Colchicine reduces the activation of NLRP3 inflammasome in COVID-19 patients.

OBJECTIVE: To evaluate whether colchicine treatment was associated with the inhibition of NLRP3 inflammasome activation in patients with COVID-19. METHODS: We present a post hoc analysis from a double-blinded placebo-controlled randomized clinical trial (RCT) on the effect of colchicine for the treatment of COVID-19. Serum levels of NOD-like receptor protein 3 (NLRP3) inflammasome products-active caspase-1 (Casp1p20), IL-1ß, and IL-18-were assessed at enrollment and after 48-72 h of treatment in patients receiving standard-of-care (SOC) plus placebo vs. those receiving SOC plus colchicine. The colchicine regimen was 0.5 mg tid for 5 days, followed by 0.5 mg bid for another 5 days. RESULTS: Thirty-six patients received SOC plus colchicine, and thirty-six received SOC plus placebo. Colchicine reduced the need for supplemental oxygen and the length of hospitalization. On Days 2-3, colchicine lowered the serum levels of Casp1p20 and IL-18, but not IL-1ß. CONCLUSION: Treatment with colchicine inhibited the activation of the NLRP3 inflammasome, an event triggering the 'cytokine storm' in COVID-19. TRIAL REGISTRATION NUMBERS: RBR-8jyhxh.

The future of higher education: How to move forward

This article reflects on possible and necessary transformations, based on the experiences lived by teachers, students, and educational institutions throughout the year 2020, as they survived, learned and adapted to the COVID-19 pandemic. Teaching should be based on pedagogical evidence, collaborative practices, educational technology, supported by computer infrastructure and evaluative practices that foster learning, through feedback and a closer interaction between learner and teacher. The direction pointed in the future includes and is based on blended education to help students to achieve competence for professional practice. The development of interpersonal skills will be fundamental, especially in the training of health professionals. Offering opportunities for faculty development and creating communities of practice for collaborative learning will also be essential. The greater flexibility of curricula and the technological mediation of the teaching and learning process should favor exchanges and the internationalization of institutions. In this way, both undergraduate, graduate and stricto-sensu education tends to expand its scope and will no longer be limited to its original niches, expanding to national and international agreements. University spaces and face-to-face moments will be adapted to a new reality, which allows the student to acquire essential clinical and relational skills, and which require activities in the professional practice settings. In the HPE, ensuring these training moments will continue to be a fundamental requirement. Thus, classrooms, laboratories and internship fields must be safe, allowing direct guidance and supervision by teachers and preceptors. It is possible and probable that, for a long time, it will still be necessary to maintain some social distance, use of personal protective equipment, hand and environment hygiene so that students are not deprived of these experiences during their training. In the health area, it will be necessary to reaffirm that there is no dilemma between the training of health professionals and patient safety, as we experienced with the interruption of most practical activities in the HPE undergraduate courses in Brazil, during the first semester of 2020. Training health professionals, in a context of a health & sanitary emergency, is equivalent to caring for people in any context or setting. It is the same if we are talking about access to personal protective equipment or access to vaccines. The challenges are launched and the possibilities for advancement emerge and need to be taken advantage of from a cohesive work between university managers, faculty, administrative staff and students.

Faculty development for emergency remote education in 2020: The experience at Ribeirão Preto School of Medicine, University of São Paulo (FMRP-USP)

After the suspension of face-to-face classes in 2020, due to the Covid-19 pandemic, it was necessary to provide emergency remote education for thousands of students at all levels of education in Brazil. No one was prepared to face such a challenge. Due to the lack of familiarity with technology-mediated education strategies, the only available at that, this situation soon brought to light signs of fatigue and stress among teachers and students. It was also noticeable the need, on the part of teachers, of training to take advantage of the existing resources for remote education at the university. The energy expended for the preparation of classes, activities, and assessments in the context of remote education was enormous and it would be necessary to acquire basic skills to keep the teaching-learning and assessment processes of students happening and with good quality. These signs and requests for help on the part of teachers and students began to become evident at the end of May 2020 at the Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP). Students complained about content overload, overlapping and disorganization of the activities proposed for the virtual environment, and were very anxious about the assessments they would have at the end of the semester. On the other hand, we saw insecure teachers offering online activities, unsure of how to take care of various aspects, such as: recording attendance, engaging students in online classes and, most importantly, student assessment. In short, how to use remote education resources, starting from little or almost no previous experience? In this context, the Center of Faculty Development for Teaching (CDDE) of FMRP-USP assesses the needs of teachers and proposes a training focused on the use of the USP e-Disciplines platform, according to the basic principles of good education and student assessment. For those teachers with greater expertise in remote education, we conducted two complete courses using hybrid teaching based on the remote flipped classroom strategy. For a more novice audience or for those who would not be able to dedicate themselves to the complete course, we provided personalized help. This is the experience that we present in this article and that will serve as a basis for the necessary adaptations to face the education challenge during and after the most acute phase of the Covid-19 pandemic.

FMRP unified for a better semester: Narratives of a Pact that celebrates human values and collective commitments during the Covid-19 pandemic

The COVID-19 pandemic impacts on higher education in several ways, demanding creativity, and resilience in facing it. In addition to the new challenges, the scenario induced by the health crisis has also aggravated pre-existing problems, especially with regard to human relations within the university, equity in access to educational resources and training for professional development, quality of life and caring for people, among many other challenges. In this context, in search for answers to the challenges presented, different FMRP centers and committees came together and proposed the celebration of the Pact “FMRP: UNIFIED FOR A BETTER SEMESTER”. The Pact was proposed to reaffirm the institution’s values, strengthen relationships and support network, minimize stress and the impact of this new reality on the health and well-being of students, staff and teachers. The purpose of this report is to present the terms and conditions that made the Pact possible, the strategies used for its execution, with integrated actions from different sectors, qualified communication, responding to the needs of the academic community. The purpose of this report is to present the terms and conditions that made the Pact possible, the strategies used for its execution, with integrated actions from different sectors, qualified communication, responding to the needs of the academic community. The pact has enabled actions to guarantee access to resources for teaching and learning, professional training and care, in addition to strengthening interpersonal relationships and between different sectors of the institution. The Pact was born in the context of the pandemic, but it calls our attention to the constant need to improve our relations, to invest in dialogue and integration. We are no longer dealing with actions for “a better semester”, but with commitments and values that we will continue to reaffirm.

Teaching and learning in the context of remote education and distance learning: Paths and possibilities

All accumulated knowledge about the teaching and learning process, considering the best teaching practices and the concepts of adult learning, meaningful learning and student-centered learning must be continually exercised and revisited, regardless of the format: face-to-face, remote teaching (ER) or distance learning (EaD). The need to expand the use of emergency ER, determined by the pandemic crisis of 2020, has brought new challenges for teachers and students worldwide. Among the challenges is the reinterpretation of the concepts present in the teaching and learning process under the lens of the digital world. This review aims to present the best practices from the perspective of the new context of digital life in teaching for the health professions, including here the opportunities offered by the pandemic.

Remote education in times of pandemic: Reflections in the academic context

The Covid-19 pandemic resulted in the suspension of face-to-face educational activities at all levels, from basic to higher education. Following the recommendations of the Ministry of Health and the São Paulo State Department of Health and without being able to maintain the usual teaching activities, students, teachers, and specialists had the opportunity to experience a new educational reality that had the technology and distance learning strategies as the main options available for maintaining the teaching and learning process throughout 2020. This article shares reflections, strategies and actions focusing on the potentialities of distance learning and remote education (RE). First, we´ll present principles of teaching, learning and student assessment. The discussions did not fall on the use of technology and possible resources that can be used in the classroom, but on the possibilities of transformation of educational programs based on good practices, whether in face-to-face, distance or hybrid education. The article also discusses faculty development and scholarship aspects inside the institutions. Aspects related to technology, infrastructure, human resources, and accessibility to distance education are emphasized. We also approach Virtual Learning Environments (VLE) as places that allow the provision of content and learning management;student assessment;review of institutional policy and rules of distance education as mechanisms that can ensure the pedagogical and curricular organization of the courses offered.

Prevalence of virological and serological markers of SARS-CoV-2 infection in the population of Ribeirão Preto, Southeast Brazil: an epidemiological survey

INTRODUCTION: This epidemiological household survey aimed to estimate the prevalence of the current and past SARS-CoV-2 infections in Ribeirão Preto, a municipality of southeast Brazil. METHODS: The survey was conducted in two phases using a clustered sampling scheme. The first phase spanned May 1-3 and involved 709 participants. The second phase spanned June 11-14, 2020, and involved 646 participants. RESULTS: During the first phase, RT-PCR performed on nasopharyngeal swabs was positive at 0.14%. The serological tests were positive in 1.27% of the patients during the first phase and 2.79% during the second phase. People living in households with more than five members had a prevalence of 10.83% (95%CI: 1.58-74.27) higher than those living alone or with someone other. Considering the proportion of the positive serological test results with sex and age adjustments, approximately 2.37% (95%CI: 1.32-3.42) of the population had been cumulatively infected by mid-June 2020, which is equivalent to 16,670 people (95%CI: 9,267-24,074). Considering that 68 deaths from the disease in the residents of the city had been confirmed as at the date of the second phase of the survey, the infection fatality rate was estimated to be 0.41% (95%CI: 0.28-0.73). Our results suggest that approximately 88% of the cases of SARS-CoV-2 infection at the time of the survey were not reported to the local epidemiological surveillance service. CONCLUSIONS: The findings of this study provide in-depth knowledge of the COVID-19 pandemic in Brazil and are helpful for the preventive and decision-making policies of public managers.