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Shared mobility has emerged in urban spaces as an alternative to owning and maintaining a vehicle, by allowing flexible and short-term mobility services at low costs. These mobility options act as promising sources of trips benefiting people in vulnerable groups and enabling them to access essential services such as healthcare and providing transport during emergency evacuations. Shared mobility services can also make the cities more sustainable and healthy for all inhabitants by reducing the number of circulating vehicles. Fewer vehicles in the urban traffic makes the air cleaner and the environment less noisy, reducing risks of respiratory, and cardiovascular diseases and improving the people's health-related quality of life. However, managing shared mobility services intensifies transport challenges. Amid these challenges are reducing operational costs and diminishing health hazards such as the ones posed by COVID-19. © 2021 Elsevier Ltd. All rights reserved
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Noise pollution has been one of the main causes of citizens' discomfort in the urban centers in Brazil, an issue enhanced by the Covid pandemic that resulted in an increase of noise complaints, especially those related to noise from construction sites. This context triggered the construction industry to pursue solutions to understand the acoustic reality and minimize the impacts through regulations that require long-term noise measurements. Due to the necessity of a comprehensive evaluation in several locations, class 1 Sound Level Meters measurement systems can hardly be considered because of their high costs. This paper discusses the practical implementation of MEMs in a low-cost monitoring system for urban noise, focusing on construction sites. The prototype, based on a Raspberry Pi (a single-board computer model widely used in IoT projects) and a MEMs microphone with I2S interface for high-fidelity digital audio communication, was compared in a controlled environment to a Sound Level Meter of Class 1 through validation tests, such as calibration, frequency response, and dynamic range. Field measurements were also carried out in typical urban noise-generating sound environments. © 2022 Internoise 2022 - 51st International Congress and Exposition on Noise Control Engineering. All rights reserved.
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Objetivos: Alteracoes em parametros laboratoriais sao descritos na infeccao por SARS-Cov-2. O objetivo deste trabalho foi analisar o comportamento de parametros do hemograma em relacao a infectividade do virus determinada pelo numero de ciclos (CT) do PCR, realizados em um laboratorio de referencia no periodo de fevereiro a junho de 2020. Material e metodos: Foram incluidos 1.218 portadores de SARS-Cov-2 detectados por RT-PCR (plataformas Roche 6800, Cepheid, protocolo Charite e kit Xgen), e 828 controles (sindromes gripais com RT-PCR negativo para SARS-Cov-2). O hemograma foi realizado no equipamento XN-10 (SYSMEX) com revisao em lamina e foram analisados os seguintes parametros: nivel de hemoglobina (Hb), numero de eritroblastos, leucocitos totais, neutrofilos, linfocitos, eosinofilos, desvio a esquerda (presenca de metamielocitos), numero de linfocitos atipicos e niveis plaquetarios. Os pacientes foram divididos em grupos a partir do CT: grupo 1 (1 a 20), grupo 2 (21 a 30), grupo 3 (31 a 40) e grupo 4 (> 40). Para comparacao entre grupos foram utilizados os testes ANOVA ouKruskal-Wallis e comparacoes multiplas pelos testes de Tukey e Dunn. Resultados: Das 1.218 amostras de infectados, 322 pertenciam ao grupo 1 (alta carga viral), 554 ao grupo 2 (moderada carga viral), 328 ao grupo 3 (baixa carga viral) e 14 ao grupo 4 (muito baixa carga viral). Houve diferenca significativa entre todos os parametros de hemograma com excecao do numero de eritroblastos em relacao a todos os grupos (controle e infectados em diferentes grupos de CT). A taxa de Hb foi menor nos grupos 2 e 3 em relacao ao controle. O numero de leucocitos foi menor no grupo 1 e 2 em relacao ao controle, e o numero de neutrofilos e leucocitos foram menores no grupo 1 em relacao a 2 e 3. O numero de linfocitos foi menor em 1, 2 e 3 em relacao ao controle, sendo menor no grupo 1 e 2 em relacao ao 3. O numero de eosinofilos foi menor nos grupos 1, 2 e 3 em relacao ao controle sendo menor nos grupos 1 e 2 em relacao a 3 e 4. A contagem plaquetaria dos grupos 1 e 2 foi menor em relacao ao grupo controle e apresentaram menores taxas em relacao aos demais grupos de infectados. Discussao: Os parametros laboratoriais do hemograma mostraram padrao semelhante ao observado em varias infeccoes virais com queda de Hb, leucocitos, eosinofilos e plaquetas nas fases com maior carga viral, com posterior recuperacao destes parametros. Entretanto, salienta-se que o grupo controle foi constituido por pacientes com sindrome gripal nao SARS-Cov-2, e, assim, e possivel considerar que o grupo de infectados peloSARS-Cov-2mostrou alteracoes mais significativas do hemograma desde o momento de alta carga viral ate a recuperacao em relacao ao grupo controle SARS-Cov-2 negativo. Estes dados refletem a fase inicial da pandemia durante a qual as linhagens predominantes foram B.1.1.28 e B.1.1.33 e na ausencia de imunizacao vacinal. Conclusao: Concluimos que ao se comparar os resultados laboratoriais de pacientes infectados pela primeira cepa do virus SARS-Cov-2, esses apresentaram maiores tendencias a queda dos parametros hematologicos durante o periodo com maior CV em comparacao a infeccoes por outros agentes etiologicos causadores de sindrome gripal. Copyright © 2022
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Objetivo: Analisar o perfil dos procedimentos de plasmaferese realizados pelo servico de aferese terapeutica. Material e metodo: Estudo descritivo e exploratorio com abordagem quantitativa. Analise retrospectiva e analitica realizada no Centro de Hematologia e Hemoterapia do Ceara, entre o periodo de janeiro de 2020 a dezembro de 2021. Os dados apresentados foram coletados a partir dos registros preenchidos em cada procedimento e tabulados em planilhas de excel mensalmente. As variaveis estudadas foram: indicacoes, genero, numero de sessoes, liquido de reposicao e reacoes adversas relacionadas aos procedimentos. Resultados: No periodo em estudo foram realizados 1.058 procedimentos, atendendo 203 pacientes. As principais indicacoes foram: sindrome de Guillain Barre 38 (18,7%), neuromielite optica 34 (16,7%), rejeicao mediada por anticorpo em transplante renal 20 (9,8%), recaida de glomeruloesclerose segmentar focal pos transplante renal 20 (9,8%), purpura trombocitopenica trombotica, (PTT) 17 (8,3%), miastenia gravis 16 (7,8%), encefalites imunes 13 (6,4%), mielites 11 (5,4%), vasculites 11 (5,4%), esclerose multipla 6 (2,9%), sindrome de Isaac 3 (1,4%), hiperviscosidade 6 (2,9%), esteatose hepatica da gravidez 4 (1,9%), sindrome de Goodpasture 1 (0,5%), Anti HLA pre transplante de medula ossea 1 (0,5%) e hipertrigliceridemia 1 (0,5%). Do total de pacientes, 76 (37,4%) eram do sexo masculino 127 (62,5%) do sexo feminino. O liquido de reposicao mais utilizado foi solucao salina com albumina, em 851 (80,4%) das sessoes. As principais reacoes adversas foram: hipotensao, parestesia e tremores, prurido e urticarias quando no procedimento foi utilizado o plasma como liquido de reposicao. O servico teve uma media mensal de 44,08 procedimentos. Discussao: A plasmaferese e uma tecnica que permite remover o plasma atraves de equipamento automatizado com finalidade terapeutica. Esse componente e substituido por outra solucao de acordo com a indicacao, acontecendo uma troca plasmatica e retirada de anticorpos e/ou toxinas. As indicacoes sao baseadas no guideline da ASFA- American Society for Apheresis. O numero de sessoes e definido de acordo com a recomendacao estabelecida no guidelin e e conforme avaliacao do medico hemoterapeuta e equipe assistente. Foi observado uma diferenca significativa em relacao ao genero, provavelmente relacionado ao carater imune das principais indicacoes e a relacao das doencas autoimunes com o sexo feminino. A plasmaferese e um procedimento capaz de reduzir a morbidade e mortalidade do paciente critico. O grande numero de procedimentos realizados mesmo durante a pandemia pode estar relacionado a reducao da disponibilidade de imunoglobulina humana no Brasil nos ultimos anos. Conclusao: Neste estudo, observamos aumento do numero de procedimentos de plasmaferese durante a pandemia de COVID. O numero de atendimentos foi maior ao sexo feminino do que ao sexo masculino e o liquido de reposicao mais utilizado foi solucao salina com albumina. Os procedimentos foram realizados ambulatorialmente e no ambito hospitalar, tanto em unidades COVID, como em unidades nao COVID, garantindo o acesso a aferese terapeutica nos casos em que ela foi necessaria. Copyright © 2022
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Introducao: O procedimento de plasmaferese tem como objetivo remover do sangue substancias patologicas. A primeira descricao de seu uso terapeutico ocorreu em 1952 em um paciente diagnosticado com Macroglobulinemia de Waldestrom. Desde entao, a plasmaferese tem sido empregada em diversas doencas, dentre essas, doencas neurologicas de etiologia imune. De acordo com o guideline da Sociedade Americana de Aferese (ASF), a plasmaferese e considerada categoria I (recomendacao em primeira linha de tratamento) em varias doencas neurologicas como por exemplo sindrome de Guillain Barre, polirradiculopatia desmielinizante cronica (PIDC) e miastenia gravis. Objetivo: O objetivo deste estudo e caracterizar o perfil epidemiologicos dos pacientes com diagnostico de doencas neurologicas submetidos a plasmaferese em 5 hospitais de Sao Paulo. Materiais e metodos: este e um estudo descritivo retrospectivo realizado atraves da revisao de prontuarios de pacientes submetidos ao procedimento de plasmaferese para tratamento de doencas neurologicas no periodo de janeiro de 2020 a junho de 2022. Foram analisados sexo, faixa etaria, numero de sessoes realizadas, diagnostico e variacao dos niveis de hemoglobina pre e pos procedimento. Resultados: Foram submetidos a plasmaferese 53 pacientes com diagnosticos neurologicos diversos. Destes, 34 (64,1%) eram do sexo feminino com uma mediana de idade de 40 anos. Diagnosticos incluidos: 12 neurites opticas, 8 miastenias gravis, 9 escleroses multiplas, 7 pacientes com sindrome de Guillan Barre, 5 mielites, 3 doencas desmielinizantes a esclarecer, 1 encefalite autoimune, 1 polirradiculopatia a esclarecer, 1 polineuropatia a esclarecer, 1 sindrome de Miller Fisher, 3 sindrome de Stiff-Person, 1 ataxia nao especificada e 1 neoplasia de sistema nervoso central. Todos realizaram troca de uma volemia plasmatica e 94% realizaram 5 sessoes. Dois pacientes realizaram apenas 3 sessoes (um paciente com diagnostico de neuromielite e uma miastenia gravis) e um realizou 7 sessoes (mielite pos covid). Seis pacientes nao foram submetidos a outros tratamentos (diagnosticos de miastenia gravis, esclerose multipla, sindrome de Stiff-Person e neurite optica). Todos os demais foram submetidos a pulso com corticoide, imunoglobulina ou rituximabe. A variacao media da hemoglobina foi de 0.14 pontos. Discussao: De acordo com os dados levantados, podemos perceber que a plasmaferese e indicada em diversas doencas neurologicas que nao estao classificadas na categoria I pela ASF. Esse numero de indicacoes em primeira linha pode estar aumentado devido a indisponibilidade de Imunoglobulina Humana neste periodo. Nos demais casos, a plasmaferese foi empregada apos pelo menos uma linha de tratamento. A demora para o confirmacao diagnostica devido a espera dos resultados de exames e tambem devido a evolucao lenta dos sintomas neurologicos dificulta a definicao da melhor abordagem terapeutica incluindo a indicacao da plasmaferese. Conclusao: A plasmaferese continua sendo amplamente empregada em doencas neurologicas de etiologia imune. A interacao entre as equipes de neurologia e hemoterapia sao essenciais para a correta indicacao do procedimento e planejamento terapeutico do paciente. Um estudo bem desenhado para avaliacao de resposta ao tratamento de forma objetiva, contribuira para adicionar dados em relacao a eficacia do tratamento. Copyright © 2022
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Backgroung: COVID-19 pandemic (SARS-CoV-2) has affected an increasing number of people worldwide, with death rates higher than previous viral epidemics. It is possible that NK cells, known to have great cytokine secreting potential are competent at the onset of the condition and that in some individuals, the viral load is able to exhaust them. Balance between tolerant (CD27- CD11b-), secretory (CD27+ CD11b-/ CD27+ CD11b+) and cytotoxic (CD27- CD11b+) NK cells involved in the inflammatory response and their anti-SARS-CoV-2 activity are still not well established. Strategies that can restore function of NK cells against the virus are worth investigating. Here, we aimed to characterize NK cells frequency, functional subtypes and maturation in early phase of COVID-19 patients, by Multiparametric Flow Cytometry (MFC). Methods: Peripheral blood from 15 COVID-19 patients in early stage of infection (day 1-14, confirmed by RT-PCR), categorized according comorbidities in: G1 (not oncologic;n = 6), G2 (oncologic;n = 3), G3 (hematologic neoplasms;n = 3) and G4 (without comorbidities;n = 3), and 10 healthy samples enrolled the study. Clinical and laboratorial data were collected from electronic medical records. Samples were stained with CD45, CD19, CD3, CD56, CD11b, CD27, acquired on a FACS Canto II (BD Biosciences) and data analyzed with FlowJo V10 software. Results: A lower frequency of lymphocytes was observed in the disease when compared to controls (P < 0.0001) and frequency of NK cells were similar in both groups (P = 0.6605). Although frequency of CD27- CD11b- NK cells was lower in the disease (P = 0.0109), there was a significantly higher frequency of CD27+ CD11b- NK cells in COVID-19 samples when compared to controls (P < 0.0001), featuring a mostly immature profile in the disease. On the other hand, no statistical significance was observed regarding the frequencies of CD27+ CD11b+ (P = 0.1370) and CD27- CD11b+ NK cells with a more mature profile (P = 0.3094). Amongst disease groups, no statistical significance was found regarding frequency of NK cells and G1 showed lower frequency of CD27- CD11b- NK cells (P = 0.0226), while G3 group had an increased frequency of CD27+ CD11b- NK cells (P = 0.0238) when compared to the other groups and controls. Finally, no statistical significance was found in the frequency of CD27+ CD11b+ (P = 0.6691) and CD27- CD11b+ (P = 0.6270) NK cells between disease groups and controls. Conclusion: Although the frequency of NK cells did not show a significant difference between COVID-19 patients and healthy controls, our findings showed a possible change in their maturation profile, which seems to be inversely proportional to normal, with the frequency of CD27+ CD11b- NK cells considerably higher in the disease. This phenotype is directly associated with secretory function of a more immature NK cell and is responsible for triggering inflammatory responses that could lead to severe respiratory failure, what seems to be consistent with COVID-19 profile. A high frequency of cytotoxic cells was observed, which seemed to be similar to what we found in normal heathy samples. Even though unregulated maturation might be associated to a dysfunctional mature NK cell, additional studies of cytotoxicity and activation of NK cells in COVID-19 are required to affirm whether there is functional exhaustion or hyperactivation of the cytotoxic subtypes of these cells.
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Introdução: A COVID-19 é uma infecção causada pelo vírus SARS-CoV-2, descrita no final de 2019, que ocasionou uma pandemia devido à sua alta transmissibilidade. Em geral, cursa sem alterações clínicas ou com sintomas leves, porém em 5-10% dos casos pode causar quadros graves, inclusive com óbito. Manifestações críticas parecem mais comuns em indivíduos com comorbidades como hipertensão arterial sistêmica e obesidade. Entretanto, como a descrição da doença é recente, há poucos estudos que esclareçam sua história natural e o grande espectro de manifestações clínicas. Considerando que indivíduos com neoplasia maligna apresentam deficiência imunológica e maior risco de doenças infeciosas oportunistas, é possível que haja uma maior incidência da COVID-19 nesse grupo. As recomendações atuais orientam adiar tratamentos e utilizar drogas menos tóxicas quando possível. Entretanto não sabemos o quanto tais medidas terão implicações na mortalidade por câncer. Além disso a incidência de COVID-19 nessa população ainda não é conhecida. Não se sabe se os sintomas infecciosos são um bom parâmetro para motivar mudanças terapêuticas ou se há benefício em testar indivíduos assintomáticos. Objetivos: Determinar a incidência de infecção por SARS-CoV-2 por meio de RT-PCR em pacientes com neoplasias malignas em quimioterapia. Em paralelo, verificar a evolução do quadro clínico dos pacientes infectados e determinar o impacto do screening no tratamento destes pacientes. Métodos: Realizou-se o RT-PCR para o SARS-COV-2 em uma coorte prospectiva de 100 pacientes adultos portadores de câncer em tratamento quimioterápico no serviço de Hematologia e no serviço de Oncologia do Hospital das Clínicas da FMRP-USP e assintomáticos para COVID-19. Além disso, foram coletados dados clínicos de seus prontuários eletrônicos através de questionários no REDCap. A análise estatística foi realizada com o software Graphpad Prism versão 9. Resultados: Apenas dois pacientes foram diagnosticados com COVID-19. Um deles desenvolveu sintomas, mas nenhum apresentou manifestações graves. Os dois apresentavam diagnóstico de neoplasia maligna gastrointestinal. Nenhum fazia uso de profilaxias infecciosas. Ambos tiveram seus tratamentos postergados inicialmente e reiniciados após o período apropriado de isolamento. Discussão: O presente estudo encontrou uma incidência de COVID-19 de 2% (IC 95% 0,5-7%) em pacientes assintomáticos com câncer em quimioterapia, que pode ser considerada como baixa. A incidência nessa população relatada na literatura varia de 0,72% a 8%, o que pode se justificar pelas diferentes incidências locais e pela adoção de medidas preventivas. Conclusão: Diante do número reduzido de casos positivos detectados, acreditamos que seja razoável não testar todos os pacientes em um contexto de saúde pública, priorizando aqueles com sintomas, aqueles com contato recente com casos suspeitos e aqueles com maior chance de desfecho grave, como os portadores de neoplasias hematológicas, desde que as medidas preventivas sejam corretamente adotadas.
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COVID-19 is an infectious disease caused by the virus SARS-CoV-2, which was first described at the end of 2019. Since then, it has affected a growing portion of the world's population because of its high transmissibility. Most patients are asymptomatic or present with mild symptoms, but approximately 5-10% of cases can develop more serious manifestations, such as severe acute respiratory syndrome, acute kidney injury, shock, myocardial injury and even death. These features seem to occur more commonly in patients with essential hypertension, diabetes mellitus, obesity and chronic pulmonary disease. However, there are few studies that clarify the natural history of the disease and its broad clinical spectrum owing to the fact that it is a new entity. Since individuals with malignancies tend to present some degree of immunological deficiency and are more prone to opportunistic infections, especially those being treated with immunosuppressive drugs, it is possible that this group has a higher incidence of COVID-19. The current recommendations of oncology specialists advise to postpone treatments and to use less toxic drugs when possible. However, we still do not know how much these measures will affect in cancer mortality. Also, the incidence of COVID-19 in this population remains undetermined. We do not know if infectious symptoms are a good parameter to motivate these therapeutic changes or if there is benefit to test asymptomatic patients. In this context, this research submitted 100 patients with hematological malignancies or solid tumors on chemotherapy at the Ribeirão Preto Medical School of the University of São Paulo's Hospital, asymptomatic for COVID-19, to RT PCR to determine the SARS-CoV-2 infection incidence in this population. Only two patients were diagnosed with COVID-19. Both had gastrointestinal cancer. One of them developed symptoms, but none presented severe manifestations. Both had their treatment postponed initially and reinitiated after the appropriate period of isolation. Hence, we believe that it's reasonable not to test every asymptomatic patient when the resource for that is scarce, prioritizing those at greater risk of infection and those more prone to severe outcomes as long as the appropriate preventive measures are being taken. Disclosures: Calado: Team Telomere, Inc.: Membership on an entity's Board of Directors or advisory committees;Agios: Membership on an entity's Board of Directors or advisory committees;Instituto Butantan: Consultancy;Alexion Brasil: Consultancy;AA&MDS International Foundation: Research Funding;Novartis Brasil: Honoraria.
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Issue/problem Covid-19 pandemic requires rapid responses. The reconfiguration of the psychosocial care network was needed to ensure access to all patients during this period. Description of the problem Psychosocial Care Centers (PCC) are strategic equipment for strengthening the mental health policy in Brazil. These services work with a multi and interdisciplinary team, aiming to assist crisis and rehabilitation processes of people with severe and persistent mental disorders or those with impairments due to the use of psychoactive substances. This work shares the experience of two PCC over the COVID-19 pandemic in São Paulo, Brazil. In April 2020, in front of the increasing Covid-19 cases and hospitalization, lack of hospital beds for mental health care, suspension of PCC group activities, and restriction of face-to-face assistance, it was necessary to adjust the PCC work process and physical structure. Results Telemedicine was implemented to assure assistance and monitoring. An internal flow was implemented to identify and assess patients seeking the service with respiratory symptoms and proceed with case notification if confirmed. A station for respiratory symptoms screening was settled outside the PCC, an isolation room to symptomatic respiratory patients was defined to medical assessment, and referral criteria to the emergency care established. To reinforce beds for hospitals in the region, inpatient beds were created in the PCC to attend hospitalization of acute crisis cases. Further, professionals from Primary Health Care were relocated and trained to support PCC assistance. Lessons This experience reaffirms the role of PCC as an articulator of the psychosocial network. Reorganization of PCC work process enabled the continuity of mental health outpatient care as well as rearguard from inpatient beds. Key messages The COVID-19 pandemic reinforce the necessity of integrated healthcare networks to provide care access and continuity of care. This experience reaffirms the role of PCC as an articulator of the psychosocial network.
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The objective of this study was to analyze associated factor to SARS-CoV-2 infection among dental professionals. This was a cross-sectional study carried out from February to September 2020 in the municipality of São Paulo, Brazil. We included all dental team working at 11 basic health units. Professionals included were from the three different categories oral surgeon-dentist, dental technician, dental assistant. The analysis included SARS-CoV-2 infection and independent variables (sociodemographic, labor and behavior) with descriptive analyses with absolute (n) and relative (%) frequencies, inferential analysis by chi-squared and Fisher exact test (p < 0.05). There was a prevalence of 20.3% of infection by SARS-CoV-2 between dental professionals. However, in the analysis by professional category the infection rate was 3.8 among oral surgeon-dentist, 30.0% among dental technician, 33.3% for dental assistant. The diagnostic of SARS-CoV-2 infection was associated with lower income (p = 0.027), lower level of formal education (p = 0.011), technical professional category (p = 0.025), and the use of public transportation (p = 0.009). The higher prevalence of COVID-19 in technical professionals than oral surgeon-dentists may suggest that infection had occurred outside the working environment, once professional had personal protective equipment available as well as the training for their professional activity. In addition, professionals reported to feel safe and prepared to perform their activities in the work environment. Key messages Transmission of SARS-CoV-2 in oral health in the public service. Promotion and prevention of SARS-CoV-2 transmission in oral health in the public service.
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Background : D-dimer tests are very important tests in follow-up and treatment of patients affected by infection by SARS-COV-2. These results are directly related to morbidity and mortality. Due to high and sudden demand, our institution faced to an unacceptable risk of lack of reagents, concomitantly to an increase of employees' sick pay in the laboratory's team. Aims : The present study aims to demonstrate the need to modify the flows of processing the laboratory tests in a critical situation, and with it offer to our clients a quick and reliable result. Methods : Before the pandemic, D-dimer tests were performed in two different methodologies. First, by immunoturbidimetry and for confirmation, just for results above 500 ng/ml, a immunoenzymatically test used to realized, both by automated equipment. This check was necessary for decreasing the risk for false-positive in patients affected by thrombosis. In the face of a risk scenario, we performed a fishbone diagram to identify possible causes for an effect or problem and a PDCA (plan-do-check-act) cycle to minimize the risks (Figure 1). In the first phase (PLAN), we planned a many actions involving doctors and laboratory professionals with the aim of reduce by 80% of repetitions of this test in 6 months. In the second phase (DO), we started a new flow operational, performed the test with just one methodology with close monitoring by medical team. Results : Checking our operational results (third phase), was observed 96% decrease in repetitions in 6 months (April to September) with an important cost reduction from around 27% (Figure). Conclusions : This joint work enabled a optimization of the equipments and reagents, wilth a improvement of our produtivity without losses of quality and security. Now we are in the last phase, when we are consolidating our new flow, with quarterly evaluations and continuous monitoring of technical and economical results.
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Background and aims: Neurological symptoms are reported in over 30% of COVID-19 hospitalized patients. However, systematic studies reporting these manifestations in ambulatory patients are still missing. We aim to characterize and compare neurological phenotypes in hospitalized and ambulatory COVID-19 patients. Methods: Retrospective study in patients with laboratory confirmation of SARS-CoV-2 infection in a tertiary hospital in the North of Portugal, between March 1st and April 30th. Data from hospitalized patients was collected through electronic medical records;ambulatory patients' data was collected using a structured telephonic survey. Results: From a total of 283 patients hospitalized in this period with COVID-19, 116 (40.9%) had at least one neurological manifestation. Mean age was 64 years (20- 100) and 58.6% were women (n=68). The most frequent manifestation was headache (24.7%), followed by myalgia (15.5%) and hyposmia (10.6%). Other neurological manifestations were reported in <10%. In this period, from 488 ambulatory patients infected with COVID-19, all but one reported at least one neurological manifestation (n=487). Mean age was 50.3 years (18-93) and 63% were women (n=307). Myalgia was the most frequent symptom (71.1%), followed by anosmia (65.4%), disgeusia (62.9%) and headache (58.4%). EPR302 Sleep disorders and cognitive complaints were also frequent (39.9% and 17.4%). Hypertension, diabetes, cardiovascular, lung and kidney disease were more prevalent in hospitalized patients. Conclusion: In the 1st systematic evaluation of neurological symptoms in outpatient COVID-19 patients we found an extremely high rate of neurological manifestations, suggesting neurological involvement is not dependent on COVID-19 disease severity. Host susceptibility and viral characteristics may drive the neurological phenotype.
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Background and aims: COVID-19 related acute neurological phenotypes have been reported in over 30% of hospitalized patients. However, multicentric studies providing a population-based overview are still lacking. Methods: We conducted a retrospective multicentric study in five hospitals in Northern Portugal, between March 1st and June 30th 2020. Patient e-records were systematically revised using a standardized form to identify neurological manifestations stratified by type and severity. Results: From a total of 13,144 persons diagnosed with COVID-19 in the northern region, 2,795 (21.3%) required hospitalization. We reviewed a sample of 1,261 (45.1%) hospitalized patients and found a rate of 362 neurological manifestations per 1000 admitted COVID-19 patients, estimating a total of 1009 hospitalized patients with a neurological manifestation in the Northern Region. Patients with neurologic manifestations were younger (p=0.002), and the most frequent neurological symptoms were headache (13.4%), delirium (10.1%) and impairment of consciousness (9.7%). We observed a rate of 7.8 severe neurological events per every 1000 COVID-19 infected patients, including stroke, seizures, Guillain-Barre syndrome and myelopathy. The fatality among patients with neurological manifestations was 19.8%, and 15.6% had a modified Rankin Scale of 4-5 at hospital discharge. Conclusion: We characterized the population of hospitalized COVID-19 patients from the northern region of Portugal and found that neurological symptoms are common and associated with a high degree of disability. CNS involvement with criteria for in-hospital admission was observed in a significant proportion of patients. Neurology support is highly relevant in the multidisciplinary care of COVID-19 patients.
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Due to the confinement by Covid-19, teachers were forced to teach at a distance, which necessarily leads to a change in their teaching practices. Using Trouche’s theoretical instrumental orchestration framework, this case study shows that this framework continues to be valid in this type of teaching, it presents the similarities and differences found in these instrumental orchestrations in the case of distance learning, using a teacher’s teaching practice 12th year math class in the chapter on antiderivative and integral calculus. A new type of orchestration has been found. © 2021, Springer Nature Switzerland AG.