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BackgroundBelimumab (BLM) is a monoclonal antibody that inhibits B-lymphocyte stimulating factor (BlyS) approved as a specific treatment for systemic lupus erythematosus (SLE) in 2011. We present the experience with BLM in a Spanish cohort with more than 460 patients.ObjectivesTo describe demographic characteristics, efficacy and safety of BLM in patients with SLE in Spanish population since its approval.MethodsDescriptive, retrospective, multicenter study in patients diagnosed with SLE according to EULAR/ACR 2019, SLICC and/or ACR 1997 diagnostic criteria. Data regarding SLE patients treated with BLM were collected from medical records (2011-2022). Demographic features, efficacy, laboratory variables, SLEDAI, renal involvement, steroid dose, administration routes and safety were assessed. To see whether a trend in BLM prescription had changed or not over time, two periods of time were analyzed: 2011-2016 (period1) and 2017-2022 (period2).ResultsBaseline characteristics of patients are summarized in Table 1.A total of 462 patients (36 hospitals) were included, 50.9% were on intravenous (IV), 34% on subcutaneous (SC) and 15.1% switched from IV to SC route. The median number of pre-BLM csDMARD use was 2.0 (2.0-3.0), being hydroxychloroquine (HCQ) the most frequently used (94.5%). Fifty-two patients were treated with IV cyclophosphamide with a median of 6 bolus received. At the time of BLM start, 443 patients were on prednisone with a median dose of 6.2 mg (5.0-10.0). Significant decreases in prednisone dose, SLEDAI and anti-DNA antibodies were observed from baseline until the last visit, whereas complement C3 and C4 values raised (Figure 1). A total of 118 patients (27.4%) had renal involvement with a median proteinuria of 1.0 g/day (0.5-2.4). Renal biopsy was done in 102 out of 118 patients, being class IV (33%), class III (21%) and class V (16%) the most frequently reported. After BLM, 73.3% of these patients improved (median proteinuria of 0.2 g/day (0.1-0.7).In period1, 100 patients started BLM compared to 362 in period2. The median time from SLE diagnosis to BLM begin was 7.1 (4.0-13.7) and 6.2 (2.1 -14.4) years in period1 and period2, respectively (p=0.454). We found a trend to use more csDMARD before BLM treatment in period1: 2.5 (2-3) vs. 2 (2-3) (p=0.088).A total of 143 (30.5%) patients discontinued treatment mostly due to inefficacy (55.9%) and infections (11.9%). In fact, 116 patients developed infections, mostly mild;2 patients died, 16 had COVID-19 and 4 patients developed tumors requiring discontinuation of the drug.ConclusionIn our cohort of SLE patients in a real-world setting, BLM has been effective, safe and seems to be a good choice to treat renal involvement.References[1]Navarra SV, Guzmán RM, Gallacher AE, et al. Lancet. 2011;377(9767):721-31.[2]Stohl W, Hiepe;rt al. Arthritis Rheum. 2012;64(7):2328-37.[3]Furie R, Rovin BH, Houssiau F, et al. N Engl J Med. 2020;383(12):1117-1128.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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The health emergency determined that classes were suspended in person, implementing virtual education, this measure required actions to adapt to the new normality. The objective was to explore the repercussions of virtual education from the perspective of teaching practice through the qualitative approach of systematic bibliographic review;Consulting academic literature, it was concluded that there were coincidences that teachers faced in the context of the health emergency, such as self-training initiatives, lack of digital skills, and emotional conditions.
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The last two Brazilian governments were responsible for the general dismantling of public policies in favor of family farming, such actions reflected directly in the Food and Nutrition Security and Insecurity indices since 2016, progressively increased and worsened in 2020 with the pandemic of COVID-19 . Thus, this article aims to interpret the historical and political threshold between the years 2002 to 2020 and the phenomenon of hunger in this period. The conduct of the research was guided by the Literature Review on national and international sites, with a qualitative and quantitative bias of a descriptive character. The study showed that there was an increase in the levels of Food and Nutritional Insecurity at its various levels: mild, moderate and severe, highlighting the North and Northeast regions of the country as most vulnerable to hunger and essentially the populations residing in rural areas. We are facing a health and food crisis in Brazil and in the world and we therefore have an opportunity to seriously reflect on the way we produce process and distribute food.
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This research is a systematic review article on teaching practice in higher education institutions in times of COVID-19, in Lima 2022, this study has a qualitative approach, basic-descriptive type, with 17 selected articles. The studies reviewed correspond to the impact of the COVID-19 pandemic on education, its impact on university management, the implementation of distance education, pedagogical management challenges, challenges, experiences and proposals, educational quality and social inequality.. In the national environment, the situation in the face of difficulties in carrying out the development of good teaching practice has been further exacerbated, highlighting the shortcomings and challenges that they had been experiencing since before the arrival of COVID-19. Given this, it should be emphasized that the presence of confinement has hindered the proper development of teaching practice by not having tools that strengthen their professional performance.
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In recent years the quality of water and sewage treatment in Brazil is in evidence and widely discussed, due to the various cases of contamination by cyanobacteria and pathogens, giving prominence in this study: Geosmina, ZikaVirus and COVID-19, that impact water bodies. The purpose of this is to debate the current legislation and regulatory agencies that classify water quality, interpreting criteria for the preservation of aquatic life, the conservation of the areas that surround the rivers and their possible consequences for human health. The methodology was based on the literary review on national and international sites, in public bodies and institutions, the IVA – Aquatic Life Preservation Index (CETESB, 2017a/b) was defined as strategic for the preservation of the aquatic ecosystem and providing drinking water for human consumption. It was found as results: The diversity of 60 controlling agencies across the country discourage a centrality of data and control. ANA (2021) is only responsible for analyzing: pH, dissolved oxygen, conductivity and temperature, without control devices to avoid contamination, and highlighted: CEDAE in repeated episodes of geosmina contamination in the Guandu River, which prove eutrophication of this body of water and the poor quality of the water supplied to the consumer, unpleasant odor and taste. © 2021, Universidade Federal de Pernambuco. All rights reserved.
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BACKGROUND AND AIMS: Age and chronic kidney disease have been described as mortality risk factors for coronavirus disease 2019 (COVID-19). Currently, an important percentage of patients in hemodialysis are elderly. This study aimed to investigate the impact of COVID-19 in this population and to determine risk factors associated with mortality. METHOD: Data was obtained from the Spanish COVID-19 CKD Working Group Registry, that included patients in renal replacement therapy (dialysis and kidney transplantation) infected by COVID-19. From March 18, 2020, to August 27, 2020, 1165 patients on hemodialysis affected by COVID-19 were included in the Registry. A total of 328 patients were under 65 years-old and 837 were 65 years old or older (elderly group). RESULTS: Mortality was 18.6% higher (95% confidence interval (CI): 13.8%-23.4%) in the elderly hemodialysis patients compared to the non-elderly group (see figure). Death from COVID-19 infection was increased 5.5-fold in hemodialysis patients compared to mortality in the general population for a similar period, and there was an age-associated mortality increase in both populations (see figure 1). In multivariate Cox regression analysis, age (hazard ratio (HR) 1.58, 95% CI: 1.31-1.92), dyspnea at presentation (HR 1.61, 95% CI: 1.20-2.16), pneumonia (HR 1.76, 95% CI: 1.12-2.75) and admission to hospital (HR 4.13, 95% CI: 1.92-8.88) were identified as independent mortality risk factors in the elderly hemodialysis population. Treatment with glucocorticoids reduced the risk of death (HR 0.71, 95% CI: 0.51-0.98) in aged patients on hemodialysis. CONCLUSION: Mortality is dramatically increased in elderly hemodialysis patients affected by COVID-19. Age, dyspnea at presentation, pneumonia or hospitalization are factors associated with a worse prognosis, after adjusting dialysis population to other confounding factors. Treatment with glucocorticoids could be a therapeutic option for this specific population. (Table Presented).
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BACKGROUND AND AIMS: Angiotensin converting enzyme 2 (ACE2) is one of the components of the renin-angiotensin system (RAS) that mainly degrades angiotensin II to angiotensin-(1-7). ACE2 is predominantly expressed in the kidney and the heart, but it has been evidenced in type 2 alveolar lung cells, where it acts as a receptor for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this context, a controversy arose as to whether the use of RAS blockers could increase ACE2 lung expression and the risk infection by COVID-19. This study aimed to investigate the effect of an ACE inhibitor (Ramipril) on ACE2 expression in experimental diabetes. METHOD: 12 weeks old diabetic db/db mice (n=7) were given ramipril (8 mg/Kg/day) during 8 weeks or the respective vehicle. db/m (n=7) vehicle-treated non-diabetic mice were included as controls. ACE2 mRNA expression and enzymatic activity were studied in kidney, heart and lung samples of these animals to identify if the diabetic condition or treatment with ramipril modulated ACE2 expression. RESULTS: In vehicle-treated diabetic db/db animals, ACE2 mRNA expression was significantly increased in the kidney (p<0.001) and ramipril treatment reversed this effect (p=0.026). In the heart, ACE2 expression decreased in db/db when compared to db/m littermates (p=0.035) and ramipril had no effect. We found no differences in ACE2 gene expression in the lung. Besides, ACE2 enzymatic activity was increased in the kidney (29%) and also in the lung (16%) of db/db mice when compared to controls. Ramipril treatment decreased ACE2 activity a 19% in the lung and had no effect in the kidney when compared to untreated db/db (see figure). In the heart, ACE2 activity tended to decrease in db/db mice (29%) when compared to db/m and ramipril increased ACE2 activity (18%) but did not exceed the cardiac ACE2 activity of the db/ m. CONCLUSION: ACE2 is increased in the kidney and the lung, and decreased in the heart of diabetic mice. Ramipril treatment restores ACE2 levels. The results suggest that ACE inhibitors do not increase ACE2 expression and the activity decrease exerted in the lung may be protective against COVID-19 infection.
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BACKGROUND: COVID-19 infection manifests as pneumonia associated with multiple organ failure, and death. Acute kidney injury is a risk factor for mortality. There is limited scientific literature on COVID-19 infection and allergic tubulointerstitial nephritis, its clinical course and short- and long-term prognosis. METHOD: We performed a retrospective study where medical records of 60 patients with histological diagnosis of allergic tubulointerstitial nephritis from January 2009 to November 2020. In these patients, we studied the incidence of COVID-19 infection, clinical characteristics and prognosis from March to the actual date. RESULTS: Of 60 patients with allergic tubulointerstitial nephritis, 6 (10%) patients were diagnosed with COVID-19. The first case, an 85-year-old woman with a history of metastatic melanoma treated with nivolumab and allergic tubulointerstitial nephritis by immunobiological agents in 2018, diagnosed with mild COVID-19 infection in April 2020 without deterioration of renal function in controls at 3 and 6 months of follow-up. The second case, a 51-year-old woman with a history of large B-cell lymphoma with plasmacytic differentiation and progression to multiple myeloma of lambda light chains and allergic tubulointerstitial nephritis due to chemotherapy since 2019, admitted for acute pyelonephritis and PRES syndrome secondary to first dose of bortezomib complicated with COVID-19 nosocomial pneumonia and acute pancreatitis treated with corticosteroids and broad spectrum antibiotic therapy;she died of abdominal refractory septic shock. The third patient, a 64-year-old man without prior renal impairment, was admitted for severe COVID-19 pneumonia and acute kidney injury secondary to acute tubulointerstitial nephritis of uncertain etiology that required orotracheal intubation and continuous veno-venous hemodiafiltration for a week who received methylprednisolone in bolus for 3 days and continued treatment with corticosteroid therapy with complete recovery of renal function and improvement in proteinuria at 3 months of follow-up. The fourth patient, an 82-yearold woman with acute kidney injury AKIN 3 secondary to acute allergic tubulointerstitial nephritis related to ciprofloxacin complicated with severe COVID-19 nosocomial pneumonia, who died despite ventilatory support and high-dose steroids therapy and tocilizumab. The fifth patient, a 75-year-old with a history of metastatic lung adenocarcinoma treated with immunobiological agents and allergic tubulointerstitial nephritis in 2018, admitted in march 2020 for mild COVID-19 pneumonia treated with steroids and hydroxychloroquine without deterioration of respiratory and kidney function. The sixth patient, an 86-years-old man with acute kidney injury AKIN 3 due to acute allergic tubulointerstitial nephritis secondary to proton-binding inhibitors and nosocomial COVID-19 infección with improvement of kidney function with steroids therapy only. CONCLUSION: Our 6 patients with allergic tubulointerstitial nephritis and COVID-19 infection presented different spectrum of the disease. It seems that nosocomial COVID-19 infection in patients admitted with recent diagnosis of acute allergic tubulointerstitial nephritis presented a worse clinical prognosis compared with long-term diagnosed acute tubulointerstitial nephritis. Further studies with a larger sample size are needed.
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BACKGROUND AND AIMS: COVID-19 infection is responsible for respiratory infection with variable clinical expression from its asymptomatic form to severe pneumonia associated with acute respiratory distress syndrome and death. Risk factors related to higher mortality are age over 65 years, cardiovascular, pulmonary and kidney disease, hypertension, and diabetes. There is limited scientific literature on COVID-19 infection and previous kidney disease, specifically in patients with glomerular and tubular kidney disease. The aim of this study was to determine general characteristics, analytical parameters and clinical evolution of patients with kidney disease who have undergone kidney biopsy and who presented infection or high suspicion of infection by COVID-19. Identify mortality and associated risk factors. METHOD: we studied patients with high clinical suspicion of infection or confirmed infection by COVID-19 from March 2020 to May 15, 2020 of all patients who underwent percutaneous renal biopsy at the Vall d'Hebron Hospital between January 2013 and December 2019. RESULTS: 39 of the 553 patients have been diagnosed with COVID-19 infection since March 2020. The average age was 63615 years and 48.7% were male. Hypertension was present in 79.5% of patients, chronic kidney disease without renal replacement therapy in 76.9%, and cardiovascular disease in 64.1%. Nasopharyngeal swab was performed in 26 patients;older patients (p=0.01), patients with hypertension (p=0.005), immunosuppression (p=0.01), use of RAS-blocking drugs (p=0.04) and gastrointestinal symptoms (p=0.02) were more likely to be tested for COVID-19. 22 patients required hospitalization and 15.4% died. In the bivariate analysis, mortality was associated with older age (p=0.03), cardiovascular disease (p=0.05), chronic obstructive pulmonary disease (COPD) (p=0.05) and low hemoglobin levels (p=0.006). Adjusted Cox regression showed that low hemoglobin levels (10.12±1.89g/dL) at admission had 1.81 greater risk of mortality [1.04-3.13;p=0.04]. CONCLUSION: Patients with COVID-19 infection and kidney disease confirmed by kidney biopsy presented mortality of 15.4%. Swab test for COVID-19 was more likely to be performed in older, hypertensive, use of RAS-blocking drugs, immunosuppressed patients and those with gastrointestinal symptoms. Low hemoglobin is a risk factor for mortality.
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The COVID-19 Pandemic significantly affected people’s lifestyles around the world. This qualitative study discusses the influence of urban restorative environments on mental health in times of pandemic. Data was collected by means of bibliographic research, to describe the phenomena related to the need to improve biophilic tendencies. Results showed strong correlations between the natural environment, mental health and quality of life of the urban population. The pandemic also questions how we live in cities and the way we treat environmental issues. Given this scenario, the natural environmental contributes greatly to the mental health of the urban population, minimizing the onset of mental illnesses and the damage to quality of life, accentuated by COVID-19. © 2022, Psicologia USP. All Rights Reserved.