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Background: The coronavirus disease 2019 (COVID-19) pandemic led to daycare and school closures and children staying home for several months. The season of the respiratory viruses have been significantly changed. Aims and objectives: This study aims to assess the course of acute bronchiolitis in Brazil during the 2020-2021 season and compare them with the previous seasons. Method(s): Data from hospitalizations of acute bronchiolitis in infants <1 year were obtained from the Brazilian Public Health database for the period between 2016 and 2021. These data were also analyzed by Brazilian macroregions. The absolute and relative reductions were calculated by analyzing the yearly subsets: 2016-2019 vs 2020, 2016- 2019 vs 2021 and 2020 vs 2021. Result(s): A statiscally significant reduction was observed between 2016-2019 vs 2020, -76% (incidence rate ratio [IRR], 0.23 [95% confidence interval {CI},. 21-.25]) while a significant increase was observed between 2020 vs 2021 +55% (IRR, 0.44 [95% CI,. 40-.48]). Conclusion(s): More than a year into the COVID-19 pandemic, intensified infection control measures have controlled most viral respiratory infections in Brazil. From March to June 2021, however, an increasing number of hospitalizations for acute bronchiolitis were reported in Brazil. This resurgence have probably resulted from restarting social activities for children.
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OBJECTIVE: Healthcare workers are at risk for COVID-19 contamination. It is important to protect them in order to reduce nosocomial transmission and maintain the assistance capacity of health systems. To evaluate the diagnostic test and retest strategy with RT-PCR for SARS-CoV-2 and factors associated with the diagnosis of COVID-19 among healthcare workers. PATIENTS AND METHODS: Cross-sectional study carried out in a Brazilian hospital. From April 27 to June 16, 2020, symptomatic healthcare workers underwent an RT-PCR test on upper respiratory tract specimens as soon as possible and, if negative, it was repeated close to the 5th day of symptom evolution. Working areas were divided into assistance areas dedicated or not dedicated to COVID-19 and non-assistance areas. The type of activity was divided into assistance or non-assistance activity. RESULTS: 775 individuals were evaluated. 114 were diagnosed with COVID-19, of whom 101 followed the testing protocol. A second RT-PCR identified five (4.9%) of the positive cases. Working in an area dedicated to patients with COVID-19 was more prevalent among positive cases (35.1% x 19.8%, p=0.001) as well as working in an assistance activity (80.7% x 70.8%, p=0.031). CONCLUSIONS: A second RT-PCR test after the 5th day of symptom evolution showed limited diagnostic improvement. The adoption of a single test-based strategy, carried out at the right time after the onset of symptoms, allows the optimal use of resources. Working in a COVID-19 dedicated area and in direct contact with patients is related to a higher prevalence of COVID-19 among symptomatic healthcare workers.
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Background: Cladribine is a selective and oral immunological reconstitution treatment, approved in Europe in 2017 and in Portugal in 2018 for very active multiple sclerosis (MS) with relapses. Its safety and efficacy profile were assessed in phase III CLARITY (2005-2009) trial. Post-commercialization studies in real life conditions, are essential to confirm this profile. Objectives: To assess the safety and tolerability of cladribine in MS patients a real-world clinical setting, during treatment follow-up. Methods: Observational, multicentric, prospective study. Consecutive MS patients treated with cladribine were included in two tertiary hospitals in Lisbon and followed during treatment. Demographic and clinical aspects, EDSS, previous disease-modifying drugs (DMD) and annual relapse rate (ARR) were recorded, as well as laboratory, imaging monitoring and adverse reactions during treatment. Results: Eighty-five included patients, 54 (63.5%) female, mean age 42±12 years old, mean disease duration 9±7 years. Seventyseven (90.6%) had relapsing-remitting MS, and the remaining had secondary progressive MS. Median pre-treatment EDSS was 2,0 (1,5-4,0). Most (65.9%) patients had been submitted to more than one DMD before, 43 (51.2%) with first-line therapies and 9 (10.7%) were naïve. Cladribine was started in 57 (68.7%) patients due to inefficacy of previous drug. Mean follow-up time was 13±6 months, and 54 (63.5%) completed first year of treatment. Second year of treatment was delayed in some patients due to global COVID-19 pandemic. Most frequent adverse reactions were lymphocytopenia (43,5%), infections (20,8%) and fatigue (18,1%). After two months of first dose, CD19+ lymphocyte count showed greater reduction compared with CD4+ and CD8+. There were no grade 4 lymphocytopenia cases registered. Four (5.5%) serious adverse reactions were recorded. There were no cases of cladribine withdrawal because of adverse reactions. Conclusions: This cohort has similar characteristics to the CLARITY trial study population. Registered adverse reactions were comparable to previously described, showing higher incidence of fatigue and lower incidence of infections. This study confirms the short-term tolerability and safety profile of cladribine in real life scenarios.
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Background: Cladribine is a selective and oral immunological reconstitution treatment, approved in Europe in 2017 and in Portugal in 2018 for very active multiple sclerosis (MS) with relapses. Its safety and efficacy profile were assessed in phase III CLARITY (2005-2009) trial. Post-commercialization studies in real life conditions, are essential to confirm this profile. Objectives: To assess the efectiveness of cladribine in multiple sclerosis patients a real-world clinical setting, during treatment follow-up. Methods: Observational, multicentric, prospective study. Consecutive MS patients treated with cladribine were included in two tertiary hospitals in Lisbon and followed during treatment. Demographic and clinical aspects, EDSS, previous disease-modifying drugs (DMD) and annual relapse rate (ARR) were recorded, as well as laboratory and imaging monitoring during treatment Results: Eighty-five included patients, 54 (63.5%) female, mean age 42±12 years old, mean disease duration 9±7 years. Seventyseven (90.6%) had relapsing-remitting MS, and the remaining had secondary progressive MS. Median pre-treatment EDSS was 2,0 (1,5-4,0), and 40 (47.1%) patients had at least one relapse in previous year. Most (65.9%) patients had been submitted to more than one DMD before, 43 (51.2%) with first-line therapies and 9 (10.7%) were naïve. Cladribine was started in 57 (68.7%) patients due to inefficacy of previous drug. Mean follow-up time was 13±6 months, and 54 (63.5%) completed first year of treatment. Second year of treatment was delayed in some patients due to global COVID-19 pandemic. Fifteen relapses were registered in 12 patients. Five (5.9%) stopped treatment because of disease activity in the first year. After 12 months of follow-up (n=54), no difference was found between previous and 12-month EDSS medians (2 (IQR 1,5-4,0) vs 2 (IQR 1,25-4) p=0.606). Mean 12-month ARR (0,1±0,4) was significantly inferior to previous year ARR (0,6±1,0), p<0.001. Conclusions: At pivot trial, the efficacy of cladribine was proved after two annual treatment cycles. In this population, short follow-up period is a limitation, but after mean follow-up of one year, clinical estabilization was found in MS patients treated with cladribine.