ABSTRACT
In this work, we study the transmission of the new coronavirus, SARS-CoV-2, which causes COVID-19. Our main aim is to analyze the disease prevalence when vaccination and social distancing strategies are used. Simulations are implemented using an agent-based model (ABM) adapted from a Susceptible-Exposed-Infectious-Recovered (SEIR) type compartmental model. Several scenarios are simulated using the most common vaccines available in Brazil. On each scenario, different fractions of the population are affected by vaccination and social distancing measures. Results show the importance to start public health interventions to reduce the size of the epidemic. Besides, simulations show that vaccination only is not capable to control the disease spread. [ FROM AUTHOR] Copyright of International Journal of Modern Physics C: Computational Physics & Physical Computation is the property of World Scientific Publishing Company and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Introduction: Pulmonary artery aneurysms (PAAs) are exceedingly rare. Etiology includes congenital, idiopathic, and acquired. Bacterial and fungal infections are the most common acquired causes. Herein described is a patient with new-onset diabetes mellitus I (DM1) with COVID-19 infection complicated by PAA and mucormycosis. Case Description: A 17-year-old female with new-onset DM1 was admitted to the PICU with diabetic ketoacidosis, and COVID-19 infection complicated by multifocal necrotizing pneumonia. She was treated with remdesivir, antibiotics, systemic glucocorticoids, and discharged on inhaled glucocorticoids. Two weeks later she presented with hemoptysis. Chest computed tomography angiography (CTA) showed a resolving necrotizing pneumonia with a 16 mm aneurysmal dilatation of the proximal portion of the right inferior pulmonary artery (RIPA). Hemoptysis resolved, with no intervention required. One month later she presented again with hemoptysis. Repeat chest CTA demonstrated increasing aneurysmal dilatation, measuring 20 mm in diameter. Echocardiography showed no evidence of endocarditis, congenital heart defects, or elevated right ventricular pressures. A comprehensive infectious workup was negative (Table 1). Due to recurrent symptoms, progressive aneurysmal enlargement, and concerns for rupture, patient underwent RIPA occlusion by cardiac catheterization. Two months later hemoptysis recurred. Chest CTA revealed erosion of the occlusion device into the right inferior segmental bronchus. She underwent emergent right middle and lower lobectomy, and arterial bronchial fistula repair. Lung histology revealed non-septate hyphae with peribronchial and perivascular necrotizing granulomas concerning for mucormycosis (Figure 1). She was treated with amphotericin B and discharged on oral posaconazole. Discussion: The incidence of PAA in adults is estimated to be 1 in 14,000 patients. In adults, the upper limit of normal of an interlobar PA by CTA is 17mm. Our patient's RIPA was dilated up to 20 mm, for which she underwent occlusion of the RIPA. The proinflammatory state generated by COVID-19 can result in vascular inflammation and ultimately aneurysmal dilatation. Desnos et al. reported four cases of hemothorax secondary to PAA rupture in COVID-19 patients on ECMO for severe ARDS. The etiology for PAA formation in our patient had a complex interplay of factors including new-onset diabetes, COVID-19 vasculitis, exposure to systemic glucocorticoids, and an opportunistic infection with Mucor spp. Mucormycosis in diabetic patients with COVID-19 has a mortality of 31% in adults. We believe that the lobectomy performed for the management of PAA in our patient led to better outcomes since surgical debridement is a mainstay of mucormycosis treatment, along with antifungal therapy. Conclusion: PAA in children is uncommon. We describe a diabetic patient with COVID-19 pneumonia, complicated by PAA and mucormycosis. In patients with COVID-19 presenting with hemoptysis, it is important to have a high index of suspicion for PAA. Furthermore, diabetic patients with COVID-19 treated with systemic steroids can be at increased risk for mucormycosis. (Table Presented).
ABSTRACT
Background: In March 2020, the Brazilian Ministry of Health (MoH) announced COVID-19 countrywide community transmission and issued guidelines on social distancing measures. Using real life data, we aimed to analyze the impact of COVID-19 on HIV care in Brazil, and summarize the actions taken by the MoH to guarantee proper health care for people living with HIV (PLWHIV). Methods: We obtained MoH electronic records, from January-October 2019/2020, on HIV self test (HIVST), viral load (VL), CD4+ T counts (CD4), genotyping, and antiretroviral (ART) prescription, including post- (PEP) and pre-exposure (PrEP) prophylaxis. We used descriptive statistics to quantify COVID-19 impact on HIV care in Brazil and compared indicators of both years by unpaired T-tests. Results: In April 2020, PEP and PrEP dispenses fell 57% and 53%, respectively, when compared to January, and new PrEP users dropped 70%. Four months supplies provision and telemedicine resulted on 64% and 53% increase on PEP and PrEP dispenses and 288% rise on new PrEP users in October, when compared to April. The number of HIVST distributed by MoH and PLWHIV who had the first CD4 and VL before ART initiation dropped 35% and 48%, respectively, when comparing April to January 2020, reflecting the pandemic impact on HIV diagnosis. In return, MoH recommended HIVST for key/ priority populations, pregnant women, patients with TB, STI, viral hepatitis, immunossupressed, or hospitalized due to respiratory syndrome. When comparing to April, HIVST distribution raised 95% in October and the number of PLWHIV who had the first CD4 and VL before ART initiation was 56% higher, in September. When comparing 2020 to 2019, the number of PLWHIV who started ART and those that had the first CD4 and VL before ART initiation was 29% and 48% lower in April 2020, respectively;but 18% and 15% in September. Considering January-October, the proportion of PLWHIV overdue for ART dispensation raised 11% and ART dispense for 30 days dropped 53% in 2020;but increased 27% and 105%, for 60 and 90 days, respectively. The use of telemedicine, annual VL for those clinically stables, and 90-days ART supply held link to public health services and viral load suppresion. Conclusion: PLWHIV are vulnerable during COVID-19 pandemic due to compromised immune system or care continuum interruption by community containment measures. Monitoring of HIV care indicators associated to timely actions is an effective way to overcome COVID-19 pandemic challenges and guarantee proper health care for PLWHIV.