Clinical evolution of patients with AF and diabetes mellitus in the COVID-19 pandemic. REFADI Registry

Introduction and objectives: To analyze the evolution of patients with atrial fibrillation (AF) and diabetes in the mid-term follow-up during the COVID-19 pandemic and to describe its impact on this population. Method(s): Multicenter and prospective registry that included patients with AF and diabetes attended in cardiology clinics. A multivariate analysis was performed to determine the variables associated with the occurrence of clinical events and mortality. Recruitment was performed in February-December 2019. Result(s): The evolution of 633 patients, 96,2% of those included in the REFADI registry with a median follow-up of 835 days was analyzed (mean age 73.8 +/- 8.5 years, 54.3% male, CHA2DS2-VASc 4,34 +/- 1,4, HAS-BLED 2,47 +/- 0,96) were analyzed. The proportion of anticoagulated patients remained constant (95.6% vs 94.5%;P = .24). There was a decrease in the prescription of vitamin K antagonists (from 31.4% to 19.7%;P < .01), and an increase in the use of direct anticoagulants (from 62.0% to 70.3%;P < .01). During the follow-up there was an increase in the prescription of SGLT2 inhibitors (from 20.0% to 25.5%;P < .01) and GLP1 agonists (from 4.2% to 9.1%;P < .01). During this period, 17.2% of patients died, the majority from cardiovascular causes, 6.4% from COVID-19, 2.8% from stroke, and 1.8% from hemorrhage. Older age, lower ejection fraction, lower hemoglobin levels, and especially lower direct anticoagulants prescription were associated with mortality. Conclusion(s): Patients with AF and diabetes have a high thromboembolic risk and a high risk of developing complications, especially of cardiovascular origin.Copyright © 2023 Sociedad Espanola de Cardiologia

Psychological care service for children and adolescents convalescing from COVID-19 in Villa Clara

Background: children and adolescents constitute a sensitive population to the psychological impacts of the COVID-19 pandemic. Recognizing it implies the need for evaluation, monitoring and intervention, especially when it comes to infants who have suffered from the disease and require comprehensive pediatric care. Objective: to implement a psychological care service for children and adolescents convalescent from COVID-19.Methods: a participatory action research design was applied from a constructive-interpretive qualitative approach. It is made up of three lines of action: psychological evaluation, psychotherapeutic intervention and social support. Its design and implementation followed stages and was carried out collaboratively. The participants involved established symmetrical relationships and followed a cyclical process of planning-acting-observing-reflecting;basic procedure to attend and improve the practice.Results: the results were obtained regarding the evaluation and the actions of psychological intervention. Regarding the evaluation, clinical-psychological alterations with affectation of the psychic functions and needs for the preservation of health in the personal and family spheres stand out. Regarding the psychological intervention, all the beneficiaries received psychological counseling actions and those diagnosed with a psychiatric condition received psychotherapeutic actions. All families received social support. Conclusions: The psychological symptoms intensity reduction or remission was verified, elaboration of grief in the loss, adaptation of coping or behavior modification, strengthening of the social support networks' capacity, expansion of family knowledge, and creation of information channels between the family and the school.

Chromatographic characterization of the fusion protein SARS-CoV-2 S protein (RBD)-hFc

At the Center of Molecular Immunology (Havana, Cuba), the fusion protein SARS-CoV-2 S protein (RBD)-hFc was synthesized linking the receptor-binding domain (RBD) of the SARS-CoV-2 virus and the crystallizable fragment of a human immunoglobulin. This fusion protein was used in the construction of a diagnostic device for COVID-19 called UMELISA SARS-CoV-2-IgG. Given the relevance of this protein, the characterization of three batches (A1, A2 and A3) was carried out. The molecular weight of the protein was determined to be 120 kDa, using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Its isoelectric point was estimated between 8.3 and 9 by isoelectric focusing. The molecular integrity was evaluated by size exclusion liquid chromatography and SDS-PAGE after one year of the production of the protein;the presence of aggregates and fragments was detected. Batches A1 and A2 have a purity percentage higher than 95% and they can be used for the construction of new diagnostic devices. © 2022 Walter de Gruyter GmbH, Berlin/Boston.

Teaching E-Commerce in Support of Costa Rican SMEs due to the COVID-19 Pandemic

This article presents the experiences obtained with the integration of the course 'EIF-439O Uso Estratégico del Comercio Electrónico', taught at the School of Informatics of the Universidad Nacional de Costa Rica, with the project UNAPROPYMES, aimed at supporting Costa Rican small and medium enterprises (SME) due to the COVID-19 pandemic. Taking advantage of this juncture, it was possible to make changes to this course to use real cases for developing e-commerce prototypes, as well as to apply design thinking and user experience (UX). Furthermore, this situation allowed to open the course to students from other disciplines. The changes introduced to the course, the results obtained, and the lessons learned are discussed © 2022 IEEE.

Social Support for Rhythmic Gymnastics Athletes: Intervention Alternative for Post-Covid-19 Sports Reincorporation in Cienfuegos

The research proposes a social support program for rhythmic gymnastics athletes of the School of Sports Initiation of Cienfuegos for the reincorporation to sports practice post-COVID-19. The program is psychosocially based on 1) reading of needs in terms of social support to rhythmic gymnastics athletes for the reincorporation to post-COVID-19 sports activity;2) social support as a resource of psychosocial strengthening for the reincorporation of rhythmic gymnastics athletes to postCOVID-19 sports activity;and 3) integral, processual and systemic character of the program of social support to rhythmic gymnastics athletes for the reincorporation to post-COVID-19 sports activity. It is structurally organized into three projects: mental health services, psychosocial accompaniment in the sports context and social support to the family. Main strategies It contains the planning of the evaluation and monitoring of the implementation and results.

Assessing the accuracy of multiple prognostic scores for immune checkpoint inhibitors (ICI) in patients with advanced solid tumors

Background: Many patients fail to achieve a clinical benefit from ICI. Several scores have been developed to improve ICI candidates selection but it is uncertain which one better predicts patients’ outcome. Here, we performed a direct comparison of the most successful scores. Methods: This is a sub-analysis of the immunoblood prospective observational study that enrolled patients diagnosed with advanced solid tumors treated with ICI. Main clinicopathological data were retrieved from medical records and responses assessed according to RECIST 1.1 criteria. LIPI, RMH, PMH, dNLR, NLR, PIPO and GRIm scores were calculated. Receiving operator characteristics (ROC) curves and their area under curve (AUC) were used to predict PFS and durable clinical benefit (DCB;stable disease≥6 months or better). Associations with PFS, OS and DCB, where assessed with Cox and logistic regressions. Scores’ correlation was assessed with Spearman rho. Significance was set at p<0.05. Results: We recruited 155 patients (65% male, mean age 63). NSCLC (28%), colorectal (20%) breast (9%) H&N (6%) cancer and melanoma (6%) were the most frequent tumor types. Frequency of the high risk/bad outcome group of each score were: LIPI 13%, RMH 36%, PMH 54%, GRIm 14%, PIPO 6%, NLR 32% and dNRL 27%. Fair accuracy in identifying patients at higher risk of progression or mild accuracy in predicting DCB were observed for the RMH (AUC PFS: 0.7, 95%CI: 0.6-0.8;AUC DCB: 0.6, 0.5-0.8) and LIPI (AUC PFS: 0.7, 95%CI: 0.6-0.8;AUC: 0.6, 0.5-0.7) scores. All other scores provided poor/no accuracy. No significant difference was observed between RMH and LIPI AUC for PFS and DCB (both p>0.05). Additionally, only LIPI and RMH were associated with PFS (p=0.001;p<0.001), OS (p<0.001;p=0.001) and DCB (p=0.034;p=0.010) at univariate analyses. At multivariate analyses RMH and LIPI remained significantly associated with PFS (p=0.030;p=0.021) and OS (p=0.012;p<0.001). A strong correlation between both scores (rho=0.72, p<0.001) was observed. Conclusions: RMH and LIPI scores were sufficiently reliable in assessing the prognosis of patients with advanced solid tumors treated with ICI. They were superior to other analyzed scores in our population and highly correlated. Legal entity responsible for the study: Hospital Clinic y Provincial de Barcelona, Medical Oncology Department. Funding: Has not received any funding. Disclosure: J. Garcia-Corbacho: Financial Interests, Personal, Advisory Board, FGFR inhibitors implementation in clinical practice: Johnson & Johnson Pharmaceutical;Financial Interests, Institutional, Invited Speaker, Participation in clinical trials of the company as PI: Johnson and Johnson Pharmaceutical, Boehringer Ingelheim, Astellas, Cytomx, Incyte, Lilly, Menarini, Merck, Bayer, AstraZeneca, Amgen, Daiichi Sankyo. L. Mezquita: Financial Interests, Personal, Advisory Board: Takeda, AstraZeneca, Roche;Financial Interests, Personal, Invited Speaker: Roche, BMS, AstraZeneca, Takeda;Financial Interests, Personal, Research Grant, SEOM Beca Retorno 2019: BI;Financial Interests, Personal, Research Grant, ESMO TR Research Fellowship 2019: BMS;Financial Interests, Institutional, Research Grant, COVID research Grant: Amgen;Financial Interests, Institutional, Invited Speaker: Inivata, Stilla. N. Baste Rotllan: Non-Financial Interests, Advisory Role: Eisai, MSD, Merck Serono, BioNTech, Roche, BMS, Exelixis. A. Prat: Financial Interests, Personal, Invited Speaker: Roche;Financial Interests, Personal, Invited Speaker, Lecture fees: Novartis, Daiichi Sankyo;Financial Interests, Personal, Advisory Board, Advisory role/consultancy: Novartis, Pfizer, BMS, Puma, Oncolytics Biotech, MSD, Guardant Health, Peptomyc;Financial Interests, Institutional, Invited Speaker, Clinical trials: Daiichi Sankyo;Financial Interests, Institutional, Other, Contracted research: Boehringer, Medica Scientia Inno. Research;Financial Interests, Personal, Advisory Board: AstraZeneca;Financial Interests, Personal, Invited Speaker, Leadership role: Reveal Genomics, SL.;Financial I terests, Personal, Stocks/Shares: Reveal Genomics, Oncolytics Biotech;Financial Interests, Personal, Royalties: Reveal Genomics;Financial Interests, Institutional, Invited Speaker: Roche, AstraZeneca, Novartis;Financial Interests, Personal and Institutional, Invited Speaker: Daiichi Sankyo;Non-Financial Interests, Institutional, Other, Leadership roles: Patronage committee: SOLTI Foundation, Actitud Frente al Cáncer Foundation. All other authors have declared no conflicts of interest.

Association between dietary exposure to bisphenols and body mass index in Spanish schoolchildren

The increase in children obesity worldwide has been of particular concern in recent decades. Environmental factors have been proposed as contributors to obesity, and there is a growing concern over obesogens, environmental chemicals with potential obesity‐related endocrine‐disrupting properties. In this regard, bisphenol A (BPA) and its analogues are suspected to have obesogenic properties. Current document report on the activities of the fellow, undertaken during the fourth, 2020–2021 cycle of the EU‐FORA programme at the University of Granada, Institute of Nutrition and Food Science, in Spain. The work programme offered by the hosting site was related to the extrapolation of bisphenols exposure following the determination of these compounds in food frequently consumed by children and in their biological samples. The fellow has participated in the recruitment of the study population in the health centres. In addition, she has participated in the collection of the children biological samples, anthropometric measurements and dietary surveys and in the optimisation of the laboratory methodology for the extraction of bisphenols in biological samples. All these activities also provided the fellow an opportunity to develop her data science related skills, which will benefit her professional development. In addition, the fellow gained an overview of various topics related to food safety risk assessment by attending the EU‐FORA dedicated training modules.

Chromatographic characterization of the fusion protein SARS-CoV-2 S protein (RBD)-hFc

At the Center of Molecular Immunology (Havana, Cuba), the fusion protein SARS-CoV-2 S protein (RBD)-hFc was synthesized linking the receptor-binding domain (RBD) of the SARS-CoV-2 virus and the crystallizable fragment of a human immunoglobulin. This fusion protein was used in the construction of a diagnostic device for COVID-19 called UMELISA SARS-CoV-2-IgG. Given the relevance of this protein, the characterization of three batches (A1, A2 and A3) was carried out. The molecular weight of the protein was determined to be 120 kDa, using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Its isoelectric point was estimated between 8.3 and 9 by isoelectric focusing. The molecular integrity was evaluated by size exclusion liquid chromatography and SDS-PAGE after one year of the production of the protein;the presence of aggregates and fragments was detected. Batches A1 and A2 have a purity percentage higher than 95% and they can be used for the construction of new diagnostic devices.

Analysis of the educational resources used in the course Fundamentals of Informatics in the face of the COVID-19 pandemic

Technology brought several advancements to the Educational area in the past few years, including digital resources such as Open Educational Resources (OER). However, higher demand associated with the lack of platforms that facilitate the search and sharing of these resources is an impeditive factor, often causing the devaluation and loss of these materials. This article presents ReaCloud, a digital repository designed to index OERs, improve the usability of adding OERs, and aligned with Brazilian standards for k-12 education. © 2021 IEEE.

Use of Circular Dichroism in the characterization of the fusion protein SARS-CoV-2 S protein (RBD)-hFc

From the receptor-binding domain (RBD) of the SARS-CoV-2 virus, which causes coronavirus disease 2019 (COVID-19), a RBD-hFc fusion protein was obtained at the Center of Molecular Immunology (Havana, Cuba). This fusion protein was used in the construction of a diagnostic device for COVID-19 called Ultramicroenzyme-Linked Immunosorbent Assay (UMELISA)-SARS-CoV-2-IgG and it is currently been used in the studies of biological activity of the Cuban vaccine Abdala (CIGB-66). In this work, Circular Dichroism (CD) is used to characterize this protein. Using Far Ultraviolet Circular Dichroism (FAR-UV CD), it was determined that the protein has a secondary structure in the form of a sheet-beta fundamentally. Using this technique, a thermodynamic study was carried out and it was determined that the melting temperature (Tm) of the protein is 71.5 degrees C. Information about the tertiary structure of the protein was obtained using Near Ultraviolet Circular Dichroism (NEAR-UV CD) and Molecular Fluorescence;they indicates that the protein has a three-dimensional folding associated with the aromatic amino acids in its structure, where tryptophan (Trp) is located inside the folded structure of the protein while tyrosine (Tyr) is exposed to the solvent.

[Epidemiological characteristics of workers with COVID-19 from the Instituto Mexicano del Seguro Social]

BACKGROUND: ¿In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused an outbreak of the respiratory disease called COVID-19, in Wuhan, China. At the end of February 2020, it was detected in Mexico the first case of COVID-19. With this disease, chronic degenerative diseases are decisive for comorbidity to continue increasing. OBJECTIVE: To know the epidemiological characteristics and comorbidity in workers sick with COVID-19 from the Veracruz Norte Regional Deconcentrated Administrative Operation Body, from the Mexican Institute for Social Security (Instituto Mexicano del Seguro Social, IMSS). MATERIAL AND METHODS: Descriptive, cross-sectional study, which included 228 COVID-19 patients, who were IMSS workers. Variables such as age, gender, as well as medical unit, contractual category, comorbidities, etc., were analyzed and were taken from April to June 2020 from the Online Notification System for Epidemiological Surveillance (SINOLAVE) database. It was used descriptive statistics, and Pearson's chi-squared, with a p < 0.05. RESULTS: 228 patients were analyzed. The nursing staff was the one with the highest prevalence with 101 patients (44.3%). Comorbidities such as obesity in the foreground, with 27 patients (11.8%), and diabetes mellitus alone with 15 patients (6.6%), and as a group, along with arterial hypertension, obesity and being a chronic smoker in 22 patients (9.6%) were the most frequent. CONCLUSIONS: The nursing staff predominated;the prevalent comorbidities were obesity, diabetes mellitus and arterial hypertension.

THINKING WITHOUT COVID, WITH COVID: SOCIAL SUPPORT NEEDS OF RHYTHM GYM ATHLETES

This research proposes the objective of unveiling social support needs for the reincorporation of rhythmic gymnastics athletes to practice sports that the Cienfuegos Sports Initiation School. The research followed a qualitative constructive interpretive approach. For the sample selection, a convenience strategy was used, accessing 12 Rhythmic Gymnastics athletes from the Cienfuegos Sports Initiation School. To obtain the information, the qualitative questionnaire of social perception of COVID-19. The main results reveal a negative significance of the pandemic as an epidemiological phenomenon, from the reference point of its definition and consequences, the confrontation and protection measures, as well as the psychological discomforts experienced. Needs, fears and discomforts are expressed mainly around sports activity and study activity. The expressed demands for social support are based on actions of emotional, instrumental and informational social support.

Subjective configuration of psychological facing up to COVID-19 of convalescent adolescent´s for the first regrowth

Introduction: For adolescent´s getting sick of COVID-19 constitute a stressful situation considering demands of being in hospital and due to the medical attention. Objective: Making known the subjective configuration of psychological facing up to COVID-19 of convalescent adolescent´s for the first regrowth of this illness trough a multi-case study. Methods: The research was carried out following an interpretative constructive qualitative approach trough a multi-case study. The sample was selected intentionally, having access to 13 convalescent adolescent´s suffering from COVID-19 over period of April-October, in 2020 that were included in order to be followed by infant and young psychiatric and psychology service from their stay on in our province of Villa Clara. Writing a composition and affective rhombus technique, were used to get some information. Content analysis was processed using the tool ATLAS.ti. Results: The psychological facing up to COVID-19 of convalescent adolescent´s for the first regrowth of this illness was characterized by psychological discomfort as fears and sadness, favorable assessment on the work of health staff, limited mobilization of tough resources and short of perception of social support. Conclusions: The rehabilitation on daily life context is faced from the concern for the Project of professional training, the protection and security needs putting into the end of pandemic, family and personal health preservation and the company of family that live at home. © 2021, Editorial Ciencias Medicas. All rights reserved.

Ensemble Models for Covid Prediction in X-Ray Images

Due to the urgency of the COVID pandemic, it is necessary to develop new and quick methods to detect the infection and stop the spread of the disease. In this work we compare a simple Deep Learning (DL) model with an ensemble model in the task of COVID detection in X-Ray images. For the simple model, we have used only frontal DX X-Ray images while, for the ensemble model, we have used frontal DX and CR X-Ray images, as well as lateral DX and CR X-Ray images. In the ensemble model, the features of the four images are combined to make a final prediction and, since not every patient possess all types of images, the model is also robust against missing information, which is crucial in these types of models. Although the dataset used is very noisy, the presented system has shown the desired robustness and offers relevant results, showing that ensemble models can generalize better over the data, which leads to a higher accuracy. Finally, we share our conclusions and discuss future work where we want to try using a similar methodology. © 2021, Springer Nature Switzerland AG.

The COVID-19 pandemic outbreak and its implications for Internet addiction

The pandemic outbreak of COVID-19 poses a challenge to biological, psychological and social resilience. Vulnerable individuals include those who have substance use disorders. Addiction can occur in many forms like behavioral addictions. This study Internet addiction previous and during physical confinement was evaluated. We evaluated 300 undergraduate students, 150 before the confinement and 150 during the confinement period. All completed a 26-item measure of Internet addiction questionnaire. Results showed in the previous condition that 38,67% were in Internet addiction condition, while 61,33% were in risk condition. In physical confinement, 8,16% were in Internet addiction condition, 51,02% did not show Internet addiction, while the 40,08% were in risk condition. Implications for the study, prevention, and treatment of behavioral addictions are discussed.

Unexpected better outcome in a liver transplant recipient with COVID-19: a beneficial effect of tacrolimus? / Evolución clínica en un receptor de trasplante de hígado con la COVID-19: ¿Un efecto benéfico del tacrolimus?

Coronavirus disease 2019 (COVID-19) is a serious respiratory illness caused by SARS-CoV-2. There is controversy about whether their immunosuppressive status is a risk factor or a protective factor for developing severe disease. We report herein the clinical outcome of three family members that had COVID-19 infection, presenting with and without different risk factors that have been described in more severe disease. Paradoxically, the patient with more risks of developing a severe disease, a 64-year-old woman, 2-years liver transplant recipient under treatment with tacrolimus, presented a similar outcome compared to the two other members of the family. She showed shorter hospitalization time, similar clinical outcome with fewer oxygen needs. The present clinical observation raises the question about the possible beneficial effect of tacrolimus in patients with COVID-19. Indeed, tacrolimus (FK-506) have an inhibitory effect on human coronaviruses by: 1) an antiviral effect by binding to the FK-506-binding proteins (FKBP) with a subsequent inhibition of their peptidyl-prolyl cis/trans isomerase (PPIase) activity, which seems to be important for the coronavirus life cycle; and 2) regulating the immune response by the inhibition of the activity of the nuclear factor of activated T-cells (NFAT) required for immunosuppression. The present observation states that liver recipients' patients with COVID-19 may not have worse outcomes when compared with other patients that have COVID-19 risk factors and puts in evidence the two mechanisms related to tacrolimus.

Pre-eclampsia-like syndrome induced by severe COVID-19: a prospective observational study.

OBJECTIVES: To investigate the incidence of clinical, ultrasonographic and biochemical findings related to pre-eclampsia (PE) in pregnancies with COVID-19, and to assess their accuracy to differentiate between PE and the PE-like features associated with COVID-19. DESIGN: A prospective, observational study. SETTING: Tertiary referral hospital. PARTICIPANTS: Singleton pregnancies with COVID-19 at >20+0  weeks. METHODS: Forty-two consecutive pregnancies were recruited and classified into two groups: severe and non-severe COVID-19, according to the occurrence of severe pneumonia. Uterine artery pulsatility index (UtAPI) and angiogenic factors (soluble fms-like tyrosine kinase-1/placental growth factor [sFlt-1/PlGF]) were assessed in women with suspected PE. MAIN OUTCOME MEASURES: Incidence of signs and symptoms related to PE, such as hypertension, proteinuria, thrombocytopenia, elevated liver enzymes, abnormal UtAPI and increased sFlt-1/PlGF. RESULTS: Thirty-four cases were classified as non-severe and 8 as severe COVID-19. Five (11.9%) women presented signs and symptoms of PE, all five being among the severe COVID-19 cases (62.5%). However, abnormal sFlt-1/PlGF and UtAPI could only be demonstrated in one case. One case remained pregnant after recovery from severe pneumonia and had a spontaneous resolution of the PE-like syndrome. CONCLUSIONS: Pregnant women with severe COVID-19 can develop a PE-like syndrome that might be distinguished from actual PE by sFlt-1/PlGF, LDH and UtAPI assessment. Healthcare providers should be aware of its existence and monitor pregnancies with suspected pre-eclampsia with caution. TWEETABLE ABSTRACT: This study shows that a pre-eclampsia-like syndrome could be present in some pregnancies with severe COVID-19.