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Health and wellness tourism had a growing interest in the Portuguese population until 2019. However, with the ap-pearance of Covid-19, several establishments had to close over these two years, this segment being one of the most affected areas. Many water users looked forward to the opening of the spa resorts to continue their treatments. Giv- en the importance of this theme, this work has as its main goal the definition of a consumer profile and to identify the determinants of satisfaction of the thermal tourists, as well as to gauge the degree of knowledge of thermal tourism and specifically of spas in the Portuguese context. In methodological terms, a questionnaire survey was conducted among the tourists to achieve the research objectives. The results show a younger, healthier and diversified thermal tourism practitioner. It also reveals similarities with other profile and motivations studies. However, it is possible to notice a few differences. Practitioners are seeking a combination of a leisure and health dimension and valorise fac- tors such as location and access of the establishments, quality of the services provided and rest and tranquillity. An issue regarding their length of stay has been identified. As they are locals and live in the same country as the thermal spa, most respondents do not stay overnight at the destination. In the future, it would be interesting to research product development and market strategies for diversified thermal practitioners.
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Introduction and Objectives: Altered biochemical and hematological markers have been associated with the aggravation of covid-19. There is limited information on the evaluation of the degree of liver injury, especially fibrosis, in infected patients who already have a history of liver injury. This study aimed to evaluate the level of fibrosis in patients coinfected with hepatitis and covid-19 during a one-year follow-up. Material(s) and Method(s): This is a longitudinal observational study. Two hundred and thirty individuals were recruited for a period of 12 months during the years 2020 to 2021. Blood was collected for hematological and biochemical tests for fibrosis calculation by using APRI index. Nasal and oropharyngeal swab samples were submitted to RT-qPCR test for detection of SARS-CoV-2 RNA. Result(s): Mean age of the population was 48 years (+/- 17.09;11-90) and half of them were women (115/230). Among the study participants, 40% (90/230) had hepatitis, and of this group, 14% (13/90) had covid-19. Compared to the group without hepatitis (140), 27% (39/140) had only covid-19 and high fibrosis grade (FIB-4) presented as a risk factor for this group. Notably, during the longitudinal study, it was noticed that there was an elevation in the degree of fibrosis among the coinfected patients when compared to the other groups. At the beginning of follow-up and during the acute phase of SARS-CoV-2 infection, coinfected patients presented a low grade of fibrosis (F0);after one year, and in a post-COVID setting, a high grade of fibrosis (F4) was observed in this group. The increase in fibrosis grade was not observed among monoinfected COVID-19 or hepatitis groups. Conclusion(s): We observed an increased level of fibrosis among COVID-19 patients with liver disease as a post-covid condition in this group, which may represent an impact of SARS-CoV-2 infection in patients with a history of liver injury.Copyright © 2023
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Introduction and Objectives: SARS-CoV-2 active infection diagnosis is currently performed through RT-qPCR. Despite the fact that PCR-based assays can provide results relatively fast, these techniques require capable professionals, specific equipment and adequate infrastructure. In order to facilitate COVID-19 diagnosis in remote areas, an alternative to RT-qPCR would be loop-mediated isothermal (RT-LAMP) amplification. SARS-CoV-2 variant genotyping through high-throughput sequencing (HTS) allows SARS-CoV-2 genomic surveillance, especially for patients with a higher vulnerability. This study aimed to optimize RT-LAMP and HTS methods for SARS-CoV-2 RNA detection and genotyping, respectively, in respiratory samples from patients with liver disease. Material(s) and Method(s): A total of 142 respiratory secretions were obtained from individuals with SARS-CoV-2 RNA detectable by RT-qPCR (N1 Ct <= 30), divided into groups with (n=18) or without (n=124) liver disease. The study also enrolled 55 individuals who had SARS-CoV-2 RNA undetectable at RT-qPCR. For RT-LAMP methodology, primers were used for ORF1 gene amplification. As for HTS genotyping, the steps of cDNA synthesis, complete SARS-CoV-2 genome PCR amplification, preparation of genomic libraries and sequencing in MinION device were performed for 26 swab samples. Result(s): Samples with viral RNA detectable by RT-qPCR had a mean Ct value of 24.3 +/- 3.75. Referring to RT-LAMP, it was observed a sensitivity of 71.1% (101/142). When considering RT-qPCR mean Ct value, RT-LAMP sensitivity was 88.9% (16/18), associated with a mean Ct of 23.3 +/- 3.5 for patients with COVID and hepatitis. A specificity of 100% (55/55) was observed since all negative swabs tested by RT-qPCR were negative at RT-LAMP. Through sequencing by MinION, SARS-CoV-2 lineages gamma (7/26;27%), zeta (1/26;3.9%), delta (6/26;23%) and omicron (12/26;46.1%) were genotyped and detected by RT-LAMP. Conclusion(s): RT-LAMP demonstrated high sensitivity for molecular detection of SARS-CoV-2 RNA for patients with high viral load. Besides, RT-LAMP was capable of detecting all SARS-CoV-2 lineages genotyped by MinION in both groups.Copyright © 2023
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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
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Background: The multimedia capturing of live lectures has increased within higher education institutions, even in the pre-COVID-19 period. Despite student satisfaction, the video lecture capture (VLC) influence on students' attainment and achievement of intended learning outcomes is controversial. Methods: To explore the impact of VLC, a cross-sectional study across 2016/17 (n=209 students) and 2017/18 (n=206 students) was conducted in the course of Mechanistic Toxicology in Pharmaceutical Education. Results: The results showed that 73% and 90% of the assessed students entirely viewed the videos of theoretical (550 minutes) and practical/laboratory classes (250 minutes), respectively. VLC impacted student attainment and the achievement of intended learning outcomes on the capacity to understand the subjects and apply knowledge. Conclusion: The effectiveness of VLC is to be considered under the framework of constructive alignment and the specificities of the course.
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The hospitality industry is one of the most significant drivers of economic growth and socioeconomic advances in both developed and developing countries. This industry contributes directly to gross domestic product, job creation, income level, destination expansion, and economic development. Forecasts for 2020 indicated a promising year was ahead for this industry, but the COVID-19 pandemic had a catastrophic impact. Hospitality companies are experiencing one of the biggest, unprecedented crises to date, and experts must now rethink strategies to ensure these businesses' recovery. © 2022 by IGI Global. All rights reserved.
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The global pandemic prompted by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has already caused more than 6 million deaths worldwide, calling for urgent effective therapeutic measures. A deep understanding of the mechanisms involved in viral replication is required. Among the nonstructural proteins (nsps) encoded by SARS-CoV-2 genome, there is the nsp14 ribonuclease, the main object of study in this work. Ribonucleases are key factors in the control of all biological processes, ensuring maturation, degradation, and quality control of all types of RNAs. Nsp14 is a bifunctional protein, holding a 3'- 5' exoribonucleolytic activity (ExoN) in the N-terminal domain, stimulated through the interaction with nsp10, and a C-terminal N7-methyltransferase activity (MTase). Both are critical for the coronavirus life cycle. In this work, we provide a complete biochemical characterization of SARS-CoV-2 nsp14-nsp10, addressing several aspects of the complex for the first time. Moreover, using a homology model, we have identified residues involved in the nsp14-nsp10 interaction that were extensively studied. We have confirmed the SARS-CoV-2 nsp14 dual function and we have shown that both ExoN and MTase activities are functionally independent. We demonstrate that the nsp14 MTase activity is independent of nsp10, contrarily to nsp14 ExoN that is upregulated in the presence of the cofactor. Additionally, our results show that the ExoN motif I has a prominent role on the ribonucleolytic activity of SARS-CoV-2 nsp14, contrasting to what was previously observed in other coronaviruses, which can be related to the pathogenesis of SARS-CoV-2. The knowledge provided in this work can serve as a basis to design effective drugs that target the pinpointed residues in order to disturb the complex assembly and affect the viral replication, ultimately, treating COVID-19 and other CoV infections.
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Considering the need for adequacy of jurisdictional provision bodies in the face of social isolation measures, this study aimed to discuss the guidelines, rules and tools used by the Court of Justice of Tocantins - TJTO in compliance with the determinations of the National Council of Justice - CNJ, aiming to corroborate the functioning of conciliation hearings through the Judiciary Center for Conflict and Citizenship Resolution - CEJUSC. Therefore, bibliographical and documentary research was carried out, with searches on official government websites, searches on official websites of the CNJ and TJTO, as well as on the academic Google platform. It was obtained that the National Council of Justice - CNJ, responded to international dictates aiming at protecting the community in the midst of the Covid-19 pandemic, by using modern tools such as "100% virtual court" and "Virtual counter" in order that the courts use such strategies in the context of virtual hearings, in order to guarantee the principle of access to justice and efficiency. Within the scope of the TJTO, rules were issued in order to authorize the use of easily accessible applications such as WhatsApp and Google Meet in the holding of conciliation hearings. However, the access of people in vulnerable situations and in relation to digital illiterates was discussed.
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Introdução: A Síndrome de Evans (SE) é uma condição rara caracterizada por anemia hemolítica e trombocitopenia autoimunes. Apesar de sua fisiopatologia não ser bem compreendida, acredita-se que uma desregulação do sistema imune é o seu principal contribuinte. SE já foi observada em infecções virais causadas por hepatite C, citomegalovírus e varicela-zoster. Desde o surgimento da pandemia pela COVID-19, complicações hematológicas foram relatadas, entretanto, a associação da infecção por COVID-19 e Síndrome de Evans foi pouco descrita. Objetivo: Relato de caso de associação de COVID-19 e Síndrome de Evans. Relato de caso: Mulher, 20 anos, portadora de obesidade grau II, iniciou quadro de cefaléia, coriza e equimoses em membros inferiores. Após 14 dias, procurou pronto atendimento por gengivorragia e febre. Hemograma evidenciou plaquetopenia (1000/mm³). Por esse motivo, foi encaminhada ao nosso serviço em junho de 2021, na triagem foi diagnosticada com COVID-19 por RT-PCR devido ao quadro febril. À admissão, apresentava plaquetopenia grave isolada, sem outros comemorativos à hematoscopia de sangue periférico. Iniciou Dexametasona 40 mg/dia por hipótese de Púrpura Trombocitopênica Idiopática, evoluindo com ascensão plaquetária e alta hospitalar. Posteriormente, readmitida com sangramento mucocutâneo e vaginal, associado a hematoma vulvar. Aos exames, apresentava anemia hemolítica com bilirrubina indireta e DHL elevados e teste de Coombs positivo, recebendo diagnóstico de SE. Evoluiu com abscesso em grande lábio e sangramento importante, com progressão para Síndrome de Fournier. Devido à gravidade do quadro infeccioso e à necessidade de desbridamento cirúrgico de emergência, indicado transfusão de plaquetas após infusão de imunoglobulina humana, agonista de receptor de trombopoetina, Rituximabe e embolização esplênica por radiointervenção para incremento plaquetário e hemostasia, com resposta frustra. Apesar das medidas realizadas, a paciente evoluiu para choque séptico refratário e óbito. Do ponto de vista respiratório, a paciente permaneceu sem necessidade de suporte ventilatório invasivo até piora hemodinâmica. Discussão: Apesar de o comprometimento respiratório ser a principal complicação da COVID-19, vários trabalhos mostraram complicações diversas associadas. Com a evolução da pandemia, complicações hematológicas são cada vez mais relatadas. Neste caso, relatamos uma associação de Síndrome de Evans com a COVID-19 por inferência temporal e/ou causal. Em Li et al. (2020), situação semelhante foi relatada em março de 2020 com um paciente masculino de 39 anos. A utilização de imunossupressão por corticoterapia para manejo da PTI ou SE na vigência da infecção por COVID-19 é um desafio, visto que estudos demonstram associação de corticoesteroides com aumento de mortalidade e atraso no clareamento viral em casos com sintomas respiratórios leves, no entanto, apesar disto, outras terapias alternativas, inclusive empregadas neste caso, não são amplamente disponíveis no Brasil. Conclusão: Compreender a fisiopatologia da Síndrome de Evans e o papel inflamatório da COVID-19 é fundamental para o entendimento de ambas as doenças e poderá auxiliar no desenvolvimento de novas terapias para suporte e manejo das complicações.
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Technology has become crucial in applying measures to refrain diseases' spread. Thus, computer vision can be an essential tool in this combat. This paper proposes and demonstrates an application that combines facial detection and artificial intelligence techniques to verify the use of masks by individuals within the range of the camera's vision field. In a pandemic period of COVID-19, it is necessary obtaining better control of mask usage in places where it is mandatory and providing quick identification of someone who will not comply with this rule. With this objective, a Machine Learning system was created to operate in real-time a classification of face mask usage to prevent the transmission of the virus and directly impact suppressing the pandemic. © 2021 IEEE
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This integrative literature review aims to describe the importance of care provided by nursing professionals to women in pregnancy and childbirth during the SARS-CoV-2 pandemic. The integrative research methodology was applied, following the Literature Review plan by Mendes, Silveira and Galv..o (2019). The survey included primary, original articles, complete in English and Portuguese from the last 5 years. The studies were verified in the VHL, SciELO, MEDLINE, BDENF, LILACS, Bireme and academic Google. It was noted that nursing professionals had to look at the health of themselves and their patients holistically, as with the new adaptations of the SARS-CoV-2 pandemic, patients and also health professionals had to betaken care of by the fact of the challenges in the emotional sphere that both had to overcome, however, the full nursing process as a work strategy contributed to a meaningful and affective quality care, supported by concise guidelines for the care of nursing professionals and women in pregnancy and childbirth during the SARS-CoV-2 pandemic under each circumstance.
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Por meio de pesquisa qualitativa, através de consulta bibliográfica em plataformas especializadas como Scientific Electronic Library Online (SciELO) e Google Scholar, este artigo frisou a importância da conservação da biodiversidade e dos recursos naturais para reduzir as chances de ocorrência de novas doenças de origem zoonótica e discorrer sobre os desafios do educador ambiental. Considering the problems associated with COVID-19 in Brazil, our research aims to highlight the main emerging challenges to be overcome by society and environmental educators in order to minimize the impacts of the pandemic and promote a more just and balanced post-pandemic context. Through qualitative research, through bibliographic consultation on specialized platforms such as Scientific Electronic Library Online SciELO and Google Scholar, our article aimed to emphasize the importance of the conservation of biodiversity and natural resources to reduce the chances of the occurrence of new diseases of zoonotic origin and talk about the challenges of the environmental educator. [...]it is necessary to join efforts to promote social transformation and improve environmental quality, highlighting the need for changes in public administration and social habits.
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Considering the problems associated with COVID-19 in Brazil, our research aims to highlight the main emerging challenges to be overcome by society and environmental educators in order to minimize the impacts of the pandemic and promote a more just and balanced post-pandemic context. Through qualitative research, through bibliographic consultation on specialized platforms such as Scientific Electronic Library Online SciELO and Google Scholar, our article aimed to emphasize the importance of the conservation of biodiversity and natural resources to reduce the chances of the occurrence of new diseases of zoonotic origin and talk about the challenges of the environmental educator. We found that the articulation of educators in social media is essential to promote Environmental Education (EE) and overcome the challenges related to the marked social inequality in Brazil. Nevertheless, it is necessary to join efforts to promote social transformation and improve environmental quality, highlighting the need for changes in public administration and social habits. We conclude that it is urgent to develop a new culture and way of life, capable of giving a new meaning to the current paradigm which represents a strong obstacle to sustainable development.
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Introduction/Purpose: COVID19 can be associated with life-threatening organ dysfunction due to septic shock, frequently requiring ICU admission, respiratory and vasopressor support. Therefore, clear clinical criteria are pivotal to early recognition of patients more likely to have poor outcomes, needing prompt organ support. Although most patients with severe COVID19 meet the Sepsis-3.0 criteria for septic shock, it has been increasingly recognized that, in this population, hyperlactatemia is frequently absent, possibly leading to an underestimation of illness severity and mortality risk. Purpose: This study aimed to identify the proportion of patients with COVID19 with hypotension despite adequate volume resuscitation, needing vasopressors to have a MAP>65mmHg, with and without hyperlactatemia, in ICU, and describe its clinical outcomes and mortality rate. Methods: We performed a single-center retrospective cohort study. All adult patients admitted to ICU with COVID19 were eligible and were further divided in 3 groups according to hyperlactatemia (lactate >2mmol/L) and persistent hypotension with vasopressor therapy requirement: (1) sepsis group (without both criteria), (2) vasoplegic shock (with persistent hypotension with vasopressor therapy requirement without hyperlactatemia) and (3) septic shock 3.0 (with both criteria). COVID19 was diagnosed using clinical and radiologic criteria with a SARS-CoV-2 positive RT-PCR test. Qui-square test was used for categorical variables and Kruskal-Wallis and logistic regression were used on continuous variables for statistical assessment of outcomes between groups. Kaplan-Meier survival curve and logrank test were also obtained. Results: 103 patients (mean age 62 years, 71% males) were included in the analysis (N=45 sepsis, N=25 vasoplegic shock;N=33 septic shock 3.0). SOFA score at ICU admission and ICU length of stay were different between groups (p<0.001). Ventilator-free days and vasopressor-free days were also different between sepsis vs vasoplegic shock and septic shock 3.0 groups (both p<0.001 and p<0.001, respectively), and similar in vasoplegic vs septic shock 3.0 groups (p=0.387 and p=0.193, respectively). Mortality was significantly higher in vasoplegic shock and septic shock 3.0 when compared with sepsis group (p<0.001) without difference between the former two groups (p=0.595). Log rank test of Kaplan-Meier survival curves were also different (p=0.07). Logistic regression identified the maximum dose of vasopressor therapy used (OR 1.065;CI 95%: 1.023-1.108, p=0.02) and serum lactate level (OR 1.543;CI 95%: 1.069-2.23, p=0.02) as the major explanatory variables of mortality rates. Conclusions: In severe COVID19 patients, the Sepsis 3 criteria of septic shock may exclude patients with a similarly high risk of poor outcomes and mortality rate, that should be equally approached. (Table Presented).
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Introduction: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly around the world, posing a major threat to human health and the economy. Chronic Liver disease (CLD) patients could be at high risk for COVID-19. At this moment, there is little data about biochemical variation according to liver disease along to COVID-19 infection. Objectives: This study aims to report the levels of biochemical markers in CLD patients with or without COVID-19 to give more information that could help clinical monitoring. Methods: A total of 66 CLD patients were included in this study during year of 2020. Study was approved by Brazilian Ethics Committee. Blood and respiratory samples were collected after signed informed consent. At baseline and during follow-up, all subjects included in this study underwent routine examination, monitoring of biochemical markers, and SARS-CoV-2 nucleic acid testing with a median follow-up interval of 15 days. Results: Most of individuals were male 56% (37/66) and mean age of population was 49±17 years. Six out 66 CLD patients were SARS CoV-2 RNA positive at baseline. At the end of follow-up, all these 6 patients achieved SARS-CoV-2 clearance. At least once during follow-up, the CLD group versus CLD/COVID-19 group, 50% (30/60) vs. 33% (2/6) had abnormal alanine aminotransferase;47% (28/60) vs. 17% (1/6) had abnormal aspartate aminotransferase;60% (36/60) vs. 67% (4/6) had abnormal γ-glutamyltransferase, 32% CLD patients (19/60) had abnormal total bilirubin levels vs. none of the CLD/COVID-19 group. Conclusions: Previous liver disease did not seem to increase the biochemical levels, except GGT, during COVID-19 infection. However, liver function monitoring is still essential for both COVID-19 patients with and without liver disease.
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Continuous Spinal Anesthesia (CSA) can be an option for high-risk comorbid patients undergoing major abdominal surgery and may be advantageous compared to general anesthesia in selected patients. CSA allows a better postoperative analgesia, less effect on respiratory physiology and a faster return to oral intake. It ensures a faster recovery, particularly important in COVID-19 pandemic, to reduce the length of hospital stay and the admissions in postoperative intensive care units. We report a fifty-year-old man, ASA III, proposed to an urgent segmental enterotomy due to an acute bowel obstruction. Patient's personal history included an acute exacerbation of chronic obstructive pulmonary disease caused by pneumonia diagnosed two days before (Figure1). For this reason and lack of available intensive care unit beds due to COVID-19 pandemic, we decided to perform a CSA in L1-L2 space. A bolus of hyperbaric bupivacaine 5mg and sufentanil 2mcg was administered and the next bolus were titrated to patient complaints. The procedure lasted 2h15min, and the patient remained hemodynamically stable and with no complaints of pain, nausea or vomiting. The catheter was removed at the end of the procedure. COVID-19 has burdened health care systems reducing the critical care units available for non-COVID- 19 patients. This limitation and also the risk of contamination, induced an adaptation of anesthesia guidelines advised to consider regional anesthesia whenever possible. Despite the advantages, CSA has also disadvantages and risks that need to be considered, such as hemodynamic instability and respiratory distress if a high block is achieved. This technique allows to perform surgical interventions in patients who would otherwise be classified as non-eligible to surgery or who would be postponed due to lack of available beds in postoperative intensive care units. Since it avoids airway approach, it also allows healthcare protection during COVID-19 pandemic.
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Background: Although initially considered at higher risk for severe presentations of COVID-19, observational studies with SCD patients have mostly pointed to clinical severity similar to the general population. However, the level of vulnerability of these individuals to become infected and the determinants for their contagion are still uncertain. Aims: To assess the prevalence of SARS-Cov-2 antibodies in SCD patients followed at a Brazilian center and its correlation with phenotypic and socioeconomic determinants. Methods: A questionnaire was applied regarding demographics, socioeconomic status, use of Hydroxyurea, working status and income, COVID-19 symptoms, and the perceptions about social isolation measures. Blood samples were taken for chemoluminescence IgG (anti-N) and IgM (anti-S) anti-SARS-CoV-2 tests (Abbott Architect™, Ireland);specific neutralizing antibody titers were accessed observing the cytopathic effect in cells incubated with patient serum-virus mixture. Results: From Jul/20 to Jan/21, 214 serological tests were performed on135 patients (86% of SCD patients registered at the center): 82 HbSS (61%), 41HbSC (30%), 8Sβ+ (6%), 4Sβ0 (3%);57% male and median age 42 (19-74). 66% were using Hydroxyurea and 4% were on chronic transfusion. In the analyzed period, 61 (45%) patients had vasoocclusive crises;37 (27%) had symptoms suggestive of COVID-19, but only 2 patients had a positive PCR for SARS-Cov-2. When questioned, only12% of patients did not consider themselves vulnerable to infection, and only17% believed that individual and collective protection measures were expendable. In fact, 91% stated that they were able to adopt basic social distance measures, with 76% reporting cancellation of social events and 64% managed to reduce the use of public transport, but only 44% could work or study remotely. Regarding serological evaluation, 57 patients (42%) were tested more than1 time during this period: 46 with 2 tests,11 with ≥ 3 tests. Among all patients,15 had positive results: 9 IgG/IgM+ and 6 IgG+ only, therefore with an overall seroprevalence of11%. Seroconversion was documented for only1 patient during the study period and, interestingly, with no signs and symptoms of infection. Moreover, 2 patients lost positivity for IgG 3 months after the initial positive test. The search for functionally neutralizing antibodies resulted in 9 patients with low titers (□1:40) and only 3 patients with remarkably high titers (≥1:640). There were no correlations between test positivity and education, income, number of household contacts and maintenance of work outside the home;however, serological positivity was associated with older age (40.3 x 22.9, p<.001) and regular use of public transport (Fisher exact test, p=0.02). Only1 patient in this cohort needed hospitalization for COVID-19, including mechanical ventilation and exchange transfusions, but was discharged after14 days Summary/Conclusion: These data attest to the effectiveness of social distancing instructions given to patients in our SCD clinic throughout the pandemic, considering the low overall positivity and only1 seroconversion during the study period. The fact that only1 patient in our center had severe disease agrees with other reports showing less severity for SCD than initially expected. In fact, the transient positivity of serological tests and the low levels of functional neutralizing antibodies in SCD patients may indicate the acquisition of protective immune responses that are not dependent on antibodies and that still need to be better evaluated.
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Candida auris was first described in Japan and since then outbreaks of infection and colonization considered serious by C. auris have been reported in different countries. This work aims to show, with updated and relevant information from the literature, the potential for emergence of the yeast C. auris, as well as to present knowledge about the means of drug resistance of this pathogen. This study is an integrative literature review. The emergence of C. auris is characterized by its high capacity for drug resistance, with various resistance mechanisms and preference for hospital environments, especially immunosuppressed patients. The pathogen has limited therapeutic options and can cause several infections, most of which are serious, as they occur in conjunction with other adjacent complications such as COVID-19. C. auris has a high potential to be the protagonist of a new pandemic with a characteristic of multidrug resistance and the capacity for high mortality rates.