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Introduction: Patients with chronic kidney disease (CKD) have a higher risk for infection caused by the new coronavirus (COVID-19). The COVID-19 pandemic and social isolation contributed to the adaptation to new health promotion and education tools, including virtual methods. The aim of this study is to analyze the guidelines made through the Renal Health profile on Instagram during the COVID-19 pandemic to patients with CKD. Method(s): This is a quantitative, descriptive study, with the analysis of posts, comments and likes, carried out on the Renal Health (@renal_health) Instagram profile, an educational project based in Brazil, initiated as part of an ISN Clinical Research Program Project, which addresses kidney health, from February 2020 to May 2022, during the COVID-19 pandemic. Result(s): Currently, the Renal Health Instagram profile (https://www.instagram.com/renal_health/) has 1333 publications and more than 10,000 followers. It is a profile administered by a nurse, a nephrologist and a team of public health researchers at the University of Fortaleza, Brazil. A total of 106 posts about COVID-19 were analyzed, covering news about the pandemic, guidelines on prevention and vaccination, association between COVID-19, CKD and transplantation, among others. There were 13,815 likes and 1,068 comments. The most liked post (n = 696) was a photo with a news item: "InCor discharges Covid patient with transplanted lung". Among the comments, it was possible to observe several compliments, reports of patients with CKD and kidney transplants, as well as doubts, which were answered by the team that maintains the profile. The most commented post was also a news item: "Hospital denies transplant to unvaccinated patients", with 146 comments. Conclusion(s): The general population's interest in the association between COVID-19 and kidney disease is evident. It is important to point out the role of the profile as an online educational tool that helps in clarifying doubts about the new coronavirus, in addition to acting as an easy and practical way to acquire knowledge from reliable sources, regarding the risks that patients with kidney diseases have when contracting the virus, as well as many other relevant subjects, always emphasizing the relevance of preventive measures, including vaccination. From the study, it is noticeable that, during the pandemic, there were a large number of clarified doubts, as well as positive feedbacks about the platform. Therefore, the Renal Health profile proved to be an important health education mechanism during the pandemic. No conflict of interestCopyright © 2023
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In the first months of the covid-19 pandemic, in 2020, indigenous movements and organizations in the Northeast region of Brazil established an extensive network of support and partnerships with groups of researchers and civil society entities to organize campaigns of solidarity with the indigenous peoples. The production of general information and empirical data on how the disease reached indigenous territories and populations constituted one of the main strategies for action. This mobilization was the basis for establishing collaborative networks that investigated how the indigenous peoples faced the pandemic, from an anthropological bias and applying methods that we could define as virtual collaborative research. The article, thus, discusses the potential of this can constitute a kind of support for social control exercised by the communities.
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Introducao: O padrao-ouro para o diagnostico de COVID-19 e o teste molecular que permite a deteccao de acidos nucleicos de SARS-CoV-2 em amostras de swab Nasofaringeo (NPS). A deteccao precoce seguida do isolamento dos individuos infectados desempenha um papel crucial para impedir a propagacao da infeccao e o controle da pandemia. No entanto, a coleta de NPS e invasiva e desconfortavel para os pacientes, requer profissionais de saude especializados e pode ser um risco de infeccao cruzada para esses profissionais. Desta forma, avaliar outras fontes de material biologico, tal como a saliva, e fundamental para facilitar o diagnostico de COVID-19. Objetivo: O objetivo deste trabalho foi avaliar o uso da saliva como amostra biologica para a deteccao do RNA do SARS-CoV-2 e sua estabilidade pos coleta. Material e Metodos: Foram coletadas 954 amostras de saliva (5 mL) e de swab nasofaringeo (NPS) de individuos entre dezembro de 2020 e fevereiro de 2021 e analisadas em diferentes tempos (24h, 48h, 72h, 5 dias e 10 dias) apos a coleta. As amostras de saliva foram armazenadas em temperatura de 2degree a 8degreeC e extraidas puras e diluidas em solucao salina na proporcao 1:1. A extracao do RNA foi realizada em extrator automatico de acidos nucleicos (Extracta, Loccus) e o diagnostico molecular do SARS-CoV-2 foi realizado com o kit Gene FinderTM COVID-19 Plus RealAmp (OSang Healthcare). A idade media dos participantes foi de 37 anos (8 a 83 anos de idade) e a maioria dos individuos 738 (77,3%) foram nao-detectaveis e apenas 216 (22,7%) foram detectaveis para SARS-CoV-2. Entre os detectaveis, 96 (44,4%%) eram do sexo masculino e 120 (55,6%) do sexo feminino. A positividade na saliva foi posteriormente comparada com os resultados do NPS bem como a carga viral ou ciclo de limiar de amplificacao (Ct). Resultados e Discussao: A analise dos testes com a saliva e NPS demonstrou concordancia nos resultados de 210 (97%) pacientes detectaveis para COVID, em apenas 2,7 % (6/216) dos casos o SARS-CoV-2 foi detectado somente no NPS. Todos os participantes com resultado positivo para a RT-PCR apresentaram sintomas relacionados a COVID-19, sendo os mais comuns: tosse seca (19%), dor de cabeca (16%), coriza e dor de garganta (11%) e diarreia (8%). As amostras de salivas apresentaram estabilidade ate o decimo dia apos a coleta do material biologico, sem diferenca de deteccao do RNA viral entre a amostra de saliva pura e saliva diluida. Esses resultados demonstram que as amostras de saliva podem ser transportadas e armazenadas em temperatura de 2degree a 8degreeC, e processadas em ate 10 dias apos a coleta. Conclusao: Os resultados mostraram que a saliva e uma alternativa para a deteccao de SARS-CoV-2. E uma amostra biologica confiavel, nao invasiva, de facil coleta e com resultados similares aos obtidos com amostras de NPS. E uma alternativa que facilitaria a coleta em lugares com baixo suprimento de swabs nasofaringeos e regioes distantes de laboratorios especializados, uma vez que pode ser analisada ate 10 dias apos a coleta. Dessa forma, podemos concluir que a saliva pode ser utilizada com seguranca para o diagnostico de COVID-19. Copyright © 2022
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Parallel to the covid-19 pandemic, the World Health Organization warns of an infodemic of fake news related to the disease. This integrative review investigates the dimension of this phenomenon and how science found ways to confront it. A bibliographic search was conducted on the Scopus/Elsevier and Medline/PubMed databases, retrieving 23 articles. Literature analysis found that fake news provide false social support and mobilize feelings which make them more acceptable than the truth. Hence, social media and the internet emerge as platforms to spread false information. Research suggests that government and media institutions can use communication channels and monitoring and infoveillance technologies as allies to alert, elucidate, and remove misleading content. We find the need of investments in scientific and digital literacy actions so people may assess the quality of the information they receive. Finally, this study proposes the adoption of creative strategies to foster reasoning skills together with scientific information translated into an accessible language, preferably approved by health and institutional authorities. Copyright © 2022, Universidade de Sao Paulo. Museu de Zoologia. All rights reserved.
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Background: Infection with severe acute respiratory syndrome coronavirus 2 has resulted in a global pandemic. The objective of this study was to investigate the prevalence, causes, and clinical implications of magnesium disturbances, including their possible association with treatment outcomes, among patients with COVID-19. Method(s): This cohort study was conducted at the Hospital das Clinicas, a tertiary care academic medical center in the city of Sao Paulo, Brazil. We included only patients diagnosed with COVID-19, and all clinical data were extracted from medical records. The patients were classified as having hypomagnesemia (HypoMg, plasma Mg <= 1.58 mg/dL) or hypermagnesemia (HyperMg, plasma Mg >= 2.55 mg/dL), and the groups were compared in terms of clinical features and outcomes. We analyzed data collected at admission, <= 72 h after admission, or both. Result(s): We analyzed 3,777 patients. Data regarding magnesium levels were available for 3,162 of those patients, and 344 (10.9%) were found to have HyperMg (240 men and 104 women). The mean age of the HyperMg group patients was 62.2 +/- 0.8 years (range, 15-98 years). Of the HyperMg group patients, 54% died during hospitalization, 86% required mechanical ventilation, 13.4% developed AKI, 4% required dialysis, and 4.3% presented cardiac arrhythmia. Comorbidities included COPD (in 6%), diabetes (in 36.6%), hypertension (in 61.5%), and cardiovascular disease (in 17%). Seven patients presented moderately high levels of Mg (> 4.0 mg/dL), and all of those patients died. Of the 344 HyperMg group patients, 97 (28%) had hypernatremia and 27 (8%) had hyponatremia. HypoMg was found in 166 (5.2%) of the patients (84 men and 82 women). The mean age of the HypoMg group patients was 59.0 +/- 1.4 years (range, 18-99 years), and 23% died during hospitalization. Of the 166 HypoMg group patients, 11 (6.6%) had hypernatremia and 11 (6.6%) had hyponatremia. Conclusion(s): Magnesium disturbances, especially HyperMg, appear to be common in COVID 19, increasing the risk of death. Further studies are needed in order to determine the cause of the high rate of hypermagnesemia in patients with COVID-19.
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Background: Obesity, which is becoming increasingly common worldwide, is known to be associated with cardiovascular disease and progression of chronic kidney disease, due to inappropriate activation of the renin-angiotensin system. Many angiotensin II effects are dependent on AT1 stimulation of reactive oxygen species (ROS). In COVID-19 patients, overweight and obesity are associated with acute respiratory distress syndrome and AKI. Although obesity increases oxidative stress, endothelial dysfunction and inflammation, its effect on IRI-induced AKI is unknown. We hypothesized that obesity would aggravate renal IRI in mice. Method(s): We fed mice a high-fat or standard diet (45 and 10 kcal% fat, respectively) for 8 weeks. Some then underwent bilateral 30-min clamping of the kidney hila and subsequent reperfusion (groups: obese, normal, obese+IRI and normal+IRI). All studies were performed 48 h after IRI. Data are mean+/-SEM. Result(s): Body weight (g) was 33+/-1.7, 32+/-0.7, 27+/-1.4 and 26+/-0.9 in the obese, obese+IRI, normal and normal+IRI groups, respectively (P<0.001). Mortality was 42% and 25% in the obese+IRI and normal+IRI groups, respectively (P <0.05);there were no deaths in the non-IRI groups. Serum glucose and cholesterol did not differ among the groups. Creatinine clearance (mL/min/100g BW) was 0.20+/-0.05 and 0.20+/-0.07 in the obese+IRI and normal+IRI groups, respectively, vs. 0.34+/-0.06 and 0.40+/-0.08 in the obese and normal groups, respectively. Renal p65 protein expression (%) was 127+/-4.8 in the obese+IRI group, vs. 100+/-4.1, 92.5+/-4.8 and 107+/-3.7, respectively, in the normal, obese and normal+IRI groups (P<0.05). Conclusion(s): In obese individuals with AKI, ROS could be a therapeutic target (FAPESP, NWO).
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Introduction: The inclusion of non-invasive ventilatory support systems in the management of ARDS in adults during the current pandemic, has been a lifeline given the lack of resources in the current international health situation. Systems such as the high flow nasal cannula have proven not to be just a temporary ventilatory system while awaiting invasive mechanical ventilation, on the contrary it has been shown that the high flow nasal cannula is an effective therapy tool in ARDS. Objective: To provide an easy guideline for the management of high-flow cannulas in hospitalized patients with severe pneumonia due to ATS criteria secondary to SARS COV2-COVID 19. Materials and methods: This is a prospective, single-centre observational study, including 59 patients, all with a diagnosis of SARS-CoV-2-related pneumonia between January and April 2021. The patients were initially managed in an intermediate care unit with high nasal cannula flow (HFNC). Results: We were able to show that there is a statistically significant correlation between age > 65 years and respiratory rate ≥28 and mortality;likewise, between age > 50 years, NEWS > 6 and again a respiratory rate ≥28 with treatment failure. Conclusions: HFNC in respiratory failure related to coronavirus disease 2019 should become a viable management alternative, particularly in settings with limited access to intensive care unit resources, taking the indications into account and recognizing that a high percentage of patients who receive it can be successfully weaned without the need for invasive mechanical ventilation. © 2022 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo
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Mobile locative games consist of a subset of mobile games that encourage players to go outside, by promoting outdoor activities and physical meetings. Because of this, their gameplay breaks the core of social distancing strategies implemented since the beginning of the COVID-19 pandemic. However, developers implemented changes in their locative games supported by the mobile game revenue model, which enabled a strategy called “playing remotely” that encourages the players to spend their money with microtransactions. This study analyses the impacts of the COVID-19 pandemic in mobile locative gaming, by examining the preferences and behavior of players from the Northeast Brazil, a region with socioeconomic inequalities and urban violence, among other issues that shape mobility practices.Accordingly, we pose a research question: how do players living in Northeast Brazil manage the mobile game revenue model for playing remotely during the COVID-19 pandemic? With this in mind, we have conducted an online survey among communities of players located in Northeast Brazil, by sharing a questionnaire with 21 questions. Seventy-four players from the region responded to our survey. The sample's age was from 16 to 58 years old, and they lived in seven of the nine states that form Northeast Brazil. We have found that players’ preference is to invest their time in gathering resources by playing the game, instead of spending their money in microtransactions for playing remotely. Moreover, we have found that mobile communication plays a significant role in keeping players in touch during the COVID-19 pandemic, allowing players to expand their networks to other cities and countries. We have concluded that playing remotely represents an important strategy to support the development of locative games and other location-based applications, which can help us to prepare for the next pandemic.
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Purpose: Compared to azathioprine (AZA), mycophenolate (MPA) is implicated in an increased risk of several viral infections. Contrariwise, mTOR inhibitors (mTORi) are protective. Therefore, the study proposal is to evaluate the Covid-19 outcomes among kidney transplants (KT) patients under different maintenance immunosuppressive regimens. Method(s): We analyzed 90-day outcomes after Covid-19 infection using nationalwide Brazilian cohort data. RT-PCR positive patients tested between Mar/20 and Apr/21 (before immunization) were included. Patients using calcineurin-inhibitors (CNI)-free regimens were excluded. Result(s): 1,833 patients from 44 centers were analyzed, divided into three groups: CNI-AZA (n=389), CNI-MPA (n=1,258), and CNI-mTORi (n=186). Except for donor source, time after KT, and diabetes, demographics were similar among groups (Table1). The main outcomes are shown in Table 1. Considering CNI-AZA as the reference group, center-adjusted multivariable Cox regression showed that the CNIMPA group was associated with higher 30-day fatality (HR 1.65, 95% CI 1.17-2.33, p=0.004), effected also demonstrated in 90-day fatality (HR 1.43, 95%CI 1.06-1.93, p=0.020). CNI-mTORi was neutral for the 30-day fatality (HR 0.75, 95%CI 0.43- 1.29, p=0.296), but protective for the 90-day (HR 0.56, 95%CI 0.34-0.94, p=0.027). Conclusion(s): This data suggests that maintenance immunosuppressive drugs impact Covid-19 outcomes in kidney transplant patients. While MPA is associated with poor prognosis, mTORi seems to be protective. (Figure Presented).
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SESSION TITLE: What Lessons Will We Take From the Pandemic? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Ethnic and racial disparities have been found to be influential drivers for poor outcomes in COVID-19 patients. Hispanic ethnic group has been recognized to have disproportionately higher COVID-19 infections and associated hospitalizations and deaths, which have been attributed to differences in socioeconomic and health factors, including high burden of comorbidities. However, studies specifically addressing the risk of death related to ethnicity alone are lacking. Therefore, we evaluated the association between Hispanic ethnicity and 30-day mortality in patients without comorbidities hospitalized with a COVID-19 diagnosis. METHODS: We included hospitalized patients with a COVID-19 diagnosis (based on the ICD-10 code U07.1) in an observational cohort study at the South Texas Veterans Health Care System (STVHCS) from April 1st, 2020 until December 31st, 2021. Additionally, we selected patients with no comorbidity burden based on a Charlson Comorbidity Index (excluding age) equal to zero. The index date was considered at the first documentation of COVID-19 diagnosis. We compared two independent groups: Hispanic vs. non-Hispanics. Our outcome of interest was 30-day all-cause mortality. Continuous variables were expressed as medians with interquartile ranges (IQR) and categorical variables were reported as absolute frequencies and percentages. A priori multivariable analysis was set to adjust for age, gender, and the probability of death at 30-days according to the validated Veterans Health Administration COVID-19 Index (VACO score). RESULTS: We identified 219 hospitalized COVID-19 patients with no comorbidities, stratified into Hispanics (n=87 [39.7%]) and non-Hispanics (n=132 [60.3%]). Demographic characteristics for Hispanics and non-Hispanics were comparable for median (IQR) age (48 [39-58] years vs. 51 [40-61] years), while there was a greater proportion of male gender in the Hispanic group (n=80 [92.0%] vs. n=110 [83.3%]). Hispanics had a lower probability of death according to the VACO score compared to non-Hispanics (0.22% [0.22%-2.95%] vs. 1.97% (0.22%-4.96%). Both groups had similar 30-day all-cause mortality, n=4 (4.6%) for Hispanics and n=4 (3.0%) for non-Hispanics with p-value=0.72. Due to the low number of deaths between the two groups, we were unable to perform a multivariate analysis. CONCLUSIONS: In this cohort of hospitalized COVID-19 patients without comorbidities, Hispanic ethnicity was not associated with an increased 30-day all-cause mortality. CLINICAL IMPLICATIONS: Our study demonstrates Hispanic ethnicity alone does not account for differences in outcomes of COVID-19 patients. Other factors, such as social determinants of health and comorbidity burden, have been shown to play significant roles and should be the focus of efforts to mitigate morbidity and mortality in COVID-19. DISCLOSURES: No relevant relationships by Liwayway Andrade No relevant relationships by Nicholas Hodgeman No relevant relationships by Michael Mader No relevant relationships by Marcos Restrepo No relevant relationships by Sandra Sanchez-Reilly
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SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: The COVID-19 pandemic resulted in an unexpected increase in mortality primarily among patients with preexisting comorbidities. San Antonio Texas and the surrounding areas are home to a proportionally larger Hispanic population relative to the remainder of the state and country. It has been well documented that patients with pre-existing comorbidities have increased mortality when admitted for COVID-19, but limited data are available regarding the Hispanic minority ethnic group. We determined whether Hispanic ethnicity contributed to 30-day mortality when compared to non-Hispanics among hospitalized COVID-19 patients with similar comorbidity burden. METHODS: We performed an observational cohort study among hospitalized patients that were enrolled at the South Texas Veterans Health Care System (STVHCS) from April 1, 2020 until December 31, 2021 and diagnosed with COVID-19 disease. The index data was defined as the day of COVID-19 diagnosis according to the ICD-10 code U07.1. Our independent variable was stratified according to the Hispanic ethnic group. We included COVID-19 patients with similar comorbidity burden, defined by a Charlson Comorbidity Index (CCI) of greater than or equal to 1. A priori adjustment was performed for variables that influence clinical outcome such as age, gender, and CCI, respectively. The primary outcome was 30-day all-cause mortality. Descriptive and multivariate analysis were performed using the IBM SPSS statistics software. RESULTS: Of the 1257 hospitalized patients during the study period, 1038 met inclusion criteria. There were 372 (35.8%) Hispanics and 666 (64.2%) non-Hispanics. Hispanic patients had similar demographic characteristics to non-Hispanic patients, regarding median age in years (68 [56-73] vs. 68 [58-74], male gender (n=354 [95.2%] vs. n=610 [91.6%]) and median CCI (4.0 [2.0-6.8] vs. 4.0 [2.0-7.0]), respectively. The 30-day all-cause mortality was 13.8% (n=50) in the Hispanic group compared to 14.0% (n=93) in the non-Hispanic group (p=0.81). After adjusting for age, gender and CCI, Hispanics had a similar 30-day all-cause mortality to the non-Hispanic group of COVID-19 hospitalized (AOR 0.98, 95% CI 0.66-1.43, p=0.97). CONCLUSIONS: Hispanic ethnicity was not associated with an increased 30-day all-cause mortality in a population of hospitalized COVID-19 patients with similar comorbidity burden. CLINICAL IMPLICATIONS: Hispanic ethnicity does not appear to be an independent risk factor for increased mortality related to COVID-19 DISCLOSURES: No relevant relationships by Liwayway Andrade No relevant relationships by Nicholas Hodgeman No relevant relationships by Marcos Restrepo
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Objective: To map scientific evidence on health promotion measures to improve the quality of life of people living with Diabetes Mellitus during the COVID-19 pandemic. Method: This is an integrative review, performed in MEDLINE databases via PubMed, CINAHL-Ebsco, Scopus, LILACS and IBECS, using the descriptors "diabetes mellitus", "coronavirus infections", "covid-19", "health promotion” and “quality of life”.The sample counted 17 articles. Results: Data were grouped into three dimensions: focusing on the individual;in the community and in government actions or public policies. Conclusion: Individual measures were more prevalent in the studies, to the detriment of a limitation of collective and governmental measures © 2022. Enfermeria Global.All Rights Reserved.
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COVID-19 , Continuity of Patient Care , COVID-19/complications , Humans , Post-Acute COVID-19 SyndromeABSTRACT
Objective: The study aimed at analyzing the international scientific publications on coronavirus infection and patient safety in health care. Methods: This research is a bibliometric study carried out by searching published articles in theISIWebofKnowledge/WebofScience database and analyzing the results through bibliometric analysis software HistCite. The selected time frame was between 1970 and 2020, and we used the following descriptors: “coronavirus infection” OR “severe acute respiratory syndrome” OR “COVID-19/SARS-CoV-2”. Results: We found 5,434 publications in 1,491 different journals;they are written by 18,274 authors linked to 4,064 institutions, which are located in 104 countries. In the citations analysis, the h-index was 155, and the average of citations each article received was 30.79. Conclusion: During the studied period, the Web of Science database showed two peaks of publications on coronavirus infections.The first comprised 768 articles published between 2003 and 2004 when a new coronavirus caused an outbreak of severe acute respiratory failure. The second consisted of 576 articles published between 2019 and 2020, during the period of the COVID-19 pandemic COVID-19. The knowledge on coronavirus infection should be widely shared so that new studies can be designed and the world scientific community can contribute to improving patient safety in healthcare and preventing new pandemics of severe acute respiratory infection caused by coronaviruses. © 2021 Nascimento et al.
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Basic Education schools suspended their classroom activities due to the new coronavirus, responsible for the Covid-19 pandemic, end therefore some institutions took the remote classes as their aegis. In this context, the objective of this research is to analyze the impacts of the new educational scenario on the professional identity and educational work of teachers from the assumptions of dialectical historical materialism, and the principles of Cultural-Historical Theory and Historical-Critical Pedagogy. Based on the results presented, it is concluded that the new world scenario maximizes old structural problems of the Brazilian educational system, evidenced by an Education project anchored in reformist matrices and managerial principles that envision the privatization of public education and the adoption of new technologies such as solution for education. Furthermore, the new competences mentioned to the teacher directly impact the de-characterization of their professional identity and their educational work.