ANTIBODY RESPONSE TO COVID-19 VACCINATION AMONG HEMODIALYSIS PATIENTS: A CASE-CONTROL STUDY

BACKGROUND AND AIMS: SARS-CoV-2 represents a challenge for hemodialysis (HD) patients due to their diminished immune defenses in the setting of kidney disease, multiple comorbidities and older age. COVID-19 vaccines have brought hope but these patients' reduced response to immunization with the hepatitis B and influenza vaccination raised concerns about a lower efficacy of the new vaccines. This study aimed at quantifying IgG in sequential samples from HD patients and compare its titers with those of a non-HD healthy population, after vaccination. METHOD: We compared IgG titers using Abbott SARS-CoV-2 IgG II Quantitative Antibody Assay on the Alinity i system (Abbott Diagnostics, Chicago, US), 3-4 months after the Pfizer-BioNTech COVID-19 vaccine in 54 HD patients and 59 non-HD controls. This method is a two-step chemiluminescent microparticle immunoassay used for the quantitative determination of IgG antibodies to the receptor binding domain of the S1 subunit of the spike protein of SARS-CoV-2. HD patients performed their treatments at the HD unit of Felgueiras, a municipality in the district of Porto, Portugal, and were vaccinated in January/February 2021. The controls were healthcare workers from the hospital of Gaia. All HD patients received 2 vaccine doses even if they had previously had COVID-19 (N = 8) whereas controls only received 1 dose of the vaccine if they had been infected (N = 28). For 48 of the HD patients, we reassessed IgG levels 8 months after vaccination and compared it with the first measurements. Statistical analysis used SPSS ® . Parametric variables were described with mean ± standard deviation and compared using independent and paired-samples t-tests. Non parametric variables were described with median ± interquartile range (IQR) and compared using Mann-Whitney U and Wilcoxon tests. RESULTS: HD patients were older (67.6 ± 15.8 years of age) when compared to the healthy controls (42.4 ± 12.1 years of age). Only 1 HD patient had IgG below the positive cutoff after vaccination, all others seroconverted. Median values were significantly lower among HD patients compared to the controls (973 IQR 387-3306 versus 4809 IQR 2557-7746 AU/mL;p < 0.001). This difference remained significant even if those who had COVID-19 were removed from the analysis (p < 0.001). Those who had had COVID-19 before vaccination, showed significantly increased IgG levels compared to those who had not (6956 IQR 4810-13 101 versus 1520 IQR 554-3950 AU/mL;p < 0.001), a similar finding among HD and non-HD individuals. In HD patients for whom this data was available, IgG levels decayed from month 4 to month 8 (973 IQR 387-3306 versus 382 IQR 168-2071 AU/mL;p < 0.001). CONCLUSION: HD patients seem to have an impaired immune response after the COVID-19 vaccines, similar to what happens with vaccines against other viruses. After the Pfizer-BioNTech COVID-19 vaccine 98% of the patients seroconverted. Although they were older which may have played a role, a limitation to the analysis, IgG titers were lower in HD-patients than in the control group. Antibodies declined over the next months. This decline may be associated with loss of neutralizing antibodies, cellular responses to SARS-CoV-2 and risk of reinfection.

First line aromatase inhibitor (AI) + pa l bocicl i b with randomized switch to fulvestrant + palbociclib upon detection of circulating ESR1 mutation in HR+ HER2-metastatic breast cancer patients: Global safety results of PADA-1, a UCBG-GINECO phase III trial

Background: Aromatase inhibitors (AI) in combination with a CDK 4/6 inhibitor have been established as the standard first line treatment of non AI-resistant hormone receptor-positive (HR+) HER2-metastatic breast cancer (mBC) patients (pts). ESR1 mutations are known drivers of resistance to AIs in the metastatic setting but their actionability remains unknown. The phase 3 PADA-1 trial aimed both at refining the global safety of palbociclib combined to any AI as first line treatment of HR+ HER2-mBC pts, and at evaluating the clinical benefit associated with a switch to fulvestrant-palbociclib upon detection of a rising ESR1 mutation in blood (bESR1mut). Methods: PADA-1 (NCT03079011), a multicenter, randomized, open-label, phase 3 trial, enrolled HR+ HER2-mBC pts with no prior therapy for mBC, in the absence of AI-resistance. In the first step, pts received a combination of any AI and palbociclib at standard recommended doses and underwent centralized bESR1mut screening every two months. In the second step, bESR1mut+ pts with no S clinical/imaging concomitant disease progression were randomized between continuing the same therapy (standard arm) or switching to fulvestrant-palbociclib (experimental arm). The third step consisted in an optional cross-over after tumor progression for patients randomized in the standard arm. PADA-1 co-primary endpoints were global safety of the combination of palbociclib + endocrine therapy in the whole population of patients, throughout the study, with focus on hematological toxicities;and PFS in the second step. We present here the results of the global safety co-primary endpoint. Results: From 3/2017 to 01/2019, 1017 pts were accrued in 83 sites. As per 05/2021, 272 pts were still in step 1, 35 in step 2, and 8 in step 3. The overall follow-up was 33.7 months. 232 pts have deceased. 333 SAEs have been reported, including 21 grade 5, 35 grade 4, 183 grade 3, 53 grade 2, 26 grade 1 and 15 unknown grade. Among the grade 5 cases, 2 have been declared as potentially related to the underlying treatment (Death of unknown cause, pulmonary embolism). No pt died of SARS-CoV2 infection. The main hematological toxicities encountered, as well as selected non-hematological events are described in Table 1. Permanent discontinuation of the treatment due to toxicity occurred in 39 pts/1017 (3.8%). Palbociclib dose decreases occurred in 419 (41.2%) pts. Conclusion: By the number of included patients, PADA-1 is the largest prospective trial with 1st line AI and palbociclib. Data confirm the favorable safety profile of palbociclib when combined to any AI +/-switch to fulvestrant. Hematological toxicity appears limited and is mostly restricted to non-clinically significant neutropenia. Permanent discontinuation was exceptional. Detailed per-step analyses will be presented.

Psychological Wellbeing and Associated Factors Among Ethnic Minorities During the COVID-19 Pandemic.

This study assessed the psychological wellbeing and its associated factors amongst ethnic minorities during the coronavirus disease 2019 (COVID-19) pandemic. A total of 310 Hong Kong South Asians aged 41.3 (SD 13.7) years completed an anonymous online survey between July 2020 and February 2021. The results showed an overall moderate level of stress and high levels of depression, anxiety and post-traumatic stress disorder (PTSD) symptoms amongst South Asian minorities. Multivariable regression analyses suggested that being single/divorced, following Hinduism or other non-Muslim religions, having lower perceived knowledge of COVID-19 and having worried about losing job were significant predictors of higher levels of depression, anxiety and/or stress; additionally, being male, having a low monthly household income, having worried about losing job and healthcare collapse were significant predictors of a higher level of PTSD symptoms. The findings suggest an urgent need to alleviate the psychological impacts of the COVID-19 pandemic on ethnic minorities, specifically for those most vulnerable to these impacts.

A review of the prevalence, associated factors and interventions of psychological symptoms among cancer patients in the Chinese Mainland during the COVID-19 pandemic

The novel coronavirus disease 2019 (COVID-19) has placed tremendous pressure on public health systems across the world. Compared with the healthy population, cancer patients are more prone to developing psychological problems, including depression and anxiety, because of worries about cancer recurrence, cancer symptoms, treatment-related discomfort, a lack of social interaction and the impact on their financial well-being. This paper aimed to identify existing evidence on psychological symptoms and their associated factors among cancer patients in the Chinese Mainland during the COVID-19 pandemic, and on interventions to effectively manage these symptoms. Articles related to the prevalence, the risk factors and interventions of psychological symptoms among cancer patients in the Chinese Mainland during COVID-19 published between December 2019 and August 2020 were searched in two English (PubMed and Embase) and two Chinese (CNKI and Wan Fang Data) databases. A total of 180 studies were identified, and 18 studies were included in the review after removing duplicates and screening for relevancy. The results suggest that patients with cancer in the Chinese Mainland have suffered psychological pressure during COVID-19, with a high prevalence of psychological distress, depression and anxiety reported across most of the reviewed studies. Pandemic-related factors such as treatment discontinuation and worry about being infected are associated with these symptoms. Nurses may help to relieve these symptoms by identifying stressors, providing relevant information through mass and social media and referring patients to specialists for psychological support. However, evidence about treatments and interventions for these symptoms is limited, and additional research is warranted to identify effective interventions to promote resilience in this patient population.

Face-to-Face Versus Remote: Effects of an Intervention in Reading Fluency During COVID-19 Pandemic

Fluency is a central skill for successful reading. Research has provided evidence that systematic reading fluency interventions can be effective. However, research is scarce on the effects of interventions delivered remotely versus face-to-face. This study investigated the efficacy of a systematic and standardized intervention for promoting reading fluency in third-grade students (N = 207) during the COVID-19 pandemic. The study had a pretest, posttest, and follow-up design, with two intervention groups (remote vs face-to-face) and a control group. The intervention groups experienced 20 intervention sessions (2 sessions per week), each lasting approximately 50 min. Word reading accuracy, text reading accuracy, and fluency were measured in the three rounds of assessment. In both intervention groups, all measures of reading showed gains from pretest to posttest. The results also suggested that the efficacy of the intervention was similar in the remote and face-to-face modalities. These findings highlight the relevance of systematic interventions in increasing reading fluency and support the use of remote interventions as an adequate alternative to face-to-face interventions.

A review of the prevalence, associated factors and interventions of psychological symptoms among cancer patients in the Chinese Mainland during the COVID-19 pandemic.

The novel coronavirus disease 2019 (COVID-19) has placed tremendous pressure on public health systems across the world. Compared with the healthy population, cancer patients are more prone to developing psychological problems, including depression and anxiety, because of worries about cancer recurrence, cancer symptoms, treatment-related discomfort, a lack of social interaction and the impact on their financial well-being. This paper aimed to identify existing evidence on psychological symptoms and their associated factors among cancer patients in the Chinese Mainland during the COVID-19 pandemic, and on interventions to effectively manage these symptoms. Articles related to the prevalence, the risk factors and interventions of psychological symptoms among cancer patients in the Chinese Mainland during COVID-19 published between December 2019 and August 2020 were searched in two English (PubMed and Embase) and two Chinese (CNKI and Wan Fang Data) databases. A total of 180 studies were identified, and 18 studies were included in the review after removing duplicates and screening for relevancy. The results suggest that patients with cancer in the Chinese Mainland have suffered psychological pressure during COVID-19, with a high prevalence of psychological distress, depression and anxiety reported across most of the reviewed studies. Pandemic-related factors such as treatment discontinuation and worry about being infected are associated with these symptoms. Nurses may help to relieve these symptoms by identifying stressors, providing relevant information through mass and social media and referring patients to specialists for psychological support. However, evidence about treatments and interventions for these symptoms is limited, and additional research is warranted to identify effective interventions to promote resilience in this patient population.

Aeroallergen immunotherapy during covid-19 pandemic

Background: Subcutaneous immunotherapy with aeroallergen (SCITA) was stopped in some departments during the lock-down period due to the COVID-19 pandemic. Objectives: To evaluate the impact of SCITA interruption on symptoms, the need for control medication, the quality of life, and the expectations and degree of safety / fear of patients on returning to the hospi-tal. Methods: Self-completion of an anonymous survey for patients over 12 years in the first 5 weeks of SCITA restart. CARAT was used as an instrument to assess rhinitis and asthma control. Results: 77 patients (90% adults, 68% women) were included, all with rhinitis and 40% with asthma. The average time interval between the last administration and the restart of SCITA was 13 ± 2.48 weeks. Seven percent of patients were seen in an emergency / unscheduled appointment due to the exacerbation of respiratory symptoms and only 1 had COVID-19. CARAT-Total scores showed control of rhinitis and asthma, respectively, in 35% and 66% patients. The proportion of uncontrolled patients rised with the increase in the SCITA interruption period (IP). The majority (> 90%) of patients reported no significant impact on their quality of life and maintained the usual control medication (48%), expressed concern about losing the benefits of SCITA with its interruption (62%) and reported feeling safer in the vaccination offices compared to the hospital building or waiting room. Conclusions: An increase in the frequency of uncontrolled patients with an increase in IP was observed. For most patients, the IP did not have a significant impact on quality of life. The frequency of patients who needed to be observed in an emergency / unscheduled appointment was low and only 1 reported having had COVID-19. The perception of safety in the vaccination room is higher than in the hospital’s common spaces. © 2021 Sociedade Portuguesa de Alergologia e Imunologia Clínica. Published by Publicações Ciência & Vida.

Covid-19 at the hemodialysis unit of felgueiras, North of Portugal

BACKGROUND AND AIMS: SARS-CoV-2 represents a challenge for hemodialysis (HD) patients due to their multiple comorbidities, disturbed immune defenses in the setting of kidney disease and increased age. Furthermore, sharing collective spaces during HD sessions increases the risk of contamination. In March 2020, the first COVID-19 cases in Portugal occurred in Felgueiras, a municipality belonging to the district of Porto. The HD unit that serves this population has 69 in-center patients and, from March 2020 until January 2021, has had 14 COVID-19 cases. We describe our experience concerning patient management and their clinical characteristics. METHOD: Clinical and laboratory data were collected. We aimed at assessing the impact of the infection in hemoglobin, alanine transaminase, several electrolytes-potassium, phosphorus, sodium and calcium-as well as the normalized protein catabolic rate (nPCR) comparing results from the month before infection with those of the month after cure. Statistical analysis used SPSS® and variables were compared using paired-samples t-test. RESULTS: We used a dedicated room and staff for COVID-19 patients, disinfection protocols and specific routes. Transportation was done with a maximum of 3 patients in a 9-seater vehicle, all patients used masks, practiced social distancing, were asked for symptoms and had their temperature measured on each HD session. SARS-CoV-2 infection was established by reverse transcription polymerase chain reaction on nasal and oropharyngeal swabs. Of the 14 cases, 3 occurred in March, 5 from October until Christmas and 6 from then onwards, accounting for approximately 20% of the unit's patients. Of these, 2 were asymptomatic, 6 had predominantly respiratory symptoms, 1 had fever and 1 had gastrointestinal symptoms. Three were hospitalized, 2 died due to COVID-19 and 1 died 1 month after cure due to advanced cancer. Mean age of these patients was 70±13.2;5 were females and 6 had diabetic nephropathy. Only 7 patients had post-COVID-19 results for comparison. The mean hemoglobin value before COVID-19 was 10.5±1.7g/dL and did not change significantly after COVID-19. Although phosphorous dropped from a mean 3.8±0.9mg/dL to 3.2±1.3mg/dL, this difference did not reach significance (p=0.43). All other electrolytes remained stable. nPCR dropped from 1.23±0.47 to 0.95±0.37 although not a significant difference (p=0.24). Five patients were tested for IgG/IgM antibodies against SARS-CoV-2 one month after cure using Elecsys® qualitative immunoassay and 4 tested positive. CONCLUSION: COVID-19 is a problem for HD patients where the percent of cases is larger than in the general population. Our 3 first cases and the 4 last cases shared the same HD shift and occurred in the same period confirming that, despite all protective measures, sharing the facilities in close proximity is a risk factor. Respiratory symptoms predominated but were only severe requiring hospital admission in 3 patients. Mortality represented 14% and the 2 patients whose death was attributable to COVID-19 had an increased burden of comorbidities and were old. Seroconversion was high 1 month after the disease. The only patient who tested negative for antibodies had been asymptomatic raising doubts about whether there could have been false test results or an undetectable immune response.

CITIES AND RIGHTS CRISIS: THE PROPOSALS PRESENTED BY THE CHAMBER OF DEPUTIES DURING THE PANDEMIC

The article aims to understand the proposals of the Chamber of Deputies during the Covid-19 pandemic on urban issues. It analyses the legislative proposals presented by federal deputies on the theme of cities during the year 2020. In an exploratory research, it seeks to understand the main issues and proposals discussed on urban mobility, transport, housing, including the bills that sought to establish new rules for urban rents, evictions and housing finance. Finally, it shows the panorama of the legal norms approved and the vetoes of the executive authority, pointing paths to understand the role of the Chamber of Deputies in the legislative production related to urban law.

A Review of Psychological Issues among Patients and Healthcare Staff during Two Major Coronavirus Disease Outbreaks in China: Contributory Factors and Management Strategies

Outbreaks of severe acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19) have affected populations worldwide. Our literature review summarises the studies reporting psychological issues among healthcare staff and infected patients in mainland China, Hong Kong, and Taiwan during these two outbreaks and the potential strategies for addressing these issues. Our review shows that patients and healthcare staff presented similar psychological symptoms, including anxiety, fear, distress, and depression, which may lead to stress-related complications such as insomnia. In patients, these psychological impairments can be contributed to by being quarantined, perceptions of threats to life, and uncertainty about health status. Quarantine is also a factor for distress among healthcare staff, together with their heavy workload, the fear that they and their families would become infected, witnessing their patients"poor and deteriorating conditions, and the requirement to wear protective gear. Strategies that are needed to address these factors include providing counselling services, implementing mindfulness-based therapies and optimism interventions, and providing telecommunication facilities for patients to communicate with their families. Healthcare staff should also be provided with these services, together with appropriate and flexible work shift arrangements and morale boosting. These strategies would improve not only the mental well-being of patients and healthcare staff, but also the self-efficacy and competence of the staff to provide quality healthcare services.

Feelings of the nursing team in the face of COVID-19 in the care of the first patients: descriptive study

Objectives: to analyze the feelings and conflicts experienced by nursing professionals in the care of patients with COVID-19;to analyze the implementation of nursing care for the first patients with COVID-19 in an intensive care unit in the city of Rio de Janeiro. Method: qualitative, descriptive and exploratory research. Participants were 71 professionals from the nursing team who develop work activities in the fight against COVID-19 in an intensive care unit in the city of Rio de Janeiro, through online collection. Descriptive statistics and thematic content analysis were used for the analyses. Results: the content analysis revealed feelings in the face of the unknown virus, fear of getting infected, fear of losing one’s life and care aspects in the face of the COVID-19 phenomenon. Conclusion: nursing presented feelings and conflicts, such as insecurity and fear. The group built knowledge and skills to handle the realization of this care in the pandemic, including creative aspects and collective construction. Descriptors: Coronavirus Infections;Nursing Care;Nursing Team. © 2022 Online Brazilian Journal of Nursing