COVID-19 Pandemic: Another Source of Stress for Medical Students

Introduction: The COVID-19 pandemic has completely changed the experience of higher education with potentially negative consequences for students' wellbeing. Objective(s): To compare medicine/dentistry students' depression/ anxiety/stress levels before versus during the pandemic and to analyse the role of COVID-19-related stressors in their psychological distress. Method(s): Students from the Faculty of Medicine University of Coimbra answered socio-demographic and personality questionnaires and the Depression, Anxiety and Stress Scale/DASS before (academic years 2016-2017-2018-2019 - SAMPLE1;n=1000) and during (September-December 2020 and January-March 2021 - SAMPLE2;n=650) the COVID-19 pandemic. Mean age (21.12+/-3.75), personality traits scores, and gender proportions (75% girls) did not significantly differ between samples. SAMPLE2 also filled in the Fear of COVID-19 Scale and a new version of the Inventory of Sources of Stress During Medical Education/ISSDME, containing a COVID-19 -related dimension (restrictions on training and on socializing with friends/colleagues). Result(s): SAMPLE2 presented significantly higher mean scores of depression (3.89+/-3.55vs.3.33+/-3.34), anxiety (3.27+/-4.08vs.2.86+/-3.29), stress (7.07+/-5.72vs.6.18+/-4.59) and total DASS (12.28+/-10.55vs.13.65+/-11.13) than SAMPLE1 (all p<.05). Fear of COVID-19 was a significant predictor of DASS score (adjusted R2=2.9%, p<.001). COVID-19-related stressors continued explaining significant increments of DASS variance after controlling for each of the ISSDME dimensions: Course demands (R2 Change=1.8%), Human demands (2.5%), Lifestyle (2.3%), Academic competition (5.5%), and Academic adjustment (5.2%) (all p<.001). Conclusion(s): This study adds to the evidence of the negative impact of COVID-19 on students and emphasizes its pernicious role on medical students' psychological distress, which is already higher due to the individual and academic stressors to which they are more exposed.

Diagnostic Challenge in a Sickle Cell Disease Patient with COVID-19

Acute chest syndrome is a life-threatening complication in sickle cell disease. Infections are frequently implied, and like other viruses, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be a trigger. In addition, due to their inflammatory status, they may present a higher risk for severe coronavirus disease 2019 (COVID-19). Pneumonia and acute chest syndrome share clinical, laboratory, and radiological features and may overlap, which makes their differential diagnosis especially challenging. We describe a case of an adolescent with homozygous sickle cell disease that developed acute chest syndrome in the context of COVID-19. With it, we intend to bring awareness to the potential role of imaging in the differential diagnosis and in establishing the best approach for the patient. Chest computed tomography findings were suggestive of an alternative diagnosis to COVID-19 pneumonia and red cell transfusion, fluid management, analgesics, and antibiotics were administered with favorable outcome. © Author(s) (or their employer(s)) and Portuguese Journal of Pediatrics 2022.

COVID-19 pneumonia in a child. A surprise finding

Background: Coronavirus disease 19 (COVID-19) tends to be milder in children, but severe cases have been reported. We described a case report of a toddler admitted to our department with additional findings, highlighting the importance of assessing the patient as a whole. Case Presentation: A previously healthy, 15-month-year-old girl presented with fever and dry cough for 10 days, respiratory distress and PCR SARS-CoV-2 was positive. At admission, she presented with hypoxemia (SpO2 89-90% in room air), global retraction and bilateral bronchospasm. She was treated with bronchodilators, methylprednisolone, remdesivir and also amoxicillin/clavulanic acid. Her complete blood count revealed leucocytosis 16,160x109/L, 41% lymphocytes, C-reactive protein 57,9 mg/L, procalcitonin 0,13 ng/mL, sedimentation rate 44 mm/h, ferritin 218,4 ng/mL. Chest computed tomography (CT) scan revealed bilateral peripheral areas of ground glass, coexisting consolidation areas at inferior lobes but also revealed a 6 cm supra-renal mass. Abdominal ultrasound and CT confirmed an heterogeneous right supra-renal gland mass of 5,5cm along the greatest diameter with diffuse calcifications, evolving the inferior vena cava and the renal vascular pedicle, no signs of liver, bone, cutaneous or ganglionic metastization. These features were suggestive of neuroblastoma in stage L2. Vanillylmandelic acid, normetanephrine/creatinine ratio and metanephrine/creatinine ratio were elevated. The metaiodobenzylguanidine (Mibg) scan showed a localized disease. The total excision of the tumour mass was performed, and the histology confirmed neuroblastoma with no N-myc oncogene amplification, nor other bad prognosis chromosomal abnormalities. She is currently under oncological surveillance, with no signs of recurrence. Learning Points Discussion: Neuroblastoma is the most common extracranial solid tumour of childhood. It is known for its broad spectrum of clinical behaviour and outcome. In this case, although this toddler was admitted due to COVID-19 pneumonia, it allowed to identify a localized tumour, perform excision and due to the favourable biology tumour, she has a very good chances of being cured and free of disease.

DIGITAL MARKETING IN CRISIS TIME

The crisis can affect an organization for many reasons, including changes that occur in the market, technology, competition or even a pandemic currently experienced. With this, it is necessary to find solutions so that it is possible to work around the situation and continue operating in the market. This article aims to analyze what are the digital marketing strategies adopted by organizations in different crisis situations, including the Covid-19 pandemic. For this purpose, an integrative review of articles published in the Web of Science, Scopus, SPELL and SciELO databases was carried out. The results show that several strategies in the digital environment are capable of collaborating with the challenges that organizations face with globalization, such as investing in their websites, acting on their social media with content and campaigns, applications, virtual assistants, advertising and others. A research framework was created with the aim of synthesizing the findings of this integrative review. Organizations from different sectors can mirror these strategies to deal with the crisis they face or even join them so that they are not hit by unexpected adversities, resulting in loss of space or even their withdrawal from the market.

Respiratory function in asthmatic patients after SARScoV-2 infection

Background: According to current evidence, the lungs are the most affected organ in SARS-CoV-2 infection. Recent data shows impairment of carbon monoxide diffusing capacity, decreased total lung capacity, and restrictive ventilatory defect in COVID-19 adult patients. Data in children are lacking. Our goal was to characterize clinically and demographically the pediatric population with asthma that tested positive for SARS-CoV-2 in our hospital during 2020 and evaluate the pulmonary function after the infection. Method: Cross-sectional study performed in Hospital Dona Estefânia, from March 2nd to December 31st, 2020. All pediatric asthmatic patients (<18 years) who tested positive for SARS-CoV-2 (RT-PCR test) were included. Asthma diagnosis was based on a previous physician's diagnosis or parent-reported history. A convenience sample of the asthmatic patients performed spirometry and carbon monoxide diffusing capacity (DLCO). Results: We were able to identify 20 asthmatic patients [50% male;median age: 10.5 years old (P25- 75: 9- 14.5)]. Atopic comorbidities were present in 75% ( n = 15) (rhinitis the most frequent). According to GINA, 11 (55%) had mild and 9 (45%) moderate asthma. Five patients (25%) needed hospital admission because of COVID-19 infection, 3 had asthma exacerbation, and 3 had COVID-19 pneumonia. Nine of the 20 patients performed spirometry and DLCO after COVID-19 infection. Respiratory function was performed few months after the infection [median=3 months (P25- 75: 2- 6.5)]. In our sample, we found 2 patients with obstructive ventilation impairment and small airway dysfunction. We didn't find any statistically significant difference between de FVC, FEV1, FEV1/FVC ratio, FEF25- 75, and peak expiratory flow (PEF) before and after COVID-19 infection. There were 2 asthmatics with impaired DLCO (65.1% and 64.7%). Conclusion: Two patients showed obstructive ventilation, but it could be due to the variable airflow limitation of asthma, and 2 had DLCO impairment. We didn't find any statistically significant difference between respiratory function before and after COVID-19 infection. However, this is a small sample, and further evaluations with larger populations are needed.