PROJETO SENTINELA COVID-19: ESTUDO DE VIABILIDADE DA DETECÇÃO VIRAL EM ASSINTOMÁTICOS UTILIZANDO O TESTE POINT OF CARE PARA DETECÇÃO DO ANTÍGENO DO SARS-COV-2 E RESULTADOS EM MEIO À EXPANSÃO DA VARIANTE DELTA NO BRASIL

A OMS estabelece como métricas para avaliação da transmissão comunitária da COVID-19 a ocorrência de casos novos, mortes, internações e positividade da testagem sentinela. A testagem sentinela por razões econômicas e logísticas não ocorreu no Brasil e sempre atuamos sob indicadores já ocorridos. Considerando a relevância da transmissão assintomática, sobretudo com a expansão da vacina, e a necessidade de aprimorar a vigilância sobre a circulação viral implementamos um projeto sentinela na cidade de Cubatão na região da Baixada Santista em São Paulo. Realizamos semanalmente, aos sábados, dois testes para cada 1000 habitantes em todas as regiões do município, incluindo as mais socialmente desafiadoras, respeitando as bases e divisões dos setores censitários do IBGE. Aplicamos o TCLE e coletamos um questionário em meio digital com dados demográficos, clínicos e epidemiológicos. Entre 31/07 e 25/09/21 foram realizados 2185 testes (Panbio-AbbottR). Foram identificados 6 casos positivos no período (0,3%). A mediana de idade dos testadas foi de 49 anos, sendo 51,8% do sexo feminino. Em média, ao longo do período de testagem, 51,1% da amostra avaliada havia tomado 2 doses de vacinas dentro do prazo e foi possível avaliar a evolução da cobertura vacinal no período. Na última data de inquérito no período (25/09/2021), 75,59% da amostra estava plenamente vacinada e quase a totalidade com uma dose ao menos. Os resultados de baixa positividade alinham-se com a redução na demanda por consultas em PA por COVID (menos 70%), por internações (menos 97%) e por vagas em UTI (menos 98%) comparando-se os meses entre março (pico) e agosto de 2021. Alinham-se ainda à redução de positividade do RT-PCR entre sintomáticos de 88% para o mesmo período (de 43,6 para 4,9%). Entre 30/08 e 08/09/21 100% das variantes isoladas no município são delta e nenhum dos pacientes teve evolução desfavorável com necessidade de internação. O uso da testagem sentinela mostrou-se uma ferramenta útil no processo da gestão dos leitos e decisões estratégicas da secretaria de saúde, teve excelente aceitação e performance sem nenhuma perda, foi sensível e esteve em linha com os dados compilados pela gestão. Seu uso deve ser realizado como ferramenta útil no monitoramento precoce e antes que desfechos clínicos mais severos estejam concretizados. Por fim, está evidente a performance da vacina como ferramenta essencial na proteção contra formas graves da COVID e na contenção da expansão da variante delta.

Malignant colorectal obstruction: a university hospital 4-year retrospective case series

Background: In 2020, colorectal cancer (CRC) was the most diagnosed cancer and the 2nd leading cause of cancer related mortality in Portugal. Early detection and adequate treatment lead to improvements in mortality. Increasing participation in screening programs has been challenging and health authorities in Portugal reported that in 2018 only 40% of the target population had an up-to-date screening status. Not only screening but also access to specialized consultation and surgery seem to preclude timely treatment. The year 2020 brought forth another challenge as the SARS-CoV2 pandemic halted screening efforts and discouraged patients from seeking healthcare. We hypothesized that under these conditions an increase in colorectal obstruction and more advanced staging at diagnosis would be observed. Materials and Methods: We retrospectively identified the consecutive cases of malignant colorectal obstruction (MCO) that presented to the emergency department and demanded emergent surgery between January 1st 2017 and March 1st 2021. Recruitment was performed by reviewing operating room logbooks and electronic patient records. A total of 226 patients operated for colorectal obstruction were identified. Patients with benign disease or non-digestive primary were excluded and the 161 remaining cases were reviewed. Results: Median age of patients 72(29-97) years and female to male ratio of 1:1.3. Statistical analysis of complete years (2017-2020) observed an overall average of 39(±8.4) cases/year with no clear increasing trend. Previous CRC diagnosis had been established in 20.0%, 28.9%, 37.3% and 31.3% of cases in 2017, 2018, 2019 and 2020 respectively. Stage III or higher at pathological diagnosis was increasingly more frequent (62.9%, 76.3%, 76.5%, 81.3 %) but M status remained stable at an average of 42.7(±5.9)%. Surgical approach did not vary and in an average of 33.6(±2.7)% of patients, derivative surgery alone was indicated (palliation or bridge to therapy) and in 72.4(±1.0)% of patients, resection with ostomy was performed. Conclusions: The descriptive nature of this analysis hinders the accuracy of its conclusions but offers some insights. The incidence of MCO did not seem to vary, however our selection is biased as patients may have searched for emergent care in other hospitals. In the patients that evolve to obstruction, the delay in screening and treatment implementation seem to result in an increase in stage at surgery dependent on lymph node status as metastatic disease remained stable. It seems early to observe the effect of the pandemic on timely diagnosis and treatment, but it seems it contributed for a higher staging at diagnosis. It is possible we would find a similar effect on non-obstructive cases rather than an increase in MCO. A larger scope and prospective recruitment seem key to capturing this difference in outcomes.

Pestis: The collective challenges of epidemics

Currently, COVID-19 is perceived as an epidemic, a new «plague», referring to the matrix metaphor of the pestis expressed in the series contagion – death – fear – isolation. This article aims to understand the multiple collective challenges posed by plague epidemics. The analysis of these challenges may contribute to the reflection on several dimensions that shape the COVID-19 pandemic threat. Individuals interpret the different pasts aiming to solve the problems they face in the present. The collective challenges that the political and medical «management» of the plague place are shaped by circumstantial coalitions of diverse interests, enabling the recognition, demarcation, and legitimisation of actions regarding its public management and control, materialised in concrete health policies, such as the development of several specific devices (isolation, health cordons, lazarettos, quarantine), thus intervening in the configuration of «collective management» of epidemics. © 2021 Ferreira et al..

Interdependencies between COVID-19, mental illness and living uneasiness

The spread of the COVID-19 pandemic has led to a profound change in the daily practices and symbolic representations of individuals, with strong social, economic and political implications, which no one is immune to. This article seeks to understand how a pandemic, specifically COVID-19, can generate or potentiate different forms of mental illness and living uneasiness. Thus, the aim is to know the varied manifestations of psychological suffering, from mild psychiatric disorders to the most intrusive ones, not forgetting the forms of widespread suffering which the pandemic causes and which are not reduced to the categories defined by the process of psychiatry. The relationships between mental illness, living uneasiness and COVID-19 are complex and multidimensional. © 2021 Martins et.al.

The COVID-19 Contagion-Pandemic Dyad: A View from Social Sciences

The objective of this concept paper focuses on the relevance of the analytical potential of Social Sciences for understanding the multiple implications and challenges posed by the COVID-19 contagion-pandemic dyad. This pandemic is generating a global threat with a high number of deaths and infected individuals, triggering enormous pressure on health systems. Most countries have put in place a set of procedures based on social distancing, as well as (preventive) isolation from possible infected and transmitters of the disease. This crisis has profound implications and raises issues for which the contribution of Social Sciences does not seem to be sufficiently mobilised. The contribution of Social Sciences is paramount, in terms of their knowledge and skills, to the knowledge of these problematic realities and to act in an informed way on these crises. Social Sciences are a scientific project focused on interdisciplinarity, theoretical and methodological plurality. This discussion is developed from the systems of relationships between social phenomena in the coordinates of time and place, and in the socio-historical contexts in which they are integrated. A pandemic is a complex phenomenon as it is always a point of articulation between natural and social determinations. The space of the discourse on the COVID-19 pandemic can be understood as the expression of a coalition of discourses, i.e., the interaction of various discourses, combined in re-interpretative modalities of certain realities and social phenomena. The circumstantial coalitions of interests, which shape the different discursive records and actions produced by different agents of distinct social spaces, enable the acknowledgement and legitimation of this pandemic threat and danger, and the promotion of its public management.

Endodontic treatment during COVID-19 pandemic - Economic perception of dental professionals

Aim: This study evaluated, by the application of questionnaires, the impact of the COVID-19 pandemic on the clinical routine and inspection by the competent authorities, on the flow of patients in the office, as well as on possible changes in Endodontic treatment costs and the amounts charged to patients. Methods: This cross-sectional study was conducted from May 2nd, 2020 to May 6th, 2020, using an online questionnaire with a convenience sample. The inclusion criterion was professionals who perform endodontic treatments in daily clinical practice and who professional setting is private practice. The questionnaire brought questions about the impact on costs and the amount charged to the patient. Results: A total of 1042 questionnaires were answered from all the different states of Brazil, by professional who usually perform Endodontic treatment, and who is working in private practice. A total of 1010 (96.9%) respondents affirm it was necessary to modify the protective equipment in endodontic treatment due to pandemic and longer intervals between appointments was cited by 922 (88.5%), economically affecting the dental practice. There was no association between routine changes and economic impacts with gender, professional experience, area of residence or education level. Conclusion: In conclusion, most dental professionals recognized changes in the routine of endodontic treatment during the COVID-19 pandemic. They have a perception of increase in endodontic costs, and reduction in the volume of patients. © 2021. All Rights Reserved.