Sleep in the COVID-19 pandemic and its influence on mental health in the infant and pediatric population

Introduction: The COVID-19 pandemic and preventive measures led to changes in the quality and quantity of sleep, impacting mental health. Objectives: To understand how the pandemic and confinement interfered with the routines and/or sleeping habits of children and adolescents and influenced mental health. Methodology: A literature review on MEDLINE was conducted, with the research question: What are the changes in the routines or sleep habits of children and adolescents during the pandemic? Results and discussion: From the 370 articles analysed, 35 were selected. Due to confinement and online learning, the number of hours of sleep increased. However, the quality of sleep decreased due to decreased physical activity, an unbalanced diet, and increased time in front of screens. Consequently, there was a negative influence on mental health. Conclusion: The increase in sleep disorders and their influence on mental health was observed, with the need to develop awareness and literacy strategies addressing this area.

Pediatric COVID-19 vaccination -Lessons learned from the vaccination of the Portuguese children

Background: Following the use of COVID-19 vaccines worldwide, few cases of severe allergic reactions were reported. According to recent Portuguese guidelines, patients (pts) with suspected allergy to a COVID-19 vaccine component, history of anaphylaxis following vaccination, idiopathic anaphylaxis and mast cell disorders, should be referenced for Immunoallergology evaluation. Fear of a hypersensitivity reaction, especially among pts with allergic disease, is associated with lower vaccine adherence. This study aimed to evaluate BNT162b2 vaccination outcomes in pediatric pts with suspected severe allergic reactions prior to or after vaccination. Method(s): W e c onducted a p rospective s tudy i ncluding p ediatric pts with high risk of allergy to COVID-19 vaccine referred to Immunoallergology Department of a Tertiary Hospital. Demographic data, primary medical conditions and vaccination status were collected. After a detailed assessment by an allergologist, in selected cases, BNT162b2 vaccine administration in hospital facilities was performed, followed by a 1-hour observation period. Result(s): Twenty-two pts were included (18 males, 13.1+/-2.6years;min 7, max 17;13 atopic), referenced mainly from primary care (9) and other specialties (8). Most of the pts were referenced for the first dose of vaccine (18), due to mastocytosis/tryptasemia (5), previous allergic reaction to another vaccine (4), idiopathic anaphylaxis (3), complex comorbidities (2), drug anaphylaxis (1), parental reluctance (1), other (2). Four pts were evaluated for the second dose of COVID-19 vaccine, due to an acute urticaria after the first BNT162b2 vaccine dose. Three pts were eligible, after our evaluation, for primary care vaccination, that occurred without adverse reactions. Regarding the remaining 19 pts eligible for hospital vaccination, 13 were premedicated with oral antihistamines +/- montelukast. Eleven pts received BNT162b2 vaccine in hospital facilities [first dose (9);second dose (2)] with no reported adverse events. Vaccine administration was postponed in 3 pts due to SARS-CoV- 2 infection and 1 due to parental hesitancy. Conclusion(s): Our data support that allergic reactions to BNT162b2 vaccines are rare, even in the pediatric population with high risk of allergic reactions or with a history of previous severe allergic reactions. The favourable safety profile outcomes, along with the risk reduction of allergic reactions, increase vaccine confidence, broadening community protection.

A Rare Case Of Peripartum Takotsubo Cardiomyopathy

Background: Takotsubo cardiomyopathy is characterized by left ventricular dysfunction with apical ballooning in the absence of significant coronary artery disease. Though rare in pregnancy, this transient cardiac dysfunction may affect women in antepartum, intrapartum, or postpartum period, making it difficult to discern the inciting event or differentiate from spontaneous coronary artery dissection or peripartum cardiomyopathy. Most patients respond well to medical management with spontaneous resolution of cardiac dysfunction within weeks of diagnosis. Case presentation: A 38-year-old female G3P0202 at 36 weeks of gestation with a history of preeclampsia, hypertension, hyperlipidemia, and recent COVID-19 infection presented with severe substernal chest pain. She was hypertensive on arrival with a blood pressure of 220/120 mm Hg. Electrocardiogram showed T-wave inversion in the anterior leads and troponin I level was 2.6 ng/ml. She was treated with aspirin 324 mg, IV hydralazine 20 mg, IV magnesium sulfate infusion for seizure prophylaxis and fetal neuroprotection. A transthoracic echocardiogram revealed left ventricular ejection fraction of 35-40% with apical ballooning. Urgent left heart catheterization did not show signs of epicardial coronary artery disease, prompting the diagnosis of Takotsubo cardiomyopathy. Hospital course included interdisciplinary team-based medical therapy until cesarean section 24 hours after arrival. Following delivery, she was started on guideline directed medical therapy for heart failure and discharged home. At her one month follow-up, she was still experiencing symptoms of heart failure and classified as New York Heart Association Class II. Conclusion(s): Stress-induced cardiomyopathy rarely occurs in gravid females with chest pain;however, it should be considered after ruling out acute myocardial infarction. Distinguishing Takotsubo cardiomyopathy from peripartum cardiomyopathy is important as peripartum cardiomyopathy is considered a contraindication for future pregnancies. Clinical suspicion for Takotsubo cardiomyopathy should be increased in patients with a history of superimposed preeclampsia. Whether COVID-19 infection-associated inflammatory state predisposes high risk pregnant patients to Takotsubo cardiomyopathy is unknown, but this is a possible inciting factor that should be assessed in patient work up. Management should involve an interdisciplinary team approach to ensure the safety of mother and child.Copyright © 2022

Development, implementation and evaluation of a seven-day clinical pharmacy service in a tertiary referral teaching hospital during surge-2 of the COVID-19 pandemic.

BACKGROUND: Seven-day clinical pharmacy services in the acute sector of the National Health Service are limited. There is a paucity of evidential patient benefit. This limits investment and infrastructure, despite United Kingdom wide calls. AIM: To optimise medicines seven-days a week during surge-2 of the COVID-19 pandemic through implementation of a seven-day clinical pharmacy service. This paper describes service development, evaluation and sustainability. SETTING: A tertiary-referral teaching hospital, London, United Kingdom. DEVELOPMENT: The seven-day clinical pharmacy service was developed to critical care, acute and general medical patients. Clinical leads developed the service specification and defined priorities, targeting complex patients and transfer of care. Contributing staff were briefed and training materials developed. IMPLEMENTATION: The service was implemented in January 2021 for 11 weeks. Multidisciplinary team communication brought challenges; strategies were employed to overcome these. EVALUATION: A prospective observational study was conducted in intervention wards over two weekends in February 2021. 1584 beds were occupied and 602 patients included. 346 interventions were reported and rated; 85.6% had high or moderate impact; 56.7% were time-critical. The proportion of medicines reconciliation within 24-h of admission was analysed across the hospital between November 2020 and May 2021. During implementation, patients admitted Friday-Sunday were more likely to receive medicines reconciliation within 24-h (RR 1.41 (95% CI 1.34-1.47), p < 0.001). Rostered services were delivered sustainably in terms of shift-fill rate and medicines reconciliation outcome. CONCLUSION: Seven-day clinical pharmacy services benefit patient outcome through early medicines reconciliation and intervention. Investment to permanently embed the service was sustained.

A taxonomy proposal of cyber threats involving children and adolescents

This exploratory research with a qualitative approach retrieves recent prominent threats involving children and adolescents on the internet during Covid-19 pandemic by searching occurrences on the digital journalistic production for a systematic review on news articles and blogs indexed by online databases. We found 45 cyber threats and classified them based on scientific literature. After, we proposed a taxonomy to help to identify, report and treat the occurrences and improve cybersecurity and cyber safety. This taxonomy aims to be a contribution to education in the post-pandemic world. © 2022 IEEE.

O Desabastecimento De Imunoglobulina Intravenosa E O Uso De Plasmaferese Em Primeira Linha Na Sindrome De Guillain - Barre Em Paciente Pediatrico: Relato De Caso E Revisao De Literatura

Objetivos: Relatar um caso de Guillain - Barre em paciente de 12 anos de idade que utilizou plasmaferese terapeutica como primeira linha, focando nos aspectos tecnicos do procedimento;Discutir as possiveis causas para o desabastecimento de imunoglobulina intravenosa (IGIV) atual. Metodologia: Coleta de dados clinicos no prontuario. Revisao de literatura, com enfase em plasmaferese na populacao pediatrica, suas indicacoes, paticularidades tecnicas e eventos adversos. Resultados: Paciente de 12 anos de idade, sexo feminino, 35 quilos, previamente higida, deu entrada no pronto - socorro com quadro de tetraparesia desproporcional - forca grau III em MMII e grau IV em MMSS - associada a mialgia difusa. Sem quadro infeccioso ou vacinacao recente antecedendo. Equipe da neurologia levantou hipotese de sindrome de Guillain- Barre e solicitou plasmaferese terapeutica, pois nao havia disponibilidade de IGIV. Foram realizadas 04 sessoes utilizando o sistema COM.TEC (Fresenius Kabi) com troca de uma volemia cada. O fluxo medio de extracao foi de 37,5ml/min (30-45ml/min). A taxa media de ACD infundido na paciente foi de 234ml e a proporcao ACD:sangue foi de 1:16. A duracao media foi de 73 minutos por procedimento. Em todas as sessoes foi utilizado reposicao profilatica com solucao de 10ml de gluconato de calcio 10%. A paciente apresentou tontura e parestesia perioral nas duas primeiras sessoes. Sem outros eventos adversos. Recebeu alta apos quarta sessao, ja sendo capaz de deambular sem auxilio. Discussao: A Sindrome de Guillain Barre corresponde a um grupo de polirradiculopatias autoimunes, inflamatorias e desmielinizantes. Os tratamentos de primeira linha constituem IGIV e plasmaferese. A IGIV costuma ser preferida principalmente em criancas por maior facilidade posologica e nao envolver uso de dispositivos invasivos. O desabastecimento de IGIV desde 2019 em diversos paises do mundo, inclusive no Brasil, tem dificultado o acesso a este tratamento. Entre as possiveis causas para este desabastecimento, podemos citar: aumento da demanda nao acompanhada por aumento na producao, impactos da pandemia de COVID- 19 sobre materia-prima (doadores de sangue) e logistica (transporte, etc), descontinuacao do produto por alguns laboratorios, entre outros. Segundo o ultimo guideline da Sociedade Americana de Aferese nao ha diferenca no desfecho entre IGIV e plasmaferese. Entre os principais eventos adversos da plasmaferese em pacientes pediatricos, destacam- se os relacionados ao acesso central (infeccoes, complicacoes mecanicas, entre outros), hipocalcemia, o volume extracorporeo utilizado no procedimento e riscos de intoxicacao por citrato. A paciente do caso apresentou apenas sintomas leves de hipocalcemia, que melhoraram apos reducao do fluxo de extracao. Conclusao: A plasmaferese terapeutica em pacientes pediatricos tem se mostrado eficaz, seja em primeira linha ou como tratamento complementar. Ajustes na taxa de extracao, reposicao profilatica de calcio e cuidados com o acesso central aumentam a seguranca do procedimento. Copyright © 2022

Do Telephone Clinics Lead to Greater Patient Satisfaction in General Surgical Outpatients?

Aims: To limit exposure risk in view of The current COVID-19 pandemic, telephone clinics have become The mainstay of outpatient assessment. Although there is data from primary care, there is little evidence for The suitability of telemedicine within General Surgery. The lack of clinical examination can be dissatisfying for both patient and surgeon. The aim of this study was to explore patient satisfaction from telephone clinics in a General Surgery setting. Method(s): Data was collected prospectively from General Surgery clinic appointments by a single surgeon in a District General Hospital from September 2021. Demographic data was obtained in addition to a short questionnaire at The end of their consultation. Patients were asked to score their experience out of 5 (5 being most favourable) and their preference in Comparison to face to face appointments. Result(s): 156 patients were included in The study, of which 95% of patients were contactable. 98% of patients gave The experience a satisfaction score of 3 or more out of 5. The median satisfaction score was 5. 97% expressed a preference over a Face-to-Face appointment. 7% of patients required a further Face-to-Face consultation and this group were more likely to have a lower patient satisfaction score. Conclusion(s): Telephone clinics within General Surgery achieve excellent satisfaction for The majority of patients. The patient experience could be further optimised by careful selection of patient suitability for The service. The data provides supportive evidence to The NHS Long Term Plan to reduce Face-to Face outpatient appointments by one third before 2024.

Can self-estimated BMI be used for pre-operative planning in elective General surgery?

Aims: Telemedicine is being increasingly used in outpatient settings following The COVID-19 pandemic. This study aimed to determine if self-estimated body mass index (BMI), from telephone consultation, was accurate and useful for planning prior to elective General surgery. Method(s): Age, gender and estimated BMI were collected from consecutive patients attending a pre-operative telephone clinic under a single surgeon at a district General hospital in The South of England between April and October 2021. Actual BMI was measured on The day of Surgery and compared. Result(s): 124 patients were included (median age 59 years, 49.2% male). BMI was accurately estimated by 38, under-estimated by 33 and over-estimated by 53 participants. Overall, there was a significant difference in The pre-operative and post-operative BMI (P = 0.003). This was significant for females (median change 0.1, IQR 0.0-0.7, P = 0.002) but not for males (median change 0.0, IQR-0.1, 0.2, P = 0.479). Those with an actual BMI >29.9 had a significantly higher median change (0.2 (0.0, 1.1) compared to those with BMI <29.9 (0.0 (-0.2, 0.1);P <0.001). only 2 patients could have required a change in surgeon on The day of The procedure (P = 0.500). Conclusion(s): Self-estimated BMI is a suitable method for assessing patients for planning in elective General surgical procedures, particularly for males. However, it is important to be aware of those with higher BMIs, particularly females, who may underestimate their BMI.

Can we optimize d-dimer cut off value to predict pulmonary embolism in covid-19 patients?

Background: Covid-19 is associated with an increased risk of pulmonary embolism (PE) therefore, should the cut off d-dimer value be adjusted for these patients? Material(s) and Method(s): Retrospective and observational study to understand if there is a d-dimer cut-off that could guide clinics to perform a thoracic computed tomography angiography (CTA) in patients with covid-19. The population was covid-19 patients admitted to covid-19 dedicated wards of a University Hospital Centre for one year. Result(s) and Conclusion(s): 725 (52%) patients with covid-19 had a d-dimer value dosed during the first 5 days of the disease. Those, 63 (9%) did a CTA with a diagnosis of 16 (25%) PE. Gender was equally represented, median age was 70 years (ID=3.49) and the majority (94%) survived. Thirteen (81%) patients with PE had a d-dimer value above 2500 ng/mL (OR=9.244, 95% CI 2.248-9.837), with 7 (54%) with values over 10000 ng/mL, but in 3 (9%) it was under 1500 ng/mL. Seventy-three (63%) of patients with a d-dimer over 1500 ng/mL did not had a thoracic CTA performed. In our population PE was not a frequent outcome. The results are influenced by the low number of thoracic CTA performed because, even tough the cut-off d-dimer value used at our hospital to perform a thoracic CTA to exclude PE is 1500 ng/mL, most patients with that d-dimer value did not take the exam and so PE could not be excluded. Although in most PE cases the d-dimer value was above 2500 ng/mL, the results of our study cannot verify if that is a better cut-off value.

Assessing How Effectively Ankle Fractures Are Managed in Accordance with the BOAST Guidelines at a Major Trauma Centre

Aim: Ankle fractures constitute approximately 10.2% of all bony injuries. Due to pressures exerted by the COVID-19 pandemic, a series of modifications have evolved within subspecialty fracture management. The aim of our study was to evaluate our adaptations to the COVID-19 pandemic and assess our management of ankle fractures according to the BOAST guidelines. Method: We performed a retrospective review of 30 skeletally mature patients with a closed ankle fracture presenting to a major tertiary centre. Our inclusion criteria comprised of the 'BOAST guidelines for ankle fracture management' published in 2016. Results: Of the 30 patients within our cohort, 40% (n= 12) had stable ankle fractures, whereas 60% (n= 18) were unstable (based on the weber classification and evidence of syndesmotic instability). 63% (n= 10) had fracture manipulations prior to surgery. 50% (n= 5) had a documented re-examination of neurovascular status. All patients had a post reduction image. 88% (n= 16) with unstable fractures underwent operative fixation. 6 patients underwent external fixation prior to definitive management. The average time from injury to definitive fixation was 12 days with a range from 0-22 days. Only 8 patients had clear documentation of intraoperative syndesmotic stability. Conclusions: The BOAST guidelines outline a range of standards that should be utilised when treating ankle fracture patients. We intend to use our study to educate healthcare professionals on the importance of accurate documentation and encourage shorter operative waiting times to improve standard of care and patient outcomes.

Evaluating the Effectiveness of Extracorporeal Shockwave Lithotripsy (ESWL) for Ureteric Stones During COVID-19 Pandemic - A Single Centre Experience

Aim Reliance on ESWL for treating ureteric stone has increased during the COVID-19 pandemic. We examined the outcomes for ureteric stones treated with our on-site lithotripter to assess the success rate and determine the variables that could affect the outcome results. Method A retrospective review using electronic records and images of patients who underwent ESWL for ureteric stones (January to December 2020). Univariate and multivariate analysis used to determine stone-free rate predictors (Stone Free rate/SFR: No residual stones on post-ESWL imagining). Results A total of 36 patients underwent ESWL for ureteric stones. Mean age was 58 years (21–90), and mean stone size was 8 mm (5–20). Stones were located in the proximal (67%) or lower ureter (33%). Overall SFR was 64% (67% proximal, 33% distal). 64% of patients required only one session to be stone free, with 60% stone free after two sessions. Stones <10mm had a SFR of 67%, compared to 58% for stone >10 mm. The only statistically significant predictor was stone size (longest dimension, p=0.04). No statistical significance with stone location (P=0.09), skin-to-stone distance (SSD) (P=0.7), stone density (P=0.3) or stone volume (P=0.3). In treatment failure, time to definitive ureteroscopy was 4 weeks. Conclusion Our overall SFR was slightly lower than expected but comparable to available literature. This data highlights the importance of patient selection for ESWL and would be useful in counselling about local success rate. More than half of the patients required only one session for stone clearance and stone size was the only significant predictor for successful ESWL.

Plasma first: Accelerating lung cancer diagnosis through liquid biopsy

Background: Molecular profiling of tumor tissue is the gold standard for treatment decision making in advanced non-small cell lung cancer. Results may be delayed or unavailable due to insufficient tissue samples or prolonged wait times for biopsy, pathology assessment and testing. We piloted the use of plasma molecular testing as part of the initial diagnostic work-up for patients with suspected advanced lung cancer (NCT04863924). Methods: Patients with radiologic evidence of advanced lung cancer referred to the lung rapid diagnostic program underwent plasma circulating tumor DNA (ctDNA) testing using InVisionFirst-Lung, a next-generation sequencing (NGS) assay targeting 37 genes. Standard tissue testing was performed with comprehensive NGS (Oncomine). The primary endpoint was time to treatment in stage IV NSCLC patients compared to an historical pre-COVID-19 cohort (2018-9). Secondary endpoints included actionable targets identified in plasma, % of patients starting targeted therapy based on liquid biopsy and result turnaround time (TAT). Results: Between July 1 to December 31, 2021, 60 patients were enrolled. Median age was 70 years (range 33-91), 52% were female, 57% Caucasian, 48% never smokers. Of these, 73% had NSCLC, 12% small cell, 10% non-lung pathology and 5% declined tissue biopsy. Of 44 NSCLC patients, 5 (11%) had early-stage disease and underwent curative therapy. Most stage IV patients (79%) had systemic treatment. Median time to treatment initiation in the study cohort was 34 days (n = 31, range 10-90) versus 62 days (n = 101, range 13- 159) in the historical cohort (p<0.0001). Two thirds (N = 23) of stage IV NSCLC patients had actionable alterations identified, (30% in current/ex-smokers);18 started targeted therapy including 10 based on plasma results before tissue results were available. Median TAT was 7 days for plasma from blood draw to reporting (range 4-14) and 26 days for tissue molecular testing (range 11-42), p<0.0001. Concordance was high between plasma and tissue testing (70%). Liquid biopsy identified actionable alterations for 3 patients not identified by tissue NGS. In 4 cases, plasma testing failed to identify actionable alterations detected in tissue, due to undetectable plasma ctDNA. Conclusions: Liquid biopsy in the initial diagnostic workup of patients with suspected advanced NSCLC leads to faster molecular results and shortens time to treatment compared to tissue testing alone. Supplementing the current standard of tissue molecular testing with a plasma-first approach during the diagnostic work up of patients with suspected advanced lung cancer may increase access to precision medicine and improve patient outcomes. (Table Presented).

Distinct Antimicrobial Analysis to Evaluate Multi-Component Wound Dressing Performance

Wound infection hinders adequate healing, being particularly grievous and prevalent in burn wounds and chronic wounds. Wound infection extends inflammation, preventing epithelialization and angiogenesis. Therefore, infection prolongs healing time, steeply increases treatment costs and degrades patients wellbeing. One successful strategy to control wound infection is to apply an active wound dressing, able to eliminate or significantly reduce the microbial population present at the infection site. Silver nanoparticles (AgNPs) are a multipurpose antimicrobial agent with a wide scope of applications which include wound dressings. Nevertheless, several studies denote AgNPs dose-dependent cytotoxicity, and their capability to bypass the blood-brain barrier and induce a neurotoxic effect. Hence, we propose to adopt two different strategies to attempt the simultaneously immobilize and increase the load of AgNPs within the wound dressing fabric. Thus, the envisaged objective is to prevent potential systemic cytotoxicity/through immobilization and to improve its antimicrobial capability due to the higher concentration of AgNPs. Two different approaches were used: i. AgNPs were suspended in an alginate (ALG) solution, ii. AgNPs were embedded in Mordenite (MOR) zeolite, followed by the addition of an ALG solution. Both suspensions were incorporated into polyester fabric assisted by its surface activation by dielectric barrier discharge (DBD) plasma treatment. The bactericidal and virucidal effectiveness of each composite was tested against bacteria species known to induce nosocomial infections and a bacteriophage that is a potential surrogate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Two distinct antimicrobial analyses were used to provide insights on the antimicrobial effectiveness of the obtained composites and to indirectly assess the release of AgNPs.

A crystallographic snapshot of SARS-CoV-2 main protease maturation process

SARS-CoV-2 is the causative agent of COVID-19. The dimeric form of the viral Mpro is responsible for the cleavage of the viral polyprotein in 11 sites, including its own N- and C-terminus. The lack of structural information for intermediary forms of Mpro is a setback for the understanding its self-maturation process. Herein, we used X-ray crystallography combined with biochemical data to characterize multiple forms of SARS-CoV-2 Mpro. For the immature form, we show that extra N-terminal residues caused conformational changes in the positioning of domainthree over the active site, hampering the dimerization and diminishing its activity. We propose that this form preludes the cis and trans-cleavage of N-terminal residues. Using fragment screening, we probe new cavities in this form which can be used to guide therapeutic development. Furthermore, we characterized a serine site-directed mutant of the Mpro bound to its endogenous Nand C-terminal residues during dimeric association stage of the maturation process. We suggest this form is a transitional state during the C-terminal trans-cleavage. This data sheds light in the structural modifications of the SARS-CoV-2 main protease during its self-maturation process.

Insights for Alzheimer's disease pharmacotherapy and current clinical trials.

Over the years, the scientific community has sought improvements in the life quality of patients diagnosed with Alzheimer's disease (AD). Synaptic loss and neuronal death observed in the regions responsible for cognitive functions represent an irreversible progressive disease that is clinically characterized by impaired cognitive and functional abilities, along with behavioral symptoms. Currently, image and body fluid biomarkers can provide early dementia diagnostic, being it the best way to slow the disease's progression. The first signs of AD development are still complex, the existence of individual genetic and phenotypic characteristics about the disease makes it difficult to standardize studies on the subject. The answer seems to be related between Aß and tau proteins. Aß deposition in the medial parietal cortex appears to be the initial stage of AD, but it does not have a strong correlation with neurodegeneration. The strongest link between symptoms occurs with tau aggregation, which antecede Aß deposits in the medial temporal lobe, however, the protein can be found in cognitively healthy older people. The answer to the question may lie in some catalytic effect between both proteins. Amid so many doubts, Aducanumab was approved, which raised controversies and results intense debate in the scientific field. Abnormal singling of some blood biomarkers produced by adipocytes under high lipogenesis, such as TNFα, leptin, and interleukin-6, demonstrate to be linked to neuroinflammation worsens, diabetes, and also severe cases of COVID-19, howsoever, under higher lipolysis, seem to have therapeutic anti-inflammatory effects in the brain, which has increasingly contributed to the understanding of AD. In addition, the relationship of severe clinical complications caused by Sars-CoV-2 viral infection and AD, go beyond the term "risk group" and may be related to the development of dementia long-term. Thus, this review summarized the current emerging pharmacotherapies, alternative treatments, and nanotechnology applied in clinical trials, discussing relevant points that may contribute to a more accurate look.

SMACovid-19 – Autonomous Monitoring System for Covid-19

The SMACovid-19 project aims to develop an innovative solution for users to monitor their health status, alerting health professionals to potential deviations from the normal pattern of each user. For that, data is collected, from wearable devices and through manual input, to be processed by predictive and analytical algorithms, in order to forecast their temporal evolution and identify possible deviations, predicting, for instance, the potential worsening of the clinical situation of the patient. © 2021, Springer Nature Switzerland AG.

Portuguese immunoallergology clinical experience in patients with severe atopic dermatitis under dupilumab treatment

Background: Dupilumab has been recently approved for treatment in patients with severe AD in Portugal-until now there is no published data regarding Portuguese experience in Allergy centers. Method: Cross sectional clinical and laboratory assessment of 33 patients (pts) with moderate to severe AD treated with dupilumab (dupi) for at least 16 weeks (W): prospective evaluation of severity scores (SCORAD-Scoring Atopic Dermatitis, EASI-Eczema Area and Severity Index, P-VAS-Pruritus Visual Analogic Scale), report of adverse events up to 52 weeks of treatment. SCORAD and EASI were assessed in 23 pts at W52, P-VAS in 21 pts at W52. Results: Of the 33 pts, 18 were female (55%) with a mean age (SD, range) of 35.3 years (13.2, 15-60). In 16 pts the age of onset was before 2 years old, mean (SD) disease duration 28.1 years (12);94% patients had a diffuse pattern of skin lesions;97% of pts had allergic rhinitis, 82% asthma, 52% conjunctivitis and 30% food allergy. Median total IgE at baseline was of 6313 U/ml (P25-P75: 2842-12491) with a 76% reduction at W52 in 16 pts. Median eosinophil count at baseline was 520 eosinophils/mm3 (P25-P75: 270-740). Before starting dupi 29 pts had been treated with cyclosporine. At the beginning, 15 pts were under oral corticosteroids, 14 under oral systemic immunosuppressive drugs (all pts but two stopped both until W12 of dupi) and 5 switched from omalizumab. At baseline, median SCORAD and EASI were 69.3 and 24.2 points. At W16, W36 and W52, median SCORAD was 27.4, 22.3 and 21.5, and median EASI 5.3, 4.1 and 2.1. At W16, the EASI-50, EASI-75 and EASI-90 were achieved by 91%, 61% and 18% pts, and at W52, by 87%, 70% and 52% pts. The mean percentage of SCORAD reduction at W16 and W52 was 55% and 73%;and of EASI was 76% and 82%. At W16 and W52, an improvement of ≥4 points in P-VAS was achieved by 77% and 95% pts. There was a mean reduction of P-VAS at W2, W4, W16 and W52 of 2.6;3.6;4.7 and 6.3 points, respectively. Conjunctivitis was reported in 10 (30%) pts, two of them with keratoconjunctivitis and blepharitis, without needing to interrupt treatment;two pts also had facial erythema. One patient had COVID, and dupilumab scheme treatment was maintained. Conclusion: The majority of AD patients had a significant and consistent improvement in all the severity scores, after one year of treatment with dupilumab. No relevant adverse events were reported.

'passing the surgical torch'-a review of appropriate surgical handover protocol on the acute surgical take

Aim: Effective handover between shifts is vital to protect patient safety. The Royal College of Surgeons has detailed the necessary information needed for each patient at handover. We aimed to assess compliance with this handover protocol. Method: Weekday surgical handover was reviewed over an 8-week period of time. Data was collected on documentation of diagnosis, up to investigations/bloods, clinical state of patient, management plan and resuscitation status/ceiling of care and COVID status. Results: 210 patients were reviewed. Of these, a clear diagnosis was documented for 152 patients. Up to date imaging results if applicable was documented in 111 of 153 patients. Up to date bloods were included in 140 of 210 patients. COVID status was only noted in 31 of 210 patients and DNAR status in only 24. After re-audit of 197 a clear diagnosis was seen in 183 patients, COVID status was documented in 170 patients and DNAR status in 169. Conclusions: Surgical handover is hugely crucial for provision of patient care. Following clear guidance from the royal college of surgeons, better compliance with handover was noted, including a critical improvement in COVID and DNAR status.