Effect of the COVID-19 Pandemic on Trauma Volume and Transport Time at a Level I Trauma Center

Introduction: Baystate Medical Center is the only Level I Trauma Center in Western, MA. The COVID-19 pandemic has had varying effects on Trauma Centers in regards to volume. Initial studies showed an increase in volume during the lockdown phase, but there has been no evidence of trends after lockdown. Method(s): Retrospective, review of trauma registry data pre- COVID (1/2016-2/2020) and during COVID-19 pandemic (3/2020-12/2021). Comparisons between time periods performed using T-Test. Result(s): Mean total traumas per month were significantly increased during the pandemic (191.3 v. 110.3 patients per month, p <0.001). Both blunt (174.2 v. 100.4, p <0.001) and penetrating (17.1 v 9.9, p <0.001) traumas increased during the COVID pandemic. There was a significant increase in both scene calls (105.0 v 73.8, p<0.001) and interfacility transfers (IFT) (42.7 v 36.0 P = 0.004) during the pandemic. There was no change in injury severity score (11.0 v 11.2, p = 0.498) during the pandemic. Ground interfacility transport times (34.13 min v 28.60 min, p = 0.036) increased significantly during COVID. Other transport times were not changed. Conclusion(s): During the COVID-19 pandemic, Baystate Medical Center saw a statistically significant increase in trauma volume across multiple dimensions that continued even after the end of the lockdown period. In addition, IFT ground transport times increased suggesting that patients were being transported from facilities farther away likely due to the strain on the regional health system from the pandemic.

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.

Pandemic sociomaterial bricolage: how vulnerable communities used social media to tackle the COVID-19 crisis

Purpose: This research was conducted to understand how vulnerable communities used social media (SM) tools to face the impacts of the COVID-19 pandemic. Affected by the lack of information and the absence of effective public policies, residents from slums in the city of Rio de Janeiro displayed new and unexpected uses to SM tools to tackle the health and socio-economic impacts of the pandemic. Design/methodology/approach: The research methodology consisted of a qualitative, exploratory study, combining a series of in-depth interviews with the analysis of various posts, containing videos and texts, extracted from SM during the first six months of the pandemic. The data were collected in the context of 10 different communities in Rio de Janeiro city. Findings: In the context of the pandemic, people combined different uses of SM not only to inform themselves and communicate with others but also to articulate and execute fundraising and food donation strategies within vulnerable communities. Accordingly, this SM use is characterized by improvisation, learning by doing and building resilience, which are all constructs related to the concept of bricolage. Users had no specific SM knowledge, and adjusted these technological tools to emergent new activities in practice, which is characteristic of sociomaterial process. In addition to emphasizing the importance of context for the emergence of the phenomenon, this work also highlights reliability, validity and authority as characteristics related to the citizen-led participation approach that was observed. Research limitations/implications: Future research can develop approaches based on pandemic sociomaterial bricolage (PSB) aspects, which could guide governments and practitioners on building innovative solutions for the use of SM by the population, especially in emergency situations. Originality/value: This study proposes a framework, termed PSB, to represent SM usage promoted by the pandemic context, which emerged from the triangulation of empirical data and an analysis based on the concepts of bricolage and sociomateriality. © 2022, Emerald Publishing Limited.

Pacientes Adultos Oncohematologicos Hospitalizados Por Covid-19

Introducao: Portadores oncohematologicos sao suscetiveis a infeccoes graves e potencialmente fatais devido a imunossupressao relacionada as doencas de base e seus tratamentos. Em Marco de 2020, a OMS declarou a COVID-19 uma pandemia e pouco se sabia do comportamento da infeccao nesses pacientes. Objetivos: Avaliar caracteristicas de pacientes adultos oncohematologicos hospitalizados por COVID-19;identificar variaveis na admissao preditoras de obito;e comparar os pacientes durante as duas primeiras ondas e a terceira onda da pandemia. Materiais e Metodos: Estudo observacional, retrospectivo, multicentrico, que incluiu pacientes acima de 18 anos com neoplasias hematologicas hospitalizados por COVID-19. Foram avaliadas variaveis demograficas, relacionadas a doenca de base e a infeccao, medicacoes, admissao em UTI e necessidade de ventilacao mecanica. Os grupos de sobreviventes e nao sobreviventes foram comparados utilizando o teste X2 ou o teste de Fisher para variaveis categoricas e o teste de Mann-Whitney para variaveis numericas. Variaveis com p-valor<0,1 foram consideradas para analise multivariada atraves de regressao logistica. Os grupos da 1/2 onda e 3 onda foram comparados utilizando os mesmos testes. A analise estatistica foi realizada no software R versao 3.6.3. Resultados: Foram avaliados 126 pacientes, com uma idade mediana de 57 anos. 66 pacientes (52%) eram do sexo masculino e os linfomas foram o grupo de doenca mais frequente (41%). 57 pacientes (45%) faleceram na internacao. Na analise bivariada, variaveis associadas a obito foram doenca de base ativa, OS >= 2, dispneia, anemia, trombocitopenia, PCR, D-Dimero e TGO elevados, baixa sO2 e vidro fosco na TC de Torax. Na analise multivariada, hemoglobina baixa, PCR-t elevada e dispneia mantiveram relacao com obito na internacao. Dos 126 pacientes, apenas 18 (14%) foram admitidos na 3 onda. A letalidade nesse grupo foi de 33% versus 47% no grupo da 1/2 onda (p = 0,4). As principais diferencas entre os grupos foram que 97% dos pacientes da 3 onda receberam ao menos 1 dose de vacina, tiveram menos dispneia (22% x 49%;p = 0,04), maior sO2 (mediana 98% x 94%;p = 0,02), DDimero mais baixo (mediana 714 x 1563;p = 0,03), foram menos anticoagulados (0 x 21%;p = 0,04) e tiveram menos admissoes em UTI (11% x 38%;p = 0.03) e necessidade de ventilacao mecanica (11% x 37%;p = 0,03). Discussao: Nesse estudo, quase metade (45%) dos pacientes oncohematologicos hospitalizados por COVID-19 faleceu durante a internacao, evidenciando alta letalidade dos quadros moderados ou graves da infeccao. As variaveis na admissao associadas a maior mortalidade foram a hemoglobina, PCR-t e a presenca de dispneia. Apesar da alta infectividade da variante Omicron, responsavel pela 3 onda da pandemia, apenas 18 pacientes internaram nesse periodo. Quase todos (97%) haviam recebido ao menos 1 dose de vacina. Esses pacientes apresentaram quadros menos graves e menos complicacoes, necessidade de suporte ventilatorio invasivo e admissao em CTI, apontando para um provavel efeito benefico da vacina em reduzir a gravidade da infeccao. A letalidade nesse grupo foi menor que na 1/2 onda, porem sem significancia estatistica. Conclusao: Pacientes oncohematologicos hospitalizados por COVID-19 apresentam alta letalidade relacionada a infeccao, mas a comparacao entre as 2 primeiras e a 3 onda aponta para um efeito benefico da vacina na reducao da necessidade de internacao e da gravidade da infeccao nos pacientes que internam. Copyright © 2022

Prognostic Accuracy of the Modified CHA(2)DS(2)-VASc Score in COVID-19 Patients Admitted to the Emergency Department Due Clinical Worsening

Introduction: Risk factors comprising the CHA(2)DS(2)VASc score are recognized as risk factors for venous thromboembolism and mortality in COVID-19 patients. A modified CHA(2)DS(2)VASc score (M-CHA(2)D(2) VASc), developed by changing gender criteria from female to male, has been proposed to predict in-hospital mortality in COVID-19 patients. The aim of this study was to evaluate the prognostic accuracy of M-CHA(2)DS(2)VASc for adverse clinical outcomes and short-term mortality in COVID-19 patients admitted to the Emergency Department. Material and Methods: Retrospective study of patients admitted to the ED who underwent computed tomography pulmonary angiography due to suspected pulmonary embolism or clinical worsening. Patients were stratified into three M-CHA(2)DS(2)-VASc risk-categories: low (0 - 1 points), intermediate (2 - 3 points) and high-risk (>= 4 points). Results: We included 300 patients (median age 71 years, 59% male). The overall mortality was 27%. The M-CHA(2)DS(2)-VASc score was higher in non-survivors compared to survivors [4 (IQR:3 - 5) vs 2 (IQR: 1 - 4), respectively, p < 0.001). The M-CHA(2)DS(2)-VASc score was identified as an independent predictor of mortality in a multivariable logistic regression model (OR 1.406, p = 0.007). The Kaplan-Meier survival curves showed that the M-CHA(2)DS(2)-VASc score was associated with short-term mortality (log-rank test < 0.001), regardless of hospitalization (log-rank test p < 0.001 and p = 0.007, respectively). The survival proportion was 92%, 80% and 63% in the lower, intermediate, and higher risk-groups. As for the risk-categories, no difference was found in pulmonary embolism, Intensive Care Unit admission, and invasive mechanical ventilation. Conclusion: The M-CHA(2)DS(2)-VASC score might be useful for prompt risk-stratification in COVID-19 patients during admission to the Emergency Department.

Cardiorespiratory fitness assessment on active patients who kept attending their phase III exercise-based cardiac rehabilitation during the COVID-19 era

Funding Acknowledgements Type of funding sources: None. Background Cardiorespiratory fitness (CRF) is a powerful predictor of all-cause mortality among individuals with coronary artery disease (CAD). A structured community-based phase III cardiac rehabilitation (CR) is very important in lifelong maintenance of phase II CRF and health gains. During the COVID-19 pandemic, CR programs had to adapt, mainly using new technologies and remote follow-up. The CRF impact in patients (Ps) who kept going their phase III program, during this troubled era is still unknown. Purpose Assess the variation in CRF and prognostic parameters in Ps with CAD who maintain high adherence levels in their phase III CR before and during the COVID-19 pandemic. Methods A cohort of Ps enrolled in a community-based phase 3 CR program, with active participation at the end of 2019, was included in this retrospective study. The inclusion criteria for this study were high levels of attendance (>80%) to the CR program before and during COVID-19 and high levels of physical activity with more than 150 mins of moderate to vigorous physical activity (MVPA). All Ps were evaluated with transthoracic echocardiography (TTE) and a cardiorespiratory exercise test (CPET) in a cycloergometer in 2019 and between october and november of 2021. All Ps had used accelerometers to measure their physical activity levels and dual-energy absorptiometry (DEXA) scan to evaluate their body composition. Between 2020 and 2021, Ps had online (in lockdown periods) and face to face exercise training sessions, 3xtimes per week, 60 mins each exercise session. A t-test paired two sample for means was used to compare CPET variables before the beginning of the first COVID lockdown (end of 2019) and after the removal of the majority of restrictions (end of 2021). Results A total of 30 Ps with high levels of adherence were included (99.6% male, 65 ± 9 years old). In this cohort, the majority had history of an ACS before the referral to the CR program (73.3%) and 55.6 ± 10.4% of left ventricular ejection fraction. There was no significant difference in body mass index (27.9 ± 3.2 kg/m2 vs 28.1 ± 3.6 kg/m2, p=0.493 but there was a significant increase in the percentage of body fat mass (30.1 ± 5.7% vs 31.0 ± 6.6%, p= 0.042). There was a maintenance on MVPA levels (352 ± 137 minutes/week vs 313 ± 194 minutes/week, p = 0.106) during this period. When comparing the 2 CPET results, Ps achieved higher exercise loads in the 2021 test (175 ± 51W vs 185 ± 52W, p=0.005), higher VO2 peak (25.3 ± 6.9 ml/kg/min vs 21.5 ± 6.3 ml/kg/min, p =0.001) and higher percentage of predicted VO2max (78.8 ± 16.8% vs 95.27 ± 20.8%, p = 0.001). Conclusion In spite of all the difficulties in maintaining a phase III CR program during the COVID-19 pandemic, we observed that in physically active CAD Ps, with the aid of new technologies and remote follow-up (during the lockdown periods) and face to face exercise sessions, it is still possible to have functional gains and improvements in CRF.

Shorter cardiac rehabilitation programs: taking time is taking effectiveness?

Introduction: Due to the covid-19 outbreak, cardiac rehabilitation programs (CRP) underwent most needed adaptions to stay operative. To face all the requests and guarantee sanitary measures, we reduced the duration of the program from about 12 weeks to about 8 weeks, so we could have smaller groups but still respond to all patients who had been referred. However, it is still unclear whether less hours of contact and exercise sessions can achieve the same results as traditional CRP. Objective: To analyse the effectiveness of shorter duration CRP on risk factor control and exercise tolerance after concluding the program. Methods: Observational single center study including two groups of patients who underwent CRP: one group who had been in 12 weeks-CRP before the pandemic sprout and another group enrolled in an 8-week program after April 2021. Albeit differences in their duration, both CRP had the same structure: observation by cardiologist, physiatrist, specialist nurse, exercise (aerobic and strength exercises) and educational sessions, as well as nutrition and psychologist consultation. Results: A total of 114 pts were analysed (mean age 62,4±11,6 years, 85.1% men, 86% with ischemic heart disease). Main comorbidities were hypertension (68,4%), dyslipidaemia (70%) and diabetes (30,7%). 78 pts completed a longer programme with 12 weeks duration while 36 underwent a shorter CRP with 8 weeks. There were no statistically significant differences between both groups regarding population demographics, aetiology, LVEF and co-morbidities. After CRP, there was significant improvement in risk factor control (mainly lipidic profile and weight) and echocardiographic parameters in both groups. We noted an important reduction in LDL levels (85±42.6mg/dL before CRP and 67.68±28.45mg/dL after), approaching the guideline recommended levels (<55mg/dL): 29.8% before vs 42.6% after (p=0.079), with no difference between the two groups (p=0,65). Significant improvement of LVEF was also observed (53% to 57%, p <0.001) without difference between the two groups (p=0.112). Exercise tolerance improved similarly in both groups, assessed by the time of exercise stress test: we registered a global increase of 65 ± 1.38s after CRP, with no difference between the two groups (p = 0.157). Conclusion: Shorter duration CRP showed similar results concerning risk factor control, echocardiographic LVEF and exercise tolerance improvement, suggesting that they can be an effective alternative when needed.

Cardiorespiratory fitness assessment on active patientswhokept attending their phase III exercise-based cardiac rehabilitation during the COVID-19 era

Background: Cardiorespiratory fitness (CRF) is a powerful predictor of all-cause mortality among individuals with coronary artery disease (CAD). A structured community-based phase III cardiac rehabilitation (CR) is very important in lifelong maintenance of phase II CRF and health gains. During the COVID-19 pandemic, CR programs had to adapt, mainly using new technologies and remote follow-up. The CRF impact in patients (Ps) who kept going their phase III program, during this troubled era is still unknown. Purpose: Assess the variation in CRF and prognostic parameters in Ps with CAD who maintain high adherence levels in their phase III CR before and during the COVID-19 pandemic. Methods: A cohort of Ps enrolled in a community-based phase 3 CR program, with active participation at the end of 2019, was included in this retrospective study. The inclusion criteria for this study were high levels of attendance (>80%) to the CR program before and during COVID-19 and high levels of physical activity with more than 150 mins of moderate to vigorous physical activity (MVPA). All Ps were evaluated with transthoracic echocardiography (TTE) and a cardiorespiratory exercise test (CPET) in a cycloergometer in 2019 and between october and november of 2021. All Ps had used accelerometers to measure their physical activity levels and dual-energy absorptiometry (DEXA) scan to evaluate their body composition. Between 2020 and 2021, Ps had online (in lockdown periods) and face to face exercise training sessions, 3xtimes per week, 60 mins each exercise session. A t-test paired two sample for means was used to compare CPET variables before the beginning of the first COVID lockdown (end of 2019) and after the removal of the majority of restrictions (end of 2021). Results: A total of 30 Ps with high levels of adherence were included (99.6% male, 65 ± 9 years old). In this cohort, the majority had history of an ACS before the referral to the CR program (73.3%) and 55.6 ± 10.4% of left ventricular ejection fraction. There was no significant difference in body mass index (27.9 ± 3.2 kg/m2 vs 28.1 ± 3.6 kg/m2, p=0.493 but there was a significant increase in the percentage of body fat mass (30.1 ± 5.7% vs 31.0 ± 6.6%, p= 0.042). There was a maintenance on MVPA levels (352 ± 137 minutes/week vs 313 ± 194 minutes/week, p = 0.106) during this period. When comparing the 2 CPET results, Ps achieved higher exercise loads in the 2021 test (175 ± 51W vs 185 ± 52W, p=0.005), higher VO2 peak (25.3 ± 6.9 ml/kg/min vs 21.5 ± 6.3 ml/kg/min, p =0.001) and higher percentage of predicted VO2max (78.8 ± 16.8% vs 95.27 ± 20.8%, p = 0.001). Conclusion: In spite of all the difficulties in maintaining a phase III CR program during the COVID-19 pandemic, we observed that in physically active CAD Ps, with the aid of new technologies and remote follow-up (during the lockdown periods) and face to face exercise sessions, it is still possible to have functional gains and improvements in CRF. (Figure Presented).

Wicked multi-problems (COVID-19+Oil Spill plus wildFires) in Brazil and their effects on socioeconomic vulnerability

Purpose - This research aims to identify Brazil's socioeconomic vulnerability to wicked multi-problems arising from coronavirus disease 2019 (COVID-19) (2019-2020), from the most extensive (similar to 3,000 km) oil spill in tropical oceans (2019/2020) and from the highest rate of wildfires in the last decade. Design/methodology/approach - To this end, the authors measured the socioeconomic vulnerabilities of the 27 Brazilian states to these multi-problems (COVID-19 + Oil Spill + wildFire), considering the effects of these events individually and together. In addition, the authors calculated the vulnerability indices using two variables: production value and number of jobs created by an economic activity. Findings - Results show the states of Sao Paulo, Minas Gerais, and Rio de Janeiro as the most susceptible, with a potential loss of 74.2% in production value and 47% in active employment relationships, caused by these overlapping events in time. The results also demonstrate that the country has failed in the coordination and management of these events (separately and jointly), showing difficulties especially in the stages of immediate response and recovery. Originality/value - Regarding its contributions, this paper innovates by establishing an unprecedented overlap of wicked problems, linking this concept to the analysis of socioeconomic vulnerability of the affected communities, through a model that applies to other regions worldwide.

Long term left ventricular impairment after SARS-COV2 infection

Introduction: The impact of acute infection by SARS-COV2 on the cardiovascular system has been previously reported in the literature, with a higher propensity in patients with more serious pattern of disease and pro-inflammatory status. Nevertheless, the long-term burden and sequels of COVID-19 on the cardiovascular system is still unknown. Purpose: To evaluate the long-term impact of COVID-19 on left ventricular function in patients with severe clinical presentation requiring intensive care hospitalization. Methods: This was a single-center observational, prospective study which included patients requiring admission to the Intensive Care Unit (ICU) due to COVID-19 infection from January to November 2020. All discharged patients were contacted to perform a clinical, electrocardiographic and echocardiographic evaluation and those who accepted were included on the protocol. Baseline and clinical characteristics were collected from clinical reports. For the global longitudinal strain (GLS) analysis all patients with significant wall motion abnormalities and valvular cardiopathy were excluded. Statistical analysis was performed with Mann-Whitney and a safety cut-off was established with ROC curve analysis. Results: A total of 43 patients were included (mean age 64 ± 12, 67.4% males). During SARS-COV2 infection 49% presented with severe ARDS and 51% with moderate, 35% required invasive mechanical ventilation, 14% noninvasive mechanical ventilation and 52% with high nasal flow cannula. On the follow-up analysis, fatigue was the most reported in symptom (52% patients) and the majority did not present other signs or symptoms suggestive of heart failure, with the mean NT-proBNP of 49 ± 389 pg/dL. The standard ECG and echocardiogram did not show significant changes with a mean LVEF of 58 ± 7.8 and mean TAPSE of 21 ± 4. The strain analysis showed low value of GLS (mean GLS of -17.14 ± 2.36) for a reference cut-off of -18%, suggesting subclinical left ventricular dysfunction in this subset of patients with preserved ejection fraction. Maximum CPR values during ICU did not correlate either with the extent of disease evolvement in CT (p= NS) or ARDS severity (p= NS). Nevertheless, maximum CPR correlated significantly with GLS reduction (R = 0.44, p = 0.019). A CPR value higher than iger30mg/ dL had 100% specificity for GLS reduction and a cut-off of 14gm/dL reported a sensitivity of 65% and specificity pf 75% for reduction in GLS. Conclusion: In our study, we reported subclinical impairment in left ventricular function detected with global longitudinal strain after serious infection with SARS-COV2. The detected myocardial dysfunction was related with higher inflammatory as expressed by CPR values. Longterm monitoring of these patients should be undertaken in order to timely detect late complications.

Scenarios for a Post-Pandemic City: urban planning strategies and challenges of making "Milan 15-minutes city"

This Covid-19 pandemic has imposed extreme impacts on many developed world global cities, especially those with high population densities and high levels of connectivity. Many cities are therefore experiencing a moment of global rethinking. In a few decades, we have gone from an idea of extreme density and the gentrification of cities to completely different proposals, such as the 'the 15-minutes city' concept where all services can be reached in a short distance. Within this context, the current paper aims to provide an overview of this concept and its application in the case of Milan by conducting desk research and analysing the official reports and documents. This paper discusses that the core idea of the 15-minute city is not new;the strategies can be traced back to different approaches to neighbourhood planning in the past century. In Milan, the municipality's '2020 Adaptation Strategy' proposed guidelines for sustainable transportation and self-sufficient neighbourhoods.

Modified CHA2DS2-VASc can predict mortality in COVID-19 patients admitted to the emergency department

Introduction: CHA2DS2-VASc score is used to determine the thromboembolic risk, but its prognostic value has been demonstrated in several cardiovascular (CV) diseases. Except for female gender, many CV risk factors comprising this score are recognized as risk factors for mortality in COVID- 19. Cetinak G. et al demonstrated the ability of modified CHA2DS2-VASc (M-CHA2DS2-VASc) to predict mortality in COVID-19, which is based on changing gender criteria from female to male. Purpose: To evaluate the prognostic value of a M-CHA2DS2-VASc score to predict pulmonary embolism (PE) and mortality in pts with COVID-19 admitted at the emergency department (ED). Methods: Retrospective study of pts admitted to the ED between June 2020-January 2021, who underwent computed tomography pulmonary angiography (CTPA) due to PE suspicion. Pts were stratified into 3 MCHA2DS2- VASc risk groups: lower (0-1), intermediate (2-3) and high risk (≥4). Kruskal-Wallis and X-square test were used to compare score risk groups. Logistic regression was used to determine predictors of PE and mortality. ROC curve was performed to evaluate the discriminative power of the score. Results: We included 300 pts: median age 71 years, 59% male. Hypertension (59%) chronic kidney disease (CKD, 33%), dyslipidemia (32%) and diabetes (28%) were the most common comorbidities. PE was diagnosed in 46 pts (15%). We found no difference in PE incidence according to MCHA2DS2- VASc groups (p=0.531) and it showed no predictive value for PE (OR: 1.050, p=0.596). The AUC of M-CHA2DS2-VASc was 0.52, suggesting no discriminative power to predict PE. Regarding mortality, M-CHA2DS2-VASc score was higher in non-survivors COVID-19 pts than in survivors [4 (IQR 3-5) vs 2 (1-4), respectively, p<0.001]. A multivariate logistic regression analysis was performed for mortality based on M-CHA2DS2-VASC, troponin, CKD and smoking history, and only M-CHA2DS2-VASc was identified as an independent predictor of mortality (OR: 1.406, p=0.007). Kaplan-Meier showed that MCHA2DS2- VASc score was associated with mortality: the survival rate was 92%, 80% and 63% in the lower, intermediate and higher MCHA2DS2VASc score risk group (logrank test p<0.001;Fig. A). Most of the pts in the cohort were hospitalized (83%), but 21 pts (17%) discharged from the ED. Among these pts, 33% (n=17) had low risk, 37% (n=19) intermediate risk and 29% (n=15) high risk for mortality according to the M-CHA2DS2VASc score. The Kaplan-Meier individual survival analysis for hospitalized patients (Fig. B) and for those discharged from the ED (Fig. C) showed that M-CHA2DS2-VASc score had a good discriminative ability to predict short-term mortality for both groups (logrank test p<0.001 and p=0.007, respectively). Conclusion: Considering the lack of validated scores to predict mortality in COVID-19 pts, the M-CHA2DS2-VASc might be a simple tool to predict short-term mortality in these pts, irrespectively of the need for hospitalization or not.

New post-pandemic educational paradigms: The important changes and adaptations in the educational system caused by the pandemic covid-19

Objective: This scientific article aims to analyze the new post-pandemic educational paradigms, proposing a re-reading in the educational system in the face of the COVID 19 pandemic. Methodology: For methodology, the deductive logical basis was used through bibliographical and documentary investigation. Results: the pandemic scenario brings profound changes in several dimensions of human existence, starting from the health aspect until reaching economic, social and cultural effects in general. Contributions to a new educational reality, highlighting the need for new skills in the pedagogical structure, the adaptation of teaching-learning on virtual platforms Contributions: the study presents an approach that proposes the analysis to reach acceptable levels of virtual education and global cooperation in favor of a new model of education, public and private authorities must make efforts, economic and social, to capillarize virtual communication allowing there to be reach and effective social awareness. © 2021, Centro Universitário Curitiba - UNICURITIBA. All rights reserved.

WHF Position Statement on COVID Vaccination.

The current COVID-19 pandemic has challenged health systems and communities globally. As such, several countries have embarked on national COVID-19 vaccination programmes in order to curb spread of the disease. However, at present, there isn't yet enough dosages to enable vaccination of the general population. Different vaccine prioritization strategies are thus being implemented in different communities in order to permit for a systematic vaccination of individuals. Here, on behalf of the World Heart Federation, we emphasize the need for individuals with Cardiovascular disease to be prioritized in national vaccine prioritization programmes as these are high risk individuals.

Sustainable development goals against COVID-19: The performance of brazilian cities in SDGS 3 and 6 and their reflection on the pandemic

The aim of this article is to understand the relationship between two of the Sustainable Development Goals (UN Agenda 2030) – Good health and well-being (SDG 3) and Clean water and sanitation (SDG 6) – and the statistics of the COVID-19 pandemic (number of cases and deaths) in Brazilian cities. To analyze this relationship, we used secondary data from public organizations on the SDG panorama by city and conducted a moderated regression analysis. The sample was composed of 649 cities with a population exceeding 50 thousand inhabitants. The results show that the higher were the indicators used to measure SDGs, the lower was the number of cases and deaths from the disease. We have also proved that cities’ population density and their distance from the pandemic epicenter moderate this relationship, since a higher level of these moderation variables increases the impact of a lower level of SDGs 3 and 6 coverage in society on the number of cases and deaths from COVID-19. Thus, the efficient and effective investment to reach SDGs 3 and 6 is directly associated with cities’ ability to successfully deal with infectious diseases and the resulting number of deaths. As for its contribution, this research innovates by establishing a model for analyzing the impact of compliance with SDGs on cities’ performance in their fight against COVID-19, which may also suit other nations. © 2021, Russian Geographical Society. All rights reserved.

Evaluating the serological status of COVID-19 patients using an indirect immunofluorescent assay, France.

An indirect in-house immunofluorescent assay was developed in order to assess the serological status of COVID-19 patients in Marseille, France. Performance of IFA was compared to a commercial ELISA IgG kit. We tested 888 RT-qPCR-confirmed COVID-19 patients (1302 serum samples) and 350 controls including 200 sera collected before the pandemic, 64 sera known to be associated with nonspecific serological interference, 36 sera from non-coronavirus pneumonia and 50 sera from patient with other common coronavirus to elicit false-positive serology. Incorporating an inactivated clinical SARS-CoV-2 isolate as the antigen, the specificity of the assay was measured as 100% for IgA titre ≥ 1:200, 98.6% for IgM titre ≥ 1:200 and 96.3% for IgG titre ≥ 1:100 after testing a series of negative controls. IFA presented substantial agreement (86%) with ELISA EUROIMMUN SARS-CoV-2 IgG kit (Cohen's Kappa = 0.61). The presence of antibodies was then measured at 3% before a 5-day evolution up to 47% after more than 15 days of evolution. We observed that the rates of seropositivity as well as the titre of specific antibodies were both significantly higher in patients with a poor clinical outcome than in patients with a favourable evolution. These data, which have to be integrated into the ongoing understanding of the immunological phase of the infection, suggest that detection anti-SARS-CoV-2 antibodies is useful as a marker associated with COVID-19 severity. The IFA assay reported here is useful for monitoring SARS-CoV-2 exposure at the individual and population levels.

Socioeconomic vulnerability in the face of covid-19 in municipalities of ceará

The effects of the COVID-19 pandemic have caused serious socioeconomic impacts, exposing the vulnerability of Brazilian states and municipalities. In a broad sense, vulnerability is related to social and economic susceptibility to potential risks or losses caused by extreme events. In this context, this article identifies the municipalities’ socioeconomic vulnerability in the State of Ceará, the epicenter of the COVID-19 pandemic in the Northeast of Brazil. This exploratory-quantitative study adopted secondary data from government databases of public access. The socioeconomic vulnerability of the municipalities was assessed dynamically, based on a mathematical model to forecast the number of cases of COVID-19 applied to the city of Wuhan, China. The vulnerability indicators were calculated under two trajectories: production value and the number of employed persons, considering municipal characteristics such as demographic density, local mobility, and human development index. In the case of the state of Ceará, the findings show a series of demographic, social and economic determinants that aggravate the impacts of the crisis. The vulnerability indicators constructed in this research can be used as a basis for decisions by municipal and state governments in the chronology of economic openings by sectors, municipalities, and regions. © 2020, Fundacao Getulio Vargas. All rights reserved.