Single centre, cross-sectional assessment of airway hemorrhage in a cohort of patients with COVID19-associated ARDS under Venovenous extracorporeal membrane oxygenation

Objectives: Airway hemorrhage (AH) frequently complicates extracorporeal membrane oxygenation (ECMO) treatment. Inflammation, coagulopathy and antithrombotic therapy are contributing factors. Patients with COVID-19- associated ARDS (CARDS) supported with ECMO present all these features. We aim to characterize the incidence and the clinical and prognostic impact of AH. Method(s): Review of a cohort of patients with CARDS treated with ECMO support at a single ECMO centre between March 2020-February 2022 (n=92). AH was defined as a clinically significant hemorrhage fit demanded interruption of anticoagulation, transfusional support or bronchoscopy. Univariate analysis was performed using GraphPadPrism. Result(s): One third (n= 31) of patients with CARDS treated with ECMO had clinically significant AH. Patients who developed AH had significantly longer ICU length-of-stay (LoS), ECMO run and invasive mechanical ventilation (IMV) duration. Significant differences in coagulation and inflammatory markers were detected between patients with early (<72h) versus late (>9 days) onset of AH (Table 1). Mortality at day 90, demographics, comorbidities, CT scan pattern and clinical severity indexes were similar between patients with and without AH (NAH). Conclusion(s): In patients with severe CARDS treated with ECMO support, the occurrence of airway hemorrhage leads to clinically important morbidity but does not increase mortality. Distinct pathways may be involved in the development of early v. late AH. (Table Presented).

Factors Related to the Presence of Lowback Pain during Remotework in the Covid-19 Pandemic in Brazil

Objectives: With the new needs that the market and the population presented, there was a need to adopt strategies to make the new work environment as safe and comfortable as possible, preserving the health of workers regardless of the work environment. Given this context, it is extremely important that the workers have knowledge about ergonomics and how environmental factors can affect their work capacity and comfort, factors such as ambient light, noise, air flow, temperature, long period in a static position and inappropriate furniture. The aim of the study was to identify the etiology of low back pain during remote work during the COVID-19 pandemic. Method(s): Two questionnaires were applied, one of them developed by the researchers and the other a disability questionnaire (Roland-Morris Disability Questionnaire-RMDQ) in the form of Google Forms for adults (n = 54) of both sexes, aged over 18 years who were working remotely during the period of the COVID-19 pandemic in Brazil in the year 2021. Result(s): With the application of the questionnaires, it was possible to notice an increase in the emergence and worsening of lowback pain in individuals who performed remote work during the COVID-19 pandemic;this increase related to factors such as: inadequate furniture at home, excessive number of hours in the sitting position using the computer, decrease in regular physical activities and weight gain. Conclusion(s): From the beginning of remote work, during the COVID-19 pandemic, most individuals studied either developed lowback pain or had increased low back pain, resulting in mild disability. These data are preliminary in Brazil;in the future, we seek to expand to a larger number of participants, as well as to create strategies and health-promoting actions for low back pain prevention.

"The truth will set you free": disinformation and post-truth in the Bolsonaro Administration in the fight against Covid-19

Biblical verses are widely used by government officers in Jair Messias Bolsonaro Administration, president of Brazil since 2019. However, the practice has not been the same as the theory, since, in their official and unofficial speeches, fake news that promote misinformation. This paper aims to present evidence that the Government contributed to disinformation in the fight against Covid-19 in Brazil. The qualitative -quantitative, exploratory and descriptive research was developed by collecting the publications of the President of the Republic of Brazil on Twitter. It was counted the times that he mentioned, in the posts on his Twitter account, the use of medicines and substances with no proven effectiveness in combating the pandemic of the new coronavirus. His speech was analyzed from the notions of "information" of fundamental authors of Information Science and of truth and "post-truth", with the purpose of explaining the reasons why disinformation finds echoes in the followers of that president, leading to the context of their speeches and behaviors in other communication vehicles is taken into account. The results demonstrate how disinformation, even in a private account disguised as public/official, on social media, has major repercussions in the lack of adequate measures and treatment and, consequently, in the deaths caused by Covid-19 in the country. It is concluded that some of their posts and attitudes culminated in hate speeches and attacks by their followers on opponents of the Government, putting society in a limbo of misinformation, lost as to which health recommendation to follow and who to believe. After all, the word of the authority that should release (from the pandemic) did not align with scientific research and the recommendations of the World Health Organization, echoing contradictions, untruths and misinformation.

What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care

Objective: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. Methods: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. Results: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39;p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136;p = 0.6), antibiotic therapy (57% versus 64%;p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%;p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5];p = 0.002) and presented a higher use of vasopressors (47% versus 36%;p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%;p < 0.001) at admission, prone positioning (45% versus 36%;p = 0.04), and hydroxychloroquine (59% versus 10%;p < 0.001) and lopinavir/ ritonavir (41% versus 10%;p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%;p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. Conclusion: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave. © 2023 Associacao de Medicina Intensiva Brasileira - AMIB. All rights reserved.

Fatigue and functional capacity post COVID-19

Background: We explored if fatigue influenced the long-term functional capacity of patients post COVID-19. Method(s): People after COVID -19, grouped by treatment setting (home - H, hospital ward - HW or intensive care unit - ICU), were studied 12 months after discharge. Fatigue-Functional Chronic Illness Assessment Questionnaire Fatigue Subscale, FACIT-F and functional capacity-6min walk test, 6MWD and 1min sit-to-stand test, 1minSTS were assessed. Groups were compared with one-way ANOVA or Kruskal-Wallis H test. Spearman's rho and multiple regression analyses were performed between fatigue-functional tests. Result(s): 148 subjects (H, n=44;HW, n=60;ICU, n=44) participated. Fatigue was clinically relevant at 12 months although not significantly different among groups [H: 41(35-49);HW: 42(33-50);ICU;42(32-48) points;p=.979). Functional capacity was significantly higher in those treated at home (6MWD: H,626 114m, HW: 527 146m, ICU: 528 129m, p<.001;1minSTS: H,29 11reps, HW: 23 8reps, ICU: 24 8reps, p<.002). Fatigue was significantly correlated with functional tests within each group (FACIT-F-6MWD,.317<rho<=.550, p<.01;FACIT-F-1minSTS, .364<rho<=.485, p<.01). Each point of FACIT-F could change 6MWD by 5-6m and 1minSTS by. 3-.5reps, explaining between 12-33% of change in 6MWD and 17-22% of change in 1minSTS (Table 1). Conclusion(s): Fatigue seems to influence functional capacity of patients post COVID-19. Early management of this symptom seems important for their long-term management.

Uso Da Saliva Como Amostra Biologica No Diagnostico Da Covid-19 Por Rt-Pcr

Introducao: O padrao-ouro para o diagnostico de COVID-19 e o teste molecular que permite a deteccao de acidos nucleicos de SARS-CoV-2 em amostras de swab Nasofaringeo (NPS). A deteccao precoce seguida do isolamento dos individuos infectados desempenha um papel crucial para impedir a propagacao da infeccao e o controle da pandemia. No entanto, a coleta de NPS e invasiva e desconfortavel para os pacientes, requer profissionais de saude especializados e pode ser um risco de infeccao cruzada para esses profissionais. Desta forma, avaliar outras fontes de material biologico, tal como a saliva, e fundamental para facilitar o diagnostico de COVID-19. Objetivo: O objetivo deste trabalho foi avaliar o uso da saliva como amostra biologica para a deteccao do RNA do SARS-CoV-2 e sua estabilidade pos coleta. Material e Metodos: Foram coletadas 954 amostras de saliva (5 mL) e de swab nasofaringeo (NPS) de individuos entre dezembro de 2020 e fevereiro de 2021 e analisadas em diferentes tempos (24h, 48h, 72h, 5 dias e 10 dias) apos a coleta. As amostras de saliva foram armazenadas em temperatura de 2degree a 8degreeC e extraidas puras e diluidas em solucao salina na proporcao 1:1. A extracao do RNA foi realizada em extrator automatico de acidos nucleicos (Extracta, Loccus) e o diagnostico molecular do SARS-CoV-2 foi realizado com o kit Gene FinderTM COVID-19 Plus RealAmp (OSang Healthcare). A idade media dos participantes foi de 37 anos (8 a 83 anos de idade) e a maioria dos individuos 738 (77,3%) foram nao-detectaveis e apenas 216 (22,7%) foram detectaveis para SARS-CoV-2. Entre os detectaveis, 96 (44,4%%) eram do sexo masculino e 120 (55,6%) do sexo feminino. A positividade na saliva foi posteriormente comparada com os resultados do NPS bem como a carga viral ou ciclo de limiar de amplificacao (Ct). Resultados e Discussao: A analise dos testes com a saliva e NPS demonstrou concordancia nos resultados de 210 (97%) pacientes detectaveis para COVID, em apenas 2,7 % (6/216) dos casos o SARS-CoV-2 foi detectado somente no NPS. Todos os participantes com resultado positivo para a RT-PCR apresentaram sintomas relacionados a COVID-19, sendo os mais comuns: tosse seca (19%), dor de cabeca (16%), coriza e dor de garganta (11%) e diarreia (8%). As amostras de salivas apresentaram estabilidade ate o decimo dia apos a coleta do material biologico, sem diferenca de deteccao do RNA viral entre a amostra de saliva pura e saliva diluida. Esses resultados demonstram que as amostras de saliva podem ser transportadas e armazenadas em temperatura de 2degree a 8degreeC, e processadas em ate 10 dias apos a coleta. Conclusao: Os resultados mostraram que a saliva e uma alternativa para a deteccao de SARS-CoV-2. E uma amostra biologica confiavel, nao invasiva, de facil coleta e com resultados similares aos obtidos com amostras de NPS. E uma alternativa que facilitaria a coleta em lugares com baixo suprimento de swabs nasofaringeos e regioes distantes de laboratorios especializados, uma vez que pode ser analisada ate 10 dias apos a coleta. Dessa forma, podemos concluir que a saliva pode ser utilizada com seguranca para o diagnostico de COVID-19. Copyright © 2022

Dissociation and emotional dysregulation in pathological personalities related to the fear of SARS-COV-2: a case report

Introduction: The COVID-19 pandemic represented a serious strain on the mental health resilience worldwide. Implementation of restrictive rules implied the disruption of social networks, eliciting emotional exhaustion and intense response to fear. This was amplified by media spread of panic and fake news, representing risk factors for post traumatic stress disorder (PTSD). Fear can be dangerous, especially accounting premorbid psychopathological vulnerability, such as pathological personality traits. Emotional dysregulation increases fear levels, mediated by the relationship between emotional dysregulation and lack of tolerance. Objective(s): Clinical case presentation of patient who developed dissociative and behavioral symptoms following COVID-19 infection. Bibliographic research. Method(s): Bibliographic research using Pubmed. Clinical file consultation and patient interviews. Result(s): Heightened psychophysiological reactivity can result from the persistent fear experienced during a traumatic event and repeated memories related to it, leading to a sensitization of the response to fear. We present 57 year-old female patient, admitted to the COVID ward after trying to escape from home isolation due to positivity to COVID-19. In the hospital setting she developed dissociative symptoms, trying to escape from the ward and infect other people. Conclusion(s): Intense fear responses to COVID-19 are likely explained by poor emotion regulation capacities as well as dissociative mechanisms. Studies have shown that this pandemic was experienced as a real traumatic event and some studies have found that it may lead to the development of PTSD. Pathological personality is positively related to PTSD symptoms, attributable to higher levels of mood instability, cognitive/perceptual disorders, interpersonal dysfunctions and negative affection.

Reviewing atypical Hemolytic Uremic Syndrome in a portuguese terciary hospital

Background: Atypical Hemolytic-uremic syndrome (aHUS) is a rare clinical syndrome whose diagnosis is based on the combination of clinical evaluation, biochemical findings and genetic testing. It develops with thrombocytopenia, microangiopathic hemolytic anemia, renal injury and non-specific symptoms. Nowadays, Eculizumab is an specific treatment for aHUS that should be considered in case of renal failure and after exclusion of other Thrombotic Microangiopathies (TM), namely Thrombotic Thrombocytopenic Purpura and infection by Shiga-Toxin producing Escherichia Coli. Aim(s): This review intends to characterize the management of aHUS at our center aiming the optimization of early recognition, diagnosis and treatment of aHUS. Method(s): This retrospective study based on the evaluation of all the patents coded as aHUS at our hospital between 2017 and 2021. Result(s): Five presumed cases were identified -three females and two males, aged between 33-75 (mean of 48 years). In all cases the onset was abrupt, mainly identified by analytical changes and few clinical relavants signs, despite fluctuating neurological symptoms in two patients. One patient had a previous asymptomatic Coronavirus Disease 2019. Platelets ranged from 30.000-135.000/ microliter, hemoglobin ranged from 7,7-12,8 grams per deciliter and renal dysfunction occurred with creatinine levels between 2.8-6.9 miligram/deciliter. The therapeutic approach varied according to disease's severity and patient outcome. Three patients were submitted to Therapeutic Plasma Exchange (TPE). The number of TPE varied from 3-12 sessions. Eculizumab was administered in two patients, as the other three had substantial clinical improvement before molecular results that led to Eculizumab request. This drug availability has few obstacles at our center. No patient had died, however two patients are now hemodialysis dependent. Conclusion(s): Further characterization of future cases is imperative to better understand this condition and it urges the implementation of protocols to optimize general practice in TM assistance and to avoid misdiagnosis of such rare diseases that need a specific approach.

An Immersive Virtual Field Experience Structuring Method for Geoscience Education

Digital outcrop models (DOMs) have facilitated quantitative and qualitative studies in digital and virtual environments of source and reservoir rock analogs important to the oil industry. The use of immersive virtual reality (iVR) to extend field experiences has motivated several research groups to develop software integrating immersive virtual reality techniques with tools to interpret and derive geological information from DOMs. This virtual approach can also contribute to the development of geological and spatial thinking skills taught in the classroom and during field trips. The immersive virtual field trips (iVFTs) can provide students access to outcrops and additional data restricted to field learning activities while allowing additional interactions impossible in the field. iVFTs have been developed recently however the structuring of iVFTs for geology classes has not been presented in a way that inexperienced iVR users can make use of such systems. In this scenario, our work proposes a method to structure an iVFT using georeferenced data containers (GDCs) and the virtual reality software Mosis LAB while evaluating users'perceptions during an iVFT study case. The evaluation using technology acceptance model (TAM) questionnaires, showed that users were positively impacted by the observational iVFT experience, effectively supporting e-learning, and class field learning activities and preparations. This approach allows field trip experiences in less accessible study sites, especially in less favorable conditions like the ones during the Coronavirus 2019 (COVID-19) pandemic where many geoscience departments had their field trips hampered. IEEE

IMU-based monitoring of discharged patients with COVID-19 for the assessment of in-home recovering

The coronavirus pandemic (COVID-19), due to severe acute respiratory syndrome coronavirus-2, is a major current public health problem worldwide. It is crucial to recognize that recovery of patients with COVID-19 does not end with the hospital discharge but rather begins, and improving daily physical activity (PA) seems crucial to this recovery. Thus, characterizing PA in patients with COVID-19 after discharge should be a priority in public health. Furthermore, reporting the impact of COVID-19 on the functional status and PA in the long-running follow-up of patients would allow to understand the evolution and prognosis of the disease and develop a strategy of its management [1]. Hence, we aim to investigate PA and functional status in patients who suffered from COVID-19 across the severity of the disease. This paper describes the algorithm developed for the estimation of PA from data collected with an inertial measurement unit (IMU) and the preliminary results of the objective evidence of the improvement of activity level over time. © 2022 IEEE.

Greenhouse gas emissions within the exergoenvironmental assessment of a compact combined cooling, heating and power system

Because of the significant public concern regarding climate change (and global warming), greenhouse gas (GHG) emissions have been successfully employed to communicate environmental impacts. This study develops a life cycle assessment of the equipment and energy flows of a combined cooling, heating and power system, expressing the environmental impacts as GHG emissions. Environmental data was used as input to an exergoenvironmental assessment based on the SPECO methodology. The GHG emissions associated with the consumption of natural gas and grid electricity are 0.258 and 0.227 kg CO2-eq/kWh, respectively. The internal combustion engine is responsible for the highest share of GHG emissions (15.95 kg CO2-eq/h), of which 15.80 kg CO2-eq/h is due to the formation of pollutants and the remainder refers to equipment. From the combined analysis of exergoenvironmental parameters, strategies that increase energy use and decrease irreversibilities should focus on the absorber heat exchanger, the steam generator, and heat recovery unit. Some of the recent energy policy responses to the COVID-19 crisis include the deployment of energy solutions such as combined energy systems, and exergoenvironmental assessments can promote the adoption of these more efficient systems.

DIGITAL COMPETENCIES FOR PLA AND PLAC TEACHERS: A PATH WITH NO SHORTCUTS OR RETURNS

The aim of this article is to examine the increase in digital competencies of PLA and PLAc teachers for their performance in the context of virtual teaching. Our interest arises from the challenges that this modality imposes on the classes due to the Sars-CoV-2 virus pandemic. We develop our proposal by reviewing studies of teaching areas in virtual environments and the teaching of foreign languages. Our methodological design considers the configuration of a case study, in a qualitative approach to the data tointerpret our object of study. The results point to how teachers face the pressures about their digital skills to respond to the immediate needs of their contexts. Also, they recognize a great dependence on digital literacy for their professional performance and for the training of their students, offering them opportunities to participate both in educational and social scopes in Portuguese.

Cost analysis of the first wave of the COVID-19 pandemic on human resource management in a Portuguese hospital

Background: The COVID-19 pandemic has brought healthcare systems to the brink of collapse worldwide, imposing relevant economic challenges. Objective: To analyze the costs related to the impact of the first wave of the COVID-19 pandemic on human resource management in a Portuguese hospital. Methodology: Economic, retrospective, and single-center study. This study analyzed the costs of absenteeism, hiring new staff, and overtime work by health professionals (nurses, physicians, operational assistants, and diagnostic and therapeutic technicians) and compared data from March 1 to May 31, 2020 to the same period in 2019 to determine differences in costs. Results: Data from 6,994 health professionals were included. Compared to 2019, an additional 8,817,199.84€ were spent on staff in this trimester (absenteeism: €6,842,284.64;hiring new staff: €363,540.03;overtime work: €1,611,375.17). Conclusion: In the first trimester of the COVID-19 pandemic, the overall costs with health professionals almost tripled, representing almost €9 million more than in the same period in 2019. © 2021, Escola Superior de Enfermagem de Coimbra. All rights reserved.

Effects of E-Business Adoption on Organizational Agility in the COVID-19 Context

The COVID-19 pandemic caused a confinement in world society that had no memory of such an event. This event caused the associations to accelerate the online transaction processes, so the continuity of the companies depended on the adoption of e-business systems, which resulted in greater flexibility and agility in the business. Digital transformation and organizational agility are two concepts present in the current COVID-19 context and the adoption of e-business systems depends on the human knowledge existing in the associations. In this context, we developed a study that aimed to study the effects of adopting e-business systems on business agility. For this, we identified that knowledge management is a basis for companies to implement e-business systems. Thus, we carried out an investigation that, through PLS estimation, found that business agility depends on the adoption of e-business systems in a pandemic context such as the case of COVID-19. In this sense, we present theoretical and practical statements of this study.

PUBLIC PERCEPTION OF COVID-19 IN THE TRIÂNGULO MINEIRO REGION, MINAS GERAIS STATE, BRAZIL: A CROSS-SECTIONAL SURVEY

This was a cross-sectional, anonymous, online survey aimed at assessing the perceptions and basic knowledge of COVID-19, a highly transmissible disease caused by SARS-CoV-2, in a sample population in the Triângulo Mineiro region, Minas Gerais, Brazil. A questionnaire devised by the researchers and distributed through social media was applied between June 16, 2020 and August 21, 2020. The survey consisted of questions about the basic aspects of COVID-19, which included symptoms, risk groups, suspicion of infection, prevention, transmission, and perception regarding social isolation. The average distribution, frequencies, similarities and differences between the responses for the different variables were evaluated. Five hundred twenty valid responses were obtained from participants aged ≥18 years. Most of the respondents showed satisfactory basic knowledge of COVID-19. Moreover, the data showed that the participants scored an average of 87.6%. Sex, age, and socioeconomic vulnerability presented a statistically significant link with knowledge of the disease;women, young participants, and the least socioeconomically vulnerable had the highest scores. This study indicated that the population in the Triângulo Mineiro region able to access social networking platforms were basically well informed regarding COVID-19, although differences were observed depending on the group analyzed. © 2021 Brazilian Society of Parasitology. All rights reserved.

How may teaching contribute to sustainability in a small scale but with wide use?

The use of technology in Education helped teaching plans reach students almost anywhere during the COVID Pandemic and some positive effects regarding the planet sustainability were also reported during this phase. A questionnaire was conducted in order to assess if students felt any resource productive in their learning and would like to keep it, contributing to lesser their ecological footprint. The more advantages to sustainability they recognize, the more educational resources they would like to keep using and the more favorable they are for a hybrid educational regime. © 2021 ACM.

Lab-based Education

Lab-based education plays an important role for students adopting science and technology-based careers. The sudden transition to a distance learning environment due to the COVID-19 pandemic and how teachers have tackled with providing lab-based teaching while trying to improve students' engagement and motivation, is the focus of the presented works. A good diversification of teaching approaches such as PBL, teamwork, gamification or the integration of complementary resources is presented. Additionally, the VISIR+ project is also addressed in the context of a study on Brazil's Educational reality, related to Engineering Education. The VISIR remote lab is also presented as a versatile tool, to be used in several subject areas, other than electronic and electrical circuits. © 2021 Owner/Author.