RED-EMAR - A Chilean pilot initiative of early detection and intervention in clinical high-risk subjects

The COVID-19 crisis has had a significant impact on the mental health of adolescents and young adults in South America. As a result, the appearance of a higher incidence of anxiety and depressive disorders in these countries have been documented and could lead to the appearance of severe mental health disorders. In this context, the prevention and early intervention in mental health is a current challenge in Central and South America. Since the last decade, the existence of initiatives in this field has been mapped in Mexico, Brazil, Chile and Argentina, mostly in first episode psychosis programs. However, Chile is the only country in South America with a multicentre prospective initiative for early detection and intervention in clinical high-risk subjects (called RED-EMAR). The aim of RED-EMAR is disseminate the value of the at-risk mental state concept (abbreviated to EMAR in Spanish), establish agreed therapeutic strategies in this field, and establish potential new evidence-based local interventions. The successful experiences of this network include the monitoring and discussion of clinical cases in telemedicine and the development of mental health psychoeducation guidelines. However, Insufficient resources, stigma, and the lack of mental health public policies are some of the weaknesses of this initiatives in South America. The development and access to early detection and intervention services in South America could be a window of opportunity to reduce the impact of severe mental health disorders such as psychosis and related disorders and move towards an approach aimed at prevention or delaying its onset.

Narratives of the convalescent plasma donor in a Peruvian social security hospital.: motivations, fears, expectations and experiences

Objectives: To know and explore from convalescent plasma donators' voices the experience in the blood donation process at a social security hospital. Methods: Qualitative study with a phenomenological design. The investigation was carried out in 01 hospitals of the social security of Peru. Semi-structured interviews were carried out. Results: Eleven donors of convalescent plasma were interviewed. The main motivations for donating were being able to contribute to national research and supporting patients affected by COVID-19. Fears focus on the possible risk of contagion within the hospital. Donors emphasised the attention and support of health personnel alongside the donation procedure. The main expectations and suggestions point towards greater dissemination of donation campaigns with special emphasis on safety. Likewise, an improvement in the time of the donation procedure (from enrolment to the extraction of convalescent plasma), and the implementation of friendly spaces to encourage future blood donation campaigns were highlighted. Conclusions: The experience of the convalescent plasma donors was positive. However, improvements must be made in terms of processes and infrastructure to ensure future successful blood donation campaigns.

The pyramid of experiential learning international relations through NationStates game

NationStates is an online game that offers players a world to simulate international relations learning through the creation of their own countries and interacting with other players as international actors. This paper describes how the game mirrors the basic structure of international relations and global politics, and on how it can be used as an education technology during the COVID-19 new normal learning. Using qualitative case study design, researchers utilised virtual transect walk to note observations within the simulation and juxtaposed to interviews gathered from students who experienced the game. Thematic analysis framed both the levels of international relations analysis and Kolb's theory of experiential learning. Results show that that such a game allows learners to experience and understand national power and the conditions within one's state, dynamics of decision-making, participation in the political system and behaviour of the global political actors under the theories of international relations.

ADHD in a patient with eating disorder. Case report

Introduction: 15-year-old female referred to outpatient unit after COVID lockdown for binge eating and purging with depressive symptoms and anxiety. Objective(s): To show the importance of a correct diagnosis in an impulsive patient with eating disorder Methods: case report and literature review Results: The patient presents emotional instability with interpersonal difficulties with high fear of rejection. She suffered from fear of gaining weight and desires to lose weight with rejection of her body image. Fluoxetine and lorazepam are started together with low doses of olanzapine. During the follow up she presented a worsening of mood, onset of self-injuries and an episode of suicidal attempt. A biographical examination was performed, expressing a feeling of academic failure with difficulty concentrating and performing simple tasks. As a child she is described as impulsive, with frequent arguments with classmates. CPT III was performed with a high probability of ADHD. Treatment was started with lisdexamfetamine up to 50 mg with good tolerance. From the beginning of the treatment the patient expressed a feeling of improvement in the control of emotions as well as in the management of her impulsivity. There was an improvement in her academic performance with a decrease in self-injury episodes. The patient was able to express improvement in the sense of incapacity she felt. Conclusion(s): This case shows how marked emotional dysregulation and impulsive symptoms improves after diagnosis and subsequent treatment of ADHD, also improving eating symptoms. ADHD is present in eating disorders, especially in those with impulse dyscontrol such as binge eating disorder or bulimia nervosa.

CNN for the detection of COVID-19 from chest X-ray images

COVID-19 can be detected by molecular tests or medical imaging. Doctors use medical images such as chest X-rays of patients to detect COVID-19, however, it is not so easy to detect the disease just by looking at an X-ray, in this work a system based on Convolutional Neural Networks (CNN) capable of classifying X-ray images of healthy patients, pneumonia patients and COVID-19 patients. The images were taken from the Kaggle open access datasets, 6279 images were taken in total, 4175 for training, 949 for validation and 1155 for testing. All the images were transformed at a resolution of 224x224 pixels and each pixel value was normalized, then the images were equalized by histogram. In the training stage, a CNN with MobileNet architecture was used, which has 50176 inputs (pixels), a hidden layer of 1000 neurons and an output layer of three neurons corresponding to the classes healthy lung, lung with pneumonia and lung with pneumonia by coronavirus. The Grad-CAM tool was used for visualization. For the test set, a batch size of 1 was used, this for the model to evaluate and classify each image, in this set a accuracy of 99.48 % was obtained on average for all categories. Where the objective is to contribute with an auxiliary tool for the detection of COVID-19 based on CNN. Thus, the proposed system is capable of differentiating and classifying chest X-ray images of healthy patients, with pneumonia and with COVID-19, so the system is capable of detecting COVID-19 with good precision. © 2022 IEEE.

Neurological manifestations associated with COVID-19 vaccine.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has spread rapidly, giving rise to a pandemic, causing significant morbidity and mortality. In this context, many vaccines have emerged to try to deal with this disease. OBJECTIVE: To review the reported cases of neurological manifestations after the application of COVID-19 vaccines, describing clinical, analytical and neuroimaging findings and health outcomes. METHODS: We carried out a review through bibliographic searches in PubMed. RESULTS: We found 86 articles, including 13 809 patients with a wide spectrum of neurological manifestations temporally associated with COVID-19 vaccination. Most occurred in women (63.89%), with a median age of 50 years. The most frequently reported adverse events were Bell's palsy 4936/13 809 (35.7%), headache (4067/13 809), cerebrovascular events 2412/13 809 (17.47%), Guillain-Barré syndrome 868/13 809 (6.28%), central nervous system demyelination 258/13 809 (1.86%) and functional neurological disorder 398/13 809 (2.88%). Most of the published cases occurred in temporal association with the Pfizer vaccine (BNT162b2), followed by the AstraZeneca vaccine (ChAdOX1-S). CONCLUSIONS: It is not possible to establish a causal relationship between these adverse events and COVID-19 vaccines with the currently existing data, nor to calculate the frequency of appearance of these disorders. However, it is necessary for health professionals to be familiar with these events, facilitating their early diagnosis and treatment. Large controlled epidemiological studies are necessary to establish a possible causal relationship between vaccination against COVID-19 and neurological adverse events.

On smoothing of data using Sobolev polynomials

Data smoothing is a method that involves finding a sequence of values that exhibits the trend of a given set of data. This technique has useful applications in dealing with time series data with underlying fluctuations or seasonality and is commonly carried out by solving a minimization problem with a discrete solution that takes into account data fidelity and smoothness. In this paper, we propose a method to obtain the smooth approximation of data by solving a minimization problem in a function space. The existence of the unique minimizer is shown. Using polynomial basis functions, the problem is projected to a finite dimension. Unlike the standard discrete approach, the complexity of our method does not depend on the number of data points. Since the calculated smooth data is represented by a polynomial, additional information about the behavior of the data, such as rate of change, extreme values, concavity, etc., can be drawn. Furthermore, interpolation and extrapolation are straightforward. We demonstrate our proposed method in obtaining smooth mortality rates for the Philippines, analyzing the underlying trend in COVID-19 datasets, and handling incomplete and high-frequency data. © 2022 the Author(s), licensee AIMS Press.

Global and Local Knowledge for English Language Learning: A Study at a National Police School

This article reports an action research study conducted to solve the problem that twenty-two English language students from a school in Cartagena de Indias considered the current teaching inadequate, and that they needed to develop topics of interest, aural-oral skills, and acquire vocabulary. The authors adjusted their practices, combined global and local themes, and brought multimodal texts to respond to the problem. The action stage of the study required the structuring of the course with themes on the identity of Cartagena de Indias under a Task-Based Learning methodology. The use of information and communication technologies was forced by the challenge of Covid-19, which demanded an abrupt transition from face-to-face to remote teaching and thus the inclusion of computer literacy. The new syllabus included topics close to the identity of the participants such as historical landmarks, economy, and tourism to simulate being a Cartagena tour guide so that learning was contextualized, evocative and expressive. The article presents one of the six workshops followed by an analysis of the data collected. The results of the study show that there were gains in language development attributable to the theme of global-local issues in the workshops that took half a school year for development. The pedagogical innovation also gave positive results in verbal fluency in which technological mediations and Task-Based Learning played an important role.

Mediation of Virtual Environments as Strategy to Develop Investigative Skills

The outbreak of the Covid-19 pandemic promoted the implementation of information technologies for academic processes, transforming paradigms and approaches at all formal levels of education. Therefore, the objective of this study was to analyze the development of research competencies in relation to the mediation of virtual learning environments. This was an exploratory-descriptive study, with a non-experimental design in the context of a case study;with an analysis from the interpretative paradigm and a mixed approach. A Likert-type virtual self-evaluation instrument was used;the study population consisted of 28 undergraduate students (84% female and 16% male), belonging to the Educational Research Workshop II course. One of the findings was the development of research competencies favored by the use of virtual learning environments. It was concluded that the development of research competencies is directly linked to the acquisition of technological competencies, which benefits the management of new didactic strategies for virtual learning environments.

Assessing the Impact of a Physician Resiliency and Wellness Program to Physician Burnout Levels in a Pediatric Department of a Tertiary Hospital: A Pilot Study of the I-CARE Program

Background. Physician burnout is a growing problem worldwide. Several interventions aimed at lowering burnout rates among physicians have been implemented. To date, there is no established structured program to combat burnout in the Philippine General Hospital. This study evaluated the effectiveness of the I-CARE program, a physician resilience and wellness program which adapted the different components of the international programs for the Philippine setting. Objective. To evaluate the effectiveness of the I-CARE program in reducing medical residents’ burnout level. Methods. After key components of the I-CARE program were identified, the program was implemented in 2 phases. The first phase involved training of consultants to hone their facilitation skills. The second phase was a before-and-after study of the I-CARE program. The participants’ burnout level was measured before and after the program using the Maslach Burnout Inventory. Results. The I-CARE program was implemented in the Department of Pediatrics from March to August 2020. There was no significant change in the overall burnout levels of 59 pediatric residents after the I-CARE implementation (p=0.32). This may be due to several challenges encountered during the implementation, such as time constraints, the increased workload caused by the COVID-19 pandemic, and the lack of physical meetings due to the restrictions of the pandemic. However, the feedback of the administrators, facilitators and residents was generally positive. All the interviewed participants recommended the continuation of the I-CARE program in the Department of Pediatrics. Conclusion. The I-CARE program shows potential in promoting mental health and emotional wellness among physicians in training. © 2022 University of the Philippines Manila. All rights reserved.

Environmental Variables and their Relation with the SARS-COV-2 Transmission: A Data Mining Approach

In the present paper are analyzed the correlations between the meteorological variables such as maximum temperature, minimum temperature, relative humidity, precipitation with the number of infections by SARS-CoV-2. The data set for the meteorological variables was obtained from web site of the National Service of Meteorology and Hydrology of Peru (SENAMHI), while the number of infections by SARS-CoV-2 was obtained from the denominated data positive by COVID 19 reported in web site by the Ministry of Health from Peru. After the preprocessing and the fusion of the data sets, it was obtained a data subset with 365 registers and 6 columns. To detect the correlations between the meteorological variables and the number of infections by SARS-CoV-2, the Spearman's rank correlation coefficient was computed. The results show significant correlations between the variables minimum temperature and number of infections by SARS-CoV-2 for a rho=-0.45, pvalor=0.00<0.05;relative humidity and number of infections by SARS-CoV-2 for a rho=-0.24, pvalor=0.00<0.05;precipitation and number of infections by SARS-CoV-2 for a rho=-0.24, p-valor=0.00<0.05. According to the results obtained, we concluded that minimum temperatures facilitate the SARS-CoV-2 transmissibility.

High Laboratory-confirmed SARS-CoV-2 Attack Rate in Lima Health Care Personnel during August 2020-March 2021 Suggests Role for Improved Infection Control

Background. Peru has one of the highest per capita SARS-CoV-2 death rates in Latin America. Healthcare workers (HCW) are a critical workforce during the COVID-19 pandemic but are themselves often at increased risk of infection. We evaluated SARS-CoV-2 attack rate and risk factors among frontline HCWs. Methods. We performed a prospective cohort study of HCW serving two acute care hospitals in Lima, Peru from Aug 2020 to Mar 2021. Participants had baseline SARS-CoV-2 serology using the CDC ELISA, active symptom monitoring, and weekly respiratory specimen collection with COVID-19 exposure/risk assessment for 16-weeks regardless of symptoms. Respiratory specimens were tested by real-time reverse transcriptase PCR (rRT-PCR). Results. Of 783 eligible, 667 (85%) HCW were enrolled (33% nurse assistants, 29% non-clinical staff, 26% nurses, 7% physicians, and 6% other). At baseline and prior to COVID-19 vaccine introduction, 214 (32.1%;214/667) were reactive for SARS-CoV-2 antibodies. In total, 72 (10.8%;72/667) HCWs were found to be rRTPCR positive during weekly follow-up. Of the rRT-PCR positive HCWs, 37.5% (27/72) did not report symptoms within 1-week of specimen collection. During follow up, HCW without detectable SARS-CoV-2 antibodies at baseline were significantly more likely to be rRT-PCR positive (65/453, 14.3%) compared to those with SARS-CoV-2 antibodies at baseline (4/214, 1.9%) (p-value: < 0.001). Three HCW were both serologically reactive and rRT-PCR positive at baseline. Looking only at HCW without SARS-CoV-2 antibodies, nurse assistants (rRT-PCR positive: 18.6%;27/141) and non-clinical healthcare workers (16.5%;21/127) were at greater risk of infection compared to nurses (8.5%;10/118), physicians (7.9%;3/38), and other staff (10.3%;4/29) (RR 1.95;95%CI 1.2,3.3;p-value: 0.01). Conclusion. Baseline SARS-CoV-2 prevalence and 16-week cumulative incidence were substantial in this pre-vaccination Peruvian HCW cohort. Almost 40% of new infections occurred in HCW without complaint of symptoms illustrating a limitation of symptom-based HCW screening for COVID-19 prevention. Nurse assistants and non-clinical healthcare workers were at greater risk of infection indicating a role for focused infection prevention and risk reduction strategies for some groups of HCW.

Pathophysiology of Acute Respiratory Failure by CoV-2 Infection: Role of Oxidative Stress, Endothelial Dysfunction and Obesity

Coronavirus disease 2019 (COVID-19) due to CoV-2 (coronavirus type 2) virus possess a particular risk of developing acute respiratory distress syndrome (ARDS) or SARS (severe acute respiratory syndrome coronavirus 2)-CoV2 in people with pre-existing conditions related to endothelial dysfunction and increased pro-inflammatory and pro-oxidant state. In between these conditions, chronic systemic inflammation related to obese patients is associated with the development of atherosclerosis, type 2 diabetes, and hypertension, comorbidities that adversely affect the clinical outcome in critical patients with COVID-19. Obesity affects up to 40% of the general population in the USA and more than 30% of the adult population in Chile. Until April 2021, 1,019,478 people have been infected, with 23,524 deaths. Given the coexistence of this worldwide obesity epidemic, COVID-19 negative outcomes are seriously enhanced in the current scenario. On the other hand, obesity is characterized by endothelial dysfunction observed in different vascular beds, an alteration which can be associated with impaired vasodilation, oxidative stress, and inflammatory events. Emerging evidence shows that obesity-related conditions such as endothelial dysfunction are associated with detrimental outcomes for COVID-19 evolution, especially if the patient derives to Intensive Care Units (ICU). This implies the need to understand the pathophysiology of the infection in the obese population, in order to propose therapeutic alternatives and public health policies, especially if the virus remains in the population. In this review, we summarize evidence about the pathogeny of Cov-2 infection in obese individuals and discuss how obesity-associated inflammatory and prooxidant status increase the severity of COVID-19. © 2021 Castillo et al.

Acute kidney injuryandhematuria aspoorprognostic factors in COVID-19 patients in one center in mexico city

INTRODUCTION AND OBJECTIVE: Kidney complications have been observed in coronavirus disease 2019 (COVID-19) patients, autopsy findings of patients who died from the disease have shown infiltration of the SARS-CoV-2 virus into the kidney podocytes. However, information is scarce about the renal clinical characteristics and their implication in patients prognosis. The objective is to assess acute renal injury (AKI), microscopic hematuria (MH) and gross hematuria (GH) in COVID-19 patients in one Mexican center as a predictive factor for invasive mechanical ventilation and mortality. METHODS: Analytical, transversal, observational and retrospective study in a single center in Mexico City, from March 2020 to July 2020. We assessed clinical records of 197 hospitalized patients with COVID-19, collecting information on clinical characteristics, lab results, AKI, MH, GH, invasive mechanical ventilation and mortality. RESULTS: 197 patients with COVID-19 were studied, 145 (73.6%) had an abnormal general urinalysis (UA) or altered serum creatinine (sCr) during their hospitalization. During a median of 14.9 days of hospitalization, 33 (16.7%) patients presented MH and 23 (11.6%) presented GH. 50 (25.3%) patients presented AKI on admission and 39 (19.7%) presented it at their last follow-up. After statistical analysis, associations for invasive mechanical ventilation were found, with MH [hazard ratio (95% confidence interval) p >] [0.78 (0.29-2.12) p >0.64], GH [0.64 (0.20-2.06) p >0.45], AKI at admission =0.93 (0.45-1.9) p > 0.85)] and AKI at their last follow-up [1.16 (0.58-2.31) p >0.66]. As well as the association of mortality with MH [0.81 (0.31-2.12) p >0.67], GH [0.62 (0.19-2.01) p >0.43], AKI at admission =0.92 (0.44-1.9 p >0.84) and AKI at their follow-up [2.77 (1.36-5.64) p >0.005]. CONCLUSIONS: Kidney abnormalities were found in a large number of COVID-19 patients. Although most cases with hematuria and kidney injury resolved, association of AKI at their last follow-up with mortality was the only statistically significant variable.