Stress in undergraduate students: knowing the effect of remote activities in the pandemic daily routine

The coronavirus pandemic brought an unprecedented disruption to society, with this, the impacts fostered by the crisis also extended to educational institutions. The aim of this study was to investigate whether higher education activities can be considered a stressor in a pandemic context. The sample consisted of 136 students with remote academic activities and 131 with suspended academic activities, who answered a sociodemographic questionnaire and an open question about the factors that have raised the level of stress in the months of April, May, June and July 2020. The textual corpus was processed with the aid of the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software. As a result, there were several stressors related or not related to academic activities for both groups, although the performance of digital academic activities has been pointed out with great frequency. Thus, digital academic activities are related to the level of stress among students © 2023 Associação Nacional de Pós-Graduação e Pesquisa em Educação – ANPEd. This is an open access article distributed under the terms of the Creative Commons license

Relato De Caso: Tromboflebite Superficial Extensa Em Paciente Portador De Hemofilia a Grave Associada a Vacina Para Covid19

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

SEMcTrA: A multilayer specialized system for COVID-19 remote triage, resource allocation and teleconsultation

The rapid regulation of telemedicine in Brazil during the COVID-19 pandemic occurred after publication of the brazilians Unified Health System (SUS) Ordinance N 467/2020 and Federal Council of Medicine (CFM) Resolution 2.314/2022, which provides definitions, usages and regulations for telemedicine during the pandemic period. Once social isolation actions have been required in pandemic, teleconsultation and remote triage combined solutions provide strategic subsidies for monitoring and treating COVID-19. When aggreded with someone allocation strategies, these solutions allowing exchange of qualified information, and strategic communication within territory, where the residents and the local assistance services are responsible for directly dealing with the pandemic. In this context, the teleconsultation multilayer expert system for COVID-19 classification, triage and intelligent allocation so-called SEMcTrA was developed. Composed of asynchronous (patient-system interaction) and synchronous (medical-patient interaction) communication modules, which legitimize and effective the medical forwarding, and enable the collect of accurate data of the disease evolution. The SEMcTrA computes the probability coefficient of Covid-19, called PCovid, to diagnostic aid decision. The remote communication with the patient is subsidized by the PCovid value in a teleconsultation environment that implements Security Assurance Level requirements. In addition, the system has a homepage for news publication to serve the population with secure information regards the new coronavirus. The system is currently being tested by the team from Division of Health Care Employee (DASS) at the Universidade Federal Rural do Semi-Árido. As a result, the multilayer triage approach (asynchronous, synchronous, and smart allocation) encapsulated in the SEMcTrA, provided support for medical-decision by offering information in an efficient and agile way to combat the pandemic. © 2022 ACM.

Higher Angiotensin Converting Enzymes Activities Are Observed In Covid-19 Positive Volunteers

The high transmissibility and the broad spectrum of clinical manifestations of COVID-19 are in part due to the high affinity of SARS-CoV-2 for its receptor, Angiotensin Converting Enzyme 2 (ACE2). The depletion of the biological functions of ACE2, due to the internalization of the receptor along with SARS-CoV-2, leads to impairment of Renin Angiotensin System (RAS), which can contribute to COVID-19 pathogenesis. In addition, genetic differences in RAS may be associated with more severe symptoms and complications observed in COVID-19 patients. This study aims to perform a comparative analysis between COVID-19 positive patients and uninfected individuals, to correlate such disease profiles with ACE I/D (Insertion/Deletion) and ACE2 G8790A polymorphisms, and their enzymatic activities. The anthropometric, demographic, clinical and cardiovascular parameters of 764 individuals from Ipaussu/SP (Brazil) were evaluated. ACE and ACE2 activities were measured by fluorometric assays, and assessment of both enzymes polymorphisms was performed by PCR. In this cohort, 35,2% (269 of 764) the volunteers were positive for COVID-19. The prevalence of COVID-19 was higher among women (67%) and individuals aged between 18 and 49 years. Also, comorbidities as obesity and arterial hypertension were more frequent in the positive group, when considered individuals under 60 years old. Higher ACE and ACE2 enzymatic activities were observed in positive group (46.4 vs 41.6 and 11.3 vs 8.5, respectively). Individuals with ID genotype in the positive group presented higher ACE activity compared to individuals with same genotype in control group (46.9 vs 41.7). In the positive group, ACE activity was increased in the DD (54.5) when compared to ID (46.9) and II (37.9) genotypes. No significant differences related to ACE2 activity and polymorphism were observed. ACE/ACE2 activity ratio was higher in the COVID-19 negative group (4.7 vs 3.7). The increased ACE activity for the DD genotype was in line with the literature data for hypertension and cardiovascular diseases. We can suggest a synergic effect between ACE DD genotype and COVID-19 infection enhancing ACE activity, what may contribute to pro-inflammatory phenotype and more severe symptoms of COVID-19.

Impact of the COVID-19 pandemic on stage at diagnosis of patients with breast cancer: An analysis of 11,752 patients from Oncoclínicas

Background: As a reaction to the COVID-19 pandemic, a nation-wide lockdown was enforced in Brazil in March 2020, cancer care was impacted, and cancer screening reduced. Therefore, an increase in cancer diagnoses at more advanced stages was expected. In this study, we extracted data from our nationwide real-world database to evaluate the impact of the COVID-19 pandemic on the stage at diagnosis of breast cancer (BC) cases. Methods: We explored curated electronic medical record data of female patients, over 18 years of age, diagnosed with BC and with established disease stage based on the AJCC 8th edition, who started treatment or follow-up in the Oncoclínicas (OC) between Jan 1, 2018, and Dec 31, 2021. The primary objective was to compare stage distribution at first visit during COVID- 19 pandemic (2020-2021) with a historical control cohort from a period prior to the pandemic (2018- 2019). We investigated stage distribution according to age at diagnosis and tumor ER/HER2 subtype in univariate models. Associations were considered significant if they had a minimum significance (P < 0.1 in Chi-square test). The historical numbers of patients with BC at OC make it possible to identify differences in the prevalence of stages in the order of 5% comparing pre and post pandemic periods with a statistical power greater than 80%. Results: We collected data for 11,752 patients with initial diagnosis of BC, with 6,492 patients belonging to the pandemic (2020-2021) and 5,260 patients to the pre-pandemic period (2018-2019). For both ER+/ HER2- and HER2+ tumors, there was a lower percentage of patients with early-stage (defined as stage I-II) in the years 2020-2021 vs 2018-2019 and a considerable increase in advanced-stage disease (defined as stage IV). For triple negative BC (TNBC), there was a significant higher percentage of patients with advanced-stage disease in the pandemic vs pre-pandemic period (table 1). Age over 50 years was associated with a greater risk of advanced stage at diagnosis after the onset of the pandemic, with an absolute increase of 7% (P twosided <0.01). Conclusions: We observed a substantial increase in cases of advanced-stage BC in OC institutions as a result of delays in BC diagnoses due to the COVID-19 pandemic. The impact appeared greater in older adults, potentially because of stricter confinement in this group.

Forecasting the COVID-19 Space-time Dynamics in Brazil with Convolutional Graph Neural Networks and Transport Modals

One of the major challenges imposed by the SARS-CoV-2 pandemic is the lack of pattern in which the virus spreads, making it difficult to create effective policies to prevent and tackle the pandemic. Several approaches have been proposed to understand the virus behavior and anticipate its infection and death curves at country ans state levels, thus supporting containment measures. Those initiatives generalize well for general extents and decisions, but they do not predict so well the trajectory of the virus through specific regions, such as municipalities, considering their distinct interconnection profiles. Specially in countries with continental dimensions, like Brazil, too general decisions imply that containment measures are applied either too soon or too late. This study presents a novel scalable alternative to forecast the numbers of case and death by SARS-CoV-2, according to the influence that certain regions exert on others. By exploiting a single-model architecture of graph convolutional networks with recurrent networks, our approach maps the main access routes to municipalities in Brazil using the modals of transport, and processes this information via neural network algorithms to forecast at the municipal level ans for the whole country. We compared the performance in forecasting the pandemic daily numbers with three baseline models using Mean Absolute Error (MAE), Symmetric Mean Absolute Percentage Error (sMAPE) and Normalized Root Mean Square Error (NRMSE) metrics, with the forecasting horizon varying from 1 to 25 days. Results show that the proposed model overcomes the baselines when considering the MAE and NRMSE (p ˂0.01), being specially suitable for forecasts from 14 to 24 days ahead. Author

A Brief Analysis of a New Device to Prevent Early Intubation in Hypoxemic Patients: An Observational Study

Featured Application A new device to support oxygen therapy for patients diagnosed with severe COVID-19. The need for mechanical ventilation is one of the main concerns related to the care of patients with COVID-19. The aim of this study is to evaluate the efficacy of a bubble device for oxygen supplementation. This device was implemented for the selected patients hospitalized with severe COVID-19 pneumonia with persistent low oxygen saturation. Patients were selected in three major COVID-19 hospitals of Bahia state in Brazil from July to November 2020, where they remained with the device for seven days and were monitored for different factors, such as vital signs, oximetry evaluation, and arterial blood gasometry. Among the 51 patients included in the study, 68.63% successfully overcame hypoxemia without the necessity to be transferred to mechanical ventilation, whereas 31.37% required tracheal intubation (p value < 0.05). There was no difference of note on the analysis of the clinical data, chemistry, and hematological evaluation, with the exception of the SpO(2) on follow-up days. Multivariate analysis revealed that the independent variable, male sex, SpO(2), and non-inhaled mask, was associated with the necessity of requiring early mechanical ventilation. We concluded that this bubble device should be a prior step to be utilized before indication of mechanical ventilation in patients with persistent hypoxemia of severe COVID-19 pneumonia.

ENHANCING ENVIRONMENTAL SUSTAINABILITY AND E-COMMERCE DELIVERIES THROUGH THE USE OF EPP BOXES IN A DARKSTORE

An unprecedented outbreak pandemic caused disruption around the world. It had a strong impact on economic sector. Although, the pandemic accelerated the growth of e-commerce for specific categories as food retailer. As a result, several companies restructured their structures, in terms of IT and operations. During the first confinement, the operations and the website of SONAE MC were not prepared for the increase that existed due to the pandemic, COVID-19, causing disruption in the supply chain and long lead times. In this paper, it is explained how SONAE MC reduced its dependence on refrigerated vehicles, simplifying operations and reducing the costs of transporting products from online orders in vehicles with cargo space able to transport positive cold food and negative cold. It is also explained how innovation has ensured that products continue to be transported with quality and safety to all customers of the SONAE MC Darkstore. The result was the implementation of the proposed solution which may grow technologically once information and equipment are available. © 2021 Samo Drobne – Lidija Zadnik Stirn – Mirjana Kljajić Borštnar – Janez Povh – Janez Žerovnik

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.

STF, indigenous peoples and Situation Room: illusory dialogue

This research analyzes the constitutional lawsuit ADPF 709, filed at the Brazilian Supreme Court (STF), with regard to the protection of the right to health of isolated and recently contacted indigenous peoples. The article deals especially with the judicial decision that determined the installation of the Situation Room, an official space within the administration, for an intercultural dialogue and the failure of this initiative.

Violations of the health rights of isolated and recently contacted indigenous peoples in the context of the COVID-19 pandemic in Brazil

This article first characterizes the socio-epidemiological vulnerability (Rodrigues, 2014) to which isolated and indigenous peoples of recent contact are subjected. Through historical examples, we try to illustrate how epidemics and violence resulting from contact processes combine to decimate entire populations. We present and analyze the specific Brazilian legislation that guarantees the right to health to these peoples, and then exemplify how the Brazilian State is failing to comply with it. Finally, we conclude that the violation of the right to health, in a moment of health emergency of pandemic proportions, may come to mean the genocide of these populations, a risk that the Brazilian State is consciously assuming.