Structural implications of SARS-CoV-2 Surface Glycoprotein N501Y mutation within receptor-binding domain [499-505]–computational analysis of the most frequent Asn501 polar uncharged amino acid mutations

The aim of this study was to evaluate the impact of the most frequent Asn501 polar uncharged amino acid mutations upon important structural properties of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) Surface Glycoprotein RBD–hACE2 (human angiotensin-converting enzyme 2) heterodimer. Mutations N501Y, N501T and N501S were considered and their impact upon complex solubility, secondary motifs formation and intermolecular hydrogen bonding interface was analyzed. Results and findings are reported based on 50 ns run in Gromacs molecular dynamics simulation software. Special attention is paid on the biomechanical shifts in the receptor-binding domain (RBD) [499-505]: ProThrAsn(Tyr)GlyValGlyTyr, having substituted Asparagine to Tyrosine at position 501. The main findings indicate that the N501S mutation increases SARS-CoV-2 S-protein RBD–hACE2 solubility over N501T, N501 (wild type): (Formula presented.), (Formula presented.). The N501Y mutation shifts (Formula presented.) -helix S-protein RBD [366-370]: SerValLeuTyrAsn into π-helix for t > 38.5 ns. An S-protein RBD [503-505]: ValGlyTyr shift from (Formula presented.) -helix into a turn is observed due to the N501Y mutation in t > 33 ns. An empirical proof for the presence of a Y501-binding pocket, based on RBD [499-505]: PTYGVGY (Formula presented.) 's RMSF peak formation is presented. There is enhanced electrostatic interaction between Tyr505 (RBD) phenolic -OH group and Glu37 (hACE2) side chain oxygen atoms due to the N501Y mutation. The N501Y mutation shifts the (Formula presented.) hydrogen bond into permanent polar contact;(Formula presented.);(Formula presented.). © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Converging Crises and the Cost of Exclusion: Unveiling the Invisible Women of Sri Lanka's Economy

In Sri Lanka, womens labor force participation has never exceeded 35% in over three decades. As of 2022, the country was ranked 110 out of 146 countries in the World Economic Forums Gender Gap Index. The gaps in womens participation in the formal economy alongside womens limited political empowerment are two leading causes for the country to be lagging in such global gender equality indicators. At a large cost to the economy, the existence of archaic gender norms that promulgate womens unpaid care work often exclude women from the formal labor force. This paper dissects the socio-economic and socio-political factors that lead to the invisibility of women in Sri Lankas economy, while seeking to understand how such underlying causes have been aggravated within the precarity of the post-pandemic context. It is important, now more than ever, to recognize the invisibility of women in Sri Lankas formal economy, while bringing about a transformative vision with a multi-pronged approach to address existing gaps and challenges. With reference to key principles of feminist economics, including the theoretical foundations of Claudia Goldin, Nancy Folbre, and Diane Elson, among others, the paper will make a case for inclusivity and intersectionality in policy recommendations aimed at encouraging womens entry, active engagement, contribution, and retention in Sri Lankas economy. The paper reaches a conclusion that when women lead, participate, and benefit equally in all aspects of life, societies and economies will thrive, thereby contributing to sustainable development and inclusive economic growth.

THE PLIGHT OF WOMEN ENTREPRENEURS DURING COVID-19 PANDEMIC LOCKDOWN IN SOUTH AFRICA

COVID-19, which is highly contagious, especially via person-to-person contact, is ravaging the world creating mayhem globally. Countries all over the world have devised various strategies to slow down the rate of spread of the COVID-19 which is not treatable presently. To curb COVID-19 spread, South Africa has been in several stages of lockdown since March 2020, restricting movement and business as usual. These lockdowns albeit imposed to keep people healthy and safe, have had tremendous negative impacts on business, especially those that require frequent movement and face-to-face contact with people. However, during lockdowns, one still needs to fend for self and family members, but without being able to work, there is no likelihood any income, even if government gives palliatives, it might not be enough to take care of critical needs of the family. Of note, a large percentage of households in South Africa are female-headed and as such, they often bear a larger burden in providing for themselves and children even prior COVID-19 outbreak not to mention during the course of the pandemic. Furthermore, many women, who are often the sole breadwinners of their households are involved in various business entrepreneurs to support themselves and their families. This paper looks at the plight of women business entrepreneurs during the COVID-19 pandemic lockdowns and their accessibility to the government stimulus package.

An understanding of how immigration offers a solution against the implications of the Covid-19 pandemic on youth entrepreneurship in South Africa

With the entire globe still amid a global pandemic, youth entrepreneurs endure the same impact as any regular business. These implications are either negative or positive or a combination of both. This paper aimed to educate South African youth and governments on the importance of ensuring that youth unemployment is kept low by engaging in entrepreneurship. Therefore, youth entrepreneurship is a solution to South Africa's youth unemployment issue. In addition, immigration was highlighted as a solution for those youth impacted tremendously by the pandemic. The pandemic brought many lockdowns and restrictions in South Africa, forcing existing and budding youth entrepreneurs to find alternatives or shut down completely. After using a qualitative approach in this paper, many recommendations are made in light of improving the state of youth entrepreneurship in South Africa. The most critical recommendation requires that South Africa, from the top-down, adopt a mindset that youth are South Africa's future. This will ensure that everything done to engage in the mentoring, uplifting and shaping of youth will reap the benefits of a better South Africa in years to come.

Coronavirus (COVID-19) pandemic implications on nursing care: A short review

The Coronavirus (COVID-19) disease is a global pandemic infectious disease caused by a novel coronavirus, which affects all age groups with a higher incidence in the geriatric population and people with chronic diseases. The outbreak of the virus is a serious public health challenge including to nurses at the various health care facilities around the world. The outbreak of the coronavirus has been a huge threat to nursing and nursing care globally. Nurses are experiencing a high level of daily emotional stress in their activities in preventing disease infections, promoting health, and saving lives. Many nurses have lost their lives to the deadly disease in their fight to save their patients, many feel stressed and burnout, and many feeling discouraged because of the protracted effects of the disease. The psychological health of the nurses as frontline health care workers should be safeguarded owing to their crucial roles in mitigating disease pandemics. Thus, adequate training of nurses would better equip them with the necessary information regarding the preventive measures, and management approaches to foster the mitigation of the disease, mitigate the disease burden on healthcare facilities, and enhance the recovery rate of the infected populations. Andfurther better prepare nurses on prioritizing personal psychological health.

Feminist Governance in the European Parliament: The Political Struggle over the Inclusion of Gender in the EU's COVID-19 Response

The research objective of this article is to analyze the European Parliament's response to the COVID-19 pandemic from the perspective of feminist governance. Feminist governance can either play a role in ensuring the inclusion of a gender perspective in crisis responses, or, quite the opposite, crises may weaken or sideline feminist governance. The empirical analysis focuses on two aspects of feminist governance: (1) a dedicated gender equality body and (2) gender mainstreaming. In addition to assessing the effectiveness of feminist governance, the analysis sheds light on the political struggles behind the policy positions. The article argues that feminist governance in the European Parliament was successful in inserting a gender perspective into the COVID-19 response. The article pinpoints the effects of the achievements of the European Parliament's Women's Rights and Gender Equality Committee and gender mainstreaming on gendering the pandemic crisis response.

Symptoms Predicting SARS-CoV-2 Test Results in Resident Physicians and Fellows in New York City

Accurate prediction of SARS-CoV-2 infection based on symptoms can be a cost-efficient tool for remote screening in healthcare settings with limited SARS-CoV-2 testing capacity. We used a machine learning approach to determine self-reported symptoms that best predict a positive SARS-CoV-2 test result in physician trainees from a large healthcare system in New York. We used survey data on symptoms history and SARS-CoV-2 testing results collected retrospectively from 328 physician trainees in the Mount Sinai Health System, over the period 1 February 2020 to 31 July 2020. Prospective data on symptoms reported prior to SARS-CoV-2 test results were available from the employee health service COVID-19 registry for 186 trainees and analyzed to confirm absence of recall bias. We estimated the associations between symptoms and IgG antibody and/or reverse transcriptase polymerase chain reaction test results using Bayesian generalized linear mixed effect regression models adjusted for confounders. We identified symptoms predicting a positive SARS-CoV-2 test result using extreme gradient boosting (XGBoost). Cough, chills, fever, fatigue, myalgia, headache, shortness of breath, diarrhea, nausea/vomiting, loss of smell, loss of taste, malaise and runny nose were associated with a positive SARS-CoV-2 test result. Loss of taste, myalgia, loss of smell, cough and fever were identified as key predictors for a positive SARS-CoV-2 test result in the XGBoost model. Inclusion of sociodemographic and occupational risk factors in the model improved prediction only slightly (from AUC = 0.822 to AUC = 0.838). Loss of taste, myalgia, loss of smell, cough and fever are key predictors for symptom-based screening of SARS-CoV-2 infection in healthcare settings with remote screening and/or limited testing capacity. [ FROM AUTHOR] Copyright of COVID is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Enhancing Employer Attractiveness: The Impact of COVID-19 on Generation Z

This paper investigates how employer attractiveness has been affected by developments in the attitudes, values, and goals of Generation Z (born between 1995-2010) due to the COVID-19 pandemic. Research shows the challenging environment for employers who are increasingly facing a 'war for talent' and the need to focus on generational needs and expectations. Work concepts in many cases have been adapted to Generation Y, but a revision of strategies is needed for the newest generation on the labour market. The insurance industry has long struggled to attract young talent and along with retail, logistics, tourism, and banking has been ranked the lowest in employer attractiveness by Generation Z. This is corroborated by the fact that larger corporations are also often perceived as unattractive by young people. While many industries have struggled with the consequences and challenges of the pandemic, the insurance sector can be seen as having mastered the crisis comparatively well. This paper questions whether the relative job security offered by the insurance sector, can be increasingly influential in post pandemic job choices. Since Generation Z was already described as securityoriented before the pandemic, this is expected to have increased as a result of COVID-19 and be reflected in their career and employer choices. The perspectives of Generation Z and employers from the German insurance industry are compared through survey and interview data. The young cohort suspects a worsening of their situation particularly in job offerings and security. At the same time, the insurance industry positions itself well in exactly these areas. Furthermore, the aspirations and expectations of Generation Z towards the professional world coincide strongly with the offerings of insurers as employers. However, the respondents see the sector's image as a deterrent. Although this paper focuses on the insurance industry, strategic recommendations given on how the sector can position itself, are relevant for other sectors facing the challenge of attracting Generation Z employees. © 2022 Authors. All rights reserved.

Herders Mobility, Food Security and Covid-19 Pandemic Challenges during Lockdown in Nigeria

Climate change is one of the cores of the herders' movement in Nigeria. Some other variable is the classification of the Fulanis as indigenous peoples that have no specific abode of their own;they roam around looking for water and foliage for their animals. During the dry season, they move towards the southern part of Nigeria where they would find foliage and water for their animals because of their status under international law. A notion that in a bid to look for food for their animals, these herders sometimes feed their animals with grown corn, cassava, millet, sweet potato and even yam of the sedentary farmers. One of the geneses of food insecurity in many communities of the southern part of Nigeria. Food availability, affordability and accessibility in the country was compromised in 2020 due to these challenges by the urban dwellers which was compromised due to the activities of mobile herders. With general lockdown in Nigeria, many farmers were unable to go to farm while the Fulanis who were hardly affected by lockdown had their field-days in feeding their animals on crops planted by small scale farmers, the only source of food security in the country. The core of this paper is to interrogate Fulanis mobility as indigenous peoples based on relevant international law and its impact on small-scale farmers' sources of income and food availability for the teeming population of Nigeria. We contextualised this based on the COVID-19 pandemic that restricts the movement of people between March and December 2020. We conclude that the rights of the indigenous peoples at the domestic level need further interrogation to create an atmosphere of peaceful co-existence through aversion of herders-farmers clashes that envelope southern Nigeria.

Platelet-monocyte aggregates: molecular mediators of thromboinflammation.

Platelets, key facilitators of primary hemostasis and thrombosis, have emerged as crucial cellular mediators of innate immunity and inflammation. Exemplified by their ability to alter the phenotype and function of monocytes, activated platelets bind to circulating monocytes to form monocyte-platelet aggregates (MPA). The platelet-monocyte axis has emerged as a key mechanism connecting thrombosis and inflammation. MPA are elevated across the spectrum of inflammatory and autoimmune disorders, including cardiovascular disease, systemic lupus erythematosus (SLE), and COVID-19, and are positively associated with disease severity. These clinical disorders are all characterized by an increased risk of thromboembolic complications. Intriguingly, monocytes in contact with platelets become proinflammatory and procoagulant, highlighting that this interaction is a central element of thromboinflammation.

Sensitivity to Neutralizing Antibodies and Resistance to Type I Interferons in SARS-CoV-2 R.1 Lineage Variants, Canada.

Isolating and characterizing emerging SARS-CoV-2 variants is key to understanding virus pathogenesis. In this study, we isolated samples of the SARS-CoV-2 R.1 lineage, categorized as a variant under monitoring by the World Health Organization, and evaluated their sensitivity to neutralizing antibodies and type I interferons. We used convalescent serum samples from persons in Canada infected either with ancestral virus (wave 1) or the B.1.1.7 (Alpha) variant of concern (wave 3) for testing neutralization sensitivity. The R.1 isolates were potently neutralized by both the wave 1 and wave 3 convalescent serum samples, unlike the B.1.351 (Beta) variant of concern. Of note, the R.1 variant was significantly more resistant to type I interferons (IFN-α/ß) than was the ancestral isolate. Our study demonstrates that the R.1 variant retained sensitivity to neutralizing antibodies but evolved resistance to type I interferons. This critical driving force will influence the trajectory of the pandemic.

Perception of training and job perspectives among final-year residents in the specialty of Endocrinology and Nutrition.

INTRODUCTION: The medical specialisation model in Spain is carried out in the context of specialised health training, through the residency programme. The aim of the study is to analyse, by an anonymous survey, the opinion on three aspects among final-year residents in Endocrinology and Nutrition (E&N): self-assessment of the knowledge acquired, working prospects, care and training consequences arising from the pandemic COVID-19. MATERIALS AND METHODS: Cross-sectional observational study using a voluntary and anonymous online survey, shared among final-year national interns in the last year of the E&N programme, carried out between June-July 2021. RESULTS: 51 responses were obtained, 66% of the fourth-year residents. Overall perception of their knowledge was 7.8 out of 10. Most external rotations were in thyroid and nutrition areas. A total of 96.1% residents, carried out some activity associated with COVID-19, with a training deterioration of 6.9 out of 10. 88.2% cancelled their rotations and 74.5% extended their working schedule. The average negative emotional impact was 7.3 out of 10. 80.4% would like to continue in their training hospital, remaining 45.1%. 56.7% have an employment contract of less than 6 months, most of them practising Endocrinology. CONCLUSION: The perception of the knowledge acquired during the training period is a "B". Residents consider that the pandemic has led to a worsening of their training, generating a negative emotional impact. Employment outlook after completing the residency can be summarised as: temporality, practice of Endocrinology and interhospital mobility.

"Y-type” PEG modified liposomes could eliminate the accelerated blood clearance (ABC) phenomenon and improved tumor therapy

Poly(ethylene glycol) (PEG) is widely applied to decorate nanocarriers due to its "long circulation” characteristics. However, the applications of linear PEG-modified nanocarriers have been hindered by severe adverse effects due to the accelerated blood clearance (ABC) phenomenon. It was universally known that anti-PEG antibodies (APAs) were main culprits in ABC phenomenon which induced the significant change in pharmacokinetics, biological distributions of the second injection and triggered complement activation-related pseudoallergies (CARPA). Recent studies have illustrated that APAs triggered the ABC phenomenon of PEGylated protein drug and even related to the CARPA of COVID-19 vaccine. Therefore, it is urgent to inhibit the generation of APAs and eliminate the ABC phenomenon. Here, "Y-type” PEG was chosen to replace linear PEG due to its weak immunogenicity. "Y-type” PEG-lipid derivatives [DSPE-mPEG2,n (n = 2, 10, and 20 kDa)]-modified doxorubicin liposomes (DOX-PL2,n) and topotecan liposomes (TP-PL2,n) induced lower levels of APAs and could avoid activating complement system. In further research, we found that liposomes decorated with DSPE-mPEG2,n could avoid the ABC phenomenon after duplicate injections. Furthermore, pharmacodynamic tests indicated that DOX-PL2,n and TP-PL2,n improved the curative effect of S180 tumor than DOX-PL2k and TP-PL2k (linear PEGylated liposomes). For the first time, DOX-PL2,n and TP-PL2,n were used for in vivo pharmacokinetic and pharmacodynamic experiments. Liposomes ornamented with "Y-type” PEG may provide new approaches to maintaining long blood circulation time, eliminating the ABC phenomenon of encapsulated active compounds, and also could weaken CARPA and improve tumor therapeutic effect. Our research aims to promote the research and development of "Y-type” PEG-decorated nanocarriers and provide a substantial academic basis for its clinical application.

Digi-cultural mindset

With this chapter, we want to provide a reading experience on how digitalization not only evokes a technical transformation but is also strongly related to a company's culture. Talking about digital transformation, there is more to consider than alignment between IT and business functions. We want to arouse interest in the reader to discover their organization's value system and provide triggers toward the development of a digi-cultural mindset. We will dive deeper into the stages of change and provide a target vision with ideas on how to master a transformation journey. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021.

How the pandemic affected interregional inequality in Russia

Analysis of trends in interregional inequality in Russia in 2015–21 and of the actual outcome during the 2020 pandemic and the subsequent recovery in 2021 reveals short-term regional convergence in seven indicators, albeit of different depth and duration. Sub-federal budget revenue experienced the most significant and persistent reduction in interregional disparities, the main sources of which were a reduction of unevenness in a number of taxes, a significant increase in federal transfers and a change in their nature. After a strong short-term convergence, industry, trade, transport and investment all tended to return to long-term divergence paths. Personal income and wage inequality responded weakly to the shock in the short term and entered the new long-term path. Multidirectional spatial trends resulted from the interaction of sectorial and fiscal policy effects during the pandemic. (English) [ FROM AUTHOR] Cómo ha afectado la pandemia en las desigualdades interregionales en Rusia. Area Development and Policy. En los análisis sobre las tendencias en las desigualdades interregional en Rusia durante el periodo de 2015 a 2021, el resultado actual durante la pandemia de 2020 y la recuperación posterior en 2021 se observa una convergencia regional a corto plazo en siete indicadores, si bien con diferencias en cuanto a la profundidad y la duración. En los ingresos presupuestales subfederales se observó la reducción más significativa y persistente en las desigualdades interregionales, siendo las principales fuentes la reducción de las desigualdades en una serie de impuestos, un aumento significativo en las transferencias federales y un cambio en su naturaleza. Tras una fuerte convergencia a corto plazo, la industria, el comercio, el transporte y las inversiones tendían a volver a las rutas de divergencia a largo plazo. Los ingresos personales y las desigualdades salariales respondieron débilmente al choque a corto plazo y entraron en una nueva fase a largo plazo. Las tendencias espaciales multidireccionales surgieron a partir de la interacción de los efectos de la política sectorial y fiscal durante la pandemia. (Spanish) [ FROM AUTHOR] Как пандемия повлияла на межрегиональное неравенство в России. Area Development and Policy. Анализ тенденций межрегионального неравенства в России в 2015–21 гг. и фактического неравенства во время пандемии 2020 г. и последующего восстановления в 2021 г. выявил краткосрочную конвергенцию регионов по семи показателям разной глубины и продолжительности. В доходах субфедерального бюджета произошло наиболее значительное и стойкое сокращение межрегиональных диспропорций, основными источниками которого стали уменьшение неравномерности по ряду налогов, значительное увеличение федеральных трансфертов и изменение их характера. После сильной краткосрочной конвергенции промышленность, торговля, транспорт и инвестиции, как правило, возвращались к долгосрочным траекториям дивергенции. Неравенство личных доходов и заработной платы слабо отреагировало на шок в краткосрочной перспективе и вступило на новую долгосрочную траекторию. Разнонаправленные пространственные тренды возникали в результате взаимодействия отраслевых эффектов и фискальной политики во время пандемии. (Russian) [ FROM AUTHOR] 流行病如何影响俄罗斯地区间不平等? Area Development and Policy. 本文分析了2015–21年间俄罗斯区域间不平等趋势、2020年爆发的流行病所造成的实际结果以及2021随后的疫情恢复情况, 研究表明七个指标在短期内区域趋同, 尽管深度和持续时间不同。联邦以下各级预算收入在区域间差异方面经历了最显著和持久的减少, 其主要来源是一些税收不平衡性减少, 以及联邦转移的显著增加和其性质的改变。在短期强劲趋同之后, 工业、贸易、运输和投资都倾向于回归长期的趋同路径。个人收入和工资不平等在短期内对冲击反应微弱, 并进入新的长期路径。多方的空间趋势是流行病期间部门和财政政策影响相互作用的结果。 (Chinese) [ FROM AUTHOR] Copyright of Area Development & Policy is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Striking a match between FHIR-based patient data and FHIR-based eligibility criteria

Inputs and Outputs: The Strike-a-Match Function, written in JavaScript version ES6+, accepts the input of two datasets (one dataset defining eligibility criteria for research studies or clinical decision support, and one dataset defining characteristics for an individual patient). It returns an output signaling whether the patient characteristics are a match for the eligibility criteria.Purpose: Ultimately, such a system will play a "matchmaker" role in facilitating point of-care recognition of patient-specific clinical decision support.Specifications: The eligibility criteria are defined in HL7 FHIR (version R5) Evidence Variable Resource JSON structure. The patient characteristics are provided in an FHIR Bundle Resource JSON including one Patient Resource and one or more Observation and Condition Resources which could be obtained from the patient's electronic health record.Application: The Strike-a-Match Function determines whether or not the patient is a match to the eligibility criteria and an Eligibility Criteria Matching Software Demonstration interface provides a human-readable display of matching results by criteria for the clinician or patient to consider. This is the first software application, serving as proof of principle, that compares patient characteristics and eligibility criteria with all data exchanged using HL7 FHIR JSON. An Eligibility Criteria Matching Software Library at https://fevir.net/110192 provides a method for sharing functions using the same information model.

Primary Care Physicians' Knowledge, Attitude and Practice towards Bariatric Operations in the Kingdom of Bahrain

Background: Obesity is an epidemic treatable disease. In Bahrain, the prevalence of obesity was 36.2%. Bariatric surgery should be considered for patients with BMI >= 40, or >= 30 with obesity-related comorbidities. Family physicians have a key role in identifying and counseling patients who may qualify for bariatric surgery. The most common reason for physicians' refusal of referral for bariatric surgeries is fear of complications followed by concern of ineffective weight loss following the surgery. Doctors are not comfortable providing post bariatric operation care. Aim(s): To study the PCPs' knowledge, attitude and practice towards bariatric surgeries in the kingdom of Bahrain. Method(s): this is a cross-sectional study of a convenient sample of physicians working in the Kingdom of Bahrain health centers, using an electronic and manual questionnaire to test the knowledge, attitude and practice towards bariatric surgery. Result(s): The sample included a total of 222 participants. 56.1% agreed that the BMI >= 40 without weight related comorbidities is an indication for bariatric surgery and 92.3% of them referred patients for bariatric surgery, with BMI (88.6%) as the most influential factor followed by presence of comorbidities (87.8%). On the other hand, lack of resources was the main cause for not referring patient for bariatric surgery (29.4%) followed by concerns with follow up (23.5%). 80.6% are comfortable to initiate conversations with their patients about bariatric surgery, while 36.1% feel comfortable explaining the procedural options to a patient. 83.8% agreed that additional medical education in bariatric surgical care would be useful. Conclusion(s): Primary care physicians showed well knowledge about the referral criteria to bariatric surgeries and that's reflected by the high referral rate (92.3%). But there is a gap in the knowledge mean score across different age groups and experience. Less than half of the physicians are not comfortable dealing with patients. Continuous medical education is essential to address the gap and to establish comprehensive obesity management guidelines for primary care physicians.Copyright © 2023, Bahrain Medical Bulletin. All rights reserved.

Evidencia sobre estrategias de prevención y rehabilitación del síndrome post-UCI en adultos: una revisión de revisiones sistemáticas

Resumen Introducción El síndrome post-UCI (PICS, por sus siglas en inglés) es un síndrome que cada vez más cobra importancia debido al creciente número de pacientes sobrevivientes a la enfermedad crítica, fenómeno que se ha visto acentuado especialmente luego de la pandemia del COVID-19. El enfoque de la práctica médica que atiende a estos pacientes debe estar orientado en las mejores intervenciones disponibles para prevenir y rehabilitar las secuelas del PICS. Objetivo Sintetizar la evidencia sobre la eficacia y la efectividad de las estrategias para la prevención y rehabilitación del PICS en pacientes adultos. Métodos Revisión de revisiones sistemáticas (CRD42022321610). Se buscaron en PubMed, Scopus, Ovid (Cochrane) y LILACS las revisiones sistemáticas que evaluaran cualquier intervención para prevenir o rehabilitar el PICS y su efecto en algunas de las esferas del PICS (es decir, desenlaces mentales, cognitivos o físicos). Resultados Se incluyeron 20 estudios, 10 catalogados como de baja y muy baja calidad metodológica, por lo que no se incluyeron en la síntesis de resultados. Las terapias a nivel de las esferas mental y cognitiva parecen tener un efecto benéfico, pero con evidencia limitada. Las intervenciones analizadas en la esfera física son muy heterogéneas y tienen resultados contradictorios, igualmente con calidad de evidencia muy limitada. Conclusiones Teniendo en cuenta las revisiones sistemáticas incluidas en este trabajo, esta investigación permite concluir que hay información de baja calidad y contradictoria sobre la eficacia de las intervenciones para la prevención o rehabilitación del PICS. La práctica futura debe centrarse en desarrollar estudios de alta calidad. Introduction Post-ICU syndrome (PICS) is a syndrome that is becoming increasingly important due to the growing number of patients surviving critical illness, a phenomenon that has been accentuated especially after the COVID-19 pandemic. The focus of the medical practice that cares for these patients should be oriented toward the best available interventions to prevent and rehabilitate the sequelae of PICS. Objective To synthesize the evidence on the efficacy and effectiveness of strategies for preventing and rehabilitating PICS in adult patients. Methods Umbrella review (CRD42022321610). PubMed, Scopus, Ovid (Cochrane), and LILACS were searched for systematic reviews evaluating any intervention to prevent or rehabilitate PICS and its effect on any of the PICS domain(s) (i.e., mental, cognitive, or physical outcomes). Results 20 studies were included, and 10were classified as of low or very-low methodological quality, so they were not included in the summary of results. Therapies at the mental and cognitive levels seem to have a beneficial effect but with limited evidence. The interventions analyzed in the physical sphere are very heterogeneous and have contradictory results, with little quality of evidence. Conclusions Considering the systematic reviews included in this work, this research allows us to conclude that there is low-quality and contradictory information on the efficacy of interventions for the prevention or rehabilitation of PICS. Future practice should focus on developing high- quality studies.

SARS-CoV-2 Alpha Variant Infection of a Patient Immunized by Inactive Sinovac (CoronaVac) Vaccine

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first detected in December 2019, and shortly after pandemic has been declared by the World Health Organization (WHO) due to its unstoppable global spread. Considerable amount of effort has beenput around the World in order to develop a safe and effective vaccine against SARS-CoV-2. Inactivated and RNA vaccines have already passed phase three studies showing sufficient efficacy and safety, respectively. Nowadays, there is a noticeable dominance of SARS-CoV-2 variants with various mutations over the wild type SARS-CoV-2. However, there is no report showing the efficacy of these vaccines on these variants. This case study describes a thirty-eight-year-old male reported to be infected with SARS-CoV-2 alpha variant following two doses of inactive CoronaVac administration with a protective level of SARS-CoV-2 specific antibodies. The variant analysis of the virus reported to be positive for N501Y mutation.This is the first case in the literature demonstrating that inactive SARS-CoV-2 vaccine might have a lower efficacy on alpha variant.Copyright © 2022 Cenk Serhan Ozverel et al., published by Sciendo.