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BackgroundThe COVID-19 pandemic has brought uncertainties to rheumatology practice, mainly related to the possibility of triggering disease activity after infection in immune mediated rheumatic diseases (IMRD). To date, there are few data in the literature specifically evaluating this issue.ObjectivesEvaluate the disease activity in IMRD patients after 6 months of the infection, compared to pre infection status.MethodsReumaCoV Brasil is a longitudinal study performed at 35 study centers designed to follow-up IMRD patients for 6 months after clinical or laboratorial COVID-19 diagnosis (cases), comparing with patients with IMRD who had not had the infection at the time of inclusion (controls). Demographic data such as age, sex, comorbidities, clinical characteristics, treatment, evolution of COVID-19 and disease activity status were collected using a Research Eletronic Data Capture (REDCap) database on three consecutive visits (inclusion and 6 months). The analysis was carried out on the four diseases with the highest inclusion number in the study: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). In addition to specific disease activity assessment metrics, we used patient's global assessment of disease activity (PGA), ranging from 0 to 10, at all visits, with 0 being no activity and 10 being intense activity. All conclusions were drawn considering the significance level of 5%. This study was registered at the Brazilian Registry of Clinical Trials—REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.ResultsBetween May 2020 and January 2021, 2032 patients were included in the registry, and of these, 1322 patients (721 cases and 601 controls), completed 6 months of follow-up, being 550 SLE (42.0%), 497 RA (37.6%) and 176 SpA (13.3%) and 99 (7.4%) PsA. Most patients were female (82.0%);the median age was 46.7 (13.8). Disease activity at the time of enrollment, according to the PGA, was similar between cases and controls, except for patients with RA and AS, where it was higher in controls. After the follow up time, no worsening of activity was observed in any of the diseases evaluated in the case group (Table 1). Despite this, worsening of disease symptoms after COVID-19 was reported by 23.3%, 24.6%, 25.0% and 25.8% of patients with SLE, RA, AS and PsA respectively, not related with disease activity.ConclusionIn patients with IMRD, no worsening of disease activity was observed after COVID-19 in this cohort of Brazilian patients. Despite this, many patients noticed worsening of symptoms, possibly associated not with the triggering of the activity, but with the so-called long COVID syndrome.Table 1.Comparison of disease activity, according to PGA, comparing disease activity status at inclusion and after 6 months of follow up, in cases and controlsINCLUSIONAFTER 6 MONTHSCasesControlsp-valueCasesControlsp-valueSLE2 (0-4,5)2 (0-4)0,8102 (0-5)2 (0-4)0,172RA3 (1-5)4 (2-6)0.0013 (1-5)3 (1-5,5)0,731AS2 (0-5)4 (1-6)0,0022 (0-5)3,5 (1-6)0,044PsA2 (0-4)2 (0-5)0,8162 (0-5)2 (0-5)0,939*Median and interquatile range;Student t test;CI 95%AcknowledgementsReumaCoV Brasil researchers, Brazilian Society of Rheumatology and National Council for Ccientific and Technological Development.Disclosure of InterestsNone Declared.
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BackgroundSome individuals may have persistent symptoms after COVID-19, a new condition known as long COVID-19. However, these complaints can be misunderstood with disease activity in patients with immune-mediated rheumatic diseases (IMRD), especially fatigue and mental distress.ObjectivesTo evaluate fatigue, depression, anxiety, and stress in IMRD patients after 6 months of COVID-19, compared with IMRD patients without COVID-19.MethodsThe ReumaCoV Brasil is a longitudinal study designed to follow-up IMRD patients for 6 months after COVID-19 diagnosis (cases) compared with IMRD patients no COVID-19 (controls). Clinical data, such as age, sex, comorbidities, as well as disease activity measurements and current treatment regarding IMRD, and COVID-19 outcomes were evaluated in all patients. The FACIT questionnaire (Functional Assessment of Chronic Illness Therapy) and the DASS 21 (Depression, Anxiety and Stress Scale - 21 Items) were applied at 6 months after COVID in both groups.ResultsA total of 606 IMRD patients were included, of whom 322 (53.1%) cases and 284 (46.9%) controls. Most patients were female (85.3%) with mean age 46.1 (13.0) years old. Specific disease activity were similar between cases and controls. There was a significant difference between FACIT scores and 3 domains of DASS-21 comparing cases and controls (Figure 1). The factors associated with FACIT were female gender, diabetes, obesity, no comorbidities, COVID manifestations (skin, joint pain, asthenia, diarrhea, and dyspnea), and chronic oral corticosteroid use. DASS-21 Depression was associated with these same factors. Female gender, COVID manifestations as skin, joint pain, asthenia, cough, dyspnea, and chronic oral corticosteroid use were associated with DASS-21-Anxiety. DASS-21 Stress was associated with female gender, asthenia, diarrhea, dyspnea, cough, chronic oral corticosteroid use, and hospitalization. Table 1 shows the variables that remained in the models after the univariate logistic analysis. A weak correlation between disease activity and FACIT was observed in rheumatoid arthritis (p=0.010;r2 = 0.035) and ankylosing spondylitis patients (p=0.010;r2 = 0.129). No other correlations were observed between the scores results and disease activity (patient's global assessment - PGA), medications or specific IMRD.ConclusionFatigue and mental changes such as depression, anxiety, and stress, occurred more frequently in IMRD patients who had COVID-19 than in those who did not have COVID-19, especially in women, regardless of disease activity score. Fatigue was more related to female gender, diabetes, obesity, and current joint pain. Mental impairment was more associated with severity of COVID-19, including respiratory and non-respiratory symptoms.Figure 1.Comparison between cases and controls of FACIT and DASS-21 depression, anxiety, and stress scoresFACIT (Functional Assessment of Chronic Illness Therapy);DASS-21 (Depression, Anxiety and Stress Scale - 21 Items):Table 1.Final model using binary Logistic Regression analysis to evaluate the preditive factors associated with FACIT and DASS-21 scoresFACIT Score ≤ 37 x score > 37§DASS-21-DEPRESSION Score ≤ 6 (normal/mild) x score > 6 (moderate/severeDASS-21-ANXIETY Score ≤ 5 (normal/mild) x score > 5 (moderate/severe)DASS-21-STRESS Score ≤ 9 (normal/mild) x score > 9 (moderate/severeVariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)Female0.151.83 (1.12-2.98)No comorbidities0.0290.66 (0.46-0.95)Joint pain0.0022.44 (1.39-4.26)Female0.0122.31 (1.20-4.46)Diabetes0.0062.35 (1.28-4.32)Joint pain**0.0012.58 (1.57-4.22)Dyspnea0.0013.61 (2.11-6.19)Dyspnea0.0013.69 (2.09-6.51)Dyspneia0.0012.00 (1.23-3.26)Dyspnea0.0012.82 (1.79-4.44)Oral CE0.0141.55 (1.09-2.21)Joint pain0.0052.20 (1.41-3.43)Oral CE0.0481.41 (1.00-1.99)§Lower scores mean worse fatigue;CE: corticosteroid;OR: odds ratio;CI: confiance intervalAcknowledgementsReumaCoV Brasil researchers, Brazilian Rheumatology Society and National Council for Scientific and Technological Deve opment.Disclosure of InterestsNone Declared.
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Objectives: To assess the impact of COVID-19 on disease activity and severity outcomes in patients with systemic vasculitis. Method(s): The Reuma-CoV Brazil is a longitudinal, multi-stage cohort study, designed to monitor patients with immune-mediated rheumatologic disease (IMRD) during the SARS-CoV-2 pandemic. Systemic vasculitis patients with COVID-19 were compared with those without COVID-19. Vasculitis activity was evaluated by the patient global assessment (PGA) and Birmingham Vasculitis Activity Score 3 (BVAS 3). The prognosis was assessed by the Five-Factor Score (FFS). Result(s): Between May 2020 and January 2021, 53 patients with vasculitis were included and followed for six months, 32 (60.3%) with COVID-19 and 21 (39.6%) in the control group. In total, 79.5% were female with a mean age (SD) of 49 (16.5) years. Both groups were homogeneous regarding sex, age, and comorbidities. Thirty-eight (71.8%) patients had at least one comorbidity. Thirty-two patients were classified as small vessels vasculitis (SVV), 10 as large vessels (LVV) and 11 as vasculitis of variable caliber. There was no difference in PGA, BVAS and FFS when comparing before and after SARSCoV-2 infection (Table 1). In the group of patients with LVV, two had clinical or laboratory worsening post infection. Compared to controls, patients with vasculitis and COVID-19 were at higher risk of intensive care unit (ICU) hospitalization [OR (IC95%) = 7.98 (3.78 - 16.8), p alpha 0.001], mechanical ventilation [OR (IC95%) = 7.45 (3.16 - 17.5), p = alpha0,001] and death [OR (IC95%) = 9.69 (3.87 - 24.3), p alpha 0,001]. Of the 7 patients who died, 40%were using high-dose prednisone (>20 mg/d) and 38.8% were using rituximab. Conclusion(s): In this sample of patients with systemic vasculitis, there was no worsening of disease activity after COVID-19, but there was a higher risk of poor outcomes, possibly related to immunosuppression.
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This study extends the literature on big data applied to tourism by validating the significance of point-of-sale (POS) electronic transactions, which have received little attention within tourism literature, as a reliable and effective alternative to surveys on guests stays at tourist accommodation establishments. Compared with official statistics on occupancy of tourist accommodation establishments, data on POS transactions tend to exhibit greater volatility and a less adverse year-on-year variation during the COVID-19 pandemic in Portugal. Still, both data sources reveal the same underlying trend. POS electronic payments, namely, at lodging establishments, deliver timely data for most municipalities in Portugal, filling in significant data gaps in many low-density areas, where statistical confidentiality is imposed in tourism indicators. This supports POS data's effectiveness to analyse regional inequalities at the municipal level, allowing to gain a clearer understanding of the impacts of COVID-19 in domestic tourism. © The Author(s) 2022.
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Aim/Introduction: 99mTc is used in about 80% of the convencional diagnostic nuclear imaging procedures and represent yearly approximately 30 million examinations/year worldwide a year in diagnostic tests in hospitals, among others by oncology, cardiology and neurology.The production of radiopharmaceuticals for use in Nuclear Medicine has a complex system. It involves carefully calculated production schedules that take into account supply, demand and many logistical operations.The aim of this study is to show how our nuclear medicine department manage the impact of the shortly 99Mo supply chain and consequently, in the 99mTc availability and other radiopharmaceuticals produced in nuclear reactora. Material(s) and Method(s): European nuclear medicine organizations had just pay attention to how the COVID-19 pandemic might affect different parts of the 99Mo supply chain when had to dealt again faced with a new problem;the shortness 99Mo production. There are only five nuclear reactors involved in the production of 99Mo on industrial scale. These aging reactors are subject to unscheduled shutdowns and longer maintenance periods making the 99Mo supply chain vulnerable. In the last few months at our nuclear medicine department we had to reinvent ourselves so as not to completely stop carrying out the previously scheduled exams and therapies. Result(s): The use of technetium generators in Europe represents about 17% - 25% of the worldwide consumption of 99Mo, representing 30,000 exams per day and about 1.1 million doses per month. The main consequences at the IPO-Porto was;Delays in diagnosis/staging, rescheduling exams, change of surgery dates (Sentinel Ganglion and Myocardial Perfusion Cardiacs), weeks of overbooking, delay in follow-up of Glomerular Filtration Rate in pre- or post-transplant patients, postponement of 131I Therapies, Scintigraphy and Whole Body Scintigraphy in patients who were already in hypothyroidism. we had to reinvent the use of 99mTc generators, change exams appointments times, reagroup exams types by defined days and other radiopharmaceutical management tools that were not commonly used. Conclusion(s): Approximately 2/3 of scheduled exams were postponed and we had to deal with weekly and daily stock updates. Our department suggest some measures and procedures that could help with future 99Mo shortages, in order to be ready in future situations and to avoid shortness of production: the creation of a centralized European radiopharmacy system, European policies to encourage long-term investment, homogenization of marketing specifications in the Member States, solid databases of radiopharmaceuticals used/ available in Europe and encouraging cooperation between other countries outside the European Union.
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Aim/Introduction: 99mTc is used in about 80% of the convencional diagnostic nuclear imaging procedures and represent yearly approximately 30 million examinations/year worldwide a year in diagnostic tests in hospitals, among others by oncology, cardiology and neurology.The production of radiopharmaceuticals for use in Nuclear Medicine has a complex system. It involves carefully calculated production schedules that take into account supply, demand and many logistical operations.The aim of this study is to show how our nuclear medicine department manage the impact of the shortly 99Mo supply chain and consequently, in the 99mTc availability and other radiopharmaceuticals produced in nuclear reactora. Material(s) and Method(s): European nuclear medicine organizations had just pay attention to how the COVID-19 pandemic might affect different parts of the 99Mo supply chain when had to dealt again faced with a new problem;the shortness 99Mo production. There are only five nuclear reactors involved in the production of 99Mo on industrial scale. These aging reactors are subject to unscheduled shutdowns and longer maintenance periods making the 99Mo supply chain vulnerable. In the last few months at our nuclear medicine department we had to reinvent ourselves so as not to completely stop carrying out the previously scheduled exams and therapies. Result(s): The use of technetium generators in Europe represents about 17% - 25% of the worldwide consumption of 99Mo, representing 30,000 exams per day and about 1.1 million doses per month. The main consequences at the IPO-Porto was;Delays in diagnosis/staging, rescheduling exams, change of surgery dates (Sentinel Ganglion and Myocardial Perfusion Cardiacs), weeks of overbooking, delay in follow-up of Glomerular Filtration Rate in pre- or post-transplant patients, postponement of 131I Therapies, Scintigraphy and Whole Body Scintigraphy in patients who were already in hypothyroidism. we had to reinvent the use of 99mTc generators, change exams appointments times, reagroup exams types by defined days and other radiopharmaceutical management tools that were not commonly used. Conclusion(s): Approximately 2/3 of scheduled exams were postponed and we had to deal with weekly and daily stock updates. Our department suggest some measures and procedures that could help with future 99Mo shortages, in order to be ready in future situations and to avoid shortness of production: the creation of a centralized European radiopharmacy system, European policies to encourage long-term investment, homogenization of marketing specifications in the Member States, solid databases of radiopharmaceuticals used/ available in Europe and encouraging cooperation between other countries outside the European Union.
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Objective To evaluate the incidence of COVID-19 and its main outcomes in rheumatic disease (RD) patients on hydroxychloroquine (HCQ) compared to household cohabitants (HC).Methods This is a 24-week nationwide prospective multi-centre cohort with a control group without RD and not using HCQ. All participants were monitored through scheduled phone interviews performed by health professionals. Details regarding COVID-19 symptoms, and epidemiological, clinical, and demographic data were recorded on a specific web-based platform. COVID-19 was defined according to the Brazilian Ministry of Health criteria and classified as mild, moderate or severe.Results A total of 9,585 participants, 5,164 (53.9%) RD patients on HCQ and 4,421 (46.1%) HC were enrolled from March 29th, 2020 to September 30th, 2020, according to the eligibility criteria. COVID-19 confirmed cases were higher in RD patients than in cohabitants [728 (14.1%) vs. 427 (9.7%), p<0.001] in a 24-week follow-up. However, there was no significant difference regarding outcomes related to moderate/ severe COVID-19 (7.1% and 7.3%, respectively, p=0.896). After multiple adjustments, risk factors associated with hospitalisation were age over 65 (HR=4.5;95%CI 1.35-15.04, p=0.014) and cardiopathy (HR=2.57;95%CI 1.12-5.91, p=0.026). The final survival analysis demonstrated the probability of dying in 180 days after a COVID-19 diagnosis was significantly higher in patients over 65 years (HR=20.8;95%CI 4.5-96.1) and with 2 or more comorbidities (HR=10.8;95%CI 1.1-107.9 and HR=24.8;95%CI 2.5-249.3, p=0.006, respectively).Conclusion Although RD patients have had a higher COVID-19 incidence than individuals from the same epidemiological background, the COVID-19 severity was related to traditional risk factors, particularly multiple comorbidities and age, and not to underlying RD and HCQ.
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The COVID-19 pandemic period resulted in a global crisis, whether in the economy, personal or professional life. Because of the pandemic, people and institutions had to change the way they did things. Even though people are becoming more aware of the value of knowledge and it is becoming more common in some institutions, knowledge management methods are still not well known in the social sector and as a key tool for institutions in crisis. Considering the beneficial role that knowledge sharing (KS) practices play in organizations, the current study aims to investigate the impact of KS practices in Portuguese private social solidarity institutions in adapting to the COVID-19 pandemic period. To achieve the purpose and considering the exploratory nature of the research, semi-structured interviews were conducted with fifteen professionals from four private social solidarity institutions in northern Portugal. Nvivo processed the interviews. Because COVID-19 is new, there is no research on knowledge sharing in these institutions, so the study can be considered as original. Before and during pandemics, the presence of knowledge sharing practises, such as the integration of new employees, the proactivity of learning, the sharing of new ideas and mistakes, and the sharing relationship between peers and superiors and other institutions, was observed through the interviews. In this study, we discovered that trust, communication, technology, and social networks, as well as the role of leadership in creating an environment conducive to formal and informal sharing, were elements that facilitated knowledge sharing practises, even throughout the pandemics. During the interviews, both technical directors and employees acknowledged the following: the relationship between superiors and employees in decision-making processes;recognition, feedback and incentives from leaders and the presence of formal and informal communication networks. When it came to sharing, which could happen in a formal or informal setting, employees seemed to prefer informal interactions.To summarise, the institutions were able to adjust to the limits imposed by the pandemic, and the basic practises of KS are part of the daily routine of the organisations analysed. © 2022, Academic Conferences and Publishing International Limited. All rights reserved.
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The coronavirus disease-19 pandemic has forced universities worldwide to develop stronger crisis responses in order to support the surrounding communities more effectively. These solutions are based on collaborations between higher education institutions and industries that facilitate knowledge co-creation. Historically, universities have been knowledge-intensive institutions capable of producing additional findings through research. Currently, these organisations' most important contributions to national economies are related to universities' development of fresh knowledge and technical expertise. In parallel, all industries' business environments have become extremely dynamic, which requires companies to focus on new solutions, rapid development and cost efficiency. To cope with these pressures, industries have been forced to search for new partners, so university-industry collaboration (UIC) has become a key resource for managers seeking to promote innovation and technological development. This study explored the relationship between research and innovation based on smart specialisation strategies and UIC, including the roles of university-industry (U-I) joint research and academics' motivations for interacting with industries. Based on data collected from 841 Portuguese and Spanish researchers, the results reveal that smart specialisation policies' effects on UIC are driven by U-I joint research development and university faculty members' motivations for co-operating with industry professionals. The findings indicate that U-I research activities and universities' incentives to collaborate with industries fully convert smart specialisation strategies' effects into higher levels of U-I knowledge transfer. © 2022, Academic Conferences and Publishing International Limited. All rights reserved.
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The COVID-19 pandemic has affected the entire world, causing millions of deaths. In addition to this disease, many countries also periodically face outbreaks of other diseases, such as dengue. Although the two diseases have their specific characteristics, there may be common factors affecting them. Knowing these factors is essential for governments to plan actions to mitigate the impacts of future epidemics. This research aims to analyze data from several dimensions to identify the critical success factors for the fight against dengue and COVID-19. For this, Data Science techniques were applied to data from 645 cities in the State of São Paulo, Brazil. The results provide important information that may explain why some locations have been more successful than others in fighting those diseases, as well as identifying the common factors that may also impact other diseases. © 2022 IEEE.
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Background: The bortezomib, lenalidomide, and dexamethasone (VRd) regimen is a standard of care for newly diagnosed multiple myeloma (NDMM). Belantamab mafodotin (belamaf) is a B-cell maturation antigen-binding antibody-drug conjugate that eliminates myeloma cells by a multimodal mechanism: direct cell kill and anti-myeloma tumor immune response. Belamaf has demonstrated deep and durable responses as a monotherapy in the DREAMM-2 study of patients (pts) with relapsed/refractory multiple myeloma (RRMM). Preclinical evidence of belamaf in combination with bortezomib or lenalidomide suggests enhanced anti-myeloma activity, providing rationale for this treatment combination. Aims: To evaluate the safety and tolerability of this combination in adult pts with transplant-ineligible (TI) NDMM and establish the recommended Phase III dose. Methods: DREAMM-9 (NCT04091126) is an ongoing Phase I, open-label, randomized study of belamaf + VRd. The belamaf dose cohorts currently being evaluated are Cohort 1 (1.9 mg/kg Q3/4W), Cohort 2 (1.4 mg/kg Q6/8W), Cohort 3 (1.9 mg/kg Q6/8W), Cohort 4 (1.0 mg/kg Q3/4W), and Cohort 5 (1.4 mg/kg Q3/4W). Belamaf is given with VRd Q3W until Cycle 8, and with Rd Q4W thereafter. After evaluation of safety data for Cohort 1, Cohorts 2-5 were opened in parallel and enrolled pts were randomized 1:1:1:1. Primary endpoint is safety. Secondary endpoints include efficacy, tolerability, and pharmacokinetics (PK). Results: As of data cutoff (07 Dec 2021), 64 pts were analyzed across all cohorts. Median age (range) was 73.0 (51- 88) years, 55% were male, 80% were white, 8% had extramedullary disease, 59% were International Staging System stage II or III, 20% had amp1q, and 17% had high-risk cytogenetics (≥1 of: t(4;14), t(14;16), del17p). The median duration of follow-up varied: Cohort 1 (17.4 months [mo]), Cohort 2 (5.9 mo), Cohort 3 (6.1 mo), Cohort 4 (4.7 mo), Cohort 5 (5.8 mo). Median number of belamaf cycles were: Cohort 1 (6), Cohort 2 (3), Cohort 3 (3.5), Cohort 4 (4.5), and Cohort 5 (5). Most common adverse events (AEs) across cohorts included thrombocytopenia (49%), constipation (43%), diarrhea (32%), and peripheral sensory neuropathy (30%). AEs related to study treatment were experienced by 61 (97%) pts. Belamaf-related grade 3/4 AEs occurred in 24 (38%) pts. Belamaf dose reductions occurred in 11 (18%) pts, with dose delays in 10 (16%) pts. Three pts experienced a fatal severe AE (unrelated to study treatment);2 due to COVID-19 infection, 1 due to pancreatic adenocarcinoma. Early deep responses were observed;67-92% pts achieved ≥very good partial response (VGPR) (Table), with median time to VGPR of 2.1-2.9 months across cohorts. Of pts with ≥VGPR, 17 were minimal residual disease (MRD) negative, 10 in Cohort 1. As of data cutoff, 8-75% of pts achieved best response of complete response (CR) or stringent CR (sCR). Grade 3 corneal exam findings were reported in 25-58% of pts;grade 3 visual acuity changes were reported in 21-75% of pts. No grade 4 corneal exam findings or visual acuity changes were reported in pts receiving belamaf Q6/8W, compared with 0-17% and 0-8%, respectively, in the Q3/4W cohorts. Belamaf PK profile was similar to that in pts with RRMM, accounting for baseline characteristics. Image: Summary/Conclusion: Belamaf + VRd demonstrated high response rates in pts with TI NDMM, with a high rate of MRD negativity indicating deep responses. No new safety signals were observed relative to DREAMM-2. Study is ongoing to evaluate the safety and efficacy of variable dose intensities of belamaf in combination with VRd.
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Background: Recognized as an entity in the 2016 WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues, Pediatric-Type Follicular Lymphoma (PTFL) is a rare nodular follicular lymphoma that affects primarily children and young adults. The clinical presentation is characterized by the sudden appearance of an isolated lymphadenopathy, with a predilection for the head and neck region, without systemic symptoms. The incidence is higher in men. It has an excellent prognosis with the excision of the affected ganglion. By definition, diagnosis is histological, immunocytochemical and molecular. There are no known risk factors or any described association with immunodeficiency or viral infections. Aims: We report two clinical cases. Methods: Case 1 - a previously healthy 18-year-old boy with an isolated, non-painful, cervical lymphadenopathy of approximately 20 mm, which was incidentally found. Case 2 - a 13-year-old boy without relevant personal history, who, after the second dose of vaccination against COVID-19, developed multiple adenomegalies that spontaneously regressed. However, one month later, a right submandibular adenomegaly appeared. It was analysed by ultrasound and was described as suspicious. In both cases, a fine-needle lymph node biopsy was performed for cytological diagnosis and material was sent for immunophenotyping by flow cytometry and molecular cytogenetics by FISH. Results: Immunophenotyping suggested a large-cell B-lymphoma with a phenotype compatible with Burkitt's Lymphoma (BL). In the cytology of both cases, the population observed was more consistent with diffuse large B cell lymphoma (DLBCL) or possibly high-grade follicular lymphoma (FL). In the FISH study, no rearrangements in the MYC, BCL2, BCL6 or IRF4 genes were detected in the samples of the two cases. The lymphadenopathies were excised with a probable diagnosis of PTFL or DLBCL. Histological examination confirmed the PTFL diagnosis. Summary/Conclusion: We did not find in the literature any reference to clear causal relationship between vaccination against COVID-19 and the onset of lymphoproliferative diseases. The cytological/immunophenotypic/molecular approach of this entity in both cases seems to define a characteristic pattern, which may eventually allow, in a first approach, to suspect this diagnosis. More extensive studies will be needed to establish the role of these methodologies in the diagnosis of this pathology.
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Keywords: Core Muscles;Functional Capacity;Peak Cough Flow;Hospitalized Patients;Case Report Introduction The "core" has been used to refer a three-dimensional space, the lumbopelvic-hip complex, which involves deeper muscles, such as the internal oblique, transverses abdominals, transversospinalis (multifidus, rotators, semispinalis), quadratus lumborum, and psoas major and minor, and superficial muscles, such as the rectus abdominis, external oblique, erector spinae (iliocostalis, spinalis, longissimus) latissimus dorsi, gluteus maximus and medius, hamstrings, and rectus femoris [1, 2]. At the beginning of the session HR, respiratory rate (RR), SpO2, Blood pressure (BP), dyspnea (using the MBS) was monitored for all patients and for those who have diabetes was also monitored glucose levels. Personal history (PH) of SARS-CoV2 pneumonia in March 2021 (hospitalized for 1 month in the Intensive Care Unit (ICU) using mechanically invasive ventilation), type 2 diabetes mellitus (DM) treated with premixed insulin, polyneuropathy for more than 10 years, arterial hypertension (AH), chronic kidney disease (CKD), coronary heart disease (placement stent in 2010), dyslipidaemia, chronic gastritis, lithiasis and renal cysts.
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Introdução: A pandemia pelo SARS-CoV-2 (COVID-19) vem desafiando a comunidade científica e os serviços de saúde, superando mais de 4 milhões de mortos no mundo. A idade avançada e a presença de comorbidades cardiovasculares são relacionadas a maior mortalidade em relação a população geral, podendo atingir 15% dos casos infectados. Pacientes onco-hematológicos, devido a doença de base e ao seu tratamento, possuem comprometimento do sistema imune por período de tempo prolongado, o que os torna mais suceptiveis a infecções. A infecção pelo COVID-19 nesse grupo de pacientes tem demonstrado piores desfechos. Nesta série de casos avaliamos os desfechos de pacientes portadores de doenças linfoproliferativas diagnosticados com COVID-19 de Fevereiro de 2020 a Agosto de 2021 em duas instituições de São Paulo. Objetivo: Descrever os desfechos de pacientes com COVID-19 em pacientes com doenças linfoproliferativas. Métodos: Estudo multicêntrico, observacional e retrospectivo. Os dados foram obtidos através do prontuário eletrônico. Os critérios de inclusão foram diagnóstico de doença linfoproliferativa e infecção por COVID-19 confirmada através de teste RT-PCR em pacientes sintomáticos realizados nos centros participantes. Resultados: Em um tempo mediano de seguimento de 399 dias foram incluídos 41 pacientes com mediana de idade de 59 anos (DP 16,8). A maior parte dos pacientes eram portadores de linfoma difuso de grandes células B (LDGCB), representando 24% da amostra, seguidos por linfoma folicular (17%) e linfoma de Hodgkin (17%). Em relação as comorbidades, 9 (22%) pacientes diabéticos, 17 (41%) hipertensos e 9 (22%) obesos. A taxa de admissão hospitalar foi de 75% e, mais da metade dos pacientes foram admitidos em unidade de terapia intensiva (UTI). Metade dos pacientes necessitaram de suporte ventilatório sendo, 15% dos pacientes com ventilação mecânica e outros 35% com cateter nasal de oxigênio. A prevalência de eventos trombóticos foi de 17%. Em relação ao tratamento quimioterápico 85% dos pacientes dessa amostra estava em vigência de tratamento quimioterápico no momento da infecção pelo Covid-19, no entando na análise univariada não houve diferença estataisticamente significativa de mortalidade entre o grupo de pacientes que estavam em tratamento quimioterápico e os que não estavam (HR 1,18;IC 0,26-5,33;p = 0,83). A taxa de sobrevida global em 100 dias foi de 66% (IC95 53-83%). Discussão: A mortalidade de pacientes hematológicos com infecção pelo COVID-19 é superior a população geral e foi estimada em 34% dos casos na metanalise publicada por Vijenthira et all. Em um estudo multicêntrico realizado na Alemanha a mortalidade em pacientes hospitalizados sem antecedente de neoplasias foi em torno de 22%. A ausência do aumento da mortalidade em pacientes com exposição recente a tratamento quimio-imunoterápico é condizente com dados apresentados em literatura, no entando não há estudos prospectivos publicados que exaltem esses achados. A idade superior a 60 anos foi o fator de maior impacto na mortalidade dos pacientes com doenças onco-hematológicos de acordo dados de literatura e em nosso estudo esse dado não foi estatisticamente significante possivelmente devido a uma mediana de idade menor que 60 anos da amostra. É importante ressaltar que esse é um estudo retrospectivo, porém que reafirma o pior desfecho clínico dos pacientes com doença onco-hematológicos com infecção pelo COVID-19.
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Introdução: A anemia aplástica adquirida (AAA) é uma condição rara, com alta morbidade. Em 70-80% dos casos é idiopática e ocorre por destruição das células tronco-hematopoiéticas por fenômeno autoimune. Com as terapias imunossupressoras e o transplante de medula óssea (TMO), a AAA teve excelentes resultados com taxas de sobrevida de 80% em 10 anos. Pode estar relacionada à outros mecanismos, como exposição a agentes tóxicos e infecções virais, especialmente vírus Epstein Barr, vírus de hepatite, HIV e parvovírus B19. A recente pandemia pelo vírus SARS-Cov-2 foi relacionada ao desenvolvimento de doenças autoimunes, corroborando a associação entre infecção viral e desbalanço imune. Apresentamos o caso de uma paciente, previamente hígida, que 60 dias após infecção pelo Sars-Cov-2 iniciou plaquetopenia, evoluindo para pancitopenia. Relato de caso: Paciente feminina, 29 anos, infecção pelo Sars-Cov-2 em agosto/20, quadro leve, sem necessidade de internação hospitalar. Em outubro/2020, apresentou equimoses persistentes, procurou atendimento médico, com os exames: Hb 11,5 g/dL;neutrófilos 1054/mm3 e 130.000/mm3 plaquetas, com conduta expectante nesse momento. Em janeiro/2021, com piora das equimoses e fadiga, retornou em atendimento com Hb 9,8 g/dL, neutrófilos 1278/mm3 e plaquetas 45.000/mm3. Iniciada investigação com sorologias para hepatites virais, HIV, sífilis, provas reumatológicas, vitamina B12, ácido fólico, função renal, hepática, tireoidiana e pesquisa de clone HPN, todos dentro da normalidade. Como tratamento, foi iniciado prednisona 1 mg/kg/dia e agendado retorno ambulatorial. Antes do previsto, procurou novamente atendimento por gengivorragia com plaquetas de 19.000/mm3, Hb 9,8 g/dL, neutrófilos 900/mm3 e Reticulócitos 46,536/mm3. Submetida a avaliação medular, com biópsia evidenciando hipocelularidade (cerca de 30%) com hipoplasia de todas as séries. O estudo imunofenotípico não mostrou proliferação de células imaturas, anômalas ou displásicas, cariótipo XX, FISH para síndrome mielodisplásica e DEB test negativos. Como pesquisas virais, citomegalovírus e parvovírus B19, além de RNA do vírus SARS-Cov-2 na extração de DNA em medula óssea, resultaram todos negativos. O diagnóstico de AAA foi estabelecido, evoluindo com piora progressiva da pancitopenia e necessidade de suporte transfusional recorrente. Apesar de candidata a transplante alogênico de medula óssea, a paciente não tinha irmãos e então, iniciado tratamento timoglobulina de coelho 3,5 mg/kg/dia por 5 dias, ciclosporina 10 mg/kg/dia e eltrombopag 150 mg/dia, além eritropoetina 40.000 UI/semana. O último exame de 29/06/2021 mostra resposta parcial a terapia estabelecida com Hb 11,7 g/dL, neutrófilos 1889/mm3 e 90.000/mm3 plaquetas. Conclusão: A AAA é uma condição que necessita de rápido diagnóstico e tratamento. O desbalanço imunológico, especialmente a hiperativação de linfócitos T citotóxicos CD8+, desencadeado por infecção viral pode ser gatilho para a condição em predispostos. Outros relatos semelhantes corroboram a associação temporal entre a infecção do SARS-Cov-2 e AAA. Sendo assim, consideramos importante compartilhar essa informação no meio científico.
ABSTRACT
This chapter aims to assess the actual contribution of fuel hedging in aviation to enhance the predictability of business costs, reduce exposure to oil price volatility, and drive positive impacts on company’s value. Recent literature on this topic was reviewed, including company reports and assessments covering major airlines, globally, encompassing the drivers, challenges, and outcomes of fuel hedging initiatives throughout the last two decades. Precise shreds of evidence could not be found correlating fuel hedging with sustained benefits to airlines concerning cost predictability, competitiveness positioning, or company value. With oil price volatility proving challenging to forecast, fuel hedging emerged more as a game, often rooted in equivocal beliefs, anecdotal tales of success, and executive management short term interests. Betting on rising oil prices often caused airlines to get heavily hit when oil prices plunged against unhedged competitors. Several airlines ended up ditching their fuel hedge programs altogether, while others have significantly reduced the hedged percentage of their needs. A contemporary understanding of the crucial factors at play in fuel hedging is presented in the final conclusions, pointing to global airlines’ general frustration. Yet, stakes remain high, with jetfuel market worth nearly USD0.3 trillion/year. Assuming that competition is not rendered to a moot-point in the post-COVID-19 aviation landscape, fuel hedging combined with ever more sophisticated predictive oil price modeling will likely remain enticing aviation stakeholders for the foreseeable future. © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
This study aims to understand how the COVID-19 pandemic affected the hotel sector and to identify the current traveler demands. The traveler’s reviews were analyzed based on sentiment analysis and a guest satisfaction model was also proposed, demonstrating a data mining approach within tourism and hospitality research. Given its popularity, TripAdvisor was the chosen platform for collection of hotel reviews in London and Paris. Text data were extracted from reviews made in two time periods, before and during the COVID-19 pandemic. The sentiment and specific aspects highlighted by travelers were compared between each period. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.