Evidence and regulation for COVID-19 self-tests

Introduction: The development of new diagnostic tests for SARS-CoV-2 is a strategic component for the prevention and control of COVID-19. To regulate the market for SARS-CoV-2 antigen detection self-tests, the regulatory agency issued a resolution that provided for the introduction of self-tests in Brazil. Objective: To perform a comparison between the new technical requirements of antigen self-tests for COVID-19 with data and information available in the literature. Method: This is a systematic literature review to carry out a comparative study between the scientific evidence and the new technical requirements for the commercialization of antigen self-tests for COVID-19 in Brazil. The search was performed in October 2021, and updated in January 2022. Results: Of the 517 studies identified, nine were included. The studies reported adequate sensitivity and specificity results for most self-tests performed in symptomatic people. The studies bring a variety of tests available and one of them was registered for commercialization in Brazil. Based on this outcome, national regulation follows standards that favor the promotion of self-monitoring by the population, which can contribute to a public health policy. Conclusions: The technical requirements contained in the new regulation and at the national level are consistent with the evidence found, which ensures reliability for decision-making by consumers, clinicians and service providers. It is necessary to continue with studies on self-test coverage for new variants, biological material disposal policies and how the use of self-tests can contribute to the role of consumers in health surveillance actions.

COVID-19: prevention, diagnosis and treatment. Recommendations of a multidisciplinary group.

BACKGROUND: SARS-CoV-2 infection, which causes COVID-19, has impacted the entire world due to its extensive and rapid spread. In the last two years, more than 412 million cases have been confirmed, with more than 5.8 million deaths, as of February 14, 2022. OBJECTIVE(S): Integrate a series of recommendations based on the best level of evidence in prevention, diagnosis and treatment of SARS-CoV-2 infection, including its new variants. METHODOLOGY: Review of different international guidelines and recent articles published in peer-reviewed journals. Issue recommendations based on the level of evidence and degree of confirmation established by the guidelines of the National Institute for Health and Care Excellence (NICE). The authors analyzed the selected articles and, based on their experience, summarized the most relevant to meet the objectives of these recommendations. RESULT(S): 200 articles were found, of which only 124 were selected that met the requirements to identify the level of evidence and degree of recommendation. CONCLUSION(S): Prevention through vaccination continues to be the best tool to establish protection mechanisms against the virus and substantially reduce hospitalizations and associated mortality. Although homologous vaccination is still the accepted reference pattern, the efficacy of heterologous schemes to avoid hospitalization and mortality must be considered. Monoclonal experiments, such as sotrovimab, have activity against the Omicron variant and the AZD7442 molecule that have shown high efficacy in preventing symptomatic COVID-19 in pre- and post-exposure conditions.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.

Using Machine Learning to Reduce Burden on Infection Control Staff

Surveillance of health care–associated infection (HAI) is the foundation of infection control and one of the first steps in infection prevention. Traditionally, however, surveillance is performed by infection control professionals (ICPs) who manually review patients' records, searching for defined criteria. Such an approach leaves room for subjective interpretation, resulting in low interrater reliability. Moreover, depending on the surveillance method used — for instance, a search based on antimicrobial results — it may have low sensitivity. In Brazil, leaders at Tacchini Hospital and Qualis, a startup that offers infection control advisory and antimicrobial stewardship, have developed a machine-learning–algorithm robot that has been demonstrated to be a reliable tool for identifying patients with HAIs using a semiautomated method. The performance of this infection surveillance assistant (ISA) robot shows optimal sensitivity, specificity, accuracy, and negative predictive values, and the precision (positive predictive value) is acceptable. The ISA robot identified more patients with HAIs than did the infection control manual surveillance reference. The time spent on patient review was also reduced compared with that spent on manual surveillance. The robot detected HAI in one of every two or three patients reviewed in the interface. The years of the Covid-19 pandemic have highlighted the problem of the shortage of health care professionals, including ICPs. Tacchini Hospital and Qualis aim to increase infection control efficiency, enabling these professionals to spend more time on inpatient wards, implementing care bundles, than handling office activities, such as manual surveillance. In this study, the authors describe the implementation of semiautomated surveillance in a single center, but expanding the model for different patient scenarios and multiple centers should be the future for external validation of machine-learning surveillance. Such models have the potential for generalization because they do not depend only on fixed rules for HAI classification, but they can also learn from data sets in different patient population settings. © 2022 Massachusetts Medical Society. All rights reserved.

Local scale dynamics to promote the sustainable management of construction and demolition waste

On a local scale, municipalities often incur high costs as a result of the illegal dumping of construction and demolition waste (CDW), due to gaps in awareness and training, a lack of adequate oversight actions or infrastructure and equipment. Moreover, there is a loss of resources, failing to close the loop of the circular economy. Six participatory workshops were implemented in 2021, via videoconference due to the Covid-19 pandemic, in a rural Portuguese region, to understand the contribution of local scale dynamics in the promotion of CDW management from an operational perspective. Three of them were dedicated to municipal technicians (39 participants, on average) and the other three to representatives of micro and small construction companies (25 participants, on average). The results reveal that strategies must rely on investment in local solutions to optimise logistics and cost issues, cooperation between stakeholders, and improving the market for recycled aggregates. Also, support for information, awareness, and training is essential, focusing on good practices onsite and oversight procedures. Additionally, municipalities were involved in the prioritisation of legal framework issues, and micro and small construction companies concerning the determinants contributing for their behaviour change. These findings contribute to solving gaps in the literature, useful for researchers and decision-makers in rural or less developed areas.Copyright © 2023 The Author(s)

Kidney Limited Complement-Mediated Thrombotic Microangiopathy- a Challenging Case

Introduction: Complement-mediated thrombotic microangiopathy (CM-TMA) is a rare disease characterized by microangiopathic hemolytic anemia (MAHA), thrombocytopenia and organ injury. The absence of hemolysis and thrombocytopenia is rare. We present a case of kidney limited CM-TMA successfully treated with eculizumab. Method(s): A 36 year-old man with poorly controlled hypertension, obesity, CKD (baseline creatinine (sCr) 2,6mg/dL, albuminuria 150mg/g), hyperlipidemia, obstructive sleep apnea, hyperuricemia, SARS-CoV-2 infection 3 months earlier, and family history of CKD of unknown etiology (father started kidney replacement therapy (KRT) at young age) presented to the ER with high blood pressure and right hemiplegy. Head CT scan showed left thalamo-capsular hemorrhage. Oftalmologic exam was normal. Laboratory findings were: hemoglobin (Hb) 12.5g/dL, elevated white cell count (17.900/uL), platelet count 214.000/uL, sCr 4.3mg/dL, lactate dehydrogenase (LDH) 303U/L. Urine dipstick revealed protein+ and Hb++. Chest X-ray showed signs of pneumonia. The patient was admitted in ICU and mechanically ventilated. After 3 weeks, renal function recovered to its baseline (sCr 1.5mg/dL, no proteinuria) without KRT, and the patient was transferred to the medical ward. Several infectious complications prolonged hospital stay. After 3 months, a new mild SARS-CoV-2 infection was detected. At this time: Hb 9.9g/dL, platelets 220.000/uL, sCr 2.2mg/dL. Six days later the patient showed Hb 9.5 g/dL, without reticulocytosis, platelets 195.000/uL, sCr 6.3mg/dL, LDH 348U/L, normal haptoglobin, no schizocytes on blood smear. After 3 days, the patient was anuric and sCr increased to 10mg/dL, prompting KRT. Kidney ultrasound showed no abnormalities. Autoimmunity study was negative, normal C3/C4, no monoclonal gammopathy, and negative viral serologies. Kidney biopsy (KB) was performed as the etiology of AKI remained unclear. Light microscopy revealed thickned glomerular capillary walls with subendothelial expansion forming double contouring, arteriolar intimal expansion and fibrin thrombi occluding the vascular lumina. Scarse C3 deposition was observed in capillary walls. Since the morphological features were consistent with TMA, secondary causes were excluded and primary causes also investigated: ADAMTS13 activity, complement factor B and I were within normal range, slight decrease of factor H with normal anti factor H antibody. The molecular studies of complement genes were performed by NGS-based gene panel revealing a rare heterozygous missense mutation on gene CFB, c.1189G>A (p.Asp397Asn), described as a genetic risk factor of CM-TMA in the presence of a trigger. Result(s): Treatment with eculizumab was started and the patient showed signs of kidney recovery allowing KRT suspension 1 month later (sCr 5.53mg/dL). Of note, the patient never presented MAHA or thrombocytopenia. After 5 months, renal function improved to sCr 3.9mg/dL. Conclusion(s): We report a case of CM-TMA with isolated kidney injury without laboratory hallmarks of TMA. Patients usually require a secondary trigger for the disease to manifest, and in this case SARS-CoV-2 infection may have been the causative agent. A mutation in gene CFB may have predisposed the patient to the outcome. KB was crucial for diagnosis and prompted the treatment with eculizumab with partial recovery without the need for chronic KRT. No conflict of interestCopyright © 2023

Antigen Diagnostic Tests With Self-Collection Of Biological Material For The Diagnosis Of COVID-19

Introduction. The self-test for COVID-19 has been a widely used strategy in some countries, especially in the context of back to face-toface work and educational activities. However, it is necessary to discuss the accuracy of antigen tests for the diagnosis of COVID-19. Methods. A systematic review was carried out. The strategy was defined by the researchers using the terms Covid-19 and Selftesting and their respective synonyms, including studies with data collection from 01/01/2021. Searches were carried out on October 20, 2021, in several databases. Results. A total of 504 studies were identified, four of which were included in this review: two self-tests of nasopharyngeal collection antigen compared to reverse transcriptase polymerase chain reaction (RT-PCR);a supervised and self-collected anterior nasal smear selftest;and a study that evaluated the performance of six self-collected rapid antigen tests against quantitative RT-PCR (gargle, sputum, and spit). Saliva self-tests were found to have low sensitivity (<45%), while anterior nasal or nasopharyngeal swab self-tests had greater than 80 percent sensitivity. In all self-tests, the specificity was less than 85 percent. The diagnostic accuracy of self-tests for the different SARS-CoV-2 variants was not identified. Conclusions. The use of self-tests as a screening strategy is recommended, being a strategy with a significant impact on the surveillance and control of SARS-CoV-2 transmission. Further studies are needed to assess: (i) accuracy considering the concern variants, (ii) safety of tests with self-collection of biological material, and (iii) disposal of biological waste.

Impact of the COVID-19 pandemic on the quality of life of older adults

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted unevenly across nations and population groups. Older adults were considered a high-risk group because of their high susceptibility to infection and potential for clinical complications and death. Long periods of home confinement and social distancing foster changes in daily life that impact the mobility, health and quality of life of older adults. This study aims to assess the quality of life of older adults during the COVID-19 pandemic, adherence to prevention measures, self-perceived impaired mobility, relating to others, daily activities, eating habits and constipation-patterns.

Higher Education Student Complaint Behavior in a Complex Service Ecosystem: A Value Co-creation Perspective

During the global covid-19 pandemic, most of higher education institutions (heis) were forced to migrate to an e-learning methodology in order to continue their academic activities. At the same time, the student complaint behavior (scb) increased due to new experiences of dissatisfaction or non-satisfaction. In this context, and seeking to ensure student satisfaction, heis have managed this behavior in the same form that companies do with their customers. Therefore, we present a critical analysis on the generic and standardized approach in the literature and practice to understanding and managing scb in the same way as customer complaint behavior (ccb) is man-aged. A review of the literature on the theories and studies related to scb and ccb and the student/ customer treatment debate are presented, highlighting the complexity of higher education (he) service, which is considered a pillar of development due to its social value. The authors argue the suitable application of the Service-Dominant Logic (sdl), specifically its value co-creation premise, as well as the principles of the Service Ecosystem theory to differentiate scb from ccb. This may allow heis to continue to ensure student satisfaction through the management of their complaints without compromising educational quality and service sustainability. The reflection hereby presented is limited to the Latin America region educational contexts and their structures. © 2023, Universidad Nacional de Colombia. All rights reserved.

Physical activity levels of Portuguese adolescents in the first period of confinement due to the COVID- 19 pandemic and the first activities of teachers and coaches: a cross-sectional study

Due to the COVID-19 pandemic, social confinement was declared in Portugal on 19th March 2020. Schools and sports clubs were closed, access to all sports and leisure facilities was limited, and young people have experienced restrictions regarding the practice of physical activities and sports. The purpose of this study was to identify the physical activity (PA) levels and sports participation of adolescents before and during confinement, with whom they practice during restrictions and to identify the activities adopted by their physical education (PE) teachers and sports coaches to keep them physically active. An online survey was conducted between March 27th and April 14th 2020. A total of 3,012 Portuguese adolescents (57% females) aged between 10 and 19 years old (14.3 +/- 2.4 years old) took part in this study. Wilcoxon test and paired-sample t-test and chi-square test of independence were used in the data analysis. The results show that the number of students engaged in PA increased during the lockdown (72.7% to 88.2%). For those who practiced PA before lockdown, the frequency of PA decreased from 4.7 sessions/week to 4.4 sessions/week (during confinement). For those who did not practice PA before confinement, they started by doing 4.1 sessions/week. The vast majority of PE teachers (77.3%) proposed some pedagogical activities such as video conference classes (53.6%). Regarding the coaches, 53.4% pro-posed some activity, mainly time circuit training, walking and cycling (around 18% each), or specific training exercises and video conference classes (about 12% each). The number of students who increased their regular PA practice can be justified by the immediate intervention of PE teachers, who implemented several online activities, or because students were able to choose different options to stay active.

Sociosexuality and Sexual Behavior in Men During the COVID-19 Pandemic

Previous studies have shown that unrestricted sociosexuality is part of a quantitative strategy where individuals prioritize the search for multiple partners and is associated with earlier onset of sexual debut, infidelity, reduced sexual disgust, and risk-taking behaviors. Thus, we aimed to investigate the relationship between sociosexuality and sexual risky behaviors during the COVID-19 pandemic due to its potential effects in sexual relationships in a long-standing period of physical distancing. Five hundred eighty-three men completed a series of online questionnaires regarding their sociosexuality, sexual experiences, and adherence to physical distancing recommendations. We found that only a small proportion of the sample had fully adhered to distancing guidelines. Sociosexuality correlated negatively with age at first sexual experience and positively with number of casual partners during the pandemic and frequency of unprotected sex with strangers. Both single and non-heterosexual (gays and bisexuals) men showed higher sociosexuality when compared to men in a relationship and heterosexual ones, respectively. Inconsistent adherence to physical distancing was associated with earlier age of sexual experience, higher number of casual sex, and higher frequency of unprotected sex with strangers. The results indicate that a large proportion of men engaged in some extent in health risk-taking sexual behaviors during the pandemic. As expected, sociosexuality was associated with variables previously found in other studies and with new ones investigated in the present study. We highlight the importance to acknowledge individual differences in response to a long period of distancing and its implications in the welfare of individuals, groups, and the population. © 2022, Associação Brasileira de Psicologia.

Two Case Reports of Cytomegalovirus Induced Collapsing Focal Segmental Glomerulosclerosis in Immunocompetent Hosts

Introduction: Collapsing focal segmental glomerulosclerosis (cFSGS) refers to a distinct pattern of glomerulopathy characterized by a glomerular capillary collapse in a segmental global manner, podocyte proliferation, and tubulointerstitial injury. Viral infections like HIV, Parvovirus B19, and CMV seem to be prominent triggers for the development of a conventional histological pattern of FSGS. CMV-associated renal disease has been described only in transplant and immunocompromised patients. Case Description: Case 1 18-year-old female with history of asthma and HbSS disease presented with fever, nausea, vomiting, and neck pain Physical examination revealed a temperature of 102 F, icterus, negative meningeal signs, no rales, rhonchi or wheezing. Initial creatinine 0.2 mg/dL. COVID-19 PCR was negative but IgG antibodies positive. Patient developed non-oliguric AKI with fluid overload requiring hemodialysis. CMV IgM and CMV PCR were positive. She recieved antibiotic therapy and also ganciclovir. Biopsy revealed collapsing FSGS with acute tubular injury. A week after completion of ganciclovir therapy creatinine returned to baseline of 1.7 mg/dL. Case 2 40-year-old African American male with history of diabetes and asthma presented with fever, fatigue, epigastric pain and chest pain. Initial creatinine 1.2 mg/dl, hepatic function (AST 333 U/L, ALT 265 U/L, ALK 207 U/L), ferritin (13682 ng/ml), triglycerides (276 mg/dl) and proteinuria (urine protein /creatinine ratio: 2, urine albumin/creatinine:1016 mg/gm). Patient developed anuric renal failure which required hemodialysis. Biopsy revealed collapsing FSGS with diffuse podocyte effacement, moderate tubular atrophy, and interstitial fibrosis. CMV DNA antibodies were positive. Methylprednisolone and valganciclovir were started with patient creatinine trending down to 3.7 mg/dL. Three weeks following discharge, creatinine levels were 1.5 mg/dL with decreased proteinuria. Discussion(s): Collapsing FSGS in immunocompetent patients is uncommon. Reports mention benefits of ganciclovir and steroid therapy for CMV infection in immunocompromised patients. CMV infection should be considered in patients with systemic inflammatory disease and severe renal failure, as early treatment with steroids and antivirals helps preserve renal function.

Design of Social Distance Monitoring Approach Using Wearable Smart Tags in 5G IoT Environment During Pandemic Conditions

Corona virus disease 2019 (COVID-19) is an enduring extensive pandemic disease globally that infected several million people, occasionally leads to fatal.COVID-19 transfers from one person to another, the prevention is possible only through maintaining social distance.This paper proposed Internet of Things (IoT)-based smart wearable tags for social distance monitoring to prevent COVID-19.The advantage of the proposed system is that it alarms the person with the proposed tag and also entries the data in the IoT ledger of the channel for further analysis.The proposed system responds adequately so that social distancing can be maintained and pandemics can be prevented from further spreading.The analysis has been carried out using an experimental setup, and Thingspeak is used as an IoT channel for data analytics.The result shows the successfulness of the developed system in the prevention of pandemics with social distancing monitoring. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Customer Value Co-creation Behavior in Times of covid-19: The Case of the Mexican Food Service Delivery Ecosystem

The global pandemic caused by covid-19 forced many countries worldwide to establish severe restrictions on mobility and access to numerous services. Mexico was no exception, and es-pecially food service underwent radical changes that forced businesses to move into or expand food service delivery. Not only organizations suffered this abrupt change, but customers also had to ven-ture into this modality, which was unknown or barely explored for many. Faced with this scenario, organizations showed a lack of knowledge about the customer role that positively contributes to the joint achievement of the expected benefits during the value exchange. This research aims to verify if Customer Participation Behavior (cpb) and Customer Citizenship Behavior (ccb) are related to Customer Value Co-creation Behavior (cvcb) generation in the Mexican food service delivery ecosystem. Through a quantitative research, online surveys based on the cvcb scale by Yi and Gong (2013) were applied. Besides, a hierarchical component modeling was used as a statistical instrument. The results highlight that both cpb and ccb are positively and significantly related to cvcb, being responsible behavior and information sharing the variables most related to cpb. As for ccb, recommendation and helping other customers are the variables with the highest relationship. These findings encourage food establishment managers to reinforce specific actions in order to develop co-creation behavior among their customers, and therefore meet the challenges posed to this service modality. © 2022, Universidad Nacional de Colombia. All rights reserved.

Relative Search Interest and Twitter Altmetrics of Chloroquine, Hydroxychloroquine and Ivermectin in Latin America

This study aims to present exploratory and descriptive research about Latin America's online information search and Twitter activity and the repercussions of chloroquine, hydroxychloroquine, and ivermectin, which were at the time considered promising alternatives to prevent or treat COVID-19. From the perspective of Webmetrics and Altmetrics -data were collected and analysed from Twitter around indexed outputs by titles with one of these three drugs and from Google Trends (Relative Search Interest) in Latin American countries. The results demonstrated that there might be parallels between Google Search and Twitter activity. The results also showed that ivermectin was, among the three selected drugs, the most searched in Google Search and higher activity on Latin America's Twitter accounts.

Protective Behavior and Psychological Health among Pregnant Women during the Covid-19 Pandemic

Pregnancy is a time of changes in a woman's life because it includes not only psychological but also physiological and anatomical changes. The woman needs all the support and understanding she can get to be able to deliver to a healthy baby. The presence of the COVID-19 pandemic has caused disruptions in many aspects of life in a pregnant woman and her family thereby causing additional mental burden that may cause psychological as well as physiological alterations in a supposedly normal life changes. The aim of the study is to find out the protective behavior, coping mechanisms and psychological status of the pregnant women in order to come up with interventional activities to help these women cope with their current situation and with the pandemic. The respondents of the study were the 35 pregnant women who consented to participate in the study. The study made use of a survey questionnaire to be able to determine and describe the protective behaviors, their coping mechanisms and the psychological status. Results showed that the respondents practice protective behaviors, have good coping mechanisms and are of normal psychological status. There is no association between the variables to the profile of the respondents except for educational attainment which showed positive perfect correlations with protective behaviors and coping mechanisms against depression, anxiety and stress. The number of respondents limits the findings of the study so it was recommended that similar studies be done in a larger population as well as in significant others of the pregnant women be included as respondent. It is also recommended that a longitudinal study be conducted for more extensive findings.

Electronic computer-based model of combined ventilation using a new medical device

Introduction: The increased demand for mechanical ventilation caused by the COVID-19 pandemic could generate a critical situation where patients may lose access to mechanical ventilators. Combined ventilation, in which two patients are ventilated simultaneously but independently with a single ventilator has been proposed as a life-saving bridge while waiting for new ventilators availability. New devices have emerged to facilitate this task and allow individualization of ventilatory parameters in combined ventilation. In this work we run computer-based electrical simulations of combined ventilation. We introduce an electrical model of a proposed mechanical device which is designed to individualize ventilatory parameters, and tested it under different circumstances. Materials and Methods: With an electronic circuit simulator applet, an electrical model of combined ventilation is created using resistor-capacitor circuits. A device is added to the electrical model which is capable of individualizing the ventilatory parameters of two patients connected to the same ventilator. Through computational simulation, the model is tested in different scenarios with the aim of achieving adequate ventilation of two subjects under different circumstances: 1) two identical subjects;2) two subjects with the same size but different lung compliance;and 3) two subjects with different sizes and compliances. The goal is to achieve the established charge per unit of size on each capacitor under different levels of end-expiratory voltage (as an end-expiratory pressure analog). Data collected included capacitor charge, voltage, and charge normalized to the weight of the simulated patient. Results: Simulations show that it is possible to provide the proper charge to each capacitor under different circumstances using an array of electrical components as equivalents to a proposed mechanical device for combined ventilation. If the pair of connected capacitors have different capacitances, adjustments must be made to the source voltage and/or the resistance of the device to provide the appropriate charge for each capacitor under initial conditions. In pressure control simulation, increasing the end-expiratory voltage on one capacitor requires increasing the source voltage and the device resistance associated with the other simulated patient. On the other hand, in the volume control simulation, it is only required to intervene in the device resistance. Conclusions: Under simulated conditions, this electrical model allows individualization of combined mechanical ventilation. © 2022 Sociedad de Anestesiologia de Chile. All rights reserved.

Mental health patterns during COVID-19 in emergency medical services (EMS)

Purpose>This study aims to explore patterns of Emergency Medical Services (EMS) personnel's mental health, regarding their levels of anxiety, depression, stress, COVID-19 anxiety, obsessive-compulsive symptoms and well-being;and to explore variables that contribute to these patterns, among sociodemographic/professional and COVID-19 experience variables.Design/methodology/approach>Participants were 214 EMS personnel, who answered the Patient-Health Questionnaire, Perceived Stress Scale, COVID-19 Anxiety Scale, Obsessive-Compulsive Inventory, Well-Being Questionnaire and COVID-19 related questions.Findings>EMS personnel showed an adequate psychological adjustment during COVID-19. Two clusters/patterns were found: the poorly (34%) and the well (66%) psychologically-adjusted. Personnel's age, COVID-19 fear and workplace security measures' adequacy contributed to which pattern they were more likely to belong to.Research limitations/implications>Despite being cross-sectional and not controlling for pre-COVID-19 data, this study adds to the COVID-19 literature. Findings call for the need to explore: other COVID-19 fears;how personnel perceive workplace security measures;COVID-19 valid instruments;pre-COVID-19 data;and mental health patterns with different rescuers.Practical implications>Findings explored EMS personnel's patterns of mental health during the COVID-19, as well as its covariates. Results allow to better prepare emergency management, which can develop prevention strategies focused on older professionals, COVID-19 related fears and how personnel assess security measures.Originality/value>This study contributes to the scarce literature focused on COVID-19 mental health patterns instead of focussing on isolated mental health variables, as well as what contributes to these patterns. Moreover, it is one of the few studies that focused on EMS personnel rather than hospital staff.

Acute Neurological Inflammatory Diseases in Colombia: A Multi-center Observational Study from Zika outbreak to SARS-CoV-2 pandemic

Objective: To evaluate clinical, laboratory, and epidemiological features of acute neuroinflammatory disorders (ANIDs) that followed the 2016 Zika epidemic in Colombia. Background: The outbreak of Zika virus infection in Colombia in 2015-2016, produced an increased incidence of Guillain-Barré Syndrome (GBS) and other ANID cases. The Neuroviruses Emerging in the Americas Study (NEAS) network was established in 2016 as a multicenter-based observatory of ANIDs to investigate the role of emerging pathogens in neuroinflammatory diseases. Design/Methods: NEAS serves as a multi-center study based on 13 hospitals in 7 cities in Colombia which study all newly diagnosed patients who fulfill established criteria for GBS, encephalitis, myelitis, meningoencephalitis, or cranial nerve disorders as part of an observational cohort. We analyzed the clinical and epidemiological features of all cases evaluated between January 2016 and September 2021. Results: An observational cohort of 825 patients with ANIDs were recruited during the study period. 58.8% of cases were male with a median age of 43 (IQR 25-58) years. The most frequent ANIDs were GBS (46.1%) and facial nerve palsy (28.7%). The diagnosis of encephalitis (9.5%), myelitis (6.5%), and optic neuritis (5.9%) were less frequent. Patients with GBS were predominantly male (70.6%) and had a median age of 49 (IQR 32-60) years. Interestingly, there was an increase incidence of GBS in 2019. Conclusions: The outbreak of Zika in Colombia produced a marked increase in the incidence of GBS in 2016. Although cases of GBS and other ANIDs continued to emerge after the incidence of Zika infection decreased in July 2016, the recent SARS-CoV-2 pandemic has not produced any significant increase in the incidence of GBS in Colombia.

IMPACTOS DA PANDEMIA DE COVID-19 NA DOAÇÃO DE SANGUE NO BRASIL: ANÁLISE HISTÓRICA DOS ANOS DE 2011-2020

Objetivos: Avaliar os impactos da pandemia de COVID-19 na doação de sangue no Brasil, pela análise histórica de 2011 a 2020. Material e métodos: Trata-se de um estudo descritivo e quantitativo, com dados do Departamento de Informática do SUS (DATASUS) no Sistema de Informações Ambulatoriais do SUS (SIA/SUS), sendo selecionadas as variáveis: quantidade aprovada por região/unidade da federação, por local de atendimento, período de 2011 a 2020, e filtro de procedimento para coleta de sangue para transfusão. Além disso, para cálculos das taxas, foi feito o levantamento demográfico no Instituto Brasileiro de Geografia e Estatística (IBGE). Resultados: Visualizou-se que a taxa de transfusão para cada 1000 habitantes no Brasil no ano de 2020 foi a menor no período estudado, sendo de 13,50. Na análise por regiões, todas tiveram em 2020 o menor índice do intervalo, em ordem crescente região Norte (11,16), Nordeste (12,07), Sudeste (13,46), Centro-Oeste (15,70) e Sul (16,69). Somente cinco estados e o Distrito Federal não tiveram recorde negativo em 2020, são eles: Rio Grande do Norte, Paraíba, Alagoas, Espírito Santo e Rio de Janeiro. Calculando-se a taxa de variação desse índice (comparação com o ano anterior), constatou-se que em 2020 houve a maior queda em relação ao Brasil (-9,98%), a segunda maior foi em 2013 (-3,80%). O mesmo ocorre quando se olha para as regiões em separado, 2020 foi recorde negativo para Sul (-8,98%), Norte (-9,06%), Sudeste (-9,88%), Nordeste (-11,87%), a exceção é a região Centro-oeste que teve o pior momento em 2018 (-8,21%), sendo 2020 (-7,91%) o segundo. Discussão: A necessidade do isolamento social frente à pandemia de COVID-19, haja vista seu alto potencial de transmissão e mortalidade, impactou as doações de sangue e, consequentemente, causou redução dos estoques dos diferentes hemocomponentes, afetando serviços de hemoterapia e a vida de pacientes. Destaca-se, que os hemocentros precisaram se adequar para garantir a segurança dos profissionais e doadores, assim, novas medidas de prevenção e segurança demandaram implementação, como: atualização na triagem com perguntas para sintomas clínicos da COVID-19, aferição de temperatura, busca ativa de testes diagnósticos positivos para o vírus em doadores recentes, limpezas e a desinfecção dos laboratórios e lavagem e desinfecção das mãos. Contudo, evitar aglomerações e fatores de propagação do coronavírus, influenciou a captação de novos doadores, sendo preponderante a atuação e busca dos já recorrentes antes do período pandêmico. Portanto, para contornar o desabastecimento de sangue, outras medidas foram tomadas como: o cancelamento de cirurgias eletivas, diminuição no rigor de alguns critérios para a doação (queda da restrição da doação de homosexuais, pelo STF) e aumento das campanhas televisivas e nas redes sociais para incentivar essa prática. Conclusão: Diante do que foi apresentado nesse estudo, ficou evidente a queda expressiva nas doações de sangue a taxas nunca vistas em quase todas as regiões do Brasil. Dessa forma, foi imperiosa a capacidade de adaptação dos hemocentros, da população e das instituições de saúde, para superar os obstáculos da pandemia. Além disso, a discussão de algumas questões sensíveis e a necessidade de reafirmação da ciência, foram questões centrais nesse cenário, para o combate da desinformação e preconceito na sociedade.