Artificial Intelligence in Telemedicine

Telemedicine can be defined as the practice of medicine, between different places, through the responsible use of information and communication technologies. From a steady pace of progressive expansion, telemedicine has grown exponentially worldwide due to the emergence of the COVID-19 pandemic. The addition of artificial intelligence to telemedicine can expand and improve its capabilities, giving endless possibilities for developing solutions for specific healthcare needs. AI in telemedicine can make a significant contribution for the implementation of the continuum of healthcare and promote and facilitate greater access to integrated healthcare, where and when necessary. The potential impact of AI in telemedicine can be identified around four emergent trends: patient monitoring, healthcare information technology, intelligent assistance and diagnosis, and information analysis collaboration. However, their implementation in healthcare faces safety, ethical, efficacy, efficiency, regulatory, and financial challenges. Their adoption will increase if physicians serve as knowledgeable and supportive guides and leaders in the process. The evidence of the benefit of AI will need to be convincing enough for the medical community and the patients to adopt the technology. For physicians AI can be helpful in aiding in decisionmaking and for specific tasks to improve healthcare delivery. It is also of extreme value by automating administrative tasks to free up valuable time that can be dedicated to the direct care of patients. AI-enabled telemedicine should suit with existing clinical practice. It requires a framework that could be based on technical and clinical considerations, reliability, reproducibility, usability, accessibility, and costs. This chapter also discusses their benefits and limitations in several medical specialties. © Springer Nature Switzerland AG 2022.

COVID-19 Induces Neuroinflammation and Suppresses Peroxisomes in the Brain.

OBJECTIVE: Peroxisome injury occurs in the central nervous system (CNS) during multiple virus infections that result in neurological disabilities. We investigated host neuroimmune responses and peroxisome biogenesis factors during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using a multiplatform strategy. METHODS: Brain tissues from coronavirus disease 2019 (COVID-19) (n = 12) and other disease control (ODC) (n = 12) patients, as well as primary human neural cells and Syrian hamsters, infected with a clinical variant of SARS-CoV-2, were investigated by droplet digital polymerase chain reaction (ddPCR), quantitative reverse transcriptase PCR (RT-qPCR), and immunodetection methods. RESULTS: SARS-CoV-2 RNA was detected in the CNS of 4 patients with COVID-19 with viral protein (NSP3 and spike) immunodetection in the brainstem. Olfactory bulb, brainstem, and cerebrum from patients with COVID-19 showed induction of pro-inflammatory transcripts (IL8, IL18, CXCL10, NOD2) and cytokines (GM-CSF and IL-18) compared to CNS tissues from ODC patients (p < 0.05). Peroxisome biogenesis factor transcripts (PEX3, PEX5L, PEX11ß, and PEX14) and proteins (PEX3, PEX14, PMP70) were suppressed in the CNS of COVID-19 compared to ODC patients (p < 0.05). SARS-CoV-2 infection of hamsters revealed viral RNA detection in the olfactory bulb at days 4 and 7 post-infection while inflammatory gene expression was upregulated in the cerebrum of infected animals by day 14 post-infection (p < 0.05). Pex3 transcript levels together with catalase and PMP70 immunoreactivity were suppressed in the cerebrum of SARS-CoV-2 infected animals (p < 0.05). INTERPRETATION: COVID-19 induced sustained neuroinflammatory responses with peroxisome biogenesis factor suppression despite limited brainstem SARS-CoV-2 neurotropism in humans. These observations offer insights into developing biomarkers and therapies, while also implicating persistent peroxisome dysfunction as a contributor to the neurological post-acute sequelae of COVID-19. ANN NEUROL 2023.

Collaboration strategies for COVID-19 vaccination: Experience of an Allergy and Clinical Immunology Department from a tertiary hospital

Background: Vaccination plays an essential role in controlling SARS-CoV- 2 pandemics. Due to initial concerns about hypersensitivity reactions (HR) to these new vaccines, our department, in articulation with Primary Healthcare Services (PHS) has developed several strategies to support COVID-19 vaccination. This work aims to describe those strategies and report the results. Method(s): The strategies developed for COVID-19 vaccination, from March to December 2021, included: 1) telephone support for health professionals (TS for HP) from the Vaccination Centres (VC), 2) priority appointments (PA) of patients classified as a higher risk for HR, 3) hospital vaccination of high-risk patients as defined by the national health authority. A retrospective and descriptive analysis of the support activity developed and from the data of patients vaccinated at the hospital in the same period were performed. Result(s): During the considered period, our department screened 1618 patients: 420 (26%) through telephone support for HP (TS for HP) from VC and 1198 (74%) at priority appointments (PA). After TS for HP, community vaccination (CV) was recommended in 87% (n = 364) of cases and a PA was advised in 13% (n = 56). Of the patients evaluated in PA, 80% were recommended CV, with restriction of the vaccine to administer in 28% of them. We always found an option to vaccine all. At the hospital were vaccinated 178 patients, 83% (n = 147) women, median age (P25-75) 61 (46-76) years. Hospital vaccination criteria were: past history of multiple drug HR (n = 93;52%), HR to vaccines (n = 46;26%), HR to the 1st dose of anti-SARS- CoV- 2 vaccine (n = 30;17%), idiopathic anaphylaxis (n = 10;6%) and systemic mastocytosis (n = 2;1%). 15% of patients (n = 26) performed skin tests with vaccines, which were negative in 25 and inconclusive in 1 case. 145 (82%) were first shots, 32 (18%) second shots, and one booster shot. Only one patient had a mild immediate reaction (2nd booster vaccination), promptly treated with antihistamine and corticosteroid. Conclusion(s): The collaboration strategies adopted by our department allowed the vaccination of 1618 patients and avoided vaccination delays in most of the VC contacts. In our sample, hospital vaccination of patients at higher risk for HR was safe.

Long-Term Sequelae of severe COVID-19: Outpatient assessment of radiological and pulmonary function tests

Objective: Identify lung sequelae of COVID-19 through radiological and pulmonary function assessment. Design(s): Prospective, longitudinal, cohort study from March 2020 to March 2021. Setting(s): Intensive Care Units (ICU) in a tertiary hospital in Portugal. Patient(s): 254 patients with COVID-19 admitted to ICU due to respiratory illness. Intervention(s): A chest computed tomography (CT) scan and pulmonary function tests (PFT) were performed at 3 to 6 months. Main variables of interest: CT-scan;PFT;decreased diffusion capacity of carbon monoxide (DLCO). Result(s): All CT scans revealed improvement in the follow-up, with 72% of patients still showing abnormalities, 58% with ground glass opacities and 62% with evidence of fibrosis. PFT had abnormalities in 94 patients (46%): thirteen patients (7%) had an obstructive pattern, 35 (18%) had a restrictive pattern, and 58 (30%) had decreased DLCO. There was a statistically significant association between abnormalities in the follow-up CT scan and older age, more extended hospital and ICU stay, higher SAPS II and APACHE scores and invasive ventilation. Mechanical ventilation, especially with no lung protective parameters, was associated with abnormalities in PFT. Multivariate regression showed more abnormalities in lung function with more extended ICU hospitalization, chronic obstructive pulmonary disease (COPD), chronic kidney disease, invasive mechanical ventilation, and ventilation with higher plateau pressure, and more abnormalities in CT-scan with older age, more extended ICU stay, organ solid transplants and ventilation with higher positive end-expiratory pressure (PEEP). Conclusion(s): Most patients with severe COVID-19 still exhibit abnormalities in CT scans or lung function tests three to six months after discharge.Copyright © 2023

Enterpreneurial Strategies for the Female Sector: Leveraging Instagram Sales During the Pandemic

The COVID-19 pandemic significantly influenced the purchasing behavior of consumers, who began to see in the tools available in the virtual environment the necessary allies to satisfy their consumption desires. Given the relevance achieved by the virtual environment, organizations began to explore more intensively the various digital platforms to enhance their reach to their customers. The traditional electronic commerce then evolved into what we call Social Commerce (S-commerce), which allowed a substantial increase in the way of interacting and promoting sales. Despite the limitations and incipient studies on how organizations use their strategies and explore digital media tools to leverage sales, it is perceived as relevant to understand how the process of joining these organizations to digital media and the influence they have passed to exercise in the reformulation of its strategies and business models. Focusing on the Instagram environment, the objective of this research is to characterize the sales strategies used by three female-owned enterprises, through Instagram, during the pandemic by COVID-19. As a methodological research strategy, the study of multiple cases was used. Three Brazilian female-owned enterprise were analyzed, being: a jewelry company, a women's adult footwear company and a beauty salon. The entrepreneurs responsible for the companies were submitted to a semi-structured questionnaire, which was conducted in loco. As a result, it was observed that the most used Instagram tools are feed resources, stories and metrics. On the other hand, the sales strategies most used by entrepreneurs were e-WOM, recommendations and feedbacks and, finally, encouraging user participation. In conclusion, it was noticed that both the entrepreneur and the company that wants to implement sales strategies in digital media, need to understand the functions and objectives of the set of tools made available by Instagram. Once the functionalities present in these resources are understood, entrepreneurs and managers can formulate their strategies in an assertive way, being more efficient in their commercial transactions, since the actions aim to promote involvement with the public that follows the business. Instagram proved to be a tool with great potential for business in the female sector. © 2022, Academic Conferences and Publishing International Limited. All right reserved.

Relationship between blood gases and inflammatory markers with clinical outcomes in critically ill patients with COVID-19

Introduction: SARS - CoV mainly affects the airways and, although most cases of COVID-19 are mild or moderate, up to 30% of patients may have the severe form of the disease and be hospitalized due to the cytokine storm in response to viral infection (Milovanovic, L. et al. BMJ Open. 2021;11(1):e042008). Of these, up to a quarter need an Intensive Care Unit (ICU) and in this unit, data on partial pressure of oxygen (PaO2), carbon dioxide (PaCO2) and inflammatory markers are collected daily to assess respiratory function and assist in decision making. Aim(s): To analyze how these blood gas and inflammatory data are related to a greater need for invasive support and mortality in the ICU. Method(s): 79 patients admitted to an Intensive Care Unit with a mean age of 60 years, of whom 50 required invasive support and 44 died. Result(s): After comparing the groups, it was observed that the need for invasive ventilatory support and death were related to higher values of PaCO2 (p<0.001;p<0.001) and C-Reactive Protein (p=0.004;p=0.006), which did not occur with those with lower PaO2 levels (p=0.339;p=0.580). Furthermore, the inflammatory activity marker CRP correlated significantly and positively with PaCO2 (p=0.007;0.378), which did not happen with PaO2 (p=0.406;-0.121). Conclusion(s): Although the respiratory involvement caused by COVID-19 has hypoxemic characteristics, it is observed that, in critically ill patients, the assessment of CRP and carbon dioxide levels are more decisive for the clinical outcome, having more relevance for patient decisions and evaluations. serious hospitalized with COVID-19.

A study of the profile and the impact of diabetes, steroid and stress hyperglycaemia on COVID-19 outcomes

Background: Diabetes Mellitus (DM) and hyperglycaemia (HG) have been identified as risk factors for morbidity and mortality in coronavirus disease 19 (COVID-19) infection. However, a detailed study of various categories of HG and the impacts and characteristics of each of these on COVID-19 was considered important to address this metabolic disorder in COVID-19. Aim(s): This study aimed to describe the patterns of HG and its impact on the clinical outcomes in hospitalised patients with COVID-19 infection. Methodology: Data on 1000 consecutive patients with COVID-19 were analysed using Statistical Package for Social Sciences (SPSS) version 20.0 software (SPSS Inc., Chicago, IL, USA). Result(s): A total of 1000 patients were included for analysis The overall mean age of the study group was 52.77 + 19.71 with 636 (63.6%) male patients;261 had mild, 317 moderate, and 422 severe infections;and 601 had HG (New-onset DM 66, known DM 386, steroid-induced HG 133 and stress HG 16). The HG group has significantly higher levels of inflammatory markers and worse outcomes. Blood glucose levels were higher in patients with known DM. The ROC cut-off of total steroids to predict mortality in the HG group was 84 mg versus 60 mg in the normoglycaemia group. The ROC cut-off of FBS to predict mortality in the overall HG group was 165, with AUC 0.58 (95% CI 0.52, 0.63, P = 0.005), whereas that for pre-existing DM and steroid HG were 232 and 166, which were also significant. There was a wide variation in mean glucose levels against time. Conclusion(s): HG is an independent predictor of mortality, with the highest significance in the steroid-induced category. COVID-19 morbidity and mortality can be minimised by identifying the blood glucose range for best results and instituting appropriate treatment guidelines.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

The Game of Words Human Creative Writing Against Computer Assisted Writing

Artificial Intelligence (AI) is fully embedded in different domains of our daily lives. However, the pandemic of 2020 seems to have accelerated and changed human behavior concerning our relationship with time as well as with language and communicative processes. Traditionally, we have learned that creative written tasks need great amounts of time, inspiration, and rewriting. Conversely, speed has become an important cultural value and computer assisted creative writing enables to accelerate the writing process. This paper is part of a preliminary research on the teaching and learning of creative writing in the post-covid times. It concerns the subject of Semiotics within the context of undergraduate Business Communication students, and it aims at studying the possibilities of speed writing and creative writing AI tools. We will discuss the qualitative results of an experiment in which our students performed a creative process of producing language elements for a media campaign (hashtag, a slogan, and a teaser text) to promote a cultural institutional event targeting a broad audience. Two groups of students were given the same time to produce the language contents above-mentioned, but they had to follow different writing methodologies according to the script. The results obtained reveal interesting perceptions concerning style, connotation, grammaticality, rewriting and editing effort. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

COVID-19 in patients with Systemic Lupus Erythematosus and the antiphospholipid syndrome

In patients with Systemic Lupus Erythematosus (SLE) and Antiphospholipid Syndrome (APS), the dysregulated immune response together with the use of immunosuppressive drugs has raised some concerns about the increased susceptibility to SARS-CoV-2 infection and the efficacy of anti-SARS-CoV-2 vaccines. Moreover, COVID-19, SLE, and APS share pathogenic pathways that may be responsible of common clinical and laboratory features and may explain why some drugs approved for SLE treatment were considered as potential treatment for COVID-19 disease. Another concern relies on "post-COVID syndrome” (the persistence of debilitating symptoms such as fatigue, dyspnea, and cognitive dysfunction) that could be confused with signs of SLE or APS. This chapter describes the common pathogenic mechanisms and clinical manifestations of COVID-19, SLE, and APS. Management strategies and immunogenicity and safety of COVID-19 vaccines are addressed. A focus on pregnant patients is also provided. Finally, similarities and differences between post-COVID syndrome and SLE/APS manifestations are described. © 2023 Elsevier Inc. All rights reserved.

Influence of Deep Sedation in Intensive Care Medicine Memories of Critical COVID-19 Survivors.

Introduction: Critical care survivors sustain a variety of sequelae after intensive care medicine (ICM) admission, and the Coronavirus Disease 2019 (COVID-19) pandemic has added further challenges. Specifically, ICM memories play a significant role, and delusional memories are associated with poor outcomes post-discharge including a delayed return to work and sleep problems. Deep sedation has been associated with a greater risk of perceiving delusional memories, bringing a move toward lighter sedation. However, there are limited reports on post-ICM memories in COVID-19, and influence of deep sedation has not been fully defined. Therefore, we aimed to evaluate ICM-memory recall in COVID-19 survivors and their relation with deep sedation. Materials/Methods: Adult COVID-19 ICM survivors admitted to a Portuguese University Hospital between October 2020 and April 2021 (second/third "waves") were evaluated 1 to 2 months post-discharge using "ICU Memory Tool," to assess real, emotional, and delusional memories. Results: The study included 132 patients (67% male; median age = 62 years, Acute Physiology and Chronic Health Evaluation [APACHE]-II = 15, Simplified Acute Physiology Score [SAPS]-II = 35, ICM stay = 9 days). Approximately 42% received deep sedation (median duration = 19 days). Most participants reported real (87%) and emotional (77%) recalls, with lesser delusional memories (36.4%). Deeply sedated patients reported significantly fewer real memories (78.6% vs 93.4%, P = .012) and increased delusional memories (60.7% vs 18.4%, P < .001), with no difference in emotional memories (75% vs 80.4%, P = .468). In multivariate analysis, deep sedation had a significant, independent association with delusional memories, increasing their likelihood by a factor of approximately 6 (OR = 6.274; 95% confidence interval = 1.165-33.773, P = .032), without influencing real (P = .545) or emotional (P = .133) memories. Conclusions: This study contributes to a better understanding of the potential adverse effects of deep sedation on ICM memories in critical COVID-19 survivors, indicating a significant, independent association with the incidence of delusional recalls. Although further studies are needed to support these findings, they suggest that strategies targeted to minimize sedation should be favored, aiming to improve long-term recovery.

Magnetic hydrogel particles improve nanopore sequencing of SARS-CoV-2 and other respiratory viruses.

Presented here is a magnetic hydrogel particle enabled workflow for capturing and concentrating SARS-CoV-2 from diagnostic remnant swab samples that significantly improves sequencing results using the Oxford Nanopore Technologies MinION sequencing platform. Our approach utilizes a novel affinity-based magnetic hydrogel particle, circumventing low input sample volumes and allowing for both rapid manual and automated high throughput workflows that are compatible with Nanopore sequencing. This approach enhances standard RNA extraction protocols, providing up to 40 × improvements in viral mapped reads, and improves sequencing coverage by 20-80% from lower titer diagnostic remnant samples. Furthermore, we demonstrate that this approach works for contrived influenza virus and respiratory syncytial virus samples, suggesting that it can be used to identify and improve sequencing results of multiple viruses in VTM samples. These methods can be performed manually or on a KingFisher automation platform.

Primary lateral sclerosis natural history study - planning, designing, and early enrollment.

Introduction/Aims. Primary lateral sclerosis (PLS) is exceedingly rare and has been an enigmatic disease. Recent progress has drastically changed this perception, with early biomarkers being investigated and potential medications for PLS emerging at the preclinical stage. The aim of this paper is to describe a study of PLS natural history and discuss the limitations and proposed solutions to the study of a rare and slowly progressive disease. Methods. The PLS Natural History Study is a 30-site, 24-month, prospective study that is supported by multiple funding sources. The study aims to enroll 50 early PLS (disease duration ≤4 years) and 50 definite PLS (disease duration 4 to 15 years) participants using modified PLS Diagnostic Criteria. Smartphone-based assessments including semi-quantitative and quantitative measures and patient-reported outcomes are utilized. In-person quantitative measures are also completed during site visits. The change in the PLS Functional Rating Scale score is the primary outcome. The study utilizes the NeuroBANK® patient-centric data capture and management platform. The biostatistical analysis plan has been developed. Results. In one year, 28 participants have been recruited. Enrollment has been much slower than anticipated due to the COVID-19 pandemic, the rarity of PLS, and potential study competition for internal resources from ALS clinical trials. Discussion. We discuss the need for more innovative methods to enroll and study individuals with such rare diseases and propose a number of mechanisms by which more efficient enrollment could be facilitated.

Purchasing challenges in times of COVID-19: resilience practices to mitigate disruptions in the health-care supply chain

Purpose - This study aims to identify supply chain (SC) management practices applied to purchasing capable of improving the resilience of the health-care SC and mitigating the effects of material and service disruption during pandemics. Design/methodology/approach - The approach adopted is qualitative and is based on a systematic literature review from the ScienceDirect, Emerald, Wiley and Web of Science databases. After selecting 705 documents, filters are applied, and 52 articles present problems faced by purchasing the health-care SC during the coronavirus disease 2019 (COVID-19) pandemic.Findings - This article suggests five propositions of resilient practices that can increase purchasing resilience in the face of pandemics such as COVID-19. The proposed practices are collaboration, flexibility, visibility, agility and information sharing, which suggest a sequence for the adoption of management practices based on the number of occurrences and importance found in the analysed studies.Research limitations/implications - This study does not find robust empirical evidence that could categorically state that the results can be replicated in organisations in general. Thus, as a continuation of research, more studies should use an empirical methodology and case analysis to organise different branches. As the human factor was decisive for the results observed in the literature, future research should dedicate part of the studies to the psychological area of professionals. Actions to combat the pandemic were implemented, impacting positively and negatively on the results obtained. Future research on combat actions could indicate which ones should be avoided.Practical implications - As a result, disruptions are expected to be reduced, and consequently, the resilience of the SC will increase. Accordingly, purchasing processes and procedures can be redefined to positively influence the resilience of the health-care SC. Resilience is related to maintaining the flow of supply, as well as systems and actions aimed at mitigating the effects of disruptions in the hospital's core business. Social implications - Health systems need to respond to society's needs even in the face of global crises, such as the one faced during the COVID-19 pandemic. The overload in hospitals and the exponential demand for specific medicines and services in the fight against the crisis caused by the COVID-19 pandemic require enormous coordination in procurement by the purchasing sector. This planning aims to ensure that the care provided by health services maintains the flow of value that serves hospitalised patients.Originality/value - This study introduces a new approach to the recurrent problem of disruption of the health-care SC during a pandemic using a combination of five important management practices. This proves useful for mitigating disruptions and their effects on the health-care SC.

Current Changes in Europe Impacting Orphan Drugs Access: A Focus on the Latest Reforms in the EU4 and England

Objectives: Post-COVID, healthcare systems are balancing the need to improve health outcomes with expenditure. Healthcare and payer policy reforms have been approved or are being discussed in major European markets: France, Germany, Italy, Spain and England. This study outlines the evolving access landscape and potential implications on orphan drug (OD) access. Method(s): For each market, qualitative and quantitative analyses were performed on information collected via targeted literature review of publicly available sources: national authority websites, peer-reviewed articles, and grey literature. Findings were segmented into policy scope, policy occurrence likelihood and OD access impact. Policy scope comprised 4 categories: access, pricing, assessing methodology and wider healthcare policy. Occurrence likelihood was subdivided into occurred, expected, and discussed reforms. The OD access impact (positive/negative) was categorised as high, intermediate, and low. Analysing the relationship between likelihood of occurrence and impact to OD access pinpointed reforms most likely to change the OD payer landscape. Result(s): This research identified 29 reforms: 8 in England, 7 in Italy, 6 in France, 4 in Spain and Germany. Our analysis framework identified highly significant reforms: 3 in France and Germany, 2 in Italy, and 1 in England and Spain. England and Italy have the highest number of reforms encouraging OD launch. France showed a relative increase in attractiveness, while Spain lagged. Draft legislation in Germany appeared the most punitive for OD access to patients. Conclusion(s): Overall, attractiveness for OD launch is increasing in Europe. Due to the size of market potential, cost containment measures in Germany may hinder European launch strategy and mitigate the positive impact of increased OD patient access in other markets. Monitoring of upcoming changes alongside working closely with physician and patient advocacy groups to maintain OD funding priorities will ensure rare disease patients are not left behind and can continue to access therapies. Copyright © 2022

Linfohistiocitose HemofagocÍtica Familiar (Lhf3) Apresentando-Se Com Quadro De Colestase Neonatal Tratada Com Emapalumabe E Tcth

Introducao: Linfohistiocitose Hemofagocitica (LHH) e uma sindrome de ativacao do sistema imune que ocorre como desordem familiar ou condicao esporadica em associacao com uma variedade de "gatilhos". Caracteriza-se por condicao hiperinflamatoria, potencialmente fatal, causada por resposta imune altamente estimulada, mas ineficaz. Linfohistiocitose Hemofagocitica Familiar (LHF), e doenca genetica autossomica recessiva, afeta principalmente lactentes. Rapidamente fatal, mediana de sobrevida menor que dois meses apos diagnostico, se nao tratada. Pacientes que iniciam o quadro no periodo neonatal, associado a colestase e frequentemente fatal. Relato do caso: Fem, 4 dias vida, br, pais jovens nao consanguineos. Tranferida ao HMIMJ para avaliacao da Hepatologia - quadro de Colestase Neonatal com rapida evolucao. Na UTI: Corada, icterica +4/+4, hepato-esplenomegalia. Ex lab - 5 dias vida - Hb 14,4 Leuco 2.710 neutro 760 Plaq 26.000 cr 0.3 ur 34 BT 43 BD 37 BI 6 Fibrinog 106 TG 245 Colest 184 BT 43.4 BD 37.22 BI 6.25 TGO 261 TGP128 GGT 557 FA 122 DHL568 Ferritina 4.379. COVID-19 e sorologias neg. Mielograma - raros histiocitos hemofagociticos. HD - LHF em rapida evolucao, solicitado exoma. Plaq cada 12h e Ig EV - 1 g/kg em 10h - 2 dias. Dexametasona 10 mg/m2/dia - 14 dias, e apos 5 mg/m2/dia - mantida, aguardando o medicamento Emapalumabe (anticorpo anti IFN-gamma humano administrado com dexametasona). Melhora por 2 sem, piora com hipertrigliceridemia, Ferritina 54.039, hipofibrinogenemia e graves citopenias/20 dias vida - dexametasona 5 mg/m2/dia e iniciado Emapalumabe 1 mg/kg/dose - 2 x /sem, com aumento progressivo 3, 6 e 10 mg/m2/dia. A partir do 5degree dia Emapalumabe - melhora progressiva clinico-laboratorial/27 dias vida - Hb 9.5 Leuco 4.720 neutro 1650 Plaq 110.000 Coagulogr NL fibrinog 190 ur 36.6 cr 0.2 PT 6.2 Alb 3.7 BT 6.32 BD 4.56 BI 1.76 TGO 402 TGP 649 GGT 1.136 FA 284/39 dias vida - recebeu 7dose de Emapalumabe - Hb 8.2 Leuco 10.700 neutro 5.500 Plaq 111.000 Coagulogr NL Fibrinogenio 219 u 37.6 cr 0.2 PT 5.9 alb 3.3 BT 3.31 BD 2.18 BI 1.13 TGO 301 TGP 463 GGT 1.227 FA 301/42 dias vida - Hb 8.6 Leuco 9.340 neutro 4.550 Plaq 96.000 BD 1.69 BI 1.15 DHL 612 TGO 448 TGP 599 GGT 1.172 FA 370 fibrinog 201. Recebeu 9 doses de Emapalumabe. 16.03.21 - Exoma - Linfohistiocitose Hemofagocitica Familiar Tipo 3 (FHL3). Transferida ao ITACI - finalizou a medicacao e realizou TCTH. Boa evolucao ate 2 meses pos TMO, quando desenvolveu Doenca Veno-Oclusiva (VOD), evoluiu para obito. Discussao: Falencia hepatica aguda e rara em neonatos e evolui com elevadas taxas de mortalidade. A etiologia dessa condicao difere daquelas ocorrendo em criancas maiores. Diagnosticos diferenciais sao hemocromatose, LHF, infeccoes virais e alguns defeitos metabolicos. Existem alguns relatos de neonatos com LHF apresentando-se com hidropsia fetal e falencia hepatica fulminante. Conclusao: LHF e uma doenca rara cujas manifestacoes ocorrem principalmente nos dois primeiros anos de vida. A apresentacao neonatal e incomum. Na literatura, poucos casos sao relatados nas primeiras semanas de vida e com rapida evolucao para falencia hepatica aguda. A evolucao desses casos e frequentemente para obito. Entretanto, estabelecer o diagnostico tem importantes implicacoes para o aconselhamento genetico. Copyright © 2022

Anxiety symptoms in critically ill COVID-19 survivors and its association with post-discharge health concerns

Introduction: Evidence suggest that critically ill COVID-19 patients are at higher risk of developing anxiety symptoms, which may be related to or exacerbated by patients concerns regarding their health status and recovery. Objective(s): To assess anxiety symptoms in critically ill COVID-19 survivors, 1-2 months after hospital discharge and to analyze its association with concerns reported by patients regarding their own health status and recovery. Method(s): In the framework of MAPA prospective research, this preliminary study included COVID-19 patients admitted in the Intensive Care Medicine Department (ICMD) of a University Hospital. Patients were excluded if they had an ICMD length of stay (LoS) <=24h, terminal illness, major auditory impairment or inability to communicate at the evaluation time. Participants were assessed at a scheduled telephone follow-up appointment, with Generalized Anxiety Disorder Scale (GAD-7). Additional questions were asked to assess the survivors' post-discharge concerns regarding discrimination against for COVID-19, infection of a family member, re-infection or sequelae related to COVID-19. Result(s): Eighty-three patients were included (median age=63 years;63% male) and 24% had anxiety symptoms. Anxiety scores were higher in survivors who reported being afraid of being discriminated against for COVID-19 (30% vs 10%;p=0.034), being re-infected (100% vs 79%;p=0.032) and having sequelae (94% vs 44%;p<0.001). Conclusion(s): These findings revealed that anxiety is common in COVID-19 survivors and is associated with post-discharge patients concerns that may limit patient daily living. This study emphasizes the importance of psychological assessment and follow-up of the COVID-19 survivors, in order to support these patients recovery.

Depression and health-related quality of life in critical COVID-19 survivors

Introduction: Long-term neuropsychiatric consequences of critical illness are well known. Therefore, it is expected that critical COVID-19 patients might also present several psychiatric symptoms such as depression, with inevitable negative effect on healthrelated quality of life (HRQoL), commonly used as an indicator of illness and treatment impact. Objective(s): To identify depressive symptoms in critical COVID-19 survivors and to examine its association with HRQoL domains. Method(s): This preliminary study involved critical COVID-19 patients admitted into the Intensive Care Medicine Department (ICMD) of a University Hospital, between October and December of 2020. Patients with an ICMD length of stay (LoS)<=24h, terminal illness, major auditory loss, or inability to communicate at the follow-up time were excluded. From 1-2 months after discharge, all participants were evaluated by telephone at follow-up appointment, with Patient Health Questionnaire (PHQ-9) (depression) and EuroQol 5-dimension 5-level EQ-5D-5L (HRQoL). This study is part of the longitudinal MAPA project. Result(s): Eighty-three patients were included with a median age of 63 years (range: 31-86) and the majority were male (63%). The most reported problems on EQ-5D-5L domains were usual activities (82%) and mobility (76%). About 27% presented depressive symptoms, and with more problems of self-care (68%vs41%;p=0.029), pain/discomfort (86%vs49%;p=0.002), and anxiety/depression (96%vs54%;p<0.001). Conclusion(s): These preliminary results are in line in previous studies in critical COVID-19 survivors, with depression being associated with worse HRQoL. Bearing this in mind, follow-up approaches with an early screening and treatment of these psychiatric symptoms will be fundamental to optimize the recovery of these patients.

Delirium and health-related quality of life in severe COVID-19 survivors

Introduction: Severe COVID-19 survivors experience long-term neuropsychiatric morbidity, particularly those who developed delirium, with a negative impact on health-related quality of life (HRQoL). Objective(s): To identify the cases of delirium in severe COVID-19 patients and to describe its association with post-hospital discharge HRQoL. Method(s): In the context of the longitudinal MAPA project, we included adult patients (>= 18 years old) admitted with COVID-19 to the Intensive Care Medicine Department (ICMD) of a Portuguese University Hospital (October 2020-April 2021). Exclusion criteria were: ICMD length of stay <=24h, terminal illness, major auditory loss, or inability to communicate at the time of assessment. Delirium during ICMD stay was ascertained based on patients' clinical records. HRQoL was evaluated using the 5-Level EQ-5D questionnaire (EQ-5D-5L), at a scheduled telephone follow-up appointment on average 1-2 months after hospital discharge. Result(s): Overall, 124 patients were included with a median age of 62 (range: 24-86) years, being mostly male (65%). About 19% had delirium, 42% were deeply sedated and 43% required invasive mechanical ventilation. Most survivors reported problems on the EQ-5D-5L domains: usual activities (85%), mobility (73%) and anxiety/depression (65%). Patients with delirium reported more pain/discomfort (75%vs46%;p=0.011) and considerably anxiety/ depression (83%vs60%;p=0.032). Conclusion(s): These findings pointed that COVID-19 patients who experienced delirium reported worse HRQoL, regarding pain/discomfort and anxiety/depression. This study highlights the importance of not only prevention but also early screening of delirium during hospital stay, as well as the crucial role of the timely interventions at discharge, in order to minimize delirium longterm impacts.

Depressive symptoms and health-related quality of life in critical COVID-19 survivors: Preliminary results of 1-year follow-up

Introduction: A higher risk of mental health consequences in critical COVID-19 patients is expected due to several reasons, including prolonged mechanical ventilation with exposure to high sedation. In this context, post-discharge depression has been reported in previous COVID-19 studies, with a profound impact on patients' health-related quality of life (HRQoL). Objective(s): To identify depressive symptoms in COVID-19 survivors 1-year after hospital discharge and to analyse its association with HRQoL. Method(s): As part of the longitudinal MAPA project, this study enrolled critical COVID-19 patients admitted in the Intensive Care Medicine Department of a University Hospital (March-May 2020). Participants were assessed through telephone by an intensive care nurse and a psychologist, with the Patient Health Questionnaire (PHQ-9) (depressive symptoms), EuroQol five-dimension fivelevel questionnaire (EQ-5D-5L) and EQ-Visual Analogue Scale (EQ-VAS) (global health status patient record). Result(s): A sample of 55 survivors (median age=66 years;69% males) were included, with 20% showing depressive symptoms. Pain/discomfort (67%) and anxiety/depression (67%) were the most EQ-5D-5L domains reported. Survivors scoring for depression had more problems in all HRQoL areas (mobility:91%vs.48%, p=0.015;self-care:64%vs.27%, p=0.035;usual activities:91%vs.50%, p=0.017;pain/discomfort:100%vs.59%, p=0.010;anxiety/depression:100% vs.59%, p=0.010). Moreover, they had a lower EQ-VAS median, corresponding a worse self-perception of health status (50vs.80, p=0.010). Conclusion(s): Even after 1-year, a significant proportion of survivors presented depressive symptoms with repercussions in all HRQoL dimensions and association with worse self-perception of global quality of life. Taking this in mind, early screening and treatment of depression in COVID-19 survivors will be crucial, minimizing its impact on quality of life.