northeast had the lowest percentage of persons with vaccination not reported (Table). Though not statistically significant, fully vaccinated persons less frequently had severe cardiac involvement (67% vs 74%), shock (33% vs 44%), severe hematologic involvement (47% vs 54%), and mucocutaneous involvement (53% vs 63%) compared with those with no vaccine reported (Table). Forty-four percent of those fully vaccinated required ICU-level care vs 59% with no vaccine reported (p=0.053). Nineteen (2%) of those without vaccine reported died;no fully or partially vaccinated persons died. (Table Presented) Conclusion. Persons who acquire SARS-CoV-2 infection after being fully vaccinated can develop MIS-C, with similar clinical characteristics to those with no vaccination reported. A lower but not statistically significant percentage of fully vaccinated persons required ICU-level care compared with those without vaccination, and there were no deaths in the fully vaccinated group. These data do not account for trends in MIS-C over time, including the influence of circulating SARS-CoV-2 variants on MIS-C clinical manifestations. We will continue to evaluate these comparisons as the sample size of reported MIS-C cases increases.
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Background. SARS-COV-2 infection is known to cause tissue damage in several organs outside of the respiratory tract. The pathogenesis of tissue damage is hypothesized to be caused by direct viral damage, endothelial injury, and ischemic or thrombotic events. Gastrointestinal symptoms were first characterized mainly as diarrhea and diffuse abdominal pain and discomfort, which can be hard to interpret in the setting of a generalized inflammatory response;gallbladder injury and inflammation causing acute acalculous cholecystitis has been scarcely reported Methods. Here we discuss five cases of patients presenting with symptoms of cholecystitis. All five patients underwent multiple imaging studies, and all of them were compatible with acute cholecystitis;some of them had an imaging report of lithiasic cholecystitis, while the rest were reported with microlithiasis or biliary sludge. Four out of the five patients underwent laparoscopic cholecystectomy;biopsies were taken, consistently those reported with acalculous cholecystitis. The remaining patient died of CoVID 19 complications prior to surgery, but after a percutaneous cholecystostomy tube was placed. Results. All these patients have in common the prolonged fasting, because they all required invasive mechanical ventilation, consequently, they all developed multiple focal pneumonia and respiratory distress syndrome. This fast is related to the development of gangrenous ischemia in the gallbladder, which manifests as a late complication due to SARS-CoV-2 infection, in addition to being related to angiotensin-2 converting receptors and virus replication proteins, as well as the pro-inflammatory and hypoxia state that in itself causes the infection (9). All showed a cholestatic pattern, highlighting that this complication developed in an average time of 3 weeks after the onset of SARS-CoV2 symptoms, in addition to the fact that in most cases a negative test was already shown at the time of the complication. Conclusion. Acalculous cholecystitis is one of the extrapulmonary complications that has been seen in patients with this infection, not being the most common, but one of those that has generated a higher mortality rate in patients due to its late diagnosis and non-specific clinical picture in certain occasions (9).
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Background. Risk factors for MIS-C, a rare but serious hyperinflammatory syndrome associated with SARS-CoV-2 infection, remain unclear. We evaluated household, clinical, and environmental risk factors potentially associated with MIS-C. Methods. This investigation included MIS-C cases hospitalized in 14 US pediatric hospitals in 2021. Outpatient controls were frequency-matched to case-patients by age group and site and had a positive SARS-CoV-2 viral test within 3 months of the admission of their matched MIS-C case (Figure 1). We conducted telephone surveys with caregivers and evaluated potential risk factors using mixed effects multivariable logistic regression, including site as a random effect. We queried regarding exposures within the month before hospitalization for MIS-C cases or the month after a positive COVID-19 test for controls. Enrollment scheme for MIS-C case-patients and SARS-CoV-2-positive outpatient controls. MIS-C case-patients were identified through hospital electronic medical records, while two outpatient controls per case were identified through registries of outpatient SARS-CoV-2 testing logs at facilities affiliated with that medical center. Caregivers of outpatient controls were interviewed at least four weeks after their positive test to ensure they did not develop MIS-C after their infection. Results. We compared 275 MIS-C case-patients with 494 outpatient SARS-CoV-2-positive controls. Race, ethnicity and social vulnerability indices were similar. MIS-C was more likely among persons who resided in households with >1 resident per room (aOR=1.6, 95% CI: 1.1-2.2), attended a large (>=10 people) event with little to no mask-wearing (aOR=2.2, 95% CI: 1.4-3.5), used public transportation (aOR=1.6, 95% CI: 1.2-2.1), attended school >2 days per week with little to no mask wearing (aOR=2.1, 95% CI: 1.0-4.4), or had a household member test positive for COVID-19 (aOR=2.1, 95% CI: 1.3-3.3). MIS-C was less likely among children with comorbidities (aOR=0.5, 95% CI: 0.3-0.9) and in those who had >1 positive SARS-CoV-2 test at least 1 month apart (aOR=0.4, 95% CI: 0.2-0.6). MIS-C was not associated with a medical history of recurrent infections or family history of underlying rheumatologic disease. Conclusion. Household crowding, limited masking at large indoor events or schools and use of public transportation were associated with increased likelihood of developing MIS-C after SARS-CoV-2 infection. In contrast, decreased likelihood of MIS-C was associated with having >1 SARS-CoV-2 positive test separated by at least a month. Our data suggest that additional studies are needed to determine if viral load, and/or recurrent infections in the month prior to MIS-C contribute to MIS-C risk. Medical and family history were not associated with MIS-C in our analysis.
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The COVID-19 pandemic illuminated the critical need for flexible mechanical engineering laboratories simultaneously deployable in multiple modalities: face-to-face, hybrid, and remote. A key element in the lesson portfolio of a forward-looking engineering instructor is economical, hands-on, accessible, "turn-key" lab activities;kits that can be deployed both in brick-and-mortar teaching labs and mailed home to remote learners. The Energy Engineering Laboratory Module (EELM (TM)) pedagogy, described elsewhere, provides an underpinning theoretical framework and examples to achieve these features. In addition, instructional lab kits must demonstrate foundational engineering phenomena while maintaining measurement accuracy and fidelity at reasonable cost. In the energy-thermal-fluid sciences, achieving these conditions presents challenges as kits require energy and matter transport and conversion in real time at scales large enough to reveal measurable phenomena but not so large as to become hazardous to users. This paper presents theoretical underpinning and experimental verification of a fluid mechanics lab experiment appropriate for undergraduate engineering students that 1) meets all the above-described criteria, 2) costs less than $30 in materials, and 3) can be easily mailed to remote learners.
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Introduction: Within the worldwide efforts to reduce the rate ofinfection and mortality, vaccination against COVID-19 is determined as a safe and universal process. To guarantee the proportionate distribution ofvaccines, globalcollaboration (COVAX)hasbecome the primary strategy in the distribution of vaccines in countries such as Honduras, located among the 71 countries in the world that report the most confirmed cases and one of the lowest vaccination coverages in the Central American region, despite having one of the best cold chains in the Americas. In the following review, we will discuss the challenges faced in the process of vaccination against COVID-19 in the Honduran health system. Objectives: To determine the situation of vaccination against COVID-19 in Honduras and the challenges it presents. M ethodology: Epidemiological analysis and strategies employedin the vaccination process against COVID-19up to epidemiologicalweek30, distribution of variants of concern, confirmed cases, and mortality due to SARS-CoV-2 in Honduras. Results: Honduras has reached percentages of positivityandhospitalizations forCOVID-19similarto the peak of the pandemic in June 2020, men represent 54% ofdeaths, 48% ofdeaths are in the group between 60-79 years. The target population for vaccination in 2021 is 5 700 985 persons. In March 2021, a donation of48000vaccines (AstraZeneca)wasreceivedthrough COVAX to immunize healthcare personnel. A total of 9 212 597 doses have been received and are still in the process of being applied to prioritized groups with different levels of acceptance. As of August 16, 2021, 7 201 820 doses had been applied, distributed between first and second doses. Discussion: Honduras has one of the lowest rates of diagnostic tests performed and one of the lowest vaccination percentages in the Central American region. The cumulative case and mortality rates per million population are 37 222 and 1 019, respectively. The percentage of positivity in the year 2021 has increased. The Central-South zone of the country has become the epicenter of the pandemic with the highest number of SARS-CoV-2 variants. The highest percentage of deaths is in men and the 60-79 age group. It is specified that by 2022 all Hondurans can be vaccinated. Conclusion: Although the vaccination process is gradually developing, there are still many challenges in terms of immunization, increasing the workload of health personnel. Distancing, mandatory use of masks, and frequent hand washing remain fundamental pillars of prevention, limited by extreme poverty and a subsistence economy. © 2022 Academia Nacional de Medicina. All rights reserved.
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The current global situation with a dominant economic development model producing social inequality, increment and intensification of urbanization has generated severe environmental degradation and an associated increase in the likelihood of pandemics. New strategies that strengthen sustainable food production are urgent in highly unequal countries as Mexico. In Mexico City, the most populated city of the country, a wetland system, named Xochimilco, still holds chinampas, a unique and ingenious food system dating from pre-Hispanic times. These days chinampas are the best example of urban sustainable agriculture production. Unfortunately, this system is under threat due to urbanization and industrial land-use changes. Among the strategies to promote sustainable modes of production and consumption is eco or green labeling, consisting of a voluntary environmental certification approach, and marketing and advertising tool, that can change producers' and consumers' behavior toward long-term sustainability. Although widely used, the benefits of green labels for producers are not always realized. This study aimed to learn more about the agro-ecological production process and commercialization challenges in Xochimilco and San Gregorio Atlapulco in Southern Mexico City to understand chinampa producers' needs and determine whether a green label can offer solutions in this vulnerable socio-ecological system, particularly suffering the effects of the COVID-19 pandemics. For this, a literature review and producers' mental model analysis based on network theory, were developed. Results show that non-resolved issues such as commercialization problems, consumers' unwillingness to pay a fair price, loss of healthy soil, and degraded water quality used for irrigation persist and can affect the benefits of a green label including to improve chinampa production and farmers' income. Farmers' current necessities comprised increasing profits, receiving financial advice to set prices of agro-ecological vegetables and production costs, among others. Under the current production and commercialization scenarios complying with the assessment cost of certification will be difficult for most producers;then, implementing the green label would probably fail to fulfill the benefits. Attending to former and persistent conflicts and satisfying chinampa producers' neglected necessities are essential before implementing any program. Copyright © 2022 Arroyo-Lambaer, Zambrano, Rivas, Vázquez-Mendoza, Figueroa, Puente-Uribe, Espinosa-García, Tapia-Palacios, Mazari-Hiriart, Revollo-Fernández, Jiménez-Serna, Covarrubias and Sumano.
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This research starts from the problem: How to improve commercial management in the company "Soluciones Integrales Grupo Lozada" online? And presents the result of implementing a web portal, based on a theoretical foundation of computer technologies online, carrying out an analysis of the situation of the promotion of the company, and how the design of a portal allowed to improve its dissemination, the investigation through the application of methods and techniques allowed an analysis of the processes that were the field of action of the project , the theoretical conceptualization and its problems, determined the necessary requirements for the solution proposal that is presented as a scientific novelty in these times of COVID 19.
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In times of pandemic the Pymes have had to adapt, which makes evident to innovate with new investigations, this investigation is the result of carrying out a computer audit inside the company "PROMAELEC" of the city of Quevedo, in time of covid-19, allowing to know the current computer reality of the company, investigation that raised "how to know the current computer situation of the company PROMAELEC".This research proposed "how to know the current IT situation of the company PROMAELEC", through the use of IT audit methodologies, including the preliminary study, review and evaluation, scope, audit approach, helping to break down the problem and define a proposal that improved the processes allowing to maintain its activities in the market with an improvement of the administrative management in an automated way.
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Bats are the only flying mammals that carry multiple pathogens, such as the SARS-CoV-2. As a consequent of fear of the zoonotic origin of SARS-CoV-2, there is an adverse reaction in multiple countries against these animals. Bats contribute with arthropod control and pollination, among other positive roles of these animals.
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Bats are a group of mammals that harbor the most significant number of coronaviruses. The aim of present review article was to analyze the broad spectrum of the coronavirus coexisting in Chiropterans hosts. Bats have certain types of cell receptors that allow them to be the potential hosts of a large number of viruses without the presence of any clinical manifestations, and to be a source of contagion infections for other animals and human species. Emphasis can be placed on five coronaviruses, such as Porcine Epidemic Diarrhea Disease, Severe Acute Diarrhea Syndrome, Middle East Respiratory Syndrome, Severe Acute Respiratory Syndrome, and Severe Acute Respiratory Syndrome 2, which have had significant impacts causing epidemic outbreaks in different parts of the world, and generating implications for both human and animal health. In conclusion, recent research indicated the importance of bats as potential hosts of multiple coroaviruses leading to some zoonotic diseases.
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The implementation of virtual laboratories based on blended education has grown in importance due to the recent events developed worldwide because of the COVID-19 pandemic. This motivated the design of a new virtual tool in MS Excel for transforming the delivery methodology of the Hydraulics Lab in the UiT. This paper shows the design of such digital educational tool which will be implemented in the next academic year, to enable the Mechanical Engineering students to virtually change different parameters to visualize and understand the movement of the different components of a hydraulic arm, which comprises 3 levers with 4 degrees of freedom (3 of them in the plane). The virtual lab consists of simulating the hydraulic arm as a 2D structure in the digital tool which allows the students to interact with the structure before the attendance to the lab and/or substituting completely the on-site activity when required. This tool represents the possibility for this laboratory to be taken by students located in different places around the globe, fostering collaboration among different institutions across Europe.
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Previous studies have demonstrated that female patients with coronavirus disease 2019 (COVID-19) demonstrate more favorable prognosis relative to male patients. In this article, we elaborate the possible role of estrogen in the modulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection severity. The potential interplay between several factors, including inherently lower estradiol (E2) and slightly higher estrogen receptor ß (ERß) levels in males, with inflammatory mediators are described. Altogether, there seems to be a sexually dimorphic response towards SARS-CoV-2 infection, and a possibility that COVID-19 severity is dependent on both E2 levels and ERα:ERß expression ratio in lymphoid and lung cells.
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UNIANDES extension in Quevedo, through the department of outreach with the community, in the Systems career, incorporates its eighth semester students, to provide computer solutions in times of pandemic, in the Quevedo Municipal Educational Unit, when building mobile applications, in order to improve teaching processes between teachers and students in virtual mode. The applications were used and the results were satisfactory, with constant feedback and formative evaluations as a priority, in different subjects. In the construction of them, the teacher contributes with his didactic experience, the contents and evaluations. Of the five students of UNIANDES, they build a mobile application for five subjects, with all the suggestions of each teacher, the same ones that were used by 150 students, who in 90% of the proposed educational objectives were met. It is intended that for subsequent projects, academic units of the curriculum will be increased by subjects, if possible, for the six part-time periods of the school year.
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Introduction: Several emerging and re-emerging diseases in the last decade have shown the global weakness to detect and act in a timely manner in situations that threaten the health of the planet. Latin America has been vulnerable to outbreaks as a result of increased poverty, social inequity and the poor response capacity of the public health system. O bjective: Describe the situation of COVID-19 in Honduras and the challenges it presents. Methodology: Analysis of the epidemiology and control strategies applied in the country to contain the spread of SARS-CoV-2, in the context of the social and economic reality until September 18, 2020. Results: Honduras ranks fifth in Central America in the number of tests performed;the cumulative incidence rate of cases is 7 105 per million inhabitants. The country has an accelerated growth in the percentage of positivity with intense community transmission. Some 63.4 % of cases are concentrated in the group 20-49 years old (43 624 cases);15.2 % in adults 60+ (10 440 cases) and 7.5 % in children under 20 (5 133 cases). With a disjointed health system and a chronic and recurrent shortage of physical and human resources, the National Risk Management System (SINAGER), which includes the Ministry of Health (SESAL), implemented various strategies to reduce the spread of the virus. Some control measures were border closures, physical distancing and the use of masks were made mandatory by legislative decree. The serious impact on the weak national economy forced an intelligent opening coinciding with the rise of cases. Conclusions: Current data show that the age group most affected is adults between 20 and 49 years old. The country’s socioeconomic situation has been aggravated by the pandemic;the continuous rise in the number of cases, hospitalizations and deaths has collapsed the public health system leaving the majority of Hondurans in continuous vulnerability. Primary care clinics and mobile medical brigades have been implemented as a new way to contain the spread and impact of transmission. Several European countries and cities in the Americas have had to reverse the process of economic reopening when faced with successive waves of outbreaks. Honduras has demonstrated limited capacity to dealwith catastrophic situations. The national epidemiological surveillance system and access to timely and quality diagnostic tests remain weak and fragmented. There is an urgent need to improve the health and surveillance system to guide strategic evidence-based decision making and to prevent future pandemics. © 2020 Academia Nacional de Medicina. All rights reserved.
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Introduction: Prone position (PP) is a therapeutic alternative widely used and recommended in patients with COVID-19. Although PP is a non-invasive procedure, it is complex and could be associated with complications such as the development of pressure ulcers (PU). We aimed to propose a standardized nursing care plan in terms of NANDA-International, NIC (Nursing Interventions Classification) and NOC (Nursing Outcomes Classification) to prevent PU secondary to the PP in people with COVID-19. Content synthesis: In patients with COVID-19, in addition to risk factors such as advanced age and the presence of comorbidities, PP contributes to the presence of pressure ulcer risk nursing diagnoses [00249], of deterioration of skin [00047] and tissue [00248] integrity. On the other hand, the nursing intervention for the prevention of pressure ulcers [3540], due to the specificity and scientific basis of its activities, is key to minimize the development of this complication, improve the quality of care and the prognosis in this type of patients. Finally, to evaluate the effectiveness of nursing care, we propose the nursing results (NOC): consequences of immobility: physiological [0204] and tissue integrity: skin and mucous membranes [1101]. Conclusion: PP is a recommended adjunctive therapy for the management of critically ill COVID-19 patients due to its benefits to improve lung function. However, it is associated with adverse effects such as PU. This article presents recommendations based on a narrative review for a better implementation of preventive nursing care that reduces the frequency of PU in this population. © 2021 River Publishers. All rights reserved.