An Echocardiographic Insight Into Post-COVID-19 Symptoms.

INTRODUCTION AND OBJECTIVES: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has frequent acute cardiovascular manifestations, but long-term sequelae are yet to be described. Our main objective is to describe the echocardiographic findings of patients with a previous SARS-CoV-2 infection. METHODS: A single-center prospective study was conducted. Patients who tested positive for SARS-CoV-2 were selected and submitted to a transthoracic echocardiogram six months after infection. A complete echocardiographic assessment was performed, including tissue Doppler, E/E' ratio, and ventricular longitudinal strain. Patients were divided into two subgroups according to their need for admission to the ICU. RESULTS: A total of 88 patients were enrolled. The mean values and respective standard deviations of the echocardiographic parameters were as follows: left ventricular ejection fraction 60.8 ± 5.9%; left ventricular longitudinal strain 17.9 ± 3.6%; tricuspid annular plane systolic excursion 22.1 ± 3.6 mm; a longitudinal strain of the free wall of the right ventricle 19.0 ± 6.0%. We found no statistically significant differences between subgroups. CONCLUSIONS: At the six-month follow-up, we found no significant impact of past SARS-CoV-2 infection on the heart using echocardiography parameters.

The effect of COVID-19 confinement on the activity behaviour of red deer.

The COVID-19 pandemic has drastically affected people's social habits, especially those related to outdoor activities. We intended to understand the effects of the two national lockdowns in Portugal on the presence and activity of a wild population of red deer (Cervus elaphus) by analysing data from camera traps installed at Lousã mountain, in the central part of Portugal. The cameras were set between 2019 and 2021, and a total of 2434 individual contacts of red deer and 182 contacts of people were recorded. Results showed a higher human presence in the mountain area during the COVID-19 outbreak, especially during the first lockdown in 2020 (0.05 ± 0.17 individuals/day), compared to the same period of the year before the pandemic (0.02 ± 0.05 individuals/day), which resulted in an increase of people by 150%. The increase in human presence did not have a significant direct effect on the presence of red deer. Despite the low overlap of activity patterns between people and red deer, deer showed avoidance behaviour in the 24 h after the detection of human presence on camera traps, as well as an increase in daily activity during the 2020 lockdown, showing red deer's awareness of human visitation. These results showed that people's increased search for cultural services in wild environments during COVID-19 lockdowns, such as hiking and biking, seemed to influence the population of red deer, albeit momentarily.

Living in an untouchable world: Barriers to recreation and tourism for Portuguese blind people during the COVID-19 pandemic

Despite the COVID-19 pandemic having affected the lives of all citizens, some groups, as people with disabilities (PwD), have felt its effects more intensely, specifically due to social distancing measures adopted. However, PwD are a heterogeneous group and the impacts of COVID-19 are, therefore, experienced differently. Blind people (BP) face considerable challenges during the COVID-19 pandemic, since they "access the world” through touch, something strongly discouraged in order to control the spread of the virus. Nevertheless, no studies are known which analyze the constraints experienced by BP during COVID-19 on participating in recreation and tourism activities. To extend knowledge in this field, the intention of this study is to examine the constraints faced by BP during COVID-19 on participation in outdoor recreation and tourism activities and the strategies used to overcome these constraints. A qualitative methodology (in-depth interviews with BP) was used. The results reveal that during the COVID-19 pandemic, BP faced several constraints that made their participation in outdoor recreation and tourism activities difficult. The paper ends with a discussion of the strategies used by BP to overcome these constraints.

Living in an untouchable world: Barriers to recreation and tourism for Portuguese blind people during the COVID-19 pandemic.

Despite the COVID-19 pandemic having affected the lives of all citizens, some groups, as people with disabilities (PwD), have felt its effects more intensely, specifically due to social distancing measures adopted. However, PwD are a heterogeneous group and the impacts of COVID-19 are, therefore, experienced differently. Blind people (BP) face considerable challenges during the COVID-19 pandemic, since they "access the world" through touch, something strongly discouraged in order to control the spread of the virus. Nevertheless, no studies are known which analyze the constraints experienced by BP during COVID-19 on participating in recreation and tourism activities. To extend knowledge in this field, the intention of this study is to examine the constraints faced by BP during COVID-19 on participation in outdoor recreation and tourism activities and the strategies used to overcome these constraints. A qualitative methodology (in-depth interviews with BP) was used. The results reveal that during the COVID-19 pandemic, BP faced several constraints that made their participation in outdoor recreation and tourism activities difficult. The paper ends with a discussion of the strategies used by BP to overcome these constraints. Management implications: Understanding the impact of COVID-19 on the recreation and tourism practices of blind people, and the constraints that they face as a consequence of this pandemic, this study provides relevant implications managers for public and private tourism supply agents. Therefore, managers and planners can use the findings of this study to design strategies to overcome the strong constraints faced by blind people due to the COVID-19 pandemic, to minimize risk exposure and to increase their quality of life. Thus, the type of activities offered and the marketing strategy should be rethought to increase the engagement of blind people in recreation and tourism experiences in an "untouchable world."

Double jeopardy from the COVID-19 pandemic: risk of exposure and income loss in Portugal.

BACKGROUND: Increasing evidence indicates that the first wave of the COVID-19 pandemic had immediate health and social impact, disproportionately affecting certain socioeconomic groups. Assessing inequalities in risk of exposure and in adversities faced during the pandemic is critical to inform targeted actions that effectively prevent disproportionate spread and reduce social and health inequities. This study examines i) the socioeconomic and mental health characteristics of individuals working in the workplace, thus at increased risk of COVID-19 exposure, and ii) individual income losses resulting from the pandemic across socioeconomic subgroups of a working population, during the first confinement in Portugal. METHODS: This study uses data from 'COVID-19 Barometer: Social Opinion', a community-based online survey in Portugal. The sample for analysis comprised n = 129,078 workers. Logistic regressions were performed to estimate the adjusted odds ratios (AOR) of factors associated with working in the workplace during the confinement period and with having lost income due to the pandemic. RESULTS: Over a third of the participants reported working in the workplace during the first confinement. This was more likely among those with lower income [AOR = 2.93 (2.64-3.25)], lower education [AOR = 3.17 (3.04-3.30)] and working as employee [AOR = 1.09 (1.04-1.15)]. Working in the workplace was positively associated with frequent feelings of agitation, anxiety or sadness [AOR = 1.14 (1.09-1.20)] and perception of high risk of infection [AOR = 11.06 (10.53-11.61)]. About 43% of the respondents reported having lost income due to the pandemic. The economic consequences affected greatly the groups at increased risk of COVID-19 exposure, namely those with lower education [AOR = 1.36 (1.19-1.56)] and lower income [AOR = 3.13 (2.47-3.96)]. CONCLUSIONS: The social gradient in risk of exposure and in economic impact of the pandemic can result in an accumulated vulnerability for socioeconomic deprived populations. The COVID-19 pandemic seems to have a double effect in these groups, contributing to heightened disparities and poor health outcomes, including in mental health. Protecting the most vulnerable populations is key to prevent the spread of the disease and mitigate the deepening of social and health disparities. Action is needed to develop policies and more extensive measures for reducing disproportionate experiences of adversity from the COVID-19 pandemic among most vulnerable populations.

Sampling Methods and Risk Stratification Regarding Environmental Contamination by SARS-CoV-2.

INTRODUCTION: Transmission of COVID-19 through close contact and droplets is well established, but the influence of aerosol and surface contamination remains to be determined. Literature is scarce and inconsistent about the viable virus particles free-distance from infected patients, as well as about different swabbing methods for surface contamination evaluation. The aim of this study was to evaluate the most sensitive method for the assessment of surface contamination, classify the likelihood of environmental contamination in risk zones and compare the environmental contamination between oxygenation and ventilatory support. MATERIAL AND METHODS: Swabs from potentially contaminated surfaces in a COVID-19 ward, with patients treated with different types of oxygen and ventilatory support, were collected. Three types of swabs were compared in order to evaluate the most sensitive collection method. For risk zone categorization, areas were divided according to the distance from the patient. RESULTS: Of the 63 swabs collected, 17 (27%) tested positive for the presence of SARS-CoV-2. The highest positivity rate was observed with the sterile premoistened swab with saline (n = 8; 38%), but without statistically significant differences. The highest number of positive samples were collected from the high-risk zones, specifically those located one meter from the patient (n = 13; 48%), with statistically significant differences. Only the rooms of patients supported with non-invasive ventilation or high-flow nasal cannula had evidence of bedroom contamination, with 45% and 27% of swab positivity, with statistically significant differences. DISCUSSION: Our findings favour the premoistened swab without transport medium for surface contamination assessment, even though without statistical differences. A statistically significant trend supporting the division in risk zones, according to the distance from the patient, was also identified. The higher positivity rate from the non-invasive ventilation and high-flow nasal cannula bedrooms suggests a significant association between ventilatory strategies and surface contamination, probably due to higher particle dispersion. CONCLUSION: Our findings support the use of the sterile premoistened swab without preservation medium, the classification of risk areas considering the distance from the patient, and the variability of RNA dispersion between oxygenation and ventilatory support.

Introdução: A transmissão da COVID-19 através do contacto e gotículas está bem estabelecida, mas a importância da sua transmissão através do aerossol e da contaminação das superfícies permanece por determinar. A literatura é escassa e inconsistente em relação à distância mínima livre de partículas víricas, desde um paciente, e também acerca dos mais adequados métodos de colheita de zaragatoas para avaliação da contaminação das superfícies. Os objectivos deste estudo foram avaliar qual o método mais sensível para avaliação da contaminação de superfícies, classificar a contaminação ambiental de acordo com zonas de risco e comparar a contaminação ambiental sob diferentes dispositivos para oxigenoterapia e suporte ventilatório. Material e Métodos: Realizamos colheitas de zaragatoas em superfícies potencialmente contaminadas numa ala COVID-19, onde se encontravam doentes sob diferentes dispositivos para oxigenoterapia e suporte ventilatório. Para avaliar o método de recolha mais sensível para verificação da contaminação das superfícies, comparámos três tipos de zaragatoas. Para a classificação das zonas de risco, dividimos as áreas de acordo com a distância ao doente. Resultados: Das 63 zaragatoas, 17 (27%) testaram positivo para SARS-CoV-2 (27%). A maior positividade foi observada na zaragatoa estéril pré-humedecida com soro fisiológico (n = 8; 38%), mas sem significância estatística. O maior número de amostras positivas obteve-se nas zonas de alto risco, especialmente aquelas a um metro do paciente (n = 13; 48%), com diferenças significativas. Apenas os quartos dos doentes sob ventilação não invasiva e cânula nasal de alto fluxo tiveram evidência de contaminação com 45% e 27% de positividade das zaragatoas, e significância estatística. Discussão: Os nossos resultados favorecem a zaragatoa estéril pré-humedecida sem meio de preservação para avaliação da contaminação das superfícies, embora sem significância estatística. Os resultados suportam também com significância estatística a divisão em zonas de risco de acordo com a distância ao doente. A maior positividade obtida nos quartos dos pacientes que se encontravam a utilizar ventilação não invasiva e cânula nasal de alto fluxo sugere uma associação, com significância, entre as estratégias ventilatória e a contaminação ambiental, provavelmente relacionada com uma maior dispersão das partículas. Conclusão: Os nossos resultados apoiam o uso da zaragatoa estéril pré-humedecida sem meio de preservação, a classificação das áreas de risco considerando a distância ao doente, e a variabilidade da dispersão do RNA entre diferentes dispositivos para oxigenoterapia e ventilação.

Gastrointestinal manifestations of COVID-19: results from a European centre.

BACKGROUND: Infection due to severe acute respiratory syndrome coronavirus 2 is typically associated with a respiratory syndrome, but gastrointestinal symptoms have been described in early reports from China. However, data from European centres are scarce. OBJECTIVES: We aimed to characterise the gastrointestinal manifestations of patients with coronavirus disease 2019 (COVID-19) and their disease course. METHODS: Patients admitted at our centre between March and April 2020 with diagnosis of COVID-19 were included. Asymptomatic patients or those without symptom information were excluded. Clinical features, laboratory data and disease severity (mechanical ventilation, intensive care admission or death) were analysed. RESULTS: Two-hundred one patients were included (median age 71 years; 56.2% male). Digestive symptoms were reported by 60 (29.9%) patients during the disease course, being part of the disease presentation in 34 (16.9%). The most frequent were diarrhoea in 36 patients (17.9%). Patients with gastrointestinal symptoms were younger (P = 0.032), had higher haemoglobin levels (P = 0.002) and lower C-reactive protein (P = 0.045) and potassium levels (P = 0.004). Patients with digestive symptoms had less severe disease (28.3 vs. 44.0%; P = 0.038). Regarding liver damage, aspartate aminotransferase (AST) was elevated in 65.2% of patients and alanine aminotransferase (ALT) in 62.7%, but these patients did not present a more severe disease (elevated AST P = 0.062; elevated ALT P = 0.276). CONCLUSION: A significant portion of COVID-19 patients have digestive symptoms, mostly at presentation. This should be taken into account in order to keep a high level of suspicion to reach an early diagnosis and setup infection control measures to control the transmission rate. This subgroup of patients appears to have a less severe disease course.

Evolution of inequalities in the coronavirus pandemics in Portugal: an ecological study.

BACKGROUND: Previous literature shows systematic differences in health according to socioeconomic status (SES). However, there is no clear evidence that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection might be different across SES in Portugal. This work identifies the coronavirus disease 2019 (COVID-19) worst-affected municipalities at four different time points in Portugal measured by prevalence of cases, and seeks to determine if these worst-affected areas are associated with SES. METHODS: The worst-affected areas were defined using the spatial scan statistic for the cumulative number of cases per municipality. The likelihood of being in a worst-affected area was then modelled using logistic regressions, as a function of area-based SES and health services supply. The analyses were repeated at four different time points of the COVID-19 pandemic: 1 April, 1 May, 1 June, and 1 July, corresponding to two moments before and during the confinement period and two moments thereafter. RESULTS: Twenty municipalities were identified as worst-affected areas in all four time points, most in the coastal area in the Northern part of the country. The areas of lower unemployment were less likely to be a worst-affected area on the 1 April [adjusted odds ratio (AOR) = 0.36 (0.14-0.91)], 1 May [AOR = 0.03 (0.00-0.41)] and 1 July [AOR = 0.40 (0.16-1.05)]. CONCLUSION: This study shows a relationship between being in a worst-affected area and unemployment. Governments and public health authorities should formulate measures and be prepared to protect the most vulnerable groups.

The Anatomic Pathology laboratory adjustments in the era of COVID-19 pandemic: The experience of a laboratory in a Portuguese central hospital.

The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the world over the past weeks, with already 8,25 million infections and 445,000 deaths worldwide, leading to an unprecedented international global effort to contain the virus and prevent its spread. The emergence of novel respiratory viruses such as the SARS-CoV-2 creates dramatic challenges to the healthcare services, including surgical pathology laboratories, despite their extensive daily experience in dealing with biological and chemical hazards. Here, we cover important aspects on the knowledge on COVID-19 gathered during the first six months of the pandemic and address relevant issues on human biological sample handling in the Anatomic Pathology laboratory in the context of COVID-19 global threat. In addition, we detail our strategy to minimize the risk of contamination upon exposure to the different biological products received in the laboratory, which can be of general interest to other laboratories worldwide. Our approach has enabled a safe work environment for laboratory staff, while ensuring the maintenance of high quality standards of the work performed. In times of uncertainty and given the lack of specific guidelines directed at Anatomic Pathology services to better deal with the global COVID-19 public-health emergency, it is essential to share with the community rigorous methodologies that will enable us to better cope with probable novel waves of COVID-19 infection and other viruses that will possibly arise in the near future.