ABSTRACT
This paper presents the development of a dynamical tropical algebra-based model of a vaccination center, which can be used to control and optimize the admission of users during center's operation. In addition, an analysis of closed-loop control methods designed to maximize the system performance in terms of service rate and minimize users' waiting time, while observing occupancy constraints due to social distancing protocols recommended by sanitary authorities due to Covid epidemic, is presented. © 2023, Brazilian Society for Automatics--SBA.
ABSTRACT
Introduction: Data about the impact of COVID-19 on patients with fibrotic ILD are limited. These patients have impaired lung function and increased risk of acute exacerbation driven by viral infection, so COVID-19 is of particular concern. Aim(s): To evaluate the impact of SARS-CoV-2 infection on patients with previous fibrotic ILD. Method(s): Single-center retrospective study including adult patients with previous fibrotic ILD and SARS-CoV-2 infection. Clinical, imaging, and respiratory functional data, pre and post infection, were revised. Result(s): A total of 49 patients (median age 68.4+/-11.1 years, 61.2% male) were analysed and major comorbidities included dyslipidaemia (69.4%), hypertension (53.1%) and obesity (29.9%). Hypersensitivity pneumonitis was the most frequent diagnosis (22.4%) followed by CTD-ILD (20.4%). Non-corticosteroid immunosuppression was present in 38.8% of the cases. Regarding COVID-19 severity, most cases were mild (55.1%) and 34.7% were severe disease requiring hospitalization. Fifteen patients died and 14 patients experienced progression of fibrosis, which was associated with a significant clinical (mean mMRC 0.86+/-0.53 vs 1.57+/-1.09, p=0.015) and DLCO decline (5.12+/-2.57 vs 4.54+/-2.96, p=0.002). Independent predictor of fibrotic worsening was the absence of non-corticosteroid immunosuppression (OR 0.072, p=0.019). Mortality correlated with OSA (p=0.011), heart failure (p=0.032), previous hypoxemic respiratory failure (p=0.013), severe COVID-19 disease (p<0.001) and hospitalization (p=0.004). Conclusion(s): Non-corticosteroid immunosuppression may have a protective role in fibrotic ILD patients. Mortality associated with COVID-19 severity, OSA, heart failure and previous hypoxemic respiratory failure.
ABSTRACT
Introduction: Few studies have evaluated the impact of COVID-19 on interstitial lung diseases (ILDs). Our aim was to compare outcomes in patients with fibrotic-ILDs (F-ILDs) and non-fibrotic-ILDs (NF-ILDs) after COVID-19. Method(s): We reviewed patients with ILD followed in a Portuguese university hospital. Patients' features and COVID- 19 outcomes were compared between F-ILDs and NF-ILDs groups. We used Kaplan-Meyer analysis to estimate overall survival (OS) and cox-proportional-hazards regression models to identify factors associated with OS. Result(s): A total of 103 patients (49.5% were male;mean age of 61.5+/-14.5 years) were included. The most prevalent ILDs were sarcoidosis (26.2%), HP (14.6%), CTD-ILD (14.6%), OP (8.7%), IPF (7.8%) and unclassifiable idiopathic interstitial pneumonia (7.8%). 47.6% of patients had F-ILD, and they had a higher prevalence of dyslipidemia (p=0.006) and immunosuppressive therapy (p<.001). Regarding the severity of COVID-19, 64.7% had mild, 11.7% moderate and 24.3% severe disease. There was a higher proportion of severe disease among F-ILDs patients (34.7% vs 14.8%, p=0.019). Post-COVID-19 mortality (median follow-up of 44 weeks) was significantly higher in FILD than NF-ILD cases (30.6% vs 5.6%, p=0.001). The median OS was significantly lower for patients who had severe disease (18.0 vs 45.5 weeks;p<.001) and F-ILD (41 vs 45 weeks;p=0.001). According to multivariate analysis, F-ILD (HR:4.00, p=0.042) and severe disease (HR:6.98, p=0.008) were the factors associated with worse OS. Concluding: In our analysis, COVID-19 was associated with worse outcomes in patients with F-ILDs and severe COVID-19, regardless of cardiovascular risk factors.
ABSTRACT
The COVID-19 pandemic crisis, among so many social, economic and health problems, also brought new opportunities. The potential of telemedicine to improve health outcomes had already been recognised in the last decades, but the pandemic crisis has accelerated the digital revolution. In 2020, a rapid increase in the use of remote consultations occurred due to the need to reduce attendance and overcrowding in outpatient clinics. However, the benefit of their use extends beyond the pandemic crisis, as an important tool to improve both the efficiency and capacity of future healthcare systems. This article reviews the literature regarding telemedicine and teleconsultation standards and recommendations, collects opinions of Portuguese experts in respiratory medicine and provides guidance in teleconsultation practices for Pulmonologists.
ABSTRACT
Introducao: A hemofilia A (HA) e uma doenca hemorragica caracterizada pela ocorrencia de sangramentos, principalmente articulares e musculares. Embora esses pacientes sejam considerados relativamente protegidos de eventos tromboticos, existem relatos de trombose venosa, associada a fatores de risco como pos-operatorio ou com reposicao de fator. Relato de caso: Homem, 22 anos, em seguimento no Hemocentro de Ribeirao Preto com diagnostico de HA grave sem inibidor em profilaxia com fator VIII recombinante (FVIIIR). Compareceu para avaliacao em marco de 2022 com queixa de dor e edema difuso na perna direita iniciados ha 10 dias, sem historia de trauma associado. No inicio do quadro clinico, o paciente nao procurou atendimento medico e realizou reposicao de FVIIIR diariamente, com dose superior a habitual (elevacao de FVIII em 50%), conforme julgamento pessoal e sem definicao diagnostica. Como nao apresentou melhora clinica, no decimo primeiro dia de evolucao, procurou atendimento e, apos avaliacao clinica, foi aventada a hipotese de hematoma muscular no compartimento posterior da perna direita, sendo optado pela manutencao do esquema de reposicao diaria, repouso muscular e reavaliacao em 72 horas. Na reavaliacao, paciente mantinha quadro clinico, realizada Tomografia Computadorizada, que nao identificou sangramento muscular. Nesse contexto, foi optado por realizacao de Doppler Venoso de membro inferior direito, que evidenciou tromboflebite de veia safena parva medindo cerca de 10 cm, estendendo-se do terco proximal ate o terco medio da perna, sem acometer o sistema venoso profundo. O hemograma nao evidenciava plaquetopenia. Como potencial fator de risco adicional, o paciente referiu ter recebido a 3degreedose da vacina para COVID19 (AstraZeneca) cerca de 3 semanas antes do inicio dos sintomas. Por se tratar de tromboflebite extensa, com repercussoes clinicas, caracterizadas por comprometimento funcional do membro, o paciente teria indicacao de anticoagulacao terapeutica. Porem, considerando contexto clinico e doenca de base, optamos por manter observacao clinica, repouso, medidas locais, reducao da reposicao de FVIIIR e repeticao do Doppler precocemente. O exame de controle com intervalo de 4 semanas mostrou recanalizacao completa da veia safena parva, bem como houve remissao completa dos sintomas e recuperacao funcional do membro acometido. Discussao: Apesar de ser uma complicacao rara, deve ser considerada, especialmente em casos que apresentem refratariedade clinica, como a situacao apresentada. Particularmente nesse caso, ha de se considerar o fato do paciente ter recebido a vacina para COVID19 anteriormente ao quadro, cuja associacao com quadros de trombose e plaquetopenia vem sendo descrito na populacao em geral, porem os dados sao escassos em paciente com coagulopatias. Ademais, estes pacientes pela "anticoagulacao natural", inerente a patologia de base, podem nao apresentar quadros tao floridos e graves quanto os descritos na literatura. Nao ha como se definir com precisao a contribuicao da reposicao de fator iniciada pelo paciente em regime domiciliar (doses maiores e de forma mais intensa) no desenvolvimento do quadro atual. Conclusao: Eventos tromboticos nessa populacao, apesar de raros, podem ocorrer, e, a decisao quanto a anticoagulacao e desafiadora. E importante avaliar os potenciais fatores de risco associados como traumas, cirurgias e, no contexto atual, a associacao com a vacina para COVID19. Copyright © 2022
ABSTRACT
Objetivo: comprender las rupturas biogr??ficas provocadas por la pandemia del COVID-19 en adolescentes y j??venes hombres trans y personas transmasculinas en el contexto de Brasil. M??todo: estudio cualitativo ??? encuesta en l??nea ??? multic??ntrico. Participaron 97 hombres trans y 22 personas transmasculinas autoidentificadas, que respondieron un formulario semiestructurado en dos etapas. Los datos se sometieron al An??lisis de Contenido Tem??tico Reflexivo. La interpretaci??n se realiz?? sobre una base sociol??gica a partir del concepto de ruptura biogr??fica. Resultados: surgieron cinco categor??as: interrupci??n de la terapia hormonal, cirug??as y seguimiento especializado;malestares precipitados por la interrupci??n de las caracter??sticas masculinas, autoimagen, autopercepci??n e identidad;vulnerabilidad por la p??rdida de familiares y seres queridos, empleo y debilitamiento de las redes de apoyo;aparici??n de problemas psicoemocionales, como la p??rdida del sentido de la vida;demandas de atenci??n de enfermer??a y valoraci??n de la vida de adolescentes y j??venes transexuales en el pospandemia. Conclusi??n: las rupturas biogr??ficas provocadas por la pandemia amenazaron las identidades de los hombres trans y personas transmasculinas adolescentes y j??venes, produjeron degradaci??n y discontinuidad de las biograf??as, llev??ndolas a perder el sentido de la vida. Los profesionales de enfermer??a pueden ser estrat??gicos e imprescindibles en la superaci??n de estas amenazas al promover una intervenci??n anticipada.
ABSTRACT
Brazil is one of the countries with the highest COVID19 mortality numbers. COVID19 deaths affected disproportionally different populations/communities, tending to be higher among more vulnerable ones. Brazil has a public-funded unified health system (SUS) built on the aegis of equity and social control. Its Primary Health Care (PHC) is organized by the Family Health Strategy (FHS) through Family Health Teams (FHT), which comprise a family doctor, a nurse, a dentist, nurse auxiliaries and Community Health Agents (CHAs). CHAs are individuals from the community trained to provide a range of services in the territories, including home visits, health promotion activities, and serve as liaisons between health units and communities. In this context, CHAs have the potential to play an important role in fighting the pandemic by working on contact tracing, collecting information on infected people, and providing guidance to them and the community in order to contain community transmission. However, not much is known about their readiness regarding the COVID19 pandemic in one of the Brazil's poorest regions. Thus, this study evaluated, though CHA perspective, aspects related to their preparedness for COVID19 in Brazil's northeast region. Questionnaires were applied to CHAs from 8 different municipalities - 4 capitals and 4 country-side municipalities. A total of 1935 CHAs were interviewed at their workplace in 2021. 77.8% said that they were acting in the COVID19 frontline, but only 16% referred to have received training for this function. Furthermore, only 13.7% mention to have had access to adequate individual protective equipment during their work, and 91.6% believe that they can get infected by SAR-COV-2 during their work duties. Additionally, 93.9% considered themselves a transmission vehicle due to work. Despite their potential in the fight against COVID19, CHAs did not received enough training, nor were equipped adequately during the COVID19 pandemic. Key messages • CHAs did not received enough training, nor were equipped adequately during the COVID19 pandemic. • Addequate trainning and work environment are essencial for proper work development.
ABSTRACT
Objective: to know the feelings of children/adolescents with Sickle Cell Disease perceived by mothers and to identify feelings experienced by mothers of children/adolescents with Sickle Cell Disease after the emergence of the COVID-19 pandemic. Method: qualitative study, developed in a city in the state of Bahia with the participation of 19 mothers of children and adolescents with Sickle Cell Disease. Data were obtained between March and April 2020 through semi-structured interviews via WhatsApp calls, which were submitted to thematic, factor and similarity analysis after transcription. Results: the participants reported feeling overload when dedicating full time to the care of their children, who were more vulnerable and emotionally unstable due to social distancing. Therefore, strategies were adopted by mothers, intending to adapt and reduce tensions-provided by the context of the pandemic-in themselves and in their children. Conclusion: mothers of children/adolescents with Sickle Cell Disease need to be supported and instrumentalized in order to implement care centered on the psychoemotional dimension and seek specialized help, especially regarding feelings triggered due to the need to maintain the therapeutic routine of their children in the midst of the pandemic. © 2022, Universidade Federal de Santa Catarina. All rights reserved.
ABSTRACT
Introdução: Desde a percepção do novo coronavírus (SARS-CoV-2), responsável pela disseminação do surto descoberto pela primeira vez na cidade de Wuhan, China, em dezembro de 2019, a raça humana tem vivenciado um difícil problema sanitário global, arrodeadas de exatidão no que diz respeito aos caracteres epidemiológicos, sorológicos e sua facilidade de se disseminar. As infecções relacionadas à assistência à saúde têm ocorrência em várias em instituições assistenciais de saúde, tanto em países desenvolvidos como subdesenvolvidos, acometendo aproximadamente 1,4 milhões de pacientes em todo o mundo, resultando em altos números morbimortalidade, prolongamento do tempo de internação, resistência de microrganismos e óbitos. Apresentam diversas causas e tem várias relações multifatoriais. A higienização das mãos retrata a conduta apartada primordial como tática de minimização da incidência das infecções ambulatoriais e hospitalares. Objetivo: O objetivo deste estudo foi orientar os profissionais do setor de ambulatório de um centro de Hemoterapia no período de 10 a 26 de fevereiro de 2020, com intuito de melhorar os métodos de limpeza e higienização e prevenção acerca da COVID-19. Material e métodos: Foi realizado um treinamento teórico através do Google Met., que é um serviço de comunicação por vídeo desenvolvido pelo Google. O treinamento foi realizado em cinco módulos com carga horária 30h com os funcionários envolvendo o preenchimento do check-list, baseado no manual Segurança do Paciente em Serviços de Saúde, Higienização das Mãos da Agência Nacional de Vigilância Sanitária. Resultados: Dos 32 funcionários que executam suas atividades profissionais no setor de transfusão e ambulatório que responderam o instrumento de pesquisa, 75% (24) eram do sexo feminino e 25% (08) do sexo masculino. O nível de formação acadêmica variou entre os docentes: 9,3% (3) são Enfermeiros, Farmacêuticos 6,2 (02), Técnicos de Enfermagem 18,7% (06), Assistente administrativo 15,6% (05), Assistente social 3,1% (01), Psicóloga 3,1% (01), Fisioterapeuta 3,1% (01), Dentista 6,2% (02), Estagiários 34,3% (11). Discussão: Neste estudo observou-se que a higienização e o uso de luvas associaram-se a uma menor velocidade de contaminação das mãos durante cuidados rotineiros nos setores laboratoriais e no ambulatório evitando a contaminação da maioria dos profissionais de saúde. Conclusão: Esta ação deve ser constantemente desenvolvida na prática educacional, além de abordagem aprofundada referente à prevenção e controle de infecções como estratégia de promoção da segurança do paciente.
ABSTRACT
Introdução: A pandemia mundial causada pelo novo coronavírus SARS-CoV-2 (COVID-19) teve impacto importante nos serviços de hemoterapia. O início da pandemia levou a diminuição tanto da demanda transfusional quanto do total de doações de sangue. Entretanto, a manutenção de estoque adequado de hemocomponentes tornou-se crítica quando o aumento no total de unidades transfundidas não ocorreu também no número de doações de sangue. A percepção de risco potencial de contaminação pela COVID-19 levou a uma queda significativa nas doações de sangue. A pandemia teve papel crucial no crescimento exponencial da telemedicina, com o sancionamento, em caráter emergencial, de novas leis regulatórias e expansão das áreas de atuação. No Brasil, a triagem clínica do candidato a doação de sangue é feita de forma presencial, face-a-face. Historicamente, o índice de inaptidão clínica no nosso serviço varia de 18% a 23%. A entrevista feita a distância (teletriagem) evitaria o deslocamento do doador com inaptidão clínica até o banco de sangue. A teletriagem, além de ser uma conveniência bem-vinda ao doador, traz a possibilidade de diminuir o tempo de sua permanência no banco de sangue. Objetivos: Avaliar a viabilidade do uso da teletriagem (triagem por telemedicina) como alternativa a triagem presencial na seleção de doadores de sangue. Materiais e métodos: A data e o horário do atendimento virtual por videoconferência foram agendados pelo candidato a doação e ele foi orientado sobre a necessidade de estar em local com privacidade durante a entrevista clínica. O questionário foi aplicado pelo profissional do banco de sangue também num local com privacidade. O candidato com inaptidão clínica não necessitaria comparecer ao banco de sangue e o candidato apto deveria realizar a sua doação até 7 dias após a teletriagem. No dia da doação, um questionário clínico reduzido foi aplicado, além da aferição dos sinais vitais e determinação do nível de hemoglobina para confirmar a aptidão para a doação. Resultados: Um total de 288 agendamentos para teletriagem foi feito de junho de 2020 a julho de 2021, sendo 153 candidatos a doação de sangue (ST) e 135 a doação de plaquetas por aférese (PQA). A teletriagem não foi realizada por problemas técnicos (áudio ou vídeo) ou ausência de 35 (12%) candidatos. Ao término da triagem clínica, 213/253 (84%) candidatos foram considerados aptos e 40/253 (16%) inaptos a doação. Neste último grupo, 36 eram candidatos a doação de ST e 4 de PQA. Dentre os 213 candidatos aptos pela teletriagem, 190 (89%) compareceram ao banco de sangue e 184 realizaram a doação. O tempo na triagem clínica no dia da doação teve redução de 36% para o doador de ST e 42% para PQA. A experiência com a teletriagem foi considerada positiva e seria indicada por 90% dos participantes. Discussão: O índice de inaptidão entre os candidatos aprovados na teletriagem foi baixo, 6/190 (3%) quando comparado ao índice de 18–23% observado no nosso serviço com a triagem presencial. Portanto, a teletriagem se mostrou eficaz em identificar candidatos com inaptidão clínica e evitar o seu deslocamento até o banco de sangue. Além disso, houve redução no tempo de triagem clínica presencial, o que contribuiu para diminuir o tempo total de permanência do doador no banco de sangue. A taxa de não comparecimento dos candidatos considerados aptos na teletriagem foi de 11% e representa uma oportunidade de melhorar a conscientização do candidato à doação. Conclusão: A teletriagem pode ser uma alternativa viável e uma conveniência bem vinda ao candidato a doação para evitar deslocamento desnecessário e reduzir o tempo de permanência do doador no banco de sangue.
ABSTRACT
Introduction: Multiple Sclerosis is a chronic autoimmune disease that affects the Central Nervous System, causing destruction of myelin, and it is believed to be caused by a combination of environmental and genetic factors. Objectives: To analyze the effect of telerehabilitation in fatigue on Multiple Sclerosis patients during the isolation period of the pandemic of COVID-19. Methods: This is a retrospective study through the analysis of medical records, with adult individuals affected by Multiple Sclerosis, through the scores of some scales. They are EDSS (Expanded Disability Status Scale) and MFIS (Modified fatigue impact scale). Results: The Wilcoxon Signed Test Station was applied to verify the differences between the moments of pre and post-intervention. In general, the MFIS scores at the time of pre-intervention are higher than the post-intervention. Spearman's correlation analysis was applied, verifying the degree of relationship between the variables of the scale results and age, sex and EDSS. The EDSS demonstrated a good relationship with the MFIS. Conclusions: We show that telerehabilitation performed during the pandemic period has a positive effect on fatigue of patients with Multiple Sclerosis.
ABSTRACT
The COVID-19 outbreak represents a global health threat due to the unprecedented number of patients admitted to intensive care units and the overwhelming need for mechanical ventilation. Performing a tracheostomy in COVID-19 patients poses unique risks and demands for safety precautions. We report a case series of 10 patients with COVID-19 who underwent elective open tracheostomies to provide access for prolonged mechanical ventilation. At the time of tracheostomy, they had required a mean mechanical ventilation period of 18.6 days (range, 13-23 days) and exhibited a mean PaO2/FiO2 ratio of 242.8 (range, 165-321). All patients still tested positive for SARS-CoV-2 at the time of tracheostomy. In all cases, total intravenous anesthesia was used and deep neuromuscular paralysis was guaranteed. Pre-oxygenation was performed before the beginning of the procedure and before tracheal incision. Ventilation was ceased whilst the window in the trachea was being performed. A cuffed non-fenestrated tracheostomy tube was inserted and the cuff was inflated before resuming ventilation. All team members wore adequate personal protective equipment (PPE). Only one patient developed postoperative complications (pneumothorax and postoperative continuous bleeding) and no viral transmission to health care workers was documented. Our experience supports the safety of tracheostomy in COVID-19 patients, provided that meticulous planning and strict safety recommendations are followed.
ABSTRACT
In a pandemic context caused by covid-19, the education had to adapt to a new global social-political scenario and find different ways to comply with society. In that sense, there is an increasing virtualization that boosts learning-teaching processes in virtual scenarios. The objective of this paper is to publicize the production of a virtual event that presents the results of collaborative international projects, developed by students from the Department of Production Engineering of University of Brasilia, in this time of social distancing. This research is applied, quali-quantitative and descriptive. As data collection technique to measure spectator’s satisfaction, it was used a questionnaire, based on a SERVPERF model that measures service quality, that contemplates the evaluation of the criteria such as tangibility, reliability, promptness, security and empathy. The event had 164 people registered and 93 actives, the majority of them students from 4 courses that apply the PBL methodology, and develop projects in an integrated way. The satisfaction evaluation questionnaire was answered by 27 spectators. The average score for the general evaluation of the event was 9.22 on a scale that goes from 1 to 10, a result that displays a high satisfaction index by the spectators with the event. It is feasible to observe that the Scrum methodology was effective for the event project management. © 2021 University of Minho. All rights reserved.
ABSTRACT
SARS-CoV-2 is a new beta coronavirus, similar to SARS-CoV-1, that emerged at the end of 2019 in the Hubei province of China. It is responsible for coronavirus disease 2019 (COVID-19), which was declared a pandemic by the World Health Organization on March 11, 2020. The ability to gain quick control of the pandemic has been hampered by a lack of detailed knowledge about SARS-CoV-2-host interactions, mainly in relation to viral biology and host immune response. The rapid clinical course seen in COVID-19 indicates that infection control in asymptomatic patients or patients with mild disease is probably due to the innate immune response, as, considering that SARS-CoV-2 is new to humans, an effective adaptive response would not be expected to occur until approximately 2-3 weeks after contact with the virus. Antiviral innate immunity has humoral components (complement and coagulation-fibrinolysis systems, soluble proteins that recognize glycans on cell surface, interferons, chemokines, and naturally occurring antibodies) and cellular components (natural killer cells and other innate lymphocytes). Failure of this system would pave the way for uncontrolled viral replication in the airways and the mounting of an adaptive immune response, potentially amplified by an inflammatory cascade. Severe COVID-19 appears to be due not only to viral infection but also to a dysregulated immune and inflammatory response. In this paper, the authors review the most recent publications on the immunobiology of SARS-CoV-2, virus interactions with target cells, and host immune responses, and highlight possible associations between deficient innate and acquired immune responses and disease progression and mortality. Immunotherapeutic strategies targeting both the virus and dysfunctional immune responses are also addressed.