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Background: Polyethylene glycol (PEG) is a condensed polymer of ethylene glycol used as excipient in over 1000 commonly medicines, as well as for industrial products or cosmetics (shampoo, toothpaste.) where it can act as thickener, solvent, softener or humectant. In relation to the recently developed COVID-19 vaccines and their excipients some questions have arisen in our consultations. Method(s): A 48-year- old woman came to our clinic with doubts about the administration of COVID-19 vaccine. 8 years ago, after rectal administration of a healing suppository for an anal fissure she immediately presented a dry cough and a generalized urticaria which subsided spontaneously without attend to the emergency department. 5 years ago, with the application of an hemorrhoid cream se presented an immediate reaction consisting of cough, difficulty breathing and generalized urticaria. The symptoms subsided spontaneously after 30-45 minutes. The patient reported previous tolerance to both drugs. She has avoided them ever since. All these medicines have in common PEG as an excipient. We performed several studies to find out if PEG was the culprit. Result(s): *Prick test with Casenlax (which contains 10 grams of PEG 4000): negative. *Oral provocation test with Casenlax: we started with the intake of 2.5 grams of Casenlax and after 5 minutes she started with oropharyngeal pruritus, dry cough, feeling of shortness of breath and desaturation (since 98% to 92-90%). The patient was monitored and administered intramuscular adrenaline (0.3 ml), methylprednisolone 60 mg and dexchlorpheniramine 5 mg. The symptoms were controlled after 15-30 minutes. *COVID-19 AstraZeneca vaccine was administered without incident. Conclusion(s): Given the high incidence of reactions to the excipients accompanying the drugs, this should be taken into account when taking the patient's medical history and in the subsequent pharmacological study.
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This article presents the results of a pioneering online survey of short-term rental (STR) hosts (N=879) in Portugal about the impact of Covid on their activity, with a sample structured into four areas (Lisbon, Porto, Algarve and the rest of the country). Despite the very high losses, especially in the cities, most of the respondents intend to continue operating in the STR sector. A massive migration from STR to long-term rental is not predicted for a number of reasons, including financial, those related to the nature of this type of supply – more temporary – and the high level of distrust of the state, specifically in terms of guaranteeing legislative stability. In the cities, medium-term rental is the alternative most commonly considered, suggesting there may be a possible restructuring of the sector. Survival capacity over the medium term will depend on the degree of losses and type of public support received during the pandemic, which has benefited hosts constituted as companies more than the sole proprietorships. © 2023,Revista Portuguesa de Estudos Regionais. All Rights Reserved.
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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.
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Background and Aims: We evaluated whether stroke severity, functional outcome and mortality are different in patients with ischemic stroke with or without COVID-19 infection. Methods: A prospective, observational, multicentre cohort study in Catalonia, Spain. Recruitment was consecutive from mid-March to mid-May 2020. Patients had had an acute ischemic stroke within 48 hours and a previous modified Rankin scale (mRS) score of 0 to 3. We collected demographic data, vascular risk factors, prior mRS score, NIHSS score, rate of reperfusion therapies, logistics and metrics. Primary end-point was functional outcome at 3 months. Favourable outcome was defined depending on the previous mRS score. Secondary outcome was mortality at 3 months. We performed mRS shift and multivariate analyses. Results: We evaluated 701 patients (mean age 72.3±13.3 years, 60.5% men), and 91 (13%) had COVID-19 infection. Median baseline NIHSS score was higher in COVID-19 patients compared to patients without COVID-19 [8 (3-18) vs 6 (2-14), p=0.049)]. Proportion of patients with a favourable functional outcome was 33.7% in the COVID-19 and 47% in the non-COVID-19 group. However, after a multivariate logistic regression analysis, COVID-19 infection did not increase the probability of unfavourable functional outcome. Mortality rate was 39.3% among COVID-19 patients and 16.1% in the non-COVID-19 group. In the multivariate logistic regression analysis, COVID-19 infection was a risk factor for mortality (HR 3.14 (95% CI, 2.10-4.71;p<0.001). Conclusions: Patients with ischemic stroke and COVID-19 infection have more severe strokes and higher mortality than stroke patients without COVID-19 infection. However, functional outcome is comparable in both groups.
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Introduction: Obesity could be a relevant player in the severity of COVID-19 illness. This work was aimed to evaluate and compare the methylation levels of the main entry factor of SARS-CoV-2, the ACE2 gene, in blood leukocytes (PBMCs) depending on adiposity and determine the effect of therapies for weight loss on the obesity-related methylation levels of ACE2. Methods: DNA methylation levels of ACE2 were evaluated by a re-analysis of data from Illumina Infinium MethylationEPIC BeadChip in PBMCs. Data were compared according to obesity and after following a therapy to lose weight based on a very-low calorie ketogenic diet (VLCKD) or bariatric surgery (BS) and correlated with the transcript levels of ACE2 and BMI. Results: ACE2 methylation levels in PBMCs were higher from patients with obesity than normal-weight patients. Moreover, in obese subjects, ACE2 methylation levels were decreased following weight loss after either VLCKD or BS. Among the studied CpG sites, the cg16734967 and cg21598868 located at promoter were the most representative and correlated with BMI. Importantly the observed DNA methylation pattern was inversely correlated with the ACE2 gene expression. Conclusion: Obesity-related blood leukocytes shows a hypermethylation and downregulation of ACE2 gen and is restored after a therapy to lose weight. These findings evidenced a methylation-based epigenetic regulation of ACE2 gene in PBMCs from patients with obesity that could be associated with the COVID-19 onset and development, suggesting that it could be a good biomarker in a minimally invasive sample to monitor the management of COVID-19 in at-risk patients.