Epidemiological trends in syphilis diagnoses during the COVID-19 pandemic in Brazil

Introduction: Syphilis, a sexually transmitted disease caused by Treponema pallidum, is a worldwide public health problem and has an essential association with the human immunodeficiency virus (HIV) through behavioral and pathological factors. In Brazil, the syphilis situation is alarming, even with actions and strategies to control transmission implemented by the Brazilian Ministry of Health during the pandemic. Objective(s): To compare the mean number of syphilis cases reported from March to December 2017-2019 with those reported in the same period of 2020 to verify if the COVID-19 pandemic is affecting the incidence of syphilis in Brazil. Material(s) and Method(s): A descriptive analysis and incidence rate of data extracted from the Ministry of Health of Brazil's public database was performed. Result(s): In all Brazilian macro regions, the incidence rates of syphilis per million population increased significantly during the pandemic, reaching +78% overall, corresponding to an additional 161 incident cases per million population. The data suggest that the social distancing measures adopted during the pandemic could not interfere with general sexual behaviors in Brazil. Conclusion(s): The observed increase in syphilis cases should be further investigated to assist with decision-making processes and the programming of health measures.

Modelling and Closed-Loop Control of Admissions in a Vaccination Center Through Tropical Algebra

This paper presents the development of a dynamical tropical algebra-based model of a vaccination center, which can be used to control and optimize the admission of users during center's operation. In addition, an analysis of closed-loop control methods designed to maximize the system performance in terms of service rate and minimize users' waiting time, while observing occupancy constraints due to social distancing protocols recommended by sanitary authorities due to Covid epidemic, is presented. © 2023, Brazilian Society for Automatics--SBA.

Omission of meals, nutritional status and metabolic profile of patients with type 2 diabetes mellitus

Introduction: Skipping meals has been associated with cardiometabolic risk factors such as overweight and insulin re-sistance. Despite this, data on the frequency of meals and the influence on the nutritional and metabolic status of individu-als with type 2 Diabetes Mellitus (DM2) are scarce.Objective: To investigate the correlation between missed meals, body mass index (BMI) and metabolic profile of DM2 patients during the COVID-19 pandemic.Methodology: Cross-sectional study with 107 individuals followed at a Nutrition outpatient clinic of a reference hospi-tal in Fortaleza, Ceara. Socioeconomic, clinical, anthropomet-ric and biochemical data were collected. Meal omission was verified using a 24-hour dietary recall. The correlation be-tween the variables was verified by the Spearman and Chi -Square test, considering p<0.05 as significant.Results: The mean age of participants was 62 +/- 11.34 years, where most were women (57.9%). The mean BMI was 28.67 +/- 5.13 kg/m2 and most were overweight (68%). Participants ate an average of 5 +/- 0.94 meals per day. The median number of meals skipped was 1 (0 -3) and 60.7% skipped at least 1 meal. The most missed meals were supper (41%) and a morning snack (38%). There was a significant positive correlation between the number of skipped meals with BMI and weight.Conclusion: The number of skipped meals is directly cor-related with the nutritional status of older adults and elderly people with DM2.

Disinformation on plataforms: actions taken by Twitter during a Covid-19 pandemic

In this article, we propose a critical reflection in the light of platform capitalism on the actions taken by Twitter to combat misinformation during the Covid-19 pandemic. For this, we contextualized the phenomenon of disinformation and the pandemic, and carried out a case study based on documentary research of the platform's activities. We emphasize that the platform's coping strategy is based on two main perspectives: stopping misleading information through content moderation and providing secure information. Finally, we tensioned the proposals, pointing out the danger of an algorithmic solutionism and the limitation of some platform actions.

Syndromic surveillance of respiratory infections during protracted conflict: experiences from northern Syria 2016-2021.

OBJECTIVE: Northern Syria faces a large burden of influenza-like illness (ILI) and severe acute respiratory illness (SARI). This study aimed to investigate the trends of Early Warning and Response Network (EWARN) reported ILI and SARI in northern Syria between 2016 and 2021 and the potential impact of SARS-CoV-2. METHODS: We extracted weekly EWARN data on ILI/ SARI and aggregated cases and consultations into 4-week intervals to calculate case positivity. We conducted a seasonal-trend decomposition to assess case trends in the presence of seasonal fluctuations. RESULTS: It was observed that 4-week aggregates of ILI cases (n = 5,942,012), SARI cases (n = 114,939), ILI case positivity, and SARI case positivity exhibited seasonal fluctuations with peaks in the winter months. ILI and SARI cases in individuals aged ≥5 years surpassed those in individuals aged <5 years in late 2019. ILI cases clustered primarily in Aleppo and Idlib, whereas SARI cases clustered in Aleppo, Idlib, Deir Ezzor, and Hassakeh. SARI cases increased sharply in 2021, corresponding with a severe SARS-CoV-2 wave, compared with the steady increase in ILI cases over time. CONCLUSION: Respiratory infections cause widespread morbidity and mortality throughout northern Syria, particularly with the emergence of SARS-CoV-2. Strengthened surveillance and access to testing and treatment are critical to manage outbreaks among conflict-affected populations.

Critical Periods, Critical Time Points and Day-of-the-Week Effects in COVID-19 Surveillance Data: An Example in Middlesex County, Massachusetts, USA.

Critical temporal changes such as weekly fluctuations in surveillance systems often reflect changes in laboratory testing capacity, access to testing or healthcare facilities, or testing preferences. Many studies have noted but few have described day-of-the-week (DoW) effects in SARS-CoV-2 surveillance over the major waves of the novel coronavirus 2019 pandemic (COVID-19). We examined DoW effects by non-pharmaceutical intervention phases adjusting for wave-specific signatures using the John Hopkins University's (JHU's) Center for Systems Science and Engineering (CSSE) COVID-19 data repository from 2 March 2020 through 7 November 2021 in Middlesex County, Massachusetts, USA. We cross-referenced JHU's data with Massachusetts Department of Public Health (MDPH) COVID-19 records to reconcile inconsistent reporting. We created a calendar of statewide non-pharmaceutical intervention phases and defined the critical periods and timepoints of outbreak signatures for reported tests, cases, and deaths using Kolmogorov-Zurbenko adaptive filters. We determined that daily death counts had no DoW effects; tests were twice as likely to be reported on weekdays than weekends with decreasing effect sizes across intervention phases. Cases were also twice as likely to be reported on Tuesdays-Fridays (RR = 1.90-2.69 [95%CI: 1.38-4.08]) in the most stringent phases and half as likely to be reported on Mondays and Tuesdays (RR = 0.51-0.93 [0.44, 0.97]) in less stringent phases compared to Sundays; indicating temporal changes in laboratory testing practices and use of healthcare facilities. Understanding the DoW effects in daily surveillance records is valuable to better anticipate fluctuations in SARS-CoV-2 testing and manage appropriate workflow. We encourage health authorities to establish standardized reporting protocols.

Immunonological biomarkers of fatal coronavirus disease 2019 (covid-19): A study of 513 patients including hematological cases

Background: Knowledge on the immunopathobiology of COVID-19 is rapidly increasing but most studies analyzed relatively small series of patients and immune features predictive of fatal outcome are unavailable for routine stratification. Furthermore, an increased risk of death in patients with hematological cancer infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been identified, but it remains unknown if this is related to possible immunosuppression caused by cancer itself and cytotoxic treatment. Aims: Characterize the immune response to SARS-CoV-2 in a large cohort of patients to identify high-risk immune biomarkers and evaluate the association between COVID-19 severity and immunosuppression in patients with hematological cancer. Methods: Multidimensional flow cytometry was used to conduct holistic and unbiased analyses of17 immune cell types on 780 peripheral blood samples obtained from 513 COVID-19 patients, 24 cases with non-SARS-CoV-2 infection and 36 age-matched healthy adults.167 COVID-19 patients had 207 longitudinal samples collected over time. RNA sequencing on FACSorted cells and high-resolution flow cytometry were used to perform a deeper characterization of various myeloid and lymphoid subsets in14 COVID-19 patients and4 healthy adults. Results: Immune profiles of COVID-19 patients were generally similar to those of age-matched patients with non-SARS-CoV-2 infection, but significantly different from those of age-matched healthy adults. When compared to the later, COVID-19 patients showed increased percentages of neutrophils, CD4+CD56+ T-cells, and plasmablasts, whereas levels of basophils, eosinophils, and non-classical monocytes, as well as double-negative, CD8loCD56-, CD8-/loCD56+ and CD8hiCD56- T-cells, and B-cells were decreased. Both transcriptional and immunophenotypic data in myeloid and lymphoid subsets suggested an association between COVID-19 severity and neutrophil activation, as well as significantly reduced levels of specific adaptive immune cell types. Unsupervised clustering analysis of 513 patients revealed three immunotypes in response to SARS-CoV-2 infection. One of them, present in14% of patients (n=74), was characterized by significantly lower percentages of all immune cell types except neutrophils and plasmablasts, and was significantly associated with more severe disease. Of note, 50% of COVID-19 patients with blood cancer displayed this immunotype. Accordingly, hematological patients showed a significantly higher frequency of admission into intensive care units (50% vs 5%, P<.001) and death (30% vs4%, P<.001) than patients without tumor did. On multivariate analysis incorporating age and comorbidities, the frequency of B-cells and non-classical monocytes were independent prognostic factors for overall survival. Indeed, <1% B-cells in peripheral blood was most strongly associated with risk of death. Among patients with immune monitoring during follow-up, significant changes in the relative distribution of eight immune cell types, including basophils, CD8loCD56- T-cells, and B-cells, were observed from the first to last peripheral blood sample between patients who survived or died. Summary/Conclusion: Our results accelerate our understanding of the immunopathobiology of COVID-19 and unveil an association between altered immune profiles in patients with hematological cancer and their poorer outcome. Reduced percentages of B-cells and non-classical monocytes are high-risk immune biomarkers that could be readily implemented in routine practice for risk-stratification of COVID-19.

Providing Food and Nutrition Services during the COVID-19 Surge at the Javits New York Medical Station.

Military field hospitals typically provide essential medical care in combat zones. In recent years, the United States (US) Army has deployed these facilities to assist domestic humanitarian emergency and natural disaster response efforts. As part of the nation's whole-of-government approach to the coronavirus disease (COVID-19) pandemic, directed by the Federal Emergency Management Agency and the Department of Health and Human Services, during New York City's (NYC) initial surge of COVID-19, from 26 March to 1 May 2020, the US Army erected the Javits New York Medical Station (JNYMS) field hospital to support the city's overwhelmed healthcare system. The JNYMS tasked a nutrition operations team (NuOp) to provide patient meals and clinical nutrition evaluations to convalescent COVID-19 patients. However, few guidelines were available for conducting emergency nutrition and dietary response efforts prior to the field hospital's opening. In this case study, we summarize the experiences of the NuOp at the JNYMS field hospital, to disseminate the best practices for future field hospital deployments. We then explain the challenges in service performance, due to information, personnel, supply, and equipment shortages. We conclude by describing the nutrition service protocols that have been implemented to overcome these challenges, including creating a standardized recordkeeping system for patient nutrition information, developing a meal tracking system to forecast meal requirements with food service contractors, and establishing a training and staffing model for military-to-civilian command transition. We highlight the need for a standardized humanitarian emergency nutrition service response framework and propose a Nutrition Response Toolkit for Humanitarian Crises, which offers low-cost, easily adaptable operational protocols for implementation in future field hospital deployments.

Combating disinformation in the Covid-19 pandemic: the digital platforms' reactions

This article proposes a reflection on the actions implemented by the digital platforms Facebook and WhatsApp to combat disinformation (WARDLE;DERAKHSHAN, 2017) during the Covid-19 pandemic. Considering factors related to the rise of these platforms and their business models (MOROZOV, 2018), we have conducted a case study based on a documentary research of the policies and measures announced, problematizing these actions based on the notion of algorithmic consensus and digital solving (MOROZOV, 2018, 2020). From the identification of the reactive action, we conclude that strengthening a relationship of dependence with these companies for this fight is insufficient and dangerous.

REFLECTIONS ON THE IMPACT OF THE PANDEMIC CORONAVIRUS ON THE PERFORMANCE OF THE RECYCLABLE MATERIALS COLLECTOR

The Covid-19 pandemic acts more severely in the lower strata of Brazilian society, where there are recyclable material collectors, who act in an organized manner in associations and cooperatives or individually. To avoid further depletion of their income, recyclable material collectors need to remain collecting for a longer time, at a time when the prices of recyclables are falling, even as their production increases. This leads to greater exposure to the Covid-19 virus because, among recyclable material scavengers, there are many sexagenarians and individuals with pre-existing comorbidities. In addition, it is necessary to discuss the post-pandemic scenario, with the possibility of a substantial increase in new scavengers arising from the economic crisis and an increase in the supply of recyclable material.