Bictegravir Use During Pregnancy: A Multi-Center Retrospective Analysis Evaluating HIV Viral Suppression and Perinatal Outcomes.

This study describes the largest cohort to date (n=147) of pregnant patients living with HIV on bictegravir (BIC). BIC in pregnancy was associated with high levels of viral suppression and similar perinatal outcomes to published literature. These findings support consideration for use of BIC in management of HIV during pregnancy.

MAF amplification licenses ERα through epigenetic remodelling to drive breast cancer metastasis.

MAF amplification increases the risk of breast cancer (BCa) metastasis through mechanisms that are still poorly understood yet have important clinical implications. Oestrogen-receptor-positive (ER+) BCa requires oestrogen for both growth and metastasis, albeit by ill-known mechanisms. Here we integrate proteomics, transcriptomics, epigenomics, chromatin accessibility and functional assays from human and syngeneic mouse BCa models to show that MAF directly interacts with oestrogen receptor alpha (ERα), thereby promoting a unique chromatin landscape that favours metastatic spread. We identify metastasis-promoting genes that are de novo licensed following oestrogen exposure in a MAF-dependent manner. The histone demethylase KDM1A is key to the epigenomic remodelling that facilitates the expression of the pro-metastatic MAF/oestrogen-driven gene expression program, and loss of KDM1A activity prevents this metastasis. We have thus determined that the molecular basis underlying MAF/oestrogen-mediated metastasis requires genetic, epigenetic and hormone signals from the systemic environment, which influence the ability of BCa cells to metastasize.

Maternal Supraphysiological Hypercholesterolemia Is Accompanied by Shifts in the Composition and Anti-Atherogenic Functions of Maternal HDL along with Maternal Cardiovascular Risk Markers at Term of Pregnancy.

BACKGROUND: Maternal physiological hypercholesterolemia (MPH) occurs in pregnancy for a proper fetal development. When cholesterol increases over the physiological range, maternal supraphysiological hypercholesterolemia (MSPH) is described, a condition underdiagnosed by a lack of evidence showing its biological and clinical relevance. AIM: To determine if MSPH associates with maternal vascular dysfunction, along with changes in the composition and function of maternal HDL leading to increased cardiovascular risk. METHODS: This study included 57 women at term of pregnancy in which a lipid profile was determined. RESULTS: Maternal total cholesterol (TC) and LDL but not HDL were increased in MSPH women. The isolated HDL from a subgroup of MSPH women had a lower protein abundance and a reduced activity of the antioxidant enzyme PON1; however, an increased antioxidant capacity compared to MPH was observed, along with higher serum levels of α-tocopherol. Moreover, HDL from a subgroup of MSPH women had a lower capacity to induce NO synthesis in endothelial cells compared to MPH. In the circulation, we observed a reduced total antioxidant capacity and augmented levels of soluble VCAM, ApoB, ApoCII, ApoCIII, IL-10, and IL-12p70, as well as the cardiovascular risk ratio ApoB/ApoAI, compared to MPH women. CONCLUSION: MSPH women present dysfunctional HDL and increased atherogenic cardiovascular risk factors.

Effect of Recycled Polyvinyl Butyral (rPVB) Addition on the Tribological Performance of Glass-Fiber Reinforced Polyamide (PAGF) during Reciprocating Sliding Wear Conditions.

Plastic recycling in the automotive industry is a priority. In this study, the effect of adding recycled polyvinyl butyral (rPVB) from automotive windshields on the coefficient of friction (CoF) and specific wear rate (k) of a glass-fiber reinforced polyamide (PAGF) is investigated. It was found that, at 15 and 20 wt.% of rPVB, it acts as a solid lubricant, reducing CoF and k up to 27% and 70%, respectively. Microscopical analysis of the wear tracks showed that rPVB spreads over the worn tracks, forming a lubricant layer, which protects the fibers from damage. However, at lower rPVB content, fiber damage cannot be prevented as the protective lubricant layer is not formed.

Medición de la situación de inseguridad alimentaria a nivel del hogar en los municipios de cobertura del Ejercicio Profesional Supervisado de la Escuela de Nutrición de la Universidad de San Carlos de Guatemala / Measurement of the situation of food insecurity at the household level in the municipalities covered by the Supervised professional Exercise of the School of Nutrition of the San Carlos of Guatemala

La inseguridad alimentaria (INSA) es la condición que resulta de un acceso incierto o nulo a alimentos nutricionalmente adecuados socialmente aceptables y/o insuficiente ingestión de alimentos. Las causas de la INSA son múltiples y difieren en cada país, entre ellas están inadecuado acceso, y disponibilidad a los alimentos nutricionalmente adecuados y a los capitales de desarrollo. Según los resultados de la Encuesta Nacional de Condiciones de Vida del 2014, la INSA afecta a más de la mitad de la población guatemalteca con repercusiones en su calidad de vida y desarrollo. El objetivo de la investigación fue determinar el nivel de INSA en hogares de los 29 municipios pertenecientes a 12 departamentos de cobertura del EPS de la Universidad de San Carlos de Guatemala. Se realizó un estudio de tipo cuantitativo, descriptivo, transversal, utilizando la metodología de recolección, validación y análisis de información establecida en el Manual de la Escala Latinoamericana y Caribeña de Seguridad Alimentaria (ELCSA). La muestra fue de 2,750 hogares, obtenida por medio de un muestreo probabilístico para poblaciones finitas. Los datos analizados fueron desagregados según sexo y edad de jefe de hogar, lugar de residencia, número de miembros en el hogar y presencia de menores de 18 años. La investigación mostró que, al momento de la entrevista, 2,035 (74%) [72.3, 75.7] hogares fueron clasificados en situación de INSA. Se presentó un mayor porcentaje de INSA en los hogares del área rural (85% [82.5, 87.4]) y en los hogares con niños menores de 18 años (80% [78.0, 81.5]). También se observó que, a mayor número de miembros del hogar, mayor porcentaje de INSA. Con los resultados obtenidos, se pretende motivar la implementación de estrategias que coadyuven a mejorar la situación de INSA en la población.

Food insecurity (FI) is the condition that results from uncertain or no access to socially acceptable, nutritionally adequate foods and/or insufficient food intake. The causes of FI are multiple and differ in each country, among them are inadequate access and availability to adequate nutritional foods and development capital. According to the results of the 2014 National Survey of Living Conditions, FI affects more than half of the Guatemalan population.The objective of the research was to determine the level of FI at household level of the 29 municipalities belonging to 12 departments covered by the Nutrition Supervised Professional Practice of the University of San Carlos of Guatemala, through a quantitative, descriptive, cross-sectional study, using the collection, validation and analysis of information established in the Manual of the Latin American and Caribbean Food Security Scale. The sample was 2,750 households, obtained by means of a probabilistic sampling for finite populations. The data analyzed were disaggregated according to the sex and age of the head of the household, place of residence, number of members in the household, and presence of children under 18 years of age. The investigation showed that, at the time of the interview, 2,035 (74%) [72.3, 75.7] households were classified as FI. There was a higher percentage of FI in households in rural areas (85% [82.5, 87.4]) and in households with children under 18 years of age (80% [78.0, 81.5]). It is intended that the results of this study contribute to motivate the implementation of strategies that help to improve the situation of FI in the evaluated population.

Síndrome de cascanueces y agenesia renal derecha. Una rara asociación

Introducción: El síndrome de cascanueces se considera una anomalía infrecuente y poco pensada en la práctica médica; su incidencia no está bien establecida debido a su sintomatología variada. La agenesia renal unilateral se estima entre 1/2500 y 1/4000 nacidos vivos. Objetivos: Describir una paciente de 18 años con sospecha prenatal de agenesia renal derecha confirmada por imágenes después del nacimiento, que ingresó por proteinuria. Presentación del caso: Paciente de 18 años con agenesia renal derecha conocida, en la que un examen de orina detectó proteinuria desde los 13 años. En su estudio se clasificó como proteinuria ortostática y evolutivamente refirió dolor lumbar izquierdo ligero y transitorio. En el ultrasonido renal, realizado para valorar crecimiento del riñón único, se detectó dilatación de la vena renal izquierda. Se repitió el estudio ecográfico para precisar ángulo aorto-mesentérico y dilatación de vena renal izquierda, y se confirmó el síndrome de cascanueces. Conclusiones: La asociación entre agenesia renal derecha y síndrome de cascanueces, resulta extremadamente rara, y, cuando se presenta con proteinuria ortostática y dolor lumbar ocasional, debe seguirse en forma expectante, pero no se necesita tratamiento quirúrgico en la mayoría de los casos.

Introduction: Nutcracker syndrome is considered an infrequent and poorly thought out anomaly in medical practice; its incidence is not well established due to its varied symptomatology. Unilateral renal agenesis is estimated to be between 1/2500 and 1/4000 live births. Objectives: To describe an 18-year-old female patient with suspected pre-natal imaging-confirmed right renal agenesis after birth, who was admitted due to proteinuria. Case presentation: An 18-year-old female patient with known right renal agenesis, in whom a urine test detected proteinuria from the age of 13. In the study it was classified as orthostatic proteinuria and evolutionarily she referred mild and transient left low back pain. Renal ultrasound, performed to assess single kidney growth, showed dilation of the left renal vein. The ultrasound study was repeated to specify aorto-mesenteric angle and left renal vein dilation, and nutcracker syndrome was confirmed. Conclusions: The association between right renal agenesis and nutcracker syndrome is extremely rare, and, when it presents with orthostatic proteinuria and occasional low back pain, it should be followed expectantly, but surgical treatment is not needed in most cases.

Un modelo para la evaluación de las habilidades no técnicas en anestesiología: una revisión de la literatura / A model for the assessment of non-technical skills in anesthesiology: a literature review

Resumen: Hasta 80% de los errores médicos se deben a fallas en factores humanos (mala comunicación, monitoreo inadecuado, fallas de verificación, etc.), por lo que el entrenamiento de los anestesiólogos exige el desarrollo de habilidades no técnicas en anestesiología. Las habilidades no técnicas son las habilidades cognitivas, sociales y personales que complementan las habilidades técnicas, y que contribuyen al desempeño seguro y eficiente de la tarea. En 2004 la Universidad de Aberdeen fue la primera en plantear un modelo para la definición y evaluación de estas habilidades en el ámbito médico. El modelo práctico consta de 15 elementos incluidos en cuatro categorías: manejo de la tarea, trabajo en equipo, conciencia de la situación y toma de decisiones. La herramienta es utilizada por anestesiólogos graduados para evaluar a quienes están en entrenamiento en el quirófano o mediante simulación clínica. La validez de este sistema, así como su importancia en la seguridad del paciente, ha sido demostrada por diferentes estudios.

Abstract: Close to 80% of medical errors are due to human factors (poor communication, inadequate monitoring, failure to check, etc.), which is why training for anaesthetists requires developing essential soft skills for Anaesthesiology. Soft skills are defined as specific cognitive, socio-emotional and interpersonal abilities complementing core skills which contribute to the safe and efficient carrying out of a job-specific task. In 2004, the University of Aberdeen established a first model for defining and evaluating these soft skills. The model consists of 15 elements across four categories: task management, team working, situational awareness and decision-making. The model is a tool employed by postgraduate anaesthesiologists to assess trainees in the operating theatre or through clinical simulation. The validity of this system, as well as its importance for patient safety have been demonstrated in a range of studies.

Environmental Nanoparticles Reach Human Fetal Brains.

Anthropogenic ultrafine particulate matter (UFPM) and industrial and natural nanoparticles (NPs) are ubiquitous. Normal term, preeclamptic, and postconceptional weeks(PCW) 8-15 human placentas and brains from polluted Mexican cities were analyzed by TEM and energy-dispersive X-ray spectroscopy. We documented NPs in maternal erythrocytes, early syncytiotrophoblast, Hofbauer cells, and fetal endothelium (ECs). Fetal ECs exhibited caveolar NP activity and widespread erythroblast contact. Brain ECs displayed micropodial extensions reaching luminal NP-loaded erythroblasts. Neurons and primitive glia displayed nuclear, organelle, and cytoplasmic NPs in both singles and conglomerates. Nanoscale Fe, Ti, and Al alloys, Hg, Cu, Ca, Sn, and Si were detected in placentas and fetal brains. Preeclamptic fetal blood NP vesicles are prospective neonate UFPM exposure biomarkers. NPs are reaching brain tissues at the early developmental PCW 8-15 stage, and NPs in maternal and fetal placental tissue compartments strongly suggests the placental barrier is not limiting the access of environmental NPs. Erythroblasts are the main early NP carriers to fetal tissues. The passage of UFPM/NPs from mothers to fetuses is documented and fingerprinting placental single particle composition could be useful for postnatal risk assessments. Fetal brain combustion and industrial NPs raise medical concerns about prenatal and postnatal health, including neurological and neurodegenerative lifelong consequences.

Using virtual reality to increase charitable donations.

Marketer interest in using virtual reality (VR) as a persuasion tactic continues to rise. Notably, one sector at the forefront of utilizing this tactic for persuasive means is nonprofit marketing. Many charities have devoted considerable resources to creating VR appeals under the assumption that this medium will increase donations over and above present tactics. However, research has not yet examined the persuasive consequences VR may provide over more traditional channels. This research seeks to understand the opportunities and limitations this emerging tactic can offer marketers. Specifically, we examine the donation effectiveness of three real VR charitable appeals by assessing actual donation behaviors, and find that VR appeals increase donations compared to a two-dimensional (2D) format. This work addresses a timely and relevant issue for practitioners and opens doors to future research investigating VR's applications to marketing. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11002-021-09601-8.

SARS-CoV-2 infection in patients with primary central nervous system lymphoma.

BACKGROUND: Cancer patients may be at higher risk for severe coronavirus infectious disease-19 (COVID-19); however, the outcome of Primary Central Nervous System Lymphoma (PCNSL) patients with SARS-CoV-2 infection has not been described yet. METHODS: We conducted a retrospective study within the Lymphomes Oculo-Cérébraux national network (LOC) to assess the clinical characteristics and outcome of SARS-CoV-2 infection in PCNSL patients (positive real-time polymerase chain reaction of nasopharyngeal swab or evocative lung computed tomography scan). We compared clinical characteristics between patients with severe (death and/or intensive care unit admission) and mild disease. RESULTS: Between March and May 2020, 13 PCNSL patients were diagnosed with SARS-CoV-2 infection, 11 (85%) of whom were undergoing chemotherapy at the time of infection. The mortality rate was 23% (3/13), and two additional patients (15%) required mechanical ventilation. Two patients (15%) had no COVID-19 symptoms. History of diabetes mellitus was more common in severe patients (3/5 vs 0/8, p = 0.03). Two patients recovered from COVID-19 after mechanical ventilation during more than two weeks and resumed chemotherapy. In all, chemotherapy was resumed after COVID-19 recovery in nine patients (69%) after a median delay of 16 days (range 3-32), none of whom developed unusual chemotherapy complication nor SARS-Cov2 reactivation. CONCLUSION: This preliminary analysis suggests that, while being at higher risk be for severe illness, PCNSL patients with COVID-19 might be treated maximally especially if they achieved oncological response at the time of SARS-CoV-2 infection. Chemotherapy might be resumed without prolonged delay in PCNSL patients with COVID-19.

Economic Inequality Increases the Preference for Status Consumption.

Prior research has shown the relationship between objective economic inequality and searching for positional goods. It also investigated the relationship between social class and low income with conspicuous consumption. However, the causal relationship between economic inequality (the difference in wealth between individuals and groups living in a shared context and consumer behavior) has been less explored. Furthermore, there are also few studies looking for the psychological mechanisms that underlie these effects. The current research's main goal is to analyze the consequences of perceived economic inequality (PEI) on conspicuous and status consumption and the possible psychological mechanisms that could explain its effects. Furthermore, the current research aims to examine whether there is a causal relationship between PEI and materialism preferences and attitudes toward indebtedness. This work includes two preregister experimental studies. In the Study 1 (n = 252), we manipulated PEI and its legitimacy through a 2 (high vs. low inequality) × 2 (Illegitimate vs. legitimate) between-participants experiment. Results showed a main effect of PEI on status consumption, status seeking, status anxiety, materialism, and attitude toward indebtedness. No interaction effect between legitimacy and inequality was found. In the Study 2 (n = 301), we manipulated the PEI through the Bimboola Paradigm. We replicated the effect of PEI on status consumption, status seeking, and materialism and found that status seeking mediated the relationship between PEI and status and conspicuous consumption. Economic inequality affects consumer behavior and favors consumption preferences for products that provide desirable symbolic values associated with status. These results could have important implications in the interpersonal and intergroup processes, including those related to consumption and purchase.

Access to Outpatient Pediatric Mental Health Care After Emergency Department Discharge.

OBJECTIVES: Pediatric mental health presentations to emergency departments (EDs) have shown dramatic increases nationally. This study aimed to identify the ability of patients discharged with mental health from the ED to establish outpatient care. METHODS: This was a cross-sectional study of all mental health patients aged 7 to 19 years who were seen by a child psychiatry consult team in a tertiary care pediatric ED from September 2016 to January 2017. Patients were contacted by phone at least 6 months after discharge. Data obtained included time to follow-up, reasons for delayed follow-up, type of provider seen, and frequency of outpatient visits. RESULTS: Two hundred twenty-eight charts were reviewed and 51 were successfully interviewed. The median age was 14 years and 61% were female. Most patients (61%) reported seeing a psychiatrist or therapist, whereas 19% reported a primary care provider and 19% reporting "other." The majority were able to establish care within 1 month (73%), whereas 9% reported never obtaining outpatient follow-up. Most patients (58%) were able to be seen more than once per month. The most common reason for delayed follow-up was provider availability. CONCLUSIONS: This study found that a large number of patients were able to be seen within 1 month of discharge for mental health care. However, almost 10% of patients never established outpatient care, which is concerning and is an area needing further research.

Evaluación de Errores de Posicionamiento en los 6 Grados de Libertad en Pacientes con Cáncer de próstata tratados con radioterapia / Evaluation of Positioning Errors in the 6 Degrees of Freedom in Patients with Prostate Cancer Treated with Radiotherapy

Objetivos Determinar la magnitud de los errores de posicionamiento en los 6 grados de libertad y calcular el Margen a CTV para un protocolo adaptado en pacientes con cáncer de próstata temprano y localmente avanzado en un centro de referencia en Colombia. Métodos Se realizó un estudio observacional prospectivo en 61 pacientes con cáncer de próstata tratados con radioterapia en el Centro Javeriano de Oncología del Hospital Universitario San Ignacio durante el 2018, con toma de imágenes volumétricas de rayos x durante los primeros 3 días de tratamiento obteniéndose un promedio en errores traslacionales y rotacionales. Posteriormente se tomaron imágenes semanales. Además, se realizó el cálculo del margen al PTV y variaciones en vejiga y recto durante el tratamiento. Resultados Un total de 508 imágenes fueron registradas durante las 8 semanas de tratamiento, los errores traslacionales y rotacionales tuvieron un comportamiento alrededor de cero sin diferencias significativas inclusive en pacientes con IMC > = 25. También se calculó el margen al PTV encontrándose entre 5 y 8 mm, en cuanto a las medidas de vejiga y recto no se encontraron diferencias estadísticamente significativas en las imágenes adquiridas durante la radioterapia. Conclusiones De acuerdo a los datos encontrados en este estudio, una adecuada reproducibilidad en paciente con cáncer de próstata puede ser encontrada usando el método de registro rígido de la anatomía pélvica ósea, promediando las 3 primeras imágenes y posteriormente con imágenes semanales, en centros con alta demanda de pacientes garantizando así una adecuada precisión del tratamiento.

Objectives To determine the magnitude of the positioning errors in the 6 degrees of freedom and calculate the Margin to CTV for an adapted protocol in patients with early and locally advanced prostate cancer in a reference center in Colombia. Methods A prospective observational study was performed in 61 prostate cancer patients treated with radiotherapy at the Javeriano Oncology Center of the San Ignacio University Hospital during 2018, with volumetric X-ray imaging during the first 3 days of treatment obtaining a average in translational and rotational errors. Subsequently, weekly images were taken. In addition, the calculation of the margin to the PTV and variations in bladder and rectum during the treatment was performed. Results A total of 508 images were recorded during the 8 weeks of treatment, translational and rotational errors had a behavior around zero without significant differences even in patients with BMI > = 25. The margin to the PTV was also calculated between 5 and 8 mm, in terms of bladder and rectum measurements, no statistically significant differences were found in the images acquired during radiotherapy. Conclusions According to the data found in this study, an adequate reproducibility in a patient with prostate cancer can be found using the method of rigid registration of the pelvic bone anatomy, averaging the first 3 images and subsequently with weekly images, in centers with high patient demand guaranteeing adequate treatment accuracy.

Rasgos de personalidad del grupo C y trastorno por déficit de atención en estudiantes de medicina: estudio transversal analítico

Background: Attentional deficit hyperactivity disorder (ADHD) in adults is associated with borderline personality characteristics or cluster B (emotional instability), but in certain populations, such as medical students, it might be associated with cluster C traits (perfectionism, dependency, anxiety). This may be compensatory to ADHD. Aim: To analyze the association between ADHD and cluster C personality traits in medical students. Material and Methods: Biodemographic characteristics, the presence of ADHD and personality traits according to clusters A, B and C were evaluated in medical students. These characteristics were compared between students with unlikely diagnosis of ADHD (Group 1) and likely or very likely diagnosis of ADHD (Group 2). Results: We included 336 participants (44% women). A likely or very likely diagnosis of ADHD was present in 64% (Group 2). Concerning personality traits, 45% exhibited traits of cluster A, 57% of cluster B, and 67% of cluster C. Compared to their counterparts of Group 1, participants in Group 2 were more likely to have a history of psychiatric/psychological care, previous diagnosis of ADHD and traits of cluster B (37 and 68% respectively) and C (55 and 74% respectively). The odds ratio of having A, B or C traits when a likely or very likely ADHD was present, were 1.29 95% confidence interval (CI) [0.8-2.07], 3.79 95% CI [2.3-6.22] and 2.4 95% CI [1.46-3.96], respectively. Conclusions: Cluster C personality traits were frequent among medical students and were significantly associated with ADHD.

Ageusia and anosmia, a common sign of COVID-19? A case series from four countries.

Over the course of the pandemic due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), multiple new clinical manifestations, as the consequence of the tropism of the virus, have been recognized. That includes now the neurological manifestations and conditions, such as headache, encephalitis, as well as olfactory and taste disorders. We present a series of ten cases of RT-PCR-confirmed SARS-CoV-2-infected patients diagnosed with viral-associated olfactory and taste loss from four different countries.

MiR-195 enhances cardiomyogenic differentiation of the proepicardium/septum transversum by Smurf1 and Foxp1 modulation.

Cardiovascular development is a complex developmental process in which multiple cell lineages are involved, namely the deployment of first and second heart fields. Beside the contribution of these cardiogenic fields, extracardiac inputs to the developing heart are provided by the migrating cardiac neural crest cells and the proepicardial derived cells. The proepicardium (PE) is a transitory cauliflower-like structure located between the cardiac and hepatic primordia. The PE is constituted by an internal mesenchymal component surrounded by an external epithelial lining. With development, cells derived from the proepicardium migrate to the neighboring embryonic heart and progressive cover the most external surface, leading to the formation of the embryonic epicardium. Experimental evidence in chicken have nicely demonstrated that epicardial derived cells can distinctly contribute to fibroblasts, endothelial and smooth muscle cells. Surprisingly, isolation of the developing PE anlage and ex vivo culturing spontaneously lead to differentiation into beating cardiomyocytes, a process that is enhanced by Bmp but halted by Fgf administration. In this study we provide a comprehensive characterization of the developmental expression profile of multiple microRNAs during epicardial development in chicken. Subsequently, we identified that miR-125, miR-146, miR-195 and miR-223 selectively enhance cardiomyogenesis both in the PE/ST explants as well as in the embryonic epicardium, a Smurf1- and Foxp1-driven process. In addition we identified three novel long non-coding RNAs with enhanced expression in the PE/ST, that are complementary regulated by Bmp and Fgf administration and well as by microRNAs that selectively promote cardiomyogenesis, supporting a pivotal role of these long non coding RNAs in microRNA-mediated cardiomyogenesis of the PE/ST cells.

Tracing New Clinical Manifestations in Patients with COVID-19 in Chile and Its Potential Relationship with the SARS-CoV-2 Divergence.

PURPOSE OF REVIEW: In this review, we discuss the current implications of the changing genomic epidemiology of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), etiological agent of the Coronavirus Disease 2019 (COVID-19) and its potential relationship with the change of clinical manifestations in patients with confirmed infection. RECENT FINDINGS: Over the course of the current pandemic, the virus has been found more diverse in new countries. Simultaneously, also new clinical manifestations are observed, particularly more prominent gastrointestinal and neurological findings. SUMMARY: SARS-CoV-2/COVID-19 is changing not only its epidemiology, but also its genomic diversity and clinical manifestations, both aspects coupled, needs to be considered in the study of this ongoing pandemic.