EPIDEMIOLOGICAL PROFILE OF HOSPITALIZED HUMAN METAPNEUMOVIRUS IN A CAPITAL OF CENTRAL-WEST OF BRAZIL FROM 2017 TO 2019: HIGH LETHALITY AT EXTREMES OF AGE

Human metapneumovirus (hMPV) is a paramyxovirus that causes airway infections. hMPV symptoms range from mild infections of the upper respiratory tract to infections as serious as bronchiolitis and pneumonia. From 2018 to 2019, there was a high incidence of severe acute respiratory syndrome (SARS) in the State of Goiás with a relative increase in hMPV incidence. This study aimed to assess the hMPV epidemiology of cases treated at tertiary hospitals of Goiás, as there are not significant published data from hMPV infection in Brazil. We performed a retrospective and descriptive analysis of a case series of patients infected with hMPV diagnosed by PCR (16 individuals), through medical records review from 2017 to 2019. The observed age distribution was bimodal, with the disease affecting individuals at extremes of age (median of 3.5 years old in the first stratum and median of 52 years in the second stratum). The time between the onset of flu-like symptoms and the first medical assessment had an average of 5 days. The most frequent severe symptoms were respiratory distress/dyspnea and oxygen saturation <95% (93.7% as media), even in patients without comorbidities. The most frequent complications were acute renal failure (18.7%) and healthcare-associated infections (43.7%). Death occurred in 37.5% of patients. hMPV may cause upper and lower respiratory tract infections in patients of all age groups, but the symptomatic disease occurs more frequently at extremes of age. In the pandemic caused by a new coronavirus (SARS-CoV-2), which is known to lead to influenza-like and SARS, the differential diagnosis of the etiologic agent becomes paramount. © 2022 Brazilian Society of Parasitology. All rights reserved.

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.

Brazilian Collaborative Network For COVID-19 Modeling: Successful Experience Of Using Real-Time Science To Support Evidence-Based Decision-Making

Introduction. Modeling is important for guiding policy during epidemics. The objective of this work was to describe the experience of structuring a multidisciplinary collaborative network in Brazil for modeling coronavirus disease 2019 (COVID-19) to support decisionmaking throughout the pandemic. Methods. Responding to a national call in June 2020 for proposals on COVID-19 mitigation projects, we established a team of investigators from public universities located in various regions throughout Brazil. The team's main objective was to model severe acute respiratory syndrome coronavirus 2 transmission dynamics in various demographic and epidemiologic settings in Brazil using different types of models and mitigation interventions. The modeling results aimed to provide information to support policy making. This descriptive study outlines the processes, products, challenges, and lessons learned from this innovative experience. Results. The network included 18 researchers (epidemiologists, infectious diseases experts, statisticians, and modelers) from various backgrounds, including ecology, geography, physics, and mathematics. The criteria for joining the network were having a communication channel with public health decision-makers and being involved in generating evidence for public policy. During a 24-month period, the following sub-projects were established: (i) development of a susceptible-exposed-infected-recovered-like, individual-based metapopulation and Markov chain model;(ii) projection of COVID-19 transmission and impact over time with respect to cases, hospitalizations, and deaths;(iii) assessment of the impact of non-pharmacological interventions for COVID-19;(iv) evaluation of the impact of reopening schools;and (v) determining optimal strategies for COVID-19 vaccination. In addition, we mapped existing COVID-19 modeling groups nationwide and conducted a systematic review of relevant published research literature from Brazil. Conclusions. Infectious disease modeling for guiding public health policy requires interaction between epidemiologists, public health specialists, and modelers. Communicating modeling results in a nonacademic format is an additional challenge, so close interaction with policy makers is essential to ensure that the information is useful. Establishing a network of modeling groups will be useful for future disease outbreaks.

Uso Da Saliva Como Amostra Biologica No Diagnostico Da Covid-19 Por Rt-Pcr

Introducao: O padrao-ouro para o diagnostico de COVID-19 e o teste molecular que permite a deteccao de acidos nucleicos de SARS-CoV-2 em amostras de swab Nasofaringeo (NPS). A deteccao precoce seguida do isolamento dos individuos infectados desempenha um papel crucial para impedir a propagacao da infeccao e o controle da pandemia. No entanto, a coleta de NPS e invasiva e desconfortavel para os pacientes, requer profissionais de saude especializados e pode ser um risco de infeccao cruzada para esses profissionais. Desta forma, avaliar outras fontes de material biologico, tal como a saliva, e fundamental para facilitar o diagnostico de COVID-19. Objetivo: O objetivo deste trabalho foi avaliar o uso da saliva como amostra biologica para a deteccao do RNA do SARS-CoV-2 e sua estabilidade pos coleta. Material e Metodos: Foram coletadas 954 amostras de saliva (5 mL) e de swab nasofaringeo (NPS) de individuos entre dezembro de 2020 e fevereiro de 2021 e analisadas em diferentes tempos (24h, 48h, 72h, 5 dias e 10 dias) apos a coleta. As amostras de saliva foram armazenadas em temperatura de 2degree a 8degreeC e extraidas puras e diluidas em solucao salina na proporcao 1:1. A extracao do RNA foi realizada em extrator automatico de acidos nucleicos (Extracta, Loccus) e o diagnostico molecular do SARS-CoV-2 foi realizado com o kit Gene FinderTM COVID-19 Plus RealAmp (OSang Healthcare). A idade media dos participantes foi de 37 anos (8 a 83 anos de idade) e a maioria dos individuos 738 (77,3%) foram nao-detectaveis e apenas 216 (22,7%) foram detectaveis para SARS-CoV-2. Entre os detectaveis, 96 (44,4%%) eram do sexo masculino e 120 (55,6%) do sexo feminino. A positividade na saliva foi posteriormente comparada com os resultados do NPS bem como a carga viral ou ciclo de limiar de amplificacao (Ct). Resultados e Discussao: A analise dos testes com a saliva e NPS demonstrou concordancia nos resultados de 210 (97%) pacientes detectaveis para COVID, em apenas 2,7 % (6/216) dos casos o SARS-CoV-2 foi detectado somente no NPS. Todos os participantes com resultado positivo para a RT-PCR apresentaram sintomas relacionados a COVID-19, sendo os mais comuns: tosse seca (19%), dor de cabeca (16%), coriza e dor de garganta (11%) e diarreia (8%). As amostras de salivas apresentaram estabilidade ate o decimo dia apos a coleta do material biologico, sem diferenca de deteccao do RNA viral entre a amostra de saliva pura e saliva diluida. Esses resultados demonstram que as amostras de saliva podem ser transportadas e armazenadas em temperatura de 2degree a 8degreeC, e processadas em ate 10 dias apos a coleta. Conclusao: Os resultados mostraram que a saliva e uma alternativa para a deteccao de SARS-CoV-2. E uma amostra biologica confiavel, nao invasiva, de facil coleta e com resultados similares aos obtidos com amostras de NPS. E uma alternativa que facilitaria a coleta em lugares com baixo suprimento de swabs nasofaringeos e regioes distantes de laboratorios especializados, uma vez que pode ser analisada ate 10 dias apos a coleta. Dessa forma, podemos concluir que a saliva pode ser utilizada com seguranca para o diagnostico de COVID-19. Copyright © 2022

O Desabastecimento De Imunoglobulina Intravenosa E O Uso De Plasmaferese Em Primeira Linha Na Sindrome De Guillain - Barre Em Paciente Pediatrico: Relato De Caso E Revisao De Literatura

Objetivos: Relatar um caso de Guillain - Barre em paciente de 12 anos de idade que utilizou plasmaferese terapeutica como primeira linha, focando nos aspectos tecnicos do procedimento;Discutir as possiveis causas para o desabastecimento de imunoglobulina intravenosa (IGIV) atual. Metodologia: Coleta de dados clinicos no prontuario. Revisao de literatura, com enfase em plasmaferese na populacao pediatrica, suas indicacoes, paticularidades tecnicas e eventos adversos. Resultados: Paciente de 12 anos de idade, sexo feminino, 35 quilos, previamente higida, deu entrada no pronto - socorro com quadro de tetraparesia desproporcional - forca grau III em MMII e grau IV em MMSS - associada a mialgia difusa. Sem quadro infeccioso ou vacinacao recente antecedendo. Equipe da neurologia levantou hipotese de sindrome de Guillain- Barre e solicitou plasmaferese terapeutica, pois nao havia disponibilidade de IGIV. Foram realizadas 04 sessoes utilizando o sistema COM.TEC (Fresenius Kabi) com troca de uma volemia cada. O fluxo medio de extracao foi de 37,5ml/min (30-45ml/min). A taxa media de ACD infundido na paciente foi de 234ml e a proporcao ACD:sangue foi de 1:16. A duracao media foi de 73 minutos por procedimento. Em todas as sessoes foi utilizado reposicao profilatica com solucao de 10ml de gluconato de calcio 10%. A paciente apresentou tontura e parestesia perioral nas duas primeiras sessoes. Sem outros eventos adversos. Recebeu alta apos quarta sessao, ja sendo capaz de deambular sem auxilio. Discussao: A Sindrome de Guillain Barre corresponde a um grupo de polirradiculopatias autoimunes, inflamatorias e desmielinizantes. Os tratamentos de primeira linha constituem IGIV e plasmaferese. A IGIV costuma ser preferida principalmente em criancas por maior facilidade posologica e nao envolver uso de dispositivos invasivos. O desabastecimento de IGIV desde 2019 em diversos paises do mundo, inclusive no Brasil, tem dificultado o acesso a este tratamento. Entre as possiveis causas para este desabastecimento, podemos citar: aumento da demanda nao acompanhada por aumento na producao, impactos da pandemia de COVID- 19 sobre materia-prima (doadores de sangue) e logistica (transporte, etc), descontinuacao do produto por alguns laboratorios, entre outros. Segundo o ultimo guideline da Sociedade Americana de Aferese nao ha diferenca no desfecho entre IGIV e plasmaferese. Entre os principais eventos adversos da plasmaferese em pacientes pediatricos, destacam- se os relacionados ao acesso central (infeccoes, complicacoes mecanicas, entre outros), hipocalcemia, o volume extracorporeo utilizado no procedimento e riscos de intoxicacao por citrato. A paciente do caso apresentou apenas sintomas leves de hipocalcemia, que melhoraram apos reducao do fluxo de extracao. Conclusao: A plasmaferese terapeutica em pacientes pediatricos tem se mostrado eficaz, seja em primeira linha ou como tratamento complementar. Ajustes na taxa de extracao, reposicao profilatica de calcio e cuidados com o acesso central aumentam a seguranca do procedimento. Copyright © 2022

Training the Armed Forces personnel in COVID-19 contact tracing: a Portuguese case study : Sofia Carmezim Pereira

Background Local contact tracing teams needed to be reinforced in preparation for a peak in Covid-19 cases. The Portuguese Armed Forces showed availability and their members initiated a formal training facilitated by the Public Health Unit (PHU) of Amadora. Health systems must be prepared to respond to all threats, as the COVID-19 pandemic showed us the need for quick task shifting and the training of non-experts’ workers. Objectives The aim of the project was to develop contact tracing skills by non-health professionals, in the context of the COVID-19 pandemic. The training program was held online, with a total duration of 48 hours, distributed by the topics described: introduction to health and epidemiology concepts, the national guidelines, and the information systems (13h). We privileged demonstrative and participatory training methods, followed by continuous supervision of each contact tracing survey and constant feedback (35h). Learning support materials were sent out to assist the trainees, including written and video support. Results More than 200 personnel - sailors, soldiers and airmen - were trained. Each Lisbon and Tagus Valley area PHU was reinforced with a team of military professionals in order to support the contact tracing process, with an increase in the number of surveys completed. We highlight as positive aspects: increased number of contact tracing surveys carried out;growth of inter-institutional partnerships;freeing up of specialized PHU resources to other important tasks. As for negative aspects we focus on the complexity in health communication, the limited time for training, and the lack of specific health knowledge of the trainees. Conclusions This pandemic revealed the Portuguese need for a transdisciplinary approach in the provision of care, specially at a Public Health level. Training programs like these highlight the vital role of reshaping and reorganizing the healthcare workforce answering Public Health necessities. Key messages • Training programs for non-health workers must be prepared to reinforce health systems when necessary. The reinforcement of contact tracing teams by the Portuguese Armed Forces was a great example. • A transdisciplinary approach in the provision of care was essential during the COVID-19 pandemic. Specific training of non-health workers can be planned in time to respond to health threats.

Cardiorespiratory fitness assessment on active patients who kept attending their phase III exercise-based cardiac rehabilitation during the COVID-19 era

Funding Acknowledgements Type of funding sources: None. Background Cardiorespiratory fitness (CRF) is a powerful predictor of all-cause mortality among individuals with coronary artery disease (CAD). A structured community-based phase III cardiac rehabilitation (CR) is very important in lifelong maintenance of phase II CRF and health gains. During the COVID-19 pandemic, CR programs had to adapt, mainly using new technologies and remote follow-up. The CRF impact in patients (Ps) who kept going their phase III program, during this troubled era is still unknown. Purpose Assess the variation in CRF and prognostic parameters in Ps with CAD who maintain high adherence levels in their phase III CR before and during the COVID-19 pandemic. Methods A cohort of Ps enrolled in a community-based phase 3 CR program, with active participation at the end of 2019, was included in this retrospective study. The inclusion criteria for this study were high levels of attendance (>80%) to the CR program before and during COVID-19 and high levels of physical activity with more than 150 mins of moderate to vigorous physical activity (MVPA). All Ps were evaluated with transthoracic echocardiography (TTE) and a cardiorespiratory exercise test (CPET) in a cycloergometer in 2019 and between october and november of 2021. All Ps had used accelerometers to measure their physical activity levels and dual-energy absorptiometry (DEXA) scan to evaluate their body composition. Between 2020 and 2021, Ps had online (in lockdown periods) and face to face exercise training sessions, 3xtimes per week, 60 mins each exercise session. A t-test paired two sample for means was used to compare CPET variables before the beginning of the first COVID lockdown (end of 2019) and after the removal of the majority of restrictions (end of 2021). Results A total of 30 Ps with high levels of adherence were included (99.6% male, 65 ± 9 years old). In this cohort, the majority had history of an ACS before the referral to the CR program (73.3%) and 55.6 ± 10.4% of left ventricular ejection fraction. There was no significant difference in body mass index (27.9 ± 3.2 kg/m2 vs 28.1 ± 3.6 kg/m2, p=0.493 but there was a significant increase in the percentage of body fat mass (30.1 ± 5.7% vs 31.0 ± 6.6%, p= 0.042). There was a maintenance on MVPA levels (352 ± 137 minutes/week vs 313 ± 194 minutes/week, p = 0.106) during this period. When comparing the 2 CPET results, Ps achieved higher exercise loads in the 2021 test (175 ± 51W vs 185 ± 52W, p=0.005), higher VO2 peak (25.3 ± 6.9 ml/kg/min vs 21.5 ± 6.3 ml/kg/min, p =0.001) and higher percentage of predicted VO2max (78.8 ± 16.8% vs 95.27 ± 20.8%, p = 0.001). Conclusion In spite of all the difficulties in maintaining a phase III CR program during the COVID-19 pandemic, we observed that in physically active CAD Ps, with the aid of new technologies and remote follow-up (during the lockdown periods) and face to face exercise sessions, it is still possible to have functional gains and improvements in CRF.

Insights about what authorities and emergency services need and expect from society

When crises occur, the society plays significant roles, such as assisting victims, helping vulnerable groups, sharing information, allocating resources etc. However, for the response to crises to succeed, society, authorities and emergency services should align their efforts and needs in a coordinated way. To identify this alignment, we designed an internet-based survey asking authorities, emergency services, and volunteer organizations about the needs and expectations they have from the society to better handle crises. The questionnaire is divided into two main sections: the first section covers the responders’ risk awareness, and the second gathers the needs they have from society in the following items: social norms and sense of communality, coping skills, resources to face a crisis, perception of trust, perception of responsibility, crisis knowledge, crisis communication, communication channels, information sharing and preparedness. The survey was launched in 7 European countries and this paper presents the results collected in Spain. The answers show that in general there is a high consensus in the analysed items, though the distribution shows that authorities differ the most from the other responder profile groups. The results show that the responders are more aware of pandemics followed by extreme weather related events. We think this is because of the huge impact that is creating the current coronavirus pandemic. © ESREL 2021. Published by Research Publishing, Singapore.

Cardiorespiratory fitness assessment on active patientswhokept attending their phase III exercise-based cardiac rehabilitation during the COVID-19 era

Background: Cardiorespiratory fitness (CRF) is a powerful predictor of all-cause mortality among individuals with coronary artery disease (CAD). A structured community-based phase III cardiac rehabilitation (CR) is very important in lifelong maintenance of phase II CRF and health gains. During the COVID-19 pandemic, CR programs had to adapt, mainly using new technologies and remote follow-up. The CRF impact in patients (Ps) who kept going their phase III program, during this troubled era is still unknown. Purpose: Assess the variation in CRF and prognostic parameters in Ps with CAD who maintain high adherence levels in their phase III CR before and during the COVID-19 pandemic. Methods: A cohort of Ps enrolled in a community-based phase 3 CR program, with active participation at the end of 2019, was included in this retrospective study. The inclusion criteria for this study were high levels of attendance (>80%) to the CR program before and during COVID-19 and high levels of physical activity with more than 150 mins of moderate to vigorous physical activity (MVPA). All Ps were evaluated with transthoracic echocardiography (TTE) and a cardiorespiratory exercise test (CPET) in a cycloergometer in 2019 and between october and november of 2021. All Ps had used accelerometers to measure their physical activity levels and dual-energy absorptiometry (DEXA) scan to evaluate their body composition. Between 2020 and 2021, Ps had online (in lockdown periods) and face to face exercise training sessions, 3xtimes per week, 60 mins each exercise session. A t-test paired two sample for means was used to compare CPET variables before the beginning of the first COVID lockdown (end of 2019) and after the removal of the majority of restrictions (end of 2021). Results: A total of 30 Ps with high levels of adherence were included (99.6% male, 65 ± 9 years old). In this cohort, the majority had history of an ACS before the referral to the CR program (73.3%) and 55.6 ± 10.4% of left ventricular ejection fraction. There was no significant difference in body mass index (27.9 ± 3.2 kg/m2 vs 28.1 ± 3.6 kg/m2, p=0.493 but there was a significant increase in the percentage of body fat mass (30.1 ± 5.7% vs 31.0 ± 6.6%, p= 0.042). There was a maintenance on MVPA levels (352 ± 137 minutes/week vs 313 ± 194 minutes/week, p = 0.106) during this period. When comparing the 2 CPET results, Ps achieved higher exercise loads in the 2021 test (175 ± 51W vs 185 ± 52W, p=0.005), higher VO2 peak (25.3 ± 6.9 ml/kg/min vs 21.5 ± 6.3 ml/kg/min, p =0.001) and higher percentage of predicted VO2max (78.8 ± 16.8% vs 95.27 ± 20.8%, p = 0.001). Conclusion: In spite of all the difficulties in maintaining a phase III CR program during the COVID-19 pandemic, we observed that in physically active CAD Ps, with the aid of new technologies and remote follow-up (during the lockdown periods) and face to face exercise sessions, it is still possible to have functional gains and improvements in CRF. (Figure Presented).

Nutrition guidelines compliance in cardiovascular disease patients attending a long-term exercise-based cardiac rehabilitation program during COVID-19 era

Introduction: Dietary habits influence cardiovascular disease (CVD) risk, mainly through risk factors such as lipids, blood pressure, body weight and diabetes. Therefore, a healthy diet is recommended as a cornerstone of CVD prevention in all individuals and in reducing risk of recurrent disease, yet few studies have examined diet quality in cardiac-rehabilitation patients on a long-term basis. Purpose: To evaluate the compliance with dietary guidelines in patients who attend a long-term cardiac rehabilitation program (phase III) during COVID-19 era. Methods: The study was developed between October 2020 and October 2021 in a phase III centre-based cardiac rehabilitation program. To evaluate dietary intake a 24hour recall questionnaire was used. Diet composition was analysed using ESHA's Food Processor® software. Cunningham equation was used to evaluate resting energy expenditure and physical activity expenditure measured by accelerometery was added to calculate daily energetic requirements. The nutrients and cut-offs considered for the analysis were saturated fat (<10%), sodium (<2g), potassium (≥3.5g), fibre (≥30g), and alcohol (<100g/week), considering the 2021 ESC Guidelines on CVD Prevention in Clinical Practice or the World Health Organization guidelines for a healthy diet. To evaluate weight and height a digital scale SECA 799 and a stadiometer SECA 220 were used, respectively. Results: A total of 57 patients (78.9% men) with a mean age of 63.8±8.5 were evaluated. Mean body mass index (BMI) was 28.4±3.8kg/m2, being most patients overweight or obese (61.7%). A higher caloric consumption, compared to the individual energy requirements, was found in 26.3% of patients. No statistical differences were found between mean saturated fat intake (10.1±3.6%) and the recommended intake (p=0.85). Mean sodium consumption was 3.42±1.46 grams and mean potassium intake was 3.0±1.0 grams. Sodium intake was significantly higher (p<0.001), and potassium intake significantly lower (p<0.001) than the recommendation. Fibre intake was also significantly lower than the recommendation (median intake was 21.1±12.2 grams, p<0.001). Among patients who drank alcoholic beverages (n=28), the median alcohol intake per day was 17.4±26.3 grams which was significantly higher than the limit recommended (p=0.043). Conclusion: Our findings showed that these patients deviated from the recommendations in some key nutrients. The intake of sodium and alcohol was higher than the recommendations, and the intake of potassium and fibre were lower than the recommendations. Moreover, most patients were overweight or obese. This study highlights the need for individual nutritional counselling sessions as a reinforcement of a standard educational program, to effectively promote an adequate diet, which may reduce the risk of recurrent disease. Further research about nutritional intervention in patients undergoing on a long-term basis cardiac rehabilitation is warranted.

PARACOCCIDIOIDOMICOSE COMO DIAGNÓSTICO DIFERENCIAL DE NEOPLASIA EM SNC

A paracoccidioidomicose (PCM) possui elevada incidência na América Latina, com amplo espectro clínico e imagiológico. A forma crônica é a mais prevalente, com o clássico acometimento pulmonar. Há ainda formas menos convencionais, destacando-se o acometimento do Sistema Nervoso Central (SNC). O padrão ouro para o diagnóstico é a visualização do fungo e seu crescimento em cultura de espécimes clínicos. Métodos sorológicos são complementares, com sensibilidade/especificidade variando de 80-95% e 85-100%, respectivamente, a depender dos antígenos utilizados. Homem, 60 anos, procedente do Tocantins, transportador de grãos, tabagista, queixava-se de vertigem há um ano, cefaleia há 5 meses, alteração progressiva da fala, da marcha e paresia em braço E. Tomografia computadorizada (TC) e Ressonância Magnética (RM) de crânio demostravam lesões nodulares volumosas (maior 4 x 3,8 cm), heterogêneas e com edema adjacente em cerebelo D, lobos frontal D e parietal E, sugestivas de neoplasia. TC de tórax com múltiplos nódulos, espessamento e adenomegalias mediastinais. Submetido a biópsia cerebral em hospital oncológico, tendo diagnóstico de COVID-19 na internação. Transferido ao Hospital das Clínicas. Avaliação da infectologia descreveu raio X de tórax com padrão em asa de borboleta e lesão granulomatosa em palato. Raspado da lesão e aspirado traqueal demonstraram leveduras multibrotantes. Histopatológico (AP) da biópsia de SNC foi resgatado e descrevia estruturas leveduriformes, birrefringentes, com brotamentos em roda denteada, compatíveis com PCM. Imunodifusão dupla reagente e cultura positiva para Paracoccidioides spp. Recebeu Anfotericina B desoxicolato por 7 dias e complexo lipídico por mais 20 dias. Obteve alta com melhora da cognição, da fala e da marcha, ainda necessitando auxilio para atividades. Em acompanhamento ambulatorial, paciente sem déficits, comunicativo e sem novas queixas. RM de controle mantém lesões nodulares, com redução significativa do tamanho, do edema e da captação de contraste. Programado Sulfametoxazol Trimetoprima 3cp 12h/12h por 18-24 meses, pela melhor penetração em SNC. A forma neurológica da PCM é de difícil diagnóstico, muitas vezes confundida com neoplasias devido ao seu efeito de massa. A pesquisa direta, AP, cultura e sorologias são métodos diagnósticos disponíveis, que facilitam a definição etiológica. A busca por outros locais de comprometimento, como pulmonar, mucosas e linfonodos podem agilizar o diagnóstico e o tratamento da PCM.

HEPATITE B E SEUS DESAFIOS: REATIVAÇÃO APÓS COVID-19 E USO DE CORTICOIDE EM PACIENTE DIALÍTICA

A reativação do vírus da hepatite B (VHB) pode ocorrer em pacientes com perfil sorológico atípico, incluindo aqueles anti-HBsAg+. Imunossupressões, seja por neoplasia, transplante, quimioterapia, uso de imunobiológicos ou corticoterapia prolongada são fatores de risco relevantes. Sugere-se que em doença renal crônica (DRC), níveis adequados de AntiHBsAg sejam > 100mUi/mL. Feminino, 72 anos, portadora de múltiplas comorbidades: hipertensão arterial, diabetes, doença pulmonar obstrutiva crônica (DPOC), DRC e lúpus eritematoso sem atividade. Em 07/2020 foi internada em unidade de terapia intensiva por descompensação de DPOC e diagnóstico confirmado de COVID-19, tendo feito uso de corticoterapia prolongada e antibioticoterapia de amplo espectro. Evoluiu com necessidade de terapia renal substitutiva (TRS). Em 10/2020, exames sorológicos de triagem da TRS demonstravam HIV, Anti-HCV e sífilis não reagentes (NR) e infecção prévia pelo VHB com soroconversão (HBsAg NR, AntiHBc IgG reagente (R), AntiHBc IgM NR, AntiHBsAg R [94 mUI/mL]), TGO 61 UI/mL, TGP 46 UI/mL. Durante acompanhamento, necessitou internações recorrentes por DPOC descompensado, pneumonia e infecção de corrente sanguínea relacionada a acesso vascular. Neste período, fez uso de múltiplos antimicrobianos, corticoide inalatório + broncodilatador continuamente e foi exposta a altas doses de hidrocortisona nas crises. Em 03/2021, após elevação de TGP (203), foi identificada reativação da Hepatite B, com a repositivação dos seguintes marcadores: HBsAg R (595, NR < 0,9), AntiHBc IgM R (39, VR < 0,9), HBeAG (1.464, NR < 0,9), AntiHbeAg NR (54, NR >1) e AntiHBs R (73). Os marcadores foram confirmados pelo laboratório de referência e o PCR DNA VHB foi 1.676.917 mUI/mL. Pela gravidade esperada para casos de reativação, a elevação de TGP e a DRC, foi optado por iniciar tratamento imediato com Entecavir 0,5 mg 1x semana (Clearance < 10ml/min). A paciente teve múltiplas internações nos últimos 6 meses, com uso irregular do entecavir e aguarda resultado de nova carga viral do VHB para controle. Ainda é incerto se a COVID-19 pode auxiliar na reativação do VHB, porém, pelo uso de corticoterapia, especialmente em altas doses (off label), esta doença pode se tornar um fator de risco associado a este fenômeno. A vigilância de marcadores virais em pacientes em TRS deve ser intensificada, especialmente naqueles com outros fatores para imunossupressão, como o uso de corticoterapia prolongada, sepse e choque séptico.

Performing Virtual Events during COVID-19 Pandemics: The case of the Startups Fair and Hackathon for New Educational Technologies in the Campo das Vertentes Region in Brazil

The COVID-19 pandemic brought harsh social restrictions as part of the strategy to deal with the situation, which also required innovation to quickly adapt and keep providing substitutes through digital solutions. In response to this emergency, the local entrepreneurship ecosystem of São João del-Rei, Brazil, spent a great effort to tackle this new reality. This article presents the experience of performing virtual events to foster innovation and raise awareness of the local entrepreneurship culture. The first event was developed under the hackathon format, aiming to encourage the local community to propose technological innovation by developing solutions to assist distance learning in universities and high schools. The other event was a virtual fair presenting local startups to the audience, besides providing online courses related to entrepreneurship and new digital technologies. It is worth noting that those events were organized by a strategic coalition following the triple helix model of innovation, gathering universities, industry, and government. The results achieved through those events reinforce the importance of having an organized local strategic coalition to provide a fast response to social emergencies and provide better adaptation capability to society by creating innovations based on digital entrepreneurship. © 2021 ACM.

Monitoring the Health System Saturation Risk During COVID-19 Pandemics

The pressure on the sanitary system caused by the Covid-19 pandemics put in risk many lives. The unknowns of the pandemic behavior caused problems for a more accurate prediction of the demands for hospitalization and ICU. As a result, two situations were observed: unnecessary expansion of the sanitary system with campaign hospitals and, worse, the saturation of the system with or without expansion. This article proposes the use of a backwards approach to compare the data predicted by a SD model with the real data obtained from the hospitals in the Basque Country. The goal was to calibrate the model to be better prepared for the eventual new wave of infections reducing the risk of collapse or unnecessary response actions to the emergency. © 2021, IFIP International Federation for Information Processing.

Student assessment in remote and distance education: How to practice effectively emphasizing feedback

Student assessment comprises an essential part of his or her education and professional training, especially in the health professions. Fundamental concepts on student assessment and their implications in school routinely practice has been evolving rapidly in recent times. Much of these changes are consequences of the increased utilization of teaching and learning strategies mediated by information and communication technology (distance education and online learning), which has been more recently accelerated by the COVID-19 pandemic. An important aspect of these changes implies in greater recognition of the educational power and effectiveness of formative assessment, carried out by frequent, high-quality feedback to students on their learning achievements, following appropriate technical recommendations. In this article, we present some basic concepts of educational evaluation and student assessment and discuss the strategic role of formative assessment and the power of feedback. We also describe some of the characteristics of effective feedback and the corresponding recommendations, and present suggestions on possible effective ways to practice student assessment in the context of remote teaching and distance education, with an emphasis on the formative purpose, but not disregarding summative assessment leading to pass or fail decision-making.

Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU.

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.

PANDEMIA DA COVID-19 COMO FENÔMENO INTEGRAL E CENTRAL NA EDUCAÇÃO EM CIÊNCIAS

In this scenario, in educational terms, emerged what was called "remote emergency activity" emerged and even with the use of technology it is necessary to highlight that no technology, however best and most developed, will supply the work of a teacher, or better, contact and human sense cannot be replaced. Concerning educational activities in science, they must go beyond a mere "transmission of content", that is, an Education in Science for the development of concrete possibilities of human emancipation, through the Discussions About Science. [...]we consider that we will not rebuilding human culture from the beginning in a post-pandemic world, but continue to develop movements of resistance and struggles engaged in transformation based on Science Education attentive social justice. Pandemics, Science Education, Phenomenon, Activity, Social Justice. 1INTRODUÇAO A pandemia da COVID-19 que temos enfrentado nos últimos meses é sentida de maneira nova e emergente, mas, ao mesmo tempo, expÐe e revela diversas e velhas conhecidas desigualdades sočiais presentes na história de produçao e reproduçao da vida na sociedade brasileira.