Severe SARS-CoV-2 Pneumonia and Pneumomediastinum/Pneumothorax: A Prospective Observational Study in an Intermediate Respiratory Care Unit.

INTRODUCTION: The occurrence of pneumomediastinum (PM) and/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated. METHODS: This was a prospective observational study conducted in patients admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital in Madrid (Spain) between December 14, 2020 and September 28, 2021. All patients had a diagnosis of severe SARS-CoV-2 pneumonia and required noninvasive respiratory support (NIRS): high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The incidences of PM and/or PTX, overall and by NIRS, and their impact on the probabilities of invasive mechanical ventilation (IMV) and death were studied. RESULTS: A total of 1306 patients were included. 4.3% (56/1306) developed PM/PTX, 3.8% (50/1306) PM, 1.6% (21/1306) PTX, and 1.1% (15/1306) PM + PTX. 16.1% (9/56) of patients with PM/PTX had HFNC alone, while 83.9% (47/56) had HFNC + CPAP/BiPAP. In comparison, 41.7% (521/1250) of patients without PM and PTX had HFNC alone (odds ratio [OR] 0.27; 95% confidence interval [95% CI] 0.13-0.55; p < .001), while 58.3% (729/1250) had HFNC + CPAP/BiPAP (OR 3.73; 95% CI 1.81-7.68; p < .001). The probability of needing IMV among patients with PM/PTX was 67.9% (36/53) (OR 7.46; 95% CI 4.12-13.50; p < .001), while it was 22.1% (262/1185) among patients without PM and PTX. Mortality among patients with PM/PTX was 33.9% (19/56) (OR 4.39; 95% CI 2.45-7.85; p < .001), while it was 10.5% (131/1250) among patients without PM and PTX. CONCLUSIONS: In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia requiring NIRS, incidences of PM/PTX, PM, PTX, and PM + PTX were observed to be 4.3%, 3.8%, 1.6%, and 1.1%, respectively. Most patients with PM/PTX had HFNC + CPAP/BiPAP as the NIRS device, much more frequently than patients without PM and PTX. The probabilities of IMV and death among patients with PM/PTX were 64.3% and 33.9%, respectively, higher than those observed in patients without PM and PTX, which were 21.0% and 10.5%, respectively.

Changes in the epidemiological profile of SARS-CoV-2-positive individuals in Mexico across pandemic waves as an explanation of fatality reduction: a retrospective observational study.

OBJECTIVES: We aim to quantify shifts in hospitalisation and mortality and how those were related to the first three phases of the epidemic and individuals' demographics and health profile among those with a positive test for SARS-CoV-2 treated at the Mexican Social Security Institute's facilities from March 2020 to October 2021. DESIGN: Retrospective observational study using interrupted time series analysis to identify changes in hospitalisation rate and case fatality rate (CFR) by epidemic wave. SETTING: Data from the Mexican Institute of Social Security's (IMSS) Online Influenza Epidemiological Surveillance System (SINOLAVE) that include all individuals that sought care at IMSS facilities all over Mexico. PARTICIPANTS: All individuals included in the SINOLAVE with a positive PCR or rapid test for SARS-CoV-2. PRIMARY AND SECONDARY OUTCOME MEASURES: Monthly test positivity rates, hospitalisation rates, CFRs and prevalence of relevant comorbidities by age group. RESULTS: From March 2020 to October 2021, the CFR declined between 1% and 3.5%; the declines were significant for those 0-9, 20-29, 30-39, 40-49 and 70 and older. The decline was steep during the first wave and was less steep or was temporarily reversed at the beginning of the second and third waves (changes in the trend of about 0.3% and 3.8%, and between 0.7% and 3.8%, respectively, for some age groups), but then continued to the end of the analytical period. Prevalence of diabetes, hypertension and obesity among patients testing positive also declined-two for most age groups (reductions of up to 10 percentage points for diabetes, 12 percentage points for hypertension and 19 percentage points for obesity). CONCLUSION: Data suggest that the decrease in COVID-19 fatality rate is at least partially explained by a change in the profile of those contracting the disease, that is, a falling proportion of individuals with comorbidities across all age groups.

Levels of Anxiety and Fear among Nurses During the COVID-19 Pandemic: A Systematic Review

Aim. The aim of this review is to find out what levels of anxiety and fear have been shown by nurses during the COVID-19 pandemic. Background. Health security crises affect not only physical health but also the mental health and wellbeing of healthcare professionals due to a higher level of exposure. Evaluation. A systematic review was carried out following the PRISMA statement. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. The literature search was carried out in the PubMed, Scopus, and Web of Science (WoS) electronic databases based on the keywords that the research question yielded following the PECOT strategy. For the selection of articles, original articles, meta-analyses, systematic reviews, short communication articles, and case reports were included. Then, a series of inclusion and exclusion criteria were applied, screening the results to obtain a total of 18 articles, which were used to elaborate the study. Key Issues. Fear and anxiety levels were described in a total of 18 selected studies. The main fear-related concerns of the nurses were associated with the fear of infecting their family or friends and the fear of the death of a family member or friend. Conclusions. The main psychological impact on nurses during the COVID-19 pandemic was related to fear, anxiety, stress, and depression. Fear of infecting family members or of being infected were the main impacts perceived by nurses. Implications for Nursing Management. In general, high scores were found for levels of fear and anxiety, although the figures varied by country and time of data collection. Resilience was considered the main tool for coping with the loss and trauma experienced by nurses.

Repercusiones en pacientes crónicos de una Zona Básica de Salud de Toledo en la Pandemia COVID-19

Introducción: Las personas con enfermedades crónicas son población vulnerable a la interrupción de la atención y al estrés producido con la pandemia por COVID-19. Se necesita reevaluar su riesgo cardiovascular postconfinamiento. Objetivo: Evaluar el impacto del confinamiento y modificaciones en sistema de atención sanitaria en la salud de personas con enfermedades crónicas de una Zona Básica de Salud de Toledo durante la pandemia COVID-19. Métodos: Estudio analítico, observacional, longitudinal, retrospectivo. Pacientes con patologías crónicas. Muestra aleatoria 420. Revisión historias clínicas para recogida parámetros clínicos/metabólicos antes y después confinamiento;N.° y tipo visitas enfermería e ingresos hospitalarios antes, durante y después confinamiento. Resultados: Se evaluaron 349 historias. Edad media 65,36 y el 52,7% fueron hombres. Se encontró que tras el confinamiento hubo una disminución significativa de peso (p=0,046) y aumento de presión arterial diastólica (p=0,018) en toda la muestra. La disminución de peso fue mayor en mujeres, mayores de 65, hipertensos y personas con hiperlipidemias. En cuanto a variables clínicas que incrementaron sus cifras postconfinamiento, se observó aumento colesterol LDL en mayores de 65 (p=0,005). Aumento presión arterial diastólica en mujeres (p=0,005), mayores de 65 (p=0,022) e hipertensos (p=0,038), y aumento de presión arterial sistólica en mujeres (p=0,041). Aumento ingresos postconfinamiento (p=0,001);57,1% de ingresos estuvo relacionado con su patología crónica y una disminución visitas enfermería durante y postconfinamiento (p=0,000). Conclusiones: Los pacientes crónicos han empeorado sus condiciones relacionadas con su patología durante y después del confinamiento. La atención presencial disminuida durante este período podría ser un factor que ha contribuido a esta situación.Alternate :Introduction: People with chronic diseases are vulnerable to disruption of care and stress with the COVID-19 pandemic. Their post-confinement cardiovascular risk needs to be reassessed. Objective: To assess the impact of confinement and modifications in health care system on the health of people with chronic diseases in a Basic Health Zone in Toledo during COVID-19 pandemic. Methods: Analytical, observational, longitudinal, retrospective study. Patients with chronic pathologies. Random sample 420. Review of clinical records to collect clinical/metabolic parameters before and after confinement. Number and type of nursing visits and hospital admissions before, during and after confinement. Results: 349 records were evaluated. Mean age 65.36 and 52.7% were men. It was found that after confinement there was a significant decrease in weight (p=0.046) and increase in diastolic blood pressure (p=0.018) in the whole sample. The decrease in weight was greater in women, patients aged >65 years, those with hypertension and those with hyperlipidemia. In terms of clinical variables that increased post-confinement figures, an increase in LDL cholesterol was observed in patients aged >65 (p=0.005). Increased diastolic blood pressure in women (p=0.005), patients aged >65 (p=0.022) and those with hypertension (p=0.038) and increased systolic blood pressure in women (p=0.041). Increased post-confinement admissions (p=0.001);57.1% of admissions were related to their chronic pathology and a decrease in nursing visits during and post-confinement (p=0.000). Conclusions: Chronic patients have worsened conditions related to their pathology during and after confinement. Decreased face-to-face patient care during this period could be a contributing factor to this situation.

SARS-CoV-2 transmission in teenagers and young adults in Fútbol Club Barcelona's Multidisciplinary Sports Training Academy.

Most studies, aimed at determining the incidence and transmission of SARS-CoV-2 in children and teenagers, have been developed in school settings. Our study conducted surveillance and inferred attack rates focusing on the practice of sports. Prospective and observational study of those attending the sports facilities of Fútbol Club Barcelona (FCB), in Barcelona, Spain, throughout the 2020-2021 season. Participants were young players (from five different sports) and adult workers, who belonged to stable teams (shared routines and were involved in same quarantine rules). Biweekly health questionnaires and SARS-CoV-2 screening were conducted. From the 234 participants included, 70 (30%) both lived and trained in the FCB facilities (Recruitment Pathway 1;RP1) and 164 (70%) lived at their own household and just came to the facilities to train (RP2). During the study, 38 positive cases were identified; none had severe symptoms or needed hospitalization. The overall weekly incidence in the cohorts did not differ compared to the one expected in the community, except for 2 weeks when an outbreak occurred. The attack rate (AR) was three times higher for the participants from RP1, in comparison to those from RP2 (p < 0.01). A Basketball team showed a significant higher AR.  Conclusion: Physical activities in stable teams are not related to an increased risk of transmission of SARS-CoV-2, since there were the same observed cases than expected in the community. The risk is higher in indoor sports (Basketball vs. Football), and in closed cohort living settings (RP1 vs. RP2). The fulfilment of preventive measures is essential. What is Known: • Despite the low numerical impact caused in paediatric hospitalizations during COVID-19 pandemic, the social impact has been maximum. • The transmission potential in children and teenagers is limited, and it had been widely demonstrated in school settings. What is New: • Group physical activities in children and teenagers are not also related to an increased risk of transmission of SARS-CoV-2, when preventive measures, such as washing hands, and screening protocols are applied. • Routine and semi-professional sports activities seem safe environments to promote during this pandemic.

Ultrasound imaging assessment of the diaphragm and abdominal muscles in people with a recent history of moderate Covid-19 infection and healthy participants: A cross-sectional pilot study.

Coronavirus disease (Covid-19) is a highly infectious disease caused by the SARS-CoV-2 virus and is associated with a decrease of respiratory, physical, and psychological function, subsequently affecting quality of life. The aim of the present pilot study was to use ultrasound imaging (USI) to evaluate and compare the thickness of the diaphragm and abdominal muscles between individuals recently diagnosed with moderate Covid-19 infection and healthy individuals. METHODS: A cross-sectional observational pilot study was performed. A total sample of 24 participants were recruited from a private medical center (Madrid, Spain): Covid-19 (n = 12) and healthy controls (n = 12). The external oblique (EO), internal oblique (IO), transversus abdominis (TrA), rectus abdominis (RA), interrecti distance (IRD) and diaphragm thickness were assessed using USI during inspiration, expiration and during contraction. RESULTS: USI measurements of the thickness of EO, IO, TrA, RA, IRD and the diaphragm did not differ significantly between groups during inspiration, expiration or during contraction (all P > 0.05). CONCLUSIONS: These preliminary results suggest that the morphology of the abdominal muscles and diaphragm is not altered in people with a recent history of moderate Covid-19 infection.

Effect of the early combination of continuous positive airway pressure and high-flow nasal cannula on mortality and intubation rates in patients with COVID-19 and acute respiratory distress syndrome. The DUOCOVID study

Introduction: Non invasive respiratory support (NIRS) is useful for treating acute respiratory distress syndrome (ARDS) secondary to COVID-19, mainly in mild-moderate stages. Although continuous positive airway pressure (CPAP) seems superior to other NIRS, prolonged periods of use and poor adaptation may contribute to its failure. The combination of CPAP sessions and high-flow nasal cannula (HFNC) breaks could improve comfort and keep respiratory mechanics stable without reducing the benefits of positive airway pressure (PAP). Our study aimed to determine if HFNC+CPAP initiates early lower mortality and endotracheal intubation (ETI) rates. Methods: Subjects were admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital between January and September 2021. They were divided according to Early HFNC+CPAP (first 24 h, EHC group) and Delayed HFNC+CPAP (after 24 h, DHC group). Laboratory data, NIRS parameters, and the ETI and 30-day mortality rates were collected. A multivariate analysis was performed to identify the risk factors associated with these variables. Results: The median age of the 760 included patients was 57 (IQR 47-66), who were mostly male (66.1%). The median Charlson Comorbidity Index was 2 (IQR 1-3) and 46.8% were obese. The median PaO2/FiO2 upon IRCU admission was 95 (IQR 76-126). The ETI rate in the EHC group was 34.5%, with 41.8% for the DHC group (p=0.045), while 30-day mortality was 8.2% and 15.5%, respectively (p=0.002). Conclusions: Particularly in the first 24 h after IRCU admission, the HFNC+CPAP combination was associated with a reduction in the 30-day mortality and ETI rates in patients with ARDS secondary to COVID-19.

Clinical Findings and Outcomes From Subjects With COVID-19 Pneumonia in an Intermediate Respiratory Care Unit.

BACKGROUND: Many patients with COVID-19 require respiratory support and close monitoring. Intermediate respiratory care units (IRCU) may be valuable to optimally and adequately implement noninvasive respiratory support (NRS) to decrease clinical failure. We aimed at describing intubation and mortality in a novel facility entirely dedicated to COVID-19 and to establish their outcomes. METHODS: This was a retrospective, observational study performed at one hospital in Spain. We included consecutive subjects age > 18 y, admitted to IRCU with COVID-19 pneumonia, and requiring NRS between December 2020-September 2021. Data collected included mode and usage of NRS, laboratory findings, endotracheal intubation, and mortality at day 30. A multivariable Cox model was used to assess risk factors associated with clinical failure and mortality. RESULTS: A total of 1,306 subjects were included; 64.6% were male with mean age of 54.7 y. During the IRCU stay, 345 subjects clinically failed NRS (85.5% intubated; 14.5% died). Cox model showed a higher clinical failure in IRCU upon onset of symptoms and hospitalization was < 10 d (hazard ratio [HR] 1.59 [95% CI 1.24-2.03], P < .001) and PaO2 /FIO2 < 100 mm Hg (HR 1.59 [95% CI 1.27-1.98], P < .001). These variables were not associated with increased 30-d mortality. CONCLUSIONS: The IRCU was a valuable option to manage subjects with COVID-19 requiring NRS, thus reducing ICU overload. Male sex, gas exchange, and blood chemistry at admission were associated with worse prognosis, whereas older age, gas exchange, and blood chemistry were associated with 30-d mortality. These findings may provide a basis for better understanding outcomes and to improve management of noninvasively ventilated patients with COVID-19.

Effect of the Early Combination of Continuous Positive Airway Pressure and High-Flow Nasal Cannula on Mortality and Intubation Rates in Patients With COVID-19 and Acute Respiratory Distress Syndrome. The DUOCOVID Study.

INTRODUCTION: Non invasive respiratory support (NIRS) is useful for treating acute respiratory distress syndrome (ARDS) secondary to COVID-19, mainly in mild-moderate stages. Although continuous positive airway pressure (CPAP) seems superior to other NIRS, prolonged periods of use and poor adaptation may contribute to its failure. The combination of CPAP sessions and high-flow nasal cannula (HFNC) breaks could improve comfort and keep respiratory mechanics stable without reducing the benefits of positive airway pressure (PAP). Our study aimed to determine if HFNC+CPAP initiates early lower mortality and endotracheal intubation (ETI) rates. METHODS: Subjects were admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital between January and September 2021. They were divided according to Early HFNC+CPAP (first 24h, EHC group) and Delayed HFNC+CPAP (after 24h, DHC group). Laboratory data, NIRS parameters, and the ETI and 30-day mortality rates were collected. A multivariate analysis was performed to identify the risk factors associated with these variables. RESULTS: The median age of the 760 included patients was 57 (IQR 47-66), who were mostly male (66.1%). The median Charlson Comorbidity Index was 2 (IQR 1-3) and 46.8% were obese. The median PaO2/FiO2 upon IRCU admission was 95 (IQR 76-126). The ETI rate in the EHC group was 34.5%, with 41.8% for the DHC group (p=0.045), while 30-day mortality was 8.2% and 15.5%, respectively (p=0.002). CONCLUSIONS: Particularly in the first 24h after IRCU admission, the HFNC+CPAP combination was associated with a reduction in the 30-day mortality and ETI rates in patients with ARDS secondary to COVID-19.

Effect of Increasing the Number of Substitutions on Physical Performance during Periods of Congested Fixtures in Football.

(I) This study aimed to evaluate the impact on physical demands induced by FIFA's new rule implemented based on the number of substitutions caused by COVID-19. (II) Sixty-six matches were analysed in peak periods (microcycles of three matches in a week) in the competition period before and after the pandemic. The variables collected were organised by team (22 from LaLigaTM SmartBank 2019-2020) for a total of 132 team records and 1077 player performance reports using a multi-camera tracking system and Mediacoach® software. Physical performance variables were analysed in the first half, second half and whole match, thus determining the individual and collective performances of the team. (III) This study shows how, despite the increase in substitutions allowed with the new rule, physical performance increased in some variables in the congested periods (e.g., total distance run and distance run in the first and second halves). Additionally, the players' physical performance involved in a substitution was greater than it was for players who completed the game. (IV) The new substitution rule helps to maintain and even improve physical performance. This measure could improve intensity levels in both individual and team performance. It could even safeguard the physical integrity of the players by reducing the risk of injury, as fewer players have to play the full match.

Machine-learning-derived predictive score for early estimation of COVID-19 mortality risk in hospitalized patients.

The clinical course of COVID-19 is highly variable. It is therefore essential to predict as early and accurately as possible the severity level of the disease in a COVID-19 patient who is admitted to the hospital. This means identifying the contributing factors of mortality and developing an easy-to-use score that could enable a fast assessment of the mortality risk using only information recorded at the hospitalization. A large database of adult patients with a confirmed diagnosis of COVID-19 (n = 15,628; with 2,846 deceased) admitted to Spanish hospitals between December 2019 and July 2020 was analyzed. By means of multiple machine learning algorithms, we developed models that could accurately predict their mortality. We used the information about classifiers' performance metrics and about importance and coherence among the predictors to define a mortality score that can be easily calculated using a minimal number of mortality predictors and yielded accurate estimates of the patient severity status. The optimal predictive model encompassed five predictors (age, oxygen saturation, platelets, lactate dehydrogenase, and creatinine) and yielded a satisfactory classification of survived and deceased patients (area under the curve: 0.8454 with validation set). These five predictors were additionally used to define a mortality score for COVID-19 patients at their hospitalization. This score is not only easy to calculate but also to interpret since it ranges from zero to eight, along with a linear increase in the mortality risk from 0% to 80%. A simple risk score based on five commonly available clinical variables of adult COVID-19 patients admitted to hospital is able to accurately discriminate their mortality probability, and its interpretation is straightforward and useful.

Burnout, resilience and psychological flexibility in frontline nurses during the acute phase of the COVID-19 pandemic (2020) in Madrid, Spain.

BACKGROUND: In April 2020, Spain was the country with the highest number of patients infected by COVID-19 in Europe. The pressure on health care providers has had a direct impact on nurses and their mental health. AIM: The aim of this study is to demonstrate the causal relationship between resilience, acceptance, experiential avoidance, psychological inflexibility and burnout syndrome, all of which are measured with validated questionnaires. METHODS: This was designed as a transversal correlational study with nurses who worked during the acute phase of the pandemic in public hospitals in the Community of Madrid with patients diagnosed with COVID-19 in COVID-19 medical hospitalization units, emergency services and intensive care units. Google Forms was used to obtain an informed consent sheet, socio-demographic variables and the following questionnaires: 10 CD-Risk, Connor-Davidson Risk Resilience Scale, Acceptance and Action Questionnaire-II and the Maslach Burnout Inventory. RESULTS: The final sample included 375 nurses with a high number of consecutive days of direct exposure to an infected patient and a very high number of consecutive days without rest; almost 18% suffered from COVID-19. The nurses presented medium levels of resilience, medium levels of experiential avoidance and medium levels as measured for emotional exhaustion, personal accomplishment and depersonalization. We also found a predictive correlation between all the dimensions of the burnout questionnaire in relation to the data obtained from the resilience questionnaire. CONCLUSIONS: There is a direct and predictive relationship between the resilience that nurses had during the acute phase of the pandemic and their capacity for acceptance, experiential avoidance, psychological inflexibility and burnout syndrome. IMPLICATIONS FOR NURSING MANAGEMENT: The scores show the necessity to implement preventive measures to avoid fatal psychological consequences for nurses.

Assessing wastewater-based epidemiology for the prediction of SARS-CoV-2 incidence in Catalonia.

While wastewater-based epidemiology has proven a useful tool for epidemiological surveillance during the COVID-19 pandemic, few quantitative models comparing virus concentrations in wastewater samples and cumulative incidence have been established. In this work, a simple mathematical model relating virus concentration and cumulative incidence for full contagion waves was developed. The model was then used for short-term forecasting and compared to a local linear model. Both scenarios were tested using a dataset composed of samples from 32 wastewater treatment plants and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) incidence data covering the corresponding geographical areas during a 7-month period, including two contagion waves. A population-averaged dataset was also developed to model and predict the incidence over the full geography. Overall, the mathematical model based on wastewater data showed a good correlation with cumulative cases and allowed us to anticipate SARS-CoV-2 incidence in one week, which is of special relevance in situations where the epidemiological monitoring system cannot be fully implemented.

Use of Anti-Mononuclear Antibodies as Therapy for Covid-19

Iphsj-22-12747(R);Published: 09-Jun-2022, DOI: 10.36648/1791809X.16.S7.948 Introduction The disease caused by a B-coronavirus, an RNA virus, had its beginnings in 2019 in Wuhan - China where a series of cases of pneumonia caused by this agent were identified, currently six serotypes that produce diseases in humans are known., four of these are prevalent and cause typical cold symptoms, the remaining two are responsible for the appearance of severe acute respiratory syndrome SarsCoV and Middle East respiratory syndrome MERS-CoV;After nucleic acid sequencing of lower respiratory tract epithelial cells from 4 patients with confirmed pneumonia of unknown cause by real-time reverse transcription PCR at Beijing Hospital, a novel 2019-nCoV beta coronavirus was found, which was then was called SARS-CoV-2, also giving as a result that this new virus has information from the subgenus Sarbecovirus, of the Orthocoronavirinae family, which makes it different from SARS-CoV and MERS-CoV, however according to various reports it was identified that the genome of SARS-Co V-2, is between 75% and 80% identical to SARS-CoV and therefore its name, SARS-CoV-2 belongs to this genus of coronavirus and its genome consists of a single-stranded RNA 29 kb in length. The last protein is present inside the virion and is associated with the viral RNA, and the other 3 proteins are associated with the external structure of the virus, this disease causing the current pandemic of global importance is characterized by affinity to the respiratory system has characteristics important as the production of increased pro-inflammatory cytokines and a decrease in the response of T cells, which is directly related to inflammation and severe lung damage that occurs in patients infected with SarsCoV2, also highlighting the onset of given symptoms from 5 days, the incubation period of approximately 14 days and the high transmission capacity of the virus given by various mechanisms such as droplet transmission (given when the infected person coughs or sneezes and these droplets released by this mechanism are inhaled by the people nearby), by contact (when an individual has direct contact with contaminated surfaces). inhaled and then passes these through the eyes and mouth) and by aerosols (this occurs when the respiratory droplets of the infected are in contact with the environment in places with little ventilation or closed that when inhaled cause infection), in addition From this, manifestations and alterations have been found in the gastrointestinal area, since enterocytes with high expression of ACE II receptors have been found in this area, which is why fecal transmission is also described in a smaller proportion and less frequently (1). Some monoclonal antibodies are currently used to treat COVID-19, standing out in this group itolizumab and tocilizumab, the group's mechanism of action is based on the fact that monoclonal antibodies bind to target molecules, which can be surface membrane receptors, proteins associated with enzymatic systems or circulating proteins, which produces direct or indirect effects on tissue function, where virus neutralization occurs when a sufficient number of epitopes (antigenic determinant is the portion of a macromolecule that is recognized by the immune system, specifically the sequence to which antibodies bind, B cell receptors or T cell receptors.) on the surface of the virus are occupied by antibodies. Severe Acute Respiratory Syndrome;Viral pneumonia;Coronavirus infections;Antibodies;Cytokines;lymphocytes;Vaccines;COVID-19 treatment and or. [...]including all the documents that will deal with the use of anti-mononuclear antibodies as a therapy for Covid-19, the data found was between 16-28 records, thus using 22 articles for the preparation of this document.

High-dose vitamin D versus placebo to prevent complications in COVID-19 patients: Multicentre randomized controlled clinical trial.

BACKGROUND: The role of oral vitamin D3 supplementation for hospitalized patients with COVID-19 remains to be determined. The study was aimed to evaluate whether vitamin D3 supplementation could prevent respiratory worsening among hospitalized patients with COVID-19. METHODS AND FINDINGS: We designed a multicentre, randomized, double-blind, sequential, placebo-controlled clinical trial. The study was conducted in 17 second and third level hospitals, located in four provinces of Argentina, from 14 August 2020 to 22 June 2021. We enrolled 218 adult patients, hospitalized in general wards with SARS-CoV-2 confirmed infection, mild-to-moderate COVID-19 and risk factors for disease progression. Participants were randomized to a single oral dose of 500 000 IU of vitamin D3 or matching placebo. Randomization ratio was 1:1, with permuted blocks and stratified for study site, diabetes and age (≤60 vs >60 years). The primary outcome was the change in the respiratory Sepsis related Organ Failure Assessment score between baseline and the highest value recorded up to day 7. Secondary outcomes included the length of hospital stay; intensive care unit admission; and in-hospital mortality. Overall, 115 participants were assigned to vitamin D3 and 105 to placebo (mean [SD] age, 59.1 [10.7] years; 103 [47.2%] women). There were no significant differences in the primary outcome between groups (median [IQR] 0.0 [0.0-1.0] vs 0.0 [0.0-1.0], for vitamin D3 and placebo, respectively; p = 0.925). Median [IQR] length of hospital stay was not significantly different between vitamin D3 group (6.0 [4.0-9.0] days) and placebo group (6.0 [4.0-10.0] days; p = 0.632). There were no significant differences for intensive care unit admissions (7.8% vs 10.7%; RR 0.73; 95% CI 0.32 to 1.70; p = 0.622), or in-hospital mortality (4.3% vs 1.9%; RR 2.24; 95% CI 0.44 to 11.29; p = 0.451). There were no significant differences in serious adverse events (vitamin D3 = 14.8%, placebo = 11.7%). CONCLUSIONS: Among hospitalized patients with mild-to-moderate COVID-19 and risk factors, a single high oral dose of vitamin D3 as compared with placebo, did not prevent the respiratory worsening. TRIAL REGISTRATION: ClincicalTrials.gov Identifier: NCT04411446.

Impact of the COVID-19 Pandemic on the Work Engagement of UK Active Employees.

The objective of this investigation was to describe the work engagement perceived by UK workers during the COVID-19 pandemic. A descriptive cross-sectional study was conducted. The sample included 1085 participants, aged 18 years and older, living in the UK during the COVID-19 pandemic, who were active workers. Data were collected using an online questionnaire and the UWES-9. They were analysed using descriptive statistics, a t-test for equality of means or ANOVA, and the Chi-squared Automatic Interaction Detection method. The mean value in the UWES-9 was 3.46 (SD = 1.11). Participants with lower satisfaction (21.8%) gave significantly low or very low UWES-9 scores in 58.5% of the cases. Greater work engagement was obtained with more resources and less conflict, risk, and stress. In cases where there had been contact with COVID-19, this was associated with slightly lower levels of work engagement. These results could motivate and guide companies to adopt risk prevention measures and protocols to return to normal working conditions after the initial crisis phase of the pandemic.

Prediction of Conserved HLA Class I and Class II Epitopes from SARS-CoV-2 Licensed Vaccines Supports T-Cell Cross-Protection against SARS-CoV-1.

Heterologous immunity-inducing vaccines against different pathogens are necessary to deal with new pandemics. In this study, the possible impact of COVID-19 licensed formulations in the cytotoxic and the helper cellular immune responses against SARS-CoV-1 is analyzed for the 567 and 41 most abundant HLA class I and II alleles, respectively. Computational prediction showed that most of these 608 alleles, which cover >90% of the human population, contain enough conserved T-cell epitopes among SARS-CoV-1 and SARS-CoV-2 spike proteins. In addition, the vast majority of these predicted peptides were defined as epitopes recognized by CD4+ or CD8+ T lymphocytes, showing a very high correlation between the bioinformatics prediction and the experimental assays. These data suggest that both cytotoxic and helper cellular immune protection elicited by the currently licensed COVID-19 vaccines should be effective against SARS-CoV-1 infection. Lastly, this study has potential implications for public health against current and future pandemics, given that the SARS-CoV-1 vaccines in pipeline since the early 20th century could generate similarly cross-protection against COVID-19.

COVID-19 Confinement Effects on Game Actions during Competition Restart in Professional Soccer Players.

The main objective of the present study was to compare high-intensity actions in a week of three matches before and after the COVID-19 lockdown. The observational methodology was used. This study analysed 551 professional soccer players from 22 different Spanish teams (LaLiga Smartbank 2019-2020) by a multi-camera tracking system and associated software (Mediacoach®, Spain). Variables of distances per minute and totals, travelled at High Intensity (HIR), Very High Intensity (VHIR), Sprint (HSR), player's maximum speed, average speed, and the number of efforts in VHIR and HSR were analysed in the first and second half of the games, the full match, as well as in relation to the playing position. Players who participated in the same number of matches pre- and post-COVID-19 showed an increase in the total minutes played, p < 0.05, and small decreases in game actions, p < 0.05, with an effect size between 0.21 and 0.45, while players who participated in different number of matches pre- and post-COVID-19 showed a performance decrease, p < 0.05, with a size effect between 0.13 and 0.51; this was evident, particularly, for midfielders, p < 0.05, with a size effect between 0.39 and 0.75. The results seem to show that the playing intensity after COVID-19 confinement did not lead to large performance losses, except for midfielders who were the most involved players and showed a higher decrease in performance. The main findings of this study could provide insight to football coaches for rotations in starting line-ups and game substitutions, so as not to affect the intensity levels of the competitions.

Age-dependency of the Propagation Rate of Coronavirus Disease 2019 Inside School Bubble Groups in Catalonia, Spain.

BACKGROUND: We analyzed contagions of coronavirus disease 2019 inside school bubble groups in Catalonia, Spain, in the presence of strong nonpharmaceutical interventions from September to December 2020. More than 1 million students were organized in bubble groups and monitored and analyzed by the Health and the Educational departments. METHODS: We had access to 2 data sources, and both were employed for the analysis, one is the Catalan school surveillance system and the other of the educational department. As soon as a positive index case is detected by the health system, isolation is required for all members of the bubble group, in addition to a mandatory proactive systematic screening of each individual. All infected cases are reported. It permits the calculation of the average reproductive number (R*), corresponding to the average number of infected individuals per index case. RESULTS: We found that propagation inside of the bubble group was small. Among 75% index cases, there was no transmission to other members in the classroom, with an average R* across all ages inside the bubble of R* = 0.4. We found a significant age trend in the secondary attack rates, with the R* going from 0.2 in preschool to 0.6 in high school youth. CONCLUSIONS: The secondary attack rate depends on the school level and therefore on the age. Super-spreading events (outbreaks of 5 cases or more) in childhood were rare, only occurring in 2.5% of all infections triggered from a pediatric index case.