COVID-19 and the Challenges of Chemotherapy: The Failure Case of Hy-droxychloroquine in the Clinical Treatment of SARS-CoV-2 Infection

In December 2019, in Wuhan, China, an outbreak of a respiratory disease was reported, and the causative agent of which was discovered to be the new coronavirus. This disease spread rapidly around the world, and in March 2020, the WHO declared a state of pandemic. According to the WHO situation in October report, more than 41,570.883 were affected, and 1,134.940 deaths had occurred. Thus, the urgency to find therapeutic targets to prevent viral replication and a vaccine to protect against the disease became a great challenge for researchers around the world. A French group began using, in patients, a drug that had already been approved for human use, hy-droxychloroquine (HQ) alone or in combination with azithromycin. The use of a drug already approved by regulatory agencies can enable treatment strategies to be put in place rapidly;however, even though in vitro may indicate success, this is not always guaranteed. For HQ, some studies have shown a satisfactory response in patients, while in many others, the result was not positive and patients actually died. Furthermore, many adverse effects of HQ have been described. In this re-view, we will briefly discuss how this therapy became an option for the treatment of SARS-CoV-2 infection. We will address the use of HQ in different pathologies and COVID-19 specifically;de-scribing the doses used, as well as the main adverse effects. The take-home message is that more ef-forts are still required to conclude the efficacy of HQ against COVID-19, however, most of the studies carried out currently are showing that the use of HQ does not bring benefits during treatment of COVID-19.Copyright © 2021 Bentham Science Publishers.

Mental health of female sex workers in the COVID-19 pandemic: stressors and coping strategies

The objective was to analyze the coping strategies adopted by female sex workers in the face of stressors resulting from the COVID-19 pandemic. Qualitative study supported by Systems and Coping theories. An in-depth interview was carried out with 30 sex workers from the Alto Sertão Produtivo Baiano between September and October 2020. The narratives were submitted to the resources of hermeneutics-dialectic to orga-nize the categories. Four categories make reference to the system’s stressors: negative feelings of fear, anxiety and difficulties in sleeping with the uncertainties in the face of the pandemic;concern about personal and family support;irritability in the face of conflicts;anxieties and insecurities with working conditions. Five categories allude to cop-ing: strategies focused on the problem (pandemic);reframing and regulation of emotions;spirituality and religiosity;support networks and social sup-port;use of medications. Stressors arise as a result of sexual service experiences combined with the pandemic situation with reduced customers and income, leading to the development of negative feelings and emotions. However, coping strategies are diverse and they women made effort to deal with problems and to balance their mental health.

Assistance Gaps in Physical Rehabilitation: Spatial Analysis of Physical Therapy Services and Users’ Households in a Brazilian Capital

Objective: The aim of this study was to analyze the spatial distribution of outpatient physical therapy rehabilitation services and associate it with the geographic location of users’ households. Methods: The public physical therapy rehabilitation services and addresses of users’ households in Campo Grande (MS) were georeferenced in 2017-2019. Results: Five physical therapy clinics were identified to supply the demand of 31,774 scheduled users. Most services are in the most central regions of the city, while most users reside in peripheral areas. Conclusion: An assistance gap in Physical therapy care was identified, with a restricted supply of services to meet demands and a geographic barrier, since the services are far from the users’ households. Physical rehabilitation must be a priority in the country’s public health, especially nowadays, where demands for rehabilitation of a significant number of Brazilians who evolved with sequelae of COVID-19 are so present.

Predictors of mortality of covid-19 in chronic hemodialysis patients

BACKGROUND AND AIMS: Coronavirus disease 2019 (COVID-19) has affected the care of patients on chronic hemodialysis (HD). It has been reported that older adults and those with comorbidities, such as diabetes mellitus, hypertension, cardiovascular disease and chronic kidney disease are prone to develop severe disease and poorer outcomes. By virtue of their average old age, multiple comorbidities, immunosuppression and frequent contact with other patients in dialysis facilities, chronic HD patients are at particular risk for severe COVID-19 infection. The aim of this study was to compare clinical presentation, laboratory and radiologic data and outcomes between HD and non-HD COVID-19 patients and find possible risk factors for mortality on HD patients. METHOD: A single center retrospective cohort study including patients on HD hospitalized with a laboratory confirmed COVID-19 infection, from March 1st to December 31st of 2020 and matched them to non-dialysis patients (non-HD) (1:1). Data regarding patient baseline characteristics, symptoms, laboratory and radiologic results at presentation were collected, as well as their outcomes. Categorical variables are presented as frequencies and percentages, and continuous variables as means or medians for variables with skewed distributions. A paired Student's t-test was performed on parametric continuous values or Mann-Whitney for non-parametric continuous variables. Chi-squared test was performed for comparing categorical variables. Logistic regression was used to identify risk factors for mortality on HD patients. A p-value of less than 0,05 indicated statistical significance. RESULTS: A total of 34 patients HD patients were included, 70,6% male, mean age of 76,5 years, median time of dialysis of 3,0 years. Among them 85,3% were hypertensive, 47,1% diabetic, 47,1% had cardiovascular disease, 30,6% pulmonary chronic disease and 23,5% cancer. The most frequent symptoms were fever (67,6%), shortness of breath (61,8%) and cough (52,9%). At admission, 55,9% of patients needed oxygen supply, one required mechanic ventilation and was admitted to intensive care unit. Regarding laboratory data, the most common features were lymphopenia in 58,9% (median-795/uL), elevated LDH in 64,7% (median-255 U/L), raised C-reactive protein in 97,1% (median-6,3 mg/dlL, raised D-dimer in 95,8% (median 1,7 ng/mL), and all patients presented high ferritin (median 1658 ng/mL) and elevated Troponin T (median 130ng/mL). The majority presented with radiologic changes, particularly bilateral infiltrates in 29,4%. Concerning clinical outcomes, the median hospitalization time was 11 days and 13 patients (38,2%) developed bacterial superinfection. Mortality rate was 32,4%. When matched to 34 non-HD patients there was no statistical significant differences in sex, age and comorbidities. The HD group had a tendency to more ventilator support need (p=0,051), higher ferritin and troponin levels (p=<0,001 for both), whereas the non-HD group presented with greater levels of transaminases (p= 0,017). There was o significant difference in hospitalization time (median of 11 vs 7 days, p=0,222) neither in mortality (median of 32,4 vs 35,3%, p=0,798). When the logistic regression was performed, only bacterial superinfection was a predictor for mortality on hemodialysis patients (p=0,004). CONCLUSION: Our study compared outcomes for COVID-19 patients on chronic HD to non-dialysis patients and showed no difference in hospitalization time nor in death rate. In spite of these results, the mortality in patients on chronic HD is still not negligible, with up to 32% of in-hospital mortality. Bacterial superinfection is a predictive risk factor for mortality. Hence the importance of interventions to mitigate the burden of COVID-19 in these patients, by preventing its spread, particularly in hemodialysis centers.

Two decades of research with the Xakriaba from the norte of Minas: from economic diagnosis to the monitoring of the COVID-19 pandemic

This paper addresses a twenty-year research process with the Xakriaba indigenous people, confronting its beginnings in the early 2000 decade, when we carried out a diagnostic survey of their economy, and the contemporary context of Covid-19 pandemic. It attempts to build dialogues and to emphasize the differences in order to indicate possibilities for its continuation. Beyond the local references, our reflection shows the displacement of questions towards an approach of the economy understood as the management of life space. Such an approach gains prominence and leads to new relationships between nature, life space and urbanization. The participation of the Xakriaba in the research processes at both times shows their roles as protagonists in controlling their own territory, in appropriating public policies and in interacting with partners from the University. The mutual learning of both academic researchers and the Xakriaba population - today, also 'academic' researchers - strengthens possibilities and reinventions of 'other' economic practices, constituting contemporary challenges for researchers, teachers and citizens.

Perception of female sex workers about quality of life during the covid-19 pandemic

Introduction: The COVID-19 pandemic has interfered with the quality of life and well-being of sex workers, as there has been a drop in income due to the absence of clients during social distancing policies. Objective: To analyze the perception that women in paid sexual service have on the quality of life during the COVID-19 pandemic. Methods: Descriptive and qualitative study, carried out with 30 women residing in the Alto Sertão de Bahía Productive Region (Brazil), in areas where prostitution sites are located, between August and September 2020. The in-depth interview was used as a technique of information gathering, whose speeches were subjected to Semantic Content Analysis. Results: Two categories were observed, which portrayed the perception of the quality of life of the participants during the pandemic, with references to the concept and attitudinal problems indicated by the World Health Organization. The positive aspects were related to the money that sex work can bring to them and the means to obtain a healthy life, however, as something far from being achieved at that time. In turn, the statements of some women showed that the negative dimension was surrounded by demotivation with the sexual service. Conclusion: There is a quality of life associated with money and well-being, obtained with sexual service, however, they are having difficulty thinking about this aspect during the pandemic due to the reduction in customer demand. © 2021, Editorial Ciencias Medicas. All rights reserved.

Indigenous community strength: reflections with the Xakriaba in Brazil in Covid-19 times

The article presents the first year of the pandemic in the Brazilian scenario in dialogue and action with indigenous peoples. The constant deconstruction of public policies and repeated aggressions against minorities in the country are aggravated by the displacements caused by Covid19. In view of this difficult context, we present a reflection on our experience with the Xakriaba indigenous people. We aim to contribute to the understanding of the processes to which we are all submitted in order to seek alliances capable of offering us alternatives and directions to face such a situation.

Risk Management Strategies And Impact On Sustainability: The Disruptive Effect Of Covid 19

The intent of this paper is to assess the impact on sustainability due to the outbreak of pandemic. The paper has been carried out on the basis of theoretical review. The outbreak of COVID-19 threw the whole world into a deep crisis. In this time of crisis during the pandemic, enterprises have been through many challenges, so as to say;to the degree that impact of sustainability needed engaging attention. As a result, this avant-garde paper attempts to do a studyof the extent to what COVID-19 all in all;as well as specifically lockdown has impacted sustainability. The researchers have carried out discussion on the many challenges faced by the organizations and economy as a whole and the need to overcome it. The research carried out additionally summaries the lessons learnt from this outbreak and investigate the risk management strategies that emerged as a result of this catastrophic pandemic. © 2021. Academy of Strategic Management Journal. All Rights Reserved.

Timely acquisition of myeloid-cell immune-regulatory phenotype and COVID-19 outcome

Background: Uncontrolled inflammatory responses, ranging from cytokine storm to immune-paralysis were described in COVID-19 worse prognosis. Patients with an aggressive course are the bottleneck of COVID-19 pandemic management, and there is urgent need of understanding the underlying mechanisms to guide clinical decisions. Myeloid cell activation is likely a key player in SARS-CoV-2 infection. Methods: Here, we longitudinally evaluated COVID-19 patients with respiratory insufficiency admitted to Hospital Santa Maria (Lisbon, Portugal), comparing those that did not require intensive care admission (NO-ICU) with those requiring high flux oxygen and/or mechanical ventilation (ICU). At each time point, an ex-vivo immune-phenotype by flow cytometry was analysed with both supervised and unsupervised approaches and clustering analysis of circulating cell subsets of monocytes (Mo) and dendritic cells (DCs), in parallel with specific antibody responses and a wide array of inflammatory mediators. Results: Contrarily to other systemic viral infections, we found that COVID-19 patients with respiratory insufficiency featured systemic immune-suppressive/ regulatory myeloid cell responses. Specifically, we observed a global reduction of CD14lowCD16+ Mo, and reduced expression of CD80, CD86, and SLAN. Contemporaneously, both Mo and DC showed increased expression of CD163, CD204, CD206 and PD-L1 immune-regulatory markers. Moreover, cDC2s, pDCs and basophils were significantly reduced. Inflammatory cytokines and chemokines associated with myeloid cell chemotaxis correlated with the phenotype changes. In NO-ICU patients (n=9) we observed a peak of these alterations at admission and a progressive regression to healthy phenotype at hospital discharge (as compared to age-matched controls, n=11). On the other hand, in ICU patients (n=11), the expression of immuno-suppressive markers progressively increased until discharge. Notably, they featured significant reduction of HLA-DRhighPD-L1- and expansion of CD80-CD86- classical Mo and an increase of HLA-DRhighPD-L1+ cells in Mo and in all DC subsets at recovery. Conclusion: Altogether, these data favour an alternative view of a beneficial role of suppressive/regulatory myeloid responses in coping with COVID-19 pathogenesis. To further support our hypothesis, we are currently collecting data on lung injury and SARS-CoV-2 viremia to correlate with the kinetics of myeloid responses.

Artificial intelligence (AI) applications for library services and resources in COVID-19 pandemic

The world social insurance frameworks have been vibrated with COVID-19 pandemic, regardless of Industry all are profoundly influenced and searching for endurance in COVID-19 pandemic and to encourage administrations for their investors and clients. Advanced education is one of the additionally affected with COVID-19 pandemic, presently searching for a choice to encourage benefits through computerized innovation. Particularly advanced education libraries are searching for to give satisfactory administrations with the goal that the understudy network will be fruitful in their evaluations, powerful information gaining to fulfill Industry needs. The current investigation endeavored toward this path, made snappy fast audit by considering databases Pubmed, Baidu, Scopus and Google Scholar and introduced computerized based methodology for libraries benefits, this will profit for colleges, libraries and understudy networks to beat the emergency of COVID-19 pandemic. © 2020 Innovare Academics Sciences Pvt. Ltd. All rights reserved.

Situations of health vulnerabilities experienced by sex workers in times of covid-19 pandemic

Objective: To reflect on the situations of health vulnerabilities experienced by sex workers during the pandemic resulting from SARS-CoV-2 infection. Method: This is a reflective study, based on the conceptual theoretical framework of vulnerability in four dimensions: Ontological, epidemiological, symbolic and political-programmatic. Result: The health of sex workers, in the daily experience of sexual work, has been a challenge for governments among all groups associated with stigmas and vulnerable populations, precisely because they are socially marginalized. This is important for understanding this phenomenon in the midst of the financial, economic and health crisis that people from different nations suffer before the progress of SARS-CoV-2. Conclusion: The situations of health vulnerability resulting from the SARS-CoV-2 infection that expose sex workers are consolidated, mainly, by the absence of the State in the social-legal protection and in the guarantee of human rights, so that these women acquire conditions of coping and prevention. © 2021 Universidade Federal da Bahia. All rights reserved.

Covid-19 coping-prevention strategies for female sexual workers in the context of various countries

Objective: to analyze the scientific evidence on COVID-19 coping and prevention strategies implemented to female sex workers in the context of several countries. Methods: this is an integrative literature review, with data collected in the PubMed, Scopus, Virtual Health Library and Google Scholar databases using the Boolean descriptors “COVID-19” and “sex workers” and “Delivery of Health Care”, with a time frame from 2019 to 2020. A priori, 215 publications were found. After selection, anchored in the inclusion criteria and in the answer to the guiding question, 19 articles were used, whose information was organized in a synoptic table, and the texts were analyzed using semantic content. Results: after content analysis of actions implemented or recommended in different countries, so that female sex workers can prevent contamination by Sars-CoV-2, four categories were highlighted: programmatic/ governmental actions and responses from society;combating the stigmas involved in sex work;health education through technological/digital and media resources;adjustment of health services. Conclusion: gender, race and class inequalities, as well as social stigmas, have been maintained by states governed by patriarchy and, therefore, are the main barriers for female sex workers to adopt strategies to combat COVID-19. Even so, intersectoral actions have been implemented/recommended in several countries such as the adjustment of sexual health services, financial incentives to improve the services of signal operators and digital technologies to implement effective actions to promote health education and enable the distribution of inputs for individual protection and prevention. © 2021, Universidade Federal de Santa Catarina. All rights reserved.

Feelings of the nursing team in the face of COVID-19 in the care of the first patients: descriptive study

Objectives: to analyze the feelings and conflicts experienced by nursing professionals in the care of patients with COVID-19;to analyze the implementation of nursing care for the first patients with COVID-19 in an intensive care unit in the city of Rio de Janeiro. Method: qualitative, descriptive and exploratory research. Participants were 71 professionals from the nursing team who develop work activities in the fight against COVID-19 in an intensive care unit in the city of Rio de Janeiro, through online collection. Descriptive statistics and thematic content analysis were used for the analyses. Results: the content analysis revealed feelings in the face of the unknown virus, fear of getting infected, fear of losing one’s life and care aspects in the face of the COVID-19 phenomenon. Conclusion: nursing presented feelings and conflicts, such as insecurity and fear. The group built knowledge and skills to handle the realization of this care in the pandemic, including creative aspects and collective construction. Descriptors: Coronavirus Infections;Nursing Care;Nursing Team. © 2022 Online Brazilian Journal of Nursing