Walk test and its effectiveness procedures in functional cardiopulmonary assessment after hospital discharge of patients infected by COVID-19: a systematic review

Walk tests have been widely used as a tool for evaluation, follow-up and prognosis in patients with cardiopulmonary diseases.

Acceptance of the covid-19 vaccine based on health belief model

Introduction: Cases of coronavirus that causes Covid-19 disease in the world have reached 1.8 million people. Cases of coronavirus that causes Covid-19 disease in the world have reached 1.8 million people. The purpose of the study analyzed predictions of covid-19 vaccine acceptance based on sufferers and health belief models in Indonesia and Timor Leste. Method: Analytical research method with cross-sectional survey approach, the population is taken from community living at Surabaya Indonesia and Timor Leste as many as 250 respondents. Sampling was conducted in a consequent sampling in two regions at Surabaya Indonesia and Timor Leste. Data collection using google form, share through were respondents. Statistical analysis with rank spearmen.Result: the relationship of vulnerability perception with acceptance vaccine covid-19 and correlation coefficient showing a figure of 0.29. It refers to the value of 0.20- 0.40 is considered weak. Similarly, the relationship of severity perception with acceptance vaccine covid-19 obtained coefficient correlation 0.41 expressed strong. on the perception of cues doing actions with acceptance vaccine covid-19, there is a strong relationship, because value correlation coefficient 0.41. For the relationship of benefit perception with acceptance vaccine covid-19 get a weak result because the correlation coefficient of 0.23 in the category below 0.40 is considered weak.Conclusion: there are four components of Health Belief Model associated with Acceptance vaccine covid-19

Social vulnerability increased the non-motor worsening in people living with Parkinson's disease during the COVID-19 pandemic

Objective: To investigate the social vulnerability impact on motor and non-motor worsening in people living with PD during the COVID- 19 pandemic. Background: The COVID-19 pandemic has imposed a large variety of unparalleled challenges, many of which appear to be disproportionately impacting the mental and physical health of people living in different social vulnerability condition. People living with Parkinson's disease (PD) experimented a clinical worsening during the pandemic explained by multidimensional factors (Silva-Batista et al.,2021). Methods: One hundred people with a confirmed diagnosis of Idiopathic PD, 45 females, mean age of 67.3 years (SD = 9.2), in stage 1-3 of disease evolution according to Hoehn and Yahr classification, participated in the present study. After presenting the informed consent form, and expressing agreement to participate in the study, participants were asked to answer, through telephone interviews, a previously established questionnaire that investigates: (1) general information;(2) socioeconomic status;(3) information associated with PD;(4) quality of life worsening;(5) health conditions related to COVID-19;(6) mental health worsening;(7) fear of falling;(8) level of physical activity;(9) cognitive health conditions and (10) motor and non-motor aspects of daily life experience. The participants were divided into two groups, according to the social vulnerability condition: high social vulnerability group (HSV) and low social vulnerability group (LSG). The comparison in worsening severity of all factors between the two groups was analyzed by ANOVA one-way. Results: The groups were comparable in demographic and clinical aspects. The ANOVA showed a significant statistical difference between the groups only for pain (F(1,95) = 6.98, p = .009), urinary problems (F (1,96) = 4.47 p = .03), and apathy F(1,95) = 4.52, p = .03). The Tukey post-hoc confirmed a more severe worsening for HSV (p < .001). Conclusion: People with PD living in a high social vulnerability condition demonstrated increased non-motor worsening during the COVID-19 pandemic. These results emphasize the importance of developing support social and health assistance to alleviate the social vulnerability impact during the COVID-19 pandemic and other similar unexpected stress situations on people living with PD.

Gender differences in stress and mental health due to COVID-19 pandemic in people living with Parkinson's disease

Objective: To investigate the gender differences in the motor and non-motor worsening associated with COVID-19 pandemic in people living with PD. Background: The COVID-19 pandemic has imposed a large variety of unparalleled challenges, many of which appear to be disproportionately impacting the mental health and well-being of men and women. People living with Parkinson's disease (PD) experimented a clinical worsening during the pandemic explained by multidimensional factors, however, gender was not one of them. Investigate the gender influence on the response to adverse effects of stressful effects of unexpected conditions may help to guide preventive programs for people living with PD. Methods: 100 people with Idiopathic PD, 45 females, mean age of 67.3 years (SD = 9.2), in stage 1-3 of disease evolution according to H&Y classification, participated in the present study. After expressing agreement to participate in the study, participants were asked to answer, through telephone interviews, a previously established questionnaire that investigates: (1) general information;(2) socio-economic status;(3) information associated with PD;(4) quality of life worsening;(5) health conditions related to COVID-19;(6) mental health worsening;(7) fear of falling;(8) level of physical activity;(9) cognitive health conditions and (10) motor and non-motor aspects of DLA. The participants were divided into two groups, according to gender. The comparison in worsening severity of all factors between the two groups (male and female), was analyzed by ANOVA one-way. Results: The groups were comparable in demographic and clinical aspects. The ANOVA showed a significant statistical difference between the groups only for discouragement, sadness, hopelessness (F(1, 95) = 5.6, p = .01) and adaptation difficulty (F(1, 95) = 11.4, p = .001. The Tukey post-hoc confirmed a more severe worsening of mental health in females (p < .001). Conclusion: Females living with PD demonstrated higher levels of discouragement, sadness, hopelessness, and higher difficulty to adapt the social isolation during the COVID-19 pandemic. These results emphasize the importance of developing support assistance to mitigate the extensive negative impacts of the COVID-19 pandemic and other similar unexpected stress situations on people living with PD, as also of the development of specific interventions to the gendered impacts on mental health and well-being.

PÚRPURA TROMBOCITOPÊNICA IMUNE SECUNDÁRIA A COVID-19: RELATO DE CASO

Introdução: A Púrpura Trombocitopênica Imune (PTI) é um distúrbio hemorrágico, de caráter autoimune, caracterizado por uma contagem plaquetária inferior a 100.000/mm³. Recentemente, diversos casos secundários à infecção por COVID-19 foram descritos na literatura. Relato de caso: Homem de 61 anos, apresentou-se com quadro de hematúria macroscópica há 12 horas e petéquias em membros inferiores há 1 dia. Referiu ter utilizado no dia anterior 1 comprimido de Xarelto prescrito no serviço de origem. Encontrava-se no 16°dia após início de sintomas gripais leves (cefaleia, tosse, mialgia e febre), com diagnóstico de SARS-CoV-2 por RT-PCR. Exames admissionais: Hb: 15 g/dL;leucócitos: 7860/mm3(diferencial normal);plaquetas: 4000/mm3;creatinina: 0,8 mg/dL;urina 1: hematúria sem dismorfismo eritrocitário;coagulograma dentro dos padrões de normalidade. Ultrassonografia de rins e vias urinárias sem alterações. Após exclusão de outras causas autoimunes e infecciosas iniciou-se 1 mg/kg/dia de prednisona oral. No 3°de internação os exames laboratoriais mostravam anemia (Hb: 11,2 g/dL) e plaquetopenia (3000/mm3). Reticulócitos, bilirrubina indireta, coombs direto, haptoglobina, análise do sangue periférico e desidrogenase lática dentro dos padrões de normalidade. Foi internado em unidade de terapia intensiva, sendo iniciado pulsoterapia com metilprednisolona (1 g/dia). Nos 2 dias subsequentes, em decorrência da persistente redução dos índices hematimétricos (Hb: 7,7 g/dL), optou-se por transfundir um total de 14 unidades de concentrado de plaquetas, com melhora parcial da hematúria e da plaquetopenia (12.000/mm3). No 7°dia de internação, encontrava-se sem sangramentos (Hb: 7,3 g/dL;plaquetas: 17.000/mm3). Recebeu alta da unidade de terapia intensiva com 1 mg/kg/dia de prednisona. No 10°dia de internação foi optado por aumentar a dose de prednisona para 1,5 mg/kg/dia pela manutenção de níveis baixos de plaquetas (15.000/mm3). No 17°dia de internação, paciente recebeu alta hospitalar com 1,5 mg/kg/dia de prednisona, após parcial melhora da plaquetopenia (22.000/mm3) e da anemia (9,1 g/dL). No 12°dia pós-alta (Hb:12,4 g/dL;plaquetas: 112.000/mm3), foi iniciado desmame lento do corticoide, sendo posteriormente suspensa a medicação com manutenção de níveis plaquetários. Discussão: A PTI secundária representa cerca de 14% de todos os casos de doença em adultos. Dentre as principais etiologias, pode-se citar inúmeras infecções virais como hepatite C, citomegalovírus e vírus da imunodeficiência humana. O mecanismo exato da PTI secundária a COVID-19 ainda não está completamente elucidado. Entretanto, assim como em outras infecções virais, a indução de autoimunidade pode ser explicada via mimetismo molecular com a produção de autoanticorpos reativos a certas glicoproteínas na superfície plaquetária. A temporalidade do caso descrito está em consonância com a literatura. Em uma revisão sistemática com 45 casos de PTI secundária à COVID-19 o diagnóstico, em cerca de 80% dos casos, foi realizado dentro das primeiras 3 semanas do início dos sintomas virais. Conclusão: A sequência temporal e a plausabilidade biológica do caso sugerem uma relação causal entre a infecção por COVID-19 e a PTI, ilustrando a importância de atentar-se a possíveis complicações atípicas da doença.

EOSINOPENIA COMO FATOR PREDITIVO DE GRAVIDADE EM PACIENTES PEDIÁTRICOS INTERNADOS POR COVID-19

Objetivo: Avaliar o primeiro hemograma realizado de crianças entre zero a 10 anos de idade com COVID-19 e relacionar seus parâmetros com a gravidade clínica. Materiais e métodos: Estudo de coorte retrospectivo (15/03/2020 a 15/09/2020) com dados do hemograma e PCR do prontuário à admissão hospitalar em dois hospitais na cidade de São Paulo, um privado e um hospital universitário. Foram avaliados, além de valores numéricos, dados categóricos quanto a presença ou não de alterações respeitando as referências para cada faixa etária. Feita avaliação das razões entre as células do leucograma e plaquetas: razão plaquetas/linfócitos, razão neutrófilos/linfócitos (NLR), razão neutrófilos/monócitos, razão linfócitos/neutrófilos, razão linfócitos/monócitos, razão monócitos/neutrófilos e razão monócitos/linfócitos. Resultados: Foram incluídas 93 crianças (idade entre 0,30–126 meses, mediana 19 meses), sendo destes 56 meninos (60,2%). Receberam alta após avaliação no pronto-socorro 24/93 (25,8%) pacientes, ficando internados 69 (74,2%). Não houve associação entre idade, sexo e valor de PCR com internação ou com a gravidade clínica. Doença de base esteve presente em 29/69 (42%) pacientes internados, enquanto que nos 24 que não internaram, esteve presente em 3 (12,5%). As crianças com alguma doença de base têm 5,08 (95% IC 1,56–22,9) vezes mais chance de internar em relação àquelas sem doença de base;no modelo ajustado para a idade, a OR foi de 4,63 (95% IC 1,36–21,59). As crianças com NLR maior (média 2,42 para o grupo internado contra 1,20 para o grupo não internado) tem 54% mais chance de internação (OR 1,54, 95% IC 1,10–2,41). Do total das crianças internadas, 21/69 (30,4%) evoluíram para uma condição crítica (sepse, síndrome inflamatória multissistêmica pediátrica – SIM-P, suporte ventilatório avançado ou óbito). A proporção de crianças críticas com eosinopenia é 3,05 vezes maior que aquelas sem eosinopenia (OR 3,05, 95% IC 1,07–9,39);ajustando o modelo para a idade, houve aumento para 5,27 (95% IC 1,62–19,35). Um óbito ocorreu nessa população por SIM-P em criança com neuropatia de base. Discussão: O conhecimento das alterações no hemograma de crianças entre 0 e 10 anos de idade ainda é escasso e possíveis fatores preditivos para gravidade que sejam de fácil acesso aos sistemas de saúde devem ser investigados. A NLR é um fator preditivo importante para doença grave e mortalidade em adultos com COVID-19. Neste estudo, na avaliação inicial no pronto socorro, as crianças com NLR maior têm maior probabilidade de apresentar um quadro clínico que exija internação. Os eosinófilos, por sua vez, têm papel na resposta imune adaptativa e na imunidade inata, com capacidade pro-inflamatória e destrutiva, estando sua presença no hemograma inicial relacionada como marcador infeccioso. A eosinopenia foi descrita em adultos com COVID-19 como um fator de pior prognóstico, sendo frequente nos pacientes com êxito letal. Este estudo demonstrou que, uma vez internadas, a eosinopenia também esteve relacionada com a gravidade da COVID-19 em crianças. Conclusão: Crianças com COVID-19 e doença de base ou NLR maior no pronto socorro são mais propensas a internar. Existe relação entre eosinopenia no hemograma à admissão hospitalar como fator preditivo de gravidade para crianças internadas com COVID-19.

Antimicrobial activity of a nanocomposite film formed by bacterial nanocellulose and titanium dioxide

The development of materials with antimicrobial properties has increased, mainly driven by the pandemic caused by the new coronavirus SARS-CoV-2. Bacterial nanocellulose (CB) is a polysaccharide produced and secreted by certain genera of bacteria that have unique properties (high purity, biodegradability, biocompatibility, among others) for the development of new materials with special characteristics. Titanium dioxide (TiO2) is an inorganic compound industrially produced as a white and odorless powder, that intrinsically presents photo activity, high stability, and antimicrobial activity, this mainly after irradiation of ultraviolet (UV) light irradiation. Aiming to provide antimicrobial properties on nanocellulose films produced by Komagataeibacter sp., TiO2 nanoparticles were incorporated into the surface and pores of nanocellulose film discs. After, antimicrobial activity assays were carried out in a photochemical reactor to evaluate Escherichia call ATCC 8739 susceptibilities when in contact with the CB-TiO2 film discs after 15 minutes, followed by count of colony-forming units (CFU) on agar plate. Results showed an inhibition of E. coli growth of 98.5% when in contact with CB-TiO2 in the presence of UV-A and an inhibition of 68.0% in the absence of UV-A, indicating the potential use of the biocomposite for the creation of materials and surfaces with antimicrobial properties.

Blockchanging politics: Opening a trustworthy but hazardous reforming era

There has been a fundamental change in the genesis of political-economic trust, with the arrival of a decentralized but structured way to reach consensuses and automatically implementing decisions through self-executable contracts. Blockchain technology (BT) is a distributed, consensus-based, and secure way for individuals to make enforceable censorship-resistant quantifiable agreements. Every vote is a transaction, and BT is paving the way for decentralizing politics, defending privacy, and streamlining voting procedures. It has the potential to provide much more granular governance that hopefully will preserve freedom and defend democracy. However, especially in an embarrassing post-COVID-19 world, BT's centralization can, instead, pave the way for citizens' control, turning cryptographic protocols into an authoritarian digital corset tightened by some to menace the privacy and freedom of many. © 2021 by IGI Global.

Omicron - The new SARS-CoV-2 challenge?

SARS-CoV-2 virus has infected nearly 300 M people worldwide and has been associated with over 6 M deaths by March 2022. Since the virus emergence in December 2019 in Wuhan, several new mutations have been described. The World Health Organization has developed a working name for these emerging variants according to their impact on the worldwide population. In this context a high alert has been paid to variants of concern (VOC) due to their high infectiousness and transmissibility patterns. The most recent VOC, Omicron (B.1.1.529), has become dominant in the shortest time ever and has placed Europe under an overwhelming and unprecedented number of new cases. This variant has numerous mutations in regions that are associated with higher transmissibility, stronger viral binding, affinity and antibody escape. Moreover, the mutations and deletions present in the spike protein suggest that the SARS-CoV-2 specific attachment inhibitors may not be the best option for Omicron therapy. Omicron is the dominant variant circulating worldwide and, at the end of February 2022, it was responsible for nearly all sequences reported to GISAID. Omicron is made up of several sublineages, where the most common are BA.1 and BA.2 (or Nextstrain clade 21K and 21L, respectively). At a global level, it is possible to say that the proportion of BA.2 has been increasing relative to BA.1 and in some countries it has been replacing it at high rates. In order to better assess the Omicron effectiveness on antibody escape, spread and infectious ability it is of the highest relevance to maintain a worldwide tight surveillance. Even though this variant has been associated with a lower death rate, it is important to highlight that the number of people becoming infected is concerning and that further unpredictable mutations may emerge as the number of infected people rises.

Gamification for Infectious Diseases Medical Education: Creating a Videogame to Teach COVID 19 Diagnosis and Treatment to Medical Students

Background. Brazillian authorities reported a total of 16.3 million cases and 454. 000 deaths during COVID-19 pandemic in Brazil by may 2021. It became necessary to educate healthcare professionals on diagnosis and treatment of the syndrome. Game based learning surfaced as an effective alternative, since it promotes critical thinking and problem solving skills. A team of Brazilian and Peruvian students, physicians, designers and programmers gathered to create a decision based computer game that simulates a hospital scenario and allows medical students to analise, make decisions and receive feedback. This work describes the creative process and showcase the initial version of the software. Methods. Professors and students of Medicine, Information Technology (IT), Design and Architecture from Brazil and Peru assembled a team in order to develop the computer game. Clinical cases were created by the medical students and professors, comprising medical procedures for the treatment and management of COVID 19, and a video game script was developed exploring gamification principles of challenge, objectivity, persistence, failure, reward and feedback. Algorithms (image 1) were created, under supervision of professors of Medicine, to define possible courses of action and outcomes (e.g. gain or loss of points, improvement or worsening of the patient). Students of Design created artistic elements, and IT students programmed with a game engine software. This fluxogram, written in portuguese, describes in detail all the possible courses of actions that can be exercised by the player. It is created by a team of Professors of Medicine and medical students, in accordance with evidence-based guidelines. Primarily, this document guides the programmers and designers throughout the development phase of the game. Results. Initially, an expandable minimum viable product was obtained. The game, visualized on image 2, consists in a non-playable character and a playable character (i.e. doctor), with a scenario and a dialogue script simulating a clinical examination of a COVID 19 patient. The player can interact with certain elements within the game, e.g. the computer and other characters, to retrieve test results or start dialogues with relevant information. Hospital scenario and dialogue window between doctor (player in black) and patient (non playable character) are displayer in the game engine software (Unity 2D). On the bottom half of the screen, the dialogue box allows the player to collect the patient's medical history. The player can interact with certain elements to obtain relevant information to make decision and progress in the game. Conclusion. The game allows medical students to practice diagnosis and treatment of COVID 19. Future versions will include assessment reports of player's actions, and a new score system will be implemented. New diseases will be incorporated in the gameplay to match the variety of scenarios offered by real hospitals and patients. Artificial intelligence will be employed to optimize gameplay, feedback and learning.

ENDOCARDITE POR BARTONELLA HENSELAE: EXPERIÊNCIA INVESTIGATIVA DE ENDOCARDITE DE HEMOCULTURAS NEGATIVAS DE UM TIME DE ENDOCARDITE INFECCIOSA NO MUNICÍPIO DO RIO DE JANEIRO

Introdução e objetivos: A incidência de Endocardite Infecciosa comunitária associada a hemoculturas negativas (EICAHN) varia de 5 a 78%. Há poucos relatos da incidência de endocardite infecciosa associada a Bartonella spp. (EIAB) no Brasil. Nesse estudo avaliaremos a incidência de endocardite (EI) por Bartonella spp. na série de 119 pacientes no Rio de Janeiro. Método: Estudo observacional, transversal, prospectivo, de 2009 a 2021, inclusos 119 pacientes com EI em hospital universitário na cidade do Rio de Janeiro. Os testes sorológicos e moleculares para Bartonella spp. foram realizados no laboratório de referência e resultados positivos de acordo com a literatura. Análise dos dados foi realizada no Stata Statistical Software. Resultados: A incidência de EIAB nesta série foi de 1,6%. Comparando os dados EICAHN (N=17) com o grupo EI comunitária com hemoculturas positivas (N = 35), 14,2% foi classificada com EICAHN. Um paciente (P1) com EIAB residia com dois cachorros e outra paciente (P2) com dois gatos. Ambos com evidência epidemiológica e laboratorial de infecção por Bartonella após visita do grupo One Health. No grupo de EIAB, o principal fator de risco foi a febre reumática (p = 0,031). A EI aórtica foi mais incidente na EICAHN (p = 0,001). Os dois casos de EIAB foram diagnosticados no ano da pandemia de COVID-19. O P1, homem branco de 47 anos, após investigação de síndrome febril e IC de evolução de três meses, foi submetido à cirurgia de troca valvar mitro-aórtica, onde foi observada vegetação valvar. Amostra de sangue submetida à imunofluorescência indireta para anticorpos anti-Bartonella, sendo reagente. A PCR sérica para Bartonella foi negativa, porém houve detecção de DNA para B. henseale na valva. Seus cachorros foram testados e em um deste houve detecção de anticorpos anti-Bartonella spp. no sangue. A P2, mulher branca, 62 anos, com prótese mitral biológica disfuncionante, internada para investigação de síndrome consumptiva há 8 meses, com insuficiência renal e anemia na ausência de febre. A pesquisa de anticorpos IgG Anti-Bartonella spp. no sangue foi positiva, assim como nos gatos que residiam com a mesma. O diagnóstico de EI se deu pelos critérios de Duke modificados. Conclusão: A incidência de EIB nesta série de 119 paciente do time de EI do Rio de Janeiro foi 1,6. Maior acometimento de EIAB foi na valva aórtica e o principal fator de risco a febre reumática. Abordagem One Health contribui em 2020 para o diagnóstico endocardite por B. henselae.

Assessing the level of acceptance of a crowdsourcing solution to monitor infectious diseases propagation

This work presents a study for assessing the technology acceptance of a contact tracing app, also proposed by us, which is a hybrid crowdsensing application (opportunistic and participatory). The goal of the app is that users are notified if they were in contact with others infected. It also allows creating a heat map identifying streets, squares, and commercial locations to which contaminated users were, allowing more assertive hygiene actions and eliminating infectious disease outbreaks. Our methodology aimed on finding whether people would be willing to share their location, as well as their health issues related to COVID-19. It is composed by a survey for verifying the interest of the proposed application;the prototype of the application;and the use of Technology Acceptance Model (TAM). We can see that the vast majority of respondents to the first survey were interested in using a contact tracking application, even though they need to share their location and report when they become infected. In addition, the proposed RISCOVID application proved to be accepted for use by participants in the second survey. © 2020 IEEE.