Space-time risk clusters of COVID-19 in a tourism area in the northeastern Brazil: an epidemiological overview after two years of pandemic

The world is facing a serious viral infection caused by the new Severe Acute Respiratory Syndrome Coronavirus 2. We aimed to evaluate and map the high-risk clusters of COVID-19 in the State of Alagoas, a touristic area in northeastern Brazil, after two years of pandemic by a population-based ecological study, using COVID-19 cases reported in the State of Alagoas, between March, 2020 and April, 2022. We performed a descriptive and statistical analysis of epidemiological data. We then map high-risk areas for COVID-19, using spatial analysis, considering the incidence rate by municipality. 297,972 positive cases were registered;56.9% were female and 42.7% aged between 20 and 39 years old. Men (OR = 1.59) and older than 60 years old (OR = 29.64) had a higher risk of death, while the highest incidence rates of the disease occurred in the metropolitan region. Our data demonstrate the impact of COVID-19 in the State of Alagoas, through the two years of pandemic. Although the number of cases were greater among women and young adults, the chance of death was greater among men and older adults. High-risk clusters of the disease initially occur in metropolitan cities and tourist areas.

Adipose tissue, systematic inflammation, and neurodegenerative diseases

Obesity is associated with several diseases, including mental health. Adipose tissue is distributed around the internal organs, acting in the regulation of metabolism by storing and releasing fatty acids and adipokine in the tissues. Excessive nutritional intake results in hypertrophy and proliferation of adipocytes, leading to local hypoxia in adipose tissue and changes in these adipokine releases. This leads to the recruitment of immune cells to adipose tissue and the release of pro-inflammatory cytokines. The presence of high levels of free fatty acids and inflammatory molecules interfere with intracellular insulin signaling, which can generate a neuroinflammatory process. In this review, we provide an up-to-date discussion of how excessive obesity can lead to possible cognitive dysfunction. We also address the idea that obesity-associated systemic inflammation leads to neuroinflammation in the brain, particularly the hypothalamus and hippocampus, and that this is partially responsible for these negative cognitive outcomes. In addition, we discuss some clinical models and animal studies for obesity and clarify the mechanism of action of anti-obesity drugs in the central nervous system.Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.

Lung Recruitment Assessed by Electrical Impedance Tomography (RECRUIT): A Multicenter Study of COVID-19 Acute Respiratory Distress Syndrome.

Rationale: Defining lung recruitability is needed for safe positive end-expiratory pressure (PEEP) selection in mechanically ventilated patients. However, there is no simple bedside method including both assessment of recruitability and risks of overdistension as well as personalized PEEP titration. Objectives: To describe the range of recruitability using electrical impedance tomography (EIT), effects of PEEP on recruitability, respiratory mechanics and gas exchange, and a method to select optimal EIT-based PEEP. Methods: This is the analysis of patients with coronavirus disease (COVID-19) from an ongoing multicenter prospective physiological study including patients with moderate-severe acute respiratory distress syndrome of different causes. EIT, ventilator data, hemodynamics, and arterial blood gases were obtained during PEEP titration maneuvers. EIT-based optimal PEEP was defined as the crossing point of the overdistension and collapse curves during a decremental PEEP trial. Recruitability was defined as the amount of modifiable collapse when increasing PEEP from 6 to 24 cm H2O (ΔCollapse24-6). Patients were classified as low, medium, or high recruiters on the basis of tertiles of ΔCollapse24-6. Measurements and Main Results: In 108 patients with COVID-19, recruitability varied from 0.3% to 66.9% and was unrelated to acute respiratory distress syndrome severity. Median EIT-based PEEP differed between groups: 10 versus 13.5 versus 15.5 cm H2O for low versus medium versus high recruitability (P < 0.05). This approach assigned a different PEEP level from the highest compliance approach in 81% of patients. The protocol was well tolerated; in four patients, the PEEP level did not reach 24 cm H2O because of hemodynamic instability. Conclusions: Recruitability varies widely among patients with COVID-19. EIT allows personalizing PEEP setting as a compromise between recruitability and overdistension. Clinical trial registered with www.clinicaltrials.gov (NCT04460859).

Association of Sociodemographic Factors and Maternal Educational Attainment with Child Development among Families Living below the Poverty Line in the State of Ceará, Northeastern Brazil.

Maternal educational attainment has been identified as relevant to several child health and development outcomes. This study aimed to evaluate the association of sociodemographic and maternal education factors with child development in families living below the poverty line. A cross-sectional study was conducted through telephone contact from May to July 2021 in Ceará, a state in Northeastern Brazil. The study population comprised families with children up to six years of age participating in the cash transfer program "Mais infância". The families selected to participate in this program must have a monthly per capita income of less than US$16.50. The Ages and Stages Questionnaire version 3 was applied to assess the children's development status. The mothers reported maternal educational attainment as the highest grade and or degree obtained. The final weighted and adjusted model showed that maternal schooling was associated with the risk of delay in all domains except for the fine motor domain. The risk of delay in at least one domain was 2.5-fold higher in mothers with a lower level of schooling (95% CI: 1.6-3.9). The findings of this study suggest that mothers with higher educational attainment have children with better child development outcomes.

Impacts of COVID-19 on Brazilian banana farming

This bulletin discusses the effects of the COVID-19 pandemic on the production, distribution, and consumption of bananas, which are an important crop in the Brazilian agricultural sector. The temporary closure of commercial points and institutions has caused significant impacts on the banana production chain, which was already facing other challenges such as phytosanitary issues and water restrictions. The bulletin highlights the nutritional benefits of bananas and presents short and medium-term alternatives to mitigate the negative impacts of the pandemic on banana producers. It also emphasizes the need for actions to strengthen the entire banana chain considering the "new normal" that is expected to emerge.

Lung-on-chip: Its current and future perspective on pharmaceutical and biomedical applications

Organ-on-a-chip is a three-dimensional microfluidic system that simulates the cellular structure and biological milieu of an organ, that seemed to be constructed and studied substantially in the last decade. Microchips can be configured to suit disease states in a variety of organs, including the lung. When contrasted to traditional in vitro models like monolayer cell lineages, lung-on-a-chip models lays out a pragmatic portrayal of disease pathophysiology and pharmaceuticals' mode of action, and this is especially more prevailing in connection with the COVID-19 pandemic. Animal models have typically been used in pharmaceutical drug screening to assess pharmacological and toxicological reactions to a new entity. These adaptations, on the other hand, do not precisely represent biological reactions in humans. Present and prospective uses of the lung-on-a-chip model in the pulmonary system are highlighted in this overview. In addition, the constraints of existing in vitro systems for respiratory disease simulation and therapeutic discovery would be emphasized. Attributes of lung-on-a-chip transformative features in biomedical applications will be addressed to illustrate the relevance of this lung-on-chip model for medical science.Copyright © 2022

Association Between Occupational Stress, Work Shift and Health Outcomes in Hospital Workers of the Recôncavo of Bahia, Brazil: The Impact of Covid-19 Pandemic.

The aim of this study was to ascertain the level of occupational stress before and during the COVID-19 pandemic, how it changed, and its association with health outcomes of hospital workers in the Recôncavo of Bahia, Brazil. A longitudinal study was conducted with 218 hospital workers over 18 years old. A semi-structured questionnaire was used for collecting sociodemographic, occupational, lifestyle, anthropometric, and health data. The main exposures were occupational stress, assessed through Job Content Questionnaire and classified according to the Demand-Control Model and reported shift work. Health outcomes considered were nutritional status assessed by Body Mass Index (BMI), Waist Circumference (WC), and Body Fat Percentage (BF%); health self-perception; and cardiovascular risk factors. We used McNemar chi-squared or Wilcoxon tests to compare levels of exposure and outcome variables before and during the pandemic, and odds ratios to evaluate associations between changes in occupational stress and shiftwork with health outcomes. During the pandemic, participants reported increased occupational stress and shift work, lower self-perceived health, and had higher BMI and cardiovascular risk factors, compared with before the pandemic. No association was observed between change in occupational stress and health outcomes. However, increased amount of shift work was related to increased BMI in the overall sample (OR 3.79, CI95% 1.40-10.30), and in health workers (OR 11.56; CI95% 2.57-52.00). These findings support calls to strengthen labour policies to ensure adequate working conditions for hospital workers in context of the COVID-19 pandemic.

IMPACT OF OACS ON OUTCOMES OF COVID-19 INFECTION IN OLDER ADULTS WITH HISTORY OF ATRIAL FIBRILLATION

Background: Age, atrial fibrillation (AF), and COVID-19 infection predispose patients to hypercoagulability and poor outcomes. It is unclear if older adults with AF and COVID-19 infection would benefit from oral anticoagulants (OACs). Methods: A retrospective study was conducted using the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). Using ICD-10 codes, adults aged 65–75 and Elixhauser Comorbidity index(ECI) >4 with a history of AF admitted for COVID-19 were identified. The use of OACs for 6 months before the index event was used to split the cohort into two propensity score-matched groups considering age, gender, and ECI. Records from both groups were reviewed for multiple outcomes during the same admission. Pearson's chi-squared test was used to compare groups. The strength of association was reported using Risk Ratios (RR). A p-value < 0.05 was deemed significant. Results: We compared 16,967 individuals in both anticoagulated and non-anticoagulated groups. Anticoagulated patients had a lower risk of mortality (RR=0.11, p=0.026), and a higher risk of 30-day all-cause readmission(RR=1.12, p < 0.0001). However, there were no differences in ICU admission, gastrointestinal bleeding, intracranial hemorrhage, thromboembolic events, or length of hospitalization. Conclusion: Compared to non-anticoagulated patients, older adults with a history AF on chronic oral anticoagulants had a lower risk of all-cause mortality, and higher risk of 30-day all-cause readmission. This information would help clinicians decide whether to prescribe OACs to this population of patients.

THE RISK OF COVID-19-RELATED MYOCARDITIS IN OLDER ADULTS WITH A HISTORY OF CORONARY ARTERY DISEASE

Background: Data suggest an increased incidence of myocarditis (MC) associated with the COVID-19 virus. However, the risk factors for COVID-19-related MC remains poorly understood and debated. Therefore, we sought to evaluate the correlation of a history of coronary artery disease (CAD) with MC in older adults admitted for COVID-19. Methods: Data were obtained from the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). The study included patients aged 65–75, hospitalized with a primary diagnosis of COVID-19, and Elixhauser Comorbidity index(ECI) >4. History of CAD upon admission was used to split the cohort into two propensity score-matched groups considering age, gender, other cardiovascular diseases, and ECI. Records from both groups were reviewed to identify patients diagnosed with MC during and up to one month after admission. Pearson's chi-squared test was used to compare groups. The strength of association was reported using Risk Ratios (RR). A p-value < 0.05 was deemed significant. Results: 182,556 patients with and 218,729 without a history of CAD admitted for COVID-19 were identified. Patients with a history of CAD were more likely to be male(54.7% vs. 42% p < 0.0001), older(mean age 70.62 vs. 70.30, p < 0.001), and had more comorbidities(ECI=11 vs. 8, p < 0.0001). After propensity score matching, 0.13% of patients with CAD and 0.12% without CAD developed MC within one month of admission(RR= 1.05, CI95%=0.87–1.26, p=0.61). Conclusion: One month following admission for COVID-19, the risk of MC was not significantly higher in older persons with a history of CAD.

Digital Pathology Training Effectiveness for the Evaluation of Pd-L1 Expression in Multiple Tumor Indications

Background In-person pathologist trainings during the COVID- 19 pandemic became impossible, necessitating a shift to remote-digital whole slide image (WSI) training. High concordance between WSI and glass slide scores from the same specimens stained with PD-L1 IHC 22C3 pharmDx (SK006) across multiple tumor indications supported the validity of digital training.1 However, in-person microscope (glass-slide) training versus remote-digital (WSI) training effectiveness must be assessed. Collated testing data on specimens (SK006 stained) spanning multiple indications scored by external pathologists during Agilent led training and testing (T&T) sessions via glass slides were compared to sessions utilizing WSIs. Methods Stained slides (30 unique specimens per tumor indication) were scanned on an Aperio AT2 scanner to generate WSIs for digital T&T. Remote T&T sessions used WebEx and PathcoreScholar's online platform to discuss scoring guidelines and WSI training cases. Subsequently, external pathologists evaluated WSIs in PathcoreScholar for PD-L1 expression using either Tumor Proportion Score (TPS) or Combined Positive Score (CPS) scoring algorithms and interpreted these scores at predefined cutoffs (figure 1). In both glass and WSI scoring test modalities, passing is defined as inter and intra-observer overall agreement (OA) >=85%. Training effectiveness pass rates from glass slide data (2018-2020) and WSI data (2021- 2022) spanning multiple indications and scoring algorithms were calculated and then compared using the Fisher-Freeman- Halton test, with a significance threshold of 0.05. Only data from initial pathologist tests were included in the pass rate calculation;data from re-tests executed after initial test failure were excluded. Results The differences between pass rates for microscope (glass slide) and digital (WSI) testing were not statistically significant (p-value > 0.05) (tables 1 and 2). Testing pass rates for indications scored with TPS or CPS using microscope glass slide vs digital WSI T&T was not statistically significant (pvalue > 0.05) (table 3). Conclusions No statistically significant differences in pathologist training effectiveness for PD-L1 were observed between remote and in-person trainings across multiple tumor indications, scoring algorithms, and cutoffs. These results demonstrate the effectiveness and equivalency of remote-digital pathologist trainings for evaluation of PD-L1 expression as detected by PD-L1 IHC 22C3 pharmDx in multiple tumor indications when compared to in-person-microscope glass slide T&T. Use of digital training and scoring proficiency testing can provide pathologists around the world with access to high-quality, interactive training from leading experts in PD-L1 expression evaluation.

Intravenous Branched Chain Amino Acid Infusion Is Associated with Early but Ill-Sustained Recovery of Overt Hepatic Encephalopathy in Acute-on- Chronic Liver Failure: A Pilot Protocol

Background: Hepatic encephalopathy (HE) in acute-on- chronic liver failure (ACLF) is associated with significant morbidity and mortality. There is paucity of data regarding HE management in patients with ACLF and most of the evidence is extrapolated from patients with cirrhosis. We conducted a prospective, randomized controlled clinical trial to study the efficacy of intravenous branched chain amino acids (IV-BCAA) with lactulose versus lactulose alone for improvement in HE scores at 24h, day 3 & day 7. Duration of ICU stay and survival at days 7 and 28 was compared. Method(s): CANONIC ACLF patients with HE grades >= 2 were assessed for eligibility and randomized into two groups -experimental arm (IV-BCAA -500mL/ day for 3 days + Lactulose;n=39) and comparator arm (Lactulose alone;n=37). Six patients developed COVID-19 after randomization & were excluded (4-experimental arm & 2-comparator arm). Grade of HE was assessed by West Haven Classification and Hepatic Encephalopathy Scoring Algorithm (HESA). ACLF severity was determined by CLIF-C ACLF and MELD scores. All patients received standard of care for HE and ACLF management. Result(s): Both groups were similar in baseline characteristics including grade of HE (2.85 +/- 0.75 vs 2.82 +/- 0.66;P = 0.864) and CLIF-C ACLF score (54.19 +/- 5.55 vs 54.79 +/- 5.74;P = 0.655). Overall survival was 40% at 28 days (48.5% vs 31.4%;P=0.143). Significant improvement in HESA score by >=1 grade at 24h was seen in 14 patients (40%) in BCAA arm and 6 patients (17.14%) in control group (P=0.034) which translated to a shorter ICU stay in the BCAA arm (Table 1). Median change in HESA score at 24h was significantly more in BCAA arm than control arm (P=0.006), however, this was not sustained at day 3 or 7. Ammonia levels did not correlate with the grade of HE (Spearman's correlation coefficient(rho) = -0.0843;P=0.295). Conclusion(s): Intravenous BCAA leads to early but ill-sustained improvement in grade of HE and reduced ICU stay in ACLF.

Spatial dissemination of COVID-19 in small cities: daily mobilities and everydayness ruralities

The spatial diffusion of COVID-19 presents different proportionalities intertwined in non-linear relationships, making it difficult to analyze the pandemic. Furthermore, the prevalence of higher scales, such as the gradual reading between large, medium and small cities, makes it difficult to identify factors related to regionalities. Therefore, to what extent can the patterns linked to population density and the constructive potential of this urban gradient fully shape the reading of data on the current risks of pandemic diffusion? In this way, the aim is to argue against these patterns through the relevance of factors linked to the ways of life of populations in their regional contexts, which relate to the small cities in the interior of Sao Paulo. More precisely, if the spread of COVID-19 is linked to densification, it is intended to show that this presents a territorial identification rooted in the cultural habits of the region in which the cities of Iracemapolis and Mogi Mirim are located, that is, the way of rural life present as ruralities, even in urban areas. Thus, these habits become a preponderant factor that allows the reading of the viral dissemination through their territory practised beyond the urban and agroindustry imposed.

Changes in athlete training patterns due to COVID-19 pandemic among Brazilian athletes.

In sports, training needs to be done according to various training patterns to optimize performance. However, this has been a major challenge to athletes due to the COVID-19 pandemic, therefore describing the impacts of lockdown caused by the COVID-19 pandemic on the athlete's training routine is necessary. 52 Brazilian athletes (Age: 31.5±10.3 years; Body Mass Index: 23.9±3.5 kg/m²), Olympic and Paralympic sports practitioners (professional and recreational) answered an online questionnaire [frequency, duration and intensity (subjective perception of effort) of training sessions], before and during lockdown (July to November/2020). The weekly training frequency (sessions/week) reduced by 48.1% (n=25) and was significantly higher among those who performed more than eight sessions before the pandemic (75% of them, p<0.000). The duration of the sessions (hours/day) decreased by 55.8% (n=29) and was significantly higher in athletes who performed training lasting more than one hour/day [75.9% of them (n=22)] and 24.1% (n= 7) performed training for more than two hours/day (p=0.132). The subjective perception of effort significantly decreased by 56%, from 8.4±1.2 to 5.5±1.7 (p=0.001). Because of the lockdown, athletes have suffered a reduction in the frequency, volume and intensity of their training sessions, but only in those with higher pre-pandemic training loads.

COVID-19 and Acute Kidney Injury - Direct and Indirect Pathophysiological Mechanisms Underlying Lesion Development.

COVID-19 is a pandemic disease caused by the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) responsible for millions of deaths worldwide. Although the respiratory system is the main target of COVID-19, the disease can affect other organs, including the kidneys. Acute Kidney Injury (AKI), commonly seen in patients infected with COVID-19, has a multifactorial cause. Several studies associate this injury with the direct involvement of the virus in renal cells and the indirect damage stimulated by the infection. The direct cytopathic effects of SARS-CoV-2 are due to the entry and replication of the virus in renal cells, changing several regulatory pathways, especially the renin-angiotensin-aldosterone system (RAAS), with repercussions on the kallikrein-kinin system (KKS). Furthermore, the virus can deregulate the immune system, leading to an exaggerated response of inflammatory cells, characterizing the state of hypercytokinemia. The such exaggerated inflammatory response is commonly associated with hemodynamic changes, reduced renal perfusion, tissue hypoxia, generation of reactive oxygen species (ROS), endothelial damage, and coagulopathies, which can result in severe damage to the renal parenchyma. Thereby, understanding the molecular mechanisms and pathophysiology of kidney injuries induced by SARS-COV-2 is of fundamental importance to obtaining new therapeutic insights for the prevention and management of AKI.

Disinformation, public health and immunization in Brazil: the effects of popular health education

Vaccine immunization is considered a true milestone in public health by contributing to the reduction, protection and prevention of numerous communicable diseases and in the context of the COVID-19 pandemic it is no different. However, among the different expressions of the denialism of the coronavirus disease pandemic (COVID-19), are the fake news and information regarding the vaccine, making it difficult to adhere to immunization due to "fake news". Therefore, the present study aimed to present the educational actions that have popular health education as a reference, which were used in favor of adherence to vaccination in Brazil, and that are cited in the scientific literature. For this, a systematic review of scientific literature was carried out, using descriptors and search strategies: "Health Education AND COVID-19 Vaccines" and "Health Education AND Immunization", in the online databases Virtual Health Library (VHL) and Scientific Electronic Library Online (SciELO) - with the filters "Brazil", and publications from 2020, until December 2021, in the languages "Portuguese", "English" and "Spanish" and "article". The results point to different strategies of popular health education (HPS), such as: (i) conversation wheels in public health services;(ii) messages and electronic journals forwarded to SUS users by Primary Health Care;(iii) explanatory videos forwarded by public schools;and (iv) posters made available in public buildings in different municipalities. It is concluded that dialogical HPS contributes to the intellectual emancipation of citizens, making them able to decide about themselves, safely, when facing health situations.

Rural sanitation: scenarios and public policies for the Brazilian semi-arid region

Brazil's primary sanitation sector has been neglected, especially concerning rural sanitation. Population dispersion and the difficulty of access in many rural communities bring more significant challenges to the universalization of the service and, consequently, vulnerabilities for the population. The present work builds a theoretical framework about the context of rural sanitation in Brazil, with history, weaknesses in the sector, the impact of COVID-19 and new technologies, and central public policies in the State of Pernambuco. It is known that COVID-19 has caused considerable challenges that, added to the obstacles to national sanitation, result in greater vulnerability to the population, especially for indigenous peoples, quilombolas, and diffuse rural communities. In the State of Pernambuco, certain policies, such as the One Million Rural Cisterns Program (P1MC), One Land and Two Waters Program (P1 + 2), Agua Doce Program and Operacao Pipa Program, significantly improved the quality of life of the rural population. However, these measures are not enough to remedy the sector's shortcomings. Although alternative sanitation technologies bring hope to the sector, there is a long way to go towards the universalization of sanitation.

Maternal and Neonatal Outcomes Associated with Mild COVID-19 Infection in an Obstetric Cohort in Brazil.

Previous coronavirus epidemics were associated with increased maternal morbidity, mortality, and adverse obstetric outcomes. Reports for SARS-CoV-2 indicate that the obstetric population is at increased risk for severe illness, although there are still limited data on mild COVID-19 infection during pregnancy. To determine the association between mild COVID-19 infection during pregnancy, and maternal and neonatal outcomes, we performed a prospective cohort study among pregnant women with COVID-19 and a control group. Postnatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. We recruited 84 pregnant women with mild COVID-19 and 88 pregnant women without COVID-19. All participants were unvaccinated. The most common acute COVID-19 symptoms were headache (82.1%), loss of smell (81%), and asthenia (77.4%). The median duration of long COVID symptoms was 60 days (interquartile range, 130). Pregnant women with a COVID-19 diagnosis were at greater risk for obstetric ultrasound abnormalities-mainly, fetal growth restriction (relative risk [RR], 12.40; 95% CI, 1.66-92.5), premature birth (RR, 2.62; 95% CI, 1.07-6.43), and postpartum depression (RR, 2.28; 95% CI, 1.24-4.21). Our results alert clinicians to the consequences of COVID-19 during pregnancy, even in mild cases, given the increased risk of ultrasound abnormalities, premature birth, long COVID symptoms, and postpartum depression. National guidelines on preventive measures and treatments should be based on scientific evidence, including attention to the impact on health and family needs during and after the COVID-19 pandemic.