The coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a profound impact on global health and socio-economic conditions. To date, various vaccines have been administered worldwide in an effort to curb the spread of the virus. Despite vaccination efforts, there have been complications. Existing antiviral drugs have shown limited effectiveness, prompting the use of computational methods to understand the dynamics of the virus and develop suitable treatments. The current study focuses on using biocompatible para-sulfonato-calix[4]arenes to dock against two key proteins of SARS-CoV-2, namely ribonucleic acid (RNA)-dependent RNA polymerase, and helicase. Docking results indicate a strong binding affinity of these compounds to the target proteins, with higher scores compared to commonly used medications. Molecular dynamics (MD) simulation validates the docking results, showing stable protein-ligand complexes over time. The compounds are also screened for absorption, distribution, metabolism, and excretion properties and toxicity, suggesting their potential as lead candidates for inhibiting the virus’s key proteins. However, further in vivo and in vitro studies are recommended to confirm these findings. COVID19 COVID 19 (COVID-19 pandemic SARSCoV2, SARSCoV2 SARSCoV SARS CoV , (SARS-CoV-2) socioeconomic socio economic conditions date efforts complications effectiveness treatments parasulfonatocalix4arenes parasulfonatocalixarenes para sulfonato calix 4 arenes 2, SARS-CoV-2 RNAdependent dependent polymerase helicase medications MD (MD proteinligand protein ligand time absorption distribution metabolism toxicity viruss s However findings COVID1 1 (COVID-1 (SARS-CoV-2 parasulfonatocalix SARS-CoV- (COVID- (SARS-CoV- SARS-CoV (COVID (SARS-CoV

ABSTRACT Unvaccinated identical twins developed bilateral anterior uveitis soon after the onset of coronavirus disease 2019 symptoms. During follow-up, both patients developed choroiditis, and one twine developed posterior scleritis and serous retinal detachment. Prompt treatment with oral prednisone ameliorated the lesions, and no recurrence was observed at the 18-month follow-up. Choroiditis may rarely be associated with severe acute respiratory syndrome coronavirus 2 infection, and it responds well to corticosteroid therapy. Although the exact mechanism is unknown, we hypothesize that the virus may act as an immunological trigger for choroiditis. 201 symptoms followup, followup follow up, up follow-up choroiditis detachment lesions 18month month 18 followup. up. infection therapy unknown 20 1

The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) stands for being the most serious epidemic (so far) of the 21st century. However, only a few computational studies have investigated the molecular mechanisms underlying the neutralization of the spike protein by antibodies of different classes. Hence, bioinformatic methods were employed to unravel the factors contributing to the remarkable neutralization capacity exhibited by specific antibodies. Initially, crystallographic structures of IgA monomeric / dimeric, IgG, and IgM antibodies binding with the receptor-binding domain region of the SARS-CoV-2 spike protein were retrieved. Subsequently, rigid molecular docking and molecular dynamic simulations were performed over 100 ns with explicit water solvation. Lastly, an energy decomposition was conducted to estimate the binding affinity using the last frames from molecular dynamics. The results revealed a higher binding affinity for both monomeric and dimeric forms of IgA antibodies against the spike protein. Additionally, a greater number of hydrogen bonds were observed during their interaction with the spike protein, as well as greater structural instability along the time and especially a more thermodynamically favorable interaction affinity. In this way, the research contributes a small piece to the complex puzzle of understanding the humoral immune response induced by the SARS-CoV-2 virus. SARSCoV2 SARSCoV SARS CoV (SARS-CoV-2 so far st century However classes Hence Initially IgG receptorbinding receptor SARS-CoV- retrieved Subsequently 10 solvation Lastly dynamics Additionally way virus (SARS-CoV- SARS-CoV 1 (SARS-CoV

RESUMO Objetivo: Verificar a utilização e identificar as vantagens dos métodos moleculares para diagnóstico de infecções congênitas no líquido cefalorraquidiano de neonatos. Fontes de dados: A revisão foi registrada na base PROSPERO (International Prospective Register of Systematic Reviews) sob CRD42021274210. A busca bibliográfica foi realizada nas bases de dados PubMed, Biblioteca Virtual em Saúde/ Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (BVS/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, e EBSCOhost. A busca foi feita no período de agosto a outubro de 2021 e atualizada em dezembro de 2022, respeitando as orientações do Preferred Reporting Items for Systematic Reviews e Meta-Analyises (PRISMA). A sequência da seleção dos estudos foi: 1) Remoção de duplicatas; 2) Exame de títulos e resumos; 3) Recuperação dos textos completos potencialmente relevantes; e 4) Avaliação do texto completo conforme critérios de elegibilidade por dois autores independentes. O critério de inclusão considerou ensaios clínicos randomizados e não randomizados, estudos longitudinais, transversais, revisados por pares, estudos em humanos, publicados em inglês, espanhol, italiano e português, com recém-nascidos de até 28 dias que sofreram neuroinfecções congênitas pelos agentes toxoplasmose, rubéola, citomegalovírus, herpes simples (TORCH), e outros como Treponema pallidum, Zika, parvovírus B-19, varicela zoster, Epstein-Barr, e SARS-CoV-2, diagnosticadas por reação em cadeia de polimerase (PCR). Dois avaliadores extraíram as seguintes informações: autor, ano de publicação, nacionalidade, sujeitos, tipo de estudo, métodos, resultados e conclusão. Síntese dos dados: O patógeno mais estudado foi Herpes Simples. Muitos artigos relataram somente sintomas iniciais inespecíficos, motivando a coleta de líquido cefalorraquidiano e realização da PCR para investigação etiológica. Conclusões: Os métodos moleculares são eficazes para detectar o genoma do patógeno no líquido cefalorraquidiano, o que pode impactar na evolução clínica e no prognóstico neurológico. Objetivo neonatos International CRD42021274210 CRD PubMed LatinoAmericano Latino Americano BVS/BIREME, BVSBIREME BVS/BIREME , BVS BIREME (BVS/BIREME) Scopus Science EMBASE, EMBASE (EMBASE) Cochrane ProQuest EBSCOhost 202 2022 MetaAnalyises Meta Analyises PRISMA. PRISMA . (PRISMA) 1 duplicatas 2 resumos 3 relevantes 4 independentes longitudinais transversais pares humanos inglês espanhol português recémnascidos recém nascidos toxoplasmose rubéola citomegalovírus TORCH, TORCH (TORCH) pallidum Zika B19, B19 B 19, 19 B-19 zoster EpsteinBarr, EpsteinBarr Epstein Barr, Barr Epstein-Barr SARSCoV2, SARSCoV2 SARSCoV SARS CoV 2, SARS-CoV-2 PCR. (PCR) informações autor publicação nacionalidade sujeitos estudo conclusão Simples inespecíficos etiológica Conclusões neurológico CRD4202127421 (BVS/BIREME (EMBASE 20 (PRISMA (TORCH B1 B-1 SARS-CoV- (PCR CRD420212742 B- SARS-CoV CRD42021274 CRD4202127 CRD420212 CRD42021 CRD4202 CRD420 CRD42 CRD4

ABSTRACT Objective: To verify the use and identify advantages of molecular methods for congenital infections diagnosis in cerebrospinal fluid of neonates. Data source: The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO), under CRD42021274210. The literature search was performed in databases: PubMed, Virtual Health Library/ Latin American and Caribbean Center on Health Sciences Information (VHL/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, and EBSCOhost. The search was carried out from August to October 2021 and updated in December 2022, respecting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The selection sequence was: 1) Duplicate title removal; 2) Examination of titles and abstracts; 3) Full-text retrieval of potentially relevant reports; and 4) Evaluation of the full text according to eligibility criteria by two independent authors. Inclusion criteria considered randomized and non-randomized control trials, longitudinal, cross-sectional, and peer-reviewed studies in humans, published in English, Spanish, Italian, and Portuguese, with newborns up to 28 days old who had congenital neuroinfections by toxoplasmosis, rubella, cytomegalovirus, herpes simplex (TORCH), and others such as Treponema pallidum, Zika, parvovirus B-19, varicella zoster, Epstein-Barr, and SARS-CoV2, diagnosed by polymerase chain reaction (PCR). Two evaluators extracted the following information: author, year of publication, nationality, subjects, study type, methods, results, and conclusion. Data synthesis: The most studied pathogen was herpes simplex. Several articles reported only nonspecific initial symptoms, motivating the collection of cerebrospinal fluid and performing PCR for etiological investigation. Conclusions: Molecular methods are effective to detect pathogen genomes in cerebrospinal fluid, which can impact clinical evolution and neurological prognosis. Objective neonates source PROSPERO, PROSPERO , (PROSPERO) CRD42021274210 CRD databases PubMed Library VHL/BIREME, VHLBIREME VHL/BIREME VHL BIREME (VHL/BIREME) Scopus Science EMBASE, EMBASE (EMBASE) Cochrane ProQuest EBSCOhost 202 2022 MetaAnalyses Meta Analyses PRISMA (PRISMA guidelines 1 removal 2 abstracts 3 Fulltext Full reports 4 authors nonrandomized non trials longitudinal crosssectional, crosssectional cross sectional, sectional cross-sectional peerreviewed peer reviewed humans English Spanish Italian Portuguese toxoplasmosis rubella cytomegalovirus TORCH, TORCH (TORCH) pallidum Zika B19, B19 B 19, 19 B-19 zoster EpsteinBarr, EpsteinBarr Epstein Barr, Barr Epstein-Barr SARSCoV2, SARSCoV2 SARSCoV SARS CoV2, CoV2 CoV SARS-CoV2 PCR. . (PCR) information author publication nationality subjects type results conclusion synthesis symptoms investigation Conclusions prognosis (PROSPERO CRD4202127421 (VHL/BIREME (EMBASE 20 (TORCH B1 B-1 SARS-CoV (PCR CRD420212742 B- CRD42021274 CRD4202127 CRD420212 CRD42021 CRD4202 CRD420 CRD42 CRD4

Resumen Este artículo es un ejercicio de reflexividad sobre investigaciones etnográficas propias de la infección por SARS-CoV-2 realizadas en 2020-2021. Se analizan aquí experiencias, narrativas y políticas de diagnóstico y control de la circulación del virus en tres ciudades de diferente escala urbana de Argentina. Realizado en la postpandemia, nuestro análisis se propone aportar al estudio del fenómeno sanitario desde la antropología social, ofreciendo recomendaciones para la planificación y gestión de futuros y probables confinamientos. Concluimos que nuestra contribución como científicas sociales es la comprensión del fenómeno sanitario en el marco de desigualdades estructurales, emergiendo la necesidad de planificar la prevención por confinamiento a escalas micro, meso y macro sociales. SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- 20202021. 20202021 2020 2021. 2021 2020-2021 experiencias Argentina postpandemia social confinamientos estructurales micro SARS-CoV 2020202 202 2020-202 202020 20 2020-20 20202 2020-2 2020-

Abstract This article is a critical reflexivity approach of our own ethnographic research on SARS-CoV-2 infection carried out during 2020-2021. Experiences, narratives, interpretations and policies for the diagnosis and control of the circulation of the virus in three cities of different urban scale in Argentina are analyzed here. Carried out in the post-pandemic, our analysis aims to converge experiences, tellings and policies to make significant contributions to the study and understanding of the health phenomenon from social anthropology, offering recommendations for the planning and management of future and probable confinements. We conclude that our contribution as social scientists is the understanding of the health phenomenon within the framework of structural inequalities, emerging the need to plan prevention due to confinement at micro, meso and macro social scales. SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- 20202021. 20202021 2020 2021. 2021 2020-2021 Experiences narratives here postpandemic, postpandemic post pandemic, pandemic post-pandemic experiences anthropology confinements inequalities micro scales SARS-CoV 2020202 202 2020-202 202020 20 2020-20 20202 2020-2 2020-

Resumen El contexto en el que se desarrolla el sector turístico en Cuba ha estado condicionado por una vertiginosa disminución de los ingresos, asociada en gran medida a la propagación del virus SARS-CoV-2 y los efectos postpandemia Covid-19. Este comportamiento ha traído consigo la búsqueda de alternativas que propicien soluciones inminentes. La necesidad de asumir nuevos patrones para volver a alcanzar la posición competitiva previa a la pandemia es un reto para Cuba, lo que demanda cambios transformadores acaecidos desde la ciencia. El objetivo de este trabajo es proponer un procedimiento para el diseño de indicadores que permitan determinar la competitividad del destino turístico Santiago de Cuba. Para ello se propone un procedimiento basado en el análisis multivariante, que se realiza a través de un estudio cienciométrico que valida las principales fuentes que sustentan la competitividad de los destinos, así como sus dimensiones y pilares. Se desarrollan a su vez el análisis documental, estadístico y exploratorio. Como principales resultados se obtienen tres dimensiones que se desagregan en cinco pilares para los cuales se definen ocho indicadores generales. En este sentido se concluye que el destino es competitivo, sin embargo, deben trazarse estrategias que garanticen la fidelización de consumidores y atracción de nuevos segmentos.

Resumo O contexto em que o setor de turismo está se desenvolvendo em Cuba foi condicionado por uma queda vertiginosa na renda, em grande parte associada à disseminação do vírus SARS-CoV-2 e aos efeitos pós-pandêmicos da Covid-19. Esse comportamento levou à busca de alternativas que ofereçam soluções iminentes. A necessidade de assumir novos padrões para retornar à posição competitiva anterior à pandemia é um desafio para Cuba, que exige mudanças transformadoras baseadas na ciência. O objetivo deste artigo é propor um procedimento para o desenho de indicadores para determinar a competitividade do destino turístico de Santiago de Cuba. Para isso, propõe-se um procedimento baseado em análise multivariada, que é realizado por meio de um estudo cienciométrico que valida as principais fontes que sustentam a competitividade dos destinos, bem como suas dimensões e pilares. Também é realizada uma análise documental, estatística e exploratória. Como principais resultados, são obtidas três dimensões, que se desdobram em cinco pilares para os quais são definidos oito indicadores gerais. Nesse sentido, conclui-se que o destino é competitivo, porém, é necessário traçar estratégias para garantir a fidelidade dos consumidores e atrair novos segmentos.

Abstract The context in which the tourism sector is developing in Cuba has been conditioned by a dizzying decline in income, largely associated with the spread of the SARS-CoV-2 virus and the post-pandemic effects of Covid-19. This behavior has brought with it the search for alternatives that would bring about imminent solutions. The need to assume new patterns to reach again the competitive position before the pandemic is a challenge for Cuba, which demands transforming changes from science. The objective of this work is to propose a procedure for the design of indicators to determine the competitiveness of the tourist destination Santiago de Cuba. For this purpose, a procedure based on multivariate analysis is proposed, which is carried out through a scientometric study that validates the main sources that support the competitiveness of destinations, as well as its dimensions and pillars. Documentary, statistical and exploratory analysis is also carried out. As main results, three dimensions are obtained, which are disaggregated into five pillars for which eight general indicators are defined. In this sense, it is concluded that the destination is competitive; however, strategies must be designed to guarantee consumer loyalty and attract new segments.

Abstract. The classification of diseases of the Northern Lacandons reflects two main categories: autochthonous diseases, or “true diseases”, which are sent by the ancestral gods, and exogenous diseases, which are foreign, and are created by foreing deities. True diseases are cured through ritual practices, while to treat foreign diseases Western medicine is required. The text presents original ethnographic information, gathered during the period of confinement due to the pandemic. The analysis of the ethnographic material highlighted the different interpretations that the Lacandons elaborated to explain the spread of the SARS-CoV-2 virus from their cosmogony, as well as the methods employed to prevent and cure the infection. This analysis shows that the concepts of health and disease are dynamic; they change and adapt according to the cultural variations, as they are closely linked to religion and worldview.

Resumen. La nosología de los lacandones del norte contempla dos categorías principales de enfermedades: las autóctonas, llamadas “verdaderas enfermedades” -enviadas por los dioses ancestrales-, y las infecciones exógenas -“de los ladinos”-, creadas por deidades extranjeras. Las primeras se curan por medio de prácticas rituales, mientras que el tratamiento de las segundas necesita de métodos terapéuticos ajenos a la cultura local. En el texto, se presenta información etnográfica inédita, recabada durante el periodo de confinamiento por la pandemia. El análisis del material etnográfico permitió destacar las distintas interpretaciones que los lacandones elaboraron para explicar la difusión del virus SARS-CoV-2 desde su cosmogonía, así como los métodos que se emplearon para prevenir o curar la infección. Este análisis muestra cómo los conocimientos sobre los procesos de salud y enfermedad son nociones dinámicas, que se modifican y adaptan de acuerdo con las variaciones culturales, pues se encuentran estrechamente vinculadas a la religión y la cosmovisión.

Abstract. The aim of this article is to describe and analyze perceptions of COVID-19, its influence on ritual practices, and the restrictions on accompanying the deceased in Huautla de Jiménez, Sierra Mazateca, Oaxaca. The ethnographic research methodology included participant observation, informal conversations, semi-structured interviews with Mazatec people, as well as the personal experience of living in Huautla. During fieldwork, there were some restrictions during intimate or public rituals, as respect was given to the grief of loss and some collaborators did not wish to discuss it. The originality of this text lies in uncovering the close relationship between death-illness-virus, as well as the mortuary treatment of the body during a pandemic, due to resistance to abandoning customs. Among the findings are beliefs in the afterlife and the rites performed by relatives for the deceased. We conclude that while this ritual practice was limited by COVID-19, it was not eliminated to avoid disrupting the journey of the deceased.

Resumen. El objetivo del artículo es describir y analizar las percepciones sobre la COVID-19, la influencia de ésta en la ritualidad y las restricciones del acompañamiento a los difuntos en Huautla de Jiménez, Sierra Mazateca, Oaxaca. La metodología de investigación etnográfica incluyó observación participante, pláticas informales, entrevistas semiestructuradas realizadas con mazatecos, además de la experiencia personal de vivir en Huautla. En el trabajo de campo, durante los rituales íntimos o públicos, hubo algunas restricciones, pues se respetó el dolor por la pérdida y que algunos colaboradores no quisieran hablar al respecto. La originalidad del texto radica en develar la estrecha relación entre muerte-enfermedad-virus, así como el tratamiento mortuorio del cuerpo en pandemia, por resistirse a dejar sus costumbres. Entre los hallazgos situamos las creencias en la vida posterior y en los ritos que realizan familiares para el difunto. Concluimos que esta ritualidad se limitó por la COVID-19, pero no se eliminó para no afectar el viaje del difunto.

Abstract Objective: To evaluate if the comorbidity and coinfections presented by SARS-CoV-2 infection vs. COVID-19 impact our Mexican children. Method: Prospective and observational study that included the 2020-2021 peak influenza season. All patients with a diagnosis of infection by SARS-CoV-2 vs. COVID-19 who were admitted to the Hospital Infantil de Mexico were analyzed. Real-time RT-PCR for SARS-CoV-2 was performed in all patients, determining E, RdRp and RP genes and protein N, as well as RT-PCR for detection of respiratory viruses. Results: The inclusion criteria were met by 163 patients. The group with the highest risk of becoming ill was adolescents (40.4%), followed by schoolchildren and preschoolers (21.4% and 19.6% of the cases, respectively). There were three cases with viral coinfection: two (1.2%) with parvovirus B-19 and one (0.6%) with herpes type I; another two (1.2%) showed bacterial coinfection. The main comorbidity were obesity, acute lymphoblastic leukemia and arterial hypertension. Regarding mortality, we only had four cases (2.4%). Conclusions: Obesity, cancer, hypertension, heart disease and diabetes are comorbidity present in our patients, as referred to in literature, but not coinfections. In our study, we did not have any associated mortality related to comorbidity.

Resumen Objetivo: Evaluar el impacto de la comorbilidad y de las coinfecciones presentadas por la infección por SARS-CoV-2 vs. COVID-19 en niños mexicanos. Método: Estudio prospectivo y observacional que comprendió la temporada alta de influenza 2020-2021, analizando todos los pacientes con diagnóstico de infección vs. enfermedad por SARS-CoV-2 vs. COVID-19 que ingresaron al Hospital Infantil de México. Se realizó en todos RT-PCR en tiempo real para SARS-CoV-2, determinando gen E, gen RdRp, gen RP y proteína N, y RT-PCR multiplex para detección de virus respiratorios. Resultados: Los criterios de inclusión los cumplieron 163 pacientes. El grupo con mayor riesgo de enfermar fueron los adolescentes (40.4%), seguidos de los escolares y preescolares (21.4% y 19.6% de los casos, respectivamente). Hubo tres casos con coinfección viral: dos (1.2%) con parvovirus B-19 y uno (0.6%) con herpes tipo I; hubo otros dos (1.2%) con coinfección bacteriana. La principal comorbilidad correspondió a obesidad, leucemia linfoblástica aguda e hipertensión arterial. En cuanto a mortalidad, solo hubo cuatro casos (2.4%). Conclusiones: Obesidad, cáncer, hipertensión, cardiopatías y diabetes constituyen la comorbilidad en nuestros pacientes, como se refiere en la literatura, no así las coinfecciones. En nuestro estudio no hubo casos de mortalidad relacionada con la comorbilidad.

RESUMEN Introducción: Estudios previos han reportado que pacientes infectados con el virus del COVID-19, podrían manifestar sintomatologías a nivel de la cavidad oral. Objetivo: Evaluar la frecuencia de manifestaciones orales asociadas a COVID-19 en un segmento de la población paraguaya y determinar cuáles son las más prevalentes. Metodología: Estudio descriptivo de corte transversal. Fue realizada una encuesta electrónica de enero a marzo del 2022. Los datos fueron presentados como frecuencias y porcentajes y analizados mediante la prueba de chi-cuadrado. El análisis estadístico se realizó con el software R versión 4.0.3. Resultados: La muestra estuvo compuesta por 478 personas. El 79,50 % correspondió al sexo femenino y el 45,19 % tenía entre 25 y 34 años. El 65,48 % informó haber experimentado al menos 1 síntoma o signo oral durante el curso de COVID-19. La pérdida de la sensación de sabores amargos, seguida de la alteración del sabor de los alimentos y la pérdida de la percepción dulce, fueron los síntomas más comunes. Se encontró una proporción significativamente mayor de manifestaciones orales en el rango de 18-24 años (χ²; p= 0,003). Entre las personas que desarrollaron COVID-19 de forma moderada a severa hubo mayor número de manifestaciones de síntomas orales (χ²; p= 0,044). Discusión: Se identificó una alta frecuencia de manifestaciones orales en pacientes con casos de moderados a severos de COVID-19, destacándose los trastornos del gusto como los más predominantes. Los individuos más jóvenes fueron los más afectados.

ABSTRACT Introduction: Previous studies have reported that patients infected with the COVID-19 virus could manifest symptoms in the oral cavity. Objective: To evaluate the frequency of oral manifestations associated with COVID-19 in a segment of the Paraguayan population and determine the most prevalent ones. Methods: Descriptive cross-sectional study. An electronic survey was conducted from January to March 2022. The data were presented as frequencies and percentages and analyzed using the chi-square test. Statistical analysis was performed with R software version 4.0.3. Results: The sample consisted of 478 individuals. 79.50% were female, and 45.19% were between 25 and 34 years old. 65.48% reported having experienced at least 1 oral symptom or sign during the course of COVID-19. The loss of the sensation of bitter tastes, followed by the alteration of the taste of foods and the loss of sweetness perception, were the most common symptoms. A significantly higher proportion of oral manifestations was found in the 18-24 age range (χ²; p= 0.003). Among people who developed COVID-19 in a moderate to severe form, a greater number of oral symptom manifestations were observed (χ²; p= 0.044). Discussion: A high frequency of oral manifestations was identified in patients with moderate to severe cases of COVID-19, with taste disorders standing out as the most predominant. Younger individuals were the most affected.

Abstract Background: After the SARS-CoV-2 pandemic, there has been an increase in hospitalization for lower respiratory infection secondary to respiratory syncytial virus (RSV), with greater complications. Associated extrapulmonary alterations, biventricular dysfunction, acute kidney injury, among others, have been found. The objective of this study was to analize the evolution and complications in hospitalized children with lower respiratory infection secondary to RSV after COVID-19 pandemic. Methods: All pediatric patients under 2 years of age admitted to the emergency department with RSV infection were included. Clinical characteristics, need for supplemental oxygen, use of amines, renal angina index, and requirement for renal replacement therapy were analyzed. Lung ultrasound was performed upon admission. Statistical analysis was carried out for the quantitative variables by means of mean and standard deviation, and qualitative variables by frequency and percentage. Differences in the distribution were evaluated with Fisher’s exact distribution. Results: 45 patients with RSV infection were identified, 26.7% required invasive mechanical ventilation and 11.1% requiered peritoneal dialysis. Fatality was observed in four cases, three of these younger than 12 months with a LUS score > 7; contrasts with 90.2% of survivors with a score < 7 (p = 0.0004). Conclusions: An increase in the incidence of bronchiolitis after pandemic was observed, with more than half having moderate to severe symptoms and requiring supplemental oxygen support in all patients upon admission. Acute kidney injury is the most common extrapulmonary manifestation.

Resumen Introducción: Posterior a la pandemia por SARS-CoV-2 se ha observado un incremento en la hospitalización por virus respiratorio sincitial (VRS), con mayores complicaciones. Se han encontrado alteraciones extrapulmonares asociadas, disfunción biventricular y lesión renal aguda, entre otras. El objetivo de este estudio fue analizar la evolución y las complicaciones en niños hospitalizados con enfermedad respiratoria de vías bajas secundaria a infección por VRS tras la pandemia de COVID-19. Métodos: Se incluyeron todos los menores de 2 años que ingresaron al servicio de urgencias con infección por VRS. Se analizaron las características clínicas, la necesidad de oxígeno suplementario, el uso de aminas, el índice de angina renal y el requerimiento de terapia de sustitución renal. Se realizó ecografía pulmonar al ingreso. En el análisis estadístico, para las variables cuantitativas se determinaron la media y la desviación estándar, y para las variables cualitativas la frecuencia y el porcentaje. Se evaluaron las diferencias de la distribución con la prueba exacta de Fisher. Resultados: Hubo 45 pacientes con infección por VRS. El 26.7% requirieron ventilación mecánica invasiva y el 11.1% diálisis peritoneal. La letalidad fue de cuatro casos, tres de ellos menores de 12 meses con puntuación de LUS > 7; esto contrasta con el 90.2% de los sobrevivientes con puntaje < 7 (p = 0.0004). Conclusiones: Se observó un aumento en la incidencia de bronquiolitis tras la pandemia, en más de la mitad de los casos con cuadros de moderados a graves, y todos requirieron oxígeno suplementario al ingreso. La lesión renal aguda fue la manifestación extrapulmonar más frecuente.

Abstract: In pediatrics, a process called Pediatric Inflammatory Multisystem Syndrome (PIMS) associated with recent infection by SARS-CoV-2 virus has been observed. One of its variants presents similarities with Kawasaki disease (KD). Objective: to compare the clinical presentation, laboratory testing, and evolution of KD with PIMS Kawasaki phenotype (PIMS-KD) in patients hospitalized before the pandemic, compared with the pandemic period. Patients and Method: Cross-sectional study in two groups of patients at the Hospital Exequiel González Cortés: typical KD (group 1) and PIMS-KD (group 2). Data on demographic, clinical, and biochemical details were collected, as well as echocardiogram, treatment, and evolution records. IgG and IgM serology for SARS-CoV-2 was performed in both groups. Results: In the KD group and the PIMS-KD group, 20 and 33 patients were analyzed, respectively. There were differences in age, days of fever, count of leukocytes, lymphocytes, and platelets, erythrocyte sedimentation rate (ESR), and hospital stay. In 25% of the KD group, there were alterations in the echocardiogram and, in the PIMS-K group, all patients received corticosteroids and 25 patients received intravenous immunoglobulin (IVIG). In both groups, a favorable clinical evolution was observed, characterized by the absence of complications and mortality. Conclusions: Based on the data obtained in our study, the importance of the epidemiological link is emphasized as an essential factor in differentiating between both pathologies, highlighting the need to consider factors such as age, duration of fever, count of leukocytes, lymphocytes, and platelets, and degree of cardiac involvement, for a differential evaluation between patients with PIMS-KD versus KD.

Resumen: En pediatría, se ha observado un proceso denominado Síndrome Inflamatorio Multisistémico asociado a infección reciente por virus SARS-CoV-2 (PIMS). Una de sus variantes, presenta similitudes con la Enfermedad de Kawasaki (EK). Objetivo: comparar la presentación clínica, laboratorio y evolución de EK con PIMS fenotipo Kawasaki (PIMS-EK) en pacientes hospitalizados antes de la pandemia, comparado con el periodo de pandemia. Pacientes y Método: Estudio de corte transversal en dos grupos de pacientes del Hospital Exequiel González Cortés: EK típica (grupo 1) y PIMS-EK (grupo 2). Se recopilaron datos demográficos, clínicos, bioquímicos, ecocardiograma, tratamiento y evolución. En ambos grupos se realizó serología IgG e IgM para SARS-CoV-2. Resultados: En el grupo 1 se analizaron 20 pacientes y en el grupo 2, 33 pacientes. Hubo diferencias en edad, días de fiebre, valores de leucocitos, linfocitos, plaquetas, velocidad de eritrosedimentación (VHS) y días de hospitalización. En 25% de pacientes del grupo EK hubo alteraciones en el ecocardiograma y en el grupo PIMS-EK todos recibieron corticoides y 25 pacientes Inmunoglobulina endovenosa (IGEV). En ambos grupos, se observó una evolución clínica favorable, caracterizada por la ausencia de complicaciones y mortalidad. Conclusiones: En base a los datos obtenidos en nuestro estudio, se destaca la importancia del nexo epidemiológico como un factor esencial para diferenciar entre ambas patologías, resaltando la necesidad de considerar factores como la edad, la duración de la fiebre, los valores de leucocitos, linfocitos y plaquetas, grado de compromiso cardíaco, para una evaluación diferencial entre pacientes con PIMS-EK versus EK.

Abstract Introduction: Since the emergence of SARS-CoV-2, pediatric admissions from all causes have decreased. This was mainly due to a decrease in all common respiratory diseases, such as bronchiolitis and pneumonia. The aim of this study was to evaluate the impact of the pandemic on pediatric admissions and diagnoses in a level II hospital. Methods: A retrospective analysis was conducted, including all children admitted to a Portuguese level II hospital between March 2020 and December 2021 and the homologous period 2018-2019. The number of admissions, most common diagnoses, and demographic data were analyzed. Results: A total of 2956 admissions were included. A 44.1% decrease in pediatric hospital admissions was observed with the onset of the COVID-19 pandemic. Admissions for common communicable diseases such as acute bronchiolitis, acute gastroenteritis, varicella, and stomatitis decreased. An increase in respiratory illnesses, mainly due to respiratory syncytial virus, was observed when the pandemic restrictions ended. Conclusion: The COVID-19 pandemic had a major impact on pediatric hospital admissions. Social distancing measures and the use of masks limited the transmission of common infectious diseases previously responsible for hospital admissions. Future studies are needed to understand whether the changes in respiratory virus epidemiology were transient.

Resumo Introdução: As admissões hospitalares em idade pediátrica diminuíram desde o início da pandemia de SARS-COV-2, maioritariamente devido à redução de doenças respiratórias comuns, como bronquiolite aguda e pneumonia. O objetivo deste estudo foi analisar o impacto da pandemia nos internamentos pediátricos e respetivos diagnósticos num hospital de nível II. Métodos: Análise retrospetiva dos doentes em idade pediátrica internados entre março de 2020 e dezembro de 2021 e o período homólogo de 2018-2019. Foram analisados dados demográficos, número de internamentos e diagnósticos mais comuns. Resultados: Foram analisadas 2956 admissões hospitalares. Registou-se uma redução de 44,1% no número de internamentos após o início da pandemia comparativamente ao período homólogo de 2018-2019. Verificou-se uma diminuição das admissões por doenças infeciosas, como bronquiolite aguda, gastroenterite aguda, varicela e estomatite. Com a redução das restrições impostas pela pandemia, o número de internamentos por doenças respiratórias aumentou, sobretudo devido ao vírus sincicial respiratório. Conclusões: A pandemia de COVID-19 teve um grande impacto nas admissões hospitalares em idade pediátrica. As medidas de contenção, nomeadamente o distanciamento social e o uso de máscara, levaram à diminuição da transmissão de doenças infeciosas comuns que habitualmente eram responsáveis por um grande número de internamentos. São necessários mais estudos para compreender se as mudanças na epidemiologia dos vírus respiratórios foram apenas transitórias.

RESUMEN Introducción: El desarrollo de vacunas seguras y eficaces contra el SARS-CoV-2 supuso un enorme reto para enfrentar la pandemia de la COVID-19. La aparición de nuevas variantes del SARS-CoV-2 representa un reto en la evaluación de la efectividad de las vacunas, diferentes candidatos vacunales y terapéuticos desarrollados por la comunidad científica. Objetivos: Caracterizar la diversidad genética de aislamientos virales cubanos en el periodo comprendido entre junio de 2020 y diciembre de 2022. Métodos: Se obtuvo el ARN de SARS-CoV-2 de 27 aislamientos a partir de sobrenadante de cultivo celular y se secuenció el gen S. Las secuencias generadas se emplearon para la identificación y posterior caracterización molecular de las variantes genéticas del virus mediante análisis filogenético y el uso de las herramientas disponibles en la base de datos GISEAD. Resultados: Las variantes detectadas en los aislamientos cubanos de SARS-CoV-2 estudiados se correspondieron a las identificadas en los estudios de vigilancia genómica realizados en las diferentes etapas pandémicas de la COVID-19 en Cuba. El 33,3 % de los aislamientos secuenciados correspondieron a los diferentes linajes de la variante Ómicron, seguido de la variante Beta B 1.351 (29,6 %), otros linajes de SARS-CoV-2 (25,9 %), Alfa B 1.1.7 (7,4 %) y Delta B.1.575 (3,7 %). Se detectó la mutación D614G en todos los aislamientos de SARS-CoV-2 estudiados. Conclusiones: La caracterización molecular de los aislamientos cubanos de SARS-CoV-2 tiene una elevada diversidad genética. Posibilita evaluar in vitro e in vivo los candidatos vacunales y agentes terapéuticos desarrollados por la industria biofarmacéutica cubana.

ABSTRACT Introduction: The development of safe and effective vaccines against SARS-CoV-2 posed a huge challenge to face the COVID-19 pandemic. The appearance of new variants of SARS-CoV-2 represents a challenge in evaluating the effectiveness of vaccines, different vaccine and therapeutic candidates developed by the scientific community. Objectives: Characterize and analyze the genetic diversity of Cuban viral isolates, in the period between June 2020 and December 2022. Methods: SARS-CoV-2 RNA was obtained from 27 isolates from cell culture supernatant and the S gene was sequenced. The generated sequences were used for the identification and subsequent molecular characterization of the genetic variants of the virus through phylogenetic analysis and the use of the tools available in the GISEAD database. Results: The variants detected in the Cuban SARS-CoV-2 isolates corresponded to those identified in the genomic surveillance studies carried out in the different stages of the COVID-19 pandemic in Cuba. 33.3% of the sequenced isolates corresponded to the different lineages of the Omicron variant, followed by Beta B 1.351 (29.6%), other SARS-CoV-2 lineages (25.9%), Alpha B 1.1.7 (7.4%) and Delta B.1.575 (3.7%). The D614G mutation was detected in all SARS-CoV-2 isolates studied. Conclusions: The molecular characterization of the Cuban isolates of SARS-CoV-2 has a high genetic diversity. It makes it possible to evaluate in vitro and in vivo vaccine candidates and therapeutic agents developed by the Cuban biopharmaceutical industry.

Abstract Introduction. During the development of the SARS-CoV-2 pandemic in Antioquia, we experienced epidemiological peaks related to the α, ɣ, β, μ, ƛ, and δ variants. δ had the highest incidence and prevalence. This lineage is of concern due to its clinical manifestations and epidemiological characteristics. A total of 253 δ sublineages have been reported in the PANGOLIN database. The sublineage identification through genomic analysis has made it possible to trace their evolution and propagation. Objective. To characterize the genetic diversity of the different SARS-CoV-2 δ sublineages in Antioquia and to describe its prevalence. Materials and methods. We collected sociodemographic information from 2,675 samples, and obtained 1,115 genomes from the GISAID database between July 12th, 2021, and January 18th, 2022. From the analyzed genomes, 515 were selected because of their high coverage values (>90%) to perform phylogenetic analysis and to infer allele frequencies of mutations of interest. Results. We characterized 24 sublineages. The most prevalent was AY.25. Mutations of interest as L452R, P681R, and P681H were identified in this sublineage, comprising a frequency close to 0.99. Conclusions. This study identified that the AY.25 sublineage has a transmission advantage compared to the other δ sublineages. This attribute may be related to the presence of the L452R and P681R mutations associated in other studies with higher evasion of the immune system and less efficacy of drugs against SARS-CoV-2.

Resumen Introducción. Durante el desarrollo de la pandemia por SARS-CoV-2 en Antioquia se presentaron picos epidemiológicos relacionados con las variantes α, ɣ, β, μ, ƛ y δ, donde δ tuvo la mayor incidencia y prevalencia. Este linaje se considera una variante de preocupación dadas las manifestaciones clínicas que desencadena y sus características epidemiológicas. Se han informado 253 sublinajes δ en la base de datos PANGOLIN. La identificación de estos sublinajes mediante análisis genómico ha permitido rastrear su evolución y propagación. Objetivo. Caracterizar la diversidad genética de los diferentes sublinajes δ de SARSCoV-2 en Antioquia y determinar su prevalencia. Materiales y métodos. Se recopiló información sociodemográfica de 2.675 muestras y de 1.115 genomas del repositorio GISAID entre el 12 de julio de 2021 y el 18 de enero de 2022. Se seleccionaron 501 por su alto porcentaje de cobertura (>90 %) para realizar análisis filogenéticos e inferencia de frecuencias alélicas de mutaciones de interés. Resultados. Se caracterizaron 24 sublinajes donde el más prevalente fue AY.25. En este sublinaje se identificaron mutaciones de interés como L452R, P681R y P681H, que comprendían una frecuencia cercana a 0,99. Conclusiones. Este estudio permitió identificar que el sublinaje AY.25 tiene una ventaja de transmisión en comparación con los otros sublinajes δ. Esto puede estar relacionado con la presencia de las mutaciones L452R y P681R que en otros estudios se han visto asociadas con una mayor transmisibilidad, evasión del sistema inmunitario y menor eficacia de los medicamentos contra SARS-CoV-2.