Conditions Matter: Considerations on the Use of Auditory and Visual Stimuli in Promoting Population Attitudes and Behaviors During the COVID-19 Pandemic in Brazil

Previous studies show that the type of content and format of messages employed in campaigns about COVID-19 can influence the attitudes and behaviors of the population, increasing their commitment and engagement with measures to contain the disease. This study describes two experiments with 998 Brazilian adults, which main objective was to investigate whether behavioral intentions that contribute to the fight against COVID-19 would be significantly influenced by videos that address the disease from different strategies: one message was informative only, and the other was framed to mobilize empathy in viewers. The results indicate that exposure to both messages contributed to an increase in behavioral intentions of participants, when compared to others who formed a control group. Data also suggest that socioeconomic conditions are an important factor to consider when analyzing the effects of these messages on people's behavior. We discuss the importance of considering the scientific evidence regarding the format and content of messages aired to the population. We also discuss the need to implement initiatives to protect people in more vulnerable socioeconomic conditions, so that actions in the field of Health Education may effectively contribute to combat the pandemic. © 2022, Sociedad Interamericana de Psicologia. All rights reserved.

Clinical Outcomes of Outpatients With Suspected Covid-19 Treated With Chloroquine Compounds in Brazil: A Nationwide Telemedicine Study

Introduction: Following the inception of the COVID-19 pandemic, chloroquine compounds were proposed as potential therapeutic strategies, at the cost of a potential increase in cardiovascular risk. We aimed to evaluate clinical outcomes of patients with COVID-19, comparing those using chloroquine compounds to individuals without specific treatment. Method(s): Outpatients with suspected COVID-19 in Brazil who had at least 1 ECG transmitted to a Telehealth Network, were prospectively enrolled in 2 arms (G1: treatment with chloroquine compounds and G2: without specific treatment) and G3: registry of other specific treatments. Outcomes were assessed through follow-up phone calls on days 3 and 14, and also administratively collected from national mortality and hospitalization databases. The primary outcome was composed of: hospitalization and all-cause death. The association between treatment groups and the primary outcome was evaluated by logistic regression. Significant variables (p<0.10) were included in 4 multivariate models: 1: unadjusted;2: adjusted for age and sex;3: adjusted for model 2 plus cardiovascular risk factors and 4: adjusted for model 3 plus COVID-19 symptoms (when available from phone contact). Result(s): In 303 days, 712 (10.2%) patients were allocated in G1 (chloroquine), 3623 (52.1%) in G2 (control) and 2622 (37.7%) in G3 (other treatments). Median age was 49 (IQR 38 - 62) years, 57% women. Of these, 1969 had successful phone contacts (G1: 260;G2: 871;G3: 838). The primary outcome was more frequent in groups 1 and 3 compared to the control group, when assessed exclusively by phone (G1: 38,5% vs. G2: 18,0% vs. G3: 34,2%, p<0,001) or combined with administrative data (G1: 19,5% vs. G2: 11,0% vs. G3: 18,2%, p<0,001). In the adjusted models, chloroquine independently associated with a greater chance of the primary outcome: phone contact (model 4): OR=3.24 (95% CI 2.31 - 4.54), p<0.001;phone + administrative data (model 3): OR=1.99 (95% CI 1.61 - 2.44), p<0.001. Chloroquine also independently associated with higher mortality, as assessed by phone + administrative data (model 3): OR=1.67 (95% CI 1.20 - 2.28). Conclusion(s): Chloroquine compounds associated with a higher risk of poor outcomes in outpatients with COVID-19 compared to standard care.

Evaluation of Clotting Factors in Hospitalized Critically-Ill Individuals with Suspected Covid-19

Aims: The Coronavirus Disease 2019 (COVID-19), that results of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, manifests with dysfunction of hemostasis and thrombosis. This study aims to evaluate laboratory parameters of hemostasis in hospitalized individuals with suspected COVID-19. Method(s): Individuals aged 18 years or older with suspected COVID-19 admitted to two hospitals were invited to participate in this study. The study inclusion period was from April 2020 to March 2021. The study was approved by the institutional ethics committees. The diagnosis of COVID-19 was confirmed by positive SARS-CoV-2 real-time reverse-transcription polymerase chain reaction. Antithrombin, factor V, factor VII, factor XI, factor XII, factor XIII and prothrombin assays were performed using the Multiplex immunoassay technique (ThermoFisher Scientific, Vienna, Austria). Propensity score matching for sex and age were estimated by a logistic regression model for COVID-19 and non-COVID-19 individuals in the R software. The proportions found in each group were compared by Fisher's exact test, when the variable was categorical, and by the Mann-Whitney test, when it was continuous. Linear regression was performed adjusting the levels of clotting factors and antithrombin for the severity score (Sequential Organ Failure Assessment - SOFA). Correlation between SOFA, clotting factors and antithrombin in individuals with COVID-19 were performed by using the Spearman test. Only very strong correlations (>=0.9) were considered;p-value<0.05 was considered statistically significant. Result(s): A total of 151 individuals were included in the study, of whom 138 (91.4%) with the diagnosis of COVID-19 and 13 (8.6%) non-COVID-19. After 2:1 matching, 26 individuals with COVID-19 and 13 non-COVID-19 participated in the study. In the univariate analysis, the group of COVID-19 had higher levels of antithrombin, factor V, factor VII, factor XI and prothrombin compared to the non-COVID-19 group. However, after adjusting for SOFA, only the levels of factor XI and prothrombin remained different between the groups (higher in the COVID-19) (p=0.04 and p=0.04, respectively). We found no association between factor XI and prothrombin with mortality. However, we found a very strong correlation between coagulation factors V and VII (r=0.923, p<0.0001). Discussion(s): Our results show that plasma levels of antithrombin, factor V, factor VII, factor XI and prothrombin were higher in the COVID-19 when compared with non-COVID-19 group of critically-ill patients, but the difference was lost after adjusting the analysis for SOFA. Only the levels of factor XI and prothrombin remained significant in the COVID-19 group after adjustment. This finding suggests that the severity of the disease rather than viral etiology was the main determinant of the difference in the plasma levels of these proteins. We also showed a strong correlation between factor V and VII in our study. Indeed, factor VII is the major trigger of coagulation in vivo. Therefore, it is possible that factor V and VII could act together to boost coagulation and promote thrombus formation in patients with COVID-19. Conclusion(s): Our study suggests that increased levels of procoagulant factors in hospitalized critically-ill individuals with suspected COVID-19 are rather related to disease severity than to its cause. Copyright © 2022

Frequency of Mutations in Abcb1 and Abcb11 Genes in Patients with Chronic Hepatitis C (Hcv) in Rio De Janeiro

Introduction: The post-COVID-19 syndrome is characterized by the appearance of symptoms and sequelae up to four weeks after the acute symptoms of COVID-19 and can affect various systems, such as respiratory, hematological and hepatic. Cases of chronic fatigue, thromboembolism events, myalgia and the increase in enzymes associated with liver damage have been reported. It is known that individuals with chronic liver disease, cirrhosis and/or hepatocellular carcinoma are more likely to develop post-COVID-19 syndrome. In addition, mutations in the ABCB1 gene (G2677T, C3435T and C1236T) that encode the drug-export pump (P-glycoprotein) are associated with drug resistance and hepatotoxicity. The T1331C mutation in the ABCB11 gene encodes the bile salt-exporting pump and is associated with cholestasis. Therefore, these mutations may be an aggravating factor for the post-COVID-19 syndrome, especially in hepatocompromised individuals. Objective(s): The aim of this study was to assess the frequencies of mutations in the ABCB1 and ABCB11 genes and to monitor the post-COVID-19 syndrome in patients with liver disease. Material(s) and Method(s): We analyzed 197 samples from patients with chronic hepatitis C from the Liver Disease Outpatient Clinic of the Gaffree and Guinle University Hospital. Extraction and mutation analysis by qPCR was performed using TaqMan Assays. Result(s): In the ABCB1 gene, the most frequent mutation was C3435T (rs1045642) in 13.7% (TT), in this group 40.1% were wild-type (CC) and 46.2% were heterozygous (CT). For the C1236T (rs1128503) the frequency of wild-type (CC) was 45.2%, of heterozygotes (CT) 43.6% and mutants (TT) 11.2%. The lowest frequency of mutations in the ABCB1 gene was G2677T (rs2032582) in 8.6% of patients, 52.8% are wild-type (GG) and 38.6% are heterozygous (GT). As for the T1331C (rs2287622) in the ABCB11 gene, most individuals were heterozygotes - TC (51.8%), followed by wild-type - TT (34.0%) and mutants - CC (14.2%). Discussion(s): This is the first study to evaluate the association of cases and severity of post-COVID-19 syndrome with mutations in the ABCB1 and ABCB11. So far, there are only reports in the literature of the association of this mutations with liver damage and resistance to drugs used in the treatment of COVID-19, such as lopinavir and dexamethasone. Therefore, the presence of these mutations could influence the presence of the post-COVID-19 syndrome. Conclusion(s): We observed a greater presence of heterozygous individuals than the other genotypes in the population studied. It is necessary to investigate its association with cases of post-COVID-19 syndrome in hepatocompromised patients, in order to establish the risks associated with the syndrome in these individuals and to understand the influence of these polymorphisms on the clinical picture and evolution of these individuals. Support: CAPES and FAPERJ. Copyright © 2022

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.

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).

Nutrition guidelines compliance in cardiovascular disease patients attending a long-term exercise-based cardiac rehabilitation program during COVID-19 era

Introduction: Dietary habits influence cardiovascular disease (CVD) risk, mainly through risk factors such as lipids, blood pressure, body weight and diabetes. Therefore, a healthy diet is recommended as a cornerstone of CVD prevention in all individuals and in reducing risk of recurrent disease, yet few studies have examined diet quality in cardiac-rehabilitation patients on a long-term basis. Purpose: To evaluate the compliance with dietary guidelines in patients who attend a long-term cardiac rehabilitation program (phase III) during COVID-19 era. Methods: The study was developed between October 2020 and October 2021 in a phase III centre-based cardiac rehabilitation program. To evaluate dietary intake a 24hour recall questionnaire was used. Diet composition was analysed using ESHA's Food Processor® software. Cunningham equation was used to evaluate resting energy expenditure and physical activity expenditure measured by accelerometery was added to calculate daily energetic requirements. The nutrients and cut-offs considered for the analysis were saturated fat (<10%), sodium (<2g), potassium (≥3.5g), fibre (≥30g), and alcohol (<100g/week), considering the 2021 ESC Guidelines on CVD Prevention in Clinical Practice or the World Health Organization guidelines for a healthy diet. To evaluate weight and height a digital scale SECA 799 and a stadiometer SECA 220 were used, respectively. Results: A total of 57 patients (78.9% men) with a mean age of 63.8±8.5 were evaluated. Mean body mass index (BMI) was 28.4±3.8kg/m2, being most patients overweight or obese (61.7%). A higher caloric consumption, compared to the individual energy requirements, was found in 26.3% of patients. No statistical differences were found between mean saturated fat intake (10.1±3.6%) and the recommended intake (p=0.85). Mean sodium consumption was 3.42±1.46 grams and mean potassium intake was 3.0±1.0 grams. Sodium intake was significantly higher (p<0.001), and potassium intake significantly lower (p<0.001) than the recommendation. Fibre intake was also significantly lower than the recommendation (median intake was 21.1±12.2 grams, p<0.001). Among patients who drank alcoholic beverages (n=28), the median alcohol intake per day was 17.4±26.3 grams which was significantly higher than the limit recommended (p=0.043). Conclusion: Our findings showed that these patients deviated from the recommendations in some key nutrients. The intake of sodium and alcohol was higher than the recommendations, and the intake of potassium and fibre were lower than the recommendations. Moreover, most patients were overweight or obese. This study highlights the need for individual nutritional counselling sessions as a reinforcement of a standard educational program, to effectively promote an adequate diet, which may reduce the risk of recurrent disease. Further research about nutritional intervention in patients undergoing on a long-term basis cardiac rehabilitation is warranted.

Working During Covid-19 Lockdowns: Qualitative Study of the Psychological Adaptation of Nurses and Teleworkers During Pandemic Phases I and III

Previous studies have shown the negative impact of the Covid-19 pandemic, associating it with anxiety, depression, and feelings of fear. Fewer studies have addressed the subjective experience and psychological processes throughout different pandemic phases. In order to analyze the subjective experiences and psychological adjustment of teleworkers and nurses regarding the impact of the Covid-19 pandemic during phases I–III lockdowns during two states of emergency, online semi-structured interviews with twenty Portuguese nurses and teleworkers were recorded, transcribed, and analyzed using the IPA methodology and Lexical Analysis with Alceste®. Classes clustered in Lexical analysis attested the validity of the IPA’s consensual themes. The two groups were info-whelmed, stressed, overworked, and anxious. They feared contagious uncertainty and financial constraints, struggling with work-life balance. Both complied rapidly with the restraints imposed, electing adaptive coping and emotional regulation strategies. The nurses’ group, faced with defiant working conditions, expressed higher burnout risk. In the III pandemic phase lockdown, participants reported less anxiety, but more stress, frustration, adapting self-regulation strategies over time. Throughout the pandemic, teleworkers and nurses identified personal experiences, feelings, and the impact related to the Covid-19 pandemic, adopting active cognitive, behavioral, and emotional self-regulation strategies focusing on their wellbeing. Over time, the negative effects may wear out personal resources, increase vulnerability and trigger the onset of psychological symptoms. We synthetize the subjective experiences regarding the psychological impact and adaptation processes through phases I–III, which may be useful to design psychological prevention and intervention programs to promote psychological adjustment in different organizations. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

ASSOCIAÇÃO ENTRE GRUPO SANGUÍNEO ABO, GRAVIDADE E MORTALIDADE POR COVID-19

Objetivo: Avaliar a relação entre o sistema ABO e os índices de gravidade e mortalidade em pacientes hospitalizados por COVID-19 no município de Uberaba-MG. Material e métodos: Participaram deste estudo 343 pacientes atendidos em unidades hospitalares do município de Uberaba – MG. Foram determinadas as fenotipagens eritrocitárias por prova reversa em todas as amostras de sangue periférico e coletados os dados clínicos e epidemiológicos de cada paciente. A análise estatística dos resultados foi realizada de forma descritiva e inferencial. Para variáveis quantitativas, utilizaram-se medidas de posição ou centralidade (média) e medidas de dispersão e variabilidade (desvio padrão). As variáveis categóricas foram analisadas por meio do software SPSS, versão 20.0, bem como análise de associação em tabelas de contingências χ2. Os valores foram considerados estatisticamente significativos quando p ≤ 0,05. Resultados: Dos 343 pacientes avaliados no período de maio a novembro de 2020, 80,17% foram diagnosticados com COVID-19 e 19,83% negativos para a doença. Os pacientes positivos tinham idade média de 60,32 anos (DP ± 17,17) e a maioria eram homens (60%). Foram observadas comorbidades em 81% dos pacientes infectados. Quanto à tipagem sanguínea ABO nos casos positivos, não foram encontradas diferenças estatísticas entre os grupos analisados (χ2 = 3,24, p = 0,37), sendo 31,8% pacientes positivos do tipo A, 2% do tipo AB, 10,3% do tipo B e 55,9% do tipo O. Em relação a gravidade foi observado que 51,2% dos casos foram considerados graves (UTI entubados), 19,3% considerados moderados (UTI sem entubação) e 29,5% considerados leves (enfermaria), e quanto a mortalidade, 51,6% tiveram alta e 48,4% foram a óbito. Não foram encontradas diferenças estatisticamente significantes entre a relação de gravidade dos pacientes positivos para COVID-19 e o tipo sanguíneo ABO (χ2 = 4,781, p = 0,57). Quando realizada a comparação entre a mortalidade por COVID-19 e a tipagem sanguínea também não foram encontradas diferenças estatísticas (χ2 = 6,088, p = 0,11). Discussão: Recentemente foi sugerida correlação entre o tipo sanguíneo e a infecção por SARS-CoV-2. Alguns estudos apontaram o tipo sanguíneo A como o mais suscetível a infecções graves. Embora tenhamos realizado a determinação da tipagem sanguínea apenas por prova reversa, nossos resultados foram semelhantes ao de outros estudos em que não houve nenhuma relação entre os tipos sanguíneos, gravidade e mortalidade por COVID-19. Conclusão: De acordo com os dados encontrados nessas análises, o tipo sanguíneo ABO não parece estar associado a gravidade e a mortalidade da COVID-19, portanto, o sistema ABO não deve ser considerado como marcador biológico prognóstico para a COVID-19.

Development and validation of the ABC2-SPH risk score for in-hospital mortality in COVID-19 patients

Introduction: Fast and efficient assessment of prognosis of coronavirus disease 19 (COVID-19) is needed to optimize the allocation of health care and human resources, to empower early identification and intervention of patients at higher risk of poor outcome. A proper assessment tool may guide decision making, to develop an appropriate plan of care for each patient. Although different scores have been proposed, the majority of them are limited due to high risk of bias, and there is a lack of reliable prognostic prediction models. Purpose: To develop and validate an easy applicable rapid scoring system that employs routinely available clinical and laboratory data at hospital presentation, to predict in-hospital mortality in patients with COVID-19, able to discriminate high vs non-high risk patients. Additionally, we aimed to compare this score with other existing ones. Method: Cohort study, conducted in 36 Brazilian hospitals in 17 cities. Consecutive symptomatic patients (≥18 years old) with laboratory confirmed COVID-19 admitted to participating hospitals. Primary outcome was in-hospital mortality. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients that were admitted between March-July, 2020. The model was then validated in the 1054 patients admitted during August-September, as well as in an external cohort of 474 Spanish patients. Results: Median (25th-75th percentile) age of the model-derivation cohort was 60 (48-72) years, 53.8% were men, in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. From 20 potential predictors, seven significant variables were included in the in-hospital mortality risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829 to 0.859), which was confirmed in the Brazilian (0.859) and Spanish (0.899) validation cohorts. Our ABC2-SPH score showed good calibration in both Brazilian cohorts, but, in the Spanish cohort, mortality was somewhat underestimated in patients with very high (>25%) risk. The ABC2- SPH score is implemented in a freely available online risk calculator. Conclusions: We designed and validated an easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation, for early stratification for in-hospital mortality risk of patients with COVID-19.

Clinical characteristics and in-hospital outcomes of patients coinfected with Chagas disease and SARS-CoV-2

Background: Underlying comorbidities have been widely associated with a worse prognosis for COVID-19 patients, since viral infections could act as triggers for worsening of chronic diseases. Although Chagas disease (CD) is endemic in Latin America, it has been recognized that the disease is now a worldwide concern. Information on the interplay between COVID-19 and CDis lacking. Purpose: To assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Methods: Patients with COVID-19 diagnosis were selected from the Brazilian COVID-19 Registry, a prospective multicenter cohort, from March to September, 2020. CD diagnosis was based on hospital record at the time of admission. Study data were collected by trained hospital staff using Research Electronic Data Capture (REDCap) tools. Genetic matching for sex, age, hypertension, DM and hospital was performed in a 4:1 ratio. Results: Of the 7,018 patients who had confirmed infection with SARSCoV- 2 in the registry, 31 patients with CD and 124 matched controls were included. Overall, the median age was 72 (64.-80) years-old and 44.5% were male. At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p<0.05 for both). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). Seventy-two (46.5%) patients required admission to the intensive care unit. In-hospital management, outcomes and complications were similar between the groups (Table 1). Conclusions: In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation. (Figure Presented).

Development of an artificial intelligence model to predict venous thromboembolic disease in COVID-19 patients at hospital admission

Background: A lot of attention has been drawn to the identification of predictors of VTE in COVID-19 patients, and an accurate clinical prediction model is still lacking in this context. Aims: To develop a clinical prediction model using artificial intelligence techniques, to predict VTE in COVID-19 patients, using variables easily available upon hospital admission. Methods: This multicenter cohort included consecutive adult patients (≥ 18 years-old) with laboratory-confirmed COVID-19 from 37 Brazilian hospitals from 17 cities, between March and September 2020. Study data were collected from medical records using Research Electronic Data Capture (REDCap) tools. We trained multiple machine learning models on various combinations of structured and non-structured features, calibrated to reflect a probability distribution while predicting the desired clinical outcome. Subsequently, we analyzed the relationship between this model ' s predicted confidence score and the fraction of false negatives in the test sample to devise a splitting point where no false negatives would occur, thus calibrating for sensitivity over specificity. The study was approved by the National Research Ethics Commission waiving off the application of informed consent. Results: The dataset included 6421 patients (median age 61 [P25-75 48-73] years-old, 54.8% men), 4.5% of them developed venous thromboembolic disease. Patient ' s age, sex and comorbidities, as well as their list of household prescription drugs, history of recent surgery and laboratory tests were significant predictors. Given a proper confidence level, our model predicted 100% of the true positive cases while eliminating a significant portion of the true negatives (Figure 1). (Figure Presented) Conclusions: This study suggests that an ensemble of decision rules can effectively predict COVID patients with high risk of VTE. It might be possible to decrease the use of anticoagulants while still treating patients with an appreciable likelihood of thromboembolism.

Venous thromboembolism in patients hospitalized with COVID-19: Results from the Brazilian COVID-19 registry

Background : COVID-19 patients are at increased risk of venous thromboembolism (VTE), and this complication leads to a worse prognosis. However, to diagnose VTE on COVID-19 patients is a challenge to physicians, as the symptoms of pulmonary embolism can often be mistaken for the overlapped viral pneumonia. Herein, there is still little information on VTE incidence and associated risk factors specifically for this population. Aims : To assess the incidence and associated risk factors for VTE in hospitalized COVID-19 patients in Brazilian hospitals. Methods : Retrospective multicenter cohort in 15 Brazilian hospitals. Consecutive adult patients (≥ 18 years-old) with laboratoryconfirmed COVID-19 between March and September 2020 were included. Study data were collected from medical records using Research Electronic Data Capture (REDCap) tools. The study was approved by the National Research Ethics Commission waiving off the application of informed consent. Results : Of 4,021 patients included, 234 (5.8%) had VTE. When comparing VTE and non-VTE groups (Tables 1 and 2), there was no statistical difference in terms of sex and age between groups. The median age was 63 years-old (IQR 51-72 years-old) in VTE group. The most common comorbidities for both groups were hypertension and diabetes. Obesity, chronic pulmonary obstructive disease, previous VTE and recent surgery were more frequent in VTE group. D-dimer, C-reactive protein, lactate dehydrogenase levels and lymphocyte count were higher in the VTE group. Admission to intensive care units (37.6% vs 69.7%;P < 0,001) and in-hospital mortality (19.0% vs 28.3%;P < 0,01) were significantly higher in those who had VTE. Conclusions : Overall, 5.8% of COVID-19 hospitalized patients had VTE. Elevated laboratory values were associated with increased risk of this condition. VTE was associated with higher rates of intensive care admission and in-hospital mortality.

The Project eMysteries - From reading to writing

Digital culture is impacting heavily on young people's lives, be it through their own attachment to social media through mobile devices, or the new Covid-19 demands on distance online education. Maryanne Wolf in Reader, Come Home (2018) argues through her cognitive neuroscientific studies on reading, that the mind of readers is changing given the media they are constantly using (mobile phones, computers). One of the issues Wolf debates is the loss of deep detailed modes of reading comprehension or the willingness of today's (young) readers to engage with complex sentences or longer texts. She claims, however, that really good reading is close reading, a form of reading that requires intellectual effort from the reader involving the intellectual skills of reasoning, thinking and understanding (Wolf, 2018). How can this be promoted in the digital age? This is the aim of a European Erasmus+ funded project the authors are involved in called e-Mysteries: Detective Stories to Engage Students in Close Reading with the Use of Mobile Devices (short name: e-Mysteries). New forms of reading, such as those being developed by the e-Mysteries project, create opportunities for the participatory empathetic, critical, and analytical engagement of students with what they read as well as with individual and collaborative writing in a modern flux of consumer-producer.

Indicators to potential infection and conditions predisposing to covid-19 in the san lorenzo department, santa fe province, in june of 2020

Early detection of Covid-19 compatible signs-symptoms has been a resource to face the pathology and enable timely treatment and early isolation of affected person and their group of relationships, in order to control disease spread. The San Lorenzo Department, Santa Fe province, is one of the most populated in this province and a part of the Rosario metropolitan area. The general objective of this work was to assess indicators to potential infection Covid 19 and detect conditions predisposing to this disease risk in passers-by in the Department of San Lorenzo towns in June 2020. It was performed a cross-section study, for which was collected information from the towns of Capitán Bermúdez, Carcarañá, Fray Luis Beltrán, Puerto Gran San Martín, Roldán, San Lorenzo, Aldao, Cnel Arnold, Fuentes, Luis Palacios, Ricardone, San Jerónimo Sud, Timbúes and Villa Mugueta. In each town and during a day a strategic place was chosen due to high pedestrian traffic for the measurement of temperature and oxygen saturation to passers-by, carried out under the supervision of a pharmacist. In addition, information on age, sex, reference to influenza vaccine, and underlying pathologies were collected. Data analysis was performed using relative frequencies and 95% confidence intervals (95% CI). The Chi-square test was used to inferences. P < 0.05 was considered significant. Information was collected from 743 passers-by, so this involves an average of 14.1 individuals per 1000 inhabitants. The 94.6% (92.6-96.1%) were adults (18 years or older). The 10.1% (8.1-12.6%) of total presented a body-temperature between 37.0 and 37.6 °C while the rest was below 37°C. Oxygen saturation level was found on average at 96%. The protocol for Covid-19 was activated in a single person. Among the adults, 38.8% (35.2-42.5%) were male, 42.1% (38.4-45.8%) referred to the application of the influenza vaccine, and 31.7% (28.1-35.5%) presented some pathological condition. Arterial hypertension 54.9% (47.8-61.9%), diabetes 15.7% (11.0-21.4%), followed by respiratory conditions 11.3% (7.3-16.4%) and hypothyroidism 10.3% (6.5-15.3%) were the most frequent pathologies. Among people that reported underlying pathologies, approximately half were elderly (60 years or older) and although they reported significantly more influenza vaccine immunization than younger ones with underlying pathologies (P = 0.00003);23% of elders with pathology did not have influenza vaccine. In conclusion, this work enables the activation of the Covid-19 protocol in a suspected case. Almost a third of the adult passers-by reported some pathological condition, particularly arterial hypertension. Almost a quarter of the elderly with underlying disease did not have influenza vaccine.

What is the potential for a second peak in the evolution of SARS-CoV-2 in emerging and developing economies? Insights from a SIRASD model considering the informal economy

We study the potential scenarios from a Susceptible-Infected-Recovered-Asymptomatic-Symptomatic-Dead (SIRASD) model. As a novelty, we consider populations that differ in their degree of compliance with social distancing policies following socioeconomic attributes that are observed in emerging and developing countries. Considering epidemiological parameters estimated from data of the propagation of SARS-CoV-2 in Brazil-where there is a significant stake of the population making their living in the informal economy and thus prone to not follow self-isolation-we assert that if the confinement measures are lifted too soon, namely as much as one week of consecutive declining numbers of new cases, it is very likely the appearance of a second peak. Our approach should be valid for any country where the number of people involved in the informal economy is a large proportion of the total labor force. In summary, our results point out the crucial relevance of target policies for supporting people in the informal economy to properly comply with preventive measures during the pandemic. © 2021 World Scientific Publishing Company.