EMBRACING THE DIVERSITY OF GRANDFAMILIES: UNDERSTANDING THE INFLUENCE OF CULTURE AND RACISM

In line with this year's conference theme, we examine diversity in different forms, such as racial, cultural, and familial diversity. We discuss the importance of diversity's influence on the experiences of grandfamilies and the impact it has on their members. Findings from a study with Latinx grandparent caregivers suggest that those raising grandchildren often do not view themselves as "raising,” but instead "helping.” Such findings highlight the importance of understanding cultural norms to appropriately tailor services and resources. In an exploration of the experiences of Korean custodial grandparents, findings demonstrated the influence of patrilineality and stigma surrounding divorce for Korean grandparent-headed families, indicating the importance of considering a grandparents' position in the family when providing services. In a study with custodial grandparents during the COVID-19 pandemic, researchers examined the role of racial discrimination on grandparents' depressive symptoms and access to health services. Results indicated a higher level of perceived racial discrimination was associated with more depressive symptoms. These results imply the need to address racial/ethnic disparities experienced by these caregivers. Similarly, in a study of emerging adults raised by grandparents, race moderated the influence of attachment on symptoms of racial discrimination. Findings support the use of interventions addressing attachment and ethnic identity to decrease symptoms of racial trauma in grandfamilies. Together these four studies reiterate the diversity of grandfamilies, enrich our understanding of these families, and encourage us to reimagine how to best serve them.

Computational modeling of the effect of five mutations on the structure of the ACE2 receptor and their correlation with infectivity and virulence of some emerged variants of SARS-CoV-2 suggests mechanisms of binding affinity dysregulation.

Interactions between the human angiotensin-converting enzyme 2 (ACE2) and the RBD region of the SARS-CoV-2 Spike protein are critical for virus entry into the host cell. The objective of this work was to identify some of the most relevant SARS-CoV-2 Spike variants that emerged during the pandemic and evaluate their binding affinity with human variants of ACE2 since some ACE2 variants can enhance or reduce the affinity of the interaction between the ACE2 and S proteins. However, no information has been sought to extrapolate to different variants of SARS-CoV-2. Therefore, to understand the impact on the affinity of the interaction between ACE2 protein variants and SARS-CoV-2 protein S variants, molecular docking was used in this study to predict the effects of five mutations of ACE2 when they interact with Alpha, Beta, Delta, Omicron variants and a hypothetical variant, which present mutations in the RBD region of the SARS-CoV-2 Spike protein. Our results suggest that these variants could alter the interaction of the Spike and the human ACE2 protein, losing or creating new inter-protein contacts, enhancing viral fitness by improving binding affinity, and leading to an increase in infectivity, virulence, and transmission. This investigation highlighted that the S19P mutation of ACE2 decreases the binding affinity between the ACE2 and Spike proteins in the presence of the Beta variant and the wild-type variant of SARS-CoV-2 isolated in Wuhan-2019. The R115Q mutation of ACE2 lowers the binding affinity of these two proteins in the presence of the Beta and Delta variants. Similarly, the K26R mutation lowers the affinity of the interaction between the ACE2 and Spike proteins in the presence of the Alpha variant. This decrease in binding affinity is probably due to the lack of interaction between some of the key residues of the interaction complex between the ACE2 protein and the RBD region of the SARS-CoV-2 Spike protein. Therefore, ACE2 mutations appear in the presence of these variants, they could suggest an intrinsic resistance to COVID-19 disease. On the other hand, our results suggested that the K26R, M332L, and K341R mutations of ACE2 expressively showed the affinity between the ACE2 and Spike proteins in the Alpha, Beta, and Delta variants. Consequently, these ACE2 mutations in the presence of the Alpha, Beta, and delta variants of SARS-CoV-2 could be more infectious and virulent in human cells compared to the SARS-CoV-2 isolated in Wuhan-2019 and it could have a negative prognosis of the disease. Finally, the Omicron variant in interaction with ACE2 WT, S19P, R115Q, M332L, and K341R mutations of ACE2 showed a significant decrease in binding affinity. This could be consistent that the Omicron variant causes less severe symptoms than previous variants. On the other hand, our results suggested Omicron in the complex with K26R, the binding affinity is increased between ACE2/RBD, which could indicate a negative prognosis of the disease in people with these allelic conditions.

COVID-19-ASSOCIATED PULMONARY MUCORMYCOSIS PRESENTING AS SPONTANEOUS PNEUMOTHORAX: A RARE PRESENTATION

SESSION TITLE: COVID-19 Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Mucormycosis is an angio-invasive fungal infection with substantial morbidity and mortality. While diabetes and immune suppression remain well-known risk factors for mucormycosis, COVID-19 is now emerging as its independent predictor. CASE PRESENTATION: A 43-year-old male, with a history of hyperlipidemia and alcoholism, presented to the hospital with complaints of progressive dyspnea on exertion, productive cough, intermittent fever, anorexia, and chest pain over the course of 2 weeks. About 5 weeks prior to the current presentation, he was tested positive for COVID-19 by a polymerase chain reaction (PCR) based test and remained in quarantine at home. He was not vaccinated against COVID-19. He had no known immunosuppressive disease. On initial examination, he was ill-appearing and had a temperature of 101 F, blood pressure 138/83 mmHg, respiratory rate 22/minute, pulse 102/minute, and saturation of 91% on 2 L nasal cannula oxygen. A computerized tomography (CT) scan of the chest revealed small bilateral pneumothorax (2 cm and 5mm) along with extensive ground-glass opacifications in all lobes. In the next 24 hours, the right-sided pneumothorax progressed to tension pneumothorax requiring pigtail pleural drainage catheter placement. The drained pleural fluid had more than 100,000/uL total nucleated cells (91% neutrophils, 2% lymphocytes, and 1% eosinophils) and ultimately cultures grew Rhizopus spp. He was started on intravenous liposomal amphotericin-B infusion (5 mg/kg daily). On hospital discharge, he was switched to oral posaconazole (started with loading 300 mg delayed-release tablet twice a day, followed by 300 mg dosing of delayed-release posaconazole tablets daily) to complete the long term treatment course. DISCUSSION: Most of the reported cases of mucormycosis in COVID-19 were in patients with either diabetes or receiving steroids. This is a rare presentation of COVID-19–associated pulmonary mucormycosis (CAPM) as spontaneous pneumothorax, in the absence of known immunosuppression history. COVID-19 results in a considerable increase in cytokines, particularly interleukin-6 (IL-6), which increase free iron by increasing ferritin levels due to increased synthesis and decreased iron transport. Also, concomitant acidosis increases free iron by reducing the ability of transferrin to chelate iron and this available iron becomes a considerable resource for mucormycosis. [1] Also, Mucorales adheres to and invades endothelial cells by specific recognition of the host receptor glucose-regulator protein 78 (GRP-78). Acidosis associated with severe COVID-19 triggers GRP-78 and fungal ligand spore coating homolog (CotH) protein expression on endothelial cells, both contributing to angioinvasion, hematogenous dissemination, and tissue necrosis. [2] CONCLUSIONS: Mucormycosis can present as spontaneous pneumothorax after recent COVID-19 and clinicians should be aware of rare clinical presentation. Reference #1: Singh AK, Singh R, Joshi SR, et al. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr Clin Res Rev 2021;15:102146. doi:10.1016/j.dsx.2021.05.019 Reference #2: Baldin C, Ibrahim AS. Molecular mechanisms of mucormycosis—The bitter and the sweet. PLOS Pathog 2017;13:e1006408. doi:10.1371/journal.ppat.1006408 DISCLOSURES: No relevant relationships by Faran Ahmad No relevant relationships by AYESHA BATOOL No relevant relationships by Zachary DePew No relevant relationships by Neil Mendoza

[Influence of risk factors on mortality from COVID-19]

Background: The main risk factors studied that have an influence on mortality from COVID-19 have so far been inconclusive in the world literature, mainly in relation to the male gender. Objective: To determine which are the main risk factors that influence a higher mortality from COVID-19. Material and methods: A case-control study was conducted, including 1190 patients with positive RT-PCR. The risk factors studied were: gender, age, systemic arterial hypertension (SAH), Diabetes mellitus (DM), obesity, Chronic Obstructive Pulmonary Disease (COPD), asthma, smoking, immunosuppressants, Human Immunodeficiency Virus (HIV), influenza vaccine. In the Group of Cases: they died from COVID-19 (n = 576), while in the Controls group: they survived (n = 614). The statistical plan included cross-tables and multivariate logistic regression model to determine the influence of these risk factors on mortality from COVID-19. Results: We found no statistically significant differences between cases and controls in relation to gender. However, the cases were aged >60 years, SAH, DM, obesity compared to controls. Conclusions: Male gender was not a risk factor for mortality from COVID-19, however, other risk factors such as age over 60 years, being hypertensive, diabetic and obese, were corroborated as such for a higher mortality from COVID-19.

Job satisfaction and burnout syndrome in teachers during confinement due to the COVID-19 pandemic

The work overload that teachers present in the current context is a risky situation, since it can generate prolonged states of stress causing a burnout syndrome and affecting theirj ob satisfaction. The objective was to determine the significant relationship between job satisfaction and the components of burnout syndrome during confinement due to the COVID -19 pandemic. The study had a cross-sectional correlational design. 205 teachers participated, who answered the Job Satisfaction Scale for Teachers (ESLA-Education) and the Maslach Burnout Inventory (MBI). The results indicate a statistically significant inverse correlation between job satisfaction and the components of burnout syndrome: emotional exhaustion (rho =-. 315 ;p = .000), depersonalization (rho =-.252;p = .000) and achievement personal (rho =-.254;p = .000). It is concluded that teachers who present high emotional fatigue, loss of sensitivity and empathy, deterioration of their abilities and a feeling of failure show job dissatisfaction. Therefore, it is necessary to have protective factors to prevent emotional distress for teachers.

Humanitarian Projects Development from Universidad del Zulia SIGHT Affinity Group

This work aims to divulge the volunteering experiences within humanitarian projects development from Universidad del Zulia SIGHT affinity group in Venezuela. At first, "Una mano por tu Facultad" project carried out in 2019 is described, which had the active participation of volunteers from the RE-IEEE-LUZ student branch and the SIGHT-LUZ affinity group and resulted in the recovery of twenty-six (26) classrooms and four (4) laboratories of the Faculty of Engineering. Furthermore, a new project is underway in response to COVID-19, which is focused on a distance education system using funds approved by the Humanitarian Activities Committee (HAC) and the Special Interest Group on Humanitarian Technology (SIGHT) of the Institute of Engineers Electrical and Electronic (IEEE). This group has the objective of bringing technologies-based solutions to problems existing in local communities in the Zulia State, Venezuela.

A case of burkholderia gladioli ventilator-associated pneumonia in a patient with COVID-19

INTRODUCTION: Burkholderia gladioli (B. gladioli) is primarily a plant pathogen but has been known to be pathogenic in patients with cystic fibrosis, chronic granulomatous disease or immunocompromised. METHODS: We hereby report a case of B. gladioli causing ventilator-associated pneumonia (VAP) in a patient with COVID-19. 68-year-old Hispanic man with a history of hypertension, type 2 diabetes mellitus, chronic kidney disease, and complete heart block with pacemaker presented to primary care office with fatigue, worsening shortness of breath, and decreased urine output for 2 days. He was found to be in acute respiratory distress with bilateral coarse breath sounds and saturating 60% on room air subsequently sent to ER for further evaluation. Transitioned to 100% high flow in the ER and was admitted to ICU. Pertinent work up showed pH of 7.2, bicarbonate (10 mmol/L), lactate (7.2 mmol/L), creatinine (5.5 mg/dl), d-dimer (2.0 mg/L), LDH (745 u/l), ferritin (5934 ng/mL). Chest x-ray showed bilateral infiltrates. Further increase in oxygen requirements required intubation. Intravenous ceftriaxone and azithromycin were started empirically for community-acquired pneumonia. Given his clinical presentation, PCR for SARS-Cov-2 was positive. He was treated with convalescent plasma and dexamethasone with decreasing ventilatory requirements and inflammatory markers. On day 13 of admission, the patient became febrile, WBC count of 24.4 k/ul, and increasing ventilatory requirements raising concern for VAP. Intravenous vancomycin and cefepime were started. Computed tomography pulmonary angiogram showed extensive pulmonary consolidation. Sputum culture grew B. gladioli. Based on susceptibilities levofloxacin was added to the antibiotic regime and cefepime was later switched to meropenem for double coverage in this critically ill patient. Despite aggressive management, he suffered multi-organ failure including acute respiratory distress syndrome (ARDS), acute renal injury requiring continuous renal replacement therapy, and shock unresponsive to vasopressors. The patient suffered cardiac arrest and died. RESULTS: COVID-19 pneumonia might have predisposed our patient to VAP with this rare organism. In spite of prompt recognition and aggressive treatment of infection, the outcome was fatal.

Health-related quality of life and resilience in peri- and postmenopausal women during Covid-19 confinement

Objective: To assess the impact of confinement due to the coronavirus (Covid-19) pandemic on health-related quality of life (HRQoL) and resilience in periand postmenopausal women. Material and Methods: We used an online questionnaire which was sent between April 30th and May 13th, 2020 to women aged 40-70 years who were perior postmenopausal according to STRAW criteria. We used the 16 item Cervantes short-form scale (Cervantes-SF) to measure HRQoL, and the 14-item Wagnild and Young Resilience Scale (RS-14) to measure resilience. High scores on the Cervantes-SF indicate low HRQoL and high scores on the RS-14 indicate high levels of resilience. Covid-19 status, sociodemographic descriptors, and lifestyle variables were also evaluated. Results: We included 2430 periand postmenopausal women with valid questionnaires. All items of the Cervantes-SF were completed in 2151 cases, whilst the RS-14 was completed in 2413 cases. There was a negative correlation between scores on the Cervantes-SF and RS-14 scales (Rho -0.350;p < 0.0001). Multiple linear regression analysis revealed a statistically significant association between Cervantes-SF scores and living with others (beta-coefficient -10.2;p < 0.001), use of antidepressants (beta 9.3;p < 0.001), physical activity (beta-8.6;p < 0.001) and sexual activity (beta-2.7;p < 0.001). Resilience was associated with the use of antidepressants (beta-5.9;p < 0.001), physical activity (beta 3.2;p < 0.001) and sexual activity (beta 1.7;p = 0.005). According to the multivariate analysis, there were no associations between either Covid-19 or menopausal status and HRQoL or resilience scores. Conclusions: During the period of mandatory Covid-19 confinement, periand postmenopausal women who engaged in physical and sexual activity had higher HRQoL and higher levels of resilience, whilst women who were using antidepressants had lower HRQoL and lower levels of resilience. HRQoL was greater in women who lived with others.