Factors associated with non-invasive positive pressure ventilation failure in a COVID-19 Intermediate Care Unit

Aim: To evaluate the efficacy of NIPPV (CPAP, HELMET-CPAP or NIV) in COVID-19 patients treated in the dedicated COVID-19 Intermediate Care unit of Coimbra Hospital and University Centre (CHUC), Portugal, and to assess factors associated with NIPPV failure. Method(s): Patients admitted to the Intermediate Care Unit of CHUC, from December 1st 2020 to February 28th 2021, treated with NIPPV due to confirmed COVID-19 were included. The primary outcome was NIPPV failure (orotracheal intubation (OTI) or death during hospital stay). Factors associated with NIPPV failure were included in an univariate binary logistic regression analysis and those with a significance level of p<0.001 were selected to enter a multivariate regression model. Result(s): 163 patients were included, 64.4% were males (n=105) and the median age was 66 years (IQR 56-75). Overall, 97 patients (59.5%) were successfully treated with NIPPV, while failure was observed in 66 (40.5%), of which 26 (39.4%) were intubated and 40 (60.6%) died during hospital stay. Highest CRP during hospital stay (OR 1.164;95%CI 1.036-1.308) and morphine use (OR 24.771;95%CI 1.809-339.241) were identified as independent predictors in the multivariate logistic model. Adherence to prone positioning (OR 0.109;95%CI 0.017-0.700) and a higher value of the lowest platelet count during hospital stay (OR 0.977;95%CI 0.960-0.994) were associated with a favourable outcome. Conclusion(s): Highest CRP and morphine use were independent predictors of OTI or death. Adherence to prone positioning and a higher value of the lowest platelet count during hospital stay were associated with a favourable outcome.

Relacao Entre O Indice Rdw, Gravidade E Mortalidade De Pacientes Internados Com Covid-19 No Municipio De Uberaba-Mg

Objetivo: Avaliar os indices RDW de pacientes hospitalizados por COVID-19 no municipio de Uberaba-MG e estabelecer uma relacao com a gravidade e mortalidade durante o periodo de internacao. Material e Metodos: Este estudo foi aprovado pelo Comite de Etica em Pesquisa do Hospital de Clinicas da Universidade Federal do Triangulo Mineiro (CAAE ndegree 31328220.8.0000.8667). Foram levantados os dados epidemiologicos de 337 pacientes que estiveram internados em 3 unidades hospitalares do municipio de Uberaba-MG no periodo de maio de 2020 a junho de 2021. Foram coletados os seguintes dados: idade, sexo e desfecho. A classificacao de gravidade foi estabelecida de acordo com os criterios determinados no COVID-19 Clinical Management Living Guidance - World Health Organization, 2021. Os dados coletados foram compilados em uma planilha no programa Excel e posteriormente analisados por meio do programa GraphPad Prism© versao 8.4.3. A variavel continua foi descrita por media+/-desvio padrao. As variaveis quantitativas foram descritas por meio dos testes: Kolmogorov-Smirnov para verificacao da normalidade e as comparacoes entre os grupos por meio dos testes Mann-Whitney e Kruskal-Wallis. Os resultados foram considerados significativos quando p < 0,05. Resultados: Dos 337 pacientes analisados, 61,2% eram homens com idade media de 58,2 anos (DP +/- 15,6). Em relacao ao desfecho foi observado um aumento estatisticamente significante do indice RDW (p < 0,0001) no grupo que de pacientes que foram a obito (mediana 14,71%) quando comparado ao grupo que teve alta (mediana 13,32%). Quanto a gravidade foi verificado um aumento estatisticamente significante do indice RDW (p < 0,0001) de acordo com a gravidade do caso, quanto mais grave maior o indice. Foram observadas diferencas estatisticas entre os grupos leve e grave (p < 0,0001) e moderado e grave (p < 0,0001). As pacientes do sexo feminino tinham em media 60,8 anos (DP +/- 18) e corresponderam a 38,8% dos casos analisados. Em relacao ao desfecho foi observado um aumento significativo do indice RDW (p < 0,0001) no grupo de pacientes que foram a obito (mediana 14,56%) comprado ao grupo de pacientes que tiveram alta (mediana 13,63%). Em relacao a gravidade tambem foi visto um aumento do indice RDW em casos moderados e graves (p<0,001). Foram observadas diferencas significativas entre os grupos leve e grave (p < 0,05) e moderado e grave (p < 0,05). Discussao: O indice RDW tem sido apontado como um potencial marcador prognostico e de desfecho no curso da COVID-19. Ja foi demonstrado um aumento do indice RDW em pacientes com doencas infecciosas graves. Esse estudo demonstrou o aumento dos indices RDW em pacientes homens e mulheres conforme a progressao da gravidade. Os casos moderados, graves e os pacientes que foram a obito, independente do sexo, demonstraram maiores indices. Conclusao: O indice RDW tem grande potencial como marcador prognostico e de monitoramento do curso da evolucao da COVID-19 em pacientes de ambos os sexos, pois quanto maior o indice RDW maiores as chances de severidade e obito. Copyright © 2022

Perfil Clinico-Epidemiologico De Individuos Com Covid-19 Atendidos Em Unidades Hospitalares Do Municipio De Uberaba - Mg

Objetivo: Descrever o perfil clinico-epidemiologico de pacientes com COVID-19 atendidos em hospitais de Uberaba - MG. Material e Metodos: Trabalho aprovado pelo Comite de Etica em Pesquisa do Hospital de Clinicas da Universidade Federal do Triangulo Mineiro (CAAE ndegree 31328220.8.0000.8667). Foram coletados dados de 371 individuos com COVID-19, atendidos entre maio/2020 e junho/2021. As variaveis analisadas foram: genero, idade, sintomatologia, comorbidades, medicamentos e desfecho (alta/obito). Utilizou-se o programa SPSS, versao 20.0 para o tratamento dos dados coletados. Considerou-se estatisticamente significantes valores de p < 0,05. Resultados: Dentre os 371 pacientes, 39,9% eram mulheres e 60,1%, homens. Os sintomas predominantes foram dispneia (70%), tosse (60%) e febre (50%). Acerca das comorbidades, HAS (44,6% M e 49,8% H), DM (29% M e 24,7% H) e obesidade (16,2% M e 12,1% H) foram as mais prevalentes. Os medicamentos mais utilizados foram heparina (87,2% M e 86,1% H) e corticoide (81,1% M e 80,7% H). Houve pior desfecho entre os pacientes mais velhos;sendo a presenca de comorbidades e o tempo de internacao significativamente maiores para homens que foram a obito se comparados aos que receberam alta (p = 0,004 e p = 0,002, respectivamente). Discussao: No presente estudo, houve um predominio de pacientes do sexo masculino, o que diverge de um estudo realizado no estado de Pernambuco, que relatou um predominio do sexo feminino. Por outro lado, esse mesmo estudo aponta achados semelhantes aos nossos em relacao aos sintomas apresentados pelos pacientes, como dispneia, tosse e febre sendo os mais frequentes nos dois estudos, demonstrando um comportamento semelhante da sintomatologia da doenca no Brasil. Alem disso, a literatura tambem vem demonstrando que a presenca de comorbidades, em especial HAS e DM, sao importantes fatores de risco para o agravamento e pior prognostico em individuos com COVID-19. No presente trabalho, a prevalencia de comorbidades foi maior no grupo de individuos do sexo masculino que foram a obito e observamos maior incidencia de hipertensao, diabetes e obesidade em toda a nossa casuistica, corroborando os dados da literatura. No tocante a medicacao, foi observado o uso de heparina e corticoide, independentemente da gravidade. Estudos demonstram que o tratamento com corticosteroides reduz o risco de morte em pacientes graves, incluindo aqueles em ventilacao mecanica. Em relacao a heparina, um ensaio clinico demonstrou que o farmaco reduz o risco de mortes por complicacoes da doenca, se administrada aos primeiros sinais de insuficiencia respiratoria. Conclusao: Conclui-se que a idade mais avancada e comorbidades previas estao relacionadas a um pior prognostico em individuos infectados pelo SARS-CoV-2 na amostra analisada. Copyright © 2022

Investigacao Do Gene Nr3c1 Em Pacientes Com Covid-19

Objetivo: O presente trabalho tem por objetivo investigar o gene NR3C1, que codifica os receptores de Glicocorticoide (GCs), em individuos com COVID-19. Material e Metodos: Foram analisadas 58 amostras de pacientes com COVID-19, atendidos em hospitais do municipio de Uberaba - MG entre maio de 2020 a junho de 2021. Este projeto foi aprovado pelo Comite de Etica em Pesquisa do Hospital de Clinicas da Universidade Federal do Triangulo Mineiro e todos os participantes assinaram o Termo de Consentimento Livre e Esclarecido. A amostra foi agrupada de acordo com o desfecho (alta ou obito) e gravidade da doenca (leve, moderada ou grave). A determinacao de gravidade dos casos foi realizada segundo os criterios estabelecidos no Manual de Manejo Clinico da COVID-19 da Organizacao Mundial de Saude. Foram coletados um tubo de 04 mL de sangue periferico na admissao do paciente e a quantificacao relativa do gene NR3C1 foi realizada por PCR em tempo real, utilizando o equipamento 7500 (Applied BiosystemsTM). O gene ACTB foi utilizado como controle endogeno. Os dados quantitativos foram submetidos ao teste de normalidade de Kolmogorov-Smirnov e as comparacoes estatisticas entre dois grupos realizadas com emprego do teste de Mann-Whitney. A significancia estatistica foi definida como p<0,05. Resultados: A idade mediana dos pacientes foi de 64,5 anos (min. 29, max. 100 anos). Dos 58 pacientes analisados, 26 eram mulheres e 32 homens. Em relacao ao desfecho, 31 obtiveram alta (17 mulheres 14 homens) e 27 evoluiram para obito (9 mulheres e 18 homens). Em relacao a gravidade, 13 pacientes tiveram quadro clinico leve (07 mulheres e 06 homens), 16 moderado (08 mulheres e 08 homens) e 29 grave (11 mulheres e 18 homens). Nao foi observada diferenca estatisticamente significativa na expressao do gene NR3C1 quanto ao desfecho ou gravidade (p=0,49 e p=0,25, respectivamente). Discussao: Acredita-se que a genetica humana tenha um importante papel na determinacao da resposta clinica ao SARS-CoV-2, no entanto, o estabelecimento dos mecanismos geneticos envolvidos na suscetibilidade ou resistencia a infeccao ainda nao sao completamente conhecidos. Os GCs inibem rapidamente a transcricao de citocinas pro-inflamatorias, como a IL-6. Essa citocina, por sua vez, esta envolvida num fenomeno denominado "tempestade de citocinas", em que ha uma exacerbacao da resposta imunologica. Na COVID-19 as manifestacoes de doenca grave e morte nao se apresentam exclusivamente pelos danos induzidos pelo virus nos pulmoes, mas tambem devido aos niveis elevados de citocinas, particularmente IL-6, que podem ser inibidas por GCs. Apesar do presente estudo nao ter observado diferenca na expressao do gene NR3C1 em relacao ao desfecho e gravidade, os receptores de GCs tem importante desempenho na supressao da "tempestade de citocinas". Alem disso, ja foi demonstrado que o uso de glicocorticoides em doses baixas e medias por ate oito dias e seguro e benefico para pacientes com COVID-19 grave. Conclusao: O presente estudo conclui que nao ha relacao entre a expressao do gene NR3C1 com o agravamento ou pior desfecho em pacientes com COVID-19. Copyright © 2022

Assessment of the Influence of Prf1 and Gzmb Genes in Relation to Severity and Outcome in Patients with Covid-19

Objective: This study aimed to evaluate the role of genes encoding perforin (PRF1) and granzyme B (GZMB) in SARS-CoV-2 infection. Material(s) and Method(s): This is a cohort study in which the expression of the PRF1 and GZMB genes was quantified by qPCR, as well as the investigation of the rs35947132 and rs885822 polymorphisms in the PRF1 gene in 86 patients with COVID-19 treated in hospitals from Uberaba/MG, Brazil. Result(s): Patients who died had significantly lower PRF1 gene expression than those who survived. As for the severity of the disease, the expression was significantly lower of both genes in those patients with more severe clinical conditions. Characteristics such as sex, age and presence of comorbidities did not show differences in the expression of the PRF1 gene. Regarding the presence of polymorphisms, no differences were observed in relation to the parameters evaluated, such as outcome, severity, sex, age and presence of comorbidities, indicating that these alterations do not seem to directly influence these aspects. Despite this, it was observed that those who were homozygous for the rs885822 polymorphism had higher expression of the PRF1 gene when compared to patients with heterozygous or homozygous wild-type alleles. Discussion(s): The difference in the expression of the perforin gene regarding the outcome and severity may be due to greater activation of lymphocytes and consequently an increase in the expression of these genes, leading to a better prognosis. It is necessary to investigate whether patients who died and those who developed more severe manifestations of the disease have some immune deficiency related to cytotoxic lymphocytes. When it comes to the analysis of polymorphisms, the results found to differ from the literature, which considers that the presence of the rs35947132 polymorphism is more prevalent in patients with severe forms of COVID-19. The literature demonstrates that individuals with the polymorphic allele rs35947132 express less perforin, but the studies analyzed were performed using different techniques. A limitation of the present study is the sample size. We believe that the increase in the number of cases evaluated can provide us with a better understanding of this topic. Regarding the rs885822 polymorphism, the higher expression of the perforin gene contradicts the initial hypothesis of the work. However, one of the possible explanations for this fact would be the existence of other polymorphisms in linkage unbalance that trigger an increase in the expression of the PRF1 gene. Conclusion(s): The present study concludes that the PRF1 gene was less expressed in patients with more severe COVID-19 and in those who died. Furthermore, in the analysis of perforin gene variants presence, no association was observed between the polymorphisms and the severity or outcome of individuals with COVID-19. Copyright © 2022

Impact of COVID-19 infection and COVID vaccinations on the management of MS and related disorders in a low middle income country-real world experience from a demyelinating disease registry

Background and objective: The impact of COVID-19 infection and the effect of vaccinations on patients with demyelinating central nervous system disease in low middle income countries (LMIC's) have not been reported in detail earlier. We sought to identify risk factors associated with COVID-19 infection and the role of vaccinations in patients with MS and related disorders in order to develop management guidelines relevant to our patients. Method(s): A total of 621 patients (297 MS and 324 non MS disorders) from our registry were contacted. COVID-19 infection and vaccination status were queried. Patients who had infection were compared with noninfected patients to identify factors associated with susceptibility for COVID-19 infection. Univariate and multivariate analysis of potential risk factors included demographic and clinical features, body mass index (BMI), presence of comorbidities, absolute lymphocyte count, treatment types and vaccination status. Result(s): Sixty seven patients with MS and 27 with non MS disorders developed COVID-19 infection. Among them 13 patients were hospitalized, all of whom recovered. Vaccination status was known in 582 patients among whom 69.8% had completed or taken one dose of vaccine at the time of inquiry. Majority of treated patients (61.3%) were on nonspecific immunosuppressants. Multivariate analysis of all patients with MS and related disorders showed that higher mean body mass index(BMI [p - 0.002, OR- 0.86,95% CI - 0.78-0.94]), presence of >= 1 comorbidity ( p-0.005, OR- 3.57,95% CI- 1.46- 8.7) and concurrent treatment with disease modifying therapy(p- 0.004, OR- 2.80, 95% CI- 1.39- 5.6)were significantly associated with risk of COVID-19 infection. Vaccination against COVID-19 infection was strongly protective (p- 0.0001, OR- 0.10, 95% CI- 0.05- 0.20). In the unvaccinated group, patients on treatment ( 61% were on nonspecific immunosuppressants) were significantly at risk of Covid-19 infection (p- 0.001, OR- 10.1, 95% CI- 4.59- 22.22) when compared to untreated patients. Conclusion(s): Frequency and severity of COVID-19 infection was low among our patient cohort.Higher rate of infection in the treated group was significant among unvaccinated patients. Our preliminary results suggests that in LMIC's, where off label therapies with inexpensive immunosuppressives are the main disease modifying drugs, mRNA vaccinations appear safe and protective against severe COVID-19 infection.

Nursing knowledge and practices regarding placing patients in the prone position: a descriptive study

Objective: to describe the knowledge and practice of nursing workers providing intensive care to COVID-19 patients in prone position. Method: descriptive and qualitative study addressing the nursing staff of an intensive care unit (ICU) from a public hospital located in Niterói, Rio de Janeiro, Brazil. Results: knowledge was grouped into three thematic categories: Nursing care provided before placing a patient in the prone position;Nursing procedures while patients are in the prone position;and Nursing care after patients return to the supine position. Conclusion: the knowledge and practices of nursing professionals concerning the care provided to COVID-19 patients while in the prone position indicate that workers focus on preventing complications and ensuring the patients' wellbeing, recovery, and improved quality of life during hospitalization. © 2022. Online Brazilian Journal of Nursing. All Rights Reserved.

Distress and pleasure indicators in health care workers on the COVID-19 front line

Objective: To evaluate distress and pleasure indicators in health care workers on the front line of care for suspected or confirmed COVID-19 cases. Method: An exploratory, analytical and cross-sectional study with a quantitative approach. The studied sample consisted of 437 health professionals invited by electronic means, who answered the questionnaire on socio demographic information, occupational aspects and clinical conditions. Distress and pleasure at work were considered as outcomes, which were analyzed with multinomial logistic regression regarding the associated independent variables. Results: Most of the participants were female (71.0%), nurses (55.6%), with a weekly working shift of 40 hours or more (75.8%);61.6% of the participants suffered from mental distress. The psychosocial characteristics of high-strain work and low social support were reported by 23.8% and 52.9% of the participants, respectively. In the multiple analysis, distress and lack of pleasure at work were associated with high job strain, low support from coworkers and mental distress. The profession is also associated with distress at work. Conclusion: Distress and lack of pleasure at work are associated with occupational characteristics and mental strain among health care workers in the COVID-19 scenario. © 2022 Revista Latino-Americana de Enfermagem.

Covid-19 among the Brazilian Amazon indigenous people: factors associated with death

This case-control study paired by gender and age analyzes factors associated with the death of indigenous people from COVID-19 in the state of Amapá, Brazil. Data were collected from a public secondary database produced by the Amapá State Department of Health. Cases (n=29) were deaths of indigenous people from COVID-19 and controls were cures of the disease (n=87), recorded between April 2020 and January 2021. Data from individuals with active disease were excluded. Univariate analysis followed by multiple logistic regression were performed to study the independent variables associated with death. Most cases of death were women (51.7%), without comorbidities (62.1%), residing in cities of the Metropolitan Region of Macapá (RMM) (65.5%) and in urban areas (89.7%). Median age of the death group was 72 years (interquartile range=21.5). The final multiple model showed that indigenous individuals with cardiovascular comorbidity had a 4.01 times greater chance (95% confidence interval – 95% CI=1.05-15.36) of death by COVID-19 when compared with indigenous people without comorbidities. And that indigenous people residing in the RMM had a 2.90 times greater chance (95%CI = 1.10-7.67) of death when compared with indigenous residing in the countryside.

COVID-19 infection and vaccination against COVID-19: Impact on managing demyelinating CNS disorders in Southern India- experience from a demyelinating disease registry.

BACKGROUND AND OBJECTIVE: The impact of COVID-19 infection and the effect of COVID-19 vaccinations on patients with demyelinating central nervous system disease in low middle income countries (LMIC's) have not been reported in detail earlier. We sought to identify risk factors associated with COVID-19 infection and the role of vaccination in order to develop management guidelines relevant to our patients. METHODS: A total of 621 patients from our registry that included 297 MS and 324 non MS disorders (Aquaporin- 4 antibody positive [50], Myelin oligodendrocyte glycoprotein antibody positive [81], seronegative [162] and clinically isolated syndrome [31]) were contacted. COVID-19 infection and vaccination status were queried. Patients who self reported COVID-19 infection based on a positive RT PCR report were compared with non infected patients to identify factors associated with susceptibility for COVID-19 infection. Univariate and multivariate analysis of potential risk factors included demographic and clinical features, body mass index (BMI), presence of comorbidities, absolute lymphocyte count, treatment types and vaccination status. RESULTS: Sixty seven patients with MS and 27 with non MS disorders developed COVID-19 infection. Among them 81 patients had mild infection and remained quarantined at home. All 13 patients who needed hospitalization recovered. Vaccination status was known in 582 patients among whom 69.8% had completed or taken one dose of vaccine at the time of inquiry. Majority of treated patients (61.3%) were on nonspecific immunosuppressants. In univariate analysis, presence of ≥1 comorbidity was significantly associated with COVID-19 infection in both MS (p value 0.01, OR-2.28, 95%CI- 1.18-4.4) and non MS patients (p- 0.001, OR-4.4, 95% CI-1.88-10.24). In the latter, BMI ≥ 30 (p-0.04, OR-3.27, 95% CI- 0.98-10.87) and EDSS score ≥ 3 (p-0.02, OR- 2.59,95% CI- 1.08-6.23) were other significant associations. History of prior COVID-19 vaccination was associated with reduced frequency of COVID-19 infection among MS (p- 0.001,OR- 0.24,95% CI- 0.13-0.43) and non MS patients (p- 0.0001,OR-0.14, 95% CI- 0.058-0.35). In multivariate analysis presence of comorbidities significantly increased and prior vaccination significantly reduced frequency of COVID-19 infection for both MS and related disorders. Concurrent disease modifying treatments showed a trend for association with infection. In the unvaccinated group, patients on disease modifying treatment were significantly at risk of infection, 81.5% unvaccinated and treated versus 18.5% who were unvaccinated and untreated (p- 0.0001, OR-10.1, 95% CI-0.56-2.11). CONCLUSION: Frequency and severity of COVID-19 infection was low among our patient cohort. Higher rate of infection in the treated group was significantly seen among unvaccinated patients. Our preliminary results suggests that in LMIC's, where "off label therapies" with inexpensive immunosuppressives are the main disease modifying drugs, mRNA vaccinations appear safe and effective against severe COVID-19 infection.

ASSOCIAÇÃO ENTRE GRUPO SANGUÍNEO ABO, GRAVIDADE E MORTALIDADE POR COVID-19

Objetivo: Avaliar a relação entre o sistema ABO e os índices de gravidade e mortalidade em pacientes hospitalizados por COVID-19 no município de Uberaba-MG. Material e métodos: Participaram deste estudo 343 pacientes atendidos em unidades hospitalares do município de Uberaba – MG. Foram determinadas as fenotipagens eritrocitárias por prova reversa em todas as amostras de sangue periférico e coletados os dados clínicos e epidemiológicos de cada paciente. A análise estatística dos resultados foi realizada de forma descritiva e inferencial. Para variáveis quantitativas, utilizaram-se medidas de posição ou centralidade (média) e medidas de dispersão e variabilidade (desvio padrão). As variáveis categóricas foram analisadas por meio do software SPSS, versão 20.0, bem como análise de associação em tabelas de contingências χ2. Os valores foram considerados estatisticamente significativos quando p ≤ 0,05. Resultados: Dos 343 pacientes avaliados no período de maio a novembro de 2020, 80,17% foram diagnosticados com COVID-19 e 19,83% negativos para a doença. Os pacientes positivos tinham idade média de 60,32 anos (DP ± 17,17) e a maioria eram homens (60%). Foram observadas comorbidades em 81% dos pacientes infectados. Quanto à tipagem sanguínea ABO nos casos positivos, não foram encontradas diferenças estatísticas entre os grupos analisados (χ2 = 3,24, p = 0,37), sendo 31,8% pacientes positivos do tipo A, 2% do tipo AB, 10,3% do tipo B e 55,9% do tipo O. Em relação a gravidade foi observado que 51,2% dos casos foram considerados graves (UTI entubados), 19,3% considerados moderados (UTI sem entubação) e 29,5% considerados leves (enfermaria), e quanto a mortalidade, 51,6% tiveram alta e 48,4% foram a óbito. Não foram encontradas diferenças estatisticamente significantes entre a relação de gravidade dos pacientes positivos para COVID-19 e o tipo sanguíneo ABO (χ2 = 4,781, p = 0,57). Quando realizada a comparação entre a mortalidade por COVID-19 e a tipagem sanguínea também não foram encontradas diferenças estatísticas (χ2 = 6,088, p = 0,11). Discussão: Recentemente foi sugerida correlação entre o tipo sanguíneo e a infecção por SARS-CoV-2. Alguns estudos apontaram o tipo sanguíneo A como o mais suscetível a infecções graves. Embora tenhamos realizado a determinação da tipagem sanguínea apenas por prova reversa, nossos resultados foram semelhantes ao de outros estudos em que não houve nenhuma relação entre os tipos sanguíneos, gravidade e mortalidade por COVID-19. Conclusão: De acordo com os dados encontrados nessas análises, o tipo sanguíneo ABO não parece estar associado a gravidade e a mortalidade da COVID-19, portanto, o sistema ABO não deve ser considerado como marcador biológico prognóstico para a COVID-19.

YOUTH AND ADULT EDUCATION (EJA) IN THE CONTEXT OF PANDEMIA

This article, part of a broader research entitled "Impact of the use of educational technologies through remote teaching on school activities in Bahia municipalities in the context of the Covid-19 pandemic', analyzes and discusses the perception of teachers, as well as the necessary measures for non-classroom teaching in Youth and Adult Education (EJA). The methodological path of the research was based on qualitative and quantitative methods, being of an exploratory and descriptive nature. The data indicate that EJA is one of the modalities of educational offer that suffers the most from the impacts caused by the pandemic, since the particularities of this field of education, in addition to the specificities of its subjects, present themselves as obstacles to operationalize emergency remote education as an alternative against the suspension of face-to-face activities.

IMPACTS OF COVID-19 SOCIAL DISTANCING ON COMMUNICATION OF CHILDREN AND ADOLESCENTS WITH AUTISM

During the Covid-19 pandemic, one of the restrictions was social distancing, which impacted everyone's lives. This study aimed to analyze the effects of social distancing on the communication of children and adolescents with autism. This is a descriptive, cross-sectional study, in which 322 parents or guardians answered an online questionnaire. As a result, the following stand out: 96.60% of the participants who study stopped attending school;88.20% of the respondents assessed that there was a change in the child's behavior during the period of social distancing;68.6% assessed that the changes were negative, 31.4% that they were positive;46.70% indicated changes in the interaction as positive, 53.30% as negative;70.35% stated that they had more eye contact and facial expression, 29.65% stated that they had less;48.45% observed that language and communication were better, 51.55% that they were worse. We conclude that at least half of the children and adolescents investigated worsen in the known aspects, the Covid-19 pandemic had implications for the communication of children and adolescents with autism, and it is important that they receive support.

CRIANÇAS COM SÍNDROME RESPIRATÓRIA AGUDA GRAVE (SRAG) CONFIRMADA EM HOSPITAL DE REFERÊNCIA PEDIÁTRICA EM BELO HORIZONTE, MINAS GERAIS

Introdução: Descrever o perfil epidemiológico de crianças com infecção confirmada por SRAG internadas no Hospital Infantil João Paulo II (HIJPII), referência em doenças infectocontagiosas, entre março de 2020 e agosto de 2021. Método: Trata-se de um estudo realizado pelo Núcleo de Vigilância Epidemiológica Hospitalar (NUVEH) do HIJPII, utilizando os dados das fichas de notificação de SRAG, Este estudo foi aprovado pelo Comité de Ética em Pesquisa da FHEMIG sob parecer: 4.312.966. Resultados: Entre março de 2020 e agosto de 2021, 2702 crianças internaram no HIJPII e foram notificados com SRAG. Foram realizados 2269 testes RT-PCR para SARS-CoV-2, 1026 pacientes realizaram teste rápido de antígeno e/ou fizeram o painel viral na Fundação Ezequiel Dias. A etiologia viral foi identificada em 692 crianças: 278 (40,2%) positivos para vírus sincicial respiratório (VSR), 174 (25,1%) positivos para rinovírus, 164 (23,7%) positivos para SARS-CoV2, 34 (4,9%) positivos para influenza A e/ou B, e 5,9% foram positivos para outros vírus (25 bocavirus, 3 parainfluenza, 13 adenovírus e 1 coronavírus sazonal). O diagnóstico de VSR foi realizado por RT-PCR em 72% e teste rápido de antígeno em 28%. SARS-CoV-2 foi detectado por RT-PCR em 81% e por teste rápido de antígeno em 19%. A idade variou entre 15 dias de vida e 18 anos, mas 72,9% eram menores de 6 anos, 55,5% do sexo masculino, 82% moravam em Belo Horizonte ou na região metropolitana. Entre as manifestações clínicas mais frequentes foram febre, tosse, diarreia, esforço respiratório, cianose e saturação menor que 95%. Nos casos mais graves as crianças tinham comorbidades, as mais frequentes: displasia broncopulmonar, doença neurológica crônica não progressiva, obesidade, anemia falciforme e cardiopatia. A letalidade por SRAG no HIJPII no período foi de 20,5% (4 crianças com SARS-CoV-2 e uma criança com VRS);entretanto apenas 29,4% dos óbitos por SRAG tiveram a etiologia viral identificada por não terem coletado painel viral. Conclusão: Os resultados encontrados reforçam a necessidade da realização do painel viral, para melhorar os dados da Vigilância Epidemiológica. Sua solicitação foi reduzida na pandemia, devido ao alto número de internações e necessidade de leitos, optou-se por realizar testes rápidos. Entretanto, como no HIJPII estão disponíveis testes rápidos apenas para VRS, SARS-CoV-2 e influenza, muitas crianças com SRAG ficaram sem identificação viral.

COVID-19: Factors associated with the death of health professionals in a state in the Brazilian amazon

Introduction Amapá is a state in the Brazilian Amazon, located on the left bank of the Amazon River, which in 2020 had a population of 860,000 inhabitants. It is one of the Brazilian states with the greatest socioeconomic vulnerability and with low medical and hospital density. In the context of COVID-19, the health services of the State presented a high burden, with the lack of personal protective equipment for health professionals and many absences from work due to illness. Objective To analyze factors associated with the death of health professionals by COVID-19 in the State of Amapá. Methods Case-control study that used official data produced and made publicly available by the State Department of Health of Amapá. The events of interest were deaths of health professionals, residing in the State, by COVID-19 and the controls were individuals cured of the disease. Active cases of the disease were excluded from the analysis. The analyzed data were recorded between March 2020 and January 2021. Logistic regression was used for analysis, with a significance level of p-value < 0.05. Results Data from 1,258 professionals were included in the analysis. Of this total, 20 had an outcome of death and 1,238 had a cured outcome of COVID-19. The majority were female (67.7%), race/brown (66.9%), without comorbidity (86.6%), living in the Metropolitan Region of Macapá (capital of the State) (56.7%). Factors associated with death were: age > 65 years (odds ratio (OR) 10.43;95% confidence interval (CI) 2.78-39.11), presence of comorbidity (OR 4.52;95% CI 1.74-11.74) and residence in the region metropolitan area of Macapá (OR 4.37;95% CI 1.25-15.29). The model was adjusted by the gender variable. Conclusion Protective actions for workers most susceptible to death, such as moving to activities with less exposure and/or teleworking, are necessary.

Socioeconomic and clinical factors associated with death and hospitalization of health professionals affected by COVID-19 in Brazil, 2020

Introduction The new coronavirus pandemic affected the lives of millions of people across the planet in 2020. Brazil, in just a few months, became the epicenter of the pandemic in Latin America. This, due to the absence of vaccines and the ineffective isolation measures adopted. In this context, health professionals stand out as a group with greater exposure and risk of being affected by COVID-19. Objective To analyze clinical and sociodemographic characteristics associated with death and hospitalization of health professionals due to COVID-19, in addition to calculating the incidence rates per occupation. Methods We conducted a cross-sectional observational study that used secondary data from the State of Espírito Santo Health Department. COVID-19 cases in healthcare professionals were recorded between February 27 and August 17, 2020 in Espírito Santo, Brazil. Cases with a lack of information were excluded. To compare the sociodemographic and clinical characteristics of health professionals with the clinical outcomes (cure or death) and the need for hospitalization, a bivariate analysis was performed using the X2 tests of independence or Fisher's exact test. Data analysis was performed using the SPSS 20.0 software. Results 75.6% (n = 9,191) of the cases were female;the general lethality rate was 0.27% and the general hospitalization rate was 1.0%. The clinical outcome of death and the occurrence of hospitalization were associated with: male gender, age greater than or equal to 50 years, higher education, fever, difficulty breathing, cough, cardiac comorbidity, diabetes and obesity (p <0.05). Only the occurrence of hospitalization was associated with: case reported in the metropolitan region of Vitória-ES, runny nose, sore throat, headache and renal comorbidity (p <0.05). The occupation with the highest incidence rate was nurses (16,053 cases/100,000 nurses). Conclusion The study demonstrated a high frequency of cases in females, low general lethality and high incidence in nurses.

Satisfaction with teleconsultation in inflammatory bowel disease patients during the covid-19 pandemic

Introduction: In the context of COVID-19 pandemic, regular health care activities had to be stopped in many centers to minimize the transmission rate of SARS-CoV-2 virus. Therefore, patients with inflammatory bowel disease (IBD) frequently had limited access to hospital consultations. Telemedicine was rapidly applied in several hospitals to overcome this challenge, however, there is only a very limited number of studies evaluating the impact and patient satisfaction with teleconsultation in this situation, particularly in IBD patients. Aims & Methods: Our main purpose was to assess IBD patient satisfaction with teleconsultation in hospital setting during COVID-19 pandemic. We performed a retrospective study in IBD patients evaluated by telephone consultation during a pandemic peak in January-February 2021. Patients were contacted by telephone to answer a quality survey composed of 18 questions on the quality of the teleconsultation and patients who agreed to answer the survey were included. Consultations were performed by two doctors and all patients have had a previous in-person consultation with the same doctor who performed the teleconsultation. Results: Ninety-three patients were included, with a mean age of 51.7(±16.3) years-old, 45,2% were male. Thirty-eight (40.9%) patients avoided medical facilities during the pandemic and 15.1% had medical consultations canceled while only 2.2% had treatments canceled. Eight (8.6%) patients required assistance from a relative during teleconsultation while no patients reported difficulties on listening or understanding the doctor by telephone. The overall satisfaction with teleconsultation was 8 (IQR 8-9.5) in a scale of 1 to 10. Forty-two (45.2%) patients considered teleconsultation acceptable during COVID-19 pandemic and 41 (44.1%) would like to have followup teleconsultations after COVID-19 era. In the 49 patients with gastrointestinal symptoms at the time of teleconsultation, 59,2% improved symptoms after the appointment. Indication to in-person evaluation at the hospital occurred in 10 (10.8%) patients, none of those requiring evaluation at the emergency department. Medication was adjusted in 16 (17.2%) patients and in 60 (64.5%) was requested a complementary test. Preference for teleconsultation was significantly higher in younger patients (mean age 47.7 vs 56.4 years;p=0.009). Acceptance to follow-up teleconsultations in the post-pandemic future was also higher in younger patients (mean age 46.5 vs 55.7 years;p=0.007) as well as male patients (57.1% vs 33.3%;p=0.021). Conclusion: The results of this study demonstrate that patient satisfaction with teleconsultation in IBD patients was high during the COVID-19 pandemic. Younger patients may also be more receptive to teleconsultation during and after COVID-19 pandemic. More studies are needed to further evaluate the impact of teleconsultation on IBP patients and provide an opportunity for its optional implementation in selected patients on post COVID-19 era.