Aumento Do Numero De Testes Reagentes Confirmados Para Hiv No Hemocentro De Sao Jose Do Rio Preto Em 2021

Introducao: O virus da Imunodeficiencia Humana (HIV) e um lentivirus que causa a Sindrome da Imunodeficiencia Adquirida, caracterizada por uma deterioracao progressiva do sistema imune, facilitando o aparecimento de doencas oportunistas. Segundo o relatorio anual UNAIDS (Programa Conjunto das Nacoes Unidas sobre HIV/AIDS), no Brasil ao menos 5 pessoas/hora foram infectadas pelo virus HIV em 2021, totalizando 1,5 milhoes de casos neste periodo. Objetivo: Analisar o perfil sorologico dos doadores de sangue em relacao aos testes de HIV nos anos de 2019 a 2021. Material e metodos: Foi realizada triagem sorologica em doadores de sangue pela metodologia de quimioluminescencia e teste de acido nucleico para HIV (NAT HIV), nos anos de 2019 a 2021 e os testes reagentes foram confirmados com metodologia complementar de eletroquimioluminescencia. Para estes doadores, foram solicitadas coleta de nova amostra para repeticao dos testes para confirmacao dos resultados encontrados. Resultados: Das 35.720 doacoes de sangue realizadas em 2019, 06 (0,016%) apresentaram resultados reagentes na triagem sorologica, testes NAT HIV detectaveis e confirmados pela metodologia de eletroquimioluminescencia. Em relacao ao genero, foi observado, 5 masculinos (83,4%) e 1 feminino (16,6%). Quanto a faixa etaria, foi identificada mediana de 31 anos (min. 24 e max. 44) e referente ao estado civil, 4 solteiros e 2 casados. Das 34.723 doacoes de sangue realizadas em 2020, 02 (0,005%) apresentaram resultados reagentes na triagem sorologica, testes NAT HIV detectaveis e confirmados pela metodologia de eletroquimioluminescencia. Foram identificados 2 doadores do genero masculino (100%) e quanto a faixa etaria, foi encontrada mediana de 35,5 anos (min. 22 e max. 49) e o estado civil de ambos solteiros. Em relacao a 2021, das 35.871 doacoes de sangue realizadas, foram observados que 11 (0,030%) doadores apresentaram resultados reagentes na triagem sorologica, testes NAT HIV detectaveis e confirmados pela metodologia de eletroquimioluminescencia. Foi observado que todos os doadores (100%) reagentes eram do genero masculinos, com mediana de 28 anos (min. 20 e max. 40) e quanto ao estado civil foram encontrados 9 solteiros, 1 casado e 1 uniao estavel. Discussao: No periodo de 2019 a 2021 as campanhas de doacao de sangue se intensificaram com o objetivo de reposicao do estoque de hemocomponentes em nosso servico, devido a escassez de doadores de sangue, incluindo o periodo da pandemia COVID-19. Analisando os dados dos perfis dos doadores confirmados reagentes, nao foi possivel estabelecer relacao com o tipo de doacao e o aumento do numero de casos de HIV no ano de 2021. Embora, os testes confirmados reagentes sejam predominantes entre os doadores de primeira doacao, foi observado estabilidade no numero de doadores desta categoria em relacao ao numero de doadores por ano ao longo deste periodo. Com isso, nao e possivel estabelecer correlacao com o aumento do numero de casos de testes reagentes confirmados para HIV, com as doacoes de primeira vez. Conclusao: Embora os dados nacionais mostrem o aumento de infectados por HIV em 2021 e o mesmo foi evidenciado em nosso servico, nao foi possivel justificar este aumento atraves dos dados epidemiologicos dos nossos doadores de sangue. Este fato pode ser reflexo das caracteristicas do aumento do numero de casos de infectados pelo virus HIV na populacao geral. Copyright © 2022

[Hematological indices associated with mortality in critically ill patients with COVID-19]

Background: The COVID-19 disease has represented one of the most important threats to health. The most severe form is acute respiratory distress syndrome (ARDS). The inflammatory response can cause hematologic changes.

Rural Tourism and Walkability. Compare Sardinia and Gran Canaria Models

The tourism crisis following the Covid-19 pandemic has caused many communities to rethink and review tourism. In fact, in European countries, many destinations are now focused on more inclusive and sustainable measures rather than over tourism, so they have invested in sustainability to create tourist-friendly places. The rural areas, in particular, are affected by a demand motivated by a longing for discovery and authenticity, and they seem to be working towards a multi-scalar planning: walkability and digitalization stand out as fundamental choices to meet the needs of tourists and residents. In this context, the paper aims, after a preliminary review of the literature on rural areas’ walkability, to highlight the relationship between rural walkability and tourism through the analysis and comparison of two rural paths: the Mining Path of Santa Barbara (Sardinia, Italy) and the Path of Saint James (Gran Canaria, Spain). It represents virtuous examples of fruition and enhancement of the insular landscape, promoting a place-based approach for a sustainable and cohesive local development. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Back to the Future: Lessons from the 2009-2012 austerity policies for the aftermath of the COVID crisis

This paper studies the relationship between austerity intensity and adjustment processes in the Eurozone in the period 2000-2021. We empirically analyse fiscal consolidation and its impact on a set of internal adjustment and expansionary austerity indicators. We also evaluate the relationship of those indicators with GDP growth using quantile regressions. Results show that austerity programmes had a negative impact on growth both in the short-run and in the long-run. Expansionary austerity indicators play a more relevant role in determining short-term growth than internal adjustment. This effect is more intense in slow-growing countries since internal adjustment processes take more time to operate.

ESTABLISHMENT of AN ANTI-RBD THRESHOLD THAT PREDICTS ROBUST NEUTRALIZING ACTIVITY

Background: Although presence of SARS-CoV-2 neutralising antibodies can provide protection against development of COVID-19, how reflective circulating anti-SARS-CoV-2 antibody levels are of underlying neutralising capacity, and whether a threshold exists to predict sufficient neutralising capacity remains unclear. Methods: In plasma from individuals with PCR-confirmed COVID-19 recruited to the All Ireland Infectious Diseases Cohort Study, we measured IgG concentrations against RBD, Spike protein sub-unit 1 and 2 (S1, S2) and Nucleocapsid (NC) using multiplex electrochemiluminescence (normalised to World Health Organisation reference serum as IU/mL). Neutralising capacity was measured against live SARS-CoV-2 virus (clinical isolate 2019-nCoV/Italy-INMI1) by determining the maximum plasma dilution required to maintain 50% inhibition of infection of Vero E6 cells (50% Neutralisation Titre (NT50)), by flow cytometry-based micro-neutralisation assay. Given that the Beta SARS-CoV-2 variant of concern (VOC) reduces neutralising activity up to six fold, we estimated a NT50 of 1:1000 against wild type SARS-CoV-2 would maintain neutralising activity against VOC. We used Spearman correlation and linear regression to model relationships between NT50 and IgG concentrations. Data are presented as median (IQR) unless specified. Results: In 190 individuals (age 50 (40-64) years, 55% female, time from symptom onset 98 (35-179) days), NT50 most highly correlated with anti-RBD IgG (Rho 0.81 p<0.001, Fig 1a) compared with other IgG classes (S1;Rho 0.8, S2;0.73, NC;0.72, all p<0.001). Median RBD titre was 246 (71-662) but trended lower over time, with a median of 319 (61-1012) IU/ml at 0-90 days, 244 (86-523) IU/ml at 90-180 days and 157 (80-364) IU/ml at >180 days post symptom onset respectively (p=0.08, Fig 1b). RBD IgG titres of 476 IU/ml corresponded to a NT50 of 1:1000. Overall, RBD ≥476 IU/ml predicted NT50 ≥1:1000 with a sensitivity of 77 (95% CI 65-87)% and specificity 89 (95% CI 82-93)%. This improved in an analysis restricted to convalescent samples (>30 days post symptom onset, n=148), with a sensitivity 88% (95% CI 74-96%) and specificity 90% (95%CI 82-95%) respectively. Conclusion: In convalescent plasma, RBD IgG titres ≥476IU/mL is sensitive and specific for predicting robust underlying neutralising capacity. Further research is required to validate these findings in other cohorts and confirm these thresholds in post-vaccinated individuals.

DIFFERENTIALLY EXPRESSED IMMUNOLOGICAL GENES in MILD and SEVERE CASES of COVID-19

Background: Coronavirus disease 2019 (COVID19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has varied clinical presentations from mild subclinical to severe disease with high mortality. Our aim was to determine whether examining immune-related gene expression early in infection could predict progression to severe disease. Methods: In subjects of the All Ireland Infectious Diseases Cohort study, we analysed expression of 579 genes with the NanoString nCounter Immunology panel in peripheral blood mononuclear cells in those with confirmed SARS-CoV-2 infection collected within 5 days of symptom onset and matched SARS-CoV-2 negative controls with respiratory infection. Subsequent maximum COVID19 disease severity was classified as mild or severe. Read counts were normalized using panel housekeeping genes. Expression changes in severity groups were estimated against control baseline. Results: Between April and July of 2020, we recruited 120 subjects, 62 with COVID19 and 58 controls, with average age 59 y.o. (IQR 34-88), 66% males and 69% Caucasian ethnicity. Maximal disease severity was used to separate COVID19 cases into mild (n=31) and severe (n=31). We identified 20 significantly deregulated genes between those with COVID19 and controls (;log2 fold;>0.5, p<0.05, Benjamin-Yekutieli p-adjustment). Function of 12 of these genes related to cytokine signaling, 9 upregulated genes to type I interferon signaling (MX1, IRF7, IFITM1, IFI35, STAT2, IRF4, PML, BST2, STAT1), while 7 downregulated genes mapped to innate immune function (IRF7, ICAM2, SERPING1, IFI16, BST2, FCER1A, PTK2). Expression in the severe group showed downregulation of FCER1A (innate immunity regulation), IL1B and TNF (inflammatory cytokines), and PTGS2 (inflammatory mediator) and greater upregulation of TNFSF4 (cytokine signaling) and PTK2 (innate immunity). Mild cases presented higher upregulation of IFIT2 (type I interferon signaling). Conclusion: Observed early downregulation of regulators and mediators of inflammation in those who developed severe COVID19, suggested dysregulation of inflammation. Specifically, IFIT2 upregulation in mild cases and FCER1A downregulation in severe cases, points to early differences in host responses centered on deregulation of the interferon and inflammation responses. Whether these patterns reflect delayed interferon involvement in pathways to control the infection and contribute to pathological inflammation and cytokine storms observed in severe COVID19 requires further research.

CIRCULATING LEVELS of TYPE I, TYPE II, and TYPE III INTERFERONS and COVID-19 SEVERITY

Background: Interferons play a pivotal role as a first line of the innate immune host response to viral infections, including COVID-19. Accumulating data suggests dysregulated interferon (IFN) responses in COVID-19. However, the clinical relevance of circulating levels of interferon to COVID-19 disease severity remains unclear Methods: In plasma from individuals with PCR confirmed SARS-CoV-2 infection recruited to the All Ireland Infectious Diseases Cohort, collected within 10 days from onset of symptoms, we measured levels of type I (IFN-α2a and IFN-β), type II (IFN-γ), and type III (IFN-a;1) interferons by electro-chemiluminescence immunoassays. Subsequent maximum COVID-19 disease severity was classified according to World Health Organization guidance (Critical, Severe, Moderate and Mild). We used Kruskal-Wallis tests to explore differences in IFN levels between COVID-19 severity groups, and logistic regression to determine associations, adjusting for demographics (age, sex at birth, ethnicity), comorbidities (obesity, hypertension, respiratory disease, heart disease) and medical management (antibiotics, immunosuppressants, anticoagulants, invasive ventilation) Results: Out of the 335 subjects with early infection and available samples, 319 had data on disease severity, 33 (10.3%) Critical, 37 (11.6%) Severe, 76 (23.8%) Moderate and 173 (54.2%) Mild. The population was predominantly Caucasian (79.3%), with a median [IQR] age of 64 [53,77] and male (52.7%). There was a significant difference between the 4 groups for the levels of Type I IFN-α2a (p=0.0028) and Type 3 IFN-a;1 (p=0.0001), both being higher in the critical group. In adjusted analyses, higher levels of Type I IFN-α2a but not Type 3 IFN-a;1 remained significantly associated with the development of Critical COVID-19 (Odds Ratio: 5.911/95% CI: 0.608, 52.388/p=0.029). (Fig 1) Conclusion: Increased circulating Type I IFN-α2a, but not other IFN classes, measured in the early stages of SARS-CoV-2 infection was associated with higher odds of Critical COVID-19 infection. These data point to specific differences in host responses that may lead to more targeted interventions to prevent development of severe COVID-19 infection.

Structuring of the Cuban Protocol of Action for the care of COVID-19 Cases

Introduction: In presence of the COVID-19 pandemic emerges the need of designing a Cuban protocol of action for the care of these cases, which creation mainly requires the selection of contents, as well as a suitable structuring. Objective: Structure the Cuban Protocol of action for the care of COVID-19 cases. Methods: There were applied the following methods: theoretical historical logical, documental analysis, systematization, synthetic analysis and concreteness ion. It was applied the technique of bibliographic review of normative documents, scientific publications indexed in international databases and web sites, in addition to the consultation to specialists. The structuring process of the Cuban Protocol of action for the care of COVID-19 cases was carried out in three phases: pre-structuring, structuring and review. Results: The final structure of the protocol was formed by four chapters, bibliography and annexes. Conclusions: The design of a protocol of action has two main processes: the selection of the contents and the structuring, and for them, the pertinent work teams must be formed. The structuring of the Cuban protocol of action for the care of COVID-19 cases is a methodological process developed in three phases that facilitate its improvement through constant review. It is formed by four chapters that favour its understanding and application being a document that contain the generalities, the management of cases according to groups and by levels of care and transfer, from the preventive scenario to the care to convalescent patients;and includes the management of corpses, as well as consulted bibliography and annexes.

Statistical model to estimate the historical impact of influenza on mortality in cuba

Introduction: Influenza has a high impact on human mortality and in Cuba influenza and pneumonia rank fourth among its general causes. In temperate climate countries, with marked seasonality, this is captured by statistical models, a task that is difficult in the tropics and pending in Cuba due to the absence of the same seasonal definition. Objective: Estimate the historical impact of influenza type A and B and subtypes A(H3N2) and A(H1N1) on mortality, by adjusting a regression model to the specific seasonal conditions of Cuba. Methods: A longitudinal and retrospective study was performed. In a first step, two Poisson models were adjusted with influenza and total pneumonia mortality and people ≥ 65 years old as response variables in the five months with the highest positivity to influenza in the period 1987-1988 to 2004-2005, and the positive ones to type A and type B as explanatory variables. In another pair of models was estimated the impact of A(H3N2) and A(H1N1), considering as a response the deaths previously attributed to type A. Results: 7 803 deaths among all ages and 6 152 among 65-year-olds were attributed to influenza, with 56.3% associated to A(H3N2), 17.6% to A(H1N1) and 26.1% to type B. Conclusions: It was possible to estimate the impact of influenza on mortality by adjusting for Cuba a statistical model that demonstrated the association of the circulation of these viruses with the mortality in the country, which confirms the need to strengthen surveillance, control and vaccination against this viral infection. The possibility of adjusting in the seasonal conditions of Cuba these regression models to other respiratory viruses and the current pandemic by COVID-19 is demonstrated. © 2021, Editorial Ciencias Medicas. All rights reserved.

Sustainability, Tourism and Digitalization. The City Smart Approach in Las Palmas de Gran Canaria (Canary Islands)

To achieve the environmental and socio-economic sustainability goals set by the 2030 Agenda, tourist destinations, particularly those that have already reached maturity, have taken steps to change their development model in the short and long term. In this context, the smartness approach can help local governments to implement smart growth projects to improve, even in a sustainable way, the use of places by tourists and, also, to optimize the residents’ quality of life. This is even more true in this historical moment characterized by the covid-19 health emergency which imposed compliance with various rules, one of which is social distancing. Thus, it is fundamental that the territories are transformed into smart spaces where the innovative aspect is the basis for efficiently offering resources and services. Starting from these considerations, the aim of the paper is to highlight the role of Information and Communication Technologies (ICT) on the island of Gran Canaria (Canary Islands). The Island and in particular the city of Las Palmas de Gran Canaria have been working for a long time to promote knowledge and valorization of the territory through greater use of new technologies and applications, for example, for smartphones and tablets. The city, to meet the “new” demands of the post-covid era, has refined, and activated new tools to enhance the tourism experience. © 2021, Springer Nature Switzerland AG.

Heterotopia work: Correlation between the domestic built environment and home offices during COVID-19 confinement

The new COVID-19 context has transported work to a domestic setting. These new locations, heterotopic, do not always adequately respond to user needs. This paper explores the relationship between the domestic built environment and certain elements that shape it, the perception, emotional state and productivity of the users. A pilot case study was carried out with 11 volunteers who evaluated their home offices for seven work days using physical environment tools, two tests-fixed data and daily evaluation-. Also, environmental parameters of the territory were monitored. Among the main findings, we observed that the perception of size does not relate to actual size;a balcony is associated with happiness and calm. We have verified how biophilic elements promote well-being. Happiness and calm are related to hight and low levels of lux. There is a tendency of happiness associated with collaborative tasks, and calm with individual ones. This article opens up a path for exploratory research on resilient situations in which physical barriers force people to seek creative solutions and offers tools to empower users. Current trends in data-driven design and teleworking support research proposals like this one, with a focus on well-being, productivity. © 2020 Universidade do Vale do Rio dos Sinos. All rights reserved.

ACQUISITION OF PEDAGOGICAL SKILLS IN PHYSICAL EDUCATION DURING THE COVID-19 CONFINEMENT IN MEXICO

The COVID-19 pandemic affected different social structures, among the internal structures that it put to the test was the educational one. The purpose of this study was to analyze the pedagogical experience of Physical Education teachers before, during and future perspectives in relation to the confinement by COVID-19 in Mexico. This study had a phenomenological design, seven technical-pedagogical advisors and Physical Education supervisors participated. As results, it stands out that, prior to the pandemic, teachers did not appropriate the educational program. During confinement, the didactic intervention was a challenge, especially the evaluation;and it is visualized that the teaching personal will be more competent in the return to face-to-face classes. Therefore, it can be concluded the need for structural reforms that contemplate the implementation of pedagogical tools that use the online environment as a valuable resource within Physical Education. © 2022, Universidade Federal do Rio Grande do Sul. All rights reserved.

Change of in-hospital mortality during the first SARS-COV-2 surge in Bogotá, Colombia

Introduction: Mortality secondary to SARS-COV 2 has decreases around the world, however this has not been evaluated in Colombia neither has the correlation between patient characteristics or treatments. Objective: To compare the mortality due to SARS-COV-2, in two periods of time, controlling risk factors associated with mortality. Methodology: Observational retrospective cohort study of patients with SARS- COV-2 treated at the San Ignacio University Hospital in Bogotá (Colombia), from March 19 to November 12, 2020. The in-hospital mortality rate of patients discharged before and after August 21, 2020 (surge mortality in Colombia) was compared. The impact of the moment of attention was analyzed controlled by comorbidities, severity at admission and treatment received using a bivariate and multivariate logistic regression model. Results: 1399 patients (944 before and 455 after August 21) were analyzed. The overall in-hospital mortality rate was similar at both times (17.6%vs16.3percentage, p=0.539). In the multivariate analysis, it was found that the moment of attention was associated with lower mortality (OR 0.66 95% CI0.47;0.93,p=0.018), in contrast to its increase associated with age (OR 1.06 95% CI 1.05;1.07,p=<0.001), male sex (OR 1.84 95%CI 1.33;2.54,p=<0.001), cirrhosis (OR1.89 95%CI 1.24;2.88, p=0.003), kidney disease (OR 1.36 95% CI1.00;1.83,p=0.043) and the use of dexamethasone (OR1.53 95%CI 1.03;2.28,p=0.031). Conclusions: The in-hospital mortality rate fell after August 21 during the first wave of the pandemic in Bogotá-Colombia, possibly associated with an improvement in response capacity, or a lower viral inoculum of infected patients. These findings may change with the saturation of the health system. © 2022 Asociacion Colombiana de Infectologia. All rights reserved.