Severe Acute Respiratory Syndrome by COVID-19: Clinical-Epidemiological Profile and Spatial Distribution of Deaths in the States of Brazil

Severe Acute Respiratory Syndrome (SARS) is a severe manifestation of COVID-19 infection that, in some cases, can result in death. In the current global epidemiological scenario, Brazil is the second country with highest number of deaths from the disease;thus, it is necessary to know the clinical and epidemiological characteristics of deaths and how they are spatially distributed across territories. Therefore, the objective was to describe the clinical and epidemiological characteristics and the spatial distribution of SARS deaths due to COVID-19 in the Brazilian federative units (states). This is a descriptive and ecological study of SARS deaths due to COVID-19 in Brazilian states, from March 2020 to June 2021, based on secondary data available on the openDataSUS database. Descriptive statistics were performed for the clinical-epidemiological variables and the monthly mortality rates were determined by state and thematic maps were made in QGIS software version 2.4.17. A total of 196,109 deaths were recorded in the investigated period, predominantly male, older, white, and low-educated. Among the clinical variables, cough, respiratory distress, dyspnea, and the presence of comorbidities stood out. A heterogeneous spatial distribution of deaths was observed, with rates ranging from 0.00 to 24.59 deaths/100,000 inhabitants, the highest rates were in the states of Rio de Janeiro, Amazonas, Ceara, Sergipe, Sao Paulo, and Pernambuco. These findings raise the need for investments on the part of public management and health systems and services in the most affected states, improvements in epidemiological surveillance, permanent health education, increased access to immunization and health prevention measures to control and monitor SARS caused by COVID-19. © 2022 Centro Universitario Sao Camilo. All rights reserved.

ALTERAÇÕES HEMATOLÓGICAS EM PACIENTES COM COVID-19: REVISÃO SISTEMÁTICA E METANÁLISE

Objetivo Realizar uma revisão sistemática com metanálise sobre as manifestações hematológicas da COVID-19, comparando as alterações entre os grupos de gravidade clínica: doença leve ou moderada versus doença grave ou crítica. Material e Métodos Foi realizada uma revisão sistemática baseada no protocolo PRISMA 2020, nas bases de dados Pubmed, Embase, LILACS e SciElo, usando os seguintes descritores do MeSH: COVID-19 ou SARS-CoV-2;hematological tests;erythrocyte count, red blood cell count, leukocyte count, platelet count, ferritin, coagulopathy, prothrombin time, partial thromboplastin time, c-reactive protein e fibrinogen. Foram excluídos artigos não disponíveis na íntegra, revisões de literatura, revisões sistemáticas, opiniões de experts e artigos que não faziam a comparação dos parâmetros entre os grupos de gravidade. O software Stata versão 14.0 foi utilizado para a análise estatística e foi feito cálculo de risco relativo com Intervalo de Confiança de 95% para avaliar as diferenças entres os grupos. A heterogeneidade foi calculada com o teste do ꭓ2 e o teste do I2. A heterogeneidade significativa foi definida com p<0,10 ou I2 >50%. Resultados A pesquisa sistemática identificou um total de 2.682 artigos, sendo que ao final da triagem, 55 foram selecionados para a revisão e 18 para metanálise. Os artigos selecionados arrolaram um total de 13.289 participantes, sendo 10.312 com quadro clínico leve a moderado e 3.977 com quadro clínico grave a crítico. As médias de idade foram de 49,8 anos para participantes com doença leve a moderada e de 61,3 anos para o grupo de doença grave a crítica. As mulheres representaram 44,5% dos indivíduos do grupo com doença leve e 32,94% dos indivíduos do grupo grave. Identificou-se que os valores médios de leucócitos (SMD=0,47;95% IC 0,24‒0,70;I2=86,2%), neutrófilos (SMD=1.44;95% IC 0,92‒1,96;I2=0,0%), PCR (SMD=3,98;95% IC 2,6‒5,80;I2=98,2%), ferritina (SMD=1,13;95% IC 0,57‒1,69;I2=72,6%), fibrinogênio (SMD=0,55;95% IC 0,16‒0,93;I2=40,5%) e TP (SMD=0,53;95% IC 0,24‒0,82;I2=55,0%) foram significativamente mais elevados e a contagem de linfócitos (SMD = -1,25;95% IC -1,67 ‒ -0,83;I2=95,7%) foi significativamente reduzida no grupo de doença grave. Discussão A infecção por SARS-CoV-2 induz uma série de mudanças nos exames laboratoriais e algumas delas podem ser usadas para monitorar a gravidade e prever o prognóstico. Diversos trabalhos demonstraram que casos graves são mais propensos a níveis elevados de leucócitos, neutrófilos, aumento da ferritina e alargamento do TP. Apesar de o presente trabalho não demonstrar associação entre níveis de plaquetas e gravidade da doença, vários estudos sugerem que a trombocitopenia também está significativamente associada à doença grave. Neste estudo também não foram observadas diferenças significativas entre os níveis de D-dímero dos grupos avaliados, mas outros trabalhos apontam que a elevação do D-dímero é um fator de risco independente para morte. Conclusão Os indivíduos com COVID-19 grave apresentaram redução da contagem de linfócitos e elevação de leucócitos, neutrófilos, PCR, ferritina, fibrinogênio e TP.

Drug allergy impact on anaphylaxis risk accessment in COVID-19 vaccination: Experience of an allergy department

Background: COVID-19 vaccination is essential for the pandemic control. Adverse reactions after vaccination are com-mon, although anaphylaxis is rare. Objective(s): To characterize the immunoallergological reactions responsible for pre--vaccination referral by Primary Care (PC), to analyze the impact of drug allergy on this referral, and to evaluate the vaccination outcome after risk stratification. Method(s): Retrospective observational study including patients referred by PC to the Allergy & Clinical Immunology Department of a tertiary hospital to evaluate the risk of severe hypersensitivity reactions (HSR) after COVID-19 vaccination, from January to June 2021. Risk stratification was carried out in accordance with the Allergy & Clinical Immunology Department's protocol. Result(s): From a total of 733 patients referred by the CSP, 510 were admitted, 445 of which were evaluated, 369 (83%) females, mean age 66+/-13 years [20-99 years], 122 (27%) atopic. The majority (n=349, 78%) were referred due to previous drug reactions, of whom 69 (15.5%) due to vaccine reactions. Nonste-roidal anti-inflammatory drugs (n=97, 51%) and antibiotics (n=70, 36%) were the most reported drugs in suspected/confirmed HSRs. Drug reaction profile differed in low-risk (61% with HSR, 39% anaphylaxis) and intermediate/high risk (92% with HSR, 65% anaphylaxis) patients. After risk assessment, 323 patients were referred for vaccination at the vaccination center, of whom 280 received at least one dose of the vaccine. Two patients had chronic urticaria worsening and one patient had a vasovagal reaction after the vaccine. 122 patients were vaccinated at the hospital, of whom 69 received one dose of the vaccine. Only two patients had mild skin reactions. Conclusion(s): Drug allergy was the main cause for pre-vaccination risk assessment. Most patients were vaccinated at the vaccination center with no HSR. Risk assessment protocol was effective, with no significant reactions or cases of anaphylaxis. Copyright © 2022, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved.

Emotional Suffering in Teenagers during the Covid-19 Pandemic

The coronavirus (Covid-19) pandemic represented a challenge to physical and emotional health for adolescents subjected to almost two years of social isolation, restricted to family life and prevented from being in school. This article presents data from the pandemic associated with emotional distress among adolescents and the impact of restricted school life in this period. This is an exploratory, descriptive research, whose objective was to identify the frequency of situations in which there are signs of emotional distress in adolescents and to compare the scores found between demographic profile issues (race, gender and smartphone use). A total of 1,991 adolescents participated in the sample, students from two directorates of the Sao Paulo state public education network. The investigation instrument was built from a broad literature review in the form of a questionnaire with closed questions, divided into two parts: the first, containing 13 questions about the student's profile and, the second, with 21 questions, about signs of emotional suffering. From the quantitative analysis, the results found highlight a higher score of emotional distress among adolescent girls and black students and point to the urgency of actions that provide welfare and the learning of assertive forms of conflict resolution, as well as the urgency of spaces for expression of feelings by students.

Skin injuries due to Personal Protective Equipment and preventive measures in the COVID-19 context: an integrative review*

Objective: to identify the diverse scientific evidence on the types of skin lesions caused due to the use of Personal Protective Equipment in health professionals during the COVID-19 pandemic and to verify the recommended prevention measures. Method: this is an integrative review carried out in the MEDLINE, CINAHL, LILACS, SCOPUS, Science Direct, Web of Science and SciELO databases. The search was conducted in a paired manner, constituting a sample of 17 studies categorized according to the types of skin lesions and preventive measures. Results: the main types of skin lesions related to mask use were stage 1 pressure ulcers, acne and cutaneous depression. Regarding the use of glasses and face shields, the most frequent were stage 1 and 2 pressure ulcers. Xerosis and irritant contact dermatitis occurred due to using gloves and protective clothing, respectively. The main preventive measures recommended were using hydrocolloid or foam dressing in the pressure regions, moisturizers and emollients. Conclusion: a considerable number of skin lesions associated with using the equipment were noticed, and the data obtained can guide the professionals in identifying risks and promoting preventive measures to avoid their occurrence. Descriptors: Personal Protective Equipment;Skin;Health Personnel;Skin Diseases;Disease Prevention;COVID-19. © 2022 Revista Latino-Americana de Enfermagem.

Portuguese immunoallergology clinical experience in patients with severe atopic dermatitis under dupilumab treatment

Background: Dupilumab has been recently approved for treatment in patients with severe AD in Portugal-until now there is no published data regarding Portuguese experience in Allergy centers. Method: Cross sectional clinical and laboratory assessment of 33 patients (pts) with moderate to severe AD treated with dupilumab (dupi) for at least 16 weeks (W): prospective evaluation of severity scores (SCORAD-Scoring Atopic Dermatitis, EASI-Eczema Area and Severity Index, P-VAS-Pruritus Visual Analogic Scale), report of adverse events up to 52 weeks of treatment. SCORAD and EASI were assessed in 23 pts at W52, P-VAS in 21 pts at W52. Results: Of the 33 pts, 18 were female (55%) with a mean age (SD, range) of 35.3 years (13.2, 15-60). In 16 pts the age of onset was before 2 years old, mean (SD) disease duration 28.1 years (12);94% patients had a diffuse pattern of skin lesions;97% of pts had allergic rhinitis, 82% asthma, 52% conjunctivitis and 30% food allergy. Median total IgE at baseline was of 6313 U/ml (P25-P75: 2842-12491) with a 76% reduction at W52 in 16 pts. Median eosinophil count at baseline was 520 eosinophils/mm3 (P25-P75: 270-740). Before starting dupi 29 pts had been treated with cyclosporine. At the beginning, 15 pts were under oral corticosteroids, 14 under oral systemic immunosuppressive drugs (all pts but two stopped both until W12 of dupi) and 5 switched from omalizumab. At baseline, median SCORAD and EASI were 69.3 and 24.2 points. At W16, W36 and W52, median SCORAD was 27.4, 22.3 and 21.5, and median EASI 5.3, 4.1 and 2.1. At W16, the EASI-50, EASI-75 and EASI-90 were achieved by 91%, 61% and 18% pts, and at W52, by 87%, 70% and 52% pts. The mean percentage of SCORAD reduction at W16 and W52 was 55% and 73%;and of EASI was 76% and 82%. At W16 and W52, an improvement of ≥4 points in P-VAS was achieved by 77% and 95% pts. There was a mean reduction of P-VAS at W2, W4, W16 and W52 of 2.6;3.6;4.7 and 6.3 points, respectively. Conjunctivitis was reported in 10 (30%) pts, two of them with keratoconjunctivitis and blepharitis, without needing to interrupt treatment;two pts also had facial erythema. One patient had COVID, and dupilumab scheme treatment was maintained. Conclusion: The majority of AD patients had a significant and consistent improvement in all the severity scores, after one year of treatment with dupilumab. No relevant adverse events were reported.

Social media in health promotion in the context of contact restriction in the Covid-19 pandemic

The objective is to analyze the contributions of social media, in the format of lives, in health promotion in the context of physical distancing in the SARS-CoV-2 pandemic. This is an observational and bibliographic study of an exploratory analytical nature with a narrative approach, using data from streaming platforms and Google Trends from January to April 2020. Search for lives had a notable rise, especially between May and April, and these contribute for health promotion, mental health care, leisure, education, social relationships, entertainment, and emotional support as they articulate and permeate public policies associated with technologies. In addition, there is ample relevance regarding the social role they assume in encouraging donations. It is believed that these analyzes and information tend to cooperate with further investigations to better understand the contributions of digital technologies during the SARS-CoV-2 pandemic for people who have and/or are experiencing such experiences.

Covid 19 and the contractual performance crisis in international contracts governed by the vienna convention on contracts for the international sale and purchase of goods (Cisg)

Objectives: This paper analyzes the implications of the COVID-19 pandemic in international commercial contracts and its impacts on the obligations performance within the United Nations Convention on Contracts for the International Sale of Goods (CISG). Methodology: The research was conducted through an inductive, hypothetical approach, based on an understanding of legal concepts and a bibliographic/documentary survey, with an exploratory and conclusive objective. Results: The study leads to some conclusions regarding the total or partial failure to perform contracts due to the COVID-19 pandemic and its consequences on international trades. Contributions: This is a topical matter of great relevance, given its impacts on the different countries’ economies and on the society as a whole, which falls within the field of interest of international law. © 2021, Centro Universitário Curitiba - UNICURITIBA. All rights reserved.

Surviving in Pandemic Times – Can Good Design Help Us to Change Our Lives?

We want to promote a reflection about a revolution that happened in our lives in the year of 2020 when suddenly we became “imprisoned” trying to have a “new “normal life for which we were not prepared. Humanity should be prepared for this kind of challenges because its history is also the history of pandemics. In 2020 the world has assumed its vulnerability, its fragility face to the unknown. As Bernard-Henri Levi said, the virus is shaking the world and humanity has gone mad. We suddenly became aware of the fragility of social boundaries;Žižek said_ the classic definition of society - humans among humans, became meaningless. We pretend to promote a discussion and a reflection about the role of Design facing this majour challenges: how Design can, or should, be applied to a new reality on the behalf of security, but also on sociability and the preservation of intimacy knowing for sure that it will happen again. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

COVID-19 pandemic: Why does it matter for consumer research?

Purpose of the Study: The purpose of this paper is to systematically review the literature on consumption and consumer behavior in the first year of the COVID-19 pandemic. To accomplish this objective, this paper seeks to answer the following research questions: What is the current state of the art of the literature on the COVID-19 pandemic and consumption/consumer behavior? What are the disruptions in consumer’s lives that the literature has been discussing? What are the gaps in the research on Consumption/Consumer Behavior and the COVID-19 Pandemic? Methodology: We conducted a scoping review of the literature using data from the Scopus and Web of Science databases. We performed a bibliometric analysis, thematic analysis, and content analysis. Main Results: Brifely, we found seven main topics in the literature: Changes in Consumer Behavior;Coping with the Lockdowns;Information Seeking and Sharing;Psychological Effects;Addictive Behavior;Changes in Food Consumption;Panic Buying and Hoarding Behavior. Also, emerging themes from consumption, as the antecedents of consumption and the crisis effect on human behavior have been explored. The survey method using SEM is the principal methology and samples were mainly from the USA and China. Theoretical and Methodological Contributions: We provide evidence-based information to the marketing literature, consumer research, and practitioners on how the pandemic has affected the consumer domain. Relevance/Originality: We highlight consumer behavior in a pandemic context from a research and managerial perspectives. We provide a literature review that identify the topocs, methods, and overall discussions regarding the pandemic effects on consumption and consumer behavior that can support companies in undestanding the behavior and also trigger more research and development of public and organizational policies. Copyright © 2021 Korean College of Helicobacter and Upper Gastrointestinal Research.

Low cost volume sensors for mechanical ventilators

This paper presents and compares three volume sensors to be used in mechanical ventilators developed in laboratory: volume sensor based on the Pitot tube, volume sensor based on the Venturi tube and infrared(IR) volume sensor. The three sensors were calibrated and tested with a mechanical ventilator in Pressure-controlled Ventilation (PCV) mode. The maximum pressure changed, keeping textitPositive End-Expiratory Pressure (PEEP) and respiratory rate fixed. For each maximum pressure value: the value measured by the sensor was compared with the reference value, the value informed by the mechanical ventilator. The infrared sensor showed better performance for the specific application in a mechanical ventilator, being the only sensor considered adequate between the tested ones.

SARS-CoV-2 in pediatric age group: Multiple clinical presentations and broad spectrum of severity

INTRODUCTION: Since the new coronavirus began to spread throughout the world children and adolescents were affected on a smaller scale than adults, being mostly asymptomatic carriers or having mild to moderate symptoms, with lower risk of developing serious complications. When infected, patients in the pediatric age group presented a range of varied symptoms associated with the virus, different from adults where the main clinical symptom was respiratory. METHODS: Eight patients were admitted to our pediatric intensive care unit with a diagnosis of SARS-CoV-2, confirmed by PCR or serology;of these 3 were asymptomatic or presented mild flu symptoms, 2 had clinical presentation typical of severe acute respiratory distress syndrome, 1 presented abdominal pain associated with multisystemic inflammatory syndrome, 1 had clinical presentation of acute respiratory distress syndrome and later admitted again to our service fulfilling criteria for multisystemic inflammatory syndrome and 1 presented ischemic stroke after SARSCoV- 2. Four patients with severe symptoms required ventilatory support through mechanical ventilation due to respiratory failure, in most cases, difficult to manage and with shock requiring vasoactive drugs. Unlike adults, none of the 8 patients required renal replacement therapy. No outcome evolved to death. RESULTS: The diagnosis and management of SARS-CoV-2 in pediatrics is a challenge, due to this varied clinic and little experience of professionals due to a small number of cases, making this study important for better knowledge about the disease, thus improving care.