Mild COVID-19 clinical course among paediatric patients with primary immunodeficiency

Background: The clinical course of coronavirus disease-2019 (COVID-19) varies from those who are asymptomatic, experience mild symptoms such as fever, cough, and dyspnea, to more severe outcomes including acute respiratory distress, pneumonia, renal failure, and death. Early reports suggested severe outcomes in patients with primary immunodeficiency (PID), particularly those with type 1 interferon signalling defects. This prompted a rigid approach to social distancing to protect this patient population, particularly children. To date, real-world data describing the course and outcome of COVID-19 in paediatric PID patients remains scarce. Method(s): In this retrospective case series, we describe the clinical course of 36 paediatric patients with underlying primary immunodeficiency (PID) followed by SickKids Hospital (Toronto, Canada) who were symptomatic and tested positive for SARS-CoV-2 infection between October 2020 to November 2022. Result(s): Our cohort consisted of patients with combined immunodeficiency (66.7%), antibody deficiency (22.2%), neutrophil dysfunction (8.3%), and immune dysregulation (2.8%). The median age was 7.5 years (range: 8 months - 17 years), with 21 male and 15 female patients. Three (8.3%) patients were post-hematopoietic stem cell transplant (HSCT) and 12 (33%) patients were on immunoglobulin replacement. Nine (25%) patients had underlying lung problems including bronchiectasis (1), interstitial lung disease on home oxygen therapy (1), and underlying asthma (7). Most patients had mild clinical course and were managed at home. The most common symptoms were fever (80%), cough (75%) and other upper respiratory tract symptoms (72%). Nineteen (52.7%) patients experienced other symptoms which included headache, lethargy, or gastrointestinal upset. At the time of the infection, 13 patients (36.1%) had received 2 doses of a SARS-CoV-2 vaccine, 5 patients (13.9%) had received 1 dose, and 18 (50%) were not vaccinated. None of the patients received antiviral or monoclonal antibody as prophylaxis or treatment. Only 1 patient required hospital admission out of precaution given the close proximity to HSCT. All patients recovered without complications. Conclusion(s): The paediatric patients with PID followed by our centre experienced mild to moderate COVID-19 symptoms and recovered fully without complications. These findings support the return of much needed social interactions among children, which were impacted severely during the COVID-19 pandemic.Copyright © 2023 Elsevier Inc.

Mild COVID-19 outcomes in adults with inborn errors of immunity: a single-center experience

Currently, 640 million cases of coronavirus disease 2019 (COVID-19) and 6.6 million deaths have been reported world-wide. Risk factors for severe COVID-19 are known, including those with compromised immunity. Among patients with inborn errors of immunity (IEI), early reports of severe outcomes lead to strict masking and social distancing measures. While this resulted in relatively low infection rates among those with IEI, real-world data describing the clinical course of COVID-19 in this patient population have remained limited. We performed a retrospective study of adult IEI patients followed by our center in which a positive test (rapid antigen or PCR) for COVID-19 was determined between November 2021-November 2022. Medical charts were reviewed, and patient interviews conducted. All patients provided informed consent. Twenty-nine patients were enrolled (22 females, 7 males), aged between 18-69 years (median: 20-29 years). The cohort included those with antibody deficiencies (41.37%), combined immunodeficiencies (34.48%;HIES, CARD11, STAT1-GOF), immune dysregulation disorders (20.69%;LRBA deficiency, AIRE deficiency) and phagocyte defect (3.45%;CGD). The duration of symptoms ranged between 3 days-4 weeks (median: < 1 week). Upper respiratory symptoms (including sore throat, congestion) were reported in 97% while fever was present in 41% of patients. Prior to infection, 14 (48%) patients had underlying asthma or bronchiectasis - 2 subsequently experienced shortness of breath and were treated with inhalers or Sotrovimab, respectively. No treatment was required in 65.5% of cases. The remaining received Paxlovid (10.3%), Sotrovimab (13.79%), or antibiotics (10.3%). Of the 2 patients with STAT1-GOF, one tested positive during a repeat episode of febrile neutropenia which required hospitalization. No other patients were hospitalized or needed ICU admission. No deaths were recorded. In light of these favourable outcomes, patients with IEI can gradually and safely return to normal activities.Copyright © 2023 Elsevier Inc.

Exploring the correlations between epi indicators of COVID-19 and the concentration of pharmaceutical compounds in wastewater treatment plants in Northern Portugal.

The COVID-19 pandemic caused by the SARS-CoV-2 virus led to changes in the lifestyle and human behaviour, which resulted in different consumption patterns of some classes of pharmaceuticals including curative, symptom-relieving, and psychotropic drugs. The trends in the consumption of these compounds are related to their concentrations in wastewater systems, since incompletely metabolised drugs (or their metabolites back transformed into the parental form) may be detected and quantified by analytical methods. Pharmaceuticals are highly recalcitrant compounds and conventional activated sludge processes implemented in wastewater treatment plants (WWTP) are ineffective at degrading these substances. As a results, these compounds end up in waterways or accumulate in the sludge, being a serious concern given their potential effects on ecosystems and public health. Therefore, it is crucial to evaluate the presence of pharmaceuticals in water and sludge to assist in the search for more effective processes. In this work, eight pharmaceuticals from five therapeutic classes were analysed in wastewater and sludge samples collected in two WWTP located in the Northern Portugal, during the third COVID-19 epidemic wave in Portugal. The two WWTP demonstrated a similar pattern with respect to the concentration levels in that period. However, the drugs loads reaching each WWTP were dissimilar when normalising the concentrations to the inlet flow rate. Acetaminophen (ACET) was the compound detected at highest concentrations in aqueous samples of both WWTP (98. 516 µg L - 1 in WWTP2 and 123. 506 µg L - 1in WWTP1), indicating that this drug is extensively used without the need of a prescription, known of general public knowledge as an antipyretic and analgesic agent to treat pain and fever. The concentrations determined in the sludge samples were below 1.65 µg g - 1 in both WWTP, the highest value being found for azithromycin (AZT). This result may be justified by the physico-chemical characteristics of the compound that favour its adsorption to the sludge surface through ionic interactions. It was not possible to establish a clear relationship between the incidence of COVID-19 cases in the sewer catchment and the concentration of drugs detected in the same period. However, looking at the data obtained, the high incidence of COVID-19 in January 2021 is in line with the high concentration of drugs detected in the aqueous and sludge samples but prediction of drug load from viral load data was unfeasible.

Diabetes mellitus and COVID-19: A bidirectional relationship?.

The COVID-19 pandemic has generated a public health emergency around the world. The risk, severity, and mortality of the disease has been associated to chronic diseases, such as diabetes mellitus. There are multiple patho-physiological explanations that relate these two entities. The possibility of a bidirectional relationship between COVID-19 and diabetes mellitus type 1 and 2 has been raised. Most studies agree that diabetes mellitus of any etiology is associated with a negative outcome of the infection. Also, CO-VID-19 can cause a worsening of glycemic control and can be a trigger for the development of diabetes mellitus type 1.Copyright © 2023 Universidad de Antioquia.

Trajectory of Post-Covid Neurocognitive Recovery in People Living with and without Hiv

Background: Neurocognitive dysfunction is common in long COVID and in people living with HIV (PWH). It is unknown whether PWH experience different disturbances in neurocognitive function following COVID-19 compared to HIVseronegative people. Method(s): The amfAR-Johns Hopkins University COVID Recovery Study is a prospective observational cohort study consisting of four groups: participants who had SARS-CoV-2 infection for the first time within 30 days prior to enrollment with HIV (PWH, arm 1) and without HIV (arm 2);participants with no history of SARS-CoV-2 infection with HIV (arm 3) and without HIV (arm 4). 93.5% of the cohort had received a COVID-19 vaccine prior to enrollment. Cognitive tests were administered at 1-and 4-months post symptom onset (arms 1-2) or post-enrollment (arms 3-4) in seven domains. Age standardized scores (all tests) and age-sex-and education-standardized scores (verbal fluency) were obtained. Standardized scores were compared using the Mann-Whitney U Test and the Kruskal-Wallis test. Result(s): PWH scored lower than HIV-seronegative participants at 1 and 4 months post-COVID on three tests: the Hopkins Verbal Learning Test-Revised (HVLT-R) learning (M1, p=0.011, M4, p=0.015), HVLT-R memory (M1, p=0.029, M4, p=0.007), and category-cued verbal fluency (VF;M1&4, p< 0.001). For the majority of timepoints, PWH who were post-COVID produced equivalent scores as PWH who never had COVID (p-levels > 0.05). Comparing post-COVID HIV-seronegative people to those who never had COVID, post-COVID participants scored lower than never-COVID participants on the Oral Trail Making Test part A (OTMT) test of processing speed at month 1 (p=0.033). Between month 1 and 4, HIV-seronegative people who were post-COVID showed improvements in HVLT-R Recognition (p=0.039), OTMT A (p=0.003), and OTMT B test of executive function (p=0.032). Conclusion(s): Neurocognitive scores in PWH were independent of COVID status, suggesting that higher frequencies of post-COVID neurocognitive dysfunction in PWH compared to HIV-seronegative people are due to HIV-associated factors more so than COVID. HIV-seronegative, post-COVID people demonstrate diminished recognition memory, processing speed, and executive function at 1 month post-COVID that improves by 4 months. Post-COVID neurocognitive dysfunction is present, if temporary, even in a highly vaccinated cohort of people.

Symptoms and Biomarkers of Long Covid in People Living with and without Hiv

Background: HIV is a risk factor for severe acute COVID-19, but it is unknown whether HIV is a risk factor for long COVID. Method(s): We conducted a prospective observational cohort study of US adults with HIV (PWH) and HIV-seronegative adults with first SARS-CoV-2 infection within 4 weeks together with people who never had COVID-19. At enrollment, participants recalled the presence and severity of 49 long COVID-associated symptoms in the month prior to COVID-19. The same symptom survey was administered at 1, 2, 4, and 6 months post-COVID or post-enrollment for never- COVID participants. Post-COVID participants donated blood 1 and 4 months post-COVID, and never-COVID participants donated blood 0-1 times. Antibody titers to 18 coronavirus antigens and levels of 30 cytokines and hormones were quantified (Meso Scale Discovery). The Mann Whitney U test was used to compare continuous variables between groups, and Pearson's chi-squared test for categorical variables. Spearman correlation analyses were used to build networks of associations between cytokines and symptoms. Result(s): 341 participants enrolled between June 2021 and September 2022. Of these, 73 were PWH post-COVID, 121 were HIV-seronegative post-COVID, 78 were PWH never-COVID, and 69 were HIV-seronegative never-COVID. Over 85% of participants were vaccinated prior to COVID-19. Most participants with HIV were male sex at birth (83% post-COVID, 59% never-COVID), on ART ( >95%), with median CD4 counts >500. Over 60% of participants reported 1+ new or worsened symptoms 2-6 months post-COVID, with higher percentages in PWH at 2 months post-COVID (p< 0.05). PWH were more likely to report body ache, pain, confusion, memory problems, and thirst and had higher levels of creatine phosphokinase post-COVID than HIV-seronegative people. SARS-CoV-2 and non-SARS human coronavirus antibody titers did not differ between PWH and HIV-seronegative post-COVID participants. Cytokine associations with each other (network density) were significantly enriched at 1 month post-COVID in both PWH and HIV-seronegative people, with significantly less enrichment at 4 months post-COVID and in never- COVID participants. Levels of four analytes (cortisol, C5a, TGF-beta1, and TIM-3) associated with specific symptoms of long COVID. Conclusion(s): PWH may experience more symptoms post-COVID with a slightly different symptom profile than people without HIV. Inflammatory networks were active in PWH and people without HIV at 1 month post-COVID.

Inverted South Trilogy: creation of theatrical texts based on perspectives of the south region of Rio Grande do Sul

This article discusses the starting point for the creation of the theatrical texts for the Inverted South Trilogy: southern Rio Grande do Sul, a Brazilian state. By observing the three plays and their respective genesis, it is possible to see how this region is used as the background of the works comprising the trilogy. The collection, written by Ingrid Duarte, Mario Celso, and Thalles Echeverry, professors graduated from the Universidade Federal de Pelotas, was launched during the COVID-19 pandemic with resources granted according to Federal Law n.degrees 14017 (Aldir Blanc Law). This trilogy highlights a change in perspective which goes beyond the capital of the state to address cities located outside the metropolitan areas, and demonstrates the importance of creating spaces for training and incentive to writing of plays, particularly to new authors.

Asymptomatic Sars-Cov-2 Infection in Pediatric Patients with Juvenile Dermatomyositis and Other Rheumatic Diseases of One Tertiary Referral Hospital

Background. Several studies and cohorts with adult populations with rheumatic diseases (RD) were performed since pandemic outbreak. RD patients were more susceptible to infections and may develop severe forms of COVID-19, since they present immunosuppressive mechanisms inherent to the disease itself and to its treatment. Healthy children and adolescents seem to be less infected and present milder diseases. However, juvenile dermatomyositis patiets and immunosuppressed children have not been extensively studied. The objectives of the study are to evaluate asymptomatic SARS-CoV-2 infection in pediatric RD patients, to identify the risk factors related to contagion and to describe demographics and the profile of COVID-19 in juvenile dermatomyositis (JDM) patients followed. Methods. A cross-sectional study was conducted in March 2021, including 77 pediatric RD patients followed at a Brazilian tertiary hospital and 45 healthy controls. Data was obtained through a questionnaire applied to outpatients during the month of March 2021, before the vaccine, and contained demographic data, symptoms compatible with COVID-19 over the past year, and contact with people with confirmed COVID-19. Patients' medical records were reviewed to access data regarding disease and current medications. A qualitative immunochromatographic SARS-CoV-2 test was performed in all participants. All patients who were using rituximab or intravenous human immunoglobulin, or had symptoms of COVID-19, were excluded. Results. Patients' group included 11 (14.3%) JDM patients, 31 (40.2%) JIA, 25 (32.4%) JSLE, six patients with vasculitis, two with SS, one MCTD and one with autoinflammatory syndrome. Patients and controls were similar in terms of female gender (70.1% vs. 57.8%, p=0.173), median age (14 vs. 13 years, p=0.269) and SARS-CoV-2 serology positivity (22% vs. 15.5%, p=0.481). 80.5% of rheumatic patients were in use of immunosuppressive drugs, 27.3% of them using corticosteroids, 33.3% in high doses, and 7.8% on immunobiologicals. No statistical differences were found between positive (n=17) and negative serology (n=60) patients regarding demographic/socioeconomic data, contact with people with confirmed COVID-19, use and number of immunosuppressive drugs, use and dose of corticosteroids, use of hydroxychloroquine and immunobiological drugs (p>0.05). Regarding the profile of JDM patients, 6/11 (54%) were female, the median age was 13 years (range 9-17) and 3/11 (27%) presented COVID-19 serology positivity. 2/11 were in immunosuppressive treatment, however none of them were in use of glucocorticoids and biologic agents. Conclusions. Pediatric JDM and other rheumatic diseases patients were infected at the same rate as healthy ones. Neither the underlying pathology nor its treatment seemed to interfere with the contagion risk.

Lung changes after COVID-19: What are the functional differences across the spectrum of disease severity?

The pulmonary limitations after COVID-19 are still not completely known. Lung function test (LFT) and 6-minute walk test (6MWT) are accessible and safe tests to access them. Aim(s): To evaluate the differences between non-severe and severe COVID-19 patients regarding LFT and 6MWT. Method(s): This study included patients with previous COVID-19 assessed in Pulmonology Department at 2 hospitals during 7 months who performed LFT and 6MWT. Baseline and immediately pos-6MWT heart rate (HR), SpO2, respiratory rate (RR) and perceived symptoms using a modified BORG scale were collected. We compared nonsevere and severe patients. Result(s): We included 151 patients, 69 (45.7%) with severe disease. LFT was performed 116.8+/-68.3days and the 6MWT 129.1+/-72.3days after COVID-19, without statistical difference between groups. We documented lower %FVC (94.4+/-14.7vs101.1+/-12.6%, p=0.003), %TLC (95.4+/-15.3vs107.1+/-12.3%, p=0.000) and %DLCO (68.8+/-16.5vs78.9+/-15.9%, p=0.000) in the severe group, without statistical differences in FEV1, FEV1/FVC and KCO. The 6MWT distance (m: 426.5+/-110.9vs498.2+/-93.5m, p=0.000;%:77.3+/-16.8%vs86.1+/-13.4%, p=0.001), estimated metabolic equivalents (3.03+/-0.5vs3.4+/-0.4, p=0.000) and minimal SpO2 (92.0+/-3.3vs93.8+/-3.1%, p=0.000) were lower in the severe group. The time spent below 90%SpO2 (5.6+/-19.4vs2.6+/-13.6%, p=0.039), %age-predicted maximal HR (68.5+/-10.5vs64.9+/-8.8%, p=0.023) and initial RR (19.1+/-5.1vs18.7+/-9.3 cpm, p=0.014) were higher. We did not document differences regarding the differential (maximal-initial) HR, final RR, differential (final-initial) RR and symptoms. Conclusion(s): Severe group showed higher functional limitation, mainly in lung volumes and in submaximal exercise evaluation.

Pregnancy-Related Acquired Haemophilia A: Description of Two Recent Cases

Introduction: Acquired haemophilia A (AHA), characterized by neutralizing autoantibodies against factor VIII (FVIII), is a rare disorder (1.5/million/y). Pregnancy-relatedAHAis an even rarer disorder affecting 0.03/million/y with an incidence of 1 case/350000 births. Aim(s): to describe two pregnancy-related AHA presented at the same year of 2022. Method(s): We evaluate data from two women (patient 1 and 2) with AHA diagnosed within 1 year following childbirth. Result(s): Two women, patient 1 (P1) and P2 with 32 and 33-year old respectively, presented AHA seven (P1) and six (P2) months after delivery. They had no relevant medical history, except for COVID-19 vaccination fifteen days before the development of bleeding in P1, and late-pregnancy COVID-19 infection in P2. They had no complications related to childbirth. The bleeding events in both patients were haematuria and apparently spontaneous hematomas in the upper limb, requiring no haemostatic treatment. Laboratorial investigation, demonstrated in P1 a FVIII activity of 0.026 IU/ml and a FVIII antibody titer of 26 Bethesda Units (BU), and in P2 a FVIII activity of 0.005 IU/ml and a FVIII antibody titer of 34 BU. Concomitant disorders were excluded. The patients started eradication of the inhibitors with prednisone (1mg/kg/day orally). In P1, inhibitor titer was 0 BU and FVIII> 0.5 IU/ml after 8 weeks of immunosuppression. During eradication period, the P2 had a hematoma in right thigh treated with bypassing agent (FEIBA), but the inhibitor titer was 0 BU and FVIII>0.5 IU/ml after 1 month of inhibitor eradication. Curiously, P2 with FVIII< 0.01 IU/ml and a higher inhibitor titer than P1 had a faster response to prednisolone therapy (4 vs. 8 weeks). Currently, prednisone has been completely withdrawn in P1 and the prednisone dosage is being gradually reduced in P2. Discussion/Conclusion: Data from these two women with pregnancyrelated AHA are similar to previously described cases and expand the knowledge about this rare disorder. The peculiarity of this report is due to the emergence of two cases of a disease with markedly low incidence, in the same local and year, raising the question of whether there were new acquired factors (as immunological triggers such as COVID-19 infection or vaccination) that could be involved in the modification of the natural history of the disease. It cannot be excluded the possibility that these two cases were a coincidence.

Analysis of Pharmacy and Laboratory Reagents Stock Management in a Portuguese Public Hospital: A Case Study

The current situation of healthcare units is characterised by the increasing cost of providing the respective care, the consequent deterioration of the financial situation, and the complicated and time-consuming processes. Together with rising demand, they may become factors contributing to a decrease in service demand. Due to this situation, more efficient and effective logistics and supply chain management are widely recognised as one of the main areas for improvement. To provide insight on which areas to improve, several objectives were looked at in this work, including the analysis of the methods and criteria for the selection of medicines in hospital pharmacies, the definition of obstacles to the rational management of stocks, and the analysis of historical data to forecast future demand for a Portuguese public hospital. The study revealed that some of the 1346 products present on the pharmacy's ERP do not have sufficient historical data to create an accurate forecast. In this context, and with a service level of 95%, 41% of products have a stock higher than what should be the maximum stock, amounting to approximately € 147.908.87 in fixed assets, and 11% of products were at risk of being out of stock at the time. The importance of the evolution of the core information system of hospitals was at stake, ensuring the technological sustainability of the ongoing digital transformation, alignment with ICT rationalisation measures, improvement of customer service, and improvement of the quality of information available to the user. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Family Functioning in a Portuguese Sample of Adults during COVID-19: Does Hope Matter?

The purpose of this study was to explore the relationships between sociodemographic, clinical, and psychological variables and their contribution towards family functioning during the first wave of COVID-19 in Portugal. The COVID-19 pandemic was an overwhelming and stressful life event with social consequences that impacted family functioning and contributed to multilevel disruptions. The study used a cross-sectional design and included 110 participants (94 women), with a mean age of 35.71 (SD = 13.53). Participants answered self-report measures assessing family satisfaction, hope, psychological well-being, risk perception, and family functioning. Hope (pathways subscale) played a moderating role in the relationship between family satisfaction and family functioning. Family satisfaction and psychological well-being partially mediated the relationship between hope and family functioning. Clinical relevance and implications for further research are addressed. Intervention should focus on increasing psychological well-being and hope together with family satisfaction in order to promote family functioning. For those individuals struggling with COVID-19 issues, mental health interventions are paramount. (English) [ABSTRACT FROM AUTHOR] Este estudio ha tenido como objetivo explorar la relación entre las variables sociodemográficas, clínicas y psicológicas y el funcionamiento familiar en la primera oleada de COVID-19 en Portugal. La pandemia de COVID-19 fue una situación de vida abrumadora y estresante con consecuencias sociales que afectaron en el funcionamiento familiar. El estudio utilizó un diseño transversal e incluyó 110 participantes (94 mujeres), con una edad media de 35.71 años ( SD = 13.53). Los participantes respondieron a medidas que evaluaban la satisfacción familiar, la esperanza, el bienestar psicológico, la percepción del riesgo y el funcionamiento familiar. La esperanza (subescala "caminos") desempeñó un papel moderador en la relación entre la satisfacción familiar y el funcionamiento familiar. La satisfacción familiar y el bienestar psicológico mediaron parcialmente en la relación entre la esperanza y el funcionamiento familiar. Se abordan la importancia clínica y las implicaciones para futuras investigaciones. La intervención deberá centrarse en aumentar el bienestar psicológico y la esperanza junto con la satisfacción familiar para promover el funcionamiento familiar. Para los individuos que luchan con problemas de COVID-19 son primordiales las intervenciones de salud mental. (Spanish) [ABSTRACT FROM AUTHOR] Copyright of Clinica y Salud is the property of Colegio Oficial de Psicologos de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Moderating Role of Self-Care Behaviors in Personal Care Aides of Older Adults during the COVID-19 Pandemic.

The COVID-19 pandemic has brought new challenges and work changes for formal caregivers such as personal care aides with an impact on their quality of life (QoL). This cross-sectional study aims to analyze the relationships and contribution of sociodemographic and psychological variables towards QoL including the moderating role of self-care. This study included 127 formal caregivers from Portugal who were assessed on depression, anxiety and stress (DASS-21); professional self-care (SCAP); quality of life (SF-12); COVID-19 traumatic stress (COVID-19TSC) and preventive COVID-19 infection behaviors (PCOVID-19 IBS). Professional self-care was positively associated with QoL and also moderated the relationship between distress and QoL (p < 0.001). According to results, nursing homes should provide formal caregivers, such as personal care aides, with the professional support they need in order to promote their QoL and prevent burnout.

Relax to Heal? Perspectives of Patients with Diabetic Foot Ulcers and Health Professionals on Relaxation Sessions for Wound Healing.

OBJECTIVE: To explore patients' and healthcare professionals' (HPs') perspectives on the suitability/acceptability of a relaxation intervention, its effects on patients' well-being and diabetic foot ulcer (DFU) healing, and its incorporation into the multidisciplinary management of patients with diabetic foot. METHODS: This qualitative study was nested within a three-arm pilot randomized controlled trial. Patients with a chronic DFU received four relaxation sessions. Investigators then interviewed patients, physicians, and nurses involved with diabetic foot consultations. Interviews were audio-recorded, transcribed, and analyzed using thematic content analysis. RESULTS: Five themes emerged from patient's interviews about the suitability/acceptability of the relaxation intervention: perceptions regarding the psychological intervention, distress, the relaxation technique, changes in the patient's life, and changes in DFU/contribution to healing. Three themes emerged from interviews with HPs: perceptions regarding relaxation, changes in the patient, and changes in DFU/healing. Regarding the feasibility of the relaxation intervention, three themes emerged for both patients and HPs: suggested modifications, stressors/difficulties, and impact of COVID-19 pandemic. The utility theme emerged only in HP interviews, with subthemes of patients' distress, psychological interventions, relaxation intervention, and integration of the psychologist in the team. CONCLUSIONS: These findings provide evidence for the suitability/acceptability, feasibility, and utility of a relaxation intervention in diabetic foot consultations.

Embracing change in tandem: resilience and sustainability together transforming supply chains

Purpose: This article investigates how micro-foundations of sustainability can build supply chain resilience (SCRes). Specifically, by defining supply chains as social-ecological systems, this article explores how sustainability as a supplier capability leads to the transformative development of SCRes capabilities. Design/methodology/approach: Longitudinal multi-case studies were developed over the first year of the COVID-19 outbreak. A total of 52 interviews were conducted with managers and employees of 12 global supplier firms as well as associated local cooperative and consultancy managers. Secondary data were also used for triangulation. An inductive approach was used for data analysis to elaborate theory through a metaphor. Findings: Nine micro-foundations of sustainability were identified and categorised using the dynamic capabilities steps: sensing, seizing and reconfiguring. They were found to move together with the preparing, responding and transforming steps of SCRes, respectively, and thus to perform as dance partners using our dance performance metaphor. Moreover, ten supplier cases were found to be adopting a transformative social-ecological perspective as they performed all key stages of our dance performance metaphor. The transformations all resulted from either institutional or social sustainability, and the associated micro-foundations generated six main SCRes capabilities, most commonly linking visibility and organisation with institutional and social sustainability respectively. Practical implications: A deeper understanding of sustainability micro-foundations is provided for supply chain managers to enhance the development of SCRes strategies in preparation for future sustainability-related crises. Originality/value: Unlike previous research, this article explores an intertwined understanding of SCRes and sustainability during a crisis. Through the micro-foundations of sustainability we explain how sustainability capability builds transformative SCRes using a supplier perspective. © 2022, Emerald Publishing Limited.

Modeling the Geospatial Evolution of COVID-19 using Spatio-temporal Convolutional Sequence-to-sequence Neural Networks

Europe was hit hard by the COVID-19 pandemic and Portugal was severely affected, having suffered three waves in the first twelve months. Approximately between January 19th and February 5th 2021 Portugal was the country in the world with the largest incidence rate, with 14-day incidence rates per 100,000 inhabitants in excess of 1,000. Despite its importance, accurate prediction of the geospatial evolution of COVID-19 remains a challenge, since existing analytical methods fail to capture the complex dynamics that result from the contagion within a region and the spreading of the infection from infected neighboring regions. We use a previously developed methodology and official municipality level data from the Portuguese Directorate-General for Health (DGS), relative to the first twelve months of the pandemic, to compute an estimate of the incidence rate in each location of mainland Portugal. The resulting sequence of incidence rate maps was then used as a gold standard to test the effectiveness of different approaches in the prediction of the spatial-temporal evolution of the incidence rate. Four different methods were tested: a simple cell level autoregressive moving average (ARMA) model, a cell level vector autoregressive (VAR) model, a municipality-by-municipality compartmental SIRD model followed by direct block sequential simulation, and a new convolutional sequence-to-sequence neural network model based on the STConvS2S architecture. We conclude that the modified convolutional sequence-to-sequence neural network is the best performing method in this task, when compared with the ARMA, VAR, and SIRD models, as well as with the baseline ConvLSTM model.

Adapting a Picu for Adult Patients during a Pandemic: Impacts and Learning from Interprofessional Care of Critically Ill Adults with Covid-19

BACKGROUND AND AIM: Worldwide health systems have been strained by the COVID-19 pandemic. Surging numbers of critically ill adult patients demanded urgent system-wide responses. Our Paediatric Intensive Care Unit (PICU) underwent a care delivery model redesign and rapid shift in processes and resources to care for critically ill adults at the peak of the pandemic. We describe novel adaptions made to accommodate adult patients for the first time in this paediatric setting. Personal insights of clinical staff, leaders and adult care partners about the experience of caring for critically ill adult patients are shared. METHOD(S): Program components included;preparation, education, collaboration (both interprofessional and interorganizational), continuous process improvement, and staff well-being initiatives. Interprofessional team impacts gathered during the implementation phase of the program and 10 months following were analysed using Havelock's Theory of Change framework1. RESULT(S): The Adult COVID-19 program facilitated rapid team capacity building and supported responsive care for adult patients. Over 12 weeks, 35 adults (426 patient days) received care in the PICU. Staff acknowledged;1] the burden of providing high quality care for adults, 2] the opportunity for individual and team growth and 3] guiding paediatric principals of strength-based, family-centered care enhanced the quality of care provided and provider perceptions of accomplishment. CONCLUSION(S): This program facilitated a rapid transformation and expansion in models of care and processes, successfully enhanced the team's capacity to deliver quality evidence-based service to adults with COVID-19 and was a source of personal growth and meaning for the health care team.

Long-term (2-year) outcomes and complications of COVID-19 in solid organ transplant (SOT) recipients

Background. The long-term complications of COVID-19 infection in the general population include mortality, re-infection, secondary infection, persistent organ dysfunction, and symptoms of long-COVID. The prevalence of these outcomes and impact on graft function in solid organ transplant (SOT) remain uncertain. We aim to describe these complications in a large series of SOT with COVID-19 with 2 years of long-term follow up. Methods. We retrospectively studied all adult (age >18) SOT from a single center hospitalized with SARS-CoV-2 diagnosed by nasopharyngeal swab between 3/ 10-5/30/2020. Patients with early mortality within 28 days were excluded. Outcomes including mortality, allograft rejection, allograft failure, secondary infections, COVID-19 re-infections, post-COVID complications (oxygen requirement, chronic renal or cardiac dysfunction), and symptoms of long-COVID were analyzed. Re-infections were characterized by severity and likely variant based on local variant predominance. Results. 117 SOT recipients were hospitalized with COVID-19 in the study period. 94 survived the first 28 days and were followed for a median of 751 (742-760) days post-infection. 9 (9.57%) died within 1 year of infection and 14 (14.9%) within 2 years. 21 (22.3%) had >=1 episode of allograft rejection and 21 (22.3%) had allograft failure. 11 (9.4%) were re-infected with COVID-19 at a median of 603 (389-642) days following initial infection, of whom 2 (18.2%) were hospitalized and 0 died. 43 (45.7%) had secondary infections and 18 (19.1%) with multi-drug resistant organisms. 32 (34.0%) developed new chronic kidney disease or end-stage renal disease, 25 (26.6%) had new cardiovascular disease, and 8 (8.51%) had a prolonged oxygen requirement following infection. Of reported long-COVID symptoms, fatigue (26, 27.7%), dyspnea (18, 19.1%), and cough (11, 11.7%) predominated with 25 (26.6%) having >1 symptom. Conclusion. In this large cohort of SOT recipients hospitalized during the first wave of the COVID-19 pandemic, long-term 2-year follow-up showed high rates of mortality, allograft rejection, allograft failure, secondary infection, organ dysfunction, and symptoms consistent with long-COVID. Ongoing study of the impact of these complications will be crucial to improving outcomes in SOT recipients. (Figure Presented).

Occurrence of adverse events and factors related to prognosis in a cohort of patients hospitalized with COVID-19 at University hospital - UNICAMP, Brazil

Background. In Brazil, 30.378.061 cases of COVID were reported and 662.866 deaths up to April 27 of 2022. Hospital infections and other hospital adverse events may increase the risk of death in patients with COVID-19. Methods. Cohort study that included 650 adult patients hospitalized with a diagnosis of SARS CoV-2 infection at Hospital HC-UNICAMP from March/20 to March/21. Results. Of the 650 patients included in the study, 139 (21.38%) died. Comparing the patients who died vs those who survived, we observed a statistically significant difference in the occurrence of thromboembolic and vascular events (23% vs 9.8%;OR 1.332;95%CI 1.12-1.59;p < 0,0001), ICU admission (84.9% vs 39.6%;OR 0.675;95%CI 0.62-0.74;p< 0.0001) and the occurrence of HI: bloodstream infections (30.2% vs 8.6%;OR 1.62;95%CI 1.31-1.99;p< 0.0001), VAP (52.5% vs 12.3%;OR 1.882;95%CI 1.57-2.26;p< 0.0001) and UTI (27.3% vs 7.2%;OR 1.672;95%CI 1.32-2.11;p< 0.0001). Gram negative bacteria were the most isolated (62.1%), especially K. pneumoniae, A. baumannii and P. aeruginosa, followed by gram positive bacteria (27%) and fungi (13.8%). When evaluating patients who had thromboembolic events, we observed a statistically significant association with male gender (15.9% vs 7.9%;p 0.003), mean initial D-Dimer values (10,418.00 ng/mL vs 3011.34 ng/ml;p 0.003);acute renal failure (19.1% vs 9.3%;p 0.001) and the occurrence of HI (24.4% vs 7.3%;p< 0.0001). The following factors associated with ICU admission were identified: diabetes mellitus (59.3% vs 40.5%;p< 0.0001);obesity (58.3% vs 41.7%;p 0.003);O2 saturation at admission < 88% (67.8% vs 32.2%);acute renal failure (78.6% vs 21.4%;p< 0.0001) and the occurrence of HI (87.8% vs 12.2%;p< 0.0001). Logistic regression analysis identified the following variables independently associated with death: age (OR 1,034;CI 1,015-1,052), ICU admission (OR 1,107;CI 1,596-5,868), use of vasoactive drugs (OR 2,93;CI 1,79-4,82), development of acute renal failure (OR 7,756;CI 4,537-13,26), and the occurrence of VAP (OR 2,205;CI 1,227-3,961) (Table 1). Conclusion. Adverse events, particularly HI, have an important impact on the evolution of patients with COVID-19, reinforcing the need for prevention and control measures to be optimized as an essential part of the care for these patients.