Acute Hepatitis of Unknown Origin in Children: Two Cases in a Portuguese Hospital.

Several cases of paediatric acute hepatitis of an unknown aetiology have been described in these last few months and in several countries worldwide. We present two patients, a 7-month-old girl and an 8-year-old boy, with gastrointestinal symptoms and lethargy, associated with elevation of transaminase levels. Serologies for hepatitis A-E virus and PCR test to SARS-CoV-2 were all negative. In the first case, an adenovirus serotype C could be isolated in a respiratory sample as well as cytomegalovirus (CMV) in the blood (100 copies/mL). In both children, there was a progressive decrease in the hepatic markers and symptomatic resolution, compatible with a good prognosis, also seen globally in most cases. To date, infection remains the most plausible cause to consider, especially when it is presumed to be linked to adenovirus. Other potential agents and causes are still being evaluated, thus emphasizing the importance of continuous epidemiological surveillance, notification, and detailed study of all hepatitis cases.

Mental health and coping strategies in graduate students in the COVID-19 pandemic.

OBJECTIVE: to verify the relation of depression, anxiety, and stress symptoms with coping strategies in graduate students in the context of the new coronavirus pandemic (COVID-19). METHOD: an electronic cross-sectional and correlational survey was conducted with 331 Brazilian graduate students, aged 20-64 years old, who answered an online form containing a sociodemographic data questionnaire, a coping strategies scale, and the DASS-21 scale. Descriptive analysis, Mann-Whitney U or Kruskal-Wallis tests, and Spearman's correlation were performed. RESULTS: the main results indicated that maintaining work and study routines, as well as a religious practice, is correlated with lower scores of depression, anxiety, and stress symptoms, as well as with coping strategies that can act as protective factors. CONCLUSION: the new coronavirus pandemic has strained public health and increased the need for studies aimed at understanding the impact of the event on the mental health of the population. It is suggested that employment and religiousness should be considered in interventions with graduate students.

"Community engagement via restorative justice to build equity-oriented crisis standards of care".

The COVID-19 (SARS-CoV-2) Pandemic has revealed multiple structural inequities within the United States (US), with high social vulnerability index communities shouldering the brunt of death and disability of this pandemic. BIPOC/Latinx people have undergone hospitalizations and death at magnitudes greater than White people in the US. The untold second casualties are health care workers that are suffering from increased risk of infection, death, and mental health crisis. Many health care workers are abandoning the profession all together. Although Crisis Standards of Care (CSC) mean to guide the ethical allocation of scare resources, they frequently use scoring systems that are inherently biased. This raises concern for the application of equity in CSC. Data examining the impact of these protocols on health equity is scarce. Structural maltreatment in healthcare and inequities have led to cumulative harms, physiologic weathering and structural adversities for residents of the US. We propose the use of Restorative Justice (RJ) practices to develop CSC rooted in inclusion and equity. The RJ framework utilizes capacity building, circle process, and conferences to convene groups in a respectful environment for dialogue, healing, accountability, and action plan creation. A phased, non-faith-based facilitated RJ approach for CSC development (or revision) that fosters ethically equitable resource distribution, authentic community engagement, and accountability is shared. This opportunity for local, inclusive decision making and problem solving will both reflect the needs and give agency to community members while supporting the dismantling of structural racism and oppressive, exclusive policies. The authors are asking legislative and health system policy makers to adopt Restorative Justice practices for Crisis Standards of Care development. The US cannot afford to have additional reductions in inhabitant lifespan or the talent pool within healthcare.

Mental health and coping strategies in graduate students in the COVID-19 pandemic Salud mental y estrategias de afrontamiento en estudiantes de postgrado durante la pandemia de COVID-19 Saúde mental e estratégias de coping em pós-graduandos na pandemia da COVID-19

Objective: to verify the relation of depression, anxiety, and stress symptoms with coping strategies in graduate students in the context of the new coronavirus pandemic (COVID-19). Method: an electronic cross-sectional and correlational survey was conducted with 331 Brazilian graduate students, aged 20-64 years old, who answered an online form containing a sociodemographic data questionnaire, a coping strategies scale, and the DASS-21 scale. Descriptive analysis, Mann-Whitney U or Kruskal-Wallis tests, and Spearman’s correlation were performed. Results: the main results indicated that maintaining work and study routines, as well as a religious practice, is correlated with lower scores of depression, anxiety, and stress symptoms, as well as with coping strategies that can act as protective factors. Conclusion: the new coronavirus pandemic has strained public health and increased the need for studies aimed at understanding the impact of the event on the mental health of the population. It is suggested that employment and religiousness should be considered in interventions with graduate students.

BNT162b2 vaccine-induced humoral and cellular responses against SARS-CoV-2 variants in systemic lupus erythematosus.

OBJECTIVES: Our aim was to evaluate systemic lupus erythematosus (SLE) disease activity and SARS-CoV-2-specific immune responses after BNT162b2 vaccination. METHODS: In this prospective study, disease activity and clinical assessments were recorded from the first dose of vaccine until day 15 after the second dose in 126 patients with SLE. SARS-CoV-2 antibody responses were measured against wild-type spike antigen, while serum-neutralising activity was assessed against the SARS-CoV-2 historical strain and variants of concerns (VOCs). Vaccine-specific T cell responses were quantified by interferon-γ release assay after the second dose. RESULTS: BNT162b2 was well tolerated and no statistically significant variations of BILAG (British Isles Lupus Assessment Group) and SLEDAI (SLE Disease Activity Index) scores were observed throughout the study in patients with SLE with active and inactive disease at baseline. Mycophenolate mofetil (MMF) and methotrexate (MTX) treatments were associated with drastically reduced BNT162b2 antibody response (ß=-78, p=0.007; ß=-122, p<0.001, respectively). Anti-spike antibody response was positively associated with baseline total immunoglobulin G serum levels, naïve B cell frequencies (ß=2, p=0.018; ß=2.5, p=0.003) and SARS-CoV-2-specific T cell response (r=0.462, p=0.003). In responders, serum neutralisation activity decreased against VOCs bearing the E484K mutation but remained detectable in a majority of patients. CONCLUSION: MMF, MTX and poor baseline humoral immune status, particularly low naïve B cell frequencies, are independently associated with impaired BNT162b2 mRNA antibody response, delineating patients with SLE who might need adapted vaccine regimens and follow-up.