Public-Private Partnerships with No Contractual Base Case: Adjusting for the Impacts of Covid-19

The purpose of this article is to discuss a method for compensating a private concession-aire for cash flow losses related to Covid-19 suffered in 2020 and 2021. The analysis is based on a public-private partnership (PPP) set up to exploit surface parking lots, signed between a Portuguese municipality and a private corporation. The contract has no financial base case. The article concludes that a base case is not an obstacle to calculate this type of compensation, that the previous performance of the contractor is a reasonable basis to estimate losses and the forecasts extending to 2026 are a good schema with which to estimate the extension of the concession period claimed by the Petitioner. The arbitration court deciding the corporation's claim has valid reasons for an equitable decision. © 2023, Lexxion Verlagsgesellschaft mbH. All rights reserved.

COVID-19 WAS NOT TRIGGER FOR RHEUMATIC DISEASE ACTIVITY AFTER 6 MONTHS FOLLOW-UP: RESULTS FROM REUMACOV BRASIL REGISTER

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.

Deaths by COVID-19 in a hospital from a city from Legal Amazon region: what lessons could be learned?

Objective: Describe the epidemiology of COVID-19 deaths within a hospital in the Amazon region in a period of 64 days, which corresponds to the growth curve of the COVID-19 first-wave pandemic in 2020. Method(s): The data were obtained from medical records of 152 deaths registered for adults and elderly hospitalized. The data were also compared with the number of deaths in previous years during the same period studied to assess the impact of the pandemic on this hospital. The study also assesses the impact of intra-hospital transfers, accounting for the number of times patients who died performed transfers between sectors of the hospital. Result(s): During the period analyzed, there was an increase in deaths compared to the previous years. The majority of dead patients were male, aged between 34 and 96 years. The deaths were associated comorbidities such as arterial hypertension, diabetes mellitus, and kidney disease. The SARS-CoV-2 infection was confirmed in 91 cases. Among them, 15 individuals were admitted without conditions related to SARS-CoV-2 infection;they had a three-fold higher number of hospital transfers than those admitted with SARS-CoV-2 infection symptoms. Sixteen patients with SARS-CoV-2 infection developed respiratory symptoms just after hospitalization. The diagnostic exam for SARS-CoV-2 infection was performed on average 4 (+/- 6) days after the onset of symptoms and 6 (+/- 6) days after admission, and the average time from the onset of respiratory symptoms to death was 4 (+/- 6) days. Conclusion(s): These data suggest the high presence of hospital infection by SARS-CoV-2 in the Brazilian Amazon region, which may be related to the number of sectorial transfers, delay in confirming the diagnosis, and lack of management. We report a serious public health problem, as it demonstrates the fragility of healthcare institutions in the hospital environment.Copyright © 2023 Faculdade de Medicina de Ribeirao Preto - U.S.P.. All rights reserved.

Quality of life and psychosocial risks of nurses involved in the battle against the COVID-19 pandemic.

Objective: The present investigation aims to understand the impact of providing care to people with suspected or confirmed SARS-CoV-2 infection on nurses' quality of life and psychosocial risk factors and to identify associations with their sociodemographic characteristics. Method(s): An exploratory-descriptive study was carried out through the World Health Organization Quality of Life Instruments - Bref and Copenhagen Psychosocial Questionnaire scales, with a total of 127 valid responses. Data were processed in SPSS, using descriptive statistics and crosstabs. Result(s): The mean values of quality of life did not reach 70 points and 22 psychosocial risk factors were identified in intermediate and high degree. Some sociodemographic characteristics seem to be associated with these results. Conclusion(s): The nurses of the sample were significantly affected by the provision of care in the context of the pandemic.Copyright © 2022, Fundacion Index. All rights reserved.

Endothelial Biomarkers in Critically Ill Patients with Covid-19: Potential Predictors of the Need for Dialysis

Introduction: Endothelial dysfunction and coagulopathy have been reported as the basis of severe Acute Kidney Injury (AKI) associated with COVID-19. Endothelial biomarkers can detect kidney damage early and allow the adoption of efficient measures to prevent the progression of the disease and its complications. This finding could facilitate the follow-up of patients at higher risk, as well as provide early diagnosis strategies and promote the rational use of resources. The aim of this study is to assess the role of vascular biomarkers to predict the need for hemodialysis in critically ill patients with COVID-19. Method(s): This is a prospective study with 58 patients critically ill due to COVID-19 infection admitted to a tertiary hospital in Fortaleza, Northeast Brazil, from 2020 to 2021. General laboratory tests and vascular biomarkers such as VCAM-1, Syndecan-1, ACE-2, ICAM-1, Angiopoietin-1 and Angiopoietin-2 were quantified on admission to the intensive care unit (ICU). Result(s): There was a 40% mortality rate. VCAM and the Ang-2/Ang-1 ratio at ICU admission were associated with the need for hemodialysis. Vascular biomarkers (VCAM-1, Syndecan-1, angiopoietin-2/anogiopoietin-1 ratio) and thrombocytopenia were predictors of dialysis, and their cutoff values were useful to stratify patients with worse prognosis in the Kaplan-Meier analysis. In the cox multivariate regression analysis with models adjusted according to the presence or absence of platelets, VCAM-1 [O.R. 1.13 (95% CI: 1.01 - 1.27);p=0.034] was an independent predictor of dialysis in all models, and the Ang-2/Ang-1 ratio [O.R. 4.87 (95% C.I.: 1.732 - 13.719);p=0.003] was associated with the need for dialysis in the model without platelet input. Conclusion(s): Vascular biomarkers, mainly VCAM-1 and Ang-2/Ang-1 ratio, and coagulation disorders showed important predictive value for the need for hemodialysis in critically ill patients with COVID-19. No conflict of interestCopyright © 2023

Rapid disease progression after enzyme replacement therapy interruption in a patient with cholesteryl ester storage disorder

Lysosomal acid lipase deficiency (LALD) has two clinical phenotypes: an infantile-onset form - Wolman disease (WD) presented by severe malabsorption, cholestasis, malnutrition, hepatosplenomegaly and early death, and a later-onset form - cholesteryl ester storage disorder (CESD) with hepatosplenomegaly, dyslipidemia, malabsorption and variable disease severity manifestation. Enzyme replacement therapy (ERT) with sebelipase alfa was approved by the Brazilian Health Regulatory Agency (ANVISA) in 2017. We report the deleterious effect of ERT interruption in a CESD patient. Male, 16y, diagnosed at 7y, positive familiar history with mother, grandfather and three siblings affected. He was enrolled in the phase 3 clinical trial from age 9-12y under the 3 mg/Kg dose regimen. Then he enrolled in the post-study donation program under the same dose. Due to personal, importation and supply issues, and the COVID-19 pandemic restrictions, he had a progressive decrease in treatment adherence rate: 68% at 12y, 27% at 13y, 30% at 14y and after that he had an interruption of 1 entire year. At 15y he presented with generalized edema, severe fatigue, tachycardia, was hospitalized, diagnosed low serum iron, albumin and protein, acute anemia (hemoglobin: 6.2 g/dL - normal range of 12,5-13,5), and received blood transfusion. In the next year, still without ERT, he was hospitalized again due to generalized edema, acute anemia (Hemoglobin = 6.9 g/dL) and worsening of hypoalbuminemia and iron deficiency, and received blood transfusion. Although our patient has the CESD phenotype, the ERT interruptions did not worsen the liver involvement nor the dyslipidemia, but caused a severe malabsorption which is classically described in WD phenotype. In conclusion, this case serves as an alert that when ERT is interrupted, there is a rapid clinical deterioration. Acknowledgements: to IGEIM, and Drs Felippe Raphael e Oliveira Previdi and Ana Eduarda Saraiva Pereira Campos for clinical assistance of the patient.

Transfusoes De Hemocomponentes Por Internacao Hospitalar Na Rede Publica Municipal De Belo Horizonte Entre 2008 E 2021: Uma Analise De Serie Temporal

Resumo: Estudo retrospectivo longitudinal ecologico com dados referentes ao uso de hemocomponentes entre janeiro de 2008 e dezembro de 2021 na rede hospitalar do municipio de Belo Horizonte, Minas Gerais. Objetivos: Descrever as series mensais do numero de transfusoes de hemocomponentes e a taxa de transfusao por internacao em internacoes gerais na rede publica hospitalar sob a perspectiva da analise de series temporais. Metodos: A partir de dados do Sistema de Informacao Hospitalar do SUS (SIH-SUS), foram criadas seis series temporais de periodicidade mensal do numero de transfusoes de hemocomponentes e da taxa de transfusao por internacao. A estacionariedade, a tendencia e a sazonalidade das series foram verificadas pelo teste de raiz unitaria, pelo teste de Mann-Kendall e pelo teste de Fisher, respectivamente, utilizando-se os niveis de significancia de 10% para o primeiro teste e de 5% para os dois ultimos. Resultados: A taxa media mensal de uso de hemocomponentes por internacao hospitalar observada foi de 45,5%, 26,9% e 26,3% no Hospital Risoleta Tolentino Neves (HRN), Hospital Dr. Celio de Castro (HCC) e Hospital Odilon Behrens (HOB), respectivamente. A maior reducao do numero de transfusoes de hemocomponentes foi observada no HCC e a maior reducao da taxa de uso de hemocomponentes foi observada no HRN. O concentrado de hemacias foi o hemocomponente mais utilizado no HRN, HOB e HCC (54,6%, 58,3% e 65,4%, respectivamente). Todas as series apresentaram-se nao estacionarias, com tendencia de queda e presenca do componente sazonal com periodicidade de 12 meses. Todas as series apresentaram reducao da tendencia de queda durante o periodo critico da pandemia da COVID-19. Discussao: Os resultados encontrados neste estudo confirmam a hipotese inicial deste estudo de que o principal hemocomponente transfundido nos servicos de saude hospitalares publicos do municipio de Belo Horizonte sao os concentrados de hemacias. As taxas de transfusoes de hemocomponentes observadas nos tres hospitais sao semelhantes as taxas observadas em estudos nacionais e internacionais. A tendencia de queda na taxa de transfusoes de hemocomponentes por internacao hospitalar vai de encontro ao observado na literatura, que aponta para o aumento das taxas de transfusoes de hemocomponentes e dos resultados de um estudo semelhante realizado com uma rede de hospitais privados do mesmo municipio, no qual foi identificada a tendencia de alta em todos os hospitais analisados no estudo. A inexistencia dos dados sociodemograficos e informacoes sobre o local de utilizacao dos hemocomponentes podem ser considerados limitacoes do estudo. Conclusao: O estudo permitiu compreender o comportamento das series temporais relacionadas ao uso de hemocomponentes na rede publica hospitalar do municipio de Belo Horizonte. Acoes que envolvem a reducao da demanda por hemocomponentes, como, por exemplo, a implementacao de programas de Patient Blood Management, podem ser realizadas nos tres hospitais, com primazia para o HRN e para os concentrados de hemacias nos tres hospitais. Copyright © 2022

Impact de l'infection par le SARS-CoV-2 sur l'activité de la maladie des patients atteints de rhumatisme psoriasique sous bDMARD : données réelles

Introduction L'infection par le SARS-CoV-2 peut entraîner une inflammation sévère et il a été suggéré d'induire des poussées de rhumatisme psoriasique (RP). Cependant, l'impact sur l'activité de la maladie et la réponse aux DMARD biologiques modificateurs de la maladie (bDMARD) reste inconnu. Patients et méthodes Nous avons réalisé une analyse rétrospective incluant tous les patients atteints de RP, répondant aux critères CASPAR et sous biothérapie, suivis dans le service de rhumatologie d'un CHU universitaire tertiaire. Les données démographiques et cliniques, y compris la survenue d'une infection par le SARS-CoV-2, ont été collectées à partir de notre base de données nationale (reuma.pt). L'activité de la maladie (CDAI, SDAI, DAS28 4v, BASDAI, ASDAS) et les réponses aux bDMARD (réponses EULAR, ASDAS, ASAS, ACR et PsARC) ont été évaluées avant et après l'infection par le SARS-Cov-2. Résultats Au total, 102 patients atteints de RP ont été inclus. Cinquante-deux étaient des femmes (51 %). L'âge moyen était de 53 ± 11,09 ans et la durée médiane de la maladie était de 15 ans [min 2, max 47]. Au total, 54 (53 %) patients avaient une atteinte axiale prédominante, 26 (26 %) périphérique et 36 (37 %) enthésopathique. Le bDMARD le plus utilisé était l'étanercept (n = 28, 27,5 %) suivi de l'adalimumab (n = 22, 21,6 %) et du sécukinumab (n = 18, 17,6 %). La prévalence de l'infection par le SARS-CoV-2 était de 15,7 % (n = 16). Soixante-trois pour cent ont reçu le vaccin BNT162b2 (Pfizer/BioNtech), 31 % ont reçu l'ARNm-1273 (Moderna), 13 % ont reçu l'AZD1222 (AstraZeneca) et 13 % ont reçu l'AD26.COV2.S (Janssen/Johnson & Johnson). Soixante-trois pour cent étaient infectés avant toute vaccination, 13 % après la première dose et 25 % après la seconde. Les symptômes les plus fréquents étaient l'anosmie (65 %), la dysgueusie (56 %) et la toux (56 %). Tous les patients se sont complètement remis de l'infection, sans nécessiter d'hospitalisation. Quel que soit le score utilisé, la différence entre l'activité moyenne de la maladie après l'infection par le SARS-CoV-2 et celle au départ n'a pas atteint la signification statistique. Au départ et après l'infection, les paramètres moyens de l'activité de la maladie étaient respectivement : CDAI 8,6 ± 5,7 vs 8,6 ± 5,7, p = 0,997 ;SDAI 9,3 ± 6,6 contre 9,2 ± 6,1, p = 0,928 ;DAS 28 4v 2,9 ± 1,2 contre 2,9 ± 1,2, p = 0,818 ;BASDAI 3,6 ± 2,6 contre 3,2 ± 2,7, p = 0,506 ;ASDAS 2,2 ± 1,2 contre 2,2 ± 1, p = 0,721. Le nombre de patients ne répondant pas aux bDMARD (selon EULAR, ASDAS, ASAS, ACR et PsARC) avant l'infection n'était pas différent de celui post-infection. Conclusion Notre étude suggère que l'infection par le SARS-CoV-2 n'a aucun impact négatif sur l'activité de la maladie PSA et les réponses bDMARD. Cependant, d'autres études sont encore nécessaires pour mieux comprendre les effets à long terme de l'infection par le SARS-CoV-2.

Retail sales forecasting for a Brazilian supermarket chain: An empirical assessment

Time series forecasting is a consolidated, broadly used approach in several fields, such as finance and industry. Retail can also benefit from forecasting in many areas such as stock demand, price optimization, and sales. This study addresses retail sales forecasting in Nordestão, a large Brazilian supermarket chain that respectively ranks 3rd and 27th in sales regionally and nationally. The data considered spans five years of daily transactions from eight different stores. Knowingly effective machine learning techniques for forecasting are adopted, namely linear regression, random forests, and XGBoost. We further improve their performance with features we engineer to address seasonal effects. The best algorithm varies per store, but for most stores at least one of the methods proves effective. Importantly, the models display effective performance across multiple testing weeks, and improve over the current approach of Nordestão by a significant margin. Besides the traditional relevance of sales forecasting, our work is a means for Nordestão to evaluate the impact of the COVID-19 pandemics on sales. © 2022 IEEE.

Tics, Functional Tics, TikTok and COVID-19: A Pediatric Case Report

Functional tics are a rare manifestation of the spectrum of functional neurological disorders. The phenomenological similarity with organic and simulated pathology poses important diagnostic challenges, but they should not be considered a diagnosis of exclusion. Recently there have been sudden outbreaks of bizarre tics in ado-lescent girls during the confinement imposed by the COVID-19 pandemic, whose appearance seems to be related to the use of TikTok application and for which we intend to alert, through a clinical case illustrated with a video. Copyright © 2022, Sociedade Portuguesa de Neurologia. All rights reserved.

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

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

Understanding Misinformation About COVID-19 in WhatsApp Messages

During the COVID-19 pandemic, the misinformation problem arose again through social networks, like a harmful health advice and false solutions epidemic. In Brazil, one of the primary sources of misinformation is the messaging application WhatsApp. Thus, the automatic misinformation detection (MID) about COVID-19 in Brazilian Portuguese WhatsApp messages becomes a crucial challenge. Recently, some works presented different MID approaches for this purpose. Despite this success, most explored MID models remain complex black boxes. So, their internal logic and inner workings are hidden from users, which cannot fully understand why a MID model assessed a particular WhatsApp message as misinformation or not. Thus, in this article, we explore a post-hoc interpretability method called LIME to explain the predictions of MID approaches. Besides, we apply a textual analysis tool called LIWC to analyze WhatsApp messages’ linguistic characteristics and identify psychological aspects present in misinformation and non-misinformation messages. The results indicate that it is feasible to understand relevant aspects of the MID model’s predictions and find patterns on WhatsApp messages about COVID19. So, we hope that these findings help to understand the misinformation phenomena about COVID-19 in WhatsApp messages. © 2022, Springer Nature Switzerland AG.

Online learning or emergency remote teaching?: Reflections on online learning as pedagogical innovation in a higher education institution

Following the recent measures implemented worldwide as result of the pandemic caused by COVID-19, educational institutions needed to implement online learning practices, demanding a rapid appropriation of digital skills by teachers and students. The Polytechnic Institute of Portalegre, in Portugal, was one of the higher education institutions (IES) that organized a transition process for this teaching model. The objectives of the study focused on the characterization of the online learning process, including the practice of online learning and the students' perspectives regarding the future of online learning. The results obtained, from 420 validated questionnaires, point to a positive evaluation of this pedagogical experience, with some particularities listed in certain areas of the teaching and learning process, suggesting an in-depth analysis on the level of digital skills on the part of teachers and students in order to consolidate distance learning as a true pedagogical innovation process and not just as an "emergency remote teaching" experience. © 2022, IGI Global.

IMPACT of SARS-COV-2 INFECTION on the DISEASE ACTIVITY of PATIENTS with PSORIATIC ARTHRITIS under BDMARDS: REAL LIFE DATA

Background: SARS-CoV-2 infection can lead to severe infammation and has been suggested to induce Psoriatic Arthritis (PsA) fares.1 However, the impact on disease activity and response to biological disease modifying anti-rheumatic drugs DMARDs (bDMARDs) remains unknown. Objectives: To evaluate the effect of SARS-CoV-2 infection on disease activity and bDMARDs responses in patients with PsA. Methods: We performed a retrospective analysis including all the patients with PsA, meeting the CASPAR criteria and under biologic therapy, followed in the Rheumatology department of a tertiary university hospital. Demographic and clinical data, including occurrence of SARS-CoV-2 infection, were collected from our national database (reuma.pt). Disease activity (CDAI, SDAI, DAS28 4v, BASDAI, ASDAS) and bDMARDs responses (EULAR, ASDAS, ASAS, ACR and PsARC responses) were evaluated before and after SARS-Cov-2 infection. Statistical analysis was performed with SPSS. Continuous variables were compared through paired samples t-test. Results: A total of 102 patients with PsA were included. Fifty-two were females (51%).The mean age was 53 ± 11.09 years and the median disease duration was 15 years [min 2, max 47]. Overall, 54 (53%) patients had predominant axial involvement, 26 (26%) peripheric and 36 (37%) enthesopathic. The most used bDMARD was etanercept (n=28, 27.5%) followed by adalimumab (n=22, 21.6%) and secukinumab (n=18, 17.6%). The prevalence of SARS-CoV-2 infection was 15.7% (n=16). Sixty-three per cent received the BNT162b2 (Pfzer/BioNtech) vaccine, 31% received mRNA-1273 (Moderna), 13% received AZD1222 (AstraZeneca) and 13% received AD26. COV2.S (Janssen/Johnson & Johnson). Sixty-three percent were infected before any vaccination, 13% after the frst dose and 25% after the second. The most common symptoms were anosmia (65%), dysgeusia (56%) and cough (56%). All patients fully recovered from the infection, with no need for hospitalization. Regardless of the score used, the difference between the mean disease activity after SARS-CoV-2 infection and that at baseline did not reach statistical significance. At baseline and after infection, mean (SD) disease activity parameters were, respectively: CDAI 8.6±5.7 vs 8.6±5.7, p=0.997;SDAI 9.3±6.6 vs 9.2±6.1, p=0,928;DAS 28 4v 2.9±1.2 vs 2.9 ±1.2, p= 0.818;BASDAI 3.6 ±2.6 vs 3.2±2.7, p=0.506;ASDAS 2.2±1.2 vs 2.2±1, p=0.721. The number of patients unresponsive to bDMARDs (according EULAR, ASDAS, ASAS, ACR and PsARC) before the infection wasn't different from post-infection. Conclusion: Our study suggests that SARS-CoV2 infection has no negative impact on PsA disease activity and bDMARD responses. However, more studies are still needed to better understand the long-term effects of SARS-CoV2 infection.

THE IMPACT of SARS-COV-2 INFECTION on DISEASE ACTIVITY and CLINICAL RESPONSE to BIOLOGICAL DMARDS in PATIENTS with RHEUMATOID ARTHRITIS

Background: Infections are a known trigger for Rheumatoid Arthritis (RA) fares.1 It is still unclear whether SARS-Cov-2 infection affects RA disease activity and the clinical response to biological disease-modifying antirheumatic drugs (bDMARDs). Objectives: To evaluate the effect of SARS-Cov-2 infection on disease activity and bDMARD responses in patients with RA. Methods: A retrospective study was carried out in a cohort of RA patients treated with bDMARDs from a tertiary hospital centre. Demographic and clinical data, including occurrence of SARS-Cov-2 infection, were obtained through medical records. Disease activity (DAS28, DAS28-CRP, CDAI and SDAI) and ACR and EULAR bDMARD responses were evaluated at four time points: baseline (t1-last evaluation before Covid-19 pandemic), before (t2) and after (t3) SARS-Cov-2 infection and at the end of follow-up (t4-last appointment of 2021). In patients with no record of SARS-Cov-2 infection the middle evaluations were obtained from two random consecutive appointments during Covid-19 pandemic. Statistical analysis (signifcance at p<0.05) was performed using paired t-test, Wilcoxon and McNemar tests for paired samples and unpaired t-test, Mann-Whitney, Fisher and χ2 tests for independent samples according to the type of variable and the presence of normal distribution. Results: Of the 237 patients included, most of them was women [n = 195 (82.3%)], with a mean age of 59.6 ± 10.1 years old and a median [min, max] disease duration of 18 [2, 50] years. The majority presented rheumatoid factor (RF) and/or anti-citrullinated protein antibodies (ACPA) positivity [n = 204 (87.9%)] and radiographic erosions [n = 119 (72.6%)]. The prevalence of SARS-Cov-2 infection was 11.4% (n=27). Mean disease activity was lower after SARS-Cov-2 infection compared to the previous evaluation on all scores used;however, this difference was not statistically signifcant. Nevertheless, when compared to the mean disease activity at the end of follow-up, there were statistically signifcant differences in DAS28-CRP (t2 3.2±1.0 vs. t4 2.8±1.1, p=0.017) and CDAI (t2 11.1±8.1 vs. t4 8.7±6.2, p=0.05) scores. The relative number of patients with no ACR or EULAR bDMARD responses before SARS-Cov-2 infection wasn't different from post infection and at the end of follow-up. At baseline, the infected and uninfected groups were similar regarding gender, age, RF and/or ACPA positiv-ity, erosive disease, disease and biologic treatment durations, baseline disease activity and ACR and EULAR response. The variation in disease activity and the relative number of patients with worsening or improving EULAR and ACR bDMARD responses between t2 and t3 were not signifcantly different in the two groups, as well as between t2 and t4. The prevalence of patients who switched to another bDMARD was signifcantly higher in the group of patients who had Covid-19 [n=4 (14.8%) vs. 9 (4.3%), p=0.047]. The main reason for switching was the ineffectiveness of the therapy (n=11). Conclusion: No worsening of disease activity or ACR and EULAR bDMARD responses was found after SARS-Cov-2 infection in RA patients under bDMARD. However, the later can be explained by the small sample size. Indeed, these patients exhibited a higher rate of switch due to ineffectiveness of therapy, suggesting a negative impact of SARS-Cov2 infection on the disease course.

COVID19 in SPONDYLOARTHRITIS PATIENTS under BDMARD-A COMPREHENSIVE ASSESSMENT

Background: SARS-Cov-2 infection had a major impact on patients with infam-matory rheumatic diseases. Spondyloarthritis (SpA) patients were one of the most affected groups of these patients. Objectives: To assess the impact of Covid19 in spondyloarthritis patients under biological disease modifying anti-rheumatic drugs (bDMARDs). Methods: A retrospective observational study was conducted using registry data of patients with SpA under bDMARD therapy, followed at a tertiary level hospital, that have been diagnosed with COVID19 from March 2019 to December 2021. At least one evaluation previous (t0) and two evaluations after SARS-CoV-2 infection (t1, t2) were included in our analysis. Sociodemographic, clinical, disease activity, therapeutic response, function and general health status data were collected. Statistical analysis (signifcance at p < 0.05) was performed using paired T-test, Wilcoxon test and McNemar tests for paired samples. Linear and logistic regression models were performed to assess direction and strength of association Results: Thirty-two patients with SpA under bDMARD had COVID19, mostly women (20, 62.5%), with a disease course time averaged 18.65 (± 9.69) years, mainly with axial involvement (19, 59.4%) and positive for HLA-B27 antigen (11, 64.7%). The majority were under TNF inhibitors (30, 93.75%), with golimumab being the most common (9, 28.1%), and with a median bDMARD persistence of 2.63 (5.09) years. Seven (21.9%) were under a cDMARD, 3 (9.4%) under NSAID and 18 (56.3%) under corticosteroids. Three (9.4%) were already vaccinated against SARS-CoV-2, 2 (66.6%) with the mRNA-1273 vaccine, presenting a medium time since inoculation of 240 (± 234.01) days. Arterial hypertension was the most common comorbidity (5, 15.6%) and one patient (3.1%) had a previous diagnosis of type 2 diabetes. Most were never-smokers (17, 53.1%) and never-drinkers (29, 90.6%). The average age at infection was 40.97 (± 6.15) years and the most common symptom was cough (22, 68.8%), followed by headache (20, 62.5%) and myalgia (19, 59.4%). Event tree analysis didn't show association with SpA subtype, education level, work status, tobacco or alcohol consumption. Only one patient needed hospital admission but without needing of oxygen, therapy, ventilator or ECMO. Only one patient had an overlaid bacterial infection and no thromboembolic complications were observed. Two patients needed specific SARS CoV-2 infection treatment, one with hydroxychloroquine and another with azithromycin. Twelve (37.5%) patients suspended bDMARD at the time of infection, with only 2 (6.3%) maintaining suspension at the time of the first post-infection visit. When comparing clinical variables, higher disease activity was seen at t1 only for BASDAI mean values, without statistical signifcance. Higher all domains VAS scores were also observed at t1, but not at t2, also without statistical signifcance;moreover, physical function didn't change signifcantly. No differences were observed according to gender or SpA subtype, nor with the use of cDMARDs, NSAIDs or corticosteroids. The only statistically signifcant difference concerned MASES score between t0 and t1 (1 ± 4 vs. 2 ± 6, p=0.04), but not between t0 and t2. Higher baseline tender joint score (p < 0.01) and higher baseline LEI (p=0.03) negatively correlated with MASES score variation. Several baseline variables correlated positively with MASES at t1, including female gender (p < 0.01), corticosteroid use (p = 0.04), BASDAI (p < 0.01), ASDAS-ESR (p < 0.01), ASDAS-CRP (p < 0.01), DAS28 (p < 0.01), SPARCC (p = 0.04), physician VAS (p = 0.03) and total spine VAS (p = 0.01). Working status varied signifcantly after SARS-Cov-2 infection (at least part-time-29, 90.6% vs. 22, 68.8%, p= 0.016). Conclusion: SpA patients on bDMARD had a mild course of SARS-CoV-2 infection, with slight changes in enthesitis score in the short term, the latter particularly in those with higher disease activity in the pre-infection period. Long-term effects on work status could represent confounding factors related to the e onomic constraints of the pandemic.

Predictors of post-stroke depression in the acute phase of ischemic stroke: a cross-sectional study

Background and aims: Ischemic stroke is a remarkable cause of death and disability worldwide. Post-stroke depression (PSD) is the most common psychiatric disturbance after stroke. Despite PSD being a potentially treatable condition, it still requires approaches to improve the early diagnosis. The present study aims to investigate the predictors and correlated variables associated with PSD during hospitalization. Methods: A cross-sectional study was carried out in a specialized center of neurology situated at Santa Catarina, Brazil. 148 patients with acute ischemic stroke hospitalized between January 2020 and February 2021 were included. Sociodemographic, clinical and radiological variables were assessed during hospitalization. The Hospital Anxiety and Depression Scale (HADS) was applied, as well as the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Predictors factors were investigated through binary logistic regression and continuous variables through correlation tests. Results: The prevalence of PSD during hospitalization was 31.1%. Predictors of PSD in the acute phase of the stroke were female sex (OR: 2.6;CI 95%: 1.3 to 5.4;p<0.01) and post-stroke anxiety during hospitalization (OR: 4.9;CI 95%: 2.3 to 10.3;p<0.01). The variables NIHSS, mRS, and stroke area were positively correlated with HADS - depression values. Conclusion: This research evidenced a high prevalence of PSD in the acute phase of stroke. Despite the study being conducted during the COVID-19 pandemic, the data found is similar to the non-pandemic periods. The research provided clues to identify and early treat patients at greater risk of developing PSD during hospitalization.

Variations of High-Intensity GPS Derived Measures between Playing Status during a Full Soccer Season in a Professional Male Team

Background: This study's aim was twofold: (i) to compare starters and non-starters on a professional soccer team in terms of variations in training intensity indexes across a season, calculated through total distance, sprint distance, accelerations (Acc), and decelerations (Dec) and (ii) to analyse the relationship between the intensity indexes for each playing status. Methods: Nineteen players (age, 29.4 ± 4.4 years;height, 1.8 ± 0.1 m;body mass, 74.8 ± 2.3 kg) were divided into starters and non-starters and followed for 43 weeks using global positioning systems. Results: Training intensity measures (acute:chronic workload ratio [ACWR], coupled and uncoupled) were higher during the latter stage of the season. Total distance peaked during the mid-season, whereas the highest value for exponentially weighted moving average (EWMA) was recorded later in the season. Interestingly, the EMWA of total distance showed little variation during the season for players of both playing statuses. The EWMA of total distance showed a significant higher value for starters than non-starters (p = 0.036;g = 1.27 [0.31, 2.32]). The interruption in games between week 34 and week 35 due to COVID-19 moved some measures into the injury risk zone - namely, the ACWR coupled of sprint distance and Dec;the ACWR uncoupled of total distance, sprint distance, Acc, Dec;and the EWMA of sprint distance, Acc and Dec. Conclusions: The highest training intensity measures were reported late in the season and were similar between starters and non-starters. Across the season, only one difference between starters and non-starters occurred, revealing that training intensity was properly managed throughout the season regardless of the status of the players.

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

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