Investigation and control actions of an outbreak COVID-19 onset in a hospital at Campos Gerais, Parana

As a result of the COVID-19 pandemic, several hospitals around the world reported the transmission of the disease in inpatient units not directed to the care of patients affected by the disease. The objective was to report the epidemiological investigation of two outbreaks of COVID-19 in an onset of a university hospital in the general fields. It took place between July and October/2021, the data were analyzed with the SIR model (susceptible-infected-recovered) to obtain the transmission rate (R). In the first outbreak (July-August), 49 people were investigated, 25/49 (51.0%) cases, 10/25 (40.0%) staff, 15/25 (60.0%) patients, 8/25 (33.3%) medical clinic, 16/25 (66.7%) surgical clinic and 21/25 (84.0%) symptomatic. Among the cases in patients, 11/15 (73.3%) had onset of symptoms after 7 days of hospitalization. The 5W2H matrix was used as an action plan. After the execution of the actions, there were active cases for 7-10 days. The duration was 35 days, the most critical moment occurred 17 days after the first patient presented symptoms, there were 15 patients active at the same time and the R was 2.92. In the second outbreak (SeptemberOctober), 127 people were investigated and there were 6/127, of these 2/6 (33.3%) staff, 4/6 (66.6%) patients, 4/6 (66.6%) medical clinic, 2/6 (33.3%) surgical clinic, 4/6 (66.6%) symptomatic. After the execution of the actions, there were active cases for 7-10 days and there were no new cases. The duration was 18 days, the most critical moment occurred after 7 days of the first patient presenting symptoms, there were 6 people active at the same time and the R was 1.35. The first experience was effective, however late in controlling the cases. The second experiment, using data from the first, was timely, the investigation was more robust and contained the outbreak quickly and efficiently.

Evaluation of Disease Activity in Patients with Systemic Lupus Erythematosus in Follow-Upata University Hospital in Manaus Aftervaccination against Covid-19

Objectives: Patients with Systemic Lupus Erythematosus (SLE) are predisposed to serious infections due to immunocompromise, comorbidities, immunomodulatory and/or immunosuppressive therapy, as well as the lack of these medications faced by patients dependent on the Sistema Unico de Saude (SUS) during the COVID-19 pandemic. Studies revealed a low risk of worsening disease activity after vaccination against SARS-CoV-2 and safety in the continuity of immunomodulatory therapy during the vaccination stages. Thus, immunization against COVID-19 is an important pillar in reducingmorbidity and mortality related to infectious conditions and SLE. This study had the objective to understand the disease activity in SLE patients after vaccination against COVID-19. Method(s): This is an observational, longitudinal, ambidirectional study with follow-up of subgroups of patients with immune-mediated rheumatic diseases immunized with vaccines made available by the Programa Nacional de Imunizacao (Butantan Institute, Pfizer/BioNTech, BioManguinhos/Fiocruz and Janssen). Data from the SLE disease activity index 2000 (SLEDAI-2 K) and sociodemographic data were collected and stored via an online platform, with a comparison of the index before and after each dose. This study was approved by the local Research Ethics Committee, and it is associated to the SAFER Project from Brazilian Society of Rheumatology. Result(s): A total of 223 patients were included, of which 83% were female and 39% had SLE, 36.7 +/- 11.76 years old. Regarding the disease activity, at inclusion the mean PGA score(SD) was 2,61 +/- 2,77. After the 1st dose it was 1.38 +/- 2.17, after the 2nd dose it was 2,35 +/- 2,99, after the 3rd dose it was 2,19 +/- 2,58 and after the 4th dose 1.18 +/- 1.88. The mean SLEDAI-2 K score at inclusion was 7,27 +/- 9,70, after the 1st dose it was 2,75 +/- 5,29, after the 2nd dose it was 4,73 +/- 6,40, after the 3rd dose 3,33 +/- 5,51 and after the 4th dose 2.12 +/- 4.27. 6% of the patients referred worsening disease activity after the 1st dose, 14,3%after the 2nd dose, and no patient reportedworsening of disease activity after the 3rd and 4th doses. Conclusion(s): Vaccination did not contribute toworsening disease activity of the SLE patientss studied, according to the indices used to assess disease activity.

Cases of Covid-19 in Patients Withi Mmune-Mediated Rheumatic Diseases after Vaccination against Sars-Cov-2 in Manaus-Amazon

Objectives: Immunization against SARS-CoV-2 is an effective strategy to reduce morbidity and mortality in the face of the COVID-19 pandemic. People with Immune-mediated Rheumatic Diseases (IMRD) also benefited from this campaign. However, there is a limited amount of data on the outcome of vaccination in these patients, in terms of those who were infected by the virus. This study had the objective to evaluate the rate of COVID-19 cases in patients with IMRD after vaccination against SARS-CoV-2. Method(s): Observational, longitudinal and ambidirectional study with follow-up of subgroups of patients with IMRD immunized with vaccines made available by the National Immunization Plan (inactivated adsorbed vaccine registered by the Instituto Butantan (IB), recombinant vaccines registered by Bio Manguinhos/ Fiocruz and by Janssen, and Pfizer/BioNTech). Sociodemographic data and questionnaires on flu syndrome, laboratory confirmation of infection and need for hospitalization and outcomes were collected and stored via an online platform. This study is associated to the SAFER Project from the Brazilian Society of Rheumatology and it was approved by the local Research Ethics Committee. Result(s): A total of 223 patients aged over 18 years, mean age 42.79 +/- 15.18 years, were included. All were within the inclusion/exclusion criteria, with 83% being female. The main IMRD included were systemic lupus erythematosus (39%) and rheumatoid arthritis (33.6%). After the 1st dose, 1.45% of patients had COVID-19, 50% sought health services (emergency care), without the need for hospitalization and after the 2nd dose, 1.5% had the disease, of which none sought health services, required hospitalization or had a negative outcome. After the 3rd dose,: 2.9%were infected with SARS-CoV-2 one month later, 15.6% two to three months later and 5.5% four to six months later, all with laboratory confirmation;only 4% presenting any serious complication;there were no deaths. After the 4th dose, 9.1%of patients had COVID-19, of which 40%were hospitalized, without the need for assisted ventilation;half of these patients had a serious complication, but there no deaths. Conclusion(s): In this study, we observed the effectiveness of the vaccine in preventing severe cases of COVID-19 and complications of SARS-CoV-2 infection.

Assessment of Disease Activity in Adolescent Patients with Chronic Inflammatory Diseases after Vaccination against Covid-19ata University Hospital in Manaus

Objectives: Chronic Inflammatory Immune-mediated Diseases (CIMD) can cause pain and severe discomfort to the patient, leading to significant reductions in his/her quality of life. Vaccination against COVID-19 has proven to be an efficient method in preventing cases and serious repercussions. However, there is insufficient evidence on the safety of these vaccines in the CIMD population. Objective(s): To assess disease activity in adolescent patients with CIMD after vaccination against SARS-CoV-2. Method(s): Observational, longitudinal, ambidirectional study with follow-up of groups of adolescent patients with CIMDwho received the vaccine provided by the National Immunization Program -Pfizer/BioNTech. Sociodemographic and clinical disease activity data were collected before and after each vaccine dose. Data were stored through an online platform (REDCap). This study is associated to the SAFER Project from the Brazilian Society of Rheumatology and was approved by the local Research Ethics Committee. Result(s): Nineteen adolescents aged between 12 and 17 years were included, all of whom met the inclusion/exclusion criteria. Of the total, 31.6% have Juvenile Idiopathic Arthritis (JIA)-14.33 +/- 2.25 years of age, whose subtypes included persistent oligoarticular JIA (16.7%), Polyarticular Rheumatoid Factor (RF) negative (33.3%), Polyarticular RF positive (16.7%) and Systemic (33.3%);68.4% have Systemic Lupus Erythematosus (SLE) -14.77 +/- 1.96 years of age. Regarding JIA patients, at inclusion, the mean disease activity assessed by the physician was 3 +/- 3.83 and 3.25 +/- 3.77 as assessed by the patient. After the 1st dose, the mean activity assessed by the physician was 2.8 +/- 3.9 and after the 2nd dose it was 3 +/- 4.24. Themean activity after the first dose as assessed by the patient was 3.2 +/- 3.96, and after the 2nd dose it was 2.8 +/- 3.11. In the SLE patients, at inclusion, the mean degree of disease activity was 1.92 +/- 1.83 and of the SLEDAI-2 K was 4.67 +/- 5.14. After the 1st dose, the mean disease activity was 1.11 +/- 1.96, and after the 2nd dose, it was 2.25 +/- 2.76. After the 1st dose, the SLEDAI-2 K was 1.11 +/- 1.76, and after the 2nd dose it was 4.25 +/- 5.28. No reports of worsening of disease activity after the vaccine were found. Conclusion(s): The vaccination proved not to contribute to worsening of clinical activity of rheumatic diseases in adolescents, without significant changes in SLE assessment indices and in the personal and medical assessment of JIA patients.

Adverse Effects of Vaccines against Covid-19 in Adolescent Patients with Chronic Inflammatory Immune Diseases in Manaus-Amazon

Objectives: In the Chronic Inflammatory Immune-mediated Diseases (CIMD), infections mainly occur in the respiratory tract and their occurrence is related to drug-induced immunosuppression, underlying diseases and comorbidities. To reduce this morbidity and mortality, vaccination is an effective means of prevention. However, the available studies on SARS-CoV-2 vaccines have not addressed this group of patients with CIMD, and there are still many doubts regarding the indications, adverse effects, safety and efficacy of these vaccines. Objective(s): to evaluate the adverse effects of vaccines against SARS-CoV-2 in adolescent patients with CIMD. Method(s): Research associated to the SAFER Project from Brazilian Society of Rheumatology. It is an observational, longitudinal, ambidirectional study, with follow-up of groups of vaccinated adolescent patients with CIMD, vaccine by Pfizer/BioNTech. Sociodemographic data were collected, stored on an online platform, and adverse events were presented by filling in diaries issued for each patient. This study was approved by the local Research Ethics Committee. Result(s): We included 19 adolescents, aged between 12 to 17 years, who met the inclusion and exclusion criteria. The mean age was 14.63 +/- 2.01 years. Of these, 68.4% were female. In relation to CIMD, 31.6% have Juvenile Idiopathic Arthritis and 68.4% have Systemic Lupus Erythematosus. All were vaccinated with the Pfizer vaccine. In the 1st dose, the main adverse effects presented were Pain at the injection site (85.7%), Headache (42.9%), Tiredness (33.3%) and Edema and skin induration at the injection site (26, 7%). After the 2nd dose, the only adverse effect reported was Pain at the injection site (57.1%), with no other complaints. Conclusion(s): The adverse effects reported are of mild tomoderate reactogenicity;no serious adverse events were reported.

Analysis of the impact of the COVID-19 pandemic on the public transport system by bus in Brazil

This article analyzes the impact of the COVID-19 pandemic on public transport by bus in two Brazilian metropolia, Belo Horizonte and Joao Pessoa. Spearman's correlation pointed out a strong relationship between the variation in the number of passengers transported and the restrictive measures to combat the COVID-19 pandemic showing that they probably dictated the use of public transport by the population. However, the correlation between the number of new confirmed cases of COVID-19 and the variation of transported users was weak in Belo Horizonte and insignificant in Joao Pessoa. Given the influence of the stringency measures, the significant differences in correlation values with the variation of passengers were identified and proven, being 60% in Belo Horizonte and 76% in Joao Pessoa. The causality test confirmed that the pandemic intensified the drop in demand for public transport. Therefore, the more severe the policy to combat the transmission of the virus, the greater the relationship with the decrease in demand for buses. Thus, the pandemic was responsible for a significant drop in the number of passengers than the estimated trend for the same period. Finally, results show a crisis in the public transport system by bus in Brazil and the urgent need to rethink strategies to attract users to this service.

Severe Acute Liver Injury due to Secondary Hemophagocytic Lymphohistiocytosis: A Case Report

Severe acute liver injury (ALI) is mostly triggered by viral infections and hepatotoxic drugs;however, it can also be seen in systemic diseases. Hemophagocytic lymphohistiocytosis (HLH) is a rare, immune-mediated syndrome that presents as a life-threatening inflammatory disorder affecting multiple organs. Secondary causes occur mainly in the set of malignancy, infection, and autoimmune disease, and are seldom triggered by vaccination. Although liver involvement is common, presentation as severe ALI is rare. We describe a case of a 65-year-old male with history of low-risk chronic lymphocytic leukemia and rheumatoid arthritis treated with prednisolone who presented with persistent fever and jaundice 1 week after COVID-19 vaccination. The diagnosis was challenging given the predominant liver impairment, characterized by hyperbilirubinemia, transaminases over 1,000 U/L, and prolonged INR, which prompted an extensive investigation and exclusion of autoimmune, toxic, and viral causes of hepatitis. Laboratory workup revealed bicytopenia, hyperferritinemia, which together with organ failure and evidence of hemophagocytosis in bone marrow suggested the diagnosis of HLH. After excluding infectious etiologies, flare of rheumatological disease, and the progression of hematological disease, HLH was diagnosed. He was successfully treated with etoposide and corticosteroids, with dramatic improvement of liver tests. After exclusion of other causes of secondary HLH, the recent vaccination for COVID-19 was the likely trigger. We report a case of double rarity of HLH, as it presented with severe liver dysfunction which was probably triggered by vaccination. In this case, the predominant liver involvement urged extensive investigation of liver disease, so a high index of suspicion was required to make an early diagnosis. Clinicians should consider HLH in patients with unexplained signs and symptoms of systemic inflammatory response and multiorgan involvement, including severe liver involvement as the first presentation. © 2023 S. Karger AG. All rights reserved.

In between the Pandemic and Populism: A look into the 2021 female presidential candidates in Portugal

The COVID-19 pandemic changed the form and substance of the official campaign for the 2021 Portuguese presidential elections. It called for several adjustments to planned campaign actions, constraining candidates' mobility and popular mobilization. This context favored the fermentation of populist discourses and the radicalization of political debate. These circumstances led to an unprecedented electoral contest in the recent history of democracy in Portugal. One of the least explored topics in studies about populism is gender and the place of women in the globalized society. In this context, this paper examines the media coverage of the 2021 Portuguese presidential elections in television news services of the following channels: RTP1, SIC, TVI and CMTV. This analysis covered the period of the official campaign and focused on the two female candidates, Ana Gomes and Marisa Matias. © 2022 Associacao Portuguesa de Estudos sobre as Mulheres. All rights reserved.

Resposta Ao Tratamento: Eltrombopag Na Pediatria

Objetivos: Descrever dois casos clinicos de pacientes Portadores de Trombocitopenia Imune (PTI) cronica que apresentaram boa resposta terapeutica ao uso do Eltrombopag. Materiais e metodos: As informacoes foram obtidas atraves de revisao de prontuario eletronico. Relato de caso: Caso 1: Paciente 7 anos, diagnostico de PTI ha 1 ano e 4 meses, refratario a tratamento com corticoterapia e imunoglobulina. Iniciado Eltrombopag com dose primaria de 25 mg dia, sem resposta apos 1 mes, progredida dose para 50 mg dia com uma resposta plaquetaria apos 34 dias de 21000 U/mm3 para 169000 U/mm3, sem intercorrencias clinicas. Caso 2: Paciente 14 anos, PTI pos COVID, diagnosticado ha 1 ano e 11 meses, refratario a terapia com corticoide, imunoglobulina e azatioprina, iniciado Eltrombopag 50 mg dia com resposta plaquetaria apos 1 mes de 15000 para 401000 U/mm3, sem intercorrencias clinicas. Discussao: A trombocitopenia imune caracteriza-se por um processo imunomediado, onde ocorre a degradacao de plaquetas com contagem total menor 100,000U/mm3. e classificada como cronica quando o tempo de doenca ultrapassa 12 meses e pode trazer grande morbidade aos seus pacientes, nao so pelos sintomas e prejuizo na qualidade de vida, como pelos efeitos colaterais das terapias a longo prazo. o presente estudo relata 2 casos de trombocitopenia imune cronica em criancas, refrataria as terapias tradicionais, que apresentaram boa resposta terapeutica ao uso de Eltrombopag. O Eltrombopag e um agonista oral nao peptidico do receptor da trombopoietina que age estimulando a producao de plaquetas. Um estudo randomizado, multicentrico, controlado por placebo, PETIT 2, comprovou a eficacia e seguranca do uso do Eltrombopag na faixa etaria pediatrica, estabelecendo as doses iniciais de 25 a 50 mg/dia para pacientes de 6 a 17 anos, sendo sua dose maxima diaria recomendada de 75 mg. Nos estudos PETIT e PETIT 2, o tratamento com Eltrombopag demonstrou uma resposta plaquetaria satisfatoria, contagem de plaquetas de pelo menos 50,000U/mm3, entre 1 e 6 semanas de uso, sem necessidade de terapia de resgate. foram observados tambem uma reducao nos sangramentos e de medicacoes concomitantes. nao foram constatados eventos adversos graves, e os efeitos relativos a medicacao encontrados se relacionavam a alteacoes laboratoriais hepatobiliares, logo tendo seus parametros de normalidade restabelecidos apos descontinuacao do uso.resultados semelhantes tambem foram encontrados em um estudo observacional de centro unico realizado na china. Embora ainda haja poucos estudos sobre o uso do eltrombopag na faixa etaria pediatrica, estes tem apresentado resultados semelhantes aos encontrados em adultos, porem sem descricao de eventos tromboticos ou malignidade. Copyright © 2022

Analysis of the Quality of Videos on Exercise Training in YouTube during the COVID-19 Pandemic: A Short Communication

Gambassi BB, de Melo MHF, Prazeres J, Almeida FJF, Costa CPS, Martins CA, Novais TM, Lauande Oliveira PL, Schwingel PA. Analysis of the Quality of Videos on Exercise Training in YouTube during the COVID-19 Pandemic: A Short Communication. JEPonline 2022;25(3):53-59. This study analyzed the quality of YouTube exercise training videos during the COVID-19 pandemic. A video search on the online video hosting platform YouTube was conducted on June 3, 2020. Videos are listed based on view counts, with the most viewed ones on the first page. We selected the ten most viewed videos in Portuguese and English using the keywords: COVID-2019;physical exercise;physical activity;exercise training. The video quality analysis showed that only 15% (n = 3) were in the high-quality group according to the GQS scores, whereas most of them were low-quality. In addition, only 30% (n = 1) of the high-quality videos were guided by a physical education teacher. We further identified the following points: (a) lack of applicability;(b) few details on the control of important exercise training variables;and (c) little scientifically based information. Therefore, the population must seek qualified physical education teachers to promote lifelong physical activity safely. © 2022, Journal of Exercise Physiology Online. All Rights Reserved.

Food security in the community of West African States: a study on policy decisions in the COVID-19 pandemic

The aim of this study is to analyze the policy decisions taken by countries in the Economic Community of West African States (ECOWAS) region to mitigate the impacts of the COVID-19 pandemic on the food supply. Information was drawn from the Food and Agriculture Policy Decision Analysis (FAPDA), which depicts policy decisions implemented to mitigate impacts with respect to food security. After analyzing these data in relation to the indicators of the Global Food Security Index (GFSI), it was found that policy decisions were centered on the dimensions "access to food" and "availability of food". In terms of access to food, we highlight food transfer policies in kind and social protection measures policies. In terms of food availability, macroeconomic policies and policies to support food production stand out. The effects of the pandemic have heightened the risk of food insecurity, particularly in sub-Saharan Africa.

Correction: PTH-60 Impact of SARS-CoV-2 pandemic on the IBD advice line- a single centre experience (Gut (2021) 70 (A203-A204) DOI: 10.1136/gutjnl-2021-BSG.375)

Selvarajah U, Martins C, Fraser B, et al. PTH-60 Impact of SARS-CoV- 2 pandemic on the IBD advice line- a single centre experience. Gut 2021;70:A203-A204. doi:10.1136/ gutjnl-2021- BSG. 375 Nur Nurmahomed should be included in the as first author. © 2022 BMJ Publishing Group. All rights reserved.

Infection in asymptomatic carriers of SARS-CoV-2 can interfere with the achievement of robust immunity on a population scale

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread worldwide as a severe pandemic, and a significant portion of the infected population may remain asymptomatic. Given this, five surveys were carried out between May and September 2020 with a total of 3585 volunteers in the municipality of Foz do Igua..u, State of Paran.., a triple border region between Brazil/Argentina/Paraguay. Five months after the first infection, volunteers were re-analysed for the production of IgG anti-Spike and anti-RBD-Spike, in addition to analyses of cellular immunity. Seroconversion rates ranged from 4.4% to a peak of 37.21% followed by a reduction in seroconversion to 21.1% in September, indicating that 25% of the population lost their circulating anti-SARS-CoV-2 antibodies 3 months after infection. Analyses after 5 months of infection showed that only 17.2% of people still had anti-RBD-Spike antibodies, however, most volunteers had some degree of cellular immune response. The strategy of letting people become naturally infected with SARS-CoV-2 to achieve herd immunity is flawed, and the first contact with the virus may not generate enough immunogenic stimulus to prevent a possible second infection.

SARS-CoV-2 serosurvey among adults involved in healthcare and health research in Guinea-Bissau, West Africa.

OBJECTIVES: Many African countries have reported fewer COVID-19 cases than countries elsewhere. By the end of 2020, Guinea-Bissau, West Africa, had <2500 PCR-confirmed cases corresponding to 0.1% of the ∼1.8 million national population. We assessed the prevalence of SARS-CoV-2 antibodies in urban Guinea-Bissau to help guide the pandemic response in Guinea-Bissau. STUDY DESIGN: Cross-sectional assessment of SARS-CoV-2 antibody in a cohort of staff at the Bandim Health Project. METHODS: We measured IgG antibodies using point-of-care rapid tests among 140 staff and associates at a biometric research field station in Bissau, the capital of Guinea-Bissau, during November 2020. RESULTS: Of 140 participants, 25 (18%) were IgG-positive. Among IgG-positives, 12 (48%) reported an episode of illness since the onset of the pandemic. Twenty-five (18%) participants had been PCR-tested between May and September; 7 (28%) had been PCR-positive. Four of these seven tested IgG-negative in the present study. Five participants reported that somebody had died in their house, corresponding crudely to an annual death rate of 4.5/1000 people; no death was attributed to COVID-19. Outdoor workers had a lower prevalence of IgG-positivity. CONCLUSIONS: In spite of the low official number of COVID-19 cases, our serosurvey found a high prevalence of IgG-positivity. Most IgG-positives had not been ill. The official number of PCR-confirmed COVID-19 cases has thus grossly underestimated the prevalence of COVID-19 during the pandemic. The observed overall mortality rate in households of Bandim Health Project employees was not higher than the official Guinean mortality rate of 9.6/1000 people.

Entrepreneurial alertness in different generations

Under COVID 19 environment it is important to analyse if there are differences between generations (X, Y, Z) within the context of entrepreneurial alertness (EA), and its influence in the creation of a new business. This study used a quantitative methodology trough a survey by questionnaire based on a sample of 978 people organized by age groups. We used, an exploratory factor analysis with principal components and varimax rotation, a one-way analysis of variance (ANOVA) by Tamhane Test and a linear regression model. An exploratory factor analysis is presented, to assess the dimensions of the entrepreneurial alertness from which two factors were obtained: the competence of processing information and establish connections to assure a profitable business (F1) and the capability of searching information and acknowledging opportunities (F2). Then, were applied one-way ANOVA and a linear regression model to compare different generations in relation with EA, and its relation to create a new business. The results demonstrate that generation Z has less propensity than generation Y in respect to F2. Besides F1 has the same importance for all generations. We found either, that the X generation has lower propension to start a new business. Testing the effects of different dimensions of EA, through a linear regression, with the propensity to develop a new business, we confirm that only F1 is significative while F2 is partial rejected. This research contributes to the field by demonstrating how different generations assign distinct relevance to entrepreneurial alertness dimensions and its importance to promote a new activity. © 2021, Academic Conferences and Publishing International Limited. All rights reserved.

Modified CHA2DS2-VASc can predict mortality in COVID-19 patients admitted to the emergency department

Introduction: CHA2DS2-VASc score is used to determine the thromboembolic risk, but its prognostic value has been demonstrated in several cardiovascular (CV) diseases. Except for female gender, many CV risk factors comprising this score are recognized as risk factors for mortality in COVID- 19. Cetinak G. et al demonstrated the ability of modified CHA2DS2-VASc (M-CHA2DS2-VASc) to predict mortality in COVID-19, which is based on changing gender criteria from female to male. Purpose: To evaluate the prognostic value of a M-CHA2DS2-VASc score to predict pulmonary embolism (PE) and mortality in pts with COVID-19 admitted at the emergency department (ED). Methods: Retrospective study of pts admitted to the ED between June 2020-January 2021, who underwent computed tomography pulmonary angiography (CTPA) due to PE suspicion. Pts were stratified into 3 MCHA2DS2- VASc risk groups: lower (0-1), intermediate (2-3) and high risk (≥4). Kruskal-Wallis and X-square test were used to compare score risk groups. Logistic regression was used to determine predictors of PE and mortality. ROC curve was performed to evaluate the discriminative power of the score. Results: We included 300 pts: median age 71 years, 59% male. Hypertension (59%) chronic kidney disease (CKD, 33%), dyslipidemia (32%) and diabetes (28%) were the most common comorbidities. PE was diagnosed in 46 pts (15%). We found no difference in PE incidence according to MCHA2DS2- VASc groups (p=0.531) and it showed no predictive value for PE (OR: 1.050, p=0.596). The AUC of M-CHA2DS2-VASc was 0.52, suggesting no discriminative power to predict PE. Regarding mortality, M-CHA2DS2-VASc score was higher in non-survivors COVID-19 pts than in survivors [4 (IQR 3-5) vs 2 (1-4), respectively, p<0.001]. A multivariate logistic regression analysis was performed for mortality based on M-CHA2DS2-VASC, troponin, CKD and smoking history, and only M-CHA2DS2-VASc was identified as an independent predictor of mortality (OR: 1.406, p=0.007). Kaplan-Meier showed that MCHA2DS2- VASc score was associated with mortality: the survival rate was 92%, 80% and 63% in the lower, intermediate and higher MCHA2DS2VASc score risk group (logrank test p<0.001;Fig. A). Most of the pts in the cohort were hospitalized (83%), but 21 pts (17%) discharged from the ED. Among these pts, 33% (n=17) had low risk, 37% (n=19) intermediate risk and 29% (n=15) high risk for mortality according to the M-CHA2DS2VASc score. The Kaplan-Meier individual survival analysis for hospitalized patients (Fig. B) and for those discharged from the ED (Fig. C) showed that M-CHA2DS2-VASc score had a good discriminative ability to predict short-term mortality for both groups (logrank test p<0.001 and p=0.007, respectively). Conclusion: Considering the lack of validated scores to predict mortality in COVID-19 pts, the M-CHA2DS2-VASc might be a simple tool to predict short-term mortality in these pts, irrespectively of the need for hospitalization or not.

Resolutive results with oral corticosteroids for patients with COVID-19 in pulmonary inflammatory phase. successful outpatient experience during the collapse of Belem do Para health system-Brazil

In the face of new diseases, medicine needs to reinvent itself in order to contain and control epidemics, such as the one we have recently faced, COVID-19, a disease with a wide spectrum of clinical severity. A new moment has been established, since the application of well-known, effective and safe medications for other diseases, has shown high success rates in the treatment of COVID-19. Thereunto, studies with early intervention are needed, which can change the unfavorable outcome of patients. In this article, we report the successful experience using an oral strategy during the collapse of Belem (Para, Brazil) Health System. Two hundred and ten patients were diagnosed with respiratory failure due to COVID-19, with no option of hospital treatment due to lack of beds and resources. These patients were then started on therapeutic regimen consisting of 40 mg prednisolone, 40 mg enoxaparin and macrolides (500 mg clarithromycin, 500 mg axetylcefuroxime) associated and followed in outpatient facilities. Two hundred and eight patients had an excellent therapeutic response and there were only two fatalities. These results push research boundaries, valuing outpatient treatment with early use of prednisolone in the initial pulmonary phase, preventing severe COVID-19 pneumonitis. Adoption of the proposed treatment intends to reduce the need for hospitalization, as well as lethality, with social robust benefits and incalculable economic savings since involves the use of accessible, safe and not expensive medications.

Food insecurity, food waste, food behaviours and cooking confidence of UK citizens at the start of the COVID-19 lockdown. (Special Issue: The future of food: responsible production, acquisition, consumption, and disposition.)

Purpose: The current pilot study explored food insecurity, food waste, food related behaviours and cooking confidence of UK consumers following the COVID-19 lockdown. Design/methodology/approach: Data were collected from 473 UK-based consumers (63% female) in March 2020. A cross-sectional online survey measured variables including food insecurity prevalence, self-reported food waste, food management behaviours, confidence and frequency of use of a range of cooking methods, type of food eaten (ultra-processed, semi-finished, unprocessed) and packaging type foods are purchased in. Findings: 39% of participants have experienced some food insecurity in the last 12 months. Being younger, having a greater BMI and living in a smaller household were associated with food insecurity. Green leaves, carrots, potatoes and sliced bread are the most wasted of purchased foods. Polenta, green leaves and white rice are the most wasted cooked foods. Food secure participants reported wasting a smaller percentage of purchased and cooked foods compared to food insecure participants. Overall, participants were most confident about boiling, microwaving and stir-frying and least confident with using a pressure cooker or sous vide. Food secure participants were more confident with boiling, stir-frying, grilling and roasting than insecure food participants. Practical implications This has implications for post lockdown policy, including food policies and guidance for public-facing communications. Originality/value: We identified novel differences in self-report food waste behaviours and cooking confidence between the food secure and insecure consumers and observed demographics associated with food insecurity.

Impact of covid-19 pandemic on non-covid-19 patients with decompensated liver cirrhosis

Introduction: The COVID-19 pandemic may have an important effect on non-COVID-19 patients, namely due to allocation of healthcare resources to COVID-19 patients. Outpatients with chronic conditions requiring frequent medical attention, like liver cirrhosis, may suffer a greater impact due to lack of access to consultations and a possible delay in emergency room admissions. Aims & Methods: Our aim is to evaluate the impact of the COVID-19 pandemic on non-COVID-19 patients with decompensated liver cirrhosis (DLC). A retrospective single center study was conducted, including patients admitted due to DLC from 15/03/2019 to 15/03/2021. DLC was defined, in cirrhotic patients, as admission due to ascites, spontaneous bacterial peritonitis (SBP), acute kidney injury (AKI), hepatic encephalopathy (EH), rupture of gastroesophageal varices (RGEV) and/or alcoholic hepatitis (AH). Hepatocellular carcinoma patients were excluded. Patients were allocated in two groups according to date of admission: COVID- 19 group (C group) if admitted between 15/03/2020 and 15/03/2021 and pre-COVID-19 group (pC group) if admitted in the previous year. Demographic, clinical and laboratory variables were compared between groups. Child-Pugh and Model for End-stage Liver Disease Sodium (MELDNa) were assessed at admission. Results: One-hundred-and-forty patients were included, 74 (53%) during COVID-19 pandemic (mean age 63±12 years, with 51 males), and 66 (47%) pre-COVID-19 (mean age 63±11 years, with 46 males). Alcohol consumption was the most frequent cause of cirrhosis in both groups. The majority of patients presented with Child-Pugh C in both groups and the mean MELDNa score at admission was 22±7 points in C group and 22±8 in pC group. The most common comorbid condition was diabetes (C group: n=15;20%;pC group: n=25;38%) and the mean Charlson Comorbidity Index was 5±2 points in both groups (p>0.05). The presentations of DLC, in C group and pC group, were respectively: ascites: 77% versus (vs) 73%;AKI: 39% vs 55%;HE: 50% vs 46%;RGEV: 14% vs 15%;AH: 14% vs 6%;SBP: 4% vs 14%. The median length of hospital stay was 8 days (IQR: 10) in C group and 11 days (IQR: 16) in pC group. Twelve patients died during hospital stay in C group (16%) and 12 in pC group (18%). The average time of follow-up was 156±119 days in C group and 112±100 days in pC group. Twenty-two deaths (30%) occurred during follow-up in C group and 15 (23%) in pC group;28 patients were readmitted during follow-up in C group (45%) and 26 (48%) in pC group. The absolute number of deaths was higher during COVID-19 (n=34 vs n=27), as well as the total number of admitted patients (n=74 vs n=66). However, mortality rates did not significantly differ in the two groups (46% vs 41%;p>0.05). SBP was more frequent in pC group (p=0.045). There was a tendency towards a higher number of first time DLC with AH during COVID- 19 (n=7 vs n=1, p=0.053). None of the other above-mentioned variables were significantly different between groups (p>0.05). Conclusion: During COVID-19 pandemic, we observed a higher absolute number of hospitalizations due to DLC and a proportional larger number of deaths. Nevertheless, severity at admission and mortality rates during and after hospitalization did not increase significantly during the pandemic period. There was a higher number of first time DLC with AH during COVID-19, which may reflect greater alcohol consumption during lockdown.