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Objective: To identify the publications that discussed COVID-19 as an occupational injury and its notification by health workers.Methods: The search for this scoping review explored national and international literature, between 2020 and 2021, in English, Portuguese and Spanish, in the databases of the Regional Portal of the Virtual Health Library, in MEDLINE through PubMed and in Capes Journal Portal used: Embase, Scopus, Web of Science, CINAHL. The texts were imported into EndNote, duplicates were removed and exported to the Rayyan application, and the articles were included in an Excel spreadsheet with the labels: COVID-19 as injuries at work and Notification of COVID-19.Results: A total of 5665 studies were identified, excluding 2088 duplicates, resulting in 3577 publications, selected by title and . Of these, 3280 did not meet the inclusion criteria, resulting in 297 articles. Of these, 10 were selected for full text analysis because they dealt with COVID-19 as an injury at work and/or notification of this condition by health workers. Two articles were excluded because they were a literature review, remaining 8 as the study's corpus.Conclusion: Although certain countries already recognize COVID-19 as an occupational injury, some workers still have difficulties in relating the SARS-CoV-2 infection with work in health care, characterizing it as an occupational injured. Everyone should be guided and trained regarding the recognition of COVID-19 as an occupational injury and notify its occurrence, since the definition of the infection as a notifiable disease already exists.
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Background: Vaccination plays an essential role in controlling SARS-CoV- 2 pandemics. Due to initial concerns about hypersensitivity reactions (HR) to these new vaccines, our department, in articulation with Primary Healthcare Services (PHS) has developed several strategies to support COVID-19 vaccination. This work aims to describe those strategies and report the results. Method(s): The strategies developed for COVID-19 vaccination, from March to December 2021, included: 1) telephone support for health professionals (TS for HP) from the Vaccination Centres (VC), 2) priority appointments (PA) of patients classified as a higher risk for HR, 3) hospital vaccination of high-risk patients as defined by the national health authority. A retrospective and descriptive analysis of the support activity developed and from the data of patients vaccinated at the hospital in the same period were performed. Result(s): During the considered period, our department screened 1618 patients: 420 (26%) through telephone support for HP (TS for HP) from VC and 1198 (74%) at priority appointments (PA). After TS for HP, community vaccination (CV) was recommended in 87% (n = 364) of cases and a PA was advised in 13% (n = 56). Of the patients evaluated in PA, 80% were recommended CV, with restriction of the vaccine to administer in 28% of them. We always found an option to vaccine all. At the hospital were vaccinated 178 patients, 83% (n = 147) women, median age (P25-75) 61 (46-76) years. Hospital vaccination criteria were: past history of multiple drug HR (n = 93;52%), HR to vaccines (n = 46;26%), HR to the 1st dose of anti-SARS- CoV- 2 vaccine (n = 30;17%), idiopathic anaphylaxis (n = 10;6%) and systemic mastocytosis (n = 2;1%). 15% of patients (n = 26) performed skin tests with vaccines, which were negative in 25 and inconclusive in 1 case. 145 (82%) were first shots, 32 (18%) second shots, and one booster shot. Only one patient had a mild immediate reaction (2nd booster vaccination), promptly treated with antihistamine and corticosteroid. Conclusion(s): The collaboration strategies adopted by our department allowed the vaccination of 1618 patients and avoided vaccination delays in most of the VC contacts. In our sample, hospital vaccination of patients at higher risk for HR was safe.
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Introduction: Patients with congenital bleeding disorders (CBD) have an increased bleeding tendency, which varies according to the factor deficiency and severity. In most cases, prolonged bleeding is observed after trauma, surgery and/or invasive procedures. Haemostatic treatment is needed to prevent bleeding complications and allow a good clinical outcome. Our aim is to evaluate the management of patients with CBD in minor procedures. Method(s): Retrospective study of patients with CBD who performed minor procedures over a 7-year period, through review of clinical files. Result(s): Between January 2015 and December 2021, 249 minor procedures were performed in 113 patients with CBD: 42 had diagnosis of Haemophilia A (HA) (15 severe without inhibitors;3 severe with inhibitors;4 moderate and 20 mild);12 had Haemophilia B (HB) (7 severe without inhibitors;2 moderate and 3 mild);5 were carriers of HA and 2 of HB. 35 had von Willebrand disease (VWD);15 had rare bleeding disorders (8 FVII deficiency;6 FXI deficiency;1 FX deficiency) and 2 had diagnosis of inherited platelet glycoprotein deficiencies (1 Glanzmann thrombasthenia and 1 Bernard Soulier syndrome). Most procedures were dental treatments (189);synoviorthesis/ infiltration/mesotherapy (17);endoscopies and colonoscopies (15);skin lesions excision (8);COVID-19 vaccination (5);sebaceous cyst excision (4);cardiac catheterization (3);ureteral stent removal (3);bone marrow biopsy (2);cystoscopy (2) and breast fibroadenoma excision (1). Prophylactic treatment was performed in 237 (95%) of the procedures, respectively FVIII concentrate factor (59);FIX concentrate factor (27);DDAVP (66);von Willebrand factor/factor VIII concentrates (44);bypassing agents (24);platelet (6);inactivated human plasma (9);tranexamic acid (47) and epsilon-aminocaproic acid (161). No side effects were reported. Discussion/Conclusion: Most patients that underwent minor procedures had Haemophilia and VDW(83%). The most common procedure was dental treatment (76%). Patients with CBD require attention and special care in dental practice. The haemostatic prophylactic treatment varies according to the specific haemostatic defect, severity and type of procedure. The treatment performed has been demonstrated safe and effective, with low incidences of haemorrhagic and treatment-related complications. These patients' treatment requires multidisciplinary teams and reference centres.
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Introduction: Long COVID is defined as the presence of symptoms that develop during or after COVID-19, continue for more than 12 weeks, and are not explained by an alternative diagnosis. Post-COVID radiological sequelae may occur and could be associated with dyspnea and cough. Decreased DLCO has been described as the main feature of PFTs abnormalities. Aims and objectives: The aim of this study was to identify potentially correlated with long COVID and its association with radiological and lung function sequelae in previously hospitalized patients. Method(s): We conducted a cross-sectional study with 93 patients that were evaluated in an outpatient setting following discharge from the hospital for COVID-19 pneumonia. Result(s): The mean age was 64 (+/-11) years old, 54 (59.1%) were male. The evaluation occurred on average 20 (+/-4) weeks after hospital discharge and 42 (45.2%) patients presented with long COVID. The most common symptoms were fatigue (31.2%) and dyspnea (26.9%). The prevalence of long COVID was higher in females (61%) (P=0.015). Obesity (OR 5.000, P=0.005), admission to ICU (OR 10.276, p=0.006), and the need for NIV (OR 7.85, p=0.01) were associated with long COVID. 65 patients performed CT scan and 43 (66%) had no or mild radiological sequelae. Radiological sequelae were more common in patients with long covid (n= 13, 30%) (p=0.024) and dyspnea/fatigue (p=0.04). Lung function was evaluated in 86 patients;decreased DLCO was the most common altered feature (n=32, 37%) and was associated with the presence of dyspnea/fatigue (p= 0.029). Conclusion(s): Obesity, ICU admission and the need for NIV were associated with a higher incidence of long COVID. The presence of radiological sequalae and/or decreased DLCO were associated with long COVID.
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A resposta imune a infeccao por SARS-CoV-2 durante o periodo gravidico puerperal e as alteracoes que podem aumentar o risco de complicacoes maternas, fetais e neonatais ainda nao sao bem caracterizadas. Para isso, foram determinados, atraves de citometria de fluxo, niveis perifericos de linfocitos T-totais (CD3+), T-auxiliar (CD3+/CD4+), T-citotoxico (CD3+/CD8+), linfocitos B (CD19+), celulas NK (CD16+/56+) e NKT (CD3+/CD16-56+) em gestantes e puerperas com suspeita de COVID-19 com o objetivo de identificar potenciais alteracoes imunologicas induzidas pelo coronavirus. Foram utilizadas amostras de sangue periferico de mulheres que realizaram RT-PCR para COVID-19 entre maio de 2021 e marco de 2022. As amostras foram coletadas em tres maternidades publicas do Rio Grande do Norte na admissao para parto e no puerperio imediato nos casos suspeitos. O sangue foi coletado em tubos contendo EDTA para a realizacao da citometria de fluxo, utilizando o analisador de fluorescencia celular ativado (FACScan) e o software Cell Quest. Os linfocitos foram identificados por alta expressao de CD45 e baixa dispersao lateral, utilizando as seguintes combinacoes de 3 cores de anticorpo monoclonal: isotiocianato de uoresceina (FITC), ficoeritrina (PE) e Proteina Clorofila Piridina (PerCP). Cinquenta mulheres precisaram realizar o RT-PCR e 32 (64%) testaram positivo para COVID-19. Gestantes e puerperas infectadas pelo SARS-CoV-2 apresentaram niveis elevados de celulas T citotoxicas, mediana (ME) = 495,0;intervalo interquartil (IIQ) = 391,5, quando comparadas com pacientes nao infectadas, ME=356,2;IIQ=297,8;p=0.032. Com relacao a quantidade das celulas NK, ME=159,1;IIQ=220,4, e dos linfocitos B, ME=126,7;IIQ=186.4, as contagens foram significativamente mais baixas no grupo com menos de 30 dias de infeccao, em comparacao com o grupo em que o RT-PCR foi negativo, ME=280,8;IIQ=214,9;p=0,021 e ME=323,9;IIQ=365,5;p=0,045, respectivamente. Gestantes e puerperas com COVID-19 apresentam maior numero de linfocitos T citotoxicos no sangue periferico e menor numero de celulas NK e linfocitos B. Considerando que gravidez e pos-parto alteram fisiologicamente o sistema imunologico e que esse estudo transversal nao permite analisar causalidade entre infeccao e alteracoes celulares, mais estudos sao necessarios para elucidar as alteracoes causadas pela COVID-19 no sistema imunologico durante o periodo gravidico puerperal, para confirmar se a infeccao viral compromete a imunidade, aumentando o risco de complicacoes para o binomio mae-feto. Declaramos que nao houve apoio financeiro e (ou) material recebido para o desenvolvimento deste trabalho. Copyright © 2022
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Objetivos: Sabe-se que os tumores neuroectodermicos primitivos (PNETs) sao tumores raros envolvendo o sistema nervoso central, ossos ou tecidos moles, com pico de incidencia na adolescencia. O PNET e um tumor extremamente agressivo cuja sobrevida livre de doenca em 2 a 3 anos varia de 25 a 60%. Cerca de 30% dos pacientes apresentam metastase no momento do diagnostico. O prognostico varia de acordo com sitio acometido e a extensao da doenca ao diagnostico. O objetivo e relatar um caso raro de PNET, avaliado pela hematologia, com hipotese diagnostica inicial de leucemia aguda. Materiais e metodos: Coleta dos dados clinicos da paciente nas Unidades de Clinica Medica e Hematologia do HUCAM, bem como o levantamento em prontuario dos resultados de provas laboratoriais e exames especializados. Resultado: Paciente do sexo feminino, 19 anos, admitida no hospital com plaquetopenia grave. A paciente relatava mialgia, cefaleia e calafrios que iniciaram apos a terceira dose da vacinacao para Covid, evoluindo 2 dias apos com o surgimento de equimoses em membros e metrorragia. Ao exame fisico apresentava-se levemente palida, afebril, com sangramento cutaneo, sem linfonodomegalias perifericas ou visceromegalia. Os exames iniciais revelaram uma anemia normocitica (Hb-10.5g/dl), leucocitos-8200/mm3, plaquetopenia (12000/mm3), aumento de desidrogenase latica (DHL-4550), beta HCG negativo. A morfologia inicial do sangue periferico nao revelou alteracoes leucocitarias, porem o mielograma mostrou uma infiltracao intensa da medula ossea por celulas com caracteristicas imaturas, compativel com celulas blasticas. A imunofenotipagem estas celulas eram negativas para CD45, e para os marcadores de linhagens mieloide, linfoides B e T, e celulas dendriticas, e positivas para CD56. O diagnostico final foi de um tumor neuroectodermico primitivo com base na histopatologia da biopsia de medula. Discussao: Apresentamos o caso de uma paciente jovem com o diagnostico de PNET avancado, com manifestacoes hemorragicas cutaneo-mucosas de evolucao aguda, associado a plaquetopenia grave e infiltracao da medula ossea por celulas imaturas com caracteristicas blasticas, que faziam suspeitar fortemente de uma leucemia aguda, portanto, uma apresentacao atipica para um tumor solido raro e de comportamento agressivo, cujo diagnostico so foi possivel atraves de exames especializados. Conclusao: O diagnostico de certas neoplasias pode ser desafiador devido a sua rara incidencia e, por vezes, apresentacao clinica atipica, que pode simular outras doencas. O envolvimento primario do sangue periferico e da medula ossea suscita a avaliacao inicial do hematologista que, com base nos conhecimentos clinico e laboratorial, e capaz de estabelecer um raciocinio amplo e diferencial, cuja confirmacao requer o conhecimento de um especialista experiente para diagnostico assertivo e precoce. Copyright © 2022
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Introduction: The COVID-19 infection rapidly became a worldwide pandemic and a public health emergency that seriously burdened healthcare systems. Health care professionals (HCPs) were faced with a new difficult and demanding challenge which frequently meant working long h shifts with low staffing members under high pressure environments. This may have had an important impact on sleep quality of HCPs. Aim(s): To evaluate the quality of sleep of HCPs after 3 waves of the COVID-19 pandemic. Method(s): A sleep questionnaire developed by the authors was sent to all HCPs of a tertiary hospital after the first 3 waves of the COVID-19 pandemic. Result(s): We had a total of 651 participants, mostly female (81.3%). Most participants were nurses (38.1%) and doctors (19.1%), with ages between 30 and 50 years. Other HCPs included were technicians, assistants, pharmaceuticals, among others. The majority dealt directly with COVID-19 patients (73.7%). Concerning quality of sleep, a significant proportion of HCPs referred a bad or very bad quality of sleep (41.5%) and only 16.1% stated a good or very good quality of sleep, of the last, 57% did not work night shifts. The majority suffered from night awakenings (88.6%), with 38.2% referring more than 2 awakenings per night;of these, 65% stated difficulty falling back to sleep. Furthermore, 46.2% HCPs referred initial insomnia and 59.9% referred terminal insomnia. Regarding quantity of sleep 16.9% slept less than 5 h, 47.3% slept approximately 6 h and only 7% slept 8 or more hours. Approximately 33% of HCPs resorted to sleeping medication, most frequently anxiolytics. In reference to daily symptoms, 71.3% of HCPs stated daytime sleepiness, most frequently after lunch (50.5%). Nonetheless, a significant proportion mentioned sleepiness during work (24%), and while driving (14.3%). Finally, 50.4% of the HCPs considered that the 3 waves of the COVID-19 pandemic worsened their sleep quality. Conclusion(s): This analysis demonstrates concerning results regarding the quality of sleep of HCPs after the first 3 waves of the COVID-19 pandemic with important daytime repercussions. This may reflect a consequence of the COVID-19 pandemic, as half of the HCPs considered that that the pandemic worsened their sleep quality.
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Air pollution, especially at the ground level, poses a high risk for human health as it can have serious negative effects on the population of certain areas. The high variability of this type of data, which are affected by weather conditions and human activities, makes it difficult for conventional methods to precisely detect anomalous values or outliers. In this paper, classical analysis, statistical process control, and functional data analysis are compared for this purpose. The results obtained motivate the development of a new outlier detector based on the concept of functional directional outlyingness. The validation of this algorithm is perfomed on real air quality data from the city of Gijón, Spain, aiming to detect the proven reduction in NO2 levels during the COVID-19 lockdown in that city. Three more variables (SO2, PM10, and O3) are studied with this technique. The results demonstrate that functional data analysis outperforms the two other methods, and the proposed outlier detector is well suited for the accurate detection of outliers in data with high variability. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
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Introduction: The sleep-wake rhythm irregularities can cause poor sleep quality and mood changes, such as increased fatigue and sleepiness in the students in consequence of the academic tasks and social life. Objective: The objective of this study was to verify the sleep quality, sleepiness, alertness state and mood state of the university students prior to the day-night-shift classes (online) during the COVID-19 Pandemic. Methods: One hundred sixty-eight university students of both sexes, with a mean age of 23.8±5.4 years, registered from the 2nd to the 7th period in three courses (Medicine, Nursing and Physiotherapy) of the two Brazilian private university in the day (n=90) and night-shift (n=78) were participated of this study. The measurements of sleep quality (Pittsburgh Sleep Quality Index - PSQI), sleepiness (Epworth Sleepiness Scale), alertness state (Karolinska Sleepiness Scale), mood state (Brazil Mood Scale - BRAMS), fatigue (FB) and vigor BRAMS domains (VB) were performed immediately prior to the classes online (day shift = 7h00;night shift = 19h00). The normality of the data was verified using the Kolmogorov-Smirnov test. The Mann-Whitney U test of independent samples was used to compare the variables between day-shift and night-shift university students. The size of the Cohen effect (ES) was estimated. The α-level for all analysis was set at ≤0.05. Results: The results showed there was a significant difference in sleep quality, fatigue mood domain, and alertness state between university students in the day and night shifts: sleep quality - PSQI (U= 2789.5;p=0.02;ES=0.46), alertness state - KSS (U= 2933.0;p=0.04, ES=0.48) and FB mood domain (U= 2877.0;p=0.05;ES=0.31). However, there was no difference in sleepiness (ESS) and Vigor mood domain (BRAMS) between day-shift and night-shift students. Therefore, the night-shift university students showed a significant worsening of the sleep quality, fatigue mood and alertness state compared to the day-shift students prior the classes. Conclusion: The results indicated that night-shift students were inattentive, fatigue, and sleepy prior to their academic activities (classes), in addition to presenting poor sleep quality (IQSP>5). Thereby, strategies implementation such as naps, restorative sleep, blue light therapy, and sleep hygiene are important to improve the alertness, attention, general health, and academic performance of the university students during the COVID-19 Pandemic.
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This chapter discusses the dual nature of Brazilian federalism and the strengthening of subnational autonomy, as evidenced during the Covid-19 pandemic. On one hand, the crisis highlighted the importance of the federal government in the institutional arrangement of Brazilian federalism, which is highly centralised;on the other, it has provided greater scope for action by state governments, whose political power has gradually diminished over the 30 years since the 1988 Constitution came into being. Municipalities have also played a stronger role based on their local interest. To analyse those aspects, the chapter presents the constitutional design of the Brazilian federation and the public policies in health and disaster management to contain the pandemic, demonstrating that the intergovernmental relations generated by the very nature of federalism were indispensable in enabling Brazil to address the pandemic and so prevent worse outcomes in terms of public health. Additionally, the expanded autonomy of states and municipalities during the pandemic, due to a Supreme Court decision, was fundamental to the struggle against the denialism of the President Jair Bolsonaro, who neglected his federal responsibilities. © 2022 selection and editorial matter, Nico Steytler.
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Objective: To analyze how COVID-19 contingency plans adopted in Brazilian state capitals and in the Federal District approach the health protection of Primary Health Care (PHC) workers.
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Background. In order to mitigate the spread of SARS-CoV-2 and the COVID-19 pandemic, public health officials have recommended self-isolation, self-quarantine of exposed household contacts (HHC), and mask use to limit viral spread within households and communities. While household transmission of SARS-CoV-2 is common, risk factors for HHC transmission are poorly understood. Methods. In this prospective cohort study, we enrolled 37 households with at least one reverse transcription polymerase chain reaction-confirmed (RT-PCR) COVID-19 index case from March 2020 - March 2021, in order to calculate secondary attack rates (SAR) and define risk factors for secondary infections. Participants were tested daily for SARS-CoV-2 via RT-PCR, using self-collected lower nasal samples. Households were followed until all members tested negative for seven consecutive days. We collected demographics, medical conditions, relationship to index case, and socioeconomic indicators. Subgroup data analysis was conducted and stratified by positivity status. Results. Of 99 enrolled participants, 37 were index cases and 62 were household contacts (HHC), of whom 25 HHC were infected (40.3%). Secondary attack rate (SAR) was highest among adults caring for a parent (n=4/4, 100%) and parents of index cases (5/10, 50%). Households whose income came from service work had greater risk of transmission compared to households whose primary income was technology (n=5/7;71.4% vs 3/8;37.5% respectively). Pediatric contacts were at lower risk of infection when compared to adult contacts (n=5/18, 27.8% vs n=20/44, 45.5% respectively). Conclusion. This study suggests that household transmission represents a key source of community-based infection of SARS-CoV-2. Allocating resources for education/ training regarding prevention among infected individuals and their close contacts will be critical for control of future outbreaks of SARS-CoV-2.
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Purpose: The SARS-CoV-2 virus continues to mutate, and the COVID-19 pandemic remains a global health crisis. The purpose of this longitudinal study was to continue to analyze the use of infection prevention and control practices (IPC) and personal protective equipment (PPE) by dental hygienists in the United States (US) during the COVID-19 pandemic.Methods: Web-based surveys on COVID-19 related health, IPC, and PPE were administered monthly to a panel of US licensed dental hygienists (n=6,976) from September 2020 to August 2021. Trends over time and predictors of IPC and PPE use were estimated using Stata 17.0 xt commands and multilevel multivariable logistic regression. Linear regression modeling for trends in time and tests for changes in trends were conducted (Joinpoint Regression Program, Version 4.9.0.0).Results: Almost all practicing dental hygienists (99.9%, 14,926 observations) reported COVID-19 specific IPC in place at their primary dental practice. Consistently >96% of dental hygienists reported operatory disinfection and staff masking over the study period. Patient face masking and physical protections such as barriers or air filtration increased in use over time, then declined in spring 2021. Screening or interviewing patients before appointments, checking patient temperatures before treatment, checking staff temperatures at shift start, disinfecting frequently touched surfaces, and encouraging distance between patients were reported by >85% of respondents until March 2021, at which point significant decreases were observed. Wearing a mask or respirator and eye protection during patient care consistently rose over time from September 2020 (77.1%) to August 2021 (81.4%). Always wearing a N95 or equivalently protective respirators during aerosol generating procedures peaked in 2/2021 and declined thereafter. Dental practice setting, supply of respirators, COVID-19 vaccination, and COVID-19 community transmission level were significantly associated with IPC and PPE use.Conclusion: Most US dental hygienists reported always wearing masks and eye protection during patient care and a variety of IPC types have been instituted to reduce the risk of COVID-19 transmission in dental practice settings. However, the use of N95 or equivalent respirators and some additional IPC methods declined during 2021.
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Purpose: Vaccinations represent an important public health tool for mitigating dangerous diseases;nevertheless, there is concern and hesitancy regarding vaccinations including those for COVID-19. The purpose of this study was to determine the intentions and hesitancy among dental hygienists in the United States (US) toward COVID-19 vaccination.Methods: Dental hygienists in the US were surveyed from 1/4/21 to 8/16/21 regarding their intentions to get vaccinated and whether they received a COVID-19 vaccine. The vaccination questions were part of an anonymous, ongoing longitudinal web-based survey of dental hygienists' employment and infection control trends. Willingness or actual COVID-19 vaccination versus vaccine hesitancy were analyzed by differences in demographic characteristics using multivariable logistic regression and X2 and Fisher's exact tests.Results: Full COVID-19 vaccination rates in US dental hygienists rose sharply from 2/5/21 to 3/5/21 (26.0% to 53.9%) and leveled off to 75.4% by 8/30/21. The highest rates of vaccine hesitancy were among dental hygienists aged 26-39 years and those who had contracted COVID-19 during the time of the survey. The lowest vaccination hesitancy rates were seen among Non-Hispanic Asians and individuals 65+. When controlling for age, race/ethnicity, and years practiced, dental hygienists who had contracted COVID-19 had higher odds of being vaccine hesitant (adjusted Odds Ratio (aOR): 1.847, 95% Confidence Interval (CI): 1.274, 2.678). Having contracted COVID-19 was also associated with respondents changing from being hesitant to be vaccinated to being willing to be vaccinated (aOR: 4.071, 95% CI: 1.652, 10.030).Conclusion: Although vaccine acceptance is high among dental hygienists in the US, vaccine hesitancy remains an ongoing concern. Dental hygienists are key prevention specialists who should promote adherence to vaccination recommendations for the health of the public. Further education in virology, epidemiology, and vaccination education is recommended.
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Introduction: In response to the Coronavirus Disease 2019 (COVID-19) pandemic, telepsychiatry was suddenly introduced in mental health services. Evidence concerning the efficacy and viability of these interventions in child and adolescent population is lacking. This study aims at developing a thorough understanding of family caregiver experiences with phone consultations, at the beginning of the pandemic. Material and Methods: We interviewed adolescent's caregivers under psychiatric follow-up, that were assisted at a phone consultation between April and June 2020. We used a semi-structured interview, that compared phone to physical consultations, regarding different dimensions: 1) accessibility and availability of care;2) effectiveness of communication (concretely, in the sub-dimensions of expression by oneself, understanding by the doctor and understanding by oneself);3) therapeutic relationship (specifically, in the sub-dimensions of one's own posture in the relationship, empathy / respect for the doctor and trust in the doctor);4) therapeutic results;5) satisfaction with care and 7) confidentiality. Results: Out of the 50 interviewed adolescent's caregivers, 34 (68%) consider there is an increment in access and availability with phone consultations. To 28 caregivers (56%), the way of expressing themselves has been affected and 33 (66%) believe that the doctor understands them in just the same manner. The majority considers there is no difference in doctor's empathy/respect (n=34, 68%), neither in reliance on the doctor (n=44, 88%). More than a half refers the therapeutic results are inferior (n=27, 54%) but the same number mentions satisfaction with the care provided (n=27, 54%). Confidentiality and trust in doctor seem to be the same, in telephone consultations, to 40 (80%) caregivers, while 8 (16%) said it is more difficult, due to impaired communication and doubts about maintaining privacy. Curiously, 2 parents (4%) consider that this aspect is superior in the telephone consultation, because face-to-face consultations are for the adolescent, and this is a way of having an exclusive and private time for them. Discussion: One of the findings to be highlighted is the benefit of phone consultations in terms of accessibility and availability of care (due to the absence of travel and less time spent). Communication seems to be impaired in phone consultations, which was mainly justified by the absence of body language and eye contact. However, due to increased access and availability, in the face of public health contingencies, most patient's caregivers were pleased with the care received. Conclusion: Telepsychiatry has emerged as a promising treatment option in the pandemic context. Nevertheless, to be a viable complement and/or alternative to physical consultations, it demands further training and investigation. It could also be important to evaluate the perspective of the adolescents and health professionals themselves, crossing it with that of caregivers, for a complete assessment of the experience from different point of views. No conflict of interest
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Background: Dupilumab has been recently approved for treatment in patients with severe AD in Portugal-until now there is no published data regarding Portuguese experience in Allergy centers. Method: Cross sectional clinical and laboratory assessment of 33 patients (pts) with moderate to severe AD treated with dupilumab (dupi) for at least 16 weeks (W): prospective evaluation of severity scores (SCORAD-Scoring Atopic Dermatitis, EASI-Eczema Area and Severity Index, P-VAS-Pruritus Visual Analogic Scale), report of adverse events up to 52 weeks of treatment. SCORAD and EASI were assessed in 23 pts at W52, P-VAS in 21 pts at W52. Results: Of the 33 pts, 18 were female (55%) with a mean age (SD, range) of 35.3 years (13.2, 15-60). In 16 pts the age of onset was before 2 years old, mean (SD) disease duration 28.1 years (12);94% patients had a diffuse pattern of skin lesions;97% of pts had allergic rhinitis, 82% asthma, 52% conjunctivitis and 30% food allergy. Median total IgE at baseline was of 6313 U/ml (P25-P75: 2842-12491) with a 76% reduction at W52 in 16 pts. Median eosinophil count at baseline was 520 eosinophils/mm3 (P25-P75: 270-740). Before starting dupi 29 pts had been treated with cyclosporine. At the beginning, 15 pts were under oral corticosteroids, 14 under oral systemic immunosuppressive drugs (all pts but two stopped both until W12 of dupi) and 5 switched from omalizumab. At baseline, median SCORAD and EASI were 69.3 and 24.2 points. At W16, W36 and W52, median SCORAD was 27.4, 22.3 and 21.5, and median EASI 5.3, 4.1 and 2.1. At W16, the EASI-50, EASI-75 and EASI-90 were achieved by 91%, 61% and 18% pts, and at W52, by 87%, 70% and 52% pts. The mean percentage of SCORAD reduction at W16 and W52 was 55% and 73%;and of EASI was 76% and 82%. At W16 and W52, an improvement of ≥4 points in P-VAS was achieved by 77% and 95% pts. There was a mean reduction of P-VAS at W2, W4, W16 and W52 of 2.6;3.6;4.7 and 6.3 points, respectively. Conjunctivitis was reported in 10 (30%) pts, two of them with keratoconjunctivitis and blepharitis, without needing to interrupt treatment;two pts also had facial erythema. One patient had COVID, and dupilumab scheme treatment was maintained. Conclusion: The majority of AD patients had a significant and consistent improvement in all the severity scores, after one year of treatment with dupilumab. No relevant adverse events were reported.
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In 2019, a new obscured pneumonia was reported by Wuhan Chinese scientists. Posteriorly, SARS-Cov-2 structure was identified, furthermore the pathology caused by this virus was named asCOVID-19. The period of incubation of this disease is something about 4 or 5 days before the onset of symptoms, with 97,5% of patients having 11,5 days of symptoms nearly. Furthermore, affected patients are having cutaneous manifestations, in addition to the classic pulmonary, laboratorial, and systemic affection. Thus, the goal of the present article was the description of the clinical, cutaneous and laboratorial manifestations in adults of 18 to 59 years old affected by COVID-19 and supported by Sao Rafael hospital, localized in Altamira-Para, a region of Amazon.