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This study analyzes the strategies and challenges identified in the beginning of the Covid-19 pandemic to the provision of schooling for special education students, particularly from the perspective of public primary education teachers. The data were generated by means of the responses of 937 teachers from across Brazil to an online questionnaire that was posted on an accessible platform and translated into Libras. Among the results, it was observed that despite pre-pandemic investments on digital technologies, remote learning was predominantly carried out using printed material, and teaching special education students was pointed out as the main challenge. It is expected that this study will contribute to mapping the implications of remote learning for special education. © 2023, Fundacao Carlos Chagas. All rights reserved.
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Introduction: Infection-related glomerulonephritis is well recognized and often included in the differential diagnosis in patients with ongoing infections. It can be missed, however, if the infection is unusual or undetected. We present three cases where the renal biopsy findings prompted the identification or treatment of systemic infections. Case Description: Case 1: A 84-year-old male presented with acute kidney injury (AKI) and a new purpuric rash. Clinically, IgA nephropathy was suspected. A renal biopsy showed active glomerulonephritis with abundant neutrophils, focal segmental tuft necrosis, and one cellular crescent. Predominantly mesangial immune complex deposits containing IgA and IgG were seen. The findings suggested IgA-rich infection-associated glomerulonephritis. Infectious workup was positive for COVID-19, suggesting exacerbation of IgA nephropathy by recent COVID-19 infection. Case 2: A 31-year-old female status post kidney transplant for granulomatosis with polyangiitis (GPA) had recent pregnancy with preterm delivery, disseminated herpes simplex virus (HSV) infection with HSV hepatitis, and AKI. Urine culture was positive for E. coli. The differential diagnosis included HSV nephritis, drug reaction, rejection, recurrent GPA, thrombotic microangiopathy (TMA), and pyelonephritis. A renal biopsy showed proliferative glomerulonephritis with subendothelial and mesangial immune complex deposits containing IgG and C3. The findings were most consistent with infection-related immune complex glomerulonephritis, most likely related to the HSV infection. Case 3: A 78-year-old female presented with AKI, proteinuria, hematuria, and positive p-ANCA. Clinically, ANCA vasculitis was suspected, and the renal biopsy did show focal, segmental, necrotizing glomerulonephritis. However, immunofluorescence and electron microscopy showed IgM-rich immune complex deposits in the mesangium. The unusual presentation of ANCA glomerulonephritis was suggestive of an underlying infection. Bartonella antibody panel showed very high titers;the patient was treated with antibiotics for Bartonella endocarditis. Discussion(s): Infection-related glomerulonephritis has a wide variety of presentations histologically and clinically. The three cases we present here emphasize the importance of recognizing these entities to help guide treatment and improve patient care.
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Introduction: Influenza seasonal infection claims half a million lives in the world every year due to complications. The most effective tool to prevent the seasonal flu infection is with an annual Influenza vaccine. Healthcare workers (HCW) are part of a high-risk occupational category, since they contact directly with flu patients, therefore the vaccination of these workers is paramount. After the breakout of the novel coronavirus disease (COVID-19), the prevention of the viral respiratory infections resurfaced to the public attention, including to HCW. The aim of this study is to evaluate the Influenza vaccination coverage of HCW in a general hospital located in Portugal (Centro Hospitalar do Baixo Vouga, Aveiro), in a 9-year timeframe. Material and Methods: This study determined the percentage of our hospital HCW who received the Influenza vaccine by our Occupational Health and Work Medicine Service, from 2012 to 2020. Results and Conclusions: Data shows a record-high vaccination coverage in 2020, the same year which the COVID-19 pandemic reached Portugal. Comparing to the previous year, data shows a 30% increase in the percentage of vaccinated HCW from all types (48,5% vs 37,4%). In comparison to 2019, the percentage of vaccinated nurse practitioners increased 24% (44,9% vs 36,1%) and the percentage of vaccinated physicians increased 46% (64,0% vs 43,9%). Although is not possible to assume causality, this study suggests a correlation between the breakout of the COVID-19 pandemic and the increase in HCW Influenza vaccination coverage of this hospital.
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Introduction: Occupational diseases are annually responsible for the death of approximately 2.0 million people worldwide. Healthcare workers are at higher risk of developing several occupational diseases such as infectious diseases, musculoskeletal disorders and mental distress. This study aims to provide a profile of the main notified occupational diseases and the affected workers in a Portuguese hospital over the last 5 years. Materials and Methods: A cross-sectional observational study was conducted using data from the Occupational Health Service of Centro Hospitalar do Baixo Vouga for the notified occupational diseases in hospital workers between July of 2016 and June of 2021. Results and Conclusions: A total of 355 cases of occupational diseases were notified among hospital workers in these 5 years. Our data showed that COVID-19 infection was the most reported disease since the onset of the current pandemic, with a total of 269 cases, 72 in the year 2020 and 197 in the first semester of 2021. Musculoskeletal disorders were the second most notified group of diseases, representing about 20% of all cases, and the most commonly reported diseases in the pre-pandemic years. Occupational diseases were more prevalent in nurses, followed by hospital aides and physicians. The notification of these diseases was highest among female workers. Ultimately, changes in working conditions and the introduction of new agents may give rise to emerging occupational health risks and diseases. The detection and investigation of these new diseases are essential from a perspective of early recognition and prevention.
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Introduction: Emergency healthcare workers (HCW) are the first point of contact for patients with traumatic injuries and acute illnesses. These professionals are at increased risk for respiratory and blood borne infections, as is the case of hepatitis B virus (HBV) infection and coronavirus disease 2019 (COVID-19). Vaccination is a major tool for preventing HBV infections. The protection provided by the COVID-19 vaccines are yet under evaluation. The objective of this study is to evaluate the HBV and COVID-19 vaccination coverage and the serological hepatitis B immunity among nurse aides working in the emergency department (EM) in a secondary hospital in Portugal. Material and Methods: A descriptive cross-sectional study was conducted by analyzing the Occupational Health Service database of Centro Hospitalar do Baixo Vouga in Aveiro, considering active nurse aides working in the EM in August 2021. Results and Conclusions: Of the total 71 workers included in the study, 61 (85.9%) had completed the vaccination against HBV. From these fully vaccinated HCW, 45 (73.7%) had confirmation of protective Hepatitis B surface antibody (HBsAb) levels (>10 mIU/mL) and 11 (18.3%) had unknown HBsAb levels. Regarding COVID-19 vaccination, 68 (95.7%) of the 71 total workers, had complete vaccination. From these, 43 (63.2%) had the last shot more than 6 months ago. Overall, there is a good adherence of nurse aides working in the EM to HBV and COVID-19 vaccination. In what concerns to HBV vaccination, it is important to implement a more robust system to diminish cases of workers only partially vaccinated or with unknown immunity status.
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In the last decade, we have seen an increase in the use cases of digital technologies in our daily lives, including advanced systems such as our mobile applications, smart digital kiosks for intelligent retailing, touch screens for ordering food, or simple implementations such as the ticket machines in the butchers. However, from the perspective of interaction design, those sensing systems suffer from a range of limitations like low usability and poor hygiene. For example, the elderly or the disabled normally have huge difficulties when interacting with these types of digital systems. Moreover, the recent SARS-CoV-2 pandemic has made us to rethink the contact manner for interaction with the digital devices. Hence, in this paper, we have presented a novel solution for digital interaction through a contactless manner. Such a system can provide human gesture recognition and therefore it can be integrated into others to achieve contactless control. We have implemented a prototype based on cost efficient sensors to validate the idea’s feasibility. A sequence of real world experiments has also been conducted to evaluate its performance. This system is composed with 1) piece of hardware–a grid of ultrasound sensors to capture the distance information from a human body;2) a piece of software to analyse the data for gesture predictions. The analysis results then will be transformed into control commands to interact with the attached system. The experimental results have shown that the proposed system is capable of providing a contactless Human Computer Interaction (HCI), and also has a great opportunity to replace existing touching interaction manner with a remote control scheme. CCBY
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The transnational nature of COVID-19 created expectations of regionally-led initiatives to address this global challenge. The pandemic has transcended health issues accounting for several political and socioeconomic implications. This study seeks to investigate four regional organisations' responses during the 'first wave' to unravel regionalism's role in a time of crisis. To do so, the method of comparative analysis has been employed. ASEAN, EU, AU and MERCOSUR, four distinct organisations were selected to evaluate their responses in terms of crisis management efficacy, level of solidarity, promotion of multilateralism and international actorness. The findings highlight each organisation's successes and shortcomings while indicating the limits of regional cooperation in effectively responding to outbreaks of infectious diseases. This empirical analysis shows that regional responses were limited and mainly facilitated national policies. This further indicates regional organisations' inability to have a more proactive role in crisis management, boost their actorness and advance more inclusive and responsive global governance.
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OBJECTIVE: Describes a case of an adult COVID-19, who was addmited patient admitted to an intensive care unit (ICU) and submitted to the prone position. CASE REPORT: Female patient, 44 years old, with a previous metabolic syndrome and acquired immuno-deficiency syndrome, arrived at the emergency department. She had fever, nasal congestion, but without dyspnea. After clinical and imaging tests, she was transferred to an ICU, with suspected COVID-19. Upon arrival at the intensive unit, she was breathing spontaneously with low flow oxygen therapy, presenting hypoxemia. In addition to the established medical therapies, he was instructed to position himself in the PP for a period of 15 to 30 minutes, performed once when turning. Arterial blood gases increase to 96mmHg in PaO2 and consequently 18% in the PaO2 / FiO2 ratio, in addition to the favorable clinical evolution. CONCLUSIONS: The early indication of PP as an additional therapy in the treatment of COVID-19 patients, can have contributed to the favorable clinical outcome, especially with regard to oxygenation, evidenced by the improvement of PaO2 parameters, PaO2/FiO2 ratio and progress discharged. © 2021 Editora Universitaria da PUCRS. All rights reserved.
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OBJECTIVE: To build and validate a checklist for disinfecting ambulances transporting patients with Covid-19. METHOD: Methodological study composed by the construction of a checklist and validation by 42 professionals, of which 35 professionals had expertise in patient transport/transfer and seven in hospital infection control. The item with a minimum agreement of 80% was considered valid, based on the Content Validation Index and binomial test. RESULTS: The checklist had the steps performed for terminal disinfection of ambulances. It had 54 items, which included the personal protective equipment and used materials, disinfection of the driver's cabin, equipment, and the patient care cabin. The minimum agreement obtained was 85% and the mean of the Content Validation Index was 0.96. CONCLUSION: The checklist was considered valid in terms of content and can be used to disinfect ambulances transporting patients with Covid-19.
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The U.S. Food and Drug Administration (FDA) has stated that the prescription of remdesivir should be cautious for patients with estimated glomerular filtration rate (eGFR) < 30 and some studies reported risk of adverse renal events. The available information on the renal safety profile for remdesivir is limited, thus we analyzed the renal and urinary adverse reactions attributed to remdesivir reported in a large open pharmacovigilance database. We obtained reports of remdesivir and other drugs used to treat COVID-19 (tocilizumab, hydroxychloroquine, lopinavir/ritonavir) registered by September 30 2020, from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS). We analyzed the reporting odds ratios (RORs) for reports of adverse renal and urinary events for remdesivir and other drugs. We found 2,922 reports with remdesivir registered in FAERS for COVID-19. Among these, 493 renal and urinary adverse effects (16.9%) were reported. The most frequent events were acute kidney injury (338;11.6%), renal impairment (86;2.9%), and renal failure (53;1.8%). Versus hydroxychloroquine, lopinavir/ritonavir, or tocilizumab, the use of remdesivir was associated with an increased chance of reporting renal and urinary disorders regardless of gender and age of patients (2.53;95%CI: 2.10-3.06). The ROR remained significant when we restricted the analysis to hydroxychloroquine (4.31;95%CI: 3.25-5.71) or tocilizumab (3.92;95%CI: 2.51-6.12). Our results reinforce this already reported signal, emphasizing that it could be extremely useful for health professionals who prescribe this new antiviral to treat COVID-19, mainly knowing its low efficacy.