Tumefactive demyelination after covid-19 successfully treated with betainterferon 1A.

The Marburg variant of MS is a rare variant that leads to a severe clinical course, with a high rate of mortality or severe residual deficits and unclear pathophysiology. A 20-year-old female patient, presented at the hospital emergency with left inferior limb paresis and visual blurring. The neurologic exam showed complete and proportionate left hemiparesis with pyramidal signs and clonus, loss of proprioception and vibration in lower limbs, tactile, and painful hypoesthesia on the left side. This report describes a rare case of Marburg variant associated with COVID-19 infection.

Readjustment of Capsule Endoscopy Protocols to the COVID-19 Pandemic in a Portuguese Tertiary Center.

BACKGROUND: The prevention of severe acute respiratory syndrome corona virus 2 transmission implies several social distancing mea- sures, imposing a change in the protocols of several hospital departments. Capsule endoscopy protocols changes were implemented and evaluated in a Portuguese tertiary center. METHODS: The authors compared pre-pandemic and peri-pandemic protocols, the latter favoring social distancing, used in MiroCam (IntroMedic, Seoul, Korea) and PillCam Crohn (Medtronic, Minneapolis, Minn, USA) capsule endoscopy, in a Gastroenterology Department of a tertiary center. All capsule endoscopy performed in outpatients between February 2018 and September 2020 was included. The authors compared significant lesions detection rate, completeness of procedure, adequate bowel preparation, complications rate, and patient satisfaction (through a brief phone call survey) among the protocols. RESULTS: This study included 70 MiroCam CE and 43 PillCam Crohn capsule endoscopy. No statistically significant differences concern- ing performance measures and patients satisfaction were found among the pre-pandemic protocol and the peri-pandemic protocol in MiroCam capsule endoscopy. Conversely, in PillCam Crohn capsule endoscopy, the rate of complete exams was significantly inferior in the peri-pandemic protocol (84.8% vs 50.0%, P = .036), with no other statistically significant differences in the remaining parameters. CONCLUSION: The performance measures and patient satisfaction were similar among the protocols analyzed for MiroCam capsule endoscopy. Thus, the readjustment of this capsule endoscopy system, which favors a reduction in hospital stay, appears to be a good alternative to the former protocols in this pandemic era. In contrast, the rate of complete exams was significantly inferior in the adapted protocol to the pandemic era for PillCam Crohn capsule endoscopy, disfavoring its maintenance in the clinical practice.

Equine Anti-SARS-CoV-2 Serum (ECIG) Binds to Mutated RBDs and N Proteins of Variants of Concern and Inhibits the Binding of RBDs to ACE-2 Receptor.

The COVID-19 pandemic caused by the severe acute syndrome virus 2 (SARS-CoV-2) has been around since November 2019. As of early June 2022, more than 527 million cases were diagnosed, with more than 6.0 million deaths due to this disease. Coronaviruses accumulate mutations and generate greater diversity through recombination when variants with different mutations infect the same host. Consequently, this virus is predisposed to constant and diverse mutations. The SARS-CoV-2 variants of concern/interest (VOCs/VOIs) such as Alpha (B.1.1.7), Beta (B.1.351), Gamma (B.1.1.28/P.1), Delta (B.1.617.2), and Omicron (B.1.1.529) have quickly spread across the world. These VOCs and VOIs have accumulated mutations within the spike protein receptor-binding domain (RBD) which interacts with the angiotensin-2 converting enzyme (ACE-2) receptor, increasing cell entry and infection. The RBD region is the main target for neutralizing antibodies; however, other notable mutations have been reported to enhance COVID-19 infectivity and lethality. Considering the urgent need for alternative therapies against this virus, an anti-SARS-CoV-2 equine immunoglobulin F(ab')2, called ECIG, was developed by the Butantan Institute using the whole gamma-irradiated SARS-CoV-2 virus. Surface plasmon resonance experiments revealed that ECIG binds to wild-type and mutated RBD, S1+S2 domains, and nucleocapsid proteins of known VOCs, including Alpha, Gamma, Beta, Delta, Delta Plus, and Omicron. Additionally, it was observed that ECIG attenuates the binding of RBD (wild-type, Beta, and Omicron) to human ACE-2, suggesting that it could prevent viral entry into the host cell. Furthermore, the ability to concomitantly bind to the wild-type and mutated nucleocapsid protein likely enhances its neutralizing activity of SARS-CoV-2. We postulate that ECIG benefits COVID-19 patients by reducing the infectivity of the original virus and existing variants and may be effective against future ones. Impacting the course of the disease, mainly in the more vulnerable, reduces infection time and limits the appearance of new variants by new recombination.

Potent Activity of a High Concentration of Chemical Ozone against Antibiotic-Resistant Bacteria.

BACKGROUND: Health care-associated infections (HAIs) are a significant public health problem worldwide, favoring multidrug-resistant (MDR) microorganisms. The SARS-CoV-2 infection was negatively associated with the increase in antimicrobial resistance, and the ESKAPE group had the most significant impact on HAIs. The study evaluated the bactericidal effect of a high concentration of O3 gas on some reference and ESKAPE bacteria. MATERIAL AND METHODS: Four standard strains and four clinical or environmental MDR strains were exposed to elevated ozone doses at different concentrations and times. Bacterial inactivation (growth and cultivability) was investigated using colony counts and resazurin as metabolic indicators. Scanning electron microscopy (SEM) was performed. RESULTS: The culture exposure to a high level of O3 inhibited the growth of all bacterial strains tested with a statistically significant reduction in colony count compared to the control group. The cell viability of S. aureus (MRSA) (99.6%) and P. aeruginosa (XDR) (29.2%) was reduced considerably, and SEM showed damage to bacteria after O3 treatment Conclusion: The impact of HAIs can be easily dampened by the widespread use of ozone in ICUs. This product usually degrades into molecular oxygen and has a low toxicity compared to other sanitization products. However, high doses of ozone were able to interfere with the growth of all strains studied, evidencing that ozone-based decontamination approaches may represent the future of hospital cleaning methods.

The Use of a Low-Fidelity Simulator to Improve Vascular Anastomosis Skills of Residents during the COVID-19 Pandemic.

BACKGROUND: To evaluate a workshop using a low-fidelity simulator for training vascular surgery residents in vascular anastomosis during the COVID-19 pandemic. DESIGN: Prospective, controlled, single-center. METHODS: Vascular surgery residents at the São Paulo University Medical School were enrolled in the COVID Group (five post graduation year 3 residents) or Control Group (five PGY-4 residents). The COVID Group was trained via a vascular anastomosis workshop. The residents were evaluated using Objective Structured Assessment of Technical Skills (OSATS), Final Product Analysis and time to perform the procedure. The number of anastomoses performed by the residents were calculated. Data were subjected to statistical analysis, and P < 0.05 was considered significant. RESULTS: There was a significant reduction in the number of vascular anastomoses performed by the residents between the COVID group and the control group (mean 22.6 ± 7.76 vs. 35.2 ± 3.9, P = 0.01, Student's t-test). Before the workshop, 80% of the residents from the COVID group failed to perform a vascular anastomosis on the simulator. During the workshop, there was improvement in the Objective Structured Assessment of Technical Skills (OSATS) score (initial: 16.5, interquartile range (IQR) 0, under supervision: 25, IQR 5, and at the end of the workshop: 26.5, IQR 2.5; P = 0.049, Friedman's test) and in the Final Product Analysis (initial: 14.5, IQR 6, under supervision: 26.5, IQR 4.625, end of the workshop: 27, IQR 4, P = 0.049, Friedman's test). Time was not significantly different (initial: 35.6, IQR 2.77; under supervision: 25.8 min, IQR 4.53; P = 0.07, Friedman's test). The residents' technical scores were stable 6 months after the training, and there was no difference between their final scores and those of the control group. The residents from the COVID Group reported an improvement in their knowledge, technical skills and confidence after the workshop. CONCLUSIONS: A workshop using a low-fidelity simulator improved vascular surgery residents' skills and confidence in vascular anastomosis during the pandemic year, when they performed fewer surgical procedures.

Impact of the COVID-19 Pandemic on Gastroenterology Department Activity: The Gastroenterologist's Perspective Nationwide and the Real Impact in a Portuguese Center.

BACKGROUND: Several gastroenterology societies have created recommendations in order to reduce nonessential exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Our aim is to evaluate the national gastroenterologists' perspective on the impact of COVID-19 and the impact of reorganization of a gastroenterology department during the COVID-19 pandemic. METHODS: For the first purpose, an online survey was distributed to gastroenterologists nationwide. For the second purpose, the authors conducted an analysis of some endoscopic procedures performed at the Gastroenterology Department of the Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E) between March 16 and May 8 during the years 2019 and 2020. RESULTS: Sixty-seven gastroenterologists answered our survey. Only 14.9% were residents and 86.6% worked in a hospital with COVID-19 patients, with 16.4% assigned to assist those patients. All of the departments suffered modifications. Ninety percent of the residents affirmed that their activity had changed. Ninety-four percent declared having nonessential endoscopic procedures postponed, and 85.1% maintained in-person medical visits, 88.1% were already having remote consultations, and 11.9% did not have any clinical visit. In our gastroenterology unit, the number of endoscopic procedures decreased by 73.1% from 2019 to 2020. In 2020, the proportion of urgent procedures was higher compared to 2019. CONCLUSION: The advent of COVID-19 has led to important changes in gastroenterology activities in Portugal, and national gastroenterology units are complying with the recommendations. Furthermore, Portuguese gastroenterologists believed that the decrease in endoscopic activity can compromise residents' education and training. The gastroenterology department at CHVNG/E has shown a significant reduction in the number of endoscopic procedures.

INTRODUÇÃO: As sociedades de Gastroenterologia criaram recomendações de modo a reduzir a exposição não necessária ao vírus da síndrome respiratória aguda grave (SARS-CoV-2). O nosso objetivo é avaliar a perspectiva nacional dos gastroenterologistas sobre o impacto da COVID-19 e avaliar o impacto da reorganização do nosso serviço de Gastroenterologia durante a pandemia. MÉTODOS: Para o 1° objetivo, um inquérito online foi disponibilizado aos gastroenterologistas de todo o país. Para o 2° objetivo, os autores realizaram uma análise dos procedimentos endoscópicos do serviço de Gastroenterologia do Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E) entre 16 de Março e 8 de Maio durante os anos de 2019 e 2020. RESULTADOS: 67 gastroenterologistas responderam o inquérito. Destes, 14.9% eram internos. 86.6% trabalharam num hospital com doentes com COVID-19, e 16.4% dos médicos prestavam cuidados a esses doentes. Todos os departamentos sofreram alterações. 90% dos internos referiram que a atividade tinha sido alterada. 94% dos médicos afirmaram que os procedimentos endoscópicos não-essenciais foram adiados. 85.1% mantinham algumas consultas médicas presenciais, 88.1% estavam a realizar consultas não presenciais, e 11.9% não tinham nenhum tipo de consulta. No nosso serviço, o número de procedimentos endoscópicos diminui em 73.1% de 2019 para 2020. Em 2020, a proporção de procedimentos endoscópicos de urgência foi superior em relação a 2019. CONCLUSÃO: A pandemia da COVID-19 conduziu a alterações importantes dentro das atividades da Gastroenterologia em Portugal, e os serviços de Gastroenterologia mostraram cumprir as recomendações. Além disso, os gastroenterologistas portugueses acreditam que a diminuição da atividade endoscópica dos internos pode comprometer a sua futura formação. O serviço de gastroenterologia do CHVNG/E mostrou uma redução significativa do número de procedimentos endoscópicos.

A fractional-order model for CoViD-19 dynamics with reinfection and the importance of quarantine.

Coronavirus disease 2019 (CoViD-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Among many symptoms, cough, fever and tiredness are the most common. People over 60 years old and with associated comorbidities are most likely to develop a worsening health condition. This paper proposes a non-integer order model to describe the dynamics of CoViD-19 in a standard population. The model incorporates the reinfection rate in the individuals recovered from the disease. Numerical simulations are performed for different values of the order of the fractional derivative and of reinfection rate. The results are discussed from a biological point of view.

What are the Clinical Implications of a Positive RT-PCR Test 6 Months after a Mild SARS-CoV-2 Infection?

We present the case of an 84-year-old female patient hospitalized for surgical treatment of a hip fracture who re-tested positive for SARS-CoV-2 with an RT-PCR nasopharyngeal swab approximately 6 months after presenting mild respiratory symptoms with confirmed COVID-19 in April 2020. We discuss the possibility of reinfection, long-term viral shedding and residual positivity, the limitations of RT-PCR swab tests, and the necessity for new testing methods as the COVID-19 pandemic spreads and long-lasting immunity is uncertain. LEARNING POINTS: This case suggests that a patient could still test positive on a standard RT-PCR nasopharyngeal swab test for as long as 6 months after previous COVID-19.Long-term non-viable viral shedding may be related to the severity of COVID-19 and to persistent pulmonary interstitial damage after COVID-19.New testing methods may be required if reinfection becomes common, as testing a patient with known past COVID-19 using a standard RT-PCR swab test could lead to a false positive diagnosis.

Management of acute stroke and urgent neurointerventional procedures during COVID-19 pandemic: recommendations on the Scientific Department on Cerebrovascular Diseases of the Brazilian Academy of Neurology, Brazilian Society of Cerebrovascular Diseases and Brazilian Society of Neuroradiology

ABSTRACT Introduction: Although the 2019 severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2, COVID-19) pandemic poses new challenges to the healthcare system to provide support for thousands of patients, there is special concern about common medical emergencies, such as stroke, that will continue to occur and will require adequate treatment. The allocation of both material and human resources to fight the pandemic cannot overshadow the care for acute stroke, a time-sensitive emergency that with an inefficient treatment will further increase mortality and long-term disability. Objective: This paper summarizes the recommendations from the Scientific Department on Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Society of Cerebrovascular Diseases and the Brazilian Society of Neuroradiology for management of acute stroke and urgent neuro-interventional procedures during the COVID-19 pandemic, including proper use of screening tools, personal protective equipment (for patients and health professionals), and patient allocation. RESUMO Introdução: A pandemia causada pelo novo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2, COVID-19) apresenta novos e importantes desafios à gestão de saúde no Brasil. Além da difícil missão de prestar atendimento aos milhares de pacientes infectados pelo COVID-19, os sistemas de saúde têm que manter a assistência às emergências médicas comuns em períodos sem pandemia, tais como o acidente vascular cerebral (AVC), que continuam ocorrendo e requerem tratamento com presteza e eficiência. A alocação de recursos materiais e humanos para o enfrentamento à pandemia não pode comprometer o atendimento ao AVC agudo, uma emergência cujo tratamento é tempo-dependente e se não realizado implica em importante impacto na mortalidade e incapacitação a longo prazo. Objetivo: Este trabalho resume as recomendações do Departamento Científico de Doenças Cerebrovasculares da Academia Brasileira de Neurologia, da Sociedade Brasileira de Doenças Cerebrovasculares e da Sociedade Brasileira de Neurorradiologia para o tratamento do AVC agudo e para a realização de procedimentos de neurointervenção urgentes durante a pandemia de COVID-19, incluindo o uso adequado de ferramentas de triagem e equipamentos de proteção pessoal (para pacientes e profissionais de saúde), além da alocação apropriada de pacientes.

Multimodal Emotion Evaluation: A Physiological Model for Cost-Effective Emotion Classification.

Emotional responses are associated with distinct body alterations and are crucial to foster adaptive responses, well-being, and survival. Emotion identification may improve peoples' emotion regulation strategies and interaction with multiple life contexts. Several studies have investigated emotion classification systems, but most of them are based on the analysis of only one, a few, or isolated physiological signals. Understanding how informative the individual signals are and how their combination works would allow to develop more cost-effective, informative, and objective systems for emotion detection, processing, and interpretation. In the present work, electrocardiogram, electromyogram, and electrodermal activity were processed in order to find a physiological model of emotions. Both a unimodal and a multimodal approach were used to analyze what signal, or combination of signals, may better describe an emotional response, using a sample of 55 healthy subjects. The method was divided in: (1) signal preprocessing; (2) feature extraction; (3) classification using random forest and neural networks. Results suggest that the electrocardiogram (ECG) signal is the most effective for emotion classification. Yet, the combination of all signals provides the best emotion identification performance, with all signals providing crucial information for the system. This physiological model of emotions has important research and clinical implications, by providing valuable information about the value and weight of physiological signals for emotional classification, which can critically drive effective evaluation, monitoring and intervention, regarding emotional processing and regulation, considering multiple contexts.

Patient's perspective on the implementation of measures to contain the SARS-CoV-2 pandemic in a Portuguese Gastroenterology Department.

BACKGROUND AND AIMS: As the COVID-19 pandemic emerged, departments had to adapt their activities, jeopardizing patient's best interests. Our aim is to evaluate the patient's perspective to the implementation of SARS-CoV-2 measures in a gastroenterology department in a Portuguese Hospital. METHODS: A survey with 13 questions was created and available to patients with at least one gastroenterology appointment at our center in the year 2019. RESULTS: Nine hundred seventy-three patients completed the survey, 51.6% (n = 502) females, and 82.6% (n = 804) with less than 65 years of age. 50.7% of 962 patients were not working. 49.5% had an appointment for monitoring a suspected or established inflammatory bowel disease (IBD). 76.8% and 69.6% subjects agreed in postponing endoscopic and non-endoscopic procedures, respectively. 93.6%, 94.3% and 95.7% patients declared to be worried about the postponing of endoscopic procedures, non-endoscopic procedures and medical visits, respectively. 88.8% supported remote consultations and 77.3% were satisfied with this type of appointment, independently of the age group (P = 0.66). 80.9% of IBD patients treated with immunosuppression or biologics were concerned about a severe infection by COVID-19. CONCLUSION: A great part of our respondents belong to IBD appointments. The majority of our patients agreed in postponing procedures, although they feel concerned. Almost all patients supported remote consultations and most patients found them positive.