ANÁLISE DO TESTE DE MMA (MONOCYTE MONOLAYER ASSAY), SUBCLASSE DE ANTICORPOS E DESFECHO TRANSFUSIONAL EM PACIENTES COMPLEXOS ATENDIDOS NA FUNDAÇÃO HEMOCENTRO DE BRASÍLIA

Introdução: A técnica de monocamada de monócitos (Monocyte Monolayer Assay – MMA) é um ensaio celular funcional in vitro, capaz de prever a sobrevivência in vivo das hemácias transfundidas. É um teste utilizado para diferenciação entre anticorpos clinicamente significantes e não significantes, principalmente em pacientes complexos, para os quais não são encontrados hemocomponentes com provas de compatibilidade negativas. Objetivos: Analisar a relação entre os resultados dos testes de MMA, títulos e subclasses dos anticorpos envolvidos e o desfecho transfusional em pacientes complexos atendidos no Laboratório de Imuno-hematologia de Pacientes da Fundação Hemocentro de Brasília (LIHP-FHB). Materiais e métodos: As amostras dos pacientes foram coletadas nas agências transfusionais do DF e encaminhadas para os testes no LIHP-FHB. A monocamada dos monócitos foi obtida a partir de doadores saudáveis do sexo masculino (O RhD positivo), seguindo as etapas de isolamento (buffy-coat), separação (Ficoll) e cultivo (meio RPMI). A preparação das lâminas incluiu as fases de: aderência monocítica, adsorção do soro do paciente com as hemácias dos doadores, incubações, lavagens e coloração com Leishman. Os controles positivos (Control Cell, Immucor) e negativos (hemácias do doador) foram realizados nas mesmas condições. O Índice Monocitário (MI) foi calculado a partir da análise por microscopia óptica das hemácias fagocitadas ou aderidas, sendo considerados os resultados de MI ≤5%, 5,1%–20% e >20%, como baixo, moderado e alto risco de hemólise pós-transfusional, respectivamente. Foram realizados testes sorológicos em cartão gel-teste (Bio-Rad) para determinação da classe (IgG, IgM, IgA), subclasse (IgG1 e IgG3) e título dos anticorpos. Resultados: Foram avaliados 6 pacientes (13 a 51 anos), sendo 3 (50%) com múltiplos aloanticorpos e autoanticorpos, 2 (33,3%) com autoanticorpos e 1 (16,7%) com múltiplos aloanticorpos, autoanticorpos e anticorpos raros (anti-Hr, -hrs). Desses, 5 (83,3%) apresentavam anemia falciforme e 1 (16,7%) apresentava IRC e infecção por COVID-19. Metade dos pacientes apresentavam anticorpos IgG1 ou IgG3 com baixo risco hemolítico e a outra metade IgG1 ou IgG3 com alto risco. Foram testados 33 concentrados de hemácias (CHs) por meio do teste de MMA, sendo 8 (24,2%) com MI ≤5%, 20 (60,7%) com MI entre 5,1%–20% e 5 (15,1%) com MI >20%. Quatro pacientes receberam transfusões de CHs fenótipo-compatíveis para os sistemas Rh, Kell, Kidd, Duffy e MNS (MIs: 0%, 2%, 6% e 8%). Apenas o CH com MI de 8% resultou em redução dos índices de Hb (8,3 para 7,7 g/dL) e Ht (25 para 23,9%), após 1 hora da transfusão. Os demais CHs transfundidos promoveram incremento nos níveis de Hb e Ht, tanto após 1 hora (0,73 a 2,0 g/dL e 2,4 a 5,8%, respectivamente), quanto após 14 dias (0,8 a 1,2 g/dL e 2,9 a 4,2%, respectivamente). Discussão e conclusão: Nossos resultados revelaram que mais de 75% dos CHs testados apresentaram moderado ou alto risco de hemólise pós-transfusional. Das quatro unidades de CHs transfundidos, três (MIs: 0%, 2%, 6%) promoverem incremento e uma (MI: 8%) declínio, nos níveis de hemoglobina e hematócrito, indicando uma possível associação entre os índices de fagocitose e o risco de hemólise. Não foi evidenciado associação entre os resultados do MMA e as subclasses e títulos dos anticorpos. Apesar do pequeno número de amostras, nossos resultados revelam que o MMA pode ser uma importante ferramenta nas decisões transfusionais em pacientes complexos.

Impact of the COVID-19 pandemic on the stroke cases notification in Brazil

Background and aims: The Coronavirus Disease Pandemic - 2019 (COVID-19) represents, to date, the greatest public health challenge of the 21st century. Stroke, on the other hand, is nationally the main cause of disability, accompanied by a considerable and costly number of hospitalizations. This paper questions the impact of COVID-19 on stroke notifications. Methods: Articles were searched using the descriptors: Ischemic Stroke;Hemorrhagic Stroke;Cerebrovascular events;COVID-19 and Brazil. The research platforms were Pubmed, Scielo, Virtual Health Library and DataSUS. Results: Since the beginning of the pandemic in Brazil, in March 2020, there has been a reduction of approximately 20% in the number of stroke cases reported compared to 2019. This reality is consistent with the international scenario of possible underreporting and reduced demand for medical care in mild and intermediate cases. Although, according to medical societies of national specialties, COVID-19 does not change the recommendations for the management of patients with stroke, the result of this context may be a late start of care, loss of the therapeutic window and worsening of stroke outcomes in the country. The attention to safety protocols and the importance of telemedicine for pre-hospital care was also highlighted. Conclusion: Given the decrease in the number of cases of stroke, there is an alert regarding underreporting and delay in care, problems already present in the national scenario that may be potentiated by the pandemic, where the concern with COVID-19 overlaps with other diseases, which may increase the damage (in the short and long term) to public health.

Impact of the COVID-19 pandemic on the notification of neurological disease complications in Brazil

Background and aims: Until the 1st week of January / 2021, Brazil is the 3rd country with the highest number of confirmed cases of Coronavirus Disease- 2019 (COVID- 19). Annually, neurological diseases and their complications culminate in approximately 200,000 hospitalisations in the Brazilian public health system. This work intends to investigate the relation between COVID-19 and its effect on the condition of neurological patients. Methods: The research used the descriptors: Coronavirus Infections, Brazil, Nervous System Diseases;in PubMed, Scielo and Virtual Health Library databases. Through DataSUS, epidemiological data was collected about: Parkinson's disease, Multiple Sclerosis and Epilepsy. Results: It was expected an increase in urgent hospitalisations related to the neurological diseases scanned. According to studies carried out in other countries, the exacerbation of neurological symptoms is possible. Contrariwise, there was a significant reduction in hospitalizations related to these diseases (DataSUS), especially between April and October 2020, when the number of COVID-19 cases increased dramatically in Brazil. The cause of reduction in hospitalisations may come from a scenario of systematic underreporting triggered by the pandemic. Hospitalisation due to coronavirus infection, in the Brazilian context, allows complications of pre-existing neurological diseases, resulting from COVID-19, to not be properly registered and notified in the integrated system. Conclusion: Brazil, due to its integrated health system, is able to provide full data collected from all its territory. Had there not been a noticeable reduction in hospital care due to fear of infection, this would enable further research and understanding of the effects of COVID-19 on pre-existing neurological conditions. (Figure Presented).

Occupying New Spaces: the “Digital Turn” of Afro-Brazilian Religions During the Covid-19 Outbreak

This paper intends to analyze how Afro-Brazilian religious minorities (like Candomblé and Umbanda) are responding to the Covid-19 crisis in Brazil both at a religious and political level. Drawing a comparison between the reactions of Neo-Pentecostal churches and Afro-Brazilian religions, we will describe how the pandemic outbreak and the social distancing measures allowed Afro-religious practitioners to occupy new online spaces. In doing so, these religions found new modalities of practising rituals and transmitting sacred knowledge in the digital world. Despite the fundamental importance of bodily engagement in these religious expressions, Candomblé and Umbanda practitioners are increasing their presence online through producing different types of pedagogical, educational and ritual contents. While on the one hand, this new content aims at promoting social distancing and sanitary precautionary measures, on the other hand, it involves a restructuring of the dynamics of legitimation and power that are present in Afro-religious social structures. We will analyze these changing dynamics as consequences of the “crisis of the body” that resulted from the lockdown measures. © 2020, Springer Nature Switzerland AG.

Outcomes of the reorganisation of a medical oncology department during the COVID-19 pandemic: Real-word experience

Background: The coronavirus disease 2019 (COVID-19) pandemic has transformed health care delivery in the world, forcing clinicians to make challenging triage decisions. COVID-19 represents a significant harm for cancer patients, who are at high risk of infections due to their immunosuppressed status and serious COVID-19-related events. Portuguese oncologists joined forces to ensure safety of clinical practice without compromising cancer patients care, as the benefit of ensuring an anti-cancer treatment outweighs the risks of COVID-19. Methods: Description and outcomes analysis of structural organization measures adopted by a Portuguese Medical Oncology Department during the COVID-19 pandemic. Results: A proactive approach to the actual emergency panorama was promptly implemented: use of individual protection equipment, triage of patients accessing the hospital, use of telemedicine in selected patients with no need for on-site assessment, customising treatment delivery, regularly test patients under immunosuppressive treatments, test all patients prior to admission in oncology wards, limited access for visitors and caregivers, health professionals worked in “mirror teams” and most multidisciplinary boards have been converted in telematic meetings. Despite all the constraints in the activity, the number of consultations (including tele-consultations) increased compared to the same period of the previous year (3245 consultations from 1/03 to 15/05/2020 versus 3305 in the same period of 2019), the number of first consultations remained similar comparatively (15%) and were carried out in a timely manner, indicative that the cancer patient circuit was not compromised. 368 fewer treatments were performed in the same period, compared to 2019. Until May 15th, 288 tests have been carried out. Four patients were positive for COVID-19 without severity criteria, two of them with a diagnosis of cure, currently being under antineoplastic treatment without related complications. Conclusions: Practice recommendations from European and national oncology societies were applied, which translated into a safe continuum of cancer care delivery. In the middle-term, will be a priority to assess the real impact on cancer mortality. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.