Clinical identification and severity in patients with COVID-19

The clinical evaluation of the patient with COVID-19 allows better care, application of safety criteria and preventive measures. The disease progresses from mild to severe and critical. In this work, is evaluated in patients with COVID-19 clinical format to identify moderate to severe stages of the disease. Following a cohort of male and female patients over 18 years of age admitted to the Infectology Service of the General Hospital of Mexico. Each patient is studied using the"COVID-19 Infectology"clinical format and in the first 24 hours of admission, a real-time RT-PCR molecular test is performed for SARS-CoV-2 infection. 65 patients classified as severe COVID-19 were studied, the RT-PCR was positive in 60 patients and negative in 5, clinical data did not differ from the positive ones and the 5 negative were considered false negative cases of the molecular test. There were no differences between positives and negatives with Fisher's test, and no difference in age, comorbidities, or prognostic evaluation with Student's t test. The conclusion is that the clinical format"COVID-19 Infectology"allows to recognize the cases and identify those that are in a severe evolution.Copyright /© 2021 Sociedad Medica del Hospital General de Mexico. Published by Permanyer.

First isolation and characterization of the prototype strain of the SARSCoV-2 virus at the beginning of the COVID-19 pandemic in Peru

Introduction: Currently, isolated from SARS-CoV-2 virus exceed 600 million cases in the world. Objective(s): Isolation and characterization of the SARS-CoV-2 virus causing COVID-19 at the beginning of the pandemic in Peru. Method(s): Twenty nasal and pharyngeal swab samples were isolated from SARS-CoV-2 using two cell lines, Vero ATCC CCL-81 and Vero E-6;virus identification was performed by RT-PCR and the onset of cytopathic effect (CPE) was evaluated by indirect immunofluorescence and subsequent identification by genomic sequencing. One of the most widely circulating isolates were selected and named the prototype strain (PE/B.1.1/28549/2020). Then 10 successive passages were performed on Vero ATCC CCL-81 cells to assess mutation dynamics. Result(s): Results detected 11 virus isolates by cytopathic effect, and subsequently confirmed by RT-PCR and indirect immunofluorescence. Of these, six were sequenced and identified as the lineages B.1, B.1.1, B.1.1.1, and B.1.205 according to the Pango lineage nomenclature. The prototype strain corresponded to lineage B.1.1. The analysis of the strains from the successive passages showed mutations mainly at in the spike (S) protein of the virus without variation in the identity of the lineage. Conclusion(s): Four lineages were isolated in the Vero ATCC CCL-81 cell line. Subcultures in the same cell line showed mutations in the spike protein indicating greater adaptability to the host cell and variation in pathogenicity in vitro, a behavior that allows it to have more survival success.Copyright © 2023 Anales de la Facultad de Medicina. All rights reserved.

CELLULAR AND HUMORAL IMMUNOGENICITY OF THE NEOANTIGEN S1 FROM SARS-COV-2 VACCINES IN PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASES

BackgroundData on cellular and humoral immunogenicity triggered by SARS-CoV-2 vaccines in patients with autoimmune rheumatic diseases (ARDs) are limited. While current vaccine efforts have focused on the induction of neutralizing antibodies against SARS-CoV-2, T-cell immunity may also provide protection against infection. Experimental data suggest that CD8+ T cell responses may have a protective role in the presence of decreasing or sub protective antibody titers [1].ObjectivesThe aim of this project is to describe the serological and T cell responses to the third dose of vaccine (either with BNT162b2 mRNA or ChAdOx1 nCoV-19 replication-deficient adenoviral vector vaccines) in a cohort of patients with ARDs (rheumatoid arthritis and spondyloarthropathies) treated with biologic therapies, to describe the impact of these treatments on vaccine response in this patient population. As a second objective, we will describe the characteristics of patients who did not present an adequate immunogenic response.MethodsCase-control study. We studied in 79 patients with ARDs and in 31 healthy controls, anti-SARS-CoV-2 specific interferon-gamma (IFN-γ) production measured by IGRA between 8-12 weeks after the third dose of anti-SARS-CoV-2 vaccine. In addition, humoral response was measured by anti-S1 IgG antibody production measured by chemiluminescent microparticle immunoassay. Statistical comparison between categorical variables was performed by Fisher's or χ2 test. For quantitative variables by Kruskal-Wallis test or Mann-Whitney test.Results79 patients with ARDs (48 women, 31 men;mean age 58±11.4) 43 (54%), with rheumatoid arthritis and 36 (45.6%) with spondyloarthropathies. 32 (49.5%) of them were on glucocorticoid treatment (mean dose 4.92 mg/day), 25 (31.6%) on methotrexate and 56 (70.9%) on anti-TNF. Post-vaccination results showed positive T-cell immune responses in 68 of 79 (86.1%) ARDs patients with mean IFN- γ anti-SARS-CoV-2 titers of 1,606.85 mUI/ml. 7 (8.9%) of ARDs patients showed negative IFN-γ SARS-CoV-2 levels, while 4 (5%) had borderline titers. 100% of patients with previous COVID 19 disease had positive cellular responses. Within the group of negative or borderline cellular responses, 7 of 10 were men (70%), with no significant differences in terms of diagnosis, comorbidities or immunosuppressive treatments used. In the control group, 100% presented positive cellular responses. Anti-Spike IgG antibodies were detectable in all patients with ARDs as in the control group.ConclusionOur preliminary data show that most patients with ARD were able to generate an adequate specific cellular response after vaccination against SARS-CoV-2, emphasizing the relevance of vaccination in this group. Specific antibody responses secondary to anti-SARS-CoV-2 vaccination were detected in all patients with ARD. Our data could support the relevance of these immune responses to personalize prevention, vaccination decision-making and treatment in this subgroup of patients.References[1]Sieiro Santos C, Calleja Antolin S, Moriano Morales C, Garcia Herrero J, Diez Alvarez E, Ramos Ortega F, et al. Immune responses to mRNA vaccines against SARS-CoV-2 in patients with immune-mediated inflammatory rheumatic diseases. RMD Open. 2022 Jan 5;8(1).Figure 1.Specific anti-SARS-CoV-2-IFN- γ responses measured by IGRA. Dotted lines represent positivity cut-off: ≥200mUI/ml. HC: Healthy controls. AIRDs: Autoimmune rheumatic diseases.[Figure omitted. See PDF]Acknowledgements:NIL.Disclosure of InterestsNone Declared.

[Cryptogenic new-onset super-refractory status epilepticus following SARS-CoV-2 vaccination. A case report]. / Estado epiléptico superrefractario de nueva aparición criptógeno tras vacunación contra el SARS-CoV-2. A propósito de un caso.

INTRODUCTION: New-onset super-refractory status epilepticus (NOSRSE) is a neurological emergency characterised by the development of status epilepticus in a patient without epilepsy or any known prior neurological disease and with no clear structural, toxic or metabolic cause, which recurs after 24 hours of induced coma. The most common identifiable cause is inflammatory-autoimmune. Consequently, we present a case of NOSRSE related to SARS-CoV-2 vaccination as an opportunity to investigate the dysimmune origin of this pathology. CASE REPORT: We report the case of a 40-year-old male who presented at the emergency department with fever and headache with no clear source of infection. His personal history included bacterial meningitis in childhood without any sequelae and protein S deficiency without treatment at the time, as well as vaccination with ChAdOx1 nCoV-19 21 days earlier. He was initially diagnosed with a urinary tract infection and treated with cefuroxime. Two days later, he was taken back to the emergency department with confusional symptoms and tonic-clonic seizures. He did not respond to midazolam and finally required sedation and orotracheal intubation for refractory status epilepticus. While in hospital, he required a number of lines of antiepileptic drugs, ketamine, a ketogenic diet, immunotherapy and plasmapheresis in order to successfully limit NOSRSE. The aetiological study offered normal results for serology, antineuronal antibodies in serum and cerebrospinal fluid, transthoracic echocardiography, testicular ultrasound and computed tomographic angiography. Only the control MRI scan showed a diffuse and bilateral alteration of the right hemispheric cortex and thalamic pulvinar as the only finding. CONCLUSION: It is crucial to report suspected adverse reactions associated with SARS-CoV-2 vaccination, thereby allowing continued monitoring of the risk/benefit ratio of vaccination.

TITLE: Estado epiléptico superrefractario de nueva aparición criptógeno tras vacunación contra el SARS-CoV-2. A propósito de un caso.Introducción. El estado epiléptico superrefractario de nueva aparición (NOSRSE) es una emergencia neurológica caracterizada por el desarrollo de estado epiléptico en un paciente sin epilepsia ni enfermedad neurológica previa conocida y sin clara causa estructural, tóxica o metabólica, que recurre tras 24 horas del coma inducido. La causa identificable más frecuente es la inflamatoria-autoinmune. En consecuencia, planteamos un caso de NOSRSE relacionado con la vacunación para el SARS-CoV-2 como una oportunidad de indagar el origen disinmune de esta patología. Caso clínico. Varón de 40 años que acude al servicio de urgencias refiriendo fiebre y cefalea sin claro foco infeccioso. Entre sus antecedentes personales destacamos una meningitis bacteriana en la infancia sin secuelas y un déficit de proteína S sin tratamiento en ese momento, así como vacunación con ChAdOx1 nCoV-19 21 días antes. Fue inicialmente diagnosticado de infección del tracto urinario y tratado con cefuroxima. Dos días después, se le llevó de nuevo a urgencias con cuadro confusional y crisis tonicoclónicas, sin respuesta al midazolam, y requirió finalmente sedación e intubación orotraqueal por estado epiléptico refractario. Durante su ingreso requirió múltiples líneas de antiepilépticos, quetamina, dieta cetógena, inmunoterapia y plasmaféresis para conseguir limitar el NOSRSE. El estudio etiológico ofrecía normalidad de los resultados de serología, anticuerpos antineuronales en el suero y líquido cefalorraquídeo, ecocardiografía transtorácica, ecografía testicular y angiotomografía computarizada. Únicamente la resonancia magnética de control mostró una alteración difusa y bilateral de la corteza hemisférica y pulvinar talámica derecha como único hallazgo. Conclusión. Es crucial notificar las sospechas de reacciones adversas asociadas a la vacunación frente al SARS-CoV-2, permitiendo así una supervisión continuada de la relación riesgo/beneficio de ésta.

Gender-Based Violence in Women's Labor Relations in Mexico

The economic crisis caused by the pandemic due to the virus that produces the disease called COVID19 has caused unemployment to affect people who had some work activity, whether in stores, offices, cab drivers, or official agencies, among others. This global situation caused health authorities to order the closure of workplaces, negatively impacting employment and working conditions in Latin America and the Caribbean, causing a setback of more than a decade in progress achieved in labor participation. Furthermore, it is assumed that inequality and discrimination against women in the economy and the labor context in this confinement stage due to the pandemic generated by the SARSCoV-2 virus have impacted gender violence against women in Mexico.

What is a Smart Destination in Practice? The Interpretation of DMO Managers from Spanish World Heritage Cities

This work intends to identify how Spanish World Heritage Cities (SWHC) are interpreting and implementing the Smart Destination Spanish Model (SD). The model has been created as a new paradigm of tourist management, and it is being sponsored by the Spanish public administration in different destinations, including Spanish World Heritage Cities. SWHC are historic, major tourist destinations with a large number of visitors. A sequence of qualitative methods has been used, consisting of documentary analysis with semi-structured interviews. The destination managers from each of the 15 cities that take part of the World Heritage Cities Spanish Group have been interviewed. In addition, an executive of the government-owned Tourism Innovation and Technologies company (SEGITTUR) has been also interviewed. The results do highlight the momentum that the model has reached, accelerated by the Covid-19 pandemic, and serve to identify what kind of strategies have been put in practice.

PostCOVID-19 condition in health workers. Havana: One-year follow-up.

Introduction: COVID-19 is a disease with gaps in its knowledge. It is required to explore its clinical manifestations over time and consequences for performance in the working population. Objective(s): To identify the clinico-epidemiological characteristics and the fitness to work in health workers convalescing from COVID-19. Material(s) and Method(s): A prospective longitudinal study was carried out on health workers in Havana. The population consisted of 40 workers who attended the COVID-19 convalescent consultation and were followed up in May 2022. Result(s): Dyspnea (18.8 %), insomnia (18.8 %), and arthralgia (12.5 %) persisted at the end of the year. Hypertension, obesity and bronchial asthma were the main comorbidities. In addition, 100 % of workers were fit for work. Conclusion(s): PostCOVID-19 symptoms deceased considerably 8 months after the onset of the disease;dyspnea, arthralgia, and insomnia persisted at the end of the year.Copyright © 2022 Universidad de Ciencias Medicas de La Hab. All rights reserved.

Epidemiological profile of SARS-COV-2 infection in pediatrics.

Objective: To describe the epidemiological and clinical profile of pediatric patients who were treated for suspected COVID-19 infecion, between March and October 2020, at the Hospital Universitario San Ignacio (HUSI), in Bogota, Colombia. Material(s) and Method(s): Cross-sectional design. Description of patients aged 1 month to 1 day before their 18th birthday, assessed between March and October 2020, who were approached by any pediatric care service of a university hospital for suspected COVID-infection. 19, according to current national and institutional protocols. Demographic variables and the reason for consultation of all individuals with suspected infection were recorded. Only when SARS-CoV-2 infection was confirmed were variables related to clinical aspects of the disease and its evolution recorded. Result(s): 920 medical records of pediatric patients with suspected SARS-CoV-2 infection were evaluated, of which there were 157 confirmed cases with COVID-19 infection. The main reason for consultation to suspect infection was fever in 50% of the cases. In patients with virological confirmation, 32.48% of the cases attended required hospital management. MIS-C was suspected in 5 patients who required intensive care unit management. In the evaluated period, there were no deaths associated with COVID-19 infection. Conclusion(s): SARS-CoV-2 infection is related in most cases to a spectrum of mild disease in the pediatric population. This study may be larger than pediatric patients presenting with gastrointestinal rather than respiratory symptoms, and the frequency of renal complications should be taken into account in patients in whom the systemic inflammatory syndrome associated with COVID-19 is suspected.Copyright © 2023 Asociacion Colombiana de Infectologia. All rights reserved.

Effectiveness of thromboprophylaxis with low molecular weight heparin in critically ill patients with COVID-19. An observational prospective, multicenter study Eficacia de la tromboprofilaxis con heparina de bajo peso molecular en pacientes críticos con COVID-19: estudio observacional, prospectivo y multicéntrico

Introduction COVID-19 induces coagulopathy associated with an increase of thromboembolic events. Due to the lack of agreement on recommendations for thromboprophylactic management, the aim of this study was to study the dosages of LMWH used in critically ill COVID-19 patients assessing the effect on their outcome. Metohds We evaluated data of the Reg-COVID19. According to LMWH dose two groups were analyzed: prophylaxis and treatment. Primary outcome was the relationship of LMWH dosage with mortality. Secondary outcomes included the incidence of thrombotic and bleeding events, length of ICU stay, invasive mechanical ventilation, and thrombotic and inflammatory parameters. Results Data of 720 patients were analyzed, 258 in the prophylaxis group and 462 in the treatment group. C Reactive Protein, invasive mechanical ventilation, tocilizumab and corticosteroid treatments were related with the choice of LMWH dose. Hemorrhagic events (66/720, 9.2%) and thrombotic complications (69/720, 9.6%) were similar in both groups (p = 0.819 and p = 0.265), as was the time course of the thrombotic events, earlier than hemorrhagic ones (9 [3–18] and 12 [6–19] days respectively). Mortality was lower in prophylaxis group (25.2% versus 35.1%), but once an inverse probability weighting model was applied, we found no effect of LMWH dose. Conclusion We found no benefit or harm with the administration of therapeutic or prophylactic LMWH dose in COVID19 critically ill patients. With a similar rate of hemorrhagic or thrombotic events, the LMWH dose had no influence on mortality. More studies are needed to determine the optimal thromboprophylaxis protocol for critically ill patients.

Educational management from the integrated input-output methodology of the dynamic model

The purpose is to analyze management in educational organizations through the integrated input-output methodology of the dynamic model with emerging technologies, in the institutions "Camilo Torres Restrepo, San José and San Isidro”, municipality of Curumaní (Cesar-Colombia). The research was of an analytical type;supported by the qualitative macro-ethnographic approach. According to the epistemological framework, the research is considered phenomenological. The technique used was the in-depth interview, applying the interview script directed to nine (9) key informant teachers of the mentioned institutions. In basic secondary education, the integrated input-output methodology of the dynamic model using emerging technologies does not constitute a teacher's priority to respond to learning mediated by virtuality during Covid-19. Finally, it is necessary for classroom managers to effectively apply the theoretical-practical elements related to the integrated input-output methodology in order to assertively guide students in their learning process. © 2023, Universidad del Zulia. All rights reserved.

Low Treatment Fidelity as an Indication to Switch Interventions: Pivoting From Child-Parent Psychotherapy to Parent-Child Interaction Therapy for Early Childhood Trauma

Young children who experience trauma and adverse experiences are at an increased risk of developing an insecure attachment style as well as negative physical and mental health problems. These can include internalizing and externalizing behavioral problems, developmental delay, emotional dysregulation, and aggression. Several evidence-based interventions exist to treat young children with symptoms related to trauma, each with different foundational theories. This article presents the case of a 4-year-old boy with posttraumatic stress disorder who was in the middle of a legal fight between caregivers and transitioning between caregivers' homes. Initially, therapy began with Child-Parent Psychotherapy to address caregivers' first concerns. Later, the therapeutical approach was switched to Parent-Child Interaction Therapy due to difficulty with treatment fidelity related to caregivers' symptoms and conflict. This case demonstrates great improvement in treatment fidelity and subsequently problem behaviors after switching to an intervention that allowed to address behavior management shortcomings in a family with ongoing conflict.Copyright © The Author(s) 2022.

Effectiveness of thromboprophylaxis with low molecular weight heparin in critically ill patients with COVID-19. An observational prospective, multicenter study.

INTRODUCTION: COVID-19 induces coagulopathy associated with an increase of thromboembolic events. Due to the lack of agreement on recommendations for thromboprophylactic management, the aim of this study was to study the dosages of LMWH used in critically ill COVID-19 patients assessing the effect on their outcome. METHODS: We evaluated data of the Reg-COVID19. According to LMWH dose two groups were analyzed: prophylaxis and treatment. Primary outcome was the relationship of LMWH dosage with mortality. Secondary outcomes included the incidence of thrombotic and bleeding events, length of ICU stay, invasive mechanical ventilation, and thrombotic and inflammatory parameters. RESULTS: Data of 720 patients were analyzed, 258 in the prophylaxis group and 462 in the treatment group. C Reactive Protein, invasive mechanical ventilation, tocilizumab and corticosteroid treatments were related with the choice of LMWH dose. Hemorrhagic events (66/720, 9.2%) and thrombotic complications (69/720, 9.6%) were similar in both groups (p = .819 and p = .265), as was the time course of the thrombotic events, earlier than hemorrhagic ones (9 [3-18] and 12 [6-19] days respectively). Mortality was lower in prophylaxis group (25.2% versus 35.1%), but once an inverse probability weighting model was applied, we found no effect of LMWH dose. CONCLUSION: We found no benefit or harm with the administration of therapeutic or prophylactic LMWH dose in COVID19 critically ill patients. With a similar rate of hemorrhagic or thrombotic events, the LMWH dose had no influence on mortality. More studies are needed to determine the optimal thromboprophylaxis protocol for critically ill patients.

The unintended consequences of confinement: Evidence from the rural area in Guatemala

Individual and social preferences have shown to be important factors in individual decision making and general economic performance. Yet, they are usually assumed as given and stable, underestimating their impact in the rhythm of economic recovery after a natural disaster or pandemic. This paper examines the effects of COVID-19 initial confinement on households' individual and social preferences across small communities in the rural area of Guatemala. We use a comprehensive panel household survey of agricultural smallholders collected during two survey rounds in 2019, prior to the pandemic, and 2020 and find that preferences generally shifted following the onset of the pandemic. We observe a significant increase in risk tolerance, deteriorated perceptions towards trust and generosity, and a higher frequency of emotional issues, while intra-household relationships remain stable. We find that experiencing a household adverse situation, a higher degree of exposure to the virus, and more stringent local confinement measures shaped several of the variations in preferences. The focus of the study on a region with high poverty and malnutrition rates offers important insights of the consequences of confinement on perceptions and attitudes in complex and vulnerable rural contexts during the wake of a public health emergency. © 2022 The Author(s)

Teledentistry and management protocol in a pediatric dental department during the first COVID-19 lockdown.

BACKGROUND: During the first COVID-19 lockdown, from March 12 to May 15, 2020, private dental practices in France and in many other countries remained closed. Dental emergencies were therefore partly redirected to hospital dental departments. The aim of this article is to describe the modalities of remote management of emergencies during this period, by the pediatric dentistry department of Nancy University Hospital (France), via an oral telemedicine protocol. PATIENTS AND METHODS: All parents of children in difficulty were invited to contact the department by phone. Initial triage was managed by externs, interns, or dental practitioners following a management protocol specifically adapted to pediatric dentistry for this context. Depending on the situation (type of complaint, geographical location of the patients, possibility of travel, availability of digital equipment, etc.), an oral telemedicine solution was proposed using the Covotem® software (Maincare Society, Canejan, France) via the Pulsy platform (public interest grouping validated by the Grand Est Regional Agency for Health) and possibly using an intraoral photographic protocol suggested by the team. RESULTS: During this period, 176 patients used the pediatric dental department, 40 of whom were managed via oral telemedicine. Of these children, 57% (23/40) required an appointment in the department during the lockdown, 30% (12/40) did not require follow-up, and 13% (5/40) required a post-lockdown appointment. This teledentistry protocol resulted in a diagnosis in most cases (93%). CONCLUSION: Patient management through oral telemedicine appears to be an effective tool for planning and organizing oral healthcare. It should be more widely considered in dentistry in the current context of pressure in medical emergencies, significant medical needs, and medical desertification.

Use of simplified models for theoretical prediction of the interactions between available antibodies and the receptor-binding domain of SARS-CoV-2 spike protein.

The negative impact of infectious diseases like COVID-19 on public health and the global economy is evident. This pandemic represents a significant challenge for the scientific community to develop new practical analytical methods for accurately diagnosing emerging cases. Due to their selectivity and sensitivity, new methodologies based on antigen/antibody interactions to detect COVID-19 biomarkers are necessary. In this context, the theoretical, computational modeling reduces experimental efforts and saves resources for rational biosensor design. This study proposes using molecular dynamics to predict the interactions between the Receptor Binding Domain (RBD) of the SARS-CoV-2 spike protein simplified model and a set of highly characterized antibodies. The binding free energy of the antigen/antibody complexes was calculated for the simplified models and compared against the complete SARS-CoV-2 ectodomain to validate the methodology. The structural data derived from our molecular dynamics and end-point free energy calculations showed a positive correlation between both approximations, with a 0.82 Pearson correlation coefficient; t = 3.661, df = 3, p-value = 0.03522, with a 95% confident interval. Furthermore, we identified the interfacial residues that could generate covalent bonds with a specific chemical surface without perturbing the binding dynamics to develop highly sensitive and specific diagnostic devices. Communicated by Ramaswamy H. Sarma.

The COVID-19 Pandemic as a driver of education 5.0 at UAH Faculty of Pharmacy

Introduction: In March 2020, the outbreak of the COVID-19 Pandemic in Madrid province, Spain, forced changes in the teaching and organisational methodologies of University educational centres in order to continue delivering knowledge contents that allowed students to acquire the competences and skills required by current regulations. Method(s): Different surveys were carried out on possible alternative teaching methodologies and strategies to be used by the teachers responsible for the different courses in the face of the pandemic situation. They explained to students how the teaching was going to proceed using different remote channels. Result(s): Different strategies such as the heuristic, discovery or playful method facilitated the teaching-learning process allowing students for the acquisition of useful knowledge, competences and skills for job placement. Innovative teaching methods were used, such as the inverted classroom or flipped classroom, cooperative learning, project-based learning or gamification, depending on the characteristics of the different disciplines. The results achieved so far have been, despite initial concerns and doubts, satisfactory, achieving the objectives and skills set at the beginning of the courses. The students have worked on specific, individual or cooperative projects, in which they have faced real problems in the context of service-learning, stimulating their critical thinking, communication, problem solving abilities, with a more practical and tangible dimension. Conclusion(s): The pandemic has accelerated the implementation of an Education 5.0 project, making teachers use resources that some but not all had used previously to promote effective and quality teaching. Combining the new technological tools with traditional educational methodologies helps teachers to achieve their teaching outcomes in a more effective way without losing sight to prepare students for lifelong learning far beyond the digital.

Evaluation of learning at UAH School of Pharmacy during the COVID-19 pandemic

Introduction: The problem caused by the COVID-19 pandemic led teachers to use different tools to measure the learning process of students in a socially distanced context. For this reason, during the 2019-20 academic year, the teachers at the Faculty of Pharmacy, University of Alcal, Spain, had to come up against the challenge of establishing a consistent, systematic and rigorous online evaluation system to screen which students had the competences and skills demanded by current regulations. Method(s): A survey was designed using Google forms and addressed, from the Dean's office, to professors and lecturers of the five undergraduate courses, concerning the type of evaluation tools that they were going to use with the students in order to proceed with a sound evaluation, taking into account that data protection regulations had to be respected, rigorously. Result(s): Doubts were raised about integrity and ethics when carrying out the different online evaluation tests. News appeared in the media and social networks about how to know the correct answers in a questionnaire through its source code, by hiring experts who solve the exams, or doing the activities together using the versatility of social networks that allow simultaneous collective interaction, etc. In this survey, in addition to indicating the number of tests to be performed, the teachers informed the authors about the tools available for use: short answer questions, multiple choice tests, essay or interrelated concepts questions with clear evaluation rubrics, reflection on practical cases, open-book exams. Conclusion(s): All teachers learned and adapted quickly to the different assessment tools available on the Blackboard platform according to the characteristics of the course and considered that the pandemic has opened a critical window for innovative technology based-assessment methodologies.

Sense of Belonging and Student Commitment in the Context of Higher Distance Learning with Virtual Mediation

Both technological advances and the context of the pandemic have positioned virtual mediation as a strong alternative for the transit and projection of higher education institutions and their adaptability to new demands, contexts, and changes.The implementation of remote virtual mediation as a consequence of the Covid-19 pandemic has impacted the sense of belonging and student commitment in higher education with face-to-face modality. However, the question arises as to how the behavior of these variables is consolidated in higher education institutions in which remote virtual mediation has always been their methodological hallmark. Seeking to establish the profile of the students of the National Open and Distance University (UNAD) in these contexts and to analyze the interaction of the variables of student commitment and sense of belonging, in this order of ideas and in a random manner, the investigators took a sample of 312 students from the aforementioned university. In this way, the study was developed from a positivist paradigm, with a descriptive-inferential level of depth, with a prospective, cross-sectional and non-experimental record. In addition, the authors used 2 instruments for data collection.The first one was focused on the measurement of the degree and the orientation of the student commitment, while the second one identified determinant factors in the sense of belonging. Finally, the investigators concluded that there is a tangible difference between the profile of the distance education student and that of face-to-face education. Likewise, it is recommended to delve into research focused on the processes of a sense of belonging and student commitment, even more so in distance Higher Education, which has not been sufficiently explored.

Surprisingly high frequency of pituitary stalk thickening in pediatric patients during COVID-19 pandemic in Chile

Introduction: Pituitary stalk thickening (PST) is a rare condition in pediatric patients. As there are few studies published in pediatric population, the definition has been difficult to establish. The etiologies involved in PST can be divided in neoplastic, congenital, inflammatory/infectious or autoimmune diseases. In children the most frequent causes are neoplastic, followed by congenital lesions. The inflammatory/infectious and autoimmune diseases are rare. Method(s): During the pandemic of COVID-19, we observed an increased incidence in the diagnosis of pediatric patients with PST in Chile, compared with previous years. A multicentric retrospective chart review of clinical, radiological and histological data was conducted on patients with confirmation of PST that presented during COVID-19 pandemic in Chile. The diagnosis of PST was made in patients with neuro-ophthalmic symptoms or pituitary dysfunction, who had a cerebral MRI with a pituitary stalk 3 mm or more at pituitary insertion or 4 mm or more at the optic chiasm, based on consensus guidelines. Result(s): A total of 11 patients were diagnosed with PST during the pandemic period, most of them were girls (82%). The mean age at the onset of symptoms was 10.1 years (range 1.1-18). The most common causes were neoplasms. Germinal cell tumors (GCT) were diagnosed in 10 patients and Langerhans cell histiocytosis in 1 patient. Tumor markers for GCT were negative in serum and cerebrospinal fluid in all patients (alpha-fetoprotein and chorionic gonadotropin). All patients presented with central diabetes insipidus and at least one anterior pituitary hormonal deficit. Thirty six percent had an abnormal campimetry. The diagnoses were confirmed by biopsy in all the patients and four patients required a second biopsy to confirm the diagnosis. Discussion(s): A surprisingly high frequency of PST presented during the COVID-19 pandemic among Chilean pediatric patients. The most frequent diagnosis was GCT. All had negative tumor markers, with a greater incidence in girls, opposed to data previously reported. The etiological diagnosis still remains challenging, and 36% of the patients required a second biopsy. It is important to establish new markers to assess patients with PST in order to make a prompt diagnosis.

COLUMBIA-1: A phase Ib/II, open-label, randomized, multicenter study of durvalumab plus oleclumab in combination with chemotherapy and bevacizumab as first-line (1L) therapy in metastatic microsatellite-stable colorectal cancer (MSS-mCRC)

Background: Despite advances in the treatment of mCRC combining chemotherapy regimens with biologics, most patients (pts) still progress within 11 months of receiving 1L chemotherapy. Addition of novel therapies to the standard of care (SoC) to improve antitumor activity is urgently needed. The randomized part 2 of COLUMBIA-1 (NCT04068610) evaluated the safety and efficacy of combining SoC (bevacizumab [BEV] + FOLFOX) with the PD-L1 inhibitor durvalumab (D) and the anti-CD73 monoclonal antibody oleclumab (O). Method(s): Pts with previously untreated, MSS-mCRC and ECOG PS <=1 received either SoC alone or SoC + D (1500 mg, Q4W) + O (3000 mg Q2W x4 then Q4W) in the experimental arm (EXP). The primary endpoint was objective response rate (ORR) per investigator assessed RECIST v1.1. Result(s): As of 10 Dec 2021, 52 pts were enrolled, of whom 51 were response evaluable. The confirmed ORR with SoC was 44.0% (95% confidence interval [CI], 24.4-65.1%) compared to 61.5% (95% CI, 40.6-79.8%) in the EXP arm. Median OS was not reached (SoC) vs 19.1 mos (EXP);median PFS was 11.1 mos (SoC) vs 10.9 mos (EXP;Table). Grade >=3 treatment emergent adverse events (TEAEs) occurred in 76.9% of pts in SoC and 65.4% EXP. Fatal TEAEs (all unrelated) were observed in 3 pts in the EXP arm: 1 with sepsis and 2 with intestinal perforation. One pt with intestinal perforation deemed related to BEV experienced fatal peritonitis. In the SoC arm, there was a single fatal COVID-19 TEAE. The most frequent treatment-related AEs in the EXP arm were diarrhea (38.5%), peripheral sensory neuropathy (38.5%) and fatigue (26.9%). There was no identified association between CD73 expression and clinical benefit. Conclusion(s): Addition of D + O to FOLFOX + BEV SoC showed a moderate response increase without PFS benefit vs SoC alone. Safety was consistent with known safety profiles. [Formula presented] Clinical trial identification: NCT04068610. Editorial acknowledgement: Editing support for this , under the direction of the authors, was provided by Catherine Crookes of Ashfield MedComms (Macclesfield, UK), an Inizio company, and was funded by AstraZeneca. Legal entity responsible for the study: AstraZeneca. Funding(s): AstraZeneca. Disclosure: N.H. Segal: Financial Interests, Personal, Advisory Board: Immunocore, PsiOxus, Roche/Genentech, BI, Revitope, ABL Bio, Novartis, GSK, AstraZeneca, Numab;Financial Interests, Personal, Research Grant: Regeneron, Immunocore, PureTech, AstraZeneca, BMS, Merck, Pfizer, Roche/Genentech. J. Tie: Financial Interests, Personal, Invited Speaker, Honorarium: Novartis, Amgen, Merck Serono, Merck Sharp and Dohme, Pierre Fabre;Financial Interests, Personal, Advisory Board: Haystack Oncology, Amgen, Novartis, AstraZeneca, Merck Serono, Merck Sharp and Dohme, Pierre Fabre, BMS;Non-Financial Interests, Personal, Principal Investigator: AstraZeneca, Pfizer, Daiichi Sankyo, Novartis. S. Kopetz: Financial Interests, Personal, Ownership Interest: MolecularMatch, Lutris, Iylon;Financial Interests, Personal, Research Grant: Sanofi, Biocartis, Guardant Health, Array BioPharma, Genentech/Roche, EMD Serono, AstraZeneca, Novartis, Amgen, Lilly, Daiichi Sankyo;Financial Interests, Personal, Other: Genetech, EMD Serono, Merck, Holy Stone, Novartis, Lilly, BI, Boston Biomedical, AstraZeneca, Bayer Health, Pierre Fabre, Redx Pharma, Ipsen, Daiichi Sankyo, Natera, HalioDx, Lutris, Jacobio, Pfizer, Repare Therapeutics, Inivata, GSK, Jazz Pharmaceuticals, Iylon, Xilis, AbbVie, Amal Therapeutics, Gilead, Mirati, Flame Biosciences, Servier, Carina Biotechnology, Bicara Therapeutics, Endeavor BioMedicines, Numab Pharma, Johnson and Johnson/Janssen. M.P. Ducreux: Financial Interests, Personal, Invited Speaker: Roche, Beigene, MSD, Servier, Pierre Fabre, Amgen;Financial Interests, Personal, Advisory Board: Terumo, Roche, Merck Serono, Bayer, Daiichi Sankyo, Sotio;Financial Interests, Institutional, Research Grant: Keocyt, Roche, Bayer. E. Chen: Financial Interests, Personal, Advisory Board: AstraZeneca;Financial Interests, Personal, Princip l Investigator: AstraZeneca. R. Dienstmann: Financial Interests, Personal, Speaker's Bureau: Roche, BI, Ipsen, Amgen, Servier, Sanofi, Libbs, Merck Sharp and Dohme, Lilly, AstraZeneca;Financial Interests, Personal, Advisory Board: Roche, BI;Financial Interests, Personal, Research Grant: Merck, Pierre Fabre. A. Hollebecque: Financial Interests, Personal, Invited Speaker: Servier, Incyte, EISAI;Financial Interests, Personal, Advisory Board: Basilea, Tahio, Relay Theraeutics, QED Therapeutics, Debiopharm;Financial Interests, Institutional, Funding: Incyte;Financial Interests, Institutional, Research Grant: AstraZeneca;Non-Financial Interests, Personal, Principal Investigator, M19-345: AbbVie;Non-Financial Interests, Personal, Principal Investigator, CO42216: Roche;Non-Financial Interests, Personal, Principal Investigator, MCLA-158: Merus;Non-Financial Interests, Personal, Principal Investigator, SGNB6A: Seattle Genetics;Non-Financial Interests, Personal, Principal Investigator, TAS-120-202: Tahio;Non-Financial Interests, Personal, Principal Investigator, Krystal-10: Mirati;Non-Financial Interests, Personal, Principal Investigator, ADP-0033: Adaptimmune;Non-Financial Interests, Personal, Principal Investigator, ACT16902: Sanofi;Non-Financial Interests, Personal, Principal Investigator, C4201002: Pfizer;Non-Financial Interests, Personal, Principal Investigator, RLY-4008: Relay Therapeutics;Non-Financial Interests, Personal, Principal Investigator, CC-90011: Celgene/BMS;Non-Financial Interests, Personal, Principal Investigator, Loxo-IDH: Loxo/Lilly;Non-Financial Interests, Personal, Principal Investigator: AstraZeneca. 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