Dysphagia rehabilitation in post-COVID patients: Review of the literature

COVID-19 causes acute respiratory failure syndrome (SIRA), leading patients to require intubation in the intensive care unit (ICU). A common complication of this ventilatory support is dysphagia, which has a prevalence of up to 30%.This work aims to describe rehabilitation methods in patients with coronavirus infection based on levels of evidence according to the GRADE System, so a systematic review of the literature was carried out. The selected articles were divided into the following subtopics: diagnosis of dysphagia and rehabilitation in COVID patients. The gold standard for the diagnosis of dysphagia is the videofluoroscopic swallowing study (VFS). Fiberoptic Evaluation of Swallowing Assessment (FEES) has high sensitivity and specificity, although they have the disjunction of an aerosol-generating procedure (AGP);however, in a pandemic situation, the study of choice in the literature is VF. Once the diagnosis is made, it is necessary to initiate rehabilitation as soon as possible, even from hospitalization in patients who have hemodynamic stability to prevent long-term effects and promote normal swallowing even before discharge. In patients with COVID-19 infection dysphagia, the risk-benefit of assessment tools and therapy used for diagnosis should be decided to help to maintain social distancing. It becomes imperative to carry out clinical studies with high levels of evidence that allow us to generate Clinical Practice Guides for the benefit of our patients.Copyright © 2021 Sociedad Medica del Hospital General de Mexico. Published by Permanyer.

Cellular stress and SARS-CoV-2

Background: SARS-CoV-2, the etiological agent responsible for COVID-19, is an RNA virus belonging to the Coronaviridae family. During the virus replication, viral components interact with the cellular machinery, inducing alterations in cell physiology, which contributes to viral pathogenesis. Method(s): A bibliographical research about cellular stress and SARS-CoV-2 was performed at NCBI/Pubmed. Result(s): In response to the infection, signaling pathways are activated in the host cell, the goal of these pathways being to restore homeostasis. If homeostasis is not recovered, the signaling leads to cell death activation. Among the best-characterized signaling pathways, the cellular stress pathways such as oxidative stress, UPR, and autophagy stand out, which are evolutionarily conserved and are also interconnected with each other. There is strong theoretical and experimental evidence of various interactions of some components of these pathways with different viral proteins of coronavirus, and some studies with SARS-CoV-2 have already been performed. In this review, we highlight some of the cellular pathways-virus characterized to date. Conclusion(s): The cellular pathways and their relationship to viral infections remains unclear. The study of these relationships might constitute an important target for new research and the development of antiviral therapies. Copyright © 2021, Revista Salus. All rights reserved.

Study of the sewage from a municipality in southern Minas Gerais, Brazil: correlation of physical and chemical variables, COVID-19 cases, and SARS-CoV-2 RNA concentration

Wastewater-based epidemiology is an important public health tool with great applicability when facing the COVID-19 pandemic, since infected individuals are able to excrete SARS-CoV-2 particles. In this context, this study aimed to correlate the number of cases of COVID-19 with physical and chemical variables and the presence of the virus in raw sewage samples from a sewage treatment plant (SIP) in the municipality of Lavras, Minas Gerais, Brazil, collected between the 19th and 25th epidemiological weeks. The samples were concentrated by electronegative membrane adsorption method and SARS-CoV-2 RNA was extracted, detected, and quantified by RT-qPCR using oligonucleotides and probes for the N gene. Moreover, the variables pH, total suspended solids, and chemical oxygen demand were evaluated. COVID-19 cases were obtained from epidemiological bulletins made available by the municipal government From the 24th epidemiological week on, a reduction in viral concentration (copies L-1) was observed concomitantly with the pandemic response countermeasures initiated by the municipality. A strong and significant positive correlation (p<0.05) between viral load and number of confirmed cases was obtained through Spearman's test. However, there was no correlation between the presence of the virus and the physical and chemical characteristics of the sewage. Therefore, it is suggested that further research be carried out in order to track SARS-CoV-2 concentrations in wastewater, thus corroborating with the fight against the pandemic and the achievement of epidemiological surveillance systems based on sewage monitoring.

Prevalence and correlation of IgG in patients infected by SARS-COV2 attended at Hospital Dr. Santiago Ramón y Cajal, ISSSTE in Durango

introduction. In the immune system there are two types of responses: rapid and unspecified innate immune response, and one adaptive response, slower but capable of creating memory. objective. To identify the prevalence of the igg in sars-cov-2 infected patients at issste Hospital in Durango. material and methods. Descriptive, observational, cross-sectional study;igg concentration was measured in 33 sars-cov-2 infected patients, the chemiluminescence method was used in the Architect i 2000 sr®;a concentration ≥1.4 was considered positive, it was expressed in conventional units. The spss v24, descriptive statistics, ji2 of Bartlett, t of student, “r” of Pearson with ic95% and p<0.05 were used as a reference point. The information obtained was kept anonymous. results. An media of 42.7 years was obtained, out of which the 60.6% were male, the media igg concentration was 3.8 conventional units, symptoms persisted 9.5 days, and between the beginning of the symptoms and sampling, 104.2 days elapsed;the 87.8% of the patients had symptoms and 86.2% of them igg was detected. There was a positive correlation between igg concentration and duration of symptoms, this being significant. conclusions. igg concentrations will depend on how many days the symptoms last, there were patients that despite presenting symptoms, igg was no longer detected for 104 days, this also happened with patients classified as asymptomatic.

Nursing care of patients with multiple sclerosis during the COVID-19 pandemic

Introduction: At the beginning of the SARS-CoV-2 pandemic, health centres were places where there was a high risk of infection, and during the period of lockdown face-to-face health care was substantially reduced, forcing rapid changes in the care of multiple sclerosis patients by the specialised nursing staff in the units and monographic consultations of this disease. Development: The experience of the nursing staff of multiple sclerosis units and monographic consultations, in 8 Spanish hospitals, is collected from the beginning of the pandemic and in later stages, and the adaptations that they made to continue caring for patients are specifically described. The scientific literature about how the SARS-CoV-2 has affected patients with multiple sclerosis is also reviewed, as well as the experiences of other multiple sclerosis teams in health centres in other countries. Conclusions: During the lockdown and in later stages, new forms and previously little used forms of care were applied to multiple sclerosis patients. The nursing staff kept contact with them by telephone and online, provided them with information about safety and behaviour in relation to COVID-19. Face-to-face visits, treatments and distribution of medication were adapted. Information was provided about how patients could receive psychosocial support and about how they could maintain their quality of life.

Epistemology of the Social Sciences of Religion

Dossier: Epistemology of the Social Sciences of Religion, fruit of the debates held during the XXIV Weeks of Religion Studies at the Methodist University of Sao Paulo, addresses central themes of the epistemological debate that involves the great field of religion, society and culture. It brings reflections that characterize the constitution and consolidation of the discipline of Science(s) of Religion(s), as well as emerging theories such as the decolonial debates to think about a decolonization of the area. The dossier is also composed of other relevant themes in the debates about contemporary sociocultural dynamics, such as the discussion of the sacred that underlies capitalist ethics;the relations between religion and gender, entering the political debate;aspects of popular religiosity that involve health;and the discussion about religious freedom in the context of the Covid-19 pandemic.

COVID-19 lockdown impact on labor and psycosocial aspects in multiple sclerosis patients

Introduction: Lockdown derived from Covid-19 pandemic may have an impact in different aspects of daily living in our patients. We should acknowledge them to better identify any posterior complication, not only clinical but also psychosocial. Objectives and Aims: We study the impact of lockdown and sanitary emergency in multiple sclerosis (MS) patients. Methods: Epidemiological retrospective observational study in MS patients during sanitary emergency. Data was collected on consumption of alcohol, tobacco and other drugs, physical activity and diet, labor, fatigue and mood, therapeutic adherence, and lack of attendance to consultations and analysis. Surveys were made: Beck Depression's inventory (BDI) and Modified Fatigue Impact Scale (MFIS). Results: Surveys were made to 101 patients. Median age was 42,83±9,46 years old with a median time of evolution of 11,61±6,97 years with a median EDSS of 2,8 ±2. Of all patients with previous toxic habits (30,7% tobacco, 9,9% alcohol consumption and 4% cannabis) 15,8% changed frequency of previous consumption during lockdown. 51,5% admitted having more fear of infection. 5% admitted lack of correct adherence to treatment and 30,7% skipped some of the consultations or analysis. Labor changes were detected in 16,8% of patients and 46,5% referred deterioration in their quality of life. 68,3% described changes in their diet and 62,4% in their daily physical activity. 23,8% and 18,8% respectively saw their modo and fatigue deteriorated. In BDI median score was 13,5±9,5 and in MFIS 33,89±18,28. Conclusions: Covid-19 lockdown has had an overall impact on different medical, labor, and psychosocial aspects in MS patients. Another study was conducted in our center about long-term effects of lockdown in our patients. Both studies, together, may help us to understand better the side effects derived from this pandemic.

SARS-COV-2 infection impact on patients with multiple sclerosis and neuromyelitis spectrum disorder in a Colombia cohort

Background: SARS-COV2, the virus responsible for COVID-19, has posed unique challenges in the management of individuals with demyelinating diseases. Objective: To describe the demographic, clinical, and outcome characteristics of patients diagnosed with multiple sclerosis and spectrum of neuromyelitis optica disease who had a SARS-CoV-2 infection during the pandemic. Methods: A retrospective descriptive study was carried out of a cohort of patients diagnosed with multiple sclerosis (MS) and neuromyelitis optic spectrum disease (NMOSD) who got infected with SARS-CoV-2. Results: 26 patients were included. Median age was 33.5 years (IQR 29-44), 81% of them were female, with a median duration of disease of 5 years (IQR 3-14). The diagnosis of COVID-19 infection was established by reverse transcriptase polymerase chain reaction (RT-PCR) in 14 patients. The remaining patients were diagnosed based on clinical symptoms and an epidemiological nexus. 77% have diagnosis of RRMS, 11% of PPMS, and seropositive and seronegative NMOSD, 8 and 4% respectively. 65% had minimal or no disability (EDSS 0 to 2), and 23% had a higher functional compromise (EDSS 6 to 9). 35% received Natalizumab, 19% Fingolimod, 15% Ocrelizumab, 8% Alemtuzumab, and 8% Rituximab;15% were not receiving DMT, and 27% had received the last dose of their respective DMT in the previous 30 days[IA1]. 12% of patients had comorbidity with hypothyroidism, 12% migraine, 8% dysautonomia and 4% diabetes mellitus, hypertension, dyslipidemia, or smoking. The most frequently reported COVID-19 symptoms were asthenia and fatigue in 65% and 15% of the patients were asymptomatic. 85% of patients were treated in an outpatient setting, 8% hospitalized and 8% required admission to the ICU. Regarding the outcome, 8% mortality was evidenced[MIZR2] (1 patient with PPMS and 1 with NMOSD )[IA3] , 100% of them had greater functional compromise, with an EDSS previous to COVID infection between 6 and 9 points. No relationship has been found between the treatment received and mortality but a higher frequency of admission into ICU was found in patients with a history of DM2, hypertension and use of AntiCD20 therapies. Conclusion: Clinical outcomes of COVID infection in patients with MS and NMOSD did not differ from what is reported in similar studies in Latin-American population.

The impact of the COVID-19 pandemic on multiple sclerosis patients: One year later

Introduction: Nowadays, Covid-19 pandemic seriously impact in general population mental status and quality of life. It is uncertain how these situation affect Multiple Sclerosis patients. Objectives: Analyze impact of Covid-19 pandemic in the quality of life in patients of a monographic Multiple Sclerosis Unit in a Spanish third level Hospital after one year Methods: Descriptive prospective study which analyzes changes in employment status, smoking habit, patient report outcomes (PROs) and Covid-19 incidence. Demographic variables (sex, age, employment status, smoking habit), and clinical (disease duration, EDSS, Covid-19 symptoms and PROs) were analyzed. Results: 100 patients Multiple Sclerosis. Median age 42.2 (SD 8.8). 74 % women. Disease duration: 11 years (1 - 37). EDSS 2 (0 - 7.5). 31 % was smoking in first evaluation. 83.3 % will not change after one year. In first assesment 47 % has an employment;1 % sick leave, 29 % inactive because disability;8 % pensioner, 9 % unemployement, 6 % another situation. In second evaluation 89.8 % does not change. 90.8 % have not Covid symptoms after one year and 3.1 % has infected SARS-Cov-2. 36 patients completed PROs in first evaluation and 25 in both. First MFIS median 34.8 (SD 17.13): physical 17.2 (SD 8.76), cognitive 15.75 (SD 9.25). Final MFIS median 38.4 (SD 17.38): physical 17.2 (SD 8.66), cognitive 17.56 (SD 10.3). Initial BDI 13.66 (SD 9.43);final BDI 11.21 (SD 9). Initial EuroQol 0.73 (SD 0.23);final 0.76 (SD 0.19). Conclusion: It does not seem that pandemic situation would have a negative impact about depression or anxiety in our patients. However, we observe a change in fatigue (physical and cognitive). It would be because of increase of sedentary life or the recently described “pandemic fatigue”.

Potential benefits of anticoagulant doses of low molecular weight heparin in COVID-19: An observational retrospective study

Hypercoagulability is a common complication of the systemic inflammation related to coronavirus disease 2019 creating debate within the critical care community on the therapeutic utility of Low Molecular Weight Heparin (LMWH). We collected data on consecutive patients with COVID-19 admitted to the Emergency Department of Castel San Giovanni Hospital, between February 29th and April 7th, 2020. Exclusion criteria were age <18 years, hospital stay <7 days, patients on dialysis and patients who had been transferred to other centers for which we could not collect data. Of the 257 patients included in the study, 49 (19.1%) died during hospitalization. We considered a wide set of variables as independent variables (age, sex, comorbidities and in-hospital treatments). We used a multivariate logistic regression model and, being heparin the only one therapy affecting survival rate, we compared prophylactic LMWH (p-LMWH) and Therapeutic LMWH (T-LMWH) groups. Kaplan Meier curve showed a higher survival probability in the T-LMWH and the difference between the two groups was statistically significant according to the log-rank or Mantel- Haenszel test (p< 0.0001). In a stratified analysis by ventilation type, the subgroup of patients who benefited from therapeutic LMWH was that in non-invasive mechanical ventilation. Using a multivariate analysis and adjusting for the drugs intake, T-LMWH was the only therapy impacting on survival (HR 0.293, p <0.001). No fatal bleeding was observed. Therapeutic dose of LMWH in patients admitted to hospital with COVID-19 pneumonia was 70 associated with a decrease risk of intra-hospital mortality.

PNS126 Simpli – a Capacity Simulator for Evaluating Measures to Reduce the Backlog of Hospital Services after the COVID-19 Pandemic

Objectives: In Portugal, due to the COVID-19 pandemic, almost 1.4 million hospital consultations were not conducted at public hospitals and the number of surgeries was reduced by 40% in comparison with 2019. Local safety measures applied by hospitals reduced hospital capacity by 1/3. SimPLI - Simulating Capacity Performance Leading to Impact, a capacity simulator to test the effectiveness of measures to reduce the hospital backlog within capacity constraints, is hereby introduced. A proof of concept was presented for a hospital ophthalmology service. Methods: A spreadsheet-based simulator was developed for testing measures to accelerate the realization of delayed external consultations and outpatient surgeries. Inputs include the number of rooms and operation times, waiting room capacity, and allocation of healthcare professionals (HCP) to multiple roles. The impact of several measures was simulated namely the reorganization of HCP schedules and hiring, patient prioritization criteria, the specific allocation of rooms, and increasing teleconsultations. The baseline backlog is represented by the number of delayed procedures. The time to eliminate this backlog was calculated and compared with the output for scenarios where one or more measures were implemented. Results: The implementation of telemedicine for subsequent ophthalmology consultations and the reduction in 10 minutes in the time of face to face consultations would allow eliminating the consultations backlog in 9.3 months vs 16.7 months without any measures. Pertaining to surgeries, allocating an additional room for ophthalmology outpatient surgery and hiring a medical doctor were predicted to reduce the time to perform all backlog surgeries by four months (7.6 vs 11.3 months). Conclusions: SimPLI is invaluable for planning the investment in efficient actions towards optimization of hospital capacity in a post-COVID era in Portugal. The proof of concept demonstrates that the proposed measures could bring significant savings to the hospital by lowering the number of outsourced surgeries.

Brazil in the face of new SARS-CoV-2 variants: emergencies and challenges in public health

This article discusses the epidemic situation of Covid-19 in Brazil, in the face of the emergence of a new strain called P.1, which is more transmissible and may be associated with reinfection. Given the collapse of hospital care in Manaus in January 2021 and the results of three recent preprints, each that reports increased transmissibility of the P.1 variant, we propose some urgent measures. Genomic surveillance based on multi-step diagnostics, starting with RT-PCR type tests and up to sequencing, should be established. Efforts to identify reinfections associated with this variant and the update of its definition in protocols should be prioritized, and studies on the efficacy of currently available vaccines in Brazil concerning the new variant should be conducted. We also propose improving the Brazilian health surveillance system such that genomic surveillance is coordinated and thereby better able to respond to future emergencies in a more timely fashion. We call on the public agents involved in health surveillance to share data and information regarding the epidemic in a clear, fast and transparent way. Finally, we propose a greater engagement in inter-institutional cooperation of all those involved in the response and production of knowledge about the pandemic in our country.

Impact of COVID-19 pandemic on the sleep quality of medical professionals in Brazil

INTRODUCTION: Coronavirus pandemic began in China in 2019 (COVID-19), causing not only public health problems but also great psychological distress, especially for physicians involved in coping with the virus or those of the risk group in social isolation, and this represents a challenge for the psychological resilience in the world population. Studies showed that health professionals had psychological symptoms such as depression, anxiety, insomnia, stress, among others. OBJECTIVES: To investigate the quality of sleep and the prevalence rate of sleeping disorders among physicians during COVID-19 pandemic, and identify the psychological and social factors associated with the condition. METHODS: A cross-sectional study of an online questionnaire was applied for physicians in Brazil. Among the 332 participants included, 227 were women. Sociodemographic assessment was used in the questionnaire, as well as the scale of impact on the events of modifications caused by COVID-19, assessment on sleep quality (PSQI), presence and severity of insomnia (ISI), depressive symptoms (PHQ-9), and anxiety (GAD-7). RESULTS: Most physicians (65.6%) had changes in sleep. Poor sleep quality was reported by 73.1%, depressive symptoms were present in 75.8%, and anxiety in 73.4%. CONCLUSION: Our study found that more than 70% of the physicians assessed had impaired sleep quality, characterizing insomnia symptoms during COVID-19 outbreak. Related factors included an environment of isolation, concerns about COVID-19 outbreak and symptoms of anxiety and depression. Special interventions are needed to promote health professionals' mental well-being and implement changes in this scenario.