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Objective: to evaluate the effectiveness of Ivermectin and Atazanavir compared to placebo in the time to resolution of symptoms and duration of illness due to COVID-19. Method: observational, prospective, longitudinal, descriptive and analytical cohort study with symptomatic outpatients, followed for 06 months in two Basic Health Units for COVID-19 care in Teresina-Piaui, Brazil, from November to April 2021 identified by 1:1:1 random sampling. Reverse transcription polymerase chain reaction (RT-PCR) tests were performed for laboratory confirmation of suspected infection with the new coronavirus and sociodemographic and clinical evaluation. Results: of the 87 randomized patients, 62.1% (n=54) were male, with a mean age of 35.1 years, had a partner (53.9%), low income (50.6%), eutrophic (40.7%) and without health comorbidities (78.2%). There was no difference between the median time to resolution of symptoms, which was 21 days (IQR, 8-30) in the atazanavir group, 30 days (IQR, 5-90) in the ivermectin group compared with 14 days (IQR, 9-21) in the control group. At day 180, there was resolution of symptoms in 100% in the placebo group, 93.9% in the atazanavir group, and 95% in the ivermectin group. The median duration of illness was 8 days in all study arms. Conclusion: Treatment with atazanavir (6 days) and ivermectin (3 days) did not reduce the time to symptom resolution or the duration of illness among outpatients with mild COVID-19 compared to the placebo group. The results do not support the use of ivermectin and atazanavir for the treatment of mild to moderate COVID-19.
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Conducting epidemiologic research usually requires a large amount of data to establish the natural history of a disease and achieve meaningful study design, and interpretations of findings. This is, however, a huge task because the healthcare domain is composed of a complex corpus and concepts that result in difficult ways to use and store data. Additionally, data accessibility should be considered because sensitive data from patients should be carefully protected and shared with responsibility. With the COVID-19 pandemic, the need for sharing data and having an integrated view of the data was reaffirmed to identify the best approaches and signals to improve not only treatments and diagnoses but also social answers to the epidemiological scenario. This paper addresses a data integration scenario for dealing with COVID-19 and cardiovascular diseases, covering the main challenges related to integrating data in a common data repository storing data from several hospitals. Conceptual architecture is presented to deal with such approaches and integrate data from a Portuguese hospital into the common repository used to explore data in a standardized way. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Risky sexual behaviors in adolescents and young adults often result in negative outcomes, such as sexually transmitted infections (STIs) and unwanted pregnancies. This case study compares the experience of implementing a digital app-based platform aimed at reducing adolescent sexual risk behavior in a rural medical clinic and a university-based mental health clinic in an effort to better understand how the cliexa-OPTIONS mobile app can inform care and enhance the overall quality of treatment in very different clinical health settings. Clinicians in charge of the implementation of the digital app report that it opens up more transparent discussions with patients/clients, allowing them to provide better care in both medical and mental health settings. The differences in context provide different demographic-related challenges at the two sites. Challenges in online recruitment and workflow were evident only at the university-based mental health clinic as a result of the COVID-19 pandemic. Implementers at both sites indicated a highly positive overall experience with cliexa-OPTIONS and a desire to use the digital app in the future. Patient/client satisfaction surveys indicate that patients/clients enjoy using the digital app and find it easy to use. © 2023 Taylor & Francis Group, LLC.
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Introduction: The novel Coronavirus (SARS-CoV-2), responsible for severe acute respiratory syndrome, has emerged as a threat to humans since December 2019, and the search for a better understanding of the pathophysiology of coronavirus disease 2019 (COVID-19) and its definitive treatment is still in progress. Objective(s): To evaluate the plasma pro- and anti-inflammatory cytokines in COVID-19 patients and their associations with the disease severity and outcome. Method(s): Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR)-confirmed COVID-19 unvaccinated patients at the Hospital de Clinicas (HC), UNICAMP, Campinas, SP, were enrolled. Clinical and laboratory data were extracted from the medical records, and the plasma cytokines levels were quantified using LUMINEX and ELISA. Result(s): There were 154 COVID-19 patients (99 survivors and 55 non-survivors) with male:female of 1.4:1, and a median age of 60 years. The non-survivors were older than survivors (65 vs. 55 years, p < 0.0001);and coronary artery disease and autoimmunity, disease severity, and oxygen therapy, intensive care, and intubation were associated with mortality. Non-survivors had higher leukocyte and neutrophil counts, and RDW and lower lymphocyte count at diagnosis. Non-survivors had higher levels of pro-inflammatory (TNF-alpha, IL-6, IFN-gamma, CCL3, IL-17/IL-17A, IL-8, G-CSF, CCL2/MCP-1) and anti-inflammatory (IL-1ra and IL-27) cytokines, but lower TGF-beta levels than the survivors. TNF-alpha levels were positively correlated with all studied cytokines except TGF-beta, while TGF-beta levels were negatively correlated with TNF-alpha, IL-6, CCL3, G-CSF, and IL-27. IL-27 levels were significantly correlated with all the cytokines except IL-37 and IL-17E. More than half (55.2%) of our patients had severe COVID-19, 18.8% had moderate, 16.2% had critical, 5.2% had mild, and 4.5% were asymptomatic. Majority of the patients (68.2%) required ICU care and had higher TNF-alpha, IL-6, IL-8, IL-17, CCL3, CCL2, IL-1ra, and IL-27 than others. 59.7% of the patients required endotracheal intubation and had higher TNF-alpha, IL-6, IL-8, CCL3, CCL2, and IL-1ra than those who did not have intubation. TNF-alpha, IL-6, and IL-8 had the highest Area Under the Receiver Operating Characteristics (AUROC) curve, sensitivity, and specificity for predicting mortality in these COVID-19 patients. Discussion and conclusion: The altered levels of pro- and anti-inflammatory cytokines support the role of SARS-CoV-2 in inducing cytokine storm, and higher concentrations seen in the deceased patients meant a more severe storm. Also, the increased leukocytes and neutrophils in our patients could have led to the release of reactive oxygen species, and end-organ damage, thus leading to poor outcomes. This study showed that the levels of these cytokines could be used as markers of mortality in COVID-19. It is possible to suggest that TNF, IL-6, and IL-8 levels at diagnosis could be efficient predictors of fatal outcomes in COVID-19 patients. If properly measured at diagnosis, these markers could be useful for triaging and predicting the outcome of COVID-19, thus guiding the treatment of the COVID-19. Funding(s): CNPq (#190374/2017-9), CAPES, FAPESP and FAEPEX (#338619). Copyright © 2022
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Introducao: Asvacinas anti-Sars CoV-2 demonstraram que sao primordiais para o controle da pandemia por possibilitarem o desenvolvimento de imunidade em pessoas devidamente vacinadas. Objetivos: O objetivo do presente estudo foi avaliar o desenvolvimento de anticorpos neutralizantes em profissionais de saude apos duas doses das vacinasCoronaVac e AstraZeneca. Metodologia: Exames com principio de quimioluminescencia LIAISONSARS CoV-2 S1/S2 IgG - DIASORIN foram realizados no Laboratorio de Sorologia do Hemocentro de Joao Pessoa, e contagens acima de 15 AU/mL (Unidades Formadoras de Anticorpos por mL) caracterizaram desenvolvimento de protecao anti-Sars CoV-2. Cem (100) profissionais de saude foram estudados apos imunizacao com CoronaVac e AstraZeneca. Resultados: Apos a primeira dose da vacina CoronaVac, 61,4% dos profissisonais de saude ainda permaneceram com baixos niveis de anticorpos;apenas 38,6% conseguiram se imunizar. Ja apos a segunda dose da CoronaVac, apenas 12% permaneceram nao imunes, e 88% se imunizaram. Desses nao imunes, um profissional de saude faleceu com Covid-19.Considerando a vacina Astrazeneca, apenas 23,8% dos profissionais de saude nao se imunizaram apos a primeira dose, sendo que 76, 2% desenvolveram anticorpos neutralizantes. Apos receberem a segunda dose da Astrazeneca, 100% dos profissionais ficaram imunizados. Discussao: Considerando que, apos contato com a vacina, nosso organismo demora entre 7 - 14 dias para desenvolvimento de anticorpos, e que estes tem meia vida entre 20 a 28 dias, os soros dos participantes foram coletados apos exatos 20 dias a partir da imunizacao dos participantes para garantia de deteccao de anticorpos. Com o final da meia vida circulante dos anticorpos IgG, os linfocitos T de memoria serao os responsaveis pela resposta imune do nosso organismo. Conclusao: O presente estudo demonstrou a evolucao do desenvolvimento de anticorpos neutralizantes contra Covid-19 apos cada dose dos diferentes tipos de vacinas aplicados em profissionais de saude, bem como a importancia de mais de uma dose de imunizante para completa seguranca vacinal da populacao. Copyright © 2022
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This paper assesses the users’ perception about the implementation of the Remote Education Program (Reanp) formulated by the government of the state of Minas Gerais. A total of 388 comments from teachers, students and guardians were monitored and analyzed in relation to 36 posts on the official Facebook page of the State Department of Education, published between May and October 2020. The data reveal that the implementation of the program and its complexity can contribute to the intensification of regional and social inequality, in addition to pointing to the exclusion of a significant number of users. Tensions are evident in relation to technologies, resources and artifacts, access asymmetries that compromise teaching work and student performance. The users’ perceptions about the implementation of Reanp indicates that the emergence of the policy led to vertical and improvised actions, increased levels of discretion, inducing different levels of commitment and motivation. © 2022, Arizona State University. All rights reserved.
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Introduction: COVID-19 disrupted traditional research infrastructures and processes most notably in-person community recruitment, especially in underrepresented populations like racial ethnic minorities. To find creative and effective strategies, our group implemented and tested the efficacy of a culturally tailored community outreach plan (COP) developed during the US COVID-19 pandemic. Methods: In February 2021, we developed an 11 step culturallytailored community outreach program to support the implementation of three NIH funded community-based sleep studies. The following steps include: (1) description of the situation statement, 2) definition of goals, 3) engagement of audience/stakeholders, 4) tailoring message, 5) defining incentives, 6) choice of outreach methods, 7) identification of spokesperson, 8) choice of tools to assess progress, 9) identification of media outlets, 10) creation of study timeline, and 11) implementation of the plan. The studies leveraged several recruitment channels: 1) community settings (Place of worship, “community recruiter”, health fairs, word of mouth, & healthcare providers/doctors' clinics), 2) online platforms (Facebook, Twitter, LinkedIn and Research Match), and 3) preexisting datasets in NYC. Results: All three studies successfully met recruitment goals. ESSENTIAL [n= 224, 69% females, mean age= 36], MOSAIC [n=109, 61% females;mean age= 64] and Latinx/Hispanics: DORMIR[n=260, 61.3% of female;32.4]. Among the three NYC cohorts, the most common recruitment channels were: preexisting datasets (74%), community settings (19%), & online platform (7%) for ESSENTIAL;preexisting datasets (85%) & community settings (15%) for MOSAIC, and (71.7%) online platform for DORMIR. However, the Miami cohorts came mostly from community settings 90% for Essential and 97% for MOSAIC. Conclusion: Overall, the TSCS community outreach plan seems to be an effective tool to engage minoritized populations in greater NY and Miami. Our current field experience indicates that recruitment channels must be adapted to age, and community resources. Limited access to technology, particularly among older Blacks seem to be a major barrier for field staff to successfully engage the disenfranchised communities.
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Background/objective: The severity and outcome of COVID-19 are determined by the level of overstimulation of the immune response, age, and comorbidities in the patients infected by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Lymphopenia is the most consistent finding that characterizes the hemogram in COVID-19 patients. We evaluated the hemogram and compared the lymphocyte count (LC),neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) at diagnosis in COVID-19 patients hospitalized at the Clinical Hospital of the State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil. Methods: In this retrospective study, we reviewed the medical notes of 320 adult hospitalized patients with PCR-confirmed COVID-19 at the Clinical Hospital of UNICAMP, Campinas, from March 2020 to March 2021. The hemogram (performed using automated counter-XN 9000™, Sysmex, Japan) at COVID-19 diagnosis was analyzed, and NLR and PLR were calculated. The primary outcomes were discharge (n = 257 patients who recovered from the disease and were discharged from the hospital), and death (n = 63 those who died during treatment). Statistical analyses were performed using SPSS (version 22). Unpaired data of deceased and discharged COVID-19 patients were compared using Mann-Whitney tests. All results were significant if p < 0.05 or except otherwise stated. Results: Compared to the 257 discharged patients, the 63 deceased patients were older 56.0 vs 64.7 ys respectively, p = 0.000), the males are more in each group and the duration of hospitalization was not different (18.6 vs 19.7 days respectively, p = 0.12). The leukocyte (8.89 ± 4.50 vs 10.37 ± 7.03, p = 0.289) and platelet counts (227.00 ± 91.15 vs 197.79 ± 97.47, p = 0.119) were not significantly different in the two groups, the hematocrit was higher in the discharged than in the deceased patients (38.84 ± 6.86 vs 35.89 ± 8.57, p = 0.021). The LC was lower in the deceased (0.81 ± 0.59 × 103 vs 1.09 ± 0.80x103/μL, p = 0.002), and negatively correlated with the age of the patients(r = -0.145, p=0.009 at a significant level of 0.01). The deceased group had a higher NLR (17.52 ± 19.20 vs 10.06 ± 12.31, p < 0.001) and PLR (366.32 ± 275.03 vs 319.23 ± 331.54, p = 0.047) higher than the discharged group, and both parameters were strongly correlated (r = 0.734, p < 0.001 significant level of 0.01). One hundred and thirty-eight (53.7%) of the discharged patients and 45 (71.4%) of the deceased had LC of < 1.0 × 103/μL. The LC is associated with the disease outcome (χ2 = 6.498, df = 1, p = 0.011), and the odds for a deceased to have a lymphopenia is 1.9 times that for the discharged patients [OR = 1.87 (95% CI = 1.135-3.085). Discussion: Though lymphopenia is consistent in COVID-19, the cause is unclear. Acute recruitment of lymphocytes to the site of infection (mainly the lung) may explain this, thus the lymphopenia may worsen and the LRs will be elevated with the increasing severity of COVID-19. The negative correlation of LC with age and higher odds of lymphopenia in the deceased patients suggest that LC and the LRs at diagnosis could be easily accessible and useful predictors of severity and mortality in these patients. Conclusion: Our study supports that lymphopenia is negatively associated with mortality in COVID-19 patients and that the deceased patients have elevated NLR and PLR at diagnosis. These parameters are easily derived from the hemogram and could be utilized as affordable and accessible predictors of outcomes in patients with COVID-19.
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The social isolation resulting from the Covid-19 pandemic has intensified use and communication through digital technologies. In education, face-to-face classes were suspended, which paved the way for the implementation of new teaching practices. In this context, this study sought, through a qualitative and quantitative approach, to assess the conditions of access and the quality of the internet, as well as the digital technologies used by students of the Social Sciences course at the Federal University of Tocantins (UFT) to a possible return from academic activities. 95% of the students enrolled in the course participated in the research. The results reveal that economic, physical and mental health, institutional and other difficulties are obstacles to the implementation of inclusive remote education.
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Background: Brazil became the South American epicenter for coronavirus disease (COVID-19) soon after the first case was diagnosed in February 2020 with the highest infection rate occurring in the state of Sao Paulo. COVID-19 is characterized by marked thrombo-inflammation mechanisms, and neutrophil-lymphocyte ratio (NLR) among many clinical and laboratory data, is becoming an inflammatory marker of severity and mortality of COVID-19. We evaluated the serial weekly lymphocyte ratios, which are easily derivable from the routine blood counts, in the survivors and non-survivors of COVID-19 at the Clinical Hospital of University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil, from time of diagnosis to the 3 rd week of care. This hospital is one of the referral centers for COVID-19 patients in this state. Methods: In this retrospective study, we reviewed the medical notes of 320 adults hospitalized patients with PCR-confirmed COVID-19 at the Clinical Hospital of UNICAMP, from March 2020 to March 2021. The serial weekly hematological parameters (analyzed using automated counter - XN 9000™, Sysmex, Japan) from the time of diagnosis were analyzed and lymphocytes ratios (neutrophil-lymphocyte, NLR, platelet-lymphocyte PLR, and monocyte-lymphocyte MLR) were calculated. The survivors (n=257) were those who recovered from the disease and were discharged from the hospital, while the non-survivors (n=63) were those who died in the course of treatment. Statistical analyses were performed using SPSS (version 22). Unpaired data of Survivors and Non-survivors with COVID-19 were compared using Mann-Whitney tests. Repeated measures were compared within and between groups using univariate and multivariate tests in general linear models. All results were considered significant if p<0.05. Results: Of the 320 patients, 257 (80.3%) were survivors and had lower mean age than the non-survivors (57.73 vs 64.65 years, p<0.001). At diagnosis, the non-survivors had a lower lymphocyte count (p=0.002), basophil count (p=0.049), and hematocrit (p=0.021) than the survivors, Table 1. We used general linear models for repeated measures and corrected for the patients who did not stay long enough to have a complete series of blood counts, Figure 1 A-G. Multivariate tests between the survivor and non-survivor groups showed significant variations with serial weekly lymphocyte count (p<0.001), neutrophil count (P=0.005), NLR (p=0.009), MLR (p=0.010), and PLR (p=0.035) but not with the weekly monocyte count (p=0.352) and platelet count (p=0.505). The NLR was higher and PLR was lower in the non-survivors at diagnosis (p<0.001 and p=0.047 respectively), both were higher in the 2 nd week post-diagnosis (p<0.001 and 0.043 respectively), and in the 3 rd week (p<0.001 and p=0.043 respectively) (Figure 1D and E). The MLR was not significantly different at diagnosis but became elevated in the following two weeks post-diagnosis (p=0.09, p=0.022, and p<0.001 respectively) (Figure 1F). Conclusions: The non-survivors were older and their NLR and MLR tend to increase from the time of diagnosis while their PLR tend to decrease after the 2 nd week post-COVID-19 diagnosis and treatment. On the other hand, all three ratios significantly decrease in the survivors. While neutrophilia and lymphopenia improved in the survivor, they worsen in non-survivors. These cells may have contributed towards the recovery by ameliorating the inflammatory response in survivors, and death by worsening the response in non-survivors of COVID-19. This study shows that serial lymphocyte count, neutrophil count, NLR, PLR, and MLR could serve as good and easily accessible markers of outcomes in patients with COVID-19 and could be used for monitoring of response to treatment. [Formula presented] Disclosures: Costa: Novartis: Consultancy.
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Background: Since 2019, we have experienced a terrible pandemic, COVID-19. Emerging countries, like Brazil, with logistical difficulties and lack of public policies, face a generalized collapse in health system. Rare Diseases Reference Centers are located distant from patients' houses. Thus, patients with lysosomal diseases, unable to travel and need to receive their recombinant enzyme replacement therapy (ERT) close to their homes. Infusion-related reactions (IRR) are uncommon;however, they can impair the treatment. Therefore, due to the impossibility of locomotion and unavailability of teams of allergists, RDD protocol were accomplished. The study aimed to describe remote points of training and protocols execution. Method: After appointments from treating lysosomal centers (TLC) diseases about adverse reactions, the following strategy was adopted: three online meetings between metabolic team and allergists to present the clinical case;lectures about adverse reactions to medications and RDD: video demonstrations off how to perform skin tests and nursing training for the use of. Two meetings were held with the families, terms of consent were applied, and a communication group was created on WhatsApp® with team leaders. Afterwards, the RDD was formulated and applied remotely, by Google Meet®. Finally, three infusions were followed up under the supervision of our center. Results:: Six patients presented immediate IRR to different recombinant enzymes: three patients with Fabry disease, one with MPS I, one with MPS II and one with MPS IV. The Allergy Center located in São Paulo, was composed of a team of allergology and health professionals with expertise in inborn errors of metabolism. The (TLC) were in the interior of São Paulo, Bahia, Pernambuco and Piauí, 300 to 1,800 miles apart. The protocols were carried out respecting the Standard 12-16 steps according to risk stratification. One of the patients, developed urticaria on the 11th step, despite the addition of premedication. Conclusion: The new Coronavirus' pandemic imposed a new reality, which include much more telecommunication. Barriers have been overcome, such as offering remote alternatives to the treatment of incurable diseases in countries with continental dimensions.
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Currently and as a future trend, many robotic systems are being adapted to allow medical procedures such as surgeries, diagnostics, and monitoring to be conducted remotely. The integration of these systems allows an alternative for traditional procedures in health to be executed more efficiently over distance. Since the coronavirus pandemic (COVID-19) and the worldwide imposed physical distancing restrictions, the use of teleoperation systems became even more relevant. Although this is now a reality, there are still some major drawbacks to teleoperation, mostly due to communication failure, transmission delays, limited bandwidth, and security breaches. To mitigate the communication problems over greater distances, many authors are giving now positive feedback on the integration of the recent 5G cellular technology in their systems. This paper aims to present a review of the relevant literature targeting the communication protocols and frameworks used in teleoperation systems since 2016. It will focus on showing insights and highlight the key technologies used for the current telerobotic communication frameworks for both short and long-distance systems. © 2021 IEEE.
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Objetivos: Estimar a prevalência e fatores associados à hesitação ao uso da vacina contra o vírus SARS-CoV-2 no Maranhão, Brasil. Métodos: Estudo transversal de base populacional realizado de 19 a 30 de outubro de 2020. As estimativas consideraram agrupamento, estratificação e não resposta. A seleção da amostra foi realizada em três estágios (estrato, setores censitários e domicílio). Após análise sistemática, em cada estrato foram selecionados trinta setores, totalizando 150 setores, sendo o número de domicílios em cada setor fixado em 34, totalizando 5.100 domicílios e um indivíduo por domicílio (residente pelo menos há seis meses e com um ano de idade ou mais) selecionado por amostra aleatória simples. A intenção de ser vacinado foi questionada aos participantes. Foi realizada análise descritiva (frequências ponderadas) e teste do qui-quadrado de Pearson para verificar associação univariada entre as variáveis independentes e o desfecho (p < 0,05). Realizou-se análise multivariada robusta utilizando-se modelagem hierarquizada em três níveis. Resultados: Foram entrevistados 4.630 indivíduos. A prevalência de hesitação vacinal foi de 17,5% (IC95% 16,1–19,1%). Após ajuste final do modelo, a hesitação vacinal foi estatisticamente maior entre moradores das cidades de Imperatriz (24,0%;RP = 1,48;IC95% 1,09–2,02) e de munícipios da Grande Ilha de São Luís (20,7%;RP = 1,34;IC95% 1,02–1,76), pessoas do sexo feminino (19,8%;RP = 1,44;IC95% 1,20–1,75), idosos (22,8%;RP = 1,79;IC95% 1,30–2,46), pertencentes às religiões de denominação evangélica (24,1%;RP = 1,49;IC95% 1,24–1,79) e entre aqueles sem relato de sintomas (18,6%;RP = 1,24;IC95% 1,02–1,51). Outras características socioeconômicas e demográficas, assim como variáveis relacionadas ao mercado de trabalho, comportamentos e condições de saúde dos entrevistados, não tiveram diferença estatística. Conclusão: A prevalência de hesitação vacinal no Maranhão e sua associação com fatores individuais, contextuais e clínicos revelam os grupos e contextos mais resistentes e que devem merecer atenção especial das estratégias públicas para garantir a ampla vacinação. Descritores: Infecções por Coronavirus, prevenção & controle. Recusa de Vacinação, psicologia. Conhecimentos, Atitudes e Prática em Saúde. Inquéritos Epidemiológicos.