Use of viscoelastic tests in the intensive care unit for the evaluation of haemostasis in SARS-CoV-2 infection

Introduction: COVID-19 coagulopathy is associated with poor prognosis and a state of coexisting 'hypercoagulopathy' (HyperC) and hypofibrinolysis, only detected by viscoelastic tests (VET). VET technology has been useful in areas where conventional tests are inadequate, such as screening for HyperC, thrombotic risk assessment and systemic anticoagulants' effect. We aim to characterize the evolution profile of coagulopathy in patients with COVID-19 infection during their intensive care unit (ICU) stay. Method(s): Consecutive recruitment of adult COVID-19 patients admitted to our hospital's ICU, during a 6 months period. Patients with thrombosis in the previous 3 months, pregnancy, under hormone therapy, and congenital coagulopathies were excluded. VET were executed every 5 days, at discharge and in complications and all of them were under low weight molecular heparin (LMWH) therapy. Group 1 (G1), n = 24-less than 10 days in ICU and group 2 (G2), n = 16-more than 10 days in ICU. In G1 there was 1 death (day 3) and in G2 there were 5 deaths (between days 15 and 42). We focused current analysis on VET-Rotem parameters (see Fig. 1). Result(s): Prognostic scores APACHE II, SAPS II and SOFA were higher in G2, but surprisingly G1 patients are more obese. G2 patients had shorter aPTT and lower platelets. The variables CT-HepTem and MCF Extem-MCF-Fib-Tem present a greater difference between groups, but no statistical significance. We observed an initial correlation between basophils number (which is lower) on CT Intem and CT Hep-Tem, lost as progression to cure, probably due to cytoplasm heparin granules. As expected, VET were in accordance with HyperC: short CTs, increased MCFs, and decreased lysis. Conclusion(s): We expected to guide/adjust LMWH dosage, using Rotem profiles, however these were not corrected by LMWH, used transversally, and remained unchanged in all patients during their stay in ICU.

Sedation in the ICU: association between dexmedetomidine and 28-day mortality in patients with COVID-19

Introduction: The aim of our study is to evaluate the relationship between dexmedetomidine (DEX) use as a sedative agent in mechanical ventilated ICU patients and 28-day mortality. DEX, a selective alfa-2 adrenergic receptor agonist, widely used for its sedative and analgesic properties, has been linked to increasing parasympathetic tone, reducing the inflammatory response and oxidative stress [1]. Since severe COVID-19 is associated with an hyperinflammatory state, it is hypothesized that DEX might improve outcomes in these patients. Method(s): This is a retrospective observational study of mechanically ventilated patients admitted with COVID-19 pneumonia in the ICU of a tertiary center in Portugal, between March 2020 and December 2021. Logistic regression analysis was performed to evaluate the association of DEX use and 28-day mortality from time of intubation. Result(s): A total of 277 patients were analyzed, 151 in the DEX group and 126 in the no DEX group. Patients in the DEX group were younger (53.3 vs. 63.3 years, p < 0.001), had less comorbidities (2.8 vs. 3.5, p = 0.01), lower SOFA at admission (6.2 vs. 7.1, p = 0.01) but had a prolonged ICU stay (21.4 vs. 15.9, p < 0.001). Male gender (65.6 vs. 69.0, p = 0.54), incidence of obesity (56.3 vs. 46.8, p = 0.12), coronary artery disease (4.0 vs. 7.9, p = 0.16) and atrial fibrillation (4.0 vs. 7.1, p = 0.25) were similar between groups. PaO2/ FiO2 ratio at admission (111.1 vs. 108.1, p = 0.61), days spent in RASS < 3 (13.7 vs. 12.4, p = 0.31) and opioid use (14.8 vs. 13.1, p = 0.16) were also similar. From time of intubation, 28-day mortality in the cohort receiving DEX was 14.7% compared to 59.5% in the no DEX group (OR 0.12;95% CI 0.07-0.21;p = 0.01). Conclusion(s): Use of DEX was associated with lower 28-day mortality in COVID-19 critically ill patients requiring invasive mechanical ventilation in our study analysis. Considering the limitations of a retrospective observational study, RCTs are needed to confirm the results.

Risk factors for nosocomial infections in COVID-19 ICU population

Introduction: The aim of this study is to identify the factors associated with an increased risk of developing nosocomial infections (NI) in COVID-19 patients admitted with pulmonary involvement in the ICU. NI in COVID-19 ICU population are an important cause of morbidity and mortality worldwide and its prompt identification might lead to its prevention and better outcomes. Method(s): This is a retrospective observational study of patients admitted with COVID-19 pneumonia in the ICU of a tertiary center in Portugal, between March 2020 and December 2021. We considered NI as any infection acquired > 48 h post ICU admission. Clinical, analytical and baseline patient data were evaluated. Logistic regression analysis was performed to correlate patient related variables with the development of NI. Result(s): A total of 338 patients were enrolled, from which 167 (47.9%) presented with NI. Baseline characteristics are described in Table 1. In the logistic regression analysis, older age (OR 1.13;95% CI 1.03-1.25;p = 0.013), coronary artery disease (CAD) (OR 28.7;95% CI 1.92-429;p = 0.02), obesity (OR 3.14;95% CI 0.86-11.42;p = 0.008), chronic liver disease (CLD) (OR 104.33;95% CI 1,.04-1008.49;p = 0.04), use of dexamethasone (OR 21.89;95% CI 3.04-157.85;p = 0.002) and days in RASS < 3 (OR 1.4;95% CI 1.05-1.86;p = 0.02) were associated with an increased risk of developing NI in the ICU. Surprisingly, SOFA at admission, days of invasive mechanical ventilation, days of sedation and PaO2/ FiO2 ratio at admission, although statistically significantly different between groups, did not correlate with the risk of infection. Conclusion(s): We identified prolonged deep sedation, corticosteroid use, and patient characteristics (CAD, obesity, CLD, older age) as independent risk factors for NI development in COVID-19 critically ill patients. It is also noteworthy to point out for the presence of confounding variables, including the excessive workload in the ICU during this period, leading to an increase in NI numbers.

Outcomes of renal replacement therapy in critically ill COVID-19 patients

Introduction: Our goal is to describe outcomes of critically ill COVID-19 patients submitted to renal replacement therapy (RRT), in particular the association of RRT with mortality. Multi-system organ failure or direct kidney injury caused by SARS-CoV-2 is associated with the development of acute kidney injury (AKI) which subsequently increases the need for RRT and may affect the outcomes. Method(s): This is a retrospective observational study of 338 critically ill patients admitted with COVID-19 pneumonia in the ICU of a tertiary center in Portugal, between March 2020 and December 2021. Clinical, analytical and baseline patient characteristics were evaluated. Logistic regression analysis was performed to correlate patient data with the need for RRT and ICU mortality. Result(s): From a total of 338 patients, 5% required RRT (n = 16), 25% of which received intermittent hemodialysis (n = 4) and 87,5% continuous veno-venous hemofiltration (n = 14). Baseline characteristics are described in Table 1. In our sample, 61 patients (18%) presented with acute AKI, from whom 14 (23%) were submitted to RRT. From all the patients receiving RRT, 10 (62.5%) did not have pre-existing chronic kidney disease. In the logistic regression analysis, AKI (OR 45.4;95% CI 7.7-269.5;p < 0.001), higher SOFA (OR 1.24;95% CI 103-1.51;p = 0,03), creatinine (OR 2.01;95% CI 1.4-3.0;p < 0.001) and C-reactive protein (OR 1.09;95% CI 1.02-1.16;p = 0,01) on admission were associated with the need for RRT. Additionally, ICU mortality associated with RRT was 75% compared to 28.3% in the group not submitted to RRT (OR 7.6;2.4-24.2;p = 0.001). Conclusion(s): The need for RRT in critically ill COVID-19 patients is associated with an increased mortality rate in our study. We were also able to identify AKI, higher SOFA, creatinine and C-reactive protein at admission as risk factors for RRT. However, due to the retrospective nature of our analysis and our small sample size, more studies on this topic are needed to confirm these results.

Between Genocide and Necropolitics: The Struggle for Life of Indigenous People and Mining in the Amazon Facing the Covid-19 Pandemic

This article presents the analysis of the strategies of indigenous peoples to denou-nce the violation of rights and the threat to the lives of indigenous peoples, particu-larly with the advance and impacts of mi-ning on indigenous lands during the Co-vid-19 pandemic period. Mining in indi-genous lands has already been widely de-bated and denounced due to its social and environmental impacts, among others, and the situation was aggravated during the pandemic caused by the dissemination of the new coronavirus, in addition to the classification of mining activity as an es-sential activity, intensifying conflicts en-vironmental issues in the Amazon. For this discussion, data will be presented from documents, reports, campaigns, pre-pared by representative organizations of indigenous peoples in the defense of life and their territories against the institutio-nal offensive of the government in protec-ting the rights of indigenous peoples in Brazil pointed out in this work as necropo-litics. This analysis will be carried out from the decolonial perspective, unders-tanding that such offensive is located in what has been called necropolitics, which points to the role of native peoples in the capitalist economy and the economic im-portance of mining as a counterpoint to the repertoire triggered by indigenous pe-oples in defense of life and its territories.

Collaboration strategies for COVID-19 vaccination: Experience of an Allergy and Clinical Immunology Department from a tertiary hospital

Background: Vaccination plays an essential role in controlling SARS-CoV- 2 pandemics. Due to initial concerns about hypersensitivity reactions (HR) to these new vaccines, our department, in articulation with Primary Healthcare Services (PHS) has developed several strategies to support COVID-19 vaccination. This work aims to describe those strategies and report the results. Method(s): The strategies developed for COVID-19 vaccination, from March to December 2021, included: 1) telephone support for health professionals (TS for HP) from the Vaccination Centres (VC), 2) priority appointments (PA) of patients classified as a higher risk for HR, 3) hospital vaccination of high-risk patients as defined by the national health authority. A retrospective and descriptive analysis of the support activity developed and from the data of patients vaccinated at the hospital in the same period were performed. Result(s): During the considered period, our department screened 1618 patients: 420 (26%) through telephone support for HP (TS for HP) from VC and 1198 (74%) at priority appointments (PA). After TS for HP, community vaccination (CV) was recommended in 87% (n = 364) of cases and a PA was advised in 13% (n = 56). Of the patients evaluated in PA, 80% were recommended CV, with restriction of the vaccine to administer in 28% of them. We always found an option to vaccine all. At the hospital were vaccinated 178 patients, 83% (n = 147) women, median age (P25-75) 61 (46-76) years. Hospital vaccination criteria were: past history of multiple drug HR (n = 93;52%), HR to vaccines (n = 46;26%), HR to the 1st dose of anti-SARS- CoV- 2 vaccine (n = 30;17%), idiopathic anaphylaxis (n = 10;6%) and systemic mastocytosis (n = 2;1%). 15% of patients (n = 26) performed skin tests with vaccines, which were negative in 25 and inconclusive in 1 case. 145 (82%) were first shots, 32 (18%) second shots, and one booster shot. Only one patient had a mild immediate reaction (2nd booster vaccination), promptly treated with antihistamine and corticosteroid. Conclusion(s): The collaboration strategies adopted by our department allowed the vaccination of 1618 patients and avoided vaccination delays in most of the VC contacts. In our sample, hospital vaccination of patients at higher risk for HR was safe.

Learning Music Theory Through Musical Theatre During a Pandemic

This research focuses on the application of Musical Theatre in the subject of Music Theory, in specialized Music Education. The issue to be explored is related to the development of new creative approaches in Music Theory Education, showing how Musical Theatre, through song, movement and performance, can contribute, as a pedagogic resource, to the implementation of strategies to promote musical, conceptual, attitudinal and motivation skills in musical learning. The methodology applied was action research, taking a first-grade Music Theory class as the target population with five students, aged between ten and twelve years, at the Castelo Branco Regional Conservatory (CRCB), Proença-a-Nova branch, during the 2019/2020 school year, and lasted 10 sessions. Surveys through questionnaires (applied at the beginning and end of the research), reflective summaries of classes and observation grids were used as research instruments. According to the evidence presented in the course of the study, the strategies adopted reveal a significant improvement in students' musical skills and knowledge, despite the limitations caused by Covid-19, positively contributing to their motivation and interest in the exploitation of musical content. In this sense, we conclude that the results obtained throughout the study reveal that the practical application of Musical Theatre in Music Theory classes can be a very significant pedagogical resource, substantially improving knowledge acquisition, interest and motivation for musical learning. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Adherence to protective mechanical ventilation in COVID-19 versus non-COVID-19-associated acute respiratory distress syndrome: Comparison between two prospective cohorts.

OBJECTIVE: To compare adherence to protective mechanical ventilation (MV) parameters in patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 with patients with ARDS from other etiologies. DESIGN: Multiple prospective cohort study. SETTING: Two Brazilian cohorts of ARDS patients were evaluated. One with COVID-19 patients admitted to two Brazilian intensive care units (ICUs) in 2020 and 2021 (C-ARDS, n=282), the other with ARDS-patients from other etiologies admitted to 37 Brazilian ICUs in 2016 (NC-ARDS, n=120). PATIENTS: ARDS patients under MV. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Adherence to protective MV (tidal volume ≤8mL/kg PBW; plateau pressure ≤30cmH2O; and driving pressure ≤15cmH2O), adherence to each individual component of the protective MV, and the association between protective MV and mortality. RESULTS: Adherence to protective MV was higher in C-ARDS than in NC-ARDS patients (65.8% vs. 50.0%, p=0.005), mainly due to a higher adherence to driving pressure ≤15cmH2O (75.0% vs. 62.4%, p=0.02). Multivariable logistic regression showed that the C-ARDS cohort was independently associated with adherence to protective MV. Among the components of the protective MV, only limiting driving pressure was independently associated with lower ICU mortality. CONCLUSIONS: Higher adherence to protective MV in patients with C-ARDS was secondary to higher adherence to limiting driving pressure. Additionally, lower driving pressure was independently associated with lower ICU mortality, which suggests that limiting exposure to driving pressure may improve survival in these patients.

Effect of Wearing a Face Mask on Vocal Self-Perception during a Pandemic

Objective. To analyze the vocal self-perception of individuals who wore face masks for essential activities and those who wore them for professional and essential activities during the coronavirus disease pandemic.Materials and Methods. This was an observational, descriptive, cross-sectional study. The study included 468 individuals who were stratified into two groups: the Working Group, comprising individuals who wore face masks for professional and essential activities during the pandemic;and the Essential Activities Group, with indi-viduals who wore face masks only for essential activities during the pandemic. The outcome measures tested were self-perception of vocal fatigue, vocal tract discomfort, vocal effort, speech intelligibility, auditory feedback, and coordination between speech and breathing. Descriptive and inferential statistics were performed. Results. Face masks increased the perception of vocal effort, difficulty in speech intelligibility, auditory feed-back, and difficulty in coordinating speech and breathing, irrespective of usage. Individuals who wore face masks for professional and essential activities had a greater perception of symptoms of vocal fatigue and discomfort, vocal effort, difficulties in speech intelligibility, and in coordinating speech and breathing.Conclusion. Use of face masks increases the perception of vocal symptoms and discomfort, especially in indi-viduals who wore it for professional and essential activities.

Helplessness and vulnerability to suicide in the pandemic

This article aims to analyze the vulnerabilities and psychosocial impacts of the pandemic of the Covid-19 in relation to the suicidal act. Starting from the concepts of prevention and health care, vulnerability and helplessness, bibliographic productions from the fields of public health, mental health and psychoanalysis were analyzed in order to investigate how the feeling of helplessness in the face of the pandemic and the situation of vulnerability affect those susceptible people to psychological suffering. The pandemic worsened the dimensions of social inequality and increased the conditions of vulnerability, mainly related to the sanitary, housing and health conditions of the population. For this, we consider that the strengthening of public policies -health, education and social welfare -can represent a confrontation with the pandemic and the collective feeling of anguish, fear and feeling of helplessness in the face of uncertainties.

Implementation of a Nationwide Online Exercise Program in Hemodialysis Patients

Background: Physical inactivity of HD patients was aggravated during the COVID-19 pandemic due to the imposed lockdown and suspension of ongoing intradialytic exercise program (IDE). To address this, we have developed an online exercise program (OLEP). The aim of this study was to analyze its implementation over a 12-weeks period. Method(s): Implementation study based on retrospective analysis using the REAIM framework (reach, effectiveness, adoption, implementation, maintenance). OLEP was proposed to 24 HD units previously offering IDE and included live online exercise sessions (3 times/week) led by 2 exercise physiologists via Zoom. For each RE-AIM dimension specific implementation outcomes were adapted to OLEP. Effectiveness measures included safety (adverse events during exercise sessions) and in-clinic physical function tests (sit-to-stand 5 and 30, 8-foot up and go (8UG), handgrip strength and single leg stance) performed at baseline and 12 weeks in a group of OLEP participants and a group of patients who refused to participate. Result(s): OLEP was adopted by 16 units (66.7%). Among 2063 patients of these units, 313 (15.2%) were eligible. Of those, 84 accepted to participate in OLEP (4.1% reach of all patients). Compared to refusals, OLEP participants had higher female proportion (p=0.009), higher education level (p<0.001), lower lean tissue index and handgrip strength (both p<0.001), and completed less steps/day (p=0.008). Maintenance in OLEP over the 12 weeks was 59.5%, i.e., 40.5% drop-out - of which 65% were voluntary. Implementation fidelity (patient's adherence to exercise sessions) was 73.1+/-18.8%, and implementation dose was 2.2+/-0.6 exercise sessions/week. Effectiveness: OLEP participants improved performance in all physical function measures (p<0.05), except in 8UG (p=0.677), whilst refusals did not (p>0.05);no severe adverse events were reported. Conclusion(s): Our data suggests that an OLEP is realistic, safe and may improve physical function. Therefore, its applicability may subsist beyond the pandemic and be used to complement IDE. However, strategies to increase proficiency to use mobile health technology may be needed to reach more patients.

Can we optimize d-dimer cut off value to predict pulmonary embolism in covid-19 patients?

Background: Covid-19 is associated with an increased risk of pulmonary embolism (PE) therefore, should the cut off d-dimer value be adjusted for these patients? Material(s) and Method(s): Retrospective and observational study to understand if there is a d-dimer cut-off that could guide clinics to perform a thoracic computed tomography angiography (CTA) in patients with covid-19. The population was covid-19 patients admitted to covid-19 dedicated wards of a University Hospital Centre for one year. Result(s) and Conclusion(s): 725 (52%) patients with covid-19 had a d-dimer value dosed during the first 5 days of the disease. Those, 63 (9%) did a CTA with a diagnosis of 16 (25%) PE. Gender was equally represented, median age was 70 years (ID=3.49) and the majority (94%) survived. Thirteen (81%) patients with PE had a d-dimer value above 2500 ng/mL (OR=9.244, 95% CI 2.248-9.837), with 7 (54%) with values over 10000 ng/mL, but in 3 (9%) it was under 1500 ng/mL. Seventy-three (63%) of patients with a d-dimer over 1500 ng/mL did not had a thoracic CTA performed. In our population PE was not a frequent outcome. The results are influenced by the low number of thoracic CTA performed because, even tough the cut-off d-dimer value used at our hospital to perform a thoracic CTA to exclude PE is 1500 ng/mL, most patients with that d-dimer value did not take the exam and so PE could not be excluded. Although in most PE cases the d-dimer value was above 2500 ng/mL, the results of our study cannot verify if that is a better cut-off value.

Variables associated with bleeding and thrombotic outcomes among patients admitted to the hospital with COVID-19 and elevated D-dimer: insights from the ACTION randomised clinical trial

Background: In the ACTION trial, therapeutic anticoagulation did not show benefit on mortality, days of hospitalization and oxygens therapy at 30 days among patients with COVID19. However, this strategy was associated with higher rate of bleeding and a potential reduction in the rate of clinical thrombotic events. The current analysis evaluated which variables were independently associated with both outcomes in order to help the identification of the risk for thrombotic and hemorrhagic events among patients with COVID19. Methods: A total of 615 patients hospitalized with COVID-19 and elevated D-dimer levels were randomly assigned to prophylactic anticoagulation (mainly in-hospital heparin) or a therapeutic strategy that used in-hospital rivaroxaban 20 mg daily for stable patients, or enoxaparin 1 mg/kg twice daily for unstable patients, followed by rivaroxaban through 30 days. One patient withdrew consent and was not included in the analysis. The current analysis tested baseline clinical characteristics and laboratorial exams one by one with independent logistic regressions for the composite of bleeding (major bleeding and clinically relevant nonmajor bleeding) and thrombotic events (venous thromboembolism, myocardial infarction, stroke, systemic embolism, and major adverse limb events). Significant variables (p<0.05) were selected to adjust several multiple logistic models. Final models were chosen based on Akaike information criterion and therapeutic anticoagulation was included in the final model based on the primary results of the trial. Results: The model for bleeding events showed an accuracy of area under the curve (AUC) of 0.635 (table 1) while the model for thrombotic events had an AUC of 0.725 (table 2). Level of respiratory support (especially invasive ventilation) was associated with both outcomes in the multivariable analysis (tables 1 and 2). Beyond respiratory support, level of creatinine and history of coronary disease were also independently associated to the risk of thrombotic events. When the utilization of therapeutic anticoagulation (mainly with rivaroxaban) was included in the multivariable analysis, this variable was strongly associated with higher risk of bleeding (model AUC of 0.718) but was not associated with lower rate of thrombotic events (Tables 1 and 2). Conclusion: Since the variables associated with higher risk of thrombotic events are similar to the variables associated to bleeding complications, the selection of patients with better balance of risk vs. benefit to use therapeutic anticoagulation in COVID-19 still a challenging decision. Coronary disease and creatine may help to identify patients at higher risk of thrombotic complications while the use of therapeutic dose of direct oral anticoagulant increased the risk of bleeding in almost 4 times among patients hospitalized due to COVID19. Funding Acknowledgement: Type of funding sources: Private company. Main funding source(s): Investigator initiated research with financial support of Bayer

Clinically Relevant Sound-Based Features in COVID-19 Identification: Robustness Assessment With a Data-Centric Machine Learning Pipeline

As long as the COVID-19 pandemic is still active in most countries worldwide, rapid diagnostic continues to be crucial to mitigate the impact of seasonal infection waves. Commercialized rapid antigen self-tests proved they cannot handle the most demanding periods, lacking availability and leading to cost rises. Thus, developing a non-invasive, costless, and more decentralized technology capable of giving people feedback about the COVID-19 infection probability would fill these gaps. This paper explores a sound-based analysis of vocal and respiratory audio data to achieve that objective. This work presents a modular data-centric Machine Learning pipeline for COVID-19 identification from voice and respiratory audio samples. Signals are processed to extract and classify relevant segments that contain informative events, such as coughing or breathing. Temporal, amplitude, spectral, cepstral, and phonetic features are extracted from audio along with available metadata for COVID-19 identification. Audio augmentation and data balancing techniques are used to mitigate class disproportionality. The open-access Coswara and COVID-19 Sounds datasets were used to test the performance of the proposed architecture. Obtained sensitivity scores ranged from 60.00% to 80.00% in Coswara and from 51.43% to 77.14% in COVID-19 Sounds. Although previous works report higher accuracy on COVID-19 detection, this research focused on a data-centric approach by validating the quality of the samples, segmenting the speech events, and exploring interpretable features with physiological meaning. As the pandemic evolves, its lessons must endure, and pipelines such as the proposed one will help prepare new stages where quick and easy disease identification is essential.

Between guidelines and standards: brazilian booklets on food and nutrition in the context of the covid-19 pandemic

The pandemic caused by the new coronavirus has impacted social interactions and lifestyle habits, including changes in the context of food. To promote health education, several food and nutrition guides were developed for the population. This study, of qualitative approach, carried out a reflexive analysis of four food and nutrition guides made during the pandemic, by content analysis, and identified three thematic axes: (1) meal planning;(2) cleaning of purchases and food;and (3) healthy eating food choice. The analyzed guides provide guidance on practical aspects of food and nutrition in this period of uncertainty regarding health protection. However, the approach to themes encompassing the individual's integral health such as: food security and cultural, symbolic, and macrosocial aspects related to food choices, showed a gap. Copyright © 2022, Universidade de Sao Paulo. Museu de Zoologia. All rights reserved.

Learning Music Theory Through Musical Theatre During a Pandemic

This research focuses on the application of Musical Theatre in the subject of Music Theory, in specialized Music Education. The issue to be explored is related to the development of new creative approaches in Music Theory Education, showing how Musical Theatre, through song, movement and performance, can contribute, as a pedagogic resource, to the implementation of strategies to promote musical, conceptual, attitudinal and motivation skills in musical learning. The methodology applied was action research, taking a first-grade Music Theory class as the target population with five students, aged between ten and twelve years, at the Castelo Branco Regional Conservatory (CRCB), Proença-a-Nova branch, during the 2019/2020 school year, and lasted 10 sessions. Surveys through questionnaires (applied at the beginning and end of the research), reflective summaries of classes and observation grids were used as research instruments. According to the evidence presented in the course of the study, the strategies adopted reveal a significant improvement in students’ musical skills and knowledge, despite the limitations caused by Covid-19, positively contributing to their motivation and interest in the exploitation of musical content. In this sense, we conclude that the results obtained throughout the study reveal that the practical application of Musical Theatre in Music Theory classes can be a very significant pedagogical resource, substantially improving knowledge acquisition, interest and motivation for musical learning. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Prevalence and impact of dysrhythmias in COVID-19 intensive care patients

Background: The COVID-19 pandemic has had a dramatic impact on clinical practice, amounting to more emergency department and intensive care unit (ICU) admissions. Due to their frequent multiple comorbidities, management in the ICU is challenging. Early studies suggest that cardiac injury is frequent in hospitalized patients with COVID-19, and it is plausible that these patients have a higher risk of cardiac dysrhythmias. Purpose: To determine the prevalence of dysrhythmias in ICU patients with COVID-19 pneumonia, identify major predictors and determine the impact on in-hospital mortality. Methods: A retrospective study of 98 consecutive patients with COVID-19 Pneumonia admitted to the ICU of a tertiary hospital in 2020. The main outcome was dysrhythmias (including significant bradycardia, high/slow ventricular rate or new-onset atrial fibrillation (AF) or atrial flutter, other supraventricular tachycardias, ventricular tachycardia and ventricular fibrillation). Significant bradycardia was defined as heart rate lower than 40 or need of treatment. Sociodemographic variables and clinical data were retrieved for each patient, severity scores at admission (Apache II, SOFA and SAPS II), number of days on mechanical ventilation or high-flow oxygen and placement on Venovenous Extracorporeal Membrane Oxygenation (ECMO) or prone position were recorded. Statistical comparison was made between groups, including logistic regression adjusting for confounding variables. Results: The most frequent arrhythmia was significant sinus bradycardia (28, 28.5%) followed by high ventricular rate AF (14, 14.2%). Patients who had dysrhythmias were older (66.24 ± 10.13 vs 60.85 ± 12.69 years, p 0.024), more severe (SAPS II score 42.55 ± 11.08 vs 35.98 ± 11.26, p 0.006), had more atrial fibrillation (AF) (p 0.022), had higher maximum C-reactive protein (mCRP) (6.56 ± 2.68 vs 6.24 vs 2.86, p 0.009), were mechanically ventilated for a longer time (15.64 ± 13.18 vs 8.92 ± 8.85 days, p 0.004), had longer intubation time (14.52 ± 9.39 vs 8.70 ± 8.21 days, p 0.002) and had higher usage of dexamethasone (p 0.042) and prone position (p 0.016). When adjusted for confounding variables, prone was the most significant predictor (OR 2.800;95% CI 1.203-6.516) followed by use of dexamethasone (OR 2.484;95% CI 1.020-6.050). Days intubated, days on mechanical ventilation, age, mCRP and SAPS II on admission were also predictors of dysrhythmia. Regarding mortality, patients with arrhythmic events had a tendency for greater in-hospital death (OR 2.440;95% CI 0.950-6.310;p 0.065). Conclusions: COVID-19 ICU patients are a subset of patients at risk of cardiac arrhythmias. Use of prone position was the main contributor to these events, but clinical history, severity and treatment may also play an important role. Efforts must be made to optimize ventilatory support and treatment in order to reduce the risk of dysrhythmias. (Figure Presented).

Practice of sanitizing the hands of the nursing team to avoid cross-contamination by COVID-19

Introduction: According to ANVISA, hands are the main source of transmission and dissemination of microorganisms, both for patients and for nursing professionals who work. One of the most used precautions as prevention of Covid19 was precisely the hygiene of the hands.