ABSTRACT
Health and wellness tourism had a growing interest in the Portuguese population until 2019. However, with the ap-pearance of Covid-19, several establishments had to close over these two years, this segment being one of the most affected areas. Many water users looked forward to the opening of the spa resorts to continue their treatments. Giv- en the importance of this theme, this work has as its main goal the definition of a consumer profile and to identify the determinants of satisfaction of the thermal tourists, as well as to gauge the degree of knowledge of thermal tourism and specifically of spas in the Portuguese context. In methodological terms, a questionnaire survey was conducted among the tourists to achieve the research objectives. The results show a younger, healthier and diversified thermal tourism practitioner. It also reveals similarities with other profile and motivations studies. However, it is possible to notice a few differences. Practitioners are seeking a combination of a leisure and health dimension and valorise fac- tors such as location and access of the establishments, quality of the services provided and rest and tranquillity. An issue regarding their length of stay has been identified. As they are locals and live in the same country as the thermal spa, most respondents do not stay overnight at the destination. In the future, it would be interesting to research product development and market strategies for diversified thermal practitioners.
ABSTRACT
This research focuses on digital adaptive experiments conducted during the COVID-19 lockdown as a remediation (Bolter and Grusin) of contemporary theatre within the online medium, generating a new medium (McLuhan) for theatre practice. In 2020, I conducted an in-depth, one-on-one interview with Kolkata theatre practitioners, including amateur as well as professional theatre practitioners, during the first phase of COVID-19 lockdowns. The research questions addressed the adaptive online experiments conducted, the applications used, and the advantages, disadvantages and overall experience of creating new works during the pandemic. The information acquired during these interviews was used to quantify and predict new avenues for this emerging style of adaptive theatre. This paper takes stock of the digital theatre form, noting the platforms used, such as Zoom, YouTube and Facebook, and articulates the efficacy of individual theatre projects developed during lockdown. The case studies in Kolkata referenced in this paper are compared with similar projects around the world, documented by newspaper articles and reviews and journal publications. The outcome of the research specifies features of this new medium of theatre which can influence the further development of the form. I identify the overall reception, significance and influence of the medium during the pandemic, and I suggest how this medium could evolve in the future. © 2022 Hazael Gomes.
ABSTRACT
BACKGROUND AND AIMS: SARS-CoV-2 represents a challenge for hemodialysis (HD) patients due to their diminished immune defenses in the setting of kidney disease, multiple comorbidities and older age. COVID-19 vaccines have brought hope but these patients' reduced response to immunization with the hepatitis B and influenza vaccination raised concerns about a lower efficacy of the new vaccines. This study aimed at quantifying IgG in sequential samples from HD patients and compare its titers with those of a non-HD healthy population, after vaccination. METHOD: We compared IgG titers using Abbott SARS-CoV-2 IgG II Quantitative Antibody Assay on the Alinity i system (Abbott Diagnostics, Chicago, US), 3-4 months after the Pfizer-BioNTech COVID-19 vaccine in 54 HD patients and 59 non-HD controls. This method is a two-step chemiluminescent microparticle immunoassay used for the quantitative determination of IgG antibodies to the receptor binding domain of the S1 subunit of the spike protein of SARS-CoV-2. HD patients performed their treatments at the HD unit of Felgueiras, a municipality in the district of Porto, Portugal, and were vaccinated in January/February 2021. The controls were healthcare workers from the hospital of Gaia. All HD patients received 2 vaccine doses even if they had previously had COVID-19 (N = 8) whereas controls only received 1 dose of the vaccine if they had been infected (N = 28). For 48 of the HD patients, we reassessed IgG levels 8 months after vaccination and compared it with the first measurements. Statistical analysis used SPSS ® . Parametric variables were described with mean ± standard deviation and compared using independent and paired-samples t-tests. Non parametric variables were described with median ± interquartile range (IQR) and compared using Mann-Whitney U and Wilcoxon tests. RESULTS: HD patients were older (67.6 ± 15.8 years of age) when compared to the healthy controls (42.4 ± 12.1 years of age). Only 1 HD patient had IgG below the positive cutoff after vaccination, all others seroconverted. Median values were significantly lower among HD patients compared to the controls (973 IQR 387-3306 versus 4809 IQR 2557-7746 AU/mL;p < 0.001). This difference remained significant even if those who had COVID-19 were removed from the analysis (p < 0.001). Those who had had COVID-19 before vaccination, showed significantly increased IgG levels compared to those who had not (6956 IQR 4810-13 101 versus 1520 IQR 554-3950 AU/mL;p < 0.001), a similar finding among HD and non-HD individuals. In HD patients for whom this data was available, IgG levels decayed from month 4 to month 8 (973 IQR 387-3306 versus 382 IQR 168-2071 AU/mL;p < 0.001). CONCLUSION: HD patients seem to have an impaired immune response after the COVID-19 vaccines, similar to what happens with vaccines against other viruses. After the Pfizer-BioNTech COVID-19 vaccine 98% of the patients seroconverted. Although they were older which may have played a role, a limitation to the analysis, IgG titers were lower in HD-patients than in the control group. Antibodies declined over the next months. This decline may be associated with loss of neutralizing antibodies, cellular responses to SARS-CoV-2 and risk of reinfection.
ABSTRACT
Introdução: A dengue é considerada a doença viral transmitida por mosquitos mais prevalente e de disseminação rápida entre os seres humanos. Geralmente se manifesta de forma abrupta com febre, cefaleia, mialgias e artralgias, podendo também apresentar sintomas respiratórios e gastrointestinais como vômitos, náuseas, diarreia e dor abdominal, mimetizando - em alguns casos - colicistite aguda alitiásica. Este trabalho objetiva destacar a importância de um diagnóstico preciso de pacientes com manifestações gastrointestinais em áreas endêmicas da dengue. Descrição do caso: Paciente feminina, 32 anos, compareceu ao serviço de emergência relatando febre, náuseas, vômitos e dor no abdome superior há um dia. Referiu ter realizado Colangiopancreatografia Retrógrada Endoscópica por coledocolitíase e colecistectomia videolaparoscópica em 2020. Ao exame físico, observou-se pele corada, levemente desidratada, anictérica e febril (37.9 °C);e dor a palpação do abdome superior, sobretudo no hipocôndrio direito. Nos exames laboratoriais, hemograma e bilirrubinas estavam normais e aspartato aminotransferase, alanina aminotransferase, gama glutamil transferase e fosfatase alcalina com valores elevados. Diante disso, solicitou-se tomografia computadorizada abdominal, que evidenciou colédoco de 1,5 mm, não sendo visualizados cálculos em via biliar. Assim, com a hipótese diagnóstica de colangite, iniciou-se antibioticoterapia e solicitou-se colangiorresonância para melhor avaliação das vias biliares e da presença ou não de cálculo de colédoco. O resultado da colangiorressonância foi normal. Tendo em vista que ela veio de uma cidade com vários casos de dengue, solicitou-se o exame de dengue NS1, cujo resultado foi positivo. Para o diagnóstico diferencial, solicitou-se exames para Covid-19 e leptospirose, os quais resultaram negativos. A paciente melhorou seu quadro clínico gradativamente, aliviando sua sintomatologia, tendo alta hospitalar com boas condições clínicas. Comentários: As manifestações gastrointestinais em pacientes com dengue e alterações laboratoriais podem nos levar subestimar patologias com gravidade considerável como por exemplo a colangite, como também pode nos levar a um “over diagnóstico” de patologias correlacionadas com histórico e exame físico do paciente. O correto direcionamento, assim como uma avaliação clínica epidemiológica cuidadosa e acompanhamento integral do paciente, constituem fatores de grande relevância em situações como a do caso relatado.
ABSTRACT
Risk factors that determine the severity of Covid-19 have not been fully elucidated. The aim of this study was to evaluate the role of coronary artery calcification (CAC) as a risk factor for death or mechanical ventilation (MV) of patients without known heart disease infected with Covid-19. We analyzed 283 consecutive in-patients with acute respiratory symptoms with chest computed tomography (chest-CT), without previous heart disease, and criteria for Covid-19 (RT-PCR positive and/or typical clinical and chest-CT findings). CAC was classified by the number of coronary segments affected as absent (0), mild (1-3), and severe calcification (more than 3). The association between CAC, CAC severity, and death or MV due to severe respiratory failure was assessed by logistic regression. The mean age was 58.7±15.7 years and 54.1% were men. Patients with CAC were older, more likely to have hypertension, and less likely to be obese. CAC was present in 75 patients (26.5%), of which 42 had a mild calcification and 33 had severe calcification, and was associated with death (OR=2.35, 95%CI: 1.01-5.48) or MV (OR=2.72, 95%CI: 1.20-6.20) adjusted for multiple confounders, with significant and increased odds ratio for the severe form of CAC (death: OR=3.70, 95%CI: 1.20-11.42; MV: OR=3.30, 95%CI: 1.09-9.95). We concluded that CAC was an independent risk factor for death or MV in Covid-19 patients without previous heart disease, particularly for those with severe calcification. CAC can be easily visualized on common chest-CT, widely used in evaluation of moderate to severe Covid-19.