Optimal evaluation of re-opening policies for COVID-19 through the use of metaheuristic schemes.

A new contagious disease or unidentified COVID-19 variants could provoke a new collapse in the global economy. Under such conditions, companies, factories, and organizations must adopt reopening policies that allow their operations to reduce economic effects. Effective reopening policies should be designed using mathematical models that emulate infection chains through individual interactions. In contrast to other modeling approaches, agent-based schemes represent a computational paradigm used to characterize the person-to-person interactions of individuals inside a system, providing accurate simulation results. To evaluate the optimal conditions for a reopening policy, authorities and decision-makers need to conduct an extensive number of simulations manually, with a high possibility of losing information and important details. For this reason, the integration of optimization and simulation of reopening policies could automatically find the realistic scenario under which the lowest risk of infection was attained. In this paper, the metaheuristic technique of the Whale Optimization Algorithm is used to find the solution with the minimal transmission risk produced by an agent-based model that emulates a hypothetical re-opening context. Our scheme finds the optimal results of different generical activation scenarios. The experimental results indicate that our approach delivers practical knowledge and essential estimations for identifying optimal re-opening strategies with the lowest transmission risk.

Antiarrhythmic drug loading at home using remote monitoring: a virtual feasibility study during COVID-19 social distancing.

The epidemiological necessity for distancing during the COVID-19 pandemic has resulted in postponement of non-emergent hospitalizations and increase use of telemedicine. The feasibility of virtual antiarrhythmic drug (AAD) loading specifically with digital QTc electrocardiographic monitoring (EM) in conjunction with telemedicine video visits is not well established. We tested the hypothesis that existing digital health technologies and virtual communication platforms could provide EM and support medically guided AAD loading for patients with symptomatic tachyarrhythmia in the ambulatory setting, while reducing physical contact between patient and healthcare system. A prospective pilot, case series was approved by the institutional ethics committee, entailing three subjects with symptomatic arrhythmia during the COVID-19 pandemic who were enrolled for virtual AAD loading at home. Clinicians met with participants twice daily via video visits conducted after QTc analysis (Kardia 6L mobile sensor) and telemetry review (Mobile Cardiac Outpatient Telemetry of silent arrhythmias). Participants received direct instruction to either terminate the study or proceed with the next single dose of AAD. All participants completed contactless loading of five AAD doses, without untoward event. Scheduled video visits allowed dialogue and participant counselling where decision-making was guided by remote review of EM. Participant adherence with transmissions and scheduled visits was 98.3%; a single electrocardiogram was delayed beyond the 2 hours of post-dose schedule. This virtual approach reduced overall expenditures based on retrospective comparison with previous AAD load hospitalizations. We found that a 'virtual hospitalization' for AAD loading with remote EM and twice-daily virtual rounding is feasible using existing digital health technologies.

Percepción social del manejo informativo en los medios sobre COVID-19 en México

Se aborda la percepción social del manejo informativo de la pandemia por SARS­-CoV-2 en una muestra de 300 sujetos, 206 mujeres (68.7%) y 94 hombres (31.3%) de la Ciudad de México. La investigación indagó: medios de consumo;razones para compartir información;verificación de información;estados de ánimo al informarse;importancia de la veracidad de la fuente y propuestas para enfrentar noticias falsas. Los resultados muestran que las redes sociales son las más consultadas para informarse (56.7 %), el estado de ánimo predominante es la incertidumbre (41.7%) y que comparten información que les parece veraz (65%). Son consideradas más confiables, en una escala del 1 al 10, la información de universidades (8.42) y autoridades internacionales de salud (8.13). Sostienen que prevalece información falsa sobre la epidemia (94.7%), la cual es considerada muy dañina, que se da por ignorancia (43.4%) y que 7 de cada 10 personas cree la información falsa. Se observó una gran polarización política en las percepciones sobre la pandemia entre los que apoyan al gobierno de López Obrador y la oposición. La muestra expresó que para evitar información falsa es necesaria información científica (53.4%), que es necesario educar sobre medidas sanitarias (36%) y fomentar el pensamiento crítico (32%).

Exercise effects on cardiovascular disease: from basic aspects to clinical evidence.

Cardiovascular (CV) disease (CVD) remains the leading cause of major morbidity and CVD- and all-cause mortality in most of the world. It is now clear that regular physical activity (PA) and exercise training (ET) induces a wide range of direct and indirect physiologic adaptations and pleiotropic benefits for human general and CV health. Generally, higher levels of PA, ET, and cardiorespiratory fitness (CRF) are correlated with reduced risk of CVD, including myocardial infarction, CVD-related death, and all-cause mortality. Although exact details regarding the ideal doses of ET, including resistance and, especially, aerobic ET, as well as the potential adverse effects of extreme levels of ET, continue to be investigated, there is no question that most of the world's population have insufficient levels of PA/ET, and many also have lower than ideal levels of CRF. Therefore, assessment and promotion of PA, ET, and efforts to improve levels of CRF should be integrated into all health professionals' practices worldwide. In this state-of-the-art review, we discuss the exercise effects on many areas related to CVD, from basic aspects to clinical practice.

Factors associated with COVID-19 preventive health behaviors among the general public in Mexico City and the State of Mexico.

OBJECTIVE: To evaluate factors associated with COVID-19 preventive health behaviors among adults in Mexico City and the State of Mexico. METHODS AND FINDINGS: We conducted a cross-sectional survey from June to October 2020 through a structured, internet-based questionnaire in a non-probabilistic sample of adults >18 years living in Mexico City and the State of Mexico. The independent variables included sociodemographic and clinical factors; health literacy; access to COVID-19 information; and perception of COVID-19 risk and of preventive measures' effectiveness. The dependent variable was COVID-19 preventive health behaviors, defined as the number of preventive actions adopted by participants. The data were analyzed through multivariate negative binomial regression analysis. The survey was completed by 1,030 participants. Most participants were women (70.7%), had a high school or above level of education (98.8%), and had adequate health literacy and access to COVID-19 information. Only 18% perceived having a high susceptibility to COVID-19, though 83.8% recognized the disease's severity and 87.1% the effectiveness of preventive measures. The median number of COVID-19 preventive actions was 13.5 (range 0-19). The factors associated with preventive health behavior were being female, of older age, a professional worker, a homemaker, or a retiree; engaging in regular physical exercise; having high health literacy and access to COVID-19 information sources; and perceiving COVID-19 as severe and preventive measures as effective. CONCLUSION: People with high education and internet access in Mexico City and the State of Mexico reported significant engagement in COVID-19 preventive actions during the first wave of the COVID-19 pandemic.

High triglyceride to HDL-cholesterol ratio as a biochemical marker of severe outcomes in COVID-19 patients.

BACKGROUND & AIMS: Coronavirus disease 2019 (COVID-19) patients with severe complications have shown comorbidities with cardiovascular-disease, hypertension and type 2 diabetes mellitus; clinical disorders that share the common metabolic alterations of insulin resistance and dyslipidaemia. A high triglyceride to high density lipoprotein cholesterol (Tg/HDL c) ratio has been associated with reduced insulin sensitivity, metabolic syndrome and adverse cardiovascular events. Our aim in this study was to determine the association between different components of the lipid profile and particularly the Tg/HDL c ratio with severe complications like the requirement of invasive mechanical ventilation in COVID-19 patients. METHODS: We collected demographic, clinical and biochemical data to conduct a cohort study in 43 adult patients with confirmed COVID-19 diagnosis by quantitative polymerase chain reaction (qPCR) at baseline and in the subsequent 15 days. Patients were subjected to a very similar treatment scheme with the JAK1/2 inhibitor ruxolitinib. Descriptive statistics, variable association and logistic regression were applied to identify predictors of disease severity among elements and calculations from the lipid profile. RESULTS: Patients were aged 57 ± 14 years; 55.8% were male from which 75% required hospitalization and 44.2% were female who 58% were hospitalized. The most common comorbidities were type 2 diabetes mellitus (58%) and hypertension (40%). Hospitalized and critical care patients showed lower HDL c blood levels and increased Tg/HDL c ratio than those with outpatient management and mild/asymptomatic COVID-19. Tg/HDL c ratio correlated with variables of disease severity such as lactate dehydrogenase (LDH) levels (r = 0.356; p < 0.05); National Early Warning Score 2 (NEWS 2) (r = 0.495; p < 0.01); quick sequential organ failure assessment (qSOFA) (r = 0.538; p < 0.001); increased need of oxygen support (r = 0.447; p < 0.01) and requirement of mechanical ventilation (r = 0.378; p < 0.05). Tg/HDL c ratio had a negative correlation with partial oxygen saturation/fraction of inspired oxygen (SaO 2/FiO2) ratio (r = -0.332;p < 0.05). Linear regression analysis showed that Tg/HDL c ratio can predict increases in inflammatory factors like LDH (p < 0.01); ferritin (p < 0.01) and D-dimer (p < 0.001). Logistic regression model indicated that ≥7.45 Tg/HDL c ratio predicts requirement of invasive mechanical ventilation (OR 11.815, CI 1.832-76.186, p < 0.01). CONCLUSIONS: The Tg/HDLc ratio can be used as an early biochemical marker of COVID-19 severe prognosis with requirement of invasive mechanical ventilation.

Amiodarone in the COVID-19 Era: Treatment for Symptomatic Patients Only, or Drug to Prevent Infection?

Amiodarone, one of the most widely prescribed antiarrhythmic drugs to treat both ventricular and supraventricular arrhythmias, has been identified as a candidate drug for use against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present the rationale of using amiodarone in the COVID-19 scenario, as well as whether or not amiodarone administration represents a potential strategy to prevent SARS-CoV-2 infection, rather than simply used to treat patients already symptomatic and/or with severe coronavirus disease 2019 (COVID-19), based on current evidence.