Cirrhosis is associated with lower serological responses to COVID-19 vaccines in patients with chronic liver disease.

Background & Aims: The response of patients with chronic liver disease (CLD) to COVID-19 vaccines remains unclear. Our aim was to assess the humoral immune response and efficacy of two-dose COVID-19 vaccines among patients with CLD of different aetiologies and disease stages. Methods: A total of 357 patients were recruited in clinical centres from six European countries, and 132 healthy volunteers served as controls. Serum IgG (nM), IgM (nM), and neutralising antibodies (%) against the Wuhan-Hu-1, B.1.617, and B.1.1.529 SARS-CoV-2 spike proteins were determined before vaccination (T0) and 14 days (T2) and 6 months (T3) after the second-dose vaccination. Patients fulfilling inclusion criteria at T2 (n = 212) were stratified into 'low' or 'high' responders according to IgG levels. Infection rates and severity were collected throughout the study. Results: Wuhan-Hu-1 IgG, IgM, and neutralisation levels significantly increased from T0 to T2 in patients vaccinated with BNT162b2 (70.3%), mRNA-1273 (18.9%), or ChAdOx1 (10.8%). In multivariate analysis, age, cirrhosis, and type of vaccine (ChAdOx1 > BNT162b2 > mRNA-1273) predicted 'low' humoral response, whereas viral hepatitis and antiviral therapy predicted 'high' humoral response. Compared with Wuhan-Hu-1, B.1.617 and, further, B.1.1.529 IgG levels were significantly lower at both T2 and T3. Compared with healthy individuals, patients with CLD presented with lower B.1.1.529 IgGs at T2 with no additional key differences. No major clinical or immune IgG parameters associated with SARS-CoV-2 infection rates or vaccine efficacy. Conclusions: Patients with CLD and cirrhosis exhibit lower immune responses to COVID-19 vaccination, irrespective of disease aetiology. The type of vaccine leads to different antibody responses that appear not to associate with distinct efficacy, although this needs validation in larger cohorts with a more balanced representation of all vaccines. Impact and Implications: In patients with CLD vaccinated with two-dose vaccines, age, cirrhosis, and type of vaccine (Vaxzevria > Pfizer BioNTech > Moderna) predict a 'lower' humoral response, whereas viral hepatitis aetiology and prior antiviral therapy predict a 'higher' humoral response. This differential response appears not to associate with SARS-CoV-2 infection incidence or vaccine efficacy. However, compared with Wuhan-Hu-1, humoral immunity was lower for the Delta and Omicron variants, and all decreased after 6 months. As such, patients with CLD, particularly those older and with cirrhosis, should be prioritised for receiving booster doses and/or recently approved adapted vaccines.

Psychological Impact of the COVID-19 Pandemic on Dentists in Latin America's Epicenter: São Paulo, Brazil.

The present study aimed to assess the prevalence and associated factors of stress and anxiety symptoms among dentists during the COVID-19 pandemic in the state of São Paulo, Brazil. A structured questionnaire was sent electronically to 93,280 dentists with active registration in the Dental Council of São Paulo, Brazil, enquiring about information regarding the first-wave peak period in Brazil. Descriptive analyses of background characteristics, perceptions of preparedness, and psychological impact were calculated. Multiple logistic regression analysis was performed, and independent variables that showed p < 0.20 were used in the adjusted logistic regression model to compare the psychological impact on dental professionals. Among the 2113 respondents, female participants had 63% lower chance of reporting anxiety than males. Older dentists had a lower likelihood of reporting anxiety compared to 21-30-year-old dentists (p ≤ 0.05). Dentists working in the public health service were 1.78 times more likely to report anxiety than those who worked in private practice. Finally, dentists in the COVID-19 high-risk group and those with a family or team member with a positive COVID-19 diagnosis were more likely to have anxiety. This study can help dental and other healthcare professionals to better understand the consequences of COVID-19 in terms of mental health.

Correction: Martínez-Reyes et al. Supplying Personal Protective Equipment to Intensive Care Units during the COVID-19 Outbreak in Colombia. A Simheuristic Approach Based on the Location-Routing Problem. Sustainability 2021, 13, 7822

The authors would like to make the following corrections to the published paper [...]

COVID-19 pandemic impact on dentists in Latin America's epicenter: São-Paulo, Brazil.

The state of São Paulo, Brazil, where more than 94.000 dentists are currently registered, has become the epicenter of COVID-19 in Latin America. The aim of this cross-sectional study was to evaluate the impact of COVID-19 pandemic on dentists in this state. A semi-structured questionnaire was sent via e-mail to 93.280 dentists with active registration in the Dental Council of São Paulo (CROSP). The impact of COVID-19 pandemic was assessed through questions related to demographic, socioeconomic, dental practice characteristics and personal protective equipment (PPE) use. Ordinal logistic regression analysis was performed to investigate the association between all the variables (p<0.05). Over 8 days, 2113 responses were received. Only 26.52% of the sample reported a low-income reduction (from 0-10%), while the majority of dentists reported a more negative financial impact, 35.6% with a reduction of more than 50% of their monthly income. Dentists who worked in the private sector and at the capital had a greater financial impact when compared to those of the public sector and countryside of the state (p<0.05). Furthermore, about 83% reported not having received any specific training to control the transmission of coronavirus in the health area. This study provides evidence of the negative impact of the COVID-19 pandemic on the routine of dentists in the state of São Paulo, Brazil. Hopefully, this study will help dental and other health care professionals to better understand the consequences of disease in dental settings and strengthen preparedness throughout the dental health care system.

Self-collected unstimulated saliva, oral swab, and nasopharyngeal swab specimens in the detection of SARS-CoV-2.

OBJECTIVES: The presence of SARS-CoV-2 virus in the saliva of patients infected with COVID-19 has been confirmed by several studies. However, the use of saliva for the diagnosis of COVID-19 remains limited, because of the discrepancies in the results, which might be due to using different saliva sampling methods. The purpose of this study was to compare the consistency of SARS-CoV-2 detection using two different saliva sampling methods (oral swab and unstimulated saliva) to that of the standard nasopharyngeal swab. METHODS: Fifty-five subjects were recruited from a pool of COVID-19 inpatient at the Hospital Israelita Albert Einstein (HIAE), Brazil. Nasopharyngeal swab, oral swab, and self-collected unstimulated saliva samples were examined for SARS-CoV-2 using RT-PCR. RESULTS: Self-collected unstimulated saliva demonstrated 87.3% agreement in the detection of SARS-CoV-2 virus as compared with the nasopharyngeal swab, while oral swab displayed 65.9% agreement when compared to nasopharyngeal swab and 73% when compared to self-collected unstimulated saliva. CONCLUSION: Unstimulated self-collected saliva samples have shown a higher agreement with the nasopharyngeal swab samples for SARS-COV-2 detection than that obtained when using oral swab samples. CLINICAL RELEVANCE: This study compares the accuracy of COVID-19 test using different saliva sampling methods to that of nasopharyngeal swab. Given the need for a simple self-applied test that can be performed at home, our findings support the efficacy of self-collected unstimulated saliva samples in the diagnosis of SARS-CoV-2 infection, alleviating the demands for swab supplies, personal protective equipment, and healthcare personnel.

Supplying Personal Protective Equipment to Intensive Care Units during the COVID-19 Outbreak in Colombia. A Simheuristic Approach Based on the Location-Routing Problem

The coronavirus disease 2019, known as COVID-19, has generated an imminent necessity for personal protective equipment (PPE) that became essential for all populations and much more for health centers, clinics, hospitals, and intensive care units (ICUs). Considering this fact, one of the main issues for cities’ governments is the distribution of PPE to ICUs to ensure the protection of medical personnel and, therefore, the sustainability of the health system. Aware of this challenge, in this paper, we propose a simheuristic approach for supplying personal protective equipment to intensive care units which is based on the location-routing problem (LRP). The objective is to provide decision makers with a decision support tool that considers uncertain demands, distribution cost, and reliability in the solutions. To validate our approach, a case study in Bogotá, Colombia was analyzed. Computational results show the efficiency of the usage of alternative safety stock policies to face demand uncertainty in terms of both expected stochastic costs and reliabilities.

Coordenação do cuidado, vigilância e monitoramento de casos da COVID-19 na Atenção Primária à Saúde

Objetivo: Descrever as ações estratégicas de coordenação do cuidado, monitoramento e vigilância dos casos de COVID-19 na Atenção Primária à Saúde. Método: Estudo do tipo relato de experiência, desenvolvido num território da Estratégia Saúde da Família da Sede do município de Sobral ­ Ceará, Brasil. Resultados: Papel da Atenção Primária à Saúde na coordenação do cuidado, vigilância e monitoramento de casos COVID-19 no território sanitário, e no ordenamento da Rede de Atenção à Saúde;a importância do isolamento social horizontal e o isolamento dos casos positivos no próprio lar, para o controle da COVID-19;a potencialidade do uso de ferramentas de tecnologias digitais no território, para divulgação das ações, disseminação de informações pelas redes sociais e a prática do teleatendimento;efetividade do trabalho em equipe e em rede no desenvolvimento das ações de controle da pandemia. Conclusão: A Atenção Primária à Saúde tem papel estratégico nas ações de combate ao COVID-19 no território, sobretudo na redução da transmissão comunitária, na resposta às demandas e monitoramento dos casos e na vigilância em cada fase da pandemia. (AU) Objective: To describe the strategic actions for the coordination of care, monitoring and surveillance of COVID-19 cases in Primary Health Care. Method: An experience report type study, developed in a territory of the Family Health Strategy at the Headquarters of the municipality of Sobral - Ceará, Brazil. Results: Role of Primary Health Care in the coordination of care, surveillance and monitoring of COVID-19 cases in the health territory, and in the organization of the Health Care Network;the importance of horizontal social isolation and the isolation of positive cases at home for the control of COVID-19;the potentiality of using digital technology tools in the territory, for the dissemination of actions, dissemination of information through social networks and the practice of call centers;effectiveness of teamwork and networking in the development of pandemic control actions. Conclusion: Primary Health Care has a strategic role in actions to combat COVID-19 in the territory, especially in reducing community transmission, in responding to demands and monitoring cases and in surveillance in each phase of the pandemic. (AU) Objetivo: Describir las acciones estratégicas de coordinación del cuidado, monitorización y vigilancia de los casos de COVID-19 en la Atención Primaria a la Salud. Método: Estudio del tipo relato de experiencia, desarrollado en un territorio de la Estrategia Salud de la Familia de la Sede del municipio de Sobral ­ Ceará, Brasil. Resultados: Papel de la Atención Primaria a la Salud en la coordinación del cuidado, vigilancia y monitorización de casos de COVID-19 en el territorio sanitario, y en el ordenamiento de la Red de Atención a la Salud;la importancia del aislamiento social horizontal y el aislamiento de los casos positivos en el propio hogar para el control del COVID-19;la potencialidad del uso de herramientas de tecnologías digitales en el territorio, para la divulgación de las acciones, diseminación de informaciones por las redes sociales y la práctica dela atención domiciliaria remota;efectividad del trabajo en equipo y en red en el desarrollo de las acciones de control de la pandemia. Conclusión: La Atención Primaria a la Salud tiene un papel estratégico en las acciones de combate al COVID-19 en el territorio, sobretodo en la reducción de la transmisión comunitaria, en la respuesta a las demandas, en la monitorización de los casos y en la vigilancia en cada fase de la pandemia. (AU)