Preparedness and coping with the COVID-19 pandemic

Health disasters have affected humanity since its dawn. In other epidemics, the casualties caused number in the hundreds of thousands. The preparation for confronting the COVID-19 epidemic at the Military Hospital of Matanzas, "Dr. Mario Muñoz Monroy”, began early. In order to analyze this experience, we reflect on the results of the confrontation in 2020, based on the main aspects, the coordination with other organizations, the decisions made, structural changes and modifications of institutional processes. Consolidating scientific improvement has been a permanent pillar, along with discipline, personal and social responsibility of the members of the collective. © 2023, Editorial Ciencias Medicas. All rights reserved.

RELATION BETWEEN COVID-19 AND ANCA VASCULITIS. STUDY IN A SINGLE UNIVERSITY HOSPITAL

BackgroundAnti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV) is a small vessel vasculitis. Hallmarked by the presence of antibodies against antigens in cytoplasmic granules of neutrophils. Different microbiological agents and vaccines can trigger an AAV, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection and Coronavirus disease 2019 (COVID-19) vaccine.ObjectivesTo compare: a) proportion of positive ANCA (+ANCA) test in 2019 (COVID-19 pre-pandemic) vs 2021 (COVID-19 pandemic), b) clinical features and c) vasculitis activity between vasculitis related to COVID 19 vaccination vs non-related.MethodsAll ANCA tests performed in 2019 and 2021 in a referral hospital were reviewed. Additionally, we studied 18 +ANCA patients diagnosed in 2021 and accepted to participate in present study. The patients were divided in two groups: a) +ANCA after SARS-CoV-2 mRNA vaccine (COVID-related) and +ANCA before COVID-19 vaccine (COVID-nonrelated). Diagnosis of underlying AAV was based on ACR/EULAR 2022 criteria. Disease activity was assessed with Birmingham Vasculitis Activity Score (BVAS). ANCA testing was done by chemiluminescence assay using IO-FLASH (Inova, San Diego, CA) according to the instructions of the manufacturer.ResultsANCA tests were positive in 14 of 1287 cases (1.1%) and in 32 of 1434 (2.2%) cases in 2019 and 2021, respectively (figure 1, the differences were statistically significant (p=0.020). The main features of 18 ANCA+ patients diagnosed in 2021 are summarized in table 1. COVID-19 related patients showed a median of 7 points on BVAS score compared of the median of 5 points on BVAS score on not related patients.ConclusionThere seems to be an increase of +ANCA at the expense of anti-PR3 antibodies following the COVID-19 vaccine. In patients with +ANCA following vaccination there seems to be an increased disease activity according to BVAS score without reaching statistical significance.References[1]Damoiseaux, J., et al Autoimmunity Reviews.2021. PMID 34896650.[2]Irure-Ventura, et al. IScience.2022. PMID 35937087.Table 1.Main general features of 18 patients with ANCA+ test diagnosed in 2021.FEATURESAll cases n= 18Related n= 13Non-related n= 5p*Age (years), mean±SD62±1767±15.352±16.50.167Male/ Female n, (% male)10/8 (55.6)9/4 (69.2%)1/4(20)0.067ANCA-test specificity, n (%)MPO-ANCA9 (50)7 (53.8)2(40)0.609PR3-ANCA8 (44.4)5 (38.5)3(60)0.423Both1 (5.6)1 (7.7)0-CRP (mg/dL), median [IQR]2,4 [0.4-10.7]3.8 [0.4-10.1]1 [0.4-10.9]0.802ESR, mm/1st hours, median [IQR]50 [25-104]47 [25.3-71.8]50 [25-120]0.634BVAS, median [IQR]6.5 [4.2-8]7 [4-8]5 [5-8]0.842FFS, n (%)03 (16.7)2 (15.4)1 (20)0.819≥115 (83.3)11 (84.6)4 (80)0.819ENT involvement, n (%)12(66.7)10 (76.9)2 (40)0.148MSK involvement, n (%)11(61.1)7(53.8)4 (80)0.322CNS/PNS involvement, n (%)10 (55.6)7 (53.8)3 (60)0.819Lung involvement, n (%)9 (50)6 (46.2)3 (60)0.609Kidney involvement, n (%)8 (44.4)7 (53.8)1 (40)0.208Ocular involvement, n (%)2 (11.1)2 (15.4)00.366Cutaneous involvement, n (%)2 (11.1)02 (40)0.019*p values according to Man Whitney test.Abbreviations (in alphabetical order):AAV: anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis;ACR: American college of Rheumatology;ANCA: Antineutrophil cytoplasmic antibody;BVAS: Birmingham Vasculitis Activity Score;CNS: central nervous system;CRP: C-Reactive protein;dL: deciliter;ENT: ear, nose, throat;ESR: erythrocyte sedimentation rate;FFS: Five-Factors Score;g;IQR: Interquartile range;mg: milligram;MSK: musculoskeletal;MPO-ANCA= ANCA specific for myeloperoxidase;n=Number;PNS: peripheral nervous system;PR3-ANCA= ANCA specific for proteinase 3;SD: Standard DeviationFigure 1.Comparison of ANCA test in 2019 and 2021.[Figure omitted. See PDF]Acknowledgements:NIL.Disclosure of InterestsFabricio Benavides-Villanueva: None declared, Vanesa Calvo-Río Speakers bureau: Dra V. Calvo had participation in company-sponsored speaker´s bureau from Roche, Novartis, Galápagos, UCB Pharma, MSD, Celgene, and Grünenthal and received support for attending m etings and/or travel from Janssen, Abbvie, Roche, Novartis, MSD, UCB Pharma, Celgene, Lilly, Pfizer, Galápagos., J. Loricera Speakers bureau: Dr. J. Loricera had participation in company-sponsored speaker´s bureau from Roche, Novartis, Galápagos, UCB Pharma, MSD, Celgene, and Grünenthal., Consultant of: Dr. J. Loricera had consultation fees in company-sponsored speaker´s bureau from Roche, Novartis, Galápagos, UCB Pharma, MSD, Celgene, and Grünenthal and received support for attending meetings and/or travel from Janssen, Abbvie, Roche, Novartis, MSD, UCB Pharma, Celgene, Lilly, Pfizer, Galápagos., Juan Irure-Ventura: None declared, Marcos Lopez-Hoyos: None declared, Ricardo Blanco Speakers bureau: Dr. R. Blanco had participation in company sponsored speaker´s bureau from Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD., Consultant of: Dr. R. Blanco had consultation from Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD., Grant/research support from: Dr. R. Blanco received grants/research supports from Abbvie, MSD and Roche.

Presence of SARS-CoV-2 in HEPA Filters of Portable Air Cleaners

A method for determining the presence of SARS-CoV-2 RNA in HEPA filters from portable air cleaners (PACs) have been developed and validated. Herein, a monitoring survey was conducted for 13 weeks in three indoor environments, school, nursery and a household of a socio-sanitary center in Ciudad Real, Spain. In this study, we employed environmental monitoring by RT-PCR of the presence of SARS-CoV-2 in HEPA filters and other surfaces of these indoor spaces for a selective screening in asymptomatic population groups. The aim was to limit outbreaks in an early stage. Only one HEPA filter tested positive in the socio-sanitary center. After analysis by RT-PCR of SARS-CoV-2 in residents and healthcare workers, one worker tested positive. Therefore, this study provides direct evidence of virus-containing aerosols trapped in HEPA filters and the possibility of using these PACs for environmental monitoring of SARS-CoV-2 while they remove airborne aerosols and trap the virus. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

PREDICTIVE SEVERITY FACTORS of COVID-19 in PATIENTS with RHEUMATIC IMMUNE MEDIATED DISEASES

Background: COVID-19 has become a common disease in patients with rheumatic immune-mediated diseases (R-IMID). A risk stratifcation of the patients at COVID-19 onset is important to predict possible unfavorable results. Objectives: To identify predictive severity factors in patients with COVID-19 with R-IMID. Methods: Cross-sectional study in a single University Hospital. We included all consecutive patients with a R-IMID and COVID-19 up to November 6th, 2020. Confrmed infection was defned if the patient had a positive nasopharyngeal swab for SARS-CoV-2. COVID-19 case severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) COVID-19 guidelines (1). We performed a multivariable analysis and calculated de odds ratio of critical COVID in patients with R-IMID, adjusting by age, sex and comorbidities. Results: We included 274 patients with R-IMID complicated with COVID-19. At COVID-19 onset, the main comorbidities, analytical values, underlying R-IMID and treatments received are shown in Table 1. According to COVID-19 severity, patients were mild (n=209;76.3%), moderate (n=35;12.8%), severe (n=9;3.3%) and critical (n=21;7.7%). The predictive variables at COVID-19 onset related statistically to critical COVID were older patients, hypertension, dyslipidemia, previous cardiovascular disease, cancer, chronic kidney disease, and chronic liver disease. The only underlying R-IMID and treatment was polymyalgia rheumatica and Rituximab, respectively. Regarding analytical values were higher values of C-reactive protein, LDH, platelets and lymphopenia (Figure 1). Conclusion: We identifed various factors associated with a worse prognosis of COVID-19 in patients with R-IMID. This can help to identify which patients can present a worse course of the disease at the moment of the diagnosis.

COVID 19 INFECTION in PATIENTS with RHEUMATIC IMMUNE-MEDIATED DISEASES in A SINGLE UNIVERSITY HOSPITAL. MATCHED CASE-CONTROL STUDY

Background: COVID19 may present different degrees of severity. It is generally thought that viral infections in patients with rheumatic infammatory diseases (R-IMID) or receiving immunosuppressive treatment tend to present more severe disease. However, data comparing the severity of the disease between R-IMID and the general population are scarce. Objectives: To assess the predisposing factors, clinical-analytical features and severity of COVID-19 infection in R-IMID compare to patients without R-IMID. Methods: Case-control study in a single University Hospital. We included all consecutive patients with a diagnosis of a R-IMID and a positive test for COVID-19 up to March 31st, 2021. A total of 274 controls were selected for each case, and matched by sex, age (± 5 years), and without previous diagnosis of R-IMID or use of immunosuppresive therapy. Confrmed infection was defned if the patient had a positive nasopharyngeal swab for SARS-CoV-2. COVID-19 case severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) COVID-19 guidelines (1). Mild/moderate COVID19 was compared with critical. Results: We included 274 patients (185 women/89 men), mean age 59.1 18 years. More frequent R-IMID were: Rheumatoid arthritis (RA) (n=87, 31.8%), Axial spondylarthritis/Psoriatic arthritis (SpA/PsA) (n=90, 32.8%), Polymyalgia Rheumatica (PMR) (n=22, 8%) and Systemic Lupus Erythematosus (SLE) (n=22, 8%) We also included 274 age and matched controls. Main characteristics of patients with R-IMID and controls are shown in Table 1. Concerning comorbidities, hypertension and dyslipidemia were more frequent in patients with R-IMID (p< 0.05). COVID-19 symptoms' distribution is shown in Figure 1. Cough and dyspnoea were more frequent and headache, odynophagia and diarrhea were less frequent in the R-IMID group. The only analytical difference was D-Dimer that was signifcantly higher in patients with R-IMID. Although most of the cases were mild, critical cases and deaths were more frequent in R-IMID (p <0.05). Conclusion: Most of the patients present a mild COVID-19. However, a more severe syndrome was observed in R-IMID.

Preferences in the Intention to Download a COVID Tracing App: A Discrete Choice Experiment Study in the Netherlands and Turkey

Introduction: High levels of adoption and usage for the COVID Tracing Apps (CTA) among the population is a stipulated prerequisite for success of the implementation of these apps, aiming to mitigate the pandemic and track spreading of the virus more efficient and effectively. In the current study, the main objective was to investigate individuals' preferences in the intention to download a COVID-19 tracing app in a pilot-study in both the Netherlands and Turkey. Methods: We conducted a discrete choice experimental study through an online survey in two countries (the Netherlands [N = 62] and Turkey [N = 83]), with four different attributes: (1) data protection (data protection vs. no information), (2) manufacturer (government vs. company), (3) reward (no reward vs. voucher as a reward) and (4) gaming (no gaming elements vs. gaming elements). Participants were recruited among a student population. Results: The results showed that data protection is one of the most important factors that significantly increases the probability to adopt a CTA. In general, the manufacturer, reward or gaming affected the probability to download the CTA less. Discussions: Health authorities worldwide have generally released high quality CTA, although scientific studies assessing the most important factors that describe and predict the intention to download is limited. Sensitive personal data is collected through these apps, and may potentially threaten privacy, equality and fairness, which are important attributes to take into account when developing or launching a CTA, following the results of this study. Copyright © 2022 Folkvord, Peschke, Gümüş Ağca, van Houten, Stazi, Roca-Umbert, Güneş Peschke, Seyfafjehi, Gallego, Gaeta, Fico, Karinsalo and Lupianez Villanueva.

Maternal characteristic and perinatal outcomes among peruvian women infected with COVID-19. An observational and cross-sectional study

Objetive: To determine the maternal characteristics of women infected with COVID-19 and their neonates born in the COVID-19 referral hospital (HRDT) between April and September 2020.Material and Methods: Observational and cross-sectional study carried out in the HRDT that included 703 obstetric patients with COVID-19. Results: The average age was 27 years. 35.7% were nulliparous and 95% were asymptomatic for COVID-19. 3%, 1% and 1% had mild, moderate and severe COVID-19;respectively. The most frequent symptoms were cough (84.85%) and anosmia (39.39%). The most common signs were tachypnea (60.61%) and respiratory distress (51.52%). Blood gas, D-dimer, and ferritin were altered in 71%, 54%, and 30%;respectively. The most frequent medical complications were: sepsis (2.28%), pneumonia (2.13%), respiratory failure (2.13%) and septic shock (1.14%). The most frequent obstetric complications were premature rupture of membranes (6.69%), severe preeclampsia (5.41%), abortive syndrome (3.27%) and preterm labor (2.56%). 73.9% of deliveries were by Caesarean section. 0.99% of patients required intensive care unit and maternal mortality was 0. 2%. 85.7% of neonates were at term and 97.2% had APGAR ≥7 at 5 minutes. There were 4 neonatal deaths (0.64%) and 16 deaths (2,58%). There were 8 positive RT-PCR in neonates (1.3%). Conclusion: The majority of patients were nulliparous, under 35 years of age and asymptomatic for COVID-19. Most of the newborns were born by cesarean section and evolved favorably. There were two maternal deaths, 16 stillbirths, and 4 neonatal deaths © Revista del Cuerpo Medico Hospital Nacional Almanzor Aguinaga Asenjo 2021.

Human computer interaction challenges in designing pandemic trace application for the effective knowledge transfer between science and society inside the quadruple helix collaboration

In the last decade, smartphone users grown from 2.8 billion worldwide in 2018 to 3.8 billion in 2021. This fact associates with greater ease of publishing and accessing fake news. This is a particularly concerning issue in a global crisis situation such as the COVID-19 pandemic. As stated by the WHO, this is a global health crisis and the spread of fake information could have a direct impact on people’s wellbeing. Due to this situation, all systems which compose the quadruple helix (i.e., science, economy, politics and media and culture-based public) are under great pressure. On the one hand, citizens demand fast and trusted information, and on the other hand, the scientific community is pushed to publish, resulting in scientific papers published very fast and, sometimes, without adequate peer review processes, as reflected by the unprecedented number of retreats. The PandeVITA ecosystem will contribute to offering a better understanding of how societal actors’ behave, understanding their reaction to and interaction with science and health developments in the context of pandemics, with the aim to encourage citizens to contribute to scientific research with different kinds of data. This paper describes a novel approach to citizen science interventions and user engagement based on motivational theory and behavioral science, aiming to provide a set of architectural components, technologies, tools and analytics to assess citizens’ activities, system performance and stakeholders-related key performance indicators (KPIs) in an observatory fashion, allowing to investigate the motivation of the target participants, user engagement and long-term retention. © Springer Nature Switzerland AG 2021.

Factors associated with mortality in patients with rheumatic diseases and COVID-19 in Mexico

Background: As of the 25th of January 2021, more than 150 thousand deaths as consequence of COVID-19 have been reported in Mexico [1]. Advanced age, male gender and comorbidities have been described as risk factors for severe disease and mortality in general population [2]. COVID-19 mortality in Mexican patients with rheumatic and musculoskeletal diseases (RMDs) is unknown. Objectives: To describe characteristics of Mexican patients with RMDs and COVID-19, and to analyse factors associated with mortality. Methods: The Global Rheumatology Alliance COVID-19 (GRA) physician reported registry, is an international effort to collect information on COVID19 in adult patients with RMDs. GRA is an observational registry. The first patient from Mexico was registered on April 17, 2020. All Mexican patients registered in GRA until October 30, 2020 were included in this analysis. The association of mortality with demographic and clinical variables was estimated using logistic regression analysis. Results: A total of 323 patients were registered, with a median age of 52 (IQR 41-61) years old, 166 (51.4%) patients lived in Mexico City. The most frequent RMDs were rheumatoid arthritis, 149 (46.1%) and systemic lupus erythematosus, 24 (19.8%). Over a third of patients with RMDs and COVID-19 (119 (36.8%)) were hospitalized, and 43 (13.3%) died. Table 1 shows clinical and demographic characteristics. In the univariable analysis, the absence of comorbidities was a protective factor, OR 0.3 (95% CI 0.1-0.6). Factors associated with mortality at COVID-19 diagnosis were age over 65 years old, having type 2 diabetes, chronic renal insufficiency, treatment at COVID-19 diagnosis with corticosteroids or with CD20 inhibitors. In the multivariable adjusted analysis, these factors remained independently associated with mortality. No associations with other treatments or comorbidities at COVID-19 diagnosis were found. Conclusion: Mexican patients with RMDs and COVID-19 in the GRA physician reported registry had a mortality of 13.3%. Factors associated with mortality were those described in the general population, such as older age and being on corticosteroids and CD20 inhibitors treatment at COVID-19 diagnosis.

Post-transplant patients with COVID-19 associated acute respiratory distress syndrome, a role for Tociluzumab: A case series.

COVID-19 is the disease caused by SARS-CoV-2 that portends both a relatively high mortality rate as well as high rate of intensive care admission amongst all age groups; however effective therapy remains poorly characterized. Post-transplant patients are especially high risk and underrepresented in the literature. In these patients, cytokine release may play a significant role in the development of acute respiratory distress syndrome, raising the hypothesis that interleukin-6 inhibitors such as tocilizumab may be of benefit. Here, we describe two high-risk post-transplant patients who were treated with single-dose tocilizumab after intubation for moderate acute respiratory distress syndrome secondary to confirmed COVID-19 infection. Both patients recovered rapidly and were successfully extubated and discharged from the hospital without need for supplemental oxygen shortly thereafter, and their clinical improvement correlated with response in interleukin-6 levels. Tocilizumab appears to hold promise for critically ill COVID-19 patients who require mechanical ventilation when given shortly after intubation.